Talk:Attention deficit hyperactivity disorder/Archive 20

good picture for pathophysiology - I want to use it, but there are some origin problems to solve first.
In the recent cleanup, this picture got binned in the process. I thought it was nice and would better replace the general brain picture in the pathophysiology section. The only problem is I can't find the context the picture was used in in order to source it appropriately, see if the source is acceptable, and verify if the public use rationale is correct. Anyone else know where in the NIMH materials it came from? 152.16.15.144 (talk) 21:59, 21 April 2010 (UTC)


 * Yes we need some source before we return it to the article. Doc James (talk · contribs · email) 22:01, 21 April 2010 (UTC)
 * After a quick check with Tineye I found NIMH used it for a press release here. --92.6.211.228 (talk) 19:11, 24 April 2012 (UTC)

Good source but is it a secondary one?
http://www.aafp.org/afp/2001/0901/p817.html - It's a good potential source. It looks like a usable secondary RS to me, but I am asking for a second opinion on whether it looks appropriate. 152.16.15.144 (talk) 22:30, 21 April 2010 (UTC)


 * Yes feel free to use it... Doc James  (talk · contribs · email) 23:46, 21 April 2010 (UTC)


 * It's definitely a secondary source. It is almost ten years old, however, so it shouldn't be used to "debunk" a more recent source (assuming that the more recent source is otherwise of similar quality).   WhatamIdoing (talk) 23:51, 21 April 2010 (UTC)


 * This newer paper from the AFP may be better  Doc James  (talk · contribs · email) 04:16, 22 April 2010 (UTC)

Diagnosis
I removed the "either" / "or" statements in the diagnosis criteria according to dsm-iv. It is just not correct, as can be seen from the reference. Lova Falk  talk  06:29, 19 May 2010 (UTC)

Shenanigans?
This reference is to an article that's totally irrelevant to ADHD, it's an editorial on words like "wheelchair-bound." Check it out: http://journals.lww.com/ajpmr/Citation/1991/02000/Words,_Words,_Words.1.aspx

cite journal |author=Johnson EW |title=Words, words, words |journal=American Journal of Physical Medicine & Rehabilitation |volume=70 |issue=1 |pages=1–2 |year=1991 |month=February |pmid=1994964 |doi=10.1097/00002060-199102000-00001 It's not really a source for diagnostic procedure, since it's an op-ed that's on a different topic. Who does this? Why does this happen? 75.73.32.46 (talk) 18:54, 27 April 2010 (UTC)


 * Yes more eyes are needed on controversial topic such as this that get frequent vandalism. Doc James (talk · contribs · email) 19:37, 27 May 2010 (UTC)

Other non-stimulant medications
Under the above mentioned header, it says: "Other medications which may be prescribed off-label include alpha-2A adrenergic receptor blockers such as and clonidine " - as you can see, a brand or generic medication name seems to be missing in the sentence (such as XXXXX and clonidine"). I tried to find an answer to it online, but couldn't, so hopefully somebody else can add it. Peapeam (talk) 03:16, 25 May 2010 (UTC)
 * If nobody finds it, you can just remove "and" so the sentences finishes with: "such as clonidine." Lova Falk   talk  06:31, 25 May 2010 (UTC)
 * Fixed Doc James  (talk · contribs · email) 19:34, 27 May 2010 (UTC)

"Famous People"
In an article about ADHD, a list of famous people just takes up space and makes for even slower loading. I don't think it belongs here.

One solution might be the one used for Dyslexia. There is a separate article: List of people diagnosed with dyslexia, listed, of course, as a See also. --Hordaland (talk) 19:24, 27 May 2010 (UTC)


 * I agree H that this is a good idea. With a condition that may affect 17% of the population this list could get very long and there is also the question of notability / trivia. Doc James  (talk · contribs · email) 19:31, 27 May 2010 (UTC)


 * Great ideas. The best idea is to remove the list, second best to create a separate article. Lova Falk  talk  19:35, 27 May 2010 (UTC)

Tolerance
The reference to the letter to the editor regarding tolerance was misrepresented. This article said that tolerance occured in doses above 60 mg but the letter actually said it may be necessary to increase the dose above 60 mg to counter-act the effects of tolerance. Looks like a good faithed misinterpretation of the source. I have fixed the issue. Tolerance and dependence are listed in the British National Formulary as adverse effects of methylphenidate as well as dexamphetamine; might be worth referencing it, although it doesn't say much about it other than they are adverse effects.-- Literature geek |  T@1k?  00:08, 10 June 2010 (UTC)

TV and children
Get rid of TV advertisements where children programs are on. :) —Preceding unsigned comment added by 89.111.97.100 (talk) 18:59, 2 July 2010 (UTC)

Diet
The section on diet are a bit missleading about E-numbers and the US. It mentions that the England has forced manufacturers that use(for example)ponceau 4R (E124)in food to display a warning. Then the text go on that "In the US, little has been done to curb food manufacturer’s use of specific food colors, despite the new evidence presented by the Southampton study". But if you go into the articel about ponceau 4R (E124) it says that this E-product is banned in the US. And that it seems that it has been banned for a long time. A search on the FDA page marks allmost all of the E-products mentioned,as "unapproved colours".

Thus, this text about diet contains missleading information and there I have will remove it. —Preceding unsigned comment added by 192.71.219.1 (talk) 07:52, 11 July 2010 (UTC)


 * On June 30, 2010, the Center for Science in the Public Interest (CSPI) called for the FDA to ban Yellow 6. The CSPI said, "These synthetic chemicals do absolutely nothing to improve the nutritional quality or safety of foods, but trigger behavior problems in children and, possibly, cancer in anybody."
 * If correct this would imply that the FDA has not banned the colourant. There is this where the FDA list of additives has it on
 * List 1 - Color additives subject to certification and permanently listed (unless otherwise indicated) for use in FOOD.
 * FD&C Yellow #6 - Food, drugs and cosmetics - GMP - 74.706, 74.1706, 74.2706, 82.706
 * This means that manufacturers are free to use it in food and only have to list it on their products as an additive.
 * I have reverted the IP edits until more references can be found that state that action has been taken "to curb their use". Merely listing it and getting approval does not state a definite process to curb it's use. (text is in the section Diet)
 * I have also added a CN tag to the statement as clarification of "by comparison" or something along those lines may be needed Chaosdruid (talk) 10:37, 11 July 2010 (UTC)


 * Sorry, this is bullshit. First of, the section builds on the claim done by ONE study that indicates that food additives might be a cause for ADHD(Thus, the support for this claim seems weak.).Another problem is that I did not make a claim, I removed a claim that I thought was false. The claim is that the US seems to do little or less then England/EU to either ban these specific additives or additives in general. Please explain to me how the US have done less then EU/England, when the US seems to have banned atleast three of these additives from use in food? While the EU don't even think that the study was done properly and have not banned these additives? This section of the ADHD-page should be flagged as biased/and or untrustworthy. —Preceding unsigned comment added by 85.224.168.108 (talk) 16:01, 12 July 2010 (UTC)


 * I am assuming that you are the same person as the IP 192.71.219.1 above?. The POV tag is not accurate. It does not represent one particular point of view. I believe you are asserting that it is biased against the US?.
 * Wikipedia relies on verifiability. The study is in the Lancet. THe UK law means that all ingredients contained in a product are listed in an ingredients panel on the product packaging. The study results did lead to the FSA and the UK recommedation for full withdrawl by 2009 and warning labels on products containing the Southampton 6. The EU has also made it mandatory to put warning labels on products containing them.
 * You have not provided any support for any US warning labels - at the moment the FDA has not made that mandatory.
 * I think you are confusing the statements and reading that the US has not made "any effort at all" but it is meant as "towards warning labels"
 * The sentence can be rewritten to better address the issue. I suggest amending it to "THe US has not taken any steps as yet to make warning labels mandatory" or something similar
 * Chaosdruid (talk) 18:11, 12 July 2010 (UTC)

Listing of status
In order to progress this I am going to list each one and their status from the FDA list and have highlighted the US status merely so it can be easily seen...


 * Ponceau 4R (E124) - Red colouring : Banned in the US, Warning label in EU - "Ponceau 4R is a non-permitted color additive in any food." (FDA)
 * Sunset yellow (E110)/FD&C Yellow #6 - Warning label in EU, Free to use in food in the US - (List 1) "FD&C Yellow #6 - Food, drugs and cosmetics - GMP - 74.706, 74.1706, 74.2706, 82.706"
 * Carmoisine (E122)/FD&C Red #3 - Red colouring in jellies : Warning label in EU, Free to use in food in the US (List 1) "FD&C Red #3 - Food and ingested drugs - GMP - 74.303, 74.1303. May no longer be used in cosmetics, external drugs, and lake."
 * Tartrazine (E102)/FD&C Yellow #5 - Yellow colouring : Warning label in EU, Free to use in food in the US "Food, drugs and cosmetics, including drugs and cosmetics for eye area - GMP - 74.705, 74.1705, 74.2705, 82.705"
 * Sodium benzoate (E211) - Preservative : Warning label in EU, Free to use in food in the US  "FDA has no standard for benzene in beverages other than bottled water"
 * "In response to consumer insistence on a more natural product and E211's links to DNA damage and ADHD, the Coca Cola Company is in the process of phasing Sodium Benzoate out of Diet Coke. The company has stated that it plans to remove E211 from its other products — including Sprite, Fanta, and Oasis — as soon as a satisfactory alternative is discovered. "


 * Quinoline yellow (E104)/D&C YELLOW #10 - Food colouring : Warning label in EU, not used in food in US - not listed for food(List1), but in use for Drug and cosmetic use(List2) and Medical devices(List7), recently taken off Externally applied drugs(List3)
 * Allura red AC (E129)/FD&C Red #40 - Orange / red food dye : Warning label in EU, Free to use in food in the US (List 1) "FD&C Red #40 and its Aluminum Lake - Food, drugs and cosmetics, including drugs and cosmetics for eye area - GMP. Other lakes for food, drugs and cosmetics are also permanently listed - 74.340, 74.1340, 74.2340"

It seems to me that this can be broken down simply.
 * The US has banned one of them completely: Ponceau 4R.
 * Removed one from food: Quinoline yellow.
 * 4 are allowed for use in food without any warning labels: Sunset Yellow, Carmoisine, Tartrazine & Allura Red.
 * Finally one is not regulated: Sodium Benzoate.

