The growing problem called 'ADHD'

Few would deny that Attention Deficit Hyperactivity Disorder has, in a short period of about 15 years, moved from an issue of relative obscurity to one well known to Australians. For this reason, among others, a diagnosis of “ADHD” and even the existence of the disorder itself tends to be regarded with suspicion.

While pediatricians may play down diagnostic and stimulant medication rates for ADHD, from the early ’90s Australian statistics show a 2,400 per cent increase in the prescription of dexamphetamine sulfate and a 620 per cent rise in methylphenidate. Since then, defined daily doses - the amount individual children are consuming a day - have also risen steadily.

While there has been mention of a slowdown in prescription rates and greater caution on the part of pediatricians, recent figures show that since the inclusion of Ritalin in the PBS, prescriptions for Ritalin rose from 523 a month in August 2005 to 5,800 a month in January 2006.

Some might argue that this increase is the result of a switch between Ritalin and Dexamphetamine use because some children may respond better and experience less side effects from Ritalin than they do dexamphetamine sulfate. If this were the case, one would expect a corresponding downwards shift in prescriptions in dexamphetamine. To date statistics to support this have not surfaced.

What we don’t know is how many children are being prescribed anti-depressants, anti-convulsants and anti-psychotics on top of stimulants. But we should. Not only that, given that these drugs lack federal approval for use in children due to issues with side effects such as suicide ideation, there should be stricter protocols to stop this from happening.

The stumbling block towards a better solution for these children is that the ADHD debate has been characterised by the need to find a bad guy. Conveniently for some, parents usually top the list - even when the suspected villain is bad food, bad television or bad video games. The road inevitably leads back to the parent, who is seen as either failing to discipline their children, feed them “healthy” food or spend quality time expanding their minds.

The hypocrisy underlying this debate is obvious.

Most contemporary parents attend antenatal and settling classes. Fathers now learn to bath their newborns, change nappies and drive screaming babies around at night. Mothers are exhorted to attend to their baby’s every cry to produce a secure, attached infant - until bedtime when they must switch to “controlled crying”. Without the support of the extended family or cohesive community networks, mothers and fathers, to greater and lesser degrees of success, struggle to achieve the exacting standards set by others.

It has to be said, unpopular though it may be, that it is those others who stand to benefit when parents fail to reach the bar. Somehow the dubious PR practices of psychologists who target their local area pre-schools and daycare centres with flyers offering parenting programs, “aimed at the prevention and treatment of behavioural and emotional problems in children between 2 and 12 years”, seem to fly under the media radar.

Speaking of which, why has no one asked how parents end up in a pediatrician’s office? In the short storm following the blow-out in Western Australia stimulant prescription rates, why was it that the focus narrowed on six pediatricians? While pediatricians are responsible for the bulk of stimulant prescriptions, to effectively deal with the problem we call “ADHD” we have to ask how parents come to believe their child might have ADHD in the first place.

Ultimately pediatricians and psychiatrists are responsible for writing prescriptions for stimulant medication. That doctors play a large part in the problem is not in dispute. But if we take a step back from the scene of the doctor’s office and begin to question how parents arrive there and, even more pointedly, what guides the conversation they have, then we can begin to unravel this very complex problem and work out ways to reduce it.

Research shows that teachers are often the first to suggest that challenging behaviour may indicate Attention Deficit Hyperactivity Disorder. Research also indicates, however, that teacher perceptions of child behaviour are influenced by factors such as class size. In the US, this has prompted several states to introduce legislation to prevent teachers recommending that children be medicated.