Talk:Attention deficit hyperactivity disorder/Archive 11

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Dispute resolution

I guess we may as well start dispute resolution at this point. I assert that there is no significant "controversy" for the ADHD diagnosis, that the articles Attention-deficit hyperactivity disorder,Adult attention-deficit disorder and Attention-deficit hyperactivity disorder controversies be flagged as "disputed" and I offer the classic "International Consensus Statement on ADHD, January 2002" as reference PubMed, Full text. According to Wikipedia policies Wikipedia:Neutral point of view "Neutrality requires that the article should fairly represent all significant viewpoints that have been published by a reliable source, and should do so in proportion to the prominence of each. Now an important qualification: In general, articles should not give minority views as much or as detailed a description as more popular views, and will generally not include tiny-minority views at all.". --Sportsmand (talk) 21:03, 20 April 2009 (UTC)

We're off to a good start then, all significant viewpoints should be represented for neutrality. I agree with that. You seem to be of the opinion that the controversy should be deleted and removed as it doesn't exist. Google scholar comes back with 7,180 for adhd and controversy and adhd controversial brings back almost 125 peer reviewed papers including 40 reviews in pubmed. Your citation is not very good. First of all they are only saying the existence of ADHD is not controversial. Most people accept that some people are hyperactive and have poor attention spans. That is only a small part of the controversy. Much of the controversy surrounds the use of amphetamines in young children, drug misuse, side effects, long term effects of medications, overdiagnosis etc etc. Also the paper is just a group of experts from around the world getting together and signing their name saying this condition exists and is not a myth etc. It is just an opinion piece essentially. It is not an opinion of a respected or influential body such as the world health org or some other big national or international health bureaucracy.--Literaturegeek | T@1k? 21:19, 20 April 2009 (UTC)

I might ask, do you also agree with the rest of the policy? But please read what I write: ADHD diagnosis - not treatment. I take your statement "..they are only saying the existence of ADHD is not controversial.. as being in favor of that distinction. Your use of Google scholar as a reference is considered "original research" according to policies and thus not a valid source. So, you have not given any counter to my claim. As for the treatment, I certainly do agree that it is controversial, but that's not the point. --Sportsmand (talk) 07:42, 21 April 2009 (UTC)

I see the reference you cited compares denial of ADHD to denial of whether smoking causes cancer or HIV causes aids LOL. It is just an opinion piece and I bet if I looked into the signators their would be a conflict of interest.--Literaturegeek | T@1k? 21:31, 20 April 2009 (UTC)

This "Opinion piece" still represents contemporary scientific understanding of ADHD. After 7 years, it has not really been countered, and I dare you to do it. What kind of science do you suggest we use as basis, if not like this? ADHD is an officially recognised disorder (usually under other names), we have it in the category infobox so why is there any doubt? This is a PubMed article and a very valid source. Furthermore, you have not any sources, so you have not countered my claim. --Sportsmand (talk) 07:42, 21 April 2009 (UTC)

I see this article actually already covers the fact barkley has finacial conflicts of interest. Interestingly Barkley himself published a paper on the controversies surrounding diagnosing ADHD!--Literaturegeek | T@1k? 21:40, 20 April 2009 (UTC)

How do you suggest we rate the risk, that financial interests may somehow influence the correctness of science? But why bother? There is capitalism and there is science. Money can't influence the results of real science - only the directions. I'm sure Barkley may have used the talk of controversies to sell another book. Does he state in the book, that ADHD is not a valid diagnosis? As you put it here, it is not a valid source and no counter to my claim. --Sportsmand (talk) 07:42, 21 April 2009 (UTC)

Sadly, there is considerable public dispute about both the existence of the disorder and the diagnosis and treatment. (I say sadly because most of the noisiest participants are usually among the least informed about the disorder.) We should cover this, somehow, and provide our users with the best available reliable information: what's true, what's false, what's disputed. htom (talk) 00:31, 21 April 2009 (UTC)

I agree, that the public may dispute ADHD - how could they not?. However, as we have seen right in this very page, the concepts of diagnosis vs. treatment may sometimes not be understood. News-papers, in search of headlines, may write dramatic stories like "ADHD - the disease where doctors give speed to children, hyperactives and addicts" (I have no quote for that one). Honestly, public opinion doesn't matter for us here. Reliable information is the goal - absolutely. --Sportsmand (talk) 07:42, 21 April 2009 (UTC)

The usual RS for Wikipedia in matters of controversy tend to the popular rather than the scientific. As medicine is as much art as science, there's lots of room for opinion to be touted as "reliable". htom (talk) 13:06, 21 April 2009 (UTC)

I am well read on the subject of ADHD. I have read a number of books and research papers on ADHD and know someone who took ritalin who wishes that they had never heard of the word ritalin. I also know of a consultant psychiatrist who is the head of a major psychiatric hospital who has noticed a pattern in that many of his patients who present with a diagnosis of borderline psychosis or schizoeffective disorder have a long history of using amphetamine based stimulants, methylphenidate and dextroamphetamine and he believes that his colleagues in child psychiatry and pediatrics are brain damaging children. He also finds that the symptoms do not typically go away after discontinuation of stimulants. He says the problem is how do you tell if it is comorbid or caused by the drug and that it is difficult to prove cause and effect. He is clearly not fringe being the head of a major psychiatric hospital, he is also works in addictions and is a psychopharmacologist. I also know of people who became addicted to ritalin and doctor shopped for it and who would become violently psychotic if they ran out of ritalin and I know of people who abused ritalin. On the other side of the coin I know of people who took stimulants who lead normal lives now and no longer take stimulants. Oh and the books that I have read, one of them was written by CHADD, a group funded by the drug companies who promote stimulants heavily. They actually put forth the hunter versus gatherer theory which suggests that ADHD is only a "problem" due to the environment of current society which actually backs up the point of view that ADHD is not a brain abnormality or neurological disorder but rather a problem for some people in the modern society environment eg school, work environment. The controversy is worse due to the very limited research into the long term effects of stimulants so no one can prove either side of the controversy correct or wrong. Infact many of the controversies can't even be cited on wikipedia as they have never even been raised in the peer reviewed literature.--Literaturegeek | T@1k? 00:50, 21 April 2009 (UTC) .

