MEDICATING OUR CHILDREN

April 2000
		Are we overmedicating our children? When should doctors prescribe psychiatric drugs for kids? Should there be restrictions imposed for younger children? Experts answer your questions.

Forum introduction Ritalin for children under 5. Diagnosing ADHD Diet and ADHD Is our definition of 'normal' accurate? Adults and medication Additional Comments     Health Spotlight: Attention Deficit Hyperactivity Disorder March 24, 2000: Treating ADHD The NewsHour's Health Spotlight. More NewsHour health coverage.	M. Zar of N.J. asks: What is the latest study on teens and adults who have not taken medication and need help focusing in college and at work. Dr. Diller responds: We have few studies on ADHD and the effects of medication in teens and adults. On one hand some studies suggest that most ADHD children continue to have significant problems as adults (the teen years seem to be particularly difficult). I question whether these findings from more highly university screened ADHD candidates reflect the outcomes for the more garden variety Tom Sawyers diagnosed in the pediatricians' offices. Many of these children have no problem focusing on things that they like and after high school the occupational niches available to them are much broader than sitting in the classroom. I am far more optimistic about the futures of most of these children. There remains a smaller core group of adults whose personalities are so extreme that they remain affected throughout their life. Identifying their problems as not solely due to emotional or moral failure can be an enormous relief to those affected people. Stimulant medication appears to be helpful to these individuals at least on the short term. However, care must be taken in prescribing Ritalin in adults because unlike children adults can and will abuse stimulants. Every twenty years or so American physicians find another reason to prescribe stimulants to adults and invariably a core group of patients become addicted. Dr. Jensen responds: In the area of ADHD, there have not been nearly as many studies of medications in teens and adults. But of the over a dozen studies that have been done, overall data do indicate that the medications are safe and effective in reducing levels of inattention, impulsivity, and improving persons' ability to function normally, whether in home, school or work settings. In other (not ADHD) areas, such as depression, anxiety, psychosis, obsessive compulsive disorder, panic disorder, and bipolar disorder, medications have generally been better studied than in children. By and large, these data indicate that such medications are better than placebo, and when used as prescribed, are safe and effective. However, medications are rarely the only option, and research has generally shown that a number of interventions can be effective. For example, in adolescents with depression or anxiety disorders, there are now a fair number of studies showing that cognitive-behavioral therapy is a safe and effective treatment, with benefits persisting up to a year. For parents and physicians with interest in more information on these treatments, sources of information on the Web include the following below. For ADHD: a) Agency for Healthcare Research and Quality: http://www.ahrq.gov/clinic/adhdsum.htm b) National Institute of Mental Health http://www.nimh.nih.gov/events/mtaqa.cfm c) National Institutes of Health Consensus Statement on ADHD http://odp.od.nih.gov/consensus/cons/110/110_intro.htm For more general issues on psychiatric medications in children a) National Institute of Mental Health: http://www.nimh.nih.gov/publicat/childmedmenu.cfm b) National Alliance for the Mentall Ill (NAMI) http://www.nami.org/youth/fact.html c) American Academy of Child & Adolescent Psychiatry: Facts for Families http://www.aacap.org/publications/factsfam/index.htm