Talk:Attention deficit hyperactivity disorder/Archive 28

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Adult ADHD statistics

In two places (including the lead) a questionably precise figure, 2.58%, is given for prevalence of adult ADHD (childhood onset), based on the estimate of a recent meta-analysis. This looks like a good source, but there are caveats: particularly the pooling of studies using different diagnostic criteria, and also variation between individual studies which the authors noted "could not be fully ruled out by a priori selected variables". If the childhood prevalence estimates are so broad (according to different diagnostic criteria) I find it hard to imagine there isn't the same level of uncertainty around adult ADHD & different diagnostic criteria. I'd be inclined to use a more explicit attributed statement, such as "a 2021 meta-analysis estimated a prevalence of 2.58%", or perhaps in the lead "an estimated prevalence of around 2.6%" or "around "2.5%" (in line with other sources). Additionally, the 2014 literature review also cited in the lead sentence provides a different figure, a range of 2.5-5%. Should we instead include a range, or does the meta-analysis unambiguously supersede this? Any thoughts welcome, & pinging @Xurizuri as I see they did some work on this in July. Jr8825 • Talk 17:38, 24 August 2022 (UTC)

The source you cite is very reliable. They generally do a good job with significant figures, so it would be OK just to leave it as is at "2.58%"; perhaps 2.6% is too imprecise and 2.58% is too precise so they had to choose one or the other, both sub-optimal. But there is nothing wrong with an encyclopedia rounding "2.58%" to "2.6%" if for no other reason that it reads more colloquially. Now, given that there are other reliable sources within a range, it would probably be even better to cite the range, particularly as the range "2.5-5%" includes 2.58%. Unless you feel that the 2014 review is out of date or includes bad references. Or you could cite both, and pull text from the references to explain why there is a difference. A range can result from differences in the population studied (no uncertainty, just a different population) or diagnostic accuracy (uncertainty), or definition of ADHD (no uncertainty, just a different choice of definition). Jaredroach (talk) 23:28, 24 August 2022 (UTC)

concur w/ Jaredroach--Ozzie10aaaa (talk) 18:09, 1 September 2022 (UTC)

Thanks for the feedback, I agree the study should be given a prominent position in the lead (I think 2.6% is adequate for the lead as all the other figures are rounded up to whole numbers, 2.58% makes sense in the body). Will take a closer look the literature review before deciding whether to add a range. If I remember correctly the meta-analysis didn't specifically mention or rebut earlier literature, but I'll need to check both carefully before making any changes. Jr8825 • Talk 18:35, 11 September 2022 (UTC)

Wiki Education assignment: Technical and Scientific Communication

This article was the subject of a Wiki Education Foundation-supported course assignment, between 22 August 2022 and 9 December 2022. Further details are available on the course page. Student editor(s): Smummert1 (article contribs).

— Assignment last updated by Brennam29 (talk) 15:21, 21 September 2022 (UTC)

Work of Dr Russell Barkley and possibility ADHD is two separate disorders

The work of Dr Barkley and other experts seems to indicate that ADHD may in fact be two separate conditions that result from different mechanisms.

One of them has historically been called ADHD-PH (predominantly hyperactive).

The other has historically been called ADHD-PI (predominantly inattentive), as well as SCT (Sluggish Cognitive Tempo) and, in Dr Barkley's work, CDD (Concentration Deficit Disorder).

The hypothesis goes that stimulants are only effective on the first disorder and not the second because they are caused by different mechanisms.

I think such interesting ideas (being also supported by some experts) would serve the reader's awareness of current research. EditorPerson53 (talk) 17:58, 24 September 2022 (UTC)

Comorbidities - Eating disorders - Treatments - "Health at every size"

Currently this article says, "Malnourishment can result in symptoms that look similar to those of ADHD, which has the potential to be misdiagnosed as "ADHD" without proper clinical assessment and screening for disordered eating and nutritional adequacy. Individuals with co-morbid ADHD and disordered eating should be referred to a Registered Dietitian who specializes in using a Health at Every Size and Intuitive Eating approach, combined with neurodivergent-affirming, eating-disorder-informed care, for proper treatment." This is the source link, a pay-to-view webinar: https://edrdpro.com/tag/adhd/

