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Subtyping Attention-Deficit/Hyperactivity Disorder Using Temperament Dimensions: Toward Biologically Based Nosologic Criteria
Open accessAbstract
IMPORTANCE: Psychiatric nosology is limited by behavioral and biological heterogeneity within existing disorder categories. The imprecise nature of current nosologic distinctions limits both mechanistic understanding and clinical prediction. We demonstrate an approach consistent with the National Institute of Mental Health Research Domain Criteria initiative to identify superior, neurobiologically valid subgroups with better predictive capacity than existing psychiatric categories for childhood attention-deficit/hyperactivity disorder (ADHD). OBJECTIVE: To refine subtyping of childhood ADHD by using biologically based behavioral dimensions (i.e., temperament), novel classification algorithms, and multiple external validators. DESIGN, SETTING, AND PARTICIPANTS: A total of 437 clinically well-characterized, community-recruited children, with and without ADHD, participated in an ongoing longitudinal study. Baseline data were used to classify children into subgroups based on temperament dimensions and examine external validators including physiological and magnetic resonance imaging measures. One-year longitudinal follow-up data are reported for a subgroup of the ADHD sample to address stability and clinical prediction. MAIN OUTCOMES AND MEASURES: Parent/guardian ratings of children on a measure of temperament were used as input features in novel community detection analyses to identify subgroups within the sample. Groups were validated using 3 widely accepted external validators: peripheral physiological characteristics (cardiac measures of respiratory sinus arrhythmia and pre-ejection period), central nervous system functioning (via resting-state functional connectivity magnetic resonance imaging), and clinical outcomes (at 1-year longitudinal follow-up). RESULTS: The community detection algorithm suggested 3 novel types of ADHD, labeled as mild (normative emotion regulation), surgent (extreme levels of positive approach-motivation), and irritable (extreme levels of negative emotionality, anger, and poor soothability). Types were independent of existing clinical demarcations including DSM-5 presentations or symptom severity. These types showed stability over time and were distinguished by unique patterns of cardiac physiological response, resting-state functional brain connectivity, and clinical outcomes 1 year later. CONCLUSIONS AND RELEVANCE: Results suggest that a biologically informed temperament-based typology, developed with a discovery-based community detection algorithm, provides a superior description of heterogeneity in the ADHD population than does any current clinical nosologic criteria. This demonstration sets the stage for more aggressive attempts at a tractable, biologically based nosology.
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Written from the paper’s full text.
TL;DR
This study used parent-rated temperament and community detection to identify three ADHD subgroups—Mild, Surgent, and Irritable—that cut across DSM-5 presentations. The subgroups showed distinct peripheral physiology, amygdala resting-state connectivity, one-year stability, and prediction of new comorbid disorders.
Key findings
- Among 247 children with ADHD, community detection produced three temperament-based types: Mild (n=64, 25.9%), Surgent (n=85, 34.4%), and Irritable (n=98, 39.7%), with strong separation (Q=.50); these types did not map onto DSM-5 ADHD presentations.
- Surgent children had shorter tonic pre-ejection period than controls and the other ADHD types (baseline F[1,305]=2.73, p=.044; task F[3,303]=3.95, p=.009), while Irritable children showed a smaller respiratory sinus arrhythmia increase during negative emotion conditions, and Surgent children showed respiratory sinus arrhythmia withdrawal during positive conditions.
- Amygdala connectivity differed by type: Irritable children had weaker amygdala–anterior insula connectivity than all other groups, Mild children had reduced posterior cingulate/precuneus connectivity, and Surgent children had increased amygdala–cingulate/precuneus connectivity relative to Mild and Irritable children.
- At one-year follow-up, types were more stable than chance (χ²[4]=71.84, p<.001); over 70% of Surgent and Irritable children stayed in the same type, whereas only 43.6% of Mild children did. Irritable children had more new comorbid disorder onsets (39.5%) than controls (11.1%), Mild (18.2%), or Surgent (11.1%) children, and temperament type predicted comorbidity onset (p=.019, OR=2.46) while DSM-5 presentation and ODD symptoms did not uniquely predict it.
Methods
- Longitudinal community-recruited sample of 437 children ages 7–11: 190 controls (46.3% male) and 247 with ADHD (71.6% male). Parent/guardian ratings on the Temperament in Middle Childhood Questionnaire provided 16 subscales used as clustering features.
- Community detection used a weight-conserving modularity algorithm on child-by-child correlations; final assignments were based on the modal group across 10 runs, with Variation of Information used to assess robustness.
