Talk:Attention deficit hyperactivity disorder/Archive 16

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Causes

Unresolved

Would like to bring people attention to the page on Major depressive disorder. In the lead the causes are described: "Psychological, psycho-social, hereditary, evolutionary and biological causes have been proposed." The different theories have been given weight as it is agreed by almost everyone that the cause is multi factorial. The same applies to ADHD. I have concerns that many of the editors here have ADHD themselves as stated on their talk pages. This might be leading to a WP:COI similar to what is seen on other pages such as chronic fatigue syndrome and fibromyalgia. Well ADHD has much better evidence for it than the previously mentioned. I find the refusal to let any but a very narrow view of ADHD to be included concerning.

Most psychiatrist subscribe to the Biopsychosocial model of mental illness well the pharmaceutical companies concentrate on the bio model. This makes up the majority of the literature as they have the most money to get the most publications. This is not a criticism per say but just the way things are. Psychologists more heavily support a psychosocial aspects. By leaving out a full discussion we would doing a disservice to both the profession of psychiatry, Wikipedia project, and society as a whole.Doc James (talk · contribs · email) 10:22, 8 August 2009 (UTC)

First, please understand that Major Depressive Disorder is not the same as ADHD. Just because MDD has a particular etiology does not imply that ADHD would have a similar etiology. MDD in fact strikes me as a very poor comparison to ADHD, whereas other developmental disorders such as Tourette's or Autism might be a better comparison. In fact, MDD is not even listed under the same category in the DSM-IV as ADHD, and the ICD-9 CM lists the two conditions in separate categories as well.

Secondly, it is rather irrelevant as to why the majority of the scientific literature supports a biological model. You claim that this is due to proponents having "the most money to get the most publications" (doubly nonsensical since most scientific journals, at least in the US, are published by non-profit medical specialty and subspecialty societies. I know this because I used to work for one such society. My particular society even went so far as to separate the Journal staff and budget from the rest of the organization so as to ensure impartiality). Wikipedia's standard is to grant weight based upon the evidence in the scientific literature. If the majority of the scientific literature supports a biological model, as you imply, then that is the determining factor. Arguments as to "big pharma" paying for studies should be addressed towards specific studies if you feel that they are improperly influenced, but as a general blanket statement, it fails. I could just as easily claim that biotech firms, big University research grants, etc have enough money to promote the Theory of Evolution, and that it is this money, and not the basic scientific evidence in favor of this theory, that is responsible for its support in the vast majority of scientific literature. The obvious logical fallacies in this argument ought to be apparent. Regardless, the standard used should be to give appropriate weight based upon the scientific literature.

Finally, many health pages on wikipedia are edited by people who have that condition or who have friends or family members with that condition. These people are often the ones who are the most motivated to maintain the article, who happen to have an interest in the subject, and who may already have a familiarity with the subject matter and literature. Blanket statements of COI based solely on an individual commenter's medical diagnosis is an ad hominem fallacy, and also could be taken as a personal insult or attack. I understand that this is not how you intended it to sound, but please understand that many people may take offense. Claiming that an individual has a COI solely due to a medical diagnosis would be every bit as fallacious as claiming that having such a diagnosis automatically makes one's viewpoint more relevant. Most of us who have been diagnosed with this condition are well aware that data is not the plural of anecdote, and that a sample of n=1 (our own experiences) does not constitute scientific evidence. However, please understand that people who have been diagnosed with a particular condition may very well have an interest in maintaining the health page, much as I would imagine that cancer survivors have an interest in cancer pages, HIV-positive individuals might have an interest in the HIV page, or deaf individuals might have an interest in maintaining a page on hearing impairment. You need more to show COI than just a tag someone has placed on their talk page. ~ Hyperion35 (talk) 21:56, 8 August 2009 (UTC)

The irony of the COI complaint is that James may very well also have a conflict of interest.

"One of the editors have insulted my University aswell as a number of my friends. They all make numerous subtle insults of me". [1] Doc James is referring to the University of British Columbia and I believe he is referring to staff working at the "Therapeutics Initiative" which may very well be an anti-pharma group. [2] I think 3 or 4 other editors who frequent this page have declared that they have ADHD, and one other contributor may have a COI due to personal situations that happened in this person's life with regard to medication. So what is the point of bringing up COI?--scuro (talk) 01:36, 9 August 2009 (UTC)

Can we address the issue which Doc James raised which is, the constant assault on even high quality secondary peer reviewedd sources, where a narrow view seems to be on the battle agenda of only amphetamines work for children and it is entirely a neurological based psychiatric disorder and everything else is fringe and not allowed in the article regardless of whether it is supported by good secondary sources or meta-analysis etc. This is the issue, the narrow POV editing on this article.--Literaturegeek | T@1k? 17:07, 10 August 2009 (UTC)

In comparing MDD and ADHD I was not saying they were the same just that they fall under the same health care specialty. As I have shown above all these ideas have support in the scientific literature. They are not placed first as I agree with you the ideas of genetics has a greater amount published in the literature. What we are discussing is not weather these ideas should be moved but weather they should be deleted / suppressed all together even though there is evidence supporting there existence. I have been accused of a COI just because I work with people who have ADHD. I do not mean to apply that all COI are a bad thing.--Doc James (talk · contribs · email) 17:59, 10 August 2009 (UTC)

Excellent analogy to Autism. Here is the Wiki page on causes. Causes of autism Vaccines are mentioned as a cause even though none within the medical community believes this to be the case. The fact that it is not believe is stated.

Wikipedia's goal is to present the breadth and depth of human knowledge not suppress it. Trying to suppress a view held by many is wrong ( opinions of people other than ADHD researchers count by the way ). The vaccine and autism argument states that many parents avoid immunization because of it. We in the medical field wish to know the beliefs of the general public as this will help us approach treatment and diagnosis with them.--Doc James (talk · contribs · email) 18:20, 10 August 2009 (UTC)

Nobody is trying to suppress any opinions here, but Wikipedia policy, as I understand it, is that statements should be cited, preferably to peer-reviewed sources, and that information ought to be given due weight based upon its acceptable by the scientific community. The beliefs of the general public, while certainly valuable, really do not deserve that level of weight. Furthermore, there is no real way to cite or source beliefs that are "held by the general public."

