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CNN Live Today

Interview with Dr. Stephen Hinshaw

Aired September 26, 2002 - 11:39   ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.


DARYN KAGAN, CNN ANCHOR: Today we're "Paging Dr. Gupta" on a condition that hits close to home for millions of families here in the United States, Attention Deficit Hyperactivity Disorder, also known as ADHD.
Millions of kids are diagnosed with it, but the question is, are they taking the medication that they need?

Lawmakers are discussing those issues on Capitol Hill this morning. In fact, Lisa Marie Presley, daughter of Elvis Presley, and national spokesperson for the Citizen's Commission on Human Rights is expected to testify, along with Neil Bush, the brother of the president. His son was diagnosed with the condition. We might just be hearing from them later today.

Meanwhile, we have heard a lot from you. Last hour, our resident doctor, Sanjay Gupta, shed some light on the condition. He is back to help answer your e-mail questions. Also along with him, Dr. Stephen Hinshaw. He is professor of psychology at UC Berkeley -- I'm a Stanford grad, doctor, I had to get that in there -- but we are glad to have you on here anyway.

DR. STEPHEN HINSHAW, PROFESSOR OF PSYCHOLOGY, UNIVERSITY OF CALIFORNIA: Thank you.

KAGAN: The response we have had here has just been incredible, a lot of people having questions. So Sanjay, why don't you take the first e-mail question, and let's get some answers.

DR. SANJAY GUPTA, CNN MEDICAL CORRESPONDENT: OK, let's jump right to it.

First question, actually, from Erika Hyde in Plattsburgh, New York. "Are there conditions that are frequently mis-diagnosed as ADD or ADHD, as particular other conditions, and how common is ADD without hyperactivity component?"

Doctor, I know do you a lot of research in this area. Any thoughts on that?

HINSHAW: Well, it takes a good while to do a proper diagnosis of ADHD. There are many reasons why a child might show inattention, impulsivity, hyperactivity. Children who have been abused, children who are in simply, just poor classrooms.

The diagnosis can be made, but it can't be done in a 10-minute office visit. A thorough history, rating scales with norms, getting information from parents and teachers and the child himself or herself, all of this is necessary to know if it is ADHD, or just other symptoms that might mimic it.

And...

KAGAN: Go ahead. I'm sorry.

HINSHAW: Go ahead.

KAGAN: I was going to say, this next question actually seems like it is a good follow-up to a point you were just making -- Wanda asking from Raleigh, North Carolina, "Should a child be labelled as ADHD if the classroom is the only place he seems to display this behavior? No problems at church, movies," the kid even sat through "four hours of 'Titanic,' he can play video games or sporting events."

You were saying this is a very involved diagnosis, doctor.

HINSHAW: Yes, it would be counter to what we know about ADHD to make a diagnosis, if the symptoms are present only in one setting. By definition, this is a condition that shows itself during homework, during school, and typically during playtime with peers.

So -- although, of course, I can't make a diagnosis on the television, a child who shows the symptoms only in one setting probably doesn't have ADHD. What you might want to be concerned about here is, are there learning problems that underlie difficulty focusing attention in the school setting only.

But to make a diagnosis, it has got to be present in multiple situations.

KAGAN: Sanjay, before the next question, I wanted to do a follow-up with the doctor, and then have you pipe in on this.

The question that this hearing is talking about today and over- medication, Sanjay, why don't you come in first and talk about if a misdiagnosis is made, and a child is given the medication when they don't need it, what can actually happen.

GUPTA: Right. Well, you know, these medications are pretty effective if someone actually -- if a child actually has ADHD, but like any other medication, they have side effects. We are talking about psycho-stimulants, such as Ritalin. We are talking about amphetamines that are used sometimes as well. Sometimes kids will have difficulty with sleeping. Sometimes kids will have difficulty with eating.

It can be very disruptive to a child's life if put on these medications, especially if they don't have the diagnosis. And Daryn, you and I were talking last hour as well, statistically about 2 million, roughly, kids actually carry the diagnosis of ADHD. That is about one kid for every school-age classroom in America, and there is about 4 to 6 million kids that are actually taking the medication at any given time. You don't need -- it is not that hard to do the math. There is a lot more kids that are getting the medication than actually carry the diagnosis.

