George Halasz and Alasdair L A Vance, in their article, Attention deficit hyperactivity disorder in Children: moving forward with divergent perspectives, claimed that the US National Institutes of Health released a statement, in the year 2000, that the diversity of opinions about ADHA raises questions concerning the literal existence of the disorder, whether it can be reliably diagnosed. And Dr. Peter Jensen, from the US National Institute of Mental Health, stated that according to the panelists, ADHA remains of an “unproven” status and should give pause to both researchers and clinicians who may have reified ADHA as a ‘thing’ or ‘true entity’. No clinical or laboratory test can validly and reliably distinguish children with ADHA from those without ADHA and given the heterogeneity of the condition as currently defined, it seems unlikely that such a test will emerge, according to the article. Halasz and Vance suggest, since there to no test for ADHA, the Diagnostic and statistical manual of mental disorders-4th edition (DSM-IV) bases diagnosis on the on the specific clinical features – behavioral symptoms and signs. According to the article, the DSM-IV taskforce chair observed that this approach perpetuates the lack of “developmentally sensitive, interactive or longitudinal perspective which limits the usefulness of the categories for both research and adolescents,” which means, DSM neglects developmentally sensitive interactive issues, such as attachment, which could into lead to misdiagnosis. This article suggests that while there is growing evidence for biological vulnerabilities associated with ADHA, George Halasz and Alasdair L A Vance believe that environmental factors, including early problems in parental attachment, are important in determining the type and timing of deficit that a child develops the risk to academic and social performance and eventual outcomes. Halasz and Vance advocate an integrated biopsychosocial approach to diagnosis and management with a thorough developmental assessment to identify developmental factors, such as deficits in early attachment, contributing to the presentation, according to the article.