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163305 tn?1333672171

ADHD: a ‘real’ brain disorder or further medicalising of childhood?

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 US, is apparently so prevalent that it is said to affect up to 5% of our nation’s children? 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 US. 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 underdiagnosed and under-treated in at least some localities in the UK. 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 taskforce 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.

4 Responses
585414 tn?1288944902
    Yes medication for adhd can cause severe side effects for some children and should not be overused. The diagnosis itself can be very helpful because it can entitle a  child to supports and services and accommodations that can be of help. Also talk therapy and cognitive behavioral therapy can also address  concerns with adhd that sometimes can help without medication with children. I do however know some people
who have benefited from treatment for adhd early on.
    The confusing of normal behavioral patterns with adhd is of concern and normal interactions should not be symptomatized. I would disagree with them putting schizophrenia in the same category because regardless of any medication side effects I acquired later on the symptoms of schizoaffective disorder I had starting early on impacted on my life
to the point where I wish I had started medication earlier.
    Further research from a psychosocial not just psychiatric
viewpoint would be of help.
163305 tn?1333672171
My son and I agree that if he'd been born just a bit later, he'd no doubt been diagnosed with adhd by his teachers. He really couldn't sit still and while young, had no interest in school. Additionally, he's left handed.As it was I often had to be his advocate during his school years as he simply didn't fit into the box.
BTW: This didn't stop him from getting his MBA from Cornell !

I'm sure there are indeed children who need medication but the idea of over medicating children because they don't sit still or learn same way as others, is problematic, to say the least.
973741 tn?1342346373
I have mixed feelings on this.  I had two sons close together both with some basic 'normal' boy qualities that frustrate your average parent but there was a difference in one of my boys.  Some of that difference he noticed himself.  He couldn't mesh well with the other kids, did things impulsively that bothered them, had social skills issues, couldn't sit and do the little activities that the other kids seemed to be enjoying, etc.  I've told people this before that when my 4 year old looked at me and said "I just want to be like one of the guys"---  my heart broke for him.  He STILL has that as a goal because it is ALWAYS an internal struggle to 'maintain'.    It's hard on him to feel different.  And make no doubt about it, add/adhd kids and those with similar neurological conditions feel like stand outs in a negative way.  

This is when I think a parent has to decide what route to take.  My son does not have add/adhd but sensory integration disorder which is add/adhd's lesser known cousin.  It's also a neurological delay.

Please don't think because your child was peppy that he'd have the same experience that a child who has a true neurological disorder has.  I would go to a park so my son could do what he needed to do to calm his nervous system and moms would stare at him.  They all looked at him like he was a freak sometimes as he cocked his head to one side and spun in circles all around the playground or as we have sand at a playground, he would run, crash into the ground with force and roll over and over again.  These were impulses that help give his nervous system calming input.  I would bet your average child doesn't do as much of that or with the same intensity of a child who's nervous system was trying to heal itself causing these impulses.  My other wacky son certainly didn't do these things.  he had his high energy moments but he never threw an utter meltdown, fit because he got water on his hands.  He never ran from a family part screaming because 'his engine didn't feel right anymore (what we called his nervous system).  Fight or flight is a rough one for parents to deal with.  Running out of the building at full force at preschool when it was time to do circle time or hold a pencil.  Got some calls and we had to problem solve on that one.  Bless them for working with us!!  

My son went to occupational therapy for 6 years.  It wasn't for high energy and normal kid stuff.  he had to learn to sit and do work.  To be able to listen to someone when they were talking. To focus enough to have a two way conversation with a peer.  To be flexible enough to last during an hour play date not doing EXACTLY what he wanted so that he could have friends.  

We spent every single day for YEARS running  our home like a mini sensory disorder bootcamp.  I set up obstacle courses, we lifted light weights, we practiced conversation skills, we practiced what it would be like to do homework, I spent the summer before preschool acting like our family room was a preschool . . .   my sons had to take turns talking, had to raise their hand, went to little stations.  Just 'trying' to get him ready.  

He's never taken medication.  But I tell you, if my son had add/adhd and medication helped his disorder, even though I would hate to give him medication, I'd do it.  

Not for me to have it easier or for him to be easier around, but for how he'd feel on the inside.  

My son is now 11, in 5th grade.  He's quite bright, gets straight A's, has a couple of good friends, swims competitively (the perfect nervous system exercise), is in band and plays trumpet (okay, THAT is a little painful), etc.

But my kid would tell you that he feels different and wishes he didn't.  I do the best I can still and hope he is okay in life.  

So, when people say it is over diagnosed?  Perhaps.  I can agree to that.  But there are a lot of people that refuse to admit that their children aren't perfect.  That their bad grades are because there child isn't a genius.  Etc.  And that is unfortunate.

And if my son had add/adhd, I'd try alternative ways of handling it especially after all I've learned about sensory.  But . . .  lots of parents are so ill equipped to help their children in any real sense.  that is not being rude but not everyone is an older mom like myself who gave up her career to focus on her kids.  (meaning, I'm educated, have financial means and am able to adapt to situations and problem solve to improve them.  I can watch an OT session and concoct something similar in our house to give the same input and do it at home during the week . . .   etc.)  My kids did have an advantage in this way.  Other kids don't have that and they get parents who just go for the pill.  

anyway, that is why I have mixed feelings.  :)  I've seen that pill also change the lives of kids I know in a very very positive way just as occupational therapy helped my son.  I'd never think that was a bad thing.  But then we do need to be prudent as well to make sure that a child really has a diagnosis and proper diagnostic criteria was used.  

Okay, everyone good luck
163305 tn?1333672171
Thank you for the heartfelt response and sharing your experience.
You are right, my hyper son was not the same as one who is 'different' in the way your son is.
AND I could not agree with this quote more "But there are a lot of people that refuse to admit that their children aren't perfect."

Kids are kids just as people are people and none of us is perfect or can be the best of everything or for most of us, the best of anything other than being ourselves.

Your boys are very lucky to have you as their mom :)
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