Talk:Attention deficit hyperactivity disorder

Controversy section

split from above. Nikkimaria (talk) 00:07, 8 August 2024 (UTC)

Looking at the broader article structure and the issues it presents, I think it would be preferable to follow the guidance at WP:CSECTION and get rid of the Controversy section entirely. This would resolve the issue around differing interpretations of the term and would allow for balancing of perspectives by redistributing content elsewhere. Nikkimaria (talk) 04:47, 7 August 2024 (UTC)

Hi Nikkimaria,

First, I'd encourage initiating a new talk page for discussion of that topic so we do not dissuade other editors from spectating and commenting because of the cluttering here.

I have read that source and it seems that controversy sections are permitted so long as they reflect neutral, accurate reporting of the status of the field and are not called "controversy" or based around the subject generally. So indeed, relocating the subjects might be needed and/or creating new sections for other topic areas.

Note that if the controversy section is to be removed I vehemently believe that certain content should be removed as well rather than relocated to scientific topic areas, or denounced accordingly, where there is a unanimous scientific consensus contradicting it. It would otherwise inadmissibly empower misinformation. Some examples include claims that ADHD is "not a neurodevelopmental disorder", "created by society", its medications are "dangerous" or "without efficacy" etc. These are objectively incorrect pseudoscientific nonsense that does not deserve neutral coverage or we would be making a middle-ground fallacy, regardless of its popularity among non-reputable sources. See another primary article, such as for Autism/ASD to give an example: it mentions the controversy regarding vaccination causing it, but explicitly claims it is disproven, as opposed to neutrally reporting both sides as if the idea had any weight to it despite the fact that it is a controversial subject.

I hope you can understand my concern; I think the involvement of other editors would help greatly in clarifying how the article should move forward. Димитрий Улянов Иванов (talk) 15:02, 7 August 2024 (UTC)

Irony

This article is about a disorder that includes the symptom of trouble paying attention -- and the article itself is very long and dry. Considering Wikipedia is intended for the readers, it might make sense to at least provide a link to the Simple English Wikipedia article in the external links so that readers with ADHD (who would be likely to read this article to find out more about their condition) have a source that is more suited to our attention span.

2601:600:9080:A4B0:F44E:6377:258D:DCD0 (talk) 01:32, 14 September 2024 (UTC)

Hi IP, there's a link to the Simple English version in the languages menu. Nikkimaria (talk) 04:34, 14 September 2024 (UTC)

Genetic component and reference 46 "Genetics of attention deficit hyperactivity disorder"

Summary The current article misrepresents heritability and the genetics of ADHD, with several of the sources contradicting the content they are references to.

The current article states "in rare cases ADHD may be caused by ... a major genetic mutation [46]" But the article referenced states "ADHD’s heritability is due to a polygenic component comprising many common variants each having small effects." This is largely corrected in the dedicated genetics section.

The current article states "ADHD has a high heritability of 74%, meaning that 74% of the presence of ADHD in the population is due to genetic factors." Heritability is not the same as genetic inheritance* as nurture imparts some level of traits.

Potentially this confusion comes from eg reference "Genomic analysis of the natural history of attention-deficit/hyperactivity disorder using Neanderthal and ancient Homo sapiens samples" which states "a considerable fraction of (ADHD) which is explained by single nucleotide polymorphisms (SNPs)". In both cases the research data in the papers cited shows a complex heritability, and indicates a complex genetic component.

• Getting struck by lightning is a heritable trait, as eg those whose parents play golf in the rain are more likely to do so them selves.

202.63.68.241 (talk) 02:00, 18 September 2024 (UTC)

Thanks for your comment but I'm sorry to say it does not stand to serious inspection.

Meta-analyses examining extensive studies of twins and molecular genetics show that 70-90% of ADHD is attributable to genetics. The remainder is the result of non-shared environmental factors, which would include injuries to the brain prenatally (such as from exposure to biohazards) or the rare cases of traumatic brain injuries later in life that damage the prefrontal EF networks. The family and rearing social environment have found to be statistically nonsignificant factors, where hypothesis of "nurture" clearly falls in. So ADHD is caused entirely by biological contributing factors (neurology and genetics).