Health at every size/Intuitive eating are pretty controversial and it seems inappropriate for the article to recommend them as a treatment for eating disorders, or to recommend treatments for eating disorders at all, really, especially making it seem as if this is the medical consensus on the topic. 2001:9E8:238:2900:D1E0:1127:ADDC:86AD (talk) 12:48, 18 October 2022 (UTC)

Agreed, the article shouldn't be recommending treatment. I've gone ahead and removed this section. Tacyarg (talk) 22:50, 20 October 2022 (UTC)

Source quality parenting style

The paragraph "Despite a popular myth, it does not appear to be related to any particular style of parenting or discipline" and the cited source [15] contain a suggestive nature and are poorly worded in my eyes. A single MD's opinion piece quoting polls does not suffice as a valid argumentative ground to call it a myth, especially if it's says at the beginning that causes are not known for sure. Suggesting a rewording like "A connection to a particular style of parenting or discipline appears to be debatable." 91.6.16.168 (talk) 21:48, 27 September 2022 (UTC)

The sentence overall was unconstructive and the source (WebMD) far from good. An expert source - the CDC here - dismisses parenting as a factor. Zefr (talk) 21:59, 27 September 2022 (UTC)

While enviormental factors such as parrenting styles can likely perpetuate symptoms in some cases, or even decrease the serverity of symptoms if done well; parenting styles definentaly dont cause adhd itself ( correct me if im wrong ) ¿V0id? {have a great day!} (talk) 14:50, 28 October 2022 (UTC)

Requested move 14 October 2022

The following is a closed discussion of a requested move. Please do not modify it. Subsequent comments should be made in a new section on the talk page. Editors desiring to contest the closing decision should consider a move review after discussing it on the closer's talk page. No further edits should be made to this discussion.

The result of the move request was: not moved. per discussion consensus. WP:MEDTITLE, WP:ACROTITLE were more convincing to participants, based upon the "official" and "recognized medical name" criteria, and that ACROTITLE may not apply given how commonly know the official name is. ACROTITLE is most commonly employed for acronym titles which are confusing to those searching for the article, given that they are seldom spelled out. This is not the case for ADHD, as multiple participants pointed out. Participants were not as convinced by WP:NCACRO as a reason to move the title, given its common usage in a spelled-out form.(closed by non-admin page mover) — Shibbolethink ^{(♔ ♕)} 03:08, 31 October 2022 (UTC)

---

Attention deficit hyperactivity disorder → ADHD – Per WP:UCRN. "ADHD" is incidentally already a redirect to this page. In this article it is referred to as "ADHD" approx. 7 times more than "attention deficit hyperactivity disorder". Regarding WP:MEDTITLE, this is the recognised medical name (as an abbreviation). 12u (talk) 17:42, 14 October 2022 (UTC) — Relisting. — Ceso femmuin mbolgaig mbung, mellohi! (投稿) 19:43, 23 October 2022 (UTC)

• Oppose — Per WP:MEDTITLE:
  • "The article title should be the scientific or recognised medical name that is most commonly used in recent, high-quality, English-language medical sources"
  • "The article title is subject to the same sourcing standards as the article content. Where there is a dispute over a name, editors should cite recognised authorities and organisations rather than conduct original research."
  • "Diseases—The World Health Organization, International Statistical Classification of Diseases and Related Health Problems (ICD-10) or the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)"

Recognized authorities are in quite clear agreement as to what the actual scientific or recognized medical name is, and the name commonly used in the medical scientific literature reflects and supports that clear consensus. Garzfoth (talk) 19:08, 14 October 2022 (UTC)