What you tell sounds horrible, and I don't doubt that it may be true. But as I see it, we as humans accept certain "life-risks", traffic accidents, lifestyle, consuming food, salt or alcohol. The risk of medication should be determined in relation to that. For the individual, it may help to see life and death as raw darwinian statistics. ;-). But finally, the ADHD diagnosis is not connected to stimulants as such, so I wont record what you write as any counter to my claim. --Sportsmand (talk) 07:42, 21 April 2009 (UTC)

Expecting symptoms relieved by drugs (although it's emphasized that the drugs do not cure) to remain relieved when the drugs are removed, shows a magical belief in something, or perhaps a hearing or reading deficiency in the believer. Take my eyeglasses away, I'm still near-sighted, even though I've worn them for a half-century. I don't know that any knowledgeable medical professional has ever claimed that stimulants "cure" ADD, in any of its forms, just as anti-convulsents don't cure epilepsy. Stop taking them, the seizures return. Take them for twenty years, maybe, if you're lucky, they don't. (Well, they haven't yet.) htom (talk) 01:06, 21 April 2009 (UTC)

Let me elaborate on my summary comment, which I mis-somethinged. It should be hunter-gatherer vs farmer; the latter requires a much larger mastery of time and delay of gratification. Indeed, it's almost the step from super-great-ape to mankind. htom (talk) 03:31, 21 April 2009 (UTC)

Epilepsy is a serious neurological disorder which failure to treat can lead to brain damage or even death. The benefits of treatment outweigh by far the risks of treatment. The reality still remains that very young children are at an early age being told they have a defect of the brain, a mental health disorder, they are different and normal like their friends and they are told they need amphetamines in their developing brains in order to "become normal". The long term effects have not been investigated so it is not possible to do a risk benefit ratio calculation. The limited amount of research into the long term effects actually backs up the controversy side rather than "the drugs are as safe" POV. Hence ADHD and amphetamines are controversial. I think the debate should be settled now with citing both sides of the controversy using reliable sources.--Literaturegeek | T@1k? 15:39, 21 April 2009 (UTC)

I understand the risks of epilepsy (which is why I kept taking the drugs even though I hated the fog they put my mind in, and why the VA had such a hard time getting me to slowly withdraw, which has turned out well.) When I think back to my childhood ... in any case, that sounds like a very poor way to explain to either parents or a child what has, is, and will be happening, and what can happen. I would hope that the debate would not "settle", but inspire research into a number of treatments (and lack of treatments) in an attempt to discover what the better treatments are. I don't think there ever will be a "best" treatment; one of my nephews intentionally goes off his meds before playing gigs as a jazz trumpet player, and he does, indeed, play jazz better that way. His grades, though, suffer when he doesn't, and he knows that, too. Adjusting mental performance like that is almost a neat hack. What are the long-term consequences? We don't know, and no one seems interested in doing the study (I can understand why, it would be very difficult and probably have results that could be read either way, adult lives are too variable.) htom (talk) 17:11, 21 April 2009 (UTC)

Here is the critique of the paper that sportsmand was asking about http://www.critpsynet.freeuk.com/Acritiqueofconsensus.htm signed by many exports who hold a different point of view. It two parties disagree one of the parties is not honestly able to deny the existence of the dispute.

And wrt to OR that only applies to the main page OR is allowed on the talk pages.--Doc James (talk · contribs · email) 13:34, 21 April 2009 (UTC)

Above you wrote on Russel Barkley: "I respect his research..". Here you present a minority report. To what proportion do you think the two views should have merit? --Sportsmand (talk) 14:23, 21 April 2009 (UTC)

Barkley published the MTA one of the best research studies available on ADHD. This is the research. The position statement of his is an opinion piece rather than a research study. The critique is also an opionion peice. The McMaster paper from 1999 hold more weight than both in my opinion.

The position statement and the critique are more of a social discussion of ADHD. Both should be mentioned on the ADHD controversies page. Part of what these two peices represent is different views of ADHD in different places. Barkley and most of those who signed his statemement are American the critique is mostly British.--Doc James (talk · contribs · email) 15:22, 21 April 2009 (UTC)

I agree, that this is a valid source. The consensus statement and the critique is most likely the best metrics we can find to assess the matter. We may include other sources. Would you agree to that? Please remember our policies NPOV and please mind, that our job is not to interpret science, but to find the best material that indicates the state of the matter. --Sportsmand (talk) 09:31, 22 April 2009 (UTC)

There is also Dr Vernon Coleman for a polar opposite POV of Barkley.--Literaturegeek | T@1k? 15:45, 21 April 2009 (UTC)

This is not a valid source and no counter to my claim. The article is called "Ritalin: Child Abuse On Prescription?" and relates to ADHD treatment, not diagnosis. I am surprised that people still doesn't comprehend that distinction. --Sportsmand (talk) 11:28, 22 April 2009 (UTC)

Here is another critique of Barkleys statement. This one from Australia. PMID 12557837 Let me know if you cannot get access. I have added a passage on the controversies page to address Barkley's statement and the two critiques.--Doc James (talk · contribs · email) 17:59, 21 April 2009 (UTC)

I am in doubt with this one. It appears a genuine source, but how can we include closed content for future verification? --Sportsmand (talk) 11:28, 22 April 2009 (UTC)

Or see PMID 18658077 from 2008, which concludes that "ADHD is unlikely to exist as an identifiable disease. Inattention, hyperactivity, and impulsivity are symptoms of many underlying treatable medical, emotional, and psychosocial conditions affecting children". II | (t - c) 18:34, 21 April 2009 (UTC)

