Talk:Attention deficit hyperactivity disorder/Archive 17

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Fringe POV

The scientific community lists both the cause as unknown as well as the pathophysiology with the most likely hypothesis being that both are multifactorial ( ie. many causes ). Saying that there are potentially many interacting causes means that we should list many causes. This is what we have done. These causes are not at the exclusion of one another. For genetics to be a cause evolutionary theory much have played a role.

Now some fringe points of view are: ADHD is completely genetic ( no one in the medical community believes this ) that the pathophysiology has been worked out conclusively ( no one believe this either ). Doc James (talk · contribs · email) 05:26, 14 August 2009 (UTC)

Couple of problems with your reasoning here. First off, you seem to have missed the part about appropriate weight. That there is no single agreed-upon cause does not mean that all potential or hypothetical causes are equal. As I have mentioned before, just because there may not be agreement on the exact cause does not imply that the hypothesis that ADHD is caused by demonic spirits that feed on people's attention span is therefore valid. Yes, this is an extreme example, but I would hope that it highlights the point that I am trying to make.

Also, your statement that nobody in the medical field believes that it is completely genetic is...well, it is extremely disingenuous. Most notably, it ignores the fact that the evidence for genetic causes far outweighs evidence for any other cause. Here I am referring to twin concordance studies as well as the various genetic studies listed on OMIM...to say nothing of the many many many studies performed by Faraone on ADHD and genetics. Add this to studies by Zametkin, Krause, and Beiderman (I've already linked to these above, please don't make me hunt down those links again until I've had my morning Vyvanse) that showed distinct differences in brain structure and activity, including studies involving medication-naive patients...

Now, do you know of any hypothetical causes for which the body of evidence matches this? When you can, then we'll list it equally. At the moment, while there does not appear to be a clearly defined cause, there is a large body of evidence that strongly suggests a genetic, hereditary cause, most likely autosomal dominant (since most genetic studies have focues on heterozygous individuals), and that these genetic differences seem to involve changes in brain structure affecting regions thought to be responsible for the very functions where ADHD individuals show distinct deficits...AND Krause's studies especially highlight that these differences appear to involve structural differences that would lead to a dopamine deficiency, and Krause neatly ties it up with a ribbon and bow by demonstrating differences, in medication-naive individuals, in the exact structure (DAT) that is targeted by all ADHD medications!

So again, when there is evidence that even BEGINS to approach this, and I mean not just a single study but several series of studies (note that Zametkin, Biederman, Krause, and Faraone have published numberous studies on these subjects), and when this evidence is published and cited repeatedly, when it is accepted by a wide range of the scientific community...well, then it ought to be given equal weight.

But until that happens, the rules regarding equal weight mean that other theories as to the cause of ADHD should be given their due weight. Now, I do not know what that weight ought to be, depending on the theory, but so far I haven't seen much that merits more than a footnote. Seriously. ~ Hyperion35 (talk) 09:59, 17 August 2009 (UTC)

No that is okay, my reasoning is just fine. We mention and give both genetics and medical management of ADHD more weight than any other of the points of view. Eliminating mention of all other view points IS the fringe POV I am referring to. (Preceding unsigned comment is by Doc James.)

No, as I mentioned above in the Hunter vs Farmer discussion, we actually don't give genetics more weight. Look at the Genetics part of the Causes section, it's given roughly the same amount of space as any other cause, despite having roughly 100 times more published papers referenced on PubMed than most of the other hypothesized causes. The Management section of this article isn't quite as bad, but note that even though both NIH and NHS cite medication as the only method of treatment with proven efficacy, we give medication roughly the same space allotted to experimental treatments. Your assertion that anyone is trying to stifle opposing views is rather ludicrous in this light. ~ Hyperion35 (talk) 12:17, 19 August 2009 (UTC)

I am getting a little tired of your repeated agression which is almost always entirely unprovoked Hyperion. I also would like to know if you have any connection with scuro? You appear to know him. How do you know him?--Literaturegeek | T@1k? 12:43, 20 August 2009 (UTC)

Excuse me, but could you please focus on the content of my comments? We were discussing the extent to which various items were discussed in the article relative to the published scientific evidence and acceptance within the medical community. DocJames had a valid point of discussion regarding how we should apportion limited space in the article. I disagree with his assessment, and I have discussed why I disagree, but it is certainly a valid question for him to ask. This article is about ADHD. Comments about me should be left on the appropriate page, my talk page, thank you. ~ Hyperion35 (talk) 18:52, 20 August 2009 (UTC)

more fringe material

Unresolved

In the last paragraph of the Pathophysiology subsection we have this material, "Critics, such as Jonathan Leo and David Cohen, who reject the characterization of ADHD as a disorder, contend that the controls for stimulant medication usage were inadequate in some lobar volumetric studies which makes it impossible to determine whether ADHD itself or psychotropic medication used to treat ADHD is responsible for the decreased thickness observed in certain brain regions. They believe many neuroimaging studies are oversimplified in both popular and scientific discourse and given undue weight despite deficiencies in experimental methodology.".

