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Biomarkers

@Doc James:

The term “biomarker”, a portmanteau of “biological marker”, refers to a broad subcategory of medical signs – that is, objective indications of medical state observed from outside the patient – which can be measured accurately and reproducibly. Medical signs stand in contrast to medical symptoms, which are limited to those indications of health or illness perceived by patients themselves.
— What are Biomarkers? http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3078627/

This section should really be placed under signs/symptoms since that's the section/topic to which those ADHD biomarkers are most relevant. Seppi333 (Insert 2¢) 21:14, 12 August 2016 (UTC)

From my understanding we have been using the lay meaning of the two terms

"Signs" refer to things you see

"Symptoms" refer to things people feel

Platelet monoamine oxidase is neither one of those. Additionally biomarkers are simply in the early stage of research so regardless IMO they belong better there. Doc James (talk · contribs · email) 21:15, 12 August 2016 (UTC)

Platelet MAO expression isn't really any different than measuring something like serum CK. They're both enzymes found in the blood. I suppose you can't "see" them unless you have a high-powered microscope, but these are literally just tests/measurements that can be obtained from standard clinical chemistry methodology. Every entry under clinical chemistry#Tests is a biomarker for some condition and they can be determined via a simple blood or urine test just like the four biomarkers that I wrote about here. This is why chemical biomarkers are classified as medical signs. Biomarkers are often included in the signs/symptoms section in other articles as well, e.g., plasma potassium concentrations are covered under Hypokalemia#Signs and symptoms; this measurement is not explicitly called a "biomarker" there, but that's exactly what it is.

As for covering this content in a research section, all four of those measurements are ADHD biomarkers and are associated to varying extents with symptom severity / disease presence. The meta-analysis from the systematic review established this while rejecting other metrics like plasma zinc/ iron. What is not known is how useful those four measurements are as diagnostic biomarkers; however, a "diagnostic biomarker" is just 1 form/use of a biomarker. E.g., the systematic review mentioned that urinary phenethylamine appears to function as a biomarker for treatment efficacy/response based upon studies involving methylphenidate and amphetamine in ADHD individuals. With that in mind, I really think this section should be moved back under signs/symptoms. I'd also be ok with cutting the "Biomarkers" section header and just lumping the content in under the Signs and symptoms level 2 heading. Seppi333 (Insert 2¢) 21:46, 12 August 2016 (UTC)

• I've uploaded the systematic review on biomarkers here if you care to read it. Seppi333 (Insert 2¢) 21:50, 12 August 2016 (UTC)

@Doc James: Since the sentence about diagnostic biomarkers is the only preclinical statement in that section, an alternative would be to just cut the sentence and then move the rest back under the signs/symptoms heading. Seppi333 (Insert 2¢) 22:03, 12 August 2016 (UTC)

"serum CK" is also neither a sign nor a symptom in how the general population uses the words. It often fits under diagnosis. In other conditions it would fit under research if it is in its very early stages. Have asked for further input at WPMED. Doc James (talk · contribs · email) 22:05, 12 August 2016 (UTC)

agree w/ DocJames (diagnostic[1])--Ozzie10aaaa (talk) 23:10, 12 August 2016 (UTC)

@Ozzie10aaaa: I don't really know what you meant by your reply; however, I decided to remove the statement about diagnostic biomarkers from the paragraph based upon Doc James' reservations about the lack of research on their diagnostic utility. It currently only covers disease biomarkers in urine and blood plasma. There is no mention of diagnosis at present. Seppi333 (Insert 2¢) 00:33, 13 August 2016 (UTC)

Assuming that what you say is true and we decide not to put biomarker information in the signs/symptoms section, the biomarkers section still needs to be moved somewhere else since all of the content (except for the diagnostic biomarker statement) is not preclinical and therefore does not belong in a section titled "research". Would you prefer it if we delete that sentence and move the material to a level 2 heading instead? I really don't care where we put it - I just think it needs to be moved somewhere more appropriate. Seppi333 (Insert 2¢) 22:47, 12 August 2016 (UTC)

You state that it is "not preclinical". So are you stating that these markers are being used in clinical practice? User:Casliber your experience? I have not see it in my area of the world. Doc James (talk · contribs · email) 23:37, 12 August 2016 (UTC)

Yes, they're "being used" in the sense that they're biomarkers for the presence and severity of ADHD. Arguing to keep this in a "Research" section is almost the same thing as arguing to put all pathophysiology content in that section; the only difference is pathophysiology involves biomarker abnormalities / mechanisms that cause the disease as opposed to biomarker abnormalities that may be a consequence of/correlated with having the disease. The vast majority of people with ADHD have "abnormalities" in these biological metrics; if they didn't, these findings wouldn't achieve statistical significance. As to whether or not an arbitrary disease biomarker actually plays a role in generating symptoms depends upon how it relates to the pathophysiology of ADHD. Peripheral NE doesn't cross the BBB/BCSFB and MHPG isn't even biologically active, but platelet MAO interacts with psychoactive endogenous compounds. Plasma phenethylamine is psychoactive and readily crosses membranes/brain barriers and the review noted that its concentration in biofluids correlates with inattentiveness symptom severity in ADHD individuals; frankly, I would've expected this to be the case considering that phenethylamine is a potent neuromodulator of dopamine neurons in the CNS and its biosynthesis increases in response to "exciting" stressors like physical exercise and skydiving. So, in a nutshell, these biomarkers reflect "clinical" research because they're based upon in vivo human studies involving ADHD individuals, the research has been reproduced several times (it comes from a meta-analysis after all), and it reflects an active disease/ADHD state just like any other medical sign. Seppi333 (Insert 2¢) 00:22, 13 August 2016 (UTC)

I would put material on biomarkers in a research section. These aren't used in clinical practice except maybe by hardcore biological psychiatrists or researchers in tertiary institutions. The article itself says, "Although the results of our statistically significant meta-analyses are promising, when considering the potential utility of biomarkers, one must address not only the statistical significance of effects, but also whether the magnitude of the effect will translate into a clinically useful measure." To be honest, research will get all excited by this stuff and ignore studies on childhood adversity/trauma which show huge increases in incidence of all mental illnesses. Cas Liber (talk · contribs) 01:06, 13 August 2016 (UTC)

Just because something isn't measured in clinical practice doesn't make it not "clinical". It's clinical data if it has relevance to the disease state in humans; in relation to every statement in the biomarker paragraph, this has been demonstrated. As I've already stated, pathophysiology covers almost exactly the same medical information as is covered in the biomarkers section. The difference is that there has not been any research into whether these are causal mechanisms of ADHD or just effects of the biological abnormalities that give rise to ADHD; however, the answer to this question is not relevant to this discussion because it has no relevance to the article text/statements in the cited sources. Placing the information on biomarkers in a research section is misleading - and I'm adamantly opposed to this on the grounds that it's WP:NPOV - because it implies that the evidence level supporting these findings is merely tentative in humans; it is in fact very well established in humans because this is a conclusion of a meta-analytic systematic review on ADHD biomarkers from studies involving living humans, not individual human RCTs or animal studies.
In any event, I've moved the content on biomarkers into the pathophysiology section (the placement of this content there is slightly misleading, since it implies that these are causal mechanisms) since everyone appears to want to redefine a biomarker as something other than a medical sign. Seppi333 (Insert 2¢) 01:30, 13 August 2016 (UTC)

Biomarkers are not pathophysiology. They are either diagnosis (when they come into clinical use) or research when they are still being studied and not yet used clinically.

Just because two thinks are link (biomarkers and ADHD) does not mean they are linked closely enough to be useful clinically. I doubt we are able to replace pediatric psychiatrists with a blood test yet.

The definition for biomarkers you provide is a "research definition" per "This article provides working definitions and a conceptual framework to understand the roles of biomarkers in clinical research." It supports putting the content under research.

Clinical means in clinical use. So if it is not in clinical use that means it is preclinical. Doc James (talk · contribs · email) 03:19, 13 August 2016 (UTC)

@Doc James: Certain biomarkers "are pathophysiology", as you put it. Accumbal ΔFosB is a therapeutic biomarker, a preclinical diagnostic biomarker, and the core pathophysiological mechanism that induces all forms of addiction. Also, diseases which are literally defined by a biomarker, like secondary TMAU or hyperkalemia, involve that biomarker as both the core pathophysiological mechanism that mediate the disease symptoms and the use of that biomarker in diagnosis. Lastly, the paper I cited at the very top of this section asserts that biomarkers are established based upon evidence of their relationship to pathophysiological mechanisms, therapeutic response, or epidemiology.

