Talk:Attention deficit hyperactivity disorder/Archive 2

Feature Article?
I think this article has FA potential. Anybody else? *Kat* 03:45, 8 May 2006 (UTC)
 * You know, I think it does have FA potential, if only because it is so representative of ADHD. If you really want to know what its like to to have ADHD, read the whole thing (I don't think I got past the second paragraph) or read the talk page :) (Patrick 15:57, 17 May 2006 (UTC))

I agree. This and related articles such as Anti-ADHD and Methylphenidate are just a jumble of competing ideas. There are sentences that have been edited so much that they are either self-contradictory or meaningless. There are also far too many unsubstantiated, vague and sweeping claims. Trying to sort it out would be a thankless waste of time because whatever good was been done would be undone within days by the same people who created the current mess.

To get a clearer picture of why this is going on it is worth reading Andrew Lakoff. Not only does he provide a well researched history of ADHD but he provides one of the few reasoned arguments for why people hold such strong views about it.

There is much valuable and reliable information in Wikipedia. Attention-deficit hyperactivity disorder would make a good feature article to warn people of what can go wrong.IanWillsIanWills

Amen Classification System / Should not be a FA
I created the page on Amen classification and linked it to ADHD page adhoc. http://wikipedia.org/wiki/amen_classification I expected that it would be evolved and information added to it, which did happen. Now I am quite annoyed that someone has deleted the link and sentence to the Amen classification.

Sure the Amen classification has not been formalised, but it should at least be referred to in the ADHD article that the classification exists and that it is an alternative to the DSM. There is the section "Formal Definitions", what about "Informal definitions?" or something along those lines?

Please in the future, evolve things, do not delete things.

-

I'm afraid that I can't agree that this article should be nominated for a Featured Article in its current form.

In the Diagnosis section it currently reads that: "In recent times the Amen classification has subclassified the DSM-IV classification and this led to improved diagnostic accuracy, which leads to better selection of medication and treatment. In nearly all developed nations (including the US and UK), doctors are required to conduct a SPECT scan in order to correctly treat the brain's chemical deficiencies. Without this scan, incorrect treatment can do damage to the brain." At the very least this needs citation as the DSM-IV is, to my knowledge, the guide most widely used for psychatric treatment by U.S. doctors.

It also turns out that under the Testing for ADHD - Other Forms of Testing section the article currently reads that "Neurometrics, PET scans, FMRI, or SPECT scans have been used to provide a more objective diagnosis. These are not typically suitable for very young children, and may unnecessarily expose the patient to harmful radiation. Because the etiology of the disorder is unknown, and a complete neurological definition of this disorder is lacking, a majority of clinicians doubt the current predictive power of these objective tests to detect ADHD to be used to direct clinical treatment. Currently, the American Academy of Pediatrics and the American Academy of Child and Adolescent Psychiatry recommend against using these neuro-imaging methods for clinical diagnosis of individuals who may have ADHD...An October 2005 meta-analysis by Alan Zametkin, M.D., with the NIMH entitled "The ADHD Report", concluded that these diagnostic methods lack adequate scientific research on accuracy and specificity to be used as a primary diagnostic tool." These statements are cited and directly contradict those in the Diagnosis section mentioned.

What little research I've done leads me to believe that the Amen system does not belong under the diagnosis section as its reliability has not been scientifically proven. If it is kept it in the article, I recommend that it be moved from the Diagnosis section to either the Other Forms of Testing or Alternative Treatments section.

Finally, I feel it is relevant to mention that Dr. Daniel Amen has set up a set of clinics using his methods, which currently charge $3,250 for a comprehensive evaluation.

Some basic research should be done before leading everyone to believe that the Amen system is widely accepted in the medical community.

Thank you. --JoeCollege 06:06, 11 May 2006 (UTC)

Reorganize
I know that it's probably not reasonable to expect this article to be structured or organized in a meaningful way; if you just skim over the headings it's obvious that this is the product of the collective efforts of a large number of people with ADHD. I know we can't organize things, so maybe someone who doesn't have ADHD could come up with a new structure for the article (detailed), and the community can then submit the information. I can't think of anything else right now to improve this; the article is becoming way too long, not to mention the talk page. Does anyone have any other suggestions on how we can bring order to this? (Patrick 16:17, 14 May 2006 (UTC))
 * I'm sure it wasn't your intention, but please don't be insulting. It's not appropriate to imply that ADHD sufferers are incapable or incompetent as Wikipedia editors, or that editing should be restricted to those without the condition.  Wikipedia is the free encyclopedia that anyone can edit, remember.  Best wishes, Kasreyn 20:13, 14 May 2006 (UTC)
 * You got me wrong, I'm not saying that people with ADHD are incompetent, I would be insulting myself! I realize that there are some things that I have difficulty with as a person who has ADHD, such as time management, organization, data management, etc, so I cope with those difficulties by joining forces with others who happen to be extremely organized, for example; that way, the aspects of my personality that need improvement don't inhibit my most appreciated features. Therefore I am suggesting that contributors with ADHD join forces with others in the same way. (Patrick 13:05, 15 May 2006 (UTC))
 * Hmm, I see. Personally, my opinion of those editors I've seen who have ADHD is that they tend to make quite good editors.  ADHD is primarily a difference in the quantity of things one's attention focuses on, and the degree.  A distributed project such as Wikipedia is excellent at including both those who excel best at focusing on a sole article, and those whose preferred focus is to watch many articles and tweak in small ways.  That's what I love about this project:  as long as someone is willing to be civil and take constructive criticism well, they can always find some way to help here.  :)  Kasreyn 11:08, 16 May 2006 (UTC)

I took a machette to this article a little over a year ago. Can't believe that it has gotten so messy again! I think still think it has FA potential, but I gotta agree, now is not the time. Maybe I'll clean it up again this summer. --*Kat* 08:16, 16 May 2006 (UTC)
 * Hey, I'm glad someone agrees that the article requires cleaning, it's not meant as an insult, look at my user page; I do agree is Kaseryn that ADHD people combined probably have the largest number of edits on Wikipedia. This site is like a playground for peole like us, there is always something new to read or some project to start. Granted, I can say I haven't finished very many projects but I've started a lot, even in the last two weeks alone. This isn't necessarily a bad thing, I happen to know things about a lot of different topics that other people have never heard of, especially things that I'm currently interested in. Cleaning up this article is an enormous task, especially if it is done in a manner that keeps it from getting messy again. It will take the combined effort of many to accomplish this. We should start by archiving some of the stuff on the talk page so we have some room to talk, this is insanely long; secondly, we should look through the article and find items that can be moved to different articles, as well as things that are not relevant.(Patrick 17:44, 16 May 2006 (UTC))
 * I agree both that it needs cleanup, and that it needs someone who very much DOES NOT have ADHD/ADD. I have it myself, and lord only knows, I can't mentally deal with all the citation-tracking, sourcing and organization this thing needs!


 * I can, however, state that since I last checked this article (which I think was a couple of weeks or more, but less than a month... can't recall exactly, but I believe it was less than a month. I think.), it HAS vastly improved, mostly due, I believe, to Kat's spring cleaning. That little sad (in that it showed how bad the article was at the time), yet amusingly ironic "this article needs attention" note has gone away, and I don't think I'd argue, at this point, since though there is still some sourcing needing to be done, it's no worse off at the moment I think than a number of other articles, including my pet project Fan fiction, or it's related article Mary Sue; in fact, I could swear it has more sourcing/citation done by far than the fan fiction article. Of course, as an article on a medical diagnosis, it needs far more cites, but this is a very heartening development! I look forward to the day (however far away it may be at this point) where it becomes a Featured Article candidate in the vein of Asperger's Syndrome. :) Runa27 08:04, 7 June 2006 (UTC)

Comparative Behavior
"teenage pregnancy (30–35%)" If the section is stating that the proportion of people with ADHD are involved in a teenage pregnancy 30-35% more than those without ADHD (as in if 3% of teens are involved in a pregnancy 38% of teens with ADHD are involved in a pregnancy), then that is simple not true. If the section is claiming that people with ADHD are 30-35% more likely than people without ADHD to be involved in a teenage pregnancy then that is an extremely misleading statistic, probably making a difference of only 1% more teen pregnancies. William conway bcc 20:05, 14 May 2006 (UTC)


