The World Federation of ADHD International Consensus Statement: 208 Evidence-based conclusions about the disorder

A meta-analysis found that ADHD was associated with more than twofold greater odds of alcohol-use disorders and nicotine-related disorder.

“A meta-analysis found that ADHD was associated with a more than twofold greater odds of alcohol-use disorders (13 studies, over 20,000 participants) and nicotine-related disorder (14 studies, over 1,800 participants) (Groenman et al., 2017).”

• Also stated in: § Substance Use Disorders · plain

  “A meta-analysis found that ADHD was associated with a more than twofold greater odds of alcohol-use disorders (13 studies, over 20,000 participants) and nicotine-related disorder (14 studies, over 1,800 participants)”

• cites Groenman et al., 2017 sourceSupported

The disorder's signs and symptoms have been clinically recognized for more than 200 years.

“The clinical significance of the signs and symptoms of the disorder has been recognized for over two centuries.”

• cites Lange et al., 2010 sourceSupported
• cites Taylor, 2011 sourceNot checked — no full text of the source
• cites Weikard, 1799Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

In most ADHD cases, multiple genetic and environmental risks combine to produce the disorder.

“For most people with ADHD, many genetic and environmental risk factors accumulate to cause the disorder”

• cites Faraone et al., 2015 sourceSupported

ADHD prevalence does not differ significantly across North America, Europe, Asia, Africa, South America, and Oceania.

“Another meta-analysis, with 135 studies and about a quarter of a million youths, found no significant differences in prevalence between North America and Europe, Asia, Africa, South America, and Oceania”

• cites Polanczyk et al., 2014 sourceSupported

Adult ADHD prevalence is estimated at 2.5%.

“A meta-analysis of six studies with over 5,300 participants estimated the prevalence of ADHD in adulthood to be 2.5%”

• cites Simon et al., 2009 sourcePartly supported

  The Results report a pooled adult ADHD prevalence of 2.5% (95% CI 2.1–3.1). The Abstract says six studies were omitted from 12 identified studies, consistent with six in the analysis, but the passages available from our copy do not substantiate the citing sentence’s figure of over 5,300 participants. (LLM, conf=0.83)

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Males are more frequently affected by ADHD than females.

“ADHD occurs throughout the developed and developing world and is more common in males compared with females.”

• Also stated in: § How Common is ADHD? · plain

  “ADHD is more common in males.”

• cites Willcutt, 2012 sourceSupported

The frequency of ADHD has not risen over the last thirty years.

“It has not become more common over the past three decades”

• Also stated in: § How Common is ADHD? · plain

  “The latter meta-analysis found no increase in the prevalence of ADHD in children and adolescents over the past three decades”

• cites Polanczyk et al., 2014 sourceSupported

Black people have a higher risk of ADHD diagnosis than the general U.S. population.

“Black individuals are at higher risk for ADHD diagnoses than the general US population.”

• cites Cénat et al., 2020 sourceSupported

ADHD prevalence among U.S. Black youths under 18 is 14%.

“A meta-analysis of 19 studies encompassing over 150,000 U.S. Black youths under 18 years old reported an ADHD prevalence rate of 14 percent.”

• cites Cénat et al., 2020 sourcePartly supported

  The Results report a pooled ADHD prevalence of 13.87% for 19 studies assessing Black people younger than 18, which rounds to 14%. However, the reported total of 154,818 participants covers all 21 studies, including adult samples; it does not establish that the 19-study youth analysis encompassed over 150,000 participants. (LLM, conf=0.90)

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ADHD is found in both developed and developing countries.

“ADHD occurs throughout the developed and developing world”

• cites Polanczyk et al., 2014 sourceSupported

Only 0.02% of people aged 50 or older receive ADHD treatment.

“A third meta-analysis performed by the same researchers, of four studies with over 9.2 million participants, found an ADHD treatment rate of only 0.02% among persons at least fifty years old”

• cites Dobrosavljevic et al., 2020 sourcePartly supported

  Table 2 reports a 0.02% pooled ADHD-treatment prevalence for the analysis restricted to an age cutoff of at least 50, but that estimate uses only two datasets and has a wide 95% confidence interval (0.00–1.88%). The four studies with 9,260,809 participants described in section 3.1 contributed nine datasets; the pooled treatment estimate for all nine was 0.09%, not 0.02%. No page number is available in our copy. (LLM, conf=0.91)

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The two symptom dimensions have different patterns of co-occurring disorders.

“Patterns of associated disorders also differ between the dimensions”

• cites Willcutt et al., 2012 sourceSupported

Among youths, 5.9% satisfy diagnostic criteria for ADHD.

“A meta-analysis of 19 studies with over 55,000 participants found that 5.9% of youths meet diagnostic criteria for ADHD”

• cites Willcutt, 2012 sourcePartly supported

  The Overall ADHD section reports a 5.9% prevalence among children and adolescents when studies used best-estimate diagnoses. But Table 1 (under Summary and Conclusions) shows that the 19 studies with 55,125 participants used parent ratings and yielded 6.1%, not 5.9%; the citing sentence combines results from different analyses. Page numbers were not available in our copy. (LLM, conf=0.91)

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About 2.8% of adults meet ADHD criteria.

“A meta-analysis of 20 studies encompassing 13 countries and seven regions/metropolitan areas, involving more than 26,000 participants, estimated that 2.8% of adults meet criteria for ADHD”

• cites Fayyad et al., 2017 sourcePartly supported

  The Results (ADHD prevalence in childhood and persistence into adulthood) report that current adult ADHD prevalence averaged 2.8% across surveys. Methods and materials (Samples; Field procedures) describe 20 WMH surveys and 26,744 respondents assessed for ADHD, but the paper presents a pooled survey analysis, not a meta-analysis of 20 studies. Its listed survey locations also do not support the stated breakdown of 13 countries and seven regions or metropolitan areas. (LLM, conf=0.89)

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Clinical-diagnosis ADHD prevalence for people aged 50 or older is 0.2%.

“a meta-analysis of seven studies with over 11.7 million participants based on ADHD clinical diagnoses, performed by the same team, reported a prevalence of only 0.2% for persons at least fifty years old”

• cites Dobrosavljevic et al., 2020 sourcePartly supported

  Section 3.1 reports seven clinical-diagnosis studies with 11,706,296 participants. Section 3.2 gives their pooled prevalence as 0.23%, which rounds to 0.2% to one decimal place. However, Table 2 distinguishes that overall estimate from the analysis limited to an age cutoff of at least 50, which reports 0.19% from seven data sets; the citing sentence conflates the two analyses. (LLM, conf=0.84)

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In youths, the male-to-female ADHD ratio is about 2:1.

“A meta-analysis of parent ratings of symptoms in 29 studies with over 42,000 participants, and teacher ratings in 24 studies with over 56,000 participants, found a roughly two-to-one male/female ratio in youth”

• cites Willcutt, 2012 sourceSupported

A tenfold rise in DMAP organophosphate metabolite is linked to 55% higher probability of ADHD.

“a tenfold increase in the organophosphate metabolite dimethyl alkylphosphate (DMAP) was associated with 55% increase in the probability of having ADHD”

• cites Bouchard et al., 2010 sourcePartly supported

  The Abstract Results and Results ('Any Subtype of ADHD') report an adjusted odds ratio of 1.55 for ADHD with a tenfold increase in urinary DMAP concentration. That is 55% higher odds, not necessarily a 55% higher probability, as the citing sentence states. (LLM, conf=0.90)

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Children with autism or ADHD show more rare genetic mutations than controls.

“those with ASD and those with ADHD had an increased rate of rare genetic mutations compared with controls”

• cites Satterstrom et al., 2019 sourcePartly supported

  The Abstract and Results (‘Rates of constrained rare variation’; page not provided) report that children with ASD and children with ADHD had higher burdens than controls of rare protein-truncating variants in constrained genes. The claim omits that restriction and implies an increased rate of rare genetic mutations generally, which the paper does not establish. (LLM, conf=0.88)

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Children with detectable levels of the most common DMAP metabolite have twice the likelihood of ADHD as those with undetectable levels.

“Children with detectable levels of the most-commonly detected DMAP metabolite were twice as likely to have ADHD compared with those with undetectable levels”

• cites Bouchard et al., 2010 sourcePartly supported

  The Results (Any Subtype of ADHD) identify dimethylthiophosphate as the most commonly detected DMAP metabolite and report approximately double the odds of ADHD for children above the median of detectable concentrations versus those below the detection limit. The claim extends that finding to all children with detectable levels, which the paper does not establish. (LLM, conf=0.92)

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After confounder adjustment, children of mothers in the top phthalate metabolite quintile are three times more likely to have ADHD than those in the bottom quintile.

“Children of mothers in the highest quintile of phthalate metabolite levels were three times more likely to have had ADHD as children compared with those in the bottom quintile, after adjusting for confounders”

• cites Engel et al., 2018 sourcePartly supported

  The Results report that, after covariate adjustment, children in the highest maternal ∑DEHP quintile had almost three times the odds of an ADHD diagnosis as those in the lowest quintile (OR 2.99). The claim omits that this finding was specific to ∑DEHP: the Results report no association for several other phthalate measures. It also describes an odds ratio as being three times more likely. (LLM, conf=0.88)

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Maternal prenatal acetaminophen shows a dose-response relation with ADHD.

“found a dose-response relationship between maternal prenatal use of acetaminophen and ADHD”

• cites Ystrom et al., 2017 sourceSupported

Most ADHD cases are polygenic: numerous variants of very small effect together raise risk.

“This study confirmed a polygenic cause for most cases of ADHD, meaning that many genetic variants, each having a very small effect, combine to increase risk for the disorder.”

• cites Demontis et al., 2019 sourcePartly supported

  The Discussion reports modest effects for individual risk variants (odds ratios 1.077–1.198) and describes an important role for common variants in ADHD’s polygenic architecture. The Results section “Polygenic Architecture of ADHD” estimates SNP heritability, but neither passage establishes that polygenic risk causes most individual ADHD cases. The claim’s “most cases” qualifier therefore goes beyond the paper’s findings. (LLM, conf=0.87)

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Other anti-epileptic drugs showed no association with ADHD.

“No associations were found for other anti-epileptic drugs”

• cites Christensen et al., 2019 sourceSupported

Youths in the top fifth of blood lead are four times more likely to have ADHD than those in the bottom fifth.

“those with blood lead levels in the highest fifth were four times more likely to have ADHD compared with those in the bottom fifth”

• cites Braun et al., 2006 sourceSupported

ADHD shares some genetic and environmental influences with many psychiatric and somatic disorders.

