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now the DSM says
there are three kinds have ADHD let's shift gears here and get honest
there is not a combined, inattentive, or hyperactive type
and dsm-5 will abandon them
they are contaminated with each other because there really is only a single
ADHD in human population and it varies in its severity and all these types have
done
is to capture the degree of severity of a single disorder
so we are now grappling for ways
above sub grouping people with ADHD that use more clinically useful
then the DSM view is because the DSM to you
is useless and one of those ways it is very compelling
is ADHD with and without conduct disorder
the europeans have done this for decades in the
North American continent we viewed conduct disorder as a co morbidity
we are now looking at it as a sub grouping criteria
because you see ADHD children who have conduct disorder
differ from ADHD children without it in many
many respects so many in fact that we are now coming to think of this subset
of children who have both disorders
as a unique form have ADHD because both disorders are more severe
both disorder start earlier both disorders are far more persistent
and the combination of these disorders will predict ongoing difficulties with
anti-social behaviour into adulthood
and just as important these individuals
carry a high risk for psychopathy one in five
these children is a budding psychopath a child who lacks
guilt conscience empathy and remorse
a child who was a predator ADHD does not contribute to suck up a thing
but ADHD with conduct disorder is the single best predictor
up the psychopath that we know of so
in the future we may be making the same distinction the europeans have
that would conduct disorder ADHD go together we have an extraordinarily
general and disorder station %uh familiar with conduct disorder it is the
early appearance of lying stealing fighting and preying on other children
in an instrument away
it is violating the rights of other people for your own gain
and it manifests early as the lying
the stealing and the fighting but other symptoms will develop thereafter
the hyperactive typeof ADHD never existed because ninety percent of all
cases go on to get the combined type within
three years and even if they don't get the combined type there just one symptom
short
and so we call them subthreshold combined types but they're not a
different type
job we take these two groups have children who really are just variations
on the good old combined type with ADHD
at 95 percent of all the kids put into this group there is a small group left
over
who are purely oppositional but because they have here oppositional disorder and
they never had ADHD they were outgrow their OD'd usually within 2
24 years and they are ADHD will go away
why are they there because parents confuse OD'd with ADHD
and if their child is only oppositional the often report that they have symptoms
of ADHD when they don't
but OD'd alone is a relatively benign disorder
unless he goes with ADHD and that it is a highly
persistent disorder now the real action during the past decade has been with
this
in a tent a group of children most of whom are combined type children
and they grew up and they'll awesome hyperactivity along the way as we said
and as a result is gonna come a time in adolescent and especially by adulthood
weather does not I've are active enough to
stay in the combined type anymore and so clinicians relabel them as inattentive
type but they shouldn't
want to combine type: always combine type: but you can see how
at least half for the individuals get put into the inattentive group they just
outgrowing their hyperactivity
and then there's that group of children who just are one or two symptom short
are being in the combined I but they have to combine type anyway
they're just a milder version have it