Talk:Attention deficit hyperactivity disorder/Archive 7

This is an archive of past discussions about Attention deficit hyperactivity disorder. Do not edit the contents of this page. If you wish to start a new discussion or revive an old one, please do so on the current talk page.

Archive 1

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Archive 5

These two sentences make no sense

"Chromosomes disaffecting health or life expectancy are not expressed by everyone with the same DNA, and have only been found in combination with one or more other chromosomes[citation needed]. One reason for this may be that nature selects against genetic abnormalities that do not have any advantage."

That's factually incorrect. Chromosomes per se aren't expressed. Genes and arguably chromosomal regions are. Further, being advantageous is not required for a mutation to be maintained in the population, especially not in humans where population sizes were relatively small. Unless someone knows which general points these two sentences are alluding to (polygenic traits?), they ought to be deleted. 91.12.214.85 (talk) 22:37, 29 March 2008 (UTC) C

Weasel words?

The first sentence attributing 3-5% of children with ADHD is a weasel phrase that implied ADHD is a childhood phenomenon and puts that information before a definition. Definition first, statistical info second per convention. • Freechild'sup? 15:33, 3 April 2008 (UTC)

I wouldn't use the phrase weasel words to describe this. That phrase is typically used for words like "some". ie - "Some critics believe adhd is a fraud". In this case we can simply move the statistic further into the paragraph.--scuro (talk) 16:20, 3 April 2008 (UTC)

concerns about labeling

This section has been moved from the controversy article. Concerns about labeling is notable, has been discussed by experts in the field, and is not controversial in that all can see that a label of ADHD is not a good thing in itself. Some in the field emphasize the positives of having a label and some focus mostly on the negative. Really it is an issue that readers with children who have ADHD should know about and at least think about when their child gets a diagnosis of ADHD. There is no reason why the issue should not be on the main page.--scuro (talk) 11:29, 5 May 2008 (UTC)

Stigmatization is not of parents concern and questioning the label does not sell drugs. --Justana (talk) 13:01, 13 May 2008 (UTC)

the possibility of moving "alternative theories of ADHD" to the main ADHD from the controversy article

I think we could move the whole "alternative theories of ADHD" ( "alternative theories of ADHD" ) section to the main ADHD article at or near the bottom. These sections link out anyways. The farmer/hunter theory is well known. Any thoughts?--scuro (talk) 22:37, 13 May 2008 (UTC)

Reference 68 is no longer valid

New here, not sure how to post this information. The reference for the "half of all ADHD students never finish highschool" reference is no longer valid. --Jamesreinhardt (talk) 21:54, 26 May 2008 (UTC)

From this webpage find the broken link template and paste it in. http://en.wikipedia.org/wiki/Wikipedia:Template_messages --scuro (talk) 03:11, 27 May 2008 (UTC)

There is a dispute on the "Attention-deficit hyperactivity disorder controversies" article and your help is needed

Hello fellow contributors. Your help is needed. There is a dispute between two editors on what is appropriate for the Attention-deficit hyperactivity disorder controversies article. One editor has attempted to insert this sentence and quote from PBS into the article several times: The program touched on controversial issues including one segment, entitled backlash where Dr Fred Baughman and Dr Peter Breggin were the "outspoken critics who insist it's a fraud perpetrated by the psychiatric and pharmaceutical industries". Another editor removed the sentence above, several times and threatens to do so again. Talk page discussion here ->http://en.wikipedia.org/wiki/Talk:Attention-deficit_hyperactivity_disorder_controversies#continued_removal_of_excellent_3rd_party_citation_and_quote_and_why_this_article_continues_to_be_biased Subsection of controversy where sentence was inserted into-> http://en.wikipedia.org/wiki/Attention-deficit_hyperactivity_disorder_controversies#Media_Coverage_of_the_ADHD_Controversy

Input from contributors who are familiar with the subject and wiki guidelines would be appreciated.--scuro (talk) 20:03, 14 June 2008 (UTC)

For clarification, when Scuro says "Another editor removed the sentence above, several times" I think he means 'The edit has been reverted 4 times by two different editors'. Restepc (talk) 22:17, 15 June 2008 (UTC)

Issue resolved.--scuro (talk) 19:18, 16 June 2008 (UTC)

Invalid reference 27?

This picture related to reference 27 seems incorrect to me. While it is aimed at showing different glucose metabolism between a normal brain and an ADHD, it shows a failed normalisation to the background. The background around the normal brain is clearly higher than around the ADHD brain, and I suspect that this also changes the results of the mesurement inside the brain. It is my suspicion that if the normalisation of the measurements had been done correctly, the results wouldn't have been that clear. This could possibly invalidate the whole research article and reference. I hope someone that understands this better than me could look into it and take the correct action.

Jontisen (talk) 16:04, 10 July 2008 (UTC)Jonathan - 2008 July 10th

The Zametkin study itself has been called into question because of its apparent irreproducibility. See here: http://www.ascd.org/portal/site/ascd/template.chapter/menuitem.ccf6e1bf6046da7cdeb3ffdb62108a0c/?chapterMgmtId=3cdb177a55f9ff00VgnVCM1000003d01a8c0RCRD&printerFriendly=true

under "Pet Scan Studies"

This is only one place where I have seen it disputed. It is a landmark study in the field of ADHD research, but it has some serious problems that should be discussed here. The gist of the problem seems to be that Zametkin and colleagues were never able to reproduce the differences observed in later studies.

Here is another article of interest: http://www.learninginfo.org/adhd-research.htm

This article makes the point that when controlled for gender, Zametkin's original study does not show significant difference between "ADHD" and "normal" brain glucose metabolism.

All of this is important and should be mentioned in the entry.

  - Ron Poirier Ron Poirier (talk) 03:52, 11 July 2008 (UTC)

Cultural Aspects rewrite 1st paragraph

Two anthropologists studied how ordinary people talk about ADHD and noticed five reoccurring, common topics: (1) assigning the symptoms of ADHD to the child, using specific diagnostic terms listed in the DSM-IV; (2) discussing the influence of the school system on the child’s constantly-developing identity; (3) questioning how much resistance the child has against ADHD--is this a biological condition or is someone or society to blame; (4) talking about alternative treatment options for a very real problem; and (5) sensing relief and hope by sharing familiar experiences with a specific, named and well-known condition.

(keep ref.81)

Kng777 (talk) 02:50, 18 July 2008 (UTC)kay powell

ADD

Should ADD have its own page since ADHD is a Sub-Disorder of ADD. Trees Rock ^{Plant A Tree} 20:51, 17 May 2008 (UTC)

I agree. Although ADD is an older term (from DSM-III, I believe) it's still a very well known term and applies to those that don't have the hyperactive component (ADHD-PI), as well to many adults (adult ADD). I'm not sure about the hierarchy of the terms. However, this article discriminates against ADD, and all mentions (except one) have been removed. Lets create a separate ADD article, or create a substantial part in this one. Significantly more than just a section. The way it is now is POV and unbalanced. — Becksguy (talk) 19:03, 19 May 2008 (UTC)

Strongly disagree While they are related, they should not be confused. Keep them separate, if not, at least emphasize the main difference in the hyperactivity levels. Prowikipedians (talk) 10:36, 14 June 2008 (UTC)

Would you please clarify what you are disagreeing with. Thanks. — Becksguy (talk) 10:44, 14 June 2008 (UTC)

ADD and ADHD are usually coined as "ADD/ADHD." They're similar disorders, which is agreeable, right? However, it is not appropriate to state that someone has ADHD if his/her diagnosis shows up as ADD. Prowikipedians (talk) 10:48, 14 June 2008 (UTC)

Yes, they are similar but not the same. So we are in agreement that they should be handled separately as different, although related disorders. Separate article, or separate section here? My vote is for a separate section. — Becksguy (talk) 11:24, 14 June 2008 (UTC)

Separate section, granted the inattentive can be flushed out a lot more but right now the subtypes are all seen under the same umbrella. If the subsection became large enough you could create a separate page. A diagnosis of ADHD consists of one of three subtypes. ADHD/ combined, ADHD/ hyperactive, or ADHD/ inattentive. --scuro (talk) 12:00, 14 June 2008 (UTC)

Agree - They MUST have seperate articles. ADD is different from ADHD and people get them confused. The two articles should at least be "Hey people, these are two different things." I know, I HAVE SEVERE ADHD. Cra sh U nderride 16:27, 11 July 2008 (UTC)

Strongly disagree per the DSM-IV-TR, page 87.

“

314.01 Attention-Deficit/Hyperactivity Disorder, Combined Type.
[...]
314.00 Attention-Deficit/Hyperactivity Disorder, Predominantly Inattentive Type.
[...]
314.01 Attention-Deficit/Hyperactivity Disorder, Predominantly Hyperactive-Impulsive Type.

