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What follows may seem new and strange and different, as it represents the viewpoint of a small, though perhaps growing, minority of mental health professionals in this country. If this causes distress, comfort could be found in knowing that this presentation in Europe would be received as old, commonplace, and familiar. It would there, in effect, represent the viewpoint of the majority of mental health professionals.
This difference in viewpoint can be made concrete by noting that, in the spring of 1993, for every 250 children in this country diagnosed as Attention Deficit/Hyperactivity Disorder and treated with psychostimulants, there would have been just one such child similarly treated for ADHD or hyperkinesis, the European equivalent, in all of Germany, England, France, and Italy combined. The discrepancy was the same for Norway, Sweden, Denmark, and Finland (Furman 1996). The ratio would be little changed today, as the estimates used for children so diagnosed and treated in the States in 1993 were most conservative and, despite increased consumption in Europe recently, the production here has practically doubled since 1993 (Feussner 1998).
I want to describe how I learned about this discrepancy, how I came to understand some of the factors responsible for it, and something about the forces that maintain the discrepancy in this country. By psychostimulants I will be referring basically to methylphenidate and will not use its commercial name, Ritalin.
Along the way I will want to address two comments that emerged from a nationally publicized conference about ADHD organized by the National Institute of Health, as reported by the Associated Press in November, 1998. The comments were: “The diagnosis is a mess,' said Dr. Mark Vonnegut,