Education And Debate

Personal paper: Attention deficit hyperactivity disorder is underdiagnosed and undertreated in BritainCommentary: Diagnosis needs tightening

BMJ 1998; 316 doi: (Published 23 May 1998) Cite this as: BMJ 1998;316:1594

Personal paper: Attention deficit hyperactivity disorder is underdiagnosed and undertreated in Britain

  1. Geoffery D Kewley, consultant paediatrician (
  1. Learning Assessment Centre, Horsham, West Sussex RH12 2PD
  2. Child Psychotherapy Trust, London NW5 4BD

    Attention deficit hyperactivity disorder is a condition of brain dysfunction 1 2 that is misunderstood and underrecognised in Britain. Research shows that it is a genetic, inherited condition that can be effectively managed. Studies of twins suggest an exceptionally high concordance, 3 and genetic studies show a likely polygenetic basis for inheritance. 4 Evidence of brain dysfunction has been found in cerebral imaging studies, including functional magnetic resonance imaging, quantitative electroencephalography, and positron emission tomography. 5 If untreated the disorder may interfere with educational and social development and predispose to psychiatric and other difficulties. There is much myth and misinformation, fuelled by personal bias and the media, surrounding the existence and treatment of the condition, which has led to an assumption that it is overdiagnosed and overtreated in Britain.

    Psychosocial approaches encourage the belief that poor parental discipline causes most children's behaviour problems. Such approaches generally ignore a biological basis to difficulties in self control, concentration, and hyperactivity. Widespread ignorance exists about attention deficit hyperactivity disorder and the need for drugs as a component of treatment. Trite and simplistic explanations for the symptoms of the disorder are perpetuated which encourage the view that merely naughty children are being diagnosed to absolve parental responsibility. Considerable care and expertise is essential in assessing children's emotional and behavioural problems to ensure accurate diagnosis. There are three main myths that need to be overcome: what constitutes attention deficit hyperactivity disorder, that the disorder is the same as hyperkinesis, and that the drugs used for treatment have serious side effects.

    Confusion over nature of attention deficit hyperactivity disorder

    Attention deficit hyperactivity disorder is a common but complex medical condition characterised by excessive inattentiveness, impulsiveness, …

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