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Changes to ADHD definition are risking 'harmful medical treatment', say researchers

Changes to the criteria used to diagnose ADHD have left children and adolescents around the world receiving “unnecessary and possibly harmful” treatment, experts have warned today.

There are ‘unquestionably’ children who have ADHD who need specialist help, says a team lead by Rae Thomas, a senior researcher at Bond University in Australia, in an article for this morning on the British Medical Journal website. But they point to a steep rise in the numbers being diagnosed in the UK, Australia, the USA and the Netherlands.

Some eight to nine per cent of school-age children in the USA and UK are thought to be diagnosed with ADHD. Australian data show a 73 per cent increase for prescriptions between 2000 and 2011, while in the Britain these increased two-fold for children and adolescents between 2003 and 2008 and four-fold in adults.

Dr Thomas's team claims that these drugs used to treat ADHD can have side effects such as weight loss, liver toxicity, and suicidal thoughts.

The steep rise is partly because clinicians are getting better at detecting and diagnosing the disorder, the article says, but they also point to a change in the formal definition of the condition.

To be diagnosed with ADHD, a child, adolescent, or adult should meet clear diagnostic criteria outlined in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders – used around the world to classify mental disorders.

But Dr Thomas and her team claim that definitions of ADHD have been broadened in successive editions of the manual, including the latest in May.

“These changes are a cause for concern because they increase the risk of confusing ADHD with normal development processes, such as pubertal restlessness and distractability.”

The researchers suggest that in order to reduce unnecessary diagnosis without risking under-treatment of those who really need help, a conservative approach to treatment should be taken.

Fintan O’Regan, behaviour and learning consultant, said being too wary of medication could also cause problems.

“Having been the headteacher of a special school, I have rarely met a parent who didn’t think long and hard about giving medication to their child,” he said.

“For most parents it is the last resort. The health of the child must come first, but there are also long-term consequences of [a child with ADHD] not taking medication.”


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