Talk:Attention deficit hyperactivity disorder

Should the Symptom List be Changed?

@Slothwizard

Perhaps my edit was too long, and hope the issue can be addressed. However, terminology should not be less precise per se merely so the lay person can understand it as this is is the main English page, and not Simple English, which is available for this reason, as I understand this,

That said, here are my main contentions. First, there a number of issues in the current/previous symptom list which I have noted above and will reprint here so other readers don't miss it:

"Currently, things are listed weirdly. For instance, ‘disinhibition’ and ‘hyperactivity’ and ‘impulsivity’ listed, yet disinhibition underlies the symptom dimension of hyperactivity-impulsivity and some aspects of the inattention implicated in the disorder, such as distractibility, as well as the impulsive and preservative aspects of emotional dysregulation. "Executive dysfunction" is also itself listed independently from some deficits in EFs. ‘Carelessness’ is also written, which is very superficial and not a core symptom so it’s odd that it’s uniquely noted alongside such core symptoms. So these are further issues that need rectifying. The main symptom dimensions should probably be mentioned upon which the more superficial expressions of them are mentioned in a parenthesis".

Second, it would probably be better to try and reflect the underlying symptomology of ADHD in some way. If the length is problematic, the examples could be omitted or shortened. It is problematic to just list the most superficial symptoms, especially when this section in the infobox is not about examples but a comprehensive description (this doesn't necessarily need to be long but at least account for the various core symptoms). Димитрий Улянов Иванов (talk) 20:11, 2 October 2024 (UTC)

I probably worded my request for layman terms poorly, I do agree that the most accurate terms should be used. I overall agree with you. I will look at diagnostic manuals for some clarification as the first thing, as I see (for example) “carelessness” is not a very objective term, even if it is subjectively a common symptom, so it should be removed. Thank you for bringing this concern. I will get back to you as soon as possible. I’ll comment here more as I find better ways to showcase symptoms. Slothwizard (talk) 20:19, 2 October 2024 (UTC)

Thanks for replying. I would just like to recommend not relying on the diagnostic manuals (such as the DSM-5 released in 2013) as they are not intended to provide a comprehensive theory describing the disorder's symptomology for several reasons. They are intended mainly for differential diagnosis, and even then, are outdated with the scientific consensus (e.g., not including emotional dysregulation as a core symptom). That said, here are some of the references published in reputable peer-reviewed journals or medical associations that support my edit:

American Psychological Association (APA): Attention-deficit/hyperactivity disorder, self-regulation, and executive functioning (psycnet.apa.org/record/2010-24692-030).

ADD/ADHD and impaired executive function in clinical practice. (https://link.springer.com/article/10.1007/s12618-009-0006-3)

Anthsel et al: Executive Functioning Theory and ADHD: https://link.springer.com/chapter/10.1007/978-1-4614-8106-5_7

The International Consensus Statement on ADHD: www.ncbi.nlm.nih.gov/pmc/articles/PMC8328933/

Executive Functions: www.ncbi.nlm.nih.gov/pmc/articles/PMC4084861/

Widely Projecting Systems: Monoamines, Acetylcholine, and Orexin. In Sydor A, Brown RY (eds.). Molecular Neuropharmacology: A Foundation for Clinical Neuroscience (2nd ed.). ISBN 978-0-07-148127-4. Димитрий Улянов Иванов (talk) 20:44, 2 October 2024 (UTC)

Noted, thank you Slothwizard (talk) 21:25, 2 October 2024 (UTC)

Porn induced adhd

Sexual development in ADHD and internet pornography consumption Pornography use has been tied to adhd 2605:59C0:E6:410:58C1:BDD9:AB57:AFE9 (talk) 19:37, 26 October 2024 (UTC)

It’s a correlation, not a cause. Димитрий Улянов Иванов (talk) 20:07, 26 October 2024 (UTC)

People are born with ADHD, and do not consume porn from their birth. SteveOllington (talk) 17:45, 8 December 2024 (UTC)

Lede Names

Dear @Slothwizard,

I understand HD is less commonly used, but it is surely not former name according to the Nature Review cited, which was published in 2024 and reflects the most up to date facts on ADHD. It is less prevalent, yes, but still a current established name and thus merits inclusion in the lede, as I understand it.

Would appreciate your input on this. Димитрий Улянов Иванов (talk) 22:55, 30 October 2024 (UTC)

I see now that I cannot definitively say it’s a “former” name of the disorder, thanks for pointing this out. Before I type further, I do not have a subscription for the Nature journal and it is behind a paywall for me, aside from the abstract, thought to let you know.

