Breaking down the ADHD construct to build a valid diagnosis

Defined by DSM-5-TR as a neurodevelopmental disorder Attention-Deficit/Hyperactivity Disorder (ADHD) has attracted ever-mounting attention from the public, coupled with a growing interest from clinicians, researchers, and patients. This is reflected in significantly higher demand for clinical assessments and frequent media reports of a surge in ADHD cases across the lifespan. These trends are puzzling as it is unknown what they truly reflect: an improvement in clinical detection or a concerning degree of overdiagnosis? A key reason for this uncertainty is our limited understanding of the disorder and imprecision of the diagnosis - a long-running subject of criticism. To better understand these issues, in this article we deconstruct ADHD through the lens of its DSM-5-TR diagnostic criteria - the basis upon which the diagnosis is routinely made. Our in-depth analysis reveals major problems associated with the diagnostic criteria with respect to their arbitrariness, vagueness, redundancy, and context-dependent normality, which together substantially undermine the validity and reliability of the diagnosis, and the ADHD construct itself, blunting the precision of ADHD research, clinical decisions and the effectiveness of treatment - all of which are contingent on having a robust diagnosis in the first place. Hence, our detailed deconstruction of the diagnosis of ADHD is critical as it provides the necessary groundwork for its accurate reconstruction - an essential step towards developing a valid, reliable, and clinically meaningful diagnostic foundation that will inform research and improve clinical care for patients with attentional and hyperactivity-impulsivity problems.