Talk:Attention deficit hyperactivity disorder/Archive 3

message: There is some controversy over the meaning of  the research by Dr. Alan Zametkin that produced these images; the statistical findings visually demonstrated here were found to be the result of sampling error. The adults in these studies were in most cases severely dysfunctional.Bitch Hoe.
I removed this statement because no reference is given and no reference could be found for it through Google.  --*Kat* 17:35, 10 September 2006 (UTC)
thread_title:  == Statement removed from Caption 

message: I'm a newbie and do not know how to correctly add info; Could an expert help?
I'd like mention of National AD/HD Awareness Day, Sept. 20, 2006 as named by Senate Resolution 544.
This will be done annually, but the date changes.  www.ADD.org (Attention Deficit Disorder Association) can be used as a "for more info" referral.  Thank You,--BonzaiBev 15:59, 13 September 2006 (UTC)
thread_title:  Newbie requesting addition 

message: I could be completely wrong here, but I believe that ADD and ADHD are not the same diagnosis.  Some sources:
Web4Health.info
add.about.com
Am I completely off base here, or do I have a point?
Minidoxigirli 21:43, 19 September 2006 (UTC)
replies: text: Ah, got it.  Should have checked there first!:)Minidoxigirli 02:37, 20 September 2006 (UTC)
thread_title:  ADD and ADHD are not the same. 

message: The 'brain scan' photograph that leads off this page should not be there. Zametkin retracted his 1990 results as being the results of gender differences and flatly stated that Brain Scans cannot be used to diagnosis ADHD. It is very misleading (especially the colors, which do not appear in the original scan) and is basically a propaganda tool. As long as Wikipedia has stuff like this on it, it will be laughable. —The preceding unsigned comment was added by 146.201.100.221 (talk • contribs) .
:I got an email from Zametkin the other day about that image.  He didn't say anything about retracting its validity.  And yes, I did ask.  Cite your source.--*Kat* 11:04, 24 September 2006 (UTC)
replies: text: Zametkin had his research re-done on brains in 1996 and the outcome was: no difference in the brains. If *Kat* had email contact with Zametkin and he didn't say anything about retracting its validity even though she asked, did he say it was valid? Immortale 21:59, 27 December 2006 (UTC)
thread_title: Brain scan image

message: we hae an adhd 7 yr old oldest of 4 girls. she has been on concerta for 6 months. helps but i wishi could do for ~ her and our family. need to share information with other peopls,  Tammy —The preceding unsigned comment was added by 24.67.253.203 (talk • contribs) .
:Would like to help you, but this is the talk page for a Wikipedia article, it's not a message board. Discussion should be about the article itself, not the topic of the article. Also, Wikipedia:Medical disclaimer. Try some of the links in the External links section. -- Ned Scott 08:36, 23 September 2006 (UTC)
thread_title:  need to talk. 

message: A recent Washington University in St. Louis study indicated that almost 50% of ADHD cases in America may not be detected and treated. This lies in stark contrast to the claim the condition is overmedicated.[16]
The study described seems to be about genetic influence rather than diagnosis in America, as all the test subjects were twins.  How can the claim be made that is representative of all of America, if it only involves twins?
The article cited states that "58 percent of boys and about 45 percent of girls who had a diagnosis of full-scale ADHD got any medication at all", so the cases are simply not treated, rather than not detected.
The article states that 3.6% of Boys and 2.6% of girls in the study were taking stimulants, despite the fact they do not meet the requirements for diagnosis.  Then the study does not contrast with the claim the condition is overmedicated, rather it proves it.  
Finally, a single, recent study by one university is not worthy of mention.
The statement should be removed. William conway bcc 22:18, 25 September 2006 (UTC)
replies: text: done. -- Ned Scott 02:45, 26 September 2006 (UTC)
thread_title:  Problems with this statement 

message: Per the recommendations of the people at FAC, I have removed the list of medications used to treat ADHD and replaced it with a paragraph that summarized that list. (found here )  Since the list contains so much useful information, I propose that a separate article be created for the contents of that list.  I further propose that we do something similar with the Timeline section.--*Kat* 19:22, 30 September 2006 (UTC)
thread_title:  Note about the Treatments section and a couple of proposals 

message: Another source of controversy, especially in the United States, is the use of psychotropic medications to treat the disorder. In the United States outpatient treatment for ADHD has grown from 0.9 children per 100 (1987) to 3.4 per 100 (1997).[49]. However it has held steady since then.[50]
The two sources give different numbers. According to http://www.nimh.nih.gov/press/adhdmedsuse.cfm (source 50) 
U.S. children ages 18 and younger had increased sharply from 0.6 percent in 1987 to 2.7 percent in 1997
The problem here may be two different definitions of 'children' in the 49th and 50th source, it may be more complex.  Someone should look into the conflicting numbers. William conway bcc 19:45, 14 October 2006 (UTC)
thread_title:  Conflicting Numbers 