Chaosdruid (talk) 19:27, 12 July 2010 (UTC)

management and Stimulant meds section
The management section, especially the stimulant med section, is getting out of hand. It's too long and a disproportional amount of it is spent on discussing in detail about addiction and abuse such that it overwhelms other important information such as what the actual stimulant drugs are, how they work, what general practice is on prescribing them, etc. The discussion of the various studies really ought to be moved to the management page, with brief summary of the current prevailing medical opinion (or lack of one whatever the case) on addiction and abuse. 152.16.15.144 (talk) 22:09, 30 July 2010 (UTC)
 * Yes agree. Doc James  (talk · contribs · email) 22:25, 30 July 2010 (UTC)
 * I also agree on all of these points, per WP:WEIGHT and availability of another article for more detail. Cresix (talk) 23:22, 30 July 2010 (UTC)
 * Since it seems I have some support that this section has problems as described above, and not much has happened to improve these issues in a while, I am adding an emphasis section tag to see if I can attract some attention to it. 152.16.15.144 (talk) 22:47, 20 September 2010 (UTC)

I'm wondering if we can provide a more substantiated reference for the following statement:

"In one study which looked at adult cocaine users, it was found that those individuals who used Ritalin between one and ten years of age had a percentage of cocaine abuse twice that of those who had been diagnosed with ADHD but had not utilized Ritalin.[146]"

I question the context and accuracy of the above statement for a number of reasons. First, it references http://www.addictionsearch.com/treatment_articles/article/ritalin-abuse-addiction-and-treatment_43.html and does not directly reference an academic source. Second, the context is questionable and does not consider cocaine use among individuals diagnosed with ADHD who are not taking any medication, or those who discontinued medication and now use illicit substances.

Tshortho (talk) 04:27, 2 November 2010 (UTC)


 * I agree completely that a better source is essential. The source does not cite a specific peer-reviewed study to back up the claim. We have no idea what the bases of this conclusion are, or whether the research appropriately controlled for confounding factors (such as severerity of ADHD and/or comorbid conditions). Perhaps even worse, the website is for a for-profit substance abuse treatment facility that can't be considered completely unbiased in their views on the relationship between ADHD stimulant use and abuse of other drugs. This is a medical article that does not need such grossly inadequate sourcing. If this finding is legitimate, someone can find a better source. I have removed the current citation for these reasons and replaced with a citation needed tag. Thanks for alerting us to this, Tshortho. Cresix (talk) 15:26, 2 November 2010 (UTC)


 * It appears that the statement which uses citations #159 and #160 is actually contradictory to the results of the cited studies. Both studies do indeed show that proper treatment of ADHD, with the use of stimulant medication, does indeed decrease the risk substance abuse later in life. The two studies, at least from what I garnered from their abstracts, indicate no results regarding increased substance use with Adults and Adolescents with ADHD who take stimulants. —Preceding unsigned comment added by 114.142.232.175 (talk) 11:50, 2 December 2010 (UTC)
 * You can't make that judgment just based on the abstracts. You need to read entire articles. When I have time I'll try to take a look at the articles. The phrase "has potential for abuse" may be the tricky part. If the full article only mentions "potential" from a more theoretical standpoint of similarities between methylphenidate and cocaine and amphetamines, then the wording in the Wikipedia article indeed is misleading. Cresix (talk) 16:38, 3 December 2010 (UTC)

Nearly One Million Children in U.S. Potentially Misdiagnosed With ADHD, Study Finds
This study seems worth mentioning in the article: http://www.sciencedaily.com/releases/2010/08/100817103342.htm  Gandydancer (talk) 23:12, 17 August 2010 (UTC)
 * Thanks for posting the link. It's an interesting article, but you will need more than a second-hand article derived from another article written by an economist in the Journal of Health Economics. This article is largely a medical article. Please find something to back up the author's conclusions in a psychiatric, psychological, or other medical peer-reviewed journal. It might be worth a brief mention in Attention-deficit hyperactivity disorder controversies, but be cautious not to violate WP:WEIGHT and WP:RECENT. Cresix (talk) 00:46, 19 August 2010 (UTC)

"Invitation to edit" trial
It has been proposed at Wikipedia talk:Invitation to edit that, because of the relatively high number of IP editors attracted to Attention-deficit hyperactivity disorder, it form part of a one month trial of a strategy aimed at improving the quality of new editors' contributions to health-related articles. It would involve placing this:"You can edit this page. Click here to find out how."at the top of the article, linking to this mini-tutorial about MEDRS sourcing, citing and content, as well as basic procedures, and links to help pages. Your comments regarding the strategy are invited at the project talk page, and comments here, regarding the appropriateness of trialling it on this article, would be appreciated. Anthony (talk) 11:42, 31 August 2010 (UTC)
 * The list of articles for the trial is being reconsidered, in light of feedback from editors, and should be ready in a day or two. If you have any thoughts about the Invitation to edit proposal, they would be very welcome at the project talk page. Anthony (talk) 14:30, 2 September 2010 (UTC)

Environmental Contaminants -Lead and Mercury, other
Joel Nigg in What Causes ADHD? makes a case for lead poisoning, mercury poisoning, as well as other environmental contaminants causing 2-15% of cases of ADHD. He also relates premature birth (in this article already?).

Joel Nigg, What Causes ADHD? Lead poisoning - p. 246,247,215,262,344,377 Mercury poisoning - p. 251,318,345,253,335,262,276,299 http://books.google.com/books?id=y_LCZuc-F8wC&printsec=frontcover&dq=joel+nigg&hl=en&ei=QB2KTNzdLoHGlQft87WeDA&sa=X&oi=book_result&ct=result&resnum=1&ved=0CCwQ6AEwAA#v=onepage&q&f=false Natural (talk) 12:00, 10 September 2010 (UTC)Natural

Television and Video Games
Nigg, p.282, 284, 287, 345, 288, 317, 100 Nigg sees a correlational relationship, not necessarily a cause - effect relationship, as far as the evidence of existing studies goes. He feels that more research is needed before coming to conclusive statements on this. Most parents are interested in the role of television and ADHD.

Another significant study is --- reported in- PEDIATRICS Vol. 113 No. 4 April 2004, pp. 708-713 Early Television Exposure and Subsequent Attentional Problems in Children Dimitri A. Christakis, MD, MPH*,,,||, Frederick J. Zimmerman, PhD,, David L. DiGiuseppe, MSc, Carolyn A. McCarty, PhD*, http://pediatrics.aappublications.org/cgi/content/abstract/113/4/708
 * Department of Pediatrics, University of Washington, Seattle, Washington

which again, gives evidence for a correlationtial relationship, rather than definite proof that TV viewing among children causes ADHD.

Nigg also mentions video games in connection with ADHD as a possible cause. p.345,280,103,301,74

Natural (talk) 12:07, 10 September 2010 (UTC)Natural


 * You make a good point that these are correlational relationships. And with these particular variables there are numerous possible explanations for the results that don't directly relate to TV viewing. For one thing, there is likely a substantial difference between parents (and their own diagnostic histories) who use TV as a babysitter and those who are judicious in what they allow their kids to watch. I personally think this information does not belong in this particular article; perhaps a brief mention in a related article, with a caveat about the interpretive problems. Thanks for raising the issue here. Cresix (talk) 16:35, 10 September 2010 (UTC)


 * I won't fight that point, but also, I feel like, a lot of parents, teachers and others bring up that question about TV and ADHD. There is some evidence supporting it, it's logical, although not proven. Many other authors have written about it, Thomas Armstrong, clinical psychologist Susan Ashley, others, in their published books. So, while there might not be many clinical studies scientifically proving it, it is a point that is mentioned in many reliable reference works. So, if it is possible, it could be mentioned in context, that is concerning television. That there is no definite proof for it, the evidence is correlational rather than direct, with a reference to the Critakis study and other reference works, I'll try to come up with the quotes and pages below. Natural (talk) 21:28, 15 September 2010 (UTC)Natural

Basically, what Susan Ashley states in her book, http://books.google.com/books?id=ZKpBEPd0w5kC&printsec=frontcover&dq=susan+ashley+adhd&hl=en&ei=vTqRTM-jC4P88Aa6vZGUDQ&sa=X&oi=book_result&ct=result&resnum=1&ved=0CDYQ6AEwAA#v=onepage&q=television&f=false

on this page, sums it up in the proper manner. page 15. Nigg says more research is needed on this, which is a good point for the professional public to note as well. No one is really sure if TV or video games cause ADHD. So, if some professional studies were forthcoming to give a more definitive answer, it would help all the way around. Natural (talk) 21:32, 15 September 2010 (UTC)Natural


 * Thanks for your response. I would strongly oppose anything about it in this article because this article is a medical article that is an overview of the entire area of ADHD that is based largely on clearer, less equivocal evidence. This article is a parent article to several other ADHD articles. A brief mention (with all the interpretive caveats) might be appropriate in one of those articles, but I suggest bringing it up on the talk page as you did here. Lots of people say lots of things about ADHD, including people who write books (even psychologists and psychiatrists), but much of it is speculative, based on anecdotal evidence (or worse, little to no evidence), and/or even bizarre theories (e.g., see Indigo children). If we open the flood gates to this type of speculation, the article soon will be overcome with some very nonscientific conclusions. That's not to minimize the importance of speculation and anecdotal information; those are often the springboard to more solid research, but let's keep the speuclation away from this article. Thanks. Cresix (talk) 22:56, 15 September 2010 (UTC)
 * I pretty much agree with Cresix here. There is such a volume of stuff about ADHD research that the entry gate has to be pretty high; my opinion is that a particular ADHD research topic in general needs to be mentioned in independent secondary sources basically showing that the general ADHD research community finds the idea notable (regardless of whether mainstream researchers think it's valid or not). Note that I haven't reviewed the sources above to see if they work as independent secondary sources, so I have no opinion either way whether this research should be included in the article. 152.16.15.144 (talk) 23:03, 20 September 2010 (UTC)
 * Thanks anon 152. Notability is important, but I don't necessrily consider it sufficient. The big problem with this information on TV and ADHD is that it is correlational research (with all the related limitatons) AND there are so many alternate explanations besides TV directly impacting attention skills. As I've said earlier, a brief mention in a related article may work, but not here because this article is largely restricted to research with more solid and less ambiguous findings. Regarding notablity, I personally consider the research notable, just not conclusive enough for this article. Cresix (talk) 01:28, 21 September 2010 (UTC)

Removed the following, recently added
I just removed the following, apparently added just a few minutes ago right at the beginning of the article:

Undiognosed ADHD is often the cause of many disorders in Adults such as Anxiety and Depression. The inability to organise, maintain focus and dibilitating social interaction and working memory problems can and do cause these aditional disorders in adults who go through life undiognosed.

