If these current prevalence estimates are accurate, ADHD is more common than major Depression, Bipolar Disorder, Schizophrenia, Panic Disorder And Obsessive Compulsive Disorder combined. ADHD is not over-diagnosed nor is it a fad diagnosis. Three out of four people with the disorder still go undetected. Jensen20 has demonstrated that a majority of children still go untreated even if accurately diagnosed as having ADHD. The recent council report of the American Medical Association spells this out in great detail.21
Despite having been described since the turn of the century and having a good treatment since 1937, ADHD is still a controversial concept and diagnosis for several reasons:
The condition may be “silent” or “noisy.” The majority (70%) of people with ADHD do not have hyperactivity and are, therefore, less likely to be detected and treated. ADHD is often silent in girls leading them to be undiagnosed more often than boys. The diagnostic criteria are subjective and dependent upon some measure of interpretation by evaluators. The symptoms are relatively non-specific and occur in other psychiatric illnesses as well as in ADHD. Inattention can occur in any Organic Brain Syndrome, Depression, OCD, Schizophrenia, Petit Mal Seizures, Sleep Apnea, or Dissociative states. Impulsivity is a hallmark of head injury, intoxication states, mental retardation, and psychoses. Hyperactivity is seen after encephalitis or head injury, and in mania. To complicate matters, 41% of adults with ADHD have another Axis I major psychiatric disorder and 38% have two or more additional psychiatric diagnoses.22,23 Comorbidity is the rule and a thorough diagnostic history must be taken in every case.