”

— DSM-IV-TR

If you want to check it out for yourself take a look at the DSM manual in Google Books.[1] What is commonly referred to as ADD is just a subtype of ADHD. The term ADD is no longer use in the article because it is no longer used in the DSM. - Headwes (talk) 05:00, 27 July 2008 (UTC)

Reference

The references on this page need a lot of work. We should be using

Doc James (talk) 15:05, 11 September 2008 (UTC)

Famous sufferers of ADHD

Is this section worth inclusion? It might be better served by a category and a "List of " article with a simple main article link. It's a lot for an already large article. Verbal chat 18:53, 21 August 2008 (UTC)

Famous suffers list may be arguable. I go for a talk first. Prowikipedians (talk) 19:19, 13 September 2008 (UTC)

ADHD and Mobile Phones

Any comments on this text? It seems to have been removed previously:

"Another factor that may be correlated with ADHD is mobile phone usage. A study surveying over 13,000 children found use of mobile phone handsets by pregnant mothers raised the risk of hyperactivity, emotional problems, and conduct problems, much to the surprise of the researchers. http://www.independent.co.uk/life-style/health-and-wellbeing/health-news/warning-using-a-mobile-phone-while-pregnant-can-seriously-damage-your-baby-830352.html —Preceding unsigned comment added by Jcemcare (talk • contribs) 04:38, 12 September 2008 (UTC)

This is primary research. We should be using systematic reviews instead.

Here is the link to the abstract: http://www.epidem.com/pt/re/epidemiology/abstract.00001648-200807000-00001.htm;jsessionid=LKGds8vhDp9RgQRJTyrBqzvtLM195Gchfn2Q3kH65T6m7ndlfNp2!-2013963969!181195629!8091!-1

Will look at the actual paper later.

--Doc James (talk) 05:59, 12 September 2008 (UTC)

Looked at things further and this is a very poor study. It is based on a mothers recall of cell phone use and her reports of hyperactive behavior. Very few confounders were controlled for. This paper could just as easily mean that mothers who use there cell phones all the time ignore there children and thus cause there kids to be more hyperactive. I had a exgirlfreind who spend all her time on the phone. Enough to drive someone of any age nuts. :-)

As this paper only used mothers self reporting NO relationship was found with ADHD as ADHD was NOT measured.

All this off course is just based on the abstract. If anyone has access to the real thing I could reassess it.

Doc James (talk) 17:56, 12 September 2008 (UTC)

Russell A. Barkley, Ph.D.

I do not think using none peer reviewed, none journal published material from one person is a good enough quality of evidence.

Here is a current nice guideline. http://www.nice.org.uk/nicemedia/pdf/TA098guidance.pdf

Doc James (talk) 18:11, 12 September 2008 (UTC)

Nice is nice but it's not Wikipedia. Barkley is a respected expert in the field and you can't discount his viewpoint. --scuro (talk) 21:56, 16 September 2008 (UTC)

Yes but please quote his peer reviewed published stuff. Or quote both his book and what he has quoted.

Doc James (talk) 15:50, 17 September 2008 (UTC)

Tripdatabase

Here is a site for finding systematic reviews:

http://www.tripdatabase.com/SearchResults.html?ssid=&s=1&categoryid=&criteria=ADHD+systematic+review&sort=t

Doc James (talk) 19:24, 12 September 2008 (UTC)

Highly biased article

This is an article which gives a highly biased view of a highly contentious topic and is, to my mind, a blot on the good name of Wikipedia. The problem starts right from the first line where ADHD is presented as an irrefutable fact:

"Attention-Deficit Hyperactivity Disorder (ADHD) is a chronic[1]neurobehavioral developmental disorder affecting about 3-5% of the world's population"

And throughout the piece alternative views are hardly mentioned, and when they are they are pre-refuted.

"Despite being a well-validated clinical diagnosis, Attention deficit–hyperactivity disorder (ADHD) has been said to be a controversial disorder."

As it is, we have an article which suggests a far less problemmatic topic than it is in the experience of childhood practitioners from outside the realms of mental health.

Hughwill (talk) 10:24, 15 September 2008 (UTC)

I agree completely. This article does not present the topic very well. Help using proper sources and formating would be appreciated.

Doc James (talk) 16:54, 15 September 2008 (UTC)

I disagree with you both completely. But that doesn't matter. Nor does it matter what you think. Wikipedia has an inherent logic of style. That is what matters. So don't be doing many major changes on a faulty consensus of two. Please slow down your pace of editing. Another editor has personally commented to me about this. What you are doing, does not lead to a collaborative style of writing.

Simply, you do go with what is majority opinion in an article. "Truth" and the experiences of alternatice health care practioners does not trump majority opinion. Nor does the experiences of a "DOC". Life with that. If you think this is a highly contentious topic then that should be noteworthy and you should be able to find excellent secondary sources which state that. BUT, that STILL doesn't trump majority opinion. Viewpoints are arranged in this order. Majority, minority, and then fringe viewpointsWP:FRINGE. If your alternative viewpoint is a fringe viewpoint, then really it deserves little WEIGHTWP:UNDUE. I, for one, think that perhaps we are over weighting some really way out there fringe viewpoints. Please do some reading on policy. --scuro (talk) 10:58, 16 September 2008 (UTC)

The problem with this article isn't so much content but the references it contains. We are not trying to figure out what the majority of editors of wikipedia feel is true. We are discussing the scientific communities opinion of ADHD. Things must be referenced. Added a link to someone web page that supports your view is not sufficient. An editors point of view is not important. All my references are from peer reviewed journals and sources.

I have posted previously on the hierarchy of evidence. A journal article in a peer reviewed paper is better then a magazine article. A systematic review is better then a single journal article. Etc.

But a single peer reviewed article really is not that great a citation. See comments below. There is nothing wrong with citing the Mayo Clinic, NICE, or the Surgeon General's webpage.--scuro (talk) 21:59, 16 September 2008 (UTC)

Doc James (talk) 15:00, 16 September 2008 (UTC)

Head injuries

No evidence shows an association as per the surgeon general review.

Doc James (talk) 17:13, 15 September 2008 (UTC)

I agree there is no evidence if it hasn't been edited out it should be. Psychonautic (talk) 18:07, 15 September 2008 (UTC)

manic editing

If you are chopping and adding several thousands of characters a day you are over doing it. Take a breather. Some of us have jobs and a family and can't devote our day to Wikipedia. Stop for tomorrow please. In when you do a large swath of editing stop for a day or two every time. It's not in the policy but it is courteous gesture to your fellow editors.--scuro (talk) 04:07, 16 September 2008 (UTC)

Umm. I must courteously disagree. I am personally an advocate of the BOLD, revert, discuss cycle. Content is added. If it sticks, great. If it doesn't, there is a talkpage.

I have already explained the importance of evidence in wikipedia. Alot of the references are unacceptable. What one must always ask is has that study been cited in secondary sources? How about citing the secondary source? You must again familiarise yourself with WP:MEDRS, because that is the crux; it is not an empty issue.

Happy editing Doc James (talk) 15:02, 16 September 2008 (UTC)

Umm. Someone is going on a limb and doing as they please. Other editors are making comment and an editor is ignoring what is being said. We are to work as a community.

Should I revert back to a month ago. Would that get someone's attention? That would be a revert in the cycle. Would you then talk before making large scale changes? Instead of being dogmatic, how about simply listening to your fellow contributors.

As for references, please explain why the Mayo Clinic citation is not appropriate. --scuro (talk) 16:27, 16 September 2008 (UTC)

Please read WP:MEDRS

Doc James (talk) 17:11, 16 September 2008 (UTC)

You think I haven't read that? Doc...come on now. I've asked you a straight forward question. Answer it. --scuro (talk) 03:00, 17 September 2008 (UTC)

Would be happy to. Let look at the ref: http://www.mayoclinic.com/health/adhd/DS00275

the page gives no references
it is self published on a web page
no indication of weather or not it is peer reviewed
author is give Mayo Clinic Staff, no one is brave enough to even attach there name to it
no indication is given that it is evidenced based
any finally IT IS NOT formated to wikipedian standard

Doc James (talk) 14:53, 17 September 2008 (UTC)

Do, please reinsert the word "chronic" in the lead sentence

As any good alternative health care professional or "Doc" in the field would know, ADHD is a chronic condition. It is not like Depression where one can be fine one month and then completely impaired the next month. We don't have a hyperactive boy driving everyone nuts one month and then a smiling angel the next. I can appreciate that you checked the Mayo clinic reference but you most certainly missed the term because it is there. Check again, and if necessary I can go back and give you the exact line. Please reinsert the term and reference.--scuro (talk) 11:41, 16 September 2008 (UTC)

chronic is helpful for many readers, because it is a contrast to the term acute. DSM criteria are that the condition has to have been present for at least 6 months. Hence chronic is appropriate.

My plea is for some discussion of these changes on the talk page. This article can be a trigger for all sorts of agenda pushing, and has the potential to become quite unstable. Lets talk first.--Vannin (talk) 14:35, 16 September 2008 (UTC)

See my above comment on being bold.

I think the term chronic is a little over done. Uptodate does not describe it as such. And many children outgrow ADHD which is a fact well recognized by the literature. I added the data that 40 - 90% of children diagnosed with ADHD no longer fulfill the criteria when the reach adulthood.

Conditions that are truly chronic include "fragile X" and "cystic fibrosis". We are not saying that ADHD is acute either. What we do need to say is that ADHD persists into adulthood in 10%-60% of those who are affected as children.

