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Attention-deficit hyperactivity disorder: should we believe the mass media or peer-reviewed literature?

  • Dave Coghill (a1)
Extract

Bailly's review describes the author's perspectives on the ‘intense controversies' surrounding attention-deficit hyperactivity disorder (ADHD) and its treatment with stimulant medications. Drawing on a range of literature sources, including the UK press, pharmaceutical industry websites and peer-reviewed scientific papers, he questions the validity of ADHD as a concept and disorder, the accuracy and reliability of diagnosis, the use of stimulant medications and the impact of advertising by the pharmaceutical industry. There are, however, additional sources and alternative interpretations.

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This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
References
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BJPsych Bulletin
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Attention-deficit hyperactivity disorder: should we believe the mass media or peer-reviewed literature?

  • Dave Coghill (a1)
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eLetters

Stimulant medication

Simon R. Wilkinson, child and adolescent psychiatrist
05 September 2005

In order to stimulate and encourage continuation of this important debate I would like to bring to readers’ attention that to date there has not been an adequate placebo controlled trial of stimulant medication for the treatment of ADHD.

The crucial issue in my rather dramatic statement depends on what constitutes ‘adequate’. Guidelines for the adequateness of placebo controlis that no one during the trial should be able to identify that they have been on the ‘active’ medication through the act of taking the medication, i.e. prior to evaluation of the outcome. If the substance produces a sensation that you have taken an active substance, and the placebo does not, then it is not an adequate trial. This major condition has not been fulfilled in any stimulant trials.

As this issue pertains to many psychopharmacological studies the issue is of general importance. Given the high placebo response in many psychiatric disorders, and the role lack of adequate control has played inleading to spuriously exaggerated claims for effectiveness, I would like to claim that the case is not yet adequately made for medication in treatment of ADHD - with the proviso that I do expect the claim to survivesuch a control. That proviso is based on clinical instinct, which we know to be highly fallible. I therefore appeal that this field of enquiry be tightened up through funding of a major placebo controlled trial. In such a trial the placebo would give the feeling of having taken an active substance, and the placebo would be referred to with optimism as an expected adequate treatment for a sizable proportion of those who receive it, in line with other research on the effect of placebo medication in relation to psychiatric disorders. This is still ethically acceptable in spite of the otherwise monumental evidence 'supporting' use of stimulant medication.

Debate please!
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Conflict of interest: None Declared

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Attention -deficit hyperactivity disorder

DEEPTHI GUNATILAKE, STAFF GRADE PSYCHIATRIST
25 August 2005

Attention-deficit hyperactivity disorder

I read with considerable interest the article by Dave Coghill (Psychiatric Bulletin, Aug.2005, 29, 288-291) in which he recognizes the importance of parents and teachers as informants in identifying symptoms of ADHD.As described by Goldberg and Haxley, the first step in attempting to applya meaning to disturbing symptoms which a person is experiencing, is enormously important in any progression along the pathway to care. When a child has ADHD, this responsibility lies in the hands of either parents orteachers.It is not uncommon to find particularly in ethnic minority communities, that there is a limited ability to understand a specific cluster of symptoms as a possible psychiatric condition. Experience suggest, that these issues involve not only a degree of stigma, but also that there is ageneral lack of awareness of this being a treatable psychiatric condition. This leaves people in the dark with regard to any form of progression, and this in turn can lead to punitive treatment of children, based on adult assumptions of disobedience and indiscipline. This lack of recognition prevents the child from entering a pathway of care, with a view to comprehensive assessment and treatment.It is clear that a great deal of work needs to be done in understanding mental health, where the National Service Framework sets standards in mental health promotion. This would enhance the awareness of parents and teachers about ADHD, particularly among ethnic minority communities who tend to retain an older pattern of beliefs and attitudes to such conditions.

Declaration of interestNone

Dinesh Bhugra, Veena Bahl (1999) Ethnicity: An agenda for mental health, The Royal College of Psychiatrists.

Deepthi Gunatilake Staff Grade Psychiatrist, Learning Disability Centre, Ridge Hill, Stourbridge, DY8 5ST.
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Conflict of interest: None Declared

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