Talk:Controversy about ADHD

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Contents 1 Evidence that hyperactivity is a genetic trait 2 Proposed rename 3 Cleanup required 4 “See also” section 5 Use of Dr Sobo's article as a source for this article 6 Citations in 'Genetic Basis of Hyperactivity' 7 Cleanup notice 8 PET scan description 9 Edits by 68.83.221.88 10 From the main ADHD article 11 Should there be suggestions on this page about diagnosis? 12 Jay Joseph 13 Lazy parents 14 POV

[edit] Evidence that hyperactivity is a genetic trait

From "Attention-Deficit/Hyperactivity Disorder: Nature, Course, Outcomes, and Comorbidity," by Russell A. Barkley, Ph.D.:

"Genetic Factors Evidence for a genetic basis to this disorders comes from three sources: family studies, twin studies, and, most recently, molecular genetic studies identifying individual candidate genes. Again, nearly all of this research applies to the Combined Type of ADHD.

Family Aggregation Studies. For years, researchers have noted the higher prevalence of psychopathology in the parents and other relatives of children with ADHD. Between 10 to 35 percent of the immediate family members of children with ADHD are also likely to have the disorder with the risk to siblings of the ADHD children being approximately 32 percent (Biederman et al., 1992; Biederman, Faraone, Keenan, et al., 1990; Pauls, 1991; Welner et al., 1977). Even more striking, research shows that if a parent has ADHD, the risk to the offspring is 57 percent (Biederman, Faraone, Mick, et al., 1995). Thus, ADHD clusters significantly among the biological relatives of children or adults with the disorder, strongly implying a hereditary basis to this condition. Subsequently, these elevated rates of disorders also have been noted in African-American ADHD samples (Samuel et al., 1999) as well as in ADHD girls compared to boys (Faraone et al., 2000).

These studies of families further suggest that ADHD with CD may be a distinct familial subtype of ADHD. By separating the group of ADHD children into those with and without conduct disorder (CD), it has been shown that the conduct problems, substance abuse, and depression in the parents and other relatives are related more to the presence of CD in the ADHD children than to ADHD itself (August & Stewart, 1983; Biederman, Faraone, Keenan, et al., 1992; Faraone, Biederman, et al., 1995; Faraone, Biederman, Mennin, Russell, & Tsuang, 1998; Lahey et al., 1988). Rates of hyperactivity or ADHD remain high even in relatives of the group of ADHD children without CD (Biederman, Faraone, Keenan, et al., 1992) but depression and antisocial spectrum disorders are most likely to appear in the comorbid group. Using sib-pairs in which both siblings had ADHD, Smalley and colleagues have also recently supported this view through findings that CD significantly clusters among the families of only those sib-pairs having CD (Smalley et al., 2000).

Some research has also suggested that girls who manifest ADHD may need to have a greater genetic loading (higher family member prevalence) than do males with ADHD (Smalley et al., 2000). Faraone and colleagues also found some evidence in support of this view in that male siblings from families with one affected child were more likely to have ADHD than were female siblings from these families (Faraone et al., 1995). They also reported that the gender difference noted above for ADHD (3:1 males-to-females) may apply primarily to children from families in which either the child or a parent has antisocial behavior.

Interestingly, research by Faraone and Biederman (1997) suggests that depression among family members of children with ADHD may be a nonspecific expression of the same genetic contribution that is related to ADHD. This is based on their findings that family members of children with ADHD are at increased risk for major depression while individuals having major depression have first-degree relatives at increased risk for ADHD. Even so, as noted above, the risk for depression among family members is largely among those children having ADHD with CD.

Adoption Research.

Another line of evidence for genetic involvement in ADHD has emerged from studies of adopted children. Cantwell (1975) and Morrison and Stewart (1973) both reported higher rates of hyperactivity in the biological parents of hyperactive children than in adoptive parents having such children. Both studies suggest that hyperactive children are more likely to resemble their biological parents than their adoptive parents in their levels of hyperactivity. Yet, both studies were retrospective and both failed to study the biological parents of the adopted hyperactive children as a comparison group (Pauls, 1991). Cadoret and Stewart (1991) studied 283 male adoptees and found that if one of the biological parents had been judged delinquent or to have an adult criminal conviction, the adopted away sons had a higher likelihood of having ADHD. A later study (van den Oord, Boomsma, & Verhulst, 1994) using biologically related and unrelated pairs of international adoptees identified a strong genetic component (47 percent of the variance) for the Attention Problems dimension of the Child Behavior Checklist, a rating scale commonly used in research on ADHD. More recently, a comparison of the families of adopted ADHD children to those living with their biological parents and to a control group also showed the same pattern of an elevated prevalence of ADHD among just the biological parents of the ADHD children (6% vs. 18% vs. 3% respectively) (Sprich, Biederman, Crawford, Mundy, & Faraone, 2000). Thus, like the family association studies discussed earlier, results of adoption studies point to a strong possibility of a significant hereditary contribution to hyperactivity.

