Lead author Stephen V. Faraone, PhD, is participating in these Q&A to discuss the study. Dr. Faraone is a distinguished professor in the Psychiatry, Neuroscience, and Physiology Departments of the Psychiatry Research Department at SUNY Upstate Medical University in Syracuse, New York. He is President of the World Association for ADHD and Program Director for www.ADHDinAdults.com.
Psychiatric Times (PT): What started the consensus guidelines and why are they important now?
Pharaoh: Despite a large scientific literature on ADHD, much misinformation about ADHD is spread on the internet and other media. This creates stigma and leads to treatment decisions that are not in the best interests of the patient. Our consensus provides doctors, patients, and family members with evidence-based results that they can use to make informed decisions.
PT: How were the authors selected?
Pharaoh: I asked thought leaders from ADHD professional associations around the world to nominate writers for the project.
PT: Since this is a global consensus declaration with 27 countries represented, what differences have you noticed internationally? How is the United States doing? compare with other countries in terms of recognition and treatment?
Pharaoh: The prevalence of ADHD, symptoms of the disorder, and their consequences are essentially the same around the world, with a few small exceptions. The main difference is how often ADHD is appropriately diagnosed and treated. Diagnosis and treatment rates are better in countries with well-developed health systems compared to other countries. The United States has higher diagnosis rates compared to other high-income countries, although ADHD is underdiagnosed in adults in the United States and around the world.
PT: The article talks about the stigma of both ADHD patients and health professionals treating the disorder. Can you tell us more about it?
Pharaoh: In patients diagnosed with ADHD, stigma leads to decreased self-esteem, lower peer acceptance, social isolation, and lower self-perception of trust. When treatments become stigmatized, patients and parents are less likely to seek appropriate treatment. In addition, clinicians are less likely to offer these treatments. This leads to unnecessary hardship and disability as well as costs to society.
PT: The piece provided 208 empirically supported statements about ADHD. Which were the most effective? What new information does the paper contain?
Pharaoh: The level of impact varies with the reader. Knowing which treatments work and which don’t work for ADHD can be life-changing for patients and families. Learning that ADHD costs society billions of dollars each year will motivate policy makers to improve access to care. Learning the conditions associated with ADHD will be of great interest to primary care physicians.
By definition, strong evidence cannot be “new” because it comes from published scientific studies. However, I expect much of this information to be new to most non-professional readers and to professionals unfamiliar with the diagnosis and treatment of ADHD.
PT: What is the clinical relevance of the consensus statement and does it offer teaching points for readers?
Pharaoh: In short, doctors 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 crime in adulthood. and the drugs used to treat ADHD are much more effective than non-medical treatments for relieving ADHD symptoms.
Further teaching points:
• ADHD is not an invention of modern society. The syndrome had been described 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 with a very minor impact.
• Neuroimaging studies show small differences in the structure and function of the brain between people with and without ADHD. These differences cannot be used to diagnose ADHD.
PT: Were there any surprises?
Pharaoh: I was surprised to learn that ADHD increases the risk of many medical disorders, including obesity, asthma, allergies, diabetes mellitus, high blood pressure, insomnia, psoriasis, epilepsy, sexually transmitted infections, eye abnormalities, immune disorders, and metabolic disorders.
PT: What’s next for this field of study?
Pharaoh: Our next goal is to spread the international consensus declaration as widely as possible. It has been translated into Spanish, French and German and we also have a summary in Welsh. The colleagues are currently in the process of translating it into Mandarin, Turkish, Portuguese, Arabic, Hindi, Dutch, Japanese and Italian. These translations will be available on the World Federation of ADHD website.
Readers can learn more about Dr. Find out about Faraone on Twitter: @StephenFaraone.
1. Faraone SV, Banaschewski T., Coghill D. et al. The International Consensus Statement of the World Association of ADHD: 208 Evidence-Based Conclusions on the Disorder. Neurosci Biobehav Rev. 2021; S0149-7634 (21) 00049-X. Accessed April 4, 2021. https://www.sciencedirect.com/science/article/pii/S014976342100049X#abs0010