Also please leave out lines like " as any GOOD health care professional knows".

Doc James (talk) 15:20, 16 September 2008 (UTC)

ADHD is already described as a "persistent pattern". This is what is well recognized. Doc James (talk) 15:33, 16 September 2008 (UTC)

May be we should be citing Doc James. He seems to know it all. How do explain that Mayo clinic and other excellent sources describe it as "chronic"? Frankly, it doesn't matter what DOC James believes. Really our job is to cite and then determine majority, minority, and fringe opinion. By the way, do not pull anything that is an excellent secondary source, off of the article without first posting in talk. Consider that my talk comment in the "Bold -Revert" process. --scuro (talk) 16:31, 16 September 2008 (UTC)

Sitting someone home page is not a good reference. Please site peer reviewed sources. I am basing my references on published peer reviewed sources please do the same. Quote and reference the literature.

Please provide these excellent sources.

Doc James (talk) 17:10, 16 September 2008 (UTC)

"ADHD is generally a chronic disorder" - Connor in Barkley 2006.--Vannin (talk) 21:20, 16 September 2008 (UTC)

Saying ADHD is generally a chronic disorder is different from saying ADHD is a chronic disorder. I am happy with Connor's wording. Especially with the numbers of cases that resolve by adulthood added. This now reflects the literature.

Doc James (talk) 22:22, 16 September 2008 (UTC)

We don't consider those who don't have it when determining this. If you have the disorder it is chronic. --scuro (talk) 02:59, 17 September 2008 (UTC)

So ADHD is chronic except when it is not in 40-90% of cases?

Doc James (talk) 14:45, 17 September 2008 (UTC)

You do not have ADHD today and not tomorrow...and then again in a month...as you would have with depression. Since it is a developmental disorder, it changes with time, hence the term, "developmental". Kids often no longer are hyperactive in their teenage years ie...climbing on furniture and such. I'd be happy with chronic childhood disorder. By the way, 40-90%...what sort of stat is that? You could fit a train through that.--scuro (talk) 15:59, 17 September 2008 (UTC)

Exactly sort of shows how contraversal the disorder actually is. And that is what the reviews show.

Doc James (talk) 16:04, 17 September 2008 (UTC)

Do you honestly take that as proof of controversy? The controversy study you refer to comes from the department of political science of Stanford. For someone so keen on using medical and scientific references only, it is ironic that to make the controversy claim we step into another field. If you want to qualify the info by stating that academics from the political science department of Harvard said,... I'd find that quite acceptable. I've looked myself...it would be a small fringe opinion within the scientific or medical community that states, ADHD is a highly controversial disorder.

Oh by the way, any thought on the "chronic" compromise?--scuro (talk) 05:02, 18 September 2008 (UTC)

The DSM IV refers to ADHD as persistent. Lower down it says ADHD is generally chronic and gives the rate that it persists into adulthood.

Doc James (talk) 13:20, 19 September 2008 (UTC)

Actually it is speaking to the symptoms and not the condition.--scuro (talk) 03:19, 20 September 2008 (UTC)

And the difference? This is a condition defined by its symptoms. If the symptoms due not exist the condition does not exist. It is not like you can have asymptomatic ADHD. Doc James (talk) 03:37, 20 September 2008 (UTC)

The difference is the term is widely used in the field to describe the condition so why avoid it? I've posted on the village pump for other opinions. You can check it out here. http://en.wikipedia.org/wiki/Wikipedia:Village_pump_(policy)#Can_one_cite_web_based_information_from_the_Mayo_Clinic.3F --scuro (talk) 15:56, 20 September 2008 (UTC)

behavioural condition

We have suddenly lost the "neuro" descriptor in the lead, without any discussion. Just calling the condition a behavioural condition is inappropriate. If that was all it was, then putting a behavioural program of reinforcers would be sufficient for treatment. But it isn't, and the research clearly demonstrates a "neuro" component. --Vannin (talk) 14:35, 16 September 2008 (UTC)

The behavioural quote is directly from uptodate.com Just because something is behavioral does not in any way mean it is not amenable to medical treatment or that a behavioural program would cure the difficulty.

Doc James (talk) 15:10, 16 September 2008 (UTC)

but neurobehavioural - as in having to do with how the brain affects behaviour - is better in this situation--Vannin (talk) 15:18, 16 September 2008 (UTC)

Please find a good review that supports this classification. All behavior is determined by the brain / endocrine system / environment. That this condition is solely determined by the brain needs good support. Everyone one agrees that it is a behavior disorder in the end. We need to site a peer reviewed source.

Doc James (talk) 15:46, 16 September 2008 (UTC)

Doc, it doesn't have to be a review. See my post in the section below. --scuro (talk) 21:47, 16 September 2008 (UTC)

This page in a nutshell: Ideal sources for biomedical articles include general or systematic reviews in reliable, third-party, published sources of reputable medical journals, widely recognised standard textbooks written by experts in a field, or medical guidelines and position statements from nationally or internationally reputable expert bodies.

Medical Collarberation

I'm trying to see if we can get other editors to help on this topic. Follow the link at the topic of this page to voice your opinion.

Doc James (talk) 17:32, 16 September 2008 (UTC)

I think one problem here is the viewpoint that only medical reviews can be used as a source of information for a citation, for this article. I'd happen to disagree with you. I think a citation using the Mayo Clinic website is excellent. See WP:PSTS Wikipedia writes: "As a rule of thumb, the more people engaged in checking facts, analyzing legal issues, and scrutinizing the writing, the more reliable the publication". You can be sure that a prestigious institution, such as the Mayo Clinic, will go over posted information on their web page with a fine toothed comb.--scuro (talk) 21:42, 16 September 2008 (UTC)

Also, a single peer reviewed study is not the best source of information. There are 5000 studies on ADHD. Sometimes these studies do not come to the same conclusion. Sometimes they are out of date. Sometimes they simply came to faulty conclusions. I could probably make any point I wanted to, using a peer reviewed study with regards to ADHD. Best are respected institutions and bodies who are familiar with all the literature, and draw conclusions.--scuro (talk) 21:55, 16 September 2008 (UTC)

A review article is not the same as a article which has been peer reviewed. Look carefully at what I am referring to. Reviews are secondary sources. Well journal articles are primary sources. Reviews that are published in peer reviewed journals are peer reviewed secondary sources well material published on the mayo clinics home page is none peer reviewed secondary sources. The peer reviewed secondary source wins out over the none peer reviewed secondary source.

Doc James (talk) 22:23, 16 September 2008 (UTC)

I disagree with you again. A review of the literature is good but it doesn't trump everything. For instance there have been a number of reviews on ECT. They vary in opinion. Simply citing one of those reviews would not trump any other sort of citation. Information on a website, of say the Mayo Clinic, might actually be more considered. You would have several experts in that one institution, as compared to what could be a single reviewer of the literature. These experts have read all the studies and the reviews of the literature. The website may also be more up to date because it may seek to give it's audience up to date information. A review is a static document stuck in a moment in time. Frankly with ECT, much of what was written in the old reviews, could now not be used as a source for any point in Wikipedia. It is simply is totally out of date.

This is why it is important to seek consensus instead simply doing what you think is best. Other contributors in this community are a valuable resource and you should use them.--scuro (talk) 00:06, 17 September 2008 (UTC)

--Vannin (talk) 14:47, 19 September 2008 (UTC)== Referenced material ==

One should not change referenced material unless you have verified that the reference matter is incorrect. When it is writen that "no randomized controlled trials assessing the harms or benefits of treatment beyond two years". You cannot change that unless you reference a RANDOMIZED CONTROLLED TRIAL of greater length that assesses safety.

The book you quote does not allow you to change the review.

Doc James (talk) 22:27, 16 September 2008 (UTC)

Fair enough, so we should leave out the two year reference as connor reviews controlled trials that have been extended to 5 years. --Vannin (talk) 22:32, 16 September 2008 (UTC)

That's a nice idea DJ, but what's good for the goose is good for the gander. Please don't remove excellent secondary sourced material without discussing in talk first.--scuro (talk) 00:08, 17 September 2008 (UTC)

I have asked you to quote the actual article that show safety in a controlled trial at 5 years for us to review. Until you do so I have removed that edit. If you are quoting a book at least give the page numbers. It is better though to quote the actual article. I have found many authors make mistakes when the reference the literature.

