The DOI matches its Crossref record; 137 of the 139 references it cites were found in a registry or an index; none of the 100 sources its claims cite is checked for support yet.
Advances in understanding and treating ADHD
Open accessAbstract
Attention deficit hyperactivity disorder (ADHD) is a neurocognitive behavioral developmental disorder most commonly seen in childhood and adolescence, which often extends to the adult years. Relative to a decade ago, there has been extensive research into understanding the factors underlying ADHD, leading to far more treatment options available for both adolescents and adults with this disorder. Novel stimulant formulations have made it possible to tailor treatment to the duration of efficacy required by patients, and to help mitigate the potential for abuse, misuse and diversion. Several new non-stimulant options have also emerged in the past few years. Among these, cognitive behavioral interventions have proven popular in the treatment of adult ADHD, especially within the adult population who cannot or will not use medications, along with the many medication-treated patients who continue to show residual disability.
Overview
AI snapshot
Written from the paper’s full text.
TL;DR
This narrative review summarizes advances in understanding ADHD as a complex neurobiological disorder and in treating it with stimulant and non-stimulant medications plus psychosocial approaches. It emphasizes that newer formulations and CBT expand options, but many patients still have residual impairment, comorbidity, and adherence problems.
Key findings
- ADHD prevalence estimates have risen from 3 to 5% of school-age children to about 7 to 8% of school-age children and 4 to 5% of adults; “uncomplicated” ADHD may exist in about 20 to 25% of adults with ADHD.
- Stimulants remain first-line and are more efficacious than non-stimulants; long-acting formulations and the prodrug lisdexamfetamine dimesylate may reduce abuse, misuse, and diversion risk.
- In adults with ADHD, 12 sessions of CBT produced more treatment responders (53%) than relaxation training and educational support (23%), with gains maintained at 6 and 12 months; however, one group CBT workshop program had one-third of participants drop out.
- Only 49% of adults with ADHD were prescribed long-acting agents, and even in non-comorbid ADHD, optimal functioning occurs in only roughly one in four children.
Methods
- Design: narrative review of current conceptualizations of ADHD causes and advances in treatment, including stimulant and non-stimulant medication and cognitive behavioral therapy.
- Data/sample: published literature and prior studies; no primary participant sample or systematic search strategy is reported.
- Main analysis: qualitative synthesis, with tables summarizing DSM-IV diagnostic criteria, pharmacological treatments, and non-pharmacological interventions.
Limitations
- The paper states that pharmacogenetics “cannot yet guide treatment choices,” that evidence for CBT as a stand-alone treatment is limited, that long-term cardiovascular side-effects are less certain, and that little is known about predictors of long-term adherence.
- Evident from the text: as a narrative review, it does not report a systematic search, inclusion criteria, risk-of-bias assessment, or quantitative synthesis, so findings may be selectively presented.
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Claims the paper makes
53 Not checked yet · 13 Own interpretation · 9 No basis given
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Current advances in cognitive neuroscience, neuroimaging, and behavioral and molecular genetics have provided evidence that ADHD is a complex neurobiological disorder.”
§ Advances in understanding and treating ADHD > Introduction > Understanding ADHD
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: passes — The paper’s conclusions depend on it.
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In the paper
“Likewise, adult ADHD is also associated with diagnoses of comorbid mood, anxiety and substance-use disorder [11-17].”
§ Advances in understanding and treating ADHD > Introduction > Comorbid conditions
What the sources say
- Not checked yetcites [11] Borland BL, Heckman HK: Hyperactive boys and their brothers: A 25-year follow-up study. Archives of General Psychiatry. 1976, 33: 669-675. source
- Not checked yetcites [12] Morrison JR: Adult psychiatric disorders in parents of hyperactive children. American Journal of Psychiatry. 1980, 137: 825-827. source
- Not checked yetcites [13] Biederman J, Faraone SV, Spencer T, Wilens T, Norman D, Lapey KA, Mick E, Lehman BK, Doyle A: Patterns of psychiatric comorbidity, cognition, and psychosocial functioning in adults with attention deficit hyperactivity disorder. Am J Psychiatry. 1993, 150 (12): 1792-1798. source
- Not checked yetcites [14] Heiligenstein E, Conyers LM, Berns AR, Miller MA: Preliminary normative data on DSM-IV attention deficit hyperactivity disorder in college students. J Am Coll Health. 1998, 46 (4): 185-188. 10.1080/07448489809595609. source
- Not checked yetcites [15] Murphy K, Barkley RA: Attention deficit hyperactivity disorder adults: comorbidities and adaptive impairments. Compr Psychiatry. 1996, 37 (6): 393-401. 10.1016/S0010-440X(96)90022-X. source
- Not checked yetcites [16] Shekim WO, Asarnow RF, Hess E, Zaucha K, Wheeler N: A clinical and demographic profile of a sample of adults with attention deficit hyperactivity disorder, residual state. Compr Psychiatry. 1990, 31 (5): 416-425. 10.1016/0010-440X(90)90026-O. source
- Not checked yetcites [17] Barkley R, Murphy K, Fischer M: ADHD in adults: what the science says. 2007, New York: Guilford Press
plaincorrelational- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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None of the sources cited for this claim have been checked yet.
