Attention-deficit hyperactivity disorder: The medicalization of misbehavior

During the past decade, there has been an increase in the diagnosis and tre atment of Attention-Deficit Hyperactivity Disorder (ADHD). This syndrome, t ypically diagnosed in childhood, is characterized by inattention, hyperacti ve motor behavior, and distractibility. Current prevalence rates obtained i n various countries generally exceed the 3-5% reported by DSM-IV; Reasons f or increased ADHD prevalence include changes in diagnostic standards, overl ap between ADHD and other externalizing disorders, nonspecific behavioral c riteria, and the rapid effects of stimulant medication on cognitive functio ning. However, social, cultural, and economic factors may also contribute t o increased diagnosis. ADHD has become a common topic in the lay media. Pop ular discussions of ADHD may serve as a metaphoric expression of social anx ieties, particularly with respect to children. At the same time, ADHD has r apidly become incorporated into a medical model, with emphasis on pharmacol ogical treatment. Reductions in mental health and educational services, as well as economic pressures of managed care, may also contribute to medicali zation of behavioral problems. Collaboration between psychologists and prim ary care physicians can lead to more accurate diagnosis and appropriate tre atment of ADHD and related disorders.