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Submission to the New South Wales Parliamentary Joint Committee on Children and Young People: Inquiry into the use of prescription drugs and medications in children and young people.
This submission is available in Microsoft Word Format or Adobe PDF.
Attention Deficit Hyperactivity Disorder
Dr Gil Anaf
Dr George Halasz
The National Association of Practising Psychiatrists (NAPP) is of the view that this enquiry by the Committee on Children and Young People is to be commended in seeking to address issues that are vital to the welfare of our children. To quote from the Mental Health Statement of Rights and Responsibilities , "supporting the community in improving the mental health of its members is a major investment in all aspects of community life.." (p vii).
In seeking to address the Committee on Children and Young People on the issue of Attention Deficit Hyperactivity Disorder (ADHD), we would respectfully ask that the Committee bear in mind that our organisation (NAPP) is comprised of practising psychiatrists. We speak from the position of clinicians who hold the interests of the patient to be paramount. We maintain that ADHD is a complex clinical, scientific and societal problem. We also hold, perhaps more importantly, that resolution of the issue of increasing rates of prescribing practice for ADHD will depend on an appreciation of the political and economic forces that are brought to bear on patients, their families, and service providers.
NAPP is aware that investigation into the complexities surrounding ADHD has already been reduced, in some quarters, to an overly simplistic notion of "doctors overprescribing". We feel it would be unfortunate if that were to become the "5 minute news grab" from this enquiry, as the truth is rather more complicated; scapegoating a profession for what is in essence a policy issue will not help families already in distress.
Healthy emotional development of children is the bedrock of our society and the requisites for this have been, and will remain, unchangeable. These are times of accelerated change and this is likely to increase, as are economic and political forces that threaten the notion of the importance of the individual. If we are to be advocates for children into the future, as we were in the past when we spoke for their needs in regard to separations in hospitals, child care and the family court, then it is imperative that the emotional needs of children are not forgotten.
In a society plagued with problems such as youth suicide and drug abuse, depression and antisocial behaviour, it is our responsibility to not forget what we already know - that children who have stable and secure relationships with their parents (Bowlby), and who can play, and thereby develop a strong sense of self and purpose, tend not to run into these problems.
A recent study of 12,000 adolescents from 80 high schools across the United States, has found that young people who indicated a strong sense of bonding, closeness and attachment to family, regardless of the nature of that family - single parent, dual parent, adoptive family, (and this was corrected for class and income), have lower levels of smoking, drinking, drug use, suicidal thinking and behaviour, risky sexual behaviour and exposure to violence. These adolescents also felt more closely connected with school and teachers (Resnick MD, Klein JD).
It follows then, that an appreciation of the importance of family attachments (what strengthens them and what weakens them, irrespective of the nature of the "family") and a thorough knowledge of the stages of normal development must underpin any assessment of children with any disorder - be it physical, emotional, behavioural or learning disorders.
Prior to addressing the Terms of Reference in order, we will detail an actual (de-identified) case study that illustrates the issues we face as clinicians - these necessarily inform the approach in our submission.
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© - National Association of Practising Psychiatrists 2004