September 29, 2000RELEASE NO. 00-46
John Blamphin202/682-6138[email protected]
APA Urges Comprehensive Evaluation and Treatment For Attention Deficit/Hyperactivity Disorder
Washington, D.C. - The American Psychiatric Association today strongly supported comprehensive evaluation and treatment--including use of medication--for children with hyperactivity and attention deficit disorders. The Association said that diagnosis and treatment decisions should be made by parents and physicians, not by schools.
In a testimony before the House Committee on Education and the Workforce, David Fassler, M.D. said "The diagnosis of Attention Deficit Hyperactivity Disorder requires a comprehensive assessment by a trained clinician," noting that it cannot be made in a five or ten minute office visit. He testified that other problems such as anxiety disorders, depression and learning disabilities present some of the same symptoms as ADHD, and that more than half of children with ADHD have another psychiatric problem. Fassler testified for the APA and for the American Academy of Child and Adolescent Psychiatry.
"In addition to direct observation, the evaluation includes a comprehensive review of the child's development, social, academic and medical history," he explained. "It should also include input from the child's parents and teachers, and a review of the child's records. Schools play a critical role in identifying kids who are having problems, but schools should not make diagnoses or dictate treatment.
"I share the concern that some children may be placed on medication without a comprehensive evaluation, accurate and specific diagnosis or an individualized treatment plan," said the child & adolescent psychiatrist who chairs the APA Council on Children, Adolescents and Their Families.
In his written testimony, Fassler emphasized that the diagnostic criteria for ADHD contained in the APA's Diagnostic and Statistical Manual of Mental Disorders "are specific and well-established within the field "the product of extensive and numerous research studies conducted at academic centers and clinical facilities throughout the country." The current DSM states that the essential feature of ADHD "is a persistent pattern of inattention and/or hyperactivity-impulsivity that is more frequently displayed and more severe than is typically observed in individuals at a comparable level of development." It adds, "there must be clear evidence of interference with developmentally appropriate social, academic, or occupational functioning."
If the diagnosis is accurate, "medication, including methylphenidate or Ritalin, can be extremely helpful for many children, but medication alone is rarely the appropriate treatment for complex child psychiatric disorders such as ADHD," Fassler added.
Fassler also expressed his concern "about the many children with ADHD and other psychiatric disorders who would benefit from treatment, including treatment with medication, who go unrecognized and undiagnosed, and who are not receiving the help that they need."
Fassler concluded: "Child psychiatric disorders, including ADHD, are diagnosable and real illnesses, and they affect lots of kids. The good news is that they are also highly treatable. We can't cure all the kids we see, but with comprehensive, individualized intervention, we can significantly reduce the extent to which their problems interfere with their lives. The key for parents and teachers is to identify kids with problems as early as possible, and make sure they get the help that they need."
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The American Psychiatric Association is the national medical specialty society representing over 40,000 psychiatric physicians who specialize in the diagnosis, prevention and treatment of mental illnesses and substance use disorders.
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