Attention deficit hyperactivity disorder controversies. This article may lend undue weight to certain ideas, incidents, or controversies. Please help to create a more neutral presentation, with details put in their proper context. Discuss and resolve this issue before removing this message. April 2. Methylphenidate Ritalin 1. Pill CibaNovartis, a drug commonly prescribed to treat ADHDAttention deficit hyperactivity disorder ADHD controversies include concerns about its causes, perceived overdiagnosis, and methods of treatment, especially with the use of stimulant medications in children. These controversies have surrounded the subject since at least the 1. Diagnosis, Evaluation and Followup of Asymptomatic Microhematuria AMH in Adults discusses proper evaluation of such patients, including use of cystoscopy and. Best Free Sandbox Software. Bile duct cancer may not cause signs and symptoms until the later stages, but in some cases they may lead to an early diagnosis. Learn what to watch for. To access the pdfs translations of individual guidelines, please log in as EAU member. NonEAU members can view the web versions. To become an EAU member, click here. Introduction to antiretroviral therapy What are antiretrovirals How do they work Nucleoside reverse transcriptase inhibitors NRTIs Nonnucleoside reverse. XmSId.jpg' alt='Handbook Of Urology Diagnosis And Therapy' title='Handbook Of Urology Diagnosis And Therapy' />Diagnosis and Treatment of NonMuscle Invasive Bladder Cancer AUASUO Guideline provides a riskstratified clinical framework for the management of nonmuscle. Headaches are very common and their impact can range from mild to disabling. Find out about the causes, types, and treatments available for headache. Status as a disordereditAccording to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition DSM 5, the leading authority in the US on clinical diagnosis and psychological behavior published by the APA in 2. ADHD is a neurodevelopmental disorder with a prevalence rate in most cultures of about 5 in children and 2. Today, the existence of ADHD is widely accepted,1 but controversy around the disorder has existed since at least the 1. Adult ADHD continues to be a source of debate. According to the DSM 5, symptoms must be present before age 1. ADHD to continue into adulthood. Parents and educators sometimes still question a perceived overdiagnosis in children and the effectiveness of treatment options, especially stimulant medications. However, according to sociology professor Vincent Parrillo, Parent and consumer groups, such as CHADD Children and Adults with Attention Deficit Hyperactivity Disorder, tend to support the medical perspective of ADHD. The pathophysiology of ADHD is unclear and there are a number of competing theories. ADHD as a biological illnesseditFrequently observed differences in the brain between ADHD and non ADHD patients have been discovered,6 but it is uncertain if or how these differences give rise to the symptoms of ADHD. Results from various types of neuroimaging techniques suggest there are differences in the brain, such as thinner regions of the cortex, between individuals with and without ADHD. ADHD is said to be highly heritable twin studies suggest that genetics explain 7. ADHD. 8 However, interest in the potential role of gene environment interactions in ADHD is also increasing maternal alcohol or tobacco use during pregnancy may be one contributor. It has also been argued that ADHD is a heterogeneous disorder1. Authors of a review of ADHD etiology in 2. Although several genome wide searches have identified chromosomal regions that are predicted to contain genes that contribute to ADHD susceptibility, to date no single gene with a major contribution to ADHD has been identified. However, many further studies have occurred since, and the same is true for many other heritable human traits e. The Online Mendelian Inheritance in Man OMIM database has a listing for ADHD under autosomal dominant heritable conditions, claiming that multiple genes contribute to the disorder. As of 2. 01. 4, OMIM listed 6 genes with variants that have been associated with ADHD. Social construct theory of ADHDeditIt has been argued that even if it is a social construct, this does not mean it is not a valid condition for example obesity has different cultural constructs but yet has demonstrable adverse effects associated with it. A minority of these critics maintain that ADHD was invented and not discovered. They believe that the disorder does not exist and that the behavior observed is not abnormal and can be better explained by environmental causes or just the personality of the patient. DiagnosiseditMethods of diagnosiseditThere is no blood test or brain scan for ADHD. Diagnosis is based on a clinical interview with the child and parents. Over the past two decades more research on the functioning of the brain is being done to help support the idea that Attention Deficit Hyperactivity Disorder is an executive dysfunction issue. The brains of males and females are showing differences, which could potentially help to explain why ADHD presents differently in boys and girls. Studies conducted using EEGs between boys and girls suggest that we can no longer ignore