Why is ADHD so under-diagnosed and treated?
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Are all young people with ADHD even being identified, far less receiving behavioural or other intervention? (Getty Images: Cancan Chu, file photo)
The child and adolescent component of the 2000 National Mental Health Survey reported a rate of attention deficit hyperactivity disorder (ADHD) of about 6 per cent, essentially identical to a recent analysis of data from throughout the world.
Yet the highest rates of medication for ADHD in Australia are no more than about 1.5 per cent. What is happening to the other 75 per cent of young people whose lives and those of their families are impaired by ADHD? Are they even being identified, far less receiving behavioural or other intervention?
Even worse, have their families fallen victim to some of the profitable programs which claim to "cure" ADHD? For example some 12000 Australian families have paid their $5,000 for the now bankrupt Dore program, marketed as a non-drug approach to ADHD and reading disability among other disorders. For ABC viewers, see the Four Corners program The Behaviour Business from last year.
There is no doubt the first form of intervention except in the most serious cases should be behavioural, but where are families going to find the necessary expert and can they afford her or him? And can they be sure there is a good evidence base for the intervention they are receiving?
Misconceptions
There are many common misconceptions about ADHD, one of which is that it is a "modern disease". It was actually really well-described by an English paediatrician, George Still back in 1902 though he called it "defective moral control"!
Secondly, ADHD is difficult to diagnose as there is no biological test for it. In fact there is no biological test for any child or adult behavioural disorder and ADHD is actually probably easier to diagnose than depression, which no one would deny exists. The symptoms of ADHD are external and easily seen. The symptoms of depression are internal and often may be unknown to others.
The third common complaint is that ADHD does not exist as all of us sometimes show common symptoms of ADHD such as being inattentive or fidgeting. That's true, because ADHD is a continuum through the population as are symptoms of depression or our blood pressure. But we have to draw the line somewhere in terms of deciding when someone needs treatment for their depression or high blood pressure. ADHD is no different.
In fact when the most recent diagnostic criteria for ADHD were developed in the USA in the mid-1990s, they set the bar pretty high in terms of the number of symptoms you had to have. Essentially all these people would have impairment at home or school or work or in personal relationships, etc. You could say the threshold is arbitrary but we accept many such decisions - try using the same argument with the police officer who stops you for speeding or being over the blood alcohol level! These cut-offs are equally as arbitrary.
'Good news is no news'
Is ADHD being over-diagnosed? There have been very few reports in the media on the NSW audit of ADHD which came out in February this year. Asking clinicians about their diagnostic practices and actually going to some 30 practices and going through their records showed that almost all practitioners were thorough in their assessment. This got no media coverage while if it had been the opposite and negative about ADHD, it would have been on the front page of every paper! Good news is no news.
What causes ADHD? Since about 1990 I have been fortunate enough to have worked with Professor Florence Levy from Sydney, developing the Australian Twin ADHD Project which is now one of the world's largest studies into the causes of ADHD. I have worked in the area of behaviour genetics since 1968 and ADHD would have one of the largest genetic components I have ever encountered. This is not just our work but has been found throughout the world.
There have even been specific genes identified for ADHD, mainly involving dopamine, the chemical messenger in the brain which is most affected by stimulant medication. Many of the environmental risk factors which have been found to contribute to ADHD may actually reflect the genetic background. So while maternal smoking during pregnancy is one such factor, is it the nicotine or the fact that only women who are high risk-takers continue to smoke during pregnancy? And people with ADHD are such risk-takers. US studies show they have much higher rates of everything from traffic accidents to teenage pregnancy. Obviously this has implications for parent training programs, if parents have problems with disorganisation or impulsive behaviour.
One of the main outcomes of our work on ADHD has been a much greater appreciation of comorbid conditions, the other problems which people with ADHD may have. Many have learning problems which pose extra challenges for the education system. Many are what used to be called clumsy - the new term is developmental co-ordination disorder. And one consequence is poor self-esteem. You are not doing well at school or at sports and your inattention to social cues or your habit of butting-in to conversations because of your impulsivity doesn't get you many friends.
Families deserve a better deal
What of adult ADHD? The diagnosis is more controversial though improving. Not helped by Time Magazine which claimed Bill Clinton has ADHD - which is one explanation for some of his indiscretions! We are now recognising that some, perhaps half of those with ADHD do not grow out of it and there is increasing evidence that they may not succeed in their careers as well as other people and their relationships may be subject to more tension.
Many people relate ADHD to substance abuse and that is true. A recent Dutch study indicated a rate of some 20 per cent among substance abusers and of one my students found a rate closer to 45 per cent in those using the needle-exchanges in Perth and who are therefore pretty serious users. But what is rarely pointed out, is that there have been 11 studies that showed there is one way to reduce this risk - take stimulant medication. Such medication does reduce the risk of starting to abuse licit or illicit substances and actually helps get the person back on a more even keel to approach the challenges in their life.
Families with ADHD deserve a better deal than they are getting. Families with depression get great support from the community, the media and especially politicians. Jeff Kennett is a great advocate for the understanding of depression. Those with ADHD deserve the same and to live in a world where there are more votes in supporting well-evidenced practice in the diagnosis and management of ADHD than in bagging the entire disorder.