“Family, twin, and DNA studies show that genetic and environmental influences are partially shared between ADHD and many other psychiatric disorders (e.g. schizophrenia, depression, bipolar disorder, autism spectrum disorder, conduct disorder, eating disorders, and substance use disorders) and with somatic disorders (e.g. migraine and obesity)”

• cites Demontis et al., 2019 sourcePartly supported

  The Introduction reports genetic overlap between ADHD and several psychiatric conditions, and the Results (Genetic correlation with other traits) report significant genetic overlap with depression, anorexia nervosa, and obesity-related phenotypes. The paper says environmental risks contribute to ADHD, but the cited passages do not establish that environmental influences are shared with those other disorders. They also do not substantiate every example in the citing sentence, including migraine. (LLM, conf=0.88)

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• cites Faraone and Larsson, 2018 sourcePartly supported

  The 'ADHD’s Clinical Features & Course' section (page not given) reports genetic overlap with several psychiatric disorders, and 'Common Variant ADHD as a Polygenic Disorder' (page not given) describes shared genetic risk with obesity. The cited text does not establish shared environmental influences across these disorders, and the searched passages do not substantiate the migraine or eating-disorder examples. (LLM, conf=0.87)

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• cites Ghirardi et al., 2018 sourcePartly supported

  The Introduction and Discussion (page numbers unavailable) support shared genetic influences between ADHD and autism spectrum disorder and suggest a role for family-shared environmental influences. The paper does not establish the claim for the other listed psychiatric disorders or for migraine and obesity. (LLM, conf=0.90)

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Youths in the highest third of blood lead have 2.3-fold higher likelihood of ADHD than those in the lowest third.

“those with blood lead levels in the top third were 2.3 times more likely to have ADHD compared with those in the bottom third”

• cites Froehlich et al., 2009 sourceSupported

Prenatal valproate exposure is linked to 50% higher ADHD risk.

“Prenatal exposure to the anti-epileptic drug valproate was associated with a 50% greater risk of ADHD.”

• cites Christensen et al., 2019 sourceSupported

Blood omega-3 PUFA levels are moderately lower in ADHD youths than in non-ADHD youths.

“A meta-analysis of nine studies and 586 people found moderately lower overall blood levels of omega-3 PUFAs in ADHD than non-ADHD youth”

• cites Hawkey and Nigg, 2014 sourceSupported

Infant exposure to PFAS through breast milk is not associated with later ADHD in offspring.

“No associations were found with ADHD in offspring”

• cites Forns et al., 2020 sourcePartly supported

  The Results report no overall association between estimated PFOS or PFOA levels from birth through 24 months and childhood ADHD. But the study combined cohorts using maternal blood or breast-milk measurements to estimate children’s exposure; it did not establish a separate null finding for PFAS exposure specifically through breast milk. The Discussion also notes possible increased ADHD prevalence in some subgroups. Page numbers were not available in our copy. (LLM, conf=0.86)

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Low birth weight has a small-to-moderate correlation with ADHD.

“Another meta-analysis, combining 85 studies with a total of over 4.6 million births, found a small-to-moderate correlation between low birth weight and ADHD (Momany et al., 2018).”

• cites Momany et al., 2018 sourcePartly supported

  The Results (Birth Weight and ADHD; page unavailable) report that 85 unadjusted studies found a significant association between lower birth weight and increased ADHD symptoms, but describe the correlation (r = −.14) as small, not small-to-moderate. The Methods (Sample of Studies; page unavailable) give the figure of 4,645,482 participants for the full meta-analysis of 94 effect sizes, not specifically for the 85-study analysis. (LLM, conf=0.90)

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Enterovirus ER71 infection is linked to 25% higher subsequent ADHD diagnosis.

“After further adjusting for paternal occupation and urbanization level of residence it found the enterovirus patients were 25 percent more likely to subsequently be diagnosed with ADHD (Tseng et al., 2020).”

• cites Tseng et al., 2020 sourcePartly supported

  The Results report a 25% higher adjusted ADHD risk among children with enterovirus infection than among controls, supporting the citing sentence. The 1.25 hazard ratio is for enterovirus infection generally; the paper does not establish that figure specifically for enterovirus 71, as the claim’s quote states. (LLM, conf=0.88)

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Maternal obesity is linked to roughly 60% higher ADHD likelihood.

“Two meta-analyses, one with seven studies with over 28,000 participants and another with three studies and over 1.4 million participants, found that children of obese mothers were roughly 60% more likely to develop ADHD (Jenabi et al., 2019; Sanchez et al., 2018).”

• cites Jenabi et al., 2019 sourcePartly supported

  The Main analysis reports a pooled hazard ratio of 1.65 for ADHD among children of women with prepregnancy obesity, supporting the roughly 60% figure; its pooled odds ratio is lower, at 1.42. The Description of studies reports 10 included papers and 1,464,097 participants, while the Discussion refers to 8 individual studies—not the three- or seven-study counts in the citing sentence. (LLM, conf=0.86)

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• cites Sanchez et al., 2018 sourceSupported

Maternal hypertensive disorders during pregnancy are linked to 25% higher ADHD rate.

“A meta-analysis of six studies combining 1.4 million people found that children whose mothers had hypertensive disorders during pregnancy had a 25% increase in the rate of ADHD (Maher et al., 2018).”

• cites Maher et al., 2018 sourcePartly supported

  The ADHD: Primary Analysis reports adjusted estimates from six studies including 1,395,605 participants and an association between maternal hypertensive disorders and offspring ADHD. Its pooled estimate is an odds ratio of 1.29 (95% CI, 1.22–1.36), not a 25% increase in the ADHD rate; an odds ratio does not directly measure a rate increase. No page number is available in our copy. (LLM, conf=0.88)

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ADHD is associated with moderate tendency to favor small immediate rewards over large delayed rewards.

“Two meta-analyses, one with 21 studies and over 3,900 participants, the other with 15 studies with over a thousand participants, found that those diagnosed with ADHD have a moderate tendency to favor small immediate rewards over large delayed rewards (Jackson and MacKillop, 2016; Marx et al., 2018).”

• cites Jackson and MacKillop, 2016 sourceSupported
• cites Marx et al., 2018Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Lower family income is linked to higher ADHD rates, persisting after adjusting for shared familial/genetic risk.

“A nationwide population-based cohort study of over 18,000 children from the South Korean National Health Insurance database found that lower levels of family income were associated with increased rates of ADHD (Choi et al., 2017). A Swedish study of over 800,000 people reported similar results even after adjusting for shared familial/genetic risk factors in families (Larsson et al., 2014b).”

• cites Choi et al., 2017 sourceSupported
• cites Larsson et al., 2014bNot matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Children with migraine are about four times more likely to have ADHD.

“A Brazilian population-based study including 5,671 children found those with migraine about four times more likely to have ADHD (Arruda et al., 2020).”

• cites Arruda et al., 2020 sourceSupported

Parents of children with ADHD report moderate quality-of-life deficit.

“A meta-analysis of 17 studies encompassing 647 families (over 2,300 participants) evaluated the quality of life of parents whose children had ADHD relative to parents with typically developing children. Parents of the former reported a moderate deficit in quality of life relative to parents of the latter (Dey et al., 2019).”

• cites Dey et al., 2019 sourcePartly supported

  The QOL ES section reports lower quality of life for parents of children with mental disorders than for parents of healthy children (g = -0.63), and Table 3 includes ADHD studies. But that effect is pooled across disorders, not reported as an ADHD-specific estimate; the paper reports 26 included studies, not an ADHD-only meta-analysis of 17 studies and 647 families. (LLM, conf=0.88)

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Large studies from Sweden, Finland, and a consortium of eight European countries found that ADHD was more likely among children of teenage mothers than among children of older mothers.

“large studies from Sweden (Chang et al., 2014a), Finland (Chudal et al., 2015) and a consortium of eight European countries (Pohlabeln et al., 2017) each found ADHD to be more likely among children of teenage mothers than among children of older mothers.”

• cites Chang et al., 2014aNot matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites Chudal et al., 2015 sourceSupported
• cites Pohlabeln et al., 2017 sourceSupported

A US study of over 8,000 high school and collegiate athletes, mostly male football players, found that those with ADHD were three times as likely to have had three or more reported concussions.

“A U.S. study of over 8,000 high school and collegiate athletes (predominantly male football players) found that those with ADHD were three times as likely to have had three or more reported concussions”

• cites Nelson et al., 2016 sourceSupported

A meta-analysis of 12 studies with over 1,900 participants found that adults with ADHD had very elevated emotional dysregulation compared with normally developing controls.

“Another meta-analysis, combining twelve studies with over 1,900 participants, found that adults with ADHD had very elevated levels of emotional dysregulation compared with normally developing controls”

• cites Beheshti et al., 2020 sourcePartly supported

  The Discussion (page unavailable) reports that adults with ADHD had significantly more pronounced emotion dysregulation than healthy controls, with a large effect size (Hedges’ g = 1.17). But the paper reports 13 studies and 2,535 participants overall—not 12 studies—and says 10 studies contributed to the between-group comparison. (LLM, conf=0.90)

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In a nationwide Icelandic study of over 21,000 adolescents and young adults, those with ADHD were twice as likely to make a false confession.

“Those with ADHD were twice as likely to make a false confession”

• cites Gudjonsson et al., 2016 sourceSupported
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A US sample of almost 30,000 adults found that those with ADHD were twice as likely not to have graduated high school on time, after adjusting for other psychiatric disorders.

“A study of a U.S. sample of almost 30,000 adults found that those with ADHD were twice as likely not to have graduated from high school on time, after adjusting other psychiatric disorders”

• cites Breslau et al., 2011 sourcePartly supported

  The Results (page not available) describe a U.S. analysis sample of 29,662 adults and report an association between ADHD and failure to graduate high school on time after adjustment for co-occurring disorders. But the adjusted odds ratios differ by ADHD subtype—1.38, 1.78, and 2.06—so saying that people with ADHD were uniformly twice as likely overstates the finding. The paper reports odds, rather than a doubling of probability. (LLM, conf=0.88)

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A Swedish study of over half a million people found a more than threefold association between ADHD and subsequent drug use disorders after adjusting for sex and parental education.

“A Swedish study of over half a million people found a more than threefold association between ADHD and subsequent drug use disorders after adjusting for sex and parental education”

• cites Sundquist et al., 2015 sourceSupported

Large studies from Denmark, Sweden, and Taiwan found that girls and women with ADHD were more likely to have teen pregnancies than those without ADHD.

“Studies of 2.7 million girls from Denmark (Ostergaard et al., 2017), 380,000 from Sweden (Skoglund et al., 2019) and 7,500 from Taiwan (Hua et al., 2020) found that those with ADHD were more likely to have teen pregnancies than those without ADHD.”

• cites Ostergaard et al., 2017 sourceNot checked — no full text of the source
• cites Skoglund et al., 2019 sourceSupported
• cites Hua et al., 2020Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

ADHD medications are as efficacious, or more efficacious, than many medications used for non-psychiatric disorders.

“These medications, which are as efficacious, or more efficacious, than many medications used for non-psychiatric disorders (Leucht et al., 2012)”

• cites Leucht et al., 2012 sourceSupported

A meta-analysis of 23 studies with over 2,900 children with ADHD reported that stimulant medications reduced anxiety by 14% relative to placebo.

