psych.colorado.edupsych.colorado.edu/~willcutt/dsm5_supplement.pdf · supplemental materials,...

Supplemental Materials, Validity of DSM-IV ADHD, Willcutt et al. 1

Validity of DSM-IV attention–deficit/hyperactivity disorder symptom dimensions and subtypes

Supplemental Materials

To conserve space in the print version of the journal, the technical details of the meta-analysis are provided in

these supplemental materials. The first section describes the methodology for the literature search and meta-analysis,

and the second section lists the reference code for each study that is cited in the detailed tables. The third section lists the

papers that were included in qualitative reviews of topics for which a full meta-analysis was not possible. The fourth

section includes 16 tables that list all individual studies and effect sizes that were used to estimate the corresponding

summary effect sizes included in Tables 1 - 8 in the main paper. Finally, Section 5 includes full citations for the

comprehensive reference list of all 546 studies that are included in the review.

Table of Contents Section 1. Methodology of the Review

1.1 Literature Search (pages 2 - 3)

1.2. Calculation of individual effect sizes (pages 3 - 6)

1.3. Calculation of overall effect sizes (pages 6 - 8)

1.4. Supplement Table 1 and Statistical power (pages 8 - 10)

1.5. Publication Bias (pages 10 - 12)

References for Section 1 (page 13)

Section 2. Reference Codes (shorthand codes used to identify studies in the summary tables; pages 14 - 22)

Section 3. Papers describing aspects of validity reviewed qualitatively (page 23)

Section 4. Supplement Tables summarizing the results of the meta-analysis. Each table lists all effect sizes that

contributed to the overall effect sizes summarized in the text and tables included in the main paper.

Table 2. Factor analyses of DSM-IV ADHD symptoms (pages 24 - 26)

Table 3. Internal validity of the DSM-IV symptom dimensions in children and adolescents (pages 27 - 31)

Table 4. Internal validity of the DSM-IV symptom dimensions in adults (pages 32 - 33)

Table 5. Inter-rater reliability of the DSM-IV ADHD subtypes (page 34)

Table 6. Longitudinal studies of the DSM-IV ADHD subtypes (pages 35 - 36)

Table 7. Correlations between ADHD symptom dimensions and measures of functional impairment (pages 37 - 51)

Table 8. Functional impairment in groups with and without the DSM-IV ADHD subtypes (pages 52 - 67)

Table 9. Correlations between ADHD symptom dimensions and symptoms of comorbid disorders (pages 68 - 97)

Table 10. Symptoms of comorbid disorders in groups with and without the DSM-IV ADHD subtypes (pages 98 - 121)

Table 11. Diagnoses of comorbid mental disorders in groups with and without DSM-IV ADHD subtypes (pgs. 122 - 137)

Table 12. Correlations between ADHD symptom dimensions and measures of cognitive functioning (pages 138 - 146)

Table 13. Cognitive functioning of groups with and without the DSM-IV ADHD subtypes (pages 147 - 173)

Table 14. Candidate gene studies of DSM-IV symptom dimensions and subtypes (pages 174 - 176)

Table 15. Factor analyses of potential sluggish cognitive tempo items (page 177)

Table 16. Correlations between the DSM-IV symptom dimensions and ratings of sluggish cognitive tempo (page 178)

Table 17. Sluggish cognitive tempo in groups with and without the DSM-IV ADHD subtypes (page 179)

Section 5: Citations for all studies included in the review (pages 180 - 199)


SUPPLEMENT SECTION 1: METHODS OF THE LITERATURE SEARCH AND META-ANALYSIS

1.1. Literature search

Inclusion criteria

Studies were included in the review if they reported analyses relevant to the internal or external validity of the

DSM-IV ADHD symptom dimensions or compared at least two of the three DSM-IV diagnostic subtypes. Because DSM-IV

was published in 1994, computer searches of were performed for the years 1994-2010 in the Pubmed, PsycINFO,

Educational Resources Information Center (ERIC), and Social Sciences Citation Index databases. All studies with

keyword ADHD were selected, and the terms ADHD, ADD, and attention deficit disorder were also cross-referenced

separately with DSM-IV, reliability, internal consistency, prevalence, validity, impairment, comorbidity, factor, subtypes

and (combined or inattentive or inattention or hyperactive-impulsive or hyperactivity-impulsivity).

Tables of contents of journals that commonly publish articles on ADHD were reviewed for the same time period.

These were American Journal of Medical Genetics (Neuropsychiatric Genetics), American Journal of Psychiatry, Archives

of Clinical Neuropsychology, Archives of General Psychiatry, Behavioral and Brain Functions, Biological Psychiatry, Child

Neuropsychology, Child Psychiatry and Human Development, Development and Psychopathology, Developmental

Neuropsychology, European Child and Adolescent Psychiatry, Journal of Abnormal Child Psychology, Journal of

Abnormal Psychology, Journal of the American Academy of Child and Adolescent Psychiatry, Journal of Attention

Disorders, Journal of Child Neurology, Journal of Child Psychology and Psychiatry, Journal of Clinical Child and

Adolescent Psychology, Journal of Consulting and Clinical Psychology, Journal of Developmental and Behavioral

Pediatrics, Journal of Learning Disabilities, Journal of Psychopathology and Behavioral Assessment, Journal of the

American Academy of Child and Adolescent Psychiatry, Journal of the International Neuropsychological Society,

Molecular Psychiatry, Psychiatric Genetics, and Psychological Medicine.

Finally, the reference list of each paper was reviewed for additional studies, and all co-authors and several

additional researchers in the field screened the final list of studies. Studies known to the authors that were in press at the

time of the literature search were included in the review, but other unpublished studies were excluded due to the

expansive published literature on DSM-IV ADHD.

Exclusion criteria

As of the end of 2010, the search procedures yielded 15,736 articles after removal of duplicates. Several screens

were used to identify the studies in the initial pool that were relevant for the review. First, papers were excluded that were

clearly beyond the scope of the review (N = 6,737; 43% of the total number of abstracts). Topics of excluded papers

included treatment of other disorders, studies of conditions only peripherally related to ADHD (e.g., overactive bladder,

eczema, allergies), and development of new measures or methodologies. Also excluded were studies that defined ADHD


based on criteria other than DSM-IV, that included only one DSM-IV subtype, or that collapsed all participants with

DSM-IV ADHD to form a single group without distinguishing subtypes or symptom dimensions (N = 3,851; 25%), Finally,

we excluded literature reviews (N = 2,934; 19%), comments and letters to the editor (N = 986, 6%), studies of nonhuman

animal models (N = 513; 3%), and case studies (N = 177; 1%). With the exception of studies that were in press that were

known to the authors, unpublished studies were not included due to the extensive published literature on ADHD. To

assess the reliability of these selection procedures, a random sample of approximately 20% of the studies were also

coded for inclusion or exclusion by a second rater. The raters agreed on over 99.5% of the studies, and all disagreements

were resolved by consensus after additional discussion (most disagreements occurred when studies defined subtypes

based on criteria that were not fully consistent with DSM-IV criteria).

The final pool of studies

The inclusion and exclusion criteria identified 546 papers based on 386 independent samples. Section 5 of the

Supplement Materials provides the full citation for all studies that were included in any aspect of the review.

Coding of Measures

A coding system was developed to classify all relevant measures for the review. Measures were coded separately by

two independent raters to assess the reliability of the coding system. Interrater agreement was high for these classifications

(96%), with most disagreements occurring on codes for subtle distinctions between specific aspects of functional impairment

(i.e., ignored by peers vs. shy / socially passive). For any codes for which there was disagreement after discussion (less

than 2%), analyses were repeated with and without the controversial effect size, and the overall pattern of results did not

change in any of these cases.

1.2. Calculation of individual effect sizes

Effect sizes from studies that reported a single effect

Calculation of effect sizes based on full statistical information. Most studies provided adequate information to

calculate the appropriate effect sizes for all relevant variables included in the study. Zero-order correlations (r) were analyzed

for correlational analyses of continuous measures. If a study reported means and standard deviations for groups with the

nominal DSM-IV ADHD subtypes and/or a comparison group without ADHD, the effect size of each group difference was

estimated by calculating Hedges’ g, the difference between the group means divided by the pooled standard deviation (e.g.,

Hedges & Olkin, 1985). Hedges' g is similar to Cohen's d (Cohen, 1988), a widely-used effect size measure, but corrects for a

small bias in d that leads to a slight overestimation of the effect size (e.g., Borenstein, 2009). Subtype comparisons that

reported rates of categorical outcomes on dichotomous dependent measures were converted to odds ratios for the meta-

analysis.


Estimation of effect sizes for studies that provided partial statistical information. Effect size calculations were

straightforward if a study provided full descriptive statistics, but some studies only reported a subset of the information needed

to calculate the relevant effect size. For example, several studies provided group means and significance levels for subtype

comparisons, but did not include the standard deviations for each group. If the study also provided the exact P value or test

statistic for these comparisons, these values were converted to the relevant effect size using standard procedures (e.g.,

Rosenthal, 1994).

Effect sizes for studies that reported multiple stochastically dependent effects

As in other statistical approaches, the effect sizes in a meta-analysis are assumed to be independent, so each study

must contribute only one effect size to each specific analysis (e.g., Hedges, Tipton, & Johnson, 2010; Ishak, Platt, Joseph, &

Hanley, 2008; Rosenthal & Rubin, 1986). Consistent with this assumption, most studies reported a single effect size for each

comparison of interest. In contrast, a subset of studies reported results for multiple dependent variables that were relevant for

a specific meta-analysis (for example, two different measures of anxiety). In some studies one of the effects was included in

the meta-analysis for theoretical reasons. For example, several studies of neuropsychological tasks provided effects for an

overall summary score that was optimal for the meta-analysis, along with other measures of more specific aspects of the

overall construct (e.g., Full Scale IQ vs. specific subscale scores on the Wechsler Intelligence Tests).

In contrast, most studies that reported multiple effect sizes did not provide a compelling theoretical rationale for the a

priori selection of one of the effects. A number of different statistical approaches have been used to obtain a single effect size

for the study in this scenario (e.g., Gleser & Olkin, 1994, 2009; Hedges & Olkin, 1985; Hedges et al., 2010; Ishak et al., 2008;

Marin-Martinez & Sanchez-Meca, 1999; Matt, 1989; Raudenbush, Becker, & Kalaian, 1988; Rosenthal & Rubin, 1986). Some

previous meta-analyses simply calculated the mean or median of the multiple effects reported by a study, but several authors

demonstrated that this procedure is not appropriate unless the effect sizes are extremely homogeneous (e.g., Hedges & Olkin,

1985; Marascuillo, Busk, & Serlin, 1988). Other studies randomly selected one of the effects, a straightforward procedure that

yields an unbiased estimate of the effect size for the study. However, because this approach discards all information about the

other relevant effect sizes in the study, effect size estimates based on this procedure have weaker statistical properties than

the alternative approach described subsequently (Gleser & Olkin, 2009; Rosenthal & Rubin, 1986).

Unless there was a strong a priori rationale to include one of the effects, the procedure described by Gleser and Olkin

(2009) was implemented using packages in R (Del Re & Hoyt, 2010a, 2010b) to compute a single effect size for each study

that reported multiple effect sizes relevant to a specific analysis. This approach estimates the aggregate effect size for the

study while taking into account the within-study dependencies among the effects. In addition to the effect sizes and sample

sizes of the groups in the study, the procedure requires an estimate of the correlations between the multiple dependent

measures. Although relatively few of the studies in the meta-analysis reported this information, in most cases we were able to


obtain the relevant correlations from the technical manuals for the measures or from other studies in the broader literature. If

the relevant correlation was not provided in the initial study, test manuals, or published literature, a correlation of .50 was used.

This value was selected because it is a medium effect size (Cohen, 1988) that falls within the range of correlations typically

reported between measures similar to those included in the meta-analysis, and it is also consistent with the recommendations

of meta-analytic experts if the true correlation is unknown (e.g., Rosenthal & Rubin, 1986). To test the sensitivity of the results

to the selection of this specific value (e.g., Riley, 2009), analyses were conducted again with plausible alternative values for

within-study correlations between dependent measures (r = .30 and .70), and there were no significant changes in the overall

pattern of results. For each study that reported multiple effect sizes, the specific procedure used to compute a single effect

size for the meta-analysis are described in a note in the relevant supplemental table.

Missing effect sizes

While most papers provided sufficient information to allow an exact effect size to be calculated, a small number of

studies only indicated whether or not a result was significant, and did not provide a specific test statistic, effect size, or

exact P value (3% of nearly 4,500 effects included in the meta-analysis). Authors of each of these studies were contacted

and this information was requested. If data were provided, the appropriate effect size was calculated and included in the

meta-analysis. However, for a number of studies the relevant data were no longer available, and it was not possible to include

effect sizes from these studies in the primary meta-analyses. To provide a comprehensive summary of the literature, these

studies are listed in the supplemental tables with a note indicating that an exact effect size estimate was not available. Several

sets of secondary analyses were then conducted to assess the potential impact of these missing effect sizes on the overall

results.

Missing nonsignificant effects. The first two sets of analyses examined the impact of the omission of

nonsignificant effects for which an exact effect size was not available (2% of all effects). If each of these nonsignificant

effects was close to zero, a meta-analysis of the effects from all other studies would yield an overestimate of the effect

size in the population. The potential impact of this scenario was examined by including a hypothetical effect size of 0 for

each of the missing studies and recalculating the overall effect size (this procedure is similar to the calculation of the fail-

safe N described in section 1.4).

Alternatively, nonsignificant effects could also potentially fall slightly below the significance threshold and in the

same direction as the effect observed in the meta-analysis, in which case an overall effect size that was initially

nonsignificant could become significant due to the increased sample size (and narrower confidence interval) if the missing

effects were included. Therefore, secondary analyses were also conducted after replacing each missing nonsignificant

effect with the largest effect size that would remain nonsignificant (P = .06) given the sample size of the study.


Missing significant effects. A similar approach was used to evaluate the potential impact of studies that

reported a significant effect but did not provide sufficient information to calculate an exact effect size (1% of all effects). A

conservative test of the potential impact of the missing effects was conducted by replacing each missing effect with the

smallest effect size that would yield a significant result based on the size of the sample (P = exactly .05, or P = .01 if that

was the threshold for significance used by the study). Additional sets of analyses were then completed after replacing

each missing effect with the overall effect from that meta-analysis, or with effect sizes defined as "medium" or "large" in

magnitude by convention (e.g., Cohen, 1988).

Results of analyses to evaluate the impact of missing effects. As noted above, only a small percentage of

effects could not be calculated due to incomplete statistical information. The analyses described in this section indicated

that the omission of these effects resulted in extremely small changes to the point estimates of the overall effect sizes.

The inclusion of the missing effect sizes did not change the significance of any of the overall effects in the meta-analysis

in any of the scenarios, and did not lead to any substantive changes in interpretation. Overall, these results suggest that

the results of the meta-analysis are robust despite the unavoidable exclusion of this small subset of effects.

1.3. Calculation of overall effect sizes

Overview

To provide a comprehensive summary of the literature, meta-analyses were completed for all comparisons for which

at least two studies used designs and measures that were sufficiently similar to allow pooled analyses (most analyses

included many more than two effects; we discuss the synthesis of results based on a small number of effect sizes in more

detail in section 1.4). To facilitate the evaluation of the validity of DSM-IV ADHD across the developmental spectrum,

studies of children and adolescents (defined as 18 years of age or younger) and studies of adults (19 years of age and

older) were analyzed separately.

Summary effect sizes (r for correlational data, g for comparisons of the means of two groups on a dimensional

dependent measure, OR for comparisons between groups on categorical dependent variables) were calculated using the

Comprehensive Meta-analysis statistical package (Biostat, 2010). For each analysis the overall weighted effect size and

corresponding 95% confidence interval is reported in Tables 1 - 8 in the main paper. Supplement Tables 2 - 17 list all effects

that were included in each overall effect size estimate, and also provide a summary of analyses used to test for publication

bias and heterogeneity among the effects.

For some relevant domains the methods used by different studies were too dissimilar to permit a formal

meta-analysis to be completed (electrophysiological and neuroimaging studies, studies of a wide range of candidate gene

polymorphisms, treatment studies of different pharmacological interventions, and studies of substance-use disorders that

incorporated a diverse range of complex cross-sectional and longitudinal designs). Instead, a brief qualitative summary of


the results is provided in the text of the main paper, and the full list of studies that were reviewed are listed in Supplement

Section 3.

Heterogeneity of effects

When the individual effect sizes in a specific meta-analysis are homogeneous, an overall effect size can be estimated

with a fixed effects model that simply weights the effect size from each study by the corresponding sample size (Hedges &

Olkin, 1985). However, fixed effects models make the strong assumption that any differences in effect sizes among the

studies are due entirely to sampling error. If there is significant heterogeneity among studies due to systematic differences in

study populations, experimental design, measures, or other study procedures, the estimated effect size and corresponding

confidence interval obtained from the fixed effects model may be biased, and a random effects model is more appropriate

(e.g., DerSimonian & Laird, 1986).

Two measures were used to test for heterogeneity among the effects in each analysis. Cochran’s Q statistic is an

estimate of the variability of individual effect sizes around the overall estimated effect size that takes a Χ2 distribution with one

less degree of freedom than the total number of effects in the analysis (Cochran, 1954). We also calculated I2, a more intuitive

measure that quantifies the percentage of the overall effect size that is attributable to heterogeneity among the effects (Higgins

& Thompson, 2002). Significant heterogeneity among the effects was observed in 103 of the 399 meta-analytic results (26%).

Due to this pervasive heterogeneity, the more conservative random effects model was used for all analyses (DerSimonian &

Laird, 1986). The random effects model adjusts for heterogeneity by weighting each effect size by both the inverse variance of

the sample and an additional weight based on Q. For analyses with low heterogeneity Q is also low and the additional weight

goes to zero, in which case the fixed effects and random effects models yield identical results.

In addition to the use of random effects models, several approaches were used to identify the source and impact

of any significant heterogeneity that was detected among the effects. First, the distribution of effects was examined to test

whether heterogeneity was attributable to a small number of outlying values at either end of the distribution of effect sizes.

Effects with a significant standardized residual (P < .05) were identified as potential outliers, and analyses were

conducted again without these effects to examine the sensitivity of the overall results to these outlying values. In 72 of 103

analyses (70%) significant heterogeneity was explained by a single or small number of outlier effect sizes. In nearly all of

these cases the point estimate of the overall effect size changed minimally when the outlier effects were excluded.

If outliers did not account for the significant heterogeneity, a modified weighted least squares regression analysis

was conducted to test if the observed effect sizes were moderated by third variables that differed across studies (age,

sex, clinical vs. community sample, rater, and type of measure). These moderators accounted for heterogeneity in 22

additional analyses (21% of all analyses with significant heterogeneity). We were unable to account for the significant


observed heterogeneity in 9 analyses (9% of all comparisons with significant heterogeneity among the effects and 2% of

all comparisons). Results of all heterogeneity analyses are summarized in the notes for each of the supplemental tables.

1.4. Statistical power

Overall power

Supplement Table 1 summarizes the statistical power for the primary comparisons in the meta-analysis. Power

calculations are based on a random effects model (for a detailed summary of these procedures see Valentine, Pigott, &

Rothstein, 2010), and compare the power for scenarios with low, moderate, or high heterogeneity among the effects (Higgins

& Thompson, 2002; Higgins, Thompson, Deeks, & Altman, 2003). Because the total number of available effect sizes and the

sample sizes of the individual studies varied across analyses, the power calculations in Supplement Table 1 are based on the

mean sample size and the mean number of effects across all meta-analyses that were completed for that comparison (e.g.,

across all analyses comparing ADHD-C and ADHD-I, the mean number of studies was 17.3).

Supplement Table 1

Estimated random effects statistical power for key comparisons in the meta-analysis

Comparison ADHD-C or ADHD-I

vs. Control ADHD-H

vs. Control ADHD-C

vs. ADHD-I ADHD-C or ADHD-I

vs. ADHD-H

Mean number of effectsa 12 6 17 8 Mean N per groupb 60 / 300 40 / 500 60 / 60 70 / 40 Effect size detected with power = .80c

Low heterogeneity .12 .19 .14 .22 Moderate heterogeneity .15 .24 .18 .28 High heterogeneity .18 .29 .21 .34

Power to detect effect size g = .20c Low heterogeneity .99 .82 .98 .70 Moderate heterogeneity .96 .68 .89 .53 High heterogeneity .88 .53 .75 .38

Power to detect effect size g = .30c Low heterogeneity 1.0 .99 1.0 .96 Moderate heterogeneity 1.0 .93 1.0 .86 High heterogeneity .99 .82 .97 .70

Power to detect effect size g = .40c Low heterogeneity 1.0 1.0 1.0 1.0 Moderate heterogeneity 1.0 .99 1.0 .98 High heterogeneity 1.0 .96 1.0 .91

Note: amean number of effects across all meta-analyses comparing the groups. bmean sample size of studies included in meta-analyses comparing the groups. cPower to detect effect size based on the mean number of effects and the mean sample size in each group (1-tailed for comparisons of ADHD groups and control group, 2-tailed for comparisons of ADHD subtypes).

For comparisons involving ADHD-C, ADHD-I, and a control group without ADHD, power was extremely high to detect

a medium effect size (e.g., g > .30) even in the presence of high heterogeneity among the effects, and adequate to detect


small effects as low as g = .12 (first and third columns of Supplement Table 1). Power was somewhat lower for comparisons

involving ADHD-H, but adequate to detect overall effect sizes that were medium or large in magnitude (second and fourth

columns of Supplement Table 1).

Power for analyses with fewer effect sizes

Although the power analyses summarized in Supplement Table 1 suggest that power was sufficient for most key

comparisons, for a subset of analyses a smaller number of effects were available. Approximately 90% of the primary

comparisons involving ADHD-C and ADHD-I included at least 8 effects, in which case power was greater than .80 in all

scenarios if g = .30 and most scenarios if g = .20. The remainder of the analyses of ADHD-C and ADHD-I included between 3

and 7 effect sizes. Even with only 3 available studies power remained greater than .80 to detect a medium effect size (g =

.40), suggesting that power was adequate for virtually all comparisons of ADHD-C, ADHD-I, and a control group without

ADHD.

In contrast to the literature on ADHD-C and ADHD-I, 18% of the effects that included groups with ADHD-H were

based on a single study, and 48% were based on four or fewer effect sizes. Similarly, whereas the sample sizes in studies of

adults were generally similar to the samples in studies of children and adolescents (mean Ns for groups of adults with ADHD-

C = 49 - 61, ADHD-I = 43 - 50, ADHD-H = 23, Control = 200 - 250), only a handful of studies were available for nearly all

analyses of adults (across all analyses, the mean number of available effect sizes from adult samples was 2.1 for ADHD-C vs.

Control and ADHD-I vs. Control, 1.6 for ADHD-H vs. Control, 3.7 for ADHD-C vs. ADHD-I, and 1.8 for ADHD-H vs. the other

subtypes).

Rationale for the inclusion of meta-analytic results for all comparisons. A recent paper by Valentine and

colleagues provided a cogent summary of the strengths and weaknesses of different approaches for the synthesis of results

when only a small number of studies are available (Valentine et al., 2010). They assert that the primary conclusion when a

meta-analysis is underpowered is that more evidence is required, and the current results suggest that additional research is

needed regarding the validity of ADHD-H in children and adolescents and most aspects of validity of ADHD subtypes in

adults.

After underscoring this key point, the authors argue that even when the number of studies is small, a meta-analysis is

still a better approach than other methods that are often used to synthesize the results of a small number of studies (Valentine

et al., 2010) . These often include counts of the number of significant studies, qualitative statements regarding the similarity of

effects across studies, and broad summary statements about the overall conclusions that should be drawn from studies that

were deemed too heterogeneous to combine for meta-analysis. Each of these approaches involve subjective judgments

based on internal rules that may be prone to bias and are unlikely to be transparent to the reader.


While the utility of meta-analysis is also constrained by a small number of available studies, several considerations

support its use even in these scenarios. Perhaps most importantly, the meta-analytic approach is more transparent and less

susceptible to bias than alternative descriptive approaches to synthesize the results. The greater degree of uncertainty in

meta-analyses of a small number of studies is explicitly reflected in a large standard error and wider confidence interval

around the point estimate of the effect size. In addition, the power calculations summarized in this section indicate that a

relatively small number of studies may still provide reasonable power, especially if the observed effect is large and

heterogeneity among the effects is minimal. Further, even if the observed effect size is small or nonsignificant, the formal

synthesis of results from a small number of studies may provide important preliminary information about issues that have

received relatively little research attention, and the clear list of available effect sizes may help to underscore the paucity of

relevant data that are available.

Therefore, to provide a comprehensive summary of the literature, the supplemental tables include effect sizes from all

individual studies of each construct that was included in the meta-analysis, and meta-analytic procedures were used to

calculate overall effect sizes if at least two studies used designs and measures that were sufficiently similar to allow

pooled analyses. Nonetheless, it is also critical to emphasize again that effect sizes derived from meta-analyses of a small

number of studies should be considered preliminary results that must be interpreted with caution.

1.5. Publication bias

In the context of meta-analysis, bias occurs if the studies included in the review are systematically

nonrepresentative of the total population of studies relevant to the question of interest (a comprehensive summary of

different aspects of bias in meta-analyses is provided in the volume by Rothstein, Sutton, & Borenstein, 2005). The type of

bias discussed most frequently is publication bias, which typically occurs if studies that report significant results are more

likely to be published than studies that report nonsignificant results. A related issue arises if published studies only report

results of analyses that were significant, and do not report analyses of other measures that yielded nonsignificant results.

Other forms of reporting bias may occur if only a subset of studies provide sufficient information to allow an exact effect

size to be calculated, if the same result is published more than once, or if results are published in journals that are not

widely cited and are not captured by typical search procedures.

These potential biases may impact the interpretation of the results of the meta-analysis in several ways (e.g.,

Borenstein, 2005; Sutton, 2009). In the most extreme case, an effect that is found to be significant in a meta-analysis

could be a spurious result that is entirely attributable by publication bias. More often, however, publication and other

biases are likely to have a more subtle effect on the magnitude of the point estimate for the overall effect size. In the

remainder of this section we describe methods that were used to test for bias and estimate its impact on the observed

results of the meta-analysis.


Fail-safe N: The fail-safe N is a method that was developed to specify the likelihood that a significant effect is

explained entirely by publication or other biases. This approach is frequently used to address the "file-drawer problem", in

which studies that obtain null results are systematically less likely to be published than studies that report a significant

effect (e.g., Cooper, 1979; Rosenthal, 1979). If this is the case, a significant overall effect obtained in a meta-analysis

could be a spurious effect that is explained entirely by the selective publication of studies that found significant results,

when in fact the effect size is null or trivial in the entire population of studies of the construct.

Two operationalizations of fail-safe Ns have been developed. The classic fail-safe N (Rosenthal, 1979) indicates

the exact number of missing studies with null results that would be required for a significant effect in a meta-analysis to

become nonsignificant. Orwin then developed an analogous procedure that focused on the magnitude of the overall effect

rather than its statistical significance (Orwin, 1983). Orwin's fail-safe N indicates the number of null results that would be

required to reduce the overall effect size to a magnitude that is determined a priori is too small to be of interest (for the

current analyses the cutoff for a "trivial" effect was operationalized as r < .10, g < .20, and OR < 1.1).

Egger's multiple regression test. This method tests whether there is evidence of significant publication bias that

may change the overall point estimate of the effect size, even if bias does not account for the entire effect (Egger, Smith,

Schnedier, & Minder, 1997). A regression model is fitted to the association between the magnitude and precision of the

observed effect sizes included in the analysis. If there is no publication bias (i.e., if all completed studies are included in

the analysis), these two variables should be unrelated. In contrast, if journals are biased toward publication of significant

results, studies with small sample sizes should have larger effect sizes, because larger effects are required for the effect

to be significant in studies with smaller samples. Therefore, a significant value for the regression intercept indicates the

possibility of publication bias.

Trim and fill. The trim-and-fill procedure is a two-step procedure that first evaluates the extent of any bias, then

estimates the true effect size and standard error that would be obtained if the missing studies had been included in the

analysis (e.g., Duval & Tweedie, 2000). The first step of the trim-and-fill procedure is based on the same idea that

underlies the funnel plot, a graphical approach that has often been used to screen qualitatively for evidence of bias in

meta-analyses. An example of a funnel plot from the current meta-analysis is provided in Figure 1. Each unfilled circle in

the figure represents the correlation between hyperactivity-impulsivity symptoms and aggression from a single study. The

x-axis of the plot indicates the effect size (each r has been converted to Fisher's z for distributional reasons), and the

vertical axis indicates the corresponding standard error for that effect (a direct function of sample size). In the absence of

bias, the scatterplot of effects should be distributed symmetrically around the overall effect size, and the distribution

should be shaped like an inverted funnel due to the less precise estimates obtained from the smaller samples at the

bottom of the chart.


In contrast, an asymmetric distribution of

effects suggests that some effects are missing. The

trim-and-fill procedure first estimates the number of

studies that are missing from one side of the

distribution (in the example in Figure 1 four effects

were missing from the lower tail of the distribution).

The same number of studies are then removed

(trimmed) from the other side of the distribution to

compensate for the hypothetical missing effects, and

the overall point estimate is recalculated. In the example the estimate of the overall effect size was reduced slightly (z =

.65 to .62, or r = .57 to .55). An imputation procedure is then used to estimate the effect size for each of the hypothetical

missing studies in the distribution, and these new effects are added to the original distribution (the filled circles in Figure

1). The resulting distribution is then used to calculate the adjusted standard error of the overall effect size when the

missing effects are included.

Summary of the impact of publication / selection bias. For each effect size that is based on three or more

studies, Supplement Tables 3 - 17 provide a summary of analyses of publication bias, including classic and Orwin's fail-

safe N, Egger's regression, and a summary of Trim and Fill procedures. All publication bias analyses were conducted

after accounting for heterogeneity among the effects (e.g., Sutton, 2009).

Classic fail-safe Ns ranged from 1 to over 20,000 (M = 889), and the more conservative Orwin's fail-safe N ranged

from 1 to 472 (M = 31). There were only a handful of effects for which a single nonsignificant study would change the

interpretation of the results, and estimated fail-safe Ns were 5 or higher for over 90% of analyses. Trim and fill procedures

suggested that at least one effect size was missing from the distribution of effects in 41% of the analyses. However, a

relatively small number of distributions were missing more than three effect sizes (7%), and Egger's regression analyses

indicated significant bias in only 3% of analyses. Most importantly, when the hypothetical missing effects were added to

the distribution as part of the trim-and-fill procedure, changes in the point estimates of the overall effect sizes were small

(mean change in OR = 0.75, g = .07, r = .02), and only one overall effect size changed from significant to nonsignificant

when the hypothetical missing effects were added. Overall, these results suggest that the substantive conclusions of the

review are unlikely to attributable to publication bias or other sampling biases in the literature search.


1.6. References for Section 1

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SUPPLEMENT SECTION 2. REFERENCE CODES

To simplify presentation of results, each study included in the review is referenced by the shortened title listed below throughout the supplemental materials. A comprehensive reference list with full citations for all references is included in Section 5 of the supplemental materials. Acosta 2008 = Acosta et al., 2008 Adams 2010 = Adams, Milich, & Fillmore, 2010 Adewuya 2007 = Adewuya & Famuyiwa, 2007 Adler 2008 = Adler et al., 2008 Alexander 2008 = Alexander et al., 2008 Alloway 2010 = Alloway, Elliott, & Holmes, 2010 Althoff 2006 = Althoff et al., 2006 Am.-Campos 2006 = Amador-Campos, Forns-Santacana, Guardia-Olmos, & Pero-Cebollero, 2006 Angold 1995 = Angold & Costello, 1995 Antshel 2003 = Antshel & Remer, 2003 Arabgol 2009 = Arabgol, Panaghi, & Hebrani, 2009 Arnold 2007 = Arnold et al., 2007 Aron 2003 = Aron, Dowson, Sahakian, & Robbins, 2003 Auerbach 2010 = Auerbach et al., 2010 Avsar 2009 = Avsar, Akbas, & Ataibis, 2009 Baldwin 2008 = Baldwin & Dadds, 2008 Barbaresi 2006 = Barbaresi et al., 2006 Barkley 2002 = Barkley, Murphy, Dupaul, & Bush, 2002 Barry 2002 = Barry, Clarke, McCarthy, & Selikowitz, 2002 Barry 2005 = Barry et al., 2005 Barry 2006 = Barry, Clarke, McCarthy, & Selikowitz, 2006 Bartgis 2009 = Bartgis, Lefler, Hartung, & Thomas, 2009 Bauerm. 2005a = Bauermeister, Barkley, et al., 2005 Bauerm. 2005b = Bauermeister, Matos, et al., 2005 Bauerm. 2007 = Bauermeister et al., 2007 Bauerm 2010a = Bauermeister, Puente, et al., 2010 Bauerm 2010b = Bauermeister, Canino, Polanczyk, & Rohde, 2010 Baumg. 1995 = Baumgaertel, Wolraich, & Dietrich, 1995 Beck 2010 = Beck, Hanson, Puffenberger, Benninger, & Benninger, 2010 Bedard 2003 = Bedard et al., 2003 Bedard 2008 = Bedard & Tannock, 2008 Belendiuk 2007 = Belendiuk, Clarke, Chronis, & Raggi, 2007 Bellgrove 2005 = Bellgrove et al., 2005 Bellgrove 2006 = Bellgrove et al., 2006 Biederman 2005 = Biederman et al., 2005 Biederman 2006a = Biederman, Gao, Rogers, & Spencer, 2006 Biederman 2006b = Biederman, Mick, et al., 2006 Biederman 2006c = Biederman, Swanson, et al., Biederman 2008a = Biederman et al., 2008 Biederman 2008b = Biederman & Pliszka, 2008 Blachman 2002 = Blachman & Hinshaw, 2002 Bohlin 2004 = Bohlin & Janols, 2004 Booth 2007 = Booth, Carlson, & Tucker, 2007 Brocki 2010 = Brocki, Eninger, Thorell, & Bohlin, 2010 Brookes 2006 = Brookes et al., 2006 Brown 2010 = Brown, Brams, Gao, Gasior, & Childress, 2010 Buitelaar 2007 = J. K. Buitelaar et al., 2007 Buitelaar 2009 = Jan K. Buitelaar, Wilens, Zhang, Ning, & Feldman, 2009 Burgio-Mur. 2007 = Burgio-Murphy et al., 2007 Burke 2007 = Burke, Loeber, White, Stouthamer-Loeber, & Pardini, 2007 Burns 1997a = Burns, Walsh, Owen, & Snell, 1997 Burns 1997b = Burns, Walsh, Patterson, et al., 1997 Burns 2001 = Burns, Boe, Walsh, Sommers-Flanagan, & Teegarden, 2001


Burns 2003 = Burns, Walsh, & Gomez, 2003 Burns 2006 = Burns, Walsh, Gomez, & Hafetz, 2006 Byun 2006 = Byun et al., 2006 Campbell 2009 = Campbell & von Stauffenberg, 2009 Canu 2007a = Canu, 2007 Canu 2007b = Canu, Newman, Morrow, & Pope, 2007 Cao 2006 = Cao et al., 2006 Capano 2008 = Capano, Minden, Chen, Schacher, & Ickowicz, 2008 Carlson 2002a = Carlson, Booth, Shin, & Canu, 2002 Carlson 2002b = Carlson & Mann, 2002 Carmona 2009 = Carmona et al., 2009 Carr 2010 = Carr, Henderson, & Nigg, 2010 Chabot 1996 = Chabot & Serfontein, 1996 Cheuk 2006a = Cheuk, Li, & Wong, 2006a Cheuk 2006b = Cheuk, Li, & Wong, 2006b Chhabild. 2001 = Chhabildas, Pennington, & Willcutt, 2001 Chiang 2008 = Chiang & Gau, 2008 Chou 2009 = Chou et al., 2009 Chronis-Tuscano 2008 = Chronis-Tuscano et al., 2008 Chronis-Tuscano 2010 = Chronis-Tuscano et al., 2010 Clarke 1998 = A. R. Clarke, Barry, McCarthy, & Selikowitz, 1998 Clarke 2001a = A. R. Clarke, Barry, McCarthy, & Selikowitz, 2001a Clarke 2001b = A. R. Clarke, Barry, McCarthy, & Selikowitz, 2001b Clarke 2003 = A. R. Clarke et al., 2003 Clarke 2007 = S. D. Clarke et al., 2007 Cohen 2007 = Cohen & Shapiro, 2007 Collings 2003 = Collings, 2003 Conners 1999 = Conners, Erhardt, & Sparrow, 1999 Conzelmann 2009 = Conzelmann et al., 2009 Cook 1995 = Cook et al., 1995 Cordier 2010 = Cordier, Bundy, Hocking, & Einfeld, 2010 Counts 2005 = Counts, Nigg, Stawicki, Rappley, & von Eye, 2005 Covey 2008 = Covey, Manubay, Jiang, Nortick, & Palumbo, 2008 Cox 2006 = Cox et al., 2006 Crosbie 2001 = Crosbie & Schachar, 2001 da Silva 2008 = da Silva et al., 2008 Dane 2000 = Dane, Schachar, & Tannock, 2000 de Luca 2004 = De Luca et al., de Nijs 2004 = de Nijs et al., de Zeeuw 2008 = de Zeeuw et al., 2008 Depue 2010 = Depue et al., 2010 Derefinko 2008 = Derefinko et al., 2008 Desman 2008 = Desman, Petermann, & Hampel, 2008 Deupree 2006 = Deupree et al., 2006 Diamant. 2007 = Diamantopoulou, Rydell, Thorell, & Bohlin, 2007 Dias 2008 = Dias et al., 2008 Dige 2010 = Dige, Maahr, & Backenroth-Ohsako, 2010 Döpfner 2006 = Dopfner et al., 2006 Dorval 2007 = Dorval et al., 2007 Drechsler 2008 = Drechsler, Rizzo, & Steinhausen, 2008 DuPaul 1997 = DuPaul, Anastopoulos, et al., 1998 DuPaul 1998a = DuPaul et al., 1997 DuPaul 1998b = DuPaul, Power, Anastopoulos, & Reid, 1998 Durell 2009 = Durell et al., 2009 Edwards 2007 = Edwards et al., 2007 Egeland 2007 = Egeland, 2007 Egeland 2009 = Egeland, Johansen, & Ueland, 2009 Egeland 2010 = Egeland, Johansen, & Ueland, 2010 Eiraldi 1997 = Eiraldi, Power, & Nezu, 1997 Elia 2008 = Elia, Ambrosini, & Berrettini, 2008 Elkins 2007 = Elkins, McGue, & Iacono, 2007


