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Cover story | TREATING ADHD of school-age children met the criteria for an ADHD diagnosis, and about 7.3 percent of kids had been prescribed stimulants. But a closer analysis showed a significant mismatch. About half the kids with ADHD weren’t getting stimulants, and about half the kids on stimulants did not have ADHD. “That’s been my experience,” Jetmalani said. “Even though the numbers correlate, my experience is that there’s still a lot of room for improvement.” Nationally, studies show that only 50 percent of children with ADHD are on stimulants, such as Ritalin or Adderall. And there is tremendous variation in the use of stimulants from region to region. “You have areas of the country where practically no child is receiving any stimulant medication and you have other counties where 24 percent of school-age boys are on stimulant medications,” said Clarke Ross, CEO of the advocacy group Children and Adolescents with Attention Deficit Disorder in Washington, D.C.


Ross believes the variation reflects differences in the training of physicians. “Those docs who have been educated in the guidelines and practice the guidelines, the odds are they’re going to diagnose it correctly,” he said. “But a lot of doctors are prescribing based on their personal experience, which may or may not be evidence-based.” Child psychologists might be more aware of the guidelines and more experienced at making the diagnosis than pediatricians or family practice doctors, but there are only about 7,500 child and adolescent psychologists nationwide and most of them work in academic centers. In Oregon, pediatricians and child psychologist are now trying to establish a psychiatric access line through which primary care doctors can get specialists to help evaluate kids for mental health issues. They’ve also received a grant to work on a telemedicine suite to extend services to rural and under-served areas. Ultimately, with better access to specialists and prudent evaluation, there may be

fewer kids with bad outcomes from ADHD medications. But experts still caution that the risks of medications must be balanced against the risks of doing nothing at all. “I always tell parents it’s my job to make sure that I’m giving a medication that’s effective, not too much that it causes side effects and not so little that it doesn’t do any good. If we stay within that, given the right diagnosis, it’s a relatively safe medication,” said Debbie Coehlo. “If we don’t treat it at all, if we just ignore it, the accident rates go up, criminal behavior goes up, failed relationships go up. It’s like you’re treating diabetes. You have to do something.” That’s why the Johnsons never wavered when it came to getting medication for Jared. They’d seen firsthand through their brothers the consequences of not addressing the problem. “My brother, jail. Her brother, jail,” Duke Johnson said. “We knew it could lead to very serious things, and we don’t want our son to go down that road.” •

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Pulse Magazine Summer/Fall 2010