Workshop - Arnstein Mykletun

Abstract: This workshop is designed to complement a keynote presentation on the “ADHD Controversy Project”. The keynote establishes that clinician attitudes — not patient symptoms — drive most of the variation in ADHD diagnosis rates. But what shapes those attitudes? A survey of clinicians across Norwegian CAMHS (Lyhmann et al., European Child and Adolescent Psychiatry, 2023) found that attitudes towards diagnosing and medicating ADHD vary widely between practitioners, and that these differences are associated with real variation in clinical decisions. Attitudes appear to be formed by a complex interplay of forces: broad societal and media narratives about ADHD; local clinical culture and institutional norms; structural and financial incentives; and each clinician’s own personality, values, and professional beliefs about medicalisation and the role of diagnosis.

The ADHD Controversy Project has also produced causal evidence on the long-term effects of ADHD medication across a range of outcomes. Participants will be invited to consider what this evidence means for their own clinical assumptions before the findings are presented and discussed. This workshop invites participants to examine their own attitudes and consider how these have been formed. Through structured exercises and facilitated discussion, participants will reflect on their personal position on the liberal-to-restrictive spectrum, explore the forces that have shaped it, and consider what the emerging causal evidence means for their own clinical practice.

 

 

 

Learning objectives: Delegates will be able to:

1. Understand that clinician attitudes influence clinical decision-making on ADHD diagnosis and treatment, and that this attitudinal variation — not symptom variation — accounts for a substantial part of the observed differences in diagnosis rates between services.

2. appreciate how these attitudes are formed — by broader societal trends and media narratives, by local clinical culture and institutional context, by financial and structural incentives, and by individual personality, values, and professional beliefs.

 

3. better understand the consequences of attitudinal variation for individual patients and for society at large, including implications for equity of access to care and population-level outcomes.

 

Level: All levels. This workshop is relevant to neuropsychologists at all career stages who are involved in ADHD assessment or work in services where ADHD diagnosis is part of clinical practice.

 

 

 

Facilitator: Prof Arnstein Mykletun, PhD, EuroPsy, Head, Centre for Population Health, Haukeland University Hospital, Bergen, Norway; Department of Community Medicine, UiT – The Arctic University of Norway

Arnstein Mykletun is Head of the Centre for Population Health, Haukeland University Hospital, Bergen, Norway, and Professor of Community Medicine at UiT – The Arctic University of Norway. He holds a European Certificate in Psychology (EuroPsy) and is a licensed clinical psychologist with experience in cognitive behavioural therapy. Prof Mykletun also holds appointments as Honorary Visiting Professor at the Institute of Psychiatry, King’s College London, and at Monash University, Melbourne, as well as Senior Researcher at the Norwegian Institute of Public Health and Head of Research at the Centre for Work and Mental Health, Nordland Hospital Trust. Prof Mykletun’s research spans psychiatric epidemiology, occupational mental health, public health, and health services research, with a focus on the population-level consequences of clinical decision-making and the use of causal inference methods, particularly instrumental variable designs. He holds an H-index of 89 with over 31,500 citations and is currently PI for grants exceeding approximately AUD 15 million. Prof Mykeltun has been elected Chairperson of the Section for Epidemiology and Social Psychiatry of the European Psychiatric Association, and was named Academic of the Year in Norway in 2024. Prof Mykletun is the principal investigator of the ADHD Controversy Project, a large-scale natural experiment using Norwegian population registry data to examine the long-term consequences of ADHD diagnosis and medication. He also leads a parallel Controversies in Psychiatry project on compulsory mental health care. Prof Mykletun chaired a Norwegian Government expert committee on sickness absence whose recommendations became national policy, and has contributed to WHO expert consultations on the inclusion of ADHD medication on the List of Essential Medicines.

 

 

Keywords: ADHD, clinician attitudes, reflective practice