Narrow focus of editorial was disappointing

EDITOR—The editorial by Zwi et al suggested that current practice in attention deficit hyperactivity disorder is largely based on belief with little good evidence available.1 Its narrow focus on inadequate methods in studies was, however, disappointing, barely touching the surface of the controversies surrounding attention deficit hyperactivity disorder and the prescription of stimulants. The disorder construct raises more questions than it answers. For example, where is the cut-off point between normal behaviour and attention deficit hyperactivity disorder? Who defines this, and why? (What does the >30-fold variance in prevalence rates in epidemiology studies mean?) Why is this diagnosis predominantly given to boys? (Is Western culture more concerned with externalised behaviour seen in boys than internalised behaviour of girls?) Why the very high rates of comorbidity with other psychiatric disorders? (Is attention deficit hyperactivity disorder a research generated idea that has little relation to the complexity commonly found in clinical practice?) Is the disorder being diagnosed …