message: :The neuropsychology literature looking at brain function in ADHD is "large and complex". Dysfunction of various fronto–striatal structures (lateral prefrontal cortex, dorsal anterior cingulate cortex, caudate, and putamen) have been implicated . Additionally, the cerebellum has been shown to be smaller in the brains of those with this disorderXavier Castellanos, Judith Rapaport, "Scientific America" (August, 2003). Changes in dopamine transporters have also been observed .
I've clipped this paragraph out of the now removed Psychopathology section.  It doesn't appear to be saying anything that the Hereditary Dopamine Deficiency section omits, but I could be wrong.  If it goes back in, it should probably be dumbed down just a bit.--*Kat* 02:16, 26 October 2006 (UTC)
replies: text: The dopamine stuff is only really related to the fronto-striatal structures, and not the cerebellum. It also leaves the Zametkin scan image hanging in the wind a bit, without referencing the other 30+ such studies conducted since then (many with improved technology over that available 15 years ago). I also think it would be preferable to have a section on known neural level changes, distinct from a causal discussion. --Limegreen 10:36, 26 October 2006 (UTC)
thread_title:  Say what??? 

message: The Analytical diagnosis is redundant, perhaps we can remove it. The mention of the brain scans is simply a summary of the section that follows two paragraphs later. The idea of diagnosing through psychological analysis is mentioned earlier. Rares 03:59, 29 October 2006 (UTC)
thread_title:  Analytical diagnosis 

message: The Diet section contains information about how a protein deficiency can cause symptoms that are consistent with ADHD.  While we have a source to back up that an early-life protein deficiency can cause this permanently, I have only barely managed to find something to back up that ADHD-like symptoms can be caused by an immediate protein deficiency.  The source is, how shall we say, less than ideal.  I would really like to find something in some form of respected medical journal, diagnostic reference, etc.  Unfortunately, having little familiarity with medical "whatnots" I wouldn't really know where to look.  I am hoping someone else will.
Just to be clear, there should be no concern over whether or not a protein deficiency can cause ADHD-like symptoms, only over finding a source to make it verifiable for Wikipedia purposes.  I have confirmed the information numerous times with nutrionists (and an endocrinologist, of all things), but unfortunately none of them could offer me a handy reference I could cite for the information. -- Y|yukichigai 07:04, 29 October 2006 (UTC)
thread_title:  Sources for Protein Deficiency as cause for ADHD-like symptoms 

message: As ADD is now being classified separately from ADHD, the article shd not be merged -- The preceeding unsigned comment was left by 
:If you have a linkable source that can back that up it would be most welcome. -- Y|yukichigai 17:34, 31 October 2006 (UTC)
replies: text: Not according to the DSM-IV-TR...unless there is a major update that has somehow slipped under my radar. -- Tim D 07:12, 1 November 2006 (UTC)

text: "ADD" isn't officially a disorder in itself...at least not right now. It's a subtype of ADHD (primarily inattentive), hence the redirect to this article. -- Tim D 01:11, 10 November 2006 (UTC)

text: Perhaps a section could be dedicated to the differences? --*Kat* 02:26, 10 November 2006 (UTC)
replies: text: Holy cow, I can't believe there isn't a section describing or comparing the subtypes! I don't know how I didn't notice. So yeah, we need to get on that. -- Tim D 04:26, 10 November 2006 (UTC)

text: Yeah, I was confused about that too. The main article (this one) contains all the useful information anyways and it pretty much applies to both children and adults. I had proposed a merge not too long ago, but no one seemed to want to go along with it. -- Ned Scott 11:02, 14 November 2006 (UTC)
thread_title:  Attention Deficit Disorder 

message: It would seem that anxiety could be quite easily mistaken for ADHD, especially in children.
http://www.healthology.com/mental-health/stress/article261.htm
In any case, I have Generalized Anxiety Disorder, and when I'm at my worst, it certainly seems to emulate the symptoms of severe inattentive ADHD (among others).
A number of things could be mistaken for a lack of focus and that is why you want an excellent practioner doing the diagnosis. Even so, an anxiety disorder has traits that are specific to it, that one would not find in straight ADD. --Scuro 22:19, 19 December 2006 (UTC)
thread_title:  Anxiety 

message: The Controversy section is getting pretty long.  I think we ought to consider moving some of the information over to the other article.  What do y'all think?--*Kat* 04:47, 6 November 2006 (UTC)
replies: text: Sounds like a good idea to me. I understand that ADD-critics want to have their say, but if the section gets too big in the main article then the neutral-point-of-view on the over-all article goes off balance. -- Ned Scott 19:13, 13 November 2006 (UTC)
replies: text: The question is: What should go, and what should stay?--*Kat* 08:25, 14 November 2006 (UTC)

text: This would be true if we didn't have a second article reserved specifically for the controversy, Controversy about ADHD. This isn't about not including the information at all, but rather about how we want to organize the information. -- Ned Scott 22:25, 1 December 2006 (UTC)
thread_title: Controversy

message: ADHD is a Neuropsychiatric disorder.  Not a psychological thing.  The Psychology Wikiproject "aims to improve articles on psychology; psychological theories, psychological research, and psychotherapy."  Making ADHD apart of this wikiproject gives the wrong idea of what ADHD is.--*Kat* 23:48, 18 November 2006 (UTC)
replies: text: I agree. -- Ned Scott 07:43, 19 November 2006 (UTC)

