Medication isn’t always the right answer for children with ADHD | Letters

We should be careful about making assumptions, say Dave Traxson and others, while Dr Julia Nelki calls for caution in prescribing medication

There are assumptions in your article (Too few children in England treated for ADHD, figures show, 6 October) that need further debating. First, it assumes girls should be medicated at the same rate as boys for ADHD. But there is a huge impact from our socialisation of children, with girls encouraged to be more people-orientated and boys more task-focused in their play. This affects social behaviours in school, so it is not surprising that teachers report far fewer problems with girls’ behaviour and consequently seek less support from mental health professionals.

Second, global estimates of the incidence of such problems are highly variable (from 12%-16% in some US states to 0.5% in some European countries), again suggesting a significant socio-cultural component. It is important, then, to remember that the National Institute for Health and Care Excellence guidelines (2018) are very clear that medication should only be given to those with serious problems.

Finally, there is very little evidence for the assertion that ADHD has a firm neuro-developmental basis. This may be a plausible hypothesis, but we must remember that even the director of the US National Institute of Mental Health, Dr Thomas Insell, recently concluded that the search for evidence for the biological origins of mental health problems has been almost entirely fruitless.

We should not rush to assume that drugs are always the solution for the very real problems experienced by children, especially when these problems are more common in members of vulnerable social groups.

Dave Traxson Chair of Cope, Challenging Over-prescription of Psychiatric drugs in Education,
Professor Peter Kinderman President of the British Psychological Society 2016-17 and vice-chair of Cope,
Dr Cynthia Pinto Educational psychologist and secretary of Cope,
Dr Brian Apter Ex-chair of the division of educational and child psychology of the BPS.
Vivian Hill Course director of educational psychology training at the Institute of Education, London

• I do not think diagnosis/prevalence should be equated with medication prescriptions as you have done in your article. Careful assessment within school, and family meetings over time, can lead to understanding a child in context and what interventions might make a difference. These might take more time and skill than a simple prescription.

Support in schools, summer camps and family work can sometimes be sufficient to help families find different ways to manage and support their children without the need to label a child as ill.

At times, children I worked with, who would fit the criteria for a diagnosis of ADHD, did find medication helpful, especially when it gave them an experience of settling in school and sustaining friendships. Even then it felt very important, for the child and their family, to try to find a way together that they could continue to do this without medication, which some did.

We do not yet fully understand the implications of prescribing amphetamine derivatives to children, often for the rest of their lives. Therefore, some caution might still be needed.
Dr Julia Nelki
Child & adolescent psychiatrist

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