See: (Grimm et al.,2020), Larsson et al., (2013); Faraone and Larsson (2019); Molly & Alexandra, (2010); Kleppesto et al., (2022).

These are all summated in the International Consensus Statement on ADHD, and are therefore, the global scientific consensus In fact, they conclude:

Kleppesto et al: "the intergenerational transmission of ADHD behaviors is primarily due to genetic transmission, with little evidence for parental ADHD behaviors causing children’s ADHD behaviors. This contradicts the life history theory."

Molly et al: "Results indicated that both dimensions were highly heritable (genetic factors accounted for 71% and 73% of the variance in INATT and HYP, respectively".

Grimm et al: "The formal heritability of ADHD is about 80% and therefore higher than most other psychiatric diseases. However, recent studies estimate the proportion of heritability based on singlenucleotide variants (SNPs) at 22%. It is a matter of debate which genetic mechanisms explain this huge difference".

So the term heritability does mean inheritance of risk genes, one simply has to look at the context of the systematic reviews where they clearly specify genetic factors, as the above quotes show. Or just the definition given by reputable groups, such as the US Medical Authorities: https://medlineplus.gov/genetics/understanding/inheritance/heritability/#:~:text=Heritability%20is%20a%20measure%20of,schizophrenia%20and%20autism%20spectrum%20disorder.

"Heritability is a measure of how well differences in people’s genes account for differences in their traits"

Here, another definition given by the peer-reviewed journal Nature, which is among the most reputable on the planet: https://www.nature.com/scitable/topicpage/estimating-trait-heritability-46889/. They concluded: "Heritability is a concept that summarizes how much of the variation in a trait is due to variation in genetic factors".

The genomic analysis was cited to show the influence of natural selection on ADHD over the course of 45,000 years; not pertinent to the causes of the disorder. Regardless, it is indeed well known that in a small but significant minority of individuals ADHD is caused by a major genetic mutation/single genetic abnormality, as the International Consensus Statement on ADHD concluded referring specifically to that review of genetics (Faraone et al). So the sources have not been misrepresented.

To sum, there is a global scientific consensus that 70-80% of ADHD (or higher) is attributable to inheritance of ADHD risk genes, mostly accumulatively but a single genetic mutation can be accountable in rare cases. In the remainding 20-30% of cases, it is either due to measurement error or non-shared, non-social and non-family environmental events such as TBI. Димитрий Улянов Иванов (talk) 07:56, 18 September 2024 (UTC)

R.e., comma in lede

@Slothwizard, I don’t believe a comma is grammatically needed in order to distinguish the two clauses because the word ‘and’ does that already. A comma can be used for emphasising a difference, but it isn’t needed here. Moreover, emotional dysregulation and disinhibition (impulsivity) are partially related. I just think adding that comma makes the sentence more cumbersome to read. Димитрий Улянов Иванов (talk) 06:29, 2 October 2024 (UTC)

Thank you for mentioning your concerns. I have noticed that the list of symptoms actually does continue on after “dysregulation”and does not split into a new one, rather they are the same. I believe that is where my confusion was. The sentence is easy to read, my only concern is the difficulty in fully interpreting it correctly in a grammatical sense, but regardless I see now it’s grammatically correct. This may only be a problem if you read text in a pedantic matter like I do, so I will keep that in mind. Will revert to original. Apologies for the inconvenience and confusion, thanks again. Slothwizard (talk) 06:59, 2 October 2024 (UTC)

No problem, thank you for checking on that issue. Also, with regards to the symptom list in the Infobox, at some point I will consider revamping that. Currently, things are listed weirdly. For instance, ‘disinhibition’ and ‘hyperactivity’ and ‘impulsivity’ listed, yet disinhibition underlies the symptom dimension of hyperactivity-impulsivity and some aspects of the inattention implicated in the disorder, such as distractibility, as well as the impulsive and preservative aspects of emotional dysregulation. ‘Carelessness’ is also written, which is very superficial and not a core symptom so it’s odd that it’s uniquely noted alongside such core symptoms. So these are further issues that need rectifying. The main symptom dimensions should probably be mentioned upon which the more superficial expressions of them are mentioned in a parenthesis. Димитрий Улянов Иванов (talk) 09:49, 2 October 2024 (UTC)

Should the Symptom List be Changed?

