Vancouver Sun

New guidelines issued for diagnosing child disorders

Drugs used to control attention-deficit/hyperactivity disorder increased five-fold from 1990 to 1997.

By Yvonne Zacharias

You see them in every school -- the class clown, the kid who keeps leaping out of his chair, the student who gets these gusts of manic enthusiasm only to lose interest and tune out altogether.

These could be the symptoms of a perplexing condition called attention-deficit/hyperactivity disorder, which has come under close scrutiny, with prescriptions for Ritalin and other drugs used to control it increasing five-fold in Canada from 1990 to 1997

On Monday, B.C. doctors welcomed new guidelines from the American Academy of Pediatrics for diagnosing the estimated five per cent of school-age children who have ADHD, saying they confirm that the province is on the right track.

For a child to be labelled as having the disorder, the academy says symptoms that affect the child's social or academic functioning should be present in two or more of a child's settings and should be present for at least six months.

Evaluation of a child with the disorder should include assessment for coexisting conditions including learning and language problems, aggression, disruptive behaviour and depression or anxiety. As many as one-third of children with ADHD have a coexisting condition, according to the American pediatrics group.

Dr. Derryck Smith, head of the department of psychiatry at Children's Hospital, said doctors in B.C. are urged to look for at least six symptoms of inattention and at least six of hyperactivity or impulsivity before concluding a child has ADHD.

The symptoms should have been present before the age of seven and there should be clear evidence of significant impairment in social or academic functioning in at least two settings.

However, the American guidelines don't appear to deal with the more controversial question: to prescribe or not to prescribe.

Smith and Dr. John Slater, president of the B.C. Pediatric Society, reject any suggestion that Ritalin and other stimulants used to treat ADHD are being overprescribed in the province, saying the drugs are among the safest on the market and are highly effective. Their two possible side-effects are loss of appetite and trouble getting to sleep.

Slater cited statistics showing that children treated for the disorder had only a five-per-cent chance of abusing alcohol and drugs as teenagers while those who weren't treated had a 30-per-cent chance.

Both rejected the notion that the prevalence of ADHD has soared, saying it is better detected and treated more aggressively now.

Far from overdiagnosing ADHD, Vancouver Dr. Gabor Mate said many doctors don't have enough confidence in their understanding of the disorder to diagnose it.

But Mate, who was diagnosed with it himself and has written a bestselling book on the subject, said that once a diagnosis is made, drugs are often too heavily relied on.

"These children often have a lot of anxiety, emotional turmoil," he said. "We need to look at the causes of the behaviour."

He and Dr. Margaret Weiss, director of research for the division of psychiatry at the University of British Columbia, say the school system is failing these children.

Most schools are not able or willing to provide proper psychological handling of these children and resort instead to punitive measures, Mate said.

Weiss, who works in the ADHD clinic at the Children's Hospital, expressed concern over the reduction of psychologists caused by education funding cutbacks. Fewer are available to assess students suspected of having the disorder.

Concluded Slater, "Society as a whole is very judgmental about these kids. It has a tendency to come up with simple answers which are wrong. There are no simple answers."