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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.

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