What sources exist to corroborate the Social Construct Theory? If you are not specifically mentioning the Social Construct Theory, but are asking a more general question about research into social or environmental factors about ADHD, then that is certainly a different question. The answer to that question no doubt would require some citations. None of the citations that you have provided appear to address that question. That is my sole concern here, that statements included in this article ought to be cited to reputable sources, and that those sources should actually corroborate the claims. I believe that I have already stated that I could not find passages in the sources that you have provided here that support your claim.

Now, obviously my inability to find a passage in those sources to support your claim is not evidence that such passages do not exist. I could be mistaken. I could have missed something. I could have misread a sentence, perhaps there was a "not" written there that I missed, this could easily change the meaning of a sentence when read. These are all possibilities. However, if I have misunderstood, misread, or mischaracterized one of these sources, then please correct me. If there are other sources, then by all means please include those as well.

Now, as to answer LiteratureGeek's question, perhaps one reason why stimulant medication is given such a strong weighting is because currently the only FDA-approved treatments for ADHD, at least in the US, are amphetamines, methylphenidate, and atomoxetine. Now, I can understand that one might be concerned that this is rather US-centric, and I agree. So, let's take a look at Britain's guidelines, published by the NHS:

While they do mention that several other treatments are sometimes used, the only treatments that are endorsed as being conclusively effective are medications (p30).

That same paper also quotes Faraone's genetic studies that demonstrated a 0.7-0.8 heritability rate. Faraone has authored over 550 journal articles, and is one of the most highly cited researchers in all of psychiatry. He is also Vice President of the International Society of Psychiatric Genetics...which is probably one reason why NHS mentions him. The NHS paper goes on to discuss environmental factors and other factors, but you will note that even in those sections they are discussed in light of genetic susceptibility. I am not stating this to "prove" a genetic cause, please understand that what I am discussing involves the reasons for why certain causes or etiologies or treatments might be given a greater weight than others. Even Britain's NHS, which is not exactly an enthusiastic supporter of ADHD or stimulant medications only mentions other causes in relation to genetic susceptibility. America's NIMH also gives greater weight to genetic causes than other causes and to stimulant treatment over other treatment.

In short: cite your sources and make sure that they back up your claims, and I won't have a problem with it. Please do not criticize me for checking citations and discussing (in the Discussion Page!) my concerns that these sources do not support the assertions made. If you disagree, then please cite other sources, or correct me by pointing to information within the sources already provided that you feel that I may have missed, or misinterpreted, or otherwise might be mistaken about. Let's argue over sources and their data, not over editors, ok? ~ Hyperion35 (talk) 19:50, 10 August 2009 (UTC)

Agree that we need to argue over sources. Will pull out the exact lines in Sept from the above refs. Currently as the section stand it reflect the social construct theory of ADHD very poorly and is not well referenced.

By the way we currently give greater weight to both stimulants and genetics and it I am sure it will stay this way.

Here is the paper by Timmins if you missed it above ADHD is best understood as a cultural construct [3] The BMJ by the way will publish minority view points but not fringe. I can get you the full paper if you do not have access and are interested.--Doc James (talk · contribs · email) 19:57, 10 August 2009 (UTC)

Mentioned this above, but, the paper is by Timimi, and given his ties to Scientology and the Scientologist front-group CCHR...well, c'mon now, does anyone disagree with the assertion that Scientology and their beliefs about psychiatric medication is pretty damned fringe? ~ Hyperion35 (talk) 20:41, 10 August 2009 (UTC)

Would recommend that you write to the BMJ and complain that they are willing to publish these views. He has said previously that he does not have a ties with Scientology. Many people have referenced the above paper in their own. See Williams J, Taylor E (2006). "The evolution of hyperactivity, impulsivity and cognitive diversity". J R Soc Interface. 3 (8): 399–413. doi:10.1098/rsif.2005.0102. PMC 1578754. PMID 16849269. {{cite journal}}: Unknown parameter |month= ignored (help) which comments on the hunter farmer theory sort of.

You cannot discount someone just because of rumors of association. Should we discount everything that is written by Barkleys just because he receives over 300,000 USD a year from the manufacturers of ADHD drugs? Of course not. If we were to eliminate all research from research who has COI nothing would be left in the field of psychiatry.Doc James (talk · contribs · email) 21:13, 10 August 2009 (UTC)

A simple google search for "Timimi AND CCHR" directed me to this page on CCHR's own website that contains a Public Service Announcement that Timimi did for them: Unfortunately the audio file itself does not appear to be accesible.

And here's Timimi speaking at a conference hosted by the Church of Scientology at their offices: http://www.scientologyreligion.org/news/pg039.html

Again, this is from the CoS's own pages.

But let's see what he actually said at that conference:

"The medicalising of children's behaviour problems and the attempt to control their behaviour with dangerous, psychiatric medication means that the new eugenics is already with us, said Dr. Sami Timimi, psychiatrist and author.

As a scientist, a doctor, a father and a citizen, continue Dr. Timimi, I believe we have a moral obligation to do all we can to protect our children from suffering any further damage and I urge policy makers to carry out an urgent review of practice in the area of ADHD and the use of medication for control of children's behaviour and to put in place a moratorium on further prescribing of psychiatric medication to children until such an investigation is completed. To remain silent on this issue is to betray our children."

http://www.free-press-release.com/news/200511/1132664299.html

Eugenics? Really? Seriously? Really? This is the guy you're quoting? Also, don't you think that someone who calls for a moratorium on prescribing *all* psychiatric medication to children just might, possibly, maybe be a bit fringe.

