This week is ADHD awareness week. One of the most misunderstood of childhood conditions, ADHD is thought to affect about one in 20 children in the UK. There are three different types of ADHD - hyperactive-impulsive subtype, inattention subtype, or combined subtype. It mainly affects behaviour - and that's where the problem starts. There is no blood test to diagnose ADHD - making a diagnosis is a complicated process that involves a detailed assessment of all aspects of a child's physical and mental health, as well as educational and social factors.
About three times as many boys as girls are diagnosed with ADHD. However, some experts think that boys are more likely to be referred and get a diagnosis. That's because, compared with girls, they have hyperactive more often, which is more disruptive to others. (1,2) A girl with inattention ADHD may be dismissed as a lazy daydreamer. A boy who constantly disrupts the whole class may be harder to miss.
There's a fundamental difference between children with ADHD and kids who are just 'badly behaved'. Naughty children have a say in the matter. Children who are simply prone to misbehaviour are capable of behaving well if the price is right. If they're offered a big enough incentive, they can sit still, wait their turn or concentrate. Children with ADHD may desperately want to be 'good' but they just can't help themselves.
Many children go through naughty or disruptive phases. But for a diagnosis of ADHD:
- The child must have at least six symptoms from the hyperactive-impulsive section, or the inattention section, or both
- The symptoms must have been present for at least six months
- The same behaviour must be seen in more than one setting (say, both at home and at school)
- The child's behaviour must be significantly different to that of other children of the same age, and be causing them problems.
There have been recent concerns about overprescribing of drugs such as methylphenidate for ADHD. While they are recommended by NICE as a first-line treatment for school-age or older patients with severe ADHD, a report in August 2013 by the Care Quality Commission highlighted a 50% increase in prescribing between 2007 and 2012, from 420,000 prescriptions in England in 2007 to 657,000 in 2012. This has prompted NICE to remind doctors that drugs should not be used as first-line treatment in moderate or mild ADHD, and that all children and young people diagnosed with the condition should be referred to a psychological group treatment programme .
These controlled drugs should absolutely not be used lightly - they delay growth in children and have a wide variety of side effects, some of which can be severe. There is also a real concern that they may be being abused by students as 'smart drugs' to increase alertness and concentration. (3,4) They should always be started by specialist teams, with GPs issuing repeat prescriptions only after a specialist diagnosis and under a 'shared care protocol' . But there are occasions where they can, in conjunction with psychological therapies, revolutionise young people's lives - for the better. Left untreated, children with ADHD are up to 100 times more likely to be excluded from school (5) and the Youth Crime Action Plan identified ADHD as one of the main risk factors for criminal offending during childhood. (6)
There is understandable anxiety about labelling children with a diagnosis of ADHD and putting them on controlled drugs long term. But labelling them as naughty, disruptive or bad and throwing them into life's dustbin without considering whether they have a treatable illness is surely just as dangerous.
5) O'Regan F. Persistent disruptive behaviour and exclusion. ADHD in Practice, 2009; 1 (1): 8-11
6) HM Government (2008). Youth Crime Action Plan 2008. London: Central office of information.
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