The DSM-5 and ICD-11 does not have entries for HD. The ICD-10 listed it as a separate disorder alongside ADHD, presented similarly to ADHD-C on the DSM-5, I believe, but correct me if I’m wrong. It has a history and does not appear to be a fully acceptable term for ADHD. Since it is presented with similar symptoms and has the same pathophysiology, I think it is appropriate to keep it under the synonyms section in the Infobox, which does not exist for no reason. Hyperkinetic disorder is not notable enough for it to be included in the lede, and just because the Nature article mentions it as a synonym does not change that. Because it still is a synonym, it should be kept in the synonyms section in the infobox with a citation. I will add, there is a whole separate article for hyperkinetic disorder. I do not know the validity of the content of this article, but it does portray HD as a former name for ADHD. Maybe it should be deleted, or maybe it should be revised and/or corrected, but that is a different discussion. But, if we include this synonym, should it be linked to that article as well? I feel as though this is creating complications, albeit fixable. Mentioning it on the lede, however, is inappropriate. Thank you and I appreciate your concerns. I am looking forward to your input. Slothwizard (talk) 00:25, 31 October 2024 (UTC)

Thank you. Reviewing this again ,I agree. Strangely, some WHO documents I was reading at the time continue to use the term specifically for ADHD (see: https://cdn.who.int/media/docs/default-source/essential-medicines/2021-eml-expert-committee/expert-reviews/a21_methylphenidate_rev2.pdf?sfvrsn=42d5434f_6) which gave me the impression it's contemporary but you are correct to point out it has been removed since the release of the ICD-11. The Nature systematic review notes that ADHD is also known as HD but that doesn't itself endorse the validity of the name as an alternative. Apologies for missing these nuances.

Accordingly, I would consider removing it unless it can be put into a section referring to "previous names". I understand it was once used but would just like to keep former names referred not as current alternatives to ADHD.

In the light of this, I shall ping @The Grid for his edit reinstating the term "ADD". I disagree. First, the infobox section refers to "other names", implying they are still valid, rather than former or previous names. That terminology (ADD) was invalidated with the revision in 1987 to ADHD in the DSM-III-R. In the DSM-IV, published in 1994, ADHD with subtypes was presented. In 2013, the DSM-5 and later the ICD-11 discarded subtypes in replacement of presentations of the same disorder that change over time in reflection of research findings. So, "ADD" should not be used in the article. Logic that it should be maintained merely because of publicity (despite the fact that the public uses ADHD for the most part) would also necessitate adding "variable attention stimulus trait" in the descriptor because it's a popular public term, even though it's inaccurate, and no credible scientific paper uses it. In the scientific literature, "ADD" is never used since the diagnostic criteria invalidated it (Faraone et al., 2021). Димитрий Улянов Иванов (talk) 16:16, 1 November 2024 (UTC)

No worries! I added “formerly” to synonyms as a compromise, which could be temporary or permanent. Hopefully this is sorted out. Thanks Slothwizard (talk) 19:55, 1 November 2024 (UTC)

Thank you! :) Димитрий Улянов Иванов (talk) 20:31, 1 November 2024 (UTC)

Usage of the term 'Maldevelopment' and 'Maldeveloped'

Hi, there are two occurrences of maldevelopment/maldeveloped in this article in reference to the ADHD brain. Given the continued amounting of evidence for the evolutionary psychology view that the traits within ADHD were beneficial outside of today's neuronormative societies (and still have certain benefits within them), this terminology doesn't work. The ADHD brain is as it should be, the it's the systems that have been built up around people that are 'maldeveloped' https://adhdworking.co.uk/change/critical-theory-nd/ SteveOllington (talk) 17:54, 8 December 2024 (UTC)

There is no evidence for such a claim, and the reference you cite is a blog post, not credible, peer-reviewed research.

As this Wikipedia article references, a meta-analytic review published in Nature (Cucala et al. 2020) has shown that natural selection has been steadily acting against the genetic variants of ADHD over the course of at least 45,000 years, going back to Neanderthals. These findings not only refute the mismatch hypothesis, but indicate that ADHD has been maladaptive throughout human evolution.

These findings align with theoretical conceptualisations of the underlying nature of executive functioning and self-regulation (e.g. Barkley et al), its development in humans, as well as the fact that ADHD impairs people's ability to do things they enjoy, to take care of themselves and their daily needs, in ways that have absolutely nothing to do with society. And to remove maldevelopment from the article would also contradict the global scientific consensus (see the International Consensus Statement on ADHD for neuroimaging references). Димитрий Улянов Иванов (talk) 19:09, 8 December 2024 (UTC)

I found maladaptive thinking in the concensus statement, but nothing on maldeveloped brains. https://link.springer.com/article/10.1186/s12888-022-03898-z#Sec25

And then in Wikipedia, it states that despite Hartmann not basing his theory on hard evidence, studies have gone on to back it up Hunter versus farmer hypothesis#Scientific basis

Plus https://psycnet.apa.org/record/2015-08351-001

On https://www.nature.com/articles/s41598-020-65322-4#Sec2, there does seem to be one at least potential flaw in the study - they explain the regions and dates where they got the DNA to test, but what about the possibility that over time, settlement increased, and farmer types would be more likely to settle. So how can we know they're not taking the DNA from biased samples? It doesn't cover that.

