Suffer the little children.......

Last week, I decided to poison my daughter.

It’s in the genes, you know. I blame Hawley, my second cousin twice removed. I just cannot cope with Hortensia any more. She never stops. She will not sit still. She never does as I ask. She caused trouble on the aeroplane recently. She won’t do her homework, her behaviour is driving the teachers mad and all her academic results have dropped off. Of course, she is at a disadvantage. Half her class have extra time for exams because they are either dyslexic or have tracking disorders, whatever those are. I thought it was something to do with tuning the video.

I just don’t understand it. When I was a child, if you did not do well in class, you sat in the back corner with a dunce’s cap on. That seemed to do the trick, but apparently dunce’s caps are not PC anymore.

Something has to be done. I was going to poison her, but Mrs Crippen found out and put me back on my medication. I thought it was a relatively modest proposal. I am feeling better now. But what to do with Hortensia? The teaching assistant says she must have ADHD. Mrs Crippen says we should take her to the paediatrician and he will to poison her for us…….

Enough! I will stop ranting.

But what are we doing to our children? Twenty years ago, in our practice of eighteen thousand patients, we had two children who had been diagnosed as hyperactive. I remember them well. They could take my consulting room apart in under five minutes. They were treated by the child psychiatrists with amphetamine derivatives and were transformed.

Nowadays, the diagnosis of “hyperactivity” has come of age. It has indeed become fashionable.

ADHD, or whatever the current acronym is, is no longer just diagnosed by specialised child psychiatrists. There have been documentaries on it, and there are web sites, so anyone can make the diagnosis. And “anyone” does. Parents, teachers, teaching assistants, nurse specialists, even the school caretaker. Even the health food market has got into it.

Put ADHD into GOOGLE. You get pages and pages of self-help groups, drug information, and articles along the lines of “make sure you get your doctor to make the diagnosis…..”

I did an audit. In my practice, we now have not two but thirty-eight children on Ritalin, Concerta or Strattera. So there has been a nineteen-fold increase in this condition in twenty years.

Really?

These drugs horrify me. They are widely advertised on the internet, on sites easily available to parents. Look at those web-sites. Look at the wonderfully healthy, smiling, good looking children who feature. Do they look like that becuase they are on medication?

Here are some “diagnostic criteria” (sic) for ADHD:

"A child must have exhibited at least six of the following symptoms for at least six months to an extent that is unusual for their age and level of intelligence:

1. Fails to pay close attention to detail or makes careless errors during work or play.
2. Fails to finish tasks or sustain attention in play activities.
3. Seems not to listen to what is said to him or her.
4. Fails to follow through instructions or to finish homework or chores (not because of confrontational behaviour or failure to understand instructions).
5. Disorganised about tasks and activities.
6. Avoids tasks like homework that require sustained mental effort.
7. Loses things necessary for certain tasks or activities, such as pencils, books or toys.
8. Easily distracted.
9. Forgetful in the course of daily activities.

Who decides what "unusual" means in this context? These days, just about anyone. I have three children who all exhibit most of the above criteria, often to a maddening extent. My diagnosis is "teenager".

ADHD does exist, and it is essential that it is treated, and treated properly. But it is rare. The incidence has not increased nineteen-fold in twenty years. I have seen perhaps four convincing cases in that time.

Look at the user-friendly drug “information” sites on the internet. Is the way that these drugs are advertised to the general public acceptable? Look at some of the concerns that are expressed.

Can someone please reassure me that there are no commercial interests at work here?

The diagnoses of ADHD can only be made after a prolonged assessment over many weeks, and should only be made by a specialised child psychiatrist. Where I work, and I have no reason to believe that it is not the same all over the UK, the diagnosis is made and the medication doled out after a twenty minute assessment by a nurse “specialist”.

And, very worryingly, do I detect a class structure to this too?

Middle class children with “homework problems” are more likely to be labelled as “dyslexic” or as suffering from “tracking disorders” and get sympathy and psychology. Working class children are more likely to be labelled as ADHD and get medication.

Medicating children for not tidying their rooms? For not doing homework? For bad behaviour? For losing pencils? For “being forgetful in the course of daily activities”?

Have we gone mad?


© Copyright NHS BLOG DOCTOR

Picture from: Min of Christ in Art