Talk:Attention deficit hyperactivity disorder

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)

 Done Addressed by Димитрий Улянов Иванов. —Sirdog (talk) 19:55, 28 January 2025 (UTC)

@Димитрий Улянов Иванов: I'm also struggling to understand this poorly written sentence and can't obtain online access to the original source (Barkley's chapter). As the sentence is directly copied from the abstract we need to paraphrase it because of copyright, anyway -- hopefully we can made its meaning clearer! The key part that's indecipherable to me is "bind contingencies across time"; the rest makes sense but its meaning is made unclear because of this phrase. Perhaps you could take a look at the original source when you have time and paraphrase it in layman's terms for us? Jr8825 • Talk 10:19, 29 January 2025 (UTC)

Certainly I will take note of this and reply here once I can, I appreciate your checking of this issue. Димитрий Улянов Иванов (talk) 20:11, 31 January 2025 (UTC)

Hi @Jr8825, sorry for the belated reply. By binding contingencies, the authors are referring to the temporal organisation of goals and events into one underlying goal. It might help to give a real life of example: if I promised to meet someone at a restaurant I'd have to take into account the time I need for preparation, traffic, weather, finding the location, and other factors.. These are all separate tasks but can be combined for the pursuit of the main goal of meeting the person at the restaurant. However, someone with executive functioning deficits (as seen in ADHD) may find it significantly harder to plan and organise their behaviour over time to that one main goal hence how it's reflected with their propensity for lateness, forgetfulness, showing up disorganised, etc. which impairs their social functioning in this context. Executive functions like inhibition and verbal and non-verbal working memory involved largely to facilitate social cooperation and thus help us address our longer-term welfare better.

With all of that said, as the term hasn't been contextualised in that sentence it is indeed confusing for readers so I would reword "bind contingencies" to something else, such as "organise behaviour over time". Димитрий Улянов Иванов (talk) 13:03, 9 March 2025 (UTC)

"Heritability rate of 70-80%" might be misleading

In the lead section, fifth paragraph: "Meta-analyses have shown that the disorder is primarily genetic with a heritability rate of 70-80%, where risk factors are highly accumulative."

Since heritability is an often misunderstood concept there should be some explanation of what the sentence means. 50.53.85.74 (talk) 00:12, 1 February 2025 (UTC)

Hi there! It is not quite clear which explanation you would like to see. Please tell us! Lova Falk (talk) 17:20, 27 April 2025 (UTC)

To-do

Please feel free to contribute.

• Rewrite and shorten summary of 2025 life expectancy study in #Prognosis, replace news sources with academic literature or science journalism.
• Continuation rates into adulthood and prevalence figures in #Prognosis and #Epidemiology: expand on widely ranging literature: [1] [2] [3] [4] [5]; Include range in updated European consensus statement
• Replace excerpt section #Problematic digital media use with shortened summary
• Keep an eye on section sizes (current readable prose size as of 12/02/25 is 10458, within the limits of WP:SIZERULE)
• Read 2024 review article on ADHD in adults and include if helpful (available free via the WP:LIBRARY).

Jr8825 • Talk 03:08, 12 February 2025 (UTC)

Hi Jr8825. Medical topics are not my area, but I was recently diagnosed and a friend told me about rejection sensitive dysphoria—emotional sensitivity caused by real or imagined rejection. I can see a lot of material about it online but it isn't mentioned in the article. I am not the expert here but I don't think it's a fringe topic. I've found the following resources but please double check them as I cannot vouch for their quality:

• Ginapp, Callie M.; Greenberg, Norman R.; MacDonald-Gagnon, Grace; Angarita, Gustavo A.; Bold, Krysten W.; Potenza, Marc N. (2023-10-12). ""Dysregulated not deficit": A qualitative study on symptomatology of ADHD in young adults". PLOS ONE. 18 (10): e0292721. doi:10.1371/journal.pone.0292721. ISSN 1932-6203. Archived from the original on 2025-02-06.{{cite journal}}: CS1 maint: unflagged free DOI (link)
• Beaton, Danielle M.; Sirois, Fuschia; Milne, Elizabeth (February 12, 2025). "Experiences of criticism in adults with ADHD: A qualitative study". PLOS ONE. 17 (2).

