P1: GYK/GXN/GKJ P2: GNI Clinical Child and Family Psychology Review (CCFP) PP491-373699 April 30, 2002 14:49 Style file version Nov. 07, 2000 Clinical Child and Family Psychology Review, Vol. 5, No. 2, June 2002 (C 2002) International Consensus Statement on ADHD January 2002 We, the undersigned consortium of international issued by an independent consortium of leading sci- scientists, are deeply concerned about the periodic entists concerning the status of the disorder. Among inaccurate portrayal of attention deficit hyperactivity scientists who have devoted years, if not entire careers, disorder (ADHD) in media reports. This is a disorder to the study of this disorder there is no controversy with which we are all very familiar and toward which regarding its existence. many of us have dedicated scientific studies if not en- tire careers. We fear that inaccurate stories rendering ADHD as myth, fraud, or benign condition may cause ADHD and Science thousands of sufferers not to seek treatment for their disorder. It also leaves the public with a general sense We cannot overemphasize the point that, as a that this disorder is not valid or real or consists of a matter of science, the notion that ADHD does not rather trivial affliction. exist is simply wrong. All of the major medical as- We have created this consensus statement on sociations and government health agencies recognize ADHD as a reference on the status of the scientific ADHD as a genuine disorder because the scientific findings concerning this disorder, its validity, and its evidence indicating it is so overwhelming. adverse impact on the lives of those diagnosed with Various approaches have been used to establish the disorder as of this writing (January 2002). whether a condition rises to the level of a valid medical Occasional coverage of the disorder casts the or psychiatric disorder. A very useful one stipulates story in the form of a sporting event with evenly that there must be scientifically established evidence matched competitors. The views of a handful of that those suffering the condition have a serious de- nonexpert doctors that ADHD does not exist are ficiency in or failure of a physical or psychological contrasted against mainstream scientific views that it mechanism that is universal to humans. That is, all does, as if both views had equal merit. Such attempts humans normally would be expected, regardless of at balance give the public the impression that there culture, to have developed that mental ability. is substantial scientific disagreement over whether And there must be equally incontrovertible ADHD is a real medical condition. In fact, there is no scientific evidence that this serious deficiency leads to such disagreement—at least no more so than there is harm to the individual. Harm is established through over whether smoking causes cancer, for example, or evidence of increased mortality, morbidity, or im- whether a virus causes HIV/AIDS. pairment in the major life activities required of one’s The U.S. Surgeon General, the American Med- developmental stage in life. Major life ctivities are ical Association, the American Psychiatric Associa- those domains of functioning such as education, social tion, the American Academy of Child and Adolescent relationships, family functioning, independence and Psychiatry, the American Psychological Association, self-sufficiency, and occupational functioning that all and the American Academy of Pediatrics, among oth- humans of that developmental level are expected to ers, all recognize ADHD as a valid disorder. Although perform. some of these organizations have issued guidelines As attested to by the numerous scientists sign- for evaluation and management of the disorder for ing this document, there is no question among the their membership, this is the first consensus statement world’s leading clinical researchers that ADHD in- volves a serious deficiency in a set of psychologi- cal abilities and that these deficiencies pose serious Address all correspondence to Russell A. Barkley, PhD, Depart- ment of Psychiatry and Neurology, University of Massachusetts harm to most individuals possessing the disorder. Cur- Medical School, 55 Lake Avenue North, Worcester, Massachusetts rent evidence indicates that deficits in behavioral in- 01655; e-mail: [email protected]. hibition and sustained attention are central to this 89 1096-4037/02/0600-0089/0 C 2002 Plenum Publishing Corporation P1: GYK/GXN/GKJ P2: GNI Clinical Child and Family Psychology Review (CCFP) PP491-373699 April 30, 2002 14:49 Style file version Nov. 07, 2000 90 International Consensus Statement on ADHD disorder—facts demonstrated through hundreds of This is why leading international scientists, such scientific studies. And there is no doubt that ADHD as the signers below, recognize the mounting evi- leads to impairments in major life activities, including dence of neurological and genetic contributions to social relations, education, family functioning, occu- this disorder. This evidence, coupled with countless pational