An American neuroscientist on his way to meet health secretary Jeremy Hunt has this week sparked controversy by claiming that ADHD is no more than a collection of symptoms and should not be considered a ‘real disease’.
Dr Bruce Perry told The Observer that the definition of the condition is so broad virtually anyone could claim to be experiencing at least some of the symptoms at any given time.
He suggests that doctors are too quick to prescribe ‘psychostimulant’ drugs to children when evidence suggests there may not be any long-term benefits.
Calm down all! This is sadly a classic example of newspapers oversimplifying a complex issue.
Before we all jump on the bandwagon accepting reported sound-bites from an overseas expert as the entire gospel truth and demonising doctors who prescribe Ritalin to hyperactive children we all need to take a deep breath.
Like most medical matters this issue needs more of a measured and nuanced approach. A detailed analysis is not possible in this brief blog but here are seven brief correctives.
1. Essentially all psychiatric diagnoses are made clinically on the basis of a constellation of symptoms so ADHD is not unusual in this regard. It is true of course that misdiagnoses are both possible and do happen but ADHD is a mental disorder with clear diagnostic criteria that anyone can look up in disease classifications like the DSM 5 and ICD 10. Only those with significant impairment meet the diagnostic criteria. It is most certainly a real condition.
2. The diagnosis of ADHD needs to be made carefully and always needs input from those who have observed the child in other social settings, especially teachers.
3. Like most mental health conditions the causes of ADHD are multifactorial – both nature and nurture play a part. Genes and upbringing may both contribute in any given case but the condition is a complex product of a variety of causal pathways with no two cases being exactly the same.
4. There is no doubt that parental neglect has a damaging impact on the brain and some of these children can have symptoms that look just like ADHD. The main need for these children is attuned nurture and a good level of care rather than drugs. This is why we have to be thorough in making a correct diagnosis whilst recognising that sometimes neglected children also have ADHD.
5. We don’t generally use Ritalin here now but rather longer acting forms of methylphenidate. This is one danger of having a US ‘expert’ comment on a UK situation.
6. Drug treatment is very effective for some children (but not all) and reduces likelihood of social exclusion, school failure and family stress which may well have an impact on later life trajectory.
7. Some children with ADHD are overtreated, but overtreatment rates are much higher in the US than in UK. NICE guidelines clearly state that specialised parenting support should be given as a first line intervention.
It’s just not as simple as the Telegraph and Observer would have us believe. Superficial and simplistic assessments of complex medical problems create needless anxiety and lead to knee-jerk political solutions.
I hope that policy makers who have listened to the journalistically filtered conclusions of Dr Perry will take soundings from UK experts in the field rather than being guided by newspaper columnists who haven’t properly researched their subject.