Talk:Attention deficit hyperactivity disorder

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Good articleAttention deficit hyperactivity disorder has been listed as one of the Natural sciences good articles under the good article criteria. If you can improve it further, please do so. If it no longer meets these criteria, you can reassess it.
Article milestones
DateProcessResult
September 16, 2006Good article nomineeListed
October 8, 2006Featured article candidateNot promoted
March 13, 2007Good article reassessmentDelisted
August 16, 2013Good article nomineeListed
February 17, 2014Peer reviewReviewed
Current status: Good article

"Executive dysfunction" claims

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

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

to

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

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

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

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

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

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

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

Thanks for writing. You make some good points and additional references should be provided (if a consensus is determined) as current ones are insufficent. Fact checking is always appreciated; we need to look for biases and synthetical conclusions in research and in ourselves among publications of edits.
First, I will address the matter of emotional dysregulation and the relevancy of DSM-5's specification , and secondly, I will try to offer a defence of ADHD being a disorder of EF/SR.
Experts are in agreement that emotional dysregulation is a core symptom of ADHD (the relevant data are described here: International Consensus Statement on ADHD and Faraone et al., 2018). Now, the DSM is not leading the research, but follows it and often a decade or two behind where the research is at the time so referring to the DSM in invalidating current research is not acceptable when robust findings contradicts and/or objects to their criteria. Thus, the symptomatic presentation of ED should not be redacted based on what the information (or lacking of) is in a diagnostic manual. But the decisions made by the APA are also political, not just scientifically-based so its hard to know where this will go in the subsequent version.
Scientifically, there is some debate among researchers on a) the definition of an EF; b) to some extent what can be classified as an EF. From my understanding, as of now Barkley's model of EF/SR in ADHD has the "most" empirical support among researchers but it's not definitive, as he and others acknowledge. Nonetheless, we're pertaining to EF underlying ADHD symptoms rather than the above.
To substantiate this, ADHD is a disorder of brain networks that contribute to executive functioning and self-regulation. Many of these networks originate in the pre-frontal cortex but they extent throughout the brain occasioning its symptoms (Hoogman et al., 2019). Thus, logically, given the well-established neuroanatomy and psychological expressions of ADHD, it has to be a disorder of EF/SR.
  • A meta-analysis of 21 functional MRI studies with 607 participants found that those with ADHD showed consistent and replicable under-activation in typical regions of executive inhibitory control such as right inferior pre-frontal cortex, supplementary motor area and the basal ganglia relative to typically developing individuals (Hart et al., 2013). The inferior frontal under-activation findings were replicated in two further fMRI meta-analyses of inhibitory control with 33 datasets/1161 participants, and 42 datasets/2005 participants, respectively (Lukito et al., 2020; Norman et al., 2016).
  • Comparative meta-analyses show that structural grey matter volume reductions in basal ganglia and insula are ADHD disorder-specific relative to OCD in 30 data sets with 1870 participants (Norman et al., 2016) while medial frontal reductions were specific to ASD in 66 data sets with 3610 participants (Lukito et al., 2020). An analysis of structural magnetic resonance imaging (MRI) data from 48 cohorts with a total of over 12,000 participants showed that ADHD participants had smaller hippocampus volume relative to OCD which was related to IQ & EF differences and smaller intracranial volume relative to ASD and OCD patients (Boedhoe et al., 2020). The functional under-activations in right inferior frontal cortex and basal ganglia during tasks of cognitive control were ADHD disorder-specific relative to OCD in 1870 participants (Norman et al., 2016), while the inferior frontal dysfunction was specific relative to autism in 3610 participants (Lukito et al., 2020).
  • A meta-analysis of ten diffusion tensor imaging studies with 947 participants found that the most consistent white matter differences between those with and without ADHD were located in the splenium of the corpus callosum extending to the right cingulum, the right sagittal stratum, and left tapetum, suggesting problems with the connections between the two hemispheres in posterior parieto-temporal attention regions and in long-range fronto-posterior association tracts (connecting inferior frontal, temporal, parietal and occipital regions) involved in sustained attention and perception (Chen et al., 2016).
  • An analysis of structural magnetic resonance imaging (MRI) data from 36 cohorts with a total of over 4100 participants found slightly reduced total cortical surface area in children with ADHD. The same team found some subcortical regions of the brain were smaller in children with ADHD, mainly in frontal, cingulate, and temporal regions with some reductions in cortical thickness in temporal regions. The same team found some subcortical regions of the brain, e.g., basal ganglia, amygdala, hippocampus, and intracranial volumes were smaller in children with ADHD in 23 cohorts of 3242 participants (Hoogman et al., 2017; et al., 2019).
Here is also an outline of performance deficits in the brains of people with ADHD from the International Consensus Statement:
  • A series of meta-analyses found that people with ADHD had small to moderate difficulties with abstract problem solving and working memory (12 studies, 952 persons), focused attention (22 studies, 1493 persons), sustained attention (13 studies, 963 persons), and verbal working memory (8 studies, 546 persons) (Schoechlin and Engel, 2005).
  • Two meta-analyses, one with 21 studies and over 3900 participants, the other with 15 studies with over a thousand participants, found that those diagnosed with ADHD have a moderate tendency to favour small immediate rewards over large delayed rewards (Jackson and MacKillop, 2016; Marx et al., 2021).
  • A meta-analysis of 37 studies with more than 2300 participants found a small-to-moderate association between ADHD and risky decision-making (Dekkers et al., 2016). Another meta-analysis, combining 22 studies with 3850 children and adolescents, found those with ADHD exhibited moderately greater impulsive decision-making overall on delay discounting and delay of gratification tasks (Patros et al., 2016).
  • A recent meta-meta-analysis included 34 meta-analyses of neurocognitive profiles in ADHD (all ages) concerning 12 neurocognitive domains. Those with ADHD had moderate impairments in multiple domains (working memory, reaction time variability, response inhibition, intelligence/achievement, planning/organisation). Effects were larger in children and adolescents than in adults (Pievsky and McGrath, 2018).
  • A meta-analysis of 49 studies and over 8200 children and adolescents found moderate impairments in working memory in those with ADHD. These deficits declined with age (Ramos et al., 2020).
  • A meta-analysis of randomized controlled trials (RCTs) with preschoolers found that cognitive training led to moderate improvement in working memory (23 studies, over 2000 participants) and small-to-moderate improvement in inhibitory control (26 studies, over 2200 participants) (Pauli-Pott et al., 2020).
There are at least 7 major EFs. They are self-awareness, inhibition (self-restraint) (occasioning symptoms of e.g. hyperactivity, distractibility, motor/cognitive/motivational/emotional impulsivity), working memory (remembering to do and involving hindsight and foresight), [both nonverbal/visual and verbal WM], emotional self-regulation, self-motivation, and planning/problem solving. ADHD to varying but highly related degrees across individuals is disrupting all 7 of these. That is why it is such an impairing disorder adversely impacting nearly every major domain of life activities we have studied to date.
Keep in mind that neuropsychological testing of EF is not useful for diagnosis and do not suggest whether EF is implicated in ADHD (International Consensus Statement, Faraone et al., 2021). While some clinicians, and to a lesser extent, some researchers have concluded that ADHD is not a disorder of EF considering so many ADHDs pass the tests; that is based on a faulty premise, that these EF tests are the gold standard for detecting executive functioning deficits. The evidence against the use of such tests due to their low accuracy at detecting the disorder, low correlation with ADHD symptoms, and limited if any relationship to predicting impairment in major life activities. Димитрий Улянов Иванов (talk) 17:13, 9 January 2024 (UTC)[reply]

