Researcher to be sacked after reporting high rates of ADHD
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《英国医生杂志》
A US researcher who said that doctors and psychologists may be overdiagnosing attention deficit hyperactivity disorder (ADHD) in children has been placed on administrative leave 搘ith intent to terminate?her employment. The move came after charges of scientific misconduct against her, and her computers have been seized.
Dr Gretchen LeFever, a clinical psychologist and associate professor in the department of paediatrics at the East Virginia Medical School, was notified that the school intends to terminate her employment with effect from the end of March.
Her work has been controversial. She first made headline news in 1999 when she reported that 8% to 10% of elementary school pupils in southeastern Virginia were being prescribed drugs for ADHD, a percentage two to three times the estimated national average (American Journal of Public Health 1999;89:1359-64).
Criticism grew after she published the results of a 2002 study showing that the prevalence of the disorder among children in grades 2 to 5 had risen to 17% (Psychology in the Schools 2002;39:63-71).
In December Gerald Pepe, interim dean of the medical school, wrote to Dr LeFever charging her with 搄eopardising the rights of children?and deviating from a research protocol.
Dr LeFever denies the charges and said she believes she is being sacked for reasons relating to her concern about widespread use of drugs. She said the charge that she jeopardised the rights of children arose during a multisite study in which parents and teachers filled out surveys about children and ADHD. The medical school抯 internal review board had ruled that such a study was 揺xempt?from consent requirements. It said consent was not needed because the board determined that 搒tudy subjects were the adults who answered the survey.?/p>
After the charges were made against Dr LeFever the medical school approached the Office of Human Research Protection for clarification and determined that both children and parents were participants and therefore her study was not exempt.
Dr LeFever said many similar studies had been carried out under an exempt status when parents filled out surveys about their children. 揑 clearly stated what I was doing, and the IRB approved everything I did. If there was a mistake, it was the IRB抯.?/p>
One of her main critics is Jeffrey Katz, a clinical psychologist in Virginia Beach and the local coordinator of the Children and Adults with Attention-Deficit/Hyperactivity Disorder group. Dr Katz questioned her claim that the condition had been diagnosed in 17% of children in grades 2 to 5.
He said, 揥hen somebody like Dr LeFever makes these claims that are apparently not based on good research, it minimises a very real problem. Parents won抰 bring their children in for evaluation, because they are afraid that medication will be automatically prescribed. They think it抯 a bad thing and the sole treatment. But medication can have significant benefits.?/p>
In May 2004 an anonymous whistleblower charged Dr LeFever with 搒cientific misconduct.?The whistleblower pointed out a discrepancy between Dr LeFever抯 published report of the wording of the survey question and the actual question used for her 2002 study. In the original survey parents were asked: 揇oes your child have attention or hyperactivity problems, known as ADD or ADHD??The published version of the question was 揌as your child been diagnosed with attention or hyperactivity problems known as ADD or ADHD??/p>
Dr LeFever counters that the difference in wording was a simple oversight resulting from repeated revision of the article. 揟he findings are validated by the rate of ADHD medication treatment,?she said. 揙f the children in our study with ADHD, 84% were on ADHD medication.?/p>
William Pelham, professor of psychology, paediatrics and psychiatry at the State University of New York, Stony Brook, dismissed the criticism of Dr LeFever over the wording of the survey question as 搑idiculous.?Dr Pelham, who is also a researcher in ADHD, said the wording used by Dr LeFever and her colleagues is 揷ommonplace?among researchers doing surveys. He added that drug companies?funding of community groups and research has created obstacles for experts who question the use of stimulants.
Julie Zito, associate professor of pharmacy and psychiatry at the University of Maryland, who reported in 2000 that preschool children as young as 2 to 4 years old were increasingly being prescribed stimulants (JAMA 2000;283:1025-30), said that the rise in the use of stimulant drugs is probably due to many factors, including wider diagnostic criteria, direct to consumer advertising, and advocacy for ADHD.
But Dr LeFever抯 detractors say the altered wording of her survey may have contributed to the high prevalence of ADHD that she reported. Tim Tjersland, a clinical psychologist in Virginia Beach, said he tried to verify Dr LeFever抯 findings for his doctoral thesis. 揥e could not replicate . When people say ADHD is overdiagnosed, that抯 a very severe and serious accusation.?/p>
David Antonuccio, a professor of psychiatry and behavioural sciences at the University of Nevada School of Medicine, said, 揟his is a case of shooting the messenger. Dr LeFever has since been vindicated by recent CDC data and other studies showing alarming increases in the use of psychotropic drugs in children.?/p>
Officials at the medical school would only confirm that Dr LeFever is on administrative leave but did not respond to other questions about her pending termination.(Jeanne Lenzer)
Dr Gretchen LeFever, a clinical psychologist and associate professor in the department of paediatrics at the East Virginia Medical School, was notified that the school intends to terminate her employment with effect from the end of March.
