Attention deficit hyperactivity disorder controversies
This article may lend undue weight to certain ideas, incidents, or controversies. (April 2016) (Learn how and when to remove this template message)
Attention deficit hyperactivity disorder (ADHD) controversies include concerns about its existence, causes, perceived overdiagnosis, and methods of treatment, especially with the use of stimulant medications in children. These controversies have surrounded the subject since at least the 1970s.
- 1 Status as a disorder
- 2 Causes
- 3 Diagnosis
- 4 Treatment
- 5 Conflicts of interest
- 6 Stigma
- 7 Perspectives on ADHD
- 8 See also
- 9 References
- 10 Further reading
- 11 External links
Status as a disorder
According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the leading authority in the US on clinical diagnosis and psychological behavior published by the APA in 2013, ADHD is a neurodevelopmental disorder with a prevalence rate in most cultures of about 5% in children and 2.5% in adults. Today, the existence of ADHD is widely accepted, but controversy around the disorder has existed since at least the 1970s. According to the DSM-5, symptoms must be present before age 12, but it's not uncommon for ADHD to continue into adulthood. Parents and educators sometimes still question a perceived overdiagnosis in children and the effectiveness of treatment options, especially stimulant medications. However, according to sociology professor Vincent Parrillo, "Parent and consumer groups, such as CHADD (Children and Adults with Attention Deficit Hyperactivity Disorder), tend to support the medical perspective of ADHD."
The pathophysiology of ADHD is unclear and there are a number of competing theories.
ADHD as a biological difference
Frequently observed differences in the brain between ADHD and non-ADHD patients have been discovered, but it is uncertain if or how these differences give rise to the symptoms of ADHD. Results from various types of neuroimaging techniques suggest there are differences in the brain, such as thinner regions of the cortex, between individuals with and without ADHD.
ADHD is said to be highly heritable: twin studies suggest that genetics explain 70-80% in the variation of ADHD. However, interest in the potential role of gene-environment interactions in ADHD is also increasing; maternal alcohol or tobacco use during pregnancy may be one contributor. It has also been argued that ADHD is a heterogeneous disorder with multiple genetic and environmental factors converging on similar neurological changes. Authors of a review of ADHD etiology in 2004 noted: "Although several genome-wide searches have identified chromosomal regions that are predicted to contain genes that contribute to ADHD susceptibility, to date no single gene with a major contribution to ADHD has been identified." However, many further studies have occurred since, and the same is true for many other heritable human traits (e.g., schizophrenia). The Online Mendelian Inheritance in Man (OMIM) database has a listing for ADHD under autosomal dominant heritable conditions, claiming that multiple genes contribute to the disorder. As of 2014, OMIM listed 6 genes with variants that have been associated with ADHD.
Social construct theory of ADHD
It has been argued that even if it is a social construct, this does not mean it is not a valid condition; for example obesity has different cultural constructs but yet has demonstrable adverse effects associated with it. A minority of these critics maintain that ADHD was "invented and not discovered". They believe that the disorder does not exist and that the behavior observed is not abnormal and can be better explained by environmental causes or just the personality of the "patient".
Methods of diagnosis
There is no blood test or brain scan for ADHD. Diagnosis is based on a clinical interview with the child and parents.
Over the past two decades more research on the functioning of the brain is being done to help support the idea that Attention Deficit Hyperactivity Disorder is an executive dysfunction issue. The brains of males and females are showing differences, which could potentially help to explain why ADHD presents differently in boys and girls. Studies conducted using EEGs between boys and girls suggest that we can no longer ignore sex difference between boys and girls when identifying ADHD. There are EEG differences between girls and boys in their maturational pattern and this suggests that more studies regarding sex differences in ADHD should be conducted.
Over- and under-diagnosis
Overdiagnosis typically refers to children who are diagnosed with ADHD but should not be. These instances are termed as "false positives". However, the "presence of false positives alone does not indicate overdiagnosis". There may be evidence of overdiagnosis if inaccuracies are shown consistently in the accepted prevalence rates or in the diagnostic process itself. "For ADHD to be overdiagnosed, the rate of false positives (i.e., children inappropriately diagnosed with ADHD) must substantially exceed the number of false negatives (children with ADHD who are not identified or diagnosed)." Children aged 8 to 15 years living in the community, indicated an ADHD prevalence rate of 7.8%. However, only 48% of the ADHD sample had received any mental health care over the past 12 months.
Evidence also exists of possible differences of race and ethnicity in the prevalence of ADHD. The prevalence of ADHD dramatically varies across cultures despite the fact that the same methodology has been used. Some believe this may be due to different perceptions of what qualifies as disruptive behavior, inattention and hyperactivity.
It is argued that over-diagnosis occurs more in well-off or more homogeneous communities, whereas under-diagnosis occurs more frequently in poorer and minority communities due to lack of resources and lack of financial access. Those without health insurance are less likely to be diagnosed with ADHD. It is further believed that the "distribution of ADHD diagnosis falls along socioeconomic lines", according to the amount of wealth within a neighborhood. Therefore, the difficulty of applying national, general guidelines to localized and specific contexts, such as where referral is unavailable, resources are lacking or the patient is uninsured, may assist in the establishment of a misdiagnosis of ADHD.
Development can also influence perception of relevant ADHD symptoms. ADHD is viewed as a chronic disorder that develops in childhood and continues into adulthood. However, some research shows a decline in the symptoms of ADHD as children grow up and mature into adulthood. As children move into the stage of adolescence, the most common reporters of ADHD symptoms, parents and teachers, tend to focus on behaviors affecting academic performance. Some research has shown that the primary symptoms of ADHD were strong discriminators in parent ratings, but differed for specific age groups. Hyperactivity was a stronger discriminator of ADHD in children, while inattentiveness was a stronger discriminator in adolescents.
Issues with comorbidity is another possible explanation in favor of the argument of overdiagnosis. As many as 75% of diagnosed children with ADHD meet criteria for some other psychiatric diagnosis. Among children diagnosed with ADHD, about 25% to 30% have anxiety disorders, 9% to 32% have depression, 45% to 84% have oppositional defiant disorder, and 44% to 55% of adolescents have conduct disorder. Learning disorders are found in 20% to 40% of children with ADHD.