Also, the GMC did actually admonish the BMJ for publishing that article, lemme see if I can find the link. Never mind, it was a group of physicians requesting that the GMC admonish Timimi and Szasz for their ties to CCHR.

And again, I'd like to point out that the BMJ article is not peer reviewed, it is a debate piece. ~ Hyperion35 (talk) 22:04, 10 August 2009 (UTC)

This is an article published in a prestigious scientific journal by a well know author. As I said above if you do not like the conclusions write to the BMJ and complain. As I said previously Barkley has ties to drug companies should we discount his published papers? Of course not. One does not get to change the rules just because on does not like the conclusions. The paper by Timmins has been referenced by a number of other papers.

What I have heard so far wrt the references I have provided: do not like the author, the source is older than 8 year ( see previous discussion ), this group has been rumored to be antipharm ( the TI ), I trained at UBC which is not a good enough University therefore evidence I present is not good enough, and the list goes on. So I ask again what criteria does the evidence I provide need to meet? I have a feeling as soon as I provide something sufficient the criteria will change.

By the way the cause and pathophysiology of ADHD is unknown. Thus most of the discussions of causes are opinion pieces.--Doc James (talk · contribs · email) 23:35, 11 August 2009 (UTC)

More papers commenting on ADHD as a social construct:

• http://ajp.psychiatryonline.org/cgi/content/full/164/10/1612
• http://ajp.psychiatryonline.org/cgi/content/full/164/6/856
• http://www.ncbi.nlm.nih.gov/pubmed/8676718?dopt=AbstractDoc James (talk · contribs · email) 23:45, 11 August 2009 (UTC)

This is much better description of the SCT of ADHD than what we have currently: "It is in defining such a diagnostic threshold that lies the social construction, as the boundaries of normality in a given region are set by psychiatrists (by choosing and applying diagnostic criteria) and society (by recognizing symptoms as deserving of medical care). Thus, it is probably not useful to ask whether DSM-IV has too low a threshold for ADHD or whether ICD-10 has too high a threshold, since there is little evidence of a biological threshold to be identified; the definition of such a threshold is the collective social duty of physicians, parents, and society. It is crucial that we acknowledge not only the existence of this construction, but also the responsibilities inherent in taking part in it. Symptoms might be constant throughout the world, but it is how we view them that will give them meaning and define the care of children worldwide." http://ajp.psychiatryonline.org/cgi/content/full/164/10/1612 Doc James (talk · contribs · email) 00:06, 12 August 2009 (UTC)

Page 48 http://books.google.ca/books?id=Lz7If3xTSCYC&pg=PA47&lpg=PA47&dq=social+construct+ADHD&source=bl&ots=v3jKBBGJTp&sig=GuYrjYaMtUAfiz17bzJOF8mqA3w&hl=en&ei=jAeCStD2NJPoMeDTzaUL&sa=X&oi=book_result&ct=result&resnum=10#v=onepage&q=social%20construct%20ADHD&f=false Doc James (talk · contribs · email) 00:09, 12 August 2009 (UTC)

Here is one published in 2009 http://www.capmh.com/content/3/1/1 Doc James (talk · contribs · email) 00:20, 12 August 2009 (UTC)

Good one! Hordaland (talk) 01:23, 12 August 2009 (UTC)

Thank you H. The literature does not get any more untouchable than this. The conclusion: "There is nothing "mere" about social constructions. To recognize that there is no bright line written in nature between impaired and unimpaired children – to recognize that it is up to human beings to choose who should receive a diagnosis and who should not – is to acknowledge that ADHD is "a social construction." But acknowledging that does not make us diagnostic nihilists; rather, it means we understand that because nature does not show us where that line is, it is our weighty responsibility to decide where to draw it." I have replaced what we had previously as it was a straw man explanation of the theory.Doc James (talk · contribs · email) 01:48, 12 August 2009 (UTC)

I'm not sure that it's fair to call it a straw man explanation. Szasz and others were the citations that were previously provided, so it was all that we had to go on. Szasz and Breggin and Baughman and Timmimi are the ones who get mentioned the most. And your link to Timimi's* article in BMJ, he even makes the arguments that you say were a "Straw man." Now, I noticed that you are citing other sources, which are making far more reasonable claims about where to draw the line, diagnostically. This is very much different from Szasz, who claims that all mental illnesses are fake, or Timimi, who argues that we should place a moratorium on all childhood psychiatric treatment.

Now, I'm still a bit confused about the arguments that you mention here, because it seems that this should apply to diabetes, hypertension, obesity, nearsightedness, hearing impairment, hypo- and hyperthyroidism, anemia, and many other medical conditions. Am I missing something, or is almost every diagnosis aside from an AMI or bacterial infection simply a matter of social construction? Human beings, physicians, make decisions every day as to whether a particular patient's symptoms are normal or abnormal, in almost every medical specialty (at least, within cognitive medicine...dunno about surgeons). Look, if you want to include this crap, go ahead, but it strikes me as a bit dishonest to pretend that physicians don't make decisions every day as to whether a patient's cholesterol is high enough to warrant treatment with statins, or whether a patient's blood pressure has been consistently high enough to warrant a diagnosis of hypertension. Hell, for that matter, epilepsy specialists can't seem to get their acts together and figure out how long a tonic-clonic seizure has to last before it's considered status epilepticus, since the numbers for that keep getting lowered.

Look, I know that I've had to have this discussion with plenty of physicians, and you've probably had to have this discussion with plenty of administrators. You know as well as I do that there are very few diagnoses for which you could say that there is no guesswork, no questions of where to draw the line between normal and abnormal. Yes, the researchers tend to act like it's etched in stone, and the physicians in the trenches are often throwing up their hands in frustration at CPGs that aren't giving them guidance for the real-world patients they have to see.

