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I'd like to add a small-to-medium section with some oft cited and well documented characteristics that are more common among Adults with ADHD than the general population. It might be most effective to pick 3-5 characteristics with a one-liner explanation, if necessary. For example, extroversion, creativity, and hyperfocus have all been associated with Adult ADHD. There seem to be many sources to pick from; I've found a bunch just by going through all the articles that can come up in a Google search and looking at the sources they cite. You'll see several at the bottom of this article: http://www.webmd.com/add-adhd/features/positives.
It seems like our description of the disorder would be incomplete without some indication that ADHD helps many adult succeed; indeed, some of the most successful people in the world are diagnosed with ADHD. Please let me know if it's OK to add this. I made a few minor edits, but this seemed like it would be too big and somewhat different from the rest of the article. ,Wil ( talk) 09:07, 16 June 2014 (UTC)
Seppi333 ( Insert 2¢ | Maintained)
@ Jmh649: Hey Doc - I want your perspective on this. Do you think any part of these refs [1] [2] from trace amine is worth summarizing and including in this article?
Unfortunately, these two reviews are the newest ones available on trace amine receptors in relation to neuropsychiatry. I'm actually kind of puzzled as to why there isn't more activity in TAAR (particularly TAAR1) research... (emphasis added only as highlights)
References
changes in trace amines, in particular PE, have been identified as a possible factor for the onset of attention deficit/hyperactivity disorder (ADHD) [5, 27, 43, 78]. PE has been shown to induce hyperactivity and aggression, two of the cardinal clinical features of ADHD, in experimental animals [100]. Hyperactivity is also a symptom of phenylketonuria, which as discussed above is associated with a markedly elevated PE turnover [44]. Further, amphetamines, which have clinical utility in ADHD, are good ligands at trace amine receptors [2]. Of possible relevance in this aspect is modafanil, which has shown beneficial effects in ADHD patients [101] and has been reported to enhance the activity of PE at TAAR1 [102]. Conversely, methylphenidate, which is also clinically useful in ADHD, showed poor efficacy at the TAAR1 receptor [2]. In this respect it is worth noting that the enhancement of functioning at TAAR1 seen with modafanil was not a result of a direct interaction with TAAR1 [102].
More direct evidence has been obtained recently for a role of trace amines in ADHD. Urinary PE levels have been reported to be decreased in ADHD patients in comparison to both controls and patients with autism [103-105]. Evidence for a decrease in PE levels in the brain of ADHD patients has also recently been reported [4]. In addition, decreases in the urine and plasma levels of the PE metabolite phenylacetic acid and the precursors phenylalanine and tyrosine have been reported along with decreases in plasma tyramine [103]. Following treatment with methylphenidate, patients who responded positively showed a normalization of urinary PE, whilst non-responders showed no change from baseline values [105].
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In addition to the main metabolic pathway, TAs can also be converted by nonspecific N-methyltransferase (NMT) [22] and phenylethanolamine N-methyltransferase (PNMT) [23] to the corresponding secondary amines (e.g. synephrine [14], N-methylphenylethylamine and N-methyltyramine [15]), which display similar activities on TAAR1 (TA1) as their primary amine precursors...Both dopamine and 3-methoxytyramine, which do not undergo further N-methylation, are partial agonists of TAAR1 (TA1). ...
TAARs as potential drug targets for the treatment of psychiatric disorders
The dysregulation of TA levels has been linked to several diseases, which highlights the corresponding members of the TAAR family as potential targets for drug development. In this article, we focus on the relevance of TAs and their receptors to nervous system-related disorders, namely schizophrenia and depression; however, TAs have also been linked to other diseases such as migraine, attention deficit hyperactivity disorder, substance abuse and eating disorders [7,8,36]. Clinical studies report increased β-PEA plasma levels in patients suffering from acute schizophrenia [37] and elevated urinary excretion of β-PEA in paranoid schizophrenics [38], which supports a role of TAs in schizophrenia. As a result of these studies, β-PEA has been referred to as the body's 'endogenous amphetamine' [39]
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Although the functional role of trace amines in mammals remains largely enigmatic, it has been noted that trace amine levels can be altered in various human disorders, including schizophrenia, Parkinson's disease, attention deficit hyperactivity disorder (ADHD), Tourette syndrome, and phenylketonuria (Boulton, 1980; Sandler et al., 1980). It was generally held that trace amines affect the monoamine system indirectly via interaction with plasma membrane transporters [such as plasma membrane dopamine transporter (DAT)] and vesicular storage (Premont et al., 2001; Branchek and Blackburn, 2003; Berry, 2004; Sotnikova et al., 2004). ...
Furthermore, DAT-deficient mice provide a model to investigate the inhibitory actions of amphetamines on hyperactivity, the feature of amphetamines believed to be important for their therapeutic action in ADHD (Gainetdinov et al., 1999; Gainetdinov and Caron, 2003). It should be noted also that the best-established agonist of TAAR1, β-PEA, shared the ability of amphetamine to induce inhibition of dopamine-dependent hyperactivity of DAT-KO mice (Gainetdinov et al., 1999; Sotnikova et al., 2004).
Furthermore, if TAAR1 could be proven as a mediator of some of amphetamine's actions in vivo, the development of novel TAAR1-selective agonists and antagonists could provide a new approach for the treatment of amphetamine-related conditions such as addiction and/or disorders in which amphetamine is used therapeutically. In particular, because amphetamine has remained the most effective pharmacological treatment in ADHD for many years, a potential role of TAAR1 in the mechanism of the "paradoxical" effectiveness of amphetamine in this disorder should be explored.
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If you happen to be interested in reading the full version of either paper, I can give you a download link or email you the pdf. The first one covers a lot more than just ADHD.
Best regards, Seppi333 ( Insert 2¢ | Maintained) 02:26, 25 May 2014 (UTC)
Reviews on ADHD and phenethylamine indicate that several studies have found abnormally low urinary phenethylamine content in ADHD individuals when compared with controls. [1] [2] In treatment responsive individuals, amphetamine and methylphenidate greatly increase urinary phenethylamine content. [1] [2]
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Although we did not find a sufficient number of studies suitable for a meta-analysis of PEA and ADHD, three studies20,57,58 confirmed that urinary levels of PEA were significantly lower in patients with ADHD compared with controls. ... Administration of D-amphetamine and methylphenidate resulted in a markedly increased urinary excretion of PEA,20,60 suggesting that ADHD treatments normalize PEA levels. ...With regard to zinc supplementation, a placebo controlled trial reported that doses up to 30 mg/day of zinc were safe for at least 8 weeks, but the clinical effect was equivocal except for the finding of a 37% reduction in amphetamine optimal dose with 30 mg per day of zinc.110
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Alright, I'll work on that soon then. In any case, I know better than to cite primary sources for medical articles; I'm not sure why pubmed didn't mark it as a review, but like it's abstract states – "This review article summarizes what is known about PEA" - the paper simply reviews the existing literature on the chemistry, pharmacology, and industrial aspects of PEA. There's no original research in it. Seppi333 ( Insert 2¢ | Maintained) 22:37, 12 July 2014 (UTC)
Under Causes --> Society, should some of the content be moved to diagnosis or Society --> Controversies? For one, the section begins with "The diagnosis of ADHD," which implies information about the diagnosis rather than the cause of the actual disorder. I guess my question is, on medical/scientific pages does a "Causes" section generally contain any discussions related to the philosophical/sociological existence of a disorder or disease? Additionally is misdiagnosis ever a "cause" of a disease or disorder? Does a false positive for hepatitis mean bad diagnosis is a cause of hepatitis? — Preceding unsigned comment added by Jandjorgensen ( talk • contribs) 21:22, 12 July 2014 (UTC)
@ Jmh649: The pathophysiology section reads like there are three different explanations for ADHD. All three sections actually just represent one aspect of the same model. In a nutshell, the brain structures listed are connected via dopaminergic and noradrenergic pathways from the ventral tegmental area and locus coeruleus; activity in these pathways is directly responsible for the modulation of cognitive control (i.e., executive function) and other behaviors. Reduced brain structure volume reflects the impairments in pathway function, which in turn results in executive function impairments. I figured I should probably link the reference; these are images of the textbook: image files. This is the textbook the images are from. Seppi333 ( Insert 2¢ | Maintained) 17:03, 16 July 2014 (UTC)
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As stated previously, one line of research that seems to be ongoing is on the pathophysiology of ADHD using larger models that include more neurotransmitter pathways and therefore link to additional brain structures that appear abnormal in ADHD individuals compared to controls. [1] [2] Recent discoveries involving a group of endogenous amines present in trace quantities in the human brain, so called trace amines, has opened a new line of research on ADHD and similar neuropsychiatric disorders. Reviews on ADHD and phenethylamine indicate that several studies have found abnormally low urinary phenethylamine content in ADHD individuals when compared with controls. [3] [4] In treatment responsive individuals, amphetamine and methylphenidate greatly increase urinary phenethylamine content. [3] [4] In 2011, a medical review on trace amine-associated receptor 1 (TAAR1) determined that amphetamine and trace amines, which includes phenethylamine, activate this receptor in humans. [5] Consequently, it is now known that these two compounds produce analogous effects in the brain's dopamine pathways. [5] [6] [7] This evidence suggests that trace amines (especially phenethylamine) and their receptors may play an important role in the pathphysiology of ADHD and other neuropsychiatric disorders. [5] Future research seems to be headed in this direction, although the number of recent studies involving ADHD and phenethylamine or TAAR1 is lacking. |
Seppi333 ( Insert 2¢ | Maintained) 06:23, 17 July 2014 (UTC)
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Recent conceptualizations of ADHD have taken seriously the distributed nature of neuronal processing [10,11,35,36]. Most of the candidate networks have focused on prefrontal-striatal-cerebellar circuits, although other posterior regions are also being proposed [10].
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Although we did not find a sufficient number of studies suitable for a meta-analysis of PEA and ADHD, three studies20,57,58 confirmed that urinary levels of PEA were significantly lower in patients with ADHD compared with controls. ... Administration of D-amphetamine and methylphenidate resulted in a markedly increased urinary excretion of PEA,20,60 suggesting that ADHD treatments normalize PEA levels. ...With regard to zinc supplementation, a placebo controlled trial reported that doses up to 30 mg/day of zinc were safe for at least 8 weeks, but the clinical effect was equivocal except for the finding of a 37% reduction in amphetamine optimal dose with 30 mg per day of zinc.110
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So after doing research, and then having a thought wondering about ADHD and potassium channels, upon googling the two I found that there was indeed a subtype associated with potassium issues, and [Hypokalemic sensory overstimulation|a wikipedia article already written for it]. The fact that I haven't heard about it until now is very odd, as I have done extensive research on the subject. I strongly think it should be mentioned and linked to within this article. LiamSP ( talk) 05:09, 25 August 2014 (UTC)
The following unreferenced claims are made in the article.
For the second allegation, I found a study of TEN kids [1]. Is that generalizable to the overall population? I think not. What the study proves is that people with high IQs, HAVE ADHD.
Why is this article locked down?
ClarificationRequired ( talk) 14:58, 27 August 2014 (UTC)
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The Controversies section should be integrated into diagnosis - the biological vs psychological debate is intrinsic to understanding the controversy and discussion of it should be in the segment directly under cause. Media commentary on effectiveness on treatment could be in teatment section or otherwise relegated to daughter article. Cas Liber ( talk · contribs) 01:53, 7 October 2014 (UTC)
Hello all, I have made changes in my Sandbox about this topic focusing on evidence-based assessment and diagnosis. It would be great if people would look at it and leave comments on my talk page before I post it on the article.
The sandbox link can be found here ( /info/en/?search=User:Sdard/sandbox).
I appreciate it! YenLingChen ( talk) 20:36, 3 November 2014 (UTC)
The end of the second paragraph reads:
The condition can be difficult to tell apart from other disorders as well as that of high normal activity.
There does not appear to be a definition for "high normal activity" (or even "high normal") anywhere, and the reference cited appears to be a dead link. This sentence needs clarification; it's a potentially "loaded" statement to begin with, but the fact that it is topped off with abnormal terminology and a rotten link makes it difficult to understand what the purpose of the sentence is in the first place.
-- CoolOppo ( talk) 00:48, 21 November 2014 (UTC)
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I wish to add different medications and the symptoms and add sites that explain percentage of kids and adults who have harmful side effects or felt dramatic side effect but all in all add the list from web Md is a diagram of the most known and used maybe all the medications and there classifications along with all known general side effects
Darienwillis ( talk) 03:24, 10 December 2014 (UTC)
Ginormous wikitable
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Seppi333 ( Insert 2¢ | Maintained) 04:07, 10 December 2014 (UTC)
See parent management training for a 2011 Cochrane review, PMID 22161373. SandyGeorgia ( Talk) 01:40, 20 December 2014 (UTC)
I just read the source referenced claiming that 25 % of the people with the disorder still have it. And 75 % of the adults grow partially out of it. (in the section for adults with adhd)
Let me quote the relevant passage:
Numerous follow-up studies of children with ADHD show that the disorder persists during adolescence and adulthood in around two-thirds of individuals [3-11] either as the full blown disorder or in 'partial remission' with persistence of some symptoms associated with continued clinical and psychosocial impairments. In the meta-analysis of these data from Faraone and colleagues it was concluded that about 15% retain the full diagnosis by age 25 years, with a further 50% in partial remission [12], indicating that around two-thirds of children with ADHD continue to have impairing levels of ADHD symptoms as adults.
Although in some cases the symptoms of ADHD may appear to diminish during adolescence, this may not be the case relative to controls and does not mean that functioning is unimpaired. In a follow-up study of 119 boys of 19 years of age with childhood onset ADHD, symptom levels seemed to be lower than in childhood but 90% still did not function well [13].
We have various claims. Here, and not really clear figures. By 12, we would have only 50 % that grow partially out of it, 35 % who no longer quality, and 15 % who have the full diagnosis. That said, [12], is 2006, and pre DSM V, the criterions for adults have been lowered, for various reasons that I will not get into. (This increase the number of people who have the full diagnosis and do not quality)
Currently, I object to the precise figure, that also avoid the possibility of total remission.
I would suggest going with the figure at [12] despite my objections, since it is the only meta-analysis quoted, while the article quoted in wikipedia is only relevant for this information, in so far as it quotes other sources, and is not in itself a meta-analysis of adults having adhd.
After looking at [12], I found out that the article, "Age-dependent decline of symptoms of attention deficit hyperactivity disorder: impact of remission definition and symptom type." has 1020 citations, . Considering this is much higher than the article given. I strongly urge to consider it, rather than the currently used: European consensus statement on diagnosis and treatment of adult ADHD: The European Network Adult ADHD", that has 270 citations. The European concensus was only used to quote the other articles, including the meta-analysis, while not itself going in depth on the topic. It might also be worth digging more seriously into the meta-analysis.
Comments? Discuss? — Preceding unsigned comment added by 192.0.228.190 ( talk) 20:22, 10 March 2015 (UTC)
There has been statements saying that ADHD is fraud and was only developed to make more money for the companies and the psychiatrists that prescribe it. Read more at PBS. — Preceding unsigned comment added by 2A00:1A28:1171:9:0:0:0:1004 ( talk) 05:47, 8 April 2015 (UTC)
In the introduction, it states that the long term effects of medication are not known.
That may be true for some of the newer medicines, perhaps atomoxetine, but not all. Methylphenidate (trade names: Ritalin, Concerta and many others, inc 'generic' versions) has been in use for several decades. The evidence on both efficacy and safety for methylphenidate is considerable.
Not sure why, but I can't edit the intro, only the part following it. I hope someone who can edit it will take a moment to simply delete this sentence. The issue is too complex to cover in the intro. In stark contrast to most 'physical' health problems, there is huge controversy over the use of medicines to treat ADHD - as can be seen on numerous websites / social media forums.
This article is otherwise very good at presenting the facts in about ADHD meds impartially, despite being somewhat US-centric (NB Adderall isn't available in many countries outside the USA, inc the UK). I feel that this line in the intro does harm to the rest of the article. If it can be reworded to something more accurate, great. I see no reason not to just delete it though.
Thanks in advance for any help others can give with this. Zctyp18 ( talk) 00:29, 15 March 2015 (UTC)
... but, in humans with ADHD, pharmaceutical amphetamines appear to improve brain development and nerve growth. [1] [2] [3] Magnetic resonance imaging (MRI) studies suggest that long-term treatment with amphetamine decreases abnormalities in brain structure and function found in subjects with ADHD, and improves function in several parts of the brain, such as the right caudate nucleus of the basal ganglia. [1] [2] [3]
Reviews of clinical stimulant research have established the safety and effectiveness of long-term amphetamine use for ADHD. [4] [5] [6] Controlled trials spanning two years have demonstrated treatment effectiveness and safety. [5] [7] One review highlighted a nine-month randomized controlled trial in children with ADHD that found an average increase of 4.5 IQ points, continued increases in attention, and continued decreases in disruptive behaviors and hyperactivity. [7]
— Amphetamine#Medical
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Basal ganglia regions like the right globus pallidus, the right putamen, and the nucleus caudatus are structurally affected in children with ADHD. These changes and alterations in limbic regions like ACC and amygdala are more pronounced in non-treated populations and seem to diminish over time from child to adulthood. Treatment seems to have positive effects on brain structure.
RESULTS: The highest proportion of improved outcomes was reported with combination treatment (83% of outcomes). Among significantly improved outcomes, the largest effect sizes were found for combination treatment. The greatest improvements were associated with academic, self-esteem, or social function outcomes. A majority of outcomes improved regardless of age of treatment initiation (60%-75%) or treatment duration (62%-72%) ... CONCLUSIONS: While the majority of long-term outcomes of ADHD improve with all treatment modalities, the combination of pharmacological and non-pharmacological treatment was most consistently associated with improved long-term outcomes and large effect sizes
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Results suggest there is moderate-to-high-level evidence that combined pharmacological and behavioral interventions, and pharmacological interventions alone can be effective in managing the core ADHD symptoms and academic performance at 14 months. However, the effect size may decrease beyond this period. ... Only one paper53 examining outcomes beyond 36 months met the review criteria. ... There is high level evidence suggesting that pharmacological treatment can have a major beneficial effect on the core symptoms of ADHD (hyperactivity, inattention, and impulsivity) in approximately 80% of cases compared with placebo controls, in the short term.22
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We also have this 2011 review that states https://www.ncbi.nlm.nih.gov/pubmed/21519262 "Two peer-reviewed studies and one published report have attempted to address the issue of long-term effects of psychostimulant medication. One is favourable, one found no benefit, and the third showed harm." Doc James ( talk · contribs · email) 05:40, 15 March 2015 (UTC)
Hum per your sentence "Reviews of clinical stimulant research have established the safety and effectiveness of long-term amphetamine use for ADHD"
First ref is not RCT trial data for medications "While most included studies were observational open-label studies, in the 5 RCT studies, individuals were randomized to receive non-pharmacological treatment or no treatment: four (57%) of the 7 total outcomes were reported to improve with treatment. "
Second ref states "However, most medication trials for ADHD have been short term and thus have not provided information on the long-term outcomes of ADHD treatment. Since the medical treatment of many children with ADHD, especially those with more severe symptoms or co-morbid disorders, has to be continued for several years, recent studies have shifted their focus from the acute effectiveness of stimulants or non-stimulant drugs to the long-term outcomes of medications for ADHD. Evidence has shown that stimulants, along with the non-stimulants atomoxetine and extended-release guanfacine, are continuously effective for 24-month treatment periods with few and tolerable adverse effects"
The third ref states "This review has highlighted the paucity and limitations of the evidence investigating the long-term outcomes of recommended interventions for managing ADHD symptoms. There is little evidence to suggest that the effects observed over the relatively short term are maintained throughout longer periods of impairment."
