110. Diagnosis and Treatment of Attention Deficit Hyperactivity Disorder

 

National Institutes of Health
Consensus Development Conference Statement
November 16-18, 1998

 

 

DRAFT - - DRAFT - - DRAFT   See also NIMH booklet on ADHD Abstracts of presentations to NIH This statement will be published as: Diagnosis and Treatment of Attention Deficit Hyperactivity Disorder. NIH Consens Statement 1998 Nov 16-18; 16(2): In press. For making bibliographic reference to consensus statement no. 110 in the electronic form displayed here, it is recommended that the following format be used: Diagnosis and Treatment of Attention Deficit Hyperactivity Disorder. NIH Consens Statement 1998 Nov 16-18; In press. [cited year, month, day]; 16(2): In press. Introduction Attention deficit hyperactivity disorder (ADHD) is the most commonly diagnosed behavioral disorder of childhood, estimated to affect 3 to 5 percent of school-age children. Its core symptoms include a developmentally inappropriate level of attention and concentration, developmentally inappropriate levels of activity, distractibility, and impulsivity. Children with ADHD usually have pronounced difficulties and impairment resulting from the disorder across multiple settingsÑin home, at school, and with peersÑas well as resultant long-term adverse effects on later academic, vocational, social-emotional, and psychiatric outcomes. Despite the 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 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. One of the major controversies regarding ADHD concerns the use of psychostimulants to treat the condition. Psychostimulants, including amphetamine, methylphenidate, and pemoline, are by far the most widely researched and commonly prescribed treatments for ADHD. The use of methylphenidate and amphetamine nationwide has increased significantly in recent years. The increased production and use of psychostimulants have intensified the concerns about use, overuse, and abuse. This 2-day conference brought together national and international experts in the fields of relevant medical research and health care as well as representatives from the public. After 1-1/2 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, weighed the scientific evidence and wrote a draft statement that was presented to the audience on the third day. The consensus statement addressed 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? The primary sponsors of this conference were the National Institute on Drug Abuse, the National Institute of Mental Health, and the NIH Office of Medical Applications of Research. The conference was cosponsored by the National Institute of Environmental Health Sciences, the National Institute of Child Health and Human Development, the U.S. Food and Drug Administration, and the Office of Special Education Programs, U.S. Department of Education. [ panelists | speakers | planners | webmaster's note]   1. What Is the Scientific Evidence To Support ADHD as a Disorder? The diagnosis of ADHD can be made reliably using well-tested diagnostic interview methods. However, we do not have an independent, valid test for ADHD, and there are no data to indicate that ADHD is due to a brain malfunction. Further research to establish the validity of the disorder continues to be a problem. This is not unique to ADHD, but applies as well to most psychiatric disorders, including disabling diseases such as schizophrenia. Evidence supporting the validity of ADHD includes the predictable course of ADHD over time, cross-national studies revealing similar risk factors, familial aggregation of ADHD (which may be genetic or environmental), and heritability. Further efforts to validate the disorder are needed: careful description of the cases, use of specific diagnostic criteria, repeated followup studies, family studies (including twin and adoption studies), epidemiologic studies, and treatment studies. To the maximum extent possible, such studies should include various controls, including normal subjects and those with other clinical disorders. Such studies may provide suggestions about subgrouping of patients that will turn out to be associated with different outcomes, responses to different treatment, and varying patterns of familial characteristics and illnesses. As homogeneous subgroups become identified, they can facilitate efforts to delineate alterations in structure and function. Certain issues about the diagnosis of ADHD have been raised that indicate the need for further research to validate diagnostic methods. Clinicians who diagnose this disorder have been criticized for merely taking a percentage of the normal population who have the most evidence of inattention and continuous activity and labeling them as having a disease. In fact, it is unclear whether the signs of ADHD represent a bimodal distribution in the population or one end of a continuum of characteristics. This is not unique to ADHD as other medical diagnoses, such as essential hypertension and hyperlipidemia, are continuous with the normal population, yet the utility of diagnosis and treatment have been proven. Nevertheless, related problems of diagnosis include differentiating this entity from other behavioral problems and determining the appropriate boundary between the normal population and those with ADHD. ADHD often does not present as an isolated disorder, and comorbidities (coexisting conditions) may act as confounders in any research studies. This may account for some of the inconsistencies in research findings.  