In his comment on the reported rise in the number of Scottish children diagnosed with ADHD, Iain FM Saint-Yves (December 20) states that accurate diagnosis is “the bed-rock on which the patient’s future depends.” He also agrees with Dr Chris Steer that the rise is a reflection of “catching-up” rather than “over-prescribing” with Ritalin. Catching-up with what, exactly? The levels of diagnosis and prescribing in the US?

The most depressing aspect of the whole ADHD saga, for me, is the extent to which the increasing rush to diagnosis constructs the issues as an internal, within-the-child problem, for which Ritalin is the current treatment of choice. Of course, prescribers will state that medication is not a stand-alone treatment, but there is no doubting that parents will place considerable - and often misplaced - faith in the magic potion among any other approaches that might be offered.

Very frequently, in my experience, what emerges from a careful analysis and formulation of presenting difficulties, is a combination of ineffective parenting and attachment difficulties. The former set of conditions creates children who have a very limited, if any, sense of boundaries, and what is OK/not OK in how they deal with others; a lack of internalised “self-controls”, and no capacity for sustained concentration and persistence with learning tasks or play.

Attachment difficulties, particularly the forms of ambivalent attachment where children cannot predictably depend on their parents to be available to them, lead to restless, needy, attention-grabbing, hyperactivated behaviours that mimic much of what passes for ADHD. Attachment problems also create difficulties with emotional regulation and the spectrum of skills involved in competent self-management, not to mention the general demands of social coping and the need to deal with negotiation and the frictions of conflict with others. (…)

Source: The Herald, UK
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