As Hyperion previously stated about the authors and their book, "..it included a passage on Realist vs. Anti-Realist philosophy and how this related to whether one can ever know whether ADHD really exists. The page that was cited actually attempts claim that Zametkin disagrees with ADHD as a medical diagnosis. I am not making this up...I actually wish it were a joke:[1]". I'm all for minority opinion but fringe opinion has no place on this article and this material should be moved to the controversies article or deleted.--scuro (talk) 14:16, 8 August 2009 (UTC)

The sources are peer reviewed and are not given undue weight so they should stay. Do you have any sources which sounter what they say regarding the robustness of the imaging studies? The passage in the book seems to be just the authors covering the range of controversies of ADHD in a large book. Books are large and often cover a large range of territories and anyway is irrelevant as the book is not cited in the article.--Literaturegeek | T@1k? 16:59, 10 August 2009 (UTC)

Would Leo & Cohen themselves count? Turns out that they revisited this a few years later. They mention that a study was done with unmedicated ADHD patients, and they report that the study found that the unmedicated patients had the same differences in brain size exhibited by medicated ADHD patients. Leo and Cohen of course still refuse to accept that medication isn't causing the difference. They go on to change tack and argue that the size differences aren't really differences at all....this is called the "Moving the Goalposts" fallacy, but I digress. Text of Leo and Cohen fessing up can be found

here

But the thing is, plenty of other neuroimaging studies have used unmedicated ADHD patients. One of my favorites is a series of SPECT studies by Krause et al. They used medication-naive patients, and demonstrated several things: That medication-naive ADHD patients demonstrate differences in dopamine transmission compared to non-ADHD controls, and that administration of methylphenidate successfully altered these differences. Furthermore, just so that you don't think that this is confined to one group of researchers, these findings were replicated by Biederman using PET scans (which are very similar), also using medication-naive patients.

1

2

3

I actually could have included more references, but I'm having difficulty accessing pubmed, so I had to resort to scholar.google.com, and thus it was more difficult to find these, simply due to my inexperience with that particular method of searching for academic papers. ~ Hyperion35 (talk) 22:47, 10 August 2009 (UTC)

You distorted and took out of context what this paper said, [2] using original research arguments. What you have said is also all original research, when citing on wikipedia we have to stick to what the papers say. Also the other refs you said are on dopamine. Dopamine is a neurotransmitter, not a brain structure! So it is an irrelevant original research argument by using irrelevant refs to dispute a ref. Please see WP:OR. Original research is not allowed on wikipedia and use of original research on talk pages is usually a waste of time and can be disruptive. Please also try to shorten your replies on talk page, see WP:TLDR, some of your other replies to myself and other editors are very long.--Literaturegeek | T@1k? 15:49, 11 August 2009 (UTC)

Everyone take a deep breath. I don't read

That medication-naive ADHD patients demonstrate differences in dopamine transmission compared to non-ADHD controls, and that administration of methylphenidate successfully altered these differences.

as saying that "dopamine is a brain structure". htom (talk) 17:40, 11 August 2009 (UTC)

Perhaps if individuals had chosen to carefully read the studies that I cited, this misunderstanding could be avoided. The research papers that I have referenced here refer to differences in the density of DAT, the dopamine transporter, which is a protein found on the cell membranes of neurons at the axon terminal. This structure plays a role in dopamine uptake, removing dopamine (yes, dopamine is a neurotransmitter) from the synapse. Again, please read these studies carefully, and please ensure that you are familiar with some basic cellular neurology, neuropharmacology, and the basic properties of neurochemical transmission *before* you critique these studies. I was trying to keep my comments brief, rather than turning this into a lecture on neuropharmacology. I did not say that dopamine was a brain structure.

So let me recap here, I was discussing how these researchers used functional neuroimaging to find differences in the expression of proteins on the cell membranes of neurons. Now, can we all agree that neurons are a part of the brain's structure? Can we all agree that proteins on the cell membranes of neurons, that facilitate neurochemical transmissions are a part of the brain's structure? Any objections so far?

Now, I am trying to keep my replies here short. Unfortunately, I may have been too short in my previous reply, as apparently there was confusion as to what I meant. In the interest of keeping this reply short, I will stop here, and if anyone has further questions, I will address them. Also, I would prefer it if individuals would be more polite, please, and ask me to clarify my remarks before dismissing them as irrelevant. I can assure you that these citations are most definitely relevant, and I am sorry if there is some sort of misunderstanding as to why I referenced them, ok? ~ Hyperion35 (talk) 08:58, 12 August 2009 (UTC)

I just realized that I messed up in the formatting tags for those links, they should work correctly now, my apologies if anyone had difficulty clicking on them ~ Hyperion35 (talk) 11:21, 12 August 2009 (UTC)

Hi Hyperion, I did read the studies and they were discussing neurotransmitters, specifically dopamine or their transporters. I am also familar with the basics of neuropharmacology and cellular neurology. The disputed sentence(s) were discussing brain volume size, so your refs on dopamine transporters were not relevant.--Literaturegeek | T@1k? 10:33, 18 August 2009 (UTC)

I did cite Leo & Cohen's followup paper in which they cited further data from Castellanos et al using unmedicated ADHD patients. That was my reference disputing Leo & Cohen's previous claim that the brain volume sizes were due to medication. The further studies that I referenced, by Krause et al and by Biederman et al, were provided to show that there were many other studies using medication-naive patients that also found structural differences in the brains of ADHD patients, contrary to the claims made by Leo & Cohen.

Now, it is true that the Krause and Biederman studies were not looking at brain volume. They were much more precise studies looking at actual differences in structures located on the axon terminals of the neurons of ADHD patients as compared to non-ADHD controls. Specifically, they looked at DAT, a protein located in the cell membrane of the axon terminal that is responsible, along with the closely related NET, for catecholamine (dopamine and norepinephrine) uptake. You will note that all drugs currently approved for the treatment of ADHD (amphetamines, methylphenidate, and atomoxetine/reboxetine) exert their pharmacodynamic effects via DAT and/or NET. Furthermore, some of Krause's studies specifically examined differences in DAT and compared this with SPECT scans of methylphenidate binding affinity in different regions of the brain and compared this between ADHD patients and non-ADHD controls, and found significant differences.