sex difference between boys and girls when identifying ADHD. There are EEG differences between girls and boys in their maturational pattern and this suggests that more studies regarding sex differences in ADHD should be conducted. Over and under diagnosiseditOverdiagnosis typically refers to children who are diagnosed with ADHD but should not be. These instances are termed as false positives. However, the presence of false positives alone does not indicate overdiagnosis. There may be evidence of overdiagnosis if inaccuracies are shown consistently in the accepted prevalence rates or in the diagnostic process itself. For ADHD to be overdiagnosed, the rate of false positives i. ADHD must substantially exceed the number of false negatives children with ADHD who are not identified or diagnosed. Children aged 8 to 1. ADHD prevalence rate of 7. However, only 4. 8 of the ADHD sample had received any mental health care over the past 1. Evidence also exists of possible differences of race and ethnicity in the prevalence of ADHD. The prevalence of ADHD dramatically varies across cultures despite the fact that the same methodology has been used. Some believe this may be due to different perceptions of what qualifies as disruptive behavior, inattention and hyperactivity. It is argued that over diagnosis occurs more in well off or more homogeneous communities, whereas under diagnosis occurs more frequently in poorer and minority communities due to lack of resources and lack of financial access. Those without health insurance are less likely to be diagnosed with ADHD. It is further believed that the distribution of ADHD diagnosis falls along socioeconomic lines, according to the amount of wealth within a neighborhood. Therefore, the difficulty of applying national, general guidelines to localized and specific contexts, such as where referral is unavailable, resources are lacking or the patient is uninsured, may assist in the establishment of a misdiagnosis of ADHD. Development can also influence perception of relevant ADHD symptoms. ADHD is viewed as a chronic disorder that develops in childhood and continues into adulthood. However, some research shows a decline in the symptoms of ADHD as children grow up and mature into adulthood. As children move into the stage of adolescence, the most common reporters of ADHD symptoms, parents and teachers, tend to focus on behaviors affecting academic performance. Some research has shown that the primary symptoms of ADHD were strong discriminators in parent ratings, but differed for specific age groups. Hyperactivity was a stronger discriminator of ADHD in children, while inattentiveness was a stronger discriminator in adolescents. Issues with comorbidity is another possible explanation in favor of the argument of overdiagnosis. As many as 7. 5 of diagnosed children with ADHD meet criteria for some other psychiatric diagnosis. Among children diagnosed with ADHD, about 2. Learning disorders are found in 2. ADHD. 1. 9Another possible explanation of over diagnosis of ADHD is the relative age effect, which applies to children of both sexes. American Urological Association Diagnosis, Evaluation and Follow up of Asymptomatic Microhematuria AMH in Adults. Rodney Davis, J. Stephen Jones, Daniel A. Barocas, Erik P. Castle, Erick K. Lang, Raymond J. Leveillee, Edward M. Messing, Scott D. Miller, Andrew C. Peterson, Thomas M. T. Turk, William Weitzel. Purpose. This guidelines purpose is to provide direction to clinicians and patients regarding how to work up and follow patients with the finding of asymptomatic microhematuria AMH. The strategies and approaches recommended in this document were derived from evidence based and consensus based processes. This document constitutes a clinical strategy and is not intended to be interpreted rigidly. The most effective approach for a particular patient is best determined by the individual clinician and patient. As the science relevant to AMH evolves and improves, the strategies presented here will require amendment to remain consistent with the highest standards of clinical care. Methodology. A systematic review was conducted to identify published articles relevant to the diagnostic yield of mass screening for microhematuria MH as well as the work up and follow up of adult patients with AMH. Literature searches were performed on English language publications using the MEDLINE database from January 1. November 2. 01. 1. Data from studies published after the literature search cut off will be incorporated into the next version of this guideline. Preclinical studies e. Review article references were checked to ensure inclusion of all possibly relevant studies. Multiple reports on the same patient group were carefully examined to ensure inclusion of only non redundant information. The review yielded an evidence base of 1. AMH. Quality of Individual Studies and Determination of Evidence Strength. Quality of individual studies that were randomized controlled trials RCTs, controlled clinical trials CCTs, or comparative observational studies was assessed using the Cochrane Risk of Bias tool. Because there is no widely agreed upon quality assessment tool for single cohort observational studies, the quality of these studies