Child psychopharmacology: Politics versus science

To the Editor

While Martin Whitely has made himself a prophet of gloom in relation to the psychopharmacology of attention deficit hyperactivity disorder (ADHD), it should be pointed out that developmental outcome studies are complex and not helped by personal insinuation about the motives of treating doctors. In some ADHD children, the preliminary work of Shaw and colleagues (2009) at the National Institute of Mental Health suggests that stimulants may even normalise cortical brain development.

Shaw and colleagues compared the change in cortical thickness between 12 and 16 years of age in children with ADHD, who were treated or not treated with stimulants, compared to typically developing children. The children who were not treated lost more cortical thickness than either the treated or typically developing children. While the significance of this approach remains to be established, it suggests that medication may, together with other factors, assist optimal development in some children.

In truth, the ‘coalface’ problems faced by small numbers of public child psychiatrists are enormous, but I believe over-prescription of medication to be the least of them. If looking for problems, Whitely could try waiting lists, and being required to cover several hospitals at night – with lack of appropriate referral pathways, among others. It is easy to sit in political offices and moralise, but try doing some front-line work, and, if not, maybe try being positive. Even politicians are trying to be positive in this election year! Perhaps Mr Whitely could politically support our latest application for research funding entitled ‘Genetic Prediction of Stimulant Side effects in ADHD’, surely of importance to his concerns. Meanwhile, I provide some relevant citations to help in this cause (Levy, 2007, 2008, 2013; Levy et al., 2013).