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Attention Deficit Hyperactivity Disorder Diagnosis Controversy


ADHD is characterized by abnormally high levels of hyperactive and impulsive behaviors. Children affected by this disorder are notoriously difficult students: they can barely focus their attention on a single task or sit still for prolonged periods. In the last few years, there has been a significant increase in the diagnosis of ADHD, which is especially true for North America. Xu et al. (2018) found that between 1997 and 2016, the prevalence of the disorder among children and adolescents aged 4-17 had risen from 6.4 to 10.2%. The concerning statistics cannot help but raise suspicions, and quite a few people are now inclined to believe that ADHD is confused with normal child development events. Others insist that ADHD has biological and even genetic origins and has nothing to with politics. This paper argues that while ADHD may be overdiagnosed, and sometimes on purpose, the increase may as well be traced back to environmental factors.

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The Biological Causes of ADHD

Today, there is an extensive body of research suggesting that ADHD may be passed genetically and traced back to specific changes in brain functioning. Hayman and Fernandez (2018) write that the brain affected by ADHD has less global and white matter volume as compared to the normal brain. Additionally, certain brain regions show ADHD-specific morphological changes: for instance, one such affected area is frontostriatal structures, which include the lateral prefrontal cortex, dorsal anterior cingulate cortex, and dorsal striatum. It has been found that children and adolescents suffering from ADHD have smaller basal ganglia, which causes issues with carrying out cognitive tasks, controlling movements, and managing reactions (Hayman & Fernandez, 2018). Apart from that, there has been some success in locating ADHD genes. The disorder is believed to run in families, which shows its hereditary nature.

Environmental Reasons for the Recent Increase

The ADHD epidemic may as well be not a mis- or overdiagnosis problem but a consequence of increasing environmental degradation. Air pollution has become worse in recent years, and the World Health Organization estimates that nine out of ten people may be breathing air with above-normal levels of environmental pollutants. Myhre et al. (2018) suggest that there might be a relationship between prenatal exposure to particulate matter in urban air and the decreased size of the corpus callosum in babies. This structure plays a significant role in the development of ADHD and autism spectrum disorder. Therefore, environmental factors cannot be ruled out when understanding the increase in ADHD prevalence.

ADHD vs. Normal Child Development

Even though the existence of ADHD is a biological fact, its diagnosis may suffer from bias stemming from parental and teachers’ expectations and changing views on childhood development. Ford-Jones (2015) states that most ADHD screening tools are developed for school-age children and may not be appropriate for preschoolers. The author writes that assessment itineraries may pathologize some behaviors that are normal for younger children. The developmental stage that they are going through is characterized by poor impulse control, high reactivity, forgetfulness, and a short attention span. Ford-Jones (2015) reports that only 5-10% of children showing ADHD symptoms will develop the disorder. However, parents may be overly anxious or frustrated with their children and, therefore, willing to proceed with medication as a quick fix. Social expectations also play a role in diagnosis as children are pushed to succeed from a young age and have to outgrow childish behaviors faster than their brains are “programmed” to.

Manipulating ADHD Diagnosis

Sometimes ADHD diagnosis is manipulated in the pursuit of a third party’s interests. In his book ADHD Nation, Alan Schwarz (2016) provides some interesting statistics regarding the ADHD epidemic in the United States. He discovered that in 2007, only 6.2% of Californian children aged 4-17 were diagnosed with ADHD while in North Carolina, the rate was 15.6%. It turned out that one factor that correlated with ADHD prevalence was the adoption of the No Child Left Behind Act. The act punished or rewarded schools based on standardized test scores, so some of them tried to find a way to manipulate grades. Children with ADHD could be excluded from the statistics due to their learning disabilities, therefore, creating an incentive to diagnose the disorder. In the first four years after No Child Left Behind came into effect, the national ADHD rates saw a 22% surge.


Very few psychological disorders stirred as much controversy as attention deficit and hyperactivity disorder, or ADHD. As the ADHD prevalence increases, some people are convinced that the epidemic is completely manufactured, and the scale of the issue is blown out of proportion. As a medical condition, ADHD does have a biological and genetic basis, as evidenced by neuroimaging. Environmental degradation may also play a role in a rapid increase in ADHD cases among children and adolescents. However, it is also true that the disorder is often misdiagnosed due to the biased assessment scales and parents’ unrealistic expectations. Aside from that, ADHD diagnosis may be manipulated to preserve school ratings and keep schools eligible for state subsidies.


Ford-Jones P. C. (2015). Misdiagnosis of attention deficit hyperactivity disorder: ‘Normal behavior’ and relative maturity. Paediatrics & Child Health, 20(4), 200–202. Web.

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Hayman, V., & Fernandez, T. V. (2018). Genetic insights into ADHD biology. Frontiers in psychiatry, 9, 251.

Myhre, O., Låg, M., Villanger, G. D., Oftedal, B., Øvrevik, J., Holme, J. A.,… & Dirven, H. (2018). Early-life exposure to air pollution particulate matter (PM) as a risk factor for attention deficit/hyperactivity disorder (ADHD): Need for novel strategies for mechanisms and causalities. Toxicology and Applied Pharmacology, 354, 196-214.

Schwarz, A. (2016). ADHD Nation: The disorder. The drugs. The inside story. Hachette UK.

Xu, G., Strathearn, L., Liu, B., Yang, B., & Bao, W. (2018). Twenty-year trends in diagnosed attention-deficit/hyperactivity disorder among US children and adolescents, 1997-2016. JAMA network open, 1(4), e181471-e181471.

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