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What's New
with ADHD
Two recent
publications--a set of guidelines (see press
release) from the American Academy of Pediatrics (AAP)
and a scientific study comparing medication to behavioral treatments--have
clarified our practice and updated our knowledge about ADHD (Attention
Deficit Hyperactivity Disorder) in children.
ADHD
is now thought to affect 9% of American children, making it the
most common developmental/behavioral disorder in school age children.
The AAP guidelines (Clinical Practice Guidelines:
Diagnosis and Evaluation of the Child with Attention-Deficit/Hyperactivity
Disorder, Pediatrics. Vol. 105; No. 5, May 2000) are a
must-read for all primary care providers.
The
guidelines emphasize the importance of:
1.)
Using clear diagnostic criteria from the DSM IV (the diagnostic and statistical manual for psychiatric
disorders)
2.)
Using standardized history forms for collecting information from
home and school
3.)
Making sure children do not have other conditions that frequently
occur with ADHD (called ‘co-morbidities’).
4.)
Using the best medications and dosages for the treatment of ADHD.
Popular
magazines often run cover stories questioning whether we should
be giving our children literally tons of stimulant medications
to help them concentrate in school. For a long time, professionals
and parents have debated whether or not children with ADHD benefit
more from medical treatments (like Ritalin), behavioral treatments
or some combination of both.
A
recent, large-scale study (A 14-Month Randomized Clinical Trial
of Treatment Strategies for Attention-Deficit/Hyperactivity Disorder
in Arch Gen Psychiatry. 1999: 56: 1073-1086) of 579 children
has clarified the debate. In this study, the combination of medication
and behavioral treatments was called 'multi-modal treatment'.
The
study concluded that:
1.)
Medication is as effective for ADHD symptoms as multi-modal Therapy
2.)
Medication is more effective than behavioral alone
3.)
Multi-modal intervention is better for ADHD associated
with co-morbidities. 'Co-morbid' conditions include anxiety,
oppositional-defiant disorders, conduct disorders, etc.
In
short, if your child has ADHD alone (no co-morbidities),
medication is likely to be the most effective single treatment. If
your child has ADHD and an associated condition, medication plus behavioral
treatment will probably work better.
******
Also newsworthy is a new long acting stimulant medication that is
like Ritalin and Adderall called Concerta.
Concerta is the same medication (methylphenidate) as Ritalin.
It comes in 18 mg. and 36 mg. tablets equivalent to Ritalin 5
mg. and 10 mg. tablets, respectively. The difference is that
Ritalin lasts 4 hours and Adderall lasts 6 hours while Concerta
lasts 10-12 hours. Concerta cannot be cut in half making it less
flexible than Ritalin or Adderall and the side effect profile
is very similar with decreases in appetite and moodiness as most
common.
P.S. The American Academy of Pediatrics now
offers a resource toolkit to clinicians caring for children with ADHD.
Reviewed by faculty and staff at the University of Michigan
Updated June 2007
U-M Health System Related Sites:
U-M Pediatrics
Our editorial policy
The information and links we provide are reviewed by University of Michigan developmental and behavioral pediatricians and child psychologists who are experts in child behavioral health. In choosing the links we provide, we use strict criteria to ensure that the information is accurate, and the source is reputable. As much as possible, we focus on information that is based on research. In areas where there is inadequate research, we include information compatible with prevailing expert opinion.
This website is updated regularly, but because of the dynamic nature of the Internet, we cannot be responsible for misinformation that may be accessed through the links provided. As always, this website is not a tool for self-diagnosis, and is not a substitute for professional care.
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