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The Hyperactive Child

Medicate -- or not?

WebMD Feature

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 Disorder.

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 months:

1. A carefully monitored medication program involving half-hour, monthly appointments with a pharmacotherapist (using various medications, predominantly Ritalin).

2. Behavioral therapy alone, including family counseling, classroom aides who worked with the kids, parent support groups, and a therapeutic summer camp.

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 a day.

Russell Barkley, PhD, professor of psychiatry and neurology at the University of Massachusetts Medical School and author of Taking Charge of ADHD, says the study should reassure concerned parents of kids correctly diagnosed with ADHD. "Parents should know that if their children are getting medication alone, they're getting the single most effective treatment."

(It's important to note that while medication alone worked best to alleviate the symptoms of ADHD, two-thirds of kids in the study had additional psychological or social problems that were most effectively treated with behavioral therapy.)

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