ADHD: Undertreated, Not Overtreated, Says Expert

      Despite recent public concern that drugs such as Ritalin are being overprescribed for attention-deficit-hyperactivity disorder (ADHD), a review article in this week's New England Journal of Medicine says that, if anything, ADHD is not treated enough. Dr. Josephine Elia of the Children's Hospital of Philadelphia, a national ADHD expert whose previous study formed the basis of the National Institutes of Health's clinical guidelines for treating the disorder, found that about 4% to 5% of children take medication for ADHD (Children's Hospital of Philadelphia release, 3/10). But according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, an estimated 10% of school-age children are affected by the disorder, leaving about half untreated. While the 250% rise in Ritalin prescriptions between 1990 to 1993 "aroused concern about abuse or overprescribing," Elia contends that the increase was probably attributable to greater awareness of ADHD, increased diagnosis among girls, greater recognition of a new inattentive subtype of ADHD and continued treatment into adolescence and adulthood (Elia et al., NEJM, 3/11 issue). Still, many children "are being missed, especially girls, who are more likely than boys to have the inattentive subtype of ADHD," rather than the more commonly diagnosed hyperactive subtype, according to Elia.

A New Option
      The researchers also found that Dexadrine is as effective as Ritalin, and that doctors should use the two drugs in succession to determine which is preferable in a particular patient (Children's Hospital release, 3/10). Nevertheless, Elia notes that drug therapy is "insufficient" for some children because of "persistent symptoms or coexisting conditions," and calls for development of "both psychosocial and pharmacotherapeutic" strategies (NEJM, 3/11 issue).