 * The data is certainly questionable, but it leads to an interesting obvservation: if ADHD is indeed inheritable and if the statistic is in fact accurate, then, in a few generations, we can expect the vast majority of people to have ADHD, because of the increased number of offspring from parents with ADHD. Even if the statistic is grossly overestimated and only lies at 1% of (unwanted) pregnancies above the norm, as you suggested, we can still expect to see the vast majority of pepole to have ADHD several generations in the future. Therefore if there are any more pregnancies from ADHD parents, compared to non-ADHD parents, almost everyone will eventually have ADHD. Therefore, the "disorder", or whatever it will be classified as, will effectively disappear, and people who don't have the ADHD gene will probably undergo some sort of treatment to compensate for their "difficulty to multitask" or perhaps "obsessive behavior", "over-organization", "rigid personality", "lack of spontaneity", etc. (Patrick 13:17, 15 May 2006 (UTC))
 * An interesting speculation, but it doesn't hold up. For one thing, even if ADHD sufferers account for an increasingly larger slice of the teenage-parent pie, that says nothing about the much larger portion of society who do not have teen pregnancies, nor about the established fact that the children of teenaged parents have statistically lower life expectancy (due to poor parenting and poverty, typically).  A combination of distinct minority status and relatively lower life expectancy do not seem to indicate a trait that is going to make much headway in the gene pool.  This is only addressing our culture, as well; there are still many cultures in the world where teen marriage and pregnancy is common or the norm, in which case ADHD won't make a noticeable difference.  Kasreyn 04:25, 16 May 2006 (UTC)
 * I see what you mean; it's one thing that there may be an increased number of teen pregnancies among ADHD teens, however, most people carry ADHD into adulthood; there is no cure and it doesn't just go away by itself. If you're going forget to use protection, or simply choose not to use it, and believe me, this is far more likely to happen to people with ADHD (see impulsivity, forgetfulness, etc) this behavior will likely continue into adulthood. What makes matters worse, from an evolutionary standpoint, is that ADHD people tend to associate with other ADHD people; therefore this can really lead to an ADHD "epidemic" generations down the line, even if it is just because ADHD people have a tendency to find each other, even in adulthood.(Patrick 17:54, 16 May 2006 (UTC))
 * First of all the point you made about the spreading of an epidemic is flawed. If any of the statistics about ADHD are true then yes people with ADHD would have a higher birth rate. BUT if any of the other statistics about higher rates of STDs and job related injuries are true then people with ADHD would also die quicker, which would cancel out the higher birth rate.  Secondly, this article states that 30% to 70% of those with ADHD continue to have the disorder in adulthood, which is not necessarily a majority.  Third, this complete section, and ALL of its information, is unreliable as it has not been cited. William conway bcc 20:13, 19 May 2006 (UTC)

This section of the article has not been cited. Requests for citations were made on May 12, 2006. How much longer should the uncited material be left on the page? I personally feel it should be left for one more week, (until May 26th) and then deleted if it cannot be cited. William conway bcc 20:13, 19 May 2006 (UTC)

Spring Cleaning by *Kat*
A little bit late, but then I am a procrastinator. ;-)

Removals/Explanations

 * It is important to understand that a diagnosis of ADD or ADHD or variants is made by a subjective evaluation by a mental health professional. There is currently no clinical diagnostic test for the disorder, although a gene has been discovered that may cause ADHD in humans as well as chimpanzees and gorillas. Furthermore, the symptoms of these disorders can be attributed to a variety of other facters. Some believe that the diagnosis is used to label behavior problems rather than identifying the actual disorder.

This paragraph was removed from the intro section because it is contradictory and does not add anything to the introduction.


 * This is often combined with problems inhibiting responding to distracting events that often draw the person off-task. Those with ADHD also have difficulties re-engaging the previous task once they have been distracted.  The hyperactivity is typically most evident in early to middle childhood and declines significantly with age.  By adulthood, it is most evident in a feeling of restlessness or inner or subjective hyperactivity as well as a need to be busy or engaged in physical activities.  The impulsiveness or poor inhibition persists throughout childhood into adulthood and may be manifest verbally (excessive talking, interrupting others, blurting out answers before questions are finished, saying what's on your mind without regard to its consequences, etc.) or physically, as in doing things on impulse or a dare. Those with ADHD are often more involved in risk-taking activities and, as a consequence, suffer 2–4 times the rate of accidental injuries as do unaffected children or adults.  A newly identified subset of children now classified as having ADHD are called the Predominantly Inattentive Type and may often appear to be day dreamy, spacey, confused, in a fog, staring frequently, slow moving, sluggish and hypo-active.  Researchers call these children Sluggish Cognitive Tempo but this is not a commonly used diagnostic label.  Some reserve the term ADD for those with Predominantly Inattentive Type due to the lack of hyperactivity in these individuals.

'I've attempted to boil this paragraph down to its bare essentials. I'm sure I think that some the details given above will need to be reincorporated, but that is a decision that I want to put off until later.'


 * From Causes
 * It has been demonstrated that children who have at least one parent diagnosed with ADHD are more likely to be diagnosed with ADHD. Studies show that a parent with ADHD is eight times more likely to have a child with ADHD than a parent who does not. A child with ADHD is seven times more likely to have a sibling with the disorder than a child who does not have ADHD.  The concordance between identical twins if one has the disorder is 78%.<>

No where to put it


 * In studies that used both teachers and parents in the United States, Canada and Australia the difference has been significant.   For example, one of these studies (Wolraich, 2004) found American teachers identified ADHD in 25.5% of a group of 6,171 children but parents identified it in only 7.8%.


 * Careful assessment must include indices of IQ scores and adaptive functioning screens. This is essential since many children and adolescents are incorrectly diagnosed as having ADHD or ADD when, in fact, their principal problems are a direct result of Borderline Intellectual Functioning (IQ 70-85) and impaired adaptive skills. Kaplan & Sadock's Comprehensive Textbook of Psychiatry, 8th Ed., 2005, devotes Chapter 26.3 to a detailed review with clinical illustrations and proposed treatments (Ninivaggi 1999, 2005).This precludes the use of psychostimulant medications, which often complicate the clinical presentation.

Again, I've attempted to boil this down into something that says essentially the same thing in fewer (and shorter) words.


 * Pycnogenol
 * Pycnogenol, a flavinoid extract of pine tree bark with potent antioxidant activity has anecdotally been reported to have a beneficial effect on attention span in children with ADHD. Experimental tests, while not ruling out a possible effect, have been inconsistent.

This article is too long already, and this bit isn't very significant, so I'm cutting it.


 * The Institutes for The Achievement of Human Potential
 * Established in 1955, IAHP is a non-profit organization dedicated to improving the health and development of children who have some form of brain injury, including children diagnosed with Attention-deficit hyperactivity disorder. The IAHP claims that with a home program consisting of a healthy diet, clean air, and respiratory programs many of these children can be well without the need for medication. The IAHP publishes the results of its treatment for over 1700 children on its website. (IAHP website.

Sounds too much like an advertisement for me to want to keep it.


 * (From Cerebellar Stimulation)


 * Moreover, independent research that is currently under way on the DORE program, yielded only suggestive results that the method works. However, more research is necessary in order to prove the validity of this alternative treatment. As Dr. Hallowell states in Delivered from Distraction, “we must remain critical, even sceptical, until we have a full body of research to give us a definite answer”(p.238)

 Again, thinly veiled advert.


 * (Under Nuerofeedback)
 * While many papers have been published, they have fallen short of scientific standards. Only two studies have used randomized assignment to treatment and placebo groups and neither found significant results from this treatment

Nothing wrong with it, but I think this is information that would be better placed in the Nuerofeedback article.


 * From Positive Aspects
 * Some argue that ADHD does not necessarily slow down a person's learning process. However, all longitudinal studies of ADHD children followed to adulthood find them, on the aggregate, to be significantly less educated than control groups of children followed over the same period of time, (see Weiss and Hechtman, 1993, Hyperactive Children Grown Up, new York: Guilford, guilford.com).  Some argue this is due to an educational system which focus on organization and long lectures that handicap ADHD individuals, which may lead one with ADHD to receive less formal education despite possessing high intellect.  Clearly  certain individuals have benefited greatly from ADHD.  Michael Flatley, originator of Riverdance, was diagnosed with ADHD during his childhood in Chicago.  He was also a golden glove boxer.  He has also repeatedly walked out on situations where people in charge tried to tell him what to do.

To see ADHD positively may seem somewhat problematic to anxious parents but it is at least a perspective that should be kept in mind. With or without hyperfocus, a common manifestation, ADD/ADHD in combination with successful coping skills may be utilized to achieve remarkable accomplishments in some people. Of course, favorable socioeconomic conditions and the home environment play key roles.

Kind of useless and redundant.


 * Famous people and ADHD


 * Among the individuals often listed is comedian Robin Williams, whose spontaneous humor, hyperactive manner, and other noted behavior (not all constructive) have combined to earn the him the label "Poster child for AD(H)D." Notwithstanding inspirational value, cited by critics is the fact that Williams' personal medical records are not public information, so including him and many others found on such lists falls below reasonable criteria for validity. (More to the point, the public behavior of Robin Williams does not resemble ADHD. The pressured speech, punning, and flight of ideas found in mania are a closer fit, but the above considerations apply.)


 * Ozzy Osbourne has said he has been diagnosed as having ADD and dyslexia

'There were two paragraphs in this section. I took one and moved it into "positive aspects" and this is the other. I'd like to keep it cut because there are no citations, its not encyclopedic, and there is already an article dedicated to this anyway'

Sources removed
Supplementation with flax oil and vitamin C improves the outcome of Attention Deficit Hyperactivity Disorder (ADHD). Prostaglandins Leukot Essent Fatty Acids. 2006 Jan;74(1):17-21. Epub 2005 Nov 28.

Singh M (2005). Essential fatty acids, DHA and human brain. Indian J Pediatr. 2005 Mar;72(3):239-42.

Pine DS, Klein RG, Lindy DC, Marshall RD. (1993) Attention-deficit hyperactivity disorder and comorbid psychosis: a review and two clinical presentations. Journal of Clinical Psychiatry, 54 (4), 140-5.

Pine DS, Klein RG, Lindy DC, Marshall RD. (1993) Attention-deficit hyperactivity disorder and comorbid psychosis: a review and two clinical presentations. Journal of Clinical Psychiatry, 54 (4), 140-5.

Kept, but...

 * Computerized tests


 * Computerized tests of attention are not especially helpful in providing a further independent assessment because they have a high rate of false negatives (real cases of ADHD can pass the tests in 35% or more of cases), they do not correlate well with actual behavioral problems at home or school, and are not especially helpful in determining treatments. Both the American Academy of Pediatrics and American Academy of Child and Adolescent Psychiatry have recommended against the use of such computerized tests for now in view of their lack of appropriate scientific validation as diagnostic tools. In the USA, the process of obtaining referrals for such assessments is being promoted vigorously by the President's New Freedom Commission on Mental Health.