“A meta-analysis of 23 studies with over 2,900 children with ADHD reported that stimulant medications reduced anxiety by 14% relative to placebo”

• cites Coughlin et al., 2015 sourceSupported

A longitudinal US study of about 15,000 adolescents found that those with ADHD had a 12% reduction in employment and a 34% reduction in earnings relative to non-ADHD siblings.

“A longitudinal study of some 15,000 U.S. adolescents reported that those with ADHD had a 12% reduction in employment and a 34% reduction in earnings relative to non-ADHD siblings”

• cites Fletcher, 2014 sourcePartly supported

  Data and Empirical Methods reports that about 15,000 participants were followed longitudinally, but the sibling analyses used nearly 3,500. The Results sections report 34–36% lower earnings and a 12–14 percentage-point reduction in employment compared with siblings; the claim incorrectly calls the employment difference a 12% reduction. Page numbers were not available in our copy. (LLM, conf=0.90)

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A Danish study of over half a million children, including over 6,400 with ADHD, found that discontinuation of ADHD medication was associated with a small but significant decline in grade point averages.

“A Danish study of over half a million children (over 6,400 with ADHD) found that discontinuation of ADHD medication was associated with a small but significant decline in grade point averages”

• cites Keilow et al., 2018 sourcePartly supported

  Table 2 (Data > Variables) lists 571,107 children in the population sample and 6,444 across the two ADHD samples. The Abstract reports significant declines in GPA with treatment discontinuation, but calls the effects large—not small—and gives reductions of 0.18 and 0.22 standard deviations. (LLM, conf=0.88)

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In an umbrella review, atomoxetine, d-amphetamine, lisdexamphetamine, methylphenidate, and modafinil were associated with significantly worse anorexia in children and adolescents with mental disorders.

“Five medications for ADHD were associated with significantly worse anorexia (atomoxetine, d-amphetamine, lisdexamphetamine, methylphenidate, modafinil), four with insomnia (d-amphetamine, lisdexamphetamine, methylphenidate, modafinil), three with weight loss (atomoxetine, methylphenidate, modafinil), two each with abdominal pain (methylphenidate, guanfacine), discontinuation due to adverse event (”

• cites Solmi et al., 2020 sourceSupported

A meta-analysis found methylphenidate treatment for ADHD produced moderate improvements in response inhibition.

“A meta-analysis of methylphenidate treatment for ADHD found moderate improvements in response inhibition (25 studies, 787 participants) and sustained attention (29 studies, 956 participants), but no significant effect on working memory (13 studies, 559 participants) (Tamminga et al., 2016).”

• cites Tamminga et al., 2016 sourceSupported

A meta-analysis found that stimulants did not increase risk for cocaine abuse or dependence.

“A meta-analysis found that stimulants did not increase the risk for alcohol (11 studies, over 1,300 participants, nicotine (6 studies, 884 participants), cocaine (7 studies, 950 participants), or cannabis abuse or dependence (9 studies, over 1,100 participants) (Humphreys et al., 2013).”

• cites Humphreys et al., 2013 sourceSupported

In a meta-analysis of 14 fMRI studies with 212 participants, medication treatment for ADHD made youth with ADHD brain function more similar to non-ADHD in cognition-control areas typically disrupted in ADHD.

“A meta-analysis of 14 fMRI studies with 212 participants reported that medication treatment for ADHD made the brains of youth with ADHD function in a way that was more like the brains of people without ADHD in brain areas involved in the control of cognition, which is typically disrupted in ADHD (Rubia et al., 2014).”

• cites Rubia et al., 2014 sourcePartly supported

  The Results (Meta-Analysis, page unavailable) report 14 pediatric fMRI datasets involving 212 children and adolescents with ADHD, not 14 distinct studies; some papers contributed multiple datasets. The Discussion reports that acute stimulants increased activation in the right inferior frontal cortex, a cognitive-control region, and the paper’s own fMRI comparison found normalization relative to healthy controls. The claim captures the general finding but blurs the dataset count and the distinction between acute effects and treatment more generally. (LLM, conf=0.86)

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Methylphenidate in children and adolescents was associated with more than three times the likelihood of weight decrease.

“A meta-analysis found that children and adolescents on methylphenidate were 50% more likely to report abdominal pain (46 studies, over 4,600 youths) and over three times more likely to experience decreases in appetite (52 studies, over 4,800 youths) and weight (7 studies, over 850 youths) (Holmskov et al., 2017).”

• cites Holmskov et al., 2017 sourceSupported

In an umbrella review, atomoxetine and lisdexamphetamine were associated with hypertension in children and adolescents with mental disorders.

“Five medications for ADHD were associated with significantly worse anorexia (atomoxetine, d-amphetamine, lisdexamphetamine, methylphenidate, modafinil), four with insomnia (d-amphetamine, lisdexamphetamine, methylphenidate, modafinil), three with weight loss (atomoxetine, methylphenidate, modafinil), two each with abdominal pain (methylphenidate, guanfacine), discontinuation due to adverse event (”

• cites Solmi et al., 2020 sourceSupported
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In an umbrella review, d-amphetamine, lisdexamphetamine, methylphenidate, and modafinil were associated with insomnia in children and adolescents with mental disorders.

“Five medications for ADHD were associated with significantly worse anorexia (atomoxetine, d-amphetamine, lisdexamphetamine, methylphenidate, modafinil), four with insomnia (d-amphetamine, lisdexamphetamine, methylphenidate, modafinil), three with weight loss (atomoxetine, methylphenidate, modafinil), two each with abdominal pain (methylphenidate, guanfacine), discontinuation due to adverse event (”

• cites Solmi et al., 2020 sourceSupported

A meta-analysis found that stimulants did not increase risk for nicotine abuse or dependence.

“A meta-analysis found that stimulants did not increase the risk for alcohol (11 studies, over 1,300 participants, nicotine (6 studies, 884 participants), cocaine (7 studies, 950 participants), or cannabis abuse or dependence (9 studies, over 1,100 participants) (Humphreys et al., 2013).”

• cites Humphreys et al., 2013 sourceSupported

A meta-analysis found methylphenidate treatment for ADHD had no significant effect on working memory.

“A meta-analysis of methylphenidate treatment for ADHD found moderate improvements in response inhibition (25 studies, 787 participants) and sustained attention (29 studies, 956 participants), but no significant effect on working memory (13 studies, 559 participants) (Tamminga et al., 2016).”

• cites Tamminga et al., 2016 sourceSupported

Methylphenidate in children and adolescents was associated with a 50% higher likelihood of abdominal pain.

“A meta-analysis found that children and adolescents on methylphenidate were 50% more likely to report abdominal pain (46 studies, over 4,600 youths) and over three times more likely to experience decreases in appetite (52 studies, over 4,800 youths) and weight (7 studies, over 850 youths) (Holmskov et al., 2017).”

• cites Holmskov et al., 2017 sourcePartly supported

  The Results report an increased risk of abdominal pain in cross-over trials (RR 1.61; 33 trials), but the parallel-group estimate was RR 1.30 (13 trials) and was not reported as a significant increase. Thus, the paper supports an association, but not a single 50% increase across the 46 trials cited in the sentence. Its Trial Sequential Analysis also says the evidence remained insufficient to establish the association conclusively. (LLM, conf=0.86)

  Experimental — accuracy not yet measured

In an umbrella review, methylphenidate and guanfacine were associated with abdominal pain in children and adolescents with mental disorders.

“Five medications for ADHD were associated with significantly worse anorexia (atomoxetine, d-amphetamine, lisdexamphetamine, methylphenidate, modafinil), four with insomnia (d-amphetamine, lisdexamphetamine, methylphenidate, modafinil), three with weight loss (atomoxetine, methylphenidate, modafinil), two each with abdominal pain (methylphenidate, guanfacine), discontinuation due to adverse event (”

• cites Solmi et al., 2020 sourceSupported

Methylphenidate was associated with more than a fourfold increase in insomnia in youths.

“A meta-analysis of methylphenidate treatment studies reported a 55% increase in adverse events relative to placebo, none life-threatening (11 studies, over 2,100 youths), but a fivefold increase in anorexia (3 studies, 613 youths), and more than fourfold increase in insomnia (4 studies, 749 youths) (Ching et al., 2019).”

• cites Ching et al., 2019 sourceSupported

In an umbrella review, atomoxetine, methylphenidate, and modafinil were associated with weight loss in children and adolescents with mental disorders.

“Five medications for ADHD were associated with significantly worse anorexia (atomoxetine, d-amphetamine, lisdexamphetamine, methylphenidate, modafinil), four with insomnia (d-amphetamine, lisdexamphetamine, methylphenidate, modafinil), three with weight loss (atomoxetine, methylphenidate, modafinil), two each with abdominal pain (methylphenidate, guanfacine), discontinuation due to adverse event (”

• cites Solmi et al., 2020 sourceSupported

A meta-analysis found that stimulants did not increase risk for cannabis abuse or dependence.

“A meta-analysis found that stimulants did not increase the risk for alcohol (11 studies, over 1,300 participants, nicotine (6 studies, 884 participants), cocaine (7 studies, 950 participants), or cannabis abuse or dependence (9 studies, over 1,100 participants) (Humphreys et al., 2013).”

• cites Humphreys et al., 2013 sourceSupported

ADHD medication treatment had no effect on brain structure in ENIGMA-ADHD studies of 4,180 patients across 36 cohorts.

“Medication treatment for ADHD had no effect on brain structure in studies of 4,180 ADHD patients in the ENIGMA-ADHD Working Group set of 36 cohorts from around the world (Hoogman et al., 2017; Hoogman et al., 2019).”

• cites Hoogman et al., 2017 sourcePartly supported

  The Results (Effect of medication; page unavailable) report no brain-volume differences between participants who had and had not used stimulant medication. But the Abstract (Methods; page unavailable) gives 1,713 participants with ADHD and 1,529 controls from 23 sites—not 4,180 ADHD patients across 36 cohorts. The Discussion also cautions that the cross-sectional design was not optimal for testing medication effects, so finding no difference does not establish that treatment had no effect on brain structure. (LLM, conf=0.90)

  Experimental — accuracy not yet measured
• cites Hoogman et al., 2019 sourcePartly supported

  The Discussion reports no significant association between psychostimulant medication and cortical dimensions, but cautions that the observational design does not justify a firm conclusion that medication had no effect. Materials and Methods says the 36-cohort cortical analysis included 4,180 individuals, of whom 2,246 had ADHD and 1,934 were healthy controls—not 4,180 ADHD patients. (LLM, conf=0.90)

  Experimental — accuracy not yet measured

A German study found methylphenidate did not increase the probability of being very short (at or below the third percentile) in boys.

“A study from Germany, however, specifically addressed whether stimulants predicted patients being very short (i.e., being less than or equal to the third percentile of the population). After comparing 3,806 boys not treated with methylphenidate with 118 treated boys, the results did not indicate that methylphenidate increased the probability of this adverse outcome (McCarthy et al., 2018).”

