ADHD Researcher Helping Japan Implement Programs

BUFFALO, N.Y. -- A leading ADHD researcher from the University at Buffalo is consulting with mental-health experts and physicians in Japan who are developing the first programs for children with attention deficit hyperactivity disorder in that country, where treatment of ADHD in children has become a national health-care priority.

William Pelham, Jr., University at Buffalo distinguished professor of psychology, pediatrics and psychiatry, is traveling this month to Japan to meet with physicians and psychiatrists responsible for developing comprehensive ADHD treatment guidelines for Japan's Ministry of Health and Labor, which plans to make the guidelines available to physicians, mental-health practitioners, teachers and parents by the year's end.

Pelham's nationally regarded Summer Treatment Program for children with ADHD, based at UB, was implemented over the summer at Japan's Kurume University, with the assistance of two of Pelham's veteran staff members. Next year it will start up in locations throughout the city of Kurume. The program provides intensive behavioral therapy in a summer camp setting for children with ADHD.

The program in Kurume was directed by Yushiro Yamashita, M.D., professor of pediatrics at Kurume University and a member of the committee developing Japan's new ADHD guidelines. Yamashita spent a month in Buffalo in the summer of 2003 learning about the program in order to establish it in Japan, and Pelham spent two weeks in Japan last fall following up on Yamashita's visit.

Pelham says he hopes his work in Japan will help create a treatment environment -- unlike that which has evolved in the United States -- where behavior therapy is as accessible as medication and medication is not over prescribed. His trip to Japan is supported by the Japan Foundation for Aging and Health.

An outspoken critic of the overuse of medication to treat ADHD in the U.S., Pelham's research has shown that behavior therapy, when used by itself or in combination with small doses of medication, is more effective and carries lower risks of long-term side effects than ADHD medication when used alone.

"ADHD medication is just beginning to be used in Japan," says Pelham, who helped develop Concerta and who has conducted many other trials involving other stimulant drugs. "My impression is the non-pharmaceutical interventions are preferred at every level of society in Japan.

"Even in the U.S., parents are willing to use medication if it is necessary, but they prefer to use non-pharmacological approaches such as behavior modification first," he says.

According to Yamashita, the push for new ADHD treatments in Japan comes as diagnosis of the disorder has increased in Japan over the past decade, but the number of psychiatrists, psychologists and pediatric neurologists trained to treat ADHD has remained stagnant.

"There is growing awareness of ADHD in Japan, not only in the field of medicine but in the field of education," he says. "More and more children are being diagnosed, but there are only 200 child psychiatrists and about 300 pediatric neurologists who see children with developmental disorders in Japan.

"I am sure that the comprehensive Summer Treatment Program in Buffalo will be just as beneficial for children with ADHD and parents in Japan," Yamashita adds. "If we could run the program in several places in Japan, collaboration among teachers, teachers, doctors and psychologists will be promoted, and we can provide training for undergraduate students."

According to Yamashita, methylphenidate (MPH), the stimulant used in popular ADHD drugs Concerta and Ritalin, has not yet been approved for use in Japan, and behavior-modification therapies are not covered by national insurance. Clinical trials of Concerta, however, recently were completed and approval for the drug from the Japanese government is expected very soon. The first trial of Concerta in children in the U.S., where it is the top-selling ADHD medication, was conducted by Pelham's laboratory at UB.

Much of the pressure to make ADHD treatments available more readily is coming from a growing number of parent associations in Japan, according to Yamashita. The largest is the Edison Club, with more than 2,000 members.

"The parents who have difficulties at home wish to have whatever effective treatments are available," Yamashita explains. But he says he worries that once MPH becomes readily available in Japan, as in the U.S., it will be over-prescribed by doctors who don't have sufficient knowledge about ADHD, and that alternative treatments will not be as available to parents.

"Pharmacological therapy has its limitations," Yamashita says. "We need to establish behavior-modification therapy programs at home and in schools. We need comprehensive treatment of children with ADHD by a team of specialists."

Pelham says he is happy to play even a small role in helping his Japanese colleagues develop these interventions. "Hopefully, this will result in a more balanced approach to treatment of ADHD in Japan, avoiding the overmedication that has characterized U.S. treatment in recent years."