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.