The American Psychological Association (APA) added the condition of Attention Deficit Disorder (ADD) to the Diagnostic and Statistical Manual (DSM) in its 1980 edition. Since that time, the U.S. Centers for Disease Control (CDC), the International Statistical Classification of Diseases and Related Health Problems (ICD-10), and the American Academy of Pediatrics have supported, and worked to further develop, the criteria that are used to diagnose children and adults. The most recent criteria are as follows:

DSM-IV Criteria:
I. Either A or B:
A. Six or more of the following symptoms of inattention have been present for at least 6 months to a point that is disruptive and inappropriate for developmental level:
1. Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities.
2 Often has trouble keeping attention on tasks or play activities.
3. Often does not seem to listen when spoken to directly.
4. Often does not follow instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions).
5. Often has trouble organizing activities.
6. Often avoids, dislikes, or doesn’t want to do things that take a lot of mental effort for a long period of time (such as schoolwork or homework).
7. Often loses things needed for tasks and activities (e.g. toys, school assignments, pencils, books, or tools).
8. Is often easily distracted.
9. Often forgetful in daily activities.
B. Six or more of the following symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for developmental level:
Hyperactivity:
1. Often fidgets with hands or feet or squirms in seat.
2. Often gets up from seat when remaining in seat is expected.
3. Often runs about or climbs when and where it is not appropriate (adolescents or adults may feel very restless).
4. Often has trouble playing or enjoying leisure activities quietly.
5. Is often “on the go” or often acts as if “driven by a motor”.
6. Often talks excessively.
Impulsiveness:
1. Often blurts out answers before questions have been finished.
2. Often has trouble waiting one’s turn.
3. Often interrupts or intrudes on others.
II. Some symptoms that cause impairment were present before age 7 years.
III. Some impairment from the symptoms is present in two or more settings (e.g. at school/work and at home).
IV. There must be clear evidence of significant impairment in social, school, or work functioning.
V. The symptoms do not happen only during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder. The symptoms are not better accounted for by another mental disorder (e.g. Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder).

Although the preceding criteria are certainly research-based and factually-driven, there’s no doubt that they are completely subjective. This means that each sign or symptom exhibited by a child (or adult), even when interpreted by a professional, can be misinterpreted.

The reality is that the testing that is currently used to identify ADD/ADHD lacks any real validity in identifying the disorder.

Why is this?

The fact is that the criteria for identifying ADD/ADHD were created as part of a movement to combat poor behavior in schools. Part of a diagnosis-of-the-moment trend, an ADD/ADHD diagnosis signaled a maximum tolerance point on the part of education professionals, and a need to explain why children had become far more difficult to handle than in previous decades. Just like other mental and developmental disorders were being over diagnosed according to the “popularity” of the disorder at any given moment, a diagnosis of ADD/ADHD had become the go-to explanation for uncontrolled behavior in children and an inability to focus in adults.*

This is not to say that ADD/ADHD, and other disorders, do not exist and that they are not very real, and very treatable, disorders. It does mean, however, that such disorders are significantly over-diagnosed and are more likely due to factors that do not warrant prescription drug treatment as a solution.

As an argument against the ability of DSM criteria to predict or accurately diagnose ADD/ADHD, criteria IA, IB, II, III, and IV are completely subjective. In order to meet the criteria present in I-IV, all it takes are the subjective observations of a teacher, caretaker, parent, or physician. The requirements of criteria V are even more interesting.

Although the only attempt at objective criteria, criteria V of the DSM-IV-R still fails to guarantee an accurate diagnosis for the following reasons:
1. Many individuals are never actually “tested”. They are diagnosed, and medicated, based solely on the observations of others.
2. Criteria V requires that an individual not present with symptoms of ADD/ADHD as part of another, diagnosable, disorder. Most people are never tested for the presence of another disorder. They may be tested for ADD/ADHD, but this is not the same as ruling out other disorders.
3. Many individuals are diagnosed according to the trial-and-error method. If the individual displays signs of ADD/ADHD, they are medicated. If the medication quiets the signs, the individual must certainly have the disorder – correct? Wrong!

The reality is that ADD/ADHD cannot be definitively diagnosed using DSM criteria and the administration of medication is not a viable method of diagnosis.

*Other disorders such as schizophrenia, dyslexia, and Tourette’s have been the focus of the same popular diagnosis issues as ADD/ADHD.