Critical analysis of the concept of adult attention-deficit hyperactivity disorder

Joanna Moncrieff,Sami Timimi

doi:10.1192/pb.bp.110.033423

Abstract

SummaryWe question whether adult attention-deficit hyperactivity disorder (ADHD) represents a discrete condition that is distinguishable from ordinary behaviour and other psychiatric disorders, and whether it is related to the childhood disorder, since adult and childhood ADHD are said to be characterised by a different range of symptoms. Although studies of stimulant drugs find marginal short-term effects, which can be explained by their known psychoactive properties, there is little evidence that there are any sustained long-term benefits of drug therapy. We suggest that adult ADHD represents one of the latest attempts to medicalise ordinary human difficulties, and that its popularity is partly dependent on marketing and the reinforcing effects of stimulants.

Highlights

In recent years attention-deficit hyperactivity disorder (ADHD) has been diagnosed with increasing frequency in adults as well as children, including increasing numbers of adults who were never diagnosed as children
The condition is endorsed by the UK National Institute for Health and Clinical Excellence (NICE)[4] and will be explicitly included in the forthcoming revision of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders.[5]
Advocates of the concept of adult ADHD argue that the condition can be reliably defined and diagnosed, that it is distinguishable from other conditions, that it predicts significant adverse outcomes, responds well to stimulant drugs and should be diagnosed more frequently.[1,6]

Summary

SPECIAL ARTICLE

Critical analysis of the concept of adult attention-deficit hyperactivity disorder. Summary We question whether adult attention-deficit hyperactivity disorder (ADHD) represents a discrete condition that is distinguishable from ordinary behaviour and other psychiatric disorders, and whether it is related to the childhood disorder, since adult and childhood ADHD are said to be characterised by a different range of symptoms. Advocates of the concept of adult ADHD argue that the condition can be reliably defined and diagnosed, that it is distinguishable from other conditions, that it predicts significant adverse outcomes, responds well to stimulant drugs and should be diagnosed more frequently.[1,6] in contrast to previous practice, many experts are recommending that drug treatment of children diagnosed with ADHD should commonly be continued into adulthood.[7,8] On the other hand, critics have suggested that adult ADHD can be seen as the ‘medicalisation of underperformance’,3,9 and there has been concern about the widespread diversion and illicit use of prescription stimulants.[10] It is possible that drugs of misuse have not been so obtainable on prescription since the widespread prescription of benzodiazepines in the 1980s Despite these issues, there has been no detailed analysis of the validity of the condition or the drivers behind its recent ascendance

The role of the pharmaceutical industry

The diagnosis of adult ADHD

Findings

Drug treatment

Discussion