Talk:Attention deficit hyperactivity disorder/Archive 18

From WikiProjectMed
Jump to navigation Jump to search
Archive 15 Archive 16 Archive 17 Archive 18 Archive 19 Archive 20 → Archive 25

No Criticism section?

Why is there not a Criticism section? Isn't it obvious that ADHD is not actually a disorder, but instead is merely behavior that a child uses to express itself? It looks like the trend is simply to medicate and suppress the causes behind the behavior.

Was this article written by a drug industry lobbyist? —Preceding unsigned comment added by 171.64.75.60 (talk) 00:34, 16 September 2009 (UTC)

A section discussing this POV is at the bottom under controversies [1] Doc James (talk · contribs · email) 01:09, 16 September 2009 (UTC)
What the heck? I can tell you that ADHD is not a way for a child to express themselves. I have it, but I'm not a child. Abce2|This isnot a test
I would not worry too much about it, the majority of the medical literature regards ADHD as a valid disorder as noted in the lead (which I added), so the article due weight (WP:DUE) will always state (for the forseeable future anyway) that it is a widely recognised disorder with only a small note for the more minority view that it is personality trait, social construct etc.--Literaturegeek | T@1k? 04:42, 16 September 2009 (UTC)
The section discusses criticisms concerning ADHD almost none of it is related to denial of its existence. Most of it is very well referenced to the scientific literature.Doc James (talk · contribs · email) 06:05, 16 September 2009 (UTC)

Editing articles rather than talk pages

Scuro stated that "1962?!?? That is 47 years ago. Stimulants have to be one of the most studied drugs on this planet.--scuro (talk) 03:19, 16 September 2009 (UTC)" Numerous other points have been brought up in the past, like they are "rarely abused" and that they are "well studied" (yes in the short term). I have addressed these issues using review articles, systematic reviews and a meta-analysis of the literature. If you disagree please find agood quality secondary source.

What is the next problem that you would like addressed scuro?--Literaturegeek | T@1k? 04:24, 16 September 2009 (UTC)

I intend to use the best quality scientific literature available, review articles, meta-analysis, systematic reviews etc to resolve issues rather than endless POV back and forth original research opinions on talk page. I hope that you can join me in developing the encyclopedia.--Literaturegeek | T@1k? 04:34, 16 September 2009 (UTC)

There are many issues, including the unwarranted removal of material by yourself and others. Check the archives #12 -16. Undue weight issues and bias issues are marked with tags. If you want to move forward, start chronologically and reintroduce one topic at a time, that would be appreciated. --scuro (talk) 11:42, 16 September 2009 (UTC)

Best way then is to request the article becomes a Wiki Med Collaboration of the Week, as I disagree; that is not to say the article is perfect. Get lots of independent doctors and pharmacologists to look at it. My name has voted for the collaboration but your name remains absent.--Literaturegeek | T@1k? 17:54, 16 September 2009 (UTC)

Do you think it is impossible to take one issue at a time and have a meeting of the minds? That is what wikipedia calls true neutrality, when those who hold opposing viewpoints can agree upon something. Will you attempt that with me and anyone else who is interested, and if you won't, why not?--scuro (talk) 03:35, 17 September 2009 (UTC)

I have always been willing to discuss citations and find neutrality. You never provide citations which is the problem.--Literaturegeek | T@1k? 11:56, 17 September 2009 (UTC)

Removed "new research" from the "Controversy" section

I have reverted one change made by DocJames to the "Controversy" section at the end of the article. I felt that I should place a note here explaining why I chose to do so. The section that DocJames added, and that I removed, was this:

Researchers from McMaster University identified five features of ADHD that contribute to its controversial nature:

  1. It is a clinical diagnosis for which there are no laboratory or radiological confirmatory tests or specific physical features.
  2. Diagnostic criteria have changed frequently.
  3. There is no curative treatment, so long-term therapies are required.
  4. Therapy often includes stimulant drugs that are thought to have abuse potential.
  5. The rates of diagnosis and of treatment substantially differ across countries.

[1]


My reason for removing this is because it's not clear exactly why this applies to ADHD? Change the name of the drugs used, and this applies equally to any psychiatric condition. Replace stimulant with "painkillers" and it applies to almost any sort of peripheral neuropathy or joint or muscle injuries. For that matter, as I mention in another section, this applies to....I really don't feel like going back and looking at the list, but you can fill in just about any medical diagnosis and it fits at least 4 of these.

I mean, it appears to be a legitimate reference, but....it really doesn't seem to apply specifically to ADHD and simply reads like a list of generalized concerns about medical diagnoses as a whole. It you want to put it back, fine, but I have some serious reservations about this as being rather overly broad and not really relevant. Maybe the source goes into this in more depth as to why these are specifically controversial with regards to ADHD and not for other psychiatric diagnoses....or for that matter, hypertension or high cholesterol. If that is the case, that this source does discuss why these are specifically a problem with regards to ADHD, then perhaps it should be added. However, the original quote could be copied into almost any other health article, with only a minor change to the medication names, and it might equally apply. ~ Hyperion35 (talk) 10:02, 12 August 2009 (UTC)

