Talk:Attention deficit hyperactivity disorder/Archive 13

Archive 10

Archive 11

Archive 12

Archive 13

Archive 14

Archive 15

→

Archive 20

The section 'Alternative theories'

It would be appreciated if I didn't see anymore WTFs. Back to question last asked, anyone care to reply? Of the "alternative" theories, the Hunter/Farmer theory has the most traction. If you mention it in conversation, some people would recognize the name. No one would recognize the SC name. If we are taking causes of ADHD, I would postulate that none of these theories would have real acceptance in the Scientific and Medical communities. Can we agree on this?--scuro (talk) 00:56, 27 May 2009 (UTC)

(←)WP:AGF on the first part... Second part, yeah, back to the task at hand... I can't honestly say that many people know any of the theories by name. I've never even heard of Hunter/Farmer theory, but I have heard the "it's just bad parenting" (social construct) theory. By name, neither one.--Unionhawk ^{Talk E-mail} 01:32, 27 May 2009 (UTC)

As per the controversies page "A 2002 survey found that of the 64% who had heard of ADHD, 78% believed it to be a "real disease"" meaning 22% who had heard of ADHD did not think it was a real disease. Therefore of the population 36% have never heard of ADHD, 14% do not think it is a real disease, and 50% beleive it a real disease. This is of course the American population with direct to consumer ads. Have not come across data from the rest of the world.--Doc James (talk · contribs · email) 01:47, 27 May 2009 (UTC)

I don't think that Social construct (which hardly anyone would know by name) means (just) the same as bad parenting. It means "an arbitrary division between "normal" and "abnormal" on a continuous spectrum of behavior," that is, it's all normal and not a disorder. This would cover most of the ordinary folks who mean that ADHD as a diagnosis is nonsense, bogus, fake.

Probably the whole 'Alternative theories' section needs looking at.

(I've taken the liberty of adding a heading to this thread.) - Hordaland (talk) 02:21, 27 May 2009 (UTC)

Adult ADHD

I removed this sentence: "A diagnosis of ADHD may offer adults insight into their behaviors and allow patients to become more aware and seek help with coping and treatment strategies." This is just speculation and the reference is to a website. The link to the website goes nowhere.--Franklinjefferson (talk) 01:48, 25 May 2009 (UTC)

I found an archived version and replaced the ref with the archived version.--Unionhawk ^{Talk E-mail} 02:16, 25 May 2009 (UTC)

The reference as listed is not a primary source reference. The cited article is a discussion of ADHD, and in the discussion they make the statement about the diagnosis offering adults insight, referring the statement to an article in Psychiatric Clinics of North America. In other words, this is a reference to a reference. Unless you have a primary reference for this statement it should be removed. --Franklinjefferson (talk) 02:47, 26 May 2009 (UTC)l

What? I'm confuseded... How does that not have the statement in it? It's an article from uspharmacist.org, and not one of the random self-help sites (that, from experience, don't work very well...)--Unionhawk ^{Talk E-mail} 02:50, 26 May 2009 (UTC)

This is an example of hearsay evidence. The reference in the Wikipedia article is not to a scientific journal, it is to someone who is just making a statement of his opinion. And in that statement of opinion, he is referring to something he read in a book. Now, the person that wrote the book may be an expert; but as far as I can tell so far, even the person that wrote the book was giving just his opinion, rather than stating a fact that was proven. A fact that is proven would be something that was published in a peer-reviewed journal. It would be a scientifically based study and would be reproducible by other scientists investigating the same hypothesis. A reference to such a study would be valid. A reference to someone's opinion is just a reference to someone's opinion. --Franklinjefferson (talk) 03:28, 26 May 2009 (UTC)

Quoting the About US Pharm link:

U.S. Pharmacist is a monthly journal dedicated to providing the nation's pharmacists with up-to-date, authoritative, peer-reviewed clinical articles relevant to contemporary pharmacy practice in a variety of settings, including community pharmacy, hospitals, managed care systems, ambulatory care clinics, home care organizations, long-term care facilities, industry and academia. The publication is also useful to pharmacy technicians, students, other health professionals and individuals interested in health management. Pharmacists licensed in the United States can earn Continuing Education credits through U.S. Pharmacist. Jobson is approved by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmaceutical education.