Although the prevalence of ADHD in the United States has been estimated at about 3 to 5 percent, it is clear that wider ranges of prevalence have been reported. The reported rate in some other countries is much lower. This indicates a need for better study of ADHD in different populations and better definition of the disorder.  All formal diagnostic criteria for ADHD were designed for diagnosing young children and have not been adjusted for older children and adults. Therefore, appropriate revision of these criteria to aid in the diagnosis of these individuals is encouraged.  In summary, there is validity in the diagnosis of ADHD, defining a maladjustive cluster of characteristics. [back to questions list] [ Home Page | ADD / ADHD / AD/HD Book List | ADD / ADHD / AD/HD Links ]   2. What Is the Impact of ADHD on Individuals, Families, and Society? Children with ADHD experience an inability to sit still and pay attention in class and the negative consequences of such behavior. They experience peer rejection and engage in a broad array of disruptive behaviors. Their academic and social difficulties have far-reaching and long-term consequences. These children have higher accident rates, and later in life, children with ADHD in combination with conduct disorders experience drug abuse, antisocial behavior, and accidents of all sorts. For many individuals, the impact of ADHD continues into adulthood. Families who have children with ADHD, as with other behavioral disorders and chronic diseases, experience increased levels of parental frustration, marital discord, and divorce. In addition, the direct costs of medical care for children and youth with ADHD are substantial. These costs represent a serious burden for many families because they frequently are not covered by health insurance. In the larger world, these individuals consume a disproportionate share of resources and attention from the health care system, criminal justice system, schools, and other social service agencies. Methodologic problems preclude precise estimates of the cost of ADHD to society. However, these costs are large. For example, additional national public school expenditures on behalf of students with ADHD may have exceeded $3 billion in 1995. Moreover, ADHD, often in conjunction with coexisting conduct disorders, contributes to societal problems such as violent crime and teenage pregnancy. Families of children impaired by the symptoms of ADHD are in a very difficult position. An already painful decision-making process is often made substantially worse by the media war between those who overstate the benefits of treatment and those who overstate the dangers of treatment. [back to questions list]  [ Home Page | ADD / ADHD / AD/HD Book List | ADD / ADHD / AD/HD Links ]   3. What Are the Effective Treatments for ADHD? A wide variety of treatments have been used for ADHD including, but not limited to, various psychotropic medications, psychosocial treatment, dietary management, herbal and homeopathic treatments, biofeedback, meditation, and perceptual stimulation/training. Of these treatment strategies, medications and psychosocial interventions have been the major focus of research. Studies on the efficacy of medication and psychosocial treatments for ADHD have focused primarily on a condition equivalent to DSM-IV combined type, meeting criteria for Inattention and Hyperactivity/Impulsivity. Until recently, most randomized clinical trials have been short term, up to approximately 3 months. Overall, these studies support the efficacy of stimulants and psychosocial treatments for ADHD. However, there are no long-term studies testing stimulants or psychosocial treatments lasting several years. There is no information on the long-term outcomes of medication-treated ADHD individuals in terms of educational and occupational achievements, involvement with the police, or other areas of social functioning. Short-term trials of stimulants have supported the efficacy of methylphenidate (MPH) dextroamphetamine, and pemoline in children with ADHD. Few, if any, differences have been found among these stimulants on average. However, MPH is the most studied and the most often used of the stimulants. These short-term trials have found beneficial effects on the defining symptoms of ADHD and associated aggressiveness as long as medication is taken. However, stimulant treatments do not "normalize" the entire range of behavior problems, and children under treatment still manifest a