Posted on 08/04/2006 12:18:12 PM PDT by Teflonic
Aug. 3, 2006 -- In contrast to claims that children are being overmedicated for attention-deficit/hyperactivity disorder (ADHD), a team of researchers at Washington University School of Medicine in St. Louis has found that a high percentage of kids with ADHD are not receiving treatment. In fact, almost half of the children who might benefit from ADHD drugs were not getting them.
"What we found was somewhat surprising," says Richard D. Todd, M.D., Ph.D., the Blanche F. Ittleson Professor of Psychiatry and professor of genetics. "Only about 58 percent of boys and about 45 percent of girls who had a diagnosis of full-scale ADHD got any medication at all."
Much has been written about the increasing number of children taking drugs for ADHD. One study found that the percentage of elementary school children taking medication for ADHD more than tripled, rising from 0.6 percent in 1975 to 3 percent by 1987. Another study reported that the number of adolescents taking ADHD drugs increased 2.5 fold between 1990 and 1995. And many reports have noted a rapid increase in the U.S. manufacture of the stimulant drug methylphenidate — usually sold under the brand names Ritalin or Concerta.
The researchers studied 1,610 twins between the ages of 7 and 17. Of those, 359 met full criteria for ADHD: 302 boys and 57 girls. The total number of boys in the sample was 1,006, and 604 girls were included.
"From a clinical point of view, this study affirms that for whatever reason, many children who could benefit from treatment are not receiving it," says first author Wendy Reich, Ph.D., research professor of psychiatry in the William Greenleaf Eliot Division of Child Psychiatry.
It's possible those children aren't being identified at schools or pediatrician's offices or that their parents are choosing not to put their children on stimulant medication, according to Reich.
"It may be that mental health professionals need to do a better job of explaining the risks and benefits of treatment," Todd says. "The vast majority of parents whose children were involved in this study reported that their kids improved with medication, and when used properly these drugs have been shown to be very safe."
Todd, who also is the chief of child psychiatry, says among the 1,251 kids in the study who did not have ADHD, some did take stimulant medications, but it was a very small percentage, only 3.6 percent of the boys and 2.6 percent of the girls.
He says, however, that in many cases, there's an understandable reason those children have sought treatment. The study found that most of the children without ADHD who took medication did have some symptoms of ADHD — some hyperactivity or problems with inattention — but not enough symptoms to meet formal diagnostic criteria as defined by the American Psychiatric Association's Diagnostic and Statistical Manual (DSM-IV). The study also found that most of the kids who took medication without an ADHD diagnosis had a twin who did have the disorder.
"These children have what we might call subsyndromal, or mild, forms of ADHD, and they seemed to come from families where other children had full-blown ADHD," Todd explains. "We didn't find that children got these drugs because they had other problems, such as conduct disorder or a learning disability."
Reich says the eventual goal of studying twins is to learn what elements of ADHD are passed down in families. She says some aspects of the disorder are certainly genetic. Others may be related to environmental factors, and studying twins allows the researchers to tease out those influences. Todd says the hope is to identify genes that contribute to the disorder, or rather, the disorders.
"It's becoming clearer that ADHD is not a single problem but a group of disorders that have different causes but similar clinical expressions," he explains. "There also can be lots of reasons why you become diabetic or hypertensive. The end result is high blood sugar or elevated blood pressure, but how that happens can differ greatly from individual to individual. It's the same thing for ADHD."
Todd believes that as genes are identified, it may become possible to intervene in new ways — with psychotherapies, environmental interventions or medications that affect biological pathways that haven't yet been identified. But he says a potential stumbling block in the future, as now, will involve getting children into treatment.
"That's especially true for girls because for whatever reason, less than half of the girls who had ADHD in this sample ever received treatment," Todd says. "As genes are discovered and treatments developed, they won't be able to solve problems unless they are used."
Those were the days...I keep hearing about all of these kids in my daughters classes are are allergic to almost everything you can think of...bread, peanut butter, sugar, chocolate...I'm waiting for some kid in her class to be allergic to air.
