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Cited by 1,410Attention Deficit Hyperactivity DisorderChild and Adolescent Psychosocial and Emotional DevelopmentClinical practice guidelines implementation

Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents

Wolraich, Mark L., Hagan, Joseph F., Allan, Carla, Chan, Eugenia, Davison, Dale, Earls, Marian, Evans, Steven W., Flinn, Susan K. +10 more·2019·Pediatrics
DOI 10.1542/peds.2019-2528PMC PMC7067282
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Abstract

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurobehavioral disorders of childhood and can profoundly affect children’s academic achievement, well-being, and social interactions. The American Academy of Pediatrics first published clinical recommendations for evaluation and diagnosis of pediatric ADHD in 2000; recommendations for treatment followed in 2001. The guidelines were revised in 2011 and published with an accompanying process of care algorithm (PoCA) providing discrete and manageable steps by which clinicians could fulfill the clinical guideline’s recommendations. Since the release of the 2011 guideline, the Diagnostic and Statistical Manual of Mental Disorders has been revised to the fifth edition, and new ADHD-related research has been published. These publications do not support dramatic changes to the previous recommendations. Therefore, only incremental updates have been made in this guideline revision, including the addition of a key action statement related to diagnosis and treatment of comorbid conditions in children and adolescents with ADHD. The accompanying process of care algorithm has also been updated to assist in implementing the guideline recommendations. Throughout the process of revising the guideline and algorithm, numerous systemic barriers were identified that restrict and/or hamper pediatric clinicians’ ability to adopt their recommendations. Therefore, the subcommittee created a companion article (available in the Supplemental Information) on systemic barriers to the care of children and adolescents with ADHD, which identifies the major systemic-level barriers and presents recommendations to address those barriers; in this article, we support the recommendations of the clinical practice guideline and accompanying process of care algorithm.

Integrity signals

Registry

Crossref · 10.1542/peds.2019-2528

Cites

149 of 149 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

41 of 151 cited sources checked · 12 supported · 1 flagged · accuracy not yet measured

  • Premisecitation

    Boys with ADHD are more likely to exhibit externalizing conditions like oppositional defiant disorder or conduct disorder.

    “Boys are more likely to exhibit externalizing conditions like oppositional defiant disorder or conduct disorder.17,19,20”
    Quote in the paperNot a substantial claim2 of 3 sources checked
    • cites [17] Elia, 2008, ADHD characteristics: I. Concurrent co-morbidity patterns in children & adolescents, Child Adolesc Psychiatry Ment Health source

      The Results report no significant sex differences in the diagnostic frequency patterns, including oppositional defiant disorder; the only exception was separation anxiety, which was more common in girls. The paper therefore does not support the claim that boys with ADHD are more likely than girls to have these externalizing conditions. (LLM, conf=0.90)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured
    • cites [19] Cuffe, ADHD and psychiatric comorbidity: functional outcomes in a school-based sample of children [published online ahead of print November 25, 2015], J Atten Disord source

      The Results report that conduct disorder and oppositional defiant disorder were significantly more common among children with ADHD than among children without ADHD at both study sites. They do not report that boys with ADHD were more likely than girls with ADHD to have these conditions; the sex comparison was not supported by the passages found. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [20] Gaub, 1997, Gender differences in ADHD: a meta-analysis and critical review, J Am Acad Child Adolesc Psychiatry source
  • Premisecitation

    The majority of both boys and girls with ADHD also meet diagnostic criteria for another mental disorder.

    “The majority of both boys and girls with ADHD also meet diagnostic criteria for another mental disorder.17,18”
    • Also stated in: § KAS 3 · plain
      “The majority of both boys and girls with ADHD also meet diagnostic criteria for another mental disorder.17,18”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [17] Elia, 2008, ADHD characteristics: I. Concurrent co-morbidity patterns in children & adolescents, Child Adolesc Psychiatry Ment Health source

      The Results report that 36.3% of the ADHD sample had no additional diagnosis, so a majority had at least one. The paper does not report this proportion separately for boys and girls; its statement that most diagnostic frequency patterns did not differ significantly by sex does not establish a majority in each group. The sample was also a selected clinical cohort. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
    • cites [18] Centers for Disease Control and Prevention (CDC), 2005, Mental health in the United States. Prevalence of diagnosis and medication treatment for attention-deficit/hyperactivity disorder--United States, 2003, MMWR Morb Mortal Wkly Rep

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

  • Premisecitation

    ADHD treatments are frequently not maintained over time.

    “Authors of longitudinal studies have found that ADHD treatments are frequently not maintained over time13 and impairments persist into adulthood.70”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [13] Molina, 2009, The MTA at 8 years: prospective follow-up of children treated for combined-type ADHD in a multisite study, J Am Acad Child Adolesc Psychiatry source
  • Premisereasoning

    ADHD is a chronic condition.

    “ADHD is a chronic condition; therefore, the PCC should manage children and adolescents with ADHD in the same manner that they would children and youth with special health care needs, following the principles of the chronic care model and the medical home (Table 5).”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [13] Molina, 2009, The MTA at 8 years: prospective follow-up of children treated for combined-type ADHD in a multisite study, J Am Acad Child Adolesc Psychiatry source
    • cites [70] Sibley, 2017, Defining ADHD symptom persistence in adulthood: optimizing sensitivity and specificity, J Child Psychol Psychiatry source
  • Premisecitation

    The diagnostic criteria for ADHD (DSM-5) can be applied to preschool-aged children.