I don't agree with this removal because it is important to define the controversy for the reader. Painkillers are not used for psychiatric disorders. Most psychiatric drugs do not have any appreciable abuse potential. The major differences between diagnosis rates in different countries even amongst western countries is fairly unique to ADHD.--Literaturegeek | T@1k? 11:07, 18 August 2009 (UTC)
The differences in diagnosis rates is likely due to differences in diagnostic criteria (DSM vs ICD), which is not mentioned. Also, many anti-anxiety medications do have appreciable abuse potential, and can result in physical dependence. So if you replace "stimulant" with "anxiolytic" and this "Controversy" would then apply to OCD, PTSD, Anxiety Disorder, Agoraphobia, and many other anziety-based disorders. Is OCD controversial? PTSD? Really? The US military is treating a lot of soldiers for PTSD, maybe you should write to DoD and the VA to let them know that this condition is "controversial."
And replace "stimulant" with "painkiller" and this list applies to migraines as well. Are migraines controversial? Sure, there are differing theories on their specific etiology, and as to whether there might be several different types with several different etiologies, although I'm not overly familiar with the research in that regard. So enlighten me, are migraines "controversial"?
This list...and let's face it, it's just a couple of bullet points without any real explanation, not even in the article itself...does not seem to be specific to ADHD. Replace a few words about the medications, and this list applies equally well to many other conditions that are not, to my knowledge, controversial. Please explain why this list applies specifically to ADHD. ~ Hyperion35 (talk) 14:32, 18 August 2009 (UTC)
Funny, when I ask Mr Google about whether PTSD is controversial, I get two million hits. So, um, yeah: PTSD diagnoses are controversial, and apparently all diagnoses that have these 'complexities', from ADHD to PTSD to chronic pain, are controversial. Evidence-based experts agree that these phenomena exist, and that in at least some instances they constitute a "disease" (instead of a desirable level of natural variation), but even experts don't agree that every single person labeled with these conditions has them (whereas, by contrast, there is no such controversy over biopsy-based cancer diagnoses), or what the most effective treatment is for any of them.
Note that this gives us a notable and obvious level of 'controversy' without considering the group of underinformed-and-noisy people that think all a kid with ADHD needs is automatic and violent punishment for any transgression of rules, or that PTSD is cured by making the affected person homeless and hungry (as an incentive to quit 'malingering'). WhatamIdoing (talk) 00:23, 20 September 2009 (UTC)
In a good article wikipedia should summarise the subject matter. If you have a ref for the differences between DSM and ICD why not cite it? Sedativee-hypnotic anxiolytics are not recommended for PTSD, OCD etc. :) Your arguments seem based on original research and I do not believe you have given good reason why we should not summarise the subject matter regarding controversies.

There are controversies regarding painkiller use for migraines (read up on medication overuse headache).--Literaturegeek | T@1k? 12:38, 20 August 2009 (UTC)


You're still dodging my main question: What about this list is specific to ADHD, aside from the mention of stimulant medication? This list was supposedly detailing reasons why ADHD is "controversial," and my point is that aside from the specific medications mentioned, it appears to be overly vague and does not appear relevant specifically for ADHD. I am focusing mostly on the list being vague and not obviously relevant. I could go over why few if any of the things mentioned on the list are themselves actually controversial, but that's a separate question.
Unfortunately, the article referenced does not really go into any detail as to why these items make ADHD controversial, it is simply presented as-is. ~ Hyperion35 (talk) 18:28, 20 August 2009 (UTC)
I just did, most psychiatric disorders don't involve the use of drugs with abuse potential. Your mention of sedative hypnotic anxiolytics is actually a very controversial treatment, particularly their long-term use. Rates of diagnosis differs significantly across countries, whether DSM or ICM differs, that is part of the controversy. Long-term use of amphetamine or amphetamine derived drugs in children is whether you agree or not part of the controveersy. It has been promoted by some as a neurological disorder but unlike other neurological disorders there are no physical tests for it. That makes it different than other neurological disorders. You have not put forward I feel a valid reason for why we should not define and summarise the subject matter just like what all other articles on wikipedia do.--Literaturegeek | T@1k? 18:18, 24 August 2009 (UTC)

(undent) The NIH Consensus Statement gives a much more thorough treatment of the issues of stimulant use. In fact, it mentions medication as being the primary controversy. I would prefer to reference the NIH Consensus Statement, as this statement details the reasons for controversy. Note that the source for the 5 bullet points does not go into any further detail as to why these are controversial, requiring us to either perform original research, or requiring us to cite another source like the NIH Consensus Statement. If we have to cite NIH anyways, it makes sense to just cite their statement.

I object to trying to use this list because it offers no other evidence from that source, simply these five statements. Of them, only the medication mention appears to be unique to ADHD. Certainly, the use of controlled substances is not common, but I am also unsure of how to explain their use as controversial when the FDA, NIH, NHS and others all conclude that they are the best treatment option. It would essentially require a statement to the effect of:

"Some individuals believe that the use of controlled substance medication to treat this disorder is controversial. Others, such as every major medical organization in the developed world, agree that these medications are the most effective treatment."

Again, please refer to the NIH Consensus Statement for a much more in-depth analysis of the controversies regarding medication use. They give a far more nuanced explanation, discussing the lack of long-term studies. Saying "amphetamines are controversial" over and over again does not make it true..and in any event, Wikipedia is not concerned with "truth" but rather verifiability. ~ Hyperion35 (talk) 23:29, 24 August 2009 (UTC)

Thank you for your well put response; I can reach consensus with this. The NIH is a much more balanced review of the controversy and they eliminated a lot of COI issues. I can't comment on the mcmaster paper as I don't have access to full text but as you put forth a well put response I can agree. Anyway the controveersy section is only meant to be a brief overview of the main points and not indepth. I still think that there is over-quoting, one sentence or statement is ok but not big chunks out of the paper.--Literaturegeek | T@1k? 23:45, 24 August 2009 (UTC)
The McMaster Statements pertain just as significantly to the controversy section as the NIH statement. The McMaster statements should be re added. This statement is about ADHD not painkillers therefore it is exceeding relevant. It was published in a respected peer reviewed journal by a respect group of researchers. It is a published paper on why ADHD is controversial which is exactly the topic at hand.Doc James (talk · contribs · email) 00:24, 16 September 2009 (UTC)