These are not diagnostic biomarkers; the text in the article does not state that they are diagnostic biomarkers. Some of them are therapeutic biomarkers. All of them are disease biomarkers. All of these biomarkers were based upon evidence from clinical research (i.e., not in vitro, ex vivo, animal models, etc) in humans with ADHD based upon clinical chemistry. The fact that testing for these biomarkers isn't commonly performed in clinical practice doesn't make this "preclinical".

It supports putting the content under research. - ROFL. That's a funny joke; it's almost like you were intentionally pulling that statement out of your ass to support your argument and ignoring the text which is underlined, bolded, and in enlarged font in the quote box. Seppi333 (Insert 2¢) 02:35, 14 August 2016 (UTC)

You simply to not have consensus. Doc James (talk · contribs · email) 02:51, 14 August 2016 (UTC)

Consensus to do what exactly? Seppi333 (Insert 2¢) 03:04, 14 August 2016 (UTC)

@Seppi333: researchers are frequently publishing material in an authoritative manner (and yes this includes secondary sources) where bold statements are made about firm associations found between marker X and condition Y. The fact is, many of these have not translated into any reliable test or investigation and don't by themselves mean anything. Hence to place this in any category other than research (falsely) indicates to the lay reader that it is somehow clinical canon...when it isn't. Cas Liber (talk · contribs) 03:39, 13 August 2016 (UTC)

@Cas Liber: I don't follow your argument. How is a section titled "Research" the only possible heading under which content on biomarkers could be placed so as to avoid this or any other NPOV issue? Have you considered simply adding a statement to the paragraph along the lines of "These biomarkers are not commonly measured in clinical practice."? That would directly address your concern. Seppi333 (Insert 2¢) 02:35, 14 August 2016 (UTC)

Just to be clear: I'm ok with not placing biomarker content in "Signs and symptoms" (I do however think that it belongs there). I'm ok with not placing biomarker content in "Pathophysiology". I'm not ok with placing biomarker content in a section titled "Research". It really should not be that hard to figure out an alternative solution given these constraints. Seppi333 (Insert 2¢) 03:04, 14 August 2016 (UTC)

At this point in time I do not see it as fitting in any spot other than research. How is it not research? Doc James (talk · contribs · email) 03:06, 14 August 2016 (UTC)

It is research, as is what is covered in the vast majority of the article. My concern is that what ends up going in sections that are titled "Research" in medical articles is nearly always preclinical research involving animals, in vitro, ex vivo, etc, since there's basically a section for any relevant material elsewhere in the article (assuming it follows MOS:MED). Moreover, if any preclinical research ends up being added to the article, it is going to end up in that section right next to a section involving clinical research on biomarkers. That juxtaposition creates a problem. I would actually be fine with calling the level 2 section "Biomarker research" instead of just "Research" since this would address both concerns. Seppi333 (Insert 2¢) 03:17, 14 August 2016 (UTC)

I support inclusion of "Biomarker research" as a sub-heading at the end of the Diagnosis section, I think this will address everybody's concerns. M. A. Bruhn (talk) 03:26, 14 August 2016 (UTC)

unique, yes could live w/ such a sub-heading--Ozzie10aaaa (talk) 13:19, 14 August 2016 (UTC)

That's fine with me. Seppi333 (Insert 2¢) 15:03, 14 August 2016 (UTC)

Sure that would be an appropriate compromise. Doc James (talk · contribs · email) 18:22, 14 August 2016 (UTC)

Thoughts on the matter:

1. We all agree that the strict definition of "sign" includes biomarkers.
2. Many of the currently listed symptoms are actually signs: "Fidget and squirm in their seats", "Talk nonstop", "Often interrupt conversations or others' activities", etc, however the DSM being used to source these refers to them as symptoms.
3. Incorporation into an appropriate existing section is preferable to creating a new stub section
4. The Diagnosis section should restrict mention of things that can be used for diagnosis to those that are actually used for diagnosis. You can diagnose the presence of a ferromagnetic foreign body with an MRI, but this isn't actually done.
5. Similarly signs should only include common and significant signs. Certain system-wide poisonings likely have very wide ranging effects on the metabolism which could have hundreds of signs if you probe around enough.
6. Signs and Symptoms shouldn't be limited to that which can be seen, although I'm not sure what it should be limited to. Other senses, such as smell, can be useful. Additionally divergence from the norm in things that are not directly perceived but are routinely measured such as blood pressure should be included.
7. An EEG-based biomarker, the theta/beta ratio, was cleared by the FDA in 2013 for use in ADHD diagnosis. Original research paper. This is at present mentioned in the Diagnosis section of this article.
8. This 2012 (outdated) consensus report of the WFSBP task force on biological markers and the World Federation of ADHD concludes "To date, available data has not yet revealed one reliable biomarker to diagnose ADHD" but notes promising candidates exist and also believes that likely combinations of biomarkers will need to be used in the future.
9. In my opinion whether there is a reliable and significant difference in the levels of these biomarkers in ADHD individuals is not sufficient for inclusion in either the signs/symptoms section or pathophysiology section. I would support inclusion in signs/symptoms following demonstration of clinical utility, i.e. a study showing clinicians using the results of the biomarkers in addition to their normal examination and demonstrating an improvement in their correct diagnosis rate as was done with the EEG-biomarker. I would support inclusion into the pathophysiology section if these biomarkers usefully elucidate the underlying mechanistic nature of the pathophysiology.
10. I don't think being in the research section is a bad thing. There is a very real need to introduce more objective metrics into ADHD diagnosis and thus far biomarker research looks promising. This doesn't mean that current evidence is poor, just that it's usefulness and significance hasn't been realized. M. A. Bruhn (talk) 06:25, 13 August 2016 (UTC)

Hmm. I thought the usual definition of these terms was:

• "Signs" are what the healthcare provider sees.
• "Symptoms" are what the patient reports.

—and, perhaps more relevantly, that "lab results" were technically neither of these things. WhatamIdoing (talk) 14:10, 13 August 2016 (UTC)

The precise, technical definition includes any objective indication of disease, as is the case here, and elsewhere. The colloquial usage of the term usually refers to things that are readily apparent/observed by the clinician. M. A. Bruhn (talk) 03:20, 14 August 2016 (UTC)

As a doctor, I'd use the term sign as something I've come across in observing or examining a patient....though upon thinking about it, I'd also probably say, "raised creatinine is a sign of chronic renal failure". In a medical article, findings from normally-performed investigations should go under a investigations section Cas Liber (talk · contribs) 06:02, 14 August 2016 (UTC)

• User:Seppi333 in my view "Signs" as well as "Symptoms" are about what is done clinically. Do you know of any sources that say that any of the biomarkers you moved into the Signs section are actually used clinically? If not this should go back into research, in my view... And in my view Biomarkers would be part of a DIagnostic work up (that is where testing goes, and measuring biomarkers takes a diagnostic test) Jytdog (talk) 19:44, 14 August 2016 (UTC)

@Jytdog: I'm not sure exactly what you mean by "used clinically" in this context - this has been a source of confusion in the discussion above (i.e., in clinical practice or in clinical research?); once a biomarker is established as a disease biomarker or therapeutic biomarker in clinical research, it may be used in further clinical research to determine whether or not it can be used in diagnosis; to my knowledge, a disease biomarker isn't normally used in clinical practice unless it has been established as a diagnostic biomarker and therapeutic biomarkers are rarely used in clinical practice, but exceptions do exist (e.g., it is sometimes necessary to closely monitor plasma levels of a drug or an endogenous substance, like an electrolyte, in response to a drug treatment). It would probably just be simplest to point you to the biomarker review for an answer since this is where the information on the biomarkers mentioned in the article came from. Therapeutic biomarkers aren't really relevant to diagnosis, but everyone here seems more interested in diagnostic biomarkers. In any event, the content currently is located under a research heading and I have no qualms with its placement there. Also, welcome back. Seppi333 (Insert 2¢) 20:55, 14 August 2016 (UTC)

Thanks for the welcome! :) By "used clinically" I mean something that is part of the actual practice of medicine that occurs between doctors and patients when somebody shows up with a problem and doctors try to figure out what it is going on and how to help address it. Whether NHS or insurance companies pay for it, is a good "marker" for what is actually medicine vs what is research. For example, C reactive protein is a widely used biomarker for inflammation etc -- that is medicine and is "clinical" as I used it above. Clinical research is not medicine and so isn't "clinical" as I used it above. To reframe my question - are there any treatment/diagnostic guidelines by the APA or the like that call for looking for any of these biomarkers for ADHD in order to diagnose someone? That is the kind of the source that would be useful. Jytdog (talk) 21:06, 14 August 2016 (UTC)

Hmm... I have no clue. Psychiatric diagnostic manuals make me sad as a result of issues that I've encountered while working on various addiction articles, so I seldom work on / read about content related to that. However, the reason why biomarkers are notable in the context of psychiatry is summarized in the content below which I've pulled from addiction.

