Talk:Attention deficit hyperactivity disorder controversies

Problems with Original Research in the ADHD as a biological illness section

I've been trying to improve the "ADHD as a biological illness section" and I am unhappy that the lines I have given below don't have sources. I am concerned that they are original arguments since the sources of the statements used to support the argument are not directly relevant to ADHD. I decided that these lines ought to be removed until someone can find a source (hopefully a well known critic) who makes this specific argument. I would like to note that I have no problem with this argument being presented in this section; however, someone needs to be accountable for it. Sifaka ^talk 00:58, 19 April 2009 (UTC)

But, critics of Dr. Castellanos’ own research have pointed out that the differences he was claiming do exist could have been the result of medication taken. Even if differences in the brain can be found, an important issue is that the physical brain can be changed by patterns of behavior. Thus learning braille causes enlargement of the part of the motor cortex that controls finger movements. After they have passed their licensing exam, London taxi drivers have been found to have a significantly enlarged hippocampus compared to non-taxi drivers. Monks who meditate show measurable differences in their prefrontal lobes.

Yea they all look like synthesis and original research to me except the last link,[1]. Although it is hosted on a free webhosting service and linking to the original which is on a blog might be problematic.[2] Does anyone know if Simon Sobo is a specialist or researcher of ADHD? If he is then we can link to his blog but if he is just a regular doctor with an opinion then we probably can't link to his blog (if I am remembering policies on citing to blogs correctly).--Literaturegeek | T@1k? 22:35, 22 April 2009 (UTC)

He has published articles on psychiatry and I presume he is a psychiatrist: PMID 19181456 He has also done some editing on the ADHD page however was driven away by Scuro. --Doc James (talk · contribs · email) 23:15, 22 April 2009 (UTC)

Dr. Sobo is/was in private practice and his user name is User:Ss06470. He still seems to be editing. Someone should ask him if anyone has published something on this argument. Sifaka ^talk 01:27, 23 April 2009 (UTC)

Please see Rethinking ADHD, a new book published by Palgrave Macmillan,[3] a very respected peer reviewed publishing house which has a chapter by me (based on my blog ADHD and Other Sins of Our Children You might also be interested in this page [4] which is put together by patients and has links to articles by me some published in peer reviewed journals, some self published. Also this recent article by me that appeared in the peer reviewed journal Medical Hypothesis [5] I can also direct you to comments made about my articles but hopefully this will be enough --Ss06470 (talk) 14:04, 10 June 2009 (UTC)

The book would be a good source to quote as would the peer reviewed source. Why not summarise it and cite it in the article? I don't have the book myself so cannot cite it. If you prefer, you could write up a summary and then provide the page numbers and someone else can cite it for you if you do not know how to use the book citation template.--Literaturegeek | T@1k? 14:48, 10 June 2009 (UTC)

I have not read Dr. Sobo's book, but reading the PubMed abstract linked above, I do not believe that it qualifies for use in Wikipedia for several reasons:

1. Medical Hypotheses .... Really? I'm not really sure whether Medical Hypotheses counts as a "peer reviewed" journal, for starters. Most mainstream medical researchers consider that publication to be a joke, and its "peer review" process has been routinely criticized as being nonexistent. Its articles are rarely if ever cited in other publications, and the only times that I have ever seen it mentioned by reputable researchers is to demonstrate how not to do research.

2. The article in question reads like an opinion piece, and does not seem to imply that any actual research was done aside from "thought experiments." Out of respect for other readers, I will not mention the vulgar slang that academics use to describe "thought experiments" except to say that it rhymes with "dental mastication."

3. The title of the article incorrectly implies that the DSM offers advice on treatment. This is not true, as the DSM is solely a set of diagnostic criteria. Questions regarding appropriate treatment are usually issued in Clinical Practice Guidelines by various specialty societies. Perhaps the full article is more clear on the difference between the DSM-IV and the APA's CPGs, but it is deeply disturbing that the author seems to be unaware of the differences between diagnostic guidelines and treatment guidelines.

3. Most importantly, the article in question eschews Evidence-Based Medicine, derides clinical research as "acting like blinders," the author appears to advocate for granting anecdotal reports the same standing as actual controlled, documented experiments...but most disconcerting is the fact that the author appears to confuse aggregate clinical data with individual results.

Finally, the article specifically states "...what is the best way to formulate treatment strategies when now, and in the foreseeable future, science cannot offer answers that we need?"

If the author is stating that science cannot provide the answers, then I am not sure how one can consider this to be a scientific paper. This is edging a bit close to a "god of the gaps" or an "exceptional pleading" or maybe even an "argument from ignorance" fallacy, and beginning to edge into the realm of pseudoscience.

I would prefer if articles linked from Wiki were actually scientific in nature, and not a bunch of rhetorical thought experiments, rants against EBM, incorrect assertions about the DSM's use in treatment decisions, special pleading to look beyond science and empirical evidence gathering, and treating psychiatry as if it were any different than any other branch of medicine.

