Attention-deficit hyperactivity disorder (ADHD): does new research support old concepts?

Objective: To examine the evidence for and against the classification of attention-deficit hyperactivity disorder (ADHD) as a valid disease entity, as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV ), criteria.

Data Sources: Sources included but were not limited to published literature on ADHD accessed via PubMed (http://www.ncbi.nlm.nih.gov/PubMed/).

Study Selection: Peer-reviewed research, review articles, consensus statements, "white papers," and proceedings of professional meetings were used.

Data Extraction: Focused on evidence base and scientific validity of conclusions.

Data Synthesis: Evidence for a genetic or neuroanatomic cause of ADHD is insufficient. Experimental work shows that executive function deficits do not explain ADHD. The psychometric properties of widely used ADHD rating scales do not meet standards expected for disease identification.

Conclusions: ADHD is unlikely to exist as an identifiable disease. Inattention, hyperactivity, and impulsivity are symptoms of many underlying treatable medical, emotional, and psychosocial conditions affecting children.