IS THIS WHY SO MANY CHILDREN ARE DIAGNOSED WITH ADHD?

Controversy over ADHD guidelines

“THE NHMRC has come under fire for lacking scientific rigour and failing to withdraw draft guidelines on ADHD that have been tainted by accusations of conflict of interest.

Disagreement among experts over ADHD treatment is in the spotlight again following revelations that a Harvard professor, Joseph Biederman – whose work underpins many of the NHMRC recommendations – has been sanctioned for failing to declare ties with pharmaceutical companies.

Associate Professor Ian Scott, who recently critiqued conflict of interest in guidelines development, said doctors viewing the draft may be unaware of the controversy and assume it was “just a matter of time” before the advice was deemed valid.

“I don’t think [the NHMRC] should have any draft guideline up there that’s subject to a conflict of interest investigation. I think they should be taken down,” said Professor Scott, director of internal medicine and clinical epidemiology at Princess Alexandra Hospital, Brisbane. The draft document has been publicly available since 2009.

But it was never approved due to conflict of interest allegations against Professor Biederman, a prominent US ADHD researcher. The allegations last week culminated in sanctions against him by Harvard Medical School.

An NHMRC spokesperson said the council could not yet assess the impact of the sanctions on the ADHD scientific literature. In May, due to the unresolved investigation into Professor Biederman, a working group was convened to develop new “clinical practice points” for ADHD, and these were due for completion in September. “In the interim, NHMRC will continue to provide access to the 2009 draft guidelines as an information source,” the NHMRC said.

Adjunct Professor Michael Fasher, chair of the RACGP Child and Young Person’s Health Network, said GPs needed best practice guidelines they could rely on.

“No GP has got time to evaluate the evidence themselves. That’s what being a generalist is,” he said. “You need… people who are not generalists to provide you with quality guidelines.” Professor Alasdair Vance, head of academic child psychiatry at Royal Children’s Hospital, Melbourne, said the NHMRC was right to release the draft, but he added the process was mired in the politics between advocates of stimulants and proponents of family-based interventions.

“People need to be aware that it is not a rigorous scientific process and that’s because the NHMRC by its very nature represents too broad an interest group to do that,” he said.

Sar Rooney BHSc., ND., DC., DASc., GDSc. (Hons), MATMS, MNHAA, MHATO

Naturopathic Medicine Practitioner, Lecturer, Researcher

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