- 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
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