Countering concerns

New guide aims to help parents ensure their children get best available ADHD treatments

In Focus -- Medicine

October 03, 2007|By Dennis O'Brien | Dennis O'Brien,Sun reporter

Assuring parents that that current medications are safe and effective, two major psychiatric organizations issued yesterday detailed treatment guidelines for children with attention-deficit/hyperactivity disorder - a condition that affects up to 4 million children nationwide.

Authors said the guidelines - including tips on spotting symptoms, a list of treatment options and details of medication side effects - are designed to dispel myths about the disorder and to help parents make sure that their children get the best available treatments.

The condition, known as ADHD, is characterized by excessive restlessness, an inability to pay attention and impulsive acts, experts say.

The 27-page document, prepared by the American Psychiatric Association and the American Academy of Child and Adolescent Psychiatry, has been posted online at It will also be distributed in doctors' offices nationwide.

"The more information parents have, the better. It puts them in a position to be effective advocates for their children," said Dr. David Fassler, a child psychiatrist at the University of Vermont College of Medicine and a co-chairman of the panel that produced the guide.

In part, the guidelines were aimed at countering concerns that increasing rates of ADHD diagnosis have led to overmedication of children. ADHD drugs generate an estimated $3.5 billion a year in sales.

"Too many children are being medicated at too young an age," said one such critic, Gretchen LeFever, a clinical psychologist and ADHD researcher at Regent University in Virginia.

But the guidelines issued yesterday state that medications such as Ritalin are safe for children. They say effective treatment of ADHD often includes a combination of drugs and behavioral therapy, with medication prescribed only after the child has been thoroughly evaluated and all options explored.

"We're not here to medicate children to be zombies in the classroom; that's not our goal," said Dr. Adelaide Robb, a panel member who is a child and adolescent psychiatrist at Children's National Medical Center in Washington.

"The fact of the matter is that Ritalin is very effective. It's not a panacea for every problem, but it is an effective tool," agreed Dr. John Walkup, a child and adolescent psychiatrist at the Johns Hopkins Children's Center who was not on the guidelines panel.

The psychiatrists decided to produce the ADHD guide in part because a similar document for parents of children with depression has attracted 1 million viewers since its posting in 2005, Fassler said.

"The real key is whether or not these signs or symptoms are interfering with a child's ability to function," Fassler said, such as the child's reaching a point of not doing well in school, or having fights at home or lacking a lot of friends, to the point of affecting the child's self-esteem.

There is a genetic component to ADHD, experts say: 76 percent of children with ADHD have a relative with the disorder. But smoking, drinking and stress during pregnancy as well as premature birth and traumatic brain injury are also possible contributors.

Nationwide health surveys show that ADHD has been diagnosed at some point in just under 8 percent of children ages 4 to 17. That amounts to 4 million youngsters, according to Susanna N. Visser, an epidemiologist with the U.S. Centers for Disease Control and Prevention.

Just over half of those children are taking some kind of medication for it, she said.

One puzzling fact: Boys with ADHD outnumber girls by a 3-to-1 margin.

"There are a lot of theories about that, but we really don't know why," Visser said.

Children with ADHD sometimes have other disorders, such as depression, making the condition difficult to diagnose, experts say. They also cite a nationwide shortage of child psychiatrists, physicians and mental health professionals with the training and time to do it.

"You can't do it in a five-minute office visit," Fassler said.

Many parents are also reluctant to seek help from a mental health professional for their children, said Crofton resident Clarke Ross, whose 17-year-old son has ADHD.

"Some parents say, `I'll just wait and see,' or `I'll just try whatever fad is out there,' and the fads don't work," said Ross, who is chief executive officer of CHADD, a support group for individuals with AD/HD and their families.

Dr. Lance Clawson, a child and adolescent psychiatrist in Cabin John, said he plans to distribute the guide to parents in his office to clarify treatment options. "There is a real misunderstanding of what ADHD is and what it isn't, on a number of levels, so I see the guidelines as a big plus," he said.

In February, the Food and Drug Administration advised the manufacturers of Ritalin, Adderall, Strattera and other ADHD drugs to issue warnings in their packaging that the medications can cause heart and psychiatric problems.

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