"It apears that the medical industry as a whole are narrow minded when it comes to the effects of Adhd in an Adult and therefore are prone to completly ignoring it as a possability in a patiant. This is mostly down to lack of education on the doctors behalf and lack of skill in how to question a possible Adhd patiant. It is shocking to see how many doctors and medical “experts” fail to gain a basic knowledge on Adult Adhd as well as Adhd in Teenagers, they are only just starting to get to grips with Adhd as a real disorder."

Aside from being badly spelled and carelessly written, it is blatantly POV. An in any case, it does not belong at the beginning of the article. Regardless of the merits--or lack thereof--of the point someone is trying to make, this sounds like someone just got on a soapbox to vent his or her frustrations. 140.147.236.194 (talk) 12:45, 21 September 2010 (UTC)Stephen Kosciesza


 * Thanks. Doc James  (talk · contribs · email) 22:45, 26 September 2010 (UTC)

Image in the lead
The PET image is very old. Pet scans are not used outside of research in ADHD. Thus having the image in the lead is WP:UNDUE. Moved to appropriate section. Doc James (talk · contribs · email) 18:16, 23 September 2010 (UTC)

Move?

 * The following discussion is an archived discussion of a requested move. Please do not modify it. Subsequent comments should be made in a new section on the talk page. No further edits should be made to this section. 

The result of the move request was: page moved: has run 19 days. Anthony Appleyard (talk) 08:46, 18 October 2010 (UTC)

Attention-deficit hyperactivity disorder → Attention deficit hyperactivity disorder —
 * nowadays usually spelled without any hyphen or slash. See for example Medscape, most major general dictionaries, medical dictionaries, other reference works, style guides,, the United States National Institute of Mental Health, and the U.S. National Library of Medicine. A minority of medical publications use uppercase or hyphenation or slashes, e.g. American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington DC, the U.S. National Institute of Neurological Disorders and Stroke, McGraw-Hill Concise Dictionary of Modern Medicine. Medscape and dictionaries base their spelling decisions on the most common spelling in reliable sources, including medical sources. --Espoo (talk) 08:46, 29 September 2010 (UTC)
 * These were my comments when the move was requested as "Uncontroversial" : This is not necessarily an "uncontroversial request". There is current discussion about how to name the disorder at Talk:Attention-deficit hyperactivity disorder. The official title for the disorder in the United States includes the hypen. See talk page. This request is premature. I ask for a wait until some consensus is reached on the talk page. Cresix (talk) 23:23, 26 September 2010 (UTC)
 * There is no such thing as an "official title in the US" - and the spelling used by most official and reputable institutions and publications in the US is without a hyphen. See above. --Espoo (talk) 08:42, 29 September 2010 (UTC)


 * Don't care, so long as, whatever title we end up with, all the other formulations (ADD, ADHD, AD/HD, ADD/ADHD, etc.) redirect to it. Anthony (talk) 09:20, 27 September 2010 (UTC)


 * Support Keep the name simple and redirect everything to it. Sounds good.  Doc James  (talk · contribs · email) 15:30, 27 September 2010 (UTC)
 * Comment - I direct everyone's attention to the discussion in the section immediately above (Talk:Attention-deficit hyperactivity disorder). I oppose the move pending outcome of above discussion about how to name the disorder in the text of the article. If that consensus is to remove the hypen, I'm fine with the move. Cresix (talk) 17:28, 27 September 2010 (UTC)
 * Don't if the hyphen is in or out but Anthony's correct -- ALL of the alternatives, including those not chosen, should redirect to the chosen title.
 * The above discussion is preserved as an archive of a requested move. Please do not modify it. Subsequent comments should be made in a new section on this talk page. No further edits should be made to this section.

Fix the "medication" section
That first paragraph is poorly written. There is one sentence, "Stimulant medication or non-stimulant medication may be prescribed." which is out of place. It breaks up the flow of the paragraph (still poorly written) as much as me now saying, "This page has a white background." —Preceding unsigned comment added by 74.138.131.215 (talk) 05:16, 25 November 2010 (UTC)
 * I moved the sentence you quoted to the beginning of the paragraph. That helps with the flow. Otherwise there's nothing wrong with the paragraph. The statement about both types of medication is needed because stimulant medication by far is the most frequently prescribed, but there are some cases when non-stimulant medication is more appropriate. Medically it's not nearly as simplistic or obvious as saying, "This page has a white background."

Moved content to subpage
Move indepth discussion of stimulants and off label medications belongs on the management subpage. Doc James (talk · contribs · email) 01:08, 10 January 2011 (UTC)
 * I have moved this content again. We have a subpage. We need only an easy overview here not an indepth discussion. Doc James  (talk · contribs · email) 18:04, 2 February 2011 (UTC)
 * I agree we don't need a lot of overlap between the parent article and the subpages. ADHD is a very broad topic, and the various areas should be discussed fully in the subpages rather than in the parent article. More than that, however, I don't think we need an edit war on this issue. I hope everyone will discuss here rather than continuing to add and delete the same info. Thanks. Cresix (talk) 20:50, 3 February 2011 (UTC)


 * For reference, the text appears to have been added to the other article here. Innab, do you agree that all of the relevant information is (still) present at Attention-deficit hyperactivity disorder management?  Did anything important get lost from Wikipedia in the move or subsequent copyediting?  If so, then we can focus entirely on how this article should summarize that one, without worrying about information being lost overall.  WhatamIdoing (talk) 20:48, 4 February 2011 (UTC)

Review articles
A few reviews with which to update this article. -- Doc James (talk · contribs · email) 03:10, 10 January 2011 (UTC)

Caffeine & ADHD Focusing
Sources for Caffeine as a stimulate for ADHD focusing: http://www.asktheneurologist.com/Adult-ADHD.html (Slides 22-24) http://en.wikipedia.org/wiki/Low_arousal_theory http://www.youtube.com/user/DocADHD http://www.youtube.com/watch?v=DzH9sNQmclo

Personal Experiences: I have Adult ADHD at age of 24 and I find Caffeine makes a big different when needing to focus. If I'm doing a task or anything and become stuck due to a lack of stimulation Caffeine is a great way to fill the gap which allows the continuation of the task. Improvements for ADHD is already mentioned "In essence, caffeine consumption increases mental performance related to focused thought while it may decrease broad-range thinking abilities." but not linked to ADHD in the statement. —Preceding unsigned comment added by 86.0.140.137 (talk) 10:49, 30 January 2011 (UTC)


 * New sections go at the bottom of the talk page. Sorry, but the sources are inadequate. Wikipedia can't source itself; not to mention that it does not directly support use of caffeine for ADHD. The other sources are not reliable. Your personal experiences may be interesting, but that's original research and have no bearing on a medical article. Cresix (talk) 16:57, 30 January 2011 (UTC)

New guidelines

 * Doc James (talk · contribs · email) 12:42, 4 February 2011 (UTC)

Edit request from Halarond, 4 February 2011
Well placed theory that ADHD does not exist, and that people are made how they are made. For example, a child may be on the Attention Deficit Hyperactivity Disorder (ADHD) scale, and will act disruptively, but a child that is disruptive is not necessarily ADHD. Many would argue that an ADHD boy is just a boy being a boy, and indeed when the child is around peers acting in a similar way, he will automatically act the same to fit in.

Halarond (talk) 13:33, 4 February 2011 (UTC)


 * We have the section on "Social construct theory of ADHD" Doc James  (talk · contribs · email) 13:46, 4 February 2011 (UTC)

Per Jmh649's comment, Already done. Qwyrxian (talk) 14:05, 4 February 2011 (UTC)

Removing big blocks of data
User:Jmh649, please stop removing data from the article that was created by multiple editors! Removing information bring down the quality of the article. I think you more concern about removing criticism and promoting your ideas, then improvement of the article. Innab (talk) 20:03, 4 February 2011 (UTC)
 * Innab, please stop edit warring and discuss this issue above at Talk:Attention deficit hyperactivity disorder. Cresix (talk) 20:24, 4 February 2011 (UTC)

"Theory" versus "Hypothesis"
While reading this article, in particular the "Causes" section, I got the distinct impression that the word "theory" is being used inappropriately to describe what are, in fact, merely hypotheses. According to Wikipedia itself (as attributed to the Unites States National Academy of Sciences), in pedagogical contexts -- such as in an encyclopedia -- a "scientific theory" is "... a comprehensive explanation of some aspect of nature that is supported by a vast body of evidence". None of the "theories" described in the ADHD article seem to fit this rigorous definition. To the contrary, a number of wildly differing and possibly conflicting theories about the same subject generally cannot all be theories simultaneously, by definition. Because if one theory is comprehensive enough, and supported by enough evidence, then the other competing theories would have by then been disproved. I propose that each use of the word "theory" in this article be scrutinized and changed to "hypothesis" where it is found to be the more appropriate choice of word. Moulding (talk) 17:08, 15 February 2011 (UTC)
 * To some extent I agree, although I think in the case of ADHD it's far to simplistic to state that "other competing theories would have then been disproved", and it also depends on what is meant by "a vast body of evidence". There certainly is empirical evidence supporting both genetic and environmental factors influencing behavior that reaches the level of symptomology to diagnose ADHD. Whether it is a "vast body" of research is a matter of interpretation. Even if funding and time were not issues in conducting research, there are ethical limits to some types of medical research that slow the progress we can make in accumulating the "vast body of evidence". Medical research has many more such constraints than research in physics or chemistry. There's a good chance that what we call ADHD today has multiple causes, and there is evidence supporting different causes. It's far too premature to expect one "theory" to push all the others aside. Over time (by that I mean decades and likely centuries), we may have enough evidence to divide what is now known as ADHD into different disorder with different causes. I agree that some of the use of the word "theory" in the article should be replace by "hypothesis" (e.g., "hunter vs. farmer theory"), but certainly not all uses of "theory" should be discarded. It's not unusual in the early stages of a scientific exploration for competing theories (each with its own supporting empiricial evidence) to co-exist. In some ways, that's where we are with ADHD. It's far too premature to expect that there should be a single, unifying theory that explains almost everything. I consider it appropriate to use the term "theory" to explain some of the likely biological and social mechanisms underlying ADHD. Eventually those theories may explain different disorders, but right now they are competing (though not mutually exclusive) theories for the same disorder. Cresix (talk) 18:03, 15 February 2011 (UTC)

Clearly unrelated source cited
While medication has been shown to improve behavior when taken over the short term, they have not been shown to alter long term outcomes.[126]

126 refers to Yamada A, Takeuchi H, Miki H, Touge T, Deguchi K (July 1990). "[Acute transverse myelitis associated with ECHO-25 virus infection]" (in Japanese). Rinshō Shinkeigaku 30 (7): 784–6. .

