Question: Thank you Dr Barkley for your time! 
  
  I'm wondering what you think the future direction of the DSM will be and whether it will eventually include emotional regulation and other criterion and how long this may take?
Answer: I can't predict where it will go for DSM6 as that is not even in the panning stages.  usually a decade or two goes by before they revise the manual.  The DSM is not leading the research, but follows it and often a decade or two behind where the research is at the time.  I hope that more items of impulsivity (cognitive, motivational, emotional) get into the next one and fewer symptoms of hyperactivity and a few others added to cover EF better so that the criteria are more sensitive to the adult stage of ADHD than they are now, based entirely on children as they originally were in earlier DSMs.  But the decisions made by the  APA are also political, not just scientifically based, so its hard to know where this will go.  I just think that more emphasis on EF and self-regulation would vastly improve the DSM.  And waiving the age of onset of age 12 as its not valid or reliable.  Onset is usually during development up to age 18-24 but can arise de novo after an injury to the brain that affects the EF networks.  So the age of onset is a problem that needs fixing.  I teach clinicians to ignore it and also use 4 symptoms endorsed on either list as the threshold to diagnose as its more science based.  Dropping it to 5 for adults (from 6 for children) was a half measure granted by APA.  Four is better.
content: Q: Thank you Dr Barkley for your time! 
  
  I'm wondering what you think the future direction of the DSM will be and whether it will eventually include emotional regulation and other criterion and how long this may take?
   Ans: I can't predict where it will go for DSM6 as that is not even in the panning stages.  usually a decade or two goes by before they revise the manual.  The DSM is not leading the research, but follows it and often a decade or two behind where the research is at the time.  I hope that more items of impulsivity (cognitive, motivational, emotional) get into the next one and fewer symptoms of hyperactivity and a few others added to cover EF better so that the criteria are more sensitive to the adult stage of ADHD than they are now, based entirely on children as they originally were in earlier DSMs.  But the decisions made by the  APA are also political, not just scientifically based, so its hard to know where this will go.  I just think that more emphasis on EF and self-regulation would vastly improve the DSM.  And waiving the age of onset of age 12 as its not valid or reliable.  Onset is usually during development up to age 18-24 but can arise de novo after an injury to the brain that affects the EF networks.  So the age of onset is a problem that needs fixing.  I teach clinicians to ignore it and also use 4 symptoms endorsed on either list as the threshold to diagnose as its more science based.  Dropping it to 5 for adults (from 6 for children) was a half measure granted by APA.  Four is better.