Another possible explanation of over-diagnosis of ADHD is the "relative-age effect", which applies to children of both sexes. Younger children are more likely to be inappropriately diagnosed with ADHD and treated with prescription medication than their older peers in the same grade. Children who are almost a year younger tend to appear more immature than their classmates, which influences both their academic and athletic performance.
The debate of underdiagnosis, or giving a "false negative", has also been discussed, specifically in literature concerning ADHD among adults, girls and underprivileged communities. It is estimated that in the adult population, rates of ADHD are somewhere between 4% and 6%. However, as little as 11% of these adults with ADHD actually receive assessment, and furthermore, any form of treatment. Between 30% and 70% of children with ADHD report at least one impairing symptom of ADHD in adulthood, and 30% to 50% still meet diagnostic criteria for an ADHD diagnosis.
Research on gender differences also reveals an argument for underdiagnosis of ADHD among girls. The ratio for male-to-female is 4:1 with 92% of girls with ADHD receiving a primarily inattentive subtype diagnosis. This difference in gender can be explained, for the majority, by the different ways boys and girls express symptoms of this particular disorder. Typically, females with ADHD exhibit less disruptive behaviors and more internalizing behaviors. Girls tend to show fewer behavioral problems, show fewer aggressive behaviors, are less impulsive, and are less hyperactive than boys diagnosed with ADHD. These patterns of behavior are less likely to disrupt the classroom or home setting, therefore allowing parents and teachers to easily overlook or neglect the presence of a potential problem. The current diagnostic criteria appear to be more geared towards males than females, and the ADHD characteristics of men have been over-represented. This leaves many women and girls with ADHD neglected. Studies have shown that girls with ADHD, especially those with signs of impulsivity, were three to four times more likely to attempt suicide when compared with female controls. Additionally, these girls were two to three times more likely to engage in self-harming behaviors.
As stated previously, underdiagnosis is also believed to be seen in more underprivileged communities. These communities tend to be poorer and inhabit more minorities. More than 50% of children with mental health needs do not receive assessment or treatment. Access to mental health services and resources differs on a wide range of factors, such as "gender, age, race or ethnicity and health insurance". Therefore, children deserving of an ADHD diagnosis may never receive this confirmation and are not identified or represented in prevalence rates.
In 2005, 82 percent of teachers in the United States considered ADHD to be over diagnosed while three percent considered it to be under diagnosed. In China 19 percent of teachers considered ADHD to be over diagnosed while 57 percent considered it to be under diagnosed.
ADHD management recommendations vary by country and usually involves some combination of counseling, lifestyle changes, and medications. The British guideline only recommends medications as a first-line treatment in children who have severe symptoms and for them to be considered in those with moderate symptoms who either refuse or fail to improve with counseling. Canadian and American guidelines recommend that medications and behavioral therapy be used together as a first-line therapy, except in preschool-aged children.
The National Institute of Mental Health recommends stimulants for the treatment of ADHD, and states that, "under medical supervision, stimulant medications are considered safe". A 2007 drug class review found no evidence of any differences in efficacy or side effects in the stimulants commonly prescribed.
Between 1993 and 2003 the worldwide use of medications that treat ADHD increased almost threefold. Most ADHD medications are prescribed in the United States. In the 1990s, the US accounted for 90% of global use of stimulants such as methylphenidate and dextroamphetamine. By the early 2000s, this had fallen to 80% due to increased usage in other countries.[better source needed] In 2003, doctors in the UK were prescribing about a 10th of the amount per capita of methylphenidate used in the US, while France and Italy accounted for approximately one twentieth of US stimulant consumption. These assertions appear to contradict the 2006 World Drug Report published by the United Nations Office on Drugs and Crime, which indicate the US constituted merely 17% of the world market for dextroamphetamine. They assert that in the early 2000s amphetamine use was "widespread in Europe."
In 1999, a study constructed with 1,285 children and their parents across four U.S. communities has shown 12.5% of children that met ADHD criteria had been treated with stimulants during the previous 12 months. In May 2000, the testimony of DEA Deputy Director Terrance Woodworth has shown that the Ritalin quota increased from 1,768 kg in 1990 to 14,957 kg in 2000. In addition, IMS Health also revealed the numerous use of Adderall prescription have increased from 1.3 million in 1996 to nearly 6 million in 1999.
Some parents and professionals have raised questions about the side effects of drugs and their long-term use. Magnetic resonance imaging studies suggest that long-term treatment with amphetamine or methylphenidate decreases abnormalities in brain structure and function found in subjects with ADHD, and improves function of the right caudate nucleus.
On February 9, 2006, the U.S. Food and Drug Administration voted to recommend a "black-box" warning describing the cardiovascular risks of stimulant drugs used to treat ADHD. Subsequently, the USFDA commissioned studies which found that, in children, young adults, and adults, there is no association between serious adverse cardiovascular events (sudden death, myocardial infarction, and stroke) and the medical use of amphetamine or other ADHD stimulants.
The effects of amphetamine and methylphenidate on gene regulation are both dose- and route-dependent. Most of the research on gene regulation and addiction is based upon animal studies with intravenous amphetamine administration at very high doses. The few studies that have used equivalent (weight-adjusted) human therapeutic doses and oral administration show that these changes, if they occur, are relatively minor. The long-term effects on the developing brain and on mental health disorders in later life of chronic use of methylphenidate is unknown. Despite this, between 0.51% to 1.23% of children between the ages of 2 and 6 years take stimulants in the US. Stimulant drugs are not approved for this age group.
In individuals who experience sub-normal height and weight gains during stimulant therapy, a rebound to normal levels is expected to occur if stimulant therapy is briefly interrupted. The average reduction in final adult height from continuous stimulant therapy over a 3 year period is 2 cm.
Reviews of clinical stimulant research have established the safety and effectiveness of long-term amphetamine use for ADHD. An evidence review noted the findings of a randomized controlled trial of amphetamine treatment for ADHD in Swedish children following 9 months of amphetamine use. During treatment, the children experienced improvements in attention, disruptive behaviors, and hyperactivity, and an average change of +4.5 in IQ. It noted that the population in the study had a high rate of comorbid disorders associated with ADHD and suggested that other long-term amphetamine trials in people with less associated disorders could find greater functional improvements.