Lol, I used that source to show the exact opposite above. The true context of your statement is current DSM-4 criteria. They are not good enough to show ADHD in children. This shows problems with current DSM-4 diagnostic criteria, not the diagnosis. This is not a valid counter to my claim. --Sportsmand (talk) 11:28, 22 April 2009 (UTC)

(unindent)There are two basic kinds of disputes, it seems that this one is a content dispute. I have not followed it in detail. I would suggest using a content RfC, and follow RfC practice: avoid threaded comments, but encourage each side of the dispute to clearly state their position(s). Do this before actually putting up the RfC for outside comment, i.e., make the issue to be resolved very clear, otherwise you will simply get drive-by comments, not well-informed. (Content disputes are best resolved on the Talk page of an affected article, behavioral disputes, except for mention on an affected article Talk, are better handled, initially, on editor Talk pages.) I'm happy to try to mediate this, though I'm also involved: I have ADHD, it's not marginal, but I have no fixed opinion on whether it's genetic, originates in trauma or other personal experience, or, for that matter, is merely a moral defect. I'd like to know the truth! And, here, to see that the article is based on reliable source, all of it, not some segment selected for how the text might look in supporting a POV. There is, if I'm correct, still a Controversies article, where most detailed examination of controversy can be stuffed, but mention here seems appropriate where failure to mention could misrepresent, as settled, something where there is still notable controversy. --Abd (talk) 18:53, 21 April 2009 (UTC)

We used lots of closed content and anyone with access to a University library can get access to this paper quoted above.--Doc James (talk · contribs · email) 13:23, 22 April 2009 (UTC)

This is the third time you place a comment out of proper context. I urge you to stop the disruptive editing practices. I will admit the reference on the basis of the author and title and weigh it as such. The burden is on you to provide additional information, possibly information that is usable under Wikipedia licensing. --Sportsmand (talk) 16:23, 22 April 2009 (UTC)

I am not sure what you are referring to? Usually one places the comments at the bottom as not everyone looks thru each section for new editions. I have offered to provide complete copies of this reference for those who are interested. I have no idea what you are talking about with respect to licensing. Cheers.--Doc James (talk · contribs · email) 17:23, 22 April 2009 (UTC)

---

Lets cut through all the bull. As I sum it up, we have the following facts on the ADHD medical diagnosis:

• Fact: It is an officially recognized diagnosis, WHO F90, wikipedia
• Fact: It may utilise schedule 2 drugs
• Fact: It is supported by a large group of international scientist (consensus)
• Fact: Valid minor scientific opposition to consensus, apart from presentation form (Doc James)
• Fact: The consensus statement was seen as "why stop asking question?" (Doc James)

To me, that doesn't look like a controversial medical diagnosis. But I call for additional sources/facts. When we can agree on the facts, we kan move on to resolve the case.--Sportsmand (talk) 21:17, 22 April 2009 (UTC)

We are still in bull at the moment. I will cut through the bull, yes it is officially recognised as a disorder, but it is OFFICIALLY recognised as a controversial disorder with controversial treatments. The National Institute of Clinical Excellence summarised some of the controversies in its National guidance for doctors on ADHD. There are literally 10,s of thousands of reliable sources regarding the controversies. The controversy article is JAM PACKED with sources. How many do you want? Tell ya what if you can persuade wikipedia to change its article size rules from 100 kb up to 100,000 kb then we can add ALL of the controversy citations and actually write an online wikipedia book.--Literaturegeek | T@1k? 22:46, 22 April 2009 (UTC)

I suppose you refer to this: CG72 Attention deficit hyperactivity disorder (ADHD): full guideline? This is a very valid source, an interesting read and I thank you for bringing it to my attention. I don't think it may be characterized as a strictly scientific work, but that doesn't mean it is irrelevant in assesing the validity of the ADHD diagnosis or whether it is controversial or not. But please mind, that merely because a source may state diagnostic controversy, does not mean that we on this basis alone can conclude whether a significant controversy exists or not. In that sense,you have not "cut through the bull" if that is how I am supposed to understand your opening statement. Neither does is constitute an "official" recognition of controversy, if such a condition exists at all. I will gladly accept it to our list of references. If we do, we will have the following interesting situation: We have on the list a scientific source (from Doc james Consensus Critique), the author of which (Sami Timimi) severely denounces the authors (GDG) and work of another source (this). Sami Timimis statements are in your own source. --Sportsmand (talk) 12:32, 23 April 2009 (UTC)

Ya know who I reckon you are, Mwalla on one of your socks again Wikipedia:Sockpuppet investigations/Mwalla/Archive. You do the same thing, start nonsensical arguments, use sockpuppets and stalk myself and other users. Infact you are Mwalla because ya using a similar name to one of Mwalla's socks, Xports or something.--Literaturegeek | T@1k? 22:53, 22 April 2009 (UTC)

As I understand it, you are trying to associate me with a known vandalist. Is that correct? If you look carefully, you may find my static, public IP in the page history. If you care to check this, you will see that this IP originates in Denmark. When I check the IP's in the reference you mention, they are all in the US. How do you explain that? That said 'Mwalla' suddenly beamed himself to Denmark in order of being able to continue disrupting editing? (da: Det er simpelthen hinsides min fatteevne til hvilke længder nogen vil gå i denne debat) For your convinience, I will put my public IP right here. Sportsmand. --217.157.164.21 (talk) 06:32, 23 April 2009 (UTC)

Definitely agree with Literaturegeek Sportsmand has done way more editing than his edit count shows and he know much more about wiki policy and editing tricks than I. He also does not seem particularly interested in discussing the research only in pushing his POV.--Doc James (talk · contribs · email) 23:21, 22 April 2009 (UTC)

