Abstract
Use of medication for treatment of ADHD (or its historical precursors) has been debated for more than forty years. Reasons for the ongoing differences of opinion are analyzed by exploring some of the arguments for and against considering ADHD a mental disorder. Relative to two important DSM criteria — that a mental disorder causes some sort of harm to the individual and that a mental disorder is the manifestation of a dysfunction in the individual — ADHD’s classification as a mental disorder is found to be contentiously value-laden. The disagreements spill over to reasoning regarding appropriate management, because justification for a drug prescription is in part predicated on the idea that the drugs manage mental disorders. These debates do not appear to be nearing resolution, so individuals offering advice, or trying to decide whether ADHD drugs are appropriate for themselves or their children, may find it helpful to compare the values underlying various perspectives with their own.
Similar content being viewed by others
References
American Academy of Pediatrics, Committee on Quality Improvement, Subcommittee on Attention-Deficit/Hyperactivity Disorder. (2001) Clinical Practice Guideline: Treatment of the School-Aged Child with Attention-Deficit/Hyperactivity Disorder. Pediatrics 108(4): 1033–1044
American Psychiatric Association. (2000) Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC: American Psychiatric Association
Anonymous: 2004, ‘Economic Impact of ADHD’, Medical News Today, http://www.medicalnewstoday.com/medicalnews.php?newsid = 13210, accessed June 17, 2005
Anonymous: 2005, ‘77 billion in Lost Income Is Attributed to ADHD Annually in the United States’ EurekAlert!, http://www.eurekalert.org/pub_releases/2005-05/pn-bi051905.php, accessed June 17, 2005
Barkley R.A. (1997) ADHD and the Nature of Self-Control. New York: The Guilford Press
Barkley R.A., Murphy K.R. et␣al. (1996) Motor Vehicle Driving Competencies and Risks in Teens and Young Adults with Attention Deficit Hyperactivity Disorder. Pediatrics 98(6):1089–1095
Biederman J., Faraone S.V. (2005) Attention-Deficit Hyperactivity Disorder. The Lancet 366:237–248
Breggin P.R. (1998) Talking Back to Ritalin: What Doctors Aren’t Telling You About Stimulants for Children. Monroe, ME: Common Courage Press
DiScala C., Lescohier I. et␣al. (1998) Injuries to Children with Attention Deficit Hyperactivity Disorder. Pediatrics 102(6):1415–1421
Eide B.L., Eide F.F. (2006) The Mislabeled Child. The New Atlantis 12(Spring):46–59
Fulford K.W.M. (1989) Moral Theory and Medical Practice. Cambridge, UK: Cambridge University Press
Fulford, K.W.M.: 2002, ‘Report to the Chair of the DSM-VI Task Force: From the Editors of Philosophy, Psychiatry, and Psychology, “Contentious and Noncontentious Evaluative Language in Psychiatric Diagnosis” (DATELINE 2010)’, in: J.Z. Sadler (ed.), Descriptions and Prescriptions: Values, Mental Disorders, and the DSMs. Baltimore: The Johns Hopkins University Press, pp. 321–362
Fulford, K.W.M.: 2004, ‘Values-Based Medicine: Thomas Szasz’s Legacy to Twenty-First Century Psychiatry’, in: J.A. Schaler (ed.), Szasz Under Fire: The Psychiatric Abolitionist Faces His Critics. Chicago: Open Court, pp. 57–92
Grady D.L., Chi H.-C. et␣al. (2003) High Prevalence of Rare Dopamine Receptor D4 Alleles in Children Diagnosed with Attention-Deficit Hyperactivity Disorder. Molecular Psychiatry 8:536–545
Hoza B., Gerdes A.C. et␣al. (2004) Self-Perceptions of Competence in Children with ADHD and Comparison Children. Journal of Consulting and Clinical Psychology 72(3):382–391
Kadison R. (2005) Getting an Edge — Use of Stimulants and Antidepressants in College. New England Journal of Medicine 353(11):1089–1091
Lahey B.B., Applegate B. et␣al. (1994) DSM-IV Field Trials for Attention Deficit Hyperactivity Disorder in Children and Adolescents. American Journal of Psychiatry 151(11):1673–1685
Leibson C.L., Katusic S.K. et␣al. (2001) Use and Costs of Medical Care for Children and Adolescents with and Without Attention-Deficit/Hyperactivity Disorder. JAMA 285(1):60–66
Litton P. (2005) ADHD, Values, and the Self. The American Journal of Bioethics 5(3):65–67
Mayes S.D., Calhoun S.L. et␣al. (2000) Learning Disabilities and ADHD: Overlapping Spectrum Disorders. Journal of Learning Disabilities 33(5):417–424
McCracken, J.T.: 2000, ‘Attention-Deficit Disorders’, in: B.J. Sadock and V.A. Sadock (eds.), Kaplan & Sadock’s Comprehensive Textbook of Psychiatry, Volume 2. Philadelphia: Lippincott Williams & Wilkins, pp. 2679–2688.
