Talk:Attention deficit hyperactivity disorder/Archive 10

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link to sleep problems

Shortly before the recent archiving of this page, someone wrote: "I understand that there is serious academic study into an ADHD/Sleep disorder link. Does anyone know more about this? It seems like something that should be added to the article." I'd like bring this forward again. A search of PubMed was suggested in reponse to the above, and there are indeed many relevant articles the last decade including a number of reviews. Most of them point out such things as:

• primary sleep disorders may be misdiagnosed as ADHD
• ADHD and primary sleep disorders may occur as comorbidities
• the nature of the neuromodulator systems underlying the associations among sleepiness, arousal, and attention
• children undergoing evaluation for ADHD should be systematically assessed for sleep disturbances
• important areas for future study

At present the ADHD article mentions the word sleep just once. While there clearly are unanswered questions, I feel there should be mention of the hypotheses and the ongoing research into this link.

If anyone can lead me back to an Israeli study I read some time back and cannot find again, I'll appreciate it. There, of an initial list of over a thousand 5 to 12-year-olds either diagnosed with ADHD or suspected of it by teachers and parents, between 20 and 30 of them, IIRC, were diagnosed with a circadian rhythm sleep disorder, and treatment for that removed their ADHD diagnoses. - Hordaland (talk) 18:37, 23 November 2008 (UTC)

I posted this before as it looks like a good review. Are you able to get the complete copy?

http://www.ncbi.nlm.nih.gov/pubmed/18803919?ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

--Doc James (talk) 06:09, 24 November 2008 (UTC)

No, I am not.  :-( The abstract is great, covering exactly the areas I'm thinking of. If I could get the whole review, I'd attempt a paragraph on this.

BTW, here in Norway, melatonin is being prescribed quite regularly for children with ADHD (usually written AD/HD here). And at 3 mg! My sleep specialist doesn't like this 'fad' and is concerned. Googling "ADHD melatonin" gives many hits, so I'd guess that it isn't just here. - Hordaland (talk) 15:47, 24 November 2008 (UTC)

There seems to be some research support for it [1]. The difficulty with it is that as a "natural" product there is less control over the actual amounts of active ingredients in any package, which contributes to uncertainty about dosages. I think some of the researchers are using particular manufacturers when doing the research, but there is likely to be slippage with this by the time it gets used clinically. --Vannin (talk) 17:43, 25 November 2008 (UTC)

[Outdent] Hmm, in that sponsored trial they corrected sleep onset latency, but this "had no demonstrable effect on ADHD symptoms." That (small) trial doesn't defend much mention in an article on ADHD. But the sleep problems should be mentioned more than they now are.

(I think that concerns about variable quality among manufacturers are overdone, and that that situation is improving. The "natural" variety made from the pineal glands of cows is no longer available. I get melatonin (for DSPS) here on a restricted, named-patient prescription, and over the years I've had it from five different labs, all of them in the USA. Doctors who prescribe 3-5 mg are IMO careless, as a tenth of that usually suffices.) - Hordaland (talk) 19:30, 25 November 2008 (UTC)

further great reference

Clayton, Paula J.; Fatemi, S. Hossein (2008). The medical basis of psychiatry. Totowa, NJ: Humana Press. ISBN 1-58829-917-1.{{cite book}}: CS1 maint: multiple names: authors list (link)--Doc James (talk) 09:11, 24 November 2008 (UTC)

spelling question

I've added some information about the recent changes in UK re additives, and also added some support groups. I have noticed that most of this page uses the British spelling; I haven't been doing this for a while, but I thought that Wikipedia used American spelling throughout. So, either the spelling I have used is wrong - or the rest of the page is wrong. Which should it be? Shulae (talk) 05:21, 1 December 2008 (UTC)

I think the wiki policy is that either is acceptible provided it is consistent throughout that article, though I could be mistaken. It may be changed later for consistency throughout other articles, as well. I am fairly sure there are no rules governing which spelling takes precedence. 198.200.181.205 (talk) 21:25, 2 December 2008 (UTC)

The FDA

The FDA in 2008 commented on what is sufficient evidence to conclude effectiveness when it comes to one ADHD drug

"The effectiveness of Focalin XR for long-term use, i.e., for more than 7 weeks, has not been systematically evaluated in controlled trials. Therefore, the physician who elects to use Focalin XR for extended periods should periodically reevaluate the long-term usefulness of the drug for the individual patient. . . .

In fact, no well-controlled trial supports long-term effectiveness, and the reference in slides 25-27 refers to an open-label, not concurrently controlled study that would not be considered substantial evidence of long-term effectiveness. An open-label (nonblinded) study is not an appropriate study design to evaluate subjective endpoints, such as those measured by the Attention Deficit/Hyperactivity Disorder Rating Scale (ADHDRS) or the Conners ADHD/DSM-IV Scales for Teachers (CADS-T). Blinding is intended to minimize potential biases resulting from differences in management, treatment, or assessment of patients, or interpretation of results that could arise as a result of subject or investigator knowledge of the assigned treatment.8 Thus, because the study was not blinded, the findings for Focalin XR are not unbiased and the study can not be relied upon as substantial evidence in support of the claims.

Second, because the cited study lacked a control group, there is no way to distinguish patient outcomes (for example, changes in symptoms, signs, or other morbidity) caused by the test treatment from outcomes caused by other factors, such as natural progression of the disease, observer or patient expectations, or other treatment.9" http://www.fda.gov/foi/warning_letters/s6935c.htm

This is why we state safety and efficacy has not been determined beyond two years.--Doc James (talk) 17:02, 10 December 2008 (UTC)

Inline tags

There has been some issues over inline tags in the past and weather inline tags questing the accuracy of sources should be added. I am concerned that they will be used similar to weasel words in an effort to cast doubt on statements editors disagree with. One was added in the past to this US government source http://www.ahrq.gov/clinic/epcsums/adhdsum.htm questioning it conclusions. Others comments would be appreciated.Doc James (talk) 17:14, 12 December 2008 (UTC)

There's a discussion just now, How to handle an uncited statement. Delete or citation-needed template?, at Wikipedia talk:Verifiability. Opinions vary, of course, and to a degree depend upon the situation. IMO, [CitationNeeded] tags are generally a good thing. The project is a work-in-progress, and there's no shame in that. I just replaced such a tag which had been sitting there since September 2007, doing no harm. (The fact seemed reasonable enough, but no one had bothered to find a more-or-less acceptable ref for it.)