    “There is evidence that the diagnostic criteria for ADHD can be applied to preschool-aged children.33–39”
    • Also stated in: § Special Circumstances: Preschool-Aged Children (Age 4 Years to the Sixth Birthday) · hedged
      “A review of the literature, including the multisite study of the efficacy of methylphenidate in preschool-aged children, found that the DSM-5 criteria could appropriately identify children with ADHD.25”
    Quote in the paperSubstantial claim2 of 8 sources checked
    • cites [33] Lahey, 1998, Validity of DSM-IV attention-deficit/hyperactivity disorder for younger children, J Am Acad Child Adolesc Psychiatry source
    • cites [34] Pavuluri, 1999, Parent reported preschool attention deficit hyperactivity: measurement and validity, Eur Child Adolesc Psychiatry source
    • cites [35] Harvey, 2009, Predicting attention-deficit/hyperactivity disorder and oppositional defiant disorder from preschool diagnostic assessments, J Consult Clin Psychol source

      The Abstract reports that early assessments support the validity of ADHD diagnoses in preschool children, and the Discussion says children with ADHD could be distinguished from those with transient problems as early as age 3. The Methods specify that the study used DSM-IV symptom counts, not DSM-5 criteria, so the DSM-5 qualification in the supplied claim is not supported by this source. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [36] Keenan, 2000, More than the terrible twos: the nature and severity of behavior problems in clinic-referred preschool children, J Abnorm Child Psychol source
    • cites [37] Gadow, 2000, Comparison of attention-deficit/hyperactivity disorder symptom subtypes in Ukrainian schoolchildren, J Am Acad Child Adolesc Psychiatry source
    • cites [38] Sprafkin, 2002, A DSM-IV-referenced screening instrument for preschool children: the Early Childhood Inventory-4, J Am Acad Child Adolesc Psychiatry source
    • cites [39] Poblano, 2006, ECI-4 screening of attention deficit-hyperactivity disorder and co-morbidity in Mexican preschool children: preliminary results, Arq Neuropsiquiatr source

      The Results report applying DSM-IV ADHD symptom criteria to preschool children, which supports the citing sentence’s general point. The paper does not address DSM-5, as specified in the supplied claim. The Discussion also says that the validity of very early ADHD diagnoses remains open to debate and that screening cannot itself provide a clinical diagnosis. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [25] Evans, 2018, Evidence-based psychosocial treatments for children and adolescents with attention deficit/hyperactivity disorder, J Clin Child Adolesc Psychol source
  • May combine two claims. 24
  • Classified as probably not a substantial claim. 27

  • May combine two claims.

    Premisecitation

    Treatment discontinuation places individuals with ADHD at higher risk for catastrophic outcomes, such as motor vehicle crashes, criminality, including drug-related crimes and violent reoffending, depression, interpersonal issues, and other injuries.

    “Treatment discontinuation also places individuals with ADHD at higher risk for catastrophic outcomes, such as motor vehicle crashes78,79; criminality, including drug-related crimes77 and violent reoffending76; depression71; interpersonal issues80; and other injuries.81,82”
    Quote in the paperSubstantial claim3 of 4 sources checked
    • cites [78] Chang, 2017, Association between medication use for attention-deficit/hyperactivity disorder and risk of motor vehicle crashes, JAMA Psychiatry source
    • cites [79] Chang, 2014, Serious transport accidents in adults with attention-deficit/hyperactivity disorder and the effect of medication: a population-based study, JAMA Psychiatry source

      Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured
    • cites [77] Lichtenstein, 2012, Medication for attention deficit-hyperactivity disorder and criminality, N Engl J Med source

      The Abstract Results and Results—Sensitivity analyses report lower criminality rates during ADHD-medication periods, including for substance-related crimes. That supports the criminality and drug-related-crime portion attributed to this paper, but the claim that discontinuation *places* people at higher risk is stronger than the paper’s observational finding; the Discussion cautions that confounding cannot be excluded. The other outcomes in the citing sentence carry separate citations. (LLM, conf=0.85)

      Experimental — accuracy not yet measured
    • cites [76] Chang, 2016, Association between prescription of major psychotropic medications and violent reoffending after prison release, JAMA source

      The Results and Sensitivity Analyses (page unavailable) associate psychostimulant treatment with lower violent reoffending rates, including among released prisoners diagnosed with ADHD. The claim overstates this as a causal effect of treatment discontinuation in individuals with ADHD generally; the Discussion explicitly says the observational study cannot prove causality. This citation is attached to violent reoffending, not the other listed outcomes. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    As individuals with ADHD enter adolescence, their overt hyperactive and impulsive symptoms tend to decline, whereas their inattentive symptoms tend to persist.

    “As individuals with ADHD enter adolescence, their overt hyperactive and impulsive symptoms tend to decline, whereas their inattentive symptoms tend to persist.13,14”
    Quote in the paperNot a substantial claim2 of 2 sources checked
    • cites [13] Molina, 2009, The MTA at 8 years: prospective follow-up of children treated for combined-type ADHD in a multisite study, J Am Acad Child Adolesc Psychiatry source
    • cites [14] Holbrook, 2016, Persistence of parent-reported ADHD symptoms from childhood through adolescence in a community sample, J Atten Disord source

  • May combine two claims.

    Premisecitation

    Patients with ADHD, whether treated or not, are at increased risk for early death, suicide, and increased psychiatric comorbidity, particularly substance use disorders.

    “It is indicated in prospective studies that patients with ADHD, whether treated or not, are at increased risk for early death, suicide, and increased psychiatric comorbidity, particularly substance use disorders.71,72”
    Quote in the paperNot a substantial claim2 of 2 sources checked
    • cites [71] Chang, 2016, Medication for attention-deficit/hyperactivity disorder and risk for depression: a nationwide longitudinal cohort study, Biol Psychiatry source

      The Introduction (page not provided) says ADHD is associated with high comorbidity, long-term morbidity and mortality, and that youths with ADHD and comorbid depression face greater risk of adverse outcomes, including suicide. It does not establish increased risk of early death or suicide in patients regardless of treatment status, or identify substance use disorders as a particularly increased comorbidity. The Discussion (page not provided) instead mentions substance use disorder in relation to a possible protective effect of medication. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
    • cites [72] Biederman, 2009, Do stimulants protect against psychiatric disorders in youth with ADHD? A 10-year follow-up study, Pediatrics source

      The Introduction (page unavailable) says ADHD is associated with high rates of psychiatric comorbidity, and the Results (page unavailable) compare subsequent disorders in stimulant-treated and untreated youth. The paper does not report an increased risk of early death or suicide, and substance use disorders were not among the outcomes analyzed. Its results also distinguish treated from untreated youth rather than finding the same psychiatric risk in both groups. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The American Psychiatric Association developed the DSM-5 using expert consensus and an expanding research foundation.

