Talk:Attention deficit hyperactivity disorder/Archive 28

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Adult ADHD statistics

In two places (including the lead) a questionably precise figure, 2.58%, is given for prevalence of adult ADHD (childhood onset), based on the estimate of a recent meta-analysis. This looks like a good source, but there are caveats: particularly the pooling of studies using different diagnostic criteria, and also variation between individual studies which the authors noted "could not be fully ruled out by a priori selected variables". If the childhood prevalence estimates are so broad (according to different diagnostic criteria) I find it hard to imagine there isn't the same level of uncertainty around adult ADHD & different diagnostic criteria. I'd be inclined to use a more explicit attributed statement, such as "a 2021 meta-analysis estimated a prevalence of 2.58%", or perhaps in the lead "an estimated prevalence of around 2.6%" or "around "2.5%" (in line with other sources). Additionally, the 2014 literature review also cited in the lead sentence provides a different figure, a range of 2.5-5%. Should we instead include a range, or does the meta-analysis unambiguously supersede this? Any thoughts welcome, & pinging @Xurizuri as I see they did some work on this in July. Jr8825 • Talk 17:38, 24 August 2022 (UTC)

The source you cite is very reliable. They generally do a good job with significant figures, so it would be OK just to leave it as is at "2.58%"; perhaps 2.6% is too imprecise and 2.58% is too precise so they had to choose one or the other, both sub-optimal. But there is nothing wrong with an encyclopedia rounding "2.58%" to "2.6%" if for no other reason that it reads more colloquially. Now, given that there are other reliable sources within a range, it would probably be even better to cite the range, particularly as the range "2.5-5%" includes 2.58%. Unless you feel that the 2014 review is out of date or includes bad references. Or you could cite both, and pull text from the references to explain why there is a difference. A range can result from differences in the population studied (no uncertainty, just a different population) or diagnostic accuracy (uncertainty), or definition of ADHD (no uncertainty, just a different choice of definition). Jaredroach (talk) 23:28, 24 August 2022 (UTC)

concur w/ Jaredroach--Ozzie10aaaa (talk) 18:09, 1 September 2022 (UTC)

Thanks for the feedback, I agree the study should be given a prominent position in the lead (I think 2.6% is adequate for the lead as all the other figures are rounded up to whole numbers, 2.58% makes sense in the body). Will take a closer look the literature review before deciding whether to add a range. If I remember correctly the meta-analysis didn't specifically mention or rebut earlier literature, but I'll need to check both carefully before making any changes. Jr8825 • Talk 18:35, 11 September 2022 (UTC)

Wiki Education assignment: Technical and Scientific Communication

This article was the subject of a Wiki Education Foundation-supported course assignment, between 22 August 2022 and 9 December 2022. Further details are available on the course page. Student editor(s): Smummert1 (article contribs).

— Assignment last updated by Brennam29 (talk) 15:21, 21 September 2022 (UTC)

Work of Dr Russell Barkley and possibility ADHD is two separate disorders

The work of Dr Barkley and other experts seems to indicate that ADHD may in fact be two separate conditions that result from different mechanisms.

One of them has historically been called ADHD-PH (predominantly hyperactive).

The other has historically been called ADHD-PI (predominantly inattentive), as well as SCT (Sluggish Cognitive Tempo) and, in Dr Barkley's work, CDD (Concentration Deficit Disorder).

The hypothesis goes that stimulants are only effective on the first disorder and not the second because they are caused by different mechanisms.

I think such interesting ideas (being also supported by some experts) would serve the reader's awareness of current research. EditorPerson53 (talk) 17:58, 24 September 2022 (UTC)

Comorbidities - Eating disorders - Treatments - "Health at every size"

Currently this article says, "Malnourishment can result in symptoms that look similar to those of ADHD, which has the potential to be misdiagnosed as "ADHD" without proper clinical assessment and screening for disordered eating and nutritional adequacy. Individuals with co-morbid ADHD and disordered eating should be referred to a Registered Dietitian who specializes in using a Health at Every Size and Intuitive Eating approach, combined with neurodivergent-affirming, eating-disorder-informed care, for proper treatment." This is the source link, a pay-to-view webinar: https://edrdpro.com/tag/adhd/

Health at every size/Intuitive eating are pretty controversial and it seems inappropriate for the article to recommend them as a treatment for eating disorders, or to recommend treatments for eating disorders at all, really, especially making it seem as if this is the medical consensus on the topic. 2001:9E8:238:2900:D1E0:1127:ADDC:86AD (talk) 12:48, 18 October 2022 (UTC)

Agreed, the article shouldn't be recommending treatment. I've gone ahead and removed this section. Tacyarg (talk) 22:50, 20 October 2022 (UTC)

Source quality parenting style

The paragraph "Despite a popular myth, it does not appear to be related to any particular style of parenting or discipline" and the cited source [15] contain a suggestive nature and are poorly worded in my eyes. A single MD's opinion piece quoting polls does not suffice as a valid argumentative ground to call it a myth, especially if it's says at the beginning that causes are not known for sure. Suggesting a rewording like "A connection to a particular style of parenting or discipline appears to be debatable." 91.6.16.168 (talk) 21:48, 27 September 2022 (UTC)

The sentence overall was unconstructive and the source (WebMD) far from good. An expert source - the CDC here - dismisses parenting as a factor. Zefr (talk) 21:59, 27 September 2022 (UTC)

While enviormental factors such as parrenting styles can likely perpetuate symptoms in some cases, or even decrease the serverity of symptoms if done well; parenting styles definentaly dont cause adhd itself ( correct me if im wrong ) ¿V0id? {have a great day!} (talk) 14:50, 28 October 2022 (UTC)

Requested move 14 October 2022

The following is a closed discussion of a requested move. Please do not modify it. Subsequent comments should be made in a new section on the talk page. Editors desiring to contest the closing decision should consider a move review after discussing it on the closer's talk page. No further edits should be made to this discussion.

The result of the move request was: not moved. per discussion consensus. WP:MEDTITLE, WP:ACROTITLE were more convincing to participants, based upon the "official" and "recognized medical name" criteria, and that ACROTITLE may not apply given how commonly know the official name is. ACROTITLE is most commonly employed for acronym titles which are confusing to those searching for the article, given that they are seldom spelled out. This is not the case for ADHD, as multiple participants pointed out. Participants were not as convinced by WP:NCACRO as a reason to move the title, given its common usage in a spelled-out form.(closed by non-admin page mover) — Shibbolethink ^{(♔ ♕)} 03:08, 31 October 2022 (UTC)

---

Attention deficit hyperactivity disorder → ADHD – Per WP:UCRN. "ADHD" is incidentally already a redirect to this page. In this article it is referred to as "ADHD" approx. 7 times more than "attention deficit hyperactivity disorder". Regarding WP:MEDTITLE, this is the recognised medical name (as an abbreviation). 12u (talk) 17:42, 14 October 2022 (UTC) — Relisting. — Ceso femmuin mbolgaig mbung, mellohi! (投稿) 19:43, 23 October 2022 (UTC)

• Oppose — Per WP:MEDTITLE:
  • "The article title should be the scientific or recognised medical name that is most commonly used in recent, high-quality, English-language medical sources"
  • "The article title is subject to the same sourcing standards as the article content. Where there is a dispute over a name, editors should cite recognised authorities and organisations rather than conduct original research."
  • "Diseases—The World Health Organization, International Statistical Classification of Diseases and Related Health Problems (ICD-10) or the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)"

Recognized authorities are in quite clear agreement as to what the actual scientific or recognized medical name is, and the name commonly used in the medical scientific literature reflects and supports that clear consensus. Garzfoth (talk) 19:08, 14 October 2022 (UTC)

