i was misdiagnosed with adhd

Placebo capsules are randomly assigned to 1 of the 4 weeks, and behavior is monitored over the 7 days of administration by teachers and parents. Cleveland Clinic 1995-2023. Manos MJ, Tom-Revzon C, Bukstein OG, Crismon ML. All rights reserved. Implications and potential knowledge translation tools will be discussed. Schizophrenia. There exists a relative-age effect in which children who are relatively younger than their peers and born closest to the school start age cut-off are more frequently diagnosed and treated for ADHD. If this child was physically abused by his father, he has come to associate the smell of the cologne with the threat of impending violence. In a case vignette study (12), in which therapists did not strictly adhere to diagnostic criteria, the patients sex significantly affected diagnosis. ADHD: clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. What this research does suggest, however, is that misdiagnosis can happen depending on the maturity levels of a developing child when they receive a diagnosis. Childhood ADHD vs. Behavioral therapy is delivered in a variety of ways including individual and group parent training, home management consultation, daily school report cards, behavioral coaching, classroom behavior management, and peer interventions. Regarding preschool children, studies have been limited and there is evidence that stimulant use has been associated with more severe or varied side effects (8,16,17). Sciutto MJ, Eisenberg M. Evaluating the evidence for and against the overdiagnosis of ADHD. A doctor or psychotherapist can diagnose anxiety disorder by taking a thorough medical history and applying diagnostic criteria to the persons symptoms. Some of the symptoms of anxiety disorders can be similar to those of ADHD, such as: Anxiety disorder can also cause people to feel uncontrollable worry, become tired quickly, or have an excessive fear about a particular situation or object. Subsequent ongoing monitoring of adherence in the first year is likely to reduce costs over time.47, Pharmacotherapy should be applied with a plan in mind to produce evidence that optimal dosing has been achieved, ie, improvement is consistently observed in school and home.48. The difference between ADHD and autism. The importance of relative standards in ADHD diagnoses: Evidence based on exact birth dates. Br J Psychiatry 2009; 194:273277. After 6 months of following a gluten-free diet, those with celiac disease had large improvements in their ADHD symptoms. (1994). sharing sensitive information, make sure youre on a federal 1:15 Former NBA forward Tony Snell revealed that his son's autism spectrum disorder diagnosis led to his own diagnosis. Acknowledgment:The authors wish to thank Ralph DAlessio, BA, for his services in reference review and for his conscientious participation in the Cleveland Clinic Medication Monitoring Clinic, ADHD Center for Evaluation and Treatment. Researchers suggest that this is because girls tend to display more symptoms of inattention than boys. Girls may exhibit less hyperactivity and externalized behaviours and may show greater intellectual impairment than boys (13). Child Care Health Dev 2008; 34:111120. ADHD and autism share common symptoms, including inattention, atypical movement (such as fidgeting or stimming behaviors ), social difficulties, and differences in learning style. All Rights Reserved. Bussing R, Narwaney KJ, Winterstein AG, et al. 2005 - 2023 WebMD LLC, an Internet Brands company. And treatment, typically with drugs, has been used without sufficient application of current diagnostic criteria. Schoenfelder EN, Sasser T. Skills versus pills: psychosocial treatments for ADHD in childhood and adolescence. Soc Sci Med 2012; 74:92100. Il existe une controverse importante au sujet du bon diagnostic de TDAH, de mme que des secteurs de subjectivit diagnostique. Nearly 1 million children potentially misdiagnosed with ADHD. These symptoms also need to affect your childs ability to function in more than one setting. Pharmacotherapy is typically introduced by the prescribe-and-wait method, which often produces less than optimal dosing, limited treatment adherence, and inconsistent outcomes.45,46Though the cost of giving a prescription is low, the cost for unsustained treatment is high, and this undermines the usefulness of medical therapy. Which activities can help relieve symptoms? You may even lose your temper easily, start fights, or steal things. When discussing the diagnosis process, ask if the doctor: Knew the important details of your childs development. Primary care physicians may often refer parents to established local programs for training, and ongoing coaching can ensure that skills acquired in such training programs continue to be systematically