Doc James ( talk · contribs · email) 05:53, 15 March 2015 (UTC)
This review has highlighted the paucity and limitations of the evidence investigating the long-term outcomes of recommended interventions for managing ADHD symptoms. There is little evidence to suggest that the effects observed over the relatively short term are maintained throughout longer periods of impairment.
— PMID 24082796
Results suggest there is moderate-to-high-level evidence that combined pharmacological and behavioral interventions, and pharmacological interventions alone can be effective in managing the core ADHD symptoms and academic performance at 14 months. However, the effect size may decrease beyond this period.
— PMID 24082796
There is high level evidence suggesting that pharmacological treatment can have a major beneficial effect on the core symptoms of ADHD (hyperactivity, inattention, and impulsivity) in approximately 80% of cases compared with placebo controls, in the short term.22 However, although pharmacological treatments are relatively safe, these treatments are not without adverse side-effects, such as, suppression of growth, sleep problems, tiredness, loss of appetite, stomach upset, headaches, nausea, and increases in heart rate and blood pressure.12,23–27 Nonpharmacological interventions, such as psychoeducational programs, behavioral interventions, and cognitive behavioral therapy are also recommended.28–30 Although there is moderate-to-high-level evidence that nonpharmacological interventions can be effective in managing the core ADHD symptoms, conduct disorders, social skills, self-efficacy, and emotional outcomes at 6 months follow up,28 little is known regarding the long-term effectiveness.
— PMID 24082796
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This is a comment on short term pharmacological treatment not long term. So doesn't support the text in the amphetamines article. The other refs to not claim long term effectiveness and what you have quoted here does not either. Doc James ( talk · contribs · email) 19:26, 15 March 2015 (UTC)
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Results suggest there is moderate-to-high-level evidence that combined pharmacological and behavioral interventions, and pharmacological interventions alone can be effective in managing the core ADHD symptoms and academic performance at 14 months. However, the effect size may decrease beyond this period. ... Only one paper53 examining outcomes beyond 36 months met the review criteria. ... There is high level evidence suggesting that pharmacological treatment can have a major beneficial effect on the core symptoms of ADHD (hyperactivity, inattention, and impulsivity) in approximately 80% of cases compared with placebo controls, in the short term.22
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@ Doc James: I made a few revisions to the article for language clarity, MOS compliance, and grammar... I also revised the statements concerning the "long-term" issue using similar language to your revision in the amphetamine article. I'm perfectly open to rephrasing the text I added if you'd prefer it. Seppi333 ( Insert 2¢ | Maintained) 23:12, 23 March 2015 (UTC)
CDC Apr 1st 2015 states "We do not know what the long-term effects of psychotropic medication are on the developing brains and bodies of little kids. What we do know is that behavioral therapy is safe and can have long-term positive impacts on how a child with ADHD functions at home, in school, and with friends," [3] Doc James ( talk · contribs · email) 10:45, 4 April 2015 (UTC)
With the main focus usually being on boys, the diagnosis of ADHD in girls has gone unnoticed, with the effects of the diagnosis on girls slipping under the radar. In an article by Skogli et al. (2013) [1], the researchers literally state “girls may be consistently under identified and underdiagnosed because of differences in the expression of the disorder among boys and girls”. In plain terms, the criteria for the diagnosis of ADHD does not fit the ways which most girls are socialized or how the disorder fits them specifically. There is a large amount of information in the article by Mahone and Wodka (2008) [2] about the neurological differences between boys and girls, and the effects these differences might have in the decreased representation of girls with ADHD. Rucklidge (2010) [3], mentioned the importance of changing the criteria of ADHD to better accommodate proper diagnosis of girls. Rucklidge (2010) [4], also makes a great case about how girls diagnosed with ADHD are often misunderstood. Misunderstood in this case meets multiple possibilities. Girls with ADHD are often misunderstood by their peers, teachers, parents, and even themselves. . Girls diagnosed with ADHD are commonly observed showing signs of internalization (Graetz, Sawyer, Baghurst, & Hirte, 2006) [5]. These researchers went on further to explain that the most common identifications of the internalization behaviors were depression and anxiety. An article by Becker, McBurnett, Hinshaw, and Pfiffner (2013) [6] also agreed that girls were more likely to internalize their symptoms. The article explained how girls with ADHD would report significantly higher levels of anxiety compared to boys with ADHD. One of the important topics discussed by researchers concerning the diagnosis of ADHD in girls is underdiagnoses. Waite (2007) [7] observed that the inequality of diagnosis in girls is that they do not typically show the common symptoms of ADHD, causing girls to be so frequently misdiagnosed. Researchers have discussed how the criteria for ADHD is predominantly focused on the symptoms displayed in boys (Rucklidge, 2010; Waite, 2007) [8] [9]. Researchers have also debated whether or not the criteria for ADHD should be improved to include the specific gender differences between girls and boys with ADHD. Researchers have come to the conclusion that the diagnostic criteria from ADHD should be altered based on gender and the symptoms should be lowered to adequately assist girls with ADHD (Rucklidge, 2010) [10]. Correctly diagnosing children is a hard task, so it is important to look at age-related children and comparing them that way. However, it is rather important for clinicians to most accurately diagnose children regardless of their gender. Waite (2007) [11], speaks directly to this saying, “the DSM-IV-TR criteria have a limited scope and lack of gender specificity, which precludes many women from being properly diagnosed”. Correctly diagnosing and treating girls with ADHD can lead to many positive social and personal experiences. If the correct diagnosis and treatment is not given to girls with ADHD there could be significant disabilities in the psychological functions and academic progress in girls with ADHD (Quinn, 2005) [12].
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— Preceding unsigned comment added by Aliciarj123 ( talk • contribs)
For example, PMID 21976033 is a recent review that should be/could be used for whatever text is written about ADHD in girsl, removing the need to work to sort out Alicia's sourcing. SandyGeorgia ( Talk) 17:34, 5 May 2015 (UTC)
See also: [4] SandyGeorgia ( Talk) 20:48, 4 May 2015 (UTC)
Can someone who has access to the full text incorporate something from:
This is a GA, but it's citing very old sources on gender differences. SandyGeorgia ( Talk) 17:37, 5 May 2015 (UTC)
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Those that complain of easy fatigability and physical pain many, relationship between autonomic imbalance are discussed. YTMX ( talk) 01:35, 13 August 2015 (UTC)
Hi all! I added a citation for the recent AACAP practice parameter on ADHD. Practice parameters are highly useful tools for diagnosis and treatment, and it's definitely worth mentioning in the diagnosis section. Let me know if any issues arise! — Preceding unsigned comment added by Kennyle78 ( talk • contribs) 18:43, 5 October 2015 (UTC)
In the therapy section, evidence-based practice, techniques that are supported by science, can be used to further back up the claims that behavioral therapies have been shown to give the best results when treating ADHD. " Effective Child Therapy lists behavioral treatments such as, behavioral parent training, behavioral classroom management, behavioral peer interventions, combined behavior management interventions, and organization training, as the most well-established treatments for ADHD in children. These treatments are considered to be the most efficient because they are backed up by science; these treatments are considered to be evidence-based practices." This information would give way to a great resource for parents about evidence-based practice, aka the most scientifically backed up treatments. -- Mktayloe ( talk) 22:24, 13 October 2015 (UTC)
Based on a meta analysis published on the Non-pharmacological treatments for ADHD published in the journal of attention disorders (DOI: 10.1177/1087054712444732) I recommend that in the "behavioral therapies" subsection of Management, information be added on the most efficacious non medical treatments for ADHD. The meta analysis concluded thatbehavioral management and neurofeedback training are the most effective non medical treatments for ADHD. The wiki page mention thats parent training and education have short term results, however the meta analysis concluded that there is no statistically significant benefit to these treatments. The wiki page should be updated to reflect this conclusion.
Additionally, the meta analysis concluded that behavioral treatments are generally more effective for girls.
Finally, it should be made clear in the prognosis section of this page that the combined ADHD subtype (inattentive and hyperactive) is associated with the worst outcomes in regards to non pharmacological treatment.
Jogunk07 (
talk) 16:01, 13 October 2015 (UTC)Jay 10-13-2015
g yuergtuiwerfghrgfo — Preceding unsigned comment added by 71.184.98.9 ( talk) 18:26, 21 October 2015 (UTC)
References
I have reverted the following addition as the ref does not support the changes [5] Doc James ( talk · contribs · email) 19:47, 22 November 2015 (UTC)
No sure that Tom Cruise's comments should be included on the page given that he is a well known puppet for scientology which has a confirmed bias/agenda against pharmaceuticals and would prefer that people joined their religion and be crazy there.
Neither should the rebuttal. Giving either comment gives weight to an invalid, obviously biased argument that has no place in a general media discussion. — Preceding unsigned comment added by Soulstudios ( talk • contribs) 00:25, 23 October 2015 (UTC)
... whenever I get around to it. Seppi333 ( Insert 2¢) 08:39, 18 July 2015 (UTC)
Also, possibly worth adding to the section on prognosis. A meta analysis of follow up studied on children diagnosed with ADHD found that evidence of symptoms associated with ADHD lessens with age. [1] Jogunk07 ( talk)jogunk07
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This section mentions that methylphenidate appears to improve symptoms as reported by teachers and parents. This may be true, however a recent Cochrane review suggests that methylphenidate causes an increase in sleep problems, as well as decreased appetite. This review also suggests that because of the low quality evidence, we can not be so sure of the magnitude of the effects that this medication has. [1] This is definitely something that should be added to this section. Kcwiley12 ( talk) 15:23, 5 December 2015 (UTC)
References
Adding more information regarding assessment techniques for diagnosing ADHD would be beneficial to this page. "While the DSM is the primary tool used by clinicians to diagnose ADHD, there are different assessments used, that when applied to the DSM criteria, can help determine the severity and type of ADHD an individual possesses. Examples of these assessments are the ADHD Rating Scale, the Vanderbilt ADHD Diagnostic Rating Scale, and the Swanson, Nolan and Pelham Teacher and Parent Rating Scale." These Wikipedia pages should be enough citation and resources to back up these assessment types, and this information should be included in the diagnosis section of the page.
Reference 32 seems to be outdated, or so says the site it links to. I haven't yet found the correct one, in case it was just moved or updated. -- 37.60.1.66 ( talk) 00:14, 8 December 2015 (UTC)
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I've noticed that there could be a more thorough expansion when it comes to the difference between genders and how each experience ADHD, I am partially doing this for a university project and I would like to be able to create some new sections. In Section 4 Diagnosis I would like to add three new sections the first: 4.5 Sex and ADHD, the second: 4.6 Difficulties in Diagnosing, and third: 4.7 Differences Between Sexes 4.5 Sex and ADHDAttention deficit hyperactivity disorder is a neurodevelopmental psychiatric disorder in which there are significant problems with executive functions (attentional control and inhibitory control) that cause attention deficits, hyperactivity, or impulsiveness which is not appropriate for a person's age (Attention-Deficit/Hyperactivity Disorder ADHD) [1]. Currently, most literature and research focuses on Caucasian males which indicates that data on women with ADHD, specifically women of color, has to a great extent been absent from literature and research [2]. For girls and women, ADHD is often a hidden disorder that is ignored or misdiagnosed which leads to psychological and academic impairments [3]. Because ADHD is so common (3% to 5% of school children) and chronic (lifelong in many cases), even a small proportion of females multiplied by such a large base means hundreds of thousands of girls and women are living with ADHD, a significant public health problem [4]. Minorities are often left by the wayside when it comes to diagnosing, so women of color are at even more of a disadvantage, facing both sexist and racist complications. Lack of recognition can partially be explained because the symptoms are less overt in females and partially because coexisting disorders in females are often different from those seen in males who have ADHD [5]. Clinicians are frequently challenged with disentangling the symptoms of ADHD from symptoms of coexisting conditions as well as fluctuating hormone levels which may affect symptoms and treatment in females [6]. 4.6 Difficulties in DiagnosingAs described in the book A Comprehensive guide to Attention Deficit Disorder in Adults Research, Diagnosis, and Treatment particular issues that may add to, or detract from, our ability to detect ADD in women are neurobiological, "as gender-related neurobiological tendencies may make diagnosis more difficult; they are psychological, as a woman's trend toward internalization rather than externalization and acting out makes diagnosis more complicated; they are social and cultural, as gender-related norms and expectations not only affect a woman’s own ability to recognize ADD but these stereotypes also shared by women and clinicians, as well as the different manifestations of ADD symptoms, preclude or delay the diagnosis of ADD in girls and women" [7].The recognition of attentional problems and the diagnosis of ADD in women elude clinicians partially because women often lack the typical symptoms of "hyperactivity" and "impulsivity" in childhood or adulthood, and partially because the societal constructs surrounding the way in which womens behavior is interpreted often changes the way in which certain symptoms are recognized [8]. In her book Women with Attention Deficit Disorder, Sari Solden MS, LMFT, addresses these cultural stereotypes that we have for women: “Because they are nice, quiet, or shy, they meet cultural expectations so people either don’t notice or are not as concerned with their subtle information processing problems”. Conflicting results reported in the salient literature on females diagnosed with attention deficit hyperactivity disorder gave credence to a study published in the Journal of Attention Disorders that looked at specific neuropsychological test data, assessing various aspects of attention, memory, personality adjustment, and psychiatric symptomatology [9]. The study, undertaken in an effort to illuminate the presentation of ADHD in adult women, addressed substantial evidence that suggests under diagnosis and treatment of the disorder in females and the possible, consequent negative implications for their lives [10]. Results indicate that females had higher scores on cognitive tests, greater degrees of anxiety and depression than males and because of their higher rates of depressive and anxiety symptoms they may as a group be underdiagnosed [11]. 4.7 Differences Between SexesAn NIMH conference on Sex Differences in ADHD on November 16-17, 1994, concluded that the difference between sexes may reflect either a difference in susceptibility or that women with ADHD are less likely to be diagnosed than males [12]. The Canadian Journal of Psychiatry reveals that retrospective studies, clinical studies, and epidemiologic studies show the overall rate of comorbidity among adults with ADHD is high and the studies which looked at ADHD subtypes showed females with ADHD were more likely to have depression or dysthymia (Cumyn, French, and Hechtman 675). As well the same studies found that more women with ADHD (68.18%) had current panic disorder than men (31.82%), there were more men (66.67%) with drug abuse issues than women (33.33%), 85% of women had a history of past anorexia, compared with 14.92% of men, and that 62% of women with ADHD had a history of past bulimia, compared with 12.5% of men (675). In addition, Volume 56 of the Clinical Psychology Journal (A study in Attributions and Perceptions of Childhood in Women with ADHD Symptomology) concluded that women with ADHD symptomatology had “more uncontrollable, and global attributions, reported more dissatisfaction in their childhood parent, peer, and teacher relationships, and felt less in control of negative childhood events suggesting that negative perceptions and attributions are more than reflections of current thinking and mood with symptomatology also an important risk factor for maladaptive attributions” [13]. Peer rejection increases as the behavior of ADD adolescent girls appears more divergent from an accepted standard. Men with ADD have low self-esteem as well, but this is mostly due to an inability to find steady employment and a tendency to externalize performativity issues such as achievement instead of rejection from their peers [14]. Research suggests that women are much more likely to feel shame and to be ostracized regarding impulsive actions than men because the culture in which these women participate in produces a certain humiliation that can also be procured internally [15]. Saakvitne and Pearlman in 1993 reported that generally both the media and popular culture stigmatize women who behave impulsively, while tolerating or even celebrating impulsivity as an attribute in males. Furthermore in 2012 Dr. Stephen Hinshaw, chair of the psychology department at UC Berkley published a study showing that girls with combined-type ADHD have significantly higher rates of attempted suicide and self-harm, even though 40 percent of them have outgrown their hyperactive and impulsive symptoms in adolescence [16]. I would also like to request another section 5.3 Research. 5.3 ResearchThe Child & Adolescent Disorders Research Brand of the Division of Clinical & Treatment Research of NIMH suggests that researchers focus on if the same instruments and diagnostic criteria used for males are also appropriate for females as well as how males and females with ADHD differ genetically, neurologically, physically, phenomenologically, and in treatment response [17].. ADHD is manageable with a proper diagnosis and with advances in research and advocacy a Gender-sensitive diagnosis and treatment allows clinicians to address and combat the public health concern posed by the under diagnosis of ADHD in females [18]. |
Hope Im doing this right, I'm new to this process. Please get back to me. Thanks!