• Strong oppose, suggest speedy closure: MEDRS sources universally refer to it as "Attention deficit hyperactivity disorder" followed by the abbreviation. The title should state clearly what the name is and not its abbreviation. The same appllies for pretty much any other medical term. Wretchskull (talk) 19:11, 14 October 2022 (UTC)
• Support per COMMONNAME.--Ortizesp (talk) 05:17, 15 October 2022 (UTC)
• Weak oppose per WP:NCA, Britannica uses the full term and I think the full term is used commonly enough to not use the acronym. Crouch, Swale (talk) 06:39, 15 October 2022 (UTC)
• Strong oppose: In addition to the very good reasons per WP:MEDTITLE and general mos med, using an abbreviation is fine within an article, but I really disagree that that kind of reasoning should be used to change the name of an article. Mason (talk) 01:00, 18 October 2022 (UTC)
• Support per WP:COMMONNAME based on the Google Ngrams. We moved "Coronavirus disease 2019" to COVID-19. I don't see how this case is any different from that. Rreagan007 (talk) 18:29, 20 October 2022 (UTC)

  @Rreagan007: COVID-19 is an official name, plus MEDRS sources also refer to it as such—that is what we base medical information on on wikipedia. ADHD is not the official name, it is an abbreviation of the official one: Attention deficit hyperactivity disorder, and all MEDRS sources name it as such. Google Ngram doesn't mean anything here. Wretchskull (talk) 18:36, 20 October 2022 (UTC)

  WP:COMMONNAME is a policy. WP:MEDRS is only a guideline. WP:COMMONNAME still applies here. Wikipedia is a general-use encyclopedia, not a medical journal. The most common name that our readers will be familiar with is what should be used for the article title. Rreagan007 (talk) 22:41, 20 October 2022 (UTC)

• Support per nom. Shwcz (talk) 13:35, 22 October 2022 (UTC)
• Support per WP:COMMONNAME, WP:NCACRO ("Acronyms should be used in a page name if the subject is known primarily by its abbreviation and that abbreviation is primarily associated with the subject") and evidence supplied above, including the precedence of COVID-19. Wikipedia is an encyclopedia, not a specialist medical publication, and we should use the term commonly used in general-purpose reliable sources.  — Amakuru (talk) 11:38, 23 October 2022 (UTC)

Relisting comment: Common-to-the-general-public name or full medical name? — Ceso femmuin mbolgaig mbung, mellohi! (投稿) 19:43, 23 October 2022 (UTC)

• Oppose for the sake of preventing repeated arguments. WP:MEDTITLE is guideline, WP:MEDRS is guideline. We can scream WP:COMMONNAME until the cows come home but let's think how many disorders are listed by their abbreviation on here? COVID-19 is a disease. – The Grid (talk) 21:35, 24 October 2022 (UTC)
• Strong Oppose WP:MEDTITLE is pretty clear here, there is already a redirect. If there is concern about the redirect we can just request it get page protection. Dr vulpes ^{(💬 • 📝)} 20:03, 26 October 2022 (UTC)

Strong oppose for all the previous reasons as to why this isnt a good idea, and every other disorder's article on wikipedia usses the full name, not the abreviation. Using abreviations for article titles is simply infromal in most cases, even when it is an official term. ¿V0id? {have a great day!} (talk) 14:55, 28 October 2022 (UTC)

• Strong oppose "ADHD""ADD", "ADHD", and "Hyperactive" all redirect to this page. Attention deficit hyperactivity disorder is the official name - it would be bizarre to me if Wikipedia was to start abbreviating all conditions ex. Borderline Personality Disorder becoming BPD or Post Traumatic Stress Disorder becoming PTSD. It might be common in your circle to abbreviate these but it's not in all. Examples used in MOS:ACROTITLE explain this quite well, if Attention deficit hyperactivity disorder wasn't the well-known name of the condition and most people wouldn't be able to tell you what ADHD stands for when asked - maybe. However that's not really the case at all since both terms are used interchangeably - so there is not a clear benefit in changing it to an acronym. --Marleeashton (talk) 00:16, 30 October 2022 (UTC)

  I do not really understand why it is considered "bizarre" to use the most common name for an article. I strongly believe most people would not be able to tell you what ADHD stands for when asked – it might however be common "in your circle" to refrain from using the abbreviation. MOS:ACROTITLE explains it well: "Acronyms should be used in a page name if the subject is known primarily by its abbreviation and that abbreviation is primarily associated with the subject". 12u (talk) 02:57, 31 October 2022 (UTC)

The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

"Paradoxical Reactions" section

Wondering if this should be removed or at least altered. It doesn't seem like the sources provided for the point that 10-20% of patients with ADHD report paradoxical reactions to stimulants and anesthetics are adequate to back up such a bold claim.

They are a letter to the editor of a journal stating that the authors observed reports of this in their outpatient ADHD clinic and then a piece published by two of the authors of the aforementioned letter that mentions paradoxical reactions existing as a side note at the end without any additional citations. These are the only mentions of this reaction I can find at all in the academic literature. If anyone else with more journal access can find something more substantial we should add it but if not, it seems like this section should either be altered to reflect the fact that in reality there's very little clinical evidence for this or just removed entirely. LanaDelEditor (talk) 21:08, 5 December 2022 (UTC)

Semi-protected edit request on 23 January 2023

Could you change DSM-4 to DSM-5 and ICD-10 to ICD-11 under Dignosis? Thank you! ÄËÖÜÏŁ (talk) 15:00, 23 January 2023 (UTC)

@ÄËÖÜÏŁ: Read the article. DSM-5 and ICD-10 have been in the Diagnosis section for several years. If you are referring to research results based on DSM-IV, we can't attribute those results to DSM-5 or ICD-10 without reliable sources. If you have such sources, please provide them here. Sundayclose (talk) 18:24, 23 January 2023 (UTC)

Semi-protected edit request on 8 February 2023

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder (Childhood) characterised by excessive amounts of inattention, hyperactivity, and impulsivity that are pervasive, impairing in multiple contexts, and otherwise age-inappropriate. Icsabc (talk) 00:17, 8 February 2023 (UTC)

 Not done: please provide reliable sources that support the change you want to be made. Lemonaka (talk) 00:44, 8 February 2023 (UTC)

Comorbidities - ODD and CD in ADHD

The figures on the comorbidities of Conduct Disorder and Oppositional Defiance Disorder with ADHD appears to be largely inflated.

"Oppositional defiant disorder (ODD) occurs in about 25% of children with an inattentive presentation and 50% of those with a combined presentation." 

"Conduct disorder (CD) occurs in about 25% of adolescents with ADHD." 

Both have referenced the DSM-5-TR however I've had a read through and was unable to find these numbers anywhere. Also couldn't find any evidence to suggest that the inverse may be true - ie that ADHD occurs in 25% of children/adolescents with ODD/CD. Aaalliex (talk) 10:25, 8 April 2023 (UTC)

Those percentages are found in the "Comorbidities" section of the ADHD chapter, although I was looking at DSM-5 (not TR). The citations should have page numbers, so I placed page requests with the citations. Sundayclose (talk) 14:27, 8 April 2023 (UTC)

Request to add findings on cannabinoids

Could someone add this under Management -> Medication -> Non-stimulants:

Low-dose cannabinoids have shown moderate to large positive effects on core ADHD symptoms in the absence of adverse effects; this implicates the cannabinoid system as a potential new target for drug development. https://pubmed.ncbi.nlm.nih.gov/28576350/ Douweziel (talk) 00:47, 4 April 2023 (UTC)

The source you cite is a single study with a total of only 30 subjects divided between medication and placebo groups, and it produced non-significant findings for cognitive performance and activity level. Your conclusion of "moderate to large positive effects on core ADHD symptoms" is not supported. More importantly, on Wikipedia, medical articles have a higher standard for reliable sources than many other Wikipedia articles. What we understand about human health and medicine is based on the basic science of biology, and biology is complex. For health-related content, the field is evidence-based medicine. And per WP:MEDRS – which the community created after long and arduous discussion – we reach for review articles (not single studies) published in the biomedical literature, or statements by major medical or scientific bodies. Read WP:MEDRS for more details. Sundayclose (talk) 01:08, 4 April 2023 (UTC)

Thank you for checking the study! You also gave me some guidelines for checking more rigorously in the future.