James, if you read the McMaster paper, you will note that they simply assert that these five things make ADHD controversial. They do not actually explain why these five items are controversial. Moreover, they do not even bother explaining why these items apply specifically to ADHD. It is a single article, one published article. On the other hand, we have the NIH consensus statement, based upon their review of a vast body of evidence, that the only real controversy with regards to ADHD is that there are not many studies on the long-term use of these medications (although it is important to note that these medications have been used for decades to treat this disorder). And then there's Barkley's Consensus Statement, which was signed by many of the foremost researchers in the field. I doubt that the combined number of publications of every single faculty member at McMaster is even a quarter that of Faraone alone, for example.
So on the one hand, we have one published article that asserts, without going into any more detail, that these five reasons make ADHD controversial. On the other hand, we have a Consensus Statement published by NIH that states that the only controversy is that there are not enough long-term studies on these medications, and yet another Consensus Statement, this one signed by many of the leading researchers in the field, that goes even further and categorically states that "controversies" over the disorder or the use of medications are pretty much all rubbish.
So do you want to go with:
"Several researchers from McMaster University state that ADHD is controversial for these reasons. On the other hand, one of the world's most prominent public research institutions, NIH, reviewed a much larger pool of data and issued a Consensus Statement saying that ADHD is not controversial, aside from the need for more research into long-term medication use. A similar statement written by Dr. Barkley, and signed by many other prominent researchers in the field, also concluded that there was no real controversy as to the existence, diagnosis methods, or treatment of this disorder within the mainstream medical community."
I mean, that's probably a good description of the disagreement here. On the one hand, we have this list of bullet points. On the other hand, we've got these Consensus Statements that represent the views of the medical community based upon a much more rigorous examination of the evidence involved. Sure, we can mention both views, but it would be ridiculous to claim that they were both equally valid. This is an encyclopedic article, not a forum for every single viewpoint and every single study ever conducted, especially when we have better sources. And at the end of the day, NIH and Barkley cite their work and back up their statements. I'm not seeing anything in the McMaster paper that goes into any depth about this list. They just wrote down a few suppositions about why they thought some people found ADHD controversial in their introduction. Seriously, please, read the McMaster study again if you don't believe me. Unfortunately, I cannot prove a negative here, I cannot "prove" that the McMaster study doesn't go into any more depth about this list, so if I have missed the part of the McMaster paper where they go into depth as to why these things make ADHD controversial, then please correct me. However, it appears to me that the McMaster paper simply put a list in the article and just sort of left it hanging there. I honestly don't care why you or LG or the Dean of McMaster University and their entire Board believes that these things are controversial...what I care about is how on Earth I can go and verify that these things are controversial, because the authors of the McMaster study did not seem to bother to do that themselves. ~ Hyperion35 (talk) 23:34, 17 September 2009 (UTC)
Reliable sources are not required to provide reliable sources to prove their assertions correct. If it's a reliable source -- and I believe we all agree that it is -- then you must accept their statements as being essentially correct. "I disagree with this statement, so they have to prove that they know more about this subject than I do" is not acceptable. WhatamIdoing (talk) 00:31, 20 September 2009 (UTC)
They state what they did "The Agency for Health Care Policy and Research charged the McMaster Evidence-based Practice Center with conducting a comprehensive systematic review of the literature on the treatment of attention-deficit hyperactivity disorder (ADHD), with input from various groups of stakeholders. One strategy used to avoid duplication of work included a critical appraisal of existing systematic reviews and metaanalyses." They reference the conclusions about the controversial nature: 1. American Academy of Child and Adolescent Psychiatry. Practice parameters for the assessment and treatment of children, adolescents and adults with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 1997;36(Suppl 10):85S–121S. 2. Goldman LS, Genel M, Bezman RJ, and Slanetz PJ. Diagnosis and treatment of attention-deficit/hyperactivity disorder in children and adolescents. JAMA 1998;279:1100–1107. 6. Kewley GD. Personal paper: attention deficit hyperactivity disorder is underdiagnosed and undertreated in Britain. BMJ 1998;316:1594–6. 7. Orford E. Commentary: diagnosis needs tightening. BMJ 1998;316:1594–6.
We do have a couple of replies to Barkleys paper. PMID 12557837 and PMID 15119688 Doc James (talk · contribs · email) 00:05, 18 September 2009 (UTC)

Here are some of Dr. Faraone conflicts of interest. He receives research support from, is on the speakers' bureaus of, and has had an advisory or consulting relationship with McNeil Pediatrics and Shire Laboratories; he has also had an advisory or consulting relationship with Novartis and Eli Lilly. DOI: 10.1097/chi.0b013e31815d6dba It is also hard to say how many of his papers were ghost written See medical ghostwriter. This is only to say that just because one side has a better PR campaign does not mean that the other side should be ignored and given no weight at all. I am not saying that the research of either Barkley or Faraone cannot be used just that a little more skepticism might be helpful. ADHD meds are a multi billion dollar industry. The companies that make ADHD drugs have been found editing pages on their own medication on Wikipedia. A two year study on about 600 children funded by the pharmaceutical industry does not close the debate and it does not make further research on the topic unethical not matter how much you would wish it did.Doc James (talk · contribs · email) 00:52, 18 September 2009 (UTC)


James, is there a point to this, other than to cast aspersions on one of the most cited authors in all of psychiatry? I honestly don't give a shit how much money drug companies make, nor do I care whether they edit pages on Wikipedia. Also, if you're referring to the MTA study, that one was funded by NIH, a government institution.
I would really appreciate it if you could stay on-topic. My problem with that list is that the study that you cite does not expand upon that list. It simply gives us five bullet points. It does not go into any more depth as to why these things are controversial. As such, it's pointless, and I'm removing it again. I have asked you repeatedly to explain why this list is relevant, and "the other side should not be ignored" is not an answer. ~ Hyperion35 (talk) 09:23, 19 September 2009 (UTC)
Hyperion I must congratulate you on this edit,[2] hopefully we can see more of the same? "Battling" with references is how we will resolve these disputes rather than going back and forth arguing. I do not believe that this edit however, was constructive,[3] as you are currently in dispute about it and have not reached consensus. Shall give you a chance to respond.--Literaturegeek | T@1k? 13:10, 19 September 2009 (UTC)
Why it is relevant is pretty obvious. The paper is peer reviewed. Is specifically about ADHD. Was conducted by a center famous for evidence based medicine after an extensive review of the literature. Will ask for some outside input.Doc James (talk · contribs · email) 17:47, 19 September 2009 (UTC)

(Undent) Hyperion, you seem to be looking for a statement of why ADHD is a uniquely controversial subject, instead of merely why ADHD diagnoses and treatment are controversial.

Problem: ADHD isn't uniquely controversial. Other conditions exist that share the same, or highly similar, problems.