Satans-doyly ( talk) 01:04, 8 December 2015 (UTC)
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Once again in Section 4 Diagnosis I would like to add three new sections the first: 4.5 Sex and ADHD, the second: 4.6 Difficulties in Diagnosing, third: 4.7 Differences Between Sexes and fourth: 5.3 Research 4.5 Sex and ADHDAttention deficit hyperactivity disorder is a neurodevelopmental psychiatric disorder in which there are significant problems with executive functions (attentional control and inhibitory control) that cause attention deficits, hyperactivity, or impulsiveness which is not appropriate for a person's age (Attention-Deficit/Hyperactivity Disorder ADHD) [1]. Currently, most literature and research focuses on Caucasian males which indicates that data on women with ADHD, specifically women of color, has to a great extent been absent from literature and research [2]. For girls and women, ADHD is often a hidden disorder that is ignored or misdiagnosed which leads to psychological and academic impairments [3]. Because ADHD is so common (3% to 5% of school children) and chronic (lifelong in many cases), even a small proportion of females multiplied by such a large base means hundreds of thousands of girls and women are living with ADHD, a significant public health problem [4]. Minorities are often left by the wayside when it comes to diagnosing, so women of color are at even more of a disadvantage, facing both sexist and racist complications. Lack of recognition can partially be explained because the symptoms are less overt in females and partially because coexisting disorders in females are often different from those seen in males who have ADHD [5]. Clinicians are frequently challenged with disentangling the symptoms of ADHD from symptoms of coexisting conditions as well as fluctuating hormone levels which may affect symptoms and treatment in females [6]. 4.6 Difficulties in DiagnosingAs described in the book A Comprehensive guide to Attention Deficit Disorder in Adults Research, Diagnosis, and Treatment particular issues that may add to, or detract from, our ability to detect ADD in women are neurobiological, "as gender-related neurobiological tendencies may make diagnosis more difficult; they are psychological, as a woman's trend toward internalization rather than externalization and acting out makes diagnosis more complicated; they are social and cultural, as gender-related norms and expectations not only affect a woman’s own ability to recognize ADD but these stereotypes also shared by women and clinicians, as well as the different manifestations of ADD symptoms, preclude or delay the diagnosis of ADD in girls and women" [7].The recognition of attentional problems and the diagnosis of ADD in women elude clinicians partially because women often lack the typical symptoms of "hyperactivity" and "impulsivity" in childhood or adulthood, and partially because the societal constructs surrounding the way in which womens behavior is interpreted often changes the way in which certain symptoms are recognized [8]. In her book Women with Attention Deficit Disorder, Sari Solden MS, LMFT, addresses these cultural stereotypes that we have for women: “Because they are nice, quiet, or shy, they meet cultural expectations so people either don’t notice or are not as concerned with their subtle information processing problems”. Conflicting results reported in the salient literature on females diagnosed with attention deficit hyperactivity disorder gave credence to a study published in the Journal of Attention Disorders that looked at specific neuropsychological test data, assessing various aspects of attention, memory, personality adjustment, and psychiatric symptomatology [9]. The study, undertaken in an effort to illuminate the presentation of ADHD in adult women, addressed substantial evidence that suggests under diagnosis and treatment of the disorder in females and the possible, consequent negative implications for their lives [10]. Results indicate that females had higher scores on cognitive tests, greater degrees of anxiety and depression than males and because of their higher rates of depressive and anxiety symptoms they may as a group be underdiagnosed [11]. 4.7 Differences Between SexesAn NIMH conference on Sex Differences in ADHD on November 16-17, 1994, concluded that the difference between sexes may reflect either a difference in susceptibility or that women with ADHD are less likely to be diagnosed than males [12]. The Canadian Journal of Psychiatry reveals that retrospective studies, clinical studies, and epidemiologic studies show the overall rate of comorbidity among adults with ADHD is high and the studies which looked at ADHD subtypes showed females with ADHD were more likely to have depression or dysthymia (Cumyn, French, and Hechtman 675). As well the same studies found that more women with ADHD (68.18%) had current panic disorder than men (31.82%), there were more men (66.67%) with drug abuse issues than women (33.33%), 85% of women had a history of past anorexia, compared with 14.92% of men, and that 62% of women with ADHD had a history of past bulimia, compared with 12.5% of men (675). In addition, Volume 56 of the Clinical Psychology Journal (A study in Attributions and Perceptions of Childhood in Women with ADHD Symptomology) concluded that women with ADHD symptomatology had “more uncontrollable, and global attributions, reported more dissatisfaction in their childhood parent, peer, and teacher relationships, and felt less in control of negative childhood events suggesting that negative perceptions and attributions are more than reflections of current thinking and mood with symptomatology also an important risk factor for maladaptive attributions” [13]. Peer rejection increases as the behavior of ADD adolescent girls appears more divergent from an accepted standard. Men with ADD have low self-esteem as well, but this is mostly due to an inability to find steady employment and a tendency to externalize performativity issues such as achievement instead of rejection from their peers [14]. Research suggests that women are much more likely to feel shame and to be ostracized regarding impulsive actions than men because the culture in which these women participate in produces a certain humiliation that can also be procured internally [15]. Saakvitne and Pearlman in 1993 reported that generally both the media and popular culture stigmatize women who behave impulsively, while tolerating or even celebrating impulsivity as an attribute in males. Furthermore in 2012 Dr. Stephen Hinshaw, chair of the psychology department at UC Berkley published a study showing that girls with combined-type ADHD have significantly higher rates of attempted suicide and self-harm, even though 40 percent of them have outgrown their hyperactive and impulsive symptoms in adolescence [16]. 5.3 ResearchThe Child & Adolescent Disorders Research Brand of the Division of Clinical & Treatment Research of NIMH suggests that researchers focus on if the same instruments and diagnostic criteria used for males are also appropriate for females as well as how males and females with ADHD differ genetically, neurologically, physically, phenomenologically, and in treatment response [17].. ADHD is manageable with a proper diagnosis and with advances in research and advocacy a Gender-sensitive diagnosis and treatment allows clinicians to address and combat the public health concern posed by the under diagnosis of ADHD in females [18]. |
Is this sufficient?
Satans-doyly ( talk) 03:57, 8 December 2015 (UTC)
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There needs to be a more thorough expansion when it comes to the difference between genders and how each experience ADHD. I have re-written each of the sections I have previously proposed and found all new sources which meet the criteria for editing medical articles. Please take another look and get back to me if need be.
In Section 4 Diagnosis I would like to add three new sections the first: 4.5 Sex and ADHD, the second: 4.6 Difficulties in diagnosing, third: 4.7 Differences between sexes and fourth: 5.3 Research.
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Sex and ADHDAttention deficit hyperactivity disorder is a neurodevelopmental psychiatric disorder in which there are significant problems with executive functions (attentional control and inhibitory control) that cause attention deficits, hyperactivity, or impulsiveness which is not appropriate for a person's age. [1] Currently, most literature and research focuses on Caucasian males which indicates that data on women with ADHD, specifically women of color, has to a great extent been absent from literature and research. [2] The risk of institutional racism is a reality within diagnosis because of the often ignored issues of gender distribution, differences in diagnosis of ethnicity, and different meanings attached to symptoms in other societies. Along with racial disparities, other factors are connected with low rates of ADHD treatment among children such as lower average expenditures delegated to special education programs in schools, education levels, poverty rates, and rural areas. [3] A study showcasing racial and ethnic disparities in ADHD diagnosis from kindergarten to eighth grade of more than 17 000 children deduced that non-white children such as African American and Hispanic populations experienced rates of ADHD that were up to 50% lower, respectively, than rates among white children. [4] Women of color within these populations are at an even more of a disadvantage, due to the focus on male symptomology. By only focusing on a certain set of cultural views, communities with differing practices and beliefs are left with a very rigid and specific perspective on childhood and its problems. [5] As well clinicians are frequently challenged with disentangling the symptoms of ADHD from symptoms of coexisting conditions coupled with fluctuating hormone levels which may affect symptoms and treatment in females. [6] However, sex differences related to comorbid psychiatric conditions that show symptoms of agitation and impulsivity overlap with ADHD in women and men. [7] But with this said, women are shown to have a higher capacity to seek treatment because they more readily 'medicalize' their symptoms. [8] At present there is a referral bias which is reflected in the lack of a difference between men and women that has resulted from the absence of data to suggest different sex-specific rates of remission. [9]
Difficulties in diagnosingAs described in the book A Comprehensive guide to Attention Deficit Disorder in Adults Research, Diagnosis, and Treatment particular issues that may add to, or detract from, our ability to detect ADD in women are neurobiological. When it comes to issues surrounding medication for women with ADHD it is frequently more complicated than for men not only because women suffer from certain comorbidities such as anxiety and depression so their treatment also has to deal with how those disorders mingle with ADHD symptoms but they are also complicated by hormone fluctuations whenever estrogen levels fall during their life span including menstrual cycles, puberty, and menopause. [10] For women with perimenopause, it's not unusual to have difficulty with word retrieval, memory and cognitive skills. [11] Pregnancy and post-partum depression along with the drastic changes in hormone levels and iron deficiency during menstruation already leads to strenuous issues with mental health before ADHD symptoms are even considered. [12] Often hormone replacement is coupled with medication. Consideration of all the aspects of a patient’s life not limited to substance abuse, and disordered eating need to be addressed to effectively treat women with ADHD. [13] Many disorders have similar symptoms and because women with ADHD have a tendency to couple these disorders with ADHD (as well as the fact ADHD tends to aggravate the symptoms of other maladities) many are mis-diagnosed. [14]. Other factors such as history of physical abuse can be prone to ADHD-like symptoms which complicates the identification of the disorder. [15]. The interplay of all of these conditions needs to be more accurately examined due to the fact that research has for too long focused only on male populations because masculine subject positions are privileged in social and educational settings which results in more interventions and special resources allocated and aimed at boys which in turn serves to perpetually re-enact male dominance within the treatment of ADHD. [16] The diagnosis of ADHD is also influenced by gender stereotypes. These gender-related norms and expectations not only affect a woman’s own ability to recognize ADD but these stereotypes are also shared by clinicians. A study which provided participants (specialists in child and adolescent mental health including social workers, child psychologists and psychiatrists) with information about the minimal and optimal behavioral symptoms to diagnosis ADHD were told to indicate which children had ADHD from a series of vignettes. [17] Approximately 20% of clinicians diagnosed ADHD when the criterion was not fulfilled. [18] Kathleen Nadeau, a clinical psychologist and director of the Chesapeake ADHD Center of Maryland in Silver Spring, explains that the societal expectations placed upon women makes dealing with their ADHD more difficult because of a continuation of traditional societal roles. [19] Many women and their families see their difficulties as merely a part of the stress of modern-day living. [20] In her book Women with Attention Deficit Disorder, Sari Solden MS, LMFT, addresses these cultural stereotypes that we have for women: “Because they are nice, quiet, or shy, they meet cultural expectations so people either don’t notice or are not as concerned with their subtle information processing problems”. Although when it comes to seeking treatment males generally combat more variables impacting their treatment seeking than females in compliance with the findings of Elias Dakwar, MD, and assistant professor of psychiatry, for Columbia University. Researchers have found that delayed treatment seeking among men is influenced by socioeconomic status, and demographic factors such as having a lower education level, having antisocial personality disorder and being African American, whereas the desire to seek treatment earlier is linked to specific psychiatric comorbidities and addiction issues such as alcohol dependence. [21] But because teachers and parents are the ones who seek treatment for ADHD children the more disruptive the behavior the more likely it is that they will notice which tends to result in more clinical attention for boys initially than girls where this behavior goes unnoticed. [22] In adolescence this starts to change possibly because of the decreased role parents and teachers have. [23]
Differences between sexesA study by David Muzina, an MD, psychiatrist and vice president of Express Scripts, a pharmacy based company, conducted research on prescription medications to treat adult attention-deficit/hyperactivity disorder and found that it increased in the United States in 2008 to 2012 by 53.4%; with 85% of that increase involving women aged 26 to 34. His study concluded that women received treatment more frequently than men because of a delay in diagnosis until adulthood and as well that women were using an unsuitable amount of stimulants possibly because of a desire to reduce appetite. [24] Whereas in childhood boys outnumber girls in the use of medications to treat ADHD by 2:1 this swaps during adulthood. [25] Women then represent a more significant proportion of adults with ADHD. [26] Patricia Quinn, director of the National Center for Gender Issues and ADHD, specifies that women often” develop strategies to hide their deficiencies, but in the process, feel ashamed and have low self-esteem”. [27] Rather than be disruptive, girls show their symptoms in a more socially acceptable way where it isn’t uncommon for them to take up extra responsibility in classroom settings as monitors or by becoming extremely social. [28] Girls are also more likely to develop anxiety due to their general need to be “people pleasers”. [29] As adults many women and in turn their families see their symptoms as simply the stress of contemporary living. [30] There is also a difference in self-reported symptoms where men focus more on stress, lacking social skills, and issues with conduct and learning. [31] Stephanie Sarkis, a psychotherapist in Boca Raton, Florida, reports that men with ADHD tend to have more substance abuse issues, discipline issues (school suspensions), car accidents, and anger/behavioral issues compared to women with ADHD. [32] Women on the other hand are concerned with dysphoria although they too have trouble with conduct problems, impulsivity, organization and attention. [33] Women project more control over external symptoms and show less cognitive challenges but report lower self-esteem and self-image issues and fewer assets than males. [34] They are also more susceptible to eating disorders, and obesity. [35] Peer rejection for girls starts early and only increases with age. [36] This ingrained and internalized low self-regard results from societal criticism of impulsive and risk taking behavior where women deal with a larger maternal criticism of ADHD behavior which is more likely to result in long-term psychological damage. [37] In corroboration with these findings, Volume 56 of the Clinical Psychology Journal (A study in Attributions and Perceptions of Childhood in Women with ADHD Symptomology) concluded that women with ADHD symptomatology had “more uncontrollable, and global attributions, reported more dissatisfaction in their childhood parent, peer, and teacher relationships, and felt less in control of negative childhood events suggesting that negative perceptions and attributions are more than reflections of current thinking and mood with symptomatology also an important risk factor for maladaptive attributions”. [38] According to the research of Anthony Rostain, a professor of psychiatry and pediatrics at the University Of Pennsylvania School Of Medicine, men are more likely to see problems in their professional lives whereas women are more likely to see their ADHD manifest as conflicts in the domestic space. [39] This can also account for the way in which women’s ADHD is sometimes overlooked until later in life, when they start to show decreased self-regulation and management. [40] The difference between gender shows clearly in the statistics illustrated by The Canadian Journal of Psychiatry which revealed that retrospective studies, clinical studies, and epidemiologic studies found that more women with ADHD (68.18%) had current panic disorder than men (31.82%), there were more men (66.67%) with drug abuse issues than women (33.33%), 85% of women had a history of past anorexia, compared with 14.92% of men, and that 62% of women with ADHD had a history of past bulimia, compared with 12.5% of men. [41] Another study in Sweden of 25, 000 individuals with ADHD showed that the risk of committing a crime decreased by 32% among men and 41% among women during treatment periods for ADHD rather than untreated periods. [42] Furthermore in 2012 Dr. Stephen Hinshaw, chair of the psychology department at UC Berkley, published a study showing that girls with combined-type ADHD have significantly higher rates of attempted suicide and self-harm, even though 40 % of them have outgrown their hyperactive and impulsive symptoms in adolescence. [43]
ResearchGender sensitive profiles and answers regarding the different ways in which ADHD manifests according to gender have been slow-moving as much still remains to be answered. [44] The Child & Adolescent Disorders Research Brand of the Division of Clinical & Treatment Research of NIMH suggests that researchers focus on how males and females with ADHD differ genetically, neurologically, physically, phenomenologically, and in treatment response. [45] The US Agency for Healthcare Research and Quality found that, particularly boys, exhibited better behavior when treated with stimulants and that women tended to engage in more emotion-oriented versus task oriented coping strategies. [46] [47] Currently the adherence to diagnostic criteria put in place limits the results of diagnosis in females to women who most resemble men with ADHD. [48] The development of more gender sensitive treatment is the only way to appropriately address the under-diagnosis of ADHD in females. [49] Screening tools and routinely incorporating questionnaires into clinician evaluations to detect ADHD among older adolescents could help combat the many adults who do not receive treatment for their symptoms. [50] There has been speculation, from such psychiatrists as Joseph Austerman, head of the Section of Child and Adolescent Psychiatry at Cleveland Clinic Children's Hospital, in Ohio, that the rise in medicating adults for ADHD signals an over-diagnosing of the adult population although it cannot be refuted that there are adults who require this medication to thrive in their private and professional lives. [51] |
Satans-doyly ( talk) 06:50, 11 December 2015 (UTC)
In reading over the information on ADHD treatments, I didn't find that there was much information on natural remedies or dietary restrictions. Here's some stuff I think would be helpful!
There is evidence supporting the use of nutritional supplements in helping to control ADHD, especially in young children. For example, supplements including omega-3 polyunsaturated fatty acid compounds and minerals have been found to improve ADHD symptoms.
While prescription drugs have been found to have positive effects on ADHD symptoms, there is also research supporting the use of nutritional supplements. While the findings have not been proven sufficient enough to draw generalized conclusions, they have shown that adding supplemental nutrients to an individual’s daily diet may indeed help with the symptoms associated with ADHD. Among the supplements tested are omega-3 fatty acid compounds (also known as fish oil), iron supplements, and zinc supplements. While these supplements have been researched, it is also important to consider the removal of certain components of a diet when treating the symptoms of ADHD. For example, because hyperactivity and issues with concentration are such a significant part of the problematic symptoms, sugar is often removed (or at least limited) when using natural remedies for such symptoms.
References
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-- — Preceding unsigned comment added by Cevance ( talk • contribs) 02:32, 9 March 2016 (UTC)
A systematic review in 2015 looked at four groups of studies that measured the efficiency of non-medicinal treatment strategies, resulting from modification of the behavior in children within their school environments. I'm hoping that another editor can share their thoughts on the review. Richardson M, Moore DA, Gwernan-Jones R, Thompson-Coon J, Ukoumunne O, Rogers M, et al. Non-pharmacological interventions for attention-deficit/hyperactivity disorder (ADHD) delivered in school settings: systematic reviews of quantitative and qualitative research. Health Technol Assess 2015;19(45). http://www.journalslibrary.nihr.ac.uk/__data/assets/pdf_file/0011/146684/FullReport-hta19450.pdf
I'll leave it to another editor to decide whether to add this review to the references, or perhaps to the page itself. I believe the findings would fit in the environmental section, societal section, or in a subsection about intervention therapies. I'm happy to write a section on the findings of this review; just wanted to check with the ADHD page community before possibly stepping on anyone's toes. Thanks for the feedback! Zharris24 ( talk) 05:18, 9 March 2016 (UTC)
Lancet doi:10.1016/S0140-6736(15)00238-X JFW | T@lk 23:52, 19 March 2016 (UTC)
The following were added today:
At "Causes: Environment":
An association of ADHD with gluten intolerance, both celiac disease and non-celiac gluten sensitivity, has been found. ADHD may be the only symptom of these two diseases, even in absence of gastrointestinal symptoms. [1] [2]
and later a subsection under Management "Gluten-free diet" was created: People with undiagnosed celiac disease or non-celiac gluten sensitivity may develop ADHD, which may be the only symptoms in absence of gastrointestinal complaints. Gluten-free diet often improves them. [1] [2] In one study, the majority of patients (74%) chose to continue the gluten-free diet due to significant relief of their symptoms after six months of gluten withdrawal. [1]
The Fasono source from 2015 is a) very clear about gluten-free being faddish, and b) is tentative on the gluten hypothesis: "Children with NCGS mainly have intestinal symptoms such as abdominal pain and chronic diarrhea without weight loss. Less frequently, they present with extraintestinal manifestations, including fatigue and attention-deficit disorders. Of particular interest is the relationship between NCGS and neurologic and neuropsychiatric disorders, including autism, schizophrenia, and peripheral neuropathy. However, it is not clear how gluten might contribute to these disorders." The older 2012 Jackson paper (which we don't need at all, since we have the Fasano review) is also tentative, noting " few studies have suggested that Attention Deficit Hyperactivity Disorder (ADHD) may be associated with gluten intolerance as well. A study measured ADHD symptoms in CD patients and found that these symptoms are “overrepresented” as compared to the general population. A 6-month gluten-free diet was reported to improved ADHD symptoms and the majority of patients (74%) in this report wanted to continue the gluten-free diet due to significant relief of their symptoms" And if you look at that clinical trial (
PMID
17085630) it is 10 years old, and is a single arm study of people with celiac, looking for ADHD-like symptoms. The proposed content doesn't represent the sources and additionally appears to be UNDUE to me.
Jytdog (
talk) 12:48, 24 March 2016 (UTC)
Although there is clearly a fad component to the popularity of the GFD, there is also undisputable and increasing evidence for NCGS.
Additional studies incorporating the exclusion of dietary gluten and casein in related conditions such as attention-deficit hyperactivity disorder (ADHD) have also noted positive effects on symptoms (Pelsser et al., 2011) particularly in cases of overlapping CD (Niederhofer, 2011) where both somatic and psychological presentation were affected. Combined however, such co-morbidities are not thought to be able to account for all cases of success despite no commonplace screening for such potential issues in ASCs and the possibility of non-CD mediated sensitivities (Biesiekierski et al., 2011).
Conclusions: Celiac disease is markedly overrepresented among patients presenting with ADHD. A gluten-free diet significantly improved ADHD symptoms in patients with celiac disease in this study. The results further suggest that celiac disease should be included in the ADHD symptom checklist.
Children with celiac disease can also suffer from neurological and psychological disorders, including headaches, attention-deficit/hyperactivity disorder (ADHD), learning and tic disorders, depression and anxiety, mostly before any dietary treatment [12-15].
CONCLUSION: This study suggests that the variability of neurologic disorders that occur in CD is broader than previously reported and includes "softer" and more common neurologic disorders, such as chronic headache, developmental delay, hypotonia, and learning disorders or ADHD. Future longitudinal prospective studies might better define the full range of these neurologic disorders and their clinical response to a gluten-free diet.