A very recent (2022/2023) meta-review https://link.springer.com/article/10.1007/s00787-023-02169-w came to a similar conclusion re. 18- population. Additionally, cannabinoid use is generally associated with stronger ADHD symptom severity. However, they do report that CBD appears to have beneficial effects on cognition compared to THC.

Another review https://www.sciencedirect.com./science/article/pii/S0022395622006549 reports that benefits are anecdotal and that studies don't differentiate between THC and CBD and/or dosages.

Neither review recommends cannabis treatment given current results.

Do you think this is worth mentioning (in condensed form)? Several studies noted that "a growing perception that cannabis is safe has led more patients and caregivers to self-medicate" in the context of ADHD. Douweziel (talk) 15:45, 18 April 2023 (UTC)

Inconsistency of prevalence figures in different sections

The article gives various prevalence figures that may be confusing and potentially not consistent with each other. We should reconcile and consolidate prevalence information:

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

• About 30–50% of people diagnosed in childhood continue to have ADHD in adulthood, with 2.58% of adults estimated to have ADHD which began in childhood. [in lede]

• Frequency 0.8-1.5% (2019, using DSM-IV-TR and ICD-10) [in infobox, using term "frequency"]

• ADHD is estimated to affect about 6–7% of people aged 18 and under when diagnosed via the DSM-IV criteria. When diagnosed via the ICD-10 criteria, rates in this age group are estimated around 1–2%. [Epidemiology subsection]

This question does not seem to have been comprehensively discussed before, although there were partial previous discussions potentially relevant: 2022-09 2013-08 AncientWalrus (talk) 10:02, 23 May 2023 (UTC)

There's also a whole article devoted to the Epidemiology_of_attention_deficit_hyperactive_disorder with a variety of numbers. Due to the range of numbers provided, I suggest we err on the side of caution and give broad ranges when there is conflicting information. AncientWalrus (talk) 10:04, 23 May 2023 (UTC)

ATX & effect on academic performance

Many studies and a highly substantiated meta-analysis (citated in article) determined that atomoxetine (ATX) is equally as effective as methylphenidate (MTH) in terms of degree of improvement in alleviating symptoms.

Said research and those studies cited by the meta-analysis used school/academic performance as core factors in substantiating effect and improvement of symptoms; especially to compare the efficacy between MTH & ATX.

The very fact that this is the case supports benefits in academic performance and this conclusion is not implied. Therefore the singular, outdated study from 2014 suggesting otherwise is scientifically unsupportable compared to the mountains of evidence showing otherwise and should be redacted, in my view.

I also wouldn't consider this a synthesised conclusion as I am utilising the available information specified in the studies, especially those reviewed by the meta-analysis in achieving their results even if this exact topic was not the main objective of the research. Димитрий Улянов Иванов (talk) 14:38, 20 September 2023 (UTC)

Recent edits clarification

Revising 'subtypes' to presentations

Basis for edit: DSM-5 (the diagnostic and statistical manual of mental disorders version 5), our diagnostic manual, does not have “subtypes" and they were replaced with presentations in the new, 5th edition. Subtypes were used in DSM-4. It was once thought there were three types of ADHD but DSM now recognises that these are not valid subtypes but presentations of the disorder that change over time.

Adding additional symptoms:

Basis for edit: emotional dysregulation, disinhibition and impaired working memory are all underlying and recognised symptoms of ADHD most of which, if not all, are mentioned further down in the article. You can also see the International Consensus Statement on ADHD for references.

Alphabetically ordering CDS above CD

Basis for edit: alphabetically, cognitive disengagement syndrome comes before conduct disorder as the g is a predecessor to n in the standard English alphabet (A, B, C, D, E, F, G, H, I, J, K, L, M, N, O, P, Q, R, S, T, U, V, W, X, Y Z)

Revising hyperfocus:

Basis for edit: it is erroneous to state that people with ADHD simply cannot sustain attention on tasks they are not interested in completing; they are often interested in completing the task, but their executive self-regulatory deficits prevent them from doing so. Usually, the delay between the action and its consequence or reward is what disables the person with ADHD. This is known as time-blindness.

Using "sustained attention" over "focus":

Basis for edit: there are 6 different types of attention in humans: focused attention, sustained attention, span of apprehension, arousal, alertness, and divided attention. Psychologists Alan Mirsky and David Posner have written reviews about them that you can find using Google Scholar. ADHD only implicates sustained attention, the self-regulatory executive functioning kind, and not focused attention hence the correction there. The other attention disorder, cognitive disengagement syndrome, affects oriented or focused attention.

(colloquially, focus/focused attention can also refer to a more broader perspective however it's still better and more accurate to use sustained attention in the context of ADHD)

If you are in disagreement with only a one or select amount of these edits, please critique here, and do not contain or reverse every single one! Thankyou. Димитрий Улянов Иванов (talk) 16:26, 20 October 2023 (UTC)

I agree with all of these points and I'd be surprised if they weren't all readily prove-able from linked citations already in the article. That being said, regarding the "subtype"/"presentation" distinction, the History section has a few sentences that disagree:

In 1987, this was changed to ADHD in the DSM-III-R, and in 1994 the DSM-IV in split the diagnosis into three subtypes: ADHD inattentive type, ADHD hyperactive-impulsive type, and ADHD combined type. These terms were kept in the DSM-5 in 2013 and in the DSM-5-TR in 2022. […] ADHD was split into the current three sub-types because of a field trial completed by Lahey and colleagues.

Further, though, the "main article" of that section, History of attention deficit hyperactivity disorder says (emphasis mine):

Under the DSM-5, there are three ADHD presentations, including one which lacks the hyperactivity component.

These should all be edited for consistency and I think "presentation" is the more accurate up-to-date term to use in the main article body. Kimen8 (talk) 16:47, 20 October 2023 (UTC)

Thanks for writing. Regarding the DSM-5's perspective on the issue, they clearly outline presentations and make no specification to 'subtypes' there. The change was in support that there is nothing qualitatively different across these. I see this all the time in trade-media articles that there are 3 "types" of ADHD; there are not. We got rid of those 10 years ago in favour of simply presentations. Because after all, people can go from the hyperactive presentation during the pre-school years up to the combined when they develop enough symptoms of inattention and then by adult-hood when the hyperactivity and motor impulsiveness is dissipating to a great extent we often notice them move into the inattentive presentation. Димитрий Улянов Иванов (talk) 17:08, 20 October 2023 (UTC)

Semi-protected edit request on 24 October 2023

The diamine oxidase (DAO) enzyme, which metabolizes histamine extracellularly, may play a key role in the pathophysiology of ADHD. A decreased DAO activity may lead to an accumulation of histamine, which could contribute to ADHD symptoms.

reference Blasco-Fontecilla H. Is Histamine and Not Acetylcholine the Missing Link between ADHD and Allergies? Speer Allergic Tension Fatigue Syndrome Re-Visited. J Clin Med. 2023 Aug 17;12(16):5350. doi: 10.3390/jcm12165350. PMID: 37629392; PMCID: PMC10455974. Jofeenstra (talk) 00:57, 24 October 2023 (UTC)

 Not done: it's not clear what changes you want to be made. Please mention the specific changes in a "change X to Y" format and provide a reliable source if appropriate. PianoDan (talk) 21:18, 24 October 2023 (UTC)

Please separate the text

ADD SECTIONS OR CREATE A SOMARY, because the article is very long. (Sorry for the english) BlueDevil455054 (talk) 02:20, 27 January 2023 (UTC)

You need to reword that request. It's very unclear what you are asking. If you're requesting that the article be divided into two articles, that can't be done with a simple request. It requires discussion and consensus. Sundayclose (talk) 14:14, 27 January 2023 (UTC)

@BlueDevil455054 The Simple English Wikipedia has a shorter article. (https://simple.wikipedia.org/wiki/Attention-deficit_hyperactivity_disorder). FunLater (talk) 22:49, 11 June 2023 (UTC)

135.129.207.179 (talk) 06:46, 23 November 2023 (UTC)

Minor edit for clarity

Suggest revising "ADHD is diagnosed approximately twice as often in boys as in girls..." to "ADHD is diagnosed approximately twice as often in boys than in girls..."

