ADHD stigma a barrier to treatment

Pharmacists can play a key role in reducing the stigma of ADHD

ADHD experts have slammed comments made in MJA InSight yesterday as stigmatising and trivialising the condition and strengthening barriers to treatment.

A study published in the MJA yesterday found that the youngest children in WA school classes are more likely than peers to receive pharmacological treatment for ADHD.

In related comments in MJA InSight, the paper’s lead author, Dr Martin Whitely, said that a diagnosis of ADHD was “a dumber down label that does nothing to explain the causes of a child’s problem behaviours”.

“When kids are given amphetamines because they are less mature than their older classmates, you have to ask what happened to ‘first do no harm’?” he said.

But Dr Caroline Stevenson, a Sydney psychologist specialising in the condition and spokesperson for ADHD Australia, told the AJP today that such comments may prevent families of children with ADHD symptoms from seeking treatment.

“When we create more stigma and more difficulties, I don’t think that’s helpful at all,” she says.

“The overwhelming evidence is that ADHD is a valid condition that has been researched for over 100 years – our first article is in The Lancet in 1902 – and a disorder for which there is an incredible amount of evidence. It’s not like we’ve just made something up.

“ADHD has a specific set of symptoms that can be recognised and diagnosed, and if people are treated early they have better outcomes.

“The guidelines around the world are that medication is only part of an intervention program that improves the function of kids, in combination with education strategies and remediating any learning difficulties. It should be part of a package, but it absolutely improves cognitive ability: and if a child can’t learn anything in the classroom because of their condition, what do we do, just leave them?”

Myths about ADHD abound, she says, particularly that of the condition being due to poor parenting techniques.

“There’s no correlation between parenting and the symptoms of ADHD,” she explains. “We know it’s quite the reverse, actually: kids with ADHD don’t respond as well to reward and consequence, so even if you’re parenting effectively, those strategies don’t work as well as they do on a mainstream child.”


What pharmacists can do

Pharmacies can play a vital role in helping reduce the stigma surrounding the condition, as well as advising on taking medication as directed.

The latter is particularly important as parents will often vary the treatment regimen by “topping up” the drugs, ceasing treatment as a response to stigma or by not administering medicines on the weekend or during school holidays, Dr Stevenson says.

“The pharmacist can stress the importance of taking the medication at a regular time, as prescribed by your treating physician, and that if parents want to make alterations to that regimen, to check with their doctor,” she says.

“This is particularly important with Strattera (atomoxetine) as parents may think it’s like the stimulants, take the child off it and find the child becomes very agitated. Atomoxetine needs to be weaned, so the pharmacist can provide that information – it’s not like taking Ritalin.

“Another issue is multiple medications. Some of the kids may start on Ritalin and then on an antidepressant, and again it’s important that parents get advice on this as they may not get it from their prescriber.

“Pharmacists can have an incredibly important role in reducing stigma and doing exactly as they’d do with any other scheduled drug – which is showing empathy and giving medicines advice.”

ADHD Australia chairman Associate Professor Michael Kohn agreed that pharmacists’ role was “critical” and encouraged them to reach out to ADHD Australia for information on supporting patients affected by ADHD.

As for the issue of immaturity being mistaken for ADHD, Dr Stevenson highlights that health professionals use age norms during the diagnostic process.

“If you’re young for your grade, you may be more likely to be referred for symptoms of ADHD, which is something we recognise,” she told the AJP.

“It’s why we try not to diagnose until after age seven, so that we don’t diagnose kids with a developmental lag. Anyone who’s been given a diagnostic workup by a clinician will be judged against their same-age peers.”

A/Prof Kohn told the AJP that ADHD Australia welcomes scientific research into ADHD, particularly findings from the Raine Study.

“The results of the Raine Study are consistent with the outcomes of several studies in the US and a recent study in Taiwan, in that children who are young for their year are more likely to be diagnosed with ADHD; but in the Raine Study the rates of diagnosis, even in this vulnerable group, were lower than the base rates of diagnosis in the US studies, clearly indicating that there is no overdiagnosis.”

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