higher level of some behavior problems than normal children. Of concern are the consistent findings that despite the improvement in core symptoms, there is little improvement in academic achievement or social skills. Several short-term studies of antidepressants show that desipramine produces improvements over placebo in parent and teacher ratings of ADHD symptoms. Results from studies examining the efficacy of imipramine are inconsistent. Although a number of other psychotropic medications have been used to treat ADHD, the extant outcome data from these studies do not allow for conclusions regarding their efficacy. Psychosocial treatment of ADHD has included a number of behavioral strategies such as contingency management (e.g., point/token reward systems, timeout, response cost) that typically is conducted in the classroom, parent training (where the parent is taught child management skills), clinical behavior therapy (parent, teacher, or both are taught to use contingency management procedures), and cognitive-behavioral treatment (e.g., self-monitoring, verbal self-instruction, problem-solving strategies, self-reinforcement). Cognitive-behavioral treatment has not been found to yield beneficial effects in children with ADHD. In contrast, clinical behavior therapy, parent training, and contingency management have produced beneficial effects. Intensive direct interventions in children with ADHD, such as summer camp programs, have produced improvements in key areas of functioning. However, no randomized control trials have been conducted on the summer camp intervention alone or in combination with medication. Emerging data suggest that medication using systematic intensive monitoring methods over a period of approximately 1 year may be superior to an intensive set of behavioral treatments on core ADHD symptoms (inattention, hyperactivity/impulsivity, aggression). Combined medication and behavioral treatment added little advantage overall, but combined treatment did result in more improved social skills, and parents and teachers judged this treatment more favorably. Both systematically applied medication and combined treatment were superior to routine community care, which often involved the use of stimulants. An important potential advantage for behavioral treatment is the possibility of improving functioning with reduced dose of stimulants. This possibility was not tested. There is a long history of a number of other interventions for ADHD. These include dietary replacement, herbal exclusion or supplementation, various vitamin or mineral regimens, biofeedback, perceptual stimulation, and a host of others. Although these interventions have generated considerable interest and there are some controlled and uncontrolled studies using various strategies, the state of the empirical evidence regarding these interventions is uneven, ranging from no data to well-controlled trials. Some of the dietary elimination strategies showed intriguing results suggesting future research. The current state of the empirical literature regarding the treatment of ADHD is such that at least five important questions cannot be answered. First, it cannot be determined if the combination of stimulants and psychosocial treatments can improve functioning with reduced dose of stimulants. Second, there are no data on the treatment of ADHD, Inattentive type, which might comprise a high percentage of girls. Third, there are no conclusive data on treatment in adolescents and adults with ADHD. Fourth, there is no information on long-term treatment (treatment lasting more than 1 year), which is indicated in this persistent disorder. Finally, given the evidence about the cognitive problems associated with ADHD, such as deficiencies in working memory and language processing deficits, and the demonstrated ineffectiveness of current treatments in enhancing academic achievement, there is a need for application and development of methods targeted to these weaknesses. [back to questions list] [ Home Page | ADD / ADHD / AD/HD Book List | ADD / ADHD / AD/HD Links ]     4. What Are the Risks of the Use of Stimulant Medication and Other Treatments? Although little information exists concerning the long-term effects of psychostimulants, there is no conclusive evidence that careful therapeutic use is harmful. When adverse drug reactions do occur, they are usually related to dose. Effects associated with moderate doses may include decreased appetite and insomnia. These effects occur early in treatment and may decrease with continued dosing. There may be negative effects on growth rate, but ultimate height appears not to be affected. It is well known that psychostimulants have abuse potential. Very higher doses of psychostimulants, particularly of amphetamines, may cause central nervous system damage, cardiovascular damage, and hypertension. In addition, higher doses have been associated with compulsive behaviors and, in certain vulnerable individuals, movement disorders. There is a very small