    “The American Psychiatric Association developed the DSM-5 using expert consensus and an expanding research foundation.32”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [32] American Psychiatric Association, 2013 source

      The passages labeled 11 September 2026 discuss WHO guidance on depression, not the development of DSM-5. Searches for “DSM-5,” “expert consensus,” and “research foundation” found no passage in our indexed copy addressing the claim. (LLM, conf=0.77)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    The growth effects diminished by the third year of treatment, but no compensatory rebound growth was observed.

    “The effects diminished by the third year of treatment, but no compensatory rebound growth was observed.110”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [110] Swanson, 2007, Effects of stimulant medication on growth rates across 3 years in the MTA follow-up, J Am Acad Child Adolesc Psychiatry source

  • May combine two claims.

    Premisecitation

    The evidence for the behavioral family approach with adolescents is mixed and less strong than PTBM with preadolescent children.

    “The evidence for this behavioral family approach is mixed and less strong than PTBM with preadolescent children92–94”
    Quote in the paperSubstantial claim2 of 3 sources checked
    • cites [92] Barkley, 1992, A comparison of three family therapy programs for treating family conflicts in adolescents with attention-deficit hyperactivity disorder, J Consult Clin Psychol source
    • cites [93] Fabiano, 2016, Efficacy of a family-focused intervention for young drivers with attention-deficit hyperactivity disorder, J Consult Clin Psychol source

      The paper says findings for parent-training programs for adolescents with ADHD are mixed (introductory passage), supporting that part of the claim. The Discussion reports long-lasting gains from behavioral parent training in young children, but it does not directly establish that the overall evidence for the adolescent approach is less strong than for PTBM with preadolescent children. Page numbers are unavailable in our copy. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
    • cites [94] Sibley, 2016, Parent-teen behavior therapy + motivational interviewing for adolescents with ADHD, J Consult Clin Psychol source

      The Discussion reports mixed results for the adolescent parent–teen intervention: several significant benefits, but no effects on five outcomes and variable maintenance at six months. The paper also describes successful clinic-based approaches for younger children, but it does not directly compare the strength of evidence for adolescent behavioral family therapy with PTBM for preadolescent children (page numbers unavailable in our copy). (LLM, conf=0.82)

      Experimental — accuracy not yet measured

  • Classified as probably not a substantial claim.

    Premisecitation

    Parent and child and adolescent education is an important component in the chronic illness model to ensure cooperation in efforts to achieve appropriate titration.

    “Parent and child and adolescent education is an important component in the chronic illness model to ensure cooperation in efforts to achieve appropriate titration, remembering that the parents themselves may be significantly challenged by ADHD.148,149”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [148] Wagner, 1998, Chronic disease management: what will it take to improve care for chronic illness?, Effect Clin Pract

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

    • cites [149] Brinkman, 2018, Predictors of medication continuity in children with ADHD, Pediatrics source

      The Discussion (page not available) identifies parent satisfaction with medication information and medication titration as predictors of continuity. A later passage labeled Figure 1 recommends educating families about treatment options and titrating medication. The paper does not establish that parent, child, and adolescent education ensures cooperation with titration, or frame that link as a component of a chronic illness model. (LLM, conf=0.84)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Addressing social determinants of health is essential to family-school partnerships.

    “Encouraging strong family-school partnerships helps the ADHD management process, and addressing social determinants of health is essential to these partnerships.145,146”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [145] Committee on Pediatric Workforce, 2013, Enhancing pediatric workforce diversity and providing culturally effective pediatric care: implications for practice, education, and policy making, Pediatrics source
    • cites [146] Berman, 2018, Screening for poverty and poverty-related social determinants of health, Pediatr Rev source

      The Conclusion (page not available in our copy) urges pediatric providers to address poverty-related social determinants of children’s health and mentions partnerships with community agencies. It does not say that addressing those determinants is essential to family-school partnerships or discuss those partnerships in ADHD management. (LLM, conf=0.78)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S2 (checkable).

    Premisecitation

    Fully addressing systemic barriers requires identifying local, state, and national entities with which to partner to advance solutions and manifest change.

    “Fully addressing systemic barriers requires identifying local, state, and national entities with which to partner to advance solutions and manifest change.156”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [156] American Academy of Pediatrics, Committee on Child Health Financing, 2012, Scope of health care benefits for children from birth through age 26, Pediatrics source

      The ESSENTIAL BACKGROUND section discusses access to pediatric health benefits and coordination of care, but not partnering with local, state, and national entities to address systemic barriers. Searches for that language and for partnerships or advocacy to overcome barriers found no passage addressing the claim. Page numbers were not available in our copy. (LLM, conf=0.75)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    There is less evidence for the PoCA than for the guidelines.

    “The PoCA provides recommendations for implementing the guideline steps, although there is less evidence for the PoCA than for the guidelines.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The subcommittee identified and considered members' potential conflicts in its deliberations.

    “The subcommittee members’ potential conflicts were identified and taken into consideration in the group’s deliberations.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    There is some evidence that African American and Latino children are less likely to have ADHD diagnosed and are less likely to be treated for ADHD.

    “There is some evidence that African American and Latino children are less likely to have ADHD diagnosed and are less likely to be treated for ADHD.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [3] Pastor, 2005, Racial and ethnic differences in ADHD and LD in young school-age children: parental reports in the National Health Interview Survey, Public Health Rep source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    No conflicts prevented subcommittee member participation on the guidelines.