English 2009 = English et al., 2009 Epstein 2001 = Epstein, Johnson, Varia, & Conners, 2001 Epstein 2003 = Epstein et al., 2003 Epstein 2006 = Epstein & Kollins, 2006 Ersan 2004 = Ersan, Dogan, Dogan, & Sumer, 2004 Evans 2005 = Evans, Allen, Moore, & Strauss, 2005 F.-Weieneth 2009 = Friedman-Weieneth, Doctoroff, Harvey, & Goldstein, 2009 Fabiano 2006 = Fabiano et al., 2006 Faraone 1998 = Faraone, Biederman, Weber, & Russell, 1998 Faraone 2000a = Faraone, Biederman, & Friedman, 2000 Faraone 2000b = Faraone, Biederman, Mick, et al., 2000 Faraone 2005a = Faraone & Biederman, 2005 Faraone 2005b = Faraone, Biederman, Monuteaux, & Spencer, 2005 Feng 2005 = Feng et al., 2005 Ferreira 2009 = Ferreira et al., 2009 Fillmore 2009 = Fillmore, Milich, & Lorch, 2009 Findling 2008 = Findling et al., 2008 Fliers 2008 = Fliers et al., 2008 Forbes 2001 = Forbes, 2001 Forssman 2009 = Forssman et al., 2009 Frazier 2007 = Frazier, Youngstrom, & Naugle, 2007 Frick 1994 = Frick et al., 1994 Frodl 2010 = Frodl et al., 2010 Fuchs 2008 = Fuchs et al., 2008 Gadow 1997a = Gadow & Sprafkin, 1997a Gadow 1997b = Gadow & Sprafkin, 1997b Gadow 2000 = Gadow et al., 2000 Gadow 1998 = Gadow & Sprafkin, 1998 Gadow 1999 = Gadow & Sprafkin, 1999 Gadow 2001 = Gadow, Sprafkin, & Nolan, 2001 Gadow 2002 = Gadow et al., 2002 Gadow 2004a = Gadow, Drabick, et al., 2004 Gadow 2004b = Gadow, Sprafkin, & Weiss, 2004 Garner 2010 = Garner, Marceaux, Mrug, Patterson, & Hodgens, 2010 Gau 2009 = S. S. F. Gau et al., 2009 Gau 2010 = S. S. Gau et al., 2010 Gaub 1997 = Gaub & Carlson, 1997 Genro 2007 = Genro et al., 2007 Geurts 2005 = Geurts, Verte, Oosterlaan, Roeyers, & Sergeant, 2005 Ghaniz. 2009 = Ghanizadeh, 2009 Ghaniz. 2010 = Ghanizadeh & Jafari, 2010 Gizer 2008 = Gizer et al., 2008 Gomez 1999 = Gomez, Harvey, Quick, Scharer, & Harris, 1999 Gomez 2003 = Gomez, Burns, Walsh, & de Moura, 2003 Gomez 2005 = Gomez, Burns, Walsh, & Hafetz, 2005 Gomez 2007 = Gomez, 2007 Gomez 2008 = Gomez, 2008 Gomez 2009 = Gomez, 2009 Gomez 2010 = Gomez & Corr, 2010 Gordon 2006 = Gordon et al., 2006 Gorman 2006 = Gorman, Klorman, Thatcher, & Borgstedt, 2006 Goth-Owens 2010 = Goth-Owens, Martinez-Torteya, Martel, & Nigg, 2010 Graetz 2001 = Graetz, Sawyer, Hazell, Arney, & Baghurst, 2001 Graetz 2005 = Graetz, Sawyer, & Baghurst, 2005 Greven 2011 = Greven, Asherson, Rijsdijk, & Plomin, 2011 Grevet 2006 = Grevet et al., 2006 Grevet 2007 = Grevet et al., 2007 Gross-Tsur 2006 = Gross-Tsur et al., 2006 Guan 2009 = Guan et al., 2009 Gul 2010 = Gul, Tiryaki, Kultur, Topbas, & Ak, 2010 Gudjonsson 2009 = Gudjonsson, Sigurdsson, Eyjolfsdottir, Smari, & Young, 2009


Gudjonsson 2010 = Gudjonsson, Sigurdsson, Gudmundsdottir, Sigurjonsdottir, & Smari, 2010 Haberstick 2007 = Haberstick et al., 2007 Hale 2009 = Hale et al., 2009 Halleland 2009 = Halleland, Lundervold, Halmoy, Haavik, & Johansson, 2009 Halmoy 2009 = Halmoy, Fasmer, Gillberg, & Haavik, 2009 Hardy 2007 = Hardy et al., 2007 Harrier 2005 = Harrier & DeOrnellas, 2005 Harrington 2010 = Harrington & Waldman, 2010 Hart 2010 = Hart et al., 2010 Hartman 2001 = Hartman et al., 2001 Hartman 2004 = Hartman, Willcutt, Rhee, & Pennington, 2004 Hartung 2002 = Hartung, Milich, Lynam, & Martin, 2002 Hastings 2009 = Hastings, Fortier, Utendale, Simard, & Robaey, 2009 Hay 2004 = David A. Hay, Bennett, McStephen, Rooney, & Levy, 2004 Hay 2007 = D. A. Hay, Bennett, Levy, Sergeant, & Swanson, 2007 Hinshaw 2002a = Hinshaw, 2002 Hinshaw 2002b = Hinshaw, Carte, Sami, Treuting, & Zupan, 2002 Hinshaw 2006 = Hinshaw, Owens, Sami, & Fargeon, 2006 Hinshaw 2007 = Hinshaw, Carte, Fan, Jassy, & Owens, 2007 Hoare 2005 = Hoare et al., 2005 Hodgens 2000 = Hodgens, Cole, & Boldizar, 2000 Holmes 2004 = Holmes et al., 2004 Houghton 1999 = Houghton et al., 1999 Huang-Poll. 2005 = Huang-Pollock, Nigg, & Carr, 2005 Huang-Poll. 2006 = Huang-Pollock, Nigg, & Halperin, 2006 Huang-Poll. 2007 = Huang-Pollock, Mikami, Pfiffner, & McBurnett, 2007 Huang-Poll. 2009 = Huang-Pollock, Mikami, Pfiffner, & McBurnett, 2009 Huang-Poll. 2010 = Huang-Pollock & Karalunas, 2010 Hudziak 1998 = Hudziak et al., 1998 Hurtig 2007 = Hurtig et al., 2007 Ickowicz 2007 = Ickowicz et al., 2007 Ivanov 2010 = Ivanov et al., 2010 Johansson 2008 = Johansson et al., 2008 Johnstone 2001 = Johnstone, Barry, & Anderson, 2001 Johnstone 2003 = Johnstone, Barry, & Dimoska, 2003 Johnstone 2007 = Johnstone, Barry, & Clarke, 2007 Johnstone 2009 = Johnstone & Clarke, 2009 Kadesjo 2004 = Kadesjo et al., 2004 Kahn 2003 = Kahn, Khoury, Nichols, & Lanphear, 2003 Kass 2003 = Kass, Wallace, & Vodanovich, 2003 Keage 2006 = Keage et al., 2006 Keage 2008 = Keage et al., 2008 Kim 2005a = S. J. Kim et al., 2005 Kim 2005b = Y. S. Kim et al., Kirley 2003 = Kirley et al., 2003 Kirley 2004 = Kirley et al., 2004 Kissling 2008 = Kissling et al., 2008 Klassen 2004 = Klassen, Miller, & Fine, 2004 Klimkeit 2005 = Klimkeit, Mattingley, Sheppard, Lee, & Bradshaw, 2005 Klorman 1999 = Klorman et al., 1999 Klorman 2002 = Klorman et al., 2002 Knouse 2008 = Knouse et al., 2008 Kollins 2005 = Kollins, McClernon, & Fuemmeler, 2005 Konold 2008 = Konold & Glutting, 2008 Kooij 2008 = Kooij et al., 2008 Kopecky 2005 = Kopecky, Chang, Klorman, Thatcher, & Borgstedt, 2005 Krane 2001 = Krane & Tannock, 2001 Kratochvil 2007 = Kratochvil et al., 2007 Kuntsi 2004 = Kuntsi et al., 2004 Kuperman 1996 = Kuperman, Johnson, Arndt, Lindgren, & Wolraich, 1996 Lahey 1994 = Lahey et al., 1994


Lahey 1998 = Lahey et al., 1998 Lahey 2002 = Lahey & Willcutt, 2002 Lahey 2004a = Lahey, Applegate, et al., 2004 Lahey 2004b = Lahey, Pelham, et al., 2004 Lahey 2005 = Lahey, Pelham, Loney, Lee, & Willcutt, 2005 Lahey 2008 = Lahey et al., 2008 Lahey 2009 = Lahey, Willcutt, & McBurnett, 2009, June Lahey 2010 = Lahey & Willcutt, 2010 Lalonde 1998 = Lalonde, Turgay, & Hudson, 1998 Langberg 2010 = Langberg et al., 2010 Langley 2005 = Langley et al., 2005 Lara 2009 = Lara et al., 2009 Larsson 2006 = Larsson, Lichtenstein, & Larsson, 2006 Lasky-Su 2007a = Lasky-Su, Banaschewski, et al., 2007 Lasky-Su 2007b = Lasky-Su, Faraone, et al., 2007 Lasky-Su 2008a = Lasky-Su, Lange, et al., 2008 Lasky-Su 2008b = Lasky-Su, Neale, et al., 2008 Laucht 2007 = Laucht et al., 2007 Laurin 2005 = Laurin et al., 2005 Laurin 2008a = Laurin et al., 2008a Laurin 2008b = Laurin et al., 2008b LaVigne 2009 = Lavigne, LeBailly, Hopkins, Gouze, & Binns, 2009 Lee 2006 = Lee & Hinshaw, 2006 Lee 2007a = S. S. Lee et al., 2007 Lee 2007b = J. Lee et al., 2007 Lee 2008a = J. Lee et al., 2008 Lee 2008b = S. I. Lee et al., 2008 Lemiere 2010 = Lemiere et al., 2010 Levy 2001 = Levy, McStephen, & Hay, 2001 Levy 2005 = Levy, Hay, Bennett, & McStephen, 2005 Li 2005 = Li et al., 2005 Li 2006a = Li, Wang, et al., 2006a Li 2006b = Li, Wang, et al., 2006b Li 2006c = Li, Zhang, et al., 2006 Li 2007a = Li, Kang, et al., 2007 Li 2007b = Li, Wang, et al., 2007 Lockwood 2001 = Lockwood, Marcotte, & Stern, 2001 Loe 2009 = Loe, Feldman, Yasui, & Luna, 2009 Loo 2007 = Loo et al., 2007 Loo 2010 = Loo et al., 2010 Lowe 2004 = Lowe et al., 2004 Lubke 2007 = Lubke et al., 2007 Lubke 2009 = Lubke, Hudziak, Derks, van Bijsterveldt, & Boomsma, 2009 Luca 2007 = Luca et al., 2007 Ludwig 2009 = Ludwig, Matte, Katz, & Rohde, 2009 Lui 2007 = Lui & Tannock, 2007 Maayan 2009 = Maayan et al., 2009 Maedgen 2000 = Maedgen & Carlson, 2000 Magnusson 1999 = Magnusson, Smari, Gretarsdottir, & Prandardottir, 1999 Magnusson 2006 = Magnusson et al., 2006 Mahone 2009 = Mahone, Mostofsky, Lasker, Zee, & Denckla, 2009 Malhi 2008 = Malhi, Singhi, & Sidhu, 2008 Manor 2000 = Manor et al., 2000 Manor 2001 = Manor et al., 2001 Manor 2004 = Manor et al., 2004 Manor 2008 = Manor et al., 2008 Marchant 2010 = Marchant, Reimherr, Halls, Williams, & Strong, 2010 Markunas 2010 = Markunas et al., 2010 Martel 2007 = M. Martel, Nikolas, & Nigg, 2007 Martel 2009 = M. M. Martel, Nigg, & von Eye, 2009 Martel 2010 = M. M. Martel, von Eye, & Nigg, 2010


Martin 2006 = Martin, Piek, & Hay, 2006 Martinn. 2006 = Martinussen & Tannock, 2006 Massetti 2008 = Massetti et al., 2008 Mattison 2003 = Mattison, Gadow, Sprafkin, Nolan, & Schneider, 2003 McBurnett 1999 = McBurnett et al., 1999 McBurnett 2001 = McBurnett, Pfiffner, & Frick, 2001 McCann 2004 = S. & Roy-Byrne, 2004 McCracken 2000 = McCracken et al., 2000 McFadden 2005 = McFadden, Westhafer, Pasanen, Carlson, & Tucker, 2005 McGough 2006 = McGough et al., 2006 McInnes 2003 = McInnes, Humphries, Hogg-Johnson, & Tannock, 2003 McLoughlin 2007 = McLoughlin, Ronald, Kuntsi, Asherson, & Plomin, 2007 Medori 2008 = Medori et al., 2008 Merrell 2001 = Merrell & Tymms, 2001 Meyer 2004 = Meyer, Eilertsen, Sundet, Tshifularo, & Sagvolden, 2004 Michelson 2003 = Michelson et al., 2003 Mikami 2007 = Mikami, Huang-Pollock, Pfiffner, McBurnett, & Hangai, 2007 Mikami 2008 = Mikami, Hinshaw, Patterson, & Lee, 2008 Mill 2002 = Mill et al., 2002 Miller 2006 = S. R. Miller, Miller, Bloom, Hynd, & Craggs, 2006 Miller 2007 = T. W. Miller, Nigg, & Faraone, 2007 Misener 2004 = Misener et al., 2004 Mitchell 2009 = Mitchell, Knouse, Nelson-Gray, & Kwapil, 2009 Mitsis 2000 = Mitsis, McKay, Schulz, Newcorn, & Halperin, 2000 Molina 2001 = Molina, Smith, & Pelham, 2001 Molina 2003 = Molina & Pelham, 2003 Molina 2009 = Molina et al., 2009 Monastra 2001 = Monastra, Lubar, & Linden, 2001 Montiel 2008 = Montiel, Pena, Montiel-Barbero, & Polanczyk, 2008 Morgan 1996 = Morgan, Hynd, Riccio, & Hall, 1996 MTA 1999 = The MTA Cooperative Group, 1999 Mugnaini 2006 = Mugnaini et al., 2006 Mulder 2010 = Mulder et al., 2010 Mullins 2005 = Mullins, Bellgrove, Gill, & Robertson, 2005 Murphy 1996 = K. Murphy & Barkley, 1996 Murphy 2000 = P. Murphy & Schachar, 2000 Murphy 2001 = K. R. Murphy, Barkley, & Bush, 2001 Murphy 2002 = K. R. Murphy, Barkley, & Bush, 2002 Murray 2007 = Murray et al., 2007 Neale 2008 = Neale et al., 2008 Neuman 1999 = Neuman et al., 1999 Neuman 2001 = Neuman et al., 2001 Neuman 2005 = Neuman et al., 2005 Neuman 2007 = Neuman et al., 2007 Newcorn 2009 = Newcorn, Sutton, Weiss, & Sumner, 2009 Nigg 2002a = Nigg, Blaskey, Huang-Pollock, & Rappley, 2002 Nigg 2002b = Nigg, John, et al., 2002 Nigg 2005 = Nigg et al., 2005 Nolan 1999 = Nolan, Volpe, Gadow, & Sprafkin, 1999 Nolan 2001 = Nolan, Gadow, & Sprafkin, 2001 Norvilitis 2008 = Norvilitis, Ingersoll, Zhang, & Jia, 2008 Norvilitis 2010 = Norvilitis, Sun, & Zhang, 2010 Nyman 2007 = Nyman et al., 2007 O'Brien 2010 = O'Brien, Dowell, Mostofsky, Denckla, & Mahone, 2010 O'Driscoll 2005 = O'Driscoll et al., 2005 Ohnishi 2010 = Ohnishi, Okada, Tani, Nakajima, & Tsujii, 2010 Ostrander 2008 = Ostrander, Herman, Sikorski, Mascendaro, & Lambert, 2008 Ouellet-Morin 2008 = Ouellet-Morin et al., 2008 Owens 2003 = E. B. Owens et al., 2003 Owens 2005 = J. S. Owens et al., 2005 Owens 2009 = E. B. Owens, Hinshaw, Lee, & Lahey, 2009


Paloyelis 2009 = Paloyelis, Asherson, & Kuntsi, 2009 Paloyelis 2010a = Paloyelis, Asherson, Mehta, Faraone, & Kuntsi, 2010 Paloyelis 2010b = Paloyelis, Rijsdijk, Wood, Asherson, & Kuntsi, 2010 Park 2005 = Park et al., 2005 Pasini 2007 = Pasini, Paloscia, Alessandrelli, Porfirio, & Curatolo, 2007 Paternite 1996 = Paternite, Loney, & Roberts, 1996 Pelletier 2006 = Pelletier, Collett, Gimpel, & Crowley, 2006 Penny 2009 = Penny, Waschbusch, Klein, Corkum, & Eskes, 2009 Pfiffner 2007 = Pfiffner et al., 2007 Piek 1999 = Piek, Pitcher, & Hay, 1999 Pineda 1999 = Pineda et al., 1999 Pineda 2002 = Pineda et al., 2002 Pineda 2003 = Pineda, Lopera, Palacio, Ramirez, & Henao, 2003 Pitcher 2003 = Pitcher, Piek, & Hay, 2003 Polanczyk 2007 = Polanczyk et al., 2007 Polanczyk 2008 = Polanczyk et al., 2008 Polderman 2007 = Polderman et al., 2007 Pope 2010 = Pope, 2010 Power 1998a = Power, Andrews, et al., 1998 Power 1998b = Power, Doherty, et al., 1998 Power 2001 = Power, Costigan, Leff, Eiraldi, & Landau, 2001 Power 2004 = Power, Costigan, Eiraldi, & Leff, 2004 Pritchard 2008 = Pritchard, Neumann, & Rucklidge, 2008 Proctor 2009 = Proctor & Prevatt, 2009 Qian 2003 = Q. Qian et al., 2003 Qian 2004 = Q. Qian, Wang, Zhou, Yang, & Faraone, 2004 Qian 2007 = Q. Qian et al., 2007 Qian 2009 = Q. J. Qian et al., 2009 Querne 2009 = Querne & Berquin, 2009 Quinlan 2003 = Quinlan & Brown, 2003 Rabiner 2008 = Rabiner, Anastopoulos, Costello, Hoyle, & Swartzwelder, 2008 Rasmussen 2002a = Rasmussen, Neuman, et al., 2002 Rasmussen 2002b = Rasmussen, Todd, et al., 2002 Rasmussen 2004 = Rasmussen et al., 2004 Reiersen 2007 = Reiersen, Constantino, Volk, & Todd, 2007 Reiersen 2008 = Reiersen, Constantino, & Todd, 2008 Retz 2008 = Retz et al., 2008 Reynolds 2004 = Reynolds & Kamphaus, 2004 Ribases 2008 = Ribases et al., 2008 Ribases 2009 = Ribases et al., 2009 Riccio 2005 = Riccio et al., 2005 Riccio 2006 = Riccio, Homack, Jarratt, & Wolfe, 2006 Riley 2006 = A. W. Riley et al., 2006 Riley 2008 = C. Riley et al., 2008 Rodriguez 2007 = P. D. Rodriguez & Baylis, 2007 Rodriguez 2008 = D. Rodriguez, Tercyak, & Audrain-McGovern, 2008 Rohde 2001 = Rohde et al., 2001 Roman 2001 = Roman et al., 2001 Roman 2002 = Roman et al., 2002 Roman 2003 = Roman et al., 2003 Roman 2006 = Roman et al., 2006 Rosenthal 2006 = Rosenthal, Riccio, Gsanger, & Jarratt, 2006 Rosler 2009 = Rosler, Fischer, Ammer, Ose, & Retz, 2009 Rowe 1998 = Rowe et al., 1998 Rowe 1999 = Rowe et al., 1999 Rowland 2007 = Rowland, Umbach, Bohlig, Stallone, & Sandler, 2007 Rowland 2008 = Rowland et al., 2008 Rucklidge 2002 = Rucklidge & Tannock, 2002 Sawyer 2002 = Sawyer, Rey, Graetz, Clark, & Baghurst, 2002 Scheres 2004 = Scheres et al., 2004 Scheres 2008 = Scheres, Lee, & Sumiya, 2008


Scheres 2010 = Scheres, Tontsch, Thoeny, & Kaczkurkin, 2010 Schmitz 2002 = Schmitz et al., 2002 Schmitz 2006 = Schmitz et al., 2006 Scholte 2001 = Scholte, Van Berckelaer-Onnes, & Van der Ploeg, 2001 Schweitzer 2006 = Schweitzer, Hanford, & Medoff, 2006 Sem-Cl 2010a = Semrud-Clikeman, 2010 Sem-Cl 2010b = Semrud-Clikeman, Walkowiak, Wilkinson, & Butcher, 2010 Sem-Cl 2010c = Semrud-Clikeman, Walkowiak, Wilkinson, & Christopher, 2010 Sem-Cl 2010d = Semrud-Clikeman, Walkowiak, Wilkinson, & Minne, 2010 Serra-Pinh. 2008 = Serra-Pinheiro, Mattos, & Angelica, 2008 Servera 2010 = Servera, Lorenzo-Seva, Cardo, Rodriguez-Fornells, & Burns, 2010 Shaffer 2000 = Shaffer, Fisher, Lucas, Dulcan, & Schwab-Stone, 2000 Shanahan 2006 = Shanahan et al., 2006 Shipp 2010 = Shipp, Burns, & Desmul, 2010 Skounti 2006 = Skounti, Philalithis, Mpitzaraki, Vamvoukas, & Galanakis, 2006 Smalley 1998 = Smalley et al., 1998 Smalley 2000 = Smalley et al., 2000 Smalley 2002 = Smalley et al., 2002 Smith 2003 = Smith, Johnstone, & Barry, 2003 Smoller 2006 = Smoller et al., 2006 Sobanski 2008 = Sobanski et al., 2008 Solanto 2004 = Solanto, Etefia, & Marks, 2004 Solanto 2007 = Solanto et al., 2007 Solanto 2009a = Solanto & Alvir, 2009 Solanto 2009b = Solanto, Newcorn, et al., 2009 Solanto 2009c = Solanto, Pope-Boyd, Tryon, & Stepak, 2009 Solanto 2009d = Solanto, Schulz, Fan, Tang, & Newcorn, 2009 Solanto 2010 = Solanto et al., 2010 Span 2002 = Span, Earleywine, & Strybel, 2002 Spencer 2001 = Spencer et al., 2001 Sprafkin 2001 = Sprafkin, Gadow, & Nolan, 2001 Sprafkin 2002a = Sprafkin, Gadow, Salisbury, Schneider, & Loney, 2002 Sprafkin 2002b = Sprafkin, Volpe, Gadow, Nolan, & Kelly, 2002 Sprafkin 2007 = Sprafkin, Gadow, Weiss, Schneider, & Nolan, 2007 Stavro 2007 = Stavro, Ettenhofer, & Nigg, 2007 Stawicki 2006 = Stawicki, Nigg, & von Eye, 2006 Stein 2003 = Stein et al., 2003 Sun et al. 2005 = Sun et al., 2005 Svanborg 2009 = Svanborg et al., 2009 Szomlaiski 2009 = Szomlaiski et al., 2009 Tahir 2000 = Tahir et al., 2000 Tandon 2009 = Tandon, Si, Belden, & Luby, 2009 Tani 2010 = Tani, Okada, Ohnishi, Nakajima, & Tsujii, 2010 Tercyak 2002 = Tercyak, Lerman, & Audrain, 2002 Thompson 2007 = Thompson, Molina, Pelham, & Gnagy, 2007 Thorell 2007 = Thorell, 2007 Tillman 2008 = Tillman, Thorell, Brocki, & Bohlin, 2008 Todd 2001a = Todd, Jong, et al., 2001 Todd 2001b = Todd, Neuman, et al., 2001 Todd 2001c = Todd, Rasmussen, et al., 2001 Todd 2002a = Todd & Lobos, 2002 Todd 2002b = Todd et al., 2002 Todd 2003 = Todd, Lobos, Sun, & Neuman, 2003 Todd 2004 = Todd, Rasmussen, Wood, Levy, & Hay, 2004 Todd 2008 = Todd et al., 2008 Toplak 2003 = Toplak, Rucklidge, Hetherington, John, & Tannock, 2003 Toplak 2005 = Toplak, Jain, & Tannock, 2005 Toplak 2009 = Toplak et al., 2009 Tucha 2008 = Tucha et al., 2008 Upadhyaya 2008 = Upadhyaya & Carpenter, 2008 Valo 2010 = Valo & Tannock, 2010


van Eck 2010 = Van Eck, Finney, & Evans, 2010 van West 2009 = van West, Claes, & Deboutte, 2009 Vaughn 1997 = Vaughn, Riccio, Hynd, & Hall, 1997 Volk 2005 = Volk, Neuman, & Todd, 2005 Volk 2006 = Volk, Henderson, Neuman, & Todd, 2006 Volk 2009 = Volk, Todorov, Hay, & Todd, 2009 Wahlstedt 2009a = Wahlstedt, 2009 Wahlstedt 2009b = Wahlstedt, Thorell, & Bohlin, 2009 Wahlstedt 2010 = Wahlstedt & Bohlin, 2010 Waldman 1998 = Waldman et al., 1998 Waldman 2006 = Waldman & Gizer, 2006 Wang et al. = Wang et al., 2006 Waschb. 2003 = Waschbusch & Sparkes, 2003 Waschb. 2006 = Waschbusch & King, 2006 Waschb. 2007 = Waschbusch, King, & Gregus, 2007 Weber 2007 = Weber, Jourdan-Moser, & Halsband, 2007 Weiler 1999 = Weiler, Bellinger, Marmor, Rancier, & Waber, 1999 Weiler 2000 = Weiler et al., 2000 Weiss 2003 = Weiss, Worling, & Wasdell, 2003 Weiss 2005 = Weiss et al., 2005 Wiersema 2009 = Wiersema & Roeyers, 2009 Wigg 2006 = Wigg et al., 2006 Wilens 2008 = Wilens et al., 2008 Willcutt 1999a = Willcutt, Hartung, Lahey, Loney, & Pelham, 1999 Willcutt 1999b = Willcutt, Pennington, Chhabildas, Friedman, & Alexander, 1999 Willcutt 2001 = Willcutt, Chhabildas, & Pennington, 2001 Willcutt 2005 = Willcutt, Pennington, Olson, Chhabildas, & Hulslander, 2005 Willcutt 2007a = Willcutt, Betjemann, Pennington, et al., 2007 Willcutt 2007b = Willcutt, Betjemann, Wadsworth, et al., 2007 Willcutt 2007c = Willcutt, Pennington, Olson, & DeFries, 2007 Willcutt 2009 = Willcutt, 2009 Willcutt 2010a = Willcutt, Betjemann, et al., 2010 Willcutt 2010b = Willcutt, Pennington, et al., 2010 Willcutt 2011a = Willcutt, Barnard, et al., 2011 Willcutt 2011b = Willcutt & Bidwell, 2011 Willcutt 2011c = Willcutt, Boada, et al., 2011 Wodka 2008a = Wodka, Loftis, et al., 2008 Wodka 2008b = Wodka, Mostofsky, et al., 2008 Wohl 2008 = Wohl et al., 2008 Wolraich 1996 = Wolraich, Hannah, Pinnock, Baumgaertel, & Brown, 1996 Wolraich 1998a = Wolraich, Feurer, Hannah, Baumgaertel, & Pinnock, 1998 Wolraich 1998b = Wolraich, Hannah, Baumgaertel, & Feurer, 1998 Wolraich 2001 = Wolraich et al., 2001 Wolraich 2003a = Wolraich, Lambert, Baumgaertel, et al., 2003 Wolraich 2003b = Wolraich, Lambert, Doffing, et al., 2003 Wolraich 2004 = Wolraich et al., 2004 Wood 2009 = Wood, Rijsdijk, Asherson, & Kuntsi, 2009 Yang 2000 = K. N. Yang, Schaller, & Parker, 2000 Yang 2004a = L. Yang, Wang, Li, & Faraone, 2004 Yang 2004b = L. Yang, Wang, Qian, Biederman, & Faraone, 2004 Yang 2007 = P. Yang, Jong, Hsu, & Tsai, 2007 Yang 2008 = J. W. Yang et al., 2008 Zhao 2005 = Zhao et al., 2005 Zucker 2002 = Zucker, Morris, Ingram, Morris, & Bakeman, 2002 Zuddas 2006 = Zuddas et al., 2006


SUPPLEMENT SECTION 3:

STUDIES INCLUDED IN QUALITATIVE REVIEWS OF CRITERIA NOT INCLUDED IN A FORMAL META-ANALYSIS

3.1. Papers describing different methods to test the validity of mental disorders: Cantwell, 1980; Cronbach & Meehl, 1955; Follette & Houts, 1996; Helzer, Kraemer, & Krueger, 2006; Lahey & Willcutt, 2002; Rutter, 1978; Spitzer & Wakefield, 1999; Wakefield, 1992, 1999; Widiger & Clark, 2000 3.2. Predictive validity of the symptom dimensions or subtypes: Hinshaw 2006, Hinshaw 2007, Lahey 2004a, Lahey 2005, Lahey 2007, Lahey 2010, Lee 2006, Owens 2009, Willcutt 2007b 3.3. Association between DSM-IV ADHD symptoms and substance-use disorders: Burke, 2007, Covey 2008, Elkins 2007, Gadow 2002, Gordon 2006, Kollins 2005, Lee 2006, Molina 2003, Rodriguez 2008, Tercyak 2002, Upadhyaya 2008 3.4. EEG/ERP studies of DSM-IV dimensions or subtypes: Alexander 2008, Barry 2002, Barry 2005, Barry 2006, Burgio-Murphy 2007, Chabot 1996, Clarke 1998, Clarke 2001a, Clarke 2001b, Clarke 2003, Clarke 2007, Johnstone 2001, Johnstone 2003, Johnstone 2007, Johnstone 2009, Keage 2006, Keage 2008, Klorman 2002, Kuperman 1996, Loo 2010, Monastra 2001, Rodriguez 2007, Smith 2003, Wiersema 2009 3.5. Family or twin studies of DSM-IV dimensions or subtypes: Faraone 2000a, Faraone 2000b, Larsson 2006, Levy 2001, Polderman 2007, Smalley 2000, Stawicki 2006, Todd 2001c, Willcutt 2010b 3.6. Treatment studies reporting results separately by DSM-IV ADHD symptom dimension or subtype: Antshel 2003, Arabgol 2009, Arnold 2007, Barbaresi 2006, Biederman 2005, Biederman 2006a, Biederman 2006b, Biederman 2006c, Biederman 2008a, Biederman 2008b, Brown 2010, Buitelaar 2007, Buitelaar 2009, Chou 2009, Chronis-Tuscano 2008, Cox 2006, Durell 2009, Evans 2010, Faraone 2005b, Findling 2008, Gorman 2006, Hoare 2005, Kratochvil 2007, Maayan 2009, Marchant 2010, McGough 2006, Medori 2008, Michelson 2003, Molina 2009, MTA 1999, Newcorn, 2009, O'Driscoll 2005, Owens 2005, Polanczyk 2008, Rosler 2009, Solanto 2009b, Spencer 2001, Stein 2003, Svanborg 2009, Weiss 2005, Wilens 2008, Wolraich 2001, Yang 2004 3.7. Studies that conducted latent class analyses of ADHD symptoms: Acosta 2008, Althoff 2006, Frazier 2007, Hudziak 1998, Lubke 2007, Lubke 2009, Neuman 1999, Neuman 2001, Neuman 2005, Neuman 2007, Ostrander 2008, Rasmussen 2002a, Rasmussen 2002b, Rasmussen 2004, Rohde 2001, Todd 2001c, Todd 2002b, Todd 2004, Volk 2006, Volk 2009 3.8. Studies of a refined inattentive type: Adams 2010, Bartgis 2009, Carr 2010, Derefinko 2008, Fillmore 2009, Goth-Owens 2010, Huang-Pollock 2010, McFadden 2005, Willcutt 2011a 3.9. Studies of sluggish cognitive tempo: Bauermeister 2005a, Carlson 2002b, Frick 1994, Garner 2010, Harrington 2010, Hartman 2004, Hinshaw 2002b, Hinshaw 2007, Huang-Pollock 2005, Lahey 2004a, Ludwig 2009, McBurnett 2001, Mikami 2007, Penny 2009, Todd 2004, Willcutt 2011a


SUPPLEMENT SECTION 4: SUMMARY TABLES FOR THE META-ANALYSIS

Supplement Table 2 Factor analyses of DSM-IV ADHD symptoms

Factor Loadinga Total Sample Age Factor Other DSM-IV Inattentive Symptoms DSM-IV Hyperactive-Impulsive Symptoms

Study N Typeb Range Analysisc symptomsd a b c d e f g h i a b c d e f g h i

PARENT RATINGS Burns 2001e 833 Comm 3 - 16 C O .75 .78 .68 .78 .78 .78 .70 .80 .79 .68 .74 .78 .74 .67 .74 .66 .80 .74 Burns 2006f 928 Comm C O .64 .60 .60 .69 .66 .71 .55 .65 .60 .63 .62 .64 .44 .58 .61 .59 .63 .67 DuPaul 1998a 4,666 Comm 5 - 17 Eh, C None .74 .47g .39g .81 .77 .79 .60 .47g .71 .59 .63 .72 .60 .77 .68 .63 .75 .73 F.-Weieneth 2009i 261 Clinic 3 - 4 Eh O .73 .63 .10g .31g .74 .50 .52 .45g .69 .52g .71 .58g .25g .62 .24g .04g .33g .49 Garner 2010 258 Clinic 5 - 17 C SCT .69 .82 .76 .81 .79 .73 .67 .84 .76 .72 .80 .84 .79 .77 .74 .69 .78 .87 Ghaniz. 2010 72 Clinic 8 - 17 Ej None .70 .77 .58 .65 .72 .62 .62 .49 .56 .57 .62 .72 .72 .71 .73 .74 .62 .61 Hardy 2007 481 Clinic 3 - 5 Eh None .73 .51 .29g .73 .81 .84 .55 .49 .61 .49 .36k .57 .50 .66 .70 .47 .59 .61 Hartman 2004 286 Comm 8 - 18 C SCT .78 .80 .76 .82 .80 .82 .77 .85 .84 .76 .74 .62 .75 .73 .63 .73 .79 .71 Hartman 2001l 805 Clinic 3 - 19 C C, A, D, O .55 .80 .15g .71 .54 .62 .43o .80 .54 .66p .69 .68 .44g .75 .60 .58 .70 .73 Hartman 2001l 965 Comm 4 - 13 C C, A, D, O .62 .82 .21o .61 .39p .63 .44p .79 .43p .67 .54 .44p .34g .67 .61 .52 .70 .45q

Hartman 2001m 906 Clinic 3 - 19 C C, A, D, O .72 .76 .50g .81 .75 .66 .68 .71 .76 --n .78 --n .77 .76 .64 .56 .68 .59q

Lui 2007 140 Comm 7 - 12 Ej None .70 .73g .69g .83 .82 .74 .79 .63g .73 .80 .71g .71 .87 .82 .81 .81 .74g .74 Magnusson 1999 427 Comm 6 - 8 Eh None .42 .52g .54 .54g .74 .59 .65 .36g .89 .67 .61 .69 .79 .72 .84 .55 .61 .71 McLoughlin 2007r 6,391 Comm 7 - 9 Ej None .66 .70 .61g .72 .72 .75 .57 .61g .67 .54g .47g .59 .62g .65 .70 .65 .56g .65 McLoughlin 2007s 6,051 Comm 7 - 9 Ej None .65 .71 .61g .75 .77 .74 .65 .61g .72 .55g .50g .61g .59g .67 .68 .66 .60g .70 Smalley 2000t 283 both 5 - 18 Ej None -- -- -- -- -- -- -- -- -- .72 .63 .74 .58 .78 .51 .60 .65 .63 Szomlaiski 2009 554 Comm 6 - 17 Ej C .70 .64g .44g .54o .67 .71 .67 .54g .65 .59 .64 .52g .48g .65 .60 .60 .68 .67o Szomlaiski 2009 138 Clinic 3 - 17 Ej C .67 .62g .42g .58g .74 .73 .70 .67g .75o .65g .78 .81o .69o .72o .50g .53g .71g .77g Tani 2010 5,977 Comm 5 - 13 C None .55 .74 .60 .71 .72 .69 .64 .74 .66 .62 .64 .67 .72 .70 .55 .60 .65 .64 Todd 2004r 1,414 Comm 7 - 19 Eh SCT .92 .83 .79 .97 1.0 .92 .87 .68 .84 .66 .40g .95 .83 .80 .92 1.00 .89 .90 Todd 2004s,u 1,430 Comm 7 - 19 Eh SCT .86 .84 .87 .96 1.0 .89 .72 .69 .92 -- -- -- -- -- -- -- -- -- Van Eck 2010 250 Clinic 10 - 18 C None .69 .69 .58 .77 .79 .75 .76 .75 .78 .57 .62 .70 .71 .73 .61 .63 .79 .66 Waschbusch 2003 777 Comm 5 - 12 C O .75 .83 .64 .79 .79 .74 .62 .72 .72 .68 .76 .78 .74 .83 .46 .56 .74 .57 Weiler 1999 349 Both 7 - 11 Eh C, D, O .57 .55 .57 .61 .77 .71 .67 .61g .76 .78 .57 .65 .66 .83 .61 --v .70 .62 Wolraich 2003b 243 Clin 5 -10 C C, A, D, O .77 .79 .73 .82 .83 .73 .72 .76 .80 .76 .79 .85 .76 .81 .55 .72 .77 .79

Mean loading on primary factor in confirmatory factor analyses: .69 .74 .55 .75 .72 .72 .63 .66 .70 .67 .70 .70 .65 .73 .62 .62 .73 .68 Mean loading on primary factor in exploratory factor analyses: .68 .64 .50 .67 .77 .72 .66 .55 .72 .62 .58 .68 .63 .72 .67 .61 .65 .68

Mean cross-loadingw: .12 .27 .33 .16 .08 .03 .13 .36 .08 .21 .21 .17 .20 .09 .09 .15 .19 .17 Percent cross-loaded > .30 on the other factor 0% 33% 67% 20% 0% 0% 0% 60% 0% 27% 27% 20% 40% 0% 13% 13% 33% 7%





TEACHER RATINGS Alloway 2010 964 Comm 10 Ej None .81 .82 .67g .85 .81 .82 .70 .70g .81 .61g .77 .72 .81 .76 .74 .84 .85 .80 Baumgaertel 1995 1,077 Comm 5 - 12 Ej C, O .80 .79 .78 .78 .83 .81 .62 .70 .71 .81 .83 .80 .67 .82 .78 .77 .70q .69q

DuPaul 1997 4,009 Comm 4 - 19 Eh, C None .84 .74 .55g .96 .92 .88 .73 .66 .88 .57g .73 .73 .66 .82 .79 .93 .92 .92 Garner 2010 276 Clinic 5 - 17 C SCT .75 .83 .78 .85 .81 .81 .78 .90 .79 .86 .85 .88 .64 .80 .82 .83 .89 .91 Hardy 2007 356 Clinic 3 - 5 Eh None .77 .37g .52g .69 .78 .76 .50 .22g .70 .76 .73 .70 .63 .77 .67 .61 .70 .73 Hartman 2004 229 Comm 8 - 18 C SCT .79 .90 .75 .81 .86 .85 .82 .81 .82 .77 .80 .67 .71 .82 .71 .81 .87 .86 Hartman 2001l 637 Clinic 3 - 17 C C, A, D, O .61 .81 .43o .74 .70 .68 .62 .65g .54p .59g .77 .52o .73p .78 .78 .74 .80 .57g

