Talk:Attention deficit hyperactivity disorder

It seems it has been an error

In this edit, Jytdog said “use most recent review”, and he removed the conclusions of 2013 source, but also removed the most recent (of 2014).

I will rescue 2014 conclusions from the text worded by Doc James in this review [1] to adjust and let the most recent review about elimination diets (which they are not synonymous of gluten-free diet, they are a broader term) as Jytdog propose. Nevertheless, it seems that is better not to remove the conclusions of the other review of 2013, to refflect the controversies and give the reader all views and what has been written on the subject.

Let's see what Doc James and other users think.

Best regards. --BallenaBlanca (talk) 12:20, 16 April 2016 (UTC)

This article is not the place to discuss the intricacies of celiac disease. Therefore removed "Its diagnosis requires consider the broad range of physical symptoms of this disease, which can present with mild or absent gastrointestinal complaints and a wide range of non-gastrointestinal symptoms which can affect several organs of the body." This belongs on the celiacs article IMO. (see PMID 26825336) Doc James (talk · contribs · email) 17:47, 16 April 2016 (UTC)

I think the above comment is Doc James based on the edit history, FYI, for the lazy. Elimination diet is not exactly synonymous with gluten and includes a wide range of other foods that more commonly cause GI upset (e.g., milk, eggs). I was coincidentally removing the Nigg et al. (2014) statement at the same time as Jytdog last night and we had an edit conflict. I'm not positive, but I assume we had the same thought process, which was that at the end of the day, Nigg and Sonuga-Barke (2013) essentially said the same thing, which was that any benefits from elimination diets were in studies that selected specifically for kids with ADHD and food sensitivities. I also preferred to cite Sonuga-Barke because Nigg combined all elimination diets in their review, where as Sonuga-Barke looked at the different kinds separately, so citing Sonuga-Barke allows us to be more specific about which types of diets have shown more benefit. The quote chosen for the Nigg citation is taken out of context. In the "Key Points" section at the very front of the article, Nigg et al. say, "A consensus has emerged among most reviewers that an elimination diet produces a small aggregate effect but may have greater benefit among some children. Very few studies enable proper evaluation of the likelihood of response in children with ADHD who are not already preselected based on prior diet response." This is how the article currently presents those 2 sources after BallenaBlanca's recent revert of Jytdog's edits ([157]=Sonuga-Barke et al. 2013; [90]=Nigg et al. 2014):

Tentative evidence supports free fatty acid supplementation and reduced exposure to food coloring.[157] However, these benefits may be limited to children with food sensitivities or those who are simultaneously being treated with ADHD medications.[157] A 2014 review states that an elimination diet could be an effective treatment in a small number of children with ADHD.[90] A 2013 review however did not support an elimination diet.[157]

In the context of what both Sonuga-Barke and Nigg actually said, this is redundant, somewhat incoherent, and a distortion of Nigg et al. (2014). PermStrump(talk) 16:20, 16 April 2016 (UTC)

Permstrump, perhaps you didn't see that this (green) text that you attribute to me is not my wording, but Doc James wording [2]. Compare them and you will notice: This is an old revision of this page, as edited by Doc James (talk | contribs) at 13:46, 16 April 2016 (→‎Diet: adjusted).

Also, I have not reverted Joytdog, I think I have explained it well enough [3]. It was an interpretion error about the meaning of elimination diets and I tried to correct it, respecting the observations of Jytdog, altough I believed that was necessary to add the controversies and also the conclusions of 2013 source, as in fact Doc James did [4].

Please, I ask you be careful with these details, to avoid misinterpretations. I'm trying to reach an agreement among all.