• Strong oppose, suggest speedy closure: MEDRS sources universally refer to it as "Attention deficit hyperactivity disorder" followed by the abbreviation. The title should state clearly what the name is and not its abbreviation. The same appllies for pretty much any other medical term. Wretchskull (talk) 19:11, 14 October 2022 (UTC)
• Support per COMMONNAME.--Ortizesp (talk) 05:17, 15 October 2022 (UTC)
• Weak oppose per WP:NCA, Britannica uses the full term and I think the full term is used commonly enough to not use the acronym. Crouch, Swale (talk) 06:39, 15 October 2022 (UTC)
• Strong oppose: In addition to the very good reasons per WP:MEDTITLE and general mos med, using an abbreviation is fine within an article, but I really disagree that that kind of reasoning should be used to change the name of an article. Mason (talk) 01:00, 18 October 2022 (UTC)
• Support per WP:COMMONNAME based on the Google Ngrams. We moved "Coronavirus disease 2019" to COVID-19. I don't see how this case is any different from that. Rreagan007 (talk) 18:29, 20 October 2022 (UTC)

  @Rreagan007: COVID-19 is an official name, plus MEDRS sources also refer to it as such—that is what we base medical information on on wikipedia. ADHD is not the official name, it is an abbreviation of the official one: Attention deficit hyperactivity disorder, and all MEDRS sources name it as such. Google Ngram doesn't mean anything here. Wretchskull (talk) 18:36, 20 October 2022 (UTC)

  WP:COMMONNAME is a policy. WP:MEDRS is only a guideline. WP:COMMONNAME still applies here. Wikipedia is a general-use encyclopedia, not a medical journal. The most common name that our readers will be familiar with is what should be used for the article title. Rreagan007 (talk) 22:41, 20 October 2022 (UTC)

• Support per nom. Shwcz (talk) 13:35, 22 October 2022 (UTC)
• Support per WP:COMMONNAME, WP:NCACRO ("Acronyms should be used in a page name if the subject is known primarily by its abbreviation and that abbreviation is primarily associated with the subject") and evidence supplied above, including the precedence of COVID-19. Wikipedia is an encyclopedia, not a specialist medical publication, and we should use the term commonly used in general-purpose reliable sources.  — Amakuru (talk) 11:38, 23 October 2022 (UTC)

Relisting comment: Common-to-the-general-public name or full medical name? — Ceso femmuin mbolgaig mbung, mellohi! (投稿) 19:43, 23 October 2022 (UTC)

• Oppose for the sake of preventing repeated arguments. WP:MEDTITLE is guideline, WP:MEDRS is guideline. We can scream WP:COMMONNAME until the cows come home but let's think how many disorders are listed by their abbreviation on here? COVID-19 is a disease. – The Grid (talk) 21:35, 24 October 2022 (UTC)
• Strong Oppose WP:MEDTITLE is pretty clear here, there is already a redirect. If there is concern about the redirect we can just request it get page protection. Dr vulpes ^{(💬 • 📝)} 20:03, 26 October 2022 (UTC)

Strong oppose for all the previous reasons as to why this isnt a good idea, and every other disorder's article on wikipedia usses the full name, not the abreviation. Using abreviations for article titles is simply infromal in most cases, even when it is an official term. ¿V0id? {have a great day!} (talk) 14:55, 28 October 2022 (UTC)

• Strong oppose "ADHD""ADD", "ADHD", and "Hyperactive" all redirect to this page. Attention deficit hyperactivity disorder is the official name - it would be bizarre to me if Wikipedia was to start abbreviating all conditions ex. Borderline Personality Disorder becoming BPD or Post Traumatic Stress Disorder becoming PTSD. It might be common in your circle to abbreviate these but it's not in all. Examples used in MOS:ACROTITLE explain this quite well, if Attention deficit hyperactivity disorder wasn't the well-known name of the condition and most people wouldn't be able to tell you what ADHD stands for when asked - maybe. However that's not really the case at all since both terms are used interchangeably - so there is not a clear benefit in changing it to an acronym. --Marleeashton (talk) 00:16, 30 October 2022 (UTC)

  I do not really understand why it is considered "bizarre" to use the most common name for an article. I strongly believe most people would not be able to tell you what ADHD stands for when asked – it might however be common "in your circle" to refrain from using the abbreviation. MOS:ACROTITLE explains it well: "Acronyms should be used in a page name if the subject is known primarily by its abbreviation and that abbreviation is primarily associated with the subject". 12u (talk) 02:57, 31 October 2022 (UTC)

The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

"Paradoxical Reactions" section

Wondering if this should be removed or at least altered. It doesn't seem like the sources provided for the point that 10-20% of patients with ADHD report paradoxical reactions to stimulants and anesthetics are adequate to back up such a bold claim.

