View source for Attention deficit hyperactivity disorder controversies

{{Short description|Controversies surrounding the topic of ADHD's nature, diagnosis, and treatment}}
[[File:Ritalin Pill.jpg|thumb|right|alt=10 mg methylphenidate tablet|Despite their safety and effectiveness in treating ADHD symptoms,<ref name="World Federation of ADHD 2021">{{cite journal |last=Faraone |first=Stephen V. |display-authors=etal |name-list-style=vanc |year=2021 |title=The World Federation of ADHD International Consensus Statement: 208 Evidence-based conclusions about the disorder |journal=Neuroscience & Biobehavioral Reviews |publisher=Elsevier BV |volume=128 |pages=789–818 |doi=10.1016/j.neubiorev.2021.01.022 |issn=0149-7634 |pmc=8328933 |pmid=33549739 |doi-access=free}}</ref> the use of [[methylphenidate]] and other [[stimulant medication]]s is frequently a topic of public controversy. ]]

Despite the scientifically well-established nature of [[attention deficit hyperactivity disorder]] (ADHD), its diagnosis, and its treatment,<ref name="World Federation of ADHD 2021" /> each of these has been controversial since the 1970s.<ref name="Elder-2010" /><ref name="parrillo">{{Cite encyclopedia |year=2008 |title=Attention Deficit Hyperactivity Disorder |encyclopedia=Encyclopedia of Social Problems |publisher=Sage |url=https://books.google.com/books?id=mRGr_B4Y1CEC&pg=PT107 |access-date=7 April 2016 |page=63 |isbn=978-1412941655 |vauthors=Parrillo VN}}</ref><ref name="Erk2009" /> The controversies involve clinicians, teachers, policymakers, parents, and the media. Positions range from the view that ADHD is within the normal range of behavior to the hypothesis that ADHD is a genetic condition. Other areas of controversy include the use of stimulant medications in children, the method of diagnosis, and the possibility of overdiagnosis.<ref name="Erk2009" /><ref name=":3" /> In 2009, the National Institute for Health and Care Excellence, while acknowledging the controversy, stated that the current treatments and methods of diagnosis are based on the dominant view of the academic literature.

With differing rates of diagnosis across countries, states within countries, races, and ethnicities, some suspect factors other than the presence of the symptoms of ADHD are playing a role in diagnosis,<ref name="Elder-2010">{{cite journal | vauthors = Elder TE | title = The importance of relative standards in ADHD diagnoses: evidence based on exact birth dates | journal = Journal of Health Economics | volume = 29 | issue = 5 | pages = 641–656 | date = September 2010 | pmid = 20638739 | pmc = 2933294 | doi = 10.1016/j.jhealeco.2010.06.003 }}</ref> although the prevalence of ADHD is consistent internationally.<ref name="World Federation of ADHD 2021" /> Some sociologists consider ADHD to be an example of the [[medicalization]] of deviant behavior, that is, turning the previously {{nowrap|non-medical}} issue of school performance into a medical one.<ref name="parrillo" /><ref name="Erk2009">{{cite book |vauthors=Mayes R, Bagwell C, Erkulwater JL | title=Medicating Children: ADHD and Pediatric Mental Health | publisher=Harvard University Press | date=2009 | pages=4–24 | isbn=978-0-674-03163-0 | edition=illustrated }}</ref> Most healthcare providers accept ADHD as a genuine disorder, at least in the small number of people with severe symptoms.<ref name="Erk2009" /> Among healthcare providers the debate mainly centers on diagnosis and treatment in the much greater number of people with mild symptoms.<ref name="Erk2009" /><ref name=":3">{{cite journal | vauthors = Merten EC, Cwik JC, Margraf J, Schneider S | title = Overdiagnosis of mental disorders in children and adolescents (in developed countries) | journal = Child and Adolescent Psychiatry and Mental Health | volume = 11 | pages = 5 | date = 2017 | pmid = 28105068 | pmc = 5240230 | doi = 10.1186/s13034-016-0140-5 | doi-access = free }}</ref><ref name=":2">{{cite journal | vauthors = Taylor E | title = Attention deficit hyperactivity disorder: overdiagnosed or diagnoses missed? | journal = Archives of Disease in Childhood | volume = 102 | issue = 4 | pages = 376–379 | date = April 2017 | pmid = 27821518 | doi = 10.1136/archdischild-2016-310487 | s2cid = 19878394 }}</ref>

==Status as a disorder==
According to the ''Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition'' ([[DSM-5]]), the leading authority in the US on clinical diagnosis, ADHD is a [[neurodevelopmental disorder]] with a prevalence rate in most cultures of about 5% in children and 2.5% in adults.<ref name=Sim/><ref name=dsm5>{{citation|author=American Psychiatric Association|title=Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition|url=https://books.google.com/books?id=-JivBAAAQBAJ&q=%22dsm-5%22&pg=PT157|year=2013|publisher=American Psychiatric Association: Arlington, VA|isbn=978-0890425572}}</ref> Today, the existence of ADHD is widely accepted,<ref name=Sim/> but controversy around the disorder has existed since at least the 1970s.<ref name=parrillo /> According to the DSM-5, symptoms must be present before age 12, but it is not uncommon for ADHD to continue into adulthood.<ref name=dsm5/> Parents and educators sometimes still question a perceived over-diagnosis in children due to overlapping symptoms with other mental disabilities, and the effectiveness of treatment options, especially the [[overprescription]] of [[stimulant]] medications.<ref name="Sim">{{cite journal|vauthors=Sim MG, Hulse G, Khong E|date=August 2004|title=When the child with ADHD grows up|journal=Australian Family Physician|type=Review|volume=33|issue=8|pages=615–8|pmid=15373378}}</ref><ref name=parrillo/><ref name="Mayes2008">{{cite journal|vauthors=Mayes R, Bagwell C, Erkulwater J|year=2008|title=ADHD and the rise in stimulant use among children|journal=Harvard Review of Psychiatry|type=Review|volume=16|issue=3|pages=151–66|doi=10.1080/10673220802167782|pmid=18569037|s2cid=18481191}}</ref> However, according to sociology professor [[Vincent N. Parrillo|Vincent Parrillo]], "Parent and consumer groups, such as CHADD (Children and Adults with Attention Deficit Hyperactivity Disorder), tend to support the medical perspective of ADHD."<ref name=parrillo/>

In 2009, the [[British Psychological Society]] and the [[Royal College of Psychiatrists]], in collaboration with the [[National Institute for Health and Care Excellence]] (NICE), released a set of diagnosis and treatment guidelines for ADHD.<ref name="NICE2008">{{cite web |date=24 September 2008 |title=CG72 Attention deficit hyperactivity disorder (ADHD): full guideline |url=http://www.nice.org.uk/nicemedia/pdf/CG72FullGuideline.pdf |access-date=2008-10-08 |publisher=[[National Health Service]] |location=UK}}</ref> These guidelines reviewed studies by Ford et al. that found that 3.6 percent of boys and 0.85 percent of girls in Britain qualified for a diagnosis of ADHD using the American DSM-IV criteria.<ref>{{cite journal |vauthors=Ford T, Goodman R, Meltzer H |date=October 2003 |title=The British Child and Adolescent Mental Health Survey 1999: the prevalence of DSM-IV disorders |journal=Journal of the American Academy of Child and Adolescent Psychiatry |volume=42 |issue=10 |pages=1203–1211 |doi=10.1097/00004583-200310000-00011 |pmid=14560170}}</ref> The guidelines go on to state that the prevalence drops to 1.5% when using the stricter criteria for the ICD-10 diagnosis of [[hyperkinetic disorder]], used mainly in Europe.<ref name="FitzgeraldBellgrove2007">{{cite book |author1=Michael Fitzgerald |url=https://books.google.com/books?id=LQRUM5v_N1IC |title=Handbook of Attention Deficit Hyperactivity Disorder |author2=Mark Bellgrove |author3=Michael Gill |year= 2007 |publisher=John Wiley & Sons |isbn=978-0-470-03215-2 |page=270}}</ref>

A systematic review of the literature in 2007 found that the worldwide prevalence of ADHD was 5.29 percent, and that there were no significant differences in prevalence rates between North America and Europe. The review did find differences between prevalence rates in North America and those in Africa and the Middle East, but cautioned that this may be due to the small number of studies available from those regions.<ref>{{cite journal |last1=Polanczyk |first1=G. |last2=De Lima |first2=M. S. |last3=Horta |first3=B. L. |last4=Biederman |first4=J. |last5=Rohde |first5=L. A. |year=2007 |title=The Worldwide Prevalence of ADHD: A Systematic Review and Metaregression Analysis |journal=American Journal of Psychiatry |type=Meta-analysis |volume=164 |issue=6 |pages=942–948 |doi=10.1176/appi.ajp.164.6.942 |pmid=17541055}}</ref>

==Causes==
{{see also | Attention-deficit hyperactivity disorder#Causes | l1 = Causes | Attention-deficit hyperactivity disorder#Pathophysiology | l2 = Pathophysiology}}

The [[pathogenesis]] of ADHD is not wholly clear,<ref>{{cite encyclopedia |name-list-style=vanc |last1=Krull |first1=Kevin R. |title=Attention Deficit Hyperactivity Disorder in Children and Adolescents: Epidemiology and Pathogenesis |encyclopedia=UpToDate |editor-first1=Marilyn |editor-last1=Augustyn |editor-first2=Mary M. |editor-last2=Torchia |date=29 October 2021 |url=https://www.uptodate.com/contents/attention-deficit-hyperactivity-disorder-in-children-and-adolescents-epidemiology-and-pathogenesis |access-date=2022-05-07}}</ref> however a large body of scientific evidence supports that it is caused by a complex mixture of genetic, pre-natal and early post-natal environmental factors.<ref name="World Federation of ADHD 2021"/>

