Driving Mum CrazyBMJ 2001; 322 doi: http://dx.doi.org/10.1136/bmj.322.7277.56/a (Published 06 January 2001) Cite this as: BMJ 2001;322:56
Channel 5, Wednesdays at 8 30 pm, 13 December to 10 January
The first series of Driving Mum Crazy last January (reviewed BMJ 2000;320:388) wasted an opportunity for accurate exploration of issues in child and adolescent mental health. Considerable media and public interest was achieved, however, hence this second series of four programmes about hyperkinetic disorder (attention deficit hyperactivity disorder (ADHD) in the United States). I hoped that the second series would explain that child and adolescent mental health problems, including hyperkinetic disorder, were complex and needed careful dissection of causative biological, psychological, and social strands (which are often unconsciously hidden by the families seeking help).
We were shown children given diagnoses of hyperkinetic disorder, with secondary conduct disorders. Hidden cameras filmed their disordered behaviour. Despondent parents and hopeless, resigned siblings were interviewed. As with the first series, the issue of genuine informed consent of the child subjects was shamefully ignored. Although these patients had diagnoses of hyperkinetic disorder, their disturbed conduct was paramount. I suspect that such children were chosen because their violent outbursts satisfied the voyeuristic instinct of television. Their parents' naive expectations that methylphenidate would magically turn Hyde back to Jekyll went unchallenged. No effort was made to explain how a child with hyperkinetic disorder but without secondary conduct disorder would have presented—after thorough assessment, such children often respond dramatically to psychological and biological treatments.
This series, like the first, ignores the profession of child psychiatry. Although the first episode showed the complexity of the Maudsley resource, the opportunity to translate this supertertiary assessment process for the lay viewer was missed. In the second programme, no assessment process was shown at all. The boy's diagnosis may as well have come from the local oracle. In fact, hyperkinetic disorder is perhaps the most objectively validated psychiatric diagnosis. Accurate rating scales are routinely used for screening, assessment, and follow up. Such standard practice, which occurs in child and adolescent mental health clinics nationwide, could easily have been shown and would have explained how the behaviour of this small group (hyperkinetic disorder affects about 5 in 1000 children) differs from “oppositional” behaviour, which is common and is often misdiagnosed as “hyperactive.”
In view of the fact that hyperkinetic disorder and methylphenidate have a high public profile, what this series should have done was to explain what hyperkinetic disorder is, how it is assessed, and what the pros and cons of methylphenidate treatment are. If this series set out to demystify hyperkinetic disorder and Ritalin, it did not succeed.