In the paper
“Pediatric ADHD commonly co-occurs with multiple psychiatric disorders including mood, anxiety and disruptive behavioral disorders [9,10].”
§ Advances in understanding and treating ADHD > Introduction > Comorbid conditions
What the sources say
- Not checked yetcites [9] Angold A, Costello EJ, Erkanli A: Comorbidity. J Child Psychol Psychiatry. 1999, 40 (1): 57-87. 10.1111/1469-7610.00424. source
- Not checked yetcites [10] Biederman J, Newcorn J, Sprich S: Comorbidity of attention deficit hyperactivity disorder with conduct, depressive, anxiety, and other disorders. American Journal of Psychiatry. 1991, 148 (5): 564-577. source
plaincorrelational- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Neurologically, the prefrontal cortex seems to be relevant to understanding ADHD.”
§ Advances in understanding and treating ADHD > Introduction > Understanding ADHD
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Research has indicated that some of these brain regions are slightly smaller or have decreased activation in people with ADHD.”
§ Advances in understanding and treating ADHD > Introduction > Understanding ADHD
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“Greater absorption of medication occurs when the patch is applied to the buttocks rather than to the subscapular area [47].”
§ Advances in understanding and treating ADHD > ADHD treatments > Stimulants
What the sources say
- Not checked yetcites [47] Gonzalez MA, Campbell D, Rubin J: Effects of application to two different skin sites on the pharmacokinetics of transdermal methylphenidate in pediatric patients with attention-deficit/hyperactivity disorder. J Child Adolesc Psychopharmacol. 2009, 19 (3): 227-232. 10.1089/cap.2008.0081. source
plaindirect- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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In the paper
“Comorbid anxiety was not found to affect stimulant efficacy in a recent study [48]”
§ Advances in understanding and treating ADHD > ADHD treatments > Stimulants
What the sources say
- Not checked yetcites [48] Garcia SP, Guimaraes J, Zampieri JF, Martinez AL, Polanczyk G, Rohde LA: Response to methylphenidate in children and adolescents with ADHD: does comorbid anxiety disorders matters?. J Neural Transm. 2009, 116 (5): 631-636. 10.1007/s00702-009-0211-3. source
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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None of the sources cited for this claim have been checked yet.
In the paper
“meta-analyses of stimulants and other ADHD medications in the treatment of ADHD comorbid with tic disorders concluded that supratherapeutic doses of dextroamphetamine should be avoided in this population.”
§ Advances in understanding and treating ADHD > ADHD treatments > Stimulants
What the sources say
- Not checked yetcites [51] Bloch MH, Panza KE, Landeros-Weisenberger A, Leckman JF: Meta-analysis: treatment of attention-deficit/hyperactivity disorder in children with comorbid tic disorders. J Am Acad Child Adolesc Psychiatry. 2009, 48 (9): 884-893. 10.1097/CHI.0b013e3181b26e9f. source
- Not checked yetcites [52] Gadow KD, Nolan EE, Sverd J, Sprafkin J, Schneider J: Methylphenidate in children with oppositional defiant disorder and both comorbid chronic multiple tic disorder and ADHD. J Child Neurol. 2008, 23 (9): 981-990. 10.1177/0883073808315412. source
plain- Asserted: passes — The authors put it forward as true.
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None of the sources cited for this claim have been checked yet.
In the paper
“some studies suggest that treatment with stimulants can help to lessen the likelihood of other psychiatric comorbidities during adolescence [49], including cigarette use and substance abuse [50].”
