Attention-deficit Hyperactivity Disorder Controversies

Attention-deficit Hyperactivity Disorder Controversies

The causes, diagnosis, and the treatment of attention-deficit hyperactivity disorder (ADHD) have been the subject of active debate at least since the 1970s. For various reasons, ADHD remains one of the most controversial psychiatric disorders despite being a widely accepted clinical diagnosis. Possible overdiagnosis of ADHD, the use of stimulant medications in children, and the methods by which ADHD is diagnosed and treated are some of the main areas of controversy.

According to the National Institute for Health and Clinical Excellence (NICE) ADHD has attracted controversy from many people. The criticisms include: how it is diagnosed, negative stereotyping of children, risks of other conditions being misdiagnosed as ADHD and alleged hegemonic practices of the American Psychiatric Association. Some even question the very existence of ADHD.

NICE concluded that while it is important to acknowledge the body of academic literature which raise controversies and criticisms surrounding ADHD for the purpose of developing clinical guidelines, it is not possible to offer alternative methods of assessment (i.e. ICD 10 and DSM IV) or therapeutic treatment recommendations. NICE stated that this is because the current therapeutic treatment interventions and methods of diagnosis for ADHD are based on the dominant view of the academic literature. NICE further concluded that despite such criticism, ADHD represented a valid clinical condition, with genetic, environmental, neurobiological, and demographic factors. Although the diagnosis has a high level of support from clinicians and medical authorities, a number of alternative theories explaining the symptoms of ADHD have been proposed; these views include the Hunter vs. farmer theory and the Social construct theory of ADHD.

The best course of ADHD management is also a source of debate. Stimulants are the most commonly prescribed medication for ADHD, and, according to the National Institute of Mental Health, "under medical supervision, stimulant medications are considered safe". Safety concerns exist with 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 for ADHD in childhood. The use of stimulant medications for the treatment of ADHD has generated controversy because of undesirable side effects, uncertain long term effects, and social and ethical issues regarding their use and dispensation. Children comprise the majority of ADHD diagnoses, but because they are unable to give informed consent due to their age, treatment decisions are ultimately determined by their legal guardians on their behalf. Ethical and legal issues also arise from the promotion of stimulants to treat ADHD by groups and individuals who receive money from drug companies.