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Resolution 2042 (2015) Final version
Ensuring comprehensive treatment for children with attention disorders
1. In 2000, concerned about the increasing
numbers of children being diagnosed with attention deficit hyperactivity
disorder (ADHD) and treated with psychostimulant 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.
2. The last decade was marked by a significant increase both
in the incidence of ADHD and the use of psychostimulants 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 under-treatment due
to the inadequate training of care providers, inequalities in access
to care as well as the stigma and misconceptions surrounding ADHD.
3. ADHD 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.
4. Research on the 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 that 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 non-existent. Similarly, compared to research
on genetic and biological factors in the aetiology of ADHD, research
on environmental aspects is less robust.
5. Today, 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 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.
6. The Assembly therefore calls on the Council of Europe member
States to:
6.1. address the risk
factors for misdiagnosis of ADHD, in particular by ensuring:
6.1.1. adequate training of health-care professionals on the
diagnosis and appropriate management of ADHD based on the principle
of the best interests of the child;
6.1.2. full compliance with diagnostic procedures provided for
in national and international guidelines;
6.2. follow a comprehensive approach for the treatment of ADHD
and ensure that psychostimulant 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;
6.3. carry 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:
6.3.1. short- and long-term outcomes of psychosocial
treatments, as well as of other non-pharmacological treatments;
6.3.2. long-term outcomes associated with psychostimulant medication,
in particular long-term adverse effects of drugs on children;
6.4. identify the underlying reasons for discrepancies in ADHD
prevalence and treatment, and where relevant, tackle possible over-
and under-diagnosis and under-treatment in this context;
6.5. increase informed awareness and recognition of ADHD, in
particular by educating parents and teachers about its diagnosis
and treatment.
7. The 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.