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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... [2] [3] 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: [4] [5] [6] [7] [8] PermStrump (talk) 15:02, 14 April 2016 (UTC)
Quotation from Ertürk et al.: (Edited to fix layout and create a box)
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References
JacksonEaton2012
was invoked but never defined (see the
help page).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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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:
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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).In this edit, Jytdog said “use most recent review”, and he removed the conclusions of 2013 source, but also removed the most recent (of 2014).
I will rescue 2014 conclusions from the text worded by Doc James in this review [10] to adjust and let the most recent review about elimination diets (which they are not synonymous of gluten-free diet, they are a broader term) as Jytdog propose. Nevertheless, it seems that is better not to remove the conclusions of the other review of 2013, to refflect the controversies and give the reader all views and what has been written on the subject.
Let's see what Doc James and other users think.
Best regards. -- BallenaBlanca ( talk) 12:20, 16 April 2016 (UTC)
Tentative evidence supports free fatty acid supplementation and reduced exposure to food coloring.[157] However, these benefits may be limited to children with food sensitivities or those who are simultaneously being treated with ADHD medications.[157] A 2014 review states that an elimination diet could be an effective treatment in a small number of children with ADHD.[90] A 2013 review however did not support an elimination diet.[157]
Jytdog, you said that you have removed "However, untreated celiac disease could predispose to ADHD-like symptoms that may see some improvement with treatment with a gluten-free diet" because of:
“b) as the previous sentence just said, there is no call to screen everyone with ADHD for coeliac but this sentence implies that we should do.” Includin the sentence that you have deleted is not WP:UNDUE, on the contrary saying “A 2016 review did not support a clear link between celiac disease and ADHD, and stated that routine screening for celiac disease in people with ADHD and the use of a gluten-free diet as standard ADHD treatment are discouraged.[158]” and hiding “untreated celiac disease could predispose to ADHD-like symptoms that may see some improvement with treatment with a gluten-free diet"” may be cherry picking or quote mining: you are ignoring the rest of the article, ignoring “those that moderate the original quote” (and you have also deleted previous conversations of this talk page, in which I showed the context of conclusions). I write again:
Ertürk et al. say:
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“Clinical Implications. Up till now, there is no conclusive evidence for a relationship between ADHD and CD. Therefore, it is not advised to perform routine screening of CD when assessing ADHD (and vice versa) or to implement GFD as a standard treatment in ADHD. Nevertheless, the possibility of untreated CD predisposing to ADHD-like behavior should be kept in mind. Therefore, it is recommended for clinicians to assess a broad range of physical symptoms, in addition to typical neuropsychiatric symptoms, when evaluating patients with ADHD.” "Untreated, CD has a wide range of clinical presentations. The “classical CD type” presents with mostly gastrointestinal symptoms such as abdominal pain, distension, chronic diarrhea, or failure to thrive. The “non-classic CD type” is characterized by fewer or no gastrointestinal symptoms and presents with extra-intestinal manifestations, such as neurologic, dermatologic, hematologic, endocrinologic, reproductive, renal, psychiatric, skeletal, and liver involvement (Celiloğlu, Karabiber, & Selimoğlu, 2011). The “asymptomatic or silent CD type” can present with no clinical symptoms and only positive serology (Bai et al., 2013)." “In children with CD, however, the risk of developing neuropsychiatric disturbances is only 2.6% (compared with 26% in adults; Ruggieri et al., 2008). This discrepancy may be due to shorter disease duration in children, earlier elimination of gluten from the diet, stricter adherence to a diet, or a different susceptibility to immune-mediated disorders” “Based on this review, there is no conclusive evidence for a relationship between ADHD and CD. However, attention difficulties, distractibility, chronic fatigue, and headache have been observed in patients with CD, especially prior to treatment or when noncompliant to GFD … Thus, it is posible that in untreated patients with CD, neurologic symptoms such as chronic fatigue, inattention, pain, and headache could predispose patients to ADHD-like behavior (mainly symptoms of inattentive type), which may be alleviated after GFD treatment.” "Possible Mechanisms" “Possible mechanisms underpinning the relation between attention/learning problems and CD point to accumulative effects of multiple effects, including both nutritional and immunologic/inflammatory factors. However, more indirect factors, related to nonspecific effects of chronic disease, cannot