Extended content

Medical researchers who actively study addiction have criticized the DSM classification of addiction for being flawed and involving arbitrary diagnostic criteria. Writing in 2013, the director of the United States National Institute of Mental Health discussed the invalidity of the DSM-5's classification of mental disorders: While DSM has been described as a “Bible” for the field, it is, at best, a dictionary, creating a set of labels and defining each. The strength of each of the editions of DSM has been “reliability” – each edition has ensured that clinicians use the same terms in the same ways. The weakness is its lack of validity. Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure. In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever. References

Seppi333 (Insert 2¢) 21:32, 14 August 2016 (UTC)

Yep I have talked to many practicing psychiatrists who wish fervently that there were more biomarkers in their field. The actual practice of medicine is constrained by many things (what doctors have time to learn, how well validated a drug or diagnostic is (this is a huge problem in psychiatry where the poorly defined diagnoses make it really hard to find biomarkers that can distinguish them; study after study finds no significance), whether anybody can make money selling it, etc) I feel it is important that we maintain clarity between what is used in the clinic vs what is emerging research. 21:41, 14 August 2016 (UTC)

To clarify this in the article, it would probably best to decensor the statement about diagnostic biomarkers in the article source. I suppose I'll go ahead and do that. The primary distinction between a disease biomarker and diagnostic biomarker is basically that the former reflects the presence of a disease/medical condition (i.e., it's just a medical sign) while the latter predicts the presence of a disease/medical condition. Using your example from before, an elevated plasma C-reactive protein value reflects (and probably predicts) the presence of inflammation, but by itself it doesn't predict/serve as a diagnosis for a specific medical condition that involves inflammation. Seppi333 (Insert 2¢) 00:11, 15 August 2016 (UTC)

we are still not connecting. see here and here and elsewhere. C Reactive protein is a clinical biomarker, used in medicine. I looked here and here and here the only diagnostic test is an EEG..... Measuring the biomarkers identified in the biomarkers section is not clinical - it is not medicine as of now. Jytdog (talk) 00:33, 15 August 2016 (UTC)

You misunderstood me. I'm not talking about whether or not a biomarker is currently used clinically - I assume this is what you mean by "clinical biomarker" - I'm talking about the distinction between a disease biomarker and a diagnostic biomarker. Whether or not something is a disease biomarker doesn't depend upon whether clinicians currently test for it; it depends upon whether there's a statistically significant relationship between it and a disease. C-reactive protein would still be a disease biomarker even if every clinician suddenly stopped testing for it. Similarly, a markedly elevated plasma potassium concentration would still be a diagnostic biomarker for hyperkalemia even if every clinician stopped ordering plasma potassium tests. Seppi333 (Insert 2¢) 00:46, 15 August 2016 (UTC)

. Hm. So a disease biomarker is not relevant to medicine, but rather to scientific research. It wouldn't go in the Signs or the Diagnostics section... 02:13, 15 August 2016 (UTC)

Various issues....

• Thomas Szasz, a supporter of this theory, has argued that ADHD was "invented and not discovered."

This shouldn't be under the cause section, but instead under the "Society and culture" section if at all. Upon first glance of their Wikipedia article it appears they believe all mental disorders are invented rather than discovered, so perhaps it is completely undue weight to mention his opinion in this article at all.

• ADHD has also been associated with motivational deficits in children.[116] Children with ADHD find it difficult to focus on long-term over short-term rewards, and exhibit impulsive behavior for short-term rewards.[116] In these individuals, a large amount of positive reinforcement effectively improves task performance.[116] ADHD stimulants may improve persistence in ADHD children as well.[116]

This section has too much info that should be presented in the "Management" section if at all.

• In the ICD-10, the symptoms of "hyperkinetic disorder" are analogous to ADHD in the DSM-5

Considering this is a GA, and that earlier in the section it is stated that "With the DSM-IV criteria a diagnosis of ADHD is 3–4 times more likely than with the ICD-10 criteria", there should be more description of the ICD-10 than it's symptoms being analogous to those of a similar disorder in the DSM, which is true in general.

• The entire diet section

Should probably be moved to the research section for reasons analogous to those given in the above talk page section, i.e. it doesn't appear anything in that section is actually routinely employed in managing ADHD, although it is actively researched.

Thoughts? M. A. Bruhn (talk) 07:17, 13 August 2016 (UTC)

• "Upon first glance of their Wikipedia article it appears they believe all mental disorders are invented rather than discovered."
  • Ding ding ding! I agree that it's undue weight. I'm sure it's already covered at ADHD controversies, but if it's not, I guess it could go there.
  • I didn't really follow your second point. what are you suggesting?
  • I'll come back to point #3 later.
  • Agreed that the diet section should be deleted or moved to the research section.

  —PermStrump(talk) 08:18, 13 August 2016 (UTC)

• With regards to the second point. They are discussing treatment effectiveness in the pathophysiology section; I feel such discussion shouldn't be presented in isolation from a broader discussion of management. M. A. Bruhn (talk) 15:23, 13 August 2016 (UTC)

Many people try to use diet to manage ADHD so IMO it still belongs in the treatment section even though it is rarely effective.

Why should the ICD classification system go in the management section? ICD is definitely notable under diagnosis. Doc James (talk · contribs · email) 16:43, 13 August 2016 (UTC)

Just about every long-term health condition has people attempting to manage them with high/low fat/carb/protein diets and multi-vitamins and supplements (particularly fish oil), usually because there is a low risk of harm and current management practices are not adequate. Lifestyle modifications, including those with diet, are already widely established and recommended for the management of a huge number of health conditions, in my opinion including lifestyle modifications in articles where they aren't established and recommended practices is giving them undue weight.

The ICD is referring to something else. The statements that I feel should be presented in the management section are: "In these individuals, a large amount of positive reinforcement effectively improves task performance. ADHD stimulants may improve persistence in ADHD children as well.". M. A. Bruhn (talk) 01:11, 14 August 2016 (UTC)

Happy to see this text moved "In these individuals, a large amount of positive reinforcement effectively improves task performance. ADHD stimulants may improve persistence in ADHD children as well."

The dietary stuff got a lot of press so address it IMO is important even though we say it usually makes no difference and the evidence is poor. Having it there balances all the external websites that are overly promoting it. It is a pertinent negative. Doc James (talk · contribs · email) 02:43, 14 August 2016 (UTC)

Fair enough, I can agree with that. M. A. Bruhn (talk) 03:02, 14 August 2016 (UTC)

There is the critic of this desease ? Russian wiki have a big article about this and here there is no choice. I.K.L — Preceding unsigned comment added by 5.141.87.30 (talk) 17:01, 14 September 2016 (UTC)

ADD

In daily usage, ADD refers to "attention deficit disorder" as a separate (though related) syndrome. I've added the three subtypes to the lead, as an iad for those people who are looking for info specifically on ADD; they most likely won't be searching for "Attention deficit hyperactivity disorder predominantly inattentive," nor have the patience to find out that that's the link they're looking for... And after all, that's the group that's most likely to be looking for info, so a consumer-friendly approach may be quite welcome here. Joshua Jonathan -Let's talk! 06:28, 1 August 2016 (UTC)

Yes ADD refers to "attention deficit disorder" and it is the previous name for ADHD. The name changed when the DSM4 was introduced.

The DSM5 does not say "Attention deficit hyperactivity disorder predominantly inattentive's popular name is ADD". Most people actually use the two terms interchangeably.

