It is not easy to establish whether a person has ADD or not. The presence of 9 symptoms characterizes the disorder, but 6 is sufficient for clinical diagnosis of ADD. Even with 6 symptoms, it is then not always straightforward to distinguish the attention deficit disorder from mania or depression.
The symptoms may increase and decrease in severity, as well. The instability of the disorder may encourage doctors to overdiagnose it and therefore to overprescribe stimulant drugs to treat it.
The medical status of ADD is unclear, and this has implications for medical insurance practices in the USA. Victims are generally perceived as having personality disorders rather than a medical problem that may be alleviated with drugs. This conception has changed, however. American companies began in 1997 to receive medical disability claims for ADD, and they remain concerned about the potential for fraud, as the symptoms are easy to fake. The potential for claiming permanent disability also looms.