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Submission to the Education and Health Standing Committee West Australian Parliament: Attention Deficit Hyperactivity Disorder.
This submission is available in Microsoft Word Format or Adobe PDF.
Attention Deficit Hyperactivity Disorder - June 2003.
Dr Gil Anaf
Dr George Halasz
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
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
Dr Halasz takes issue with comments made by Dr T Parry, of the State Child Development Centre in
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.
Dr G Anaf
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© - National Association of Practising Psychiatrists 2004