How is this related to long term treatment of ADHD with medication? —Preceding unsigned comment added by 149.43.82.54 (talk) 18:04, 25 February 2011 (UTC)

edit semi-protected
Please change "ADHD is diagnosed two to four times as frequently in boys as in girls" to "ADHD is diagnosed two to four times more frequently in boys as in girls", or so. --114.250.17.77 (talk) 06:28, 26 February 2011 (UTC)


 * Yes check.svg Done I changed it to "ADHD is diagnosed two to four times more frequently in boys than in girls". Adrian J. Hunter(talk•contribs) 07:06, 26 February 2011 (UTC)

Conflict in contents
In the "In adult" section, it states "Researchers found that 60 percent of the children diagnosed with ADHD continue having symptoms well into adulthood.", but the lead states "It is a chronic disorder with 30 to 50 percent of those individuals diagnosed in childhood continuing to have symptoms into adulthood." phalacee (talk) 01:08, 4 March 2011 (UTC)
 * In behavioral science, rarely do we get exact agreement on percentages. Different studies, different methodologies, and vague and different diagnostic criteria produce different results. 30-60 percent is probably a reasonable estimate, which isn't out of the ballpark for either statement that you mention. Cresix (talk) 01:15, 4 March 2011 (UTC)

Edit request from 130.39.0.200, 16 March 2011
edit semi-protected

On the page "Attention deficit hyperactivity disorder" under section 10: Society and Culture, subsection 10.2: Controversies, two spelling/grammar errors need to be corrected in the first paragraph and a sentence needs restructuring in the second paragraph. Below are the sections that need editing. Two copies of each section are given, the first is the original text highlighting the errors currently present and the second is the edited version of the original highlighting the corrections made. Both the errors and the corrections are bolded and enlarged in parenthesis.

1) In the first paragraph of subsection 10.2: Controversies, the word dunctioning three lines from the bottom needs to be changed to functioning, and the word state two lines from the bottom needs to be changed to states:

"...thresholds are socially and culturally influenced and determine how an individual's level of (d) unctioning within the "normal cultural environment" is assessed. It further state (_) that "the acceptable thresholds for impairment are partly driven by the contemporary societal view of what is an acceptable level of deviation from the norm." "

"...thresholds are socially and culturally influenced and determine how an individual's level of (f) unctioning within the "normal cultural environment" is assessed. It further state (s) that "the acceptable thresholds for impairment are partly driven by the contemporary societal view of what is an acceptable level of deviation from the norm." "

2) In the second paragraph of subsection 10.2: Controversies, the second sentence needs reconstruction. (Current and recommended reconstruction will be shown below, the sentence reconstruction is isolated to 4 areas labelled 1-4 to easily match the original text with the reconstructed [the numbers are NOT part of the reconstruction], the first sentence has been added in for orientation purposes but has been reduced in size in order to differentiate it from the problem sentence):

" Others have included that it may stem from a misunderstanding of the diagnostic criteria and how they are utilized by clinicians,[15]:p.3 teachers, policymakers, parents and the media.[17]  1) (Debates center around) : whether ADHD is a disability or 2) (whether it is) merely a neurological description, the cause of the disorder, the changing of the diagnostic criteria, 3) (and) the rapid increase in diagnosis of ADHD  4) (_) and the use of stimulants to treat the disorder." " Others have included that it may stem from a misunderstanding of the diagnostic criteria and how they are utilized by clinicians,[15]:p.3 teachers, policymakers, parents and the media.[17] 1) (Debates center around key controversial issues) : whether ADHD is a disability or 2) (text deleted) merely a neurological description, the cause of the disorder, the changing of the diagnostic criteria, 3) (text deleted) the rapid increase in diagnosis of ADHD  4)  and the use of stimulants to treat the disorder."

130.39.0.200 (talk) 04:18, 16 March 2011 (UTC)
 * ✅ lovely, thanks for your corrections. -- gtdp (T)/(C) 18:14, 16 March 2011 (UTC)

Edit Request: legal status of Ritalin for consistency with other wikipedia sections
The wikipedia page http://en.wikipedia.org/wiki/Methylphenidate states:

"Israel Over The Counter: February 9, 2011 The Ethics Committee of the Medical Histadrut (Federation) will now be permitted to sell the psycho-stimulant drug that treats attention-deficit hyperactivity disorder (ADHD) Ritalin (Methylphenidate) without a doctor’s prescription.http://www.onejerusalem.com/2011/02/09/medical-histadrut-permits-over-the-counter-ritalin/"

This ADHD page section on the legal status of ADHD medications may need to be updated to reflect this change and to be consistent. —Preceding unsigned comment added by 66.75.76.27 (talk) 04:27, 12 April 2011 (UTC)
 * Such specific details as the legal status of a drug by country do not belong in this article. It's explained in Methylphenidate, which is linked here. That is sufficient. Cresix (talk) 16:19, 12 April 2011 (UTC)

Images
Images are important. If we do not wish this one is there a better one people can propose? Doc James (talk · contribs · email) 23:21, 20 April 2011 (UTC)


 * Images are only important if they're useful. The image at the start of the article isn't. It doesn't provide any information of its own, or make written information easier to understand. We shouldn't have images for images' sake. Dbpjmuf (talk) 00:27, 21 April 2011 (UTC)
 * That's a matter of opinion. Please stop edit warring and wait for a consensus here before removing the image again. Cresix (talk) 00:37, 21 April 2011 (UTC)
 * This image was used to illustrate a page regarding ADHD at CDC. Does anyone have anything better to suggest? Otherwise I suggest we keep it as IMO it adds to the page. Doc James  (talk · contribs · email) 01:28, 21 April 2011 (UTC)
 * We should use that image unless another free one is found. Frankly, I consider this dispute absurd. The image hurts nothing. If it were a random image of something completely irrelevant to the topic, this dispute might make sense. But in the absence of anything better, this image is relevant and should be included. Cresix (talk) 01:58, 21 April 2011 (UTC)

But what is the *point* of the image? What does it do? Does it inform the reader in any way? Does it clarify anything? Image —Preceding unsigned comment added by 79.97.92.28 (talk) 02:33, 21 April 2011 (UTC) Sorry, ^that^ was me on someone else's computer, didn't realise I wasn't logged in. 79.97.92.28 (talk) 15:36, 21 April 2011 (UTC) Shit. Forgot to log in again. Dbpjmuf (talk) 16:34, 21 April 2011 (UTC)


 * I don't see that it informs the reader of anything, or that it clarifies anything -- and at thumbnail size, you can't tell what it's illustrating, anyway. It doesn't appear to be to be at all useful. --SarekOfVulcan (talk) 11:14, 21 April 2011 (UTC)


 * As the image has been there a long time and there is still no consensus for removal you must wait for consensus before removing. Doc James  (talk · contribs · email) 15:42, 21 April 2011 (UTC)


 * I don't see any consensus for restoring, either, as it's currently 2 for and 2 against. --SarekOfVulcan (talk) 16:36, 21 April 2011 (UTC)


 * The image has been there a long time. It is on the CDC web page for ADHD. Yes you and IP a new user do not like it. But you need consensus before removing. All the best. BTW if you can suggest something better... Doc James  (talk · contribs · email) 16:40, 21 April 2011 (UTC)


 * How is the fact that I'm "a new user" in any way relevant? Dbpjmuf (talk) 19:24, 21 April 2011 (UTC)

Dr. Amen
Shouldn't there at least be some mention of Dr. Daniel G. Amen and his AD/HD subtypes? OzW (talk) 15:47, 6 May 2011 (UTC)
 * I personally don't consider him very notable, but if there is a mention, it should be very brief with an indication that there is very little empirical evidence supporting many of his claims, including his ADHD subtypes. Cresix (talk) 15:52, 6 May 2011 (UTC)

Hyperfocus and ADHD
This article ignores the Hyperfocus aspect of ADHD. I was part of a group studied by Ohio State University in the early 1970s (it was still called Hyperkinesis) and they found that if we found something we were interested we would Hyperfocus on that one task. There should be some material in the literature regarding this.--BruceGrubb (talk) 12:07, 26 May 2011 (UTC)

Adding link to subsections of another articles
I consider adding this unnecessary as we link just a couple paragraphs above to the whole article thus linking to a single subsection here is not needed. Doc James (talk · contribs · email) 20:02, 1 June 2011 (UTC)

Overdiagnosis
We all are trying to write a better and more accurate encyclopedia. Thus I was surprised that the article has failed to address the issue of overdiagnosis (and is quite skimpy on this topic in its satellite article on Attention-deficit hyperactivity disorder controversies). Recently, two studies brought this issue into the public limelight. My attempt to bring the topic into the main article was twice censored the main argument being  that the  supporting studies were made by "economists" in an "economic  journal." Really? Do we want to restrict medical information - important enough to be picked up by CNN and Time Magazine (August 30, page 16) - from inclusion simply by flimsy assertions that the information was not written by experts and the (peer-reviewed) journal is not “medical” and thus can be excluded as a reliable source in medical articles? The articles have been published, and it is not productive to dismiss the authors as "economists" instead of looking at the evidence. I submit that, as the response by CNN and Time Magazine shows, the issue of overdiagnosis is important enough to be addressed in the main article, and I suggest the following section to be placed in its “Controversies” section:


 * With the substantial increase in the diagnosis of ADHD in recent decades, and the “wide variation in diagnosis across states, races, and ethnicities” investigators suspect that factors other than neurological conditions play a role when the diagnosis of ADHD is made.   Two studies published in  2010 confirm earlier data that the diagnosis  is more likely to be made in the younger children within a grade.  Thus Evans et al demonstrate that it is made twice as often in young-for-their-grade children compared to their older classmates and suggest that ADHD in these individuals may be overdiagnosed due to immaturity leading to potentially inappropriate treatment.  Elder presents evidence that the likelihood of later treatment is reduced when a child begins kindergarten one year later and estimates that close to one million children are misdiagnosed in the US to have ADHD.
 * References