§ Advances in understanding and treating ADHD > ADHD treatments > Stimulants
What the sources say
- Not checked yetcites [49] Biederman J, Monuteaux MC, Spencer T, Wilens TE, Faraone SV: Do stimulants protect against psychiatric disorders in youth with ADHD? A 10-year follow-up study. Pediatrics. 2009, 124 (1): 71-78. 10.1542/peds.2008-3347. source
- Not checked yetcites [50] Wilens TE, Adamson J, Monuteaux MC, Faraone SV, Schillinger M, Westerberg D, Biederman J: Effect of prior stimulant treatment for attention-deficit/hyperactivity disorder on subsequent risk for cigarette smoking and alcohol and drug use disorders in adolescents. Arch Pediatr Adolesc Med. 2008, 162 (10): 916-921. 10.1001/archpedi.162.10.916. source
hedgedconditional- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“Dexmethylphenidate comes in capsules that can be opened and mixed with food, and has the earliest onset of efficacy of the long-acting preparations [42,43].”
§ Advances in understanding and treating ADHD > ADHD treatments > Stimulants
What the sources say
- Not checked yetcites [42] Childress AC, Spencer T, Lopez F, Gerstner O, Thulasiraman A, Muniz R, Post A: Efficacy and safety of dexmethylphenidate extended-release capsules administered once daily to children with attention-deficit/hyperactivity disorder. J Child Adolesc Psychopharmacol. 2009, 19 (4): 351-361. 10.1089/cap.2009.0007. source
- Not checked yetcites [43] Moen MD, Keam SJ: Dexmethylphenidate extended release: a review of its use in the treatment of attention-deficit hyperactivity disorder. CNS Drugs. 2009, 23 (12): 1057-1083. 10.2165/11201140-000000000-00000. source
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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- Probably not a substantial claim. 6
- It may state two separate claims as one. 27
In the paper
“Comorbidity rates in adult ADHD do not differ as a function of gender [18].”
§ Advances in understanding and treating ADHD > Introduction > Comorbid conditions
What the sources say
- Not checked yetcites [18] Lahey BB, Applegate B, McBurnett K, Biederman J, Greenhill L, Hynd GW, Barkley RA, Newcorn J, Jensen P, Richters J, et al: DSM-IV field trials for attention deficit hyperactivity disorder in children and adolescents. Am J Psychiatry. 1994, 151 (11): 1673-1685. source
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: fails — The paper’s conclusions may not depend on it.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“some data suggest that 'uncomplicated' ADHD exists in about 20 to 25% of adults with ADHD [13].”
§ Advances in understanding and treating ADHD > Introduction > Comorbid conditions
What the sources say
- Not checked yetcites [13] Biederman J, Faraone SV, Spencer T, Wilens T, Norman D, Lapey KA, Mick E, Lehman BK, Doyle A: Patterns of psychiatric comorbidity, cognition, and psychosocial functioning in adults with attention deficit hyperactivity disorder. Am J Psychiatry. 1993, 150 (12): 1792-1798. source
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“Research has continued to suggest that osmotic-release oral system (OROS) methylphenidate lessens ADHD symptoms throughout the day and has greater adherence, thought to be associated with the convenience of once-daily dosing [39-41].”
§ Advances in understanding and treating ADHD > ADHD treatments > Stimulants
What the sources say
- Not checked yetcites [39] Kim Y, Shin MS, Kim JW, Yoo HJ, Cho SC, Kim BN: Neurocognitive effects of switching from methylphenidate-IR to OROS-methylphenidate in children with ADHD. Hum Psychopharmacol. 2009, 24 (2): 95-102. 10.1002/hup.1010. source
- Not checked yetcites [40] Chou WJ, Chou MC, Tzang RF, Hsu YC, Gau SS, Chen SJ, Wu YY, Huang YF, Liang HY, Cheng H: Better efficacy for the osmotic release oral system methylphenidate among poor adherents to immediate-release methylphenidate in the three ADHD subtypes. Psychiatry Clin Neurosci. 2009, 63 (2): 167-175. 10.1111/j.1440-1819.2009.01937.x. source
- Not checked yetcites [41] Abikoff H, Nissley-Tsiopinis J, Gallagher R, Zambenedetti M, Seyffert M, Boorady R, McCarthy J: Effects of MPH-OROS on the organizational, time management, and planning behaviors of children with ADHD. J Am Acad Child Adolesc Psychiatry. 2009, 48 (2): 166-175. 10.1097/CHI.0b013e3181930626. source
hedgeddirect- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Transdermal methylphenidate bypasses the oral route entirely, and in short-term studies is associated with efficacy throughout the day, with improved family quality of life, and when carefully titrated, little effect on sleep [44-46].”
