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April 28, 1999

Treatment of Attention-Deficit/Hyperactivity Disorder—Reply

JAMA. 1999;281(16):1490-1491. doi:10-1001/pubs.JAMA-ISSN-0098-7484-281-16-jbk0428

In Reply: Dr Baughman calls attention to a point that we made in our article, namely that to date, the pathophysiology of ADHD remains unknown. We share with him the hope that further research will elucidate it and thus improve diagnostic accuracy and treatments. We do, however, disagree with his assertion that the absence of "a confirmatory, physical abnormality" makes ADHD not a "real disease" and that pharmacological treatment represents the drugging of "normal," disease-free children. There are many conditions in medicine (eg, schizophrenia, idiopathic epilepsy) without uniform anatomic or well-understood physiological abnormalities. Physicians would do a grave disservice to patients with symptoms of these conditions by withholding empirically established pharmacotherapies until the scientific understanding reached a threshold to satisfy the austere standards proposed by Baughman.