adhd

NICE has produced guidelines on diagnosis and management options for ADHD.

Pulse reviews the guidelines which saves me reading anything.

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The Cockroach Catcher has an interesting post on the amount of money drug companies are spending on marketing ADHD drugs like atomoxetine and methylphenidate.

Here’s a little thought from me:

Before I came to CAMHS I worked on a rehab ward with people who had enduring mental health problems, and often a whole slew of physical illnesses too. Not only were we handing out antipsychotics, mood stabilisers, antidepressants, hypnotics, anxiolytics like they were smarties, but we were also giving meds for diabetes, epilepsy, hypertension - you name it. Despite this, we never saw a drug rep. Ever.

Now I work in CAMHS, which probably prescribes less medication than any other form of healthcare. Despite this, the drug reps for the ADHD medications (Strattera, Equisym, Concerta, Medikinet etc) are round here every other week, showering us with pens, post-it notes, staplers, calculators, cordless mouses, buying us lunch, making sure we’re nicely stocked up on behaviour monitoring charts, educational materials, anger management booklets, sticker charts. God, they’re desperate to prove they care about us.

If I were a more cynical being, I’d suggest that this means that the drug companies clearly see ADHD as being something of a cash cow.

Danny is a rather troublesome 9 year old, and his parents are convinced he has ADHD. They know this because he won’t behave himself, so that must mean he has ADHD. They come to us, wanting a diagnosis and medication.

In clinic, Danny isn’t displaying any signs of hyperkinesis or inattention. We get Danny’s parents to fill out a Connors Questionnaire. Their answers score him as horrific. We send another Connors Questionnaire to his teacher. The teacher scores him as a moderately naughty kid. We carry out a school observation. In class he’s able to focus on tasks, doesn’t fidget in his seat, doesn’t get up and wander about, gets told off occasionally by teacher for playing pranks on the other kids. In the playground he’s a bit of scrapper who likes to play rough. Nothing majorly untoward.

We break the news to Danny’s parents. No, your son does not have ADHD. Are they pleased to hear that their son does not in fact have a debilitating and chronic neurological condition?

Are they bollocks.
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Since there’s currently a lively debate going on about ADHD over on NHS Blog Doctor, I think I’ll do a post of my own giving my personal tuppence worth.

Diagnosing ADHD, as the slightly scary Scientology guy who keeps spamming my inbox will tell you, is a pretty controversial business. One thing that’s particularly striking is the difference in prevalence rates between the UK and the US. Over here, ADHD is estimated to affect somewhere between 3 and 7 percent of children. Over in the States, the estimates can go as high as 18%.

(I should have some references for the above, but I’m afraid my mouth was too crammed with bourbon biscuits to jot them down. Sorry.)

So what does that difference tell us? Personally, it tells me that the Americans are rampantly over-diagnosing ADHD, and we’re being (rightly) more cautious.

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