![]() Moreover, we aimed to highlight any existing evidence gaps. In this study, we systematically reviewed the literature to identify, appraise, and synthesize the evidence on overdiagnosis of ADHD in children and adolescents. Physical and psychosocial harms (and financial costs) may be experienced directly by the young patients and their family, but economic and opportunity costs are experienced by the wider society. Although the benefits of appropriate diagnosis and treatment of ADHD may be well known, 12 harms are less well appreciated. However, for increased detection to represent current overdiagnosis rather than previous underdiagnosis of ADHD, we also need evidence that these additional cases do not derive a net benefit from diagnosis (ie, these children’s overall health is not improved because the harms of diagnosis and treatment outweigh the benefits 23 - 25). Overdiagnosis of ADHD could happen because of diagnostic inflation 10, 19 by widening the definition to include ambiguous or mild symptoms, by explicitly changing the diagnostic definition, 10, 20 or by implicitly medicalizing behavioral patterns that previously would not have been considered abnormal 1, 21 (eg, those behaviors that are typical of children who are relatively young for their school year 22). 15 - 17 Methods to investigate overdiagnosis in noncancer conditions were published recently 18 but have not been applied to ADHD yet. 7 - 12 The concept of overdiagnosis is well established in cancer, 13, 14 but it also occurs in noncancer conditions. 1 - 6 Disagreement continues about how much of the increased diagnoses can be attributed to true increases in frequency, improved detection, or diagnostic inflation because of misdiagnosis and/or overdiagnosis. Public debate over the appropriateness of attention-deficit/hyperactivity disorder (ADHD) diagnosis has grown along with diagnosis rates. ![]() Evidence gaps remain and future research is needed, in particular research on the long-term benefits and harms of diagnosing and treating ADHD in youths with milder symptoms therefore, practitioners should be mindful of these knowledge gaps, especially when identifying these individuals and to ensure safe and equitable practice and policy. These studies supported a hypothesis of diminishing returns in which the harms may outweigh the benefits for youths with milder symptoms.Ĭonclusions and Relevance This review found evidence of ADHD overdiagnosis and overtreatment in children and adolescents. However, only 5 studies evaluated the critical issue of benefits and harms among the additional, milder cases. A total of 151 studies reported on outcomes of diagnosis and pharmacological treatment (question 5). Twenty-five studies showed that these additional cases may be on the milder end of the ADHD spectrum (question 3), and 83 studies showed that pharmacological treatment of ADHD was increasing (question 4). Evidence that actual ADHD diagnosis had increased was found in 45 studies (question 2). Substantial evidence of a reservoir of ADHD was found in 104 studies, providing a potential for diagnoses to increase (question 1). Of the 334 studies, 61 (18.3%) were secondary and 273 (81.7%) were primary research articles. Two researchers independently reviewed all abstracts and full-text articles, and all included studies were assessed for quality.įindings Of the 12 267 potentially relevant studies retrieved, 334 (2.7%) were included. Studies of children and adolescents (aged ≤18 years) with ADHD that focused on overdiagnosis plus studies that could be mapped to 1 or more framework question were included. MEDLINE, Embase, PsychINFO, and the Cochrane Library databases were searched for studies published in English between January 1, 1979, and August 21, 2020. Objective To systematically identify, appraise, and synthesize the evidence on overdiagnosis of ADHD in children and adolescents using a published 5-question framework for detecting overdiagnosis in noncancer conditions.Įvidence Review This systematic scoping review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Extension for Scoping Reviews and Joanna Briggs Methodology, including the PRISMA-ScR Checklist. Although overdiagnosis is often suggested, no comprehensive evaluation of evidence for or against overdiagnosis has ever been undertaken and is urgently needed to enable evidence-based, patient-centered diagnosis and treatment of ADHD in contemporary health services. ![]() Importance Reported increases in attention-deficit/hyperactivity disorder (ADHD) diagnoses are accompanied by growing debate about the underlying factors.