This article isn't supposed to be limited to what's unique to ADHD; it's supposed to cover the entire subject, including those parts that are shared by other medical and non-medical conditions. WhatamIdoing (talk) 00:27, 20 September 2009 (UTC)

LG, there was consensus between you and I that this source was probably not as good as other sources such as NIH. Furthermore, when asked about why the study should be included, DocJames responded with vague statements about "all sides should be heard," and fairly irrelevant accusations about drug company conspiracies. You mention that I should not have removed it while it was being debated, but you ignore the fact that it was re-added by DocJames during that same period that it was being debated, when there was equally no consensus...in fact, if anything there was consensus that it was right to have been removed.
WhatamI, you raise two questions, so I will respond to them one by one. First you mention that reliable sources are not required to cite their sources to prove their assertions. Actually, that is part of the definition of a reliable source, but this is only tangential to my concerns. My concern is that the source itself gives this list, and then goes on to discuss other topics. If the source had given this list, and then gone on to explain what they meant by this list, then I would be more willing to use the list. As it stands, the list appears to be only a small part of this source.
My second concern is that I am not sure what this list adds to the "Controversy" section. It lists reasons why someone might consider the disorder controversial, but it does not actually illuminate areas where there is controversy within the medical community. As for "uniqueness," I think that you are again misunderstanding my concerns. When I say that other conditions share these qualities, I am not referring to one or two other conditions. Most of these items, with the exception of the medication, appear to apply equally to all psychiatric conditions, and to a very large number of other conditions as well. Some, such as changing diagnostic criteria, apply to virtually every medical condition known to man. For this reason, the list is extremely vague, and the source does not do anything to disambiguate this. Ironically enough, this source states that they specifically excluded a number of reviews from their research because those reviews were not specifically focused on ADHD.
And finally, I would like to once again reiterate that we have far more detailed consensus statements from NIH and from leading researchers in the field, which discuss "controversies." These sources are both more comprehensive, and they do not appear to support most of this list, with the exception of concerns over long-term studies on medications. ~ Hyperion35 (talk) 03:20, 20 September 2009 (UTC)
Another issue is that, if we're comparing ADD to an anxiety disorder; with an anxiety disorder the subject has to believe that the anxiety is out of place. That's what makes it a disorder. With ADD, it may be parents or teachers who believe that the child's behavior is out of place. It's easier to argue for treatment when the treatment is sought by the subject than when it is imposed on him by authority figures. —Preceding unsigned comment added by Wiserd911 (talk • contribs) 05:18, 25 November 2009 (UTC)

Signs vs. Symptoms

There's a medical vocabulary distinction here; the two words are not strictly synonyms. Signs are what the medical practitioner observes, symptoms are what the patient reports to the practitioner. "I'm bleeding from this cut on my arm" is a symptom; "The patient is bleeding from a cut on her arm" is a sign. At least as I understand it, I'm not a medical practitioner. Please let's not have an edit war changing them universally back and forth. htom (talk) 18:31, 16 September 2009 (UTC)

Hi, htom. I don't have strong views one way or the other but are articles not meant to be written for the lay person as well? Most other articles would use the word symptoms I think? Maybe I am wrong. Might be worth asking the folk over at wiki med if this is disputed. :)--Literaturegeek | T@1k? 22:02, 16 September 2009 (UTC)
Isn't JMH under an editing restriction? He has now reverted by adding the McMaster study back in (despite discussion on the talk page against it, and then gone on to revert this change, which everyone seemed happy with. Again both without explaining himself on the talk page. Wasn't he limited to one revert a week or is that over now in order to prevent this type of edit war?--Vannin (talk) 14:03, 17 September 2009 (UTC)
It is one revert per week Vannin. Anyway I re added it in a slightly different format, have discussed it further on talk, and one week has passed. The second change was obvious vandalism. An IP changed all the "symptoms" to "signs" without discussion. This is not how it is referred to in the scientific literature. I am not restricted from reverting vandalism.
Now I know psychologist have a vendetta again me for my involvement in the Rorschach test and that you admit to being a psychologist does this contribute to your comments here.?
Have reverted back to this anon edit [4] as you state "everyone seemed happy with". It however does go against the woring of emedicine.com , uptodate.com , and the DSMIV TR Doc James (talk · contribs · email) 16:31, 17 September 2009 (UTC)
When have I "admitted to being a psychologist?". I am talking about the ADHD page here, and not about anything else, other than your editing restrictions. Let's stick to the subject at hand, shall we?--Vannin (talk) 17:31, 17 September 2009 (UTC)
During the Rorschach discussion. Do not feel inclined to find it now. Now back to the matter at hand you have stated that "everyone seemed happy with" the change of symptoms to signs through out the text. This change supported by no evidence from the scientific literature ( I have provided a number of sources above ). I consider this obvious vandalism.Doc James (talk · contribs · email) 17:38, 17 September 2009 (UTC)
A while back you accused me of making derogatory comments about a university, which I had not done. Similarly, you now claim I have said something I have not. You will not find that link, so no point in looking.--Vannin (talk) 18:07, 17 September 2009 (UTC)
Any comments on the issue at hand? Any evidence that I reverted any thing other than vandalism or to justify your comments above? You are correct I did mistake Scuro for you when comments were made regarding one of my Universities. I gave you an apology for getting the two of you confused. Doc James (talk · contribs · email) 18:12, 17 September 2009 (UTC)
I have two doctors in my house right now. I shall ask them their opinion and then form an opinion one way or the other. Busy at the moment though.--Literaturegeek | T@1k? 17:59, 17 September 2009 (UTC)
I spoke to 3 doctors about this. Signs are what doctors look for if they are doing a clinical examination. Symptoms are what are experienced or described by the patient. As a result I think that symptoms is the appropriate word for this encylopedia article as it is an article aimed at the general reader. If it was aimed at the clinician and was about how to diagnose ADHD then it would be signs. I think that it should be changed back to symptoms.--Literaturegeek | T@1k? 06:10, 23 September 2009 (UTC)


(undent)I agree that symptoms probably makes sense for the purpose of the article. I believe that the DSM-IV-TR also uses the word "symptoms" as well. While DSM section of this article uses the word "signs," the source given, which excerpts from the (copyrighted) DSM text, uses the word "symptoms." So I agree that "symptoms" is the better word to use. Additionally, using the word "symptoms" may help clarify for the reader the fact that the symptoms associated with ADHD are intended to be above and beyond the everyday levels of inattention and impulsive behavior that non-ADHD people might experience occasionally, and that they are intended to apply to situations involving actual impairment of function.

