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We, the undersigned
consortium of international scientists, are deeply
concerned about the periodic inaccurate portrayal
of attention deficit hyperactivity disorder (ADHD)
in media reports. This is a disorder with which we
are all very familiar and toward which many of us
have dedicated scientific studies if not entire
careers. We fear that inaccurate stories rendering
ADHD as myth, fraud, or benign condition may cause
thousands of sufferers not to seek treatment for
their disorder. It also leaves the public with a
general sense that this disorder is not valid or
real or consists of a rather trivial
affliction.
We have created this
consensus statement on ADHD as a reference on the
status of the scientific findings concerning this
disorder, its validity, and its adverse impact on
the lives of those diagnosed with the disorder as
of this writing (January 2002).
Occasional coverage of the
disorder casts the story in the form of a sporting
event with evenly matched competitors. The views of
a handful of non-expert doctors that ADHD does not
exist are contrasted against mainstream scientific
views that it does, as if both views had equal
merit. Such attempts at balance give the public the
impression that there is substantial scientific
disagreement over whether ADHD is a real medical
condition. In fact, there is no such disagreement
--at least no more so than there is over whether
smoking causes cancer, for example, or whether a
virus causes HIV/AIDS.
The U.S. Surgeon General, the
American Medical Association (AMA), the American
Psychiatric Association, the American Academy of
Child and Adolescent Psychiatry (AACAP), the
American Psychological Association, and the
American Academy of Pediatrics (AAP), among others,
all recognize ADHD as a valid disorder. While some
of these organizations have issued guidelines for
evaluation and management of the disorder for their
membership, this is the first consensus statement
issued by an independent consortium of leading
scientists concerning the status of the disorder.
Among scientists who have devoted years, if not
entire careers, to the study of this disorder there
is no controversy regarding its
existence.
ADHD and
Science
We cannot over emphasize the
point that, as a matter of science, the notion that
ADHD does not exist is simply wrong. All of the
major medical associations and government health
agencies recognize ADHD as a genuine disorder
because the scientific evidence indicating it is so
is overwhelming.
Various approaches have been
used to establish whether a condition rises to the
level of a valid medical or psychiatric disorder. A
very useful one stipulates that there must be
scientifically established evidence that those
suffering the condition have a serious deficiency
in or failure of a physical or psychological
mechanism that is universal to humans. That is, all
humans normally would be expected, regardless of
culture, to have developed that mental
ability.
And there must be equally
incontrovertible scientific evidence that this
serious deficiency leads to harm to the individual.
Harm is established through evidence of increased
mortality, morbidity, or impairment in the major
life activities required of one's developmental
stage in life. Major life activities are those
domains of functioning such as education, social
relationships, family functioning, independence and
self-sufficiency, and occupational functioning that
all humans of that developmental level are expected
to perform.
As attested to by the
numerous scientists signing this document, there is
no question among the world's leading clinical
researchers that ADHD involves a serious deficiency
in a set of psychological abilities and that these
deficiencies pose serious harm to most individuals
possessing the disorder. Current evidence indicates
that deficits in behavioral inhibition and
sustained attention are central to this disorder --
facts demonstrated through hundreds of scientific
studies. And there is no doubt that ADHD leads to
impairments in major life activities, including
social relations, education, family functioning,
occupational functioning, self-sufficiency, and
adherence to social rules, norms, and laws.
Evidence also indicates that those with ADHD are
more prone to physical injury and accidental
poisonings. This is why no professional medical,
psychological, or scientific organization doubts
the existence of ADHD as a legitimate
disorder.
The central psychological
deficits in those with ADHD have now been linked
through numerous studies using various scientific
methods to several specific brain regions (the
frontal lobe, its connections to the basal ganglia,
and their relationship to the central aspects of
the cerebellum). Most neurological studies find
that as a group those with ADHD have less brain
electrical activity and show less reactivity to
stimulation in one or more of these regions. And
neuro-imaging studies of groups of those with ADHD
also demonstrate relatively smaller areas of brain
matter and less metabolic activity of this brain
matter than is the case in control groups used in
these studies.
These same psychological
deficits in inhibition and attention have been
found in numerous studies of identical and
fraternal twins conducted across various countries
(US, Great Britain, Norway, Australia, etc.) to be
primarily inherited. The genetic contribution to
these traits is routinely found to be among the
highest for any psychiatric disorder (70-95% of
trait variation in the population), nearly
approaching the genetic contribution to human
height. One gene has recently been reliably
demonstrated to be associated with this disorder
and the search for more is underway by more than 12
different scientific teams worldwide at this
time.
Numerous studies of twins
demonstrate that family environment makes no
significant separate contribution to these traits.
This is not to say that the home environment,
parental management abilities, stressful life
events, or deviant peer relationships are
unimportant or have no influence on individuals
having this disorder, as they certainly do. Genetic
tendencies are expressed in interaction with the
environment. Also, those having ADHD often have
other associated disorders and problems, some of
which are clearly related to their social
environments. But it is to say that the underlying
psychological deficits that comprise ADHD itself
are not solely or primarily the result of these
environmental factors.
This is why leading
international scientists, such as the signers
below, recognize the mounting evidence of
neurological and genetic contributions to this
disorder. This evidence, coupled with countless
studies on the harm posed by the disorder and
hundreds of studies on the effectiveness of
medication, buttresses the need in many, though by
no means all, cases for management of the disorder
with multiple therapies. These include medication
combined with educational, family, and other social
accommodations. This is in striking contrast to the
wholly unscientific views of some social critics in
periodic media accounts that ADHD constitutes a
fraud, that medicating those afflicted is
questionable if not reprehensible, and that any
behavior problems associated with ADHD are merely
the result of problems in the home, excessive
viewing of TV or playing of video games, diet, lack
of love and attention, or teacher/school
intolerance.
ADHD is not a benign
disorder. For those it afflicts, ADHD can cause
devastating problems. Follow-up studies of clinical
samples suggest that sufferers are far more likely
than normal people to drop out of school (32-40%),
to rarely complete college (5-10%), to have few or
no friends (50-70%), to under perform at work
(70-80%), to engage in antisocial activities
(40-50%), and to use tobacco or illicit drugs more
than normal. Moreover, children growing up with
ADHD are more likely to experience teen pregnancy
(40%) and sexually transmitted diseases (16%), to
speed excessively and have multiple car accidents,
to experience depression (20-30%) and personality
disorders (18-25%) as adults, and in hundreds of
other ways mismanage and endanger their
lives.
Yet despite these serious
consequences, studies indicate that less than half
of those with the disorder are receiving treatment.
The media can help substantially to improve these
circumstances. It can do so by portraying ADHD and
the science about it as accurately and responsibly
as possible while not purveying the propaganda of
some social critics and fringe doctors whose
political agenda would have you and the public
believe there is no real disorder here. To publish
stories that ADHD is a fictitious disorder or
merely a conflict between today's Huckleberry Finns
and their caregivers is tantamount to declaring the
earth flat, the laws of gravity debatable, and the
periodic table in chemistry a fraud. ADHD should be
depicted in the media as realistically and
accurately as it is depicted in science -- as a
valid disorder having varied and substantial
adverse impact on those who may suffer from it
through no fault of their own or their parents and
teachers.
Sincerely,
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