The
identification and treatment of both children and adults with ADHD is a very
politicized and controversial topic. Due to the potential magnitude of the
problem, especially among our nation’s youth, and the consequences of
large numbers of persons seeking and/or receiving treatment at any given
time, long-term outcomes (risks and benefits) of treatment should be
monitored to ensure safety and optimal functioning where possible. The most
common treatment is the psychopharmacological agent methylphenidate. Due to
the lack of research of the long-term efficacy (greater than 24 months and
in preschool populations), and safety of such treatment at the population
level, a public health perspective should be applied to the treatment of
ADHD. The lack of such research, coupled with an increase in length of
treatment during the formative growth years, a decrease in the age of
initiation into treatment, and growing prevalence estimates, are all causes
for concern. As treatment options are considered, it is apparent that more
reliance is placed on pharmaceutical remedies than on psychological
interventions such as behavior modification, although the latter have been
shown to have beneficial effects. This emphasis is apparent even without
adequate evidence of long-term academic and functional improvements from
pharmacological interventions.
An additional concern in
the treatment of ADHD is the issue of comorbidity. Comorbid conditions and
health risk behaviors associated with ADHD are often not identified or
treated appropriately and those factors result in a significantly higher
social cost burden, increased risk for poor educational attainment, and
compromised social integration. A public health perspective must be applied
to this disorder in a manner that acknowledges and addresses the high risk
for comorbidity, secondary conditions, and participation in significant
health risk behaviors associated with impulsive and inattentive behavior.
An internal CDC workgroup
hosted a one-day meeting with several ADHD experts on this topic to answer
specific questions and generate ideas for needed research. The
executive
summary of this meeting provides detailed questions and answers to
related issues.