That aside, even if you Google search "ADHD maldeveloped brains" the only result matching that exactly is this Wikipedia article, others speak of the brain differences, structurally, chemically, etc... but without resorting to that kind of terminology. SteveOllington (talk) 18:34, 10 December 2024 (UTC)

Hi there, that's not the consensus statement I was referring to. I was referencing the International Consensus Statement on ADHD (Faraone et al., 2021-24) and its predecessor International Consensus Statement (Barkley et al., 2002) cited in this article.

It represents the global scientific consensus because Faraone et al. (2021-24) is authored by 80 scientists, endorsed by over 403 other experts and numerous professional associations, from 27 countries and 6 continents. The statement also has over 1000 citations, and its predecessor over 600.

In the sections regarding neuropsychological and neuroimaging differences, they characterise ADHD as showing impaired, dysfunctional, deficient, etc. brain development. Perhaps they use "maldevelopment" specifically too, but because of time constraints I can't check the entirety of the statement or its references in full at this time; in either case, such words are clearly replaceable with maladaptive for contextual reasons.

Regarding the hunter/father hypothesis, it has no credible scientific evidence behind it and has been refuted extensively, as the references in the article show.

The paper you reference (Grossman et al., 2015) was published in 2015, and is a primary source. Their results merely supports "consistency" with the hypothesis based on superficial evidence of attentional performance. Even if we disregard the fact that ADHD is a far more complex disorder of executive functioning and self-regulation, not of mere inattention or inactivity level, the study does not substantiate the hypothesis but indirectly suggests its results align with the hypothesis.

I would like to preface that such a hypothesis, even if it were valid, cannot comprehensively represent ADHD as a whole. This is because 20-30% of cases are not genetic but arise out of neurobiological events, typically prenatally from exposure to biohazards, or secondary to a traumatic brain injury later in life. Additionally, a subset of the genetic cases occur as a result of randomised, de-novo mutations, as opposed to inheritance of risk genes (see lede for ref). These would not be the explicit subject of natural selection.

The aforementioned Nature systematic review and meta-analysis concluded that:

"However, given the lack of genomic data available for ADHD, these theories have not been empirically tested". Thus, it's the first reputable study to empirically test the farmer/hunter gather hypothesis.

Further on, they conclude:

"All analyses performed support the presence of long-standing selective pressures acting against ADHD-associated alleles until recent times [going back to Neanderthals] "

"The hunter-farmer hypothesis cannot explain why current ADHD-risk alleles would have not been beneficial at least for the past 45,000 years, as this is the estimated age of the oldest sample included in our analyses."

"The wader theory, which explains the rise in frequency of ADHD in the Homo lineage living in aquatic environments, cannot account for the enrichment of derived alleles associated with the protective ADHD phenotype compared to chimpanzees, nor for the differences in the proportions of introgressed ADHD-risk and ADHD-protective alleles either. This is because both Neanderthals and AMH share a common recent ancestor with respect to chimpanzees, yet with these analyses we see genomic differences in their ADHD load. Moreover, the response-readiness theory, which links ADHD to the hunter-gatherer environment, fails to explain why fADHD decreases over time during Pre-Neolithic times."

Therefore, direct, genomic evidence points to the invalidity of the hunter-gather hypothesis and at least several other prominent mismatch hypotheses.

Two other systematic reviews regarding this issue are cited in this article. The first includes Keller (2008), which provides empirical support for an alternative and more scientifically reconcilable theory that neurodevelopmental disorders such as ADHD remain at a relatively stable rate within the population despite their being maladaptive due to the balance of natural selection and susceptibility to genetic mutation. Evolution is, in essence, and incredibly slow process at eliminating ADHD risk genes from the population as Culcala et al. (2020) demonstrated.

The second being the American Psychological Association (APA), which have developed a theory supporting the fact that ADHD has been maladaptive throughout human evolution, while genes promoting executive functions and self-regulation are adapative. Support for this model is based on many, indirect lines of evidence (Baumister et al., Barkley).