text: It's both, actually. The sources of ADHD may be biological, but psychology is involved in assessment and intervention. -- Tim D 20:31, 19 November 2006 (UTC)
replies: text: There is no hard boundary between psychology and psychiatry. As a result many medical schools have departments of "psychological medicine", containing both psychologists and psychiatrists. With respect to the research, many neuroscientists looking at ADHD will be in anatomy or psychology departments (and very rarely in psychiatry). Behavioural research will be the purview of psychology and psychiatry/psych med departments. I'm not aware of any neurologists actively studying ADHD, although their will be some.--Limegreen 22:07, 19 November 2006 (UTC)
replies: text: I'm the one who added the banner. There was a discussion on WikiProject Medicine about whether psychiatry-related topics could be included under WikiProject Psychology or if they should fall only under WikiProject Medicine. The discussion was brief, but everyone seemed okay with psychiatry articles being listed under both WikiProjects. The discussion can be found at Wikipedia talk:WikiProject Medicine/Archive 2#Overlap with Psychology WikiProject. ADHD (as well as OCD, which was also removed from the project) are topics covered in psychology programs and are of interest to psychologists as well as psychiatrists, so I think that the Psychology WikiProject would be relevant to the article. —Cswrye 05:59, 20 November 2006 (UTC)
replies: text: The discussion at the Medicine project was very brief, and it's not clear there was a consensus that medical conditions should be listed under the Psychology project:  I don't necessarily agree that neuropsychiatric conditions should be part of the Psychology project, and believe that Project needs to get more involved with writing and improving psychology articles, which are woefully inadequate on Wiki, with several of them recently losing FA status, as no one from the Psychology project worked to improve them.  Sandy (Talk) 15:23, 21 November 2006 (UTC)
replies: text: Okay, I'll leave this out of the project for now. Thanks for the input. —Cswrye 16:38, 21 November 2006 (UTC)

text: There's a very blurry line between neurological/psychiatric and psychological issues. By the arguments here, almost nothing listed in the DSM should be included in the project! Personally, I do not think that there should be a necessary distinct separation between the fields of study -- Tim D 17:04, 21 November 2006 (UTC)
replies: text: I agree with you, Tim D, but if the consensus of the editors of this article don't want this included in WikiProject Psychology, I'm willing to concede. Sandy makes a point in that we have many other articles we could be working on. —Cswrye 17:14, 21 November 2006 (UTC)
replies: text: I think this argument is predicated on weak reasoning. Neuropsychiatry is a fairly recent buzz word, and despite the initial ADHD is a Neuropsychiatric disorder.  Not a psychological thing., Neuropsychiatry is, by their own definition, interdisciplinary. There are no hard boundaries between any of these things as I, and others, have noted above. This statement also concerns me Making ADHD apart of this wikiproject gives the wrong idea of what ADHD is., because it could be interpreted as subtle POV (psychology=mental illness; neuropsychiatry=biological illness; mental illness is stigmatized; therefore let's make sure this is on the other side of the divide). --Limegreen 21:32, 21 November 2006 (UTC)
replies: text: I was born with ADHD.  I will die with ADHD. And no amount of psychological intervention can change that. On the other hand, the depression and anxiety that I have developed as a result of the ADHD, those are psychological issues.  I was not born with them, I will not necessarily die with them.  For me, that is the difference between a psychiatric and psychological disorder. Just my POV. --*Kat* 01:06, 23 November 2006 (UTC)
replies: text: And anxiety, depression, etc. can (and in many cases, must) be treated as psychiatric issues with medications (although usually not if they're sourced in a situation). Techniques taken from psychology can teach someone with ADHD how to best cope with and fight against the problems that come with it, and co-morbid problems can be prevented or treated through secondary effects. Research has shown that the best treatment for ADHD is a combination of psychopharmacological and psychosocial interventions. There is absolutely no doubt that ADHD is neurologically based, but like it's been mentioned before, the classifications are not mutually exclusive! -- Tim D 04:06, 23 November 2006 (UTC)
replies: text: Also, psychology doesn't equal psychological intervention. Psychology is the study of behaviour and cognition. It is not exclusively about humans, and really very little to do with mental illness. It is a *very* broad discipline, which overlaps with a great many things. Perhaps 10% of psychology overlaps with medicine, and probably 3/4 of that overlap is what might be considered psychiatry. However, very little of psychiatry does not overlap psychology. --Limegreen 11:17, 23 November 2006 (UTC)

text: Well, "consensus" is another tough thing to define on Wikipedia :) I wouldn't take a definitive judgment based on the opinion of a few, especially when the logic isn't completely clear. -- Tim D 00:58, 22 November 2006 (UTC)
thread_title:  WikiProject Psychology: Ummm...No. 

