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An A-Z of ADHD

Cast your mind back to the distant year of 1999.

It was the year that featured the introduction of the Euro, the launch of Napster.com, and most importantly, the release of Sonic Adventure for the Sega Dreamcast, a move which ushered in a new renaissance for videogaming, and ensured Sega’s dominance over the coming decade.

Sort of.

It was also the year in which doctors in England wrote 158,000 prescriptions for the drug methylphenidate hydrochloride, or as it’s more commonly known, Ritalin.

By 2010, that number had more than quadrupled, to slightly over 661,000, most of which are used to treat Attention Deficit Hyperactivity Disorder, or ‘ADHD’.

But why are so many more prescriptions apparently necessary, barely a decade later? Has the number of children with ADHD really increased by that much? And if so, why? And who’s to blame? And if there’s nobody to blame, what am I going to do with all these angry slogans I’ve already written? Do you know how much a rhyming dictionary costs these days?

To understand why, we first have to understand what ADHD actually is, and how it has been studied over the years.

ADHD is a developmental disorder (a disorder that occurs in childhood, that slows or otherwise impedes a child’s mental development). The primary symptoms are hyperactivity, and problems in maintaining attention to any one thing. It is diagnosed in between 2 and 16 percent of school-aged children, though that statistic is based on an American study.  It is also a chronic disorder, meaning that it persists into adulthood. 4.7% of American adults are thought to live with ADHD.

Incidentally, that’s 1.2% higher than the amount of the U.S. population thought to be homosexual. Get it together, gays! You’re never going to take over the world at this rate!

At the moment, there isn’t a single known cause for why children get ADHD. However, based on existing research studies, diet, environment, and genetics are all thought to play a role. In particular, Twin Studies (studies of pairs of twins, not studies of the movie ‘Twins’) have shown that genetics is a factor in 75% of cases of ADHD.

However, this lack of a single reason to point to, combined with the (false) perception that ADHD is a relatively new disorder, has led some people to assume misdiagnosis must play a role in the current explosion of Ritalin prescriptions.

These people may have a point. In private medical practice, it’s certainly not unheard of for a doctor who earns commissions on prescriptions to prescribe unnecessarily, but reliable statistics on medical corruption are few and far-between, so we won’t dwell on that for now.

More pertinently, we might investigate misdiagnosis by looking at research into the disorder.

For many years, ADHD was thought of as ‘An American Condition’, because very few children outside of the U.S.A and Western Europe were ever diagnosed with it. Because of this, some people came to the conclusion that it was a condition fabricated out of neurotic Westerners’ fears for their children.

In reality, this was simply due to the fact that the vast majority of research into ADHD over the past 40 years has been conducted in America, meaning that medical professionals living there were naturally far more aware of the condition that in most other places.

Aan analysis performed by Queen’s University in Ontario, Canada, found that in 30 studies conducted since the 1980’s, the prevalance in ADHD of children outside of the U.S. was “at least as high in many non-US children”. In particular, a study into children from a large variety of ethnic groups by Limpopo University in South Africa found ADHD rates “very similar to those reported in Western countries, which suggests that ADHD is caused by the same fundamental neurobiological processes, probably caused by genetic factors expressed independently of cultural differences”.

Now, they might have been bribed. I don’t know. I wasn’t there. But as far as I know, there is no such thing as ‘Big Limpopo Pharma’.

So, barring some kind of global, decades-spanning, Canada-based conspiracy, we may have to discount misdiagnosis for now.

Based on these statistics, it seems overwhelmingly likely that there has always been the same amount of children with ADHD, but for some reason doctors in the U.K. and U.S. are now prescribing them medication on a much, much larger scale.

To answer this, we have to remember that these doctors, and these children, don’t exist in a vacuum.

Both the United Kingdom and the United States have been in a recession for several years now, with the economic sitaution remaining dire. People in both countries work more, on average, than almost any nation in the world. The U.K. conservative government has massively cut funding to healthcare services in recent years, and, well, the less said about the U.S. healthcare system, particularly in relation to poor people, the better.

As well that, we also have to consider that it takes an enormous amount of time, money, and effort it takes to properly treat any developmentally challenged child. Many parents simply don’t have the resources to allow them to choose therapeutic treatments for their children, and have to turn to  medication as a way of managing their child’s behaviour.

It’s understandable, but that doesn’t stop it being dangerous, much like a jaguar.

A variety of drugs are used to treat ADHD, and their long-term effects aren’t well-understood. More worrying is the fact that international guidelines for their use vary wildly, with the U.S. recommending medication in almost all cases, while the U.K’s National Institute for Health and Clinical Excellence (they’re N.I.C.E. guys) say that their use should be restricted to all but the most severe cases.

This is a complicated problem, with a relatively simple cause.

Poverty.

Drugs aren’t the best solution, far from it, but until we significantly increase the funding of public healthcare, and improve working conditions to the point where people who have children with special needs are able to devote more time to them, the only option will be the cheapest option.

And anyone who’s ever eaten at McDonald’s can tell you why that’s a bad thing.

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Photo by ADHD Center

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alexdhoyle

alexdhoyle

Alex Hoyle is a blogger, student, transvestite, and occasional stand-up comedian from Bristol, England. He can be found on Twitter as @alexdhoyle.

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