KAGAN: And Dr. Hinshaw, what do you see when a child has been mis-diagnosed, being given the wrong medication?

HINSHAW: Well, again, the proper diagnosis is the key to this. Lots of symptoms can be misread as ADHD that could be signaling other things.

These are medications that should never be taken lightly. They are central nervous stimulants. We need to do more research on very young children, what they are doing in the brain, but as Dr. Gupta said, there has been a lot of research, and when they are given for children with true ADHD in the proper dosages, they can be effective, only as long as they are given, and the side effects are usually manageable.

GUPTA: You know, our next question, doctor, is something that comes up a lot, we talk about a lot here on CNN, actually relating to homeopathic remedies for the treatment of ADHD, nontraditional medications. Any role there, doctor?

HINSHAW: Well, we don't have enough empirically sound research to know what so-called alternative treatments like homeopathy really do for children with ADHD.

Many parents are worried about diet. Diet plays a role in a small percentage of kids with ADHD. I think most kids in America could probably have a better diet, but this doesn't seem to be a major culprit for ADHD.

Homeopathy, we just don't have the research base. Validated treatments involve medications, if they are well delivered, and the behavioral treatments of consulting with parents, consulting with teachers, getting a more regular reward program for the child at home and school.

KAGAN: Here is a question, kind of politically loaded, and actually deals more with adults. We have been focussing a lot about kids, but perhaps you can weigh in on this, Dr. Hinshaw.

This one coming from Vermont, "do you believe that employers should make reasonable accommodations for persons with ADHD as they are required to do for persons with physical disabilities?"

Sanjay, not to steal your next question, but that does lead into the next one, where someone wrote in and asked us, Does a kid grow out of ADHD?

GUPTA: Exactly. Good points.

HINSHAW: Well, it's the law that an employer needs to makes reasonable accommodations for mental disorders as well as physical disabilities, but there would need to be solid documentation that there is a real, underlying condition of ADHD in such an adult, and the sort of follow-up question is, Does ADHD exist in adulthood? Twenty years ago, the field didn't really think so. Follow-up studies hadn't been done. The symptom of over-activity, kids running and fidgeting, that does tend to go away by adolescence, but the underlying inattention and impulse control problems in a majority of cases persist into late adolescence and even adulthood. So, the feeling is now that in many cases, this can be a life-long disorder. That's not to say that people can't learn to cope and handle it better, but the symptoms tend to persist most of the time.

KAGAN: Well, here is one family -- one woman in Vicksburg where she is dealing with, it sounds like, on different generational levels. She writes that "My son is ADD, not hyper at all. All I hear about are kids with it. I swear his father is ADD also. Can adults be put on medications to help? Can my husband be trained to focus? When I look at my husband, am I seeing my son's future?"

I think we have some marital issues here as well, but -- are there -- are there hopes for adults?

HINSHAW: Well, a big issue that this question raises is how genetic is ADHD, is there a genetic predisposition for it, and...

KAGAN: Good point.

HINSHAW: ... there is good research now, in many countries, that ADHD is one of the most heritable conditions we know of. It has more heritability -- in other words, genetic liability than even schizophrenia.

It does tend to run in families -- and biological families rather than foster or adoptive families.

A big controversy is, how can you make a diagnosis of ADHD in adulthood, in a parent, when the symptoms of hyperactivity and fidgeting aren't as salient?

It takes a careful diagnostic workup, and adults can be treated with the same treatments, including medication, but again, only if the diagnosis is well made and well delivered.

KAGAN: Well, as you say, ending your point with the first point you made, it really begins and ends with the diagnosis.

Dr. Hinshaw in San Francisco, thank you so much.

Sanjay, thank you.

HINSHAW: Thanks very much.

KAGAN: And as we said, we had huge response from our viewers about this.