ELIMINATION DIETS AND HEALTH The focus of elimination diets is to remove specific foods from the diet in an effort to eliminate potential allergens that occur naturally in food (eg, eggs, wheat, dairy, soy) or artificial ingredients that may have allergenic or even toxicant effects (eg, synthetic food additives: artificial colors, flavors, sweeteners, as well as flavor enhancers [like monosodium glutamate (MSG)] and preservatives). These diets are used to attempt to diagnose and treat food allergies and intolerances. (...) When putting together both studies of restriction/elimination diets generally and studies of food color elimination specifically, effects sizes across the best studies therefore appear to range from d = 0.2 to d = 0.4 depending on study selection, with the possibility that effects are somewhat larger in children with ADHD. However, the finding of larger mean symptom changes in children with ADHD is difficult to interpret, because those children by definition have more extreme symptom scores and therefore less restriction of range in their scores in response to intervention. In addition, if food colors are not the main culprit in dietary effects, then challenge studies of food colors will underestimate the effects of an elimination diet. Carter and colleagues47 challenged children who had responded to an elimination diet with foods to identify what caused their symptoms to worsen. During these challenges, a wide range of foods provoked reactions, including typical allergenic foods (wheat, eggs, milk, cheese), chocolate, and additive-containing foods. Only a small minority of children seemed to react primarily to artificial colorings.
Recently, Sabra et al.(104) hypothesised that food allergy is the pivotal causative factor that produces lesions in the ileum that consist of enlarged lymphoid nodules containing large collections of lymphocytes in the GI lymphoid tissues adjacent to Peyer’s patches. These GI lesions would allow the entry of food antigens across the inflamed mucosa of the bowel and elicit an inflammatory response in the GI tract(104). They found LNH, reactive lymphoid follicular hyperplasia and chronic inflammation in twelve children with attention-deficit/hyperactivity disorder, autism, anorexia and/or migraine. Th1-associated cytokines were found to be decreased compared with control values, which, together with a predominance of CD4þ cells, support an immunological basis for non-IgEmediated food allergy (NFA) in this group(104). (...) Consequently, there have been many reports on the role of a GFCF diet on alleviating several symptoms of autistic individuals(19,110 – 116) (however, not all of sufficient methodological quality; see below). Significant improvements have been noted within psychological and behavioural categories in vocal and non-vocal communication, attention and concentration, episodes of aggressiveness, affection, motor skills, sleeping patterns, displaying of routines and rituals, anxiety, empathy and responses to learning(19,111,112,115,116). Moreover, reintroduction of dietary gluten elicited a worsening of behaviours in areas of hyperactivity and impulsivity, stereotyped behaviours, aggression and language and communication skills(19). A slight initial worsening in behaviour after introduction of the GFCF diet was also noted, which was suggested to be comparable with the withdrawal behaviours exhibited by opioid addicts on the removal of opioids(19). Changes in physical and physiological areas were measured in some studies as well. One patient showed abnormal peptides not found in controls, including b-casomorphin (BCM), a-gliadin, dermorphin, deltorphin I and II, and morphine-modulating neuropeptide(117). Some of these have also been observed in other studies(57,112,118).
FWIW, a positive correlation between celiac disease or gluten intolerance and ADHD could be mediated entirely at a genetic level, in which case gluten itself has nothing to do with ADHD in otherwise healthy individuals. All that association suggests is that celiac disease/gluten intolerance and ADHD are comorbid disorders. I doubt gluten itself has anything to do with ADHD pathology in individuals without a gluten sensitivity, especially because this unfiltered search returned nothing. Seppi333 ( Insert 2¢) 22:43, 24 March 2016 (UTC)
Pathogenesis. Researchers are investigating the pathogenesis of NCGS; this disorder only recently has become a subject of systematic research. Our level of knowledge about NCGS pathogenesis is comparable with what was known about celiac disease more than 20 years ago. Gluten is the undisputable cause of celiac disease and therefore it was assumed that the same applied to NCGS. However, besides gluten, wheat, barley, rye, and their derivatives contain other components that induce symptoms, including amylasetrypsin inhibitors (ATIs) and FODMAPs. FODMAPs cause mild wheat intolerance at most, limited to intestinal symptoms, so we can exclude them from further discussion in the context of NCGS. Patients with NCGS resolve symptoms after they eliminate glutencontaining grains, despite continuing to ingest FODMAPs from other sources. Children with NCGS mainly have intestinal symptoms such as abdominal pain and chronic diarrhea without weight loss. Less frequently, they present with extraintestinal manifestations, including fatigue and attention-deficit disorders.25 Of particular interest is the relationship between NCGS and neurologic and neuropsychiatric disorders, including autism, schizophrenia, and peripheral neuropathy.26–28 However, it is not clear how gluten might contribute to these disorders. (...) more evidence is needed about the mechanisms leading to the improvement of diseases affecting the nervous system as well as other organs after dietary elimination of gluten or nongluten proteins. (...) there is growing evidence that other proteins that are unique to gluten-containing cereals can elicit an innate immune response that leads to NCGS, raising a nomenclature issue. For this reason, wheat sensitivity, rather than gluten sensitivity, seems to be a more appropriate term, keeping in mind that other gluten-containing grains such as barley and rye also can trigger the symptoms.
ATIs are plant-derived proteins that inhibit enzymes of common parasites, such as mealworms and mealbugs, in wheat. (...) Studies of biopsy specimens from patients with celiac disease showed that ATIs increase the gluten-specific T-cell response.49 Therefore, ATIs could be the long-sought inducers of innate immunity in patients with celiac disease or NCGS. Importantly, ATIs are present in commercial gluten and resist proteolytic digestion, such as by the gastric and enteric proteases pepsin and trypsin, maintaining the ability to activate TLR4 throughout oral ingestion and intestinal passage. (...) ATI species, approximately 120–150 amino acids long, in modern wheat, with a variant primary sequence but a conserved secondary structure.51
The conclusions of this source are: "The literature clearly demonstrates that a minority of children with ADHD will benefit from an elimination diet. Research funders, scientists, and clinicians would do well to re-invigorate investigation of this intervention, while avoiding both excessive skepticism (clearly, it may work for some), and excess optimism (it probably only works for a minority) ... dietary intervention for ADHD was abandoned too quickly in North America. Although it is likely that only a minority of children with ADHD will respond to dietary intervention, the evidence persistently suggests that for some children such intervention can be quite effective. ". Diets are not profitable for pharmaceutical companies....
I did not say that a gluten-free diet may work for everyone, just for one subgroup (people with CD or NCGS), and it is documented although they are few studies (dietary intervention for ADHD was abandoned too quickly...). And I repeat: this minority of people who develop ADHD symptoms because of celiac disease / non-celiac gluten sensitivity have no right to cure or improve, or to know this information...? Are "minorities" have no right?
Elimination diets reinforce the idea that wheat ("gluten and ATIs") may be involved. Also, very often in gluten-free diet is not enough to remove only gluten, more food must be removed, especially in cases with long delays in diagnosis (which is usual, there often are delays of many years, including children). Intestinal permeability and mucosal damage caused by gluten are responsible for the appearance of more food allergies and intolerances, which are often reversible after months or years of strict GFD, and avoidable with an early diagnosis. But researchers are badly lost and disoriented, generally uninterested or they do not get money to fund the studies (diets are not profitable for pharmaceutical companies).
Authors of this paper PMID 25220094, when summarizing the results, talk about of all elimination diets in general terms.
The focus of elimination diets is to remove specific foods from the diet in an effort to eliminate potential allergens that occur naturally in food (eg, eggs, wheat, dairy, soy) or artificial ingredients that may have allergenic or even toxicant effects (eg, synthetic food additives: artificial colors, flavors, sweeteners, as well as flavor enhancers [like monosodium glutamate (MSG)] and preservatives). These diets are used to attempt to diagnose and treat food allergies and intolerances.
Food elimination diets vary in their specific content, but take 3 main forms. A single food exclusion diet excludes one suspected food, such as eggs. A multifood exclusion diet, such as the 6-food elimination diet, eliminates the most common food allergens: cow-milk protein, soy, wheat, eggs, peanuts, and seafood. A “few foods diet” (also called an oligoantigenic diet) restricts a person’s diet to only a few less commonly consumed foods (eg, lamb/venison, quinoa/rice, pear, and others with low allergenic potential). (...)
Other specific elimination diets exist, such as a gluten-free diet and the Kaiser Per-manente (or Feingold) diet. The gluten-free diet is currently the only successful treatment for patients with celiac disease15 and is also being used to treat nonceliac gluten sensitivity.16 Gluten is the protein found in wheat, rye, and barley, and thus, any item in the diet containing these grains (including some food additives) must be removed. A gluten and casein-free diet is also being tested in autism.17 (...)
Overall, for children presenting for ADHD treatment with no obvious gastrointestinal symptoms or strong prior evidence of a dietary effect, a strict elimination diet may have a 10% to 30% chance of providing a true effect detectable on a double-blind measurement, but this estimate is limited by very small samples and widely varying methods. The best estimate on the small literature is about a 25% rate of at least some symptom improvement. For some children, perhaps a minority of 10% of children with ADHD, response can include a full remission of symptoms equivalent to a successful medication trial. In short, the literature suggests that an elimination diet should be considered a possible treatment for ADHD, but one that will work partially or fully, and only in a potentially small subset of children. (...)
With that said, (1) many parents remain interested in dietary intervention, (2) the literature suggests that some children may benefit (a trial is not senseless), and (3), clinicians need some idea what the family would be getting into if they attempt a restriction diet. Therefore, a brief presentation of clinical considerations if such an intervention is going to be pursued follows. (...)
A major recommendation coming out of this review, echoing prior reviews (see Table 1), is that dietary intervention for ADHD was abandoned too quickly in North America. Although it is likely that only a minority of children with ADHD will respond to dietary intervention, the evidence persistently suggests that for some children such intervention can be quite effective. Thus, where should the field go to develop and realize this possibility? Several additional future study and design considerations and suggestions were offered by Stevenson and colleagues.46 The present authors highlight selected recommendations of their own here.
Best regards. -- BallenaBlanca ( talk) 11:05, 25 March 2016 (UTC)
Ref says "an elimination diet produces a small but reliable aggregate effect" [6] The ref comments on celiacs but makes no claim that it improves ADHD symptoms I agree. Doc James ( talk · contribs · email) 09:57, 26 March 2016 (UTC)
Attention Deficit-Hyperactivity Disorder (ADHD). A few studies have suggested that Attention Deficit Hyperactivity Disorder (ADHD) may be associated with gluten intolerance as well. A study measured ADHD symptoms in CD patients and found that these symptoms are “overrepresented” as compared to the general population. A 6-month gluten-free diet was reported to improved ADHD symptoms and the majority of patients (74%) in this report wanted to continue the gluten-free diet due to significant relief of their symptoms
People with symptoms of any mental health problem should always see their PCP to rule out likely physical ailments first. Celiacs is not unique in having some overlapping symptoms with ADHD and it's far from the most common. It not in the top 5. This reads like doctors have no idea ADHD symptoms could be caused by something else. We can't/shouldn't attempt to address every other issue that might present like ADHD and if we're going to mention some things that should be ruled out first, it should be the most common: seasonal allergies, asthma hearing or vision disorders, anemia, hashimotos/thyroid issues, tonsil/adenoid issues, sleep apnea and other sleep disorders, brain injury, elevated lead levels... [3] [4] and that's not even mentioning things like learning disabilities, other mental illnesses, and having crappy parents. If your pediatrician isn't ruling out other likely possibilities before officially diagnosing your kid with anything, you need a new pediatrician. As far as celiacs goes, it would encompassed with due weight in sentence like, "doctors should always rule out potential physiological explanations for attentional issues as part of a thorough ADHD evaluation." More sources talking about common things to rule out in patients with ADHD symptoms that don't mention celiacs: [5] [6] [7] [8] [9] PermStrump (talk) 15:02, 14 April 2016 (UTC)
References
The diseases significantly associated with patients with ADHD compared with the control group were the following: allergic diseases (asthma 25% vs. 18%, allergic rhinitis 41% vs. 30%, atopic dermatitis 18% vs. 13%, and urticaria 8% vs. 6%), autoimmune diseases (ankylosing spondylitis 0.1% vs. 0%, odds ratio [OR] 2.78; ulcerative colitis 0.2% vs. 0.1%, OR 2.31; autoimmune thyroid disease 2.1% vs. 0.8%, OR 2.53); and psychiatric disorders (depressive disorders 5.5% vs. 0.5%; anxiety disorders 15% vs. 0.4%). In contrast, Crohn's disease, celiac disease, and type 1 diabetes mellitus did not show any significant correlations with ADHD.
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Attention deficit hyperactivity disorder is a heterogeneous behavioral disorder with several possible etiologies. Environmental and central nervous system insult, such as head trauma, exposure to lead, cigarette exposure,and low-birth weight (less than 1,000 grams) are thought to be a possible cause... Some common problems in the pediatric population that can cause ADHD-like symptoms include anemia, lead toxicity, thyroid problems, learning disabilities, uncorrected hearing or vision problems, substance abuse, depression, anxiety, bipolar disorder, and anxiety disorders. The target symptoms for each patient should be carefully documented for proper diagnosis and treatment.
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I've just full-protected this page for 24 hours to prevent edit-warring and allow discussion to take place. I am happy for any admin to unprotect if they feel the problem has resolved. Cas Liber ( talk · contribs) 00:33, 25 March 2016 (UTC)
@ Doc James: Why did you remove the statements about problems with executive functions in the lead a while back? Seppi333 ( Insert 2¢) 10:43, 29 March 2016 (UTC)
Attention deficit hyperactivity disorder (ADHD, similar to hyperkinetic disorder in the ICD-10) is a neurodevelopmental psychiatric disorder in which there aresignificantproblems with executive functions(e.g., attentional control and inhibitory control)that cause attention deficits, hyperactivity, or impulsiveness which is not appropriate for a person's age.
No, it's my way of acknowledging "I have heard what you said." Arbitrarily adding it back into the lead instead of having a discussion is just me reflecting your behavior at MDMA in this article. FWIW, it also irritates me that instead of having a discussion on the talk page and arriving at some form of compromise version that suits both of us, you decide on an RFC to go with one version or the other when we have content disputes. Seppi333 ( Insert 2¢) 12:43, 7 April 2016 (UTC)
This is a fairly moot issue because I'm not disputing the removal; I don't really care if it's in the lead or not. Nonetheless, ignoring any evidence supporting the characterization, the "AD" in ADHD is nominally an EF disorder. It's not essential to mention this in order to describe ADHD, I agree, but it is for any body of text that gives any serious weight to the pathophysiology of the disorder. The lead of this article is not such a body of text. Seppi333 ( Insert 2¢) 20:25, 8 April 2016 (UTC)
References
Brown-2008
was invoked but never defined (see the
help page).Malenka pathways
was invoked but never defined (see the
help page).Malenka ADHD neurosci
was invoked but never defined (see the
help page).We have had in the article for some time that ADHD is both a mental disorder and a neurodevelopmental disorder. Not sure why there are attempts to remove that it is a mental disorder. [11]. All the main listing in the DSM5 are mental disorders / psychiatric disorders. We all agree that it is also a neurodevelopmental disorder.
Doc James ( talk · contribs · email) 06:11, 10 April 2016 (UTC)
In the section on managing ADHD symptoms with
diet, a
literature review by Ertürk et al. (2016) is used to support this statement: "A 2016 review states that evidence does not support a clear link between celiac disease and ADHD, and that routine screening for celiac disease in people with ADHD and the use of a gluten-free diet are discouraged. However, untreated celiac disease, which often present with mild or even absent gastrointestinal complaints, could predispose to ADHD symptoms, especially those of inattentive type, which may be improved with a gluten-free diet."
[1] Now that I've had a chance to thoroughly read the paper, I don't think it's a reliable source for this statement. My issue is with the second sentence, because it was easy to find alternate sources to the support the first sentence alone, like Sethi and Hughes (2015).
[2] My issue with Ertürk et al.'s paper is that they contradict themselves in several locations and their conclusions are not supported by actual findings. Only 3 of the 8 studies they found a positive correlation between ADHD and celiacs and only 2 of those studies (both with the same lead author - Niederhofer) "showed" a decrease in ADHD-like symptoms after starting a GFD. All 3 were "low quality" with "very poor internal validity and small sample sizes" according to Sethi and Hughes.
[2]
Quotes from sources
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For context, in Feb 2016, Ertürk et al. did a lit review of all of the trials ever published on ADHD and celiacs and they found 8 that discussed a possible association between CD and ADHD:
After reviewing those 8 studies, these were their findings:
*Note Ertürk et al. didn't even mention if the 3 studies that showed a positive correlation between ADHD and celiacs found that GFD improved symptoms. In fact, Zelnik et al. explicitly found the opposite. According to other reliable sources, there's so much bias in the Niederhofer studies that they don't count. [2] Yet, somehow Ertürk et al. came to the conclusion that:
*Note that neither of the 2 studies cited in the conclusion were one of the 8 analyzed for the lit review. And if you look at those two studies, they don't support this statement. Lichtwak et al. (2014) [3] weren't explicitly measuring ADHD or inattention symptoms, Lichtwak and all of the co-authors noted massive conflicts of interest, and their study was heavily criticized for bias and poor design by Lebwohl et al. (2014) for additional reasons. [4] Terrone et al. (2013) [5] also weren't testing for tru ADHD, just "inattention" in combination with other mental health issues like depression, anxiety, oppositional behavior, etc., and they were really vague about what inattention symptoms were reported and didn't show the before and after data. There's a reason they weren't included in Erturk or Sethi and Hughes lit reviews, so it's pretty shady for Erturk to turn around and act like those studies support their hypothesis when the actual studies they analyzed didn't. Sethi and Hughes (2015) [2] also did a lit review of the published studies on celiacs and ADHD. They found 8 studies (with only one difference from Erturk - Chen et al. instead of Pynnönen et al.):
This is what Sethi and Hughes found:
|
More importantly, beginning a gluten-free diet with out concrete biological markers for celiacs is contraindicated, so there's absolutely no reason we should be suggesting it might help ADHD symptoms. That suggestions should only come from their doctor after definitive diagnosis of celiacs.
I propose this change: "A 2015 review states that evidence does not support a clear link between celiac disease and ADHD, and that routine screening for celiac disease in people with ADHD and the use of a gluten-free diet are discouraged." [2] Another alternative would be not mentioning celiacs at all, which is my #1 preference. PermStrump (talk) 03:54, 15 April 2016 (UTC)
"Nobody is recommending to start a gluten-free diet without a diagnosis of CD. "Untreated CD" means by both CD diagnosed patients with lack of compliance with the diet and undiagnosed patients prior to CD diagnosis."That's what the article currently sounds like it's saying. PermStrump (talk) 07:55, 15 April 2016 (UTC)
References
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A serious issue, related to the small sample size, is the relative lack of variability in clinical, serological and histological outcomes. Every one of these subjects (100%) was found to have excellent adherence to the gluten-free diet, and nine of 10 had Marsh 0 or 1 findings on follow-up biopsy at 52 weeks, rates of healing far greater than typically seen among groups of patients with CD. It is therefore difficult to know whether improvements in these cognitive tests reflect the gluten-free diet as nearly everyone healed, and there was not a control arm. Supporting the notion that this is a selected population was the exclusion of more than 30% of the enrolled participants (5/16). It is premature to conclude that these results characterise the precise cognitive deficit in CD, as the statistical testing in this study did not account for multiple comparisons and there was not a specific pre-specified outcome.