- External validation included peripheral physiology (respiratory sinus arrhythmia and pre-ejection period) during emotion tasks for 178 ADHD and 128 control children, resting-state functional connectivity MRI with an amygdala seed for 39 ADHD children (18 Mild, 11 Surgent, 10 Irritable) and 15 controls, and one-year follow-up for 101 children with ADHD. Analyses included repeated-measures ANOVAs, connectivity t-tests with Monte Carlo correction, and logistic/multinomial regression.
Limitations
- The paper states that imaging results come from a small subsample and should be considered preliminary; it also notes known limitations of parent-report measures and calls for future work on family history, genetics, replication in other samples, and treatment response.
- The paper states that the Mild type was less well validated because it showed normative peripheral physiology and was not particularly stable over time.
- Evident from the text: community detection is nondeterministic, so the authors relied on modal assignments across 10 runs; the follow-up sample was only 101 children with ADHD, and the MRI subsample was small, limiting confidence in neural findings.
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48 Own result · 28 Not checked yet · 20 Own interpretation · 7 Own method · 2 No basis given
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The Surgent Type differed from the other three groups during the negative suppression condition (p=.036, η2=0.04) because they showed no change in RSA in this condition from baseline.”
§ Subtyping attention-deficit/hyperactivity disorder using temperament dimensions: toward biologically based nosologic criteria > Results > External Validity: I. Peripheral Physiology
plaindirect- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Type 1 had milder impulsivity, inhibition, and attentional dyscontrol than the other two ADHD types (all p<.001).”
§ Subtyping attention-deficit/hyperactivity disorder using temperament dimensions: toward biologically based nosologic criteria > Results > Community Detection Analyses
plain- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Only the group main effect was significant (F[3, 303]=3.95, p=.009, η2=0.05).”
§ Subtyping attention-deficit/hyperactivity disorder using temperament dimensions: toward biologically based nosologic criteria > Results > External Validity: I. Peripheral Physiology
plain- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Community detection using the 247 children with ADHD identified as the modal solution three profiles (referred to herein as “types”) with n= 64 (25.9%), 85 (34.4%), and 98 (39.7%) based on modal type assignments.”
§ Subtyping attention-deficit/hyperactivity disorder using temperament dimensions: toward biologically based nosologic criteria > Results > Community Detection Analyses
plainn = 247- Asserted: passes — The authors put it forward as true.
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- The authors state this as an assumption: The TMCQ subscales and higher order factors are influenced by underlying neurobehavioral systems.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Post-hoc tests indicated that the Surgent group had significantly shorter PEP values than typically-developing children or the other ADHD types.”
§ Subtyping attention-deficit/hyperactivity disorder using temperament dimensions: toward biologically based nosologic criteria > Results > External Validity: I. Peripheral Physiology
hedgedn = 64- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The DSM-5-based presentations of ADHD were split across the types suggesting the temperament types did not reduce to DSM presentations.”
§ Subtyping attention-deficit/hyperactivity disorder using temperament dimensions: toward biologically based nosologic criteria > Results > Community Detection Analyses
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The follow up simple comparisons revealed that the Irritable type had a smaller increase in RSA than both the control and Mild groups during the two negative emotion conditions (all p<.05).”
§ Subtyping attention-deficit/hyperactivity disorder using temperament dimensions: toward biologically based nosologic criteria > Results > External Validity: I. Peripheral Physiology
plain- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Post-hoc tests again confirmed that the Surgent type had shorter PEP values than the typically-developing controls, Irritable, and Mild ADHD types.”
§ Subtyping attention-deficit/hyperactivity disorder using temperament dimensions: toward biologically based nosologic criteria > Results > External Validity: I. Peripheral Physiology
boostedn = 64- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The quality quotient suggested strong separation of the groups (Q=.50).”
§ Subtyping attention-deficit/hyperactivity disorder using temperament dimensions: toward biologically based nosologic criteria > Results > Community Detection Analyses
hedgedcorrelationaln = 247- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In the positive emotion conditions, the Surgent group also significantly differed from the other ADHD types and non-ADHD controls (p=.012, η2=0.05). Where other ADHD types and typically-developing children increased RSA, the Surgent group decreased RSA (p=.012, η2=0.05), consistent with withdrawal of parasympathetic activity (see Figure 2 and eTable 3).”