It would have been very helpful for me, personally, to see this a long time ago, so thought I would ask about it. — ImaginesTigers (talk∙contribs) 14:22, 27 February 2025 (UTC)

Hi ImaginesTigers, I found a short paragraph about this and copied it into this article. I kept the social rejection parts because earlier in this article, it says: "About half of children and adolescents with ADHD experience social rejection by their peers compared to 10–15% of non-ADHD children and adolescents." What do you think about this paragraph? Lova Falk (talk) 15:58, 17 March 2025 (UTC)

Burden to Society

The line "The disorder costs society hundreds of billions of US dollars each year, worldwide" exists solely to put the topic in a political light, painting those with a disability as a burden to society.

Medical topics should not be used to have a sly debate about whether or not those with the medical condition should or should not be supported by society. If this existed on the alzheimers page or dementia people would rightfully and immediately recognise it and remove it. Why not here?

Eugenicspedia 2A02:C7C:4624:8100:50F6:6460:74E6:1A2D (talk) 03:53, 17 March 2025 (UTC)

First of all, you are projecting your own assumption of a political bias when in fact there is none. Its inclusion in the article was done to reflect the global scientific consensus. The International Consensus Statement on ADHD highlights it as one of five of the most key research findings (see: https://www.sciencedirect.com/science/article/pii/S014976342100049X).

It is also equally if not more plausible that the finding encourages policymakers to invest more resources into diagnosis, treatment, accommodations and protections to help with reducing people's impairments. That is antithetical to stigmatising people with ADHD.Димитрий Улянов Иванов (talk) 14:21, 17 March 2025 (UTC)

ADHDer here - While I do see your point, there a possibility of this statistic being misinterpreted to mean people with ADHD are a burden to society, especially given how misunderstood ADHD sometimes is. Perhaps this section could be reworded to clarify its intended meaning? 2604:2B80:10:5:859F:8C00:38D:BF8C (talk) 02:12, 11 May 2025 (UTC)

May I ask how you think it can be reasonably misinterpreted? I agree that, as with any statement of fact, one may reach some interpretation that isn't conveyed or suggested with what was said. As an encyclopaedia, we should focus on presenting the facts as they are, rather than changing what is written in fear of what some readers will wrongly presume as that is their responsibility. Димитрий Улянов Иванов (talk) 20:08, 11 May 2025 (UTC)

It is badly written. Hundreds of billions for what exactly? Is it for treatment? Research? Mentioning societal costs isn’t bad, but this statement has no details. "Hundreds of billions" is also not very formal. Maybe it can be rewritten with better detail? Slothwizard (talk) 04:37, 11 May 2025 (UTC)

After looking further into it, most of this statement is directly quoted from the source without quotation marks, so I went ahead and removed it. Am tagging @Димитрий Улянов Иванов in case he has any input. If it would be re-added, it should be reworded and provide greater detail as to what it means. Slothwizard (talk) 04:42, 11 May 2025 (UTC)

It's not an explicit quotation because three words differ between the two statements (ADHD, the disorder, US). The sentence is short, so I don't understand why it needs to be changed so dramatically so as to not count as a quote. We can contextualise it further based on eits contributingj factors but for a statement of fact,this is unnecessary. I don't see a meanginful difference between that and the statement:

"It is associated with other mental disorders as well as non-psychiatric disorders, which can cause additional impairment"

And the importance of the fact is evident with the global scientific consensus affirming it as one of the 5 key research findings on the entire topic of ADHD . For this reason, I included it in the lede. Димитрий Улянов Иванов (talk) 20:03, 11 May 2025 (UTC)

