Talk:Attention deficit hyperactivity disorder/Archive 21

Image RFC
The infobox at the start of the article contains a picture showing three children working at school desks, with a fourth child making rude gestures. Is this an appropriate illustration for ADHD? SarekOfVulcan (talk) 19:52, 21 April 2011 (UTC)
 * (Originally filed by Dbpjmuf (talk) 19:23, 21 April 2011 (UTC), rephrased by Sarek with permission.)


 * I came here from the RfC notice. I can understand the argument that it's very subjective to claim that the image shows the subject at all, while I also realize that other sources have used this image to illustrate it. For me, that makes this question come down to what else might be available, as other editors have also commented above. I've tried to look for some alternatives, with mixed results. I'm not really sure that any are really better, just slightly flawed in ways that are different from the ways in which this image is flawed. Here is what I can think of:
 * File:Ritalin Pill.jpg. Good simple image, directly related to this page, but illustrates a treatment rather than the disease itself.
 * File:Muntham House School - geograph.org.uk - 113490.jpg. Relevant, but not obviously relevant without an explanation.
 * File:Proposed Symptoms of ADHD.PNG. I'm not enthusiastic, because it seems to be WP:OR.
 * Pick someone from List of people diagnosed with attention-deficit hyperactivity disorder, and use a picture of them. But it might be WP:UNDUE to single out one individual; perhaps an alternative would be to make a montage of maybe four people.
 * Overall, I think I may have given you a lot of information that doesn't really get us anywhere. I don't see anything particularly objectionable with keeping the existing image until something better comes along. --Tryptofish (talk) 21:30, 21 April 2011 (UTC)
 * Yes agree it is difficult to illustrate hyperactivity. The image we have currently is an example of disruptive behavior which is typical of the disorder. As the cause is unknown showing a brain is not appropriate. Doc James  (talk · contribs · email) 21:37, 21 April 2011 (UTC)


 * My opinion is that we shouldn't have a picture at all. Nothing that we include is going to apply to all cases -- if we show hyperactivity (which that image doesn't show anyway, it just shows a kid acting out in class), we leave out those who have the inattentive form of the disorder. If we show Ritalin, we leave out those who are treated through non-medical means.--SarekOfVulcan (talk) 21:50, 21 April 2011 (UTC)
 * How do you think 10% of US children are diagnosed with ADHD? Doc James  (talk · contribs · email) 21:53, 21 April 2011 (UTC)
 * Well, my daughter was diagnosed with the WISC-IV, not a non-representative picture. I was diagnosed at age 37 with a somewhat less elaborate evaluation. --SarekOfVulcan (talk) 22:05, 21 April 2011 (UTC)
 * No psychological test can diagnose ADHD. First year med students know that. The closest to a diagnostic tests for ADHD are continuous performance tests. The WISC-IV says almost nothing about ADHD. There is not a single research study to support using the WISC-IV to diagnose ADHD. Your daughter either had a very bad diagnostician, or your information isn't correct. Cresix (talk) 01:38, 22 April 2011 (UTC)
 * "Not a single research study" -- O RLY? http://jad.sagepub.com/content/9/3/486.abstract (And it might have been the WISC-III, it's been a while.) Anyhow, that's not relevant to the question of whether the picture is appropriate or not. --SarekOfVulcan (talk) 13:43, 22 April 2011 (UTC)
 * Yes, not a single research study. Did you read the full article, or just the abstract? Did you find discriminant function analysis results that would effectively discriminate between ADHD, normals, and non-ADHD disorders with overlapping symptoms? "Significantly higher" on an index score is not diagnostic. There are literally dozens of explanations for "significantly higher" that have nothing to do with ADHD. Yes. Not a single study. If doctors used your style to make or rule out diagnoses of all disorders, people would be dropping dead at alarming rates. And tell us, what specific WISC-IV score did the person who diagnosed your daughter finding conclusively diagnostic? I understand the arguments against the image in this section (but I disagree), but claiming that any intelligence test can diagnose ADHD is equivalent to claiming that blood pressure can diagnose pneumonia. Yes. Not a single study. Cresix (talk) 15:16, 22 April 2011 (UTC)
 * A low blood pressure is correlated with pneumonia and is part of the diagnosis of severe pneumonia though :-) But yes there is no single test that diagnosis ADHD. It is based on a constellation of findings. Doc James (talk · contribs · email) 15:19, 22 April 2011 (UTC)
 * One final comment on this matter. Rule out pneumonia only by looking at blood pressure and you're guilty of malpractice. Diagnose ADHD only by looking at the WISC-IV and you're guilty of malpractice. Now, I'll move on. Thanks. Cresix (talk) 15:30, 22 April 2011 (UTC)


 * A quick Google image search showed up a few brain scan images, suggesting there might be something there indicative of ADHD. If so, my first preference would be to include such an image if at all possible. Failing that, there should be no image at all, as I don't see any other way to objectively depict the ADHD condition in an image. TechnoSymbiosis (talk) 05:58, 27 April 2011 (UTC)
 * Regarding brain scan as an emblematic image (rather than just illustrating a section on neural correlates), I agree with Doc James above: it may reinforce the erroneous perception that etiology has been found in the brain. Peculiar brain structure and function is as likely to be a product of the unknown cause as inattention and impulsivity are products of the unknown cause. I also oppose the current image (acting out) as it does not well illustrate ADHD predominantly inattentive, and may mislead the inattentive reader into believing that acting out and hyperactivity have to be prominent for a diagnosis of ADHD.


 * Though I know lead images improve the appeal of articles, I think it's better that there is no infobox image until an appropriate one is found. --Anthonyhcole (talk) 06:55, 27 April 2011 (UTC)


 * This isn't my area of technical expertise unfortunately so I'll defer to the judgement of others in that respect. Nevertheless, while brain-related imagery may falsely imply a definitive cause, surely it would still be better than what we currently have? It seems there's a brain scan in the article already (and apparently previous arguments for not having it in the infobox), so I'd argue to use it in the event that it is the most informative image we currently have available to us - it may not show cause but it certainly seems to show effect, and in a better way than a misbehaving child. As with my comment above though, if it is indeed completely inappropriate then I'm in favour of using no image at all until such time as an appropriate image is available. TechnoSymbiosis (talk) 04:00, 29 April 2011 (UTC)
 * I don't agree that a brain image "surely would still be better than what we currently have". No image would be preferable to a brain image. An image of the brain would be meaningless at best, and misleading at worst. The level of knowledge in neurology and neuropsychiatry simply does not allow us to illustrate ADHD with a picture of the brain. Cresix (talk) 04:12, 29 April 2011 (UTC)
 * How many kids have a PET / fMRI as part of there ADHD diagnosis? None. How many does hyperactivity / not paying attention in school play a role? Read the DSM criteria for this condition. Doc James (talk · contribs · email) 04:15, 29 April 2011 (UTC)
 * The current image illustrates nothing unique or distinct about ADHD. If the brain scan image is similarly uninformative as you both suggest, then I advocate having no image. Showing a staged picture of apparent hyperactivity/attention loss here would be akin to showing a picture of pollution as the main image in the Car article. TechnoSymbiosis (talk) 06:33, 29 April 2011 (UTC)
 * Disruptive classroom behavior is a very common symptoms of ADHD. Thus the image does apply. The CDC uses the image on there page regarding ADHD and thus they agree that it is applicable. Doc James  (talk · contribs · email) 19:34, 29 April 2011 (UTC) Doc James  (talk · contribs · email) 19:32, 29 April 2011 (UTC)

The car-pollution analogy does not apply. Pollution (although present) is not a major component that defines a car. The behavior illustrated in the ADHD image is one of the most frequent symptoms that define ADHD. If we had an image that could illustrate "talks too much" or "too loud" those might be included, but so far the closest free image we have illustrating symptoms is the current image. Cresix (talk) 19:42, 29 April 2011 (UTC)


 * I don't actually object to this image, but I can see how it might be offensive, particularly to adults with well-controlled ADHD. Given the diversity of symptoms, I doubt that we'll be able to find a perfect solution.  IMO a picture of a child daydreaming in class, rather than making faces, would be more appropriate, but both inattentiveness and acting out happen.  Another possibility is to show a messy, disorganized desk, since that's also a typical effect, and applies to adults, too.  WhatamIdoing (talk) 23:36, 29 April 2011 (UTC)


 * I believe that this image is inapropriate, regarding that it makes the article look at least partly unproffesional. A diagram, PET scan image, or even (although I don't reconmend it) no image at all would seem more apropriate. —Preceding unsigned comment added by Elongated (talk • contribs) 10:45, 30 April 2011 (UTC)