§ Subtyping attention-deficit/hyperactivity disorder using temperament dimensions: toward biologically based nosologic criteria > Results > External Validity: I. Peripheral Physiology
plaindirect- Asserted: passes — The authors put it forward as true.
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- It may state two separate claims as one. 28
- The quote only partly states this claim. 1
- Probably not a substantial claim. 15
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“At the first step, including all 437 children in the sample, community detection identified three profiles of children (Q=.55) with sizes of 192, 181, 64.”
§ Subtyping attention-deficit/hyperactivity disorder using temperament dimensions: toward biologically based nosologic criteria > Results > Community Detection Analyses
plainn = 437- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Type 3, in addition to greater impulsivity and attentional dyscontrol than the Mild type, also had more negative emotionality than the other two types or the controls (all p<.001).”
§ Subtyping attention-deficit/hyperactivity disorder using temperament dimensions: toward biologically based nosologic criteria > Results > Community Detection Analyses
plaincorrelational- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“A main effect of group (F[3, 303]=3.97, p=.047, η2=0.03) was qualified by a 3-way interaction of Valence×Condition × Group (F[3, 303]=4.09, p=.018, η2=0.03).”
§ Subtyping attention-deficit/hyperactivity disorder using temperament dimensions: toward biologically based nosologic criteria > Results > External Validity: I. Peripheral Physiology
plaincorrelational- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Profile 1 included 82% of the control children and only 13% of the ADHD children. Profiles 2 and 3 together included 87% of the ADHD children and only 18% of non-ADHD controls.”
§ Subtyping attention-deficit/hyperactivity disorder using temperament dimensions: toward biologically based nosologic criteria > Results > Community Detection Analyses
plaincorrelationaln = 437- Asserted: passes — The authors put it forward as true.
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In the paper
“This included higher levels of anger, discomfort, fear, and sadness, and lower levels of soothability (all p<.001), suggesting this is a group of children prone to anger, tantrums, and irritable behavior as described in recent literature [53].”
§ Subtyping attention-deficit/hyperactivity disorder using temperament dimensions: toward biologically based nosologic criteria > Results > Community Detection Analyses
What the sources say
- Not checked yetcites [53] Leibenluft E Severe mood dysregulation, irritability, and the diagnostic boundaries of bipolar disorder in youths The American Journal of Psychiatry 2011 168 2 129 21123313 PMC3396206
plaincorrelational- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“None of the groups showed significant change in PEP from baseline to task (i.e. PEP reactivity scores did not differ from zero, all p>.05), and there were no significant main or interaction effects when PEP reactivity scores were examined for the emotion task (all p>.05).”
§ Subtyping attention-deficit/hyperactivity disorder using temperament dimensions: toward biologically based nosologic criteria > Results > External Validity: I. Peripheral Physiology
plain- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Type 2 had more severe impulsivity than Type 1, and also less shyness and more assertiveness/dominance, high-intensity pleasure seeking, and activity level than either of the other two types or than controls (all p<.001); we labeled this type “Surgent ADHD.””
§ Subtyping attention-deficit/hyperactivity disorder using temperament dimensions: toward biologically based nosologic criteria > Results > Community Detection Analyses
plaincorrelational- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Clinically, Type 1 was more impulsive and inattentive (all p<.01) than controls, as well as less affiliative (all p<.05), but otherwise did not differ from controls on any temperament domain.”
§ Subtyping attention-deficit/hyperactivity disorder using temperament dimensions: toward biologically based nosologic criteria > Results > Community Detection Analyses
plain- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In contrast, the Mild type often changed profile: 43.6% remained Mild type at Time 2; 41% became Surgent type and 15.4% became Irritable type (see eVideo 1 in Supplement for depiction of stability of types over time).”
§ Subtyping attention-deficit/hyperactivity disorder using temperament dimensions: toward biologically based nosologic criteria > Results > External validation: III. Longitudinal Stability and Clinical Outcome
plaincorrelationaln = 18- Asserted: passes — The authors put it forward as true.
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- Rests on an assumption: The one-year follow-up period is sufficient to assess stability and clinical prediction.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“neither DSM-5 presentations nor groups based on the presence/absence of ODD symptoms (i.e. 0 symptoms versus 1+ symptoms) differed in their rates of new comorbid disorder onsets at Time 2 (χ2[1]=0.68, p=.409 and χ2[1]=2.54, p=.111, respectively).”