Best regards. --BallenaBlanca (talk) 17:44, 16 April 2016 (UTC)

Corrected some wording. We do not need to lead each sentence with the author. Doc James (talk · contribs · email) 17:47, 16 April 2016 (UTC)

• I've removed "However, untreated celiac disease could predispose to ADHD-like symptoms that may see some improvement with treatment with a gluten-free diet". This is WP:UNDUE - it is a) obvious that treating anyone who has an undiagnosed condition makes them better; b) as the previous sentence just said, there is no call to screen everyone with ADHD for coeliac but this sentence implies that we should do. Reading the content as it stood this stood out like a sore thumb. Jytdog (talk) 20:11, 16 April 2016 (UTC)

The way Doc James fixed it makes it's clear which information came from which study without needing their names. I didn't particularly care about having their names in there; I was just trying to clarify the original wording and that was the best I came up with. The current version is my favorite so far. PermStrump(talk) 20:43, 16 April 2016 (UTC)

Jytdog, you said that you have removed "However, untreated celiac disease could predispose to ADHD-like symptoms that may see some improvement with treatment with a gluten-free diet" because of:

“b) as the previous sentence just said, there is no call to screen everyone with ADHD for coeliac but this sentence implies that we should do.” Includin the sentence that you have deleted is not WP:UNDUE, on the contrary saying “A 2016 review did not support a clear link between celiac disease and ADHD, and stated that routine screening for celiac disease in people with ADHD and the use of a gluten-free diet as standard ADHD treatment are discouraged.[158]” and hiding “untreated celiac disease could predispose to ADHD-like symptoms that may see some improvement with treatment with a gluten-free diet"” may be cherry picking or quote mining: you are ignoring the rest of the article, ignoring “those that moderate the original quote” (and you have also deleted previous conversations of this talk page, in which I showed the context of conclusions). I write again:

Ertürk et al. say:

“Clinical Implications. Up till now, there is no conclusive evidence for a relationship between ADHD and CD. Therefore, it is not advised to perform routine screening of CD when assessing ADHD (and vice versa) or to implement GFD as a standard treatment in ADHD. Nevertheless, the possibility of untreated CD predisposing to ADHD-like behavior should be kept in mind. Therefore, it is recommended for clinicians to assess a broad range of physical symptoms, in addition to typical neuropsychiatric symptoms, when evaluating patients with ADHD.” "Untreated, CD has a wide range of clinical presentations. The “classical CD type” presents with mostly gastrointestinal symptoms such as abdominal pain, distension, chronic diarrhea, or failure to thrive. The “non-classic CD type” is characterized by fewer or no gastrointestinal symptoms and presents with extra-intestinal manifestations, such as neurologic, dermatologic, hematologic, endocrinologic, reproductive, renal, psychiatric, skeletal, and liver involvement (Celiloğlu, Karabiber, & Selimoğlu, 2011). The “asymptomatic or silent CD type” can present with no clinical symptoms and only positive serology (Bai et al., 2013)." “In children with CD, however, the risk of developing neuropsychiatric disturbances is only 2.6% (compared with 26% in adults; Ruggieri et al., 2008). This discrepancy may be due to shorter disease duration in children, earlier elimination of gluten from the diet, stricter adherence to a diet, or a different susceptibility to immune-mediated disorders” “Based on this review, there is no conclusive evidence for a relationship between ADHD and CD. However, attention difficulties, distractibility, chronic fatigue, and headache have been observed in patients with CD, especially prior to treatment or when noncompliant to GFD … Thus, it is posible that in untreated patients with CD, neurologic symptoms such as chronic fatigue, inattention, pain, and headache could predispose patients to ADHD-like behavior (mainly symptoms of inattentive type), which may be alleviated after GFD treatment.” "Possible Mechanisms" “Possible mechanisms underpinning the relation between attention/learning problems and CD point to accumulative effects of multiple effects, including both nutritional and immunologic/inflammatory factors. However, more indirect factors, related to nonspecific effects of chronic disease, cannot be ruled out (Zelnik et al., 2004). With respect to nutritional factors, micronutrient deficiencies and anemia are frequently seen in untreated patients with CD (Kupper, 2005; Wierdsma, van Bokhorst-de van der Schueren, Berkenpas, Mulder, & van Bodegraven, 2013). These factors may also play a role in causing ADHD-like behavior. However, when studying iron and zinc deficiencies in patients with ADHD, results remained inconclusive and needed further elaboration (for a review, see Millichap & Yee, 2012). There is emerging evidence that immunological mechanisms may contribute to ADHD development and manifestation (Verlaet, Noriega, Hermans, & Savelkoul, 2014). CD may induce an immune dysregulation in the gut, leading to chronic inflammation, which on its turn may be the cause for developing ADHD-like symptoms (Esparham, Evans, Wagner, & Drisko, 2014). Studies on the brain level point to the possible implication of serotonergic dysfunction in developing neuropsychiatric disorders in CD. More specifically, these studies refer to an impaired availability of tryptophan and decreased serotonin and dopamine metabolite concentrations (Hernanz & Polanco, 1991; Jackson et al., 2012; Pynnönen et al., 2005). Neuroimaging studies show structural and functional brain deficits in adult patients with CD. Structural deficits include bilateral decrease in cortical gray matter and caudate nuclei volumes (Bilgic et al., 2013), bilateral decrease in cerebellar gray matter, and smaller volume in multiple cortical regions (Currie et al., 2012). Functional deficits include a hypoperfusion of cerebral regions, primarily in the frontal cortex in untreated adult patients with CD, but not in treated patients (Addolorato et al., 2004; Usai et al., 2004). Such brain abnormalities may induce problems in high-cognitive functions such as attention span. Further research is however needed to confirm this hypothesis. To our knowledge, there are no studies on structural and functional brain deficits in pediatric patients with CD. A final hypothesis relates to increased oxidative stress that has been described in both ADHD (Lopresti, 2015) and CD (Stojiljković et al., 2009). Therefore, oxidative stress may represent a possible mediator in the development of ADHDlike behavior in CD patients. However, it remains uncertain whether oxidative stress itself contributes to the development or exacerbation of ADHD symptoms or whether it is the result of environmental factors (Lopresti, 2015). Further empirical studies are needed to understand the mechanisms underlying the potential association between ADHD, ADHD-like behavior, and CD.”