They are a letter to the editor of a journal stating that the authors observed reports of this in their outpatient ADHD clinic and then a piece published by two of the authors of the aforementioned letter that mentions paradoxical reactions existing as a side note at the end without any additional citations. These are the only mentions of this reaction I can find at all in the academic literature. If anyone else with more journal access can find something more substantial we should add it but if not, it seems like this section should either be altered to reflect the fact that in reality there's very little clinical evidence for this or just removed entirely. LanaDelEditor (talk) 21:08, 5 December 2022 (UTC)

Semi-protected edit request on 23 January 2023

Could you change DSM-4 to DSM-5 and ICD-10 to ICD-11 under Dignosis? Thank you! ÄËÖÜÏŁ (talk) 15:00, 23 January 2023 (UTC)

@ÄËÖÜÏŁ: Read the article. DSM-5 and ICD-10 have been in the Diagnosis section for several years. If you are referring to research results based on DSM-IV, we can't attribute those results to DSM-5 or ICD-10 without reliable sources. If you have such sources, please provide them here. Sundayclose (talk) 18:24, 23 January 2023 (UTC)

Semi-protected edit request on 8 February 2023

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder (Childhood) characterised by excessive amounts of inattention, hyperactivity, and impulsivity that are pervasive, impairing in multiple contexts, and otherwise age-inappropriate. Icsabc (talk) 00:17, 8 February 2023 (UTC)

 Not done: please provide reliable sources that support the change you want to be made. Lemonaka (talk) 00:44, 8 February 2023 (UTC)

Comorbidities - ODD and CD in ADHD

The figures on the comorbidities of Conduct Disorder and Oppositional Defiance Disorder with ADHD appears to be largely inflated.

"Oppositional defiant disorder (ODD) occurs in about 25% of children with an inattentive presentation and 50% of those with a combined presentation." 

"Conduct disorder (CD) occurs in about 25% of adolescents with ADHD." 

Both have referenced the DSM-5-TR however I've had a read through and was unable to find these numbers anywhere. Also couldn't find any evidence to suggest that the inverse may be true - ie that ADHD occurs in 25% of children/adolescents with ODD/CD. Aaalliex (talk) 10:25, 8 April 2023 (UTC)

Those percentages are found in the "Comorbidities" section of the ADHD chapter, although I was looking at DSM-5 (not TR). The citations should have page numbers, so I placed page requests with the citations. Sundayclose (talk) 14:27, 8 April 2023 (UTC)

Request to add findings on cannabinoids

Could someone add this under Management -> Medication -> Non-stimulants:

Low-dose cannabinoids have shown moderate to large positive effects on core ADHD symptoms in the absence of adverse effects; this implicates the cannabinoid system as a potential new target for drug development. https://pubmed.ncbi.nlm.nih.gov/28576350/ Douweziel (talk) 00:47, 4 April 2023 (UTC)

The source you cite is a single study with a total of only 30 subjects divided between medication and placebo groups, and it produced non-significant findings for cognitive performance and activity level. Your conclusion of "moderate to large positive effects on core ADHD symptoms" is not supported. More importantly, on Wikipedia, medical articles have a higher standard for reliable sources than many other Wikipedia articles. What we understand about human health and medicine is based on the basic science of biology, and biology is complex. For health-related content, the field is evidence-based medicine. And per WP:MEDRS – which the community created after long and arduous discussion – we reach for review articles (not single studies) published in the biomedical literature, or statements by major medical or scientific bodies. Read WP:MEDRS for more details. Sundayclose (talk) 01:08, 4 April 2023 (UTC)

Thank you for checking the study! You also gave me some guidelines for checking more rigorously in the future.

A very recent (2022/2023) meta-review https://link.springer.com/article/10.1007/s00787-023-02169-w came to a similar conclusion re. 18- population. Additionally, cannabinoid use is generally associated with stronger ADHD symptom severity. However, they do report that CBD appears to have beneficial effects on cognition compared to THC.

