International Consensus Statement on ADHD - January 2002
Dr. Russell Barkley and 74 other prominent medical doctors and researchers in AD/HD
issued the following statement in January 2002.
We, the undersigned consortium of 75 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.
Russell A. Barkley, Ph.D., Professor, Depts. Of Psychiatry and Neurology, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655
Mina Dulcan, M.D., Professor, Department of Child and Adolescent Psychiatry, 2300 Children's Plaza #10, Children's Memorial Hospital, Chicago, IL 60614
Margot Prior, Ph.D., Professor, Department of Psychology, Royal Children's Hospital, Parkville, 3052 VIC, Australia
Christopher Gillberg, M.D., Professor, Department of Child and Adolescent Psychiatry, University of Gothenberg, Gothenberg, Sweden
Jeffrey Halperin, Ph.D., Professor, Department of Psychology, Queens College, CUNY 65-30 Kissena Ave., Flushing, NY 11367
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
John S. Werry, M.D., Professor, Emeritus Department of Psychiatry, University of Auckland, Auckland, New Zealand
Ronald T. Brown, Ph.D., Associate Dean, College of Health Professions, Professor of Pediatrics,
Medical University of South Carolina, 19 Hagood Avenue, P. O. Box 250822, Charleston, SC 29425
Arthur D. Anastopoulos, Ph.D., Professor, Co-Director of Clinical Training, Department of Psychology, University of North Carolina at Greensboro, P. O. Box 26164, Greensboro, NC 27402-6164
George J. DuPaul, Ph.D., Professor of School Psychology, Lehigh University, 111 Research Drive, Hilltop Campus, Bethlehem, PA 18015
Florence Levy, M.D., Associate Professor School of Psychiatry, University of New South Wales,
Avoca Clinic, Joynton Avenue, Zetland, NSW, 2017, Australia
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
Stephen Houghton, Ph.D., Professor of Psychology, Director, Centre for Attention & Related Disorders, The University of Western Australia, Perth, Australia
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, Trapelo Rd., 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
Stephen P. Hinshaw, Ph.D.,Professor, Department of Psychology, #1650 University of California at Berkeley, 3210 Tolman Hall, Berkeley, CA 94720-1650
Herbert Quay, Ph.D., Professor, Emeritus University of Miami, 2525 Gulf of Mexico Drive, #5C
Long Boat Key, FL 34228
John Piacentini, Ph.D., Associate Professor, Department of Psychiatry, UCLA Neuropsychiatric Institute, 760 Westwood Plaza, 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, 550 First Avenue, New York, NY 10016
Keith McBurnett, Ph.D., Associate Professor, Department of Psychiatry, University of California at San Francisco Children's Center at Langley Porter, 401 Parnassus Avenue, Box 0984, San Francisco, CA 94143
Linda Pfiffner, Ph.D., Associate Professor, Department of Psychiatry, University of California at San Francisco Children's Center at Langley Porter, 401 Parnassus Avenue, Box 0984, San Francisco, CA 94143
Oscar Bukstein, M.D.,Associate Professor, Department of Psychiatry, Western Psychiatric Institute and Clinic, 3811 O'Hara Street, Pittsburgh, PA 15213
Ken C. Winters, Ph.D., 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
Mezes 330, 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, 840 S. Wood Street,Chicago, IL 60612
Jan Loney, Ph.D., Professor, Emeritus State University of New York at Stony Brook Lodge Associates (Box 9), Mayslick, KY 41055
Harold S. Koplewicz,M.D., Arnold and Debbie Simon Professor of Child and Adolescent Psychiatry and Director of the NYU Child Study Center
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, 1051 Riverside Drive, New York, NY 10032
Eric J. Mash, Ph.D., Professor, Department of Psychology,University of Calgary,2500 University Drive N.W., Calgary, Alberta T2N 1N4
Russell Schachar, M.D.,Professor of Psychiatry, Hospital for Sick Children, 555 University Avenue, 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
Mark. D. Rapport, Ph.D., Professor and Director of Clinical Training, Department of Psychology,
P.O. Box 161390, University of Central Florida, Orlando, Florida 32816-1390
Bruce Pennington, Ph.D., Professor, Department of Psychology, University of Denver, 2155 South Race Street, Denver, CO 80208
Anita Thapar MB BCh, MRCPsych, PhD, 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, Ph.D., Associate Professor, Department of Psychology, University of Wisconsin - Milwaukee, Milwaukee, WI 53201
Stephen Shapiro, Ph.D., 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
Bennett L. Leventhal, M.D., 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, 3811 O'Hara Street
Pittsburgh, PA 15213
Sheila Eyberg, PhD, ABPP, Professor of Clinical &Health Psychology, Box 100165, 1600 SW Archer Blvd.,University of Florida, Gainesville, FL 32610
Rob McGee,PhD, 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, Los Angeles, CA 90024
William Pelham, Jr., Ph.D., Professor of Psychology, Center Children and Families State University of New York at Buffalo, 318 Diefendorf Hall, 3435 Main Street, Building 20
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
Thomas M. Lock, M.D., Associate Professor of Clinical Pediatrics, Acting Chief, Division of Developmental Pediatrics and Rehabilitation, Acting Director, Robert Warner Rehabilitation Center, State University of New York at Buffalo School of Medicine and Biomedical Sciences, 936 Delaware Ave., Buffalo, NY 14209
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