Volume 3 • Issue 1 • 1000112
Bipolar Disord, an open access journal
ISSN: 2472-1077
Mini Review Open Access
Balbuena, Bipolar Disord 2017, 3:1
DOI: 10.4172/2472-1077.1000112
Bipolar Disorder: Open Access
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ISSN: 2472-1077
*Corresponding author: Francisco Balbuena, Professor, Department of Psychology
and Experimental, Universidad de Huelva, Avenida Tres de Marzo s/n (Campus de
El Carmen), Huelva, 21007, Spain, Tel: 34 625945506; E-mail: balbuena@uhu.es
Received December 27, 2016; Accepted January 06, 2017; Published January
13, 2017
Citation: Balbuena F (2017) High Prevalence of ADHD: How Best can we
Identify Cases of ADHD from the General Population? Bipolar Disord 3: 111. doi:
10.4172/2472-1077.1000112
Copyright: © 2017 Balbuena F. This is an open-access article distributed under
the terms of the Creative Commons Attribution License, which permits unrestricted
use, distribution, and reproduction in any medium, provided the original author and
source are credited.
Abstract
The high prevalence of attention defcit hyperactivity disorder (ADHD) demonstrated in the last decades in the
child and adult population carried us to examine how best we can identify cases of ADHD from the general population.
In doing so, we note that different methodologies are used for obtaining data, as well as different diagnostic criteria.
An additional fnding of considerable interest for this line of reasoning is the medicalization of ADHD. Our assumption
is that this tendency for prescribing certain medications is caused by the relentless pressure of pharmaceutical
companies and not only as a result of clinical judgment.
High Prevalence of ADHD: How Best can we Identify Cases of ADHD from the
General Population?
Francisco Balbuena*
Department of Psychology and Experimental, Universidad de Huelva, Avenida Tres de Marzo s/n (Campus de El Carmen), Spain
Keywords: ADHD; Diagnosis; Prevalence; Comorbidity;
Neurodevelopment
Introduction
Major advances have been made over the past decades in
understanding the difculties of children and adults with ADHD
(attention defcit/hyperactivity disorder (ADHD). In spite of it,
numerous research studies have documented the increase of people
diagnosed with ADHD in the last few decades [1]. Tus, the aim of this
paper has been to provide the cornerstones for a basic understanding of
such high prevalence of ADHD.
Recent population-based studies indicate that ADHD is a condition
afecting approximately 5% of the child population [2]. It this is the case,
yet signifcant evidence exists that far fewer children receive ADHD
services [3]. As result of it, in many countries concerted serious eforts
directed at earlier detection and diagnosis of ADHD are well justifed.
In fact, the diagnosis in practice is made with remarkable diferences in
frequency between nations. At the same time, taking into consideration
individual diferences, the data over the past 10 years have shown that
there is great heterogeneity in the diagnostic methods for children and
adults with ADHD.
Given all of the preceding, it is not surprising that McLennan [4] recently
reported on the need to de-emphasize categorical conceptualizations of
ADHD. To arrive at this conclusion, research fndings were reviewed to
consider whether ADHD is a discrete entity or whether it is more consistent
with an extreme end-of-trait distribution in the population. All studies
published from this search and that involve empirically based studies support
a predominately dimensional rather than a qualitatively distinct existence for
ADHD. From a practical standpoint, it is clear that, whatever approach is
used, this does not negate the clinical needs of those who have substantial
ADHD symptoms clusters, nor the risks that such symptoms entail [4].
In addition, many clinicians, educators, and parents tend to focus
their attention on diferent cognitive and behavioral measures and the
like to determine the degree of expression of ADHD in the children
under observation. With this in mind, it is also interesting to recall a
set of studies that provide evidence of medicalization of ADHD [5]. As
consequence of it, many ADHD experts have asserted that this is likely
to be the case for pressure of pharmaceutical companies and not only as
a result of clinical judgment.
Of course, many would agree that it is unlikely that any single type
of intervention will be sufcient to mitigate the complex developmental
disturbances of ADHD. Rather, future efective intervention may need
to combine both biological (e.g. pharmacological) and cognitive-
behavioral approaches to most efectively address the needs of children
and adults with ADHD. Understanding the biological substrates
of ADHD may be critical to guiding the development of efective
intervention strategies within both modalities.
Efects of Clinical Guidelines for ADHD Diagnosis
We have learned that, despite the fact of using conventional clinical
guidelines for ADHD, these are not applied in the same way by clinicians
and educators. To this extent, they are not the only explanatory factor
postulated for such a signifcant increase in the prevalence of ADHD
in recent decades. Many experts have asserted that this very likely was
related to ADHD requires multimodal treatment. Because we do not
know the “active ingredient” behind successful ADHD treatments,
there is relatively little understanding of whether certain treatments are
better than others and, if so, for whom and when [6].
In the same vein, a large body of research has also evidenced a range
of factors infuencing diagnosis, irrespective of the guidelines used, and
hence some part of the increase might simply be an artifact of the use
of diferent clinical tools or criteria for diagnosis. Supporting these
assertions there are some cases where ADHD has been diagnosed when
it was manifested solely in the school context and not in the family
environment. However, this way of doing diagnosis is contrary to the
recommendations of many ADHD experts.
It is also important to note that the measures based on reported
information capitalize on the knowledge of a familiar person who
interacts with the child on a daily basis. However, parents or teachers
may over- or underestimate the child´s social difculties. Te accuracy
of the information gathered from any source of information, such as a
parent or teacher, needs to be documented.