Professor David Hay is a professor of psychology at Curtin University of Technology. He is a member of the group drawing up new national guidelines on ADHD, but is writing here in a personal capacity. Professor Hay discloses that he accepts travel expenses from pharmaceutical companies in order to speak at conferences, in adherence with his employer's guidelines, but does not accept fees from such companies.
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Comments (112)
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Another Perspective:
29 Aug 2008 10:09:33am
I'd like to know how we got to the point where we drug millions of children whose brains are still developing to combat (ADHD). It is worth repeating that this alleged disorder has no medical validity whatsoever. That is, no tests can prove or deny its existence.
ADHD, its symptoms and diagnosis are entirely subjective. And I know first hand that the medical establishment are far too keen to prescribe drugs such as Ritalin, Concerta, and others.
These same children/adults can focus on what interests them, master complex video games, have the discipline and drive to win 8 Gold medals (Phelps), but come the arrival of homework and tests - out comes the prescription bottles of mind altering drugs to assist in the treatment of ADHD. Something isn't adding up right.Agree (0) Alert moderator
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John R:
29 Aug 2008 10:46:20am
The luxury of the recent era has been that we can readily buy off-the-shelf solutions to our problems. Alcohol is another mind-altering substance taken in binge-drinking sessions to have a particular effect. Coffee and caffeine/sugar drinks are taken for buying a different state of mind. Drugs are taken to relieve cold symptoms.
Drugs to alter the behaviour of children doesn't really stand out as something particularly different. Some parents will readily alter their child's behaviour just by regulating their diet, but with parents not having much time on their hands, its easier to not have to worry so much about the diet and instead just use the drugs from the pharmaceutical companies.
As part of this drugging approach, we could also see a solution to crime in the community, with people who are genetically at risk of being criminals being directed to undergo drug treatments to "fix" their behaviour. All we need to do is find genes that are correlated with violent assault (for example), call it a condition, give it an acronym, and prescribe the drugs. With the talk of increased treatment of adult ADHD, the author of this article is pointing in this direction.Agree (0) Alert moderator
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Tara Sykes:
29 Aug 2008 12:15:24pm
For all of you who who choose to live in ignorance and who are not parents of a child with diagnosed ADHD...let me tell you this.
The Education System demanded that we have our daughter diagnosed and medicated.
A diagnosis is not handed out willy nilly nor is medication dispensed at the leisure of a pediatric specialist. The effect of appropriate medication can be observed physically and almost instantainously. As responsible parents we want the best opportunities for our child. She is not an uncontrollable brat nor is her behaviour the result of bad parenting. Conerta has helped her concentrate better at school, improve her social skills and blossom into the lovely well mannered bright creative child that she is.
Unfortunatly these children are labelled, victims of bullies and discriminated at school which exacerbates their anxiety and impulsive behaviour. People can be so cruel at times.
ADHD is not a recognised disability here in Australia so schools can not get allocated extra funding to employ provisional education support assistants.
It is an uphill struggle to advocate for her right to be accepted for who she is.
Before any of you pass judgement ....walk a mile in our shoes.Agree (3) Alert moderator
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Ford:
29 Aug 2008 12:46:16pm
"The effect of appropriate medication can be observed physically and almost instantainously".
Not really a convincing argument, I could give my nephew a shot of morphine and the effect would be instant...doesn't mean it was warranted or effective.
The poster was quite correct to point out there is no definitive proof of the existence of ADHD, which doesn't mean it isn't an entirely valid and real condition...but it might just as easily be something as simple as the fact that some kids are disruptive brats, or that some parents want an easy way out of dealing with behavioural problems. It might even be linked to diet, lifestyle, recreational habits...there's any number of possible causes.
Personally, I think the jury is still out...but if a few pills will enable a child to sit down and get a decent education that they'd otherwise miss out on (for whatever reason), so be it.Agree (0) Alert moderator
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BillyBoy:
29 Aug 2008 2:31:34pm
Presumably Ford, the shot of morphine would be administered in response to a specified symptom... so naturally it would be it would be both warranted and effective! I think you'll find that Tara's child has exhibited symptoms and the medication has been effective. Yes there are chemical reactions that are observable.. but the symptom has been alleviated... in other words Tara's point is precisely accurate!
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James:
29 Aug 2008 1:47:54pm
My nephew was "diagnosed" with ADHD so now every time he played up at school they medicated him. (Why did he play up in class? Must be the ADHD! Teachers and the rest of the school just assumed that because some fruit at some stage had said the poor kid had ADHD then every outburst must be that!)
The school told my sister that if they didn't medicate him he wouldn't be allowed back.
My nephew hated the drugs - he'd tell me that make him feel slow and dopey. My sister hated them because such an active child suddenly wanted to sit around and do nothing.
The problem was solved when we sat down with the child and said that if he misbehaves in class they'll drug him. So now he is a lot better behaved and when they do give him the pills he spits them out when they're not watching.
