Talk:Attention deficit hyperactivity disorder/Archive 15

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Controversy - really?

 Not done "There is controversy amongst experts on whether ADHD persists into adulthood. " - really? Experts interviewed on tv here, just said its a proven fact that if you have it, you have it for life. --IceHunter (talk) 12:13, 23 July 2009 (UTC)

The world however is more than just the United States. Opinion vary more widely if you look at the world literature. ADHD is just being recognized as continueing in adults.--Doc James (talk · contribs · email) 12:36, 23 July 2009 (UTC)

Perhaps it's the way it was said. Could we attribute this opinion to avoid undue weight issues? Who believes this? Is it a majority, a minority, singular or fringe opinion? A statement like, "A minority of experts believe that ADHD does not persist into adulthood", would be far more neutral. Anyone mind if I place an attribution tag behind this sentence?--scuro (talk) 20:12, 23 July 2009 (UTC)

This sentence was deleted, but was reverted by Literaturegeek today. Literaturegeek, could you flush out the controversy for us as noted above? A citation would really be appreciated here also.--scuro (talk) 17:52, 4 August 2009 (UTC)

Movement of alternative causes

{{Deadlocked}} Do not agree with this move therefore moved back. Further discussion is needed. There is published research and articles on these.--Doc James (talk · contribs · email) 17:27, 23 July 2009 (UTC)

The Social Construct theory is a theory that states ADHD doesn't exist. A non-theory can't explain the causes of ADHD. Ditto with Neurodiversity, which believes there is no impairment. The low arousal theory is a theory that explains symptoms not the disorder, so this theory isn't appropriate in this section either. The Hunter-farmer theory is notable with the general public but is not seen as a credible theory within the scientific community. None of them belong in the Causes section and the Culture and Society section seemed like a good spot for them. Could you explain why you believe they belong in the Causes section?--scuro (talk) 19:55, 23 July 2009 (UTC)

I agree with your moving Social Construct Theory because that really is about the non-existence of ADHD (the way it is phrased at the moment), but neurodiversity, hunter/farmer and low arousal theories still recognise that the phenomena of ADHD are real, on the spectrum of normality, but maladaptive. I think this "dimensional" approach would add to the reader's understanding of ADHD. Anonymaus (talk) 20:44, 23 July 2009 (UTC)
Because that is were people reading about ADHD would expect to find them.--Doc James (talk · contribs · email) 22:13, 23 July 2009 (UTC)
Anonymaus, when one talks of causes one is looking for the reason that ADHD exists. The folks who do that are scientists. Neurodiversity is a philosophy. It is not a credible scientific theory with regards to the causes of ADHD. Low arousal theory speaks to symptoms and not causes, and again is not a credible scientific theory to ADHD's cause. Now Hunter-farmer theory does speak to cause but really has little support in the scientific community. I could see perhaps a line mentioning this disorder because it is notable, but greater weight would create undue weight issues. Doc James could you give another reason why you believe these alternative theories belong in the Cause section?--scuro (talk) 03:38, 24 July 2009 (UTC)
I've put the alternative theories with regards to causes on the fringe notice board [1].--scuro (talk) 19:08, 24 July 2009 (UTC)
I do not think we should be narrowly discussing the possible cause when the accepted cause is unknown. Leave it be until others come to comment.--Doc James (talk · contribs · email) 19:15, 24 July 2009 (UTC)
"Narrowly discussing the possible cause"? You go to any appropriate website on ADHD and virtually every page discusses a possible cause.--scuro (talk) 13:10, 25 July 2009 (UTC)
DocJames, I think that Scuro's point here is that the decision to include or exclude each possible "cause" hypothesis ought to rest upon the evidence that exists to support that particular hypothesis. For example, we can probably rule out the hypothesis that ADHD is caused by demonic spirits possessing people's souls and feeding off of their attention spans. This hypothesis is ruled out based upon a complete lack of evidence to support it, and we can rule out this hypothesis regardless of whether we are certain of what the actual cause is.
Thus, I would say that the decision to include a hypothesis, and the question of how much weight each hypothesis should be given, should be based upon the evidence present to support such a hypothesis. A hypothesis that ADHD is caused by neurological differences is supported by many imaging studies, and some of the newer SPECT studies have even gone farther and started looking at differences in levels of vesicular and synaptic neurotransmitters as well as looking at transporter density and uptake rates. Social Construct Theory actually begins to fall apart at this point, since it would predict little or no differences in neurological activity if the condition were merely a social construct. Neurodiversity is, as was stated, a philosophy more than a scientific hypothesis, and in any event, Neurodiversity fails as an explanation because it posits that these differences are beneficial (or at least, non-negative or neutral in effect), when the DSM guidelines specifically state that ADHD can only be diagnosed if the symptoms are causing impairment.
Now, if one wanted to include mention of the "Low Arousal Theory," then one would have to explain exactly what causes the low arousal (otherwise it becomes a bit of circular logic). If this theory were fleshed out so as to explain what causes the low arousal and then how this low arousal causes the symptoms, and if this were published in a respectable, peer-reviewed journal, then it would be appropriate to include here. Similarly, the Hunter-Farmer theory is lacking in credible evidence. One would have to do quite a bit of anthropological research into both pre-industrial agrarian societies as well as pre-agricultural hunter-gatherer societies, just for starters. This is very difficult, time-consuming, expensive, and dangerous work. I am not aware of Mr. Hartmann actually engaging in such research, and I would be concerned as to the validity of his conclusion in the absence of demonstrable evidence from such sources that supports his claims. Personally, I like Barkley's (possibly apocryphal) refutation of the Hunter-Farmer theory: "If I'm going to go hunting, an ADHD person with a gun is the last thing I'd want to have with me."Hyperion35 (talk) 12:50, 2 August 2009 (UTC)
Hyperion35, I think you're wrong about how we give weight to different theories. We don't personally analyse the plausibility of hypotheses in constructing Wikipedia articles, we take our lead from reliable sources. So always base the decision of inclusion and weight on what reliable sources say and never on what any of us think. Fences&Windows 13:14, 2 August 2009 (UTC)
No, we don't personally attribute causes through plausibility, but Hyperion makes excellent points. The scientific community gives no credence to any of these alternative theories as a cause to ADHD. This is what this disagreement is about. There are probably hundreds, may be even thousands of alternative theories. Why have we included these four?--scuro (talk) 13:24, 2 August 2009 (UTC)

Physical injury and/or disease consequence as a cause?