The bigger issue is that it isn’t written in an understandable way. What is the "hundreds of billions" for? This isn’t Parkinson’s disease, it isn’t exactly clear where this money is being spent towards and who is spending it. I also mention that "hundreds of billions" is not very formal. It should be rewritten to include more detail, which would fix any doubt about the quoting issue on the side. Slothwizard (talk) 20:09, 11 May 2025 (UTC)

I understand your concern. I'll try to get back to you with some ideas once I have some free time to do so. Thanks for checking on this issue Димитрий Улянов Иванов (talk) 20:12, 11 May 2025 (UTC)

Here is the non-summarised version of the conclusion in the International Consensus Statement:

"People diagnosed with ADHD have an elevated risk for school failure, antisocial behavior, other psychiatric problems, somatic disorders, drug and alcohol abuse, accidental injuries, and premature death, including attempted and completed suicide. As a result, ADHD costs society hundreds of billions of dollars each year."

The lede should provide a summary of the finding. Thus, we could write something along the lines of:

"As a result of such impairments, the disorder costs society hundreds of billions of US dollars each year, worldwide".

Inserting the sentence after "...a reduction in life expectancy" so as to contextualise it.

I disagree about the formality. The international consensus statement consistently writes it as such and it is in compliance with the journal's policy on formal, academic writing. Димитрий Улянов Иванов (talk) 10:38, 14 May 2025 (UTC)

Accident/injury type, and overall risk, changes over lifespan

In the "Comorbidities" section, [Attention deficit hyperactivity disorder#Non-psychiatric|"Non-psychiatric"] subsection, an error in punctuation can confuse readers in this phrase:

"In June 2021, Neuroscience & Biobehavioral Reviews published a systematic review of 82 studies that all confirmed or implied elevated accident-proneness in ADHD patients and whose data suggested that the type of accidents or injuries and overall risk changes in ADHD patients over the lifespan."

The sentence phrase is largely copied verbatim (and possibly in violation of WP:COPYVIO) from the cited source...

(Brunkhorst-Kanaan N, Libutzki B, Reif A, Larsson H, McNeill RV, Kittel-Schneider S (June 2021). "ADHD and accidents over the life span - A systematic review". Neuroscience and Biobehavioral Reviews. 125. Elsevier: 582–591. doi:10.1016/j.neubiorev.2021.02.002. PMID 33582234. S2CID 231885131.)

...which states, in the study's abstract, that:

Our results suggested that accident/injury type and overall risk changes in ADHD patients over the lifespan.

However, a closer, more thorough reading of the source reveals that the source abstract's sentence should have commas (or em-dashes) separating the phrase "and overall risk" -- as a separate topic from "accident/injury type". This is exemplified by the fact that each phrase has its own separate topic subsection in the source article:

• 3.1. Is there a change in the risk of accidents and injuries over the lifespan in ADHD?

...and...

• 3.2. ADHD and accidents – does the type of accident/injury change over time?

Thus, for clarity -- and to avoid verbatim transcription that might violate copyright -- I've modified the sentence to read:

"In June 2021, Neuroscience & Biobehavioral Reviews published a systematic review of 82 studies that all confirmed or implied elevated accident-proneness in ADHD patients and whose data suggested that the type of accidents or injuries -- and overall risk -- changes over the lifespan of ADHD patients."

Penlite (talk) 03:02, 21 April 2025 (UTC)

Like Good work! Lova Falk (talk) 17:14, 27 April 2025 (UTC)

"About 70 per cent respond to the first stimulant tried and as few as 10 per cent respond to neither amphetamines nor methylphenidate"

As far as I can tell, the citation for this just cites another paper, a 1991 paper, "Methylphenidate and dextroamphetamine treatments of hyperactivity: Are there true nonresponders?", which itself only tests boys, not girls, and only children, not adults, with n=48. 138.251.184.150 (talk) 00:47, 10 May 2025 (UTC)

Why is Atomoxetine listed in a different category?