===ADHD as a biological difference===
Large, high quality research has found small differences in the brain between ADHD and non-ADHD patients.<ref name="World Federation of ADHD 2021" /><ref name="pmid22851201">{{cite journal|vauthors=Cortese S, Castellanos FX|date=October 2012|title=Neuroimaging of attention-deficit/hyperactivity disorder: current neuroscience-informed perspectives for clinicians|journal=Curr Psychiatry Rep|type=Review|volume=14|issue=5|pages=568–578|doi=10.1007/s11920-012-0310-y|pmc=3876939|pmid=22851201}}</ref> [[Jonathan Leo]] and David Cohen, critics who reject the characterization of ADHD as a disorder, contended in 2003 and 2004 that the controls for stimulant medication usage were inadequate in some lobar volumetric studies, which makes it impossible to determine whether ADHD itself or [[psychotropic]] medication used to treat ADHD is responsible for decreased thickness observed<ref>{{cite journal |last1=Shaw |first1=Philip |last2=Lerch |first2=Jason |last3=Greenstein |first3=Deanna |last4=Sharp |first4=Wendy |last5=Clasen |first5=Liv |last6=Evans |first6=Alan |last7=Giedd |first7=Jay |last8=Castellanos |first8=F. Xavier |last9=Rapoport |first9=Judith |year=2006 |title=Longitudinal Mapping of Cortical Thickness and Clinical Outcome in Children and Adolescents With Attention-Deficit/Hyperactivity Disorder |journal=Arch Gen Psychiatry |volume=63 |issue=5 |pages=540–549 |doi=10.1001/archpsyc.63.5.540 |pmid=16651511 |doi-access=}}</ref> in certain brain regions.<ref name="David Cohen 2004 161–166">{{cite journal |author=David Cohen |author2=Jonathan Leo |year=2004 |title=An Update on ADHD Neuroimaging Research |url=http://psychrights.org/research/Digest/NLPs/neruoimagingupdate.pdf |journal=The Journal of Mind and Behavior |publisher=The Institute of Mind and Behavior, Inc |volume=25 |issue=2 |pages=161–166 |issn=0271-0137}}</ref><ref>{{cite journal |author=David Cohen |author2=Jonathan Leo |year=2003 |title=Broken brains or flawed studies? A critical review of ADHD neuroimaging studies |journal=The Journal of Mind and Behavior |volume=24 |pages=29–56}}</ref> They believe many neuroimaging studies are oversimplified in both popular and scientific discourse and given undue weight despite deficiencies in experimental methodology.<ref name="David Cohen 2004 161–166" /> Many studies and meta-analyses have demonstrated differences in multiple aspects of brain structure and function.<ref name="World Federation of ADHD 2021" />

ADHD is highly heritable: [[Twin study|twin studies]] suggest that genetics explain 70 to 80 percent of the variation of ADHD.<ref>{{Cite journal|last1=Nikolas|first1=Molly A.|last2=Burt|first2=S. Alexandra|date=2010-02-01|title=Genetic and environmental influences on ADHD symptom dimensions of inattention and hyperactivity: a meta-analysis|journal=Journal of Abnormal Psychology|type=Meta-analysis|volume=119|issue=1|pages=1–17|doi=10.1037/a0018010|issn=1939-1846|pmid=20141238}}</ref> There is also strong evidence to support genetic-environment interactions with some fetal and early post-natal environmental factors.<ref name="World Federation of ADHD 2021" /> However, some have questioned whether a genetic connection exists as no single gene has been found – this is known as the [[missing heritability problem]], which ADHD shares with many other heritable human traits such as [[schizophrenia]].<ref name="David Cohen 2004 161–166" /> In 2000, Dr. Joseph Glenmullen stated that "no claim of a gene for a psychiatric condition has stood the test of time, in spite of popular misinformation. Although many theories exist, there is no definitive biological, neurological, or genetic [[etiology]] for 'mental illness'."<ref>{{cite book |last=Glenmullen |first=J. |url=https://books.google.com/books?id=nqrjeYwa7foC |title=Prozac Backlash: Overcoming the Dangers of Prozac, Zoloft, Paxil, and Other Antidepressants with Safe, Effective Alternatives |publisher=Simon & Schuster |year=2000 |isbn=978-0-7432-0062-2 |publication-place=New York |pages=192–198 |oclc=42968080}}</ref> Authors of a review of ADHD etiology in 2004 noted: "Although several [[Genome-wide association study|genome-wide searches]] have identified chromosomal regions that are predicted to contain genes that contribute to ADHD susceptibility, to date no single gene with a major contribution to ADHD has been identified."<ref>{{cite journal |author1=M. T. Acosta |author2=M. Arcos-Burgos |author3=M. Muenke |year=2004 |title=Attention deficit/hyperactivity disorder (ADHD): Complex phenotype, simple genotype? |journal=Genetics in Medicine |type=Review |volume=6 |issue=1 |pages=1–15 |doi=10.1097/01.GIM.0000110413.07490.0B |pmid=14726804 |doi-access=free}}</ref> However, several large studies and reviews provide strong support that ADHD is [[Polygene|polygenic]] in most cases, caused by a complex interaction between multiple genes – there is no single gene which would cause the majority of ADHD cases.<ref name="World Federation of ADHD 2021" />

===Social construct theory===
<!-- [[Social construct theory of ADHD]] redirects to this section. If this section is renamed, please update the redirect. -->
Some social constructionist theories of ADHD reject the dominant medical consensus that ADHD has a distinct pathophysiology and genetic components. The symptoms of ADHD also happen to be morally questionable attributes, this is why the symptoms are described as inappropriate. Many social constructionists trenchantly question deterministic views of behaviour, such as those views sometimes put forth within behavioural/abnormal psychology and the biological sciences. Concerns have been raised over the threshold at which symptoms are pathologized, and how strongly [[Social constructionism|social construct]]s surrounding the symptoms and diagnosis of ADHD may differ between cultures.<ref name="ParensJohnston2009">{{cite journal |vauthors=Parens E, Johnston J |year=2009 |title=Facts, values, and Attention-Deficit Hyperactivity Disorder (ADHD): an update on the controversies |journal=Child and Adolescent Psychiatry and Mental Health |type=Workshops |volume=3 |issue=1 |pages=1 |doi=10.1186/1753-2000-3-1 |pmc=2637252 |pmid=19152690 |doi-access=free }}</ref><ref name="Singh I 2008 957–64">{{cite journal |author=Singh I |date=December 2008 |title=Beyond polemics: science and ethics of ADHD |journal=Nature Reviews Neuroscience |type=Review |volume=9 |issue=12 |pages=957–964 |doi=10.1038/nrn2514 |pmid=19020513 |s2cid=205504587}}</ref> The social construction theory of ADHD argues that [[attention deficit hyperactivity disorder]] is not necessarily an actual [[pathology]], but that an ADHD [[diagnosis]] is a [[Social constructionism|socially constructed]] explanation to describe behaviors that simply do not meet prescribed [[social norms]].<ref name="ParensJohnston2009" />

Some proponents of the social construct theory of ADHD seem to regard the disorder as genuine, though over-diagnosed in some cultures. These proponents cite as evidence that the [[DSM IV]], favored in the United States for defining and diagnosing mental illness, arrives at levels of ADHD three to four times higher than criteria in the [[ICD 10]], the diagnostic guide favored by the [[World Health Organization]].<ref name="Singh I 2008 957–64" /> A popular proponent of this theory, [[Thomas Szasz]], has argued that ADHD was "invented and not discovered."<ref>{{cite book|vauthors=Chriss JJ |url=https://archive.org/details/socialcontrolint0000chri|title=Social control: an introduction |publisher=Polity|year=2007|isbn=978-0-7456-3858-4|location=Cambridge, UK|page=[https://archive.org/details/socialcontrolint0000chri/page/230 230]|url-access=registration}}</ref><ref>{{cite book|author=Szasz, Thomas Stephen|url=https://archive.org/details/pharmacracymedic0000szas/page/212|title=Pharmacracy: medicine and politics in America|publisher=Praeger|year=2001|isbn=0-275-97196-1|location=New York|page=[https://archive.org/details/pharmacracymedic0000szas/page/212 212]}}</ref>

Psychiatrists [[Peter Breggin]] and [[Sami Timimi]] oppose pathologizing the symptoms of ADHD. Sami Timimi, who is a child and adolescent psychiatrist with the [[National Health Service|NHS]], argues that ADHD is not an objective disorder<ref name="TimimiTaylor2004">{{cite journal |last1=Timimi|first1=Sami |last2=Taylor |first2=Eric|date=January 2004|title=In Debate: ADHD is best understood as a cultural construct|url=http://bjp.rcpsych.org/cgi/content/full/184/1/8|journal=[[British Journal of Psychiatry]] |volume=184|issue=1 |pages=8–9 |doi=10.1192/bjp.184.1.8|pmid=14702221|doi-access=free}}</ref> but that western society creates stress on families which in turn suggests environmental causes for children expressing the symptoms of ADHD.<ref>{{cite book |vauthors=Timimi S, Begum M |year=2006 |title=Critical Voices in Child and Adolescent Mental Health |place=London |publisher=[[Free Association Books]] }}</ref> They also believe that parents who feel they have failed in their parenting responsibilities can use the ADHD label to absolve [[Culpability|guilt]] and [[Blame#Self-blame|self-blame]]. Timimi's view has been heavily criticized by [[Russell Barkley]], a strong proponent of ADHD as an independent pathology and of medicating children for ADHD symptoms.<ref>{{cite journal |last=Barkley |first=Russell A. |author-link=Russell Barkley |year=2004 |others=20 Coendorsers |title=Critique or Misrepresentation? A Reply to Timimi et al. |journal=Clinical Child and Family Psychology Review |publisher=Springer Science and Business Media LLC |volume=7 |issue=1 |pages=65–69 |doi=10.1023/b:ccfp.0000020193.48817.30 |issn=1096-4037 |s2cid=140921934}}</ref>

A common argument against the medical model of ADHD asserts that, while the traits that define ADHD exist and may be measurable, they lie within the spectrum of normal healthy human behaviour and are not dysfunctional.<ref name=":2" /> As Thomas Szasz puts it, everyone has problems and difficulties that should be categorized as "problems of living", not mental illnesses or diseases.<ref>{{Cite journal |last=Benning |first=Tony B. |date=December 2016 |title=No such thing as mental illness? Critical reflections on the major ideas and legacy of Thomas Szasz |journal=BJPsych Bulletin |language=en |volume=40 |issue=6 |pages=292–295 |doi=10.1192/pb.bp.115.053249 |issn=2056-4694 |pmc=5353517 |pmid=28377805}}</ref> However, by definition, in order to diagnose with a mental disorder, symptoms must be interpreted as causing a person distress or be especially maladaptive.<ref name=":1" /> In the United States, the Diagnostic and Statistical Manual (DSM-IV) requires that "some impairment from the symptoms is present in two or more settings" and that "there must be clear evidence of significant impairment in social, school, or work functioning" for a diagnosis of ADHD to be made.<ref name=":1">{{Cite web|title=Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision: Attention-Deficit/Hyperactivity Disorder|url=http://www.psychiatryonline.com/content.aspx?aID=7721|url-status=dead|archive-url=https://web.archive.org/web/20090825205253/http://www.psychiatryonline.com/content.aspx?aID=7721|website=PsychiatryOnline|archive-date=2009-08-25|access-date=2009-08-09}}</ref>