Hyperfocus & ADHD

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

Overkill

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

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


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

Sorry for the belated reply. From my perspective, we can certai,ly bundle the references this way pertaining to:
  1. "ADHD symptoms arise from executive dysfunction". Citation 7 may be subsumed to 6, citation 9 to 8 and citations 10, 11 and 12 to 13; resulting in these three primary references, which, in my opinion, hold most relevance.
  2. "ADHD represents the extreme lower end of..." can have citation 20 subsumed to 18 while leaving the rest.
  3. "Genetic factors play an important role..." can have citation 39 subsumed to 37, citations 36 and 38 to 34 thereby distinguishing 3.
Feel free to mention if any references should be removed rather than amalgamated with others. Be well. ~~~~ Димитрий Улянов Иванов (talk) 22:59, 29 January 2024 (UTC)[reply]

missing/unclear reference? (suicide risk chapter)

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

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

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

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

source is dogshit for ephedrine and pseudoephedrine

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

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

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

Edit request

Regarding te paragraph under "Epidemiology" that reads:

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

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

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

Causes

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

No nutritional deficiency ‘causes’ ADHD. The only associations that have been indicated include a) weak evidence suggesting exposure to specific artificial food colourants leads to a very small exacerbation of symptoms in a small subset of people with ADHD and b) a significant zinc deficiency may slightly and indirectly worsen symptoms in some. But none of these are causal of the disorder, nor are they robust findings or lead to significant adverse effects in individual patients.
See the International Consensus Statement on ADHD for references. Димитрий Улянов Иванов (talk) 23:40, 25 February 2024 (UTC)[reply]

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

Lead size

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

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

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

Typo in paragraph 3

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

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