• cites McCarthy et al., 2018 sourceSupported

Methylphenidate in children and adolescents was associated with more than three times the likelihood of appetite decrease.

“A meta-analysis found that children and adolescents on methylphenidate were 50% more likely to report abdominal pain (46 studies, over 4,600 youths) and over three times more likely to experience decreases in appetite (52 studies, over 4,800 youths) and weight (7 studies, over 850 youths) (Holmskov et al., 2017).”

• cites Holmskov et al., 2017 sourceSupported

A meta-analysis found methylphenidate treatment for ADHD produced moderate improvements in sustained attention.

“A meta-analysis of methylphenidate treatment for ADHD found moderate improvements in response inhibition (25 studies, 787 participants) and sustained attention (29 studies, 956 participants), but no significant effect on working memory (13 studies, 559 participants) (Tamminga et al., 2016).”

• cites Tamminga et al., 2016 sourceSupported

A meta-analysis found that stimulants did not increase risk for alcohol abuse or dependence.

“A meta-analysis found that stimulants did not increase the risk for alcohol (11 studies, over 1,300 participants, nicotine (6 studies, 884 participants), cocaine (7 studies, 950 participants), or cannabis abuse or dependence (9 studies, over 1,100 participants) (Humphreys et al., 2013).”

• cites Humphreys et al., 2013 sourceSupported

In an umbrella review, lisdexamphetamine and guanfacine were associated with discontinuation due to adverse events in children and adolescents with mental disorders.

“Five medications for ADHD were associated with significantly worse anorexia (atomoxetine, d-amphetamine, lisdexamphetamine, methylphenidate, modafinil), four with insomnia (d-amphetamine, lisdexamphetamine, methylphenidate, modafinil), three with weight loss (atomoxetine, methylphenidate, modafinil), two each with abdominal pain (methylphenidate, guanfacine), discontinuation due to adverse event (”

• cites Solmi et al., 2020 sourceSupported

Methylphenidate was associated with a fivefold increase in anorexia in youths.

“A meta-analysis of methylphenidate treatment studies reported a 55% increase in adverse events relative to placebo, none life-threatening (11 studies, over 2,100 youths), but a fivefold increase in anorexia (3 studies, 613 youths), and more than fourfold increase in insomnia (4 studies, 749 youths) (Ching et al., 2019).”

• cites Ching et al., 2019 sourceSupported

Half of the studies in the meditation-based therapy meta-analysis did not use active controls.

“It found moderate reductions in ADHD symptoms in both children and adolescents (6 RCTs, 240 participants) and adults (6 RCTs, 339 participants), but half the studies did not use active controls.”

• cites Zhang et al., 2018 sourceSupported

Non-medical use of prescription stimulants in individuals without ADHD is associated with lower educational attainment.

“The non-medical use of prescribed stimulants in individuals without ADHD is associated with lower educational attainment.”

• cites McCabe et al., 2017 sourcePartly supported

  The Results section ('Predicting adult educational attainment'; page unavailable) reports that adolescents who used prescription stimulants nonmedically had lower odds of obtaining a college degree by age 35. It does not report this association specifically for individuals without ADHD; the nonmedical-use groups include people with and without a history of medical stimulant use. (LLM, conf=0.86)

  Experimental — accuracy not yet measured

Obtaining prescriptions from multiple prescribers or filling at multiple pharmacies is highly correlated with abuse, misuse, and diversion.

“Obtaining prescriptions from multiple prescribers or filling prescriptions at multiple pharmacies was highly correlated with abuse, misuse, and diversion.”

• cites Cepeda et al., 2014 sourcePartly supported

  The Introduction says obtaining ADHD prescriptions from multiple prescribers or pharmacies may reflect unsanctioned use. The Discussion says the study did not assess shoppers’ intent or their association with substance abuse or dependence. It therefore does not establish the claimed high correlation with abuse, misuse, and diversion. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

Only one in 250 people with stimulant prescriptions engaged in shopping behavior.

“Those dispensed stimulant medications were more than eight times as likely to engage in shopping behavior than those dispensed nonstimulants, but only one in 250 people with stimulant prescriptions engaged in shopping behavior (Cepeda et al., 2014).”

• cites Cepeda et al., 2014 sourceSupported

Removing studies with waiting list controls made the meditation-based therapy results nonsignificant.

“Removing studies with waiting list controls made results nonsignificant.”

• cites Zhang et al., 2018 sourceCould not verify

  The Original article reports that results became nonsignificant after removing two studies whose interventions were not exclusively meditation-based, not after removing waiting-list-controlled studies. It reports that restricting analyses to waiting-list controls increased effect sizes, but our copy does not report results for an analysis excluding those studies. (LLM, conf=0.76)

  Experimental — accuracy not yet measured

In Swedish dispensing data, 7.6% of methylphenidate users overused medication as measured by dispensed prescriptions.

“A study examined Swedish national pharmacy dispensing data for all 56,922 individuals who filled a methylphenidate prescription between 2010 and 2011. 4,304 of the methylphenidate users (7.6%) overused medication as measured by dispensed prescriptions.”

• cites Bjerkeli et al., 2018 sourceSupported

Shopping behaviors were four times more frequent in the ADHD medication group than in the asthma medication group.

“These “shopping” behaviors were four times more frequent in the ADHD group than in the asthma group.”

• cites Cepeda et al., 2014 sourceSupported

Amphetamine use during pregnancy was not associated with a higher risk of cardiac malformations.

“A cohort study of over 1.8 million pregnancies in the United States and over 2.5 million pregnancies in the health registries of Denmark, Finland, Sweden, Norway, and Iceland reported that use of methylphenidate (but not amphetamines) by pregnant woman was associated with a higher risk for cardiac malformations from 12.9 per thousand infants to 16.5 per thousand infants (Huybrechts et al., 2018).”

• cites Huybrechts et al., 2018 sourceSupported

Atomoxetine was not associated with increased risk of all-cause treatment discontinuation in youths.

“Two others, one combining twenty studies with over 3,000 participants, and another combining 37 studies with over 3,800 participants, found no increase in risk of all-cause treatment discontinuation in youths (Catala-Lopez et al., 2017; Schwartz and Correll, 2014).”

• cites Catala-Lopez et al., 2017 sourceSupported
• cites Schwartz and Correll, 2014 sourceNot checked — no full text of the source

A Swedish registry study found no evidence for an association between psychosis and methylphenidate treatment.

“A Swedish registry study of over 23,000 adolescents and young adults treated with methylphenidate for ADHD found no evidence for an association between psychosis and methylphenidate treatment. A year after initiation of methylphenidate treatment, the incidence of psychotic events was 36% lower in in those with a history of psychosis and 18% lower in those without a history of psychosis relative to”

• cites Hollis et al., 2019 sourcePartly supported

  The Abstract (Interpretation) reports no evidence that starting methylphenidate increases psychotic-event risk, and the Discussion reports no immediate increase in the 12 weeks after initiation. But the Discussion also reports lower psychotic-event incidence one year later, so the broader claim of no association with treatment is not fully supported. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

Overuse was 17 times more frequent for ages 46-65 compared with ages 6-12.

“Overuse was 17 times more frequent for ages 46–65 compared with ages 6–12 year.”

• cites Bjerkeli et al., 2018 sourceSupported

In a US prospective study, non-medical prescription stimulant users were 17% less likely to earn a bachelor's degree than those with neither medical nor non-medical use.

“Those who used prescription stimulants non-medically were 17% less likely to earn a bachelor’s degree than those who had neither medical or non-medical use (McCabe et al., 2017).”

• cites McCabe et al., 2017 sourcePartly supported

  The Methods (Measures; page unavailable) define population controls as adolescents with neither medical nor nonmedical stimulant use. The Results (Predicting adult educational attainment; page unavailable) report significantly lower odds of earning a bachelor’s degree by age 35 among adolescent nonmedical users than among those controls, but the passages in our copy do not give the claimed 17% figure. (LLM, conf=0.86)

  Experimental — accuracy not yet measured

One year after methylphenidate initiation, incidence of psychotic events was 18% lower in those without a history of psychosis versus before treatment.

“A year after initiation of methylphenidate treatment, the incidence of psychotic events was 36% lower in in those with a history of psychosis and 18% lower in those without a history of psychosis relative to the period immediately before the beginning of treatment (Hollis et al., 2019).”

• cites Hollis et al., 2019 sourceSupported

Methylphenidate use during pregnancy was associated with a higher risk of cardiac malformations, increasing from 12.9 to 16.5 per 1,000 infants.

“A cohort study of over 1.8 million pregnancies in the United States and over 2.5 million pregnancies in the health registries of Denmark, Finland, Sweden, Norway, and Iceland reported that use of methylphenidate (but not amphetamines) by pregnant woman was associated with a higher risk for cardiac malformations from 12.9 per thousand infants to 16.5 per thousand infants (Huybrechts et al., 2018).”

• cites Huybrechts et al., 2018 sourcePartly supported

  The Discussion and Validation Analyses (page not supplied) report a small increased risk of cardiac malformations with first-trimester methylphenidate exposure, but not amphetamine exposure. The stated change from 12.9 to 16.5 per 1,000 is not reported: Table 3 gives 12.7 per 1,000 unexposed infants versus 18.8 per 1,000 methylphenidate-exposed infants in the US cohort; the Nordic figures are 13.3 versus 17.1. (LLM, conf=0.90)

  Experimental — accuracy not yet measured

One year after methylphenidate initiation, incidence of psychotic events was 36% lower in those with a history of psychosis versus before treatment.

“A year after initiation of methylphenidate treatment, the incidence of psychotic events was 36% lower in in those with a history of psychosis and 18% lower in those without a history of psychosis relative to the period immediately before the beginning of treatment (Hollis et al., 2019).”

• cites Hollis et al., 2019 sourceSupported

After ongoing methylphenidate treatment, the risk for attempted suicide was no longer elevated among ADHD patients.

“After ongoing treatment, the risk for attempted suicide was no longer elevated among patients with ADHD (Man et al., 2017).”

• cites Man et al., 2017 sourceSupported

Those dispensed stimulants were more than eight times as likely to engage in shopping behavior than those dispensed nonstimulants.

“Those dispensed stimulant medications were more than eight times as likely to engage in shopping behavior than those dispensed nonstimulants, but only one in 250 people with stimulant prescriptions engaged in shopping behavior (Cepeda et al., 2014).”

• cites Cepeda et al., 2014 sourceSupported

Risk for psychosis did not differ between periods on and off methylphenidate in a Hong Kong database.

“Using the same Hong Kong database, the risk for psychosis did not differ between periods when patients were on and off methylphenidate treatment (Man et al., 2016).”

• cites Man et al., 2016 sourceSupported

Overuse was twice as frequent among those with previous alcohol and drug misuse.

“It was also twice as frequent among those with previous alcohol and drug misuse (Bjerkeli et al., 2018).”