§ Advances in understanding and treating ADHD > ADHD treatments > Stimulants
What the sources say
- Not checked yetcites [44] Faraone SV, Glatt SJ, Bukstein OG, Lopez FA, Arnold LE, Findling RL: Effects of once-daily oral and transdermal methylphenidate on sleep behavior of children with ADHD. J Atten Disord. 2009, 12 (4): 308-315. source
- Not checked yetcites [45] Wilens TE, Hammerness P, Martelon M, Brodziak K, Utzinger L, Wong P: A controlled trial of the methylphenidate transdermal system on before-school functioning in children with attention-deficit/hyperactivity disorder. J Clin Psychiatry. 71 (5): 548-556. source
- Not checked yetcites [46] Manos M, Frazier TW, Landgraf JM, Weiss M, Hodgkins P: HRQL and medication satisfaction in children with ADHD treated with the methylphenidate transdermal system. Curr Med Res Opin. 2009, 25 (12): 3001-3010. 10.1185/03007990903388797. source
plaincorrelational- Asserted: passes — The authors put it forward as true.
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- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Long-acting stimulants are less prone to diversion, probably because extraction of active drug is more difficult, and for some, the delivery of drug to the brain is slower.”
§ Advances in understanding and treating ADHD > ADHD treatments > Stimulants
hedgedconditional- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“LDX requires gut metabolism to reach its active form, and hence lessens the likelihood of abuse and overdose.”
§ Advances in understanding and treating ADHD > ADHD treatments > Stimulants
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
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It may state two separate claims as one.
In the paper
“The general consensus on cardiovascular side-effects at this point is that the short/medium term side-effects are usually of no clinical significance, but the long-term potential side-effects are less certain [63].”
§ Advances in understanding and treating ADHD > ADHD treatments > Stimulants
What the sources say
- Not checked yetcites [63] Graham J, Banaschewski T, Buitelaar J, Coghill D, Danckaerts M, Dittmann RW, Dopfner M, Hamilton R, Hollis C, Holtmann M, et al: European guidelines on managing adverse effects of medication for ADHD. Eur Child Adolesc Psychiatry. 2011, 20 (1): 17-37. 10.1007/s00787-010-0140-6. source
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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It may state two separate claims as one.
In the paper
“However, a recent review article has shown that treatment with stimulants in childhood modestly reduced expected height and weight [62]. These effects were dose-dependent and attenuated over time.”
§ Advances in understanding and treating ADHD > ADHD treatments > Stimulants
What the sources say
- Not checked yetcites [62] Faraone SV, Biederman J, Morley CP, Spencer TJ: Effect of stimulants on height and weight: a review of the literature. J Am Acad Child Adolesc Psychiatry. 2008, 47 (9): 994-1009.
plaindirect- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“The efficacy and side-effects of LDX are similar to the other long-acting stimulant preparations [68-72].”
§ Advances in understanding and treating ADHD > ADHD treatments > Stimulants
What the sources say
- Not checked yetcites [68] Najib J: The efficacy and safety profile of lisdexamfetamine dimesylate, a prodrug of d-amphetamine, for the treatment of attention-deficit/hyperactivity disorder in children and adults. Clin Ther. 2009, 31 (1): 142-176. 10.1016/j.clinthera.2009.01.015. source
- Not checked yetcites [69] Antonucci D, Kunins C, Manos M, Lopez FA, Kerney DL: Assessing effects of treatment with lisdexamfetamine dimesylate for pediatric ADHD using a parental survey. CNS Spectr. 2010, 15 (4): 248-256. source
- Not checked yetcites [70] Findling RL, Ginsberg LD, Jain R, Gao J: Effectiveness, safety, and tolerability of lisdexamfetamine dimesylate in children with attention-deficit/hyperactivity disorder: an open-label, dose-optimization study. J Child Adolesc Psychopharmacol. 2009, 19 (6): 649-662. 10.1089/cap.2008.0165. source
- Not checked yetcites [71] Faraone SV, Spencer TJ, Kollins SH, Glatt SJ: Effects of lisdexamfetamine dimesylate treatment for ADHD on growth. J Am Acad Child Adolesc Psychiatry. 49 (1): 24-32. source
- Not checked yetcites [72] Boellner SW, Stark JG, Krishnan S, Zhang Y: Pharmacokinetics of lisdexamfetamine dimesylate and its active metabolite, d-amphetamine, with increasing oral doses of lisdexamfetamine dimesylate in children with attention-deficit/hyperactivity disorder: a single-dose, randomized, open-label, crossover study. Clin Ther. 32 (2): 252-264. source
plain- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
In the paper
“Because atomoxetine has been rarely associated with acute suicidality [86], it has been given a 'black box' warning.”