I felt that mentioning these studies was very relevant, as it showed that there were a number of other studies that had found structural brain differences using medication-naive individuals. The main reason why these other studies are not often mentioned is because they involve more hardcore clinical neuroscience, and it might be difficult to adequately summarize them in this Wikipedia article in a manner accessible to most lay individuals. Their relevance also requires an understanding of the clinical pharmacodynamics of the medications used to treat ADHD.

However, I would hope that this puts to rest the claims by Leo & Cohen and others that the structural differences observed in neuroimaging studies were due to the effects of medication. Many studies have found structural differences in medication-naive ADHD patients. ~ Hyperion35 (talk) 14:05, 18 August 2009 (UTC)

No these studies have found differences in neuronal makeup, not brain structure and even when talking about neurons it is still pushing it to call it neuronal structural. The studies found differences in DAT levels between in ADHD individuals, which is an interesting finding.--Literaturegeek | T@1k? 12:31, 20 August 2009 (UTC)

LG, you asked for citations that countered what Leo & Cohen said about the lack of neuroimaging studies involving medication-naive ADHD patients. I believe that I have provided a number of citations. However, let's go back specifically to the original Castellanos study that Leo & Cohen specifically disputed. The full text of it can be found here

I really should have just gone directly to this study instead of even bothering with Leo & Cohen's update. Turns out that in addition to controlling for medication usage, Castellanos et al did control for age differences, contrary to what Leo & Cohen wrote. Here is the relevant passage, from the study:

"To examine the influence of medications more closely we compared patients with ADHD who were never previously treated with psychotropic medications (unmedicated ADHD), medicated patients (medicated ADHD), and controls. The unmedicated ADHD patients were significantly younger than the medicated ADHD and controls; thus, we confirmed findings in age-matched subgroups (n = 128). All pairwise comparisons were conducted with Bonferroni corrections."

Does this finally answer your question? Leo & Cohen's assertions were erroneous. Castellanos et al did control for medication usage and while the unmedicated pool was on average younger, they used age-matched subgroups to control for any age discrepancies. Note that I have quoted directly from the paper here so as to avoid any concerns over OR. This is the absolute last that I will say on this particular topic, as I am getting tired of debating how many amines can dance on the terminal of an axon. ~ Hyperion35 (talk) 19:59, 20 August 2009 (UTC)

I am not sure if you even read the review articles. Cohen never said that there have been no comparison studies, at least in his most recent review. He criticises the methodology. I cannot help it if you do not agree with his criticisms but your criticisms I feel are original research and a misrepresention what the references say. Anyway here are some exerpts.

"Moreover, the few recent studies using unmedicated ADHD subjects have inexplicably avoided making straightforward comparisons of these subjects with controls."

"The most important — and we would say legitimate — comparison was between unmedicated patients and controls. However, compared to the controls, the unmedicated patients were two years younger, shorter and lighter.4 Castellanos et al. state that height and weight did not correlate with brain size in their study. Yet in that study these variables were significantly correlated with the diagnosis of ADHD. Thus, although finding three biological differences between the ADHD children and controls, the researchers only focused on brain size."

"for the most important comparison in the paper the subgroup of unmedicated patients is drawn from this already smaller and lighter group of patients; we are not told the height and weight of this subgroup of unmedicated patients but we are told that they are almost two years younger than the entire patient group; and for this reason the unmedicated patients are probably also significantly shorter and lighter than the control group. We say “probably” because for the most important comparison in the article the subjects’ specific physical characteristics are not provided. The issue of height and weight is especially relevant here because most research on brain size has found brain size to be correlated with body weight."

"this effect was not eliminated in the Castellanos et al. (2002) study."

"In fact, given all these other variables it would be noteworthy if they did not have smaller brains."

"However, this hardly seems the type of study to adequately address this issue, since the authors provided no information whatsoever about medication use (such as doses, durations, or even types of drugs used) except this one sentence: “At the time of the first scan, 103 patients (68%) were being treated with psychostimulants”"

I assume that you did not read the review by Cohen. He raises valid criticisms which you are most likely in good faith misrepresenting. As stated earlier I would respectfully request that you do not reply with original research, I cannot help it if you do not agree with Cohen's review of the evidence base.--Literaturegeek | T@1k? 17:55, 24 August 2009 (UTC)

Did you read the Castellanos study? I mean the one written by Castellanos, not the summary provided by Cohen. And yes, I did read Cohen's review. Now again, perhaps I am misunderstanding something, but Castellanos specifically states:

"To examine the influence of medications more closely we compared patients with ADHD who were never previously treated with psychotropic medications (unmedicated ADHD), medicated patients (medicated ADHD), and controls. The unmedicated ADHD patients were significantly younger than the medicated ADHD and controls; thus, we confirmed findings in age-matched subgroups (n = 128). All pairwise comparisons were conducted with Bonferroni corrections."

Now, Cohen mentions that the unmedicated patients were significantly younger, but he does not seem to address Castellanos' additional methodology of using age-matched subgroups. Stating that Castellanos used age-matched subgroups is not original research. I am citing Castellanos' published, peer-reviewed study, and quoting specifically how Castellanos described his methodology. Does Cohen address the use of age-matched subgroups? I did not see any mention of this in Cohen's review, but it is entirely possible that I have missed it. ~ Hyperion35 (talk) 23:14, 24 August 2009 (UTC)

Hello, In the above quotes Cohen mentioned a subgroup in the Castellos study which presumably was the age matched group. I will read the Cohen review again more in depth when I have time. Cohen states for the subgroup they did not give height and weight variables, as Cohen says that overweight children have different brain volumes than say average or slim children. Did the Castellos study give height and weight variables for the age matched controls? The cohen review whilst sceptical is basically saying that there are methodological limitations and more robust studies need to be done before firm and definite conclusions can be drawn is all.--Literaturegeek | T@1k? 00:01, 25 August 2009 (UTC)

