When you want to post reference, don't post articles from newspapers and websites. Really?
Try posting PEER REVIEWED SCIENTIFIC STUDIES. We(providers) practice according to evidence based medicine. Not what drug companies tell us. Not what we read in the WSJ or USA today, LOL.
Here is some "evidence". Both on antidepressants and ADD treatment.
The bottom line is that PROPERLY prescribed by a SPECIALIST and not your family doc helps many more than those hurt by side effects. I refuse to prescribe for any ADD and will not treat a child with a depressive disorder. They get a specialist referral.
So it is easy for a non scientist person as yourself to not understand statistics and benefit/risk ratio but it is not some great conspiracy to "gain control" or some other ridiculous theory.
TYPES OF INTERVENTION — There are three general categories of intervention for adolescent depression:
Psychosocial interventions
Pharmacologic therapy
Combination therapy
Psychosocial — Psychosocial interventions teach patients and their families to understand themselves and the nature of depression, as well as to effectively manage relationships and life stressors associated with depression [5]. They help the patient to cope with depressive symptoms, improve social and self-management skills, and increase self-confidence. In addition, psychological interventions may prevent onset of depression [31].
Psychosocial treatments include, but are not limited to, cognitive-behavioral therapy (CBT), interpersonal therapy for adolescents (IPT-A), family therapy, dynamic therapy, group therapy, and supportive therapy. Among these, only CBT and IPT-A are considered to be evidence-based by the American Psychological Association's Society of Clinical Psychology. Psychosocial treatment for adolescent depression is discussed in greater detail separately. (See "Psychosocial treatment for adolescent depression".)
Pharmacologic — Pharmacologic agents that have been used to treat adolescent major depression include tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) and related compounds. There is some evidence from published studies to support the use of SSRI, particularly fluoxetine, in the treatment of adolescent depression. However, the use of antidepressants in children and adolescents has been associated with a slightly increased risk of suicidal thoughts and behaviors.
The use of TCA and SSRI in the treatment of adolescent major depression and the risk of suicide with antidepressant therapy are discussed in detail separately. (See "Psychopharmacological treatment for adolescent depression" and "Effect of antidepressants on suicide risk in children and adolescents".)
Combination — Combination therapy uses both psychosocial and pharmacologic interventions. We suggest combination therapy with fluoxetine and CBT as the initial treatment for adolescents with MDD.
Balancing the risks and benefits, as discussed below, combination therapy appears to be superior to monotherapy with SSRI or CBT [10,11,32-37]. However, findings from the Adolescent Depression Antidepressant and Psychotherapy Trial (ADAPT) suggest that monotherapy with SSRI may be a reasonable option for adolescents with moderate to severe depression, particularly if access to CBT may be delayed [38]. In addition, long-term follow-up for up to five years after treatment found no significant difference in the rate of recovery or recurrence between combination treatment and monotherapy [39].
TADS — Short-term combination therapy is supported by the results of the Treatment for Adolescent Depression Study (TADS), which compared the effectiveness of four treatments for MDD in adolescents: fluoxetine (an SSRI); CBT; combination fluoxetine and CBT; and pill placebo [10,11]. After the first 12 weeks, patients were treated openly; the analysis of long-term (36 weeks) safety and effectiveness included only those 327 patients who were initially assigned to an active treatment group.
The primary outcome measures were the Children's Depression Rating Scale-Revised (CDRS-R) and a dichotomized Clinical Global Impression improvement (CGI-I) score, in which a positive response was defined as a CGI score of 1 or 2: very much improved or much improved, respectively (table 1) [10,11]. The following results were noted:
Over the course of therapy, all groups had improved scores on the CDRS-R (table 1). During the first 12 weeks, the greatest improvement in depressive symptoms based upon the CDRS-R occurred in the group treated with combination fluoxetine and CBT (figure 1); this was the only group that differed significantly from placebo [10]. In the long-term study, combination therapy and fluoxetine were superior to CBT at 6, 12, and 18 weeks, but by 30 weeks, the three treatments converged [11].
