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Psychostimulants ‘over prescribed for ADHD’

Practitioners need to be more careful when assessing and diagnosing attention deficit hyperactivity disorder (ADHD), experts say.

In an editorial published in the Medical Journal of Australia, 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 wrote that the implication of overdiagnosis is that disorders of children are being ‘medicalised’.

“There are risks for children that the use of stimulant medication is a simplistic attempt to find solutions to more complex problems underlying behavioural and emotional difficulties,” they wrote.

Related: ADHD under-recognised, not over-diagnosed: expert

They said there has been a rise in ADHD diagnoses since the 1970s, which is in part due to an increasing understanding and awareness of risk factors.

When diagnosing, other conditions such as trauma-related neurodevelopmental difficulties, autistic spectrum disorder, and fetal alcohol spectrum disorders need to be excluded.

“It is therefore important that diagnosis includes a clear differential approach and that it is not made in a perfunctory fashion,” they wrote.

There are no national guidelines, however the Royal Australian and New Zealand College of Psychiatrists supports the Canadian or United Kingdom guidelines for ADHD treatment.

Related: ADHD critique divides specialists

Those guidelines both highlight the need for comprehensive assessment for ADHD.

There is also an approach supported by specialist medical colleges that suggests the ‘universal precautions’ concept could be applied, which routinely assesses 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.

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