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Erturk
was invoked but never defined (see the
help page).This is an archive of past discussions. Do not edit the contents of this page. If you wish to start a new discussion or revive an old one, please do so on the current talk page. |
Archive 20 | ← | Archive 22 | Archive 23 | Archive 24 | Archive 25 | Archive 26 | → | Archive 28 |
I'd like to add a small-to-medium section with some oft cited and well documented characteristics that are more common among Adults with ADHD than the general population. It might be most effective to pick 3-5 characteristics with a one-liner explanation, if necessary. For example, extroversion, creativity, and hyperfocus have all been associated with Adult ADHD. There seem to be many sources to pick from; I've found a bunch just by going through all the articles that can come up in a Google search and looking at the sources they cite. You'll see several at the bottom of this article: http://www.webmd.com/add-adhd/features/positives.
It seems like our description of the disorder would be incomplete without some indication that ADHD helps many adult succeed; indeed, some of the most successful people in the world are diagnosed with ADHD. Please let me know if it's OK to add this. I made a few minor edits, but this seemed like it would be too big and somewhat different from the rest of the article. ,Wil ( talk) 09:07, 16 June 2014 (UTC)
Seppi333 ( Insert 2¢ | Maintained)
@ Jmh649: Hey Doc - I want your perspective on this. Do you think any part of these refs [1] [2] from trace amine is worth summarizing and including in this article?
Unfortunately, these two reviews are the newest ones available on trace amine receptors in relation to neuropsychiatry. I'm actually kind of puzzled as to why there isn't more activity in TAAR (particularly TAAR1) research... (emphasis added only as highlights)
References
changes in trace amines, in particular PE, have been identified as a possible factor for the onset of attention deficit/hyperactivity disorder (ADHD) [5, 27, 43, 78]. PE has been shown to induce hyperactivity and aggression, two of the cardinal clinical features of ADHD, in experimental animals [100]. Hyperactivity is also a symptom of phenylketonuria, which as discussed above is associated with a markedly elevated PE turnover [44]. Further, amphetamines, which have clinical utility in ADHD, are good ligands at trace amine receptors [2]. Of possible relevance in this aspect is modafanil, which has shown beneficial effects in ADHD patients [101] and has been reported to enhance the activity of PE at TAAR1 [102]. Conversely, methylphenidate, which is also clinically useful in ADHD, showed poor efficacy at the TAAR1 receptor [2]. In this respect it is worth noting that the enhancement of functioning at TAAR1 seen with modafanil was not a result of a direct interaction with TAAR1 [102].
More direct evidence has been obtained recently for a role of trace amines in ADHD. Urinary PE levels have been reported to be decreased in ADHD patients in comparison to both controls and patients with autism [103-105]. Evidence for a decrease in PE levels in the brain of ADHD patients has also recently been reported [4]. In addition, decreases in the urine and plasma levels of the PE metabolite phenylacetic acid and the precursors phenylalanine and tyrosine have been reported along with decreases in plasma tyramine [103]. Following treatment with methylphenidate, patients who responded positively showed a normalization of urinary PE, whilst non-responders showed no change from baseline values [105].
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In addition to the main metabolic pathway, TAs can also be converted by nonspecific N-methyltransferase (NMT) [22] and phenylethanolamine N-methyltransferase (PNMT) [23] to the corresponding secondary amines (e.g. synephrine [14], N-methylphenylethylamine and N-methyltyramine [15]), which display similar activities on TAAR1 (TA1) as their primary amine precursors...Both dopamine and 3-methoxytyramine, which do not undergo further N-methylation, are partial agonists of TAAR1 (TA1). ...
TAARs as potential drug targets for the treatment of psychiatric disorders
The dysregulation of TA levels has been linked to several diseases, which highlights the corresponding members of the TAAR family as potential targets for drug development. In this article, we focus on the relevance of TAs and their receptors to nervous system-related disorders, namely schizophrenia and depression; however, TAs have also been linked to other diseases such as migraine, attention deficit hyperactivity disorder, substance abuse and eating disorders [7,8,36]. Clinical studies report increased β-PEA plasma levels in patients suffering from acute schizophrenia [37] and elevated urinary excretion of β-PEA in paranoid schizophrenics [38], which supports a role of TAs in schizophrenia. As a result of these studies, β-PEA has been referred to as the body's 'endogenous amphetamine' [39]
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Although the functional role of trace amines in mammals remains largely enigmatic, it has been noted that trace amine levels can be altered in various human disorders, including schizophrenia, Parkinson's disease, attention deficit hyperactivity disorder (ADHD), Tourette syndrome, and phenylketonuria (Boulton, 1980; Sandler et al., 1980). It was generally held that trace amines affect the monoamine system indirectly via interaction with plasma membrane transporters [such as plasma membrane dopamine transporter (DAT)] and vesicular storage (Premont et al., 2001; Branchek and Blackburn, 2003; Berry, 2004; Sotnikova et al., 2004). ...
Furthermore, DAT-deficient mice provide a model to investigate the inhibitory actions of amphetamines on hyperactivity, the feature of amphetamines believed to be important for their therapeutic action in ADHD (Gainetdinov et al., 1999; Gainetdinov and Caron, 2003). It should be noted also that the best-established agonist of TAAR1, β-PEA, shared the ability of amphetamine to induce inhibition of dopamine-dependent hyperactivity of DAT-KO mice (Gainetdinov et al., 1999; Sotnikova et al., 2004).
Furthermore, if TAAR1 could be proven as a mediator of some of amphetamine's actions in vivo, the development of novel TAAR1-selective agonists and antagonists could provide a new approach for the treatment of amphetamine-related conditions such as addiction and/or disorders in which amphetamine is used therapeutically. In particular, because amphetamine has remained the most effective pharmacological treatment in ADHD for many years, a potential role of TAAR1 in the mechanism of the "paradoxical" effectiveness of amphetamine in this disorder should be explored.
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If you happen to be interested in reading the full version of either paper, I can give you a download link or email you the pdf. The first one covers a lot more than just ADHD.
Best regards, Seppi333 ( Insert 2¢ | Maintained) 02:26, 25 May 2014 (UTC)
Reviews on ADHD and phenethylamine indicate that several studies have found abnormally low urinary phenethylamine content in ADHD individuals when compared with controls. [1] [2] In treatment responsive individuals, amphetamine and methylphenidate greatly increase urinary phenethylamine content. [1] [2]
References
Although we did not find a sufficient number of studies suitable for a meta-analysis of PEA and ADHD, three studies20,57,58 confirmed that urinary levels of PEA were significantly lower in patients with ADHD compared with controls. ... Administration of D-amphetamine and methylphenidate resulted in a markedly increased urinary excretion of PEA,20,60 suggesting that ADHD treatments normalize PEA levels. ...With regard to zinc supplementation, a placebo controlled trial reported that doses up to 30 mg/day of zinc were safe for at least 8 weeks, but the clinical effect was equivocal except for the finding of a 37% reduction in amphetamine optimal dose with 30 mg per day of zinc.110
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Alright, I'll work on that soon then. In any case, I know better than to cite primary sources for medical articles; I'm not sure why pubmed didn't mark it as a review, but like it's abstract states – "This review article summarizes what is known about PEA" - the paper simply reviews the existing literature on the chemistry, pharmacology, and industrial aspects of PEA. There's no original research in it. Seppi333 ( Insert 2¢ | Maintained) 22:37, 12 July 2014 (UTC)
Under Causes --> Society, should some of the content be moved to diagnosis or Society --> Controversies? For one, the section begins with "The diagnosis of ADHD," which implies information about the diagnosis rather than the cause of the actual disorder. I guess my question is, on medical/scientific pages does a "Causes" section generally contain any discussions related to the philosophical/sociological existence of a disorder or disease? Additionally is misdiagnosis ever a "cause" of a disease or disorder? Does a false positive for hepatitis mean bad diagnosis is a cause of hepatitis? — Preceding unsigned comment added by Jandjorgensen ( talk • contribs) 21:22, 12 July 2014 (UTC)
@ Jmh649: The pathophysiology section reads like there are three different explanations for ADHD. All three sections actually just represent one aspect of the same model. In a nutshell, the brain structures listed are connected via dopaminergic and noradrenergic pathways from the ventral tegmental area and locus coeruleus; activity in these pathways is directly responsible for the modulation of cognitive control (i.e., executive function) and other behaviors. Reduced brain structure volume reflects the impairments in pathway function, which in turn results in executive function impairments. I figured I should probably link the reference; these are images of the textbook: image files. This is the textbook the images are from. Seppi333 ( Insert 2¢ | Maintained) 17:03, 16 July 2014 (UTC)
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As stated previously, one line of research that seems to be ongoing is on the pathophysiology of ADHD using larger models that include more neurotransmitter pathways and therefore link to additional brain structures that appear abnormal in ADHD individuals compared to controls. [1] [2] Recent discoveries involving a group of endogenous amines present in trace quantities in the human brain, so called trace amines, has opened a new line of research on ADHD and similar neuropsychiatric disorders. Reviews on ADHD and phenethylamine indicate that several studies have found abnormally low urinary phenethylamine content in ADHD individuals when compared with controls. [3] [4] In treatment responsive individuals, amphetamine and methylphenidate greatly increase urinary phenethylamine content. [3] [4] In 2011, a medical review on trace amine-associated receptor 1 (TAAR1) determined that amphetamine and trace amines, which includes phenethylamine, activate this receptor in humans. [5] Consequently, it is now known that these two compounds produce analogous effects in the brain's dopamine pathways. [5] [6] [7] This evidence suggests that trace amines (especially phenethylamine) and their receptors may play an important role in the pathphysiology of ADHD and other neuropsychiatric disorders. [5] Future research seems to be headed in this direction, although the number of recent studies involving ADHD and phenethylamine or TAAR1 is lacking. |
Seppi333 ( Insert 2¢ | Maintained) 06:23, 17 July 2014 (UTC)
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Recent conceptualizations of ADHD have taken seriously the distributed nature of neuronal processing [10,11,35,36]. Most of the candidate networks have focused on prefrontal-striatal-cerebellar circuits, although other posterior regions are also being proposed [10].
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Although we did not find a sufficient number of studies suitable for a meta-analysis of PEA and ADHD, three studies20,57,58 confirmed that urinary levels of PEA were significantly lower in patients with ADHD compared with controls. ... Administration of D-amphetamine and methylphenidate resulted in a markedly increased urinary excretion of PEA,20,60 suggesting that ADHD treatments normalize PEA levels. ...With regard to zinc supplementation, a placebo controlled trial reported that doses up to 30 mg/day of zinc were safe for at least 8 weeks, but the clinical effect was equivocal except for the finding of a 37% reduction in amphetamine optimal dose with 30 mg per day of zinc.110
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So after doing research, and then having a thought wondering about ADHD and potassium channels, upon googling the two I found that there was indeed a subtype associated with potassium issues, and [Hypokalemic sensory overstimulation|a wikipedia article already written for it]. The fact that I haven't heard about it until now is very odd, as I have done extensive research on the subject. I strongly think it should be mentioned and linked to within this article. LiamSP ( talk) 05:09, 25 August 2014 (UTC)
The following unreferenced claims are made in the article.
For the second allegation, I found a study of TEN kids [1]. Is that generalizable to the overall population? I think not. What the study proves is that people with high IQs, HAVE ADHD.
Why is this article locked down?
ClarificationRequired ( talk) 14:58, 27 August 2014 (UTC)
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The Controversies section should be integrated into diagnosis - the biological vs psychological debate is intrinsic to understanding the controversy and discussion of it should be in the segment directly under cause. Media commentary on effectiveness on treatment could be in teatment section or otherwise relegated to daughter article. Cas Liber ( talk · contribs) 01:53, 7 October 2014 (UTC)
Hello all, I have made changes in my Sandbox about this topic focusing on evidence-based assessment and diagnosis. It would be great if people would look at it and leave comments on my talk page before I post it on the article.
The sandbox link can be found here ( /info/en/?search=User:Sdard/sandbox).
I appreciate it! YenLingChen ( talk) 20:36, 3 November 2014 (UTC)
The end of the second paragraph reads:
The condition can be difficult to tell apart from other disorders as well as that of high normal activity.
There does not appear to be a definition for "high normal activity" (or even "high normal") anywhere, and the reference cited appears to be a dead link. This sentence needs clarification; it's a potentially "loaded" statement to begin with, but the fact that it is topped off with abnormal terminology and a rotten link makes it difficult to understand what the purpose of the sentence is in the first place.
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I wish to add different medications and the symptoms and add sites that explain percentage of kids and adults who have harmful side effects or felt dramatic side effect but all in all add the list from web Md is a diagram of the most known and used maybe all the medications and there classifications along with all known general side effects
Darienwillis ( talk) 03:24, 10 December 2014 (UTC)
Ginormous wikitable
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Seppi333 ( Insert 2¢ | Maintained) 04:07, 10 December 2014 (UTC)
See parent management training for a 2011 Cochrane review, PMID 22161373. SandyGeorgia ( Talk) 01:40, 20 December 2014 (UTC)
I just read the source referenced claiming that 25 % of the people with the disorder still have it. And 75 % of the adults grow partially out of it. (in the section for adults with adhd)
Let me quote the relevant passage:
Numerous follow-up studies of children with ADHD show that the disorder persists during adolescence and adulthood in around two-thirds of individuals [3-11] either as the full blown disorder or in 'partial remission' with persistence of some symptoms associated with continued clinical and psychosocial impairments. In the meta-analysis of these data from Faraone and colleagues it was concluded that about 15% retain the full diagnosis by age 25 years, with a further 50% in partial remission [12], indicating that around two-thirds of children with ADHD continue to have impairing levels of ADHD symptoms as adults.
Although in some cases the symptoms of ADHD may appear to diminish during adolescence, this may not be the case relative to controls and does not mean that functioning is unimpaired. In a follow-up study of 119 boys of 19 years of age with childhood onset ADHD, symptom levels seemed to be lower than in childhood but 90% still did not function well [13].
We have various claims. Here, and not really clear figures. By 12, we would have only 50 % that grow partially out of it, 35 % who no longer quality, and 15 % who have the full diagnosis. That said, [12], is 2006, and pre DSM V, the criterions for adults have been lowered, for various reasons that I will not get into. (This increase the number of people who have the full diagnosis and do not quality)
Currently, I object to the precise figure, that also avoid the possibility of total remission.
I would suggest going with the figure at [12] despite my objections, since it is the only meta-analysis quoted, while the article quoted in wikipedia is only relevant for this information, in so far as it quotes other sources, and is not in itself a meta-analysis of adults having adhd.
After looking at [12], I found out that the article, "Age-dependent decline of symptoms of attention deficit hyperactivity disorder: impact of remission definition and symptom type." has 1020 citations, . Considering this is much higher than the article given. I strongly urge to consider it, rather than the currently used: European consensus statement on diagnosis and treatment of adult ADHD: The European Network Adult ADHD", that has 270 citations. The European concensus was only used to quote the other articles, including the meta-analysis, while not itself going in depth on the topic. It might also be worth digging more seriously into the meta-analysis.
Comments? Discuss? — Preceding unsigned comment added by 192.0.228.190 ( talk) 20:22, 10 March 2015 (UTC)
There has been statements saying that ADHD is fraud and was only developed to make more money for the companies and the psychiatrists that prescribe it. Read more at PBS. — Preceding unsigned comment added by 2A00:1A28:1171:9:0:0:0:1004 ( talk) 05:47, 8 April 2015 (UTC)
In the introduction, it states that the long term effects of medication are not known.
That may be true for some of the newer medicines, perhaps atomoxetine, but not all. Methylphenidate (trade names: Ritalin, Concerta and many others, inc 'generic' versions) has been in use for several decades. The evidence on both efficacy and safety for methylphenidate is considerable.
Not sure why, but I can't edit the intro, only the part following it. I hope someone who can edit it will take a moment to simply delete this sentence. The issue is too complex to cover in the intro. In stark contrast to most 'physical' health problems, there is huge controversy over the use of medicines to treat ADHD - as can be seen on numerous websites / social media forums.
This article is otherwise very good at presenting the facts in about ADHD meds impartially, despite being somewhat US-centric (NB Adderall isn't available in many countries outside the USA, inc the UK). I feel that this line in the intro does harm to the rest of the article. If it can be reworded to something more accurate, great. I see no reason not to just delete it though.
Thanks in advance for any help others can give with this. Zctyp18 ( talk) 00:29, 15 March 2015 (UTC)
... but, in humans with ADHD, pharmaceutical amphetamines appear to improve brain development and nerve growth. [1] [2] [3] Magnetic resonance imaging (MRI) studies suggest that long-term treatment with amphetamine decreases abnormalities in brain structure and function found in subjects with ADHD, and improves function in several parts of the brain, such as the right caudate nucleus of the basal ganglia. [1] [2] [3]
Reviews of clinical stimulant research have established the safety and effectiveness of long-term amphetamine use for ADHD. [4] [5] [6] Controlled trials spanning two years have demonstrated treatment effectiveness and safety. [5] [7] One review highlighted a nine-month randomized controlled trial in children with ADHD that found an average increase of 4.5 IQ points, continued increases in attention, and continued decreases in disruptive behaviors and hyperactivity. [7]
— Amphetamine#Medical
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Basal ganglia regions like the right globus pallidus, the right putamen, and the nucleus caudatus are structurally affected in children with ADHD. These changes and alterations in limbic regions like ACC and amygdala are more pronounced in non-treated populations and seem to diminish over time from child to adulthood. Treatment seems to have positive effects on brain structure.
RESULTS: The highest proportion of improved outcomes was reported with combination treatment (83% of outcomes). Among significantly improved outcomes, the largest effect sizes were found for combination treatment. The greatest improvements were associated with academic, self-esteem, or social function outcomes. A majority of outcomes improved regardless of age of treatment initiation (60%-75%) or treatment duration (62%-72%) ... CONCLUSIONS: While the majority of long-term outcomes of ADHD improve with all treatment modalities, the combination of pharmacological and non-pharmacological treatment was most consistently associated with improved long-term outcomes and large effect sizes
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Results suggest there is moderate-to-high-level evidence that combined pharmacological and behavioral interventions, and pharmacological interventions alone can be effective in managing the core ADHD symptoms and academic performance at 14 months. However, the effect size may decrease beyond this period. ... Only one paper53 examining outcomes beyond 36 months met the review criteria. ... There is high level evidence suggesting that pharmacological treatment can have a major beneficial effect on the core symptoms of ADHD (hyperactivity, inattention, and impulsivity) in approximately 80% of cases compared with placebo controls, in the short term.22
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We also have this 2011 review that states https://www.ncbi.nlm.nih.gov/pubmed/21519262 "Two peer-reviewed studies and one published report have attempted to address the issue of long-term effects of psychostimulant medication. One is favourable, one found no benefit, and the third showed harm." Doc James ( talk · contribs · email) 05:40, 15 March 2015 (UTC)
Hum per your sentence "Reviews of clinical stimulant research have established the safety and effectiveness of long-term amphetamine use for ADHD"
First ref is not RCT trial data for medications "While most included studies were observational open-label studies, in the 5 RCT studies, individuals were randomized to receive non-pharmacological treatment or no treatment: four (57%) of the 7 total outcomes were reported to improve with treatment. "
Second ref states "However, most medication trials for ADHD have been short term and thus have not provided information on the long-term outcomes of ADHD treatment. Since the medical treatment of many children with ADHD, especially those with more severe symptoms or co-morbid disorders, has to be continued for several years, recent studies have shifted their focus from the acute effectiveness of stimulants or non-stimulant drugs to the long-term outcomes of medications for ADHD. Evidence has shown that stimulants, along with the non-stimulants atomoxetine and extended-release guanfacine, are continuously effective for 24-month treatment periods with few and tolerable adverse effects"
The third ref states "This review has highlighted the paucity and limitations of the evidence investigating the long-term outcomes of recommended interventions for managing ADHD symptoms. There is little evidence to suggest that the effects observed over the relatively short term are maintained throughout longer periods of impairment."