message: Looking at Wikipedia:Manual of Style (medicine-related articles), I noticed that it recommened that articles such as this one include a section on cultural references.  Which shouldn't be hard.  
It also recommended that (if possible) we include some notable cases. 
--*Kat* 00:01, 20 November 2006 (UTC)
thread_title: Cultural References

message: Hello- new here (this being my first addition), so please be gentle ;)
While doing research for a Psych final, I found an interesting bit of research stating early childhood exposure to television can be very harmful to the formation of an adaptive attention schema, as well as to the physiology of the brain itself.  a report issued by the AAP (American Academy of Pediatrics) warned parents not to let their youngsters watch TV between the ages of 1-3, as it can "negativly affect early brain development"
:ADHD is a genetic disorder that as far as I know (and I have been digging alot) is only Genetic or developed by a occigen shortage in the brein so I think it's unlikely that the tv can caus ADHD.
:StephanAB 12:36, 5 January 2007 (UTC)
thread_title:  Television as a possible factor in developing ADHD 

message: After twenty-five years, and thirty-five studies, there is not a single straightforward experiment comparing typical unmedicated children with an ADHD diagnosis to typical controls. The overwhelming majority of studies that have compared "ADHD" children to controls have used ADHD children with a history of medication use.  Why the researchers have not used medication-naive children is unknown.  It is hard to know if any differences seen between the patients and controls in these studies is due to an organic brain defect, as proposed by the researchers, or to the effects of the medication. In a 2002 NIMH sponsored study by Castellanos three groups were constituted: 49 unmedicated patients, 103 medicated patients, and 139 controls. Thus the authors had the opportunity to make numerous comparisons: unmedicated versus medicated, unmedicated versus controls, medicated versus controls, and ADHD versus controls.  The most important comparison being between unmedicated patients and controls. However, compared to the controls, the unmedicated patients were two years younger, shorter and lighter.Thus the researchers had to age match the patients with controls.  Why the researchers could not find more appropriately matched aged controls is unclear. (Leo and Cohen, 2003. Available at: http://psychrights.org/Research/Digest/NLPs/criticalreviewofadhd.pdf
In a 2003 NIMH sponsored study by Sowell et al the researchers also had a group of non-medicated children but according to the authors, “We did not directly compare brain morphology across groups of patients on and off drugs because the sample size was considerably compromised when taking lifetime history of stimulant drugs into account” (p.1705). Although NIMH states that researchers who receive grants should be willing to share their data, even a Freedom of Information act request to see the Sowell data was denied. See Cohen and Leo 2003 for more discussion at:
http://psychrights.org/Research/Digest/NLPs/neruoimagingupdate.pdf
------
Perhaps the answer is that there is no such thing as a "straighforward" experiment when children and brain imaging are involved.  Any experiment involving children involves serious ethical constraints.  Finding parents willing to allow their children to participate is difficult in and of itself.  Then there's the issue of the brain scans:  PET and SPECT brain scans involve not only ionizing radiation, but the injection of radioactive materials into the body.  While the health risks are generally considered small, there is still some risk involved, especially when you're considering control subjects, who do not have the condition and thus receive absolutely no benefits from the study.  Functional MRIs (fMRI) are at least safer in that they do not involve ionizing radiation, but most of the studies I've seen are either PET or SPECT.
And then you have the problem of finding medication-naive patients.  Most persons diagnosed with ADHD will take medication at some point in their lives.  For what you're asking, to completely rule out the effects of medication, you would have to find those who have been diagnosed but never medicated.  Newly-diagnosed patients might be an easy source for such volunteers, but newly-diagnosed patients would also present a problem in that there might be less certainty of an accurate diagnosis.  This also presents problems with age-matching, because diagnoses tend to occur at certain ages, since we are talking about a developmental disorder.  Aside from those patients who are newly-diagnosed, and those who cannot take medications for other health reasons (which might complicate the experiment anyways), I'd imagine that many parents who refuse to medicate their children would tend to be the types who would be highly distrustful of mainstream medicine and highly unlikely to allow their children to volunteer for such experiments.
68.83.217.164 10:25, 4 February 2007 (UTC)
thread_title:  ADHD Imaging 

message: EricaAckerman 23:00, 18 January 2007 (UTC)
thread_title:  Executive Function and Working Memory are not the same thing (as stated in the article) 

message: There is a grammatical error in the third paragraph of the "Hereditary Dopamine Deficiency" heading. In "the study was done by injected 20 ADHD subjects..." the "injected" should be "injecting"
Sharksandwich 03:11, 20 January 2007 (UTC)
replies: text: Done. -- Ned Scott 07:59, 20 January 2007 (UTC)
thread_title:  Grammatical Error 

message: I suggest people remove this link, and keep taking it out until it stays out! --Rdos 20:30, 23 January 2007 (UTC)
replies: text: What specific link are you talking about? -- Y|yukichigai (ramble argue check) 20:51, 23 January 2007 (UTC)
replies: text: I assume the link in Template:Infobox Disease. However, I would have thought that if you object to the idea of ADHD as a disease/illness, you'd be after removing the entire infobox, not just that link. I don't know anything about the disease database, so I'm not sure if it is particulary more or less offensive. There is a little discussion at Template talk:Infobox Disease about the box not being appropriate for "symptom" articles. However, despite a (perhaps significant) minority perspective that ADHD is not a medical entity, I think that is already fairly well covered here and in other articles. --Limegreen 22:18, 23 January 2007 (UTC)
thread_title:  Disease database - highly offensive 

