In November 1998, the National Institutes of Health held a three and a half day
conference of non-advocate, non-federal experts with the goal of establishing a
professional consensus on a number of questions surrounding ADHD, including:
Over the course of two days, thirty-one experts presented their research
findings before the consensus panel and an audience of over 1,000. Then the
consensus panel, which consisted of 13 experts representing the fields of
psychology, psychiatry, neurology, pediatrics, epidemiology, biostatistics,
education, and the public, wrote and presented a draft of a consensus statement
to for discussion and refinement. Despite some criticism of the
consensus process, the final version remains the most comprehensive and
unbiased evaluation of ADHD and its treatments to date.
- What is the scientific evidence to support ADHD as a disorder?
- What is the impact of ADHD on individuals, families, and society?
- What are the effective treatments for ADHD?
- What are the risks of the use of stimulant medication and other
- What are the existing diagnostic and treatment practices, and what are the
barriers to appropriate identification, evaluation, and intervention?
- What are the directions for future research?
"Attention deficit hyperactivity disorder or ADHD is a commonly diagnosed
behavioral disorder of childhood that represents a costly major public health
problem. Children with ADHD have pronounced impairments and can experience
long-term adverse effects on academic performance, vocational success, and
social-emotional development which have a profound impact on individuals,
families, schools, and society. Despite progress in the assessment, diagnosis,
and treatment of ADHD, this disorder and its treatment have remained
controversial, especially the use of psychostimulants for both short- and
Although an independent diagnostic test for ADHD does not exist, there is
evidence supporting the validity of the disorder. Further research is
needed on the dimensional aspects of ADHD, as well as the comorbid (coexisting)
conditions present in both childhood and adult forms.
Studies (primarily short term, approximately 3 months), including randomized
clinical trials, have established the efficacy of stimulants and psychosocial
treatments for alleviating the symptoms of ADHD and associated aggressiveness
and have indicated that stimulants are more effective than psychosocial
therapies in treating these symptoms. Because of the lack of consistent
improvement beyond the core symptoms and the paucity of long-term studies
(beyond 14 months), there is a need for longer term studies with drugs and
behavioral modalities and their combination. Although trials are under way,
conclusive recommendations concerning treatment for the long term cannot be
There are wide variations in the use of psychostimulants across communities and
physicians, suggesting no consensus regarding which ADHD patients should be
treated with psychostimulants. These problems point to the need for improved
assessment, treatment, and followup of patients with ADHD. A more consistent
set of diagnostic procedures and practice guidelines is of utmost importance.
Furthermore, the lack of insurance coverage preventing the appropriate
diagnosis and treatment of ADHD and the lack of integration with educational
services are substantial barriers and represent considerable long-term costs
Finally, after years of clinical research and experience with ADHD, our
knowledge about the cause or causes of ADHD remains largely speculative.
Consequently, we have no documented strategies for the prevention of ADHD."
Read the whole Consensus Statement on the NIH web site.
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Abstracts of many of the conference presentations are available online from
about.com. Some that are particularly interesting:
||Overview of Attention Deficit Hyperactivity Disorder|
C. Keith Conners, Ph.D., M.A.
This introduction provides a brief history of ADHD and its changing
definitions, and highlights ongoing areas of research into treatment methods
and risk factors.|
||Biological Bases of Attention Deficit Hyperactivity Disorder: Neuroanatomy,
Genetics, and Pathophysiology|
James Swanson, Ph.D., and F. Xavier Castellanos, M.D.
A review of recent pivotal studies from neuroanatomy and molecular biology.|
Dr. Lawrence Greenhill reviews the research on the rates of stimulant
prescription, and the studies on short and long term efficacy and risks of the
||Is Attention Deficit Hyperactivity Disorder a Valid Disorder?|
William B. Carey, M.D.
Carey argues that ADHD as currently defined is not a valid disorder. He claims,
among other things, that ADHD symptoms are not clearly distinguishable from
normal temperament variations among children, and that the DSM-IV definition
mistakenly ignores the role of the child's environment in creating behavioral
||The Prevalence and Cross-Cultural Validity of Attention Deficit
Hector R. Bird, M.D.
This is a review of cross-cultural epidemiological studies. Despite the fact
that the rate of ADHD diagnosis rates vary widely--from 1 percent to 20 percent
of the population - among different cultures, the reviewers found that in
general, "the overall syndrome repeatedly shows high internal consistency
across settings. When behavior questionnaires are subjected to factor analytic
procedures, the results are invariably similar across cultural settings as
disparate as the United States, Italy, China, Germany, Brazil, and Thailand.
These analyses repeatedly show a syndrome that breaks down into two robust
factors of inattention and hyperactivity/impulsivity."|
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