This is a minor change. For what it's worth, I had to read the sentence a few times to understand the meaning. 2603:6000:DC01:AC86:4D7B:52CE:5C39:7452 (talk) 19:19, 1 December 2023 (UTC)

Hyperactivity

I heard (from my psychiatrist, actually) that ADHD is just a nomenclature and even that being the name of the disorder, people may or may not develop hyperactivity. I'm a bit busy at the moment and away from my Computer. But I'll try to find any reliable source on that as soon as I can. —Nanami73 ^talk 17:17, 20 December 2023 (UTC)

• There's quite a bit of information already in the article about how hyperactivity is not necessarily present in all people with ADHD. You should give it a read or re-read. Firefangledfeathers (talk / contribs) 17:20, 20 December 2023 (UTC)

  Ah yes, I just checked, sorry for my inattention. I mean, there is a reason why this article interests me. But seriously now. yeah I reread it and now I saw the detail in the History section. Thanks for bringing it to my attention. —Nanami73 ^talk 18:09, 20 December 2023 (UTC)

  There is also Adult attention deficit hyperactivity disorder which seems to describe non-hyperactive presentations more, as in adults it generally is the case that inattentive presentation becomes more common than hyperactive. Kimen8 (talk) 18:22, 20 December 2023 (UTC)

"Executive dysfunction" claims

In this edit on 22 October 2023, Димитрий Улянов Иванов changed the lead sentence of the article from:

"Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterised by excessive amounts of inattention, hyperactivity, and impulsivity that are pervasive, impairing in multiple contexts, and otherwise age-inappropriate."

to

"Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterised by executive dysfunction occasioning inattention, hyperactivity, impulsivity and emotional dysregulation that are excessive and pervasive, impairing in multiple contexts, and otherwise age-inappropriate."

The edit summary states: "Revised the initial description to be more accurate concerning the disorder and its symptoms. As noted in the paragraph below (with citations), ADHD symptoms arise from executive dysfunction (the underlying deficit in ADHD is EF) and emotional dysregulation is often considered a core symptom."

While the user is correct that this article does note that the article does state that "ADHD symptoms arise from executive dysfunction", this is not necessarily accurate about ADHD, nor are the statements claiming it well supported. (I do not object to the "emotional dysregulation" aspect being added.)

For example, let's examine that statement in the second paragraph of the article: "ADHD symptoms arise from executive dysfunction..." To support this, three references are given; however, only two actually discuss "executive dysfunction" in ADHD. (The Malenka does not mention “executive dysfunction" in regards to ADHD and would be an WP:OR interpretation). The first is a 2008 article with the single author, Thomas Brown, in which the author acknowledges that his opinion that ADHD is "cognitive disorder, a developmental impairment of executive functions (EFs)" is a departure from the belief of "many clinicians". This article fails WP:MEDRS and also likely fails WP:FRINGE and/or WP:DUE, as the author notes his opinion is in conflict with “many clinicians” and is also in conflict with the WP:MEDRS compliant article below. The second is a single-author manuscript by Diamond from 2012–13, which only mentions ADHD twice, and the references to it appear to be “provided in passing” per WP:CONTEXTMATTERS. In any case, it is also not a WP:MEDRS complaint source.

Other areas of the article also seem to have similar statements: The symptoms of ADHD arise from a deficiency in certain executive functions (e.g., attentional control, inhibitory control, and working memory)." To support this, a single reference is given with the supporting quote, "Early results with structural MRI show thinning of the cerebral cortex in ADHD subjects compared with age-matched controls in prefrontal cortex and posterior parietal cortex, areas involved in working memory and attention." The source merely notes that "early results" show that those with ADHD, as a group, may have thinning in areas that impact "working memory and attention." It does not say "symptoms of ADHD arise from a deficiency in certain executive functions". Attempts to say otherwise would be, at best, WP:OR.

The objection I have to the phrase "executive dysfunction" being used in the way it is used in article is that it implies that executive dysfunction is not only required for a diagnosis of ADHD, but is also the cause of ADHD. I do not feel this is accurate, nor is supported by the weight of the evidence, nor do the DSM nor the ICD mention "executive dysfunction" in regards to ADHD. While executive dysfunction is certainly more common in those with ADHD, it is far from required for a diagnosis, much less the cause of the disorder. A WP:MEDRS complaint source states: "Specifically, estimates for the proportion of pediatric ADHD cases who exhibit any form of executive dysfunction range from 21% to 60% across studies employing a wide range of tasks and impairment criteria (Biederman et al., 2004; Coghill et al., 2014; Fair, Bathula, Nikolas, & Nigg, 2012; Geurts, van der Oord, & Crone, 2006; Nigg et al., 2005; Solanto et al., 2001; Sonuga-Barke, Bitsalou, & Thompson, 2010)." (Kofler MJ, Irwin LN, Soto EF, Groves NB, Harmon SL, Sarver DE (February 2019). "Executive Functioning Heterogeneity in Pediatric ADHD". Journal of Abnormal Child Psychology. 47 (2): 273–286. doi:10.1007/s10802-018-0438-2. PMC 6204311. PMID 29705926.) My point is more explicitly stated in a WP:RS (but admittedly not a WP:MEDRS due to age): "Indeed, executive dysfunction is not required for the diagnosis of ADHD, which is defined at the behavioral, rather than neuropsychological, level." (Cortese S, Comencini E, Vincenzi B, Speranza M, Angriman M (November 2013). "Attention-deficit/hyperactivity disorder and impairment in executive functions: a barrier to weight loss in individuals with obesity?". BMC Psychiatry. 13: 286. doi:10.1186/1471-244X-13-286. PMC 4226281. PMID 24200119.{{cite journal}}: CS1 maint: unflagged free DOI (link))

In summary, I feel the above statements should be modified to remove "executive dysfunction" as a cause of and/or requirement of ADHD. At the absolute minimum, if WP:RS and WP:MEDRS are found to give the viewpoint WP:DUE, WP:CONFLICTING states both viewpoints should be acknowledged. Wikipedialuva (talk) 10:15, 9 January 2024 (UTC)

Thanks for writing. You make some good points and additional references should be provided (if a consensus is determined) as current ones are insufficent. Fact checking is always appreciated; we need to look for biases and synthetical conclusions in research and in ourselves among publications of edits.

First, I will address the matter of emotional dysregulation and the relevancy of DSM-5's specification , and secondly, I will try to offer a defence of ADHD being a disorder of EF/SR.

Experts are in agreement that emotional dysregulation is a core symptom of ADHD (the relevant data are described here: International Consensus Statement on ADHD and Faraone et al., 2018). Now, the DSM is not leading the research, but follows it and often a decade or two behind where the research is at the time so referring to the DSM in invalidating current research is not acceptable when robust findings contradicts and/or objects to their criteria. Thus, the symptomatic presentation of ED should not be redacted based on what the information (or lacking of) is in a diagnostic manual. But the decisions made by the APA are also political, not just scientifically-based so its hard to know where this will go in the subsequent version.

Scientifically, there is some debate among researchers on a) the definition of an EF; b) to some extent what can be classified as an EF. From my understanding, as of now Barkley's model of EF/SR in ADHD has the "most" empirical support among researchers but it's not definitive, as he and others acknowledge. Nonetheless, we're pertaining to EF underlying ADHD symptoms rather than the above.

To substantiate this, ADHD is a disorder of brain networks that contribute to executive functioning and self-regulation. Many of these networks originate in the pre-frontal cortex but they extent throughout the brain occasioning its symptoms (Hoogman et al., 2019). Thus, logically, given the well-established neuroanatomy and psychological expressions of ADHD, it has to be a disorder of EF/SR.