 * The boy seems to be attention-seeking rather than displaying something more typical of ADHD. See this source for a comment on the difference. How about, rather than trying to illustrate an ADHD symptom, we illustrate something that ADHD makes difficult, such as a child or student concentrating on homework. There's this pic on commons and there are some, , pics on Flickr which might be appropriately licensed (I'm no expert). The last Flickr pic is really good but we should be careful about asking permission to use an identifiable person on an health article (even if we are stating the person in the pic doesn't have the health issue). Colin°Talk 12:03, 30 April 2011 (UTC)
 * Students doing homework is better than nothing but not as good as the current image IMO. It is sort of showing ADHD by what it isn't. Doc James (talk · contribs · email) 17:32, 30 April 2011 (UTC)
 * The boy may or may not be attention seeking; that's a subjective judgment. What is clearer is that he is being disruptive, which is a frequent characteristic of ADHD children. As for the other images linked, they simply show everyday activities (solving a math problem; children doing their work) with no suggestion of a problem. The current image, although not perfect, clearly is superior to those images in illustrating something about ADHD. Cresix (talk) 16:36, 30 April 2011 (UTC)
 * That boy's expression just shouts "look at me; give me attention". The fact that the other children are getting on with their work shows that he isn't being disruptive. If everybody in the class was looking at him, then he'd be disruptive. So it is not a good image of ADHD, and it is a fairly poor-quality image too. You miss the point about the homework images -- which is that it shows a normal activity that is impossible or very difficult in someone with ADHD. A suitable caption such as "Children with ADHD find it hard to concentrate on homework." would be ideal.
 * Maybe that's what it shouts to you, but to me it shouts, "I can't keep my mind on my work. I'd rather goof around, so that's what I'm going to do." As for the other children, we don't know how bothered they are because we dont' know how hard they're trying to ignore him. No, I got the point about the other images. It's a choice between showing what ADHD is and what it is not. What it is makes more sense. Cresix (talk) 20:19, 30 April 2011 (UTC)


 * The suggestion by WhatamIdoing to use a messy desk is an interesting one. I found: File:Messy desk.jpg. --Tryptofish (talk) 18:08, 30 April 2011 (UTC)
 * Better than a brain image, but the current image is just as good if not better. Cresix (talk) 18:15, 30 April 2011 (UTC)
 * I think the best suggestion so far is WhatamIdoing's kid looking out the classroom window but I'm on a slow, tenuous connection just now and can't image search. --Anthonyhcole (talk) 08:15, 1 May 2011 (UTC)
 * I mentioned this earlier, but is there any interest in picking four different people from List of people diagnosed with attention-deficit hyperactivity disorder, and making a montage of the four? I'm just saying that in the spirit of tossing ideas around. --Tryptofish (talk) 17:32, 1 May 2011 (UTC)


 * I agree with Doc James's reasoning that/why the unruly kids image is appropriate for the lead, and that/why the proposed alternatives (brain scans etc.) are not. Tijfo098 (talk) 05:35, 1 May 2011 (UTC)
 * I am comfortable with the current image. I am not convinced that an alternative image/no image would be better. Axl  ¤  [Talk]  09:20, 4 May 2011 (UTC)

I don't particularly like the current image for a number of reasons, at least partly because I'm not sure that it does a very good job of conveying the severity of the condition. ADHD is more than just goofing off in class, in the same sense that autism is about more than just being antisocial and bipolar disorder is more than just mood swings.

I happen to like the brain scan images, and while there is disagreement over the precise etiology, there are a good number of published neuroimaging studies that indicate that there's something going on, and certain regions of the frontal lobe seem to be consistently highlighted. Most importantly is the part about [i]published[/i] studies. That is to say that the images are, at least, [i]verifiable[/i] and easily referenced. Zametkin's PET scans are the most common ones used, partly because his was the first major functional neuroimagine study published on the subject. I don't know whether the more recent SPECT studies (Krauss and others) would be useful. I haven't seen images from them, but I know that the findings from the study are a bit esoteric, and I'm not sure how to fit in an explanation about neurotransmitter transport proteins in the cell membrane of the axon terminal into a caption.

Further, there are several Medical articles in Wikipedia that include clinical images in their introductory picture. Look at the pages on Multiple Sclerosis, Hashimoto's Thyroiditis, Alzheimer's Disease (and remember, the precise etiology of that disease is currently unknown), Creutzfeld-Jakob Disease....hell, the Epilepsy page has an EEG readout, which also requires a good bit of training to read properly. I think that there is ample precedent for using brain images in the lead picture, as is done for a number of other medical conditions. Many of those images are equally difficult for a layperson to understand, but they are from published clinical research that demonstrates the issue at hand.

However, if there is consensus on using a picture that illustrates ADHD in action (as opposed to actual published clinical images), then perhaps we might find better ones from this booklet from the National Institute of Mental Health:

http://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder/adhd_booklet.pdf

This booklet contains a number of images that attempt to portray ADHD in a similar manner to the one on the front of this page. The images on Page 2, Page 6, or especially Page 12 would be more enlightening. Page 12 is especially good, as I feel that it conveys the issue of a child trying very hard but still having difficulty paying attention. There's a part of me that likes the image on Page 5, but it's not very specific to ADHD. The end of this booklet specifically states that it is public domain, so there shouldn't be any copyright issues. Hyperion35 (talk) 02:05, 16 May 2011 (UTC)


 * Yes I would not have a problem with the image on page 12 except that the quality is not sufficient. It is blurry at image box size. Is there a better quality copy? Doc James (talk · contribs · email) 02:39, 16 May 2011 (UTC)


 * The only copy I could find was in the PDF file. However, the resolution of the Page 12 image (let's call it "ADHD_Kid" to avoid confusion) is 177x167, and the currently-used image (let's call it "Kids In Class") is 230x132 in the image box, and the full size is 349x200.  I downloaded the ADHD_Kid image from the PDF file and rescaled it using Lanczos Resampling to 230x217 (ADHD_Kid2) and 300x283 (ADHD_Kid3).  Hopefully one of these will be acceptable.


 * http://en.wikipedia.org/wiki/File:ADHD_KId2.jpeg
 * http://en.wikipedia.org/wiki/File:ADHD_KId3.jpeg


 * Interestingly enough, I looked around the CDC site where you found the Kids In Class picture, and they use the ADHD_Kid picture in one of their widgets:


 * http://www.cdc.gov/ncbddd/adhd/multimedia.html


 * One issue of concern with using these images is that in the NIMH Booklet there is a disclaimer at the end: "The photos in this publication are of models and are used for illustrative purposes only."  It is likely that the same applies to the images on the CDC website.  This makes me a little bit wary of using "illustrative" images of this nature as the leading image on the article.  It is one reason why I would prefer an image from peer-reviewed published medical literature as the lead image.  Images from the medical literature are likely to be of a higher quality, and more notable and more easily verifiable than illustrative images of models.  While both the Kids In Class and ADHD_Kid images are probably acceptable for use in the article, I wonder if the lead image ought to be held to a higher standard.  MEDRS seems fairly clear that public booklets like this are not as authoritative as the underlying medical literature.


 * There are high quality images from clinical neuroimaging studies that have been published in prestigious medical journals such as NEJM and JAMA. These images verifiably demonstrate differences between individuals professionally diagnosed with ADHD and undiagnosed controls.  Zametkin's 1990 neuroimaging study, for example, has been cited at least 135 times in the published medical literature, including twice in 2011 and four times in 2010.  I cannot find the source of the sole PET scan currently on the page, but the 2009 JAMA study mentioned in its summary (which does not contain this image) has been cited 28 times.  The 2005 review cited in this Wikipedia article concludes that neuroimaging studies have demonstrated significant differences in several specific brain regions.


 * I would propose that published clinical neuroimaging scans are of a higher quality, are more notable, are more authoritative, have wider scientific agreement, and better demonstrate the differences between ADHD patients and non-ADHD controls than the current Kids In Class image, the ADHD_Kid image, or any of the other "illustrative" images. Hyperion35 (talk) 14:34, 18 May 2011 (UTC)

I think the "ADHD kid" image is too fuzzy. Scaling down an image is rarely a problem. Scaling up usually results in poor quality. As for whether the NIMH images are freely available, my understanding is that U.S. government owned images are not copyrighted; please correct me if I'm wrong. I continue to oppoose any brain images in the infobox for the reasons given above: It would be meaningless at best and misleading at worst. We simply don't have the data to identify ADHD with a brain image. Cresix (talk) 00:24, 19 May 2011 (UTC)
 * The ADHD_Kid image is the sort of thing we want but I agree it is too small and rescaling doesn't help. We could always try emailing somone at the NIMH to see if they could supply the original. I would be quite opposed to a brain image. We are an encyclopaedia, not a neurology journal. We use pictures to illustrate the condition and to help readers remember aspects of it. It doesn't matter if the picture uses models (you are not going to get a model-release for a picture of a child with ADHD to use on Wikipedia -- just blight the poor child's employment chances for life!) It doesn't matter if the picture is abstract even. It is just a powerful technique to help implant the facts in the reader's head while also making the article more attractive. Showing some brain scan with coloured blobs on it doesn't help the reader and may put off readers who aren't naturally scientific in nature. Colin°Talk 07:47, 19 May 2011 (UTC)

I agree that the lead image should convey basic facts about the condition (I wouldn't use the word "implant" but otherwise I agree with the idea). I'm not sure what the current image conveys, it's a child misbehaving in class. Yes, this is one possible symptom of ADHD. It is not the most debilitating symptom, it is not present in all patients, and I'm not sure that it conveys a very clear message. In fact, I could see how it conveys two false and very misleading messages, in that it implies that this is solely a pediatric condition (even though it continues into adulthood) and it implies that it's something that only happens in school (happens in almost all settings).