The consumer friendly thing to do is to inform people who learned about this condition when it was known as ADD that its new name is ADHD. Doc James (talk · contribs · email) 07:50, 1 August 2016 (UTC)

@Doc James: the name-change from ADD to ADHD was in 1987, so I doubt it that there are many, or even a few, people who come looking for ADHD while using the term ADD. But you can be quite sure that there are people who come looking for ADD as in ADHD-pi, and end up at this page, without finding what they are looking for. So, how are you going to help those people to find what they're looking for? Joshua Jonathan -Let's talk! 10:39, 1 August 2016 (UTC)

A lot of use were born before 1987... This page covers ADHD-pi fairly well and than links out to that subtype for more details. Doc James (talk · contribs · email) 10:43, 1 August 2016 (UTC)

I think there should be a separate ADD page. In practise ADD and ADHD are two different things, with very different implications. I don't agree that most people use the term interchangeably, far from it in fact. - Anonymous coward — Preceding unsigned comment added by 31.149.77.58 (talk) 13:40, 26 September 2016 (UTC)

No they are not two separate things. ADD is simply the old name for ADHD. Doc James (talk · contribs · email) 19:48, 26 September 2016 (UTC)

2016 systematic reviews

We have two 2016 systematic reviews published on the same journal, Journal of Attention Disorders.

One concludes (Jan 2016):

PMID 26825336 "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. ... It is possible 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."

and the other one concludes (Sep 2016):

PMID 27664125 "We found a consistent association between aADHD and increased risk of obesity, sleep disorders, and asthma. Associations were also consistent for migraine and celiac disease."

I would like to know your opinions about how we should reword or expand this text already present, reflecting the conclusions of both reviews:

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.(127) 127. PMID 26825336

Best regards. --BallenaBlanca (talk) 14:20, 27 October 2016 (UTC)

"Tentative evidence" (see 27664125's abstract in PubMed) is not sufficient, and given that we have a recent quality review of the literature focusing on celiac disease alone that concludes that "there is no conclusive evidence for a relationship between ADHD and CD", we cannot claim that celiac disease is associated with ADHD. In particular, I want to draw attention to the distinction between a literature review performed on a specific disorder vs a broad literature review encompassing multiple disorders. It stands to reason that the first would be considered much stronger evidence than the second. Garzfoth (talk) 07:13, 30 October 2016 (UTC)

Update: After further review, I noticed that PMID 27664125 reviewed only 3 trials on CD and ADHD, all three of which reported correlations. There were also potentially substantial flaws with at least the first study due to the mixed patient disorders. Anyways, here's the really big issue - PMID 26825336 says there are eight studies (although their criteria is certainly a bit different), and "Only three out of eight studies report a positive correlation between ADHD and CD". This implies that PMID 27664125 has an inherent bias due to an incomplete (and rather notably uncritical) assessment of the literature. I find this highly concerning and believe that this is a violation of WP:MEDRS, specifically this part: "Controversies or uncertainties in medicine should be supported by reliable secondary sources describing the varying viewpoints". Of course, one can argue that the literature reviewed by PMID 26825336 is potentially problematic to the point of violating WP:MEDRS, but no clear evidence to support this argument exists, and a more comprehensive view that critically considers a broader range of evidence with a specific focus on one disorder is clearly considered to be superior. Thus, I maintain my stance that it is inappropriate to claim that CD is associated with ADHD based on the provided evidence. Garzfoth (talk) 09:17, 30 October 2016 (UTC)

I reviewed again the two papers. In theory, this review PMID 27664125 includes only adults (Adult ADHD and Comorbid Somatic Disease: A Systematic Literature Review.). However, the inclusion criteria of the studies...:

1. Niederhofer, H. (2011). Association of attention-deficit/ hyperactivity disorder and celiac disease: A brief report. The Primary Care Companion to CNS Disorders, 13. doi: 10.4088/PCC.10br01104 Number of Participants: 67 - Age: 7-42 (M = 11.4 years)
2. Niederhofer, H., & Pittschieler, K. (2006). A preliminary investigation of ADHD symptoms in persons with celiac disease. Journal of Attention Disorders, 10, 200-204. Number of Participants: 132 - Age: 3-57 (M = 19.3 years)
3. Zelnik, N., Pacht, A., Obeid, R., & Lerner, A. (2004). Range of neurologic disorders in patients with celiac disease. Pediatrics, 113, 1672-1676. Number of Participants: 111 - Age: M = 20.1 ± 8.9 years

...are unclear and in my opinion, they are poorly selected as "adults", especially if we consider the median age of the rest of studies selected in the other review PMID 26825336 (page 3 Table 1. Summary of Studies Evaluating the Association of CD and ADHD/ADHD Symptomatology: Lahat, Broide, Leshem, Evans, and Scapa (2000) 6-13 (M = 8.6 years); Pynnönen et al. (2004) 12–17 years; Ruggieri et al. (2008) 9months-17 (M = 7.8 years); Güngör, Celiloğlu, Ozcan, Raif, and Selimoğlu (2013) 5-15 years; Dazy, Rubenstein, Holevinski, and Kao (2013) Not specified adult and children).

So I agree with your conclusions, Garzfoth, we must maintain the conclusions of the PMID 26825336 review.

Best regards. --BallenaBlanca (talk) 12:52, 30 October 2016 (UTC)

• i don't see any contradiction between the two. The second is about correlation and says it the correlation ~may~ exist (it takes pain to show how weak the underlying evidence is); the first says there is no reason the correlation (if it exists) means anything. Jytdog (talk) 18:04, 30 October 2016 (UTC)

You are right, Jytdog, there is really no contradiction between the two papers, it is a matter of approach. The second paper is about correlation, the authors did an exhaustive literature search in the electronic databases Embase, Psychinfo, and Medline retrieving 4,091 papers, and subsequently an exahustive study selection (page 3 - Figure 1.), and found a "grade 2" of "association and quality of evidence" between ADHD and CD ("The reported studies were classified into conditions (1) where the association between ADHD and the somatic disease is well established, (2) where there is tentative evidence for an association, and (3) where evidence is still too weak to make conclusions.")

But about this you say: "the first says there is no reason the correlation (if it exists) means anything", it is not entirely accurate, the problem is that we have not reflected in the text what the authors say: "Discussion: ADHD-Like Behavior and CD 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 (Terrone et al., 2013). Newly diagnosed children with CD often complained of “aches and pains,” “easily tired,” “easily distracted,” and “trouble concentrating.” After 1 year of GFD treatment, scores on these items were reduced and remained low in GFD-compliant children (Terrone et al., 2013). Also in newly diagnosed adults with CD, a significant improvement in cognitive functioning, particularly verbal fluency, attention, and motor function, is noted after a 12-month adherence to GFD (Lichtwark et al., 2014). Thus, it is possible 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." Perhaps we should include a brief summary of this explanation.

Tentative evidence for an association is reflected in multiple articles of Wikipedia, so I will modify the text and also specify it for migraine (wich is currently included)

Best regards. --BallenaBlanca (talk) 04:31, 31 October 2016 (UTC)

Society as a Cause

This section doesn't seem to address society as a cause very well. It just outlines why some people might think they have adhd when they don't or why they might try to get a diagnosis without having symptoms. Maybe it's just poor writing or poor reading on my behalf but in my opinion, it's badly sectioned and should be moved or edited.

What do you think? Luxorbostian 00:24, 01 November 2016 (UTC)

Wikipedia content is driven by reliable sources, and for content about health, WP:MEDRS defines what a reliable source is. So... there would need to be sources that comply with WP:MEDRS that say this. Are you aware of any? Jytdog (talk) 02:14, 1 November 2016 (UTC)

diagnostic methods

The following is all unsourced:

Methodology

Diagnosis is usually done in a two step process. A screening tool is used to screen a larger population. A diagnostic test is applied thereafter.

