A Symposium on Attention Deficit Hyperactivity Disorder (ADHD)
It is suggested that ethical considerations are paramount when distinguishing between children’s ‘illness’ behaviour and behaviour that communicates emotional states such as anxiety, panic, sadness, grief, frustration and resentment.
Abstract
At the heart of the unfolding story of Attention Deficit Hyperactivity Disorder (ADHD) are three questions: are these children ill?; if not, why do children behave so? and why do they present now? In this paper, I suggest that ethical considerations are paramount when distinguishing between children’s ‘illness’ behaviour and behaviour that communicates emotional states such as anxiety, panic, sadness, grief, frustration and resentment. Examples of ethical problems that lead to biased diagnosis and non-rational prescribing highlight the challenge the doctor faces to avoid turning ‘moral judgement into . . . medical truth’. Many researchers and clinicians accept ADHD as a valid diagnostic category unaware it is the focus of a USA National Institute of Health (NIH) [2] consensus statement: this states that ADHD remains of ‘unproven’ status and ‘should give pause to both researchers and clinicians who may have reified ADHD as a “thing” or a “true entity” (rather than a working hypothesis that serves scientific, communication, and clinical decision making purposes)’. The statement is ‘independent, expert and credible’, in spite of the controversy surrounding ADHD. Thirty-one experts provided scientific ‘testimonies’ to a consensus panel, the scientific ‘jury’. The draft was subjected to rigorous revision attesting to the authoritative nature of the final statement [3]. The NIH reminds developmentally minded child psychiatrists to assess and diagnose symptoms in childhood on the understanding that ‘chaotic’, ‘acting out’, ‘out of control’ behaviours, as found in ADHD, can be ascribed to biopsychosocial factors. For example, Rutter [4] notes that the ‘process of development constitutes the crucial link between genetic determinants and environmental variables, between sociology and individual psychology, and between physiogenic and psychogenic causes.’ (p.1) Psychiatrists face special concerns with families, educators and non-developmentally minded colleagues, since the nature of ADHD raises for each of these groups inherently ambiguous perspectives. Australian and New Zealand Journal of Psychiatry 2002; 36:472–487