Ritalin, in a properly titrated dose for a PROPERLY DIAGNOSED child, is a help. The problem is this: kids are being 'diagnosed" behaviorally, while there is a perfectly viable and accurate clinical test available. And, the drugs are passed out like high-yield candy - where the dosages being used are way, way too big.
I have had 2 kids diagnosed clinically, put on the smallest dosage of ritalin, received proper therapy (where they are trained to recognize when they are paying proper attention via brainscan readings), and who have subsequently gone entirely off of the medication. They have been ritalin free for several years, while retaining their gains in the ability to sort through environmental noise.
One thing to keep in mind, though... The clinical test shows that up to 50% of those "behaviorally diagnosed" (think of a teacher saying Johnny can't sit still) do not have the condition. That means that up to or even more than half of the kids being drugged up have no reason to even be around ritalin. Of the remaining few that could benefit from it, the drug is over-dosage, and nobody is helping the kids learn how to manage their attention themselves.
Yeah. That's the problem. Not enough kids on Ritalin.
That's the answer.
I did a quick scan......it did not say who funded the research. Indirectly it could be a ritalin manufacturer. Would also be curious to know if any of the researchers have a connection to companies or would benefit in some way from the increased drugging of kids
If there is more ADHD, I bet its because of the parental tendency to allow infants and toddlers to vegetate in front of a TV, where there can now be found 24-hour baby and kid channels. Its been shown to affect brain development.
Personally I'm all for abolishing public schools entirely, and replacing them with a voucher system in the amount currently being spent on public school students. Make the vouchers redeemable by anyone, including homeschooling parents and private tutors, who the child's parents register as the child's educator in advance, and who can get the child to pass basic verbal and math tests, with passing score set at the 50th percentile of current public school averages. Pay AFTER the child passes the test (which must be administered in a different location from where the child regularly studies, and by people who have no financial interest whatsoever in who passes or how many pass. At the very least, this would raise the achievement level of 50% of the students currently in public school at no additional cost to taxpayers. Keep in mned that when capital expenditures (i.e. buildings, land) are included, most school systems are spending between $10,000 and $20,000 per year per child (with $10,000 being mostly in rural areas where land is cheap and teachers can be hired for less and students don't expect Olympic swimming pools, etc.).
I would have said something equally stupid 5 years ago. I would rather my child not be on concerta, but it helps her considerably.As somebody who was only diagnosed at 31 years old I commend you for trying the treatment for your daughter. Many of us that have been properly diagnosed look back and wonder how our lives would have been if only we had been diagnosed earlier.
For kids who really have ADHD it's not just school that's hard, it's getting everything together in life so that you can be successful, so that you can be the person that you WANT to be.
Is ADHD over-diagnosed in children? Probably. Is it under-diagnosed in adults? Probably.
Either way if somebody tried to take me off Concerta, they'd have to deal with my wife, and it wouldn't be pretty.
And after they realised how many kids were dropping dead after eating those sandwiches, they stopped giving them those things. ADD is a very real disorder, despite the rantings of folk psychologists. It's not simple "just boys being boys and being bored with school". It's more complicated than that. I have ADD and througout all my life, it's been very hard to concentrate on anything. I've had interests in many things but I just abruptly quit because I got distracted by something else. I've never been even close to concentrating on things until I started taking caffine pills, which are similar to ritalin, but without all the bad side effects.
I can't say that homeschooling is a panacea, but for my children and others, it overwhelmingly works amazingly and seems to be tailormade for children with attention problems.
After you walk in someone elses shoes you might know what you are talking about. I wouldn't wish the confusion and heartache ADD has brought my family on anyone. It isn't just about hyperactivity. I shouldn't get upset about the unfounded comments posted by people that don't know anything about ADD. I would and did say the same thing 4-5 years ago.
Perhaps there are kids on Ritalin/concerta that don't need to be. I don't pretend to talk to that issue. All I can talk to is my daughter's case. Please STFU and don't lump everyone together.
by the way 40 years ago dyslexia was not diagnosed either.
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