Maudsley Debate Comes Down In Favour Of Medication
Last night (February 28th) at The Wolfson Lecture Theatre, in
London, a debate took place entitled This house believes that psychiatrists over-medicate the exuberance of youth.
Just over 100 people attended the debate and early on there was a show of hands, which produced a split of approximately 22% for the motion, 43% against with 46% unsure.
Speaking for the motion was Dr. Clive Jones. Tragically, Professor Steve Baldwin who was also to speak for the motion, was killed in the terrible rail crash at Selby. See our report here. Those speaking against the motion were Professor Eric Taylor from The Maudsley Hospital and Andrea Bilbow of ADDISS.
We were unfortunately not able to attend from adders.org but initial reports indicate that a show of hands at the end produced a vote against the motion i.e. not believing that psychiatrists over medicate. The final vote was approximately 18% for the motion, 69% against with 13% unsure.
Kathy West from the South London Support Group attended the debate and we are very grateful to her for the following report:
"I attended this debate, held in a large lecture theatre in the Institute of Psychiatry, around the corner from the Maudsley Hospital. What was interesting is that the topic wasn't entirely followed - All three speakers agreed ADHD was a genuine condition which could make life for children and families extremely difficult and often led to very negative outcomes. So the debate went beyond just the exuberance of youth, agreed there was a serious problem to be tackled and promoted a range of ways of doing this.
Prof. Eric Taylor helped to define ADHD - noting that the diagnostic criteria were very predictive of an adverse outcome. So if a diagnosis is done carefully, it does both predict problems and is shown to be valid over time - as the outcomes justify the diagnosis at a very high rate. He stated that medication was the one most effective intervention for most people, but all the speakers indicated that much more than medication should also be available for children with ADHD. Dr. Clive Jones, while recognising ADHD as a serious problem for many, would opt for trying other interventions, including changes in diet, and would consider medication only as a last resort for a very few.
Prof. Taylor promoted the early use of medication as part of the armoury in serious cases and for others when educational and other support proved unsatisfactory on their own. Andrea Bilbow spoke from a parent's perspective - giving examples of how medication had helped turn her son's failure towards success, and also that of many other children. Prof. Taylor lamented the inadequate resources given to children's mental health services in the UK - much less than in many other western countries. All essentially agreed that more should be done for those affected by ADHD - in a number of key areas. Clive Jones was concerned about the side effects of medication and over prescription. Both Prof. Taylor and Andrea Bilbow agreed that over-prescription or incorrect use of medication could be a problem with a very few - as it is no doubt in all areas of medicine - and should be tackled where it occurs. They agreed that the real problem was under-treatment on a very significant level. Andrea stated that she felt it was "abuse" not to offer medication when the alternative of not treating meant so many unnecessary negative consequences.
At the end of the "debate", which included questions and contributions from the audience, quite a few people had changed their views and opposed the motion. What did really surprise me was that most of the audience seemed to be academics and/or professionals and that so many still seemed to equate ADHD with youthful exuberance - clearly not the case for anyone who understands ADHD! Even at the end, quite a lot of people still supported the motion and if they are mental health professionals and academics, as I suspect, they still have some significant gaps in their knowledge of a condition that NICE (the National Institute for Clinical Excellence) estimates affects 5% of the population. I remember hearing Dr. Sam Goldstein saying that the best way to learn to diagnose ADHD was to live with a family affected by it for a few weeks. I wish I could arrange this for some of the audience - and even then they might not learn about the struggles of those who don't have the hyperactive variety of ADHD. Clearly we are making progress, but we still have a long way to go. The goal of mental health professionals should be to help people (using strategies which are safe and work) who are struggling and having problems - and that means listening to those who are, observing, and learning. Some still need to adopt this approach if they are going to be "real professionals".
So far as supporting parents and families, 10 out of 10 to both Andrea Bilbow and Eric Taylor - who stood up for the kinds of support, services and interventions which we need to support children with ADHD - including the early option of medication!"