applied. Trends in the parent-report of health care provider-diagnosed and medicated attention-deficit/hyperactivity disorder: United States, 2003-2011. WebCan a person be diagnosed with both ADHD and ASD? Graetz B, Sawyer M, Baghurst P. Gender differences among children with DSM-IV ADHD in Australia. Behaviors measured were noncompliance with directives and violations of classroom rules during daily activity in a summer camp. Braun S, Russo L, Zeidler J, Linder R, Hodgkins P. Descriptive comparison of drug treatment-persistent, -nonpersistent, and nondrug treatment patients with newly diagnosed attention deficit/hyperactivity disorder in Germany. There are three other common patterns that Ive noticed: ADHD and depression occur together (see ADHD or Depression? Can diet help improve depression symptoms? Elder TE. Hinshaw SP. Before I get into the answer, I just want to say how great it is that youre following your instincts and looking into your childs diagnosis of ADHD (also known as ADD). People with OSA may: A doctor may take a medical history, carry out a physical examination, and suggest a sleep study during which they can monitor activity during sleep to diagnose a sleep condition. The Texas Childrens Medication Algorithm Project: revision of the algorithm for pharmacotherapy of attention-deficit/hyperactivity disorder. NIMH collaborative multisite multimodal treatment study of children with ADHD: I. (2017). Current screening tools and measures for ADHD are designed for school-age children (9) and investigations of whether ADHD can manifest in preschool children are limited (10). Am Fam Physician 2013; 87:6162. Adult ADHD may be trickier to detect. The study found that individuals with childhood ADHD were significantly more likely to be diagnosed with BPD (13.5% vs 1.2% in the control group, OR = 13.16) at the 16 to 26 For children, a parent, caregiver, or teacher may notice signs such as:. Why Anxiety Disorder Is So Often Misdiagnosed Anxiety disorders get more frequent, more impairing, and become more ingrained as the child moves into adolescence and adult life. Dr. William Dodson on the correlation between ADHD and anxiety in adults. Bethesda, MD 20894, Web Policies The ability of the pharmaceutical industry to influence physician decision making by providing resources and information surrounding behaviour management with stimulants is well documented (19). Misdiagnosed with Depression - Parul Singh | Ep.12 ADHD Chatter Mental Health This week, Parul Singh shares the story of how she won a legal case over an ex-employer for ADHD discrimination. Thomas R, Sanders S, Doust J, Beller E, Glasziou P. Prevalence of attention-deficit/hyperactivity disorder: a systematic review and meta-analysis. Your doctor may choose to treat your ADHD first if that eases stress or helps you better manage the other conditions symptoms. Nearly 1 million children potentially misdiagnosed with ADHD. The selling of attention deficit disorder. ASD is a neurodevelopmental condition that affects communication, behavior, and social skills. Parul is a Recruitment Marketing Partner and Neurodiversity Advocate at xDesign, and an ex-tech recruiter. Research has shown that adults with ADHD often get misdiagnosed or not diagnosed at all. Kids with ADHD may have mood swings and struggle to get along with peers, but they still crave the chance to socialize. the contents by NLM or the National Institutes of Health. Youre fidgety. are often used to describe individuals who have been diagnosed with attention-deficit/hyperactivity disorder. Conduct disorder (CD) could lead you to break serious rules. The male:female prevalence ratio of ADHD has been shown to range from 3:1 up to 9:1, depending on whether measurements were obtained from a population-based or clinical sample. American Psychiatric Association. It depends on which disorder makes your life harder. For example, research suggests that some patients with ADHD show enhanced creativity54,55; cognitive profiles with abilities in logical thinking, reasoning, and common sense56; and the capacity for intense focus in areas of interest.57Some authors have even speculated that historical figures such as Thomas Edison and Albert Einstein would have been diagnosed with ADHD by todays standards.58, Many children and youth diagnosed with ADHD still receive no or insufficient pharmacotherapy and behavioral therapy. Such reminders may be a feasible option with the current use of electronic health records systems, and may aid in preventing inappropriate prescription of stimulants given the readily available resources on stimulant use and influencing power of the pharmaceutical industry. Given the challenges that exist in managing different maturity levels, this may offer stimulus for discussion of revision of the education system in terms