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As an OT, I often argued with the psychiatrists about some of the kids. With the kinds of tasks I did in my groups, it was pretty clear who couldn't focus ever and who had bouts of anxiety or boredom.
And yes, I was working with a unique population of kids who had a wide variety of complex behaviors that needed to be looked at. It just seemed crazy to me to diagnose by whether the meds worked or not. There is testing available and full time observation by staff in those situations.
And, as with most things, there are varying degrees. Some have only mild ADD and can learn to compensate. My ex-husband is definitely ADHD but did learn to compensate and got his MBA without meds. I sometimes wonder how he manages to be an accountant, but he did finally get a diagnosis and went on meds briefly. Because he was so adjusted to functioning in his own way, the meds threw him off kilter and he was a mess. He thought there was something really odd about focusing on one task for a couple hours at a time and it made him really uncomfortable.
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