Twin Studies. Since the last edition of this text, the number of twin studies of ADHD and its underlying behavioral dimensions has increased markedly. More exciting has been the striking consistency across all of these studies. This research strategy provides a third avenue of evidence for a genetic contribution to ADHD. But it also provides a means of testing any competing environmental theories of the disorder (e.g., that ADHD is due to poor parenting, adverse family life, excessive TV viewing, etc.). That is because twin studies can not only compute the proportion of variance in a trait that is genetically influenced (heritability), but also the proportion that results from common or shared environment (things twins and siblings have in common growing up in the same family) and that which results from unique environment (all non-genetic factors or events that are unique or specific to one child and not to others in the family) (Plomin, Defries, McClearn, & Rutter, 1997).

Early research on ADHD using twins looked only at twin concordance (likelihood of twins sharing the same disorder) and did not compute these estimates of heritability, shared, and unique environment. These early studies demonstrated a greater agreement (concordance) for symptoms of hyperactivity and inattention between monozygotic (MZ) compared to dizygotic twins (DZ) (O'Connor, Foch, Sherry, & Plomin, 1980; Willerman, 1973). Studies of very small samples of twins (Heffron, Martin, & Welsh, 1984; Lopez, 1965) found complete (100%) concordance for MZ twins for hyperactivity and far less agreement for DZ twins. For instance, Gilger, Pennington, and DeFries (1992) found that if one twin was diagnosed as ADHD, the concordance for the disorder was 81 percent in MZ twins and 29 percent in DZ twins. Sherman, McGue, and Iacono (1997) found that the concordance for MZ twins having ADHD (mother identified) was 67 percent versus 0 percent for DZ twins.

Later research has computed heritability and environmental contributions to ADHD. One such study of a large sample of twins (570) found that approximately 50 percent of the variance in hyperactivity and inattention in this sample was due to heredity while 0-30 percent may have been environmental (Goodman & Stevenson, 1989). The relatively limited number of items assessing these two behavioral dimensions, however, may have reduced the sensitivity of the study to genetic effects. Later and even larger twin studies have found an even higher degree of heritability for ADHD, ranging from .75 to .97 (see Levy & Hay, 2001; Thapar, 1999 for reviews) (Burt, Krueger, McGue, Iacono, 2001; Coolidge et al., 2001; Gjone, Stevenson, & Sundet, 1996; Gjone, Stevenson, Sundet, & Eilertsen, 1996; Hudziak, 1997; Levy, Hay, McStephen, Wood, & Waldman, 1997; Rhee, Waldman, Hay, & Levy, 1995; Sherman, Iacono, & McGue, 1997; Sherman, McGue, & Iacono, 1997; Silberg et al., 1996; Thapar, Harrington, & McGuffin, 2001; Thapar, Hervas, & McGuffin, 1995; van den Oord, Verhulst, & Boomsma, 1996). Thus, twin studies indicate that the average heritability of ADHD is at least 0.80, being nearly that for human height (.80-.91) and higher than that found for intelligence (.55-.70). These studies consistently find little, if any, effect of shared (rearing) environment on the traits of ADHD while sometimes finding a small significant contribution for unique environmental events. In their totality, shared environmental factors seem to account for 0-6 percent of individual differences in the behavioral trait(s) related to ADHD. It is for this reason that I stated at the opening of this section that little attention would be given here to discussing purely environmental or social factors as involved in the causation of ADHD.

The twin studies cited above have also been able to indicate the extent to which individual differences in ADHD symptoms are the result of nonshared environmental factors. Such factors not only include those typically thought of as involving the social environment, but also all biological factors that are nongenetic in origin. Factors in the nonshared environment are those events or conditions that will have uniquely affected only one twin and not the other. Besides biological hazards or neurologically injurious events that may have befallen only one member of a twin pair, the nonshared environment also includes those differences in the manner in which parents may have treated each child. Parents do not interact with all of their children in an identical fashion and such unique parent-child interactions are believed to make more of a contribution to individual differences among siblings than do those factors about the home and child-rearing that are common to all children in the family. Twin studies to date have suggested that approximately 9-20 percent of the variance in hyperactive-impulsive-inattentive behavior or ADHD symptoms can be attributed to such nonshared environmental (nongenetic) factors (Levy et al., 1997; Sherman, Iacono et al., 1997; Silberg et al., 1996). A portion of this variance, however, must be attributed to the error of the measure used to assess the symptoms. Research suggests that the nonshared environmental factors also contribute disproportionately more to individual differences in other forms of child psychopathology than do factors in the shared environment (Pike & Plomin, 1996). Thus, if researchers were interested in identifying environmental contributors to ADHD, these studies suggest that such research should focus on those biological and social experiences that are specific and unique to the individual and are not part of the common environment to which other siblings have been exposed."