I cannot find any reference to height and weight in any of the data. However, this is not unique to this particular subgroup. If anything, one might have expected the medicated children to be slimmer and shorter, rather than the unmedicated children, contrary to what Cohen states, but that's pure conjecture. Look, Cohen may be right to state that more research is needed, but that's really his sole defensible point. Note that Cohen keeps moving the goalposts here. First he claims that the study is invalid because it did not control for the effects of medication. Then he claims that the unmedicated group was younger. Then he claims that it's an issue of weight. I'll fully admit that this is original research on my part, but my intuition in these situations is that Cohen is simply grasping at straws to disprove the Castellanos study. If Castellanos was the only one to find differences in the brains of ADHD individuals, I might be willing to buy Cohen's logic, but when you look at the totality of functional neuroimaging studies by others, there is a clear pattern of studies showing at least functional differences. My personal opinion is that I have difficulty accepting Cohen's claims at face value, because it would require a certain level of credulity that I do not possess. ~ Hyperion35 (talk) 00:17, 25 August 2009 (UTC)

You have made a good point albeit OR. If you look at the pathophysiology section it is only a small paragraph criticising some of the research, so I think due weight is given. I think that it was just the brain volume studies that they criticised (I could be wrong?) rather than the dopamine levels.--Literaturegeek | T@1k? 00:26, 25 August 2009 (UTC)

Controversy and the great divide

From the NIH consensus statement of 2002:[3] We, the undersigned consortium of international scientists, are deeply concerned about the periodic inaccurate portrayal of attention deficit hyperactivity disorder (ADHD) in media reports. This is a disorder with which we are all very familiar and toward which many of us have dedicated scientific studies if not entire careers. We fear that inaccurate stories rendering ADHD as myth, fraud, or benign condition may cause thousands of sufferers not to seek treatment for their disorder. It also leaves the public with a general sense that this disorder is not valid or real or consists of a rather trivial affliction.

We have created this consensus statement on ADHD as a reference on the status of the scientific findings concerning this disorder, its validity, and its adverse impact on the lives of those diagnosed with the disorder as of this writing (January 2002). Occasional coverage of the disorder casts the story in the form of a sporting event with evenly matched competitors. The views of a handful of nonexpert doctors that ADHD does not exist are contrasted against mainstream scientific views that it does, as if both views had equal merit. Such attempts at balance give the public the impression that there is substantial scientific disagreement over whether ADHD is a real medical condition. In fact, there is no such disagreement—at least no more so than there is over whether smoking causes cancer, for example, or whether a virus causes HIV/AIDS. The U.S. Surgeon General, the American Medical Association, the American Psychiatric Association, the American Academy of Child and Adolescent Psychiatry, the American Psychological Association, and the American Academy of Pediatrics, among others, all recognize ADHD as a valid disorder. Although some of these organizations have issued guidelines for evaluation and management of the disorder for their membership, this is the first consensus statement issued by an independent consortium of leading scientists concerning the status of the disorder. Among scientists who have devoted years, if not entire careers, to the study of this disorder there is no controversy regarding its existence.

Dr. Silver has also mentioned this divide about what is considered controversial.[4] The scientific and medical community see little controversy in comparison to the media and general public. This material will be added shortly unless there are objections.--scuro (talk) 12:07, 13 August 2009 (UTC)

Already added this a while back to the controversies page. There is also a rebuttal published aswell. Doc James (talk · contribs · email) 12:40, 13 August 2009 (UTC)

It needs to be on the ADHD page also. It is noteworthy that there is a major divide on the viewpoint of controversy.--scuro (talk) 16:21, 13 August 2009 (UTC)

If NIH, which is a taxpayer-funded public health institution, one of the best in the world (and a beautiful campus) has issued a consensus statement that there is no controversy, that would strongly imply that there is no controversy, at least within the United States. Or at least, this statement appears to imply that any "controversy" about the existence of ADHD as a valid medical condition is roughly on par with HIV denialists.

If we must have a "controversy" section in this article, surely this statement must be there. Why the (expletive) did we have Szasz and various other Scientologist wackjobs cited there and not NIH? That strikes me as a serious oversight. Clearly NIH is considered a major scientific source. This NIH statement absolutely should be included, and should be the main highlight of the Controversy section in this article, given its weight as a source. ~ Hyperion35 (talk) 10:12, 17 August 2009 (UTC)

I'm confused!! The two links above go to "Barkley_2002.pdf" (a private initiative, signed by many people) and a page in Silver's book (google books). What does either of these have to do with NIH? -Hordaland (talk) 14:25, 17 August 2009 (UTC)

I'm also confused as we do mention this paper already on the controversies page.Doc James (talk · contribs · email) 15:53, 17 August 2009 (UTC)

Ah, you are correct, Hordaland, there were in fact TWO International Consensus Statements on ADHD, one published by NIH in 1998, another published by Barkley in Clinical Child and Family Psychology Review in 2002. As for Silver's book, it's an academic/clinical publication and it was quoted simply for summarizing and synthesizing information from the consensus statements and from other sources.

As for DocJames' question, yes this is mentioned on the Controversy page (although given such a short mention that it makes a mockery of WP:UNDUE), but I think it is fair to ask why two major consensus statements as to the lack of real scientific controversy on this subject are not mentioned in the Controversy section of this article, given that these are high-profile papers. There is only room for a small paragraph in this article, so I think it is worth mentioning these consensus statements. ~ Hyperion35 (talk) 20:14, 17 August 2009 (UTC)

Sorry, forgot to include the link to the NIH consensus statement, which can be found here ~ Hyperion35 (talk) 20:45, 17 August 2009 (UTC)

Yes I have no concerns with this source. Add away. It mentions that ADHD is controversial, that there are concerns about were one draws the line between normal and abnormal, it says that most studies of stimulants are of short duration and that stimulants are controversial for a number of reason. It reflects well the current ADHD page.Doc James (talk · contribs · email) 05:14, 18 August 2009 (UTC)

James, dear, please actually read the NIH Consensus statement beyond the first few pages, thank you. You will find that they state that

"Despite progress in the assessment, diagnosis, and treatment of ADHD, this disorder and its treatment have remained controversial in many public and private sectors. The major controversy regarding ADHD continues to be the use of psychostimulants both for short-term and long-term treatment."

