Kids and Health Care: Attention Deficit Disorder
Perhaps the biggest chronic condition facing kids in the U.S. is Attention Deficit/Hyperactivity Disorder (known as ADHD, more commonly, ADD).
ADD is controversial for several reasons, but two stand out. First, the drugs that are prescribed to help kids manage the disorder may have serious side effects; second, the disorder itself may be over-diagnosed by doctors eager to give "medical" explanations -- which insurance companies will accept -- for a child's erratic or destructive behavior.
We'll consider the second issue first.
Pediatricians and pediatric psychiatrists are diagnosing mental illness in children at increasingly young ages. The diagnoses include conditions (including manic depression and schizophrenia) once thought to appear exclusively in adults and older adolescents. But some doctors insist that children are still just developing emotionally and psychologically -- and that they're too young to suffer from advanced psychiatric disorders. So, ADD remains the most frequently diagnosed head case among children.
Why so many cases? Some doctors claim that they're just becoming aware of mental illness among kids. That claim is dubious. More candid MDs say the trend is the result of managed care plans -- and the effects of managed care on traditional insurance and government programs. Managed care plans prefer clear diagnoses that can be treated by approved prescription drugs to psychiatry's more complex conditions and open-ended, talking-therapy cures.
HMOs insist drugs work. They point to various studies, including one that concluded drug treatment helps about 70 percent of children with ADD -- as opposed to counseling, which only improved symptoms in about half of them. This is a twist on the traditional managed care approach to debated medical conditions; instead of denying any coverage because of expert dispute, the plans encourage drug therapy. As one Texas MD notes ruefully, "The only thing HMOs hate worse than drug bills is years of therapy sessions."
But the pressure for easy, prescription cures leads to some bad results. In early 2004, the U.S. Food and Drug Administration warned doctors not to prescribe the popular antidepressant Paxil to children for depression, citing evidence that the drug could increase the risk of suicide.
The growing wariness about drug therapies is partly due to suspicions about the diagnosis of ADD. There's no single test for the condition, and doctors don't always agree on a diagnosis. Not even medical experts understand exactly how one standard prescription drug treatment -- Ritalin, a powerful stimulant -- calms kids and improves mental focus.
Amidst all of this disagreement, what can you do if your doctor says your child has ADD? Many parents prefer behavior management to prescription drugs. Common alternatives include:
- Detailed time management. Kids with attention problems sometimes do better when their days are strictly scheduled. This means setting schedules -- in writing and posted -- of each hour or half-hour of each day. It also means scheduling time to discuss or reiterate goals for the day, the week and the month or year. Some studies have found that the intensive use of goal setting and time management can help 30 to 50 percent of children with attention problems do better in school and at home. The downside: It's time-consuming for parents and other family members.
- Restrictive diet. The notion that food dyes, preservatives and other ingredients can cause mental problems in kids goes back several generations. There is some evidence that kids on so-called "elimination diets" become more focused and settled. Such diets exclude processed foods that may cause allergic or other problematic reactions. A typical diet might include lamb, chicken, potatoes, rice and simple fruits and vegetables. In one widely cited study, researchers at the University of Alberta found that an elimination diet improved behavior in 12 of 24 hyperactive preschool-age boys. The improvements were noticeable within the first month. Of course, imposing a strict diet on a child who's already distracted or temperamental can add to family tension.
- Supplementation. Researchers have examined blood samples of children diagnosed with attention or learning problems, looking for deficiencies in vitamins, minerals or other nutrients. Their theory: Distracted children don't absorb nutrients properly or get sufficient nutrition in their diets. Some studies have picked up low levels of fatty acids, such as omega-3 and omega-6; others have discovered deficiencies in minerals, such as iron or zinc. Some children who take supplements to make up for a specific nutritional shortfall become noticeably more settled in school and at home. But the medical research on supplementation remains scientifically inconclusive.
- Biofeedback. The idea behind biofeedback is that people can train themselves to focus more deeply and continuously by controlling the electrical activity in their own brain. A handful of studies have concluded that people with ADD tend to have a distinct, lower-frequency wave pattern in their frontal cortexes.
By concentrating on patterns and mazes while receiving mild electric "signals" (okay, shocks) from a device called an electroencephalogram, some people can alter their brain activity and focus more, generally. The problem: There aren't any standards to evaluate the effectiveness of biofeedback treatments -- or the devices used. And many doctors consider the whole process sheer quackery.