So in my experience, ADHD diagnosis is a joke, the drugs given to kids are criminal and any one who supports such a system is guilty of child abuse!Agree (0) Alert moderator
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Mick:
29 Aug 2008 2:09:37pm
yes true that... instead of ritilin my parents had "the boot" "the belt" and the classic "firm open hand smack on the bum"
i had all the symptoms of ADHD, mind you this was at school, where i was BORED!, at home i never had a problem because of my parents medication for when i mucked up... but i don't know crap, i've only turned myself from the class clown (89-00) into a manager at 25Agree (0) Alert moderator
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Mick:
29 Aug 2008 2:31:21pm
except of course, instead of being drugged i was told my parents would be called if i didnt stop mucking up.... that would of course lead to a good smacking/boot to the bum
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Mick:
29 Aug 2008 3:41:42pm
"The Education System demanded that we have our daughter diagnosed and medicated"
so the education system is medicare too... something new to me
i think the education department should stick to teaching kids and not labelling these poor children "ill" and need to be medicated
how many children are there on these mind altering drugs and don't actually need to be?
trust me i was a terror of a child, but i had a weakness.... DADAgree (0) Alert moderator
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prickly pear:
29 Aug 2008 5:45:22pm
Its called HYPERFOCUS!!
"From a neurodiversity perspective, hyperfocus is a mental ability that is a natural expression of personality. However, hyperfocus can also be regarded as a psychiatric diagnosis, as a distraction from reality and a symptom of attention deficit hyperactivity disorder (ADHD) or autism spectrum disorder."Agree (0) Alert moderator
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twobob:
29 Aug 2008 10:14:03am
What a load of garbage
ADHD is different to high blood pressure and is not different to depression.
Why? Because you can measure blood pressure and you cant measure the other two.
Some kids are very active (its a biological thing that makes them fitter) and nature has selected for it for a very long time.
Mostly its boys but here is a news flash for you - boys are different from girls and not all boys are the same.
ADHD is not real AD is (eg these kids require more attention than others) and HD is (eg these kids require more exercise than others).
Treat it with attention and exercise DONT try to push the line that a pill will fix everything.
Keep your drugs, or better yet stick them where the sun does not shine, our kids are better off without them.Agree (0) Alert moderator
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Annoyed:
29 Aug 2008 10:33:26am
Ignorance such as yours is astounding.
Here is an article by someone with years of work in this area and you dismiss it outright?
What do you base your assumptions on; A Current Affair? Tabloid newspapers? What research have you done that brings you to your fantastical conclusions?
Barbarian attitudes like yours are what disadvantage these children far more than Adhd.
You should be ashamed of yourself.Agree (2) Alert moderator
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twobob:
29 Aug 2008 10:51:18am
I am afraid that youre very wrong.
I base my evidence upon an article printed by a professor emeritus on the subject, who apologised for the disservice that his profession has done to society. And upon my own experience and that of my son (who the teachers have difficulty with and want to dope up with drugs).
Drugs for something that you can not measure? To even call phycology a science is misleading. What though do you base your opinions on? A Current Affair? Tabloid newspapers? What research have you done? Annoyed is damn right.
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Annoyed:
29 Aug 2008 10:57:45am
An article? Do you not reference and cross reference to get a variety of opinions? I tend to look at a number of sources before i make a judgment, i don't jump on the first ship that's heading in the direction i want it to go.
Can you measure depression? Would you argure depression doesn't exist?
If you are so aware of adhd you would know it runs in a continuum from no adhd to very severe adhd, just like depression. This is why it is so difficult to diagnose and measure. Reread the article objectively and without your pre(mis)conceptions please. Be understanding and tolerant.Agree (1) Alert moderator
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Annoyed:
29 Aug 2008 11:09:21am
It's obvious we disagree on this and a slanging match is unproductive. Suffice to say ill stay on the side of the vast majority of scientific opinion and believe that adhd does exist. I'll put my faith in science before opinion.
Also, I have been a primary school teacher for 20 years and have had my fair share of experience in this area.Agree (1) Alert moderator
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twobob:
29 Aug 2008 11:39:41am
Your right we disagree. It is disagreeable to call me arrogant, barbaric and insinuate that I base my opinions upon the piffle dished out by the popular media. I am a scientist with only 2 years experience so I will leave it up to others to judge who is best qualified to asses this scientific argument.
I have much other evidence to support my opinion but only quoted the weightiest (do you know what a professor emeritus is?). It is the schoolteachers who have the greatest desire to treat my child with drugs (I feel they just dont like active children who question their assertions and disagree with their judgements). I admit it does make teaching the class more of a challenge, but my son is learning quite well despite them.Agree (0) Alert moderator
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Greg h:
29 Aug 2008 2:26:34pm
Yeah depression exists, may be it can also be measured.
There are people who manage it well and who cure it through medidation and exercise rather than prescriptions.Agree (0) Alert moderator
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BillyBoy:
29 Aug 2008 2:15:51pm
A single article by a Professor Emeritus and the experience with your son's teachers? Twobob... that represents barely sufficient basis for any conclusion whatever. How you can assert that psychology is not a science is beyond comprehension and demonstrates a significant level of ignorance! Annoyed you may be, but don't let emotion cloud your judgement... rational, dispassionate examination of the facts is truly the correct course of action... I suggest you try it! It works!
BillyBoyAgree (0) Alert moderator
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twobob:
29 Aug 2008 11:00:29am
AND I would like to say that this fellow who has done years of research still confuses qualitative and quantitative measures. For example blood pressure and depression. This is annoying because I doubt very much if he is confused about these at all, I think he is mixing these measures to add weight to his argument especially to those who dont understand the science of such things.