a) obvious that treating anyone who has an undiagnosed condition makes them better; This is an ambiguous, simplistic and non specific reasoning. We are talking about ADHD, you must focus on ADHD. If we give treatment and cure sore throat, sinusitis, flu... in a person with ADHD, he/she will obviously feel better, but that will not take away the symptoms of ADHD. ADHD symptoms will only improve if we treat a medical condition which may cause in some people ADHD symptoms, as hyperthyroidism, sleep apnea, drug interactions, etc. And as we see above, Ertürk et al. after review the literature state that several studies show that ADHD symptoms improve ADHD symptoms in some people with ADHD and CD with a gluten-free diet (which is not the same as “makes them better”) and list the current hypothesis for this causative effect.

Also, if you are so kind, I'd like you to explain me what is the criteria that you apply to "remove excess quotation" (one quotation that talks about eliminations diets, and other one with the conclusions of the systematic review about ADHD on CD people, and the effect of gluten-free diet in undiagnosed CD people with ADHD, extracted because this is a non free-access paper) and " remove quotation clutter from ref. makes editing way harder than it needs to be)" (removing again the quotation talking about gluten-free diet in undiagnosed CD people with ADHD), and you consider, however, that these others 13 quotations can remain:

• 17. (231 characters, talking about epidemiology and underdiagnosis)
• 23. (655 characters, talking about pharmacological interventions)
• 90. (258 characters, talking about elimination diets)
• 97. (1,505 characters, talking about psychostimulants)
• 98. (919 characters, talking about treatment with 5HT)
• 110. (617 characters, talking about pharmacotherapy and interventions to improve motivational processes)
• 134. (750 characters, talking about exercise interventions)
• 135. (1,224 characters, talking about exercise interventions)
• 145. (379 characters, saying that changes and alterations in limbic regions are more pronounced in non-treated populations)
• 146. (726 characters, talking about amphetamine psychosis and findings from one trial which indicate that the use of antipsychotic medications effectively resolves symptoms of acute amphetamine psychosis)
• 147. (522 characters, talking about side effects of stimulants)
• 151. (574 characters, talking about treatment with stimulants, amphetamines and methylphenidate, and school failure in untreated children)
• 157. (244 characters, talking about free fatty acid supplementation and artificial food color exclusions)

Best regards. --BallenaBlanca (talk) 06:32, 17 April 2016 (UTC)