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The rise of ADHD: An educational psychology perspective

27 October 2017

October has been Attention Deficit Hyperactivity Disorder (ADHD) Awareness Month. Past chair of our Division of Educational Psychology (DECP), Vivian Hill, gives her thoughts on rising ADHD rates and the role of educational psychologists.

Educational psychologists (EPs) have become increasingly concerned by the number of children being identified as suffering from ADHD and prescribed medication, often without sufficient consideration of systemic factors or adequate professional liaison. Many children living in adversity may demonstrate behaviours that are associated with ADHD, but may be a reaction to stresses in their life rather than as a result of the underlying biology.

Current NICE Guidelines recommend that the first line of treatment for children displaying these behaviours should be a psychological intervention. The reality, however, is that in a time of unprecedented cuts to public serves and increasing concern about access to mental health services for young people, too many are being placed on drug treatment programmes without any form of psychological support.

The Care Quality Commission’s annual report on controlled drugs has provided clear evidence of the increasing numbers of children receiving psychostimulant medication, with a 60 per cent increase in the prescription of methylphenidate psychostimulant drugs, such as Ritalin, in the period of 2007 to 2012.

Further data details GP prescription rates, noting a 92-fold increase in the rate of psychostimulant medication being prescribed to children under the age of six between 1992 and 2001. This paints a worrying picture, with the prescribing of these drugs to such young children being actively discouraged by NICE.

ADHD remains a controversial condition as it is based on a subjective set of diagnostic criteria. There is no biological assessment for the condition and diagnosis comes from the use of subjective checklists of different types of behaviour. This leads to concern that there is no specification of the prevalence of these behaviours that is required for an accurate diagnosis and that this information is often collected without consideration of wider contextual factors.

Educational psychologists are particularly keen to ensure that consideration is given to the influences of exposure to domestic violence, abuse and neglect, inconsistent parenting, living conditions, and poverty, to ensure that misdiagnosis and inappropriate use of medication is avoided.

Information provided by 136 EPs, based across 70 different local authorities, suggested that children from vulnerable populations are prescribed medication at disproportionate levels, with 22 per cent being aware of children under five who had been prescribed psychostimulants, despite the NICE directives to the contrary.

In areas where there were effective multi-disciplinary protocols for the assessment and diagnosis of ADHD, which included the involvement of EPs, contextual factors were more likely to be considered and families were more likely to access a psychological or therapeutic intervention.

Given current concerns about children’s mental health, it is vital that we are able to provide community based and accessible services that can work in a preventative and a proactive fashion. EPs typically work in schools, providing access to psychological support that will take account of these influences and ensure access to an appropriate intervention.

As a society, we must be able to understand the factors that influence a child’s behaviour and be able to respond with relevant support, including early psychological support for children displaying behaviours consistent with an ADHD diagnosis that can avoid the inappropriate use of medication in children.

As psychologists we have a duty to protect the rights of children, give them a voice, and ensure that they have access to the most appropriate, safe, and effective support for them as an individual.

Many of the figures quoted come from a 2016 study by Hill and Turner, which can be accessed and read here.

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