I get that this is a frustration that goes far beyond the subject of ADHD or the scope of this article, but I do wonder why exactly we're including it in this article. At some point, it really just boils down to "diagnosis and E&M are complicated, even for professionals. Guidelines change, and for some patients with mild to moderate symptoms, it can be unclear where to draw the line." That's something that you could say for almost any medical condition, though, so I'm not exactly sure what it is about this particular condition, as opposed to many other conditions, that makes it a social construct unless most of cognitive medicine is just social constructs. Is that the case?

• For god's sake, it's Timimi....the reason why I'm a bit frustrated is because there happens to be another researcher named Timmins, but it appears that your papers are written by Timimi.

~ Hyperion35 (talk) 09:34, 12 August 2009 (UTC)

Could the issue be that ADHD a psychiatric condition, and some see all psychiatric conditions as "social constructs"?--scuro (talk) 13:00, 12 August 2009 (UTC)

Excellent I will take this as you agreeing to inclusion: "Look, if you want to include this crap, go ahead, but it strikes me as a bit dishonest to pretend that physicians don't make decisions every day as to whether a patient's cholesterol is high enough to warrant treatment with statins" Primary prevention of cholesterol is controversial btw. We could discuss Ezetamibe but that would be way off topic. You must agree that a 3 to 4 fold difference in diagnosis rates between the two most commonly used diagnosis rates is more than a subtle different in BS for diagnosis diabetes. We all agree that society plays an important role in disease / dysfunction / disability.Doc James (talk · contribs · email) 13:37, 12 August 2009 (UTC)

Well, my point is that it would be....I'm not sure if it's specifically undue weight, or just generally disingenuous...if the section is written as to imply that this specific diagnosis is societally influenced in a manner different from most other medical diagnoses. I'm also not sure to what extent it represents information that is unique to this diagnosis or that is specifically relevant. Certainly it might be worth mentioning the difference in diagnosis rates depending on which diagnostic criteria are being used, but the DSM and ICD criteria have some significant differences (not to mention different names for the condition), and those differences in criteria ought to be mentioned, if you're going to discuss that. So to the extent that you want to discuss how societal views relate to diagnostic criteria, that's certainly an avenue that could be interesting, but I'd focus more on the diagnostic criteria themselves, since that's obviously easier to reference. In other words, it's easier to discuss where the differences in diagnostic criteria exist, than it is to discuss why those differences exist...do you agree?

I can certainly agree that guidelines for anything can be controversial, and that there is often debate within the medical community over guidelines on diagnosis, procedures, treatment, etc in many areas. Even the basic framework for defining a particular procedure, from a routine office visit to open-heart surgery, is described in basic CPT codes used by American physicians. The wording and definitions used to describe each code (of which there are tens of thousands) is debated and in the end is usually voted on by committee...which is sort of why I find it surprising to see this mentioned as a controversy for this particular subject, since the basic issues involved are common to almost all medical diagnosis, procedure, E&M, and treatment guidelines across the board (which reminds me of a story about watching surgeons attempt to quantify E&M guidelines for pre- and post-op work...and coming up with such a byzantine description that even the policy wonks were sitting there scratching their heads going "this is too arcane").

So it's not that I'm disputing that society plays a role in the practice of Medicine, but rather that I'm questioning the relevance to this specific subject. ~ Hyperion35 (talk) 19:00, 12 August 2009 (UTC)

removing OR sentence

Unresolved

"It should be noted that stimulant medication itself can affect growth factors of the central nervous system.[74]" The paragraph talks about a brain development lag, then it ends with that sentence. Placing these unrelated sentences together is OR. Because of proximity, the two ideas appear to be connected. The sentence was deleted.--scuro (talk) 13:23, 6 August 2009 (UTC)

Joshi SV (2002). "ADHD, growth deficits, and relationships to psychostimulant use". Pediatr Rev. 23 (2): 67–8, discussion 67–8. doi:10.1542/pir.23-2-67. PMID 11826259. Retrieved 2009-05-25. {{cite journal}}: Unknown parameter |month= ignored (help)--Doc James (talk · contribs · email) 18:35, 6 August 2009 (UTC)

Bussing found caudate differences between children who were exposed to methylphenidate and those who were not (Bussing et al., 2002). The treated group demonstrated smaller left and total caudate volumes than their untreated peers. This finding was not supported by a larger comparison of 49 unmedicated and 103 medicated ADHD patients, although a possible association between stimulant effects and smaller caudate volume should not be ruled out (Castellanos et al., 2002). http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6VB8-4J7B150-5&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&_docanchor=&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=efcbb49ed0ba9fccfb87fba26641f7f0 --Doc James (talk · contribs · email) 18:49, 6 August 2009 (UTC)

Since the data is poor in this area it should be changed to: "It should be noted that stimulant medication itself may affect growth factors of the central nervous system.[74]" Some papers found certain areas smaller some found certain areas larger. But none of these papers say these changes are either good or bad. Maybe it is good to change growth factors in a persons brain. Also small brains might actually be desired. ie women make up 60% of the medical student / university student and have significantly smaller brains. Maybe having a big brain makes you stupid... More likely though it is all meaningless.

What is concerning however is the removal of referred material without discussion.--Doc James (talk · contribs · email) 19:04, 6 August 2009 (UTC)

There has been academic debate about decreased growth rates for children taking stimulants. The paragraph in which the sentence was removed, was about brain development. This is an apples and oranges type of thing, and putting them together connects different ideas by association. I've seen no study which states that stimulant medication delays brain development. I think I recall seeing a study which actually stated the opposite. So to me it was a no brainer, a clear case of OR. The edit was done in good faith. Does the article not touch on the growth issue? If not, I could insert the deleted sentence in the management section.

