One important consideration in the diagnosis of Attention Deficit Hyperactivity Disorder (ADHD), as set forth in the criterion D of DSM-IV, is the assessment of clinically significant impairment insocial and academic functioning. Despite the avowed importance in the assessment of ADHD, there is little guidance in DSM-IV in defining impairment. Rating scales assessing impairmentare few in number and rarely used in clinical practice. Overlooking impairment in diagnostic approaches has strong clinical implications, leading to false positive or false negativediagnoses. The relation between impairment and symptoms remains currently undefined and a controversial field in the ADHD literature, as many children can display the full range of ADHDsymptoms without necessarily displaying significant impairment in their functioning. The relation between symptoms and impairment is more obvious in older children, where domainsof impairment are more expanded. This finding suggests that symptoms and impairment are related, but yet there are distinct domains that should be measured independently to confirmthe presence of ADHD. In conclusion, an operational definition of impairment, valid measures and diagnostic decision rules for incorporating impairment into the assessment of ADHD iswarranted. Additional research is also needed to determine whether the age of onset of symptoms (before the age of seven) is different or should be separated from the age of onsetof impairment.

Key words: Attention deficit hyperactivity disorder, diagnosis, clinical impairment, prevalence

M. Skounti, A. Bitzaraki (page 158)