§ Advances in understanding and treating ADHD > ADHD treatments > Non-stimulants
What the sources say
- Not checked yetcites [86] Paxton GA, Cranswick NE: Acute suicidality after commencing atomoxetine. J Paediatr Child Health. 2008, 44 (10): 596-598. 10.1111/j.1440-1754.2008.01389.x. source
plaincorrelational- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
In the paper
“When atomoxetine is administered once daily, some evidence suggests that morning dosing may be more efficacious, but evening dosing may be more tolerable [84].”
§ Advances in understanding and treating ADHD > ADHD treatments > Non-stimulants
What the sources say
- Not checked yetcites [84] Block SL, Kelsey D, Coury D, Lewis D, Quintana H, Sutton V, Schuh K, Allen AJ, Sumner C: Once-daily atomoxetine for treating pediatric attention-deficit/hyperactivity disorder: comparison of morning and evening dosing. Clin Pediatr (Phila). 2009, 48 (7): 723-733. 10.1177/0009922809335321. source
hedgedconditional- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Modafinil [73] and reboxetine [74,75] have both shown some promise in the treatment of ADHD.”
§ Advances in understanding and treating ADHD > ADHD treatments > Non-stimulants
What the sources say
- Not checked yetcites [73] Kahbazi M, Ghoreishi A, Rahiminejad F, Mohammadi MR, Kamalipour A, Akhondzadeh S: A randomized, double-blind and placebo-controlled trial of modafinil in children and adolescents with attention deficit and hyperactivity disorder. Psychiatry Res. 2009, 168 (3): 234-237. 10.1016/j.psychres.2008.06.024. source
- Not checked yetcites [74] Arabgol F, Panaghi L, Hebrani P: Reboxetine versus methylphenidate in treatment of children and adolescents with attention deficit-hyperactivity disorder. Eur Child Adolesc Psychiatry. 2009, 18 (1): 53-59. 10.1007/s00787-008-0705-9. source
- Not checked yetcites [75] Cohen-Yavin I, Yoran-Hegesh R, Strous RD, Kotler M, Weizman A, Spivak B: Efficacy of reboxetine in the treatment of attention-deficit/hyperactivity disorder in boys with intolerance to methylphenidate: an open-label, 8-week, methylphenidate-controlled trial. Clin Neuropharmacol. 2009, 32 (4): 179-182. 10.1097/WNF.0b013e318183796d. source
hedgedconditional- Asserted: passes — The authors put it forward as true.
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- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Recent studies have shown that adding clonidine to methylphenidate [95], extended-release guanfacine to stimulants [96], or OROS methylphenidate to atomoxetine [97] improved residual ADHD symptoms and was well tolerated.”
§ Advances in understanding and treating ADHD > ADHD treatments > Non-stimulants
What the sources say
- Not checked yetcites [95] Cannon M, Pelham WH, Sallee FR, Palumbo DR, Bukstein O, Daviss WB: Effects of clonidine and methylphenidate on family quality of life in attention-deficit/hyperactivity disorder. J Child Adolesc Psychopharmacol. 2009, 19 (5): 511-517. 10.1089/cap.2009.0008. source
- Not checked yetcites [96] Spencer TJ, Greenbaum M, Ginsberg LD, Murphy WR: Safety and effectiveness of coadministration of guanfacine extended release and psychostimulants in children and adolescents with attention-deficit/hyperactivity disorder. J Child Adolesc Psychopharmacol. 2009, 19 (5): 501-510. 10.1089/cap.2008.0152. source
- Not checked yetcites [97] Wilens TE, Hammerness P, Utzinger L, Schillinger M, Georgiopoulous A, Doyle RL, Martelon M, Brodziak K: An open study of adjunct OROS-methylphenidate in children and adolescents who are atomoxetine partial responders: I. Effectiveness. J Child Adolesc Psychopharmacol. 2009, 19 (5): 485-492. 10.1089/cap.2008.0125. source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“studies in populations around the world have continued to confirm its efficacy [78-81], including for children with oppositional defiant disorder [82] or those who have received previous stimulant therapy [83].”
