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
I find Dr Turner’s view outdated at best, and offensive at worst. The very description of children with ADHD as “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” is problematic. Many children, especially girls, mask their inattentive symptoms to a huge degree in school and exhibit no bad behaviour whatsoever. The impact of their ADD can be devastating in terms of their confidence and emotional well-being and, in an education system as stressed and prescriptive as ours, where National Curriculum literacy targets seem hugely at odds with what a child would need to learn in order to work in the 21st century, medication, support and understanding, rather than criticism and judgement, is needed.
The evidence base for adult ADHD is similarly growing in terms of size and quality, and there are undoubtedly many “functional” adults who have been misdiagnosed with a range of mental health diagnoses before discovering lisfexamine and finally being able to concentrate on one thing at once. Perhaps a more helpful approach is to recognise that the concept of being neurotypical is rare, we are after all a diverse species, but that the current approach, and in particular the hugely critical narrative which accompanies it, is wholly unhelpful to the individual.
Good outline Dr. Turner and an OTT response from Dr. McKinnon.
With 22 years of experience as a (private) School Physician to a population of 11 – 17yr olds – it was almost an automatic referral by the teachers to the ‘Special Eduction’ staff member for any distracted in-class behaviour … and then the same referral approach to her pet (off campus) psychologist who pretty much always recommended a ‘trial’ of amphetamines – although this was against guidelines for ADHD.
No parental questionnaires were obtained nor any from the teaching staff.
I admit this was a number of years ago but my sense it that the ADHD scenario in now an industry unto itself.
clearly biased, should be removed.
ADHD is a real thing.
What is sad, is adults with fear of missing out, seeking a private diagnosis to justify their social problems.
Dear All,
Sorry I should have typed re Sue McKinnon’s comment that it was clearly biased and should be removed. Just where does the medicalization of the spectrum of Normal human behavior begin, or end? Maybe one day doctors, who diagnose these conditions more frequently than others, might be classified as “high diagnosing spectrum disorder doctors? Make your own judgement,
Regards
Paul C
I wonder how much Covid and post Covid disruption is impacting on these conditions and possibly made them more overt.
ADHD is a real condition and merits appropriate assessment and management which appears in limited supply
Some people are always offended by the truth. Thanks for saying what we all think but can verbalise for fear of the multiple regulators in this ridiculous nhs we work in. Ignore the haters, just like Taylor Swift said you should. Thank you for this perfectly worded and spot on opinion echo across every GP surgery every day, day by day by day….
Can’t verbalise…
let’s be realistic- we are not attaching those diagnostic labels, it’s done by specialist services. we need to be careful not to follow the lead of various private ones that are happy to diagnose and medicate after 10 minute assessment. otherwise- not guilty
There are more people seeing about ADHD diagnosis on Tik Tok than the entire population of the world.
https://adhduk.co.uk/tiktok/
Go figure than one out.
The solution is to ask the school to consider referral to an education psychologist. They are funded by the council and attached to schools and deal with behavioural problems as well as other special needs.
From the adhduk.co.uk website (linked in post of Born Jovial above) there are famous people listed who have ADHD.
I picked 2 at random:
Will.i.am : says ‘Its a gift not a flaw’. No mention of medication.
Heston Blumenthal: says ‘I wouldn’t change me for the world’. No mention of medication.
“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.”
Oh dear. Showing your ignorance here Dr. Turner. That’s like saying that only those who are sectioned can have mental illness, or you can’t have a heart attack unless you’re in cardiac arrest. I’d suggest you do some reading about how girls present with ADHD (clue – not as you described above) and how bright kids can stay under the radar of busy teachers but significantly limit their potential until their ADHD is treated.
And you’ve presumably never met the large number of high flying doctors who have been close to burnout, pulled back from the edge by recognition and treatment of their ADHD.
Entirely agree with you on the clunky referral process and IMO these services should be self-referral, but the rest of your article is offensive tripe.
Of course ADHD is being over-diagnosed. Hardly a week passes without at least 1 patient requesting referral to the already overwhelmed newish Adult ADHD clinic. Nearly all of them have self diagnosed online…….it’s the trendiest Mental Health problem out there (bipolar is SO 2010s, darling.) and is clearly an example of Social Contagion.
Undoubtedly a few will genuinely benefit from treatment, but the “worried well” will inevitably clog the system which will grind to a halt, just as children’s services have already done.
Calm down Toni you are allowed to have a difference of opinion, that’s what makes medicine great. Accusing someone with a different view to your own of ignorance is often the first weapon of the ignorant.
The difference of opinion also allows for an element of safety which is particularly necessary we are diagnosed these are so subjective and the prevalence is so high. And in 30 years of practice I haven’t met any high flying doctors who have been pulled back from the edge by the administration of amphetamines.
I have however seen several clinicians pushed to the edge by the overuse of opioids and other psychoactive drugs which were also once thought to be a panacea.
@some bloke is right. “We” don’t generally diagnose ADHD (or autistic spectrum disorder, to mention the other common neurodivergent condition). All we do is offer patients further assessment when they request it.
I am struck however, by the apparent 100% diagnostic rate of our local NHS adult ADHD / ASD service: I can’t remember the last time a letter came back from the adult ADHD / ASD service saying the patient doesn’t have the condition. (It’s very different in the child service, where the letter often says they don’t have the condition).
Either this shows how brilliant I am at only selecting the correct patients for referral, or it suggests that a large proportioin of the population meet the diagnostic criteria. If the latter case is true, it most surely raise some philosophical questions around the meaningfulness of the diagnoses?
A large proportion of the population meet the criteria, and a large proportion of the population feel good on amphetamines – which would be fine except Big Pharma has added a couple of molecules to make them patented, very expensive amphetamines!