1. An investigation of the controversies surrounding human rights of patients with ADHD Dr. Pooria Sarrami Foroushani M.D. School of Sociology & Social Policy University of Nottingham lqxps@nottingham.ac.uk 1 of 16

2. Attention Deficit Hyperactivity Disorder (ADHD) Increase in diagnosis and treatment rate 2 of 16 Children and adults A common psychiatric disorder 3-5 % (potentially 3,000,000 in UK) Attention difficulties, hyperactivity and impulsivity

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4. Why ADHD is controversial? Sign and symptoms could be found in everybody; 4 of 16 Drug treatment of children; Diagnosis demanded by others; No start and end; It has a biological treatment; the basis (cause) is also claimed to be biological, but no biological diagnosis method has established yet;

5. Why ADHD is controversial? (continue) Sign and symptoms of this disorder might decrease and even disappear. 5 of 16 Stimulant drugs are claimed to be safe, but are classified as schedule II drugs; Stimulant drugs are symptomatic treatment; Sign and symptoms of this disorder might be an advantage for patients;

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7. The right to access psychiatric evaluation in this perspective, medical organizations are providers of human right. 7 of 16 It is the formal approach and is based on medical model: Patients should have access to medical evaluation, to achieve welfare and proper education; Patients could have the right to choose their doctors; Patients have the right to negotiate the offered treatment; however, parents are sometimes legally forced to treat their children (Charatan, 2000).

8. The right to avoid drugs in this perspective, human right of people is violated by medical organizations 8 of 16 It is the idea of opponents of medical model of ADHD (e.g. Church of scientology, etc): Labelling and medicating of ADHD `patients` is inappropriate; Health care organizations are scarifying rights of people in favour of drug companies; There are better ways to provide welfare and proper education for people.

9. Controversies surrounding human right of ADHD `patients`: Both sides agree with articles of universal declaration of human rights on importance of welfare, liberty, and proper education. 9 of 16 However, different interpretation of ADHD and related phenomena lead to opposite conclusions.

10. A third perspective… 10 of 16 At present, patients could have access to drugs, only if they are diagnosed and labelled by health care professionals. There are histories of cases, who desperately demand these drugs and it seems that drugs could benefit them, but their doctors do not agree with their diagnosis (Wender, 2000). It is possible to accept the efficacy of drugs like the medical model, and challenge the control of health care professionals on them similar to opponents of medical model.

12. Why labeling is used? A historical perspective (Conrad & Schneider, 1992): Opiates were regularly available in pharmacies in USA till 19 th century. Addiction was prevalent, but harmless. In 1920, definition and moral concepts of opiate addiction changed; as a result, opiates were not available in pharmacies, prevalence of addiction reduce since then, but it become a social problem. In 1937, usefulness of amphetamines for some people was discovered, but they could not be distributed freely, as the moral concepts were against a drug that could be potentially addictive. In 1957, a label was introduced for ADHD (hyperkinetic impulse disorder), In 1961, FDA approved use of amphetamines as a drug for treatment of a disorder in children (ADHD). 12 of 16

13. Some reasons against the necessity of labeling: 13 of 16 1. Practically in many cases labeling do not provide any help other than access to drugs. 2. Health care professionals have not a biological method for diagnosis. 3. Distribution of similar substances is done without prescriptions. 4. People can potentially access the drugs via other routes (role playing and black market)

14. Some reasons against the necessity of labeling: (continue) 7. There is a force in getting the label, if somebody is interested to use these `drugs`. 6. Labeling put the responsibility of drug consumption on health care professionals, instead of individuals. 5. There is a huge financial burden on health care system (NHS spend annually £247 million is for treatment of ADHD) (National Institute for clinical Excellence, 2000a; in: Blew and Kenny, 2006). 14 of 16

15. Freedom to access the drugs? People would be still free to get help and guidance, if they wish. 15 of 16 Avoiding unnecessary labelling. Freedom of choice,

16. Suggestions for future studies Investigating safety and benefits of amphetamines for `ordinary` people. 16 of 16 Biological method for diagnosis of ADHD.

17. Thank you! Dr. Pooria Sarrami Foroushani M.D. School of Sociology & Social Policy University of Nottingham lqxps@nottingham.ac.uk