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![]() This property is managed by a professional host. ![]() Special requests can't be guaranteed and may incur additional charges. Special requests are subject to availability at the time of check-in. Safety features at this property include a carbon monoxide detector and a smoke detectorĬharges for extra guests may apply and vary according to property policy.Ī cash deposit, credit card, or debit card for incidental charges and government-issued photo identification may be required upon check-in. This property accepts credit cards, debit cards, and cash Special requests are subject to availability upon check-in and may incur additional charges special requests cannot be guaranteed Government-issued photo identification and a credit card, debit card, or cash deposit may be required at check-in for incidental charges Wheelchair-accessible meeting spaces/business centerĮxtra-person charges may apply and vary depending on property policy.Wheelchair-accessible registration desk.In-room accessibility (in select rooms).Wheelchair accessible (may have limitations).Wheelchair-accessible on-site restaurant.If you have requests for specific accessibility needs, please contact the property using the information on the reservation confirmation received after booking. In-room massages and hypo-allergenic bedding can be requested. Additionally, rooms include coffee/tea makers and irons/ironing boards. Business-friendly amenities include desks and phones free local calls are provided (restrictions may apply). Guests can surf the web using the complimentary wired and wireless Internet access. Bathrooms include complimentary toiletries and hair dryers. 32-inch flat-screen televisions come with premium cable channels. Pillowtop beds feature Egyptian cotton sheets and premium bedding. Hotel Roanoke & Conference Ctr, Curio Collection by Hilton offers 330 accommodations with laptop-compatible safes and video-game consoles. Smoking is allowed in designated areas at this 4-star Roanoke hotel. An area shuttle within 5 mi and a roundtrip airport shuttle (available 24 hours) are free. A fitness center, spa services, and a terrace are also featured at the business-friendly Hotel Roanoke & Conference Ctr, Curio Collection by Hilton . There's an onsite 24-hour business center. A computer station is on site, and both WiFi and wired Internet are free in public spaces. You can enjoy a drink at one of the bars, which include 2 bars/lounges and a poolside bar. There are 2 restaurants on site, along with a coffee shop/café. ![]() Hotel Roanoke & Conference Ctr, Curio Collection by Hilton offers its guests a full-service spa, an outdoor pool, and a spa tub. ![]() ![]() Go to these Philly restaurants with the confidence of the Phillie Phanatic on an ATV, or that guy who ate 40 rotisserie chickens for no apparent reason. Because, frankly, I or my co-writers ate at all these restaurants recently, and who among us without a corporate card has the time and resources to do such a thing? Rankings are also meant to help you make up your mind about how to spend your money. Actually, that’s why they’re back: to make you pay special attention, to celebrate the places that have been ignored on previous ranked lists, to declare emphatically that $15 worth of fried bananas and turmeric-doused chicken skewers at the Southeast Asian Market at FDR Park can be just as remarkable as a $100-plus meal. Rankings tend to have that effect on people. ![]() ![]() Perhaps you’ve already stopped reading these prefatory words entirely out of an obsession with said digits. It asks, 50 times over, how likely are you to shout from the rooftops about a dining experience, or demand that a friend cross the city for dim sum and vegan polenta and jerk chicken, or spend hard-earned money on an anniversary dinner?Īnd by now, I’m sure you’ve noticed that this year’s guide involves hot little numbers. This 50 Best list is the result of nearly a year’s worth of dining out, sometimes four or five or six nights a week. 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Huge thanks to Lollipop Scythe for coding the framework, and to PurityGuy for further work. ![]() ![]() “Bare your struggles very close to your heart and have them be a part of you that you’re proud of instead of something that you’re ashamed of.”ġ7. But to be unique, it’s a complicated thing.”ġ6. “I’ve always been famous, it’s just no one knew it yet.”ġ5. “Sometimes in life you don’t always feel like a winner, but that doesn’t mean you’re not a winner”.”ġ4. ![]() “Do you know the feeling, when your heart is so hurt, that you could feel the blood dripping?”ġ3. “I would rather die than have my fans see me without a pair of heels on. “I want you to walk out of here tonight not loving me more, but loving yourselves more.” Famous Lady Gaga Quotesġ1. “As artists, we are eternally heartbroken.”ġ0. “Sometimes in life you don’t always feel like a winner, but that doesn’t mean you’re not a winner.”ĩ. it means to be in the midst of those things and still be calm in your heart”Ĩ. it does not mean to be in a place where there is no trouble, noise, or hard work. “Money can run out, but talent is forever.”ħ. “People will always talk, so lets give them sumthin to talk about”Ħ. 