January 2002
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,
Russell A. Barkley, Ph.D.
Professor
Depts. Of Psychiatry and Neurology
University of Massachusetts Medical School
55 Lake Avenue North
Worcester, MA 01655 ,
Edwin H. Cook, Jr., M.D.
Professor
Departments of Psychiatry and Pediatrics
University of Chicago
5841 S. Maryland Ave.
Chicago, IL
Mina Dulcan, M.D.
Professor
Department of Child and Adolescent Psychiatry
2300 Children’s Plaza #10
Children’s Memorial Hospital
Chicago, IL 60614
Susan Campbell, Ph.D.
Professor
Department of Psychology
4015 O’Hara Street
University of Pittsburgh
Pittsburgh, PA 15260
Margot Prior, Ph.D.
Professor
Department of Psychology
Royal Children’s Hospital
Parkville, 3052 VIC
Australia
Marc Atkins, Ph.D.
Associate Professor
University of Illinois at Chicago
Institute for Juvenile Research
Department of Psychiatry
840 South Wood Street, Suite 130
Chicago, IL 60612-7347
Christopher Gillberg, M.D.
Professor
Department of Child and Adolescent Psychiatry
University of Gothenburg
Gothenburg, Sweden
Mary Solanto-Gardner, Ph.D.
Associate Professor
Division of Child and Adolescent Psychiatry
The Mt. Sinai Medical Center
One Gustave L. Levy Place
New York, NY 10029-6574
Jeffrey Halperin, Ph.D.
Professor,
Department of Psychology
Queens College, CUNY
65-30 Kissena Ave.
Flushing, NY 11367
Jose J. Bauermeister, Ph.D.
Professor,
Department of Psychology
University of Puerto Rico
San Juan, PR 00927
Steven R. Pliszka, M.D.
Associate Professor and Chief
Division of Child and Adolescent Psychiatry
University of Texas Health Sciences Center
7703 Floyd Curl Drive
San Antonio, TX 78229-3900
Mark A. Stein, Ph.D.
Chair of Psychology
Children’s National Medical Center and
Professor of Psychiatry & Pediatrics
George Washington Univ. Med. School
111 Michigan Ave. NW
Washington, DC 20010
John S. Werry, M.D.
Professor Emeritus
Department of Psychiatry
University of Auckland
Auckland, New Zealand
Joseph Sergeant, Ph.D.
Chair of Clinical Neuropsychology
Free University
Van der Boecharst Straat 1
De Boelenlaan 1109
1018 BT Amsterdam
The Netherlands
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Associate Dean, College of Health Professions
Professor of Pediatrics
Medical University of South Carolina
19 Hagood Avenue
P. O. Box 250822
Charleston, SC 29425
Alan Zametkin, M.D.
Child Psychiatrist
Kensington, MD
Arthur D. Anastopoulos, Ph.D.
Professor, Co-Director of Clinical Training
Department of Psychology
University of North Carolina at Greensboro
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Greensboro, NC 27402-6164
James J. McGough, M.D.
Associate Professor of Clinical Psychiatry
UCLA School of Medicine
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Los Angeles, CA 90024
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Professor of School Psychology
Lehigh University
111 Research Drive, Hilltop Campus
Bethlehem, PA 18015
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Associate Professor of Psychology
Harvard University
750 Washington St., Suite 255
South Easton, MA 02375
Florence Levy, M.D.
Associate Professor
School of Psychiatry
University of New South Wales
Avoca Clinic
Joynton Avenue
Zetland, NSW, 2017, Australia
Mariellen Fischer, Ph.D.
Professor,
Department of Neurology
Medical College of Wisconsin
9200 W. Wisconsin Avenue
Milwaukee, WI 53226
Joseph Biederman, M.D.
Professor and Chief
Joint Program in Pediatric Psychopharmacology
Massachusetts General Hospital and
Harvard Medical School
15 Parkman St., WACC725
Boston, MA 02114
Cynthia Hartung, Ph.D.
Assistant Professor
Oklahoma State University
215 North Murray
Stillwater, OK 74078
Stephen Houghton, Ph.D.
Professor of Psychology
Director, Centre for Attention & Related Disorders
The University of Western Australia
Perth, Australia
Gabrielle Carlson, M.D.
Professor and Director,
Division of Child and Adolescent Psychiatry
State University of New York at Stony Brook, Putnam Hall
Stony Brook, NY 11794
Charlotte Johnston, Ph.D.
Professor
Department of Psychology
University of British Columbia
2136 West Mall
Vancouver, BC, Canada V6T 1Z4
Thomas Spencer, M.D.