§ Advances in understanding and treating ADHD > ADHD treatments > Non-stimulants
What the sources say
- Not checked yetcites [78] Svanborg P, Thernlund G, Gustafsson PA, Hagglof B, Poole L, Kadesjo B: Efficacy and safety of atomoxetine as add-on to psychoeducation in the treatment of attention deficit/hyperactivity disorder: a randomized, double-blind, placebo-controlled study in stimulant-naive Swedish children and adolescents. Eur Child Adolesc Psychiatry. 2009, 18 (4): 240-249. 10.1007/s00787-008-0725-5. source
- Not checked yetcites [79] Martenyi F, Zavadenko NN, Jarkova NB, Yarosh AA, Soldatenkova VO, Bardenstein LM, Kozlova IA, Neznanov NG, Maslova OI, Petrukhin AS, et al: Atomoxetine in children and adolescents with attention-deficit/hyperactivity disorder: a 6-week, randomized, placebo-controlled, double-blind trial in Russia. Eur Child Adolesc Psychiatry. 2010, 19 (1): 57-66. 10.1007/s00787-009-0042-7. source
- Not checked yetcites [80] Takahashi M, Takita Y, Yamazaki K, Hayashi T, Ichikawa H, Kambayashi Y, Koeda T, Oki J, Saito K, Takeshita K, et al: A randomized, double-blind, placebo-controlled study of atomoxetine in Japanese children and adolescents with attention-deficit/hyperactivity disorder. J Child Adolesc Psychopharmacol. 2009, 19 (4): 341-350. 10.1089/cap.2008.0154. source
- Not checked yetcites [81] Durell TM, Pumariega AJ, Rothe EM, Tamayo JM, Baron D, Williams D: Effects of open-label atomoxetine on African-American and Caucasian pediatric outpatients with attention-deficit/hyperactivity disorder. Ann Clin Psychiatry. 2009, 21 (1): 26-37.
- Not checked yetcites [82] Dell'Agnello G, Maschietto D, Bravaccio C, Calamoneri F, Masi G, Curatolo P, Besana D, Mancini F, Rossi A, Poole L, et al: Atomoxetine hydrochloride in the treatment of children and adolescents with attention-deficit/hyperactivity disorder and comorbid oppositional defiant disorder: A placebo-controlled Italian study. Eur Neuropsychopharmacol. 2009, 19 (11): 822-834. 10.1016/j.euroneuro.2009.07.008. source
- Not checked yetcites [83] Hammerness P, Doyle R, Kotarski M, Georgiopoulos A, Joshi G, Zeitlin S, Biederman J: Atomoxetine in children with attention-deficit hyperactivity disorder with prior stimulant therapy: a prospective open-label study. Eur Child Adolesc Psychiatry. 2009, 18 (8): 493-498. 10.1007/s00787-009-0017-8. source
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Recently, once-daily extended-release guanfacine has proven effective in both short-term [90,91] and long-term studies [92,93].”
§ Advances in understanding and treating ADHD > ADHD treatments > Non-stimulants
What the sources say
- Not checked yetcites [90] Sallee FR, McGough J, Wigal T, Donahue J, Lyne A, Biederman J: Guanfacine extended release in children and adolescents with attention-deficit/hyperactivity disorder: a placebo-controlled trial. J Am Acad Child Adolesc Psychiatry. 2009, 48 (2): 155-165. 10.1097/CHI.0b013e318191769e. source
- Not checked yetcites [91] Biederman J, Melmed RD, Patel A, McBurnett K, Konow J, Lyne A, Scherer N: A randomized, double-blind, placebo-controlled study of guanfacine extended release in children and adolescents with attention-deficit/hyperactivity disorder. Pediatrics. 2008, 121 (1): e73-84. 10.1542/peds.2006-3695. source
- Not checked yetcites [92] Sallee FR, Lyne A, Wigal T, McGough JJ: Long-term safety and efficacy of guanfacine extended release in children and adolescents with attention-deficit/hyperactivity disorder. J Child Adolesc Psychopharmacol. 2009, 19 (3): 215-226. 10.1089/cap.2008.0080. source
- Not checked yetcites [93] Biederman J, Melmed RD, Patel A, McBurnett K, Donahue J, Lyne A: Long-term, open-label extension study of guanfacine extended release in children and adolescents with ADHD. CNS Spectr. 2008, 13 (12): 1047-1055. source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“As with stimulant treatment, atomoxetine rarely completely normalizes behavior [87], but symptom improvement is often reflected in gains in social and behavioral function [88].”
§ Advances in understanding and treating ADHD > ADHD treatments > Non-stimulants
What the sources say
- Not checked yetcites [87] Whalen CK, Henker B, Ishikawa SS, Emmerson NA, Swindle R, Johnston JA: Atomoxetine versus stimulants in the community treatment of children with ADHD: an electronic diary study. J Atten Disord. 2010, 13 (4): 391-400. 10.1177/1087054708325118. source
- Not checked yetcites [88] Buitelaar JK, Wilens TE, Zhang S, Ning Y, Feldman PD: Comparison of symptomatic versus functional changes in children and adolescents with ADHD during randomized, double-blind treatment with psychostimulants, atomoxetine, or placebo. J Child Psychol Psychiatry. 2009, 50 (3): 335-342. 10.1111/j.1469-7610.2008.01960.x. source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Sedation is a common side-effect, which diminishes over time [94].”