I have commented on all the sources and most entries in this section. How can you see that as being "not interested in discussing the research?". On the contrary, many of the comments and questions I posted was never replied to. Including a number I posted in response to you. I started editing at Danish Wikipedia a few weeks ago. When I turned to English Wikipedia for references and material, I saw how skewed it looked to me. Thus, I decided to do something about it. Yes, I know the policies, and so should all other editors as well. The NPOV is not that difficult to understand. Do you hold it against me that I do? Btw, my understanding may be augmented by the fact, that I have worked with free software for many years and pretty well understand GFDL and associated licensing. Yes, I have the POV that the understanding of ADHD is severely lacking in this article. Yes, I have the POV that some editors here have extreme bias (right down to not understanding fundamental medical concepts). And yes, I assert my free right to edit here with exactly that POV. Finally, to witness, I have another user here called "sportsmandda", created before I understood that I could use my danish account here as well. --Sportsmand (talk) 06:59, 23 April 2009 (UTC)

I feel prompted to do a side-note to so-called "anti-pharm" or "anti-med" editors (if any such are present): I just wish your justified concerns about medication wouldn't spill all the way over to medical diagnosis. --Sportsmand (talk) 12:32, 23 April 2009 (UTC)

Thanks sportsmand for verifying your identity. Sorry about the false accusations. Still not sure what in particular you are having problems with? The McMaster study comments on why the diagnosis is controversial PMID 10637682 What exactly do you wish to change within the article?--Doc James (talk · contribs · email) 22:25, 23 April 2009 (UTC)

A valid source, but allow me paraphrase directly from the synopsis: "CONTEXT: The Agency charged McMaster with conducting a review of the literature on the treatment of ADHD.. OBJECTIVE: To identify and appraise [sources] on the treatment of ADHD.. CONCLUSIONS: Most [sources] on the treatment of ADHD have limited value for guiding clinical, policy, and research decisions..." What McMaster say is that we can't say much about treatment, because the material we got (1982-98) were of limited value. Sorry, this is about treatment, not diagnosis. --Sportsmand (talk) 02:52, 24 April 2009 (UTC)

Thanks, I accept that. False identities are a pest. The very quick one on my conclusion is this: A controversy implies opposing views. That is not the case here. Consensus says ADHD exists, opposition say we dont know for sure. That is not a controversy. Besides that, different views in science are usally not called controversies. The controversy was the position of "why stop asking questions" vs the unlucky absolutes of the consensus statement. It has been 5-7 years since that, so for how long does a controversy linger? In any case that has no bearing on the diagnosis. I can put a lot more behind this if you choose to challenge it ;-)

I agree that I have not been very clear with regard to my intentions, what I propose is along these lines:

• Obviously, I think that the main portion of the articles should reflect the majority view concerning the diagnosis. The minorty view should be included as well, but in a less prominent position. As a quick version of this, it seems to be only the statements "ADHD and its diagnosis and treatment have been considered controversial since the 1970s" we need to fix somehow.
• Secondly the articles should not distinguish between adhd in children and adult adhd. I hope we do not have to dispute that, because there is no evidence either way afaik, only that ADHD is generally recognised to be a permanent condition. We get one less article to maintain. It is probably a major change so it will obviously take some time to get done
• Thirdly, I think there is some need for cleaning the structure, in particular concerning the categorization section. I don't see it as a big deal.
• As to the basic statement on treatment, as you mentioned yourself, we have not much science. I suggest that we mainly adobt the conclusions of the MTA and MTA 8-year follow-up. Sadly, this is the strongest evidence we have on the long-term effects.

Cheers --Sportsmand (talk) 00:42, 24 April 2009 (UTC)

A group of PhDs/MDs writing up a little article and putting "consensus" in the title does necessarily mean there is a consensus, no matter what the title of the article says. The opposition article had a comparable number of qualified individuals, and recent publications have not reasserted the so-called consensus. II | (t - c) 01:02, 24 April 2009 (UTC)

• Saying that the diagnosis is controversial does not mean that we have a group which says it does not exist and one that says it does. There is a lot of discussion about were the cut off between being normal and being abnormal stand. You also have different diagnostic criteria between the ICD10 and the DSM4.
• Uptodate.com divides ADHD in peads and adult. Medicine is also devided into peads and adults. Concerns about cardiac side effects are much greater in adults. Obesity on wikipedia is divided into peads and adults with a subsection on the adult page pertaining to kids.
• What changes are you suggesting for the catergories? It currently mostly follow Wikipedia:Manual_of_Style_(medicine-related_articles)
• The conclusions of MTA and it followup are already there and I agree they could be clarified. --Doc James (talk · contribs · email) 01:33, 24 April 2009 (UTC)

Ok, several points made here by Sportsmand. Having an opinion on a few drugs that the risks outweigh the benefits or that long term effects are not well or properly studied does not make someone anti-pharm or antimed as there are THOUSANDS of drug classes prescribed by physicians, so one would need to be opposed to all or most drugs to be anti-pharm or anti-med. Your explaination as to your identity seems plausable. I was aware that your ip address was Danish as I was active on wikipedia when you signed your ip and I looked it up and saw it was Danish but thought that it was a proxy. Mwalla was banned and is on a static ip but he was able to evade his ban and come back before on a different username so I assume he is using proxys. Anyway he has a habit of following me around creating new socks for targeting me on different pages so assumed you were him. Sorry for accusing you. Anyway today I had the opportunity to speak with a pediatrician (which isn't very difficult as I can fone them up or sometimes walk down the stairs and speak to them) and asked them about ADHD. I asked them if ADHD was "highly controversial diagnosis" and they said yes of course it is. I said why? They said there are lots of reasons but the main one is the diagnostic criteria. I see peer reviewed articles using the term controversial ALL the time in a clinical context. We seem to be having pointless debates again which was why I initially thought that you were Mwalla. You speak very good english I do wonder as to your intentions in triggering debates over what is used by English speaking doctors and not. Your stances really are not going to go anywhere because they are nonsensicle arguments like "doctors don't use the word controversy in a clinical context" so therefore there is no controversy..--Literaturegeek | T@1k? 22:06, 24 April 2009 (UTC)

