Consensus Statement Revises Previous Assertions About ADHD

Q&A

An international group of experts analyzed findings from a large pool of select studies and developed an updated consensus statement with declarations about attention deficit hyperactivity disorder (ADHD). They curated a collection of validated statements, addressing questions on topics ranging from nutrition, neuropsychiatry, and nonpharmacologic treatments. The statement was published online in Neuroscience & Biobehavioral Reviews.¹

Stephen V. Faraone, PhD

Lead author Stephen V. Faraone, PhD, joins us in this Q&A to talk about the study. Dr Faraone is Distinguished Professor in the Departments of Psychiatry and Neuroscience and Physiology, Psychiatry Research Division, SUNY Upstate Medical University, Syracuse, New York. He is President of the World Federation of ADHD and Program Director for www.ADHDinAdults.com.

Psychiatric Times (PT): What prompted the consensus guidelines and why are they important now?

Faraone: Despite a large scientific literature about ADHD, much misinformation about ADHD is spread by the internet and other media. This creates stigma and leads to treatment decisions that are not in the best interests of patients. Our consensus provides clinicians, patients, and family members evidence-based results they can use to make informed decisions.

PT: How were the authors selected?

Faraone: I asked thought leaders from ADHD professional associations from around the world to nominate authors for the project.

PT: Since this is a worldwide consensus statement with 27 countries represented, what sort of differences did you find internationally? How does the United States compare with other countries in terms of recognition and treatment?

Faraone: The prevalence of ADHD, the symptoms of the disorder and its outcomes are essentially the same around the world, with some small exceptions. The main difference is in how often ADHD is appropriately diagnosed and treated. Diagnosis and treatment rate are better in countries with well-developed health care systems compared with other countries. The United States has higher rates of diagnosis compared with other high-income countries, although ADHD in adults is underdiagnosed in the United States and around the world.

PT: The article talks about stigma of both patients with ADHD and the health professionals who treat the disorder. Can you tell us more about that?

Faraone: For patients diagnosed with ADHD, stigma leads to decreased self-esteem, less acceptance by peers, social isolation, and lower self-perceptions of confidence. When treatments are stigmatized, patients and parents are less likely to seek appropriate treatment. Moreover, clinicians are less likely to provide those treatments. This leads to unnecessary distress and disability and costs to society.

PT: The piece came up with 208 empirically supported statements about ADHD. Which ones were most impactful? What new information does the paper provide?

Faraone: The degree of impact will vary with the reader. Learning about what treatments do and do not work for ADHD can be life changing for patients and families. Learning that ADHD costs societies billions of dollars each year will motivate policy makers to improve access to care. Learning about the medical conditions associated with ADHD will be of much interest to primary care clinicians.

By definition, strong evidence cannot be “new” because it arises from published scientific studies. But I expect that much of this information will be new to most nonprofessional readers and for those professionals that are new to diagnosing and treating ADHD.

PT: Of what clinical relevance is the consensus statement, and does it offer teaching points for readers?

Faraone: In a nutshell, clinicians will learn that ADHD is a well-defined condition that can be diagnosed at any age; untreated ADHD has many, many serious consequences ranging from school failure in childhood to criminality in adulthood; and the medications for treating ADHD are much more effective than nonmedical treatments for relieving ADHD symptoms.

Other teaching points:

• ADHD is not an invention of modern society. The syndrome had been reported in medical writings in Europe as early as 1775.

• ADHD is rarely caused by a single genetic or environmental risk factor, but most cases of ADHD are caused by the combined effects of many genetic and environmental risks each having a very small effect.

• Neuroimaging studies find small differences in the structure and functioning of the brain between people with and without ADHD. These differences cannot be used to diagnose ADHD.

PT: Were there any surprises?

Faraone: I was surprised to learn that ADHD puts people at increased risk for many medical disorders including obesity, asthma, allergies, diabetes mellitus, hypertension, sleep problems, psoriasis, epilepsy, sexually transmitted infections, abnormalities of the eye, immune disorders, and metabolic disorders.

PT: What is next for this area of study?

Faraone: Our next goal is to disseminate the International Consensus Statement as widely as possible. It has been translated into Spanish, French, and German and we also have a summary in Welsh. Colleagues are currently in the process of translating it into Mandarin, Turkish, Portuguese, Arabic, Hindi, Dutch, Japanese, and Italian. These translations will be available at the World Federation of ADHD website.

Readers can learn more about the Consensus Statement from Dr Faraone via Twitter: @StephenFaraone.

Reference

1. Faraone SV, Banaschewski T, Coghill D, et al. The World Federation of ADHD International Consensus Statement: 208 Evidence-based Conclusions about the Disorder. Neurosci Biobehav Rev. 2021;S0149-7634(21)00049-X. Accessed April 4, 2021. https://www.sciencedirect.com/science/article/pii/S014976342100049X#abs0010