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Psychiatrist skeptical of new ADHD data.

A new population-based study suggests that half of children with attention-deficit hyperactivity disorder are not receiving potentially helpful medication.

The study, which looked at 1,610 twins aged 7-17 years, runs counter to previous research showing that more children are being treated for ADHD.

Despite these findings, Dr. Manuel Mota-Castillo, a child and adolescent psychiatrist in private practice in Lake Mary, Fla., remains concerned about the overuse of the ADHD diagnosis.

"If a child is showing unprovoked aggression, defiance toward authority figures, insomnia, grandiose mood, and decreased attention span due to racing thoughts, why should one think of ADHD, instead of a mood disorder?" Dr. Mota-Castillo said in an interview.

ADHD should always be a diagnosis of exclusion, because ADHD symptoms are unspecific and can be manifestations of more than 10 different conditions, Dr. Mota-Castillo added.

In the study, 302 boys and 57 girls in the study met the diagnostic criteria for ADHD, and 58% of boys and 45% of girls received medication, reported Wendy Reich, Ph.D., and her colleagues at Washington University in St. Louis. The investigators conducted the review to assess diagnosis and treatment patterns for ADHD in children between 1996 and 2001. The twins and one parent were interviewed separately about each child's psychiatric and health history (J. Am. Acad. Child Adolesc. Psychiatry 2006;45:801-7).

Most of the children who met ADHD criteria and received medication showed improvement in symptoms (85% of boys and 65% of girls). Most of the children who received medication were given methylphenidate (79% of boys and 63% of girls).

In addition, about 4% of boys and 3% of girls who were not diagnosed with ADHD received medication, and the undiagnosed boys and girls averaged 10 lifetime ADHD symptoms.

The strongest factor associated with a physician visit or treatment was a co-twin who had sought treatment or received medication for ADHD. But the twins' zygosity did not affect whether children received medication or how they responded, the researchers said.

Dr. James Perrin, professor of pediatrics at Harvard University, Boston, said in an interview that the findings were not surprising.

"We have known that there are lots of children who have ADHD who are not getting adequate treatment," said Dr. Perrin, cochairman of the American Academy of Pediatrics' ADHD practice guidelines committee.

He agreed that making the diagnosis is not easy. "It's not as if you can examine a child and decide in 20 minutes whether he or she has ADHD," Dr. Perrin said.

Dr. Perrin said he discourages primary care physicians from diagnosing children with ADHD before school age, because no one wants to label a child with a problem he or she might not have, and ADHD can be hard to distinguish from the range of normal preschool behavior.

For school-age children, though, methylphenidate and amphetamines are often prescribed for ADHD. These drugs have been used for nearly 30 years and have demonstrated effectiveness. "They are quite safe, we know they work, and the dangers are quite limited," Dr. Perrin said. But doctors and parents need to ensure that the child is on the right dose of the right medication and is not experiencing significant side effects.

Dr. Mota-Castillo said medication failures might be attributable to misdiagnosis of ADHD or the presence of co-morbidities, such as anxiety or bipolar disorder. "There is a benefit to doing a medication trial when there is doubt, for example, of a possible attention deficit without hyperactivity," he said.

Dr. Reich's study was supported in part by the National Institute of Mental Health.


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Title Annotation:News; attention-deficit hyperactivity disorder
Author:Splete, Heidi
Publication:Clinical Psychiatry News
Geographic Code:1USA
Date:Sep 1, 2006
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