Epidemiology and Etiology

            In the United States, there has been an enormous increase in the amount of diagnosed cases of ADHD. The amount of office visits regarding ADHD and its symptoms for from 947,208 in 1990 to over 2,000,000 in 1995! Over that same period, the amount of prescriptions written for stimulant medication to treat ADHD rose almost 3-fold. This increase could be related to any number of factors, some of which include the changes in the diagnostic standards over time, the overlap being ADHD and other externalizing disorders such as Oppositional Defiance Disorder and Conduct Disorder, or economic factors that have led to reductions in mental health, education, and managed care services.

            More possible cause of ADHD include heredity, brain structural difference, and parenting habits. There have been genetic links related to dopamine and norepinephrine levels. The frontal lobe, the right hemisphere, and the caudate nucleus are have been discovered to be structurally different in children with ADHD when compared to those without it. Parenting and parental mental health have also been linked to ADHD. With a little less certainty, thyroid dysfunction, early life experiences, and adverse social factors are other possible causes. Lastly, our research has shown very little empirical support for food additives, sugar intoxication, lead poisoning, and nutritional deficiencies as being possible causes of ADHD.

            The diagnostic criteria for ADHD include direct observation, parent interviews, teacher interviews, behavioral rating scales, situation questionnaires, psychoeducational testing, and medical evaluations.

            Based on those criteria listed above, I’m sure you can see that ADHD is very difficult to diagnose. It is often looked at in a school setting, where children who move around too much, don’t think before blurting out answers, and can’t focus on the teacher’s tasks are all seen to be abnormal and possess a disease. One doctor was quoted as saying, “Attention Deficit Disorder is not a disease, it’s part of the spectrum of children’s behavior. The issue is to find the link where abnormality stops and normality begins… and the line moves according to who’s drawing it.” This shows that there are discrepancies between what various mental health professionals are considering ADHD and that it’s a very subjective diagnosis.