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ADHD in Children Health Center

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ADHD: New Info, New Drug

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May 17, 2001 -- Use of stimulants to treat attention deficit hyperactivity disorder has been a source of considerable controversy, with some claiming that drugs like Ritalin can be abused by kids and may lead to later longer-term substance abuse.

But researchers at the annual meeting of the American Psychiatric Association (APA) in New Orleans last week reported that analysis of several studies on the subject appears to indicate just the opposite: Early treatment of attention deficit hyperactivity disorder, or ADHD, with drugs is liable to protect kids from abusing substances later in life.

Timothy Wilens, MD, tells WebMD that analysis of five large studies of approximately 500 children treated for ADHD with medication and followed for five to 15 years suggests that they may be less likely to abuse substances later in life than those who are not treated.

One of the studies did indicate that treated children were more likely to abuse drugs. But Wilens says those results may have been altered by the fact that kids in the study began treatment later in life, when their ADHD had progressed further.

"These studies show a protective effect of [medical] treatment for ADHD against the risk of substance abuse in adolescents and adults," Wilens tells WebMD. "We think leaving this disorder untreated puts you at risk."

Wilens says the meta-analysis -- in which researchers pool the results of multiple studies -- is due to be published later this year. He is director of substance abuse services in the pediatric and adult psychopharmacology clinics at Massachusetts General Hospital in Boston.

In presentations at the APA meeting, Wilens and other experts painted a picture of ADHD as a disorder that begins in childhood, but persists throughout life.

While earlier attempts to understand the disorder focused primarily on hyperactivity in youth, ADHD is now believed to be a more fundamental disorder of concentration and inability to focus and organize thoughts. As the disorder progresses throughout life, its symptoms change, but the underlying condition remains.

"The impulsivity and hyperactivity seen in children goes away, but problems with [concentration] persist," says Thomas J. Spencer, MD, of the department of psychiatry at Massachusetts General Hospital.

And Spencer says brain imaging and other kinds of studies show similarities between adult ADHD and ADHD in children. Many adults with the disorder report having had problems with concentration going back to childhood, he says.

So failure to treat ADHD early and aggressively means that the concentration problems caused by the disorder will accumulate over time, with multiple potential consequences, including later substance abuse, they say.

Steven Mirin, MD, the medical director of the APA, described a possible course of untreated ADHD leading to drug abuse: A kid who is criticized for being disruptive, and whom teachers don't look forward to having in class, will not likely find school a rewarding place to be, Mirin says.

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