Reality of ADHD Treatment Far From Ideal
WebMD News Archive
Nov. 10, 1999 (Chicago) -- While there are definite federal guidelines for
diagnosing and treating children with attention deficit hyperactivity disorder
(ADHD), the reality is that psychiatrists are often all over the map in their
approaches to the common disorder. That's the finding of a study conducted by
Deborah Zarin, MD, deputy medical director of the American Psychiatric
Association. The research was presented here Tuesday at the 127th Annual
Meeting of the American Public Health Association.
What Zarin wanted to know is what happens when a child comes to a
psychiatrist's office in a routine setting. She says that while most of those
with ADHD go to primary care physicians, about one-fifth seek help from
psychiatrists. However, Zarin tells WebMD that there is a wide variation in how
these specialists take care of these patients. It's estimated that 3.5% of U.S.
children have the condition, which hinders their performance in school and can
undermine social and familial relationships.
In early 1997, Zarin got data about ADHD treatments from what's called the
Practice Research Network. The organization is comprised of psychiatrists
around the country in enough different settings to provide a snapshot of how
ADHD is typically handled. Sixty-five psychiatrists filled out a 20-item
questionnaire on a total of 166 children. They were mostly male, white, and
between the ages of 5 and 9. The treatment range varied from between 3 to 12
In addition to ADHD, many of the children also had other psychiatric
disorders. Thirty-one percent suffered from depression, and about the same
number required special education.
But Zarin says that she's worried that a number of things that should have
happened to the ADHD children did not. For instance, she says only 19%
underwent all the recommended assessments. While virtually every child received
a screening interview, only 46% of the time did the psychiatrists check to see
if their patients had been given a physical exam within the last year.
Obviously, that's an important matter when considering whether a child should
be started on drug treatment.
The study also revealed that 98% of the children were given medication for
their ADHD, and 69% received psychotherapy. However, the research shows that
50% of the children were put on two medications, and 12% were taking three
drugs for the condition.
Zarin says that another large study of ADHD in primary care shows that for
37% of the patients, medications weren't even discussed. The net result is a
mixed bag, says Zarin, that isn't always in the patient's interest. Zarin tells
WebMD that she has a hunch that if three ADHD children went to three
physicians, they might get three different diagnoses.
"There is a need for a more systematic approach," she says based on
improved assessment techniques. This in turn could lead to more clinical
research to close the "apparent gap" between what is being done and
what ought to be done. Zarin says she's working on updated ADHD guidelines
through the American Psychiatric Association.