Doc James ( talk · contribs · email) 05:53, 15 March 2015 (UTC)
This review has highlighted the paucity and limitations of the evidence investigating the long-term outcomes of recommended interventions for managing ADHD symptoms. There is little evidence to suggest that the effects observed over the relatively short term are maintained throughout longer periods of impairment.
— PMID 24082796
Results suggest there is moderate-to-high-level evidence that combined pharmacological and behavioral interventions, and pharmacological interventions alone can be effective in managing the core ADHD symptoms and academic performance at 14 months. However, the effect size may decrease beyond this period.
— PMID 24082796
There is high level evidence suggesting that pharmacological treatment can have a major beneficial effect on the core symptoms of ADHD (hyperactivity, inattention, and impulsivity) in approximately 80% of cases compared with placebo controls, in the short term.22 However, although pharmacological treatments are relatively safe, these treatments are not without adverse side-effects, such as, suppression of growth, sleep problems, tiredness, loss of appetite, stomach upset, headaches, nausea, and increases in heart rate and blood pressure.12,23–27 Nonpharmacological interventions, such as psychoeducational programs, behavioral interventions, and cognitive behavioral therapy are also recommended.28–30 Although there is moderate-to-high-level evidence that nonpharmacological interventions can be effective in managing the core ADHD symptoms, conduct disorders, social skills, self-efficacy, and emotional outcomes at 6 months follow up,28 little is known regarding the long-term effectiveness.
— PMID 24082796
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This is a comment on short term pharmacological treatment not long term. So doesn't support the text in the amphetamines article. The other refs to not claim long term effectiveness and what you have quoted here does not either. Doc James ( talk · contribs · email) 19:26, 15 March 2015 (UTC)
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Results suggest there is moderate-to-high-level evidence that combined pharmacological and behavioral interventions, and pharmacological interventions alone can be effective in managing the core ADHD symptoms and academic performance at 14 months. However, the effect size may decrease beyond this period. ... Only one paper53 examining outcomes beyond 36 months met the review criteria. ... There is high level evidence suggesting that pharmacological treatment can have a major beneficial effect on the core symptoms of ADHD (hyperactivity, inattention, and impulsivity) in approximately 80% of cases compared with placebo controls, in the short term.22
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@ Doc James: I made a few revisions to the article for language clarity, MOS compliance, and grammar... I also revised the statements concerning the "long-term" issue using similar language to your revision in the amphetamine article. I'm perfectly open to rephrasing the text I added if you'd prefer it. Seppi333 ( Insert 2¢ | Maintained) 23:12, 23 March 2015 (UTC)
CDC Apr 1st 2015 states "We do not know what the long-term effects of psychotropic medication are on the developing brains and bodies of little kids. What we do know is that behavioral therapy is safe and can have long-term positive impacts on how a child with ADHD functions at home, in school, and with friends," [3] Doc James ( talk · contribs · email) 10:45, 4 April 2015 (UTC)
With the main focus usually being on boys, the diagnosis of ADHD in girls has gone unnoticed, with the effects of the diagnosis on girls slipping under the radar. In an article by Skogli et al. (2013) [1], the researchers literally state “girls may be consistently under identified and underdiagnosed because of differences in the expression of the disorder among boys and girls”. In plain terms, the criteria for the diagnosis of ADHD does not fit the ways which most girls are socialized or how the disorder fits them specifically. There is a large amount of information in the article by Mahone and Wodka (2008) [2] about the neurological differences between boys and girls, and the effects these differences might have in the decreased representation of girls with ADHD. Rucklidge (2010) [3], mentioned the importance of changing the criteria of ADHD to better accommodate proper diagnosis of girls. Rucklidge (2010) [4], also makes a great case about how girls diagnosed with ADHD are often misunderstood. Misunderstood in this case meets multiple possibilities. Girls with ADHD are often misunderstood by their peers, teachers, parents, and even themselves. . Girls diagnosed with ADHD are commonly observed showing signs of internalization (Graetz, Sawyer, Baghurst, & Hirte, 2006) [5]. These researchers went on further to explain that the most common identifications of the internalization behaviors were depression and anxiety. An article by Becker, McBurnett, Hinshaw, and Pfiffner (2013) [6] also agreed that girls were more likely to internalize their symptoms. The article explained how girls with ADHD would report significantly higher levels of anxiety compared to boys with ADHD. One of the important topics discussed by researchers concerning the diagnosis of ADHD in girls is underdiagnoses. Waite (2007) [7] observed that the inequality of diagnosis in girls is that they do not typically show the common symptoms of ADHD, causing girls to be so frequently misdiagnosed. Researchers have discussed how the criteria for ADHD is predominantly focused on the symptoms displayed in boys (Rucklidge, 2010; Waite, 2007) [8] [9]. Researchers have also debated whether or not the criteria for ADHD should be improved to include the specific gender differences between girls and boys with ADHD. Researchers have come to the conclusion that the diagnostic criteria from ADHD should be altered based on gender and the symptoms should be lowered to adequately assist girls with ADHD (Rucklidge, 2010) [10]. Correctly diagnosing children is a hard task, so it is important to look at age-related children and comparing them that way. However, it is rather important for clinicians to most accurately diagnose children regardless of their gender. Waite (2007) [11], speaks directly to this saying, “the DSM-IV-TR criteria have a limited scope and lack of gender specificity, which precludes many women from being properly diagnosed”. Correctly diagnosing and treating girls with ADHD can lead to many positive social and personal experiences. If the correct diagnosis and treatment is not given to girls with ADHD there could be significant disabilities in the psychological functions and academic progress in girls with ADHD (Quinn, 2005) [12].
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— Preceding unsigned comment added by Aliciarj123 ( talk • contribs)
For example, PMID 21976033 is a recent review that should be/could be used for whatever text is written about ADHD in girsl, removing the need to work to sort out Alicia's sourcing. SandyGeorgia ( Talk) 17:34, 5 May 2015 (UTC)
See also: [4] SandyGeorgia ( Talk) 20:48, 4 May 2015 (UTC)
Can someone who has access to the full text incorporate something from:
This is a GA, but it's citing very old sources on gender differences. SandyGeorgia ( Talk) 17:37, 5 May 2015 (UTC)
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Those that complain of easy fatigability and physical pain many, relationship between autonomic imbalance are discussed. YTMX ( talk) 01:35, 13 August 2015 (UTC)
Hi all! I added a citation for the recent AACAP practice parameter on ADHD. Practice parameters are highly useful tools for diagnosis and treatment, and it's definitely worth mentioning in the diagnosis section. Let me know if any issues arise! — Preceding unsigned comment added by Kennyle78 ( talk • contribs) 18:43, 5 October 2015 (UTC)
In the therapy section, evidence-based practice, techniques that are supported by science, can be used to further back up the claims that behavioral therapies have been shown to give the best results when treating ADHD. " Effective Child Therapy lists behavioral treatments such as, behavioral parent training, behavioral classroom management, behavioral peer interventions, combined behavior management interventions, and organization training, as the most well-established treatments for ADHD in children. These treatments are considered to be the most efficient because they are backed up by science; these treatments are considered to be evidence-based practices." This information would give way to a great resource for parents about evidence-based practice, aka the most scientifically backed up treatments. -- Mktayloe ( talk) 22:24, 13 October 2015 (UTC)
Based on a meta analysis published on the Non-pharmacological treatments for ADHD published in the journal of attention disorders (DOI: 10.1177/1087054712444732) I recommend that in the "behavioral therapies" subsection of Management, information be added on the most efficacious non medical treatments for ADHD. The meta analysis concluded thatbehavioral management and neurofeedback training are the most effective non medical treatments for ADHD. The wiki page mention thats parent training and education have short term results, however the meta analysis concluded that there is no statistically significant benefit to these treatments. The wiki page should be updated to reflect this conclusion.
Additionally, the meta analysis concluded that behavioral treatments are generally more effective for girls.
Finally, it should be made clear in the prognosis section of this page that the combined ADHD subtype (inattentive and hyperactive) is associated with the worst outcomes in regards to non pharmacological treatment.
Jogunk07 (
talk) 16:01, 13 October 2015 (UTC)Jay 10-13-2015
g yuergtuiwerfghrgfo — Preceding unsigned comment added by 71.184.98.9 ( talk) 18:26, 21 October 2015 (UTC)
References
I have reverted the following addition as the ref does not support the changes [5] Doc James ( talk · contribs · email) 19:47, 22 November 2015 (UTC)
No sure that Tom Cruise's comments should be included on the page given that he is a well known puppet for scientology which has a confirmed bias/agenda against pharmaceuticals and would prefer that people joined their religion and be crazy there.
Neither should the rebuttal. Giving either comment gives weight to an invalid, obviously biased argument that has no place in a general media discussion. — Preceding unsigned comment added by Soulstudios ( talk • contribs) 00:25, 23 October 2015 (UTC)
... whenever I get around to it. Seppi333 ( Insert 2¢) 08:39, 18 July 2015 (UTC)
Also, possibly worth adding to the section on prognosis. A meta analysis of follow up studied on children diagnosed with ADHD found that evidence of symptoms associated with ADHD lessens with age. [1] Jogunk07 ( talk)jogunk07
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This section mentions that methylphenidate appears to improve symptoms as reported by teachers and parents. This may be true, however a recent Cochrane review suggests that methylphenidate causes an increase in sleep problems, as well as decreased appetite. This review also suggests that because of the low quality evidence, we can not be so sure of the magnitude of the effects that this medication has. [1] This is definitely something that should be added to this section. Kcwiley12 ( talk) 15:23, 5 December 2015 (UTC)
References
Adding more information regarding assessment techniques for diagnosing ADHD would be beneficial to this page. "While the DSM is the primary tool used by clinicians to diagnose ADHD, there are different assessments used, that when applied to the DSM criteria, can help determine the severity and type of ADHD an individual possesses. Examples of these assessments are the ADHD Rating Scale, the Vanderbilt ADHD Diagnostic Rating Scale, and the Swanson, Nolan and Pelham Teacher and Parent Rating Scale." These Wikipedia pages should be enough citation and resources to back up these assessment types, and this information should be included in the diagnosis section of the page.
Reference 32 seems to be outdated, or so says the site it links to. I haven't yet found the correct one, in case it was just moved or updated. -- 37.60.1.66 ( talk) 00:14, 8 December 2015 (UTC)
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I've noticed that there could be a more thorough expansion when it comes to the difference between genders and how each experience ADHD, I am partially doing this for a university project and I would like to be able to create some new sections. In Section 4 Diagnosis I would like to add three new sections the first: 4.5 Sex and ADHD, the second: 4.6 Difficulties in Diagnosing, and third: 4.7 Differences Between Sexes 4.5 Sex and ADHDAttention deficit hyperactivity disorder is a neurodevelopmental psychiatric disorder in which there are significant problems with executive functions (attentional control and inhibitory control) that cause attention deficits, hyperactivity, or impulsiveness which is not appropriate for a person's age (Attention-Deficit/Hyperactivity Disorder ADHD) [1]. Currently, most literature and research focuses on Caucasian males which indicates that data on women with ADHD, specifically women of color, has to a great extent been absent from literature and research [2]. For girls and women, ADHD is often a hidden disorder that is ignored or misdiagnosed which leads to psychological and academic impairments [3]. Because ADHD is so common (3% to 5% of school children) and chronic (lifelong in many cases), even a small proportion of females multiplied by such a large base means hundreds of thousands of girls and women are living with ADHD, a significant public health problem [4]. Minorities are often left by the wayside when it comes to diagnosing, so women of color are at even more of a disadvantage, facing both sexist and racist complications. Lack of recognition can partially be explained because the symptoms are less overt in females and partially because coexisting disorders in females are often different from those seen in males who have ADHD [5]. Clinicians are frequently challenged with disentangling the symptoms of ADHD from symptoms of coexisting conditions as well as fluctuating hormone levels which may affect symptoms and treatment in females [6]. 4.6 Difficulties in DiagnosingAs described in the book A Comprehensive guide to Attention Deficit Disorder in Adults Research, Diagnosis, and Treatment particular issues that may add to, or detract from, our ability to detect ADD in women are neurobiological, "as gender-related neurobiological tendencies may make diagnosis more difficult; they are psychological, as a woman's trend toward internalization rather than externalization and acting out makes diagnosis more complicated; they are social and cultural, as gender-related norms and expectations not only affect a woman’s own ability to recognize ADD but these stereotypes also shared by women and clinicians, as well as the different manifestations of ADD symptoms, preclude or delay the diagnosis of ADD in girls and women" [7].The recognition of attentional problems and the diagnosis of ADD in women elude clinicians partially because women often lack the typical symptoms of "hyperactivity" and "impulsivity" in childhood or adulthood, and partially because the societal constructs surrounding the way in which womens behavior is interpreted often changes the way in which certain symptoms are recognized [8]. In her book Women with Attention Deficit Disorder, Sari Solden MS, LMFT, addresses these cultural stereotypes that we have for women: “Because they are nice, quiet, or shy, they meet cultural expectations so people either don’t notice or are not as concerned with their subtle information processing problems”. Conflicting results reported in the salient literature on females diagnosed with attention deficit hyperactivity disorder gave credence to a study published in the Journal of Attention Disorders that looked at specific neuropsychological test data, assessing various aspects of attention, memory, personality adjustment, and psychiatric symptomatology [9]. The study, undertaken in an effort to illuminate the presentation of ADHD in adult women, addressed substantial evidence that suggests under diagnosis and treatment of the disorder in females and the possible, consequent negative implications for their lives [10]. Results indicate that females had higher scores on cognitive tests, greater degrees of anxiety and depression than males and because of their higher rates of depressive and anxiety symptoms they may as a group be underdiagnosed [11]. 4.7 Differences Between SexesAn NIMH conference on Sex Differences in ADHD on November 16-17, 1994, concluded that the difference between sexes may reflect either a difference in susceptibility or that women with ADHD are less likely to be diagnosed than males [12]. The Canadian Journal of Psychiatry reveals that retrospective studies, clinical studies, and epidemiologic studies show the overall rate of comorbidity among adults with ADHD is high and the studies which looked at ADHD subtypes showed females with ADHD were more likely to have depression or dysthymia (Cumyn, French, and Hechtman 675). As well the same studies found that more women with ADHD (68.18%) had current panic disorder than men (31.82%), there were more men (66.67%) with drug abuse issues than women (33.33%), 85% of women had a history of past anorexia, compared with 14.92% of men, and that 62% of women with ADHD had a history of past bulimia, compared with 12.5% of men (675). In addition, Volume 56 of the Clinical Psychology Journal (A study in Attributions and Perceptions of Childhood in Women with ADHD Symptomology) concluded that women with ADHD symptomatology had “more uncontrollable, and global attributions, reported more dissatisfaction in their childhood parent, peer, and teacher relationships, and felt less in control of negative childhood events suggesting that negative perceptions and attributions are more than reflections of current thinking and mood with symptomatology also an important risk factor for maladaptive attributions” [13]. Peer rejection increases as the behavior of ADD adolescent girls appears more divergent from an accepted standard. Men with ADD have low self-esteem as well, but this is mostly due to an inability to find steady employment and a tendency to externalize performativity issues such as achievement instead of rejection from their peers [14]. Research suggests that women are much more likely to feel shame and to be ostracized regarding impulsive actions than men because the culture in which these women participate in produces a certain humiliation that can also be procured internally [15]. Saakvitne and Pearlman in 1993 reported that generally both the media and popular culture stigmatize women who behave impulsively, while tolerating or even celebrating impulsivity as an attribute in males. Furthermore in 2012 Dr. Stephen Hinshaw, chair of the psychology department at UC Berkley published a study showing that girls with combined-type ADHD have significantly higher rates of attempted suicide and self-harm, even though 40 percent of them have outgrown their hyperactive and impulsive symptoms in adolescence [16]. I would also like to request another section 5.3 Research. 5.3 ResearchThe Child & Adolescent Disorders Research Brand of the Division of Clinical & Treatment Research of NIMH suggests that researchers focus on if the same instruments and diagnostic criteria used for males are also appropriate for females as well as how males and females with ADHD differ genetically, neurologically, physically, phenomenologically, and in treatment response [17].. ADHD is manageable with a proper diagnosis and with advances in research and advocacy a Gender-sensitive diagnosis and treatment allows clinicians to address and combat the public health concern posed by the under diagnosis of ADHD in females [18]. |
Hope Im doing this right, I'm new to this process. Please get back to me. Thanks!