I'm keeping this paragraph for now, but we need some examples and citations.

Under Incidence
Not sure what I want to do with this yet, so I'm sticking it here until I decide. Most Some of this will might be reincorporated in some form.


 * Some experts theorize that ADHD is under-diagnosed in girls, since their symptoms tend to be less dramatic than those in boys and thus draw less attention from parents and teachers. This may be due to a lower likelihood of aggressive and antisocial behavior in girls and possibly a higher incidence of the inattentive type of ADHD among girls. Even girls with hyperactivity, however, are under-detected because their hyperactivity might manifest in non-physical ways, such as excessive talking.


 * Others (e.g. Singh ) explain the difference as being due to a lower tolerance of the normal range of boys' behavior that has developed in the past fifty years. That is, they claim that many boys are diagnosed with ADHD who do not, in fact, meet the diagnostic criteria but have attracted attention for other reasons. More rigorous diagnosis would lower the incidence in boys to that of girls.


 * Speculation exists to explain the higher diagnostic quota in the U.S. One theory suggests that due to the high-risk traits of ADHD-affected people, it can be suggested that there was a higher prevalence for ADHD in the immigrants heading for America in former centuries than in the general population. No evidence exists at the moment to support such a popular idea. And it is becoming increasingly evident that ADHD can be found in equally high rates of countries with far less migratory patterns, such as in Japan and China.


 * Another explanation put forward by the United Nations International Narcotics Control Board is that the increased incidence in the U.S. can, in part, be explained by the fact that the U.S. permits direct marketing of ADHD drugs to the general public whereas most other countries do not.


 * It is also possible that social and other factors may underlie ethnic and gender differences. For example, obstacles to ADHD treatment are higher in the African-American and female populations . Cultural factors also inhibit treatment being sought.


 * Since most explanations of the disorder are expressed in biological terms (see ) the incidence should not vary between communities or countries when adjusted for possible factors such as smoking during pregnancy. However some research has, found that such differences do exist. Jensen et al studied children in four U.S. communities finding that only 12.5% of children diagnosed with ADHD had been treated with stimulants but that the incidence of diagnosis, while averaging 5.1% (roughly the DSM-IV prediction) varied from 9.4% in Atlanta, Georgia to 1.6% in Puerto Rico. They also found that the incidence was higher in urban than rural communities and higher in more affluent than less affluent.


 * Yet another theory, links the statistical difference mainly to a higher problem awareness and competence in the U.S. due to the longer research and public acquaintance with ADHD. Although all of these theories have some support, many are debated. At present most research focuses on broadly medical issues with very little probing possible social and economic explanations of the observed differences.

Recommendations

 * We need to broaden the data given the Incidence section. Right now it is very US-centric.  We should incorporate facts and figures from other countries such as Japan, Australia, and Mexico.


 * I'd like to separate the Timeline into a separate article. It doesn't really fit into this one.


 * I'd like to archive the first hundred topics on this talk page.

notes to Kat #1
Thank you for asking for my input. I can see you and others have done a lot of work on this difficult subject.

I do have a few comments:

In your paragraph on nutrition as a treatment, the sentence remains:

Granted, according to a recent meta-analysis, there is little scientific evidence for the effectiveness of the Feingold diet in treating ADHD specifically

Unfortunately, I do not have the full text of this report. However, in Schnoll's meta review, the abstract itself states:


 * Attention-deficit hyperactivity disorder (ADHD) is multidetermined and complex, requiring a multifaceted treatment approach. Nutritional management is one aspect that has been relatively neglected to date. Nutritional factors such as food additives, refined sugars, food sensitivities/allergies, and fatty acid deficiencies have all been linked to ADHD. There is increasing evidence that many children with behavioral problems are sensitive to one or more food components that can negatively impact their behavior. Individual response is an important factor for determining the proper approach in treating children with ADHD. In general, diet modification plays a major role in the management of ADHD and should be considered as part of the treatment protocol.


 * "Increasing evidence" is not the same as "little evidence" .....


 * I wrote to Dr. Schnoll for her comment, and she answered, "The comment that the studies conducted did not eliminate all the foods listed on the Feingold diet was correct, but more importantly, the amounts of food dye and additives that were tested did not even come close to what children consume in a typical diet."

May I suggest, as wording: According to a recent meta-analysis, there has been little scientific evidence for the effectiveness of the Feingold diet in treating ADHD specifically, but this could be because most of the research has focused only on food dyes, in amounts far below what children consume in a typical diet, and the diet eliminates much more than that.


 * done. *Kat* 01:28, 2 June 2006 (UTC)

You might also include the newer Lau study which shows that a combination of additives (the way we get them in the real world) has much more effect than each alone ... see http://www.diet-studies.com/adhd.html#Lau2005

Note #2
Under Cerebeller Stimulation, is the sentence:

As noted above several studies have shown that the cerebellums of children with ADHD are notably smaller than their non-ADHD counterparts.


 * The link at "above" does not go anywhere
 * fixed. *Kat* 01:25, 2 June 2006 (UTC)


 * In your resources, are they using children who are untreated? It can be argued that stimulant medication actually may change the size of parts of the brain.
 * I didn't read the resources. My intention was to re-write the article.  *Kat* 01:25, 2 June 2006 (UTC)


 * It can also be argued that this is not necessarily genetic but caused by vaccine damage since vaccines are given in infancy, before the brain has matured. Dr. Mary Megson in her presentation to Congress which you can see here claims that ADHD is a type of vaccine damage ....she talks also about children whose moms have night blindness, indicating a G-protein problem, which she says is a risk factor for autism or ADHD resulting from vaccines -- in other words, maybe our genetic research should be aimed at identifying those children at risk for sensitivity to additives or vulnerability to vaccine damage (or both), rather than continuing to give one-size-fits-all treatment to babies and blaming "genetics" for the damage done.  When we talk about genetics here, we forget one thing -- there is no way to have an epidemic of a genetic disorder, unless we have done something in the environment to impact a (previously harmless) genetic variance.   .... well, this is not encyclopedic, just ranting, but maybe there is something in there you can use.
 * I've read about that too, but I believe this theory has been discredited. *Kat* 01:25, 2 June 2006 (UTC)

Note #3
The following paragraph seems to have been left as it was originally, before your editing:

In the 1980s vitamin B6 was promoted as a helpful remedy for children with learning difficulties including inattentiveness. After that, zinc was promoted for ADD and autism. Multivitamins later became the claimed solution. Thus far, no reputable research has appeared to support either of these claims, except in cases of malnutrition.

Thus, in a couple of sentences, this paragraph denigrates B6, zinc, and vitamins. Not only does it say that there is NO REPUTABLE RESEARCH but the tone is negative and biased - sounds like the Quackbusters have been here.

B6 (and other vitamins):


 * First, about B6, there is actually quite a bit of research. Dr. Rimland once told me that there were 18 consecutive studies showing that B6+Mg was helpful, and there were no studies showing it was harmful.  I cannot document that, at the moment, but I will get back to you on it later.   Meanwhile, you can see what he wrote about B6 for autism.


 * There is the Harding 2003 study on vitamin supplements working as well as Ritalin. See it here.


 * See Berdonces 2001


 * See the Kidd review 2000 which refers to several of the alternatives besides vitamins, and the full text is attached there too


 * Remember that B6 is a cofactor in the making of neurotransmitters serotonin, dopamine, and orepinephrine ... See some interesting information about it.


 * See Part 1 and Part 2 of a study on B6 and Downs syndrome.


 * And how about this one? Coleman showed that B6 worked as well as Ritalin, and laster longer, with fewer side effects. This study has never been disputed - it has simply been ignored.

Zinc


 * Back in 1979, Brenner reported that kids with ADHD had different trace minerals.


 * You have already mentioned the Ward 1990 study and also the one in 1997 where he found that kids with ADHD lost zinc (resulting in behavioral disorders) when exposed to coloring.


 * If you go to MedLine and do a search for "zinc adhd" you will find 16 studies and reviews in prestigious journals. It is certainly not right to say there has been no reputable research
 * See the Arnold 2005 review in which he says "Numerous controlled studies report cross-sectional evidence of lower zinc tissue levels (serum, red cells, hair, urine, nails) in children who have ADHD, compared to normal controls and population norms."
 * Even in Tehran, they are finding that zinc can be useful in addition to Ritalin. See Akhondzadeh 2004

Note #4
Other alternatives such as Ginko biloba .... again, it says there is NO RESEARCH. Since I have found research in a quick search of MedLine, I don't think we can say that. See the Lyon 2001 study for example. The free full text is there, too. I don't know anything about Ginko, etc, can we say something less biased-sounding? Encouraging further research is a far cry from saying there is none as though the issue is closed.

Views on Parenting
I noticed that the views on parenting section was left, dispite the fact that the entire section does not cite its sources. I suggest that the section be deleted two weeks from now (June 16, 2006) unless there are any objection to allow it to remain longer. 4.249.84.35 05:45, 2 June 2006 (UTC)


 * I object!   I suggest that it remain because it represents the logic behind another perspective that many feel is crucial to a fair presentation of the issues.  The contents of the citation  mentioned in that section  covers many of these criticisms.  Limiting such discussion to an anti ADHD page, even if mentioned in this article,  fails to do justice to this point of view.  Although I recognize that this section (written mainly by me, Simon Sobo, MD) strays from the predominant point of view in my profession I strongly feel that it is a valid perspective that is being dismissed a little too easily.  It is almost impossible to have this point of view represented in the major journals, but as I note elsewhere, I am not a nut and have the support of many in the profession who feel similarly.  The contents of the section repeatedly emphasize that it is controversial, and make no attempt to falsify information.  Citations have an important purpose in allowing readers to track down sources to make sure the information being presented is not false, but they are not an end in themselves. The issue is the transparency of how information is arrived at and is generally a good thing, but it also can  contribute to group think, so that information can be screened by "experts".  I know that sounds awfully paranoid, but we are talking about an issue here that involves billions upon billions of dollars spent on care, so objectivity is truly a problem.