Rating scales

There are a number of validated questionnaires that may be used for screening. Some of them are:

• Disruptive Behavior Disorders Rating Scale
• Vanderbilt ADHD Diagnostic Rating Scale
• Conners parent and teacher rating scale
• Behavioral assessment scale for children
• Child behavior checklist/Teacher report form
• Strengths and difficulties questionnaire

Common factors across rating scales are:

• Parent and teacher versions
• Based on DSM classification system
• Use a Likert scale of rating
• All have evidence of reliability and validity; psychometric soundness
• Effective at distinguishing between clinical and non-clinical groups
• Sensitive to behavioral and pharmacological treatment effects

Diagnostic interviews

Semi structured

• Diagnostic interview for children and adolescents - Revised
• Diagnostic interview schedule for children

Structured

• Kiddie schedule for affective disorders and schizophrenia
• Child and adolescent psychiatric assessement

-- Jytdog (talk) 20:40, 13 November 2016 (UTC)

The concept is ok, but agree needs sourcing and some rewording probably. Cas Liber (talk · contribs) 20:48, 13 November 2016 (UTC)

Agree that content is good. The screeners that are mentioned have their Wikipedia pages and have sources there. Next best step could be to read the relevant Wikipedia pages and verify sources. If they are good, should be ok to use them as sources for this content. Cool to see more assessment work reflected on this page! Ongmianli (talk) 01:06, 14 November 2016 (UTC)

ADHD in adults

Hello! I recently changed some things but wasn't too familiar with the rule process so I apologize for that. My laptop's dead ATM so I'm on mobile and getting sources are hard atm, but the wikipedia page puts too much emphasis on ADHD in children although it is recently believed to be a chronic condition by experts that usually continues into adulthood.. Adhd affects both children and adults. I personally think saying adhd is considered to be (what it says now) overlooks much of the symptoms in adults, and also in women (women's are seen as being less hyperactive than men), and is not as specific as it could be. Instead of saying "the behavior may be deemed inappropriate for someone their age" is from an expert consensus a very narrow way to look at issues with planning, problem solving, emotional regulation, and inhibition control. Most also agree that it isn't an issue of having less attention, but rather an issue in controlling attention (it's easy to look up "hyperfocus" and read about it, which is why children can focus on tasks they find interesting, but usually this focus is extreme, which leads into self regulation issues buts that a whole other topic too) I would like to hear what you guys think and if you agree or think it should be changed to. Jennyalpin (talk) 21:02, 9 December 2016 (UTC)

We have an entire article on Adult attention deficit hyperactivity disorder Doc James (talk · contribs · email) 22:04, 9 December 2016 (UTC)

It isn't a separate disorder though? — Preceding unsigned comment added by Jennyalpin (talk • contribs) 02:18, 11 December 2016 (UTC)

Not according to ICD, and for DSM it is required to have been present in childhood. I imagine the separate article is due to diagnostic and treatment considerations unique to adults, though the disorder is still linked to early development. Qzd (talk) 19:40, 11 December 2016 (UTC)

Effect of behavioral, pharmacological, and combination treatment on long-term functional outcomes in ADHD individuals

Following a discussion at talk:Adderall, I made these revisions to the amphetamine article to cover the effect of long-term stimulant therapy on long-term ADHD-related functional outcomes. The systematic review that cited these statements also covers the effects of behavioral therapy and combination therapy on functional outcomes (effect sizes are stated in the text of the review; the proportion of improved functional outcomes within each outcome domain for each treatment type is summarized in this figure).

Is this topic (i.e., the effect of behavioral, pharmacological, and combination treatment on long-term functional outcomes in ADHD individuals) something that people think is also worth covering in the Attention deficit hyperactivity disorder#Management section of this article? Seppi333 (Insert 2¢) 02:32, 11 December 2016 (UTC)

I think a summary of "While the majority of long-term outcomes of ADHD improve with all treatment modalities, the combination of pharmacological and non-pharmacological treatment was most consistently associated with improved long-term outcomes and large effect sizes." is appropriate here. With further details on the subapage. Doc James (talk · contribs · email) 19:02, 11 December 2016 (UTC)

That sounds fine to me, although I think the phrase "long-term outcomes" should be clarified in a sentence that follows so that the reader knows what it refers to when that statement is added to this article. Without further clarification, that sentence is excessively vague and will probably be almost meaningless to our readers. Seppi333 (Insert 2¢) 01:47, 12 December 2016 (UTC)

Summary of symptoms

Currently we say:

"It is characterized by problems paying attention, excessive activity, or difficulty controlling behavior which is not appropriate for a person's age.

The NIH lists three key symptoms "inattention" which equals problems paying attention, hyperactivity which means excessive activity, and impulsivity that means "difficulty controlling behavior".

The DSM5 says "to a degree that is inconsistent with developmental level" that supports "which is not appropriate for a person's age"

So well supported.

References

--Doc James (talk · contribs · email) 00:26, 13 December 2016 (UTC)

Symptoms

Are required to be present before a person is somewhere between 6 and 12 years old (depending on the definition used). Doc James (talk · contribs · email) 05:30, 23 May 2017 (UTC)

The reverts to my edits do not say that the child is expected to have symptoms INSIDE of 6-12 margin. That actually makes sense, but someone is saying "by" 6 to 12. This is the same as saying that you will pass an oncoming vehicle BY six to twelve miles. There is no information on how soon a child may develop symptoms, or in the hypothetical case, how many miles one has driven before a certain behicle has passed from the other direction. But we know that in neither case it exceeds 12. the figure of 6 is redundant. --Coldtrack (talk) 18:58, 1 June 2017 (UTC)

Some say the symptoms most occur before 6 years of age. Doc James (talk · contribs · email) 01:25, 2 June 2017 (UTC)

Absolutely, I totally concur with what you are saying. It's just I cannot see a way of introducing "six" into the text. Don't get me wrong, I'm no medical expert but I do have a son who was diagnosed with ADHD and this was when he was four (so it follows what we are discussing) but a Ukrainian doctor has more recently "undiagnosed" him because he found that the attention issue can be resolved through nurture while the hyperactivity is not related to the attention problems (it is confusing but in Britain where I've lived for many years, both ADHD and Autism are known to be over-diagnosed). Anyhow, one way we could rephrase the part is to say that "sympoms generally appear between ages 6 and 12, but not exclusively, and can appear before 6". This would allow cases like mine to fall into an "exception" category. Does that sound good to you Doc James? --Coldtrack (talk) 04:43, 2 June 2017 (UTC)

With respect to the "controversy" section.

@Doc James: Thanks for reaching out. Since I am not native English speaker, my English is not as good as yours, I hope you can understand! Thank you! ^_^

1. "Less severe" can include patients with moderate and mild symptoms. The sentence "Among healthcare providers the debate mainly centers on diagnosis and treatment in the much greater number of people with less severe symptoms." has the potential of giving some people grounds to suspect that most ADHD are just mimicking or falsifying the symptoms of ADHD.

I, as an ADHD patient, when I look back my life, just can't tolerate such kind of statement. Besides, I am afraid that the citations attached to the statement are out-of-date, which can't truly reflect the present situation. =) --It's gonna be awesome!#Talk♬ 08:38, 24 June 2017 (UTC)

I changed "less severe" to "mild" and added an instance of the 2013 NYT article and 2 reviews from this year. The issue of overprescribing is current. Jytdog (talk) 17:47, 24 June 2017 (UTC)

Mild is perfectly fine aswell. Doc James (talk · contribs · email) 02:00, 25 June 2017 (UTC)

Thank you all! --It's gonna be awesome!#Talk♬ 06:44, 25 June 2017 (UTC)

Hunter vs Farmer

In the "Genetics" section it is suggested that ADHD may be advantageous to people in survival situaions - quicker response to danger etc, but the source cited is purely speculative and has no basis in any research. I think this should be cleared up as it is very misleading to suggest that what for the most part seems to be a disability is some how a gift waiting to be realised. Too many people talk about hyperfocus as though not being able to switch tracks and actually work productively is evidence of some kind of super human ability and this "Hunter vs Farmer" notion feeds into this. If indeed there is evidence of increased ability under certain circumstances then by all means, the case can be made, but so far it is entirely in the realm of speculation. If there is any evidence that the impulsivity associated with ADHD in every day situations contributes to improved responsiveness in high stress situations I would like to see it!

I think it is fine. Yes different personality traits do better in certain environments. This is like the foundation of evolution and is why we are not all the same. Doc James (talk · contribs · email) 14:55, 12 September 2017 (UTC)

Update

Is there any update on the prognosis section? Thx. --It's gonna be awesome!✎Talk♬ 20:07, 25 October 2017 (UTC)

What sort of update are you looking for? Doc James (talk · contribs · email) 01:03, 26 October 2017 (UTC)

The following statement in the prognosis section. : ) Are they still standing true nowadays almost a decade after their releases and conclusion?