A 2008 review found that the use of stimulants improved teachers' and parents' ratings of behavior; however, it did not improve academic achievement. The same review also indicates growth retardation for children consistently medicated over three years, compared to unmedicated children in the study. Intensive treatment for 14 months has no effect on long-term outcomes 8 years later. No significant differences between the various drugs in terms of efficacy or side effects have been found.
Treatment non-adherence and acceptability
The rates of treatment discontinuation are higher than the rates of ADHD patients that receive no treatment at all; few studies present evidence that adherence to ADHD treatment is occurring at high rates with low acceptability. A literature review on empirical studies from 1997 to 2014 revealed a lack of research on adult non-adherence, however there is a large body of research on children and adolescents who discontinue treatment. Some of the common reasons for stopping treatment includes the idea that it is not needed or doesn’t reduce the symptoms of ADHD, as well as reported adverse drug effects like weight and appetite loss, sleeping difficulties, combined with other medically diagnosed conditions.
Research has shown that adherence and acceptability improvements are possible with accessible and convenient community-based treatment options. Some schools in the United States have attempted to make it mandatory for hyperactive children to receive medication based treatment in order to attend classes, however the United State Senate passed a bill in 2005 against this practice.
Potential for misuse
Stimulants used to treat ADHD are classified as Schedule II controlled substances in the United States.
Controversy has surrounded whether methylphenidate is as commonly abused as other stimulants with many[who?] proposing that its rate of abuse is much lower than other stimulants. However, the majority of studies assessing its abuse potential scores have determined that it has an abuse potential similar to that of cocaine and d-amphetamine.
Both children with and without ADHD abuse stimulants, with ADHD individuals being at the highest risk of abusing or diverting their stimulant prescriptions. Between 16 and 29 percent of students who are prescribed stimulants report diverting their prescriptions. Between 5 and 9 percent of grade/primary and high school children and between 5 and 35 percent of college students have used nonprescribed stimulants. Most often their motivation is to concentrate, improve alertness, "get high," or to experiment.
Non-medical prescription stimulant use is high. A 2003 study found that non prescription use within the last year by college students in the US was 4.1%. A 2008 meta analysis found even higher rates of non prescribed stimulant use. It found 5% to 9% of grade school and high school children and 5% to 35% of college students used a nonprescribed stimulant in the last year.
As of 2009[update], 8% of all United States Major League Baseball players had been diagnosed with ADHD, making the disorder common among this population. The increase coincided with the League's 2006 ban on stimulants, which has raised concern that some players are mimicking or falsifying the symptoms or history of ADHD to get around the ban on the use of stimulants in sport.
Conflicts of interest
In 2008 five pharmaceutical companies received warning from the FDA regarding false advertising and inappropriate professional slide decks related to ADHD medication. In September 2008 the FDA sent notices to Novartis Pharmaceuticals and Johnson & Johnson regarding advertisings of Focalin XR and Concerta in which they overstated products' efficacies. A similar warning was sent to Shire plc with respect to Adderall XR.
Russell Barkley, a well-known ADHD researcher who has published diagnostic guidelines, has been criticized for his works because he received payment from pharmaceutical companies for speaking and consultancy fees.
In 2008, it was revealed that Joseph Biederman of Harvard, a frequently cited ADHD expert, failed to report to Harvard that he had received $1.6 million from pharmaceutical companies between 2000 and 2007. E. Fuller Torrey, executive director of the Stanley Medical Research Institute which finances psychiatric studies, said "In the area of child psychiatry in particular, we know much less than we should, and we desperately need research that is not influenced by industry money."
Children and Adults with Attention-Deficit/Hyperactivity Disorder, CHADD, an ADHD advocacy group based in Landover, MD received a total of $1,169,000 in 2007 from pharmaceutical companies. These donations made up 26 percent of their budget.
Russell Barkley believes labeling is a double-edged sword; there are many pitfalls to labeling but by using a precise label, services can be accessed. He also believes that labeling can help the individual understand and make an informed decision how best to deal with the diagnoses using evidence-based knowledge. Furthermore studies also show that the education of the siblings and parents has at least a short-term impact on the outcome of treatment. Barkley states this about ADHD rights: "... because of various legislation that has been passed to protect them. There are special education laws with the Americans with Disabilities Act, for example, mentioning ADHD as an eligible condition. If you change the label, and again refer to it as just some variation in normal temperament, these people will lose access to these services, and will lose these hard-won protections that keep them from being discriminated against. ..." Psychiatrist Harvey Parker, who founded CHADD, states, "we should be celebrating the fact that school districts across the country are beginning to understand and recognize kids with ADHD, and are finding ways of treating them. We should celebrate the fact that the general public doesn't look at ADHD kids as "bad" kids, as brats, but as kids who have a problem that they can overcome". However, children may be ridiculed at school by their peers for using psychiatric medications including those for ADHD.
Perspectives on ADHD
Medical perspectives outside of North America
In 2009, the British Psychological Society and the Royal College of Psychiatrists, in collaboration with the National Institute for Clinical Excellence (NICE), released a set of diagnosis and treatment guidelines for ADHD. These guidelines reviewed studies by Ford et al. that found that 3.6 percent of boys and 0.85 percent of girls in Britain qualified for a diagnosis of ADHD using the American DSM-IV criteria. The guidelines go on to state that the prevalence drops to 1.5% when using the stricter criteria for the ICD-10 diagnosis of hyperkinetic disorder used mainly in Europe.
A systematic review of the literature in 2007 found that the worldwide prevalence of ADHD was 5.29 percent, and that there were no significant differences in prevalence rates between North America and Europe. The review did find differences between prevalence rates in North America and those in Africa and the Middle East, but cautioned that this may be due to the small number of studies available from those regions.
Norwegian National Broadcasting (NRK) broadcast a short television series in early 2005 on the increase in the use of Ritalin and Concerta for children. Sales were six times higher in 2004 than in 2002. The series included the announcement of a successful group therapy program for 127 unmedicated children aged four to eight, some with ADHD and some with oppositional defiant disorder.
Politics and media
The validity of the work of many of the ADHD experts (including Biederman) has been called into question by Marcia Angell, former editor in chief of the New England Journal of Medicine, in her book review, "Drug Companies & Doctors: A Story of Corruption." Newspaper columnists such as Benedict Carey, science and medical writer for The New York Times, have also written controversial articles on ADHD.
