UF researchers find opinions split on ADHD treatment
GAINESVILLE, Fla. — The popular perception may be that parents clamor to put their children on stimulant medications such as Ritalin at the first sign of hyperactive behavior. But a new University of Florida study has found that many parents actually are quite frightened of drug therapy.
ADHD experts increasingly are recommending stimulant medications as the “gold standard” treatment for curbing inattentiveness and hyperactive or impulsive behavior. But in focus groups organized by UF psychiatrist Dr. Regina Bussing, parents and other primary caregivers rarely mentioned prescription drugs when asked to name treatments that worked for their children. Instead, they spoke extensively about the bad reputation such medications have among their friends and relatives, and their fears that the drugs would do lasting harm to their children.
“If you put him on it, he is going to be crazy the rest of his life, walking around like a zombie,” one focus group participant said acquaintances had told her. Others said people had claimed the drugs would turn children into addicts.
With professional and lay attitudes heading down such different paths, physicians risk having their advice and prescriptions ignored if they don’t ask families about reservations regarding treatment, said Bussing, whose research findings appear in the September/October issue of the Harvard Review of Psychiatry.
“We need to let health professionals know that all is not well,” said Bussing, chief of child and adolescent psychiatry at the UF College of Medicine. “Doctors keep reading research results that say, ‘You’re a good doctor if you prescribe stimulants.’ But physicians need to realize there is another story out there, and they need to more actively address these widespread concerns when they talk with parents of children with ADHD.”
The most common psychiatric disorder in children, ADHD affects an estimated 3 percent to 5 percent of the school-age population in the United States, according to the National Institute of Mental Health, or NIMH. During the past decade, a growing number of children have been diagnosed, and millions now take prescription stimulants daily. These include methylphenidate, sold as Ritalin or under other trade names, and amphetamines, such as Dexedrine and Adderall.
A 1999 NIMH-sponsored study of ADHD treatments showed that stimulants were more effective than behavioral therapies, such as using positive reinforcement for good behavior or responding to bad behavior with “time outs” or the withdrawal of privileges. Scientists do not understand precisely why such drugs improve symptoms, but some have theorized the medications arouse areas of the brain involved in planning and inhibiting actions, and exercising foresight.
Medical experts generally regard the medicines as safe, in part because some stimulants have been in use for more than four decades. Some children experience minor side effects, such as decreased appetite, stomach pains or jitteriness, but physician practice guidelines indicate most effects can be managed by adjusting dosages or switching products.
The U.S. Drug Enforcement Agency classifies these stimulants as Schedule II drugs, a category that recognizes their medicinal use but also indicates a high potential for abuse. Yet many research studies show that therapeutic use in children does not lead to abuse or addiction. Furthermore, in medicinal doses, the drugs do not sedate or intoxicate children. Research studies also indicate that by receiving proper care for their psychiatric problems, children with ADHD who take stimulants are less prone to substance abuse.
“There is agreement that long-term studies of the safety and efficacy of stimulants are needed, and those studies are under way,” Bussing said. “But it should be noted that we have not seen any indication that careful use of stimulants causes problems in the long run. If that were the case, we would be seeing case reports in the medical literature. It is therefore reasonable to carefully consider putting a child on stimulants if he or she is having significant problems.”
Bussing and her research collaborator, Faye A. Gary, a distinguished service professor at UF’s College of Nursing, held focus groups to better understand what parents face in deciding to seek help for their children with ADHD. Twenty-five parents and primary caregivers were divided into four groups for two-hour discussions about suspected causes of ADHD, treatment, factors that influenced the decision to seek professional care for their children and obstacles to obtaining such care. Fifteen of the 25 children were taking prescription medicine for ADHD.
“We knew that compliance with medications is a problem area, so that was one area that we wanted to shed light on,” said Bussing, who is affiliated with the Evelyn F. and William L. McKnight Brain Institute of UF. “A complex picture emerged. Throughout the sessions, we heard 38 positive comments about medications being helpful, but when we specifically asked them to name effective treatments, the drugs were mentioned just three times.”
In contrast, home-care strategies, such as maintaining discipline and providing structured activities, and other options including counseling or assistance offered by school systems, were mentioned 34 times. Parents and caregivers commented 33 times on their own fears about medications and negative attitudes of people around them. Such attitudes may prevent some people from seeking care for their children, Bussing said.
“It seems that parents are getting their information and advice from friends, family members and magazines, whereas medical professionals get treatment recommendations from medical journals and practice guidelines formulated by experts in the field. Stimulant medications therefore don’t look the same to these groups,” said Bussing, who noted that some articles in lay publications sensationalize the subject of ADHD. “The articles can feed into parents’ anxieties.”
Gary said schools can help bridge the gap between health-care professionals and the lay public regarding the role of stimulant medications. “Children spend so much of their day at school, where school nurses are often responsible for dispensing medications,” Gary said. “That provides an opening for nurses to give parents as well as teachers information about the therapeutic effects of the medicines in the social and academic domains of children’s lives.”
- Victoria White