More generally, rewrite the sentence in your mind: "A diagnosis of blindness may offer adults insight into their behaviors and allow patients to become more aware and seek help with coping and treatment strategies." "A diagnosis of near-sightedness ...." htom (talk) 17:13, 26 May 2009 (UTC)

(←)exactly. One, this is a reliable source, and two, that sentence makes absolute logical sense...--Unionhawk ^{Talk E-mail} 19:07, 26 May 2009 (UTC)

and besides, although it may or may not be a primary source, it has like, 30 references to back it up.-Unionhawk ^{Talk E-mail} 19:09, 26 May 2009 (UTC)

That's fine. I understand your viewpoint. I think it is a matter of how conscientious you want to be as an editor and what you consider an appropriate reference. In my view the only appropriate reference for a statement that is presented as a scientific fact is a reference to the peer-reviewed publication where the findings were originally published. If this was followed consistently it would improve the quality of scholarship in Wikipedia. However, I understand that some might not feel the need to maintain this standard. --Franklinjefferson (talk) 16:12, 27 May 2009 (UTC)

ADHD and dyalexia

when I added this article to the Dyslexia category that was because ADHD anhd dyalexia can share some common medical issues see "Symptoms of hyperactivity and inattention can mediate deficits of postural stability in developmental dyslexia" Kim S. H. Rochelle, Caroline Witton and Joel B. Talcott1 School of Life and Health Sciences, Aston University, Birmingham, UK http://www.springerlink.com/content/yl41483583810w70/ or doi:10.1007/s00221-008-1568-5

I was not inferring that ADHD was a form of dyslexia, but that there areas of symptom overlap

You can also see the WIKI dyslexia category page at http://en.wikipedia.org/wiki/Category:Dyslexia

dolfrog (talk) 14:06, 26 May 2009 (UTC) editing WIKI Dyslexia article

Perhaps your purpose would be better served by adding 'Dyslexia' to this article's 'See also' section? - Hordaland (talk) 16:14, 26 May 2009 (UTC)

the section on categorization describes it as a way of connecting related articles, rather than it being a hierarchy - thus ADHD does not have to be a form of dyslexia but can be related, and certainly there are areas of symptom overlap as Dolfrog has said - eg relatively lower working memory is often characteristic of both, and certainly learning disabilities are co-morbid with ADHD, so it makes sense to have the category tag as it would allow readers to find related articles - the goal. --Vannin (talk) 16:19, 26 May 2009 (UTC)

I put Dyslexia in the related conditions portion of the see also section.--Unionhawk ^{Talk E-mail} 16:21, 26 May 2009 (UTC)

Notice: Do not remove tags placed by Scuro, unless they break common sense boundaries

I'm trying to improve this article in general. If Scuro's tags can possibly help, then let him place them. If they break the bounds of common sense (i.e. complete article rewrite, needs consensus, ect.) they may be removed at will. I'm betting that this may help. If not, then, blame me, as that would be my fault for even offering this.--Unionhawk ^{Talk E-mail} 02:11, 26 May 2009 (UTC)

Unionhawk, I appreciate your offer. It is a good faith offer.--scuro (talk) 03:52, 26 May 2009 (UTC)

Good move, UH. The tag wars and even 3RR are, IMO, minor bumps in the road. We all, not just Scuro, need try to define & isolate the major problems to be dealt with. Another item we all should just drop for a good while, IMO, is civility concerns; they are not a major problem on these pages. "Don't sweat the small stuff." Regards, Hordaland (talk) 11:29, 26 May 2009 (UTC)

What you two say is positive.--scuro (talk) 03:02, 29 May 2009 (UTC)

Classification

The reference for this sentence: "Using magnetic resonance imaging of the prefrontal cortex, this developmental lag has been estimated to range from 3 to 5 years." is from a discussion on a website, not from a scientific journal. As a non-peer reviewed source it really has no credibility beyond that of the person that wrote the article. Unless there is a peer-reviewed scientific reference supplied this statement should be removed. --Franklinjefferson (talk) 03:20, 26 May 2009 (UTC)

• sigh* That one was "Adapted from materials provided by NIH/National Institute of Mental Health." (http://www.nimh.nih.gov/ )--Unionhawk ^{Talk E-mail} 19:05, 26 May 2009 (UTC)

In the pathophysiology section, the major paper the finding is based on is cited. Without the ref tags: Philip Shaw, MD; Jason Lerch, PhD; Deanna Greenstein, PhD; Wendy Sharp, MSW; Liv Clasen, PhD; Alan Evans, PhD; Jay Giedd, MD; F. Xavier Castellanos, MD; Judith Rapoport, MD (2006). "Longitudinal Mapping of Cortical Thickness and Clinical Outcome in Children and Adolescents With Attention-Deficit/Hyperactivity Disorder". Arch Gen Psychiatry. 5 (63): 540–549. PMID 16651511.{{cite journal}}: CS1 maint: multiple names: authors list (link) Sifaka ^talk 23:02, 26 May 2009 (UTC)

