Asian Journal of Advances in Medical Science

Attention-deficit/hyperactivity disorder (ADHD) is among the most frequently diagnosed neurodevelopmental conditions of childhood, and the past decade has produced an unusually rapid accumulation of diagnostic technologies, pharmacological options and psychosocial or digital interventions. Whether this activity constitutes genuine advance, or largely the elaboration of a diagnostic and therapeutic framework whose foundations remain unsettled, has not been examined critically in a single integrated appraisal. This review evaluates the strength, consistency and translational readiness of recent evidence on paediatric ADHD diagnosis and treatment, and distinguishes conclusions that can be regarded as secure from those that remain provisional. Literature was identified through structured searching of freely accessible bibliographic and metadata resources, supplemented by citation tracking and institutional guideline sources, and appraised for design adequacy, outcome blinding, replication and external validity rather than citation frequency alone. Four findings organise the synthesis. First, measured prevalence continues to be governed principally by assessment method and administrative context rather than by any demonstrable change in underlying population morbidity, and contextual artefacts such as relative age within the school year remain detectable in diagnosis and prescribing. Second, neuroimaging, genomic and computational approaches have clarified aetiological architecture and generated group-level effects of consistent direction, but effect magnitudes and the scarcity of external validation place individual-level diagnostic application beyond current reach. Third, pharmacological evidence has shifted from questions of whether medication works towards questions of dose, duration and cumulative risk, with newer dose-effect and long-term safety analyses providing more actionable guidance than further placebo-controlled efficacy trials. Fourth, the divide between unblinded and probably blinded outcomes continues to separate apparent from demonstrated benefit across almost the whole non-pharmacological field. The most defensible conclusion is that the principal constraint on child outcomes is no longer the absence of effective agents but the weakness of diagnostic precision, outcome measurement and service delivery. Priorities include active-placebo and blinded-outcome trial designs, prospectively registered external validation of computational classifiers, and evaluation of care models against functional rather than symptom-scale endpoints.