§ Subtyping attention-deficit/hyperactivity disorder using temperament dimensions: toward biologically based nosologic criteria > Results > External validation: III. Longitudinal Stability and Clinical Outcome
plain- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Neither the presence of Time 1 ODD symptoms (p=.563) nor ADHD DSM-5 presentation (p=.113) uniquely predicted new onsets at Time 2.”
§ Subtyping attention-deficit/hyperactivity disorder using temperament dimensions: toward biologically based nosologic criteria > Results > External validation: III. Longitudinal Stability and Clinical Outcome
plain- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The Irritable group displayed weaker connectivity (in the form of reduced negative relationships) from the amygdala to the anterior insula relative to all other groups (including non-ADHD controls) and weaker connectivity to the posterior cingulate (a key hub in the default network) relative to typically-developing and the Surgent children.”
§ Subtyping attention-deficit/hyperactivity disorder using temperament dimensions: toward biologically based nosologic criteria > Results > External Validation: II. Neural Connectivity
plaincorrelational- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The Surgent type evidenced increased connectivity from the amygdala to cingulate/precuneus compared to the Mild and Irritable groups, but was similar relative to control populations.”
§ Subtyping attention-deficit/hyperactivity disorder using temperament dimensions: toward biologically based nosologic criteria > Results > External Validation: II. Neural Connectivity
plain- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“the subgroups found here were largely stable over time”
§ Subtyping attention-deficit/hyperactivity disorder using temperament dimensions: toward biologically based nosologic criteria > Discussion
hedged- Asserted: passes — The authors put it forward as true.
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A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Thus, data suggest that the Surgent and Irritable types have distinct peripheral physiological profiles as compared to each other and to typically-developing children.”
§ Subtyping attention-deficit/hyperactivity disorder using temperament dimensions: toward biologically based nosologic criteria > Results > External Validity: I. Peripheral Physiology
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
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What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“List of scales and reliabilities in the current sample (which were all satisfactory) are provided in the Supplement.”
§ Subtyping attention-deficit/hyperactivity disorder using temperament dimensions: toward biologically based nosologic criteria > Methods > Temperament Ratings
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“The amygdala, in particular, plays a key role in emotion and motivation, and so is one important brain correlate of temperament domains [17, 28, 29].”
§ Subtyping attention-deficit/hyperactivity disorder using temperament dimensions: toward biologically based nosologic criteria > Introduction > Phenotypic features
What the sources say
- Not checked yetcites [17] Smillie LD Extraversion and Reward Processing Current Directions in Psychological Science 2013 22 3 167 172 PMC3989147 24748727
- Not checked yetcites [28] Miskovic V Schmidt LA New directions in the study of individual differences in temperament: A brain–body approach to understanding fearful and fearless children Monographs of the Society for Research in Child Development 2012 77 2 28 38
- Not checked yetcites [29] Rothbart MK Temperament, development, and personality Current Directions in Psychological Science 2007 16 4 207 212
plaincorrelational- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“Standard methods for artifact detection were followed as published in our prior work [40] and are also provided in the Supplement.”
§ Subtyping attention-deficit/hyperactivity disorder using temperament dimensions: toward biologically based nosologic criteria > Methods > External Validation
What the sources say
- Not checked yetcites [40] Musser ED Emotion regulation via the autonomic nervous system in children with attention-deficit/hyperactivity disorder (ADHD) Journal of Abnormal Child Psychology: An official publication of the International Society for Research in Child and Adolescent Psychopathology 2011 39 6 841 852 PMC3112468 21394506
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“but DSM-IV subtypes (and thus DSM-5 presentations) fail to elucidate clear differences in pathophysiology or clinical course, in part due to their own instability over time [5, 7–9].”
§ Subtyping attention-deficit/hyperactivity disorder using temperament dimensions: toward biologically based nosologic criteria > Introduction
What the sources say
- Not checked yetcites [5] Khan SA Faraone SV The genetics of ADHD: a literature review of 2005 Current Psychiatry Reports 2006 8 5 393 16968622
- Not checked yetcites [7] Chhabildas N Pennington BF Willcutt EG A comparison of the neuropsychological profiles of the DSM-IV subtypes of ADHD Journal of Abnormal Child Psychology 2001 29 6 529 540 11761286
- Not checked yetcites [8] Lahey BB Pelham WE Loney J Lee SS Willcutt E Instability of the DSM-IV subtypes of ADHD from preschool through elementary school Archives of General Psychiatry 2005 62 8 896 902 16061767
- Not checked yetcites [9] Willcutt EG Validity of DSM–IV Attention Deficit/Hyperactivity Disorder Symptom Dimensions and Subtypes 2012 PMC3622557 22612200
plain- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
In the paper
“To account for multiple comparisons, thresholding based on Monte Carlo simulation was implemented [52].”