Part of the problem (at least as I understand it, having relatives who are pediatricians and who are elementary teachers) is that some parents are so competitive and try to get every possible advantage (or what they see as an advantage) for their child; the teachers fear that if they don't report Robin's daydreaming or Terry's horseplay that the school will be sued for depriving the child of needed extra care. We all know (hopefully) that every child (and for that matter, every adult) has an "ADD moment" every once in a while; the treatable problem is when they have "ADD hours" and "ADD days", rarely having a moment or two of developmentally appropriate behavior. htom (talk) 23:47, 24 April 2009 (UTC)

Yes. I think that is another controversial aspect. The problem is not a matter of "doctors and drug companies" but also parents wanting their children on stimulants to increase their "competative edge" or for other reasons that you have raised.--Literaturegeek | T@1k? 01:39, 25 April 2009 (UTC)

Another notable point Sportsmand but worth bringing up. Take a look around the various medical, psychiatric and pharm pages and read their talk pages and you will soon notice that the ADHD pages are the MOST controversial pages on wikipedia. I have never edited an article with so much controversy archived and active. There are already 8 archived full talk pages of mostly controversy for this article alone!--Literaturegeek | T@1k? 01:53, 25 April 2009 (UTC)

(You have not looked at Waterboarding and its many talk pages, I suspect.) htom (talk) 05:29, 25 April 2009 (UTC)

other treatment options

The idea that Attention-deficit hyperactivity disorder is only treatable by medication and seeing a psychologist is false. Many people have found that sometimes something as simple as a diet change or social change can essentially cure this "condition". This may not always be the answer for treating it however it does provide an alternative to try instead of spending the money on medicines and therapyGlopus14 (talk) 21:59, 25 March 2009 (UTC)

All we need is a study to back up those claims.--Doc James (talk · contribs · email) 23:18, 25 March 2009 (UTC)

But that should lead to a question of whether those who were "cured" with diet change or social change actually had the disorder in the first place. In these cases, it seems like it would be a disorder of the environment, not of the brain. Too bad we don't really have a sure-fire way of differentiating these things during diagnosis. Tim D (talk) 00:37, 26 March 2009 (UTC)

No one knows if this is a condition of the brain or the environment or both. The PET scan studies or old, seriously questioned, and no one has been able to repeat them. I read an interesting book about mental illness and war. During the first world war it was found that the average kid in the army would love his mind after about 6 to 12 weeks in the trenches. Are culture now says what to this condition as a chemical imbalance.

NO mental illness has a PROVEN chemical cause. Some want us to believe that this question has been settled but it hasn't. Psychiatrists do not diagnosis anything with imaging or labs they still send all their patients to be medically cleared. Glopus may have a valid point he just needs evidence to back it up. Mental illness also may be caused by a chemical balance BUT once again we need evidence. Both of these are still conjectures as far as I know. Cheers --Doc James (talk · contribs · email) 01:19, 26 March 2009 (UTC)

in cases where diet and lifestyle change "cure the disease" it may not have been ADD —Preceding unsigned comment added by 71.208.113.39 (talk) 23:55, 2 May 2009 (UTC)

Low arousal approach-

Low arousal approach in the links section should be changed to low arousal theory, as the former is about handling patients who are sexually aroused... Nina124.171.248.88 (talk) 13:51, 27 April 2009 (UTC)

Done. And 'twas about time! - Hordaland (talk) 20:02, 30 April 2009 (UTC)

We could use some images

Here is a nice image of prevalence in the US. Wondering how to add it or something like it to this page?

http://www.cdc.gov/ncbddd/ADHD/adhdmedicated.htm

Here is a paper that given the prevalence in different area of the world.

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1525089

--Doc James (talk) 10:59, 25 November 2008 (UTC)

The first link is broken. The second looks great; have we used it? - Hordaland (talk) 13:52, 3 May 2009 (UTC)

Dispute2

Sportsman has stated that there is "no significant "controversy" for the ADHD diagnosis". He has put forth one reference to support his conclusion. Four peer reviewed references have been provided to counter this statement and many more on available on the ADHD pages. I hope we can all now say that the majority of evidence supports that ADHD is a controversial diagnosis both within the medical community and within the public at large. We have commented on Barkley's position statement on the controversies page.--Doc James (talk · contribs · email) 19:51, 21 April 2009 (UTC)

This is the second time you place comments out of context, and I will consider editing all such to maintain overview of the argumentation. --Sportsmand (talk) 09:31, 22 April 2009 (UTC)

Sorry I am not sure what you are referring to under dispute resolution and what changes you are proposing.--Doc James (talk · contribs · email) 13:26, 22 April 2009 (UTC)

Sportsman, judging by your contributions I think that you are a sock of someone, what was your previous username?--Literaturegeek | T@1k? 16:55, 22 April 2009 (UTC)

Let's keep a cool head here everyone. It doesn't matter whether Sportsmand is a sock or not. People have legit reasons for using socks. Regardless, we seem to have reached a consensus that it is appropriate to characterize certain aspects of ADHD as controversial, including the diagnosis. At this point, pressing the issue of whether or not the diagnosis is controversial much further might be considered disruptive editing. Sifaka ^talk 03:20, 23 April 2009 (UTC)

We have not reached such a consensus. We have not even agreed what material the dispute resolution should be based on. If you consider what I write 'disruptive editing', by all means: Charge me. --Sportsmand (talk) 07:11, 23 April 2009 (UTC)

That is because all you have done here is start pointless arguments and filled the talk page up with them with very little talk of specific refs or detail on the article. See above.--Literaturegeek | T@1k? 22:09, 24 April 2009 (UTC)

How the article currently stands it represents primarily the mainstream consensus of ADHD. It describes the diagnostic criteria of the DSM and says that stimulants are the most effective treatment. There is a brief bit in the lead saying that ADHD is controversial which is than backed up with very good references. There is a small section in the bottom of the main article with most of the discussion about the controversy split off into its own page.

