Autism-style assessments won't cure over-prescribing in ADHD

摘要

As McClure points out, inability to halt the upward trend of stimulant prescription was a predictable outcome of the National Institute for Health and Care Excellence guideline on attention-deficit/hyperactivity disorder (ADHD). However, the guideline's problems go deeper than having an insufficient mechanism for differentiating moderate from severe ADHD. By theirown criteria, the guideline development group found little to support the validity ofthe ADHD construct-their conclusion that it is valid was more a reflection of who wrote the guideline than the evidence base. Regardingtreatment, the guideline's most important recommendation was that drugs should be offered as first line treatment in "severe" ADHD. However, only one reference was cited to support this. It concluded that, in a 14 month trial, drugs produced a larger decrease in symptoms in the more severe subgroup than did behavioural therapy. Yet a 36 month follow-up ofthese patients found no continuing benefits of drugs over behaviour therapy, regardless of initial severity. Other naturalistic studies have found that drugs offer little prospect of improving longterm outcomes whateverthe initial severity, rendering discussion about cut-off points between severe and moderate disease academic.