 * I would invite the above user to go to my article  for a discussion of the issue of objectivity. --Ss06470 12:23, 3 June 2006 (UTC)


 * Keep This may be the one and only time where Dr. Sobo and I are in agreement, but I too believe the section is necessary to the article's balance.  I even support most of what he has written, although I don't agree with a word of it (but lets not argue about that here).  However I do object to his use of quotation marks.  I find their usage insulting, and I do not believe that their use is in accordance with a neutral point of view.  I also do not like how it refers to the rest of the article.  Dr. Sobo, this is an encyclopedia, and encyclopedia articles do not refer to themselves.  *Kat* 10:13, 3 June 2006 (UTC)


 * But here are a few links about the problem of objectivity It was like a whitewash Go to the section of this admittedly anti ADHD site to the discussion of Professor Pelham's difficulties having his views represented in the journal that published his own article

Or perhaps this editorial about journal objectivity in the NEJM by then editor Marcia Angell will be helpful Is Academic Medicine for Sale. It is noteworthy that Dr. Angell felt so strongly about this issue that she went on to write a book about this subject. She has since been repeatedly portrayed as some kind of nut in order to discredit her point of view. One has to wonder how the editor of the NEJM could ever be characterized this way, except she has dared to take on the powers that be. In my article there are also references to an article by the editor of the Lancet along similar lines.

So yes when there are billions of dollars involved objectivity becomes difficult to maintain and "experts" are not always what they seem.

I believe the user offering to delete the section on parenting is innocent of foul motives and is simply trying to be "scholarly". But why is the insistence on citations and the desire to delete this section being pursued by a person who is invisible. This user name thing was explained to me on the talk page but I still don't get it. Exactly what does the above user know about ADHD and why is this so important to him/her. Who are you? --Ss06470 12:23, 3 June 2006 (UTC)


 * Please sign your posts by adding four tildes ~ . The tildes transform into a signiture.  Without signitures, this conversation is difficult to follow. *Kat* 09:33, 3 June 2006 (UTC)

WRONG WRONG WRONG WRONG WRONG
ADD is NOT the same thing as ADHD. Damnit...


 * OMFG, mr. or mrs. anonymous spillbabblemouth, the provided evidence is really extraordinary, thank you very much. SCNR. seriously: practically all persons with an AD(H)D condition i know, including myself, show a mixture of both hyper- and hypoacticity. with either prevalence the type of thought and perception stays the same, it is most propably still one and the same condition of mind. --brsma 03:58, 4 June 2006 (UTC)

the use of quotation marks for "experts"
I will try to find a better way to express my utter disgust for the use of that word and the attempt to imtimidate and impress most doctors. They are busy people trying to do a good job and when someone teaches at a good school and is presented as an "expert" they often fall into line. If you could only see the literally pounds of verbiage that comes to my office each week trying to sell a diagnosis and pharmaceutical treatments all in the name of "experts" recommendations. It is truly a wizard of oz phenomenon. Now mind you there are good meds out there and the drugs companies lately need defending, because the pendulum has swung too far, but I can't stand the lack of integrity of these professors and the group think that so many in my profession have fallen in to. See my reference to Marci Angell above as confirmation of this particular rant.


 * Why not refer to them as proponents of medication? --*Kat* 06:50, 5 June 2006 (UTC)

--Ss06470 02:25, 6 June 2006 (UTC) The hot issue is not that they are proponents of medication but that they are supported by an industry with deep deep pockets who manipulate information. They pay enormous amounts of money to professors, control journals, conferences and  deluge doctors with mailings of free journals that constantly refer to experts. Since the professors hold prestigious positions in very fine universities this doesn't seem at first that preposterous but it is. I keep adding references to the article about how little is known (the NIH consensus statement, Castellanos statements, the absurd Zametkin pictures of the brain.) and about the distortions (see the reference to Dr. Pelham,Dr Angell's book, and the editor of Lancet rant in the New York Review of Books If I can find the Wall Street Journal article which documented the % of continuing education funds paid for by drug companies that will highlight my point  All of it is presented as "science" or  "evidence based medicine" etc .  But good scientists talk about what we don't know and where the controversies are, not "hear this I am an expert"  That is why I am comparing it to The Wizard of Oz, and trying to expose "experts" for what they are AS for referring people to my article in a more dignified encyclopedia style fashion I am open to suggestions, but frankly I am taking on an awful lot of powerful people who have their views regularly confirmed, circulated and reinforced by repetition. So if the purpose of this article is to inform I feel stylistic considerations should be secondary. Once again, however, if there is a good editor out there who can help me accomplish my purpose to inform the public and slow down the run away freight train which ADHD treatment has become please don't be shy and show me what you can do.

--Ss06470 12:21, 3 June 2006 (UTC)Simon Sobo, M.D.

Further Edits
Cut from the Parental Roles section.
 * Nonetheless, the author misses on the evident problems of persistent mid- to long-term focus when there are no immediate rewards in the activities themselves, the high propability of social failures, and the fact that even with rewarding activities focus is not under control of the person affected by ADHD.

Lets not have another intra-article arguement. If the rest of the article doesn't make this point, then the point can't be made.--*Kat* 06:58, 5 June 2006 (UTC)

--Ss06470 11:11, 5 June 2006 (UTC) While it is true that often, even with rewarding activities, focus is not under the control of the person affected by ADHD. But the problem with this observation is that it assumes that offering a reward will do the trick. There is no question kids with ADHD may start out wanting to concentrate especially, say, if a reward is offered, but they may fail when they get into their customary difficulties when challenged (by the burden of the work required of them). Nevertheless, I would argue that reward is somehow involved in their difficulties, specifically a difficulty dealing with not fun, frustrating tasks Here is a short quote  from my article on this subject.

''Chances are if you ask one of these children how they do with video games most will tell you they have no problem. Hour after hour they can sit totally attentive, totally focused, totally absorbed by these games. This should not be the case if there is a biological interference with concentration. Very often these kids are said to have eye-hand coordination problems (supporting the argument for a biological basis) as illustrated by their sloppy penmanship and also psychological testing shows this to be the case. But video games require an amazing amount of dexterity. Why is there no impairment here?

''I treated a teen-ager who told me that he could not read without his medication. His eyes glazed over, he could go over a page a hundred times and nothing would be absorbed. During summer vacation he stopped his meds, except when he had to read something for school. I asked if he ever read anything else, something not required for school. He told me he didn’t but then remembered one exception. He loved mountain biking. Each month when his mountain biking magazine arrived he tore through it, reading every word, cover to cover. He did not require medication to do this.

Many of the children I have spoken to do okay in one school subject and not another. Sometimes they are simply gifted in this area, so that it comes very easily year after year. But many of them do well in one subject one year and another subject the next year depending on how charismatic the teacher is. ''

While the successful teacher does not offer rewards per se, his/her gift is a reward. This may come from an entertaining style, but also some teachers manage to engage their students (including ADHD students) with the relevance of their subject so that it is no longer boring or as much of an unpleasant task

Finally Castellanos' (then head of ADHD research at the NIMH) Frontline  speculations on how stimulants work is worth noting. “ ''It used to be said that dopamine (which stimulants cause to be enhanced) was the reward chemical--that if something was rewarding, then you would release dopamine. It turns out to be more complicated than that. It's not just whether something's going to feel good, or be rewarded; it's more if there's a possibility that something would feel good. If an animal knows that they're going to be rewarded when they correctly do a task, then dopamine is no longer involved. But when the animal thinks that maybe this is the way to solve the task, dopamine is leading the way, saying, "This, try this, try this." ''


 * I have severe ADHD. Therefore the opinions that you have expressed above, including the quotes from your article have succeeded in making me sick to my stomach.  Doctors like you make the lives of patients like me into a living Hell.  Never the less, I agree that your opinions have a place in this ADHD article.  But this talk page is not a debate forum.  Its a place where we can attempt to come to an agreement over what does and does not belong in this article.--*Kat* 04:14, 6 June 2006 (UTC)

--Ss06470 19:45, 6 June 2006 (UTC)My intention is not to make you sick to your stomach but appeal to your mind with a fair presentation of the evidence. Exactly why should that make you sick? Some of my ADHD patients never come back when they hear my point of view, but many are relieved to learn that their brain may not be physically broken after all. Some tell me that they think of their special ed classmates as "retards" and hated being told they were born with ADHD. They simply refused to accept it. I can't imagine a worse verdict, particularly as a child, than if I had been told told that something was wrong with my brain. That I was born that way. The diminished expectations that I would challenge myself with, not to mention my teachers and partents not expecting too much would easily become a self fulfilling prophecy. I can't tell you how many times at moments of uncertainty I started to wonder if I had what it takes to be a doctor. That is even after being a Phi Bete student? What if I had been told I had ADHD? I realize it would be very cruel to tell some one with MS in a wheel chair to get out of the chair and play baseball like everyone else. So if ADHD is biological what I am arguing could be comparable. But even then, you will discover those who refuse to be held back by their impairments often do better than those who find it comforting. It is not my call, but a patient's and I would not think less of a person if they can't muster that stubborness. But I would hope for it for their sake. Anyway, with ADHD the issue is a little more subtle. The bottom line is that I think it is crucial, if I am right, to not go away and allow the biological people to spread their certainties based on the facts (which is that we do not know the answer to this important question.) I do appreciate that you are fair minded enough to consider the importance of a point of view that you don't agree with. At least that is a beginning.