I do not know if I am right sportsman but I get the feeling that you think all discussion of the controversies should be removed from wikipedia. This will not happen as that would be eliminating the opinions of a substancial minority with well referenced ideas. A previous editor tried to remove all discuss of ideas that were contrary to those of Barkleys.--Doc James (talk · contribs · email) 06:28, 25 April 2009 (UTC)

I think I may briefly suspend commenting in the previous section, to address a pattern in the dialogue above, that may be at the root of our disagreement.

• First, I see our roles here as being encyclopaedic editors. In principle, we cannot use any knowledge that we may have or may not have, to conclude anything in any matter that relates to Encyclopaedic content. What we have are sources. We may refer to facts, but essentially, we cannot conclude new facts. That would be original research. We are obviously allowed to read material and on the basis of those, write our encyclopaedic entries, but that is not the same. When we try to access facts, we use the best sources we can get. To me, that is scientific research. Secondary source are usable, myth, stories, legend, talk, count the least.
• Secondly, an Encyclopedia is very much about how we use words. If we state "controversy", it better live up to our own definitions.
• Finally, this is a topic in medicine, which is also a scientific discipline. When we access facts, this must absolutely be the proper viewpoint/aspect/context.

So I guess this is it: You are talking about "controversy" in the public. I am talking about "controversy" from the aspect of medical science. That may be why some may think that my arguments are "non-sensical" or such..

If we are to assume that the view of the public - in stead of medical science - would be the correct context of this, the following would be true as well: Wikipedia is in the public. Wikipedia states "controversy". Ergo, there is "controversy" in the public. Due to the size and importance of Wikipedia, the moment we state "controversy", it may definately amplify the impression of "controversy". The whole thing becomes a self reference, an endless recursion, an oxymoron. That is not a place I want to be.

To say it one more time: I have no intention of removing all signs of "controversy" in relation to ADHD. Because that would be untrue. Again, I am talking about the medical diagnosis from the aspect of medical science. ADHD "is", it is a real thing, it is a valid diagnose. There is no real scientific opposition to that, let alone "controversy". --Sportsmand (talk) 10:25, 28 April 2009 (UTC)

It seems to me that the areas/subjects of controversy haven't been well-enough defined for the purposes of discussion. Here's an attempt. Even if useful, it no doubt will require revision.

1) Is ADHD a valid diagnosis?

a) Few scientists and/or medical professions claim that the diagnosis should not exist.

b) Many members of the public believe that ADHD as a diagnosis, is nonsense.

2) Should young children be treated with stimulants? Addition: age 5 and under? age 6 and over?

a) A substantial proportion, probably not a majority, of scientific/medical professionals says no.

b) A substantial proportion of the public says no.

3) Is ADHD an over-used diagnosis in many countries; that is, should other causes of symptoms be more actively sought?

a) Many, perhaps most, professionals: yes.

b) Many, perhaps most, members of the public: yes.

4) ............

Feel free to add to the above and/or argue with it. - Hordaland (talk) 13:00, 28 April 2009 (UTC)

This is a very useful structure as it separates the question of "controversy" into public and scientific/professional aspects. What I have been asserting is probably adequately described under 1a). I would personally put it a bit stronger as "Few or no scientists..", as I actually do not know of any relevant source that states that the diagnosis should not exist. In general, I find it a bit hard to see how we can "meter" the opinion of the public (no,few,some,many,most,all..?) but nevertheless, I am not inclined to disagree with 1b), 2b) and 3b) at all. As to 2a) I have no real knowledge, but I would absolute tend to agree. I am a bit unsure of how to interpret your question in 3), but I suppose it means something like "should a doctor rule out other explanations of the symptoms before diagnosing ADHD?". To that I most definately agree, and I guess that a huge majority of doctors thinks so as well. Finally, I have somewhere read sources, that describes ADHD as simultaneously being the most over-diagnosed disorder and the most under-diagnosed disorder. As I remember it, this relates primarily to over-diagnosis in children and under-diagnosis in adults. Thus we may consider having that in the structure as well. --Sportsmand (talk) 10:54, 29 April 2009 (UTC)

To add to the section on children. NICE guidelines recommend children under 6 not be treated. I would say the majority of physicians would not agree with treating children under six with stimulants. Just as many do not agree with the treatment of adults due to concerns of CV side effects.--Doc James (talk · contribs · email) 13:13, 28 April 2009 (UTC)

That sounds to me to be a very good summary of the main aspects of the controversy Hordaland. Agree with Doc James as well. What bothers me as well is the repeated essentially original research of using short term clinical trials to determine safety and effectiveness of long term use. This is not just a problem with ADHD medications but essentially almost all drug classes.:)--Literaturegeek | T@1k? 21:37, 28 April 2009 (UTC)

I am not sure what you mean by "..repeated essentially original research..". Do you by this mean "original research" in terms of Wikipedia policies or what? --Sportsmand (talk) 10:54, 29 April 2009 (UTC)

Would agree. We have good long term data with the cardiovascular drugs but not much on psychiatric meds and these are drugs people are expected to be one for the rest of their lives all based on trial of on average 4 weeks. Hopefully the new US administration will require and fund these studies. We have little idea on how these meds affect long term morbidity and mortality and much of the data for antipsychotics anyway show that they increase mortality.

