Debate concentrates attention on adult ADHD

A debate in the BMJ on whether adult attention deficit-hyperactivity disorder is a valid diagnosis has included vigorous claims that it has been fostered by the pharmaceutical industry in the absence of any convincing evidence. Drs Joanna Moncrieff and Sami Timimi said that even if childhood ADHD was accepted as valid, it did not automatically follow that the same diagnosis could be made in adults. “Definitions of adult ADHD include numerous aspects of mental functioning and behaviour that are not normally examined in children,” they said. These included mood swings, irritability, stress intolerance, anger and risk taking, while playing down central features of childhood ADHD such as hyperactivity. In addition, nearly 90% of adults diagnosed with ADHD had at least one other psychiatric diagnosis, and many had two, highlighting the very high level of comorbidity. A much more robust evidence base was needed before long-standing problematic behaviours in adults, usually attributed to personality traits or disorders, were accepted as ADHD. “A major driver behind the increased popularity of diagnosing adult ADHD is the idea that it responds to treatment with stimulant drugs,” they said. But even here, the evidence for a response was controversial. The argument that adult ADHD was a valid diagnosis was based largely on the fact that it had been defined by DSM-IV and subject to clinical and epidemiological research, and therefore existed. BMJ 2010; published online....