Attention-deficit hyperactivity disorder, better known by the acronym ADHD, is a condition commonly treated with a long-term drug regimen, especially in the US. However, a study at the University of California, Los Angeles, casts doubt on the effectiveness of this traditional treatment method as well as the way ADHD itself is diagnosed. The study indicates long-term drug treatments are ineffective and ADHD diagnosis methods are insufficient.
Attention-deficit hyperactivity disorder (ADHD) is a neurological and behavioral disorder related to the brain. ADHD patients exhibit persistent patterns of inattentiveness, or hyperactivity and impulsiveness, or a combination thereof (source).
Inattentiveness is characterized by an inability to focus on a task for an age-appropriate amount of time resulting in lack of attention to details, listening problems, forgetfulness, avoidance of mentally challenging tasks, disorganization, and distractibility.
Hyperactivity-Impulsiveness is characterized by the inability to essentially remain still for an age-appropriate amount of time resulting in excessive fidgeting and squirming, excessive talking, impatient behavior like interrupting and not wanting to wait turns, as well as the inability to play quietly but rather run and climb.
Most patients exhibit a combination of inattentive and hyperactive-impulsive behavior.
There is no test available through which ADHD can clearly be diagnosed. Instead physicians look for clues in the behavioral pattern and may diagnose ADHD in a patient, if the behavior was present before the age of seven and is exhibit in a much stronger version than the behavior of the peers of the same age. Additionally, the behavior has to be persistent and must have been present for at least six months before the diagnosis is made. Furthermore, the behavior the child exhibits must has negative consequences for the child at school, at home, at day care, or in social life.
With no strict guidelines, it should be quite difficult to diagnose ADHD in a child, especially at such an early stage in life, where ‘misbehavior’ is common. There are no measurement guidelines a physician can apply for the diagnosis. According to a statistic provided by the National Institute of Mental Health (NIMH) ADHD is diagnosed in three to five percent of children, approximately two million children in the US alone. This means there is a high probability that in a classroom with twenty-five to thirty children, one will have ADHD.
While the condition undoubtedly exists, these statistics beg the question whether the condition is over-diagnosed, and treatment, especially in the form of drugs, is dished out to children, who don’t need it. Twenty years ago, hardly any parent knew what ADHD (at the time still called ADD, or Attention Deficit Disorder) was. Nowadays it’s a well-known condition. A continuously misbehaving child is quickly diagnosed with ADHD and given drugs and therapy to control the symptoms. The parents are relieved that the behavior is not a result of their parenting but a ‘condition’. But are we drugging children whose parents are unwilling to deal with even normal misbehavior? And even if ADHD symptoms are genuinely present, but mild, should drug therapy really be used? Shouldn’t the approach to the diagnosis and treatment of this condition be re-evaluated to benefit the children involved? Are all ADHD patients the same and receive the same treatment method? Shouldn’t there be additional and more sophisticated tests in place for the diagnosis of ADHD? Shouldn’t the focus be on more exact diagnosis and behavior therapy rather than on the development of better drugs?
According to the UCLA study only about half of the children diagnosed with ADHD actually exhibit the excessive symptoms and cognitive defects related to the condition. While children often outgrow ADHD as they mature, if cognitive defects are present, the disease will follow them into adulthood affecting overall intelligence and academic achievement. Yet this group of children does not show different symptoms or a different level of intensity of the symptoms compared to the rest of the children diagnosed with ADHD. Thus, the study suggests that a behavior-based ADHD diagnosis is not sufficient, but an additional psychological test should be applied to detect cognitive impairments. These findings should lead physicians to find methods in order to improve their overall diagnostic methods. They should find ways to not only differentiate between the main three different ADHD types, but find subcategories in order to allow for more specialized treatment and to reduce drug prescriptions for those with only mild symptoms.
The UCLA findings are based on a long-term study, which was started in 1986 by researchers from the Imperial College in London, UK, and Finland’s University of Oulu. The study originally tracked 9,432 children in northern Finland from early fetal period to age 16 to 18. UCLA later joint the study.
The treatment methods in the US were compared to those in northern Finland, where drugs are rarely used to treat ADHD. The scientists found that the prevalence, symptoms, psychiatric comorbidity, and cognition of the condition to be the same in both countries. These findings indicate long-term drug treatment is ineffective to treat the condition. In adolescence both groups, the Finnish as well as the US children, exhibit the same level of ADHD in presentation and problems associated with the condition. The scientists don’t deny the short-term effectiveness of drug treatments but seriously question the long-term outcome in treating ADHD. Therefore, the study findings should lead to research into other non-drug related treatment methods in order to treat ADHD. While in the short term there appears to be a quick fix through drugs, there seem to be no long-term benefits at all.
This first long-range study results also include the findings that ADHD symptoms decrease as the child matures. However, while hyperactivity-impulsiveness diminishes, a level of excessive inattentiveness will remain in about two-thirds of the children diagnosed with ADHD.
The study also found ADHD patients are at a greatly increased risk of developing psychological problems such as depression, anxiety, oppositional behavior, and conduct disorders.
Lastly, two genes, DBH and DRD2, were identified as the root of a genetic variation underlying ADHD. These genes are part of the body’s dopamine regulation, which affects attention, motivation, and emotion. This supports the thought that problems with the dopamine pathway are involved in the development of ADHD.
As a conclusion it can be said that an overhaul of ADHD diagnosis and treatment is necessary in order to treat the disorder more effectively and with long-term results as the traditional methods appear to be without a positive long-term effect.