I have news for the author of this paper: You might hoodwink a few laypeople, but most educated individuals are aware that the AMA and most medical specialty societies endorse Evidence-Based Medicine, that the AMA and most specialty societies issue their own CPGs and treatment guidelines based upon scientific research just the same as the APA does, and that virtually all branches of Cognitive Medicine utilize the same basic differential diagnostic approach as the APA outlines in the DSM.

Perhaps the author should read through the CDC's diagnostic criteria for Swine Flu, for example, to see how physicians often look for clusters of symptoms to make a differential diagnosis based upon clinical evidence. Medical practice isn't like an episode of "CSI" or "House" where they run a whole bunch of diagnostic tests that magically reveal the answer. It isn't Star Trek where you wave some magical device over someone and it tells you what's wrong with them. While laboratory work and diagnostic testing are certainly useful, the vast majority of medical diagnoses are and most likely always will be made by a basic differential diagnosis based upon clinical research, patient history, and symptom presentation and progression, and this is as true for cardiology, nephrology, dermatology, otolaryngology, rheumatology etc as it is for psychiatry.

Hyperion35 (talk) 15:41, 1 August 2009 (UTC)

Extraordinarily strong words from someone who has not read the literature in question. Medical Hypothesis is a Medline, peer reviewed journal and is far from a joke. Its particular focus is ideas that challenge dominant paradigms. AS for evidence based medicine, Hyperion is quite correct that it is the current mindset of most organization. That does not mean that clinicians are particularly thrilled with it. The problem is that it falsely gives an impression of scientific prestige to findings that are not based on scientific understanding. A treatment is compared to placebo and if it bests it is deemed evidence based. There is nothing wrong with this except many times the treatment is effective 50% or 60% of the time, which while beating placebo, is still treatment without scientific understanding of what is occurring. No one has any trouble with penicillin for strept throat which is going to work 99% of the time because we understand the disease and have the right treatment. The problem is trying to force clinicians to follow evidence based treatment in protocols ( eg one of the proposals currently being considered for health reform is that those who follow evidence based guidelines cannot be sued) One of the key issues isn't that "evidence based medicine" has no value. It is the false impression of scientific validity that it conveys. It reliance on diagnoses, which are in themselves very iffy ... I just realized that I am essentially presenting my article which is easy enough to access.link Pursuing Treatments that are not evidence based I am including the link to my internet version which is free, but those who want to go to Medical Hypothesis are free to do so.Medical Hypothesis —Preceding unsigned comment added by Ss06470 (talk • contribs) 13:10, 10 August 2009 (UTC)

First off, no, Medical Hypotheses does not appear to be a peer-reviewed publication, at least not in the conventional sense. Here is their description of their review process, in their own words, from their own website:

"Medical Hypotheses takes a deliberately different approach to review: the editor sees his role as a 'chooser', not a 'changer', choosing to publish what are judged to be the best papers from those submitted. The Editor sometimes uses external referees to inform his opinion on a paper, but their role is as an information source and the Editor's choice is final. The papers chosen may contain radical ideas, but may be judged acceptable so long as they are coherent and clearly expressed. The authors' responsibility for the integrity, precision and accuracy of their work is paramount."

This is not the standard peer-review process. Technically it doesn't really count as peer-review at all, since nothing is reviewed.

As for the rest...well, by your own admission, this sounds like fringe work. EBM is considered the gold standard in medicine, endorsed by pretty much every medical specialty and subspecialty society. Treatment efficacy with stimulants has been shown to be closer to 70-80%, although obviously other medications for other conditions may have different efficacy values. Regardless, I can think of no other way to determine the best treatment aside from trial and error. The entire point of EBM is to avoid having to use each individual patient as a guinea pig due to a lack of information about what might be the best treatment.

And finally, if medicine is not to rely on diagnoses...you know what, I don't think there's a point to rebutting that, I'll just let that last statement stand. If medicine is not to rely on diagnoses or on the use of evidence to determine the best treatment, then we may as well throw out every major medical advance in the past 200 years. Your statements speak for themselves. If you would like me to ask for an outside opinion on this from an uninterested editor from the Wikiproject Medicine, I can, but you're just going to get the same answer. ~ Hyperion35 (talk) 14:23, 10 August 2009 (UTC)

Hyperion, I think that you have given this debate long enough now and it is irrelevant to this article. The only support that Ss06470 got was for citing the book but for some reason you have went off on a tagent triggering a debate and Ss06470 has fueled it by responding, I would ask you both to stop. The sources other than the book are not reliable sources, so are not relevant to this discussion, which has deteriorated into discussing each other's beliefs and whatnot, such discussions are counter-productive. I recommend that forum like debates are at least moved to someone's talk page or else perhaps you could give Ss06470 your email address and you can continue this debate. Ss06470, I asked if you would be willing to summarise the book in a few sentences or paragraph for consideration for citing but this has not happened. I cannot as I do not have access to the book.--Literaturegeek | T@1k? 15:58, 10 August 2009 (UTC)