The proportion of children meeting criteria for ADHD drops by about half in the three years following the diagnosis and this occurs regardless of treatments used.[191][192] ADHD persists into adulthood in about 30–50% of cases.[20] Those affected are likely to develop coping mechanisms as they mature, thus compensating to some extent for their previous symptoms.[29]

--It's gonna be awesome!✎Talk♬ 19:18, 26 October 2017 (UTC)

Yes more or less. Doc James (talk · contribs · email) 20:43, 26 October 2017 (UTC)

Ok though it's not in my case/experience. I think it's because I also have asthma and got heart palpitation following administration of stimulant. I still lack of persistence and emotional control. hahs --It's gonna be awesome!✎Talk♬ 05:01, 28 October 2017 (UTC)

lack [?] of an objective test ["!"] for ADHD

Some conditions (such as, "Turner's syndrome", and acne) can be diagnosed accurately and scientifically, completely without regard to (that is, without the decision or "results" depending upon) the "persuasion" (i.e., the opinions) of the professional who is responsible for evaluating the symptoms of the person [called the "patient"] and for making a decision about a diagnosis.

Something that I read recently about ADHD surprised me. (The fact that it is ["alleged" to be] true was not what surprised me. What surprised me was the fact that it it was 'stated' in black and white, in a professional journal ... and quoted in a "popular press" [or "popular psychology"] article.)

Here is what I was 'considering' adding to the article about ADHD:

According to a statement from a 2007 letter to the editor in The American Journal of Psychiatry that was quoted or "referenced" in "Causes for the Explosion of the ADHD Diagnosis", [quote:] "[T]here is no objective test for ADHD".

That anthology ("Causes for the Explosion of the ADHD Diagnosis") was, in turn, found via a link to it from "ADHD in the News 06-29-17".

However, before going ahead, I thought it might be appropriate to get some comments here (first), from those who are more familiar with this article, and with this topic, and with the customs of the several projects listed on the header of the "Talk:" page ... such as Wikipedia:WikiProject Psychology etc.

Any comments? --Mike Schwartz (talk) 23:09, 3 July 2017 (UTC)

References

There is no objective test for pretty much all psychiatric disorders. This is not new or surprising. The article describes how ADHD is diagnosed - it is entirely clinical. If you are not aware, "objective test" would be a Medical test - like measuring blood sugar or C reactive protein. There is nothing like that for ADHD, PTSD, major depressive disorder, etc etc. Jytdog (talk) 23:12, 3 July 2017 (UTC)

OK, thank you (Jytdog) for that very prompt reply.

I still have some questions. It sounds like, the fact that there is (currently) no genetic test (nor any "chemical" test) for ADHD is [apparently] obvious. Does that mean that, (since it is "obvious") it should not be added to the Wikipedia article about ADHD? One might think so, because ... well, since it is "obvious", therefore it "goes without saying"! One also might conclude that (it could be argued that) because it is "obvious", therefore "the fact that it is true" is not [sufficiently] *** notable *** to be "appropriate for" /slash, "deserving of" being included in a Wikipedia article.

On the other hand, what is "obvious" to one reader, might not be "obvious" to another reader. IMHO it might be helpful to 'some' readers, if the article about ADHD did include a sentence like the ("blockquoted") one shown above about "no objective test". The ("blockquoted") sentence shown above that I mean, is the one that ends with << [quote:] "[T]here is no objective test for ADHD". >>. For me at least, it would have been interesting, / helpful, if that had been included as part of the article. YMMV. --Mike Schwartz (talk) 02:23, 5 July 2017 (UTC)

We say in the lead:

• "Based on symptoms after other possible causes ruled out"
• "The condition can be difficult to tell apart from other disorders, as well as to distinguish from high levels of activity that are still within the normal-range."

In the body we say "ADHD is diagnosed by an assessment of a person's childhood behavioral and mental development, including ruling out the effects of drugs, medications and other medical or psychiatric problems as explanations for the symptoms.[57] It often takes into account feedback from parents and teachers[9] with most diagnoses begun after a teacher raises concerns.[94] It may be viewed as the extreme end of one or more continuous human traits found in all people.[120] Whether someone responds to medications does not confirm or rule out the diagnosis. As imaging studies of the brain do not give consistent results between individuals, they are only used for research purposes and not diagnosis."

I think currently we provide a good overview. There are many many diseases for which there is no concrete test. For example no test perfectly separates bacterial and viral pneumonia. Doc James (talk · contribs · email) 02:32, 5 July 2017 (UTC)

Great question Mike Schwartz, therefore the diagnosis of ADHD is mostly based on anecdotal evidence from teachers and parents. Strange how anecdotal evidence is allowed to make diagnosis but not to persuade scientific consensus.--Mickey ☠ Dangerez 21:11, 3 October 2017 (UTC)

There are objective tests that can contribute towards a diagnosis, for example, neuropsychological testing can find certain executive functioning deficits and slow processing speed which can be characteristic of ADHD. qEEG analysis can also reliably show features of ADHD. Also, slow language developmental delay and nocturnal enuresis are red flags for ADHD (but can occur for other reasons, like almost any sign). If these objective features are combined with subjective evidence (parental and teacher opinions on behaviour and concentration, etc), then ADHD can be much more reliably diagnosed. ADHD assessment and diagnosis is not just all about a DSM V or ICD 10 based questionnaire checklist. I'm sure some of this information can be reliably sourced and incorporated into the diagnosis section of the article. Many professionals, experienced in this area, combine objective and subjective evidence when diagnosing ADHD and it would be considered to be good practice.--Literaturegeek | T@1k? 14:50, 22 March 2018 (UTC)

Citation overkill

• Treatment with stimulants is effective for up to 14 months; however, its long term effectiveness is unclear.[25][26][27][28]

Why does this statement need four citations, and why is one of the citations from 2009? SandyGeorgia (Talk)

• About 30–50% of people diagnosed in childhood continue to have symptoms into adulthood and between 2–5% of adults have the condition.[19][20][21]

Why does this sentence need three citations, and why is one of them from 2008?

• Most healthcare providers accept ADHD as a genuine disorder in children and adults, and the debate in the scientific community mainly centers on how it is diagnosed and treated.[33][34][35]

Why does this require three citations? Since all of them are well over ten years old, it seems the matter is settled and one citation should suffice.

• ADHD is diagnosed approximately three times more often in boys than in girls, although the disorder is often overlooked in girls due to their symptoms differing from those of boys.[16][17][18]

Why three citations, all at least 10 years old?

SandyGeorgia (Talk) 19:39, 3 April 2018 (UTC)

NICE, British, UK

The body of the article says:

• ... the United Kingdom's National Institute for Health and Care Excellence (NICE) recommending use for children only in severe cases ...

The article does not say how they are defining severe. Also, the entire sentence is:

• Guidelines on when to use medications vary by country, with the United Kingdom's National Institute for Health and Care Excellence (NICE) recommending use for children only in severe cases, though for adults medication is a first-line treatment, while most United States guidelines recommend medications in most age groups.[23]

oddly cited to a 2009 Canadian source, which does not inspire confidence that it is the most recent NICE guideline. Futher, the lead says:

• The British guideline only recommends medications as a first-line treatment in children who have severe symptoms and for medication to be considered in those with moderate symptoms who either refuse or fail to improve with counseling, though for adults medications are a first-line treatment.[22]

which uses "British" while the body says "United Kingdom", and is curiously sourced to NICE. Could the British/UK, definition of severe, and correct sourcing be sorted? SandyGeorgia (Talk) 19:54, 3 April 2018 (UTC)

ICD-10 vs DSM

The lead says:

• It affects about 5–7% of children when diagnosed via the DSM-IV criteria[13][2] and 1–2% when diagnosed via the ICD-10 criteria.[14]

which leads the reader to expect that the DSM is looser in diagnosis than the ICD, but the article doesn't provide an adequate sorting of that for the novice reader. (To be resolved in 2018 ICD-11 hopefully, but a brief explanation here would serve the reader well.) SandyGeorgia (Talk) 19:58, 3 April 2018 (UTC)

Page could be rewritten so it doesn't focus primarily on children

I'm not going to try to do this because I'm not an expert (in ADHD or Wikipedia) but rather than having the main ADHD page focus on children with occasional references to adults, I think it should be rewritten to apply to any age group, since both children and adults can have ADHD. The fact that the main ADHD article focuses on children means that the page is portraying an incomplete view of ADHD, which does a disservice to adults with ADHD.

I propose that this article be age-generalized, with child-specific information being moved to a new "ADHD in Children" article, just as there's one for ADHD in Adults right now. Then the main ADHD article can have prominent "See Also" links to both of these articles.