• cites Bjerkeli et al., 2018 sourcePartly supported

  The Abstract’s Results report about twice the adjusted odds of methylphenidate overuse among people with a previous diagnosis related to psychoactive substance use (OR 2.1). But the Results’ bivariate comparison gives overuse prevalences of 20.0% versus 5.5%—about 3.6 times as frequent, not twice. The paper measured prior diagnoses rather than alcohol and drug misuse directly. (LLM, conf=0.86)

  Experimental — accuracy not yet measured

In a US study, use of illegal drugs or other non-medical prescription drug use preceded non-medical ADHD medication use in more than three out of four cases.

“A U.S. study of over 440,000 respondents found that use of illegal drugs or other non-medical use of prescription drugs preceded non-medical use of ADHD medication in more than three out of four cases (Sweeney et al., 2013).”

• cites Sweeney et al., 2013 sourceSupported

Cognitive training resulted in small to moderate improvements in executive functioning in preschoolers with ADHD.

“A meta-analysis of 32 studies with over two thousand participants found that cognitive training resulted in small to moderate improvements in executive functioning in preschoolers with ADHD (Scionti et al., 2019).”

• cites Scionti et al., 2019 sourcePartly supported

  The Results (Main Analyses) report improved executive functioning among preschoolers with ADHD symptoms, but that subgroup comprised four studies and 112 participants—not all 32 studies. The Discussion reports an ADHD-subgroup effect of g = 0.785, larger than the sentence’s ‘small to moderate’ description. The copy identifies 32 studies overall but does not establish the claimed total of over two thousand participants. (LLM, conf=0.87)

  Experimental — accuracy not yet measured

Neurofeedback had no significant reduction in hyperactivity-impulsivity.

“A meta-analysis of five randomized controlled trials (RCTs) with 263 participants exploring the efficacy of neurofeedback found a small reduction in inattention, but no significant reduction in hyperactivity-impulsivity or overall ADHD symptoms with ratings by probably blinded evaluators (researchers measuring outcomes did not know if patients were receiving the active or control treatment) (Micou”

• cites Micoulaud-Franchi et al., 2014 sourceSupported

Neurofeedback was associated with a small reduction in inattention.

“A meta-analysis of five randomized controlled trials (RCTs) with 263 participants exploring the efficacy of neurofeedback found a small reduction in inattention, but no significant reduction in hyperactivity-impulsivity or overall ADHD symptoms with ratings by probably blinded evaluators (researchers measuring outcomes did not know if patients were receiving the active or control treatment) (Micou”

• cites Micoulaud-Franchi et al., 2014 sourceSupported

Omega-3 fatty acid supplementation was associated with small-to-medium improvements in ADHD symptoms in three meta-analyses.

“Omega-3 fatty acid supplementation was associated with small-to-medium improvements in ADHD symptoms in three meta-analyses (ten studies with 699 participants, 16 studies with 1,408 participants, 7 studies with 534 participants) (Bloch and Qawasmi, 2011; Chang et al., 2018; Hawkey and Nigg, 2014).”

• cites Bloch and Qawasmi, 2011 sourceSupported
• cites Chang et al., 2018 sourceSupported
• cites Hawkey and Nigg, 2014 sourceSupported

There is insufficient methodologically sound evidence to support recommending meditation-based therapies for targeting ADHD core symptoms or related neuropsychological dysfunctions in children, adolescents, or adults with ADHD.

“The authors concluded “there is insufficient methodologically sound evidence to support the recommendation of meditation-based therapies as an intervention aimed to target ADHD core symptoms or related neuropsychological dysfunctions in children/adolescents or adults with ADHD” (Zhang et al., 2018).”

• cites Zhang et al., 2018 sourceSupported

There were no significant effects of cognitive training on academic outcomes in math and reading.

“There were no significant effects on academic outcomes in math and reading (95 studies, 290 youths) (Cortese et al., 2015).”

• cites Cortese et al., 2015 sourcePartly supported

  The Results section (Academic Ability; page not provided) reports no significant effects on reading or arithmetic, supporting the main claim. The citing sentence’s parenthetical is not supported as written: the paper reports five trials measuring reading and five measuring arithmetic, with 15 trials in the meta-analysis overall—not 95 studies. The passages do not establish the figure of 290 youths. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

Probably blinded cognitive training studies with active controls reported no significant reduction in ADHD symptoms.

“Probably blinded cognitive training studies with active controls (6 studies, 287 youths) reported no significant reduction in ADHD symptoms. But they did find moderate improvements in verbal working memory (5 studies, 263 youths). There were no significant effects on academic outcomes in math and reading (95 studies, 290 youths) (Cortese et al., 2015).”

• cites Cortese et al., 2015 sourceSupported

Exercise had no significant effect on hyperactivity/impulsivity symptoms.

“Another meta-analysis found no significant effect of exercise on either hyperactivity/impulsivity (4 studies, 227 participants) or inattention symptoms (6 studies, 277 participants), but significant reductions in anxiety and depression (5 studies, 164 participants) (Zang, 2019).”

• cites Zang, 2019 sourceSupported

Exercise had no significant effect on inattention symptoms.

“Another meta-analysis found no significant effect of exercise on either hyperactivity/impulsivity (4 studies, 227 participants) or inattention symptoms (6 studies, 277 participants), but significant reductions in anxiety and depression (5 studies, 164 participants) (Zang, 2019).”

• cites Zang, 2019 sourceSupported

Probably blinded cognitive training studies with active controls found moderate improvements in verbal working memory.

“But they did find moderate improvements in verbal working memory (5 studies, 263 youths).”

• cites Cortese et al., 2015 sourcePartly supported

  The Results (Neuropsychological Outcomes; page unavailable) report a significant improvement in verbal working memory that persisted in an analysis restricted to trials with active controls; the reported overall effect (SMD 0.52) is moderate. Our copy does not verify that this analysis comprised five studies and 263 youths, or that the verbal-working-memory assessments were classified as probably blinded. (LLM, conf=0.84)

  Experimental — accuracy not yet measured

Neurofeedback had no significant reduction in overall ADHD symptoms.

“A meta-analysis of five randomized controlled trials (RCTs) with 263 participants exploring the efficacy of neurofeedback found a small reduction in inattention, but no significant reduction in hyperactivity-impulsivity or overall ADHD symptoms with ratings by probably blinded evaluators (researchers measuring outcomes did not know if patients were receiving the active or control treatment) (Micou”

• cites Micoulaud-Franchi et al., 2014 sourceSupported

Exercise was associated with significant reductions in anxiety and depression.

“but significant reductions in anxiety and depression (5 studies, 164 participants) (Zang, 2019).”

• cites Zang, 2019 sourcePartly supported

  The Discussion (page unavailable) says the meta-analysis found that physical exercise significantly improved anxiety and depression in children with ADHD. The cited sentence also specifies 5 studies and 164 participants, but those figures were not found in our copy, so that part is unsupported. (LLM, conf=0.84)

  Experimental — accuracy not yet measured

Restricting synthetic food colors from children's diets was associated with a small reduction in ADHD symptoms.

“A meta-analysis of five double-blind crossover studies with 164 participants found that restricting synthetic food colors from children’s diets was associated with a small reduction in ADHD symptoms (Nigg et al., 2012).”

• cites Nigg et al., 2012 sourcePartly supported

  The Results > Dietary Restriction section reports a small reduction in ADHD symptoms (g = 0.29) across five studies after an outlier was removed, leaving 164 children. But those studies tested restriction diets that removed food colors alongside other foods or additives, not the restriction of synthetic colors alone. The paper also describes the original six studies as using either a placebo-controlled diet challenge or a crossover design, so it does not establish that all five were double-blind crossover studies. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

Clinicians trained well across different settings and cultures concur on whether ADHD is present or absent when using clear criteria.

“well-trained professionals in a variety of settings and cultures agree on its presence or absence using well-defined criteria”

• cites Faraone, 2005 sourceNot checked — no full text of the source

Youth who are younger relative to their classmates have a higher likelihood of receiving an ADHD diagnosis.

“A meta-analysis comprising 25 studies with over eight million participants found that children and adolescents who are relatively younger than their classmates are more likely to have been diagnosed with ADHD”

• cites Caye et al., 2020 sourceNot checked — no full text of the source

Artificial food colorings are linked to a small rise in childhood hyperactivity.

“In a meta-analysis of 15 double-blind, placebo-controlled trials with 219 participants, artificial food dyes were associated with a small increase in hyperactivity in children”

• cites Schab and Trinh, 2004 sourceNot checked — no full text of the source

Secondhand smoke exposure in childhood is linked to 60% higher odds of ADHD.

“A meta-analysis of nine studies spanning three continents and over 100,000 participants found that childhood exposure to secondhand cigarette smoke was associated with a 60% greater likelihood of ADHD.”

• cites Huang et al., 2020 sourceNot checked — no full text of the source

Prenatal acetaminophen use by mothers is linked to 33% higher likelihood of ADHD in children.

“In a Taiwanese study of over 10,000 births, maternal use of acetaminophen during pregnancy was associated with a 33% greater likelihood of ADHD in their children”

• cites Chen et al., 2019bNot matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Nitric oxide exposure is linked to 25% higher odds of ADHD.

“It did find a 25 percent greater odds for having ADHD with exposures to nitric oxide, a common traffic pollutant”

• cites Shih et al., 2020 sourceNot checked — no full text of the source

Elevated blood lead is linked to about four times the odds of ADHD.

“A more recent meta-analysis of 14 studies with over 17,000 children reported that higher blood lead levels were associated with quadrupled odds of ADHD”

• cites Nilsen and Tulve, 2020 sourceNot checked — no full text of the source

ADHD also has a distinct genetic risk component.

“However, there is also a unique genetic risk for ADHD.”

Maternal smoking during pregnancy is linked to more than a 50% higher ADHD incidence.

“Three meta-analyses with over twenty studies covering more than three million persons have found prenatal exposure to maternal smoking associated with a greater than 50% increase in incidence of ADHD”

• cites Huang et al., 2017Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites Dong et al., 2018 sourceNot checked — no full text of the source
• cites Nilsen and Tulve, 2020 sourceNot checked — no full text of the source

Gestational exposure to small particulate matter, sulphur dioxide, or nitrogen dioxide is not associated with ADHD diagnoses in offspring through age eight.

“found no association between small particulate matter levels, sulphur dioxide levels, or nitrogen dioxide levels during gestation and ADHD diagnoses in the first eight years of their offsprings’ lives”

• cites Shih et al., 2020 sourceNot checked — no full text of the source

The link between air pollutant spikes and ADHD hospital admissions does not differ significantly by sex or age among adolescents.

“There were no significant differences between male and female adolescents, or between older and younger adolescents”

• cites Park et al., 2020 sourceNot checked — no full text of the source

Sugar intake in youth shows no evidence of association with ADHD.

“found no evidence of an association between sugar consumption and ADHD in youth”

• cites Farsad-Naeimi et al., 2020 sourceNot checked — no full text of the source

Lower maternal vitamin D is linked to about 50% higher likelihood of ADHD in children.

