The rise and rise of attention deficit hyperactivity disorder
| Pages | 9-13 |
| Date | 01 June 2005 |
| DOI | https://doi.org/10.1108/17465729200500013 |
| Published date | 01 June 2005 |
| Author | Sami Timimi,Nick Radcliffe |
| Subject Matter | Health & social care |
Sami Timimi
Consultant child and
adolescent psychiatrist
Lincoln District
Healthcare NHS Trust
stimimi@talk21.com
Nick Radcliffe
Consultant clinical
psychologist
The Glebe Centre,
Wellington
Telford and Wrekin
Primary Care Trust
Nick.Radcliffe@
telfordpct.nhs.uk
DEBATE
9
journal of public mental health
vol 4 • issue 2
©Pavilion Publishing (Brighton) Ltd
Something strange has been happening to
children in western society in the past couple
of decades. The diagnosis of attention deficit
hyperactivity disorder (ADHD) has reached
epidemic proportions, particularly among
boys in North America. The diagnosis is usually made
by a child psychiatrist or paediatrician, with advocates
of the diagnosis claiming that children who present with
what they consider to be over-activity, poor
concentration and impulsivity are suffering from a
medical condition that needs treatment with
medication. The main medications used for children
with a diagnosis of ADHD are stimulants such as
Ritalin, whose chemical properties are virtually
indistinguishable from the street drugs speed and
cocaine. Boys are four to ten times more likely than girls
to receive the diagnosis and stimulants, with children as
young as two being diagnosed and prescribed stimulants
in increasing numbers (Zito et al, 2000).
By 1996 over six per cent of school-aged boys in
America were taking stimulant medication (Olfson et al,
2002), with more recent surveys showing that in some
schools in the US over 17 per cent of boys have the
diagnosis and are taking stimulant medication (LeFever
et al,1999). In the UK prescriptions for stimulants have
also increased significantly, suggesting that the UK is
rapidly catching up with the US. In the three years 1994
to 1997 the UK prescription rate increased 15-fold, from
6000 a year to 92,000. By 1999 this had reached 131,000
prescriptions for some 21,000 children, and 345,000 in
the latter half of 2003/04 (Baldwin, 2000; Baldwin &
Anderson, 2000; Wright, 2003). In Scotland,
prescribing of methylphenidate (Ritalin) for ADHD
rose from 69 to 603 prescriptions per 10,000 of the
population aged 6-14 years between 1996 and 2003
(NHS Quality Improvement Scotland, 2004). These
figures are likely to be an underestimation because
official statistics (based on pharmacy returns) do not
include prescriptions given out in private practice,
young offender centres or residential homes.
Concerned professionals and parents are
increasingly vocal in their criticism of the excessive use
of stimulants, and there are growing debates among
clinicians about ADHD – notably the view that it is
more appropriately regarded as a ‘cultural construct’
than a bona-fide medical disorder (Timini & Taylor,
2004; Baldwin & Cooper, 2000).
Despite the assertion from ADHD industry insiders
that ADHD is a medical disorder (Barkley et al,2002),
even they have to concede that, despite many years and
millions of dollars spent on research (it is the most
thoroughly researched child psychiatric label – from a
biological perspective, that is), no medical test for it
exists, nor has any proof been forthcoming of what the
supposed physical deficit is, so diagnosis is based on the
subjective opinion of the person making the diagnosis
(Timini et al,2004). Indeed, its validity as a distinct
diagnostic entity is widely questioned as it cannot
The rise in the diagnosis of attention deficit hyperactivity disorder (ADHD) and the use of stimulant
medication such as Ritalin to treat it raises important questions about how childhood is
conceptualised in contemporary western society today. By focusing on within-child explanations for
behaviour, the diagnosis of ADHD divorces a child from their context; real life experiences,including
traumatic ones, are marginalised or excluded from clinical consideration.This paper1explores how
ADHD manages to occupy and hold on to such a dominant position despite the lack of evidence
supporting its supposed medical origins, and explores what the ADHD diagnosis reveals about
cultural expectations of childhood and power hierarchies in the UK and North America.
The rise and rise of attention
deficit hyperactivity disorder
1This is an edited version of the chapter with the same title by Sami Timimi and Nick Radcliffe in Making and Breaking Children’s Lives, edited by Craig
Newnes and Nick Radcliffe, published by PCCS Books ISBN 898059 70 5 www.pccs-books.co.uk
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