"Symptoms" makes the most sense based on the DSM-IV-TR text and in light of LiteratureGeek's comments. ~ Hyperion35 (talk) 14:53, 23 September 2009 (UTC)

Is ADHD controversial?

Well we are back to this question again. Some feel that because Barkley found ADHD not controversial in 2001 than this must be so. However others disagree and have had their disagreement published in respected journals since the above publication. To list a few:

One can produce whole lists of recent papers (2007 - 2009) which deal with the controversy. I could keep going but I think their is sufficient evidence to prove that some within the scientific community find ADHD controversial. I have not come across much research stating the exact number of people who find it controversial but it is substantial. Barkley could not have taken these papers into account when he published his consensus more than 5 years ago. I am sure that the money he receives from the makers of drugs for ADHD does not affect his opinion or research. Wait all the research actually shows it does effect research and opinions. Doc James (talk · contribs · email) 00:35, 18 September 2009 (UTC)

I would say that it is not the disorder itself that is controversial, but the treatment. And by the treatment is controversial, quite frankly, I mean it's controversial to a bunch of people and/or scientologists who either don't believe that ADHD is a legitimate disorder, claim that there is "great risk" of death while studies only document such a risk in patients with heart defects, or, even better, people who think ADHD can one: be cured, and two: be cured "naturally." Just look at the adsense listings for any site that ever mentions ADHD.
On a serious note, I would say that among the medical community, the disorder itself is not a controversial issue, and since the treatment is not directly related to this article, I would have nothing against removing the controversial tag or any claims that the disorder itself is controversial.--Unionhawk Talk E-mail Review 01:22, 18 September 2009 (UTC)
The FDA's Drug Safety and Risk Management Advisory Committee in 2006 voted 8-7 in favor of adding a black box warning to the label of ADHD drugs to raise awareness that cases of sudden death and nonfatal cardiovascular events have been reported in children and adults on these drugs. This did not happen of course but I think it makes it clear that more then just fringe members of the scientific community have concerns. http://download.journals.elsevierhealth.com/pdfs/journals/0031-398X/PIIS0031398X06709031.pdf Doc James (talk · contribs · email) 01:52, 18 September 2009 (UTC)
Edit conflict:
I feel that you hopped over a step, UH. "I would say that it is not the disorder itself that is controversial, but the treatment." Many physicians and others who do believe that ADHD is a legitimate disorder, feel that many, a majority even, of diagnosed cases shouldn't have that diagnosis. That's a controversy right there, before one even starts discussing treatment. - Hordaland (talk) 01:58, 18 September 2009 (UTC)
I would agree with Hordaland very few within the medical community would say ADHD does not exists but the literature is full of question over were the line between normal and abnormal should be drawn. There are concerns for example that what determines diagnosis and treatment is more the push of your teachers and parents than the severity of your symptoms. There are concerns voiced by many that some of the people who need treatment most are not getting it because of much of the resources are being used by borderline cases with pushy parents. This opinion is very well referenced and discussed in this book. http://books.google.ca/books?hl=en&lr=&id=drBejRLWkHkC&oi=fnd&pg=PR6&dq=ADHD+controversies&ots=CeU6hnDoSo&sig=zmXtlwjzGEgRFYL_XGVzUUmSDmc#v=onepage&q=ADHD%20controversies&f=false This book was reviewed by Barkleys among others before publication. And than who should be treated and with what is also discussed extensively as well is the safety of treatment especially in adults with a higher rate of co morbid cardiovascular disease.Doc James (talk · contribs · email) 02:12, 18 September 2009 (UTC)
UH you state that "among the medical community, the disorder itself is not a controversial issue". I have started a list of article which would disagree with this opinion all from the medical community. Lumping everyone who disagree with Scientology does not get use any father ahead. User:Jmh649/List of studies which find ADHD controversialDoc James (talk · contribs · email) 02:54, 18 September 2009 (UTC)
I think that UH is refering to its existance at all, there is not much controversy in the medical community. Most doctors accept it as a diagnosable disorder, there are certainly real and serious controversies over overdiagnosing, where to draw the line between personality traits and when it reaches the stage of disorder. there is controversies with the DSM (very subjective [flash backs of rorschach lol?]) and ICD (less subjective). This article sums up the controversy regarding ADHD quite well.[5] Ref does say that it is a "minority" of psychologists and psychiatrists who question its existance.--Literaturegeek | T@1k? 09:26, 18 September 2009 (UTC)

(←) Yeah, there is some controversy as to the existence of the disorder among the medical community, but the number that don't believe that it's an actual disorder is minority at best, even perhaps negligible. I would say that there are basically 3 groups of people: people who believe ADHD is a real disorder that can and should be treated, people who believe that ADHD is a real disorder that either can't or shouldn't be treated, and people who do not believe that ADHD is a real disorder at all.--Unionhawk Talk E-mail Review 12:01, 18 September 2009 (UTC)


