By Harvey C. Parker, Ph.D.
Clinical
Psychologist, Private Practice, Plantation, Florida
Co-founder,
Children and Adults with Attention Deficit Hyperactivity Disorder (CHADD)
Despite high prevalence,
chronicity, and impairment created by ADHD in children, adolescents, and adults
there is still tremendous skepticism throughout the world about the validity of
this disorder. Is ADHD just an American disorder? Is it simply the result of
depression, emotional disturbance, unstable home life, or inadequate parenting?
Does childhood ADHD persist into adulthood? Does ADHD respond to
treatment? All these questions
challenge the validity of this disorder.
With decades of research to rely
upon, investigators have concluded that ADHD is a valid, neurobiological
disorder, which severely impacts patients, health delivery systems, schools,
work environments, families, and society at large. Research into the causes of ADHD have led to advances in our
understanding of the brain, the
role of executive functions, the importance that genetics plays in the
expression of ADHD symptoms, and the efficacy of various treatments.
Mainstay treatments for ADHD
include pharmacotherapy, behavior therapy, educational interventions, and
counseling for patients and families. Despite decades of efficacy research on
these interventions, practitioners often under-perform in their treatment of
those with ADHD. Some of this is
due to inadequate diagnosis of co-morbid conditions such as learning disorders,
anxiety, depression, social
impairment, and behavior disorders which greatly complicate treatment.
Inadequacies in health delivery systems place great obstacles to patients
receiving optimal care. Services
for those with ADHD are often time-consuming and expensive and go beyond the
limits that payors (insurance companies) stipulate as Ñreasonable.æ While health care professionals grow
more confident in psychopharmacologic interventions, the public is still
suspicious and reluctant to accept decades of research that validate the
efficacy of these treatments.
Physicians still must jump over the hurdles of parental fear and
skepticism about medicating children.
Despite decades of efficacy
research on medication and behavior therapy (BT) in ADHD, our findings have had
limited impact in the day-to-day decisions made by providers. Answers to
practice-relevant questions, e.g., ÑWhich treatment works best? When should
they be combined? Can one match
patients to treatments?æ How can have remained elusive. The results of the MTA
study (and others before it) can help practitioners shape their treatments.
Parents and educators must
cooperate to bring about change in the home and school environment to best meet
the needs of children and adolescents with ADHD. Accommodations in the
classroom, whether mandated by disability law or merely by better understanding
of the limitations and needs of ADHD students, can play an important part in
helping such students succeed in school. Parents must become ÑADHD expertsæ in
their own right to properly manage their childºs environment, ensure they
receive appropriate treatments, and advocate effectively on behalf of their
child.
Indeed, ADHD is a complicated
problem. Despite all the research findings there remains a substantial gap
between Ñwhat we knowæ vs. Ñwhat we doæ in clinical practice and education.
These gaps result from many obstacles, not just in providers, but also in
consumers/parents, payors, and policy-makers. Although research offers promise,
we must continue to work united, with one voice, to make such promise a
reality.
References:
MTA Cooperative Group: ÑA
14-month Randomized Clinical Trial of Treatment Strategies for Attention
Deficit Hyperactivity Disorder.æ
Arch Gen Psychiatry, 56:1073-1086, 1999.
Jensen PS, Hinshaw SP, Swanson
JM, Greenhill LL, and the MTA Cooperative Group: Findings from the NIMH
Multimodal Treatment Study of ADHD (MTA): Implications and Applications for
Providers.æ J Dev. Behav. Pediatrics
22:1-14, 2001.
Title for Breakout
Session on Saturday Morning 9:00 am to 10:30 pm
ADHD Today:
Strategies for Success at Home and in School
This program will focus on what
parents, teachers, and practitioners can do to improve outcomes for children
and adolescents with ADHD. Focus will be on specific behavioral strategies that
can improve performance in the classroom and community settings.