I'm sorry, I was under the impression that the Medical Hypotheses article was being cited, either on its own or as a substitute for the book citation. If it is not being offered as a citation, then obviously there is no further point to discussing it. ~ Hyperion35 (talk) 18:46, 10 August 2009 (UTC)

Literature geek sorry, I cannot let Hyperion have the last word on the issue of the shortcomings of diagnostic pschiatry. I am not taking a position like Szaz that there is no such thing as psychopathology. Clearly there is, but diagnostic labels are not always the best way to understand this pathology. It isn't only that efficacy is not where we would expect it to be if we had a good grasp of the issues through scientific understanding. As I note the diagnoses themselves may not represent real illnesses. Yes one can, and should, for research purposes take a stab at operational definitions of the phenomenon you want to study. But that doesn't mean that something like oppositional-defiant disorder represents an actual disease like diabetes, pneumonia, and the like. Yes you can define what everyone will agree to call oppositional defiant disorder, and find patients that fit this description, but no it is not a disease and trying treatments out on this "disease" even if it reaches evidence based confirmation, does not mean it will be the correct treatment for an individual before you. There are so many reasons a child can become oppositional and defiant. What you call a preference for anecdotal results from the treatment of individuals is simply trying to understand where a particular individual is coming from. Thinking of everyone who is oppositional and defiant as being the same as evryone else showing the the same behavior is absurd.

But even if we leave aside the crudenss of diagnoses that are so uncertain they are called (for this reason) "disorders" in DSM III abd IV rather than "diagnoses", the key issue is what do clinicians do when the evidence based treatment isn't working. Are we only allowed to consider evidence based treatment or can we consider other strategies. Italic textMore to the point shouldn't clinicians be writing about their case histories and discoveries so that we can create a literature that is rich in intuitions or should it be barred as nonsense since it is not evidence based. That is the issue I was addressing. The limitations in our scientific understanding are so great that the literature should be rich with the sharing of sensible insights with each other. You see this as using patients as guinea pigs. I see it as the kind of clinical judgement that has always characterized the best medical practice , and which, by the way, often leads to the kind of scientific discoveries we are all waiting for. That you can't see this as necessary tells me that you are not a clinician, but rather an academic who isn't forced to come up with solutions for the patients looking to them for help (other than offering a clinical trial speaking of guinea pigs) To repeat, we have no need for intuitions and insights when we get to the promised land of scientific understanding (my example of penicillin for strept throat is an example of good scientific practice) Claiming the prestige of science when the knowledge isn't there is pseudo science. Yes scientific method is being followed, but not the highest quality of science, absolute clarity about what is known and not known. Evidence based medicine as ideology obscures this crucial point

. Finally, I just don't get this policy of user names. One of the most important qualities of scholarly discussion is that people identify themselves. This site is full of pedantic distinctions in the interest of intellecutal balance, but annonymous posters are certainly detrimental to a reasonable airing of the issues,--Ss06470 (talk) 03:26, 11 August 2009 (UTC) Simon Sobo, M.D

ADHD Issues where there is active debate

I've made a list of topics in ADHD where there is active debate. Some issues are primarily debated in mainstream psychiatric practice and research, others are debated more in "laypeople land," and some are in both. If I omitted something egregious, please add it to the list. Do note I'm not picking sides on the debates presented, only trying to offer what is in my not so distinguished opinion the level of discussion in various communities. Whether or not these collectively constitute "controversy" is up for consensus, but I thought it would be a good idea not to pigeon hole the topic of conversation on one debate alone. Sifaka ^talk 03:46, 29 April 2009 (UTC)

1. Does ADHD exist or not exist?

• Not really debated in maintream research or practicing communities. I would go so far as to say a significant number of lay people believe it exists.
• S-mand said: Natural trait called disordered. Potentially.
• Hordaland says: The laypeople who say it does not exist are many: bogus, bad parenting. (Hard to source.) Organized resistance must be mentioned: Scientology, Anti-psychiatry, social rather than individual problem.
• * Many different communities dispute the ontology of ADHD, and not just based on 'bogus' reasoning- the fact that there is no scientific, consistent diagnostic criteria, and the geographic, cultural, and historical isolation of epidemiology, are strong indicators of the fact that ADHD is likely pattern of behavior with its origin in environmental factors, not a neurological disorder. —Preceding unsigned comment added by RebelBodhi (talk • contribs) 02:32, 7 July 2009 (UTC)

I don't disagree, RebelB, and I think my comment just above was ambiguous. I meant to say that laypeople who say that ADHD does not exist are many, and they think that it is a bogus diagnosis and/or it's due to bad parenting. - Hordaland (talk) 12:24, 7 July 2009 (UTC)

2. Should ADHD be considered a disorder?

- Will it hurt the children to say they have a disorder? Should people with ADHD get any special benefits?

• In the mainstream end of things, people who meet patients care more about this than the researchers. It's more mainstream than "fringe". I'd call it an "alternative theoretical formulation".
• Legally it is considered a learning disability and schools and workplaces and whatnot are required to provide accommodations.

3. "Special cases" of ADHD : Valid or Not?

• Sub-clinical ADHD: If valid, do we do anything differently?