I see now that this comment may not address your actual concern, which seems to be about doubting existing refs? - Hordaland (talk) 18:45, 18 December 2008 (UTC)

I personally think unref questionable claims should just be deleted, but I do not see any problem with tagging them either. But for referenced claims adding tags questioning their accuracy etc. I do not agree with.--Doc James (talk) 19:13, 18 December 2008 (UTC)

Diet

Made a number of changes to the section on diet to highlight the conclusions of the research.--Doc James (talk) 17:16, 18 December 2008 (UTC)

WTF

Okay I have ADHD who ever wrote this forgot somestuff out one example alot of people who are born with hypothyrïod often have adhd Steahl (talk) 23:16, 22 December 2008 (UTC)

Can you find a reference that supports this? Thanks.--Doc James (talk) 14:17, 23 December 2008 (UTC)

What James means to say (in a kinder voice :-p) is that you need a source (web, book, medical journals, whatever) that says that hypothyroid and ADHD are connected. There's a good chance that your source isn't reliable, but we can cross that bridge when we come to it (IF we come to it) :-) Xavexgoem (talk) 17:47, 23 December 2008 (UTC) Apologies, James ;-)

Thanks for that X. I guess I might have come across a little harsh. Do not in any way mean too.--Doc James (talk) 20:33, 23 December 2008 (UTC)

Found a source. It says that thyroid testing in not routinely required in ADHD but that it should be in ones differential diagnosis. http://www.uptodate.com/online/content/topic.do?topicKey=behavior/8293&selectedTitle=4~150&source=search_result Cheers --Doc James (talk) 20:35, 23 December 2008 (UTC)

(I'd say the section heading is a bit harsh, too, but whatever.)

Hypothyroidism is mentioned in the article, with [CitationNeeded], so you can fix that now?

Actually I'd think that the section Differential diagnoses could be substantially added to. Cheers, --Hordaland (talk) 00:37, 24 December 2008 (UTC)

Here is another article relating to this topic. Cannot find the CDC ref therefore removed: http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6TDD-45NFPG7-8&_user=7054564&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000070927&_version=1&_urlVersion=0&_userid=7054564&md5=da55c97e4563c2413228708e9c7df307 --Doc James (talk) 14:11, 24 December 2008 (UTC)

Virtually everything causes ADHD. At least according to the internets.--scuro (talk) 15:43, 24 December 2008 (UTC)

Prevalence

Uptodate says "The reported prevalence rates of ADHD in children vary from 2 to 16 percent depending upon the diagnostic criteria and the population studied (eg, primary care versus referral)"

The NIMH says "It is estimated that between 3 and 5 percent of children have ADHD"

The percentage of people with ADHD depends on what you define as normal. The obvious cases are easy but for the large majority it is a judgment call. --Doc James (talk) 13:51, 29 December 2008 (UTC)

I'm reverting (about causes)

This diff, with no talk page discussion and no edit summary, removes "A specific cause of ADHD is not known." with its ref and adds the "known causes" of ADHD and a probably non-reliable source. Such a major change is totally inappropriate without prior discussion. - Hordaland (talk) 10:42, 31 December 2008 (UTC)

I agree with Hordaland. Many references say the cause is unknown. There is some evidence in a few directions but none of it is concrete.--Doc James (talk) 13:50, 31 December 2008 (UTC)

Is ADHD controversial

The question "Is ADHD controversial?" has come up a number of times over the last couple of years. I have added a number of references about this topic and we have a complete page dedicated to it. The controversy has however been referred to as FRINGE. Wondering what others think? To get some balance it would be great if everyone comments once before further comments are made.--Doc James (talk) 04:09, 30 November 2008 (UTC)

Many things have been called controversial with regards to ADHD. No one claims that every controversial issue is fringe. Some issues are definitely fringe.--scuro (talk) 04:17, 30 November 2008 (UTC)

I have ADHD myself and I do think the issue is controverisal. If we could have some sort of ADHD portals that showed famous people speculated to have ADHD or that have ADHD such as michael phelps. One problem I have is these conditions are presented as undesirable disorders and often linked to Deviance_(sociology) (see medicalization) when it is really society that could be the problem. If the diagnostic material can be pointed out as being from the medical research community (see medical literature, scientism and APA controversies) and not representing a "worldwide" view of ADHD that may lower conflict. I think the conflcit is common even on ADHD cites and there many disability rights movments as well so those issues might just be reenacting themselves on wikipedia. I may be able to find some information from disability studies to explain the social view as well as the resources people can have to make it in society. Psychiatry initself I think is going through a crisis and does not have the greatest reputation as well, which I think adds to the ocnlfict.Matsuiny2004 (talk) 01:02, 10 December 2008 (UTC)

• added

I do like that neurodiversity, and alternative views are respected and think this article is very close to representing both views. It does seem that the social aspects are covered fairly well too. Matsuiny2004 (talk) 01:02, 10 December 2008 (UTC)

• added

looking though this article again I would say it is a very scholarly article. What exactly are the problems with it? I will say the medical part could be given its own section as ADHD is its own category and requires years of research to understand in the first place. There should be a wikiportal as well. That would allow there to be much more discussion, if star wars can have its own portal I think ADHD can.Matsuiny2004 (talk) 01:12, 10 December 2008 (UTC)

• added

I think where I can see some problems is the views on ritalin. These days it seems that the discussion of using medication, behavioral therapy, etc are controversial in themselves. If there is a way of discussing that it may help resolve some conflict. The ritalin debate for example could be linked to the debat over should stimulant medication also known as Methylphenidate be used. This can link to the debate of human enhancement, as well as cognitive liberty. There beggining to be people that do not have ADHD or a certain condition that use it for performance enhancement. Behavioral thereapy could be linked to the debate of behacvioral modifcation which I think is a very senstive topic to certain people. Stigma can be inlcuded as well.Matsuiny2004 (talk) 01:12, 10 December 2008 (UTC)

I agree about the importance of looking at the controversy in an academic way. Mental illness issues are controversial as they deal with the philosophical question of what is normal human experience.

The causes are also extensive discussed as the cause often determines the treatment. If the problem is a chemical imbalance then the treatment would be drugs. If the cause is ones society then one has to work on changing society. And just posing this question makes many uncomfortable. If the cause is psychological then cognitive behavior therapy or talk therapy might help.

