News from Three Recent Conferences on ADHD

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).

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Community Ritalin Use Rates Reach Twenty Per Cent in the U.S. and Canada

"The Extent of Drug Therapy for Attention Deficit-Hyperactivity Disorder Among Children in Public Schools," GB LeFever, KV Dawson and AL Morrow. American Journal of Public Health, September 1999, vol. 89, pages 1359-1364.

"'Boys Will Be Boys' -- That's Why We've Got Them Popping Pills," Anne Rees. The Province, Vancouver, BC, August 9, 1999, pp. A14-16.

These two articles just out convincingly demonstrate there are communities where the rates of stimulants prescribed to children is twenty per cent (Ritalin).

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ADA Cases Hard to Prove for Mental Disabilities

"ADA Cases Hard to Prove for Mental Disabilities," J. Schieszer, Clinical Psychiatric News, April 1998, p. 26.

According to Tracy M. Miller, a lawyer presenting at the annual meeting of the Academy of Organizational and Occupational Psychiatry, the vast majority of mental disability cases under Title I of the American With Disabilities Act (ADA) in 1997 were decided in favor of the employer.

The trouble with winning these cases is the following: Not only do they have to be disabled to be covered by the ADA, but they also have to be otherwise qualified. In many cases, proving they are qualified for their job has resulted in plaintiffs disqualifying themselves as being ëmentally disabled.í Conversely, proving they are mentally disabled has resulted in plaintiffs showing that they are not otherwise qualified to be doing the job for which they have been hired.

I have experienced this conundrum both conceptually and clinically in thinking about the problems of ADHD disability and the legal rights of accommodation, especially in the workplace. It is a bit different with children because they are compelled to attend school through age sixteen. Therefore it seems reasonable to insist that educational efforts adapt to the childís needs. It is a different kettle of fish with a job situation where a person ostensibly can quit and look for employment elsewhere (another employer or another kind of job). I know itís hardly as easy as that for most people.

ADHD can be interpreted as a tautology (a logical term that basically says the symptoms are the disease and the reasoning quite circular). Thus someone who is chronically late and disorganized may qualify for an ADHD diagnosis but in the process could be disqualified as incapable of performing the the job for which he was hired. In general Iíve shied away from getting involved in adult disability claims because of ambiguities in the law and the diagnosis and the possibilities of secondary gain in claiming a disability. This article should alert both employer and employee to the difficulties of pursuing accommodations when there are disagreements as to what is reasonable. It also suggests how ultimately the community views the situation.

Reviewed 8/15/98