1. Gezondheidsraad ADHD: medication and society input for the discussion Health Council of the Netherlands Lucas Cornips, Mphil scientific secretary

2. Percentage methylphenidate users in the Netherlands, age 4-18 Is this a problem? How to understand ADHD? Mechanisms behind the rise? How to respond to request for help? Setting the agenda: the rise of ADHD

3. Gezondheidsraad Scientific advice on contested and complex issues related to ADHD > Since 1902 committee model of the Health council of the Netherlands

4. Health council of the Netherlands (anno 1930)

5. Health council committee on ADHD / participation of young people Independent Based on scientific state-of-the-art Multidisciplinary Personal membership Deliberations confidential, reports public *patience until July 3*

6. Contested and complex 1.Epistemological; what is ADHD? 2.The rise of ADHD: ‘normal’ prevalence or medicalisation? 3.The rise of ADHD: factors of influence Individual social 4.Kind of response to request for help

7. 1. What is ADHD? Disease? Disorder? (Neuro)physical / genetic? Social / environmental factors? Big pharma myth? (disease mongering)  Committee: I. ADHD-related behavior is a continuum II.ADHD is a risk factor: negative long term outcomes; higher chance of smoking & drug addiction, associated with low SES

8. Literature on prevalence What criteria? Core symptoms and disfunctioning? Subjectivity in putting criteria to work Source of information? Quality of diagnosis? * Epidemiological research: 0,5 % – 24 % of children meet criteria *on average 5% of children aged 4-18 meet DSM-IV criteria *Based on ICD criteria: lower prevalence *4,3% of children aged 4-18 use methylphenidate 2. The rise of ADHD: determining prevalence

9. 2. The rise of ADHD Medicalisation of ‘normal’ behavior?

10. 3.Factors of influence Individual risk factors Genes Premature birth, exposure to chemicals, etc Youth trauma, etc.  Insufficient to understand the rise

11. 3. Factors of influence Societal factors Public attitude towards psychiatry School system Changes in family, society, media Policy: pay-for-performance system & DSM diagnosis  Challenge for research

12. 4. Response to request for help Contextual approach, e.g. school Therapy Pharmaceutical Psychosocial Other  Evaluation of effectiveness. Client perspective & outcome measures New care models

13. New model of care within GP’s practice Multidisciplinary approach Early detection – ‘stepped care’ Supporting counsellor mental health care Promising: relatively less referals, less medication, satisfied clients

14. Promising avenues 1.‘Blind spots’ in sight > new types of research 2.Move towards participation 3.Awareness perverse incentives policy 4.New models of care

15. Conclusions Contested issues 1.Epistemological nature ADHD 2.Medicalisation? 3.(Social) factors related to rise of ADHD 4.Response to request for help Approach committee  ADHD-related behavior: a continuum and as a risk factor  Reflection on request for help  Multidisciplinary perspective, new research  ‘Contextual’ nature of ADHD, emphasis on participation, new models of care

16. Gezondheidsraad Advisory reports: www.gr.nl 3 July 2014…