• I know almost nothing about it, but I know it comes up in respectable places in research from time to time. I don't know how well the idea has caught on.

• Adult ADHD

• Definitely has gained a lot of mainstream steam. The laypeople community has been slower to pick it up.

4. What are the biological causes of ADHD?

- Environmental, genetic, diet? What proportion is genetic and what proportion is environmental? Do the different causes of ADHD affect the presentation of the symptoms?

• Debate is mostly in the research community. They're so many unknowns it's hard to argue. However researchers have seem to rule out most aspects of diet as a part of ADHD.

5. Does the current ADHD diagnosis criteria allow too high a rate of misdiagnosis or over-diagnosis and if so what is the best way to fix it?

• Reminds me of lines like: "children with problematic behavior" "students who want to use stimulants to get a study edge" "fad diagnosis"

• Active debate in the mainstream psychiatric community and very often in "layperson land."

• The difference in diagnosis rates between girls and boys means we don't have it quite right yet. Who is the best source of information in the diagnosis: teachers, parents, the child themselves. We need to account for differing cultures... etc

• Debated both by the psychiatric community and the lay-people at large. Mentioned all the time by review papers.

Perhaps it's just that boys hit their heads against things harder and more frequently than girls, causing more -- but accumulative -- very slight frontal lobe damages. htom (talk) 04:26, 29 April 2009 (UTC)

Let's don't get into the girl/boy statistics. One argument is that cavemen had to be active while cave-women just sat there and nursed babies. Thus, twice as many boys... - Hordaland (talk) 09:36, 9 May 2009 (UTC)

• S-mand said: Diagnostic criteria controversial?. No, I dont see that. All professionals afaik thinks they must be improved. Public aspect? Can't really see it.
• S-mand said: Overdiagnosis. Absolutely an issue.
• S-mand said: Underdiagnosis. Probably an issue. But controversial?
• Hordaland says: Major problem for the public. Recently medical & research people are recognizing this, that too little work is done to find differential or comorbid diagnoses. For example, Barbara Fisher says, page 35: “If children do not get restorative sleep at night or they have insufficient sleep or sleep deprivation, daytime symptoms can easily mimic hyperactivity. By remaining active during the day, children can stay awake.” She also talks at length about anxiety causing ADD symptoms.

6. What is the best way to make a diagnosis?

- Repeated office meetings, a battery of cognitive tests, observation, circle the number and add up the score type tests?

• Definitely debated in the mainstream psychiatric community, especially when the issue of too many diagnoses or misdiagnosis crops up.

7. Best, if any, treatment method:

Stimulant medications versus alternative medicine versus no treatment at all?

• Overwhelming support for stimulants in the mainstream community, but a google search for ADHD treatments suggests that natural remedies are marketed heavily to laypeople
• There is a subtle element of the alternative medicine practiced by mainstream psychiatrists: a doctor may recommend taking omega three supplements alongside stimulant meds because it couldn't hurt and maybe it would help. In my experience, it's not uncommon for doctors to mention some of the alternative stuff when talking ADHD, but only as supplementary treatment.

• The FDA and the pharmaceutical companies seem to disagree about how effective stimulants are for ADHD. I submit [6] and [7]--Doc James (talk · contribs · email) 10:31, 9 May 2009 (UTC)

• • Best treatment is going to depend upon the patient. This is a spectrum disorder, and someone who has it making a severe impact may require very different treatment than someone with minor impact. This is a little more complicated than a broken leg -- which also has varying best treatments, depending on the patient. htom (talk) 15:59, 14 June 2009 (UTC)

8. Use of stimulants

When and when not to use stimulant medications versus other options (ADHD coaches, nothing all, etc.) -Is the long term use of stimulants effective and are they necessary? Is there a lower age limits to when a child should start? Is it ever too late to start stimulant meds? Should stimulant meds only be taken when needed or all the time? What about when the abuse potential is high?

• Very much a major debate in the psychiatric and research community.
• S-mand said: Treatment with Stimulant and its (ab)use. This is probably the main public controversy.

9. media & big pharm

• S-mand said: Media coverage and interest. Sales before science.

Thanks for this section, Sifaka; can't hurt, might help. I'm a layperson, though as an elementary school teacher, some might allow me a degree of expertise. ;-) I am most concerned with your point #5. Obviously, doctors should always rule out other explanations of the symptoms before diagnosing ADHD. I believe that this isn't taken anywhere seriously enough in the case of ADHD. For example, treating sleep deprivation/disturbances of various causes such as delayed sleep phase syndrome, narcolepsy and sleep apnea has removed children from the ranks of ADHD sufferers. (No, I don't have one source demonstrating that.) That ADHD is a fad and a catch-all is a reality; the pendulum has swung way too far in that direction. - Hordaland (talk) 21:17, 30 April 2009 (UTC)

• Comment - The first sentence of the article should describe what the controversy about ADHD is. Statements about how controversial it is can follow, but only after what about ADHD is controversial has been described. LK (talk) 16:01, 8 May 2009 (UTC)

