Talk:Attention deficit hyperactivity disorder

Evaluating the evidence for the efficacy of exercise

Although the article cites a series of studies suggesting exercise is efficacious for reducing the symptoms of ADHD, the International Consensus Statement on ADHD concluded that exercise has no statistically significant effects due to the results of two comprehensive meta-analyses and systematic reviews.1

Since that is the global scientific consensus, it seems to me that it may need to take priority as a replacement of the statements entirely, as I've seen elsewhere. But would the best course of action be to reference both lines of evidence? Димитрий Улянов Иванов (talk) 18:53, 25 May 2024 (UTC)

I would include both POVs as excercise as a method of treatment for ADHD has tons of conflicting evidence and I don't think there is sufficiant evidence to completely disprove it's effectiveness, however results have been conflicted about how effective it is. CursedWithTheAbilityToDoTheMath (talk) 17:09, 26 July 2024 (UTC)

Typo/Outdated Name for Autism in Sidebar

This is a very simple edit, but the hyperlink to Autism in the "differential diagnosis" section in the sidebar is outdated, being listed as "autism spectrum disorder." If this could be changed ASAP, that would be wonderful. Thank you. Smartestpuppy (talk) 22:51, 1 July 2024 (UTC)

Sorry, but Autism Spectrum Disorder is not an outdated name; for it is currently established by standardised diagnostic criteria (i.e., DSM-5, ICD-11) and the developers of evidence-based international guidelines (e.g. WHO, NICE). Димитрий Улянов Иванов (talk) 17:31, 4 July 2024 (UTC)

Infobox Image; discussion

I agree with @Omphalographer that the current image is unnecessary, considering it hardly represents the disorder. While academic performance is a common domain of impairment for those with ADHD, the implication that it is primarily a school-based issue trivialises the seriousness of ADHD and the main domains in life it impacts, especially when the image fails to capture symptomatic expressions.

It may be prudent to find a replacement image but some candidates could be showcasing the underlying neurology of ADHD or the relationship of the executive functions to its behavioural and cognitive expressions (see Barkley et al. for figures). That would convey ADHD much more comprehensively. Димитрий Улянов Иванов (talk) 11:00, 23 July 2024 (UTC)

You can barely read anything with the image you added. The text should at least be readable as a thumbnail. There's also a similar existing image in the article. – The Grid (talk) 16:51, 24 July 2024 (UTC)

The text is readable viewing from both my laptop and mobile. Plenty of infobox images use images with text around this size (e.g. Bulgarian or russian alphabet) and I'm not aware of a guideline prohibiting this, especially when its evidently readable. Even then, the image can always be made to appear larger. And there is no comparable image already in the article; this is the only image in the article which displays both the neuroanatomy and neuropsychology of ADHD and their relationship with each other, with description.

ADHD is, at it's core, a disorder of executive functioning and self-regulation. Depicting that in the infobox in a summatory way is important, rather than an arbitrary picture of a school environment, which does not represent ADHD or its symptoms, and trivialises the disorder for the reasons we discussed. Димитрий Улянов Иванов (talk) 17:10, 24 July 2024 (UTC)

ADHD is, at it's core, a disorder of executive functioning and self-regulation. Depicting that in the infobox in a summatory way is important, rather than an arbitrary picture of a school environment, which does not represent ADHD or its symptoms

I don't agree. The school environment is shown because in the DSM IV explains Attention-Deficit/Hyperactivity Disorder is a disorder classified throughout infancy, childhood, and adolescence (this was changed in DSM-5 to include adults), the list of items have focus on social, school, or work functioning. [1] An infobox is for summarizing the content that is in the prose. We also have the lede that is for summarizing the article in a few paragraphs.

It seems trying to summarize the item twice is overkill for the prose and infobox. That's where I even question having an image at the start but the school environment picture made some sense towards that. Showing a brain seems to be like any other disorder. (MOS:LEADIMAGE provides some guidance.) – The Grid (talk) 13:08, 25 July 2024 (UTC)

Thank you for your diplomatic comments and the opportunity to discuss this further. I address each of these below:

R.e. ADHD symptoms and impairments

I understand you referenced the DSM-5 (2013) but relying on that is problematic for several reasons, which I will discuss below. First, consider the International Classification of Diseases v-11 (ICD-11) (World Health Organization) (2022) which makes it clear that "In order for a diagnosis to be made, manifestations of inattention and/or hyperactivity-impulsivity must be evident across multiple situations or settings (e.g., home, school, work, with friends or relatives), but are likely to vary according to the structure and demands of the setting.",1 as does the European Consensus Statement on ADHD.2

