Sarah Gill (Comment, 7/2) is right that medication has a place in the management of Attention Deficit Hyperactivity Disorder. But ADHD is not a diagnosis of a disease, only a label for a set of behavioural problems needing to be explored. A child's behavioural repertoire is limited. Overactive and inattentive behaviour is non-specific. In a national survey more than 19 per cent of boys were rated by parents to meet ADHD criteria. A relationship to poverty and family disruption has been shown. Overworked teachers, time-poor parents and the removal of playing spaces at schools are also important factors. Stimulant medication will sedate most children, whether hyperactive or not. Before it is prescribed the following should be considered: overactivity in response to neglect, trauma, classroom understimulation or inadequate limit-setting at home; anxiety, depression and asthma medication side effects; and normal or abnormal developmental delay and intellectual disability.
Dr Andrew Firestone, East Malvern
Illustration: Andrew Dyson
Acting out often a cry for help
I have seen many students diagnosed with ADHD without an investigation into whether they had dyslexia. Students with learning difficulties are commonly unable to sit still and concentrate. Medication calms them, making them easier for teachers to manage. But the behaviour is often a cry for help for underlying problems. The ADHD checklist is broad and is limited to behaviours, and not their possible causes. Medication has risky side effects, and going down this path sends a message that control of the situation lies in passively taking medicine. This is problematic because the development of internal resilience is a strong predictor of success in life despite the existence of learning difficulties.
Nola Firth, honorary research fellow, Murdoch Childrens Research Institute
Moving to a more holistic model
Sarah Gill commendably highlights the impact, on parents and their children, of the "diagnosis wars" in the mental health field. A label of ADHD designates one as a patient, and in such a setting the answer to the question, "why is this person presenting in this way at this time?" is usually biased towards a physical hypothesis. This has been so ever since those who specialised in mental symptoms opted to become part of medicine 200 years ago, striving to be accepted as "scientific". Gill uses the term "ADHD brain". But it is not the brain that feels, thinks and behaves; it is the whole person, set in a social context. The mental health world is gradually realising that using the model of physical medical illness and diagnostic labelling is unproductive in researching mental symptoms. The National Institute of Mental Health in the US now prioritises funding of research into underlying biological, psychological and social mechanisms and their interaction in producing mental symptoms. This revives a holistic model that seeks to establish valid ways of understanding and facilitating change in ways of feeling, thinking and behaving that cause suffering. Gill's call for more divergent thinking suggests she supports a broader approach.
Graeme Smith, Emeritus Professor of Psychiatry, Monash University
Youth in detention at high risk
Studies have shown that 50 per cent of youth detention inmates have previously undiagnosed ADHD; while 25 per cent of youth arrested any day of the week have previously undiagnosed ADHD. Some 50 per cent of all those who are dependent on methamphetamine have ADHD; while 80 per cent of long-term adult prisoners have ADHD. The disorder and its mental health implications must be tackled by all governments, especially in light of the growing crisis in the youth justice system.
Dr Peter Heffernan, Langwarrin
THE FORUM
Painful cuts
The government's proposed changes to child-care and family benefits once again target the most vulnerable. An estimated $5.5 billion will be cut from welfare payments and replaced with $1.3 billion in childcare subsidies.
You don't need to be Einstein to know that taking $4.2 billion out of welfare will hurt many of our most disadvantaged citizens.
This news item contrasted nicely with the revelation that Australia Post's chief executive is being paid $5.6 million annually, with five other executives pocketing between $1.3 and $1.8 million, for providing a service widely condemned as among the worst in the developed world. Is it any wonder the average citizen is disillusioned from the political process?
Hans Pieterse, Narre Warren North
Reroute the salary
How does a government-owned corporation such as Australia Post reconcile Ahmed Fahour's salary with the government's current debt collection debacle, the relentless hounding of people on disability and other pensions, along with its repetitive script of cutting the debt and deficit. To be paying a public servant $5.6 million when growth in average earnings has slowed almost to a standstill seems unconscionable.
