He was the psychiatrist who introduced attention- deficit and obsessive- compulsive disorders. Now he has doubts. Jonathan Milne reports
TEACHERS TEAR their hair out dealing with children diagnosed with attention deficit and obsessive-compulsive disorders. Now the eminent scientist who introduced the concepts says many may not really have them.
Dr Robert Spitzer, professor of psychiatry at Columbia university in New York, chaired the editorial task force of the Diagnostic and Statistical Manual of Mental Disorders in the 1980s. It was regarded as the bible of mental disorder classification.
His team added dozens of new diagnoses to the psychiatric lexicon, including attention deficit, post-traumatic stress, obsessive-compulsive, and panic disorders.
But now he says the classifications led to many people being diagnosed as medically disordered when their mood swings were simply normal feelings of happiness and sadness. In a TV documentary series, The Trap, he says that 20 to 30 per cent of mental disorder diagnoses may be incorrect.
"Many of these conditions might be normal reactions which are not really disorders," Dr Spitzer said. Speaking to The TES this week, Dr Spitzer said the side effects of drugs like Ritalin were not greatly problematic, so it was not a major worry if some children were wrongly diagnosed.
He said: "By and large the treatments for these disorders don't have serious side effects. I mean, some do, but they're not that serious, whereas the failure to treat can often be very hard on the child and on the family."
He acknowledged that some parents put pressure on doctors to diagnose disorders like ADD and obsessive-compulsive, and prescribe drugs. "We don't know to what extent that's been happening inappropriately," he said. Ian Graham, headmaster of the Slindon independent boys' boarding college in Arundel, West Sussex, has 20 out of 100 pupils diagnosed with ADD and a few more with related diagnoses such as oppositional-defiant disorder.
About 17 of the boys are prescribed drugs such as Ritalin, Concerta and Equasym. The remainder have their ADD controlled through diets that exclude chocolate, sweets or gluten.
The school also employs Bowen therapy, using massage over clothes, and the old-fashioned tactic of getting pupils to run off their energy in outdoor activities.
"I've never met a parent who is happy with the drugs," said Mr Graham.
"They would all prefer not to use them, but to a man and woman, they all say they can't believe the change in their sons' ability to concentrate in lessons."
However, Mr Graham also said that he had met parents who looked upon an ADD diagnosis and medication as a quick fix for normal childhood misbehaviour or low achievement. He said: "Some parents, if their children are not successful, look for a reason. And 'isms' are very convenient."
Only two out of five young ADD sufferers were given formal special education needs statements by the Department for Education and Skills - such statements require local authorities to pay for special assistance.
'The Trap' begins on Sunday, BBC2, 9pm
CONTROVERSIAL CAREER OF DR SPITZER
1973 He argues that homosexuality is not a clinical disorder, a view adopted by the mainstream.
1974-1987 Chairs the task force for the Diagnostic and Statistical Manual of Mental Disorders, which defined attention deficit, obsessive-compulsive, and panic disorders as well as post-traumatic stress.
1985 Prompts fury over plans to introduce defined psychiatric disorders for those with a masochistic personality, for men who rape and for women with premenstrual syndrome.
2001 Delivers a paper saying it was possible for "highly motivated"
homosexuals to become heterosexual. The paper was disavowed by the American Psychiatric Association.