This is undoubtedly the most controversial of all the psychiatric diagnoses with implications that touch on major public health and educational concerns. More than two million schoolchildren in the United States are taking stimulant medication intended to help their concentration and/or to reduce their hyperactivity. For many children, this results in a dramatic improvement in performance, self-esteem, and interpersonal relationships.
Nonetheless, there is a serious disagreement even among the best experts in the field on the optimal threshold for defining Attention-Deficit/Hyperactivity Disorder (ADHD or sometimes shortened to ADD) and how to decide which and how many kids to treat. Many parents, and some experts, believe that the diagnosis of ADHD is being made too liberally and that stimulants are being used indiscriminately as a quick fix for more complex educational, family, or social problems. It is impossible to know with any degree of certainty how many children are being needlessly exposed to the potentially harmful side effects of the stimulant medications. It is equally unclear how many kids who would benefit from the medication are not yet receiving it.
The debate arises because there is no precise way to draw the line between normal distractibility and hyperactivity and the pathological levels that require treatment. Perfectly normal children are inherently fairly distractible and hyperactive—especially during certain stages of their development.
There are many psychiatrists, pediatricians, psychologists, teachers, and parents who believe that the early diagnosis and treatment of ADHD has been enormously beneficial both to the individual child and to their classroom colleagues. They point out that without a diagnosis of ADHD, many of these children would have been just labeled as lazy, spacey, unintelligent, or poorly behaved, with the inevitable negative effects on their self-esteem.
On the other hand, there are many other psychiatrists, pediatricians, psychologists, teachers, and parents who believe that the diagnosis is sometimes being given too readily to children who are really well within normal limits of hyperactivity and poor focus. Interestingly, there is clear difference between U.S. and European views on the subject. The diagnosis of ADHD (and the consequent prescribing of stimulants to children) is much more common on this side of the ocean. Either there is something that U.S. children are being exposed to that is causing increased rates of ADHD or, much more likely, clinicians and parents here are more likely to seek medical cures for behavioral problems.
Because ADHD has become something of a media darling, many adults have come to wonder whether it is responsible for their perceived difficulty in concentrating. The flood of publicity has been both helpful and detrimental. On the plus side, it has exploded the myth that everyone grows out of ADHD — in fact fully 65 percent of children continue to have some symptoms into their adulthood. Increased awareness helps identify cases that were previously missed and encourages long-term treatment for those who need it. On the negative side, adult ADHD has become almost the diagnosis du jour—broadly misapplied both to normal people who aspire to supernormal powers of concentration and to people whose poor concentration is caused by any one of a number of other psychiatric and substance use problems.