TO ORDER A VIDEO OF THIS TRANSCRIPT, PLEASE CALL 800-CNN-NEWS OR USE OUR SECURE ONLINE ORDER FORM LOCATED AT www.fdch.com







Aired September 26, 2002 - 11:39   ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
DARYN KAGAN, CNN ANCHOR: Today we're "Paging Dr. Gupta" on a condition that hits close to home for millions of families here in the United States, Attention Deficit Hyperactivity Disorder, also known as ADHD.
Millions of kids are diagnosed with it, but the question is, are they taking the medication that they need?

Lawmakers are discussing those issues on Capitol Hill this morning. In fact, Lisa Marie Presley, daughter of Elvis Presley, and national spokesperson for the Citizen's Commission on Human Rights is expected to testify, along with Neil Bush, the brother of the president. His son was diagnosed with the condition. We might just be hearing from them later today.

Meanwhile, we have heard a lot from you. Last hour, our resident doctor, Sanjay Gupta, shed some light on the condition. He is back to help answer your e-mail questions. Also along with him, Dr. Stephen Hinshaw. He is professor of psychology at UC Berkeley -- I'm a Stanford grad, doctor, I had to get that in there -- but we are glad to have you on here anyway.

DR. STEPHEN HINSHAW, PROFESSOR OF PSYCHOLOGY, UNIVERSITY OF CALIFORNIA: Thank you.

KAGAN: The response we have had here has just been incredible, a lot of people having questions. So Sanjay, why don't you take the first e-mail question, and let's get some answers.

DR. SANJAY GUPTA, CNN MEDICAL CORRESPONDENT: OK, let's jump right to it.

First question, actually, from Erika Hyde in Plattsburgh, New York. "Are there conditions that are frequently mis-diagnosed as ADD or ADHD, as particular other conditions, and how common is ADD without hyperactivity component?"

Doctor, I know do you a lot of research in this area. Any thoughts on that?

HINSHAW: Well, it takes a good while to do a proper diagnosis of ADHD. There are many reasons why a child might show inattention, impulsivity, hyperactivity. Children who have been abused, children who are in simply, just poor classrooms.

The diagnosis can be made, but it can't be done in a 10-minute office visit. A thorough history, rating scales with norms, getting information from parents and teachers and the child himself or herself, all of this is necessary to know if it is ADHD, or just other symptoms that might mimic it.

And...

KAGAN: Go ahead. I'm sorry.

HINSHAW: Go ahead.

KAGAN: I was going to say, this next question actually seems like it is a good follow-up to a point you were just making -- Wanda asking from Raleigh, North Carolina, "Should a child be labelled as ADHD if the classroom is the only place he seems to display this behavior? No problems at church, movies," the kid even sat through "four hours of 'Titanic,' he can play video games or sporting events."

You were saying this is a very involved diagnosis, doctor.

HINSHAW: Yes, it would be counter to what we know about ADHD to make a diagnosis, if the symptoms are present only in one setting. By definition, this is a condition that shows itself during homework, during school, and typically during playtime with peers.

So -- although, of course, I can't make a diagnosis on the television, a child who shows the symptoms only in one setting probably doesn't have ADHD. What you might want to be concerned about here is, are there learning problems that underlie difficulty focusing attention in the school setting only.

But to make a diagnosis, it has got to be present in multiple situations.

KAGAN: Sanjay, before the next question, I wanted to do a follow-up with the doctor, and then have you pipe in on this.

The question that this hearing is talking about today and over- medication, Sanjay, why don't you come in first and talk about if a misdiagnosis is made, and a child is given the medication when they don't need it, what can actually happen.

GUPTA: Right. Well, you know, these medications are pretty effective if someone actually -- if a child actually has ADHD, but like any other medication, they have side effects. We are talking about psycho-stimulants, such as Ritalin. We are talking about amphetamines that are used sometimes as well. Sometimes kids will have difficulty with sleeping. Sometimes kids will have difficulty with eating.

It can be very disruptive to a child's life if put on these medications, especially if they don't have the diagnosis. And Daryn, you and I were talking last hour as well, statistically about 2 million, roughly, kids actually carry the diagnosis of ADHD. That is about one kid for every school-age classroom in America, and there is about 4 to 6 million kids that are actually taking the medication at any given time. You don't need -- it is not that hard to do the math. There is a lot more kids that are getting the medication than actually carry the diagnosis.