Neither of these are listed as causes, but if ADHD is a frontal cortex problem, direct injury there (or rebound injury), or disease affecting that area, would seem to be a cause. Doesn't happen? So infrequent it's not mentioned (or not RS mentions?) htom (talk) 21:52, 23 July 2009 (UTC)

Historically was considered a cause. However reasearch has shown that it does not play a role. There used to be a line about this if it is not still there.--Doc James (talk · contribs · email) 22:15, 23 July 2009 (UTC)
Russell Barkley believes differently, "It should be evident from the research reviewed here that ADHD arises from multiple etiologies, neurological and genetic factors being substantial ones (Nigg, 2006. Like Taylor (1999), I envision ADHD as having a heterogeneous etiology with various developmental pathways leading to this behavioral syndrome. These various etiologies and pathways, however, may give rise to the disorder through disturbances in a final common pathway in the nervous system. That pathway appears to be the integrity of the prefrontal cortical-striatal network. It now appears that hereditary factors play the largest role in the occurrence of ADHD symptoms in children. It may be that what is transmitted genetically is a tendency toward a smaller and less active prefrontal�striatal-cerebellar network. The condition can also be caused or exacerbated by pregnancy complications, exposure to toxins, or neurological disease. Social factors alone cannot be supported as causal of this disorder but such factors may exacerbate the condition, contribute to its persistence, and, more likely, contribute to the forms of comorbid disorders associated with ADHD. Cases of ADHD can also arise without a genetic predisposition to the disorder provided the child is exposed to significant disruption or neurological injury to this final common neurologic pathway, but this would seem to account for only a small minority of ADHD children".[2]--scuro (talk) 03:09, 24 July 2009 (UTC)
Refering only to head injuries and encephalitis.--Doc James (talk · contribs · email) 13:16, 24 July 2009 (UTC)
The key is age of onset. A head injury at 6 months leading to frontal problems will be indistinguishable from other causes of ADHD-behaviour. Whereas a head injury at 21 means that by definition you cannot diagnose ADHD, even if the behaviour is the same. --Vannin (talk) 19:28, 24 July 2009 (UTC)
Interesting...at a young age you would have stunted development of those regions at the brain that might never recover. Whereas with a head injury at 25, those regions would be fully developed.--scuro (talk) 19:59, 24 July 2009 (UTC)

You may be right and I think this is a point that should be included if a ref can be found.--Doc James (talk · contribs · email) 03:43, 25 July 2009 (UTC)

Discussion before making changes

Resolved

We had this discussion previously to leave ADHD as decribed as "generally chronic" and consenus should be acheived before changed. ADHD is refered to as general chronic because about 50% of people with ADHD not longer have the diagnosis once they reach adulthood. see ref 8 and 9

Cystic fibrosis is chronic ( no one with CF grows out of it ). Viral infections are acute lasting weeks / months. ADHD is half way between.--Doc James (talk · contribs · email) 19:06, 24 July 2009 (UTC)

I remember no such discussion which I agreed to, but I could be wrong. Then again I remember several agreements...the door is always open to true consensus seeking.
The qualifier "generally" is an issue. Adhd is chronic, not "generally chronic" which is an oxymoron. It's not like one describes a bout of ADHD which one has recovered from. ADHD is with you everyday. ADHD does change, but that is because of long term developmental reasons". Would you have specific references that state it is "generally" chronic?--scuro (talk) 19:19, 24 July 2009 (UTC)
Title:Early identification and systemic educational intervention for young children with Attention-Deficit/Hyperactivity Disorder (AD/HD) Source:European Journal of Special Needs Education [0885-6257] Brandau yr:2004 vol:19 iss:1 pg:1 "Given the fact that AD/HD is a generally chronic neuropsychiatric condition that may last many years, studies assessing long-term stimulant treatment safety and efficiency are requested when stimulant therapy is initiated for young AD/HD children. With the introduction of new pharmacological drugs (atomoxetine) during the next years, there is the hope for better methodological research."--Doc James (talk · contribs · email) 20:15, 24 July 2009 (UTC)
I've been requesting true consensus since I came to this page about two years ago. If you folks want to work as a team, and there are certain principles that you would like us ALL to follow, like discuss before you edit, then I am all for that. No one has ever taken me up on the offer. All it takes is one to break the ice. Otherwise, I do not feel bound to others self imposed restrictions. My edits are in total good faith and follow the principles of wikipedia.
James thanks for the citation. One citation does not decide an issue, here is the Mayo Clinic describing ADHD as a chronic condition.[3]--scuro (talk) 13:20, 25 July 2009 (UTC)
There have been studies that people with ADHD can grow out of it, but, I would say that generally speaking, it's a chronic condition.--Unionhawk Talk E-mail 21:05, 26 July 2009 (UTC)
Not sure which side of the fence you are on after that last sentence. ;) My deletion of the word has been reverted so it's still a relevant issue.--scuro (talk) 01:26, 27 July 2009 (UTC)
Hey guys, long time no post from me, but I have been following the discussion. I'm going to agree with scuro on this one. ADHD is genetic. A person's genes don't/can't change. Ergo, ADHD remains with that person throughout their life, regardless of whether or not they continue to be treated for it. --*Kat* (talk) 20:38, 30 July 2009 (UTC)
Hey Kat do you have a reference saying that it is genetic?--Doc James (talk · contribs · email) 02:29, 31 July 2009 (UTC)
How's this: Review: Genetics of attention deficit hyperactivity disorder
Here are a few more quotes and articles that I found while searching for that one:
--*Kat* (talk) 07:22, 31 July 2009 (UTC)
That review (abstract) says that they "review a variety of concepts including: ... (b) evidence for a primarily genetic component of ADHD." Which might be "even generally accepted". Doesn't mean it's proven. And primarily genetic doesn't mean solely genetic. (And if I understood epigenetic influence, I might even be able to argue against "A person's genes don't/can't change.") - Hordaland (talk) 15:17, 31 July 2009 (UTC)
Most people (including myself) don't have access to full journal articles. PubMed's abstracts have long been considered acceptable sources. That particular artical is a review of a bunch (if not most) of the other articles pertaining to the possibilty of ADHD being genetic. The result of this review was, "It is now generally accepted that ADHD has a biological and even primarily genetic basis. However, despite the identification of several candidate genes, none of them seems to have a substantial effect and the exact etiology underlying ADHD has remained elusive."
What do you think, James? I only piped up because I thought that I could help break the deadlock. If what I have said here is enough to break the deadlock, great. But if it isn't then it isn't. I'm not interested in becoming heavily involved in the debate once again. --*Kat* (talk) 20:27, 31 July 2009 (UTC)
Full journal access would be very useful. I think -- warning, original thinking -- that what happens is that many people with ADHD outgrow the hyperactive component (or at least the running around the room part of it), and others -- including those with hyperactive component -- then presume that all of the problem is gone. Some build coping mechanisms which last for their entire lives; others get decades and then those become ineffective. "Generally chronic" seems appropriate. htom (talk) 21:10, 31 July 2009 (UTC)
I agree with you, what you speak of speaks to the nature of developmental disabilities. That being that the level of impairment doesn't necessarily stay static, and usually changes over time. A lot of kids outgrow their hyperactivity but often other impairments remain. At the one end of the spectrum the high end ADHDers "develop" to the point where much of their impairment is more in the normal range of behaviour. No one would see them as having ADHD although ADHD symptoms may still be a relative weakness for them. Coping mechanisms here also play a role. Compare school to a different environment that suit strengths and avoid weaknesses, such as having an independent business. But those points don't negate that it is a chronic disorder. You will have this as a child and it will be unrelenting in it's nature for years and years. There is no one stating, "boy did I have an attack of ADHD last week, but I'm normal now". So in my opinion, the term "generally" doesn't do justice to the chronic nature of the disorder.--scuro (talk) 10:45, 1 August 2009 (UTC)
Changing my mind. "Generally chronic" isn't correct, but I can't think of a good alternative. "Chronic (with incorrect belief of remission)" is just too wordy. htom (talk) 13:37, 1 August 2009 (UTC)
chronic doesn't mean permanent. People have "chronic fatigue" or "chronic pain". They have an on-going condition that may or may not improve, but is likely to last longer than an acute condition. Acute is short-term, chronic is long-term, and by definition we are talking about a long-term condition. --Vannin (talk) 17:11, 1 August 2009 (UTC)
the wikipedia section on chronic describes it as "long lasting" [4] and mentions being longer than 3 months. As this is a developmental disorder, by definition it is long lasting and "generally long lasting" doesn't make sense in that context. --Vannin (talk) 22:55, 2 August 2009 (UTC)