Satans-doyly ( talk) 01:04, 8 December 2015 (UTC)
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Once again in Section 4 Diagnosis I would like to add three new sections the first: 4.5 Sex and ADHD, the second: 4.6 Difficulties in Diagnosing, third: 4.7 Differences Between Sexes and fourth: 5.3 Research 4.5 Sex and ADHDAttention deficit hyperactivity disorder is a neurodevelopmental psychiatric disorder in which there are significant problems with executive functions (attentional control and inhibitory control) that cause attention deficits, hyperactivity, or impulsiveness which is not appropriate for a person's age (Attention-Deficit/Hyperactivity Disorder ADHD) [1]. Currently, most literature and research focuses on Caucasian males which indicates that data on women with ADHD, specifically women of color, has to a great extent been absent from literature and research [2]. For girls and women, ADHD is often a hidden disorder that is ignored or misdiagnosed which leads to psychological and academic impairments [3]. Because ADHD is so common (3% to 5% of school children) and chronic (lifelong in many cases), even a small proportion of females multiplied by such a large base means hundreds of thousands of girls and women are living with ADHD, a significant public health problem [4]. Minorities are often left by the wayside when it comes to diagnosing, so women of color are at even more of a disadvantage, facing both sexist and racist complications. Lack of recognition can partially be explained because the symptoms are less overt in females and partially because coexisting disorders in females are often different from those seen in males who have ADHD [5]. Clinicians are frequently challenged with disentangling the symptoms of ADHD from symptoms of coexisting conditions as well as fluctuating hormone levels which may affect symptoms and treatment in females [6]. 4.6 Difficulties in DiagnosingAs described in the book A Comprehensive guide to Attention Deficit Disorder in Adults Research, Diagnosis, and Treatment particular issues that may add to, or detract from, our ability to detect ADD in women are neurobiological, "as gender-related neurobiological tendencies may make diagnosis more difficult; they are psychological, as a woman's trend toward internalization rather than externalization and acting out makes diagnosis more complicated; they are social and cultural, as gender-related norms and expectations not only affect a woman’s own ability to recognize ADD but these stereotypes also shared by women and clinicians, as well as the different manifestations of ADD symptoms, preclude or delay the diagnosis of ADD in girls and women" [7].The recognition of attentional problems and the diagnosis of ADD in women elude clinicians partially because women often lack the typical symptoms of "hyperactivity" and "impulsivity" in childhood or adulthood, and partially because the societal constructs surrounding the way in which womens behavior is interpreted often changes the way in which certain symptoms are recognized [8]. In her book Women with Attention Deficit Disorder, Sari Solden MS, LMFT, addresses these cultural stereotypes that we have for women: “Because they are nice, quiet, or shy, they meet cultural expectations so people either don’t notice or are not as concerned with their subtle information processing problems”. Conflicting results reported in the salient literature on females diagnosed with attention deficit hyperactivity disorder gave credence to a study published in the Journal of Attention Disorders that looked at specific neuropsychological test data, assessing various aspects of attention, memory, personality adjustment, and psychiatric symptomatology [9]. The study, undertaken in an effort to illuminate the presentation of ADHD in adult women, addressed substantial evidence that suggests under diagnosis and treatment of the disorder in females and the possible, consequent negative implications for their lives [10]. Results indicate that females had higher scores on cognitive tests, greater degrees of anxiety and depression than males and because of their higher rates of depressive and anxiety symptoms they may as a group be underdiagnosed [11]. 4.7 Differences Between SexesAn NIMH conference on Sex Differences in ADHD on November 16-17, 1994, concluded that the difference between sexes may reflect either a difference in susceptibility or that women with ADHD are less likely to be diagnosed than males [12]. The Canadian Journal of Psychiatry reveals that retrospective studies, clinical studies, and epidemiologic studies show the overall rate of comorbidity among adults with ADHD is high and the studies which looked at ADHD subtypes showed females with ADHD were more likely to have depression or dysthymia (Cumyn, French, and Hechtman 675). As well the same studies found that more women with ADHD (68.18%) had current panic disorder than men (31.82%), there were more men (66.67%) with drug abuse issues than women (33.33%), 85% of women had a history of past anorexia, compared with 14.92% of men, and that 62% of women with ADHD had a history of past bulimia, compared with 12.5% of men (675). In addition, Volume 56 of the Clinical Psychology Journal (A study in Attributions and Perceptions of Childhood in Women with ADHD Symptomology) concluded that women with ADHD symptomatology had “more uncontrollable, and global attributions, reported more dissatisfaction in their childhood parent, peer, and teacher relationships, and felt less in control of negative childhood events suggesting that negative perceptions and attributions are more than reflections of current thinking and mood with symptomatology also an important risk factor for maladaptive attributions” [13]. Peer rejection increases as the behavior of ADD adolescent girls appears more divergent from an accepted standard. Men with ADD have low self-esteem as well, but this is mostly due to an inability to find steady employment and a tendency to externalize performativity issues such as achievement instead of rejection from their peers [14]. Research suggests that women are much more likely to feel shame and to be ostracized regarding impulsive actions than men because the culture in which these women participate in produces a certain humiliation that can also be procured internally [15]. Saakvitne and Pearlman in 1993 reported that generally both the media and popular culture stigmatize women who behave impulsively, while tolerating or even celebrating impulsivity as an attribute in males. Furthermore in 2012 Dr. Stephen Hinshaw, chair of the psychology department at UC Berkley published a study showing that girls with combined-type ADHD have significantly higher rates of attempted suicide and self-harm, even though 40 percent of them have outgrown their hyperactive and impulsive symptoms in adolescence [16]. 5.3 ResearchThe Child & Adolescent Disorders Research Brand of the Division of Clinical & Treatment Research of NIMH suggests that researchers focus on if the same instruments and diagnostic criteria used for males are also appropriate for females as well as how males and females with ADHD differ genetically, neurologically, physically, phenomenologically, and in treatment response [17].. ADHD is manageable with a proper diagnosis and with advances in research and advocacy a Gender-sensitive diagnosis and treatment allows clinicians to address and combat the public health concern posed by the under diagnosis of ADHD in females [18]. |
Is this sufficient?
Satans-doyly ( talk) 03:57, 8 December 2015 (UTC)
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There needs to be a more thorough expansion when it comes to the difference between genders and how each experience ADHD. I have re-written each of the sections I have previously proposed and found all new sources which meet the criteria for editing medical articles. Please take another look and get back to me if need be.
In Section 4 Diagnosis I would like to add three new sections the first: 4.5 Sex and ADHD, the second: 4.6 Difficulties in diagnosing, third: 4.7 Differences between sexes and fourth: 5.3 Research.
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Sex and ADHDAttention deficit hyperactivity disorder is a neurodevelopmental psychiatric disorder in which there are significant problems with executive functions (attentional control and inhibitory control) that cause attention deficits, hyperactivity, or impulsiveness which is not appropriate for a person's age. [1] Currently, most literature and research focuses on Caucasian males which indicates that data on women with ADHD, specifically women of color, has to a great extent been absent from literature and research. [2] The risk of institutional racism is a reality within diagnosis because of the often ignored issues of gender distribution, differences in diagnosis of ethnicity, and different meanings attached to symptoms in other societies. Along with racial disparities, other factors are connected with low rates of ADHD treatment among children such as lower average expenditures delegated to special education programs in schools, education levels, poverty rates, and rural areas. [3] A study showcasing racial and ethnic disparities in ADHD diagnosis from kindergarten to eighth grade of more than 17 000 children deduced that non-white children such as African American and Hispanic populations experienced rates of ADHD that were up to 50% lower, respectively, than rates among white children. [4] Women of color within these populations are at an even more of a disadvantage, due to the focus on male symptomology. By only focusing on a certain set of cultural views, communities with differing practices and beliefs are left with a very rigid and specific perspective on childhood and its problems. [5] As well clinicians are frequently challenged with disentangling the symptoms of ADHD from symptoms of coexisting conditions coupled with fluctuating hormone levels which may affect symptoms and treatment in females. [6] However, sex differences related to comorbid psychiatric conditions that show symptoms of agitation and impulsivity overlap with ADHD in women and men. [7] But with this said, women are shown to have a higher capacity to seek treatment because they more readily 'medicalize' their symptoms. [8] At present there is a referral bias which is reflected in the lack of a difference between men and women that has resulted from the absence of data to suggest different sex-specific rates of remission. [9]
Difficulties in diagnosingAs described in the book A Comprehensive guide to Attention Deficit Disorder in Adults Research, Diagnosis, and Treatment particular issues that may add to, or detract from, our ability to detect ADD in women are neurobiological. When it comes to issues surrounding medication for women with ADHD it is frequently more complicated than for men not only because women suffer from certain comorbidities such as anxiety and depression so their treatment also has to deal with how those disorders mingle with ADHD symptoms but they are also complicated by hormone fluctuations whenever estrogen levels fall during their life span including menstrual cycles, puberty, and menopause. [10] For women with perimenopause, it's not unusual to have difficulty with word retrieval, memory and cognitive skills. [11] Pregnancy and post-partum depression along with the drastic changes in hormone levels and iron deficiency during menstruation already leads to strenuous issues with mental health before ADHD symptoms are even considered. [12] Often hormone replacement is coupled with medication. Consideration of all the aspects of a patient’s life not limited to substance abuse, and disordered eating need to be addressed to effectively treat women with ADHD. [13] Many disorders have similar symptoms and because women with ADHD have a tendency to couple these disorders with ADHD (as well as the fact ADHD tends to aggravate the symptoms of other maladities) many are mis-diagnosed. [14]. Other factors such as history of physical abuse can be prone to ADHD-like symptoms which complicates the identification of the disorder. [15]. The interplay of all of these conditions needs to be more accurately examined due to the fact that research has for too long focused only on male populations because masculine subject positions are privileged in social and educational settings which results in more interventions and special resources allocated and aimed at boys which in turn serves to perpetually re-enact male dominance within the treatment of ADHD. [16] The diagnosis of ADHD is also influenced by gender stereotypes. These gender-related norms and expectations not only affect a woman’s own ability to recognize ADD but these stereotypes are also shared by clinicians. A study which provided participants (specialists in child and adolescent mental health including social workers, child psychologists and psychiatrists) with information about the minimal and optimal behavioral symptoms to diagnosis ADHD were told to indicate which children had ADHD from a series of vignettes. [17] Approximately 20% of clinicians diagnosed ADHD when the criterion was not fulfilled. [18] Kathleen Nadeau, a clinical psychologist and director of the Chesapeake ADHD Center of Maryland in Silver Spring, explains that the societal expectations placed upon women makes dealing with their ADHD more difficult because of a continuation of traditional societal roles. [19] Many women and their families see their difficulties as merely a part of the stress of modern-day living. [20] In her book Women with Attention Deficit Disorder, Sari Solden MS, LMFT, addresses these cultural stereotypes that we have for women: “Because they are nice, quiet, or shy, they meet cultural expectations so people either don’t notice or are not as concerned with their subtle information processing problems”. Although when it comes to seeking treatment males generally combat more variables impacting their treatment seeking than females in compliance with the findings of Elias Dakwar, MD, and assistant professor of psychiatry, for Columbia University. Researchers have found that delayed treatment seeking among men is influenced by socioeconomic status, and demographic factors such as having a lower education level, having antisocial personality disorder and being African American, whereas the desire to seek treatment earlier is linked to specific psychiatric comorbidities and addiction issues such as alcohol dependence. [21] But because teachers and parents are the ones who seek treatment for ADHD children the more disruptive the behavior the more likely it is that they will notice which tends to result in more clinical attention for boys initially than girls where this behavior goes unnoticed. [22] In adolescence this starts to change possibly because of the decreased role parents and teachers have. [23]
Differences between sexesA study by David Muzina, an MD, psychiatrist and vice president of Express Scripts, a pharmacy based company, conducted research on prescription medications to treat adult attention-deficit/hyperactivity disorder and found that it increased in the United States in 2008 to 2012 by 53.4%; with 85% of that increase involving women aged 26 to 34. His study concluded that women received treatment more frequently than men because of a delay in diagnosis until adulthood and as well that women were using an unsuitable amount of stimulants possibly because of a desire to reduce appetite. [24] Whereas in childhood boys outnumber girls in the use of medications to treat ADHD by 2:1 this swaps during adulthood. [25] Women then represent a more significant proportion of adults with ADHD. [26] Patricia Quinn, director of the National Center for Gender Issues and ADHD, specifies that women often” develop strategies to hide their deficiencies, but in the process, feel ashamed and have low self-esteem”. [27] Rather than be disruptive, girls show their symptoms in a more socially acceptable way where it isn’t uncommon for them to take up extra responsibility in classroom settings as monitors or by becoming extremely social. [28] Girls are also more likely to develop anxiety due to their general need to be “people pleasers”. [29] As adults many women and in turn their families see their symptoms as simply the stress of contemporary living. [30] There is also a difference in self-reported symptoms where men focus more on stress, lacking social skills, and issues with conduct and learning. [31] Stephanie Sarkis, a psychotherapist in Boca Raton, Florida, reports that men with ADHD tend to have more substance abuse issues, discipline issues (school suspensions), car accidents, and anger/behavioral issues compared to women with ADHD. [32] Women on the other hand are concerned with dysphoria although they too have trouble with conduct problems, impulsivity, organization and attention. [33] Women project more control over external symptoms and show less cognitive challenges but report lower self-esteem and self-image issues and fewer assets than males. [34] They are also more susceptible to eating disorders, and obesity. [35] Peer rejection for girls starts early and only increases with age. [36] This ingrained and internalized low self-regard results from societal criticism of impulsive and risk taking behavior where women deal with a larger maternal criticism of ADHD behavior which is more likely to result in long-term psychological damage. [37] In corroboration with these findings, Volume 56 of the Clinical Psychology Journal (A study in Attributions and Perceptions of Childhood in Women with ADHD Symptomology) concluded that women with ADHD symptomatology had “more uncontrollable, and global attributions, reported more dissatisfaction in their childhood parent, peer, and teacher relationships, and felt less in control of negative childhood events suggesting that negative perceptions and attributions are more than reflections of current thinking and mood with symptomatology also an important risk factor for maladaptive attributions”. [38] According to the research of Anthony Rostain, a professor of psychiatry and pediatrics at the University Of Pennsylvania School Of Medicine, men are more likely to see problems in their professional lives whereas women are more likely to see their ADHD manifest as conflicts in the domestic space. [39] This can also account for the way in which women’s ADHD is sometimes overlooked until later in life, when they start to show decreased self-regulation and management. [40] The difference between gender shows clearly in the statistics illustrated by The Canadian Journal of Psychiatry which revealed that retrospective studies, clinical studies, and epidemiologic studies found that more women with ADHD (68.18%) had current panic disorder than men (31.82%), there were more men (66.67%) with drug abuse issues than women (33.33%), 85% of women had a history of past anorexia, compared with 14.92% of men, and that 62% of women with ADHD had a history of past bulimia, compared with 12.5% of men. [41] Another study in Sweden of 25, 000 individuals with ADHD showed that the risk of committing a crime decreased by 32% among men and 41% among women during treatment periods for ADHD rather than untreated periods. [42] Furthermore in 2012 Dr. Stephen Hinshaw, chair of the psychology department at UC Berkley, published a study showing that girls with combined-type ADHD have significantly higher rates of attempted suicide and self-harm, even though 40 % of them have outgrown their hyperactive and impulsive symptoms in adolescence. [43]
ResearchGender sensitive profiles and answers regarding the different ways in which ADHD manifests according to gender have been slow-moving as much still remains to be answered. [44] The Child & Adolescent Disorders Research Brand of the Division of Clinical & Treatment Research of NIMH suggests that researchers focus on how males and females with ADHD differ genetically, neurologically, physically, phenomenologically, and in treatment response. [45] The US Agency for Healthcare Research and Quality found that, particularly boys, exhibited better behavior when treated with stimulants and that women tended to engage in more emotion-oriented versus task oriented coping strategies. [46] [47] Currently the adherence to diagnostic criteria put in place limits the results of diagnosis in females to women who most resemble men with ADHD. [48] The development of more gender sensitive treatment is the only way to appropriately address the under-diagnosis of ADHD in females. [49] Screening tools and routinely incorporating questionnaires into clinician evaluations to detect ADHD among older adolescents could help combat the many adults who do not receive treatment for their symptoms. [50] There has been speculation, from such psychiatrists as Joseph Austerman, head of the Section of Child and Adolescent Psychiatry at Cleveland Clinic Children's Hospital, in Ohio, that the rise in medicating adults for ADHD signals an over-diagnosing of the adult population although it cannot be refuted that there are adults who require this medication to thrive in their private and professional lives. [51] |
Satans-doyly ( talk) 06:50, 11 December 2015 (UTC)
In reading over the information on ADHD treatments, I didn't find that there was much information on natural remedies or dietary restrictions. Here's some stuff I think would be helpful!
There is evidence supporting the use of nutritional supplements in helping to control ADHD, especially in young children. For example, supplements including omega-3 polyunsaturated fatty acid compounds and minerals have been found to improve ADHD symptoms.
While prescription drugs have been found to have positive effects on ADHD symptoms, there is also research supporting the use of nutritional supplements. While the findings have not been proven sufficient enough to draw generalized conclusions, they have shown that adding supplemental nutrients to an individual’s daily diet may indeed help with the symptoms associated with ADHD. Among the supplements tested are omega-3 fatty acid compounds (also known as fish oil), iron supplements, and zinc supplements. While these supplements have been researched, it is also important to consider the removal of certain components of a diet when treating the symptoms of ADHD. For example, because hyperactivity and issues with concentration are such a significant part of the problematic symptoms, sugar is often removed (or at least limited) when using natural remedies for such symptoms.
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-- — Preceding unsigned comment added by Cevance ( talk • contribs) 02:32, 9 March 2016 (UTC)
A systematic review in 2015 looked at four groups of studies that measured the efficiency of non-medicinal treatment strategies, resulting from modification of the behavior in children within their school environments. I'm hoping that another editor can share their thoughts on the review. Richardson M, Moore DA, Gwernan-Jones R, Thompson-Coon J, Ukoumunne O, Rogers M, et al. Non-pharmacological interventions for attention-deficit/hyperactivity disorder (ADHD) delivered in school settings: systematic reviews of quantitative and qualitative research. Health Technol Assess 2015;19(45). http://www.journalslibrary.nihr.ac.uk/__data/assets/pdf_file/0011/146684/FullReport-hta19450.pdf
I'll leave it to another editor to decide whether to add this review to the references, or perhaps to the page itself. I believe the findings would fit in the environmental section, societal section, or in a subsection about intervention therapies. I'm happy to write a section on the findings of this review; just wanted to check with the ADHD page community before possibly stepping on anyone's toes. Thanks for the feedback! Zharris24 ( talk) 05:18, 9 March 2016 (UTC)
Lancet doi:10.1016/S0140-6736(15)00238-X JFW | T@lk 23:52, 19 March 2016 (UTC)
The following were added today:
At "Causes: Environment":
An association of ADHD with gluten intolerance, both celiac disease and non-celiac gluten sensitivity, has been found. ADHD may be the only symptom of these two diseases, even in absence of gastrointestinal symptoms. [1] [2]
and later a subsection under Management "Gluten-free diet" was created: People with undiagnosed celiac disease or non-celiac gluten sensitivity may develop ADHD, which may be the only symptoms in absence of gastrointestinal complaints. Gluten-free diet often improves them. [1] [2] In one study, the majority of patients (74%) chose to continue the gluten-free diet due to significant relief of their symptoms after six months of gluten withdrawal. [1]
The Fasono source from 2015 is a) very clear about gluten-free being faddish, and b) is tentative on the gluten hypothesis: "Children with NCGS mainly have intestinal symptoms such as abdominal pain and chronic diarrhea without weight loss. Less frequently, they present with extraintestinal manifestations, including fatigue and attention-deficit disorders. Of particular interest is the relationship between NCGS and neurologic and neuropsychiatric disorders, including autism, schizophrenia, and peripheral neuropathy. However, it is not clear how gluten might contribute to these disorders." The older 2012 Jackson paper (which we don't need at all, since we have the Fasano review) is also tentative, noting " few studies have suggested that Attention Deficit Hyperactivity Disorder (ADHD) may be associated with gluten intolerance as well. A study measured ADHD symptoms in CD patients and found that these symptoms are “overrepresented” as compared to the general population. A 6-month gluten-free diet was reported to improved ADHD symptoms and the majority of patients (74%) in this report wanted to continue the gluten-free diet due to significant relief of their symptoms" And if you look at that clinical trial (
PMID
17085630) it is 10 years old, and is a single arm study of people with celiac, looking for ADHD-like symptoms. The proposed content doesn't represent the sources and additionally appears to be UNDUE to me.
Jytdog (
talk) 12:48, 24 March 2016 (UTC)
Although there is clearly a fad component to the popularity of the GFD, there is also undisputable and increasing evidence for NCGS.
Additional studies incorporating the exclusion of dietary gluten and casein in related conditions such as attention-deficit hyperactivity disorder (ADHD) have also noted positive effects on symptoms (Pelsser et al., 2011) particularly in cases of overlapping CD (Niederhofer, 2011) where both somatic and psychological presentation were affected. Combined however, such co-morbidities are not thought to be able to account for all cases of success despite no commonplace screening for such potential issues in ASCs and the possibility of non-CD mediated sensitivities (Biesiekierski et al., 2011).
Conclusions: Celiac disease is markedly overrepresented among patients presenting with ADHD. A gluten-free diet significantly improved ADHD symptoms in patients with celiac disease in this study. The results further suggest that celiac disease should be included in the ADHD symptom checklist.
Children with celiac disease can also suffer from neurological and psychological disorders, including headaches, attention-deficit/hyperactivity disorder (ADHD), learning and tic disorders, depression and anxiety, mostly before any dietary treatment [12-15].
CONCLUSION: This study suggests that the variability of neurologic disorders that occur in CD is broader than previously reported and includes "softer" and more common neurologic disorders, such as chronic headache, developmental delay, hypotonia, and learning disorders or ADHD. Future longitudinal prospective studies might better define the full range of these neurologic disorders and their clinical response to a gluten-free diet.