Doc James (talk) 14:38, 17 September 2008 (UTC)

I think this is very instructive. You don't trust my reference but expect me to trust yours. Working collaboratively tends to mean AGF. The reference is pretty much as I gave it: Barkley, Russell (2006). Attention-Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment. New York: The Guildford Press, 608-645. ISBN 2005016986 Parameter error in {{ISBN}}: checksum. This is a good academic reference, and certainly as good, if not better than a therapeutic letter. It has more references. The actual quote "Three controlled and one open-label study have examined the efficacy and safety of stimulants over 4- to 60-month treatment durations for children with ADHD CHarach, Ickowicz, & Schachar, 2004; Gillberg et al., 1997; MTA Cooperative Group, 1999; Schachar, Tannock, Cunningham & Corkum, 1997; Wilens, Pelham, et al., 2003). Schachar et al. (1997) investigated methylphenidate compared to placebo in 91 children with ADHD over a 4-month clinical trial. The children continued to demonstrate benefits of methylphenidate over the 16-week trial. Lack of weight gain was a side effect documented in the treatment group (Scharch el al., 1997). This study has now been extended for 5 years, and data are reported on 79 of the original 91 children (Charach et al., 2004)" etc. etc. I grow weary of typing leading to "These longer-term results include data from a total of 1,021 stimulant treated children. Both methylphenidate and amphetamine preparations have been studied in these longer-duration clinical trials. The data are encouraging in that stimulants continue to be effective for the core symptoms of ADHD and appear well tolerated over 4 months to 5 years of treatment" and then he calls for more research, of course, as all academics tend to!

The specified research studies are all in good journals.

I think that collaboration means working together, rather than trying to write a whole article on one's own, which may be more the style of Ask DrWiki.--Vannin (talk) 18:26, 17 September 2008 (UTC)

The open label study is the one that is of 5 years duration. It is not a controlled trial which was what was refered to by the Therapeutics Initiative. Therefore you CANNOT change what is writen without understanding it first. All I asked for is the controled trial of 5 years duration and what you gave me was not a controled trial of 5 years duration. --Doc James (talk) 19:15, 17 September 2008 (UTC)

(Wilens et al is the open-label study, the others are controlled, with the 5-year study being an extension)--Vannin (talk) 22:12, 17 September 2008 (UTC)

Okay so your wrote: Connor reports that stimulants appear to be tolerated well over 5 years of treatment and that longer-duration clinical trials are encouraging.

Who is Connor? Looks to me like the author is Charach. The study I presented was a systematic review. What you presented was a trial of 79 people.

Doc James (talk) 13:27, 19 September 2008 (UTC)

Okay I have found the source myself. It looks like the first twelve month were randomized. After that it was not. Very small numbers which conclusion was "Psychostimulants improve ADHD symptoms for up to 5 years, but adverse effects persist."

http://www.ncbi.nlm.nih.gov/pubmed/15100562?ordinalpos=5&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum Doc James (talk) 13:32, 19 September 2008 (UTC)

Connor is the person writing the review chapter in Barkley's book. The chapter is on stimulants - the review is a good quality academic publication. If you read the quote you will see that there are other studies there - I'm away at a conference today so don't have the book with me. The Charach is one of three controlled studies and one open label study. It is not a piece of fluff. There is a variety of opinion here among professionals. Regardless of the black box label the medication has not been withdrawn. We have to be careful not to go all OR on this topic. The good academic review says positive things about tolerance over time - the only side effect noted was reduced weight gain, (which could almost be a positive factor because I've seen some weight gain issues in people with ADHD, particularly people who are unmedicated). I feel that you are assuming that we are all idiots and it is making it difficult to work with you.--Vannin (talk) 14:47, 19 September 2008 (UTC)

I am not saying that this is inappropriate for this page. I think this study does add to a balance view of ADHD treatment. We have to be careful we are not one sided. We begin by saying these meds are the most clinically effective.

The black box warning was however very significant news. The FDA does get the opportunity to review data that is not available to the rest of the scientific community and therefore their words should not be taken lightly. There recommendations were followed by a statement by the American Heart Association and the AAP.

All I asked for was the pubmed link to the original article saying that there is safety out to five years in a controlled trial as I was skeptically. What you gave me was NOT a a controlled trial out to five years confirming my skeptism.

I am still looking for a good review. Doc James (talk) 16:51, 19 September 2008 (UTC)

The black box warning was a knee jerk reaction that was not at all considered. Hence it's quick removal. It doesn't really matter if the 5 year study was controlled or not. It is information on the topic at hand. I take it that there are no other studies that have looked at the issue? It should be briefly mentioned and can be qualified.--scuro (talk) 11:09, 22 September 2008 (UTC)

admin help

It's beginning to look like we might need some admin help here. JMH, maybe you could try discussing scuro's edits one by one rather than simply dismissing them all out of hand and starting an edit war?--Vannin (talk) 03:33, 17 September 2008 (UTC)

In reality I'd say our viewpoints are probably not that different. Where there are differences discussion is needed. The door is open.--scuro (talk) 11:16, 17 September 2008 (UTC)

The issue I have stated previously is not so much the content but

the formating of the references
the quality of the references

The other issue is the fact that edits are often changed so that they no longer reflect the published material.

Doc James (talk) 14:42, 17 September 2008 (UTC)

The major issue is what DJ refers to as "quality of references". I have asked him point blank why a citation that references info from the Mayo Clinic is not a quality reference. I am still waiting for an answer.--scuro (talk) 16:00, 17 September 2008 (UTC)

Have posted the answer on your talk page a few days ago. We discussed what makes a good source and about formating and here once more below.

Let look at the ref: http://www.mayoclinic.com/health/adhd/DS00275

the page gives no references to the literature
it is self published on a web page
no indication of weather or not it is peer reviewed
author is give Mayo Clinic Staff, no one is brave enough to even attach there name to it
no indication is given that it is evidenced based
it is not a comprehensive review of the literature
any finally IT IS NOT formated to wikipedian standard

Doc James (talk) 14:53, 17 September 2008 (UTC)

Thanks for the post.

You are speculating...assuming, and from my vantage point, falsely. If you have ever worked for a major institution you would know that any info posted on the web that is directly related to your business would be gone over with a fine tooth comb. Double and triple so for the finest institutions of the land. We are not NICE or the NEJM. The standards here for citations, are not the same as in a medical journal although they may share numerous policies. From what I can take on policy, the criteria of Wikipedia is secondary fact checking. I would appreciate it if you could show us Wikipedian policy that states citing (the Mayo Clinic) web page based info on ADHD is a poor reference or not allowed.--scuro (talk) 03:10, 18 September 2008 (UTC)

If they do not say if the above are the case. One does not just assume that they are. I will continue reverting until you start properly formatting your edits. Wikipedia does outline what is a good reference. And I have already made that clear to you.

Doc James (talk) 04:14, 19 September 2008 (UTC)

As a fellow contributor your job is not to threaten. It is to work with the those who are already on the article. It would be appreciated if you would do so.--scuro (talk) 05:14, 20 September 2008 (UTC)

Please learn how to format your references. Your previous one didn't work.Doc James (talk) 05:21, 20 September 2008 (UTC)

The discussion at the village pump (http://www.mayoclinic.com/health/adhd/DS00275) found agreement that citations using info from excellent secondary websites is acceptable. Every citation does not need to be a review or study.--scuro (talk) 11:03, 22 September 2008 (UTC)

By the way DJ - I've just seen an editor blocked for threatening to continue to revert on one article. I guess this is a warning in that I'm thinking of going to ANI. This is not a constructive attitude. Either write your own article, or work together, please. And not everyone is perfect at formatting - that is another reason why we work together--Vannin (talk) 16:16, 22 September 2008 (UTC)

social critics vrs. medical and scientific community and attribution of controversy

Recently DJ been repeatedly inserting the line that, ADHD holds the distinction of being one of the most controversial pediatric disorders. This comes from the political science branch of Harvard. Nice source but that should allow the blanket statement to made. I have seen no medical institution or scientific body state that it is a controversial disorder. The quote should be attributed and it would be appreciated if DJ did so.--scuro (talk) 05:19, 20 September 2008 (UTC)

I do not understand what you write. There are two references for the quote.Doc James (talk) 05:27, 20 September 2008 (UTC)

Very simply the idea that, "ADHD holds the distinction of being one of the most controversial pediatric disorders", comes from non medical or scientific sources. It's a blanket statement that is sourced to people who don't work in the field. It would be like NICE stating that rap is eroding the moral fiber of society. Sure the quote is noteworthy but it needs to be qualified.--scuro (talk) 15:15, 20 September 2008 (UTC)

Uhh No! Doc James (talk) 19:06, 20 September 2008 (UTC)

Doc, Uh won't do. Explain.--scuro (talk) 19:33, 20 September 2008 (UTC)

Classifying something as "the most controversial disorder" is a bit strange - was there a contest? It does not seem terribly controversial to child psychiatrists, but there is controversy among groups such as Scientology who have led a rather sophisticated campaign against this condition. Thus to say that it is an area with controversy seems fine, particularly if this comment is placed in context. This seems like a point where we should slow down, and talk first. Dj's rate of edits is not conducive to collaborative writing. --Vannin (talk) 21:46, 20 September 2008 (UTC)

Again - the controversy is outside of mainstream medicine but is present in general society - this context should be clear to the reader and it is not currently clear. --Vannin (talk) 16:11, 21 September 2008 (UTC)

Agreed, without further input I see no reason not to make changes.--scuro (talk) 11:00, 22 September 2008 (UTC)

rewrite

One solution that I have seen in other articles when an editor wants to completely rewrite an article rather than discussing point to point is for that editor to basically write up their own article in their user space, and then when it is ready ask people to comment on it. Given that DJ seems to want to write this up on his own, this may work better - once it is rewritten then the rest of us can start to have input (probably at a slower, more thoughtful and consensus-based pace). What do you think DJ? That way you could get it all the way you want first? --Vannin (talk) 06:18, 20 September 2008 (UTC)

No I prefer writing slowly over time. But thanks.

