Dr Sami Timimi gives a lucid account of the socio-cultural context behind the rising rates of prescription of psycho-stimulants for children. Unfortunately, he does not balance this account with a consideration of the issues that face clinicians on a day-to-day basis as they try to reach reasoned judgement in relation to individual children.

The analysis produced by Dr Timimi has been expressed strongly by a number of vocal critics of the medical profession and the pharmaceutical industry. It is notable that, unlike Dr Timimi, a number of the critics of psychostimulants go on to propound the advantages of alternative therapeutic regimes, such as nutritional management for hyperactive children with attention deficit. It is true that the scientific justification for the use of psychostimulants is limited to short and medium term use and that there is an inherent bias against non-pharmaceutical interventions in research. Nevertheless, there is evidence supporting the use of psychostimulants in a selected group of children and this is borne out in experience of clinical practice.

As a psychiatrist with a critical attitude to my own profession, I have watched the discourse of the anti-psychiatry movement shift. It has become necessary to accept a reality of madness in our society in order to be able to engage with the needs of that vulnerable subgroup of the population who doctors diagnose as mentally ill.

Within our current bio-psychosocial context there are children whose futures are blighted by problems of over-activity and restricted attention span. Psycho-social interventions often fail to prevent such children progressing to a position of increasing disturbance and social exclusion. There are children whose lives have been transformed in a very positive way by the prescription of psychostimulants. In some cases that prescription and its associated benefits would have come earlier were it not for the polemic of unqualified opposition to the use of psychostimulants in children.

I believe that Dr Timimi is in danger of being left behind in the debate about psychostimulants in the same way that some of the early anti-psychiatrists were left behind in the development of radical approaches to mental health practice.