This 3-5 years thing confuses me. I've seen this expressed like that, 3-4-5 years, and as a (persistent?) 25-30-33% of age, which would mean that not only are those with ADD/ADHD behind, patients always getting more behind (or their age mates are always getting more ahead.) (I can see possible arguments for either to be the case, or something else.) htom (talk) 03:38, 27 May 2009 (UTC)

Unionhawk Apparently you find this tedious somehow. But tedious or not my statement is true. If you want to have your work respected by those readers with a background in the sciences you have to present the information using the agreed upon standards. And the standard for science writing is to refer to the journal where the information originally appeared. If you do not do this your presentation will be perceived as amateurish, and I know that you do not want that. --Franklinjefferson (talk) 16:26, 27 May 2009 (UTC)

WP:NPA. And you might want to read Wikipedia:Reliable sources (medicine-related articles) as well.--Unionhawk ^{Talk E-mail} 20:49, 27 May 2009 (UTC)

Franklin instead of trying to tell other users to track down the original medical paper, how about you locate it and add it to the article?--Literaturegeek | T@1k? 20:56, 27 May 2009 (UTC)

I already did. It's the one I listed above. While science papers are excellent, I kinda like the news article too because it's more easily readable for a lay person. How about we cite both? Sifaka ^talk 17:57, 29 May 2009 (UTC)

No objections from me Sifaka.--Literaturegeek | T@1k? 21:57, 29 May 2009 (UTC)

ADD

I'm sorry but what happened to ADD?? Have i been liveing under a rock since i was diagnosed or did it just dissapear?? Theres no such mention of ADD that i can find on wiki (although i just skimmed around\0 There is only one metion of ADD at all on wiki and that is one sentence. Shouldnt there be an ADD section of this page at least or a page of its on? can anyone enlighten me on this subject? 130.123.128.114 (talk) 02:58, 10 March 2009 (UTC)

You may have been living under a rock! The diagnosis of ADD was actually removed from the DSM in 1987; it became the "predominantly inattentive" subtype of ADHD. People still use the terminology because it makes sense, but it's technically not correct. Tim D (talk) 05:16, 10 March 2009 (UTC)

Well thats lame. Is there an article around explaining why ADHD is prevalent over ADD? And maybe it should be in here in a section of history of terminology or something like that. 130.123.128.114 (talk) 20:45, 10 March 2009 (UTC)

I think that would be good. Feel free to add a section under history about the changing terminology used to describe hyperactivity in children. This condition has been refered to be many different name over time and is refered to by different names in different areas of the world.--Doc James (talk · contribs · email) 22:01, 10 March 2009 (UTC)

FYI, there already is a section that addresses the history of terminology and such. But anyway, there are some researchers who argue that the predominantly inattentive subtype of ADHD is a completely different disorder from the combined subtype; it essentially comes down to how they're defined neurologically. I personally wouldn't be too upset if the DSM-V ended up redefining them separately... Tim D (talk) 23:58, 10 March 2009 (UTC)

Yes the classification is debated. The ICD10 uses different terminology and criteria all together. All I was saying is that if the above user find the discussion inadequate then he should feel free to clarify issues.--Doc James (talk · contribs · email) 01:16, 11 March 2009 (UTC)

ADD and ADHD are the same thing. It's just the difference between there being a "Hyperactivity" part there or not. The symptoms (possibly excepting hyperactivity), treatment, and diagnosis are the same. If you want to be technical, ADD is "ADHD predominantly inattentive"--Unionhawk ^Talk 18:19, 30 April 2009 (UTC)

Really ADD is the same thing as ADHD withouth the Hyperactivity. I think alot more people have ADD then ADHD. So really ADD is just not being able to pay attention and not remembering things. So it actualy covers alot of people. lol--Blake (talk) 21:57, 5 May 2009 (UTC)

I think there should be a separate page for ADD. I personally have ADD and dont like it when people assume ADD and ADHD are the exact same thing. And theres more to it than not being able to pay attention and not remembering things. Please do some research before making a claim like that. There's a distinction between ADD and ADHD. Please do your research. Sas 03:11, 29 May 2009 (UTC)Sas

Please if you disagree find a reference to back up what you say. ADD is the old term ADHD is the new term. Both terms are from the APA.--Doc James (talk · contribs · email) 03:42, 29 May 2009 (UTC)

To be technical, the DSM-IV TR refers to it as "Attention-deficit/hyperactivity disorder" which seems to refer to the optional subtypes. - cyclosarin (talk) 12:16, 11 June 2009 (UTC)

Section tagging the controversies section

Resolved

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

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

"the high rates of ADHD diagnosis" - There are mainstream sources that say ADHD is under-diagnosed or may be under-diagnosed in certain populations like girls [1] or adults (NICE). Also this controversial view is currently presented without any counterbalancing information. This statement presents as fact that over-diagnosis is due to alleged policies which force schools due identify children with ADHD, when there is are also arguments that overdiagnosis might be due to vague diagnostic criteria. And again there are mainstream sources which state that some populations have ADHD under-diagnosed. This should probably be reworded somehow to better express the over-diagnosis debate.

