Rethinking ADHD: Fixed Disorder or Context-Dependent Continuum?

Abstract

Attention-deficit/hyperactivity disorder, also known as ADHD, is one of the most commonly diagnosed neurodevelopmental disorders in children, often continuing into adulthood. In the past, ADHD has been viewed as a fixed condition, where you either have it or you don’t. However, researchers have begun to explore the idea of ADHD existing on a continuum, with symptoms manifesting on a spectrum of varying intensities. Evidence from research supports the idea that ADHD symptoms appear differently across individuals and can fluctuate with time and context. Additionally, ADHD has no single, clear biomarker, further supporting the dimensional view of this condition. Therefore, examining ADHD through a dimensional lens can provide new insights, helping clinicians better understand the unique ways the condition presents in each individual and enabling more comprehensive and individualized interventions. While there are clear benefits to this approach, concerns exist regarding insurance coverage, clinical implementation, and diagnostic thresholds, all of which can pose barriers to its application. This paper proposes an integration of both categorical and dimensional frameworks, where a categorical structure can be used for access to services, while a dimensional approach can be utilized in further understanding and personalizing interventions. This combined approach will allow for more accuracy and effectiveness during diagnosis and treatment, creating better overall care for individuals with ADHD.