• A meta-analysis of 21 functional MRI studies with 607 participants found that those with ADHD showed consistent and replicable under-activation in typical regions of executive inhibitory control such as right inferior pre-frontal cortex, supplementary motor area and the basal ganglia relative to typically developing individuals (Hart et al., 2013). The inferior frontal under-activation findings were replicated in two further fMRI meta-analyses of inhibitory control with 33 datasets/1161 participants, and 42 datasets/2005 participants, respectively (Lukito et al., 2020; Norman et al., 2016).
• Comparative meta-analyses show that structural grey matter volume reductions in basal ganglia and insula are ADHD disorder-specific relative to OCD in 30 data sets with 1870 participants (Norman et al., 2016) while medial frontal reductions were specific to ASD in 66 data sets with 3610 participants (Lukito et al., 2020). An analysis of structural magnetic resonance imaging (MRI) data from 48 cohorts with a total of over 12,000 participants showed that ADHD participants had smaller hippocampus volume relative to OCD which was related to IQ & EF differences and smaller intracranial volume relative to ASD and OCD patients (Boedhoe et al., 2020). The functional under-activations in right inferior frontal cortex and basal ganglia during tasks of cognitive control were ADHD disorder-specific relative to OCD in 1870 participants (Norman et al., 2016), while the inferior frontal dysfunction was specific relative to autism in 3610 participants (Lukito et al., 2020).
• A meta-analysis of ten diffusion tensor imaging studies with 947 participants found that the most consistent white matter differences between those with and without ADHD were located in the splenium of the corpus callosum extending to the right cingulum, the right sagittal stratum, and left tapetum, suggesting problems with the connections between the two hemispheres in posterior parieto-temporal attention regions and in long-range fronto-posterior association tracts (connecting inferior frontal, temporal, parietal and occipital regions) involved in sustained attention and perception (Chen et al., 2016).
• An analysis of structural magnetic resonance imaging (MRI) data from 36 cohorts with a total of over 4100 participants found slightly reduced total cortical surface area in children with ADHD. The same team found some subcortical regions of the brain were smaller in children with ADHD, mainly in frontal, cingulate, and temporal regions with some reductions in cortical thickness in temporal regions. The same team found some subcortical regions of the brain, e.g., basal ganglia, amygdala, hippocampus, and intracranial volumes were smaller in children with ADHD in 23 cohorts of 3242 participants (Hoogman et al., 2017; et al., 2019).

Here is also an outline of performance deficits in the brains of people with ADHD from the International Consensus Statement:

• A series of meta-analyses found that people with ADHD had small to moderate difficulties with abstract problem solving and working memory (12 studies, 952 persons), focused attention (22 studies, 1493 persons), sustained attention (13 studies, 963 persons), and verbal working memory (8 studies, 546 persons) (Schoechlin and Engel, 2005).
• Two meta-analyses, one with 21 studies and over 3900 participants, the other with 15 studies with over a thousand participants, found that those diagnosed with ADHD have a moderate tendency to favour small immediate rewards over large delayed rewards (Jackson and MacKillop, 2016; Marx et al., 2021).
• A meta-analysis of 37 studies with more than 2300 participants found a small-to-moderate association between ADHD and risky decision-making (Dekkers et al., 2016). Another meta-analysis, combining 22 studies with 3850 children and adolescents, found those with ADHD exhibited moderately greater impulsive decision-making overall on delay discounting and delay of gratification tasks (Patros et al., 2016).
• A recent meta-meta-analysis included 34 meta-analyses of neurocognitive profiles in ADHD (all ages) concerning 12 neurocognitive domains. Those with ADHD had moderate impairments in multiple domains (working memory, reaction time variability, response inhibition, intelligence/achievement, planning/organisation). Effects were larger in children and adolescents than in adults (Pievsky and McGrath, 2018).
• A meta-analysis of 49 studies and over 8200 children and adolescents found moderate impairments in working memory in those with ADHD. These deficits declined with age (Ramos et al., 2020).
• A meta-analysis of randomized controlled trials (RCTs) with preschoolers found that cognitive training led to moderate improvement in working memory (23 studies, over 2000 participants) and small-to-moderate improvement in inhibitory control (26 studies, over 2200 participants) (Pauli-Pott et al., 2020).

There are at least 7 major EFs. They are self-awareness, inhibition (self-restraint) (occasioning symptoms of e.g. hyperactivity, distractibility, motor/cognitive/motivational/emotional impulsivity), working memory (remembering to do and involving hindsight and foresight), [both nonverbal/visual and verbal WM], emotional self-regulation, self-motivation, and planning/problem solving. ADHD to varying but highly related degrees across individuals is disrupting all 7 of these. That is why it is such an impairing disorder adversely impacting nearly every major domain of life activities we have studied to date.

Keep in mind that neuropsychological testing of EF is not useful for diagnosis and do not suggest whether EF is implicated in ADHD (International Consensus Statement, Faraone et al., 2021). While some clinicians, and to a lesser extent, some researchers have concluded that ADHD is not a disorder of EF considering so many ADHDs pass the tests; that is based on a faulty premise, that these EF tests are the gold standard for detecting executive functioning deficits. The evidence against the use of such tests due to their low accuracy at detecting the disorder, low correlation with ADHD symptoms, and limited if any relationship to predicting impairment in major life activities. Димитрий Улянов Иванов (talk) 17:13, 9 January 2024 (UTC)

Hyperfocus & ADHD

Here I examine the nature of and evidence for a frequently cited benefit of ADHD claimed in this article – that being “hyper-focusing (HF).". Despite its widespread belief, this relationship has not been explored much in the scientific literature, with less than 8 studies being identified. The results are conflicting, depending on whether the study used people who just had elevated symptoms of ADHD, and not the disorder, compared to studies of clinically diagnosed individuals who had the full disorder (symptoms and impairments). In general, there does seem to be a significant relationship between ADHD and HF when ADHD is measured as rated symptoms. But in clinically diagnosed people the results are conflicting, with one study finding the relationship and another not (Groen et al., 2020; Ozel-Kizil et al., 2016). And while HF is often presented as a benefit or gift of ADHD, some studies show that it also has a very negative side, being related to risk for internet addiction (Ishii et al., 2023) and certain types of offending behaviour (Worthington & Wheeler, 2023). From my understanding the roots of hyperfocus are in the EF/poor self-regulation that underlies ADHD. People vary in the degree to which their behaviour is controlled by distant rewards (e.g., if I study a lot, I'll get a good job a few years from now) vs. immediate rewards (e.g., when playing a video game, the environment is providing a great deal of continuous and immediate rewards for engagement; placing little demands on EF) (Jackson & Mackillop, 2016; Marx et al., 2021). For many people with ADHD, immediate rewards are very potent and can lead to such perseverative responding (Patros et al., 2016), even to the point of an inability to disengage from such environments likely linked to the same deficits in the disorder (i.e., in inhibition and working memory). So, the claim that ADHD is definitely linked to hyper-focusing and that it is a positive trait is not definitively established at this time. More research is clearly needed but such claims of HF as being widespread among those with ADHD, and entirely a benefit, cannot be taken on face value as an established fact. Assertions in this article regarding HF should therefore be amended. Димитрий Улянов Иванов (talk) 00:34, 16 January 2024 (UTC)

Overkill

The article currently looks like an instance of ref-WP:OVERKILL. Just in the top section, there are sentences with:

• 5 sources
• 8 sources
• 4 sources (×4)
• 6 sources

I think we should consider trimming some sources, but if the sources are all deemed useful and should be kept, then perhaps we should look at bundling the references. Kimen8 (talk) 21:17, 28 January 2024 (UTC)

Sorry for the belated reply. From my perspective, we can certai,ly bundle the references this way pertaining to:

1. "ADHD symptoms arise from executive dysfunction". Citation 7 may be subsumed to 6, citation 9 to 8 and citations 10, 11 and 12 to 13; resulting in these three primary references, which, in my opinion, hold most relevance.
2. "ADHD represents the extreme lower end of..." can have citation 20 subsumed to 18 while leaving the rest.
3. "Genetic factors play an important role..." can have citation 39 subsumed to 37, citations 36 and 38 to 34 thereby distinguishing 3.

