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• In her letter ‘Medication for ADHD’ (Therapy Today, February 2009), Jan Topley states that ADHD is caused through genetics and seems to favour medication over psychological interventions. In my view there is always the other side of the coin.

  Firstly she expresses that ADHD is caused through genetics. However a contrary view is held by Sadock & Sadock¹ who confirm there is ‘no evidence’ to support a biological aetiology of ADHD. This is further echoed by Tyrer & Steinberg² who state that there is no scientific evidence to support disease processes or organic processes operating in the aetiology of ADHD. Unfortunately the exact cause of ADHD is unknown though there are a number of differing and conflicting theories that make an attempt to explain the cause of the disorder.^{1, 3} These theories are considered as theoretical assumptions rather than scientific fact⁴ as there is no absolute truth and as yet there is no agreed cause.
  
  There appear to be four main theories that are postulated to explain ADHD; there is the medical view but also psychodynamic, psychosocial and cultural perspectives as to the cause of ADHD. Although Jan Topley expresses that medication is effective in treating the symptoms, Efron et al⁵ express it is not clear how medications work. This is further supported by Singh⁶ who suggests that there is no scientific evidence to demonstrate how the use of stimulants actually works on decreasing the symptoms of ADHD.
  
  Breggin & Breggin⁷ viewed the ADHD diagnosis as unhelpful, degrading and stigmatising and perceived the prescribing of medication as damaging. Jan Topley suggests from the reports that she has read that medication is stronger than psychological interventions. However the use of medication does not offer the space for self-understanding nor of the exanimation of thoughts and feelings.^{8, 9} O’Brien¹⁰ viewed that children with ADHD have poor self-esteem and he suggested that the main thrust of the therapeutic work should be centred on resolution on the child impoverished self-esteem and reducing the child’s internalised negativity – something that tablets cannot do.

  Jan Topley also suggested that medication reduces the risk of subsequent drug and alcohol misuse. Unfortunately this is inaccurate as the NICE guidelines¹¹ indicate that ADHD is a lifelong condition and may continue to present with difficulties with substance misuse and crime. It is interesting to note that children who are diagnosed with ADHD do not see themselves as suffering from an illness nor view themselves as being ill despite having an ADHD diagnosis.¹² In my own research¹³ exploring counsellors’ and carers’ perceptions of children and young people with a diagnosis of ADHD, the key factor identified in helping children with ADHD was seen as giving the child a voice, listening, understanding, respecting and empowering, all of which are an important role for counsellors. 

   

• Mental Health Nurse and Counsellor

• References:
  

  1. Sadock BJ, Sadock VA. Synopsis of psychiatry: behavioural sciences/clinical psychiatry (9th edition). Philadelphia: Lippincott Williams & Wilkins; 2003.
  2. Tyrer P, Steinberg D. Models for mental disorder: conceptual models in psychiatry (2nd edition). Chichester: Wiley & Sons; 1994: 18.
  3. Stiefel I, Dossetor D. The synergistic effects of stimulants and parental psychotherapy in the treatment of attention deficit hyperactivity disorder. Journal of Paediatrics and Child Health. 1998; 34:391-394.
  4. Anastopoulos AD, Klinger EE, Temple EP. Treating children and adolescents with attention-deficit/hyperactivity disorder. In Hughes JN, La Greca AM, Close Conoley J (eds) Handbook of psychological services for children and adolescents. Oxford: Oxford University Press; 2001: 245-266.
  5. Efron D, Jarman FC, Barker MJ. Child and parent perceptions of stimulant medication treatment in attention deficit hyperactivity disorder. Journal of Paediatrics and Child Health. 1998; 34:288-292.
  6. Singh I. Doing their jobs: mothering with Ritalin in a culture of mother-blame. Social Science & Medicine. 2004; 59:1193-1205.
  7. Breggin PR, Breggin GR. The war against children. New York: St Martins Press; 1994.
  8. Jones JD. Plea for a measure of understanding: the importance of intensive psychotherapy in the treatment of children with ADHD. Psychotherapy: theory/research/practice/training. 2002; 39(1):12-20.
  9. Ladnier RD, Massanari AE. Treating ADHD as attachment disorder. In Levy TM (ed) Handbook of attachment interventions. USA: Academic Press; 2000: 27-64.
  10. O’Brien J. Children with attention-deficit hyperactivity disorder and their parents. In O’Brien JD, Pilowsky DJ, Lewis OW (eds) Psychotherapies with children and adolescents: adapting the psychodynamic process. USA: American Psychiatric Press; 2000: 109-124.
  11. National Institute for Health and Clinical Evidence. Attention deficit hyperactivity disorder. Diagnosis and management of ADHD in children, young people and adults. NICE; 2008.