On the other hand, neuroimaging conveys an important verifiable concept: there are differences in brain activity between patients with ADHD and appropriately matched controls when asked to do tasks that involve focus and attention. The point of using brain scans is not to identify ADHD, but rather it's a published verifiable MEDRS-compliant image that demonstrates a difference between people with the disorder and those without. Cresix is correct that it's still unclear as to what is the ultimate cause of these differences, but there are a large number of neuroimaging studies over a 20 year period that demonstrate that there are differences. That, I believe, is exactly the sort of concept that a lead image ought to convey. Additionally, brain scans also convey important facts to the reader: this page is discussing a neuropsychiatric disorder, it is a condition involving differences in how some people's brains work.

Even if readers don't completely understand what the images mean (Zametkin's 1990 PET scans looked fairly easy to read), they convey the important framework for understanding the condition. The Epilepsy page has an EEG printout as its lead image. I doubt many readers could actually interpret it, it looks like a bunch of squiggly lines, like a seismograph of an earthquake or something. However, it does convey basic verifiable medical information about that condition: it illustrates the difference between what an EEG picks up during normal activity and what it picks up during a seizure. It also illustrates that it is a complicated medical condition. As I mentioned previously, several other Wikipedia medical pages have lead images of micrographs showing...honestly I can't tell what they're showing, but apparently some sort of pathological process.

The current image for this article doesn't inform the reader of any particularly useful information. It tells them that some kids with ADHD will goof off in class. That's not particularly useful. Maybe it would be appropriate to use that image in a section on the page that discusses academic issues. The ADHD_Kid picture isn't that much better. It at least demonstrates a child who is unable to pay attention despite trying very hard...but then again, am I only seeing that because I can identify with the kid in the picture? Would someone who does not have ADHD understand it?

Does anyone know if there is a specific MEDRS or general Wikipedia guideline for what to consider when determining what should be the lead image? The current image, or even the ADHD_Kid image, does not seem consistent with many of the other Medicine articles, as I have stated previously. It might be worth looking around to see if there are some general guidelines, this can't be the first time that this sort of question has popped up. Given that many other Medicine articles do use clinical information in their lead image even when those images are difficult for lay individuals to interpret, that makes me wonder if they are following specific guidelines. Hyperion35 (talk) 22:19, 21 May 2011 (UTC)


 * Maybe you should write to the CDC and let them know that you disagree with their usage of this image to represent ADHD? Doc James  (talk · contribs · email) 23:14, 21 May 2011 (UTC)


 * It doesn't really matter what the CDC uses to represent ADHD. This is not the CDC, it's not a medical association, it's not a waiting-room brochure for concerned parents of hyperactive children. It's an encyclopedia. Whether or not the image is considered appropriate by the CDC makes absolutely no bearing on whether or not it's suitable for an encyclopedia. Organizations are not infallible - I trust the CDC to know the symptoms, treatment, and progression of ADHD. I do not trust them to know how to paint a room, dress a hyperactive child, or illustrate an encyclopedia. Badger Drink (talk) 04:34, 22 May 2011 (UTC)


 * With FMRI, scientists try to reduce all human emotions and behaviours to coloured blobs on areas of a brain image. We could, if this approach was reasonable, illustrate all neurological, psychological, behavioural, emotional and mental articles with such images. Epilepsy is the one condition for which such images (or earlier, more primitive, EEG technology) is actually illustrative of what is going on: meaningless over-excitement of neurons on a large scale. [BTW: I agree that EEG is difficult for the reader to interpret and would probably not choose that image for the lead for that reason.] For practically all other such topics, the excitement of neurons on a macro scale is an oversimplification of what the condition is about. We've found something we can measure, like the temperature of a sick patient, and are trying to deduce something from it. In many cases, the images are only meaningful statistically rather than individually. Epilepsy is defined as a propensity to having epileptic seizures, which are defined as over- stimulation of neurons. Until we start defining ADHD as having an underdeveloped X part of the brain, or as having too little/much of some neurotransmitter, then leading the article with a brain image would be misleading.


 * WP hasn't got guidelines for choosing images in medical articles. This is almost certainly because we are grateful for what few free images we can find. If this were a for-profit organisation that could pay for stock images, then we could take our pick from millions of possible illustrations, and guidelines would be useful. The Epilepsy article could be much better illustrated, so please don't take that as an example to base any argument on. Colin°Talk 07:41, 22 May 2011 (UTC)

Apparently this is a heated discussion and I admit I have not read all the posts above, but I think what I have to say stands on its own. Regardless of what the CDC website thinks, that is not an image of "A boy not paying attention in class." That child is acting like the class clown and mugging for the camera. That is not in any way reflective of my educational experience and struggles with ADD. When I was in class at his age I stared off into space while I daydreamed -- I absolutely, positively did not stick out my tongue and waggle my hands in the air. That behavior is also not reflective of a child with ADHD who has trouble sitting still.

Secondly, and just as importantly, ADHD is not a childhood condition and any image solely of schoolchildren is factually misleading.

Regardless of the stance of the CDC website, I strongly feel this image is not up to the Wikipedia standards of objectivity, relevance or appropriateness. --Boradis (talk) 07:32, 5 July 2011 (UTC)

ADHD and dementia
There are websites which claim that people with ADHD are three times more likely to suffer from dementia. If anyone knows about this, it would make a nice addition to the article. ACEOREVIVED (talk) 15:29, 20 July 2011 (UTC)

Jenny Brockis is behind some of these websites. She refers to the following publication:

A. Golimstok, J. I. Rojas, M. Romano, M. C. Zurru, D. Doctorovich, E. Cristiano. Previous adult attention-deficit and hyperactivity disorder symptoms and risk of dementia with Lewy bodies: a case-control study. European Journal of Neurology, 2011; 18 (1): 78 DOI: 10.1111/j.1468-1331.2010.03064.x

which describes a study in Argentina suggesting that adults with ADHD are at increased risk of dementia with Lewy bodies. ACEOREVIVED (talk) 09:44, 21 July 2011 (UTC)

Here is a website which has more of this information.I am not informed enough on this myself, but if anyone is, s/he could improve the article's comprehensiveness by incorporating this information into the article.ACEOREVIVED (talk) 15:24, 26 July 2011 (UTC)

http://drjennybrockis.com/tag/lewy-bodies/

Efficacy of Medication fo ADHD
ADHD

A: Short term Efficacy 1.	One study demonstrated that when children diagnosed with ADHD were given Ritalin, there was a marked improvement in the child`s ability to sit still, reduced fidgety, less off task behaviour and fewer classroom disturbances.
 * J. Richter, ``NIMH Collaborative Multisite Multimodal Treatment Study of Children with ADHD,`` Journal of the American Academy of Child and Adolescence Psychiatry 34 (1995):987 -1000.

2.	 Another study clearly demonstrates that “ADHD stimulants diminish behaviours prototypical of ADHD including motoric over-activity, impulsivity and inattentiveness.” T. Spencer, ``Pharmacotherapy of ADHD across the life cycle,`` Journal of the American Academy of Child and Adolescence Psychiatry 35 (1996):1109- 32.

These results were excellent for the teachers, parents and doctors as it confirmed that the drugs do in fact work in children, meaning the drugs make the child sit still, behave the way adults want them to behave, it helps them do as they are told children and not to question authority.

B: What are other effects of medication

3.	However, the one crucial element that was over-looked was what the children say about taking these drugs. Dr Sleaton’s study found that in all of the 52 children studied and given Ritalin, there “was a pervasive dislike among the ADHD children for taking the stimulants.” E. Sleaton, ``How do ADHD children feel about taking stimulants and will they tell the Dr.,`` Clinical Pediatrics 21 (1982): 474-79.

4.	  Another study revealed that children on ritalin rated themselves as, “less happy and less pleased with themselves and more dysphoric.”  And when it came to friendships there were “few significant positive effects and a high incidence of negative effect.” D. Jacobvitz, ``Treatment of attentional and hyperactivity problems in children with sympathominetic drugs,``  Journal of the American Academy of Child and Adolescence Psychiatry 29 (1990):677-88.

5.	 Other research details these drugs (ritalin) harmed the child`s self esteem, meaning that the child felt they were “bad or dumb because they were the only ones that had to take a pill”. The subtle message that is sent to the child is very negative and stigmatizing. “The child comes to believe NOT in the soundness of their brain and body or in his own growing ability to learn and control his own behaviour, but ‘in a magic pill that makes me into a good boy’ ” A. Stroufe, ``Treating problem children with stimulant drugs,`` New England Journal of Medicine 289 (1973):407-13.

6.	Another study conducted by Herbert  Rie gave more negative results about the use of drugs on ADHD children stating “that ritalin did NOT produce any benefits for the student`s vocabulary, reading, spelling or math, and hindered their ability to solve problems. Reactions of the children strongly suggest that a reduction in the commitment of that sort would seem critical for learning.” H. Rie, ``Effects of Methylphenidate,``

7.	 Russel Barkley reviewed the relevant literature and concluded,  “the major effect of stimulants appears to be in classroom manageability and rather than academic performance.”  He also found that children on Ritalin showed a “marked drug related increase in solitary play and corresponding reduction in their initiation of social interactions.” R. Barkley, ``Do stimulant drugs improve the academic performance of hyperkinetic children.`` Clinical Pediatrics 8 (1978):137-46

8.	 Finally in 2002 Canadian investigators conducted a meta analysis of the literature reviewing 14 studies involving 1379 youths and determined that “there was little evidence for improved performance.” R. Schachar, ``ADHD,`` Canadian Journal of Psychiatry 47 (2002):337-48.
 * To re-iterate, short-term use of medication is very effective for abating the ADHD symptoms that trouble parents and teachers. However, taking medication is clearly not effective for academic performance, their self-esteem or their social interactions.

