"Problems in the Management of Attention-Deficit-Hyperactivity Disorder," AJ Zemetkin and M Ernst, New England Journal of Medicine, vol. 340 (1999), pp. 40-46.

"Treatment of Attention-Deficit-Hyperactivity Disorder," J. Elia, PJ Ambronsini and JL Rapoport, New England Journal of Medicine, vol. 340 (1999), pp. 780-788.

"Problems in Diagnosing Attention and Activity," WB Carey, Pediatrics, vol. 103, pp. 664-667.

Whew! When it rains it pours.

The continuing power and interest in ADD and Ritalin is revealed in these reviews appearing in these prestigious journals. It is virtually unheard of that two reviews on the same subject appear in the New England Journal of Medicine within two months of one another. They cover very similar ground and since they are reviews basically coming from the same source, the Child Psychiatry Branch of the National Institutes of Mental Health, one shouldn't be surprised that they promote a primarily biological view of ADD behavior and emphasize medication interventions.

Both briefly mention the great rise in the diagnosis of this uniquely American phenomenon but do not see this as troubling. Zametkin acknowledges that the possibility of over diagnosis remains a concern. The Carey piece, on the other hand, is a tour-de-force concise summary of the construct and practical problems associated with the DSM-IV ADHD diagnosis. Carey, the nation's leading researcher on child temperament, raises the provocative question whether impulsivity and activity should be seen as the main problem for ADHD kids. He suggests that cognitive disablities and the quality of low adaptability are the true causes of problems for children with high activity and low persistence.

Reviewed 4/17/99