BMJ  2004;329:908-909 (16 October), doi:10.1136/bmj.329.7471.908

Education and debate

Use of stimulants for attention deficit hyperactivity disorder

AGAINST

¹ Honeysuckle House, Balscote OX15 6JW h.marcovitch@btinternet.com

Definitive diagnosis of attention deficit hyperactivity disorder is complex. David Coghill believes the condition is undertreated, but Harvey Markovitch argues that current uncertainties about diagnosis and treatment mean doctors should be cautious

The first 150 words of the full text of this article appear below.

Introduction

Doctors must take great care before prescribing psychoactive drugs for children. Relying on published trials and manufacturers' summaries of product characteristics (data sheets) has proved inadequate for selective serotonin reuptake inhibitors.¹ Doctors should be just as cautious before prescribing central nervous system stimulants for attention deficit hyperactivity disorder (ADHD) and consider their response to the fact that despite decades of use, the first reasonably large medium term controlled trial (14 months' use) was not published until 1999.²

Even though evidence of safety and efficacy is more qualitative than quantitative, overall prevalence of stimulant use may be as high as 6% in the United States. If we were to follow the American Academy of Pediatrics guidelines on treating school aged children with ADHD,³ as many as 17% of all children would be treated.⁴ Putting this alongside the National Institute for Clinical Excellence's recommendation that about 1% of UK children probably merit . . . [Full text of this article]

Problems of diagnosis

Caution is needed

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