@Slothwizard

Perhaps my edit was too long, and hope the issue can be addressed. However, terminology should not be less precise per se merely so the lay person can understand it as this is is the main English page, and not Simple English, which is available for this reason, as I understand this,

That said, here are my main contentions. First, there a number of issues in the current/previous symptom list which I have noted above and will reprint here so other readers don't miss it:

"Currently, things are listed weirdly. For instance, ‘disinhibition’ and ‘hyperactivity’ and ‘impulsivity’ listed, yet disinhibition underlies the symptom dimension of hyperactivity-impulsivity and some aspects of the inattention implicated in the disorder, such as distractibility, as well as the impulsive and preservative aspects of emotional dysregulation. "Executive dysfunction" is also itself listed independently from some deficits in EFs. ‘Carelessness’ is also written, which is very superficial and not a core symptom so it’s odd that it’s uniquely noted alongside such core symptoms. So these are further issues that need rectifying. The main symptom dimensions should probably be mentioned upon which the more superficial expressions of them are mentioned in a parenthesis".

Second, it would probably be better to try and reflect the underlying symptomology of ADHD in some way. If the length is problematic, the examples could be omitted or shortened. It is problematic to just list the most superficial symptoms, especially when this section in the infobox is not about examples but a comprehensive description (this doesn't necessarily need to be long but at least account for the various core symptoms). Димитрий Улянов Иванов (talk) 20:11, 2 October 2024 (UTC)

I probably worded my request for layman terms poorly, I do agree that the most accurate terms should be used. I overall agree with you. I will look at diagnostic manuals for some clarification as the first thing, as I see (for example) “carelessness” is not a very objective term, even if it is subjectively a common symptom, so it should be removed. Thank you for bringing this concern. I will get back to you as soon as possible. I’ll comment here more as I find better ways to showcase symptoms. Slothwizard (talk) 20:19, 2 October 2024 (UTC)

Thanks for replying. I would just like to recommend not relying on the diagnostic manuals (such as the DSM-5 released in 2013) as they are not intended to provide a comprehensive theory describing the disorder's symptomology for several reasons. They are intended mainly for differential diagnosis, and even then, are outdated with the scientific consensus (e.g., not including emotional dysregulation as a core symptom). That said, here are some of the references published in reputable peer-reviewed journals or medical associations that support my edit:

American Psychological Association (APA): Attention-deficit/hyperactivity disorder, self-regulation, and executive functioning (psycnet.apa.org/record/2010-24692-030).

ADD/ADHD and impaired executive function in clinical practice. (https://link.springer.com/article/10.1007/s12618-009-0006-3)

Anthsel et al: Executive Functioning Theory and ADHD: https://link.springer.com/chapter/10.1007/978-1-4614-8106-5_7

The International Consensus Statement on ADHD: www.ncbi.nlm.nih.gov/pmc/articles/PMC8328933/

Executive Functions: www.ncbi.nlm.nih.gov/pmc/articles/PMC4084861/

Widely Projecting Systems: Monoamines, Acetylcholine, and Orexin. In Sydor A, Brown RY (eds.). Molecular Neuropharmacology: A Foundation for Clinical Neuroscience (2nd ed.). ISBN 978-0-07-148127-4. Димитрий Улянов Иванов (talk) 20:44, 2 October 2024 (UTC)

Noted, thank you Slothwizard (talk) 21:25, 2 October 2024 (UTC)

Porn induced adhd

Sexual development in ADHD and internet pornography consumption Pornography use has been tied to adhd 2605:59C0:E6:410:58C1:BDD9:AB57:AFE9 (talk) 19:37, 26 October 2024 (UTC)

It’s a correlation, not a cause. Димитрий Улянов Иванов (talk) 20:07, 26 October 2024 (UTC)

Lede Names

Dear @Slothwizard,

I understand HD is less commonly used, but it is surely not former name according to the Nature Review cited, which was published in 2024 and reflects the most up to date facts on ADHD. It is less prevalent, yes, but still a current established name and thus merits inclusion in the lede, as I understand it.

