Drugs are not the cure for naughty children: DR MAX

A study this week claimed to have found conclusive evidence that ADHD was an actual brain disorder and not just another way of labelling poor parenting or badly behaved children

Are children born naughty? This is an important question when considering Attention Deficit Hyperactivity Disorder (ADHD), a condition characterised by issues with impulsiveness, restlessness and difficulties with focus.

A study this week claimed to have found conclusive evidence that ADHD was an actual brain disorder and not just another way of labelling poor parenting or badly behaved children.

The study looked at brain volumes of more than 3,200 people and noticed that those of people with ADHD were underdeveloped — actually smaller — in five key areas involved in emotion and motivation, compared to those of people without the condition.

It was published in The Lancet, a hugely respected medical journal, and there’s no doubt that it is an important piece of the jigsaw when trying to understand ADHD.

But the study was seized upon as evidence that ADHD is purely a biological phenomenon: nothing more than the result of problems with brain anatomy.

But this isn’t the case at all.

This interpretation totally ignores the idea of ‘brain plasticity’ — that the brain develops and grows specific areas in response to environmental stimulation.

This is why in the brains of taxi drivers, the areas responsible for orientation and navigation are particularly well-developed. They weren’t born that way, though. Their brains have grown in these areas because the drivers spend years becoming ever more familiar with the roads.

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T he same point can be made about this study. The fact that those with ADHD have different brains to those without doesn’t mean that it can’t still be down to parenting.

If a child is not being disciplined properly, if he or she is not being taught key behavioural skills from an early age, then the relevant parts of the brain won’t develop.

YOUR DOCTOR NEEDS… YOUR DEAD BODY

Heading footballs into the net may increase the risk of dementia, according to scientists at University College London — adding that more research is needed to give crucial insight into the impact of small traumas.

In response to this, former World Cup winner George Cohen and ex Manchester United star Pat Crerand have pledged to donate their brains to science to help the effort.

Good on them. Science benefits hugely from researchers being able to examine human tissue, and relies on people’s altruism in donating their bodies.

The biggest need, though, is in medical schools, where there is a worrying shortage of cadavers donated for students to dissect.

The problem is that we, as a nation, don’t really like to think about dead bodies — least of all our own — so recruiting people to donate their bodies to medical science has always been difficult.

But the problem has become more acute over the past few years, for complex social and political reasons.

There was a marked decrease in donations in 2001 after the organ-retention scandals which shook the public’s confidence in pathology — and the numbers have never really recovered.

There was a further drop in donations after Channel 4 aired a series of pubic autopsies by the anatomist Gunther von Hagens — presumably because, however unlikely, the idea of being dissected on live television by a creepy German made people feel deeply uneasy.

Meanwhile, in recent years the Government has increased the number of medical students and opened several new medical schools — so the demand for cadavers has increased just as the number of donations has dropped. Add into this the caution that has to be taken over conditions such as MRSA, which mean that not all bodies donated are suitable for use, and we are facing a crisis.

Many medical schools can now no longer offer students human dissection and have had to resort to group demonstrations or using plastic models.

But all medical students benefit from human dissection, regardless of the discipline in which they eventually specialise.

Even in psychiatry, I frequently rely on my anatomical knowledge, not just of the brain but of the body, too.

Unless there’s a dramatic increase in people donating their bodies it won’t just be science that suffers, but all of us, because doctors won’t have an adequate anatomical understanding.

 

Of course, just as some people have naturally stronger navigation skills and are therefore going to find becoming a taxi driver easier than others, children are different, too — and some are better able to concentrate than others.

But like anything, this ability still needs to be developed in all of them, through perseverance and practice — encouraging a child to pay attention to a book that’s being read to him or her, for instance, or to listen to a teacher without getting distracted.

Simply looking at an under-developed area on a brain scan and saying that this explains everything is just poor science. And it reveals nothing about the brain’s ability to develop or our capacity to change our behaviour.

