Attention-deficit hyperactivity disorder. In pursuit of diagnostic accuracy

Attention-deficit behaviors create a substantial burden for healthcare facilities. The incidence of ADHD is estimated at 5% to 10% of school-age children, but it is possible that many diagnoses of ADHD are flawed. At present, because the etiology of the disorder is not well understood, the diagnosis of ADHD by DSM-IV criteria hinges on the presence of inattention, hyperactivity, impulsivity, or a combination of these. Children who do not have ADHD also exhibit such behaviors in certain environments, as do children with learning disorders, family relational problems, and emotional difficulties. Thus it is imperative that physicians take a comprehensive approach to diagnosis when a child presents with behavioral difficulties. Noting that a number of myths about ADHD (eg, that improved behavior after being given stimulant medication proves a diagnosis of ADHD) have recently gained currency, the authors recommend going beyond the first step of behavior checklists in diagnosing the disorder and describe situations in which further assessment is indicated.