§ Subtyping attention-deficit/hyperactivity disorder using temperament dimensions: toward biologically based nosologic criteria > Methods > External Validation
What the sources say
- Not checked yetcites [52] Forman SD Improved assessment of significant activation in functional magnetic resonance imaging (fMRI): use of a cluster-size threshold Magnetic Resonance in Medicine 1995 33 5 636 647 7596267
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim.
In the paper
“A secondary validation method [Variation of Information Algorithm (VOI), 37] was also used to evaluate internal validity (group robustness to chance data variation).”
§ Subtyping attention-deficit/hyperactivity disorder using temperament dimensions: toward biologically based nosologic criteria > Methods > Community Detection Analyses
What the sources say
- Not checked yetcites [37] Karrer B Levina E Newman ME Robustness of community structure in networks Physical Review E 2008 77 4 046119 18517702
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“Community detection is a widely used optimization clustering method (another well-known optimization clustering method is mixture modeling). As a clustering approach it has the attractive features of being data-driven (in that the number of communities does not have to be pre-specified in the model) and provides a quantitative measure of group robustness to chance variations in the data structure.”
§ Subtyping attention-deficit/hyperactivity disorder using temperament dimensions: toward biologically based nosologic criteria > Introduction > Clustering methods
What the sources say
- Not checked yetcites [30] Newman MEJ Modularity and community structure in networks Proceedings of the National Academy of Sciences of the United States of America 2006 103 23 8577 8582 16723398 PMC1482622
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- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Temperament traits also have distinct neurobiological correlates with a substantial literature in humans and animals [18–20].”
§ Subtyping attention-deficit/hyperactivity disorder using temperament dimensions: toward biologically based nosologic criteria > Introduction > Phenotypic features
What the sources say
- Not checked yetcites [18] Depue RA Lenzenweger MF A neurobehavioral dimensional model of personality disturbance Major theories of personality disorder 2005 2 391 453
- Not checked yetcites [19] Kennis M Rademaker AR Geuze E Neural correlates of personality: An integrative review Neuroscience & Biobehavioral Reviews 2012 23142157
- Not checked yetcites [20] Zuckerman M Psychobiology of personality 2005 2nd ed. New York, NY Cambridge University Press
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Motion, a known confound in functional MRI studies, was corrected and quantified several ways [46, 49] (for details see the Supplement).”
§ Subtyping attention-deficit/hyperactivity disorder using temperament dimensions: toward biologically based nosologic criteria > Methods > External Validation
What the sources say
- Not checked yetcites [46] Fair DA Distinct neural signatures detected for ADHD subtypes after controlling for micro-movements in resting state functional connectivity MRI data Frontiers in Systems Neuroscience 2012 6 PMC3563110 23382713
- Not checked yetcites [49] Power JD Barnes KA Snyder AZ Schlaggar BL Petersen SE Spurious but systematic correlations in functional connectivity MRI networks arise from subject motion Neuroimage 2012 59 3 2142 2154 22019881 PMC3254728
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“Clustering algorithms can be expected to yield varying results depending on the algorithm used and features selected as input [13] and therefore are, in themselves, exploratory [14]”
§ Subtyping attention-deficit/hyperactivity disorder using temperament dimensions: toward biologically based nosologic criteria > Introduction
What the sources say
- Not checked yetcites [13] Everitt BS Landau S Leese M Stahl D Cluster Analysis 2011 5th ed. West Sussex, United Kingdom John Wiley & Sons, Ltd
- Not checked yetcites [14] Jain AK Data clustering: 50 years beyond K-means Pattern Recognition Letters 2010 31 8 651 666
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“To generate a single, stable depiction of structure, final group assignments for each child were based on the modal group assignment across 10 runs of the modularity algorithm.”
§ Subtyping attention-deficit/hyperactivity disorder using temperament dimensions: toward biologically based nosologic criteria > Methods > Community Detection Analyses
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
None of the sources cited for this claim have been checked yet.
In the paper
“In humans, temperament domains are differentially related to peripheral nervous system indicators [21–25], as well to specific neural circuitry [e.g. amygdala, hippocampus, insula, and striatum, anterior cingulate cortex, and prefrontal cortex, 26, 27].”