functioning, self-sufficiency, and adherence studies on the harm posed by the disorder and hun- to social rules, norms, and laws. Evidence also indi- dreds of studies on the effectiveness of medication, cates that those with ADHD are more prone to phys- buttresses the need in many, though by no means ical injury and accidental poisonings. This is why no all, cases for management of the disorder with mul- professional medical, psychological, or scientific or- tiple therapies. These include medication combined ganization doubts the existence of ADHD as a legiti- with educational, family, and other social accommo- mate disorder. dations. This is in striking contrast to the wholly un- The central psychological deficits in those with scientific views of some social critics in periodic media ADHD have now been linked through numerous accounts that ADHD constitutes a fraud, that medi- studies using various scientific methods to several cating those afflicted is questionable if not reprehen- specific brain regions (the frontal lobe, its connec- sible, and that any behavior problems associated with tions to the basal ganglia, and their relationship to ADHD are merely the result of problems in the home, the central aspects of the cerebellum). Most neuro- excessive viewing of TV or playing of video games, logical studies find that as a group those with ADHD diet, lack of love and attention, or teacher/school have less brain electrical activity and show less reac- intolerance. tivity to stimulation in one or more of these regions. ADHD is not a benign disorder. For those it And neuro-imaging studies of groups of those with afflicts, ADHD can cause devastating problems. ADHD also demonstrate relatively smaller areas of Follow-up studies of clinical samples suggest that suf- brain matter and less metabolic activity of this brain ferers are far more likely than normal people to drop matter than is the case in control groups used in these out of school (32–40%), to rarely complete college studies. (5–10%), to have few or no friends (50–70%), to un- These same psychological deficits in inhibition derperform at work (70–80%), to engage in antiso- and attention have been found in numerous studies cial activities (40–50%), and to use tobacco or illicit of identical and fraternal twins conducted across var- drugs more than normal. Moreover, children grow- ious countries (US, Great Britain, Norway, Australia, ing up with ADHD are more likely to experience etc.) to be primarily inherited. The genetic contribu- teen pregnancy (40%) and sexually transmitted dis- tion to these traits is routinely found to be among the eases (16%), to speed excessively and have multiple highest for any psychiatric disorder (70–95% of trait car accidents, to experience depression (20–30%) and variation in the population), nearly approaching the personality disorders (18–25%) as adults, and in hun- genetic contribution to human height. One gene has dreds of other ways mismanage and endanger their recently been reliably demonstrated to be associated lives. with this disorder and the search for more is underway Yet despite these serious consequences, studies by more than 12 different scientific teams worldwide indicate that less than half of those with the disorder at this time. are receiving treatment. The media can help sub- Numerous studies of twins demonstrate that fam- stantially to improve these circumstances. It can do ily environment makes no significant separate contri- so by portraying ADHD and the science about it bution to these traits. This is not to say that the home as accurately and responsibly as possible while not environment, parental management abilities, stressful purveying the propaganda of some social critics and life events, or deviant peer relationships are unimpor- fringe doctors whose political agenda would have you tant or have no influence on individuals having this and the public believe there is no real disorder here. disorder, as they certainly do. Genetic tendencies are To publish stories that ADHD is a fictitious disorder expressed in interaction with the environment. Also, or merely a conflict between today’s Huckleberry those having ADHD often have other associated dis- Finns and their caregivers is tantamount to declaring orders and problems, some of which are clearly re- the earth flat, the laws of gravity debatable, and the lated to their social environments. But it is to say that periodic table in chemistry a fraud. ADHD should be the underlying psychological deficits that comprise depicted in the media as realistically and accurately ADHD itself are not solely or primarily the result as it is depicted in science—as a valid disorder having of these environmental factors. varied and substantial adverse impact on those who P1: GYK/GXN/GKJ P2: GNI Clinical Child and Family Psychology Review (CCFP) PP491-373699 April 30, 2002 14:49 Style file version Nov. 07, 2000 International Consensus Statement on ADHD 91 may suffer from it through no fault of their own or Avi Sadeh, DSc their parents and teachers.