“Lower maternal vitamin D levels were associated with a roughly 50% greater likelihood of ADHD in their children”

• cites Sucksdorff et al., 2019Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

The charge that ADHD diagnosis is subjective because no biological test exists is not justified.

“The diagnosis of ADHD has been criticized as being subjective because it is not based on a biological test. This criticism is unfounded.”

A large portion of ADHD research findings rest on meta-analytic evidence.

“Many findings in ADHD are supported by meta-analysis.”

ADHD satisfies the Robins and Guze standards for validity as a mental disorder.

“ADHD meets standard criteria for validity of a mental disorder established by Robins and Guze”

• cites Faraone, 2005 sourceNot checked — no full text of the source
• cites [1970]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Links between environmental factors and ADHD onset have very strong evidential backing.

“The associations between aspects of the environment and the onset of ADHD have attained a very high level of evidential support.”

Environmental risk factors for ADHD act very early, in fetal or early postnatal life.

“The environmental risks for ADHD exert their effects very early in life, during the fetal or early postnatal period.”

The genetic and environmental risks discussed are not necessarily unique to ADHD.

“The genetic and environmental risks described below are not necessarily specific to ADHD.”

Having another psychiatric disorder does not exclude an ADHD diagnosis.

“Their presence does not rule out a diagnosis of ADHD.”

Several professional bodies have issued and endorsed ADHD diagnostic guidelines.

“Professional associations have endorsed and published guidelines for diagnosing ADHD”

• cites Alliance, 2011Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites Banaschewski T, 2018Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites Bolea-Alamanac et al., 2014 sourceNot checked — no full text of the source

Whether the secondhand-smoke association is causal or confounded remains uncertain.

“It was unclear to what extent the association was causal versus due to confounders”

• cites Huang et al., 2020 sourceNot checked — no full text of the source

Overlapping genetic and environmental risks suggest shared pathophysiology in pathways that disrupt neurodevelopment and produce brain changes leading to disorder.

“Evidence of shared genetic and environmental risks among disorders suggest that these disorders also share a pathophysiology in the biological pathways that dysregulate neurodevelopment and create brain variations leading to disorder onset.”

Other genes suggested by meta-analyses remain uncertain risk genes until confirmed in genomewide studies.

“Additional genes have been implicated by meta-analyses, but their status as risk genes remains uncertain until validated in a genomewide study.”

• cites Pan et al., 2015 sourceNot checked — no full text of the source
• cites Grunblatt et al., 2019bNot matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites Liu et al., 2017bNot matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Boys born to mothers who lost a close relative during pregnancy are twice as likely to have ADHD.

“A nationwide population-based cohort study using Danish registers compared over 29,000 children born to women who lost a close relative during pregnancy with a million other children in the same cohort and found that boys born to these women were twice as likely to have ADHD (Li et al., 2010).”

• cites Li et al., 2010Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

ADHD inattentive type is associated with sexual abuse and physical neglect exposure.

“A U.S. population-based study of over 14,000 participants in the National Longitudinal Study of Adolescent Health found that after adjusting for demographic, socioeconomic, and familial risk factors for child maltreatment, ADHD inattentive type was associated with having been exposed to sexual abuse and physical neglect (Ouyang et al., 2008).”

• cites Ouyang et al., 2008 sourceNot checked — no full text of the source

Greater family cohesion and community support decrease risk for moderate to severe ADHD.

“In a sample of 4,122 U.S. youths with ADHD from the 2016 U.S. National Survey of Children’s Health, greater family cohesion and community support decreased the risk for moderate to severe ADHD (Duh-Leong et al., 2020).”

• cites Duh-Leong et al., 2020 sourceNot checked — no full text of the source

Very preterm or very low birth weight is associated with about threefold higher ADHD rate.

“A meta-analysis of twelve studies with over 6,000 participants found a threefold increase in the rate of ADHD among very/extremely preterm or very/extremely low birth weight babies (Franz et al., 2018).”

• cites Franz et al., 2018 sourceNot checked — no full text of the source

ADHD is associated with moderate tendency to make rule violations.

“Another meta-analysis, with 11 studies with 829 participants, reported people with ADHD were moderately more prone to cognitive errors known as “rule violations” (Patros et al., 2019).”

• cites Patros et al., 2019 sourceNot checked — no full text of the source

Finnish registers found a similar prematurity-ADHD association.

“Similar results were reported from the Finnish national registers when comparing over 10,000 people with ADHD with over 38,000 controls (Sucksdorff et al., 2015).”

• cites Sucksdorff et al., 2015 sourceNot checked — no full text of the source

Among youths with ADHD, there are no significant sex differences in total, inattention, or hyperactivity-impulsivity symptoms.

“Among youths with ADHD, a series of meta-analyses found no significant sex differences in either total ADHD symptoms (15, studies, over 3,400 youths), inattention symptoms (26 studies, over 5,900 youths), or hyperactivity-impulsivity symptoms (24 studies, over 4,900 youths) (Loyer Carbonneau et al., 2020).”

• cites Loyer Carbonneau et al., 2020Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Adolescents and young adults with ADHD are over three times more likely to develop STIs after adjustment.

“A longitudinal study using the Taiwan Health Insurance Research Database compared almost 18,000 adolescents and young adults with ADHD with over 70,000 age- and sex-matched controls. Those with ADHD were over three times more likely to develop sexually transmitted infections, after adjusting for demographic data, other psychiatric disorders, and ADHD medications (Chen et al., 2018a).”

• cites Chen et al., 2018aNot matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Children with ADHD have small-to-moderate reductions in mismatch negativity amplitude.

“A meta-analysis of six studies with 148 participants examined mismatch negativity, which assesses the integrity of auditory sensory memory and involuntary attention switching. It reported that ADHD children had small-to-moderate reductions in mismatch negativity amplitude compared with healthy controls (Cheng et al., 2016).”

• cites Cheng et al., 2016 sourceNot checked — no full text of the source

Boys with ADHD are twice as likely to develop testicular dysfunction.

“A study of over 59,000 boys diagnosed with ADHD and over 52,000 healthy boys in Taiwan reported that those in the ADHD group were twice as likely to develop testicular dysfunction (Wang et al., 2019).”

• cites Wang et al., 2019 sourceNot checked — no full text of the source

The most consistent white matter differences in ADHD are in splenium of corpus callosum, right cingulum, right sagittal stratum, and left tapetum, suggesting interhemispheric and long-range tract problems.

“A meta-analysis of ten diffusion tensor imaging studies with 947 participants found that the most consistent white matter differences between those with and without ADHD were located in the splenium of the corpus callosum extending to the right cingulum, the right sagittal stratum, and left tapetum, suggesting problems with the connections between the two hemispheres in posterior parieto-temporal”

• cites Chen et al., 2016 sourceNot checked — no full text of the source

A Danish national registry study of 678,000 youths aged 7-18 found that children with ADHD were 2.7 times more likely to be victims of violent crimes than typically developing peers, after adjusting for confounders.

“Children with ADHD were 2.7 times more likely to be victims of violent crimes than their typically developing peers, after adjusting for confounding risk factors”

• cites Christoffersen, 2019 sourceNot checked — no full text of the source

The same meta-analysis found moderate impairments in social-information processing among children with ADHD, including recognizing social cues, identifying problems, generating solutions, and avoiding biases, across 23 studies and over 3,750 children.

“and social-information processing, such as recognizing social cues, identifying problems, generating solutions, and avoiding biases (23 studies, over 3,750 children)”

• cites Ros and Graziano, 2018 sourceNot checked — no full text of the source

In a US National Health Interview Survey sample of more than 8,600 youths, those with ADHD were about six times more likely than others to have high levels of emotional, conduct, and peer problems.

“A study of over 8,600 youths from the US National Health Interview Survey found that those with ADHD were six times as likely to have a high level of emotional, conduct, and peer problems”

• cites Strine et al., 2006Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

A meta-analysis of nine studies with almost 1.5 million people found that ADHD was associated with a threefold greater risk of poisoning in children.

“A meta-analysis of nine studies encompassing almost a million and a half people found that ADHD is associated with a threefold greater risk of poisoning in children”

• cites Ruiz-Goikoetxea et al., 2018bNot matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

A cohort study of more than 2.2 million Taiwanese found no increased risk of death from natural causes associated with ADHD.

“A cohort study of more than 2.2 million Taiwanese found no increased risk of death from natural-causes associated with ADHD.”

• cites Chen et al., 2019cNot matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Respiratory medications are the most likely somatic co-prescriptions for ADHD, followed by alimentary/metabolic and cardiovascular medications.

“Respiratory medications (primarily for allergies reactions and asthma) were the most likely to be dispensed for somatic purposes, followed by alimentary tract and metabolic medications (most frequently proton pump inhibitors indicated for gastric/duodenal ulcers and gastroesophageal reflux disease), then cardiovascular system medications (primarily for hypertension and arrhythmias) (Zhang et al.,”

• cites Zhang et al., 2020aNot matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

A meta-analysis of 32 studies covering more than four million people found that people with ADHD had a 40% to 50% greater risk of accidental physical injuries.

“A meta-analysis of 32 studies covering more than four million people found that those with ADHD had a 40 to 50% greater risk of accidental physical injuries”

• cites Ruiz-Goikoetxea et al., 2018aNot matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

A Taiwanese study comparing 3,685 children with ADHD and 36,000 controls found that those with ADHD had more than fourfold greater risk of deliberate self-poisoning.

“In a study from Taiwan comparing 3,685 children with ADHD with 36,000 controls, those with ADHD had a more than fourfold greater risk of deliberate self-poisoning”

• cites Chou et al., 2014 sourceNot checked — no full text of the source

In the same US survey, youths with ADHD were about nine times more likely to have high impairment affecting home life, friendships, classroom learning, and leisure activities.

“nine times as likely to manifest a high level of impairment including interference with home life, friendships, classroom learning, and leisure activities”

• cites Strine et al., 2006Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

The same meta-analysis found moderate impairments in social skills such as sharing, cooperating, turn-taking, and reciprocity among children with ADHD, across 68 studies and over 148,000 children.

“They also had moderate impairments in social skills such as sharing, cooperating, turn-taking, reciprocity (68 studies, over 148,000 children)”

• cites Ros and Graziano, 2018 sourceNot checked — no full text of the source

A retrospective cohort study of over 18,000 New Jersey drivers found that crash risk was one-third greater among those with ADHD.

“A retrospective cohort study of over 18,000 New Jersey drivers found that the crash risk for those with ADHD was a third greater than for those without”

• cites Curry et al., 2017 sourceNot checked — no full text of the source

A Swedish national registers study of 17,408 individuals with ADHD found an almost 50% greater risk of serious transport accidents.