message: First, the Zametkin findings in the article need to be clarified. The original study turned out to be sampling error. Above, in the discussion section, someone mentions this and then says that because they can't confirm it with Google, they deleted a previous comment to this effect. I would say that if you expect it to be found on Google, that's a bit silly. You will need to access PubMed or find some other way to actually read these articles.
The images are misleading also.
You're perpetuating a huge myth about ADHD because you are getting all your information from lay sources.
------
Do you have a source for your claim that Zametkin's original study (do you mean 1990?  1993? which study?) was due to a sampling error?  Did he retract the study or its findings, and if so, could you please provide a citation for the retraction?  Also, I think that the google remark may have been referring to http://scholar.google.com , a google engine that scours scholarly (and some not-so-scholarly) journals.  That being said, a pubmed search for "Zametkin AND retraction" and "Zametkin AND retract" produces no results (and no, I did not use the quotation marks in the actual search, I merely use them here to separate the Boolean "AND" from the conjunctive "and").  A similar search of http://www.nimh.nih.gov also produced no findings.  If the study or its findings were retracted, the retraction should have been published in the journal that originally published them, and should be available for citation.  It is your responsibility to provide evidence for your claim that the study was in error or was retracted, just as it was originally the responsibility of those writing the article to cite the study itself.  The study has been cited in the article, and will likely continue to be cited in the article until you provide evidence that it has been retracted.
Finally, the source for the PET scan image and its caption is cited as being the "New England Journal of Medicine", which was not a lay source the last time I checked.  In fact, a large number of the citations, especially in the sections to which you seem to be objecting, appear to be from peer-reviewed scientific journals.  Finally, what is this "huge myth" to which you refer?
68.83.217.164 10:48, 4 February 2007 (UTC)
thread_title:  zametkin issue 

message: Rafalovich, Adam.  2004.  Framing ADHD children : a critical examination of the history, discourse, and everyday experience of attention deficit/hyperactivity disorder.  Lanham, Md: Lexington Books.
 Buddyholly41 03:37, 1 February 2007 (UTC)
thread_title: New reading source

message: I've noticed there's been a lot of edit-warring over the External Links section, and yet most of the links there seem to be site promotion (WP:NOT#DIR). I think the entire section should go. Everything in there that doesn't better fit into the References section is going to be site promotion, "alternative" treatments, and general crap. --Boradis 23:28, 2 February 2007 (UTC)
thread_title:  External links spam 

message: If you check the peer-reviewed literature you will find that, indeed, he is correct. You are constructing a page on a complex behavioral condition by reading *abstracts*....?
------
A:  Please sign your posts, it makes things easier for everyone, especially those of us with short attention-spans.
B:  To whom are you referring when you state that "he is correct"?  Are you asserting that Zametkin (and/or his findings) were correct, or are you agreeing with someone on the talk page who asserted that Zametkin's findings were in error?  Please be more specific.
C:  "Peer-reviewed literature" is an extremely broad category, mind narrowing that one down for us?  Are you referring to a specific study, a specific journal, a specific researcher?
Your statement is as abstract as any pubmed search (ba-dump-bump-ching!)  
Hyperion35 22:47, 5 February 2007 (UTC)
thread_title:  zametkin 

message: I edited the Zametkin picture from NEJM and put in the appropriate caveats. This picture belongs in this Wiki entry as an example of a well-distributed image that has been used to explain ADHD, but it seems reasonable to add enough information to give real context. If someone went through the stimulant treatment and other sections with a critical eye the would also have to reduce claims and be more realistic. Blingbling1000 19:17, 6 February 2007 (UTC)
thread_title:  zAMETKIN REFERENCE AND FIGURE 

message: Almost forgot to write up the changes here, just for reference.  The caption now reads:
"An early PET scan study found that global cerebral glucose metabolism was 8.1% lower in medication-naive adults who had been diagnosed as ADHD while children. The image on the left illustrates glucose metabolism in the brain of an 'normal' adult while doing an assigned auditory attention task; the image on the right illustrates the areas of activity of the brain of an adult who had been diagnosed with ADHD as a child when given that same task. Additionally, the regions with the greatest deficit of activity in the ADHD patients (relative to the controls) included the premotor cortex and the superior prefrontal cortex. [16] A second study in adolescents failed to find statistically significant differences in global glucose metabolism between ADHD patients and controls, but did find statistically significant deficits in 6 specific regions of the brains of the ADHD patients (relative to the controls). Most notably, lower metabolic activity in one specific region of the left anterior frontal lobe was significantly inversely correlated with symptom severity. [17] These findings strongly imply that lowered activity in specific regions of the brain, rather than a broad global deficit, is involved in ADHD symptoms."
I removed the part about color being added, since it's a PET scan and thus redundant.  I added that the patients in the first study were medication-naive.  I left in the part about failing to find statistically significant global differences in the second study but added that there were important differences in specific regions, including the part about correlation to symptom severity (which is really the most important part of the study).  It might be a bit long, but at least it contains the main important information from Zametkin's 1990 study and the 1993 follow-up.  Also, it should be remembered that Zametkin wasn't the only one to find imaging differences, such as the multiple studies showing excess DAT density (Dougherty et al and Dresel et al are listed, also several studies by Krause et al could be included in that).  It's not just the one Zametkin study here, there's a long chain of evidence pointing to something odd going on involving dopamine and certain frontal lobe and associated striatal areas (and there are likely a few other regions involved as well).
By the way, a PubMed search for author Tyson between 1990-1992 returned 64 citations, but none of them were relevant to this discussion.  As I mentioned earlier, there is an unsigned editorial in NEJM from April, 1991, but I can't imagine that this is the Tyson article to which you refer, as it is an editorial essay and not peer-reviewed research.  I tracked down the link at NEJM, but there's no author listed.
Hyperion35 12:47, 7 February 2007 (UTC)
replies: text: Any "caption" that's that long should just be another paragraph in the article. Then the caption can just be a few simple words, as captions are supposed to be. --Boradis 20:00, 7 February 2007 (UTC)