Vannin is correct in that chronic means long lasting, not permanent or at least not necessarily permanent. If you check out this diff you will see that I changed it to reflect the ref or at least the abstract of the ref.--Literaturegeek | T@1k? 23:06, 2 August 2009 (UTC)

I can get some journals if people wish. I do not see anything wrong with generally chronic. But we do follow it with the fact that only 30-50% of cases continue into adulthood so I assume people will get the point.--Doc James (talk · contribs · email) 16:40, 3 August 2009 (UTC)
Yea they will, I think it is important that it is clarified in the following sentence that not all people continue with ADHD symptoms indefinitely.--Literaturegeek | T@1k? 20:15, 3 August 2009 (UTC)

Merger Proposal

Resolved

These articles look like POV forks and probably need to be merged into this page. (Or perhaps, outright deleted.) Irbisgreif (talk) 06:27, 25 July 2009 (UTC)

Is the requirement for an article notability? The SCT is discussed by a small and select group of people, some who would be notable, who are generally anti=psychiatry in their world view. The Hunter-farmer theory is notable and probably known by a majority, or a good minority of the general public. I don't know if low arousal theory is notable. Regardless, my beef is that any of these theories are mentioned in the "Causes" section of the article. For a medical condition, cause is determined by the scientific community, and none of the four theories have any support within the scientific community. Would you support removing the four theories from the causes section of the article?--scuro (talk) 13:28, 25 July 2009 (UTC)
I don't know enough about it to decide either way on whether it belongs or not, but I can see that those three articles don't need to be separate. Irbisgreif (talk) 13:32, 25 July 2009 (UTC)
How would you merge them? There is a controversy of ADHD article, I could see it there. It could also go in the society section. Also, would you support the notion that theories without any scientific support should be removed from the causes of a medical article? Even if we move these theories from the causes section, the neurodiversity theory would still be in that section. Others may also add new fringe theories of causes at a later date.--scuro (talk) 13:52, 25 July 2009 (UTC)
  • Oppose merge, support moving most discussion of these fringe theories from the Causes section to the Controversies section. The article is too long to merge in those articles. Fences&Windows 16:15, 25 July 2009 (UTC)

Most of these theories are backed up by meta-analysis, secondary sourced reviews, systematic reviews and so forth. You seem to be using your own original research or going on scuro's own original research to decide what is fringe and what is majority. Original research cannot trump secondary sources in my view. I mean no offense or disrespect to you fences. We have just been having a lot of drama which lead to an arbcom and it is sad to see the original research being propagated onto the fringe noticeboard which is then endorsed by members of fringe noticeboard. The origional research arguments led to immense prolonged disruption which as stated led to an arbcom so is why I think that discussion must be kept focused on reliable sources. I hope that you understand and I sure the other editors here are happy to discuss any issues.--Literaturegeek | T@1k? 14:38, 26 July 2009 (UTC)

It appears that no one wants the merge as proposed. Removing tag. - Hordaland (talk) 18:23, 26 July 2009 (UTC)
I am not yet convinced of a merge, but have asked questions about the justification for it. I think there is support for moving the alternative theories to the controversies section.--scuro (talk) 01:28, 27 July 2009 (UTC)

What neutrality issues remain?

Unresolved

Scuro in your view what neutrality issues remain in the article?--Literaturegeek | T@1k? 18:45, 26 July 2009 (UTC)

There a number of recent threads that are unresolved. Yes, I think neutrality is still an issue.--scuro (talk) 00:20, 27 July 2009 (UTC)
Most if not all of the issues were addressed, I would rather you explain which ones are remaining? I am not sure which ones you still feel need resolved. Please list below.--Literaturegeek | T@1k? 00:34, 27 July 2009 (UTC)

Simply look at all the threads on the page. Starting from the "Ambiguity in the culture section" thread, any thread that ends with my response is still unresolved or needs an action. That is except the "diagnosis section" and "lead paragraph" thread. That would be about ten threads.--scuro (talk)

Looks mostly neutral to me. I do not think we need to warn the readers.--Doc James (talk · contribs · email) 15:02, 27 July 2009 (UTC)

Current list of what still needs to be done

Since the article has been edited quite a bit and some discussion has taken place since the original neutrality check tag has been added, it is probably worth relisting everything that needs attention. Let's start a list in this section. I would encourage the use of section tags instead of global tags, as it will make it easier to keep track what sections are currently still in need of attention. If you want to know where to find cleanup tags including merge, split, and inline tags, look here. To make it easier I copy pasted some here for reference. Sifaka talk 15:30, 27 July 2009 (UTC)

Thanks for organizing this and actually tackling old and outstanding stuff. Bravo. To me a tag is only needed on sections or the top of an article if no forward progress is being made. I do like an inline tag for small things like a citation request. l find that easier then cutting and pasting the sentence and posting a new thread. I do also like the resolved box, as long as you don't mind if it is removed if someone still feels there is an issue. Lots of issues are minor ones, yes...lets move forward and get the little stuff out of the way. To do that can we simply post a thread heading? ie Controversy - really? If it's not resolved, usually you can tell by the last post in a thread.--scuro (talk) 22:58, 27 July 2009 (UTC)

Lots needs to be done. Helping hands would be appreciated. There are lots of "not done" tags on this talk page. Feel free to comment or edit.--scuro (talk) 04:43, 8 August 2009 (UTC)

Click on show to view the contents of this section

For other tags - "Many of these cleanup tags require you to place "|article" as the first parameter when you use the tag at the top of an article. When you want the template to refer to just one section, however, you replace "|article" with "|section" (where the | is a wp:pipe key found on most keyboards as a capitalized backslash (\). See the specific template below to determine if such "section use" is supported and appropriate."

informative website on adult adhd

http://www.continuingedcourses.net/active/courses/course034.php --scuro (talk) 13:48, 27 July 2009 (UTC)


possible poor citations or citations that don't support material

 Done If it is agreed that the citation is of poor quality, it should be replaced or removed. 1)Currently citation 12 - Potochny D (October 2008). Dear Mary: My Life with ADHD. p. 334. This citation is a personal life story and supports statistics.--scuro (talk) 01:53, 27 July 2009 (UTC)

I have no problem with the citation being removed but the sentence it supports was also removed. Would it not have been better to leave the sentence in the article, or put a citation tag behind the sentence? The sentence stated that 4% of the adult population has ADHD. I've found a better citation[5], and the figure quoted is actually 5%. Literaturegeek could please insert the sentence back into the article with the new citation?--scuro (talk) 13:55, 27 July 2009 (UTC)
Done. Sifaka talk 15:50, 27 July 2009 (UTC)
Uh, scuro, you are aware that the restrictions on your editing are only 1RR, right? You can edit the article, instead of needing to ask somebody else to do it for you.--Unionhawk Talk E-mail 01:54, 28 July 2009 (UTC)
Someone has taken time posting these citations, because they are in the proper format. I'd at least like to give them the opportunity to object before something is removed.--scuro (talk) 04:45, 28 July 2009 (UTC)
A note that personal reflections/life stories may not meet WP:RS. Nja247 12:02, 28 July 2009 (UTC)

 Not done 2)Currently citation #56 - Adam James (2004) Clinical psychology publishes critique of ADHD diagnosis and use of medication on children published on Psychminded.co.uk Psychminded Ltd -supports this sentence, "while other researchers have found behavior typical of ADHD in children who have suffered violence and emotional abuse". The website appears to be citing an academic journal. The website appears to be a biased anti-psychiatry website. This citation should be removed and could be replaced by the journal.--scuro (talk) 12:50, 5 August 2009 (UTC)

