This article appeared in the October 17, 2007, edition of Behavioral Healthcare
Important new research on attention-deficit/hyperactivity disorder (AD/HD) has been featured in peer-reviewed professional literature over the past several months. This research includes the 36-month update of the National Institute of Mental Health's (NIMH) Multimodal Treatment Study of Children with AD/HD (MTA) in the
Journal of the American Academy of Child & Adolescent Psychiatry (JAACAP), the new national study on the prevalence of AD/HD in school-age children in the
Archives of Pediatrics and Adolescent Medicine, and the NIMH-financed Preschool ADHD Treatment Study (PATS) in
JAACAP. These three studies confirm the chronic nature and seriousness of some forms of AD/HD.
The MTA is NIMH's largest and most comprehensive and continuous treatment study of children. The original study was published in 1999, and the 24-month follow-up analysis was published in 2003. The major finding of the July 2007 MTA update was that comprehensive treatment is likely to make a long-term difference only if continued with optimal intensity and not started too late in the child's clinical course. For some children, the benefits of medication wore off when the intensity of treatment was not continued. The study also documented, as did the 2003 update, that medication initially influenced growth rates for a minority of children.
The article on prevalence by a University of Cincinnati researcher and colleagues documented an 8.7% school-age child prevalence rate of AD/HD. This is consistent with previous studies by the Mayo Clinic and Centers for Disease Control and Prevention. Two Mayo Clinic studies showed a 7.8% school-age prevalence rate, and two CDC studies showed a 7.5% school-age prevalence rate.
Both the CDC and University of Cincinnati studies documented that only half of children with AD/HD are being treated for the disorder. Other studies have documented significant geographic variance in medication prescribing rates, leading to conclusions that AD/HD either is overdiagnosed or underdiagnosed. Such variance implies that not all physicians practice evidence-based medicine as outlined by the American Academy of Pediatrics and American Academy of Child and Adolescent Psychiatry.
PATS documents the importance of early intervention services, including behavioral management and parent training, for preschool children with AD/HD. For those who do not respond to behavioral interventions, medication can be effective. While PATS is an important contribution to evidence-based medicine for AD/HD, a recent issue of the
Harvard Mental Health Letter undermines this science by claiming that "hyperactive behavior often results from the effects of parental negligence, intrusiveness, or hard discipline." This takes us back to the time when we unfairly blamed parents for what the NIMH characterizes as a neurobiologic disorder. This antiquated thinking creates undue stress and guilt for parents. While it is common sense that parenting skills cannot cause a child to develop a neurobiologic disorder, it is important to recognize that parenting styles can impact the success of behavioral management programs.
CHADD, the world's largest family-based organization serving people affected by AD/HD, provides more information on these studies at
E. Clarke Ross, DPA, is the CEO of CHADD and the father of a 16-year-old son with special needs. He is also a member of
Behavioral Healthcare’s Editorial Board.