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ADHD in Children Health Center

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Reality of ADHD Treatment Far From Ideal

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WebMD Health News

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 months.

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.

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