3) Currently citation #58 - ^ "Sensory integration disorder". healthatoz.com. 2006-08-14. http://www.healthatoz.com/healthatoz/Atoz/common/standard/transform.jsp?requestURI=/healthatoz/Atoz/ency/sensory_integration_disorder.jsp. Retrieved on 2008-12-30. I'm not sure if the website is either reliable or neutral. --scuro (talk) 13:00, 5 August 2009 (UTC)

4) Currently citation #59 - ^ Arcos-Burgos M, Acosta MT (June 2007). "Tuning major gene variants conditioning human behavior: the anachronism of ADHD". Curr. Opin. Genet. Dev. 17 (3): 234–8. doi:10.1016/j.gde.2007.04.011. PMID 17467976. http://linkinghub.elsevier.com/retrieve/pii/S0959-437X(07)00076-7. This citation supports this sentence, "He believes that these conditions may be a result of adaptive behavior of the human species". You don't need an academic citation to support an opinion. It appears the citation seems to be stating scientific evidence supports the Hunter-Farmer theory. If this citation has any weight then this should be flushed out, and may take this theory out of the fringe category. If not, then it should be deleted, it would be extraneous.--scuro (talk) 13:37, 5 August 2009 (UTC)

5) Currently citation #62 - ^ Bailey, Eileen (2007-11-23). "ADHD and Creativity". Healthcentral.com. http://www.healthcentral.com/adhd/c/1443/16796/adhd-creativity. Retrieved on 2009-05-25. - The article is written by an "expert" whose qualification is that she is a "life coach". She is appears to be quoting academic studies. This website may not be a reliable and neutral website, it would be better to find a better source and delete this citation.--scuro (talk) 13:52, 5 August 2009 (UTC)

6-8) Currently citations #64-66

  1. ) ^ Joan Stead; Gwynedd Lloyd; Cohen, David (2005). Critical new perspectives on AD/HD. New York: Routledge. p. 48. ISBN 0-415-36037-4...and..
  2. )^ Chriss, James J. (2007). Social control: an introduction. Cambridge, UK: Polity. p. 230. ISBN 0-7456-3858-9...and...
  3. )^ Szasz, Thomas Stephen (2001). Pharmacracy: medicine and politics in America. New York: Praeger. p. 212. ISBN 0-275-97196-1.

Hyperion has made the case[6] that these citations are fringe viewpoint.

9) Currently citation #23 - ^ a b c d e f g h i "CG72 Attention deficit hyperactivity disorder (ADHD): full guideline" (PDF). NHS. 24 September 2008. http://www.nice.org.uk/nicemedia/pdf/CG72FullGuideline.pdf. Retrieved on 2008-10-08. - Hyperion pointed out that that citation is used to support the SCT of ADHD yet the term can't be found in the guideline.[7]--scuro (talk) 22:53, 5 August 2009 (UTC)

10) Currently citation #67 - ^ a b c "Attention Deficit Hyperactivity Disorder is a neurologically based disorder". Incrediblehorizons.com. http://www.incrediblehorizons.com/Understanding%20Add.htm. Retrieved on 2009-05-25. [year needed] - this is a commercial website and is inappropriate. The home page is http://www.incrediblehorizons.com/ --scuro (talk) 03:42, 6 August 2009 (UTC)

11) Currently citation #68 - "ADHD". Sci.csuhayward.edu. http://www.sci.csuhayward.edu/~dsandberg/CHLDPATHLECTS/ChldPathLect05ADHD.htm. Retrieved on 2009-05-25 - when one goes to this link we have point form lecture notes as noted in the URL address. A better source is needed.--scuro (talk) 03:52, 6 August 2009 (UTC)

12) Currently citation #83 - ^ Armstrong, Thomas (1999). MAVM2K6SdAfcSf0nGYQ&hl=en&sa=X&oi=book_result&resnum=1&ct=result#PPA3,M1 Add/Adhd Alternatives in the Classroom. ASCD. pp. 3–5. ISBN 9780871203595.http://books.google.ca/books?id=EzXt100I4A8C&pg=PA3&lpg=PA3&dq=National+Institute+of+Mental+Health+ADHD+PET+scan&source=web&ots=GlP-TIeiqN&sig=JADzxFyez- MAVM2K6SdAfcSf0nGYQ&hl=en&sa=X&oi=book_result&resnum=1&ct=result#PPA3,M1. - Thomas Armstrong wrote the Myth of ADHD. The book cited is fringe opinion and is supposed to support this statement, "The significance of the research by Zametkin has not been determined and neither his group nor any other has been able to replicate the 1990 results". He is not a researcher in the field and doesn't have the background to make a qualified judgement. Since there are three citations supporting the statement, this is an easy delete.--scuro (talk) 13:57, 8 August 2009 (UTC)

13-15)Currently citations 86-88

  1. Philip Shaw, MD; Jason Lerch, PhD; Deanna Greenstein, PhD; Wendy Sharp, MSW; Liv Clasen, PhD; Alan Evans, PhD; Jay Giedd, MD; F. Xavier Castellanos, MD; Judith Rapoport, MD (2006). "Longitudinal Mapping of Cortical Thickness and Clinical Outcome in Children and Adolescents With Attention-Deficit/Hyperactivity Disorder". Arch Gen Psychiatry 5 (63): 540–549. PMID 16651511.
  2. a b David Cohen; Jonathan Leo (2004). "An Update on ADHD Neuroimaging Research" (PDF). The Journal of Mind and Behavior (The Institute of Mind and Behavior, Inc) 25 (2): 161–166. ISSN 0271–0137. http://psychrights.org/research/Digest/NLPs/neruoimagingupdate.pdf. Retrieved on 2009-05-25
  3. David Cohen; Jonathan Leo (2003). "Broken brains or flawed studies? A critical review of ADHD neuroimaging studies". The Journal of Mind and Behavior 24: 29–56.
All of the above citations are part of a probable fringe paragraph.[8]--scuro (talk) 17:22, 8 August 2009 (UTC)

16) Currently citation #35 - ^ a b c "University of Central Florida Study: Hyperactivity Enables Children With ADHD to Stay Alert". Ascribe Newswire: Health, 3/9/2009. - This citation is for "Ascribe". The study can be seen for free on the sciencedaily website [9]--scuro (talk) 18:06, 8 August 2009 (UTC)

17) Currently citation #117 - ^ a b "What is the evidence for using CNS stimulants to treat ADHD in children? | Therapeutics Initiative". http://www.ti.ubc.ca/letter69. This is not a notable publication and appears to be biased, as noted by Wikiproject Medicine[10] The citation supports a statement already supported by 4 other citations. It's a no brainer that this citation should be removed.--scuro (talk) 18:39, 8 August 2009 (UTC)

18) Currently citation #70 - # ^ "Evaluation and diagnosis of attention deficit hyperactivity disorder in children". December 5, 2007. http://www.uptodate.com/online/content/topic.do?topicKey=behavior/8293&selectedTitle=4~150&source=search_result. Retrieved on 2008-09-15. - Can only access this through Uptodate. It may be legit but couldn't find any exact matches of the title on google except through wikipedia or Uptodate.--scuro (talk) 01:57, 9 August 2009 (UTC)