    “No conflicts prevented subcommittee member participation on the guidelines.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationnone given

    The procedures recommended in this guideline necessitate spending more time with patients and their families, developing a care management system of contacts with school and other community stakeholders, and providing continuous, coordinated care to the patient and his or her family.

    “The procedures recommended in this guideline necessitate spending more time with patients and their families, developing a care management system of contacts with school and other community stakeholders, and providing continuous, coordinated care to the patient and his or her family.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    Evaluation, diagnosis, and treatment are a continuous process.

    “In this revised guideline and accompanying PoCA, we recognize that evaluation, diagnosis, and treatment are a continuous process.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    ADHD is the most common neurobehavioral disorder of childhood, occurring in approximately 7% to 8% of children and youth.

    “As noted, ADHD is the most common neurobehavioral disorder of childhood, occurring in approximately 7% to 8% of children and youth.8,18,28,29”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [8] Thomas, 2015, Prevalence of attention-deficit/hyperactivity disorder: a systematic review and meta-analysis, Pediatrics source
    • cites [18] Centers for Disease Control and Prevention (CDC), 2005, Mental health in the United States. Prevalence of diagnosis and medication treatment for attention-deficit/hyperactivity disorder--United States, 2003, MMWR Morb Mortal Wkly Rep

      Not checked in the free run.

    • cites [28] Visser, 2007, National estimates and factors associated with medication treatment for childhood attention-deficit/hyperactivity disorder, Pediatrics source
    • cites [29] Centers for Disease Control and Prevention (CDC), 2010, Increasing prevalence of parent-reported attention-deficit/hyperactivity disorder among children–United States, 2003 and 2007, MMWR Morb Mortal Wkly Rep

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Although the chronic illness model has not been specifically studied in children and adolescents with ADHD, it has been effective for other chronic conditions, such as asthma.

    “Although the chronic illness model has not been specifically studied in children and adolescents with ADHD, it has been effective for other chronic conditions, such as asthma.68”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [68] Medical Home Initiatives for Children With Special Needs Project Advisory Committee. American Academy of Pediatrics, 2002, The medical home, Pediatrics

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Studies were only included in the review when they met a variety of criteria designed to ensure the research was based on a strong methodology that yielded confidence in its conclusions.

    “Under this format, studies were only included in the review when they met a variety of criteria designed to ensure the research was based on a strong methodology that yielded confidence in its conclusions.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    The subcommittee reached consensus on the evidence, which was then used to develop the clinical practice guideline's KASs.

    “The subcommittee reached consensus on the evidence, which was then used to develop the clinical practice guideline’s KASs.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    A variety of other behavioral, developmental, and physical conditions can be comorbid in children and adolescents who are evaluated for ADHD, including emotional or behavioral conditions or a history of these problems, and including but not limited to learning disabilities, language disorder, disruptive behavior, anxiety, mood disorders, tic disorders, seizures, autism spectrum disorder, and sleep

    “A variety of other behavioral, developmental, and physical conditions can be comorbid in children and adolescents who are evaluated for ADHD, including emotional or behavioral conditions or a history of these problems.”
    • Also stated in: § KAS 3 · plain
      “These include but are not limited to learning disabilities, language disorder, disruptive behavior, anxiety, mood disorders, tic disorders, seizures, autism spectrum disorder, developmental coordination disorder, and sleep disorders.50–66”
    Quote in the paperSubstantial claim0 of 10 sources checked
    • cites [50] Rowland, 2002, The epidemiology of attention-deficit/hyperactivity disorder (ADHD): a public health view, Ment Retard Dev Disabil Res Rev source
    • cites [51] Cuffe, 2005, Prevalence and correlates of ADHD symptoms in the national health interview survey, J Atten Disord source
    • cites [52] Pastor, 2008, Diagnosed attention deficit hyperactivity disorder and learning disability: United States, 2004-2006, Vital Health Stat 10
    • cites [53] Biederman, 2004, Further evidence of unique developmental phenotypic correlates of pediatric bipolar disorder: findings from a large sample of clinically referred preadolescent children assessed over the last 7 years, J Affect Disord source
    • cites [54] Biederman, 2005, Absence of gender effects on attention deficit hyperactivity disorder: findings in nonreferred subjects, Am J Psychiatry source
    • cites [55] Biederman, 2008, New insights into the comorbidity between ADHD and major depression in adolescent and young adult females, J Am Acad Child Adolesc Psychiatry source
    • cites [56] Biederman, 2008, Long-term, open-label extension study of guanfacine extended release in children and adolescents with ADHD, CNS Spectr source
    • cites [57] Crabtree, 2003, Clinical and parental assessment of sleep in children with attention-deficit/hyperactivity disorder referred to a pediatric sleep medicine center, Clin Pediatr (Phila) source
    • cites [58] LeBourgeois, 2004, Snoring, sleep quality, and sleepiness across attention-deficit/hyperactivity disorder subtypes, Sleep source
    • cites [59] Chan, 2002, Health care use and costs for children with attention-deficit/hyperactivity disorder: national estimates from the Medical Expenditure Panel Survey, Arch Pediatr Adolesc Med source

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    The AAP policy statement, 'Classifying Recommendations for Clinical Practice Guidelines,' was followed in designating aggregate evidence quality levels for the available evidence.

    “The AAP policy statement, “Classifying Recommendations for Clinical Practice Guidelines,” was followed in designating aggregate evidence quality levels for the available evidence (see Fig 1).27”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [27] American Academy of Pediatrics Steering Committee on Quality Improvement and Management, 2004, Classifying recommendations for clinical practice guidelines, Pediatrics source

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    The intervention's results may inform the subsequent diagnostic evaluation.

    “In addition, the intervention’s results may inform the subsequent diagnostic evaluation.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationreasoning

    Referral to an early intervention program or enrolling in a PTBM program can help provide information about the child's behavior in other settings or with other observers.