However, they go on to state that there is ample evidence that stimulant medication is the most effective treatment, more effective than the few psychosocial treatments that had been found to have some benefit. They do mention a lack of long-term data, and I'm not going to go into the reasons why long-term data is difficult to gather, except to say that the vast majority of pharmaceutical treatments for many conditions involve only short-term clinical trials, for reasons that are again far too lengthy to discuss in this space.

They also state, in the NIH Consensus Statement:

"The diagnosis of ADHD can be made reliably using well-tested diagnostic interview methods. However, as of yet, there is no independent valid test for ADHD. Although research has suggested a central nervous system basis for ADHD, further research is necessary to firmly establish ADHD as a brain disorder. This is not unique to ADHD, but applies as well to most psychiatric disorders, including disabling diseases such as schizophrenia. Evidence supporting the validity of ADHD includes the long-term developmental course of ADHD over time, cross-national studies revealing similar risk factors, familial aggregation of ADHD (which may be genetic or environmental), and heritability."

Also:

"In summary, there is validity in the diagnosis of ADHD as a disorder with broadly accepted symptoms and behavioral characteristics that define the disorder."

Further, I can find absolutely no support within the NIH Consensus statement for any of the claims made in the Controversy section of this article or in the ADHD Controversy article. The extent of the "controversy" mentioned in the NIH Consensus Statement appears to involve the need for more long-term research into stimulants and the need for more research into the neurological correlates of ADHD...as for the latter, I have already discussed Krause's SPECT scans and Biederman's PET scans, both of which were conducted after the NIH Consensus Statement was written.

I am once again sorry for answers that may appear to be too lengthy, but I am concerned that short snippets tend to obscure what are very nuanced and complex medical issues. ~ Hyperion35 (talk) 13:24, 18 August 2009 (UTC)

(undent) Please do not be partronizing. --Doc James (talk · contribs · email) 14:45, 18 August 2009 (UTC)

I have added the information from the two Consensus Statements into the Controversy section of the article. My Wikipedia formatting skills are horrific, so there may still be one or two minor formatting errors. I added quite a bit, and I know that it is probably too long for the section, but I figured that it would be better to add as much information, and then presumably it can be distilled into a shorter summary. My intent was to quote the citations directly so as to avoid POV and OR concerns. As for appearing patronizing, I apologize, but from your comments, it really did appear that you have not read the Consensus Statement fully, or perhaps that you had missed several very important paragraphs, which I have quoted. ~ Hyperion35 (talk) 15:33, 18 August 2009 (UTC)

The problem with quoting too much is you will then get someone coming along alledging plagiarism and delete your additions or reword them. It is also unencylopedic.--Literaturegeek | T@1k? 12:41, 20 August 2009 (UTC)

It's not plagiarism. Plagiarism would be if I claimed that Barkley's words were my own. What you are thinking of is copyright violation. The NIH Consensus Statement shouldn't be an issue, since NIH is funded by the US Government. I suppose that Barkley's 2002 Consensus Statement might be slightly different, but the amount quoted probably constitutes fair use. I suppose I could email Dr. Barkley about it. However, as it is a Consensus Statement, and the basic idea is for it to be distributed widely, I don't expect that he would be upset about it.

As for being encyclopedic....well, it does add to the length of the article. On the other hand, these are two very weighty statements that are directly addressing questions regarding controversies. Also, one intent behind directly quoting these statements is that I felt that it would be less likely to create dispute. ~ Hyperion35 (talk) 18:38, 20 August 2009 (UTC)

What has been done is copying and pasting paragraph after paragraph of research. This is not quoting what someone said or stated. Please summarise in your own words. The copying and pasting in the controversy section is unencyclopedic.--Literaturegeek | T@1k? 18:43, 24 August 2009 (UTC)

They are Consensus Statements. They are written specifically to communicate certain findings, summaries of current research. My reason for quoting them directly is that there is a very disturbing trend of misquoting and misrepresenting scientific findings in this article that goes back for a fairly long time. The number of times that I have had to correct gross misrepresentations of Zametkin's findings alone is heartbreaking. ~ Hyperion35 (talk) 00:01, 25 August 2009 (UTC)

Are you suggesting that the bulk of this article should be copied and pasted from sources? It is still unencyclopedic.--Literaturegeek | T@1k? 08:59, 26 August 2009 (UTC)

I would totally agree with Hyperion. The term that best describes this is "cherry picking" and it happens in several places on the article. Such sections will be fixed but they have a way of creeping back into the article. The gross misrepresentations of Zametkin has indeed been going on for YEARS....even though the need NOT to change this section has been pointed out many times. This is why I believe this article is so deserving of a NPOV tag. The article varies in the level of bias, but one can always be sure that at no point it is neutral. While there is a lot that is good with this article, there is a lot that still needs to be fixed. --scuro (talk) 23:44, 14 September 2009 (UTC)

The so called cheery picking was me using secondary sources, reviews and meta-analysis. Please focus on content and not the contributer scuro! There is a lot of good, but the remaining stuff that you don't agree with means that it is not neutral? Hmmm, ok.--Literaturegeek | T@1k? 00:15, 15 September 2009 (UTC)

Clarification of the purpose of Wikipedia

Wikipedia is here to represent the breadth and depth of human knowledge. What we have here is two camps. One who questions a purely pharmaceutical and genetic approach to ADHD and the other that claims ADHD has a genetic basis and all other view points need to be banished. Wikipedia is not here to take a position only to represent all POV as they are presented by their proponents ( not their opponents as was done previously ) .Doc James (talk · contribs · email) 15:56, 17 August 2009 (UTC)

James, Wikipedia is an encyclopedia, a resource. Please see WP:UNDUE to review Wikipedia's policy on giving appropriate weight to sources. Also please see WP:INDISCRIMINATE and WP:SOAP as well.