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![]() ![]() Remember the plumb bob may be a useful guide if you’re not sure on a subtle slope but it’s not a given, and it also won’t help you determine if the putt is up or downhill. If it appears to the left of the cup, the slope should take the ball from left to right. Updated OctoImage Credits If you’ve ever wondered why your playing partner is holding their putter in front of their eyes on the green, it’s a green-reading method called plumb bobbing. If the shaft appears to the right of the cup, the slope you are on should take the ball from right to left. If the shaft also covers the hole, the putt should be straight – the ground you are standing on should be level. The Best Way to Read Greens for Golfers This green reading method the plumb bob technique has been around for many years and has stood the test of time. Hold the putter up, as described above between thumb and forefinger, towards the end of the grip if you can, covering the ball with the shaft. Stand about 10 feet or so behind the ball (maybe further back for longer putts) so you are looking directly through the ball to the hole in a straight line. You need to gain a good understanding of how the plumb bob method works before you put it into practice on the course, so you should spend some time on the putting green learning the process. This is very important as it’s how you must hold your putter each time in order to have a true vertical line when plumb bobbing – It won’t work otherwise. ![]() Look where the putter head is positioned and remember that. Twist the putter round between thumb and forefinger to find the point where shaft and the chosen vertical are level. Find a known vertical, like the edge of a building, and hold the putter up so you can compare the vertical with the shaft lean. In other words, in which direction the ball will break. It likely won’t do that automatically as the shaft will generally not go into the very centre of the head meaning there will be some tilting. In essence, plumb-bobbing can tell you which side of a putts line is higher. In order to plumb bob effectively, you have to check the shaft of your putter hangs absolutely vertically when you hold it lightly between thumb and forefinger on the grip. Multifunctional and can be used for many purpose, great for clothing decoration, braid, crafts, etc. ![]() ![]() ![]() One thing of note is that Photoshop Elements doesn’t have any iCloud or Photos integration, nor is it part of Adobe’s Creative Cloud ecosystem. You can’t, however, perform more complex editing tasks such as frequency separation… but this won’t affect the average photographer. Quick Edit and Guided Edits do a lot of the heavy lifting for you.Įxpert level, on the other hand, offers a lot of the manual control you can find in Photoshop, like layers, healing brushes, and paintbrushes. The photo editor in Elements provides three editing modes: Quick Edit, Guided Edits, and Expert. (Unless you keep paying for the Lightroom subscription, you can’t continue to use the software – you never actually own Lightroom – it’s like you’re paying to use it. The key advantage of Photoshop Elements over Lightroom is the attractive one-time fee – you can buy Elements for the equivalent price of just 10 months of Lightroom subscription. Sensei also tags and sorts your photos for you (though it helps if you do at least some of the tagging yourself). It also offers a number of slideshows and collages automatically curated by Adobe’s Sensei AI. The home screen allows you to choose between the photo organizer and photo editor, as well as offering Guided Edit options for inspiration. In fact, it’s designed especially for beginners and by far the easiest to learn of all of Adobe’s photo editing software. It does just about everything a casual photographer needs, from photo organization and basic edits to object removal, layers, and even skin smoothing.Īdobe Photoshop Elements also happens to be extremely user-friendly. Now let’s compare Lightroom to Elements to find out which one is best for you.Īs the name suggests, the program takes the main elements in Photoshop and Lightroom and combines them into a quick, easy-to-learn program. However, to use Lightroom, you’ll need to enter into a monthly subscription, but at only $9.99/mo, it’s less than the cost of Netflix. Lightroom makes Elements look like a bit of a child’s toy in comparison. Lightroom offers many more features than Elements for both editing images and organising them. It’s the professional photographer’s editing program of choice. It provides advanced non-destructive editing, streamlined workflow management, and many tools for batch processing and publishing. ![]() Adobe Photoshop Lightroom was designed for professional photographers and serious amateurs. See also our guide on the differences between Photoshop Elements and Photoshop.Ģ. The best thing about Photoshop Elements is that you can buy it outright – this means you only need to pay for it once, and you’ll own it forever.Ĭurrently, Elements is the only Adobe product that you don’t need to subscribe to, and that makes it incredibly attractive. If you’ve never used editing software before, it’s a fantastic place to start. ![]() It’s dubbed as a lighter version of Photoshop and offers a picture organizer with artificial intelligence, a photo editor, layers, special effects, and print tools. Adobe Photoshop Elements was created for beginners who dabble in both photography and graphic arts. Here’s a quick look at the differences between Elements and Lightroom:ġ.
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