    “Referral to an early intervention program or enrolling in a PTBM program can help provide information about the child’s behavior in other settings or with other observers.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The guidelines and PoCA underwent extensive peer review by more than 30 internal stakeholders and external stakeholder groups identified by the subcommittee.

    “The guidelines and PoCA underwent extensive peer review by more than 30 internal stakeholders (eg, AAP committees, sections, councils, and task forces) and external stakeholder groups identified by the subcommittee.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The subcommittee members with the most epidemiological experience assessed the strength of each recommendation and the quality of evidence supporting each draft KAS.

    “The subcommittee members with the most epidemiological experience assessed the strength of each recommendation and the quality of evidence supporting each draft KAS.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    PTBM has been modified to include parents and adolescents in sessions together to develop a behavioral contract and improve parent-adolescent communication and problem-solving.

    “PTBM has been modified to include the parents and adolescents in sessions together to develop a behavioral contract and improve parent-adolescent communication and problem-solving (see above).91”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [91] Robin, 1989

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Preschool programs (such as Head Start) and ADHD-focused organizations (such as CHADD) can also provide behavioral supports.

    “In addition, preschool programs (such as Head Start) and ADHD-focused organizations (such as CHADD84) can also provide behavioral supports.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [84] Children and Adults with Attention-Deficit/Hyperactivity Disorder. CHADD. Available at: www.chadd.org. Accessed September 8, 2019

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

  • May combine two claims.

    Interpretationnone given

    The evidence is particularly strong for stimulant medications; it is sufficient, but not as strong, for atomoxetine, extended-release guanfacine, and extended-release clonidine, in that order.

    “The evidence is particularly strong for stimulant medications; it is sufficient, but not as strong, for atomoxetine, extended-release guanfacine, and extended-release clonidine, in that order (see the Treatment section, and see the PoCA for more information on implementation).”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    eTNS cannot be recommended as a treatment of ADHD without considerably more extensive study on its efficacy and safety.

    “Overall, the current evidence supporting treatment of ADHD with eTNS is sparse and in no way approaches the robust strength of evidence documented for established medication and behavioral treatments for ADHD; therefore, it cannot be recommended as a treatment of ADHD without considerably more extensive study on its efficacy and safety.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Interpretationreasoning

    Children with inattention or hyperactivity/impulsivity at the problem level, as well as their families, may also benefit from the chronic illness and medical home principles.

    “Children with inattention or hyperactivity/impulsivity at the problem level, as well as their families, may also benefit from the chronic illness and medical home principles.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    The largest multisite study of methylphenidate use in preschool-aged children revealed symptom improvements after PTBM alone, although it was limited to children who had moderate-to-severe dysfunction.

    “Although it was limited to children who had moderate-to-severe dysfunction, the largest multisite study of methylphenidate use in preschool-aged children revealed symptom improvements after PTBM alone.83”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [83] Greenhill, 2006, Efficacy and safety of immediate-release methylphenidate treatment for preschoolers with ADHD, J Am Acad Child Adolesc Psychiatry source

  • May combine two claims.

    Interpretationreasoning

    The current evidence supporting treatment of ADHD with eTNS is sparse and does not approach the strength of evidence for established medication and behavioral treatments.

    “Overall, the current evidence supporting treatment of ADHD with eTNS is sparse and in no way approaches the robust strength of evidence documented for established medication and behavioral treatments for ADHD; therefore, it cannot be recommended as a treatment of ADHD without considerably more extensive study on its efficacy and safety.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: There is no long-term safety and efficacy evidence for eTNS.

  • May combine two claims.

    Premisecitation

    The risks of mood and anxiety disorders and risky sexual behaviors increase during adolescence, as do the risks of intentional self-harm and suicidal behaviors.

    “In addition, the risks of mood and anxiety disorders and risky sexual behaviors increase during adolescence, as do the risks of intentional self-harm and suicidal behaviors.31”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [31] Wolraich, 2005, Attention-deficit/hyperactivity disorder among adolescents: a review of the diagnosis, treatment, and clinical implications, Pediatrics source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationreasoning

    The DSM-PC cannot be used as a definitive source for diagnostic codes related to ADHD and comorbid conditions, although it can be used conceptually as a resource for enriching the understanding of problem-level manifestations.

    “Therefore, the DSM-PC cannot be used as a definitive source for diagnostic codes related to ADHD and comorbid conditions, although it can be used conceptually as a resource for enriching the understanding of problem-level manifestations.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The DSM-PC was published in 1995, and it has not been revised to be compatible with the DSM-5.

  • May combine two claims.

    Interpretationreasoning

    All 4 [substance use, anxiety, depression, learning disabilities] are common comorbid conditions that affect the treatment approach.

    “As noted, all 4 are common comorbid conditions that affect the treatment approach.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Longer-acting or late-afternoon, short-acting medications may be helpful in providing medication coverage for symptom control while driving.

    “Longer-acting or late-afternoon, short-acting medications may be helpful in this regard.138”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [138] Cox, 2006, Relative benefits of stimulant therapy with OROS methylphenidate versus mixed amphetamine salts extended release in improving the driving performance of adolescent drivers with attention-deficit/hyperactivity disorder, Pediatrics source

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    The steps required to sustain appropriate treatments and achieve successful long-term outcomes remain challenging.

    “The steps required to sustain appropriate treatments and achieve successful long-term outcomes remain challenging, however.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    The combination of medication management and behavioral therapy allowed for the use of lower stimulant dosages, possibly reducing the risk of adverse effects.

    “Finally the combination of medication management and behavioral therapy allowed for the use of lower stimulant dosages, possibly reducing the risk of adverse effects.141”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [141] Pelham, 1999, Psychosocial and combined treatments for ADHD, Ment Retard Dev Disabil Res Rev source

  • Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing).

    Premisecitation

    More than 90% of patients will have a beneficial response to one of the psychostimulants if a range of medications from both the methylphenidate and amphetamine/dextroamphetamine classes are tried.

