The article in the April 6 issue on the lawsuits charging APA and Novartis Pharmaceuticals with conspiracy to create the diagnosis of attention deficit/hyperactivity disorder as a way to build a market for Ritalin once again brings the issue of medicating America’s children to the forefront. Among the arguments offered by the plaintiffs is that the behavioral component of ADHD has been greatly inflated by APA, causing “normal childhood behavior” to be construed socially and clinically as pathological and thus requiring treatment.
Although the medical literature demonstrates that behavioral problems correlate with higher rates of unintentional injury in children, many psychiatrists and the media overlook the most dangerous threat to child and adolescent lives. Instead, social behavior and school performance are used as clinical thresholds for a diagnosis of ADHD.
As unintentional injury is the leading cause of death in children and young adults, one may speculate that the consequences of severe ADHD symptoms may be a shortened life expectancy. There is a relationship between ADHD and accident proneness in childhood, as well as with speeding and auto accidents in adolescents and young adults. Young people with poor attention are at greater risk of traffic violations, involvement in accidents, and drinking while driving. Cognitive factors of lower expectations of personal risk in hazardous situations are linked with less ability to generate prevention strategies. Thus, the ability to recognize hazardous situations and in turn develop safety strategies are important life-saving skills that ADHD patients may need to develop.
Pediatricians traditionally have been responsible for legislative initiatives to reduce injury, serving as an excellent model for psychiatry’s role in public health. Prevention strategies need to be developed that target those with behavioral risk factors of unintentional injury, and these strategies should be incorporated into practice. Psychiatrists are bound, as all physicians are, to educate those at risk for illness or injury. Until APA establishes practice guidelines for ADHD, an active role in emphasizing these risks to patients may be the first step for us.
An important part of any evaluation or monitoring of a patient with ADHD is a history of unintentional injuries, including driving violations. For physicians treating children and adolescents with ADHD, it is important to discuss impulsive behavior and encourage patients and their parents to be vigilant about safety and safety consciousness. For example, a young boy with ADHD who has frequent accidents while driving a motor scooter is at risk for repeated injury later in life, and potentially more serious injury when driving an automobile.
Frequently, doctors consider improvement in school functioning and behavior at home when deciding on the adequacy and timing of treatment with medication. They should also consider the potential for injury if patients with ADHD are not adequately treated. The driving performance of young adults who have ADHD has been shown to improve significantly by taking stimulant medication.
The road signs are clear: a comprehensive approach to injury risk assessment and prevention with adolescents and young adults with ADHD saves lives.