In 1998, the US National Institutes of Health (NIH) released a consensus statement on the diagnosis and treatment of ADHD. The statement, while recognizing that stimulant treatment is controversial, supports the validity of the ADHD diagnosis and the efficacy of stimulant treatment. It found controversy only in the lack of sufficient data on long-term use of medications and in the need for more research in many areas.
In 2014, a preliminary retrospective analysis on the effect of increased use of methylphenidate among children in Quebec due to a policy change found little evidence of positive effects and limited evidence of negative effects.
The National Institute for Health and Care Excellence (NICE) concluded that while it is important to acknowledge the body of academic literature which raises controversies and criticisms surrounding ADHD for the purpose of developing clinical guidelines, it is not possible to offer alternative methods of assessment (i.e. ICD 10 and DSM IV) or therapeutic treatment recommendations. NICE stated that this is because the current therapeutic treatment interventions and methods of diagnosis for ADHD are based on the dominant view of the academic literature.:p.133 NICE further concluded that despite such criticism, ADHD represented a valid clinical condition,:p.138 with genetic, environmental, neurobiological, and demographic factors.:p.139 The diagnosis has a high level of support from clinicians and medical authorities.
Baroness Susan Greenfield, a leading neuroscientist, wanted a wide-ranging inquiry in the House of Lords into the dramatic increase in the diagnosis of ADHD in the UK and its possible causes. This followed a BBC Panorama programme in 2007 which highlighted US research (The Multimodal Treatment Study of Children with ADHD by the University of Buffalo showing treatment results of 600) suggesting drugs are no better than therapy for ADHD in the long-term. In the UK medication use is increasing dramatically. Other notable individuals have made controversial statements about ADHD. Terence Kealey, a clinical biochemist and vice-chancellor of University of Buckingham, has stated his belief that ADHD medication is used to control unruly boys and girls behavior.
The British Psychological Society said in a 1997 report that physicians and psychiatrists should not follow the American example of applying medical labels to such a wide variety of attention-related disorders: "The idea that children who don't attend or who don't sit still in school have a mental disorder is not entertained by most British clinicians." The National Institute for Health and Care Excellence (NICE), in collaboration with others, release guidelines for the diagnosis and treatment of ADHD. They are currently devising an update for 2018.
An article in the Los Angeles Times stated that "the uproar over Ritalin was triggered almost single-handedly by the Scientology movement." The Citizens Commission on Human Rights, an anti-psychiatry group formed by Scientologists in 1969, conducted a major campaign against Ritalin in the 1980s and lobbied Congress for an investigation of Ritalin. Scientology publications claimed the "real target of the campaign" as "the psychiatric profession itself" and said that the campaign "brought wide acceptance of the fact that (the commission) [sic] and the Scientologists are the ones effectively doing something about ... psychiatric drugging".
Tom Cruise has described the medications Ritalin (methylphenidate) and Adderall (a mixed-salt amphetamine formulation) as being used as "street drugs". Ushma S. Neill criticized this view, stating that the doses of stimulants used in the treatment of ADHD do not cause addiction and that there is some evidence of a reduced risk of later substance addiction in children treated with stimulants.
In the UK, Susan Greenfield spoke out publicly in 2007 in the House of Lords about the need for a wide-ranging inquiry into the dramatic increase in the diagnosis of ADHD, and possible causes. Her comments followed a BBC Panorama program that highlighted research that suggested medications are no better than other forms of therapy in the long term. In 2010, the BBC Trust criticized the 2007 Panorama program for summarizing the research as showing "no demonstrable improvement in children's behaviour after staying on ADHD medication for three years" when in actuality "the study found that medication did offer a significant improvement over time" although the long-term benefits of medication were found to be "no better than children who were treated with behavior therapy." In 2017, Senator Johnny Isakson was criticized by his constituents when he stated that ADD is not a learning disability but a "parental deficit disorder", and that it is a result of parents not "raising their kids like they should".
- Chemical imbalance theory
- The Gene Illusion
- Ethical problems using children in clinical trials
- hegde, BM (21 May 2018). "Pharma Industry and Disease Mongering". Moneylife India. Health. Retrieved 30 October 2018.
- Sim MG, Hulse G, Khong E (August 2004). "When the child with ADHD grows up". Australian Family Physician. 33 (8): 615–8. PMID 15373378.
- American Psychiatric Association (2013), Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, American Psychiatric Association: Arlington, VA, ISBN 9780890425572
- Parrillo, VN (2008), Encyclopedia of Social Problems, Volume 1, SAGE, p. 63, ISBN 9781412941655, retrieved 7 Apr 2016
- Mayes R, Bagwell C, Erkulwater J (2008). "ADHD and the rise in stimulant use among children". Harvard Review of Psychiatry. 16 (3): 151–66. doi:10.1080/10673220802167782. PMID 18569037.
- "Evaluation and diagnosis of attention deficit hyperactivity disorder in children". December 5, 2007. Retrieved 2008-09-15.
- Cortese S, Castellanos FX (October 2012). "Neuroimaging of attention-deficit/hyperactivity disorder: current neuroscience-informed perspectives for clinicians". Curr Psychiatry Rep. 14 (5): 568–78. doi:10.1007/s11920-012-0310-y. PMC 3876939. PMID 22851201.
- Philip Shaw; Jason Lerch; Deanna Greenstein; Wendy Sharp; Liv Clasen; Alan Evans; Jay Giedd; F. Xavier Castellanos; Judith Rapoport (2006). "Longitudinal Mapping of Cortical Thickness and Clinical Outcome in Children and Adolescents With Attention-Deficit/Hyperactivity Disorder". Arch Gen Psychiatry. 63 (5): 540–549. doi:10.1001/archpsyc.63.5.540. PMID 16651511.
- Nikolas, Molly A.; Burt, S. Alexandra (2010-02-01). "Genetic and environmental influences on ADHD symptom dimensions of inattention and hyperactivity: a meta-analysis". Journal of Abnormal Psychology. 119 (1): 1–17. doi:10.1037/a0018010. ISSN 1939-1846. PMID 20141238.