On a last note, as Wikipedians, we are not supposed to peer-review scientific papers. If you believe the Nature review are "taking DNA from bias samples", and you have no credible, peer-reviewed citations to attest to that, then this opinion is irrelevant, especially when it contradicts the conclusions established by this highly reputable journal. Due weight, reflecting scientific consensus, and reputability of research are much more pertinent for determining content inclusion. For further details, please see the Wikipedia policies/guidelines on these issues. Димитрий Улянов Иванов (talk) 19:48, 10 December 2024 (UTC)

I've looked through the consensus, there is no mention of maldeveloped brains. Suggest that just as language evolves in areas, the terminology should be replaced with something less insulting/derogatory. There's enough of a battle with stigma around ADHD as it is, including ADHD children worrying about their futures and being bullied more than others, without them having to be described as having maldeveloped brains (to read this themselves, or face peers having read it in the playground). SteveOllington (talk) 13:05, 16 December 2024 (UTC)

Article is missing the other side of the coin, the ADHD strengths

This article is typically (of ADHD commentary) one-sided. There is plenty of research (including what I'm currently in the middle of) to show that there are benefits with ADHD. It would be good to see the article reflect the strengths as well as the challenges. Some examples:

https://adhdworking.co.uk/adhd-benefits/the-adhd-mind-at-work-how-a-lack-of-filtering-fuels-creativity/

https://adhdworking.co.uk/adhd-benefits/from-distraction-to-direction-adhd-as-a-path-to-new-ideas/

https://adhdworking.co.uk/differences/adhd-coping-strategies-turning-challenges-into-creative-solutions/

SteveOllington (talk) 18:39, 8 December 2024 (UTC)

You are not citing any credible, peer-reviewed research. To rely on your blog posts as reputable sources would contradict Wikipedia guidelines and policies (see Wikipedia:scientific consensus and Wikipedia:Reliable_sources), the claims of which contradict the global scientific consensus (see the International Consensus Statement).

Systematic reviews and meta-analyses, which combine the results of many primary studies, have actually shown that ADHD is not positively associated with creativity and that treatment with medication does not affect their creativity (Hoogman et al., 2020;Paek et al., 2016; Healey et al., 2008; Abraham et a., 2014). Such research finds that when one has somewhat elevated symptoms of ADHD, but not high enough to be diagnosable with the disorder, there is a small or modest correlation with increased levels of divergent but not convergent creativity. But when diagnosed groups of people with ADHD are studied, research finds they are not more creative, either on divergent or convergent measures.

There appears to be an inverted-U relationship of ADHD to creativity as has been found for other forms of psychopathology, in which slightly higher symptoms might be associated with more divergent thinking and creativity but when symptoms become sufficiently severe to cause impairment to be a disorder they are not associated with greater creativity. And, if high enough, may even detract from creativity. Димитрий Улянов Иванов (talk) 19:23, 8 December 2024 (UTC)

The blog posts reference peer reviewed research, I was assuming the sources would be followed. But there are papers to that effect anyway, see:

https://www.researchgate.net/publication/251531335_Creative_style_and_achievement_in_adults_with_attention-deficithyperactivity_disorder

https://psycnet.apa.org/record/2006-03090-006

https://psycnet.apa.org/record/2016-37756-006

https://link.springer.com/article/10.1007/s12402-018-0272-y

https://pmc.ncbi.nlm.nih.gov/articles/PMC8023171/#:~:text=In%20fact%2C%20studies%20have%20been,self%2Demployment%20and%20inattentive%20symptoms.

But that aside, something not having been published in a medical journal yet, doesn't make high correlations of observations by experts like psychiatrists, psychologists, etc... moot. If Wikipedia could only include peer reviewed research papers as sources, it would lose 90% of its content. Not all things can even be studied if they're highly nuanced, too many variables, etc... SteveOllington (talk) 17:45, 10 December 2024 (UTC)

Unfortunately, your citations are entirely primary sources. An astonishingly high number of primary data cannot be replicated, and the pertinence of their controls/methods require secondary evaluation. For these reasons, reliance on primary sources in generally dissuaded on Wikipedia when comprehensive, systematic reviews and meta-analyses exist on the topic. As I did say - these assess and combine the results of many primary studies for robust conclusions. These were the types of papers I referenced in my comment which consistently found that ADHD, the disorder, is not associated with statistically significant creativity differences.

As for hyperfocusing, the secondary literature cited in the lede of the article does not support that people with ADHD are more effective in their functioning relative to others; but they did find that the symptom is associated with various adverse, functional outcomes.

Again to comply with Wikipedia's policies and guidelines, blog posts cannot be used for substantiating article content nor overturning the cited scientific consensus, regardless of your opinion. In my reply I cited Wikipedia:Reliable Sources, which is an "an English Wikipedia content guideline... that editors should generally follow", concluding:

"Material such as an article, book, monograph, or research paper that has been vetted by the scholarly community is regarded as reliable, where the material has been published in reputable peer-reviewed sources"

"Research that has not been peer-reviewed is akin to a blog, as anybody can post it online. Their use is generally discouraged"

Wikipedia:scientific consensus concludes:

"It is important to note that in forming its consensus it is the members of a particular scientific discipline who determine what is scientific and what is questionable science or pseudoscience. Public opinion or promoters of what is considered pseudoscience by the scientific consensus hold no sway in that determination. (See Wikipedia policy and guidelines regarding Undue weight, extraordinary claims sourcing, verifiability, reliability, and dealing with fringe theories.)"

