Attention-deficit/hyperactivity disorder (ADHD) is a real and treatable disease was the message that the House of Representatives Committee on Government Reform heard in September from witnesses representing APA, Children and Adults With Attention-Deficit/Hyperactivity Disorder (CHADD), and the National Institute of Mental Health (NIMH).
"At the other end of the discussion is the Citizens Commission for Human Rights. They challenge the legitimacy of calling ADHD a neurobiological disorder and raise serious questions about giving strong medications to young children," said committee chair Rep. Dan Burton (R-Ind.) in his opening statement.
David Fassler, M.D., testified on behalf of APA and the American Academy of Child and Adolescent Psychiatry.
"As a psychiatrist, when I think of ADHD, I think first of the faces of children and families I have seen over the years," said Fassler, immediate past chair of the APA Council on Children, Adolescents, and Their Families and an APA trustee. "I think in particular of a 7-year-old boy who is about to be left back in second grade due to his ‘disruptive behavior.’ And I think of a 12-year-old girl with an IQ of 130. She’s not disruptive, but she’s failing seventh grade."
The diagnosis of ADHD requires a comprehensive assessment by a trained clinician that includes direct observation and a review of the child’s developmental, social, academic, and medical history, Fassler testified. "It should also include input from the child’s parents and teachers, and a review of the child’s records." He added that "schools play a critical role in identifying kids who are having problems, but should not diagnose or dictate treatment."
He referred to two recent studies that found that children were not being overdiagnosed with ADHD or overmedicated (see page 20). Fassler told the committee that APA and AACAP back the following recommendations and urged Congress to do the same:
• Support the allocation of appropriate funds and resources to establish the Office of Children’s Therapeutic Research within the Food and Drug Administration as authorized under the Best Pharmaceuticals for Children Act (PL 107-109).
• Support federal comprehensive parity legislation, in particular the Mental Health Equitable Treatment Act (HR 4066).
• Support the passage of the Child Mental Health Service Expansion Act (HR 5078) sponsored by Reps. Patrick Kennedy (D-R.I.) and Ileana Ros-Lehtinen (R-Fla.) that would encourage recruitment into all children’s mental health professions.
"Finally, we fully support and appreciate the efforts of the current administration, through the New Freedom Commission on Mental Health, to focus increased attention on the diagnosis and treatment of all psychiatric conditions, including those that affect children and adolescents," Fassler said.
Fassler told Psychiatric News in a follow-up interview, "I received a lot of positive feedback from people around the country who read news articles about the hearing or saw my interview afterward with CNN. They appreciated that APA and the academy spoke out about what’s known about the science of the disorder." The hearing clearly showed, he emphasized, "that we still have work to do in educating the public, including elected officials, that a lot of people are affected by psychiatric disorders and that the disorders are real and treatable."
Richard Nakamura, Ph.D., acting director of NIMH, testified that many studies "have established the safety and efficacy of stimulants and psychosocial treatments for alleviating the symptoms of ADHD. NIMH research has indicated that the two most effective treatment modalities for elementary schoolchildren with ADHD are closely monitored medication treatment and a treatment that combines medication with intensive behavioral interventions."
Also testifying was Clarke Ross, chief executive officer of CHADD, who stressed the importance of "the evidence-based assessment and treatment guidelines of the American Academy of Pediatrics and AACAP."
The guidelines emphasize the importance of multimodal treatment, which includes parental education on diagnosis, treatment, and specific behavior management techniques; an appropriate educational program; individual and family counseling when needed; and medication when required, said Ross.
His son Andrew, now 11 years old, was diagnosed with ADHD at an early age, he noted. "Multimodal treatment as described in the guidelines including medication has provided. . .the support that Andrew needs in order to thrive and flourish."
Lisa-Marie Presley, the daughter of Elvis Presley, testified on behalf of the Citizens Commission on Human Rights, affiliated with the Church of Scientology. She mentioned the "totally needless and tragic drugging of innocent children" and said that teenagers on powerful psychiatric drugs committed more than half of the recent teenage shooting sprees, resulting in 19 deaths and 51 wounded, according to her statement.
Mary Ann Block, D.O., an osteopathic physician from Texas, told the committee, "There is no valid test for ADHD. The diagnosis is completely subjective. While some compare ADHD to diabetes, there is no comparison because ADHD cannot be objectively measured, and amphetamines are not made by the body or needed for life."
Patricia Weathers, a mother from New York state, testified that school officials coerced her into putting her son Michael on Ritalin, which along with an antidepressant had "horrendous side effects," according to her statement.
Weathers maintained that the school expelled her son when she stopped giving him drugs and called child protective services charging her and her husband with medical neglect. This charge that was later ruled unfounded, she said.
Weathers has filed a lawsuit against the school system. Her complaint is that she was not told about the controversy surrounding the disorder including the validity of ADHD tests, warnings about medication side effects, and studies showing that Ritalin can lead to substance abuse, according to her statement.
Bruce Wiseman testified that numerous states have introduced or passed legislation or regulations to limit the use of psychotropic medications by children (see box). He recommended that the House committee develop federal legislation to prohibit schools from making medication of children a condition of staying in school, protect parents from losing child custody if they refuse to medicate their child, and require that parents be informed about alternatives to psychotropic drugs.
Burton responded that such legislation is beyond the scope of Congress. The No Child Left Behind Act of 2001 (PL 107-110) prohibits federal officials and employees from interfering with state and local education issues.
Fassler’s testimony is posted on the APA Web site www.psych.org/pub_pol_adv/adhd_testimony92602.cfm. ▪