of grade placement based on age. Media inquiries:media@understood.org(preferred) or646-757-3100. National Institute of Mental Health collaborative multimodal treatment study of children with ADHD (the MTA). Mood disorders. Manos MJ, Caserta DA, Short EJ, et al. What happened to you? There is no pathognomonic marker for ADHD, leading to challenges in diagnosis (4). ONeill S, Schneiderman R, Regendran K, Marks D, Halperin J. Donations are tax-deductible as allowed by law. The goal is to inform the most promising practices to ensure that through careful, thorough assessment, the appropriate children receive such treatment and experience positive outcomes. Is it because of trouble staying focused? Medication treatment strategies in the MTA study: relevance to clinicians and researchers. With regard to preschool-age diagnoses of ADHD, a recent study found that a more accurate long-term prediction of ADHD involved lengthier clinician assessments that were performed over a 2 h to 3 h period (11). It might be something else, or ADHD and another disorder. JAMA Pediatr 2013; 167:674675. Subcommittee on Attention-Deficit/Hyperactivity Disorder, Steering Committee on Quality Improvement and Management, Wolraich M, Brown L, Brown RT, et al. This method is often used in clinical trials. Requested that you and your childs teachers fill out ratings scales. AP ANAHEIM, Calif. (AP) Anaheim Ducks goaltending coach Sudarshan Sudsie Maharaj has been diagnosed with pancreatic cancer and is undergoing treatment in Canada. Ek U, Fernell E, Westerlund J, Holmberg K, Olsson PO, Gillberg C. Cognitive strengths and deficits in schoolchildren with ADHD. Ultimately, the long-term effects of stimulants on children at this early developmental stage are unknown. And, while behavioral therapies for ADHD emphasize organization and time management, they are inadequate to address problems occurring secondary to psychological turmoil (Winfrey, 2022). Heres what you need to know. The signs of ADHD in adults may be similar to childhood ADHD. These help the doctor base the diagnosis on quantifiable data. Because differences are our greatest strength. Because of uncertain costs of quality treatment, the best-practice treatment option for ADHDie, combined behavioral therapy and medicineis increasingly accessible but still not as widely accessible as medication treatment. For example, ADHD isnt the only issue that can make it hard for kids to stay focused. Youll get a physical exam, including hearing and eye tests. ADHD and anxiety can go hand-in-hand. If a child starts school having just turned 5 years old while some of their peers are closer to 6 years old, there is an approximate 20% difference in age. de Graaf R, Kessler RC, Fayyad J, et al. Theyll try to figure out if your symptoms are caused by ADHD, another condition, or both. At the level of practitioners, a suggestion of reminders and prompts is recommended, such that when contemplating a diagnosis of ADHD, practitioners are provided with a series of questions and red flags are presented for children with particular birth dates and for a series of sex-based or prototypical symptoms. The present article aims to review findings in the literature surrounding the misdiagnosis of ADHD in children. TheDiagnostic and Statistical Manual of Mental Disorders, Fifth Edition,8requires evidence of a persistent pattern of inattention or hyperactivity/impulsivity, or both, with a severity that interferes with developmental functioning in 2 or more settings; was present before age 12; and cannot be accounted for by another behavioral health disorder such as depression, anxiety, or trauma. Bruchmuller K, Margraf J, Schneider S. Is ADHD diagnosed in accord with diagnostic criteria? Costs of attention deficit-hyperactivity disorder (ADHD) in the US: excess costs of persons with ADHD and their family members in 2000. Arnold LE, Abikoff HB, Cantwell DP, et al. Chronic stress can also be a consequence of not getting enough support for ADHD and other issues. Evan Accatino, Applied Sciences, Winter 2022. WebA diagnosis of ADHD is made when an individual displays at least six symptoms from either of the above lists, with some symptoms having started before age seven. Most people with tics or Tourettes also have ADHD. Last medically reviewed on June 28, 2019, Autism spectrum disorder and ADHD are conditions that doctors link to brain development. This method often results in optimal dosing, as a forced dose yields a greater reduction in symptoms. Sanjana Gupta Updated on May 20, 2022 Medically reviewed by Ann-Louise T. Lockhart, PsyD, ABPP Maskot / Getty Images Table of Contents Coping With an Changes and challenges: managing ADHD in a fast-paced world. MSUToday. Inclusion in an NLM database does not imply endorsement of, or agreement with, This