Димитрий Улянов Иванов (talk) 20:14, 10 December 2024 (UTC)

Can you point me to where the consensus states anything about it being pseudoscience?

Qualitative evidence is not easily replicated, and a lot of this has only just begun to be studied. Is the stance then, that this page alone on Wikipedia must ignore any other forms of evidence than quantitative that has been replicated?

Either way, there are various forms of evidence such as the below studies, and much else. To discount all of it, to the extent it's felt not even worthy of mention that there is evidence of positive aspects seems odd.

https://psycnet.apa.org/record/2018-49082-001

https://psycnet.apa.org/record/2016-37756-006

https://journals.sagepub.com/doi/10.1177/10870547211060547

https://journals.sagepub.com/doi/full/10.1177/1087054717727352

https://pmc.ncbi.nlm.nih.gov/articles/PMC11107134/

https://pmc.ncbi.nlm.nih.gov/articles/PMC10551976/

https://link.springer.com/article/10.1007/s12402-018-0277-6

https://journals.sagepub.com/doi/10.1177/08295735231225261

https://www.emerald.com/insight/content/doi/10.1108/jwam-05-2023-0048/full/html

https://journals.sagepub.com/doi/10.1177/1042258719892987

https://www.emerald.com/insight/content/doi/10.1108/ijebr-12-2022-1079/full/html

https://link.springer.com/epdf/10.1007/s11187-018-0061-1?sharing_token=Yv6ZppWCsocL0ggH6iz8tve4RwlQNchNByi7wbcMAY5aD5OhajLNsSFUmv1DIIwR56zfAyPdwtqAU_5ug8KS17PqOja0M-1WjT8_dVgCxaSTtevEkxvcqIMdxet8_gechTDsYnTmouUPl2k-AdLnzqhqHtL4lkxJBmxcmz-pkb8%3D SteveOllington (talk) 13:47, 16 December 2024 (UTC)

I've been reading through the Wikipedia guidelines, and there doesn't appear to be any issue with primary sources as long as it's from peer reviewed and reputable journals. In fact, it explicitly states that secondary source doesn't mean good, and primary source doesn't mean bad. https://en.wikipedia.org/wiki/Wikipedia:Identifying_and_using_primary_sources SteveOllington (talk) 22:44, 16 December 2024 (UTC)

Semi-protected edit request on 7 January 2025

Under Medication subheading before Stimulant subheading ADD: A systematic review published by PCORI in 2024, showed there was no significant difference in ADHD symptom relief or adverse side effects when comparing stimulant and nonstimulant medications, though both groups of children showed significant benefit from receiving medication therapy. FrogDoc25 (talk) 23:58, 7 January 2025 (UTC)

References

Semi-protected edit request on 9 January 2025

I request the removal of the following sentence:

"Throughout human evolution, the EFs involved in ADHD likely provide the capacity to bind contingencies across time thereby directing behaviour toward future over immediate events so as to maximise future social consequences for humans.[153]"

Reasons:

1) It is incomprehensible, even for a specialist in this field whom I consulted. Completely unclear what is the message, even more so for the normal reader. 2) It is a direct quote from the source article abstract. The writing is so bad we suspect the article may be AI-generated. Can't discuss it on pubpeer though as it does not even have a DOI, like a proper scientific article. Hence, it should probably not be used as a reliable source at all. 3) The "EFs" mentioned in the sentence are defined in the original source article, but not in the wikipedia section where it appears. The sentence is pasted out of context and takes away rather than adds to this section.

Alternatively, please rewrite to make the relevant conclusions of the source article clear.

Thanks for your time. Xevaycrirth (talk) 18:52, 9 January 2025 (UTC)

No, it is not "AI generated" because you find the writing unclear. It is a peer-reviewed source, as evidenced by the citation linking to the database of the American Psychological Association to the systematic review of self-regulation and executive functions published by Russell Barkley, one of the world's most forefront experts on ADHD. Димитрий Улянов Иванов (talk) 12:36, 12 January 2025 (UTC)

That said, I do agree we should define what "EF" means as the abbreviation hasn't thus far been used in the article. So I will change "EFs" to "executive functions" for clarity. Димитрий Улянов Иванов (talk) 12:38, 12 January 2025 (UTC)

Requested move 12 January 2025

The following is a closed discussion of a requested move. Please do not modify it. Subsequent comments should be made in a new section on the talk page. Editors desiring to contest the closing decision should consider a move review after discussing it on the closer's talk page. No further edits should be made to this discussion.

