From Joseph Grillo
While it is generally agreed that attention deficit hyperactivity disorder (ADHD) is overdiagnosed and medications to treat it overprescribed, what is not discussed are the reasons why (1 April, p 8).
As your report suggested, here in the US at least, far too many prescriptions are written by physicians without expertise in diagnosis of ADHD and other psychiatric conditions. General practitioners write the vast majority of prescriptions for psychotropic medication and they do so because they can – via generic medical licensure – but they do not have the training needed to discriminate ADHD from other conditions.
But your report overlooks a critical problem. While most competent psychiatrists should be able to discriminate ADHD from an anxiety disorder, they do not have the training to tell it apart from other conditions, such as central auditory processing disorder (CAPD), with which ADHD shares symptoms. Testing to differentiate ADHD, CAPD and other learning and behavioural disorders is not routinely done, as it necessitates referral to another professional, such as a psychologist. Psychiatrists typically do the diagnosis by observation and interview (with the occasional computerised continuous performance test). This is simply inadequate. Proper diagnosis requires an adequate data pool, and without testing to rule out other conditions, the likelihood of misdiagnosis rises.
Pyschiatry’s inadequacy in diagnosis is the unacknowledged smoking gun behind the problem of too many diagnoses and too many prescriptions. Until this issue is addressed, the problems will persist.
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From Ian Hare
I read with interest the letter from Oriole Parker-Rhodes, which suggested that ADHD might be less of a problem if children with the disorder could use their abilities in a positive way (8 April, p 25). I myself am a 13-year-old child with ADHD and have managed to find a direction for my energies – biology. I aim to become a biologist when I am older and currently reach a high standard in science.
Although paying attention has always been a problem for me, recently I read a book on neurolinguistic programming (NLP), and that has helped significantly with my concentration. However, the hyperactivity aspect was less significantly changed. To other children with ADHD, I would strongly suggest that you find something worthwhile to do with your life, if you have not already done so.
Wilmslow, Cheshire, UK
Culver City, California, US
