Breaking down the ADHD construct to build a valid diagnosis

Defined by DSM-5-TR as a neurodevelopmental disorder Attention-Deficit/Hyperactivity Disorder (ADHD) has attracted ever-mounting attention from the public, coupled with a growing interest from clinicians, researchers, and patients. This is reflected in significantly higher demand for clinical assessments and frequent media reports of a surge in ADHD cases across the lifespan. These trends are puzzling as it is unknown what they truly reflect: an improvement in clinical detection or a concerning degree of overdiagnosis? A key reason for this uncertainty is our limited understanding of the disorder and imprecision of the diagnosis – a long-running subject of criticism. To better understand these issues, in this article we deconstruct ADHD through the lens of its DSM-5-TR diagnostic criteria – the basis upon which the diagnosis is routinely made. Our in-depth analysis reveals major problems associated with the diagnostic criteria with respect to their arbitrariness , vagueness , redundancy , and context-dependent normality , which together substantially undermine the validity and reliability of the diagnosis, and the ADHD construct itself, blunting the precision of ADHD research, clinical decisions and the effectiveness of treatment – all of which are contingent on having a robust diagnosis in the first place. Hence, our detailed deconstruction of the diagnosis of ADHD is critical as it provides the necessary groundwork for its accurate reconstruction – an essential step towards developing a valid, reliable, and clinically meaningful diagnostic foundation that will inform research and improve clinical care for patients with attentional and hyperactivity-impulsivity problems.