HYPERACTIVITY LABELED 'MAJOR' PROBLEM

Attention Deficit Disorder Is Diagnosed Inconsistently, Panel Says

Attention deficit hyperactivity disorder (ADHD) is a "major public health
problem," an expert panel concluded yesterday, and despite its increasing
treatment with stimulants such as Ritalin, no one knows whether such drugs
help sufferers in the long term.

Children with ADHD typically are unusually active or easily distracted,
have trouble focusing on schoolwork or completing assignments, and may be
impulsive and accident-prone. Studies suggest between 3 percent and 5
percent of U.S. elementary-school children have ADHD -- as many as 2
million children -- but during the 1990s the number receiving Ritalin,
amphetamines and other stimulants has almost tripled, raising concerns that
doctors are too quick to make the diagnosis and prescribe such drugs. In
addition, teenagers and adults are increasingly being treated for the
disorder.

The independent panel, after listening to two days of scientific
presentations at the request of the National Institutes of Health,
concluded that ADHD is inconsistently diagnosed and treated in different
communities and that its true prevalence is unclear. The cause of the
disorder is unknown, and some critics dispute its very existence. Some
speakers at the conference offered evidence that ADHD is a genetic
condition that leads to brain abnormalities while others called it a false
label that stigmatizes children whose behavior is at one extreme of normal.

Since there is no diagnostic test for ADHD, doctors must rely on
information from parents and teachers and on observing a child's behavior.
"Diagnosis is a mess," acknowledged Mark Vonnegut, a panel member.

Nevertheless, the impact of ADHD on sufferers' lives "is profound," said
University of Pittsburgh psychiatrist David J. Kupfer, the panel's
chairman, "and necessitates much more attention than we have given it up to
now."

In addition to having severe problems in school, children with ADHD are
often rejected by their peers and may have higher accident rates, the panel
concluded. As adolescents, those ADHD sufferers who also have conduct
problems are more likely to abuse drugs and engage in antisocial behavior.
"For many individuals, the impact of ADHD continues into adulthood," the
panel's report said.

The greatest controversy surrounds the use of stimulants, including
methylphenidate (Ritalin), amphetamines and pemoline, to treat ADHD. Most
studies of their use have lasted three months or less, although recently a
large, government-funded study compared drug treatment to psychosocial
treatments (involving various efforts by parents and teachers to change
children's behaviors) over 14 months. That study found that medications
worked better than psychosocial treatments, and combining the two offered
little added advantage.

The studies suggest medications improve ADHD symptoms over the short term,
making it easier for children to concentrate, and they appear to be safe
when used carefully, the panel concluded.

But their long-term impact is unknown. " . . . Stimulant treatments do not
'normalize' the entire range of behavior problems," the report said. "Of
concern are the consistent findings that despite the improvement in core
symptoms, there is little improvement in academic achievement or social
skills."

Panel members said that despite the need for further research, children
with ADHD should receive access to the full range of treatments, which
often involve mental health services and educational evaluations that are
not covered by insurance.

"The fact that the panel is not making a stronger statement is because we
don't have data. That doesn't mean that children won't improve," said Janis
Ferre, past chair of the Utah Governor's Council for People with Disabilities.

Steven E. Hyman, director of the National Institute of Mental Health, which
co-sponsored the conference, said he was troubled by the wide variations in
treatment, including evidence that girls and African Americans with ADHD
often are not diagnosed or treated.

"For the kids most profoundly affected, the outcomes are quite poor," he
said. "It's immoral not to provide a level playing field for all our
children."

Checked-by: Mike Gogulski