Bruce Perry on ADHD The Guardian-30 Mar 2014
One of the world's leading neuroscientists, whose work has been acknowledged by work and pensions secretary Iain Duncan Smith, has suggested that attention deficit hyperactivity disorder (ADHD) is not "a real disease".
On the eve of a visit to Britain to meet Duncan Smith and the health secretary, Jeremy Hunt, Dr Bruce D Perry told the Observer that the label of ADHD outlined a broad set of symptoms. "It is best thought of as a description. If you look at how you end up with that label, it is remarkable because any one of us at any given time would fit at least a couple of those criteria," he said.
Prescriptions for methylphenidate drugs, such as Ritalin, which are used to treat children diagnosed as suffering from ADHD, have soared by 56% in the UK, from 420,000 in 2007 to 657,000 in 2012. Such "psychostimulants" are thought to stimulate a part of the brain that changes mental and behavioural reactions.
However, Perry, a senior fellow of the ChildTrauma Academy in Houston, Texas, said he was concerned that children were being labelled as having ADHD when that merely described the symptoms of a range of different physiological problems. The symptoms that lead to a diagnosis of ADHD include inattentiveness, hyperactivity and impulsiveness over a sustained period.
Perry added that clinicians were also too readily prescribing psychostimulants to children when the evidence suggested there were no long-term benefits. Animal studies have raised concerns over the potential for damage to be done.
Perry, who will also meet cabinet secretary Sir Jeremy Heywood during his visit as a guest of the Early Intervention Foundation, a charity aimed at tackling the root causes of childhood dysfunctions, said: "We are very immature in our current evolution in giving diagnoses. A hundred years ago, someone would come to the doctor and they would have chest pain and would be sweating. And they would say, 'Oh, you have fever.' They would label it, just like we label it [ADHD] now. It's a description rather than a real disease."
He added: "If you give psychostimulants to animals when they are young, their rewards systems change. They require much more stimulation to get the same level of pleasure.
"So on a very concrete level they need to eat more food to get the same sensation of satiation. They need to do more high-risk things to get that little buzz from doing something. It is not a benign phenomenon.
"Taking a medication influences systems in ways we don't always understand. I tend to be pretty cautious about this stuff, particularly when the research shows you that other interventions are equally effective and over time more effective and have none of the adverse effects. For me it's a no-brainer."
Perry said he favoured an approach that went back to the root causes of the problem, and often required attention being focused on the parents. "There are number of non-pharmacological therapies which have been pretty effective. A lot of them involve helping the adults that are around children," he said.
"Part of what happens is if you have an anxious, overwhelmed parent, that is contagious. When a child is struggling, the adults around them are easily disregulated too. This negative feedback process between the frustrated teacher or parent and disregulated child can escalate out of control.
"You can teach the adults how to regulate themselves, how to have realistic expectations of the children, how to give them opportunities that are achievable and have success and coach them through the process of helping children who are struggling.
"There are a lot of therapeutic approaches. Some would use somato-sensory therapies like yoga, some use motor activity like drumming.
"All have some efficacy. If you can put together a package of those things: keep the adults more mannered, give the children achievable goals, give them opportunities to regulate themselves, then you are going to minimise a huge percentage of the problems I have seen with children who have the problem labelled as ADHD."
The chairman of the Early Intervention Foundation, Labour MP Graham Allen, said Perry was the "best in his field" and was meeting senior officials and politicians already "convinced by the philosophy of his research. I would argue that if you can diminish adverse childhood experience, then we eliminate a lot of the causes of dysfunction."