They do not emphasise the school setting or any for that matter, but do emphasise the presence of impairment in multiple settings which can vary. It references examples which include home, work, friends, and relatives, and thus more. Even then, both the DSM and ICD are used for differential diagnosis which means certain symptoms and impairments central to the disorder (like emotional dysregulation and impairments in EF in daily life) have been excluded to reduce overlap with other conditions or diagnostic complications, yet remain core to the disorder.2

Also note that the DSM does not lead the research, but is often a decade or two behind where the research and scientific consensus is at that time. And the decisions made by the APA are political, not just scientifically based, so it's hard to know where this will go in the subsequent version.

More importantly is that ADHD symptoms are impairing in a substantial variety of settings, not merely school or academic functioning. There is a global scientific consensus that there is so many things it impairs, such as driving, taking care of oneself, cohabiting with others, executive functioning in daily life, health and routine, substance use, teenage pregnancy, financial management, comorbidity, criminality, overall quality of life, self-esteem, hobbies, other life commitments, etc. etc. as a direct result of its underlying self-regulatory and executive deficits. You can read extensive references about these in the International [Global] Consensus Statement on ADHD3, the European Consensus Statement on ADHD, and other peer-reviewed research (e.g.4, 5). So the previous image is indeed trivialising and probably stigmatising.

R.e. Current image

I disagree that the image is akin to any other disorder, considering it shows the relationship of ADHD's neuropsychology and neuroanatomy.

I understand it may not be optimal, and certainly there may be better alternatives out there or perhaps no image at all. However, the same issue you described is applicable to the previous image caption in that it describes an ADHD symptom mentioned in the lede (inattention) and a lead paragraph (hyperfocus). The current image caption does mention executive dysfunction as well that is mentioned in the lede, but is focused much more on the neuroanatomy (implicated brain regions) which is not mentioned in the lede or any below paragraphs.

Interpretation

In my view, the current image is good, but no image is also good (as in the ASD article) or an alternative one that is better fitting. There may be problems with it. I do however disagree with the use of the previous image. If a consensus cannot be reached, the infobox image can be excluded entirely. Димитрий Улянов Иванов (talk) 14:41, 25 July 2024 (UTC)

I would go for no image altogether if that's the case. Also, are you using LLM (AI) for responses? The responses you have been providing isn't normal for someone whose primary language is other than English. It's more than simple lexicon. If you're using some type of automation tool, it should be disclosed. The type of automation is very similar to using user scripts where the edits are disclosed and the pattern of edits are known. An essay about the use of them on Wikipedia. – The Grid (talk) 14:44, 26 July 2024 (UTC)

I am fine with that so long as there is a consensus; currently there isn’t.

Also, no, I am not. I have been learning English for a long time. It also comes from knowing my material as well or better than others so there is no hesitation when writing due to uncertainty. Confused as to the basis for your assumption, especially with my word dumping. Димитрий Улянов Иванов (talk) 15:05, 26 July 2024 (UTC)

Typo for CDH13

Under the genetics section, CDH13 is written as CHD13 in the next sentence. Just wanted to point it out! Aiden3c (talk) 17:14, 25 July 2024 (UTC)

Fixed, thanks. Nikkimaria (talk) 22:30, 29 July 2024 (UTC)

Redundancies

@Димитрий Улянов Иванов: please don't do that. If you agree that some of the changes are good, then don't revert them. That edit reintroduced a pile of redundancy and prose issues that really need to be cleaned up if this is to remain a GA. Nikkimaria (talk) 22:30, 29 July 2024 (UTC)

Hi, thanks for reaching out. Despite the fact that some of your editing appeared helpful, I identified a number of major concerns with your edit including unexplained removal of content that is otherwise considered appropriate in regards to its implementation and relevance in the article, removing summary content from the infobox as well as altering the implications of information. I also found no evidence of a consensus or a discussion of these nor did the edit summary reflect much. Considering all these shortcomings, the edit is misplaced.

Before enacting such an edit again please substantiate your edits such as:

- Removing the info, in the controversy section, about the measures taken by the global scientific consensus to combat misinformation and stigma

- Removing details in the infobox (e.g. typical onset of disorder) that can be considered a summation of the diagnostic section for it. From my understanding, the infobox should summarise key details, even if this results in repetition. Onset is one such key detail in the diagnostic of ADHD (see DSM-5 and ICD-11).

