It is a decade since Professor Fiona Stanley told a conference of Australian politicians that “The vast majority of kids on ADHD drugs are on drugs unnecessarily. They are just naughty little boys and they would have been coped with before but they are now being medicalised”.[1]
As demonstrated in Figure 1 below, in the decade since the former Australian of the Year, Professor Stanley, made her "naughty little boys" comment, the number of Australian child prescribed ADHD medications has more than doubled, despite our population increasing by less than 16%.
In 2009, according to the Australian Government data 60,931 children were dispensed at least one prescription of an ADHD medication (primarily amphetamines).[2] In 2017 the latest year for which age specific data is available this number had risen to 107,345.[3] Since then (from January 2018 until September 2019) the total number of Australian PBS subsidised prescriptions has risen at 11% per annum.[4] Based on this rate of growth, it is estimated that more than 130,000 Australian children will be dispensed an ADHD medication in 2019. In summary, from 2009 until 2019, the percentage of Australian children aged 4-17 years dispensed ADHD drugs has grown from 1.6% to an estimated 3.0%.
Of even greater concern is evidence from Western Australia that suggests it is at as common for teenagers to abuse ADHD medications, as it is for them to take them for 'medical' purposes. In 2017, 3.0% of WA high school students self-reported abusing dexamphetamine.[5] This is more than double the number WA high school students prescribed 'dexies'.[6] There is no data regarding the abuse of other ADHD drugs, like Ritalin, or from other Australian states. However, it is very likely ADHD amphetamines and near amphetamines are also frequently abused by young Australians elsewhere.
If you consider this, what we already knew, and new evidence regarding ADHD that has emerged since 2009, allowing this massive growth in prescribing of addictive amphetamines to our children makes no sense. It has become even more obvious ADHD is a unscientific label carelessly applied to children, and that the drugs used to treat it (primarily amphetamines) are bad for developing brains and bodies and are frequently abused. However, the explosion in prescribing rates makes perfect sense when you realise that ADHD is a very big, profitable, and influential industry, that promises 'quick fixes' to overwhelmed, time-poor, gullible parents (and to be brutally honest, some disinterested parents).
In 2018 global ADHD drug sales were worth a staggering US$16.4 Billion in 2018. That was bigger than the 2018 GDP of 75 of the world’s 193 countries. This figure does not include the billions earned by the 'experts' who diagnose this contrived disorder in children who fidget, dislike homework, play too loudly, or display at least six of the 15 other similarly absurd behavioural diagnostic criteria of ADHD.
The clearest evidence of how irredeemably flawed the ADHD label is, comes from research led by the PsychWatch Australia editorial team. We demonstrated that across the globe the youngest children in a classroom are much more likely than their oldest classmates (up to a year older) to be 'medicated' for ADHD.[7] We showed this ADHD late birthdate effect occurs in countries with high prescribing rates, like the USA and Canada, and low prescribing rates like Finland and Sweden. This indicates that misdiagnosis is an inevitable consequence of ADHD's extremely vague and broad diagnostic criteria, and that there is no safe level of diagnosis and prescribing. Some children diagnosed with ADHD clearly do have problems that need attention (and are not just naughty) but as is demonstrated in our research, an ADHD diagnosis is little more than a dumbed-down label, that explains nothing about a child's individual circumstances and needs.
Our global research built on our earlier award winning research that showed the youngest children in a WA primary school classrooms (born in June) are about twice as likely to be given ADHD drugs as their oldest classmates born the previous July.[8] Instead of acknowledging the implications of the ADHD late birthdate effect, the ADHD Industry did what it usually does in response to inconvenient truths; it ignored it.
A few of the other things we have learned about ADHD since Fiona Stanley made her "naughty little boys" comment in 2009 include:
In 2013 the American Psychiatric Association (APA) published its highly controversial, disease-mongering manual DSM-5 which expanded the already absurdly broad diagnostic criteria for ADHD. It is notable that the APA tried to expand the diagnostic criteria even further, by adding four extra ways ADHD could be displayed. These included, "is often impatient" and "finds it difficult to resist temptations or opportunities". Fortunately, a significant backlash against this and other absurd proposals in early drafts of the DSM-5, saw the APA drop these changes from the final version. This back-down reinforces the fact that the DSM is a product of political and marketing processes, that have nothing to do with science. Nonetheless, Australia has adopted DSM-5 as the model for diagnosing ADHD and other disorders, just as it did with DSM-IV (published in 1994), without adequate critical analysis.
Nearly all prescribing regulation and treatment guidelines development processes for ADHD in Australia have been dominated by those with vested interest.[9]
Multiple other non-neurobiological factors including ethnicity of students and teachers, divorce and family dysfunction, poverty, low maternal education, lone parenthood and the reception of social welfare, sexual abuse, sleep deprivation, perinatal issues, artificial food additives, mobile phone use with high lead exposure, and of course, being a boy (which approximately triples a child's chances), have all been associated with an increased risk of an ADHD diagnosis.
Further evidence of sustained harms from stimulants use by ADHD diagnosed children came from a long-term study into children’s health and well-being conducted in Quebec, Canada.[10] The study followed the long term educational outcomes of 8,643 children of whom 9% had ever used stimulants for ADHD by age 16. The academic performance of the children medicated with stimulants for ADHD relative to their peers declined significantly in the years after using medication. The Quebec study also found medicated children experienced deteriorations “in relationships with [their] parents” and “increases in the probability that a child has ever suffered from depression”. Early studies showed similar results, but the myth that ADHD drugs improve academic performance remains.