Feel free to mention if any references should be removed rather than amalgamated with others. Be well. ~~~~ Димитрий Улянов Иванов (talk) 22:59, 29 January 2024 (UTC)

missing/unclear reference? (suicide risk chapter)

sorry, I'm new to this whole Wikipedia editor/talk page poster thing so excuse me if I don't do this right.

I'm reading through, and got to the suicide risk chapter(?) and am wondering where these numbers are from? " the prevalence of suicide attempts in individuals with ADHD was 18.9%, compared to 9.3% in individuals without ADHD."

I'm personally looking for general worldwide attempt percentage, but I cannot find anything else past this.

thank you :> Mteaseil (talk) 03:27, 11 February 2024 (UTC)

source is dogshit for ephedrine and pseudoephedrine

the original paper literally has a single sentence with ZERO fucking citations. ZERO!

Claim is unverified and should be deleted. CDLLBOSS (talk) 01:08, 13 February 2024 (UTC)

Sorry, where? Димитрий Улянов Иванов (talk) 03:28, 13 February 2024 (UTC)

Edit request

Regarding te paragraph under "Epidemiology" that reads:

"Due to disparities in the treatment and understanding of ADHD between caucasian and non-caucasian populations, many non-caucasian children go undiagnosed and unmedicated. It was found that within the US that there was often a disparity between caucasian and non-caucasian understandings of ADHD. This led to a difference in the classification of the symptoms of ADHD, and therefore, its misdiagnosis. It was also found that it was common in non-caucasian families and teachers to understand the symptoms of ADHD as behavioural issues, rather than mental illness."

'Caucasian' and 'non-Caucasian' should be edited to the proper capitalizations. Crextorbium (talk) 22:00, 14 February 2024 (UTC)

 Done Thank you. QuietCicada chirp 00:37, 15 February 2024 (UTC)

Causes

Certain nutritional deficiencies are known to be associated with ADHD, yet none of these are mentioned. Drsruli (talk) 21:06, 23 February 2024 (UTC)

No nutritional deficiency ‘causes’ ADHD. The only associations that have been indicated include a) weak evidence suggesting exposure to specific artificial food colourants leads to a very small exacerbation of symptoms in a small subset of people with ADHD and b) a significant zinc deficiency may slightly and indirectly worsen symptoms in some. But none of these are causal of the disorder, nor are they robust findings or lead to significant adverse effects in individual patients.

See the International Consensus Statement on ADHD for references. Димитрий Улянов Иванов (talk) 23:40, 25 February 2024 (UTC)

ADHD is a set of symptoms that may be predicated by a nutritional deficiency. (An absence of certain nutrients can certainly make concentration difficult.) This is elsewhere alluded to in the article. Just not in the ‘causes’ section. (And aside from zinc, an associated magnesium deficiency has also been found in some cases, resolving with correction.) There has been much research into the possibility of deficiency of certain nutrients during development. The research should be mentioned. Drsruli (talk) 07:59, 29 February 2024 (UTC)

Lead size

Currently the WP:LEAD contains about 10 paragraphs, which is too lengthy (MOS:LEADLENGTH). The lead should contain the most important information and leave the details/elaborations to the body. Димитрий Улянов Иванов, please do not extend the lead any further. If you want to add something, add it to the body under the respective subheading.

The leads needs to be trimmed to 4-5 paragraphs. --WikiLinuz (talk) 02:20, 5 March 2024 (UTC)

Thank you for notifying me. I will review as soon as time permits. Be well Димитрий Улянов Иванов (talk) 02:23, 5 March 2024 (UTC)

Typo in paragraph 3

“...they may be to maintain an unusually prolonged level of attention...” should probably be: ”...they may be able to maintain an unusually prolonged level of attention...” Viewpoint2927 (talk) 11:37, 10 March 2024 (UTC)

 Done --WikiLinuz (talk) 14:30, 10 March 2024 (UTC)

Cool recent discovery; first ADHD reference found in 1753

Not sure where this can be placed, but the first reference to ADHD can now be pushed back in the medical literature to a Latin text in 1753 by Dutch physician Cornelius Kloekhof, describing a condition closely resembling ADHD. The previously first known references were by Adam Weikard (1770-75) and Alexander Crichton (1798) who describes both an ADHD and CDS-like disorders of attention. See: https://journals.sagepub.com/doi/10.1177/10870547241238926 Димитрий Улянов Иванов (talk) 20:38, 28 March 2024 (UTC)

There is no evidence that methylphenidate is actually effective. Remove the claims.

A comprehensive Cochrane review: https://www.bmj.com/content/351/bmj.h5203.short found very low certainty that Ritalin is more effective than placebo. Cochrane is the GOLD STANDARD for evidence. So, effectiveness of stimulants is actually unknown, contrary to the edits by Димитрий Улянов Иванов. 2A00:23C8:A821:8D01:95ED:5D0C:6FE:FD84 (talk) 20:44, 21 April 2024 (UTC)

While I appreciate your effort to criticise with the scientific literature, the meta-analysis you cited is seriously flawed. For details, see Banaschewski et al. (2016), Cortese et al. (2016) and Hoekstra et al. (2016) Димитрий Улянов Иванов (talk) 21:13, 21 April 2024 (UTC)

ScienceDirect Topics

User:Димитрий Улянов Иванов, ScienceDirect topics is a random collection of excerpts that an algorithm thinks may be relevant to the subject. Its content changes all the time so claims based on it are nor verifiable, the quotes on it are out of context which limits their utility, and the authors that wrote the excerpts are not credited when only Topics is cited. That's why its use is deprecated on Wikipedia according to WP:RSP. I'll be removing the citation again but if you can find the paper you were talking about in your edit, I don't have any problem with you adding it in place of the Topics citation. HansVonStuttgart (talk) 14:37, 1 May 2024 (UTC)

No problem, sorry for the misplaced citation. My contention was just that it is identified by the International Consensus Statement on ADHD as a reputable source. I will reference that instead. Димитрий Улянов Иванов (talk) 21:01, 1 May 2024 (UTC)

Typo/Outdated Name for Autism in Sidebar

This is a very simple edit, but the hyperlink to Autism in the "differential diagnosis" section in the sidebar is outdated, being listed as "autism spectrum disorder." If this could be changed ASAP, that would be wonderful. Thank you. Smartestpuppy (talk) 22:51, 1 July 2024 (UTC)

Sorry, but Autism Spectrum Disorder is not an outdated name; for it is currently established by standardised diagnostic criteria (i.e., DSM-5, ICD-11) and the developers of evidence-based international guidelines (e.g. WHO, NICE). Димитрий Улянов Иванов (talk) 17:31, 4 July 2024 (UTC)

Infobox Image; discussion

I agree with @Omphalographer that the current image is unnecessary, considering it hardly represents the disorder. While academic performance is a common domain of impairment for those with ADHD, the implication that it is primarily a school-based issue trivialises the seriousness of ADHD and the main domains in life it impacts, especially when the image fails to capture symptomatic expressions.

It may be prudent to find a replacement image but some candidates could be showcasing the underlying neurology of ADHD or the relationship of the executive functions to its behavioural and cognitive expressions (see Barkley et al. for figures). That would convey ADHD much more comprehensively. Димитрий Улянов Иванов (talk) 11:00, 23 July 2024 (UTC)

You can barely read anything with the image you added. The text should at least be readable as a thumbnail. There's also a similar existing image in the article. – The Grid (talk) 16:51, 24 July 2024 (UTC)

The text is readable viewing from both my laptop and mobile. Plenty of infobox images use images with text around this size (e.g. Bulgarian or russian alphabet) and I'm not aware of a guideline prohibiting this, especially when its evidently readable. Even then, the image can always be made to appear larger. And there is no comparable image already in the article; this is the only image in the article which displays both the neuroanatomy and neuropsychology of ADHD and their relationship with each other, with description.

