If only it was a matter of a lack of teaching. Keep in mind that children may be jerks both because they are jerks, and because they suffer from a condition that makes it harder for them to be mindful of things like social graces, taking turns, that people may not find it funny to make a weird noise in their face. So, trying harder to train children so may be generally effective, but it may also need to be set in the context of a broader therapeutic program for a subset of children.
As an aside, I forgot to mention earlier - medication may be employed with greater frequency because it is easier to do so, but also because often times HMOs and other insurance entities refuse to pay for psychological (i.e. therapy other than medication prescription) services for children who are “only” suffering from ADHD. Often times the clinician is put in the position of giving a diagnosis that may not be accurate, but will allow for treatment to occur, or seeing the child go without treatment (unless the parent can pay out of pocket). Yes, the first option is unethical, but I have seen it done.
In five years time, nobody will be talking about Ritalin anymore. There is a drug called Straterra , chemical name atomexine (not sure about either spelling), that will supplant Ritalin and Adderall and Concerta as well as their generic forms, in terms of prescriptions filled. This drug is the first in its therapeutic class to be categorized as non-addictive, which means that many pediatricians and family care docs will have no qualms about prescribing this to kids they feel might have ADD/ADHD. As far as the overdiagonising thing goes, it is still controversial and you can find many, many physicians who lean one way or the other so it can’t be answered right now. (IMHO)
It’s atomoxetine, and according to a MEDLINE search I just ran, there are a few good studies out there on it. One compared it to methylphenidate (Ritalin) head-to-head, and it was similarly effective. (It was an open-label study, but the drugs appear to be different enough that I doubt you could have blinded it.)
Don’t expect to see Straterra totally supplant the stimulant class. There is nothing about it that shows that it works any better or with any fewer side-effects than the stimulants. And the stimulants have a long track record of safety. It’s difference is that it works exclusively on the norepinepherine system, while most of the others are mixed dopamine and norepinepherine.
The advantage it has to the prescribing docs is that it is not the same level of a controlled substance. The stimulants are a hassle to prescribe: no refills allowed, fresh script written each month, no call in scripts, must be filled within 5 days, etc … This one can be written for more at a time and with refills. This is not a minor thing to our offices. But still not enough to motivate changing someone from something that works and that we know. I think most of us generalists will let the specialists develop some experience with this first. I think it will be third line for the rest of us for a while.
And BTW, not to knock cognitive therapy, but stimulants have been shown, in controlled double-blinded studies, to work. Therapy alone has never been shown to be effective. Which is not to say that meds are a panacea: the best approach is to get therapy when appropriate, to get learning disabilities addressed when present, and to medicate when indicated.