Another review https://www.sciencedirect.com./science/article/pii/S0022395622006549 reports that benefits are anecdotal and that studies don't differentiate between THC and CBD and/or dosages.

Neither review recommends cannabis treatment given current results.

Do you think this is worth mentioning (in condensed form)? Several studies noted that "a growing perception that cannabis is safe has led more patients and caregivers to self-medicate" in the context of ADHD. Douweziel (talk) 15:45, 18 April 2023 (UTC)

Inconsistency of prevalence figures in different sections

The article gives various prevalence figures that may be confusing and potentially not consistent with each other. We should reconcile and consolidate prevalence information:

• It affects about 5–7% of children when diagnosed via the DSM-IV criteria, and 1–2% when diagnosed via the ICD-10 criteria. [in lede]

• About 30–50% of people diagnosed in childhood continue to have ADHD in adulthood, with 2.58% of adults estimated to have ADHD which began in childhood. [in lede]

• Frequency 0.8-1.5% (2019, using DSM-IV-TR and ICD-10) [in infobox, using term "frequency"]

• ADHD is estimated to affect about 6–7% of people aged 18 and under when diagnosed via the DSM-IV criteria. When diagnosed via the ICD-10 criteria, rates in this age group are estimated around 1–2%. [Epidemiology subsection]

This question does not seem to have been comprehensively discussed before, although there were partial previous discussions potentially relevant: 2022-09 2013-08 AncientWalrus (talk) 10:02, 23 May 2023 (UTC)

There's also a whole article devoted to the Epidemiology_of_attention_deficit_hyperactive_disorder with a variety of numbers. Due to the range of numbers provided, I suggest we err on the side of caution and give broad ranges when there is conflicting information. AncientWalrus (talk) 10:04, 23 May 2023 (UTC)

ATX & effect on academic performance

Many studies and a highly substantiated meta-analysis (citated in article) determined that atomoxetine (ATX) is equally as effective as methylphenidate (MTH) in terms of degree of improvement in alleviating symptoms.

Said research and those studies cited by the meta-analysis used school/academic performance as core factors in substantiating effect and improvement of symptoms; especially to compare the efficacy between MTH & ATX.

The very fact that this is the case supports benefits in academic performance and this conclusion is not implied. Therefore the singular, outdated study from 2014 suggesting otherwise is scientifically unsupportable compared to the mountains of evidence showing otherwise and should be redacted, in my view.

I also wouldn't consider this a synthesised conclusion as I am utilising the available information specified in the studies, especially those reviewed by the meta-analysis in achieving their results even if this exact topic was not the main objective of the research. Димитрий Улянов Иванов (talk) 14:38, 20 September 2023 (UTC)

Recent edits clarification

Revising 'subtypes' to presentations

Basis for edit: DSM-5 (the diagnostic and statistical manual of mental disorders version 5), our diagnostic manual, does not have “subtypes" and they were replaced with presentations in the new, 5th edition. Subtypes were used in DSM-4. It was once thought there were three types of ADHD but DSM now recognises that these are not valid subtypes but presentations of the disorder that change over time.

Adding additional symptoms:

Basis for edit: emotional dysregulation, disinhibition and impaired working memory are all underlying and recognised symptoms of ADHD most of which, if not all, are mentioned further down in the article. You can also see the International Consensus Statement on ADHD for references.

Alphabetically ordering CDS above CD

Basis for edit: alphabetically, cognitive disengagement syndrome comes before conduct disorder as the g is a predecessor to n in the standard English alphabet (A, B, C, D, E, F, G, H, I, J, K, L, M, N, O, P, Q, R, S, T, U, V, W, X, Y Z)

Revising hyperfocus:

Basis for edit: it is erroneous to state that people with ADHD simply cannot sustain attention on tasks they are not interested in completing; they are often interested in completing the task, but their executive self-regulatory deficits prevent them from doing so. Usually, the delay between the action and its consequence or reward is what disables the person with ADHD. This is known as time-blindness.

