Talk:Attention deficit hyperactivity disorder

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)

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)