Hartman 2001l 965 Comm 4 - 13 C C, A, D, O .61 .83 .28g .71 .68 .65 .38g .63g .55 .65 .69 .43o .32g .73 .69 .69 .75 .43o

Hartman 2001m 852 Clinic 3 - 19 C C, A, D, O .68 .83 .51g .82 .83 .70 .63 .59g .71 --n .79 --n .79 .75 .73 .73 .84 .84 Hartman 2001m 1,523 Comm 5 - 13 C C, A, D, O .80 .89 .66g .89 .89 .82 .81 .86 .85 --n .68g --n .85 .84 .79 .83 .87 .85 Magnusson 1999 353 Comm 6 - 8 Eh None .82 .84 .69 .83 .90 .77 .73 .38g .75 .60g .72 .64 .75 .67 .77 .93 .86 .92 Meyer 2004 6,094 Comm 6 - 15 Ej None .78 .73g .61g .81 .81 .81 .64g .42g .79 .68g .71g .71 .46g .76 .75 .75 .63g .72 Molina 2001x 247 Comm 11 - 16 C O .89 .91 .86 .91 .90 .90 .86 .86 .83 .82 .87 .87 .87 --y .87 .87 .88 .89 Molina 2001aa 224 Clinic 13 - 18 C O .87 .89 .83 .80 .92 .87 .77 .84 .84 .72 .77 .75 .81 .80 .77 .81 .85 .84 Ohnishi 2010 7,414 Comm 6 - 15 C None .73 .84 .58 .73 .71 .75 .72 .81 .68 .70 .70 .66 .75 .73 .65 .63 .71 .71 Rowland 2007ab 2,996 Comm 6 - 12 C C, O .89 .95 .91 .94 .93 .90 .91 .95 .91 .93 .93 .92 .92 .92 .84 .93z .93z .93z

Rowland 2007ac 3,046 Comm 6 - 12 C C, O .88 .95 .91 .94 .94 .90 .92 .96 .92 .93 .91 .92 .93 .91 .84 .92z .92z .92z

Shipp 2010 872 Comm 11 - 19 C O, acad .88 .91 .88 .90 .90 .92 .89 .88 .88 .84 .89 .90 .88 .90 .83 .90 .88 .86 Waschbusch 2003 777 Comm 5 - 12 C O .94 .96 .86 .96 .96 .95 .90 .91 .89 .87 .95 .87 .92 .92 .86 .90 .94 .92 Wolraich 1998a 6,591 Comm 6 - 12 Eh, C C, A, D, O .75 .71 .65 .74 .85 .71 .68 .73 .80 .56g .64 .57 .77 .69 .77 .81 .73 .68 Wolraich 2003aad 6,090 Comm M = 8 C C, A, D, O .89 .93 .86 .92 .93 .87 .87 .90 .88 .88 .91 .86 .90 .89 .81 .90 .92 .93 Wolraich 2003aae 1,283 Comm M = 8.2 C C, A, D, O .91 .93 .86 .91 .90 .88 .84 .90 .91 .90 .93 .91 .77 .80 .71 .91 .91 .91 Yang 2000r,af 231 Comm 6 - 12 Ej None .79g .81g .68g .82 .85g .86 .74g .78g .78g .77g .76g .77g .80g .81g .76 .85 .82g .86g

Yang 2000s,af 223 Comm 6 - 12 Ej None .83 .82g .71g .83g .82g .86g .80g .83g .79g .78g .84g .86 .86 .79 .55g .81g .80g .83 Mean loading on primary factor in confirmatory factor analyses: .79 .86 .68 .84 .84 .81 .75 .79 .78 .75 .80 .74 .74 .81 .77 .81 .85 .81

Mean loading on primary factor in exploratory factor analyses: .80 .74 .65 .81 .84 .81 .68 .60 .78 .68 .75 .72 .71 .77 .73 .81 .78 .79 Mean cross-loadingw: .16 .35 .38 .16 .17 .16. .25 .45 .23 .35 .22 .24 .31 .17 .22 .14 .20 .17

Percent cross-loaded > .30 on the other factor 9% 36% 82% 9% 18% 9% 36% 82% 18% 64% 36% 9% 36% 9% 9% 9% 27% 18%





SELF REPORT RATINGS

Rasmussen 2002b 497 Comm Eh None .87 .69 .98 1.00 .92 .74 .94 .54 .87 .61 .66 .87 .73 1.00 .95 .92 .88 .65 Rohde 2001 1,013 Comm Eh None .78 .59 .73 .88 1.00 .73 .84 .18g .99 .90 .49 .82 .59 .97 1.00 .84 .29g .78

Note: Studies in the table are those that provided specific item loadings. Additional factor analytic studies that did not provide specific loadings include Amador-Campos 2006, Burns 1997, Burns 2003, Döpfner 2006, Gau 2009, Gomez 1999, Gomez 2003, Gomez 2005, Gomez 2009, Hay 2007, Hurtig 2007, Lahey 2004a, Lahey 2008, McBurnett 2001, Pelletier 2006, Proctor 2009, and Toplak 2009. aloading of the symptom on the specified DSM-IV factor. bClinic = clinic sample, Comm = nonreferred community sample. cE = exploratory factor analysis, C = confirmatory factor analysis. In EFA, results were extremely similar for oblique and orthogonal rotations, with slightly lower loadings after oblique rotation for the items with the lowest overall loadings on the inattention factor (mean EFA loading for orthogonal vs. oblique loadings: inattention symptom c = .56 vs. .45 for parents and .69 vs. .60 for teachers, inattention symptom h = .59 vs. .51 for parents and .69 vs. .50 for teachers). dOther symptoms included in the factor analysis: A = anxiety, C = conduct disorder, D = depression, O = oppositional defiant disorder, SCT = sluggish cognitive tempo. ealso included in Burns 2006. fMalaysian sample. gitem cross-loaded above .30 on the other ADHD dimension. hoblique rotation. imother ratings used because father ratings were only available for a subset of children. jorthogonal rotation. khyp-imp item 2 (out of seat) dropped from final model. lNetherlands sample. mUnited States sample. n"fidgets" and "runs about or climbs" not administered. ocross-loaded on CD factor. pcross-loaded on depression factor. qcross-loaded on ODD factor. rmales. sfemales. tInattention symptoms 5, 7, 9 loaded on third factor, so inattention loadings are not included in the means. uhyp-imp factor split into hyp-imp and impulsive-talkative in females. These loadings are not included in the summary means. v"blurts answers" not administered. w15 studies of parent ratings and 11 studies of teacher ratings reported secondary loadings from exploratory factor analyses, and Hartman et al. (2001) reported cross-loadings based on post-hoc model modification in confirmatory factor analyses. Secondary loadings were not provided for all items by Baumgaertel et al. (1995), Wolraich et al. (1998a), or Magnusson et al. (1999). xStudy 1. y"on the go" inadvertently omitted in study 1. zdue to extremely high item intercorrelations, the three impulsivity items were collapsed to form a single symptom. aaStudy 2. abyear 1. acyear2. adUrban US sample. aeSpanish sample. af"driven by a motor" translated as "overenergetic" due to lack of corresponding word in Chinese.


Supplement Table 3 Internal validity of the DSM-IV symptom dimensions in children and adolescents

Age Internal Reliability (α) Correlation Inter-rater Reliability (r) Test-retest Correlations (r) Study Samplea Range Ratersb N Inattention Hyp-Imp Inatt X Hyp-Imp Ratersb Inattention Hyp-Imp Interval Inattention Hyp-Imp

Am-Campos 2006 Comm 4 - 12 P 653 -- -- .62c -- -- -- -- -- -- Am-Campos 2006 Comm 4 - 12 T 653 -- -- .63c -- -- -- -- -- -- Angold 1995 Clinic 6 - 13 P 47 -- -- -- -- -- -- 1 wk .77 .79 Bauerm. 2005a/b Comm 7 - 11 P 79 .89 - .96c .89 - .96c .71 -- -- -- 4 wks .84 .84 Bauerm. 2010b Comm 6 - 12 P 568 .80 .86 -- -- -- -- -- -- -- Brocki 2010 Comm 5 - 7 P 72 .87 - .97c .87 - .97c .84 P & T .80 .76 -- -- -- Brocki 2010 Comm 5 - 7 T 72 .87 - .97c .87 - .97c -- -- -- -- -- -- -- Burns 1997 Comm 4 - 15 T 1,711 .95 .92 .78 -- -- -- -- -- -- Burns 2001 Comm 3 - 10 P 494 .92 .90 -- -- -- -- -- -- -- Burns 2001 Comm 3 - 16 P 91 .91 .92 -- -- -- -- -- -- -- Burns 2001 Comm 11 - 16 P 248 .94 .91 -- -- -- -- -- -- -- Burns 2006 Comm M = 9 P 928 .86 .83 -- -- -- -- -- -- -- Campbell 2009 Comm 3 - 6 P & T 921 -- -- -- P & T .52 .49 -- -- -- de Nijs 2004 Clinic 6 - 16 P & T 30 -- -- -- P & T .51 .27 -- -- -- Diamant. 2007 Comm 5 - 10 P & T 112 .71 .81 .70 -- -- -- -- -- -- Döpfner 2006 Clinic 6 - 18 CL & P 1,478 .81 .88 .43 -- -- -- -- -- -- DuPaul 1997 Comm 4 - 19 T 4,009 -- -- .70 -- -- -- -- -- -- DuPaul 1998a Comm 5 - 17 P 4,666 -- -- .68 -- -- -- -- -- -- DuPaul 1998b Comm 5 - 17 P 43 .86 .88 -- P & T .45 .40 4 wks .78 .86 DuPaul 1998b Comm 5 - 17 T 52 .96 .88 -- -- -- -- 4 wks .89 .88 English 2009 Clinic 6 - 17 P & T 63 -- -- -- -- .76 .69 -- -- -- Evans 2005 Comm 11 - 14 T & T 176 -- -- -- -- .30 .37 -- -- -- Fr-Weienath 2009 Comm 3 - 4 P 261 .87 .83 .68 P & P .60 .60 -- -- -- Gadow 1997a Clinic 6 - 12 P 101 -- -- .44c P & T .37 .40 -- -- -- Gadow 1997a Clinic 6 - 12 T 94 -- -- .51c -- -- -- -- -- -- Gadow 1997a Comm 6 - 12 P 824 -- -- .71c -- -- -- -- -- -- Gadow 1997a Comm 6 - 12 T 1,324 -- -- .60c -- -- -- -- -- -- Gadow 1997b Clinic 3 - 5 P 105d -- -- .59c P & T .49 .31 3 mths .64 .72 Gadow 1997b Clinic 3 - 5 T 36 -- -- .46c -- -- -- -- -- -- Gadow 1997b Comm 3 - 5 P 531 -- -- .70c -- -- -- -- -- -- Gadow 1997b Comm 3 - 5 T 398 -- -- .80c -- -- -- -- -- -- Gadow 1998 Clinic 13 - 18 P 144 -- -- .50c -- -- -- -- -- -- Gadow 1998 Clinic 13 - 18 T 123 -- -- .46c P & T .20 .41 -- -- -- Gadow 1998 Comm 13 - 18 P 824 -- -- .54c -- -- -- -- -- --




Gadow 1998 Comm 13 - 18 T 1,072 -- -- .64c -- -- -- -- -- -- Gadow 2001 Comm 3 - 6 P 256 .87c .87c -- -- -- -- -- -- -- Gadow 2001 Clinic 3 - 6 T 256e .95c .94c -- -- -- -- 8 mths .26 .61 Gadow 2002 Comm 11 - 18 S 239 .81 .79 .58 S & P .39 .32 2 wks .65 .65 Gadow 2004a Clinic 6 - 10 P & T 248 -- -- -- -- .25 .20 -- -- -- Garner 2010 Clinic 5 - 17 P 212 .89 - .92c .89 - .92c .70c P & T .31 .47 -- -- -- Garner 2010 Clinic 5 - 17 T 212 .89 - .92c .89 - .92c .67c -- -- -- -- -- -- Gau 2009 Comm 6 - 15 T 3,899f .95 --g -- -- -- -- 2 wks .84 --g

Gau 2010 Clinic 11 - 16 P & S 93 .89h --g -- -- -- -- -- -- -- Ghanizadeh 2010 Clinic 8 - 17 P 72 .81 .85 -- -- -- -- -- -- -- Gizer 2008 Clinic 5 - 17 P & T 99 -- -- -- P & T .25c .44c -- -- -- Gizer 2008 Clinic 5 - 17 P & P 68 -- -- -- P & P .72c .72c -- -- -- Gomez 1999 Comm 5 - 11 P 1,275 .92c .90c -- -- -- -- 3 mths .55c .55c Gomez 1999 Comm 5 - 11 T 1,275 .95c .94c -- -- -- -- 3 mths .70c .73c Gomez 2005 Comm 5 - 11 P 917 .86c .84c .66c -- -- -- -- -- -- Gomez 2005 Comm 5 - 11 T 917 .95c .93c .70c -- -- -- -- -- -- Gomez 2007 Comm 5 - 11 P 213 .92 .91 P & T .32 .22 -- -- -- Greven 2011 Comm 8 P 14,468 .90i .84i .57i -- -- -- 3.5 yrs .62 .65 Harrington 2010 Clinic 5 - 18 P 154 .96 .95 .69 -- -- -- -- -- -- Hartman 2001 Multiple 3 - 19 P & T 12,892 .69 Hartman 2004 Comm 8 - 18 P 296 .73c Hartman 2004 Comm 8 - 18 T 229 .63c Hartung 2002 Clinic 13 - 18 P & S 172 .92 .81 .64 P & S .50 .14 -- -- -- Hay 2004 Comm 7 - 15 P 2,320 -- -- -- -- -- -- 3 yrs .65 .66 Holmes 2004 Clinic 6 - 13 T & T 36 -- -- -- T & T .76 .87 1 wk .95 .94 Hudziak 1998 Comm 12 - 18 P 1,066 .88 .83 -- -- -- -- 2 yrs .72 .59 Kadesjo 2004 Comm 6 - 14 P 854 .90 .88 -- P & P .80 .76 6-8 wks .80 .84 Klassen 2004 Clinic M=10 P & T 131 -- -- .34 .39 -- -- -- Lahey 2008 Comm 6 - 17 P 4,050j -- -- .76k -- -- -- 1-2 wks .89 .88 Langberg 2010 Clinic 7 - 9 P & P 320 -- -- -- -- .39 .40 -- -- -- Lee 2006 Clinic 11 - 18 P & T 226 .88 .79 .76 P & T .79 .66 -- -- -- Levy 2005l Comm 4 - 18 P 2,173 .92 .90 .63 -- -- -- -- -- -- Levy 2005m Comm 4 - 18 P 2,198 .92 .90 .51 -- -- -- -- -- -- Lui 2007 Comm 7 - 12 P 140 .64 Magnusson 1999 Comm 6 - 8 P 427n .87c .89c .77c P & T .37 .46 -- -- --




Magnusson 1999 Comm 6 - 8 T 316 .93c .93c .68c -- -- -- -- -- -- Malhi 2008 Clinic 3 - 14 P & T 119 -- -- -- .33 .36 -- -- -- Martel 2009o Comm 7 - 12 P & T 179 .42 Martel 2009p Comm 13 - 18 P & T 184 .53 Mattison 2003 Comm 5 - 13 T 74 .92 .93 -- T & T .54 .52 2 wks .84 .85 McBurnett 1999 Clinic 3 - 18 P 692 .80c,q .85c,q -- -- -- -- -- -- -- McBurnett 1999 Clinic 3 - 18 T 692 .85c,q .91c,q -- -- -- -- -- -- -- McInnes 2003 Comm 9 - 12 P 77 -- -- .68c P & T .67 .65 -- -- -- McInnes 2003 Comm 9 - 12 T 77 -- -- .57c -- -- -- -- -- -- Merrell 2001 Comm 6 - 7 T 113 -- -- -- -- -- 18 mths .58 .63 Meyer 2004 Comm 6 - 15 T 6,094 .92 .90 -- -- -- Mitsis 2000 Clinic 7 - 11 P & T 74 -- -- -- -- .30 .39 -- -- -- Molina 2001r Clinic 11 - 16 T 247 .97 .96 .85 -- -- -- -- -- -- Molina 2001s Clinic 13 - 18 T 224 .96 .93 .77 -- -- -- -- -- -- Mugnaini 2006 Comm 6 - 8 T 1,891 .95 .93 -- -- -- -- -- -- -- Murray 2007 Clinic 3 - 5 P 452 .85c .72c .37c P & T .24 .26 -- -- -- Murray 2007 Clinic 3 - 5 T 452 .89c .90c .50c -- -- -- -- -- -- Ohnishi 2010 Comm 6 - 15 T 7,414 .91 .88 .78 -- -- -- -- -- -- Paloyelis 2010b Comm 8 - 11 P & T 1,312 -- -- .60 P & T .46 .40 -- -- -- Pelletier 2006 Comm M = 4.6 T 221 .93 .91 .81 -- -- -- -- -- -- Penny 2009 Comm 4 - 13 P 325 .67c Penny 2009 Comm 4 - 13 T 288 .61c Pierre 1997t Clinic 6 - 10 P 75 -- -- -- -- -- -- 6 wks .76 .82 Power 1998a Clinic 5 - 14 P 325 -- -- .67c P & T .41 .30 -- -- -- Power 1998a Clinic 5 - 14 T 288 -- -- .56c -- -- -- -- -- -- Rowe 1998 Clinic 8 - 12 P 239 -- -- -- P & P .83 .76 -- -- -- Rowland 2007 Comm 6 - 12 T 6,072u .96 .96 -- -- -- -- 2 wks .94 .90 Scholte 2001 Clinic 4 - 18 CL 412v .91 .93 .80 C & C .87 .87 2 wks .92 .94 Servera 2010 Comm 6 - 11 P 1,749 .90c .85c -- -- -- -- -- -- -- Servera 2010 Comm 6 - 11 T 1,749 .95c .94c -- -- -- -- -- -- -- Solanto 2009a Clinic 7 - 12 P 50 .84c .71c -- -- -- -- -- -- -- Solanto 2009a Clinic 7 - 12 T 50 .97c .90c -- -- -- -- -- -- -- Solanto 2009a Clinic 7 - 12 P 213 .91c .92c -- -- -- -- -- -- -- Solanto 2009a Clinic 7 - 12 T 213 .92c .95c -- -- -- -- -- -- --




Sprafkin 2001 Clinic 5 - 17 P 103 .95c .95c -- P & T .25 .46 -- -- -- Sprafkin 2001 Clinic 5 - 17 T 103 .95c .95c -- -- -- -- -- -- -- Sprafkin 2002a Clinic 6 - 11 P 247 .92 .91 .45 -- -- -- <4 mthsw .73 .83 Sprafkin 2002a Clinic 6 - 11 P 92 -- -- -- -- -- -- 4 yrs .16 .60 Sprafkin 2002b Clinic 3 - 6 P 224 .91 .90 -- P & T .40 .42 -- -- -- Tani 2010 Comm 5 - 13 P 5,977 .88 .85 .82 -- -- -- -- -- -- Tercyak 2002 Comm 14 S 672 .84 .78 .70 -- -- -- -- -- -- Thompson 2007 Clinic 11 - 25 P & S 347 .90 .91 .83 -- -- -- -- -- -- Thorell 2007 Comm 5 - 7 T 145 -- -- .58 -- -- -- -- -- -- Tillman 2008 Comm 4 - 12 T 525 .94 .94 -- -- -- -- -- -- -- Todd 2004y Comm 7 - 19 P 1,414 -- -- .58 -- -- -- -- -- -- Todd 2004z Comm 7 - 19 P 1,430 -- -- .43 -- -- -- -- -- -- Wahlstedt 2010 Comm 7 - 9 P & T 209 .93 .93 -- P & T .45 .41 -- -- -- Waschbusch 2003 Comm 5 - 12 P 777x .94c .92c .70c P & P .77 .77 9 mths .67c .75c Waschbusch 2003 Comm 5 - 12 T 1,520y .98c .97c .73c P & T .40 .43 9 mths .69c .63c Weiler 2000 Clinic 7 - 11 P 300z -- -- .72 P & T .66 .52 2-6 mths .70 .78 Weiss 2003 Clinic M = 13 P & T 276 -- -- -- P & T .09 .39 -- -- -- Willcutt 1999a Clinic 4 - 6 P & T 252 .96 .96 -- -- -- -- -- -- -- Willcutt 2001 Comm 8 - 18 P 357 -- -- -- P & T .49 .38 18 mths .87 .78 Willcutt 2007a Comm 13 - 23 P & T 306 -- -- -- -- -- -- 5 yrs .55 .49 Willcutt 2007b Comm 4 - 5 P 1,608 .89 .86 .56 -- -- -- 1 yr .69 .75 Wolraich 1998a Comm 6 - 12 T 6,591 .92 .90 .61 -- -- -- -- -- -- Wolraich 2003a Comm N/A T 6,090 .96 .93g -- -- -- -- -- -- -- Wolraich 2003a Comm M = 8.0 T 6,819 .95 .89g -- -- -- -- -- -- -- Wolraich 2003a Comm M = 8.2 T 1,283 .95 .89g -- -- -- -- -- -- -- Wolraich 2003a Comm M = 8.6 T 1,077 .95 .93g -- -- -- -- -- -- -- Wolraich 2003b Comm 5 - 10 P 243 -- -- .75 -- -- -- -- -- -- Wolraich 2004 Comm 5 - 10 P / T 213 -- -- .83 P & T .34 .27 -- -- -- Yang 2000aa Clinic 6-12 T 27 .84 .89 -- -- -- -- 6 wks .62 .79 Yang 2000ab Clinic 6-12 T 27 .89 .92 -- -- -- -- 6 mths .59 .76 Zuddas 2006 Comm 6-12 P 1,575 .89c .82c .64c P & T .46 .44 -- -- -- Zuddas 2006 Comm 6-12 T 1,085 .94c .93c .58c -- -- -- -- -- --



Results of the Meta-Analysis

ALL STUDIES

Mean α Correlation between inattention

and hyperactivity-impulsivity Inter-rater reliability Test-retest Reliability

kac total N Inatt Hyp-Imp kac total N r [95% CI] kac total N Inattention r [95% CI]

Hyp-Imp r [95% CI] Interv kac total N

Inattention r [95% CI]

Hyp-Imp r [95% CI]

60 88,220 .91 .89 59 96,406 .67 [.64, .70] 38 10,312 .51 [.44, .58] .49 [.43, .55] < 1 yr 21 6,061 .78 [.72, .83] .82 [.76, .86] 1+ yrs 7 19,264 .64 [.56, .70] .64 [.60, .68]

SEPARATE ANALYSES BY RATER

Raterad kac total N Inatt Hyp-Imp Raterad kac total N r [95% CI] Raterad kac total N Inattention r [95% CI]

Hyp-Imp r [95% CI] Raterad kac total N


Hyp-Imp r [95% CI]

P 34 40,597 .89 .87 P 39 55,341 .66 [.63, .70] P & T 29 8,460 .43 [.37, .48] .42 [.38, .46] P 16 23,040 .74 [.70, .78] .77 [.73, .81] T 31 57,026 .93 .92 T 28 32,528 .67 [.64, .70] P & P 6 1,850 .72 [.59, .81] .67 [.54, .77] T 11 2,758 .78 (.67, .86) .79 [.67, .87] T & T 3 313 .54 [.26, .74] .63 [.29, .83]

SEPARATE ANALYSES IN CLINIC VERSUS COMMUNITY SAMPLES

Sample kac total N Inatt Hyp-Imp Sample kac total N r [95% CI] Sample kac total N Inattention r [95% CI]

Hyp-Imp r [95% CI] Sample kac total N


Hyp-Imp r [95% CI]

Clinic 21 5,924 .90 .89 Clinic 15 4,603 .63 [.54, .71] Clinic 18 3,494 .52 [.39, .63] .50 [.41, .58] Clinic 7 574 .81 [.64, .90] .85 [.74, .91] Comm 39 81,553 .91 .89 Comm 40 78,475 .69 [.65, .72] Comm 20 6,818 .51 [.44, .58] .48 [.39, .56] Comm 20 24,659 .75 [.70, .79] .75 [.70, .79]

Notes. aComm = community. bP = parent, T = teacher, S = self, CL = clinician. cmultiple effects reported by the study were combined into a single effect size for meta-analysis (see Supplement section 2). dN = 32 for test-retest and inter-rater reliability. eN = 52 for test-retest reliability. fN = 233 for test-retest reliability. greliability reported separately for impulsivity only or for hyperactivity and impulsivity composites. Not included in the calculations of the means for the hyperactivity-impulsivity symptom dimension. hInattention = mean of parent and self report. imean of estimates at 8 and 11 years old. jN for test-retest reliability = 290. kmean of 6-11 and 12-17 year old samples. lmales. mfemales. nN = 265 for inter-rater reliability. ochild sample (7 - 12 years of age). padolescent sample (13 -18 years of age). qproxy DSM-IV measure. rstudy 1. sstudy 2. tunpublished study described by Gadow & Sprafkin (1997a). uN = 416 for test-retest reliability. vN = 190 for test-retest reliability, N = 109 for inter-rater reliability. wmean test-retest reliability for 1, 2, and 4 month intervals (Ns = 38 - 106). xN = 376 for inter-rater reliability between parents, N = 777 for inter-rater reliability between mother and teacher. N = 206 for test-retest reliability. yN = 659 for test-retest reliability. zN = 73 for inter-rater and test-retest reliability. aapilot study of sample of children with disabilities. abpilot study of separate sample of children suspected to have ADHD. ack = number of studies. adP = parent, T = teacher.


Supplement Table 4 Internal validity of the DSM-IV symptom dimensions in adults


Adler 2008 Clinic adultsc S 536 .81 .84 -- S & CL .45 .65 -- -- -- Belendiuk 2007d Clinic M = 38 S 69 -- -- .57 S & P .57 .43 -- -- -- Belendiuk 2007d Clinic M = 38 P 69 -- -- .79 -- -- -- -- -- -- Belendiuk 2007e Clinic M = 38 S 69 .90 .83 .64f S & O .54 .29 -- -- -- Belendiuk 2007e Clinic M = 38 O 69 -- -- .45f -- -- -- -- -- -- Canu 2007 Comm 18 - 24 S 37 -- -- -- -- -- -- 1 mth .81 .64 Conners 1999 Comm 19 - 50+ S 226 .80f .67f .48 -- -- -- -- -- -- Conners 1999 Comm 19 - 50+ O 219 .87f .82f .63 -- -- -- -- -- -- Covey 2008 Clinic M = 41 S 583 .87 .78 .60 -- -- -- -- -- -- Epstein 2006d Clinic 18 - 56 S 30 -- -- -- S & P .51f .14f 4 wks .49f .83f

Epstein 2006e Clinic 18 - 56 S 30 -- -- -- S & O .32f .42f 4 wks .91f .86f

Faraone 2005d Comm adultsc S 966 .88f .79f -- -- -- -- -- -- -- Faraone 2005e Comm adultsc S 966 .86f .75f -- -- -- -- -- -- -- Gadow 2004bg Comm 18 - 75 S 900 .87 .78 .56 -- -- -- -- -- -- Gadow 2004bh Clinic 18 - 76 S 487 .89 .88 .67 -- -- -- -- -- -- Gadow 2004bi Clinic 18 - 65 S 75 .83f .81f -- S & O .36 .29 -- -- -- Gadow 2004bi Clinic 18 - 65 O 75 .90f .86f .48 -- -- -- -- -- -- Gadow 2004bj Comm 18 - 49 S 209 .87 .88 -- -- -- -- -- -- -- Gadow 2004bk Comm adultsc S 219 -- -- -- -- -- -- 2 wks .63 .71 Gadow 2004bl Clinic adultsc S 37 .89 .88 -- -- -- -- -- -- -- Gadow 2004bm Clinic adultsc S 77 .90 .83 -- -- -- -- -- -- -- Gomez 2010 Comm 18 - 75 S 214 .83 .78 .64 -- -- -- -- -- -- Gudjonsson 2010d Comm 16 - 58 S 397 .91f .90f .68f -- -- -- -- -- -- Gudjonsson 2010e Comm 16 - 58 S 397 .85f .80f .59f -- -- -- -- -- -- Haberstick 2007 Comm 18 - 24 S 4,356 .67 Kass 2003 Comm M = 23 S 148 .90 .85 .70 -- -- -- -- Knouse 2008 Comm M = 19 S 206 .83 .74 .70 -- -- -- -- -- -- Konold 2008 Comm 17 - 22 S 1,079 .63 .65 -- -- -- -- -- -- -- Konold 2008 Comm 17 - 22 P 1,079 .79 .74 -- -- -- -- -- -- -- Kooij 2008d Clinic 19 - 57 S 120 .77f .81f .63f S & O .31f .43f -- -- -- Kooij 2008d Clinic 19 - 57 O 120 .87f .82f .63f -- -- -- -- -- -- Kooij 2008e Clinic 19 - 57 S 120 .86f .81f .39f S & O .39f .42f -- -- -- Kooij 2008e Clinic 19 - 57 O 120 .88f .83f .33f -- -- -- -- -- --


Supplement Table 4 Internal validity of the DSM-IV symptom dimensions in adults


Magnusson 2006d,n Clinic 17 - 77 S 46 .91 .94 .78f S & O .53f .58f -- -- -- Magnusson 2006d,n Clinic 17 - 77 O 46 .87 .91 .71 -- -- -- -- -- -- Magnusson 2006d,o Clinic 17 - 77 S 80 .93 .89 .85f S & O .65f .66f -- -- -- Magnusson 2006d,o Clinic 17 - 77 O 80 .92 .93 .88 -- -- -- -- -- -- Magnusson 2006e,n Clinic 17 - 77 S 46 .84f .90f .69f S & O .58f .66f -- -- -- Magnusson 2006e,n Clinic 17 - 77 O 46 .83 .84 .52 -- -- -- -- -- -- Magnusson 2006e,o Clinic 17 - 77 S 80 .92f .86f .82f S & O .69f .60f -- -- -- Magnusson 2006e,o Clinic 17 - 77 O 80 .92 .89 .73 -- -- -- -- -- -- McCann 2004 Clinic M = 38 S 82 .84 .86 -- -- -- -- -- -- -- Mitchell 2009p Comm M = 20 S 102 .85 .81 .69 -- -- -- Mitchell 2009q Comm M = 19 S 240 .83 .76 .63 -- -- -- Murphy 2000p Clinic 20 - 50 S & P 50 -- -- -- S & P .76 .69 -- -- -- Murphy 2000q Clinic 25 - 65 S & O 100 -- -- -- S & O .70 .59 -- -- -- Nigg 2002b Mult adultss P / S 1,620 .84 - .94f,r .84 - .94f,r .56s -- -- -- -- -- -- Nigg 2005 Comm 18 - 37 S & O 195 -- -- .72 -- -- -- -- -- -- Norvilitis 2008t,e Comm M = 21 S 283 .81 .71 -- -- -- -- -- -- -- Norvilitis 2008u,e Comm M = 21 S 343 .72 .62 -- -- -- -- -- -- -- Pope 2010 Comm adultc S 464 -- -- .58 -- -- -- -- -- -- Stavro 2007 Comm 18 - 37 P & S 195 .93 .89 -- -- -- -- -- -- -- Zucker 2002d Clinic collegev S & O 279 .89 - .91 .84 - .91 .61f S & O .56 .65 -- -- -- Zucker 2002e Clinic collegev S & O 279 .89 - .91 .84 - .91 -- S & O .55 .57 -- -- --

RESULTS OF THE META-ANALYSIS

Mean α Correlation between inattention

and hyperactivity-impulsivity Inter-rater reliability Test-retest Reliability

k total N Inattention Hyp-Imp k total N r [95% CI] k total N Inattention r [95% CI]

Hyp-Imp r [95% CI] k total N


Hyp-Imp r [95% CI]

29 14,167 .86 .82 20 10,669 .63 [.60, .66] 12 1,796 .54 [.46, .61] .47 [.34, .57] 3 286 .70 [.56, .80] .73 [.62, .82]

Notes. Note: The summary statistics for the meta-analysis are described in detail in Online Supplement section 2. k = number of studies included in the meta-analysis. aComm = community. bP = parent, S = self, O = other reporter. cspecific age range not provided. dchildhood. ecurrent. fmultiple effects reported by the study were combined into a single effect size for meta-analysis (see Supplement section 2). gnormative sample. hclinic sample. irandomized clinical trial of adults with ADHD. jYork normative sample. kcollege sample. lmothers of children in a follow-up study of children with ADHD. mmothers of a clinical sample of children with ADHD. nmales. ofemales. pstudy 1. qstudy 2. rrange across 6 samples. smean correlation in 6 samples. tUnited States. uChina. vcollege sample, specific age not provided.


Supplement Table 5 Inter-rater agreement for DSM-IV subtypes

Rates of inter-rater agreement for DSM-IV ADHD subtypes ADHD-C ADHD-I ADHD-H Total Age Raterb Total Raters Agree Total Raters Agree Total Raters Agree

Study Samplea N Range 1 2 Measure Nc N (%) Kd Nc N (%) Kd Nc N (%) Kd Am.-Campos 2006 Comm 653 4 - 12 P T Rating Scale 40 6 (15%) .25 102 17 (17%) .24 120 21 (18%) .21 Bauermeister 2005b Comm 98 6 - 11 Int Clin Best Estimate 44 --e .90 25 --e .82 -- -- -- Gadow 2004a Clinic 248 6 - 10 P T Rating Scale 94 21 (22%) .17 118 45 (38%) .33 19 4 (21%) .32 Gomez 1999 Comm 1,275 5 - 11 P T Rating Scale 57 7 (12%) .20 107 21 (20%) .29 44 2 (5%) .07 Malhi 2008 Clinic 119 3 - 14 P T Rating Scale 55 7 (13%) .02 43 9 (21%) .16 44 6 (14%) .05 Mitsis 2000 Clinic 74 7 - 11 P T Structured Interview 55 17 (31%) .03 20 2 (10%) .06 24 1 (4%) -.10 Nolan 1999 Clinic 62 3 - 5 P T Rating Scale 27 --e .55 7 --e .43 12 --e .29 Nolan 1999 Clinic 61 6 - 12 P T Rating Scale 18 --e .32 25 --e .71 3 --e .64 Nolan 1999 Clinic 73 13 - 18 P T Rating Scale 18 --e .57 40 --e .70 3 --e --f Power 2004 Clinic 150 8 - 14 P P Recode same interview --e --e .86 --e --e .78 -- -- -- Rowland 2008 Comm 509 6 - 12 P T Parent int., teacher ratings 42 3 (7%) .10 61 3 (5%) .03 19 3 (16%) .26 Vaughn 1997 Clinic 54 6 - 11 Clin Clin Best Estimate --e --e .87 --e --e .87 -- -- -- Weiler 1999 Clinic 93 7 - 11 P T Rating Scale 34 7 (21%) .16 51 28 (55%) .50 8 2 (25%) .37 Weiler 1999 Comm 93 7 - 11 P T Rating Scale 18 3 (17%) .20 28 10 (36%) .41 3 0 (0%) .00 Willcutt 2001 Comm 357 8 - 18 P T Rating Scale 25 5 (20%) .30 62 20 (32%) .42 15 2 (13%) .22 Wolraich 2004 Comm 243 5 - 10 P T Rating Scale -- -- .15 -- -- .11 -- -- .11

Overall % agreement [95% CI]: 19% [15%, 24%] 26% [18%, 36%] 16% [12%, 20%] mean Kappa: .47 .52 .27

Note: aComm = community sample, Clinic = clinic-based sample. bP = parent, T = teacher, Int = interviewer, Clin = clinician best estimate. cN = all cases with the subtype based on either rater. Inter-rater agreement indicates the number of cases that are assigned to the same subtype by both raters. dK = Cohen's Kappa. einsufficient information provided to calculate. fK could not be calculated.


