Another Nail in the Coffin of ADHD

In spite of the originator, Dr. Robert Spitzer, of the ADHD syndrome and other such conditions, admitting that he got it wrong because he had failed to look at the contexts of labelled children’s lives, the practice continues of testing children for these non-existent biological syndromes.  There are 500,000 children in Britain who have been given the label ADHD (attention deficit hyperactivity disorder).  Curiously, only 55,000 of them have received some type of treatment.  The most common treatment is prescribed stimulants, like Ritalin and Concerta.  There are thousands of children in Ireland who have also been labelled with ADHD and most of them have been medicated.  The use of these medications accelerated in 1999 when an American study concluded that after one year medication worked better than behavioural therapy for ADHD.  Indeed, the prescription of Ritalin and Concerta tripled on both sides of the Atlantic.

However, in a similar vein to Dr. Spitzer’s u-turn, Professor William Pelham of the University of Buffalo, co-author of the 1999 study, now says that ‘I think that we exaggerated the beneficial impact of medication in the first study.’  The latter is a curious statement, because from the results of a longer term follow-up of 600 children across the US, the evidence that has emerged is that ‘there is no indication that the medications are better than nothing in the long run!’  In other words, Professor Pelham got it totally wrong in 1999 – there are no beneficial results.  However, what is even more alarming is that the long-term study of children who have been medicated over several years reveals ‘no beneficial effects’ and a seemingly negative impact instead.

Professor Pelham goes on to explain that ‘these children had a substantial decrease in their rate of growth so they weren’t growing as much as other children in terms of their height and in terms of their weight!’

As a result of these findings, it appears that the National Institute for Clinical Excellence is currently reviewing the treatment guidelines for ADHD.  Chair of the working group, Dr. Tim Kendall, said they were devising a strategy which was likely to involve training for parents as well as ‘behavioural interventions.’  ‘The important thing is that we have an approach which doesn’t focus just on one type of treatment’ Dr Kendall said.  I assume this means no more medicating, even though this is not at all clear.  Furthermore, I am wondering why Dr. Kendall insists on sticking with the label of ADHD, when there is no such biological condition!

There is no disputing that children can present with extremely difficult and challenging behaviours.  There is no doubt too that when they do parents and teachers have a hard job trying to manage these troubling responses.  However, what is urgently needed is a follow-up on Dr. Spitzer’s admitted serious oversight – the context of these children’s lives.  The contexts that need examining are the children’s homes, schools and communities.  So many parents and teachers become defensive when such an examination is proposed, as if they are going to be judged as ‘bad’ parents and teachers.  There is no doubt that both parenting and teaching are the most difficult of professions and society has let down both professions in terms of adequate preparation and training for their responsible roles.  Parents and teachers always do their best; no parent or teacher ever wants to deliberately block the progress of a child.  However, the reality is that we all have emotional baggage due to unresolved self-esteem issues and conflicts from our own childhoods.  When we haven’t resolved these issues, inevitably our vulnerabilities impact on the lives of children.

Parents and teachers especially need all the help they can get to know self, know their children and be sure their children know them.  They need the skills to maintain boundaries in the face of children’s challenging behaviours and the understanding that there is always a creative purpose to children’s troublesome actions.  One of the most common intentions is to draw attention to how difficult life is for them and the need for the security of predictable and consistent loving, caring and positive firmness.  Equally, when parents or teachers ‘lose it’ with children, they too are revealing how difficult life is for them, and it is for the rest of us to offer support, understanding, compassion and training to these parents and teachers.  After all, it not only takes a village to raise a child, it also takes a community to make it safe for distressed adults to reach out for help and support.

Dr. Tony Humphreys is a clinical psychologist and author of All About Children, Questions Parents Ask.