Hi, You’re right, I’m equivocating a little. After we “rediagnose” the majority of people with attention deficits as being caused, or “secondary” to something else, and then we assess the majority of the rest as “mismatches” along the normal spectrum, are there a few people who actually have a “primary” disorder that should be called ADHD? My sense is that there are, buried under the avalanche of all these other people, a few people, mostly children, who have some kind of neurodevelopmental disorder, perhaps of the timing of myelination, that causes attention problems, often transiently as their brain further develops. I’ve met a handful of adults who I thought had that and hadn’t outgrow it. Child psychiatrists may have a different experience. When I shared this article with my college psychiatrist list serve, they generally agreed with my sentiments, but almost all thought I shouldn’t refuse to ever use stimulants, that there are a few people who should be prescribed them – this same group. Coincidently, or maybe not, last week I met a woman whose older brother was violent to her every day of her life, until at age 18 her parents were pressured into giving him stimulants and his severe hyperactivity, agitation, and violence all disappeared and he went on to college, marriage, having kids and she was able to begin her recovery. Its still hard for me to prescribe stimulants even in that setting, without really knowing what the risks really are, but they’re probably right, I shouldn’t say never.