Attention-deficit/hyperactivity disorder: are we helping or harming?

摘要

Prevalence and prescribing rates for attention-deficit/hyperactivity disorder (ADHD) have risen steeply over the past decade, partly in response to concerns about underdiagnosis and undertreat-ment. But although clinicians have become better at recognising, diagnosing, and treating children with ADHD, recent US data showed that 86% of children diagnosed with ADHD are described as having "mild or moderate" disorder, and some diagnosed without fulfilling diagnostic criteria for ADHD. Mental health diagnoses are vulnerable to overdiagnosis because decisions are based predominantly on observed or self reported behaviours and interpretations of the severity of certain behaviours and whether they should be described as abnormal are subjective. There are no definitions in the UK, US, or Australian guidelines or in DSM-5 that quantify mild or moderate ADHD (box I). We argue that the overdiagnosis of ADHD resides within the clinical subjectivity of impairment.