In this view, in societies where passivity and order are highly valued, those on the active end of the active-passive spectrum may be seen as problems. Medically defining their behaviour (through medical labels such as ADHD) serves the purpose of removing blame from those causing the problem. However, strict social constructions views are controversial, due to a number of studies that cite significant psychological and social differences between those diagnosed with the disorder, and those who are not. The specific reasons for these differences are not certain, and this does not suggest anything other than a difference in behavior. Studies have also shown [[neurological]] differences, but whether this signifies an effect rather than a cause is unknown{{Citation needed|date=November 2024}}. Such differences could also be attributed the drugs commonly prescribed to people with this disorder{{Citation needed|date=November 2024}}. Studies have also been able to differentiate ADHD from other psychiatric disorders in its symptoms, associated features, life course, and comorbidity.<ref name="TimimiTaylor2004" /><ref>{{cite journal|author1=Taylor E.|author2=Chadwick O.|author3=Heptinstall E.|display-authors=etal|year=1996|title=Hyperactivity and conduct problems as risk factors for adolescent development|journal=Journal of the American Academy of Child and Adolescent Psychiatry|volume=35|issue=9|pages=1213–1226|doi=10.1097/00004583-199609000-00019|pmid=8824065}}</ref><ref>{{cite book |last1=Taylor |first1=E. |last2=Sandberg |first2=S. |last3=Thorley |first3=G. |last4=Giles |first4=S. |year=1991 |title=The Epidemiology of Childhood Hyperactivity |series=Maudsley Monographs No. 33 |location=Oxford |publisher=Oxford University Press}}</ref>{{page needed|date=April 2016}}<ref>{{cite journal | last1=Meltzer | first1=H. | last2=Gatward | first2=R. | last3=Goodman | first3=R. | last4=Ford | first4=T. | title=Mental health of children and adolescents in Great Britain | journal=International Review of Psychiatry | publisher=Informa UK Limited | volume=15 | issue=1–2 | year=2003 | issn=0954-0261 | doi=10.1080/0954026021000046155 | pages=185–187 |pmid=12745331| s2cid=46469959 }}</ref>

Gerald Coles, an educational psychologist and formerly an associate professor of clinical psychiatry at [[Robert Wood Johnson Medical School]] and the University of Rochester who has written extensively on literacy and learning disabilities, asserts that there are partisan agendas behind the educational policy-makers and that the scientific research that they use to support their arguments regarding the teaching of literacy are flawed. These include the idea that there are neurological explanations for learning disabilities. Gerald Coles argues that school failure must be viewed and treated in the context of both the learning environment and the child's individual abilities, behavior, family life, and social relationships. He then presents a new model of learning problems, in which family and school environments are the major determinants of academic success. In this interactive paradigm, the attitudes and methods of education are more important than inherent strengths or deficits of the individual child.<ref>{{cite book |last1=Coles|first1=Gerald |url=https://archive.org/details/learningmystique00cole_0 |title=The Learning Mystique: A Critical Look at "Learning Disabilities" |year= 1989|publisher=Ballantine Books|isbn=978-0449903513|url-access=registration}}</ref>{{page needed|date=April 2016}}

==Diagnosis==

===Methods of diagnosis===
Since the early 2000s, research on the functioning of the brain has been conducted to help support the idea that Attention Deficit Hyperactivity Disorder is an executive dysfunction issue.<ref>{{Cite journal|title = The neurobiological profile of girls with ADHD|author1=Mahone, E. M. |author2= Wodka, E. L. |name-list-style=amp |date = 2008|journal = Developmental Disabilities Research Reviews|doi = 10.1002/ddrr.41|pmid = 19072756|volume=14 |issue = 4|pages=276–284|pmc=3534724}}</ref> The brains of males and females are showing differences, which could potentially help explain why ADHD presents differently in boys and girls. The current method of diagnosis made is using the [[DSM-5]], along with a possible physical and visual examination.<ref>{{Cite web|title=Diagnosing ADHD in Children and Adults|url=https://www.webmd.com/add-adhd/childhood-adhd/diagnosing-adhd|access-date=2021-01-04|website=WebMD|language=en}}</ref>

===Over- and under-diagnosis===
[[Overdiagnosis]] typically refers to the phenomenon of children without ADHD being systematically erroneously diagnosed with ADHD. These instances are termed as ''false positives''. However, the "presence of false positives alone does not indicate overdiagnosis". There may be evidence of overdiagnosis if inaccuracies are shown consistently in the accepted prevalence rates or in the diagnostic process itself. "For ADHD to be overdiagnosed, the rate of false positives (i.e., children inappropriately diagnosed with ADHD) must substantially exceed the number of false negatives (children with ADHD who are not identified or diagnosed)."<ref name="Sciutto, M. J. 2007">{{cite journal | author = Sciutto M. J., Eisenberg M. | year = 2007 | title = Evaluating the Evidence For and Against the Overdiagnosis of ADHD | journal = Journal of Attention Disorders | volume = 11 | issue = 2| pages = 106–113 | doi=10.1177/1087054707300094| pmid = 17709814 | s2cid = 21584371 }}</ref> Children aged 8 to 15 years living in the community indicated an ADHD prevalence rate of 7.8%. However, only 48% of the ADHD sample had received any mental health care over the past 12 months.<ref>{{cite journal |last= Connor |first= DF |title= Problems of overdiagnosis and overprescribing in ADHD |journal= Psychiatric Times |volume= 28 |issue= 8 |year= 2011 |pages= 14–18}}</ref>

Evidence also exists of possible differences of race and ethnicity in the prevalence of ADHD. Some believe this may be due to different perceptions of what qualifies as disruptive behavior, inattention and hyperactivity.<ref name="Cuffe, S. P. 2005">{{cite journal |last1= Cuffe |first1= SP |last2= Moore |first2= CG |last3= McKeown |first3= RE |year= 2005 |title= Prevalence and correlates of ADHD symptoms in the National Health Interview Survey |journal= Journal of Attention Disorders |volume= 9 |issue= 2 |pages= 392–401 |doi=10.1177/1087054705280413|pmid= 16371662 |s2cid= 23930729 }}</ref>

It is argued that over-diagnosis occurs more in well-off or more homogeneous communities, whereas under-diagnosis occurs more frequently in poorer and minority communities due to lack of resources and lack of financial access. Those without health insurance are less likely to be diagnosed with ADHD. It is further believed that the "distribution of ADHD diagnosis falls along socioeconomic lines", according to the amount of wealth within a neighborhood. Therefore, the difficulty of applying national, general guidelines to localized and specific contexts, such as where referral is unavailable, resources are lacking or the patient is uninsured, may assist in the establishment of a misdiagnosis of ADHD.<ref>{{cite journal |last= Morely |first= CP |s2cid= 19697226 |year= 2010 |title= Disparities in ADHD assessment, diagnosis and treatment |journal= International Journal of Psychiatry in Medicine |volume= 40 |issue= 4 |pages= 383–389|pmid= 21391409 |doi= 10.2190/PM.40.4.b }}</ref>

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 the symptoms of ADHD as children grow up and mature into adulthood. As children move into the stage of adolescence, the most common reporters of ADHD symptoms, parents and teachers, tend to focus on behaviors affecting academic performance. Some research has shown that the primary symptoms of ADHD were strong discriminators in parent ratings, but differed for specific age groups. Hyperactivity was a stronger discriminator of ADHD in children, while inattentiveness was a stronger discriminator in adolescents.<ref name="Harrison, J. R. 2011">{{cite journal |last1= Harrison |first1= JR |last2= Vannest |first2= KJ |last3= Reynolds |first3= CR |year= 2011 |title= Behaviors that discriminate ADHD in children and adolescents: Primary symptoms, symptoms of comorbid conditions or indicators of functional impairment? |journal= Journal of Attention Disorders |volume= 15 |issue= 2 |pages= 147–160 |doi=10.1177/1087054709356170|pmid= 20354233 |s2cid= 22203218 }}</ref>

Issues with comorbidity are another possible explanation in favor of the argument of overdiagnosis. As many as 75% of diagnosed children with ADHD meet criteria for some other psychiatric diagnosis.<ref name="Cuffe, S. P. 2005"/> Among children diagnosed with ADHD, about 25% to 30% have [[anxiety disorders]], 9% to 32% have [[Major depressive disorder|depression]], 45% to 84% have [[oppositional defiant disorder]], and 44% to 55% of adolescents have [[conduct disorder]].<ref name="Harrison, J. R. 2011"/> [[Learning disability|Learning disorders]] are found in 20% to 40% of children with ADHD.<ref name="Cuffe, S. P. 2005"/>

Another possible explanation of over-diagnosis of ADHD is the "relative-age effect", which applies to children of both sexes. Younger children are more likely to be inappropriately diagnosed with ADHD and treated with prescription medication than their older peers in the same grade. Children who are almost a year younger tend to appear more immature than their classmates, which influences both their academic and athletic performance.<ref name=CMAJ>{{cite journal|last1=Morrow|first1=R |last2=Garland |first2= J |last3= Wright |first3= J |last4= Maclure |first4= M |last5= Taylor |first5= S |last6= Dormuth |first6= C |display-authors= 4 |title=Influence of relative age on diagnosis and treatment of Attention-Deficit/Hyperactivity Disorder in children|journal=Canadian Medical Association Journal |date=17 April 2012|volume=184|issue=7|pages=755–762|doi=10.1503/cmaj.111619 |pmid=22392937 |pmc=3328520}}</ref>

The debate of underdiagnosis, or giving a "false negative", has also been discussed, specifically in literature concerning ADHD among adults, girls and underprivileged communities. It is estimated that in the adult population, rates of ADHD are somewhere between 4% and 6%.<ref>{{cite journal |last1= Able |first1= SL |last2= Johnston |first2= JA |last3= Adler |first3= LA |last4= Swindle |first4= RW |year= 2007 |title= Functional and psychosocial impairment in adults with undiagnosed ADHD |journal= Psychological Medicine |issue= 1 |pages= 97–107 | doi = 10.1017/s0033291706008713 |pmid= 16938146 |volume=37|s2cid= 22230788 }}</ref> However, as little as 11% of these adults with ADHD actually receive assessment, much less any form of treatment.<ref>{{cite journal |last1= Kessler |first1= RC |last2= Adler |first2= L |last3= Barley |first3= R |last4= Biederman |first4= J |last5= Conners |first5= CK |last6= Demler |first6= O |display-authors= 4 |year= 2006 |title= The prevalence and correlates of adult ADHD in the United States: Results from the National Comorbidity Survey Replication |journal= The American Journal of Psychiatry |volume= 163 |issue= 4 |pages= 716–723 |pmid= 16585449|doi= 10.1176/appi.ajp.163.4.716 |pmc=2859678}}</ref> Between 30% and 70% of children with ADHD report at least one impairing symptom of ADHD in adulthood, and 30% to 50% still meet the diagnostic criteria for ADHD.<ref>{{cite journal |last= Manos |first= MJ |year= 2010 |title= Nuances of assessment and treatment of ADHD in adults: A guide for psychologists |journal= Professional Psychology: Research and Practice |volume= 41 |issue= 6 |pages= 511–517 |doi=10.1037/a0021476}}</ref>

