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Survey: Attention-deficit disorder goes undiagnosed

Ritalin bottles
The best-known drug used to treat ADHD is Ritalin  

WASHINGTON (Reuters) -- Many American children with the neurological problem known as attention deficit/ hyperactivity disorder (ADHD) go undiagnosed and untreated, doctors said in a survey released Sunday.

In the same survey, parents and grandparents of children with ADHD disagreed with the doctors, with about two-thirds saying they thought the problem was over diagnosed among school-age kids.

Only one in five said they felt the disorder was under diagnosed and one in seven said they believe it was diagnosed in about the right amount.

The survey by the Harris group was commissioned by Shire Richwood Inc., a subsidiary of Shire Pharmaceuticals Group which makes the ADHD drug Adderall. The best-known drug used to treat the disorder is Ritalin, made by Novartis Pharma AG.

The diagnosis and treatment of ADHD has sparked a national debate, with many critics questioning the use of drugs to treat very young children for symptoms that may be unrelated to the disorder.

People with ADHD have persistent problems paying attention and controlling their impulses and hyperactivity. Since most children behave this way some of the time, diagnosis can be problematic.

The disorder affects 3 percent to 5 percent of all school-age children, and is considered the most frequently diagnosed psychiatric disorder in children and adolescents.

Dr. Peter Jensen, a professor of child psychiatry at Columbia University College of Physicians and Surgeons in New York who is affiliated with the survey, acknowledged the potential for difficulties with diagnosis and treatment, but said that overall, the disorder is not diagnosed enough.

"Could it be over diagnosed? There's no question that sometimes children without ADHD are inappropriately labeled," Jensen said in a telephone interview. However, he said, "Of children with ADHD, half are missed."

Dr. Peter Lipkin, director of the center for development and learning at Baltimore's Kennedy Krieger Institute for children with disabilities, including ADHD, said Jensen's remarks and the survey findings seemed reasonable.


Among poor children, Lipkin said by telephone, the problem is often undiagnosed, at least partly because of the health care available to them. But teachers, doctors, parents and other care-givers for middle-class children are more sensitive to the disorder and are more likely to refer children for evaluation for ADHD, Lipkin said.

Jensen and Lipkin favored a coordinated approach to treatment including medication, behavioral therapy and counseling, but both agreed that medication alone could be effective.

Jensen noted, though, that even children who do not have ADHD but are having "temporary difficulties" will benefit from drugs.

"But that would be an inappropriate treatment," Jensen said.

The problem of possible over-treatment of young children with Ritalin and other psychotropic drugs was the subject of a White House news conference in March, when First Lady Hillary Rodham Clinton announced a $5 million study by the National Institute of Mental Health of the impact of these drugs on children younger than age 7.

The Harris survey also found that doctors, parents, grandparents and ADHD patients considered the condition to be serious, and that many parents and grandparents said lack of information and confusing media reports prevent many children from getting proper treatment.

The survey's margin of error was plus or minus 3 percentage points for the public, 4 percentage points for teachers, adult patients, parents and grandparents of patients, and 7 percentage points for doctors, including child psychiatrists, psychiatrists and pediatricians.

The survey's backer was sponsoring a call-in telephone education campaign for the disorder running from Monday through Wednesday, at 1 888 ASK ADHD.

Copyright 2000 Reuters. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

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