ADHD is, at it's core, a disorder of executive functioning and self-regulation. Depicting that in the infobox in a summatory way is important, rather than an arbitrary picture of a school environment, which does not represent ADHD or its symptoms, and trivialises the disorder for the reasons we discussed. Димитрий Улянов Иванов (talk) 17:10, 24 July 2024 (UTC)

ADHD is, at it's core, a disorder of executive functioning and self-regulation. Depicting that in the infobox in a summatory way is important, rather than an arbitrary picture of a school environment, which does not represent ADHD or its symptoms

I don't agree. The school environment is shown because in the DSM IV explains Attention-Deficit/Hyperactivity Disorder is a disorder classified throughout infancy, childhood, and adolescence (this was changed in DSM-5 to include adults), the list of items have focus on social, school, or work functioning. [1] An infobox is for summarizing the content that is in the prose. We also have the lede that is for summarizing the article in a few paragraphs.

It seems trying to summarize the item twice is overkill for the prose and infobox. That's where I even question having an image at the start but the school environment picture made some sense towards that. Showing a brain seems to be like any other disorder. (MOS:LEADIMAGE provides some guidance.) – The Grid (talk) 13:08, 25 July 2024 (UTC)

Thank you for your diplomatic comments and the opportunity to discuss this further. I address each of these below:

R.e. ADHD symptoms and impairments

I understand you referenced the DSM-5 (2013) but relying on that is problematic for several reasons, which I will discuss below. First, consider the International Classification of Diseases v-11 (ICD-11) (World Health Organization) (2022) which makes it clear that "In order for a diagnosis to be made, manifestations of inattention and/or hyperactivity-impulsivity must be evident across multiple situations or settings (e.g., home, school, work, with friends or relatives), but are likely to vary according to the structure and demands of the setting.",1 as does the European Consensus Statement on ADHD.2

They do not emphasise the school setting or any for that matter, but do emphasise the presence of impairment in multiple settings which can vary. It references examples which include home, work, friends, and relatives, and thus more. Even then, both the DSM and ICD are used for differential diagnosis which means certain symptoms and impairments central to the disorder (like emotional dysregulation and impairments in EF in daily life) have been excluded to reduce overlap with other conditions or diagnostic complications, yet remain core to the disorder.2

Also note that the DSM does not lead the research, but is often a decade or two behind where the research and scientific consensus is at that time. And the decisions made by the APA are political, not just scientifically based, so it's hard to know where this will go in the subsequent version.

More importantly is that ADHD symptoms are impairing in a substantial variety of settings, not merely school or academic functioning. There is a global scientific consensus that there is so many things it impairs, such as driving, taking care of oneself, cohabiting with others, executive functioning in daily life, health and routine, substance use, teenage pregnancy, financial management, comorbidity, criminality, overall quality of life, self-esteem, hobbies, other life commitments, etc. etc. as a direct result of its underlying self-regulatory and executive deficits. You can read extensive references about these in the International [Global] Consensus Statement on ADHD3, the European Consensus Statement on ADHD, and other peer-reviewed research (e.g.4, 5). So the previous image is indeed trivialising and probably stigmatising.

R.e. Current image

I disagree that the image is akin to any other disorder, considering it shows the relationship of ADHD's neuropsychology and neuroanatomy.

I understand it may not be optimal, and certainly there may be better alternatives out there or perhaps no image at all. However, the same issue you described is applicable to the previous image caption in that it describes an ADHD symptom mentioned in the lede (inattention) and a lead paragraph (hyperfocus). The current image caption does mention executive dysfunction as well that is mentioned in the lede, but is focused much more on the neuroanatomy (implicated brain regions) which is not mentioned in the lede or any below paragraphs.

Interpretation

In my view, the current image is good, but no image is also good (as in the ASD article) or an alternative one that is better fitting. There may be problems with it. I do however disagree with the use of the previous image. If a consensus cannot be reached, the infobox image can be excluded entirely. Димитрий Улянов Иванов (talk) 14:41, 25 July 2024 (UTC)

I would go for no image altogether if that's the case. Also, are you using LLM (AI) for responses? The responses you have been providing isn't normal for someone whose primary language is other than English. It's more than simple lexicon. If you're using some type of automation tool, it should be disclosed. The type of automation is very similar to using user scripts where the edits are disclosed and the pattern of edits are known. An essay about the use of them on Wikipedia. – The Grid (talk) 14:44, 26 July 2024 (UTC)

I am fine with that so long as there is a consensus; currently there isn’t.

Also, no, I am not. I have been learning English for a long time. It also comes from knowing my material as well or better than others so there is no hesitation when writing due to uncertainty. Confused as to the basis for your assumption, especially with my word dumping. Димитрий Улянов Иванов (talk) 15:05, 26 July 2024 (UTC)

Evaluating the evidence for the efficacy of exercise

Although the article cites a series of studies suggesting exercise is efficacious for reducing the symptoms of ADHD, the International Consensus Statement on ADHD concluded that exercise has no statistically significant effects due to the results of two comprehensive meta-analyses and systematic reviews.1

Since that is the global scientific consensus, it seems to me that it may need to take priority as a replacement of the statements entirely, as I've seen elsewhere. But would the best course of action be to reference both lines of evidence? Димитрий Улянов Иванов (talk) 18:53, 25 May 2024 (UTC)

I would include both POVs as excercise as a method of treatment for ADHD has tons of conflicting evidence and I don't think there is sufficiant evidence to completely disprove it's effectiveness, however results have been conflicted about how effective it is. CursedWithTheAbilityToDoTheMath (talk) 17:09, 26 July 2024 (UTC)

Typo for CDH13

Under the genetics section, CDH13 is written as CHD13 in the next sentence. Just wanted to point it out! Aiden3c (talk) 17:14, 25 July 2024 (UTC)

Fixed, thanks. Nikkimaria (talk) 22:30, 29 July 2024 (UTC)

Redundancies

@Димитрий Улянов Иванов: please don't do that. If you agree that some of the changes are good, then don't revert them. That edit reintroduced a pile of redundancy and prose issues that really need to be cleaned up if this is to remain a GA. Nikkimaria (talk) 22:30, 29 July 2024 (UTC)

Hi, thanks for reaching out. Despite the fact that some of your editing appeared helpful, I identified a number of major concerns with your edit including unexplained removal of content that is otherwise considered appropriate in regards to its implementation and relevance in the article, removing summary content from the infobox as well as altering the implications of information. I also found no evidence of a consensus or a discussion of these nor did the edit summary reflect much. Considering all these shortcomings, the edit is misplaced.

Before enacting such an edit again please substantiate your edits such as:

- Removing the info, in the controversy section, about the measures taken by the global scientific consensus to combat misinformation and stigma

- Removing details in the infobox (e.g. typical onset of disorder) that can be considered a summation of the diagnostic section for it. From my understanding, the infobox should summarise key details, even if this results in repetition. Onset is one such key detail in the diagnostic of ADHD (see DSM-5 and ICD-11).

- Removing the implication that executive functioning is central to ADHD, thus instead implying it may be a mere aspect of it

- Removing the fact that ASD and ADHD can be comorbid (this clarification is needed here because, until the most recent DSM, they were considered mutually exclusive).

Among others.

Overall, I fail to see how you considered this information redundant. Much of it has been established as being necessary for the article. Димитрий Улянов Иванов (talk) 01:59, 30 July 2024 (UTC)

Hi Димитрий Улянов Иванов, every single one of these was present prior to this revert of yours. Meanwhile, you also reverted a number of other changes, ranging from as straightforward as reinserting the typo identified in the previous section, to as significant as removing citation-needed tags from claims requiring citations. Please self-revert. Nikkimaria (talk) 02:37, 30 July 2024 (UTC)

Sorry for the belated reply. I have just relooked at that edit and would like to first apologise for an oversight. Removing the information about the comorbid diagnosis of ADHD and ASD is indeed necessary as it's already clarified in a previous sentence above. I did not see that. Certainly will restore the edits soon. However, there remains several problems:

- The implication that EFs are central to ADHD is still removed. While the lede summaries this point, it's not in the same section and the lede summary is based directly on the specifics of this information later in the article, which is consistent with the relationship of other details with the lede.