- Thapar, Anita; Stergiakouli, Evangelia (2017-05-08). "An Overview on the Genetics of ADHD". Xin Li Xue Bao. Acta Psychologica Sinica. 40 (10): 1088–1098. doi:10.3724/SP.J.1041.2008.01088. ISSN 0439-755X. PMC 2854824. PMID 20396407.
- Barkley, Russel A. "Attention-Deficit/Hyperactivity Disorder: Nature, Course, Outcomes, and Comorbidity". Retrieved 2006-06-26.
- M. T. Acosta; M. Arcos-Burgos; M. Muenke (2004). "Attention deficit/hyperactivity disorder (ADHD): Complex phenotype, simple genotype?". Genetics in Medicine. 6 (1): 1–15. doi:10.1097/01.GIM.0000110413.07490.0B. PMID 14726804.
- "Attention deficit-hyperactivity disorder; ADHD". Online Mendelian Inheritance in Man. Archived from the original on 21 July 2015. Retrieved 14 May 2014.
- Parens, Erik; Johnston, J (2009). "Facts, values, and Attention-Deficit Hyperactivity Disorder (ADHD): an update on the controversies". Child and Adolescent Psychiatry and Mental Health. 3 (1): 1. doi:10.1186/1753-2000-3-1. PMC 2637252. PMID 19152690.
- medicating kids: interviews: dr. lawrence diller Archived April 20, 2016, at the Wayback Machine PBS – Frontline
- Mahone, E. M. & Wodka, E. L. (2008). "The neurobiological profile of girls with ADHD". Developmental Disabilities Research Reviews. 14 (4): 276–284. doi:10.1002/ddrr.41. PMC 3534724. PMID 19072756.
- Dupuy, F. E.; Barry, R. J.; Clarke, A. R.; McCarthy, R. & Selikowitz, M. (2013). "Sex differences between the combined and inattentive types of attention-deficit/hyperactivity disorder: An EEG perspective". International Journal of Psychophysiology. 89 (3): 320–327. doi:10.1016/j.ijpsycho.2013.04.004. PMID 23603052.
- Sciutto M. J., Eisenberg M. (2007). "Evaluating the Evidence For and Against the Overdiagnosis of ADHD". Journal of Attention Disorders. 11 (2): 106–113. doi:10.1177/1087054707300094. PMID 17709814.
- Connor, DF (2011). "Problems of overdiagnosis and overprescribing in ADHD". Psychiatric Times. 28 (8): 14–8.
- Cuffe, SP; Moore, CG; McKeown, RE (2005). "Prevalence and correlates of ADHD symptoms in the National Health Interview Survey". Journal of Attention Disorders. 9 (2): 392–401. doi:10.1177/1087054705280413. PMID 16371662.
- Morely, CP (2010). "Disparities in ADHD assessment, diagnosis and treatment". International Journal of Psychiatry in Medicine. 40 (4): 383–9. doi:10.2190/PM.40.4.b. PMID 21391409.
- Harrison, JR; Vannest, KJ; Reynolds, CR (2011). "Behaviors that discriminate ADHD in children and adolescents: Primary symptoms, symptoms of comorbid conditions or indicators of functional impairment?". Journal of Attention Disorders. 15 (2): 147–60. doi:10.1177/1087054709356170. PMID 20354233.
- Morrow, R; Garland, J; Wright, J; Maclure, M; et al. (17 April 2012). "Influence of relative age on diagnosis and treatment of Attention-Deficit/Hyperactivity Disorder in children". Canadian Medical Association Journal. 184 (7): 755–62. doi:10.1503/cmaj.111619. PMC 3328520. PMID 22392937.
- Able, SL; Johnston, JA; Adler, LA; Swindle, RW (2007). "Functional and psychosocial impairment in adults with undiagnosed ADHD". Psychological Medicine. 37 (1): 97–107. doi:10.1017/s0033291706008713. PMID 16938146.
- Kessler, RC; Adler, L; Barley, R; Biederman, J; et al. (2006). "The prevalence and correlates of adult ADHD in the United States: Results from the National Comorbidity Survey Replication". The American Journal of Psychiatry. 163 (4): 716–23. doi:10.1176/appi.ajp.163.4.716. PMC 2859678. PMID 16585449.
- Manos, MJ (2010). "Nuances of assessment and treatment of ADHD in adults: A guide for psychologists". Professional Psychology: Research and Practice. 41 (6): 511–7. doi:10.1037/a0021476.
- Bruchmuller, K; Margraf, J; Schneider, S (2012). "Is ADHD diagnosed in accord with diagnostic criteria? Overdiagnosis and influence of client gender on diagnosis". Journal of Consulting and Clinical Psychology. 80 (1): 128–38. doi:10.1037/a0026582. PMID 22201328.
- Beiderman, J., Joseph; Stephen Farone; Eric Mick (1999). "Clinical correlates of ADHD in females: Findings from a large group of girls ascertained from pediatric and psychiatric referral sources". Journal of the American Academy of Child and Adolescent Psychiatry. 38 (8): 966–975. doi:10.1097/00004583-199908000-00012. PMID 10434488.
- Hinshaw, S; Owens, E; Zalecki, C (2012). "Prospective follow-up of girls with Attention-Deficit/ Hyperactivity Disorder into early adulthood: Continuing impairment includes elevated risk for suicide attempts and self-Injury" (PDF). Journal of Consulting and Clinical Psychology. 80 (6): 1041–1051. doi:10.1037/a0029451. PMC 3543865. PMID 22889337.
- Norvilitis JM, Fang P (November 2005). "Perceptions of ADHD in China and the United States: a preliminary study". J Atten Disord. 9 (2): 413–24. doi:10.1177/1087054705281123. PMID 16371664.
- "Attention Deficit Hyperactivity Disorder". National Institute of Mental Health. Retrieved 5 March 2016.
- National Collaborating Centre for Mental Health (2009), Attention Deficit Hyperactivity Disorder: Diagnosis and Management of ADHD in Children, Young People and Adults, British Psychological Society, pp. 19–27, 38, 130, 133, 317, ISBN 9781854334718
- Canadian ADHD Practice Guidelines (PDF), Canadian ADHD Alliance, retrieved 4 February 2011
- Attention-Deficit/Hyperactivity Disorder (ADHD): Recommendations, Centers for Disease Control and Prevention, 24 June 2015, retrieved 13 July 2015
- "NIMH · ADHD · The Treatment of ADHD".