In the research setting, initial treatment with placebo for 12 weeks was not associated with harm or diminished response to subsequent treatment [40]. This observation suggests that placebo treatment is an acceptable intervention in randomized controlled trials for adolescent depression. It does NOT suggest that it is acceptable to delay the onset of active treatment of adolescent depression in nonresearch settings.
When treatment response was measured by the Clinical Global Impression Improvement score (CGI-I, (table 1)) at 12 weeks, fluoxetine alone was effective, but not as effective as the combination of fluoxetine and CBT [10]. The response rates were 71 percent for combination therapy, 61 percent for fluoxetine, 43 percent for CBT, and 35 percent for placebo (CBT monotherapy was not statistically different than placebo). By 24 weeks, the three treatments converged [11].
The mean highest dose of fluoxetine was lower in the combination group than in the fluoxetine monotherapy group (28.4 versus 33.3 mg/day) [10].
The combination of fluoxetine and CBT appeared to be protective against harm-related adverse events (nonsuicidal self-harm, worsening of suicidal ideation without self-harm, suicide attempt, aggressive or violent ideation or action against another person or property) [10,11]. (See "Effect of antidepressants on suicide risk in children and adolescents".)
The response rate for CBT monotherapy in TADS at 12 weeks was lower than that described in other studies (43 versus approximately 60 percent). However, in the second phase of TADS, the response rate for CBT increased to 65 percent at week 18 [11]. This supports the hypothesis that the increased severity of illness in TADS patients compared to those in other studies delayed the onset of benefit for CBT relative to other therapies [11]. This is consistent with results of trials in adults in which the comparative of strength of CBT is greater during follow-up than acute treatment [41]. (See "Initial treatment of depression in adults", section on 'Psychotherapy'.)
Data regarding rates of remission, speed of recovery, safety, function and quality of life, and predictors of outcome at 12 and 36 weeks were reported separately [42-47]. Key findings include:
Remission occurred in 23 percent of patients overall but was more frequent in patients treated with combination therapy (odds ratio 2.1 for combination therapy versus fluoxetine, 3.3 for combination therapy versus CBT, and 3.0 for combination therapy versus placebo) [42]. At 36 weeks, the remission rates in all treatment groups were approximately 60 percent [47].
Recovery occurred earlier in patients treated with combination therapy or fluoxetine than in those treated with CBT or placebo [43]. Between 65 and 72 percent of patients who achieved remission during acute treatment met criteria for recovery at 36 weeks; the recovery rate was similar across groups [47].
Treatment with fluoxetine was associated with an increased risk of suicide related events (9 percent versus approximately 5 percent in the combination and CBT groups, and 3 percent in the placebo group) [44].
Combination therapy was effective in improving functioning, global health, and quality of life; fluoxetine therapy improved functioning, but not other parameters [45].
Younger and less severely impaired adolescents responded better than older, more impaired adolescents or those with comorbid diagnoses [46].
The combined results of the acute and long-term phases of the TADS, as well as the subgroup analyses, suggest that fluoxetine, CBT, and combination therapy are effective over a course of 36 weeks. Response occurs earlier in patients treated with fluoxetine, with or without CBT. However, CBT appears to protect against treatment-emergent suicidal events in patients taking fluoxetine.
Considering the risks and benefits, combination therapy appears to be superior to fluoxetine or CBT across 36 weeks of treatment [11]. Fluoxetine monotherapy is an alternative for patients with moderate to severe depression when CBT is not readily available, provided that the patient is monitored closely [11]. (See "Psychopharmacological treatment for adolescent depression", section on 'Monitoring'.)