be ruled out (Zelnik et al., 2004). With respect to nutritional factors, micronutrient deficiencies and anemia are frequently seen in untreated patients with CD (Kupper, 2005; Wierdsma, van Bokhorst-de van der Schueren, Berkenpas, Mulder, & van Bodegraven, 2013). These factors may also play a role in causing ADHD-like behavior. However, when studying iron and zinc deficiencies in patients with ADHD, results remained inconclusive and needed further elaboration (for a review, see Millichap & Yee, 2012). There is emerging evidence that immunological mechanisms may contribute to ADHD development and manifestation (Verlaet, Noriega, Hermans, & Savelkoul, 2014). CD may induce an immune dysregulation in the gut, leading to chronic inflammation, which on its turn may be the cause for developing ADHD-like symptoms (Esparham, Evans, Wagner, & Drisko, 2014). Studies on the brain level point to the possible implication of serotonergic dysfunction in developing neuropsychiatric disorders in CD. More specifically, these studies refer to an impaired availability of tryptophan and decreased serotonin and dopamine metabolite concentrations (Hernanz & Polanco, 1991; Jackson et al., 2012; Pynnönen et al., 2005). Neuroimaging studies show structural and functional brain deficits in adult patients with CD. Structural deficits include bilateral decrease in cortical gray matter and caudate nuclei volumes (Bilgic et al., 2013), bilateral decrease in cerebellar gray matter, and smaller volume in multiple cortical regions (Currie et al., 2012). Functional deficits include a hypoperfusion of cerebral regions, primarily in the frontal cortex in untreated adult patients with CD, but not in treated patients (Addolorato et al., 2004; Usai et al., 2004). Such brain abnormalities may induce problems in high-cognitive functions such as attention span. Further research is however needed to confirm this hypothesis. To our knowledge, there are no studies on structural and functional brain deficits in pediatric patients with CD. A final hypothesis relates to increased oxidative stress that has been described in both ADHD (Lopresti, 2015) and CD (Stojiljković et al., 2009). Therefore, oxidative stress may represent a possible mediator in the development of ADHDlike behavior in CD patients. However, it remains uncertain whether oxidative stress itself contributes to the development or exacerbation of ADHD symptoms or whether it is the result of environmental factors (Lopresti, 2015). Further empirical studies are needed to understand the mechanisms underlying the potential association between ADHD, ADHD-like behavior, and CD.” |
a) obvious that treating anyone who has an undiagnosed condition makes them better; This is an ambiguous, simplistic and non specific reasoning. We are talking about ADHD, you must focus on ADHD. If we give treatment and cure sore throat, sinusitis, flu... in a person with ADHD, he/she will obviously feel better, but that will not take away the symptoms of ADHD. ADHD symptoms will only improve if we treat a medical condition which may cause in some people ADHD symptoms, as hyperthyroidism, sleep apnea, drug interactions, etc. And as we see above, Ertürk et al. after review the literature state that several studies show that ADHD symptoms in some people with ADHD and CD improve with a gluten-free diet (which is not the same as “makes them better”) and list the current hypothesis for this causative effect.
Also, if you are so kind, I'd like you to explain me what is the criteria that you apply to "remove excess quotation" (one quotation that talks about eliminations diets, and other one with the conclusions of the systematic review about ADHD on CD people, and the effect of gluten-free diet in undiagnosed CD people with ADHD, extracted because this is a non free-access paper) and " remove quotation clutter from ref. makes editing way harder than it needs to be)" (removing again the quotation talking about the conclusions of the systematic review about ADHD on CD people, and the effect of gluten-free diet in undiagnosed CD people with ADHD), and you consider, however, that these others 13 quotations can remain:
Best regards. -- BallenaBlanca ( talk) 06:32, 17 April 2016 (UTC)
Some of these sources were reviews. This edit also changed 75% from genetics to 5%? [15] Doc James ( talk · contribs · email) 18:03, 17 April 2016 (UTC)
As ADHD is common, natural selection likely favored the traits, at least individually, and they may have provided a survival advantage. [1] For example, some women may be more attracted to males who are risk takers, increasing the frequency of genes that predispose to ADHD in the gene pool. [2] As it is more common in children of anxious or stressed mothers, some argue that ADHD is an adaptation that helps children face a stressful or dangerous environment with, for example, increased impulsivity and exploratory behavior. [3]
Looking at the sources:
Doc James ( talk · contribs · email) 14:08, 20 April 2016 (UTC)
unreadable and almost all OFFTOPIC; please feel free to restate concisely, focused on article content |
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The following discussion has been closed. Please do not modify it. |
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I apologize for my previous message, Garzfoth. It was inappropriate nor are ways to argue.