Doc James (talk) 16:33, 20 September 2008 (UTC)

Doc, you need to compromise. What has been done is wrong.--scuro (talk) 11:00, 22 September 2008 (UTC)

Use of language in psych or med sciences

Hello, I am new to this. I would like to add a quick comment about use of language in contentious medical issues such as this one.

It is indicated several times in the article that the ADHD is a disorder that is transmitted genetically. In fact, to my knowledge, there is no known or agreed upon etiology for the ADHD disorder. There is still much contention over whether there are any identifiable psycho-chemical or biological bases of the disorder ^[1]. That is, unless I am mistaken, no researcher has yet to identify an agreed upon biological cause for the disorder. In this case, it is erroneous to affirm that ADHD is categorically genetic. Studies on heritability do provide some compelling evidence toward this point. However, this evidence does not constitute truth, many confounds may cloud heritability research. It does not constitute the strongest evidence (moreover, there is no identified and agreed upon gene to which one might refer as the ADHD gene). In controversial scientific issues such as this one, it is more customary to use the eviden½ce to suggest rather than to affirm. For example, 'Studies on heritability seem to suggest that there is a strong genetic component in the ADHD disorder. However, ....' Same goes for other purported 'causes' of ADHD, eg. smoking during pregnancy, premature birth. These 'causes' do not refer to a known etiology. They are rather based on correlations between persons exhibiting symptoms of ADHD and having concurrently experienced other difficulties, eg. premature birth. It is, in as much as I know about medical science, erroneous to talk about a definite 'cause' until we are sure the etiology of this cluster of symptoms - or disorder - is specified.

I hope this is well met. I believe that this dispute over the controversial nature of the ADHD disorder can be resolved with care in language. It is imperative to distinguish what are facts from what are evidences that merely 'suggest' facts. It is my belief that the encyclopedic review should not lead one to believe that more is understood than what is truly understood. I suggest that perhaps reviewers should limit themselves to detailing what work is being done in the field, and to suggest references to users who would like to find out more. →→→→ —Preceding unsigned comment added by 99.239.192.216 (talk) 15:48, 20 September 2008 (UTC)

Sounds reasonable. Feel free to go ahead and make changes you think would be appropriate.

Doc James (talk) 16:09, 20 September 2008 (UTC)

The language can be tweaked. There are bigger problems that need to be dealt with first. I don't think there is much point in putting the trim on when the foundations need work.--scuro (talk) 10:54, 22 September 2008 (UTC)

Attention Doc James

Instead of edit waring we should resolve issues on talk. There are several. I'd be pleased to hear your opinion on this. --scuro (talk) 19:41, 20 September 2008 (UTC)

You seem to enjoy edit wars rather then making constructive edits. Of course it is a controversial disorder. We have a whole subsection on the controversy and a whole separate page on the controversy and you do not feel it is important enough to put in the lead. One reference was published in the Harvard review of psychiatry. The other from the Institute of Psychiatry at the Maudsley. Who are YOU to say that they are not involved in the feild. And I even formatted the reference properly. Doc James (talk) 20:00, 20 September 2008 (UTC)

You are putting words in my mouth. Tone it done a bit there bub. I said that the idea that ADHD is the most controversial idea ever, doesn't belong in the lead. It is minority opinion. This you have glossed over. Think about it and lets start fresh.--scuro (talk) 20:31, 20 September 2008 (UTC)

Doc James, it's time to come to the table. Lets talk, start fresh. Lets move forward.--scuro (talk) 10:43, 22 September 2008 (UTC)

black box warning

There is a black box warning for methylphenidate - but it is not for cardiovascular issues. Wasn't that particular warning removed the following year? Now it is for the chronic abuse issues and history of drug dependence etc isn't it? Should we just remove the reference to the black box warning altogether or do we really want to get into the details of the removal of one warning, and the issue of not prescribing it to people with addictions issues, which seems a little detailed for this summary--Vannin (talk) 02:40, 21 September 2008 (UTC)

Yes if you can find a reference that says the black box warning was removed then we need to comment on that. Have looked briefly for an article about the removal but havn't yet been able to find one. We should touch on the concerns with addiction. This are important parts of the controversy as a lot of these drugs end up being used by addicts illegally. Doc James (talk) 03:46, 21 September 2008 (UTC)

Well first off - you could check the black box warnings themselves - Black Box Warnings to see that there is no mention of cardiac issues. ( I believe that there was some concern that they had gone overboard on the basis of some deaths that may have been due to other issues and so they recanted on that warning) or you could try FDA Rejects "Black Box" Warning for Stimulant Meds. --Vannin (talk) 05:13, 21 September 2008 (UTC)

Yes there is no black box for the stimulant class of therapeutic drugs. When they studied the deaths some were because of preexisting heart abnormalities. When they looked at the stats again, the death rate was not significantly different from the general population. Thus the black box label was removed. All of this is mentioned in the treatment section of the article.--scuro (talk) 10:59, 22 September 2008 (UTC)

There is black box warnings. One was recommended for cardiac concerns as the quote said. There are still strong recommendations to look for cardiac abnormalities before prescribing stimulants. The black box warning that are there are for addition.

Here are the warning: for "Amphetamine, Dextroamphetamine, Lisdexamfetamine dismesylate, Methamphetamine, Mixed Salts of Single Entity Amphetamine Products

High abuse/diversion potential: Amphetamines have a high potential for abuse. Particular attention should be paid to the possibility of subjects obtaining amphetamines for non-therapeutic use or distribution to others, and the drugs should be prescribed or dispnsed sparingly. Drug dependence:Administration of amphetmaines for prolonged periods of time may lead to drug dependence and must be avoided. Serious Adverse Events: Misuse of amphetamines may cause sudden death and serious cardiovascular adverse events"

--Doc James (talk) 21:51, 22 September 2008 (UTC)

I was talking about the black box warning for methylphenidate, which if you check you will see does not make mention of cardiovascular events--Vannin (talk) 22:08, 22 September 2008 (UTC)

From what I have read, at this moment, there is no black box warning for all therapeutic stimulants. I looked on the list that Vannin provided and looked under classes of drugs (stimulants) and individual drugs and saw none listed It didn't even mention stimulants as one of the classes. Here also is a link indicating that the order was rescinded. http://www.additudemag.com/addnews/29/1166.html --scuro (talk) 23:04, 22 September 2008 (UTC)

What? Here is some info from lexi drug. First is methyphenadate the second is dextroamphetamines. Black box warning for cardiovascular concerns is on the second one. " WARNINGS / PRECAUTIONS Boxed warnings:

Drug abuse: See "Disease-related concerns" below.

Concerns related to adverse effects:

Cardiovascular events: CNS stimulant use has been associated with serious cardiovascular events including sudden death in patients with pre-existing structural cardiac abnormalities or other serious heart problems (sudden death in children and adolescents; sudden death, stroke, and MI in adults). These products should be avoided in patients with known serious structural cardiac abnormalities, cardiomyopathy, serious heart rhythm abnormalities, or other serious cardiac problems that could further increase their risk of sudden death. Patients should be carefully evaluated for cardiac disease prior to initiation of therapy. Some products are contraindicated in patients with heart failure, arrhythmias or recent MI. Visual disturbance: Difficulty in accommodation and blurred vision has been reported with the use of stimulants.

Disease-related concerns:

ADHD treatment: Appropriate use: Recommended to be used as part of a comprehensive treatment program for attention deficit disorders. Drug abuse: [U.S. Boxed Warning]: Potential for drug dependency exists; avoid abrupt discontinuation in patients who have received for prolonged periods. Use caution in patients with history of ethanol or drug abuse. Hypertension: Use with caution in patients with hypertension and other cardiovascular conditions that might be exacerbated by increases in blood pressure or heart rate. Some products are contraindicated in patients with severe hypertension, hyperthyroidism or angina. Psychiatric disorders: Use with caution in patients with pre-existing psychosis or bipolar disorder (may induce mixed/manic episode). May exacerbate symptoms of behavior and thought disorder in psychotic patients; new onset psychosis or mania may occur with stimulant use; observe for symptoms of aggression and/or hostility. Seizure disorder: Use with caution in patients with a history of seizure disorder; may lower seizure threshold leading to new onset or breakthrough seizure activity.

Special populations:

Pediatrics: Not labeled for use in children <6 years of age. Use of stimulants has been associated with suppression of growth in children; monitor growth rate during treatment.

