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Original papers: Sarah Buckley, Philip Dodd, Amanda Burke, Suzanne Guerin, John McEvoy, and John Hillery Diagnosis and management of attention-deficit hyperactivity disorder in children and adults with and without learning disability Psychiatr Bull 2006; 30: 251-253 [Abstract] [Full text] [PDF]

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Prathibha Rao   (9 August 2006)

Response 9 August 2006
Prathibha Rao, Senior House Officer In Psychiatry Leeds Mental Health Trust Send letter to journal: Re: Response p.rao{at}nhs.net Prathibha Rao	The authors have raised a very important gap in the training and service provision, but before accepting the results of the study, there are certain questions which are worth thinking about. Firstly, to answer the first outcome - The authors question whether consultants believe that ADHD exists. The response bias, where in the response, rather the lack of it from general adult consultants, could have seriously affected the results. I would only imagine that it could be really difficult for a person who does not believe in the diagnosis of ADHD to continue to sustain himself/herself in child and adolescent psychiatry. Hence, the fact that the response has favoured the presence of ADHD could be a reflection of this bias in response. Perhaps, a better way to overcome the limitation of the poor response would be for the authors to ensure a better ascertainment, by employing methods like a telephone survey or personal contact for a brief interview, rather than just relying on postal questionnaires. Secondly, the authors mention that consultants might be more confident in making a diagnosis of ADHD in patients without learning disability than one with. However, is not this a common problem one has would encounter, when dealing with a co morbid disorder in any one, either with or without a learning disability? So, to extrapolate this finding to a diagnostic overshadowing to this specific population is slightly misgiving. Also, to answer this question, the authors would have got a more useful response by targeting only the child psychiatrists and the learning disability psychiatrists. Not many general adult consultants work with people with learning disabilities and they would find diagnosing any mental illness in the learning disabilities a task, leave alone ADHD. Research into the presentation of ADHD in learning disabilities is limited and very frequently encountered in routine practice. This puts the clinician into a dilemma in diagnosing, as problems of poor concentration, impulsivity, short attention span can present in both the conditions and teasing out one from the other is next to impossible. In my experience of working in ADHD teams, such cases would usually be referred to clinical psychologists, and hence including psychologists in these kinds of surveys might be more helpful. However,the area of difficulty highlighted in this article is important and concerns like this will pave the way for better understanding and management in the future.