Talk:Attention deficit hyperactivity disorder

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Stimulants and sudden death

Wondering were people think this paper should noted? "This case-control study provides support for an association between the use of stimulants and sudden unexplained death among children and adolescents."[[1]] The FDA recommends caution WRT the result which should be commented on as well.--Doc James (talk · contribs · email) 14:38, 16 June 2009 (UTC)

If I recall correctly the FDA has mandated stimulants have a black box warning for sudden death so I don't see why not.--Literaturegeek | T@1k? 01:08, 17 June 2009 (UTC)

surely this level of detail should go in the article of stimulants, not the article on ADHD. --Vannin (talk) 01:55, 17 June 2009 (UTC)

How about the article about the treatment of ADHD? Stimulants are not used for much else. And the FDA does comment specifically that this study should not lead to masses of parents removing their children from treatment.--Doc James (talk · contribs · email) 01:58, 17 June 2009 (UTC)

Vannin has a point, article is on ADHD. I think Attention-deficit hyperactivity disorder management and perhaps also stimulants article are more relevant.--Literaturegeek | T@1k? 02:02, 17 June 2009 (UTC)

The consensus is,...or was, that there was no increased risk of sudden death from the therapeutic use of stimulants. At face value this primary source challenges that notion. It is important to note that this is a single study and it is a correlation study. Correlation does not equal causation.

The FDA did comment on the study, "It's hard to characterize the results as reassuring," the FDA's Robert Temple said at a news conference. Still, Temple said, it's possible that the study missed stimulant use by the car-accident victims, because the parents of children whose deaths were unexplained might have better recall years later of what drugs they took. It's not a robust finding," he said, noting that if only one more automobile victim had been found to have taken an ADHD stimulant, the difference between that group and the sudden unexplained death group would no longer have been statistically significant. But, Temple said, "that doesn't mean that this is off the table and we're not concerned about it anymore." [2]--scuro (talk) 03:57, 12 July 2009 (UTC)

My medication has a warning at the top of the giant warnings sheet that it may cause sudden death in patients with heart defects, which makes sense because stimulants raise blood pressure. Whether or not this warning was FDA mandated is another issue.--Unionhawk ^{Talk E-mail} 15:55, 30 July 2009 (UTC)

Low arousal theory

Unresolved

A question is asked at this article's talk page which I cannot answer. Just a heads up. - Hordaland (talk) 18:20, 20 June 2009 (UTC)

I've shorten that article by half and removed 1 of the 3 references. See its Talk. The article could just as well be deleted, but I'm leaving it there. - Hordaland (talk) 00:09, 7 July 2009 (UTC)

These speaks to a symptom of ADHD? Who are the proponents of this theory? My fear is that it may be a business. Not sure if this belongs on the ADHD page unless someone wants to flesh it out for us.--scuro (talk) 20:46, 21 July 2009 (UTC)

Move to have this section removed from the article. I don't think it is even worthy of mention because it is not notable. See discussion within that article's talk pages.--scuro (talk) 09:22, 3 August 2009 (UTC)

Section tagging the controversies section

Resolved

I'm posting a cleanup tag on the controversies subsection for the following reasons:
1. This section needs copyediting for tone and flow. It reads choppily and awkwardly.
2. Some statments needs to be clarified. As an example, "One source of controversy is that the pathophysiology of ADHD is currently unclear." Who is it a controversy for? For anti-psychiatrists and the like, they argue that because there currently no definitive pathophysiology, ADHD doesn't exist. For the researchers in the field there is no question that there is a pathophysiology, but there are probably competing ideas on the precise identity of it.
3. Currently the section contradicts some of information in the main article ADHD controversies

"the promotion of ADHD to the public as well as policies aimed at schools which force schools to identify children with ADHD being blamed for over diagnosis." There is no mention of or only faint passing references in ADHD controversies about and "promotion of ADHD to the public" and "policies which force schools identify children with ADHD being blamed for over diagnosis".

"the high rates of ADHD diagnosis" - There are mainstream sources that say ADHD is under-diagnosed or may be under-diagnosed in certain populations like girls [3] or adults (NICE). Also this controversial view is currently presented without any counterbalancing information. This statement presents as fact that over-diagnosis is due to alleged policies which force schools due identify children with ADHD, when there is are also arguments that overdiagnosis might be due to vague diagnostic criteria. And again there are mainstream sources which state that some populations have ADHD under-diagnosed. This should probably be reworded somehow to better express the over-diagnosis debate.

4. Some aspects of ADHD controversy which have substantial page-time on the main controversies page are totally ignored here. These include impact of labeling and politics and the media. A mention for both could be worked in. Sifaka ^talk 00:56, 27 June 2009 (UTC)

You must have (at least) 2 monitors; how do you keep track to compare? The controversy section here is supposed to be a summary of the contoversy article. Should one rather begin there? - Hordaland (talk) 19:25, 6 July 2009 (UTC)

With regards to controversies, I don't believe the points below have been addressed yet. I've posted them again so that we can move forward on this issue.

1. What is the controversy?
2. What is the majority and minority viewpoint about the controversy?
3. Have both viewpoints been stated clearly with due weight according to wiki standards?

As wiki states WP:UNDUE "Undue weight applies to more than just viewpoints. Just as giving undue weight to a viewpoint is not neutral, so is giving undue weight to other verifiable and sourced statements. An article should not give undue weight to any aspects of the subject, but should strive to treat each aspect with a weight appropriate to its significance to the subject. Note that undue weight can be given in several ways, including, but not limited to, depth of detail, quantity of text, prominence of placement, and juxtaposition of statements."

Input would be most welcome.--scuro (talk) 04:07, 12 July 2009 (UTC)

I hadn't heard from anyone and wondered if some of you are considering what was stated but need more time to comment. Does anyone need clarification on the points made? If I can be of service to anyone please let me know. I'm eager to clean up what I perceive to be this long standing undue weight mess with regards to controversy.--scuro (talk) 16:44, 15 July 2009 (UTC)

Why do you not write something with references to the literature that you think is better / more balanced than what we have. Post it here and we can then discuss these proposed changes?--Doc James (talk · contribs · email) 17:01, 15 July 2009 (UTC)

It is entirely possible, as Sifaka suggests at the top of this thread, that we do need a more general discussion before attempting concrete re-writes? We don't have one controversy (as suggested by scuro "What is the controversy?"), but several. Sifaka explains/defines some of them; why not start there? - Hordaland (talk) 08:44, 16 July 2009 (UTC)

I've no problem with the viewpoint that there are several controversies. I also agree with you that a general discussion would be the best approach. Can't seem to find Sifaka's classification of controversies. Can anyone find a link?--scuro (talk) 10:57, 16 July 2009 (UTC)

An editor posted this link [4] on my talk page. Dr Silver is, "...a Child and Adolescent Psychiatrist, is in private practice in the Washington, D. C. area. He is Clinical Professor of Psychiatry at Georgetown University Medical Center. Prior to his current activities, he was Acting Director and Deputy Director of the National Institute of Mental Health of the National Institutes of Health. Prior to his positions at the National Institute of Mental Health he was Professor of Psychiatry, Professor of Pediatrics, and Chief of the Division of Child and Adolescent Psychiatry at the Robert Wood Johnson School of Medicine. For more than thirty years his primary areas of research, clinical, and teaching interest have focused on the psychological, social, and family impact of a group of related, neurologically-based disorders—Learning Disabilities, Language Disabilities,Sensory Integration Dysfunction, and Attention Deficit Hyperactivity Disorder". I think he would meet the criteria of an expert in the field, and the book is considered a clinical book. He clearly delineates between between current research and medical perceptions of little current controversy. Specifically, "current debate over ADHD within the research and medical communities has been minimal and mostly concerned with subtle details within the diagnosis process and treatment program". That would seem to be at odds with what the article states about current perceptions, based on citations that are 10 or more years old.--scuro (talk) 03:36, 19 July 2009 (UTC)

I don't see why that ref cannot be used scuro. You can use the book citation template Template:Cite book to cite it.--Literaturegeek | T@1k? 21:48, 19 July 2009 (UTC)

Ambiguity in the culture section.

Resolved

The first paragraph of Attention-deficit hyperactivity disorder#Culture is difficult to follow. What do "The core impairments are expressed in different cultural contexts" and "ADHD is considered differently based" mean. Who are "they?" I am adding some inline tags requesting clarification. Sifaka ^talk 01:01, 27 June 2009 (UTC)

I still don't think part of the culture section has been made more readable, so I will explain in more depth.

ADHD is considered differently based on how those who have an interest in the topic approach the subject. --> This statement is awkwardly worded making its meaning unclear. "Considered differently based" is especially unclear in the "these words don't make sense together" kind of way. Based on what?

Depending on one's paradigm, the meanings of ADHD related subjects and terms vary within the everyday language of lay persons. --> "One's paradigm" is unclear. Does it refer to one's beliefs about existence of ADHD or how it is treated?

Part of this section was also directly copied from the abstract of the paper. It is now paraphrased. Although the source was cited, I want to point out that it is probably a violation of WP policy to copy-paste text without paraphrasing it unless it is quoted. (There wasn't a strong statement that I saw on the policy page to this effect but it seemed to be implied).

Also I am wondering if the title of the section should be changed to something like Perception of ADHD instead? Thoughts? Sifaka ^talk 23:29, 4 July 2009 (UTC)

The whole first paragraph in "Culture" belongs far above, in "Causes". Can probably be combined into a section up there. The explanation in quotes applies to ADHD, not just to the high frequency, I think.

The "differently based" sentence is not good, but not as bad as you'd have it. Read it with a comma after "differently". I think it says that people have different approaches to the topic, and, based on this, they "consider" it differently. I'd say: Obviously they do... But "consider" isn't a good word here. That paragraph makes an interesting point, but is so unclear that no one is going to get it.

"Culture" is a strange name for the section, but not sure "Perceptions" is any better? Maybe "In society"? Or does the content needs its own section, at all? There are parts which quite specifically echo "Controversies" (high frequency, etc.); could/should they rather be there? What is the point of including this section? I suppose it's sorting out various types of experts, lay people & media? - Hordaland (talk) 22:21, 6 July 2009 (UTC)

Thanks for clarifying the "differently based" line. It makes a lot more sense when you mentally insert a comma, but the whole sentence is kind of vague. I agree that the first paragraph belongs somewhere else. (epidemiology? I'm not sure.) The last paragraph (baseball) probably belong in the epidemiology section. As a name "ADHD in society" is ok too but maybe "ADHD in popular discourse" or "popular culture"? Ignoring the two paragraphs that belong in other sections, I think the culture section has two main focuses: How lay people perceive and discuss ADHD and instances of when ADHD became a popular topic and attracted a lot of attention - enough attention to affect general perceptions. I think the material is different enough in scope from that in the the controversies section to warrant its own section, but there are probably some details that need to be resolved. Sifaka ^talk 03:12, 7 July 2009 (UTC)

"Culture," "Perception of ADHD," "ADHD in society," "ADHD in popular discourse," "ADHD in society," and "Popular culture" were suggested above. I just happened to be over at NPOVnoticeboard and saw this suggestion in another context: "Societal views." I like it. Perhaps it could be its own section, instead of looking to be a part of "History." Alternatively the content could be considered history. Leaning toward "Societal views." - Hordaland (talk) 18:10, 10 July 2009 (UTC)

There is supposed to be a standard format for medical articles. I believe "Culture" can be one of the major subheadings and I have no problem with "societal views" being a minor subheading within that area. On the other hand, is this section just a rehashing of "alternative theories", which already has it's own section?

With regards to ambuguity, the lede sentence is just as confusing within the context of society, "Adaptive explanations of the high frequency of ADHD in contemporary settings propose that "the disorder represents otherwise normal behavioral strategies that become maladaptive in such evolutionarily novel environments as the formal school classroom." However, one study showed that inattention and hyperactivity appear to be at least as problematic at home as at school". What, or who believes in "adaptive explanations"? Is this Hunter/gatherer terminology? The sentence contradicts itself. Either ADHD is really only a problem in the classroom or it isn't. That is unless you want to divide this into majority opinion and minority opinion. The bigger problem is that the opening line should summarize the whole section.

The second sentence/paragraph(?) again contradicts itself, and yes...is not clear. The sentence seems to be written from the "social construct" theory. ie ADHD exists because the medical community has created terms etc, and people use these terms, so the disorder exists. Thoughts on all of this?--scuro (talk) 11:17, 16 July 2009 (UTC)

I think that you may be right about what that paragraph is about, but, I can't tell at all... I'm not sure that that paragraph even belongs in a culture section, but, it's too confusing for me to be able to tell one way or the other. And, of course, the source for that paragraph is blocked by parental controls... I'm going to take a guess and say that it's redundant. Revert if you disagree.--Unionhawk ^{Talk E-mail} 20:22, 16 July 2009 (UTC)

The line that I quoted in my previous post is now the lede sentence. Problems noted in that last post still exist. This sentence could also be removed, and a new lede sentence could be added. Or, does someone else have a solution?--scuro (talk) 02:37, 18 July 2009 (UTC)

It's been fixed.--scuro (talk) 13:37, 1 August 2009 (UTC)

Comorbid conditions

Resolved

OK so can someone tell me after checking out citation 102 and 103 (which are identical) which states in the conclusion "There is no published evidence to suggest that either the short or long term treatment with methylphenidate increases the risk of developing seizures in children with ADHD."

can be reconciled with...

"Some forms of epilepsy can also cause ADHD like behaviour which can be misdiagnosed as ADHD"

The citation is regarding the drugs to treat ADHD and the correlation b/w the 2, not a diagnosis.

josst10 (talk) 01:46, 8 July 2009 (UTC)

Did you read the full citation? I don't see what you are trying to say. I recall reading that citation and it did mention that epilepsy can causes ADHD like symptoms which can be misdiagnosed.--Literaturegeek | T@1k? 02:10, 8 July 2009 (UTC)

Reconciled? Cutting out weasel words your two quotes say:

1. Person with ADHD will not get seizures from taking methylphenidate
2. Person with epilepsy may show ADHD-like behaviour

What's to reconcile? - Hordaland (talk) 14:33, 8 July 2009 (UTC)

I don't see a conflict either. Both are telling clinicians to be careful to determine whether the child has ADHD, epilepsy, both, or [shrugs]. htom (talk) 17:23, 8 July 2009 (UTC)

questionable sentence in the lede?

Resolved

"In the first decade of the 2000s, ADHD diagnoses have increased dramatically in the United States, prompting some scholars from various fields to question the scientific validity of this relatively recent childhood disorder".[14]

Didn't the dramatic increase of the diagnosis of ADHD occur in the 90's? The use of "some" creates an undue weight issue in this sentence. Who are these scholars? Are they majority, minority, or fringe? That's kinda of important for the lede paragraph, don't ya think? The Journal of Ethical Human Psychology and Psychiatry is also of questionable standards. It has no wiki entry and was founded by Peter Breggin. I could be wrong but I don't believe it is viewed as a scholarly journal. An article from this journal is used as the citation for the sentence. Anyone have input here on who put that sentence in and if it should be removed from the page?--scuro (talk) 04:33, 12 July 2009 (UTC)

I am not at this time offering any opinion on whether that sentence should stay or go or be revised or be differently sourced.

I looked around a bit and see that Jeanne M. Stolzer, Ph.D., is (or fairly recently was) an Assistant Professor of Child Development at the University of Nebraska @ Kearney. Her "research interests include the biocultural implications of attachment parenting, the multivariational effects of labeling children, and challenging the existing medical model which seeks to pathologize normal range child behaviors." ...from this PDF, 2006. So we see which camp she's in: probably minority but not fringe IMO.

She's been using the phrase "the last decade" for some time. That phrase cannot be used in an encyclopedia article which is meant to be read 5 and 10 and 20 years from now. - Hordaland (talk) 13:20, 12 July 2009 (UTC)

Utter geniuses who are Nobel Prize winners, and dominate their fields,...have been known to take on extremely controversial positions outside of their field of expertise. One scientist that comes to mind was an utter racist to the core. Their reputation in one field has little credence within another field. Likewise, the position that one holds means little. The question should be, is this person a recognized expert in the field of ADHD, and if she is, why isn't she publishing in mainstream journals instead of "alternative" and exclusive journals? Is there a better source?--scuro (talk) 14:16, 12 July 2009 (UTC)

I have moved the source down to the controversies section scuro. There has been an increase both in the 90's and 2000's. It is not a review article. I have no idea who added that citation or sentence to the lede.--Literaturegeek | T@1k? 21:48, 12 July 2009 (UTC)

The controversy section should be a brief summary of the controversy page, not a catch all. What is the value of this sentence? The facts appear to be wrong, the source questionable at best, and the conclusion OR. I'd suggest removing it all together or finding a better source that states the same thing. It detracts from the quality of the article.--scuro (talk) 01:38, 13 July 2009 (UTC)

I would need to read the full text first, so dunno how they based their findings. As I did not add the ref, I want to wait and hear from other users first. I don't mind one way or the other if that ref gets deleted or not.--Literaturegeek | T@1k? 11:19, 14 July 2009 (UTC)

You are welcome to read the text, the issue though, is the source. Content within the source, in that regard, really doesn't matter. A possible solution here would be to put the "dubious" tag on the citation until you have had the time to consult other editors. The tag may pull in other editors with insights. Is this a workable solution..or do you still need more time?--scuro (talk) 15:27, 14 July 2009 (UTC)

Since there has been no response I've deleted the sentence and citation. Feel free to return the material but please explain why it should be included in talk.--scuro (talk) 14:04, 21 July 2009 (UTC)

Clean up controversies section

Resolved

I agree with Scuro here. We have a controversies article. Given that, the material under Controversies here should represent a summary of the most important material from that article, with high consensus, like a mini-lede, and the controversies article would contain all the citations, the summary need not be cited at all, and extensive quotes are really inappropriate. The removed material should be moved to the controversies article if it is not already there. (Indeed, the summary might actually be the lede of the Controversies article if it has been well done. Good work, Scuro. --Abd (talk) 15:23, 21 July 2009 (UTC)

Ty Abd. Would you be willing to fix this section?--scuro (talk) 15:08, 22 July 2009 (UTC)

Please remind me in January

ArbCom follow-up: diff, FYI.—Preceding unsigned comment added by Hordaland (talk • contribs) 09:28, July 14, 2009

causes section

Template:Deadlocked It would be my opinion that none of the alternative theories would have real acceptance in the Scientific and Medical communities as causes of ADHD. The low arousal theory speaks to a symptom. Diet as a direct cause of ADHD would also not have acceptance in those communities. This creates undue weight issues. As a solution, may I suggest that his material be moved from the causes section. It could be moved to the culture section because it is society which believes many of these things. I'm open to other ideas.--scuro (talk) 23:02, 20 July 2009 (UTC)

There is a box in this section with the following sentence in italics, "As of mid-2009, the consensus on a sensible approach to nutrition for children with ADHD is the same recommended for all children: eat a diet that emphasizes fruits and vegetables, whole grains, healthful unsaturated fats, and good sources of protein; go easy on unhealthy saturated and trans fats, rapidly digested carbohydrates, and fast food; and balance healthy eating with plenty of physical activity. (Emphasis added) [53]". Stylistically is this supposed to be done?--scuro (talk) 14:12, 21 July 2009 (UTC)

We are writing an encyclopedia for the general population. Ideas held by that general population should also be discussed even though they may be wrong. This is similar to many article were we have sections on alternative medicine even though there is no evidence for much / all of it.--Doc James (talk · contribs · email) 14:46, 21 July 2009 (UTC)

ADHD by the way exists in a social cultural context. This is more important in this condition than most because it is a pediatric condition (which means families / school / governement) becomes more involved.--Doc James (talk · contribs · email) 14:52, 21 July 2009 (UTC)

The issue is appropriate weight and if this information belongs in the "causes" section. We do not look to society for answers as to what causes ADHD. I'm not advocating that the material be deleted, rather that it be moved, and or be shortened because of undue weight issues.--scuro (talk) 15:08, 21 July 2009 (UTC)

If one looks back at the history of pyschiatry one sees that less than fifty years ago many of these ideas were by far the majority opinion. There are still many in academics who beleive they place a role. There is very little currently on each of the three ideas.--Doc James (talk · contribs · email) 17:16, 21 July 2009 (UTC)

The issue here is that the section is the "causes" section. Sure, things have moved at exponential pace when it comes brain science and psychiatry. But 50 years is a coons age in this field, even 25 years ago is more like an archaic period. There are many academics with a variety of ideas, but would you not agree that if the information is about the causes of ADHD, that this would fall under the realm of science? That you may have majority and minority within this field, and those outside that field may very well fall under fringe opinion?--scuro (talk) 21:07, 21 July 2009 (UTC)

