'ADD' Diagnosis And Proper
Treatment Remain Unknown -
New Report
WASHINGTON (AP) -- Doctors still don't know the best way to treat or even diagnose attention deficit disorder in children -- even though more than a million children now take powerful drugs to control their hyperactive behaviour, according to the National Institutes of Health.
In a report issued Wednesday, a panel of experts selected by the NIH called attention deficit disorder a "profound problem" that may affect three per cent to five per cent of all American schoolchildren and costs schools more than $3 billion US.
But a consistent, proven method of diagnosing and treating the disorder remains elusive, the experts said.
"There is no current validated diagnostic test for" the disorder, said Dr. David Kupfer, a University of Pittsburgh psychiatry professor and chairman of the panel.
Some treatments are effective in the short term -- principally drugs such as Ritalin -- but no studies have examined their effect on children who take them for more than 14 months, Kupfer said.
Attention deficit disorder, or ADD, also known as attention deficit hyperactivity disorder, usually is diagnosed in school-age children, often as the result of a child's disruptive behaviour.
Symptoms include the inability to sit still for reading, study or even to watch television. Often a child cannot play in group games and will act on inappropriate impulses.
Yet defining precisely what constitutes ADD is difficult, said Dr. Mark Vonnegut, a pediatrician and panel member from Quincy, Mass.
"The diagnosis is a mess but we all believe we are dealing with a serious core problem."
For professionals who spend much time around children, he said, "these kids stick out like a sore thumb."
Nonetheless, Janis Ferre of the Utah Governor's Council for People with Disabilities, also on the panel, said there's wide inconsistency in how a diagnosis is made. "This results in over-diagnosis and under-diagnosis," she said.
Panel member Donald Berry of Duke University Medical Centre said he thought Ritalin and other powerful, mind-altering drugs are prescribed too often for children, criticizing the lack of studies on the drugs' long-term effects.
"There is no gold standard for therapy, so it is difficult to look at the prescribing practice and say what is appropriate or not appropriate," said panel member Dr. Robert Baltimore of the Yale University School of Medicine.
The president of a leading advocacy group, Children and Adults with Attention Deficit Disorders, said she was pleased the report confirms "that ADD is a serious disorder with potentially devastating consequences whose effects extend into adulthood." But the report clearly shows the need for "a more consistent system for diagnosis and for treatment," said Mary Robertson of Lexington, Ky.
Among the panel's conclusions:
--Although Ritalin and other therapies may correct classroom behaviour problems, there's no evidence that such correction improves a child's academic performance.
--Although there is no independent, validated test for ADD, some "well-tested diagnostic interview methods" have proved reliable. However, the report notes, "research to establish the validity of the disorder continues to be a problem."
--Short-term trials of Ritalin and other drugs show beneficial effects on some behaviours and are superior to behaviour modification training. Combining the two resulted in improved social skills, and parents and teachers judged this combination "more favourably."
--Many other treatments have been tried, including vitamins, herbs, biofeedback and eliminating some foods such as sugar. None have proved effective.
--Doctors and schools usually do a poor job of communicating and co-ordinating when treating children with ADD, and follow-up often is poor. Teachers and parents play a key role in successfully treating ADD and fine-tuning medication.
Are Children Overmedicated? NIH Studying Ritalin Usage By Children Over A Million Children Take Medical Stimulants By John Roberts 11-19-98
VALLEY FORGE (CBS) -- U.S. health experts Wednesday concluded a conference about the most commonly found disorder in America's children: Hyperactive Behavior Disorder. CBS News Correspondent John Roberts reports.
Jarryd Novotni is a pretty normal twelve year old, a far cry from his early childhood.
"When he was about one and a half, he jumped out of our living room window," says Michele Novotni. "He would color on the walls, he ripped stuffing out of the couch. He tore down curtains."
Jarryd has ADHD, Attention Deficit Hyperactivity Disorder. It is a condition that drove him out of control until age 5, when he started taking Ritalin.
"Within 20 minutes of his first dose of Ritalin, I had a child back," says Jarryd's mother. "That's all it took."
Ritalin can almost be a lifesaver for children like Jarryd. But, with two and a half million prescriptions for the drug written last year, many people are wondering if ADHD is being over diagnosed.
Critics question if Ritalin is used as a catchall for other childhood problems and worry that children are overmedicated.
The conference on ADHD, sponsored by the National Institutes of Health, failed to come up with any clear answers.
"You can't really simply say that it's overdiagnosed and overtreated, cause there are many, if you will, important areas where it's underdiagnosed and we would conclude undertreated," says David Kupfer, NIH Conference Chairman.
One problem is there's no clear test for ADHD. While the NIH is studying whether there is physical evidence of the disorder in the brain, for now doctors, like Marian Callaghan of St. Christopher's Children's Hospital, have to rely on their instincts and training.
"You want to make sure that you are not just dealing with someone who is a normal, very active child," says Dr. Callaghan.
The NIH conference called for more research into ADHD and better guidelines for diagnosis and treatment. The NIH is working to insure fewer children will be medicated unnecessarily and more, like Jarryd Novotni, can live a normal life.
Reported By John Roberts Copyright 1998, CBS Worldwide Inc., All Rights Reserved