You are right, LK. I fear there are so many subsets of controversial areas that it will take more than 1 sentence. But we're on the right track. Input is welcome. - Hordaland (talk) 02:08, 9 May 2009 (UTC)

removing POV tags without discussion

Certain editors continue to remove POV tags unilaterally from the article without discussion. I will be seeking action shortly for such behaviour and wanted to let all members of this community know that anyone who continues with this behaviour will be a party mentioned on the complaint. This behaviour is wrong and goes against wiki policies.--scuro (talk) 16:05, 27 April 2009 (UTC)

Good luck with that because "drive by tagging" without discussing the content of the dispute on the talk page is strongly discouraged. See WP:NPOVD. You are fast turning the talk pages into a drama based forum or chat site. Perhaps that is your intention?--Literaturegeek | T@1k? 08:50, 28 April 2009 (UTC)

I am discussing content, specifically citation 12, but I did bring up a number of generalized observed shortcomings of the article. I choose to keep the discussion in a very narrow band so that criticisms should also be narrowly focused on one specific piece of content. That a number of members have trouble focusing on one specific piece of content justifies the approach.--scuro (talk) 14:06, 28 April 2009 (UTC)

How about we introduce a "seconding policy" with major article tags - what I mean is that if someone wants to add a tag or remove a tag, they ask on the talk page and wait for their request to be seconded before adding/removing the tag. That way, there is at least some feedback between users regarding tags, the tagger must be specific in explaining why the article needs a tag or how the content has been fixed so it doesn't need a tag anymore, and a section for discussion automatically gets made. Sifaka ^talk 06:06, 29 April 2009 (UTC)

Feedback is nice but your policy would go against current policy. A second "vote" isn't justification to remove a tag nor is it required to add a tag.--scuro (talk) 11:44, 29 April 2009 (UTC)

Explain Scuro how it goes against current policy. Please be detailed and give links to the appropriate section of the appropriate policy pages. I'm suggesting this additional level of regulation to prevent edit warring over something unrelated to article content. Sifaka ^talk 16:55, 29 April 2009 (UTC)

Here is a link that some contributors really must internalize.WP:OWN But I think the link you are looking for is this one. WP:DEMOCRACY I appreciate it that you don't like edit warring. But I am feed up with this environment of lawlessness. Where contributors can hijack a page and keep any edit of another contributor off the page simply because they believe that they are wrong, or haven't met some expectation which moves whenever the criteria are met. I've tried mediation twice and this contributor simply let the mediation end with no resolution. Really I think it is time that administrators step in. I'm done with jumping through Wikipedian process hoops to file some lengthy mediation process that in the end has no teeth. I get the lead by example, expect the best in people approach...but it's been months and months and nothing has changed. Why should other contributors endlessly suffer? I'm not playing nice anymore until I see change.--scuro (talk) 21:31, 29 April 2009 (UTC)

Concerned about the Concerns over research section

I've removed the section and put it here.

Concerns over research

There is a significant amount of controversy surrounding ADHD in the medical, psychological, academic and educational communities. Some involved in this controversy have described the arguments used in support of ADHD as phoney, scientifically weak, fallacious, and similar to the tactics used by politically biased major news networks. According to philosophy professor Gordon Tait, fallacious arguments have often been used by advocates of ADHD to support their position. These fallacies include material, psychological and logical fallacies. It suggests that all researchers, whether into ADHD or otherwise, "need to pay much closer attention to the construction of their arguments if they are not to make truth claims unsupported by satisfactory evidence, form or logic."

There are quite a few problems with this.

First is that the section has nothing to do with research. Looking at content and the source, this section is really about alleged poorly constructed arguments used to support ADHD as a disorder. The title has to be changed to something else.

I think this source is sketchy. It should not be used as support for the existence of "fallacies" because the author offers no support that the fallacious arguments he presents are actually used. Although I haven't looked into it much, the sources he bases some of his claims on may be questionable themselves. I really think an alternative source should be found. Most of the fallacies he brings up are really concerned with issues addressed in other sections like over diagnosis, misuse of stimulants, etc where we have much better sources.

Finally, I think this source is of poor quality because it contains some really questionable arguments. I'll outline a few of what I thought were the worst offenders below in case you can't get the paper because of paywalls. Sifaka ^talk 22:02, 19 May 2009 (UTC)

(1) Golden Mean Fallacy - This fallacy is based upon the pre-existence of two contrary, or widely divergent, positions. Faced with the difficulty of choosing between those positions, a compromise solution is reached when both elements are incorporated into the conclusion. This argument is a fallacy since nothing in the premises provides any support for that conclusion. ... It is estimated that 1–12% of school age children are affected by ADHD, with 3% the consensus estimate.

This is a terrible argument because it misrepresents how prevalence rates which are likely to be considered "consensus rates" are determined. The claim the author makes is that 3% consensus number was decided because it is a compromise between 1% and 12%. While I can't be sure of what the author was thinking when he wrote this, it sure seems like he's saying that there were two figures: 1% and 12%, and that the number 3% was chosen as an average between the two. The prevalence rates which are likely to be considered "consensus" are calculated with considerably more care, thought, and scientific rigor. While essentially the consensus number is an average, it's a weighted average with a confidence interval. See this study's methods and discussion.