Would appreciate your input on this. Димитрий Улянов Иванов (talk) 22:55, 30 October 2024 (UTC)

I see now that I cannot definitively say it’s a “former” name of the disorder, thanks for pointing this out. Before I type further, I do not have a subscription for the Nature journal and it is behind a paywall for me, aside from the abstract, thought to let you know.

The DSM-5 and ICD-11 does not have entries for HD. The ICD-10 listed it as a separate disorder alongside ADHD, presented similarly to ADHD-C on the DSM-5, I believe, but correct me if I’m wrong. It has a history and does not appear to be a fully acceptable term for ADHD. Since it is presented with similar symptoms and has the same pathophysiology, I think it is appropriate to keep it under the synonyms section in the Infobox, which does not exist for no reason. Hyperkinetic disorder is not notable enough for it to be included in the lede, and just because the Nature article mentions it as a synonym does not change that. Because it still is a synonym, it should be kept in the synonyms section in the infobox with a citation. I will add, there is a whole separate article for hyperkinetic disorder. I do not know the validity of the content of this article, but it does portray HD as a former name for ADHD. Maybe it should be deleted, or maybe it should be revised and/or corrected, but that is a different discussion. But, if we include this synonym, should it be linked to that article as well? I feel as though this is creating complications, albeit fixable. Mentioning it on the lede, however, is inappropriate. Thank you and I appreciate your concerns. I am looking forward to your input. Slothwizard (talk) 00:25, 31 October 2024 (UTC)

Thank you. Reviewing this again ,I agree. Strangely, some WHO documents I was reading at the time continue to use the term specifically for ADHD (see: https://cdn.who.int/media/docs/default-source/essential-medicines/2021-eml-expert-committee/expert-reviews/a21_methylphenidate_rev2.pdf?sfvrsn=42d5434f_6) which gave me the impression it's contemporary but you are correct to point out it has been removed since the release of the ICD-11. The Nature systematic review notes that ADHD is also known as HD but that doesn't itself endorse the validity of the name as an alternative. Apologies for missing these nuances.

Accordingly, I would consider removing it unless it can be put into a section referring to "previous names". I understand it was once used but would just like to keep former names referred not as current alternatives to ADHD.

In the light of this, I shall ping @The Grid for his edit reinstating the term "ADD". I disagree. First, the infobox section refers to "other names", implying they are still valid, rather than former or previous names. That terminology (ADD) was invalidated with the revision in 1987 to ADHD in the DSM-III-R. In the DSM-IV, published in 1994, ADHD with subtypes was presented. In 2013, the DSM-5 and later the ICD-11 discarded subtypes in replacement of presentations of the same disorder that change over time in reflection of research findings. So, "ADD" should not be used in the article. Logic that it should be maintained merely because of publicity (despite the fact that the public uses ADHD for the most part) would also necessitate adding "variable attention stimulus trait" in the descriptor because it's a popular public term, even though it's inaccurate, and no credible scientific paper uses it. In the scientific literature, "ADD" is never used since the diagnostic criteria invalidated it (Faraone et al., 2021). Димитрий Улянов Иванов (talk) 16:16, 1 November 2024 (UTC)

No worries! I added “formerly” to synonyms as a compromise, which could be temporary or permanent. Hopefully this is sorted out. Thanks Slothwizard (talk) 19:55, 1 November 2024 (UTC)

Thank you! :) Димитрий Улянов Иванов (talk) 20:31, 1 November 2024 (UTC)