- Placing tags on thigns like the age of onset on the infobox, suggesting it requires clarification, ignores the conclusive data referenced in the accompanying section in the article the summary is based on. As for the expert consensus efforts to combat misinformation and stigma, how is that a non-sequitur exactly?

- Implying that the subjectivity of an ADHD diagnosis is problematic and leads to misdiagnoses based on cultural differences, directly contradicts the global scientific consensus cited later in the article for the same issue (Faraone et al., 2021), which is considerably more reputable than the source provided. Димитрий Улянов Иванов (talk) 21:40, 30 July 2024 (UTC)

Thank you for partially undoing your edit. However, I have some remaining concerns:

-That ADHD arises from problems with executive networks is already noted in the Causes section. There is overlap between the Causes section and subsections, adn the Pathophysiology section and subsections. Additionally some of the details in the Pathophysiology section are mentions under Symptoms in the infobox, but not mentioned in the Signs and symptoms section. This suggests larger, persistent problems with the article's structure and organization.

-|onset= is meant to be used for age of onset; at the moment no specific age or age range is mentioned, but rather the term "developmental period" is used. This needs clarification for the lay reader. As to stigma, this is misplaced because it is not a "controversy", and the connection between stigma and the Statement is not drawn for the reader, again requiring clarification.

-The claim that ADHD diagnosis is subjective was present in the article both before and after my changes. If you have concerns about the reliability of that sourcing, that is an issue separate from this discussion. Nikkimaria (talk) 22:35, 30 July 2024 (UTC)

1. Okay, accepted
2. The developmental period in primary ADHD (P-ADHD) is defined as ending at age 12. If this needs specification, that is okay, but the fact that the symptomology and impairments typically occur within that timeframe has been established int the article.
3. I was not disputing the fact that the diagnosis of ADHD is subjective, it indeed is, as is the case for other neurodevelopmental disorders (e.g. ASD or Tourette's syndrome) and almost the entirety of psychology. However, to imply this is problematic and results in misdiagnoses due to cultural differences is what contradicts the International scientific Consensus on ADHD. See the controversy section for details. According to wikipedia guidelines I have seen, scientific consensus should take priority over other sources obviously due to its reputability.

Димитрий Улянов Иванов (talk) 22:48, 30 July 2024 (UTC)

Also, to address the combating stigma sentence, the consensus statement referenced clearly makes the connection between stigma and controversy in ADHD and their response to it. The sentence uses a semi-colon to denote the subsequent sentence as being related, so I am confused as to why it's problematic. Димитрий Улянов Иванов (talk) 22:52, 30 July 2024 (UTC)

On 3, again, that's not something I'm disputing, but would warrant separate discussion. On 2: I don't disagree that it's in the article, but the statement in the infobox remains unclear. And on stigma: the Statement may make that connection, but what's in the article doesn't - that stigma exists is not a controversy, the Statement is not a controversy (or is not noted as being a controversy), so this is still a non sequitur as presented. Nikkimaria (talk) 23:59, 30 July 2024 (UTC)

3: Okay, accepted

2: Ah, I see. In that case, I would consider rewriting it to: "In most cases at least some ADHD symptoms and impairments onset before the age of 12 years".

R.e. Controversy I disagree. Stigma is a form of controversy and is relevant to the subject, even if the exact word of 'controversy' is not used in the sentence. Regardless, because I don't wish to belabour this further, I would also consider just mentioning controversy explicitly in addition to "stigma", and this is consistent with the citation. Димитрий Улянов Иванов (talk) 15:21, 2 August 2024 (UTC)

Stigma is not a form of controversy. What would you propose saying about controversy? Nikkimaria (talk) 15:25, 2 August 2024 (UTC)

Hi, I just enacted an edit which I hope addressed your concern. If I have indeed interpreted it correctly, the absence of the word "controversy" was the problem and perhaps in relation to what so I have clarified this in the article.

Let me know if there are remaining problems. Димитрий Улянов Иванов (talk) 15:35, 2 August 2024 (UTC)

Your edit mentioned a "formatting mistake" - it wasn't, single-sentence paragraphs should be minimized per MOS:PARA. On the stigma point, I don't see any mention of controversy in the source - what is this based on? Nikkimaria (talk) 03:11, 3 August 2024 (UTC)

1. Indeed, single-sentence paragraphs have been minimised and it is thus permittable according to that source, especially when the sentence has several clauses and due to its irrelevancy from the other paragraphs. So it fits best on its own. That sentence has also been grammatically modified in the past by other editors while still keeping it separated from the rest, if I recall.
2. Controversy means significant public disagreement or discussion (i.e. first result on google). Stigma also is a type of controversy, here is a peer-reviewed scientific paper demonstrating so: https://link.springer.com/chapter/10.1007/978-3-030-11908-9_19 - ("Stigma as a mental health public controversy"). The International Consensus Statement is based on addressing controversy, such as misconceptions, stigma, and public disagreements. The consensus statement also has a discussion section. Moreover, to cite three examples of controversy being addressed/discussed: a) "The diagnosis of ADHD has been criticized as being subjective because it is not based on a biological test. This criticism is unfounded." b) "We also know little about stigma and ADHD. Stigmatizing attitudes toward ADHD are common and may play a role in socially and clinically important outcomes. These negative attitudes affect patients at all stages of their life. Such attitudes have been documented among individuals at all ages and in all groups, including family, peers, teachers, clinicians, and even individuals with ADHD themselves". C) "Misconceptions about ADHD stigmatize affected people, reduce credibility of providers, and prevent/delay treatment. To challenge misconceptions, we curated findings with strong evidence base." :::::::::::Therefore, the statement is obviously relevant to the controversy section, and other sources in the controversy section are too, even if they might not explicitly say the word "controversy" exactly. There appears to be a consensus on keeping this, given that it has been reviewed by other editors in the past who edited and kept it.

Димитрий Улянов Иванов (talk) 13:11, 4 August 2024 (UTC)

The issue of subjectivity in diagnosis is already covered elsewhere in the section. That citation has to do with stigma as a mental health policy issue; it doesn't support the claim that stigma in general is a controversy. Similarly there is no evidence to support the claim that there is consensus on keeping this where and as it is. I've moved the International Consensus Statement to the History section since there was no previous general explanation of it, and added a mention of stigma in Prognosis. Nikkimaria (talk) 14:31, 4 August 2024 (UTC)

Hello, your edit is problematic.

The issue of subjectivity is indeed covered elsewhere in the section, but that was not what the sentence and the International Consensus Statement cited was primarily in relation to.

You are seriously misrepresenting the peer-reviewed source. It does not specify mental health as a policy issue as you italicised, but, explicitly, a policy controversy. Entitled, it concludes: "Stigma as a mental health policy controversy". [bold added]. I already made this clear in my previous talk response. Here is a screenshot this is still not clear as I am just reiterating myself: https://ibb.co/Q6XD4Fp and here is the exact source again: https://link.springer.com/chapter/10.1007/978-3-030-11908-9_19

In addition, you have not addressed the implications and relevance of stigma, misconceptions and discussion, all covered in the International Consensus Statement to controversy. Indeed, as definitions show (see my previous reply), controversy means significant disagreement or discussion and thus stigma, misconceptions, disagreements, and instances of the ICS disagreeing explicitly with public claims would clearly qualify as being relevant to the section.

Here, another peer-reviewed, reputable source indicates relevance too: the American Psychiatric Association (APA) concluded that: "Stigma often comes from lack of understanding or fear. Inaccurate or misleading media representations of mental illness contribute to both those factors". See: https://www.psychiatry.org/patients-families/stigma-and-discrimination

Even then, it wasn't just about stigma.

To provide the evidence of an agreement and consensus among editors: here, another editor reviewed the original content added, reworded it substantially, and decided it should remain included in that section. See: https://en.wikipedia.org/w/index.php?title=Attention_deficit_hyperactivity_disorder&diff=prev&oldid=1216756689. Димитрий Улянов Иванов (talk) 16:58, 6 August 2024 (UTC)