CMAJ/JAMC Letters
Correspondance

 

Signing up with ADD

CMAJ 1997;157:1513
Children and adolescents in whom attention deficit disorder (ADD) has been diagnosed1 and who have been managed medically, psychologically and behaviourally2,3 during their school years are restricted in their choice of careers, particularly in the armed forces.4

To be fair to these applicants, all aspects of their medical condition should be considered. This would involve a detailed investigation of the medical history and consultation with the applicant's physician, as well as aptitude and psychological testing. Such a comprehensive review might offer these applicants a better chance of a military career.

The causes, neuroanatomy, physiology and neurobiology of ADD are well understood.5­7 Family studies,8 long-term outcome studies, prognostic indicators and information about concomitant conditions have been thoroughly reviewed. All of these factors should be taken into consideration in deciding an applicant's suitability for the armed forces.

A few significant points to consider:

  • ADD is not diagnosed only in individuals under 12 years of age. It is a life-long disorder, the manifestations of which change with age.

  • Treatment of ADD in the form of medication, counselling and structured programs allows many affected individuals to do well.

  • There is a genetic predisposition to the development of ADD, and the disorder is 4 times more common in males than in females.9

  • Continuation of treatment such as pharmacotherapy and psychotherapy would help these individuals function efficiently within the armed forces.

Sujatha M. Lena, MD
Pediatrician/Adolescent Health
Clinic for Adolescents
Smyth Medical Centre
Ottawa, Ont.

References

  1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington: The Association; 1994.
  2. Wilens TE, Beiderman J. The stimulants. In: Shafer D, editor. The psychiatric clinics of North America. Philadelphia: WB Saunders; 1992. p. 191-222.
  3. Klein RG, Bessler AW. Stimulant side effects in children. In: Kane JM, Liebermann JA, editors. Adverse effects of psychotropic drugs. New York: Guildford Press; 1992. p. 470-96.
  4. Using Ritalin makes many unable to enlist in military. San Antonio Express News 1996 Nov 28; Sect. A:20.
  5. Castellanos FX, Giedd JN, Marsh WL, Hamburger SD, Vaituzis AC, Dickstein DP, et al. Quantitative brain magnetic resonance imaging in attention-deficit hyperactivity disorder. Arch Gen Psychiatry 1996;53(7):607-16.
  6. Castellanos FX, Giedd JN, Eckburg P, Marsh WL, Vaituzis AC, Kaysen D, et al. Quantitative morphology of the caudate nucleus in attention deficit hyperactivity disorder. Am J Psychiatry 1994;151:1791-6.
  7. Ernst M, Zametkin A. The interface of genetics, neuroimaging, and neurochemistry in ADHD. In: Bloom FE, Kupfer DJ, editors. Psychopharmacology: the 4th generation of progress. New York: Raven Press; 1995. p. 1643-52.
  8. Biederman J, Faroone SV, Keenan K, Knee D, Tsuang MT. Family -- genetic and psychosocial risk factors in DSM-III ADD. J Am Acad Child Adolesc Psychiatry 1990;29:526-33.
  9. Ratey JJ, Greenberg MS, Bemporad JR, et al. Unrecognised ADHD in adults presenting for out patient psychotherapy. J Child Adolesc Psychopharmacol 1992;2:267-75.

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| CMAJ December 1, 1997 (vol 157, no 11) / JAMC le 1er décembre 1997 (vol 157, no 11) |