Some one should get it right
Some one really needs to say that ADD and ADHD are different... Because they are. ok now that that's over with, basically people with ADD (rather than ADHD) find it harder to pay attention (eg in class) and things like that. people with ADHD are different and someone needs to state this and get rid of the redirect from the Attention Deficit Disorder page.

From a very angry --Xykon 10:44, 5 June 2006 (UTC)


 * Ok, I understand that those two conditions are different, therefore the different abbreviations; however, officially the medical name of the diagnosis is "ADD/ADHD"; the DSM-IV, for example does not distinguish between the two, but each patient's case is reviewed and treated appropriately by the patient's provider. (no need to yell...) -- (Patrick 11:18, 5 June 2006 (UTC))

Sorry for yelling by the way (was in a bad mood to start with). Here is a basic list from the DSM IV and to have ADD, you must have at least 6 of these that's right ADD. the version (not sure if thats the right word) I read (given to me from my doctor) notes that they are two different things and puts them under two different headings. •	often ignores details; makes careless mistakes

•	often has trouble sustaining attention in work or play

•	often does not seem to listen when directly addressed

•	often does not follow through on instructions; fails to finish

•	often has difficulty organizing tasks and activities

•	often avoids activities that require a sustained mental effort

•	often loses things he needs

•	often gets distracted by extraneous noise

•	is often forgetful in daily activities

Xykon

--203.32.87.250 09:39, 7 June 2006 (UTC)

Nowhere in the article does it say that ADD and ADHD are the same things.--*Kat* 07:50, 8 June 2006 (UTC)

Actually it does. In the very first sentence of the article it says "Attention-deficit/hyperactivity disorder (ADHD) (formerly known as ADD)" emphasis on the last part. Xykon 09:06, 15 August 2006 (UTC)

Opening sentence confusing
Can someone rewrite please? I am unable to parse the sentence. -- Barrylb

Attention-deficit hyperactivity disorder (ADHD) is considered to be a neurological syndrome that exhibits symptoms such as hyperactivity, forgetfulness, mood shifts, poor impulse control, and distractibility, when judged to be chronic, as symptoms of a neurological pathology.


 * Barrylb, I've rewritten the first sentence as you requested; it should nwo be intelligible, especially if one follows the Wikilinks should clarification of any particular term in this sentences be necessary. (Patrick 23:25, 30 June 2006 (UTC))

GA failure
Auto-fail reason: Use of and. Make sure all "negative" tags are not on a page before nomination.--SeizureDog 18:41, 9 June 2006 (UTC)

deletion of made of statement by the surgeon general
--Ss06470 03:17, 13 June 2006 (UTC)I have deleted a statement that the surgeon general was said to have made after checking the surgeon general's page on the subject of ADHD. Sorry to just act but others are invited to find a statement from the surgeon general's office stating that ADHD is a form of metabolic encephalopathy, or that the limbic system is affected or any other fictional content attributed to that office by whoever wrote that statement. The surgeon general, in fact states that the cause of ADHD is unknown. If there is a different surgeon general page then my citation, my apologies and please return the statement
 * Good catch. Thanks.  --*Kat* 01:50, 14 June 2006 (UTC)

Ss06470Kat. Are you saying that you agree with something I have written? Thank the lord!!!! If you can control your nausea, you really may find other things in my article that you may agree with. I know you think I am this mean doctor, but believe it or not, I am trying my hardest to be constructive on this subject and many others. You might be interested in this oneon the use of psychotherapy along with meds http://www.psychiatrictimes.com/p990423.html


 * I don't consider you to be mean, just wrong. Your point is one that would jive with many people who don't have ADHD, and apparently it jives with people who do have ADHD, but who don't consider that to be a bad thing.  And if that is how they feel, more power to them.  Myself, I know better.--*Kat* 08:31, 15 June 2006 (UTC)

Nutrition
I note in the tidy up of the article (which is a good thing), there have been some bits get a bit skewed, for example, in the Nutrition section, the meta-analysis is attributed to Schnoll et al. The Schnoll paper is a literature review, and the meta-analysis in question was: Neal L. Rojas and Eugenia Chan. (2005). Old and new controversies in the alternative treatment of attention deficit hyperactivity disorder. Mental Retardation and Developmental Disabilities, 11, 116-130. There was plenty of cruft that needed removing, but this ended up mis-representing the views --Limegreen 10:44, 13 June 2006 (UTC)

POV problem
I suggest that the article on ADHD be classified under a neutrality dispute, or point-of view problem, as many here argue about the disorder's very existence. If I'm not mistaken, Wikipedia is supposed to be neutral on all topics of discussion.
 * If the article discusses the doubts about the disorder's existence in a neutral manner, it is not a problem. Wikipedia does allow multiple points of view to be presented. Let us know if there is some particular aspect with which you have a problem. -- Barrylb 02:20, 16 June 2006 (UTC)


 * I would like to also respectfully point out that we helped establish an entirely separate article (and include in this article a reference link to it) for the express purpose to be sure that there is plenty of room for discussion for those who have the "it doesn't even exist" belief to express themselves, present supporting information, and in general be heard. So, I feel that tagging the article itself as having a POV or neutrality problem would be wrong. I truly believe that the issue is that we do not all agree about the subject, not that there is an unfairness in presentation(s). There is so much to be learned on this subject that any credible information deserves to be presented; that way, our readers can form their own conclusions about the subject itself.     Vaoverland 03:21, 16 June 2006 (UTC)

POV problem
I understand. I humbly retract my earlier suggestionMelW 13:04, 16 June 2006 (UTC)MelW

Cortisol?
I'm surprised to see there is no mention of cortisol levels in ADHD-diagnosed persons, as several studies seem to show a correlation between lowered cortisol levels and ADHD.
 * Interesting, if you have a source, I will be glad to add the information (Patrick 18:47, 28 June 2006 (UTC))

Zametkin's brain image
ss06470 I've taken the liberty of changing the description of Zametkins brain image. It incorrectly stated that the subjects were children. I also noted that the picture is of the brain when doing an assigned task. I did not add the discussion regarding this finding that someone added from my article on the ADHD controversy page Here is a reference to Zametkin's article http://content.nejm.org/cgi/content/abstract/323/20/1361

Parental Role
I have multiple problems with this section. This section does not cite its sources. This section is in violation of NPOV, including the parts which mention that the section is "According to one point of view”. This point of view is not significant enough to include in the article if it cannot be cited. Only two points of view are significant regardless; the view of the majority (or at least plurality) and the view of the relevant medical community.  I greatly suspect that this section is the result of original research.  Contradictory statements are made in the two paragraphs in this section; arguments should be made on the talk page, rather than in the text of the article.  Finally this section refers to the ADHD article itself, something which should never happen.  The second paragraph attacks the request for citations in first paragraph!  All (in my opinion), or at least parts of this section, should be deleted. I suggest that the uncited information should be deleted after 2 weeks unless there are objects, and that the rest of the section should be fixed as soon as possible. William conway bcc 00:10, 23 June 2006 (UTC)

--69.0.14.248 06:11, 24 June 2006 (UTC)Please see discussion above "views of paremting" and "futher edits" also above. There is no question that the style could be improved but the content is important. By the way, I have no illusion that my position, and the position of many similar minded people is a minority position among professionals, and all major organizations are lined up behind the biological model, but before you delete this I think you should address the content concerns raised by the article. Yes it is in opposition to mainstream thinking but the logic and questions being raised are powerful ones. That this should be cut and the crazy (sorry scientology people, food additive people, etc etc) stuff left is extraordinary but not surprising. Some day this "disease" will make for interesting reading. Don't know who you are Mr Conway but please understand that children are being put on speed, some at very early ages

--Ss06470 17:46, 24 June 2006 (UTC)Okay, I've rewritten the parental role section in a way that seems more appropriate to an encyclopedia article. If you have objections to the current section please let me know and I will try to work with you for improvement


 * The section has been improved, but the first six lines still need citations. The claim is made that evidence shows this or that.  If evidence does show that “parents of ADHD children experience more stress and depression, give more commands, spend less leisure time with their children, and vacillate between lax and harsh punishment” then this should not be difficult to cite.  Also most of my objection was to sentences such as “although it has not been scientifically proven to the satisfaction of people who have been declared to be experts in the field,”   I suggest this be rewritten as; although it has not been scientifically proven to the point of satisfaction.  There are other problems like this that I am concerned about. William conway bcc 03:49, 25 June 2006 (UTC)

--Ss06470 04:27, 26 June 2006 (UTC) "although it has not been scientifically proven to the point of satisfaction" is not a solution since it completely undermines what is being stated. The key issue is that there are people who claim to be speaking about what is scientific known when, in fact, that isn't the case at all. Some adhere to strict protocols but then make wild generalizations about very iffy data. I have tried to demonstrate some of the fallacies with the Zametkin picture of the brain which has been used again and again as a picture that proves the issue is biological yet all it shows is that ADHD patients were not using the part of the brain that is involved in concentrating on a task. Gee what a surprise. Castellanos conclusions about the smaller cerebellum in ADHD children seems to be valid. He is convinced the problem is biological but he is honest about how little is known and I respect him. The smaller cerebellum could easily be the result of using the brain differently which ADHD people clearly do but that does not mean the problem is biological (see the discussion in the article) So as I state repeatedly science does not have the answers, despite claims to the contrary, and the love affair doctors have for scientific approaches. I have the same love of science, but I respect true scientists who are clear about what is known and not known. So if the answers are by no means clarified by science, I think other approaches to explain the syndrome are valid and should not be dismissed too easily, especially because they represent the common sense view of parents and educators for centures. If you have kids you know they have to be taught early and repeatedly to stay on task, do their homework, remember to bring it home, put up with boring subjects and teachers, sit still, get on line when asked to do so, wait their turn and so on through the list of ADHD symptoms. It doesn't come naturally. Could there be certain kids who are not able to integrate the pressures placed on them into purposive behavior because there is something wrong bioloically. Definitely some of them. Could there be biological factors that are not well understood but neverhtheless there. Probably. But we are leaping ahead without any scientific basis if we claim millions upon millions of children are born with ADHD. So to stress that parental roles are an important factor but is not supported by science puts a criticism there that is uncalled for.

