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Could it (or should it) be ADHD?

It has long been recognised that psychiatric diagnoses are powerfully influenced by social and temporal factors with some favoured in some times and countries over others. Sharpe et.al (1974) explored the discrepancies in national statistics for admissions to psychiatric hospitals between the United States which favoured the diagnosis of schizophrenia as compared to Britain where patients were more likely to be labelled as affective disorder. They noted that discrepancy appeared to be due to differences in diagnostic criteria rather than the patients themselves.

Currently those who work with children, adolescent and families are increasingly presented with clients who have or are being assessed for ADHD, a developmental disorder that ‘affects the brain’s executive functioning, the ability to self-regulate and control words, thoughts, actions and emotions’ (Australian Government Health Direct website) The treatment of choice is stimulant medication. Problem solved.

Perhaps not. Kazda et al (2021) in a systematic scoping review of 334 published studies in children and adolescents, found convincing evidence that ADHD is over diagnosed in children and adolescents and that for those with milder symptoms harm may well outweighed benefit. Some studies showed that the biomedical view was associated with disempowerment. ‘By providing an excuse for problems, a decrease in responsibility by all involved can occur, often followed by inaction and stagnation. This view can also deflect from other underlying individual, social, or systemic problems, which can prompt a self-fulfilling prophecy, wherein the perceived inability to change reduces opportunities as well as promotes hopelessness and passiveness.’ It can also be associated with stigmatization producing even greater feelings of ‘isolation, exclusion, and shame’.

Of particular concern are children whose behaviour appears to be reactive to family situations that are at best confusing and unpredictable and at worst abusive. Symptoms of hyperactivity and inattention are understandable in such circumstances and diagnosing the child and locating the problem inside them effectively allows those who should be exercising proper authority to effectively side-step that responsibility. Challenging the weight of a ‘proven’ medical diagnosis makes work with the whole family more challenging and may leave a child at greater risk.

Luise Kazda, MPH; Katy Bell, PhD; Rae Thomas, PhD; Kevin McGeechan, PhD; Rebecca Sims, MPsych (Clin); Alexandra Barratt, PhD Overdiagnosis of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents A Systematic Scoping Review JAMA Network Open. 2021;4(4): e215335. doi:10.1001/jamanetworkopen.2021.5335

Sharpe, L. et al Comparisons of American, Canadian And British Psychiatrists in Their Diagnostic Concepts Canadian Psychiatric. Assoc. J. Vol. 19 (1974) P235-245

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