...Inclusion of three subtypes in DSM-IV increases the prevalence of the condition (3). Issues of syndrome thresholds clearly have a major impact on case definition, and it is clear that important problems, e.g., the pervasiveness of symptoms over settings, the degree of distress or impairment exhibited, and the persistence of disability over development need to be addressed (6). These issues call for a careful reappraisal of the current 'epidemic' of ADHD in this country...
...In conclusion, although DSM-IV opens the door to increased prevalence of ADHD, we must also be concerned about missing cases in schools and primary care settings. Moreover, even when ADHD is recognized, children may not get appropriate treatment because of problems of access to services or difficulites in dissemination of best practices....