Long-term observational follow-up was conducted in 196 patients treated in the TADS trial for up to five years after study entry [39]. Nearly all of these patients eventually recovered (96 percent), and recovery was not significantly associated with any of the short-term treatments (fluoxetine, CBT, combination, or pill placebo). Of the 189 patients who recovered, 47 percent subsequent suffered a recurrence. Recurrence was not associated with the initial treatment received, but recurrence was significantly higher among females compared with males (57 versus 33 percent).
ADAPT — The Adolescent Depression Antidepressant and Psychotherapy Trial (ADAPT) compared SSRI and routine specialist care with and without CBT in 208 adolescents (aged 11 to 17 years) with moderate to severe major or probable major depression [34]. ADAPT included only patients with persistent depression and did not exclude patients with active suicidal intent, self harm, thought disorder, depressive psychosis, or conduct disorder.
Combination therapy with SSRI and CBT was no more beneficial than monotherapy with SSRI [34]. The treatment effect was similar in both groups after 12 weeks (with 40 and 43 percent of patients much or very much improved, respectively) and after 28 weeks (with 53 and 61 percent much or very much improved, respectively). Symptoms of suicidality and self-harm improved over time in both groups; treatment with CBT did not appear to be protective for suicidality.
These results are consistent with those of a smaller trial [35], but differ from those of the acute phase of the TADS [10]. The discrepant results may be related to the low attendance rates for CBT in ADAPT, differences in dose of or duration of therapy with SSRI, choice of outcome measure, or differing patient populations (patients in ADAPT were more severely impaired than those in TADS) [38,46]. Moreover, a significant methodological weakness in the ADAPT involved the implementation of the CBT treatment condition. Specifically, the CBT was not delivered using a systematic protocol specific for depression and the method of evaluating the integrity of the CBT provided did not involve assessment of variables generally deemed central to effective psychosocial management of depression. Nonetheless, the results are consistent with subgroup analysis of TADS, which found no greater response with combination therapy than SSRI monotherapy in more severely affected patients [46].
Taken together, ADAPT and TADS findings suggest that although combination therapy is preferred, monotherapy with SSRI may be a reasonable option for adolescents with moderate to severe depression, particularly if access to CBT is delayed [11,38,43,46]. If undertaken, such treatment should be accompanied by frequent clinical review and careful monitoring for benefit and adverse effects, particularly suicidal ideation [11]. (See "Psychopharmacological treatment for adolescent depression", section on 'Monitoring'.)
EFFICACY — The typical response rate to monotherapy with psychosocial or pharmacologic interventions for MDD is approximately 60 percent [21,48-50]; the rate of remission is between 35 and 40 percent [21]. (See "Psychosocial treatment for adolescent depression" and "Psychopharmacological treatment for adolescent depression".)
Because the response and remission rates of monotherapy are so low, expert clinicians often recommend combined treatment [5,36,37,51]. Even though SSRI monotherapy has been associated with more rapid improvement, the TADS outcomes suggest that combined treatment is advantageous in multiple other domains: promoting remission, improving functionality, protecting against treatment-emergent suicidal events
CHOICE OF AGENT — When the clinician and patient or parents agree to a trial of medication for ADHD in a school-aged child or adolescent, we suggest a stimulant as the first-line agent [2,3,11]. However, the preferences of the patient and family must be taken into consideration [3,4]. Atomoxetine is an alternative. Other medications (eg, alpha-2-adrenergic agonists) usually are used when children respond poorly to a trial of stimulants or atomoxetine, have unacceptable side effects, or have significant coexisting conditions.