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

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

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

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

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

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

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

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

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

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

An editor posted this link [2] on my talk page. Dr Silver is, "...a Child and Adolescent Psychiatrist, is in private practice in the Washington, D. C. area. He is Clinical Professor of Psychiatry at Georgetown University Medical Center. Prior to his current activities, he was Acting Director and Deputy Director of the National Institute of Mental Health of the National Institutes of Health. Prior to his positions at the National Institute of Mental Health he was Professor of Psychiatry, Professor of Pediatrics, and Chief of the Division of Child and Adolescent Psychiatry at the Robert Wood Johnson School of Medicine. For more than thirty years his primary areas of research, clinical, and teaching interest have focused on the psychological, social, and family impact of a group of related, neurologically-based disorders—Learning Disabilities, Language Disabilities,Sensory Integration Dysfunction, and Attention Deficit Hyperactivity Disorder". I think he would meet the criteria of an expert in the field, and the book is considered a clinical book. He clearly delineates between between current research and medical perceptions of little current controversy. Specifically, "current debate over ADHD within the research and medical communities has been minimal and mostly concerned with subtle details within the diagnosis process and treatment program". That would seem to be at odds with what the article states about current perceptions, based on citations that are 10 or more years old.--scuro (talk) 03:36, 19 July 2009 (UTC)

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

Comorbid conditions

Resolved

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

can be reconciled with...

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

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

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

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

Reconciled? Cutting out weasel words your two quotes say:

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

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

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

questionable sentence in the lede?

Resolved

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

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

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

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

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

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

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

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

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

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

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

Clean up controversies section

Resolved

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

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

see also section

Resolved

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

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

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

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

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

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

Based my statement on this [[3]] were it says avoid if possible.--Doc James (talk · contribs · email) 13:30, 22 July 2009 (UTC)

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

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

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

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

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

prognosis section

Resolved

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

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

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

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

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

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

Balancing NPOV

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

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

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

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

"A study..."

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

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

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

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

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

Addition of content

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

Image size

Resolved

This is too small to read

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

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

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

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

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

Further arbitation

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

[4]

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

Stimulants and sudden death

Wondering were people think this paper should noted? "This case-control study provides support for an association between the use of stimulants and sudden unexplained death among children and adolescents."[[5]] The FDA recommends caution WRT the result which should be commented on as well.--Doc James (talk · contribs · email) 14:38, 16 June 2009 (UTC)

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

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

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

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

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

The FDA did comment on the study, "It's hard to characterize the results as reassuring," the FDA's Robert Temple said at a news conference. Still, Temple said, it's possible that the study missed stimulant use by the car-accident victims, because the parents of children whose deaths were unexplained might have better recall years later of what drugs they took. It's not a robust finding," he said, noting that if only one more automobile victim had been found to have taken an ADHD stimulant, the difference between that group and the sudden unexplained death group would no longer have been statistically significant. But, Temple said, "that doesn't mean that this is off the table and we're not concerned about it anymore." [6]--scuro (talk) 03:57, 12 July 2009 (UTC)

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

Low arousal theory

Unresolved

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

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

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

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

Ambiguity in the culture section.

Resolved

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

causes section

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

"Ilina Singh is at the London School of Economics and Political Science, Houghton Street, London" - not exactly a scientific expert. Lots of people want to put their finger in the, cause of ADHD "pie", but it belongs to the domain of the scientific community. It is after all, an accepted medical condition. Philosophy just doesn't cut it here, ie what does society believe and how did they come to believe that? Scientists already have spent a great deal of time examining the role of environment. Yes, ADHD most likely has different forms, and different causes, but they attribute of the bulk of cause of ADHD to genetics. Russell Barkley does an excellent job of sifting it all out for the lay person at his continuing ed course. Look under the Etiologies subheading. [7] Chunks of Singh's quote above are accepted within the scientific community. The notion that philosophy has any role in determining the "validity of the disorder" or that philosophy should be "integrated with scientific research", is not accepted at all by that community. Science doesn't do philosophy to get to a point of understanding. --scuro (talk) 11:41, 1 August 2009 (UTC)

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

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

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

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

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