- Removing the implication that executive functioning is central to ADHD, thus instead implying it may be a mere aspect of it

- Removing the fact that ASD and ADHD can be comorbid (this clarification is needed here because, until the most recent DSM, they were considered mutually exclusive).

Among others.

Overall, I fail to see how you considered this information redundant. Much of it has been established as being necessary for the article. Димитрий Улянов Иванов (talk) 01:59, 30 July 2024 (UTC)

Hi Димитрий Улянов Иванов, every single one of these was present prior to this revert of yours. Meanwhile, you also reverted a number of other changes, ranging from as straightforward as reinserting the typo identified in the previous section, to as significant as removing citation-needed tags from claims requiring citations. Please self-revert. Nikkimaria (talk) 02:37, 30 July 2024 (UTC)

Sorry for the belated reply. I have just relooked at that edit and would like to first apologise for an oversight. Removing the information about the comorbid diagnosis of ADHD and ASD is indeed necessary as it's already clarified in a previous sentence above. I did not see that. Certainly will restore the edits soon. However, there remains several problems:

- The implication that EFs are central to ADHD is still removed. While the lede summaries this point, it's not in the same section and the lede summary is based directly on the specifics of this information later in the article, which is consistent with the relationship of other details with the lede.

- Placing tags on thigns like the age of onset on the infobox, suggesting it requires clarification, ignores the conclusive data referenced in the accompanying section in the article the summary is based on. As for the expert consensus efforts to combat misinformation and stigma, how is that a non-sequitur exactly?

- Implying that the subjectivity of an ADHD diagnosis is problematic and leads to misdiagnoses based on cultural differences, directly contradicts the global scientific consensus cited later in the article for the same issue (Faraone et al., 2021), which is considerably more reputable than the source provided. Димитрий Улянов Иванов (talk) 21:40, 30 July 2024 (UTC)

Thank you for partially undoing your edit. However, I have some remaining concerns:

-That ADHD arises from problems with executive networks is already noted in the Causes section. There is overlap between the Causes section and subsections, adn the Pathophysiology section and subsections. Additionally some of the details in the Pathophysiology section are mentions under Symptoms in the infobox, but not mentioned in the Signs and symptoms section. This suggests larger, persistent problems with the article's structure and organization.

-|onset= is meant to be used for age of onset; at the moment no specific age or age range is mentioned, but rather the term "developmental period" is used. This needs clarification for the lay reader. As to stigma, this is misplaced because it is not a "controversy", and the connection between stigma and the Statement is not drawn for the reader, again requiring clarification.

-The claim that ADHD diagnosis is subjective was present in the article both before and after my changes. If you have concerns about the reliability of that sourcing, that is an issue separate from this discussion. Nikkimaria (talk) 22:35, 30 July 2024 (UTC)

1. Okay, accepted
2. The developmental period in primary ADHD (P-ADHD) is defined as ending at age 12. If this needs specification, that is okay, but the fact that the symptomology and impairments typically occur within that timeframe has been established int the article.
3. I was not disputing the fact that the diagnosis of ADHD is subjective, it indeed is, as is the case for other neurodevelopmental disorders (e.g. ASD or Tourette's syndrome) and almost the entirety of psychology. However, to imply this is problematic and results in misdiagnoses due to cultural differences is what contradicts the International scientific Consensus on ADHD. See the controversy section for details. According to wikipedia guidelines I have seen, scientific consensus should take priority over other sources obviously due to its reputability.

Димитрий Улянов Иванов (talk) 22:48, 30 July 2024 (UTC)

Also, to address the combating stigma sentence, the consensus statement referenced clearly makes the connection between stigma and controversy in ADHD and their response to it. The sentence uses a semi-colon to denote the subsequent sentence as being related, so I am confused as to why it's problematic. Димитрий Улянов Иванов (talk) 22:52, 30 July 2024 (UTC)

On 3, again, that's not something I'm disputing, but would warrant separate discussion. On 2: I don't disagree that it's in the article, but the statement in the infobox remains unclear. And on stigma: the Statement may make that connection, but what's in the article doesn't - that stigma exists is not a controversy, the Statement is not a controversy (or is not noted as being a controversy), so this is still a non sequitur as presented. Nikkimaria (talk) 23:59, 30 July 2024 (UTC)

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