Using "sustained attention" over "focus":

Basis for edit: there are 6 different types of attention in humans: focused attention, sustained attention, span of apprehension, arousal, alertness, and divided attention. Psychologists Alan Mirsky and David Posner have written reviews about them that you can find using Google Scholar. ADHD only implicates sustained attention, the self-regulatory executive functioning kind, and not focused attention hence the correction there. The other attention disorder, cognitive disengagement syndrome, affects oriented or focused attention.

(colloquially, focus/focused attention can also refer to a more broader perspective however it's still better and more accurate to use sustained attention in the context of ADHD)

If you are in disagreement with only a one or select amount of these edits, please critique here, and do not contain or reverse every single one! Thankyou. Димитрий Улянов Иванов (talk) 16:26, 20 October 2023 (UTC)

I agree with all of these points and I'd be surprised if they weren't all readily prove-able from linked citations already in the article. That being said, regarding the "subtype"/"presentation" distinction, the History section has a few sentences that disagree:

In 1987, this was changed to ADHD in the DSM-III-R, and in 1994 the DSM-IV in split the diagnosis into three subtypes: ADHD inattentive type, ADHD hyperactive-impulsive type, and ADHD combined type. These terms were kept in the DSM-5 in 2013 and in the DSM-5-TR in 2022. […] ADHD was split into the current three sub-types because of a field trial completed by Lahey and colleagues.

Further, though, the "main article" of that section, History of attention deficit hyperactivity disorder says (emphasis mine):

Under the DSM-5, there are three ADHD presentations, including one which lacks the hyperactivity component.

These should all be edited for consistency and I think "presentation" is the more accurate up-to-date term to use in the main article body. Kimen8 (talk) 16:47, 20 October 2023 (UTC)

Thanks for writing. Regarding the DSM-5's perspective on the issue, they clearly outline presentations and make no specification to 'subtypes' there. The change was in support that there is nothing qualitatively different across these. I see this all the time in trade-media articles that there are 3 "types" of ADHD; there are not. We got rid of those 10 years ago in favour of simply presentations. Because after all, people can go from the hyperactive presentation during the pre-school years up to the combined when they develop enough symptoms of inattention and then by adult-hood when the hyperactivity and motor impulsiveness is dissipating to a great extent we often notice them move into the inattentive presentation. Димитрий Улянов Иванов (talk) 17:08, 20 October 2023 (UTC)

Semi-protected edit request on 24 October 2023

The diamine oxidase (DAO) enzyme, which metabolizes histamine extracellularly, may play a key role in the pathophysiology of ADHD. A decreased DAO activity may lead to an accumulation of histamine, which could contribute to ADHD symptoms.

reference Blasco-Fontecilla H. Is Histamine and Not Acetylcholine the Missing Link between ADHD and Allergies? Speer Allergic Tension Fatigue Syndrome Re-Visited. J Clin Med. 2023 Aug 17;12(16):5350. doi: 10.3390/jcm12165350. PMID: 37629392; PMCID: PMC10455974. Jofeenstra (talk) 00:57, 24 October 2023 (UTC)

 Not done: it's not clear what changes you want to be made. Please mention the specific changes in a "change X to Y" format and provide a reliable source if appropriate. PianoDan (talk) 21:18, 24 October 2023 (UTC)

Please separate the text

ADD SECTIONS OR CREATE A SOMARY, because the article is very long. (Sorry for the english) BlueDevil455054 (talk) 02:20, 27 January 2023 (UTC)

You need to reword that request. It's very unclear what you are asking. If you're requesting that the article be divided into two articles, that can't be done with a simple request. It requires discussion and consensus. Sundayclose (talk) 14:14, 27 January 2023 (UTC)

@BlueDevil455054 The Simple English Wikipedia has a shorter article. (https://simple.wikipedia.org/wiki/Attention-deficit_hyperactivity_disorder). FunLater (talk) 22:49, 11 June 2023 (UTC)

135.129.207.179 (talk) 06:46, 23 November 2023 (UTC)

Minor edit for clarity

Suggest revising "ADHD is diagnosed approximately twice as often in boys as in girls..." to "ADHD is diagnosed approximately twice as often in boys than in girls..."

