ADHD is a diagnosis that is constantly growing in both children, young people and adults. In the USA, it is now a trend for ADHD drugs to be marketed and used as preventive measures for children and young people at risk of criminal maldevelopment. Is this on the way to becoming an accepted attitude also in Norwegian academic circles? As a striking example of the trend, the psychiatrists Jørgen G. Bramness and Lars Lien, the former professor at the Institute of Public Health and the latter head of the Norwegian Psychiatric Association, write in an opinion on news that they are “on safe professional ground” when they claim that “many had avoided a prison sentence if they had received the ADHD diagnosis in time”. It is important to note that the two are not arguing for following up and treating those who have already committed crimes. This is a group with far too poor psychiatric services. What they want, however, is to diagnose and treat more children and young people. Children and young people who are thought to have a risk of perhaps ending up in the crime statistics. This actually implies a claim that crime should be fought with drugs. Crime which is a complex behavioral and societal problem which is not immediately the domain of medicine. It is a strong claim, which requires good evidence and argumentation. Do the campaigners actually have it? No, is the short answer. Here comes the long story: What does the research say? ADHD is almost always treated with drugs, mainly with Ritalin (methylphenidate) and amphetamines. These medicines are class A preparations, i.e. potent and addictive narcotics. Many people diagnosed with ADHD often have complex problems. Therefore, it is not really surprising that people with such major problems are overrepresented in prisons. Medication can help some, but is not an easy solution. A Swedish study from 2012 and two Danish studies from 2014 and 2019 may indicate that those diagnosed with ADHD have a lower risk of committing criminal acts in phases where they use medication. It is nevertheless important to understand that none of these three studies were controlled treatment studies that take into account other factors that may affect the result other than medication. In the context of medical research, this is not good documentation. The largest, longest-running and best-controlled study that has looked at the impact of different ADHD treatments over time is called MTA. The study followed over 500 children and young people into adulthood. After 16 years, they found no positive long-term effects of medication. In contrast, the medicated had a side effect: 2–3 centimeters reduced height growth. The researchers emphasized that the evidence for the long-term effects of ADHD drugs is weak. In our opinion, those who defend increased ADHD medication for Norwegian children on the grounds of crime prevention are based on weak knowledge. Medication of social problems Even if it turns out that treatment should reduce the risk of crime somewhat, there is a dubious reason for implementing extended medication. Most people with the diagnosis do not commit serious crimes. Of the small proportion who commit such crimes, crime can only be prevented in a minority. At the same time, there is a risk of stigmatizing children with ADHD as future criminals. Crime statistics hide complex problems that require complex measures. In the Danish study from 2019, for example, it was found that the risk of offending in those with an ADHD diagnosis was strongly associated with concurrent substance abuse, behavioral disorders, low socio-economic status, parents in prison and poor parental relationships. The researchers therefore recommended focusing on those with such difficult life circumstances. Environmental factors were of great importance for the risk of crime. Medicines do not fix this. In the study from 2014, the statistical relationship between treatment and reduced crime was also smaller the more children with milder symptoms who were treated. The researchers therefore emphasized that their findings were not a good argument for diagnosing and medicating even more. We are missing a psychiatric holistic view and a consequential approach to over-diagnosis in questions about ADHD drugs. How many children must be treated to prevent one serious crime? What consequences does it have for drug abuse and resale, which in turn is linked to crime? Research has documented that these narcotic drugs have a potential for abuse, and this increases as more and more people are diagnosed. We think it is disturbing if Norwegian psychiatry wants to follow the American trend of medicating children “preventively”. Not only is there a thin knowledge base for such practice; it will also be able to prevent other relief measures that do not require a diagnosis being prioritized. ALSO READ:
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Ritalin against crime – a boom – Statement