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Mick:
29 Aug 2008 12:16:50pm
i am 25, had all the "symptoms" of this "ADHD" at school and my parents didn't pay any attention to the teachers saying i should be on ritilin, i was a very active (and still am) person/child, i hated being stuck in a classroom (one of those symptoms) hated class work (symptom again) couldn't sit still at my desk for 10 minutes (duh, i was bored but yes another symptom) didnt complete homework/assignments (was too busy playing with my friends on our BMX bikes and catching lizards at the creek after school, but another symptom)
the ones at my school who were the "worst" of the ADHD kids usually came from a single parent family with no discipline which gave them free reign, and they knew it, they knew they could call the police if their mother/father smacked them... i knew but i was scared to call the police on my dad
funny how right as parents lost the right to smack their children, we end up with a bunch of uncontrollable kids who get labelled "ill" and are medicated, my medicine to keep me out of trouble was my fathers boot in my butt as a kid, nothing was more scary to me than my dad when i was growing up because i knew even though it was called "child abuse" he didnt care because he knew he was doing it for the good of me,
to that i say THANK YOU DAD, THANKS FOR THE SMACKS, THE BELT, YOUR BOOT IN MY BUTT, WITHOUT THOSE THINGS I'D PROBABLY BE OUT ROBBING GRANDMOTHERS OF THEIR PENSIONS!, and because of that i will have no problem in putting my size 10 up my sons butt to keep him in lineAgree (0) Alert moderator
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Roland:
29 Aug 2008 12:59:37pm
Beautifully put Mick!
I too come from the same background, but I'm 33 so I missed out on the dope them up generation, rather I had the cane / the paddle or even worse, dad finding out when he got home...
I too think that kept me on the straight and narrow... sure I hated it at the time, but now I have the maturity and sense to thank my parents for the upbringing because they loved me and sometimes it needed to be hard love...
Get rid of the drugsAgree (0) Alert moderator
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Mick:
29 Aug 2008 1:18:35pm
i am now at 25 a manager in my specific field, although when i was younger i hated my dad when i left school and got into the work force i realised everything he had done was out of love and wanting to see his son make something of himself,
thanks again Dad, i hope to follow you parenting footsteps and will too smack my kid, even at the shopping centre and i dont care i'll do it infront of the police for all i care because i know i'll be doing it out of love for that child and wanting the best for him... my dad did it to me, his dad did it to him.... and so fourth
smacking kids has been around since the dawn of timeAgree (0) Alert moderator
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Peter O:
29 Aug 2008 1:02:26pm
Bad behaviour caused by lack of parental discipline, over indulged brats, and teachers prevented from punishing bad and disruptive behaviour.
ADHD.............A "disorder" invented by drug manufacturers to sell " legal speed".
The disruptive student until 25 years ago, received the cane or the strap, problem solved. Now kids who have never experienced discipline are kept quite by keeping them "stoned ".Agree (0) Alert moderator
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BillyBoy:
29 Aug 2008 2:35:15pm
I suppose you would apply the same treatment regime to cancer, apendicitis and high blood pressure would you boys? Violence solves everything does it? It's the Australian way.. the enlightened path.. give 'em a good kicking and everything will be alright!!!
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Mick:
29 Aug 2008 2:58:50pm
cancer, apendicitis and high blood pressure can be measured... i'm just stating that i grew up when in 89 and i was in kindergarten ADD wasn't known... fast forward to say 96, half my class was ADD/ADHD
all i'm saying is i was too like the ADD/ADHD kids, but i had firm parents and i was too scared of them to muck up because i knew they had no problem in giving me a smackAgree (0) Alert moderator
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Mick:
29 Aug 2008 3:18:04pm
and billy boy, ADD/ADHD is a mental thing (so they tell us) you cannot confuse mental illness to physical illness, chalk and cheese mate
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BillyBoy:
29 Aug 2008 3:36:02pm
So you'd recommend kicking the hell out of a person diagnosed with depression, or autism, or schizophrenia? Hmmm... what an exceptional diagnostic framework!Chalk and cheese right? I don't think so Mick... but, hey... you seem to know... what branch of medicine do you practice?
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Informed Parent:
29 Aug 2008 1:19:14pm
Twobob you are wrong.
A professional paediatrician will subject a patient to many tests, some on a using a computer. The tests record reading, comprehension, spelling, maths abilities etc as well as visual and audio latencies when recognising sounds and patterns. Scores are recorded. A patient will be tested medicated and unmedicated on alternating visits. If there is no difference between medicated and unmedicated then the patient will not be medicated. The results of these alternating tests are real and measurable.
Where do you get your unmeasurable information from?
One more thing. ADHD is caused by genetics(inherited).
Both of my children were medicated and have not gone on to use drugs(in their 20's now). You would not believe how many of their older uncles and aunts have wasted their lives hooked on marijuana etc starting at 15 years of age. Nearly all of these uncles and aunts were diagnosed with Dyslexia or Hyperactivity in the 60's and 70's as the term ADHD along with medication was not introduced until 1988 . I am glad my kids were born in the late 80's.