--Ss06470 03:33, 12 June 2006 (UTC) Dr. Biederman cited again and again and again above has written 294 (!) papers on ADHD. He is the most cited expert in this field. Here is an interview with him An interview with Joseph Biederman You might be interested to know about his relationship with the pharmaceutical industry. He has received research support from Shire, Lilly, Wyeth, Pfizer, Cephlon, Janssen, and Noven. He is on the speakers bureau for GlaxoSmithKline, Lilly, Pfizer, Wyeth, Shire, Alza, and Cephalon. He is also on the advisory board for Lilly, Celltech and Shire, Noven and Alza/McNeil. May 18th 2000 Marcia Angell – who was then the editor-in-chief of the New England Journal of Medicine – wrote a surprisingly candid editorial titled, “Is Academic Medicine for Sale?” Angell referred to the “Faustian bargain” that takes place when scientists accept pharmaceutical money.She felt so strongly about it that she subsequently wrote a book The Truth About the Drug Companies: How They Deceive Us and What to Do About It.

It should also be noted Richard Horton, editor of Lancet, England's most respected medical journal had this to say in the New York Review of Books (March 11, 2004) “The Dawn of McScience” “ Indeed, medical journals have become an important but under recognized obstacle to scientific truth-telling. Journals have devolved into information-laundering operations for the pharmaceutical industry. "

You have a lot of citations in your piece, which seems to be greatly valued here. Unfortunately, the question is whether the 294 articles (and many of the other citations) establish valid information or are part of an attempt to deceive the public

[edit] Proposed rename

I'd suggest renaming this page to Controversy about ADHD, as that title is much more encyclopedia-like than the current one, which sounds rather informal. Any objections? JulesH 08:34, 13 May 2006 (UTC)

• ADHD controversy...?  Regards, David Kernow 17:24, 13 May 2006 (UTC)

Done. —Nightstallion (?) 08:40, 18 May 2006 (UTC)

I disagree with the current name of the article. 'Controversy' implies that the criticism of ADHD is not widespread. But an informal survey of laymen indicates that doubt and distrust of the diagnosis is widely accepted. The content of this article does not present a 'controversy' as such, but an assortment of criticisms. I propose that the article be renamed to 'Criticism of ADHD' or something similar. Is there any strong objection to renaming it 'Anti-ADHD' again? Oneismany 21:35, 5 June 2006 (UTC)

I think merely having an article called Controversy about ADHD sends a strong message that this is a major issue. I would rather keep the current name. -- Barrylb 01:53, 6 June 2006 (UTC)

'Controversy about' does seem more encyclopedia-like to me, vs. 'anti-ADHD,' which tends to be more ambiguous (opposed to having the condition? opposed to the name? opposed to the people? opposed to ...?). Calling it 'Criticism of' seems to me to face the same problem. The current name seems to be more standard. Library of Congress subject headings, for example, tend to have something like "Attention-deficit Hyperactivity Disorder -- Controversial literature," so the term "controversy" seems to be a useful flag within the reference community. Lawikitejana 03:51, 9 August 2006 (UTC)

I think "Controversy about ADHD" is good, but somehow the phrasing with the word "about" seems clunky. How about "Controversy over ADHD" or "Controversy regarding ADHD"? -- Tomlouie | talk 05:16, 12 August 2006 (UTC)

[edit] Cleanup required

I've tagged the article with 'cleanup' as there are a lot of shortcomings at the moment, IMO. While we have some good information here, I'd like to address the following:

• The long text on the picture. Some of this should be moved into the body of the article instead.
• The picture: can someone please indicate which brain (left or right) is the ADHD brain scan and which brain is 'non-ADHD' brain scan?
• The lack of citing of sources
• Apparently POV sections
• Lack of information concerning arguments against these theories
• Structure of the document. As I see it, there should be three main sections, one addressing theories that ADHD doesn't exist and is a misdiagnosis, one addressing concerns over labelling it as a pathology when it should perhaps be seen more as natural variations, and one addressing alternative theories of the origin of the condition. At the moment, all three of these are jumbled together and the flow of the article is hard to follow.

I don't really have time to work on this right now, but I'll be putting this article on my watchlist and heading back over here in the next few days to start on it. JulesH 08:51, 13 May 2006 (UTC)

Re: the long text in the picture. Perhaps the picture and the information in the text should be rearranged into a separate section. But, the current presentation of the picture and the information points out the shortcomings of the PET scan research in a way that perhaps a straightforward approach would be inadequate to accomplish. Your other comments are very astute and any assistance in improving the article would be appreciated. Most of this text was lifted from the ADHD page, and perhaps some of the attribution was lost in the process. Perhaps some of the references on that page should be moved to this one? Oneismany 19:53, 23 May 2006 (UTC)

OK, I've tried restructuring the article, and I think it flows better now. There are still a number of sections that are confusing, IMO, but I'm not sure what to do about them because I'm not sure I fully understand the arguments involved. E.g. the genetic causes section: why exactly does a genetic basis that is not fully understood present any problem to the mainstream view of ADHD?