- McDonagh MS, Peterson K, Dana T, Thakurta S. (2007). Drug Class Review on Pharmacologic Treatments for ADHD. Results[permanent dead link] "lack of evidence of a difference between the drugs studied in efficacy or adverse events."
- "Global Use of ADHD Medications Rises Dramatically". NIMH. Archived from the original on 2013-05-12. Retrieved 2013-05-06.
- Marwick, C. (2003-01-11). "US doctor warns of misuse of prescribed stimulants". BMJ. Washington, DC. 326 (7380): 67. doi:10.1136/bmj.326.7380.67. ISSN 0959-8138. PMC 1125021. PMID 12521954.
- Chawla S, Le Pichon T (2006). "World Drug Report 2006" (PDF). United Nations Office on Drugs and Crime. pp. 143–144. Retrieved 2 November 2013.
- Jensen PS, Kettle L, Roper MT, et al. (July 1999). "Are stimulants overprescribed? Treatment of ADHD in four U.S. communities". Journal of the American Academy of Child and Adolescent Psychiatry. 38 (7): 797–804. doi:10.1097/00004583-199907000-00008. PMID 10405496.
- "Statistics on Stimulant Use". Public Broadcasting Service. Retrieved 31 March 2013.
- Lakhan SE, Hagger-Johnson GE (2007). "The impact of prescribed psychotropics on youth". Clin Pract Epidemiol Ment Health. 3 (1): 21. doi:10.1186/1745-0179-3-21. PMC 2100041. PMID 17949504.
- Hart H, Radua J, Nakao T, Mataix-Cols D, Rubia K (February 2013). "Meta-analysis of functional magnetic resonance imaging studies of inhibition and attention in attention-deficit/hyperactivity disorder: exploring task-specific, stimulant medication, and age effects". JAMA Psychiatry. 70 (2): 185–198. doi:10.1001/jamapsychiatry.2013.277. PMID 23247506.
- Spencer TJ, Brown A, Seidman LJ, Valera EM, Makris N, Lomedico A, Faraone SV, Biederman J (September 2013). "Effect of psychostimulants on brain structure and function in ADHD: a qualitative literature review of magnetic resonance imaging-based neuroimaging studies". J. Clin. Psychiatry. 74 (9): 902–917. doi:10.4088/JCP.12r08287. PMC 3801446. PMID 24107764.
- Frodl T, Skokauskas N (February 2012). "Meta-analysis of structural MRI studies in children and adults with attention deficit hyperactivity disorder indicates treatment effects". Acta Psychiatrica Scand. 125 (2): 114–126. doi:10.1111/j.1600-0447.2011.01786.x. PMID 22118249.
Basal ganglia regions like the right globus pallidus, the right putamen, and the nucleus caudatus are structurally affected in children with ADHD. These changes and alterations in limbic regions like ACC and amygdala are more pronounced in non-treated populations and seem to diminish over time from child to adulthood. Treatment seems to have positive effects on brain structure.
- Nissen SE (April 2006). "ADHD drugs and cardiovascular risk". N. Engl. J. Med. 354 (14): 1445–8. doi:10.1056/NEJMp068049. PMID 16549404.
- "FDA Drug Safety Communication: Safety Review Update of Medications used to treat Attention-Deficit/Hyperactivity Disorder (ADHD) in children and young adults". United States Food and Drug Administration. 20 December 2011. Retrieved 4 November 2013.
- Cooper WO, Habel LA, Sox CM, Chan KA, Arbogast PG, Cheetham TC, Murray KT, Quinn VP, Stein CM, Callahan ST, Fireman BH, Fish FA, Kirshner HS, O'Duffy A, Connell FA, Ray WA (November 2011). "ADHD drugs and serious cardiovascular events in children and young adults". N. Engl. J. Med. 365 (20): 1896–1904. doi:10.1056/NEJMoa1110212. PMC 4943074. PMID 22043968.
- "FDA Drug Safety Communication: Safety Review Update of Medications used to treat Attention-Deficit/Hyperactivity Disorder (ADHD) in adults". United States Food and Drug Administration. 15 December 2011. Retrieved 4 November 2013.
- Habel LA, Cooper WO, Sox CM, Chan KA, Fireman BH, Arbogast PG, Cheetham TC, Quinn VP, Dublin S, Boudreau DM, Andrade SE, Pawloski PA, Raebel MA, Smith DH, Achacoso N, Uratsu C, Go AS, Sidney S, Nguyen-Huynh MN, Ray WA, Selby JV (December 2011). "ADHD medications and risk of serious cardiovascular events in young and middle-aged adults". JAMA. 306 (24): 2673–2683. doi:10.1001/jama.2011.1830. PMC 3350308. PMID 22161946.
- Steiner H, Van Waes V (January 2013). "Addiction-related gene regulation: risks of exposure to cognitive enhancers vs. other psychostimulants". Prog. Neurobiol. 100: 60–80. doi:10.1016/j.pneurobio.2012.10.001. PMC 3525776. PMID 23085425.
- Kimko HC, Cross JT, Abernethy DR (December 1999). "Pharmacokinetics and clinical effectiveness of methylphenidate". Clin Pharmacokinet. 37 (6): 457–70. doi:10.2165/00003088-199937060-00002. PMID 10628897.
- Vitiello B (October 2001). "Psychopharmacology for young children: clinical needs and research opportunities". Pediatrics. 108 (4): 983–9. doi:10.1542/peds.108.4.983. PMID 11581454.
- Millichap JG (2010). "Chapter 9: Medications for ADHD". In Millichap JG (ed.). Attention Deficit Hyperactivity Disorder Handbook: A Physician's Guide to ADHD (2nd ed.). New York, US: Springer. pp. 121–123, 125–127. ISBN 9781441913968.
Ongoing research has provided answers to many of the parents’ concerns, and has confirmed the effectiveness and safety of the long-term use of medication.
- Huang YS, Tsai MH (July 2011). "Long-term outcomes with medications for attention-deficit hyperactivity disorder: current status of knowledge". CNS Drugs. 25 (7): 539–554. doi:10.2165/11589380-000000000-00000. PMID 21699268.