C: Long term outcomes of drug use.

9.	In the 1990`s the ADHD experts conducted a multi-site and multi-modal study of children with ADHD for NIMH (National Institute for Mental Health) which concluded, “the long term efficacy of stimulant medication has not been demonstrated for any domain of child functioning.”. Richters, ``NIMH collaborative Multisite.”

10.	 There was a follow-up study conducted and, this time, the NIMH declared that “with carefully crafted medication management there was a hint that medicated children fared better on reading tests but not in any other subject areas.” They finally stated that, “since ADHD is a chronic disorder, on-going treatment seems necessary.” The MTA Cooperative Group, ``A 14 month randomized clinical trail of treatment strategies for ADHD,``  Archives of General Psychiatry 56 (1999):1073-86.

11.	 These results led to another follow-up study to see if the outcomes of these children were maintained while on the medication. At the end of the 3 years, Jensen and his colleagues found evidence and stated that, “medication use was of a significant marker, NOT of beneficial outcome but of deterioration. That is participants using medication in a 24-36 month period actually showed increased symptoms during the interval relative to those not taking the medication.” P. Jensen, ``3 year follow-up study of NIMH of MTA,`` Journal of the American Academy of Child and Adolescence Psychiatry 46 (2007):989-1002.

12.	 In other words the medicated children saw their ADHD symptoms of impulsivity, inattentiveness and hyperactivity worsen compared to those not on any drugs. As well, these medicated children had higher delinquent scores, meaning they were more likely to get in trouble in school or with the police. B. Molina, ``Delinquent behaviour and emerging substance use in the MTA at 36 months,``  Journal of the American Academy of Child and Adolescence Psychiatry 46 (2007):1028-39.

13.	 A confirmation study was done at 6 years and the results were the same concluding that, “medication use was associated with worse hyperactivity, impulsivity and obsessive compulsive disorder (ODD) and with greater overall functioning impairment.” B. Molina, ``MTA at 8 Years,``  Journal of the American Academy of Child and Adolescence Psychiatry 46 (2007):1028-39.

14.	As Dr William Pelham states with long-term outcomes of drug use, “there were NO beneficial effects, none. In the short term, medication will help the child behave better, in the long run it WON’T. And that information should be made very clear to parents.” C. Miranda, ``ADHD drug could stunt growth,`` Daily telegraph (UK), November 12, 2007. — Preceding unsigned comment added by 174.117.66.66 (talk) 15:53, 4 August 2011 (UTC)
 * Links to the studies you refer too and PMIDs would be useful. Also what changes are you proposing? Doc James  (talk · contribs · email) 18:37, 21 August 2011 (UTC)

Edit request from 75.25.160.89, 4 August 2011
The first line, "Attention Deficit/Hyperactivity Disorder is a developmental disorder" I think overstates the degree of consensus. Several alternatives to the "disorder" hypothesis are listed lower down in the same wikipedia page. For example the evolutionary view that it is a variant that improves hunting, and the neurodiversity view that it is a different type of normal. I think that first line should be changed to this: "Although controversial, Attention Deficit/Hyperactivity Disorder is considered to be a developmental disorder by the American Psychiatric Association " and then reference the DSM.

75.25.160.89 (talk) 21:49, 4 August 2011 (UTC)
 * Red information icon with gradient background.svg Not done: please establish a consensus for this alteration before using the template.  Ryan Vesey  Review me!  22:57, 4 August 2011 (UTC)

Remove of a stereotype, disparage, misleading and downplaying Picture
I really don't know what do say about this Picture? As a professional I only can propose to remove this picture. 1. The syndrom don't mean, all the child act like a clown. 2. Sometimes ADHD-Children got a lot of social, an emotional problems. They don't acting out like that. 3. Often ADHD-Children are not so "naughty" in school, but a lot more aggressiv in other social situations, for example in the family, 4. ADHD is not only a school problem! Why you don't show a picture of a mother trying to do homworks with an child an the child not paying attention? 5. Ask yourselv if the picture is more the perception of what unaware people think about ADHD or if this picture clarifying anything? 6. Last but not least, ADHD concerned people are no molester. They have problems controling their behaviour. Do you think it's helpful to show an ADHD-child disturbing others without beeing aggrieved by themselve? WSC ® 11:49, 20 August 2011 (UTC)


 * This is an image from the CDC. And they use it on their page concerning this condition. If you can convince them (the CDC) that it is inappropriate I would then consider removing it here. A lead image does not need to say everything about a condition. For lupus just because we show a facial rash in the lead this does not mean people with lupus cannot get or have other problem. Doc James  (talk · contribs · email) 16:32, 20 August 2011 (UTC)
 * Whats up Doc? What if the CDC remove the picture and replace it by an picture, that calls up anyone to kill all ADHD childs. Would you also want to see that here? And since when you can diagnose ADHD by take a look at the face of an ADHD concerned? Futhermore the cdc is an government agency. We are a work of enlightment. Is this an unattended difference for you? WSC ® 18:29, 21 August 2011 (UTC)
 * Sorry I am unsure of what you mean. But for starters there are not "ADHD children" only children that have ADHD... Doc James  (talk · contribs · email) 18:33, 21 August 2011 (UTC)
 * We had a discussion about the image further up this talk page. Lots of people (including me) are unhappy with it. James, you set too high a barrier. The CDC website is just a website. Who says any professional from the CDC had a say in the photograph or actually likes it either. I think we should try to do better, either with a bigger Flickr search or by requesting an image from some professional. Colin°Talk 18:09, 20 August 2011 (UTC)
 * Can anyone propose anything better? BTW would be happy with this image but not sure of the copyright It shows someone who is inattentive in class.  Doc James  (talk · contribs · email) 18:29, 20 August 2011 (UTC)
 * I can propose somthing better: remove the picture! Even no picture is better then this one. The picture you propose is not bad.   WSC ® 18:36, 21 August 2011 (UTC)
 * I disagree. It is difficult to illustrate psychological conditions. There will be no perfect image. But this one is useful. ADHD is more common in children, more common in males, is important specifically in the school environment, frequently involves classroom disruption. I have quoted refs above that support this. This is not a sterotype as it is part of the DSM criteria for diagnosis. It does not downplay the situation as it shows ADHD disrupting school performance. Doc James  (talk · contribs ·email) 18:37, 21 August 2011 (UTC)
 * I know, I got the same problem in de.wikipdia. But because of this reason I don't set disturbing pictures, who are able to spread wrong contents. ADHD-childs do disrupt school lessons. But not all of them act like a clown. Some of them are agressive some just jaw arround, and belive it or not, some students without ADHS do the same things too. WSC ® 18:40, 21 August 2011 (UTC)
 * Ok, if nobody is against the remove of the picture anymore, I will kick it out soon. WSC ® 17:47, 22 August 2011 (UTC)

I am against the removal of this image. Doc James (talk · contribs · email) 17:52, 22 August 2011 (UTC)
 * I tell you what: I just can tell you what this picture triggers at the people. You decide if you want to have these reactions and if you want to be a slave to CDC views, an us-american governmental department. But if you want to keep the picture, I will be sure you are really understand what that means. And the picutre seem to be the officially position of what the United States of America thinks what ADHD is? But did you ever find such an picutre in an textbook? I don't. Especially because they don't want to set wrong beliefs. Maybe the USofA consider that ADHD-Childs are just annoying molesters. But the science don't. So think about what this little encyclopedia is. The press officer of CDC or rather an indipendent scintific knowledge-based publication? Excuse my lousy english.  WSC ® 18:48, 22 August 2011 (UTC)
 * As above, I agree that the picture is not representative and should be removed. -- SarekOfVulcan (talk) 19:11, 22 August 2011 (UTC)