I've also gone through and added notes where I feel references are needed to back up statements made. Some of these references shouldn't be hard to find, as they are references to mainstream beliefs about ADHD that are contradicted by a controversial belief, but we probably need those as well as references about the controversial beliefs themselves. The latter will probably be hard to find, as most such references are self-published, and self-published articles are unfortunately not generally acceptable as sources for wikipedia articles, according to the relevant policies. I'm not sure what to do about this. JulesH 22:26, 26 June 2006 (UTC)

[edit] “See also” section

Reference to the Biopsychiatry controversy article and others has been added. Incidentally, I have written an OR article about the obscene alliance of abusive parents with psychiatrists [1], and I just wrote a letter to Jimbo in which I mention the nasty ADHD article [2]. —Cesar Tort 03:56, 25 June 2006 (UTC)

[edit] Use of Dr Sobo's article as a source for this article

We have a lot of content on this page that references ADHD and Other Sins of Our Children by Simon Sobo M.D.. I don't wish to cast aspersions on Dr Sobo (who I understand has contributed to this article himself as User:Ss06470) or the validity of his research, I'm not sure if we can continue to use this article as a reference. The problem is that according to wikipedia's verifiability policy, self published information is not an acceptable source except for uncontentious biographical information.

Now, it could be argued that this article's topic is, essentially, what different people believe about ADHD that is not the mainstream view of the psychiatric profession, and that the article is therefore providing biographical information: it is asserting that this is what Dr Sobo believes, and I don't think that this is a contentious assertion. However, the presentation of the information is likely to be interpreted as presenting facts about ADHD and the evidence for its existence, not merely on what Dr Sobo believes. In this context, it is fairly clearly original research, and is as such prohibited.

I'm not sure how to procede from here. I don't want to simply delete it, because I feel the points raised are significant. Dr Sobo has a good reputation, and has had articles critical of standard psychiatric practices published in a number of sources. I'm sure his point of view here has at least some validity. But I don't see how it can be expressed within the policies that are in place for wikipedia. JulesH 22:27, 26 June 2006 (UTC)

--Ss06470 02:43, 27 June 2006 (UTC)I give up. I notice that the clear explanation of the PET scan being used to lead this article has been stripped of its content. That explanation there was not an opinion. It was simply an explanation of what that PET scan shows What better place to put that explanation than here, the ADHD controversy article but alas... How nice it is to repeatedly refer to what "Dr. Sobo believes" rather than to deal with the content issues. AS for self published material I challenge anyone to get this material published given the extreme bias of the journals. That is the reason I have spent so much time carefully documenting what is going on in my profession. If it werem't so serious it would almost be funny. So keep your article any way you want it to be, Jules H. You are making a major contribution to continuing the one sided point of view being presented to the public

The new description of the image is certainly worse than the old, but there is no shortage of WP:V criticism of Zametkin et al. For example, the control group had a much higher proportion of women or prior medication exposure (Baumeister and Hawkins 2001; Leo and Cohen 2003). --Limegreen 03:23, 27 June 2006 (UTC)

The Wikipedia style guide for image captions suggests keeping them to three lines or fewer. I edited the caption to comply with this guideline. It was not the place for the information that had been put there. If anyone wants to put it back somewhere in the body of the article, I'm not going to stop them. As to phrasing Dr. Sobo's opinions in the form of statements about his beliefs rather than as facts, that is all that can be done here -- these are contested opinions to which there is no clear right or wrong answer. We cannot simply ignore the fact that they are minority opinions, and we must therefore express them as such. I don't make the rules that require publication before we can use an article as a reference, although I do believe the rule is a necessary one. Wikipedia is not a place to present fringe opinions as if they were fact. It should reflect the generally accepted understanding, and note where others disagree the basis for this disagreement. I think the article in question can be used for this purpose, but the phrasing must be careful to avoid giving the impression that Wikipedia is making statements about the accuracy of the research. JulesH 07:23, 27 June 2006 (UTC)

--Ss06470 13:02, 27 June 2006 (UTC) Limegreen I know there has been other criticisms of Zametkin's work and for that matter Castellano's work for failing to take into account the findings might be the result of prior medication exposure. Indeed, Castellanos has been hard at work trying to prove his critics wrong,[3] which I respect. My criticism is that this PET scan picture has been used over and over over as "proof" the whole problem is biological. The contrasting pictures of the brain are amazing when presented as a picture without an explanation. After seeing it, how could any one argue that the differences are not biological? Except once an explanation is given about what the picture represents it is clearly meaningless. I'll go further and put it straighforwardly. It is a big fat lie to show the picture and then intentionally not discuss what it represents. Rather than address the other criticisms I thought simply revealing what this picture is was the most dramatic criticism of the unstoppable freight train which biological advocates, stoked by billions of pharmaceutical dollars, are foisting upon practitioners. As for your criticism Jules H. I am glad you are willing to concede that an article about ADHD controversies can include opinions, although I suppose by your reasoning that "there is no clear right or wrong answer" everything comes down to who has the most citations, or what "experts" believe. I don't know what your knowlege of the subject matter is, but I would invite you to sample some of my writings to get a feeling for the subject matter at hand. The basis of thinking about a subject is to weigh the evidence and the reasoning of those with opinions and try to conclude what makes the most sense. Unfortunately science does not hold the answer yet about these subjects. For now, trying to sift the evidence and the reasoning of proponents is the best we can do given the limited state of our hard knowledge.

