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Public Health Concerns in the Treatment of ADHD

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.

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