This is partly why psychiatry is so controversial among professionals. The quality of research in psychiatry sucks.--Doc James (talk · contribs · email) 21:54, 28 April 2009 (UTC)

I must take clear exception to your last statements. Are you really now trying to say, that the field of psychiatry is controversial in medical science? These statements begs an explanation. --Sportsmand (talk) 10:54, 29 April 2009 (UTC)

Hi Sportsmand. Your position on secondary sources is not how wikipedia views them. They are considered the best sources to use actually. Please see WP:MEDRS. There is significant controversy amongst doctors as to the diagnostic criteria and "false positives" or labeling someone with mild to moderate attentional or hyperactive symptoms as being mentally ill under the DSM or other diagnostic guides for determining whether someone is mentally ill or disordered. Of course there is controversy over labeling 5 - 10% of children mentally disordered in the scientific community. There are plenty of scientific peer reviewed publications which acknowledge this. I really don;t know how much evidence you need.--Literaturegeek | T@1k? 02:48, 29 April 2009 (UTC)

To start with: I have been asking all the way in this debate for sources that shows a "controversy" as to the diagnosis. Where are the "..plenty of scientific peer reviewed publications.." you refer to?? If they are easy to find - do please bring them to our attention. The reason I ask for evidence is simple. I can't find it - and neither has anyone else up to this point. When you state "Of course there is controversy over labeling 5 - 10% of children mentally disordered..", you are absolutely conducting original research. We can't use that.

Secondly, the Wikipedia policy you mention is very relevant and I wasn't aware of its existense. I don't see my statements/opinion as being counter to policies, but I appreciate the qualification.

Finally, please consider this: In the previous section, you 2 times refer to the source "Consensus Statement" as an "opinion piece". Now you are saying that secondary sources "..are considered the best sources to use..". In the policy you just referred to, secondary sources are explicitly examplified by the words "..position statements..". Would you please care to explain to me how I am to interpret that? --Sportsmand (talk) 10:54, 29 April 2009 (UTC)

Agreed Doc. I believe sometimes and in certain aspects of psychiatry or perhaps often certain drug trials these trials are intentionally designed that way to produce certain results.--Literaturegeek | T@1k? 02:52, 29 April 2009 (UTC)

Here is a review article stating that 5-10% of children are mentally ill with the mental health disorder called ADHD diagnosable under the Diagnostic and Statistical Manual of Mental Disorders criteria for psychiatric disorders. I assumed that you were aware that the official rate of ADHD was 5-10% in children so didn't cite a source. Here are refs disputing diagnosis or else talking about overdiagnosis.[1], [2], [3]. Here is a good quote, "The idea that children who don’t attend or who don’t sit still in school have a mental disorder is not entertained by most British clinicians." from the British Psychological Society. [4], see full text. Consensus statement is a primary source and an opinion piece. You are free to cite it in the article if you like. Your argument is with wikipedia policy of reliable sources. I suggest if you have a problem with the wording or criteria on the reliable sources page that you take it up on the talk page over there. If you don't understand something then please ask for help on the relevant talk page. I would rather keep discussion here on ADHD.--Literaturegeek | T@1k? 13:09, 29 April 2009 (UTC)

Allow me to address the last part of your statement first. No, my argument is not with Wikipedia policies, quite the contrary actually. But I agree, that there was something that I did not understand. Now however, it is becoming increasingly evident to me.

• The first source you mention clearly states: "Converging evidence from epidemiologic, neuropsychology, neuroimaging, genetic and treatment studies shows that ADHD is a valid medical disorder.". The source, as you say, states a prevalence of 5-10% in children which is somewhat higher than the figues I am familiar with. You have been an editor here for several years as I understand it. Yet you did apparently not put that prevalence figure in the article - it states 3-5%. So, as I see it, it appears to be only a point in arguing with me.
• The source [5] you mention, appears to be about treatment only and I don't see it as relevant in this context.
• The source [6], was discussed briefly in the sections above. It proves that current DSM-4 diagnostic criteria are insufficient, so how is that in any sense relevant to this debate?
• The source [7] - the "consensus critique", was introduced as a source previously - see the section above. Yes, some scientists are less sure of the data, etc. Do they say, that ADHD is not a valid diagnosis? Answer: No, they are not even close to saying that. Do you read it differently?
• The source [8] is from 1999, and is a highly abridged version of a report from 1996. Besides the fact that it is old, I can't see anything to support any notion of "controversy". Do you?
• You state "Consensus statement is a primary source and an opinion piece". I simply can't understand that grouping, and I would ask you to please clarify it. --Sportsmand (talk) 15:39, 29 April 2009 (UTC)

Here is another one saying about its diagnosis being one of the most controversial mental illnesses.--Literaturegeek | T@1k? 13:35, 29 April 2009 (UTC)

That source is in the article reference list and is well known to me. It is actually used as a source for the "controversy" claim in the first section of the article. Excuse me for saying so, but do you actually read the sources you refer? The synopsis of this source clearly states (my emphasis) "The enduring controversy over ADHD in the public arena..". How on Earth can you interpret that as anything that counters my assertion? As a matter of fact, I count that as a source that supports my assertion. --Sportsmand (talk) 15:39, 29 April 2009 (UTC)

Several of the editors on this thread have MAJOR page ownership issues. I've been debating on the controversies talk page for what seems like forever about a single citation. They don't address that citation but throw up a pile of new citations or call me names. I'm not allowed to edit that page without it being reverted. I'm not even allowed to put a POV tag up without it being removed. One contributor has been through two mediation processes, the last one was specifically about page ownership and supported by an administrator. In both cases he withdrew from mediation. A link to his RFC is on the other talk page. Also look at the archived history of this talk page.