    “Authors of other reports suggest that more than 90% of patients will have a beneficial response to 1 of the psychostimulants if a range of medications from both the methylphenidate and amphetamine and/or dextroamphetamine classes are tried.147”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [147] Solanto, 1998, Neuropsychopharmacological mechanisms of stimulant drug action in attention-deficit hyperactivity disorder: a review and integration, Behav Brain Res source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Encouraging strong family-school partnerships helps the ADHD management process.

    “Encouraging strong family-school partnerships helps the ADHD management process.142”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [142] Homer, 2008, A review of the evidence for the medical home for children with special health care needs, Pediatrics source

  • May combine two claims.

    Premisecitation

    Stimulant medications can be effectively titrated on a 7-day basis, but in urgent situations, they may be effectively titrated in as few as 3 days.

    “Stimulant medications can be effectively titrated on a 7-day basis, but in urgent situations, they may be effectively titrated in as few as 3 days.140”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [140] Jensen, 2001, Findings from the NIMH Multimodal Treatment Study of ADHD (MTA): implications and applications for primary care providers, J Dev Behav Pediatr source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The SDBP is developing a guideline to address complex ADHD cases and aid pediatricians and other PCCs; the SDBP expects to publish this document in 2019.

    “The SDBP is developing a guideline to address such complex cases and aid pediatricians and other PCCs to manage these cases; the SDBP currently expects to publish this document in 2019.67”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [67] Society for Developmental and Behavioral Pediatrics. ADHD special interest group. Available at: www.sdbp.org/committees/sig-adhd.cfm. Accessed September 8, 2019

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

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    Full implementation of the guideline's KASs, the PoCA, and recommendations to address barriers to care may require changes in office procedures and identification of community resources.

    “Full implementation of the guideline’s KASs, the PoCA, and the recommendations to address barriers to care may require changes in office procedures and the identification of community resources.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Additional adverse effects of atomoxetine include initial somnolence, gastrointestinal tract symptoms (particularly if dosage is increased too rapidly), and decreased appetite.

    “Additional adverse effects of atomoxetine include initial somnolence and gastrointestinal tract symptoms, particularly if the dosage is increased too rapidly, and decreased appetite.119–122”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [119] Garnock-Jones, 2009, Atomoxetine: a review of its use in attention-deficit hyperactivity disorder in children and adolescents, Paediatr Drugs source
    • cites [120] Reed, 2016, The safety of atomoxetine for the treatment of children and adolescents with attention-deficit/hyperactivity disorder: a comprehensive review of over a decade of research, CNS Drugs source
    • cites [121] Bangs, 2008, Meta-analysis of suicide-related behavior events in patients treated with atomoxetine, J Am Acad Child Adolesc Psychiatry source
    • cites [122] Bangs, 2008, Hepatic events associated with atomoxetine treatment for attention-deficit hyperactivity disorder, Drug Saf source

  • May combine two claims.

    Interpretationreasoning

    Evidence is clear with regard to the legitimacy of the diagnosis of ADHD and the appropriate diagnostic criteria and procedures required to establish a diagnosis, identify comorbid conditions, and effectively treat with both psychosocial and pharmacologic interventions.

    “Evidence is clear with regard to the legitimacy of the diagnosis of ADHD and the appropriate diagnostic criteria and procedures required to establish a diagnosis, identify comorbid conditions, and effectively treat with both psychosocial and pharmacologic interventions.”
    Quote in the paperSubstantial claim
45 of 45

  • The paper relies on this without support.

    Since the release of the 2011 guideline, the DSM has been revised to the fifth edition, and new ADHD-related research has been published.

    “Since the release of the 2011 guideline, the Diagnostic and Statistical Manual of Mental Disorders has been revised to the fifth edition, and new ADHD-related research has been published.”

  • The paper relies on this without support.

    ADHD is one of the most common neurobehavioral disorders of childhood and can profoundly affect children’s academic achievement, well-being, and social interactions.

    “Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurobehavioral disorders of childhood and can profoundly affect children’s academic achievement, well-being, and social interactions.”

  • The paper relies on this without support.

    Symptoms of ADHD occur in childhood, and most children with ADHD will continue to have symptoms and impairment through adolescence and into adulthood.

    “Symptoms of ADHD occur in childhood, and most children with ADHD will continue to have symptoms and impairment through adolescence and into adulthood.”

  • The paper relies on this without support.

    The DSM-5 system is used by professionals in psychiatry, psychology, health care systems, and primary care; it is also well established with third-party payers.

    “The DSM-5 system is used by professionals in psychiatry, psychology, health care systems, and primary care; it is also well established with third-party payers.”

  • The paper relies on this without support.

    The DSM-5 classification criteria are based on the best available evidence for ADHD diagnosis and are the standard most frequently used by clinicians and researchers to render the diagnosis and document its appropriateness for a given child.

    “As with the previous guideline recommendations, the DSM-5 classification criteria are based on the best available evidence for ADHD diagnosis and are the standard most frequently used by clinicians and researchers to render the diagnosis and document its appropriateness for a given child.”

  • The paper relies on this without support.

    There are minimal changes in the specific behaviors from the DSM-IV, on which all the other DSM-based ADHD rating scales obtained normative data.

    “There are, however, minimal changes in the specific behaviors from the DSM-IV, on which all the other DSM-based ADHD rating scales obtained normative data.”

  • The paper relies on this without support.

    Both the ADHD Rating Scale-IV and the Conners Rating Scale have preschool-age normative data based on the DSM-IV.

    “Both the ADHD Rating Scale-IV and the Conners Rating Scale have preschool-age normative data based on the DSM-IV.”

  • The paper relies on this without support.

    The specific behaviors in the DSM-5 criteria for ADHD are the same for all children younger than 18 years and are only minimally different from the DSM-IV.

    “The specific behaviors in the DSM-5 criteria for ADHD are the same for all children younger than 18 years (ie, preschool-aged children, elementary and middle school-aged children, and adolescents) and are only minimally different from the DSM-IV.”

