[Is The ADHD Bomb About to Explode? The Impact of The Medicalization of Attention-deficit/hyperactivity Disorder on Its Pharmacotherapy and Institutional Context in Hungary]

László Lajtai;

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ABSTRACT

The manuscript addresses the social, clinical, and institutional dimensions of attention-deficit/hyperactivity disorder (ADHD), with particular emphasis on the problem of medicalization and controversies surrounding pharmacological treatment. It briefly summarizes the discrepancies in epidemiological literature across countries and age groups and critically analyzes selected aspects of DSM-5 criteria (e.g., the undefined threshold for "often"). The paper highlights that the expansion of diagnoses is partly driven by institutional, economic, and cultural factors, including educational expectations, access to healthcare, and pharmaceutical interests. It provides a detailed discussion of the benefits and risks of methylphenidate, the issue of misuse, and the role of atomoxetine as an alternative. Shortages of system capacity, lack of specialists, and pressures on primary care are emphasized. Illustrative clinical vignettes are presented, though the author underscores their anecdotal nature and cautions against overgeneralization. The concluding section offers consistent recommendations: avoiding liberalization of methylphenidate prescribing and/or introducing stricter centralized control, concentrating the management of severe cases in designated centres, and strengthening psychosocial interventions as well as school- and young adult-related support systems. The paper is intended as a position piece and a contribution to a possible ongoing debate. Orv Hetil. 2025; 166(49): 1935-1942.

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