 * I agree, this picture has more problems than benefits. Yes, it illustrates some aspects of ADHD but it is executed so clumsily that it makes me cringe and offends some. We are better off with none. The daydreaming pictures are less offensive and show the "attention deficit" aspect rather than some "attention seeking" behaviour (though nobody has found a free one to use). I still think my suggestion of illustrating a positive-opposite behaviour (,, children doing homework) with a caption like "Children with ADHD find it difficult to do their homework patiently." is our best bet licence wise (we can't afford models, and free pics that a parent would want us to use of their ADHD or misbehaving child are unlikely to be forthcoming). Colin°Talk 08:21, 23 August 2011 (UTC)
 * Would be okay with the use of this one instead . Doc James  (talk · contribs · email) 09:48, 23 August 2011 (UTC)
 * Why not? But it's not indispensable to have a picture in the article. Ideal would be a picture of a lot of raving kids. WSC ® 16:21, 23 August 2011 (UTC)
 * Doc James' suggestion is probably better. See obsessive compulsive disorder and autism which show a couple of the issues that patients *can* but do not necessarily *always* experience. Concentration problems or attention issues are reflected in a less silly way by the new suggestion, but I don't know what the rights are or if there are other better images; there are some help boards where some image experts might be able to help. But as someone who has worked with children with ADHD, I agree this image was a little suboptimal for wikipedia... --PaulWicks (talk) 19:17, 23 August 2011 (UTC)
 * I'm relieved, I don't have to see Dustin Hoffman counting cards in the autism articel. But seriously, there is a big different between giving an example of behavior or support sterotyps and reduce people up to one attribute. A typical stereotype about autistic people is they are all a kind of savant. A typical stereotype of ADHD is, they are all molesters (I don't know if this word is best word maybe troublemaker is better?). Both is not right. Futhermore the photos of autistic chils are authentic. It shows an autistic child does "normal" things. The ADHS-Photo is posed. A Photographer told an probably normal child to act like a fool for camera. Maybe the commission of the photographer was to "illustrate" ADHD? See whats the result is: an stereotype of ADHD childs who always act like they were dumb. But maybe I'm too sensitive? WSC ® 22:07, 23 August 2011 (UTC)
 * I agree that the current image is probably not the best example. The CDC might use it, but, still, probably not the best image. The ones I've seen proposed so far seem reasonable enough to me. It's just a matter of deciding which kid not paying attention picture is best. Now stop complaining about the current picture and work on a consensus for a replacement.--Unionhawk Talk E-mail 01:48, 24 August 2011 (UTC)
 * Unionhawk, we haven't found a pic of a child not paying attention that we can use. The one James selected, from a choice of Flickr pictures I suggested, shows a child patiently doing their homework, with the point that this is something that is difficult for children with ADHD. I agree with WSC that while ADHD children can cause trouble in class, making troublemaking the defining lead image is insensitive. And I agree that the picture is clearly and crudely posed. I can't imaging any ADHD charity using it. If we accept that for now, we haven't found the best pic with a suitable licence, I shall upload the Flickr pic to Commons and propose it here. Although the pic has a stuitable licence, there are personality rights issues, so I think we should ask permission. I don't have a Flickr account but I suppose I could get one... Colin°Talk 07:37, 24 August 2011 (UTC)
 * Colin, this might be splitting hairs, but even though children with ADHD may struggle with their homework, they still do it... Just perhaps not as effectively. I think the photograph of the child doing homework is illustrative immediately of the kind of issues that the article will be about, but I agree for these invisible illnesses it's not quite the same as say the parkinson's disease or acne pages where you can clearly illustrate the pathology, not just the function that is impaired. --PaulWicks (talk) 12:26, 25 August 2011 (UTC)

I'm afraid I've been too busy to upload the Flickr pic and the other things, and am about to go on holiday for a week. I'll pick things up when I get back. Cheers, Colin°Talk 18:27, 25 August 2011 (UTC)


 * Ok, there have to be a picture in the article. So here are my suggestions. WSC ® 21:19, 25 August 2011 (UTC)


 * There is no DSM 5 yet. Doc James  (talk · contribs · email) 13:51, 26 August 2011 (UTC)
 * The picture was not replaced but suspended. My arguments against this picture are exhausted. I gave some suggestions of pictures I found more expressiv. I can't add anything to this discussion. I hope nobody felt to take offence. But this picture is still redundant. WSC ® 14:59, 26 August 2011 (UTC)

Missing Sources
Cited text #88 "MerckMedicus Modules: ADHD - Pathophysiology" does not exist. Either the link is broken or the site it was/is on changed it. --65.96.148.148 (talk) 17:17, 12 October 2011 (UTC)

Medications
This article is supposed to be a summary with further details found on the subpage. We have this sentence "Some adverse effects may emerge during chronic use of stimulants, including psychosis, hallucinations, insomnia, poor appetite and addiction. "

Thus I fell this can go on the subpage.

"Methylphenidate, for example, has high potential for abuse and addiction due to its pharmacological similarity to cocaine and amphetamines." Doc James (talk · contribs · email) 22:54, 10 October 2011 (UTC)

Methylphenidate is the #1 treatment for ADD, so this phrase is suitable. Innab (talk) 22:19, 11 October 2011 (UTC)
 * I substituted discussion of methylphenidate itself to stimulants, and the reviews show it actually decreases risk of substance abuse. I once again removed the Pediatrics article as it is a primary study, and is contradicted by some reviews (re: substance abused) and by this review which shows that psychosis is a rare complication.  Will need a review to place back in the article, as is required by our guideline on sourcing medical claims. Yobol (talk) 22:09, 18 October 2011 (UTC)
 * Hi Yobol, I undid your edit as the peadiatrics article is actually a review paper; check the pubmed MESH description. Addiction is still a possible treatment emergent side effect, even if overall addiction risk is reduced, so there is no contraindication; this side effect is listed in british national formulary. I have not seen the full text of the case report and review paper. What does it say? Literature geek |  T@1k?  23:03, 18 October 2011 (UTC)
 * The issue is that this page is a summary. We should list addiction once rather than twice per WP:DUE Doc James  (talk · contribs · email) 23:09, 18 October 2011 (UTC)
 * I think you have misinterpreted, check what I undid. Yobol deleted both sentences. I only undid one (not both) of his edits as his rationale for deleting was mistaken. The sentence that you were suggesting being moved from this article, I left that deleted by Yobol. Check my undo and yobol's edits. Literature geek |  T@1k?  23:24, 18 October 2011 (UTC)
 * Ah yes you are indeed correct. Thanks :-) Doc James  (talk · contribs · email) 23:55, 18 October 2011 (UTC)
 * Thank you for correcting my mistake. I added another review for context. Should either of these sentences be in this section on the overview page?  The balance of weight appears to be off here; either the medication section needs to be expanded, or it seems these two sentences should be moved to a subpage. Thoughts? Yobol (talk) 00:27, 19 October 2011 (UTC)
 * It is a tough call to determine the balance here. We need to just state the facts though and as we always use the best sources do not need to state they are reviews :-) Doc James  (talk · contribs · email) 06:12, 19 October 2011 (UTC)
 * I don't understand why we are emphasizing rare adverse events (such as psychosis) while ignoring much more common ones and concerns (such as diversion of medication). I guess it just seems arbitrary to have these points in the overview article. Yobol (talk) 14:19, 19 October 2011 (UTC)
 * Addiction and abuse is most common sideffect of these drugs, so it needs to be mentioned. Innab (talk) 16:22, 19 October 2011 (UTC)
 * Not according to this review: "All stimulants are classified as Controlled Class II (CII) substances and carry a warning regarding their potential for abuse. At the same time, most studies have found that the risk of abuse in patients treated for ADHD under medical supervision is very low." I'd like to keep from this section from bloating, if possible. Yobol (talk) 16:57, 19 October 2011 (UTC)

Typically one mentions common sides effects and serious side effects. Doc James (talk · contribs · email) 20:59, 19 October 2011 (UTC)
 * We barely even mention which medications are used, and now we're going to talk in-depth about side effects? Yobol (talk) 21:16, 19 October 2011 (UTC)
 * Yes I agree this should be a summary. Doc James  (talk · contribs · email) 16:37, 26 October 2011 (UTC)

MTA at 8 years follow up
I'm new to this subject. I'm surprised that more attention is not given (both in the article and generally) to the findings in Molina BS, Hinshaw SP, Swanson JM (May 2009). "The MTA at 8 years: prospective follow-up of children treated for combined-type ADHD in a multisite study". Journal of the American Academy of Child and Adolescent Psychiatry 48 (5): 484–500.

This paper is cited in the prognosis section of the article. But it would seem to indicate that the long-term benefits of treatment are uncertain, which would come up in the management section. Thoughts? (Anon, 10/13/2011)
 * The findings should be included in the medication section, just a sentence or two say long-term benefits are uncertain. It would make the article more inclusive.Millertime246 (talk) 23:11, 18 October 2011 (UTC)
 * We already state "There is very little data on the long-term adverse effects or benefits of stimulants for ADHD" Doc James  (talk · contribs · email) 23:23, 18 October 2011 (UTC)
 * This is why I brought the article up. When I read "very little data," I thought that meant that there weren't studies of sufficient design. So I was surprised to find the article above in the references. Just superficially looking at secondary coverage and the abstract, it seemed like a much heralded, well-funded study of significance. So is there enough other data to say that the data on long term benefits are "mixed" or "contradictory" instead of the current implication that such data are simply absent? Or is the MTA sufficiently noteworthy that the article should read "A significant NIMH study found short-term benefits associated with medication, but did not find significant differences in long-term outcomes between medication or non-medication approaches." (Not quite right, but you get the idea.) Thanks from someone who is trying to learn this field.  Much appreciated. 192.150.10.200 (talk) 00:10, 19 October 2011 (UTC)
 * The problem with this trial is that it lost it blinding after 14 month. Patients where than followed by not keep in any specific group. For a condition that supposedly affects 10% of kids 700 is a small number to look at. A lot of the cardiology trials involve 10,000 people. And this is the best study we have which is unfortunate. Thus the data we have of long term outcomes remains poor. Doc James  (talk · contribs · email) 00:15, 19 October 2011 (UTC)
 * Might be worth describing the study on a sub page, including its limitations? Literature geek |  T@1k?  00:26, 19 October 2011 (UTC)
 * Thanks, Doc James, that's what I wanted to know. To editorialize for a moment, it's really surprising and disturbing. Given the prevalence of the condition alone, I'd expect more study of long-term outcomes. But all the more so for the young ADHD population, I expected that long-term studies would be especially prioritized, given the obvious potential impact on developmental outcomes. If this is all we have, not sure how I'd make a decision about treatment. Okay, just had to say it . . . .getting off my soapbox and returning to the article . ..
 * It seems like the question is whether the MTA deserves more mention in the article. This appears to be a question of notability. Do folks think the MTA deserves a one- to two-sentence summary as the best data out there? Or a sub-page? Or better to leave it as "the data are poor" or some such?  Thanks again -- 192.150.10.201 (talk) 21:00, 20 October 2011 (UTC)
 * Sure deserves a summary on this page Attention-deficit/hyperactivity disorder management but not on the main page. Doc James  (talk · contribs · email) 01:26, 21 October 2011 (UTC)

