DEFINITION OF ADHD

Abstract

I read with an uneasy feeling the article by Russell Barkley and Joseph Biederman (Barkley and Biederman, 1997). The last thing the attention-deficit/hyperactivity disorder (ADHD) diagnosis needs is a broader definition . Indeed, the criteria can hardly be any broader. ADHD is a descriptive diagnosis. A child's baby-sitter can be as accurate in making it as a board-certified psychiatrist. It is also a misnomer, which implies deficit of attention rather than deficit in regulation of attention, which is more neurophysiologically correct. ADHD is also a developmental diagnosis. The symptomatology changes drastically with age. The present ADHD criteria (American Psychiatric Asso~ia­ tion, 1994) suggest, and the previous DSM-III-R version stated directly, that the child's behavior must be matched against developmentally appropriate behavior of peers. In fact, all 2-year-olds are hyperactive and inattentive, and the attention span of an 18-year-old with ADHD is substantially better than that of a typical 8-year-old without ADHD. Improvements in attention regulation, impulse control, and hyperactivity are part of the normal maturational pr?cess.. ADHD is also a nonspecific and heterogeneous diagnosis, Young children have a limited range of behaviors, and problems in childhood frequently are manifested as inattentive and/or disruptive behavior. Neither disruptive nor inattentive behaviors are specific to a particular disorder. The universal descriptive diagnosis for these behaviors is attentio~ defic~t disorder. A common misconception about ADHD IS that It represents a unique entity with clearly defined etiology and pathology (akin to strep throat), while in reality it is a syndrome (not unlike fever of unknown origin). The Barkleyand Biederman article opened with a paragraph citing tendentiously selected studies in support of relative persistence of the disorder into adolescent and adu.1t years. These data quickly led the authors to the conclusion that adult ADHD is a legitimate diagnosis. The intent was, of course, to keep stretching the definition of ADHD to include a larger group of potential adult sufferers under one diagnostic umbrella. Surprisingly missing were any references contradicting the authors' point of view, such as a hallmark study (Hill and Schoener, 19%) on the epidemiology of ADHD. Hill and Schoener demonstrated the rate of decline of AD HD symptomatology by 50% approximately every. 5 years. The study estimated that if a prevalence of ADHD In