This is psychiatry were the diagnostic criteria are decided by group consensus. Psychiatry is the least scientific of all the medical subspecialties. So no I do not agree that the cause falls under the realm of science. The science at this point does not claim to have answer. The cause is unknown the patho is unknown. Therefore the discussion of cause at this point is mostly philosophy. --Doc James (talk · contribs · email) 21:59, 21 July 2009 (UTC)

If ADHD is real or not, is not a debatable issue here. Nor is Psychiatry, and its supposed failings. The issue is what is majority, minority, and fringe opinion on the topic of what causes ADHD? Neither the social construct theory(notion that ADHD is fake}, nor the other alternative theories, or diet theories, would meet the threshold to be considered majority or minority opinion with regards to causes.--scuro (talk) 12:34, 22 July 2009 (UTC)

We know that that is your opinion. Others have disagreed. We can wait for more comments if you want.--Doc James (talk · contribs · email) 14:31, 22 July 2009 (UTC)

Really what this is about is how one determines majority, minority, and fringe opinion. Comments on that topic would move this forward.--scuro (talk) 15:11, 22 July 2009 (UTC)

I have provided evidence on the controveries page that this is one of the majority opinions in the general population. This is a general encyclopedia therefore needs to address the topic in a manner that deals with the questions of a general audience. --Doc James (talk · contribs · email) 16:22, 22 July 2009 (UTC)

How one determines what is majority or minority viewpoint isn't done by canvassing other contributors. Society at large doesn't determine what the causes of ADHD are or if the disorder exists. This is determined by the scientific and medical communities. WP:FRINGE The fringe theory page allows for an issue to be seen from different angles. This could be a compromise. That the scientific community clearly believes that ADHD has genetic underpinnings while a minority of the general population believes the disorder to be a fabrication. Could that be the start of solution?--scuro (talk) 19:41, 22 July 2009 (UTC)

The cause is multifactorial. We all agree that there is evidence a genetic contribution. This is mentioned. There is also evidence of a social component ie this is what makes the cause multifactorial. Genes interact with the enviroment and now with epigenetics we know the enviroment interacts with ones genes. So the majority view point is that the cause is multifactorial. So even say that it is not a homogenous condition but a number of different conditions that end with similar symptoms.--Doc James (talk · contribs · email) 22:29, 22 July 2009 (UTC)

Generally there is no real disagreement with what you have stated as long as due weight is respected. So, there is no need to mention any of the alternative theories or diet theories. Philosophy has nothing to do with what causes of ADHD. Diet can help with symptoms but not eliminate symptoms. These sections should be removed from this area.--scuro (talk) 11:02, 23 July 2009 (UTC)

What is considered normal behaviour is a philosophical / social / political question. It is not decided by science. So no I diagree.--Doc James (talk · contribs · email) 04:08, 25 July 2009 (UTC)

I have to agree that it's odd to have unaccepted (by science) theories in the article as 'causes'. Yes we need to thorough as the audience is the general public, but it would make sense to create a sub-section called theories (or something similar), so as not to give the same weight to likely rubbish theories versus accepted theories. Nja²⁴⁷ 12:25, 28 July 2009 (UTC)

All these theories are supported to some degree by people within the feild. Look at the references to the different theories. There have been attempts to make these ideas sound completely unsupported but this is not the cause.--Doc James (talk · contribs · email) 13:53, 28 July 2009 (UTC)

We have a review in nature in 2008 discussing the different POV. Singh I (2008). "Beyond polemics: science and ethics of ADHD". Nat. Rev. Neurosci. 9 (12): 957–64. doi:10.1038/nrn2514. PMID 19020513. {{cite journal}}: Unknown parameter |month= ignored (help) --Doc James (talk · contribs · email) 14:12, 28 July 2009 (UTC)

In the past decade, scientific research has focused on strengthening the first position, with an emphasis on identifying primary genetic causes of ADHD4. More-recent evidence, however, suggests that complex psychiatric disorders are mediated by a combination of genetic and environmental factors4, 12, 13. Scientific research into the complex and potentially multiple aetiologies of ADHD is still in early stages14; however, it is attracting a lot of attention as ADHD becomes a global phenomenon: in the past decade rates of diagnosis have increased sharply in most countries around the world15. These increases are linked to parallel growth in the consumption of stimulant medications16. A better scientific understanding of the aetiology of ADHD might clarify whether the growing number of school-age children that are being diagnosed with ADHD and taking stimulant drugs represents over-diagnosis and overuse of stimulant treatments or an actual increase in ADHD prevalence4, 17.

Growing scientific evidence suggests that ADHD cannot be explained by genetic or environmental factors alone. Research that integrates social and scientific perspectives is likely to achieve a more complete explanation. This article reviews the scientific and social debates over ADHD and identifies key areas in which social investigations should be integrated with scientific research to generate richer models of the causes of ADHD and better understanding of the validity of the diagnosis.

"Ilina Singh is at the London School of Economics and Political Science, Houghton Street, London" - not exactly a scientific expert. Lots of people want to put their finger in the, cause of ADHD "pie", but it belongs to the domain of the scientific community. It is after all, an accepted medical condition. Philosophy just doesn't cut it here, ie what does society believe and how did they come to believe that? Scientists already have spent a great deal of time examining the role of environment. Yes, ADHD most likely has different forms, and different causes, but they attribute of the bulk of cause of ADHD to genetics. Russell Barkley does an excellent job of sifting it all out for the lay person at his continuing ed course. Look under the Etiologies subheading. [5] Chunks of Singh's quote above are accepted within the scientific community. The notion that philosophy has any role in determining the "validity of the disorder" or that philosophy should be "integrated with scientific research", is not accepted at all by that community. Science doesn't do philosophy to get to a point of understanding. --scuro (talk) 11:41, 1 August 2009 (UTC)

Most importantly, this page is a part of the WikiProject Medicine, under the subproject of Neurology, as well as the project of Psychology. Neurology and Psychology are subsets of Medical Science. Thus this page is in fact filed, on this encyclopedia, under a scientific project heading. Thus questions of philosophical, social, or political importance really do need to take a back seat. Look, HIV has fairly significant social and political issues attached to it, but in general one would expect an article on that particular subject to focus more on the scientific research and medical aspects of that disease, right? I mean, if I pull up the wiki article on HIV, I'd expect to see lots of information on retroviruses, T-cells, reverse-transcriptase inhibitors, etc. I wouldn't particularly want to read about people postulating that HIV is some divine retribution for homosexual sex or whatever other kooky social and political statements people might wish to make just to prove some ridiculous point. Sure, make a note that there are people out there who believe that, along with something to indicate that this is a fringe opinion, and maybe include a link to a page that goes more in depth on it.

But seriously...philosophical, social, and political questions really aren't relevant to the scope of an article on a Medical topic. More importantly, philosophical, social, and political arguments are rather irrelevant and invalid with regards to scientific questions.

Now, if one wanted to discuss this in a scientific fashion, then by all means, there are ways to do that. For example, if one wished to question whether ADHD medications were overprescribed, then the scientific method for answering that question might be to look at data on prescription patterns for these medications. What percentage of individuals in various age groups are currently prescribed medication for ADHD. Then one might check studies that estimate the prevalence of ADHD in society. Then one could ask how these two percentages compare. If these drugs are being prescribed at a rate higher than might be expected by the prevalence data....in other words, if there were more people taking these medications in a given age group compared to the number we might expect based upon prevalence estimates, then this would be evidence of possible overprescribing.

However, what we see is that the prescription rate is actually slightly below the estimated prevalence rate. What does this mean? It implies that it is unlikely that ADHD medications are being overprescribed.....or that if there are cases of overprescription, then there would also have to be a significant amount of underprescription to match.

Regardless, this is how one would approach this from a scientific standpoint. Instead of attempting to make a philosophical, social, or political point, all of which are inherently subjective, it is essential to examine the scientific evidence and formulate and test various hypotheses. Hyperion35 (talk) 17:24, 1 August 2009 (UTC)

how to properly reference?

How would one properly wiki reference this citation? http://books.google.com/books?id=gjojY1WoIOIC&pg=PA4&lpg=PP6&output=html --scuro (talk) 23:08, 20 July 2009 (UTC)

It is a strange URL. My recommendation is to cite the book, not the Google URL: first, because the user may want to order the book or seek it at a library; and second, the Google URL could change over time. You could use the book template. My personal preference is to just type in an MLA citation that should look something like this:

Here's how it will look in the Notes section: Silver, Larry B. Attention-deficit/hyperactivity disorder. American Psychiatric Publishing, Inc.; 3 edition (September 2003) ISBN 1585621315; Online: http://books.google.com/books?id=gjojY1WoIOIC&pg=PA4&lpg=PP6&output=html July 20, 2009

Further down from where Google shows you the page, there is a box on the left side as to where to buy the book from several difference dealers. Any one of those will contain the info for the full citation, including ISBN.

I'm sure other editors will have other ideas for you. Thanks for being conscientious about your citations. Afaprof01 (talk) 23:40, 20 July 2009 (UTC)

I've added a place for references to show up on the talk page so that I can see exactly how it should look like and practice. Tweak it if you wish.--scuro (talk) 00:46, 21 July 2009 (UTC)

I forgot to thank you for explaining this. The real test will be the next time that I want to include a citation. Hope your still around then!--scuro (talk) 14:05, 21 July 2009 (UTC)

The whole long URL should not show in the ref section in the article. One could do it like this: (At Google books).

If just referring to one page: (Page xx). - Hordaland (talk) 18:18, 22 July 2009 (UTC)

Not sure how to properly reference a continuing ed website. http://www.continuingedcourses.net/active/courses/course034.php --scuro (talk) 14:04, 27 July 2009 (UTC)

look up the cite web template. There should be a few examples on the page. Sifaka ^talk 14:20, 27 July 2009 (UTC)

see also section

Resolved

There seems to be a lot of links that don't belong there. Are there guidelines for this section?--scuro (talk) 14:09, 21 July 2009 (UTC)

Guidelines say this section should be avoided and this links should be combined into the text.--Doc James (talk · contribs · email) 17:12, 21 July 2009 (UTC)

Feel free to edit away. I'll get around to it if it's not done, sometime in the future. The business links should be removed immediately.--scuro (talk) 21:09, 21 July 2009 (UTC)

James, are you sure that "should be avoided" applies to See also? Or maybe External links? "See also" section on the page Wikipedia:Layout doesn't seem to say that See also should be avoided. (However, links which already appear in the article should not be repeated in a See also section.) - Hordaland (talk) 10:04, 22 July 2009 (UTC)

More on what is not accepted WP:ELNO. Links should be directly related to the topic and undue weight in this section also applies.--scuro (talk) 12:44, 22 July 2009 (UTC)

The see also links are internal links, not external links, just to clarfiy.--Literaturegeek | T@1k? 12:50, 22 July 2009 (UTC)

Based my statement on this [[6]] were it says avoid if possible.--Doc James (talk · contribs · email) 13:30, 22 July 2009 (UTC)

Is there any link that is a "must"?--scuro (talk) 15:12, 22 July 2009 (UTC)

No, it is just a guideline, it is not a must, above I said should. It is just a recommendation for a good article. Most of them are in the text anyway and thus I have removed them.--Doc James (talk · contribs · email) 16:17, 22 July 2009 (UTC)

See also links are internal (link to wikipedia articles/pages on wiki site), so wrong guideline is cited. External links are links to pages outside of wikipedia domains, usually linked in either further reading or external links sections. I have read some guideline somewhere though that if a see also link is linked in the article then it should not be linked at the bottom of the article.--Literaturegeek | T@1k? 17:04, 22 July 2009 (UTC)

Looks like we (mostly?) agree on See also. James is right that MOS-(medicine-related_articles) advises against such a section, more strongly than the general advice. Articles already linked to in the text, should not appear in See also. But if common sense says an article is peripherally related and might be of interest to the reader, it can/should be in a See also section. OK? - Hordaland (talk) 18:34, 22 July 2009 (UTC)

Ah, yes it does say that, "http://en.wikipedia.org/wiki/Wikipedia:Manual_of_Style_(medicine-related_articles)#Sections", Doc James is right, the guideline does recommend avoiding them if possible. I retract what I said about wrong guideline being cited, I was just looking at what it said about external links, appologies.--Literaturegeek | T@1k? 19:15, 22 July 2009 (UTC)

Pathophysiology section

Unresolved

-The opening statement states, "The pathophysiology of ADHD is unclear and there are a number of competing theories.[74]". Surely there must be majority opinion here in the scientific community and should this be stated at the front of this section?

-Not sure what the following sentence is concluding. Is it stating that Neuroimaging is not a diagnostic tool? "Neuroimaging studies in ADHD have not always given consistent results and as of 2008 are only used for research purposes.[76]".--scuro (talk) 14:22, 21 July 2009 (UTC)

That the pathophysio is unclear is stated by many sources and is the majority opinion (see uptodate for example). Neuroimaging is not used in a clinical setting to diagnose ADHD only to rule out other possible problems. It is used in research settings only.--Doc James (talk · contribs · email) 14:37, 21 July 2009 (UTC)

I agree that there is no definitive definable cause, yet there are theories about the cause and this where one could state majority opinion. With regards to Neuroimaging, perhaps the sentence could be more clear?--scuro (talk) 14:43, 21 July 2009 (UTC)

One states what is agreed upon. Everyone agrees that the pathphysio is unclear. Than it is follow by different ideas of what some consider might be possible.--Doc James (talk · contribs · email) 17:11, 21 July 2009 (UTC)

Having read a large number of papers on the topic, there doesn't seem to be a majority opinion among researchers about what causes ADHD although the prefrontal cortex and lobar volume and dopamine misregulation seem to be popular. Also there could be several different causes that have similar effects. It's confusing. The research community seems fairly unified behind the idea that there probably is a biochemical/neurostructural difference, but they don't know what that is yet or what causes it yet. Unfortunately I don't have sources for that statement.

Regarding the neuroimaging studies, basically what it means is that that it isn't a good idea to try to diagnose someone with a "computed tomography [CT], computerized axial tomography [CAT], or magnetic resonance imaging [MRI]."[7] I have the feeling that the reason why boils down to significant variation between people (and perhaps also doctors/researchers not being sure of what to look for). While over a large number of people averaged together, reduced lobar volume in some areas of the brain may be statistically significant, the variation in size may be large enough that it is impossible to tell if a single patient is in the ADHD group or the control group by looking at lobar size alone. Sifaka ^talk 01:23, 22 July 2009 (UTC)

Sifaka is right. The majority would believe in biochemical/neurostructural differences, and that should be stated in the opening. I did try to look at the citation but you can't have access unless you pay the subscription. Are not such links to be avoided?--scuro (talk) 13:43, 22 July 2009 (UTC)

Most of the published literature requires payment. As long as you can reasonably get it at an academic library.--Doc James (talk · contribs · email) 14:30, 22 July 2009 (UTC)

Thoughts on the first part of my last statement?--scuro (talk) 15:13, 22 July 2009 (UTC)

I would disagree. The majority beleive that the patho physio is unknown. The idea that it is biochemical is just the current leading hypothysis. And this is the way we have it presented.--Doc James (talk · contribs · email) 16:12, 22 July 2009 (UTC)

My thoughts scuro are that you say "I agree that there is no definitive definable cause", but yet are disputing a sentence that you agree with.--Literaturegeek | T@1k? 17:07, 22 July 2009 (UTC)

I would disagree, by not clearing stating majority opinion, and instead stating a "number of theories", bias is created.--scuro (talk) 10:43, 23 July 2009 (UTC)

As soon as the cause is not known we should list the prevelant potential theories.--Doc James (talk · contribs · email) 12:42, 23 July 2009 (UTC)

I really don't understand this: "... by not clearing stating majority opinion, and instead stating a "number of theories", bias is created." Even if one can define the majority opinion, it is not the only opinion, and it is not necessarily right. When there is a variety of opinions, Wikipedia is not to take sides, but to present each of them as its proponents describe it. If we only provide a majority opinion, we're not doing our job. - Hordaland (talk) 18:05, 24 July 2009 (UTC)

We do state the majority opinion by listing it first.--Doc James (talk · contribs · email) 18:09, 24 July 2009 (UTC)

"...a number of competing theories" makes it sound like a sporting event with no clear leader. That is not the case. Majority opinion is obvious with regard to theories. I have no objection to other minority opinions being stated according to wikiepedian undue weight. That is the objection.--scuro (talk) 18:40, 24 July 2009 (UTC)

There is no majority opinion among experts at this point regarding which of the theories currently presented in the pathophysiology section is right; in short there is no clear leader among the theories. (Which would make it like a sporting event.) The research is still in its infancy and there are plenty of biochemical/"neurostructural" possibilities that have not been investigated. There are promising leads and theories that have received a lot of attention (like dopamine transporters and lobar volume) but nothing is remotely definitive. I strongly believe the majority opinion is that there is some physical and/or chemical difference which gives rise to ADHD rather than it being "all in their head" so to speak, but that kind of undue weight issue doesn't currently seem like an problem in the pathophysiology section. Sifaka ^talk 16:21, 28 July 2009 (UTC)

It doesn't matter which theory is "right". Could one not generalize and state, "currently scientists believe that genetics plays the major role..."...or something like that?--scuro (talk) 10:22, 1 August 2009 (UTC)

I think I was misunderstanding your point Scuro. I thought you were trying to say "pick the pathophysiology theory with the most support". If I'm reading this right, what you want to emphasize is that even if the pathophysiology is currently unclear, the significant evidence for genetic and environmental underpinnings implies that there is almost certainly a neurophysiological pathophysiology. In short, just because we don't know what the pathophysiology is definitively does not imply that there is a good possibility there isn't one. Researchers just haven't nailed it down yet. It might be worth repeating that researchers believe that a large majority of ADHD cases arise from a combination of various genes, many of which affect dopamine transporters. The broad selection of targets (this phrase could be reworded for better layperson clarity) indicates that ADHD does not follow the traditional model of a "genetic disease" and should therefore be viewed as a complex interaction among genetic and environmental factors. The major problem currently is figuring out, given the suspect genes or appropriate environmental factors, what is/are the ADHD neurophysiological phenotype(s) and how do they cause the symptoms of ADHD? Sifaka ^talk 02:50, 3 August 2009 (UTC)

Honestly, that section is just horrible. It's fairly clear that it was written by laypeople with little understanding of what all these technical words actually mean. The Zametkin parts are especially misleading, to the point of almost being...well, false is the most polite word I can come up with. I mean, the article actually states things about Zametkin's findings that are contradicted by what Zametkin actually found.

For example, this section states:

"a study in girls failed to find a decreased global glucose metabolism,"

http://www.ncbi.nlm.nih.gov/pubmed/9334553

but when we look at the citation, we find:

"Global CMRglc was similar between ADHD and control girls. Lateralization of normalized CMRglc differed significantly between ADHD and control girls in parietal and subcortical regions, with rCMRglc lower on the left than on the right side in girls with ADHD, and conversely in control girls. The sylvian area of the parietal region and the anterior putamen of the subcortical region were the main contributors to this effect. Normalized rCMRglc of the hippocampus was higher in ADHD than in control girls."

So yeah, it didn't find a decreased *global* metabolism, but it found a whole bunch of differences in various regions of the brain. And yet this section in this article implies that this study found no differences. This sentence also leaves out the reasons mentioned as to why the global levels were similar:

"Sexual maturation was the only clinical characteristic that differed between present and previous samples, and it correlated with global CMRglc. CONCLUSIONS: Although failing to confirm abnormally low CMRglc in girls with ADHD, this study suggested that (1) functional interactions between sex and brain development may contribute to ADHD pathophysiology, and (2) sexual maturation should be controlled in future CMRglc studies of adolescent girls."

Translation: The reason that this study didn't find the global differences seen in previous studies was that the girls in this study were not at the same stages of sexual maturation as in the previous study, and that these differences seemed to correlate with global differences. However, this still ignores the point that there were significant differences within certain regions of the brain.

Now let's look at the next study that gets summed up in a single, misleading, factually-challenged sentence in this section:

"and in teenagers PET scans were unable to differentiate normal children from those with ADHD."

http://www.ncbi.nlm.nih.gov/pubmed/8489322

Here's what the actual study said:

"Global or absolute measures of metabolism did not statistically differ between groups, although hyperactive girls had a 17.6% lower absolute brain metabolism than normal girls. As compared with the values for the controls, normalized glucose metabolism was significantly reduced in six of 60 specific regions of the brain, including an area of the left anterior frontal lobe (P < .05). Lower metabolism in that specific region of the left anterior frontal lobe was significantly inversely correlated with measures of symptom severity (P < .001-.009, r = -.56 to -.67)."

I will assume good faith and presume that this is simply a problem of laypersons misunderstanding what is, admittedly, rather arcane scientific text. However, the statements in this article drastically misrepresent the scientific research here to the point that it is misleading and almost falsified. This article states that Zametkin's scans could not differentiate between normal children and those with ADHD....and yet the study itself not only found significant differences in certain specific regions of the brain, but also found that those differences were CORRELATED WITH SYMPTOM SEVERITY!