Side-effects of medication
I think that "Medication" section has to adequately list main adverse effects of stimulant medications, including addiction potential due to their similarity to cocaine and amphetamines. Hiding this information put children in danger. This is FDA required black-box label on Ritalin: http://medicalopedia.org/1908/ritalin-abuse-among-students-is-increasing-alarmingly/ Innab (talk) 16:36, 26 October 2011 (UTC)
 * This is not a main stream publication. Please use something better.  Medicalopedia is also not suitable. -- Doc James  (talk · contribs · email) 16:45, 26 October 2011 (UTC)

Here is goverment site: http://www.ncbi.nlm.nih.gov/books/NBK47127/ Innab (talk) 17:01, 26 October 2011 (UTC)
 * Okay we now have both in the article, the mention of addiction risk and the mention that treatment decreases risk overall-- Doc James (talk · contribs · email) 00:10, 27 October 2011 (UTC)

What about adults? ADHD is not exclusively a children's disorder!
This article carries a strong (and unfortunately common) systematic bias about this subject, namely that it wrongly presents ADHD as almost entirely a disorder of children. Sadly, with the exception of a couple of token sentences mentioning that "ADHD may persist into adulthood" and the (very last) section entitled "In adult" that links to Adult ADHD, this article goes beyond neglecting the topic and specifically restricts its coverage to children (take a look at the epidemiology section for example). While there is an Adult ADHD article, this article is that one's parent, and its myopic view of the ADHD population is doing the subject a tremendous disservice. – – ClockworkSoul 01:12, 26 October 2011 (UTC)
 * We should change the name to Attention deficit hyperactivity disorder in children, that would allow people to see both sections when they search ADHD.Meatsgains (talk) 01:25, 26 October 2011 (UTC)
 * We have a page on Obesity and another page on Obesity in children. The main article is not called obesity in adults. The same situation applies here. We have a section on adult ADHD in this article. I oppose the suggested rename. Doc James  (talk · contribs · email) 10:33, 26 October 2011 (UTC)
 * By that rationale wouldn't it mean we should have an article on ADHD in general and one on children with ADHD? I had the same reaction to this article as Clockwork. The article definitely seems to be predominantly about ADHD in children and gives one the impression that it mainly occurs in children. Which only re-enforces the public misconception. And all the photos are of children. I suggest that the lead either be changed to make the fact that many adults have ADHD more prominant, or a hatnote be added that says something along the lines of "This article deals primarily with childhood ADHD. For ADHD in adults please see Adult attention-deficit disorder". -MsBatfish (talk) 06:04, 16 December 2011 (UTC)

HUH? First paragraph: It is a chronic disorder with 30 to 50 percent of those individuals diagnosed in childhood continuing to have symptoms into adulthood. Last paragraph: Researchers found that 60 percent of the children diagnosed with ADHD continue having symptoms well into adulthood.24.118.168.217 (talk) 17:36, 1 November 2011 (UTC)

Quotation or not quotation?
I think we have to make up our mind. Is the list of diagnostic behaviours a quotation, or not? Many of the words are identical to the source, but some are not. Were there good reasons for changing them? If it's a quotation, then it needs to be presented as such, with quotation marks or other clear indication that it's a quotation, and the words need to all be identical to the source. If it's not a quotation, then to avoid copyright violation or plagiarism, perhaps it needs to be significantly different from the wording of the source, much more so than it now is; which can be done by shortening and summarizing, or combining information from multiple sources, (but has to be done in a way that doesn't change the facts unjustifiably). Or, it could be a combination of quotations and non-quotations, with quotation marks around the parts that are quoted word-for-word. Is the original material copyrighted? See WP:CV.

Also, we need to fix the grammar. If the list is introduced with "symptoms include:", then the first item can begin with "Being" or "Be[ing]", but not with "Be". The grammar is correct in the source.

I suggest giving just one of the behaviours, quoted word for word, as an example, and if the reader wants to read the rest they can follow the link to the source. I welcome comments from others as to how to handle this. ☺ Coppertwig (talk) 21:56, 30 October 2011 (UTC)
 * The APA has written to Wikipedia expressing concerns that we are plagiarizing their mental illnesses. Thus we do need to paraphrase.-- Doc James (talk · contribs · email) 10:31, 31 October 2011 (UTC)

Lead image
Agree with Dbachmann. The other image has good precedent, too. . -- J N  466  15:56, 18 November 2011 (UTC)
 * I might sit this one out. --Anthonyhcole (talk) 16:05, 18 November 2011 (UTC)
 * I accepted the current arrangement as a compromise and still do.-- Doc James (talk · contribs · email) 18:45, 13 December 2011 (UTC)

ADD is not the same as ADHD
Please don´t write ADD when you mean ADHD. ADD is indeed a term which is not used in the current DSM-manuals, but the term is still used among people and refers to the type without the hyperactivity. I think it's very important to separate these two conditions, since it's not the same type of problem. I see many people on the net write that they have ADD, when they mean ADHD. Maybe we should use ADHD-PI or ADHD-I. But personally I think these terms will change quite soon, since the H stands for "Hyperactivity" and a person with ADD has no hyperactivity, so why use the H? It's just confusing and I both hope and think it will be changed in a near future.
 * Reference? -- Doc James (talk · contribs · email) 03:12, 16 November 2011 (UTC)
 * I remember reading this somewhere. I'll look into it if no one else does in the near future. --Anthonyhcole (talk) 13:52, 18 November 2011 (UTC)
 * I've heard of people using this as a distinction, but have no source, doubt there is one other than the popular press, and I don't think it's even a good idea. ADHD is a "spectrum disorder", some are more hyperactive, some less. OR -- I know a lot of people with ADHD (and am one myself); some claim not to be hyperactive, and it's true they're not running about the room. Most of them do not sit still, however; they tap their fingers ... there's a long list of motions they do instead of being still. htom (talk) 15:39, 18 November 2011 (UTC)
 * Maybe it was in DSM III. --Anthonyhcole (talk) 16:08, 18 November 2011 (UTC)


 * Yes, I think that this is simply confusion over the change in terminology between the DSM-III and DSM-IV. If I remember correctly, the DSM-III specified ADD with or without hyperactivity.  The DSM-IV changed it to ADHD with three subtypes, inattentive, hyperactive/impulsive, and combined.  That continued with the DSM-IV-TR and I believe ADHD with the three subtypes is also proposed as the terminology for the DSM-V.  I think I understand the reasons for this terminology, but that's above my pay grade.  I think it's simplest to stick with the currently accepted terminology, especially since this will avoid confusion if readers choose to explore the topic further by pursuing links to other sources such as NIMH or published literature, where ADHD and its subtypes are the preferred terminology.  — Preceding unsigned comment added by Hyperion35 (talk • contribs) 16:33, 30 November 2011 (UTC)


 * I was recently diagnosed by a prominent US psychiatrist of "ADD" (which was formally written on paper), so I assume the term is still used by people other than just the ignorant public. Personally I would find it harmful and misleading to describe myself (and others in this situation) as having "ADHD". I am very far from anything you could call hyperactive, which is one of the reasons it took me so long to get assessed, because I believed the myth that all people with ADHD are ""hyperactive". I also have many friends who have been diagnosed and show no signs of hyperactivity, including no signs of "motions they do instead of being still" as OtterSmith described. It is my understanding that it is actually very common particularly in adults with ADD/ADHD, that there is no hyperactivity involved. Perhaps it would be helpful to include something further explaining about the current terminology versus "older" terminology and/or less common terminology and/or terminology used in the public vernacular (and if it is mistakenly used, that's fine, we can state that). I will try to look for some sources when I have more time. Although it might be a difficult task to find sources that actually explain this. But even if there are, say, prominent medical sources that use the term "ADD", we could still state that. The only mention of ADD I could find in the article is "The previously used term ADD expired with the most recent revision of the DSM." Well, please don't shoot me for saying this, but the DSM is not the only reliable source that exists, and the article is about ADHD/ADD itself and not solely its entry in the DSM. The article currently makes it seem like ADD is just an old synonym for ADHD, when that is not the way it is commonly used outside the DSM. -MsBatfish (talk) 12:13, 19 December 2011 (UTC)
 * Years ago I read an explanation along the lines you're discussing, MsBatfish, in a textbook, I think. From memory, the old ADD is now "ADHD without hyperactivity," but I'm not in the least surprised that practitioners are using ADD rather than that absurd designation. I guess we're waiting for one of us to find a concise description of the evolution of the terms and syndomes to base an explanation on. Someone's just deleted ADD and AD/HD from the lede, which I'm OK with, because I think equating ADHD with ADD is probably misleading.  --Anthonyhcole (talk) 08:03, 29 January 2012 (UTC)

