ADHD: Addressing Common Myths
Given the proliferation of information regarding attention deficit hyperactivity disorder (ADHD) it is little wonder that the public and sometimes even professionals are confused about this disorder? Is it a real disorder? Can it reliably be diagnosed? What is the most effective treatment? Are drugs given to control it safe? This article summarizes information about ADHD and debunks some common myths about this mental illness as it affects children.
Fiction: ADHD is Not a Real Disorder.
Some people question whether ADHD is a real disorder. Perhaps it is just the natural exuberance or high activity level of certain children, particularly boys, and society is making too much out of this high energy level by calling it a disorder. Furthermore, some suggest that ADHD is primarily an American disorder and it is not found to be as prevalent in other countries.
Fact: ADHD is Real Disorder, Recognized and Diagnosed Around the World.
According to Hector Bird, M.D. the world’s pre-eminent epidemiologist in children’s mental health, the frequency of ADHD is about 5% in most places where it has been studied, including such places as Hong Kong, England, Germany, Puerto Rico, Brazil, Sweden, Italy, and Australia.
There is currently no single test, such as a brain scan or blood test,that would allow us to reliably make a diagnosis – but this also true of other maladies that are accepted as real such as migraine headaches or premenstrual syndrome (PMS) which are primarily based on patient reports. However, there is evidence of difference in brain structures and functions in children and adults with ADHD as well as differences in the presence of specific genetic abnormalities compared to those who do not experience ADHD symptoms. Today’s differences among professionals regarding ADHD is not whether the disorder is real, but “where to draw the distinction in cases that fall between normal childhood restlessness and extreme disturbances in motor activity, inattention and impulsivity.”
Fiction: ADHD Treatments Are Neither Safe nor Effective.
What is the best type of treatment for ADHD: medication, psychosocial interventions, or alternative treatments such as diet or vitamin supplementation, etc. ADHD has always had a number of “alternative speculations and treatments with proposals mixing real science with untested assumptions. Yet advocates of these new theories too often seem unwilling to conduct the only scientifically accepted method used to test such claims: clinical trials with adequate placebo controls.
Some of these controversies appear to reflect fundamental attitudes and beliefs regarding the use of behavior-altering drugs with children. Psycho stimulants and other drugs turn out to be powerful and undeniably effective ways of removing ADHD and related symptoms. Despite this overwhelming evidence for efficacy, concerns are raised about what else the drugs might do. Perhaps they teach children to attribute success to the pills, not to their skills, thus harming their self esteem. Perhaps the pills quash the free spirited and creative impulses that lead to divergent thinking and creative problem solving.
Fact: There are Available Effective Treatments.
However, not only are medications (principally the stimulants and tricyclics), behavior therapies, and their combination all quite effective, they are also the only well-established proven types of therapies available today. Indeed, hundreds of well designed studies show the of the various medication treatments. Moreover, while there remain important outstanding issues concerning the long-term hazards associated with their use, even though they have been used for over 40 years. Thus, while all forms of therapy should be used judiciously and cautiously, there are no data suggesting that these treatments do harm, compared to the large amount of evidence that untreated ADHD does a good deal of long term harm.
What treatment works best? This is always a critical and personal decision to be made by parents and/or patients, with advice and consultation from the doctor. There is no one “size that fits all”, and everyone has a unique response to treatment. On average, studies show that medication is more effective than behavior therapy for treating ADHD symptoms, and that behavior therapy and medication together are most useful for other, non-ADHD symptoms such as Anxiety/depression, oppositional and aggressive behaviors, peer relations, and academics. And even though medication and /or medication plus therapy are generally more effective than behavior therapy alone, these results are only averages of groups of children: in fact, some children do very well on behavior therapy alone, even though the “average child does best with medication or medication plus therapy. Which approach is best for any given child cannot always be known ahead of time, just as we may not know whether a child’s ear infection will be resistant to the first antibiotic tried. But the good news is that most children and adults with ADHD are likely to respond well to one or more of the various medications now available.
SOURCE: Report on Emotional and Behavioral Disorders in Youth, Volume 3, #1, Winter 2002 by Peter Jensen. M.D. Director, Center for the Advancement of Children’s Mental Health, Columbia University.