  • The paper relies on this without support.

    PTBM helps parents learn age-appropriate developmental expectations, behaviors that strengthen the parent-child relationship, and specific management skills for problem behaviors.

    “This type of training helps parents learn age-appropriate developmental expectations, behaviors that strengthen the parent-child relationship, and specific management skills for problem behaviors.”

  • The paper relies on this without support.

    PTBM has documented effectiveness with a wide variety of problem behaviors, regardless of etiology.

    “Clinicians do not need to have made an ADHD diagnosis before recommending PTBM because PTBM has documented effectiveness with a wide variety of problem behaviors, regardless of etiology.”

  • The paper relies on this without support.

    Obtaining teacher reports for adolescents is often more challenging than for younger children because many adolescents have multiple teachers.

    “Obtaining teacher reports for adolescents is often more challenging than for younger children because many adolescents have multiple teachers.”

  • The paper relies on this without support.

    An adolescent’s parents may have less opportunity to observe their child’s behaviors than they did when the child was younger.

    “Likewise, an adolescent’s parents may have less opportunity to observe their child’s behaviors than they did when the child was younger.”

  • The paper relies on this without support.

    Some problems experienced by children with ADHD are less obvious in adolescents than in younger children because adolescents are less likely to exhibit overt hyperactive behavior.

    “Furthermore, some problems experienced by children with ADHD are less obvious in adolescents than in younger children because adolescents are less likely to exhibit overt hyperactive behavior”

  • The paper relies on this without support.

    Variability in ratings is to be expected because adolescents’ behavior often varies between different classrooms and with different teachers.

    “Variability in ratings is to be expected because adolescents’ behavior often varies between different classrooms and with different teachers.”

  • The paper relies on this without support.

    Certain substances, such as marijuana, can have effects that mimic ADHD.

    “Certain substances, such as marijuana, can have effects that mimic ADHD”

  • The paper relies on this without support.

    Trauma experiences, posttraumatic stress disorder, and toxic stress are additional comorbidities and risk factors of concern.

    “Trauma experiences, posttraumatic stress disorder, and toxic stress are additional comorbidities and risk factors of concern.”

  • The paper relies on this without support.

    Teachers, parents, and child health professionals typically encounter children who demonstrate behaviors relating to activity level, impulsivity, and inattention but who do not fully meet DSM-5 criteria.

    “Teachers, parents, and child health professionals typically encounter children who demonstrate behaviors relating to activity level, impulsivity, and inattention but who do not fully meet DSM-5 criteria.”

  • The paper relies on this without support.

    These symptoms may suggest other problems that mimic ADHD.

    “Also consider that these symptoms may suggest other problems that mimic ADHD.”

  • The paper relies on this without support.

    Behavioral interventions, such as PTBM, are often beneficial for children with hyperactive/impulsive behaviors who do not meet full diagnostic criteria for ADHD.

    “Behavioral interventions, such as PTBM, are often beneficial for children with hyperactive/impulsive behaviors who do not meet full diagnostic criteria for ADHD.”

  • The paper relies on this without support.

    The DSM-PC was published in 1995, and it has not been revised to be compatible with the DSM-5.

    “The DSM-PC was published in 1995, however, and it has not been revised to be compatible with the DSM-5.”

  • The paper relies on this without support.

    In some cases, the presence of a comorbid condition will alter the treatment of ADHD.

    “In some cases, the presence of a comorbid condition will alter the treatment of ADHD.”

  • The paper relies on this without support.

    Available treatments address symptoms and function but are usually not curative.

    “Available treatments address symptoms and function but are usually not curative.”

  • The paper relies on this without support.

    This communication can be difficult to achieve.

    “This communication can be difficult to achieve and is discussed in both the PoCA and the section on systemic barriers to the care of children and adolescents with ADHD in the Supplemental Information, as is the medical home model.69”

  • The paper relies on this without support.

    PTBM programs for preschool-aged children are typically group programs and, although they are not always paid for by health insurance, they may be relatively low cost.

    “PTBM programs for preschool-aged children are typically group programs and, although they are not always paid for by health insurance, they may be relatively low cost.”

  • The paper relies on this without support.

    One evidence-based PTBM, parent-child interaction therapy, is a dyadic therapy for parent and child.

    “One evidence-based PTBM, parent-child interaction therapy, is a dyadic therapy for parent and child.”

  • The paper relies on this without support.

    Other stimulant or nonstimulant medications have not been adequately studied in children in this age group with ADHD.

    “Other stimulant or nonstimulant medications have not been adequately studied in children in this age group with ADHD.”

  • The paper relies on this without support.

    The medical home and chronic illness approach may be particularly beneficial for parents who also have ADHD themselves.

    “The medical home and chronic illness approach may be particularly beneficial for parents who also have ADHD themselves.”

  • The paper relies on this without support.

    Stimulants have a stronger immediate effect on the 18 core symptoms of ADHD than behavior therapy in most studies comparing them.

    “Most studies comparing behavior therapy to stimulants indicate that stimulants have a stronger immediate effect on the 18 core symptoms of ADHD.”

  • The paper relies on this without support.

    Parents were more satisfied with the effect of behavioral therapy than with stimulants.

    “Parents, however, were more satisfied with the effect of behavioral therapy, which addresses symptoms and functions in addition to ADHD’s core symptoms.”

  • The paper relies on this without support.

    The positive effects of behavioral therapies tend to persist, whereas the positive effects of medication cease when medication stops.

    “The positive effects of behavioral therapies tend to persist, but the positive effects of medication cease when medication stops.”

  • The paper relies on this without support.

    Some nonmedication treatments for ADHD-related problems have too little evidence to recommend them or have been found to have little or no benefit, including mindfulness, cognitive training, diet modification, EEG biofeedback, and supportive counseling.

    “Some nonmedication treatments for ADHD-related problems have either too little evidence to recommend them or have been found to have little or no benefit. These include mindfulness, cognitive training, diet modification, EEG biofeedback, and supportive counseling.”