There is evidence however supporting all three of these points of view. Changing rates of diagnosis and differing rates in different countries support a social / psychological cause. Some of the brain imaging and genetic studies support a chemical cause. The effectiveness of drugs support a chemical cause but the fact that drugs work in all people not those classified as having ADHD casts doubt on this assertion. The fact that the classification is just a subjective list of human actions also causes concern with the bio psychiatric model. None of this data is conclusive and trying to exclude any one of these is POV pushing.

The pharmaceutical industry often tries to frame the cause in such a way that it promotes the use of the treatments they offer. And they of course fund those who share their point of view. This of course is just common business sense.

The cause of all mental illnesses of course is unknown... This makes it different then all other area of medicine and thus so controversial...Doc James (talk) 14:43, 10 December 2008 (UTC)

Doc James, I do not disagree with your viewpoint that if a condition is created or caused by a society, then it is the society that needs to change but unfortunately, that is not always plausible. If one does not fit within a given societal framework and cannot change the society, then the psychological discomfort that accompanies that can be so distressing that it is damaging over the long term. An important remedy in such cases, particularly with ADHD, may be treatment with medication. In other words, treatment with medication can apply to both of your stated causes.

In terms of regarding all psychological disorders as controversial, rather than simply ADHD, that needs to be stated in the article. Referring to ADHD as controversial, when it is meant to encompass all disorders, may be misleading. --Snailgoop (talk) 03:11, 18 February 2009 (UTC)

The cause is however independent of the effectiveness of the treatment. And I would agree changing society is very difficult. I read some interesting stats from the second world war when psychiatry was popularized. They found that about 50% of soldiers went crazy after a 60 days in the trenches and nearly all when mad after half a year. ( This is from a book called Loss of Sadness ).

I have found many refs that ADHD is controversial and some even say it is the most controversial pediatric mental illness. Have come across some refs that say all psychiatry is controversial but they are not a good as the ones for ADHD.

No one can deny the existence of hyperactive children and adults. Activity however is a continuum and were you draw the line between normal and abnormal is subjective. This is not hard science. And even though ADHD is the best studied pediatric mental illness this says more about how poorly mental illnesses in kids have been studied rather than how good the evidence base is. Even Barkleys says that this is so.

Now when it comes to treatments just beccause the condition causes all sort of problems ( which no one denies ) this doesn't mean that treatment gets ride of all these problems. The MTA study illustrate how effective / ineffective stimulants were at treating ADHD. They are not a cure but make a small difference at best. And this has only been shown to be true over the short term.

Those who make these medications have tried to make it sound like they work so well that we should no longer study them as it is unethical not to treat everyone. A previous editor Scuro tried to make this point. Yet we have literature the gives a frequency of ADHD from 1 % to 17% with the average at 5%.--Doc James (talk · contribs · email) 04:43, 18 February 2009 (UTC)

"when it is really society that could be the problem"

society is not the problem...it is how our children are being raised...no guidance and dicipline...its all wrong. I have a suggestion about changing society in this connection. I'd really like to see it tried somewhere, as I'll bet the prevalence of ADHD would be reduced considerably, perhaps to just the genuine cases. Let boys start school at age 6 or 12 months older than their female classmates. School just does require sitting still and paying attention. On average, girls are much more able to do that than boys of the same age at least through elementary school. Has this been tried anywhere? If not, why not; it seems so obvious to me. - Hordaland (talk) 12:59, 18 February 2009 (UTC)

Excellent suggestion. An MD, PHD has actually written two very good books on the subject. http://www.boysadrift.com/ And that was his recommendation. He makes a number of other points such as gender segregation in school. Research shows that girls do equally well in coed and girl only schools but boys do much better in male only school than in coed school. Some people are following his advice. Doc James (talk · contribs · email) 13:31, 18 February 2009 (UTC)

Thanks for the link. I read his chapter one and would certainly read the book if it dropped in my lap. He is very clearly talking about North America, but you'll find the same things happening in Europe, at least here in Norway. I wonder about East and Southeast Asia. - Hordaland (talk) 16:32, 18 February 2009 (UTC)

Boys more often than girls

Lead says: ADHD occurs twice as commonly in boys as in girls.[5]

Epidemiology says: male children (10%) and female children (4%) in the United States.[103].

Society and Culture says: and ADHD is diagnosed approximately three times more often in boys than in girls.[134]

The article should perhaps agree with itself? - Hordaland (talk) 09:12, 3 December 2008 (UTC)

Uptodate.com says the ratio is between 2 andd 4 "ADHD occurs two to four times more commonly among boys than girls (male to female ratio 4:1 for the predominantly hyperactive type and 2:1 for the predominantly inattentive type) [6,14,15]."http://www.uptodate.com/online/content/topic.do?topicKey=behavior/8293&linkTitle=EPIDEMIOLOGY&source=preview&selectedTitle=4~150&anchor=2#2 I agree internal consistencey would be a good idea. Doc James (talk) 14:16, 3 December 2008 (UTC)

ADHD is diagnosed more often in males than in females, but the incidence of ADHD is nearly the same for males and females. Some aspects of the condition have however been suggested to occur with gender dependent incidence. Agalmic (talk) 15:20, 5 January 2009 (UTC)

Do you have a reference for that? It is a debated issue. Is it that males have more hyperactivity and are therefore diagnosed more well more females are undiagnosed as they have more attention problems. Or is there a true difference. Doc James (talk) 15:50, 5 January 2009 (UTC)

I've seen the claim stated by Agalmic written somewhere as well. As I understand it, girls with inattentive ADHD are more likely to go unnoticed and undiagnosed whereas boys with the combined subtype are hard to ignore, which is in line with your above commentary Doc James. It certainly makes sense. "The squeaky wheel gets the oil." --Snailgoop (talk) 03:16, 18 February 2009 (UTC)

Yes, I have read the same and this point definitely deserves better coverage. We need to find a ref and add this.--Doc James (talk · contribs · email) 04:21, 18 February 2009 (UTC)

I added something today, just a small preliminary entry with a reference. It definitely deserves more.--Snailgoop (talk) 07:20, 18 February 2009 (UTC)

NPV

I think this article has reached a NPOV. Should we now remove the tags?--Doc James (talk) 13:02, 9 December 2008 (UTC)

Nope, the editing process and consensus building are dysfunctional. That needs to be fixed first.--scuro (talk) 05:51, 10 December 2008 (UTC)