Research on gender differences also reveals an argument for underdiagnosis of ADHD among girls. The ratio for male-to-female is 4:1 with 92% of girls with ADHD receiving a primarily inattentive subtype diagnosis.<ref name="Cuffe, S. P. 2005"/> This difference in gender can be explained, for the majority, by the different ways boys and girls express symptoms of this particular disorder.<ref name="Bruchmuller, K. 2012">{{cite journal |last1= Bruchmuller |first1= K |last2= Margraf |first2= J |last3= Schneider |first3= S |year= 2012 |title= Is ADHD diagnosed in accord with diagnostic criteria? Overdiagnosis and influence of client gender on diagnosis |journal= Journal of Consulting and Clinical Psychology |volume= 80 |issue= 1 |pages= 128–138 |doi=10.1037/a0026582 |pmid=22201328|s2cid= 6436414 }}</ref> Typically, females with ADHD exhibit less disruptive behaviors and more [[Internalization (sociology)|internalizing behaviors]].<ref name="Sciutto, M. J. 2007"/><ref name = Beiderman>{{cite journal|last=Beiderman, J.|first=Joseph|author2=Stephen Farone |author3=Eric Mick |title=Clinical correlates of ADHD in females: Findings from a large group of girls ascertained from pediatric and psychiatric referral sources|journal=Journal of the American Academy of Child and Adolescent Psychiatry|date=1999|volume=38|issue=8|pages=966–975|doi=10.1097/00004583-199908000-00012|pmid=10434488}}</ref> Girls tend to show fewer behavioral problems, show fewer aggressive behaviors, are less impulsive, and are less hyperactive than boys diagnosed with ADHD. These patterns of behavior are less likely to disrupt the classroom or home setting, therefore allowing parents and teachers to easily overlook or neglect the presence of a potential problem.<ref name="Bruchmuller, K. 2012"/> The current diagnostic criteria appear to be more geared towards symptoms more common in males than in females, and the ADHD characteristics of men have been over-represented. This leaves many women and girls with ADHD neglected.<ref>{{Cite journal |last1=Skogli |first1=Erik Winther |last2=Teicher |first2=Martin H |last3=Andersen |first3=Per Normann |last4=Hovik |first4=Kjell Tore |last5=Øie |first5=Merete |date=2013-11-09 |title=ADHD in girls and boys – gender differences in co-existing symptoms and executive function measures |journal=BMC Psychiatry |volume=13 |pages=298 |doi=10.1186/1471-244X-13-298 |doi-access=free |issn=1471-244X |pmc=3827008 |pmid=24206839}}</ref>

As stated previously, underdiagnosis is also believed to be seen in more underprivileged communities. These communities tend to be poorer and inhabit more minorities. More than 50% of children with mental health needs do not receive assessment or treatment. Access to mental health services and resources differs on a wide range of factors, such as "gender, age, race or ethnicity and health insurance". Therefore, children deserving of an ADHD diagnosis may never receive this confirmation and are not identified or represented in prevalence rates.<ref name="Sciutto, M. J. 2007"/>

In 2005, 82 percent of teachers in the United States considered ADHD to be over diagnosed while three percent considered it to be under diagnosed. In China 19 percent of teachers considered ADHD to be over diagnosed while 57 percent considered it to be under diagnosed.<ref>{{cite journal |vauthors=Norvilitis JM, Fang P |title=Perceptions of ADHD in China and the United States: a preliminary study |journal=J Atten Disord |volume=9 |issue=2 |pages=413–424 |date=November 2005 |pmid=16371664 |doi=10.1177/1087054705281123 |s2cid=922904 }}</ref>

The [[British Psychological Society]] said in a 1997 report that physicians and psychiatrists should not follow the American example of applying medical labels to such a wide variety of attention-related disorders: "The idea that children who don't attend or who don't sit still in school have a mental disorder is not entertained by most British clinicians."<ref name="Reason R 1999 85–91">{{Cite journal |author=Reason R |author2=Working Party of the British Psychological Society |year=1999 |title=ADHD: a psychological response to an evolving concept. (Report of a Working Party of the British Psychological Society) |journal=Journal of Learning Disabilities |volume=32 |issue=1 |pages=85–91 |doi=10.1177/002221949903200108 |pmid=15499890 |s2cid=8480210}}</ref><ref>{{Cite encyclopedia |title=Attention-deficit/hyperactivity disorder: Controversy – mental disorder or state of mind? |encyclopedia=[[Encyclopædia Britannica]] |url=https://www.britannica.com/science/attention-deficit-hyperactivity-disorder/Controversy-mental-disorder-or-state-of-mind |language=en |archive-url=https://web.archive.org/web/20100515043015/http://www.britannica.com/EBchecked/topic/279477/attention-deficithyperactivity-disorder/216017/Controversy-mental-disorder-or-state-of-mind |archive-date=May 15, 2010}}</ref> The NICE, in collaboration with others, release guidelines for the diagnosis and treatment of ADHD.<ref>{{cite web |title=Attention deficit hyperactivity disorder2013 |date=30 July 2013 |url=https://www.nice.org.uk/guidance/qs39 |publisher=NICE}}</ref> An update was last published in 2019.<ref name="update NICE">{{cite web |title=Attention deficit hyperactivity disorder (update) |date=14 March 2018 |url=https://www.nice.org.uk/guidance/indevelopment/gid-cgwave0798 |publisher=NICE}}</ref>

There have been notable differences in the diagnosis patterns of birthdays in school-age children. Those born relatively younger to the school starting age than others in a classroom environment are shown to be more likely diagnosed with ADHD. Boys who were born in December in which the school age cut-off was December 31 were shown to be 30% more likely to be diagnosed and 41% to be treated than others born in January. Girls born in December had a diagnosis percentage of 70% and 77% treatment more than ones born the following month. Children who were born at the last 3 days of a calendar year were reported to have significantly higher levels of diagnosis and treatment for ADHD than children born at the first 3 days of a calendar year. The studies suggest that ADHD diagnosis is prone to subjective analysis.<ref name=":02">{{Cite journal |last=Ford-Jones |first=Polly Christine |date=May 2015 |title=Misdiagnosis of attention deficit hyperactivity disorder: 'Normal behaviour' and relative maturity |journal=Paediatrics & Child Health |volume=20 |issue=4 |pages=200–202 |doi=10.1093/pch/20.4.200 |issn=1205-7088 |pmc=4443828 |pmid=26038639}}</ref>

==Treatment==
[[Attention deficit hyperactivity disorder management|ADHD management]] recommendations vary by country and usually involves some combination of [[psychotherapy|counseling]], lifestyle changes, and medications.<ref name=NIH2016>{{cite web|title=Attention Deficit Hyperactivity Disorder|url=http://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml|website=National Institute of Mental Health|access-date=5 March 2016}}</ref> The British guideline only recommends medications as a first-line treatment in children who have severe symptoms and for them to be considered in those with moderate symptoms who either refuse or fail to improve with counseling.<ref name="NICE 2009">{{citation|title=Attention Deficit Hyperactivity Disorder: Diagnosis and Management of ADHD in Children, Young People and Adults|author=National Collaborating Centre for Mental Health|publisher=British Psychological Society|isbn=978-1854334718|year=2009|pages=19–27, 38, 130, 133, 317}}</ref> Canadian and American guidelines recommend that medications and behavioral therapy be used together as a first-line therapy, except in preschool-aged children.<ref name=CADDRA>{{citation|title=Canadian ADHD Practice Guidelines|url=http://www.caddra.ca/cms4/pdfs/caddraGuidelines2011Introduction.pdf|publisher=Canadian ADHD Alliance|access-date=4 February 2011}}</ref><ref name=cdc>{{citation|title=Attention-Deficit/Hyperactivity Disorder (ADHD): Recommendations|url=https://www.cdc.gov/ncbddd/adhd/guidelines.html|publisher=Centers for Disease Control and Prevention|access-date=13 July 2015|date=24 June 2015}}</ref>

===Stimulants===
{{Confusing|section|date=May 2022|reason=Paragraph two is discussing multiple types of stimulants but is still trying to compare the statistics}}

The [[National Institute of Mental Health]] recommends [[stimulant]]s for the treatment of ADHD, and states that, "under medical supervision, stimulant medications are considered safe".<ref name="NIMH">{{cite web |title=NIMH · ADHD · The Treatment of ADHD |url=http://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder/medications.shtml}}</ref> A 2007 drug class review found no evidence of any differences in efficacy or side effects in the stimulants commonly prescribed.<ref>{{Cite book |last1=McDonagh |first1=Marian S. |url=http://www.ncbi.nlm.nih.gov/books/NBK10293/ |title=Drug Class Review on Pharmacologic Treatments for ADHD: Final Report |last2=Peterson |first2=Kim |last3=Dana |first3=Tracy |last4=Thakurta |first4=Sujata |date=2007 |publisher=Oregon Health & Science University |series=Drug Class Reviews |location=Portland (OR) |pmid=20480923}}</ref>

Methylphenidate and amphetamine are the most common stimulants used for treating ADHD. Studies have shown that providing low doses of methylphenidate and amphetamine improves individuals' executive functioning and focus attention.<ref name=":23">{{Cite journal |last=Arnsten |first=Amy F. T. |date=2006 |title=Stimulants: Therapeutic Actions in ADHD |journal=Neuropsychopharmacology |language=en |volume=31 |issue=11 |pages=2376–2383 |doi=10.1038/sj.npp.1301164 |issn=1740-634X|doi-access=free |pmid=16855530 }}</ref> Individuals with ADHD have a weaker prefrontal cortex.<ref name=":23"/> The prefrontal cortex is the target of the stimulants as it is what regulates individuals attention and behavior.<ref name=":23"/> The stimulants have shown to increase the levels of norepinephrine and dopamine that are released into the prefrontal cortex.<ref name=":23" /> Stimulants are often used multiple times a day and/or in combination with other treatments.

Methylphenidate is commonly used for treating ADHD, narcolepsy, and for cognitive enhancement.<ref name=":32">{{Cite journal |last1=Challman |first1=Thomas D. |last2=Lipsky |first2=James J. |date=2000 |title=Methylphenidate: Its Pharmacology and Uses |journal=Mayo Clinic Proceedings |volume=75 |issue=7 |pages=711–721 |doi=10.4065/75.7.711 |issn=0025-6196|doi-access=free |pmid=10907387 }}</ref> It was first created by chemist Leandro Panizzon in 1944 and later patented in 1954 by a Swiss pharmaceutical company known as Ciba.<ref>{{Cite journal |last=Jane |first=U. |date=2015 |title=A brief history of methylphenidate: psychiatry-ADHD |url=https://journals.co.za/doi/abs/10.10520/EJC173264 |journal=The Specialist Forum |volume=15 |issue=6 |pages=24}}</ref> Methylphenidate was first introduced into the market as Ritalin in the 1950s.<ref name=":32" /> Methylphenidate gradually gained attention for its effects in treating narcolepsy. The use of methylphenidate expanded in the 1960s when it was discovered to be effective in treating hyperkinetic disorder, now known as ADHD.<ref>{{Cite journal |last1=Conrad |first1=Peter |last2=Bergey |first2=Meredith R. |date=2014 |title=The impending globalization of ADHD: Notes on the expansion and growth of a medicalized disorder |url=https://www.sciencedirect.com/science/article/pii/S0277953614006650 |journal=Social Science & Medicine |volume=122 |pages=31–43 |doi=10.1016/j.socscimed.2014.10.019 |pmid=25441315 |issn=0277-9536|url-access=subscription }}</ref>