Do you understand what I am saying? This section of this wiki article is stating the EXACT OPPOSITE of what these studies showed. No wonder people think there is some sort of "controversy" here, when basic findings from landmark studies are misrepresented like this. Furthermore, the section goes on to claim that Zametkin's findings could not be reproduced, despite the fact that he repeatedly found differences between ADHD and non-ADHD subjects on these scans. Zametkin didn't "fail" to reproduce his findings, he was looking for slightly different things on these different scans, and in some cases studies found different results because they were looking at patients of different ages. Sure, finding gross global differences in glucose metabolism sounds sexy, but it's where there are specific differences in specific regions of the brain that are actually far more useful from a research perspective.

Finally, the mention of Leo and Cohen is misleading in that it fails to acknowledge that many of the imaging studies have used medication-naive patients specifically so as to avoid that complication.

This whole section is an embarassment. Again, I am assuming good faith and presuming that this section was written by an individual or individuals who may not have been familiar with scientific literature, but the end result is that it is misleading and contains verifiably false information regarding its own cited source articles. Hyperion35 (talk) 18:06, 1 August 2009 (UTC)

Please, fix this section.--scuro (talk) 13:31, 2 August 2009 (UTC)

Originally the Leo and Cohen section was much worse: it looked like this previously. I made a half hearted attempt to look for a review that covered lobar volume studies on medication naive patients but came up empty handed. I really think the Leo and Cohen section better belongs in the controversy article (it is already in there), but wound up not doing anything else about it since I couldn't find an authoritative review level RS (since debunking secondary sources with primaries is frowned upon) to demonstrate that mainstream thought about lobar volume studies conflicts with Leo and Cohen's conclusion that the stimulant-use-confounding-results factor has not been suitably extricated. I never looked into Zametkin by the way. I'm glad you are going through the sources to verify the statements they are sourcing. I did a little of that in this section, but never made it through the whole thing. Sifaka ^talk 03:20, 3 August 2009 (UTC)

diagnosis section

Unresolved

Not sure about the appropriateness of having lede sentence of this section start like this, "No objective test exists to make a diagnosis of ADHD". There is no objective test for Migraine headaches or most disorders. It's not that this information is not valid information, it's that by making it the lede sentence, undue weight issues come into play.--scuro (talk) 14:43, 21 July 2009 (UTC)

This sentence puts what comes after it into context. Some headaches do have a diagnositic test ( ie CT for CNS tumours ) but many conditions you are right do not. I do not see any undue weight issues.--Doc James (talk · contribs · email) 17:03, 21 July 2009 (UTC)

The undue weight issue is that you don't give context first. You state how how diagnosis is achieved and then you give context.--scuro (talk) 13:48, 22 July 2009 (UTC)

Agree and switched arround. BTW it is not me who states. This page is edited by numerous people.--Doc James (talk · contribs · email) 14:36, 22 July 2009 (UTC)

My apologies for not being more specific in my statement. The "you" was a generalized "you".--scuro (talk) 15:16, 22 July 2009 (UTC)

This still appears to be undue weight to place that first sentence first. Check any website, none start with that sentence.--scuro (talk) 04:30, 28 July 2009 (UTC)

Fixed to say: "There is currently no physical examination for ADHD. It thus remains a psychological diagnosis." Sifaka ^talk 22:35, 28 July 2009 (UTC)

That's better Sifaka but I don't think the issue is resolved. Again, the point of how one doesn't diagnosis ADHD should be placed after the method of diagnosis is described. Undue weight is created by stating the negative before giving information. As an aside, this line of reasoning is often used by the "deniers". They will tell you that ADHD is a disease and then point out that there is no objective physical test for the disorder. First off, it's not a disease but a disorder. Most mental health disorders such as Autism and Schizophrenia also have no objective physical test like a blood sample. Fred Baughman is big on using this line of reasoning. I'm not sure if it might not even be undue weight to mention that there is no physical test. Do the highly respected websites on ADHD couch this issue in such a way? Or do they simply state there is no definite cause for ADHD?--scuro (talk) 13:51, 1 August 2009 (UTC)

I switched it around to state the positive first. "ADHD is diagnosed with a psychological evaluation because there currently is no physical examination for it." While improving the wording to increase readability and clarity and eliminate undue weight bias is always helpful, we shouldn't be trying to phrase things specifically to debunk deniers in this article. For the purposes of this article, we assume that ADHD is a genuine disorder because that is the mainstream opinion. We shouldn't be shy about explaining which aspects of ADHD are unclear, etc. if those are the facts. Being overly preoccupied with not giving deniers ammo gives credence to the opposing idea that it isn't a real disorder. ("I'm not afraid of the dark. I'm definitely not afraid of the dark. The darkness doesn't scare me one bit. Not at all. I really mean it." -- a bad example but see what I mean about preoccupation with getting one idea across can actually give credence to the idea the opposite has a chance of being true?) The best writing will get the facts across clearly without giving deniers ammo. For the purposes of this article, if it comes down to the choice between including valuable information or keeping deniers from potentially having ammo, including the valuable information should probably win. Mentioning the physical exam is valuable since neuroimaging has been investigated for diagnostic potential and neuroimaging results have shown statically significant findings regarding lobar volume differences in people with ADHD. Knowing just that, it would be easy to think that you could use neuroimaging for detecting ADHD, otherwise I would have suggested ignoring it altogether. Sifaka ^talk 04:41, 3 August 2009 (UTC)

Still think it is undue weight to mention "what it is not", in the opening sentence. That could be done after the diagnostic info has been presented.--scuro (talk) 09:29, 3 August 2009 (UTC)

I posted the issue on the Neutral point of view noticeboard requesting further opinions. [8] Sifaka ^talk 15:38, 3 August 2009 (UTC)

management section

Unresolved

-If one has an outside link to that section with an article on that topic, should the section on the main article not be brief?

-The major treatment method is medication sometimes in combination with other treatments. By starting with behavioural treatment first, undue weight issues come into play.

-Are not experimental treatments fringe? This whole section takes up way too much space in the article, especially considering that it has it's own separate article.--scuro (talk) 14:50, 21 July 2009 (UTC)

The organization of presentations of treatments in medicine always follow: pychological, pharmaceutical, surgical. This is regardless of which of the three modalities is the most effective.--Doc James (talk · contribs · email) 14:55, 21 July 2009 (UTC)

Would that conflict with wikipedia's undue weight policy? These are not subject headings after all. Anyone know more about this?--scuro (talk) 15:03, 21 July 2009 (UTC)

This is the way medicine is presented but we can see what others have to say.--Doc James (talk · contribs · email) 17:00, 21 July 2009 (UTC)

(I moved this section up from below since I didn't realize someone was already discussing this.) I noticed Doc James swapped the order of the management section to behavioral, pharmacological, and then experimental from P., B., and E.. In your edit summary you said it goes that way (it always goes behaviour, pharmacology, surgery). I originally put the discussion of the swap and my reason why here. My reason in brief was that I ordered the section to match the order of effectiveness of the different kinds of treatment per the sources. I wanted to note when I originally reordered the section, I swapped the entirety of the ADHD management article so it goes pharmacological, behavioral, experimental. Just to be clear, I'm not against the reordering although I prefer the p,b,e ordering pending better reasons. I was wondering if there was a good reason that I missed for doing it the other way. I also wanted to know if there was a manual of style I was missing. I checked Wikipedia:Manual of Style (medicine-related articles) and unfortunately it doesn't say anything on the topic. In any case the treatments article should be in the same order as the section of the main page for consistency's sake which may mean it needs to be reordered as well. Sifaka ^talk 00:34, 22 July 2009 (UTC)

Seems to me that in an encyclopedia aimed at the general public, the preferred or most oft-used treatment should come first. Physicians/scientists who might check what Wikipedia has to say on the subject should understand that reasoning. - Hordaland (talk) 09:18, 22 July 2009 (UTC)

So since environmental / pyschological measures are used for all children with ADHD well medications are only used in 70% of US children with ADHD a less frequently in other coutries we should have the section on pyschological measure first?

This would make it similar to hypercholesterolemia, obesity, and hypertension were diet and exercise are always recommended first. They very rarely work but are still always mentioned first even though medications are recognized to be much more effective. Have posted this question at MOS [[9]]--Doc James (talk · contribs · email) 13:24, 22 July 2009 (UTC)

I strongly disagree with your statement Doc James about the prevalence of behavioral intervention; of the psych measures we discuss, counseling and various therapies are almost certainly used far less than meds. I'm not sure what you mean by "environmental / pyschological measures are used for all children." Certainly all children encounter behavioral intervention as a part of the parenting and general social process, but for this paragraph what matters is ADHD specific behavioral intervention that is actively sought out. Also following up the MOS discussion it seemed pretty apathetic or slightly for the pharm, behav, exp ordering. I want switch it to Pharm, beh, exp. Since you have the 1RR in effect, I won't BRD, and I'll wait until you can post again before doing anything so I can hear you opinion. Sifaka ^talk 16:16, 27 July 2009 (UTC)

Behavioural techniques are used routinely in schools for children with ADHD. Treatments are usually listed by safety not by effectiveness. I think it is best to use a consistent formatting for treatment measures. Using what is used by the medical community seems in my opinion reasonable. We list for many other topics less effective treatments before more effective treatments as per the examples above. But if you feel strongly that this somehow gives undue weight even though I will continue to disagree you can go ahead and rearrange it.--Doc James (talk · contribs · email) 16:57, 27 July 2009 (UTC)

I want to work this out and do it satisfactorily rather than change it and find out I'm wrong later. I'm not sure the med community is unified behind the B then P ordering regarding ADHD (maybe it is unified for autism or asperger (Asperger's?) but I'm not sure about ADHD). DSM-IV -TR would be nice to have in front of me right now, but I don't have it. In the meanwhile, this guideline ("Clinical practice guideline: treatment of the school-aged child with attention-deficit/hyperactivity disorder". Pediatrics. 108 (4): 1033–44. 2001. doi:10.1542/peds.108.4.1033. PMID 11581465. {{cite journal}}: Unknown parameter |month= ignored (help)) goes Pharm then Behav. That NICE one goes Behav, then diet, and then Pharm. Sifaka ^talk 21:03, 27 July 2009 (UTC)

Sifaka, did you know the issue was talked about at MOS[10]? How about discussing it in terms of European and American models of treatment?--scuro (talk) 23:40, 27 July 2009 (UTC)

That's a long thread to wade through. The only sentence pertinent to what scuro suggests is vague: "Medecine[sic] is a complicated and vast subject, treated in different ways in different countries, ..." It says countries, not continents. I doubt that this avenue is worth following. Otherwise in that thread there were varied opinions as to the "right" order and no resolution of the issue. Sifaka's examples just above would seem to show that there is no hard and fast rule. Conclusion: it's up to us. - Hordaland (talk) 06:31, 28 July 2009 (UTC)

Ordering Straw Poll

Per Hordaland, let's take a straw poll on what everyone thinks the ordering should be. We have three sections: Behavioral, Pharmacological, and Experimental. For the sake keeping this simple ignore the issue of whether or not certain sections should or shouldn't be there and just list your preferred order with your signature and a brief explanation why.

• Pharmacological, Behavioral, and Experimental - order matches effectiveness. Sifaka ^talk 22:54, 28 July 2009 (UTC)
• Behavioral, Pharmacological, and Experimental - order matches safety and usual way medical treatment is presented.--Doc James (talk · contribs · email) 23:15, 28 July 2009 (UTC)
• Behavioral and Pharmacological, Behavioral, Pharmacological, Experimental. Personal history: I needed the drugs to be able to notice and then change my behavior; either alone was much less effective. To restrict it to the three, Behavioral first, but with a note that drugs can be a great assistant. htom (talk) 15:09, 29 July 2009 (UTC)
• Behavioral, Pharmacological, and Experimental - You're diagnosed with ADHD (Behavioral), then you get prescribed medication (Pharmacological), and if that doesn't work, some people turn to other means (Experimental).--Unionhawk ^{Talk E-mail} 19:06, 29 July 2009 (UTC)
• BP/P/B/E. I would be willing to insert sentence based on culture that would explain the different viewpoints on this issue, across the globe, as long as undue weight was followed.--scuro (talk) 10:58, 1 August 2009 (UTC)

trimming as a solution

This section needs to be trimmed anyways, why not simply trim the section and then it isn't so much of an issue. I started by trimming the experimental section. Will continue with the other forms of management unless objections are made.--scuro (talk) 09:04, 3 August 2009 (UTC)

I reverted the trim of the experimental section. My primary motive was that given its coverage in the ADHD management article, it is appropriate for experimental treatments to have their own section like the behavioral and pharmacological treatments. However, I do agree the information should be trimmed down. My point is that they should still have their own subsections. Sifaka ^talk 15:22, 3 August 2009 (UTC)

prognosis section

Resolved

-It would be my opinion that the literature states that once you have a diagnosis of ADHD, a significant amount of this population would suffer some form of long term impairment. I'm not negating that the fact that a percentage of this population no longer appears to have ADHD as they grow older, nor that a significant percentage of this population finds coping mechanisms. The second paragraph in this section would attest to longer term impairment, and that sort of conclusion should open the paragraph.

-the last sentence doesn't belong in this section, perhaps it belongs in the management section?--scuro (talk) 15:00, 21 July 2009 (UTC)

I agree the last unreferenced sentence should be removed till a reference is found.

There is significant morbidity. And this is discussed. What changes are you suggesting exactly? We could reverse the two paragraphs.--Doc James (talk · contribs · email) 17:10, 21 July 2009 (UTC)

The last sentence should be moved or deleted, the paragraphs should be switched in order, and information about longer term impairments should be added.--scuro (talk) 15:21, 22 July 2009 (UTC)

Agree and done.--Doc James (talk · contribs · email) 16:15, 22 July 2009 (UTC)

symptoms section

Resolved

It is my opinion that the second sentence in this section is not majority viewpoint. "The symptoms of ADHD are especially difficult to define because it is hard to draw the line at where normal levels of Inattention, hyperactivity, and impulsivity end and clinically significant levels requiring intervention begin.[4]". The validity of the assessment is widely accepted by those in the field and there is a fair degree of certainty in the diagnostic tools.--scuro (talk) 15:15, 21 July 2009 (UTC)

I must disagree. There is a great deal of disagreement between the two side of the Atlantic for example. The UK limits prescibing of stimulant to specific physicians for example because of this concern. The validity is widely accepted but this does not mean it is an easy diagnosis to make.--Doc James (talk · contribs · email) 17:06, 21 July 2009 (UTC)

I don't have the ref in front of me since it's a book, so I can't check if that line is misrepresenting what is being said in the book. The way it is currently written doesn't appear to be discounting the validity of the diagnostic assessments; I think it is simply stating that there is a continuous spectrum of inattention, hyperactivity, etc. and that drawing the line between ADHD and not ADHD is difficult. That issue of where to draw the line is at the center of Sub-clinical ADHD by the way. Sifaka ^talk 00:54, 22 July 2009 (UTC)

In reading the Nice Guideline(pg 18)[11], it states that the same symptoms used, only that the ICD criteria are more strict for a diagnosis and has additional requirements. The issue is not how define the symptoms or if the symptoms are nebulous. Sifaka and Doc James, perhaps if it was stated more clearly there would be no possibility of confusion.--scuro (talk) 15:36, 22 July 2009 (UTC)

I believe that the line is currently clear, unambiguous, and not UndueW, so it is hard for me to relate to your reading of it. Can you propose a succinct improvement? Sifaka ^talk 16:33, 28 July 2009 (UTC)

What would make it clear for you?--Doc James (talk · contribs · email) 02:05, 23 July 2009 (UTC)

The symptoms for ADHD is clear. The diagnostic tools used to determine clinically significant levels of inattention...etc. have been shown to have strong validity. If the point of the sentence is about subclinical ADHD then it should be stated as such and be more exact. That would make it more clear. If the sentence is about Adult ADHD, as inferred by the citation being about Adult ADHD, then this should be clarified. In either case the sentence needs to be changed and not given undue weight by being the second sentence of the paragraph. This info should be at the bottom of the paragraph.--scuro (talk) 13:52, 23 July 2009 (UTC)

The statement is not about sub-clinical ADHD or adult ADHD. Rephrasing the statement more verbosely: "The symptoms of ADHD don't present themselves in clearly defined levels like "imparing" or "not impairing." There is a lot of middle ground which means that there is no "natural" bright-line rule for deciding whether behavior is normal level or ADHD level." As I said above, to me the meaning of the line is clear, so it hard for me to understand why you are "stuck on it." (I don't mean that in a bad way) It might help if we request a third opinion and see if other people are reading the same way you are. The language ref desk might be a good place to ask for opinions since it is read by quite a few people and they are always eager to make improvement suggestions. In any case, I strongly think it should stay where it is. It might help to mention after the line that cases where people's symptoms just fall short of meeting the diagnostic criteria are sometimes classified as subclinical ADHD. Sifaka ^talk 16:53, 28 July 2009 (UTC)

clarify what the sentence means

 Not done Before I go to third person, looking back to the original statement, do you agree with both notions of that sentence? 1) That the symptoms are difficult to define 2) It is hard to clinically define ADHD? Also this issue is still unresolved.--scuro (talk) 13:59, 1 August 2009 (UTC)

"A study..."

In reviewing the article there seems to be a lot points made based on a single piece of primary research. As I understand it this information is to be used sparingly after majority and minority have been stated. The danger in only using a PS is that OR may happen.--scuro (talk) 15:22, 21 July 2009 (UTC)

Which are you refering too?--Doc James (talk · contribs · email) 17:07, 21 July 2009 (UTC)

None specifically, the point being that we could clean up the article by eliminating points made with primary research unless mainstream viewpoints supported by secondary sources have been stated previously. Would you agree?--scuro (talk) 20:03, 22 July 2009 (UTC)

Primary research should generally be avoided. Except in the instances of important peives like MTA.--Doc James (talk · contribs · email) 22:21, 22 July 2009 (UTC)

They can be used to demonstrate recent findings, once majority/minority opinions have been stated. But yes, I agree with you. So as part of the clean up of the article, better sources should be found for these citations.--scuro (talk) 13:41, 23 July 2009 (UTC)

ADHD causes and diet fork?

Resolved

I have noticed that the section involving the causes of ADHD and diet has become quite long. It's all well sourced and seems like notable info but it is overwhelming the causes section. I think it might be a good idea to fork it out for the following reasons:
1. The section is often expanded, but new information added is frequently gutted to the bare minimum since it is large already large.
2. The section creates an undue weight issue since genetics accounts for 70%, but the amount of writing dedicated to genetics is much less than diet.
Good idea or not? Comments and Concerns? Sifaka ^talk 02:11, 22 July 2009 (UTC)

Agree spliting off into a sub page is a good idea. Just a point on the genetics however. A recent well done paper showed that it is impossible to divide the effects of multifactorial conditions into what percent of the condition is due to the environment and what percent is do to genetics. The reason being that one gets many feed back loops. Therefore these are not linear conditions but non linear conditions and as such one cannot get hard numbers but only probability ranges out of the equations.--Doc James (talk · contribs · email) 13:21, 22 July 2009 (UTC)

This is also being discussed on another thread [12]. Roughly a quarter of ADHD has been attributed to environmental factors, and of that total smoking and drinking appears to be the major cause. It is neither majority or minority opinion that diet is the cause of ADHD. The information should be deleted or moved. This is an undue weight issue.--scuro (talk) 13:55, 22 July 2009 (UTC)

Scuro, the section nor the refs say anything about deficiencies are the cause of ADHD in most cases. The evidence shows that a proportion of children, be it 10%-25% or whatever respond very well to dietary changes, this is not fringe, nor minority. Your position which seems to be only amphetamines work and if we discuss anything but amphetamines for children then we are being fringe really is bogus. Also nutrients are utilised by the brain and body and are important to neurotransmission, it is basic biology and not up for debate. Please stop attacking the article with original research.--Literaturegeek | T@1k? 17:20, 22 July 2009 (UTC)

Could we also please focus on the content and not the contributor as mentioned in Arbitration?