General considerations — The choice of the initial medication depends upon a number of factors, including (table 3) [3-6,12]:
The duration of desired coverage (completion of homework or driving may require coverage into the evening)
The ability of the child to swallow pills or capsules
The time of day when the target symptoms occur
The desire to avoid administration at school
Coexisting tic disorder (avoidance of stimulants or use of alpha-2 adrenergic agonists may be warranted)
Coexisting emotional or behavioral condition (an alpha-2-adrenergic agonist may be useful for patients who are overaroused, easily frustrated, highly active, or aggressive) [3]
Potential adverse effects
History of substance abuse in patient or household member: avoid stimulants or use stimulants with less potential for abuse (eg, lisdexamfetamine, osmotic-release preparation, methylphenidate patch) (see "Pharmacology of drugs used to treat attention deficit hyperactivity disorder in children and adolescents", section on 'Stimulants')
Preference of the child/adolescent and his/her parent/guardian
Expense (in general, short acting stimulants are least expensive; among long-acting stimulants, pulse formulations are less expensive than bead preparations, osmotic-release preparations, and the methylphenidate patch; generic drugs are less expensive than brand-names, but not available for all formulations) [13]; generic medications may be used as long as they are systematically titrated (see 'Dose titration' below)
Stimulants versus other medications — When the clinician and patient or parents agree to a trial of medication for ADHD in a school-aged child or adolescent (≥6 years), we suggest a stimulant as the first-line agent [6]. Stimulants are preferred to other medications because stimulants have a rapid onset of action and long record of safety and efficacy [4,5,13-18].
Atomoxetine may be more appropriate than stimulants for patients with a history of illicit substance use or family members with a history of illicit substance use, concern about abuse or diversion, or a strong family preference against stimulant medication [3,6,12].
Alpha-2-adrenergic agonists usually are used when children respond poorly to a trial of stimulants or atomoxetine, have unacceptable side effects, or have significant coexisting conditions.
In randomized trials, systematic reviews, and meta-analyses, stimulants [15,19-23], atomoxetine [24-34], and alpha-2-adrenergic agonists [35-38] are more effective than placebo in reducing the core symptoms of ADHD. However, stimulants typically have a slightly larger treatment effect size (standardized mean difference) than nonstimulants (approximately 1.0 versus approximately 0.7 for both atomoxetine and alpha-2-adrenergic agonists) [2,3,35,39-41]. The standardized mean difference describes the extent to which the performance in the treatment group differed from that in the control group; by consensus, differences of 0.2, 0.5, and 0.8 are considered small, moderate, and large, respectively [42].
In open-label and blinded randomized trials comparing methylphenidate and atomoxetine, methylphenidate was more effective than or as effective as atomoxetine in reducing target symptoms/behaviors [39,43-48]. Most of these trials were sponsored, at least in part, by the stimulant manufacturers [49].
The response rate to a specific stimulant (ie, reduction in hyperactivity or increase in attention as rated by parents, teachers, and/or research raters) is approximately 70 percent [19,50,51]. At least 80 percent of school-age children and adolescents will respond to one of the stimulants if the stimulants are tried in a systematic way.
In addition to improvement in core symptoms of ADHD, treatment with stimulants also improves parent-child interactions, aggressive behavior, and academic productivity and accuracy [52,53]. The effect on academic performance is less strong [22].
Stimulant medications do not significantly affect learning problems, reduced social skills, oppositional behavior, or emotional problems that are secondary to or coexist with ADHD [54]. However, stimulant medications may facilitate the psychologic or behavioral treatment of these problems by controlling the core symptoms of ADHD. In addition, the use of stimulant medications may improve self-esteem in children with ADHD and comorbid conditions [55].
There are few controlled studies of long-term therapy for ADHD; however, ADHD symptoms appear to improve with time regardless of treatment modality [23,56]. A systematic review found few good quality studies assessing the long-term effectiveness of treatment with stimulants or atomoxetine, but concluded that medications continue to be effective and well-tolerated over at least 12 months [42]. In one study, participants in a controlled trial of methylphenidate were followed over five years [57]. Patients who continued on stimulants for five years had fewer teacher-reported ADHD symptoms than those off medication and those who did not adhere to stimulant therapy. The most common adverse effect in the group that continued stimulants for five years was appetite suppression.