Between 1993 and 2003 the worldwide use of medications that treat ADHD increased almost threefold.<ref name=NIMH2007>{{cite web | url=http://www.nimh.nih.gov/news/science-news/2007/global-use-of-adhd-medications-rises-dramatically.shtml | title=Global Use of ADHD Medications Rises Dramatically | date=6 March 2007 | publisher=NIMH | access-date=2013-05-06 | archive-url=https://web.archive.org/web/20130512105530/http://www.nimh.nih.gov/news/science-news/2007/global-use-of-adhd-medications-rises-dramatically.shtml | archive-date=2013-05-12 | url-status=dead }}</ref> Most ADHD medications are prescribed in the United States.<ref name = NIMH2007/> In the 1990s, the US accounted for 90% of global use of stimulants such as methylphenidate and dextroamphetamine. Although in the 2000s, trends and patterns in data show that there was a rise in the percentage of drug usage in other countries worldwide. Prevalence and incidence rates of the use of stimulants increased at a high rate worldwide after 1995 and continued to rise at a lower rate until it plateaued in 2008. The global usage of stimulants was rising at rates related to the high percentage used originally in the US. Many other countries began to see more prescriptions for stimulants as well as more usage of prescription stimulants such as methylphenidate and dextroamphetamine among children and adults.<ref>{{Cite journal |last1=Beau-Lejdstrom |first1=R. |last2=Douglas |first2=I. |last3=Evans |first3=SJ. |last4=Smeeth |first4=L. |date=13 June 2016 |title=Latest Trends In ADHD Drug Prescribing Patterns in Children in the UK: Prevalence, Incidence, and Persistence |journal=  BMJ Open|volume=6 |issue=6|pages=e010508 |doi=10.1136/bmjopen-2015-010508 |pmid=27297009 |pmc=4932306 }}</ref> From 1994-2000 as many as 10 countries saw a dramatic 12% increase in the use of stimulants. Australia and New Zealand became the third highest users of stimulants after the United States and Canada respectively.<ref>{{Cite journal |last1=Berbatis |first1=C.G. |last2=Sunderland |first2=V.B. |last3=Bulsara |first3=M. |date=2002 |title=Licit Psychostimulant Consumption in Australia, 1994-200: International and Jurisdictional Comparison |url=https://onlinelibrary.wiley.com/doi/abs/10.5694/j.1326-5377.2002.tb04948.x |journal=Medical Journal of Australia |volume=177 |issue=10 |pages=539–543|doi=10.5694/j.1326-5377.2002.tb04948.x |pmid=12429001 |s2cid=2909911 |url-access=subscription }}</ref> By 2015 countries such as the UK saw a rise of stimulant prescriptions by 800%. The time period with the highest rise in percentage being from 1995-2003.'''<ref>{{Cite journal |last1=Renoux |first1=C |last2=Shin |first2=JY |last3=Dell'Aniello |first3=S |last4=Fergusson |first4=E |last5=Suissa |first5=S |date=September 2016 |title=Prescribing Trends of Attention-Deficit Hyperactivity Disorder (ADHD) Medications in UK Primary Care, 1995-2015 |journal=  British Journal of Clinical Pharmacology|volume=82 |issue=3 |pages=858–68|doi=10.1111/bcp.13000 |pmid=27145886 |pmc=5338115 }}</ref>'''

Dextroamphetamine is an extremely powerful stimulant, commonly used to treat sleep disorders and ADHD.  The medicine can be taken with or without food, and it is available in three different forms, Oral tablet, Oral extended-release capsule, and oral solutions.  However, you cannot buy this medicine without a doctor's prescription. 

In 2003, doctors in the UK were prescribing about a 10th of the amount per capita of methylphenidate used in the US, while France and Italy accounted for approximately one twentieth of US stimulant consumption.<ref name="USE2003">{{cite journal |last=Marwick |first=C. |date=2003-01-11 |title=US doctor warns of misuse of prescribed stimulants |journal=BMJ |type=news article |location=Washington, DC |volume=326 |issue=7380 |page=67 |doi=10.1136/bmj.326.7380.67 |issn=0959-8138 |pmc=1125021 |pmid=12521954}}</ref> However, the 2006 World Drug Report published by the [[United Nations Office on Drugs and Crime]] indicated the US constituted merely 17% of the world market for dextroamphetamine.<ref name="World Drug Report" /> They assert that in the early 2000s amphetamine use was "widespread in Europe."<ref name="World Drug Report">{{cite web |vauthors=Chawla S, Le Pichon T | title = World Drug Report 2006 | year = 2006 | pages = 143–144 | work = United Nations Office on Drugs and Crime | url = http://www.unodc.org/pdf/WDR_2006/wdr2006_volume1.pdf | access-date = 2 November 2013 }}</ref>

In 1999, a study constructed with 1,285 children and their parents across four U.S. communities has shown 12.5% of children that met ADHD criteria had been treated with stimulants during the previous 12 months.<ref>{{cite journal |vauthors=Jensen PS, Kettle L, Roper MT |title=Are stimulants overprescribed? Treatment of ADHD in four U.S. communities |journal=Journal of the American Academy of Child and Adolescent Psychiatry |volume=38 |issue=7 |pages=797–804 |date=July 1999 |pmid=10405496 |doi=10.1097/00004583-199907000-00008|display-authors=etal|url=https://zenodo.org/record/1234802 }}</ref>
In May 2000, the testimony of DEA Deputy Director Terrance Woodworth has shown that the Ritalin quota increased from 1,768&nbsp;kg in 1990 to 14,957&nbsp;kg in 2000. In addition, IMS Health also revealed the number of Adderall prescriptions have increased from 1.3 million in 1996 to nearly 6 million in 1999.<ref name=STI2013>{{cite web | url = https://www.pbs.org/wgbh/pages/frontline/shows/medicating/drugs/stats.html |title = Statistics on Stimulant Use | publisher = Public Broadcasting Service |access-date = 31 March 2013 }}</ref>

====Adverse effects====
Some parents and professionals have raised questions about the side effects of drugs and their long-term use.<ref>{{cite journal |vauthors=Lakhan SE, Hagger-Johnson GE |title=The impact of prescribed psychotropics on youth |journal=Clin Pract Epidemiol Ment Health |volume=3 |issue= 1|pages=21 |year=2007 |pmid=17949504 |pmc=2100041 |doi=10.1186/1745-0179-3-21 |doi-access=free }}</ref> [[Magnetic resonance imaging]] studies suggest that long-term treatment with amphetamine or methylphenidate decreases abnormalities in brain structure and function found in subjects with ADHD, and improves function of the right [[caudate nucleus]].<ref name="Neuroplasticity 1">{{cite journal |vauthors=Hart H, Radua J, Nakao T, Mataix-Cols D, Rubia K |title=Meta-analysis of functional magnetic resonance imaging studies of inhibition and attention in attention-deficit/hyperactivity disorder: exploring task-specific, stimulant medication, and age effects |journal=JAMA Psychiatry |volume=70 |issue=2 |pages=185–198 |date=February 2013 |pmid=23247506 |doi=10.1001/jamapsychiatry.2013.277 |doi-access= }}</ref><ref name="Neuroplasticity 2">{{cite journal |vauthors=Spencer TJ, Brown A, Seidman LJ, Valera EM, Makris N, Lomedico A, Faraone SV, Biederman J |title=Effect of psychostimulants on brain structure and function in ADHD: a qualitative literature review of magnetic resonance imaging-based neuroimaging studies |journal=J. Clin. Psychiatry |volume=74 |issue=9 |pages=902–917 |date=September 2013 |pmid=24107764 |doi=10.4088/JCP.12r08287 |pmc=3801446}}</ref><ref name="Neuroplasticity 3">{{cite journal | title=Meta-analysis of structural MRI studies in children and adults with attention deficit hyperactivity disorder indicates treatment effects. | journal=Acta Psychiatrica Scandinavica | date=February 2012 | volume=125 | issue=2 | pages=114–126 | pmid=22118249 |vauthors=Frodl T, Skokauskas N | quote=Basal ganglia regions like the right globus pallidus, the right putamen, and the nucleus caudatus are structurally affected in children with ADHD. These changes and alterations in limbic regions like ACC and amygdala are more pronounced in non-treated populations and seem to diminish over time from child to adulthood. Treatment seems to have positive effects on brain structure. | doi=10.1111/j.1600-0447.2011.01786.x| s2cid=25954331 | doi-access=free |type=Meta-analysis}}</ref> On February 9, 2006, the [[U.S. Food and Drug Administration]] voted to recommend a "black-box" warning describing the cardiovascular risks of stimulant drugs used to treat ADHD.<ref>{{cite journal |author=Nissen SE |s2cid=7648853 |title=ADHD drugs and cardiovascular risk |journal=N. Engl. J. Med. |volume=354 |issue=14 |pages=1445–1448 |date=April 2006 |pmid=16549404 |doi=10.1056/NEJMp068049 |doi-access=free }}</ref> Subsequently, the USFDA commissioned studies which found that, in children, young adults, and adults, there is no association between serious adverse cardiovascular events ([[sudden cardiac death|sudden death]], [[myocardial infarction]], and [[stroke]]) and the medical use of amphetamine or other ADHD stimulants.<ref>{{cite web | title=FDA Drug Safety Communication: Safety Review Update of Medications used to treat Attention-Deficit/Hyperactivity Disorder (ADHD) in children and young adults | date=20 December 2011 | url=https://www.fda.gov/Drugs/DrugSafety/ucm277770.htm | archive-url=https://web.archive.org/web/20111103131407/http://www.fda.gov/Drugs/DrugSafety/ucm277770.htm | url-status=dead | archive-date=November 3, 2011 | work=United States Food and Drug Administration | access-date=4 November 2013}}</ref><ref name="pmid22043968">{{cite journal |vauthors=Cooper WO, Habel LA, Sox CM, Chan KA, Arbogast PG, Cheetham TC, Murray KT, Quinn VP, Stein CM, Callahan ST, Fireman BH, Fish FA, Kirshner HS, O'Duffy A, Connell FA, Ray WA | title = ADHD drugs and serious cardiovascular events in children and young adults | journal = N. Engl. J. Med. | volume = 365 | issue = 20 | pages = 1896–1904 |date=November 2011 | pmid = 22043968 | pmc = 4943074 | doi = 10.1056/NEJMoa1110212 }}</ref><ref>{{cite web | title=FDA Drug Safety Communication: Safety Review Update of Medications used to treat Attention-Deficit/Hyperactivity Disorder (ADHD) in adults | date=15 December 2011 | url=https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-safety-review-update-medications-used-treat-attention-0 | work=United States Food and Drug Administration | access-date=4 November 2013}}</ref><ref name="pmid22161946">{{cite journal |vauthors=Habel LA, Cooper WO, Sox CM, Chan KA, Fireman BH, Arbogast PG, Cheetham TC, Quinn VP, Dublin S, Boudreau DM, Andrade SE, Pawloski PA, Raebel MA, Smith DH, Achacoso N, Uratsu C, Go AS, Sidney S, Nguyen-Huynh MN, Ray WA, Selby JV | title = ADHD medications and risk of serious cardiovascular events in young and middle-aged adults |date=December 2011 | journal = JAMA | volume = 306 | issue = 24 | pages = 2673–2683 | pmid = 22161946 | pmc = 3350308 | doi = 10.1001/jama.2011.1830 }}</ref>