“A Swedish national registers study followed 17,408 individuals with ADHD from 2006 to 2009 and found that patients with ADHD had an almost 50% greater risk of serious transport accidents”

• cites Chang et al., 2014bNot matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

A meta-analysis of 22 studies with over 21,000 participants found that youths with ADHD had strong impairment in modulating reactivity to novel or stressful events.

“A meta-analysis of 22 studies with over 21,000 participants found that youth with ADHD were strongly impaired in the ability to modulate their reactivity to novel or stressful events”

• cites Graziano and Garcia, 2016 sourceNot checked — no full text of the source

A meta-analysis of five studies with over 3,000 minor traumatic brain injury patients and over 9,000 controls found that those with minor traumatic brain injury were twice as likely to have ADHD.

“A meta-analysis of five studies, comprising over three thousand patients with minor traumatic brain injury (mTBI) and over nine thousand controls found that those with mTBI were twice as likely to have ADHD than those without mTBI”

• cites Adeyemo et al., 2014 sourceNot checked — no full text of the source

A meta-analysis found that children with ADHD had medium-to-large impairments in peer socializing, including rejection/likability, popularity, and friendships, across 61 studies and over 24,000 children.

“A meta-analysis found that children with ADHD had medium-to-large impairments in socializing with peers as measured by rejection/likability, popularity, and friendships (61 studies, over 24,000 children).”

• cites Ros and Graziano, 2018 sourceNot checked — no full text of the source

A Taiwanese nationwide study comparing 675 adults with ADHD and 2,025 matched controls found that, after adjustment, those with ADHD had 3.4 times the risk of developing dementia.

“After adjusting for other psychiatric disorders, urbanization level of residence, and monthly income, those with ADHD had 3.4 times the risk of developing dementia”

• cites Tzeng et al., 2019 sourceNot checked — no full text of the source

A meta-analysis of ten studies and 830 youths found that ADHD was strongly associated with poorer performance on overall, expressive, receptive, and pragmatic language measures.

“A meta-analysis of ten studies and 830 youths found that ADHD was strongly associated with poorer performance on measures of overall, expressive, receptive, and pragmatic language”

• cites Korrel et al., 2017 sourceNot checked — no full text of the source

A meta-analysis of 16 studies with over 175,000 people estimated that, after controlling for mileage driven, people with ADHD were 23% more likely to be involved in vehicular crashes.

“A meta-analysis of 16 studies encompassing over 175,000 people estimated that controlling for mileage driven, those with ADHD were 23% more likely to be involved in vehicular crashes”

• cites Vaa, 2014 sourceNot checked — no full text of the source

In a Danish register study of 460 sibling pairs, adults with ADHD had an average annual economic burden just over €20,000 compared with their normally developing siblings.

“On average, adults with ADHD had an annual economic burden of just over €20,000 compared with their normally developing siblings”

• cites Daley et al., 2019 sourceNot checked — no full text of the source

A Hong Kong population-based electronic medical records study of over 17,000 individuals aged 6-19 prescribed methylphenidate found a 9% reduction in trauma-related emergency room admissions during periods covered by a methylphenidate prescription compared with periods with no active prescription.

“Researchers found a 9% reduction in such admissions during periods covered by a methylphenidate prescription compared with periods with no active prescription”

• cites Man et al., 2015 sourceNot checked — no full text of the source

Among people with ADHD in that Swedish cohort, longer stimulant medication duration was associated with lower substance abuse rate.

“The longer the duration of medication, the lower the rate of substance abuse (Chang et al., 2014c).”

• cites Chang et al., 2014cNot matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

A Taiwanese study of over 6,200 youths newly diagnosed with ADHD found that the risk of bone fractures was 20% lower in those with more than half a year of methylphenidate treatment.

“The risk of bone fractures was 20% lower in those who had over half a year of methylphenidate treatment”

• cites Chen et al., 2017bNot matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

A meta-analysis of nine studies with over 1,300 youths reported that atomoxetine was associated with small reductions in emotional symptoms.

“Another meta-analysis covering nine studies with over 1,300 youths reported atomoxetine to be associated with small reductions in emotional symptoms”

• cites Schwartz and Correll, 2014 sourceNot checked — no full text of the source

A meta-analysis reported moderate-to-strong improvements in ADHD symptoms with methylphenidate in patients with borderline intellectual functioning or intellectual disability.

“A meta-analysis reported moderate-to-strong improvements in ADHD symptoms with methylphenidate in ADHD patients with borderline intellectual functioning or intellectual disability (8 studies, 423 children).”

• cites Sun et al., 2019aNot matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

In a Swedish national register cohort of 38,753 people born 1960-1998 with ADHD, prescription stimulant medication in 2006 was associated with a greater than 30% reduction in substance abuse indicators during 2009 after adjustment for relevant variables.

“A study using the Swedish national registers investigated the association between prescription stimulant medication for ADHD in 2006 and substance abuse during 2009 among all 38,753 people born between 1960 and 1998 and diagnosed with ADHD. After controlling for relevant variables, it found a greater than 30% reduction in indicators of substance abuse among those prescribed stimulants.”

• cites Chang et al., 2014cNot matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

A Danish national registry study of over 4,200 individuals with childhood ADHD found that adult crime rates were 30-40% lower during periods of ADHD medication use.

“A Danish national registry study of over 4,200 individuals with childhood ADHD found that crime rates in adulthood were 30–40% lower during periods of taking ADHD medication”

• cites Mohr-Jensen et al., 2019 sourceNot checked — no full text of the source

A Taiwanese study of over 124,000 youths with ADHD found that methylphenidate treatment decreased the risk of traumatic brain injuries after adjusting for confounders.

“A Taiwanese study of over 124,000 youths with ADHD found that methylphenidate treatment decreased the risk for traumatic brain injuries, after adjusting for confounders”

• cites Liao et al., 2018 sourceNot checked — no full text of the source

A meta-analysis of four studies with 216 youths found mixed amphetamine salts slightly more effective than methylphenidate at reducing ADHD symptoms.

“Another meta-analysis, combining four studies with 216 youths, found mixed amphetamine salts to be slightly more effective at reducing ADHD symptoms than methylphenidate”

• cites Faraone et al., 2002 sourceNot checked — no full text of the source

A meta-analysis of five studies with over 13,000 participants found that ADHD medications, primarily stimulants, were associated with a greater than 10% reduction in unintentional injuries.

“A meta-analysis of five studies with over 13,000 participants found that ADHD medications (primarily stimulants) were associated with a greater than 10% reduction in unintentional injuries”

• cites Ruiz-Goikoetxea et al., 2018aNot matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

A meta-analysis of seven studies with over 1,600 participants reported that atomoxetine moderately reduced ADHD symptoms.

“A meta-analysis of seven studies with over 1,600 participants reported that atomoxetine moderately reduced ADHD symptoms.”

• cites Cheng et al., 2007 sourceNot checked — no full text of the source

A meta-analysis of 18 studies with over 2,000 adults with ADHD found that three amphetamine derivatives were associated with moderate reductions in ADHD symptoms.

“A meta-analysis of 18 studies with over 2,000 adults with ADHD found three amphetamine derivatives (dextroamphetamine, lisdexamfetamine, and mixed amphetamine salts) to be associated with moderate reductions in ADHD symptoms”

• cites Castells et al., 2011 sourceNot checked — no full text of the source

A Swedish national register study of over 61,000 youths with ADHD found that their test scores were higher during medicated periods than during non-medicated periods.

“A Swedish national register study of over 61,000 youths with ADHD found that their test scores were higher during periods they were taking medication vs non-medicated periods”

• cites Lu et al., 2017Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

A US Fortune 100 company database study of over 100,000 beneficiaries found that annual average cost per family member was $2,728 for non-ADHD family members of ADHD patients, almost double the $1,440 for controls.

“The annual average cost per family member was $2,728 for non-ADHD family members of ADHD patients, almost double the $1,440 for family members of matched controls”

• cites Swensen et al., 2003 sourceNot checked — no full text of the source

A Taiwanese study comparing 7,200 youths with ADHD and 36,000 children without ADHD found that, after adjustment, boys with ADHD were almost 40% more likely and girls with ADHD 60% more likely to suffer bone fractures.

“After adjusting by age, sex, urbanization level, and geographic region, boys with ADHD were almost 40% more likely and girls with ADHD 60% more likely to suffer bone fractures”

• cites Guo et al., 2016 sourceNot checked — no full text of the source

In a Taiwan NHIRD cohort of over 90,000 individuals under 18 with ADHD, methylphenidate use for less than 90 days was associated with a 30% lower risk of burn injury than no methylphenidate after confounder adjustment.

“Compared with patients not taking methylphenidate, those taking it for less than 90 days had a 30% lesser risk of burn injuries, and those taking it for 90 days or more a 57% reduction in risk, after adjusting for confounders (Chen et al., 2020b).”

• cites Chen et al., 2020bNot matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Stimulant-treated children may have delayed expected height gains averaging 2 cm over 1-2 years.

“Children treated with stimulants may show delays in expected height gains averaging two centimeters over one or two years. These sometimes attenuate over time and often reverse when treatment is stopped (Faraone et al., 2008).”

• cites Faraone et al., 2008 sourceNot checked — no full text of the source

The data suggested that half of burn injuries in that ADHD cohort could have been prevented by taking methylphenidate.

“The data suggested that fully half the incidence of burn injuries could have been prevented by taking methylphenidate.”

• cites Chen et al., 2020bNot matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

In a Taiwan NHIRD cohort of over 68,000 children and adolescents with ADHD, methylphenidate prescription was associated with a one-fifth lower all-cause mortality rate than no methylphenidate after confounder adjustment.

“After controlling for potential confounders, ADHD individuals prescribed methylphenidate had a one-fifth lower rate of all-cause mortality than ADHD individuals not prescribed methylphenidate.”

• cites Chen et al., 2020aNot matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

These cardiovascular events were rare.

“A study using Danish national registers followed over 700,000 individuals for an average period of almost a decade. Looking at 8,300 people with ADHD, stimulant users had more than twice the rate of cardiovascular events (primarily hypertension) than nonusers. These events were rare (Dalsgaard et al., 2014).”

• cites Dalsgaard et al., 2014 sourceNot checked — no full text of the source

In a nationwide study of over 7,500 Taiwanese adolescents with ADHD and over 30,000 matched controls, long-term ADHD medication use was associated with a 30% decrease in teenage pregnancy.

“A nationwide study of over 7,500 Taiwanese adolescents with ADHD and over 30,000 matched controls found that long-term use of ADHD medication use was associated with a 30% decrease in teenage pregnancy (Hua et al., 2020).”

• cites Hua et al., 2020Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Methylphenidate use for 90 days or more was associated with a 57% lower risk of burn injury than no methylphenidate after adjustment.

“Compared with patients not taking methylphenidate, those taking it for less than 90 days had a 30% lesser risk of burn injuries, and those taking it for 90 days or more a 57% reduction in risk, after adjusting for confounders (Chen et al., 2020b).”

• cites Chen et al., 2020bNot matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Methylphenidate was more than twice as likely to induce insomnia as atomoxetine in youths.

