Family Environment's Impact on Attention-Deficit Disorder Studied

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Children whose families suffer from poverty, severe marital discord, and other adversities are more likely than others to be diagnosed with attention-deficit hyperactivity disorder.

Harvard University researchers drew that conclusion in a study published in the June issue of the American Medical Association's Archives of General Psychiatry. Several articles in the journal focused on hyperactivity, including the use of Ritalin, the drug often used to control the symptoms of the disorder, known as A.D.H.D.

Both the Harvard research and another study found that Ritalin worked safely and effectively in hyperactive children with motor and vocal tics. Historically, experts have disagreed over whether Ritalin can make such tics worse.

A third article looked at similarities between the effects on the brain of Ritalin and cocaine.

The family-environment study was led by researchers from Massachusetts General Hospital and Harvard Medical School. They found that low social class, living in foster care, large family size, having a father involved in crime, and having a mother with mental illness were linked with mental disorders and psychological and social problems in both A.D.H.D. children and those without the disorder.

The more adversity factors children in either group faced, the more likely they were to show depression, anxiety, bad behavior, and other problems.

"We believe that adversity plays an important role in maintaining and aggravating the precarious balance that A.D.H.D. children may already have," said Dr. Joseph Biederman, the lead author of the study and an associate professor of psychiatry at Harvard Medical School.

Researchers studied 140 white, non-Hispanic boys between the ages of 6 and 17 years with A.D.H.D., and 120 boys without the disorder.

Contrary to popular belief, the study did not find a link between adversity factors and children who repeated grades, had school-based tutoring, or were placed in special classes.

The researchers said that, because none of the study subjects was in abject poverty or at other extreme social disadvantage, their findings suggest that even modest levels of adversity can impair a child's mental and social well-being.

Understanding the apparent association of adversity with attention-deficit hyperactivity disorder may help physicians and educators intervene where they can, said Dr. Biederman. A.D.H.D. children with family strife may have a harder time than others responding to medical treatment, he said.

"Certain interventions can provide the opportunity to diminish the ill fate of A.D.H.D. children," Dr. Biederman said, especially those methods that, for example, try to improve family relations or help a mother's depression. But he acknowledged that doctors and educators can do little about poverty or large family size.

Dr. Biederman cautioned that the study does not show a cause-and-effect relationship and urged that educators not lay blame for A.D.H.D. at the family's doorstep.

Rachel Klein, a professor of clinical psychology at the Columbia University College of Physicians and Surgeons who was not involved in the Harvard study, agreed. She said causality could not be inferred from the study and added that a family situation should not be a major focus of treatment for A.D.H.D.

High school students who use anabolic steroids to build muscle are more likely than their peers to be "shooting up" other drugs and to be users of multiple drugs, says a study out this week.

Teenagers who use steroids without a doctor's prescription are also more likely to use cocaine and other drugs such as amphetamines and heroin, according to researchers from Harvard Medical School and the federal Centers for Disease Control and Prevention. Those teenagers are also more likely to drink alcohol, the study found.

The researchers based the study, published this month in the journal Pediatrics, on 12,267 responses to the C.D.C.'s 1991 Youth Risk Behavior Survey. Public and private school students in grades 9 through 12 from the 50 states and the District of Columbia responded to the questionnaire.

The scientists found that about 4 percent of male students and 1.2 percent of female students reported ever using steroids without a prescription. Anabolic steroids are synthetic derivatives of the male hormone testosterone.

Students living in the South were more likely to have used steroids than students in other parts of the country. And, the study found, students who perceived themselves to have below-average academic performance reported higher steroid use.

When school-based health services became part of last year's debate over health-care reform, experts in the field realized they had no national group serving their interests.

The rapid growth of the field in recent years has made the need for such a group increasingly urgent, said Julia Graham Lear, the director of Making the Grade, a program based at George Washington University in Washington that supports school-based health centers. Demands for information and technical assistance have multiplied as the number of school-based health centers has increased--doubling in the past three years alone, from just over 300 in 1992 to about 650 this year, Ms. Lear said.

So, to that end, she and others organized the first-ever National Assembly on School-Based Health Care, which was sponsored by several foundations as well as the C.D.C. More than 500 participants from all over the country convened last month in Washington to discuss topics such as starting a school-based health center, negotiating the world of managed care, and how to find funding.

A national membership group was also born at the conference. It bears the same name as the meeting--the National Assembly on School-Based Health Care. Participants elected Donna Zimmerman, the executive director of Health Start Inc., as the group's first president. The company runs several school-based health centers in St. Paul. The assembly can be reached at (703) 556-0411.

--Millicent Lawton

Vol. 14, Issue 40

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