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Sunday, January 11, 2015

ADHD: A ‘Real’ Brain Disorder or Further Medicalising of Childhood?

From The Guardian (U.K.)

By Dr. Lucy Johnstone
December 30, 2014

Educational psychologists’ alarm about the over-prescribing of hyperactivity drugs to very young children (Report, 22 December) is welcome.

But the underlying question remains: how it is that a “disorder” which scarcely existed in the UK in the 1980s, though widespread in the U.S., is apparently so prevalent now that it is said to affect up to 5% of our nation’s children?

‘Children under six meant to be hyperactive! In the sense that
they should be running around pretty much 12 hours a day.’
Photograph: Angela Hampton Picture Library/Alamy

Even the National Institute for Health and Care Excellence guidelines, to which your report refers, do not question that attention deficit hyperactivity disorder is a “real” brain disorder, rather than a convenient way of labelling a child who is boisterous and disruptive in class.

Ask paediatricians how often they saw children with “minimal brain dysfunction”, as ADHD was then known, in the 80s, and their answers range from one in 100 to one in 500. In the early 90s, Ritalin prescriptions were running at about 2,000 a year, although the drug had been available for years and was in massive use in the U.S.

Today, the figure is over 600,000. Does the fault really lie inside our children’s brains, or is it a further – and dangerous – manifestation of a medicalising culture?

Steven Rose
Emeritus Professor of Biology (Neuroscience), The Open University

"I was not surprised to read that “overstretched health workers go straight to medication rather than offering psychological interventions” to children with ADHD. Being a community paediatrician, I see the lion’s share of children who have neurodevelopmental disorders – at my clinic we see around three children under the age of six every week that are suspected to have ADHD.

Psychological interventions should always be prioritised (as per NICE guidance); however, as the burden of ADHD is grossly under-recognised and therefore underfunded, many community paediatric departments do not have a clinical psychologist in place. This makes providing psychological treatment much easier said than done.

If this postcode lottery does not end and these fragile young children fail to receive the appropriate help they so desperately need, they are, albeit unwittingly, being set on a slippery path – latest research suggests that children with undiagnosed or untreated mental health conditions are much more likely to struggle to achieve educational qualifications and are at much greater risk of committing crime, suffering alcoholism and abusing drugs later in life.

Investment in these vital support services is needed now to help guide these children to a safer future."

Dr. Neel Kamal
Royal College of Paediatrics and Child Health

"Children under six are meant to be hyperactive! In the sense that they should be running around pretty much 12 hours a day. What they lack is opportunities for exercise, particularly outdoors. I see children being taken to and from infant school in buggies, when any normal child over 18 months should not be in a buggy at all. Too many young children are already obese; cooped up at home, in a car, or plonked in front of a TV, then won’t sleep at night."

Mary Smith
Upminster, Essex

"There is a danger of confusing the moral panic in relation to medication for ADHD with the reality of the nature of this condition. The result is to dismiss it as some sort of pseudo-scientific construct sponsored by pharmacological corporations.

My own research and working practice shows, if anything, that ADHD is under-diagnosed and under-treated in at least some localities in the U.K. Perhaps it would be helpful to dispense with the hyperbole and focus more on the statistical evidence regarding incidence and intervention rates.

Health and local authorities need precise information about the extent of the problem, and professionals and clinicians need actively to identify affected children and young people in order to provide adequate services. While “pills are not a substitute for skills”, the evidence clearly shows the efficacy of medication as part of a comprehensive treatment plan.

In approaching the issue I make no excuses in being biased in favour of scientific, egalitarian and humanistic values through seeking to bring some measure of objectivity to bear on the subject."

Henryk Holowenko
Deputy Principal Educational Psychologist, London Borough of Tower Hamlets

"At YoungMinds, we have welcomed recent government announcements: the increased funding for eating disorder services; the ending of children being detained under the Mental Health Act in police cells; and the establishment of a task force to review children’s mental health services. However, we are deeply concerned that the announced cuts to local government funding will be a significant step backwards.

Funding for children’s mental health services comes from a variety of sources, not just the NHS. Local government plays a crucial role in many areas, especially for early intervention services, which the government itself recognises as vital in supporting children and young people, helping them before mental illness becomes entrenched.

Earlier this year we revealed that almost two-thirds of councils had cut or frozen their budgets for children’s mental health services since 2010-11, with one making a cut of 94%. The 1.8% cut to local government funding is likely to further this trend.

If local government no longer has the financial capacity to support early intervention in children’s mental health services, it is essential that these services are provided elsewhere. If they are not, and early intervention services continue to be cut, we will see more children and young people needing more intensive and more expensive support for mental illness, a situation that will cost millions and cause extreme distress and pain to thousands of young people and their families across the country."

Lucie Russell

Director of Campaigns, YoungMinds

"All the mental health charities you are supporting are doing excellent work, but your editorial (24 December) does not reflect the most recent thinking and practice.

The British Psychological Society’s report Understanding Psychosis and Schizophrenia, praised by your columnist Clare Allen (theguardian.com, 2 December), argues that “professionals should not insist that people accept any one particular framework of understanding, for example that their experiences are symptoms of an illness”.

Diagnosis is helpful for some, but others, even those with what you describe as a “critical illness such as schizophrenia”, see their distress as an understandable response to life events and circumstances.

We all share your aim of reducing stigma and bringing mental health issues into the open. Biological views about chemical imbalances, faulty genes and so on are not only unproven but have been shown to increase fear and stigma. Avoiding uncritical use of the language of diagnosis and illness is an important step that the media can take towards changing attitudes."

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