The effects of amphetamine and methylphenidate on gene regulation are both dose- and route-dependent.<ref name="Addiction genetics">{{cite journal |vauthors=Steiner H, Van Waes V |title=Addiction-related gene regulation: risks of exposure to cognitive enhancers vs. other psychostimulants |journal=Prog. Neurobiol. |volume=100 |pages=60–80 |date=January 2013 |pmid=23085425 |pmc=3525776 |doi=10.1016/j.pneurobio.2012.10.001 }}</ref> Most of the research on gene regulation and addiction is based upon animal studies with intravenous amphetamine administration at very high doses.<ref name="Addiction genetics" /> The few studies that have used equivalent (weight-adjusted) human therapeutic doses and oral administration show that these changes, if they occur, are relatively minor.<ref name="Addiction genetics" /> The long-term effects on the developing brain and on mental health disorders in later life of chronic use of methylphenidate is unknown. Despite this, between 0.51% to 1.23% of children between the ages of 2 and 6 years take stimulants in the US. Stimulant drugs are not approved for this age group.<ref>{{cite journal |vauthors=Kimko HC, Cross JT, Abernethy DR |s2cid=397390 |title=Pharmacokinetics and clinical effectiveness of methylphenidate |journal=Clin Pharmacokinet |volume=37 |issue=6 |pages=457–470 |date=December 1999 |pmid=10628897 |doi= 10.2165/00003088-199937060-00002}}</ref><ref>{{cite journal |author=Vitiello B |title=Psychopharmacology for young children: clinical needs and research opportunities |journal=Pediatrics |volume=108 |issue=4 |pages=983–989 |date=October 2001 |pmid=11581454 |doi= 10.1542/peds.108.4.983|url=http://pediatrics.aappublications.org/cgi/content/full/108/4/983|url-access=subscription }}</ref>

In individuals who experience sub-normal height and weight gains during stimulant therapy, a rebound to normal levels is expected to occur if stimulant therapy is briefly interrupted.<ref name="Millichap">{{cite book | author = Millichap JG | editor = Millichap JG | title = Attention Deficit Hyperactivity Disorder Handbook: A Physician's Guide to ADHD | year = 2010 | publisher = Springer | location = New York| isbn = 978-1441913968 | pages = 121–123, 125–127 | edition = 2nd | chapter = Chapter 9: Medications for ADHD | quote = Ongoing research has provided answers to many of the parents' concerns, and has confirmed the effectiveness and safety of the long-term use of medication.}}</ref><ref name="Long-Term Outcomes Medications">{{cite journal |vauthors=Huang YS, Tsai MH | s2cid = 3449435 | title = Long-term outcomes with medications for attention-deficit hyperactivity disorder: current status of knowledge | journal = CNS Drugs | volume = 25 | issue = 7 | pages = 539–554 |date=July 2011 | pmid = 21699268 | doi = 10.2165/11589380-000000000-00000 | quote = Recent studies have demonstrated that stimulants, along with the non-stimulants atomoxetine and extended-release guanfacine, are continuously effective for more than 2-year treatment periods with few and tolerable adverse effects.}}</ref><ref name="pmid18295156">{{cite journal | author = Vitiello B | title = Understanding the risk of using medications for attention deficit hyperactivity disorder with respect to physical growth and cardiovascular function | journal = Child Adolesc. Psychiatr. Clin. N. Am. | volume = 17 | issue = 2 | pages = 459–474 |date=April 2008 | pmid = 18295156 | pmc = 2408826 | doi = 10.1016/j.chc.2007.11.010 }}</ref> The average reduction in final adult height from continuous stimulant therapy over a 3-year period is 2&nbsp;cm.<ref name="pmid18295156" /> Amphetamines doubles the risk of psychosis compared to methylphenidate in ADHD patients.<ref>{{cite news|title=With ADHD, amphetamine has double the psychosis risk of methylphenidate |newspaper=Reuters|date=20 March 2019|url=https://www.reuters.com/article/us-health-adhd-adderall-psychosis-idUSKCN1R12PR}}</ref>

====Effectiveness====
The use of stimulant medication for treatment of attention-deficit hyperactivity disorder (ADHD) is well-researched and considered one of the most effective treatments in psychiatry.<ref name=":03">{{Cite journal |last1=Craig |first1=Stephanie G. |last2=Davies |first2=Gregory |last3=Schibuk |first3=Larry |last4=Weiss |first4=Margaret D. |last5=Hechtman |first5=Lily |date=2015-03-01 |title=Long-Term Effects of Stimulant Treatment for ADHD: What Can We Tell Our Patients? |journal=Current Developmental Disorders Reports |language=en |volume=2 |issue=1 |pages=1–9 |doi=10.1007/s40474-015-0039-5 |issn=2196-2987|doi-access=free }}</ref> A 2015 study examined the long-term effects of stimulant medication for ADHD, and reported that stimulants are a highly effective treatment for ADHD in the short term when used properly.<ref name=":03" /> The findings for long term effects were limited. However, this study concluded that stimulant medication is a safe and effective treatment for ADHD.

A 2017 review assessed the advantages and disadvantages of both behavioral therapies and pharmacological interventions for the treatment of ADHD.<ref>{{Cite journal |last1=Rajeh |first1=Adnan |last2=Amanullah |first2=Shabbir |last3=Shivakumar |first3=K. |last4=Cole |first4=Julie |date=2017-02-01 |title=Interventions in ADHD: A comparative review of stimulant medications and behavioral therapies |url=https://www.sciencedirect.com/science/article/pii/S1876201816303963 |journal=Asian Journal of Psychiatry |volume=25 |pages=131–135 |doi=10.1016/j.ajp.2016.09.005 |pmid=28262134 |issn=1876-2018|url-access=subscription }}</ref> It was reported that stimulants are a very effective treatment during the time period in which they are taken. While the short-term benefits were clearly demonstrated, the long-term benefits were less clear.

Another 2013 review aimed to identify the direct and indirect impacts of stimulant medication on the long-term outcomes of adults with ADHD.<ref name=":04">{{Cite journal |last1=Fredriksen |first1=Mats |last2=Halmøy |first2=Anne |last3=Faraone |first3=Stephen V. |last4=Haavik |first4=Jan |date=2013-06-01 |title=Long-term efficacy and safety of treatment with stimulants and atomoxetine in adult ADHD: A review of controlled and naturalistic studies |journal=European Neuropsychopharmacology |series=Making IMPACT on adult ADHD – recent advances in neurobiology and treatment |volume=23 |issue=6 |pages=508–527 |doi=10.1016/j.euroneuro.2012.07.016 |issn=0924-977X|doi-access=free |pmid=22917983 |hdl=10852/40257 |hdl-access=free }}</ref> It was found that medication was significantly more effective than placebos for treating adults. Additionally, after conducting longitudinal and cross-sectional studies, it was reported that stimulant treatment for ADHD is tolerated well, and has long term benefits.<ref name=":04" />

Reviews of clinical stimulant research have established the safety and effectiveness of long-term amphetamine use for ADHD.<ref name="Millichap_3">{{cite book | author = Millichap JG | editor = Millichap JG | title = Attention Deficit Hyperactivity Disorder Handbook: A Physician's Guide to ADHD | year = 2010 | publisher = Springer | location = New York | isbn = 978-1441913968 | pages = 111–113 | edition = 2nd | chapter = Chapter 3: Medications for ADHD}}</ref><ref name="ADHD">{{cite web | title=Stimulants for Attention Deficit Hyperactivity Disorder | url=http://www.webmd.com/add-adhd/childhood-adhd/stimulants-for-attention-deficit-hyperactivity-disorder | work = WebMD | publisher = Healthwise | date = 12 April 2010 | access-date=12 November 2013 }}</ref><ref name="Safety">{{cite journal |vauthors=Chavez B, Sopko MA, Ehret MJ, Paulino RE, Goldberg KR, Angstadt K, Bogart GT |s2cid=23355404 |title=An update on central nervous system stimulant formulations in children and adolescents with attention-deficit/hyperactivity disorder |journal=Ann. Pharmacother. |volume=43 |issue=6 |pages=1084–1095 |date=June 2009 |pmid=19470858 |doi=10.1345/aph.1L523 }}</ref> An evidence review noted the findings of a [[randomized controlled trial]] of amphetamine treatment for ADHD in Swedish children following 9&nbsp;months of amphetamine use.<ref name="Millichap" /> During treatment, the children experienced improvements in attention, disruptive behaviors, and hyperactivity, and an average change of&nbsp;+4.5 in [[intelligence quotient|IQ]].<ref name="Millichap" /> It was noted that the population in the study had a high rate of [[comorbid]] disorders associated with ADHD, and suggested that other long-term amphetamine trials in people with fewer associated disorders could find greater functional improvements.<ref name="Millichap" />

==== Treatment non-adherence and acceptability ====
The rates of treatment discontinuation are higher than the rates of ADHD patients that receive no treatment at all; few studies present evidence that adherence to ADHD treatment is occurring at high rates with low acceptability.<ref name=":0">{{Cite journal|last1=Frank|first1=Elliot|last2=Ozon|first2=Cristina|last3=Nair|first3=Vinitha|last4=Othee|first4=Karandeep|s2cid=6895118|date=2015-11-25|title=Examining Why Patients With Attention-Deficit/Hyperactivity Disorder Lack Adherence to Medication Over the Long-Term|journal=The Journal of Clinical Psychiatry|volume=76|issue=11|pages=e1459–e1468|doi=10.4088/jcp.14r09478|pmid=26646041|issn=0160-6689 |type=Review}}</ref> A literature review on empirical studies from 1997 to 2014 revealed a lack of research on adult non-adherence, however there is a large body of research on children and adolescents who discontinue treatment.<ref name=":0" /> Some of the common reasons for stopping treatment includes the idea that it is not needed or does not reduce the symptoms of ADHD, as well as reported adverse drug effects like weight and appetite loss, sleeping difficulties, combined with other medically diagnosed conditions.<ref name=":0" />

Research has shown that adherence and acceptability improvements are possible with accessible and convenient community-based treatment options.<ref>{{Cite journal|last1=Power|first1=Thomas J.|last2=Russell|first2=Heather F.|last3=Soffer|first3=Stephen L.|last4=Blom-Hoffman|first4=Jessica|last5=Grim|first5=Suzanne M.|s2cid=71339805|date=2002|title=Role of Parent Training in the Effective Management of Attention-Deficit/Hyperactivity Disorder|journal=Disease Management and Health Outcomes|volume=10|issue=2|pages=117–126|doi=10.2165/00115677-200210020-00007|issn=1173-8790 |type=Review}}</ref> Some schools in the United States have attempted to make it mandatory for hyperactive children to receive medication based treatment in order to attend classes, however the United States Senate passed a bill in 2005 against this practice.<ref name="Coercion">{{cite web|url=http://www.webmd.com/add-adhd/news/20051116/schools-cant-require-adhd-drugs|title=Schools Can't Require ADHD Drugs|last=Zwillich|first=Todd|date=November 16, 2005|website=WebMD}}</ref>