Just a passing observation from a college student mired in research on ADHD, but this article strikes me as entirely PoV, from CHADD's perspective, CHADD being the 'Grassroots Organization' recieving near a million dollars from Ciba-Geigy. (this taken from http://www.pbs.org/merrow/tv/transcripts/add.pdf , specifically in the middle of page 15. the text is quoted at http://adhd-report.com/adhd/9_ritalin_CHADD.html , which is where i encountered it. i should note that http://adhd-report.com/ is, aside from the biting sarcasam, a fairly good counter-source to what's currently on the page, as well as having links to numerous other counter-ADD arguments.) sidebar aside, even as a mildly informed passing observer, this seems highly spun in favor of CHADD and (perhaps incidentally, perhaps otherwise) Ciba-Geigy. i'm doing a five-page research paper on the whole thing, and i'm allowed to show bias on it; i'm going for anti-ADHD. if you all want, i'll PDF it up and get a link up here for use. otherwise, my two measly cents. Masterofmymind (talk) 06:57, 19 December 2008 (UTC)

There is an entire page on the ADHD controversy. The financial conflicts of interest is mentioned. Theses pages still need alot of work. Feel free to join in.--Doc James (talk) 15:13, 19 December 2008 (UTC)

CHADD does not fail to represent the majority of scientific research on ADHD, regardless of the source of its funding (Shire pharmaceuticals). The problem, in my view, is that organizations who have essentially sold out to pharmaceutical influence largely dismiss alternative theories. Certainly it can be said that funding for alternative approaches is almost non-existent compared with funding research to further treatment with medication. A personal pet peeve of mine is that organizations like CHADD are littered with pharmaceutical advertisements, which in my opinion tends to tip the scales into the realm of biased information.--Snailgoop (talk) 03:22, 18 February 2009 (UTC)

Geographical bias/vagueness

- cross posted to Wikipedia talk:WikiProject Countering systemic bias -

Article contains a number of statements like "It affects about 3 - 5% of children with symptoms starting before seven years of age." "ADHD is generally a chronic disorder with 10 to 40% of individuals diagnosed in childhood continuing to meet diagnostic criteria in adulthood."
In the USA?? In the UK?? In the western cultures?? Worldwide??
The sources cited presumably make the geographic areas clear, but we really need to specify these in the article text itself.
We need to try to eliminate USA-centrism (or other-country-centrism) in this article, and make country-specific facts and cites plain when we include them. -- 201.37.230.43 (talk) 16:45, 24 January 2009 (UTC)

Yes feel free to make changes. --Doc James (talk · contribs · email) 22:15, 24 January 2009 (UTC)

NPOV tag

Well I think we have reached NPOV. Should we now remove the tags. --Doc James (talk · contribs · email) 14:30, 29 January 2009 (UTC)

Yes, it's neutral but I think this article still needs more work (and would edit it if I could!), especially as it as a hot topic!

The initial summary is inaccurate: ADHD is defined primarily by a constellation of symptoms relating to inattention and distractibility with or without a component of hyperactivity and impulsivity. These symptoms must have been present in some form in early childhood (usually < 7 years of age) and impair functioning in school/education, work, and social interactions.

The whole pathophysiology section needs to be reworked. It's confusing and unclear.

Some of the references are confusing and refer to outdated/obsolete info and detract overall from the article (like that whole discussion over PET scans from the 90s) - I'd get rid of it entirely and replace it with data from this decade.

Imaging data is not necessarily cause and effect - if you have a small prefrontal cortex doesn't necessarily mean you have a functional impairment! Besides PET technology is much better now than 10 years ago and lots of studies are in progress to try and make that link between structure and function

More recent studies suggest that ADHD is based in a neurobiological problem where dopamine and norepinephrine transporters on inhibitory neurons in the prefrontal cortex are too efficient resulting in less of these neurotransmitters available in the synapse. The stimulants counteract that effect by blocking these transporters and/or increasing the release of neurotransmitters, thereby slowing down the clearance of these neurotransmitters. In essence, "strengthening the signal". Their absence means loss of inhibition of excitatory neurons, which leads to the constellation of ADHD symptoms.

I would also include a paragraph about how the childhood constellation of symptoms manifests in adulthood (ie how hyperactivity leads to impulsive speech and thinking, tactlessness, etc.)

A statement that clarifies the role of stimulants (and how they don't work for ~20% of people) - they only compensate as far as allowing you to maintain focus and controlling impulses, but they don't make up for not learning certain skills (ie. if you can now focus and listen better, you should be able to learn). Stimulants alone are not a "cure" - they need to be complemented by other interventions.

ADHD is also associated with learning disorders, especially dyslexia.

That statement on hypokalemic disorder confuses the issue. What does that mean? People who are truly hypokalemic may have neurologic symptoms (usually shortly before they die, if untreated) but that has nothing to do with ADHD...

It is estimated in North America that 4% of the total adult population have ADHD, but only 10% are diagnosed formally and have some form of treatment. Quite the impact on productivity!

Most articles regarding ADHD come from the US and Canada. If readers can find references to European models/points of view, please include it.

--CVZ (talk) 21:50, 30 January 2009

I couldn't agree more. Tried a while back to make many of these changes. With your support hopefully we can bring them about.--Doc James (talk · contribs · email) 22:10, 30 January 2009 (UTC)

List

Since last time I saw the article it seems to have improved a lot. However the list of associations should be removed (Maybe to a secondary article similar to List of multiple sclerosis organizations): Lists should be avoided per WP:MOS, wikipedia is not a directory (See WP:NOT) and they only name north america organizations (See WP:BIAS). Best regards.--Garrondo (talk) 14:50, 9 February 2009 (UTC)

Many thanks. And I agree they should be a list.--Doc James (talk · contribs · email) 15:06, 9 February 2009 (UTC)

Consider linking to clinical scales publicly available online

Perhaps after the phrase where the text mentions getting detailed histories from teachers and parents you would consider adding that the following scales are publicly available at psychiatrictimes.com:

Vanderbilt ADHD Diagnostic Parent Rating Scale Vanderbilt ADHD Diagnostic Teacher Rating Scale

http://www.psychiatrictimes.com/clinical-scales/adhd/vadrs/

and where the text discusses adult ADHD you might offer a link to:

Adult ADHD Self-rating Scale

http://www.psychiatrictimes.com/clinical-scales/adhd/

Loiswingerson (talk) 22:38, 12 February 2009 (UTC)Lois Wingerson, CMP Medica

Is this an OK source?

http://www.russellbarkley.org/adhd-facts.htm

It looks all very scholarly, but it is a personal site, not peer-reviewed. It would be preferable to use journal articles/reviews (or newer textbooks) as sources. In this case the prognosis info was changed & the above ref replaced a dead link and an NEJM article from 1999. The article was probably improved, but I question whether the source cited is acceptable in WP. - Hordaland (talk) 10:41, 17 February 2009 (UTC)

Thanks for bringing this up Hordland. Quoting someones personally opinion is completely inappropriate. I have found a 2008 review which says only 30-50% of adult still have symptoms by the time they reach adulthood which I think means even less would still have a formal diagnosis of ADHD. Therefore I have removed the above reference. Still looking for this info.

