July 10, 2000 -- When Beth Kaplaneck was told in the early '90s that her 8-year-old son had attention deficit hyperactivity disorder (ADHD), one of the most common childhood behavior disorders in the United States, she began a decade-long struggle to get appropriate care -- the right combination of medication, psychological counseling, and classroom assistance. She fought the school system, her insurance company, and sometimes her doctors. "I had to be very, very aggressive," says Kaplaneck, the president of the Washington, D.C.-based group Children and Adults With Attention Deficit and Hyperactivity Disorder.
A decade later, parents still face many of the same barriers to proper treatment that Kaplaneck did, even though studies have shown the type of care most of these kids need to thrive, including the use of drugs. But treating ADHD with medication has come under increasing criticism lately, leaving parents confused and concerned. What really works best for kids with ADHD?
When Hal Meyer learned that his son, 5, had ADHD, he couldn’t believe it. When his child was at school, “He was rambunctious, he couldn’t stay in his seat, he was going around, helping everybody,” Meyer recalls. But to him and his wife, these were signs of brightness and curiosity, not symptoms of inattention, impulsivity, and hyperactivity.
But experts told them, “You don’t understand. These are not typical of a 5-year-old.”
After they explained the disorder, the couple took a long time to accept...
In the largest ADHD clinical trial undertaken to date, published December 1999 in the Archives of General Psychiatry, nearly 600 children with ADHD, aged 7 to 10, were randomly assigned to one of four groups for 14 months:
1. A carefully monitored medication program involving half-hour, monthly appointments with a pharmacotherapist (using various medications, predominantly Ritalin).
2. Behavioral therapy alone, including family counseling, classroom aides who worked with the kids, parent support groups, and a therapeutic summer camp.
3. A combination of medicine and therapy.
4. Standard community care with referrals to local, low-cost mental health clinics where medication or behavior therapy, or both, might be offered.
The study found that a well-managed medication program, or drug therapy alone, was more effective than behavior therapy alone in alleviating the symptoms of ADHD.
"The message here is that medicine is nothing to be afraid of," says Peter S. Jensen, MD, the principal investigator. "It is clearly the most effective treatment and has a powerful beneficial effect." Jensen explains that the medication worked so well in the study because it was very carefully monitored and individually adjusted. Children received on average 35 milligrams of medication a day, while doctors often prescribe an average of only 20 to 23 milligrams a day for any particular medication. The medicine was administered three times a day, although children ordinarily take their medicine only twice a day.