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ADHD debate not new, but still much needed

Among the past year's best books on special needs are ideas for inclusive PE, a picture book about an autistic boy, and a critical study of ADHD.

Karen Gold reports

The NASENTES Academic Book Award winner this year is called Critical New Perspectives on ADHD, edited by two Edinburgh academics, Gwynedd Lloyd and Joan Stead, and an American, David Cohen.

But Gwynedd Lloyd admits there is nothing new about these perspectives on attention deficit hyperactivity disorder. Ten years ago, deeply concerned at the increasing diagnosis and drug treatment of a condition which seemed to come from nowhere, she began a correspondence from her base teaching in the Department of Educational Studies at Edinburgh university, with David Cohen, professor of social work at Florida International university. Both were writing critical papers about the phenomenon.

They got, she says, precisely nowhere. "Since then there has been a fantastic expansion in the number of children diagnosed with the condition and prescribed medication for it."

Nevertheless, the three editors agreed that their book was "not shutting the stable door. I think we are reaching a stage now where people will start to review things. In 15 years' time I believe people will say 'What were we thinking of, sweeping all these children up into one diagnosis?'."

The editors wanted the scope to be as international as possible. Dr Lloyd points out that ADHD is not recognised in Japan, so no one writes about it.

Some of the book's contributors argue that it is simply a medical fiction: a psychiatrists' and pharmaceutical companies' creation. Others argue that at least some of the children labelled undoubtedly have difficulties, but they are often not the same difficulties. Dr Lloyd observes that in the US, for example, the majority of children diagnosed are middle-class, whereas in Scotland they are "the usual suspects", and there are other ways of managing them apart from by chemical cosh.

Pharmaceutical companies may drive the expansion - prescriptions for methylphenidate (Ritalin) grew by 7,600 per cent in the UK between 1994 and 2004 - but, she argues, schools and the state have fuelled it in two ways.

First, because funding for in-school support and disability allowances follow a medical diagnosis, creating an incentive for families to accept one. But more powerfully, because the diagnosis removes blame from the child and the family.

Schools need to find new ways of supporting families, she argues. "ADHD has been a label of forgiveness. And I understand why they would want it because then the school isn't implying it is the family's fault."

Teachers and schools are capable of grasping the complex interplay between a child's environment and personality without having to resort to simplistic explanations, she insists. Ultimately that was why the three editors created the book. "If you look on the web, it says 'This is what ADHD is, this is how you diagnose it, this is how it's treated.' It's extraordinarily uncritical and simplistic. So are the books that are written for teachers. They completely underestimate teachers' capacity to understand that something might be complex, or contested, and not everybody agrees. We wanted to make people stop and think."

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