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twobob:
29 Aug 2008 2:15:24pm
Informed Parent you are measuring reading, comprehension, spelling, maths abilities etc NOT ADHD.
You are also drugging children just to see if it has a measurable difference on the above.
That is barely ethical if ethical at all.
As for genetics, well I expect that you are right, if your children have ADHD then either you or your partner must also have had ADHD, otherwise you could not have passed it on. Were you treated with drugs? or your parents ect ect? I think not.
You see we can get by without the drugs YOU are living proof, so I content that its not me who is wrong but you.Agree (0) Alert moderator
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Mick:
29 Aug 2008 2:35:46pm
sounds alot like Ritilin is the supersession for a good smack on the bum... going from alot of posts on here
all the bloggers whose children have been diagnosed with ADD/ADHD, tell me this, when was the last time you said No to your child, and when was the last time you gave them a good smack on the bum and sent them to their room without any dessert?Agree (0) Alert moderator
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Informed Parent:
29 Aug 2008 2:48:46pm
There is a measuable difference between the way my kids turned out on medication than that of their cousins, aunts and uncles that were born a decade or two earlier and not treated.
Obviously anyone can get by without medication for ADHD, however the outcome will differ. Is that not worth measuring.Agree (0) Alert moderator
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twobob:
29 Aug 2008 4:36:23pm
Different parents, different environment, different resources, different treatment and different kids all contributed to your childrens different outcome.
Therefore it was definitely positively the drugs that they were given that changed the outcomes experienced by your children? It may help if you were a little more informedAgree (0) Alert moderator
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BillyBoy:
29 Aug 2008 3:53:00pm
Sorry twobob, your understanding of genetics is deficient. Generations may intercede before recurrence of a genetic trait will emerge again. Your science is flawed old boy... in fact... your entire argument, which hinges on the assumption that genes must be dominant and observable in the generation immediately before that one in which the gene presents, is totally, utterly and irrefutably wrong!!!
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Mark:
29 Aug 2008 10:16:59am
This author is joking, right? ADHD would have to be one of the most overdiagnosed conditions in Australia, used as an excuse for parents who won't discipline their children and doctors who just want to prescribe something and shuffle the patient along.
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Shaz:
29 Aug 2008 12:41:06pm
Can you cite a reliable source for your assertions? This article is a well thought out and well researched piece. Most of the responses are ignorant doctor-bashing rants based on urban myth and stereotypes. As the author says, the anti-Ritalin groups get all the attention from our sensationalist media, and "good news is no news".
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Mick:
29 Aug 2008 1:53:10pm
smacking children became illegal in the late 80's.... first diagnosis of ADD/ADHD was in the late 80's
thank god my parents ignored what the government told them not to do, otherwise i would have been one of these "stoned" studentsAgree (0) Alert moderator
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Shaz:
29 Aug 2008 3:11:36pm
... which proves my point about the urban myths and stereotypes. Smacking kids is not banned and never has been, and ADHD was described in the early 1900s. Do some research!
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Mick:
29 Aug 2008 3:28:58pm
if you smack your child now, theres DOCS who will take your children away from you, you will be charged by police, you will have to go to court to get your children back, you will have to do classes before you get your children back
and its not banned? i thought if you did something "not banned" then you dont have to worry about DOCS, Police, Courts etc
wake upAgree (0) Alert moderator
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Greg h:
29 Aug 2008 2:28:00pm
The medical profession is also well known for pushing junk science and the over selling of pharmaceutical producsts.
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Mick:
29 Aug 2008 3:35:18pm
yes i've been diagnosed by a GP of things, had a second opinion and it seemed the GP just wanted to get me on meds so he can get kickbacks from writing a prescription every 3 months
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Speth:
29 Aug 2008 4:40:29pm
over-diagnosed yes it may be....the fault of parents who don't effictively discipline theis children????? - NOW tell me who is joking. My ten year old has been through several paediatricians - all of who were accepting their luxury weekends away and conferences in exotic locations at 5-star resorts because they prescribed a certain amount of the favoured company's stimulant.....FINALLY now we have a paed who has done a thorough assessment of my son and have been given the diagnosis of Asperger's Syndrome. My son now receives intensive cognitive therapy, is happier for not being medicated and we are seeing a great improvement in the home and school environments....get off our backs and stop blaming us.....start looking at the pharmecutical companies who indirectly FORCE these treatments on families by way of the kickback holiday to doctors.
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G:
29 Aug 2008 10:25:43am
Not wishing to conflict with the good Dr. who is an expert ,whereas I am not - but didn't I see/read some article recently that said that ADHD was OVER-diagnosed?
To simply state that the rate of uptake of medical treatment is not keeping pace with diagnosis rates seems almost specious.
One conclusion is that not enough people are taking medication, but the other conclusion is that too many people are being diagnosed as having ADHD.Agree (0) Alert moderator
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Stanley:
29 Aug 2008 10:31:52am
And so psychologists continue to demonstrate their complete and continuing irrelevance to modern day life, considering any and all conditions to be diseases which require treatment rather than conditions which can be prevented. How convenient that this treatment must come from 'highly qualified' - and highly paid - 'professionals' such as the good Professor himself.