One may quote Barkleys peer reviewed publications. But his personal site and personal opinion are meanless, as are his power point presenations.--Doc James (talk · contribs · email) 20:55, 17 February 2009 (UTC)

I disagree, Doc James. Based on his considerable authority and the amount of literature that he has contributed to the field, his personal estimate is far from "meanless." Those people coming to Wikipedia to learn about ADHD may easily access his website from the reference and learn more, which is quite useful considering most people do not have access to a research library.—Preceding unsigned comment added by Snailgoop (talk • contribs) 01:57, 18 February 2009 (UTC)

Please use APA style references, when possible. It is the most appropriate citation style given the topic.

Not sure who wrote the last bit but having your refs link to a copy of the PMID at pubmed or the journal article is helpful. This tool will do it for you and puts it in the style agreed upon by the WP:MED portal http://diberri.dyndns.org/cgi-bin/templatefiller/index.cgi?ddb=&type=url&id=http%3A%2F%2Fwww.etymonline.com%2Findex.php%3Fsearch%3DObesity%26searchmode%3Dnone --Doc James (talk · contribs · email) 02:12, 18 February 2009 (UTC)

Documentation of patient experience on stimulant drugs?

I would like to see reporting or reviews which categorize and quantify the different outcomes of people on these stimulant meds. A good report or review would probably include side effects, patient experience as they would describe it, and include some follow up with those who participated in the data collection.

We have reported on the experience of unmedicated people who are labaled ADHD, but not the experience of those who are medicated, which seems like an imbalance.

I would be skeptical of any reports which do not include negative experiences associated with the early high dosages of Ritalin that many were put on back when stim drugs were introduced into treatment. I would also be skeptical of reports which bias toward a placebo effect, however this is based purely on my experience, which includes an increase in memory, memory accuracy, awareness of surroundings and the option to choose what I attend to. Also the non-stop talking has decreased.  :)

These are personal observations, and so I read that this means I can't include them in the content of the article, however I thought an article or study probably exists which might include some more rigorous scientific collection and presentation of this info.

Thanks to everyone who wiki's, this is a great place to learn! ~anonymous user —Preceding unsigned comment added by 151.151.98.234 (talk) 16:25, 30 March 2009 (UTC)

ADHD even though it is "the best studied" pediatric psychiatric disorder is still very poorly studies. Only one study of 18 month of treatment with an extension to 30 months of observation of about 500 people with lots of issues to it. Long term side effects and benefits are thus unknown. One needs to compare a blinded group who received treatment to a group who did not. About 60 % of people who do not get any treatment resolve on there own.--Doc James (talk · contribs · email) 17:10, 30 March 2009 (UTC)

Look at the pharmocological treatments section. I saw a news article on a long-term study today. II | (t - c) 19:08, 30 March 2009 (UTC)

Yes this is the MTA study that I am referring to above. It did not show a great success with stimulants. But people believe in drugs thus regardless of the effectiveness of them they take them / prescribe them / force them on those under their care. Another great example is the use of antipsycotics in dementia. They have been shown to be ineffective and increase mortality, but my colleagues still use them extensively. I see people dieing from there use daily makes me hold my head in shame for my profession.--Doc James (talk · contribs · email) 00:03, 31 March 2009 (UTC)

I need help

I am currently working on a Junior Thesis on ADD/ADHD and how it affects people in life and I was wondering if anyone could help me out in any way. Thank you.Jaj6 (talk) 22:47, 7 April 2009 (UTC)

There are lots of great sources. It is a big topic and very controversial. How ADHD affects ones life of course depends on were you live, how tolerant your society is, and how you define ADHD. It is a very American dominated condition as the ICD 10 does not contain this diagnosis but uses hyperactivity instead with more stringent criteria. ADHD is not a single condition but a spectrum. Being hyper vigilant to your surrounding and easily distracted wrt what you are doing would be a good trait to keep you alive for example if you lived in the jungles of the congo were roving bands of militia go around killing people.

By all means feel free to research and edit this page. Would probably be good to narrow down your topic.

The problem with trying to figure out how ADHD affects ones life is not easy. For example does a child get the diagnosis of ADHD because he or she uses drug and is deficult to deal with or does ADHD cause the use of drug.--Doc James (talk · contribs · email) 23:48, 7 April 2009 (UTC)

I specifically am taking on this big challenge originally because I have ADHD and I am taking the majority of my info from Driven to Distraction Recognizing and Coping with Attention Deficit Disorder from Childhood through Adulthood by Hallowell, Edward M., M.D., and John J Ratey, M.D. and ADD: Attention Deficit Disorder a Common but Often Overlooked Disorder of Children by Hunsucker, Glenn, M.A. so I know I have good cretible sources. mainly what I'm looking for are ways to treat it and then the points that are against it. of which I have zero treatments as of yet and I only have one point on the negative and that would be that there's no real evicence that proves it exists as a real disorder of the brain. then for one of the points I have proving it it says "'Half of all medical disorders are diagnosed without benefit of a lab procedure," notes Dr. Russell Barkley, professor of psychology at the College of Health Professionals at the Medical University of South Carolina. "Where are the lab tests for headaches and multiple sclerosis and Alzheimer's?" he asks. "Such a standard would virtually eliminate all mental disorders.'" (as a basic link).Jaj6 (talk) 00:19, 8 April 2009 (UTC)

I would give a word of warning to Barkley. He is the most pro drug treatment MD alive. Alzheimers can be diagnosed with a brain biopsy. A headache is a symptom not a diagnoisis ( the brain tumor is diagnosed by CT, menigitis is diagnosed by LP as is a subarachnoid HA ) Primary headaches are diagnosed by a discription from the patinet and you can tell they are in destress whe they have a migraine. Multiple sclerosis is diagnosed by MRI and LP. ADHD however is usually diagnosed by your teacher. It is the label someone gives you when they do not think you are listening to what they are saying. It is not the child who complains. This is a diagnoisis given to someone without their input. And thereare not many other conditions like this. See the page about ADHD controversies. Cheers