19) Currently citation #133 - ^ a b Holtmann M, Stadler C, Leins U, Strehl U, Birbaumer N, Poustka F (July 2004). "[Neurofeedback for the treatment of attention-deficit/hyperactivity disorder (ADHD) in childhood and adolescence]" (in German). Z Kinder Jugendpsychiatr Psychother 32 (3): 187–200. doi:10.1024/1422-4917.32.3.187. PMID 15357015. Study is linked go German version only. English version here.[11]--scuro (talk) 22:57, 10 August 2009 (UTC)

removing neutrality check tag

After Unionhawk plead that my tags not be removed[12] , literaturegeek removed a tag once more. She did start a thread asking what issues remained, to which I responded.[13] There are almost a dozen issues that need action or need to be resolved, and I've only just begun looking at the citations.--scuro (talk) 04:43, 27 July 2009 (UTC)

Attribution tag also removed
The attribution tag for this sentence was also removed, "It's symptoms can be difficult to differentiate from other psychiatric or other disorders, increasing the likelihood that the diagnosis of ADHD will be missed".--scuro (talk) 13:32, 27 July 2009 (UTC)
fixed with Ramsay's ref.Sifaka talk 15:30, 27 July 2009 (UTC)
For the record, scuro, I sort of assumed the 1RR editing restriction ended the problem with tags being removed unreasonably. You say that there are issues, but, I still have yet to see a single unresolved thread... (besides this one)--Unionhawk Talk E-mail 01:51, 28 July 2009 (UTC)
Ok, uresolved thread prior to the "what issues?" thread--Unionhawk Talk E-mail 01:52, 28 July 2009 (UTC)
talk page tags

I've added tags to the threads so you can see where work needs to be done.--scuro (talk) 04:46, 28 July 2009 (UTC)

I move to mark the following threads as resolved since I'm not sure anyone is paying attention to what has been posted there: Pathophysiology section, diagnosis section, Movement of diet section to treatment. Reasons are at each respective thread. Sifaka talk 22:43, 28 July 2009 (UTC)
Isn't the point of the tag to alert other editors to things that still need to be resolved or fixed? One could create the same thread over and over again until the task is done, or the issue is resolved. But, it would be my opinion that this would clutter the talk page when there are numerous threads that are not resolved. It would be my opinion that the "to do" and unresolved tags should stay on the talk page until the issue is resolved.--scuro (talk) 12:02, 1 August 2009 (UTC)
The tag means the article is mostly or entirely biased to one POV or another. I left it up for a week or 2 after one editor agreed that there were a couple of issues that you raised that should be resolved. I made some changes to resolve the issues you raised or addressed them as did other editors. Then I removed the tag. If you go through the article history over the months and years the article seemed to almost permanently have a neutrality tag on it. The article is not a POV monstor, it is actually quite balanced in my view. Just because an editor or editors may not agree with one or two sentences or paragraphs does not mean we need to flag the entire article indefinitely as has happened in the past. We could flag the entire wikipedia encyclopedia if that was the case.--Literaturegeek | T@1k? 12:09, 1 August 2009 (UTC)
My post was in response to Sifaka's post on removing talk page tags. It was not about article tags. I agree with you Literaturegeek, as long as things are getting done and resolved, there is no reason for a POV article tag.--scuro (talk) 13:10, 1 August 2009 (UTC)

Diagnosis 2

Unresolved

Currently we have There is no physical examination for ADHD. It thus remains a psychological diagnosis. And I agree there is no physical exam but there is ALSO not radiological imaging and no laboratory tests for ADHD. I think all should be mentioned. I agree with Scuro however that we should mention how ADHD is diagnosed before we mention how it is not diagnosed. What we had was ADHD is diagnosed via a psychological assessment with physical examination, radiological imaging, and laboratory tests only used to rule out other potential possibilities. and this is what I think we should go with. --Doc James (talk · contribs · email) 14:46, 30 July 2009 (UTC)

support --*Kat* (talk) 20:41, 30 July 2009 (UTC)
I like "ADHD is diagnosed via a psychological assessment with physical examination, radiological imaging, and laboratory tests only used to rule out other potential possibilities." --Sifaka talk 23:57, 30 July 2009 (UTC)
The intended content looks good, but the sentence isn't easy to read. (One can first read "ADHD is diagnosed via a psychological assessment with physical examination, radiological imaging, and laboratory tests." That makes sense (but it's wrong). Needs to be divided into 2 sentences, I'd say. - Hordaland (talk) 15:26, 31 July 2009 (UTC)
Agree --Doc James (talk · contribs · email) 15:47, 31 July 2009 (UTC)
Question, shouldn't describing what it is not, be at the end of the section? By placing "what it is not", before describing diagnosis, are you not creating undue weight?--scuro (talk) 10:15, 1 August 2009 (UTC)


I think that everyone involved would do well to please read the entry on Differential Diagnosis. This is a basic medical concept that is used in all medical specialties, including psychiatry. The Differential Diagnosis process here is no different than anywhere else. There are plenty of medical conditions that are diagnosed based on examining the patient, taking patient history, and asking the patient to describe the problems that they have been having. As with ADHD, input from friends and family members is often used in aiding many diagnoses.

For example, I recently injured my ankle. If it's anything like my last ankle injury (a strained achilles tendon), then what will happen when I see a physician next week is that he/she will examine my ankle, ask me what I did to injure it, ask me how it felt, what kind of pain, where did it hurt, were there any other symptoms, etc. It is possible that they might order an X-Ray just to rule out any broken bones (just as one might run tests for hypothyroidism or hypoglycemia to rule those out when diagnosing ADHD), but assuming that the X-Ray doesn't find anything wrong, the doc will probably give me some prescription-strength NSAIDs, an ice pack, and an order for physical therapy if necessary.

But...but....the doc didn't do any objective tests, how can be be sure that it's a tendon strain? Sure, he ruled out a break, but he didn't do any sort of diagnostic testing here. So is my ankle injury not real? Did my doc screw up?

And what about when I had a sinus infection a few months ago. I went to see my doc, she asked me what symptoms I was having, when they started, etc. She asked me what color my snot was (dark greenish-brown, and lots of it, as I showed her), and then she prescribed me some antibiotics and told me to come back in two weeks, unless I started getting worse, in which case obviously I should come back sooner.

So did my doc screw up that time, too? I mean, all the doc did was ask about my symptoms. All the doc did was take a list of symptoms, and use them to rule out certain conditions (allergies, influenza, etc), and concluded that the symptoms matched those of a sinus infection, and then....of all the things...my doc went and prescribed medication for this made-up condition. I mean, it must be made up, right? My doc didn't do any tests at all.

So why is it that these diagnoses are somehow more valid than a psychiatric diagnosis? Same basic principle, you talk to the patient, take their history, ask about their symptoms, not to mention just generally observing and examining the patient for any useful information. For example, people with ADHD are often forgetful, so noticing that the patient's shoes are untied, their hair is uncombed, they're constantly checking to make sure they've remembered everything, or perhaps they even have to excuse themselves because they left their keys in their car or something.

