GWAS on the other hand yield a heritability estimate of 22%, and their suggestive findings mentioned in the manual are yet lacking convincing replication. The authors of DSM also leave unmentioned that the 74% heritability estimate stems from twin-studies, which as a method cannot reliably disentangle genetic from environmental factors for psychiatric presentations. Apart from what is already stated in DSM, there is no hard evidence available in the literature which proves that ADHD is a brain disorder-something that denotes a deficit in people's brains. Specifically, DSM-5-TR authors state that “no biological marker is diagnostic for ADHD” and that “meta-analysis of all neuroimaging studies do not show differences between individuals with ADHD and control subjects”, thus “no form of neuroimaging can be used for diagnosis of ADHD”. However, as the authors of DSM-5-TR themselves explicitly admit, the discoveries that could confirm ADHD as a neurodevelopmental disorder have not yet materialized. The authors state that heritability is approximately 74% and that genome-wide association studies (GWAS) “have identified a number of loci enriched in evolutionarily constrained genomic regions and loss-of-function genes as well as around brain-expressed regulatory regions.” (p. This assertion is strengthened in section “Risk and Prognostic Factors”, which is more detailed than in DSM-5. The authors of the manual assert that issues relevant to the placement of ADHD have been resolved by the available data “with the preponderance of evidence supporting placement in the “Neurodevelopmental Disorders” chapter”. According to the DSM-5-TR neurodevelopmental disorders “are characterized by developmental deficits or differences in brain processes that produce impairments of personal, social, academic, or occupational functioning” (p. Placement within “neurodevelopmental disorders”Īs in its predecessor, ADHD is placed within the manual's chapter “Neurodevelopmental Disorders”. We point out how DSM-5-TR keeps the faith in the neo-Kraepelinian paradigm by explicitly and implicitly cultivating the essentialist medical scientific metaphor of disorder. The third scrutinizes the changes in the diagnostic criteria for ADHD and assesses whether these changes make the diagnosis more accurate. The second examines the definition of ADHD provided in the updated edition of the manual. The first discusses the acknowledgment of ADHD as a neurodevelopmental disorder. We structure our critique around three points. In this opinion paper, we critically review the changes made to the DSM-5 Text Revision published in 2022 regarding the diagnostic entity of Attention Deficit/Hyperactivity Disorder (ADHD). Debates surrounding the critical reception of DSM-5 primarily relate to the pseudo-scientific nature of the manual and its normalizing power ( 5). By the time of publishing DSM-5 in 2013, the continuous medicalization of natural human responses led by APA became increasingly critiqued within psychiatry, mental health sector, practitioners, and academia in general. This paradigm shift was not based on promising scientific discoveries but on pragmatic consensus. DSM-5-TR keeps the faith in the neo-Kraepelinian paradigm by explicitly and implicitly cultivating the essentialist medical scientific metaphor of disorder, creating the illusion that it represents scientific progress that validates ADHD as a neurodevelopmental disorder.įrom the publication of the third edition in 1980 and on, the Diagnostic and Statistical Manual of Mental Disorders (DSM) has embraced psychiatry as a branch of medicine by committing to a “neo-Kraepelinian” cause-effect biomedical framework with the assumption that biological discoveries will eventually establish the somatic etiology of separate and independent mental diseases ( 1). We conclude that DSM's latest edition does not escape the logical and scientific pitfalls of its predecessor. In this article, we critically review the changes made to the DSM-5 Text Revision published in 2022 regarding the diagnostic entity of Attention Deficit/Hyperactivity Disorder (ADHD). 2Faculty of Educational Sciences, University of Helsinki, Helsinki, Finland.1Department of Primary Education, Democritus University of Thrace, Alexandroupolis, Greece.Athanasios Koutsoklenis 1 † Juho Honkasilta 2 * †
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