Should other treatment areas be mentioned?
I was thinking Neurofeedback methods. Some methods have been proven effective (see the refs on the prev link). What do others think? (I am studying to be a neuroscientist, is this too specific a treatment for this page?) — Preceding unsigned comment added by AJake88 (talk • contribs) 02:22, 15 December 2011 (UTC)
 * Are there good review articles to back it up? Doc James  (talk · contribs · email) 06:11, 16 December 2011 (UTC)
 * I think that Neurofeedback should be mentioned. One meta-analysis called Efficacy of Neurofeedback Treatment in ADHD: the Effects on Inattention, Impulsivity and Hyperactivity: a Meta-Analysis (from 2009 incl. 15 studies and 1194 people) draws the conclusion "Therefore, in line with the AAPB and ISNR guidelines for rating clinical efficacy, we conclude that neurofeedback treatment for ADHD can be considered “Efficacious and Specific” (Level 5) with a large ES for inattention and impulsivity and a medium ES for hyperactivity.". The full analysis is available here:PDF. I do not think that Neurofeedback is to specific for this article, because the German article mentions this method to control ADHD. Google for it an you will see that there are 3.260.000 results. I think, based on these informations it should be mentioned in this article as an alternative and/or complementary treatment to medication. Regards --Cyrus Grisham (talk) 19:51, 10 January 2012 (UTC)
 * Sure have added. Doc James (talk · contribs · email) 20:00, 10 January 2012 (UTC)

Edit request on 14 February 2012
The section "Comorbid disorders" begins: ''Inattention and "hyperactive" behavior are not the only problems in children with ADHD. ADHD exists alone in only about 1/3 of the children diagnosed with it. Such combinations can greatly complicate diagnosis and treatment. "Such combinations" is meaningless as no combination has been descibed, only the negative fact that the absence'' of some sort of combination is rare. The last sentence should be changed to The combination of ADHD with other conditions can greatly complicate diagnosis and treatment.

86.41.41.138 (talk) 11:25, 14 February 2012 (UTC)
 * Done. --Anthonyhcole (talk) 11:57, 14 February 2012 (UTC)

Interwiki
Please, can someone add the followinf interwiki: Motnja pomanjkanja pozornosti?? Thank you. Irena Plahuta (talk) 18:46, 2 April 2012 (UTC)

Divorce rates
The "divorce rate is higher" point is quickly getting debunked. Even the citation flat out comes to that conclusion: "Surprisingly, research has not consistently found that divorce rates differ between parents of children and adolescents with and without ADHD. Although several studies revealed a greater prevalence of divorce among families of children and adolescents with ADHD (Barkley, Fischer, Edelbrock, & Smallish, 1990; Brown & Pacini, 1989; Faraone, Biederman, Keenan, & Tsuang, 1991; Jensen et al., 1988), an equal number found no differences (Barkley et al. 1991; McGee, Williams, & Silva, 1984; Minde et al., 2003; Schachar & Wachsmuth, 1991). These conflicting findings likely occurred for two reasons: (1) all but two studies (Barkley et al. 1990, 1991) assessed parents of pre-adolescents and (2) all studies used a single assessment point. Investigations using longitudinal data sets with families of children across a wider age-range are needed to examine the probability of divorce over a greater passage of time. Furthermore, because young children are not the only ones negatively affected by divorce, but adolescents and young adults as well (Amato, 2000), studies are needed to compare the prevalence of divorce in families with or without ADHD youth of all ages." From: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2631569/?tool=pmcentrez (the study quoted in the first place) — Preceding unsigned comment added by Pizzamancer (talk • contribs) 06:54, 19 December 2011 (UTC) Signed:Pizzamancer (talk) 12:18, 19 December 2011 (UTC)  (I keep forgetting to do that)
 * Can you quote the text you're discussing from our article please Pizzamancer? I just did a quick page search for divorce and couldn't see anything. --Anthonyhcole (talk) 08:20, 29 January 2012 (UTC)
 * I think he might be referring to the Prognosis section bit that reads "Russell Barkley states that adult ADHD impairments affect "[...] social relationships, [...] dating and marriage [...]". That or text referring to divorce directly was removed after he commented. -92.6.211.228 (talk) 17:05, 20 April 2012 (UTC)
 * Have removed the content in question as the ref was not peer reviewed and does not fulfill WP:MEDRS.-- Doc James (talk · contribs · email) 17:46, 20 April 2012 (UTC)

Soc and culture section
The end of the toplevel part has two items, both poorly sourced even for a section of this type IMO. The first refers to Neil Bush, the former president's brother, who apparently commented in a "feature length documentary" trailer.

The refs for it - one to imdb.com, the other self-sourced to the filmmaker - profess it "examines the alarming growth in the prescription of powerful psychotropic drugs [...] recounts the national tragedy of Columbine and focuses on the largely unknown fact that teenage shooter Eric Harris was on the psychotropic drug Luvox [... then] proceeds to show the dangerous links between psychotropic drugs like Paxil, Luvox, Effexor and Prozac". These are all SSRIs, not medications for ADHD. It doesn't appear to be a notable docu.

More than anything else though, it seems to have precious little focus on ADHD going by its maker's page, they don't mention it *at all* as far as I can see. The a) inherited notability of a person who in their article is described as a "businessman based in Texas" in a b) apparently non notable and seemingly sensationalist docu that doesn't focus on ADHD enough to warrant mentioning the condition or ADHD-specific drugs in the lengthy filmmakers blurb lead me to say it should be removed. Maybe it's worth a mention in Neil Bush's own article, but here it's namedropping.

The slate.com sourced Major League Baseball players item implies some players, at least in 2009, sought a novel way to obtain stimulants to make them perkier after a 2006 ban. It doesn't shed any real light on prevalence of conditions such as ADHD among sportspersons or use of medication in sport. It comes across as mere trivia. I think it should be removed as it detracts from the better quality content in that section. --92.6.211.228 (talk) 17:52, 20 April 2012 (UTC)
 * Removed half of it. We do not require as high quality of references for the society and culture section. As these players where claiming they have ADHD I would say it relates.-- Doc James (talk · contribs · email) 17:56, 20 April 2012 (UTC)
 * Sounds good to me. I felt more strongly about the first item than the second, more relevant one, so am fine with that. -92.6.211.228 (talk) 18:02, 20 April 2012 (UTC)

Image isn't helpful
Having an (oddly black-and-white) stock photography image of a child doing schoolwork doesn't make sense for this article. The caption says it all: "Children with ADHD find it more difficult to focus and to complete their schoolwork." An illustration of someone exhibiting the behavior the article is about is worse than pointless. It's certainly unencyclopedic; it's what a journalistic editor desperate to insert an image for layout reasons would do. — SMcCandlish   Talk⇒ ɖ∘¿ ¤ þ  Contrib.  03:31, 14 May 2012 (UTC)
 * See much of Talk:Attention deficit hyperactivity disorder/Archive 21. Far from being a "desperate" choice, I think this image is an excellent choice, and a wonderful picture. The fact that it is the opposite behaviour is the point. There are lots of ways in which a child can choose not to do their homework (and none of them would illustrate "not doing homework") but few that illustrate actually concentrating on homework. This illustration was not chosen as eye candy for some "journalistic" rather than "encyclopedic" reason. It helps to emphasise an issue that is a significant problem for children with ADHD, and helps the brain remember the point. Colin°Talk 07:45, 14 May 2012 (UTC)
 * You can find an more cliched picture below. I'll never understand the manic tendencies of anglophone wikipeida to illustrate everything. Even if the picture is absolutely inappropriate. You can also show an depressive child (however that looks like). Because it's also an comorbid disorder of adhd. Or you can show an picture of a child on a chair doin' nothing. Write under it: Child, medicated with a dose of 40mg Methylphenidate. Did you ever seen a child? It could suffer from adhd. The point is: You can't see it in their face suffering from adhd. And trying to record the multiple and complicate behaviordisorders of adhd by some picture is pointless. Here's another suggestion: Show an AK 47 at the front, to illustrate the comorbidity with conduct disorder. The idea of illustrating the article is comprehensible. But at this article it's rather harmful with those kind of pictures. WSC ® 22:07, 20 May 2012 (UTC)
 * This image was a compromise. I preferred the previous one but am okay with this one. It simply illustrates that one of the key characteristics of this condition is it association with education. Doc James (talk · contribs · email) 09:40, 21 May 2012 (UTC)
 * Yes, this picture was a compromise. But what kind of? The compromise is: The disturbing picture was placed below. Doc James didn't even understand whats the problem with this Pircture is. But I try it once again: I think this Picture (taken by an professional Photographer in an contrived situation) dosn't even show an adhd child. It shows an child with conduct disorder. And don't tell me, the centers of disease control and prevention (CDC), wanted more than just an loosening photo for their webside: . The problem is, we try to start up an enzyklopedia. We want facts an not stereotyps. We don't need no loosening photos. WSC ® 20:26, 21 May 2012 (UTC)
 * I have another Idea! Why don't we stick an picture of a man, holding a long knife at the top of the article Schizophrenia? We could write among: Paranoid schizophrenic people often fear phantom manaces. Let's assigne a professional photographer. Maybe we can find a compromise: Let's put Russel Crowe at the top. And the Guy with the knife below! Deal? WSC ® 17:05, 25 May 2012 (UTC)
 * Or, even better! you find a picture you think is better (though I doubt, that there is one), instead of joining morbid sarcastics examples. Just a thought away. seen from here--109.232.72.49 (talk) 21:13, 25 May 2012 (UTC)
 * Oh, I found some: . But meanwhile I really think no picture would be better. WSC ® 16:05, 26 May 2012 (UTC)