The next time someone who kills a family member of yours gets off lightly due to mental impairment or is diagnosed with one of a billion 'mental disorders' and given 6 months in a psychiatric facility, don't forget to thank your friendly neighborhood psychologist.Agree (0) Alert moderator
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JayR:
29 Aug 2008 11:56:51am
You might want to actually understand who you are talking about before you slate them off the cuff. Psychologists dont prescribe drugs of any sort, their treatment is essentially coming from talking to the patient and working on cognitive behavioural changes. Psychiatrists are the ones who can choose to prescribe drugs.
Kinda makes your post a tad pointless seeing you seem not to understand the difference, let alone know it exists.Agree (0) Alert moderator
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katie:
29 Aug 2008 1:41:41pm
What a very good point you and many others make...... what better way to highlight the need for more effective community education on such things as so many misinformed opinions.... I dont know whether to laugh more at the comments that throw all people in a very diverse profession into having the same opinions on such a controversial topic as ADHD, or that their highly paid (this is coming from a psychologist, whose partner works dogwatch at Australia post and makes more), or as Jay pointed out the fact that many of the comments are so patently incorrect, ie psychologists medicating...
In regards to the under diagnosed aspect, from my experience, which Im sure is not representative of all Australia, i agree, however I also feel that it is misdiagnosed as well; that meaning that many people with the label may actually fit better into another category...whether that be a behavioural or cognitive disorder, or whether they are being influenced by a less than desirable family or peer environment, food intolerances etc..Agree (0) Alert moderator
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Bertrand:
29 Aug 2008 10:36:37am
interstingly, a study found that tribepeople in Kenya with ADHD were fitter and more healthy than the others in their community. They had greater anticpation and other traits that assisted them as hunter gatherers. Perhaps this was a suvival mechanism.
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John R:
29 Aug 2008 11:02:28am
As mentioned in the article, its a continuous range of personality types. People with different personalities have different benefits that can be used in different aspects of society.
However, in our current society the process of raising children is being streamlined to be the easiest and most pleasant for parents of "average" children. With such children, society can afford to have both parents in the workforce with production line childcare, together with TV and computer games for babysitters. Psychologists and society have put huge amounts of research in how to raise such children with minimal effort.
When it comes to the outliers, for the sake of society efficiency, one of the approaches is to treat these children in such a way that they become more like the "normal" children - which we know how to raise efficiently. One of the roles for psychologists is to help maintain this efficiency by getting all children to fit the mould so they can follow the formula.Agree (0) Alert moderator
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twobob:
29 Aug 2008 11:49:28am
John R you are spot on. This describes my problems to a tee. My son is active bright and bored at school. In several cases he is smarter than his teachers and dreadfully disrupts the class. They dont have the resources or ingenuity to deal with him and just want to treat him with drugs. We have had him assed for disorders so many times and the conclusion is overwhelming that he is bright active and bored. This does not stop the school asserting that he needs drugs though. School teachers ALLWAYS know better
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JayR:
29 Aug 2008 12:03:04pm
Similarly, 'high needs babies' may often seem to be just more difficult and clingy than other babies, but often grow up to be far more independant and emotionally intelligent if their needs are met and they arent just ignored or left to cry because its easier for the parent at the time.
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vm:
29 Aug 2008 11:07:14am
VERY interesting.
I would be surprised if an unbiased research finds that ADHD kids - are just smart bored to death kids locked up in a mediocre education system and coping with inadequacy of their parents.Agree (0) Alert moderator
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John O:
29 Aug 2008 11:53:55am
Absolutely combine that with poor diet, too many chemicals (preservataives etc) and you get kids who act out or are too active for the teachers to handle. If this issue is genetic surely these kids would've been a huge issue in the past when drugs were not around?
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John R:
29 Aug 2008 12:05:54pm
They probably were a huge issue to their parents, but we just didn't hear about them so much. Discipline approaches would also have been used that are not considered appropriate now. Diet, chemicals, and lack of parenting are undoubtedly important factors in many cases but these alone are not enough to explain all the deviations from normal behaviour patterns.
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Steve:
29 Aug 2008 5:01:43pm
That's correlative, not necessarily causitive. Plus the hunter v. farmer theory of ADHD was first proposed by a radio host who states that it was never intended as hard science.
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G:
29 Aug 2008 10:40:55am
I just noticed this..
"Professor Hay discloses that he accepts travel expenses from pharmaceutical companies in order to speak at conferences, in adherence with his employer's guidelines, but does not accept fees from such companies."
So, travel costs are not regarded as a "fee"?
I must have adult ADHD, I got bored from reading this sponsored hooey after 30 seconds. Apparently, I should now get medication for it.Agree (0) Alert moderator
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JayR:
29 Aug 2008 12:10:43pm
Pharmo sponsored doctors are more of a concern than any real or imagined ADHD epidemic! And dont believe for a second that MOST of them arent on the gravy-train!
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Bert:
29 Aug 2008 10:43:03am
Hey, if some pharmo company wants to fly me around the world for free, I'll sing the virtues of drugging up other peoples kids too!
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BJ:
29 Aug 2008 12:22:06pm
Bert
In your black and white world, your opinion must seem most obvious.
95% of this world is lived in the grey areas between the black and white margin. To this end, there is no one 'right' way to treat ADHD.