Ekem (talk) 13:25, 31 August 2010 (UTC)


 * Ekem, as has been stated previously (several times), this is a medical article. The two main sources you provide are written by economists in economic journals; the other one does not confirm your statement "substantial increase in the diagnosis of ADHD". For this article, please find sources in peer-reviewed psychiatric or psychological journals. And even if you find sources, please address that on the talk page of Attention-deficit hyperactivity disorder controversies. If it goes anywhere (and that is yet to be seen), it goes in that article. This article is too limited in scope for such details. If others disagree, that's fine. But I hope you don't continue repeatedly bringing up this matter without additional support. Cresix (talk) 00:26, 1 September 2010 (UTC)

Dear ::Cresix, This is not a 'medical' article as ADHD is not formed of a biological basis it is environmental and thus a psychological article and therefore one which can be debated in various articles. This whole article is in fact bias. kind regards. Dr.A.Williams (Consultant Clinical Psychologist)  — Preceding unsigned comment added by 86.163.127.47 (talk) 00:32, 25 June 2011 (UTC)


 * Cresix, you criticized that a secondary source, CNN, had been used; that needed to be addressed. We seem to agree on the point that peer-reviewed journals should be used, but differ in their selection: you want to restrict it to those where psychiatrists/psychologists are the authors, and I would include others, thus health economists, statisticians and other scientists are perfectly qualified as long as they follow the scientific method. Article quality is ultimately based on substance, not authorship. Evidence-based medicine relies to some degree on the crunching of large numbers and that is not necessary done by physicians. I propose to leave the discussion here open for comments by others, and if no resolution is found, to bring this to arbitration to see what type of peer-reviewed evidence is admissible.Ekem (talk) 14:19, 1 September 2010 (UTC)


 * Ekem, thanks for your posts and for keeping this ball rolling. In my experience editing medical-related articles, the very guidelines that wikipedia has adopted to keep information accurate and unbiased can be used to bias an article if one persists in doing so.   Certainly this information does belong in this article.  I find no substance to Cresix's arguments that it does not. Gandydancer (talk) 15:55, 1 September 2010 (UTC)


 * Papers about health economics are perfectly acceptable for an article like this. However, the first two papers look like WP:PRIMARY studies (original experimental results), and we'd be better off with a good review.  WhatamIdoing (talk) 16:24, 1 September 2010 (UTC)

Ekem, I would never object to any discussion on a talk page. That having been said, this change needs a solid consensus because the "science" behind it is weak. I don't have access to the Journal of Health Economics, but from what I can see in the pmid links you provided, there is absolutely nothing to support your statement: "substantial increase in the diagnosis of ADHD in recent decades" or your assertion of "overdiagnosis". From what I can see, the most that is demonstrated is that diagnosis may be confounded with age of entry in school. That may be a legitimate point, but it is a far cry from substantiating "overdiagnosis" of ADHD. Note I am not arguing one way or the other as to whether ADHD is overdiagnosed. My criticism is directed at making such a conclusion with little to no scientific evidence, as is the case in the sources you provide. And this speaks directly to my earlier point: Economists, even healthcare economists, do not have sufficient expertise to address diagnostic procedures for a medical disorder; and it doesn't matter how many numbers they crunch. I'm a doctor, but I would not dare try to publish anything in a journal related to economics, unless it directly pertained to medicine. These articles (at least as much as I have access to), although interesting and informative in some issues related to ADHD, are simply inadequate to draw conclusions about "overdiagnosis" of ADHD. Cresix (talk) 00:00, 2 September 2010 (UTC)


 * Cresix, are you aware that there has been a substantial increase in the diagnosis of ADHD in recent decades? Gandydancer (talk) 11:50, 2 September 2010 (UTC)
 * Gandydancer, are you aware that immediately above I wrote "Note I am not arguing one way or the other as to whether ADHD is overdiagnosed"? If that answer is not clear enough, then my answer to you is "Yes", I have read the literature on ADHD. Cresix (talk) 17:00, 2 September 2010 (UTC)


 * Cresix, I have access to these journals. I am are not arguing about the incidence of ADHD, said to be between 2-17% (see Elder), but about inappropriate diagnosis, specifically as the two recent articles provide independent evidence that young-for-grade children are at risk for overdiagnosis, as a consequence of which Evans et al as well as well as Elder argue that about one million children get overdiagnosed in the US, and most of them then receive inappropriate therapy  (this is not trivial). I do not accept your notion that these articles can be rejected on the basis of authorship.  Your concern  that the health economists  made a medical diagnosis is unfounded. The other side of the “systematic” (Elder) age bias is that old-for–grade children are at risk for underdiagnosis.  LeFever was, as far as I know, one of the first to point out the age issue, and paid a very high price, as she was later subjected to a professional  “witch hunt” (see J Lenzer, BMJ (2005) ; 330: 691), before she was cleared of all charges.  This certainly raises the possibility of some risk for psychiatrists and  psychologists to touch this issue.  LeFever’s 1999 article is free-access - don’t we wish they all are - and includes references to an increase in diagnosis in the introduction, that’s why I thought I should reference it; there are other references  that claim that there is an increase in the diagnosis of ADHD, at last in certain communities, (including: LeFever, G., Arcona, A., Antonuccio, D., 2003. ADHD among American schoolchildren: evidence of overdiagnosis and overuse of medication. The Scientific Review of Mental Health Practice 2 (1), 49–60.; also Evans et al) and claims to the contrary, as well. However, the issue of  “increase in the diagnosis” can be tabled, as it is different from “inappropriate diagnosis” or “overdiagnosis in young-for-grade children”  what the recent two articles are about. Ekem (talk) 15:11, 2 September 2010 (UTC)
 * I think we are in more agreement about the phrase "inappropriate diagnosis", because that is suggested by the findings of the study. Where we differ (and for me it's a major difference) is in the use of the economic journals to argue for "overdiagnosis". There is a difference between "misdiagnosis" and "overdiagnosis". Misdiagnosis of one group of children (in this case, those who may be misdiagnosed in relationship to their age of entry in school) says nothing about misdiagnosis in other groups (whether age groups, gender groups, or a variety of other demographic factors). For all we know, the other groups may be underdiagnosed. As far as I can tell without reading the actual articles in the economic journals, those issues are not addressed. I also would disagree if you are arguing that economists are in a position to make judgments about the DSM-IV diagnostic criteria (which by implication I believe you are concluding). It's one thing to reach a tentative conclusion (tentative because this is only one study) that age of school entry is confounded with diagnosis; it's entirely another matter to then move from that finding to the conclusion that we need to change diagnostic criteria X, Y, and Z because they are causing this confounding (which is the only way to address the issue of "overdiagnosis"). That's horrible science.
 * Here are my suggestions for changes that might help you and me move to stronger agreement. Limit your comments based on the studies you cite to a brief mention that "the diagnosis is more likely to be made in the younger children within a grade" (I say keep it brief because, again, these data are limited and need further investigation). Don't overplay the increase in diagnosis (I believe that is mentioned elsewhere in the article with better sources) and don't use the phrase "overdiagnosis" simply because the word might have been used in the journals you cite. If you feel compelled to use the word "overdiagnosis", back it up with mulitple sources from medical or psychological journals. I think we have some area of agreement here; I'm simply trying to limit the conclusions to the specific data in the studies, and not overblow other matters that, although possibly valid, are not backed up by the data in these specific studies. Thanks. Cresix (talk) 17:00, 2 September 2010 (UTC)
 * I just read the LeFever article (thanks for the access tip). I think my major remaining concern with your proposed addition is the relative weight placed on the addition compared to the other rather limited information in the controversies section. I think if you trim it down for this article, and add your suggested edit to Attention-deficit hyperactivity disorder controversies we may be close to agreement. In fact, I think a substantial rewrite of the controversies section, incorporating a condensed version of what you wrote above, will improve the section. Some of your points are already mentioned indirectly in the section. If your information can be merged into what's already there without a substantial increase in length of the section, I might be able to accept it. Thanks. Cresix (talk) 18:26, 2 September 2010 (UTC)

(undent) I agree with both people here. First of all concerns about over diagnosis have been voiced. Second we should use a medical review article to support this assertion. Doc James (talk · contribs · email) 18:41, 2 September 2010 (UTC)


 * About the "over" in overdiagnosis: This data could equally support a claim that ADHD is being correctly diagnosed in young-for-grade children and underdiagnosed in old-for-grade children.  Furthermore, there could be confounding factors, like parents of highly active children being more likely to enroll them sooner (e.g., to avoid the expense of child care, or to get a few hours' rest) compared to parents of docile children.  All it really says is that the youngest students in a group are more likely to be diagnosed than the oldest students.  We don't really know what that means on an absolute scale.
 * This is a good reason to leave the interpretation up to an independent expert (like a good review article). WhatamIdoing (talk) 20:34, 2 September 2010 (UTC)

Basically I agree, WhatamIdoing, although I think a very brief mention of the findings in the context of diagnostic controversies might be appropriate. The LeFever article makes a good case for overdiagnosis, but I think we need to proceed with caution in placing such a conclusion in the Wikipedia article. BTW, one other issue that occurred to me (because I don't have access to the economic journals) is how the authors determined that the children had ADHD. That has been a problematic issue in some other research. If someone who has read the articles could enlighten me I would appreciate it. Cresix (talk) 20:41, 2 September 2010 (UTC)


 * WhatamIdoing, it is not up to the parent to decide when they want to enter their child. Years ago children were sometimes admitted early, but no more.  Also, the suggestion that the older children may actually be underdiagnosed does not seem reasonable to me. Gandydancer (talk) 21:12, 2 September 2010 (UTC)

In many school districts in the United States, there are procedures for early entry into kindergarten if the parent seeks it, and (more often) it can be a parent's choice to delay entry into kindergarten or have a child repeat kindergarten. As for whether it is reasonable to conclude that older children may be underdiagnosed, I think WhatamIdoing's point is that the data in the studies cited provide no less evidence for underdiagnosis of older children than it provides evidence for overdiagnosis of younger children. That makes perfect sense. If a child is more likely to be diagnosed by being a younger child in his/her grade, then by definition a child who is an older child in a grade is less likely to be diagnosed. What we don't know is why. Cresix (talk) 21:24, 2 September 2010 (UTC)