Perhaps part of Mr Fahour's remuneration could be redirected to building accommodation for the homeless.
Julie Conquest, Brighton
Overpaid at the top
Senior ministers and public servants are paid in the range of $350-500k per annum, so how is it that the head of Australia Post is paid more than 10 times this? To add insult to injury, he received a decoration in the Australia Day awards. Sack him now.
James Ogilvie, Kew
Playing by the book
A cavalcade of Liberal MPs claim Cory Bernardi should do the honourable thing and resign his "Liberal" seat. Senator Bernardi is simply applying the modern political maxim that all MPs seem to follow that if it is within the letter of the law (or entitlement), then it is OK. Adhering to the spirit of the law or public expectations are moot points.
Brendan Harrison, Bacchus Marsh
What national interest?
"I don't give a stuff about the national interest, I want to be re-elected and this needs to go away." So said WA politician Don Randall during a heated party room debate (The Age, 7/2).
And this was when Senator Bernardi first sensed a problem and never forgot these words. To remind him of what? Of the almost comic sense of self-serving that afflicts most of today's politicians? Of the absence of common decency in every house of parliament in Australia? That it is worth losing your soul if you can delude yourself that the triumph of ideology is the real reason for the efforts to attain that power?
What if, instead, Senator Bernardi had risen from his seat and unequivocally said that such moral sickness could be catching. Had he pondered about morality being a concept needing perspective, maybe his utterances about same-sex marriage, climate change and welfare would never have left his mouth.
Victor Ramirez, Sunbury
Not good role model
So Cory Bernardi quotes the late Dan Randall. This statement came from a politician who flew from Perth to Cairns at taxpayers' expense claiming electoral business, yet actually went to buy an apartment. Randall later paid the money back. It is about time politicians realise they are supposed to working for the national interest.
Glenn Carmichael, Werribee
Don't shame the dogs
I am disgusted to hear a senator refer to Cory Bernardi's behaviour as "a dog act". Obviously there must be no dog in his family or he would know that loyalty is the overriding virtue of all dogs. I lodge this protest on behalf of all the dogs in my street, labradors, border collies, beagles, and every other member of our tribe in Stonnington.
Bozo, c/- Tony Dawson, Armadale
Got the right look
As champions of the angry, the disgruntled and the fed-up-with-everything segment of the population, Pauline Hanson and Bernardi have, at least, the right facial expressions (The Age, 8/2).
Margaret Brennan, Yarraville
Stuck in time warp
The problem for such politicians as Bernardi, George Christensen, Tony Abbott and Eric Abetz is they think that, like John Howard did, they are skilfully reading the electorate's mood. Stuck in their mindset they do not see the climate for change on such issues as refugees, same sex marriage, wealth inequality and, indeed, climate. An abrupt realisation and about-face is vital if the Liberal Party wants to avert a Whitlam-style "Time for change" shake-up. Turnbull could then assume the role of leader rather than puppet.
Robert Brown, Camberwell
Sinkhole metaphor
Perhaps Mr Turnbull's oracle should be reading the ominous signs from the yawning chasm opening up in his home suburb of Point Piper as a metaphor for his government and future career.
Peter Taylor, Midway Point, Tas
Turnbull's slip-up
Aviation causes about 5 per cent of all global warming, yet the Paris Agreement's voluntary emissions reduction commitment's specifically excluded aviation emissions. This will allow growth in an industry projected to be responsible for 22 per cent of global emissions by 2050. So can we say that scrapping the free-flights perk for retired MPs is one small step for the planet but one giant slip-up for our pro-emissions Prime Minister?
Mark Carter, North Melbourne
Ocean-washed coal
Coal and fine black dust have been found washed ashore on a beach near Mackay, right alongside the Great Barrier Reef. Is this a new form of the PM's "clean coal" – "ocean-washed"?
John Kirk, Canterbury
Serve of hypocrisy
On a day when the public is reeling at the shocking revelations about the Catholic Church, our politicians in Canberra attend a service – at the Catholic Church. Can we expect real action?
