Attention-Deficit/Hyperactivity Disorder: A Controversial Diagnosis

Article excerpt

Attention-deficit/hyperactivity disorder (ADHD) had its origins in the diagnosis of hyperkinesis or the hyperkinetic reaction of childhood (HRC) that was developed in the 1960s in the United States as a replacement for minimal brain dysfunction (MBD; Barkley, 1990, 1998; Schrag & Divoky, 1975). The distinction between the HRC and the MBD category was the removal, in the diagnosis, of the need to establish specific evidence of neurological damage. The requirement of evidence of neurological damage to the child was replaced by reliance upon observations of the child's behavior, generally reported to the medical practitioners by parents or teachers, as evidence of existence of the condition (Barkley, 1990, 1998).

Over the next 40 years, the HRC undergoes a series of name changes including attention deficit disorder (ADD), ADD plus or minus hyperactivity, and finally to ADHD with the subtypes of inattention, hyperactivity, or a combined type. With each revision to the diagnosis in the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (DSM), the behavioral descriptors are broaden resulting in significant increases in the use of the diagnosis on children, adolescents, and adults (APA, 1968, 1980, 1987, 1994, 2000). With the release of the DSM-V in the near future, indications are that the trend demonstrated by APA to broaden the descriptors will be evidenced in the fifth edition of the manual.

ADHD has been surrounded by controversy. There is little difference between the original diagnosis of the HRC and the definition of ADHD today. The controversy that surrounded the diagnosis of hyperkinesis still surrounds the use of the diagnosis of ADHD today. A United States House of Representatives hearing entitled, Federal Involvement in the Use of Behavior Modification Drugs on Grammar School Children of the Right to Privacy Inquiry: Hearing Before a Subcommittee of the Committee on Government Operations (Federal Involvement, 1970) highlighted the following concerns in relation to the diagnosis and associated drug treatment:

* There was a philosophy of expediency underpinning the medical approach whereby,

dependence on quick and inexpensive solutions offered by the new technology without adequate attention being paid to slower and perhaps more costly methods which would preserve the sanctity of human values and the precious resources of the human spirit. (Federal Involvement, 1970, p. 2)

* The child who is subjected to medication therapy has a permanent record that may "cast a suspicion over that child's future" (Federal Involvement, 1970, p. 2).

* An "overreliance on drug therapy could spread far beyond its apparent valid applications and thus denigrate the novel learning methods" (Federal Involvement, 1970, p. 2).

* The adequacy of educational programs especially for gifted and creative children had not been addressed as a possible solution for behavioral problems (Federal Involvement, 1970).

* There was a paradox of giving "speed" to children when at the same time the substance had been subject to widespread abuse in the community (Federal Involvement, 1970, p. 1).

* There had been a focus in federal funding on drug experiments without due consideration of funding of alternative methods including improved educational practice (Federal Involvement, 1970). …