In November 2013, the British Medical Journal published Attention-deficit/hyperactivity disorder: are we helping or harming? by Rae Thomas, PhD, Psychologist, Australia; Geoffrey K. Mitchell, MB BS, FRACGP, PhD, Professor of General Practice, Australia; and Laura Batstra, PhD, Psychologist, Netherlands. The article is part of a series on the dangers of overdiagnosis.
Here are some quotes:
“Prevalence and prescribing rates for attention-deficit/hyperactivity disorder (ADHD) have risen steeply over the past decade, partly in response to concerns about underdiagnosis and undertreatment.”
“…prescribing rates for commonly used drugs such as dexamfetamine, methylphenidate, and atomoxetine for children diagnosed with ADHD have increased.”
“DSM-5 widens the definition of ADHD by expanding behavioural descriptions to include more examples and increasing the maximum age of symptom onset from 7 to 12 years.”
“Among the work group advisers of DSM-5 for ADHD and disruptive behaviour disorders, 78% disclosed links to drug companies as a potential financial conflict of interest.”
“The main medications for ADHD are methylphenidates and amfetamines, which can cause adverse reactions such as weight loss, hepatotoxicity, and suicide ideation, and in the short term may suppress pubertal growth.”
“A diagnostic label is value laden and has the potential to cause harm and, paradoxically, increase mental health problems.”
SUMMARY
This is an interesting and important article. The authors emphasize the factors that are driving the increased “prevalence” and the consequent potential damage, particularly in what they call mild and moderate cases.
Unfortunately, although they don’t describe ADHD as an illness, they do appear to accept a medical perspective, or at least a need for medical intervention, in severe cases. If the problems persist after “minimal intervention” with parents and some “brief …counselling,” they recommend that the child be referred to “a developmental pediatrician or psychiatrist for definite diagnosis and treatment”.
This general theme – that the condition known as ADHD is a valid medical entity that is simply being overused – is becoming quite common. It was the primary thread in Dr. Lieberman’s latest article, and is being widely promoted in an attempt to rescue the illness concept from collapsing under its own weight.
But in reality, there is no more reason to conceptualize severe inattention/impulsivity as an illness, than mild inattention/impulsivity.
Nevertheless, the article is useful. It is certainly a step in the right direction, and provides a long list of references. With regards to the illness concept, my guess is that the wording of the article represents a compromise. Dr. Batstra is quoted elsewhere as saying that “It is a fallacy to regard ADHD as an illness.” Dr. Thomas in Moving the diagnostic goalposts: medicalizing ADHD, states: “I believe that attention deficit hyperactivity disorder is a real disorder; I also believe it’s too frequently diagnosed and over-treated.” Dr. Mitchell’s position is harder to assess, but from the wording of some articles of which he was a co-author, it seems possible that he conceptualizes ADHD as an illness.
For the record, and to guard against misunderstanding, it is my position that the condition known as ADHD is a loose cluster of vaguely-defined problem behaviors, most of which can be conceptualized as a failure on the part of the child to acquire age-appropriate habits in the areas of discipline, self-control, and social interaction. It is not an illness in any meaningful sense of the term.