I have been citing the many very important people who are disturbed by the money and power of pharmaceutical companies(enough for the editor of NEJM to not only write her editorial exposing what is going on, but then go on to write a book about the subject.) I have also provided a link where I have defended drug companies, and the content of emails to me asking me to write for Peter Breggin and/or scientology front organizations and turned them down because they have gone way too far in condemning medication. I am also not claiming that only I am dispassionate. I may be wrong about plenty of issues. Obviously I have a fiery temperament, am an iconoclast and enjoy a good debate. But I don't simply choose any old subject to argue about. I get fired up when people are clearly being dishonest, whatever the source. That is the reason that I defended Lilly Pharm when it was getting a bum rap.[4]The kind of murderous drug company depicted in the movie "The Constant Gardener" was completely offensive because it went too too far. But I strongly feel drug companies' hired guns ("experts") are distorting the discussion on this topic and many others.

It isn't only direct coercion, although there are many mailings to doctors that through sheer repetition make doubtful assertions seem true. There are also pendulum swings in paradigms that make certain points of view officially sanctioned and others verboten. It is not unlike the various schisms that take place in political parties where one group is kicked out of the in group, and banned from respectability. That is what happened to the former rulers of academia and most of the journals, the psychoanalysts. To even hint at sympathy for these "discredited" ideas is to reveal yourself to be a secret believer. It should be that way, but in fact it is.

I will repeat what I have written before. On many occasions academicians have whispered to me that they admire my "courage", which is ironic, because outside of academia it takes no courage to simply state what you believe. I might add that in many conversation with real scientists doing the basic lab research that leads to discoveries, they joked about the whole "expert" thing that is so popular with "scientific" clinicins. If you look at the statement of the discoverer of Prozac when he was given a prize (I'll track down the details) his emphasis was not on his expertise but on how little we understand. Regarding the politics of belief one other fact might interest you. The professor who invited me to give the Psychiatry Grand Round Lecture at the University of Alabama (on a different subject)asked me to communicate with him on his private e mail, so worried was he that the content of some of my e mails might get him in trouble. It is noteworthy that our private discussions, initiated by him, quickly turned to the absurdity of the ADHD literature. You might also look into Professor Healy's withdrawn academic appointment once his views on Prozac became known. So for the thousandth time we are not dealing with a topic where intellectual integrity characterizes the debate. It is in fact pathetic that my views, when they are freely expressed will not be published by mainstream journals whose citations you so admire One other comment. I am as opposed to 3/4's of the criticisms and nut theories about ADHD posted on these pages. I am especially opposed to material generated by scientologists. I am beginning to wonder if my spirited posts here are becoming counterproductive since the more I argue my point of view the more they become the focus of editors while truly crazy ideas go undisturbed

[edit] Citations in 'Genetic Basis of Hyperactivity'

The '^{[citation needed]}' tag begs a source at two points in this section, but I thought the statements were sufficiently general to accommodate many points of view, and so they do not reference specific sources. For instance, there is no identified defective gene that corresponds to ADHD. I propose that the section be modified to state specifically that there is no defective gene mentioned in the ADHD literature. (That we might be 'searching' for one based on no evidence, may be enough comment on the scientific status of the disorder.) The followup statement merely emphasizes that the hereditary basis of ADHD does not prove that it is a disorder. What citations can be made for the observations that there is no evidence of a defective gene and that there is no proof that this heredity is a disorder? The section may very well be rewritten to avoid the perceived lack of sources; anyone is welcome to improve it. Oneismany 20:37, 27 June 2006 (UTC)

I've changed the subsection. I hope this meets with everyone's approval. Please discuss here, before making any major changes. Oneismany

[edit] Cleanup notice

This article has been substantially altered since the cleanup tag was posted. Any strong objections to removing it? Oneismany 20:06, 29 June 2006 (UTC)

I still think there's a lot of work needed on this article, so would prefer it remained. But if you really disagree, feel free. I probably don't have time to do any further work on this article any time soon. JulesH 10:50, 30 June 2006 (UTC)

[edit] PET scan description

--Ss06470 21:48, 29 June 2006 (UTC)I've changed the section accompanying the pet scan. This is getting ridiculous. The only controversy is whether the differences in ADHD brain activity are due to the fact that the parts of the brain that are used to accomplish the task are broken and can't be used or simply are not being used. Whoever wrote the latest simply does not understand what a PET scan is. They don't measure the energy of the brain. The whole thing is gobblygook.

