While ADD/ADHD is a known psychiatric condition, there are various theories about the cause and some controversy over the number of persons diagnosed and the cost of medications. Some denial in families may also relate to the negative perception of the condition as a hereditary brain disorder.

Critics have complained that the ADHD diagnostic criteria are sufficiently general or vague to allow virtually any child with persistent unwanted behaviors to be classified as having ADHD of one type or another.

A growing number of critics have wondered why the number of children diagnosed with ADHD in the U.S. and UK has grown so dramatically over a short period of time. However, doctors often claim that improving methods of diagnosis and greater awareness are probably in part, if not mostly the reason for this increase.

It has often been suggested that the causes of the apparent ADHD epidemic lie in cultural patterns that variously encourage or sanction the use of drugs as a simple and expeditious cure for complex problems that may stem primarily from social and environmental triggers rather than any innate disorder. Some critics assert that many children are diagnosed with ADHD and put on drugs as a substitute for parental attention, whereas many parents of ADHD children assert that the associated demand for attention goes beyond what can be humanly provided, causing massive disruption to other individuals and relationships, as well as to environments with dysfunctionally structured relationships such as are manifest in many classrooms. This criticism also includes the use of prescription drugs as a substitute for parental duties such as communication and supervision.

Another source of skepticism towards making the diagnosis of "ADHD or not ADHD" may arise from the rising diagnosis of subclinical forms of ADHD.

Proposed by Thom Hartmann, this evolutionary psychology theory holds that ADHD was an adaptive behavior for the "restless" hunter before agriculture became widespread. Scientific concern around Hartmann's theory revolves around the mismatch between the behaviors symptomatic of ADHD, and those he describes as being adaptive for hunters, which better fit a diagnosis of hypomania (Mota-Castillo, 2005). A positive feature of the theory is the idea that thinking in terms of attentional 'differences' rather than attentional 'disorders' may direct effort toward utilizing an affected individual's strengths and uniqueness.

Following from the Hunter-versus-farmer theory, as with many conditions in the field of psychiatry, ADHD can be explained as a social construct rather than an objective 'disorder'.

In this view, in societies where passivity and order are highly valued, those on the active end of the active-passive spectrum may be seen as 'problems'. Medically defining their behavior (by giving a label such as ADHD) serves the purpose of removing blame from those 'causing the problem'.

Showing that people with ADHD show differences from others by the use of medical tests such as PET scans does not answer the social constructionist view since such differences could be expected to be found in people at one end of any behavioral spectrum. Nor does evidence of successful treatment undermine the social constructionist view; for example the American National Institute on Drug Abuse reports that Ritalin is abused by non-ADHD students partly for its ability to increase their attention. To undermine the social construction explanation, it would need to be demonstrated that ADHD is a true disorder (rather than a collection of traits) and that there is a distinct sub-group who clearly fall into the category. Neither proof yet exists.

There are some claims that ADD/ADHD is simply a hoax. Some of these charges are that there has been a conspiracy between medical and counseling professionals and the pharmaceutical companies, or that the former have been misled by the latter, which have profited greatly from the sale of medication such as Ritalin and Adderall, and have advertised their products extensively. Since medications became available, there has been an increased number of persons diagnosed. This might be explained by increased awareness or easy solution for doctors.

Another explanation comes from a common misconception of the symptoms that leads to an incorrect diagnosis. For example, an employee of a school might think that a student has ADD simply because the child cannot be controlled in the classroom. A teacher may think a student whom they cannot control has ADD, but in reality the problem may be a lack of discipline. The same teacher might not notice a child who forgets their papers, stares (entranced) at the carpet for long periods of time, or shows many of the recognized symptoms.

However, the results achieved in clinical tests with medication and anecdotal evidence of parents, teachers, and both child and adult sufferers has been taken as "proof" that there is both a condition and successful treatment options for most people who meet the criteria for a diagnosis. One problem lies in misdiagnosis; critics believe many of those being treated for ADHD do not suffer from the disorder to such a point that potentially mind-altering drugs should be prescribed.

A further problem is that ADD and ADHD are syndromes, associations of symptoms. There is no well established cause for the condition. This means that it may actually be a blanket term covering a multitude of conditions with a variety of causes.

Confusion may also arise from the fact that ADD/ADHD symptoms vary with each individual, and some mimic those of other causes. A known fact is that, as the body (and brain) matures and grows, the symptoms and adaptability of the individual also change. Many individuals diagnosed with ADD/ADHD successfully develop coping skills, while others may never do so.

Some people use the hunter-versus-farmer theory mentioned above to support the idea that ADHD is not a true "disorder". Our society, in which many people sit in an office or school for long periods of time without moving about, puts those who feel the urge to be active at a disadvantage and they may be singled out. In fact, some people say, it is society at large that is to blame, and what we know as ADHD may be just a social construct.

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