ebook_ADHD2019_engl.

48 Rohde, Buitelaar, Gerlach & Faraone the population), failure to incorporate interference of symptoms in functioning as part of the diagnostic criteria for the disorder results in a substantial increase in prevalence rates. CRITERION E – EXCLUSIONARY CRITERIA Although ADHD continues to be excluded when inattentive or hyperactive/impul- sive symptoms only occur during the course of a disorder with higher diagnostic hierarchy (e.g. psychosis) or when these symptoms are better explained by a dif- ferent disorder (e.g. mood, anxiety, or substance use disorders), the exclusion of the diagnosis in the presence of autism spectrum disorders (ASDs) was removed. The literature does not provide any evidence that supports exclusion of an ADHD diagnosis in the presence of ASD. In fact, substantial evidence has shown that ADHD and autism frequently, but not always, coexist, and that the presence of ADHD symptoms in patients with ASD confers distinct clinical correlates from those with pure ASD. Also, stimulants may successfully treat ADHD symptoms in patients with ASD, reassuring the clinical pertinence of the independent diagnosis of these disorders. 7 A final issue regarding ADHD diagnosis in DSM-5 is the characterization of the current presentation based on the distribution of inattentive and/or hyperacti- ve/impulsive symptoms. The three possible presentations are: yy predominantly inattentive yy predominantly hyperactive/impulsive yy combined Willcutt et al. 13 conducted an extensive meta-analysis assessing the validity of ADHD subtypes. The absence of major neuropsychological differences between the two most frequent types (predominantly inattentive and combined types) and the lack of developmental stability of ADHD types supported the DSM-5 decision to change the nomenclature from ADHD types to ADHD current presentation. While the word ‘presentation’ denotes the status of the present clinical assess- ment; ‘types’ denotes a more stable condition. The current ADHD presentation might have some nosological implications. It might depend on the nature of the sample assessed (e.g., inattentive presentation is more common in non-referred samples while combined presentation is more frequent in clinical samples of chil- dren), on gender (e.g., inattentive presentation is more common in females) and on developmental stage (see below). 2