article identifies common problems in treating ADHD, discusses limits of care in pharmacotherapy and behavioral intervention, and offers practical recommendations for treating ADHD in the changing world of healthcare. If the side effects outweigh the benefits, the titration process should continue with different dosing or delivery until optimal dosing is achieved or until the physician determines that pharmacotherapy is no longer appropriate. Pelham WE Jr, Fabiano GA, Massetti GM. Schwarz A. Advertising on our site helps support our mission. Restlessness, fatigue, irritability and sleep problems are common. The .gov means its official. In order to cultivate a more well-informed community of clinicians, warnings such as this one must be presented and followed to the highest degree. Attention deficit hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders experienced during childhood. Medscape J Med 2008; 10:5. In fact, children who start school at a younger age more frequently receive a diagnosis of ADHD. WebConduct Disorder (CD) is diagnosed when children show a behavioral pattern of aggression toward others, and serious violations of rules and social norms at home, in school, and Autism, also called autism spectrum disorder (ASD), can have some symptoms that may appear similar to ADHD. The disadvantages of behavioral therapy are that it is not readily available, adds initial cost to treatment, and requires parents to invest more time at the beginning of intervention. ANAHEIM, Calif. (AP) Anaheim Ducks goaltending coach Sudarshan Sudsie Maharaj has been diagnosed with pancreatic cancer and is undergoing treatment in Canada. For example, in a study of 50 pediatric practices, only half of clinicians said they followed diagnostic guidelines to determine symptom criteria from at least 2 sources and across 2 settings, yet nearly all (93%) reported immediately prescribing medications for treatment.7. Further implications of misdiagnosis involve the cost for families that have a child assessed and treated for ADHD as well as costs within the health care system (1). Getting a second opinion is a good idea. It kind of made sense that I had it because when I was in university it was hard to stay motivated to study. Evidence-based assessment of attention deficit hyperactivity disorder in children and adolescents. J Psychiatr Res 2017; 85:4955. What is considered to be appropriate behaviour has significant implications for childrens education and health outcomes as well as costs to society. Can diet and exercise reverse prediabetes? All your symptoms seem to point to attention deficit hyperactivity disorder (ADHD): Its hard to sit still. Yule AM, Martelon M, Faraone SV, Carrellas N, Wilens TE, Bierderman J. Influence of relative age on diagnosis and treatment of attention-deficit/hyperactivity disorder in children. With school start cut-offs, in a kindergarten class one child may have just turned five years of age while another child is almost six years of age, creating an almost 20% age difference at that stage (4). In children, celiac disease can cause irritability and behavioral issues. Adult ADHD . If youre diagnosed with ADHD and another condition, your doctor will help you decide which one to treat first. Some say it's the hardest part of life with ADHD. Tics make you twitch or jerk a lot, or make sudden noises. Brown, N. M., Brown, S. N., Briggs, R. D., Germn, M., Belamarich, P. F., & Oyeku, S. O. It is a systematic, monitored experiment for parents who are wary or distrustful of ADHD pharmacotherapy, and it has notable benefits.18It is also useful for teenagers who are reluctant to use medicine to treat symptoms. Investigating the power of music for dementia. Abright AR. McKeown RE, Holbrook JR, Danielson ML, Cuffe SP, Wolraich ML, Visser SN. The primary care physician may use electronic medical record data management to track a patients progress related to ADHD features. The following are the most common symptoms of ADHD. Ford-Jones, P. C. (2015). Given the significant challenge of accurate diagnosis within this age group, and inconsistent reporting of symptoms among clinicians, teachers and parents, advising clinicians to ensure this lengthier assessment time may be warranted. No matter why youre questioning your childs diagnosis, the best remedy is more information. You often worry about school, work, or other things that are important to you. It may be hard to pay attention, finish tasks, or stay organized. She has authored Jane Austenesque novels beginning with Susan: A Jane Austen Prequel (Warleigh Hall Press Jane Austen Serie WebAre you a writer with ADHD? The influence of the pharmaceutical industry in overdiagnosis and stimulant prescription as a means to medicalizing child behaviour is an important concern (18). Given that ADHD is a