What causes ADHD? Is it due to some sort of diet issue? The literature states no. Diet may improve symptoms but that has nothing to do with what causes ADHD. Diet can be in other sections of the article but it doesn't belong in the causes section.--scuro (talk) 20:01, 22 July 2009 (UTC)

I disagree that the literature says it doesn't cause ADHD. The literature actually says that ADHD has many causes including dietry factors being a cause in a small number of children. Genetic factors and environmental factors are also common causes. Remember ADHD is a diagnosis of a set of symptoms, it is not a diagnosis of cause, just a set of symptoms. See this systematic review.[13]--Literaturegeek | T@1k? 20:48, 22 July 2009 (UTC)

In response to the original concerns raised by Sifaka, I agree that the section is too big, the additives section at least and could do with some shortening.--Literaturegeek | T@1k? 20:51, 22 July 2009 (UTC)

I agree with you that ADHD has a number of causes. The generally accepted majority opinion is that a clear majority of ADHD (75%) has genetic underpinnings. The Nice guideline states that diet may influence symptoms for a very small percentage of those with ADHD. It doesn't speak about diet as a cause of ADHD. Larry Silver states diet seems to only have influence on symptoms in about 1% of those with ADHD. [14] In reviewing the literature there are several factors listed as possible causes. I have yet to see a noteworthy publication which states diet as a cause of ADHD. It is mentioned as a possible treatment for symptoms.--scuro (talk) 21:16, 22 July 2009 (UTC)

Movement of diet section to treatment

Resolved

The diet section got moved to the management section. I'm moving it back because currently a significant portion of the diet section discusses diet and the causes of ADHD, and there is already a section about diet in the experimental treatments section. While some of it does talk about management more than causes, those parts should be gutted or migrated to the ADHD management page instead. Sifaka ^talk 01:48, 24 July 2009 (UTC)

Diet is not a cause of ADHD and if you believe it is a cause I would like to see citations. If diet were a cause of ADHD you would find large differences in the prevalence of ADHD with different populations depending on their diet, and there would be robust correlational studies to support such a notion. There are no such studies. For example, if iron caused ADHD, then you would expect nations with a high red meat intake to have a high rate of ADHD and vegetarians to have little or no ADHD. There is no such link. Changes in diet improves symptoms, it does not eliminate all symptoms. From the studies I remember reading changes in diet work on attention but not so much on behaviour. So diet needs to be eliminated or moved from this section. It doesn't belong. Can we agree to this?--scuro (talk) 03:24, 24 July 2009 (UTC)

The problem with migrating the whole section to management is that some of the material currently in it does belong in the causes section. Diet has been and is being investigated as a potential cause of ADHD. Reliable source assessments of if and how much dietary factors contribute to causing ADHD belong in this section. I wish I had a clear review to cite in the lead paragraph of the section because it doesn't currently state if or how much of a contributing factor diet is to the causes of ADHD. Consider this a solicitation for help finding one. I will begin looking for one myself because this is a pretty important lapse. This section has some problems which I did mention above; part - but not all- of it talks about improvement of symptoms caused by altering the diet. That stuff belongs in the treatments section or should be entirely migrated to the ADHD management page. Finally, it would be misleading to conflate my opinions of ADHD with my edits. I'm not trying to push a viewpoint by moving the section back, I undid a move which I believe put material into the wrong context. Sifaka ^talk 22:52, 24 July 2009 (UTC) (added more to comment 00:29, 25 July 2009 (UTC))

ADHD is a set of symptoms scuro (See DSM IV for how it is diagnosed), impaired attention (relevant to normal baseline), increased impuslisivity and hyperactivity. Similar to other disorders, lets say anxiety, depression, CFS, fibromyalgia, there are many causes as well as theories etc. I shall provide refs soon.--Literaturegeek | T@1k? 23:23, 24 July 2009 (UTC)

Diet alters symptoms, it doesn't stop ADHD. If you believe it does, show me the link. Believe me, I've looked.--scuro (talk) 04:57, 28 July 2009 (UTC)

I would tend to agree that diet could be a treatment. Diet may alter ADHD symptoms and improve ones health in a variety of ways, and whilst it's not a cure, it could very well be a form of treatment that works for some. I suppose the issue is is it the diet itself that effects ADHD symptoms, or is it the general feeling of well-being from eating responsibly that's the true reason for the improved state of things. I think if emphasis can be made that it's a subjective treatment it shouldn't be an issue that couldn't be overcome here by consensus. Nja²⁴⁷ 12:43, 28 July 2009 (UTC)

I think this thread has kind of been rendered pointless by the fork of the diet article. Some of the content of the fork does discuss causes and the rest of it discusses treatment. That information could be sorted out over in that article into a causes and treatments section while leaving the link in the causes. Some of ADHD treatments does discuss diet and treatment as well, so it may be worthwhile to fork out information or copy over and expand upon information from that article. It may also be worthwhile to merge things like Feingold diet article into the diet and ADHD article as well. Currently that article is missing a lot of information. Sifaka ^talk 15:56, 28 July 2009 (UTC)

 Not done

Diet should not be in the causes section.

Diet should be in the treatment section. Diet can alter symptoms but can not stop ADHD. Anything to do with diet should be eliminated from this section.--scuro (talk) 13:36, 2 August 2009 (UTC)

Move to delete diet from the causes section.--scuro (talk) 09:33, 3 August 2009 (UTC)

It only says "a number of factors that may contribute to ADHD including genetics, diet and social and physical environments." Under the subheading Diet it's even more weaselworded. I'd think it could stay as it is. - Hordaland (talk) 13:32, 3 August 2009 (UTC)

The reason for diets inclusion into the causes section should be that a majority or minority of scientific community believes diet causes ADHD. Or, as a bare minimum that an established expert in the field believes this. Perhaps one could argue that a sentence at the end of the section, based on a notable fringe theory, deserves inclusion. The basis of inclusion shouldn't be the tiny amount of space diet is taking up in this section. A compromise here might be to include a small mention in the symptoms section, as long as undue weight issues were considered. One could mention that certain substances may magnify symptoms. Otherwise, where is the support with regards to citations, for diets inclusion?--scuro (talk) 15:23, 3 August 2009 (UTC)

I think I don't understand your comment. No one believes that diet is the one-and-only cause of ADHD! It's listed as a possible contributing factor. - Hordaland (talk) 20:53, 3 August 2009 (UTC)

How do we know that diet can help cause ADHD? Citations would help. Here is one that talks about diet as a cause of ADHD.[15]--scuro (talk) 06:57, 4 August 2009 (UTC)

Lead paragraph

 Done These two sentences basicall say the same thing: Currently, there is little active debate within the research and medical communities about most issues. and Most healthcare providers accept that ADHD is a genuine disorder; debate in the scientific community centers mainly around how it is diagnosed and treated. Would recommend that we combine them.--Doc James (talk · contribs · email) 16:06, 22 July 2009 (UTC)

No opposition from me.--Literaturegeek | T@1k? 17:23, 22 July 2009 (UTC)

Done--scuro (talk) 19:55, 22 July 2009 (UTC)

sentence removed from the lede, why?

 Not done

Compare

"ADHD and its diagnosis and treatment have been considered controversial since the 1970s.[15] The controversies have involved clinicians, teachers, policymakers, parents and the media. Opinions regarding ADHD range from not believing it exists at all to believing there are genetic and physiological bases for the condition as well as disagreement about the use of stimulant medications in treatment.[16][17][18] Most healthcare providers accept that ADHD is a genuine disorder with debate in the scientific community centering mainly around how it is diagnosed and treated.[19][20][21]"

and what was there before...

"ADHD and its diagnosis and treatment have been considered controversial since the 1970s. The controversies have involved clinicians, teachers, policymakers, parents and the media. Currently, there is little active debate within the research and medical communities about most issues".

The sentence above, and the citation which accompanied it, was approved by Literaturegeek. By removing the sentence, the connection between what was believed in the past, and what is now believed has been altered. More importantly, the degree of current disagreement has been eliminated. Can anyone explain why this was done?--scuro (talk) 11:18, 23 July 2009 (UTC)

Hordaland, why did you remove this sentence?[16]--scuro (talk) 20:58, 24 July 2009 (UTC)

I'll have to figure that out and get back to you. - Hordaland (talk) 14:25, 25 July 2009 (UTC)

My edits in the area being questioned:

• 22 July, 23:10, Edit summary: (re-added Classification (gone missing). Psych and other disorders. Other minor changes (like "general population" twice in same paragraph).)
• 22 July, 23:12, Edit summary: (Minus 1 wikilink. (Overdone IMO))
• 22 July, 23:17, Edit summary: (Add back in TOClimit (went missing again...))
• 23 July, 00:07, Edit summary: (Looks like I messed up stg there was agreement on. Hope I've fixed it OK!)

I’ve been trying to figure out if I’d seen the above thread by Doc James before I did these edits. I had not. My starting point was the version as of 22 July, 21:54. I noticed that the heading “Classification” was gone. I fixed several things as noted above at 23:10 to 23:17, {TOClimit|limit=3} was gone as well. Then I read the talk page and did the last edit above, see edit summary. - Hordaland (talk) 22:41, 26 July 2009 (UTC)

I don't believe you have restored the sentence...did I miss something?--scuro (talk) 01:16, 27 July 2009 (UTC)

"there is little active debate within the research and medical communities about most issues" is vague. There's little debate about "most issues", which ones are not specified.

"debate in the scientific community centering mainly around how it is diagnosed and treated" specifies what the remaining debate is about.

Doc James suggested that one of two sentences could be removed. When/where did LG support which one of them should remain? - Hordaland (talk) 03:12, 27 July 2009 (UTC)

LG's support is at the bottom of this thread.[17] Here is a compromise. The importance is to show the viewpoint then and now. Use the outdated quote about the controversies but then use a direct quote to show the current status now. It could read like this, ADHD and its diagnosis and treatment have been considered controversial since the 1970s. The controversies have involved clinicians, teachers, policymakers, parents and the media. "Current debate over ADHD within the research community has been minimal and mostly concerned with subtle details in the diagnostic process and the treatment program". The last sentence is a direct quote from Dr. Silver.--scuro (talk) 04:31, 27 July 2009 (UTC)

"Subtle" and "minimal" is POV and citations do not say that.--Literaturegeek | T@1k? 21:55, 31 July 2009 (UTC)

It's not POV if it's a direct quote. It attributes an experts opinion on the current state of affairs.--scuro (talk) 10:52, 1 August 2009 (UTC)

npov fact check tag added

I've added a npov fact check following the NPOV dispute guidelines. WP:NPOVD. Several recent points brought up in talk demonstrate that there is disagreement in talk about undue weight on several issues. See above.--scuro (talk) 15:04, 22 July 2009 (UTC)

I do not think this is needed just because there is diagreement. And thus it should be removed. Envolvement of WP:MCOTW should hopefully bring more eyes and thus neutrality to the page if this continues to be a concern.--Doc James (talk · contribs · email) 16:08, 22 July 2009 (UTC)

I disagree. I'm pretty sure that the tag should be kept because there is disagreement on its neutrality. The tag should theoretically alert outside editors to help balance it out (but, alas, the backlog does not help...)--Unionhawk ^{Talk E-mail} 16:52, 22 July 2009 (UTC)

Scuro please outline in this section what you think is not neutral about this article? I disagree Union, I feel that we are now back to using original research and opinions, providing no refs and declaring things biased with original research.--Literaturegeek | T@1k? 17:33, 22 July 2009 (UTC)

I don't know that I agree with the tag, but I agree with Literaturegeek in thinking "see above" is insufficient reasoning for the tag. Point out, here, two or three of the most offensive points, please. htom (talk) 19:41, 22 July 2009 (UTC)

Hopefully we can work things out. I see it as a fundamental disagreement about the causes of ADHD. Doc James seems to be advocating for the social construct theory of ADHD point of view, or that the disorder is a fabrication of society. That point of view has become an undue weight issue in several threads, most notably the [Causes section]. The notion that ADHD is a fabrication of society strays far from the accepted majority viewpoint. A compromise was offered on that thread.--scuro (talk) 19:48, 22 July 2009 (UTC)

It is not a majority view point, but it is only mentioned in 3 sentences in the article. How is 3 sentences undue weight? What are your other reasons for flagging the article?--Literaturegeek | T@1k? 21:13, 22 July 2009 (UTC)

By majority I meant that the prevailing viewpoint is that ADHD is a real disorder generally caused by genetic underpinnings. When majority opinion is suppressed by minority or fringe opinion we have bias. I didn't count sentences. Undue weight in this regard can also mean the amount of text, and the placement of text within the article. Undue weight can be expressed in many ways. For instance, placing numerous theories in the "Causes" section, that don't have acceptance within the field, creates significant undue weight issues. Placing the "Social construct theory" in the causes section, which states ADHD is a fabrication, creates major undue weight issues because this is a fringe theory with regards to the causes of ADHD.--scuro (talk) 21:26, 22 July 2009 (UTC)

I am not advocating for the social construct theory of ADHD. And have stated this in the past. All I am saying is this is a prevalent idea in society. Three lines I do not think is overly much. Find a reference that says it is wrong. Add it to that section and than hopefully we can move on.--Doc James (talk · contribs · email) 22:19, 22 July 2009 (UTC)

attribute viewpoint

 Not done

Instead of stating it is a prevalent idea in society, get specific and state the figures. If I remember what you posted correctly it was about 30% of the population didn't believe in ADHD. Wikipedia asks us always to attribute things. With regards to causes you could state something like this, the scientific and medical communities believe that ADHD is real and has genetic underpinnings. You could then state that a minority(30%?) of the population doesn't believe that ADHD exists and questions the prevailing viewpoint. How is that for a compromise?--scuro (talk) 02:04, 23 July 2009 (UTC) Would be happy with stating that: The majority of the scientific community beleives ADHD is real and the cause unknown well 30% of the general US population who have heard of the condition doesn't beleive it is a real desease.--Doc James (talk · contribs · email) 12:41, 23 July 2009 (UTC)

As far as I know, there is no true minority within the scientific community that believes that ADHD is not a real disorder. Those who disagree would most likely be fringe opinion, but I could be wrong. So unless minority opinion can be demonstrated, the qualifier "majority" would not be needed, you would simply state, the scientific community believes... Could you please explain how you arrived at the 30% (or whatever figure) of the population doesn't believe ADHD exists. I remember seeing your calculations before but can't remember where that was posted. Also, ADHD is not a disease, it's a disorder.--scuro (talk) 13:37, 23 July 2009 (UTC)

Scuro, your misrepresentation of the social construct idea as meaning "ADHD isn't real" is inaccurate and doubtless offensive to anyone that holds this view. "Real" is not synonymous with "100% physical," especially when talking about people's behaviors. The social construct folks generally say that ADHD represents a very real difference between people's natural, inborn temperaments. According to proponents, these very real differences should not divided into "real" and "fake" conditions, or into "good" and "bad" behaviors, or into "sick" and "normal" people, but considered as a seamless spectrum that runs from "traits valued by this culture" (e.g., sitting still) and "traits rejected by this culture" (e.g., impulsivity). They also generally believe that modern society causes these people to suffer simply for being different, and that a different society might be able to benefit from and value ADHD-related behaviors.

There's not much data to support this idea, but there's nothing at all in this idea that says people with ADHD don't show measurable differences from typical behavior, or that people with ADHD aren't suffering. WhatamIdoing (talk) 05:30, 25 July 2009 (UTC)

What you stated sounds very much like the neurodiversity theory. Would you have a link which supports your view of what the social construct theory stands for? Regardless, the point is that scientists determine the cause of a medical condition, not philosophy.--scuro (talk) 01:23, 27 July 2009 (UTC)

No, the point is that scientists don't get to decide whether society considers a given behavioral trait to be a medical condition. This ADHD debate isn't entirely about "how" this or that trait happens (the realm of science); it's also about what meaning and value we attach to it.

(I agree that the neurodiversity and "ex-patient" ideas have much in common with this.) WhatamIdoing (talk) 02:04, 27 July 2009 (UTC)

The scientific and medical community decides if it is a medical decision. When it comes to causes, yes, it is "the realm of science", that determines this. Philosophy doesn't really come into play here. During the Ritalin class action suit, Breggin et al, tried to prove in court that the ADHD was a fabrication of drug companies. The judge believed the scientific experts, and I don't recall any experts within Philosophy being called to the stand.

Do you have a citation for your take on the SCT?--scuro (talk) 02:32, 27 July 2009 (UTC)

SCT basically holds that ADHD is a personality variation rather than a pathological psychiatric or medical disorder. SCT is cited in the article scuro, whether it is true or not it is a view held by some and is cited in the article.--Literaturegeek | T@1k? 22:02, 31 July 2009 (UTC)

Because I'm confused, is SCT = Social Construct Theory or SCT = Slow Cognitive Tempo ? htom (talk) 22:12, 31 July 2009 (UTC)

It's the former, unless I, too, am confused. - Hordaland (talk) 00:26, 1 August 2009 (UTC)

I should have put SCT of ADHD. The theory goes much beyond natural variance, it goes on to explain many "myths" about ADHD. Timimi is a proponent of the theory A website describes his viewpoint on this issue, "Timimi does not believe ADHD is a valid medical diagnosis. Instead ADHD is a "cultural construct"; the result of speculative "biobabble".[18] Quotes from him can also be found at that website.--scuro (talk) 14:21, 1 August 2009 (UTC)

Balancing NPOV

Came across and excellent comment on how one deals with POV. I hope LjL does not mind but I think it provides go advice here:

Yeah, the answer is "so fix it", and, no, you won't get reverted if you just follow the long and proven tradition of not removing content but instead adding other content that offsets the "POV" with another (putting "POV" in scare quotes since I doubt it's strictly a matter of POV here, but the concept still applies).

--LjL (talk) 00:03, 23 July 2009 (UTC)

When I first came across this page I found that it did not represent a significant POV ( ie. the fact that some find this condition controversial ). I added a POV and balanced the previous POV rather than removing content. If people feel that the benefits of treatment or the harms of the condition are not adequately mentioned then please as stated above fix it.--Doc James (talk · contribs · email) 00:39, 23 July 2009 (UTC)

Addition of content

I am going to be adding some content from the book: Dr Jennifer Erkulwater; Dr Rick Mayes; Dr Catherine Bagwell (2009). Medicating Children: ADHD and Pediatric Mental Health. Cambridge: Harvard University Press. p. 5. ISBN 0-674-03163-6.{{cite book}}: CS1 maint: multiple names: authors list (link) To give people a bit of an overview it has been reviewed by Russell Barkley, and many others see page vii The author Rick Mayes is a public policy analyst and former NIMH postdoctoral fellow specializing in health care policy and mental health Catherine Bagwell is a trained child clinical psychologist and has worked in clinics with children with ADHD. Jennifer Erkulwater is a political scientist whose research focuses on disability, education, and social welfare policy. see page. 10 The book has over 120 pages of references. It looks at the social and cultural phenomina that has lead to the rise of ADHD from being a mostly unheard of disorder 50 years ago to being one of the most come in the USA today.--Doc James (talk · contribs · email) 02:17, 23 July 2009 (UTC)

Controversy - really?

 Not done "There is controversy amongst experts on whether ADHD persists into adulthood. " - really? Experts interviewed on tv here, just said its a proven fact that if you have it, you have it for life. --IceHunter (talk) 12:13, 23 July 2009 (UTC)

The world however is more than just the United States. Opinion vary more widely if you look at the world literature. ADHD is just being recognized as continueing in adults.--Doc James (talk · contribs · email) 12:36, 23 July 2009 (UTC)

Perhaps it's the way it was said. Could we attribute this opinion to avoid undue weight issues? Who believes this? Is it a majority, a minority, singular or fringe opinion? A statement like, "A minority of experts believe that ADHD does not persist into adulthood", would be far more neutral. Anyone mind if I place an attribution tag behind this sentence?--scuro (talk) 20:12, 23 July 2009 (UTC)

This sentence was deleted but reverted by Literaturegeek today. Literaturegeek, could you flush out the controversy for us as noted above? A citation would really be appreciated here also.--scuro (talk) 17:52, 4 August 2009 (UTC)

Movement of alternative causes

Template:Deadlocked Do not agree with this move therefore moved back. Further discussion is needed. There is published research and articles on these.--Doc James (talk · contribs · email) 17:27, 23 July 2009 (UTC)

The Social Construct theory is a theory that states ADHD doesn't exist. A non-theory can't explain the causes of ADHD. Ditto with Neurodiversity, which believes there is no impairment. The low arousal theory is a theory that explains symptoms not the disorder, so this theory isn't appropriate in this section either. The Hunter-farmer theory is notable with the general public but is not seen as a credible theory within the scientific community. None of them belong in the Causes section and the Culture and Society section seemed like a good spot for them. Could you explain why you believe they belong in the Causes section?--scuro (talk) 19:55, 23 July 2009 (UTC)

I agree with your moving Social Construct Theory because that really is about the non-existence of ADHD (the way it is phrased at the moment), but neurodiversity, hunter/farmer and low arousal theories still recognise that the phenomena of ADHD are real, on the spectrum of normality, but maladaptive. I think this "dimensional" approach would add to the reader's understanding of ADHD. Anonymaus (talk) 20:44, 23 July 2009 (UTC)

Because that is were people reading about ADHD would expect to find them.--Doc James (talk · contribs · email) 22:13, 23 July 2009 (UTC)

Anonymaus, when one talks of causes one is looking for the reason that ADHD exists. The folks who do that are scientists. Neurodiversity is a philosophy. It is not a credible scientific theory with regards to the causes of ADHD. Low arousal theory speaks to symptoms and not causes, and again is not a credible scientific theory to ADHD's cause. Now Hunter-farmer theory does speak to cause but really has little support in the scientific community. I could see perhaps a line mentioning this disorder because it is notable, but greater weight would create undue weight issues. Doc James could you give another reason why you believe these alternative theories belong in the Cause section?--scuro (talk) 03:38, 24 July 2009 (UTC)

I've put the alternative theories with regards to causes on the fringe notice board [19].--scuro (talk) 19:08, 24 July 2009 (UTC)

I do not think we should be narrowly discussing the possible cause when the accepted cause is unknown. Leave it be until others come to comment.--Doc James (talk · contribs · email) 19:15, 24 July 2009 (UTC)

"Narrowly discussing the possible cause"? You go to any appropriate website on ADHD and virtually every page discusses a possible cause.--scuro (talk) 13:10, 25 July 2009 (UTC)

DocJames, I think that Scuro's point here is that the decision to include or exclude each possible "cause" hypothesis ought to rest upon the evidence that exists to support that particular hypothesis. For example, we can probably rule out the hypothesis that ADHD is caused by demonic spirits possessing people's souls and feeding off of their attention spans. This hypothesis is ruled out based upon a complete lack of evidence to support it, and we can rule out this hypothesis regardless of whether we are certain of what the actual cause is.