(3) " Weak Analogy Fallacy" - ADHD is often compared to a wide range of common, unproblematic illnesses and diseases, everything from pneumonia to mumps. However, this is ultimately a weak analogy which attempts to mask a significant problem with the psychological construct of ADHD, in that there appears to be no objective physical evidence for its existence at all—‘no physical symptoms, no neurological signs, and no blood tests’ (Breggin 1998, pp. 141–142).

The lack of an objective diagnosis does not mean ADHD does not exist; there may eventually be an objective diagnosis for certain subtypes (like genetically linked ADHD). Also, the statement that there is no objective physical evidence for its existence is also wrong. The pathophysiology section lists quite a few studies which demonstrate statistically significant findings of differences between people with ADHD and without. While some claim the results are not conclusive or have confounding factors, it is really irresponsible to completely ignore the existence of these studies altogether. Also I'm not sure Peter Breggin can be considered a reliable source here.

(4) "False Dichotomy" -This logic is particularly common within ADHD commentary, particularly, it seems, from doctors. What can be a very complex problem is distilled down to two simple alternatives i.e. take Ritalin, or become a drug-taking criminal. Clearly, as one of these options is spectacularly undesirable, the taking of Ritalin is not only logical, it is all-but necessary. This argument can be seen across a range of different contexts, but always with the same fallacy firmly in place: it’s either Ritalin or a chaotic classroom, Ritalin or a dysfunctional family. This is not a real dilemma. The alternative is so disagreeable as to be redundant, and it also neglects all the other options available to the good teacher or the good parent, options which remain viable for addressing specific kinds of unwanted behaviour. This is the case whether ADHD is accepted as a valid disorder or not.

This really is a wall banger. Despite what he claims is common rhetoric from doctors, I strongly doubt that anyone professional says "take Ritalin or become a drug-taking criminal." He offer no evidence in support that this is common discourse. Sifaka ^talk 22:02, 19 May 2009 (UTC)

Thank you for your commentsI don't mind the title being changed. He does use evidence that the arguments are used by referencing peer reviewed literature and sometimes if I remember correctly directly quoting arguments used in the peer reviewed literature. He used like 70 or so references, only one of which was to breggin if I remember correctly. I think that some of his arguments have a point and are valid. I don't necessarily agree with all of this authors points but that doesn't mean that it shouldn't be cited. The genetic traits does not prove a disorder in everyone's mind. One would find genetic traits no doubt for people are poor sportsmen at school but does this mean a disorder but one could say it was a disorder if sportsman like skills were required eg in a society where one needed to be good at running and coordination for say hunting eg 3rd world countries. ADHD is controversial and I have added some literature on the controversies but I don't necessarily agree with all of the data that I have added, I don't but equally I don't agree with all of the data from the other point of view added. I have read arguments in the peer reviewed literature and also heard from pediatricians who have stated that ADHD untreated can lead to drug addiction and increased crime infact I watched a documentary on discovery channel with doctors talking about how untreated ADHD can lead to crime and drug addiction etc. I don't think that the entire section should have been deleted for the reasons outlined but I am happy to discuss.--Literaturegeek | T@1k? 23:50, 19 May 2009 (UTC)

The author uses quotes for some of the arguments he presents but there is no indication of the context they're in, and it seems pretty likely to me some of the quotes are taken out of context. I still haven't looked into his sources in general, but using Breggin for the one spot I pointed out was definitely not good. Whether or not he makes some good points is kind of besides the point. He makes quite a few bad points too and also uses a lot of terrible arguments to try and support his points. Even though he lists lots of sources, there are few in-line citations to support any of his major points. Furthermore, according to my OR, there are some blatant factual errors. "As the examples I have chosen accurately illustrate the dominant arguments employed when discussing the disorder. Not only are they regularly used within the academy, they are also the most common discourses employed at the twin coalfaces of the classroom and the living room—and more often than not, they are fallacious." If "by the academy" he means "in scientific discourse", I have never read a research paper which makes the statements he says they commonly do. While it is likely someone somewhere has made some overreaching statements of the kind he proposes, it is the exception and not the rule. This is really an unprofessional and less than satisfactory source.

