Talk:Attention deficit hyperactivity disorder

Genetic component and reference 46 "Genetics of attention deficit hyperactivity disorder"

Summary The current article misrepresents heritability and the genetics of ADHD, with several of the sources contradicting the content they are references to.

The current article states "in rare cases ADHD may be caused by ... a major genetic mutation [46]" But the article referenced states "ADHD’s heritability is due to a polygenic component comprising many common variants each having small effects." This is largely corrected in the dedicated genetics section.

The current article states "ADHD has a high heritability of 74%, meaning that 74% of the presence of ADHD in the population is due to genetic factors." Heritability is not the same as genetic inheritance* as nurture imparts some level of traits.

Potentially this confusion comes from eg reference "Genomic analysis of the natural history of attention-deficit/hyperactivity disorder using Neanderthal and ancient Homo sapiens samples" which states "a considerable fraction of (ADHD) which is explained by single nucleotide polymorphisms (SNPs)". In both cases the research data in the papers cited shows a complex heritability, and indicates a complex genetic component.

• Getting struck by lightning is a heritable trait, as eg those whose parents play golf in the rain are more likely to do so them selves.

202.63.68.241 (talk) 02:00, 18 September 2024 (UTC)

Thanks for your comment but I'm sorry to say it does not stand to serious inspection.

Meta-analyses examining extensive studies of twins and molecular genetics show that 70-90% of ADHD is attributable to genetics. The remainder is the result of non-shared environmental factors, which would include injuries to the brain prenatally (such as from exposure to biohazards) or the rare cases of traumatic brain injuries later in life that damage the prefrontal EF networks. The family and rearing social environment have found to be statistically nonsignificant factors, where hypothesis of "nurture" clearly falls in. So ADHD is caused entirely by biological contributing factors (neurology and genetics).

See: (Grimm et al.,2020), Larsson et al., (2013); Faraone and Larsson (2019); Molly & Alexandra, (2010); Kleppesto et al., (2022).

These are all summated in the International Consensus Statement on ADHD, and are therefore, the global scientific consensus In fact, they conclude:

Kleppesto et al: "the intergenerational transmission of ADHD behaviors is primarily due to genetic transmission, with little evidence for parental ADHD behaviors causing children’s ADHD behaviors. This contradicts the life history theory."

Molly et al: "Results indicated that both dimensions were highly heritable (genetic factors accounted for 71% and 73% of the variance in INATT and HYP, respectively".

Grimm et al: "The formal heritability of ADHD is about 80% and therefore higher than most other psychiatric diseases. However, recent studies estimate the proportion of heritability based on singlenucleotide variants (SNPs) at 22%. It is a matter of debate which genetic mechanisms explain this huge difference".

So the term heritability does mean inheritance of risk genes, one simply has to look at the context of the systematic reviews where they clearly specify genetic factors, as the above quotes show. Or just the definition given by reputable groups, such as the US Medical Authorities: https://medlineplus.gov/genetics/understanding/inheritance/heritability/#:~:text=Heritability%20is%20a%20measure%20of,schizophrenia%20and%20autism%20spectrum%20disorder.

"Heritability is a measure of how well differences in people’s genes account for differences in their traits"

Here, another definition given by the peer-reviewed journal Nature, which is among the most reputable on the planet: https://www.nature.com/scitable/topicpage/estimating-trait-heritability-46889/. They concluded: "Heritability is a concept that summarizes how much of the variation in a trait is due to variation in genetic factors".

The genomic analysis was cited to show the influence of natural selection on ADHD over the course of 45,000 years; not pertinent to the causes of the disorder. Regardless, it is indeed well known that in a small but significant minority of individuals ADHD is caused by a major genetic mutation/single genetic abnormality, as the International Consensus Statement on ADHD concluded referring specifically to that review of genetics (Faraone et al). So the sources have not been misrepresented.

To sum, there is a global scientific consensus that 70-80% of ADHD (or higher) is attributable to inheritance of ADHD risk genes, mostly accumulatively but a single genetic mutation can be accountable in rare cases. In the remainding 20-30% of cases, it is either due to measurement error or non-shared, non-social and non-family environmental events such as TBI. Димитрий Улянов Иванов (talk) 07:56, 18 September 2024 (UTC)

R.e., comma in lede

@Slothwizard, I don’t believe a comma is grammatically needed in order to distinguish the two clauses because the word ‘and’ does that already. A comma can be used for emphasising a difference, but it isn’t needed here. Moreover, emotional dysregulation and disinhibition (impulsivity) are partially related. I just think adding that comma makes the sentence more cumbersome to read. Димитрий Улянов Иванов (talk) 06:29, 2 October 2024 (UTC)

Thank you for mentioning your concerns. I have noticed that the list of symptoms actually does continue on after “dysregulation”and does not split into a new one, rather they are the same. I believe that is where my confusion was. The sentence is easy to read, my only concern is the difficulty in fully interpreting it correctly in a grammatical sense, but regardless I see now it’s grammatically correct. This may only be a problem if you read text in a pedantic matter like I do, so I will keep that in mind. Will revert to original. Apologies for the inconvenience and confusion, thanks again. Slothwizard (talk) 06:59, 2 October 2024 (UTC)

No problem, thank you for checking on that issue. Also, with regards to the symptom list in the Infobox, at some point I will consider revamping that. Currently, things are listed weirdly. For instance, ‘disinhibition’ and ‘hyperactivity’ and ‘impulsivity’ listed, yet disinhibition underlies the symptom dimension of hyperactivity-impulsivity and some aspects of the inattention implicated in the disorder, such as distractibility, as well as the impulsive and preservative aspects of emotional dysregulation. ‘Carelessness’ is also written, which is very superficial and not a core symptom so it’s odd that it’s uniquely noted alongside such core symptoms. So these are further issues that need rectifying. The main symptom dimensions should probably be mentioned upon which the more superficial expressions of them are mentioned in a parenthesis. Димитрий Улянов Иванов (talk) 09:49, 2 October 2024 (UTC)

Should the Symptom List be Changed?

@Slothwizard

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

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

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

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

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

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

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

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

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

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

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

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

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

Porn induced adhd

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

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

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

Lede Names

Dear @Slothwizard,

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

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

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

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

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

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

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

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

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

Usage of the term 'Maldevelopment' and 'Maldeveloped'

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Further on, they conclude:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Wikipedia:scientific consensus concludes:

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

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