  • The paper relies on this without support.

    The suggestion that cannabidiol oil has any effect on ADHD is anecdotal and has not been subjected to rigorous study.

    “The suggestion that cannabidiol oil has any effect on ADHD is anecdotal and has not been subjected to rigorous study.”

  • The paper relies on this without support.

    There is no long-term safety and efficacy evidence for eTNS.

    “To date, there is no long-term safety and efficacy evidence for eTNS.”

  • The paper relies on this without support.

    Much less research has been published on psychosocial treatments with adolescents than with younger children.

    “Much less research has been published on psychosocial treatments with adolescents than with younger children.”

  • The paper relies on this without support.

    Meaningful improvements in functioning have not been reported from cognitive behavioral approaches for adolescents.

    “Meaningful improvements in functioning have not been reported from cognitive behavioral approaches.”

  • The paper relies on this without support.

    None of the nonstimulants have FDA approval for use in preschool-aged children.

    “None of the nonstimulants have FDA approval for use in preschool-aged children.”

  • The paper relies on this without support.

    The effect size for nonstimulants is 0.7.

    “The effect size for stimulants is 1.0 and for nonstimulants is 0.7.”

  • The paper relies on this without support.

    An individual’s response to methylphenidate versus amphetamine is idiosyncratic, with approximately 40% responding to both and about 40% responding to only one.

    “An individual’s response to methylphenidate verses amphetamine is idiosyncratic, with approximately 40% responding to both and about 40% responding to only 1.”

  • The paper relies on this without support.

    The subtype of ADHD does not appear to be a predictor of response to a specific agent.

    “The subtype of ADHD does not appear to be a predictor of response to a specific agent.”

  • The paper relies on this without support.

    The evidence base supporting norepinephrine reuptake inhibitors and α-2 adrenergic agonists is considerably less than that for stimulants, although it was adequate for FDA approval.

    “Norepinephrine reuptake inhibitors and α-2 adrenergic agonists are newer medications, so, in general, the evidence base supporting them is considerably less than that for stimulants, although it was adequate for FDA approval.”

  • The paper relies on this without support.

    Pharmacogenetic tests may cost thousands of dollars and are typically not covered by insurance.

    “In addition, these tests may cost thousands of dollars and are typically not covered by insurance.”

  • The paper relies on this without support.

    Stimulants’ most common short-term adverse effects are appetite loss, abdominal pain, headaches, and sleep disturbance.

    “Stimulants’ most common short-term adverse effects are appetite loss, abdominal pain, headaches, and sleep disturbance.”
42 of 42

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.

  • Conflicting publication years for the DSM-PC

    Minor

    The text says the DSM-PC was published in 1995, but its cited reference lists 1996.

1 of 1

Cites

Flagged first, then by citations

3 of the 152 references couldn’t be matched to a known paper.

Research works printed but not linked: 5

  1. American Academy of Pediatrics Task Force on Mental Health, 2010, Addressing Mental Health Concerns in Primary Care: A Clinician’s Toolkit [CD-ROM]
  2. Wolraich, 1996, The Classification of Child and Adolescent Mental Conditions in Primary Care: Diagnostic and Statistical Manual for Primary Care (DSM-PC), Child and Adolescent Version
  3. Robin, 1989, The Guilford Family Therapy Series. Negotiating Parent–Adolescent Conflict: A Behavioral–Family Systems Approach
  4. Avigan, 2004, Review of AERS Data From Marketed Safety Experience During Stimulant Therapy: Death, Sudden Death, Cardiovascular SAEs (Including Stroke). Report No. D030403
  5. Davila, 1991, Memorandum on clarification of policy to address the needs of children with attention deficit disorders within general and/or special education, 261

Cited by

Sorted by citations

Related

Authors
Wolraich, M. L., Hagan, J. F., Allan, C., Chan, E., Davison, D., Earls, M., Evans, S. W., Flinn, S. K., Froehlich, T., Frost, J., Holbrook, J. R., Lehmann, C. U., Lessin, H. R., Okechukwu, K., Pierce, K. L., Winner, J. D., Zurhellen, W., & DISORDER, S. O. C. A. A. W. A.-D.
Affiliations
  • University of Oklahoma (US)
  • University of Vermont (US)
  • Children's Mercy Hospital (US)
  • Boston Children's Hospital (US)
  • Children and Adults with Attention Deficit/Hyperactivity Disorder (US)
  • University of North Carolina at Chapel Hill (US)
  • Ohio University (US)
  • American Academy of Pediatrics (US)
  • Cincinnati Children's Hospital Medical Center (US)
  • American Academy of Family Physicians (US)
  • Centers for Disease Control and Prevention (US)
  • Vanderbilt University (US)
  • uThe Children’s Medical Group, Poughkeepsie, New York;
  • Northwestern University (US)
  • yAtlanta, Georgia; and
  • zHolderness, New Hampshire
Corresponding author
Wolraich, Mark L.
ORCID
Venue
Pediatrics
Publisher
American Academy of Pediatrics (AAP)
Published
2019-10-01
Volume
144
Issue
4
ISSN
  • 0031-4005 (ISSN-L)
  • 1098-4275
DOI
10.1542/peds.2019-2528
PMC
PMC7067282
OpenAlex
W4213383170
Cited by
1,410
References
152
Citations by year
2026: 222 · 2025: 248 · 2024: 231 · 2023: 212 · 2022: 203 · 2021: 171 · 2020: 94 · 2019: 8 · 2016: 1 · 2015: 1 · 2013: 2
FWCI
82.92
Type
journal article
Language
en
Open access
closed
Locations
PEDIATRICS (publishedVersion)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
  • Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
Keywords
attention deficit hyperactivity disorder, ADHD treatment, comorbidities, children and adolescents, DSM-5

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.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-11.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-11.

Cited sources are checked by gpt-6-sol.

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.

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