Columnist Dr David Turner argues that we have gone too far in medicalising normal variations of attention deficit hyperactivity disorder (ADHD)
A parent with a teenage offspring arrives at the surgery, and they have booked a double appointment. A quick flick through the notes shows no obvious long-term medical conditions.
Your stomach tightens as you know what’s coming: The parent says that the teenager’s behaviour has ‘always been a problem…worse recently…school said to see a GP to get them referred for an ADHD assessment’.
At that moment, I may as well just press a button on a pre-recorded script. What I say is almost always the same:
‘Your child’s school may well think that he/she has ADHD, as you are probably aware the waiting time is measured in years. They will not accept a referral without a school report, so I am going to signpost you straight back to the school for them to do this. Please bear in mind that it is likely your child will become 18 before they are seen, and in which case, they will need to start all over again and be referred on the adult ADHD pathway.’
It is a depressing dialogue, which I am thoroughly bored of repeating.
I can see this from the parents’ and school’s perspective; behavioural problems affecting schooling and ability to socialise and make friends. Teacher isn’t sure what to do, bats it to the GP, who immediately bats it back to the school. School report done, refer to ADD/ADHD service, 50% of referrals immediately batted back to GP on spurious grounds. Back to school, back to GP, back to ADHD service a second time. Hopefully referral accepted, then the waiting starts.
Figures released by NHS Business Services Authority estimated that 170,000 identified patients were prescribed at least one drug for ADHD between July and September 2022 – this is a 20.4% increase from the 141,000 identified patients during the same period in 2021. How did we get to this situation?
I do accept that ADHD is real. There are individual patients whose lives have undoubtedly been transformed by this diagnosis being made and treatment being given. These are the sort of teenagers who are in so much trouble at school that they are on the threshold of being expelled; the sort of kids who regularly get into trouble with the police and for whom an ADHD diagnosis stops them ending up in prison.
What I struggle with is the medicalisation of the normal range of neurodiversity. There is no precedent in the natural world where groups of young adolescents are forced to sit still for several hours a day learning abstract concepts, such as maths and English. The fact that most kids do is amazing. Yet we feel that those who struggle to pay attention to the teacher for a required number of hours are in some way abnormal and must be diagnosed with a mental illness and treated with amphetamines.
I know of highly functioning adults in responsible jobs who have been diagnosed with ADHD as adults and started on amphetamines. This is absurd. The reason, of course, is the private sector and the huge fees being charged by some providers for a diagnosis of ADHD. The recent BBC Panorama documentary Private ADHD Clinics Exposed highlighted some dubious practices in some of these private clinics.
I fear that with ADHD we have gone too far in medicalising normal variations and created a new ‘fashionable illness’. In times gone by many patients wanted an allergy to be the cause of their symptoms. Now it seems that a formal diagnosis of neurodiversity is in vogue.
Yes, ADHD is a genuine illness. But as GPs we must be careful who we attach this diagnosis to. In the digital age it is easy to add a label, but virtually impossible to remove it – and in years to come, that is something some of our patients may deeply regret.
Dr David Turner is a GP in Hertfordshire. Read more of his blogs here