Are you interested in seeking true consensus? If you want to work together as a team, I'm all for that. If there is a procedure that you would like us all to follow, I be for that too. Otherwise I'm following the BOLD, revert, discuss cycle WP:BRD, but did it one better by posting my change.--scuro (talk) 21:14, 6 August 2009 (UTC)

A change in growth factors does not mean it delays brain development. Maybe it improves brain development. I guess the question is do stimulants affect the human brain? I think all would say yes. Next question how does it do this? Well it possibly affect growth factors among other chemicals? Does this have an effect on brain development? Well hopefully it improves brain development but the evidence is not conclusive.

Does it have no effect on the brain? One would hope not or what would be the point of taking all these meds. I see no were were it said in the ADHD page that stimulants cause "brain development lag". No one here is claiming this as it is not supported by the literature. But the article never said it did.

This section is on pathophysiology. What effects ADHD meds might be more suitable to the page on ADHD treatment. But the effects of treatment also gives indications to the pathophysio. Doc James (talk · contribs · email) 10:33, 8 August 2009 (UTC)

Then you agree the sentence should have been deleted from this section, and we can mark this thread as resolved?--scuro (talk) 14:03, 8 August 2009 (UTC)

I have heard the "amphetamines" improve brain growth argument before and it is based on mice! On the other hand other research in monkeys and rats have shown doses similar to those given to children cause brain cell atrophy, i.e. brain damage. I think that it is unlikely impairing brain development would improve brain development but who knows. Anyhow, this is all irrelevant, the sentence is cited to a peer reviewed secondary source and its deletion was uncalled for, so I reverted this deletion.--Literaturegeek | T@1k? 17:22, 10 August 2009 (UTC)

LG, the citation from Joshi appears to discuss the relationship between ADHD and growth. I can only find an extract, but it strongly implies that they are discussing growth in terms of height and weight, not neurological development or brain growth. Do you have another source demonstrating the effects of psychostimulant use on brain development? Perhaps I am mistaken, but the citation provided in this section appears to be for this article Am I correct? ~ Hyperion35 (talk) 20:49, 10 August 2009 (UTC)

From the Timmins study below "have been shown in animal studies to have brain-disabling effects (Moll et al, 2001; Sproson et al, 2001; Breggin, 2002)" --Doc James (talk · contribs · email) 21:17, 10 August 2009 (UTC)

Citing Peter Breggin?!?? The noted anti-psychiatry critic who never does scientific research, but is a great cherry picker of data. Using single studies on animals to come to the conclusion that therapeutic levels of stimulants disable brains and decrease brain growth?!??? The animal studies that I have seen on this issue relates to high levels of stimulants and addiction. Is this not an example of really going out a limb, to support an obviously biased viewpoint? Show us real support for these notions with links to government agencies. Does any respectable government agency, like NICE, state this?--scuro (talk) 13:20, 12 August 2009 (UTC)

I am going to try and track down the full text of the article Hyperion, just to make sure it is being interpreted properly. If I or others have misinterpreted it then we can delete it. I shall get back in a day or 2 to this.--Literaturegeek | T@1k? 10:28, 18 August 2009 (UTC)

EEG, a clinically proven therapy?

Unresolved

While there are studies and reviews that indicate the benefits of this treatment, a number of experts have said that the therapy does not have any clinical benefit. Dr. Silver comments, "...no research has shown that the theory behind the treatment or the treatment itself is effective for people with ADHD". [4] Russell Barkley states, "A variety of treatments have been attempted with ADHD children over the past century ‑‑ far too numerous to review here.13 Vestibular stimulation,14 running,15 EMG biofeedback and relaxation training,16 sensory integration training,17 EEG biofeedback or neuro-feedback,18 among others, have been described as potentially effective in either uncontrolled case reports, small series of case studies, or in some treatment vs. no-treatment comparisons, yet are lacking in well‑controlled experimental replications of their efficacy. Many dietary treatments, such as removal of additives, colorings, or sugar from the diet or addition of high doses of vitamins, minerals, or other “health food” supplements to the diet have proven very popular despite minimal or no scientific support.13,19 Certainly traditional psychotherapy and play therapy have not proven especially effective for ADHD or other externalizing disorders.20"[5]--scuro (talk) 16:56, 9 August 2009 (UTC)

One source is attitude magazine so is not a reliable source and the other source is a prominant doctor working for drug manufactures who market amphetamine based drugs to children basically arguing that only amphetamines work for children with ADHD. Hardly good sourrces to go deleting good secondary sourced material from wikipedia. There is some truth to what he says in the sense that there are all sorts of dubious treatments marketed by all sorts of alternative healthcare charlatains with weak, dubious or no support at all for not just ADHD but a range of other medical conditions. As far as EEG studies are concerned, it is notable enough for mention. It is sourced to secondary peer reviewed sources. The sources basically say it is a promising treatment from the available evidence and recommend larger clinical trials of it. It is not given undue weight. My stance is that the article shouldn't be reduced to only amphetamines work, everything else is fringe. We should follow what the peer reviewed literature says.--Literaturegeek | T@1k? 16:50, 10 August 2009 (UTC)

What can we agree to Literaturegeek? Surely you agree that Barkley and Silver are highly respected experts in the field of ADHD? You can not discount what they have said, and if you do want to exclude their opinion from the article you are going to have to link to the wiki policy, and back up your strong opinions with citations. The Barkley info would be an excellent secondary source. The one eeg link is a dead link. The other two are primary research done in Germany. Undue weight would go to the majority viewpoint of secondary sources. Cutting edge research could be mentioned if the studies are kosher.

