Adhd

THERE's a lot of controversy surrounding the use of Ritalin to treat attention-deficit hyperactivity disorders in children. That's why the American Pediatric Association's recent guidelines on diagnosing ADHD are such a needed step in better evaluating school-age children with this problem. ADHD itself is controversial. The diagnosis is derived from observations, not blood or brain-imaging tests. About 2.5 million American kids, mostly boys, have been diagnosed with the disorder -- and many doctors prescribe Ritalin to relieve symptoms that include extreme restlessness, an inability to concentrate, impulsive behavior and difficulty sitting still.

Hyperactivity's cause not behavioral drugsAs a pediatrician, I take issue with the Colorado Board of Education's resolution discouraging the use of medication to manage attention deficit and hyperactivity disorder (ADHD) and associated behavioral disorders ("Kids' behavioral drugs at issue," Nov. 25).The "Colorado Solution," to use "discipline and instruction" rather than medication for such disorders, is an impulsive reaction to a complex issue -- and is itself the type of thinking that often characterizes ADHD.

Medication works better than behavioral approaches in the treatment of attention deficit hyperactivity disorder, or ADHD, the largest disorder affecting school-age children. That's the finding of a major study released yesterday of almost 600 elementary school children funded by the National Institute of Mental Health. Researchers said the results, which address a major controversy in the field, should change the way children with ADHD are diagnosed and treated. Dr. Peter Jensen, who initiated the study while he was head of child and adolescent research at the agency, which is part of the National Institutes of Health in Bethesda, said that right now, "many children are being deprived of the proper treatment."

WASHINGTON -- A reaction is under way against drugging children because they are behaving like children, especially boy children. Colorado's elected school board recently voted to discourage what looks like drug abuse in the service of an ideological agenda. The board urged teachers and other school personnel to be more restrained about recommending drugs such as Ritalin for behavior modification of children, and to rely more on discipline and instruction.One reason for the vote is that some school violence has been committed by students taking psychotropic drugs.

The Office of Drug Enforcement estimates that by 2000, fully 15 percent of school-age children will be taking ritalin for something. The question remains, "for what?" -- brattiness, boredom, reluctance, defiance? Whose attention is truly deficient -- kids' or parents'? (Or both?) Lately more adults are appropriating the diagnosis, using it to retroactively explain their own disappointments in life.Few people familiar with ritalin are neutral about it. A milder form of speed and structurally kin to cocaine, ritalin is used to treat attention deficit disorder, a grab bag of unruly behaviors that interfere with some children's ability to learn and obey.

Stanford researchers have found the first clear difference in brain functioning between children with attention deficit hyperactivity disorder, or ADHD, and healthy children, a discovery that may lead to more objective ways to diagnose this mysterious brain malfunction.Researchers estimate that as many as 6 percent of school-aged children suffer from ADHD and require medication with Ritalin or other drugs to allow them to function properly. Critics, however, charge that the drugs are widely overprescribed and are routinely given to children who are merely exuberant, not hyperactive.

Back in Catholic school, when we Baby Boomers sat 45 to a classroom and often two to a desk, most of us behaved so well for the Sisters of Charity that you could hear a pin drop. Most, that is, except George.George lived life with shirt tails, shoelaces and spitballs flying. His knuckles surely had ruler-rapping calluses. He spent most of grade school standing in the corner, where he somehow absorbed enough to go on to higher education and a career as an accountant. We met decades later and reminisced about his days as class clown.

I have a 7-year-old grandson with ADHD. He is very hyperactive and on medicine for it. Your column about how families can disagree over punishing a child with ADHD made me cry. I don't want to make my grandson miserable, but I do have to admit we have had many arguments about him. Can you say more about how to discipline a child with ADHD?The basic principles of discipline for children with ADHD -- attention deficit hyperactivity disorder -- are the same as for other children. They need lots of love; adults they can depend upon who are consistent in their expectations and rules; praise for the things they do right even if those are small; and short, reasonable punishment -- like timeout -- for important mistakes.

My two sons, who are 7 and 8, are on medication for attention deficit hyperactivity disorder. I am trying to find alternative remedies. Can you help?...CindyAkron, OhioThere's no one magic cure for attention problems. The best approach is to combine strategies.As the use of drugs like Ritalin has exploded in the past few years, many experts have become concerned that drugs are being prescribed too hastily and in doses that are too high."Ritalin use is up over 500 percent in the last five years, while the medical establishment is still unclear about what causes ADHD and exactly what it is," says Thomas Armstrong, author of "The Myth of the A.D.D.

My parents are coming for Thanksgiving and I'm already nervous. Our 9-year-old has ADHD. He is very active and impulsive, but he does well at school with medication. My parents seem to think his behavior at home is a result of poor disciplining on our part and are very harsh with him. He dreads their visits. Any suggestions?Children with attention deficit/hyperactivity disorder have a medical condition that makes it difficult for them to pay attention and to control their behavior. They can be quite a challenge for their families, and it helps to remember that their overactive behavior and impulsiveness are not their fault.