ADHD Researcher Helping Japan Implement Programs

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.