The brain consumes sugar and generates heat; that is energy output. PET scans follow the sugar where it is consumed, and help model the locations where heat is generated. It may well be that some brains consume more or less sugar than others; or, generate more or less heat than others. The fact that some locations in the brain are more metabolically active in certain people than others does not prove anything by itself; this data must be interpreted by a person, and that is how its significance is determined. As with CPUs in computers, there may very well be differences in wiring or speed or energy metabolism between one brain and another that cannot be accounted for by this method. Maybe ADHD brains do not need as much sugar as other brains to accomplish the same task. The apparently lower level of activity may not reflect a biological difference or a difference in attention span; it may very well reflect something else altogether. Oneismany 14:53, 12 July 2006 (UTC)

I think this picture should go. It gives people the misleading impression that brain scans are actually credible. -- Barrylb 19:12, 20 July 2006 (UTC)

No. This image is an artifact of a specific approach to studying personality. Time will tell whether this approach is valid or not. Oneismany 21:57, 25 July 2006 (UTC)

Brain scans do have a degree of credibility. Admittedly, this image is ancient in scientific terms, but perhaps there are not others that are freely replicable. There was a review of all the ADHD-brain scan studies published last year (Bush G, Valera EM, Seidman LJ. (2005) Functional neuroimaging of attention-deficit/hyperactivity disorder: A review and suggested future directions. BIOLOGICAL PSYCHIATRY 57 (11): 1273-1284), which contains both a summary of the work so far, and covers quite a bit of the criticism of scanning studies.--Limegreen 03:02, 21 July 2006 (UTC)

[edit] Edits by 68.83.221.88

Freyr reverted these edits, presumably because we shouldn't have notes like these on the article page. They might be worth discussing, though, so I'm C&P'ing them here, including a little context from the article. JulesH 18:04, 4 July 2006 (UTC)

If brain imaging is done while one person moves their arm and another doesn't there will also be a demonstrable difference. [edit - could arm movement cause the differences seen in these scans? Goes to relevancy]

Despite this shortcoming, this brain image and many similar pictures of the brain are repeatedly displayed as proof of the supposed biological cause of the condition. [edit - if this is in reference to Zametkin's 1990 study, there were 25 ADHD patients scanned. Is the author asserting that all 25 patients were simply not even attempting to pay attention to the task, or that all 25 patients were moving ther arms? Could the author address the reasons why he finds an explanation that all 25 ADHD patients were willfully refusing to pay attention to be more parsimonious than the explanation that their common disorder prevented them from doing so?]--4.245.140.58 23:01, 7 August 2006 (UTC)The most parsimonious explanation is that either could be the case. A biological problem is keeping them from doing the task or a psychological problem is causing them to not pay attention to the assigned task And yes 25 ADHD patients could not be doing the assigned task That is what ADHD is all about. In any case the difference in the PET scan can be explained by a lack of effort. The issue about moving their arms is not that moving their arms can cause this divergence, it is that if you do a PET of an individual moving his arms and one not moving his arms the PET scan could be different. The PET scan simply shows where there is activity in the brain at a given moment. Using a dramatic picture where someone is paying attention to an assigned task and somepne isn't and using thhe two pictures as an illustration of a biological difference in the brains is silly to be charitable or intentionally misleading. (Those contrasting PET scans have been shown over and over as an illustration of biological difference)

The same teacher might not notice a child who forgets their papers, stares (entranced) at the carpet for long periods of time, or shows many of the recognized symptoms. [edit - While input from a teacher is often one of many factors involved in a diagnosis, teachers do not make the final diagnosis. Arguing that a teacher may misunderstand the diagnostic criteria is therefore irrelevant as to the validity and application of said criteria.]

But critics point out that neurological differences exist among individuals just as with any human trait, such as eye color or height; and that stimulants have an effect on anyone, not just those diagnosed with ADHD. [edit - could you cite a source showing that stimulants reduce anxiety and hyperactivity in patients not diagnosed with ADHD?]

In other words, ADHD may be better seen as a form of neurodiversity. // [edit - Current DSM criteria require that symptoms create an impairment in function in two separate fields (ie school and home). A person for whom these symptoms constitute a positive or neutral attribute therefore cannot be diagnosed with ADHD. This argument is therefore irrelevant, as it would only apply to people who by definition do not have ADHD.]

By this theory, a person cannot be impaired in 2 different contexts by an attribute that might be positive or neutral in some other context. But the "impairment" is an opinion, as is the neutrality or positivity of the attribute. I do not see how 2 identical opinions can rule out every other opinion as a possibility, no matter how authoratitve the opinions. This is not math, or physics we are discussing here. The whole basis of this "impairment" can be called into question by simple suggestions about the methodology for investigating it, or the theory behind it. Oneismany 14:38, 12 July 2006 (UTC)

[edit] From the main ADHD article

This came from the main ADHD article which already has an overly large section dedicated to the topic: --*Kat* 18:38, 26 September 2006 (UTC)