Her work has been controversial. She first made headline news in 1999 when she reported that 8% to 10% of elementary school pupils in southeastern Virginia were being prescribed drugs for ADHD, a percentage two to three times the estimated national average (American Journal of Public Health 1999;89:1359-64).
Criticism grew after she published the results of a 2002 study showing that the prevalence of the disorder among children in grades 2 to 5 had risen to 17% (Psychology in the Schools 2002;39:63-71).
In December Gerald Pepe, interim dean of the medical school, wrote to Dr LeFever charging her with 搄eopardising the rights of children?and deviating from a research protocol.
Dr LeFever denies the charges and said she believes she is being sacked for reasons relating to her concern about widespread use of drugs. She said the charge that she jeopardised the rights of children arose during a multisite study in which parents and teachers filled out surveys about children and ADHD. The medical school抯 internal review board had ruled that such a study was 揺xempt?from consent requirements. It said consent was not needed because the board determined that 搒tudy subjects were the adults who answered the survey.?/p>
After the charges were made against Dr LeFever the medical school approached the Office of Human Research Protection for clarification and determined that both children and parents were participants and therefore her study was not exempt.
Dr LeFever said many similar studies had been carried out under an exempt status when parents filled out surveys about their children. 揑 clearly stated what I was doing, and the IRB approved everything I did. If there was a mistake, it was the IRB抯.?/p>
One of her main critics is Jeffrey Katz, a clinical psychologist in Virginia Beach and the local coordinator of the Children and Adults with Attention-Deficit/Hyperactivity Disorder group. Dr Katz questioned her claim that the condition had been diagnosed in 17% of children in grades 2 to 5.
He said, 揥hen somebody like Dr LeFever makes these claims that are apparently not based on good research, it minimises a very real problem. Parents won抰 bring their children in for evaluation, because they are afraid that medication will be automatically prescribed. They think it抯 a bad thing and the sole treatment. But medication can have significant benefits.?/p>
In May 2004 an anonymous whistleblower charged Dr LeFever with 搒cientific misconduct.?The whistleblower pointed out a discrepancy between Dr LeFever抯 published report of the wording of the survey question and the actual question used for her 2002 study. In the original survey parents were asked: 揇oes your child have attention or hyperactivity problems, known as ADD or ADHD??The published version of the question was 揌as your child been diagnosed with attention or hyperactivity problems known as ADD or ADHD??/p>
Dr LeFever counters that the difference in wording was a simple oversight resulting from repeated revision of the article. 揟he findings are validated by the rate of ADHD medication treatment,?she said. 揙f the children in our study with ADHD, 84% were on ADHD medication.?/p>
William Pelham, professor of psychology, paediatrics and psychiatry at the State University of New York, Stony Brook, dismissed the criticism of Dr LeFever over the wording of the survey question as 搑idiculous.?Dr Pelham, who is also a researcher in ADHD, said the wording used by Dr LeFever and her colleagues is 揷ommonplace?among researchers doing surveys. He added that drug companies?funding of community groups and research has created obstacles for experts who question the use of stimulants.
Julie Zito, associate professor of pharmacy and psychiatry at the University of Maryland, who reported in 2000 that preschool children as young as 2 to 4 years old were increasingly being prescribed stimulants (JAMA 2000;283:1025-30), said that the rise in the use of stimulant drugs is probably due to many factors, including wider diagnostic criteria, direct to consumer advertising, and advocacy for ADHD.
But Dr LeFever抯 detractors say the altered wording of her survey may have contributed to the high prevalence of ADHD that she reported. Tim Tjersland, a clinical psychologist in Virginia Beach, said he tried to verify Dr LeFever抯 findings for his doctoral thesis. 揥e could not replicate . When people say ADHD is overdiagnosed, that抯 a very severe and serious accusation.?/p>
David Antonuccio, a professor of psychiatry and behavioural sciences at the University of Nevada School of Medicine, said, 揟his is a case of shooting the messenger. Dr LeFever has since been vindicated by recent CDC data and other studies showing alarming increases in the use of psychotropic drugs in children.?/p>
Officials at the medical school would only confirm that Dr LeFever is on administrative leave but did not respond to other questions about her pending termination.(Jeanne Lenzer)