Choosing among stimulants — Individual preferences of the clinician and family determine the choice of the initial stimulant medication [3,6]. In choosing among the various stimulants, duration of action is a primary consideration [16]. Another consideration is whether or not the child can swallow pills (since some formulations cannot be crushed, split, or opened) (table 3).
In most systematic reviews, methylphenidate, dexmethylphenidate, and amphetamines appear to be equally effective and to have similar adverse effect profiles [22,58,59]. However, one meta-analysis found amphetamines to be moderately more efficacious than methylphenidate [60].
Short-acting forms of medication (table 4A) are often used as the initial treatment in children <6 years, who are more sensitive to dose-dependent adverse effects and should be started at low doses [3,18]. Long-acting formulations generally are not available at doses small enough for young children. Short-acting forms also may be used to determine the optimal daily dose before switching to a comparable long-acting agent (table 4B) [61]. However, in children older than six years, a longer-acting preparation may be used initially, starting at the lowest dose and titrating up [3]. (See 'Dose titration' below.)
Intermediate or long-acting preparations generally are indicated for children who require a duration of action longer than four hours or in whom the administration of medication every four hours is inconvenient, stigmatizing, or impossible [3,6,18,62]. Long-acting medications may improve adherence and are potentially less likely to be misused or diverted [18,63].
A combination of a long-acting and late-afternoon short-acting medication may be necessary to provide adequate coverage in the evening hours for homework completion or driving [6].
Preschool children — Medication may be helpful for preschool children who have failed an adequate trial of behavior therapy [2,3,6]. When the clinician and parents agree that medication is warranted for a preschool child, we suggest methylphenidate rather than amphetamines or nonstimulant medication.
A systematic review found only one good quality study of stimulant medication in preschool children with ADHD [42]. In the multicenter Preschool ADHD Treatment Study (PATS), treatment with immediate release methylphenidate improved ADHD symptoms in children (3 to 5.5 years) with ADHD who were unresponsive to psychosocial interventions (effect size [standardized mean difference] 0.4 to 0.8) [64]. However, the effect size was smaller than that generally seen in older children (approximately 1.0) [3,40]. The standardized mean difference describes the extent to which the performance in the treatment group differed from that in the control group; by consensus, differences of 0.2, 0.5, and 0.8 are considered small, moderate, and large, respectively [42]. In a subsequent trial randomized trial, atomoxetine improved core symptoms of ADHD in preschool children, but did not improve clinical function [32]. Controlled studies comparing methylphenidate with other medications for preschool children are lacking.
Initiation and titration of methylphenidate for preschool children is discussed below. (See 'Dose titration for preschool children' below.)
Teacher feedback is essential. Many parents choose a medication regimen for their child that has maximal effects during the school day. In such cases, parents may not be in a position to observe medication effects on core ADHD symptom and reports from the parents alone are not sufficient to make a determination of treatment failure.
Managing stimulant adverse effects — When children or adolescents who are being treated with stimulant medications develop adverse effects, it is important to determine the timing of the effect in relation to medication administration and whether the effect is related to a coexisting disorder or environmental stressor [8,76]. Mild adverse effects may resolve with time or can be addressed by adjusting the dose, time of administration, or formulation of stimulant [3,6,73]. Tips for initial management of common adverse effects of stimulant medications are provided below [76].
Decreased appetite – Administer the medication at or after a meal; encourage the child to eat nutrient dense foods before those with “empty calories”; offer food that the child likes for the noon meal, which is often affected [6,8,72,76]. When making these changes, an important caveat is that meals with high fat content may delay the onset and increase peak concentrations of some formulations (eg, Metadate CD®, Methylin® chewable tablets or oral solutions, Adderall XR®). See Methylphenidate drug information and Dextroamphetamine drug information.
Poor growth – Drug holidays may be beneficial for children in whom stimulant therapy is associated with a growth trajectory that crosses two major percentiles (ie, the 5th, 10th, 25th, 50th, 75th, 90th, and 95th) [3]. Drug holidays should only be undertaken if they can be tolerated without marked impairment in functioning. (See 'Drug holidays' below.)
