Presented by:
George DuPaul, Ph.D.
Department of Education and Human Services
Lehigh University
Bethlehem, Pennsylvania

November 17, 1998

Good afternoon. I am pleased to be here today on behalf of the more than 155,000 members of the American Psychological Association (APA). Before I begin, I would like to commend the National Institutes of Health for convening this conference. Proper diagnosis and treatment of Attention Deficit Hyperactivity Disorder, or ADHD, is an important concern to many parents, teachers, and health professionals across the nation. The APA applauds your decision to devote three days and considerable effort and resources to developing consensus about this disorder.

As you may know, the APA is the largest scientific organization representing psychology in the United States. The APA's membership includes researchers, educators, clinicians, consultants, and graduate students. Psychology is unique among health and human service professions because it is both a scientifically grounded, academic discipline as well as a health care service-oriented profession.

Child development and child and family concerns are a priority to psychologists. That priority is illustrated by the APA's member-affiliated divisions and sections devoted to developmental psychology, clinical child psychology, pediatric psychology, school psychology, and family psychology and is demonstrated by the APA's governance that includes an ongoing Committee on Children, Youth and Families as well as various task forces devoted to child, family, and adolescent issues.

Psychological research plays a pivotal role in society's understanding of human development and makes an essential contribution to appropriate diagnoses and treatments of complex disorders. Current research demonstrates that ADHD is a complex disorder that may affect someone across his or her entire life span. The APA believes that psychologists' unique training in evaluation, diagnosis, and treatment of complex mental disorders prepares them to integrate their expertise in child development, human behavior, and psychosocial functioning to collaborative efforts to diagnose and treat ADHD, and that research into the types of collaborative approaches that work best should be a priority.

I am sure that everyone agrees that the first step in successfully treating any disorder is an accurate diagnosis. In practice, that may not always happen. In that regard, we urge that you keep in mind the following three points:

1) It is extremely important that practitioners do not diagnose ADHD without an understanding the wide variability of child development, or diagnose based solely on the results of trial psychostimulant interventions.

2) We all are aware of the possible over-diagnosis of ADHD. An ability to recognize other childhood disorders, such as anxiety or depression, that often mimic the same symptoms and behaviors is essential to differentiating ADHD from other, possibly more accurate, diagnoses.

3) Especially for children, knowledge and consideration of the social environments in which a child functions - what the child is experiencing at home and at school - makes an essential contribution to a more complete understanding of any child.

Psychological assessment is an important contribution that psychology can make to any collaborative effort to diagnose and treat ADHD. Psychological assessment provides data to help distinguish between possible diagnoses and improves intervention outcomes by:

• describing current functioning across a range of environments,
• confirming or refuting clinical impressions,
• identifying treatment needs,
• identifying appropriate interventions, and
• providing a means of monitoring treatment progress.

We all know that treatment for ADHD often includes pharmacological intervention and that the current empirical literature supports the efficacy of stimulant medications. In setting research and practice priorities, however, that empirical support for use of stimulant medications should not reduce the need to look at other alternatives as well.

The APA believes, as do many manufacturers of psychostimulant medications, that in many cases the use of pharmacological intervention alone is either inappropriate or inadequate. For these reasons, the APA believes that the best way to diagnose and treat children and adults with ADHD is through the integrated collaboration of pediatricians, family physicians, psychologists and other health and mental health professionals, parents, and teachers, according to the training, skills and capacities of each and as indicated by a child's individual needs.

Throughout this conference, we have heard of successful pharmacological and psychosocial interventions for ADHD. The effectiveness of many of these treatments is beyond dispute. Unfortunately, we have only a relatively small amount of data on the long-term impact of sustained use of psycho-stimulants. At the same time, children are being given stimulant psychopharmacological interventions for ADHD at increasingly younger ages. Yet, there is a lot that we still do not know. Research on psychosocial intervention for children diagnosed with ADHD is very much needed and should be a priority.

As NIH continues research on ADHD, we strongly urge an increased emphasis on the inclusion of psychosocial factors and interventions in evaluation and treatment. The APA believes that research on behavioral interventions and on the combination of behavioral and psychopharmacological interventions for ADHD can guide practice to even more appropriate intervention strategies overall and result in even more effective outcomes.

To conclude, the APA supports a consensus that coordinated collaboration is essential for diagnosing and treating ADHD and believes that additional research into the types of collaborative and integrative approaches that work best will greatly benefit the children, adults and families who confront the challenges brought on by this complex disorder each and every day.

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