This is a minor change. For what it's worth, I had to read the sentence a few times to understand the meaning. 2603:6000:DC01:AC86:4D7B:52CE:5C39:7452 (talk) 19:19, 1 December 2023 (UTC)

Hyperactivity

I heard (from my psychiatrist, actually) that ADHD is just a nomenclature and even that being the name of the disorder, people may or may not develop hyperactivity. I'm a bit busy at the moment and away from my Computer. But I'll try to find any reliable source on that as soon as I can. —Nanami73 ^talk 17:17, 20 December 2023 (UTC)

• There's quite a bit of information already in the article about how hyperactivity is not necessarily present in all people with ADHD. You should give it a read or re-read. Firefangledfeathers (talk / contribs) 17:20, 20 December 2023 (UTC)

  Ah yes, I just checked, sorry for my inattention. I mean, there is a reason why this article interests me. But seriously now. yeah I reread it and now I saw the detail in the History section. Thanks for bringing it to my attention. —Nanami73 ^talk 18:09, 20 December 2023 (UTC)

  There is also Adult attention deficit hyperactivity disorder which seems to describe non-hyperactive presentations more, as in adults it generally is the case that inattentive presentation becomes more common than hyperactive. Kimen8 (talk) 18:22, 20 December 2023 (UTC)

"Executive dysfunction" claims

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

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

to

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

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

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

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

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

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

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

Thanks for writing. You make some good points and additional references should be provided (if a consensus is determined) as current ones are insufficent. Fact checking is always appreciated; we need to look for biases and synthetical conclusions in research and in ourselves among publications of edits.

First, I will address the matter of emotional dysregulation and the relevancy of DSM-5's specification , and secondly, I will try to offer a defence of ADHD being a disorder of EF/SR.

Experts are in agreement that emotional dysregulation is a core symptom of ADHD (the relevant data are described here: International Consensus Statement on ADHD and Faraone et al., 2018). Now, the DSM is not leading the research, but follows it and often a decade or two behind where the research is at the time so referring to the DSM in invalidating current research is not acceptable when robust findings contradicts and/or objects to their criteria. Thus, the symptomatic presentation of ED should not be redacted based on what the information (or lacking of) is in a diagnostic manual. But the decisions made by the APA are also political, not just scientifically-based so its hard to know where this will go in the subsequent version.

Scientifically, there is some debate among researchers on a) the definition of an EF; b) to some extent what can be classified as an EF. From my understanding, as of now Barkley's model of EF/SR in ADHD has the "most" empirical support among researchers but it's not definitive, as he and others acknowledge. Nonetheless, we're pertaining to EF underlying ADHD symptoms rather than the above.

To substantiate this, ADHD is a disorder of brain networks that contribute to executive functioning and self-regulation. Many of these networks originate in the pre-frontal cortex but they extent throughout the brain occasioning its symptoms (Hoogman et al., 2019). Thus, logically, given the well-established neuroanatomy and psychological expressions of ADHD, it has to be a disorder of EF/SR.

• A meta-analysis of 21 functional MRI studies with 607 participants found that those with ADHD showed consistent and replicable under-activation in typical regions of executive inhibitory control such as right inferior pre-frontal cortex, supplementary motor area and the basal ganglia relative to typically developing individuals (Hart et al., 2013). The inferior frontal under-activation findings were replicated in two further fMRI meta-analyses of inhibitory control with 33 datasets/1161 participants, and 42 datasets/2005 participants, respectively (Lukito et al., 2020; Norman et al., 2016).
• Comparative meta-analyses show that structural grey matter volume reductions in basal ganglia and insula are ADHD disorder-specific relative to OCD in 30 data sets with 1870 participants (Norman et al., 2016) while medial frontal reductions were specific to ASD in 66 data sets with 3610 participants (Lukito et al., 2020). An analysis of structural magnetic resonance imaging (MRI) data from 48 cohorts with a total of over 12,000 participants showed that ADHD participants had smaller hippocampus volume relative to OCD which was related to IQ & EF differences and smaller intracranial volume relative to ASD and OCD patients (Boedhoe et al., 2020). The functional under-activations in right inferior frontal cortex and basal ganglia during tasks of cognitive control were ADHD disorder-specific relative to OCD in 1870 participants (Norman et al., 2016), while the inferior frontal dysfunction was specific relative to autism in 3610 participants (Lukito et al., 2020).
• A meta-analysis of ten diffusion tensor imaging studies with 947 participants found that the most consistent white matter differences between those with and without ADHD were located in the splenium of the corpus callosum extending to the right cingulum, the right sagittal stratum, and left tapetum, suggesting problems with the connections between the two hemispheres in posterior parieto-temporal attention regions and in long-range fronto-posterior association tracts (connecting inferior frontal, temporal, parietal and occipital regions) involved in sustained attention and perception (Chen et al., 2016).
• An analysis of structural magnetic resonance imaging (MRI) data from 36 cohorts with a total of over 4100 participants found slightly reduced total cortical surface area in children with ADHD. The same team found some subcortical regions of the brain were smaller in children with ADHD, mainly in frontal, cingulate, and temporal regions with some reductions in cortical thickness in temporal regions. The same team found some subcortical regions of the brain, e.g., basal ganglia, amygdala, hippocampus, and intracranial volumes were smaller in children with ADHD in 23 cohorts of 3242 participants (Hoogman et al., 2017; et al., 2019).

