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Evidence and belief in attention deficit hyperactivity disorder

BMJ 2001; 322 doi: (Published 03 March 2001) Cite this as: BMJ 2001;322:555

Narrow focus of editorial was disappointing

  1. Sami Timimi, consultant child and adolescent psychiatrist
  1. Lincoln District Healthcare NHS Trust, Lincoln LN2 5RT
  2. Laboratory for Mother and Child Health, Istituto di Ricerche Farmacologiche Mario Negri, Via Eritrea 62, 20157 Milano, Italy

    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 …

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