Intended for healthcare professionals


Evidence and belief in ADHD

BMJ 2000; 321 doi: (Published 21 October 2000) Cite this as: BMJ 2000;321:975

Informed decisions on stimulants must be based on studies with good methodology

  1. Morris Zwi, consultant child and adolescent psychiatrist,
  2. Paul Ramchandani, specialist registrar, child and adolescent psychiatry (,
  3. Carol Joughin, project manager (
  1. Richmond Royal Hospital, Richmond TW9 2TE
  2. Child and Family Psychiatric Service, Aylesbury HP20 1EG
  3. FOCUS, Royal College of Psychiatrists Research Unit, London SW1H 0HW

    Attention deficit hyperactivity disorder (ADHD) generates controversy. Some believe that it does not exist, whereas others see the reluctance of clinicians to diagnose and treat it as denying effective health care to children.1 Epidemiological studies show that 3-5% of children of school age may be classified as having attention deficit hyperactivity disorder.2 No validated diagnostic test exists to confirm the clinical diagnosis.

    It is a complex neurodevelopmental constellation of problems rather than a single disorder. The core symptoms are inattention, hyperactivity, and impulsivity. These are also, however, normal behavioural traits present in unaffected children. The extent to which each causes disability varies and should be seen within the context of a child's developmental level. For example, an active 3 year old, impulsive and frequently interrupting of others, differs from a disruptive, unfocused 8 year old who is unable to cope educationally. Yet both may display core symptoms. Also, it is important to establish that symptoms exist …

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