63.225.137.32 (talk) 14:19, 27 March 2018 (UTC)

63, please have a look at WP:Summary style; there is an article Adult attention deficit hyperactivity disorder, it is summarized back to this article, and WP:WEIGHT is used to determine what goes in to a main article. SandyGeorgia (Talk) 20:08, 3 April 2018 (UTC)

Tourette syndrome

The CDC says 1% of children with ADHD have Tourette syndrome. [2] That's the same as the prevalance for TS generally. This article says:

• Tourette syndrome has been found to occur more commonly in the ADHD population. ref name=NIH2016

That text is not supported by the cited source, and is there not a higher quality, recent secondary review on this at any rate? SandyGeorgia (Talk) 18:08, 3 April 2018 (UTC)

It is a misinterpretation of the user who added this here, Revision as of 05:23, 6 November 2013. What is true is the opposite. This is the version of the source, which he consulted in November 2013 [3].

I'm going to remove it, there's no reason for the error to remain on the page. --BallenaBlanca 🐳 ♂ (Talk) 23:42, 3 April 2018 (UTC)

Thanks, BB ... I was wondering if the world had changed overnight :) SandyGeorgia (Talk) 01:50, 4 April 2018 (UTC)

Yikes, that text stood for five years, and snuck in two days after I cleaned up some citations, and then got lost in some edit warring. And then I edited again a few weeks later and never even saw that it had snuck in and was not reverted. Amazing that no one caught that. SandyGeorgia (Talk) 02:10, 4 April 2018 (UTC)

Hoping To Add And Update Page

Dear Fellow Editors,

I am looking to copy edit, add the sections Neurofeedback, as well as Positive Thinking and Mentorship in Schools (last heading all as one idea), which would be under the Management section of Attention deficit hyperactivity disorder (section). I understand that these ideas are mentioned briefly under Behavioral therapy, but I feel they add to the medical information presented and should be talked about due to significance. I hope that it would also benefit readers so they can quickly obtain that information. I have several sources that add credible information, but may be hard for others to access due to journal subscriptions. I welcome any recommendations that add to the two topics or anything that needs to added or updated to the page. Based on the response I will be more than happy to add the current sources I have found. my edit.

--Thanks Again-- Devon Cosgrove (talk . contribs). 8:34, 27 March 2018 (UTC)

@Devon Cosgrove: perhaps you could first list your sources here, so other editors could help you understand how much WP:WEIGHT they might be given in the article. SandyGeorgia (Talk) 20:09, 3 April 2018 (UTC)

@SandyGeorgia: I have compiled a list of sources that I believe meet the WP:WEIGHT required for this article. I now would like to actually do Neurofeedback and, a small section on the effect ADHD has on gender (Male/Female). Let me know how it looks. Devon Cosgrove (talk . contribs). 10:40, 16 April 2018 (UTC)

Hansen, Cheri, et al. “Adhd Boys in Young Adulthood: Psychosocial Adjustment.” Journal of the American Academy of Child and Adolescent Psychiatry, vol. 38, no. 2, 1999, pp. 165–171.

Levy, Florence, et al. “Gender Differences in Adhd Subtype Comorbidity.” Journal of the American Academy of Child and Adolescent Psychiatry, vol. 44, no. 4, 2005, pp. 368–376.

Brian W. Graetz, et al. “Are Adhd Gender Patterns Moderated by Sample Source?” Journal of Attention Disorders, vol. 10, no. 1, 2006, pp. 36–43., doi:10.1177/1087054705286055.

Quinn, Patricia O. “Treating Adolescent Girls and Women with Adhd: Gender-Specific Issues.” Journal of Clinical Psychology, vol. 61, no. 5, 2005, pp. 579–587.

Bálint S, et al. “Attention Deficit Hyperactivity Disorder (Adhd): Gender- and Age-Related Differences in Neurocognition.” Psychological Medicine, vol. 39, no. 08, 2009, pp. 1337–1337., doi:10.1017/S0033291708004236.

Pahlevanian, Aliakbar, et al. “Neurofeedback Associated with Neurocognitive-Rehabilitation Training on Children with Attention-Deficit/Hyperactivity Disorder (Adhd).” International Journal of Mental Health and Addiction, vol. 15, no. 1, 2017, pp. 100–109., doi:10.1007/s11469-015-9621-7.

Hammond, D. Corydon. “What Is Neurofeedback?” Journal of Neurotherapy, vol. 10, no. 4, 2007, pp. 25–36.

Irene W. Gaskins, and Jonathan Baron. “Teaching Poor Readers to Cope with Maladaptive Cognitive Styles : A Training Program.” Journal of Learning Disabilities, vol. 18, no. 7, 1985, pp. 390–394., doi:10.1177/002221948501800704.

• @Devon Cosgrove:, if you can add PMID (search Pubmed) for each article, it will be much easier for others to check them. You also might employ the cite template (see any citation in the article now for how these citations should be formatted for others to be able to review them). Without PMIDs, we have to go to Pubmed ourselves to check each of your sources to see if they are secondary reviews. SandyGeorgia (Talk) 15:06, 16 April 2018 (UTC)

• @Devon Cosgrove: as but one example, PMID 15782084 is a 2005 source, and it is a primary study, so is unlikely to be useful in this article or to meet WP:MEDRS. All of your sources should have a PMID so they can be similarly checked. SandyGeorgia (Talk) 15:08, 16 April 2018 (UTC)

If your intent is to write on Neurofeedback and ADHD, you can find sources by going to PubMed, entering ADHD neurofeedback in the search field, and then on the left-hand side of the page, restricting your search to Reviews within the last five years. That will return things like PMID 29445867 and PMID 27238063 (which states that "Evidence from well-controlled trials with probably blinded outcomes currently fails to support neurofeedback as an effective treatment for ADHD," so that may be about what can be added to the article (replacing the outdated statement about neurofeedback that is there now).

Also, because there is not good evidence for neurofeedback in the treatment of ADHD, that is probably about all that can be said in this article, and the topic can be explored in more depth at the sub-article, Attention deficit hyperactivity disorder management. SandyGeorgia (Talk) 15:17, 16 April 2018 (UTC)

Also, Devon, looking at your User:Devon Cosgrove/sandbox, your proposed text does not account for how we use Wikilinks on Wikipedia. Much of what you are writing is a description of what neurofeedback is, and that is covered at the article on neurofeedback, and not necessarily repeated in other articles. SandyGeorgia (Talk) 15:22, 16 April 2018 (UTC)

@SandyGeorgia: I understand that PubMed is an effective way to quickly link sources, I understand it is easier to link to PubMed for many, but most of my sources should be available in reputable libraries, archives, or collections wich is harder but accepted.[[4]] I understand it makes it difficult for a quick analysis, but a lot of the texts were not readily available and took me time to obtain them. In terms of out of date sources I understand the 1980s study, but the oldest of my studies are well within early 2000s. In my sandbox I have noted that some sources currently in use have dates from 2006, which I would assume are then similarly out of date. You can correct me if I am wrong, but I think that Neurofeedback deserve at least a little more information on the page. The quote from the PMID 29445867 study was done in 2016, but the other source which was done in 2018 PMID 27238063, comments something slightly different: ("Compared to non-active control treatments, NF appears to have more durable treatment effects, for at least 6 months following treatment. More studies are needed for a properly powered comparison of follow-up effects between NF and active treatments and to further control for non-specific effects."). Even though it is not an outright change, it is suggesting that more reputable studies are being done and are looking effective.

- I think this has potential to be mentioned further so it can inform more, just as I had hoped to similarly add more about supportive education and family treatments.I stated earlier I would hope to included or add somewhere a small section on how ADHD may affect the genders (Male/Female). I am not sure how you felt about it, since it was not specifically mentioned. However, at this point it is almost too late in the game for me to do any of these changes mentioned, based on my class.

