LONDON - In a major report from the British Psychological Society, British physicians and psychologists are warned not to follow the Canadian and U.S. practice of applying the label attention deficit hyperactivity disorder (ADHD) to such a wide variety of behaviors in children.
Above all, the report urges restraint in the prescribing of psychostimulants: "It must not be the first, and definitely not the only, line of treatment."
The report by a society working party is based on the literature, information and advice from a variety of organizations and professionals in Canada, the U.S., Europe and Australia.
There are no single or simple causes and no simple answers among those children who display a variety of conditions including hyperactivity, aggression, inattentiveness and anti-social behavior. The concept of ADHD as a single condition is controversial for a variety of reasons, the report argues. "Many factors affect the way attention is displayed in particular situations and professionals should be wary of describing children as having ADHD without a thorough investigation of alternative explanations."
The concept of ADHD is new to most European professionals who tend to use the diagnostic systems of the International Classification of Diseases published by the World Health Organization. "As a consequence, children reaching (or meeting) criteria for hyperkinetic disorder are far less common than those reaching DSM III or DSM IV criteria (in Canada and the U.S.)," the report continued.
The widespread appellation of ADHD in North America to difficult children means that most classrooms, and many families, have children who are so classified. Although ADHD is officially a term for a category of mental disorder, the report said, "it has become so widely used ... that it has a prominent place in the contemporary culture."
Yet in Britain, there is a stark difference, according to the report: "The idea that children who don't attend or don't sit still in school have a mental disorder is not entertained by most British clinicians."
Among British children at most 1% are classed as hyperkinetic, the report pointed out. "While small in number, these children are likely to show more severe signs of problems and subsequently to be at greater risk during development."
The report says the major fear is any increased physician prescribing of methylphenidate (Ritalin), dextroamphetamine (Dexedrine) and pemoline (Volital).
It is important when physicians prescribe stimulants "to separate questions about the effectiveness of medication from arguments about whether to use medications," the report continued. "The former questions are empirical, the latter ethical and sociological."
Children do make progress with the assistance of stimulants, but a substantial subgroup appears not to benefit and a minority may have adverse reactions as there are a number of well documented side effects.
It is estimated that some 90% of those identified as having ADHD in the U.S. are prescribed stimulants at some time during treatment. Among many U.S. children the only therapeutic response by doctors is to prescribe stimulants. "It is important to prevent this happening in Britain," the report declared.
Heed should also be taken of warnings from the U.S. Drug Enforcement Administration last year that a significant number of children and adolescents are now diverting or abusing methylphenidate which is intended for treatment of ADHD.
"In order this does not happen in the U.K. we need carefully targeted and monitored interventions and good cooperation between professionals from different disciplines," the report concluded.
Copyright © 1997 Maclean Hunter Publishing Limited
Reprinted with permission.
Internet Mental Health (www.mentalhealth.com) copyright © 1995-2011 by Phillip W. Long, M.D.