§ Subtyping attention-deficit/hyperactivity disorder using temperament dimensions: toward biologically based nosologic criteria > Introduction > Phenotypic features
What the sources say
- Not checked yetcites [21] Beauchaine TP Katkin ES Strassberg Z Snarr J Disinhibitory psychopathology in male adolescents: Discriminating conduct disorder from attention-deficit/hyperactivity disorder through concurrent assessment of multiple autonomic states Journal of Abnormal Psychology 2001 110 4 610 624 11727950
- Not checked yetcites [22] Healy B Treadwell A Reagan M Measures of RSA suppression, attentional control, and negative affect predict self-ratings of executive functions Journal of Psychophysiology 2011 25 4 164 173
- Not checked yetcites [23] Miller JG Children's dynamic RSA change during anger and its relations with parenting, temperament, and control of aggression Biological Psychology 2012 PMC4055035 23274169
- Not checked yetcites [24] Stifter CA Dollar JM Cipriano EA Temperament and emotion regulation: the role of autonomic nervous system reactivity Developmental psychobiology 2011 53 3 266 279 21400489 PMC3737744
- Not checked yetcites [25] Zalewski M Lengua LJ Wilson AC Trancik A Bazinet A Emotion regulation profiles, temperament, and adjustment problems in preadolescents Child Development 2011 82 3 951 966 21413935 PMC4080917
- Not checked yetcites [26] Ochsner KN Silvers JA Buhle JT Functional imaging studies of emotion regulation: a synthetic review and evolving model of the cognitive control of emotion Annals of the New York Academy of Sciences 2012 1251 1 E1 E24 23025352 PMC4133790
- Not checked yetcites [27] Whittle S Allen NB Lubman DI Yücel M The neurobiological basis of temperament: Towards a better understanding of psychopathology Neuroscience & Biobehavioral Reviews 2006 30 4 511 525 16289282
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Functional images were processed to reduce artifacts and connectivity was processed following published methods [48] and are reproduced in the Supplement.”
§ Subtyping attention-deficit/hyperactivity disorder using temperament dimensions: toward biologically based nosologic criteria > Methods > External Validation
What the sources say
- Not checked yetcites [48] Miezin FM Maccotta L Ollinger J Petersen S Buckner R Characterizing the hemodynamic response: effects of presentation rate, sampling procedure, and the possibility of ordering brain activity based on relative timing Neuroimage 2000 11 6 735 759 10860799
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“imaging results are based on a small subsample of participants and should be considered preliminary”
§ Subtyping attention-deficit/hyperactivity disorder using temperament dimensions: toward biologically based nosologic criteria > Discussion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Together these data may highlight the region’s importance for emotional regulation and impulse control.”
§ Subtyping attention-deficit/hyperactivity disorder using temperament dimensions: toward biologically based nosologic criteria > Discussion
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Rests on an assumption: The insula is important for monitoring and adjusting sympathetic and parasympathetic tone.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Importantly, this and other modularity algorithms are not deterministic, and thus can yield slightly different solutions on different runs.”
§ Subtyping attention-deficit/hyperactivity disorder using temperament dimensions: toward biologically based nosologic criteria > Methods > Community Detection Analyses
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“they emerge as promising, novel types of ADHD”
§ Subtyping attention-deficit/hyperactivity disorder using temperament dimensions: toward biologically based nosologic criteria > Discussion
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“temperament traits have been investigated in many other disorders [65]”
§ Subtyping attention-deficit/hyperactivity disorder using temperament dimensions: toward biologically based nosologic criteria > Discussion
What the sources say
- Not checked yetcites [65] Nigg JT Temperament and developmental psychopathology Journal of Child Psychology and Psychiatry 2006 47 3–4 395 422 16492265
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“while being mostly consistent with and building on previous work exploring temperament subgroups in ADHD in a different sample [66]”
§ Subtyping attention-deficit/hyperactivity disorder using temperament dimensions: toward biologically based nosologic criteria > Discussion
What the sources say
- Not checked yetcites [66] Martel MM Goth-Owens T Martinez-Torteya C Nigg JT A person-centered personality approach to heterogeneity in attention-deficit/hyperactivity disorder (ADHD) Journal of Abnormal Psychology 2010 119 1 186 196 20141255 PMC2846424
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Results suggest that revising the nosology in the case of ADHD is tractable and will be biologically meaningful.”
