Use of stimulants for attention deficit hyperactivity disorder
http://www.100md.com
《英国医生杂志》
1 Honeysuckle House, Balscote OX15 6JW h.marcovitch@btinternet.com
Definitive diagnosis of attention deficit hyperactivity disorder is complex. David Coghill believes the condition is undertreated, but Harvey Markovitch argues that current uncertainties about diagnosis and treatment mean doctors should be cautious
Introduction
Evidence exists that stimulants are mostly safe and often effective. What is lacking is evidence that the right children are being treated. While there is so much disagreement about prevalence, confusion about how to distinguish ADHD from conduct disorders, and inconsistent guidelines, prescribers should tread warily. Paediatrics, like other specialties, is full of ideas that seemed good at the time. We have (I hope) stopped prescribing antihistamines to treat crying and sleeplessness in small infants, even though this was standard practice in the past. Cisapride was abandoned in haste, when its potential cardiac ill effects were defined, despite having been used extensively in treating children and even premature babies with gastrooesophageal reflux. Most selective serotonin reuptake inhibitors are no longer recommended for children. If we do not take care, methylphenidate might meet a similar fate, even though it clearly benefits some children and their families.—Harvey Marcovitch
Contributors and sources: Harvey Marcovitch was a practising paediatrician for 25 years so was faced with many such children. Lack of resources meant that few had the luxury of a referral to child and adolescent mental health services. As press officer for the Royal College of Paediatrics and Child Health he has had to field constant, sometimes hostile, media inquiries and so has had to make himself familiar with the scientific literature on the subject.
Competing interests: HM is employed by BMJ Publishing Group but is unaware of any advantage to him of being invited to submit this paper. He once received a small fee for contributing to a debate on this subject.
References
Jureidini JN, Doecke CJ, Mansfield PR, Haby MM, Menkes DB, Tonkin AL. Efficacy and safety of antidepressants for children and adolescents BMJ 2004;328: 879-83.
MTA Cooperative Group. A 14-month randomised clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. Arch Gen Psychiatry 1999;56: 1073-86.
American Academy of Pediatrics. Clinical practice guideline: treatment of the school aged child with attention-deficit/hyperactivity disorder. Pediatr 2001;108: 1033-44.
Rey JM, Sawyer MG. Are psychostimulant drugs being used appropriately to treat child and adolescent disorders? Br J Psychiatr 2003;182: 284-6.
National Institute for Clinical Excellence. Guidance on the use of methylphenidate for attention deficit/hyperactivity disorder (ADHD) in childhood. Technology appraisal guideline No 13. www.nice.org.uk/page.aspx?o=11652 (accessed 15 Sep 2004).
Hill P, Taylor E. An auditable protocol for treating attention deficit/hyperactivity disorder. Arch Dis Child 2001;84: 404-9.(Harvey Marcovitch, paedia)
Definitive diagnosis of attention deficit hyperactivity disorder is complex. David Coghill believes the condition is undertreated, but Harvey Markovitch argues that current uncertainties about diagnosis and treatment mean doctors should be cautious
Introduction
Evidence exists that stimulants are mostly safe and often effective. What is lacking is evidence that the right children are being treated. While there is so much disagreement about prevalence, confusion about how to distinguish ADHD from conduct disorders, and inconsistent guidelines, prescribers should tread warily. Paediatrics, like other specialties, is full of ideas that seemed good at the time. We have (I hope) stopped prescribing antihistamines to treat crying and sleeplessness in small infants, even though this was standard practice in the past. Cisapride was abandoned in haste, when its potential cardiac ill effects were defined, despite having been used extensively in treating children and even premature babies with gastrooesophageal reflux. Most selective serotonin reuptake inhibitors are no longer recommended for children. If we do not take care, methylphenidate might meet a similar fate, even though it clearly benefits some children and their families.—Harvey Marcovitch
Contributors and sources: Harvey Marcovitch was a practising paediatrician for 25 years so was faced with many such children. Lack of resources meant that few had the luxury of a referral to child and adolescent mental health services. As press officer for the Royal College of Paediatrics and Child Health he has had to field constant, sometimes hostile, media inquiries and so has had to make himself familiar with the scientific literature on the subject.
Competing interests: HM is employed by BMJ Publishing Group but is unaware of any advantage to him of being invited to submit this paper. He once received a small fee for contributing to a debate on this subject.
References
Jureidini JN, Doecke CJ, Mansfield PR, Haby MM, Menkes DB, Tonkin AL. Efficacy and safety of antidepressants for children and adolescents BMJ 2004;328: 879-83.
MTA Cooperative Group. A 14-month randomised clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. Arch Gen Psychiatry 1999;56: 1073-86.
American Academy of Pediatrics. Clinical practice guideline: treatment of the school aged child with attention-deficit/hyperactivity disorder. Pediatr 2001;108: 1033-44.
Rey JM, Sawyer MG. Are psychostimulant drugs being used appropriately to treat child and adolescent disorders? Br J Psychiatr 2003;182: 284-6.
National Institute for Clinical Excellence. Guidance on the use of methylphenidate for attention deficit/hyperactivity disorder (ADHD) in childhood. Technology appraisal guideline No 13. www.nice.org.uk/page.aspx?o=11652 (accessed 15 Sep 2004).
Hill P, Taylor E. An auditable protocol for treating attention deficit/hyperactivity disorder. Arch Dis Child 2001;84: 404-9.(Harvey Marcovitch, paedia)