Supplement Table 6 Studies of the longitudinal stability of the DSM-IV ADHD subtypesa

ANY ADHD SUBTYPE AT TIME 2 % with each subtype at time 1 that met Odds Ratio for comparisons between groupsb ADHD Mean age N at time 1 criteria for DSM-IV ADHD at time 2 ADHD-C ADHD-I ADHD-H ADHD-C ADHD-C ADHD-I

Study Sampc Raterd Time 1 Time 2 Cont CT IT HT Cont ADHD-C ADHD-I ADHD-H v. Cont v. Cont. v. Cont. v. ADHD-I v. ADHD-H v. ADHD-H

Gau 2010 Clinic P 7.3 13.3 -- 53 26 14 -- 88.7% 73.1% 78.6% -- -- -- 2.9 2.1 0.7 Hinshaw 2006 Clinic P 9.8 14.2 81 85 41 -- 4.9% 65.9% 75.6% -- 37.2* 59.7* -- 0.6 -- -- Lahey 2009 Clinic P & T 5.3 13.4 130 88 14 27 19.2% 78.4% 42.9% 33.3% 15.3* 3.2* 2.1 4.8* 7.3* 1.5 Todd 2008 Comm P 12.8 18.1 570 50 79 9 3.5% 44.0% 20.3% 11.1% 21.6* 7.0* 3.4 3.1* 6.3 2.0 Willcutt 2007e Comm P & T 10.7 16.0 118 43 58 14 3.4% 65.1% 41.4% 14.3% 53.2* 20.1* 4.8 2.6* 11.2* 4.2 Pooled results 899 319 218 64 % / OR 6.1% 69.8% 50.2% 33.2% 24.1* 12.3* 2.5* 2.2* 6.1* 1.7 [95% CI] [2.0, 16.9] [54.6, 81.7] [27.6, 72.6] [11.1, 66.2] [14.5, 40.1] [4.0, 37.9] [1.2, 5.5] [1.1, 4.6] [3.1, 12.0] [0.8, 3.7] Cochrane's Q, I2 39.6, 92% 25.9, 85% 38.5, 90% 12.9, 77% 4.2, 28% 14.4, 79% 0.7, 0% 11.5, 65% 2.5, 0% 2.4, 0%

Classic fail-safe N / Orwin's fail-safe N: 222 / 65 91 / 48 3 / 13 14 / 16 21 / 36 -- / 8 Egger's regression intercept: P = .04 ns ns ns ns ns Trim and Fill number of missing studies (higher or lower than point estimate): 2 (lower) 0 2 (lower) 1 (lower) 1 (lower) 1 (lower) Trim and fill adjusted odds ratio: 18.0* 12.3* 2.1* 1.9* 5.3* 1.3

ADHD-C AT TIME 2 % with each subtype at time 1 that met Odds Ratio for comparisons between groups ADHD Mean age N at time 1 criteria for ADHD-C at time 2 ADHD-C ADHD-I ADHD-H ADHD-C ADHD-C ADHD-I

Study Samp Rater Time 1 Time 2 Cont CT IT HT Cont ADHD-C ADHD-I ADHD-H v. Cont v. Cont. v. Cont. v. ADHD-I v. ADHD-H v. ADHD-H

Gau 2010 Clinic P 7.3 13.3 -- 53 26 14 -- 54.7% 11.5% 21.4% -- -- -- 9.3* 4.4* 0.5 Hinshaw 2006 Clinic P 9.8 14.2 81 85 41 -- 0.0% 38.8% 9.8% -- 104.0* 19.6* -- 5.9* -- -- Lahey 2009 Clinic P & T 5.3 13.4 130 88 14 27 6.2% 36.4% 14.3% 14.8% 8.7* 2.5 2.7 3.4 3.3* 1.0 Todd 2008 Comm P 12.8 18.1 570 50 79 9 0.5% 24.0% 2.5% 0.0% 59.7* 4.9 8.5 12.2* 6.2 0.6 Willcutt 2007e Comm P & T 10.7 16.0 118 43 58 14 0.8% 30.2% 6.9% 7.1% 50.7* 8.7* 9.0 5.9* 5.6 1.0 Pooled results 899 319 218 64 % / OR 2.6% 37.0% 8.0% 14.4% 31.5* 5.1* 3.7* 6.6* 4.1* 0.7 [95% CI] [0.2, 4.5] [28.2, 46.3] [4.8, 13.1] [7.5, 25.8] [8.5, 117.1] [1.9, 13.9] [1.2, 11.0] [3.7, 11.9] [1.9, 8.9] [0.3, 2.0] Cochrane's Q, I2 16.2, 81% 11.3, 64% 4.3, 6% 1.8, 0% 8.5, 65% 1.7, 0% 0.9, 0% 1.6, 0% 0.3, 0% 0.4, 0%

Classic fail-safe N / Orwin's fail-safe N: 82 / 61 8 / 32 3 / 19 46 / 47 9 / 27 -- / 3 Egger's regression intercept: ns ns ns ns ns ns

Trim and Fill number of missing studies (higher or lower than point estimate): 1 (lower) 2 (lower) 2 (lower) 0 2 (lower) 0 Trim and fill adjusted odds ratio: 25.4* 3.4* 2.7* 6.6* 3.7* 0.7


Supplement Table 6 Studies of the longitudinal stability of the DSM-IV ADHD subtypesa

ADHD-I AT TIME 2 % with each subtype at time 1 that met Odds Ratio for comparisons between groups ADHD Mean age N at time 1 criteria for ADHD-I at time 2 ADHD-C ADHD-I ADHD-H ADHD-C ADHD-C ADHD-I


Gau 2010 Clinic P 7.3 13.3 -- 53 26 14 -- 30.2% 61.5% 0.0% -- -- -- 0.3* 12.8 45.6* Hinshaw 2006 Clinic P 9.8 14.2 81 85 41 -- 4.9% 23.5% 63.4% -- 5.9* 33.4* -- 0.2* -- -- Lahey 2009 Clinic P & T 5.3 13.4 130 88 14 27 13.1% 42.0% 28.6% 14.8% 4.8* 2.7 1.2 1.8 4.2* 2.3 Todd 2008 Comm P 12.8 18.1 570 50 79 9 2.5% 20.0% 17.7% 0.0% 9.9* 8.6* 2.0 1.2 4.9 4.2 Willcutt 2007e Comm P & T 10.7 16.0 118 43 58 14 1.7% 32.6% 34.5% 0.0% 18.5* 20.2* 1.1 0.9 14.3 15.4 Pooled results 899 319 218 64 % / OR 4.4% 29.8% 39.9% 5.2% 7.8* 11.9* 1.3 0.6 5.5* 6.2* [95% CI] [1.5, 12.1] [22.3, 38.6] [22.3, 60.6] [0.5, 14.3] [4.2, 14.7] [4.1, 34.6] [0.5, 3.6] [0.3, 1.4] [2.1, 14.0] [1.6, 23.6] Cochrane's Q, I2 25.9, 88% 9.9, 59% 29.4, 86% 5.0, 39% 5.0, 41% 10.3, 71% 0.1, 0% 17.2, 77% 1.0, 0% 3.7, 19%

Classic fail-safe N / Orwin's fail-safe N: 73 / 39 73 / 49 -- / 2 -- / 9 9 / 34 7 / 34 Egger's regression intercept: ns ns ns ns ns ns

Trim and Fill number of missing studies (higher or lower than point estimate): 0 0 2 (lower) 0 2 (lower) 2 (lower) Trim and fill adjusted odds ratio: 7.8* 11.9* 1.2 0.6 4.3* 2.7

ADHD-H AT TIME 2 % with each subtype at time 1 that met Odds Ratio for comparisons between groups ADHD Mean age N at time 1 criteria for ADHD-H at time 2 ADHD-C ADHD-I ADHD-H ADHD-C ADHD-C ADHD-I


Gau 2010 Clinic P 7.3 13.3 -- 53 26 14 -- 3.8% 0.0% 57.1% -- -- -- 2.6 0.1* 0.1* Hinshaw 2006 Clinic P 9.8 14.2 81 85 41 -- 0.0% 3.5% 2.4% -- 6.9 6.0 -- 1.5 -- -- Lahey 2009 Clinic P & T 5.3 13.4 130 88 14 27 0.0% 0.0% 0.0% 3.7% -- -- 14.8 -- -- -- Todd 2008 Comm P 12.8 18.1 570 50 79 9 0.5% 0.0% 0.0% 11.1% 1.6 1.0 23.6* -- 0.1 0.1* Willcutt 2007e Comm P & T 10.7 16.0 118 43 58 14 0.8% 2.3% 0.0% 7.1% 2.8 0.7 9.0 4.1 0.3 0.1 Pooled results 899 319 218 64 % / OR 0.6% 2.7% 1.6% 14.5% 3.1 1.6 15.6* 2.2 0.1* 0.1* [95% CI] [0.2, 1.4] [1.3, 5.6] [0.1, 5.0] [2.6, 52.4] [0.6, 16.8] [0.3, 9.5] [3.2, 76.0] [0.4, 10.9] [0.0, 0.2] [0.0, 0.3] Cochrane's Q, I2 0.3, 0% 2.3, 0% 1.1, 0% 13.9, 78% 0.5, 0% 1.0, 0% 0.3, 0% 0.3, 0% 2.0, 0% 2.9, 0%

Classic fail-safe N / Orwin's fail-safe N: -- / 16 -- / 5 6 / 43 -- / 10 13 / 46 8 / 45 Egger's regression intercept: ns ns ns ns ns ns

Trim and Fill number of missing studies (higher or lower than point estimate): 0 0 0 2 (lower) 2 (lower) 0 Trim and fill adjusted odds ratio: 3.1 1.6 15.6 1.5* 0.1* 0.1* Note: Summary statistics for the meta-analysis are described in detail in Supplement section 2. alongitudinal studies that assessed ADHD subtype status at each point in time. Studies that used retrospective reports to define subtype classifications earlier in development are not included (e.g., Hurtig et al., 2007; Kessler et al., 2005; Lara et al., 2009). bOdds ratios greater than 1 indicate that the group listed first was more likely to meet criteria for the subtype at time 2, and odds ratios less than 1 indicate that the group listed second was more likely to meet criteria for the subtype at time 2. cClinic = clinic-referred sample, Comm = unselected community sample. dP = parent, T = teacher. eRe-analysis by subtype of the longitudinal sample described by Willcutt, Betjemann, Pennington, et al. (2007). * = P < .05


Supplement Table 7 Correlations between DSM-IV symptom dimensions and measures of functional impairment

Age

ADHD Impairment Correlation with DSM-IV

Symptom Dimensionc

Significant difference Construct / Study Samplea N Range Raterb Raterb Measure Inattention Hyp-Imp between dimensions

GLOBAL FUNCTIONING Studies of children and adolescents

Döpfner 2006d Clinic 1,478 6 - 18 P P Child Global Assessment Scale .21* .26* ns Döpfner 2006d Clinic 1,478 6 - 18 P P SDQ total problems .36* .47* Hyp-Imp > Inatt Fabiano 2006d Comm 1,550 5 - 12 T T Impairment Rating Scale Global .47* .32* Inatt > Hyp-Imp Fabiano 2006d Comm 853 5 - 12 P P Impairment Rating Scale Global .41* .39* ns F.-Weieneth 2009 Clinic 261 3 - 4 P P Overall daily report .46* .48* ns Weiss 2003d Clinic 276 M = 13 P P Child Global Assessment Scale .00 .13* ns Weiss 2003d Clinic 276 M = 13 T P Child Global Assessment Scale .12* .14* ns Willcutt 2011cd,e Clinic 593 6 - 18 P P Home Situations Questionnaire .43* .41* ns Willcutt 2011cd,e Clinic 327 6 - 18 T T School Situations Questionnaire .51* .35* Inatt > Hyp-Imp Willcutt 2011cf Comm 1,144 8 - 18 P & T P Child Global Assessment Scale .53* .49* ns Willcutt 2011cg Comm 1,890 6 - 13 P P Child Global Assessment Scale .57* .46* Inatt > Hyp-Imp Wolraich 1998a Comm 4,226 6 - 12 T T VADTRS Global Behavior .50* .63* Inatt > Hyp-Imp Pooled results Overall r [95% CI]: .47 [.40, .53] .46 [.36, .55] ns

Number of studies (total N): 7 (11,142) 7 (11,142) Cochrane's Q, I2: 115.9*, 95%h 257.8*, 98%h

Classic fail-safe N / Orwin's fail-safe N: 3,914 / 20 3,795 / 29 Egger’s regression intercept: ns ns

Trim and Fill number of missing studies (higher or lower than point estimate): 0 0 Trim and fill adjusted r: .47* .46*

Notes: SDQ = Strengths and Difficulties Questionnaire, VADTRS = Vanderbilt ADHD Diagnostic Teacher Rating Scale. Summary statistics for the meta-analysis are described in Supplement section 2. aComm = community, Clinic = clinic-referred. bP = parent, T = teacher. cAll effects are scaled so that positive correlations indicate that higher ADHD symptoms are associated with greater impairment. dmultiple effects reported by the study were combined into a single effect size for meta-analysis (see Supplement section 2). eDenver Clinic sample. ftwin sample. gcommunity sample. hheterogeneity due to significant outlier effect sizes reported by Döpfner et al. (2006) and Weiss et al. (2003). Exclusion of these studies resulted in minimal changes to the overall point estimates (r = .50 for inattention and r = .47 for hyperactivity-impulsivity). * = P < .05



Age


Symptom Dimensionc


GLOBAL FUNCTIONING CONTINUED Studies of adults

Adler 2008d Clinic 536 adultse S S Sheehan Disability .32* .19* ns Adler 2008d Clinic 536 adultse S S CGI .27* .31* ns Gudjonsson 2009f Comm 259 18 - 51 S S Life Satisfaction .40* .22* Inatt > Hyp-Imp Gudjonsson 2009g Comm 107 19 - 53 S S Life Satisfaction .26* .08 ns Willcutt 2011b Comm 328 18 - 25 S & P S & P CGI .31* .24* ns Pooled results Overall r [95% CI]: .32 [.28, .36] .23 [.17, .28] Inatt > Hyp-Imp

Number of studies (total N): 4 (1,230) 4 (1,230) Cochrane's Q, I2: 2.9, 0% 3.1, 2%

Classic fail-safe N / Orwin's fail-safe N: 127 / 10 56 / 6 Egger’s regression intercept: ns ns

Trim and Fill number of missing studies (higher or lower than point estimate): 1 (higher) 0 Trim and fill adjusted r: 0.33* 0.23*

Notes: CGI = Clinical Global Impressions. Summary statistics for the meta-analysis are described in Supplement section 2. aComm = community, Clinic = clinic-referred. bP = parent, S = self. cAll effects are scaled so that positive correlations indicate that higher ADHD symptoms are associated with greater impairment. dmultiple effects reported by the study were combined into a single effect size for meta-analysis (see Supplement section 2). eadult sample, exact age range not specified. ffemales. gmales. * = P < .05.



Age


Symptom Dimensionc


ADAPTIVE FUNCTIONING Studies of children and adolescents

Reynolds 2004d Comm 55 12 - 18 P P BASC-II Adaptive Skills .45* .47* ns Reynolds 2004d Comm 45 12 - 18 T T BASC-II Adaptive Skills .70* -.05 Inatt > Hyp-Imp Reynolds 2004d Comm 54 6 - 11 T T BASC-II Adaptive Skills .76* .51* ns Reynolds 2004d Comm 60 6 - 11 P P BASC-II Adaptive Behavior .52* .57* ns Weiler 2000 Clinic 60 6 - 12 P P BASC-II Adaptive Behavior .34* .33* ns Willcutt 2011ce Comm 1,890 6 - 13 P P BASC Adaptive Skills .48* .38* Inatt > Hyp-Imp Willcutt 2011cd,f Clinic 178 6 - 18 P P BASC-II Adaptive Behavior .47* .42* Inatt > Hyp-Imp Willcutt 2011cd,f Clinic 147 6 - 18 T T BASC-II Adaptive Behavior .53* .24* ns Pooled results of studies of children and adolescents Overall r [95% CI]: .49 [.43, .55] .37 [.33, .41] Inatt > Hyp-Imp



Trim and Fill number of missing studies (higher or lower than point estimate): 1 (lower) 1 (higher) Trim and fill adjusted r: .48* .38*

Notes: BASC = Behavior Assessment Schedule for Children. Summary statistics for the meta-analysis are described in Supplement section 2. aComm = community, Clinic = clinic-referred. bP = parent, T = teacher. cAll effects are scaled so that positive correlations indicate that higher ADHD symptoms are associated with greater impairment. dmultiple effects reported by the study were combined into a single effect size for meta-analysis (see Supplement section 2). ecommunity sample. fUniversity of Colorado Clinic Sample. * = P < .05.



Age


Symptom Dimensionc


ADAPTIVE FUNCTIONING CONTINUED Driving impairment in adults

Gordon 2006 Clinic 239 19 - 25 P P accidents .04 .15* ns Thompson 2007 Clinic 347 16 - 25 P P mean of 3 measures .03 .12* nsd Willcutt 2011b Comm 328 18 - 25 S & P S composite .29* .23* nse Pooled results Overall r [95% CI]: .12 [-.05, .29] .17 [.10, .23] ns

Number of studies (total N): 3 (914) 3 (914) Cochrane's Q, I2: 14.6*, 86%f 2.3, 11%


Trim and Fill number of missing studies (higher or lower than point estimate): 0 0 Trim and fill adjusted r: .12 .17*

Occupational functioning in adults Gordon 2006 Clinic 239 19 - 25 P P Percent fired .26* .31* ns Murphy 1996 Comm 720 17 - 84 S S Occupational level .18* .15* ns Willcutt 2011b Comm 328 18 - 25 S & P S composite .50* .34* Inatt > Hyp-Impe

Pooled results Overall r [95% CI]: .34 [.12, .52] .26 [.13, .38] ns

Number of studies (total N): 3 (1,287) 3 (1,287) Cochrane's Q, I2: 30.3*, 93%f 11.0, 82%



Notes: Summary statistics for the meta-analysis are described in Supplement section 2. aComm = community, Clinic = clinic-referred. bP = parent, S = self. cAll effects are scaled so that positive correlations indicate that higher ADHD symptoms are associated with greater impairment. dzero-order correlations were not significantly different, but negative driving outcomes were only predicted independently by hyperactivity-impulsivity symptoms and not inattention symptoms. eonly inattention symptoms independently predicted occupational functioning in multiple regression analyses. fsignificant heterogeneity due to large effect size reported by Willcutt & Bidwell (2011b). * = P < .05



Age


Symptom Dimensionc


SOCIAL FUNCTIONING Social Problems in Children and Adolescents Overall Social Problems Bohlin 2004 Comm 834 5 - 13 P P CBCL Social Problems .56* .53* ns Döpfner 2006 Clinic 1,478 6 - 18 P P SDQ Peer Problems .23* .29* ns Fabiano 2006d Comm 1,550 5 - 12 T T IRS Impaired Peer Relations .37* .35* ns Fabiano 2006d Comm 853 5 - 12 P P IRS Impaired Peer Relations .33* .34* ns Gadow 1997a Clinic 94 6 - 12 T T CBCL Social Problems .49* .38* ns Gadow 1997bd Clinic 36 3 - 5 T T CBCL Social Problems .39* .22 ns Gadow 1997bd Clinic 105 3 - 5 P P CBCL Social Problems .27* .17 ns Gadow 1997bd Comm 398 3 - 5 T T ECI Peer Conflict .57* .67* Hyp-Imp > Inatt Gadow 1997bd Comm 531 3 - 5 P P ECI Peer Conflict .48* .48* ns Gadow 1998d Clinic 122 13 - 18 T T CBCL Social Problems .46* .47* ns Gadow 1998d Clinic 144 13 - 18 P P CBCL Social Problems .30* .32* ns Gadow 2000 Comm 546 10 - 12 P P CBCL Social Problems .35* .22* Inatt > Hyp-Imp Gadow 2002 Clinic 110 13 - 18 S S YSR Social Problems .38* .40* ns Garner 2010d Clinic 276 5 - 17 P P & T CBCL / TRF Social Problems .35* .37* ns Garner 2010d Clinic 258 5 - 17 T P & T CBCL / TRF Social Problems .44* .45* ns Mattison 2003 Clinic 101 6 - 18 T T TRF Social Problems .32* .20* ns Sprafkin 2001d Clinic 103 5 - 17 P P CBCL Social Problems .41* .35* ns Sprafkin 2001d Clinic 103 5 - 17 T T TRF Social Problems .44* .43* ns Sprafkin 2002a Clinic 247 6 - 10 P P CBCL Social Problems .28* .34* ns Sprafkin 2002bd Clinic 188 3 - 6 P P CBCL Social Problems .43* .45* ns Sprafkin 2002bd Clinic 107 3 - 6 T T TRF Social Problems .35* .34* ns Willcutt 2011ce Comm 1,815 8 - 18 P & T P & T Social Problems composite .38* .36* ns Willcutt 2011cd,f Clinic 571 6 - 18 P P CBCL Social Problems .40* .37* ns Willcutt 2011cd,f Clinic 327 6 - 18 T T TRF Social Problems .39* .39* ns Willcutt 2011cd,g Clinic 178 6 - 18 P P BASC-II Social Problems .38* .42* ns Willcutt 2011cd,g Clinic 147 6 - 18 T T BASC-II Social Problems .42* .38* ns Willcutt 2011ch Comm 1,890 6 - 13 P P BASC Social Problems .37* .41* ns



Age


Symptom Dimensionc


SOCIAL FUNCTIONING CONTINUED Overall Social Problems continued Pooled results Overall r [95% CI]: .39 [.34, .44] .38 [.33, .43] ns

Number of studies (total N): 18 (10,790) 18 (10,790) Cochrane's Q, I2: 114.0*, 85%i 112.1*, 85%i



Notes: BASC = Behavior Assessment Schedule for Children, CBCL = Child Behavior Checklist, IRS = Impairment Rating Scale , TRF = Achenbach Teacher Report Form, YSR = Youth Self Report. Summary statistics for the meta-analysis are described in Supplement section 2. aComm = community, Clinic = clinic-referred. bP = parent, T = teacher, S = self. cAll effects are scaled so that positive correlations indicate that higher ADHD symptoms are associated with greater impairment. dmultiple effects reported by the study were combined into a single effect size for meta-analysis (see Supplement section 2). eColorado twin sample fUniversity of Denver Clinic sample. gUniversity of Colorado Clinic Sample. hColorado community sample. isignificant heterogeneity due to higher correlations in community versus clinic samples (inattention r = .45 vs. .35, hyperactivity-impulsivity r = .41 vs. .33). * = P < .05.



Age


Symptom Dimensionc


SOCIAL FUNCTIONING CONTINUED Disliked by peers Lee 2006 Clinic 228 11 - 18 P & T P Proportion like - dislike .27* .36* ns Willcutt 2011cd,e Comm 5,045 6 - 13 P P Proportion dislike .25* .30* ns Willcutt 2011cd,e Comm 3,673 6 - 13 T T Proportion dislike .33* .41* ns Willcutt 2011cf Comm 1,474 8 - 18 P & T T Proportion dislike .33* .40* ns Pooled Results Overall r [95% CI]: .30 [.27, .33] .37 [.34, .39] Hyp-Imp > Inattg



Trim and Fill number of missing studies (higher or lower than point estimate): 1 (lower) 0 Trim and fill adjusted r: .30* .37*

Note: Summary statistics for the meta-analysis are described in Supplement section 2. aComm = community, Clinic = clinic-referred. bP = parent, T = teacher. cAll effects are scaled so that positive correlations indicate that higher ADHD symptoms are associated with greater impairment. dmultiple effects reported by the study were combined into a single effect size for meta-analysis (see Supplement section 2). eColorado community sample. fColorado twin sample. gin addition to the studies in the table, multiple regression analyses in two independent samples indicated that only hyperactivity-impulsivity symptoms were associated with being disliked by peers (Lahey & Willcutt, 2002). * = P < .05.



Age


Symptom Dimensionc


SOCIAL FUNCTIONING CONTINUED Passive / isolated DuPaul 1998b Comm 71 5 - 17 T T CTRS Anxious / passive .47* .25* ns Willcutt 2011cd Comm 1,815 8 - 18 P P Social isolation composite .34* .15* Inatt > Hyp-Imp Willcutt 2011ce Comm 5,045 6 - 13 P P Social isolation composite .39* .18* Inatt > Hyp-Imp Willcutt 2011cf Clinic 563 6 - 18 P P Social isolation composite .32* .19* Inatt > Hyp-Imp Willcutt 2011cg Clinic 178 6 - 18 P P Social isolation composite .43* .22* Inatt > Hyp-Imp Pooled results Overall r [95% CI]: .37 [.33, .41] .18 [.15, .20] Inatt > Hyp-Imph


Classic fail-safe N / Orwin's fail-safe N: 1,011 / 15 214 / 4 Egger’s regression intercept: ns ns

Trim and Fill number of missing studies (higher or lower than point estimate): 2 (lower) 2 (lower) Trim and fill adjusted r: 36* .17*

Notes: Summary statistics for the meta-analysis are described in Supplement section 2. aComm = community, Clinic = clinic-referred. bRaters: P = parent, T = teacher. cAll effects are scaled so that positive correlations indicate that higher ADHD symptoms are associated with greater impairment. dtwin sample. ecommunity sample. fUniversity of Denver clinic sample. gUniversity of Colorado Clinic sample. hin addition to the studies in the table, multiple regression analyses in a preschool sample indicated that only inattention symptoms independently predicted passive social behavior and social isolation (Lahey & Willcutt, 2002). * = P < .05.



Age


Symptom Dimensionc


SOCIAL FUNCTIONING CONTINUED

Social skills / prosocial Döpfner 2006 Clinic 1,478 6 - 18 P P SDQ Prosocial .18* .20* ns Gordon 2006d Clinic 340 6 - 18 P P CBCL Social Competence .37* .28* ns Reynolds 2004e Comm 60 6 - 11 P P BASC Social skills .47* .34* ns Reynolds 2004e Comm 55 12 - 18 P P BASC Social skills .21 .25 ns Reynolds 2004e Comm 54 6 - 11 T T BASC Social skills .56* .36* ns Reynolds 2004e Comm 45 12 - 18 T T BASC Social skills .54* -.08 Inatt > Hyp-Imp Shipp 2010 Comm 873 11 - 19 T T Social competence .41* .11 Inatt > Hyp-Imp Weiler 2000 Clinic 60 6 - 12 P P BASC Social skills .44* .41* ns Willcutt 2011cf Clinic 563 6 - 18 P P Social cognition composite .45* .31* Inatt > Hyp-Imp Willcutt 2011cg Comm 1,474 8 - 18 P & T T Liked by peers .41* .28* ns Willcutt 2011ch Comm 3,673 6 - 13 P & T P & T Prosocial composite .49* .39* Inatt > Hyp-Imp Willcutt 2011ce,i Clinic 178 6 - 18 P P BASC Social Skills .39* .35* ns Willcutt 2011ce,i Clinic 147 6 - 18 T T BASC Social Skills .44* .38* ns Pooled results Overall r [95% CI]: .43 [.39, .47] .28 [.20, .35] Inatt > Hyp-Imp

Number of studies (total N): 10 (8,767) 10 (8,767) Cochrane's Q, I2: 19.3, 58% 94.6*, 92%j


Trim and Fill number of missing studies (higher or lower than point estimate): 1 (higher) 1 (lower) Trim and fill adjusted r: .44* .27*

Notes: BASC = Behavior Assessment Schedule for Children, CBCL = Child Behavior Checklist, SDQ = Strengths and Difficulties Questionnaire. Summary statistics for the meta-analysis are described in Supplement section 2. aComm = community, Clinic = clinic-referred. bP = parent, T = teacher. cAll effects are scaled so that positive correlations indicate that higher ADHD symptoms are associated with greater impairment. dmaternal ratings. emultiple effects reported by the study were combined into a single effect size for meta-analysis (see Supplement section 2). fDenver Clinic sample. gtwin sample. hcommunity sample. iUniversity of Colorado clinic sample. jsignificant heterogeneity not explained by outliers or covariates. * = P < .05.



Age


Symptom Dimensionc



Social functioning in adults Belendiuk 2007 Clinic 69 M = 38 S S WURS Social Skills .15 .00 Inatt > Hyp-Impd

Gordon 2006 Clinic 239 19 - 25 P P Close friendships .09 .15* ns Gudjonsson 2010e Comm 256 16 - 58 S S SIPP Relational Functioning .34* .15* Inatt > Hyp-Imp Gudjonsson 2010f Comm 141 17 - 58 S S SIPP Relational Functioning .19* .16* Inatt > Hyp-Imp Willcutt 2011b Comm 328 18 - 25 S & P S & P composite .52* .49* ns Pooled results Overall r [95% CI]: .27 [.08, .44] .21 [.02, .38] nsg

Number of studies (total N): 5 (1,033) 5 (1,033) Cochrane's Q, I2: 38.2*, 89%h 36.3*, 89%h



Notes: SIPP = Severity Indices of Personality Problems, WURS = Wender Utah Rating Scale. Summary statistics for the meta-analysis are described in Supplement section 2. aComm = community, Clinic = clinic-referred. bP = parent, S = self. cAll effects are scaled so that positive correlations indicate that higher ADHD symptoms are associated with greater impairment. dalthough the correlations were not significantly different, only inattention independently predicted social functioning in multiple regression analyses. efemales. fmales. gin addition to the studies in the table, multiple regression analyses in three independent samples of adults indicated that only inattention predicted social dysfunction (Knouse et al., 2008; Norvilitis et al., 2010). hsignificant heterogeneity due to large effect sizes reported by Willcutt & Bidwell (2011b). When these effects were excluded correlations were lower (r = .20 for inattention, r = .14 for hyperactivity-impulsivity), and the correlation with hyperactivity-impulsivity was no longer significant . * = P < .05.



Age


Symptom Dimensionc


ACADEMIC FUNCTIONING Studies of children and adolescents Parent and teacher ratings of academic performance Diamantopolou 2007 At Risk 112 8 - 10 P & T T Academic performance .41* .19 ns Döpfner 2006 Clinic 1,478 6 - 18 P P CHIP-CE overall academic .38* .23* Inatt > Hyp-Imp DuPaul 1998b Comm 43 5 - 17 P P CPRS Learning Problems .66* .45* ns Fabiano 2006d Comm 1,550 5 - 12 T T IRS Academics .53* .25* Inatt > Hyp-Imp Fabiano 2006d Comm 853 5 - 12 P P IRS Academics .50* .31* Inatt > Hyp-Imp Gordon 2006e Clinic 340 6 - 18 P P CBCL School Competence .58* .38* Inatt > Hyp-Imp Levy 2005f Comm 2,197 4 - 18 P P Reading performance .29* .17* Inatt > Hyp-Imp Levy 2005g Comm 2,173 4 - 18 P P Reading performance .33* .24* Inatt > Hyp-Imp Molina 2001h Comm 247 11 - 18 T T Grade point average .56* .37* Inatt > Hyp-Imp Molina 2001i Clinic 224 11 - 18 T T Grade point average .63* .45* Inatt > Hyp-Imp Paloyelis 2010bd Comm 1,312 8 - 11 P P Colorado Learning Diff. Quest. .41* .22* Inatt > Hyp-Imp Paloyelis 2010bd Comm 1,312 8 - 11 T P Colorado Learning Diff. Quest. .47* .17* Inatt > Hyp-Imp Reynolds 2004d Comm 54 6 - 11 T T BASC-II School Problems .86* .58* Inatt > Hyp-Imp Reynolds 2004d Comm 54 6 - 11 T T BASC-II Learning Problems .77* .44* Inatt > Hyp-Imp Reynolds 2004d Comm 45 12 - 18 T T BASC-II School Problems .79* -.02 Inatt > Hyp-Imp Reynolds 2004d Comm 45 12 - 18 T T BASC-II Learning Problems .77* -.06 Inatt > Hyp-Imp Ser.-Pinhiero 2008d School 205 10 - 16 T T Failing Grades .61* .44* Inatt > Hyp-Imp Ser.-Pinhiero 2008d School 205 10 - 16 P P Failing Grades .38* .22* ns Shipp 2010 Comm 873 11 - 19 T T Academic competence .65* .29* Inatt > Hyp-Imp Wahlstedt 2009 Comm 182 7 - 9 P & T T Overall Academic Functioning .47* .29* Inatt > Hyp-Imp Weiler 2000 Clinic 60 6 - 12 P P CPRS Learning Problems .57* .25 Inatt > Hyp-Imp Willcutt 2011cj Clinic 147 6 - 18 T T BASC-II Learning Problems .73* .34* Inatt > Hyp-Imp Willcutt 2011ck Comm 1,474 8 - 18 P & T P & T grades .63* .31* Inatt > Hyp-Imp Willcutt 2011cd,l Comm 5,045 6 - 13 P P grades .45* .30* Inatt > Hyp-Imp Willcutt 2011cd,l Comm 3,673 6 - 13 T T grades .60* .32* Inatt > Hyp-Imp Wolraich 1998a Comm 4,226 6 - 12 T T VABRS academic performance .50* .23* Inatt > Hyp-Imp



Age


Symptom Dimensionc


ACADEMIC FUNCTIONING CONTINUED Studies of children and adolescents

Pooled results Overall r [95% CI]: .54 [.49, .59]* .28 [.25, .31]* Inatt > Hyp-Imp Number of studies (total N): 20 (21,986) 20 (21,986) Cochrane's Q, I2: 460.3*, 95%m 80.2*, 76%n



Note: BASC = Behavior Assessment Schedule for Children, CHIP-CE = Child Health and Illness Profile, Child Edition, CPRS / CTRS = Conners Parent / Teacher Rating Scale, IRS = Impairment Rating Scale, VABRS = Vanderbilt ADHD Diagnostic Rating Scale. Summary statistics for the meta-analysis are described in Supplement section 2. aComm = community, Clinic = clinic-referred. bP = parent, T = teacher. cAll effects are scaled so that positive correlations indicate that higher ADHD symptoms are associated with greater impairment. dmultiple effects reported by the study were combined into a single effect size for meta-analysis (see Supplement section 2). ematernal ratings. ffemales. gmales. hstudy 1. istudy 2. jUniversity of Colorado Clinic Sample. ktwin sample. lcommunity sample. mheterogeneity was primarily explained by significant outlier effect sizes reported by Levy et al. (2005) and Reynolds (2004); when these studies were excluded the point estimate was higher and remained significant (r = .57). nheterogeneity primarily due to significant outlier effect sizes reported for females in the study by Levy et al. (2005), study 2 by Molina et al. (2001), and both samples in the study by Reynolds (2004); when these studies were excluded the point estimate did not change. * = P < .05.



Age


Symptom Dimensionc


ACADEMIC FUNCTIONING CONTINUED

Academic achievement tests Bauerm. 2005ad Comm 79 6 - 11 P & T Test WJ Reading .57* .39* ns Bauerm. 2005ad Comm 79 6 - 11 P & T Test WJ Math .56* .36* ns Fuchs 2008d Comm 924 7 - 9 P Test Mean of 7 math tasksd .46* --e -- Fuchs 2008d Comm 924 7 - 9 P Test Word Identification .51* --e -- Hart 2010d Comm 328 9 - 11 P Test WJ Calculation .27* .17* ns Hart 2010d Comm 328 9 - 11 P Test WJ Word ID .28* .16* ns Hartman 2004d Comm 229 8 - 18 T Test PIAT Math .32* .13* Inatt > Hyp-Imp Hartman 2004d Comm 286 8 - 18 P Test PIAT Math .18* .10 ns Molina 2001 Clinic 224 11 - 18 T Test WIAT Academic Performance .27* .27* ns Ohnishi 2010d Comm 6,397 6 - 15 T Test Math .30* .12* Inatt > Hyp-Imp Tani 2010d Comm 4,390 6 - 15 P Test Math .16* .11* Inatt > Hyp-Imp Thorell 2007 Comm 145 5 - 6 T Test Math screening .28* .13 ns Willcutt 2005 Comm 825 8 - 18 P & T Test PIAT Reading Recognition .36* .18* Inatt > Hyp-Imp Willcutt 2011cd,f Clinic 592 6 - 18 P & T Test WJ Reading Composite .25* .08 Inatt > Hyp-Imp Willcutt 2011cd,f Clinic 592 6 - 18 P & T Test WJ Math Composite .26* .12 Inatt > Hyp-Imp Willcutt 2011cd,g Clinic 145 6 - 18 P & T Test WJ Broad Math .30* .11 ns Willcutt 2011cd,g Clinic 145 6 - 18 P Test WJ Letter Word ID .28* .12 ns Willcutt 2011cd,h Comm 725 6 - 13 P & T Test WJ Letter Word ID .36* .19* Inatt > Hyp-Imp Willcutt 2011cd,h Comm 725 6 - 13 P & T Test WJ Calculations .30* .18* Inatt > Hyp-Imp



Age


Symptom Dimensionc


ACADEMIC FUNCTIONING CONTINUED

Academic achievement tests continued Pooled results Overall r [95% CI]: .33 [.26, .39]* .16 [.12, .19]* Inatt > Hyp-Impi

Number of studies (total N): 11 (10,670) 10 (9,746) Cochrane's Q, I2: 81.4*, 88%j 16.7, 46%

Classic fail-safe N / Orwin's fail-safe N: 2,021 / 22 364 / 4 Egger’s regression intercept: ns ns


Note: PIAT = Peabody Individual Achievement Test, WIAT = Wechsler Individual Achievement Test, WJ = Woodcock-Johnson Tests of Achievement. Summary statistics for the meta-analysis are described in Supplement section 2. aComm = community, Clinic = clinic-referred. bP = parent, T = teacher. cAll effects are scaled so that positive correlations indicate that higher ADHD symptoms are associated with greater impairment. dmultiple effects reported by the study were combined into a single effect size for meta-analysis (see Supplement section 2). eonly inattention symptoms were measured and reported. fDenver Clinic sample. gUniversity of Colorado Clinic Sample. hColorado twin sample. iIn addition to the studies in the table, multiple regression analyses in several additional samples also indicated that inattention symptoms but not hyperactivity-impulsivity symptoms were independently associated with academic difficulties (Diamantopoulou et al., 2007; Lahey & Willcutt, 2002; Riley et al., 2006). jsignificant heterogeneity due to significantly higher correlations in community versus clinic samples (r = .36 vs. .26). * = P < .05.



Age


Symptom Dimensionc


ACADEMIC FUNCTIONING CONTINUED Academic functioning / outcomes in adults

Belendiuk 2007d Clinic 69 M = 38 S S WURS Academic .20 .09 Inatt > Hyp-Impe

Gordon 2006 Clinic 239 19 - 25 P P Grade point average .41* .34* ns Murphy 1996 Comm 720 17 - 84 S S Years of education completed .21* .17* ns Pope 2010 Comm 464 collegef S S Grade point average .16* .09* ns Willcutt 2011b Comm 328 18 - 25 S & P S & P Achievement composite .49* .18* Inatt > Hyp-Imp Pooled results Overall r [95% CI]: .31 [.16, .45] .18 [.10, .26] nsg

Number of studies (total N): 5 (1,820) 5 (1,820) Cochrane's Q, I2: 41.0*, 90%h 11.4, 65%


Trim and Fill number of missing studies (higher or lower than point estimate): 0 1 (higher) Trim and fill adjusted r: .31* .19*

Note: WURS = Wender Utah Rating Scale. Summary statistics for the meta-analysis are described in Supplement section 2. aComm = community, Clinic = clinic-referred. bP = parent, S = self. cAll effects are scaled so that positive correlations indicate that higher ADHD symptoms are associated with greater impairment. dmultiple effects reported by the study were combined into a single effect size for meta-analysis (see Supplement section 2). ecorrelations were not significantly different, but only inattention independently predicted academic functioning in multiple regression analyses. fcollege sample, exact age range not specified. gin addition to the studies in the table, multiple regression analyses in additional samples indicated that inattention symptoms independently predicted difficulties with academic adjustment and study skills in college students, whereas hyperactivity-impulsivity symptoms did not (Norvilitis et al., 2010). hheterogeneity due to significant outlier effect size reported by Willcutt & Bidwell (2011b); the overall effect was lower but remained significant when this effect was excluded (r = .26). * = P < .05.