ELIMINATION DIETS AND HEALTH The focus of elimination diets is to remove specific foods from the diet in an effort to eliminate potential allergens that occur naturally in food (eg, eggs, wheat, dairy, soy) or artificial ingredients that may have allergenic or even toxicant effects (eg, synthetic food additives: artificial colors, flavors, sweeteners, as well as flavor enhancers [like monosodium glutamate (MSG)] and preservatives). These diets are used to attempt to diagnose and treat food allergies and intolerances. (...) When putting together both studies of restriction/elimination diets generally and studies of food color elimination specifically, effects sizes across the best studies therefore appear to range from d = 0.2 to d = 0.4 depending on study selection, with the possibility that effects are somewhat larger in children with ADHD. However, the finding of larger mean symptom changes in children with ADHD is difficult to interpret, because those children by definition have more extreme symptom scores and therefore less restriction of range in their scores in response to intervention. In addition, if food colors are not the main culprit in dietary effects, then challenge studies of food colors will underestimate the effects of an elimination diet. Carter and colleagues47 challenged children who had responded to an elimination diet with foods to identify what caused their symptoms to worsen. During these challenges, a wide range of foods provoked reactions, including typical allergenic foods (wheat, eggs, milk, cheese), chocolate, and additive-containing foods. Only a small minority of children seemed to react primarily to artificial colorings.
Recently, Sabra et al.(104) hypothesised that food allergy is the pivotal causative factor that produces lesions in the ileum that consist of enlarged lymphoid nodules containing large collections of lymphocytes in the GI lymphoid tissues adjacent to Peyer’s patches. These GI lesions would allow the entry of food antigens across the inflamed mucosa of the bowel and elicit an inflammatory response in the GI tract(104). They found LNH, reactive lymphoid follicular hyperplasia and chronic inflammation in twelve children with attention-deficit/hyperactivity disorder, autism, anorexia and/or migraine. Th1-associated cytokines were found to be decreased compared with control values, which, together with a predominance of CD4þ cells, support an immunological basis for non-IgEmediated food allergy (NFA) in this group(104). (...) Consequently, there have been many reports on the role of a GFCF diet on alleviating several symptoms of autistic individuals(19,110 – 116) (however, not all of sufficient methodological quality; see below). Significant improvements have been noted within psychological and behavioural categories in vocal and non-vocal communication, attention and concentration, episodes of aggressiveness, affection, motor skills, sleeping patterns, displaying of routines and rituals, anxiety, empathy and responses to learning(19,111,112,115,116). Moreover, reintroduction of dietary gluten elicited a worsening of behaviours in areas of hyperactivity and impulsivity, stereotyped behaviours, aggression and language and communication skills(19). A slight initial worsening in behaviour after introduction of the GFCF diet was also noted, which was suggested to be comparable with the withdrawal behaviours exhibited by opioid addicts on the removal of opioids(19). Changes in physical and physiological areas were measured in some studies as well. One patient showed abnormal peptides not found in controls, including b-casomorphin (BCM), a-gliadin, dermorphin, deltorphin I and II, and morphine-modulating neuropeptide(117). Some of these have also been observed in other studies(57,112,118).
FWIW, a positive correlation between celiac disease or gluten intolerance and ADHD could be mediated entirely at a genetic level, in which case gluten itself has nothing to do with ADHD in otherwise healthy individuals. All that association suggests is that celiac disease/gluten intolerance and ADHD are comorbid disorders. I doubt gluten itself has anything to do with ADHD pathology in individuals without a gluten sensitivity, especially because this unfiltered search returned nothing. Seppi333 ( Insert 2¢) 22:43, 24 March 2016 (UTC)
Pathogenesis. Researchers are investigating the pathogenesis of NCGS; this disorder only recently has become a subject of systematic research. Our level of knowledge about NCGS pathogenesis is comparable with what was known about celiac disease more than 20 years ago. Gluten is the undisputable cause of celiac disease and therefore it was assumed that the same applied to NCGS. However, besides gluten, wheat, barley, rye, and their derivatives contain other components that induce symptoms, including amylasetrypsin inhibitors (ATIs) and FODMAPs. FODMAPs cause mild wheat intolerance at most, limited to intestinal symptoms, so we can exclude them from further discussion in the context of NCGS. Patients with NCGS resolve symptoms after they eliminate glutencontaining grains, despite continuing to ingest FODMAPs from other sources. Children with NCGS mainly have intestinal symptoms such as abdominal pain and chronic diarrhea without weight loss. Less frequently, they present with extraintestinal manifestations, including fatigue and attention-deficit disorders.25 Of particular interest is the relationship between NCGS and neurologic and neuropsychiatric disorders, including autism, schizophrenia, and peripheral neuropathy.26–28 However, it is not clear how gluten might contribute to these disorders. (...) more evidence is needed about the mechanisms leading to the improvement of diseases affecting the nervous system as well as other organs after dietary elimination of gluten or nongluten proteins. (...) there is growing evidence that other proteins that are unique to gluten-containing cereals can elicit an innate immune response that leads to NCGS, raising a nomenclature issue. For this reason, wheat sensitivity, rather than gluten sensitivity, seems to be a more appropriate term, keeping in mind that other gluten-containing grains such as barley and rye also can trigger the symptoms.
ATIs are plant-derived proteins that inhibit enzymes of common parasites, such as mealworms and mealbugs, in wheat. (...) Studies of biopsy specimens from patients with celiac disease showed that ATIs increase the gluten-specific T-cell response.49 Therefore, ATIs could be the long-sought inducers of innate immunity in patients with celiac disease or NCGS. Importantly, ATIs are present in commercial gluten and resist proteolytic digestion, such as by the gastric and enteric proteases pepsin and trypsin, maintaining the ability to activate TLR4 throughout oral ingestion and intestinal passage. (...) ATI species, approximately 120–150 amino acids long, in modern wheat, with a variant primary sequence but a conserved secondary structure.51
The conclusions of this source are: "The literature clearly demonstrates that a minority of children with ADHD will benefit from an elimination diet. Research funders, scientists, and clinicians would do well to re-invigorate investigation of this intervention, while avoiding both excessive skepticism (clearly, it may work for some), and excess optimism (it probably only works for a minority) ... dietary intervention for ADHD was abandoned too quickly in North America. Although it is likely that only a minority of children with ADHD will respond to dietary intervention, the evidence persistently suggests that for some children such intervention can be quite effective. ". Diets are not profitable for pharmaceutical companies....
I did not say that a gluten-free diet may work for everyone, just for one subgroup (people with CD or NCGS), and it is documented although they are few studies (dietary intervention for ADHD was abandoned too quickly...). And I repeat: this minority of people who develop ADHD symptoms because of celiac disease / non-celiac gluten sensitivity have no right to cure or improve, or to know this information...? Are "minorities" have no right?
Elimination diets reinforce the idea that wheat ("gluten and ATIs") may be involved. Also, very often in gluten-free diet is not enough to remove only gluten, more food must be removed, especially in cases with long delays in diagnosis (which is usual, there often are delays of many years, including children). Intestinal permeability and mucosal damage caused by gluten are responsible for the appearance of more food allergies and intolerances, which are often reversible after months or years of strict GFD, and avoidable with an early diagnosis. But researchers are badly lost and disoriented, generally uninterested or they do not get money to fund the studies (diets are not profitable for pharmaceutical companies).
Authors of this paper PMID 25220094, when summarizing the results, talk about of all elimination diets in general terms.
The focus of elimination diets is to remove specific foods from the diet in an effort to eliminate potential allergens that occur naturally in food (eg, eggs, wheat, dairy, soy) or artificial ingredients that may have allergenic or even toxicant effects (eg, synthetic food additives: artificial colors, flavors, sweeteners, as well as flavor enhancers [like monosodium glutamate (MSG)] and preservatives). These diets are used to attempt to diagnose and treat food allergies and intolerances.
Food elimination diets vary in their specific content, but take 3 main forms. A single food exclusion diet excludes one suspected food, such as eggs. A multifood exclusion diet, such as the 6-food elimination diet, eliminates the most common food allergens: cow-milk protein, soy, wheat, eggs, peanuts, and seafood. A “few foods diet” (also called an oligoantigenic diet) restricts a person’s diet to only a few less commonly consumed foods (eg, lamb/venison, quinoa/rice, pear, and others with low allergenic potential). (...)
Other specific elimination diets exist, such as a gluten-free diet and the Kaiser Per-manente (or Feingold) diet. The gluten-free diet is currently the only successful treatment for patients with celiac disease15 and is also being used to treat nonceliac gluten sensitivity.16 Gluten is the protein found in wheat, rye, and barley, and thus, any item in the diet containing these grains (including some food additives) must be removed. A gluten and casein-free diet is also being tested in autism.17 (...)
Overall, for children presenting for ADHD treatment with no obvious gastrointestinal symptoms or strong prior evidence of a dietary effect, a strict elimination diet may have a 10% to 30% chance of providing a true effect detectable on a double-blind measurement, but this estimate is limited by very small samples and widely varying methods. The best estimate on the small literature is about a 25% rate of at least some symptom improvement. For some children, perhaps a minority of 10% of children with ADHD, response can include a full remission of symptoms equivalent to a successful medication trial. In short, the literature suggests that an elimination diet should be considered a possible treatment for ADHD, but one that will work partially or fully, and only in a potentially small subset of children. (...)
With that said, (1) many parents remain interested in dietary intervention, (2) the literature suggests that some children may benefit (a trial is not senseless), and (3), clinicians need some idea what the family would be getting into if they attempt a restriction diet. Therefore, a brief presentation of clinical considerations if such an intervention is going to be pursued follows. (...)
A major recommendation coming out of this review, echoing prior reviews (see Table 1), is that dietary intervention for ADHD was abandoned too quickly in North America. Although it is likely that only a minority of children with ADHD will respond to dietary intervention, the evidence persistently suggests that for some children such intervention can be quite effective. Thus, where should the field go to develop and realize this possibility? Several additional future study and design considerations and suggestions were offered by Stevenson and colleagues.46 The present authors highlight selected recommendations of their own here.
Best regards. -- BallenaBlanca ( talk) 11:05, 25 March 2016 (UTC)
Ref says "an elimination diet produces a small but reliable aggregate effect" [6] The ref comments on celiacs but makes no claim that it improves ADHD symptoms I agree. Doc James ( talk · contribs · email) 09:57, 26 March 2016 (UTC)
Attention Deficit-Hyperactivity Disorder (ADHD). A few studies have suggested that Attention Deficit Hyperactivity Disorder (ADHD) may be associated with gluten intolerance as well. A study measured ADHD symptoms in CD patients and found that these symptoms are “overrepresented” as compared to the general population. A 6-month gluten-free diet was reported to improved ADHD symptoms and the majority of patients (74%) in this report wanted to continue the gluten-free diet due to significant relief of their symptoms
People with symptoms of any mental health problem should always see their PCP to rule out likely physical ailments first. Celiacs is not unique in having some overlapping symptoms with ADHD and it's far from the most common. It not in the top 5. This reads like doctors have no idea ADHD symptoms could be caused by something else. We can't/shouldn't attempt to address every other issue that might present like ADHD and if we're going to mention some things that should be ruled out first, it should be the most common: seasonal allergies, asthma hearing or vision disorders, anemia, hashimotos/thyroid issues, tonsil/adenoid issues, sleep apnea and other sleep disorders, brain injury, elevated lead levels... [3] [4] and that's not even mentioning things like learning disabilities, other mental illnesses, and having crappy parents. If your pediatrician isn't ruling out other likely possibilities before officially diagnosing your kid with anything, you need a new pediatrician. As far as celiacs goes, it would encompassed with due weight in sentence like, "doctors should always rule out potential physiological explanations for attentional issues as part of a thorough ADHD evaluation." More sources talking about common things to rule out in patients with ADHD symptoms that don't mention celiacs: [5] [6] [7] [8] [9] PermStrump (talk) 15:02, 14 April 2016 (UTC)
References
The diseases significantly associated with patients with ADHD compared with the control group were the following: allergic diseases (asthma 25% vs. 18%, allergic rhinitis 41% vs. 30%, atopic dermatitis 18% vs. 13%, and urticaria 8% vs. 6%), autoimmune diseases (ankylosing spondylitis 0.1% vs. 0%, odds ratio [OR] 2.78; ulcerative colitis 0.2% vs. 0.1%, OR 2.31; autoimmune thyroid disease 2.1% vs. 0.8%, OR 2.53); and psychiatric disorders (depressive disorders 5.5% vs. 0.5%; anxiety disorders 15% vs. 0.4%). In contrast, Crohn's disease, celiac disease, and type 1 diabetes mellitus did not show any significant correlations with ADHD.
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Attention deficit hyperactivity disorder is a heterogeneous behavioral disorder with several possible etiologies. Environmental and central nervous system insult, such as head trauma, exposure to lead, cigarette exposure,and low-birth weight (less than 1,000 grams) are thought to be a possible cause... Some common problems in the pediatric population that can cause ADHD-like symptoms include anemia, lead toxicity, thyroid problems, learning disabilities, uncorrected hearing or vision problems, substance abuse, depression, anxiety, bipolar disorder, and anxiety disorders. The target symptoms for each patient should be carefully documented for proper diagnosis and treatment.
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I've just full-protected this page for 24 hours to prevent edit-warring and allow discussion to take place. I am happy for any admin to unprotect if they feel the problem has resolved. Cas Liber ( talk · contribs) 00:33, 25 March 2016 (UTC)
@ Doc James: Why did you remove the statements about problems with executive functions in the lead a while back? Seppi333 ( Insert 2¢) 10:43, 29 March 2016 (UTC)
Attention deficit hyperactivity disorder (ADHD, similar to hyperkinetic disorder in the ICD-10) is a neurodevelopmental psychiatric disorder in which there aresignificantproblems with executive functions(e.g., attentional control and inhibitory control)that cause attention deficits, hyperactivity, or impulsiveness which is not appropriate for a person's age.
No, it's my way of acknowledging "I have heard what you said." Arbitrarily adding it back into the lead instead of having a discussion is just me reflecting your behavior at MDMA in this article. FWIW, it also irritates me that instead of having a discussion on the talk page and arriving at some form of compromise version that suits both of us, you decide on an RFC to go with one version or the other when we have content disputes. Seppi333 ( Insert 2¢) 12:43, 7 April 2016 (UTC)
This is a fairly moot issue because I'm not disputing the removal; I don't really care if it's in the lead or not. Nonetheless, ignoring any evidence supporting the characterization, the "AD" in ADHD is nominally an EF disorder. It's not essential to mention this in order to describe ADHD, I agree, but it is for any body of text that gives any serious weight to the pathophysiology of the disorder. The lead of this article is not such a body of text. Seppi333 ( Insert 2¢) 20:25, 8 April 2016 (UTC)
References
Brown-2008
was invoked but never defined (see the
help page).Malenka pathways
was invoked but never defined (see the
help page).Malenka ADHD neurosci
was invoked but never defined (see the
help page).We have had in the article for some time that ADHD is both a mental disorder and a neurodevelopmental disorder. Not sure why there are attempts to remove that it is a mental disorder. [11]. All the main listing in the DSM5 are mental disorders / psychiatric disorders. We all agree that it is also a neurodevelopmental disorder.
Doc James ( talk · contribs · email) 06:11, 10 April 2016 (UTC)
In the section on managing ADHD symptoms with
diet, a
literature review by Ertürk et al. (2016) is used to support this statement: "A 2016 review states that evidence does not support a clear link between celiac disease and ADHD, and that routine screening for celiac disease in people with ADHD and the use of a gluten-free diet are discouraged. However, untreated celiac disease, which often present with mild or even absent gastrointestinal complaints, could predispose to ADHD symptoms, especially those of inattentive type, which may be improved with a gluten-free diet."
[1] Now that I've had a chance to thoroughly read the paper, I don't think it's a reliable source for this statement. My issue is with the second sentence, because it was easy to find alternate sources to the support the first sentence alone, like Sethi and Hughes (2015).
[2] My issue with Ertürk et al.'s paper is that they contradict themselves in several locations and their conclusions are not supported by actual findings. Only 3 of the 8 studies they found a positive correlation between ADHD and celiacs and only 2 of those studies (both with the same lead author - Niederhofer) "showed" a decrease in ADHD-like symptoms after starting a GFD. All 3 were "low quality" with "very poor internal validity and small sample sizes" according to Sethi and Hughes.
[2]
Quotes from sources
|
---|
For context, in Feb 2016, Ertürk et al. did a lit review of all of the trials ever published on ADHD and celiacs and they found 8 that discussed a possible association between CD and ADHD:
After reviewing those 8 studies, these were their findings:
*Note Ertürk et al. didn't even mention if the 3 studies that showed a positive correlation between ADHD and celiacs found that GFD improved symptoms. In fact, Zelnik et al. explicitly found the opposite. According to other reliable sources, there's so much bias in the Niederhofer studies that they don't count. [2] Yet, somehow Ertürk et al. came to the conclusion that:
*Note that neither of the 2 studies cited in the conclusion were one of the 8 analyzed for the lit review. And if you look at those two studies, they don't support this statement. Lichtwak et al. (2014) [3] weren't explicitly measuring ADHD or inattention symptoms, Lichtwak and all of the co-authors noted massive conflicts of interest, and their study was heavily criticized for bias and poor design by Lebwohl et al. (2014) for additional reasons. [4] Terrone et al. (2013) [5] also weren't testing for tru ADHD, just "inattention" in combination with other mental health issues like depression, anxiety, oppositional behavior, etc., and they were really vague about what inattention symptoms were reported and didn't show the before and after data. There's a reason they weren't included in Erturk or Sethi and Hughes lit reviews, so it's pretty shady for Erturk to turn around and act like those studies support their hypothesis when the actual studies they analyzed didn't. Sethi and Hughes (2015) [2] also did a lit review of the published studies on celiacs and ADHD. They found 8 studies (with only one difference from Erturk - Chen et al. instead of Pynnönen et al.):
This is what Sethi and Hughes found:
|
More importantly, beginning a gluten-free diet with out concrete biological markers for celiacs is contraindicated, so there's absolutely no reason we should be suggesting it might help ADHD symptoms. That suggestions should only come from their doctor after definitive diagnosis of celiacs.
I propose this change: "A 2015 review states that evidence does not support a clear link between celiac disease and ADHD, and that routine screening for celiac disease in people with ADHD and the use of a gluten-free diet are discouraged." [2] Another alternative would be not mentioning celiacs at all, which is my #1 preference. PermStrump (talk) 03:54, 15 April 2016 (UTC)
"Nobody is recommending to start a gluten-free diet without a diagnosis of CD. "Untreated CD" means by both CD diagnosed patients with lack of compliance with the diet and undiagnosed patients prior to CD diagnosis."That's what the article currently sounds like it's saying. PermStrump (talk) 07:55, 15 April 2016 (UTC)
References
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A serious issue, related to the small sample size, is the relative lack of variability in clinical, serological and histological outcomes. Every one of these subjects (100%) was found to have excellent adherence to the gluten-free diet, and nine of 10 had Marsh 0 or 1 findings on follow-up biopsy at 52 weeks, rates of healing far greater than typically seen among groups of patients with CD. It is therefore difficult to know whether improvements in these cognitive tests reflect the gluten-free diet as nearly everyone healed, and there was not a control arm. Supporting the notion that this is a selected population was the exclusion of more than 30% of the enrolled participants (5/16). It is premature to conclude that these results characterise the precise cognitive deficit in CD, as the statistical testing in this study did not account for multiple comparisons and there was not a specific pre-specified outcome.
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Erturk
was invoked but never defined (see the
help page).