percentage of children and adults treated at high doses who have hallucinogenic responses. Drugs used for ADHD other than psychostimulants have their own adverse reactions: tricyclic antidepressants may induce cardiac arrhythmias, bupropion at high doses can cause seizures, and pemoline is associated with liver damage. The degree of assessment and followup by primary care physicians varies significantly. This variance may contribute to the marked differences in appropriate prescribing practices. Adequate followup is required for any prescribed medications, especially for higher doses of psycho-stimulants. Although an increased risk of drug abuse and cigarette smoking is associated with childhood ADHD (see Question 2), existing studies come to conflicting conclusions as to whether use of psychostimulants increases or decreases the risk of abuse. A major limitation of inferences from observational databases is that the diagnosis of ADHD is confounded with the use of stimulant medication; additional confounders include severity of ADHD and coexisting conditions. The increased availability of stimulant medications may pose risks for society. The threshold of drug availability that can lead to oversupply and consequent illicit use is unknown. There is little evidence that current levels of production have had a substantial effect on abuse. However, there is a need to be vigilant in monitoring the national indices of use and abuse among high school seniors and Drug Abuse Warning Network (DAWN) emergency room reports. [back to questions list] [ Home Page | ADD / ADHD / AD/HD Book List | ADD / ADHD / AD/HD Links ]     5. What Are the Existing Diagnostic and Treatment Practices, and What Are the Barriers to Appropriate Identification, Evaluation, and Intervention? The American Academy of Child and Adolescent Psychiatry has published practice parameters for the assessment and treatment of ADHD. The American Academy of Pediatrics has formed a subcommittee to establish parameters for pediatricians, but those guidelines are not available at this time. Primary care and developmental pediatricians, family practitioners, (child) neurologists, psychologists, and psychiatrists are the providers responsible for assessment, diagnosis, and treatment for most children with ADHD. There exists wide variation among type of practitioner with respect to frequency of diagnosis of ADHD. The type of practitioner also determines the frequency of stimulant prescription management; data indicate that family practitioners prescribe medication more frequently than psychiatrists or pediatricians. This may be due in part to the limited time spent making the diagnosis. This propensity for prescribing medications may remove incentives for establishing educationally relevant interventions. Some practitioners invalidly use response to medication as a diagnostic criterion. Primary care practitioners are less likely to recognize comorbid (coexisting) disorders. Diagnoses are often made in an inconsistent manner with children sometimes being overdiagnosed and sometimes being underdiagnosed. Some practitioners do not use structured parent questionnaires or rating scales or teacher or school input. Pediatricians, family practitioners, and psychiatrists tend to rely on parent rather than teacher input. There appears to be a "disconnect" between developmental or educational (school-based) assessments and health- related (medical practice-based) services. There is often poor communication between diagnosticians and those who implement and monitor treatment in schools. In addition, followup may be inadequate and fragmented. This is particularly important to ensure monitoring and early detection of any adverse effect of therapy. School-based clinics with a team approach that includes parents, teachers, school psychologists, and other mental health specialists may be a means to remove these barriers and improve access to assessment and treatment. Ideally, primary care practitioners with adequate time for consultation with such school teams should be able to make an appropriate assessment and diagnosis, but they should also be able to refer to mental health and other specialists when deemed necessary. What are the barriers to appropriate identification, evaluation, and intervention? Studies identify a number of barriers to appropriate identification, evaluation, and treatment. Barriers to identification and evaluation arise when central screening programs limit access to mental health services. The lack of insurance coverage of neuropsychological evaluations, behavior modification programs, school consultation, parent management training, and other specialized programs presents a major barrier to accurate classification, diagnosis, and management of ADHD. Substantial cost barriers exist in that diagnosis results in out-of-pocket costs to families for services not covered by managed care or other health insurance. Mental health benefits are carved out of many policies offered to families, and thus