We need a different national conversation about ADHD

Attention deficit hyperactivity disorder (ADHD) is the most diagnosed childhood disorder in Australia. Most of us now know someone, or someone’s child, who has been diagnosed with ADHD. Reports on television current affairs shows often portray the impact of the hyperactive and inattentive behaviour…

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Whatever the specific cause of ADHD-like behaviours for a particular child, it’s the people and institutions around them that define it as problematic. Katy Stoddard

Attention deficit hyperactivity disorder (ADHD) is the most diagnosed childhood disorder in Australia. Most of us now know someone, or someone’s child, who has been diagnosed with ADHD.

Reports on television current affairs shows often portray the impact of the hyperactive and inattentive behaviour associated with ADHD. At the same time, there’s ongoing controversy about potential ADHD over-diagnosis and its treatment with psychostimulant medication. Media reports also commonly raise the question of whether ADHD is “real”. The answer to this question is not difficult.

First, there’s no reason to doubt that the span of human diversity results in some people being more active, more tactile and more prone to distraction. In centuries past, these qualities may have been vital to survival.

Second, we know that if people treat something as real, then it will be real in its consequences. So, there’s also no reason to doubt that an ADHD diagnosis can help a child make sense of his struggles and relieve feelings of guilt for his parents.

But ultimately, the “is ADHD real” debate is about blame. It results in either blaming parents for not disciplining their child or professionals who should be doing more to help. The result is a deadlock with a lot of spent energy and very little positive difference.

One way to break out of this deadlock is to ask why these particular behaviours have become such a problem over the past 20 years. Another is to ask about the difference in national levels of ADHD diagnosis and the rates in lower socioeconomic regions.

Psychologists might note that the presence of poverty, stress, conflict and need in a child’s environment can increase the risk for those with a disposition for such behaviours. And social theorists might observe that contemporary society has less space for children who are active and workers who are inattentive.

Media and cultural theorists might also respond by noting that an obscure diagnostic category has become a popular phenomenon. For me, the turning point was when Bart Simpson was diagnosed with ADHD. It was then that I knew ADHD had become the label for any bad behaviour.

Recently, the revised Australian National Guidelines for ADHD were put on hold because of public controversy over alleged links between one of the key contributors and pharmaceutical interests. For those working in ADHD research, this event wasn’t particularly surprising.

It’s long been easy to get funding for medical or psychiatric studies on ADHD. What hasn’t been so easy is securing funding, gaining ethics approval and recruiting participants for studies in non-clinical areas.

The result is an evidence imbalance that can lead policy-makers to think that ADHD is only about diagnosing and treating the individual with psychostimulants. This is a concern because if we only ask medical questions, we will only get medical answers, and a greater focus on diagnosis and drug treatment.

So, the issue for the terms of reference for the pending National Guidelines isn’t so much who they included, but what they excluded. That is why it was pleasing, as noted in George Halasz’s contribution to The Conversation, that the new national Clinical Protocols for ADHD took a much broader scope.

While they still focus on intervention, these protocols also ask broader health questions such as how might we respond to ADHD (and its co-morbidities) as a holistic condition.

Not for a moment do I want to dismiss the difference that diagnosis and medication can make in the life of a family. Nor am I advocating taking away what may be the only support they have. But what we need to remember is that irrespective of the specific cause of ADHD-like behaviours for a particular child, it’s the people and institutions around them that define particular behaviour as problematic.

That’s why Australia needs to start a broader conversation about ADHD. And if we do, we might uncover a deep contradiction in our past response.

While we laud the qualities of activity, alertness and resistance to authority in our grandparents as foundations of the ANZAC tradition, we consider these same qualities in our children as something to be treated with medication.

It leads to the question – if Ginger Meggs were around today, would he be ADHD?

Brenton Prosser is the author “ADHD: who’s failing who?”

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12 Comments sorted by

  1. bob gregory

    retired

    Interesting article on ADHD. Could the argument be extended to children's intelligence as influenced by lead intake as discussed in the media recently? Could the argument be extended to obesity and links with junk and low quality food, or to ill health and cancer due to tobacco smoke, or to fetal alcohol syndrome and related illnesses connected with the consumption of alcohol by parents, or even to atmospheric testing of nuclear weapons and resulting cancers. What about exposure to asbestos in…

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    1. Sue Ieraci

      Public hospital clinician

      In reply to bob gregory

      Lead levels may or may not be associated with tiny changes in IQ in some studies (at levels of no practical significance), but recently, blood lead levels have been falling in wealthy countries (due to changes in paint and petrol) while ADHD diagnoses have been rising.