Dosage form specific issues:

Concerta®: Should not be used with pre-existing severe gastrointestinal narrowing conditions, such as esophageal motility disorders, small bowel disease, "short" gut syndrome, cystic fibrosis, history of peritonitis, chronic intestinal pseudo-obstruction, or Meckel's diverticulum. Daytrana™: Transdermal system may cause allergic contact sensitization, characterized by intense local reactions (eg, edema, papules); sensitization may subsequently manifest systemically with other routes of methylphenidate administration; monitor closely. Avoid exposure of application site to any direct external heat sources (eg, hair dryers, heating pads, electric blankets); may increase risk of overdose. Efficacy of therapy for >7 weeks has not been established. Metadate® CD: Contains sucrose; avoid administration in hereditary galactose intolerance, Lapp lactase deficiency, or glucose-galactose malabsorption. Concomitant use with halogenated anesthetics is contraindicated; may cause sudden elevations in blood pressure; if surgery is planned, do not administer Metadate® CD on the day of surgery. Metadate® ER: Contains lactose; avoid administration in hereditary galactose intolerance, Lapp lactase deficiency, or glucose-galactose malabsorption. Concomitant use with halogenated anesthetics is contraindicated; may cause sudden elevations in blood pressure; if surgery is planned, do not administer Metadate® ER on the day of surgery.

Other warnings/precautions:

Long-term use: Safety and efficacy of long-term use of methylphenidate have not yet been established.

RESTRICTIONS — C-II

An FDA-approved medication guide must be distributed when dispensing an outpatient prescription (new or refill) where this medication is to be used without direct supervision of a healthcare provider. Medication guides are available at http://www.fda.gov/cder/Offices/ODS/medication_guides.htm."

""

WARNINGS / PRECAUTIONS Boxed warnings:

Cardiovascular events: See "Concerns related to adverse effects" below. Drug abuse: See "Disease-related concerns" below.

Concerns related to adverse effects:

Cardiovascular events: [U.S. Boxed Warning]: Use has been associated with serious cardiovascular events including sudden death in patients with pre-existing structural cardiac abnormalities or other serious heart problems (sudden death in children and adolescents; sudden death, stroke and MI in adults). These products should be avoided in the patients with known serious structural cardiac abnormalities, cardiomyopathy, serious heart rhythm abnormalities, or other serious cardiac problems that could increase the risk of sudden death that these conditions alone carry. Patients should be carefully evaluated for cardiac disease prior to initiation of therapy. CNS effects: Amphetamines may impair the ability to engage in potentially hazardous activities. Visual disturbance: Difficulty in accommodation and blurred vision has been reported with the use of stimulants.

Disease-related concerns:

Drug abuse: [U.S. Boxed Warning]: Potential for drug dependency exists; prolonged use may lead to drug dependency. Use is contraindicated in patients with history of ethanol or drug abuse. Prescriptions should be written for the smallest quantity consistent with good patient care to minimize possibility of overdose. Hypertension: Use with caution in patients with hypertension and other cardiovascular conditions that might be exacerbated by increases in blood pressure or heart rate. Use is contraindicated in patients with moderate to severe hypertension. Psychiatric disorders: Use with caution in patients with pre-existing psychosis or bipolar disorder (may induce mixed/manic episode). May exacerbate symptoms of behavior and thought disorder in psychotic patients; new onset psychosis or mania may occur with stimulant use; observe for symptoms of aggression and/or hostility. Seizure disorder: Use with caution in patients with a history of seizure disorder; may lower seizure threshold leading to new onset or breakthrough seizure activity. Tourette's syndrome: Use with caution in patients with Tourette's syndrome; stimulants may unmask tics.

Special populations:

Pediatrics: Safety and efficacy have not been established in children <3 years of age. Appetite suppression may occur; monitor weight during therapy, particularly in children. Use of stimulants has been associated with suppression of growth; monitor growth rate during treatment.

Other warnings/precautions:

Discontinuation of therapy: Abrupt discontinuation following high doses or for prolonged periods may result in symptoms for withdrawal.

RESTRICTIONS — C-II

An FDA-approved medication guide must be distributed when dispensing an outpatient prescription (new or refill) where this medication is to be used without direct supervision of a healthcare provider. Medication guides are available at http://www.fda.gov/cder/Offices/ODS/medication_guides.htm."

Doc James (talk) 02:51, 23 September 2008 (UTC)

So in other words there is black box warning from the FDA on both drugs. Methyphenadate for drug abuse and dextramphetamines for both drug abuse and cardiac death. I will add that back in when I get time. Vannin is right one was recommened for cardiac problems with methyphenadate but in the end it was not approved.Doc James (talk) 02:55, 23 September 2008 (UTC)

so bottom line is we should summarize the article on treatments rather than trying to create something entirely new and not put out of date info in the main article.--Vannin (talk) 03:13, 23 September 2008 (UTC)

What was written was that the FDA recommended a black box warning for CV problems with methyphenadate in 2006. All of this is true. A black box warning wasn't added for methyphenadate in the end but it was added for dextramphetamines which are also used to treat ADHD.

Adding this info is much better then a blanket statement that ADHD meds are safe. With no qualifications given.

Doc James (talk) 04:04, 23 September 2008 (UTC)

Doc James, do you have a direct link to that first chunk of cut and paste you posted from was it Lexi? I have no doubt that there are all sorts of warnings and procedures for therapeutic stimulants but my doubt is that there are currently black box warnings still for those drugs, especially after reading Vannin's website.

FDA Rejects "Black Box" Warning for Stimulant Meds https://healthlibrary.epnet.com/GetContent.aspx?token=94e729bf-2a24-406f-8083-f1484720ce65&chunkiid=113536

This is what I believe they did, "The U.S. Food and Drug Administration's pediatric advisory committee reached a consensus that, instead of a "black box" warning, the medications should use simpler language and include more information on the labels". So I doubt it is true that stimulants carry black box warnings.--scuro (talk) 04:35, 23 September 2008 (UTC)

Hey Scuro the site is called lexi drugs. It is combined with a resources called www.uptodate.com I pay $400 a year for access to this site. It is basically the single most well know and respected medical resource for internal medicine. I cut and pasted directly from the site. http://online.lexi.com/crlsql/servlet/crlonline www.uptodate.com

Doc James (talk) 04:48, 23 September 2008 (UTC)

Vannin reference says the same for amphetamines. http://www.formularyproductions.com/master/showpage.php?dir=blackbox&whichpage=16 So I am not sure were you are getting that there are no black box warnings on ADHD meds?

--Doc James (talk) 04:55, 23 September 2008 (UTC)

Give me some time here to investigate. I find all sorts of sites that tell there are no black box warnings. http://today.msnbc.msn.com/id/12956008/

Also this press release. http://www.fda.gov/bbs/topics/NEWS/2007/NEW01568.html was interesting too. I can ask some people I know who would have their finger on this issue.--scuro (talk) 11:43, 23 September 2008 (UTC)

From your link. Here is what is printed on the package and shows two black boxed warnings. http://www.fda.gov/cder/foi/label/2007/011522s040lbl.pdf One for cardiac concerns and one for abuse. We should have this one the page. The other link is old, 2006.

Doc James (talk) 14:17, 23 September 2008 (UTC)

(EC) ==arbitrary break== Prescription details about each medication really should be placed in the article for treatment - and this article should be a more general summary, surely--Vannin (talk) 14:51, 23 September 2008 (UTC)

I get that there are a gazillion warnings and precautions. But 'black box" is NOT the same as serious warnings. Black box speaks of serious and dangerous risk. I took a look at the PDF and saw the many warnings...no mention of black box. I've offered several sources which state there is no black box and so consequently there is doubt in my mind. Do you come in contact with ADHD medication on a regular basis? If so have you seen a black box recently? If you don't mind, I'd just like to double check with a few sources. They work in the field and are highly knowledgable and will give me a lot background information on this issue. Thanks,--scuro (talk) 16:18, 23 September 2008 (UTC)

Black box warning are the most serious warning from the FDA. The are surrounded by a black box. Look at http://www.fda.gov/cder/foi/label/2007/011522s040lbl.pdf The text you see in the black box is a black box warning. Wikipedia has a nice article on the subject. Black box warning. And please this is what I do for a living I have spent the last 13 years in the field of medicine. The warning did not go on methyphenadate but did go on other ADHD drugs.

--Doc James (talk) 17:49, 23 September 2008 (UTC)

I totally agree with you that the black box warning is about as serious a warning as you can get. It's really significant and that is why we should get it right. Which ADHD drugs specifically have that black box label? I'm wondering if the label that you posted on the PDF isn't the new required non-black box label.

