Dear Libby, re The Times "Opinion" 21st March 2011

I'll call you Libby, may I? Only you seem to know my family so well from your comments in Monday's (21st March) "Opinion" piece you wrote for The Times that we surely must be on first name terms. I do apologise for my delayed reply, as it is now a full two days since you wrote. Unfortunately my parenting inadequacies prevent me from taking a break from my 9 year old son to read newspapers most days, let alone successfully get him into bed before 11pm and find time to respond on an average night.

Your "insightful" comments on ADHD diagnoses and Ritalin prescription undoubtedly touched a raw public nerve but just how familiar are you with ADHD?

According to the 1994, Diagnostic and Statistical Manual of Mental Disorders, Ed IV (DSM-IV) ADHD is "a Disruptive Behaviour Disorder characterised by the presence of a set of chronic and impairing behaviour patterns that display abnormally levels of inattention, hyperactivity, or their combination." The diagnostic criteria clearly states that behaviours must be present at least six months and be to such a degree that they are maladaptive and inconsistent to developmental level. I would say multiple exclusions before age 6, landing younger siblings in A and E and rarely sleeping more than a few hours with frequent night terrors were a little more significant than uncontrolled naughtiness.

No doubt you would agree with the parent at H's school who told me I "should not have been allowed more children because I could not control my son" but it may interest you to know I have three other well adjusted, high achieving children who have never shown such behaviours in such a prolonged and detrimental way. I'm not speaking about the impact on the family or school either - and I can assure you I could write an essay on such effects - physical, emotional, psychological.... but you have already formed such hard-set opinions there would be little point. I am referring to the impact ADHD has on my son.

My 9 year old son is also Autistic, a condition commonly co-morbid with ADHD and vice versa. Without his ADHD medication we cannot tackle his Autism, and he was prevented from making appropriate social and emotional progress before his ADHD diagnosis. Most of each school day was spent under the table and anyone endeavouring to coerce or persuade him out would most likely be attacked. It has been a long journey unpicking his difficulties and we are by no means there yet, but ignorant accusations of social ills causing ADHD does little to help H and others like him in their daily battle to cope with the basics of life which so many take for granted.  Maybe you could even ask someone with ADHD what their Ritalin does for them - those genuinely needing it often WANT to take it, without it they know they cannot stay in school/college, keep friends, stay out of trouble. Have you even MET anyone with ADHD?

Your comment about prescribing for under 6's was a valid and sensible one. Few would endorse it and a discussion of the point would have added value and perception to an ongoing dialogue. Sadly though, like many others you slipped into the classic trap of challenging the existence of a condition which has historically been shameful and poorly acknowledged. ADHD is not a new phenomenon. Asperger's Syndrome did not exist until Hans Asperger defined it in 1944 - but undoubtedly it was not a new collection of symptoms. The same is true of ADHD.

Neither is medication the only answer, a 1995 study showed that medication and behavioural therapy together, followed by medication only then therapy only had the best long term outcome. Without medication, few would reach stage 3. My son face permanent exclusion from from Key Stage 1, at age 7. I would hazard a guess that goes a little beyond infant "naughtiness". He had no friends and was desperately unhappy. He threatened to kill himself many times, jump out of windows... and he would try and run away. The World was a confusing and distressing place for him.

Whilst medication must always be respected and used with caution, and diagnostic criteria constantly re-evaluated there is a place for it in the valid treatment of a very real disorder. ADHD is real, and it IS a disability. If you cannot see that, then you have not had much experience of it, for which you should be thankful. You makes a valid comment about over diagnosis, overprescription and preschoolers getting medicated - sensible points you had the opportunity to sensibly explore but instead got totally sucked down the ADHD/Ritalin-bashing drainpipe. Because that's where it belongs - that kind of argument is outdated, disproven and belongs in the gutter.