It is also a SNRI just like methylphenidate. As such just as much of a stimulent. Is this some ad-edit by the company, or just a mistake?Carewolf (talk) 07:25, 21 May 2025 (UTC)

Atomoxetine is a selective norepinephrine reuptake inhibitor (sNRI). Methylphenidate is a norepinephrine–dopamine reuptake inhibitor (NDRI). They are different categories that produce different effects. Additionally, atomoxetine is not fast acting and takes multiple weeks before any therapeutic effect is seen – it is not a stimulant. Slothwizard (talk) 09:01, 25 May 2025 (UTC)

Bias towards describing ADHD too severely on this article

The article describes ADHD very negatively, and lists countless ways the condition is likely to cause a problem. If someone was reading this article as their first introduction to ADHD, by the second paragraph they would probably be convinced that ADHD is a massive problem, not only to the affected persons productivity, but also on their mental health, physical health, and even to the economy, meaning we should obviously work towards eradicating the condition if we could. This lead describes the condition around as severely you would expect for Major depressive disorder (in fact, the second lead paragraph is probably more severe than anything in the depression lead, which doesn't even mention reduced life expectancy or the suicide).

Compare this to the article on Autism, which has a paragraph in the lead dedicated towards the idea of Neurodiversity, that autism is not necessarily strictly bad and that its even "a healthy variation of the human condition". Keep in mind, the autism article is still critical of the idea of neurodiversity, but at least it mentions it at all, given that it's become a pretty prominent topic of discussion, at least in developed countries. Potential positives are relegated to a small paragraph near the bottom, and they are described as new research and hypothetical. Here are examples of sources specifically tied neurodiversity and how it relates to ADHD: [1] [2], [3]. [4] [5] It seems like bias to me to not even mention neurodiversity at all in this article, even if it's described critically. ALittleClass (talk) 20:24, 21 May 2025 (UTC)

Thanks for the opportunity to evaluate this matter but I'm sorry to say that your post does not stand up to serious inspection.

First, all of your 5 citations are links to newspapers/trade media outlets, which are not scientific material peer-reviewed in reputable journals. Wikipedia guidelines indicate that such citations should not be relied on but rather the scientific consensus in the field. The Neurodiversity Movement's assertions are wrong. In September 2021, 80 of the world's leading scientists on the topic published the 2nd International Consensus Statement on ADHD, endorsed by over 400 other experts and numerous professional groups, from 27 countries and 6 continents, thus representing a global scientific consensus and hence its inclusion in this page. As they conclude, ADHD is a valid disorder, and its seriousness is reflected similarly to the page here. The justifications used in those articles to claim otherwise are refuted in great detail in the corresponding section of the International Consensus Statement. The Neurodiversity Movement's perspective on ADHD has no scientific relevance which is why it is not mentioned nor legitimatised. Standardised diagnostic criteria (e.g the DSM-5 or ICD-11 from the World Health Organization (WHO)) and guidelines (e.g the UK National Institute for Health & Care Excellence (NICE) or the European Society for Child & Adolescent Psychiatry) are also unanimous in recognising the validity of ADHD as a disorder.

Second, according to the scientific consensus, which goes back to the first International Consensus Statement, two criteria must be met to establish a neurodevelopmental disorder. (1) There must be evidence of variation or a deficit in a psychological trait universal to humans (2) that is sufficiently severe to cause significant impairment in major life domains, and/or predispose to increased risks for morbidity and early mortality.

ADHD easily meets this criteria. It is an underlying disorder of executive functioning deficits, which cause significant impairment in those domains of functioning, it predisposes to numerous health risks as a direct consequence of its inhibitory deficits including a 13 reduction in life expectancy (e.g., see Barkley & Fischer, 2019 and Cattoi et al., 2022). Considering the statistics, ADHD is also arguably more serious than MDD.

