Clinical psychology publishes critique of ADHD diagnosis and use of medication on children

August 5, 2004
by Adam James

The discipline of clinical psychology has published a far-reaching critique of the ADHD diagnosis and the use of stimulant medication on children.

This month's special edition of Clinical Psychology, published by the clinical psychology division of the British Psychological Society, features contributions from practitioners and academics who argue that ADHD (attention deficit hyperactivity disorder) does not exist as a medical entity, and that "overzealous" mental health professionals are prescribing "addictive and brain-disabling" drugs such as Ritalin and Concerta.

The edition's 11 papers might be held up by some as a position statement from clinical psychology on ADHD and the use of medication on children. The edition not only effectively marks out how clinical psychologists can intervene with children with problematic behaviour, it also deconstructs the ADHD diagnosis.

The edition's editors, clinical psychologists Nick Radcliffe, Scott Sinclair and Craig Newnes, wrote that it is estimated that anything from three to 26 per cent of children in the UK are diagnosed with ADHD.

In an editorial they wrote: "Our impression from spending time with young people, their families and indeed colleagues from other disciplines is that a medical diagnosis and medication is not enough.

"In our clinical experience, without exception, we are finding that the same conduct typically labelled ADHD is shown by children in the context of violence and abuse, impaired parental attachments and other experiences of emotional trauma."

Prescriptions of medical stimulants such as Ritalin and Concerta for children have increased in the UK from about 6000 in 1994 to about 345,000 children in 2003. The editors wrote this statistic was largely due to "overzealous mental health professionals" i.e. prescribing psychiatrists, "complaining adults" and "overstretched class teachers"

"To suggest we have a growing epidemic of brain-deseased children with attention, impulsiveness or hyperactiviy is simplistic and misleading," they wrote.

However, it was child and adolscent psychiatrist Dr Sami Timimi of the Lincolnshire Partnership NHS Trust who was most scathing of the ADHD diagnosis and the prescribing of psychiatric medication on children.

In a paper entitled The Rise and Rise of ADHD co-written by Nick Radcliffe of Telford and Wrekin Primary Care Trust, he wrote there was "no evidence that stimulants leads to any lasting improvement". He added that ADHD was "primarily a culturally constructed entity".

Dr Timimi wrote: "As a diagnosis ADHD is based on the observation of behaviours alone, this has led to a kind of 'open season' where anyone can 'have a go': teachers, parents, school doctors, welfare officers and so on.

"ADHD is a 'dumping ground' allowing all of us to avoid the messy business of understanding human relationships and institutions and their difficulties, and our common responsibility for nurturing and raising well behaved children…Children are persuaded to take highly addictive and potentially brain-disabling drugs for many years and may well be cultured into the attitude of a 'a pill for life's problems'

In a separate paper, entitled Helping Children and Adolescents Who Could Be Diagnosed With ADHD And Their Families, Dr Timimi documented the methods he used to wean 30 children off stimulant medication within 18 months.

He explained: "By seeing my basic role as that of empowering children, parents and schools to find their own solutions, dependency on doctors need not happen."

He also added that non-pharmacological therapeutic interventions with children is a more economic use of resources.

One other paper in the special issue described the work of the Cactus Clinic based at the University of Teeside in Middlesborough. Founded by clinical psychologist Prof Steve Baldwin who was killed in the Selby train crash in 2002, the clinic helps children withdraw from stimulant medication. Nutritional supplements are used during this process.

A 'caregivers' skills programme' is then worked on with parents and the child in a bid to change a child's "inappropriate" behaviour.

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'Thank god I was diagnosed with ADHD'

Comment from: Joe Atkinson, insurance clerk, Colorado, US
Date: December 11, 2006

I am 55 years old and thank god I was diagnosed with this disorder when I was 30.

Before being diagnosed, I couldn't read above an eight grade level. I was almost homeless, and was one failure after another.

If a person has ADHD, they can't concentrate well enough to be productive and contribute.

Once I got the stimulant drugs, I read history for 10 years, trying to make up for all of those years I could not read. I was able to get my college education, work and then retire in a professional field.

The people trying to get people off these medications scare me. To do that, to even to one child, is taking away that poor child's ability to live a successful life.

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Pressure for a medical diagnosis

Comment from: Dean Robinson, psychologist, Keene High School, Keene, New Hampshire, United States
Date: December 13, 2007

There is a force in many US state departments of education that requires a medical diagnosis of ADHD. As expected, that often leads to prescription of ADHD meds, often without a thorough differential psychological diagnosis to rule out anxiety, depression, PTSD, etc.

We only need a medical evaluation to rule out medical conditions that can mimic ADHD symptomatology, such as abnormal blood sugar levels and abnormal thyroid function. A good article.

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