Recent studies have demonstrated that stimulants, along with the non-stimulants atomoxetine and extended-release guanfacine, are continuously effective for more than 2-year treatment periods with few and tolerable adverse effects.
- Vitiello B (April 2008). "Understanding the risk of using medications for attention deficit hyperactivity disorder with respect to physical growth and cardiovascular function". Child Adolesc. Psychiatr. Clin. N. Am. 17 (2): 459–474. doi:10.1016/j.chc.2007.11.010. PMC 2408826. PMID 18295156.
- Millichap JG (2010). "Chapter 3: Medications for ADHD". In Millichap JG (ed.). Attention Deficit Hyperactivity Disorder Handbook: A Physician's Guide to ADHD (2nd ed.). New York: Springer. pp. 111–113. ISBN 9781441913968.
- "Stimulants for Attention Deficit Hyperactivity Disorder". WebMD. Healthwise. 12 April 2010. Retrieved 12 November 2013.
- Chavez B, Sopko MA, Ehret MJ, Paulino RE, Goldberg KR, Angstadt K, Bogart GT (June 2009). "An update on central nervous system stimulant formulations in children and adolescents with attention-deficit/hyperactivity disorder". Ann. Pharmacother. 43 (6): 1084–1095. doi:10.1345/aph.1L523. PMID 19470858.
- "What is the evidence for using CNS stimulants to treat ADHD in children?". March–May 2008. Retrieved 2011-03-20.
- Molina BS, Hinshaw SP, Swanson JM, et al. (March 2009). "The MTA at 8 Years: Prospective Follow-Up of Children Treated for Combined Type ADHD in a Multisite Study". J Am Acad Child Adolesc Psychiatry. 48 (5): 484–500. doi:10.1097/CHI.0b013e31819c23d0. PMC 3063150. PMID 19318991.
- King S, Griffin S, Hodges Z, et al. (July 2006). "A systematic review and economic model of the effectiveness and cost-effectiveness of methylphenidate, dexamfetamine and atomoxetine for the treatment of attention deficit hyperactivity disorder in children and adolescents". Health Technol Assess. 10 (23): iii–iv, xiii–146. doi:10.3310/hta10230. PMID 16796929. Archived from the original on 2009-08-15.
- Brown RT, Amler RW, Freeman WS, et al. (June 2005). "Treatment of attention-deficit/hyperactivity disorder: overview of the evidence". Pediatrics. 115 (6): e749–57. doi:10.1542/peds.2004-2560. PMID 15930203.
- Frank, Elliot; Ozon, Cristina; Nair, Vinitha; Othee, Karandeep (2015-11-25). "Examining Why Patients With Attention-Deficit/Hyperactivity Disorder Lack Adherence to Medication Over the Long-Term". The Journal of Clinical Psychiatry. 76 (11): e1459–e1468. doi:10.4088/jcp.14r09478. ISSN 0160-6689. PMID 26646041.
- Ibrahim, El Sheikh R. (2002). "Rates of adherence to pharmacological treatment among children and adolescents with attention deficit hyperactivity disorder". Human Psychopharmacology: Clinical and Experimental. 17 (5): 225–231. doi:10.1002/hup.406. ISSN 0885-6222. PMID 12404679.
- Power, Thomas J.; Russell, Heather F.; Soffer, Stephen L.; Blom-Hoffman, Jessica; Grim, Suzanne M. (2002). "Role of Parent Training in the Effective Management of Attention-Deficit/Hyperactivity Disorder". Disease Management and Health Outcomes. 10 (2): 117–126. doi:10.2165/00115677-200210020-00007. ISSN 1173-8790.
- Zwillich, Todd (November 16, 2005). "Schools Can't Require ADHD Drugs". WebMD.
- Jim Rosack (2001). "Controversy Erupts Over Ads for ADHD Drugs". Psychiatric News. 36 (21): 20–21. doi:10.1176/pn.36.21.0020. Archived from the original on 2003-09-02.
- Kollins SH, MacDonald EK, Rush CR (March 2001). "Assessing the abuse potential of methylphenidate in nonhuman and human subjects: a review". Pharmacol. Biochem. Behav. 68 (3): 611–27. doi:10.1016/S0091-3057(01)00464-6. PMID 11325419.
- Wilens TE, Adler LA, Adams J, et al. (January 2008). "Misuse and diversion of stimulants prescribed for ADHD: a systematic review of the literature". J Am Acad Child Adolesc Psychiatry. 47 (1): 21–31. doi:10.1097/chi.0b013e31815a56f1. PMID 18174822.
- "Ritalin abuse scoring high on college illegal drug circuit". CNN. 2001-01-08. Retrieved 2010-04-25.
- McCabe SE, Knight JR, Teter CJ, Wechsler H (January 2005). "Non-medical use of prescription stimulants among US college students: prevalence and correlates from a national survey" (PDF). Addiction. 100 (1): 96–106. doi:10.1111/j.1360-0443.2005.00944.x. hdl:2027.42/74786. PMID 15598197.
- Saletan, William (12 January 2009). "Doping Deficit Disorder: Need performance-enhancing drugs? Claim ADHD". Slate. The Slate Group LLC. Archived from the original on 21 May 2009. Retrieved 2 May 2009.
- "FDA Warns Five Drugmakers Over ADHD Ads // Pharmalot". Archived from the original on 2012-09-08.
- "Focalin XR (dexmethylphenidate hydrochloride) extended-release capsules CII". Warning Letters. U.S. Food and Drug Administration. 2008-09-25. Retrieved 2009-08-05.
- "CONCERTA (methylphenidate HCI) Extended-release Tablets CII". Warning Letters. U.S. Food and Drug Administration. 2008-09-25. Retrieved 2009-08-05.
- "Adderall XR Capsules". Warning Letters. U.S. Food and Drug Administration. 2008-09-25. Retrieved 2009-08-05.
- Adams G. (9 July 2008). "Harvard medics "concealed drug firm cash"". The Independent. London. Retrieved 2010-04-25.
- Harris, Gardiner; Carey, Benedict (2008-06-08). "Researchers Fail to Reveal Full Drug Pay". The New York Times. Retrieved 2010-04-25.
