Hopefully they can get it right and stop fussing about between themselves
before too many more lives are ruined. Over focus, inattention, under
medicated, over medicated, just about right, milder impairment, sever form,
both drugs hae potention side-effects, etc., etc., etc.
Jan
http://www.theage.com.au/articles/2004/04/26/1082831498396.html
Hyperactive kids 'get wrong drug dose'
By Ewin Hannan, Amanda Dunn
April 27, 2004
Children with the most severe forms of attention deficit hyperactivity disorder
were under-medicated, while those with milder forms were probably
over-medicated, according to a leading child and adolescent psychiatrist.
Alasdair Vance, head of academic child psychiatry at Melbourne University, said
he believed the 10 per cent of children at the most severe end of the ADHD
spectrum were under-treated.
But for the middle 40 per cent, with milder impairment, Dr Vance said,
medication was probably prescribed too readily. About 3 to 5 per cent of
children aged six to nine had ADHD, Dr Vance said, with boys far more likely to
have the condition than girls.
But George Halasz, a child psychiatrist at the Monash Medical Centre, said he
thought the most severe end of the spectrum was treated just about right.
However, most of the others were over or under-medicated, Dr Halasz said.
Daryl Efron, a pediatrician at the Royal Children's Hospital, said the best
evidence available did not show excessive prescribing of stimulants.
Federal Government figures show 270,000 prescriptions for dexamphetamine were
issued in the past 12 months, equivalent to at least 30,000 patients.
According to the Health Insurance Commission, annual prescriptions for
dexamphetamine - known as "kiddie speed" - have doubled since 1997.
University of NSW figures show between 8000 and 14,500 stimulant prescriptions
were issued nationally by GPs to children last year.
Dr Vance said children were also often not given an appropriate dose of
stimulants. Even though stimulants improved organisation and planning abilities
in children, their attention problems improved only at a low dose. If the dose
was too high, he said, there was a risk of them "over-focusing," which was "as
bad for learning as inattention".
He said the right dose of the drug was probably about half the recommended
level, but that was not always followed in clinical practice. The most severe
cases should be treated with psychological therapy first and then medication
where necessary, Dr Vance said, while psychotherapy should be the first-line
treatment for milder cases.
Dr Vance, who treats only the most severe cases, said his research showed that
children in this group were two to three times more likely than other children
to have a parent with a major psychological problem, and to have tried a
psychological treatment or medication that had failed.
Psychologist Michael Carr-Gregg said he believed doctors were now taking the
treatment of ADHD more seriously. "Whereas there might have been a tendency to
slap ADHD on any behavioural disorder, I am seeing much more sensible diagnosis
coming through now," he said.
Dexamphetamine's availability through the Pharmaceutical Benefits Scheme means
it is much cheaper than other drugs used to treat ADHD, including Ritalin,
which is not a PBS-listed drug. New longer-lasting drugs to treat ADHD have
recently come onto the market, but are not on the PBS.
Dr Efron said doctors were confronted with a two-tiered system in which
low-income families were often not able to afford the best drugs. "In
Australia, because of this system, we're actually out of step with the rest of
the world... where Ritalin is the market leader," he said.
Dr Louise Newman of the Royal Australian and New Zealand College of
Psychiatrists said neither drug was superior, and both had potential
side-effects.