THE use of medication for the treatment of Attention Deficit Hyperactivity Disorder has always been a topic of controversy.

There is some dispute about whether the improvements in school and wider social functioning associated with stimulants such as Ritalin can be obtained equally with school and parental methods.

We know that children vary in temperament which can make child-rearing more challenging for some families. A medication that can make the difference between succeeding rather than be rejected in school can bring long term benefits. However, how parents bring up their children and how consistent they are in setting limits and rewarding socially appropriate behaviour has a very significant impact on the way a children behave as they grow up.

France has fewer ADHD children than both America and the United Kingdom and there is discussion to be had around whether school and family child-rearing practices there are part of the reason.

In France, family traditions are strong with events such as set meal and sleep times seen as very important by society in developing a good regimen for children to grow up in.

Adult diagnosis of ADHD is more controversial. One reason is that diagnosis is sometimes made in people whose behaviour, moods and function have been altered due to psychoactive substances or heavy session drinking. Abuse of drugs and alcohol can result in patterns of behaviour which mimic ADHD.

Poor concentration and attention, failing academic and employment performance, difficulty remembering, being disorganised, difficulty focussing thoughts, impulsivity and restlessness are shared features.

Some think adult ADHD is a different disorder from childhood ADHD. One study showed that only 15 per cent of people diagnosed with childhood ADHD meet the criteria when they reached their 20s.

That tells us that childhood ADHD can resolve on its own with social and brain maturation.

At Castle Craig Hospital, where we treat adults with addiction, a number arrive on a prescription of stimulants. These are stopped on arrival with the patient’s agreement because, with our fairly long in-patients period we can observe whether, once their addiction is addressed, their ADHD symptoms persist.

Many patients are surprised at how well they can concentrate on the treatment programme which includes discussions with their peers and even some written work and study - activities that in the past their concentration and irritability interfered with.

A significant advantage is having the residential programme because it allows us to put the emphasis on re-establishing sleep patterns. Physical activity in the day also contributes to re-learning a good pattern of sleep and wakefulness.

Using the records we keep of impulsive or problematic behaviour we have documented that this has been a medically safe and preferred approach. We find that in general ceasing these stimulant medications results in improvement. Outcomes from this type of approach are also good in the longer term once patients leave.

Our work tells us that people's emotional stability, wellbeing and their functioning in society can improve with approaches that do not depend on medications some of which cause complications in their own right.

Professor Jonathan Chick is the medical director at Castle Craig, an addiction rehabilitation centre in West Linton.

He is an eminent Consultant Psychiatrist with a distinguished career in the National Health Service.