====Potential for misuse====
{{Confusing|section|date=November 2024|reason=Paragraph 2 seems to imply that people with ADHD commonly abuse methylphenidate, which is not backed up with evidence.}}
Stimulants used to treat ADHD are classified as Schedule II controlled substances in the United States.<ref>{{cite journal|url=http://pn.psychiatryonline.org/cgi/content/full/36/21/20 |archive-url=https://web.archive.org/web/20030902151553/http://pn.psychiatryonline.org/cgi/content/full/36/21/20 |url-status=dead |archive-date=2003-09-02 |author=Jim Rosack |title=Controversy Erupts Over Ads for ADHD Drugs |volume=36 |issue=21 |pages=20–21 |journal= Psychiatric News|doi=10.1176/pn.36.21.0020 |year=2001 |url-access=subscription }}</ref> Schedule II controlled substances are substances that are highly likely to be abused.<ref name=":4">{{Cite web |title=Methylphenidate Abuse Symptoms, Signs and Addiction Treatment |url=https://drugabuse.com/stimulants/methylphenidate/ |access-date=2023-12-09 |website=DrugAbuse.com |language=en}}</ref>

[[Methylphenidate]] has become a commonly used drug for people diagnosed with ADHD. Aside from its medical usage, it has gained popularity from people who aim to use the drug as a “study drug” or for a feeling similar to that of [[cocaine]].<ref name=":4" /> A 2005 study looked at 100 college students who used Methylphenidate of which, 30% of the subjects claimed to use Methylphenidate for studying purposes, and these students were less likely to partake in intranasal usage of the substance. The other 70% of the students were using it recreationally accompanied with other illicit substances, as well as more likely to partake in intranasal use of methylphenidate.<ref>{{Cite journal |last1=Barrett |first1=Sean P |last2=Darredeau |first2=Christine |last3=Bordy |first3=Lana E |last4=Pihl |first4=Robert O |date=July 2005|title=Characteristics of Methylphenidate Misuse in a University Student Sample |journal=The Canadian Journal of Psychiatry |language=en |volume=50 |issue=8 |pages=457–461 |doi=10.1177/070674370505000805 |issn=0706-7437|doi-access=free |pmid=16127963 }}</ref>

There were about 6.4 million children who received a diagnosis for ADHD in 2011 according to the CDC.<ref name=":4" /> Both children with and without ADHD abuse stimulants, with ADHD individuals being at the highest risk of abusing or diverting their stimulant prescriptions{{Citation needed|date=November 2024}}.

In 2008, Between 16 and 29 percent of students who are prescribed stimulants report diverting their prescriptions.<ref name=":5">{{Cite journal |last1=Wilens |first1=Timothy E. |last2=Adler |first2=Lenard A. |last3=Adams |first3=Jill |last4=Sgambati |first4=Stephanie |last5=Rotrosen |first5=John |last6=Sawtelle |first6=Robert |last7=Utzinger |first7=Linsey |last8=Fusillo |first8=Steven |date=January 2008 |title=Misuse and diversion of stimulants prescribed for ADHD: a systematic review of the literature |url=https://pubmed.ncbi.nlm.nih.gov/18174822/#:~:text=The%20studies%20reported%20rates%20of,sell,%20or%20trade%20their%20medications. |journal=Journal of the American Academy of Child and Adolescent Psychiatry |volume=47 |issue=1 |pages=21–31 |doi=10.1097/chi.0b013e31815a56f1 |issn=0890-8567 |pmid=18174822}}</ref> Between 5 and 9 percent of grade/primary and high school children and between 5 and 35 percent of college students have used nonprescribed stimulants.<ref name=":5" /> Most often their motivation is to concentrate, improve alertness, get high, or to experiment.<ref name="Wilens TE, Adler LA, Adams J, et al. 2008 21–31">{{cite journal |author=Wilens TE |title=Misuse and diversion of stimulants prescribed for ADHD: a systematic review of the literature |journal=J Am Acad Child Adolesc Psychiatry |volume=47 |issue=1 |pages=21–31 |date=January 2008 |pmid=18174822 |doi=10.1097/chi.0b013e31815a56f1 |name-list-style=vanc |author2=Adler LA |author3=Adams J |display-authors=3 |last4=Sgambati |first4=Stephanie |last5=Rotrosen |first5=John |last6=Sawtelle |first6=Robert |last7=Utzinger |first7=Linsey |last8=Fusillo |first8=Steven}}</ref> Stimulant medications may be resold by patients as [[recreational drug]]s, and [[methylphenidate]] (Ritalin) is used as a study aid by some students without ADHD.<ref>{{cite news |url=http://edition.cnn.com/2001/HEALTH/children/01/08/college.ritalin/ |title=Ritalin abuse scoring high on college illegal drug circuit|work=CNN |access-date= 2010-04-25| date=2001-01-08}}</ref>

Non-medical prescription stimulant use by US students is high. A 2003 study found that non-prescription use within the last year by college students in the US was 4.1%.<ref>{{cite journal |vauthors=McCabe SE, Knight JR, Teter CJ, Wechsler H |title=Non-medical use of prescription stimulants among US college students: prevalence and correlates from a national survey |journal=Addiction |volume=100 |issue=1 |pages=96–106 |date=January 2005 |pmid=15598197 |doi=10.1111/j.1360-0443.2005.00944.x |url=https://deepblue.lib.umich.edu/bitstream/2027.42/74786/1/j.1360-0443.2005.00944.x.pdf|hdl=2027.42/74786 |hdl-access=free }}</ref> A 2008 meta-analysis found even higher rates of non-prescribed stimulant use. It found 5% to 9% of grade school and high school children and 5% to 35% of college students used a non-prescribed stimulant in the last year.<ref name="Wilens TE, Adler LA, Adams J, et al. 2008 21–31" />

In 2009, 8% of United States [[Major League Baseball]] players had been diagnosed with ADHD, making the disorder particularly common among this population. The increase coincided with the League's 2006 ban on [[stimulant]]s, which raised concern that some players were mimicking or falsifying the symptoms or history of ADHD to get around the ban on the use of stimulants in sport.<ref>{{cite web|url=http://www.slate.com/id/2208429/|title=Doping Deficit Disorder: Need performance-enhancing drugs? Claim ADHD|first=William|last=Saletan|website=Slate|publisher=The Slate Group LLC|date=12 January 2009|access-date=2 May 2009| archive-url=https://web.archive.org/web/20090521114505/http://www.slate.com/id/2208429/| archive-date= 21 May 2009 |url-status= live}}</ref>

=== Role and views of Scientology ===
{{Further|Scientology and psychiatry}}
An article in the ''[[Los Angeles Times]]'' stated that "the uproar over Ritalin was triggered almost single-handedly by the [[Scientology]] movement."<ref name="LA Times">{{cite news |last=Sappell |first=Joel |author2=Welkos, Robert W. |date=1990-06-29 |title=Suits, Protests Fuel a Campaign Against Psychiatry |page=A48:1 |work=[[Los Angeles Times]] |url=https://www.latimes.com/local/la-scientology062990a-story.html |url-status=live |access-date=2006-11-29 |archive-url=https://web.archive.org/web/20080304130509/http://www.latimes.com/news/local/la-scientology062990a,1,6085874,full.story?coll=la-news-comment |archive-date=2008-03-04}}</ref> Ritalin is a common stimulant medication. The [[Citizens Commission on Human Rights]], an [[anti-psychiatry]] group formed by Scientologists in 1969, conducted a major campaign against Ritalin in the 1980s and lobbied the US Congress for an investigation into Ritalin.<ref name="LA Times" /> Scientology publications claimed that the "real target of the campaign" was "the psychiatric profession itself" and said that the campaign "brought wide acceptance of the fact that (the commission){{sic}}<!-- formatting as in original Times article --> and the Scientologists are the ones effectively doing something about ... psychiatric drugging".<ref name="LA Times" />

==Conflicts of interest==
In 2008 five [[pharmaceutical]] companies received warning from the FDA regarding false [[advertising]] and inappropriate [[professional slide deck]]s related to ADHD medication.<ref>{{cite web|url=http://www.pharmalot.com/2008/09/fda-warns-five-drugmakers-over-adhd-ads/ |archive-url=https://archive.today/20120908113301/http://www.pharmalot.com/2008/09/fda-warns-five-drugmakers-over-adhd-ads/ |url-status=dead |archive-date=2012-09-08 |title=FDA Warns Five Drugmakers Over ADHD Ads |website=Pharmalot |publisher=[[UBM Canon|UBM Canon Pharmaceutical Media Group]] }}</ref> In September 2008 the FDA sent notices to [[Novartis|Novartis Pharmaceuticals]] and [[Johnson & Johnson]] regarding advertisings of [[Focalin|Focalin XR]] and [[Methylphenidate#Available forms|Concerta]] in which they overstated products' efficacies.<ref>{{cite web|url=https://www.fda.gov/ICECI/EnforcementActions/WarningLetters/2008/ucm1048118.htm|archive-url=https://web.archive.org/web/20090710042607/http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/2008/ucm1048118.htm|url-status=dead|archive-date=July 10, 2009|title=Focalin XR (dexmethylphenidate hydrochloride) extended-release capsules CII|date=2008-09-25|work=Warning Letters|publisher=[[Food and Drug Administration (United States)|U.S. Food and Drug Administration]]|access-date=2009-08-05}}</ref><ref>{{cite web|url=https://www.fda.gov/ICECI/EnforcementActions/WarningLetters/2008/ucm1048119.htm|archive-url=https://web.archive.org/web/20090710042606/http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/2008/ucm1048119.htm|url-status=dead|archive-date=July 10, 2009|title=CONCERTA (methylphenidate HCI) Extended-release Tablets CII|date=2008-09-25|work=Warning Letters|publisher=[[Food and Drug Administration (United States)|U.S. Food and Drug Administration]]|access-date=2009-08-05}}</ref> A similar warning was sent to [[Shire plc]] with respect to [[Adderall#Adderall XR|Adderall XR]].<ref>{{cite web|url=https://www.fda.gov/ICECI/EnforcementActions/WarningLetters/2008/ucm1048117.htm|archive-url=https://web.archive.org/web/20090710042611/http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/2008/ucm1048117.htm|url-status=dead|archive-date=July 10, 2009|title=Adderall XR Capsules|date=2008-09-25|work=Warning Letters|publisher=[[Food and Drug Administration (United States)|US Food and Drug Administration]]|access-date=2009-08-05}}</ref>

In 2008, it was revealed that [[Joseph Biederman]] of Harvard, a frequently cited ADHD expert, failed to report to Harvard that he had received $1.6 million from pharmaceutical companies between 2000 and 2007.<ref name=Adams2008>{{cite journal |author=Adams G. |title=Harvard medics 'concealed drug firm cash' |journal=The Independent |date=9 July 2008|url=https://www.independent.co.uk/news/world/americas/harvard-medics-concealed-drug-firm-cash-842792.html |archive-url=https://web.archive.org/web/20080609115122/http://www.independent.co.uk/news/world/americas/harvard-medics-concealed-drug-firm-cash-842792.html |url-status=dead |archive-date=June 9, 2008 | location=London | access-date=2010-04-25}}</ref><ref name=NYT2008>{{cite news |url=https://www.nytimes.com/2008/06/08/us/08conflict.html |title=Researchers Fail to Reveal Full Drug Pay|work= The New York Times|access-date= 2010-04-25| first1=Gardiner | last1=Harris | first2=Benedict | last2=Carey | date=2008-06-08}}</ref> [[E. Fuller Torrey]], executive director of the Stanley Medical Research Institute which finances psychiatric studies, said "In the area of child psychiatry in particular, we know much less than we should, and we desperately need research that is not influenced by industry money."<ref name=NYT2008/>

In 2014, [[Keith Conners]], one of the early advocates for the recognition of the disorder, spoke out against overdiagnosis in a ''[[New York Times]]'' article.<ref name="Sim" /> In contrast, a 2014 peer-reviewed medical literature review indicated that ADHD is underdiagnosed in adults.