Thus, I would say that the decision to include a hypothesis, and the question of how much weight each hypothesis should be given, should be based upon the evidence present to support such a hypothesis. A hypothesis that ADHD is caused by neurological differences is supported by many imaging studies, and some of the newer SPECT studies have even gone farther and started looking at differences in levels of vesicular and synaptic neurotransmitters as well as looking at transporter density and uptake rates. Social Construct Theory actually begins to fall apart at this point, since it would predict little or no differences in neurological activity if the condition were merely a social construct. Neurodiversity is, as was stated, a philosophy more than a scientific hypothesis, and in any event, Neurodiversity fails as an explanation because it posits that these differences are beneficial (or at least, non-negative or neutral in effect), when the DSM guidelines specifically state that ADHD can only be diagnosed if the symptoms are causing impairment.

Now, if one wanted to include mention of the "Low Arousal Theory," then one would have to explain exactly what causes the low arousal (otherwise it becomes a bit of circular logic). If this theory were fleshed out so as to explain what causes the low arousal and then how this low arousal causes the symptoms, and if this were published in a respectable, peer-reviewed journal, then it would be appropriate to include here. Similarly, the Hunter-Farmer theory is lacking in credible evidence. One would have to do quite a bit of anthropological research into both pre-industrial agrarian societies as well as pre-agricultural hunter-gatherer societies, just for starters. This is very difficult, time-consuming, expensive, and dangerous work. I am not aware of Mr. Hartmann actually engaging in such research, and I would be concerned as to the validity of his conclusion in the absence of demonstrable evidence from such sources that supports his claims. Personally, I like Barkley's (possibly apocryphal) refutation of the Hunter-Farmer theory: "If I'm going to go hunting, an ADHD person with a gun is the last thing I'd want to have with me."Hyperion35 (talk) 12:50, 2 August 2009 (UTC)

Hyperion35, I think you're wrong about how we give weight to different theories. We don't personally analyse the plausibility of hypotheses in constructing Wikipedia articles, we take our lead from reliable sources. So always base the decision of inclusion and weight on what reliable sources say and never on what any of us think. Fences&Windows 13:14, 2 August 2009 (UTC)

No, we don't personally attribute causes through plausibility, but Hyperion makes excellent points. The scientific community gives no credence to any of these alternative theories as a cause to ADHD. This is what this disagreement is about. There are probably hundreds, may be even thousands of alternative theories. Why have we included these four?--scuro (talk) 13:24, 2 August 2009 (UTC)

Physical injury and/or disease consequence as a cause?

Neither of these are listed as causes, but if ADHD is a frontal cortex problem, direct injury there (or rebound injury), or disease affecting that area, would seem to be a cause. Doesn't happen? So infrequent it's not mentioned (or not RS mentions?) htom (talk) 21:52, 23 July 2009 (UTC)

Historically was considered a cause. However reasearch has shown that it does not play a role. There used to be a line about this if it is not still there.--Doc James (talk · contribs · email) 22:15, 23 July 2009 (UTC)

Russell Barkley believes differently, "It should be evident from the research reviewed here that ADHD arises from multiple etiologies, neurological and genetic factors being substantial ones (Nigg, 2006. Like Taylor (1999), I envision ADHD as having a heterogeneous etiology with various developmental pathways leading to this behavioral syndrome. These various etiologies and pathways, however, may give rise to the disorder through disturbances in a final common pathway in the nervous system. That pathway appears to be the integrity of the prefrontal cortical-striatal network. It now appears that hereditary factors play the largest role in the occurrence of ADHD symptoms in children. It may be that what is transmitted genetically is a tendency toward a smaller and less active prefrontal�striatal-cerebellar network. The condition can also be caused or exacerbated by pregnancy complications, exposure to toxins, or neurological disease. Social factors alone cannot be supported as causal of this disorder but such factors may exacerbate the condition, contribute to its persistence, and, more likely, contribute to the forms of comorbid disorders associated with ADHD. Cases of ADHD can also arise without a genetic predisposition to the disorder provided the child is exposed to significant disruption or neurological injury to this final common neurologic pathway, but this would seem to account for only a small minority of ADHD children".[20]--scuro (talk) 03:09, 24 July 2009 (UTC)

Refering only to head injuries and encephalitis.--Doc James (talk · contribs · email) 13:16, 24 July 2009 (UTC)

The key is age of onset. A head injury at 6 months leading to frontal problems will be indistinguishable from other causes of ADHD-behaviour. Whereas a head injury at 21 means that by definition you cannot diagnose ADHD, even if the behaviour is the same. --Vannin (talk) 19:28, 24 July 2009 (UTC)

Interesting...at a young age you would have stunted development of those regions at the brain that might never recover. Whereas with a head injury at 25, those regions would be fully developed.--scuro (talk) 19:59, 24 July 2009 (UTC)

You may be right and I think this is a point that should be included if a ref can be found.--Doc James (talk · contribs · email) 03:43, 25 July 2009 (UTC)

Image size

Resolved

This is too small to read

This is readable at 800x600 without hogging too much screen size

Here it recommends that we keep the image size at the default: http://en.wikipedia.org/wiki/Wikipedia:Images#Forced_image_size A image of a brain can be clicked on if more detail is desired.--Doc James (talk · contribs · email) 13:46, 24 July 2009 (UTC)

I looked over the manual of style for images and I agree that forcing the image size isn't the best option, however at the screen resolution (800x600) the manual of style is ideally catering too, the text is too small to read. I think this is definitely a case where some bending can be condoned. I switched out from a forced image size to the scaling upright parameter set to 2.5. Looking at it with a 800x600, 2.5 is probably too large, but 2 is excellent. I won't adjust the state of the current image without additional consent, but I strongly believe that at its current thumb size it it pretty much worthless information because it can't easily be read. Sifaka ^talk 22:27, 24 July 2009 (UTC)

Most of the other medical article which are either GA or FA do follow these guidelines for all there images. Also the information provided by this picture is hardly specific to ADHD. It does not really matter to me however. Leaving it at thumb size or setting it at 2 would be fine.--Doc James (talk · contribs · email) 22:38, 24 July 2009 (UTC)

Alright, I will bump it to 2. At 2 it is less than 300 wide I believe (The MOS said larger than 300 wasn't so good, but it doesn't mention less than 300). I agree this is a non ideal image because it isn't specific to ADHD and there is text in it, but I couldn't find a better replacement. Also as a heads up, I'm thinking about adding an image in the lead of a messy desk or room or something similar belonging to someone with ADHD as an illustration of disorganization (only because distractibility and impulsiveness are harder to illustrate in an image). I don't actually have an image yet, but if people think it's a nice idea, I'll get permission from someone I know. Sifaka ^talk 23:24, 24 July 2009 (UTC)

Discussion before making changes

Resolved

We had this discussion previously to leave ADHD as decribed as "generally chronic" and consenus should be acheived before changed. ADHD is refered to as general chronic because about 50% of people with ADHD not longer have the diagnosis once they reach adulthood. see ref 8 and 9

Cystic fibrosis is chronic ( no one with CF grows out of it ). Viral infections are acute lasting weeks / months. ADHD is half way between.--Doc James (talk · contribs · email) 19:06, 24 July 2009 (UTC)

I remember no such discussion which I agreed to, but I could be wrong. Then again I remember several agreements...the door is always open to true consensus seeking.

The qualifier "generally" is an issue. Adhd is chronic, not "generally chronic" which is an oxymoron. It's not like one describes a bout of ADHD which one has recovered from. ADHD is with you everyday. ADHD does change, but that is because of long term developmental reasons". Would you have specific references that state it is "generally" chronic?--scuro (talk) 19:19, 24 July 2009 (UTC)

Title:Early identification and systemic educational intervention for young children with Attention-Deficit/Hyperactivity Disorder (AD/HD) Source:European Journal of Special Needs Education [0885-6257] Brandau yr:2004 vol:19 iss:1 pg:1 "Given the fact that AD/HD is a generally chronic neuropsychiatric condition that may last many years, studies assessing long-term stimulant treatment safety and efficiency are requested when stimulant therapy is initiated for young AD/HD children. With the introduction of new pharmacological drugs (atomoxetine) during the next years, there is the hope for better methodological research."--Doc James (talk · contribs · email) 20:15, 24 July 2009 (UTC)

I've been requesting true consensus since I came to this page about two years ago. If you folks want to work as a team, and there are certain principles that you would like us ALL to follow, like discuss before you edit, then I am all for that. No one has ever taken me up on the offer. All it takes is one to break the ice. Otherwise, I do not feel bound to others self imposed restrictions. My edits are in total good faith and follow the principles of wikipedia.

James thanks for the citation. One citation does not decide an issue, here is the Mayo Clinic describing ADHD as a chronic condition.[21]--scuro (talk) 13:20, 25 July 2009 (UTC)

There have been studies that people with ADHD can grow out of it, but, I would say that generally speaking, it's a chronic condition.--Unionhawk ^{Talk E-mail} 21:05, 26 July 2009 (UTC)

Not sure which side of the fence you are on after that last sentence. ;) My deletion of the word has been reverted so it's still a relevant issue.--scuro (talk) 01:26, 27 July 2009 (UTC)

Hey guys, long time no post from me, but I have been following the discussion. I'm going to agree with scuro on this one. ADHD is genetic. A person's genes don't/can't change. Ergo, ADHD remains with that person throughout their life, regardless of whether or not they continue to be treated for it. --*Kat* (talk) 20:38, 30 July 2009 (UTC)

Hey Kat do you have a reference saying that it is genetic?--Doc James (talk · contribs · email) 02:29, 31 July 2009 (UTC)

How's this: Review: Genetics of attention deficit hyperactivity disorder

Here are a few more quotes and articles that I found while searching for that one:

• "Attention-deficit hyperactivity disorder (ADHD) has an established heritable component, but identifying the genes involved has proven difficult." "Understanding genes, enviroment and their interaction in ADHD..." Neuroscience. 2009 Jul 17
• "Attention-deficit hyperactivity disorder (ADHD) is a prevalent and debilitating disorder diagnosed on the basis of persistent and developmentally-inappropriate levels of overactivity, inattention and impulsivity. The etiology and pathophysiology of ADHD is incompletely understood. There is evidence of a genetic basis for ADHD but it is likely to involve many genes of small individual effect." "Neurobiology of ADHD". Neuropharmacology. 2009 Jul 21.
• A quantitative trait locus analysis of the dopamine transporter gene in adults with ADHD. Neuropsychopharmacology. 2002 Oct;27(4):655-62.

--*Kat* (talk) 07:22, 31 July 2009 (UTC)

That review (abstract) says that they "review a variety of concepts including: ... (b) evidence for a primarily genetic component of ADHD." Which might be "even generally accepted". Doesn't mean it's proven. And primarily genetic doesn't mean solely genetic. (And if I understood epigenetic influence, I might even be able to argue against "A person's genes don't/can't change.") - Hordaland (talk) 15:17, 31 July 2009 (UTC)

Most people (including myself) don't have access to full journal articles. PubMed's abstracts have long been considered acceptable sources. That particular artical is a review of a bunch (if not most) of the other articles pertaining to the possibilty of ADHD being genetic. The result of this review was, "It is now generally accepted that ADHD has a biological and even primarily genetic basis. However, despite the identification of several candidate genes, none of them seems to have a substantial effect and the exact etiology underlying ADHD has remained elusive."

What do you think, James? I only piped up because I thought that I could help break the deadlock. If what I have said here is enough to break the deadlock, great. But if it isn't then it isn't. I'm not interested in becoming heavily involved in the debate once again. --*Kat* (talk) 20:27, 31 July 2009 (UTC)

Full journal access would be very useful. I think -- warning, original thinking -- that what happens is that many people with ADHD outgrow the hyperactive component (or at least the running around the room part of it), and others -- including those with hyperactive component -- then presume that all of the problem is gone. Some build coping mechanisms which last for their entire lives; others get decades and then those become ineffective. "Generally chronic" seems appropriate. htom (talk) 21:10, 31 July 2009 (UTC)

I agree with you, what you speak of speaks to the nature of developmental disabilities. That being that the level of impairment doesn't necessarily stay static, and usually changes over time. A lot of kids outgrow their hyperactivity but often other impairments remain. At the one end of the spectrum the high end ADHDers "develop" to the point where much of their impairment is more in the normal range of behaviour. No one would see them as having ADHD although ADHD symptoms may still be a relative weakness for them. Coping mechanisms here also play a role. Compare school to a different environment that suit strengths and avoid weaknesses, such as having an independent business. But those points don't negate that it is a chronic disorder. You will have this as a child and it will be unrelenting in it's nature for years and years. There is no one stating, "boy did I have an attack of ADHD last week, but I'm normal now". So in my opinion, the term "generally" doesn't do justice to the chronic nature of the disorder.--scuro (talk) 10:45, 1 August 2009 (UTC)

Changing my mind. "Generally chronic" isn't correct, but I can't think of a good alternative. "Chronic (with incorrect belief of remission)" is just too wordy. htom (talk) 13:37, 1 August 2009 (UTC)

chronic doesn't mean permanent. People have "chronic fatigue" or "chronic pain". They have an on-going condition that may or may not improve, but is likely to last longer than an acute condition. Acute is short-term, chronic is long-term, and by definition we are talking about a long-term condition. --Vannin (talk) 17:11, 1 August 2009 (UTC)

the wikipedia section on chronic describes it as "long lasting" [22] and mentions being longer than 3 months. As this is a developmental disorder, by definition it is long lasting and "generally long lasting" doesn't make sense in that context. --Vannin (talk) 22:55, 2 August 2009 (UTC)

Vannin is correct in that chronic means long lasting, not permanent or at least not necessarily permanent. If you check out this diff you will see that I changed it to reflect the ref or at least the abstract of the ref.--Literaturegeek | T@1k? 23:06, 2 August 2009 (UTC)

I can get some journals if people wish. I do not see anything wrong with generally chronic. But we do follow it with the fact that only 30-50% of cases continue into adulthood so I assume people will get the point.--Doc James (talk · contribs · email) 16:40, 3 August 2009 (UTC)

Yea they will, I think it is important that it is clarified in the following sentence that not all people continue with ADHD symptoms indefinitely.--Literaturegeek | T@1k? 20:15, 3 August 2009 (UTC)

Further arbitation

To keep all uptodate here are the links to were further arbitration is taking place:

[23]

--Doc James (talk · contribs · email) 22:51, 24 July 2009 (UTC)

Merger Proposal

Resolved

These articles look like POV forks and probably need to be merged into this page. (Or perhaps, outright deleted.) Irbisgreif (talk) 06:27, 25 July 2009 (UTC)

Is the requirement for an article notability? The SCT is discussed by a small and select group of people, some who would be notable, who are generally anti=psychiatry in their world view. The Hunter-farmer theory is notable and probably known by a majority, or a good minority of the general public. I don't know if low arousal theory is notable. Regardless, my beef is that any of these theories are mentioned in the "Causes" section of the article. For a medical condition, cause is determined by the scientific community, and none of the four theories have any support within the scientific community. Would you support removing the four theories from the causes section of the article?--scuro (talk) 13:28, 25 July 2009 (UTC)

I don't know enough about it to decide either way on whether it belongs or not, but I can see that those three articles don't need to be separate. Irbisgreif (talk) 13:32, 25 July 2009 (UTC)

How would you merge them? There is a controversy of ADHD article, I could see it there. It could also go in the society section. Also, would you support the notion that theories without any scientific support should be removed from the causes of a medical article? Even if we move these theories from the causes section, the neurodiversity theory would still be in that section. Others may also add new fringe theories of causes at a later date.--scuro (talk) 13:52, 25 July 2009 (UTC)

• Oppose merge, support moving most discussion of these fringe theories from the Causes section to the Controversies section. The article is too long to merge in those articles. Fences&Windows 16:15, 25 July 2009 (UTC)

Most of these theories are backed up by meta-analysis, secondary sourced reviews, systematic reviews and so forth. You seem to be using your own original research or going on scuro's own original research to decide what is fringe and what is majority. Original research cannot trump secondary sources in my view. I mean no offense or disrespect to you fences. We have just been having a lot of drama which lead to an arbcom and it is sad to see the original research being propagated onto the fringe noticeboard which is then endorsed by members of fringe noticeboard. The origional research arguments led to immense prolonged disruption which as stated led to an arbcom so is why I think that discussion must be kept focused on reliable sources. I hope that you understand and I sure the other editors here are happy to discuss any issues.--Literaturegeek | T@1k? 14:38, 26 July 2009 (UTC)

It appears that no one wants the merge as proposed. Removing tag. - Hordaland (talk) 18:23, 26 July 2009 (UTC)

I am not yet convinced of a merge, but have asked questions about the justification for it. I think there is support for moving the alternative theories to the controversies section.--scuro (talk) 01:28, 27 July 2009 (UTC)

What neutrality issues remain?

