November 16–18, 1998
National Institutes of Health

Introduction
(text-only version available)

Attention deficit hyperactivity disorder, or ADHD, is the most common behavioral disorder of childhood, estimated to affect 3 to 5 percent of school-age children. Its core symptoms include an inability to sustain attention and concentration; developmentally inappropriate levels of activity; distractibility; and impulsivity. Although some persons have suggested that ADHD is just normal childhood behavior, children with ADHD usually have pronounced difficulties and impairment resulting from the disorder across multiple settings—in home, at school, and with peers—as well as resultant long-term adverse effects on later academic, vocational, social-emotional, and psychiatric outcomes. The ADHD symptoms, degree of impairment, and longitudinal course form a coherent pattern from which well-trained clinicians can reliably diagnose ADHD at a level of accuracy that rivals or exceeds many other medical diagnostic and assessment procedures. Moreover, many clinical treatment studies of the condition have also been conducted, resulting in substantial evidence of efficacy for a variety of treatments. Despite the substantial progress in the assessment, diagnosis, and treatment of children and adults with ADHD, the disorder has remained controversial in many public and private sectors. The confusion resulting from diverse, frequently expressed opinions (often not based on research evidence) has made many families, health care providers, educators, and policymakers uncertain about the status of the disorder and its long-term consequences; whether it should be treated and, if so, how; which treatments yield the best outcomes; and what the personal, family, and societal costs and consequences of the disorder are, whether treated or not. One of the major controversies regarding ADHD concerns the use of psychostimulants to treat the condition. Psychostimulants, including dextroamphetamine, methylphenidate, and pemoline, are by far the most widely researched, clinically effective, and commonly prescribed treatments for ADHD. These medications are regarded by many in the medical community as the psychopharmacologic treatment of choice for ADHD. The use of methylphenidate and amphetamine nationwide has increased significantly in recent years. The increased availability and use of psychostimulants have intensified the concerns about use, overuse, and abuse. This 2½-day conference will bring together national and international experts in the fields of relevant medical research and health care as well as representatives from the public. On the second day of the conference, 1 hour has been allocated for 5- to 10-minute formal oral presentations by individuals presenting statements on behalf of interested organizations regarding the conference issues. After 1½ days of presentations and audience discussion, an independent, non-Federal consensus panel chaired by Dr. David J. Kupfer, Thomas Detre Professor and Chair, Department of Psychiatry, University of Pittsburgh, will weigh the scientific evidence and write a draft statement that will be presented to the audience on the third day. The statement will take into account the panel’s review of the scientific literature prepared during the preceding year. The consensus statement will address the following key questions:   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 treatments? 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? On the final day of the meeting, the conference chairperson, Dr. David J. Kupfer, will read the draft statement to the conference audience and invite comments and questions. A press conference will follow to allow the panel and chairperson to respond to questions from media representatives.

© 1998 Charles K. Kenyon