Dizziness – Monitor blood pressure and pulse; ensure adequate fluid intake; if associated only with peak effect, try a longer-acting preparation (table 4A-B) [76].
Insomnia/nightmares – Establish a bedtime routine and good sleep hygiene habits; omit or reduce the last dose of the day or, if using a long-acting preparation, change to a short-acting preparation (table 4A-B) or administer earlier in the day [16,76,77].
Mood lability – If mood lability occurs at the time of peak concentration, try reducing the dose or switching to a longer acting preparation; irritability, sadness, and increased activity as the medication wears off is particularly common when short-acting medication is used on a morning and noon twice-a-day schedule—try adding an afternoon dose or switching to long-acting form; referral for coexisting mood disorder or anxiety disorder may be warranted [8]
Rebound – “Rebound” refers to symptoms or adverse effects that occur as the medication is wearing off; rebound effects may improve by stepping down the dose at the end of the day (by increasing the dose of the long-acting agent administered in the morning or adding a smaller dose of short-acting medication at the end of the day) [3,76].
Tics – Conduct a drug trial at different doses, including no medication, to be sure that tics are drug-related; if tics abate on no medication, reconsider the risks and benefits of treatment with the patient and family [76].
Psychosis – If children taking stimulant medications develop psychotic symptoms (eg, suicidality, hallucinations, or increased aggression), verify that the dose is appropriate and that the medication is being administered as prescribed [76]. If so, discontinue the stimulant; stimulant medications can be discontinued abruptly, without tapering. Referral to a qualified mental health specialist or psychopharmacologist may be warranted to assess for bipolar disorder or a thought disorder [76].
Diversion and misuse – It is important for clinicians to monitor symptoms and prescription refills for evidence of misuse or diversion of ADHD medication [6]. Stimulant diversion and misuse can be prevented, to some extent, by prescribing long-acting stimulants (table 4B) with less potential for abuse, and by keeping track of prescription dates [16,63]. It is also helpful to have an open discussion about stimulant diversion and misuse with patients and parents so that students can be prepared if they are approached by peers to sell or misuse medications and so that parents can remain vigilant in monitoring medications [16].
PROGNOSIS — Most of the information about prognosis in children with ADHD is derived from small cohort studies of male patients who were evaluated and treated for ADHD in psychiatric clinics [65,77-84]. The generalizability of the information to other patient groups is limited. Long-term follow-up (six to eight years) of the MTA study cohort suggests that functioning during adolescence is predicted by the initial clinical presentation (including severity of symptoms, and comorbid conduct problems), intellect, social advantage, and the strength of ADHD response to any mode of treatment [85].
Injury and self-injury – Children with ADHD or symptoms of ADHD are at greater risk for incurring intentional and unintentional injury than are children without these symptoms [86-92]. In a review of medical, pharmaceutical, and disability claims for injuries or poisoning treatments, individuals with ADHD were more likely to have at least one claim related to unintentional injury than controls (28 versus 19 percent for children, 32 versus 23 percent for adolescents, and 38 versus 18 percent for adults) [86].
In a prospective study of 140 girls with ADHD diagnosed at age 6 to 12 years (93 with combined type [ADHD-C], 47 with inattentive type [ADHD-I]), those with ADHD-C were more likely to have attempted suicide during the 10-year follow-up than those with ADHD-I or controls (22, 8, and 6 percent, respectively) [91]. Self-injury was also more common among girls with ADHD-C than girls with ADHD-I or controls (51, 29, and 19 percent, respectively).
Driving – Adolescents with ADHD are two to four times more likely than those without the disorder to have motor vehicle accidents [93]. They also are more likely to have their driving licenses suspended or revoked [94]. In randomized trials, driving performance improves with stimulant medication [95-97].