Also, please refrain from attempting to characterize other editor's views using your own words, as doing so edges fairly close to a Straw Man fallacy. If you feel that certain viewpoints are not being addressed, then your responsibility is to find verifiable sources to support those viewpoints AND if you wish for those views to be accorded equal weight with existing scientific hypotheses, then you need to find sources of similar quality. In short, it is the responsibility of those who wish to include information to demonstrate why such information ought to be included. All viewpoints are not equal when dealing with medical science, and you should know this. ~ Hyperion35 (talk) 19:58, 17 August 2009 (UTC)

I am well aware of Wiki policies. I have supported the points I have added with peer reviewed literature. Thus they shall stay. Please do not twist my words. No one is asking for equal weight for the social construct theory. It is given a couple of lines at the end of the section.

View points are currently addressed, what I am refering to is attempts to change this.Doc James (talk · contribs · email) 05:01, 18 August 2009 (UTC)

James, some of the sources that you have provided have included a survey of Scandanavian schoolteachers and a paper examining the social forces that shape how the term ADHD is used in news media and among lay individuals. You have also cited papers that state that more research is needed with regards to biological causes, but that is not the same as research showing other causes or demonstrating any real evidence for the disorder being a social construct. I have, on several occasions, gone through your sources, and described my opinion, which is no more valid than anyone else's, of whether these sources actually support these claims.

Further, the main researcher who you have cited more than anyone else is Timimi, and while I will rescind my earlier statement that he was a Scientologist, I would like to draw your attention to the speech that he gave at a Scientology center in which he called for a moratorium on prescribing psychiatric medication, all psychiatric medication, to children. He also used language that was extremely unprofessional, likening the prescription of psychiatric medication to "eugenics" (his own words). Even in the paper of his that you cited, he claimed that psychiatrists were acting as "agents of social control" and "victimising young children." Now, my opinion is that he appears to represent fringe viewpoints.

I guess I'm just confused as to why you are so adamant in demanding space for a theory that appears not to be endorsed by the AMA, APA, AAP, AAFP, ANPA, AACAP, NIH/NIMH/NINDS, NHS, and lord knows how many other alphabet-soup medical organizations....literally the only initials I can think of that support this theory are CCHR, and again, that's not a good thing. ~ Hyperion35 (talk) 12:58, 18 August 2009 (UTC)

And I am confused as to why you are attempting to remove well referenced opinions. Anyway sorry for the short responses will try to address your concerns more fully in latter Sept. as currently busy with real life.Doc James (talk · contribs · email) 15:04, 18 August 2009 (UTC)

I personally think that due to the huge and valid controversies and drama and debate on this talk page regarding authors with a conflict of interest, be it scientology, clearly identified as antipsychiatrists, employed by drug manufacturers of amphetamine based medications that we should strive to use other sources for these view points OR ELSE if we are citing them we should make clear their conflict of interest in the article text, such as "So and so with ties to CCHR (or ties to the drug manufacturers) found (or stated) that xyz".--Literaturegeek | T@1k? 12:51, 20 August 2009 (UTC)

Actually, that's fairly easy. To my knowledge, not a single individual has been cited who was an employee of Shire, Novartis, Lilly, or any other company that manufactures ADHD medications.

Also, the reason why Scientology/CCHR was mentioned, and why I mentioned Timimi's statements, is that they go to my assertion that he represents fringe viewpoints. Viewpoints such as calling for a complete moratorium on prescribing all psychiatric medications, including ADHD medications, to children, and comparing the use of psychiatric medications to Eugenics are in my opinion fringe viewpoints. I am not advocating for placing this in his citations, I am offering this as evidence for his being a fringe source who is probably not appropriate to quote. I also mention it because I do not think that including Timimi as a source is particularly helpful to the points that DocJames wishes to make. In fact, I think that it actually detracts from DocJames's points quite a bit, and I think that by pointing this out to him, he may be encouraged to search for better sources.

Finally, please note that I also expressed concern that a number of the non-Timimi papers that Doc James has cited did not support the assertions for which they were cited. I went and read through those sources, and documented the problems that I found. That is one of the purposes of this discussion page, to discuss and review various sources. A similar example would be where Scuro mistakenly referenced Barkley's 2002 International Consensus Statement as being the 1998 NIH Consensus Statement. Another editor noticed this and asked why Barkley's statement did not appear to come from NIH. I did a few quick searches and found that the confusion stemmed from the fact that there were two Consensus Statements, which was doubly confusing since Barkley served as a speaker during the 1998 NIH Consensus Statement process. ~ Hyperion35 (talk) 19:17, 20 August 2009 (UTC)

Ok, good sounds like we have consensus on this issue regarding drug companies and scientology and attributing association. I would like to see the context in which Timmi made these statements as scientology has a habit of cutting sentences out of context and rewording it to suit an agenda, not just doctors who they agree with but also those they oppose. However, I agree that the statements by Timmi are rather extreme.--Literaturegeek | T@1k? 18:41, 24 August 2009 (UTC)