What we are witnessing is a pendulum swing in the paradigm. When I began in psychiatry 35 years ago no one dared criticize Freud. Now no one dares to claim parents play a key role. The only environmental issues allowed in the discussion are toxins, fetal trauma, vitamins, food additives, etc. The extreme turn around is absurd, more like an ideological war than reasonable inquiry. Psychoanalysts once controlled academia (and they were no more open minded). Biological psychiatrists were on the out. When they gained control it was psychoanalysts turn to be out of a job, and their point of view, in essence, banned. To repeat I welcome true scientific understanding when it will come, but I have no respect for "science" as a blinder that excludes important points of view, and somehow claims that it is the only true way to view phenomena when the science simply isn't there  Please see the difficulites one researcher had from the journals when he suggested that pediatricians should do more than hand out pills.(See "it was like a whitewash") His innocent little statement that they cut would have completely undermined drug companies focused advertising that tells pediatrians to hand out Ritaline to ttheir patients and not to worry. They are treating by scientific principles. Also note my comments about the lack of objectivity in "experts" point of view scattered throughout the article and discussions. I keep harping on that term "experts" because it is an intellectually inappropriate self description when the facts of the matter are that modesty should be more appropriate when ignorance is the true state of affairs for everyone. That, plus doctors are relentlessly bombarded by the opinion of "experts" and this has the effect of intimidating the average doctor. (malpractice fears for missing the diagnosis are high-some of the mailings directly imply there will be malpractice implications)   The whitewash article gives you a taste of how serious drug companies are about getting their point of view across. Also see the discussion of the the editor of the NEJM editorial Is Academic Medicine for Sale With literally billions of dollars involved in these issues, this one time where conspiracy theories are appropriate. Also see the discussion of the the editor of the NEJM editorial (Is academic medicine for sale). In other discussions I have reference similar comments by the editor of Lancet (the British eqivalent of NEJM) It is also noteworthy that Dr Angell felt so strongly about this issue that she went on to write a book about it, following which she was often portrayed as some kind of nut. It may also interest you that, as background to my involvement, I might add that I defend drug companies when I feel they are getting a bum wrap (like lately)Moreover, I have been asked to write for phony organizations supported by scientolgists and also to write for Peter Breggin who I feel is far too critical of medications. I have turned both down. I am not a saint and I am sure I am wrong about some of my observations but it is pretty amazing how difficult it is to maintain an independent voice. I am, for instance eventually going to give up on this site since unfortunately, I don't have the time to keep reinstating a fair discussion of the issues. But I hope my discussions have given you a taste of the ferocious forces involved and the difficulty of getting unbiased information out to the public.

Self-published references
There are a couple of places in this article (as I write this, I'm talking about footnote number 28 and external link 12, although obviously these numbers are subject to change as further edits are performed) that reference "http://www.geocities.com/ss06470/ADHD.html". As this is a self-published article (albeit written by an acknowledged expert in the field with numerous previous publication credits), it should possibly not be used for this purpose, as it may not be a WP:Reliable source. I'm not sure what best to do about this. There may be alternative sources for the information referenced here. JulesH 00:34, 27 June 2006 (UTC)

--69.37.53.91 21:58,

--69.37.53.91 22:02, 10 August 2006 (UTC)10 August 2006 (UTC)Regarding the above comments you might be interested in this e-mail received today as to it being a reliable source

Dear Simon, I wonder if you've read my book 'Naughty Boys: Anti-Social Behaviour, ADHD and the Role of Culture'? Your thoughts on the subject are not too far away from mine. I really enjoyed your article, particularly the weaving together of personal narrative and academic enquiry. Would you be willing to put together an abbreviated version (max. 10,000 words) of your article as a chapter for a book that myself and Jonathan Leo are putting together- trying to bring together a cross-section of critiques of ADHD from differing perspectives? I think in paticular a focus on the movement from religious morality to 'fun' morality and the relevance of Freudian theories of instinct would be most welcome (we need someone who is capable of providing some relevant exploration of psychodynamic aspects of the development of attention/impulsivity). In case you might be intrested, I have also attached our stylistic guidelines (Although we are asking for chapters by the end of august, obviously we would be happy to give you more time as this is a relatively late request). Our proposal has been accepted for publication be Palgrave-MacMillan. Look forward to hearing from you. Best wishes, Sami

ATTENTION DEFICIT DISORDER-VISION DEFECT
Bold textI am interested in feedback on my 40 years experience with A.D.D. I have yet to see a patient who was 'diagnosed' as A.D.D. who did manifest those symptoms and who did not have the following visual problems: 1. FARSIGHTED-UNCOMPENSATED 2. ASTIGMATISM-UNCOMPENSATED 3. EXCESSIVE WEAKNESS TO CROSS EYES-CONVERGENCE INSUFFICIENCY 4. OVER COMPENSATED NEARSIGHTEDNESS/MYOPIA


 * This isn't exactly the place to discuss, but sure, I'll bite. I have ADD and I'm not farsighted, nor do I have a convergence insufficiency.  However, I'm incredibly nearsighted, but my up-close vision is, to be blunt, excellent. (If I get close to my laptop screen I can pick out the individual r/g/b pixels for each pixel in the screen)  I do also have astigmatism, left eye only.  For reference, my diagnosis with ADD was made AFTER I first started wearing glasses, not before.  If you're looking for a link between vision imparment(sp?) and ADD though I think there's something there, kind of.  Were it not for a friend of mine having recently gotten glasses at the time -- and me and the other friends doing the typical "oo, what's the world look like with those things on" kid thing -- I never would have figured out that my vision was getting worse.  I failed to notice or understand that being unable to read the blackboard from the rear of the room was a problem.  It was only after suddenly being able to read the license plate of a car several feet in front of me while wearing my friend's glasses that I realized something was up. -- Y&#124;yukichigai 17:20, 9 August 2006 (UTC)

ACID test/profile
My daughter was diagnosed with ADHD, in part because she fit the ACID profile on the WISC-III. I don't see any mention of that here, though: is it something that hasn't come up, or something that's been rejected through consensus? I see here that there have been studies that show it's not a good determinant. --Sar e kOfVulcan 00:14, 30 June 2006 (UTC)

Plagiarism
The section Positive aspects of this article include the text;
 * Though ADHD is classified as a serious disorder, some people have a different perspective and note the positive aspects. They argue that ADHD children tend to look at situations in a different manner, and that those with ADD tend to look beyond the norm. "While the A students are learning the details of photosynthesis, the ADHD kids are staring out the window and pondering if it still works on a cloudy day" (Underwood). Some children might be uneasy about getting into a situation. One positive side of impulsive behavior is the ability to try new things without trepidation. This can be a strength and a weakness: "Impulsivity isn't always bad. Instead of dithering over a decision, they're willing to take risks" (Underwood).

This is word for word indentical to text from http://www.understanding-add.info/adhd-children.htm Other parts of the section are idential or extremely similar to other text from the above site.


 * There is nothing wrong with using the material as long as the source is cited (which is currently not the case, as far as I can tell). However, I'm a little unsure about the credibility of the source, as the web site referenced, to the best of my knowledge, contains only that one page; when comparing the URL to the title, as well as the keywords used in the article, and considering that text ads encapsulate the entire article, in addition to the fact that no authorship or external sites are mentioned, it looks like the page was created for promotional purposes *only*. (There is nothing wrong with that either, however, it should be noted that commercial publications may not always be

unbiased / may be biased in favor of the product promoted, if any). I'm sure there are additonal / alternate sources available which underscore the point in question, but which are not affiliated with commercial interests. (Patrick 23:34, 30 June 2006 (UTC))
 * Yes there is something wrong with using the material. It is not ok to include an entire section mostly been word for word copied.  Lines 1 -6 are copied from the first two paragraphs.  Lines 6 and 7 are copied but selected from other parts of the site's text.  Lines 8 and 9 are copied from the text but a period is put into the middle of the sentence.  This much text is not fair use, citing something does not allow someone to copy as much as they want. I agree that even if it was fair use, it is still an unreliable source. The text should be deleted, but by July 2nd, I also apologize that I wrote May instead of July below.   William conway bcc 00:56, 1 July 2006 (UTC)


