This is a controversial
topic only because there's so much agenda-driven noise around this question.
There are a lot of groups and individuals out there (and we've all run
across some of them) who believe that ADD/ADHD is (you pick) 1) the result
of bad parenting, 2) a manifestation of low self-esteem, 3) an excuse by
lazy teachers, and/or 4) a conspiracy by the doctors and/or pharmaceutical
industry.
Sure, bad parenting may contribute
to the symptoms, and lazy teachers might increase the number of misdiagnosed
kids (since statements/evaluations from those in contact with children
are weighted along with other instruments in arriving at a diagnosis),
but at its root, ADD/ADHD is a legitimate disorder with a biological basis.
My background is biology,
so rather than dealing with the soft science of psychology or indirect
assessments via the field of education (and special education in particular),
I'll stick to the lines of evidence for the existence of (and even causal
and/or mechanistic candidates for) ADD/ADHD that originate in neuroscience
research. The question of whether ADD/ADHD exists has already been
answered by neuroscience, and thus more ambiguous results in other, more
subjective disciplines should be interpretted based on what is found there.
A few areas that come to
mind in include:
1) Genetics - Families
show patterns of heritability. Taken alone, this only raises the
nature/nurture debate; however, specific genes (e.g., variants of certain
dopamine receptors) have been isolated that have been correlated with the
existence of alcoholism, drug addiction, OCD, and ADD/ADHD. These
additional disorders are, of course, known to be correlated with (i.e.,
are often co-morbid with) ADD/ADHD.
2) fMRI (function magnetic
resonance imaging) - This method shows which parts of the brain are
active from moment to moment while performing a given task. In patients
with ADD/ADHD, the prefrontal cortex has been shown to be less active.
This area is thought to be largely involved with impulse control, and in
those patients where this structure has been damaged, these individuals
are prone to emotional outbursts, acting on short-term impulses rather
than acting on long-term planning. Further, the prefrontal cortex
is one of the least mature parts of the brain in children, thus a deficit
in that area in an adult often leads child-like impulsivity... which is
a characteristic trait of ADD/ADHD.
3) The pharmacological
paradox - When ADD/ADHD children are given drugs known to treat the
condition (e.g., stimulants), their hyperactive and/or attention deficient
symptoms tend to dissipate in a dose-dependent manner. By contrast,
"normal" children tend to become more active and less focused when given
the same medication. Essentially, this points to the existence of
two separate populations, one of which, obviously, is composed of children
with this cluster of symptoms we have identified as ADD/ADHD.
4) Additional causal hypotheses
- In addition to being a heritable trait, instances of ADD/ADHD (or symptoms
thereof) are correlated with a history of childhood illness and/or trauma.
One of the problems that
critics of the verifiability of ADD/ADHD point to is the subjectivity of
psychological tests. Specifically, diagnoses are made from questionnaires
on which patients self-report their symptoms and from external assessments
from parents and teachers that are arguably even further removed.
The areas highlighted above are less subjective and, taken together, make
a stronger case for the existence of a genuine medical condition.
That is something that needs to be communicated to the general public who
might otherwise be swayed by groups who have a stake in refuting this diagnosis
and/or the existence of this disorder. That being said, input from
the realm of psychology continues to validate the diagnosis and offer suggestions
for treatment as well as assays to evaluate treatments based both in psycho-social
realm and pharmacological in nature..