When I went to the wiki article on black box warnings I found this: "In February 2006, the FDA's Drug Safety and Risk Management Advisory Committee voted to include black box warnings on methylphenidate formulations—used to treat ADHD—due to possible cardiovascular side-effects.[4] A month later, the agency's Pediatric Advisory Committee effectively rejected recommending boxed warnings for both cardiovascular and psychiatric adverse effects.[5] Minutes and transcripts of the relevant meetings are available on the FDA website.[6][7]" Again this casts doubt in my mind. Should I contact the people I know who would have a very specific answer on this issue?--scuro (talk) 19:53, 23 September 2008 (UTC)

I did contact both people last night. I shoudl hear from them today. Funny thing is that both the black box article and the treatment article agree about no black box warning. It will be interesting to compare notes with you. Do you know why methyphenadate did not get a black box warning and if any other stimulants did not get a black box warning?--scuro (talk) 15:49, 24 September 2008 (UTC)

No not sure why some got the black box warning for cardiac concerns and others did not. All I now is it is a very controversial issue. --Doc James (talk) 17:44, 24 September 2008 (UTC)

Editing

Dear Vannin You have started with the threats not I. I have explained my point of view. Scuro has brought his concerns to another page which didn't agree with him. They said that if better sources do not confirm his precious unformatted reference to the mayo clinic site then it should not be used. The two of you do not control the content of this article, very sorry. I think both of you have referred to reverting the article back to the sorry state it was in a month ago. And then threaten to try to get me banded. Do what ever you feel you have to do though wrt to me. No worries. Other editors have come along and also disagreed with the direction the two of you are trying to take the article. Scuro has complained bitterly now that three of use have removed his POV stickers in the last few days. It is not appropriate for you two to scare away other editors who might have different points of view and then with only the two of you left claim that you then have the majority opinion. I am happy to work together. There is however a hierarchy of evidence which we must follow. And there is formatting guidelines we must follow to. I do not appreciate sloppy editing. Doc James (talk) 22:03, 22 September 2008 (UTC)

Sarcasm really isn't appreciated here. Nor is putting false words in my mouth. I am really trying to assume good faith but these issues, and a doggedness of approach makes this difficult. Do not try to also turn this into a us against you issue and paint us in a very disparaging way. That is an assumption of bad faith and is also not appreciated. I will seek help very soon if no forward progress is made.

Yes, with the specific Mayo reference they said if a better source could be found it should be used. Problem is you never found a better source or any source remotely related to the issue. The contributors at the village pump pointed out that any good cited material from the web is usable. As for controlling this article, no one controls it. Policy and the interpretation of that policy through talk is what in the end, determines what gets on the page. I'd appreciate if we can focus on content and not other contributors and get down to work in a good faith manner.--scuro (talk) 23:18, 22 September 2008 (UTC)

You should also show some good faith. And I am not being sarcastic :-) It doesn't matter if 20 people think that it is wrong? This from a guy who says he believes in consensus. I guess you only believe in consensus when it falls in your favor then. Funny that.

Oh and by the way you hit your four reverts when you re added the POV line after three other editors removed it. I think you get banded for that.

Now to be serious I would be happy to work together in good faith. I however think good faith is lacking and there are two editors trying to control the page. Doc James (talk) 23:31, 22 September 2008 (UTC)

Report me, if you wish. I'd love that this issue see the light of day. There are rules and then there are issues. Rules don't need consensus. If you really feel that we can't work together then may be we should seek assistance and mediation. As for control I see only one who has completely dominated the page recently.--scuro (talk) 23:43, 22 September 2008 (UTC)

Really I do not care that much. Do whatever you like. Notice at the bottom of the edit page: If you don't want your writing to be edited mercilessly or redistributed for profit by others, do not submit it.--Doc James (talk) 23:49, 22 September 2008 (UTC)

I think of the few hundred edits you have made in short order, the only edits that I have made, that have stuck(momentarily possibly) is that I have put a POV tag on one sentence and have had two words restored.--scuro (talk) 00:16, 23 September 2008 (UTC)

Yup, my POV tags removed for about the 10th time with zilich communication in talk or on my talk page. It's the wild west here folks. Doc James even has the nerve to lecture me on reverting this obviously manipulative POV practice. We could use a sherif or two around here.--scuro (talk) 03:19, 25 September 2008 (UTC)

Criticisms

No critics of ADHD? There is loads. Hope some of you add the concerns of some professionals in regards to ADHD some of whom believe its another classic case of pharmaceutical companies and their sponsored professionals classifying normal human behavioral differences as conditions, disorders etc. to sell more drugs. It still makes me laugh, a new group has emerged calling it an disorder to show a dislike towards homosexuals. Soon there will be drugs for homophobia! Watch out men! They are already thinking on Nalmefene for gamblers and shoppers who lack the will power to stop. --78.86.159.199 (talk) 02:25, 6 September 2008 (UTC)

Yes I agree there are many of us who consider that the diagnosis is made more often then it should be and that the meds are less affective then many claim and less safe. A nice review of the literature was recently done by the Therapeutics Initiative. I am working on adding this info to the page to create a more balance overview.

See: http://ti.ubc.ca/en/letter69 216.174.136.2 (talk) 04:51, 11 September 2008 (UTC)

I believe it's the doctors "Easy way out" So to speak I've had ADHD from when I was young and I've seen many diagnosed who have nothing near my symptoms when they aren't medicated they hardly have any symptoms at all. I don't believe they should be taking the medications they respectively take though they are diagnosed and in my opinion it was a bad diagnosis. Although not every doctor has time to get to know their patients like friends know them I still believe some doctors are taking the easy way out. (On a side note they may have learned to control it because like me they were diagnosed at a fairly young age.) It just seems more cases are popping up not that I think there are more children with ADHD just more Children being diagnosed and it's hard to call the doctor's on whether they are making a mistake or correcting long term misdiagnosis as ADHD is more recognized. Psychonautic (talk) 18:14, 15 September 2008 (UTC)

Agree that this seems a very one-sided article. ADHD is a reasonably controversial condition in that the explosion of cases in recent years suggests a strongly social component related to modern lifestyles. Yet the article presents, without any serious critique, the view that it is a hereditary disorder that has presumably sprung up only in recent years (and mostly in the west). The article needs heavy revising, and preferably not by the usual suspects on either side of the argument. And while I'm certainly not a "conspiracy theorist", the involvement of the pharmaceutical trade in promoting the idea that this is an unavoidable genetic disorder that affects 300,000,000 people - best treated by their drugs of course - cannot be ruled out here on Wiki. Fig (talk) 13:17, 24 September 2008 (UTC)

I don't agree with many of the points you made. Can you cite what you state? Post it here and we can then put the well sourced info on the page.--scuro (talk) 15:53, 24 September 2008 (UTC)

arbitrary break

Prescription details about each medication really should be placed in the article for treatment - and this article should be a more general summary, surely--Vannin (talk) 14:49, 23 September 2008 (UTC)

The page on treatment doesn't really talk about the black box warning of abuse potential.

Doc James (talk) 15:28, 23 September 2008 (UTC)

removing POV tags unilaterally should not be done

We have two editors who are removing POV tags. This should not be done. Moral reasoning doesn't cut it. Please explain yourselves.--scuro (talk) 11:15, 22 September 2008 (UTC)

I think it is three editors now. And all have given reasons. Doc James (talk) 21:43, 22 September 2008 (UTC)

Yes it is three, but even if it were twenty, the edit reasons don't cut it. You can not unilaterally strip someone else's POV tag. What's even worse is that no attempt was made at discussing this issue in talk. I've been involved in a mediation cabal where this was a specific issue. The moderator made specific reference to this issue. It shouldn't be done.--scuro (talk) 22:58, 22 September 2008 (UTC)

Well my POV tag has been removed for about the 10th time and no one has taken the time to discuss the issue in talk. I would appreciate it if another contributor would reinsert it. We just can't have contributors willy-nilly removing POV tags with no communication going on.--scuro (talk) 19:57, 23 September 2008 (UTC)

The editors left communication in there edit histories. --Doc James (talk) 20:35, 23 September 2008 (UTC)

That is the problem, you can't reason with a hit and run. How can I counter what they have to say when all they post is a quick quip in the edit summary? I have posted on two of their talk pages but have heard nothing back. It's a serious breech of etiquette to take down a POV tag and not communicate within the talk pages or specifically with the contributor of the tag. It shows uncivilness that is not the wiki way.--scuro (talk) 23:14, 23 September 2008 (UTC)

Note that one or two editors can not force a page to have a POV tag on the grounds that it's impolite for others to remove it, if there are just a couple of editors on each side disputing the point the tag should be left until the dispute is resolved, but overwhelming consensus can force the removal of a tag. 92.2.223.10 (talk) 17:52, 24 September 2008 (UTC)

Wikipedia is not a democracyWP:NOTDEMOCRACY. One can not shove something down everyone's throat with a "vote" or a counting of heads. No attempt at consensus on this issue was made at all.--scuro (talk) 11:50, 25 September 2008 (UTC)

No, this isn't an example of what I was mentioning, I was simply pointing out that "t's a serious breech of etiquette to take down a POV tag and not communicate within the talk pages or specifically with the contributor of the tag." Doesn't always apply. 92.0.130.10 (talk) 12:13, 27 September 2008 (UTC)

That is new to me. So there are instances where you could take someone's POV off repeatedly and that would be okay? Care to elaborate?--scuro (talk) 14:17, 27 September 2008 (UTC)

Think of a potentially controversial article like...abortion. Say a very religious anti-abortion dude comes along and put a POV tag on it. As much as he genuinely feels the article is unbalanced, the tag would/should be removed if there was clear consensus that it was misplaced, I believe that such tags on extremely high hit count articles are relatively frequently removed as vandalism/disruptive. 92.0.130.10 (talk) 14:38, 27 September 2008 (UTC)

One can strip the tag but you need to also post in talk explaining why it was done. That is something that hasn't been done here. Secondly, after the tag is put up again, you could strip the tag a second time and mention your reasoning in more detail. Also link to the disruptive editing policy. Again this wasn't done in this case. If the person was totally unreasonable and wouldn't bend in any way you shouldn't get into an edit war, which was done here. You should seek help and the editor can be banned off the page. I've seen it done.--scuro (talk) 15:30, 27 September 2008 (UTC)

POV

Scuro is wondering if this line: "ADHD is one of the most controversial pediatric disorders.[11][12]" is POV or not.