Another argument which has been offered against the diagnosis is that the behavior of putative ADHD sufferers is the "natural" way for children to behave in a situation which does not engage them. It has never been a simple task to teach children how to behave in a "grown up" fashion, and therefore great amounts of time and energy have traditonally been spent by parents and educators trying to inspire, cajole, threaten, lecture, bribe (and every other imaginable strategy) in the service of teaching a child how to gain self control, act with consideration for others, and do tasks that are not fun. In other words, it is argued, a child who is not successfully taught how to behave, obey the rules and stay on task will display all of the symptoms of ADHD. Those who place emphasis on the parental role in ADHD claim that while neurological impairments, or innate tendencies, can be a factor in the ability to stay focused on tasks being demanded, the "nature" (or biological) aspects of the nature vs.nurture controversy have been greatly exaggerated. They claim millions of children being diagnosed with this condition have nothing physically wrong with their brains. ^[1]

A believer that ADHD is a biological condition, Xavier Castellanos M.D., then head of ADHD research at the National Institute of Mental Health, (NIMH), ^[2] has also expressed reservations about the extent of available biological information about that condition in an interview on Frontline in 2000:

Frontline: "How does ADHD work on the brain? What do we know about it?"

Castellanos: "We don't yet know what's going on in ADHD..."

Frontline: "Give me one true fact about ADHD."

Castellanos "The posterior inferior vermis of the cerebellum is smaller in ADHD. I think that that is a true fact. It's taken about five years to convince myself that that's the case. That's about as much as I know--that I'm confident about..."

1. ^ ADHD and Other Sins of Our Children
2. ^ interviewed October 10, 2000 on Frontline

[edit] Should there be suggestions on this page about diagnosis?

"Anyone diagnosed with AD(H)D should have a complete evaluation by a behavioral optometrist." quote from the article

Making treatment or diagnosis suggestions does not seem to fit with the title of the article or the spirit of wikipedia. Perhaps this should be along the lines of stuff like alternative diagnosis. Lonjers 02:48, 6 December 2006 (UTC)

[edit] Jay Joseph

Two books by Jay Joseph challenge the current genetic theories, including the ADHD theories:

http://www.jayjoseph.net/GeneIllusionChapters.html

and

http://www.jayjoseph.net/MissingGeneChapters.html

―Cesar Tort 07:35, 31 December 2006 (UTC)

[edit] Lazy parents

Would like to see a section about how lazy parents who would rather drug their kids up than actually parent them added to this article. —The preceding unsigned comment was added by 64.207.61.98 (talk) 15:59, 15 January 2007 (UTC).

There are numerous "faith based" critics yet they all lack a good scientific foundation for their claims. Speaking of lazy parents, Peter Breggin the outspoken anti-psych, came up with DADD as the cause of ADHD back in 1991. "...most so-called ADHD children are not receiving sufficient attention from their fathers who are separated from the family, too preoccupied with work and other things, or otherwise impaired in their ability to parent. In many cases the appropriate diagnosis is Dad Attention Deficit Disorder (DADD) (Breggin, 1991)....The "cure" for these children is more rational and loving attention from their dads. Young people are nowadays so hungry for the attention of a father that it can come from any male adult. Seemingly impulsive, hostile groups of children will calm down when a caring, relaxed, and firm adult male is around...."

Yeah right, I fear Breggin has watched one to many Stephen Speilburg movies where children have an absent father and all is resolved when dad watches their baseball game. The world just ian't that simple. Will the Austic kid and Bipolar kid get better when dad coaches their team?

There are numerous studies that show that this is not primarily an environmental disorder. Studies show that there is a strong genetic component to ADHD, it's more heritable then height or intelligence. --Scuro 21:21, 15 January 2007 (UTC)

It amazes me anyone really believes this disease. My brother was "diagnosed" with this "disease" and he can concentrate fine on a video game for 9 or 10 hours straight. He can't concentrate on schoolwork because he finds it boring. If you want to drug your kids into studying instead of teaching them discipline, be my guest, but no need to make up a disease to help parents feel a little better about doping up their kids simply so they can have a few less headaches as a parent.

It's not a disease, there is no agent that causes ADHD. You have been reading to much Fred Baughman. His poor logic is visible in your ideas. --scuro 22:40, 19 March 2007 (UTC)

[edit] POV

This article is just a hodgepodge of POV.

Many critics of the diagnosis of ADHD do not agree that it should be classified as a disorder even though there is a wide body of clincal evidence that indicates ADHD causes impairment in life functioning and that behaviour associated with ADHD has been clinically shown to be abnormal in those with ADHD. [1] Yet, these critics believe that it should only be considered a difference in methods of thought and mental organisation, more akin to a distinctive physique than to an actual disorder.

-Fairness of tone is lacking here. The clinical evidence is asserted as true and it's place in the article just serves to make the critics' point seem inferior and in total contradiction to science.

