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Stigma and stimulants: the ADHD controversy.

screen-shot-2016-11-14-at-08-43-59In recent years, the growing number of children diagnosed with attention-deficit hyperactive disorder (ADHD) has received a huge amount of media scrutiny. A quick Google search turns up pages of articles suggesting ADHD can be blamed on everything from less time spent outside, greater demands at school, to bad behaviour and poor parenting. Unsurprisingly, the disorder can have severe social and educational consequences, which can often affect relationships and workplace productivity throughout adult life. These problems are exacerbated by the fact that an estimated 89% of cases of adult ADHD in the USA alone are still inadequately recognised and treated.

ADHD is characterised by a combination of behavioural traits including inattentiveness, hyperactivity and impulsivity. Despite being the most commonly diagnosed neurodevelopmental disorder, there is still no global consensus on the real prevalence of ADHD. Estimates range between countries and even across states due to discrepancies in social acceptance, regulation and healthcare availability. Also, despite recognisable biological symptoms including altered brain wave activity and dysfunctions in dopamine and noradrenaline transmission, research is yet to identify a clear cause for this disorder, making it far more difficult to decipher a clear explanation for the recent rise in cases.

As more and more children are labelled with the condition, concerns have been raised by some as to whether the influx of new cases is simply the result of a society searching to medicalise disruptive behaviours. Some argue that increased diagnosis can be attributed to better awareness of the disorder. Others however, suggest that high rates of mis- and over-diagnosis of ADHD have been the cause of this apparent surge in new cases. An article published this year in the Daily Mail even claimed that ‘unrealistic expectations from parents’ were to blame for the recent rush of new cases.

Such disagreement over the validity of an ADHD diagnosis is partly to blame for the growing stigma surrounding the condition. Poor public perception results in patients often being stereotyped simply as naughty children.

This leads us to the matter of how to tackle these misconceptions. At present, diagnosis focuses on psychological assessment along with fulfilment of certain behavioural criteria. However, this form of diagnosis can be subjective. In a bid to better regulate assessment of potential cases, research is now being carried out with the aim of developing a safe and affordable routine testing method for ADHD. One promising area of research is focussed on finding brain wave biomarker for ADHD based on electroencephalogram results. Researchers are also currently in the process of testing a behavioural animal model of ADHD. This model will provide us with a better understanding of the causes of this disorder and a more accurate way of testing potential treatments.

As is the case with many mental illnesses, there is as yet no cure for ADHD. Medication is often used to control symptoms rather than target the underlying cause of the condition – with nearly a million children prescribed either Ritalin (methylphenidate) or Adderall (amphetamine and dextramphetamine) in the UK in 2014. Unfortunately, alongside symptom control, these psychostimulant drugs can come with a multitude of unpleasant side effects, including insomnia and weight loss. Concerns have also been raised about the abuse potential of these drugs, particularly at a time when availability is increasing. In 2013, it was estimated that 13% of American teenagers had abused either Ritalin or Adderall.

It is hoped that further research could lead to a better understanding of the disorder and improved treatments, perhaps mitigating the need for the prescription of stimulants. Furthermore, until a failsafe diagnostic test has been developed, questions are likely to remain concerning the accuracy and legitimacy of ADHD as a medical condition. This will leave children at risk of prejudice and stigmatisation, with potentially devastating effects on their quality of life and self-esteem.

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Post by: Sarah Lambert

Sarah is a neuroscience Masters student at the University of Manchester with a particular interest in mental health and the effect of drugs on behaviour. Currently working on a project in episodic memory deficits in schizophrenia, in her free time she enjoys writing, travelling and baking.

Reference:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2174588/

https://www.theguardian.com/society/2015/aug/15/ritalin-prescriptions-double-decade-adhd-mental-health

http://www.dailymail.co.uk/health/article-3462680/Are-blame-child-s-ADHD-Adults-unreasonable-expectations-blame-surge-diagnoses.html

http://www.drugfree.org/newsroom/full-report-and-key-findings-the-2012-partnership-attitude-tracking-study-sponsored-by-metlife-foundation/

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