DÄ internationalArchive51-52/2010Uncritical Prescription
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If less methylphenidate is prescribed in countries such as France, then this is explained with underdiagnosis or with belonging to an academic social stratum.

A recent Swedish study has shown that social class is important (1).

7960 children aged 6–19 years were investigated who had been prescribed psychostimulant drugs in 2006. They were compared with a national cohort of 1.1 million children.

It turned out that:

  • Children of parents living on social security benefits had received psychostimulants 2.3 more often,
  • Children of mothers of a low educational status had received psychostimulants 2.3 more often,
  • Children of single parents had received psychostimulants 1.5 more often,
  • Children of parents who were registered because of a psychiatric disorder had received psychostimulants 1.5 more often than in the national cohort.
  • The mentioned socioeconomic and psychosocial factors in combination accounted for 60% of prescriptions. In view of the burden on the families, it is not surprising that the children were restless and their concentration was poor.

Uncritical prescribing of ever increasing daily doses of methylphenidate even in older age groups should give us cause for concern. Are psychosocial background factors overlooked in favor of overhasty prescription of psychostimulant drugs? Can the assumption of neuropsychiatric causes be sustained?

A study (2) that is reported in the book “ADHS-Symptome verstehen—Beziehungen verändern [Understanding the symptoms of ADHD—changing relationships]” shows a different way forward. Of 93 children who received at least 10 sessions of child and family therapy, a minimum of 6 months after the study was completed, only one child had to temporarily take stimulants, and that was because of an acute crisis in his family.

The therapy had taught the children to verbalize their inner states, enabling them to get by without conspicuous behavior.

DOI: 10.3238/arztebl.2010.0919a

Dr. med. Terje Neraal

Höhenstraße 33 c

35435 Wettenberg

t.neraal@t-online.de

Conflict of interest statement
The author declares that no conflict of interest exists according to the guidelines of the International Committee of Medical Journal Editors.

1.
Hjern A, et al.: Social adversity predicts ADHD-medication in school children – a national cohort study. Acta pædiatrica 2010; 99: 920–4. MEDLINE
2.
Neraal T, Wildermuth M: ADHS: Symptome verstehen – Beziehungen verändern. Giessen: Psychosozial-Verlag 2008.
3.
Schubert I, Köster I, Lehmkuhl G: The changing prevalence of attention-deficit/hyperactivity disorder and methylphenidate prescriptions: A study of data from a random sample of insurees of the AOK health insurance company in the german state of Hesse, 2000–2007. Dtsch Arztebl Int 2010; 107(36): 615–21. VOLLTEXT
1.Hjern A, et al.: Social adversity predicts ADHD-medication in school children – a national cohort study. Acta pædiatrica 2010; 99: 920–4. MEDLINE
2.Neraal T, Wildermuth M: ADHS: Symptome verstehen – Beziehungen verändern. Giessen: Psychosozial-Verlag 2008.
3.Schubert I, Köster I, Lehmkuhl G: The changing prevalence of attention-deficit/hyperactivity disorder and methylphenidate prescriptions: A study of data from a random sample of insurees of the AOK health insurance company in the german state of Hesse, 2000–2007. Dtsch Arztebl Int 2010; 107(36): 615–21. VOLLTEXT