I strongly thing it is well referenced to peer reviewed literature. That a discussion of the controversy does not have to published by psychiatrists. And that being published in a psychiatric journal and therefore having been peer reviewed by psychiatrist and people in the field is good enough qualify.

Here are more articles we could reference: http://findarticles.com/p/search?tpp=adhd&qt=ADHD+Controversy

--Doc James (talk) 16:31, 25 September 2008 (UTC)

I suggest replacing pediatric with psychiatric, for obvious reasons. 92.3.169.248 (talk) 18:43, 25 September 2008 (UTC)

I agree.--Doc James (talk) 23:30, 25 September 2008 (UTC)

My point is that the sentence is in the lead, and I don't believe that quote is majority opinion. It is a minority opinion, and as such I question why it is in the lead? Try doing a search of gardening and controversy or doves and controversy. Seems like you can link controversy to nearly anything. Yes, the words controversy and ADHD often appear together. Sometimes with good merit sometimes not. That isn't the issue. It's the statement, and I don't believe the pillars of society (law, medicine, science, education) would agree with that statement. Since it is criticism it should also be attributed. Who says this? My final point is that when I put a POV tag on that sentence no one in this community should take it down. If you strongly disagree with the tag you would communicate and explain why. If you thought I was totally out to lunch on this issue then you would get outside help. But when you strip tags unilaterally and then edit war to make sure it stays that way...well that is about the worst kind of POV pushing there is. --scuro (talk)

The lead should really summarize the article rather than introduce new information, thus the quote and this sort of detail should probably go elsewhere in the article. Providing the information about the authors seems appropriate though, and I suggest that it not be reverted without discussion --Vannin (talk) 04:07, 27 September 2008 (UTC)

ever feel like we are spinning our wheels here?

I can tell you that I am unhappy with the direction of the article even though some would argue it is a better article. I'm sure others are not happy with the new direction, or lack there of. Unhappy editors leads to poor productivity, edit waring, frustration, and spite. That's why the idea of seeking consensus is so important. Civility, good faith...are other wiki ideas that we should all try to follow. There needs to be order and process and there is none right now. If anyone else would like to work together on this article, let us know.--scuro (talk) 02:47, 26 September 2008 (UTC)

I think the article is much improved with more direct references to the peer reviewed literature and more balance. We are addressing many of the concerns made at the GA review (see above)--Doc James (talk) 03:36, 26 September 2008 (UTC)

While I applaud the use of better references, many edits have removed good (not best) citations and also material that had made the article a better article. Poor material has been added. It's the wild west in here where might is right, and some make sure that their edits are the only edits that stay on the page. The wiki way means nothing. I'd like to see the return of consensus building, civility, and good faith. Ignoring the wiki way builds resentment on the part of all editors who have been shunted to the side.--scuro (talk) 11:31, 26 September 2008 (UTC)

Dear Scuro you are not willing to work together well at the same time claiming other are no willing to do so. You are pushing your own agenda. You are trying to keep the article one sided.--Doc James (talk) 17:24, 26 September 2008 (UTC)

Before we saw POV tags stripped without discussion, now you are seeing the striping of proper attribution. Once again this is done without discussion in talk and kept that way through edit warring. Criticism must be attributed. Yet you believe that my attempted attribute of criticism, is really an attempt to keep the article one sided. This is an assumption of bad faith, and simply just an assumption. Could it be that I am following wiki policy to the letter and you are not at all justified to do what you are doing? Think about it.

I have followed the process. http://en.wikipedia.org/wiki/Wikipedia:Disruptive_editing#Dealing_with_disruptive_editors This is where the next step takes me. WP:ANI Hope to hear from you soon before I go down that road.--scuro (talk) 19:57, 26 September 2008 (UTC)

I don't think DJ is being overly friendly, but I can't see his edits as disruptive, or anything warranting ANI. Try discussing individual edits/content rather than threatening people. 92.0.130.10 (talk) 12:09, 27 September 2008 (UTC)

He seems like a nice enough guy, just a little controlling. I haven't had any of my additions stick since he arrived on the scene. That is until I've added the attribution recently and also threatened ANI. Talking certainly didn't work. But hey, I'm always willing to start over. I think a good start would be to work as a group. 92, are you willing to work together? The invitation is open to all who work on the page. Perhaps if you, Vannin, and I started...he would join in. I see no reason why we can't work together and be more productive. Consensus building is a cornerstone of wiklipedia.--scuro (talk) 14:30, 27 September 2008 (UTC)

I think the article is making good progress as it is, there will always be disagreements, but I think the article is better now than it was before DJ arrived, although I can't say for sure as I never read this article before, and I'm only judging by the edits that I see happening. One exception is the brain scan image, which is a mess now...perhaps it would be better to simply scrap it, from what I've read it seems like the study is a bit controversial...if you do want to use a brain scan study, the 1993 one without that image would probably be better than the 1990 one which seems to be disputed. 92.0.130.10 (talk) 14:50, 27 September 2008 (UTC)

You can't have your cake and eat it too. You can't want to work outside of any consensus building and then seek consensus when a particular issue annoys you. Other editors will see this as self serving and may not want to put in the effort to help you get the changes you want. We can slice and dice that Pet Scan image until the cows come home ( a big waste of time ) or we could simply talk and come to agreement. When everyone is on the "same page", we won't see the disruptive editing that we see now.--scuro (talk) 15:35, 27 September 2008 (UTC)

What on earth are you talking about?

The ADHD image is a mess, currently the description makes absolutely no sense, and even when it was making sense it was a point of contention. The reliability/accuracy/sampling methods of the 1990 study have been called into question, I suggest using the 1993 study instead, and scrapping the image. What is your view on the three points/suggestions?

getting rid of that image entirely

If the image is kept, the caption needs fixing/rewriting...it seems to have got messed up...read it you'll see what I mean.

Where the disputed 1990 study is used in the article, we replace it with the 1993 study.

92.0.130.10 (talk) 18:23, 27 September 2008 (UTC)

My answer is above in the Zametkin thread.--scuro (talk) 01:07, 28 September 2008 (UTC)

Scuro

Warning to all editors Scuro is very disruptive. He made editing here very difficult as he has his own ideas about what constitutes evidence and does not come around to reason. Doc James (talk) 00:00, 27 September 2008 (UTC)

Hmmmm...since Doc James arrived on the scene he has made several hundred edits. I have made two, possibly three that have stuck. We shall see if my recent attribution gets pulled down by Doc James again tonight.
Hmmmm... the village pump agrees with my viewpoint on what evidence can be, and DJ calls that, "has his own ideas about what constitutes evidence".
Finally Doc James states that, "I do not come around to reason", but we hear of this only when I finally threaten to post him on the Administrators' noticeboard.

The invitation has been offered many times to Doc James work together in the wiki way. If you can assume good faith and follow proper wiki procedures, I can be a very reasonable editor. Time is running out, tic toc doc.--scuro (talk) 00:56, 27 September 2008 (UTC)

please refractor your comments DJ. This is quite rude and unnecessary. --Vannin (talk) 02:22, 27 September 2008 (UTC)

"most controversial"

That quote isn't majority opinion and doesn't belong in the lead. --scuro (talk)

the full quote being "ADHD is one of the most controversial psychiatric disorders". That sounds accurate to me, are there many psychiatric disorders that are even more controversial than ADHD? 92.0.130.10 (talk) 18:16, 27 September 2008 (UTC)

Like Doc James, you believe that "truth" is more important then verifiability. Like you I have my own set of beliefs but they don't matter squat in wikipedia. It's what I can support, and although the quote is supported, it is supported by only three academics not even in the fields of science or medicine. I can think of several disorders that are more controversial, like Childhood Bipolar disorder. But that is not the litmus test. If you want to make blanket majority opinion statements, then you have to find it in a citation. --scuro (talk) 20:18, 27 September 2008 (UTC)

Regarding the last section of the lead, I have edited using the source which was provided. My goal was to 1. clean up incorrect naming of the affiliated institutions for the 3 authors 2. correct spelling (California), and 3, Of greater concern to me, include the rest of quoted statement, which changes the implied meaning. Vaoverland (talk) 05:34, 28 September 2008 (UTC)

ADD/ADHD clarification

I think the new clarification of these terms is very good and will be helpful to a lot of readers. --Vannin (talk) 15:29, 28 September 2008 (UTC)

^ eg. Nylund, D. (2000). Treating Huckleberry Finn. San Francisco: Jossey-Bass.; also book reviewed in the Journal of Constructivist Psychology,2003, vol. 16)

[1] . Nylund, D. (2000). Treating Huckleberry Finn. San Francisco: Jossey-Bass.; also book reviewed in the Journal of Constructivist Psychology,2003, vol. 16)

[1]