James, I'm going through your sources that you've just cited, but could you perhaps be a bit more specific about what you're citing them for? For example, perhaps you could explain what you mean by "controversial." For example, your first source is pretty clear about the validity of ADHD as a disorder and the efficacy of medication treatment. In fact, the author bemoans the fact that many children are not given access to medication. There is a "Controversy" section, of which the vast majority of citations are for Szasz and Timimi. In fact, lemme quote you the first paragraph of the "Controversy" section of that paper, so that you can appreciate the true absurdity that is Szasz's belief system:
"Psychiatry is part law and part medicine. It is the psychiatrist's social mandate to function as a double agent: that is, to help voluntary patients cope with their problems in living and to help relatives and society rid themselves of certain unwanted persons, under medical auspices. The latter task requires coercing the denominated patient; the former is rendered impossible by the slightest threat of coercion, much less its actual exercise. (Szasz, 2003)"
But the thing is, it actually then goes even further off the deep end from here. No seriously, the authors turn to Focault, a frikkin' philosopher who is often considered to be a founding father (along with Szasz) of the anti-psychiatry movement. If I start quoting the rest here, it'll take too long, but go read through it. Not only does it not really make much of a case for controversy, but it kinda reinforces the idea that the people who think that ADHD (and psychiatric conditions in general) are "controversial" tend to sound like raving loons. Ok, I realize that might sound a bit harsh, so I'll back it up with one more quote from that paper:
"In the case of the diagnosis and treatment of ADHD, we see a dramatic extension of discipline beyond the surface body, into the very physiology of the child. In the pre-20th century schools and institutions described in Foucault's account, many of the children would have been selected into, or at least not selected out of, the student body. It is likely that the military-style discipline described in those accounts was effective in a more homogenous classroom. In current liberal societies with aims of universal and compulsory education, however, the gates are thrown open. The hyperactive child, the disinterested or distracted soul, the one who "disturbs other children" (or the teacher) with "fidgeting" and "outbursts," will need to be dealt with in both quicker and more subtle fashion, if they cannot simply be excluded permanently from the room. Where traditional discipline fails, stimulants may lead us to the docile body."
I'm not sure which is worse, the implication that the diagnosis of ADHD exists to control children, or the implication that things were better back in the days when kids with ADHD were just kicked out of the classroom and sent to schools for juvenile delinquents. However, the author is largely trying to summarize the views of guys like Szasz and Focault and Timimi, and I suppose it's hard to do that without sounding a bit crazy. Interestingly enough, though, the authors of that first paper you cite conclude thusly:


"Though presented as controversial in media expositions, ADHD, when correctly diagnosed, arguably meets criteria for being a valid medical disorder (Biederman and Faraone, 2005; Faraone, 2005). As noted above, cross-cultural studies are able to identify ADHD cases outside United States, Canada, and the liberal first-world democracies of Europe (Reid et al., 1998; Yang, Schaller, and Parker, 2000; Rohde et al., 2005), and prevalence is similar worldwide (Faraone et al., 2003). Furthermore, although individual patients may respond in various ways to particular medications or dosage levels, this probably speaks more to the overall etiological heterogeneity and complexity of ADHD than to a fundamental issue of validity. In fact, viewed on a large scale, stimulant medication has a fairly predictable affect in reducing hyperactivity, impulsivity, and inattentiveness and is one of the most efficacious classes of medication used in psychiatry. Furthermore, a concern commonly expressed by some ADHD researchers with the use of stimulants is that the dosages prescribed and/or actually administered can be too small to be of therapeutic benefit or that use of medication drops or stops completely over time in individual patients. Although ADHD frequently is comorbid (co-occurs) with other mental illnesses such as conduct disorder, oppositional defiance disorder, bipolar disorder, and generalized learning disabilities, its symptoms are demonstrably separable from these other phenomena (Biederman and Faraone, 2005; Faraone, 2005). Finally, there is a good deal of evidence for a substantial genetic component in the etiology of ADHD (Faraone et al., 2005). Where critics have sought to use discrepancies in epidemiological rates, the lack of any "cognitive, metabolic, or neurological markers for ADHD," cross-cultural discrepancies, comorbidity with other illnesses, and so forth, to question the very existence of a coherent concept of ADHD (Timimi et al., 2004), such issues may merely point to the difficulty in firmly establishing nosological definitions of complex illnesses."
I'll look over the rest of your citations later. I would strongly suggest that you do the same, James. The second paper that you cite, for example, actually appears to debunk the notion that ADHD is actually controversial...and certainly the NICE guidelines are fairly similar to NIH's. So as I said, read them, understand what they're saying, and it will begin to make sense as to why, as I have stated before, virtually every medical organization in the developed world agrees that ADHD isn't very controversial. ~ Hyperion35 (talk) 12:33, 18 September 2009 (UTC)
(re LG @ FDA 8-7 on black box) Oh. I thought it was like, a no-questions at all thing. Maybe the treatment is more controversial than I once thought...--Unionhawk Talk E-mail Review 12:45, 18 September 2009 (UTC)
Hyperion, the refs acknowledge the existance of a controversy and the point is that there is controversy amongst a minority of doctors as to the existance of ADHD. The lead of this wiki article on ADHD clearly states that the disorder called ADHD is accepted by the majority of doctors. This article clearly reflects these facts. What is it that you want, that all controversy is removed from the article? An encyclopedia reports the facts and I am here to defend the facts.--Literaturegeek | T@1k? 12:48, 18 September 2009 (UTC)