It's important to discuss it. I'm certain that it is work for the Professor, not play and 'singing virtues'...Agree (0) Alert moderator
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shocked by u lot:
29 Aug 2008 10:46:21am
May i ask what you non-believers are basing you assumptions on?
May i ask why you are so right yet someone with years of research is so wrong?
It is so very expert to shout how adhd is not real when your ignorance on the subject is so blatant.
Good on you Annoyed. Tolerance and understanding is what's needed on this issue not judgmental ignorance.Agree (0) Alert moderator
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Green:
29 Aug 2008 11:09:42am
When there is a parent with a screaming brat sitting beside me and they seemingly do nothing to try to discipline or moderate their child's behaviour (because they "can't help it") I don't feel very tolerant!
I really do wonder how many parents just assume their kids have (undiagnosed) ADHD because they are a bit bratty, without ever having tried to actually teach them self-discipline or manners. While I don't doubt that ADHD exists, I suspect that many parents use it as a convenient excuse for abrogating their parental responsibilities.Agree (1) Alert moderator
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BJ:
29 Aug 2008 12:18:58pm
Green
It is a real condition, but unfortunately there are plenty with the mindset you describe as well.
They cheapen the real claims of those and their carers who are really suffering through ADHD.Agree (0) Alert moderator
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katie:
29 Aug 2008 1:48:54pm
And what does a screaming brat have to do ADHD? Real ADHD is generally not misparenting.... sure conduct disorders come very much from the enviroment, but id be very interested in someone explaining to me how this medical inbalance can be cause by someone NOT belting a winging child .......
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maggzs:
29 Aug 2008 2:55:33pm
I have been in the nursing & education profession for many years wih an emphasis on special education. I am fully understanding of the pressures & issues placed upon many families in our communities. I will in no way dispute the actuality of ADHD however I totally agree with BJ.
Many parents simply do not discipline their children AT ALL nor in this age of both families working & the abundance of extra curricular runnning around do we feed children appropriately nowa days.
I had 1 year 2 child in a mainstream class who's mother continually stated she believed her son had ADHD, in her opinion it had nothing to do with the Mcdonalds she brought him every day (yes everyday) for lunch.
Furthermore, does anybody not consider the rise in pc, playstation & X Box games phenominon, an activity a good many children spend a good many hours a day playing, not bearing a strong correlation with the increase in ADHD diagnosed individuals?Agree (0) Alert moderator
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sinekal:
29 Aug 2008 10:46:25am
So the obnoxious brat screaming in the supermarket because his/her mother refuses to put chips in the shopping trolley with the sugary drinks and chocolates has an illness right? How amazing the treatment for that illness seems to be putting chips in the shopping basket. Why bother with the drugs?
For those with genuine ADHD family members our understanding, sympathy and support is important. I can diagnose the difference in every supermarket aisle in Australia.
For a minority of those whose businesses and careers rely on ADHD I say shame on you for exploiting parents total lack of ability to apply a basic standard of disipline. No means no, not well maybe if you scream enough.Agree (0) Alert moderator
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Susan:
29 Aug 2008 11:16:52am
Ah, how easy it is to criticise when you don't know the reality. That screaming brat in the supermarket probably doesn't have ADHD, the child with ADHD is the one whose mother probably didn't even take him to the supermarket because it is too difficult, or because she is sick of the world judging her because she has a child with an illness that no-one takes seriously, so she left him at home with hubby/nanna or some understanding friend while she raced out to buy the groceries.
I knew my son was different from his peers at a very early age - I began to have suspicions when he was late with all his milestones. Why was he late? No-one really knows - there's nothing wrong with him physically, the only explanation is that he didn't want to roll over, crawl, walk, talk etc... so he didn't do it. Over the years we have had to use the services of many different specialists, trying to get a handle on how we could help him. A restricted diet worked wonders - it's amazing how much worse he would be if he had been chomping on things containing artificial colours and flavours. (I even remember at one kids party giving him cola because although it has caffeine, it has no artificial colours, while other mothers looked down their noses at me while they dosed their kids up on Fanta which contains dyes which can aggravate conditions such as asthma, but they all thought they were 'experts' on childrearing because we all know how evil coke is!) He did take ritalin at school, but only on school days, not at home, as it was only to enable him to pay attention in the classroom environment in order to learn (and to enable the rest of the class to learn!) At home, he could run around all he wanted. But taking him out was a nightmare. He required constant supervision, far more than my other child. And I lost count of the number of self righteous people who thought he was just a naughty boy because he couldn't sit still, or whatever their expectation was.
Yes, I do believe that some people use the ADHD excuse to excuse lazy parenting, but there are a lot of genuine families out there who are struggling with these special children, not getting any support from a society which is filled with ignorant people who think they know it all just because of a couple of articles they have read somewhere.
For the record, my son has grown into a beautiful adult, who still has some residual difficulties (mostly stemming from academic underachievement) but who has managed to stay out of trouble, and while aware of his condition, refuses to be ruled by it.Agree (1) Alert moderator
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Clownfish:
29 Aug 2008 11:45:27am
The "screaming brat" cliche of ADD/ADHD really irks me.
My son has ADD, yet he is not a screaming, uncontrollable brat: On the contrary, he is very quiet.
