Neuroscientist
says children are being 'labelled' as having ADHD when there could be other
reasons for their disorder
The Guardian, The Observer, Daniel Boffey, policy editor, Sunday 30 March 2014
One of the world's leading neuroscientists, whose work has been acknowledged by work and pensions secretary Iain Duncan Smith, has suggested that attention deficit hyperactivity disorder (ADHD) is not "a real disease".
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| Bruce D Perry of the Houston ChildTrauma Academy: 'We are very immature in giving diagnoses.' |
One of the world's leading neuroscientists, whose work has been acknowledged by work and pensions secretary Iain Duncan Smith, has suggested that attention deficit hyperactivity disorder (ADHD) is not "a real disease".
On the eve
of a visit to Britain to meet Duncan Smith and the health secretary, Jeremy
Hunt, Dr Bruce D Perry told the Observer that the label of ADHD outlined a
broad set of symptoms. "It is best thought of as a description. If you
look at how you end up with that label, it is remarkable because any one of us
at any given time would fit at least a couple of those criteria," he said.
Prescriptions
for methylphenidate drugs, such as Ritalin, which are used to treat children
diagnosed as suffering from ADHD, have soared by 56% in the UK, from 420,000 in 2007 to 657,000 in 2012. Such "psychostimulants" are thought to
stimulate a part of the brain that changes mental and behavioural reactions.
However,
Perry, a senior fellow of the ChildTrauma Academy in Houston, Texas, said he
was concerned that children were being labelled as having ADHD when that merely
described the symptoms of a range of different physiological problems. The
symptoms that lead to a diagnosis of ADHD include inattentiveness,
hyperactivity and impulsiveness over a sustained period.
Perry added
that clinicians were also too readily prescribing psychostimulants to children
when the evidence suggested there were no long-term benefits. Animal studies
have raised concerns over the potential for damage to be done.
Perry, who
will also meet cabinet secretary Sir Jeremy Heywood during his visit as a guest
of the Early Intervention Foundation, a charity aimed at tackling the root
causes of childhood dysfunctions, said: "We are very immature in our
current evolution in giving diagnoses. A hundred years ago, someone would come
to the doctor and they would have chest pain and would be sweating. And they
would say, 'Oh, you have fever.' They would label it, just like we label it
[ADHD] now. It's a description rather than a real disease."
He added:
"If you give psychostimulants to animals when they are young, their
rewards systems change. They require much more stimulation to get the same
level of pleasure.
"So on
a very concrete level they need to eat more food to get the same sensation of
satiation. They need to do more high-risk things to get that little buzz from
doing something. It is not a benign phenomenon.
"Taking
a medication influences systems in ways we don't always understand. I tend to
be pretty cautious about this stuff, particularly when the research shows you
that other interventions are equally effective and over time more effective and
have none of the adverse effects. For me it's a no-brainer."
Perry said
he favoured an approach that went back to the root causes of the problem, and
often required attention being focused on the parents. "There are number
of non-pharmacological therapies which have been pretty effective. A lot of
them involve helping the adults that are around children," he said.
"Part
of what happens is if you have an anxious, overwhelmed parent, that is
contagious. When a child is struggling, the adults around them are easily
disregulated too. This negative feedback process between the frustrated teacher
or parent and disregulated child can escalate out of control.
"You
can teach the adults how to regulate themselves, how to have realistic
expectations of the children, how to give them opportunities that are
achievable and have success and coach them through the process of helping
children who are struggling.
"There
are a lot of therapeutic approaches. Some would use somato-sensory therapies
like yoga, some use motor activity like drumming.
"All
have some efficacy. If you can put together a package of those things: keep the
adults more mannered, give the children achievable goals, give them
opportunities to regulate themselves, then you are going to minimise a huge
percentage of the problems I have seen with children who have the problem
labelled as ADHD."
The
chairman of the Early Intervention Foundation, Labour MP Graham Allen, said
Perry was the "best in his field" and was meeting senior officials
and politicians already "convinced by the philosophy of his research. I
would argue that if you can diminish adverse childhood experience, then we eliminate
a lot of the causes of dysfunction."
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