There is nothing written in the article that would suggest or imply a narrative of eradicating the disorder. A far more plausible implication, which isn't explicitly stated as we're just presenting the facts here, is that the seriousness of ADHD warrants an individual to seek a diagnosis and get access to treatment if they want to. I don't see how the information here would imply some authoritative dictatorship of some sort forcing people to be cured (there is no known cure for ADHD at this time, by the way) so as to eradicate it.

I've been involved in the dispute regarding similar issues on the ASD page on Wikipedia, I'm well aware of the issues there. In my opinion, the pagr has been hijacked by editors with their own conflicts of interest seeking to promote a political movement's view of the disorder, which has led to an inaccuracy of content. I'm glad to see that this hasn't happened here. However, the page continues to represent the validity of autism as a neurodevelopmental disorder, even if it contradicts the scientific consensus in other ways.

There are more points I could make here but I think I've written enough. Димитрий Улянов Иванов (talk) 12:36, 22 May 2025 (UTC)

I was not disputing that we should list ADHD as a disorder (although many people could), or that it causes people significant issues. As someone with ADHD, I know this firsthand.

You're probably right to suggest that I link scientific studies instead of just news articles. Well, there have been research studies on the ideas surrounding neurodiversity: [1] [2] [3] (on the theory of Double empathy, which has been supported numerous times). Obviously, the idea that ADHD is not as disorder not the universally accepted consensus currently, but we need more than one person's opinion to conclude that this movement as a whole has "no scientific relevance", or that editors that disagree with your view are people with "conflicts of interest seeking to promote a political movement".

(Also, claiming "ADHD is arguably more serious than MDD." is just untrue. As someone who has ADHD, knows multiple people with ADHD, and has known people with MDD, I can say with certainty that MDD is in the vast majority of cases much more serious than ADHD. Just from a cursory glance at studies, people with ADHD had a 24% increased risk of suicide compared to the general population [1] which is still an issue, but people with MDD had an increased suicide risk of 766%. [2] Extrapolating from your talk page, I assume you know a great deal specifically about ADHD and it's negatives, so I will trust your information on the condition itself, but not a comparison like that.) ALittleClass (talk) 20:26, 22 May 2025 (UTC)

over-emphasis on executive functions in article + errors in source usage

Hi wikipedia editors!

I've been reading this article as part of research for my MSc dissertation on ADHD, and it seems like there'a a consistant error with regards to the emphasis being placed on executive functions - the article repeatedly asserts that executive function deficits are the primary reason for ADHD symptoms. e.g. (from the first paragraph) "ADHD symptoms arise from executive dysfunction"

This seems to ignore the fact that this is a matter of some controversy in the field, and many top researchers would deny this is the case. This is explained really well by source 10 (Pievsky & McGrath, 2018), which lays out briefly in their introduction the many competing approaches to understanding the origins of ADHD symptoms. Indeed, this article (Pievsky & McGrath, 2018) ultimately ends up supporting the default mode model over the executive functions model. To quote the authors:

"These results lend support to the default mode model, which posits that deficits in ADHD arise because the brain has difficulty switching from rest mode to an active mode." (Pievsky & McGrath, 2018)

Even more puzzling, this article (Pievsky & McGrath, 2018) is cited in support of the statement "ADHD symptoms arise from executive dysfunction", despite the fact that it explicitly endorses an alternative theory, and also lays out a whole range of theories which compete with the executive function theory of ADHD.

I think this controversy ought to be acknowleged in the wikipedia page, whether by rewriting the many sections of the page which state that executive function deficits are the cause of ADHD symptoms to reflect the uncertainty in the field, or by including a dedicated section to explaining why this is a contentious statement.

Interested to hear your thoughts! Gidonyosef (talk) 11:34, 27 May 2025 (UTC)