Mistaken identity

Fife is the largest single user of drugs to treat attention deficit hyperactivity disorder in Scotland, but it may be that medication is being given to youngsters with normal mood swings

Thousands of children in Scotland could be wrongly receiving medication for attention deficit hyperactivity disorder because of incorrect diagnosis, according to the man who named the condition.

Robert Spitzer, professor of psychiatry at Columbia University, chaired the team which created the diagnostic bible, Diagnostic and Statistical Manual of Mental Disorders, and added attention deficit, post-traumatic stress, obsessive-compulsive and panic disorders to the medical lexicon.

Now he believes these classifications have led to many mistaken medical diagnoses when people were only experiencing normal mood swings. In the television documentary The Trap, shown on BBC2, he suggested 20 to 30 per cent of mental disorder diagnoses could be wrong. With estimates of 49,258 ADHD prescriptions issued in Scotland in 2005-06 (an increase of 15.6 per cent on the previous year), that could mean as many as 16,419 prescriptions were taken last year by youngsters in Scotland unaffected by the condition.

At an ADHD conference last week, organised by Edinburgh University, it was revealed that Fife was the largest single user of drugs for the condition in Scotland, with nearly 180 prescribed items for every 1,000 five to 14-year-olds in 2005-06, compared to the Scottish average of just under 83 per 1,000.

Pippa San Roman, educational psychologist at Fife Council, put the anomaly down to the county's proactive ADHD team. However, she revealed that an in-depth study of 20 Fife children diagnosed with attention deficit hyperactivity disorder found that 90 per cent were not suitable for ADHD referral.

Questioned on whether doctors in Fife were too quick to diagnose the condition, she said: "I don't want to insult others' professionalism, but yes. But it doesn't worry me and I'm not going to say those children have all been wrongly diagnosed. The people who diagnose do so because they are asked to in a very challenging environment - they are asked to find solutions by angry and tired mums."

She said teachers should be brought into the loop more, because they often only find out there is an issue when parents reveal their child has started taking Ritalin.

A Scottish Executive health spokeswoman said the decision on whether to prescribe drugs for the condition was a clinical one for doctors, based on a full assessment. She attributed increasing prescriptions to new mental health services' increasing awareness of attention deficit. "There is no evidence to suggest that the prevalence of ADHD has increased, but awareness of the condition and compliance with national guidelines have and this explains a rise in prescriptions in the last year," she said. "We would not expect to see a similar rise year-on-year in the prescribing of these drugs."

The Scottish Intercollegiate Guidelines Network published recommendations in June 2001 on how to manage attention deficit hyperactivity disorder. NHS Quality Improvement Scotland is currently auditing how practice complies with the SIGN guidelines, which will included public consultation.


We live in a world of flashing images, thumping music and instant technology. In today's fast-paced lifestyle, children can multi-task and dazzle with their deft manipulation of technology - but ask them to sit down and concentrate for 30 minutes and it's no wonder they struggle.

Leading neuroscientist Baroness Susan Greenfield argues that environment may be the ignored factor in the swelling tide of attention deficit hyperactivity disorder diagnosis. Speaking at the Edinburgh ADHD conference, she revealed that only one brain condition is caused purely by genetics, Huntington's disease, meaning the environment must be acknowledged as contributory in other mental disorders.

"It is wrong to talk about nature and nurture, because they are inextricably linked," she said. "We are born more sensitive to the environment than any other creature. Humans learn brilliantly and adapt to our environment."

Professor Greenfield put forward one theory to explain the dramatic rise in ADHD diagnoses: "Could it be the change in environment? We need to ask ourselves what has changed, because an alternative to drug use may be to change that environment."

She quoted journalist Kevin Kelly, who said: "Screen culture is a world of constant flux, of endless sound bites, quick cuts and half-baked ideas."

And Professor Greenfield said that, after children experienced this world, teachers and parents faced a huge challenge: "Imagine you have then got to get them to school, and get them to sit still for an hour. Might they not be a little fidgety?"

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