Supplement Table 8 Studies comparing the DSM-IV subtypes on dimensional measures of functional impairment Sample Size Effect Size (Hedges' g) for comparisons between groupsc

Impairment Sample Age Cmb Inatt H-I ADHD Impairment ADHD-C ADHD-I ADHD-H ADHD-C ADHD-C ADHD-I Domain / Study Typea Range Cont Type Type Type Raterb Raterb Measure vs. Control vs. Control vs. Control vs. ADHD-I vs. ADHD-H vs. ADHD-H

GLOBAL IMPAIRMENT Overall impairment in children and adolescents

Bauerm. 2005b Comm 6 - 11 29 44 25 -- P & T CL CGAS 3.16* 2.20* -- 1.14 -- -- Bauerm. 2007d Comm 4 - 17 849 36 35 59 P P CGAS 1.50* 0.90* 0.82* 0.58* 0.71* 0.08 Bauerm. 2007e Comm 4 - 17 847 14 12 40 P P CGAS 1.49* 0.74* 0.94* 0.64* 0.41 -0.18 Chiang 2008 Clinic 7 - 10 52 52 17 -- P P CGAS 3.10* 3.47* -- 0.57* -- -- Faraone 1998 Clinic 3 - 18 135 182 92 28 P P GAF 2.72* 2.23* 2.15* 0.28 0.37 0.06 Lahey 1994f Clinic 4 - 17 93 134 63 43 P & T P CGAS 1.06* 0.62* 0.81* 0.43* 0.24 -0.19 Lahey 1994f Clinic 4 - 17 99 145 65 45 P & T CL CGAS 0.95* 0.24 0.64* 0.86* 0.29 -0.56* Lahey 1998f Clinic 4 - 6 125 84 14 29 P & T P CGAS 2.03* 1.63* 1.56* 0.57* 0.47 -0.09 Lahey 1998f Clinic 4 - 6 125 84 14 29 P & T CL CGAS 2.41* 1.36* 1.41* 0.93* 0.78* -0.10 Lee 2008b Clinic 6 - 16 47 200 113 60 P & T P & T OCHS Glob Imp 1.81* 1.75* 2.29* 0.32* 0.00 -0.33* Montiel 2008 Comm 4 - 12 79 96 13 45 P P CGAS 0.66* 0.57* 1.16* 0.01 -0.76* -1.02* Rosenthal 2006 Clinic 9 - 15 27 28 12 -- P & T CL CGAS 2.04* 1.56* -- 0.28 -- -- Weiss 2003 Clinic M = 13 -- 133 143 -- Chart P CGAS -- -- -- 0.48* -- -- Willcutt 2011a Comm 8 - 18 275 113 211 36 P & T P CGAS 2.03* 1.40* 0.80* 0.26* 1.09* 0.64* Willcutt 2011cg Comm 6 - 13 1,783 138 108 36 P & T P CGAS 1.66* 1.22* 0.79* 0.42* 0.77* 0.42 Pooled results Overall Hedges' g: 1.92* 1.45* 1.21* 0.43* 0.38* -0.03

[95% CI]: [1.54, 2.30] [1.10, 1.81] [0.87, 1.58] [0.31, 0.56] [0.02, 0.74] [-0.18, 0.21] Number of significant effects / total studies: 12 / 12 12 / 12 9 / 9 9 / 13 5 / 9 4 / 9

Ngroup 1 / Ngroup 2: 1,142 / 4,347 717 / 4,347 360 / 4,239 1,275 / 860 1,008 / 378 663 / 360 Cochrane's Q, I2: 170.8*, 94%h 117.3*, 91%h 59.5*, 87%h 20.0, 40% 65.4*, 88%i 33.1*, 76%j

Classic fail-safe N / Orwin's fail-safe N: 4,056 / 104 1,832 / 75 756 / 46 245 / 15 50 / 9 N/A Egger's regression intercept: ns ns ns ns ns ns

Trim and Fill number of missing studies (Higher or lower than point estimate): 0 0 0 3 (lower) 0 0 Trim and fill adjusted g: 1.92* 1.46* 1.21* 0.37* 0.38* -0.03

Note: CGAS = Child Global Assessment Scale, GAF = Global Assessment of Functioning, OCHS = Revised Ontario Child Health Study scales. Summary statistics for the meta-analysis are described in Supplement section 2. aComm = community, Clinic = clinic-referred. bP = parent, T = teacher, CL = clinician, Chart = chart review. cPositive effect sizes indicate that the group listed first is more impaired than the group listed second, and negative effect sizes indicate that the group listed second is more impaired. dmales. efemales. fmultiple effects reported by the study were combined into a single effect size for meta-analysis (see Supplement section 2). gColorado community sample. hHeterogeneity due to larger effect sizes in studies that required impairment as part of the inclusion criteria for ADHD. In studies that defined groups based on symptom criteria only, effect sizes were lower but remained significant (g = 1.32 for ADHD-C, 0.98 for ADHD-I, and 0.86 for ADHD-H). iHeterogeneity due to significant outlier effect sizes in the study by Montiel et al. (2008). When these effects were excluded the overall effect size was larger (g = 0.51), but the overall interpretation did not change. jHeterogeneity due to significant outlier effect sizes in the studies by Montiel et al. (2008) and Willcutt et al. (2011a). When these effects were excluded the overall effect size remained nonsignificant (g = -0.08). * = P < .05




GLOBAL IMPAIRMENT CONTINUED Overall impairment in adults

Grevet 2006 Comm M = 34 -- 117 88 -- S S Imp. domains -- -- -- 0.28 -- -- Riccio 2005 Clinic 18 - 35 -- 18 14 -- BE BE GAF -- -- -- 0.84* -- -- Pooled results Overall Hedges' g: -- -- -- 0.46 -- --

[95% CI]: -- -- -- [-0.05, 0.97] -- -- Number of significant effects / total studies: -- -- -- 1 / 2 -- --

Ngroup 1 / Ngroup 2: -- -- -- 135 / 102 -- -- [heterogeneity and publication bias analyses not conducted if < 3 studies] Occupational functioning in adults

Sobanski 2008 Clinic 18 - 59 70 64 30 -- S & O S unemployed 2.21* 2.08* -- 0.14 -- -- Sprafkin 2007f Clinic 18 - 76 840g 74 97 32 S S unemployed 0.24 0.14 -0.16 0.10 0.40 0.30 Sprafkin 2007f Clinic 18 - 76 840g 74 97 32 S S occup. level 0.16 -0.16 0.00 0.35 0.18 -0.18 Sprafkin 2007f Comm 18 - 75 840 14 28 18 S S unemployed 0.04 0.30 -0.33 -0.55 0.36 0.87 Sprafkin 2007f Comm 18 - 75 840 14 28 18 S S occup. level 0.69* 0.00 0.31 0.59 0.33 -0.25 Pooled results Overall Hedges' g: 0.50 0.31 -0.05 0.18 0.32 0.14

[95% CI]: [-0.10, 1.10] [-0.22, 0.85] [-0.70, 0.65] [-0.07, 0.42] [-0.07, 0.72] [-0.19, 0.47] Number of significant effects / total studies: 1 / 3 1 / 3 0 / 2 0 / 3 0 / 2 0 / 2

Ngroup 1 / Ngroup 2: 152 / 910 155 / 910 50 / 854 152 / 155 88 / 50 125 / 50 Cochrane's Q, I2: 6.4, 69% 8.1, 75% -- 0.4, 0% -- --

Classic fail-safe N / Orwin's fail-safe N: -- / 1 -- / -- -- -- / -- -- -- Egger's regression intercept: ns ns -- ns -- --

Trim and Fill number of missing studies (Higher or Lower than point estimate): 0 0 -- 2 (higher) -- -- Trim and fill adjusted g: 0.50 0.31 -- 0.23 -- --

Note: GAF= Global Assessment of Functioning. Summary statistics for the meta-analysis are described in Supplement section 2. aComm = community, Clinic = clinic-referred. bP = parent, T = teacher, CL = clinician, S = self, O = other observer, Chart = chart review. cPositive effect sizes indicate that the group listed first is more impaired than the group listed second, and negative effect sizes indicate that the group listed second is more impaired. dmales. efemales. fmultiple effects reported by the study were combined into a single effect size for meta-analysis (see Supplement section 2). gthe control group from the community sample was also used as a control group for the clinic sample for analyses. * = P < .05




ACADEMIC IMPAIRMENT Academic functioning in children and adolescents Parent and teacher ratings of academic performance Bauerm. 2007d Comm 4 - 17 849 36 35 59 P P BIS School 1.08* 1.16* 0.32* -0.12 0.85* 0.89* Bauerm. 2007e Comm 4 -17 847 14 12 40 P P BIS School 0.97* 0.43 0.36* 0.56 1.14* 0.21 Carlson 2002a Clinic 9 - 12 22 22 11 -- P & T T Work Completion 1.59* 1.82* -- -0.20 -- -- Forbes 2001 Clinic 6 - 12 -- 88f 27 -- P P CPRS Learn Prb. -- -- -- -0.57* -- -- Gadow 2000 Comm 10 - 12 443 32 72 58 P P Grade Point Avg. 0.51* 0.67* 0.00 0.18 0.55* 0.66* Gadow 2004a Clinic 6 -10 -- 60 81 12 T T CBCL -- -- -- -0.28 0.72* 1.01* Gaub 1997 Comm 5 - 12 221 51 123 47 T T CBCL Learn Prb. 1.48* 1.58* 0.31 0.02 1.43* 1.53* Klorman 1999 Clinic 7 - 13 28 66 51 -- P T Multi-grade Inv. 0.43* 0.66* -- 0.22 -- -- Lahey 1994g Clinic 4 - 17 23 71 38 11 P & T T Acad. Perf 0.95* 1.05* 0.20 -0.02 0.69* 0.75 Lahey 1994g Clinic 4 - 17 55 114 57 13 P & T P Homework prob 1.29* 1.28* 0.28 -0.14 1.00* 0.80* Lalonde 1998g Clinic 3 - 17 -- 78 15 7 P P OCHS school fx -- -- -- -0.11 -0.19 -0.31 Lalonde 1998g Clinic 3 - 17 -- 78 15 7 P T OCHS school fx -- -- -- -0.12 0.21 0.16 McBurn 1999 Clinic 3 - 17 -- 424 184 48 P & T T CBCL / TRF -- -- -- No ESh No ES*h No ES*h

Mugnaini 2006 Comm 6 - 7 -- 25 67 43 T T Scholastic Impair -- -- -- 0.28 1.37* 1.67* Paternite 1996 Clinic 6 - 12 -- 59 28 9 P P CBCL Acad. Perf -- -- -- No ESh No ES*h No ESh

Solanto 2009 Clinic 7 - 12 34 20 24 -- P & T T SSRS Academic 1.90* 2.04* -- -0.31 -- -- Willcutt 2011ci Comm 6 - 13 4,570 238 246 46 P & T P Academic Prob 1.01* 1.04* 0.09 -0.03 0.75* 0.81* Willcutt 2011cj Clinic 6 - 18 -- 67 50 8 P & T P Academic Prob -- -- -- 0.13 0.89* 0.83* Willcutt 2011ck Clinic 8 - 16 -- 277 135 21 P & T P Academic Prob -- -- -- 0.06 0.97* 0.83* Willcutt 2011cl Comm 8 - 18 1,280 133 273 41 P & T P Academic Prob 1.06* 0.97* 0.07 0.04 0.82* 0.73*




ACADEMIC IMPAIRMENT CONTINUED Academic functioning in children and adolescents continued Parent and teacher ratings of academic performance continued Pooled results Overall Hedges' g: 1.06* 1.08* 0.19* 0.00 0.88* 0.87*

[95% CI]: [0.87, 1.26] [0.87, 1.29] [0.07, 0.31] [-0.10, 0.10] [0.71, 1.07] [0.64, 1.11] Number of significant effects / total number of studies 10 / 10 9 / 10 2 / 7 1 / 18 13 / 14 11 / 14

Ngroup 1 / Ngroup 2: 740 / 8,335 906 / 8,335 304 / 8,265 1,335 / 1,281 1,125 / 395 1,166 / 395 Cochrane's Q, I2: 32.7*, 72%m 46.4*, 80%n 5.6, 0% 20.7, 27% 18.1, 39% 36.3, 70%

Classic fail-safe N / Orwin's fail-safe N: 1,141 / 43 806 / 31 12 / -- -- / -- 450 / 48 500 / 47 Egger's regression intercept: ns ns ns ns ns ns

Trim and Fill number of missing studies (Higher or lower than point estimate): 0 0 0 0 1 (higher) 3 (higher) Trim and fill adjusted g: 1.06* 1.08* 0.19* 0.00 0.94* 1.02*

Note: BIS = Brief Impairment Scale, CBCL = Child Behavior Checklist, CPRS = Conners Parent Rating Scale, OCHS = Revised Ontario Child Health Study scales; SSRS = Social Skills Rating Scale, TRF = Teacher Report Form. Summary statistics for the meta-analysis are described in detail in Supplement section 2. aComm = community sample, Clinic = clinic-referred sample. bP = parent, T = teacher. cPositive effect sizes indicate that the group listed first is more impaired than the group listed second, and negative effect sizes indicate that the group listed second is more impaired. dmales. efemales. fADHD-C group includes 81 with ADHD-C , 7 with ADHD-H. gmultiple effects reported by the study were combined into a single effect size for meta-analysis (see Supplement section 2). hinsufficient data available to calculate effect size. iColorado community sample. jUniversity of Colorado Clinic Sample. kUniversity of Denver Clinic sample. lColorado twin sample. mheterogeneity due to significant outlier effect sizes reported by Solanto et al. (2009) and Klorman et al. (1999); when these effects were excluded the overall effect size was slightly higher and remained significant (g = 1.07). nheterogeneity due to significant outlier effect sizes reported by Solanto et al. (2009) and Gaub et al. (1997); when these effects were excluded the overall effect size was slightly higher and remained significant (g = 0.95).

* = P < .05




ACADEMIC IMPAIRMENT CONTINUED Academic functioning in children and adolescents continued Academic achievement tests Bauerm. 2005bd Comm 6 - 11 29 44 25 -- P & T Test WJ Reading 1.31* 1.43* -- -0.16 -- -- Bauerm. 2005bd Comm 6 - 11 29 44 25 -- P & T Test TRWL Spelling 1.80* 1.73* -- 0.01 -- -- Bauerm. 2005bd Comm 6 - 11 29 44 25 -- P & T Test WJ Math 1.20* 1.65* -- -0.43 -- -- Booth 2007d Clinic 7 - 13 24 16 26 -- P & T Test WRAT Reading 1.32* 0.91* -- 0.44 -- -- Booth 2007d Clinic 7 - 13 24 16 26 -- P & T Test WRAT Math 0.60* 0.75* -- -0.08 -- -- Carlson 2002ad Clinic 9 - 12 22 21 13 -- P & T Test WRAT Math 0.81* 0.54 -- 0.19 -- -- Carlson 2002ad Clinic 9 - 12 22 21 13 -- P & T Test WRAT Reading 0.77* 0.79* -- -0.02 -- -- Chhabild. 2001 Comm 8 - 18 82 33 67 14 P & T Test PIAT Reading 1.80* 1.60* 0.61 0.18 1.14* 0.97* Edwards 2007d Clinic 6 - 12 -- 50 33 -- P Test WRAT-III Spell -- -- -- 0.23 -- -- Edwards 2007d Clinic 6 - 12 -- 50 33 -- P Test WRAT-III Read -- -- -- 0.07 -- -- Edwards 2007d Clinic 6 - 12 -- 50 33 -- P Test WRAT-III Math -- -- -- 0.12 -- -- Faraone 1998d Clinic 3 - 18 135 182 92 28 P Test WRAT Math No ES*e No ES*e No ESe No ESe No ESe No ESe

Faraone 1998d Clinic 3 - 18 135 182 92 28 P Test WRAT Reading No ES*e No ESe No ESe No ESe No ESe No ESe

Gadow 2004a Clinic 10 - 12 -- 102 70 10 P & T Test WRAT Math -- -- -- 0.28 0.85* 0.69* Gorman 2006d Clinic 6 - 12 34 22 19 -- P & T Test WJ Broad Math 1.39* 1.78* -- -0.20 -- -- Gorman 2006d Clinic 6 - 12 34 22 19 -- P & T Test WJ Basic Read 1.33* 1.04* -- -0.20 -- -- Gorman 2006d Clinic 6 - 12 34 22 19 -- P & T Test Kaufman Spelling 0.96* 1.02* -- -0.12 -- -- Hinshaw 2002ad Clinic 6 - 12 88 93 47 -- P & T Test WIAT Math 0.84* 0.79* -- 0.04 -- -- Hinshaw 2002ad Clinic 6 - 12 88 93 47 -- P & T Test WIAT Reading 0.73* 0.83* -- -0.07 -- -- Johnstone 2009 Clinic 8 - 14 15 15 15 -- NS P Spelling Age 0.60 1.05* -- -0.34 -- -- Klorman 1999d Clinic 7 - 13 28 207 51 -- P Test WJ Calculations 0.94* 1.03* -- -0.12 -- -- Klorman 1999d Clinic 7 - 13 28 207 98 -- P Test WJ Reading 1.63* 1.71* -- -0.04 -- -- Lahey 1998d Clinic 4 - 6 125 84 14 29 P & T Test WJ Calculations 0.81* 1.10* 0.35 -0.26 0.43 0.67* Lahey 1998d Clinic 4 - 6 125 84 14 29 P & T Test WJ Reading 0.54* 1.00* 0.33 -0.51 0.17 0.59* Lee 2008bd Clinic 6 - 16 47 200 113 60 P & T Test mean of 3 read 1.02* 1.11* 1.10* -0.01 -0.07 -0.06 Lee 2008bd Clinic 6 - 16 47 200 113 60 P & T Test mean of 2 math 1.21* 1.17* 1.07* 0.00 0.10 0.04 Loo 2007 Comm 16 - 18 165 66 72 37 P & T Test Word Fluency 0.81* 0.68* 0.56* 0.10 0.15 0.18 Martinn. 2006 Clinic 7 - 13 34 60 22 12 P & T Test WRAT Reading 1.01* 0.93* 1.47* 0.20 -0.26 -0.47 Merrell 2001d,f Comm 4 - 7 829 83 158 85 T Test Key Math 1.00* 1.13* 0.28 -0.13 0.72* 0.85* Merrell 2001d,f Comm 4 - 7 829 83 158 85 T Test Key Reading 0.88* 0.96* 0.45* -0.08 0.43* 0.51*




ACADEMIC IMPAIRMENT CONTINUED Academic functioning in children and adolescents continued Academic achievement tests Merrell 2001d,g Comm 4 - 7 1,030 20 83 37 T Test Key Math 0.65* 1.26* 0.19 -0.61* 0.46* 1.07* Merrell 2001d,g Comm 4 - 7 1,030 20 83 37 T Test Key Reading 0.80* 1.07* 0.38 -0.27 0.42* 0.69* Mikami 2007 Clinic 7 - 12 38 33 45 -- P & T Test WIAT Reading 1.11* 0.86* -- 0.29 -- -- Morgan 1996d Clinic 6 - 11 -- 26 30 -- P & T Test BASIS Math -- -- -- -0.29 -- -- Morgan 1996d Clinic 6 - 11 -- 26 30 -- P & T Test BASIS Reading -- -- -- 0.49 -- -- Morgan 1996d Clinic 6 - 11 -- 26 30 -- P & T Test BASIS Spelling -- -- -- 0.36 -- -- Nigg 2002a Comm 7 - 12 41 46 18 -- P & T Test WIAT Reading 0.76* 0.71* -- 0.03 -- -- O'Driscoll 2005 Clinic 11 - 14 10 10 12 -- P & T Test WJ Reading 0.57 0.03 -- 0.51 -- -- Paternite 1996 Clinic 6 - 12 -- 59 28 9 P Test WRAT multiple -- -- -- No ESe No ESe No ESe

Riccio 2006d Clinic 9 - 15 -- 27 13 -- P & T Test WJ Word ID -- -- -- -0.06 -- -- Riccio 2006d Clinic 9 - 15 -- 27 13 -- P & T Test WJ Read Flu. -- -- -- -0.38 -- -- Riccio 2006d Clinic 9 - 15 -- 27 13 -- P & T Test WJ Pass. Comp -- -- -- -0.33 -- -- Riccio 2006d Clinic 9 - 15 -- 27 13 -- P & T Test WJ Calculations -- -- -- -0.81 -- -- Riccio 2006d Clinic 9 - 15 -- 27 13 -- P & T Test WJ App. Probs -- -- -- -0.39 -- -- Riley 2008d Clinic 3 - 5 -- 71 -- 31 P & T Test WJ Word ID -- -- -- -- 0.31 -- Riley 2008d Clinic 3 - 5 -- 71 -- 31 P & T Test WJ App. Probs -- -- -- -- 0.33 -- Scheres 2010 Clinic 6 - 17 37 25 20 -- P Test WIAT Total Ach. 0.53* 0.20 -- 0.37 -- -- Sem.-Cl. 2010cd Clinic 9 - 16 113 76 80 -- BE Test Reading -0.02 -0.14 -- 0.11 -- -- Sem.-Cl. 2010cd Clinic 9 - 16 113 76 80 -- BE Test Math calc. 0.69* 0.71* -- -0.06 -- -- Todd 2002bd Comm 7 - 17 446 104 154 24 P Test WRAT Math 0.69* 0.54* 0.09 0.15 0.66* 0.49* Todd 2002bd Comm 7 - 17 446 104 154 24 P Test WRAT Reading 0.65* 0.35* 0.16 0.28 0.47 0.18 Todd 2002bd Comm 7 - 17 446 104 154 24 P Test WRAT Spelling 0.70* 0.40* 0.05 0.28* 0.65* 0.35 Vaughn 1997d Clinic 6 - 11 -- 38 16 -- P & T Test WRAT Math -- -- -- -0.26 -- -- Vaughn 1997d Clinic 6 - 11 -- 38 16 -- P & T Test WRAT Reading -- -- -- -0.27 -- -- Vaughn 1997d Clinic 6 - 11 -- 38 16 -- P & T Test WRAT Spelling -- -- -- -0.11 -- -- Willcutt 2001 Comm 8 - 18 150 36 80 14 P & T Test PIAT Math 1.09* 1.01* 0.20 0.09 0.97* 0.87* Willcutt 2011ad Comm 8 - 18 288 135 235 40 P & T Test PIAT Read. Rec. 0.85* 1.14* 0.37 -0.24 0.31 0.58* Willcutt 2011ad Comm 8 - 18 288 135 235 40 P & T Test PIAT Math 1.08* 1.14* 0.38* -0.03 0.47* 0.52* Willcutt 2011ad Comm 8 - 18 288 135 235 40 P & T Test PIAT Spelling 0.90* 1.19* 0.35 -0.27 0.48* 0.76* Willcutt 2011ad Comm 8 - 18 288 135 235 40 P & T Test WRAT Spelling 1.24* 1.23* 0.36 -0.05 0.56* 0.59*




ACADEMIC IMPAIRMENT CONTINUED Academic functioning in children and adolescents continued Academic achievement tests Pooled results Overall Hedges' g: 0.91* 0.91* 0.48* 0.02 0.43* 0.50*


Ngroup 1 / Ngroup 2: 1,430 / 3,675 1,416 / 3,675 352 / 3,196 1,673 / 1,578 995 / 393 1,068 / 362 Cochrane's Q, I2: 54.0, 61% 94.7*, 78%h 23.4, 62% 26.4, 1% 25.3, 56% 31.8*, 69%i

Classic fail-safe N / Orwin's fail-safe N: 2,680 / 82 2,945 / 82 146 / 16 -- / -- 120 / 17 146 / 20 Egger's regression intercept: ns ns ns ns ns ns

Trim and Fill number of missing studies (Higher or Lower than point estimate): 3 (higher) 0 1 (higher) 0 1 (lower) 0 Trim and fill adjusted g: 0.97* 0.91* 0.54* 0.02 0.39* 0.50*

Note: BASIS = Basic Achievement Skills Individual Screener, PIAT = Peabody Individual Achievement Test, TRWL = Test of Reading and Written Language, WIAT = Wechsler Individual Achievement Test, WJ = Woodcock-Johnson Achievement Test, WRAT = Wide-Range Achievement Test. Summary statistics for the meta-analysis are described in detail in Supplement section 2. aComm = community sample, Clinic = clinic-referred sample. bP = parent, T = teacher, CL = clinician, S = self, BE = best estimate summary from multiple sources of data, Chart = chart review. cPositive effect sizes indicate that the group listed first is more impaired than the group listed second, and negative effect sizes indicate that the group listed second is more impaired. dmultiple effects reported by the study were combined into a single effect size for meta-analysis (see Supplement section 2). einsufficient data available to calculate effect size. fmales. gfemales. hheterogeneity due to significant outlier effect sizes in studies by Chhabildas et al. (2001), Semrud-Clikeman (2010), Todd et al. (2002) and O’Driscoll et al. (2005); the point estimate was slightly higher when analyses were conducted without these studies (g = 1.07). iheterogeneity due to significant outlier effect size reported by Martinussen et al. (2006); results changed minimally when analyses were conducted without this effect (g = 0.56).

* = P < .05




ACADEMIC IMPAIRMENT CONTINUED

Academic functioning / outcomes in adults Egeland 2007 Clinic 15 - 46 -- 51 19 -- BE S years education -- -- -- 0.12 -- -- Grevet 2006 Comm M = 34 -- 117 88 -- S S repeated graded -- -- -- -0.02 -- -- Miller 2007 Comm 18 - 37 146 48 47 -- S S high school gradd 0.76* 0.44 -- 0.32 -- -- Millstein 1997 Clinic 19 - 60 -- 111 35 -- S S repeated graded -- -- -- -0.20 -- -- Murphy 2002 Clinic 17 - 27 64 60 36 -- S S years education 0.72* 0.67* -- 0.00 -- -- Riccio 2005 Clinic 18 - 35 -- 18 14 -- BE S years education -- -- -- -0.32 -- -- Schweitzer 2006 Clinic M = 34 18 17 16 -- S & O S years education 0.22 0.77* -- -0.36 -- -- Sobanski 2008 Clinic 18 - 59 70 64 30 -- S & O S college gradd 0.44* 0.46 -- -0.02 -- -- Solanto 2004 Clinic M = 35 -- 44 26 -- BE S college gradd -- -- -- 0.16 -- -- Sprafkin 2007 Clinic 18 - 76 840e 74 97 32 S S years education 0.45* 0.18 0.09 0.27 0.39 0.10 Sprafkin 2007 Comm 18 - 75 840 14 28 18 S S years education 0.27 0.09 0.18 0.44 0.08 -0.26 Pooled results Overall Hedges' g: 0.50* 0.35* 0.12 0.06 0.31 -0.02

[95% CI]: [0.34, 0.65] [0.15, 0.56] [-0.16, 0.41] [-0.08, 0.20] [-0.05, 0.66] [-0.35, 0.31] Number of significant effects / total number of studies 4 / 6 2 / 6 0 / 2 0 / 11 0 / 2 0 / 2

Ngroup 1 / Ngroup 2: 277 / 1,138 254 / 1,138 50 / 840 618 / 438 88 / 50 125 / 50 Cochrane's Q, I2: 3.9, 0% 7.7, 35% -- 8.5 , 0% -- --

Classic fail-safe N / Orwin's fail-safe N: 48 / 9 25 / 5 -- -- / -- -- -- Egger's regression intercept: ns ns -- ns -- --

Trim and Fill number of missing studies (Higher or Lower than point estimate): 1 (higher) 3 (lower) -- 2 (higher) -- -- Trim and fill adjusted g: 0.51* 0.19 -- 0.09 -- --

Note: Summary statistics for the meta-analysis are described in detail in Supplement section 2. aComm = community sample, Clinic = clinic-referred sample. bS = self, O = other observer, BE = best estimate summary from multiple sources of data. cPositive effect sizes indicate that the group listed first is more impaired than the group listed second, and negative effect sizes indicate that the group listed second is more impaired. dTo simplify interpretation effect sizes for categorical academic outcomes reported by studies of adults were converted to Hedges' g. ethe control group from the community sample was also used as a control group for the clinic sample for the meta-analysis.

* = P < .05




SOCIAL FUNCTIONING Studies of children and adolescents Overall social problems Byun 2006 Clinic 5 - 16 -- 70 22 -- P P CBCL Soc. Prob. -- -- -- 0.47 -- -- Cordier 2010 Clinic 5 - 11 -- 31 46 28 P P CPRS -- -- -- 0.88* 0.98* -0.19 Faraone 1998d Clinic 3 - 18 135 182 92 28 P P SAICA 1.97* 1.44* 1.34* 0.46* 0.74* 0.26 Faraone 1998d Clinic 3 - 18 135 182 92 28 P P CBCL 0.94* 0.67* -0.01 0.20 0.74* 0.47* Forbes 2001 Clinic 6 - 12 -- 88e 27 -- P & T P CBCL Soc. Prob. -- -- -- 0.19 -- -- Gadow 2000 Comm 10 - 12 443 32 72 58 P P CBCL Soc. Prob. 1.19* 0.79* 0.27 0.29 0.76* 0.44* Gadow 2004ad Clinic 6 - 10 -- 55 82 11 P P CBCL Soc. Prob. -- -- -- 0.44 0.24 -0.24 Gadow 2004ad Clinic 6 - 10 -- 60 81 12 T T TRF Soc. Prob. -- -- -- 0.78* 1.17 0.36 Gaub 1997 Comm 5 - 12 221 51 123 47 T T TRF Soc. Prob. 2.00* 0.98* 1.13* 0.77* 0.72* -0.05 Geurts 2005 Comm 6 - 13 -- 16 16 -- P & T P ADI-R Social -- -- -- 0.41 -- -- Graetz 2001 Comm 6 - 17 3,298 67 133 68 P P CBCL Soc. Prob. 2.13* 1.66* 1.20* 0.21 0.48* 0.26 Gr.-Tsur 2006 Clinic 5 - 18 -- 138 64 -- P & T P CBCL Soc. Prob. -- -- -- 0.37 -- -- Johnstone 2009 Clinic 8 - 14 15 15 15 -- NS P CBCL Soc. Prob. 1.44* 0.52 -- 1.00* -- -- Lahey 1994 Clinic 4 - 17 17 72 29 19 P & T T Social preference 1.01* 0.84* 0.21 0.35 0.88* 0.67* Lalonde 1998d Clinic 3 - 17 -- 78 15 7 P T OCHS Social -- -- -- 1.12* 0.19 1.06* Lalonde 1998d Clinic 3 - 17 -- 78 15 7 P P OCHS Social -- -- -- 0.85* -0.13 0.53* Maedgen 2000 Clinic 8 - 11 17 16 14 -- P P CABS Social 1.72* 0.67* -- 0.72* -- -- McBurnett 1999 Clinic 3 - 18 -- 424 184 48 P & T P SNAP Soc. Prob. -- -- -- No ES*f No ESf No ES*f

McBurnett 1999 Clinic 3 - 18 -- 424 184 48 P & T P SNAP Soc. Prob. -- -- -- No ES*f No ES*f No ESf

Morgan 1996d Clinic 6 - 11 -- 26 30 -- P & T P CBCL Soc. Prob. -- -- -- 0.75* -- -- Morgan 1996d Clinic 6 - 11 -- 26 30 -- P & T T TRF Social Prob. -- -- -- 0.02 -- -- Mugnaini 2006 Comm 6 - 7 -- 25 67 43 T T VADRS Social -- -- -- 1.80* 1.01* -0.79* Nolan 2001 Comm 6 - 12 1278 50 157 35 T T CSI Peer Relat. 2.26* 0.97* 0.99* 0.48* 0.79* 0.09 Nolan 2001 Comm 3 - 5 338 32 16 27 T T ECI Peer Relat. 1.56* 0.61* 0.91* 0.73* 0.59* -0.25 Paternite 1996 Clinic 6 - 12 -- 59 28 9 P P & T CBCL Soc. Prob. -- -- -- No ESf No ESf No ESf

Reiersen 2007 Comm 8 - 25 812 55 75 14 P P SRS Soc. Impair. 1.64* 0.90* 0.67* 0.58* 0.77* 0.20 Scheres 2010 Clinic 6 - 17 37 25 20 -- P P CPRS Soc. Prob. 2.08* 1.68* -- 0.26 -- -- van West 2009d Clinic 6 - 12 25 52 23 -- P & S P CBCL Soc. Prob. 2.28* 2.49* -- 0.96* -- -- van West 2009d Clinic 6 - 12 25 52 23 -- P & S T TRF Soc. Prob. 1.84* 2.28* -- 0.29 -- -- Vaughn 1997d Clinic 6 - 11 -- 38 16 -- P & T T BASC Soc. Prob. -- -- -- 0.75* -- --




SOCIAL FUNCTIONING CONTINUED Studies of children and adolescents continued

Overall social problems continued Vaughn 1997d Clinic 6 - 11 -- 38 16 -- P & T P BASC Soc. Prob. -- -- -- 0.77* -- -- Vaughn 1997d Clinic 6 - 11 -- 38 16 -- P & T P CBCL Soc. Prob. -- -- -- 1.00* -- -- Vaughn 1997d Clinic 6 - 11 -- 38 16 -- P & T T TRF Soc. Prob. -- -- -- 0.89* -- -- Willcutt 2011a Comm 8 - 18 288 145 235 40 P & T P & T CBCL / TRF 1.27* 1.01* 0.84* 0.26 0.53* 0.27* Pooled results Overall Hedges' g: 1.68* 1.06* 0.80* 0.53* 0.68* 0.12

[95% CI]: [1.44, 1.92] [0.85, 1.27] [0.55, 1.04] [0.41, 0.67] [0.55, 0.81] [-0.10, 0.33] Number of significant effects / total number of studies 13 / 13 11 / 13 7 / 9 14 / 25 13 / 15 4 / 15

Ngroup 1 / Ngroup 2: 783 / 7,246 1,004 / 6,924 341 / 7,152 1,343 / 1,383 869 / 431 1,142 / 426 Cochrane's Q, I2: 67.5, 82%g 74.9*, 84%h 33.3, 76% 52.0*, 58%i 9.1, 0% 36.4, 67%

Classic fail-safe N / Orwin's fail-safe N: 3,570 / 97 1,083 / 42 413 / 29 652 / 28 353 / 36 -- / -- Egger's regression intercept: ns ns ns P = .01 ns ns

Trim and Fill number of missing studies (Higher or Lower than point estimate): 0 2 (higher) 0 7 (lower) 3 (lower) 2 (lower) Trim and fill adjusted g: 1.69* 1.14* 0.80* 0.38* 0.63* 0.05

Note: ADI-R = Autism Diagnostic Interview, Revised, BASC = Behavior Assessment System for Children, CABS = Children's Assertiveness Behavior Scale, CBCL = Child Behavior Checklist, CPRS = Conners Parent Rating Scale, CSI = Child Symptom Inventory, ECI = Early Childhood Inventory, OCHS = Revised Ontario Child Health Study scales; SAICA = Social Adjustment Inventory for Children and Adolescents, SNAP = Swanson, Nolan, & Pelham checklist, SRS = Social Responsiveness Scale, TRF = Teacher Report Form. Summary statistics for the meta-analysis are described in detail in Supplement section 2. aComm = community sample, Clinic = clinic-referred sample. bP = parent, T = teacher, S = self. cPositive effect sizes indicate that the group listed first is more impaired than the group listed second, and negative effect sizes indicate that the group listed second is more impaired. dmultiple effects reported by the study were combined into a single effect size for meta-analysis (see Supplement section 2). finsufficient data available to calculate effect size. gNo outliers or significant moderators account for heterogeneity. hHeterogeneity among effects due to a significant outlier effect sizes reported by van West et al. (2009) and Graetz et al. (2001); when this effect was excluded the overall effect was smaller but remained significant (g = 0.95). iheterogeneity due to significant outlier effect size reported by Mugnaini et al. (2006); when this effect was excluded the overall effect size was smaller but remained significant (g = 0.47).

* = P < .05





Disliked by peers Gaub 1997 Comm 5 - 12 221 51 123 47 T T Disliked by peers 1.51* 0.75* 1.23* 0.53* 0.24 -0.30 Hinshaw 2002a Clinic 6 - 12 88 93 47 -- P & T Peer Disliked by peers 1.19* 0.90* -- 0.67* -- -- Hodgens 2000 Clinic 8 - 11 15 15 15 -- P Peer Liked - disliked No ES*d No ES*d -- No ESd -- -- Lahey 1994 Clinic 4 - 17 17 72 29 19 P & T T Disliked by peers 1.19* 0.87* 0.25 0.38 1.05* 0.72* Lahey 1998 Clinic 4 - 6 121 82 14 29 P & T T Disliked by peers 1.06* 0.37 0.77* 0.74* 0.49* -0.32 Maedgen 2000e Clinic 8 - 11 13 15 10 -- P T Disliked by peers 1.24* 0.40 -- 0.81* -- -- Maedgen 2000e Clinic 8 - 11 17 16 14 -- P P Disliked by peers 0.99* -0.46 -- 1.21* -- -- McBurnett 1999 Clinic 3 - 17 -- 424 184 48 P & T P Annoys / Disliked -- -- -- No ES*d No ES*d No ES*d

Mikami 2007 Clinic 7 - 12 38 33 45 -- P & T T Disliked by peers 1.75* 1.40* -- 0.60* -- -- Willcutt 2011a Comm 8 - 18 156 61 104 19 P & T T Disliked by peers 0.81* 0.60* 0.65* 0.28 0.35 0.06 Willcutt 2011cf Comm 6 - 13 4,570 238 246 61 P & T P & T Disliked by peers 0.99* 0.45* 0.55* 0.55* 0.50* -0.06 Pooled results Overall Hedges' g: 1.15* 0.67* 0.73* 0.53* 0.50* -0.01

[95% CI]: [0.97, 1.35] [0.45, 0.89] [0.42, 1.05] [0.42, 0.64] [0.27, 0.73] [-0.32, 0.30] Number of significant effects / total number of studies 9 / 9 7 / 9 4 / 5 8 / 10 4 / 6 2 / 6

Ngroup 1 / Ngroup 2: 646 / 5,228 603 / 6,906 160 / 5,085 747 / 603 504 / 175 516 / 175 Cochrane's Q, I2: 18.0, 61% 24.6, 72% 12.2, 67% 5.7, 0% 6.1, 35% 9.5, 58%

Classic fail-safe N / Orwin's fail-safe N: 829 / 43 263 / 22 80 / 14 145 / 17 34 / 9 -- / -- Egger's regression intercept: ns ns ns ns ns ns

Trim and Fill number of missing studies (Higher or Lower than point estimate): 0 1 (lower) 2 (higher) 2 (lower) 1 (higher) 0 Trim and fill adjusted g: 1.16* 0.74 0.91* 0.51* 0.57 -0.01

Note: Summary statistics for the meta-analysis are described in detail in Supplement section 2. aComm = community sample, Clinic = clinic-referred sample. bP = parent, T = teacher, Peer = peer nominations. cPositive effect sizes indicate that the group listed first is more impaired than the group listed second, and negative effect sizes indicate that the group listed second is more impaired. dinsufficient data available to calculate effect size. emultiple effects reported by the study were combined into a single effect size for meta-analysis (see Supplement section 2). fColorado community sample.

* = P < .05




SOCIAL FUNCTIONING CONTINUED Ignored by peers Gaub 1997 Comm 5 - 12 221 51 123 47 T T Ignored 0.76* 0.82* 0.62* 0.09 0.12 0.21 Hinshaw 2002a Clinic 6 - 12 88 93 47 -- P & T Obs Isolated 0.04 0.58* -- 0.66* -- -- Hodgens 2000 Clinic 8 - 11 15 15 15 -- P Peer Left Out No ESd No ES*d -- No ESd -- -- Lahey 1998 Clinic 4 - 6 121 82 14 29 P & T T Ignored 1.11* 1.06* 0.51* -0.17 0.55* 0.36 Maedgen 2000e Clinic 8 - 11 13 15 10 -- P T Ignored 1.20* 1.06* -- -0.13 -- -- Maedgen 2000e Clinic 8 - 11 17 16 13 -- P P Ignored 1.18* 0.59 -- -0.57 -- -- Willcutt 2011a Comm 8 - 18 157 60 105 19 P & T T Ignored 0.95* 0.81* 0.39 -0.03 0.46 0.41 Willcutt 2011cf Comm 6 - 13 4,570 238 227 61 P & T P & T Ignored 0.86* 0.64* 0.21 0.13 0.70* 0.47* Pooled results Overall Hedges' g: 0.79* 0.71* 0.42* 0.12 0.48* 0.36*


Ngroup 1 / Ngroup 2: 540 / 5,174 530 / 5,174 141 / 5,069 653 / 545 431 / 156 469 / 156 Cochrane's Q, I2: 33.2*, 85%g 4.6, 0% 3.6, 18% 12.3, 59% 5.5, 45% 1.4, 0%

Classic fail-safe N / Orwin's fail-safe N: 299 / 40 255 / 18 19 / 5 -- / -- 20 / 6 9 / 4 Egger's regression intercept: ns ns ns ns ns ns

Trim and Fill number of missing studies (Higher or Lower than point estimate): 0 3 (lower) 0 2 (higher) 0 2 (lower) Trim and fill adjusted g: 0.79* 0.67* 0.42* 0.20 0.47* 0.24*

Note: Summary statistics for the meta-analysis are described in detail in Supplement section 2. aComm = community sample, Clinic = clinic-referred sample. bP = parent, T = teacher, Obs = observations, Peer = peer nominations. cPositive effect sizes indicate that the group listed first is more impaired than the group listed second, and negative effect sizes indicate that the group listed second is more impaired. dinsufficient data available to calculate effect size. emultiple effects reported by the study were combined into a single effect size for meta-analysis (see Supplement section 2). fColorado community sample. gheterogeneity due to significant outlier effect reported by Hinshaw (2002a); when this effect was excluded the overall effect size was higher and remained significant (g = 0.89).