Unresolved

Scuro in your view what neutrality issues remain in the article?--Literaturegeek | T@1k? 18:45, 26 July 2009 (UTC)

There a number of recent threads that are unresolved. Yes, I think neutrality is still an issue.--scuro (talk) 00:20, 27 July 2009 (UTC)

Most if not all of the issues were addressed, I would rather you explain which ones are remaining? I am not sure which ones you still feel need resolved. Please list below.--Literaturegeek | T@1k? 00:34, 27 July 2009 (UTC)

Simply look at all the threads on the page. Starting from the "Ambiguity in the culture section" thread, any thread that ends with my response is still unresolved or needs an action. That is except the "diagnosis section" and "lead paragraph" thread. That would be about ten threads.--scuro (talk)

Looks mostly neutral to me. I do not think we need to warn the readers.--Doc James (talk · contribs · email) 15:02, 27 July 2009 (UTC)

Current list of what still needs to be done

Since the article has been edited quite a bit and some discussion has taken place since the original neutrality check tag has been added, it is probably worth relisting everything that needs attention. Let's start a list in this section. I would encourage the use of section tags instead of global tags, as it will make it easier to keep track what sections are currently still in need of attention. If you want to know where to find cleanup tags including merge, split, and inline tags, look here. To make it easier I copy pasted some here for reference. Sifaka ^talk 15:30, 27 July 2009 (UTC)

Thanks for organizing this and actually tackling old and outstanding stuff. Bravo. To me a tag is only needed on sections or the top of an article if no forward progress is being made. I do like an inline tag for small things like a citation request. l find that easier then cutting and pasting the sentence and posting a new thread. I do also like the resolved box, as long as you don't mind if it is removed if someone still feels there is an issue. Lots of issues are minor ones, yes...lets move forward and get the little stuff out of the way. To do that can we simply post a thread heading? ie Controversy - really? If it's not resolved, usually you can tell by the last post in a thread.--scuro (talk) 22:58, 27 July 2009 (UTC)

Lots needs to be done. Helping hands would be appreciated. There are lots of "not done" tags on this talk page. Feel free to comment or edit.--scuro (talk) 04:43, 8 August 2009 (UTC)

Click on show to view the contents of this section

For other tags - "Many of these cleanup tags require you to place "|article" as the first parameter when you use the tag at the top of an article. When you want the template to refer to just one section, however, you replace "|article" with "|section" (where the | is a wp:pipe key found on most keyboards as a capitalized backslash (\). See the specific template below to determine if such "section use" is supported and appropriate."

informative website on adult adhd

http://www.continuingedcourses.net/active/courses/course034.php --scuro (talk) 13:48, 27 July 2009 (UTC)

possible poor citations or citations that don't support material

 Done If it is agreed that the citation is of poor quality, it should be replaced or removed. 1)Currently citation 12 - Potochny D (October 2008). Dear Mary: My Life with ADHD. p. 334. This citation is a personal life story and supports statistics.--scuro (talk) 01:53, 27 July 2009 (UTC)

I have no problem with the citation being removed but the sentence it supports was also removed. Would it not have been better to leave the sentence in the article, or put a citation tag behind the sentence? The sentence stated that 4% of the adult population has ADHD. I've found a better citation[24], and the figure quoted is actually 5%. Literaturegeek could please insert the sentence back into the article with the new citation?--scuro (talk) 13:55, 27 July 2009 (UTC)

Done. Sifaka ^talk 15:50, 27 July 2009 (UTC)

Uh, scuro, you are aware that the restrictions on your editing are only 1RR, right? You can edit the article, instead of needing to ask somebody else to do it for you.--Unionhawk ^{Talk E-mail} 01:54, 28 July 2009 (UTC)

Someone has taken time posting these citations, because they are in the proper format. I'd at least like to give them the opportunity to object before something is removed.--scuro (talk) 04:45, 28 July 2009 (UTC)

A note that personal reflections/life stories may not meet WP:RS. Nja²⁴⁷ 12:02, 28 July 2009 (UTC)

 Not done 2)Currently citation #56 - Adam James (2004) Clinical psychology publishes critique of ADHD diagnosis and use of medication on children published on Psychminded.co.uk Psychminded Ltd -supports this sentence, "while other researchers have found behavior typical of ADHD in children who have suffered violence and emotional abuse". The website appears to be citing an academic journal. The website appears to be a biased anti-psychiatry website. This citation should be removed and could be replaced by the journal.--scuro (talk) 12:50, 5 August 2009 (UTC)

3) Currently citation #58 - ^ "Sensory integration disorder". healthatoz.com. 2006-08-14. http://www.healthatoz.com/healthatoz/Atoz/common/standard/transform.jsp?requestURI=/healthatoz/Atoz/ency/sensory_integration_disorder.jsp. Retrieved on 2008-12-30. I'm not sure if the website is either reliable or neutral. --scuro (talk) 13:00, 5 August 2009 (UTC)

4) Currently citation #59 - ^ Arcos-Burgos M, Acosta MT (June 2007). "Tuning major gene variants conditioning human behavior: the anachronism of ADHD". Curr. Opin. Genet. Dev. 17 (3): 234–8. doi:10.1016/j.gde.2007.04.011. PMID 17467976. http://linkinghub.elsevier.com/retrieve/pii/S0959-437X(07)00076-7. This citation supports this sentence, "He believes that these conditions may be a result of adaptive behavior of the human species". You don't need an academic citation to support an opinion. It appears the citation seems to be stating scientific evidence supports the Hunter-Farmer theory. If this citation has any weight then this should be flushed out, and may take this theory out of the fringe category. If not, then it should be deleted, it would be extraneous.--scuro (talk) 13:37, 5 August 2009 (UTC)

5) Currently citation #62 - ^ Bailey, Eileen (2007-11-23). "ADHD and Creativity". Healthcentral.com. http://www.healthcentral.com/adhd/c/1443/16796/adhd-creativity. Retrieved on 2009-05-25. - The article is written by an "expert" whose qualification is that she is a "life coach". She is appears to be quoting academic studies. This website may not be a reliable and neutral website, it would be better to find a better source and delete this citation.--scuro (talk) 13:52, 5 August 2009 (UTC)

6-8) Currently citations #64-66

1. ) ^ Joan Stead; Gwynedd Lloyd; Cohen, David (2005). Critical new perspectives on AD/HD. New York: Routledge. p. 48. ISBN 0-415-36037-4...and..
2. )^ Chriss, James J. (2007). Social control: an introduction. Cambridge, UK: Polity. p. 230. ISBN 0-7456-3858-9...and...
3. )^ Szasz, Thomas Stephen (2001). Pharmacracy: medicine and politics in America. New York: Praeger. p. 212. ISBN 0-275-97196-1.

Hyperion has made the case[25] that these citations are fringe viewpoint.

9) Currently citation #23 - ^ a b c d e f g h i "CG72 Attention deficit hyperactivity disorder (ADHD): full guideline" (PDF). NHS. 24 September 2008. http://www.nice.org.uk/nicemedia/pdf/CG72FullGuideline.pdf. Retrieved on 2008-10-08. - Hyperion pointed out that that citation is used to support the SCT of ADHD yet the term can't be found in the guideline.[26]--scuro (talk) 22:53, 5 August 2009 (UTC)

10) Currently citation #67 - ^ a b c "Attention Deficit Hyperactivity Disorder is a neurologically based disorder". Incrediblehorizons.com. http://www.incrediblehorizons.com/Understanding%20Add.htm. Retrieved on 2009-05-25. [year needed] - this is a commercial website and is inappropriate. The home page is http://www.incrediblehorizons.com/ --scuro (talk) 03:42, 6 August 2009 (UTC)

11) Currently citation #68 - "ADHD". Sci.csuhayward.edu. http://www.sci.csuhayward.edu/~dsandberg/CHLDPATHLECTS/ChldPathLect05ADHD.htm. Retrieved on 2009-05-25 - when one goes to this link we have point form lecture notes as noted in the URL address. A better source is needed.--scuro (talk) 03:52, 6 August 2009 (UTC)

12) Currently citation #83 - ^ Armstrong, Thomas (1999). MAVM2K6SdAfcSf0nGYQ&hl=en&sa=X&oi=book_result&resnum=1&ct=result#PPA3,M1 Add/Adhd Alternatives in the Classroom. ASCD. pp. 3–5. ISBN 9780871203595.http://books.google.ca/books?id=EzXt100I4A8C&pg=PA3&lpg=PA3&dq=National+Institute+of+Mental+Health+ADHD+PET+scan&source=web&ots=GlP-TIeiqN&sig=JADzxFyez- MAVM2K6SdAfcSf0nGYQ&hl=en&sa=X&oi=book_result&resnum=1&ct=result#PPA3,M1. - Thomas Armstrong wrote the Myth of ADHD. The book cited is fringe opinion and is supposed to support this statement, "The significance of the research by Zametkin has not been determined and neither his group nor any other has been able to replicate the 1990 results". He is not a researcher in the field and doesn't have the background to make a qualified judgement. Since there are three citations supporting the statement, this is an easy delete.--scuro (talk) 13:57, 8 August 2009 (UTC)

13-15)Currently citations 86-88

1. Philip Shaw, MD; Jason Lerch, PhD; Deanna Greenstein, PhD; Wendy Sharp, MSW; Liv Clasen, PhD; Alan Evans, PhD; Jay Giedd, MD; F. Xavier Castellanos, MD; Judith Rapoport, MD (2006). "Longitudinal Mapping of Cortical Thickness and Clinical Outcome in Children and Adolescents With Attention-Deficit/Hyperactivity Disorder". Arch Gen Psychiatry 5 (63): 540–549. PMID 16651511.
2. a b David Cohen; Jonathan Leo (2004). "An Update on ADHD Neuroimaging Research" (PDF). The Journal of Mind and Behavior (The Institute of Mind and Behavior, Inc) 25 (2): 161–166. ISSN 0271–0137. http://psychrights.org/research/Digest/NLPs/neruoimagingupdate.pdf. Retrieved on 2009-05-25
3. David Cohen; Jonathan Leo (2003). "Broken brains or flawed studies? A critical review of ADHD neuroimaging studies". The Journal of Mind and Behavior 24: 29–56.

All of the above citations are part of a probable fringe paragraph.[27]--scuro (talk) 17:22, 8 August 2009 (UTC)

16) Currently citation #35 - ^ a b c "University of Central Florida Study: Hyperactivity Enables Children With ADHD to Stay Alert". Ascribe Newswire: Health, 3/9/2009. - This citation is for "Ascribe". The study can be seen for free on the sciencedaily website [28]--scuro (talk) 18:06, 8 August 2009 (UTC)

17) Currently citation #117 - ^ a b "What is the evidence for using CNS stimulants to treat ADHD in children? | Therapeutics Initiative". http://www.ti.ubc.ca/letter69. This is not a notable publication and appears to be biased, as noted by Wikiproject Medicine[29] The citation supports a statement already supported by 4 other citations. It's a no brainer that this citation should be removed.--scuro (talk) 18:39, 8 August 2009 (UTC)

18) Currently citation #70 - # ^ "Evaluation and diagnosis of attention deficit hyperactivity disorder in children". December 5, 2007. http://www.uptodate.com/online/content/topic.do?topicKey=behavior/8293&selectedTitle=4~150&source=search_result. Retrieved on 2008-09-15. - Can only access this through Uptodate. It may be legit but couldn't find any exact matches of the title on google except through wikipedia or Uptodate.--scuro (talk) 01:57, 9 August 2009 (UTC)

19) Currently citation #133 - ^ a b Holtmann M, Stadler C, Leins U, Strehl U, Birbaumer N, Poustka F (July 2004). "[Neurofeedback for the treatment of attention-deficit/hyperactivity disorder (ADHD) in childhood and adolescence]" (in German). Z Kinder Jugendpsychiatr Psychother 32 (3): 187–200. doi:10.1024/1422-4917.32.3.187. PMID 15357015. Study is linked go German version only. English version here.[30]--scuro (talk) 22:57, 10 August 2009 (UTC)

removing neutrality check tag

After Unionhawk plead that my tags not be removed[31] , literaturegeek removed a tag once more. She did start a thread asking what issues remained, to which I responded.[32] There are almost a dozen issues that need action or need to be resolved, and I've only just begun looking at the citations.--scuro (talk) 04:43, 27 July 2009 (UTC)

Attribution tag also removed

The attribution tag for this sentence was also removed, "It's symptoms can be difficult to differentiate from other psychiatric or other disorders, increasing the likelihood that the diagnosis of ADHD will be missed".--scuro (talk) 13:32, 27 July 2009 (UTC)

fixed with Ramsay's ref.Sifaka ^talk 15:30, 27 July 2009 (UTC)

For the record, scuro, I sort of assumed the 1RR editing restriction ended the problem with tags being removed unreasonably. You say that there are issues, but, I still have yet to see a single unresolved thread... (besides this one)--Unionhawk ^{Talk E-mail} 01:51, 28 July 2009 (UTC)

Ok, uresolved thread prior to the "what issues?" thread--Unionhawk ^{Talk E-mail} 01:52, 28 July 2009 (UTC)

talk page tags

I've added tags to the threads so you can see where work needs to be done.--scuro (talk) 04:46, 28 July 2009 (UTC)

I move to mark the following threads as resolved since I'm not sure anyone is paying attention to what has been posted there: Pathophysiology section, diagnosis section, Movement of diet section to treatment. Reasons are at each respective thread. Sifaka ^talk 22:43, 28 July 2009 (UTC)

Isn't the point of the tag to alert other editors to things that still need to be resolved or fixed? One could create the same thread over and over again until the task is done, or the issue is resolved. But, it would be my opinion that this would clutter the talk page when there are numerous threads that are not resolved. It would be my opinion that the "to do" and unresolved tags should stay on the talk page until the issue is resolved.--scuro (talk) 12:02, 1 August 2009 (UTC)

The tag means the article is mostly or entirely biased to one POV or another. I left it up for a week or 2 after one editor agreed that there were a couple of issues that you raised that should be resolved. I made some changes to resolve the issues you raised or addressed them as did other editors. Then I removed the tag. If you go through the article history over the months and years the article seemed to almost permanently have a neutrality tag on it. The article is not a POV monstor, it is actually quite balanced in my view. Just because an editor or editors may not agree with one or two sentences or paragraphs does not mean we need to flag the entire article indefinitely as has happened in the past. We could flag the entire wikipedia encyclopedia if that was the case.--Literaturegeek | T@1k? 12:09, 1 August 2009 (UTC)

My post was in response to Sifaka's post on removing talk page tags. It was not about article tags. I agree with you Literaturegeek, as long as things are getting done and resolved, there is no reason for a POV article tag.--scuro (talk) 13:10, 1 August 2009 (UTC)

Diagnosis 2

Unresolved

Currently we have There is no physical examination for ADHD. It thus remains a psychological diagnosis. And I agree there is no physical exam but there is ALSO not radiological imaging and no laboratory tests for ADHD. I think all should be mentioned. I agree with Scuro however that we should mention how ADHD is diagnosed before we mention how it is not diagnosed. What we had was ADHD is diagnosed via a psychological assessment with physical examination, radiological imaging, and laboratory tests only used to rule out other potential possibilities. and this is what I think we should go with. --Doc James (talk · contribs · email) 14:46, 30 July 2009 (UTC)

support --*Kat* (talk) 20:41, 30 July 2009 (UTC)

I like "ADHD is diagnosed via a psychological assessment with physical examination, radiological imaging, and laboratory tests only used to rule out other potential possibilities." --Sifaka ^talk 23:57, 30 July 2009 (UTC)

The intended content looks good, but the sentence isn't easy to read. (One can first read "ADHD is diagnosed via a psychological assessment with physical examination, radiological imaging, and laboratory tests." That makes sense (but it's wrong). Needs to be divided into 2 sentences, I'd say. - Hordaland (talk) 15:26, 31 July 2009 (UTC)

Agree --Doc James (talk · contribs · email) 15:47, 31 July 2009 (UTC)

Question, shouldn't describing what it is not, be at the end of the section? By placing "what it is not", before describing diagnosis, are you not creating undue weight?--scuro (talk) 10:15, 1 August 2009 (UTC)

I think that everyone involved would do well to please read the entry on Differential Diagnosis. This is a basic medical concept that is used in all medical specialties, including psychiatry. The Differential Diagnosis process here is no different than anywhere else. There are plenty of medical conditions that are diagnosed based on examining the patient, taking patient history, and asking the patient to describe the problems that they have been having. As with ADHD, input from friends and family members is often used in aiding many diagnoses.

For example, I recently injured my ankle. If it's anything like my last ankle injury (a strained achilles tendon), then what will happen when I see a physician next week is that he/she will examine my ankle, ask me what I did to injure it, ask me how it felt, what kind of pain, where did it hurt, were there any other symptoms, etc. It is possible that they might order an X-Ray just to rule out any broken bones (just as one might run tests for hypothyroidism or hypoglycemia to rule those out when diagnosing ADHD), but assuming that the X-Ray doesn't find anything wrong, the doc will probably give me some prescription-strength NSAIDs, an ice pack, and an order for physical therapy if necessary.

But...but....the doc didn't do any objective tests, how can be be sure that it's a tendon strain? Sure, he ruled out a break, but he didn't do any sort of diagnostic testing here. So is my ankle injury not real? Did my doc screw up?

And what about when I had a sinus infection a few months ago. I went to see my doc, she asked me what symptoms I was having, when they started, etc. She asked me what color my snot was (dark greenish-brown, and lots of it, as I showed her), and then she prescribed me some antibiotics and told me to come back in two weeks, unless I started getting worse, in which case obviously I should come back sooner.

So did my doc screw up that time, too? I mean, all the doc did was ask about my symptoms. All the doc did was take a list of symptoms, and use them to rule out certain conditions (allergies, influenza, etc), and concluded that the symptoms matched those of a sinus infection, and then....of all the things...my doc went and prescribed medication for this made-up condition. I mean, it must be made up, right? My doc didn't do any tests at all.

So why is it that these diagnoses are somehow more valid than a psychiatric diagnosis? Same basic principle, you talk to the patient, take their history, ask about their symptoms, not to mention just generally observing and examining the patient for any useful information. For example, people with ADHD are often forgetful, so noticing that the patient's shoes are untied, their hair is uncombed, they're constantly checking to make sure they've remembered everything, or perhaps they even have to excuse themselves because they left their keys in their car or something.

But yes, I can see how this all might be a bit misleading if one is not familiar with the concept of a Differential Diagnosis. After all, popular culture gives us TV shows like "CSI" where you can run some sample through a computer and immediately find out everything that you need to know. We're told that high-tech innovations have given us some new certainty about things....but the truth of the matter is that the vast majority of medical diagnoses tend to be made by simple patient history. Hyperion35 (talk) 18:31, 1 August 2009 (UTC)

So then you support describing the diagnosis and eliminating what a diagnosis doesn't do, or removing what the diagnosis doesn't do altogether?--scuro (talk) 13:18, 2 August 2009 (UTC)

I think that we should perhaps be clearer about how ADHD involves a Differential Diagnosis, possibly with a link to the Wiki page on the subject. The problem with simply stating that there is no blood test or other diagnostic test is that it is every bit as irrelevant as stating that there is no blood test or other diagnostic test to check for a strained tendon. Does the article on astigmatism mention that there is no blood test for that either? Is it common to list the tests that are not used in diagnosing a condition? Perhaps describing how the diagnosis is determined, including mention of the DSM, maybe mention the DSM criteria or link to them, as well as a short mention of what a differential diagnosis is, along with a link to that page, and then end it by saying that other diagnostic testing might be performed to rule out other conditions. ~ Hyperion35 (talk) 14:40, 2 August 2009 (UTC)

Feel free to edit, perfection is not required.WP:IMPERFECT As long as one edits in good faith and have discussed issues, seeking consensus when other editors show an interest, no one should object. Perhaps there is a little too much talk and not enough editing going on.--scuro (talk) 17:50, 2 August 2009 (UTC)

I posted the issue on the Neutral point of view noticeboard requesting further opinions. [33] Sifaka ^talk 15:38, 3 August 2009 (UTC)

Not much happening on the noticeboard. Are you opposed to moving the sentence past the description of a diagnosis? It could be flushed out there, and I think it would be good to describe differential diagnosis, and that ADHD is not unique in not having a fail proof test for diagnosis. This could touch on possible subjective shortcomings, perhaps be a paragraph in length.--scuro (talk) 18:02, 4 August 2009 (UTC)

Social Construct Theory of ADHD 2

Unresolved

This issue was brought up a few months ago and was never resolved. As I understand it, SCT is a theory which believes that ADHD has been fabricated. Typically Big Pharma or Psychiatry is seen as the creator of this "myth". The theory goes that once the myth is accepted by institutions, it is then validated by society. I could be wrong on the exact mechanisms of the theory here, but in a nutshell the belief is that ADHD is fake. This theory is a fringe theory of ADHD and does not belong on this page.--scuro (talk) 13:34, 1 August 2009 (UTC)

Agreed, and the sources provided are three books, rather than any peer-reviewed published journal articles. The first book listed, I looked up in Google's preview...it included a passage on Realist vs. Anti-Realist philosophy and how this related to whether one can ever know whether ADHD really exists. The page that was cited actually attempts claim that Zametkin disagrees with ADHD as a medical diagnosis. I am not making this up...I actually wish it were a joke:

http://books.google.com/books?id=Lz7If3xTSCYC&pg=PA87&dq=isbn:0415360374#v=onepage&q=&f=false

The page listed in the citation (where they attempt to claim Zametkin as an ally) is page 46, and the page with the Realist vs. Anti-Realist philosophical mental mastur....is page 88

The second book cited isn't even about ADHD, it's called "Social Control" and reads like a long conspiracy theory about governments using social science to control the population. The citation is for p230, but the book is listed (according to Google) as being 230 pages long, so I'm not sure exactly why only the final page of the book is cited. Here's a quote from the conclusion of the "Medical Control" chapter of that book (warning, this is 10 pounds of crazy in a five pound bag):

"What purpose or purposes is served by the rephrasing of these issues into the language of medicine, pathology, or disease? Since the medical concepts and terminologies per-se add no value to the explanation of problems in communities - whether violence or other issues - it must be that such concepts are invoked because of the social functions that they serve."

http://books.google.com/books?id=btZuF51uuHYC&dq=isbn%3A0745638589&q=ADHD#v=snippet&q=ADHD&f=false (page 145)

As for the Szasz citation, it lists a page 212 for a book that is 212 pages long, again. Perhaps they mean to cite the entire book. Szaz's other books all appear to be critiques of psychiatry, including "The Myth of Mental Illness." Not surprisignly, Szaz was a co-founder of Scientology's Citizen's Commission on Human Rights (CCHR). To describe Szaz as "fringe" is probably an understatement.

So there's what has been cited to support the inclusion of this section. One book that seems to incorrectly cite a prominent medical ADHD researcher as opposing ADHD as a medical concept, a conspiracy-theory book claiming that the medical community is a part of a larger plot of maintaining control over society, and a book by the founder of a Scientology front group whose views are rejected by pretty much the entire medical community and really the entire sane world.