 * Cresix, could you please post a reference to support your claims? Both of my sisters started school early, but even back in the 40's it was rare.  Even back then I know of no other kid that started early.  I am no expert, however I have no knowledge of a parent holding a child back from their starting date.  As for the school holding a child back a grade, that's a different story - it is quite common.  At any rate, to suggest that starting early is common enough to affect the study needs supporting information and I'd like to see it.  Gandydancer (talk) 02:18, 3 September 2010 (UTC)

Gandydancer, I'm not suggesting that we add anything about early or late entry into kindergarten in the article. I don't need a reference any more than you do for your assertion that it doesn't happen. It may not be your experience in your geographical area, but in my work I see at least five or six kids every year who have entered kindergarten at four years old. I see dozens of children whose parents voluntarily delayed their kindergarten entry because their parents felt they weren't ready. I'm not saying that parents have absolute authority or that it's done 100% of the time parents request it (school are especially hesitant to allow early entry; much less so with late entry). I'm saying there are procedures used by many school systems (and I've worked throughout the USA) for these exceptions to five-year-old kindergarten entry when parents request it. To some extent we have strayed from the main issue, however. The important point is that there are potentially confounding factors in the research on greater diagnosis of ADHD according to age within a grade. We simply can't conclude on the basis of the journal articles cited that age is the only factor leading up to a younger child's diagnosis of ADHD. It may be one factor in the diagnosis, but that doesn't mean it's the only factor. For example, there may be differences in how parents treat children who enter kindergarten at a younger age (and I emphasize may be); we don't know that unless we examine it or control for it in the research. There could be many other differences in these younger children that we are unaware of. That's the challenge of behavioral research: ruling out all of the possible alternative explanations. That is rarely done with one or two studies. And that is why we have to be cautious in jumping to conclusions about overdiagnosis or underdiagnosis. Cresix (talk) 03:31, 3 September 2010 (UTC)
 * BTW, read Kindergarten for a brief discussion of age differences in kindergarten in the United States. I'm sure there is discussion elsewhere (Google "early kindergarten entry"), but like I said, we have strayed from the main issue. If I wanted to state in the ADHD article that children enter kindergarten at different ages, I would go to the trouble to find a source, but that is not my plan. Cresix (talk) 03:40, 3 September 2010 (UTC)

There are three studies as, far as I see, that indicate that young-for-grade children are more likely to be diagnosed with ADHD, the two recent studies in the Journal of Health Economics (JHE) and the earlier study by DeFever, a psychologist. It would be nice to have an objective review or analysis, but, I fear, that there has not yet enough time for such an analysis.

Regarding the data collection:

Evans et al use three data sets that are not merged for their analysis. One is the NHIS,  an “annual survey of roughly 60,000 households that collects data on the extent of illness, disease, and disability in the civilian, non-institutionalized population of the United States” which includes self-reported medical conditions of respondents including  information on ADHD diagnosis in its  Sample Child Supplement. The authors state that “ ADHD incidence rates from the NHIS are comparable to results from other national surveys from similar periods”. Their second data source is the Medical Expenditure Survey (MEPS), “ a series of surveys administered since 1996 by the Agency for Healthcare Research and Quality and the National Center for Health Statistics”. For this purpose it evaluates medication use for ADHD identified by its ICD-9 code 314.10. The third data set comes from a “proprietary claims data base constituting private insurance contracts for nearly 1 million covered lives and representing at least 40 of the 50 U.S. states”. Elder uses in his study the ECLS-K,  a “ National Center for Education Statistics (NCES) longitudinal survey that initially included 18,644 kindergarteners from over 1000 kindergarten programs in the fall of the 1998–1999 school year”. Individuals, parents and teachers were again re-sampled  five times until 8th grade. Elder states that the ECLS-K is “ particularly useful for studying ADHD because it includes binary measures of ADHD diagnoses and treatment as well as teacher and parent reports of ADHD-related symptoms”. The study also includes follow-up questions on medication use. Although different data sets are used, the two studies are in agreement that young-for –grade children are at higher risk for a diagnosis of ADHD.

Regarding over- and underdiagnosis:

The data, by themselves, as Evans et al point out, do not indicate whether the diagnostic pattern is correct for the young-for-grade group or the old-for-grade group; all they show is that there is a difference which means that factors other than neurological causes are at work. It is their interpretation that the younger group contains more individuals who are misdiagnosed because of immaturity. Elder comes to the same conclusion. As the authors speak of “inappropriate diagnosis” and “misdiagnosis”, I agree to drop the perhaps loaded term “overdiagnosis” and use the terms they use.

Things are complicated and the project is getting bigger as we look at it. I hope that we can agree that the basic notion - younger-for-grade children at higher risk for diagnosis -  goes into the controversies section,  and a more detailed discussion into the satellite article. Back after the weekend.Ekem (talk) 03:49, 3 September 2010 (UTC)


 * I agree that this research thread should be discussed in the article. Overdiagnosis should also be discussed as it is a frequently discussed topic in the literature (see a GScholar search for overdiagnosis ADHD for plenty of sources. Personally I think a health economics article is fine - it is scientific and on the health topic. Many medical articles are written by MDs who are not formally trained in science (have no PhD) and when it comes to the science all they can do is basically their opinion on the effectiveness of the diagnostic criteria. The GScholar search shows opinions that the diagnostic criteria is too vague (Mota-Castillo 2007, The crisis of overdiagnosed ADHD) and that the criteria can be misunderstood but is basically OK (e.g., Diagnosing and Managing Complicated ADHD). Our article notes that according to Singh 2008, using the DSM results in 3-4 diagnoses than using the ICD-10. MDs are also plausibly (and likely) in many cases is affected by cognitive dissonance since they've diagnosed ADHD a lot in the past, and also often also generate fees based on the diagnosis - that might sound like an offensive cheap shot, but it is unquestionably true. The way to reliably test whether ADHD is under or overdiagnosed is to first come up with an objective test for ADHD (genetic, biological, neurological, or some combination); then the total number of diagnoses can be compared to a good sample of those who test positive for an objective test. You could also do country comparisons - Porter 2009 (unpublished) says Columbia has a 19.8% incidence (no source, but Bailey 2006 cites a 19.8% number from Yeh et al - only paywalled link I've used here, which I can't access) suggesting overdiagnosis in that area but also says there could be underdiagnosis in girls. Anyway, partly I'm just documenting some of my own research here for future use. II  | (t - c) 06:48, 3 September 2010 (UTC)


 * Cresix said: The important point is that there are potentially confounding factors in the research on greater diagnosis of ADHD according to age within a grade. We simply can't conclude on the basis of the journal articles cited that age is the only factor leading up to a younger child's diagnosis of ADHD. It may be one factor in the diagnosis, but that doesn't mean it's the only factor. For example, there may be differences in how parents treat children who enter kindergarten at a younger age (and I emphasize may be); we don't know that unless we examine it or control for it in the research. There could be many other differences in these younger children that we are unaware of. That's the challenge of behavioral research: ruling out all of the possible alternative explanations. That is rarely done with one or two studies. And that is why we have to be cautious in jumping to conclusions about overdiagnosis or underdiagnosis. Cresix (talk) 03:31, 3 September 2010 (UTC)


 * I really do not see how you could question whether or not parents treat their child differently when the child is 4 rather than 5. Of course they do, because a 4 year old is much different than a 5 year old in the same way that a 3 year old is much different than a 2 year old. The study looked at children born just a few days on either side of the cutoff date, in other words some children in kindergarten are intellectually and emotionally  4 and others are 5.  It does not take a great deal of new research to know that there is a great deal of difference in the length of time an average 4 year old can sit still, follow instructions, be emotionally secure enough to be away from their mother, and on and on. The authors of the study propose that younger children may be mistakenly diagnosed as having ADHD, when in fact they are simply less mature.  We don't need to go off on tangents such as "there could be confounding factors, like parents of highly active children being more likely to enroll them sooner (e.g., to avoid the expense of child care, or to get a few hours' rest) compared to parents of docile children" or arguing about dx criteria. Gandydancer (talk) 12:30, 3 September 2010 (UTC)
 * Gandydancer, sorry but I think you missed my point. I'm not talking about whether a parent treats a four-year-old different than a five-year-old. My point is that a parent who seeks early entry or late entry for their child into kindergarten may treat that child in different ways (ways that we may not know of) than a parent who doesn't. I think the key point that you're missing is this: If there are differences in children who are young for their grade compared to children who are old for their grade, the scientific method does not allow us to automatically conclude that the age difference alone accounts for all behavioral differences. If young age is associated more with hyperactivity and inattentiveness compared to older age, we cannot necessarily conclude that the association means that age difference causes the behavioral differences. Relationships between two variables does not confirm that one variable causes the other variable. That's fundamental science. Here is an unrelated example that may clarify: Racial differences are related to socioeconomic status; but that certainly does not mean that there are characteristics within a race that would lower or raise their socioeconomic status. Sorry for the overelaborate analogy, but that's the best example I can think of even though it doesn't relate to ADHD. The studies cited in our discussion found a relationship between age within a grade and ADHD diagnosis. What the studies haven't shown us is that age alone is what led to younger children being diagnosed with ADHD. So, even though I don't dispute the studies' results, I am hesitant to go beyond those results in reaching conclusions. That happens a lot in behavioral research.
 * Now the point with which I strongly disagree is that discussion of confounding factors is "going off on tangents". Scientists grapple with potential confounding factors endlessly in their research. If we don't recognize, control for, or at least acknowledge the possible existence of confounding factors in research, we might as well discard much of the research that has been conducted in the last few decades. You might want to brush up on the Scientific method and related links. That's not a personal criticism because I don't expect non-scientists to be experts. At the same time, however, I cannot let go unchallenged questioning of basic scientific methods in a discussion of scientific research. Thanks. Cresix (talk) 16:59, 3 September 2010 (UTC)


 * I am still interested in going forth with this discussion and will get back to it asap, but there is a lot on my table right now that needs my time. Gandydancer (talk) 16:54, 7 September 2010 (UTC)