“A meta-analysis found that methylphenidate was more than twice as likely to induce insomnia as atomoxetine (10 studies, over 3,000 youths), but about half as likely to cause nausea (8 studies, over 2,750 youths) and vomiting 97 studies, over 2,500 youths), and about a sixth as likely to cause drowsiness (9 studies, over 2,800 youths) (Liu et al., 2017a).”

• cites Liu et al., 2017aNot matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Stimulants slightly-to-moderately decreased sleep efficiency in children.

“A meta-analysis found that stimulants moderately reduced total sleep time (7 studies, 223 children), delayed the onset of sleep (7 studies, 171 children), and slightly-to-moderately decreased sleep efficiency (7 studies, 155 children) (Kidwell et al., 2015).”

• cites Kidwell et al., 2015 sourceNot checked — no full text of the source

In adults with ADHD, atomoxetine was associated with about 40% higher likelihood of discontinuation due to adverse events versus placebo.

“A meta-analysis of twelve studies with over 3,300 adults found that those taking atomoxetine were about 40% more likely to discontinue treatment due to adverse events than those on placebo (Cunill et al., 2013).”

• cites Cunill et al., 2013 sourceNot checked — no full text of the source

Methylphenidate was about one-sixth as likely to cause drowsiness as atomoxetine in youths.

“A meta-analysis found that methylphenidate was more than twice as likely to induce insomnia as atomoxetine (10 studies, over 3,000 youths), but about half as likely to cause nausea (8 studies, over 2,750 youths) and vomiting 97 studies, over 2,500 youths), and about a sixth as likely to cause drowsiness (9 studies, over 2,800 youths) (Liu et al., 2017a).”

• cites Liu et al., 2017aNot matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

In a Danish register study of 8,300 people with ADHD, stimulant users had more than twice the rate of cardiovascular events, primarily hypertension, than nonusers.

“A study using Danish national registers followed over 700,000 individuals for an average period of almost a decade. Looking at 8,300 people with ADHD, stimulant users had more than twice the rate of cardiovascular events (primarily hypertension) than nonusers. These events were rare (Dalsgaard et al., 2014).”

• cites Dalsgaard et al., 2014 sourceNot checked — no full text of the source

Long-term methylphenidate use was associated with a one-sixth lower all-cause mortality rate.

“Long-term methylphenidate use was associated with a one-sixth lower rate of all-cause mortality.”

• cites Chen et al., 2020aNot matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Methylphenidate was about half as likely to cause vomiting as atomoxetine in youths.

“A meta-analysis found that methylphenidate was more than twice as likely to induce insomnia as atomoxetine (10 studies, over 3,000 youths), but about half as likely to cause nausea (8 studies, over 2,750 youths) and vomiting 97 studies, over 2,500 youths), and about a sixth as likely to cause drowsiness (9 studies, over 2,800 youths) (Liu et al., 2017a).”

• cites Liu et al., 2017aNot matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

In that Taiwan cohort, unmeasured confounding cannot be excluded because the database lacked information on family history, psychosocial stressors, behavioral therapy effects, and comorbidity severity.

“The authors caution, however, that “information lacking in the database precluded the measurement of other possible confounders, such as family history, psychosocial stressors, effect of behavioural therapy or severity of comorbidities,” and thus unmeasured confounding cannot be excluded (Chen et al., 2020a).”

• cites Chen et al., 2020aNot matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

A US medical records study found continuing declines in expected height over four years in stimulant-treated ADHD children versus controls.

“A medical records study from the USA comparing 32,999 stimulant-treated ADHD children with 11,515 controls found continuing declines in expected height over a four-year period.”

In a meta-analysis of 14 studies with over 2,300 participants, people with ADHD regularly treated with stimulants were about half as likely to smoke cigarettes.

“A meta-analysis of 14 studies with over 2,300 participants found that people with ADHD were about half as likely to smoke cigarettes when regularly treated with stimulant medications (Schoenfelder et al., 2014).”

• cites Schoenfelder et al., 2014 sourceNot checked — no full text of the source

Stimulants delayed sleep onset in children.

“A meta-analysis found that stimulants moderately reduced total sleep time (7 studies, 223 children), delayed the onset of sleep (7 studies, 171 children), and slightly-to-moderately decreased sleep efficiency (7 studies, 155 children) (Kidwell et al., 2015).”

• cites Kidwell et al., 2015 sourceNot checked — no full text of the source

Delayed methylphenidate use was associated with slightly higher (5%) mortality.

“Delayed use of methylphenidate, on the other hand, was associated with slightly higher (5%) mortality.”

• cites Chen et al., 2020aNot matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Stimulants moderately reduced total sleep time in children.

“A meta-analysis found that stimulants moderately reduced total sleep time (7 studies, 223 children), delayed the onset of sleep (7 studies, 171 children), and slightly-to-moderately decreased sleep efficiency (7 studies, 155 children) (Kidwell et al., 2015).”

• cites Kidwell et al., 2015 sourceNot checked — no full text of the source

Methylphenidate was about half as likely to cause nausea as atomoxetine in youths.

“A meta-analysis found that methylphenidate was more than twice as likely to induce insomnia as atomoxetine (10 studies, over 3,000 youths), but about half as likely to cause nausea (8 studies, over 2,750 youths) and vomiting 97 studies, over 2,500 youths), and about a sixth as likely to cause drowsiness (9 studies, over 2,800 youths) (Liu et al., 2017a).”

• cites Liu et al., 2017aNot matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Methylphenidate was not associated with a higher risk of heart attack or stroke.

“A meta-analysis covering people of all ages reported methylphenidate was not associated with a higher risk of all-cause death (3 studies, over 1.4 million people), heart attack or stroke (3 studies, over half a million people) (Liu et al., 2019a).”

• cites Liu et al., 2019aNot matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Independent assessments reported a small reduction in negative parenting after parent training.

“Independent assessments reported a small reduction in negative parenting (10 studies, 771 participants) (Rimestad et al., 2019).”

• cites Rimestad et al., 2019 sourceNot checked — no full text of the source

CBT for adult ADHD led to large to moderate improvements compared with waiting list controls.

“In another meta-analysis of 160 patients with adult ADHD, CBT led to large to moderate improvements compared with waiting list controls. In three studies of 191 patients CBT led to small to moderate improvements compared with active controls (Young et al., 2020).”

• cites Young et al., 2020 sourceNot checked — no full text of the source

There is little evidence that academic performance is improved by non-medical stimulant use in individuals without ADHD.

“Academic and occupational performance enhancement were the most commonly cited motivations for non-medical use of stimulants, but there is little evidence that academic performance is improved by non-medical use in individuals without ADHD (Faraone et al., 2020).”

• cites Faraone et al., 2020 sourceNot checked — no full text of the source

Atomoxetine has a poor benefit-risk balance for treating adults with ADHD.

“However, a meta-analysis of twelve studies with over 3,300 adults found 40% greater rate of all-cause treatment discontinuation, leading to a conclusion that “atomoxetine has a poor benefit–risk balance for the treatment of adults with ADHD” (Cunill et al., 2013).”

• cites Cunill et al., 2013 sourceNot checked — no full text of the source

Most non-medical use of prescribed stimulants is associated with zero or minor medical effects.

“Most non-medical use is associated with zero or minor medical effects, but adverse medical outcomes, including death, occur in some individuals, particularly when administered by non-oral routes.”

• cites Faraone et al., 2020 sourceNot checked — no full text of the source

In adults, atomoxetine was associated with a 40% greater rate of all-cause treatment discontinuation.

“However, a meta-analysis of twelve studies with over 3,300 adults found 40% greater rate of all-cause treatment discontinuation, leading to a conclusion that “atomoxetine has a poor benefit–risk balance for the treatment of adults with ADHD” (Cunill et al., 2013).”

• cites Cunill et al., 2013 sourceNot checked — no full text of the source

Atomoxetine was not associated with a significant increase in irritability in children.

“A meta-analysis examining the safety of atomoxetine found no significant increase in risk of irritability (3 studies, over 1,100 children) (Pozzi et al., 2018).”

• cites Pozzi et al., 2018 sourceNot checked — no full text of the source

Methylphenidate was not associated with a higher risk of all-cause death.

“A meta-analysis covering people of all ages reported methylphenidate was not associated with a higher risk of all-cause death (3 studies, over 1.4 million people), heart attack or stroke (3 studies, over half a million people) (Liu et al., 2019a).”

• cites Liu et al., 2019aNot matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Adverse medical outcomes including death occur in some individuals with non-medical stimulant use, particularly when administered by non-oral routes.

“Most non-medical use is associated with zero or minor medical effects, but adverse medical outcomes, including death, occur in some individuals, particularly when administered by non-oral routes.”

• cites Faraone et al., 2020 sourceNot checked — no full text of the source

Academic and occupational performance enhancement are the most commonly cited motivations for non-medical stimulant use.

“Academic and occupational performance enhancement were the most commonly cited motivations for non-medical use of stimulants, but there is little evidence that academic performance is improved by non-medical use in individuals without ADHD (Faraone et al., 2020).”

• cites Faraone et al., 2020 sourceNot checked — no full text of the source

Parent training for preschool children with ADHD had no significant effect on independently assessed ADHD symptoms.

“A meta-analysis found parent training for preschool children with ADHD to be associated with a moderate reduction in parent-reported ADHD symptoms (15 studies, few with active controls, over a thousand participants) and conduct problems (14 studies, few with active controls, over a thousand participants), but no significant results for independently assessed ADHD symptoms (6 studies, 403”

• cites Rimestad et al., 2019 sourceNot checked — no full text of the source

No significant difference in adverse cardiac events was found between methylphenidate and atomoxetine in children and adolescents.

“A meta-analysis of five studies with over 43,000 children and adolescents found no significant difference in adverse cardiac events between methylphenidate and atomoxetine, and a meta-analysis of three studies with 775 adults found no significant difference in adverse cardiac events between methylphenidate and placebo (Liang et al., 2018a).”

• cites Liang et al., 2018aNot matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

No significant difference in adverse cardiac events was found between methylphenidate and placebo in adults.

“A meta-analysis of five studies with over 43,000 children and adolescents found no significant difference in adverse cardiac events between methylphenidate and atomoxetine, and a meta-analysis of three studies with 775 adults found no significant difference in adverse cardiac events between methylphenidate and placebo (Liang et al., 2018a).”

• cites Liang et al., 2018aNot matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Parent training for preschool children with ADHD was associated with a moderate reduction in parent-reported conduct problems.

“A meta-analysis found parent training for preschool children with ADHD to be associated with a moderate reduction in parent-reported ADHD symptoms (15 studies, few with active controls, over a thousand participants) and conduct problems (14 studies, few with active controls, over a thousand participants), but no significant results for independently assessed ADHD symptoms (6 studies, 403”

• cites Rimestad et al., 2019 sourceNot checked — no full text of the source