access to treatment other than medication might be severely limited. Parity for mental health conditions in insurance plans is essential. Another cost implication lies in the fact that there is no funded special education category for ADHD, which leaves these students underserved. This results in educational and mental health service sources disputing responsibility for coverage of special educational services. Barriers exist in relationship to gender, race, socioeconomic factors, and geographical distribution of patients seeking identification and evaluation. Other important barriers include those perceived by patients, families, and clinicians. These include lack of information, concerns about risks of medications, loss of parental rights, fear of professionals, social stigma, negative pressures from families and friends against seeking treatment, and jeopardizing jobs and military service. For health care providers, the lack of specialists and difficulties obtaining insurance coverage as outlined above present significant obstacles to care. [back to questions list] [ Home Page | ADD / ADHD / AD/HD Book List | ADD / ADHD / AD/HD Links ]   6. What Are the Directions for Future Research? Basic research is needed to better define ADHD. This research includes the following: (1) studies of cognitive development and cognitive processing in ADHD and (2) brain imaging studies before the initiation of medication and following the individual through young adulthood and middle age. Further research should be conducted with respect to the dimensional aspects of this disorder, as well as the comorbid (coexisting) conditions present in both childhood and adult ADHD. Therefore, an important research need is the investigation of standardized age- and gender-specific diagnostic criteria. The impact of ADHD should be determined. Studies in this regard include (1) the nature and severity of the impact on individuals, families, and society of adults with ADHD beyond the age of 20 and (2) determination of the financial costs related to diagnosis and care of children with ADHD. Additional studies are needed to develop a more systematized treatment strategy. These include: Studies of the inattentive type of ADHD, especially since it might comprise a higher proportion of girls than the other subtypes.  Studies of long-term treatment (treatment lasting longer than 1 year), which are needed because of the persistence of the disorder.  Prospective controlled studies, up to adulthood, of the risks and benefits associated with childhood treatment with psychostimulants.  Studies to determine the effects of psychotropic therapy on cognitive function and school performance.  Studies of the effects of instructional treatments on the academic achievement of children with ADHD.  Studies to determine whether the combination of stimulants and psychosocial treatments can improve functioning with a reduced dose of stimulants.  Studies to determine the risks and benefits associated with treating children younger than age 5 with stimulants. Greater attention should be given to developing integrated programs for diagnosis and treatment. These include: Model projects to demonstrate methods of training teachers to recognize and provide appropriate special programs for children with ADHD.  Incorporation of classroom strategies to effectively serve a greater variety of students and thereby reduce the prevalence of ADHD referral and diagnosis.  Determination of the extent to which individuals with ADHD are being served in postsecondary education and, if so, where they are being served, with what types of accommodations, and with what level of success. [back to questions list] [ Home Page | ADD / ADHD / AD/HD Book List | ADD / ADHD / AD/HD Links ]   Conclusions Attention deficit hyperactivity disorder or ADHD is a commonly diagnosed behavioral disorder of childhood that represents a major public health problem. Children with ADHD usually have pronounced difficulties and impairments resulting from the disorder across multiple settings. They also can experience long-term adverse effects on later academic, psychosocial, and psychiatric outcomes. Despite progress in the assessment, diagnosis, and treatment of ADHD, this disorder and its treatment have remained controversial in many public and private sectors. The major controversy regarding ADHD continues to be the use of psychostimulants both for short-term and long-term treatment. Although a consistent diagnostic test for ADHD does not exist, evidence supporting the validity of the disorder can be found. Further research will need to be conducted with respect to the dimensional aspects of ADHD, as well as the comorbid (coexisting) conditions present in both childhood and adult ADHD. Therefore, an important research need is the investigation of standardized age-and gender-specific diagnostic criteria. The impact of ADHD on individuals, families, schools, and society is profound and necessitates immediate attention because a considerable share