§ Advances in understanding and treating ADHD > ADHD treatments > Non-stimulants
What the sources say
- Not checked yetcites [94] Faraone SV, Glatt SJ: Effects of extended-release guanfacine on ADHD symptoms and sedation-related adverse events in children with ADHD. J Atten Disord. 2010, 13 (5): 532-538. 10.1177/1087054709332472. source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Stimulant misuse seems to be more common in those with comorbid alcohol-, drug- and cigarette-related problems, and those with higher levels of ADHD symptoms [115].”
§ Advances in understanding and treating ADHD > ADHD treatments > Non-stimulants
What the sources say
- Not checked yetcites [115] Wilens TE, Adler LA, Adams J, Sgambati S, Rotrosen J, Sawtelle R, Utzinger L, Fusillo S: Misuse and diversion of stimulants prescribed for ADHD: a systematic review of the literature. J Am Acad Child Adolesc Psychiatry. 2008, 47 (1): 21-31. 10.1097/chi.0b013e31815a56f1. source
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“A recently published study suggests that, when compared with adults with ADHD who received relaxation training and educational support, adults with ADHD who received 12 sessions of CBT had lower self-reported ADHD symptoms and greater functional improvements as rated by a blinded assessor [119].”
§ Advances in understanding and treating ADHD > ADHD treatments > Non-stimulants
What the sources say
- Not checked yetcites [119] Safren SA, Sprich S, Mimiaga MJ, Surman C, Knouse L, Groves M, Otto MW: Cognitive behavioral therapy vs relaxation with educational support for medication-treated adults with ADHD and persistent symptoms: a randomized controlled trial. Jama. 2010, 304 (8): 875-880. 10.1001/jama.2010.1192. source
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“At this point, the consensus for most alternative and complementary therapies is that these therapies are best used as a complement to ongoing pharmacotherapy rather than as an alternative.”
§ Advances in understanding and treating ADHD > ADHD treatments > Non-stimulants
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“However, the only non-stimulant with FDA approval for adults with ADHD is atomoxetine.”
§ Advances in understanding and treating ADHD > ADHD treatments > Non-stimulants
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The potential for diversion and misuse may be greater in adults than in children, as parents might control the medications for the latter.”
§ Advances in understanding and treating ADHD > ADHD treatments > Non-stimulants
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds. It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Short-chain fatty acids [108] and omega-3/omega-6 fatty acids [109] have not been found to be efficacious.”
§ Advances in understanding and treating ADHD > ADHD treatments > Non-stimulants
What the sources say
- Not checked yetcites [108] Raz R, Carasso RL, Yehuda S: The influence of short-chain essential fatty acids on children with attention-deficit/hyperactivity disorder: a double-blind placebo-controlled study. J Child Adolesc Psychopharmacol. 2009, 19 (2): 167-177. 10.1089/cap.2008.070. source
- Not checked yetcites [109] Johnson M, Ostlund S, Fransson G, Kadesjo B, Gillberg C: Omega-3/omega-6 fatty acids for attention deficit hyperactivity disorder: a randomized placebo-controlled trial in children and adolescents. J Atten Disord. 2009, 12 (5): 394-401. 10.1177/1087054708316261. source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Although most people with ADHD will respond favorably to pharmacological interventions [126], optimal functioning may not be attained.”
§ Advances in understanding and treating ADHD > ADHD treatments > Non-stimulants
What the sources say
- Not checked yetcites [126] Elia J, Borcherding BG, Rapoport JL, Keysor CS: Methylphenidate and dextroamphetamine treatments of hyperactivity: are there true nonresponders?. Psychiatry Res. 1991, 36 (2): 141-155. 10.1016/0165-1781(91)90126-A. source
plainconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Furthermore, both groups reported less depression and anxiety. Both groups also had improved self-esteem at the end of the study, but the intervention group reported a greater improvement in self-esteem [120].”
§ Advances in understanding and treating ADHD > ADHD treatments > Non-stimulants
What the sources say
- Not checked yetcites [120] Bramham J, Young S, Bickerdike A, Spain D, McCartan D, Xenitidis K: Evaluation of group cognitive behavioral therapy for adults with ADHD. J Atten Disord. 2009, 12 (5): 434-441. 10.1177/1087054708314596. source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Likewise, medications may improve some but not all aspects of cognitive functioning, and even when both symptoms and cognitive function are improved, the two are not necessarily correlated [130].”