Also, much of the research about ADHD actually contradicts facts asserted by the mainstream psychiatric establishment. The brain scans that lead this article supposedly show the difference between an "ADHD" and "Normal" brain, yet Zametkin later admitted that differences in sampling led to any discovered differences in the 1990 study.[citation needed] There are massive ambigiutities still in the science and NIMH does not widely release their data for re-analysis by other researchers who may be critical of the concept of ADHD[citation needed], which is exactly the opposite of the ideal scientific method.

-Ok, first the phrase "mainstream psychiatric establishment" is showing clear bias against psychiatry. last sentence is full of statements such as "there are massive ambigiuties[sp] still in science" and "exactly the opposite of the ideal scientific method". These arguments need to be sourced and ideally that whole section needs to be rewritten, pretty much nothing is sourced and only the critics views are really represented.

The section about Sub-Clinical ADHD is written without attributing views to anybody, and is partial toward the critics leaving most of their claims unchallenged while only putting in a token statement "However, the results achieved in clinical tests with medication and anecdotal evidence of parents, teachers, and both child and adult sufferers has been taken as proof that there is both a condition and successful treatment options for most people who meet the criteria for a diagnosis." which is compromised by phrases like "anecdotal evidence" and "has been taken as proof".

Confusion may also arise from the fact that ADD/ADHD symptoms vary with each individual, and some mimic those of other causes. A known fact is that, as the body (and brain) matures and grows, the symptoms and adaptability of the individual also change. Many individuals diagnosed with ADD/ADHD successfully develop coping skills, while others may never do so.

-If you assert that some point of view is confused you damn better source that statement

There are numerous, often contradictory, claims that the brain is physically different in children with ADHD.

-Using the phrase "often contradictory" undermines the validity of this statement and it makes pretty much no sense.

There are numerous, often contradictory, claims that the brain is physically different in children with ADHD. However, even if this eventually is confirmed, by no means does it establish that the condition is biological. Behavior can cause changes to the structure of the brain. For example, learning Braille causes enlargement of the part of the motor cortex that controls finger movements.[2] After they have passed their licensing exam, London taxi drivers have been found to have a significantly enlarged hippocampus compared to non-taxi drivers[3][4]. Patients abused during their childhood with post traumatic stress disorder will have a flattened out hippocampus.[5] Professional musicians have brains that are different from non-musicians.[6] Monks who meditate show measurable differences in their prefrontal lobes.)[7][8][9] So diminished concerted effort when confronted with tasks thought to be drudgery (homework, paying attention to teachers, and the like) even if not caused by differences in the brain, could have brain changing effects.

-Attribute this argument to somebody, this should really be sourced if a significant minority holds it, or removed if it's just a couple people who believe this. As far as I see it, this is a logically flawed argument as theory claims that it is possible to diagnose ADHD at early ages, and in fact many are diagnosed before 7. This paragraph represents bias in favor of critics and skews the whole etiology section.

Critics have noted that the hypothesis "ADHD exists as an objective disorder" is unscientific, and point out that people generally assume that something is scientific just because it sounds scientific [10]. A minority but vocal number of critics have stated that ADHD is not falsifiable and that ADHD is simply a list of symptoms. Yet, theories for the origin of ADHD behaviour were made as far back as 1902 by George Still. He believed these behaviours could be explained a "notion of defective volitional inhibition and moral regulation of behavior". [3] Numerous theories from other researchers have been made since then with most current theories focusing on inhibition as the core deficit of ADHD.

These vocal critics also believe that even if a sharp objective difference is found between ADHD and non-ADHD groups, that this does not prove that the difference constitutes a pathology. They point out that behavior that is considered normal-variant like homosexuality or left-handedness, likely has a neurochemical or neuroanatomical basis as well. These criticisms fail to take into account that ADHD is not a disease but a disorder and that normal-variant behaviours such as homosexuality do not meet the main criteria of a disorder which is disfunction or distress of the individual.

-Using the phrase "vocal critics" is unecessary and undermines their message -Second paragraph makes assertions without sourcing them, homosexuality causes distress to some people and there are ADHDers who believe in its special powers and refuse to be medicated.

Nor does a genetic basis for the characteristic of hyperactivity prove a biological basis of Attention Deficit Hyperactivity Disorder. Particularly, the theory that DNA may contribute a probabilistic susceptibility to mental disorders, often assumed in medical literature, is unproved, and possibly unprovable. Psychological diagnoses may well fall into the category of unfounded cultural prejudices, along with racial classifications based on skin color, and religious hatred.

-You seriously need to source claims like this. If something is "often assumed in medical literature" then readers should be provided with sources of who makes the claim and why exactly it is supposed to be unproved.

Ok, I'm tired now. The other half of the article on alternative theories isn't too bad. But the first half looks like the aftermath of a battle between scientologists and ADHDers ending in the ADHDers losing interest and the scientologists going off to rant elsewhere. What we are left with is an article that contradicts itself in a number of places and strong bias in at least half the sections. I am posting this analysis to see if anyone agrees that I have correctly identified the biases. If we have some kind of consensus then this article should be edited and every unsourced statement taken out until a source is found.