Special Episode 14. The Misdiagnosis of ADHD with Assoc Professor Soumya Basu
Attention Deficit Hyperactivity Disorder (ADHD) is a chronic condition including difficulty maintaining attention, hyperactivity, and impulsiveness. ADHD often begins in childhood and can persist into adulthood and reflects an ongoing pattern of behaviour that results in poor concentration and control of impulses and interferes with functioning and or development. It may contribute to low self-esteem, troubled relationships and difficulty at school or work.
ADHD is one of the most common neurodevelopmental disorders of childhood, it is estimated that one in 20 children in Australia have ADHD and diagnosis in adults is on the rise where it is estimated that fewer than 20% of adults with ADHD are currently diagnosed or treated by a psychiatrist.
I was curious in this podcast to explore ADHD in more detail and was hoping to gain insights into its neurobiology and the long-term consequences for patients with ADHD especially if not diagnosed. I was also keen to explore the concept of “late birthdate effect” where a younger child in a school year group may be diagnosed with ADHD and medicated at a higher rate than older classmates possibly as a misdiagnosis reflecting the relative immaturity of the student rather than a true developmental condition.
A new companion guide recently published in Australia is referred to as The Australian Evidence Based Clinical Practice Guideline for Attention Deficit Disorder and is designed to help parents and others understand ADHD and the different ways of managing it. It makes 113 recommendations about recognising, diagnosing, and treating the condition. Whilst generally well received these Clinical Practice Guidelines have drawn criticism from some child psychiatrists for recommending amphetamine medications for children as young as five years diagnosed with ADHD based on their impulsive, active, or inattentive behaviour. Some specialists have criticised this decision for relying on ‘low quality ‘evidence, so this warrants discussion also. I was also hoping to learn more about cognitive training and non-pharmacologic techniques that may be of value such as neurofeedback.
It was a great pleasure to welcome back to Everyday Medicine Associate Professor Soumya Basu who has a special interest in developmental disabilities including ADHD and autism spectrum disorder. Soumya is a fellow of the Royal Australian and New Zealand College of Psychiatrists and is a senior lecturer at the Department of Psychological Medicine, Monash University with other keen interests in youth mental health and developmental trauma and provides expertise both at the St John of God Langmore Centre in Berwick and in Warragul Gippsland. Please enjoy this conversation with Soumya.
References:
Associate Professor Soumya Basu: Victorian Centre for mental Health www.vcmh.com.au,warragulspecialistcentre.com.au, St John of God Langmore Centre: www.sjog.org.au
CHADDhttps://chadd.org › overviewAbout ADHD - Symptoms, Causes and Treatment
Coghill DR, Banaschewski T, Soutullo C, Cottingham MG, Zuddas A (November 2017). "Systematic review of quality of life and functional outcomes in randomized placebo-controlled studies of medications for attention-deficit/hyperactivity disorder".
Franke B, Michelini G, Asherson P, Banaschewski T, Bilbow A, Buitelaar JK, et al. (October 2018). "Live fast, die young? A review on the developmental trajectories of ADHD across the lifespan". European
Attention deficit hyperactivity disorder". International Classification of Diseases 11th Revision. February 2022 [2019].
Institute for Health Metrics and Evaluation (17 October 2020). "Global Burden of Disease Study 2019: Attention-deficit/hyperactivity disorder—Level 3 cause" The Lancet. 396(10258).