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Turning ADHD on Its Head

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Dec. 28, 1999 (Indianapolis) -- In many respects, 1999 challenged almost everything we "knew" about attention deficit hyperactivity disorder (ADHD). The year brought about the release of the first major study giving guidance on how to treat the disorder. It was also the year when brain scans gave an indication of what may cause the disorder, while helping to suggest a possible method to diagnose it. Many controversies were laid to rest, while others moved to the forefront.

ADHD is one of the most commonly diagnosed disorders in children, estimated to affect between 3-5% of school-aged children. The core symptoms include an inability to maintain attention and concentration, distractibility, and impulse control problems.

One of the more earth-shaking announcements this year came from the National Institutes of Mental Health. In the largest clinical trial ever conducted under their control, investigators compared the leading treatments for ADHD. They reported that carefully managed medication regimens are superior to behavioral therapies alone in managing these symptoms in children. However, for those with other problems, such as high stress levels, combination therapy that incorporates behavioral treatment works best.

The study included nearly 600 children recruited at six research sites in North America. The children were randomly assigned to one of four approaches that included medical management or behavioral therapy alone, a combination treatment, or routine community care. The researchers concluded that a carefully monitored medication program, with monthly follow-up and input from teachers, is more effective than the other alternatives.

"One of the things that came out of this study is that ADHD is a treatable disorder," says Stephen P. Hinshaw, PhD, a professor of psychology at the University of California, Berkeley. "We know that it doesn't just go away with puberty like we once thought. But these findings indicate that medication strategies, whether or not they are combined with intensive behavioral treatment, are quite helpful in the relief of the core symptoms."

Timothy Wilens, MD, an associate professor of psychiatry at Harvard University, tells WebMD that this study helps to further understanding of treatment of ADHD.

"This is important because the treatment received was not based on severity or other subjective criteria," says Wilens. "It also reconfirms other studies showing the importance not only of medication, but of good medication management."

Thomas E. Brown, PhD, the associate director of The Yale Clinic for Attention Related Disorders in New Haven, Conn., goes even further.

"This underscores the importance of medication treatments in this population," says Brown. "We now recognize that there is a significant difference between those who are treated with appropriate medication, where it is very carefully tailored and fine tuned to them, vs. those who have medication just handed to them."

One of the controversies surrounding the initial release of this study was concern that some would see this as a reason to medicate almost any child who was perceived as being "too" active. However, the experts noted that the message was really that medication works in those with diagnosed ADHD when managed properly.

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