Talk:Attention deficit hyperactivity disorder

Semi-protected edit request on 7 January 2025

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

Hi FrogDoc25, the information you want to add appears to already be in the section on non-stimulants. I've added the PCORI systematic review as a supporting reference for the relevant sentence, though. Jr8825 • Talk 10:35, 29 January 2025 (UTC)

References

 Not done: it's not clear what changes you want to be made. Please mention the specific changes in a "change X to Y" format and provide a reliable source if appropriate. Sophisticatedevening ^(talk) 20:13, 27 January 2025 (UTC)

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)

Requested move 12 January 2025

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

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

---

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

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

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

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

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

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

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

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

Life expectancy

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

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

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

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

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

Thanks for expressing your concerns with these papers.

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

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

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

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

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

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

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

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

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

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

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

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

We don't need to follow precise wording if the meaning is the same, but I think we need to be careful in terms of accuracy. The other factual statements in our lead are supported by review papers and multiple studies, whereas the finding about significantly reduced life expectancy is supported circumstantially by the body of evidence on mortality and by two individual (strong and well-cited) studies, so I'd personally summarise it as emerging or new evidence, rather than established evidence. For example, here's a UCL press release describing the 2025 study; it uses the phrase "may have reduced life expectancies" and notes the study limitations at the end.

I agree there's strong enough evidence about increased mortality that we could state that in the lead without any contextualisation, although I do think significantly decreased life expectancy is a more notable finding even though I believe that statement would require a contextualising sentence. Jr8825 • Talk 09:01, 29 January 2025 (UTC)

That said, what about the current version? With "significant" dropped (as I don't think we have strong enough evidence that it's universal), the wording is "collectively predisposing to ... a reduction in life expectancy, which I'd be happy with as "predisposing" is itself a caveat. Jr8825 • Talk 11:21, 29 January 2025 (UTC)

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

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

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

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

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

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

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

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

"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)

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: [4] [5] [6] [7] [8]; 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)