 * I must disagree with your assessment of the inclusion of third-party quotations as they relate to fair-use policy: if you could point me to a Wikipedia policy page which states that quotations are limited in length, I would greatly appreciate that; it is my understanding that Wikipedia policy does allow for quotations to be included in articles, properly cited, I'm sure we are in agreement on this. The length of a properly cited quotation, however, is, to my knowledge not limited by policy or statute, rather, the intent of the writer who included the material, as well as the substance, novelty and authorship of the quoted source are taken into consideration when making decisions regarding fair use issues.
 * I believe that the quotation in question here does not violate fair use or other policies based on its length, rather the quote is not cited properly (no quotation marks, no links, no lead-in with reference to original author, etc), on the other hand, the site from which it is quoted also fails to properly cite the source of the material (no author is mentioned, no links or other references are provided). Unless any given work (in any medium) is a new creation / inventive (such as lyrics to a new song) and not simply a statement of already known facts (such as a mathematical formula, the speed of light, the diameter of the earth, or the definition of the term 'song lyrics'), it does not qualify for copyright protection under applicable law (see obviousness, United States copyright law and fair use).
 * Fortunately, however, we are in agreement, that the source material is of questionable veracity to begin with, making the fair use discussion but a moot point; I recommend summarizing the material and avoiding this reference due to lack of credibility. If you know of any alternate sources that may be used regarding this matter, that would be most helpful as well.
 * As far as article content is concerned, I plead against completely removing information regarding positive aspects, even if no reliable source is currently available / I suggest finding a source as soon as possible. Positive aspects of ADHD are important to include in this article to maintain its neutrality / NPOV.(Patrick 02:32, 1 July 2006 (UTC))


 * "Brief attributed quotations of copyrighted text used to illustrate a point, establish context, or attribute a point of view or idea may be used under fair use." "In general, extensive quotation of copyrighted news materials (such as newspapers and wire services), movie scripts, or any other copyrighted text is not fair use and is prohibited by Wikipedia policy."  http://en.wikipedia.org/wiki/Wikipedia:Fair_use#Text   It also states here http://en.wikipedia.org/wiki/United_States_Copyright_Act_of_1976#Fair_use that in the US “the amount and substantiality of the portion of the original work used” is used to determine fair use, regardless of wikipedia policy (as wikipedia is subject to US law).


 * Obviousness is patent law, which is different from copyright law, the article in question as well as lyrics to a song would not be subject to patent law. The article in question has copyright protection as defined by US copyright law. http://en.wikipedia.org/wiki/United_States_Copyright_Act_of_1976#Subject_matter_of_copyright


 * In fact if you wrote something down on a piece of paper in your house right now it would have copyright protection, regardless of whether or not it contains new ideas (as long as it was in your own words). By your definition, of whether or not something is subject to copyright protection, news paper articles for example would not be subject to copyright law because they simply state facts.   For plagiarism a citation would be sufficient, but not for fair use as well.  My goal was not to eliminate the section however, rather remove the portion which has been copied and start over. But I stand by my assertion that the text should be removed.  William conway bcc 03:36, 3 July 2006 (UTC)

I suggest the copied material be remove by May 1st. William conway bcc 03:05, 30 June 2006 (UTC)


 * William, if you wish, please remove the content as we have already discussed above. However, before you do so, please summarize the quoted portion in one or two sentences, starting with "some experts believe that..." or words to that effect, so that we can keep material in this article that establishes this viewpoint. Further, please make a reference after your summary to the website from you said the content was copied. Thanks! (Patrick 12:54, 21 July 2006 (UTC))

ADD
This is ridiculous, ADD without hyperactivity is just as common yet there is no article about ADD and ADD does not come up once in this article, why is this? Samuel 14:08, 30 June 2006 (UTC)


 * To make it easier to come to a consensus regarding nomenclature, as well as ensure consistency and avoid confusion throughout this (rather long) article, I suggest sticking with the naming conventions of the DSM-IV, which is considered an authoritative reference for mental disorders used by health care professionals in the United States and other countries. If you have a better / more authoritative or widely used reference, it is certainly worth including such material in the article, however, the DSM-IV refers to ADHD only, implying that ADD and ADHD may be used interchangeably. (I believe this may not always have been the case, however) (Patrick 23:38, 30 June 2006 (UTC))

"Lack of definitive evidence" problem
This section operates from a logical fallacy, the Argument from Ignorance, by implying that ADD/ADHD does not exist since current science isn't able to determine what underlies the disorder. Perhaps someone with experience tending this page can take care of that. --70.37.248.113 14:51, 30 June 2006 (UTC)TomK

Chop
I'm removing the following few sentences from the Possible Causes section because they really are beside the point. *Kat* 02:30, 1 July 2006 (UTC)


 * In 1998 NIH (US National Institutes of Health) called together most of the experts in this field. They issued a consensus statement. This is the next to last sentence of that report:   "Finally, after years of clinical research and experience with ADHD, our knowledge about the cause or causes of ADHD remains largely speculative. Consequently, we have no documented strategies for the prevention of ADHD."  Similarly the  Surgeon General states the etiology of  ADHD is unknown.

--Ss06470 23:43, 13 July 2006 (UTC)Yes Kat the NIMH and the Surgeon Gerneral's carefully cited statements about the cause of ADHD in a section about the causes of ADHD "really are beside the point." I'm beginning to believe your professed scholarly impulses are not so pure. Where do you get the nerve to pull off this kind of distortion of the material

I think the following would make a great footnote/endnote, but its too much for the main article.
 * For example, learning Braille causes enlargement of the part of the motor cortex that controls finger movements. After they have passed their licensing exam, London taxi drivers have been found to have a significantly enlarged hippocampus (a part of the brain that stores memories (in this case spatial-visual memories))compared to non-taxi drivers Patients abused during their childhood with post traumatic stress disorder will have a flattened out hippocampus. Professional musicians have brains that are different from non-musicians. Monks who meditate show measurable differences in their prefrontal lobes.)

More Edits
From Parental Roles *Kat* 06:39, 4 July 2006 (UTC)

Massive POV
 * ''From a historical perspective, that is, before failures in inculcating self control became a focus of ADHD by those labeled experts (holding to the belief that the explanation for the syndrome must be biological) the crucial role of parenting in this area was not in need of "proof". These critics point out that the requirement for proof is part of a narrowly defined "science" paradigm which  narrows the focus of discussions to exclude important criticisms, and wildly exaggerates what is scientifically known.(See above "lack of definitive evidence" and the contrasting claims in the rest of this article.)

This needs a citation (outside of Dr. Sobo's webpage) before it is reincorporated: ''The number of free journals, carrying the opinions of specialists in this field, that repeatedly call attention to this disorder might have something to do with this.

--Ss06470 04:18, 11 July 2006 (UTC)Kat (whoever that is) you have taken away the NIMH consensus statement regarding the cause of ADHD and robbed the section on parental roles of its themeat so that it is now inane. I will not be returning to this page. You win. You have managed to wear me down and now have a completely useless discussion of ADHD filled with standard unproven assertions by the "experts" and every fringe nutty group that pipes in with their bizarre viewpoints. Good job!

--Ss06470 03:40, 12 July 2006 (UTC)I could not resist taking one last peek since today Kat,  today's lead story in the Wall Street Journal is about the lack of objectivity of the expert science industry. This is not news. As I have repeatedly noted the editor of the NEJM's editorial "Is Academia for Sale" describes the articles in journals you are citing as by authors who are for hire. It is a shameful chapter in the history of medicine. I guess it is time to come right out and say it since your veneer of gentlemanly objectivity is a lot of nonsense. You have pointedly gone about destroying important content in the debate over whether ADHD represents a widespread biological illness, or is the result of changes in the way many children are being motivated to learn how to work and act differently than they might act in the playground. You have been outrageously rude in your actions, and managed to prevent a fair presentation of the subject under the guise of scholarly detachment. So let me just say it. You are a complete idiot

SOS mommy of 2 adhd kids need support
i came here looking for support and it was great i got info but i need a support forum please help me!!!!!!!!!!

alternative treatments section neutrality
I'm tagging the Alternative treatments section as non-neutral. Scanning through it I'm finding lots of questionable prose and probable original research ("Granted, according to a recent meta-analysis, there is little scientific evidence...", "It is claimed by some with ADHD that...", "There has been a lot of interesting work done with..."). This sounds like advocacy at its worst and it has no place in Wikipedia. --Bk0 (Talk) 00:39, 15 July 2006 (UTC)


 * Yes, the whole article seems to be in dreadful shape. --Guinnog 20:36, 3 August 2006 (UTC)

Removal of Inappropriate link
ADD hoax added without discussion, from a high school, non-regulated, nor peer-reviewed site. Thanks (Jocomama 20:36, 29 July 2006 (UTC))

I think this paragraph should be removed
''Because most of the medications used to treat ADHD are Schedule II under the U.S. DEA schedule system, and are considered powerful stimulants with a potential for diversion and abuse, there is controversy surrounding prescribing these drugs for children and adolescents. However, research studying ADHD sufferers who either receive treatment with stimulants or go untreated has indicated that those treated with stimulants are in fact much less likely to abuse any substance than ADHD sufferers who are not treated with stimulants.[24]''

This only applies in the United States. Canada has different, more lenient laws for ADHD.--*Kat* 00:34, 4 August 2006 (UTC)

I think this paragraph from the Timeline is entirely spurious and should probably be removed
I don't see any connection between Dr. Heinrich Hoffman, Struwwelpeter and ADHD; and I don't think Dr. Hoffman's intention was anything more serious than to write an amusing children's story.--House of Usher 17:02, 6 August 2006 (UTC)

''1845. ADHD was first alluded to by Dr. Heinrich Hoffmann, a physician who wrote books on medicine and psychiatry, Dr. Hoffman was also a poet who became interested in writing for children when he couldn't find suitable materials to read to his 3-year-old son. The result was a book of poems, complete with illustrations, about children and their characteristics. "Die Geschichte vom Zappel-Philipp" (The Story of Fidgety Philip) in Der Struwwelpeter was a description of a little boy who could be interpreted as having attention deficit hyperactivity disorder. http://www.fln.vcu.edu/struwwel/philipp_e.html Alternatively, it may be seen as merely a moral fable to amuse young children at the same time as encouraging them to behave properly.''


