Opinion Review
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatry. May 19, 2023; 13(5): 138-143
Published online May 19, 2023. doi: 10.5498/wjp.v13.i5.138
Differences between DSM-5-TR and ICD-11 revisions of attention deficit/hyperactivity disorder: A commentary on implications and opportunities
Rapson Gomez, Wai Chen, Stephen Houghton
Rapson Gomez, School of Science, Psychology, and Sport, Federation University, Melbourne 3806, Australia
Wai Chen, Curtin Medical School, Curtin University, Perth 6102, Australia
Stephen Houghton, Graduate School of Education, The University of Western Australia, Perth 6009, Australia
Author contributions: Gomez R reviewed the literature and drafted the manuscript; Chen W conceived the idea for the manuscript, reviewed the literature and revised the manuscript; Houghton S reviewed the literature and revised the manuscript.
Conflict-of-interest statement: Nil. Wai Chen served as a reviewer for the DSM-5 Clinical and Public Health Committee during the DSM-5 revision; but this role did not and has not led to any conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wai Chen, BMed, MPhil, MRCP, PhD, Professor, Curtin Medical School, Curtin University, 410 Koorliny Way, Perth 6102, Australia. wai.chen@curtin.edu.au
Received: December 16, 2022
Peer-review started: December 16, 2022
First decision: February 20, 2023
Revised: March 2, 2023
Accepted: April 18, 2023
Article in press: April 18, 2023
Published online: May 19, 2023
Processing time: 154 Days and 5.4 Hours
Abstract

Current ICD-11 descriptions for attention deficit hyperactivity disorder (ADHD) were recently published online, in the same year as the DSM-5-TR (text revised edition) was released. In this commentary, we compare and contrast the DSM-5/DSM-5-TR and ICD-11 diagnostic criteria, summarize important differences, and underscore their clinical and research implications. Overall, three major differences emerge: (1) The number of diagnostic criteria for inattention (IA), hyperactivity (HY) and impulsivity (IM) symptoms (i.e., DSM-5-TR has nine IA and nine HY/IM symptoms, whereas ICD-11 has 11 IA and 11 HY/IM sym-ptoms); (2) the clarity and standardization of diagnostic thresholds (i.e., the diagnostic thresholds for symptom count in IA and HY/IM domains are explicitly specified in DSM-5-TR, whereas in ICD-11 they are not); and (3) the partitioning of HY and IM symptoms into sub-dimensions (i.e., difference in partitioning HY and IM symptom domains relates to the differences between the current and previous editions of DSM and ICD, and this has important research implications). Currently, no ICD-11 based ADHD rating scales exist and while this absence represents an obstacle for respective research and clinical practice, it also presents opportunities for research development. This article highlights these challenges, possible remedies and novel research opportunities.

Keywords: Attention deficit hyperactivity disorder; ICD-11; DSM-5-TR; Clinical implication; Diagnostic threshold; Taxonomy; Research

Core Tip: Three major differences between DSM-5-TR and ICD-11 are: (1) The number of diagnostic criteria for inattention, hyperactivity (HY) and impulsivity (IM) symptoms; (2) the clarity and standardization of diagnostic thresholds; and (3) the partitioning of HY and IM symptoms into sub-dimensions between previous and current editions of DSM and ICD. Currently, no ICD-11 based attention deficit hyperactivity disorder (ADHD) rating scales exist. The absence of research evidence to inform and reconcile these differences represents opportunities for research. Emerging research findings suggest that 'impulsivity’ is likely the key latent factor underlying different expressions of ADHD symptoms; and the current criteria merging HY/IM could limit such explorations.