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ADHD
Fact or Fiction?
Dr Ruth Marshall
Consultant Child and Adolescent Psychiatrist
The Winnicott Centre (Central Manchester)
Fact or Fiction?
What are the facts?
And the fiction?
Where is the info from?
Can we be better informed?
What can we do?
The Source of our Information….
The naughty children who aren’t really misbehaving, 1996
Noisy kids don’t need sedating, 2003
Schoolchildren Are Increasingly Dosed With Both Ritalin and AntiPsychotic Drugs, 2004
Why we have created a medical condition to excuse our spoilt brats, 2005
Tenfold increase in Ritalin prescriptions for ADHD children sets off U.K.
investigation, 2006
ADHD: Excuse Or Misunderstood? 57% Of British Public Believe Disorder
Used To Excuse Children's Bad Behaviour, 2007
The ADHD Scam and the Mass Drugging of Schoolchildren, 2008
And more……..
Food Additives Found to Cause Hyperactivity in Children, 2008
Half of all prisoners had ADHD as a child – 2010
First Direct Evidence That ADHD Is a Genetic Disorder: Children With
ADHD More Likely to Have Missing or Duplicated Segments of DNA, 2010
Brain Scans Show Children With ADHD Have Faulty Off-Switch for
Mind-Wandering, 2011
ADHD 'caused by genetic faults‘, 2011
A genetic basis for Attention Deficit Hyperactivity Disorder (ADHD) has
been discovered by British scientists, who say their research explodes the
myth that it is just an excuse for bad parenting, 2011
The most recent…….
Unscrupulous parents seek ADHD diagnosis
for benefits, 2011
Debate Over Drugs For ADHD Reignites
What is ADHD
A disorder characterised by the following
symptoms:
Overactivity
Inattention
Impulsivity
Present since early in development
Pervasive
The Facts
The evidence
Genetics (twin studies, genes)
Neuroanatomy (changes in brain
volume)
Neurophysiology (EEG and blood flow
changes)
Neurochemistry (Dopamine,
noradrenaline)
The numbers
3-6% of the population in UK <17yrs
(The ADHD Scam and the Mass Drugging of Schoolchildren, 2008)
Population of Manchester <17 yrs = 111,410 (25% of total
population)
Therefore there might be over 6,000 children with
ADHD in Manchester!
Currently ~ 450 diagnosed in Manchester (7.5% of the
possible no in Manchester)
Bad parenting or an excuse for bad
behaviour?
Genetic influences
parents with the gene
The effects of a challenging child
The chicken or the egg?
The expression of the disorder
The effects of boundaries
Who has it and who hasn’t?
Assessment:
History
Information (home and school)
Observation
Specific tests
Management
Psychosocial interventions
Parenting
Psychological interventions
Educational interventions
Medication
Stimulants
Others
Follow-up
Clinic
Liaison
Drugs – do they work?
First line treatment
Effective in 90-95% cases
Parental feedback
Young people’s feedback
Educational success
Reduction in risks
And the drawbacks…
Side effects
Appetite reduction
Sleep problems
Tics
Stomach and head aches
No evidence of dependence
Minimal risk of abuse
And when we don’t treat…
Educational failure
Behavioural problems
Criminality
Substance misuse
Relationship breakdown
Underachievement
Risk taking
Psychiatric co-morbidities
Pathways to Care
Referral from:
GP
Paediatrician (community or hospital)
Discuss with/inform GP:
School nurse
Health visitor
Educational psychologist
42nd Street worker
Through liaison meetings:
Social worker
Youth offending team worker
Eclypse (substance misuse service) worker
Child and Adolescent Mental Health
Services in Manchester
Central Manchester and Manchester Children’s
University Foundation Trust (CMFT)
4 services
North (The Bridge)
Central (The Winnicott Centre)
South (The Carol Kendrick Centre)
Emerge -16/17yr old service (The Powerhouse)
Child Psychiatry (multi-disciplinary teams) and Child
Psychology
Referral lottery
Need to be identified before referred
Professionals with different experience
Different beliefs about ADHD
Severity of problems
Perception of services
Understanding of the child
Family/social/cultural influences
What’s it got to do with schools?
Legislation (Every Child Matters/Disability Act)
Recognition and referral – we need you!
Behaviour management – we could help!
Attendance
Targets
It’s not all bad……
Positive attributes:
Energy
Observational skills
Enthusiasm
Who’s got it….
Hans Christian Anderson
John Lennon
Whoopi Goldberg
Beethoven
Jim Carrey
Lewis Carroll
Prince Charles
Cher
Agatha Christie
Winston Churchill
Bill Crosby
Salvador Dali
Leonardo da Vinci
Walt Disney
Kirk Douglas
John F Kennedy
Mozart
Picasso
Edgar Allen Poe
George Bernard Shaw
Socrates
Steven Spielberg
Sylvester Stallone
Vincent Van Gogh
Lindsay Wagner
Stevie Wonder
Dustin Hoffman
Ernest Hemingway
Galileo
Albert Einstein