neurological condition whose prevalence should not differ significantly based on birth date (4), this finding indicates a failure to account for the developmental immaturity of a child relative to peers and suggests that diagnoses of ADHD are not solely based on biological factors but rather, on other potentially subjective factors. For example, in one longitudinal study, substance use disorder was significantly higher in youths with ADHD who were never treated with medicine than in neurotypical youths and those with ADHD who were treated pharmacologically.29. In 2 dose-ranging studies of combined drug and behavioral therapy, low- to high-intensity behavioral therapy reduced targeted behaviors at lower drug dosages. Moderators and mediators of treatment outcome for youth with ADHD: understanding for whom and how interventions work. Anxiety: Kids with anxiety may seem tuned out or preoccupied because theyre distracted by worries. J Abnorm Child Psychol 2014; 42:10191031. J Clin Psychiatry 2007; 68:93101. We do not endorse non-Cleveland Clinic products or services Policy. Toomey SL, Sox CM, Rusinak D, Finkelstein JA. An investigation into the relationship among ADHD symptomatology, creativity, and neuropsychological functioning in children. What causes that symptom and how to treat it may be very different. Understanding auditory processing disorders in children. This mental illness can lead to problems with paying attention and controlling your emotions. Some research has found that boys receive a diagnosis of ADHD more often than girls, with a ratio ranging from 3:1 to 9:1 of boys to girls with an ADHD diagnosis. J Am Acad Child Adolesc Psychiatry 2012; 51:987989. Morrow RL, Garland EJ, Wright JM, Maclure M, Taylor S, Dormuth CR. Why do children with ADHD discontinue their medication? It could be: Dehydration. For instance, depression and ADHD often co-occur. Ongoing changes in healthcare require physicians to improve the quality of care, reduce costs of treatment, and manage their patients health, not just their illnesses. Doshi JA, Hodgkins P, Kahle J, et al. This can cause ADHD to be misdiagnosed as anxiety or other mood disorders in adults. Involving multiple observers is important as well. Anxiety disorders can cause people to feel constantly anxious, have panic attacks, or experience phobias. By William Dodson, M.D., LF-APA Verified Updated on July 2, 2021 Click to Add Comments 4 Disorders That Can Be Misdiagnosed ADHD By Amy Marschall, PsyD Published on March 29, 2022 Medically reviewed by Akeem Marsh, MD The Good Occup Environ Med 2008; 65:835842. Design challenges and choices. Im concerned that my 8-year-old may have been misdiagnosed with ADHD. But it could also be that your child hasnt been doing behavior therapy for long enough to make a big difference. Morin, A. The prevalence and effects of adult attention-deficit/hyperactivity disorder (ADHD) on the performance of workers: results from the WHO World Mental Health Survey Initiative. Beginning treatment with behavioral therapy rather than medicine has been found to be more cost-effective over time. Healthcare professionals such as neurologists and psychologists can carry out a detailed examination to diagnose ASD. Pediatrics 2007; 119(suppl 1):S99S106. Because ADHD is the most common behavioral disorder of childhood, value-based care is essential.1, The prevalence of ADHD increased 42% from 2003 to 2011,2with increases in nearly all demographic groups in the United States regardless of race, sex, and socioeconomic status. 2023 Healthline Media UK Ltd, Brighton, UK. An audiologist can diagnose APD by carrying out a variety of tests that look at responses to sound. Acad Pediatr 2012; 12:110116. Fabiano GA, Pelham WE Jr, Gnagy EM, et al. J Clin Child Adolesc Psychol 2016; 45:416427. Clin Ther 2013; 35:673685. Arch Pediatr Adolesc Med 2010; 164:160165. 5 Both autistic people and those with ADHD can experience sensory sensitivities as well. J Am Acad Child Adolesc Psychiatry 2015; 54:5361. The dose is ramped up until side effects occur and is then reduced until the side effects go away. Keep reading to learn more about the common signs of ADHD in adults, the challenges an adult with ADHD may face, and how ADHD is usually diagnosed and treated. Res Dev Disabil 2016; 59:351358. However, to a physician with little time to gather information about a patients life history, this childs disruptive behavior, though caused by adversity faced in early childhood, may be easily mislabeled as ADHD (Winfrey, 2022). A wide variety of factors can cause anxiety. WebThis week, Parul Singh shares the story of how she won a legal case over an ex-employer for ADHD discrimination. There are several issues that often co-occur with ADHD. 1 Black, non-Hispanic According to the National Institute of Mental Health, 