I've gotten the full texts and I read the chain of cited articles. Now I understand what you meant, I had not understood well it before, sorry. I agree.
Well, I will accept your edit, it's clear that the issue was where to include "untreated celiac disease" and that we all accept to include it into Differential diagnosis section. I will add a quotation, because it is not a free access text, and thus avoid future problems or doubts when other editors review the page, and for my part, we can leave this issue closed.
Best regards. -- BallenaBlanca ( talk) 04:33, 26 April 2016 (UTC)
References
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pmid=16849269
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Just because we have the DSM5 does not mean every bit of research based on the DSM4 is all of a sudden obsolete. Doc James ( talk · contribs · email) 17:51, 17 April 2016 (UTC)
Merge /info/en/?search=Hyperkinetic_disorder into ADHD, it's listed as a synonym and the ICD 10 code is F90 which is the same ICD 10 code listed on the ADHD page. — Preceding unsigned comment added by Throwawaysomyipdoesntshowup ( talk • contribs) 14:56, 3 July 2016 (UTC)
Currently, this is how the last half of the section on genetic causes reads:
Several authors have hypothesized that evolution may have played a role in the prevalence of ADHD, particularly hyperactive and impulsive traits in males.[74] Jonathan Williams and Eric Taylor (2006) hypothesized that some women may be more attracted to males who are risk takers, increasing the frequency of genes that predispose to hyperactivity and impulsivity in the gene pool.[75] According to psychobiologist Vivette Glover, some authors have claimed that these traits may be an adaptation that helped males face stressful or dangerous environment with, for example, increased impulsivity and exploratory behavior.[74][75] Others have argued that in certain situations, ADHD traits may have been beneficial to society as a whole even while being harmful to the individual.[74][75][76] According to Esther Cardo and colleagues (2010), the high prevalence and heterogeneity of ADHD may have increased reproductive fitness and benefited society by adding diversity to the gene pool despite being detrimental to the individual.[76] Walter Adriani and colleagues (2012) hypothesized that in certain environments, some ADHD traits may have offered personal advantages to individuals, such as quicker response to predators or superior hunting skills.[77]
People with Down syndrome are more likely to have ADHD.[78]
The sentence about Down syndrome seems really out of place, but I'm not sure where it fits better or if it's worth keeping and I'd be interested in hearing other opinions. IMO the amount of space given to evopsych hypotheses that are unlikely to be tested is WP:UNDUE. I suggest reducing the text to:
My reasoning is that reference [74] ( PMID 21250994) is a review and the hypotheses that I didn't strike out were mentioned in the review, whereas the others come from primary sources. Thoughts? —PermStrump (talk) 22:33, 24 July 2016 (UTC)
No idea why this ref about COPD was added "Switzerland strongly limits the authorised medications, [1]"? Doc James ( talk · contribs · email) 01:45, 28 July 2016 (UTC)
References
Garzfoth Hello. You reverted here. [33] Could you please explain then in what cases the cause is known and where in that source it states that? Charlotte135 ( talk) 00:56, 26 July 2016 (UTC)
Current: "Despite being the most commonly studied and diagnosed mental disorder in children and adolescents, the cause is unknown in the majority of cases."
Compromise: "Despite being the most commonly studied and diagnosed mental disorder in children and adolescents, the immediate cause is unknown."