text: As a former newspaper and magazine editor, let me just say that bloated captions offend me in a semi-religious way. :) Seriously though, how about a subsection of the article that's just about the photo that says what needs to be said, and the caption can just be the image credit: "Zametkin, et. al, 1993" or whatever. --Boradis 00:47, 10 February 2007 (UTC)
thread_title:   Revised Picture Caption  

message: I think that the controversy surrounding ADHD should comprise at least half of the article! This change should be made, to reflect the actual status of the matter ! —The preceding unsigned comment was added by 60.229.242.69 (talk • contribs).
:We did one better than that, we gave it it's own article called Controversy about ADHD. -- Ned Scott 06:06, 8 February 2007 (UTC)
replies: text: Sorry, that's not how things work here. Go troll somewhere else. -- Ned Scott 11:05, 9 February 2007 (UTC)
thread_title:  ADHD Contoversy 

message: I think that there should be a whole chapter about comorbility in ADHD since its known to be very commonly associated to many different syndromes such bipolar disorder (see articles of Biederman), learning disorders; drugs and alcohol abuse;antisocial behaviour... and quite some others (even more risk of having brain injuries or car accidents)
This problems are crucial both in the diagnostic procedure and for the outcome of the patient.
Does anybody agree? 
--Garrondo 19:17, 8 February 2007 (UTC)
thread_title: Comorbility

message: wow i can see why some people get frustrated with this page. 
-a PET scan being colored is not redundant, based on how it is colored, it can make the differences look more and less striking. 
- the revised caption to the Zametkin illustration certainly demonstrates the bias of those who are commited to keeping this page shaped towards sloppy non-significant evidence
----
Ok, but the caption edit that was made before claimed that the original scans were monochrome, and that they were given color to magnify the differences.  This is incredibly misleading, as all PET scans are colored, because the entire point of the PET scan is to highlight differences in signal intensity.  It is not an MRI.  Now, the study itself reported that it found statistically significant differences in the data.  Given these findings, it should not be surprising if the scans themselves show differences.  Do you have any evidence, aside from unsourced assertion, that the image used is falsely magnifying the differences as found in the study?  Do you have any evidence that the image used is colored in a manner not consistent with generally-accepted PET protocol?  Do you have any evidence that the differences highlighted in the image are well within generally accepted norms for PET imaging?  If you have some evidence to show, then perhaps it might be worth including in the article, but do you really expect that people are going to remove or alter a widely accepted published peer-reviewed article based upon unsourced assertions by an anonymous poster?  Even by wikipedia's admittedly lax standards, that's a bit of a stretch.
Also, how was my revised caption biased, and what "sloppy non-significant evidence" was involved?  I cited Zametkin's 1990 study as published in NEJM, and his 1993 study as published in the Archives of General Psychiatry.  Both are well-respected peer-reviewed scientific journals.  I also only mentioned findings that were considered statistically significant.  I do not know how you can call findings with P values of .05 and .001-.009 (from the 1993 study) "non-significant," as these are the statistical values that specifically measure the significance of a given finding.  In fact, the P values of .001-.009 encountered in the findings of correlation between specific frontal-lobe deficits and symptom severity are phenominally solid.
Hyperion35 01:36, 10 February 2007 (UTC)
thread_title:  zametkin and other stuff 