James, perhaps my morning Vyvanse is kicking in slower than I'd thought, but could you please be a bit clearer about what your overall point is here? I don't think that anyone is saying that there are no physicians who believe that ADHD is controversial. Similarly, there are physicians who refuse to accept that HIV causes AIDS, and idiots like Patch Adams claim that SSRIs are unnecessary because all depressed patients need is a big warm hug. Yes, there are dumb physicians out there, and contrary to the stereotypes, they're not all surgeons(I know, bad joke).
And again, I would like to reiterate that it is important to be specific about what is meant by the term "Controversy." The Intelligent Design nutjobs would have you believe that there is "controversy" over the Theory of Evolution, for example. Granted, pretty much the entirety of that controversy is manufactured by said nutjobs, but my point is twofold: one is that if you dig deep enough, you can always find someone willing to claim that any widely-accepted valid scientific concept is "controversial." What is important is the degree to which the scientific community takes such controversies seriously. The other is that it really does depend on what you mean when you use the word "controversy." Do you mean controversy over the disorder's validity? Pretty much nonexistent. Controversy over whether stimulants are effective treatment? Hah. Controversy over whether it's better to use a higher dose to control symptoms better at the risk of greater side effects (my personal preference as a patient), or use a lower dose that may be less effective but might have fewer side effects? Well, that might actually a matter of some debate, depending on whom you ask.
My point is, I'm trying to figure out what is controversial. Just saying "look, this paper uses the word 'controversy'" isn't really helpful. Not helpful to me in terms of trying to understand your concerns, nor is it particularly helpful in terms of putting together an encyclopedia article. ~ Hyperion35 (talk) 13:38, 18 September 2009 (UTC)
You have just characterised over half of the American medical profession as nutjobs as I read survey where more than 50% did not believe in evolution (it was published in medscape), uhoh where does that leave the ADHD controversy then if most doctors are nutjobs? On a more serious point though we do not reference only what is the so called "scientific truth", for to do that we would need to install on wikipedia a majority rule scientific dictatorial panel to "enforce" the "majority" "truth". Wikipedia is quite libertarian and we simply report verifiable facts and viewpoints which reach the threshold of notability (excluding fringe theories as defined by wikipedia policy]. Please also don't soap box on talk pages.WP:SOAP--Literaturegeek | T@1k? 14:11, 18 September 2009 (UTC)
Akkk, definitely falling asleep this morning, confusing James and LG. Sorry about that. ~ Hyperion35 (talk) 13:41, 18 September 2009 (UTC)
The point is hyperion that nearly everyone recognizes that there is a controversy and only a few deny the existence of a controversy about ADHD. In 1999 the Us Departement of Health and Human Services Said "ADHD has been surrounded by great controversy involving clinicians, teachers, policymakers, parents, and the media. The range of opinion regarding the validity of ADHD extends from those who do not believe it exists and regard it as a myth, to those who believe that there is genetic and physiological evidence supporting its existence." Now there was mention that maybe that applied in the year 1999 but that this is ancient history and therefore does not belong in the article. This is way I am collecting more refs. People on both sides recognize the controversy which is why they mention it. They than either provide evidence for or against the point being discussed. It there was no controversy as some try to make out than the literature would not even mention it. Medicating Children: ADHD and Pediatric Mental Health By Rick Mayes, Catherine Bagwell, Jennifer L. Erkulwater discusses the issue in length and would recommend it.Doc James (talk · contribs · email) 16:08, 18 September 2009 (UTC)

Just did a minor copy edit to the "controversy" section. I think we could probably have arguments for controversy about virtually any topic where the scientific method is used. There is always data for and against. It is the quality of the data that is important. The quality of data do not depend on quality of arguments nor on there being published expert reviews or opinions about the subject. In this case, as a reader, it looks like the controversy is not about the existence of the disorder, maybe a little about the cause, but there are 2 controversies: First the diagnosis may be too broadly applied to people who don't have it, and Second, the nature of treatment - appears to emphasize drugs. Maybe the controversy section could/should say this more clearly. I'll probably bow out at this point, just came across the article and found it interesting. --Fremte (talk) 18:15, 18 September 2009 (UTC)

Thanks for the feedback Frem and largely agree that the main thrust of the controversy surrounds how it is treated as well as how and to what level it is or should be diagnosed. I agree that the controversy section should focus more on this.--Literaturegeek | T@1k? 18:38, 18 September 2009 (UTC)
Just a reminder that there need not be any scientific issue to be settled for something to be controversial: we have vaccine controversy, thimerosal controversy, evolution-creation controversy, and so forth. If underinformed lay people make a public stink about ADHD, then there's a controversy about ADHD -- even if the 'experts' provide an unbroken, monolithic defense (which they don't). WhatamIdoing (talk) 00:49, 20 September 2009 (UTC)
Very true. By that standard (which is probably a good standard), then, yeah, ADHD is controversial. I don't know how many adsense hits I've seen saying something along the lines that ADHD doesn't exist or shouldn't be treated.--Unionhawk Talk E-mail Review 01:02, 20 September 2009 (UTC)
WhatamI, I really do not think that such discredited ideas as thimerosol controversies and creationism are necessarily helping the case here. But leaving that aside, you will note that with those subjects, there is at least some definition of what is specifically controversial about those particular issues. As Frem mentions, you can find controversy in just about anything, but it is far more important to note what the parts are considered controversial. So far, what we have are papers that use the term "controversy," but when I have asked, repeatedly, for DocJames to specify what is controversial about ADHD, the response continues to be "here are papers that mention the word 'controversy.'"
If we're going to mention controversy (and quite frankly, I think that many "controversies" over ADHD are roughly as scientifically rigorous as the thimerosol crap and creationism), then it would help to pin down what is actually controversial. I do not think that it is much of a stretch to claim that an encyclopedic article should strive to be precise, no? So then what precisely is controversial? In fact, if the standard for controversy is simply that uninformed laypeople raise a stink, then this increases the need to be precise when discussing any perceived "controversy," as well as raising some very serious questions about ensuring that mention of controversy actually reflects the due weight of available sources.
I would prefer to think that there is a higher standard for a subject being "controversial" than merely the fact that lay people raise a stink about it. Otherwise we are going to have to put "controversy" sections into almost every article on Wikipedia. For example, there are uninformed laypeople who refuse to believe in the germ theory of disease, so every article about infectious diseases would need to have a controversy section. And articles about antibiotic drugs need a section discussing the controversy from the point of faith healers. The NASA article needs a controversy section to point out the Flat Earth view. Every article that references an event more than 10,000 years ago needs a controversy section because young-earth creationists find it controversial. And of course, any article that references reasonably-expected future events (ie the 2038 problem with Unix, buildings currently under construction) needs to have a controversy section noting that some people believe that the Mayan calendar predicts the end of the world in 2012. And every political and government oriented article will need a controversy section discussing the true one-world government run by the Illuminati and the Freemasons and...ok, seriously, this is making my head hurt. Sadly, however, there are real people who believe these things.
Now, obviously I am being facetious. Obviously I am making an argument reductio ad absurdium. But I do hope that you will consider that there is a point at which a given controversial position becomes irrelevant for an article. There are issues that can reasonably be discussed, such as concerns over medication and differences in diagnosis rates. In fact, there are even good reliable sources that discuss these issues in depth.
So in conclusion, I am still wondering what the point of this particular talk section is? We have an article titled ADHD Controversies, and we have a section in this article titled "Controversies." DocJames started this section by asking whether ADHD was controversial, but without defining that question any further, it really adds nothing to the article other than to create a fairly pointless argument. Instead of repeatedly asserting that "ADHD is controversial" and linking to articles that use the word "controversy," it would be far more productive to discuss what the hell is exactly controversial about a condition that is, let me repeat this for the last time, recognized as a valid condition by every single medical organization in the developed world, or about medications recognized as efficacious first-line treatments by virtually every medical organization in the developed world as well.
DocJames has started this discussion section, but he has still not even mentioned what relevance this has to the article itself, nor has he mentioned what proposed changes he would like to make, given that we already have a Controversy section in this article and another article devoted entirely to ADHD controversies. This honestly feels more like an intent to troll than an actual discussion of the article. Given his past reputation for controversial (no pun intended) actions involving psychological/psychiatric issues on WP, I do believe that this is a valid concern. This is a talk page to discuss the article, not a forum for DocJames to continually assert that this condition is "controversial" when there is already a "controversy" section in this article. ~ Hyperion35 (talk) 04:12, 20 September 2009 (UTC)

