Criticism of the ADHD diagnosis
• “Too many young people are diagnosed with ADHD, giving them a stigma that they don’t need.” Professionals should take such criticisms seriously. If the number of people diagnosed with ADHD does not exceed the estimated prevalence, there is no general over-diagnosing. The competence of the professionals diagnosing ADHD is important in order to avoid over- as well as under-diagnosing the disorder. In general diagnoses are meant to guide understanding of the problems and point out the most relevant treatment options. Informing the patient and the people close to him/her about ADHD; what it is and what it is not, what can be done etc. is important to avoid stigma.
• “The causes of the symptoms may not be ADHD.” This is true, as mentioned above.
Several medical and psychiatric causes must be considered. It is claimed that psychosocial factors such as neglect, trauma, posttraumatic stress disorder (PTSD) and reactive attachment disorder may cause similar symptoms. This is a very complex issue, partly because ADHD in patients and family members may increase the risk of being exposed to such psychosocial loads. Whenever relevant, all issues, ADHD, trauma, neglect etc. must be considered.
• “Objective methods for diagnosing ADHD are lacking. There is too much subjectivity involved.” Objective methods that can supplement the present criteria based on behaviour are lacking. The issue of including objective methods (“biomarkers”) as supplements to the behavioural criteria was discussed during preparation of the present diagnostic manual (DSM-5). A limited number of supporting research studies is one reason that such criteria were not included.
• “The pharmaceutical industry ‘pushes’ a high prevalence of ADHD.”
To be approved by health authorities all medications must document effects and side-effects in so called randomized double-blind placebo-controlled studies, which is the highest scientific level of documentation. (When medication effects are evaluated, no one knows if the patient received “real” medication or a “fake pill”). Researchers doing medication studies are committed to an agreement that all treatment results, positive as well as negative, will be published, regardless of the institution financing the study.
For many years the interaction between the pharmaceutical companies and the prescribing doctors in the Nordic countries has been strictly regulated to secure that the drug prescription is purely professional.