P.S. It does not suprise me that Barkley said the above quote. It only confirms my conviction that he is a quake. --Doc James (talk · contribs · email) 00:39, 8 April 2009 (UTC)

You're welcome to think that both Barkley and the condition are quacks, of course. I was first diagnosed long before he was practicing, and before the use of stimulants was known. I was referred to Psychology Department of the Student Health Service at the University I was attending because of falling grades. The testing (then, early 1960s) was doing a bunch of boring clerical chores, moving little pegs around on a big board, adding up columns of numbers, sorting 3x5 cards into alphabetical order, ... tasks which made no sense to me then (and I now understand that the distractions and interruptions by the psychiatrist were intentional on his part; the test was not the task correctness or completion, which I did well on, but the speed at which I returned to the test after the interruption, which I did poorly at.) Their conclusion was that under normal circumstances, they would say that I had Minimal Brain Dysfunction, but since I was a sophomore in the Honors Engineering program, a Merit Scholar, had nearly perfect SAT scores ... I just could not have MBD, and I should apply myself to my studies. Bzzzt. Ah well, I learned, slowly, but it seems some new to the scene haven't. Strattera has, according to my wife and friends, changed me, for the better. Mostly I think it's made me more aware of my failings. But that's a good thing, in many ways. It may be that the current understandings about ADD are wrong. Ulcers were like that for many years, too, and the diets, although ineffective, were not quackery. htom (talk) 03:22, 8 April 2009 (UTC)

A quack? Seriously? Regardless of one's views on the use of medication with ADHD, it's pretty hard to argue that Barkley's research and theory development haven't been invaluable to the field. Tim D (talk) 06:43, 8 April 2009 (UTC)

One word about that though is that I was not diagnosed by any teacher, but my parents suspected and then my doctor diagnosed it. And that quote I got from Barkley was a quote someone quoted him with in an essay titled ADHD Is Not a Myth or Hoax. which I got from the reference I gave earlier.Jaj6 (talk) 00:47, 8 April 2009 (UTC)

It is more his comments that following the MTA study that further research on ADHD would be unethical as all should be treated. The MTA study did not in anyway show fabulous results with treatment and was only of 14 month of duration with an extension to 30 months no blinded.

An extension of this trial to 8 years was published last week. It found no benfit in any variable from prior treatment with stimulants. Further more only 436 people were in this study and this is the best evidence available.Molina BS, Hinshaw SP, Swanson JM; et al. (2009). "MTA at 8 Years: Prospective Follow-up of Children Treated for Combined-Type ADHD in a Multisite Study". J Am Acad Child Adolesc Psychiatry. doi:10.1097/CHI.0b013e31819c23d0. PMID 19318991. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)

What this study found is that treatment makes no meaningful difference in outcomes.

Barkley also published a position paper saying ADHD is not controversial. It made me laugh when I read it.

So to summarize. Hyperactive/ADHD people exist. Hyperactivity can cause problems in our culture for some people. Stimulants leads minor short term improvements. There are no meaningful long term improvements. There are side effects to stimulants ( addiction, short stature, psychosis to name a few). Stimulants are far from a panacia.--Doc James (talk · contribs · email) 07:24, 8 April 2009 (UTC)

I think the key is that the most effective treatments are those that involve psychosocial components as well. The way I look at it (and I'm sure many others do as well) is that medications can ameliorate the neurological deficiencies enough to open doors, but without the right knowledge and development of adaptive behaviors/habits, they won't do much good in the long term. Tim D (talk) 03:31, 9 April 2009 (UTC)

(out)

CONCLUSIONS:: Type or intensity of 14 months of treatment for ADHD in childhood (at age 7.0-9.9 years) does not predict functioning 6 to 8 years later. Rather, early ADHD symptom trajectory regardless of treatment type is prognostic. This finding implies that children with behavioral and sociodemographic advantage, with the best response to any treatment, will have the best long-term prognosis. As a group, however, despite initial symptom improvement during treatment that is largely maintained after treatment, children with combined-type ADHD exhibit significant impairment in adolescence. Innovative treatment approaches targeting specific areas of adolescent impairment are needed.Clinical trial registration information-Multimodal Treatment Study of Children With Attention Deficit and Hyperactivity Disorder. URL: http://www.ClinicalTrials.gov. Unique identifier: NCT00000388.

It seems to me that you confuse the symptom of hyperactivity for the problem being successfully treated, even though there is still a long-term change in ability to master intentional goal pursuit. htom (talk) 15:47, 8 April 2009 (UTC)

Extension of MTA published

Molina BS, Hinshaw SP, Swanson JM; et al. (2009). "MTA at 8 Years: Prospective Follow-up of Children Treated for Combined-Type ADHD in a Multisite Study". J Am Acad Child Adolesc Psychiatry. doi:10.1097/CHI.0b013e31819c23d0. PMID 19318991. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)--Doc James (talk · contribs · email) 07:24, 8 April 2009 (UTC)

Disorder

I am sorry to say it, but it is this page that has a serious development disorder.

When I look it over, I try to image what kind of user may want the information in these pages. Is it children, adolescents, doctors, people with ADHD, their families or just some "average" user? Who are we writing for?

I see obsolete facts and bad structure, e.g at the very start: Having an opening statement like "It affects about 3 to 5% of children" is close to 50% truth - ahem. This is not a childhood only disorder. Sure, that fact has a reference, but sorry, wrong context. I suspect the author at that point had no concept of adult ADHD. When someone had, a separate article was created - huh??. I guess it's merge time. Or maybe some of you, here, still believe that this is a childhood only disorder? What are we gonna do - throw references at each other?

Another example is the scattered classification information: A standard infobox with classfication, a classification section that contains generic ADHD info (except the rather surprising information that ADHD appear to be associated with antisocial disorder). This section manages within a few lines to call ADHD a 'developmental disorder', a 'behavior disorder', a 'disruptive behaviour disorder' and then the infamous association with psychopaths. All this without in any sense relating to the reader what the similarities or differences may be. Further classification information appear in various other sections below this. Now, really, is this just lack of structure or is it just really bad qualty?