* = P < .05




SOCIAL FUNCTIONING CONTINUED Shy / passive Bauerm. 2005bd Comm 6 - 11 29 44 25 -- P & T P SSQ Social Init. -0.63 0.08 -- -0.66* -- -- Bauerm. 2005bd Comm 6 - 11 29 44 25 -- P & T T SSQ Assertion 1.23* 1.98* -- -0.67* -- -- Hinshaw 2002a Clinic 6 - 12 88 93 47 -- P & T Obs Observations 0.04 0.49* -- -0.53* -- -- Hodgens 2000 Clinic 8 - 11 15 15 15 -- P Obs Solitary No ESe No ES*e -- No ES*e -- -- Lahey 1998 Clinic 4 - 6 125 84 14 29 P & T T TASB Shy/withd. 0.46* 0.44 0.09 0.00 0.39 0.37 Maedgen 2000d Clinic 8 - 11 13 15 10 -- P T Passive / isolated 0.24 1.07* -- -0.97* -- -- Maedgen 2000d Clinic 8 - 11 17 16 14 -- P P Passive / isolated -0.39 0.84* -- -1.13* -- -- Mikami 2007 Clinic 7 - 12 38 33 45 -- P & T Chat Response freq. 0.07 0.70* -- -0.65* -- -- Solanto 2009d Clinic 7 - 12 15 27 24 -- P & T P SSRS Assertion 1.23* 0.77* -- 0.14 -- -- Solanto 2009d Clinic 7 - 12 15 27 24 -- P & T T SSRS Assertion 1.15* 1.45* -- -0.46* -- -- Pooled results Overall Hedges' g: 0.32* 0.71* 0.09 -0.48* 0.39 0.37

[95% CI]: [0.03, 0.62] [0.49, 0.93] [-0.32, 0.49] [-0.74, -0.23] [-0.04, 0.81] [-0.27, 1.01] Number of significant effects / total effects: 3 / 7 6 / 7 0 / 1 5 / 7 0 / 1 0 / 1

Ngroup 1 / Ngroup 2: 304 / 317 171 / 317 29 / 125 297 / 169 84 / 29 14 / 29 Cochrane's Q, I2: 14.9, 66% 5.5, 9% N/A 7.7, 35% N/A N/A

Classic fail-safe N / Orwin's fail-safe N: 15 / 4 69 / 18 -- / -- 29 / 10 -- / -- -- / -- Egger's regression intercept: ns ns N/A ns N/A N/A

Trim and Fill number of missing studies (Higher or Lower than point estimate): 1 (higher) 2 (lower) N/A 1 (higher) N/A N/A Trim and fill adjusted g: 0.37* 0.61* N/A -0.43* N/A N/A

Note: SSQ = Social Skills Questionnaire, SRS = Social Responsiveness Scale, SSRS = Social Skills Rating Scale, TASB = Teacher Assessment of Social Behavior. Summary statistics for the meta-analysis are described in detail in Supplement section 2. aComm = community sample, Clinic = clinic-referred sample. bP = parent, T = teacher, Obs = observations, Chat = chatroom. cPositive effect sizes indicate that the group listed first is more impaired than the group listed second, and negative effect sizes indicate that the group listed second is more impaired. dmultiple effects reported by the study were combined into a single effect size for meta-analysis (see Supplement section 2). einsufficient data available to calculate effect size.

* = P < .05




SOCIAL FUNCTIONING CONTINUED Prosocial behaviors / friendships Bauerm. 2005bd Comm 6 - 11 29 44 25 -- P & T P SSQ Total 1.19* 0.70* -- 0.36 -- -- Bauerm. 2005bd Comm 6 - 11 29 44 25 -- P & T T SSQ Total 3.09* 3.49* -- 0.28 -- -- Blachman 2002d Clinic 6 - 12 88 93 47 -- P & T S reciprocal friend. 0.46 0.44 -- 0.02 -- -- Blachman 2002d Clinic 6 - 12 88 93 47 -- P & T S positive features 0.15 0.43 -- -0.25 -- -- Blachman 2002d Clinic 6 - 12 88 93 47 -- P & T S negative features 0.82 0.62 -- 0.14 -- -- Campbell 2009d Comm 7 - 9 790 57 80 -- P & T P SSRS Soc. Skills 1.16* 0.72* -- 0.43* -- -- Campbell 2009d Comm 7 - 9 790 57 80 -- P & T T SSRS Soc. Skills 1.89* 1.63* -- 0.28* -- -- Carlson 2002d Clinic 9 - 12 22 22 11 -- P & T T PRAAM coop. 1.39* 0.80* -- 0.69* -- -- Carlson 2002d Clinic 9 - 12 22 22 11 -- P & T T TRAAM coop. 1.96* 1.45* -- 0.63* -- -- Forbes 2001 Clinic 6 - 12 -- 88e 27 -- P & T T ACTeRS Soc. Sk -- -- -- 0.25 -- -- Gaub 1997 Comm 5 - 12 221 51 123 47 T T liked by peers 1.58* 0.89* 1.35* 0.51* 0.22 -0.31 Hinshaw 2002a Clinic 6 - 12 88 93 47 -- P & T Peer liked by peers 0.63* 0.61* -- 0.05 -- -- Lahey 1994 Clinic 4 - 17 17 72 29 19 P & T T liked by peers 0.94* 0.69* 0.18 0.28 0.79* 0.55 Lahey 1998d Clinic 4 - 6 121 84 14 29 P & T T liked by peers 1.53* 1.54* 0.93* 0.17 0.55* 0.36 Lahey 1998d Clinic 4 - 6 125 84 14 29 P & T T SSRS coop. 1.90* 2.12* 1.11* -0.05 0.79* 0.84* Lahey 1998d Clinic 4 - 6 125 84 14 29 P & T T Prosocial 1.47* 1.32* 1.08* 0.14 0.42* 0.23 Maedgen 2000 Clinic 8 - 11 17 16 14 -- P P liked by peers 1.62* 0.43 -- 1.12* -- -- Mikami 2007d Clinic 7 - 12 38 33 45 -- P & T P SSRS Soc. Skills 1.89* 1.38* -- 0.28 -- -- Mikami 2007d Clinic 7 - 12 38 33 45 -- P & T T liked by peers 1.54* 1.60* -- 0.12 -- -- Miller 2006 Clinic 6 - 12 40 18 12 -- BE P Social Comp. 1.02* 0.60 -- 0.40 -- -- Paternite 1996 Clinic 6 - 12 -- 59 28 9 P P friendships -- -- -- No ESf No ESf No ESf

Riley 2008d Clinic 3 -5 -- 71 -- 31 P & T P SSRS Soc. Skills -- -- -- -- 0.47* -- Riley 2008d Clinic 3 - 5 -- 71 -- 31 P & T T SSRS Soc. Skills -- -- -- -- -0.37 -- Sem.-Cl. 2010ad Clinic 9 - 16 113 76 80 -- BE P SSRS Soc. Skills 1.40* 0.80* -- 0.53* -- -- Sem.-Cl. 2010ad Clinic 9 - 16 113 76 80 -- BE T SSRS Soc. Skills 1.24* 0.98* -- 0.27 -- -- Solanto 2009d Clinic 7 - 12 15 27 24 -- P & T P SSRS Soc. Skills 2.39* 2.02* -- 0.41 -- -- Solanto 2009d Clinic 7 - 12 15 27 24 -- P & T T SSRS Soc. Skills 3.04* 2.33* -- 0.43 -- -- Willcutt 2011a Comm 8 - 18 157 61 106 19 P & T T liked by peers 1.27* 0.93* 0.53* 0.24 0.60* 0.40 Willcutt 2011cg Comm 6 - 13 4,570 238 227 61 P & T P & T liked by peers 1.14* 0.67* 0.63* 0.45* 0.53* 0.08




SOCIAL FUNCTIONING CONTINUED Prosocial behaviors / friendships continued Pooled results Overall Hedges' g: 1.38* 1.01* 0.79* 0.34* 0.45* 0.09

[95% CI]: [1.15, 1.61] [0.81, 1.21] [0.41, 1.16] [0.25, 0.43] [0.24, 0.66] [-0.10, 0.28] Number of significant effects / total effects: 15 / 15 14 / 15 4 / 5 6 / 17 4 / 7 0 / 6

Ngroup 1 / Ngroup 2: 991 / 6,331 882 / 6,331 158 / 5,090 1,180 / 908 678 / 189 498 / 158 Cochrane's Q, I2: 85.1*, 84%h 61.7*, 77%h 16.9, 76% 14.1, 0% 7.5, 34% 11.2, 64%

Classic fail-safe N / Orwin's fail-safe N: 537 / 75 1,561 / 61 95 / 15 169 / 12 36 / 9 -- / -- Egger's regression intercept: ns ns ns ns ns P = .09

Trim and Fill number of missing studies (Higher or Lower than point estimate): 0 0 1 (higher) 0 0 1 (lower) Trim and fill adjusted g: 1.38* 1.01* 0.89* 0.34* 0.45* 0.11

Note: ACTeRS = ADD-H Comprehensive Teacher's Rating Scale, PRAAM = Parent Rating of Academic Achievement Motivation, SSQ = Social Skills Questionnaire, SSRS = Social Skills Rating Scale, TRAAM = Teacher Rating of Academic Achievement Motivation. Summary statistics for the meta-analysis are described in detail in Supplement section 2. aComm = community sample, Clinic = clinic-referred sample. bBE = best estimate summary from multiple sources of data, P = parent, T = teacher, S = self, Peer = peer nominations. cPositive effect sizes indicate that the group listed first is more impaired than the group listed second, and negative effect sizes indicate that the group listed second is more impaired. dmultiple effects reported by the study were combined into a single effect size for meta-analysis (see Supplement section 2). eADHD-C group includes 81 with ADHD-C , 7 with ADHD-H. finsufficient data available to calculate effect size. gcommunity sample. hSignificant heterogeneity of effects for ADHD-C and ADHD-I vs. control due to lower effect sizes on self-report measures and peer nominations (Blachman et al., 2002; Hinshaw, 2002). Effect sizes were higher for both subtypes when data were re-analyzed excluding these measures (ADHD-C g = 1.48, ADHD-I g = 1.04), but the overall interpretation of the results did not change.

* = P < .05.





Social functioning / outcomes in adults Sobanski 2008 Clinic 18 - 59 70 64 30 -- S & O S no stable relat. 0.32 0.39 -- -0.10 -- -- Sprafkin 2007 Clinic 18 - 76 840d 74 97 32 S S not married 0.70* 0.83* 0.76* -0.13 -0.06 0.06 Sprafkin 2007 Comm 18 - 75 840 14 28 18 S S not married 0.33 0.65* 0.08 -0.32 0.24 0.56 Pooled results Overall Hedges' g: 0.55* 0.69* 0.44 -0.15 0.03 0.26

[95% CI]: [0.29, 0.81] [0.45, 0.93] [-0.23, 1.11] [-0.41, 0.12] [-0.37, 0.43] [-0.22, 0.73] Number of significant effects / total effects: 1 / 3 2 / 3 0 / 2 0 / 3 0 / 2 0 / 2


Classic fail-safe N / Orwin's fail-safe N: 11 / 6 29 / 8 -- -- / -- -- -- Egger's regression intercept: ns ns -- ns -- --

Trim and Fill number of missing studies (Higher or Lower than point estimate): 2 (higher) 2 (higher) -- 0 -- -- Trim and fill adjusted g: 0.70* 0.83* -- -0.15 -- --

Note: Summary statistics for the meta-analysis are described in detail in Supplement section 2. aComm = community sample, Clinic = clinic-referred sample. bO = other observer, S = self. cPositive effect sizes indicate that the group listed first is more impaired than the group listed second, and negative effect sizes indicate that the group listed second is more impaired. dthe mean and SD of the control group without ADHD in the community sample was used to estimate effect sizes for both the clinic and community samples.

* = P < .05


Supplement Table 9 Correlations between DSM-IV symptom dimensions and symptoms of other mental disorders

Age

ADHD Comorbidity Correlation with DSM-IV

Symptom Dimensionc

Significant difference Construct / Study Samplea N Range Raterb Raterb Measure Inattention Hyp - Imp between dimensionsd

GENERALIZED ANXIETY DISORDER Studies of children and adolescents Gadow 1997ae Clinic 94 6 - 12 T T CSI .22* .44* ns Gadow 1997ae Clinic 101 6 - 12 P P CSI .23* .35* ns Gadow 1997ae Comm 1,324 6 - 12 T T CSI .61* .49* Inatt > Hyp-Imp Gadow 1997ae Comm 264 6 - 12 P P CSI .59* .53* ns Gadow 1997be Clinic 36 3 - 5 T T ECI .66* .46* ns Gadow 1997be Clinic 105 3 - 5 P P ECI .58* .54* ns Gadow 1997be Comm 398 3 - 5 T T ECI .76* .70* ns Gadow 1997be Comm 531 3 - 5 P P ECI .60* .59* ns Gadow 1998e Clinic 122 13 - 18 T T ASI .49* .42* ns Gadow 1998e Clinic 144 13 - 18 P P ASI .34* .42* ns Gadow 1998e Comm 1,072 13 - 18 T T ASI .65* .53* Inatt > Hyp-Imp Gadow 1998e Comm 824 13 - 18 P P ASI .51* .46* ns Gadow 2002 Clinic 239 13 - 18 S S YSI .50* .53* ns Hartman 2004 Comm 286 8 - 18 P P DICA-R .14* .13* ns Hartman 2001 Multiple 12,892 3 - 19 P & T P & T Multiple measures .44* .41* ns Levy 2005f Comm 2,197 4 - 18 P P ATBRS .29* .30* ns Levy 2005g Comm 2,173 4 - 18 P P APBRS .34* .31* ns Sprafkin 2002a Clinic 243 6 - 10 P P CSI .43* .50* ns Willcutt 2011ce,h Clinic 145 6 - 18 P P CSI/ASI .40* .49* ns Willcutt 2011ce,h Clinic 127 6 - 18 T T CSI/ASI .46* .42* ns Pooled results Overall r [95% CI]: .45 [.38, .52]* .44 [.38, .49]* ns

total number of effects (total N): 13 (21,204) 13 (21,204) Cochrane's Q, I2: 302.2*, 96%i 193.1*, 94%i

Classic fail-safe N / Orwin's fail-safe N: 7,245 / 41 4,152 / 33 Egger’s Regression Intercept: ns ns




Age


Symptom Dimensionc


GENERALIZED ANXIETY DISORDER CONTINUED

Studies of adults Gadow 2004bj Comm 900 18 - 75 S S ASRI GAD .56* .42* ns Gadow 2004bk Clinic 487 18 - 75 S S ASRI GAD .51* .44* ns Gadow 2004bl Clinic 80 18 - 65 O O AI-4 GAD .39* .39* ns Pooled results Overall r [95% CI]: .52 [.45, .58]* .43 [.38, .47]* ns

total number of effects (total N): 3 (1,467) 3 (1,467) Cochrane's Q, I2: 4.4, 54% 0.3, 0%

Classic fail-safe N / Orwin's fail-safe N: 315 / 15 193 / 11 Egger’s Regression Intercept: ns ns

Trim and Fill number of missing studies (higher or lower than point estimate): 2 (higher) 1 (higher) Trim and fill adjusted r: .56* .43*

Note: AI-4 = Adult Inventory - 4, ASI = Adolescent Symptom Inventory, ASRI = Adult Self-Report Inventory, APBRS/ATBRS = Australia Parent/Teacher Behavior Rating Scale, CSI = Child Symptom Inventory, DICA = Diagnostic Interview for Children and Adolescents, ECI = Early Childhood Inventory, YSI = Youth Symptom Inventory. Summary statistics for the meta-analysis are described in detail in Supplement section 2. aComm = community sample, Clinic = clinic-referred sample. bP = parent, T = teacher, S = self, O = other observer. cAll effects are scaled so that positive correlations indicate that higher ADHD symptoms are associated with greater impairment. dSignificant difference between correlations, P < .05. emultiple effects reported by the study were combined into a single effect size for meta-analysis (see Supplement section 2). ffemales. gmales. hUniversity of Colorado Clinic Sample. iheterogeneity was primarily explained by the significant outlier effect sizes reported by Hartman et al. (2004) and in the community sample described by Gadow & Sprafkin (1997b). When these studies were omitted the overall correlations changed slightly but remained significant (r = .51 for inattention and r = .44 for hyperactivity-impulsivity). jnormative sample. kOutpatient clinic sample. lrandomized clinical trial for adults with ADHD. * = P < .05.



Age


Symptom Dimensionc


SEPARATION ANXIETY DISORDER Studies of children and adolescents Gadow 1997a Clinic 101 6 - 12 P P CSI .11 -.02 ns Gadow 1997a Comm 264 6 - 12 P P CSI .15* .21* ns Gadow 1997b Clinic 105 3 - 5 P P ECI .13 .17 ns Gadow 1997b Comm 531 3 - 5 P P ECI .30* .25* ns Gadow 1998 Clinic 144 13 - 18 P P ASI .06 .08 ns Gadow 1998 Comm 824 13 - 18 P P ASI .09* .18* ns Gadow 2002 Clinic 239 13 - 18 S S YSI .27* .36* ns Lahey 2008 Comm 2,025 6 - 11 P P CAPS .40* .42* ns Lahey 2008 Comm 2,025 12 - 17 P P CAPS .39* .50* Hyp-Imp > Inatt Levy 2005e Comm 2,197 4 - 18 P P APBRS .22* .22* ns Levy 2005f Comm 2,173 4 - 18 P P APBRS .16* .22* Hyp-Imp > Inatt Sprafkin 2002a Clinic 243 6 - 10 P P CSI .06 .18* ns Willcutt 2011cg Comm 1,474 8 - 18 P & T P DICA .17* .22* ns Willcutt 2011ch Comm 145 6 - 18 P P CSI or ASI .18* .19* ns Pooled results Overall r [95% CI]: .20 [.13, .26]* .24 [.16, .32]* ns




Note: ASI = Adolescent Symptom Inventory, APBRS = Australia Parent/Teacher Behavior Rating Scale, CAPS = Child and Adolescent Psychopathology Scale, CSI = Child Symptom Inventory, DICA = Diagnostic Interview for Children and Adolescents, ECI = Early Childhood Inventory, YSI = Youth Symptom Inventory. Summary statistics for the meta-analysis are described in detail in Supplement section 2. aComm = community sample, Clinic = clinic-referred sample. bP = parent, T = teacher, S = self. cAll effects are scaled so that positive correlations indicate that higher ADHD symptoms are associated with greater impairment. dSignificant difference between correlations, P < .05. efemales. fmales. gColorado twin sample. hUniversity of Colorado Clinic Sample. iSignificant heterogeneity due to significant outlier effect sizes reported by Lahey et al. (2008) and Gadow 1997a; when these effects were excluded the overall correlations were slightly lower for both symptom dimensions (r = .17 for inattention and r = .21 for hyp-imp), but both remained significant. * = P < .05



Age


Symptom Dimensionc


SOCIAL PHOBIA Studies of children and adolescents Gadow 1997ae Comm 264 6 - 12 P P CSI .13* .10 ns Gadow 1997ae Clinic 101 6 - 12 P P CSI .06 .09 ns Gadow 1997ae Comm 1323 6 - 12 T T CSI .19* .00 Inatt > Hyp-Imp Gadow 1997ae Clinic 94 6 - 12 T T CSI .16 .12 ns Lahey 2008 Comm 2,025 6 - 11 P P CAPS .40* .28* Inatt > Hyp-Imp Lahey 2008 Comm 2,025 12-17 P P CAPS .37* .33* ns Pooled results Overall r [95% CI]: .28 [.16, .40] .20 [.04, .34] ns

total number of effects (total N): 4 (5,474) 4 (5,474) Cochrane's Q, I2: 61.4*, 95%f 84.0*, 96%f


Trim and Fill number of missing studies (higher or lower than point estimate): 0 0 Trim and fill adjusted r: .28* .20* Studies of adults Gadow 2004bg Comm 900 18 - 75 S S ASRI .44* .25* ns Gadow 2004bh Clinic 487 18 - 75 S S ASRI .36* .30* ns Gadow 2004bi Clinic 80 18 - 65 O O AI-4 .04 -.05 ns Pooled results Overall r [95% CI]: .32 [.17, .46] .21 [.09, .33] ns

total number of effects (total N): 3 (1,467) 3 (1,467) Cochrane's Q, I2: 14.6, 86%j 8.6, 77%


Trim and Fill number of missing studies (Higher or Lower than point estimate): 0 0 Trim and fill adjusted r: .32* .21*

Note: AI-4 = Adult Inventory - 4, ASRI = Adult Self-Report Inventory, CAPS = Child and Adolescent Psychopathology Scale, CSI = Child Symptom Inventory. Summary statistics for the meta-analysis are described in Supplement section 2. aComm = community sample, Clinic = clinic-referred sample. bP = parent, T = teacher, S = self, O = other observer. cAll effects are scaled so that positive correlations indicate that higher ADHD symptoms are associated with greater impairment. dSignificant difference between correlations, P < .05. emultiple effects reported by the study were combined into a single effect size for meta-analysis (see Supplement section 2). fsignificant heterogeneity due to larger effects on latent measures in the study by Lahey et al. (2008) than in Gadow & Sprafkin (1997a). gnormative sample. hOutpatient clinic sample. irandomized clinical trial for adults with ADHD. jsignificant heterogeneity due to the lower correlation for ratings by others in comparison to self-report ratings. * = P < .05.



Age


Symptom Dimensionc


SPECIFIC PHOBIA Studies of children and adolescents Lahey 2008 Comm 2,025 6 - 11 P P CAPS .30* .31* ns Lahey 2008 Comm 2,025 12 - 17 P P CAPS .21* .32* Hyp-Imp > Inatt Pooled results Overall r [95% CI]: .26 [.16, .35] .32 [.28, .36] ns

total number of effects (total N): 2 (4,050) 2 (4,050) [heterogeneity and publication bias analyses were not conducted if < 3 studies]

OBSESSIVE-COMPULSIVE DISORDER Studies of children and adolescents Lahey 2008 Comm 2,025 6 - 11 P P CAPS .33* .48* Hyp-Imp > Inatt Lahey 2008 Comm 2,025 12 - 17 P P CAPS .33* .50* Hyp-Imp > Inatt Pooled results Overall r [95% CI]: .33 [.31, .35] .49 [.47, .51] ns

total number of effects (total N): 2 (4,050) 2 (4,050) [heterogeneity and publication bias analyses were not conducted if < 3 studies] Studies of adults Gadow 2004be Comm 276 18 - 75 S S BSI Obsessive Compulsive .58* .51* ns Gadow 2004bf Clinic 77 adultsg S S BSI Obsessive Compulsive .83* .57* ns Pooled results Overall r [95% CI]: .72 [.38, .89] .52 [.44, .60] ns

total number of effects (total N): 2 (353) 2 (353) [heterogeneity and publication bias analyses were not conducted if < 3 studies]

Note: AI-4 = Adult Inventory - 4, ASRI = Adult Self-Report Inventory, CAPS = Child and Adolescent Psychopathology Scale, CSI = Child Symptom Inventory. Summary statistics for the meta-analysis are described in Supplement section 2. aComm = community sample, Clinic = clinic-referred sample. bP = parent, T = teacher, S = self, O = other observer. cAll effects are scaled so that positive correlations indicate that higher ADHD symptoms are associated with greater impairment. dSignificant difference between correlations, P < .05. erandomized clinical trial for adults with ADHD. fmothers of children with ADHD. gadult sample, specific age range not reported. * = P < .05.



Age


Symptom Dimensionc


DEPRESSION Studies of children and adolescents F.-Weieneth 2009 Clinic 261 3 - 4 P P BASC .42* .39* ns Gadow 1997ae Clinic 101 6 - 12 P P CSI .12 -.13 ns Gadow 1997ae Clinic 94 6 - 12 T T CSI .32* .00 Inatt > Hyp-Imp Gadow 1997ae Comm 1,324 6 - 12 T T CSI .43* .25* Inatt > Hyp-Imp Gadow 1997ae Comm 264 6 - 12 P P CSI .30* .29* ns Gadow 1997be Comm 398 3 - 5 T T ECI .45* .41* ns Gadow 1997be Comm 531 3 - 5 P P ECI .43* .38* ns Gadow 1997be Clinic 36 3 - 5 T T ECI .26 .01 ns Gadow 1997be Clinic 105 3 - 5 P P ECI .31* .27* ns Gadow 1998e Clinic 144 13 - 18 P P ASI .03 .07 ns Gadow 1998e Clinic 122 13 - 18 T T ASI .37* .10 Inatt > Hyp-Imp Gadow 1998e Comm 1,072 13 - 18 T T ASI .61* .38* Inatt > Hyp-Imp Gadow 1998e Comm 824 13 - 18 P P ASI .36* .24* Inatt > Hyp-Imp Gadow 2002e Clinic 110 13 - 18 S S CDI .56* .54* ns Gadow 2002e Clinic 239 13 - 18 S S YSI .46* .47* ns Hartman 2001 Multiple 12,892 3 - 19 P & T P & T Multiple .52* .40* Inatt > Hyp-Imp Hartman 2004 Comm 286 8 - 18 P P DICA-R .34* .22* ns Reynolds 2004e Comm 55 13 - 18 P P BASC-II .46* .51* ns Reynolds 2004e Comm 55 13 - 18 T T BASC-II .31* .34* ns Reynolds 2004e Comm 54 13 - 18 S S BASC-II .33* .30* ns Reynolds 2004e Comm 54 6 - 11 P P BASC-II .49* .50* ns Reynolds 2004e Comm 54 6 - 11 T T BASC-II .56* .49* ns Sprafkin 2002a Clinic 243 6 - 10 P P CSI .25* .23* ns Weiler 2000 Clinic 60 6 - 12 P P DRS .31 .08 ns Willcutt 1999 Comm 200 8 - 18 P & T P DICA-R .44* .20* Inatt > Hyp-Imp

Willcutt 2011ce,f Clinic 145 6 - 18 P P CSI or ASI .29* .14 ns Willcutt 2011ce,f Clinic 127 6 - 18 T T CSI or ASI .28* .09 ns Willcutt 2011ce,g Comm 1,890 6 - 13 P & T P BASC .43* .34* ns



Age


Symptom Dimensionc


Depression Continued

Pooled results Overall r [95% CI]: .40 [.35, .44] .29 [.23, .34] Inatt > Hyp-Imph total number of effects (total N): 17 (19,601) 17 (19,601)

Cochrane's Q, I2: 135.9*, 88%i 122.6*, 87%i Classic fail-safe N / Orwin's fail-safe N: 8,511 / 73 4,394 / 49

Egger’s Regression Intercept: ns ns Trim and Fill number of missing studies (higher or lower than point estimate): 0 0

Trim and fill adjusted r: .40* .29*

Note: ASI = Adolescent Symptom Inventory, BASC = Behavior Assessment Schedule for Children, CSI = Child Symptom Inventory, CDI = Children's Depression Inventory, DICA = Diagnostic Interview for Children and Adolescents, ECI = Early Childhood Inventory, YSI = Youth Symptom Inventory. Summary statistics for the meta-analysis are described in detail in Supplement section 2. aComm = community sample, Clinic = clinic-referred sample. bP = parent, T = teacher, S = self. cAll effects are scaled so that positive correlations indicate that higher ADHD symptoms are associated with greater impairment. dSignificant difference between correlations, P < .05. emultiple effects reported by the study were combined into a single effect size for meta-analysis (see Supplement section 2). fUniversity of Colorado Clinic Sample. gColorado community sample. hIn addition to the correlational studies included in the meta-analysis, multiple regression analyses of two samples indicated that only inattention symptoms were independently associated with elevations of depression (Lahey & Willcutt, 2002). isignificant heterogeneity due to lower correlations in clinic samples than community samples (r = .32 vs. .43 for inattention and .21 vs. .30 for hyperactivity-impulsivity). In both clinic and community samples the correlation with depression was significantly higher for inattention than hyperactivity-impulsivity. * = P < .05.



Age


Symptom Dimensionc


Depression Continued

Studies of adults Gudjonsson 2009e,f Comm 259 18 - 51 S S DASS Depression .59* .34* Inatt > Hyp-Imp Gudjonsson 2009e,g Comm 107 19 - 53 S S DASS Depression .60* .34* Inatt > Hyp-Imp Adler 2008 Clinic 536 adultsh S S Hamilton Depression .13* .18* ns Gadow 2004bi Comm 900 18 - 75 S S ASRI-4 MDD .65* .48* ns Gadow 2004bj Clinic 487 18 - 75 S S ASRI-4 MDD .55* .40* ns Gadow 2004bk Clinic 80 18 - 65 O O AI-4 MDD .49* .23 ns Gadow 2004bl Clinic 77 adultsh S S BSI Depression .62* .52* ns Pooled results Overall r [95% CI]: .59 [.54, .64] .40 [.33, .47] Inatt > Hyp-Impm


Classic fail-safe N / Orwin's fail-safe N: 1,117 / 34 438 / 22 Egger’s Regression Intercept: ns ns

Trim and Fill number of missing studies (Higher or Lower than point estimate): 0 1 (higher) Trim and fill adjusted r: .59* .42*

Note: AI-4 = Adult Inventory - 4, ASRI = Adult Self-Report Inventory, BSI = Behavioral Symptom Inventory, DASS = Depression Anxiety Stress Scales. Summary statistics for the meta-analysis are described in detail in Supplement section 2. aComm = community sample, Clinic = clinic-referred sample. bO = other observer, S = self. cAll effects are scaled so that positive correlations indicate that higher ADHD symptoms are associated with greater impairment. dSignificant difference between correlations, P < .05. emultiple effects reported by the study were combined into a single effect size for meta-analysis (see Supplement section 2). ffemales. gmales. hadult sample, specific age range not provided. inormative sample. jOutpatient clinic sample. krandomized clinical trial for adults with ADHD. lparents of children with ADHD. mIn addition to the studies in the meta-analysis, additional multiple regression analyses indicated that inattention symptoms were independently associated with high levels of negative affect and low positive affect, whereas hyperactivity-impulsivity symptoms were not independently associated with either affective dimension (Knouse et al., 2008). * = P < .05



Age


Symptom Dimensionc


WITHDRAWN Studies of children and adolescents Bohlin 2004 Comm 834 5 - 13 P P CBCL .33* .19* Inatt > Hyp-Imp Gadow 1997ae Clinic 101 6 - 12 P P CBCL .28* .10 ns Gadow 1997ae Clinic 94 6 - 12 T T TRF .28* .14 ns Gadow 1997be Comm 531 3 - 5 P P CBCL .11* .06 ns Gadow 1997be Clinic 36 3 - 5 T T TRF .15 -.20 ns Gadow 1998e Clinic 144 13 - 18 P P CBCL .21* .07 ns Gadow 1998e Clinic 122 13 - 18 T T TRF .28* .06 ns Gadow 2000 Comm 546 10-12 P P CBCL .25* .05 Inatt > Hyp-Imp Gadow 2002 Clinic 110 13 - 18 S S YSR .17* .08 ns Mattison 2003 Clinic 101 6 - 18 T T TRF .07 -.30* Inatt > Hyp-Imp Reynolds 2004 Comm 55 13 - 18 P P BASC-II .43* .40* ns Reynolds 2004e Comm 54 6 - 11 T T BASC-II .55* .35* ns Reynolds 2004e Comm 60 6 - 11 P P BASC-II .27* .27* ns Sprafkin 2001e Clinic 103 5 - 17 P P CBCL .26* -.03 Inatt > Hyp-Imp Sprafkin 2001e Clinic 103 5 - 17 T T TRF .41* -.28* Inatt > Hyp-Imp Sprafkin 2002a Clinic 243 6 - 10 P P CBCL .20* .01 Inatt > Hyp-Imp Sprafkin 2002be Clinic 188 3 - 6 P P CBCL .25* .16* ns Sprafkin 2002be Clinic 107 3 - 6 T T TRF .16 -.15 Inatt > Hyp-Imp Weiler 2000 Clinic 60 6 - 12 P P BASC .32* .19 ns Willcutt 2011ce,f Comm 1,515 8 - 18 T T TRF .44* .31* Inatt > Hyp-Imp Willcutt 2011ce,f Comm 1,474 8 - 18 P P CBCL .32* .21* Inatt > Hyp-Imp Willcutt 2011ce,g Clinic 145 6 - 18 P P BASC .26* .08 ns Willcutt 2011ce,g Clinic 128 6 - 18 T T BASC .28* .07 ns Willcutt 2011ce,h Comm 1,890 6 - 13 P P BASC .26* .13* ns Willcutt 2011ce,i Clinic 571 6 - 18 P P CBCL .31* .10 ns Willcutt 2011ce,i Clinic 327 6 - 18 T T TRF .34* .11 Inatt > Hyp-Imp



Age


Symptom Dimensionc


WITHDRAWN CONTINUED

Pooled results Overall r [95% CI]: .28 [.24, .32] .09 [.03, .15] Inatt > Hyp-Impj total number of effects (total N): 17 (6,793) 17 (6,793) Cochrane's Q, I2: 37.3, 57% 77.0*, 79%k

Classic fail-safe N / Orwin's fail-safe N: 1,774 / 35 248 / -- Egger’s Regression Intercept: ns ns


Note: BASC = Behavior Assessment Schedule for Children, CBCL = Child Behavior Checklist, TRF = Achenbach Teacher Report Form, YSR = Youth Self Report. Summary statistics for the meta-analysis are described in detail in Supplement section 2. aComm = community sample, Clinic = clinic-referred sample. bP = parent, T = teacher, S = self. cAll effects are scaled so that positive correlations indicate that higher ADHD symptoms are associated with greater impairment. dSignificant difference between correlations, P < .05. emultiple effects reported by the study were combined into a single effect size for meta-analysis (see Supplement section 2). fColorado twin sample. gUniversity of Colorado Clinic Sample. hColorado community sample. iDenver Clinic sample. jIn addition to the correlational studies included in the meta-analysis, multiple regression analyses indicated that only inattention symptoms were independently associated with withdrawn behaviors (Lahey & Willcutt, 2002). kheterogeneity due to significant outlier effect sizes reported in the adolescent sample from the study by Reynolds (2004) and in the samples described by Mattison et al. (2003) and Sprafkin et al. (2001). When these studies were excluded the correlation between withdrawn behavior and hyperactivity-impulsivity was slightly higher (r = .11), but remained significantly lower than the correlation between withdrawn behavior and inattention. * = P < .05



Age


Symptom Dimensionc


BIPOLAR DISORDER Studies of children and adolescents Gadow 1998e Comm 1,072 13 - 18 T T ASI .61* .82* Hyp-Imp > Inatt Gadow 1998e Comm 824 13 - 18 P P ASI .25* .33* ns Gadow 2002 Comm 239 13 - 18 Self Self YSI .63* .52* ns Pooled results Overall r [95% CI]: .54 [.33, .70] .57 [.49, .64] ns

total number of effects (total N): 2 (1,311) 2 (1,311) [heterogeneity and publication bias analyses not conducted if < 3 studies] Studies of adults Gadow 2004bf Clinic 487 18 - 75 S S ASRI mania symptoms .65* .75* ns Gadow 2004bg Comm 900 18 - 75 S S ASRI mania symptoms .51* .58* ns Gadow 2004bh Clinic 80 18 - 65 O O AI-4 mania symptoms .28 .54* ns Pooled results Overall r [95% CI]: .51 [.35, .65] .64 [.47, .76] ns




Note: AI-4 = Adult Inventory - 4, ASI = Adolescent Symptom Inventory, ASRI = Adult Self-Report Inventory, YSI = Youth Symptom Inventory. Summary statistics for the meta-analysis are described in detail in Supplement section 2. aComm = community sample, Clinic = clinic-referred sample. bP = parent, T = teacher, O = other observer, S = self. cAll effects are scaled so that positive correlations indicate that higher ADHD symptoms are associated with greater impairment. dSignificant difference between correlations, P < .05. emultiple effects reported by the study were combined into a single effect size for meta-analysis (see Supplement section 2). fOutpatient clinic sample. gnormative sample. hrandomized clinical trial for adults with ADHD. isignificant heterogeneity due to the lower correlation for ratings by others in comparison to self-report ratings. * = P < .05



Age


Symptom Dimensionc


ANXIOUS / DEPRESSED Studies of children and adolescents Bohlin 2004 Comm 834 5 - 13 P P CBCL .33* .34* ns Gadow 1997ae Clinic 94 6 - 12 T T CBCL .29* .17 ns Gadow 1997ae Clinic 101 6 - 12 P P CBCL .24* .10 ns Gadow 1997be Clinic 36 3 - 5 T T CBCL .08 .16 ns Gadow 1997be Clinic 105 3 - 5 P P CBCL .18* .14* ns Gadow 1998e Clinic 122 13 - 18 T T CBCL .34* .32* ns Gadow 1998e Clinic 144 13 - 18 P P CBCL .09 .19* ns Gadow 2000 Comm 546 10 - 12 P P CBCL .24* .25* ns Gadow 2002 Comm 110 13 - 18 S S YSR .39* .39* ns Garner 2010e Clinic 276 5 - 17 P P & T CBCL / TRF .18 .16 ns Garner 2010e Clinic 258 5 - 17 T P & T CBCL / TRF .23* .19* ns Mattison 2003 Clinic 101 6 - 18 T T TRF .16 .06 ns Sprafkin 2001e Clinic 103 5 - 17 P P CBCL .22* .17 ns Sprafkin 2001e Clinic 103 5 - 17 T T TRF .39* .23* ns Sprafkin 2002a Clinic 243 6 - 10 P P CBCL .17* .24* ns Sprafkin 2002be Clinic 188 3 - 6 P P CBCL .21* .36* ns Sprafkin 2002be Clinic 107 3 - 6 T T TRF .16 .21* ns Willcutt 2011ce,f Comm 1,474 8 - 18 T T TRF .27* .26* ns Willcutt 2011ce,f Comm 1,515 8 - 18 P P CBCL .34* .27* ns Willcutt 2011ce,g Clinic 571 6 - 18 P P CBCL .36* .29* ns Willcutt 2011ce,g Clinic 327 6 - 18 T T TRF .18* .22* ns Wolraich 1998a Comm 4,226 6 - 12 T T VABRS .37* .24* Inatt > Hyp-Imp Pooled results Overall r [95% CI]: .27 [.23, .32] .26 [.22, .29] ns

total number of effects (total N): 14 (9,063) 14 (9,063) Cochrane's Q, I2: 40.6*, 68%h 20.1, 40%





Age


Symptom Dimensionc


ANXIOUS / DEPRESSED CONTINUED

Note: CBCL = Child Behavior Checklist, TRF = Achenbach Teacher Report Form, YSR = Youth Self Report, VABRS = Vanderbilt ADHD Diagnostic Rating Scale. Summary statistics for the meta-analysis are described in detail in Supplement section 2. aComm = community sample, Clinic = clinic-referred sample. bP = parent, T = teacher, S = self. cAll effects are scaled so that positive correlations indicate that higher ADHD symptoms are associated with greater impairment. dSignificant difference between correlations, P < .05. emultiple effects reported by the study were combined into a single effect size for meta-analysis (see Supplement section 2). fColorado twin sample. gUniversity of Denver Clinic sample. hSignificant heterogeneity due to lower correlations in clinic samples (r = .32 vs. .24). * = P < .05.



