Comment: The broad scope of ADHD research
Nikos Myttas
pp 3-3
As a new publication in the field of psychiatry, ADHD in practice aims to consolidate existing knowledge, inform
of recent advances and promote evidence based clinical practice. This is a tall order,
as the condition attracts an insatiable research interest, being the most widely
investigated topic in child and adolescent mental health and one of the most validated psychiatric conditions – with a
knowledge base that is rapidly expanding.
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A history and review of ADHD – how far have we come?
Nikos Myttas
pp 4-7
Hippocrates wrote in 400 BC of a condition that today seems compatible with what we now
know as attention deficit hyperactivity disorder
(ADHD). He described patients who had ‘quickened responses to sensory experience, but also
less tenaciousness because the soul moves on quickly to the next impression’, and he
attributed this condition to an ‘overbalance of fire over water’. Hippocrates’ remedy for this situation was ‘barley rather than wheat bread,
fish rather than meat, water drinks and many natural and diverse physical activities’.
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Persistent disruptive behaviour and exclusion
Fintan O’Regan
pp 8-11
Attention deficit hyperactivity disorder (ADHD)
is a highly prevalent condition affecting 3–9% of school-age children, with boys being affected more than girls in a ratio as high as 9:1 in terms of clinic referrals (although the ratio in the community may be closer to 3:1 or even equal). ADHD will provide many challenges for both children and their teachers in the school community. In some cases, specific incidents may result in decisions that will lead to a permanent or fixed-term exclusion from school. However,
for most individuals with ADHD, early diagnosis and treatment can result in successful educational
and social outcomes.
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What can psychodynamic psychotherapy offer?
Antoinette Geoghegan
pp 12-14
At first glance, it may seem that the title question is not productive or relevant. Few clinicians following standard evidence-based practice would propose that a patient diagnosed with attention deficit hyperactivity disorder
(ADHD) is referred for, or treated with, psychodynamic
psychotherapy.
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The NICE guidance on ADHD
Noreen Ryan
pp 15-17
Attention deficit hyperactivity disorder (ADHD) is one of the most common disorders of childhood and it can have a devastating impact on children and young people’s development, socialisation,
family life and peer relationships. The long awaited
guideline from the National Institute for Health and Clinical Excellence (NICE) on ADHD provides multidisciplinary teams with a framework for best practice and individualised care for
young people and their families.
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ADHD and substance abuse – problems with dual diagnosis
Nigel Humphrey
pp 18-19
Adolescents and adults with untreated attention deficit hyperactivity disorder (ADHD) are more vulnerable to developing substance use disorder (SUD) than those without ADHD. There is a wide body of epidemiologic data indicating that the diagnoses of ADHD and substance abuse
occur together more frequently than would be expected by chance alone. When the diagnosis of ADHD is comorbid with bipolar or conduct
disorder, the risk of comorbid SUD increases considerably. Those with ADHD are at greater
risk for earlier onset substance abuse and even a
family history of ADHD is a risk factor for developing
SUD. Adult ADHD seems to be related to a longer period of active substance abuse and a
lower recovery rate. A 1995 study by Biederman et al found that 52% of adults with ADHD, versus 27% of controls, had met criteria for substance abuse at some point in their lives.
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Can we afford to treat ADHD?
Phil Anderton
pp 20-21
A question often asked by service providers proposing any new service is: ‘What is the cost of this to us?’ The enquirer is framing another question, perhaps not so tangibly: ‘Can we afford to do this?’ Perhaps the more appropriate question regarding the provision of adequate services for young people, especially those with a mental
health disorder, should be: ‘Can we afford not to deliver this service adequately?’ Should providers pose that question, examine their responses and ascertain how they can best deliver the required service to ensure a reasonable investment return?
It is argued that investment in preventive interventions
should be at the forefront of decision making, but acknowledged that this is not the case within current NHS practices concerning mental health disorders.
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Clinical and neurological differentiation in ADHD
Nikos Myttas
pp 22-23
‘Understanding ADHD – Clinical and Neurological Differentiation’ was a valedictory symposium of the European Network on Hyperkinetic Disorders (EUNETHYDIS) to honour Professor Eric Taylor’s retirement and his substantial contributions in the field of
attention deficit hyperactivity disorder (ADHD).
Taylor has been head of the Child and Adolescent Psychiatry department at the
Institute of Psychiatry (IOP) for the past 15 years. The symposium took place in December 2008 at the Royal College of Physicians.
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