- In the end I would like to do some copyediting instead under the Management section. It looks like under Mangament, the Medication section specifically pushes Ritalin. It looks to be only referring to ADHD drug makeups that are associated with (Methylphenidate) which is part of Ritalin. While there are other varieties ("phenethylamine used in drugs like Adderall. Lisdexamfetamine in Vyvanse. Dextroamphetamine used in Concerta"). I would like to suggested a new picture too, which is in my sandbox, swapping out the Ritalin one (it is now up if you want to check it out on my sandbox). It might be confusing, my notes that is, but I hope they make enough sense to understand my edits and jotted down ideas. Thanks, Devon Cosgrove (talk. contribs). 14:43, 18 April 2018 (UTC)

Hi, Devon Cosgrove my aim was to give you some ideas to help assure that your work to add text to this article would pay off in a contribution that could be kept; I have little interest in arguing over how I might best help your effort, and will let you decide that with the other regular followers of this page. Perhaps they are interested in looking up each source themselves to determine if you are using sources correctly; I'm sorry, I don't have that much free time myself. SandyGeorgia (Talk) 20:16, 18 April 2018 (UTC)

Hi, SandyGeorgia I understand completely. My hope was to try not to attack you in any way, and I apologize if it came off that way. I was hoping to make edits and felt under pressure to do so. I think at this point I will copyedit some for basic wording and edit the Ritalin part. Once again my apologize if I offended you. User:Devon Cosgrove (Talk) 21:18, 18 April 2018 (UTC)

No need, I did not feel attacked :) I was hoping to help you understand the importance of sourcing, so that your edits could be retained, but it was taking more time than I had. SandyGeorgia (Talk) 12:55, 23 April 2018 (UTC)

added results of May 2018 Cochrane Review: please review (feedback greatly appreciated)

https://en.wikipedia.org/w/index.php?title=Attention_deficit_hyperactivity_disorder&type=revision&diff=840619566&oldid=840373393

I would appreciate some feedback on my edit, or if you have any other suggestions on how to use this review. The PMID is not out yet, I added the citation with the DOI.

Thank you! JenOttawa (talk) 01:18, 11 May 2018 (UTC)

Summarized it a little further but looks good. Doc James (talk · contribs · email) 01:49, 11 May 2018 (UTC)

attention deficit dis-Instruction

attention-deficit-dis-instruction is a branch of ADHD were the effected can not obey simple instructions it appears you still do not possess the same instincts I do and when you possess the same instincts come and face me then so you just could not do it could not obey instructions and this is how you come to me without confidence.2001:558:6012:1B:6534:F271:5C4:FA60 (talk) 14:50, 30 May 2018 (UTC)

Just suspicious

"Underdosing of stimulants can occur and result in a lack of response or later loss of effectiveness.[171] This is particularly common in adolescents and adults as approved dosing is based on school-aged children, causing some practitioners to use weight based or benefit based off-label dosing instead.[172][173][174]"

This part is suspicious cause I saw there were maximum daily doses of stimulants for adults written in labels of respective medications recently updated and approved by the FDA in the DailyMed website. I don't have time to read the citations supporting that said part above, therefore I would like to raise my suspicion here. Thanks. --It's gonna be awesome!✎Talk♬ 19:37, 11 June 2018 (UTC)

Requested move 29 June 2018

The following discussion is an archived discussion of a requested move. Please do not modify it. Subsequent comments should be made in a new section on the talk page. No further edits should be made to this section.

Not moved. There is a clear absence of consensus for the proposed move. bd2412 T 03:41, 12 July 2018 (UTC)

Attention deficit hyperactivity disorder → Attention-deficit hyperactivity disorder – The spelling "attention deficit hyperactivity disorder" is confusing (attention disorder of deficit hyperactivity?). Wipur (talk) 13:36, 29 June 2018 (UTC)

This is a contested technical request (permalink). –Ammarpad (talk) 18:11, 29 June 2018 (UTC)

• Not always seen with a hyphen, better discuss first. JE98 (talk) 15:58, 29 June 2018 (UTC)

  Nothing is "always" seen with a hyphen. That's not our standard.  — SMcCandlish ☏ ¢ 😼  18:29, 29 June 2018 (UTC)

• Support per MOS:HYPHEN. This is a hyperactivity disorder involving an attention deficit, which serves as a compound adjective in the title. It is not a deficit hyperactivity disorder about attention, or an attention disorder of deficit hyperactivies, or anything else. Hyphens exists for a reason (well several, but in this context just one: joining parts of a compound modifier). It can be found without the hyphen, but in styles that drop hyphens from nearly everything. Wikipedia is not written in that style.  — SMcCandlish ☏ ¢ 😼  18:29, 29 June 2018 (UTC)
• Oppose per WP:NCMED. Both ICD10 and 11 [5] use "Attention deficit hyperactivity disorder", although recent medical journal articles are mixed. jamacfarlane (talk) 23:30, 29 June 2018 (UTC)
• Oppose per ICD. Doc James (talk · contribs · email) 11:24, 30 June 2018 (UTC)
• Support per generally accepted English orthography. Roger (Dodger67) (talk) 14:57, 2 July 2018 (UTC)
• Oppose per ICD and I'm assuming it's not the spelling but the etymology of the word you're stating as the case. If you want to get into semantics, it's presented as attention-deficit/hyperactivity disorder in DSM-5. – TheGridExe (talk) 20:43, 2 July 2018 (UTC)

The above discussion is preserved as an archive of a requested move. Please do not modify it. Subsequent comments should be made in a new section on this talk page. No further edits should be made to this section.

Wiki Education Foundation-supported course assignment

This article is or was the subject of a Wiki Education Foundation-supported course assignment. Further details are available on the course page. Peer reviewers: AlexLambright, Jessicasener.

Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 17:40, 17 January 2022 (UTC)

Wiki Education Foundation-supported course assignment

This article was the subject of a Wiki Education Foundation-supported course assignment, between 27 August 2018 and 28 December 2018. Further details are available on the course page. Student editor(s): Alope13. Peer reviewers: Kpaon1.

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Sentence about coping mechanisms

"Adolescents and adults tend to develop coping skills which make up for some or all of their impairments."

Used ref: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2957278/

I believe this should be deleted as it goes against the definition of ADHD (impairment defines disorder). There is also no source for this sentence in the source. So even in any case, a new ref is needed. At present it only says: "There is a high probability of co-morbid disorders, as well as the likelihood that the adult with ADHD has developed coping mechanisms to compensate for his or her impairment." I think that's too vague. --NorthernNights (talk) 07:45, 10 September 2018 (UTC)

Removed source and added template "citation needed".--NorthernNights (talk) 16:44, 2 November 2018 (UTC)

I'm restoring the source for the time being, so it can be marked for possible synthesis for other reviewers. I'm going to dig through the source when I have time and see if anything can be better quoted or just simply be removed. Thanks. – The Grid (talk) 17:14, 2 November 2018 (UTC)

Ref says "There is a high probability of co-morbid disorders, as well as the likelihood that the adult with ADHD has developed coping mechanisms to compensate for his or her impairment."

Source do not need perfect sources. They have a peer review process and experts involved in their creation.Doc James (talk · contribs · email) 21:55, 2 November 2018 (UTC)

A number of issues with this change

[6]

• Refs go after the punctuation not before
• The states for the rates of ADHD are NOT based on DSM 5 criteria but DSM 4 ones
• Will the DSM 5 is a great source it is not the only source.
• Restored some simplification of language
• Not sure why the association with substance misuse was removed
• We do not need to use a 1932 source.
• Hyperactivity and "inappropriate movement" are not the same
• "Attention-Deficit/Hyperactivity Disorder" is not really a rename from ADHD
• Saying that methyphenedate is the primary medication based on a 2008 source is not really founded. Need a newer source as is likely no longer true.
• Not just "significantly interfere with development" could simple be interfere with functioning

Doc James (talk · contribs · email) 23:51, 20 December 2018 (UTC)

Found a newer source and as of 2016 it is not the most commonly used in the United States any more.[7] Doc James (talk · contribs · email) 05:03, 22 December 2018 (UTC)

Methylphenidate is actually almost universally the most commonly prescribed medication for treatment of ADHD outside of the US — as far as I am aware the US is actually the only country where this is not true.

• PMID 21497704
• PMID 24736469 (abstract insufficient, please see full text)
• PMID 24776713 (abstract insufficient, please see full text)
• PMID 28280346
• PMID 27297009 (abstract insufficient, please see full text)
• PMID 22712630 (abstract insufficient, please see full text)
• PMID 22856384 (abstract insufficient, please see full text)
• PMID 28351466
• PMID 28336088
• PMID 28748725
• PMID 27145504 (abstract insufficient, please see full text)
• PMID 26599576 (note that this study has been criticized for various issues unrelated to the usage prevalence claims)
• PMID 29744873
• PMID 24927734 (abstract insufficient, please see full text)

I could keep digging up sources for this near endlessly but I think I've made my point pretty well by now. The reasons for the heavy dominance of methylphenidate outside of the US are quite interesting, but I don't think a detailed explanation is really necessary here so I won't bother with that. Garzfoth (talk) 12:23, 22 December 2018 (UTC)

Most people people any med for ADHD are in the USA so that country have a disproportional effect on totals. Doc James (talk · contribs · email) 18:35, 7 January 2019 (UTC)