Skeptics and cynics- the biggest challenge for adult ADHD
The suggestion to start a specialist ADHD clinic for Adults in was
met with
combination of raised eyebrows and apprehension from both colleagues and
Commissioners in my region.
What is clear is that there is a growing body of carers and patients who
are
demanding that their needs are met. Psychiatry has long prided itself as a
field of medicine that places emphasis on the subjective and objective
aspects of clinical contact- areas that are often marginalised by other
specialties. The suggestion of Moncrieff et al that impairment could be a
normal variation or related to comorbidity fails to take into account the
fact
that diagnosis in adulthood requires a judgment to be made by the
clinician
on the degree of impairment. Is this any different from the diagnosis of
clinical depression or PTSD? Inconsistency amongst experienced clinicians
is
not unusual in these so-called "established diagnoses".
Yes, ADHD is highly comorbid. Yes, the current understanding of the
condition is grounded in conceptualizations of the illness as a childhood
disorder. And yes, drug companies may profit.
But the skill in making the diagnosis is identifying which symptoms are
related to comorbidity and which symptoms are explained on the basis of
underlying ADHD. Not difficult when one has seen several individuals
referred
for problems related to the condition.
Overdiagnosis is a concern for all psychiatrists and the legion of
individuals
diagnosed with schizophrenia within the prison system bears testament to
this.Reliable diagnosis and competent management is ultimately up to the
individual clinicians who have the confidence to deal with ADHD in adults
while remaining focussed on the possibility of comorbidity and potential
diversion of stimulants for purposes of misuse.
It is time for colleagues and Commissioners to take notice of a
condition for
which there is an overwhelming body of evidence. Ignore it at your peril.
Skepticism is not a defence.
Competing interests:
Dr Naidoo runs a specialist clinic
for Adults with ADHD in Liverpool.
I have also acted as an advisor in
the area of aDHD for Janssen Cilag
Rapid Response:
Skeptics and cynics- the biggest challenge for adult ADHD
The suggestion to start a specialist ADHD clinic for Adults in was
met with
combination of raised eyebrows and apprehension from both colleagues and
Commissioners in my region.
What is clear is that there is a growing body of carers and patients who
are
demanding that their needs are met. Psychiatry has long prided itself as a
field of medicine that places emphasis on the subjective and objective
aspects of clinical contact- areas that are often marginalised by other
specialties. The suggestion of Moncrieff et al that impairment could be a
normal variation or related to comorbidity fails to take into account the
fact
that diagnosis in adulthood requires a judgment to be made by the
clinician
on the degree of impairment. Is this any different from the diagnosis of
clinical depression or PTSD? Inconsistency amongst experienced clinicians
is
not unusual in these so-called "established diagnoses".
Yes, ADHD is highly comorbid. Yes, the current understanding of the
condition is grounded in conceptualizations of the illness as a childhood
disorder. And yes, drug companies may profit.
But the skill in making the diagnosis is identifying which symptoms are
related to comorbidity and which symptoms are explained on the basis of
underlying ADHD. Not difficult when one has seen several individuals
referred
for problems related to the condition.
Overdiagnosis is a concern for all psychiatrists and the legion of
individuals
diagnosed with schizophrenia within the prison system bears testament to
this.Reliable diagnosis and competent management is ultimately up to the
individual clinicians who have the confidence to deal with ADHD in adults
while remaining focussed on the possibility of comorbidity and potential
diversion of stimulants for purposes of misuse.
It is time for colleagues and Commissioners to take notice of a
condition for
which there is an overwhelming body of evidence. Ignore it at your peril.
Skepticism is not a defence.
Competing interests:
Dr Naidoo runs a specialist clinic
for Adults with ADHD in Liverpool.
I have also acted as an advisor in
the area of aDHD for Janssen Cilag
Competing interests: No competing interests