Treatment of attention deficit disorder still
More than a million children take drugs to control hyperactivity, but a consistent method of diagnosis and treatment remains elusive
By PAUL RECER
The Associated Press
WASHINGTON - Doctors still don't know the best way to treat or even diagnose attention deficit disorder in children - even though more than a million children take powerful drugs to control their hyperactive behavior, according to the National Institutes of Health.
In a report issued Wednesday, a panel of experts selected by the NIH called attention deficit disorder a "profound problem" that may affect 3 percent to 5 percent of all American schoolchildren and costs schools more than $3 billion.
But a consistent, proven method of diagnosing and treating the disorder remains elusive, the expert said.
"There is no current validated diagnostic test for" the disorder, said Dr. David J. Kupfer, a University of Pittsburgh psychiatry professor and chairman of the panel.
Some treatments are effective in the short term - principally drugs such as Ritalin - but no studies have examined their effect on children who take them for more than 14 months, Kupfer said.
Attention deficit disorder, or ADD, also known as attention deficit hyperactivity disorder, usually is diagnosed in school-age children, often as the result of a child's disruptive behavior.
Symptoms include the inability to sit still for reading, study or even to watch television. Often a child cannot play in group games and will act on inappropriate impulses.
Yet defining precisely what constitutes ADD is difficult, said Dr. Mark Vonnegut, a pediatrician and panel member from Quincy, Mass.
"The diagnosis is a mess," Vonnegut said, "but we all believe we are dealing with a serious core problem."
Nonetheless, Janis Ferre of the Utah Governor's Council for People with Disabilities, also on the panel, said there's a wide inconsistency in how a diagnosis is made. "This results in overdiagnosis and underdiagnosis," she said.
Panel member Donald A. Berry of Duke University Medical Center said he thought Ritalin and other powerful, mind-altering drugs are prescribed too often for children, and he criticized the lack of studies on the drugs' long-term effects.
"There is no gold standard for therapy, so it is difficult to look at the prescribing practice and say what is appropriate or not appropriate," said panel member Dr. Robert S. Baltimore of the Yale University School of Medicine.
Among the panel's conclusions:
Originally published in THE OREGONIAN, Thursday, November 19, 1998.
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