Editor, – We were most concerned to read Dr Hazell's statement ('Letters' Aust Prescr 1996;19:5) that 'The important take home message ... is that clinicians, educators and parents should not expect conduct or learning problems to respond to stimulants in the absence of ADHD'. This comment perpetuates the myth that a response to stimulant medication confirms the diagnosis of ADHD. Medications which alter the balance of neurotransmitters in the brain modify symptoms, not diagnoses. Stimulants, like most centrally-acting medications, do not obey any particular diagnosis-therapy couplings. As there is considerable overlap in symptom complexes between the various disruptive behaviour syndromes of children, as well as with other emotional disturbances, there is no logical basis for assuming that the effects of stimulants are married to any particular diagnosis. In fact, it has been shown that even 'normal' children often demonstrate improvements in cognitive performance and behaviour when given stimulants.1 These somewhat unpalatable truths strike at the very heart of the on-going debate regarding the reasonable and proper use
of these medications.
Certainly, there is now a large body of research evidence that the majority of children with ADHD display clinically significant and often dramatic improvements in impulse control, sustained attention, task completion, compliance and social acceptability when treated with stimulants. However, children with other related problems may also show response. We feel it is important that discussion be informed by what is known from the literature rather than biased by misinformation.
Dr Daryl Efron
Dr Rick Jarman
Paediatricians Centre for Community Child Health & Ambulatory Paediatrics Royal Children's Hospital Melbourne, Vic.