Even among those who concur that ADHD is a real disorder, there's disagreement
over what causes it, how it's diagnosed and how it affects the brain. Here are
the views of Russell Barkley, professor of psychiatry and neurology; Peter
Jensen, director of Columbia University's Center for the Advancement of
Children's Mental Health; Lawrence Diller, author of Running on Ritalin;
Harvey Parker, child psychologist and founder of CHADD; and ADHD scientist
Xavier Castellanos. These excerpts are drawn from FRONTLINE's extended
interviews which were conducted in late 2000 and early 2001.
In 1998 the National Institutes of Health convened a panel of experts in an
attempt to come to a professional consensus on a number of questions
surrounding ADHD, including whether or not it should be considered a valid
disorder. This review remains the most comprehensive and unbiased evaluation of ADHD and its
treatments as of April 2001.
The Diagnostic and Statistical Manual of Mental Disorders (DSM) provides
the official definition of ADHD and many other psychiatric disorders. The DSM
lists the symptoms required to establish an ADHD diagnosis and is used by the
majority of mental health professionals as well as insurers and managed health
care organizations. Throughout the 50-year history of the manual, the criteria
for ADHD diagnosis evolved with each new edition. Here's a short history of
these changes, plus the currently accepted diagnostic criteria as of 2001.
The National Institutes of Health published this explanation for parents of how
a specialist--whether a pediatrician, psychiatrist, or other
practitioner--would go about evaluating a child for ADHD.
The American Academy of Pediatrics published these guidelines for pediatricians
and family doctors to provide clinicians with more user-friendly guidance in
diagnosing ADHD than is provided by the Diagnostic and Statistical Manual of
From a fictional patient called "Fidgety Philip" in a turn-of-the-century medical journal, to contemporary research into dopamine neurotransmitter
systems, authors Edward Hallowell and John Ratey track how psychologists and
medical researchers accumulated insights into the nature and causes of ADHD
symptoms. Excerpted from Driven to Distraction.
In this excerpt from his book Running on Ritalin: A Physician Reflects on
Children, Society, and Performance in a Pill, Dr. Lawrence Diller critiques
the current diagnosis. For example, he discusses how the process of defining
'objective' diagnostic standards for ADD has itself been quite subjective. He
also criticizes the symptoms list, saying it doesn't take into account
environmental and social factors that may contribute to a child's behavior.
Researchers Dr. Rachel Klein and Dr. Salvatore Mannuzza have conducted one of the most extensive prospective longitudinal studies of children diagnosed with ADHD. They followed 226 children over sixteen years to determine how long ADHD symptoms persisted, and if the children were at further risk for other problems as they were growing up. Here are some key findings from their work.