Calling Attention to ADHD: Is the Disorder Real?
There are many other possible explanations for the behaviors seen in children who are diagnosed with ADHD, Victoroff tells WebMD, including depression, physical or sexual abuse at home, or anxiety about school or some situation in the family or community. He says he is concerned that in the rush to treat ADHD, too many children may be given strong medication for treatment of a disorder they do not have.
"The widespread drugging of preschoolers ups the ante," he writes. "We need to discover scientifically rigorous, replicable specific and scientific markers that could rescue parents, child psychiatrists, pediatric neurologists, and especially family doctors from being forced to make this critical diagnosis based on the current [criteria] -- and rescue a mixed group of children from being swept like dolphins into a tuna net to [mood-altering] intervention with potentially lifelong consequences."
But as another psychiatrist points out to WebMD, the lack of a specific or sensitive diagnosis for a specific condition doesn't mean that ADHD is not a very real problem.
"We have no objective test, we all know that, that's why it's called a disorder. ... It's a clinical diagnosis, just as rheumatic heart disease was a clinical diagnosis until we had a specific test, but that doesn't mean that rheumatic heart disease did not exist. We've done field trials in thousands and thousands of kids. This has been a stable diagnosis since the 1930s. We have treatments for it, and we have ways of following improvement, but we don't have a test for it," says Charles H. Enzer, MD, associate clinical professor of psychiatry at the University of Cincinnati Medical Center.
Victoroff says that his intention was not to cast doubt on the existence of a hyperactivity disorder, but to raise questions about the validity of ADHD primarily out of concern for the safety of children. "I think it's one thing once the brain is fully formed to expose it to a drug that alters [chemicals involved in transmission of nerve impulses]," he tells WebMD, explaining though that we cannot be sure of the consequences for the brain of a child, which is not fully developed.