Please also stick to content. It would be so appreciated!--scuro (talk) 23:18, 10 August 2009 (UTC)

I don't recall saying I was going to delete Barkley and Silver from ADHD articles on wiki? My only crime is to add meta-analysis and review articles to the ADHD articles. The German paper is actually a review article, so is a secondary source and is superior to your magazine citation and web page citation. I am glad you agree that secondary sources are superior. I did stick to content, when did I not?--Literaturegeek | T@1k? 16:01, 11 August 2009 (UTC)

Here are some textbooks on the issue.[6][7][8]Consider what is written, and let me know what you think.--scuro (talk) 20:57, 11 August 2009 (UTC)

Interesting books. They basically say that there are methodological weaknesses in the studies and more robust research is needed. I agree and I have referenced this with my latest edit to the article. Some of the books are before the latest review of the literature and according to the 2007 review "in recent years" scientific evidence has been increased in favour of EEG biofeedback for ADHD.--Literaturegeek | T@1k? 21:59, 11 August 2009 (UTC)

• Keep in mind if there are issues that are getting you stuck then consider one of the many noticeboards for community insight. Good luck. Nja²⁴⁷ 07:01, 12 August 2009 (UTC)

That is probably a good idea Nja247. What is the current majority opinion about this treatment? The reviews have polar opposite findings. For instance, Loo and Barkley noted that the quality of studies to date, "make interpretation of the results and conclusions about the actual effect of EEG biofeedback impossible. They noted the following shortcomings:

• Lack of control groups;
• Confounding variables: Treatments other than the one being studied may not be accounted for and could distort the results (an example would be a person with AD/HD who is taking medication to treat the condition and the investigators not accounting for the effects of the medication treatment);
• Small sample sizes;
• Uncertainty as to whether all the children in the studies were accurately diagnosed with AD/HD;
• Lack of placebo control procedures: The control group or another group was not subjected to a placebo treatment to determine if the actual outcome was a result of the treatment provided;
• Absence of "blinding" on the part of clinicians ("blinding" or "masking" keeps a clinician from knowing whether a particular individual is receiving the treatment being studied or placebo), which could cause the researchers to skew the results unintentionally;
• Lack of randomization in some studies (study subjects were not randomly assigned to control and experimental groups). Subjects or parents chose whether they wanted neurofeedback (usually at additional cost to them), and the financial, motivational, and other family resources that would allow such a choice may well select for those who would fare better anyhow regardless of treatment. This is a particular problem for the large study (Monastra) that otherwise would have been most convincing despite its lack of blinding;
• Lack of rigorous peer review.

They would seem to suggest that the studies and reviews to date were not of a high enough standard. When one looks in text books, experts in the field seem to agree with them. What wiki policy would help us here?--scuro (talk) 12:53, 12 August 2009 (UTC)

Something like "Various forms of biofeedback are being investigated as a treatment, but the published results are inconclusive; individuals claim to have been helped, but much more research is needed to move those individual reports into scientific conclusions." ? htom (talk) 13:05, 12 August 2009 (UT

I don't think that gives the full picture. "Inconclusive" usually means we just don't know yet. For instance one can state that our understanding of the mechanisms of ADHD are inconclusive, even though there is excellent research that has looked into this. What we have here are researchers who have pointed out major flaws in research to date, and don't believe that any solid conclusions can be drawn yet. I've added to this section of the article. Take a look and see if the section better describes majority and minority opinion.--scuro (talk) 15:06, 12 August 2009 (UTC)

Those points come from an older review in 2004 and there has been a lot more research done since then. The lack of blinding and control groups is still relevant and probably always will be relevant. Why not include that? I might include it myself as I think we can all get consensus on that.--Literaturegeek | T@1k? 10:46, 18 August 2009 (UTC)

hunter vrs farmer

Unresolved

Is this minority opinion or fringe? I've snipped a small sentence out of the synopsis that questioned the theory and placed that on the HF article page.--scuro (talk) 15:51, 5 August 2009 (UTC)

The Evolutionary approaches to depression is discussed on the Major depressive disorder page which is a featured article by the way. It than has its own sub page. The hunter vs farmer theory is sort of the same thing.--Doc James (talk · contribs · email) 10:10, 8 August 2009 (UTC)

Then you would see this as a minority opinion, or popular fringe opinion? Since it is a theory on a medical condition are there proponents in the field, or experts who support this theory?--scuro (talk) 14:20, 8 August 2009 (UTC)

WP:DISRUPT, asking questions you know the answer to and wearing people down.--Literaturegeek | T@1k? 17:25, 10 August 2009 (UTC)

I am confused as to how this is disruptive? Scuro asked whether this was a minority opinion, or a popular fringe opinion, and asked whether there are experts who support this theory. Quite frankly, I think that's probably a good question to ask about any sort of hypothesis or theory, and I also believe that it's pretty much Wikipedia policy to ask these questions. ~ Hyperion35 (talk) 20:04, 10 August 2009 (UTC)

I think it has to do with the fact that the refs in the article comment on this. Also for most ideas the research has not been done to figure out who supports and does not support different ideas. Therefore the fact that it is published in a journal has to be taken as sufficient evidence that it is a verifiable none fringe idea. The has also been brought up a number of times previously over the last few years.Doc James (talk · contribs · email) 20:23, 10 August 2009 (UTC)

James, we haven't even been editing the page for a year together, are you suggesting this issue is resolved because it was discussed several years ago? Looking at the ADHD article, are you referring to this study? [9] Hartman is a radio show host and author and former psycho-therapist. That background would fit for "populist fringe opinion". Are you suggesting that the researcher from the citation above may be minority opinion?--scuro (talk) 04:29, 11 August 2009 (UTC)

This ref belongs here: Williams J, Taylor E (2006). "The evolution of hyperactivity, impulsivity and cognitive diversity". J R Soc Interface. 3 (8): 399–413. doi:10.1098/rsif.2005.0102. PMC 1578754. PMID 16849269. {{cite journal}}: Unknown parameter |month= ignored (help)Doc James (talk · contribs · email) 02:11, 12 August 2009 (UTC)

By the way the evolutionary theories of which hunter farmer is one base there mechanism on genetics ( ie this is how evolution works ). Therefore moved to genetics sections.Doc James (talk · contribs · email) 02:26, 12 August 2009 (UTC)

