I attended three conferences in September 1999.
Attention Deficit Hyperactivity Disorder: A Public Health Perspective Conference, Centers for Disease Control (Atlanta), September 23-24. I made a special effort to make it to this conference because of my belief that the rise in the rates of the ADHD diagnosis and the use of stimulants (Ritalin, Dexedrine, Adderall) signify a public health crisis in our children. That's why I was delighted that the CDC decided to take a look at the issues involved (Richard Jackson, M.D., M.P.H., the Director of the National Center for Environmental Health, a pediatrician and an old friend of mine from training days was a prime force for having this conference).
The tenor of this conference was quite different from last year's NIH Consensus Conference. As opposed to the rancor and extremism present at the Consensus Conference where ostensibly they were searching for the "truth" about ADHD, the CDC Conference was more interested in learning how they might further explore ADHD within a public health context. To that extent, I was quite pleased in their viewpoint in that they are as much interested in the social and cultural conditions present for the host (the child) as they are in whatever environmental toxins, viruses or brains might be involved. Julie Zito's presentation particularly affected me as I saw her epidemiologist's mind carefully frame certain studies that would attempt to tease out the various economic, social and cultural aspects of the ADHD/Ritalin phenomenon in America. Overall, I was glad I made it to this conference while at the same time felt many of the ideas expressed in Running on Ritalin were now "on the table" at scientific convocations on ADHD. That was great.
Annual National Meeting of CHADD (Children and Adults with Attention Deficit Disorders), Washington DC, September 16-18. This was a more difficult meeting for me to attend. I am interested in trying to forge an alliance with CHADD even as they and I have had some differences in the past and may continue to struggle on some issues. Nevertheless, I have tried to bridge these gaps because I feel there are many good things that CHADD offers parents, and they are the leading self-help group for ADHD and a powerful political lobby in Washington. Russell Barkley presented the opening keynote address. He continued his intellectual attack on Thom Hartmann and Peter Jensen, both of whom have written about the possible evolutionary advantages of ADHD in the past (hunters vs. farmers, alert warriors, etc.). Dr. Barkley strongly believes there is no evidence to support these theories and that they potentially harm present day ADHD sufferers in that they can wind up trivializing the disorder -- you cannot claim to benefit from ADHD and then want to call it a disorder. He got a very positive reaction from the audience even as Peter Jensen sat in the first row. Jensen had just been inducted to CHADD's Hall of Fame. The juxtaposition of the two events struck others and me as quite awkward. Matt Cohen, after Barkley's presentation, went to some length to explain how the organization can tolerate different voices. It is with that belief that I met with CHADD's executive board in the hope that my ideas may also come to be represented within CHADD's tent some day. The next day Edward Hallowell gave a stirring almost evangelical speech on the value of "Connections" (relationships) the topic of his new book by the same name. I was given a small stage (with little publicity reflecting, I believe, CHADD's ambivalence in having me at their meeting) and met with about twenty people to exchange ideas and feelings over Running on Ritalin. I sincerely hope CHADD and I can work out our differences and work together in the future.
Annual Meeting of the American Academy of Pediatrics, Washington DC, September 18-20. This conference followed immediately after the CHADD conference. Here I was given the stage with Matt Cohen and Danny Kessler, another behavioral-developmental pediatrician and recently added to CHADD executive council, to discuss advocacy and ethical issues of ADHD. I went first and Matt and Danny followed extensively discussing (and dissecting) Running on Ritalin. I was slightly bemused since I was told specifically not to mention my book yet my fellow debaters quoted many sections verbatim (pro or con) and even had the cover of R on R for one their slides. Matt's concerns seem to revolve around the potential problems for the legal definition ADHD as a disability if there are questions raised about the ADHD construct or not categorizing children's underperformance or misbehavior as a disorder. It is very clear that the clinic-referred university screened ADHD child is quite different from the Tom Sawyers who walk into the average pediatrician's office for an ADHD evaluation. Danny made the case that more pediatricians involved in clinical practice should participate in meetings of policy over ADHD. He also thought I deemphasized a bit too much the biology of ADHD -- what he and I both agree should be called a "biopsychosocial condition" rather than what CHADD calls a "neurobiological disorder." Perhaps we can agree on BIOpsychosocial problem.