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Attention Deficit Care Uncertain

November 19, 1998

WASHINGTON (AP) _ More than a million American children are being given powerful drugs for attention deficit disorder, but doctors still don’t know how best to diagnose or treat the often-disruptive behavior, a panel of experts concludes.

A committee selected by the National Institutes of Health said Wednesday that attention deficit disorder is a ``profound problem″ that may affect as much as 5 percent of American schoolchildren and costs schools more than $3 billion for special programs.

But the group of experts said that a consistent, proven method of diagnosing and treating the disorder remains elusive. Some of the committee members worried that doctors may be too quick to prescribe the mind-altering drugs that are the principal form of therapy.

``There is no current validated diagnostic test for″ the disorder, said Dr. David J. Kupfer, a University of Pittsburgh psychiatry professor and chairman of the panel.

Some treatments are effective in the short term _ principally drugs such as Ritalin _ but no studies have examined their effect on children who take them for more than 14 months, Kupfer said.

Attention deficit disorder, or ADD, also known as attention deficit hyperactivity disorder, usually is diagnosed in school-age children, often as the result of a child’s disruptive behavior.

Symptoms include the inability to sit still for reading, study or even to watch television. Often a child cannot play in group games and will act on inappropriate impulses.

Yet defining precisely what constitutes ADD is difficult, said Dr. Mark Vonnegut, a pediatrician and panel member from Quincy, Mass.

``The diagnosis is a mess,″ Vonnegut said, ``but we all believe we are dealing with a serious core problem.″

For professionals who spend much time around children, he said, ``these kids stick out like a sore thumb.″

Nonetheless, Janis Ferre of the Utah Governor’s Council for People With Disabilities, also on the panel, said there’s wide inconsistency in how a diagnosis is made. ``This results in over-diagnosis and under-diagnosis,″ she said.

Panel member Donald A. Berry of Duke University Medical Center said he thought Ritalin and other powerful, mind-altering drugs are prescribed too often for children. He criticized the lack of studies on the drugs’ long-term effects.

``There is no gold standard for therapy, so it is difficult to look at the prescribing practice and say what is appropriate or not appropriate,″ said panel member Dr. Robert S. Baltimore of the Yale University School of Medicine.

The president of a leading advocacy group, Children and Adults With Attention Deficit Disorders, said she was pleased the report confirms ``that ADD is a serious disorder with potentially devastating consequences whose effects extend into adulthood.″

But the report clearly shows the need for ``a more consistent system for diagnosis and for treatment,″ said Mary Robertson of Lexington, Ky.

Among the panel’s conclusions:

_Although Ritalin and other therapies may correct classroom behavior problems, there’s no evidence that this improves a child’s academic performance.

_Although there is no independent, validated test for ADD, some ``well-tested diagnostic interview methods″ have proved reliable. However, the report notes, ``research to establish the validity of the disorder continues to be a problem.″

_Short-term trials of Ritalin and other drugs show beneficial effects on some behaviors and are superior to behavior modification training. Combining the two resulted in improved social skills, and parents and teachers judged this combination ``more favorably.″

_Many other treatments have been tried, including vitamins, herbs, biofeedback and eliminating some foods such as sugar. None has proved effective.

_Doctors and schools usually do a poor job of communicating and coordinating when treating children with ADD, and follow-up often is poor. Teachers and parents play a key role in successfully treating ADD and fine-tuning medication.

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