was not assessed except in the case of diagnostic accuracy studies. Diagnostic accuracy studies were rated using the QUADAS. The categorization of evidence strength is conceptually distinct from the quality of individual studies. Evidence strength refers to the body of evidence available for a particular question and includes consideration of study design, individual study quality, consistency of findings across studies, adequacy of sample sizes, and generalizability of samples, settings, and treatments for the purposes of the guideline. The AUA categorizes body of evidence strength ES as Grade A well conducted RCTs or exceptionally strong observational studies, Grade B RCTs with some weaknesses of procedure or generalizability or generally strong observational studies, or Grade C observational studies that are inconsistent, have small sample sizes, or have other problems that potentially confound interpretation of data. For some clinical issues, there was little or no evidence from which to construct evidence based statements. Where gaps in the evidence existed, the Panel provides guidance in the form of Clinical Principles or Expert Opinion with consensus achieved using a modified Delphi technique if differences of opinion emerged. A Clinical Principle is a statement about a component of clinical care that is widely agreed upon by urologists or other clinicians for which there may or may not be evidence in the medical literature. Expert Opinion refers to a statement, achieved by consensus of the Panel, that is based on members clinical training, experience, knowledge, and judgment for which there is no evidence. AUA Nomenclature Linking Statement Type to Evidence Strength. The AUA nomenclature system explicitly links statement type to body of evidence strength and the Panels judgment regarding the balance between benefits and risksburdens. Standards are directive statements that an action should benefits outweigh risksburdens or should not risksburdens outweigh benefits be undertaken based on Grade A or Grade B evidence. Recommendations are directive statements that an action should benefits outweigh risksburdens or should not risksburdens outweigh benefits be undertaken based on Grade C evidence. Options are non directive statements that leave the decision to take an action up to the individual clinician and patient because the balance between benefits and risksburdens appears relatively equal or appears unclear Options may be supported by Grade A, B, or C evidence. Limitations of the Literature. The Panel proceeded with full awareness of the limitations of the MH literature. These limitations included poorly defined patient groups, heterogeneous patient groups, or patient groups with limited generalizability use of different AMH work up thresholds use of different AMH work up protocols failure to follow all patients and limited follow up durations. The completed evidence report may be requested from AUA. Process. The Asymptomatic Microhematuria Panel was created in 2. American Urological Association Education and Research, Inc. AUA. The Practice Guidelines Committee PGC of the AUA selected the Panel Chair and Vice Chair who in turn appointed the additional panel members with specific expertise in this area. The AUA conducted a thorough peer review process. The draft guidelines document was distributed to 5. The panel reviewed and discussed all submitted comments and revised the draft as needed. Once finalized, the guideline was submitted for approval to the PGC, and finally to the AUA Board of Directors for final approval. Funding of the panel was provided by the AUA, although panel members received no remuneration for their work. Background. Definition. For the purpose of this guideline, microhematuria is defined by the presence of three or more red blood cells RBCs per high powered field HPF6 8 on microscopic examination of one properly collected, non contaminated urinalysis with no evidence of infection for which a combination of microscopic urinalysis and dipstick excludes other abnormalities such as pyuria, bacteriuria, and contaminants. In addition, benign causes, such as menstruation, vigorous exercise, viral illness, trauma, and infection, have been excluded. Literature Limitations and Interpretation. The Panel notes that requiring a single positive urinalysis verified by microscopy is a departure from the 2. AUA Best Practice Statement on asymptomatic microhematuria in adults,9 which required that two of three properly collected samples be positive on microscopy. The Panel searched for an evidence base to directly support the selection of one, two, or more positive samples as the threshold for evaluation. Such an evidence base would be comprised of studies that used different numbers of positive samples to trigger an evaluation, conducted thorough evaluations, and followed all patients regularly and over long periods of time to determine the impact of requiring one, two or more positive samples on diagnostic timing, missed diagnoses, and short and long term patient outcomes. The existing literature does not contain studies of this type that is, the literature does not examine the impact of number of positive samples on evaluation yield or patient outcomes.