contd. from

There are studies, like the NIH consensus report, that question the diagnosis. A panel of experts concluded that we know something, but not everything.

Let me point out two things. The consensus conference that was held earlier and sponsored by a number of organizations, including NIMH, was a reasonable idea. But it was seriously flawed from the start, and you have to keep these flaws in mind in understanding this document.

First of all, it was a political activity, not a scientific activity. The experts that were chosen to review the literature are not experts in ADHD. They are practicing professionals in other fields of science, or are simply clinical practitioners. They are certain not experts in ADHD. Experts, people like myself and others, were called to present our information to the panel. But the panel itself was not a body of experts, and it shouldn't be misrepresented as such. That also leads to problems, because you have people who don't know the literature trying to understand what the science has to say within just a few days.

. . . Because it was a political document, it also had to include phrasing that was a bit of a bone to the critics of ADHD, tossing them a certain kind of sentence here and there so that they wouldn't feel misrepresented in the panel discussions. But many scientists would not have put those phrases in there, because they make it sound like we know less than we really do about this disorder.

For instance, saying that we're not sure about the safety and the long-term use of the stimulant medication is nice to say. But the fact is that we know more about the stimulant medications than just about any other medication that's given to children in medicine. . . . All of the research we have indicates that these drugs are some of the safest that we employ in the field of psychiatry and psychology. That's not to say that we know everything about them. But we know a lot more than we know about cough medicines and Tylenol and aspirins and other things that children swill whenever they come down with a common cold. Nobody asks those questions about those over-the-counter medications, yet we know substantially less about them.

So I think that the consensus document was flawed in a number of ways, and largely, it has to be viewed as a political document, not as a series of scientific conclusions drawn up by experts who specialize in this field. You would have had a very different document if you had asked the experts to write it.

As a psychologist, how do you view this issue of the effectiveness of behavioral modifications and medicines?

There's supposed to be some controversy these days about the role of behavior modification and psychological treatments, versus the role of medication, in the management of ADHD children. I think that controversy stems from the fact that, the more we have studied these treatments, the more we have come to realize that, in head-to-head comparisons, medication appears to be more effective than behavioral interventions in managing the symptoms of the disorder itself. But the behavioral interventions appear to be useful in managing other disorders that are sometimes seen in conjunction with ADHD.

For instance, ADHD children, in over half the instances we see, are going to be very oppositional, very defiant, very difficult to manage. That's a second disorder known as oppositional disorder, and it's going to create a great deal of stress in the parent-child relationship in the home environment. We know that parent training and child management skills and behavior modification techniques can help with that kind of disorder, and with those kinds of parent-child relationship problems, even if it doesn't address the difficulties the child has with their symptoms of ADHD. . . .

But there's no question that, if you compare medication with behavioral interventions for the disorder itself, that the medication is always more effective than the behavioral interventions tend to be; which is why we continue to use it as much as we do. . . .

Is there over-medicating, or under-medicating?

The question that keeps being raised in the media now is whether there's over- or under-medication. We don't know for sure, because we don't have any national databases where we keep track of all prescriptions in the United States, like some other countries do. So we can't turn to that database to answer the question.

If we go out to Utah where a survey was recently done, it's about 1.4 percent of children in the Salt Lake City public schools. If we go to five different metropolitan areas, as Peter Jensen did in one of his studies, we might find that the figure is around 1.8 percent to about 2.4 percent of ADHD children who are taking medication. In their own survey, the state of Maryland recently found that about 2.6 percent of children within the state were taking medication during school hours for management of ADHD. So it just depends on where you look.

If you were to average across all of these figures, it appears to be that somewhere between about 1.5 percent and about 2.5 percent of school-age children are taking medication right now for ADHD. Now, you have to look at that figure in the context of how much ADHD is there. It's the only way you can answer the question of over-medication, and that is, what's the reference point? We know that approximately 5 percent to 7 percent of school-age children have this disorder. If we use the conservative figure of 5 percent, and we know that about 2.5 percent of individuals may be taking medication, there's your answer. We don't have over-medication. Only about half of all ADHD children are ever taking medication for their disorder. . . .

continue page 4

top . page 1 2 3 4 5 . send to friend . section table of contents . adhd site map

Written 2000. Updated 2001. Reviewed: 02/2006