Comments, anyone? —Preceding unsigned comment added by Sportsmandda (talk • contribs) 17:54, 19 April 2009 (UTC)

Adult ADHD is not in the DSM 4R and is an even more controversial diagnosis. I am sure it will be in the DSM5. It states 3-5% than says 50% resolves leaving use with 1.5 - 2.5 %.--Doc James (talk · contribs · email) 20:07, 19 April 2009 (UTC)

The article needs a re-writing, but this is very difficult to do with topics that have controversy attached. I suspect (but I'm only a patient) that the DSM5 will abandon both ADD and ADHD as being labels that are not useful, and instead have a Hyperactivity Disorder, an Executive Function Disorder, and a Slow C Process Disorder (where in C might be Cognitive or Communication). There's also the possibility of some reference to dopamine receptors and dopamine transport, but that will probably not be until DSM6. htom (talk) 23:59, 19 April 2009 (UTC)

Here we go with the "controversy" thing again, but I'll refrain from discussing that until later. Using the DSM as any kind of reason for not the merging child and adult ADHD articles is misleading, IMO. To illustrate, one recent source concluded that current DSM-4 criteria for children makes ADHD "unlikely to exist as an identifiable disease" PubMed. Where does that leave adult ADHD? That aside, I have read you comment above concerning Ritalin side-effects. You mention "addiction, short stature, psychosis to name a few". The current figures I have concerning this is "stature - less than 0.1%, "psychosis - less than 0.01%". Do you agree with these figures? The "addiction" claim is totally unsubstantiated afaik. None of these side effect are mentioned in the Ritalin article - shouldn't they be if they are that important? Your emphasis on these side-effects makes me suspect you hold distinct anti-Ritalin bias. Your comments above on Russell Barkley ("..confirms my conviction that he is a quake") convinces me that you hold considerable bias to the topic as such. --Sportsmand (talk) 09:19, 20 April 2009 (UTC)

I assume you're addressing Doc James' comment? htom (talk) 13:49, 20 April 2009 (UTC)

Since I have added this article to my watch list after a recent edit I made I will share my views on this debate. This study, suggests more than 0.1% have slowed growth but depends how severe the measurement is, infact they suggest smaller height is typical. If the measurement is just one that reaches "statistical significance" then shortened height is fairly typical from long term use of amphetamine or related drugs in growing children. If the measurement is like they are one foot or half a foot shorter than normal then yeah probably 0.1%. The other side effects really depend on the methodology of how they were calculated and also there is little or no data on long term outcomes of stimulants eg long term randomised placebo controlled trials. Tolerance and dependence is listed in the British National Formulary as a side effect of methylphenidate as well as for dexamphetamine. It is also a schedule 2 controlled drug so obviously there is a strong potential for it to be misused addictively. That is not to say that most people misuse their medication, clearly they don't but clearly some do and it is quite well known that addictive drugs prescribed get diverted to the black market or misused by a subgroup of patients. I have know of people in real life who have abused methylphenidate specifically and doctor shopped for it and become addicted to it. Your above comments regarding antisocial behaviour disorder and classification of ADHD. That argument would need to be taken up with medical journals who publish such studies finding an association and also with the various psychiatric panels who decided to class ADHD in the way that they did. Wikipedia just reports the facts, we can't get into reclassifying disorders regardless of the unpopularity by some readers of official classifications. If you lobby lets say The American Psychiatric Association to change the definition of ADHD as a desruptive behavioural disorder then we can change it here but until then unfortunately we just report the encyclopedic facts about ADHD. Adult ADHD is mentioned in the lead and throughout the article so I confused as to your complaint.--Literaturegeek | T@1k? 14:23, 20 April 2009 (UTC)

Sportsman: If you provide some references to support your assertions would be happy to look at them. It looks like about 1 million people in the US abuse prescription stimulants. http://www.nida.nih.gov/ResearchReports/Prescription/Prescription4.html Psychosis is rare but when it occurs is a big deal. I would not be surprised at the rate you give and if you find a ref to back it up I recommend you add it. The growth issues are complicated and I have not added info on this.

The common side effects per uptodate are: Anorexia or appetite disturbance (80 percent) Sleep disturbances (3 to 85 percent) Weight loss (10 to 15 percent), tics(Approximately 15 to 30 percent of children) The common side effects are usually mild well the severe side effects are rare.

The group from McMaster did a good job summing up why ADHD is controversial. Russell Barkley than goes ahead and writes a position paper denying the exsistance of anyones opionion other than his own. I respect his research just not his personal oppinions when it comes to ADHD . Cheers--Doc James (talk · contribs · email) 17:31, 20 April 2009 (UTC)

You refer to a statistic that has nothing to do with ritalin side-effects. It is well-known that Ritalin is being abused, it is well-known that ADHD has comorbidity with drug abuse, but your implication was that Ritalin leads to "addiction". I can't believe a real doc would make a mistake like that. --Sportsmand (talk) 21:26, 20 April 2009 (UTC)

As it turns out, ritalin is abused a lot less than many other drugs with 2% of teens reporting that they have used it in the past 12 months, but 12% reporting non-prescription use of pain medications. The trade off is that kids with ADHD who are prescribed stimulants are less likely to abuse street drugs in general than kids with ADHD who do not. Plus there are the risks of car accidents etc if they are not taking stimulants. Everything is a cost-benefit analysis, and those who do not work with unmedicated patients with ADHD do not realise what the costs are of not taking the medications. But, it is probably not worth it to fight this one, Sportsmand, unless you can cope with a lot of aggro from the anti-med side. --Vannin (talk) 21:54, 20 April 2009 (UTC)

Thanks, but I'm very tenacious :-) It is indeed worth fighting. The Google page ranking makes this article a premier source of ADHD information. Biased information may be a great disservice to a great number of people. --Sportsmand (talk) 22:40, 20 April 2009 (UTC)

Eh, Sportsmand, I don't see Doc James making any implication like that at all. Let's focus on the article. Should side effects of stimulant medications should be mentioned in the pharmacological treatments section? II | (t - c) 22:00, 20 April 2009 (UTC)

"Doc" James asserted above "There are side effects to stimulants ( addiction, short stature, psychosis to name a few)." Side effects of medication should obviously be described in Wikipedia IMO. --Sportsmand (talk) 22:30, 20 April 2009 (UTC)

You honestly think people children can't get addicted to their stimulant medications? II | (t - c) 22:57, 20 April 2009 (UTC)

How do you define "addiction" in terms of chronic patients taking prescribed medication? I can't. --Sportsmand (talk) 23:38, 20 April 2009 (UTC)