- Susan Buningh. "CHADD's Income and Expenditures (2006–2007)". Archived from the original (PDF) on 2012-06-10.
- PBS – frontline: medicating kids: interviews: russell barkley Archived July 31, 2016, at the Wayback Machine
- Practice Parameter for the Assessment and Treatment of Children and Adolescents With Attention-Deficit/Hyperactivity Disorder "Archived copy" (PDF). Archived from the original (PDF) on 2008-12-17. Retrieved 2008-10-09.CS1 maint: archived copy as title (link)
- PBS – frontline: medicating kids: interviews: harvey parker Archived March 11, 2016, at the Wayback Machine
- Santosh PJ, Taylor E (2000). "Stimulant drugs". European Child & Adolescent Psychiatry. 9 (Suppl 1): I27–43. doi:10.1007/s007870070017. PMID 11140778.
- "CG72 Attention deficit hyperactivity disorder (ADHD): full guideline" (PDF). UK National Health Service. 24 September 2008. Retrieved 2008-10-08.
- Ford T, Goodman R, Meltzer H (October 2003). "The British Child and Adolescent Mental Health Survey 1999: the prevalence of DSM-IV disorders". Journal of the American Academy of Child and Adolescent Psychiatry. 42 (10): 1203–11. doi:10.1097/00004583-200310000-00011. PMID 14560170.
- Michael Fitzgerald; Mark Bellgrove; Michael Gill (30 April 2007). Handbook of Attention Deficit Hyperactivity Disorder. John Wiley & Sons. p. 270. ISBN 978-0-470-03215-2.
- Polanczyk, G.; De Lima, M. S.; Horta, B. L.; Biederman, J.; Rohde, L. A. (2007). "The Worldwide Prevalence of ADHD: A Systematic Review and Metaregression Analysis". American Journal of Psychiatry. 164 (6): 942–8. doi:10.1176/appi.ajp.164.6.942. PMID 17541055.
- Bergløff, Charlotte Berrefjord; Tor Risberg; Kjell Herning (2 May 2005). "Mister diagnosen AD/HD" (in Norwegian). Norwegian National Broadcasting. Archived from the original on 2009-10-27. Retrieved 2009-05-09.
title, translated: [They] Lose the Diagnosis AD/HD
- "Marcia Angell". The New York Review of Books. Retrieved 2009-07-21.
Marcia Angell is a Senior Lecturer in Social Medicine at Harvard Medical School. A physician, she is a former Editor in Chief of The New England Journal of Medicine.
- Angell, Marcia (15 January 2009). "Drug Companies & Doctors: A Story of Corruption". The New York Review of Books. Retrieved 2009-07-21.
- Carey, Benedict (2006-12-22). "Parenting as Therapy for Child's Mental Disorders". The New York Times. Retrieved 2010-04-25.
- Carey, Benedict (2006-11-11). "What's Wrong With a Child? Psychiatrists Often Disagree". The New York Times. Retrieved 2010-04-25.
- "Diagnosis and Treatment of Attention Deficit Hyperactivity Disorder (ADHD)" (PDF). NIH Consens Statement. National Institutes of Health. 16 (2): 1–37. Nov 16–18, 1998. PMID 10868163.
- Currie, Janet; Stabile, Mark; Jones, Lauren (2014). "Do stimulant medications improve educational and behavioral outcomes for children with ADHD?". Journal of Health Economics. 37: 58–69. doi:10.1016/j.jhealeco.2014.05.002. PMC 4815037. PMID 24954077.
- Goldman LS, Genel M, Bezman RJ, Slanetz PJ (April 1998). "Diagnosis and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Council on Scientific Affairs, American Medical Association". JAMA. 279 (14): 1100–7. doi:10.1001/jama.279.14.1100. PMID 9546570.
- "Peer calls for ADHD care review". BBC News. 2007-11-14. Retrieved 2010-04-25.
- "Questions over drugs for ADHD". United Kingdom: BBC. 12 November 2007.
- Kealey, Terence (2004-06-04). "Boisterous boys are too much like hard work so we drug them into conformity". The Times. London. Retrieved 2010-04-25.
- Reason R; Working Party of the British Psychological Society (1999). "ADHD: a psychological response to an evolving concept. (Report of a Working Party of the British Psychological Society)". Journal of Learning Disabilities. 32 (1): 85–91. doi:10.1177/002221949903200108. PMID 15499890.
- Encyclopedia – Britannica Online Encyclopedia Archived May 15, 2010, at the Wayback Machine
- "Attention deficit hyperactivity disorder2013".
- "Attention deficit hyperactivity disorder (update)".
- Sappell, Joel; Welkos, Robert W. (1990-06-29). "Suits, Protests Fuel a Campaign Against Psychiatry". Los Angeles Times. p. A48:1. Retrieved 2006-11-29. Backup copy link here Archived March 3, 2016, at the Wayback Machine
- Leiby, Richard (25 June 2005). "A Couch Tom Cruise Won't Jump On". Washington Post. Retrieved 22 September 2015.
- Neill, Ushma S. (August 2005). "Tom Cruise is dangerous and irresponsible". Journal of Clinical Investigation. 115 (8): 1964–5. doi:10.1172/JCI26200. PMC 1180571. PMID 16075033.
- "Peer calls for ADHD care review". BBC News. 14 November 2007. Retrieved 29 January 2012.
- Singh, Anita (25 February 2010). "BBC must broadcast apology over inaccurate Panorama programme". The Telegraph. Retrieved 29 January 2012.
- Ross, Kaitlyn (August 17, 2017). "VERIFY: Did Sen. Isakson blame Attention Deficit Disorder on parents?". 11 Alive News.[dead link]
- Jennifer Erkulwater; Rick Mayes; Catherine Bagwell (2009). Medicating Children: ADHD and Pediatric Mental Health. Cambridge: Harvard University Press. ISBN 978-0-674-03163-0.
- ScienceDaily: ADD and ADHD News
- Simon Sobo, MD, "ADHD and Other Sins of Our Children"
- The New England Skeptical Society: Defending ADHD
- Dikkat Eksikliği ve Hiperaktivite bozukluğu nedir?
- http://www.icspp.org International Center for the Study of Psychiatry and Psychology