Ironically when Professor Stanley made her comments at the November 2009 Perth conference, child prescribing rates in her home state, Western Australia, had fallen significantly. A crackdown on heavy amphetamine prescribers, instigated in 2002, was followed by a 50% fall (between 2002 and 2010) in WA child prescribing rates. However, this had little effect on WA's very high adult* prescribing rates, and since 2010 WA child prescribing rates have rebounded strongly. From 2010 until 2017 the number of WA children prescribed stimulants rose from 5,636 to 9,587, this represents a per-capita increase of 51%.
Despite the rapid rebound in Western Australian child prescribing rates, as demonstrated in the graph below (produced by the Australian Government), Queensland and New South Wales now vie for the title as having Australia's highest child prescribing rates.[11]
Nonetheless, ADHD drug (particularly amphetamine) prescribing rates continue to rise rapidly all across Australia. This has been going on for so long now it invites the questions:
Will we ever stop giving vast numbers of Australian children a daily amphetamine habit?
And if not, can we please admit that we are drugging them in order to immediately change their behaviour and stop pretending we care about their long term welfare?
* Western Australia remains Australia's adult ADHD amphetamine prescribing and abuse hotspot.
Western Australia has, since at least since the early 2000s, consistently had much higher adult ADHD amphetamine (primarily dexamphetamine) prescribing rates than all other Australian states and territories. As demonstrated in Figure 9 above this continues to be he case.[11]
Dexamphetamine carries the highest possible black box warning that "AMPHETAMINES HAVE A HIGH POTENTIAL FOR ABUSE. ADMINISTRATION OF AMPHETAMINES FOR PROLONGED PERIODS OF TIME MAY LEAD TO DRUG DEPENDENCE AND MUST BE AVOIDED. PARTICULAR ATTENTION SHOULD BE PAID TO THE POSSIBILITY OF SUBJECTS OBTAINING AMPHETAMINES FOR NON-THERAPEUTIC USE OR DISTRIBUTION TO OTHERS, AND THE DRUGS SHOULD BE PRESCRIBED OR DISPENSED SPARINGLY."
Western Australia has also consistently reported high amphetamine abuse rates compared to other jurisdictions.
Can you join the dots?...As outlined in an earlier PsychWatch Australia blog it is obvious that the Western Australian Health Minister Roger Cook can't or won't.
References
[1] Professor Fiona Stanley Transcript from Australian Parliamentary Conference Parliament House, Perth Western Australia Friday, 6 November 2009 pp.35-36
[2] Department of Health and Ageing, Letter to Martin Whitely MLA dated 21 April 2012
[3] Australian Government Pharmaceutical Benefits Scheme Drug Utilisation Sub-Committee (DUSC) Attention Deficit Hyperactivity Disorder: Utilisation Analysis, Public Release Document, May 2018 DUSC Meeting. Table 5 on page 11. Available at http://www.pbs.gov.au/industry/listing/participants/public-release-docs/2018-05/adhd-dusc-prd-2018-05-final.pdf (accessed 5 January 2019)
[4] Department of Health and Ageing, Medicare Australia. Self-generated report from http://medicarestatistics.humanservices.gov.au/statistics/mbs_item.jsp
[5] Page 2 of Illicit Drug Trends in Western Australia: Australian School Students Alcohol and Drug Survey 2017 reported that 3% of the WA students aged 12 to 17 surveyed, had useddexamphetamine non-medically in the last 12 months.
[6] In 2017, approximately 1.2% of WA children were prescribed dexamphetamine. This estimate is calculated from data on page 26 of the WA Stimulant Regulatory Scheme 2015 Annual Report and page 7 of the Department of Health Western Australia WA Stimulant Regulatory Scheme 2017 Annual Report prepared by the Pharmaceutical Services Branch of the WA Health Department.
[7] Whitely M, Raven M, Timimi S, Jureidini J, Phillimore J, Leo J, Moncrieff J, Landman P, Attention deficit hyperactivity disorder late birthdate effect common in both high and low prescribing international jurisdictions: systematic review, Journal of Child Psychology and Psychiatry, October 2018. https://onlinelibrary.wiley.com/doi/abs/10.1111/jcpp.12991
[8] Whitely M, Lester L, Phillimore J, Robinson S, Influence of birth month of Western Australian children on the probability of being treated for ADHD, Medical Journal of Australia, 2017. https://www.mja.com.au/journal/2017/206/2/influence-birth-month-probability-western-australian-children-being-treated-adhd
[9] Whitely M. Attention Deficit Hyperactivity Disorder (ADHD) Policy, Practice and Regulatory Capture in Australia 1992–2012, Curtin University in 2014.
[10] Currie J (et al). Do Stimulant Medications Improve Educational and Behavioral Outcomes for Children with ADHD? Journal of Health Economics September 2014 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4815037/
[11] Australian Government Pharmaceutical Benefits Scheme Drug Utilisation Sub-Committee (DUSC) Attention Deficit Hyperactivity Disorder: Utilisation Analysis, Public Release Document, May 2018 DUSC Meeting. Figure 9 on page 22. Available at http://www.pbs.gov.au/industry/listing/participants/public-release-docs/2018-05/adhd-dusc-prd-2018-05-final.pdf (accessed 5 January 2019)