No, we do not have a consensus. You mentioned employment in your previous statement. To my knowledge, Barkley is not and has never been employed by any pharmaceutical company. My assent was with regards to your statement of employment. Further, with regards to accepting money, it should be noted that there is a difference between accepting money to fund research or travel expenses to a sponsored conference, and accepting money for personal gain. On a related note, I find the "Pharma shill" gambit to be very distasteful, and my experience is that it is often used when there are few convincing arguments to be made. If you really believe that Barkley's Consensus Statement was influenced by pharmaceutical company money, then feel free to cite that. It's not an ad hominem, per se, I just fail to see the relevance and I really do not believe that anyone with a background in Medicine would consider it noteworthy. Should I include a note on my user talk page that I once had a pharmaceutical company pay for breakfast because they wished to discuss regulatory issues with me? Surely you see the utter vapidity of such reasoning. Eventually it turns into a postmodernist rejection of all authority as being "tainted," and down that road lies madness.

Similarly, If you want to include Timimi, feel free. I would not even request that you add in his quotes at the Scientology conference on the main page. I was mentioning them here because I believe that upon reading them, most reasonable people might feel uncomfortable about using Timimi as a source. I also did wonder whether CoS was taking his remarks out of context, but his remarks are consistent with his published statements in other sources. For example, his letter to BMJ called psychiatrists "Agents of Social Control" who "victimise young children." And the funny thing is, Timimi is probably the most respectable of the main proponents of Social Construct Theory...not that it's a particularly high hurdle, given that Breggin isn't even board-certified.

And that's sort of the gist of my entire point about "controversies" surrounding ADHD. At first glance, there may appear to be controversies, there may appear to be other views with legitimate backing. But if you examine the sources, even just scratch the surface, most of the "controversies" fall apart like a house of cards. It's built largely on innuendo, quotes taken out of context, and shady sources like Breggin, Szasz, Baughman, and Timimi. ~ Hyperion35 (talk) 23:57, 24 August 2009 (UTC)

The ref said Barkley works as a consultant or advisorary board for several pharmaceutical companies, so that would be an employment, a job. You may be of the view that it is distasteful and that most doctors don't agree that drug company connections can influence behaviour and research etc but your wrong as almost every medical journal now requires or requests that publishers declare their conflict of interest on any submissions of peer reviewed literature. The NIH I believe also tried to eliminate conflict of interest. Do you find the NIH and mainstream medical and psychiatric journals distasteful as well? A paid breakfast is not really a COI, a breakfast costs what $15? It is not the same as working for them like Barkley and Bielderman and getting thousands or millions of $$$ etc. I am going to try and avoid citing Timmi actually as he has reduced credibility in my eyes now. I have never cited to Breggin and Baughman and have no opposition for removing Szasz from the article. I am of the view we should whenever possible avoid authors who have a conflict of interest. That is not to say we should never cite them, sometimes they are worth citing but just if a better source is available (eg the NIH consensus statement) then we should strive to use it. If we do this then we should avoid a lot of the drama and disputes that develop on this page. Do we have consensus or some sort of an agreement now?--Literaturegeek | T@1k? 00:14, 25 August 2009 (UTC)

Not entirely. The problem with avoiding anyone with any ties to pharmaceutical industries is that it eventually winds up excluding the vast majority of authoritative researchers. My point with regards to the breakfast was that at some point, everyone in Medicine works with private interests, at least in America, because private organizations such as pharmaceutical companies play a very large role in medical research. I'm still not sure what the relevance to Barkley's work is, since he does not specifically endorse a specific medication, and his statements regarding medication usage are sourced to treatment guidelines from the FDA and do not appear to deviate from statements from others. Is there a perceived COI there? Maybe, but I'm having difficulty imagining how it would work. It would imply that Shire, Novartis, and Lilly had conspired together to pay Barkley to write that statement, in which he cites numerous other sources who then must also have been paid off by these companies, and then these companies would also have had to bribe every single signatory. The scope of this would be such a far-reaching conspiracy theory that it would encompass the entire mental health field. Or it might just be that these companies paid him for the same reason that I've seen companies pay other physicians: they needed the advice of an expert in the field.

If you want to cite it as a potential COI, then go ahead, I'm not going to get into an edit war over something this minor. However, I do wish to impress upon you the extent to which this potential COI would have to involve a conspiracy so vast that it would extend into multiple government agencies in several different countries, if it were to actually be of relevance. Otherwise, it strikes me as the sort of minor issue that is probably not worth mentioning. ~ Hyperion35 (talk) 00:32, 25 August 2009 (UTC)

Just wanted to add that since amphetamines have been used to treat ADHD since the 1930s, and methylphenidate since the 1950s, this must be one deep and far-reaching conspiracy indeed. Sounds like a job for Robert Langdon ~ Hyperion35 (talk) 00:35, 25 August 2009 (UTC)

As I said medical journals think it is relevant enough to request conflict of interest statements so I don't feel it is fair to label what I have said a conspiracy theory. I was only wanting to apply it to very contentious statements which lead to drama on this article, not routine statements by people tied to drug companies or antipsychiatry groups. I felt it would make editing more easy. Oh and by the way anywhere from 30-50% possibly higher number of people on chronic therapeutic benzodiazepines experience a significant physical withdrawal syndrome but YET it took the medical profession and scientists about 30 years to even acknowledge its existence, so the amphetamines have been used since the 1930's is not a convincing argument and amphetamines only in the past couple of decades became wide spread in use in children and for ADHD and also the NIH statement still says more long-term research needs to be conducted etc.--Literaturegeek | T@1k? 02:32, 25 August 2009 (UTC)