Associate Professor and Assistant Director, Pediatric Psychopharmacology
Harvard Medical School and
Massachusetts General Hospital
15 Parkman St., WACC725
Boston, MA 02114
Thomas Joiner, Ph.D.
The Bright-Burton Professor of Psychology
Florida State University
Tallahassee, FL 32306-1270
Rosemary Tannock, Ph.D.
Professor of Psychiatry,
Brain and Behavior Research
Hospital for Sick Children
55 University Avenue
Toronto, Ontario, Canada M5G 1X8
Adele Diamond, Ph.D.
Professor of Psychiatry
Director, Center for Developmental Cognitive Neuroscience
University of Massachusetts Medical School
Shriver Center
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Waltham, MA
Carol Whalen, Ph.D.
Professor
Department of Psychology and Social Behavior
University of California at Irvine
3340 Social Ecology II
Irvine, CA 02215
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Professor,
Department of Psychology #1650
University of California at Berkeley
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Berkeley, CA 94720-1650
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Professor Emeritus
University of Miami
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Long Boat Key, FL 34228
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Associate Professor
Department of Psychiatry
UCLA Neuropsychiatric Institute
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Los Angeles, CA 90024-1759
Philip Firestone, Ph.D.
Professor
Departments of Psychology & Psychiatry
University of Ottawa
120 University Priv.
Ottawa, Canada K1N 6N5
Salvatore Mannuzza, M.D.
Research Professor of Psychiatry
New York University School of Medicine
550 First Avenue
New York, NY 10016
Howard Abikoff, Ph.D.
Pevaroff Cohn Professor of Child and Adolescent Psychiatry
NYU School of Medicine
Director of Research
NYU Child Study Center
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Associate Professor
Department of Psychiatry
University of California at San Francisco
Children’s Center at Langley Porter
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Associate Professor
Department of Psychiatry
University of California at San Francisco
Children’s Center at Langley Porter
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Associate Professor
Department of Psychiatry
Western Psychiatric Institute and Clinic
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Pittsburgh, PA 15213
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Associate Professor
Director, Center for Adolescent
Substance Abuse Research
Department of Psychiatry
University of Minnesota
F282/2A West, 2450 Riverside Ave.
Minneapolis, MN 55454
Michelle DeKlyen, Ph.D.
Office of Population Research
Princeton University
286 Wallace
Princeton, NJ 08544
Lily Hechtman M.D. F.R.C.P.
Professor of Psychiatry and Pediatrics,
Director of Research,
Division of Child Psychiatry,
McGill University, and
Montreal Childrens Hospital.
4018 St. Catherine St. West.,
Montreal, Quebec, Canada. H3Z-1P2
Caryn Carlson, Ph.D.
Professor
Department of Psychology
University of Texas at Austin
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Austin, TX 78712
Donald R. Lynam, Ph.D.
Associate Professor
University of Kentucky
Department of Psychology
125 Kastle Hall
Lexington, KY 40506-0044
Patrick H. Tolan Ph.D.
Director, Institute for Juvenile Research
Professor, Department of Psychiatry
University of Illinois at Chicago
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Professor Emeritus
State University of New York at Stony Brook
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Arnold and Debbie Simon Professor of Child and Adolescent
Psychiatry and Director of the NYU Child Study Center
New York, NY
Richard Milich, Ph.D.
Professor of Psychology
Department of Psychology
University of Kentucky
Lexington, KY 40506-0044
Laurence Greenhill, M.D.
Professor of Clinical Psychiatry
Columbia University
Director, Research Unit on Pediatric Psychopharmacology
New York State Psychiatric Institute
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Professor
Department of Psychology
University of Calgary
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Calgary, Alberta T2N 1N4
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Professor of Psychiatry
Hospital for Sick Children
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Toronto, Ontario
Canada M5G 1X8
Eric Taylor
Professor of Psychiatry
Institute of Psychiatry
London, England
Betsy Hoza, Ph.D.
Associate Professor
Department of Psychology, #1364
Purdue University
West Lafayette, IN 47907-1364
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Professor and Director of Clinical Training
Department of Psychology
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University of Central Florida
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Professor
Department of Psychology
University of Denver
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Denver, CO 80208
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Professor,
Child and Adolescent Psychiatry Section
Dept of Psychological Medicine
University of Wales College of Medicine
Heath Park, Cardiff
CF14 4XN United Kingdom
Ann Teeter, Ed.D.