John Howell, Heathmont
An end to the denial
If there is one positive coming out of the child abuse royal commission it is that finally the victims are not only being listened to, but being believed. Much of their trauma comes from years of institutional denial of their experiences.
Jill Burn, Ivanhoe
Reality beckons
Trump is talking and tweeting a big game from the safety of the White House walls. How long do we have to wait for the apprentice president to submit himself to the ultimate reality check of an appearance in a public forum?
Greg Ware, Middle Park
Prolific writers
Regarding the "Political Personas Project" (The Age, 7/2): I see that "activist egalitarians" and "progressive cosmopolitans" make up 36.5 per cent of the population, but they account for about 90 per cent of the letters published in The Age.
Peter Louden, Mitcham
Availability the key
Victoria's Auditor General has found that the government system for approving liquor outlets is just a rubber stamp that takes little account of the harm the saturation of bottle shops is causing. In the last year there were 65,000 cases of family violence that involved alcohol – more than half of all such cases. Further, cases of family violence involving alcohol are more brutal and violent.
Research clearly shows that more bottle shops drive up the number of cases of family violence. The government needs to demonstrate it is serious about protecting women and children from family violence by restricting the numbers of bottle shops. And shop owners should be required to close by 10pm and not use advertising strategies that drive alcohol misuse.
Mark Zirnsak, social justice spokesman, Uniting Church
Stern lecture needed
I wrote a letter in July 2015 stating that I thought public transport users had no manners. I can now say I know they have no manners. Back then I was concerned about people not making room and crowding the doors. Now in my sixth month of pregnancy when it is quite clear the belly I am sporting isn't a beer gut, I am certain that commuters have no idea what it is to be polite, respectful and to follow the rules. Signs indicate the specified seats where people with medical conditions, the elderly and pregnant women have priority, yet I am rarely offered a seat. Yesterday morning I was on the train for 10 stops and not one person offered me a seat.
When I moved to Australia more than three years ago, I was told it was a "nanny state". I now believe that the public needs to be told everything, including how to show common decency.
Katie Conte, Thornbury
Eddie out of the picture
Why should Eddie McGuire's absence from Collingwood's inaugural AFLW game cause such a stir (Comment, 7/2)?
Women's football is not men's football. The women's league will reap enormous benefits from this distinction.
Madelene Rich, Seaford
AND ANOTHER THING...
Cory Bernardi
Wouldn't it be funny if Cory had a Party and nobody came.
Layla Godfrey, Mt Eliza
It's cool, Cory. I've also been known to party on my own, usually after a drink or two.
Helen Russell, Murrumbeena
He has shown colleagues the shortcut to party leadership.
Phil Lipshut, Elsternwick
How long before Bernardi walks out on his own party?
Tony Lenten, Glen Waverley
An unethical moralist.
Linda Mackie, Collingwood
He doesn't seem to stand for anything – just against everything.
Lawry Mahon, Port Fairy
Did he know he was in line for a three-month taxpayer-funded UN secondment in New York before the election?
Richard Jemison, Carlton River, Tasmania
The PM must ban MPs from travelling to extremist countries and returning radicalised to endanger our democracy.
Ken Gillespie, Yarrawonga
Bernardi was elected on a Liberal ticket to represent his state — not himself.
Mem Cohen, Brighton
A new epigram for SA car number plates: "The minor party state".
Thos Puckett, Ashgrove, Qld
Other matters
Where are they now, the 1880 alleged perpetrators of sex abuse within Catholic institutions? Surely not all "gone to god"? My heart sinks.
Glenda Johnston, Queenscliff
The Gold Pass for retired MPs is to be cancelled. What will Bronwyn do?
Margaret Ady, Avondale Heights
If we pay Ahmed Fahour a bit more could he possibly make Australia Post work for us?
Eric Willson, Brighton
I'd send a letter of protest, but it may not get there for months.
Myra Fisher, Brighton East