Turning ADHD on Its Head
"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.
"This study [looks at] very well-characterized kids with ADHD, not just with hyperactivity, but the whole spectrum of criteria for the diagnosis," says Wilens. "This is not generalizable to just active kids and should not be used as a reason to put someone on Ritalin [methylphenidate]."
Brown thinks that what confuses people is that many of the symptoms are problems everybody has sometimes. But those with the disorder experience the symptoms with greater frequency.
"So many times people will look at the list of symptoms and say, 'Well everyone has these,'" says Brown. "They don't realize that those with ADHD have chronic and severe difficulties that impair their ability to function."
Another watershed announcement came from a group at Massachusetts General Hospital in Boston. Researchers there found that there were measurable biochemical differences in the brains of adults with ADHD when compared with controls.
The researchers used Single Proton Emission Computed Tomography (SPECT) scans to look at a picture of the activity in a person's brain. In SPECT, a chemical is "labeled" using a very low level of radioactivity. When given to a patient, the areas of the brain that are using a labeled substance show up as areas that have more activity. What the researcher sees is the brain equivalent of a weather radar.