ADHD Health Perspective : Part 3

by CDC

(Page 3 of 3)

Action to Address Public Health Needs

Develop standard case identification protocols for use in research projects. Conduct etiologic studies of ADHD using population-based approaches to identify important risk factors and opportunities for prevention activities and research.

Use observational epidemiologic methods to describe the impact of ADHD, its impact, and its intervention patterns at the population level. Utilize scientific findings to develop, design, and implement ADHD prevention efforts where possible.

Identify current national or regional surveys where adding ADHD questions would provide particularly useful information regarding the magnitude of the disorder, the nature of common comorbidity and/or secondary conditions, as well as data on health risk behaviors and long-term outcomes for those with ADHD.

Establish a Federal interagency workgroup to pool research expertise and resources in order to launch epidemiologic research efforts that address the public health research needs in ADHD. Such collaborations should be multi-disciplinary and include professionals in epidemiology, mental/physical health, risk behavior prevention, and health communication for example.

Establish a resource for both professionals and the public regarding what is known about the epidemiology of ADHD.

Interventions for ADHD

Issues

ADHD is a chronic condition of high prevalence that requires long-term intervention. Because ADHD is an impairing condition and can have lifelong consequences, interventions designed to reduce negative outcomes and increase capacities should be carefully considered at the national level. One key public health concern is the safety of pharmacological interventions. A second key concern is the effectiveness of current interventions to reduce the impairment associated with ADHD thereby improving health and functioning for ADHD individuals over time. A third public health concern is access to appropriate interventions for individuals and families affected by the disorder.

There are several public health concerns relative to pharmacotherapy. Pharmacologic treatment is extremely prevalent. Assessing the health risks and benefits to young children, particularly preschoolers, is a high priority. Children who begin medication therapies very early and receive treatment on a long-term basis may have unknown risks associated with current treatments. Additionally, pharmacologic interventions often do not normalize behavior. Research, albeit limited, suggests that even with long-term treatment, children and adults with ADHD experience substantial problems in the school, home, workplace, and community settings. This raises questions about the effectiveness of pharmacologic interventions as a long-term approach.

Another intervention option to treat ADHD is behavior modification. It is clear that behavior modification therapies, for youth in particular, have been tested and shown beneficial for the treatment of behavioral disorders including ADHD. However, the majority of youth receiving psychological interventions for ADHD are probably receiving treatments that have not been shown to be effective, such as individual therapy and/or play therapy. The effectiveness of behavioral interventions must be further studied in the treatment of ADHD, to better understand their potential to normalize the behavior and functioning of those with the disorder, especially when combined with pharmacotherapy.

Access to interventions is a critical public health concern. ADHD affects a person's ability to learn and be socialized to his/her potential; therefore access to diagnosis and intervention is a necessity. Common barriers to services include lack of insurance coverage for mental health problems, exclusion of behavior disorders, including ADHD, from mental health coverage, and under-identification or mis-identification. Community practice with respect to the diagnosis of ADHD fails to uniformly employ accepted methods for establishing cross-situational symptomatology, measurement of functional impairment, and diagnosis of comorbid conditions. Nationally, we must begin to look at a wide variety of intervention issues surrounding ADHD, including how current interventions impact individuals and systems over time, as well as problems with access to appropriate services.

Action to Address Public Health Needs

Disseminate educational materials relating to the diagnosis of and intervention opportunities for ADHD. Recipients should include but would not be limited to primary care physicians, physician extenders (NP's and PA's), mental health professionals, and educators.

Promote the necessity of careful case identification using standardized instruments and the employment of the most effective interventions in common practice by disseminating useful information to professionals and the public related evidence-based interventions for ADHD.

Conduct population-based studies of ADHD intervention practices to examine such variables as age of initiation of treatment, type(s) of treatment, duration of treatment, and barriers to receipt of services.

Establish a mechanism (possibly a registry) of treated individuals to monitor the health effects and potential benefits of long-term treatment for ADHD, particularly among pre-school age children. Additionally collect other related outcomes such as school attainment, interface with judicial system, work performance, and other pertinent variables.

Collaborate with other organizations to educate and promote what is known about ADHD interventions, appropriate standards of practice, their effectiveness, and their safety. Establish a resource to the public for accurate and valid information about ADHD and evidence-based interventions.

About the Author

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The Centers for Disease Control and Prevention (CDC) is one of the 13 major operating components of the Department of Health and Human Services (HHS), which is the principal agency in the United States government for protecting the health and safety of all Americans and for providing essential human services, especially for those people who are least able to help themselves.