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 23 | Archive 24 | Archive 25 | Archive 26 | Archive 27 | Archive 28 |
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... [2] [3] 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: [4] [5] [6] [7] [8] PermStrump (talk) 15:02, 14 April 2016 (UTC)
Quotation from Ertürk et al.: (Edited to fix layout and create a box)
|
---|
|
References
JacksonEaton2012
was invoked but never defined (see the
help page).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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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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citation}}
: Explicit use of et al. in: |last=
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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.
{{
citation}}
: Explicit use of et al. in: |last=
(
help)
Erturk
was invoked but never defined (see the
help page).In this edit, Jytdog said “use most recent review”, and he removed the conclusions of 2013 source, but also removed the most recent (of 2014).
I will rescue 2014 conclusions from the text worded by Doc James in this review [10] to adjust and let the most recent review about elimination diets (which they are not synonymous of gluten-free diet, they are a broader term) as Jytdog propose. Nevertheless, it seems that is better not to remove the conclusions of the other review of 2013, to refflect the controversies and give the reader all views and what has been written on the subject.
Let's see what Doc James and other users think.
Best regards. -- BallenaBlanca ( talk) 12:20, 16 April 2016 (UTC)
Tentative evidence supports free fatty acid supplementation and reduced exposure to food coloring.[157] However, these benefits may be limited to children with food sensitivities or those who are simultaneously being treated with ADHD medications.[157] A 2014 review states that an elimination diet could be an effective treatment in a small number of children with ADHD.[90] A 2013 review however did not support an elimination diet.[157]
Jytdog, you said that you have removed "However, untreated celiac disease could predispose to ADHD-like symptoms that may see some improvement with treatment with a gluten-free diet" because of:
“b) as the previous sentence just said, there is no call to screen everyone with ADHD for coeliac but this sentence implies that we should do.” Includin the sentence that you have deleted is not WP:UNDUE, on the contrary saying “A 2016 review did not support a clear link between celiac disease and ADHD, and stated that routine screening for celiac disease in people with ADHD and the use of a gluten-free diet as standard ADHD treatment are discouraged.[158]” and hiding “untreated celiac disease could predispose to ADHD-like symptoms that may see some improvement with treatment with a gluten-free diet"” may be cherry picking or quote mining: you are ignoring the rest of the article, ignoring “those that moderate the original quote” (and you have also deleted previous conversations of this talk page, in which I showed the context of conclusions). I write again:
Ertürk et al. say:
|
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“Clinical Implications. Up till now, there is no conclusive evidence for a relationship between ADHD and CD. Therefore, it is not advised to perform routine screening of CD when assessing ADHD (and vice versa) or to implement GFD as a standard treatment in ADHD. Nevertheless, the possibility of untreated CD predisposing to ADHD-like behavior should be kept in mind. Therefore, it is recommended for clinicians to assess a broad range of physical symptoms, in addition to typical neuropsychiatric symptoms, when evaluating patients with ADHD.” "Untreated, CD has a wide range of clinical presentations. The “classical CD type” presents with mostly gastrointestinal symptoms such as abdominal pain, distension, chronic diarrhea, or failure to thrive. The “non-classic CD type” is characterized by fewer or no gastrointestinal symptoms and presents with extra-intestinal manifestations, such as neurologic, dermatologic, hematologic, endocrinologic, reproductive, renal, psychiatric, skeletal, and liver involvement (Celiloğlu, Karabiber, & Selimoğlu, 2011). The “asymptomatic or silent CD type” can present with no clinical symptoms and only positive serology (Bai et al., 2013)." “In children with CD, however, the risk of developing neuropsychiatric disturbances is only 2.6% (compared with 26% in adults; Ruggieri