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Alan Sugarman introduced the panel as being concerned with the fact that attention deficit hyperactivity disorder (ADHD) is being understood by too many professionals and parents around the world as a neurologically or biochemically based disorder for which stimulant medication is the treatment of choice. The three panelists are part of a cadre of child clinicians challenging this disturbing trend and the assumptions that underlie it. All three have found that early trauma contributes to the symptoms for which children are diagnosed with ADHD. The prominence of early trauma in these children should not be surprising; after all, ADHD is just a set of behavioral, emotional, and cognitive symptoms that indicate an underlying disturbance in the synthetic, organizing, and integrative functions of the ego (Gilmore, 2000). Sugarman emphasized that such children have serious problems with self-regulation because affect regulation, narcissistic regulation, and stability of self- and object-representations are problematic. Consequently, their minds have difficulty balancing and maintaining a homeostatic equilibrium between the many mental processes and contents necessary for adequate self-regulation. Some ADHD children are born with constitutional limitations in these regulatory functions. But even these children develop unconscious fantasies to account for their functional difficulties, fantasies that must be analyzed. Other ADHD children have had these regulatory functions disrupted by early trauma, leading to internal conflict and inhibition of the functions in question.
Sugarman pointed out that the panelists suggest that the psychoanalytically informed treatment of these children be two pronged; they need both sensitive individual treatment to overcome the regulatory problems, and they need intervention in the traumatizing sociocultural milieu to prevent the trauma from repeating itself and undermining treatment gains. He concluded by suggesting that the individual treatm