Here is also an outline of performance deficits in the brains of people with ADHD from the International Consensus Statement:

• A series of meta-analyses found that people with ADHD had small to moderate difficulties with abstract problem solving and working memory (12 studies, 952 persons), focused attention (22 studies, 1493 persons), sustained attention (13 studies, 963 persons), and verbal working memory (8 studies, 546 persons) (Schoechlin and Engel, 2005).
• Two meta-analyses, one with 21 studies and over 3900 participants, the other with 15 studies with over a thousand participants, found that those diagnosed with ADHD have a moderate tendency to favour small immediate rewards over large delayed rewards (Jackson and MacKillop, 2016; Marx et al., 2021).
• A meta-analysis of 37 studies with more than 2300 participants found a small-to-moderate association between ADHD and risky decision-making (Dekkers et al., 2016). Another meta-analysis, combining 22 studies with 3850 children and adolescents, found those with ADHD exhibited moderately greater impulsive decision-making overall on delay discounting and delay of gratification tasks (Patros et al., 2016).
• A recent meta-meta-analysis included 34 meta-analyses of neurocognitive profiles in ADHD (all ages) concerning 12 neurocognitive domains. Those with ADHD had moderate impairments in multiple domains (working memory, reaction time variability, response inhibition, intelligence/achievement, planning/organisation). Effects were larger in children and adolescents than in adults (Pievsky and McGrath, 2018).
• A meta-analysis of 49 studies and over 8200 children and adolescents found moderate impairments in working memory in those with ADHD. These deficits declined with age (Ramos et al., 2020).
• A meta-analysis of randomized controlled trials (RCTs) with preschoolers found that cognitive training led to moderate improvement in working memory (23 studies, over 2000 participants) and small-to-moderate improvement in inhibitory control (26 studies, over 2200 participants) (Pauli-Pott et al., 2020).

There are at least 7 major EFs. They are self-awareness, inhibition (self-restraint) (occasioning symptoms of e.g. hyperactivity, distractibility, motor/cognitive/motivational/emotional impulsivity), working memory (remembering to do and involving hindsight and foresight), [both nonverbal/visual and verbal WM], emotional self-regulation, self-motivation, and planning/problem solving. ADHD to varying but highly related degrees across individuals is disrupting all 7 of these. That is why it is such an impairing disorder adversely impacting nearly every major domain of life activities we have studied to date.

Keep in mind that neuropsychological testing of EF is not useful for diagnosis and do not suggest whether EF is implicated in ADHD (International Consensus Statement, Faraone et al., 2021). While some clinicians, and to a lesser extent, some researchers have concluded that ADHD is not a disorder of EF considering so many ADHDs pass the tests; that is based on a faulty premise, that these EF tests are the gold standard for detecting executive functioning deficits. The evidence against the use of such tests due to their low accuracy at detecting the disorder, low correlation with ADHD symptoms, and limited if any relationship to predicting impairment in major life activities. Димитрий Улянов Иванов (talk) 17:13, 9 January 2024 (UTC)

Hyperfocus & ADHD

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