You still haven't declared if TH is a fringe populist, and if the research in this field would make it majority, minority, or fringe opinion within this field of study. Do government agencies like NICE or NIH recognize this theory, or are we giving undue weight to a theory by noting the little research done on this issue and giving it far too much weight on the page. What is your opinion here?--scuro (talk) 13:31, 12 August 2009 (UTC)

I will say that I agree with the decision to move this into a "genetics" section, since that makes it clearer what is being discussed. Certainly there is ample scientific evidence OMIM for genetic involvement in ADHD. Am I correct in assuming that where the Hunter-Farmer theory branches off here is where it is looking at potential selective forces that might act on these differences? If so, then I think that Scuro raises an important question, and I might go a step further, if you're having difficulty finding references from the medical community, and check to see whether any mainstream anthropologists support this theory. Since most of the genetic studies listed at OMIM involve individuals who are heterozygous for these mutations, one major question that I would think would pop up from the get-go would be to ask why such a trait, if it conferred some specific benefit, would then exist in only a small percentage of the population. I'm not saying that sources have to address this question simply because I raise it, but rather I am just pointing out the sort of things to look for that a good source from the anthropology or genetics community would likely address. ~ Hyperion35 (talk) 19:51, 12 August 2009 (UTC)

Hunter-farmer is most often used as an easy to understand term for lay-people. I have read books years ago for the general public on ADHD by CHADD, a drug company funded organisation and they were pushing the hunter farmer theory or laymans explaination of ADHD. I can probably find the name of the book as I think that I still have it, somewhere,,,,... It is used in the literature as well. It is not fringe and has been quite widely diseminated. Refs have been provided for it. We should write articles aimed at the layperson anyway.--Literaturegeek | T@1k? 10:22, 18 August 2009 (UTC)

If we're going to include every lay explanation of ADHD, then why not just go with the old "they're just stupid and lazy" explanation. That was the "lay explanation" for a fairly long time. Similarly, the terms "lunacy" and "lunatic" stem from the lay explanation that mental illness was caused, or at least triggered, by the influence of the moon. Demonic possession and/or witches' curses were once lay explanations for epilepsy.

Have I made it clear as to why "lay explanations" are not always appropriate? I agree that there is ample scientific evidence for genetic factors in ADHD, but what I am concerned about is the lack of scientific research that indicates that this was due to selection factors encountered in pre-agricultural societies. Also, if you take a look at the DSM diagnostic criteria for ADHD, I am not aware of any evidence that an inability to maintain attentiveness, impulsive behavior, frequently losing objects, making careless errors, being easily distracted, and an inability to remain still would be beneficial in a hunter-gatherer setting. Now, I am certainly not up to date on the latest anthropological, paleoanthropological, and sociological research, so it is very possible that there are good reputable sources that can be cited that would demonstrate this. If so, please cite them. ~ Hyperion35 (talk) 16:12, 18 August 2009 (UTC)

Ok, reading through the Williams & Taylor paper provided by DocJames, I do see some very interesting information. It is most definitely heavily referenced and clearly well-researched. In fact, what I see is actually what I was asking for, ironically. The reason why I am surprised is because the conclusions of the paper do not seem to match the "lay" version of the Hunter-Farmer theory. In fact, it does not appear to be specifically about Hunter vs. Farmer or the transition to an agricultural society. Rather, it discusses why the ADHD genes do continue to spread in the population.

The authors discuss several hypotheses, and while I do find the hypothesis that the mutations responsible for ADHD persist because we go at it like rabbits amusing, as well as the hypothesis that ADHD makes men more attractive (which my girlfriend would almost certainly dispute), the authors conclude with:

"Probably, the most prevalent current view of the evolutionary status of ADHD is that it is a side-effect of alleles which usually help, but which in particular unfortunate combinations, or large numbers, cause individual impairment (Gangestad & Yeo 1997; Goldstein & Barkley 1998; Ding et al. 2002; Swanson et al. 2002). According to this view, ADHD is not the result of adaptive pressure for itself, but of adaptation for something else, i.e. a ‘maladaptive spandrel’ (Gould & Lewontin 1979; Andrews et al. 2002). The characteristic selected for is often presumed to be either a particular collection of individual traits (Sih et al. 2004)—or variety per se, which is independently selected for (Lloyd & Gould 1993)."

This is most definitely very different from Hartmann's Hunter-Farmer theory. They also make it clear that they are discussing whether ADHD-HI individuals (dunno if they would include ADHD-combined types who exhibit HI traits) are a benefit to society by, essentially, being expendable individuals who take risks, usually wind up becoming "Darwin Awards," but every so often discover something that benefits society as a whole, for instance by increased tendency to wander off and explore. What they are discussing is not whether ADHD is beneficial to the individual, but whether the benefit of having a number of individuals with ADHD-HI traits might be beneficial to society despite incurring a high cost to the individuals with those genetic mutations. Their hypothesis is that the negative symptoms of ADHD are a side-effect of the genetic mutations that confer those traits.

This is actually a rather interesting hypothesis. They also note that this would explain why a genetic mutation would persist in 5-10% of the population, despite obvious harmful effects to the individual.

One particularly interesting passage from the article discusses the relationship between certain ADHD symptoms and society as a whole:

"At a practical level, how could the children in a village benefit from having one or two children with ADHD–HI in their midst? The children with ADHD–HI do things they should not. They burn their hands on the stove. They eat poisonous berries and fall out of trees. They do not focus on their classwork, and they break the rules in games. All these physical and social mistakes provide useful lessons for the majority, while the majority remain safe. Much less often, but possibly also importantly, children with ADHD–HI discover something advantageous, that the other children would not. The reduction in ADHD–HI symptoms with increasing age (El Sayed et al. 2003) may have evolved because of the reducing likelihood that such disorganized experimentation would produce novel information, combined with the increasing cost of losing the individual."