So yes, this section does not belong here unless better sources can be found.Hyperion35 (talk) 13:54, 2 August 2009 (UTC)

Oh, also, this section cites an NHS report on ADHD. A search of the NHS report for "Social Construct" yielded zero results. However, the report did contain a chapter titled "Position Statement on the Validity of ADHD." This chapter of this source pretty much eviscerates the entire "Social Construct" hypothesis. It can be found here:

http://www.nice.org.uk/nicemedia/pdf/CG72FullGuideline.pdf (page 131)

Hyperion35 (talk) 14:08, 2 August 2009 (UTC)

Then it is agreed that it should be removed from the causes section, unless someone can justify why this fringe theory belongs on the ADHD article. There is a SCT of ADHD section on the controversies article so the information will not be lost.--scuro (talk) 14:18, 2 August 2009 (UTC)

Yeah, and someone owes me a beer for having to dig through that conspiracy-theory crap. ~ Hyperion35 (talk) 14:41, 2 August 2009 (UTC)

Don't get your hopes up on that beer. Previously, I had moved the SCT of ADHD, along with other alternative theories plus diet, to the culture and society section and it got reverted. It was considered a "controversial" edit even though these issues had been discussed many times. That move seemed like a no brainer to me. There has not been much of a response on the talk pages recently, and you have added relevant and important information. You would be justified in following the BOLD, revert, discuss cycle WP:BRD.--scuro (talk) 17:40, 2 August 2009 (UTC)

I support removing it from the causes section. If it deserves a mention on the page maybe it should be mentioned in the controversies section? Good call on discussing it first Scuro. Sifaka ^talk 01:23, 3 August 2009 (UTC)

Could you remove it? When I moved it, it got reverted. I'm not opposed to a one sentence mention of it in the controversies section, perhaps it could be incorporated into the the "some don't believe it exists at all", sentence.--scuro (talk) 18:07, 4 August 2009 (UTC)

Evidence showing recognition of the social construst theory of ADHD by the medical community

Here are a couple papers supporting the existance of the social construct theory of ADHD.

• http://www.jstor.org/pss/3196091

• Safer DJ (2000). "Are stimulants overprescribed for youths with ADHD?". Ann Clin Psychiatry. 12 (1): 55–62. PMID 10798827. {{cite journal}}: Unknown parameter |month= ignored (help)
• Here is a PHD thesis on the topic. Maybe not suitable for Wikipedia but its references are. http://etheses.qmu.ac.uk/97/1/97.pdf

A passage from this paper:

A biopsychosocial construction has been proposed likewise for ADHD, particularly in the UK (e.g. Singh, 2001; Cooper, 2001) whereby a range of factors are considered to interact in any individual to bring about the condition of ADHD. Thus while an individual may have a biological propensity towards ADHD through genetics, only through particular interactions with the environment would such biological propensity be expressed (e.g. through poor parental coping; low socioeconomic status). In this account of ADHD, psychological factors as well as the socio-cultural environment are given greater credence than they were in purely biomedical constructions.

I can get full copies if anyone wishes. The fact that Annals of Clinical Psychiatry recognize this opinion means that 1) it is a minority opinion not a fringe opinion 2) it is verifiable.--Doc James (talk · contribs · email) 03:39, 5 August 2009 (UTC)

So I have concerns about efforts to limit the view of this paper exclusively to the majority view held in the United States. To cover this topic properly we must recognize other views from other areas of the world. This geographical difference is highlighted by the fact that the USA uses more stimlants than the rest of the world combined.--Doc James (talk · contribs · email) 03:46, 5 August 2009 (UTC)

Another journal article [34]

These are theories presented by scientist in the feild of psychiatry. We are not here to decide if they are right or wrong but we are here to reflect the literature. The fact that ADHD is not 100% genetic means that something else makes up the rest. We must comment on this contribution once we have distribed the major genetic theories.--Doc James (talk · contribs · email) 03:50, 5 August 2009 (UTC)

This paper from journal of child neurology states that ADHD is unlikely to be an identifiable disease. Which I think support the social influence on the condition. Published in 2008. http://jcn.sagepub.com/cgi/content/abstract/23/7/775

This paper also comments on theories of social causes. Saying that they are less accepted than genetic causes but acknowledging there existance. http://66.102.1.104/scholar?q=cache:nYP5v7n7DuYJ:scholar.google.com/+causes+of+ADHD&hl=en--

Well this paper from nature reviews comments on the three leading theories of ADHD one being primarily social / environmental, one genetic, and one a combination.Doc James (talk · contribs· email) 04:27, 5 August 2009 (UTC)

I am sure I could find many others if needed. No one here is refusing to recognize the published literature which states that ADHD has a strong genetic component. What justification needs to be found to show that some within the scietific community beleive social and environmental factors may contribute to / affect ADHD? --Doc James (talk · contribs · email) 04:34, 5 August 2009 (UTC)

Are we on the same page here? Could a poor upbringing be a trigger for the development of ADHD? That might be a social influence on the cause of ADHD. That is worthwhile debatable point. On the other hand, when we are talking about the social construct theory of ADHD, are we not talking about ADHD being nothing more then a construct of society...with no validity....as Fred Baughman so often states, a FAKE disease. There are two issues here. One, does the theory belong on the article, and two...does it belong in the causes section? Lets start with #2. Which scientist, or researcher in the field, is advocating that the disorder is fake? That it is merely a social construct?--scuro (talk) 05:04, 5 August 2009 (UTC)

That is not what the social construct theory of ADHD is first of all. No one says it is fake. Many accept it to some degree. The papers above discuss social influences / causes of ADHD. This section should be expanded to discuss were we make the cuts offs between normal and mentally ill. The social construct theory is just a more extreme version of this. But read the reference above.--Doc James (talk · contribs · email) 05:25, 5 August 2009 (UTC)

I'm confused about the SCT of ADHD. The sentence within the ADHD article states, "Some of these critics, such as Thomas Szasz, maintain that ADHD was "invented and not discovered." They believe that no such disorder exists...". The opening paragraph of the wiki article on SCT of ADHD states, that ADHD was invented and not discovered. We have two anti-psychiatry critics Peter Breggin and Sami Timimi mentioned as proponents in our article. Both believe the disorder is a fabrication. Timimi, once stated, .."throw in the profit-dependent pharmaceutical industry and a high-status profession looking for new roles and we have the ideal cultural preconditions for the birth and propagation of the ADHD construct". Breggin was the medical expert in the Ritalin Class Action lawsuits, these failed lawsuits hinged on the notion that ADHD was a fraud. Sure sounds like the proponents of the SCT of ADHD believe that ADHD is fake. Looking through your citations, I couldn't find minority opinion with regards to cause. Again I ask, which scientist or researcher working in the field is advocating that ADHD can best be understood through the SCT of ADHD?--scuro (talk) 12:34, 5 August 2009 (UTC)

James, in reading through the papers that you are citing here, I am not actually seeing anything to back up your assertions. For example, you cited this paper: http://66.102.1.104/scholar?q=cache:nYP5v7n7DuYJ:scholar.google.com/+causes+of+ADHD&hl=en--

First off, this was a survey primarily of elementary school teachers. While these teachers may be very adept at dealing with students with ADHD, their opinions are of absolutely no relevance as to the question of causes. They have no training or experience in neuroanatomy, neurology, brain development, etc. Furthermore, the survey involved a questionnaire with vignettes describing fictitious students whose symptoms were supposed to be similar to those of ADHD. This is fairly irrelevant. What you are actually citing this for is the section in which this paper cites *other* papers as to what *those* papers said regarding causes. For example: "In a more recent study, Frankenberger, Farmer, Parker, and Cermak (2001) reported that school psychologists generally agreed that ADHD was caused by brain malfunction."

You also cite this paper: http://www.ncbi.nlm.nih.gov/pubmed/10798827

Let's look at what they actually say:

"The critics view the underlying reason for the "epidemic" as societal, due to our modern pace of living, our competitive society, and our consumer emphasis. Rejoinders to and clarifications of the more tangible points of the critics are presented, followed by a discussion of some more practical and legitimate concerns for researchers in this area."

Sounds to me as if they are summarizing the "critics" of ADHD, followed by eviscerating those arguments....and here's the kicker...if they follow it with a discussion of "more practical and legitimate concerns," then don't you think that this implies that the concerns of these "critics" are impractical and illegitimate? It sounds to me as though this paper is implying that the Social Construct proponents are in fact fringe and are not of concern for the vast majority of researchers.

And then there's the first link: http://www.jstor.org/pss/3196091?cookieSet=1

This is an article discussing the manner in which lay persons use (and misuse) ADHD and related terms. Specifically:

"This article examines the ways that meanings about the concept of Attention Deficit Hyperactivity Disorder (ADHD) are socially constructed within the everyday language use of laypersons. The 224 language events referencing ADHD, including media sources, were recorded in journals by student assistants. These data reveal five patterned ways that lay persons appropriate and interpret discourses originating in medical and school communities of practice."

This has absolutely nothing to do with any Social Construct theory of ADHD. It is (ironically) about the ways in which lay persons interpret and/or misinterpret medical data, and the language that lay persons use when discussing these issues. This is really not relevant at all to the causes of ADHD. If anything, its relevance is to the way that lay persons tend to MISUNDERSTAND complex medical issues such as ADHD, and the different ways in which lay persons will interpret medical discussions.

The thesis paper is, by definition, original research.

And finally, the paper in JCN is....well I suppose that it might support your contention that more neurobiological evidence is needed, although I'm really not sure how the author reached her conclusion. However, it says absolutely nothing about any Social Construct theory nor does it conclude that ADHD is a social construct.

As for your question: "What justification needs to be found to show that some within the scietific community beleive social and environmental factors may contribute to / affect ADHD?"

Well, for starters, the standard is more than just "some." There are "some" people in the scientific community who are creationists, for example. No really, there are. That doesn't change the fact that it's practically the classic case of a fringe theory. For starters, you'd have to show some level of consensus on that, not just "some." "Some" is also a classic weasel word. "Some say" "Some believe" etc. Finally, while many papers do discuss social and environmental factors, this is most definitely different from claiming that ADHD is a social construct. When researchers talk about social and environmental factors, usually it is in the context of behavioral interventions and structured study environments, etc. Other situations in which social and environmental factors are discussed would be with regards to twin concordance studies. Twin studies have shown that one identical twin will have a very high but not 100% likelyhood of having ADHD if the other twin does. This implies that there may be social factors that act *in addition* to genetic susceptibility. However, it is important to understand the difference between this, and the hypothesis that ADHD itself is merely a social construct.

Please, I do not doubt that you are acting in good faith, but I really do not believe that you understand much of the evidence that you are presenting. Also, your statement about wanting more discussion about "were we make the cuts offs between normal and mentally ill" implies that perhaps you are not familiar with the DSM-IV diagnostic criteria for ADHD. Those criteria are quite clear that the cutoff exists where the symptoms result in significant impairment, that at least some symptoms must have been present before the age of 7, and that both the symptoms and impairment must exist in at least two separate settings (ie at school and at home). Now, it is certainly possible that the criteria used in other countries is not as specific...although if anything, the ICD and other international diagnostic criteria are even more restrictive. Regardless, my point is that the diagnostic criteria (which ought to be mentioned) are themselves fairly specific about where the cutoff is between normal and abnormal.

Wikipedia is an encyclopedia, a reference, designed to distill and summarize basic information about various subjects. It is not, among other things, a forum for airing fringe opinions that are not reflected by most major medical organizations. How much weight does the Epilepsy article give to the theory that seizures were caused by curses from witches or possession by evil spirits? ~ Hyperion35 (talk) 09:09, 8 August 2009 (UTC)

So here is one of the important points in the DSM "significant impairment". The question is who decides what is significant. The ICD 10 uses a different cut off than the DSM based on the number of criteria needing to be fulfilled. This leads to a 3 to 4 fold difference in the rates of ADHD. This difference represents different societies calling different degrees of symptoms normal vs ADHD. Behavior is not dichotomous. So it is not that some researches consider social norms to be important in determining cut offs for ADHD but all researcher consider this important. This book deals with these issues in great length. Dr Jennifer Erkulwater; Dr Rick Mayes; Dr Catherine Bagwell (2009). Medicating Children: ADHD and Pediatric Mental Health. Cambridge: Harvard University Press. p. 5. ISBN 0-674-03163-6.{{cite book}}: CS1 maint: multiple names: authors list (link) It will help you understand what I am getting at.

I am in no way saying that ADHD is does not have a genetic component. I am not saying that ADHD is not a real disease. But it is a subjective line between ADHD and normal. One that is not determined by science but by society. Other wise how do you think this condition went from being unheard of 50 years ago to affecting in some areas 10% of children and possibly the population?

By the way some estimate that 85% of obesity is due to genetics. Does that mean we should eliminate all discussion of social and enviromental influences? That diet and exercise should not be discussed? Ignoring a large part of the literature just because you disagree with it is concerning.

And by the way. I understand the DSM just fine. I also understand the literature I have quoted above.Doc James (talk · contribs · email) 09:47, 8 August 2009 (UTC)

I think that you are conflating two separate questions. The first question is with regards to the symptoms. Those are discrete symptoms that are listed, and even the DSM has a number of symptomatic criteria. The second question, once it has been ascertained that a person has these symptoms, would then be to look at the level of impairment that these symptoms cause. Everyone has differing levels of hearing and eyesight, for example. Many people can get by with mild myopia or mild hearing loss, and it will not affect their lives one bit. On the other hand, many other people will find that it causes much impairment. In fact, the cutoffs for "nearsighted" and "farsighted" are quite a bit more "subjective" and "societal" than the cutoffs for ADHD. However, only the most ignorant individuals would question whether people who find that they need glasses or hearing aids to be able to handle most life activites should use them, or whether these people would qualify as having vision or hearing impairments.

Also, I think that you may be confused as to what the "Social Construct Theory" means. This is not simply a theory that says that part of ADHD is caused by environmental factors. If you want to discuss that, then go ahead, but please understand that the term "Social Construct Theory" is a bit more specific than that. Scuro has already discussed what this term means. It is a discredited pseudoscientific "theory" proposed by a number of members of the anti-psychiatry movement, many of whom (Szaz, Breggin, Baughman) have ties to Scientology and the Scientologist front organization CCHR. Further, the citations that were previously used for this theory came from Szaz and from a lunatic conspiracy theory book that alleged a secret government plot to control society through modern medicine.

But my biggest concern is that the sources that you have supplied, as I mentioned above, do not seem to support what you are saying here. A survey of schoolteachers is irrelevant as to the scientific evidence for various potential causes of ADHD (although such a survey could be quite useful for ascertaining the effect that ADHD has on a child's academic performance, and the effect that an ADHD child might have on the rest of the class, for example). Another article discussed the ways that ADHD is mentioned and discussed among lay persons and how lay persons use that terminology. This is equally irrelevant. Its only tie to "social constructs" has to do with how social forces affect the manner that non-experts interpret scientific evidence. The closest thing that you have mentioned regarding mainstream scientific mention of Social Construct Theory appears to be a paper that acknowledges that some people believe that ADHD is a social construct, but goes on to strongly imply that this theory is not legitimate and is not helpful in the course of diagnosis and treatment. If you want to use that source, then you have to find the full text of it so that you can include the part where "Rejoinders to and clarifications of the more tangible points of the critics are presented, followed by a discussion of some more practical and legitimate concerns for researchers in this area." In other words, you can't just use a paper that rebuts a particular theory as evidence of scientific acknowledgment of that theory...that's actually rather dishonest, you would need to include the parts of the paper where the author discusses the problems with that theory, not just the part where the author acknowledges that it exists. ~ Hyperion35 (talk) —Preceding undated comment added 21:25, 8 August 2009 (UTC).

I agree I think discussing the problems with this theory is important. When I have time I will look into it more carefully. The social construct theory implies that were the cut off is defined between normal and abnormal along the continuum is a social construct and thus a number of the cases of ADHD are determined by this. Medicating Children: ADHD and Pediatric Mental Health comments on this. It is discussed in the scientific literature. Will add more second half of Sept. Cheers--Doc James (talk · contribs · email) 18:11, 10 August 2009 (UTC)

The autism page specifically refers to ADHD as also having a social construct theory.[35] Here is the paper by Timmins [36] The BMJ by the way will publish minority view points but not fringe. This one paper alone makes it a minority view point period.-Doc James (talk · contribs · email) 18:22, 10 August 2009 (UTC)

Errrm, James, did you mean Timmins or Timimi? Timimi has some pretty long-standing ties to Scientology and their CCHR front group. The full text of that paper can be found here: http://bjp.rcpsych.org/cgi/content/full/184/1/8

Note that it is a debate paper, not a peer-reviewed paper. They wanted to show opposing sides to an issue, but the fact that Timimi was the best they could find, and the fact that he did not disclose his ties to CCHR in that paper, ought to raise some red flags. Also note that he mostly cites himself (along with another Scientologist, Peter Breggin). His only non-Scientologist citations are simply with regard to stimulant toxicity.

Here's one particular gem that Timimi mentions in his conclusion in the article that you cite (sourced to himself):

"By acting as agents of social control and stifling diversity in children, we are victimising millions of children and their families by putting children on highly addictive drugs that have no proven long-term benefit."

Agents of social control? Victimising millions of children? Does this really sound like rational academic discourse?

Look, I'm not criticizing you, you're not responsible for what Timimi writes, but I do want to impress upon you the fact that Sami Timimi is involved with Scientology's CCHR front group, and ask whether you think that this might make him a less than desirable source, as well as whether this might imply that he is not all that "mainstream" (lord help us the day that Scientologists are considered "mainstream.") ~ Hyperion35 (talk) 20:33, 10 August 2009 (UTC)

confused about "Requires registration" tag

This tag has been placed after "developmental disorder" citation in the first sentence. There are several links to this citation including pub med. Is the tag justified and can someone explain when such a tag would be justified?--scuro (talk) 18:03, 2 August 2009 (UTC)

I put it there as you can't actually view/verify the reference without having a subscription of some kind. Therefore if another source that doesn't have this limitation can be found to support the ascertain then that would be preferred. I'll move the notice to the footnotes though so it's not immediately visible. Nja²⁴⁷ 18:43, 2 August 2009 (UTC)

hunter vrs farmer

Is this minority opinion or fringe? I've snipped a small sentence out of the synopsis that questioned the theory and placed that on the HF article page.--scuro (talk) 15:51, 5 August 2009 (UTC)

The Evolutionary approaches to depression is discussed on the Major depressive disorder page which is a featured article by the way. It than has its own sub page. The hunter vs farmer theory is sort of the same thing.--Doc James (talk · contribs · email) 10:10, 8 August 2009 (UTC)

Then you would see this as a minority opinion, or popular fringe opinion? Since it is a theory on a medical condition are there proponents in the field, or experts who support this theory?--scuro (talk) 14:20, 8 August 2009 (UTC)

WP:DISRUPT, asking questions you know the answer to and wearing people down.--Literaturegeek | T@1k? 17:25, 10 August 2009 (UTC)

I am confused as to how this is disruptive? Scuro asked whether this was a minority opinion, or a popular fringe opinion, and asked whether there are experts who support this theory. Quite frankly, I think that's probably a good question to ask about any sort of hypothesis or theory, and I also believe that it's pretty much Wikipedia policy to ask these questions. ~ Hyperion35 (talk) 20:04, 10 August 2009 (UTC)

I think it has to do with the fact that the refs in the article comment on this. Also for most ideas the research has not been done to figure out who supports and does not support different ideas. Therefore the fact that it is published in a journal has to be taken as sufficient evidence that it is a verifiable none fringe idea. The has also been brought up a number of times previously over the last few years.Doc James (talk · contribs · email) 20:23, 10 August 2009 (UTC)

James, we haven't even been editing the page for a year together, are you suggesting this issue is resolved because it was discussed several years ago? Looking at the ADHD article, are you referring to this study? [37] Hartman is a radio show host and author and former psycho-therapist. That background would fit for "populist fringe opinion". Are you suggesting that the researcher from the citation above may be minority opinion?--scuro (talk) 04:29, 11 August 2009 (UTC)

removing OR sentence

"It should be noted that stimulant medication itself can affect growth factors of the central nervous system.[74]" The paragraph talks about a brain development lag, then it ends with that sentence. Placing these unrelated sentences together is OR. Because of proximity, the two ideas appear to be connected. The sentence was deleted.--scuro (talk) 13:23, 6 August 2009 (UTC)

Joshi SV (2002). "ADHD, growth deficits, and relationships to psychostimulant use". Pediatr Rev. 23 (2): 67–8, discussion 67–8. doi:10.1542/pir.23-2-67. PMID 11826259. Retrieved 2009-05-25. {{cite journal}}: Unknown parameter |month= ignored (help)--Doc James (talk · contribs · email) 18:35, 6 August 2009 (UTC)

Bussing found caudate differences between children who were exposed to methylphenidate and those who were not (Bussing et al., 2002). The treated group demonstrated smaller left and total caudate volumes than their untreated peers. This finding was not supported by a larger comparison of 49 unmedicated and 103 medicated ADHD patients, although a possible association between stimulant effects and smaller caudate volume should not be ruled out (Castellanos et al., 2002). http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6VB8-4J7B150-5&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&_docanchor=&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=efcbb49ed0ba9fccfb87fba26641f7f0 --Doc James (talk · contribs · email) 18:49, 6 August 2009 (UTC)

Since the data is poor in this area it should be changed to: "It should be noted that stimulant medication itself may affect growth factors of the central nervous system.[74]" Some papers found certain areas smaller some found certain areas larger. But none of these papers say these changes are either good or bad. Maybe it is good to change growth factors in a persons brain. Also small brains might actually be desired. ie women make up 60% of the medical student / university student and have significantly smaller brains. Maybe having a big brain makes you stupid... More likely though it is all meaningless.

