This remains a controversial diagnosis, currently less with regard to its existence (at least in some children) and much more with regard to the methods and frequency of making the diagnosis and with regard to causation and treatment.

In children, this diagnosis is over-used and often is made without attention to alternative causes for the observed clinical behavior.  In adults it could become another waste-basket in the process of “medicalizing” all inappropriate or even criminal behavior.  This situation led the Connecticut Legislature in the recent session to enact a law which constrains local and regional non-medical agencies from recommending that a child use psychotropic drugs.  It also prohibits considering parental refusal to administer such drugs to their children as grounds for taking official action regarding “child abuse”.  (PA 01-124-sHB5701), effective Oct. 1, 2001.

The positions regarding this subject range from apparent total acceptance by the field of Psychiatry, through serious reservations by some neurologists and other physicians, to labeling the entire concept as a “hoax” and a “fictitious disease”(see Citizens Commission on Human Rights International).

The following are some  “facts”and issues which must addressed here.

• “It is a specific diagnosis, complete with its own DSM -IV designation”.  But it cannot be confirmed by objective findings; eg. brain scan, EEG, neurologic exam findings or neuropsychologic testing.
• “It can be diagnosed as early as age 3”.  But it is often associated with “co-morbid conditions”: conduct and anxiety disorders, oppositional conduct, mood disorders.... So, how is it distinguished from these?
• “The clinical features which must be present for the diagnosis of ADHD to be made include inattention, impulsivity, hyperactivity...non-continuous and occurring in more than one environment (eg. not only in school or only at home).”  But these findings can also occur with fetal-alcohol syndrome and post-encephalitis.
• “There is a hereditary basis: it occurs in 90% of identical twins; a child of parents with ADHD has a 50% chance of having ADHD”.  But is this nature or nurture?
• “It occurs in 2-9% of children in the United States. But it is diagnosed much less frequently in Europe, where it appears to be considered a further “medicalization” of social and societal problems.
• “It persists in 75% into adolescence and continues in 50% into adulthood.”  But...how can we tell, given the rampant results of 30 years of frequent parental failure and of  civil decay?
• “Federal Law includes ADHD among its “disabilities”.  But that over-used, politically correct and remunerative designation is gradually being constrained by court decisions.

Differential diagnoses such as the ones listed below should be formally considered by a pediatrician, by a neurologist and by a psychologist or psychiatrist (who also investigates the family dynamics) before making ADHD as a diagnosis of exclusion.

• Sensory deficits: hearing, sight.
• Undiagnosed Obstructive Sleep Apnea or other sleep disorder.
• Seizure disorder, brain tumor, etc.
• Untreated severe allergies.
• Poor parental attention and nurturing in this age of “quality time”.   There is no “quality time”...there is only TIME.
• Child over-scheduling and over-stimulation  (TV and computer use, especially programs depicting violence and/or adult subject-matter...which means just about all “popular” programming).
• Poorly suited or trained teachers.
• Class  “main-streaming” wherein disturbed  and special-needs children routinely disturb the learning process for the majority of the class.
• Perhaps the built-in financial incentives to label children as “disabled” or as requiring “special education”.
• Bi-polar Affective Disorder, so-called Manic-depressive disorder, which can sometimes be diagnosed as early as age 3, and which is treatable.   This can even co-exist with ADHD.  Thus, the importance of an accurate diagnosis before lables are placed.

GS