message: yes the caption on the Zametkin photograph is misleading. They found statistical signifcance by lumping all the brains together and doing in aggregate statistical analyses. Individual comparisons found NO DIFFERENCES!!!!
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Errrrm, no.  Presumably they found some differences between individuals, as any brain imaging will find at least some differences between individuals.  The entire point of performing aggregate statistical analysis is to figure out which differences are statistically significant and which ones are meaningless.  The whole point of using multiple patients is to analyze the data of the group rather than comparing a few individuals, thus minimizing the effects of random variation and hopefully finding significant differences between the two groups if they exist.  That's the whole point of the phrase "statistical significance."  First you claim that the lack of statistically significant aggregate differences in global metabolic levels is an important finding (and I agree, albeit for different reasons), and now you claim that aggregate statistical analysis gives misleading findings.  Well, which is it?  Also, I have seen no mention in the literature of "individual comparisons," just about every study discusses statistically significant aggregate differences (for the reasons I just mentioned), so could you please provide a citation for your claim that there were individual comparisons made that found no differences?  
This is an encyclopedia entry, it ought to be based upon published medical research.  This research was published in NEJM, which is one of the oldest and most respected medical journals in the world.  I understand that you disagree with these findings, and I understand that you believe that this is somehow misleading, but you have not actually cited anything to back up your claims.  Zametkin's studies are not the only ones that have found significant differences between ADHD and non-ADHD patients on imaging scans.  Krause and others have found significant differences in frontal-lobe dopamine uptake on SPECT scans:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=16894328&query_hl=1&itool=pubmed_docsum
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=16861140&query_hl=1&itool=pubmed_docsum
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=16839567&query_hl=1&itool=pubmed_docsum
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=16616981&query_hl=1&itool=pubmed_docsum
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=16479247&query_hl=1&itool=pubmed_docsum
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=16139732&query_hl=1&itool=pubmed_docsum
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=16091862&query_hl=1&itool=pubmed_docsum
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=15486990&query_hl=1&itool=pubmed_docsum
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=14624805&query_hl=1&itool=pubmed_DocSum
I could go on, but you're beginning to get the picture here.  These are all studies that are going one step further than Zametkin's early pioneering works.  They've gone from showing broad differences with PET scans into using far more sophisticated SPECT (single-photon emission computed tomography) scans to look at specific neurophysiological differences in dopaminergic activity, which is a logical place to look given that all known ADHD medication have an effect on uptake of either dopamine or it close chemical relative (and metabolite) norepinephrine.  The reason why Zametkin's 1990 study is so widely discussed is because it was the landmark study that first showed statistically significant differences.  It is also a broader study that is perhaps easier to comprehend for lay individuals than disussions of dopamine transporters and uptake activity.  In a basic encyclopedia article, it makes sense to refer to the first major study to demonstrate differences, and then include links to more information, but perhaps including this in the main article would be helpful since some individuals seem to believe that there hasn't been any progress in this field in 17 years.
Xavier Castellanos has an interesting commentary piece in the Journal of Nuclear Medicine comparing several SPECT studies and discussing the limitations of the technology and of testing in general.  He also has concerns over statistical validity and sample sizes, but notice that he actually cites data, and acknowledges that many of these difficulties are difficult to surmount (such as finding adequate control subjects).  It is a very interesting look at how far brain imaging has advanced since Zametkin:
http://jnm.snmjournals.org/cgi/content/full/43/12/1630
Hyperion35 01:13, 10 February 2007 (UTC)
thread_title:  yes 

message: for this to be accurate it should be noted that although the picture shows the brains that look 'different', you cannot compare two brains and tell which one has ADHD through this imaging- there is significant overlap between ADHD and non-ADHD brains. It seems to give the misleading impression that this is like comparnig a brain with MS versus one without MS- and it is nothing like that. if you show individual brain scans to a neuroscientist, he can't tell you who has ADHD and who does not. when he does aggregate statistics, he finds some statistically signifcant differences may arise (along with significant overlap in many cases)- which leads to the question, does this picture accurately reflect the true situation?
:That information is in the 'Brain Scan' section. Also, it seems quite likely that each of those "brains" is actually an average of all the brains in each group, rather than being an image of a single participant. --Limegreen 00:30, 12 February 2007 (UTC)
thread_title:  zametkin diagram 

message: the definition of a disease would be an entity that can be shown via some sort of objective imaging, dissection, or pathological examination to exist within an indvidual. NO other diseases are thought to be real through GROUPS of people being examined. it's ludicrus.
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Ummmm, no.  Almost every disease is discovered through groups of people being examined.  And many diseases do not involve imaging, biopsies, or other pathological testing.  Even when they do, labwork is not and cannot be the sole component of any diagnosis.  This isn't CSI.  The main diagnostic technique in many medical fields is still the Differential diagnosis, for which imaging or pathological testing can sometimes be an important component.  Just to give you an example, MRIs and autopsies have shown that persons with Alzheimer's Disease have damage to the cholinergic neurons in the hippocampus, which is thought to be caused by a buildup of beta-amyloid plaques that are found upon autopsy.  This has been discovered through testing GROUPS of persons with Alzheimer's, and finding that on average, they have more damage and more plaque buildup than persons without the disease.  However, there is no clinical imaging or blood test that can test for Alzheimer's disease.  There are tests that can be done to rule out other possible problems, such as a brain tumor, stroke, vascular problems, etc, which can aid in the diagnosis, but nothing that can test FOR Alzheimer's disease.  According to the Wiki page on Alzheimer's disease:
"The diagnosis is made primarily on the basis of history, clinical observation and tests of memory and intellectual functioning over a series of weeks or months, with various physical tests (blood tests and neuroimaging) being performed to rule out alternative diagnoses. No medical tests are available to diagnose Alzheimer's disease conclusively pre-mortem. Expert clinicians who specialize in memory disorders can now diagnose AD with an accuracy of 85–90%, but a definitive diagnosis of Alzheimer's disease must await microscopic examination of brain tissue, generally at autopsy."
Aside from the autopsy part, every other part of that paragraph could just as easily diagnose ADHD.  So, is Alzheimer's disease not real?  Is Alzheimer's disease ludicrous?
If this post is a good example of the extent of your medical knowledge, perhaps you should do some more research before suggesting changes to this (or any other) medical page.
Hyperion35 15:02, 12 February 2007 (UTC)
thread_title:  DISEASE 

