The Multiple Questions Surrounding the Diagnosis of ADHD

By Esther B. Hess, Ph.D.

The controversy over Attention Deficit Hyperactive Disorder (ADHD), a neurological condition, includes concerns about its existence as a disorder, its causes, the methods by which ADHD is diagnosed and treated including the use of stimulant medications in children, possible over diagnosis, misdiagnosis as ADHD leading to under treatment of the real underlying disease, alleged hegemonic practices of the American Psychiatric Association and negative stereotypes of children diagnosed with ADHD.

ADHD is controversial in part because most children are diagnosed and treated based on decisions made by their parents and clinicians with teachers being the primary source of diagnostic information. Only about 20% of children who end up with a diagnosis of ADHD show hyperactive behavior in the physician’s office. Additionally, evidence exists of possible race and ethnicity in the prevalence of diagnosing ADHD. The thinking is that the prevalence of ADHD various dramatically across cultures due to different perceptions of what clarifies as disruptive behavior, inattention and hyperactivity. 

Development can also influence perception of relevant ADHD symptoms. ADHD is viewed as a chronic disorder that develops in childhood and continues into adulthood. However, some research shows a decline in symptoms of ADHD as children grow and mature into adulthood. Hyperactivity is more typical in children and inattentiveness tends to be a stronger discriminator in adolescents. 

The best course of ADHD management is also a major topic of debate. Stimulants are the most commonly prescribed medication for ADHD in the USA. Stimulant medication additionally tends to be surrounded by both myths and often inaccurate information. Parental concerns tend to focus on the potential for children to become addicted or over controlled by the medication.  Furthermore, there is often a worry that medication for ADHD symptoms are over prescribed by the medical community. 

The National Institute of Mental Health maintains that stimulants are considered safe when used under medical supervision, but there are concerns regarding the higher rates of schizophrenia and bipolar disorder, as well as increased severity of these disorders in individuals with a history of stimulant use of ADHD in childhood.

Despite the controversy, the facts about ADHD medication remain clear. Hundreds of studies have shown that, when appropriately prescribed for someone who genuinely has ADHD that these medications tend to be safe and effective for most people. What the medication does do is increase the activity of the brain related to attention, behavioral control and executive functioning.  Consequently, people on the medication tend to be thought of as more reliable, consistent and organized. 

No psychotropic medication is without its side effects.  These side effects can include among others, anorexia and difficulty in getting to sleep. In evaluating the potential benefits and side effects, parents need to consider the cost of not treating their child medicinally.  The risks for not medicating a child with ADHD can include greater school difficulties, increased family stress, and higher incidence of depression and anxiety in 

Even when they acknowledge the potential benefits, some people do not like the idea of becoming dependent on medication. They compare the use of ADHD stimulants to an addictive dependency on alcohol. Addictive dependency limits the person’s life and overall brings more problems than solutions. By contrast, using medication to appropriately treat ADHD enables the person to live a bigger, more interesting, more effective life.