I was rather troubled after reading the latest report from the Center for Disease Control on the prevalence of attention deficit hyperactivity disorder (ADHD). Based upon a survey of 76,000 parents, the study found that 11 percent of schoolkids have been diagnosed with this disorder.
As expected, high school boys are more likely to be diagnosed with ADHD than girls, 19 percent compared with 10 percent. What was really worrisome was the wide degree of variability among states. If you are a boy living in Southern states such as Kentucky, Arkansas or South Carolina, then you are twice more likely to be diagnosed with this disorder than if you lived in Colorado or Nevada.
I wonder why. Perhaps health care is better in the Southern states than elsewhere, or maybe some other factor is responsible for such a dramatic difference. Note that 66 percent of kids with ADHD are on medication, resulting in an increase in sales for pharmaceutical companies from $4 to $9 billion in the past five years. Is this diagnosis a way to justify a pseudo-solution to a complex emotional or behavioral problem?
Clinicians have long debated the relative value of medication versus other treatment approaches, such as parent behavior training. Research published by Alice Charach and others in the April 1 edition of Pediatrics looked at 55 studies that used medicine or therapy to treat preschools at risk for ADHD. The authors concluded that parental interventions “… have greater evidence of effectiveness” than medication. In addition, therapy has fewer risks, as the authors note that “high rates of somatic concerns, irritability, moodiness, and decrements in growth” are risks of medication with young children.
If you have concerns about possible ADHD with your child, consider the following:
• Obtain a comprehensive evaluation. These can be done by a psychologist, pediatrician or others who have specialized training and experience with this diagnosis.
ADHD is very difficult to evaluate, as this disorder shares symptoms with so many other problems including depression and conduct disorders. I’m very concerned that normal childhood active behavior (usually by boys) gets mislabeled and stigmatized as a disorder.
• Consider a variety of treatment options. There is no single best way to treat this problem. Parental counseling, special education, environmental management, self-control training and medication are all options.
• Avoid medication if possible. There are times when medication is the preferred treatment of choice, but be careful. Remember that all medicines have potential side effects, and the goal is always to help your child learn ways to manage his behavior rather than staying on medicine throughout his life.
In the Pediatrics article cited above, up to 28 percent of parents failed to complete the intervention program. I wonder if those were the parents who then sought medication for their child rather than worked hard to solve the real problem.
The key message is to seek help for your child if he is having problems, preferably early rather than later, and be prepared for no easy solution.
Next week: Questions from readers.