message: : How come the word disease keeps on getting interjected into the discussions about ADHD? It is not called Attention Deficit Hyperactive Disease. Some people must be reading Fred Baughman of "ADHDFRAUD.COM" fame. He uses the word disease often with regards to ADHD. He does this so that he can then state, if it's a disease where is the blood test for ADHD? Well Fred, it's not a disease, there is no pathogen, it's genetic. Fred works for the CCHR and it's his job to discredit ADHD as a concept. 
: Studies using DSM4 list of criteria it has been determined that the heritability of the disorder is 97%. Michael Goldman had this to say about Steadman's definitions of the words disease and disorder. His interpretation of these ideas seem logical and fits in with the genetic theory of ADHD.
: Steadman defines a disorder as a disturbance of function, structure, or both resulting from a genetic or embryologic failure in development. This is an extremely important point because when we, as doctors, think about a disorder, we’re saying something is wrong. We can’t define it, we don’t know what it is but something went wrong either before birth or in genetics and you have a fixed entity that’s not a disease process.
: Steadman’s Dictionary defines disease as an interruption or cessation or disorder of bodily functions, system or organ illness, morbus, ill, sickness. A morbid entity characterized by at least two criteria: a recognizable agent, an identifiable group of signs or symptoms, or consistent anatomical alterations. Literally, disease means something is wrong with the body. 
: --scuro 04:49, 13 February 2007 (UTC)
replies: text: Well said. -- Ned Scott 06:38, 13 February 2007 (UTC)
thread_title: ADHD a ludicrous disease?...no silly it's a disorder

message: the point above about alzheimers misses the point entirely. on post-mortem you can find pathology in an alzheimer's brain. an ADHD brain on autopsy looks COMPLETELY NORMAL!!!! everyone should know this. this should be in the main text of the article. 
the DSM states this, there are no laboratory tests or findings that can identify ADHD. why isn't this in the main text of the article since the DSM defines what ADHD is? —Preceding unsigned comment added by 146.201.100.221 (talk • contribs) 
Ok, one major reason why an autopsy is not a good way to look for ADHD is because there is usually a very long time between the onset of symptoms and the post-mortem autopsy.  Alzheimer's is (almost always) a late-onset degenerative disorder that strikes late in life.  Because the deficits increase over time and because the patient usually dies a few years after the symptoms become severe, it is easier to find on autopsy.  With ADHD, you have a developmental disorder that presents first in childhood.  As most patients have a normal lifespan, it is hard to tell on autopsy what differences might be due to ADHD and which are simply the sequellae of 70+ years of life.
That being said, the SPECT studies to which I have linked earlier found physiological differences in ADHD patients, and some of these studies were using medication-naive patients.  This is in addition to Zametkin's studies showing different brain activity in medication-naive patients.  The vast preponderance of the evidence strongly implies that the disorder is due to physical differences at the cellular level that affect how neurons in certain regions of the brain communicate with each other.
Also, I think you misunderstand the importance of what I mentioned regarding Alzheimer's:  There is currently no laboratory test that can identify Alzheimer's disease while the patient is still alive.  In general, physicians like to treat patients while they are still alive for obvious reasons.  Thus patients are diagnosed with Alzheimer's disease, and given medication, based upon physical examination, patient history, observations of cognitive abilities, etc, JUST AS IS DONE WITH ADHD!  The point that I am attempting to make here is that current diagnosis and treatment of ADHD is done in a manner no different from that of Alzheimer's disease.  A differential diagnosis based upon patient symptoms, history, and observed behavior and abilities is a perfectly acceptable and common method for diagnosing and treating medical problems, so your objections on this point are irrelevant unless you are also criticizing the diagnosis and treatment of a number of other unrelated and relatively non-controversial diseases.
Hyperion35 17:08, 14 February 2007 (UTC)
thread_title:  alzheimers 

message: Under the subheading of homeopathic alternatives, it reads
"Many alternative treatments have been proposed for ADHD. An example would be the homeopathic treatment "attend".
"Attend" appears to be a very specific 'alternative remedy' and unless it can substantiate itself in a reputable journal we shouldn't  pass itself off as an example. If someone is searching for herbal alternatives to ADHD it would seem to be misleading to present "attend" - one might infer that it was more effective than other herbal supplements or that it was used more frequently. It may well be, but someone would have to support that idea with a credible citation.
--Substantiate 10:29, 15 February 2007 (UTC)
thread_title: Attend

message: My son who is ten has adhd but is also violent with it he is on ritalin.where does the violence come from we are at our wits end he runs away and smashes the house up  and the windows refuses to do school work attacks other children at school attacks me his sister and step dad hardly sleeps  please help     susan forrest —Preceding unsigned comment added by 81.97.196.141 (talk • contribs) 
: I'd go to ADDforums if you want advice from other parents about Ritalin, it has a large community. If he is smashing up your windows and wrecking your house only on Ritalin it would be advisable to stop the medication but please get an appointment with your Dr. as soon as possible.
: This talk page is more improving the ADHD article.
: --scuro 04:26, 20 February 2007 (UTC)
thread_title:  adhdmymm