Ped Med: The ADHD quandary

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Ped Med: The ADHD quandry

By LIDIA WASOWICZ

UPI Senior Science Writer

A is for the alarming number of children as young as 2 diagnosed with a

chronic psychiatric disorder.

D is for the debate surrounding diagnostic criteria that include common

childhood behaviors.

H is for the hue and cry over the hiked-up use of mind medicines in minors.

D is for the discovery yet to be made of the number of children

inappropriately or inadequately diagnosed and treated and of means to bring

down those rates.

Put them all together and you get ADHD, which stands for

attention-deficit/hyperactivity disorder, which stands for one of the most

common, and controversial, behavioral conditions reported in America's

children.

Improved understanding and methods of care have spelled untold relief for

youngsters who previously would have been dismissed as incorrigible or inept

and left behind to failure. Yet, the degree of attention focused on deficits

in attention has even some experts squirming in their professional seats.

" What we expect from children is changing and maybe we're too quick to

see -- and treat -- (lapsed attention) as a medical problem, " says

Maddux, clinical child psychologist and professor of psychology at

Mason University in Fairfax, Va.

The concern of others runs in the opposite direction.

" Are there some children treated with Ritalin (a drug commonly used to treat

ADHD) who don't need it? Probably. Are there some children treated with

antidepressants who don't need them? Probably. But the bigger overarching

problem is undertreatment, " says Dr. Walkup, deputy director of the

Child and Adolescent Psychiatry Division at the s Hopkins Children's

Center in Baltimore.

Some 4 million to 6 million, or 6 percent to 9 percent, of youngsters ages 3

to 17 have been diagnosed with ADHD, a variety of statistics keepers

estimate. Since they were first described in U.S. literature a century ago,

the series of behaviors associated with the condition -- in broad terms,

marked by impulsivity, hyperactivity and/or inattention -- have posed under

a variety of aliases, including " minimal brain dysfunction. "

Only 26 years ago did they get their current name and listing. ADHD now

officially appears on the pages of the American Psychiatric Association's

Diagnostic and Statistical Manual of Mental Disorders, the mental health

professionals' gold-standard reference from which psychiatric diagnoses and

their treatments are derived.

The behavioral disturbance has been reported in more than twice as many boys

as girls, perhaps because their distracting symptoms -- fidgeting,

interrupting, blurting out -- snag more attention, and annoyance, than the

less obtrusive daydreaming, withdrawal and lack of focus that often

characterize the female manifestation of the disorder.

ADHD and learning disabilities account for the bulk of chronic conditions

that limit activity in children ages 5 to 17, according to the Centers for

Disease Control and Prevention's 2004 National Health Interview Survey.

A consortium of U.S. government agencies and international experts

considered the problem sufficiently significant to warrant, for the first

time, a special section in their annual measure of children's health. In the

2005 analysis, parents reported 5 percent -- or some 2.7 million -- of

America's 4-to-17-year-olds exhibit " definite " or " severe " mental

disturbances that interfere with their family, school and social life.

Despite its growing recognition, ADHD can be difficult to pin down. In part,

that's because its symptoms can mimic those of other conditions, such as

depression or anxiety, as well as those of normal comportment. In part, it's

because, like other mood and behavioral disorders, ADHD is easy to

misdiagnose. Those cautionary words come from the advocacy group Consumers

Union.

As a result, some youngsters taking stimulants -- the most popular treatment

for ADHD -- may not have the condition or have only mild symptoms, and thus

may risk experiencing adverse effects, the consumer advocates' report says.

Psychiatrists assure the medicines are not addictive -- but only to children

with ADHD.

A 2005 study by the National Center on Addiction and Substance Abuse at

Columbia University revealed a disturbing 212-percent jump from 1992 to 2003

in the number of teens 12 to 17 abusing controlled prescription drugs. These

included depressants and stimulants.

Americans spent some $2.5 billion in 2003 on psychiatric drugs for children,

according to figures from Medco Health Solutions, a top pharmacy benefits

management company that serves some 65 million members. That represented an

attention-grabbing jump in just three years of 183 percent in such spending

overall and of 369 percent in spending for ADHD drugs for preschoolers.

At a congressional hearing in May 2000 Terrance Woodworth, a deputy director

in the Drug Enforcement Administration, testified some 17 million

prescriptions for psychoactive drugs for minors are written each year -- 40

percent of them for youngsters 3 to 9 and 4,000 for tots 2 and under.

Untreated, ADHD raises the risk of a plethora of perils, from academic

underperformance to social and emotional maladjustments to dangerous or

illegal behaviors, including reckless driving and substance abuse, research

indicates.

However, some critics have voiced concern about the equally daunting, though

in the mind of psychiatric experts less likely, possibility of mistakenly

affixing a medical label, and prescribing unnecessary and potentially

harmful medicines, to a normally developing youngster.

Issues of misdiagnosis aside, there is a paucity of information on the

long-term effects on humans still under development of psychiatric drugs --

most of which have undergone little or no testing in children.

" The bottom line is there's more use of psychotropic medication with

children than there is research data on it, " said Brown, dean of the

College of Health Professions and professor of public health, psychology and

pediatrics at Temple University Health Sciences Center in Philadelphia and

chair of a working group investigating use of psychoactive medications in

minors.

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UPI Health News welcomes comments on this column. E-mail: lwasowicz@...

Regards,

" Every science touches art at some points while

every art has its scientific side; the worst man

of science is he who is never an artist, and the

worst artist is he who is never a man of science. "

[Armand Trousseau]