Actually I read a paper a couple of years ago where they followed up stimulant treated kids to a longer followup date and found an increased risk of cocaine abuse versus those with ADHD who never took stimulant medications. It is true there are studies showing no increased risk of substance abuse but they did not followup beyond I think age 18. If remembering correctly the study I am talking about followed them up to age 23. So the reduction in drug use is controversial, infact I am not sure there have been any studies which showed such a reduction? If there are I would like to read them and why not cite them? The issue with me is not a matter of trying to delete the view point of "the meds have benefits". It is a matter of citing peer reviewed facts from reliable sources and not having significant view points in the literature removed. Sportsmand says there is no controversy, delete everything that says ADHD or its treatment is controversial etc. That is ridiculous and bias. Your claims need to be backed up with reliable sources. If you have a reliable source which states that ADHD meds cause a reduction in car accidents then please do cite it. Wikipedia works via reliable sources.--Literaturegeek | T@1k? 22:02, 20 April 2009 (UTC)

I suggest you read what I wrote about Dispute resolution below in stead of putting the words into my mouth. --Sportsmand (talk) 22:30, 20 April 2009 (UTC)

Sportsmand I find your comments insulting. "I can't believe a real doc would make a mistake like that." But then again I have been called a nazi during my time here so no worries I have thick skin. I have asked your to provide evidence for the numbers you quote. I have agreed with you that 0.01 percent is not unreasonable for a rate of psychosis seen with stimulant use. I think it is a good idea to add this to the page to put the side effects in context. There are lots of reliable sources documenting the controversial nature of ADHD. Stimulants are NOT the most abused drugs. I agree with that part of Vannin's statement. The ref I provided above list them as third. That they decrease car crashes and addiction to other drugs with use in ADHD I would love to see the paper that supports that. Other papers do not support that assertion.--Doc James (talk · contribs · email) 13:42, 21 April 2009 (UTC)

If you move this to the proper context, I would be happy to reply. By placing it here like this, I consider it trying to conceal the fact that you were mistaken. --Sportsmand (talk) 09:31, 22 April 2009 (UTC)

BTW I have never said "Ritalin leads to "addiction"" I have said addiction is one of the concerns wrt stimulants, but that as far as I am aware there is no evidence to show stimulant used to treat ADHD either increase or decrease addictions rates among the people diagnosed. This concern of course is why they are schedule 2 drugs in the USA and some parents are concerned about their children having schedule 2 drugs.

--Doc James (talk · contribs · email) 14:21, 21 April 2009 (UTC)

All: Is it possible that the increase in cocaine use by those formerly on prescribed stimulants as a treatment for ADHD is because they are no longer allowed access to those prescription stimulants, and cocaine is easier or cheaper on the illegal market? In other words, having been deprived of what they consider to be useful treatment, they have switched to an illegal substitute in an attempt to return to their former medication? htom (talk) 14:33, 21 April 2009 (UTC)

I have not seen this paper that you mention saying cocaine use is greater in those with previous stimulant use. I would not be suprised if this association were true however it still does not mean that stimulants lead to increase cocain use. The affects of stimulants on addiction is a difficult question to address. People who are prescribed stimulants are likely to have ADHD and thus have borderline personality disorder / conduct disorder (40% association). Those with conduct disorder are more likely to be addicts. Some evidence show stimlants decrease long term drug use, some shows it increases long term drug use. All the evidence is unfortantely of poor quality as is most ADHD research. Part of the reason why it is controversial is that the evidence is not great.

I do know that addicts often use any stimulant they can get their hands on be it cocaine, crystal meth, or amphetamines. We see the same thing with benzos and etoh. People often become addicted to both.--Doc James (talk · contribs · email) 15:32, 21 April 2009 (UTC)

It was 0.1% for psychosis not 0.01% but it was a review of short term clinical trials. However, the limited amount of research into long term use of stimulants suggests a much higher rate of psychosis of more than 6%. Stimulant related psychosis usually only occurs from either chronic use or in overdose. Be careful not to apply short term effects statistics to long term effects statistics, that is original research and almost certainly inaccurate in the case of stimulants.--Literaturegeek | T@1k? 15:31, 21 April 2009 (UTC)

Otter what you just said is a theory so is irrelevant unless you can find a reliable source which demonstrates that theory.--Literaturegeek | T@1k? 15:34, 21 April 2009 (UTC)

Literature sounds like these numbers would be useful to add. Would put the side effects into context.--Doc James (talk · contribs · email) 15:35, 21 April 2009 (UTC)

stimulant therapy associated with reduction in risk for subsequent drug and alcohol use disorders in a meta-analysis [2]--Vannin (talk) 02:47, 22 April 2009 (UTC)

there is a much greater risk of accidents in drivers with ADHD. That risk is reduced by stimulant therapy [3] and [4]. I do actually know what I'm talking about --Vannin (talk) 02:56, 22 April 2009 (UTC)

Vannin never implied you didn't. If you have time you should add these conclusions to the article.--Doc James (talk · contribs · email) 04:56, 22 April 2009 (UTC)

Ref does not say reduced accident rate, (unless I missed it when reading refs). The meta analysis was of mostly short term studies showing improved driving performances after short term acute intake of methylphenidate. There was one study on long term users which was not very strong, basically it asked a relative of the ADHD person, "Do you think he/she drives better on methylpheidate?". Best that you can say is ADHD is associated with worse driving performance and an increased risk of motor vehicle accidents. Treatment with methylphenidate enhances driving performance. I would like to see a source, even a primary source which assesses motor vehicle accident rates in long term users of methylphenidate versus unmedicated ADHD drivers. What happens after chronic use of stimulants? No robust strong studies on driving performance after long term therapy and no evidence at all of reduced accident rate.

Thanks for the meta analysis on methylphenidate and lower drug abuse rates. I have seen criticism of those studies, methodology but nevertheless it is a reliable secondary source as is the one on accident rates and enhanced driving performance after methylphenidate, so please do cite them in the article.--Literaturegeek | T@1k? 17:06, 22 April 2009 (UTC)

Uptodate indicates that the improvement in driving skills is independent of weather a person has ADHD or not. I guess this might be part of the reason why the US uses methyphenadate in its airforce pilots. "The cognitive functions influenced by stimulants impact a number of daily living skills. As an example, methylphenidate ingestion has been found to reduce driving errors in adults [58]. Stimulants may also produce these effects in patients without ADHD, and not all patients with ADHD improve with such therapy. Thus, the patient's response cannot be used to confirm or exclude the diagnosis of ADHD [7]."--Doc James (talk · contribs · email) 17:43, 22 April 2009 (UTC)