The result of the move request was: not moved. Fathoms Below (talk) 04:58, 19 January 2025 (UTC)

---

Attention deficit hyperactivity disorder → ADHD – per WP:COMMONNAME and WP:UCRN. pretty much everyone uses 'ADHD' instead of the full name, so let's change it to that. 🗽Freedoxm🗽(talk • contribs) 04:56, 12 January 2025 (UTC)

As both ADHD and ADD already redirect here, I can't see a point in moving the page. CAVincent (talk) 06:33, 12 January 2025 (UTC)

redirecting from ADHD and ADD is completely irrelevant from moving the page to ADHD, Besides, it's the more common name between this long name and that. 🗽Freedoxm🗽(talk • contribs) 07:09, 12 January 2025 (UTC)

• Oppose, the average reader will recognize the full name just as well as the abbreviations. The relevant guideline, MOS:ACROTITLE, cites Central Intelligence Agency as an example of a similar case, where the abbreviation is well known but the full name is just as prevalent in sources.

PubMed shows 53,000 results for "ADHD" [1] and 49,000 results for "Attention deficit hyperactivity disorder" [2]. ("ADD" has far more results than either due to false positives.) Given the spelled-out name is ten times longer, one would expect far fewer results. Since these numbers are almost exactly equal, we cannot reasonably say the subject is known primarily by its abbreviation. Toadspike [Talk] 09:11, 12 January 2025 (UTC)

• Oppose per Britannica I think as noted enough people know the full name not to use the acronym. Crouch, Swale (talk) 18:29, 12 January 2025 (UTC)

• Oppose as with the other arguments stated here (the average reader will know the full name and its abbreviations equally), other articles on Wikipedia about other mental disorders use the full name (e.g., post-traumatic stress disorder, obsessive-compulsive disorder) and there has been no proposition for these articles to be renamed into their acronym--I feel like changing the name on this article would just be a weird break in consistency. Unit Mango (talk) 16:53, 15 January 2025 (UTC)
• Oppose per WP:MEDTITLE. – The Grid (talk) 20:43, 16 January 2025 (UTC)

The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

Life expectancy

Hi @Dmitry, thanks for your edit summary during your partial revert. Leading off from this, regarding life expectancy, I've had a look at the two sources provided and I don't think they are strong enough to support stating the figure of 13 years in the article voice. I also have concerns about including this emerging research in the article lead until there is a larger evidence base, but perhaps I'm too cautious on this.

The CHADD paper isn't a strong source for a medical article. The cited article, from a peer-reviewed journal, is only a summary of the white paper's recommendations, which doesn't mention the 13 year figure. The full paper is unpublished, as the summary article notes. Although I can see CHADD is led by experts, the list of summit attendees on page 3 of the full paper includes representatives of various American health and insurance companies as well as academics, so there's potential for conflict of interest. The paper addresses life expectancy on pages 11-15. It cites 5 different studies looking at ADHD and mortality and although I haven't delved into each of them, judging from its discussion of these studies and their titles I gather they aren't investigating life expectancy specifically. The only mention of 13 years refers to the other source cited here, Barkley & Fischer (2018).

Barkley & Fischer estimate a "a 9.5-year reduction in healthy ELE, and a 8.4-year reduction in total ELE" for children with ADHD-C, and a "12.7-year reduction in ELE" linked to "the persistence of ADHD to adulthood" by inputting variables into a life expectancy calculator. I know there's longstanding uncertainty about continuation rates of ADHD into adulthood, but the authors explicitly limit their claim of a reduction of 13 years to adults, so to be accurate we need to acknowledge this as our article encompasses childhood ADHD as well. I think it would also need contextualisation as a US study, as it could be impacted by cultural/socioeconomic differences internationally. More generally, I don't think it's appropriate to be using one figure based off a single study.

A study published this month in the UK, which has already garnered some media attention here, claims it's the first worldwide to use "mortality data to examine the life expectancy deficit experienced by adults with diagnosed ADHD", which seems to a layperson like myself to be the gold standard for determining a life expectancy deficit. I haven't read it fully, but it finds a deficit of 6.78 years for males and 8.64 years and for females.

Please let me know if I've missed something here. Going forward, my suggestions are to either A) mention life expectancy in the lead without a figure, noting that recent/emerging studies have found significantly reduced life expectancy, or B) wait for more studies/a review paper to emerge in the future before including this in the lead. Either way, I think we should detail the main findings of both Barkley & Fischer's study and the recent UK one in ADHD#Prognosis -- I'm happy to add this later. Jr8825 • Talk 12:46, 25 January 2025 (UTC)

Thanks for expressing your concerns with these papers.

The paper by Bob Cattoi and colleagues (Cattoi et al., 2021) has been published in the peer-reviewed journal as specified in the heading of the journal page ("Research article - First published online September 29, 2021"). It appears that you have reached your conclusion through the references section, which cites the aforementioned paper and states it is unpublished. Yet the citation is in reference to a prior iteration of the paper and thus does not reflect on the version published in the journal. Cattoi and colleagues substantiate the predisposing symptoms of ADHD to the increased risks of morbidity and earlier mortality; indeed, they do not provide an exact number but it helps contextualise the sentence in the lede, which states that the self-regulatory deficits of the disorder predispose to such adverse outcomes.