§ Subtyping attention-deficit/hyperactivity disorder using temperament dimensions: toward biologically based nosologic criteria > Discussion
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“suggesting some validity and clinical applicability for these measures”
§ Subtyping attention-deficit/hyperactivity disorder using temperament dimensions: toward biologically based nosologic criteria > Discussion
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“these findings are broadly consistent with, but suggest some modifications to, prior theory of ADHD temperament variation that inspired this work [64, 65]”
§ Subtyping attention-deficit/hyperactivity disorder using temperament dimensions: toward biologically based nosologic criteria > Discussion
What the sources say
- Not checked yetcites [64] Nigg J Goldsmith HH Sachek J Temperament and Attention Deficit Hyperactivity Disorder: The Development of a Multiple Pathway Model Journal of Clinical Child and Adolescent Psychology 2004 33 1 42 53 15028540
- Not checked yetcites [65] Nigg JT Temperament and developmental psychopathology Journal of Child Psychology and Psychiatry 2006 47 3–4 395 422 16492265
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“it has also been shown to be heavily involved in higher order control processing [62, 63]”
§ Subtyping attention-deficit/hyperactivity disorder using temperament dimensions: toward biologically based nosologic criteria > Discussion
What the sources say
- Not checked yetcites [62] Dosenbach NU Fair DA Cohen AL Schlaggar BL Petersen SE A dual-networks architecture of top-down control Trends in Cognitive Sciences 2008 12 3 99 105 18262825 PMC3632449
- Not checked yetcites [63] Dosenbach NU Distinct brain networks for adaptive and stable task control in humans Proceedings of the National Academy of Sciences 2007 104 26 11073 11078 PMC1904171 17576922
boostedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“A parent/guardian completed the widely used Temperament in Middle Childhood Questionnaire [TMCQ, 34].”
§ Subtyping attention-deficit/hyperactivity disorder using temperament dimensions: toward biologically based nosologic criteria > Methods > Temperament Ratings
What the sources say
- Not checked yetcites [34] Simonds J Rothbart MK The Temperament in Middle Childhood Questionnaire (TMCQ): A computerized self-report measure of temperament for ages 7–10, in Occasional Temperament Conference 2004 Athens, GA
boosted- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
The paper relies on this without support.
No prior study of alternative nosology has demonstrated both biological validity and clinical prediction within the same sample.
“For example, no study of alternative nosology has demonstrated both biological validity and clinical prediction within the same sample.”
The authors state this as an assumption.
The TMCQ subscales and higher order factors are influenced by underlying neurobehavioral systems.
“Items form 16 subscales and three higher order factors that are hypothesized to be influenced by underlying neurobehavioral systems.”
The paper relies on this without support.
The 247 children with ADHD in this community-recruited sample are representative of the broader ADHD population.
“Data are reported for 437 children: NControl=190 (46.3% male); NADHD=247 (71.6% male) between the ages of 7–11. Participants were drawn from the Oregon ADHD Program, a child cohort for which the community-based recruitment and enrollment procedures and multi-informant assessment procedures for ADHD diagnosis are published elsewhere [31–33] and described in the Supplement.”
The paper relies on this without support.
The one-year follow-up period is sufficient to assess stability and clinical prediction.
“One-year longitudinal follow-up data on clinical features and TMCQ ratings are reported for 101 children with ADHD (98% of those currently due for follow up in this ongoing study).”
The paper relies on this without support.
Parent-report on the TMCQ broadly captures RDoC domains of negative valence systems, positive valence systems/approach motivation, and cognitive control.
“parent-report on the TMCQ broadly captures RDoC domains of negative valence systems, positive valence systems/approach motivation, and cognitive control”
The paper relies on this without support.
The insula is important for monitoring and adjusting sympathetic and parasympathetic tone.
“the insula is a region that has been long known to be important for monitoring and adjusting sympathetic and parasympathetic tone”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Limited sample size, clinical heterogeneity in terms of comorbidities, gender effects, diverse courses and outcomes, varying etiological sources, also play their roles (Hyman, 2007; Kapur et al., 2012; Karalunas et al., 2014).”
From A Review of Heterogeneity in Attention Deficit/Hyperactivity Disorder (ADHD) (2019) · cites this paper as Karalunas et al., 2014
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“discovery methods applied to temperamental traits distinguished ADHD subtypes defined by high positive and negative emotionality (Karalunas et al., 2014).”
From Data‐driven identification of subtypes of executive function across typical development, attention deficit hyperactivity disorder, and autism spectrum disorders (2020) · cites this paper as Karalunas et al., 2014
The cited source says what the claim attributes to it.