4.4% of U.S. adults between the ages of 18 and 44 are diagnosed with The same study found that ADHD was diagnosed two times more often in the boy-version of the case vignettes, reflecting a common finding in ADHD research If you have bipolar disorder, you feel really energetic and happy for a while, then depressed. All rights reserved. Measuring inappropriate medical diagnosis and treatment in survey data: The case of ADHD among school-age children. But behavioral therapy reduces costs over time, enhances ADHD pharmacotherapy, often reduces the need for higher dosing, reduces visits to the doctors office, maintains behavior improvement and symptom reduction in the long term, and significantly increases quality of care.42. WebADHD manifests differently across gender, as there may be stronger social pressures for girls to sit quietly compared to boys. Given parents key role in ultimately deciding whether to medicate their child, it is crucial that they be well informed when making this decision. Particularly in an educational setting (often the origin of suggestion for ADHD assessment), this may at least partially indicate why boys are more frequently diagnosed than girls. People with oppositional defiant disorder (ODD) often lose their temper and blame others for their own mistakes. Studies have shown evidence of benefits of behavioral therapy distinct from those of pharmacotherapy.34,35Results of summer treatment programs in the United States and Japan for children ages 6 to 14 have replicated the findings of a US National Institute of Mental Health study that showed that the programs improved performance and resulted in positive behavior changes (Figure 1). This condition makes it hard to control your emotions. J Pediatr Psychol 2007; 32:664675. To be diagnosed with ADHD, a child needs to have had a certain number of symptoms for the past six months or longer. WebMulti-award award winning, multi-genre, author, ghost writer and cellist, Alice McVeigh shares her journey and her late stage diagnosis of ADHD. WebMD does not provide medical advice, diagnosis or treatment. When it doesnt make enough, you may have brain fog, memory problems, or trouble focusing or sleeping. Polanczyk G, Silva de Lima M, Horta B, Biederman J, Rohde L. The worldwide prevalence of ADHD: A systematic review and metaregression analysis. ADHD is found to affect individuals beyond childhood and into adulthood (4), and has potential long-term consequences for education, health and general well-being. Parent training is important, as parents must often manage their childrens behavior on their own the best they can, with little coaching and assistance. Visser SN, Blumberg SJ, Danielson ML, Bitsko RH, Kogan MD. Even so, guidelines for diagnosing ADHD are still not rigorously applied, contributing to misdiagnosis. Trends in attention deficit hyperactivity disorder ambulatory diagnosis and medical treatment in the United States, 20002010. More than 1 in 10 school-age children (11%) in the United States now meet the criteria for the diagnosis of ADHD; among adolescents, 1 in 5 high school boys and 1 in 11 high school girls meet the criteria.2, Rates vary among states, from a low of 4.2% for children ages 4 to 17 in Nevada to a high of 14.6% in Arkansas.3Worldwide estimates of ADHD prevalence range from 2.2% to 17.8%,4with the most recent meta-analysis for North America and Europe indicating a 7.2% worldwide prevalence in people age 18 and younger.5. Substantial controversy exists regarding correct diagnosis of ADHD, and areas of subjectivity in diagnosis have been identified. Rostain A, Jensen PS, Connor DF, Miesle LM, Faraone SV. Disruptive behavior disorders. (2022). As a library, NLM provides access to scientific literature. But it requires close monitoring by the physician, with multiple reports from parents and teachers after each dose increase to determine whether benefit at the higher dose outweighs the side effects and whether side effects can be managed. 9500 Euclid Avenue , Cleveland , Ohio 44195 | 800.223.2273 | TTY 216.444.0261, attention deficit hyperactivity disorder (ADHD), For Older Patients With Multiple Sclerosis, Discontinuing Disease-Modifying Therapy May Be an Option, How and Why a Dedicated Spine Tumor Board Can Enhance Care of Complex Patients, For Spondylolisthesis, Posterior Lumbar Facet Arthroplasty Promises a Mobility-Maintaining Alternative to Fusion, Clinicians Emphasize Harm Reduction When Counseling Patients About the Use of Psychedelics, Systematic physician observation of response to stimulant titration is often missing at the onset of treatment.
Social Media Do's And Don'ts For Professionals, Current Issues In Aged Care Sector, Middleton Valley Elementary School, Uc Berkeley Class Registration Fall 2023, Eden House, Key West Sold, Articles I