McHugh P. (1999) How Psychiatry Lost Its Way. Commentary 108(5):32–38
McHugh, P. and L.R. Kass: 2003, `Exchange of Letters on Medicalization Between Leon R. Kass, M.D. and Paul McHugh, M.D, President’s Council on Bioethics, http://www.bioethics.gov/background/kass_mchugh.html, accessed January 2, 2006
McNeil Consumer & Specialty Pharmaceuticals. (2003) ADHD Success Stories on DVD: Once-Daily Concerta (Methylphenidate HCl). Fort Washington, PA: McNeil-PPC, Inc
MTA Cooperative Group. (2004a) National Institute of Mental Health Multimodal Treatment Study of ADHD Follow-up: 24-Month Outcomes of Treatment Strategies for Attention-Deficit/Hyperactivity Disorder. Pediatrics 113(4):754–761
MTA Cooperative Group. (2004b) National Institute of Mental Health Multimodal Treatment Study of ADHD Follow-up: Changes in Effectiveness and Growth after the End of Treatment. Pediatrics 113(4):762–769
National Institutes of Health: 1998, NIH Consensus Statement: Diagnosis and Treatment of Attention Deficit Hyperactivity Disorder (ADHD), Bethesda, Maryland: National Institutes of Health, vol. 16, No. 2, pp. 1–37
Rappley M.D. (2005) Attention Deficit-Hyperactivity Disorder. New England Journal of Medicine 352(2):165–173
Reznek, L.: 1991, The Philosophical Defence of Psychiatry. London: Routledge
Sadler, J.Z.: 2002, ‘Introduction’ in: J.Z. Sadler (ed.), Descriptions and Prescriptions: Values, Mental Disorders, and the DSMs. Baltimore: The Johns Hopkins University Press, pp. 3–8.
Sagvolden T., Johansen E.B. et␣al. (2005). A Dynamic Developmental Theory of Attention-Deficit/Hyperactivity Disorder (ADHD) Predominantly Hyperactive/Impulsive and Combined Subtypes. Behavioral and Brain Sciences 28(3):397–468
Singh I. (2005) Will the “Real Boy” Please Behave: Dosing Dilemmas for Parents of Boys with ADHD. The American Journal of Bioethics 5(3):34–47
Smith, L. and K. Smith: 2001, ‘Our 14-Year-Old Son Died from Ritalin Use’ http://www.ritalindeath.com/, accessed January 20, 2006
Szasz, T.: 2004a, ‘Reply to Fulford’ in: J.A. Schaler (ed.), Szasz Under Fire: The Psychiatric Abolitionist Faces His Critics. Chicago: Open Court, pp. 93–117.
Szasz, T.: 2004b, ‘Reply to Bentall’ in: J.A. Schaler (ed.), Szasz Under Fire: The Psychiatric Abolitionist Faces His Critics. Chicago: Open Court, pp. 321–326
University of Medicine and Dentistry of New Jersey and Liberty Communications Network. (2005) Special Edition: Assessing the Safety of ADHD Medications: An Expert Panel Considers the Clinical Significance of Potential Adverse Effects. Medical Crossfire 6(10):1–21
Wakefield J.C. (1992a) Disorder as Harmful Dysfunction: A Conceptual Critique of DSM-III-R’s Definition of Mental Disorder. Psychological Review 99(2):232–247
Wakefield J.C. (1992b) The Concept of Mental Disorder: On the Boundary Between Biological Facts and Social Values. American Psychologist 47(3):373–388
Wakefield, J.C.: 2002, ‘Values and the Validity of Diagnostic Criteria: Disvalued Versus Disordered Conditions of Childhood and Adolescence’ in: J.Z. Sadler (ed.), Descriptions and Prescriptions: Values, Mental Disorders, and the DSMs. Baltimore: The Johns Hopkins University Press, pp. 148–164
Widiger T.A, Samuel D.B. (2005) Diagnostic Categories or Dimensions? A Question for the Diagnostic and Statistical Manual of Mental Disorders — Fifth Edition. Journal of Abnormal Psychology 114(4):494–504
Woodward L.J., Fergusson D.M. et␣al. (2000) Driving Outcomes of Young People with Attentional Difficulties in Adolescence. Journal of the American Academy of Child and Adolescent Psychiatry 39(5):627–634
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Hawthorne, S. ADHD drugs: Values that drive the debates and decisions. Med Health Care Philos 10, 129–140 (2007). https://doi.org/10.1007/s11019-007-9056-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11019-007-9056-4