et al., 2008). This discrepancy may be due to shorter disease duration in children, earlier elimination of gluten from the diet, stricter adherence to a diet, or a different susceptibility to immune-mediated disorders” “Based on this review, there is no conclusive evidence for a relationship between ADHD and CD. However, attention difficulties, distractibility, chronic fatigue, and headache have been observed in patients with CD, especially prior to treatment or when noncompliant to GFD … Thus, it is posible that in untreated patients with CD, neurologic symptoms such as chronic fatigue, inattention, pain, and headache could predispose patients to ADHD-like behavior (mainly symptoms of inattentive type), which may be alleviated after GFD treatment.” "Possible Mechanisms" “Possible mechanisms underpinning the relation between attention/learning problems and CD point to accumulative effects of multiple effects, including both nutritional and immunologic/inflammatory factors. However, more indirect factors, related to nonspecific effects of chronic disease, cannot be ruled out (Zelnik et al., 2004). With respect to nutritional factors, micronutrient deficiencies and anemia are frequently seen in untreated patients with CD (Kupper, 2005; Wierdsma, van Bokhorst-de van der Schueren, Berkenpas, Mulder, & van Bodegraven, 2013). These factors may also play a role in causing ADHD-like behavior. However, when studying iron and zinc deficiencies in patients with ADHD, results remained inconclusive and needed further elaboration (for a review, see Millichap & Yee, 2012). There is emerging evidence that immunological mechanisms may contribute to ADHD development and manifestation (Verlaet, Noriega, Hermans, & Savelkoul, 2014). CD may induce an immune dysregulation in the gut, leading to chronic inflammation, which on its turn may be the cause for developing ADHD-like symptoms (Esparham, Evans, Wagner, & Drisko, 2014). Studies on the brain level point to the possible implication of serotonergic dysfunction in developing neuropsychiatric disorders in CD. More specifically, these studies refer to an impaired availability of tryptophan and decreased serotonin and dopamine metabolite concentrations (Hernanz & Polanco, 1991; Jackson et al., 2012; Pynnönen et al., 2005). Neuroimaging studies show structural and functional brain deficits in adult patients with CD. Structural deficits include bilateral decrease in cortical gray matter and caudate nuclei volumes (Bilgic et al., 2013), bilateral decrease in cerebellar gray matter, and smaller volume in multiple cortical regions (Currie et al., 2012). Functional deficits include a hypoperfusion of cerebral regions, primarily in the frontal cortex in untreated adult patients with CD, but not in treated patients (Addolorato et al., 2004; Usai et al., 2004). Such brain abnormalities may induce problems in high-cognitive functions such as attention span. Further research is however needed to confirm this hypothesis. To our knowledge, there are no studies on structural and functional brain deficits in pediatric patients with CD. A final hypothesis relates to increased oxidative stress that has been described in both ADHD (Lopresti, 2015) and CD (Stojiljković et al., 2009). Therefore, oxidative stress may represent a possible mediator in the development of ADHDlike behavior in CD patients. However, it remains uncertain whether oxidative stress itself contributes to the development or exacerbation of ADHD symptoms or whether it is the result of environmental factors (Lopresti, 2015). Further empirical studies are needed to understand the mechanisms underlying the potential association between ADHD, ADHD-like behavior, and CD.” |
a) obvious that treating anyone who has an undiagnosed condition makes them better; This is an ambiguous, simplistic and non specific reasoning. We are talking about ADHD, you must focus on ADHD. If we give treatment and cure sore throat, sinusitis, flu... in a person with ADHD, he/she will obviously feel better, but that will not take away the symptoms of ADHD. ADHD symptoms will only improve if we treat a medical condition which may cause in some people ADHD symptoms, as hyperthyroidism, sleep apnea, drug interactions, etc. And as we see above, Ertürk et al. after review the literature state that several studies show that ADHD symptoms in some people with ADHD and CD improve with a gluten-free diet (which is not the same as “makes them better”) and list the current hypothesis for this causative effect.
