Problems in Diagnosing and Treating ADD/ADHD.

• Author: VATZ, RICHARD E.
• Position: Attention deficit disorder, attention deficit-hyperactivity disorder

PUBLIC AND MEDICAL concern regarding the overdiagnosing of attention deficit disorder (ADD) and attention deficit-hyperactivity disorder (ADHD) and the overprescribing of Ritalin hit the mainstream in 2000 with the publication of a study in the Journal of the American Medical Association (JAMA). As early as 1988, researchers Daniel J. Safer and John M. Krager reported in JAMA that there was a doubling of Ritalin use every four to seven years from 1971 to 1987, which was then followed by a decline in response to public concern about excessive use of the drug. They indicated, nonetheless, that there was no cause for concern.

In the 2000 report, an alarming increase in the general use of psychiatric drags for preschoolers was documented for the first time. Some of the findings of that study revealed that the number of preschoolers on antidepressants had risen 200% from 1991 to 1995 (among those enrolled in two state Medicaid programs and a health maintenance program in the Northwest), and there was a twofold to threefold increase in the number of children ages two to four who were taking methylphenidate (the generic form of Ritalin). In addition, the use of clonidine (popularly used for blood pressure) for children had risen substantially.

An editorial by Joseph T. Coyle of Harvard Medical School's Psychiatry Department accompanying the JAMA article points to the salient concerns: Methylphenidate, or Ritalin, carries a warning against its use in children younger than six, and "the validity and reliability of the diagnoses of ADHD [has] not been demonstrated." Moreover, the editorial makes a stunning admission: "There is virtually no clinical research on the consequences of pharmacologic treatment of behavioral disorders in very young children ... it would seem prudent to carry out much more extensive studies to determine the long-term consequences of the use of psychotropic [having an altering effect on the mind] drags at this early stage of childhood."

The lead researcher of the study, Julie Zito, associate professor of pharmacy and medicine at the University of Maryland, summed up the significance of the new findings by saying that "This seems to support the anecdotes that more children are receiving a diagnosis and treatment for attention deficit-hyperactivity disorder in the late 1990s than ever before."

Even psychiatric experts were shaken by the study's results. Steven Hyman, director of the National Institute of Mental Health (NIMH), described himself as "more than shocked" by the findings.

In April, 2000, then-First Lady Hillary Clinton announced a multimillion-dollar government study to examine the consequences of the increase in the number of schoolage children who are...