Let me try and come to some kind of consensus here. This here is like an onion, as there appears layer after layer of controversy, yet not much of this is evident when reading the main article. In any case, it appears that we can agree (can we?) on the point that there is some credible evidence of “inappropriate diagnosis”, as shown by three studies referenced above that show a higher risk for the diagnosis of ADHD in young-for-grade children (or lower risk for old-for-grade children): this information should be in the main article, maybe briefly, and can be more elaborated on in the satellite article. A second controversy is the topic of overdiagnosis per se: can we agree to make a statement that  this is, first of all, a valid topic, something that is being discussed when ADHD is addressed, an item of concern? The 2007 study by Sciutto and Eisenberg is founded  on the premise that there is a common perception that AHDH is overdiagnosed. Assuming there is no overdiagnosis, there is also evidence of significant variation in the diagnosis - this is, indeed, brought out in the article, but not explained. Another issue is the steep increase in medical therapy in the 90s that has been documented (Zuvekas et al, 2006 ) which, in turn, may be related to a perception of overdiagnosis. Let me add another controversy, the recent finding that medical therapy has been reported to have failed to show long term benefits (but, instead, treated subjects ended up shorter) - the reference is in the article only to indicate that subjects later have problems "regardless of treatment" (Molina et al, 2009 ). Ekem (talk) 02:08, 10 September 2010 (UTC)
 * I prefer to say that there is some "suggestion" in two studies of misdiagnosis. That may sound like semantic quibbling, but to the layperson the word "evidence" often equates with "proof". I would use "suggestion" because of that reason, and because two studies are enough to tell us that something is going on here, but we need to look into it with more research. Two studies simply aren't enough to make any sweeping conclusions. I don't mean to minimize the studies because they certainly have raised some challenging questions.
 * Sorry, but I got a bit lost in your additional comments about the Sciutto and Zuvekas articles. And I was especially confused by your comments about medical therapy failing to show long term benefits. Maybe you could elaborate.
 * I have one other concern from a comment a few paragraphs above, based on the Evans and Elder articles. You stated that the findings (differential results for young- and old-for-grade) indicate that "factors other than neurological causes are at work" (I'm not sure if those are your words or the authors'). I would be hesitant to state that so directly because the studies did not focus on neurological factors and, as has been noted, there are potential confounding factors. There is some evidence that environmental experiences can shape our neurology, particularly in childhood. I wouldn't be surprised if these diagnostic differences are not related to neurological differences (as you suggest), but I don't think we have enough evidence at this point to conclude that there are "factors other than neurological causes are at work". That certainly does not minimize the importance of the studies' results, however. Cresix (talk) 02:35, 10 September 2010 (UTC)

How about phrasing it this way:
 * With a "wide variation in diagnosis across states, races, and ethnicities" (Elder) some investigators suspect that factors other than neurological conditions play a role when the diagnosis of ADHD is made.(Elder; Evans et al) Two studies published in  2010 suggest that the diagnosis  is more likely to be made in the younger children within a grade; it is proposed that such a misdiagnosis of ADHD within a grade may be due to different states of maturity and lead to potentially inappropriate treatment.(Elder; Evans et al)

The quoted sentence is from the authors, not me. I plan to return to Molina et al later.Ekem (talk) 13:43, 13 September 2010 (UTC)


 * I would change "it is proposed" to "the authors propose", primarily for clarity but also it is better grammatically. Otherwise I believe it's OK. Thanks. Cresix (talk) 16:32, 13 September 2010 (UTC)

Edit request from Davsch65, 21 June 2011
Some minor spelling errors (e.g., terminal s missing from some plural words) in section on History/Society.

Davsch65 (talk) 13:15, 21 June 2011 (UTC)


 * Red question icon with gradient background.svg Not done: please be more specific about what needs to be changed. Please provide exact words that are misspelled and lit them like:deos → does . GaneshBhakt (talk) 18:38, 22 June 2011 (UTC)

History
The history section appears to have had some vandalism, see below. Anyone know how to clean this up? Also, the source referenced is just a link to the civil rights act, which is, obviously, off-topic.

However, in 2010, Dr. Taylor Warfield, a scientist at the ADHD research institute in, Missouri, attempted to prove his theory that "ADHD is not a disease, but merely a disorder,"

—Preceding unsigned comment added by 207.22.18.147 (talk • contribs) 21:02, 9 April 2010 (UTC)

Spelling
has twice changed the capitalization and punctuation in spelling the name of the disorder. This is not something worth edit warring over, but my main point is that there is flexibility in how the disorder is spelled. In fact, in the United States (and I presume Canada) the official name for the disorder according the most authoritative source (DSM-IV) is "Attention-Deficit/Hyperactivity Disorder" with that exact capitalization and punctuation. Other medical diagnostic systems have different ways to capitalize and punctuate. Espoo has sourced his version with NIMH materials and various dictionaries. I personally prefer the medical sources because this is a medical article. In any event, I would like some comment here. Thanks. Cresix (talk) 23:09, 26 September 2010 (UTC)


 * We should go with the working as used in the article heading "Attention-deficit hyperactivity disorder" ICD9/10 does not us this term at all. The DSM is US centric. Doc James (talk · contribs · email) 23:51, 26 September 2010 (UTC)


 * Cresix twice changed it back even though he was clearly violating MOS, and he did this once without giving any source and a second time after supplying a single cherry-picked source. It would have been more constructive to add your single source instead of removing all of mine.
 * 1) The uppercase spelling is in clear violation of the article's title and MOS and the established spelling of all other disorders and diseases.
 * 2) It's quite ridiculous removing a long list of reliable resources and replacing them with a single one that uses the less common spelling you prefer, especially when you even ignore Medscape in your arguments above. Medscape and dictionaries base their spelling decisions on the most common spelling in reliable sources, including medical sources. I've also added some medical dictionaries below in the suggested reference:


 * --Espoo (talk) 00:12, 27 September 2010 (UTC)


 * Agree that Wikipedias internal consistency between articles is more important than following the DSM4. Doc James (talk · contribs · email) 00:24, 27 September 2010 (UTC)


 * Espoo I would appreciate your toning down the personal accusations. MOS is a guideline, not a policy. It is perfectly appropriate to seek consensus here, which is what I have done. I'll kindly ask you to wait for consensus before making any changes. And I did add the source, so please stop splitting hairs. I'll go along with whatever consensus emerges here. I also agree with DocJames' first comment to use the more universally accepted way to do it among medical practitioners, which is the ICD. Cresix (talk) 00:28, 27 September 2010 (UTC)


 * Are you seriously suggesting one single disorder should be uppercase in WP though all others are lowercase? You seem to have no idea what the purpose of a manual of style is or even what it is. You also don't seem to understand that the topic of an article cannot be spelled differently than its title.
 * You present my actions in an unfair and incorrect way and then accuse me of getting too personal when i defend myself and describe your actions objectively. You accuse me of twice "changing" the spelling when in fact i tried to make it conform better to the existing title and when you in fact twice reverted well-sourced edits and removed reliable sources. Then you ask me to not revert your unconstructive deletions of valuable info, and when i comply with that request and explain here what you've been doing, you again present me as disruptive and talk down to me again with "I'll kindly ask you to wait for consensus before making any changes" as if i'd done the opposite. You seem to be projecting your behavior on me. And also splitting hairs is exactly what you've been doing all along - digging up individual sources for your preference and ignoring and trying to hide the large consensus behind MOS and in the reliable sources presented. --Espoo (talk) 01:39, 27 September 2010 (UTC)
 * Once again, please back off on the accusations. I have not presented your actions as unfair or any other way. This is a disagreement about content. There was no "accusation" in my saying "twice changing"; that's a simple statement of fact, not good and not bad, and certainly not an accusation. If there is a more neutral way to say that, I apologize for an unintentional error in choice of words; perhaps I should have said "an editor" without naming you. I have never said you have been disruptive. And I have not tried to "hide" anything. Please. This is a simple content dispute; it's not a personal matter between you and me, despite your efforts to make it such. I did nothing wrong by seeking consensus here. That's the way it's done all the time on Wikipeida. So please cool down and wait to see what shows up on this talk page. If there is a consensus to change the article as you have suggested, that's the way it will be. What I am "seriously suggesting" (to use your words) is a simple respect for two of the cornerstones of Wikipedia: consensus and assume good faith, nothing more and nothing less. I really would appreciate it if you would focus on the issue here and not on me and what you perceive as my motives against you. Cresix (talk) 02:04, 27 September 2010 (UTC)


 * Seriously this is not that big of a deal. This is something that can simply be dealt with by calm discussion. There are arguments for both ways. Doc James  (talk · contribs · email) 01:59, 27 September 2010 (UTC)
 * DocJames, I agree with you wholeheartedly. This is a simple content dispute that occurs dozens or hundreds of times daily on Wikipedia. I'm fine with what most people agree on in this dispute. I just want a consensus, not a major battle of personalities. Cresix (talk) 02:04, 27 September 2010 (UTC)
 * Apology accepted and i apologise for overreacting, but i still feel that removing valuable information consisting of a summary of the current situation and a long list of valuable sources is at the very least "hiding". Instead of removing so much information (and not respecting all the work that went into it) and replacing it with a single source, it would have been better to add it. --Espoo (talk) 08:29, 29 September 2010 (UTC)
 * Interesting that you apologize and in the same breath make another personal attack. No one is "hiding" anything, and you have no idea whether I have attempted to "hide" anything. You attribute motives to me as if you can read my mind. Worst of all, you continue to assume bad faith. If you have nothing more to say on the issue of capitalization and punctuation of the disorder, then please say nothing (to me anyway). I'm finished with your hostile approach to discussion, and will make no further comments unless you violate policy. If you raise a new content issue, I may or may not respond. If I don't respond to any future comments directed at me, you can assume I am ignoring your personal attacks. To Doc James, thanks for your comments whether they agree with mine or not, and thanks for a civil discussion. Cresix (talk) 17:04, 29 September 2010 (UTC)
 * Stating the fact that you removed much valuable information and replaced it with a single source instead of adding your source is not a personal attack and can in no way be construed as such. Your strong reaction seems to indicate a bad conscience. I in no way resisted or was in any way hostile to discussion. On the contrary. I simply objected to the removal of well-sourced information. Please show you are willing to discuss and please finally respond to the argument that one single disorder cannot be uppercase in this encyclopedia if all other disorders and diseases are lowercase. --Espoo (talk) 08:25, 30 September 2010 (UTC)
 * Falsely assuming (and accusing) that someone is purposefully "hiding" something is clearly a personal attack and assumption of bad faith. And now you've followed it with another false assumption: that I have a "bad conscience". Consider this your first warning. No more comments by me to your personal attacks; next time I go straight to WP:ANI. Cresix (talk) 15:50, 30 September 2010 (UTC)
 * Please show you are willing to discuss the real issue by responding to the argument that one single disorder cannot be uppercase in this encyclopedia since all other disorders and diseases are lowercase.
 * I'm very sorry you felt attacked by use of the word "hide", which was an admittedly clumsy, angry, and frustrated summary of the objective situation that you ignored/downplayed the large consensus behind MOS and in the many reliable sources and removed valuable information instead of simply adding yours. Please accept my apology, but please also accept my right to vent my frustration, despite being done clumsily. --Espoo (talk) 16:55, 30 September 2010 (UTC)
 * Thank you. I accept your apology (for a second time), assuming you don't follow this with another attack. No, you do not have a right to "vent frustration" by making personal attacks on other editors. You have a right to express your disagreement about the issue, but not by attacking other editors. "Willing to discuss" does not mean I have to agree with you (or anyone else); it simply means I have to take your opinions seriouisly, which I have, but with which I continue to disagree. And I assume in good faith that you have considered my opinion but disagree with it, which is perfectly OK. Now let's, see how this issue plays out in terms of consensus; as I have said repeatedly, I will easily accept a clear consensus because this matter is not worth arguing about. Cresix (talk) 17:05, 30 September 2010 (UTC)
 * You didn't respond to the actual issue that we should be discussing here. Does "I have to take your opinions seriouisly, which I have, but with which I continue to disagree" mean that you feel this single disorder should be uppercase in Wikipedia although all other disorders and diseases are lowercase? --Espoo (talk) 21:36, 1 October 2010 (UTC)
 * Sorry, I thought you realized that I disagree with you. My understanding of your position is that you think the first sentence should begin "Attention deficit hyperactivity disorder". If I'm wrong please correct me. My position is that the first sentence should begin "Attention-Deficit Hyperactivity Disorder". Thanks. Cresix (talk) 01:04, 2 October 2010 (UTC)
 * Actually, after a bit of consideration, since I agreed above with Doc James that ICD-9 is a more universal medical diagnostic system, and ICD-9 doesn't capitalize all words, I'm OK with not capitalizing. That should partially resolve this dispute. I'll be happy to make the change, although I'll wait a bit to be sure everyone is OK with that. Espoo, if you change it I won't have a problem with it. I still think the hyphen should remain unless there's a consensus otherwise. Just to make sure I'm clear, I agree to "Attention-deficit hyperactivity disorder" unless there is a consensus to remove the hyphen. In addition to any other sources that are placed after the name, I think either a source to ICD-9 or DSM-IV should be included. Thanks. Cresix (talk) 01:36, 2 October 2010 (UTC)