In many cases [criticism sections] are necessary, and in

many cases they are not necessary.

And I agree with the view expressed by others that often, they are a symptom of bad writing. That is, it isn't that we should not include the criticisms, but that the information should be properly incorporated throughout the article rather than having a troll magnet section of random criticisms.

— Jimbo Wales, Criticism sections on bios of living people

--Unionhawk Talk E-mail Review 04:17, 20 September 2009 (UTC)

I think that the very first paragraph in the 'Controversies' section (4 sentences) is very good. Particularly "The controversies have involved clinicians, teachers, policymakers, parents and the media" says a whole lot. The controversies article is linked. The 'Controversies' section here could be shortened, perhaps to just that paragraph. I do agree with WhatamIdoing that, with all the media attention, there is controversy on many levels among more than just the very ignorant. It relates primarily if not solely to diagnosis and treatment of children.
(The related 'Society and culture' section is not as good, unfortunately.)
I see Hyperion's concerns and feel that this whole discussion could rather have been on the Talk page for the 'Controversies' article. But Hyperion, with your way with words you don't have to sink to using an expression like "an intent to troll," which resembles a personal attack. - Hordaland (talk) 05:31, 20 September 2009 (UTC)


Perhaps "intent to troll" was not the best way for me to describe my worries. Obviously I cannot presume to know DocJames motives, merely that this discussion section strikes me as having been created more to provoke an argument about the subject of this article than for the purpose of discussing the article itself. The initial comment for this section begins by erecting a strawman ("some feel..."), makes no attempt to define what specifically is "controversial", offers sources that do not appear to support statements made, and then goes on to cast aspersions on a leading researcher in the field...all without discussing a single proposed change to the article. It appears as though this talk section was started with the intent of provoking an argument.
There are already several discussion sections on this talk page in which issues specific to the "Controversy" section of the article are discussed, such as which sources to cite, how to word it, etc. I do not believe that anything productive is likely to come out of this particular discussion section. ~ Hyperion35 (talk) 06:11, 20 September 2009 (UTC)
Thank you. That was much better.  :-) - Hordaland (talk) 06:30, 20 September 2009 (UTC)

The quote by Jimbo is in relation to biography of living persons. A lot of the differing points of views are incorporated into the article. We have an entire seperate article on the controversies of ADHD and how it is treated so I think that a section devoted to summarising the controversies is warranted on this article.--Literaturegeek | T@1k? 06:13, 23 September 2009 (UTC)

Perhaps, although it's worth noting that few medical articles tend to have controversy sections either. I did a quick check, and the pages for Tourette's Syndrome and Autism lack a controversy section. These are two conditions listed with ADHD in the DSM under Disorders Diagnosed in Childhood that are sometimes comorbid with ADHD, making them good comparison conditions. Similarly, Obsessive-Compulsive Disorder and Bipolar Disorder, two other conditions sometimes diagnosed as comorbid with ADHD, lack "controversy" sections on their articles. Even less similar psychiatric conditions such as Major Depressive Disorder and Schizophrenia lack "controversy" sections.
And even if we look at the other disorders listed next to ADHD in the DSM, under Attention Deficit and Disruptive Behavior Disorders, we find that Conduct Disorder does not have a "controversy" section, and Oppositional Defiant Disorder has a brief "controversy" section that only mentions differences between DSM and WHO diagnostic criteria, and the difficulties involved in comorbidity, while also noting that AJP studies have confirmed the validity of the disorder and of its diagnostic criteria.
Granted, the "controversy" section in this article isn't too bad. Like the "controversy" section of the ODD article, it notes the difference between public opinion and the current medical/scientific consensus. Aside from the mention of the 1997 BPS report, with a fairly bizarre quote attached, which is quite obviously contradicted by their own guidelines, the section appears to do a good job of summarizing where there is realistic controversy. However, much of what is in the current Controversy section could just as easily be integrated into related sections of the article as a whole, such as Medication and Diagnosis sections. In fact, most of what is in the Controversy section is already discussed in those sections.
Now, probably the only case to be made for having a "controversy" section is because there is a separate "controversy" article...although again it is probably worth noting that few medical conditions have a separate article specifically regarding controversies, likely for exactly the reasons that Jimbo's quote mentions. The current article devoted to ADHD controversies is quickly becoming a catchall for every altie-woo brainfart related to ADHD. I have occasionally tried to go through and fix up that article, but doing so is extremely painful. I'm trying to be polite here, but the only phrase that comes to mind when looking at that controversy article is: "The stupid, it burns."
However, my concerns over the separate article on ADHD Controversies is probably best mentioned on that article's talk page. I am not certain as to what exactly DocJames was intending when he started this talk section, as few of the sources that he cites above actually add anything not currently mentioned in the Controversy section of this article. ~ Hyperion35 (talk) 16:07, 23 September 2009 (UTC)
  1. ^ Jadad AR, Booker L, Gauld M; et al. (1999). "The treatment of attention-deficit hyperactivity disorder: an annotated bibliography and critical appraisal of published systematic reviews and metaanalyses". Canadian journal of psychiatry. Revue canadienne de psychiatrie. 44 (10): 1025–35. PMID 10637682. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
Retrieved from "https://mdwiki.org/wiki/Talk:Attention_deficit_hyperactivity_disorder/Archive_18"