But yes, I can see how this all might be a bit misleading if one is not familiar with the concept of a Differential Diagnosis. After all, popular culture gives us TV shows like "CSI" where you can run some sample through a computer and immediately find out everything that you need to know. We're told that high-tech innovations have given us some new certainty about things....but the truth of the matter is that the vast majority of medical diagnoses tend to be made by simple patient history. Hyperion35 (talk) 18:31, 1 August 2009 (UTC)

So then you support describing the diagnosis and eliminating what a diagnosis doesn't do, or removing what the diagnosis doesn't do altogether?--scuro (talk) 13:18, 2 August 2009 (UTC)


I think that we should perhaps be clearer about how ADHD involves a Differential Diagnosis, possibly with a link to the Wiki page on the subject. The problem with simply stating that there is no blood test or other diagnostic test is that it is every bit as irrelevant as stating that there is no blood test or other diagnostic test to check for a strained tendon. Does the article on astigmatism mention that there is no blood test for that either? Is it common to list the tests that are not used in diagnosing a condition? Perhaps describing how the diagnosis is determined, including mention of the DSM, maybe mention the DSM criteria or link to them, as well as a short mention of what a differential diagnosis is, along with a link to that page, and then end it by saying that other diagnostic testing might be performed to rule out other conditions. ~ Hyperion35 (talk) 14:40, 2 August 2009 (UTC)
Feel free to edit, perfection is not required.WP:IMPERFECT As long as one edits in good faith and have discussed issues, seeking consensus when other editors show an interest, no one should object. Perhaps there is a little too much talk and not enough editing going on.--scuro (talk) 17:50, 2 August 2009 (UTC)

I posted the issue on the Neutral point of view noticeboard requesting further opinions. [14] Sifaka talk 15:38, 3 August 2009 (UTC)

Not much happening on the noticeboard. Are you opposed to moving the sentence past the description of a diagnosis? It could be flushed out there, and I think it would be good to describe differential diagnosis, and that ADHD is not unique in not having a fail proof test for diagnosis. This could touch on possible subjective shortcomings, perhaps be a paragraph in length.--scuro (talk) 18:02, 4 August 2009 (UTC)

confused about "Requires registration" tag

This tag has been placed after "developmental disorder" citation in the first sentence. There are several links to this citation including pub med. Is the tag justified and can someone explain when such a tag would be justified?--scuro (talk) 18:03, 2 August 2009 (UTC)

I put it there as you can't actually view/verify the reference without having a subscription of some kind. Therefore if another source that doesn't have this limitation can be found to support the ascertain then that would be preferred. I'll move the notice to the footnotes though so it's not immediately visible. Nja247 18:43, 2 August 2009 (UTC)

Social Construct Theory of ADHD 2

Unresolved

This issue was brought up a few months ago and was never resolved. As I understand it, SCT is a theory which believes that ADHD has been fabricated. Typically Big Pharma or Psychiatry is seen as the creator of this "myth". The theory goes that once the myth is accepted by institutions, it is then validated by society. I could be wrong on the exact mechanisms of the theory here, but in a nutshell the belief is that ADHD is fake. This theory is a fringe theory of ADHD and does not belong on this page.--scuro (talk) 13:34, 1 August 2009 (UTC)

Agreed, and the sources provided are three books, rather than any peer-reviewed published journal articles. The first book listed, I looked up in Google's preview...it included a passage on Realist vs. Anti-Realist philosophy and how this related to whether one can ever know whether ADHD really exists. The page that was cited actually attempts claim that Zametkin disagrees with ADHD as a medical diagnosis. I am not making this up...I actually wish it were a joke:

http://books.google.com/books?id=Lz7If3xTSCYC&pg=PA87&dq=isbn:0415360374#v=onepage&q=&f=false

The page listed in the citation (where they attempt to claim Zametkin as an ally) is page 46, and the page with the Realist vs. Anti-Realist philosophical mental mastur....is page 88
The second book cited isn't even about ADHD, it's called "Social Control" and reads like a long conspiracy theory about governments using social science to control the population. The citation is for p230, but the book is listed (according to Google) as being 230 pages long, so I'm not sure exactly why only the final page of the book is cited. Here's a quote from the conclusion of the "Medical Control" chapter of that book (warning, this is 10 pounds of crazy in a five pound bag):

"What purpose or purposes is served by the rephrasing of these issues into the language of medicine, pathology, or disease? Since the medical concepts and terminologies per-se add no value to the explanation of problems in communities - whether violence or other issues - it must be that such concepts are invoked because of the social functions that they serve."

http://books.google.com/books?id=btZuF51uuHYC&dq=isbn%3A0745638589&q=ADHD#v=snippet&q=ADHD&f=false (page 145)

As for the Szasz citation, it lists a page 212 for a book that is 212 pages long, again. Perhaps they mean to cite the entire book. Szaz's other books all appear to be critiques of psychiatry, including "The Myth of Mental Illness." Not surprisignly, Szaz was a co-founder of Scientology's Citizen's Commission on Human Rights (CCHR). To describe Szaz as "fringe" is probably an understatement.


So there's what has been cited to support the inclusion of this section. One book that seems to incorrectly cite a prominent medical ADHD researcher as opposing ADHD as a medical concept, a conspiracy-theory book claiming that the medical community is a part of a larger plot of maintaining control over society, and a book by the founder of a Scientology front group whose views are rejected by pretty much the entire medical community and really the entire sane world.
So yes, this section does not belong here unless better sources can be found.Hyperion35 (talk) 13:54, 2 August 2009 (UTC)


Oh, also, this section cites an NHS report on ADHD. A search of the NHS report for "Social Construct" yielded zero results. However, the report did contain a chapter titled "Position Statement on the Validity of ADHD." This chapter of this source pretty much eviscerates the entire "Social Construct" hypothesis. It can be found here:

http://www.nice.org.uk/nicemedia/pdf/CG72FullGuideline.pdf (page 131)

Hyperion35 (talk) 14:08, 2 August 2009 (UTC)

Then it is agreed that it should be removed from the causes section, unless someone can justify why this fringe theory belongs on the ADHD article. There is a SCT of ADHD section on the controversies article so the information will not be lost.--scuro (talk) 14:18, 2 August 2009 (UTC)
Yeah, and someone owes me a beer for having to dig through that conspiracy-theory crap. ~ Hyperion35 (talk) 14:41, 2 August 2009 (UTC)
Don't get your hopes up on that beer. Previously, I had moved the SCT of ADHD, along with other alternative theories plus diet, to the culture and society section and it got reverted. It was considered a "controversial" edit even though these issues had been discussed many times. That move seemed like a no brainer to me. There has not been much of a response on the talk pages recently, and you have added relevant and important information. You would be justified in following the BOLD, revert, discuss cycle WP:BRD.--scuro (talk) 17:40, 2 August 2009 (UTC)
I support removing it from the causes section. If it deserves a mention on the page maybe it should be mentioned in the controversies section? Good call on discussing it first Scuro. Sifaka talk 01:23, 3 August 2009 (UTC)
Could you remove it? When I moved it, it got reverted. I'm not opposed to a one sentence mention of it in the controversies section, perhaps it could be incorporated into the the "some don't believe it exists at all", sentence.--scuro (talk) 18:07, 4 August 2009 (UTC)

Evidence showing recognition of the social construst theory of ADHD by the medical community

Here are a couple papers supporting the existance of the social construct theory of ADHD.

A passage from this paper:

A biopsychosocial construction has been proposed likewise for ADHD, particularly in the UK (e.g. Singh, 2001; Cooper, 2001) whereby a range of factors are considered to interact in any individual to bring about the condition of ADHD. Thus while an individual may have a biological propensity towards ADHD through genetics, only through particular interactions with the environment would such biological propensity be expressed (e.g. through poor parental coping; low socioeconomic status). In this account of ADHD, psychological factors as well as the socio-cultural environment are given greater credence than they were in purely biomedical constructions.