Age


Symptom Dimensionc


SOMATIC COMPLAINTS Studies of children and adolescents Bohlin 2004 Comm 834 5 - 13 P P CBCL .23* .17* ns Gadow 1997ae Clinic 94 6 - 12 T T CBCL .20 .15 ns Gadow 1997ae Clinic 101 6 - 12 P P CBCL .29* .01 Inatt > Hyp-Imp Gadow 1997be Clinic 36 3 - 5 T T CBCL .27 -.05 ns Gadow 1997be Clinic 105 3 - 5 P P CBCL .10* .07 ns Gadow 1998e Clinic 122 13 - 18 T T CBCL .30* .16 ns Gadow 1998e Clinic 144 13 - 18 P P CBCL .01 .01 ns Gadow 2000 Comm 546 10 - 12 P P CBCL .11* .13* ns Gadow 2002 Clinic 239 13 - 18 S S YSR .30* .21* ns Garner 2010e Clinic 276 5 - 17 P P & T CBCL / TRF .16 .11 ns Garner 2010e Clinic 258 5 - 17 T P & T CBCL / TRF .14 .04 ns Mattison 2003 Clinic 101 6 - 18 T T TRF .25* .10 ns Reynolds 2004e Comm 60 6 - 11 P P BASC-II .28* .14 ns Reynolds 2004e Comm 54 6 - 11 T T BASC-II .04 -.06 ns Reynolds 2004e Comm 55 13 - 18 P P BASC-II .23 .10 ns Reynolds 2004e Comm 54 13 - 18 S S BASC-II .38* .43* ns Reynolds 2004e Comm 45 13 - 18 T T BASC-II .53* .38* ns Sprafkin 2001e Clinic 103 5 - 17 P P CBCL .00 .00 ns Sprafkin 2001e Clinic 103 5 - 17 T T TRF .27* -.17* ns Sprafkin 2002a Clinic 243 6 - 10 P P CBCL .14* .20* ns Sprafkin 2002be Clinic 188 3 - 6 P P CBCL .24* .25* ns Sprafkin 2002be Clinic 107 3 - 6 T T TRF .18 .11 ns Weiler 2000 Clinic 60 6 - 12 P P BASC .10 .21 ns Pooled results Overall r [95% CI]: .19 [.15, .22] .13 [.10, .17] ns



Trim and Fill number of missing studies (higher or lower than point estimate): 1 (lower) 2 (higher) Trim and fill adjusted r: .18* .14*



Age


Symptom Dimensionc


SOMATIC COMPLAINTS CONTINUED

Studies of adults Gadow 2004bf Clinic 77 18 - 75 S S ASRI Somatic .40* .34* ns Gadow 2004bg Comm 276 18 - 75 S S ASRI Somatic .38* .35* ns Gadow 2004bh Clinic 80 18 - 65 O O AI-4 Somatic .13 .13 ns Pooled results Overall r [95% CI]: .32 [.16, .46] .29 [.16, .41] ns

total number of effects (total N): 3 (433) 3 (433) Cochrane's Q, I2: 4.8, 58% 3.4, 41%



Note: AI-4 = Adult Inventory - 4, ASRI = Adult Self-Report Inventory, BASC = Behavior Assessment Schedule for Children, CBCL = Child Behavior Checklist, TRF = Achenbach Teacher Report Form, YSR = Youth Self Report. Summary statistics for the meta-analysis are described in detail in Supplement section 2. aComm = community sample, Clinic = clinic-referred sample. bP = parent, T = teacher, S = self. cAll effects are scaled so that positive correlations indicate that higher ADHD symptoms are associated with greater impairment. dSignificant difference between correlations, P < .05. emultiple effects reported by the study were combined into a single effect size for meta-analysis (see Supplement section 2). fparents of children with ADHD. gnormative sample. hrandomized clinical trial for adults with ADHD. * = P < .05



Age


Symptom Dimensionc


INTERNALIZING COMPOSITE Studies of children and adolescents Bohlin 2004 Comm 834 5 - 13 P P CBCL .34* .30* ns Gadow 1997ae Clinic 101 6 - 12 P P CBCL .32* .03 Inatt > Hyp-Imp Gadow 1997ae Clinic 94 6 - 12 T T TRF .31* .08 ns Gadow 2002 Clinic 239 13 - 18 S S YSR .35* .31* ns Hartman 2004e Comm 229 8 - 18 T T CBCL .46* .33* ns Hartman 2004e Comm 286 8 - 18 P P CBCL .38* .39* ns Mattison 2003 Clinic 101 6 - 18 T T TRF .19 -.05 ns Reynolds 2004e Comm 60 6 - 12 P P BASC-II .48* .40* ns Reynolds 2004e Comm 54 6 - 12 T T BASC-II .36* .27* ns Reynolds 2004e Comm 55 12 - 18 P P BASC-II .44* .35* ns Reynolds 2004e Comm 45 12 - 18 T T BASC-II .40* .51* ns Sprafkin 2001e Clinic 103 5 - 17 P P CBCL .17 .02 ns Sprafkin 2001e Clinic 103 5 - 17 T T TRF .44* -.02 Inatt > Hyp-Imp Sprafkin 2002a Clinic 243 6 - 10 P P CBCL .21* .20* ns Wahlstedt 2009 Comm 182 7 - 9 P & T P & T DSM-IV .23* .13 ns Weiler 2000 Clinic 60 6 - 12 P P BASC .21 .22 ns Willcutt 2011ce,f Clinic 121 6 - 18 P P BASC .27* .39* ns Willcutt 2011ce,f Clinic 109 6 - 18 T T BASC .21* .16 ns Willcutt 2011cs Comm 1,890 6 - 13 P P BASC .34* .26* ns Pooled results Overall r [95% CI]: .32 [.28, .36]* .23 [.17, .29]* Inatt > Hyp-Imp


Classic fail-safe N / Orwin's fail-safe N: 1,000 / 31 532 / 21 Egger’s Regression Intercept: ns ns


Note: BASC = Behavior Assessment Schedule for Children, CBCL = Child Behavior Checklist, DSM-IV = DSM-IV Rating Scale, TRF = Achenbach Teacher Report Form, YSR = Youth Self Report. Summary statistics for the meta-analysis are described in detail in Supplement section 2. aComm = community sample, Clinic = clinic-referred sample. bP = parent, T = teacher, S = self. cAll effects are scaled so that positive correlations indicate that higher ADHD symptoms are associated with greater impairment. dSignificant difference between correlations, P < .05. emultiple effects reported by the study were combined into a single effect size for meta-analysis (see Supplement section 2). fUniversity of Colorado Clinic Sample. * = P < .05.



Age


Symptom Dimensionc


OPPOSITIONAL DEFIANT DISORDER Studies of children and adolescents Bauerm. 2005 Comm 79 6 - 11 P & T P DBRS .63* .69* ns F.-Weieneth 2009 Clinic 261 3 - 4 P P DISC .44* .44* ns Gadow 1997ae Clinic 94 6 - 12 T T CSI .36* .47* ns Gadow 1997ae Clinic 101 6 - 12 P P CSI .32* .28* ns Gadow 1997ae Comm 1,324 6 - 12 T T CSI .48* .66* Hyp-Imp > Inatt Gadow 1997ae Comm 264 6 - 12 P P CSI .59* .63* ns Gadow 1997be Clinic 36 3 - 5 T T ECI .20 .57* Hyp-Imp > Inatt Gadow 1997be Clinic 105 3 - 5 P P ECI .39* .56* ns Gadow 1997be Comm 398 3 - 5 T T ECI .57* .66* ns Gadow 1997be Comm 531 3 - 5 P P ECI .58* .61* ns Gadow 1998e Clinic 122 13 - 18 T T ASI .39* .65* Hyp-Imp > Inatt Gadow 1998e Clinic 144 13 - 18 P P ASI .28* .39* ns Gadow 1998e Comm 824 13 - 18 P P ASI .54* .47* ns Gadow 1998e Comm 1,072 13 - 18 T T ASI .57* .62* ns Gadow 2002 Comm 239 13 - 18 S S YSI .41* .49* ns Gomez 2005e Comm 917 5 - 11 P P DSM-IV .58* .64* ns Gomez 2005e Comm 917 5 - 11 T T DSM-IV .61* .78* Hyp-Imp > Inatt Gomez 2005e Comm 917 7-12 P P DBRS .65* .74* ns Gomez 2005e Comm 917 7-12 T T DBRS .65* .85* Hyp-Imp > Inatt Hartman 2001 Mult 12,892 3-19 P & T P & T multiple .52* .66* Hyp-Imp > Inatt Hartman 2004 Comm 286 8 - 18 P P DICA-R .35* .43* ns Lahey 2008 Comm 2,025 6 - 11 P P CAPS .72* .82* Hyp-Imp > Inatt Lahey 2008 Comm 2,025 12 - 17 P P CAPS .72* .76* Hyp-Imp > Inatt Levy 2005f Comm 2,197 4 - 18 P P ATBRS .44* .49* Hyp-Imp > Inatt Levy 2005g Comm 2,173 4 - 18 P P ATBRS .52* .56* ns Molina 2001h Comm 341 11 - 18 T T DBD .77* .87* Hyp-Imp > Inatt Molina 2001i Clinic 341 11 - 18 T T DBD .75* .87* Hyp-Imp > Inatt Penny 2009e Comm 325 4 - 13 P P DBD .67* .69* ns Penny 2009e Comm 266 4 - 13 T T DBD .61* .79* Hyp-Imp > Inatt Shipp 2010 Comm 842 11 - 19 T T CADBI .73* .82* Hyp-Imp > Inatt



Age


Symptom Dimensionc


OPPOSITIONAL DEFIANT DISORDER CONTINUED

Studies of children and adolescents continued Sprafkin 2002ae Clinic 243 6 - 10 P P CSI .31* .50* Hyp-Imp > Inatt Sprafkin 2002ae Clinic 243 6 - 10 P P DICA-P .18* .37* Hyp-Imp > Inatt Wahlstedt 2009 Comm 182 7 - 9 P & T P & T DSM-IV .45* .58* nsj Waschbusch 2003e Comm 777 5 - 12 P P ADS-IV .63* .66* ns Waschbusch 2003e Comm 1,520 5 - 12 T T ADS-IV .62* .74* ns Willcutt 1999e Comm 200 8 - 18 P & T T DBRS .47* .61* nsj Willcutt 1999e Comm 200 8 - 18 P & T P DICA-R .36* .46* nsj Willcutt 2011ce,k Comm 5,125 6 - 13 P P DBRS .60* .61* ns Willcutt 2011ce,k Comm 5,004 6 - 13 T T DBRS .57* .71* Hyp-Imp > Inatt Willcutt 2011ce,l Clinic 145 6 - 18 P P CSI/ASI .45* .64* ns Willcutt 2011ce,l Clinic 128 6 - 18 T T CSI/ASI .42* .59* ns Wolraich 1998am Comm 4,226 6 - 12 T T VABRS .41* .53* Hyp-Imp > Inatt Wood 2009e Comm 1,314 7 - 10 P P CPRS-LF .40* .55* Hyp-imp > Inatt Wood 2009e Comm 1,314 7 - 10 T T CTRS-LF .38* .68* Hyp-imp > Inatt Zuddas 2006e Comm 1,575 6 - 12 P P DBD .59* .64* Hyp-Imp > Inatt Zuddas 2006e Comm 1,085 6 - 12 T T DBD .53* .70* Hyp-Imp > Inatt Pooled results Overall r [95% CI]: .54 [.50, .58] .65 [.61, .69] Hyp-Imp > Inattn

total number of effects (total N): 29 (41,363) 29 (41,363) Cochrane's Q, I2: 952.5*, 97%o 1,247*, 98%p





Age


Symptom Dimensionc


OPPOSITIONAL DEFIANT DISORDER CONTINUED

Studies of adults Gadow 2004bq Clinic 487 18 - 75 S S ASRI oppositional .48* .58* ns Gadow 2004br Comm 900 18 - 75 S S ASRI oppositional .49* .52* ns Gadow 2004bs Clinic 80 18 - 65 O O AI-4 oppositional .36* .52* ns Pooled results Overall r [95% CI]: .46 [.41, .50] .54 [.49, .58] Hyp-Imp > Inatt



Trim and Fill number of missing studies (Higher or Lower than point estimate): 1 (higher) 0 Trim and fill adjusted r: .46* .54*

Note: APBRS/ATBRS = Australia Parent/Teacher Behavior Rating Scale, ASI = Adolescent Symptom Inventory, AI-4 = Adult Inventory - 4, ASRI = Adult Self-Report Inventory, CADBI = Child and Adolescent Disruptive Behavior Inventory, CAPS = Child and Adolescent Psychopathology Scale, CPRS/CTRS = Conners Parent/Teacher Rating Scale, CSI = Child Symptom Inventory, DBD = Disruptive Behavior Disorders Questionnaire, DBRS = Disruptive Behavior Rating Scale, DICA = Diagnostic Interview for Children and Adolescents, DISC = Diagnostic Interview Schedule for Children, DSM-IV = DSM-IV Rating Scale, ECI = Early Childhood Inventory, YSI = Youth Symptom Inventory, VABRS = Vanderbilt ADHD Diagnostic Rating Scale. Summary statistics for the meta-analysis are described in detail in Supplement section 2. aComm = community sample, Clinic = clinic-referred sample. bP = parent, T = teacher, S = self. cAll effects are scaled so that positive correlations indicate that higher ADHD symptoms are associated with greater impairment. dSignificant difference between correlations, P < .05. emultiple effects reported by the study were combined into a single effect size for meta-analysis (see Supplement section 2). ffemales. gmales. hstudy 1. istudy 2. jalthough the correlations were not significantly different, multiple regression analyses indicated that only hyperactivity-impulsivity symptoms were independently associated with elevations of ODD symptoms. kColorado community sample.lUniversity of Colorado Clinic Sample. mODD/CD combined. nIn addition to the correlational studies included in the meta-analysis, multiple regression analyses of two samples indicated that only hyperactivity-impulsivity symptoms were independently associated with elevations of ODD symptoms (Lahey & Willcutt, 2002). osignificant heterogeneity due to higher correlation in community samples (r = .57) versus clinic-referred samples (r = .35). pNo significant moderators or outliers were detected. qOutpatient clinic sample. rnormative sample. srandomized clinical trial for adults with ADHD. * = P < .05



Age


Symptom Dimensionc


CONDUCT DISORDER Studies of children and adolescents Döpfner 2006 Clinic 1,478 6 - 18 P P SDQ .28* .42* Hyp-Imp > Inatt DuPaul 1998be Comm 43 5 - 17 P P CPRS .45* .65* ns DuPaul 1998be Comm 70 5 - 17 T T CTRS .29* .55* ns Gadow 1997ae Clinic 94 6 - 12 T T CSI .18 .33* ns Gadow 1997ae Comm 1,324 6 - 12 T T CSI .34* .48* Hyp-Imp > Inatt Gadow 1997ae Clinic 101 6 - 12 P P CSI .11 .17 ns Gadow 1997ae Comm 264 6 - 12 P P CSI .37* .42* ns Gadow 1997be Clinic 36 3 - 5 T T ECI .20 .39* ns Gadow 1997be Comm 398 3 - 5 T T ECI .53* .57* ns Gadow 1997be Clinic 105 3 - 5 P P ECI .36* .45* ns Gadow 1997be Comm 531 3 - 5 P P ECI .44* .45* ns Gadow 1998e Clinic 122 13 - 18 T T ASI .34* .44* ns Gadow 1998e Comm 1,072 13 - 18 T T ASI .49* .50* ns Gadow 1998e Clinic 144 13 - 18 P P ASI .10 .20* ns Gadow 1998e Comm 824 13 - 18 P P ASI .35* .38* ns Gadow 2002 Clinic 239 13 - 18 S S YSI .21* .39* Hyp-Imp > Inatt Hartman 2001 Mult 12,892 3 - 19 P & T P & T Multiple measures .46* .59* Hyp-Imp > Inatt Hartman 2004 Comm 286 8 - 18 P P DICA-R .24* .28* ns Hartung 2002 Clinic 172 13 - 18 P or S P or S DSM-IV .40* .39* ns Lahey 2008 Comm 2,025 6 - 11 P P CAPS .63* .68* Hyp-Imp > Inatt Lahey 2008 Comm 2,025 12 - 17 P P CAPS .63* .70* Hyp-Imp > Inatt Levy 2005f Comm 2,197 4 - 18 P P ATBRS .23* .22* ns Levy 2005g Comm 2,173 4 - 18 P P ATBRS .32* .35* ns Penny 2009e Comm 325 4 - 13 P P DBD .47* .51* ns Penny 2009e Comm 325 4 - 13 T T DBD .55* .75* Hyp-Imp > Inatt Reynolds 2004e Comm 60 6 - 11 P P BASC-II .56* .62* ns Reynolds 2004e Comm 55 12 - 18 P P BASC-II .29* .49* ns Reynolds 2004e Comm 54 6 - 11 T T BASC-II .71* .64* ns Reynolds 2004e Comm 45 12 - 18 T T BASC-II .24 .25 ns Sprafkin 2002ae Clinic 243 6 - 10 P P CSI .10 .27* Hyp-Imp > Inatt



Age


Symptom Dimensionc


CONDUCT DISORDER CONTINUED

Sprafkin 2002ae Clinic 243 6 - 10 P P DICA-P .02 .21* Hyp-Imp > Inatt Weiler 2000e Clinic 60 6 - 12 P P BASC .53* .56* ns Weiler 2000e Clinic 60 6 - 12 P P CPRS .57* .42* ns Willcutt 1999 Comm 200 8 - 18 P & T P DICA-R .37* .48* ns Willcutt 2011ce,h Clinic 121 6 - 18 P P CSI/ASI .30* .52* ns Willcutt 2011ce,h Clinic 109 6 - 18 T T CSI/ASI .32* .68* Hyp-Imp > Inatt Willcutt 2011ci Comm 1,890 6 - 13 P P BASC .43* .48* ns Zuddas 2006 Comm 1,575 6 - 12 P P DBD .46* .48* ns Pooled results Overall r [95% CI]: .38 [.33, .43] .47 [.42, .53] Hyp-Imp > Inattj

total number of effects (total N): 25 (31,326) 25 (31,326) Cochrane's Q, I2: 658.0*, 96%k 964.1*, 97%l


Trim and Fill number of missing studies (higher or lower than point estimate): 0 1 (higher) Trim and fill adjusted r: .38* .48* Studies of adults Gadow 2004bm Clinic 487 18 - 75 S S ASRI Conduct .25* .30* ns Gadow 2004bn Comm 900 18 - 75 S S ASRI Conduct .20* .20* ns Gadow 2004bo Clinic 80 18 - 65 O O AI-4 Conduct .46* .31* ns Thompson 2007 Clinic 347 18 - 25 P P CD symptoms .36* .40* ns Pooled results Overall r [95% CI]: .29 [.19, .38] .30 [.20, .39] ns



Trim and Fill number of missing studies (Higher or Lower than point estimate): 1 (lower) 2 (lower) Trim and fill adjusted r: .27* .25*



Age


Symptom Dimensionc



Note: Summary statistics for the meta-analysis are described in detail in Supplement section 2. AI-4 = Adult Inventory - 4, ASI = Adolescent Symptom Inventory, APBRS/ATBRS = Australia Parent/Teacher Behavior Rating Scale, ASRI = Adult Self-Report Inventory, BASC = Behavior Assessment Schedule for Children, CAPS = Child and Adolescent Psychopathology Scale, CPRS/CTRS = Conners Parent/Teacher Rating Scale, CSI = Child Symptom Inventory, DBD = Disruptive Behavior Disorders Questionnaire, DICA = Diagnostic Interview for Children and Adolescents, DSM-IV = DSM-IV Rating Scale, ECI = Early Childhood Inventory, YSI = Youth Symptom Inventory. aComm = community sample, Clinic = clinic-referred sample. bP = parent, T = teacher, O = other observer, S = self. cAll effects are scaled so that positive correlations indicate that higher ADHD symptoms are associated with greater impairment. dSignificant difference between correlations, P < .05. emultiple effects reported by the study were combined into a single effect size for meta-analysis (see Supplement section 2). ffemales. gmales. hUniversity of Colorado Clinic Sample. iColorado community sample. jIn addition to the correlational studies included in the meta-analysis, multiple regression analyses of two samples indicated that only hyperactivity-impulsivity symptoms were independently associated with elevations of CD symptoms (Lahey & Willcutt, 2002). kheterogeneity due to higher correlations in community samples (r = .44) versus clinic samples (r = .24). lsignificant moderators or outliers were detected. mOutpatient clinic sample. nnormative sample.orandomized clinical trial for adults with ADHD. * = P < .05



Age


Symptom Dimensionc


AGGRESSIVE BEHAVIOR Studies of children and adolescents Bohlin 2004 Comm 834 5 - 13 P P CBCL .46 .57* Hyp-Imp > Inatt F.-Weieneth 2009 Clinic 261 3 - 4 P P BASC .41* .46* ns Gadow 1997ae Clinic 101 6 - 12 P P CBCL .38* .55* ns Gadow 1997ae Clinic 94 6 - 12 T T TRF .36* .59* Hyp-Imp > Inatt Gadow 1997be Clinic 105 3 - 5 P P CBCL .23* .53* Hyp-Imp > Inatt Gadow 1997be Clinic 36 3 - 5 T T TRF .37* .76* Hyp-Imp > Inatt Gadow 1998e Clinic 144 13 - 18 P P CBCL .27* .54* Hyp-Imp > Inatt Gadow 1998e Clinic 122 13 - 18 T T TRF .42* .71* Hyp-Imp > Inatt Gadow 2000 Comm 546 10-12 P P CBCL .34* .47* Hyp-Imp > Inatt Gadow 2002 Clinic 239 13 - 18 S S YSR .40* .52* ns Garner 2010e Clinic 276 5 - 17 P P & T CBCL / TRF .29* .61* Hyp-Imp > Inatt Garner 2010e Clinic 258 5 - 17 T P & T CBCL / TRF .32* .63* Hyp-Imp > Inatt Mattison 2003 Clinic 101 6 - 18 T T TRF .19 .58* Hyp-Imp > Inatt Reynolds 2004e Comm 60 6 - 11 P P BASC-II .58* .69* ns Reynolds 2004e Comm 54 6 - 11 T T BASC-II .67* .69* ns Reynolds 2004e Comm 55 12 - 18 P P BASC-II .25* .45* ns Reynolds 2004e Comm 45 12 - 18 T T BASC-II .16 .60* Hyp-Imp > Inatt Sprafkin 2001e Clinic 103 5 - 17 P P CBCL .38* .63* Hyp-Imp > Inatt Sprafkin 2001e Clinic 103 5 - 17 T T TRF .34* .73* Hyp-Imp > Inatt Sprafkin 2002a Clinic 243 6 - 10 P P CBCL .25* .57* Hyp-Imp > Inatt Sprafkin 2002be Clinic 188 3 - 6 P P CBCL .37* .65* Hyp-Imp > Inatt Sprafkin 2002be Clinic 107 3 - 6 T T TRF .22 .68* Hyp-Imp > Inatt Weiler 2000 Clinic 60 6 - 12 P P BASC .35 .58* ns Willcutt 2011cf Comm 1,515 8 - 18 P & T P & T CBCL / TRF .46* .59* Hyp-Imp > Inatt Willcutt 2011cg Comm 1,890 6 - 13 P P BASC .44* .50* Hyp-Imp > Inatt Willcutt 2011ce,h Clinic 571 6 - 18 P P CBCL .41* .58* Hyp-Imp > Inatt Willcutt 2011ce,h Clinic 327 6 - 18 T T TRF .33* .57* Hyp-Imp > Inatt Willcutt 2011ce,i Clinic 145 6 - 18 P P BASC .25 .63* Hyp-Imp > Inatt Willcutt 2011ce,i Clinic 127 6 - 18 T T BASC .23 .64* Hyp-Imp > Inatt



Age


Symptom Dimensionc


AGGRESSIVE BEHAVIOR CONTINUED

Studies of children and adolescents Pooled results Overall r [95% CI]: .37 [.33, .41]* .57 [.54, .60]* Hyp-Imp > Inatt

total number of effects (total N): 19 (7,189) 19 (7,189) Cochrane's Q, I2: 49.7*, 64%j 47.6*, 62%k

Classic fail-safe N / Orwin's fail-safe N: 8,129 / 69 10,590 / 100 Egger’s Regression Intercept: P = .01 ns

Trim and Fill number of missing studies (higher or lower than point estimate): 4 (higher) 4 (lower) Trim and fill adjusted r: .42* .55*

Note: BASC = Behavior Assessment Schedule for Children, CBCL = Child Behavior Checklist, TRF = Achenbach Teacher Report Form, YSR = Youth Self Report. Summary statistics for the meta-analysis are described in detail in Supplement section 2. aComm = community sample, Clinic = clinic-referred sample. bP = parent, T = teacher, S = self. cAll effects are scaled so that positive correlations indicate that higher ADHD symptoms are associated with greater impairment. dSignificant difference between correlations, P < .05. emultiple effects reported by the study were combined into a single effect size for meta-analysis (see Supplement section 2). fColorado twin sample. gColorado community sample. hDenver Clinic sample. iUniversity of Colorado Clinic Sample. jheterogeneity due to significant outlier effects reported by Mattison et al. (2003) and the child sample from Reynolds and Kamphaus (2004); exclusion of these effects resulted in a slightly higher correlation (r = .39). kNo significant moderators or outliers were detected. * = P < .05



Age


Symptom Dimensionc


DELINQUENT / ANTISOCIAL BEHAVIOR

Studies of children and adolescents Bohlin 2004 Comm 834 5 - 13 P P CBCL .35* .38* ns Gadow 1997ae Clinic 101 6 - 12 P P CBCL .18 .18 ns Gadow 1997ae Clinic 94 6 - 12 T T CBCL .33* .29* ns Gadow 1997be Clinic 36 3 - 5 T T CBCL .22 .28 ns Gadow 1997be Clinic 101 3 - 5 P P CBCL .19* .16* ns Gadow 1998e Clinic 144 13 - 18 P P CBCL -.02 .10 ns Gadow 1998e Clinic 122 13 - 18 T T TRF .36* .40* ns Gadow 2000 Comm 546 10-12 P P CBCL .31* .25* ns Gadow 2002 Clinic 239 13 - 18 S S YSR .19* .28* ns Garner 2010e Clinic 276 5 - 17 P P & T CBCL / TRF .27* .49* Hyp-Imp > Inatt Garner 2010e Clinic 258 5 - 17 T P & T CBCL / TRF .28* .46* Hyp-Imp > Inatt Mattison 2003 Clinic 101 6 - 18 T T TRF .11 .15 ns Molina 2001f Comm 213 11-18 T S self rating .18* .19* ns Molina 2001g Clinic 213 11-18 T T DBD .48* .54* ns Sprafkin 2001e Clinic 103 5 - 17 P P CBCL .24* .32* ns Sprafkin 2001e Clinic 103 5 - 17 T T TRF .33* .36* Hyp-Imp > Inatt Sprafkin 2002a Clinic 243 6 - 10 P P CBCL .14* .24* ns Sprafkin 2002be Clinic 188 3 - 6 P P CBCL .36* .46* ns Sprafkin 2002be Clinic 107 3 - 6 T T TRF .10 .32* ns Willcutt 2011ce,h Comm 1,515 8 - 18 P P CBCL .37* .45* ns Willcutt 2011ce,h Comm 1,474 8 - 18 T T TRF .34* .28* ns Willcutt 2011ce,i Clinic 571 6 - 18 P P CBCL .37* .40* ns Willcutt 2011ce,i Clinic 327 6 - 18 T T TRF .37* .37* ns



Age


Symptom Dimensionc


DELINQUENT / ANTISOCIAL BEHAVIOR CONTINUED

Studies of children and adolescents Pooled results Overall r [95% CI]: .28 [.23, .33] .33 [.28, .38] ns

total number of effects (total N): 15 (5,175) 15 (5,175) Cochrane's Q, I2: 40.0*, 65%j 50.4*, 72%k

Classic fail-safe N / Orwin's fail-safe N: 1,159 / 31 1,509 / 34 Egger’s Regression Intercept: P = .02 ns

Trim and Fill number of missing studies (higher or lower than point estimate): 6 (higher) 3 (higher) Trim and fill adjusted r: .34* .35* Studies of adults Gadow 2004bl Clinic 487 18 - 75 S S ASRI Antisocial .47* .52* ns Gadow 2004bm Comm 900 18 - 75 S S ASRI Antisocial .44* .41* ns Gadow 2004bn Clinic 75 18 - 65 O O AI-4 Antisocial .62* .46* ns Gordon 2006 Clinic 239 19 - 25 P P Arrested .21* .30* ns Gudjonsson 2010 Comm 388 18 - 51 S S RATE Antisocial .21* .29* ns Pooled results Overall r [95% CI]: .39 [.26, .51] .40 [.30, .48] ns

total number of effects (total N): 5 (2,089) 5 (2,089) Cochrane's Q, I2: 39.5*, 90%o 20.8, 81%



Note: AI-4 = Adult Inventory - 4, ASRI = Adult Self-Report Inventory, CBCL = Child Behavior Checklist, DBD = Disruptive Behavior Disorders Questionnaire, TRF = Achenbach Teacher Report Form, YSR = Youth Self Report. Summary statistics for the meta-analysis are described in detail in Supplement section 2. aComm = community sample, Clinic = clinic-referred sample. bP = parent, T = teacher, O = other observer, S = self. cAll effects are scaled so that positive correlations indicate that higher ADHD symptoms are associated with greater impairment. dSignificant difference between correlations, P < .05. emultiple effects reported by the study were combined into a single effect size for meta-analysis (see Supplement section 2). fstudy 1. gstudy 2. hColorado twin study. iUniversity of Denver Clinic Sample. jheterogeneity due to significant outlier effect size reported in study 2 by Molina et al. (2001). When this effect was excluded the overall effect size decreased slightly but remained significant (r = .27). kheterogeneity due to significant outlier effect sizes reported by Mattison et al. (2003) and Garner et al. (2010). When these effects were excluded the overall effect size decreased but remained significant (r = .31). lOutpatient clinic sample. mrandomized clinical trial for adults with ADHD. nnormative sample. oNo significant moderators or outliers were detected. * = P < .05



Age


Symptom Dimensionc


EXTERNALIZING COMPOSITE Studies of children and adolescents Bohlin 2004 Comm 834 5 - 13 P P CBCL .47* .56* Hyp-imp > Inatt Gadow 1997ae Clinic 101 6 - 12 P P CBCL .36* .50* ns Gadow 1997ae Clinic 94 6 - 12 T T TRF .37* .56* ns Gadow 2002 Clinic 110 13 - 18 S S YSR .36* .48* ns Mattison 2003 Clinic 101 6 - 18 T T TRF .19 .53* Hyp-imp > Inatt Reynolds 2004e Comm 60 6 - 12 P P BASC-II .68* .78* ns Reynolds 2004e Comm 55 12 - 18 P P BASC-II .39* .59* ns Reynolds 2004e Comm 54 6 - 11 T T BASC-II .81* .76* ns Reynolds 2004e Comm 45 12 - 18 T T BASC-II .27 .46* ns Sprafkin 2001e Clinic 103 5 - 17 P P CBCL .35* .54* ns Sprafkin 2001e Clinic 103 5 - 17 T T TRF .40* .69* Hyp-Imp > Inatt Sprafkin 2002a Clinic 243 6 - 10 P P CBCL .24* .53* Hyp-imp > Inatt Weiler 2000 Clinic 60 6 - 12 P P BASC .59* .73* ns Willcutt 2011ce,f Comm 1,515 8 - 18 P P CBCL .46* .55* Hyp-imp > Inatt Willcutt 2011ce,f Comm 1,474 8 - 18 T T TRF .43* .58* Hyp-imp > Inatt Willcutt 2011cg Comm 1,890 6 - 13 P P BASC .59* .67* ns Willcutt 2011ch Clinic 145 6 - 18 P & T P & T BASC .40* .56* Hyp-imp > Inatt Willcutt 2011ci Clinic 573 6 - 18 P P CBCL .38* .57* Hyp-imp > Inatt Pooled results Overall r [95% CI]: .43 [.36, .50) .59 [.54, .63] Hyp-imp > Inatt

total number of effects (total N): 13 (5,774) 13 (5,774) Cochrane's Q, I2: 105.3*, 88%j 50.6*, 76%j



Note: ASI = Adolescent Symptom Inventory, BASC = Behavior Assessment Schedule for Children, CBCL = Child Behavior Checklist, ECI = Early Childhood Inventory, TRF = Achenbach Teacher Report Form, YSR = Youth Self Report. Summary statistics for the meta-analysis are described in Supplement section 2. aComm = community sample, Clinic = clinic-referred sample. bP = parent, T = teacher, S = self. cAll effects are scaled so that positive correlations indicate that higher ADHD symptoms are associated with greater impairment. dSignificant difference between correlations, P < .05. emultiple effects reported by the study were combined into a single effect size for meta-analysis (see Supplement section 2). fColorado twin sample. gColorado community sample. hUniversity of Colorado Clinic Sample. iUniversity of Denver Clinic sample. jSignificant heterogeneity due to lower correlations in clinic samples than community samples (r = .35 vs. .53 for inattention and .53 vs. .61 for hyperactivity-impulsivity). * = P < .05



Age


Symptom Dimensionc


SUBSTANCE USE DISORDERS Studies of children and adolescents Gadow 2002 Clinic 239 13 - 18 S S YSI .03 .07 ns Lee 2006 Clinic 228 11 - 18 P & T P Substance dependence symptoms .11 .19 ns Pooled results Overall r [95% CI]: .07 [-.02, .16] .13 [.01, .25] nse

k (total N): 2 (467) 2 (467) [heterogeneity and publication bias analyses not conducted if < 3 studies]

Studies of adults Gadow 2004bf Clinic 487 18 - 75 S S ASRI Substance Use .18* .28* ns Gadow 2004bg Comm 900 18 - 75 S S ASRI Substance Use .15* .24* ns Gadow 2004bh Clinic 75 18 - 65 O O AI-4 Substance Use .13 .13 ns Gordon 2006 Clinic 239 19 - 25 S S used drugs last three months .05 .04 ns Pooled results Overall r [95% CI]: .14 [.10, .19] .19 [.09, .29] nse

Total number of effects (total N): 4 (1,701) 4 (1,701) Cochrane's Q, I2: 2.8, 0% 11.0, 73%


Trim and Fill number of missing studies (Higher or Lower than point estimate): 2 (higher) 2 (higher) Trim and fill adjusted r: .16* .26*

Note: AI-4 = Adult Inventory - 4, ASRI = Adult Self-Report Inventory, YSI = Youth Symptom Inventory. Summary statistics for the meta-analysis are described in detail in Supplement section 2. aComm = community sample, Clinic = clinic-referred sample. bP = parent, T = teacher, CL = clinician, S = self. cAll effects are scaled so that positive correlations indicate that higher ADHD symptoms are associated with greater impairment. dSignificant difference between correlations, P < .05. esee text in the main paper for a summary of the mixed results of studies that conducted multivariate analyses of DSM-IV ADHD symptom dimensions and measures of substance use and abuse. fOutpatient clinic sample. gnormative sample. hrandomized clinical trial for adults with ADHD. * = P < .05



Age


Symptom Dimensionc


EATING DISORDERS Studies of children and adolescents Gadow 2002 Clinic 239 13 - 18 S S YSI .03 .07 ns Pooled results Overall r [95% CI]: .07 [-.02, .16] .13 [.01, .25] ns

total number of effects (total N): 2 (467) 2 (467) [heterogeneity and publication bias analyses not conducted if < 3 studies]

Studies of adults Gadow 2004be,f Clinic 487 18 - 75 S S ASRI Anorexia symptoms .23* .30* ns Gadow 2004be,g Comm 900 18 - 75 S S ASRI Anorexia symptoms .27* .31* ns Gadow 2004be,h Clinic 75 18 - 65 O O AI-4 Anorexia symptoms .02 .22 ns Gadow 2004be,f Clinic 487 18 - 75 S S ASRI Bulimia symptoms .20* .27* ns Gadow 2004be,g Comm 900 18 - 75 S S ASRI Bulimia symptoms .27* .30* ns Gadow 2004be,h Clinic 75 18 - 65 O O AI-4 Bulimia symptoms .20 .05 ns Pooled results Overall r [95% CI]: .24 [.18, .30] .29 [.24, .34] ns



Trim and Fill number of missing studies (Higher or Lower than point estimate): 2 (higher) 2 (higher) Trim and fill adjusted r: .27* .31*

Note: Summary statistics for the meta-analysis are described in detail in Supplement section 2. AI-4 = Adult Inventory - 4, ASRI = Adult Self-Report Inventory, YSI = Youth Symptom Inventory. aComm = community sample, Clinic = clinic-referred sample. bO = other observer, S = self. cAll effects are scaled so that positive correlations indicate that higher ADHD symptoms are associated with greater impairment. dSignificant difference between correlations, P < .05. emultiple effects reported by the study were combined into a single effect size for meta-analysis (see Supplement section 2). fOutpatient clinic sample. gnormative sample. hrandomized clinical trial for adults with ADHD. * = P < .05



Age


Symptom Dimensionc


PERVASIVE DEVELOPMENTAL DISORDERS Studies of children and adolescents Gadow 1997be Clinic 36 3 - 5 T T ECI Autism .61 .52 ns Gadow 1997be Clinic 105 3 - 5 P P ECI Autism .36 .11 Inatt > Hyp-imp Gadow 1997be Comm 398 3 - 5 T T ECI Autism .20 -.16 Inatt > Hyp-imp Gadow 1997be Comm 531 3 - 5 P P ECI Autism .45 .36 ns Gadow 1997ae Clinic 94 6 - 12 T T CSI Asperger’s Dis .39 .27 ns Gadow 1997ae Clinic 94 6 - 12 T T CSI PDD NOS .39 .24 ns Gadow 1997ae Clinic 101 6 - 12 P P CSI Asperger’s Dis .19 .03 ns Gadow 1997ae Clinic 101 6 - 12 P P CSI PDD NOS .20 .06 ns Gadow 1997ae Comm 1,324 6 - 12 T T CSI Asperger’s Dis .43 .40 ns Gadow 1997ae Comm 264 6 - 12 P P CSI Asperger’s Dis .46 .44 ns Gadow 1997ae Comm 1,324 6 - 12 T T CSI PDD NOS .44 .38 ns Gadow 1997ae Comm 264 6 - 12 P P CSI PDD NOS .42 .40 ns Sprafkin 2002ae Clinic 243 6 - 10 P P CSI Autism .21 .34 ns Sprafkin 2002ae Clinic 243 6 - 10 P P CSI Asperger’s Dis .16 .39 Inatt > Hyp-imp Willcutt 2011cf Clinic 145 6 - 18 P P CSI PDD NOS .32 .18 ns Pooled results Overall r [95% CI]: .35 [.26, .43] .27 [.13, .40] ns

total number of effects (total N): 6 (2,449) 6 (2,449) Cochrane's Q, I2: 22.3*, 78%g 49.3*, 90%h



