ADHD is the number-one disorder among children. Drug prescription for ADHD has also reached epidemic proportions. But children who are ‘always on the go’ usually do not have a medical problem, says Laura Batstra, researcher and lecturer at the University of Groningen. According to Batstra, ADHD can often be prevented by not making the diagnosis: ‘It is a fallacy to regard ADHD as an illness.’
It is a misconception to categorize ADHD (Attention Deficit Hyperactivity Disorder) as a brain disorder, explains Batstra. ‘By far the majority of children with ADHD do not have brain abnormalities. There are no chemicals deficiencies, and no parts of the brain that are smaller. ADHD is no more than a name we give to problematic hyperactive, impulsive and distracted behaviour. By no means all easily distracted children need to go to the psychiatrist.’
Yet this is usually what happens, claims Batstra. In nine out of ten cases, parents who take their hyperactive child to the GP are referred directly to a psychiatrist, who then diagnoses ADHD. Consequently, there has been an exponential increase in the number of children diagnosed with ADHD. In fact, it is the most common diagnosis made by child psychiatrists, and the number is still growing. Drug prescription for ADHD has also increased exponentially. Last year, ADHD medication was prescribed 1.1 million times – more than double the figure for 2007.
Batstra: ‘But in the vast majority of cases, ADHD is a behavioural problem, and should therefore be treated by behavioural experts such as pedagogy specialists, remedial educationalists and psychologists. It should not be treated by physicians, who usually look for a medical solution and prescribe medication.’ Batstra’s study of GPs in Groningen showed that they seldom refer the children to a primary-care practitioner. ‘I advocate consulting behavioural specialists first, since we now know that assistance given to parents and teachers is just as effective as medication. Behavioural specialists can provide primary care without diagnosing ADHD. That saves a lot of money – psychiatric testing is expensive.’
The ADHD ‘label' is damaging to children in other ways too, Batstra claims. ‘What concerns me is that children are given the message that the problems belong to them. An ADHD diagnosis attributes the cause of the condition entirely to the child. In the first place, this is unfair: ADHD is caused by external as well as internal factors. In the second place, I ask myself what effect it has on a child who has this cross to bear.’
According to Batstra, instead of pointing to the child as the source of the hyperactivity, the cause should be sought in a complex of factors. Apart from predisposition, factors such as school, parents and the demands of modern-day society also play a role. ‘This interplay makes things complicated, and people don’t like this. It is much easier to point to a single cause, but that is an oversimplification.
The pharmaceutical industry plays a negative role in this, Batstra believes. The diagnosis ADHD is in the industry’s interest, in terms of driving up sales of medicines such as Ritalin, Concerta, Medikinet and Equasym. ‘An information flow is therefore created in which ADHD is categorized as a neurobiological brain disorder’, says Batstra, who believes that the industry plainly promotes the disorder. ‘It goes much too far. The industry has tentacles everywhere. Pharmacists sponsor parents’ groups, produce websites about ADHD and ‘lionize’ doctors who prescribe the medicines. The companies spend twice as much on marketing a product than they do on developing it.
Too little attention is paid to the effects of extensive drug prescription, according to Batstra. ‘There are certainly cases in which medicines are a solution. But medication should be a last resort, not a panacea as is currently the case. We have to be more honest about what ADHD medication can and cannot do’, states Batstra. ‘Medication only suppresses behavioural symptoms, and is only effective for a period of two to three years. Medication does not ultimately improve performance at school and social behaviour.’
The use of medication – the long-term effects of which are still far from clear – amounts to ‘tinkering’ with the child. Batstra: ‘The child is given the message that it is all his or her fault. Moreover, there are serious side effects such as stomachache, headache, nausea and sleeplessness. This is played down by saying that the side effects will last only a few weeks, but the children have to deal with these too.’
Batstra has developed a treatment model that begins with normalizing and acceptance: some children are very demanding for their parents/educators. This is difficult, but is not a sign of psychiatric illness. Batsta advocates a more realistic approach to bringing up children: ‘We need to move away from the idea that parenting is nothing but fun.’ In some cases it may help if parents feel that they are being listened to, and if they accept that parenting stress is inevitable, They can also find support from parenting books, information material and regular consultations. ‘Special training for parents and teachers is sufficient to help most hyperactive children. The children that do not respond to this can be referred for psychiatric help anyway.’
Laura Batstra (1973) graduated cum laude in psychology in 1997. She worked at the University Medical Center Groningen (UMCG), and from 2006 as a treating psychologist at an institution for child and youth psychiatry. Since June 2010, Batstra has worked as a researcher and lecturer in the Department of Orthopedagogy at the University of Groningen.
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