Regarding the exact number, I agree that we shouldn't at this time include 13 years precisely because of the slightly conflicting and uncertainty of the result. The longitudinal study (Barkley et al., 2019) has been cited about 130 times in the literature the methodology and controls undertaken are reputable, with it also examining the contributions to the findings. The study found that behavioural disinhibition was the number 1 contributor to life expectancy in both people with ADHD and the control group, aligning perfectly with the lede sentence (as inhibitory deficits are central to ADHD). But I do think we should change the number to "significantly" instead.

Also note that O'Ninons et al. (2025) did not examine the persistence of ADHD into adulthood from childhood and hence the difference in results. In Barkley et al. (2019), the 12.7 year reduction was specific to when ADHD persisted throughout the lifespan (which, in most cases, it does). I just rounded it to 13 for clarity, as I recall when I made the original edit there. Their findings are consistent where their methods overlap though, so the replication of results with two distinct methodologies provides ample evidence for the statement in my view.

Regarding social-cultural factors, there is a global scientific consensus that the prevalence of ADHD has not changed over time and is consistent globally (International Consensus Statement on ADHD, September 2021). We also know its aetiological is entirely biological (genetics and, to a lesser extent, neurobiological injury). The rearing social environment is not a contributor to its symptoms. Thus, with the findings above on the factors that create the reduction in life expectancy (ADHD symptoms) it is reasonable to extrapolate it more internationally as well. Of course, differing availability of treatment will be a factor here but will have not be anywhere near so influential such that life the difference becomes nonsignificant in a particular region of the world.

Lastly, I agree with the way you have rephrased the lede in your most recent edit as of writing with regards to executive dysfunction and emotional dysregulation. Thanks for doing so. That will help get rid of the redundancy while still emphasising the importance of both by inclusion in the lede sentence. Personally, I think I can find even better citations for substantiating the emotional dysregulation as a core symptom, and I'll consider doing this once time permits me. Димитрий Улянов Иванов (talk) 13:41, 25 January 2025 (UTC)

Thanks for the thorough reply, much appreciated. Sorry I must've copied the doi incorrectly for Cattoi -- I wasn't trying to query the quality of the research article, other than pointing out it's being cited for something it doesn't explicitly say (but the unpublished paper does, sort of). If you've agreed on replacing the 13 year figure, how shall we modify the lead? My suggestion for the wording would be "...collectively predisposing to a diminished quality of life. Recent studies have found that ADHD is associated with a significant reduction in average life expectancy." Your thoughts? Jr8825 • Talk 14:09, 25 January 2025 (UTC)

No problem! Fact checking is always appreciated. I think we should reword it to "...quality of life and a significant reduction in life expectancy" which is shorter than your proposal and conveys the underlying point. For a lede, I don't think its necessary to include the context (i.e. studies have shown...) and the finding is not recent in the general sense of that term. Димитрий Улянов Иванов (talk) 17:54, 25 January 2025 (UTC)

I agree there are now two strong studies showing this as well as a plethora of supporting evidence about increased mortality, so I don't strongly object to that wording, although I'd personally prefer to include the context rather than state it in the article voice, as there isn't yet a scientific review we can cite. Jr8825 • Talk 11:53, 26 January 2025 (UTC)

It's a good point to distinguish between the primary and secondary literature but we do have systematic reviews confirming the finding, including the International Consensus Statement on ADHD (Faraone et al., 2022) (see §10.4) and thus a global scientific consensus. Димитрий Улянов Иванов (talk) 12:12, 26 January 2025 (UTC)

The conclusion statement says there is increased risk of premature death, but that's not the same as the proposed wording "significant reduction in life expectancy". And of the 6 studies summarised (pp. 21-22), two find a "small increase" of premature death [increasing with comorbidities] (114 & 119), while the other 4 talk about much higher rates of suicide and accidents but not life expectancy. Jr8825 • Talk 12:22, 26 January 2025 (UTC)

In this context, reduced life expectancy, mortality, and premature death are interchangeable. The latter tend to be investigating specific causes of death but an increase of the parameter necessarily means life expectancy is slower, and this is generalisable when its about overall-cause mortality as reported in e.g. Dalsgaard et al. (2015) in the consensus statement. The disparity may be small relative to the number of years overall but still of statistical significance. The ultimate conclusion in the consensus statement (summary section) includes "People with ADHD are at increased risk for... premature death.", without context to a specific cause, and so I see it as a pertinent secondary source.

