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Submission to the Education and Health Standing Committee West Australian Parliament: Attention Deficit Hyperactivity Disorder.

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Attention Deficit Hyperactivity Disorder - June 2003.

Authors

Dr Gil Anaf
MBBS FRANZCP
President, National Association of Practising Psychiatrists
Psychiatrist in private practice

Dr George Halasz
MBBS BMedSc MRCPych FRANZCP
Child & Adolescent Psychiatrist
Honorary Senior Lecturer
Department of Psychological Medicine
Monash Medical Centre
Clayton, Victoria

Preamble

The National Association of Practising Psychiatrists (NAPP) would like to thank the Education and Health Standing Committee for the opportunity to contribute to this important enquiry. NAPP would congratulate any move aimed at improving access to services that would improve outcomes for all children.

NAPP has for some time been concerned that the practice of medicine is being realigned along business and managerial models, where turnover and "desired" outcomes are measured and enforced at the expense of quality care. The latter involves time to understand the patient and their family problems, and necessarily involves multi-disciplinary assessments in the field of child psychiatry. We contend that current funding models make this increasingly difficult to achieve, with a resulting decrease in the expertise necessary to more fully treat children diagnosed, or misdiagnosed, with ADHD.

In turn, the lack of expertise in assessing longitudinal and developmental issues affecting children and their problems increases the chances of "manual - based" approaches gaining ascendancy. NAPP feels this may be a contributing factor in the rapid rise of reliance on medication to deal with issues which may well have more psychological origins.

NAPP is of the view then, that a rapid rise in prescribing rates may well be proportional to the decrease in availability of multi-disciplinary approaches which emphasise a need to understand, assess, and treat the psychological issues underpinning family disturbances.

The following table illustrates the issue.

Dexamphetamine PBS prescriptions, state by state. Methylphenidate is not on PBS

State                NSW   Vic       Qld      SA      WA      Tas      ACT    NT

1992-93           6253    1590    2555    2250    3450    191      190      80                   

1999-00           69312  35761 32290  22446  71510   8226   2891    960

By way of comparison, it is useful to look at figures for the number of psychiatrists who are members of the Faculty of Child and Adolescent Psychiatry of the Royal Australian and New Zealand College of Psychiatrists. This might serve as a rough guide to the availability of expertise to these families. We do acknowledge though, that other psychiatrists also deal with these patients, as do psychologists.

Members of Child & Adolescent Psychiatry Faculty

State             NSW   VIC   QLD   SA   WA   TAS   ACT  

2003               99       83      52       22    24      3         5

It is NAPP's view then, that the underlying issues in Western Australia are little different to the problems in enhancing the role of psychiatric and psychotherapeutic expertise in South Australia and other states. We therefore append our submission (2001) to that Parliament for the Committee's perusal.

We are also sending, by separate mail, a copy of a chapter from a recently released monograph on this subject. The book, Cries Unheard, A New Look at Attention Deficit Hyper activity Disorder, is by Common Ground Publishing, 2002.

The chapter quoted was written by Dr George Halasz, a Victorian child psychiatrist, and is entitled "Smartening Up or Dumbing Down? A Look Behind the Symptoms, at Overprescribing, and Reconceptualising ADHD."

Of particular relevance to the Committee are his assertions that prescribing rates in WA are much higher in WA compared with Victoria , despite Victoria having a much larger population. We note too, that Victoria has at least 3 times more Child psychiatrists than Western Australia .

Dr Halasz takes issue with comments made by Dr T Parry, of the State Child Development Centre in Perth . Dr Parry is reported as seeing large prescribing rates as a process of "smartening up" the therapeutic practices in WA. Dr Halasz's chapter is an explication of an opposing view - that there is much to be concerned about, and that it has to do with the decline in the perceived importance of listening and understanding children and their families' needs.

In conclusion, we thank you again for the opportunity to contribute to this debate. NAPP would urge the Committee to consider closely the issues raised in our submission to the SA Parliamentary Standing Committee. The needs of children to be listened to, do not change because they live in different States of Australia. And it will be difficult to listen if we medicate our children first and ask questions later.

Yours sincerely,

Dr G Anaf

 

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