Between 2003 and 2007, the CDC reported a rise from 7.8% to 9.5% in diagnoses of attention deficit hyperactivity disorder, also known as ADHD or ADD, in children from the ages of four to seventeen in the United States. In 2007, that translated to more than five million U.S. children diagnosed with ADHD, with 2.8 million children receiving prescriptions for stimulant medication by 2008 (Breggin). One may say that the United States has come upon an ADHD epidemic. However, the increase in cases of ADHD in the United States can be accounted for because the disorder is largely misdiagnosed, and the disorder is not necessarily a genuine biological or psychological disorder. Furthermore, the prescription stimulant medications used as treatment for ADHD are potentially dangerous and have the potential result in dependency and addiction.
In the United States, ADHD is the most commonly diagnosed behavioral disorder. ADHD however, currently has no neurological markers that can directly and clearly diagnose ADHD (Singh). The DSM-IV for ADHD diagnoses part of the disorder, attention deficit, through the presence of behavioral symptoms such as inattention to detail, making careless mistakes in schoolwork or other activities, having trouble keeping attention, not listening when spoken to directly, not following through on instructions or failing to finish work, trouble organizing activities, avoids or doesn?t want to do things that take a lot of mental effort for a long period of time, losing things, being easily distracted, or forgetful during daily activities. The other part, hyperactivity, is also diagnosed with behavioral symptoms such as fidgeting, excessively running, having trouble playing quietly, being often ?on the go? or often acts as if ?driven by a motor?, or talking excessively. ADHD does not have any laboratory tests to determine unequivocally whether a person has the disorder (Singh). The behavioral symptoms listed in the DSM-IV are ambiguous, especially ones like, ?Is often ?on the go? or often acts as if ?driven by a motor.?? The problem of ADHD diagnosis is aggrandized by the fact that ADHD symptoms, are difficult to differentiate from normal childhood behaviors and behaviors of other disorders (Hartnett, Nelson, Rinn). People with Asperger?s syndrome can lack the ability to appropriately allocate attention and can become over-excited in high-stimulus environments. Iron deficiency anemia can cause inability to concentrate, impairment of cognitive skills, and a short attention span (Malen). Sleeping disorders can cause sleep deprivation, which can lead to inabilities to concentrate or perform cognitive activities properly (Cortese et al.). Even gifted children may exhibit symptomatic behavior, such as imaginational overexcitability and daydreaming (Hartnett et al.). One study showed that gifted students have struggles in school because of the slower pace of teaching. Symptoms of other disorders or simply normal behavior can easily be misinterpreted as ADHD by the DSM-IV?s definition.
Because of the ambiguities in the diagnosis of ADHD and school year cutoff dates, one study found that nearly one million children in the U.S. are potentially misdiagnosed (Evans et al.). Cutoff dates put younger children with older children. Although the separation is only one year, the difference of a year is much more important during the earlier years of a child?s life. Younger children may not be able to be as attentive in school as the older children, whom they are compared with, making seem as if their inability to concentrate is age inappropriate.
Another problem is that ADHD is diagnosed using a categorical system of classifying symptoms, rather than a dimensional system. Categorical diagnosis creates a solid distinction between what is and is not symptomatic of ADHD (Singh). The disorder, however, should be diagnosed along a continuum or spectrum to represent the varying degrees of the disorder?s prevalence and interference in a subject?s life. Along with the problems with diagnosing the disorder, in the United States, the clinician diagnosing the disorder can vary considerably in expertise. In most of Europe, evaluations are performed in special child-psychiatric services. In the United States however, obtaining a diagnosis is possible through primary-care physicians, nurses, pediatricians, psychiatrists, and neurologists (Singh).
The unreliability of the system of ADHD diagnosis has driven some researchers to even believe that the diagnosis is being used to serve social or cultural purposes by controlling socially undesirable behavior. The higher prevalence rates of the disorder in the United States, compared to elsewhere in the world have been used to support this claim (Singh).
Regardless of the validity of ADHD diagnoses, current research