of resources from the health care system and various social service agencies is currently devoted to ADHD, often in a nonintegrated manner. Resource allocation based on better cost data leading to integrated care models needs to be developed for individuals with ADHD. Effective treatments for ADHD have been evaluated primarily for the short term (approximately 3 months). These studies have included randomized clinical trials that have established the efficacy of stimulants and behavioral treatments for positive effects on the defining symptoms of ADHD and associated aggressiveness. Lack of consistent improvement beyond the core symptoms leads to the need for treatment strategies that utilize combined approaches. At the present time, there is a paucity of data providing information on long-term treatment beyond 14 months. Although trials combining drugs and behavioral modalities are underway, conclusive recommendations concerning treatment for the long term cannot be made easily. The risks of treatment, particularly the use of stimulant medication, are of considerable interest. Substantial evidence exists of wide variations in the use of psychostimulants across communities and physicians, suggesting no consensus among practitioners regarding which ADHD patients should be treated with psychostimulants. As measured by attention/activity indices, patients with varying levels and types of problems (and even possibly unaffected individuals) may benefit from stimulant therapy. However, there is no evidence regarding the appropriate ADHD diagnostic threshold above which the benefits of psychostimulant therapy outweigh the risks. Existing diagnostic and treatment practices, in combination with the potential risks associated with medication, point to the need for improved awareness by the health service sector concerning an appropriate assessment, treatment, and followup. A more consistent set of diagnostic procedures and practice guidelines is of utmost importance. Current barriers to evaluation and intervention exist across the health and education sectors. The cost barriers and lack of coverage preventing the appropriate diagnosis and treatment of ADHD and the lack of integration with special educational services represent considerable long-term cost for society. The lack of information and education about accessibility and affordability of services must be remedied. Finally, after years of clinical research and experience with ADHD, our knowledge about the cause or causes of ADHD remains speculative. Consequently, we have no strategies for the prevention of ADHD. [back to questions list] [ Home Page | ADD / ADHD / AD/HD Book List | ADD / ADHD / AD/HD Links ]   Consensus Development Panel David J. Kupfer, M.D. Panel and Conference Chairperson Thomas Detre Professor and Chair of Psychiatry Western Psychiatric Institute and Clinic Department of Psychiatry University of Pittsburgh Pittsburgh, Pennsylvania Donald A. Berry, Ph.D. Professor Institute of Statistics and Decision Sciences Duke University Medical Center Durham, North Carolina Everett H. Ellinwood, M.D. Professor of Psychiatry and Pharmacology Duke University Medical Center Durham, North Carolina Donna M. Ferriero, M.D. Associate Professor of Neurology Division of Child Neurology Department of Neurology University of California, San Francisco San Francisco, California Samuel B. Guze, M.D. Spencer T. Olin Professor of Psychiatry Department of Psychiatry Washington University School of Medicine St. Louis, Missouri Jane McGlothlin, Ph.D. Assistant Superintendent for Curriculum and Instruction Scottsdale Unified School District Phoenix, Arizona Mark Vonnegut, M.D. Pediatrician Milton Pediatrics Quincy, Massachusetts Robert S. Baltimore, M.D. Professor of Pediatrics, Epidemiology, and Public Health Division of Infectious Diseases Department of Pediatrics Yale University School of Medicine New Haven, Connecticut Naomi Breslau, Ph.D. Director of Research Department of Psychiatry Henry Ford Health System Detroit, Michigan Janis Ferre Past Chair Utah Governor's Council for People With Disabilities Salt Lake City, Utah Lynn S. Fuchs, Ph.D. Professor Department of Special Education Peabody College Vanderbilt University Nashville, Tennessee Beatrix A. Hamburg, M.D. Visiting Professor Department of Psychiatry Cornell University Medical College New York, New York Samuel M. Turner, Ph.D., ABPP Professor of Psychology Director of Clinical Training Department of Psychology University of Maryland College Park, Maryland [back to questions list] [ Home Page | ADD / ADHD / AD/HD Book List | ADD / ADHD / AD/HD Links ]   Speakers Howard Abikoff, Ph.D. Professor of Clinical Psychiatry Director of Research NYU Child Study Center New York University School of Medicine New York, New York Russell A. Barkley, Ph.D. Director of Psychology Department of Psychiatry University of Massachusetts Medical Center Worcester, Massachusetts Joseph Biederman, M.D. Professor of Psychiatry, Harvard Medical School Chief, Joint Program in