Director of Training, School Psychology
University of Wisconsin – Milwaukee
Milwaukee, WI 53201
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Department of Psychology
Auburn University
226 Thach
Auburn, AL 36849-5214
Avi Sadeh, D.Sc
Director, Clinical Child Psychology Graduate Program
Director, The Laboratory for Children's Sleep Disorders
Department of Psychology
Tel-Aviv University
Ramat Aviv, Tel Aviv 69978
ISRAEL
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Irving B. Harris Professor of Child and Adolescent Psychiatry
Director, Child & Adolescent Psychiatry
Vice Chairman, Dept. of Psychiatry
The University of Chicago
5841 S. Maryland Ave.
Chicago, IL 60637
Hector R. Bird, M.D.
Professor of Clinical Psychiatry
Columbia University
College of Physicians and Surgeons
1051 Riverside Drive (Unit 78)
New York, NY 10032
Carl E. Paternite, Ph.D.
Professor of Psychology
Miami University
Oxford, OH 45056
Mary A. Fristad, PhD, ABPP
Professor, Psychiatry & Psychology
Director, Research & Psychological Services
Division of Child & Adolescent Psychiatry
The Ohio State University
1670 Upham Drive Suite 460G
Columbus, OH 43210-1250
Brooke Molina, Ph.D.
Assistant Professor of Psychiatry and Psychology
Western Psychiatric Institute and Clinic
University of Pittsburgh School of Medicine
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Pittsburgh, PA 15213
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Professor of Clinical &Health Psychology
Box 100165
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University of Florida
Gainesville, FL 32610
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Associate Professor,
Department of Preventive & Social Medicine,
University of Otago Medical School,
Box 913 Dunedin,
New Zealand.
Terri L. Shelton, Ph.D.
Director
Center for the Study of Social Issues
University of North Carolina – Greensboro
Greensboro, NC 27402
Steven W. Evans, Ph.D.
Associate Professor of Psychology
MSC 1902
James Madison University
Harrisonburg, VA 22807
Sandra K. Loo, Ph.D.
Research Psychologist
University of California, Los Angeles
Neuropsychiatric Institute
760 Westwood Plaza, Rm 47-406
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William Pelham, Jr., Ph.D.
Professor of Psychology
Center Children and Families
State University of New York at Buffalo
318 Diefendorf Hall
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Buffalo, NY 14214
J. Bart Hodgens, Ph.D.
Clinical Assistant Professor
of Psychology and Pediatrics
Civitan International Research Center
University of Alabama at Birmingham
Birmingham, AL 35914
Terje Sagvolden, Ph.D.
Professor
Department of Physiology
University of Oslo
N-0316 Oslo, Norway
Thomas E. Brown, Ph.D.
Asst. Professor
Dept. of Psychiatry
Yale University School of Medicine
New Haven, CT
Daniel F. Connor, M.D.
Associate Professor
Department of Psychiatry
University of Massachusetts Medical School
55 Lake Avenue North
Worcester, MA 01655
Daniel A. Waschbusch, Ph.D.
Assistant Professor of Psychology
Director, Child Behaviour Program
Department of Psychology
Dalhousie University
Halifax, NS B3H 4R1 CANADA
Kevin R. Murphy, Ph.D.
Assistant Professor
Dept. of Psychiatry
University of Massachusetts Medical School
55 Lake Avenue North
Worcester, MA 01655
Michael Aman, Ph.D.
Professor of Psychology and Psychiatry
The Nisonger Center
Ohio State University
1581 Dodd Drive
Columbus, Ohio, U.S.A.
Blythe Corbett, Ph.D.
M.I.N.D. Institute
University of California, Davis
4860 Y Street, Suite 3020
Sacramento, CA 95817
Deborah L. Anderson, Ph.D.
Assistant Professor
Department Pediatrics
Medical University of South Carolina
Charleston, SC 29425
Lisa L. Weyandt, Ph.D.
Professor, Dept. of Psychology
Central Washington University
400 East 8th Avenue
Ellensburg, WA 98926-7575
Michael Gordon, Ph.D.
Professor of Psychiatry
Director, Child & Adolescent Psychiatric Services, & Director, ADHD Program
SUNY Upstate Medical University
750 East Adams Street
Syracuse, NY 13210
Lawrence Lewandowski, Ph.D.
Meredith Professor of Teaching Excellence
Department of Psychology
Syracuse University
Syracuse, NY
Erik Willcutt, Ph.D.
Assistant Professor
Department of Psychology
Muenzinger Hall D-338
345 UCB
University of Colorado
Boulder, CO 80309