I can get full copies if anyone wishes. The fact that Annals of Clinical Psychiatry recognize this opinion means that 1) it is a minority opinion not a fringe opinion 2) it is verifiable.--Doc James (talk · contribs · email) 03:39, 5 August 2009 (UTC)

So I have concerns about efforts to limit the view of this paper exclusively to the majority view held in the United States. To cover this topic properly we must recognize other views from other areas of the world. This geographical difference is highlighted by the fact that the USA uses more stimlants than the rest of the world combined.--Doc James (talk · contribs · email) 03:46, 5 August 2009 (UTC)
Another journal article [15]
These are theories presented by scientist in the feild of psychiatry. We are not here to decide if they are right or wrong but we are here to reflect the literature. The fact that ADHD is not 100% genetic means that something else makes up the rest. We must comment on this contribution once we have distribed the major genetic theories.--Doc James (talk · contribs · email) 03:50, 5 August 2009 (UTC)
This paper from journal of child neurology states that ADHD is unlikely to be an identifiable disease. Which I think support the social influence on the condition. Published in 2008. http://jcn.sagepub.com/cgi/content/abstract/23/7/775
This paper also comments on theories of social causes. Saying that they are less accepted than genetic causes but acknowledging there existance. http://66.102.1.104/scholar?q=cache:nYP5v7n7DuYJ:scholar.google.com/+causes+of+ADHD&hl=en--
Well this paper from nature reviews comments on the three leading theories of ADHD one being primarily social / environmental, one genetic, and one a combination.Doc James (talk · contribs· email) 04:27, 5 August 2009 (UTC)
I am sure I could find many others if needed. No one here is refusing to recognize the published literature which states that ADHD has a strong genetic component. What justification needs to be found to show that some within the scietific community beleive social and environmental factors may contribute to / affect ADHD? --Doc James (talk · contribs · email) 04:34, 5 August 2009 (UTC)
Are we on the same page here? Could a poor upbringing be a trigger for the development of ADHD? That might be a social influence on the cause of ADHD. That is worthwhile debatable point. On the other hand, when we are talking about the social construct theory of ADHD, are we not talking about ADHD being nothing more then a construct of society...with no validity....as Fred Baughman so often states, a FAKE disease. There are two issues here. One, does the theory belong on the article, and two...does it belong in the causes section? Lets start with #2. Which scientist, or researcher in the field, is advocating that the disorder is fake? That it is merely a social construct?--scuro (talk) 05:04, 5 August 2009 (UTC)

That is not what the social construct theory of ADHD is first of all. No one says it is fake. Many accept it to some degree. The papers above discuss social influences / causes of ADHD. This section should be expanded to discuss were we make the cuts offs between normal and mentally ill. The social construct theory is just a more extreme version of this. But read the reference above.--Doc James (talk · contribs · email) 05:25, 5 August 2009 (UTC)

I'm confused about the SCT of ADHD. The sentence within the ADHD article states, "Some of these critics, such as Thomas Szasz, maintain that ADHD was "invented and not discovered."[1][2] They believe that no such disorder exists...". The opening paragraph of the wiki article on SCT of ADHD states, that ADHD was invented and not discovered. We have two anti-psychiatry critics Peter Breggin and Sami Timimi mentioned as proponents in our article. Both believe the disorder is a fabrication. Timimi, once stated, .."throw in the profit-dependent pharmaceutical industry and a high-status profession looking for new roles and we have the ideal cultural preconditions for the birth and propagation of the ADHD construct". Breggin was the medical expert in the Ritalin Class Action lawsuits, these failed lawsuits hinged on the notion that ADHD was a fraud. Sure sounds like the proponents of the SCT of ADHD believe that ADHD is fake. Looking through your citations, I couldn't find minority opinion with regards to cause. Again I ask, which scientist or researcher working in the field is advocating that ADHD can best be understood through the SCT of ADHD?--scuro (talk) 12:34, 5 August 2009 (UTC)


James, in reading through the papers that you are citing here, I am not actually seeing anything to back up your assertions. For example, you cited this paper: http://66.102.1.104/scholar?q=cache:nYP5v7n7DuYJ:scholar.google.com/+causes+of+ADHD&hl=en--

First off, this was a survey primarily of elementary school teachers. While these teachers may be very adept at dealing with students with ADHD, their opinions are of absolutely no relevance as to the question of causes. They have no training or experience in neuroanatomy, neurology, brain development, etc. Furthermore, the survey involved a questionnaire with vignettes describing fictitious students whose symptoms were supposed to be similar to those of ADHD. This is fairly irrelevant. What you are actually citing this for is the section in which this paper cites *other* papers as to what *those* papers said regarding causes. For example: "In a more recent study, Frankenberger, Farmer, Parker, and Cermak (2001) reported that school psychologists generally agreed that ADHD was caused by brain malfunction."

You also cite this paper: http://www.ncbi.nlm.nih.gov/pubmed/10798827

Let's look at what they actually say:

"The critics view the underlying reason for the "epidemic" as societal, due to our modern pace of living, our competitive society, and our consumer emphasis. Rejoinders to and clarifications of the more tangible points of the critics are presented, followed by a discussion of some more practical and legitimate concerns for researchers in this area."

Sounds to me as if they are summarizing the "critics" of ADHD, followed by eviscerating those arguments....and here's the kicker...if they follow it with a discussion of "more practical and legitimate concerns," then don't you think that this implies that the concerns of these "critics" are impractical and illegitimate? It sounds to me as though this paper is implying that the Social Construct proponents are in fact fringe and are not of concern for the vast majority of researchers.

And then there's the first link: http://www.jstor.org/pss/3196091?cookieSet=1

This is an article discussing the manner in which lay persons use (and misuse) ADHD and related terms. Specifically:

"This article examines the ways that meanings about the concept of Attention Deficit Hyperactivity Disorder (ADHD) are socially constructed within the everyday language use of laypersons. The 224 language events referencing ADHD, including media sources, were recorded in journals by student assistants. These data reveal five patterned ways that lay persons appropriate and interpret discourses originating in medical and school communities of practice."

This has absolutely nothing to do with any Social Construct theory of ADHD. It is (ironically) about the ways in which lay persons interpret and/or misinterpret medical data, and the language that lay persons use when discussing these issues. This is really not relevant at all to the causes of ADHD. If anything, its relevance is to the way that lay persons tend to MISUNDERSTAND complex medical issues such as ADHD, and the different ways in which lay persons will interpret medical discussions.

The thesis paper is, by definition, original research.

And finally, the paper in JCN is....well I suppose that it might support your contention that more neurobiological evidence is needed, although I'm really not sure how the author reached her conclusion. However, it says absolutely nothing about any Social Construct theory nor does it conclude that ADHD is a social construct.

As for your question: "What justification needs to be found to show that some within the scietific community beleive social and environmental factors may contribute to / affect ADHD?"

Well, for starters, the standard is more than just "some." There are "some" people in the scientific community who are creationists, for example. No really, there are. That doesn't change the fact that it's practically the classic case of a fringe theory. For starters, you'd have to show some level of consensus on that, not just "some." "Some" is also a classic weasel word. "Some say" "Some believe" etc. Finally, while many papers do discuss social and environmental factors, this is most definitely different from claiming that ADHD is a social construct. When researchers talk about social and environmental factors, usually it is in the context of behavioral interventions and structured study environments, etc. Other situations in which social and environmental factors are discussed would be with regards to twin concordance studies. Twin studies have shown that one identical twin will have a very high but not 100% likelyhood of having ADHD if the other twin does. This implies that there may be social factors that act *in addition* to genetic susceptibility. However, it is important to understand the difference between this, and the hypothesis that ADHD itself is merely a social construct.

