Uses and misuses of treatments for ADHD. The second Birgit Olsson lecture

BACKGROUND: Medication in attention deficit/hyperactivity disorder (ADHD) is so controversial that in some countries many children go untreated, while in others the prevalence of medication has become very high, and possibly even higher than the rate of ADHD. AIMS: This lecture addresses the reasons for overuse and the obstacles to adequate use. METHODS: Clinical and scientific literature is reviewed, with emphasis on published meta-analyses and national guidelines. RESULTS AND CONCLUSIONS: The lecture suggests that overuse is associated with economic forces affecting prescribers, while underuse may come about in some European countries because we have overestimated the hazards of drugs, overestimated the value of non-pharmaceutical interventions or underestimated the severity of disorder.