Also, a lot of his points are very similar to other issues brought up in status as a disorder section and also some of the social construct theories sections (such as ADHD is not a disorder because there is no objective diagnosis). I don't see this section adding any real additional value to the article; this section would only be reduplicating the points made in these sections. I've been trying to streamline and classify a lot of the content to prevent the article from becoming a lengthy catalogue of debate and rebuttals where deluges of information obfuscate the big picture. Effectively I'm trying to avoid lots of sections which go along the lines of "this guy says A, mainstream science disagrees and says X." It's far more readable and informative to categorize this article by types of arguments than try to categorize it by people who make the arguments. Sifaka ^talk 01:36, 20 May 2009 (UTC)

The professional slide deck for Focalin does say untreated ADHD causes drug addiction and implies that taking this drug from Novartis prevents it. http://www.fda.gov/foi/warning_letters/s6935c.htm For this they got a warning letter from the FDA.--Doc James (talk · contribs · email) 01:49, 20 May 2009 (UTC)

Good example, but I still hold that this kind of discourse isn't common - in my experience it's the exception rather than the rule. Do note that most of my experience is in research rather than marketing. Keeping in mind my OR isn't worth anything, there are still lots of other problems with the source including the use out of context quotes (1, 2, 3, 5, 8, 10, 11 are probably taken out of context but I can't check all of them right now), quotes which use outdated/incorrect information (12 - the response to stimulant medication is not considered diagnostic), or use incorrect information/misconstrue the quote entirely to make an argument (9 - genetics are a factor in 75% of ADHD cases and hyperactivity also seems to be primarily a genetic condition, so there is a good reason to suspect ADHD when other family members have ADHD) to support the notion that these fallacies are used in regular discourse. Sifaka ^talk 02:43, 20 May 2009 (UTC)

I agree that these discussions are not common and that a lot of these arguments overlap. To take "the response to stimulant medication is not considered diagnostic" for example. Some physicians say lets try stimulants and if they work that must mean you / your child has ADHD. The only published study we have was many years ago but showed stimulants work in all people. Recently some are even promoting stimulant use for the general population see cognitive enhancers. And of course the US airforces uses them. No further trials have been done with stimulants in the general population as far as I am aware.

I am not sure if a drug works for everyone does the FDA then allow you to advertise it to everyone? This is part of the reasons why stimulants are controversial and have been compared to mental steroids.--Doc James (talk · contribs · email) 17:38, 20 May 2009 (UTC)

I agree that a positive response to stimulants are often used incorrectly as diagnostic evidence for ADHD. This is due to the myth that is widely believed even by health professionals that improved attention and calmness is a "paradoxical effect" of CNS stimulants and that other people get stimulated on stimulants. At moderate doses CNS stimulants calm people down by increasing attention and alertness regardless of ADHD diagnosis or not. It is higher or excessive doses which make people high, excessively energetic etc. The myth exists because people don't realise the different pharmacological behavioural effects from moderate versus high or very high doses of amphetamines and their derivatives.--Literaturegeek | T@1k? 23:35, 14 June 2009 (UTC)

this looks controversial but not sure where it should go. Does someone else wish to add a line in here somewhere

Attorney Stephen Sheller is suing Janssen, which makes Risperdal. He claims Janssen marketed Risperdal for unapproved uses in children, downplayed serious risks like diabetes and seizures.

see video[8] on recent breast development of teenage boys treated with risperdal for ADHD Earlypsychosis (talk) 11:35, 27 May 2009 (UTC)

Interesting, thanks. I don't think that it is specific enough for this ADHD article. If it is worth citing it would be worth citing in a small controversy section in the risperidone article rather than this article. Here is another citation for that story.[9]--Literaturegeek | T@1k? 23:59, 14 June 2009 (UTC)

I agree with Litgeek here. The risperidone article seems to be the place to put it. It could also use a mention in Janssen Pharmaceutica. Risperidal doesn't mention that it is used even off label as an ADHD treatment. Sifaka ^talk 01:53, 15 June 2009 (UTC)

foodstuff causes

Studies should have already been initiated and completed that investigate the relationship between ADHD and ungulate milk/cheese/ice-cream/butter product ingestion. Lifetimes of such nourishment behavior include serious doubts about the sanity and motives of providers. beadtot66.217.68.79 (talk) 02:10, 6 June 2009 (UTC)

You are going to need to find reliable sources for this if you wish to add this information to the article. Should you find said reliable sources, in the interest of NPOV you are going to have to leave off the line about the sanity of providers. Sifaka ^talk 01:57, 15 June 2009 (UTC)

My girlfriend is lactose intolerant. I can assure you that the symptoms associated with ingestion of ungulate milk/cheese/ice-cream/butter, while extremely unpleasant, do not resemble ADHD at all. Also, while no studies have directly compared ADHD and lactose ingestion, it is quite well known that the ability to digest lactose varies among people of different ethnic/genetic backgrounds. However, despite the fact that there are great differences in the prevalence of lactose-digestion abilities across different ethnic groups, there is very little evidence of any differences in ADHD prevalence between various ethnic and racial groups. Note that *prevalence* is not the same as *treatment/diagnosis/prescription rates* which obviously might vary based upon country or socioeconomic status or whether one has health insurance.

And of course, this ignores the fact that examining a relationship between ADHD and dairy product consumption would be extremely difficult due to the fact that dairy product consumption is fairly common (in the US at least) for both ADHD and non-ADHD individuals. It would be as difficult as investigating a relationship between consumption of bread and ADHD, or the consumption of fruit juice and ADHD. You're looking at something consumed by a large number of individuals who are both positive and negative for the condition. You're simply going to have far too much useless data that the "noise" is going to obscure any meaningful information. Hyperion35 (talk) 14:12, 1 August 2009 (UTC)

Scientology

Is the section about Scientology really necessary? There are many religious groups that oppose psychiatric treatment, maybe we could generalize this a bit (and include Scientology as a specific example).