 * No, that's kind of important. Its mentioned in most major "histories" of the disorder, and was even referred to in The Lancet back in 1899 (not sure about the date).  --*Kat* 03:02, 7 August 2006 (UTC)

NPOV alternative treatments
At the request of Kat, I've taken a shot at NPOVing the alternative treatments section and removed the NPOV-section template. The text got a lot shorter, but I think I've retained all facts and references. Please take a look, and I hope people will check especially for any ignorant removal I may have done of something that's actually essential. Btw, the reference for the neurofeedback research review seems to need some attention, and the "ADD Coaching" paragraph needs a reference. Bishonen | talk 10:22, 7 August 2006 (UTC).
 * Thank you, Bishonen. You did a great job, and I really, really, appreciate it.  Kudos.  --*Kat* 06:46, 9 August 2006 (UTC)

Controversy section
Reorganized this section as well, and attempted to remove all POV. Tricky! Bishonen | talk 17:28, 7 August 2006 (UTC).
 * Again, thank you.

Jeff Rense
Jeff Rense has material that someone else has submitted to him that indicates that ADHD is nothing more than a "invented disease" so that "Big Pharma" (Heard the expressions of "Big Tobacco" and "Big Oil" ?!) can make Million$. This may be found on his site itself and in the archives as well. Martial Law 18:58, 7 August 2006 (UTC)
 * And..? Your external link is still there. I only formatted it. Bishonen | talk 20:20, 7 August 2006 (UTC).
 * You ought to see what is on his site, such as the 9-11 attacks, more on how "diseases" are invented so that Big Pharma can make Million$, the Morgollons disease, other real shockers. Martial Law 23:36, 7 August 2006 (UTC)
 * I've seen it. The fact is, if the mainstream media won't touch it, Wikipedia won't touch it either. Martial Law, this talkpage isn't for discussing "shockers"; please let's keep to things that have a realistic chance of going in the ADHD article (fringe 9/11 theories sure don't), otherwise discussion becomes too diffuse to be useful. Bishonen | talk 00:19, 8 August 2006 (UTC).
 * Will do, Bish. Martial Law 03:57, 8 August 2006 (UTC)

Why can't ADD be a seperate article?
Why can't ADD be a seperate article?

There is obviously a difference between the two and the two terms are used in different contexts.

raptor 12:58, 9 August 2006 (UTC)
 * As mentioned in the article, ADD is considered by some to be an "outdated" name. (Though perosnally I think it's just fine) Furthermore, the differences between "ADD" and "ADHD" (using the old-school terms) are simply a lack of certain hyperactivity and related symptoms; all other aspects of the disease are the same.  Having two pages for two remarkably similar and obviously related diseases is unnecessary. -- Y&#124;yukichigai 17:10, 9 August 2006 (UTC)
 * Maybe this question should be made the first on top of the discussion page. This is the fourth time in the last 37 posts that it has been asked (#8, 11, 25, 36), and before the last archive it was asked many more times. William conway bcc 19:35, 11 August 2006 (UTC)

Regarding biomedical analysis of ADD/ADHD
The article does a good job in mentioning that the disease cannot be identified from any biological tests, and that subjective tests are used instead. However, it needs to make the connection with the fact that drugs are typically applied as a solution. That is, without being able to identify the disease from a chemical test, we are nevertheless applying a chemical solution. This is highly illogical -- in the realm of physics if I applied an electromagnetic solution to something that I couldn't demonstrate as having electric and magnetic components, then you would chalk me up as incompetent. Likewise, the prescription of drugs to solve ADHD is a glaring indicator that scientific method is not being strictly adhered to in this case.

Dr. Karl Hoffower just did a podcast episode discussing this fact among a few other pertinent issues. He got his data from the Citizens Commission on Human Rights


 * First off, you forgot to sign your comments. Are you ADHD by chance? :P
 * Anyway, the suggested additions you propose are WAY out of the realm of Neutral Point of View. That being said, I think you're overlooking an obvious use of the scientific method: a person has problem behaviors; when the person takes medication, they go away.  By definition that makes it a medically treatable disease.
 * There are numerous other dieases out there which do not have any readily identifiable cause or biologically testable symptoms which can confirm it, and instead must rely on testing to exclude other possible causes. Lupus is a good example of such a disease.  -- Y&#124;yukichigai 20:07, 11 August 2006 (UTC)


 * Oh good. CCHR. Can't beat them for an informed an impartial source.  NOT! --*Kat* 06:31, 14 August 2006 (UTC)

Postive Aspects Section
I am removing the following text: ''If, as some theorists claim, ADHD is not a single biological condition, but an inability to "get with the program" from whatever cause, then the outlook for these children is obviously variable. It often is linked with conduct disorder and may be the beginning of a life of irresponsibility and possibly crime. It may also be the beginning of a creative career that creates its own "program." Many children with ADHD flounder until they find something they love to do, or are inspired by a figure who teaches them the skills that are needed. And some never get there.''

Removal of such a large portion of text deserves the following explanation. The first sentence is not related to positive aspects of ADHD. The second sentence describes a negative aspect. The third sentence is reliant of the first two sentences. The fourth sentence describes ways in which the disadvantages of ADHD can be overcome rather than a positive aspect. The fourth sentence is also not ADHD specific. The fifth sentence is reliant on the fourth sentence. William conway bcc 01:27, 15 August 2006 (UTC)

Another hunka chunk of junk removed
Until we find a more credible source for the information below, I propose that it remain excluded from this article.--*Kat* 01:48, 28 August 2006 (UTC)


 * Another interesting example of great success with ADHD is Michael Flatley, the man with the "Feet of Flames". Creator of River Dance, winner at 17 of the all-Ireland flute championship, and once a golden glove competitor, while growing up in Chicago Flatley was an ADHD-diagnosed Irish punk and charmer.

Repeats
This just goes to show that I'm not going insane (no pun or shades of malodorous meaning with that)... but the third paragraph in the Skepticism sub-section and the second in the Parental role are, but for a couple of words, the same. That probably shout be cleaned up or both redefined as from my reading the said idea (that it's the natural order of bored kids) could fit under both. Desk Jockey 04:05, 28 August 2006 (UTC)

It seems as though this repetition of information is probably an error. If you read the two sub-sections you can see that in the second paragraph of the Parental role section the first sentence speaks about the possibility that certain parenting methods may cause ADHD but then the second goes on to talk about ADHD being seen as a "natural" way for children to behave when they are stuck in a situation that doesn't engage them. There is conceptual confusion with this, so a rewrite or deletion of this paragraph altogether seems required. (Cf1 11:22, 29 August 2006 (UTC)) --69.37.244.31 11:14, 8 September 2006 (UTC) Here we go again! It is saying that the natural way for children to behave resembles the symptoms of ADHD unless parents can successfully guide them to different behavior. The conceptual confusions is yours and indicates to me that you probably don't have children. You might take a look at the abstract of my article to get a bit more focused.

Suggested additions--under control and cited!
As with alcoholism, drug abuse, and other neurological spectrum disorders from bi-polar to Asperger's, I would suggest a section with citations on the likely and under-counseled effects of ADHD: on the family dimension--non-ADHD spouses and children and/or siblings; the high recorded incidence in prison populations; in divorce; in adoptive children (from impulsive accidental parent(s)); and the cumulative generational effect (ADHD parent(s) trying to raise ADHD kids, or in denial, or alerted to their own adult diagnosis vi the children), not to mention a stand-alone section on the co-morbid overlap and resulting difficulty in diagnosing and treating when presenting alongside with bi-polar, anxiety, depression, Tourette's, epilepsy, OCD, etc.

A mention of the national organizations and journals would be helpful.
 * There already are several references to the journals. I'm pretty sure that there are links to the organizations in the external links and references sections.--*Kat* 11:15, 3 September 2006 (UTC)

Also, helpful: a note re: the booming research and the percentage of medical doctors, specialists, neurologists, psychiatrists, and mental health counselors of all stripes who are "behind" on the ADHD research overall, the impact, the pharmacology, and misapplied or mistaken mainstream treatments--and as a reason for the few but highly publicized cases of misdiagnosis, or over- or mis-prescribing versus the thousands who go untreated.

"Controversies" should include not only a note re: alleged the financial boon of pharma companies as a spur to diagnosis, but on the other side the scattered anti-ADHD voices--potentially born of the undiagnosed or in-denial overcompensating ADHD superego, especially in males-- of those with ADHD with a personal bent to avoid or disprove the mainstream research, appealing to no-drug solution and miracle treatments without scientific backing. While speculative, this tendency is by definition and observation within the predictable reaction of those who feel threatened rather than relieved, non-empirical leftovers of the mental health treatment stigma. Larry Nemecek
 * You make a valid point, but given this article's prior instability, I believe (strongly recommend in fact) that we work out the wording on a talk page or somewhere out of site. --*Kat* 11:15, 3 September 2006 (UTC)

Landmark achievement
The article is stable and fully referenced.--*Kat* 11:15, 3 September 2006 (UTC)