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BACKGROUND: Attention Deficit Hyperactivity Disorder (ADHD) holds the distinction of being both the most extensively studied pediatric mental disorder and one of the most controversial. This is partly due to the fact that it is also the most commonly diagnosed mental disorder among minors. On average, 1 in every 15 to 20 children in the U.S. has been diagnosed with the disorder and 1 in every 20 to 25 uses a stimulant medication—often Ritalin, Adderall, or Concerta—as treatment. The biggest increase in youth diagnosed with ADHD and prescribed a stimulant drug occurred during the 1990s, when the prevalence of physician visits for stimulant pharmacotherapy increased five-fold. This unprecedented increase in U.S. children using psychotropic medication triggered an intense public debate. When the 1990s began, most schools across the country had only a handful of (if any) children diagnosed with ADHD and using stimulants. By 2000, every classroom in the United States had, on average, at least 1 to 2 such students treated for the disorder. Currently, almost 8 percent of youth aged 4 to 17 years have a diagnosis of ADHD, and approximately 4 percent both have the diagnosis and are taking medication for the disorder. RESEARCH QUESTIONS: ADHD has been present under different diagnostic labels in the U.S. for at least seventy years, so what accounts for the rapid growth in diagnoses, stimulant treatment and the disorder's popular acceptance within the past twenty years? To what extent have the evolution of ADHD and stimulants been unique compared to other mental disorders and forms of pharmacotherapy? And why did stimulant use by children become so controversial yet commonplace? FINDINGS: As this book attempts to explain, the massive increase in the number of U.S. children diagnosed with ADHD and using stimulants stemmed from: a confluence of trends (clinical, economic, educational, political), an alignment of incentives (among clinicians, educators, policy makers, health insurers, the pharmaceutical industry), and the sizeable growth in scientific knowledge about ADHD and stimulants that converged in the first half of the 1990s. Growing political movements advocating for children's welfare and mental health consumers, along with the decreasing stigma associated with mental disorders, led to three seemingly minor changes—to disability, special education, and Medicaid policies—in the early 1990s that helped trigger the surge in ADHD diagnoses and related stimulant use.DISCUSSION: The use of stimulant medication for the management and treatment of ADHD has vocal supporters and critics alike, and as our book describes, the history of the diagnosis and treatment of the disorder reveal numerous controversies. Today, however, the controversy is not focused as much on whether or not ADHD is a "real" disorder. It is widely recognized as such. If controversies about ADHD continue, then, they are less focused on the existence of the disorder than on some of the consequences of the disorder. For example, what are the policy implications? What are the implications of the increase in the use of stimulant medication in recent years? How do ADHD and the use of stimulants fit with concerns about "cosmetic psychopharmacology"? The enduring controversy about ADHD in the public arena reflects the discomfort about what happens when the science is translated into policies and rules that govern how children will be treated. A diagnosis of ADHD is not simply a private medical finding; it carries with it a host of public ramifications... ..PAT.-Unpublished Manuscript [ABSTRACT FROM AUTHOR]