If some churches are anti-drug, the would oppose stimulant treatment of ADD (and maybe SNRI treatment as well).

Jacob.vankley (talk) 19:54, 12 July 2009 (UTC)

I have a good ref that comments on this. It explains that many concervatives have concerns with the diagnosis of ADHD as it weakens the central role of parents in the family. Will post in a weeks or 2 when I am back.--Doc James (talk · contribs · email) 22:53, 12 July 2009 (UTC)

Scientology deserves a special mention for their somewhat extreme efforts to oppose the use of any psychiatric medications, including those used for ADHD. Furthermore, unlike other religious groups that might prohibit their followers from using particular substances (LDS and Islam both forbid alcohol, for example), Scientology has actively sought to stop non-believers from consuming these substances, even going so far as to file lawsuits against Novartis (the makers of Ritalin), and setting up numerous websites such as ritalindeath.com through various front groups. The Church of Scientology also operates the "Citizen's Commission on Human Rights" whose only goal, it appears, is to convince patients to ignore their physician's advice and file lawsuits against anyone who disagrees.

To this extent, it is no different than mentioning the Catholic Church in an article on abortion, as they are a prominent and vocal religious group who have taken a public stance in favor of banning that procedure for all individuals, not only their own followers. In this case, the issue is not so much that the Church of Scientology forbids the use of these drugs for their followers, but their public (and sometimes not-so-public) actions that they have taken.

After all, if a Muslim organization were to sue Anheiser-Busch or Bacardi, or if a Jewish organization were to sue The Honey Baked Ham Company, or if a Jehovah's Witness organization were to sue the Red Cross blood banks, that would probably also be something that might be worth noting in an article on alcohol or pork or blood banks. Hyperion35 (talk) 14:35, 1 August 2009 (UTC)

reverted deleted text

Text deleted from the passage was returned.[10]--scuro (talk) 15:58, 15 July 2009 (UTC)

In the section about media issues I have added a phrase which puts the LA Times quote about scientology being the main cause of ADHD opposition. If left alone, as the summing up statement of that section it erroneously implies that everything that comes before it derived from scientology, an absurd conclusion--Ss06470 (talk) 02:39, 21 July 2009 (UTC)

Section: "ADHD in politics and the media"

I've just mangled rearranged this section, removing some redundancies. I looked at it in isolation - haven't compared it to rest of article (yet). Thus some of my {fact} and {when} tags may be unnecessary... - Hordaland (talk) 18:59, 21 July 2009 (UTC)

"Stimulant misuse"

This section looks to me to be very blatantly applicable to the USA only. If that's the case, it should be stated. Is "Schedule II" an international term? The review from Harvard represents more than 100 000 subjects. Impressive. But the abstract doesn't say if they are/were all in the USA, in North America or perhaps elsewhere. - Hordaland (talk) 12:03, 23 July 2009 (UTC)

Agree.--Doc James (talk · contribs · email) 13:01, 23 July 2009 (UTC)

OK, so you were tempted to say "just do it"? I did google 'Schedule II' to try to find out. Found a pharmacist who says it applies differently in different countries. Didn't quite answer my question. And the Harvard abstract doesn't say where the subjects were. So I did try :-) - Hordaland (talk) 05:24, 24 July 2009 (UTC)

The term "Schedule II" refers to the legal regulations that apply to Amphetamine (and other drugs) in the United States. The 1970 Controlled Substances Act allows the FDA to classify controlled substances into several different categories, or "Schedules." These classifications place limits on the number of refills that can be allowed or the amount that can be dispensed at a given time. It also places recordkeeping and storage requirements for pharmacies when storing and dispensing these drugs.

Other countries do have different regulatory classifications for drugs (I believe that the UK uses letters instead of numbers, for example), but the general concept is usually similar. Some drugs need to be tightly controlled, others less so. A pharmacy can't lock up all of the drugs that might possibly be abused, but it does make sense to put the stimulants and painkillers in a higher category than a mild anti-anxiety drug, for example.

Generally, the drug classifications for most Advanced Industrialized (ie "First World") nations tend to be pretty much the same. There are a few minor differences, such as where heroin is often used as a painkiller in medical practice in the UK (as "diamorphine"), but is considered to have no medical use in the US. Cannabis is another substance whose legal status varies from country to country, especially in Europe. However, Amphetamine and Methylphenidate generally tend to have similar legal and regulatory classifications in most Advanced Industrialized states, usually placed in one of the more restrictive but still "medically acceptable" classifications, similar to many painkillers. And just like with painkillers, they can be abused, but also have legitimate medical uses, and abuse is not often an issue when used in the course of proper medical care.

Also, this section is a bit misleading, as it fails to mention studies that have shown that substance abuse problems are far more prevalent in unmedicated persons with ADHD than in those taking medication. Hyperion35 (talk) 14:59, 1 August 2009 (UTC)