Attention deficit hyperactivity disorder in children: moving forward with divergent perspectives

George Halasz and Alasdair L A Vance
Med J Aust 2002; 177 (10): 554-557.


  • Current controversy about diagnosis and treatment of attention deficit hyperactivity disorder (ADHD) reflects the divergence between developmental and non-developmental approaches.

  • While there is growing evidence for biological vulnerabilities associated with ADHD, we believe that environmental factors, including early problems in parental attachment, are also important in determining the type and timing of deficit that a child develops, the risk to academic and social performance and eventual outcome.

  • We warn against labelling children with ADHD simply because they fulfil the cross-sectional diagnostic symptom criteria of the Diagnostic and statistical manual of mental disorders — 4th edition (DSM-IV).

  • We advocate an integrated biopsychosocial approach to diagnosis and management with a thorough developmental assessment to identify developmental factors, such as deficits in early attachment, contributing to the presentation.

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  • George Halasz1
  • Alasdair L A Vance2

  • Department of Psychological Medicine, Monash Medical Centre, East Malvern, VIC.



We thank Jeannette Friedman (US) for her editing suggestions.

Competing interests:

None identified.

  • 1. National Institutes of Health Consensus Development Conference Statement: Diagnosis and Treatment of Attention-Deficit/Hyperactivity Disorder (ADHD). J Am Acad Child Adolesc Psychiatry 2000; 39: 182-193.
  • 2. Jensen PS. Commentary: The NIH ADHD consensus statement: win, lose, or draw? J Am Acad Child Adolesc Psychiatry 2000; 39: 194-197.
  • 3. American Psychiatric Association. Diagnostic and statistical manual of mental disorders — 4th edition (DSM-IV). Washington, DC: American Psychiatric Association, 1994.
  • 4. Frances AJ, Egger HL. Whither psychiatric diagnosis. Aust N Z J Psychiatry 1999; 33: 161-165.
  • 5. Rutter M. Scientific foundations of developmental psychiatry. London: William Heinemann, 1980.
  • 6. Tannock R. Attention deficit hyperactivity disorder: advances in cognitive, neurobiological and genetic research. J Child Psychology Psychiatry 1998; 39: 65-99.
  • 7. Denney CB, Rapport MD. Cognitive pharmacology of stimulants in children with ADHD. In: Solanto MV, Arnsten AFT, Castellanos FX, editors. Stimulant drugs and ADHD: basic and clinical neuroscience. New York: Oxford University Press, 2001: 283-302.
  • 8. Eisenberg L. The ethics of intervention: acting amidst ambiguity. J Child Psychology Psychiatry 1975; 16: 93-104.
  • 9. Eisenberg L. The clinical use of stimulant drugs in children. Pediatrics 1972; 49: 709-715.
  • 10. Halasz G, Anaf G, Ellingsen P, et al. Cries unheard. A new look at attention deficit hyperactivity disorder. Altona: Common Ground, 2002.
  • 11. Greenberg MT. Attachment and psychopathology in childhood. In: Cassidy J, Shaver PR. Handbook of attachment theory, research, and clinical applications. New York: Guilford Press, 1999: 469-496.
  • 12. Zeanah CH Jr, editor. Handbook of infant mental health. 2nd ed. New York: Guilford Press, 2000.
  • 13. National Health and Medical Research Council. Attention deficit hyperactivity disorder (ADHD). Canberra: Commonwealth of Australia, 1997.
  • 14. American Academy of Pediatrics Subcommittee on Attention-Deficit/Hyperactivity Disorder. Clinical practice guideline: treatment of the school-aged child with attention-deficit/hyperactivity disorder. Pediatrics 2001; 108: 1033-1044.
  • 15. Wilens TE, Biederman J. The stimulants. Psychiatric Clin N Am 1992; 15: 191-222.
  • 16. Gillberg C, Melander H, von Knorring A-L, et al. Long-term stimulant treatment of children with attention-deficit hyperactivity disorder symptoms. Arch Gen Psychiatry 1997; 54: 857-864.
  • 17. Efron D, Jarman FC, Barker MJ. Medium-term are comparable with short-term outcomes in children with ADHD treated with stimulant medication. J Paediatr Child Health 2000; 36: 457-461.
  • 18. Schachar R, Tannock R, Cunningham C. Treatment. In: Sandberg S, editor. Hyperactivity disorders of childhood. Cambridge: Cambridge University Press, 1996: 433-476.
  • 19. Kempton S, Vance ALA, Maruff P, et al. Executive function and attention deficit hyperactivity disorder: stimulant medication and better executive function performance in children. Psych Med 1999; 29: 527-538.
  • 20. Barnett R, Vance, ALA, Maruff P, et al. Abnormal executive function in attention deficit hyperactivity disorder: The effect of stimulant medication and age on spatial working memory. Psych Med 2001; 31: 1107-1115.
  • 21. Vance ALA, Luk ESL. Heart of the matter review: attention deficit hyperactivity disorder: progress and controversies. Aust N Z J Psychiatry 2000; 34: 719-730.
  • 22. Swanson JM, Sergeant JA, Taylor E, et al. Attention deficit hyperactivity disorder and hyperkinetic disorder. Lancet 1998; 351: 429-433.
  • 23. Zametkin AJ, Ernst M. Problems in the management of attention-deficit-hyperactivity disorder. N Engl J Med 1999; 340: 40-46.
  • 24. Hinshaw SP, Whaien CK, Henker B. Cognitive behavioural and pharmacological interventions for hyperactive boys: comparative and combined effects. J Consulting Clin Psychol 1984; 52: 739-749.
  • 25. The MTA Cooperative Group. A 14-month randomized clinical trial of treatment strategies for ADHD. Mulitmodal Treatment Study of Children with ADHD. Arch Gen Psychiatry 1999; 56: 1073-1086.
  • 26. Schachar RJ, Tannock R, Cunningham C, Corkum PV. Behavioural, situational, and temporal effects of treatment of ADHD with methylphenidate. J Am Acad Child Adolesc Psychiatry 1997; 36: 754-763.
  • 27. Ladnier RD, Massanari AE. Treating ADHD as attachment deficit hyperactivity disorder. In: Levy TM, editor. Handbook of attachment interventions. San Diego: Academic Press, 2000: 27-65.
  • 28. Social Development Committee. Inquiry into Attention Deficit Hyperactivity Disorder. Sixteenth Report of the Social Development Committee, Parliament of South Australia, January 2002.
  • 29. Sattefield JH, Satterfield BT, Cantwell DP. Three year multimodality treatment study of 100 hyperactive boys. J Paediatr 1981; 98: 650-655.
  • 30. Sattefield JH, Satterfield BT, Schell AM. Therapeutic intervention to prevent delinquency in hyperactive boys. J Am Acad Child Adolesc Psychiatry 1987; 26: 56-64.


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