Pediatric Psychopharmacology Massachusetts and McLean General Hospitals Boston, Massachusetts     Peter R. Breggin, M.D. Director Center for the Study of Psychiatry and Psychology Bethesda, Maryland   Betty Chemers, M.A. Director of Research and Program Development Office of Juvenile Justice and Delinquency Prevention Washington, D.C. Louis Danielson, Ph.D. Director, Division of Research to Practice Office of Special Education Programs Office of Special Education and Rehabilitative Services U.S. Department of Education Washington, D.C. Gretchen Feussner Pharmacologist Drug and Chemical Evaluation Section Office of Diversion Control Drug Enforcement Administration Arlington, Virginia Laurence L. Greenhill, M.D. Research Psychiatrist II New York State Psychiatric Institute Columbia University New York, New York Kimberly Hoagwood, Ph.D. Chief of Child and Adolescent Services Research Services Research Branch National Institute of Mental Health National Institutes of Health Rockville, Maryland Charlotte Johnston, Ph.D. Associate Professor Department of Psychology University of British Columbia Vancouver, British Columbia Canada Kelly J. Kelleher, M.D., M.P.H. Staunton Professor of Pediatrics and Psychiatry Child Services Research and Development Program University of Pittsburgh Pittsburgh, Pennsylvania Benjamin B. Lahey, Ph.D. Professor of Psychiatry Chief of Psychology Department of Psychiatry University of Chicago Chicago, Illinois Jan Loney, Ph.D. Professor Department of Psychiatry State University of New York at Stony Brook Stony Brook, New York Andrew S. Rowland, Ph.D. Epidemiologist Epidemiology Branch National Institute of Environmental Health Sciences National Institutes of Health Research Triangle Park, North Carolina Rosemary Tannock, Ph.D. Scientist Associate Professor of Psychiatry Brain and Behavior Program Research Institute for the Hospital for Sick Children University of Toronto Toronto, Ontario Canada Mark L. Wolraich, M.D. Professor of Pediatrics Director, Division of Child Development Department of Pediatrics Vanderbilt University Nashville, Tennessee Sheila Anderson Immediate Past National President Children and Adults With Attention Deficit Disorders Plantation, Florida   L. Eugene Arnold, M.D., M.Ed. Professor Emeritus of Psychiatry Ohio State University, Columbus Sunbury, Ohio   Hector R. Bird, M.D. Professor Clinical Psychiatry Columbia University Deputy Director Child Psychiatry New York State Psychiatric Institute New York, New York William B. Carey, M.D. Clinical Professor of Pediatrics University of Pennsylvania School of Medicine Division of General Pediatrics Children's Hospital of Philadelphia Philadelphia, Pennsylvania C. Keith Conners, Ph.D., M.A. Director, ADHD Program Department of Psychiatry Duke University Medical Center Durham, North Carolina James R. Cooper, M.D. Associate Director for Medical Affairs Division of Clinical and Services Research National Institute on Drug Abuse National Institutes of Health Rockville, Maryland Steven R. Forness, Ed.D. Professor of Psychiatry and Biobehavioral Sciences Neuropsychiatric Hospital University of California, Los Angeles Los Angeles, California Stephen P. Hinshaw, Ph.D. Professor of Psychology Director of Clinical Psychology Training Program Department of Psychology University of California, Berkeley Berkeley, California Peter S. Jensen, M.D. Associate Director for Child and Adolescent Research National Institute of Mental Health National Institutes of Health Rockville, Maryland Peter W. Kalivas, Ph.D. Professor and Chair Department of Physiology and Neuroscience Medical University of South Carolina Charleston, South Carolina Rachel G. Klein, Ph.D. Director of Clinical Psychology Department of Psychology New York State Psychiatric Institute New York, New York Nadine M. Lambert, Ph.D. Professor Cognition and Development Area Director, School Psychology Program Graduate School of Education University of California, Berkeley Berkeley, California William E. Pelham, Jr., Ph.D. Professor and Director of Clinical Training Department of Psychology State University of New York at Buffalo Buffalo, New York James Swanson, Ph.D. Professor of Pediatrics Department of Pediatrics University of California, Irvine Irvine, California Timothy E. Wilens, M.D. Associate Professor of Psychiatry Harvard Medical School Massachusetts General Hospital Boston, Massachusetts [back to questions list] [ Home Page | ADD / ADHD / AD/HD Book List | ADD / ADHD / AD/HD Links ]   Planning Committee James R. Cooper, M.D. Planning Committee Co-Chairperson Associate Director for Medical Affairs Division of Clinical and Services Research National Institute on Drug Abuse National Institutes of Health Rockville, Maryland Sheila Anderson Immediate Past National President Children and Adults With Attention Deficit Disorders Plantation, Florida   Cheryl Boyce, Ph.D. Society for Research in Child Development Fellow Developmental Psychopathology Research Branch National Institute of Mental Health National Institutes