Also, if you are so kind, I'd like you to explain me what is the criteria that you apply to "remove excess quotation" (one quotation that talks about eliminations diets, and other one with the conclusions of the systematic review about ADHD on CD people, and the effect of gluten-free diet in undiagnosed CD people with ADHD, extracted because this is a non free-access paper) and " remove quotation clutter from ref. makes editing way harder than it needs to be)" (removing again the quotation talking about the conclusions of the systematic review about ADHD on CD people, and the effect of gluten-free diet in undiagnosed CD people with ADHD), and you consider, however, that these others 13 quotations can remain:
Best regards. -- BallenaBlanca ( talk) 06:32, 17 April 2016 (UTC)
Some of these sources were reviews. This edit also changed 75% from genetics to 5%? [15] Doc James ( talk · contribs · email) 18:03, 17 April 2016 (UTC)
As ADHD is common, natural selection likely favored the traits, at least individually, and they may have provided a survival advantage. [1] For example, some women may be more attracted to males who are risk takers, increasing the frequency of genes that predispose to ADHD in the gene pool. [2] As it is more common in children of anxious or stressed mothers, some argue that ADHD is an adaptation that helps children face a stressful or dangerous environment with, for example, increased impulsivity and exploratory behavior. [3]
Looking at the sources:
Doc James ( talk · contribs · email) 14:08, 20 April 2016 (UTC)
unreadable and almost all OFFTOPIC; please feel free to restate concisely, focused on article content |
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The following discussion has been closed. Please do not modify it. |
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I apologize for my previous message, Garzfoth. It was inappropriate nor are ways to argue.
I've gotten the full texts and I read the chain of cited articles. Now I understand what you meant, I had not understood well it before, sorry. I agree.
Well, I will accept your edit, it's clear that the issue was where to include "untreated celiac disease" and that we all accept to include it into Differential diagnosis section. I will add a quotation, because it is not a free access text, and thus avoid future problems or doubts when other editors review the page, and for my part, we can leave this issue closed.
Best regards. -- BallenaBlanca ( talk) 04:33, 26 April 2016 (UTC)
References
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Just because we have the DSM5 does not mean every bit of research based on the DSM4 is all of a sudden obsolete. Doc James ( talk · contribs · email) 17:51, 17 April 2016 (UTC)
Merge /info/en/?search=Hyperkinetic_disorder into ADHD, it's listed as a synonym and the ICD 10 code is F90 which is the same ICD 10 code listed on the ADHD page. — Preceding unsigned comment added by Throwawaysomyipdoesntshowup ( talk • contribs) 14:56, 3 July 2016 (UTC)
Currently, this is how the last half of the section on genetic causes reads:
Several authors have hypothesized that evolution may have played a role in the prevalence of ADHD, particularly hyperactive and impulsive traits in males.[74] Jonathan Williams and Eric Taylor (2006) hypothesized that some women may be more attracted to males who are risk takers, increasing the frequency of genes that predispose to hyperactivity and impulsivity in the gene pool.[75] According to psychobiologist Vivette Glover, some authors have claimed that these traits may be an adaptation that helped males face stressful or dangerous environment with, for example, increased impulsivity and exploratory behavior.[74][75] Others have argued that in certain situations, ADHD traits may have been beneficial to society as a whole even while being harmful to the individual.[74][75][76] According to Esther Cardo and colleagues (2010), the high prevalence and heterogeneity of ADHD may have increased reproductive fitness and benefited society by adding diversity to the gene pool despite being detrimental to the individual.[76] Walter Adriani and colleagues (2012) hypothesized that in certain environments, some ADHD traits may have offered personal advantages to individuals, such as quicker response to predators or superior hunting skills.[77]
People with Down syndrome are more likely to have ADHD.[78]
The sentence about Down syndrome seems really out of place, but I'm not sure where it fits better or if it's worth keeping and I'd be interested in hearing other opinions. IMO the amount of space given to evopsych hypotheses that are unlikely to be tested is WP:UNDUE. I suggest reducing the text to:
My reasoning is that reference [74] ( PMID 21250994) is a review and the hypotheses that I didn't strike out were mentioned in the review, whereas the others come from primary sources. Thoughts? —PermStrump (talk) 22:33, 24 July 2016 (UTC)
No idea why this ref about COPD was added "Switzerland strongly limits the authorised medications, [1]"? Doc James ( talk · contribs · email) 01:45, 28 July 2016 (UTC)
References
Garzfoth Hello. You reverted here. [33] Could you please explain then in what cases the cause is known and where in that source it states that? Charlotte135 ( talk) 00:56, 26 July 2016 (UTC)
Current: "Despite being the most commonly studied and diagnosed mental disorder in children and adolescents, the cause is unknown in the majority of cases."
Compromise: "Despite being the most commonly studied and diagnosed mental disorder in children and adolescents, the immediate cause is unknown."