Please, I do not doubt that you are acting in good faith, but I really do not believe that you understand much of the evidence that you are presenting. Also, your statement about wanting more discussion about "were we make the cuts offs between normal and mentally ill" implies that perhaps you are not familiar with the DSM-IV diagnostic criteria for ADHD. Those criteria are quite clear that the cutoff exists where the symptoms result in significant impairment, that at least some symptoms must have been present before the age of 7, and that both the symptoms and impairment must exist in at least two separate settings (ie at school and at home). Now, it is certainly possible that the criteria used in other countries is not as specific...although if anything, the ICD and other international diagnostic criteria are even more restrictive. Regardless, my point is that the diagnostic criteria (which ought to be mentioned) are themselves fairly specific about where the cutoff is between normal and abnormal.

Wikipedia is an encyclopedia, a reference, designed to distill and summarize basic information about various subjects. It is not, among other things, a forum for airing fringe opinions that are not reflected by most major medical organizations. How much weight does the Epilepsy article give to the theory that seizures were caused by curses from witches or possession by evil spirits? ~ Hyperion35 (talk) 09:09, 8 August 2009 (UTC)

So here is one of the important points in the DSM "significant impairment". The question is who decides what is significant. The ICD 10 uses a different cut off than the DSM based on the number of criteria needing to be fulfilled. This leads to a 3 to 4 fold difference in the rates of ADHD. This difference represents different societies calling different degrees of symptoms normal vs ADHD. Behavior is not dichotomous. So it is not that some researches consider social norms to be important in determining cut offs for ADHD but all researcher consider this important. This book deals with these issues in great length. Dr Jennifer Erkulwater; Dr Rick Mayes; Dr Catherine Bagwell (2009). Medicating Children: ADHD and Pediatric Mental Health. Cambridge: Harvard University Press. p. 5. ISBN 0-674-03163-6.{{cite book}}: CS1 maint: multiple names: authors list (link) It will help you understand what I am getting at.
I am in no way saying that ADHD is does not have a genetic component. I am not saying that ADHD is not a real disease. But it is a subjective line between ADHD and normal. One that is not determined by science but by society. Other wise how do you think this condition went from being unheard of 50 years ago to affecting in some areas 10% of children and possibly the population?
By the way some estimate that 85% of obesity is due to genetics. Does that mean we should eliminate all discussion of social and enviromental influences? That diet and exercise should not be discussed? Ignoring a large part of the literature just because you disagree with it is concerning.
And by the way. I understand the DSM just fine. I also understand the literature I have quoted above.Doc James (talk · contribs · email) 09:47, 8 August 2009 (UTC)


I think that you are conflating two separate questions. The first question is with regards to the symptoms. Those are discrete symptoms that are listed, and even the DSM has a number of symptomatic criteria. The second question, once it has been ascertained that a person has these symptoms, would then be to look at the level of impairment that these symptoms cause. Everyone has differing levels of hearing and eyesight, for example. Many people can get by with mild myopia or mild hearing loss, and it will not affect their lives one bit. On the other hand, many other people will find that it causes much impairment. In fact, the cutoffs for "nearsighted" and "farsighted" are quite a bit more "subjective" and "societal" than the cutoffs for ADHD. However, only the most ignorant individuals would question whether people who find that they need glasses or hearing aids to be able to handle most life activites should use them, or whether these people would qualify as having vision or hearing impairments.
Also, I think that you may be confused as to what the "Social Construct Theory" means. This is not simply a theory that says that part of ADHD is caused by environmental factors. If you want to discuss that, then go ahead, but please understand that the term "Social Construct Theory" is a bit more specific than that. Scuro has already discussed what this term means. It is a discredited pseudoscientific "theory" proposed by a number of members of the anti-psychiatry movement, many of whom (Szaz, Breggin, Baughman) have ties to Scientology and the Scientologist front organization CCHR. Further, the citations that were previously used for this theory came from Szaz and from a lunatic conspiracy theory book that alleged a secret government plot to control society through modern medicine.
But my biggest concern is that the sources that you have supplied, as I mentioned above, do not seem to support what you are saying here. A survey of schoolteachers is irrelevant as to the scientific evidence for various potential causes of ADHD (although such a survey could be quite useful for ascertaining the effect that ADHD has on a child's academic performance, and the effect that an ADHD child might have on the rest of the class, for example). Another article discussed the ways that ADHD is mentioned and discussed among lay persons and how lay persons use that terminology. This is equally irrelevant. Its only tie to "social constructs" has to do with how social forces affect the manner that non-experts interpret scientific evidence. The closest thing that you have mentioned regarding mainstream scientific mention of Social Construct Theory appears to be a paper that acknowledges that some people believe that ADHD is a social construct, but goes on to strongly imply that this theory is not legitimate and is not helpful in the course of diagnosis and treatment. If you want to use that source, then you have to find the full text of it so that you can include the part where "Rejoinders to and clarifications of the more tangible points of the critics are presented, followed by a discussion of some more practical and legitimate concerns for researchers in this area." In other words, you can't just use a paper that rebuts a particular theory as evidence of scientific acknowledgment of that theory...that's actually rather dishonest, you would need to include the parts of the paper where the author discusses the problems with that theory, not just the part where the author acknowledges that it exists. ~ Hyperion35 (talk) —Preceding undated comment added 21:25, 8 August 2009 (UTC).
I agree I think discussing the problems with this theory is important. When I have time I will look into it more carefully. The social construct theory implies that were the cut off is defined between normal and abnormal along the continuum is a social construct and thus a number of the cases of ADHD are determined by this. Medicating Children: ADHD and Pediatric Mental Health comments on this. It is discussed in the scientific literature. Will add more second half of Sept. Cheers--Doc James (talk · contribs · email) 18:11, 10 August 2009 (UTC)
The autism page specifically refers to ADHD as also having a social construct theory.[16] Here is the paper by Timmins [17] The BMJ by the way will publish minority view points but not fringe. This one paper alone makes it a minority view point period.-Doc James (talk · contribs · email) 18:22, 10 August 2009 (UTC)


Errrm, James, did you mean Timmins or Timimi? Timimi has some pretty long-standing ties to Scientology and their CCHR front group. The full text of that paper can be found here: http://bjp.rcpsych.org/cgi/content/full/184/1/8

Note that it is a debate paper, not a peer-reviewed paper. They wanted to show opposing sides to an issue, but the fact that Timimi was the best they could find, and the fact that he did not disclose his ties to CCHR in that paper, ought to raise some red flags. Also note that he mostly cites himself (along with another Scientologist, Peter Breggin). His only non-Scientologist citations are simply with regard to stimulant toxicity.

Here's one particular gem that Timimi mentions in his conclusion in the article that you cite (sourced to himself):

"By acting as agents of social control and stifling diversity in children, we are victimising millions of children and their families by putting children on highly addictive drugs that have no proven long-term benefit."

Agents of social control? Victimising millions of children? Does this really sound like rational academic discourse?

Look, I'm not criticizing you, you're not responsible for what Timimi writes, but I do want to impress upon you the fact that Sami Timimi is involved with Scientology's CCHR front group, and ask whether you think that this might make him a less than desirable source, as well as whether this might imply that he is not all that "mainstream" (lord help us the day that Scientologists are considered "mainstream.") ~ Hyperion35 (talk) 20:33, 10 August 2009 (UTC)

I am no fan of Scientology. Please provide me a ref saying that Timimi is a Scientology? People speak for groups because that group pays them not because they are necessarily affiliated.Doc James (talk · contribs · email) 02:00, 12 August 2009 (UTC)
  1. ^ Chriss, James J. (2007). Social control: an introduction. Cambridge, UK: Polity. p. 230. ISBN 0-7456-3858-9.
  2. ^ Szasz, Thomas Stephen (2001). Pharmacracy: medicine and politics in America. New York: Praeger. p. 212. ISBN 0-275-97196-1.
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