I was ready to dismiss their computer models as just being models, but there is one interesting finding that jumped out at me. They ran a simulation in which they examined human groups with varying numbers of individuals who would act "unpredictably" in choosing food. There were two risks in choosing food, the risk of malnutrition from not having enough edible food, and the risk of poisoning by trying new food that was toxic. As I said, I was ready to dismiss this until I saw this finding:

"In figure 2, the highly unpredictable group acquires the most accurate knowledge of food quality (figure 2b), but does not use this information reliably, so its population falls the fastest, through poisoning (figure 2c). The highly predictable group has the least knowledge of food quality (figure 2b), but always eats the best food it knows, so tends to lose members more to malnutrition than to poisoning. The two mixed groups have intermediate knowledge of food quality (figure 2b), and most of their members eat the best foods they know. Of these two groups, the one with 5% unpredictable individuals survives best of all groups; this group has its level of exploration matched to the risks and benefits of the environment. The group with 25% unpredictable individuals has about the same survival rate as the predictable group."

I found it interesting that they found that the group with the best results was the group whose prevalence of individuals with "unpredictable behavior" (their way of accounting for ADHD traits in this model) was similar to the estimated prevalence of ADHD in society.

However, it is VERY important to note that the hypothesis here is much different from Hartmann's Hunter-Farmer hypothesis. This section would almost certainly need to be rewritten (as would the Hunter-Farmer article) and perhaps the name itself would need some changing. The hypothesis presented in this paper is essentially that certain genetic mutations such as DRD4-7R produced a number of behavioral changes in individuals. This minority of individuals essentially became a disposable but indispensable part of human society, in that the behaviors themselves were often very harmful to the individual, but may have benefitted society as a whole, so long as these particular mutations, and the accompanying behaviors, were confined to a small subset of the population.

As I said, this is very different from Hartmann's hypothesis. It is also...how can I say this...not exactly a happy bedtime story to tell the ADHD kids, trust me. "Back in the old days, you would have been eaten by a bear so that the rest of the people would know not to go into that cave" is not going to make people with ADHD feel better. This is likely why Hartmann and others prefer his more simplistic (and optimistic) lay explanation. However, Williams & Taylor's hypothesis that maladaptive traits in a small minority might have conferred a benefit on the overall population does appear to have much greater validity. ~ Hyperion35 (talk) 17:10, 18 August 2009 (UTC)

Yes as you see I changed the title of the section to evolutionary theories of ADHD. Hunter farmer is just the one well known in the lay person community but by far not the only one.--Doc James (talk · contribs · email) 19:25, 18 August 2009 (UTC)

Yes, and I agree that the Williams & Taylor paper is certainly more academically rigorous than Hartmann's. They cite references for most of their assertions and they tend to be fairly clear about what is their own conjecture and what they can actually cite. It certainly would deserve more weight than Hartmann's hypothesis. However, I note that the section in this article does not accurately reflect the information in the W&T paper at all. W&T's paper isn't really further evidence for Hartmann's Hunter-Farmer hypothesis. If anything, it is a fairly good rebuttal to Hartmann's hypothesis.

One option would be separating Hartmann's Hunter-Farmer hypothesis, and given that Hartmann himself stated that it was conjecture (read: mental masturbation), that really deserves at best maybe two sentences. Then perhaps rewrite the Evolutionary section around the hypothesis from the W&T paper.

On the other hand, it might make more sense to put this under the Genetic causes section. After all, the W&T paper pretty clearly supports a genetic cause for ADHD. All that W&T are discussing are the selective forces that resulted in these genes remaining in the population despite their maladaptive nature.

This brings up a related point: Looking at the Causes section of this article, do you really think that it represents current scientific thinking on this subject? Sure, we put Genetics first (and even that is fairly badly written), but it comprises maybe 1/6 of the section, and is given roughly the same amount of space as most other hypothetical causes. At first glance, this might sound reasonable, but remember that WP:UNDUE demands that we cover these causes according to the weight of their scientific evidence and acceptance within the scientific community.

I ran a PubMed search to see how much research has been published on each hypothetical cause. This is a crude method, but it should demonstrate my point:

ADHD AND Genetic: 1523 including 403 reviews

ADHD AND Hunter: 16 including 5 reviews (and note that several of the articles simply had an author named "Hunter")

ADHD AND Evolutionary: 23 including 12 reviews

ADHD AND Environmental:1080 including 264 reviews

ADHD AND Diet: 207 including 50 reviews

ADHD AND "Social Factors": 13 including 4 reviews

ADHD AND Neurodiversity: No Items Found

ADHD AND "Social Construct": No Items Found

ADHD AND "Low Arousal": 3, including 2 reviews

I'd argue that it makes sense to expand the Genetics part of the Causes section, include some info on W&Ts hypothesis in that Genetics section. Perhaps expand the Environmental section as well, although I'd withold judgement on that until looking at the evidence for specific environmental factors. As for the rest, there are more reviews of Genetic studies than there are total studies for any of these other causes. Of them, Diet has at least a respectable number of studies mentioning it, although it is worth noting that the NIH Consensus Statement, Barkley's International Consensus Statement, as well as the guidelines from NIH and NHS all mention Diet only to discount its significance.

So let's redo the Causes part of this article, by expanding the Genetics section and include evolutionary hypotheses such as W&T's paper within Genetics. Environmental factors and Diet factors ought to get their own sections, although I wouldn't devote much space to the Diet stuff. A paragraph titled "Others" or "Misc" that briefly mentions each of the remaining ones ought to suffice. After all, the ratio of ADHD persons to non-ADHD persons in the general population is greater than the ratio of all of the combined "other" studies to the number of genetic studies...just to put these numbers into perspective.

As it currently stands, the Causes section does not appear to accurately reflect the quantity of scientific research on each cause, nor does the amount of space given to each hypothetical cause accurately reflect the extent to which these causes have support within the scientific community. Thus I believe that WP:UNDUE requires changes to this section, as I have outlined above. ~ Hyperion35 (talk) 12:03, 19 August 2009 (UTC)