plan Gets approval
By MARILYN ELIAS
USA TODAY 10/2/2001
The American Academy of Pediatrics (AAP) yesterday endorsed the use
of Ritalin and other stimulants on children with attention
deficit/hyperactivity disorder (ADHD), so long as there are clear treatment
goals and the kids are carefully monitored.
It's the first time the nation's pediatricians have weighed in with
guidelines on how to treat ADHD. "Our doctors have been clamoring for
guidance on this," says Harvard Medical School pediatrician James Perrin,
co-chair of the panel issuing the new policy.
Last year, the group advised doctors to diagnose the disorder only
by using the DSM-IV, a precise summary of behaviors developed by the
Psychiatric Association to identify ADHD.
After children are diagnosed, the new policy says, doctors should
collaborate with parents, teachers and the child on a treatment plan
specific goals. Stimulants and/or behavior therapy should be recommended,
virtually all research shows that pills have a much stronger effect
controlling the behavior than therapy, the policy says.
Youngsters should be closely monitored by doctors to make sure the
treatment is working - dosages or medications often need to be changed
there are no harmful side effects. When a child is doing well, he still
should be seen by the doctor every three to six months, the guidelines
Kids with ADHD show a significant amount of impulsive, hyperactive
or inattentive behavior. The National Institutes of Health estimates
percent to 5 percent of US children have the disorder, but fewer than
percent overall get medication. Use of ADHD drugs has gone up 37 percent
the past five years, with 20.5 million prescriptions written for them
12 months ending in June.
"Some kids medicated now definitely should not be medicated, and
others aren't getting the help they need," Perrin says.
White middle-class youngsters are about twice as likely as poor
kids or minorities to be taking the stimulants, says Peter Jensen,
of the Center for the Advancement of Children's Mental Health at Columbia
University in New York.
Jensen called the new guidelines "an important step" toward
improving care. He led a recent federal study that found combining
therapy with stimulants offers children and their parents "modest
advantages" over drugs alone. Some youngsters were diagnosed in Jensen's
study and then released to be treated as their parents saw fit; they