In the citing paper
“Interestingly, community detection applied to temperamental traits in ADHD, revealed segregation by positive and negative emotion regulation problems (Karalunas et al., 2014)”
From Data‐driven identification of subtypes of executive function across typical development, attention deficit hyperactivity disorder, and autism spectrum disorders (2020) · cites this paper as Karalunas et al., 2014
The cited source says what the claim attributes to it.
In the citing paper
“Attempts to group mental disorders by biological substrates have been made (Hyman 2010, Karalunas et al. 2014), but more research is required to establish meaningful links to behaviors, developmental course, or treatment (Sisti et al. 2013).”
From Recent Advances in Autism Research as Reflected in DSM-5 Criteria for Autism Spectrum Disorder (2015) · cites this paper as Karalunas et al. 2014
In the citing paper
“The findings here are not that dissimilar with other modeling approaches such as latent class analysis that often derive low and high performing groups ( Karalunas et al., 2014, Katuwal et al., 2016).”
From Heterogeneity of executive function revealed by a functional random forest approach across ADHD and ASD (2020) · cites this paper as Karalunas et al., 2014
In the citing paper
“Three temperament subtypes, “mild,” “irrita- ble,” and “surgent,” were identified from 437 children with or without ADHD followed longitudinally (50).”
From Methods and challenges for assessing heterogeneity (2020) · cites this paper as [50]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
“There were baseline differences in PEP between groups (F[1, 305]=2.73, p=.044, η2=0.03).”
§ Subtyping attention-deficit/hyperactivity disorder using temperament dimensions: toward biologically based nosologic criteria > Results > External Validity: I. Peripheral Physiology
Reported 1 · recomputed 3
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Subtyping attention-deficit/hyperactivity disorder using temperament dimensions: toward biologically based nosologic criteria > Results > Community Detection Analyses
“At the first step, including all 437 children in the sample, community detection identified three profiles of children (Q=.55) with sizes of 192, 181, 64. Profile 1 included 82% of the control children and only 13% of the ADHD children.”
§ Subtyping attention-deficit/hyperactivity disorder using temperament dimensions: toward biologically based nosologic criteria > Methods > Participants and Diagnostic Procedures
“Data are reported for 437 children: NControl=190 (46.3% male); NADHD=247 (71.6% male) between the ages of 7–11.”
Citations
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Metadata
- Authors
- Karalunas, S. L., Fair, D., Musser, E. D., Aykes, K., Iyer, S. P., & Nigg, J. T.
- Affiliations
- Oregon Health & Science University (US)
- Florida International University (US)
- Brigham and Women's Hospital (US)
- Corresponding author
- Karalunas, Sarah L.
- Venue
- JAMA Psychiatry
- Publisher
- American Medical Association (AMA)
- Published
- 2014-09-01
- Volume
- 71
- Issue
- 9
- Pages
- 1015
- ISSN
- 2168-622X (ISSN-L)
- PMC
- PMC4278404
- OpenAlex
- W1983915852
- Semantic Scholar
- 15a19b0e1e4cfa79179c3b4e696bd06c7c77fc40
- Cited by
- 340
- References
- 71
- Citations by year
- 2026: 16 · 2025: 15 · 2024: 18 · 2023: 17 · 2022: 29 · 2021: 37 · 2020: 39 · 2019: 37 · 2018: 26 · 2017: 41 · 2016: 32 · 2015: 29 · 2014: 4
- FWCI
- 26.96
- Type
- journal article
- Language
- en
- Status
- Retracted
- Update notices
- retraction (2018-03-07)
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- JAMA Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (5r01mh099064-05)
- National Institute of Mental Health (R01-MH099064, R01MH115357, F32MH098632, R00MH091238, R37MH059105, R01MH096773, R01MH059105, R01MH086654)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Keywords
- attention deficit hyperactivity disorder, childhood ADHD, temperament dimensions, Research Domain Criteria, community detection, emotion regulation, approach motivation, negative affectivity, pre-ejection period, resting-state functional connectivity, disease classification, clinical prediction, longitudinal stability
- MeSH terms
- Algorithms, Attention Deficit Disorder with Hyperactivity, Brain, Child, Electrocardiography, Female, Heart Rate, Humans, Longitudinal Studies, Magnetic Resonance Imaging, Male, Surveys and Questionnaires, Temperament, Case-Control Studies, Functional Neuroimaging, Respiratory Sinus Arrhythmia
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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