Simply because something is well referenced doesn't mean it belongs as posted. Undue weight issues are a major problem with this article. When one focuses on a narrow band of information, and you ignore, or play short shrift to majority opinion...you are cherry picking.--scuro (talk) 23:57, 14 September 2009 (UTC)

Scuro I insist that you stop accusing me of cherry picking, I regard this as a personal attack. I have from day 1 added review articles and meta-analysis, at least 95% of my additions to ADHD articles were of this nature. I stuck to WP:MEDMOS, so please quit your original research personal attacks and find some good refs for your position. I have never stopped you finding refs for your position so your accusations are irrelevant.--Literaturegeek | T@1k? 00:18, 15 September 2009 (UTC)

I have not personally accused you of anything. Stating that my position is irrelevant speaks volumes.--scuro (talk) 03:19, 16 September 2009 (UTC)

The fact that stimulants have been around since the 1930 has no effect on how useful they are. Effectiveness is based on scientific research. The requirement to prove effectiveness has only been around since 1962 in the USA.[5] And evidence based medicine is even younger than that.Doc James (talk · contribs · email) 07:02, 15 September 2009 (UTC)

1962?!?? That is 47 years ago. Stimulants have to be one of the most studied drugs on this planet.--scuro (talk) 03:19, 16 September 2009 (UTC)

(undent) Not at all true. The largest and longest study involving ADHD was 2 years in duration and involved 579 children. The Women's Health Initiative involved 93,000 women and lasted 11 years.Doc James (talk · contribs · email) 23:30, 17 September 2009 (UTC)

unresolved

{{Deadlocked}} Many issues are still unresolved, see archives 12-16. Contributors have had plenty of time to respond to these unresolved issues but they have been ignored.--scuro (talk) 00:06, 15 September 2009 (UTC)

On what grounds do you have to dictate to me what I do with my time? Shall I assign you tasks on wikipedia to do and insist you perform them? Last time I checked I was not getting paid for my work on wikipedia. I have responded non-stop to those hundreds of kilobytes of drama churned out on these ADHD articles but apparently I am not working (for free) hard enough!?! If you like we could do a deal, I can find you work to do on wikipedia, when you have performed appropriately then I will consider "working harder", spending dozens more hours per week on ADHD pages.--Literaturegeek | T@1k? 00:20, 15 September 2009 (UTC)

Agree completely accusing others of not working hard and fast enough is not productive.Doc James (talk · contribs · email) 06:55, 15 September 2009 (UTC)

The fact is that all of those holding minority viewpoint on key issues, have largely ignored many significant undue weight issues. It is my impression that the article is biased and other contributors have commented on this, and the "snail pace" of change. That certain contributors pull off NPOV tags, is poor optics. If these contributors don't have the time, then why do they have the time to pull off NPOV tags repeatedly? You folks wanted to hear what was wrong with the article and that information has been provided. Why are you complaining that someone asks for change, even though these requests are over a month old? Tell me exactly how you envision forward progress on these long standing undue weight issues and issues of bias?--scuro (talk) 19:44, 15 September 2009 (UTC)

Best way is to reassure the Wikipedia:WikiProject_Medicine/Collaboration_of_the_Week that the article is safe for them to review (without drama or disruption etc). Add your name to the list of people there and get this article as the focus of the wiki medicine project. Lets get lots of doctors and pharmacists involved, if we can.--Literaturegeek | T@1k? 23:56, 15 September 2009 (UTC)

If you feel that LG and I hold minority view points why have you blocked all of our attempts to increase medical participation in this page? I have hoped all along that further collaboration would deal with any concerns. Maybe you could submit the article for a review?Doc James (talk · contribs · email) 00:11, 16 September 2009 (UTC)

Or those who have a similar viewpoint about ADHD to anti-psychiatry/scientology's viewpoint.... can finally come to the table and seek true consensus. I've been asking for that for YEARS and no one from this group has EVER earnestly taken me up on this offer. The door is open. Any one of you can engage with someone who holds a different viewpoint from your own. That is how wikipedia is supposed to work. When those with different viewpoints can agree, we have real neutrality. That is my concern, that on some key issues, minority or even fringe viewpoint has undue weight and this has made the article biased. I would really appreciate it if you folks came to the table.--scuro (talk) 00:18, 16 September 2009 (UTC)

I request that you acquire a mentor before making further edits to this topic. I have requested administrator involvement. [6] Doc James (talk · contribs · email) 00:21, 16 September 2009 (UTC)

Scuro I want you to retract and apologise for the character slur you have made against editors. You have no right to behave like this and label people as this. You have no right to publicly denigrate editors here as anti-psychiatry/scientology like. Retract this attack immediately and acknowledge that it is not true. You know that this is lies as I stated that I wanted to avoid use of anti-psychiatrists etc in this article as much as possible.--Literaturegeek | T@1k? 01:24, 16 September 2009 (UTC)

Request away Doc James. The mediator mentioned in arbitration was specifically for citations. Literaturegeek, take a deep breath, I believe you have overreacted to this whole situation. The issue you speak of is being addressed here. ->[7]. If either of you would agree to mediation, perhaps we could have some forward movement. Until that time I'd like to know why those holding minority opinion have avoided answering questions and moving forwards with regards to the many points made about undue weight and bias? (see archives 12-16) --scuro (talk) 03:15, 16 September 2009 (UTC)

Scuro, thanks for another attack on editors here as you have been doing for years, accusing them of minority. Anyway, are you sure that it is not you who is minority? Editors here actually develop the article using for the most part high quality refs, why can't you do battle with refs rather than belittling constructive editors?--Literaturegeek | T@1k? 18:04, 16 September 2009 (UTC)

Why the avoidance of moving forwards on talk page issues? We can focus on content or the contributor. I'm ready to focus on content, are you?--scuro (talk) 03:38, 17 September 2009 (UTC)