Education And Debate

Use of stimulants for attention deficit hyperactivity disorder: FOR

BMJ 2004; 329 doi: https://doi.org/10.1136/bmj.329.7471.907 (Published 14 October 2004) Cite this as: BMJ 2004;329:907
  1. David Coghill (david.coghill@tpct.scot.nhs.uk), senior lecturer in child and adolescent psychiatry1
  1. 1 Division of Pathology and Neuroscience (Psychiatry), University of Dundee Centre for Child Health, Dundee DD3 6HH

    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

    Introduction

    The consequences of persistent, pervasive, and disabling hyperactivity, impulsivity, and inattentiveness on a child's development and functioning are serious. The presence of attention deficit hyperactivity disorder (ADHD) or hyperkinetic disorder predicts a wide range of negative outcomes. These include poor self esteem, academic achievement, occupational status, peer relationships, and family functioning and increased injury rates, disruptive and antisocial behaviour, substance misuse, and mood and anxiety disorders.1 As treatment can restore healthy functioning to many of these children and young people, a reluctance to diagnose ADHD seems unreasonable and withholding effective treatments from those who have had the condition diagnosed is unjustifiable.

    Opponents of the validity of ADHD as a diagnosis cite our incomplete understanding of its precise biological basis. Sensationalist journalism has often caught public, and at times professional, attention by delivering negative messages about the “dangers” of stimulants such as methylphenidate and the sharp increases in use over the past decade. It is important, however, to examine this …

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