ADHD kids 'given wrong care and treatment'

LOIS CAIRNS
Last updated 10:00 13/02/2011

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Many of the children being given drugs for attention deficit hyperactivity disorder (ADHD) may have been misdiagnosed, an expert believes.

Psychologist and behavioural expert Frances Steinberg believes shoddy diagnostic processes are seeing kids labelled with ADHD when they are suffering from other problems such as foetal alcohol syndrome (FAS).

"Most people diagnosing the problem operate from an orientation of `if it moves around and daydreams, it must be ADHD' rather than doing a careful exclusion of other factors that could be causing the inattention, impulsivity, and hyperactivity," Steinberg told the Sunday Star-Times. "And if you've labelled the child incorrectly, no amount of medication could fix what is wrong because you would not be addressing the underlying problem behind the attention problem.

"If we get the diagnostic end of the process correct, the high levels of inappropriate medications will be automatically sorted out."

Last weekend, the Sunday Star-Times revealed that record numbers of children are being medicated because of behavioural problems despite lingering concerns about the safety and effectiveness of the drugs they are taking.

In the past year, more than 106,000 prescriptions were issued for methylphenidate – commonly sold under the brand names Ritalin and Rubifen – and typically used to treat children and young people with ADHD.

Family First is now calling for changes to the prescribing rules so that at least two specialist doctors must be consulted before any child is given methylphenidate, which stunts growth.

Steinberg says the key is getting the diagnosis correct in the first place. "It's not just naughty kids who are thrown into the ADHD basket. Children who have foetal alcohol syndrome, processing difficulties, depression and anxiety disorders, traumatic stress difficulties, head injuries, autistic spectrum disorders – you name it – are also lumped into the category.

"In the early 2000s, we developed a programme in West Auckland that operated as a model for how the assessment process could be done, for little or no extra funds, by co-ordinating previously existing services.

"In the pilot programme, of the 18 children studied, all of whom the psychiatrist said would have been diagnosed with ADHD under normal circumstances, only four were found to have ADHD. The others had various other processing, behaviour, or developmental problems."

Peter Bell, from the Foetal Alcohol Support Trust, said children suffering from FAS were often misdiagnosed with ADHD and given Ritalin because they were difficult or impossible to teach, and hyperactive. The problem was that while the symptoms of ADHD and FAS were similar, the recommended course of treatment was different.

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WHAT IS FASD?

Foetal alcohol spectrum disorder (FASD) is the umbrella term used to describe the range of adverse effects on development when alcohol is consumed during pregnancy.

FASD is estimated to occur in at least one of every 100 live births (about 600 babies each year), although no research has confirmed the prevalence in New Zealand.

FASD can cause serious social and behavioural problems and is the leading known preventable cause of mental retardation yet there are no specialist diagnostic centres here and women still get conflicting messages about whether it is safe to consume alcohol during pregnancy.

The most recent national figures from the 2007-08 Alcohol Use in New Zealand data indicate that 28% of women aged 18-44 drank during pregnancy.

Alcohol Healthwatch health promotion adviser Christine Rogan said the current assessment process for FASD was "grossly inadequate" and a generation of children were being let down because they were not being properly diagnosed and treated.

Families with children with FASD were being passed from "pillar to post" because of the lack of knowledge about FASD and how to diagnose it, and it was costing the health system a fortune. "We need to recognise this is happening to our children out there," Rogan said.

The tragedy of it all was that FASD could be prevented if women refrained from drinking while pregnant.

"There is no evidence to say any amount [of alcohol] is safe," said Rogan.

- Sunday Star Times

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