Depressingly, the way this study has been interpreted completely removes the idea that we are able to improve aspects of our lives.

Nor is the diagnosis of ADHD as cut and dried as this research would have us believe.

Last year, an equally important study found that ADHD was vastly overdiagnosed, with many cases being children who were simply immature. Tellingly, those who were young for their school year were more likely to be diagnosed with ADHD, and given medication. The researchers suggested this was because teachers and parents were comparing the behaviour of more mature children to that of children born up to a year earlier.

All this is part of a disturbing trend which sees children being given a label and put on medication while the adults in their lives effectively give up trying to instil discipline in them. Why parent them when you can drug them?

And there is a trend to medicate children at an ever younger age.

Ritalin, a drug used to treat ADHD, is licensed for use in children from the age of six, with the guidance that prescriptions for children younger than this is advisable only in exceptional circumstances. But six — an age when a child’s brain is still developing — is very young to be prescribed a behaviour-altering drug.

Thankfully, doctors here are typically cautious about prescribing medication for children, particularly compared to their counterparts in the U.S. Even so, in total about 660,000 prescriptions for Ritalin are made out for children every year — a seven-fold increase compared to 20 years ago.

ADHD is a complex condition, with genetics, environment and social factors playing a part.

No less an authority than the World Health Organisation states that a diagnosis of ADHD can point to family dysfunction or inadequacies rather than a problem with the individual child — and it’s this that worries me.

It’s much easier to dose up a young child than it is to unpick the complicated family dynamics that contribute to their disruptive behaviour and put in place appropriate social support structures.

But by taking the easy option, are we not missing an opportunity to intervene in families with deep-rooted problems?

HIDDEN PITFALLS OF PLASTIC SURGERY

As a psychiatrist, I have nothing against people going under the knife if their expectations are realistic

Cosmetic surgery just isn’t as popular as it used to be, according to the British Association of Aesthetic Plastic Surgeons (BAAPS). Last year, they say, the number of people going under the knife fell by 40 per cent.

I’ve no doubt that this, in part, is because more people are opting for non-invasive treatments, such as Botox. BAAPS suggests it’s also down to people realising that surgery is an empty ‘quick fix’.

I hope so. As a psychiatrist, I have nothing against people going under the knife if their expectations are realistic. I’d always advise, though, that you think carefully not just about the procedure, but about how you hope it will change your life.

Any good surgeon will tell you that they often see people in their clinics who are really there because of family or emotional difficulties that no operation has a chance of correcting.

Several times, I’ve seen a patient who has had a facelift only to then go through a divorce. Why? Because after the surgery, she realised that her husband wasn’t unpleasant to her because of her wrinkles — he just wasn’t a very nice man. Sometimes it’s your relationship you need to change, not your face.

And for those with underlying emotional or psychological problems, such as depression, plastic surgery can actually make them feel worse.

They attach all their hopes on the operation making them feel better — so, then, when it doesn’t, they feel hopeless.

It’s true, though, that correcting an imperfection can sometimes make us feel more confident — which can, in turn, have a positive impact on our careers or our relationships. But it would be wrong to think that it holds the answer to every problem.

Studies have shown that people who undergo cosmetic surgery report afterwards that they find the part of their body that was operated on more attractive. Yet overall, they do not report feeling more satisfied with their appearance.

It’s fine to change what you’re dissatisfied with — but you would be wise to remember that life is not necessarily going to get better simply because you’ve had cosmetic surgery.

 

I’m not sure how to feel about the latest attempts to stop pregnant women smoking. Stoke-on-Trent City Council is paying mums-to-be £260 in shopping vouchers if they quit.

That’s taxpayers’ money, of course. But those defending the plan argue that the cost of dealing with the myriad health issues in babies born to smokers — such as prematurity and breathing problems — far outweigh the cost of the scheme. Really, though, what kind of person isn’t persuaded to give up smoking by the damage it’s doing to her baby, but is persuaded by a wad of vouchers?

Someone who’s not fit to be a mother, that’s who.