Overdiagnosis of attention deficit hyperactivity disorder (ADHD) and overprescription of psychostimulants to treat it are contributing to increased rates of misuse, with more careful assessment and diagnosis needed, according to the authors of an editorial published in the Medical Journal of Australia.
The use of stimulant medication in children to treat ADHD may be a “simplistic attempt to find solutions to more complex problems underlying behavioural and emotional difficulties”, wrote Dr Adrian Dunlop, from the University of Newcastle, and Professor Louise Newman, from the Centre for Women’s Mental Health at the Royal Women’s Hospital in Melbourne.
Increasing awareness and understanding of risk factors, as well as recognition of the need for coordinated educational and family support had contributed to the rising rates of ADHD diagnosis, the authors wrote. Excluding other conditions – such as trauma-related neurodevelopmental difficulties, autistic spectrum disorder, and fetal alcohol spectrum disorders, for which stimulants were an appropriate treatment – was vital, the authors wrote. “It is therefore important that diagnosis includes a clear differential approach and that it is not made in a perfunctory fashion.”
There are no Australian guidelines for the diagnosis and treatment of ADHD, with the Royal Australian and New Zealand College of Psychiatrists supporting Canadian and British guidelines which highlight the need for comprehensive assessment and the authors recommending “universal precautions” – routinely assessing all patients for risk of diversion, misuse or overdose, both before and on an ongoing basis while prescribing psychoactive drugs.
“While careful assessment and universal precautions will not stop all non-medical use of prescription stimulants, including poisonings, they remain practical and feasible approaches to limit misuse,” the authors concluded.