KAGAN: And Dr. Hinshaw, what do you see when a child has been mis-diagnosed, being given the wrong medication?

HINSHAW: Well, again, the proper diagnosis is the key to this. Lots of symptoms can be misread as ADHD that could be signaling other things.

These are medications that should never be taken lightly. They are central nervous stimulants. We need to do more research on very young children, what they are doing in the brain, but as Dr. Gupta said, there has been a lot of research, and when they are given for children with true ADHD in the proper dosages, they can be effective, only as long as they are given, and the side effects are usually manageable.

GUPTA: You know, our next question, doctor, is something that comes up a lot, we talk about a lot here on CNN, actually relating to homeopathic remedies for the treatment of ADHD, nontraditional medications. Any role there, doctor?

HINSHAW: Well, we don't have enough empirically sound research to know what so-called alternative treatments like homeopathy really do for children with ADHD.

Many parents are worried about diet. Diet plays a role in a small percentage of kids with ADHD. I think most kids in America could probably have a better diet, but this doesn't seem to be a major culprit for ADHD.

Homeopathy, we just don't have the research base. Validated treatments involve medications, if they are well delivered, and the behavioral treatments of consulting with parents, consulting with teachers, getting a more regular reward program for the child at home and school.

KAGAN: Here is a question, kind of politically loaded, and actually deals more with adults. We have been focussing a lot about kids, but perhaps you can weigh in on this, Dr. Hinshaw.

This one coming from Vermont, "do you believe that employers should make reasonable accommodations for persons with ADHD as they are required to do for persons with physical disabilities?"

Sanjay, not to steal your next question, but that does lead into the next one, where someone wrote in and asked us, Does a kid grow out of ADHD?

GUPTA: Exactly. Good points.

HINSHAW: Well, it's the law that an employer needs to makes reasonable accommodations for mental disorders as well as physical disabilities, but there would need to be solid documentation that there is a real, underlying condition of ADHD in such an adult, and the sort of follow-up question is, Does ADHD exist in adulthood? Twenty years ago, the field didn't really think so. Follow-up studies hadn't been done. The symptom of over-activity, kids running and fidgeting, that does tend to go away by adolescence, but the underlying inattention and impulse control problems in a majority of cases persist into late adolescence and even adulthood. So, the feeling is now that in many cases, this can be a life-long disorder. That's not to say that people can't learn to cope and handle it better, but the symptoms tend to persist most of the time.

KAGAN: Well, here is one family -- one woman in Vicksburg where she is dealing with, it sounds like, on different generational levels. She writes that "My son is ADD, not hyper at all. All I hear about are kids with it. I swear his father is ADD also. Can adults be put on medications to help? Can my husband be trained to focus? When I look at my husband, am I seeing my son's future?"

I think we have some marital issues here as well, but -- are there -- are there hopes for adults?

HINSHAW: Well, a big issue that this question raises is how genetic is ADHD, is there a genetic predisposition for it, and...

KAGAN: Good point.

HINSHAW: ... there is good research now, in many countries, that ADHD is one of the most heritable conditions we know of. It has more heritability -- in other words, genetic liability than even schizophrenia.

It does tend to run in families -- and biological families rather than foster or adoptive families.

A big controversy is, how can you make a diagnosis of ADHD in adulthood, in a parent, when the symptoms of hyperactivity and fidgeting aren't as salient?

It takes a careful diagnostic workup, and adults can be treated with the same treatments, including medication, but again, only if the diagnosis is well made and well delivered.

KAGAN: Well, as you say, ending your point with the first point you made, it really begins and ends with the diagnosis.

Dr. Hinshaw in San Francisco, thank you so much.

Sanjay, thank you.

HINSHAW: Thanks very much.

KAGAN: And as we said, we had huge response from our viewers about this.

TO ORDER A VIDEO OF THIS TRANSCRIPT, PLEASE CALL 800-CNN-NEWS OR USE OUR SECURE ONLINE ORDER FORM LOCATED AT www.fdch.com