attention deficit hyperactivity disorder controversies attention deficit hyperactivity disorder controversies despite the scientifically well-established nature of attention deficit hyperactivity disorder (adhd), its diagnosis, and its treatment, each of these has been controversial since the 1970s. the controversies involve clinicians, teachers, policymakers, parents, and the media. positions range from the view that adhd is within the normal range of behavior to the hypothesis that adhd is a genetic condition. other areas of controversy include the use of stimulant medications in children, the method of diagnosis, and the possibility of overdiagnosis. in 2009, the national institute for health and care excellence, while acknowledging the controversy, states that the current treatments and methods of diagnosis are based on the dominant view of the academic literature. despite their safety and effectiveness in treating adhd symptoms, the use of methylphenidate and other stimulant medications is frequently a topic of public controversy. with differing rates of diagnosis across countries, states within countries, races, and ethnicities, some suspect factors other than the presence of the symptoms of adhd are playing a role in diagnosis, although the prevalence of adhd is consistent internationally. some sociologists consider adhd to be an example of the medicalization of deviant behavior, that is, turning the previously non-medical issue of school performance into a medical one. most healthcare providers accept adhd as a genuine disorder, at least in the small number of people with severe symptoms. among healthcare providers the debate mainly centers on diagnosis and treatment in the much greater number of people with mild symptoms. status as a disorder according to the diagnostic and statistical manual of mental disorders, fifth edition (dsm-5), the leading authority in the us on clinical diagnosis, adhd is a neurodevelopmental disorder with a prevalence rate in most cultures of about 5% in children and 2.5% in adults. today, the existence of adhd is widely accepted, but controversy around the disorder has existed since at least the 1970s. according to the dsm-5, symptoms must be present before age 12, but it is not uncommon for adhd to continue into adulthood. parents and educators sometimes still question a perceived over-diagnosis in children due to overlapping symptoms with other mental disabilities, and the effectiveness of treatment options, especially the overprescription of stimulant medications. however, according to sociology professor vincent parrillo, "parent and consumer groups, such as chadd (children and adults with attention deficit hyperactivity disorder), tend to support the medical perspective of adhd." in 2009, the british psychological society and the royal college of psychiatrists, in collaboration with the national institute for health and care excellence (nice), released a set of diagnosis and treatment guidelines for adhd. these guidelines reviewed studies by ford et al. that found that 3.6 percent of boys and 0.85 percent of girls in britain qualified for a diagnosis of adhd using the american dsm-iv criteria. the guidelines go on to state that the prevalence drops to 1.5% when using the stricter criteria for the icd-10 diagnosis of hyperkinetic disorder, used mainly in europe. a systematic review of the literature in 2007 found that the worldwide prevalence of adhd was 5.29 percent, and that there were no significant differences in prevalence rates between north america and europe. the review did find differences between prevalence rates in north america and those in africa and the middle east, but cautioned that this may be due to the small number of studies available from those regions. causes