The Hyperactive Child
Medicate -- or not?
July 10, 2000 -- When Beth Kaplaneck was told in the early '90s that her
8-year-old son had attention deficit hyperactivity disorder (ADHD), one of the
most common childhood behavior disorders in the United States, she began a
decade-long struggle to get appropriate care -- the right combination of
medication, psychological counseling, and classroom assistance. She fought the
school system, her insurance company, and sometimes her doctors. "I had to
be very, very aggressive," says Kaplaneck, the president of the Washington,
D.C.-based group Children and Adults With Attention Deficit and Hyperactivity
A decade later, parents still face many of the same barriers to proper
treatment that Kaplaneck did, even though studies have shown the type of care
most of these kids need to thrive, including the use of drugs. But treating
ADHD with medication has come under increasing criticism lately, leaving
parents confused and concerned. What really works best for kids with ADHD?
Medication Still Most Effective Treatment
In the largest ADHD clinical trial undertaken to date, published December
1999 in the Archives of General Psychiatry, nearly 600 children with
ADHD, aged 7 to 10, were randomly assigned to one of four groups for 14
1. A carefully monitored medication program involving half-hour, monthly
appointments with a pharmacotherapist (using various medications, predominantly
2. Behavioral therapy alone, including family counseling, classroom aides
who worked with the kids, parent support groups, and a therapeutic summer
3. A combination of medicine and therapy.
4. Standard community care with referrals to local, low-cost mental health
clinics where medication or behavior therapy, or both, might be offered.
The study found that a well-managed medication program, or drug therapy
alone, was more effective than behavior therapy alone in alleviating the
symptoms of ADHD.
"The message here is that medicine is nothing to be afraid of," says
Peter S. Jensen, MD, the principal investigator. "It is clearly the most
effective treatment and has a powerful beneficial effect." Jensen explains
that the medication worked so well in the study because it was very carefully
monitored and individually adjusted. Children received on average 35 milligrams
of medication a day, while doctors often prescribe an average of only 20 to 23
milligrams a day for any particular medication. The medicine was administered
three times a day, although children ordinarily take their medicine only twice