Sportsmand, let me first say that what you are stating makes perfect sense to me. To the others who know better and choose to be silent, well your strategy really hasn't worked. I left Wikipedia for over two months and the same issues are here when I left. For administrators watching this page, it's about time something was done. Why must a lawlessnes environment be endured for months on end when a contributor has shown virtually no personal growth? Doesn't such a policy drive away many excellent people from wikipedia?--scuro (talk) 16:07, 29 April 2009 (UTC)

Thanks, Scuro for bringing this to my attention. See below. --Sportsmand (talk) 21:33, 29 April 2009 (UTC)

I see now, that Doc James has created an Rfc in the ADHD controversies talk page with the following content:

• reason=Editors disagree on whether or not (the diagnosis of) Attention-deficit hyperactivity disorder (ADHD) is controversial.
• reason=Some editors say that ADHD is not controversial and thus try to remove any information implying that it is

This is a distinct misrepresentation of what I claim and what I intend. I take extreme exception to that, and to the fact that this Rfc was created in "ADHD controversies" talk page, but clearly aimed at my position in the ADHD talk page. Neither was I notified by Doc James that the Rfc was created. As is evident, I have never contributed to the "ADHD controversies" talk page, so I obviously cannot be expected to have read this without being informed. If this is how the formal process of dispute resolution is supposed to work, we have very serious problems. --Sportsmand (talk) 21:33, 29 April 2009 (UTC)

Would like to state first of all that the RfC was not started because of you. I know that you are not saying no controversy exists. To tell you the truth though I am still not sure what exactly you want to see changed. And what you want this to be changed too? I think if you say I want to changed such and such a line to such and such based on these references than we could move forwards. --Doc James (talk · contribs · email) 01:05, 30 April 2009 (UTC)

As long as you state that the mentioned Rfc is not directed towards my position in this talk page, it is perfectly fine with me and I rest my objection. Yes, it is time to move forward with some concrete changes and I will present my first suggestion "shortly". I did mention some pretty concrete things in the section above and I will resume commenting there as well.--Sportsmand (talk) 17:31, 30 April 2009 (UTC)

Would like to add to 1 a) above. Peter Breggins does not believe the diagnosis exists and has published extensively on this in respected journals. But there are not many others. So I would agree few clinicians agree it does not exists. There is however dispute about the diagnositic criteria.--Doc James (talk · contribs · email) 01:08, 30 April 2009 (UTC)

A ref "a minority ( 12.5% )of clinicians (British adult psychiatrists in the year 2000) expressed the view that ADHD did not exist in adults" PMID 10757256

And another "ADD and ADHD are politically manufactured concepts, created by committees of the American Psychiatric Association. ADD was created in 1980, ADHD in 1987. The plain truth is that they are not real diseases in any legitimate scientific meaning of the term disease. To declare otherwise is not medicine; it is fraud. " http://jhp.sagepub.com/cgi/content/abstract/43/2/50

And this says it is unlikely to exist. PMID 18658077 --Doc James (talk · contribs · email) 01:42, 30 April 2009 (UTC)

I reply here to Doc James' comments in last four paragraphs above.

Diagnostic criteria first: First I must stress, that I use the word "diagnosis" to separate this aspect of ADHD from etiology and treatment. I do not claim that any sources state that "ADHD has fully validated diagnostic criteria" or anything like that. At least none I know of. So in that sense, I concur that some disagreement may exist. However, I don't know of any actual dispute as such; my impression is that "everybody" agrees that current diagnostic criteria must be improved.

The source you mention as "this says it is unlikely to exist", is related to this. It actually has the title "ADHD: does new research support old concepts?" and the full conclusion sentence sounds "ADHD is unlikely to exist as an identifiable disease" (my emphasis). The context of this statement is explicitly current DSM-4 criteria.

Concerning Peter Breggin. This is an intersting source, even though it appears to be mainly a portal for his book sales. I couldn't find any source of his in PubMed that relates to the ADHD diagnosis. Indeed, most of his books seems more related to countering treatment that is being used (very) irresponsibly. One can only wish him good luck with advancing that.

The "fraud" paragraph seems to not be connected to the source you refer to. It is called "Informed Consent And The Psychiatric Drugging Of Children". But I would love to read the proper article.

Finally, concerning the british psychiatrists: The article is called "..Trent Adult Psychiatry Psychostimulant Survey.." (2000), but I think you mixed your quotations. The source states "only a minority of 11 (12.5%) used psychostimulants in their usual practice" and "..a minority of clinicians expressed the view that it did not exist in adults."--Sportsmand (talk) 20:09, 30 April 2009 (UTC)

What about the same set of problems under the old names? Minimal Brain Dysfunction, etc? http://www.ncbi.nlm.nih.gov/pubmed/4581984 http://www.britannica.com/EBchecked/topic/384045/minimal-brain-dysfunction The description of the behavior set goes back to the 1800's. htom (talk) 05:27, 30 April 2009 (UTC)

Breggin has failed both the Daubert standard and the Frye Standard in court and has been criticized harshly by several judges for poor credibility, including the Colombine case where apparently Breggin never looked at any of the physical evidence including 100's of hours of video by the killers before he went to court. As far as I know, he almost exclusively publishes in journals which he created, or journals created by organizations he has founded. As far as I know, he has also done no independent research. No one in the field takes him seriously. This is not the sort of "scholar" one would want to hang your hat on.--scuro (talk) 11:16, 1 May 2009 (UTC)

I see, that Doc James misspelled Peter Breggins. Scuro didn't refer me to the fact, that WE have an article on and including the controvertial nature of Peter Breggin. So, both of you, didn't get your sources straight in response to me. We seem to have issues communicating clearly and putting the proper context into things for all to understand. I say, look forward now and work together with all. New disputes will be handled according to policy. --Sportsmand (talk) 10:42, 4 May 2009 (UTC)

Fake

people who have this are faking it and it is basically caused by bad parenting (Unsigned edit as of 18:18, 17 January 2009 by user:Aquafina09 with edit summary: "addendum to the cervacle reference theorem")

That's a common myth of ADHD perpetuated by ignorant people.--Snailgoop (talk) 03:32, 18 February 2009 (UTC)

Agree.--Doc James (talk · contribs · email) 04:18, 18 February 2009 (UTC)

no its not i have ADD and i can tell you it has nothing to do with parenting my dad was a drill sergent and a very strict parent but i constantly struggled with number and letter reversals forgetfullness attentiveness and emotional issues associated with negative thought loops it is very real trust me and its much tougher to deal with then people think —Preceding unsigned comment added by 71.208.113.39 (talk) 23:52, 2 May 2009 (UTC)

Agree. This is why this is listed as controversial. You think I like having ADHD?--Unionhawk ^Talk 21:43, 5 May 2009 (UTC)