What is concerning however is the removal of referred material without discussion.--Doc James (talk · contribs · email) 19:04, 6 August 2009 (UTC)

There has been academic debate about decreased growth rates for children taking stimulants. The paragraph in which the sentence was removed, was about brain development. This is an apples and oranges type of thing, and putting them together connects different ideas by association. I've seen no study which states that stimulant medication delays brain development. I think I recall seeing a study which actually stated the opposite. So to me it was a no brainer, a clear case of OR. The edit was done in good faith. Does the article not touch on the growth issue? If not, I could insert the deleted sentence in the management section.

Are you interested in seeking true consensus? If you want to work together as a team, I'm all for that. If there is a procedure that you would like us all to follow, I be for that too. Otherwise I'm following the BOLD, revert, discuss cycle WP:BRD, but did it one better by posting my change.--scuro (talk) 21:14, 6 August 2009 (UTC)

A change in growth factors does not mean it delays brain development. Maybe it improves brain development. I guess the question is do stimulants affect the human brain? I think all would say yes. Next question how does it do this? Well it possibly affect growth factors among other chemicals? Does this have an effect on brain development? Well hopefully it improves brain development but the evidence is not conclusive.

Does it have no effect on the brain? One would hope not or what would be the point of taking all these meds. I see no were were it said in the ADHD page that stimulants cause "brain development lag". No one here is claiming this as it is not supported by the literature. But the article never said it did.

This section is on pathophysiology. What effects ADHD meds might be more suitable to the page on ADHD treatment. But the effects of treatment also gives indications to the pathophysio. Doc James (talk · contribs · email) 10:33, 8 August 2009 (UTC)

Then you agree the sentence should have been deleted from this section, and we can mark this thread as resolved?--scuro (talk) 14:03, 8 August 2009 (UTC)

I have heard the "amphetamines" improve brain growth argument before and it is based on mice! On the other hand other research in monkeys and rats have shown doses similar to those given to children cause brain cell atrophy, i.e. brain damage. I think that it is unlikely impairing brain development would improve brain development but who knows. Anyhow, this is all irrelevant, the sentence is cited to a peer reviewed secondary source and its deletion was uncalled for, so I reverted this deletion.--Literaturegeek | T@1k? 17:22, 10 August 2009 (UTC)

LG, the citation from Joshi appears to discuss the relationship between ADHD and growth. I can only find an extract, but it strongly implies that they are discussing growth in terms of height and weight, not neurological development or brain growth. Do you have another source demonstrating the effects of psychostimulant use on brain development? Perhaps I am mistaken, but the citation provided in this section appears to be for this article Am I correct? ~ Hyperion35 (talk) 20:49, 10 August 2009 (UTC)

From the Timmins study below "have been shown in animal studies to have brain-disabling effects (Moll et al, 2001; Sproson et al, 2001; Breggin, 2002)" --Doc James (talk · contribs · email) 21:17, 10 August 2009 (UTC)

Causes

Would like to bring people attention to the page on Major depressive disorder. In the lead the causes are described: "Psychological, psycho-social, hereditary, evolutionary and biological causes have been proposed." The different theories have been given weight as it is agreed by almost everyone that the cause is multi factorial. The same applies to ADHD. I have concerns that many of the editors here have ADHD themselves as stated on their talk pages. This might be leading to a WP:COI similar to what is seen on other pages such as chronic fatigue syndrome and fibromyalgia. Well ADHD has much better evidence for it than the previously mentioned. I find the refusal to let any but a very narrow view of ADHD to be included concerning.

Most psychiatrist subscribe to the Biopsychosocial model of mental illness well the pharmaceutical companies concentrate on the bio model. This makes up the majority of the literature as they have the most money to get the most publications. This is not a criticism per say but just the way things are. Psychologists more heavily support a psychosocial aspects. By leaving out a full discussion we would doing a disservice to both the profession of psychiatry, Wikipedia project, and society as a whole.Doc James (talk · contribs · email) 10:22, 8 August 2009 (UTC)

First, please understand that Major Depressive Disorder is not the same as ADHD. Just because MDD has a particular etiology does not imply that ADHD would have a similar etiology. MDD in fact strikes me as a very poor comparison to ADHD, whereas other developmental disorders such as Tourette's or Autism might be a better comparison. In fact, MDD is not even listed under the same category in the DSM-IV as ADHD, and the ICD-9 CM lists the two conditions in separate categories as well.

Secondly, it is rather irrelevant as to why the majority of the scientific literature supports a biological model. You claim that this is due to proponents having "the most money to get the most publications" (doubly nonsensical since most scientific journals, at least in the US, are published by non-profit medical specialty and subspecialty societies. I know this because I used to work for one such society. My particular society even went so far as to separate the Journal staff and budget from the rest of the organization so as to ensure impartiality). Wikipedia's standard is to grant weight based upon the evidence in the scientific literature. If the majority of the scientific literature supports a biological model, as you imply, then that is the determining factor. Arguments as to "big pharma" paying for studies should be addressed towards specific studies if you feel that they are improperly influenced, but as a general blanket statement, it fails. I could just as easily claim that biotech firms, big University research grants, etc have enough money to promote the Theory of Evolution, and that it is this money, and not the basic scientific evidence in favor of this theory, that is responsible for its support in the vast majority of scientific literature. The obvious logical fallacies in this argument ought to be apparent. Regardless, the standard used should be to give appropriate weight based upon the scientific literature.

Finally, many health pages on wikipedia are edited by people who have that condition or who have friends or family members with that condition. These people are often the ones who are the most motivated to maintain the article, who happen to have an interest in the subject, and who may already have a familiarity with the subject matter and literature. Blanket statements of COI based solely on an individual commenter's medical diagnosis is an ad hominem fallacy, and also could be taken as a personal insult or attack. I understand that this is not how you intended it to sound, but please understand that many people may take offense. Claiming that an individual has a COI solely due to a medical diagnosis would be every bit as fallacious as claiming that having such a diagnosis automatically makes one's viewpoint more relevant. Most of us who have been diagnosed with this condition are well aware that data is not the plural of anecdote, and that a sample of n=1 (our own experiences) does not constitute scientific evidence. However, please understand that people who have been diagnosed with a particular condition may very well have an interest in maintaining the health page, much as I would imagine that cancer survivors have an interest in cancer pages, HIV-positive individuals might have an interest in the HIV page, or deaf individuals might have an interest in maintaining a page on hearing impairment. You need more to show COI than just a tag someone has placed on their talk page. ~ Hyperion35 (talk) 21:56, 8 August 2009 (UTC)

The irony of the COI complaint is that James may very well also have a conflict of interest.

"One of the editors have insulted my University aswell as a number of my friends. They all make numerous subtle insults of me". [38] Doc James is referring to the University of British Columbia and I believe he is referring to staff working at the "Therapeutics Initiative" which may very well be an anti-pharma group. [39] I think 3 or 4 other editors who frequent this page have declared that they have ADHD, and one other contributor may have a COI due to personal situations that happened in this person's life with regard to medication. So what is the point of bringing up COI?--scuro (talk) 01:36, 9 August 2009 (UTC)

Can we address the issue which Doc James raised which is, the constant assault on even high quality secondary peer reviewedd sources, where a narrow view seems to be on the battle agenda of only amphetamines work for children and it is entirely a neurological based psychiatric disorder and everything else is fringe and not allowed in the article regardless of whether it is supported by good secondary sources or meta-analysis etc. This is the issue, the narrow POV editing on this article.--Literaturegeek | T@1k? 17:07, 10 August 2009 (UTC)

In comparing MDD and ADHD I was not saying they were the same just that they fall under the same health care specialty. As I have shown above all these ideas have support in the scientific literature. They are not placed first as I agree with you the ideas of genetics has a greater amount published in the literature. What we are discussing is not weather these ideas should be moved but weather they should be deleted / suppressed all together even though there is evidence supporting there existence. I have been accused of a COI just because I work with people who have ADHD. I do not mean to apply that all COI are a bad thing.--Doc James (talk · contribs · email) 17:59, 10 August 2009 (UTC)

Excellent analogy to Autism. Here is the Wiki page on causes. Causes of autism Vaccines are mentioned as a cause even though none within the medical community believes this to be the case. The fact that it is not believe is stated.

Wikipedia's goal is to present the breadth and depth of human knowledge not suppress it. Trying to suppress a view held by many is wrong ( opinions of people other than ADHD researchers count by the way ). The vaccine and autism argument states that many parents avoid immunization because of it. We in the medical field wish to know the beliefs of the general public as this will help us approach treatment and diagnosis with them.--Doc James (talk · contribs · email) 18:20, 10 August 2009 (UTC)

Nobody is trying to suppress any opinions here, but Wikipedia policy, as I understand it, is that statements should be cited, preferably to peer-reviewed sources, and that information ought to be given due weight based upon its acceptable by the scientific community. The beliefs of the general public, while certainly valuable, really do not deserve that level of weight. Furthermore, there is no real way to cite or source beliefs that are "held by the general public."

What sources exist to corroborate the Social Construct Theory? If you are not specifically mentioning the Social Construct Theory, but are asking a more general question about research into social or environmental factors about ADHD, then that is certainly a different question. The answer to that question no doubt would require some citations. None of the citations that you have provided appear to address that question. That is my sole concern here, that statements included in this article ought to be cited to reputable sources, and that those sources should actually corroborate the claims. I believe that I have already stated that I could not find passages in the sources that you have provided here that support your claim.

Now, obviously my inability to find a passage in those sources to support your claim is not evidence that such passages do not exist. I could be mistaken. I could have missed something. I could have misread a sentence, perhaps there was a "not" written there that I missed, this could easily change the meaning of a sentence when read. These are all possibilities. However, if I have misunderstood, misread, or mischaracterized one of these sources, then please correct me. If there are other sources, then by all means please include those as well.

Now, as to answer LiteratureGeek's question, perhaps one reason why stimulant medication is given such a strong weighting is because currently the only FDA-approved treatments for ADHD, at least in the US, are amphetamines, methylphenidate, and atomoxetine. Now, I can understand that one might be concerned that this is rather US-centric, and I agree. So, let's take a look at Britain's guidelines, published by the NHS:

While they do mention that several other treatments are sometimes used, the only treatments that are endorsed as being conclusively effective are medications (p30).

That same paper also quotes Faraone's genetic studies that demonstrated a 0.7-0.8 heritability rate. Faraone has authored over 550 journal articles, and is one of the most highly cited researchers in all of psychiatry. He is also Vice President of the International Society of Psychiatric Genetics...which is probably one reason why NHS mentions him. The NHS paper goes on to discuss environmental factors and other factors, but you will note that even in those sections they are discussed in light of genetic susceptibility. I am not stating this to "prove" a genetic cause, please understand that what I am discussing involves the reasons for why certain causes or etiologies or treatments might be given a greater weight than others. Even Britain's NHS, which is not exactly an enthusiastic supporter of ADHD or stimulant medications only mentions other causes in relation to genetic susceptibility. America's NIMH also gives greater weight to genetic causes than other causes and to stimulant treatment over other treatment.

In short: cite your sources and make sure that they back up your claims, and I won't have a problem with it. Please do not criticize me for checking citations and discussing (in the Discussion Page!) my concerns that these sources do not support the assertions made. If you disagree, then please cite other sources, or correct me by pointing to information within the sources already provided that you feel that I may have missed, or misinterpreted, or otherwise might be mistaken about. Let's argue over sources and their data, not over editors, ok? ~ Hyperion35 (talk) 19:50, 10 August 2009 (UTC)

Agree that we need to argue over sources. Will pull out the exact lines in Sept from the above refs. Currently as the section stand it reflect the social construct theory of ADHD very poorly and is not well referenced.

By the way we currently give greater weight to both stimulants and genetics and it I am sure it will stay this way.

Here is the paper by Timmins if you missed it above ADHD is best understood as a cultural construct [40] The BMJ by the way will publish minority view points but not fringe. I can get you the full paper if you do not have access and are interested.--Doc James (talk · contribs · email) 19:57, 10 August 2009 (UTC)

Mentioned this above, but, the paper is by Timimi, and given his ties to Scientology and the Scientologist front-group CCHR...well, c'mon now, does anyone disagree with the assertion that Scientology and their beliefs about psychiatric medication is pretty damned fringe? ~ Hyperion35 (talk) 20:41, 10 August 2009 (UTC)

Would recommend that you write to the BMJ and complain that they are willing to publish these views. He has said previously that he does not have a ties with Scientology. Many people have referenced the above paper in their own. See Williams J, Taylor E (2006). "The evolution of hyperactivity, impulsivity and cognitive diversity". J R Soc Interface. 3 (8): 399–413. doi:10.1098/rsif.2005.0102. PMC 1578754. PMID 16849269. {{cite journal}}: Unknown parameter |month= ignored (help) which comments on the hunter farmer theory sort of.

You cannot discount someone just because of rumors of association. Should we discount everything that is written by Barkleys just because he receives over 300,000 USD a year from the manufacturers of ADHD drugs? Of course not. If we were to eliminate all research from research who has COI nothing would be left in the field of psychiatry.Doc James (talk · contribs · email) 21:13, 10 August 2009 (UTC)

A simple google search for "Timimi AND CCHR" directed me to this page on CCHR's own website that contains a Public Service Announcement that Timimi did for them: Unfortunately the audio file itself does not appear to be accesible.

And here's Timimi speaking at a conference hosted by the Church of Scientology at their offices: http://www.scientologyreligion.org/news/pg039.html

Again, this is from the CoS's own pages.

But let's see what he actually said at that conference:

"The medicalising of children's behaviour problems and the attempt to control their behaviour with dangerous, psychiatric medication means that the new eugenics is already with us, said Dr. Sami Timimi, psychiatrist and author.

As a scientist, a doctor, a father and a citizen, continue Dr. Timimi, I believe we have a moral obligation to do all we can to protect our children from suffering any further damage and I urge policy makers to carry out an urgent review of practice in the area of ADHD and the use of medication for control of children's behaviour and to put in place a moratorium on further prescribing of psychiatric medication to children until such an investigation is completed. To remain silent on this issue is to betray our children."

http://www.free-press-release.com/news/200511/1132664299.html

Eugenics? Really? Seriously? Really? This is the guy you're quoting? Also, don't you think that someone who calls for a moratorium on prescribing *all* psychiatric medication to children just might, possibly, maybe be a bit fringe.

Also, the GMC did actually admonish the BMJ for publishing that article, lemme see if I can find the link. Never mind, it was a group of physicians requesting that the GMC admonish Timimi and Szasz for their ties to CCHR.

And again, I'd like to point out that the BMJ article is not peer reviewed, it is a debate piece. ~ Hyperion35 (talk) 22:04, 10 August 2009 (UTC)

more fringe material

In the last paragraph of the Pathophysiology subsection we have this material, "Critics, such as Jonathan Leo and David Cohen, who reject the characterization of ADHD as a disorder, contend that the controls for stimulant medication usage were inadequate in some lobar volumetric studies which makes it impossible to determine whether ADHD itself or psychotropic medication used to treat ADHD is responsible for the decreased thickness observed in certain brain regions. They believe many neuroimaging studies are oversimplified in both popular and scientific discourse and given undue weight despite deficiencies in experimental methodology.".

As Hyperion previously stated about the authors and their book, "..it included a passage on Realist vs. Anti-Realist philosophy and how this related to whether one can ever know whether ADHD really exists. The page that was cited actually attempts claim that Zametkin disagrees with ADHD as a medical diagnosis. I am not making this up...I actually wish it were a joke:[41]". I'm all for minority opinion but fringe opinion has no place on this article and this material should be moved to the controversies article or deleted.--scuro (talk) 14:16, 8 August 2009 (UTC)

The sources are peer reviewed and are not given undue weight so they should stay. Do you have any sources which sounter what they say regarding the robustness of the imaging studies? The passage in the book seems to be just the authors covering the range of controversies of ADHD in a large book. Books are large and often cover a large range of territories and anyway is irrelevant as the book is not cited in the article.--Literaturegeek | T@1k? 16:59, 10 August 2009 (UTC)

Would Leo & Cohen themselves count? Turns out that they revisited this a few years later. They mention that a study was done with unmedicated ADHD patients, and they report that the study found that the unmedicated patients had the same differences in brain size exhibited by medicated ADHD patients. Leo and Cohen of course still refuse to accept that medication isn't causing the difference. They go on to change tack and argue that the size differences aren't really differences at all....this is called the "Moving the Goalposts" fallacy, but I digress. Text of Leo and Cohen fessing up can be found here

But the thing is, plenty of other neuroimaging studies have used unmedicated ADHD patients. One of my favorites is a series of SPECT studies by Krause et al. They used medication-naive patients, and demonstrated several things: That medication-naive ADHD patients demonstrate differences in dopamine transmission compared to non-ADHD controls, and that administration of methylphenidate successfully altered these differences. Furthermore, just so that you don't think that this is confined to one group of researchers, these findings were replicated by Biederman using PET scans (which are very similar), also using medication-naive patients.

I actually could have included more references, but I'm having difficulty accessing pubmed, so I had to resort to scholar.google.com, and thus it was more difficult to find these, simply due to my inexperience with that particular method of searching for academic papers. ~ Hyperion35 (talk) 22:47, 10 August 2009 (UTC)

You distorted and took out of context what this paper said, [42] using original research arguments. What you have said is also all original research, when citing on wikipedia we have to stick to what the papers say. Also the other refs you said are on dopamine! Dopamine is a neurotransmitter! Not a brain structure! So it is an irrelevant original research argument by using irrelevant refs to dispute a ref. Please see WP:OR. Original research is not allowed on wikipedia and use of original research on talk pages is usually a waste of time and can be WP:DISRUPT. Please also try to shorten your replies on talk page, see ]]WP:TLDR]].--Literaturegeek | T@1k? 15:49, 11 August 2009 (UTC)

EEG, a clinically proven therapy?

While there are studies and reviews that indicate the benefits of this treatment, a number of experts have said that the therapy does not have any clinical benefit. Dr. Silver comments, "...no research has shown that the theory behind the treatment or the treatment itself is effective for people with ADHD". [43] Russell Barkley states, "A variety of treatments have been attempted with ADHD children over the past century ‑‑ far too numerous to review here.13 Vestibular stimulation,14 running,15 EMG biofeedback and relaxation training,16 sensory integration training,17 EEG biofeedback or neuro-feedback,18 among others, have been described as potentially effective in either uncontrolled case reports, small series of case studies, or in some treatment vs. no-treatment comparisons, yet are lacking in well‑controlled experimental replications of their efficacy. Many dietary treatments, such as removal of additives, colorings, or sugar from the diet or addition of high doses of vitamins, minerals, or other “health food” supplements to the diet have proven very popular despite minimal or no scientific support.13,19 Certainly traditional psychotherapy and play therapy have not proven especially effective for ADHD or other externalizing disorders.20"[44]--scuro (talk) 16:56, 9 August 2009 (UTC)

One source is attitude magazine so is not a reliable source and the other source is a prominant doctor working for drug manufactures who market amphetamine based drugs to children basically arguing that only amphetamines work for children with ADHD. Hardly good sourrces to go deleting good secondary sourced material from wikipedia. There is some truth to what he says in the sense that there are all sorts of dubious treatments marketed by all sorts of alternative healthcare charlatains with weak, dubious or no support at all for not just ADHD but a range of other medical conditions. As far as EEG studies are concerned, it is notable enough for mention. It is sourced to secondary peer reviewed sources. The sources basically say it is a promising treatment from the available evidence and recommend larger clinical trials of it. It is not given undue weight. My stance is that the article shouldn't be reduced to only amphetamines work, everything else is fringe. We should follow what the peer reviewed literature says.--Literaturegeek | T@1k? 16:50, 10 August 2009 (UTC)

What can we agree to Literaturegeek? Surely you agree that Barkley and Silver are highly respected experts in the field of ADHD? You can not discount what they have said, and if you do want to exclude their opinion from the article you are going to have to link to the wiki policy, and back up your strong opinions with citations. The Barkley info would be an excellent secondary source. The one eeg link is a dead link. The other two are primary research done in Germany. Undue weight would go to the majority viewpoint of secondary sources. Cutting edge research could be mentioned if the studies are kosher.

Please also stick to content. It would be so appreciated!--scuro (talk) 23:18, 10 August 2009 (UTC)