Education – Follow-up studies of children with ADHD into adolescence consistently indicate impaired academic functioning (eg, completion of less schooling, lower achievement scores, failure of more courses) compared with controls [44,64,65,77,91,98-100]. This is particularly true for children with the inattentive or combined subtype of ADHD [101]. In the few studies in which subjects were followed into adulthood, the findings persisted (25 to 33 percent of probands versus 1 to 9 percent of controls dropped out of high school; 15 to 19 percent of probands versus 50 to 64 percent of controls had completed a bachelor's or higher level degree) [77,80,81,84,102]. Impaired academic function appears to persist, even in those children who no longer meet criteria for diagnosis of ADHD in adolescence [65].
Substance use – Whether children with ADHD have an increased risk of engaging in substance use during adolescence or adulthood is controversial [77]. Several follow-up studies reported an increased prevalence of nonalcohol substance use disorder among probands (12 to 20 percent versus 4 to 12 percent in controls) [78,80,84,103], whereas others did not [81,91,104-107]. The increased prevalence of substance use is present predominantly among patients who have comorbid conduct or antisocial disorders [103,108-113].
Persistence of symptoms – Prevalence and natural history data suggest that one- to two-thirds of the 3 to 10 percent of children diagnosed with ADHD continue to manifest appreciable ADHD symptoms into adult life [92,108,118]. (See "Adult attention deficit hyperactivity disorder", section on 'Epidemiology'.)
In a prospective study of 140 girls with ADHD diagnosed at age 6 to 12 years (93 with ADHD-C, 47 ADHD-I), 115 were available for the 10-year follow-up (41 with ADHD-I and 87 with ADHD-C) [91]. Among girls diagnosed with ADHD-I during childhood, 39 percent continued to meet criteria for ADHD-I, 22 percent met criteria for ADHD-C, and 39 percent no longer met criteria for ADHD. Among girls diagnosed with ADHD-C during childhood, 37 percent continued to meet criteria for ADHD-C, 2 percent met criteria for hyperactive/impulsive ADHD, 17 percent met criteria for ADHD-I, and 44 percent no longer met criteria for ADHD.
Employment – In studies that followed children with ADHD into early adulthood, the rate of employment of ADHD probands did not differ from that of controls [80,81]. However, in a prospective male cohort that was followed for 33 years (mean age 41 years), fewer probands than controls were employed (83 versus 95 percent) [84]. Probands were reported to have lower status jobs and to perform poorly compared with controls when rated by their employers in various areas of work performance [77,84].
Antisocial personality – Children who have ADHD are at increased risk to develop antisocial personality disorder (ASPD) and behaviors in adulthood [77,84,109]. In studies that followed children with ADHD into adulthood, the prevalence of ASPD ranges from 12 to 23 percent in probands (predominantly with the hyperactive-impulsive subtype of ADHD) versus 2 to 3 percent in controls [78,80,81,84].
The increased risk of developing ASPD appears to be independent of comorbid conduct disorder in childhood because children with comorbid problems were excluded from several study cohorts [79,80]. In an observational study, 54 percent of 147 ADHD patients self-reported having been arrested at least once by age 21 years (compared with 37 percent of 73 community controls); 24 percent of ADHD patients had been arrested for misdemeanors (compared with 11 percent of controls) and 27 percent for felony (compared with 11 percent of controls) [109].
Really?
Maybe...Some kids have been helped with drugs but are you, seriously, trying to imply there is not an issue in America...an issue driven by profit margins that the pharm companies and doctors make in conjunction with prescribing these drugs?
What would you call them?
When he was there he put his feet up on his desk and read books and let me "teach". There was little teaching, however. He had used the gifted money for a whole bunch of random workbooks which those kids would choose and work on at will while the rest of the class struggled through the regular texts, at least when they showed up for class and were not goofing off. I actually ended up enjoying the class as I got to know the kids, but I was sure enlightened about the realities of public school!
