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Editorial |

The Difference Between Efficacy and Effectiveness Research in Studying Attention-Deficit/Hyperactivity Disorder

Mark L. Wolraich, MD
Arch Pediatr Adolesc Med. 1999;153(12):1220-1221. doi:10.1001/archpedi.153.12.1220.
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THE STUDY by Zito and colleagues1 in this issue of the ARCHIVES is a welcome first step in understanding the clinical use of stimulant medications in the treatment of attention-deficit/hyperactivity disorder (ADHD). The controversy about treatment with methylphenidate hydrochloride raised in the popular press2,3 continues despite the fact that ADHD and its treatment with stimulant medications and psychosocial interventions have been rigorously studied to a greater degree than any other mental disorder.4,5 The continued concern is the perception that too many children are being treated with stimulant medication.6 The evidence to date suggests that, while there may be inappropriate treatment with methylphenidate as implied by the wide variation in physician and local prescription rates,7 the variations include both undertreatment and overtreatment such that the prevalence of stimulant medication use does not exceed the most commonly accepted prevalence rates for the disorder.8,9 The study by Zito et al further substantiates these findings in that while they found a considerable increase in the number of children treated, the treatment prevalence within the practices was still within the most frequently cited prevalence range.8,9 It is actually similar to prevalence rates in a group of Iowa pediatricians and family practitioners from 1987.10

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