Facts, values, and Attention-Deficit Hyperactivity Disorder (ADHD): an update on the controversies

Abstract

The Hastings Center, a bioethics research institute, is holding a series of 5 workshops to examine the controversies surrounding the use of medication to treat emotional and behavioral disturbances in children. These workshops bring together clinicians, researchers, scholars, and advocates with diverse perspectives and from diverse fields. Our first commentary in CAPMH, which grew out of our first workshop, explained our method and explored the controversies in general. This commentary, which grows out of our second workshop, explains why informed people can disagree about ADHD diagnosis and treatment. Based on what workshop participants said and our understanding of the literature, we make 8 points. (1) The ADHD label is based on the interpretation of a heterogeneous set of symptoms that cause impairment. (2) Because symptoms and impairments are dimensional, there is an inevitable "zone of ambiguity," which reasonable people will interpret differently. (3) Many other variables, from different systems and tools of diagnosis to different parenting styles and expectations, also help explain why behaviors associated with ADHD can be interpreted differently. (4) Because people hold competing views about the proper goals of psychiatry and parenting, some people will be more, and others less, concerned about treating children in the zone of ambiguity. (5) To recognize that nature has written no bright line between impaired and unimpaired children, and that it is the responsibility of humans to choose who should receive a diagnosis, does not diminish the significance of ADHD. (6) Once ADHD is diagnosed, the facts surrounding the most effective treatment are complicated and incomplete; contrary to some popular wisdom, behavioral treatments, alone or in combination with low doses of medication, can be effective in the long-term reduction of core ADHD symptoms and at improving many aspects of overall functioning. (7) Especially when a child occupies the zone of ambiguity, different people will emphasize different values embedded in the pharmacological and behavioral approaches. (8) Truly informed decision-making requires that parents (and to the extent they are able, children) have some sense of the complicated and incomplete facts regarding the diagnosis and treatment of ADHD.

Prevalence of attention deficit hyperactivity disorder among school-aged children in Jordan

“…These factors include low socioeconomic status, living in economically stressed neighbourhoods, poor family functioning, family size, age, and gender. ADHD is a complex disorder, with genetic and environmental risk factors contributing to its onset (1,9). ADHD is one of the most common neurodevelopmental disorders of childhood, with a worldwide prevalence ranging from 2.2 to 17.8% (10).…”

“…ADHD is one of the most common neurodevelopmental disorders of childhood, with a worldwide prevalence ranging from 2.2 to 17.8% (10). The variability in prevalence might be due to several factors, such as study methodology, diagnostic criteria, populations studied, sample size, cultural perceptions, and informants (e.g., respondents to questionnaires) (1,6,9,10). Moreover, the literature indicates that the reported rates might vary depending on the source of the information (1,3,11).…”

Social Information Processing and Reactive and Proactive Aggression among Children with ADHD

“…The perception of ADHD behavioral symptoms varies considerably across cultures (Parens & Johnston, 2009). Thus, to completely understand how to identify and treat ADHD, it must be studied from within a cultural perspective.…”

Implicaciones éticas del conocimiento acerca del cerebro. Una aproximación a la neuroética

“…Los autores señalan que específicamente en relación al tema de las neuro-imágenes (pero también deberíamos mencionar a todas las nuevas tecnologías que actúan de una u otra manera sobre el cerebro), se ejerce una gran presión por parte de las industrias de neurotecnología con la finalidad de que se utilice ésta, o para enrolar pacientes en protocolos de investigación en relación a la misma. Cuando hay tantos intereses en juego, la información es sesgada y orientada para facilitar el consumo 24 .…”