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  2. Adrian A Clarke

    Adrian A Clarke

    In the 1940's ( born 1941 ) I suffered ADHD but was quickly cured by my "old man " who gave me a fell clip around the ears !
    Have had no recurrence since !
    I can still recall the moment clearly & from that time was happy to continue family life supported by the firm comfort of knowing that if I complied all would be good , and it has been
    My children have continued in similar manner.

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  3. Liz O'Brien

    Research Development Manager

    I think the Bart example of ADHD = naughty is just one version of the disorder. There are the quiet inattentive dreamers as well. Nice kids with heads full of ideas and information swirling around, reducing their will to concentrate. One psychologist I have met with suggested that Leonardo da Vinci displays the typical characteristics of ADHD - type inattentive. Imagine the loss to the world if he was medicated. I agree with Brenton that research, addressing a more holistic approach, will be of great…

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  4. Anna Bowden

    Partnership Manager

    ADHD is an umbrella term used to describe symptoms. It makes sense therefore that the symptoms can have multiple causes - some of which may be explained by the social changes we have seen over the past generation in regards to children's outdoor unstructured playtime and dietary changes. However, it is simplistic to say that the families and institutions around the child have the problem - it is the child themselves, struggling year in and year out with schoolwork and social relations. Anxiety and depression go hand in hand with these disorders.

    A holistic discussion on ADHD is well overdue. We now know that we can remediate weak cognitive areas - a cognitive profile of my son gave far more answers and solutions than did an umbrella diagnosis of ADHD. These are children with genuine and distressing issues and the system for the most part is failing them.

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    1. Linus Bowden

      management consultant

      In reply to Anna Bowden

      Anna, just on how powerful a child's socioeconomic support systems (or lack thereof) can affect ADHD over-diagnosis, and why even the most ethical doctors, still think the best intervention is stimulants, read this doctor's story in the New York Times. We've all seen out-of-control 8 year old boys who can still not read, but pull apart a whole car in just 40 minutes, a sofa in ten!.

      It must be a real dilemma for the medico when the parents are poor, have low insurance, and parents themselves…

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  5. john mills

    john mills is a Friend of The Conversation.

    artist

    Great article!! Is adhd real? Its as real as the individual thinks it is, or wants it to be, what you see is what you get, always has been always will be, or is it what you imagine, either way, kids are being poisoned, and called names, and its criminal and wrong, in the minds and hearts of the honestly compassionate, and the evolved, every action has a cause or a reason, and its not a chemical imbalance, its a one plus one reason-equals two = reality, equation, so its an investigation reality…

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  6. Paul Meleng

    Management Consultant

    I have watched several family members and friends find great relief with correct diagnosis and thoughtful treatment of ADHD. The main thing I have learned is that it is missing the point to focus on whether someone's behaviour is annoying. What about how that person is feeling themself?

    People diagnosed later as adults are able to describe the experience. Say you have a 150 IQ but your ADHD makes it like trying to drive a Brock Commodore with a wonky steering wheel . I call it Attention…

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    1. Paul Meleng

      Management Consultant

      In reply to Paul Meleng

      I should add. Only some of our family or friends who have undergone the extensive testing actually needed ADHD medication. But in the others were discovered very specific learning difficulties that were being masked by the extreme effort and high IQ. In those cases approriate cognitive therapies and techniques were devised to add to the self knowledge that allows them to easily overcome the specific glich. "."If the whole story was really known, each person including you and I has always done the very best they can, even when appearances suggest otherwise".

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  7. Linus Bowden

    management consultant

    Brenton

    "For me, the turning point was when Bart Simpson was diagnosed with ADHD. It was then that I knew ADHD had become the label for any bad behaviour."

    Ah Brento, you have tweaked to what I tweaked to 2001. Ritalin is not a neurocognitive palliative for kid. Ritalin is the beta version of Soma, which the kids take, but the main beneficiaries in mind are the parents, teachers, and classmates.

    ""You don't say so," said Lenina politely, not knowing in the least what the Warden had said…

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  8. Anne Powles

    Retired Psychologist

    As a retired child and family psychologist I can now detail how I've watched with dismay, during my working life, the growth of the distinct "syndrome" ADHD. I am certainly not suggesting that there is not a problem and I acknowledge that some very hyperactive children, who also cannot attend, can benefit from a short period on drug therapy while they are being taught some coping strategies. But assuming all children with some or all of the  myriad of different symptoms which make up this "diagnosis…

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  9. william mcinnes

    investigator into medical negligence

    ADHD has two likely causes including

    1. inheritance of the disorder and;

    2. early lesions to the brain caused by hypoxic (lack of oxygen) ischemia (lack of oxygenated blood flow to the cell tissues) which has been reported to be responsible for up to 25% of all brain damage in neonates.

    Hypoxic Ischemia induced lesions in infants have also been correlated with the development of ADHD later on in life.

    Defendants in medical litigation prefer familial / inheritance as the cause of the…

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