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Is Attention Deficit Hyperactivity Disorder (ADHD) a "brain disorder"? Should it be managed regularly with stimulant drugs? This article critically examines the evolving biomedical discourse surrounding these questions through a close inspection of the latest edition of the influential psychiatric manual - the DSM-5-TR - as well as additional authoritative sources (e.g., previous DSM editions, consensus statements, FDA communications). The DSM-5-TR acknowledges that "no biological marker is diagnostic for ADHD" and that "meta-analyses of all neuroimaging studies do not show differences between individuals with ADHD and control subjects." The authors of the DSM-5-TR, therefore, conclude that "until these issues are resolved, no form of neuroimaging can be used for diagnosis of ADHD." These statements, along with biases in the neuroimaging literature and additional empirical evidence presented in the article, challenge popular myths about the neurobiological basis of ADHD. Similarly, common beliefs about the first-line treatment of ADHD with stimulant drugs are being increasingly questioned today. For instance, the DSM-5-TR's section on Stimulant-Related Disorders introduces a new diagnostic entity named: Stimulant-Induced Mild Neurocognitive Disorder. This addition aligns with a recent FDA Drug Safety Communication for "all prescription stimulants," which highlights longstanding concerns regarding the safety of medications prescribed to millions of diagnosed individuals, primarily children. The FDA now mandates that "the Boxed Warning, FDA's most prominent warning, will describe the risks of misuse, abuse, addiction, and overdose," emphasizing that such "misuse and abuse of prescription stimulants can result in overdose and death." In light of these challenges to the biomedical discourse, this article offers a neurodiversity-oriented alternative. Using evolutionary principles and historical context, it argues that most cases of ADHD fall under the DSM's socio-philosophical category of "conflicts that are primarily between the individual and society" (similar to homosexuality, which was removed from the DSM in 1973), and are therefore "not mental disorders". [ABSTRACT FROM AUTHOR]

Two publications by Merzon and colleagues in the Journal of Attention Disorders (JAD) suggest that attention-deficit hyperactivity disorder (ADHD) increases the risk of COVID-19 infections (2020) and severe outcomes (2021). Adherence to stimulant treatments was recommended to attenuate the spread of the pandemic (2020). The conclusions of these timely studies attracted considerable attention, probably due to their wide-scope implications for the public health. But how valid are they? Furthering our earlier critique published in this journal, the current article outlines seven severe gaps in these publications, including inconsistencies in the definitions and rates of ADHD, inadequate definition for ADHD medications, omissions of crucial information, unsuitable analyses, and unmet declarations regarding conflicts of interests and data availability. In fact, the latter, which constitutes a repeated avoidance of data sharing (up to this day, March 28, 2023), seems to have led the editor-in-chief of JAD to propose the write-up of the current article (which he then judged, after the peer review process, as "worthy of publication," but also that JAD is "not the best placement" of its publication—despite its specific focus on several JAD articles). To complete the picture regarding this burning public health issue, this article also provides a glimpse into the problematic happenings that took place behind the scenes, which included a personal defamation and various stalling tactics, along with an elaborated and fully-referenced response that was sent by the authors of the current article to the reviewers and the editor-in-chief of JAD in real time (Appendix). Together, the discrepancies and problematic ethical conducts that are exposed in the current article suggest that the speculation regarding the link between a neurodevelopmental diagnosis (ADHD) and a respiratory virus (COVID-19) has not been subjected to adequate scientific inquiry. On the contrary, the lack of transparency, the observed gaps, and the existing extensive literature on stimulant-related cardiovascular risks, including the recently published guidelines for starting ADHD medications by one of the authors of the 2021 study, raise concerns regarding the potentially dangerous implications of stimulant use during a global epidemic. [ABSTRACT FROM AUTHOR]

Stimulant medications (e.g., Ritalin) are considered a relatively safe first-line treatment for attention deficit hyperactivity disorder (ADHD), the most common neuropsychiatric diagnosis among children. This study explores the prevalence of side-effects and risks of stimulants, as perceived by 218 Israeli young adults with ADHD who used stimulants. Participants completed questionnaires that addressed representative side-effects (eight side-effects copied from the patient leaflet of Ritalin, as approved by the Israel Ministry of Health, and five additional side-effects), medication dependence, and substance use. Results indicated that almost all side-effects were extremely common – significantly and substantially more than the leaflet's estimates. "Mood changes such as depression" for example, were observed among 66%, compared with the reported "1 in 10,000 users." Suicidal thoughts, which are mentioned as "side-effect that occurred with other medications that contain same ingredient," were observed among 3.2%. Side-effects not mentioned in the leaflet, such as "zombie-like sensation" (72.5%) and "alterations in sense-of-self" (39.4%), were also very common. Most participants tried quitting the medications (some even resisted taking them as children), mainly to disengage from their medication dependence and cease their adverse-effects, however many struggled coping without the medications and experienced withdrawal reactions, such as decreased mood or motivation as well as increased stress and anxiety. Notably, stimulant use frequency significantly correlated with alcohol and drug use. Although the observational nature of the study limits its generalizability, its findings suggest that the safety profile of stimulants requires further consideration, especially today with the large increase in diagnoses and medication use among millions of children. [ABSTRACT FROM AUTHOR]

Background: Recent advancements in Artificial Intelligence (AI) contributed significantly to suicide assessment, however, our theoretical understanding of this complex behavior is still limited., Objective: This study aimed to harness AI methodologies to uncover hidden risk factors that trigger or aggravate suicide behaviors., Methods: The primary dataset included 228,052 Facebook postings by 1,006 users who completed the gold-standard Columbia Suicide Severity Rating Scale. This dataset was analyzed using a bottom-up research pipeline without a-priory hypotheses and its findings were validated using a top-down analysis of a new dataset. This secondary dataset included responses by 1,062 participants to the same suicide scale as well as to well-validated scales measuring depression and boredom., Results: An almost fully automated, AI-guided research pipeline resulted in four Facebook topics that predicted the risk of suicide, of which the strongest predictor was boredom. A comprehensive literature review using APA PsycInfo revealed that boredom is rarely perceived as a unique risk factor of suicide. A complementing top-down path analysis of the secondary dataset uncovered an indirect relationship between boredom and suicide, which was mediated by depression. An equivalent mediated relationship was observed in the primary Facebook dataset as well. However, here, a direct relationship between boredom and suicide risk was also observed., Conclusion: Integrating AI methods allowed the discovery of an under-researched risk factor of suicide. The study signals boredom as a maladaptive 'ingredient' that might trigger suicide behaviors, regardless of depression. Further studies are recommended to direct clinicians' attention to this burdening, and sometimes existential experience., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Lissak, Ophir, Tikochinski, Brunstein Klomek, Sisso, Fruchter and Reichart.)