Hypersexuality
Hypersexuality is considerably more common in adolescents and adults with ADHD than it is in the general population. Can ADHD cause hypersexuality, or is it due to comorbid bipolar disorder? 188.28.227.101 (talk) 14:32, 4 June 2012 (UTC)
 * We would need a reference. :-)-- Mr ADHD |  T@1k?  01:44, 12 June 2012 (UTC)

Reviews
A new review Diagnosis and management of attention-deficit/hyperactivity disorder in adults http://www.ncbi.nlm.nih.gov/pubmed/22612184  Doc James  (talk · contribs · email) 15:36, 15 June 2012 (UTC)

Evolution section flagged as fringe
Someone has flagged the evolution section as 'fringe theories'. I suggest removing the banner as evolution is not fringe, even in religious circles, natural selection within a species is widely accepted. I have added a recent review about ADHD being favoured by natural selection due to its high prevalance (hard to argue against that); additionally the section is quite well sourced. Surely if we have good quality reviews of the medical literature saying that there are evolutionary/natural selection benefits to ADHD, we can't then label the prevailing/dominant viewpoint of the medical literature as 'fringe'? What are other people's views?-- MrADHD  |  T@1k?  01:46, 13 July 2012 (UTC)


 * Well, the Hartmann "Hunter-Gatherer hypothesis" probably does fall under fringe theories, to be honest. That particular hypothesis is not supported by the medical literature at all.  Now, some of the other hypotheses may be more rigorous, and to the extent that they're well-sourced and that we're discussing what they actually conclude rather than wishful fantasies, then it might be worth including.  The conclusion for the first paper cited in that section, for example, contains  statement that is similar to a few other papers I've seen on the subject:  " It is possible that the presence of altered gene combinations, as in ADHD, can bring concrete benefits to society but are detrimental to the individual."


 * I've seen a few papers that discuss this possibility, that the symptoms themselves are harmful to the individual, but that the society as a whole benefits from having individuals who engage in impulsive behavior, both from the small percentage of the times that the impulsive behavior results in figuring out something new, and in the vast majority of times that the impulsive behavior demonstrates to the rest of the society the importance of not tbrowing rocks at a hornet's nest, for example.


 * The problem is that it is incredibly difficult to really demonstrate what selective pressures, if any, were involved in the evolution and spread of these alleles. It's going to be mostly speculation, because behwvioral and cognitive differences due to neurological development are simpky not something that will be apparent in the fossil record.  When you compare the handful of papers on the potential evolutionary reasons why ADHD exists to the thousands of papers documenting the deleterious nature of the symptoms and the increased risk factors for things like substance abuse and incarceration, it might be reasonable to conclude that the hypothesis that ADHD confers some sort of evolutionary benefit is an extraordinary claim that requires extraordinary evidence.  Hyperion35 (talk) 10:37, 15 July 2012 (UTC)
 * Thanks for replying Hyperion. :-) The hunter-gatherer hypothesis was 'designed' by Hartmann for his young son to understand ADHD from an evolutionary/natural selection perspective; it subsequently became a popular way for authors writing books on ADHD for lay people and children/adolescents to describe ADHD and why natural selection favoured it. I can recall my pediatrician way back using the term when discussing ADHD with me and my family and there was a whole chapter in a book on ADHD that I read many many years ago when I was young about the term. The reason that it is not commonly used in the medical literature is because the medical literature uses terms such as 'evolution' and 'natural selection' but for children, adolescents and lay parents hunter-gatherer is a way of simplifying the scientific term evolution/natural selection.
 * I fully agree that ADHD can have serious detrimental effects to the individual particularly in modern day society. The extraordinary evidence is how common ADHD is and there is no dispute in the medical literature about ADHD being a creation of natural selection to my knowledge. It is not heavily researched but when it is discussed in natural selection terms researchers don't dispute that natural selection/evolution has created and favoured ADHD. If there are papers which say ADHD is not a creation of natural selection by all means feel free to add them to the evolution section of this article.-- MrADHD  |  T@1k?  13:31, 15 July 2012 (UTC)


 * I think that you misunderstand my objections, which are multiple. I am not saying that ADHD, or any other hereditary condition or trait, is not affected by natural selection.  I am not arguing against evolution, dear lord no, what I am saying is that the evolution of ADHD is not something that has been heavily researched, that I'm not sure that there is any sort of definitive evidence much less a scientific consensus, and that there is a lot of evidence to suggest that for the individual, at least, it is a deleterious trait.


 * First, Hartmann's hypothesis, as you describe it, is not a scientific hypothesis but a "just-so" story, and really doesn't rise to the level of scholarly material. Whether it is a useful analogy for a layman, the question is how well it actually reflects scientific findings, and the Arcos-Burgos paper you cite is pretty much the only time I've ever seen it mentioned in peer-reviewed material.  Hartmann is not a geneticist, or a psychiatrist, or an ecologist or evolutionary biologist, and his particular hypothesis is not something that he submitted for peer review.  As such, it is at best pseudoscience, and perhaps survives the "fringe" label only because of how many people might have read it.  I think it was Barkley who responded to Hartmann's hypothesis by pointing out that if he was going hunting, someone with ADHD did not strike him as being a good hunting partner.


 * Currently the Williams & Taylor paper is the only one with full text access. Looking over it, one thing that strikes me is that it is most definitely is not making the claims mentioned in this article or in what you are saying, and certainly it bears no relation to Hartmann's hypothesis. They note that ADHD consists of deleterious effects to the individual, and offer several hypotheses for how these traits might benefit society as a whole.  When they talk about natural selection "favoring" ADHD, what they are saying is that there is likely some positive selecting pressure to outweigh the well-documented deleterious effects, not that there is some evolutionary advantage to ADHD itself.  This is a very important distinction.


 * Williams & Taylor state that the "most prevalent view" is that there may be traits that are beneficial, but that when these various traits are combined as seen in patients with ADHD, the result is maladaptive. Thus these individual traits might undergo positive selection, but people with ADHD are "maladaptive spandrels".  They then go on to explain the findings of their research, concluding that it implies that society as a whole might benefit from having a small number of people with ADHD for a number of reasons.  Again, in evolutionary terms, this is not something that is undergoing positive selection, and in fact the gene itself would be said to be selected against.  In fact, in addition to noting that ADHD results in bad outcomes for the individual, the authors are fairly clear that on the societal level, ADHD would not be beneficial in large numbers of people, but only that there might be "advantages to confining unpredictability to a small subgroup" to use their exact words.


 * As for what the prevalence of ADHD tells us about its evolutionary fitness, I'd honestly be more comfortable having a geneticist review that claim. OMIM lists ADHD as being an autosomal dominant genetic condition, and a prevalence of 5-10% for an autosomal dominant condition does not strike me as a sign that it is undergoing positive selection.  I am not a geneticist, however, so I don't feel qualified to say that with any certainty, but the argument does not match what I understand of mendelian inheritance or natural selection.  However, this would match what Williams & Taylor write about negative selective pressure operating to minimize ADHD to a small subgroup.


 * I'm sorry for the long response, but this is a complicated and complex topic, and I thought that you deserved an answer more comprehensive than simply "you're wrong" or "Hartmann is an idiot". Unfortunately, to be brutally honest I would say that the section in this article on the evolution of ADHD is absurdly large in proportion to the due weight of research actually conducted on the subject.  And I would go on to say that what we have in this article on the subject is dramatically inaccurate in terms of representing what published evidence exists on the subject.Hyperion35 (talk) 21:56, 15 July 2012 (UTC)


 * I agree that ADHD has lots of negative effects especially for the individual. I do not agree with you that the Hartmann's theory is pseudoscience as it was never written or promoted as hard science (pseudoscience is something unscientific claiming to be scientific); it is just a simplified explaination of natural selection for children and adolescents. I certainly agree that ADHD in large numbers of a population would be a very bad idea. I can't imagine how society would be if 50 percent or more of people in it had ADHD!!! 5 percent is maybe okish, LOL. Yes, but for the societal group to survive or thrive, someone has to go out there and take risks, for themselves and their group. Naturally those that are more cautious will be less likely to run into problems. In simplistic terms, 'gathering/farming' is safer than 'hunting'. Given that this paper lends some scientific support to Hartmann's theory, and also given the notability of his theory in popular culture and books etc, I think a 'see also' link to the hunter farmer article is justified.-- MrADHD  |  T@1k?  00:50, 18 July 2012 (UTC)