The Australian Medical Association Limited and state AMA entities comply with the Privacy Act 1988. Please refer to the AMA Privacy Policy to understand our commitment to you and information on how we store and protect your data.

×

Search

×

Speed Up and Sit Still – The Controversies of ADHD Diagnosis and Treatment

Attention-deficit hyperactivity disorder (ADHD) is a legitimate medical condition. It is not a construct of big pharma or a modern phenomenon. ADHD is the inability to possess effective working memory and to persist in completing uninteresting tasks. Not all ADHD needs to be treated and a person needs to have functional impairment to be disordered. ADHD is a condition in flux. No two children of the same age have the same disorder. ADHD in an affected individual’s life at age 50 is different to age 15. These are important facts to consider when reading this book.

07 Feb 2011

Martin Whiteley: Speed Up and Sit Still – The Controversies of ADHD Diagnosis and Treatment

Publisher: UWA Publishing

ISBN: 9781742582498

Reviewed by Dr Anthony Zehetner

Attention-deficit hyperactivity disorder (ADHD) is a legitimate medical condition. It is not a construct of big pharma or a modern phenomenon. ADHD is the inability to possess effective working memory and to persist in completing uninteresting tasks. Not all ADHD needs to be treated and a person needs to have functional impairment to be disordered. ADHD is a condition in flux. No two children of the same age have the same disorder. ADHD in an affected individual’s life at age 50 is different to age 15. These are important facts to consider when reading this book.

Martin Whitely, a politician and self-proclaimed ADHD patient, believes that ADHD is a fraud and stands for “amphetamine deficit disorder”. Outdated arguments of ‘pathologised’ healthy children and claims that ADHD is caused by bad parenting form most of Whitely’s stance.

Having cleared the air of prejudice, I find little left for debate.

Whitely confuses and blends his two main arguments: the case for ADHD and the case for stimulants (he questions ADHD as a legitimate condition on the one hand and, on the other, that stimulants do not work as we are over-medicating healthy children who improve on their own). He highlights infrequent adverse effects of therapy, such as ‘over focused’ restricted behaviour and tics. He selectively reports outcomes of trials and claims “amphetamines cause school failure”, when underachieving students are more likely to have significant ADHD and require prescribed medication.

Stimulants do work in ADHD and are a first-line therapy.  Denying an impaired individual treatment by not prescribing effective first-line medication is as bad as medicating a person without the condition.

Whitely calls for some positive changes within the field, such as more precise age-specific diagnostic criteria and increasing diagnostic accuracy (such as discriminating inattention and hyperactivity due to post-traumatic stress disorder). He advocates restructuring school environments to facilitate learning in children with ADHD. However, his idea of removing PBS subsidies for stimulants and using the savings to fund occupational and speech therapy services instead, although idealistic, is unfeasible logistically.

Whitely’s view that only “psychiatrists who favour non-drug interventions” for ADHD (instead of the Royal Australasian College of Physicians) are used to draft guidelines for the management of the condition is extremist. Whitely cannot accept that stimulants might actually work or that current evidence indicates that stimulants reduce illicit substance abuse in children with ADHD. Advances in the ADHD field and the recent discovery of ‘ADHD’ candidate genes date Whitely’s work.

Ultimately, this is an unappealing overview of one Western Australian man’s perspective and concern of the prominence of ADHD in the public eye in the past two decades. It is not a book to learn about the condition or refer patients to. Whatever your standpoint, this book won’t change it. It’s an unsatisfying account of an unfounded whistleblower.

Dr Zehetner is a General Paediatrician with an interest in psychopharmacology, neurodevelopmental and behavioural disorders. He is also a consultant pharmacist and a Clinical Lecturer for The Universities of Newcastle and Sydney.


Published: 07 Feb 2011