Spurious Diagnosis, Specious Treatment
NIH ADHD Consensus Conference

Judith Bluestone, Neurodevelopmental/Educational Therapist

Judith Bluestone attended and participated in the National Institutes of Health Consensus Conference on Attention Deficit Hyperactivity Disorder in Bethesda, Maryland, in November 1998. Some of her reflections are presented here..

I was amazed to learn that the majority of the NIH studies on ADHD have, over the past decades, been conducted for an average of only three to four months. The only "long term" studies have been this past year, and those extended for a maximum of 18 months.  Some of the specialists chosen to form the consensus report acknowledged that they did not see value in education and rehabilitation services in the treatment of ADHD, and therefore insurance coverage of such services is not necessary. I calmly told them in public forum that I hope they will soon realize that those very services are the avenues by which they can make a real difference.

The panel agreed that there were no valid diagnostic tests for the assessment of ADHD, and yet felt that the diagnoses being made were reliable. This statement confuses the scientist in me. I do not know how to respond to such an obvious inconsistency being presented in defense of scientific exploration.   There were frequent references to the "co-morbidity" – that is presence of other disorders as well—found in children with ADHD. This was the first statement that prompted me to grab a microphone and address the conference.

I received applause for the two-pronged question I posed to the group: "First, in light of the co-morbidity of ADHD, Learning Disabilities, Obsessive Compulsive Disorder, Oppositional Defiant Disorder, Anxiety, Depression, etc.,--does this not imply that there are clusters of symptoms that stem from various weaknesses or immaturities in neurophysiological subsystems and their interaction with other subsystems, and in the discrepancy between the individual’s behaviors and subjective expectations on specific tasks in specific situations? And, second, does this not mandate us to seek not only ways to diagnose but also methods to resolve the root causes—in the individual and in the environment—rather than seeking more ways to merely mask the symptoms and control behaviors?"

On the last morning of the conference, the consensus statement (see http://odp.od.nih.gov/consensus/cons/110/) revealed that, after many years of expensive studies, NIH is still unable to discern what ADHD was, how to diagnose it, and how to treat it. I once again was given the microphone. I asked those convened if they can entertain the idea that there is no such thing as an attention deficit disorder. Everyone is always attending to something. Differences in our neurophysiological make-up, our emotional status, and other factors make it more or less difficult for us to set and sustain our attention on what someone else considers the task at hand. I then invited them to join HANDLE in renaming the issue we were examining and call it Attentional Priority Disorder. With this major change in perspective, the problem can come into focus and be dealt with systemically, holistically, fully.

One of the concluding statements in the consensus report was that a major problem in finding appropriate treatment and services for ADHD was lack of information. I wished to address this point, but did not have the chance. My statement is simply, there is no lack of information. There is a lack of information that is readily available to the public because of political and financial funding for a specific agenda only. Those of us who believe there are alternative perspectives must support those voices, so information of options and the options themselves will be available to those who need them.