§ Advances in understanding and treating ADHD > ADHD treatments > Non-stimulants
What the sources say
- Not checked yetcites [130] Coghill DR, Rhodes SM, Matthews K: The neuropsychological effects of chronic methylphenidate on drug-naive boys with attention-deficit/hyperactivity disorder. Biol Psychiatry. 2007, 62 (9): 954-962. 10.1016/j.biopsych.2006.12.030. source
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“There were more treatment responders in the CBT group (53%) relative to the relaxation training and educational support group (23%), and gains were maintained over periods of 6 and 12 months [119].”
§ Advances in understanding and treating ADHD > ADHD treatments > Non-stimulants
What the sources say
- Not checked yetcites [119] Safren SA, Sprich S, Mimiaga MJ, Surman C, Knouse L, Groves M, Otto MW: Cognitive behavioral therapy vs relaxation with educational support for medication-treated adults with ADHD and persistent symptoms: a randomized controlled trial. Jama. 2010, 304 (8): 875-880. 10.1001/jama.2010.1192. source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“New stimulant formulations have made it possible to tailor treatment to the duration of efficacy required by patients and to help mitigate the potential for abuse, misuse and diversion.”
§ Advances in understanding and treating ADHD > Conclusions
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: unclear — It is unclear why the paper says it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Although they tend to be less efficacious than stimulants, new non-stimulant options also allow for extended duration of treatment without the adverse consequences associated with stimulant therapy.”
§ Advances in understanding and treating ADHD > Conclusions
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Poor treatment adherence and psychiatric comorbidity clearly complicate treatment and negatively affect outcomes.”
§ Advances in understanding and treating ADHD > ADHD treatments > Non-stimulants
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“ADHD symptoms, especially hyperactive-impulsive symptoms, tend to decline through adolescence into adulthood, so that the adult presentation of ADHD differs somewhat from the childhood presentation.”
§ Advances in understanding and treating ADHD > Conclusions
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper may give no reason why it holds. It may state two separate claims as one.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The cited source says what the claim attributes to it.
In the citing paper
“Treatment strategies for ADHD symptoms include medication-based, behavior-based, and combined interventions (Antshel et al., 2011; Sibley et al., 2014).”
From A Review of Heterogeneity in Attention Deficit/Hyperactivity Disorder (ADHD) (2019) · cites this paper as Antshel et al., 2011
The check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“As a result of internalising neurodivergent traits and stress [72], unsupported neurodivergent adults are at risk for co-morbid mental health disorders such as anxiety, depression, and post-traumatic stress [6, 47, 70] and suicide [35].”
From Burnout by Design: How Digital Systems Overburden Neurodivergent Students in Higher Education (2025) · cites this paper as [6]
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Advances in understanding and treating ADHD > ADHD treatments > Non-stimulants
“the selective norepinephrine reuptake inhibitor (SNRI), atomoxetine”
§ Advances in understanding and treating ADHD > List of Abbreviations
“SNRI: Serotonin-norepinephrine reuptake inhibitor”
Citations
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Metadata
- Authors
- Antshel, K. M., Hargrave, T. M., Simonescu, M., Kaul, P., Hendricks, K., & Faraone, S. V.
- Affiliations
- SUNY Upstate Medical University (US)
- Corresponding author
- Antshel, Kevin M
- Venue
- BMC Medicine
- Published
- 2011-06-10
- Volume
- 9
- Issue
- 1
- Pages
- 72-72
- ISSN
- 1741-7015 (ISSN-L)
- PMC
- PMC3126733
- OpenAlex
- W2164896423
- Cited by
- 140
- References
- 139
- Citations by year
- 2026: 1 · 2025: 6 · 2024: 5 · 2023: 5 · 2022: 10 · 2021: 7 · 2020: 5 · 2019: 3 · 2018: 11 · 2017: 19 · 2016: 17 · 2015: 9 · 2014: 13 · 2013: 13 · 2012: 15
- FWCI
- 1.72
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Medicine (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Eli Lilly and Company
- Pfizer
- National Institutes of Health
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Social Sciences › Psychology › Developmental and Educational Psychology › Behavioral and Psychological Studies
- Social Sciences › Psychology › Neuropsychology and Physiological Psychology › Developmental and Educational Neuropsychology
- Keywords
- attention deficit hyperactivity disorder, adult ADHD, ADHD treatment, stimulant medication, non-stimulant medication, cognitive-behavioral intervention, ADHD pathophysiology, residual disability
- MeSH terms
- Central Nervous System Stimulants, Attention Deficit Disorder with Hyperactivity, Humans, Cognitive Behavioral Therapy, Adrenergic Uptake Inhibitors, Biomedical Research
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
A language model drew the claims from the paper on 2026-10-10, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-10-10 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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