==Stigma==
[[Russell Barkley]] believes labeling is a double-edged sword; there are many pitfalls to labeling but by using a precise label, services can be accessed. He also believes that labeling can help the individual understand and make an informed decision how best to deal with the diagnoses using evidence-based knowledge.<ref name="autogenerated5">{{cite web |url=https://www.pbs.org/wgbh/pages/frontline/shows/medicating/interviews/barkley.html |publisher=PBS |work=Frontline |series=Medicating kids |title=Interview: Russell Barkley |date=10 April 2001 |archive-url=https://web.archive.org/web/20160731120422/http://www.pbs.org/wgbh/pages/frontline/shows/medicating/interviews/barkley.html |archive-date=July 31, 2016 }}</ref> Studies also show that the education of the siblings and parents has at least a short-term impact on the outcome of treatment.<ref name="autogenerated3">{{cite web |url=http://www.aacap.org/galleries/PracticeParameters/JAACAP_ADHD_2007.pdf |title=Practice Parameter for the Assessment and Treatment of Children and Adolescents With Attention-Deficit/Hyperactivity Disorder |website=[[American Academy of Child & Adolescent Psychiatry]] |access-date=2008-10-09 |url-status=dead |archive-url=https://web.archive.org/web/20081217120625/http://www.aacap.org/galleries/PracticeParameters/JAACAP_ADHD_2007.pdf |archive-date=2008-12-17 }}</ref> Barkley states this about ADHD rights: "... because of various legislation that has been passed to protect them. There are special education laws with the Americans with Disabilities Act, for example, mentioning ADHD as an eligible condition. If you change the label, and again refer to it as just some variation in normal temperament, these people will lose access to these services, and will lose these hard-won protections that keep them from being discriminated against."<ref name="autogenerated5" /> Psychiatrist Harvey Parker, who founded CHADD, states, "we should be celebrating the fact that school districts across the country are beginning to understand and recognize kids with ADHD, and are finding ways of treating them. We should celebrate the fact that the general public doesn't look at ADHD kids as 'bad' kids, as brats, but as kids who have a problem that they can overcome".<ref>{{cite web |url=https://www.pbs.org/wgbh/pages/frontline/shows/medicating/interviews/parker.html |publisher=PBS |work=Frontline |series=Medicating kids |title=Interview: Harvey Parker |date=12 September 2000 |archive-url=https://web.archive.org/web/20160311133217/http://www.pbs.org/wgbh/pages/frontline/shows/medicating/interviews/parker.html |archive-date=11 March 2016 }}</ref> However, children may be ridiculed at school by their peers for using [[psychiatric medications]] including those for ADHD.<ref>{{cite journal |vauthors=Santosh PJ, Taylor E |s2cid=7286521 |title=Stimulant drugs |journal=European Child & Adolescent Psychiatry |volume=9 |issue=Suppl 1 |pages=I27–I43 |year=2000 |pmid=11140778 |doi=10.1007/s007870070017 |type=Review}}</ref>

==Politics and media==

===North America===
In 1998, the US National Institutes of Health (NIH) released a consensus statement on the diagnosis and treatment of ADHD. The statement, while recognizing that stimulant treatment is controversial, supports the validity of the ADHD diagnosis and the efficacy of stimulant treatment. It found controversy only in the lack of sufficient data on long-term use of medications and in the need for more research in many areas.<ref>{{cite journal |url=http://consensus.nih.gov/1998/1998AttentionDeficitHyperactivityDisorder110PDF.pdf |publisher=National Institutes of Health |title=Diagnosis and Treatment of Attention Deficit Hyperactivity Disorder (ADHD) |journal=NIH Consens Statement |date=Nov 16–18, 1998 |volume=16 |issue=2 |pages=1–37 |pmid=10868163 |access-date=2013-03-26 |archive-date=2005-11-21 |archive-url=https://web.archive.org/web/20051121050919/http://consensus.nih.gov/1998/1998AttentionDeficitHyperactivityDisorder110PDF.pdf |url-status=dead }}</ref>

The validity of the work of many of the ADHD experts (including Biederman) has been called into question by Marcia Angell, former editor in chief of the ''[[New England Journal of Medicine]]'',<ref>{{cite web |url= http://www.nybooks.com/authors/10553 |title= Marcia Angell |access-date= 2009-07-21 |publisher= The New York Review of Books |quote= Marcia Angell is a Senior Lecturer in Social Medicine at Harvard Medical School. A physician, she is a former Editor in Chief of The New England Journal of Medicine.}}</ref>{{Self-published inline|date=March 2022|certain=yes}} in her book review, "Drug Companies & Doctors: A Story of Corruption."<ref>{{cite journal |url= http://www.nybooks.com/articles/22237 |title= Drug Companies & Doctors: A Story of Corruption |journal= The New York Review of Books |access-date= 2009-07-21 | last= Angell |first= Marcia |date= 15 January 2009 |volume= 56 |issue= 1 }}</ref>

=== Europe ===
The UK's National Institute for Health and Care Excellence ([[NICE]]) concluded that while it is important to acknowledge the body of academic literature which raises 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.<ref name=NICE2008/>{{Rp|133}} NICE further concluded that despite such criticism, ADHD represented a valid clinical condition,<ref name=NICE2008/>{{Rp|138}} with genetic, environmental, neurobiological and demographic factors.<ref name = NICE2008/>{{Rp|139}} The diagnosis has a high level of support from clinicians and medical authorities.<ref name=NICE2008/><ref>{{cite journal |vauthors=Goldman LS, Genel M, Bezman RJ, Slanetz PJ |title=Diagnosis and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Council on Scientific Affairs, American Medical Association |journal=JAMA |volume=279 |issue=14 |pages=1100–1107 |date=April 1998 |pmid=9546570 |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid= |doi=10.1001/jama.279.14.1100|url-access=subscription }}</ref>

[[House of Lords|Baroness]] [[Susan Greenfield]] wanted a wide-ranging inquiry in the UK House of Lords into the dramatic increase in the diagnosis of ADHD in the UK and its possible causes.<ref name=pcfadhdcr>{{cite news| url=http://news.bbc.co.uk/1/low/health/7093944.stm | work=BBC News | title=Peer calls for ADHD care review | date=2007-11-14 | access-date=2010-04-25}}</ref> This followed a [[BBC]] ''[[Panorama (TV series)|Panorama]]'' program which distorted research in order to suggest that medications are not effective in the long term.<ref name="BBCinaccurate">{{cite news |title=BBC must broadcast apology over inaccurate Panorama programme |last=Singh |first=Anita |url=https://www.telegraph.co.uk/news/7307972/BBC-must-broadcast-apology-over-inaccurate-Panorama-programme.html |newspaper=The Telegraph |date=25 February 2010 |access-date=29 January 2012}}</ref> In 2010, the [[BBC Trust]] criticized the 2007 ''Panorama'' program for how it summarized the research, as the research had found that there was a significant improvement over time.<ref name="BBCinaccurate" />

Other notable individuals in the UK have made controversial statements about ADHD. [[Terence Kealey]], a clinical biochemist and vice-chancellor of [[University of Buckingham]], has stated his belief that ADHD medication is used to control unruly boys and girls behavior.<ref>{{cite news| url=http://www.timesonline.co.uk/tol/comment/columnists/guest_contributors/article440373.ece | work=The Times | location=London | title=Boisterous boys are too much like hard work so we drug them into conformity | date=2004-06-04 | access-date=2010-04-25 | first=Terence | last=Kealey}}{{dead link|date=September 2024|bot=medic}}{{cbignore|bot=medic}}</ref>

Norwegian National Broadcasting ([[Norwegian Broadcasting Corporation|NRK]]) broadcast a short television series in early 2005 on the increase in the use of Ritalin and Concerta for children. Sales were six times higher in 2004 than in 2002. The series included the announcement of a successful group therapy program for 127 unmedicated children aged four to eight, some with ADHD and some with [[oppositional defiant disorder]].<ref>{{cite web|url=http://www.nrk.no/programmer/tv/puls/4710766.html |title=Mister diagnosen AD/HD | trans-title=[They] Lose the Diagnosis ADHD |access-date=2009-05-09 |last=Bergløff |first=Charlotte Berrefjord |author2=Tor Risberg |author3=Kjell Herning |date=2 May 2005 |publisher=Norwegian National Broadcasting |language=no |url-status=dead |archive-url=https://web.archive.org/web/20091027203204/http://www.nrk.no/programmer/tv/puls/4710766.html |archive-date=2009-10-27 }}</ref>

== See also ==
* [[Chemical imbalance theory]]
* [[Ethical problems using children in clinical trials]]
* ''[[The Gene Illusion]]''
* [[Hunter vs. farmer hypothesis]]
* [[Low arousal theory]] – alternate theory of ADHD
* [[Neurodiversity]]
* [[Nootropic]]

==References==
{{Reflist|30em}}

==Further reading==
* {{cite journal|last=Joseph|first=Jay|date=December 2000|title=Not in Their Genes: A Critical View of the Genetics of Attention-Deficit Hyperactivity Disorder|journal=Developmental Review|volume=20|issue=4|pages=539–567|doi=10.1006/drev.2000.0511}}
{{Adhd}}
{{Medicine}}

{{DEFAULTSORT:Attention deficit hyperactivity disorder controversies}}
[[Category:Medical controversies]]
[[Category:Psychiatry controversies]]
[[Category:Attention deficit hyperactivity disorder]]
[[Category:Social problems in medicine]]
[[Category:Social constructionism]]
[[Category:Medical sociology]]