Because he has the Attention Deficit, but not the Hyperactivity.
Left to his own devices, and untreated, he would spend all day off in la-la land, with his school and social life suffering as a consequence.
Thank God for his incredibly professional Grade 4 teacher, and the wonderful paediatricians who have made such a remarkable difference to our son's life.Agree (0) Alert moderator
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Yad:
29 Aug 2008 11:54:40am
Right on the money Susan. The parent of the ADHD child does not take them shopping unless it is absolutley necassary and a restricted diet works but unfortunately only until they are out of sight.
I too have lived through ADD \ ADHD, drugs, behaviour modification etc, etc, ad nauseam with 2 children. My eldest was diagnosed nearly 20 years ago, well before it became trendy excuse, then the untrendy unmentionable diagnosis.Agree (0) Alert moderator
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sinekal:
29 Aug 2008 11:57:26am
Ah Susan Susan, How easy it is to criticise when you dont know the reality. I was different from my peers at an early age. During my own childhood I was affected by a lack of attention and disruptive behaviour. I did not pass my exams when I completed Year 10. By every measure used for determining ADHD one of my own children was affected. Both of us were disciplined by our respective loving parents. That discipline included a smack on the bottom with an open palm after two warnings.
Neither of us ever had prescription drugs for anything but infections and immunisations.
My life has been a memorable experience of growth and learning. I have received awards for my contribution in a specific industry area. My son has graduated and is now doing his Masters.
You might note I did not deny the existence of ADHD, rather the opportunistic maximisation and abuse of its income producing capacity by drug companies and self interested health professionals.Agree (1) Alert moderator
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Clownfish:
29 Aug 2008 12:18:49pm
You seem very ignorant on the topic of ADD/ADHD. Perhaps you should read some responsible literature on the subject, and not just gain your opinions from "A Current Affair".
My eldest son has ADD (Attention Deficit, but not Hyperactivity). He is not an obnoxious, screaming brat; on the contrary, he is quiet, sometimes to the point of invisibility.
We do not load our kids with sugary drinks and chocolate. With the exception of the occasional treat of lemonade, our kids drink water, milk (cow's and soy) and a glass of fruit juice in the morning. We hardly ever eat take-away.
We discipline our children as best we can.
Yet, from the early years, our son's schooling was going from bad to worse. Simply because he just couldn't concentrate, and drifted away and did nothing.
Putting him on medication was the hardest decision we ever had to make, but it was the best we ever made. He has never looked back. We continue to monitor his medication with regular consultations with a paediatrician.
Medication has not been a panacea or an easy fix, but it sure as hell has made his life a whole lot better.Agree (0) Alert moderator
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drwoood:
29 Aug 2008 11:00:43am
There are more risks associated with giving children stimulant medication than with giving adults stimulant medication. Adult ADHD is probably more likely to be underdiagnosed than child ADHD. Maybe it will be better to sort of the adult ADHD issue first, and the child ADHD more cautiously.
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stargirl:
29 Aug 2008 11:04:41am
I just don't know enough about this topic, and the article didn't give much detail. Where is everyone getting their info from? And I wonder whether the author has any personal experience (superior to professional experience, I reckon) with ADHD.
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John R:
29 Aug 2008 11:15:50am
On the other hand, the emotion of a specific personal experience can sometimes cloud the bigger picture across society - so I wouldn't dismiss the professor on that account even if he doesn't have personal experience.
What he says in the article is clearly quite correct. If we treat more children with drugs, they will fit in better with society. The issues of dispute more come down to what methods society thinks are acceptable as tools to alter the behaviour and personality of others, and how much we should be chemically altering behaviour from what appears as "natural".Agree (0) Alert moderator
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BJ:
29 Aug 2008 12:13:42pm
An old social work aphorism goes:
You don't have to have been a drug user to know how to treat drug addiction.
To be frank, the worst people I've seen to treat drug / alcohol / gambling addiction are former addicts themselves that have crossed over to treating those addicted.
I believe their objectivity becomes non-existant, their belief that what worked for them must necessarily work for all addicts, the lack of wanting to learn about other methods of relieving addiction, and the 'personal' and emotive (read crusading) nature of their past affecting their present work.
Not a good recipe.Agree (0) Alert moderator
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Pen:
29 Aug 2008 11:15:32am
"Professor Hay discloses that he accepts travel expenses from pharmaceutical companies in order to speak at conferences"
I think that is an important point. Question the interests/angle of the author based on this.Agree (0) Alert moderator
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John R:
29 Aug 2008 11:39:03am
Once someone has been an academic long enough to be a professor, conference travel is as likely to be a chore as anything else. His basic observations appear quite unbiased. The things up for debate are along the lines of whether it is right to give a name to range of personalities, and what methods we, as a society, want to use to control the behaviour of others.
In the midst of that debate, we shouldn't forget that there are parents up against huge challenges in raising some children.Agree (0) Alert moderator
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JayR:
29 Aug 2008 12:17:17pm
And you believe that in getting considerable funding from a pharmecutical company to talk about using their product would have no effect on how you feel about recommending or prescribing said pharm's product? Really?
Yeah, Im sure said company would be funding his travel if he said "I dont believe medication is needed at all"...Agree (0) Alert moderator
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