OK, so we've agreed to lowercase. The reason seems to be because MOS says to avoid capitalisation unless necessary and because all other diseases and disorders on Wikipedia are lowercase.

But trying to decide whether or not to use a hyphen here can't be resolved that easily, and it can't really or shouldn't be decided on the basis of a consensus because it's not a question of style. We should go by what the majority of carefully edited texts do (attention deficit hyperactivity disorder).

Whether or not to use a hyphen in a normal compound modifier is usually a style issue and often the cause of senseless and petty fights (often along ENGVAR lines or between generations). A hyphen in a normal compound modifier is only rarely necessary to prevent misunderstanding (e.g. "little-celebrated paintings" to prevent "little celebrated paintings" from being misunderstood or at least momentarily misread as celebrated paintings that are little).

ADHD is not a (or the) hyperactivity disorder characterised by attention deficit. Only if that were the case, would the spelling "attention-deficit hyperactivity disorder" be correct. ADHD is a disorder usually characterised by both attention deficit and hyperactivity and rarely characterised by only one of these two behaviors. If we try to make a single term out of all that, we get the long but plain-English expression: "attention-deficit and hyperactivity or attention-deficit or hyperactivity disorder". (As you can see, i'm far from being an enemy of the hyphen. Each of these hyphens could be left out without causing confusion, but they help the reader, and i'd definitely prefer a hyphen even in the short term "attention-deficit disorder".)

Various spellings such as "attention deficit-hyperactivity disorder" and "attention deficit/hyperactivity disorder" try to use a slash or a hyphen (or an en dash) to indicate that the term "attention deficit" does not modify the term "hyperactivity" or the term "hyperactivity disorder" and to indicate, on the contrary, that the terms "attention deficit" and "hyperactivity" express a parallel relationship or alternatives.

But the majority of medical and other carefully edited publications nowadays use "attention deficit hyperactivity disorder" without any hyphen or slash. I think it's because they've decided that "a-d h d" would be illogical and wrong (as explained above) and "a d/h d" and "a d-h d" are very hard to parse and would be misread and misunderstood, probably as something chaotic such as "a disorder affecting attention and characterised by deficit or hyperactivity" and "a disorder affecting attention and characterised by 'deficit hyperactivity'" respectively. By not using a hyphen or a slash, the most common (and apparently most modern) spelling "attention deficit hyperactivity disorder" elegantly avoids misleading the reader (and the public). So what looks like sloppiness (many people, including myself, prefer using hyphens in compound modifiers even when not necessary) is in fact less confusing or illogical. --Espoo (talk) 21:55, 13 October 2010 (UTC)
 * I appreciate your opinions, but I oppose removal of the hyphen for the reasons I have presented previously. However, if the consensus below is to remove the hyphen in the article title, I'm not opposed to removing it throughout the article. Let's see what happens below. Thanks. BTW, feel free to change to lowercase at any time; I would ask that you either leave the DSM-IV source or add one to ICD-9 (in addition to any that you want to add). Cresix (talk) 22:38, 13 October 2010 (UTC)


 * Please try to respond to what i said instead of simply repeating your position (or, worse still, only referring to it), especially since it seems to be very weak. This is supposed to be a discussion, not a poll. If i understand correctly, you believe we should ignore the majority of medical and other carefully edited texts ("attention deficit hyperactivity disorder") based on the different (and least common) spelling ("attention-deficit hyperactivity disorder") that is in one source that you feel is the most authoritative. Please respond to at least the following two arguments so that this becomes a productive discussion that doesn't continue to waste the time of anyone reading it, including the admin that has to read through it:
 * 1) ADHD is not a (or the) hyperactivity disorder characterised by attention deficit. Only if that were the case, would the spelling "attention-deficit hyperactivity disorder" be correct. The hyphen in "attention-deficit" makes this into a compound modifier of "hyperactivity disorder", which is simply medically wrong.
 * 2) Whether or not to use a hyphen or slash or nothing here can't really or shouldn't be decided on the basis of a consensus because it's not a question of style. We should go by what the majority of carefully edited texts do (attention deficit hyperactivity disorder). --Espoo (talk) 23:40, 13 October 2010 (UTC)
 * "ADHD is not a (or the) hyperactivity disorder characterised by attention deficit": Medically that is wrong. ADHD is a disorder characterized by an attention deficit. From DSM-IV:"The essential feature of Attention-Deficit/Hyperactivity Disorder is a persistent pattern of inattention and/or hyperactivity-impulsivity"
 * "Whether or not to use a hyphen or slash or nothing here can't really or shouldn't be decided on the basis of a consensus: Consensus can determine virtually anything on Wikipedia that is not vandalism or a serious policy violation. Hyphenation on Wikipedia is not a policy; it is a style. Now, I seriously don't intend to go back and forth with you endlessly on this matter, nor do I have an obligation to do so regardless of any requests, demands, or tantrums you may have. Your style to discussion seems to me to be nagging your opponent into endless discussion, I presume in the hope that you will eventually wear them down and they'll give in and let you have what you want. I don't play that game. I did it too much with you in that endless (and largely unnecessary) "discussion" about capitalization. You have the capitalization issue as you wish, not because of your incessant nagging at me but because I considered the issue in terms of medical experts' use of lower case. If enough people agree with you here, or if there is a consensus below, the hyphen can go. Feel free to pursue other means of dispute resolution, but don't remove the hyphen without consensus either here or below. Remember that there is no such thing as a consensus of one person on Wikipedia, regardless of how right you think you are or how wrong you think I am or how many times you demand that I respond to you over and over and over. And that most definitely is the end of my exchange with you. Thank you. Cresix (talk) 00:29, 14 October 2010 (UTC)


 * (OK, i'll address this discussion to other readers since you don't want to discuss.) DSM-IV apparently uses a slash (in addition to a hyphen), so the reference for the spelling "Attention-Deficit Hyperactivity Disorder" placed at the beginning of the article is apparently incorrect and misleading.
 * The definition quoted from DSM-IV ("The essential feature of Attention-Deficit/Hyperactivity Disorder is a persistent pattern of inattention and/or hyperactivity-impulsivity") differs from the one given in the article ("a disorder characterized by the co-existence of attentional problems and hyperactivity, with each behavior occurring infrequently alone"), but it also clearly puts attention deficit and hyperactivity on the same footing. The spelling "attention-deficit/hyperactivity disorder" with a slash also shows this clearly. The spelling "attention-deficit hyperactivity disorder" puts them on a different footing and posits the disorder as a (or the) "hyperactivity disorder" with the addition of the determiner "attention-deficit". The spelling "attention-deficit hyperactivity disorder" therefore seems to be medically wrong. Please correct me if i'm wrong, but as far as i understand, there are no other hyperactivity disorders that can be defined using other determiners.
 * Hyphenation is usually but not always a style issue. When use or non-use of a hyphen changes the meaning, it is not a petty issue. In any case, MOS says to follow the sources and to follow the most common usage in the sources (unless it's an ENGVAR issue).
 * We can either follow MOS in following the sources by moving the article to the (corrected) DSM-IV spelling now cited with hyphen and dash ("attention-deficit/hyperactivity disorder") and point out that this is not the most common spelling in medical (and reliable non-medical) sources but the one used by one of the most reputable sources. Or we can follow MOS in following the sources and follow MOS by using the spelling ("attention deficit hyperactivity disorder") most common in medical sources (and reliable non-medical sources). --Espoo (talk) 14:15, 16 October 2010 (UTC)

The International Reading Association Guide to Style and Usage, the Encyclopaedia Britannica, the Centers for Disease Control and Prevention, the DSM-IV-TR, the National Institute of Neurological Disorders and Stroke, and the Mayo Clinic use the hyphen. The National Institute of Mental Health, the American Academy of Child and Adolescent Psychiatry, the Attention Deficit Disorder Association, ADDitude magazine, and Children and Adults with Attention Deficit/Hyperactivity Disorder do not use the hyphen. From this admittedly small sample, it appears that while academics are split and possibly lean slightly toward using the hyphen, advocacy groups may prefer no hyphen. rouenpucelle (talk) 23:44, 1 July 2011 (UTC)