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Ensuring comprehensive treatment for children with attention problems

Doc. 13712: collection of written amendments | Doc. 13712 | 04/03/2015 | Final version

Caption: AdoptedRejectedWithdrawnNo electronic votes

ADraft Resolution

1In 2000, concerned about the increasing numbers of children being diagnosed with attention deficit hyperactivity disorder (ADHD) and treated with psycho-stimulant drugs, the Parliamentary Assembly adopted Recommendation 1562 (2002) on controlling the diagnosis and treatment of hyperactive children in Europe. Today, ADHD is one of the most commonly diagnosed childhood disorders worldwide, affecting 3.3 million children and adolescents in the European Union alone.
2The last decade was marked by a significant increase both in the incidence of ADHD and the use of psycho-stimulants to treat it. While there are different scenarios explaining this increase, including possible over-diagnosis, changing environmental factors, growing awareness of ADHD and over-reliance on medication, attention is also drawn to possible under-diagnosis and undertreatment due to the inadequate training of care providers, inequalities in access to care as well as stigma and misconceptions surrounding ADHD.
3ADHD is a complex disorder, which makes its assessment equally complex, thereby increasing the risk of misdiagnosis. In addition, two different sets of criteria continue to be applied for its diagnosis, one adopted by the American Psychiatric Association, the other, more stringent, by the World Health Organization (WHO), with the gap between the two sets of criteria still growing.
4Research on treatment of ADHD has mostly focused on pharmacological interventions, without enough consideration of other treatment options, in particular psychosocial/behavioural interventions aimed at teaching skills to improve the behaviour of children with ADHD. Moreover, research on long-term outcomes associated with different treatment options, including adverse effects of long-term stimulant use on children, is almost inexistent. Similarly, compared to research on genetic and biological factors in the aetiology of ADHD, research on environmental aspects is less robust.
5Today, there is an increasing recognition that ADHD requires a comprehensive multimodal treatment approach combining medical, behavioural and educational interventions, including parent and teacher education about diagnosis and treatment, behaviour management techniques for the child, the family and the teachers, medication and school programming and support. Multimodal interventions not only focus on ADHD symptoms but also target the associated conditions, such as school difficulties, family dysfunction, and low self-esteem as well as co-morbid disorders.

In the draft resolution, paragraph 5, first sentence, replace the words "medication and" with the following words: "and medication - which should be resorted to only when other interventions have failed - as well as".

Explanatory note

To bring the resolution in full compliance with the United Nations Convention on the Rights of the child, article 3 ("the best interests of the child shall be a primary consideration") and article 24 (on the "right of the child to the enjoyment of the highest attainable standard of health").

6The Assembly therefore calls on the Council of Europe member States to:
6.1address the risk factors for misdiagnosis of ADHD, in particular by ensuring:
6.1.1adequate training of health-care professionals on the diagnosis and appropriate management of ADHD;

In the draft resolution, at the end of paragraph 6.1.1, add the following words: "applying the principle of less harmful and best interests of the child".

Explanatory note

To bring the resolution in full compliance with the United Nations Convention on the Rights of the child, article 3 ("the best interests of the child shall be a primary consideration") and article 24 (on the "right of the child to the enjoyment of the highest attainable standard of health").

6.1.2full compliance with diagnostic procedures provided for in national and international guidelines;

In the draft resolution, at the end of paragraph 6.1.2, add the following words: "ensuring that every condition and life situation that could cause the symptoms of ADHD is addressed and only if this has no result should the psychiatric diagnosis of ADHD be considered".

Explanatory note

To bring the resolution in full compliance with the United Nations Convention on the Rights of the child, article 3 ("the best interests of the child shall be a primary consideration") and article 24 (on the "right of the child to the enjoyment of the highest attainable standard of health").

6.2follow a comprehensive approach for the treatment of ADHD and ensure that psycho-stimulant drugs are used as a measure of last resort – and always in combination with other treatments – with priority given to behavioural interventions and academic support;
6.3carry out and/or finance research on environmental factors involved with ADHD and promote the introduction of early identification and intervention programmes, as well as independent and well-designed studies on ADHD treatment, with a focus on the following priority areas:
6.3.1short- and long-term outcomes of psycho-social treatments, as well as of other non-pharmacological treatments;
6.3.2long-term outcomes associated with psycho-stimulant medication, in particular long-term adverse effects of drugs on children;
6.4identify the underlying reasons for discrepancies in ADHD prevalence and treatment, and where relevant, tackle possible over- and under-diagnosis and undertreatment in this context;
6.5increase informed awareness and recognition of ADHD, in particular by educating parents and teachers about its diagnosis and treatment.

In the draft resolution, at the end of paragraph 6.5 add the following words: "and, if ADHD is identified in a child, ensure the principle of fully informed written consent is applied to the child in a language fitting to him or her and to his or her parents".

Explanatory note

To bring the resolution in full compliance with the United Nations Convention on the Rights of the child, article 3 ("the best interests of the child shall be a primary consideration") and article 24 (on the "right of the child to the enjoyment of the highest attainable standard of health").

7The Assembly also invites WHO to extensively disseminate the upcoming new edition of the International Classification of Diseases and use this as an opportunity to increase adherence to the proposed stricter criteria for the diagnosis of ADHD, based upon the latest scientific knowledge.