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Why are we failing young patients with ADHD?

BMJ 2014; 349 doi: (Published 13 October 2014) Cite this as: BMJ 2014;349:g6082

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The answer to Dr Bower's question lie in the very philosophy on how British Psychiatry using ICD 10 viewed ADHD or Hyperkinetic Disorder compared to US Psychiatrist using DSM IV. Even two decades ago, concerns were raised in the UK at the rising prescription of stimulants in the US; this was reinforced by the CDC publication in 2003 (1) and Collishaw et al study in 2004 (2).

I came to Liverpool over 2 decades ago having completed by postgraduate residency training from one of the most recognised institutes in India, Post Graduate Institute of Medical Education and Research, Chandigarh. The institute is one of the few centres in the world that runs a DM course in child psychiatry. I was well trained in recognising, diagnosing ( was very aware of the non-categorical nature of the disorder) and treating ADHD in children with stimulants. During my registrar posting in child psychiatry in the city, I was astounded to find that my experienced, respected, renowned consultant trainer had never prescribed Ritalin!
The focus of treatment instead was on family therapy, behavioural modification and psychoeducation. I don't think Liverpool was an outlier at the time.

Hence Dr Bower's concerns come as no surprise to me in 2014. The effect size of methylphenidate, dexamphetamine and atomextine are between 0.6 and 0.8 SD, the last NICE TA (98) recognises this, so paediatricians and child psychiatrists should not have any concerns in confidently prescribing medication along with non-pharmacological intervention ( which can be provided by Non NHS organisation) through an integrated pathway.

We have developed an adult ADHD service in Sefton (northern part of Liverpool), are working with Liverpool CCG to develop a youth mental health service to fill the large gap where adolescents with multiple established and emerging mental disorders are failed during transition from child to adult psychiatry and are hoping Dr Bower's and his colleagues would help us improve the quality of service and get value for the 'Liverpool Pound'!

Competing interests: No competing interests

15 November 2014
Sudip Sikdar
Consultant Psychiatrist, Clinical Director
FRCPsych, MD
South Sefton Neighbourhood Centre, Mersey Care NHS Trust, Liverpool, L22 3XR