of Health Rockville, Maryland J.A. Costa e Silva, M.D. Director Division of Mental Health and Prevention of Substance Abuse World Health Organization Geneva, Switzerland Jerry M. Elliott Program Analysis and Management Officer Office of Medical Applications of Research National Institutes of Health Bethesda, Maryland Gretchen Feussner Pharmacologist Drug and Chemical Evaluation Section Office of Diversion Control Drug Enforcement Administration Arlington, Virginia William H. Hall Director of Communications Office of Medical Applications of Research National Institutes of Health Bethesda, Maryland David J. Kupfer, M.D. Panel and Conference Chairperson Thomas Detre Professor and Chair of Psychiatry Western Psychiatric Institute and Clinic Department of Psychiatry University of Pittsburgh Pittsburgh, Pennsylvania Jan Loney, Ph.D. Professor Department of Psychiatry State University of New York at Stony Brook Stony Brook, New York Stuart L. Nightingale, M.D. Associate Commissioner for Health Affairs Food and Drug Administration Rockville, Maryland Elizabeth Rahdert, Ph.D. Research Psychologist Treatment Research Branch Division of Clinical and Services Research National Institute on Drug Abuse National Institutes of Health Rockville, Maryland Ellen Schiller, Ph.D. Special Assistant Division of Research to Practice Office of Special Education Programs U.S. Department of Education Washington, D.C. Charles R. Sherman, Ph.D. Deputy Director Office of Medical Applications of Research National Institutes of Health Bethesda, Maryland Timothy E. Wilens, M.D. Associate Professor of Psychiatry Harvard Medical School Massachusetts General Hospital Boston, Massachusetts Peter S. Jensen, M.D. Planning Committee Co-Chairperson Associate Director for Child and Adolescent Research National Institute of Mental Health National Institutes of Health Rockville, Maryland Elaine Baldwin Chief, Public Affairs and Science Reports Branch Office of Scientific Information National Institute of Mental Health National Institutes of Health Rockville, Maryland Sarah Broman, Ph.D. Health Science Administrator Division of Fundamental Neuroscience and Developmental Disorders National Institute of Neurological Disorders and Stroke National Institutes of Health Bethesda, Maryland Dorynne J. Czechowicz, M.D. Medical Officer Division of Clinical and Services Research National Institute on Drug Abuse National Institutes of Health Rockville, Maryland John H. Ferguson, M.D. Director Office of Medical Applications of Research National Institutes of Health Bethesda, Maryland Laurence L. Greenhill, M.D. Research Psychiatrist II New York State Psychiatric Institute Columbia University New York, New York John King Deputy Assistant Administrator Office of Diversion Control Drug Enforcement Administration Arlington, Virginia Benjamin B. Lahey, Ph.D. Professor of Psychiatry Chief of Psychology Department of Psychiatry University of Chicago Chicago, Illinois Reid Lyon, Ph.D. Chief Child Development and Behavior Branch National Institute of Child Health and Human Development National Institutes of Health Bethesda, Maryland William E. Pelham, Jr., Ph.D. Professor and Director of Clinical Training Department of Psychology State University of New York at Buffalo Buffalo, New York Andrew S. Rowland, Ph.D. Epidemiologist Epidemiology Branch National Institute of Environmental Health Sciences National Institutes of Health Research Triangle Park, North Carolina Bennett Shaywitz, M.D. Professor of Pediatrics and Neurology Department of Pediatrics Yale University School of Medicine New Haven, Connecticut Benedetto Vitiello, M.D. Chief Child and Adolescent Treatment and Preventive Intervention Research Branch Division of Services and Intervention Research National Institute of Mental Health National Institutes of Health Rockville, Maryland [back to questions list] [ Home Page | ADD / ADHD / AD/HD Book List | ADD / ADHD / AD/HD Links ]   Webmaster's note - not part of official statement: 6 government representatives specializing in mental health / child development (3 from National Institute on Mental Health) (6 includes FDA) 5 government representatives specializing in drug abuse/enforcement (3 from National Institute on Drug Abuse)(5 includes 2 from Drug Enforcement Agency) Any thoughts on what this conference was about? [back to questions list] [ Home Page | ADD / ADHD / AD/HD Book List | ADD / ADHD / AD/HD Links ]       Conference Sponsors Office of Medical Applications of Research John H. Ferguson, M.D. Director National Institute on Drug Abuse Alan I. Leshner, Ph.D. Director National Institute of Mental Health Steven E. Hyman, M.D. Director Conference Cosponsors National Institute of Environmental Health Sciences Kenneth Olden, Ph.D. Director National Institute of Child Health and Human Development Duane Alexander, M.D. Director U.S. Food and Drug Administration Michael A. Friedman, M.D. Acting Commissioner Office of Special Education Programs U.S. Department of Education Thomas Hehir, Ed.D. Director