Attention, Attention!

It seems to me that attention-deficit/hyperactivity disorder (ADHD) is the focus of considerable controversy these days. Clearly, the National Institutes of Health (NIH) ADHD Consensus Conference generated considerable controversy in the popular press, and much misinformation has been transmitted regarding the use of stimulant medications in children with ADHD. Various politicians have also suggested that psychotropic medications are being overprescribed in children. Finally, there is a dramatically different perception of ADHD and the use of stimulants in the United States vs Europe, with much less awareness of the problem (ADHD) and little access to stimulants in Europe. This issue of CNS Spectrums provides a breath of fresh air. As always, the best approach to resolving controversy is to provide information which is topical, concise, and addresses a gap in our knowledge base. This issue of CNS Spectrums takes a large step in this direction. I would like to congratulate Jeffrey Newcorn, MD, my good friend and colleague and the director of child psychiatry at the Mount Sinai School of Medicine in New York, NY, for guest editing this issue. He suggests that ADHD is not just an issue of temperament or a reflection of teachers' need to maintain order in the classroom. Rather, ADHD is a real disorder with significant morbidity, which places children at risk for the development of conduct disorders, antisocial disorders, substance abuse, academic underachievement, and vocational underachievement, as well as secondary mood and anxiety disorders if untreated. Peter S. Jensen, MD, reports on the NIH ADHD Consensus Development Conference, which provides a solid body of evidence showing that careful medication management can result in noticeable improvement in several measures, with little risk of adverse events. Kurt P. Schulz and colleagues describe neurobiological models of ADHD which suggest that dysfunction in the prefrontal-striatal neural circuits, as well as in brain stem catecholamine systems that innervate these circuits, may underlie the executive function deficits in ADHD. Mary V. Solanto, PhD, addresses the predominantly inattentive subtype of ADHD, which is frequently overlooked by clinicians. Of interest, this subtype has a relatively larger proportion of affected females, a later age of onset, and is less likely to be associated with symptoms of oppositional defiant disorder or conduct disorder. Also, the neurobiologic substrates and treatment needs may differ in this subgroup, suggesting the need for additional research. David J. Marks and colleagues suggest that early verbal aggression may be the most accurate predictor of later physical aggression in ADHD and may represent a stable, temperamental characteristic. Jessica Himelstein and Jeffrey M. Halperin, PhD, suggest that ADHD persists into adulthood in 30% to 60% of childhood-onset cases, and thus many adults may be suffering from this disorder. The deficiency of information processing in adults with ADHD appears to be related to difficulties in motor output/response organization, not poor sustained attention functioning. Again, I would like to congratulate Dr. Newcorn and colleagues for providing our readers with an up-to-date examination of key issues in this complex, fascinating, and greatly misunderstood neuropsychiatric disorder. My hope is that by informing clinicians and researchers, we can increase awareness, counter misinformation, resolve controversy, and improve treatment and outcome for ADHD sufferers. BBS