If Wikipedia mandates that we quote the precise wording, then I guess we can change it to significantly premature death or earlier mortality Димитрий Улянов Иванов (talk) 13:36, 26 January 2025 (UTC)

Just regarding the issue of executive functioning, would it not be better to restore the original wording in the lede sentence? It just seems unnecessary to move it into a separate sentence which is also more lengthy than the original wording. Димитрий Улянов Иванов (talk) 17:57, 25 January 2025 (UTC)

I'm against this for two reasons. Firstly, while I appreciate that our understanding of ADHD has evolved and that executive dysfunction is increasingly used as the an overall term for the spectrum of symptoms ADHD presents, I'm not convinced it is generally used in defining ADHD. I've done a very brief search for review papers on ADHD from the last year (I'm sure you are more familiar with the literature than me) to see how the latest research defines and summarises ADHD, and it appears that it is still typically defined as "symptoms of inattention and/or hyperactivity/impulsivity" (e.g. [3]). This is in line with non-primary sources such as the 2021 intl. consensus statement (p. 37), NICE CKS (I'm aware you're worked with NICE in the past), the public-facing CDC summary, and our encyclopedic sibling, Britannica.

Because of this, while we know ADHD symptoms are underpinned by executive dysfunction, I'm not seeing ADHD being widely defined by it in the literature, even though my feeling is that there is a strong movement among experts in that direction, and we may end up there. It's not that I personally disagree with describing ADHD as a disorder of executive functions, simply that as a tertiary source, Wikipedia needs to follow the weight of other sources. However, perhaps you are aware of more literature (particularly reviews) that describe ADHD as being characterised by EF, leading to its common symptoms?

I've also come across one systematic review on childhood ADHD from last year which concludes "Objective, quantitative neuropsychological test measures of executive functioning correlate only weakly with the clinical symptoms that define ADHD. Thus, many youth with ADHD have normal executive functioning profiles on neuropsychological testing, and many who have impaired executive functioning on testing do not have ADHD. Future research is needed to understand how test measures of executive functioning and the real-world functional problems that define ADHD map on to one another and how that mapping can be improved." So it appears there is some complexity in the relationship between existing measures of EF and the executive dysfunction of ADHD? There's also the issue of EF being caused by many other conditions other than ADHD -- including temporary, non-lifelong ones -- so I think for reader clarity it's better to start with how ADHD is specifically diagnosed.

Secondly, and more simply, I think that adding executive dysfunction to the opening sentence makes it more technical and wordy, and therefore less reader friendly. I don't think executive dysfunction is minimised with the current solution of it being a second, brief sentence, especially as the 4th paragraph describes how ADHD is effectively characterised by poor EF. Jr8825 • Talk 11:50, 26 January 2025 (UTC)

There are numerous reviews and comprehensive theories concluding ADHD represents an underlying disorder of executive functioning (e.g., American Psychological Association, 2011; Brown, 2008; Antshel et al., 2014), based on the extensive body of neuropsychological and neuroimaging research. I will note that some of these reviews do not reach their conclusion with definitive certainty, and their absence in the current DSM and ICD means the field is moving in this direction and we are not there yet. At this time the debate concerns mainly whether all ADHD symptoms are explicable through the lens of EF, and the recent recognition of CDS as a distinct syndrome has further complicated matters (Becker et al., 2022). There is fairly minimal controversy about the fact that ADHD symptoms generally arise from executive dysfunction though. Neuropsychological tests indeed may report only a subset of people with ADHD exhibit EF deficits but such tests are far from the gold standard for assessing EF due to their low accuracy at detecting the disorder, low correlation with real-world measures of executive functioning (e.g. rating scales, which show otherwise), and limited if any relationship to predicting impairment in major life domains . As they are based on a faulty understanding of EF (Barkley & Murphy, 2011; Barkley & Eme, 2019), they cannot be used to diagnose the disorder (Faraone et al., 2021).

Yes, the general literature predominately describes ADHD as the DSM5 does; that it is a disorder of inattention, hyperactivity and impulsivity. Executive dysfunction and emotional dysregulation often go unmentioned because of the way the diagnostic manuals (DSM and ICD) standardise the definition of ADHD and the time it takes for a new revision to be published. They are not guiding the research but are trailing it by a couple decades and even then, their decisions are not just scientific but politically motivated to a degree so its hard to know where this will go in subsequent versions. This doesn't invalidate those components of ADHD because the general literature is not usually examining its underlying nature, so reliance on the superficial DSM definition is understandable, and thus are not relevant to the issue in my view. Keep in mind both the descriptions are accurate and not mutually exclusive; it is just that one is more surface level and the other more comprehensive and hence the disparity in research contexts.

I see your point about the original wording complexifying the first sentence with technical language. I don't know if that conflicts with any Wikipedia guidelines, but I don't see the harm in mentioning "ADHD symptoms arise from executive dysfunction" in a separate sentence. That probably would align better with the status of the field because its not implying all symptoms arise from EFDs. Димитрий Улянов Иванов (talk) 13:18, 26 January 2025 (UTC)