Note: Summary statistics for the meta-analysis are described in detail in Supplement section 2. CSI = Child Symptom Inventory, ECI = Early Childhood Inventory. aComm = community sample, Clinic = clinic-referred sample. bP = parent, T = teacher. cAll effects are scaled so that positive correlations indicate that higher ADHD symptoms are associated with greater impairment. dSignificant difference between correlations, P < .05. emultiple effects reported by the study were combined into a single effect size for meta-analysis (see Supplement section 2). fUniversity of Colorado Clinic Sample. gsignificant heterogeneity due to the significant outlier effects reported by Sprafkin et al. (2002a). The overall estimated correlation was higher and remained significant (r = .38) when these effects were excluded from the analysis. hsignificant heterogeneity due to outlier effect sizes reported for the clinic sample in the study by Gadow & Sprafkin (1997a). The overall estimated correlation was higher and significant when these effects were excluded from the analysis (r = .31). * = P < .05


Supplement Table 10 Dimensional measures of psychopathology in groups with and without the DSM-IV ADHD subtypes

Sample Size Effect Size (Hedges' g) for comparisons between groupsc

Sample Age Comb Inatt H-I ADHD Comorbidity ADHD-C ADHD-I ADHD-H ADHD-C ADHD-C ADHD-I Study Typea range Cont Type Type Type Raterb Raterb Measure vs. Control vs. Control vs. Control vs. ADHD-I vs. ADHD-H vs. ADHD-H

OVERALL ANXIETY Studies of children and adolescents Eiraldi 1997 Clinic 6 - 12 33 27 26 -- P P / T DSMD No SD*d No SD*d -- No SDd -- -- Forbes 2001 Clinic 6 - 12 -- 88e 27 -- P & T P CPRS -- -- -- -0.21 -- -- Hinshaw 2002af Clinic 6 - 12 88 93 47 -- P & T S MASC 0.20 0.10 -- 0.10 -- -- Hinshaw 2002af Clinic 6 - 12 88 93 47 -- P & T Obs Anxiety 1.19* 1.12* -- 0.40 -- -- Maedgen 2000 Clinic 8 - 11 17 16 14 -- P P RBPC 1.94* 1.41* -- 0.41 -- -- Power 2004f Clinic 8 - 14 -- 42 45 -- P & T P BASC -- -- -- -0.19 -- -- Power 2004f Clinic 8 - 14 -- 42 45 -- P & T S RCMAS -- -- -- 0.50* -- -- Riley 2008f Clinic 3 - 5 -- 71 -- 31 P & T P CPRS -- -- -- -- 0.03 -- Riley 2008f Clinic 3 - 5 -- 71 -- 31 P & T T CTRS -- -- -- -- 0.06 -- Scheres 2010 Clinic 6 - 17 37 25 20 -- P P CPRS 0.91* 1.13* -- -0.13 -- -- Sem-Cl 2010af Clinic 9 - 16 113 76 80 -- BE P BASC-II 0.20 0.09 -- 0.11 -- -- Sem-Cl 2010af Clinic 9 - 16 113 76 80 -- BE T BASC-II 0.57* 0.62* -- -0.02 -- -- Solanto 2007 Clinic 7 - 12 15 27 24 -- P & T P MASC 0.61* 0.63* -- -0.10 -- -- Vaughn 1997f Clinic 6 - 11 -- 38 16 -- P & T T BASC -- -- -- -0.14 -- -- Vaughn 1997f Clinic 6 - 11 -- 38 16 -- P & T P BASC -- -- -- 0.12 -- -- Pooled results Overall Hedges' g: 0.80* 0.74* -- 0.06 0.05 --

[95% CI]: [0.42, 1.18] [0.40, 1.09] -- [-0.10, 0.22] [-0.37, 0.47] -- Number of significant effects / total effects: 5 / 6 5 / 6 -- 0 / 9 0 / 1 --

Ngroup 1 / Ngroup 2: 246 / 275 187 / 275 -- 414 / 275 71 / 31 -- Cochrane's Q, I2: 14.2, 72% 10.4, 61% -- 5.0, 0% -- --

Classic fail-safe N / Orwin's fail-safe N: 74 / 8 56 / 7 -- -- / -- -- --

Egger's regression intercept: ns P = .04 -- ns -- --

Trim and Fill number of missing studies (higher or lower than point estimate): 0 0 -- 0 -- --

Trim and fill adjusted g: 0.80* 0.74* -- 0.06 -- --

Note: Summary statistics for the meta-analysis are described in detail in Supplement section 2. BASC = Behavior Assessment Schedule for Children, CPRS/CTRS = Conners Parent/Teacher Rating Scale, DSMD = Devereaux Scales of Mental Disorders, MASC = Multi-dimensional Anxiety Scale for Children, RBPC = Revised Behavior Problem Checklist, RCMAS = Revised Children's Manifest Anxiety Scale. aComm = community sample, Clinic = clinic-referred sample. bP = parent, T = teacher, S = self, Obs = observations, BE = best estimate summary from multiple sources of data. cPositive effect sizes indicate that the group listed first had more anxiety symptoms than the group listed second, and negative effect sizes indicate that the group listed second had more symptoms. dinsufficient data available to calculate effect size. eADHD-C included 81 with ADHD-C and 7 with ADHD-H. fmultiple effects reported by the study were combined into a single effect size for meta-analysis (see Supplement section 2). * = P < .05.





GENERALIZED ANXIETY DISORDER Studies of children and adolescents Gadow 2004ad Clinic 6 - 10 -- 55 82 11 P P CSI -- -- -- 0.74* 0.45 -0.24 Gadow 2004ad Clinic 6 - 10 -- 60 81 12 T T CSI -- -- -- 0.71* 0.96* 0.26 Harrington 2010 Clinic 5 - 18 -- 124 81 23 P P DSM-IV -- -- -- 0.49* 0.35 -0.14 Nolan 1999d Clinic 13 - 18 -- 20 45 -- P P ASI -- -- -- 0.74* -- -- Nolan 1999d Clinic 13 - 18 -- 11 31 -- T T ASI -- -- -- 1.15* -- -- Nolan 1999d Clinic 6 - 12 -- 16 22 -- P P CSI -- -- -- 0.65 -- -- Nolan 1999d Clinic 6 - 12 -- 16 15 -- T T CSI -- -- -- 0.69 -- -- Nolan 1999d Clinic 3 - 5 -- 29 16 -- P P ECI -- -- -- 1.04* -- -- Nolan 1999d Clinic 3 - 5 -- 4 5 -- T T ECI -- -- -- 0.15 -- -- Nolan 2001 Comm 13 - 18 914 27 123 9 T T ASI 2.81* 1.67* 2.16* 0.81* 0.40 -0.32 Nolan 2001 Comm 6 - 12 1,278 50 157 35 T T CSI 2.15* 1.30* 1.04* 0.62* 0.78* 0.24 Nolan 2001 Comm 3 - 5 338 32 16 27 T T ECI 2.33* 1.50* 1.62* 0.72* 0.62* -0.12 Willcutt 1999 Comm 8 - 18 95 32 58 15 P & T P DICA-P 0.54* 0.18 0.04 0.31 0.37 0.12 Pooled results Overall Hedges' g: 1.96* 1.16* 1.20* 0.60* 0.55* 0.02


Ngroup 1 / Ngroup 2: 141 / 2,625 354 / 2,625 86 / 2,625 356 / 568 325 / 121 517 / 121 Cochrane's Q, I2: 69.4*, 95%e 57.1*, 95%e 30.3*, 90%e 5.0, 0% 2.7, 0% 3.3, 0%

Classic fail-safe N / Orwin's fail-safe N: 456 / 36 369 / 20 103 / 20 142 / 18 31 / 11 -- / -- Egger's regression intercept: ns ns ns ns ns ns

Trim and Fill number of missing studies (higher or lower than point estimate): 0 0 0 3 (lower) 0 2 (higher) Trim and fill adjusted g: 1.96* 1.16* 1.19* 0.56* 0.56* 0.12

Note: Summary statistics for the meta-analysis are described in detail in Supplement section 2. ASI = Adolescent Symptom Inventory, ASRI-4 = Adult Self-Report Inventory - 4, CSI = Child Symptom Inventory, DICA = Diagnostic Interview for Children and Adolescents, DSM-IV = DSM-IV checklist, ECI = Early Childhood Inventory. aComm = community sample, Clinic = clinic-referred sample. bP = parent, T = teacher. cPositive effect sizes indicate that the group listed first had more symptoms of the comorbid disorder than the group listed second, and negative effect sizes indicate that the group listed second had more symptoms. dmultiple effects reported by the study were combined into a single effect size for meta-analysis (see Supplement section 2). eSignificant heterogeneity due to the larger effects obtained on the dimensional ratings of GAD ratings administered by Nolan et al. (2001) versus the symptom counts from the structured interview used by Willcutt et al (1999).

* = P < .05





GENERALIZED ANXIETY DISORDER CONTINUED Studies of adults Sprafkin 2007d Comm 18 - 75 419 8 15 8 S S ASRI-4 1.37* 1.44* 1.36* 0.47 0.00 0.46 Sprafkin 2007e Comm 18 - 75 421 6 13 10 S S ASRI-4 2.60* 2.02* 1.03* 0.80 1.01* 0.41 Sprafkin 2007 Clinic 18 - 76 -- 74 97 32 S S ASRI-4 -- -- -- 0.19 0.31 0.10 Pooled results Overall Hedges' g: 1.96* 1.74* 1.18* 0.27* 0.36 0.21

[95% CI]: [0.77, 3.16] [1.16, 2.31] [0.71, 1.65] [0.00, 0.54] [-0.04, 0.75] [-0.12, 0.54] Number of significant effects / total effects: 2 / 2 2 / 2 2 / 2 0 / 3 1 / 3 0 / 3

Ngroup 1 / Ngroup 2: 14 / 800 28 / 800 18 / 800 88 / 125 88 / 58 125 / 58 Cochrane's Q, I2: -- -- -- 1.7, 0% 2.2, 0% 0.9, 0%

Classic fail-safe N / Orwin's fail-safe N: -- -- -- 2 / 1 -- -- Egger's regression intercept: -- -- -- ns ns P = .03

Trim and Fill number of missing studies (higher or lower than point estimate): -- -- -- 2 (lower) 0 2 (lower) Trim and fill adjusted g: -- -- -- 0.19 0.36 0.10

Note: Summary statistics for the meta-analysis are described in detail in Supplement section 2. ASI = Adolescent Symptom Inventory, ASRI-4 = Adult Self-Report Inventory - 4, CSI = Child Symptom Inventory, DICA = Diagnostic Interview for Children and Adolescents, DSM-IV = DSM-IV checklist, ECI = Early Childhood Inventory. aComm = community sample, Clinic = clinic-referred sample. bS = self. cPositive effect sizes indicate that the group listed first had more symptoms of the comorbid disorder than the group listed second, and negative effect sizes indicate that the group listed second had more symptoms. dmales. efemales.

* = P < .05





ANXIOUS / DEPRESSED Studies of children and adolescents Bauerm. 2005a Comm 6 - 11 29 44 25 -- P & T P CBCL 0.71* 0.59* -- 0.13 -- -- Byun 2006 Clinic 5 - 16 -- 70 22 -- P P CBCL -- -- -- 0.24 -- -- Forbes 2001 Clinic 6 - 12 -- 88d 27 -- P & T P CBCL -- -- -- -0.20 -- -- Gadow 2000 Comm 10 - 12 443 32 72 58 P P CBCL 0.50* 0.72* 0.29 -0.21 0.21 0.39 Gaub 1997 Comm 5 - 12 221 51 123 47 T T TRF 1.14* 0.40* 0.53* 0.70 0.51* -0.12 Graetz 2001 Comm 6 - 17 3,298 67 133 68 P P CBCL 1.56* 0.96* 0.88* 0.33 0.38* 0.06 Gr.-Tsur 2006 Clinic 5 - 18 -- 138 64 -- P & T P CBCL -- -- -- 0.27 -- -- Johnstone 2009 Clinic 8 - 14 15 15 15 -- NS P CBCL 1.19* 0.75* -- 0.11 -- -- Mikami 2007 Clinic 7 - 12 38 33 45 -- P & T P CBCL 1.30* 1.92* -- -0.55* -- -- Morgan 1996e Clinic 6 - 11 -- 26 30 -- P & T P CBCL -- -- -- 0.31 -- -- Morgan 1996e Clinic 6 - 11 -- 26 30 -- P & T T TRF -- -- -- 0.03 -- -- Nigg 2002a Comm 7 - 12 41 46 18 -- P & T P CBCL 1.14* 0.42 0.79* -- -- Paternite 1996 Clinic 6 - 12 -- 59 28 9 P P / T CBCL / TRF -- -- -- No ESf No ESf No ESf

van West 2009e Clinic 6 - 12 25 52 23 -- P & S P CBCL 2.40* 2.64* -- -0.15 -- -- van West 2009e Clinic 6 - 12 25 52 23 -- P & S T TRF 1.38* 2.73* -- -0.40 -- -- Vaughn 1997e Clinic 6 - 11 -- 38 16 -- P & T P CBCL -- -- -- 0.80* -- -- Vaughn 1997e Clinic 6 - 11 -- 38 16 -- P & T T TRF -- -- -- 0.05 -- -- Willcutt 2011a Comm 8 - 18 288 135 235 40 P & T P & T CBCL / TRF 0.76* 0.58* 0.53* 0.19 0.31 0.12





ANXIOUS / DEPRESSED CONTINUED

Pooled results Overall Hedges' g: 1.24* 0.92* 0.57* 0.16 0.36* 0.10 [95% CI]: [0.86, 1.63] [0.62, 1.23] [0.29, 0.84] [-0.03, 0.34] [0.17, 0.56] [-0.07, 0.27]

Number of significant effects / total effects: 9 / 9 8 / 9 3 / 4 4 / 15 2 / 5 0 / 5 Ngroup 1 / Ngroup 2: 475 / 4,398 689 / 4,398 213 / 4,250 835 / 842 254 / 213 563 / 213

Cochrane's Q, I2: 72.2*, 89%g 62.7*, 87%h 10.4, 71% 36.1*, 64%i 1.1, 0% 4.4, 32%

Classic fail-safe N / Orwin's fail-safe N: 522 / 34 260 / 17 57 / 8 17 / -- 10 / 4 -- / -- Egger's regression intercept: ns ns ns ns ns ns

Trim and Fill number of missing studies (higher or lower than point estimate): 0 0 0 0 1 (higher) 0 Trim and fill adjusted g: 1.24* 0.92* 0.57* 0.16 0.40* 0.10

Note: Summary statistics for the meta-analysis are described in detail in Supplement section 2. CBCL = Child Behavior Checklist, TRF = Achenbach Teacher Report Form. aComm = community sample, Clinic = clinic-referred sample. bP = parent, T = teacher, S = self. cPositive effect sizes indicate that the group listed first had more symptoms of the comorbid disorder than the group listed second, and negative effect sizes indicate that the group listed second had more symptoms. dADHD-C included 81 with ADHD-C and 7 with ADHD-H. emultiple effects reported by the study were combined into a single effect size for meta-analysis (see Supplement section 2). finsufficient data available to calculate effect size. gheterogeneity due to significant outlier effect size reported by van West et al. (2009); when this effect was excluded the overall effect was smaller but remained significant (g = 0.93). hsignificant heterogeneity due to the significant outlier effect sizes reported by van West et al. (2009) and Mikami et al. (2007). When these effects were excluded the overall effect sizes were smaller but remained significant (g = 0.65). iheterogeneity due to a significant outlier effect size reported by Mikami et al. (2007). When this effect was excluded ADHD-C was significantly higher than ADHD-I (g = 0.25).

* = P < .05





DEPRESSION Studies of children and adolescents Eiraldi 1997 Clinic 6 - 12 33 27 26 -- P P DSMD MDD No ES*d No ES*d -- No ESd -- -- Gadow 2004ae Clinic 6 - 10 -- 60 81 12 T T CSI MDD -- -- -- 0.43* 0.87* 0.71* Gadow 2004ae Clinic 6 - 10 -- 55 82 11 P P CSI MDD -- -- -- 0.38 0.62 0.22 Harrington 2010 Clinic 5 - 18 -- 124 81 23 P P DSM-IV -- -- -- 0.48* 0.67* 0.23 Hinshaw 2002a Clinic 6 - 12 88 93 47 -- P & T S CDI 0.74* 0.82* -- 0.00 -- -- Nolan 1999e Clinic 13 - 18 -- 20 45 -- P P ASI MDD -- -- -- 0.17 -- -- Nolan 1999e Clinic 13 - 18 -- 11 31 -- T T ASI MDD -- -- -- 0.17 -- -- Nolan 1999e Clinic 6 - 12 -- 16 22 -- P P CSI MDD -- -- -- -0.87 -- -- Nolan 1999e Clinic 6 - 12 -- 16 15 -- T T CSI MDD -- -- -- 0.03 -- -- Nolan 1999e Clinic 3 - 5 -- 29 16 -- P P ECI MDD -- -- -- 0.87 -- -- Nolan 1999e Clinic 3 - 5 -- 4 5 -- T T ECI MDD -- -- -- -0.68 -- -- Nolan 2001 Comm 13 - 18 914 27 123 9 T T ASI MDD 2.08* 1.65* 0.76 0.22 0.61* 0.62 Nolan 2001 Comm 6 - 12 1,278 50 157 35 T T CSI MDD 1.29* 1.07* 0.52 0.08 0.41* 0.35 Nolan 2001 Comm 3 - 5 338 32 16 27 T T ECI MDD 1.27* 0.05 1.02 0.91* 0.16 -0.70*

Power 2004 Clinic 8 - 14 -- 42 45 -- P & T P BASC -- -- -- 0.73* -- -- Scheres 2004 Clinic 6 - 12 22 15 8 -- P P DSM-IV Screen 3.88* 3.76* 0.50 Sem-Cl 2010ae Clinic 9 - 16 113 76 80 -- BE P BASC-II 1.21* 0.64* -- 0.66* -- -- Sem-Cl 2010ae Clinic 9 - 16 113 76 80 -- BE T BASC-II 1.09* 0.49* -- 0.56* -- -- Vaughn 1997e Clinic 6 - 11 -- 38 16 -- P & T P BASC -- -- -- 0.52 -- -- Vaughn 1997e Clinic 6 - 11 -- 38 16 -- P & T T BASC -- -- -- 0.56 -- -- Willcutt 1999 Comm 8 - 18 95 32 58 15 P & T P DICA-R 1.24* 1.82* 0.20 -0.03 0.76* 1.42* Pooled results Overall Hedges' g: 1.50* 1.14* 0.64* 0.33* 0.53* 0.38*

[95% CI]: [1.08, 1.92] [0.75, 1.53] [0.30, 0.98] [0.17, 0.50] [0.31, 0.74] [0.17, 0.59] Number of significant effects / total effects: 8 / 8 7 / 8 1 / 4 5 / 15 4 / 6 2 / 6

Ngroup 1 / Ngroup 2: 325 / 2,848 724 / 3,136 86 / 2,625 654 / 796 325 / 121 517 / 121 Cochrane's Q, I2: 51.3*, 88%f 104.3*, 93%g 6.6, 54% 27.0, 52% 3.7, 0% 23.8*, 79%h

Classic fail-safe N / Orwin's fail-safe N: 282 / 23 763 / 27 28 / 9 105 / 10 30 / 10 14 / 6 Egger's regression intercept: ns ns ns ns ns ns

Trim and Fill number of missing studies (higher or lower than point estimate): 0 0 0 1 (lower) 1 (lower) 0 Trim and fill adjusted g: 1.50* 1.14* 0.64* 0.31* 0.50* 0.38*





DEPRESSION CONTINUED Studies of adults Murphy 2002 Clinic 17 - 27 64 60 36 -- S S SCL-90 Depress 1.77* 2.17* -- -0.09 -- -- Sprafkin 2007 Clinic 18 - 76 -- 74 97 32 S S ASRI-4 MDD -- -- -- 0.21 0.46* 0.28 Sprafkin 2007 Comm 18 - 75 840 14 28 18 S S ASRI-4 MDD 2.60* 1.84* 1.29* -0.03 0.76* 0.40 Pooled results Overall Hedges' g: 2.17* 1.96* 1.29* 0.15 0.62* 0.32*

[95% CI]: [1.36, 2.97] [1.64, 2.28] [0.84, 1.74] [-0.11, 0.41] [0.16, 1.09] [-0.01, 0.65] Number of significant effects / total effects: 2 / 2 2 / 2 1 / 1 0 / 3 2 / 2 0 / 2

Ngroup 1 / Ngroup 2: 74 / 904 64 / 904 28 / 840 148 / 161 88 / 50 125 / 50 Cochrane's Q, I2: -- -- -- 2.5, 0% -- --

Classic fail-safe N / Orwin's fail-safe N: -- -- -- n/a -- -- Egger's regression intercept: -- -- -- ns -- --

Trim and Fill number of missing studies (higher or lower than point estimate): -- -- -- 1 (lower) -- -- Trim and fill adjusted g: -- -- -- 0.09 -- --

Note: Summary statistics for the meta-analysis are described in detail in Supplement section 2. ASI = Adolescent Symptom Inventory, ASRI-4 = Adult Self-Report Inventory - 4, BASC = Behavior Assessment Schedule for Children, CSI = Child Symptom Inventory, DICA = Diagnostic Interview for Children and Adolescents, DSM-IV = DSM-IV Rating Scale, DSMD = Devereaux Scales of Mental Disorders, ECI = Early Childhood Inventory, SCL-90 = Symptom Checklist - 90. aComm = community sample, Clinic = clinic-referred sample. bP = parent, T = teacher, S = self, BE = best estimate summary from multiple sources of data. cPositive effect sizes indicate that the group listed first had more symptoms of the comorbid disorder than the group listed second, and negative effect sizes indicate that the group listed second had more symptoms. dinsufficient data available to calculate effect size. emultiple effects reported by the study were combined into a single effect size for meta-analysis (see Supplement section 2). fHeterogeneity was attributable to a significant outlying effect sizes in the study by Scheres et al. (2004) and the adolescent sample described by Nolan et al. (2001); when these effects were excluded the overall effect size was lower but remained significant (g =1.13). gheterogeneity was primarily due to the significant outlier effect sizes reported by Scheres et al. (2004) and in the preschool sample described by Nolan et al. (2001). When these effects were excluded the overall effect was slightly lower but remained significant (g = 1.11). hfor the comparison between ADHD-I and ADHD-H, the effect size in the preschool study by Nolan et al. (2001) was excluded from the final estimated effect size because it was a significant outlier that dramatically shifted the estimated effect.

* = P < .05.





WITHDRAWN Studies of children and adolescents Bauerm. 2005a Comm 6 - 11 29 44 25 -- P & T P CBCL 0.89* 1.14* -0.27 Byun 2006 Clinic 5 - 16 -- 70 22 -- P P CBCL -- -- -- -0.02 -- -- Carlson 2002 Clinic 9 - 12 25 25 13 -- P & T P RBPC 1.82* 1.21* 0.62 Forbes 2001 Clinic 6 - 12 -- 88d 27 -- P & T P CBCL -- -- -- -0.39 -- -- Gadow 2000 Comm 10 - 12 443 32 72 58 P P CBCL 0.56* 0.80* 0.40* -0.20 0.10 0.30 Gaub 1997 Comm 5 - 12 221 51 123 47 T T CBCL 0.73* 1.00* 0.07 -0.32 0.66* 0.83* Graetz 2001 Comm 6 - 17 3,298 67 133 68 P P CBCL 1.24* 1.06* 0.74* 0.09 0.32 0.20 Gr.-Tsur 2006 Clinic 5 - 18 -- 138 64 -- P & T P CBCL -- -- -- 0.12 Hinshaw 2002a Clinic 6 - 12 88 93 47 -- P & T Obs Observation 0.02 0.44* -- -0.45* -- -- Johnstone 2009 Clinic 8 - 14 15 15 15 -- NS P CBCL 0.58 0.46 -- 0.04 -- -- Morgan 1996e Clinic 6 - 11 -- 26 30 P & T P CBCL -- -- -- -0.14 -- -- Morgan 1996e Clinic 6 - 11 -- 26 30 -- P & T T TRF -- -- -- -0.70 -- -- Paternite 1996 Clinic 6 - 12 -- 59 28 9 P P / T CBCL -- -- -- No ESf No ESf No ESf

Sem-Cl 2010ae Clinic 9 - 16 113 76 80 -- BE P BASC-II 0.54* 0.80* -- -0.04 -- -- Sem-Cl 2010ae Clinic 9 - 16 113 76 80 -- BE T BASC-II 0.86* 0.58* -- -0.04 -- -- van West 2009e Clinic 6 - 12 25 52 23 -- P & S P CBCL 1.86* 4.28* -- -0.70* -- -- van West 2009e Clinic 6 - 12 25 52 23 -- P & S T TRF 0.79* 2.22* -- -0.64* -- -- Vaughn 1997e Clinic 6 - 11 -- 38 16 -- P & T P CBCL -- -- -- 0.50 Vaughn 1997e Clinic 6 - 11 -- 38 16 -- P & T T TRF -- -- -- 0.12 Willcutt 2011a Comm 8 - 18 288 135 235 40 P & T P & T CBCL / TRF 0.74* 0.80* 0.07 -0.13 0.65 0.71* Pooled results Overall Hedges' g: 0.83* 0.96* 0.33* -0.14* 0.42* 0.50*

[95% CI]: [0.55, 1.11] [0.73, 1.18] [0.01, 0.66] [-0.28, 0.00] [0.17, 0.68] [0.18, 0.83] Number of significant effects / total effects: 8 / 10 9 / 10 2 / 4 2 / 16 2 / 5 2 / 5

Ngroup 1 / Ngroup 2: 590 / 4,545 766 / 4,545 213 / 4,250 950 / 919 253 / 204 563 / 213 Cochrane's Q, I2: 56.4*, 84%g 44.7*, 79%h 15.8, 81% 25.1, 44% 4.9, 39% 10.6, 71%

Classic fail-safe N / Orwin's fail-safe N: 393 / 27 662 / 31 28 / 9 105 / 10 30 / 10 14 / 6 Egger's regression intercept: ns ns ns ns ns ns

Trim and Fill number of missing studies (higher or lower than point estimate): 0 0 0 0 0 1 (lower) Trim and fill adjusted g: 0.83* 0.96* 0.33* -0.14* 0.43* 0.41*





WITHDRAWN CONTINUED

Note: Summary statistics for the meta-analysis are described in detail in Supplement section 2. BASC = Behavior Assessment Schedule for Children, CBCL = Child Behavior Checklist, RBPC = Revised Behavior Problem Checklist, TRF = Achenbach Teacher Report Form. aComm = community sample, Clinic = clinic-referred sample. bP = parent, T = teacher, CL = clinician, S = self, BE = best estimate summary from multiple sources of data, Chart = chart review. cPositive effect sizes indicate that the group listed first had more symptoms of the comorbid disorder than the group listed second, and negative effect sizes indicate that the group listed second had more symptoms. dADHD-C included 81 with ADHD-C and 7 with ADHD-H. emultiple effects reported by the study were combined into a single effect size for meta-analysis (see Supplement section 2). finsufficient data available to calculate effect size. gHeterogeneity due to significant outlier effect sizes in the studies by Hinshaw (2002) and Carlson et al. (2002); when these effects were excluded the overall effect was slightly larger and remained significant (g = 0.85). hHeterogeneity due to significant outlier effect size in the studies by Van West et al. (2009); when this effect was excluded the overall effect size was lower but remained significant (g = 0.85).

* = P < .05.





SOMATIC COMPLAINTS Studies of children and adolescents Bauerm. 2005a Comm 6 - 11 29 44 25 -- P & T P CBCL 0.49* 0.68* -- -0.22 -- -- Byun 2006 Clinic 5 - 16 -- 70 22 -- P P CBCL -- -- -- -0.15 -- -- Forbes 2001 Clinic 6 - 12 -- 88d 27 -- P & T P CBCL -- -- -- -0.41 -- -- Gadow 2000 Comm 10 - 12 443 32 72 58 P P CBCL 0.44* 0.35* 0.24 0.04 0.21 0.12 Gaub 1997 Comm 5 - 12 221 51 123 47 T T CBCL 0.74* 0.37* 0.11 0.27 0.46* 0.23 Graetz 2001 Comm 6 - 17 3,298 67 133 68 P P CBCL 0.55* 0.44* 0.33 0.09 0.17 0.08 Gr.-Tsur 2006 Clinic 5 - 18 -- 138 64 -- P & T P CBCL -- -- -- -0.16 -- -- Johnstone 2009 Clinic 8 - 14 15 15 15 -- NS P CBCL 1.17* 0.93* -- 0.33 -- -- Morgan 1996e Clinic 6 - 11 -- 26 30 -- P & T P CBCL -- -- -- 0.14 -- -- Morgan 1996e Clinic 6 - 11 -- 26 30 -- P & T T TRF -- -- -- -0.65* -- -- Paternite 1996 Clinic 6 - 12 -- 59 28 9 P P CBCL -- -- -- No ESf No ESf No ESf

van West 2009e Clinic 6 - 12 25 52 23 -- P & S P CBCL 0.93* 1.61* -- -0.60* -- -- van West 2009e Clinic 6 - 12 25 52 23 -- P & S T TRF 0.51* 0.17 -- 0.37 -- -- Vaughn 1997e Clinic 6 - 11 -- 38 16 -- P & T P BASC -- -- -- 0.60* -- -- Vaughn 1997e Clinic 6 - 11 -- 38 16 -- P & T T BASC -- -- -- 0.24 -- -- Vaughn 1997e Clinic 6 - 11 -- 38 16 -- P & T P CBCL -- -- -- 0.29 -- -- Vaughn 1997e Clinic 6 - 11 -- 38 16 -- P & T T TRF -- -- -- -0.04 -- -- Pooled results Overall Hedges' g: 0.61* 0.45* 0.24* -0.03 0.27* 0.14

[95% CI]: [0.46, 0.76] [0.32, 0.57] [0.09, 0.40] [-0.16, 0.11] [0.05, 0.49] [-0.05, 0.32] Number of significant effects / total effects: 6 / 6 6 / 6 0 / 3 0 / 12 1 / 4 0 / 4

Ngroup 1 / Ngroup 2: 261 / 4,031 391 / 4,031 173 / 3,962 621 / 544 150 / 173 328 / 173 Cochrane's Q, I2: 4.3, 0% 5.7, 12% 1.2, 0% 11.3, 11% 1.3, 0% 0.7, 0%

Classic fail-safe N / Orwin's fail-safe N: 93 / 13 87 / 8 4 / 1 -- / -- 2 / 2 -- / -- Egger's regression intercept: ns P = .03 P = .03 ns ns ns

Trim and Fill number of missing studies (higher or lower than point estimate): 1 (lower) 2 (lower) 2 (higher) 0 0 0 Trim and fill adjusted g: 0.59* 0.42* 0.33* -0.03 0.27* 0.14

Note: Summary statistics for the meta-analysis are described in Supplement section 2. BASC = Behavior Assessment Schedule for Children, CBCL = Child Behavior Checklist, TRF = Achenbach Teacher Report Form. aComm = community sample, Clinic = clinic-referred sample. bP = parent, T = teacher, S = self. cPositive effect sizes indicate that the group listed first had more symptoms of the comorbid disorder than the group listed second, and negative effect sizes indicate that the group listed second had more symptoms. dADHD-C included 81 with ADHD-C and 7 with ADHD-H. emultiple effects reported by the study were combined into a single effect size for meta-analysis (see Supplement section 2). finsufficient data available to calculate effect size. * = P < .05





INTERNALIZING COMPOSITE Studies of children and adolescents Bauerm. 2005a Comm 6 - 11 29 44 25 -- P & T P CBCL 0.99* 1.02* -- -0.08 -- -- Byun 2006 Clinic 5 - 16 -- 70 22 -- P P CBCL -- -- -- 0.31 -- -- Edwards 2007d Clinic 6 - 12 -- 50 33 -- P P CBCL -- -- -- 0.46 -- -- Edwards 2007d Clinic 6 - 12 -- 50 33 -- P T TRF -- -- -- 0.50* -- -- Eiraldi 1997 Clinic 6 - 12 33 27 26 -- P P DSMD No ES*e No ES*e -- No ES*e -- -- Forbes 2001 Clinic 6 - 12 -- 88f 27 -- P & T P CBCL -- -- -- -0.39 -- -- Gaub 1997 Comm 5 - 12 221 51 123 47 T T CBCL 1.07* 0.74* 0.35 0.28 0.61* 0.37* Graetz 2001 Comm 6 - 17 3,298 67 133 68 P P CBCL 1.40* 0.98* 0.82* 0.24 0.36* 0.11 Gr.-Tsur 2006 Clinic 5 - 18 -- 138 64 -- P & T P CBCL -- -- -- 0.20 -- -- Hinshaw 2002a Clinic 6 - 12 88 93 47 -- P & T P CBCL 1.24* 1.17* -- 0.06 -- -- Massetti 2008 Clinic 4 - 14 130 85 14 26 P & T P DSM-III-R Sympt. 1.10* 1.37* 0.51 -0.05 0.59* 0.71 Morgan 1996d Clinic 6 - 11 -- 26 30 -- P & T P CBCL -- -- -- 0.29 -- -- Morgan 1996d Clinic 6 - 11 -- 26 30 -- P & T T TRF -- -- -- -0.47 -- -- Power 2001d Clinic 5 - 12 -- 22 19 -- P & T T TRF -- -- -- -0.31 -- -- Power 2001d Clinic 5 - 12 -- 22 19 -- P & T P CBCL -- -- -- 0.06 -- -- Sem-Cl 2010ad Clinic 9 - 16 113 76 80 -- BE P BASC-II 0.82* 0.39* -- 0.44* -- -- Sem-Cl 2010ad Clinic 9 - 16 113 76 80 -- BE T BASC-II 0.88* 0.45* -- 0.42* -- -- van West 2009d Clinic 6 - 12 25 52 23 -- P & S P CBCL 2.68* 2.85* -- -0.45* -- -- van West 2009d Clinic 6 - 12 25 52 23 -- P & S T TRF 2.53* 2.75* -- -0.68* -- -- Vaughn 1997d Clinic 6 - 11 -- 38 16 -- P & T T BASC -- -- -- 0.01 -- -- Vaughn 1997d Clinic 6 - 11 -- 38 16 -- P & T P BASC -- -- -- 0.64 -- -- Vaughn 1997d Clinic 6 - 11 -- 38 16 -- P & T P CBCL -- -- -- 0.84 -- -- Vaughn 1997d Clinic 6 - 11 -- 38 16 -- P & T T TRF -- -- -- 0.10 -- --





INTERNALIZING COMPOSITE CONTINUED

Pooled results Overall Hedges' g: 1.26* 1.10* 0.58* 0.11 0.50* 0.27* [95% CI]: [0.98, 1.54] [0.76, 1.43] [0.27, 0.90] [-0.05, 0.25] [0.27, 0.72] [0.06, 0.48]

Number of significant effects / total effects: 8 / 8 8 / 8 1 / 3 3 / 15 3 / 3 1 / 3 Ngroup 1 / Ngroup 2: 468 / 3,904 445 / 3,904 141 / 3,649 900 / 650 203 / 141 270 / 141

Cochrane's Q, I2: 29.0*. 79%g 40.4*, 85%g 5.8, 66% 24.4, 47% 1.1, 0% 3.3, 39% Classic fail-safe N / Orwin's fail-safe N: 446 / 29 307 / 21 30 / 6 -- / -- 13 / 5 4 / 1

Egger's regression intercept: ns ns ns ns ns ns Trim and Fill number of missing studies (higher or lower than point estimate): 0 0 0 0 0 2 (lower)

Trim and fill adjusted g: 1.26* 1.10* 0.58* 0.11 0.50* 0.11

Note: Summary statistics for the meta-analysis are described in detail in Supplement section 2. BASC = Behavior Assessment Schedule for Children, CBCL = Child Behavior Checklist, DSMD = Devereaux Scales of Mental Disorders, TRF = Achenbach Teacher Report Form. aComm = community sample, Clinic = clinic-referred sample. bP = parent, T = teacher, S = self, BE = best estimate summary from multiple sources of data. cPositive effect sizes indicate that the group listed first had more symptoms of the comorbid disorder than the group listed second, and negative effect sizes indicate that the group listed second had more symptoms. dmultiple effects reported by the study were combined into a single effect size for meta-analysis (see Supplement section 2). einsufficient data available to calculate effect size. fADHD-C included 81 with ADHD-C and 7 with ADHD-H. gheterogeneity due to significant outlier effect sizes reported by Van West et al. (2009). When these effects were excluded the overall effect sizes were smaller for both comparisons (g = 1.13 for ADHD-C vs. control and g = 0.91 for ADHD-I vs. control), but both effects remained significant and the overall interpretation did not change.

* = P < .05.





AGGRESSION Studies of children and adolescents Bauerm. 2005a Comm 6 - 11 29 44 25 -- P & T P CBCL 1.67* 0.46 -- 1.27* -- -- Byun 2006 Clinic 5 - 16 -- 70 22 -- P P CBCL -- -- -- 0.75* -- -- Carlson 2002 Clinic 9 - 12 25 25 13 -- P & T P RBPC 1.30* 0.47 -- 0.93* -- -- Forbes 2001 Clinic 6 - 12 -- 88d 27 -- P & T P CBCL -- -- -- 0.49* -- -- Gadow 2000 Comm 10 - 12 443 32 72 58 P P CBCL 1.40* 0.79* 1.15* 0.56 0.22 -0.32 Gaub 1997 Comm 5 - 12 221 51 123 47 T T CBCL 2.13* 0.58* 2.23* 1.33* -0.07 -1.40* Gorman 2006 Clinic 6 - 12 34 22 19 -- P & T P IOWA Conn 1.57* 0.37* -- 0.87* -- -- Graetz 2001 Comm 6 - 17 3,298 67 133 68 P P CBCL 3.17* 1.06* 1.90* 1.40* 0.84* -0.59* Gr.-Tsur 2006 Clinic 5 - 18 138 64 -- P & T P CBCL -- -- -- 0.51* -- -- Hinshaw 2002ae Clinic 6 - 12 88 93 47 -- P & T Obs Covert agg. 1.10* 0.41 -- 0.86* -- -- Hinshaw 2002ae Clinic 6 - 12 88 93 47 -- P & T Obs Overt agg. 0.99* 0.48 -- 0.74* -- -- Hinshaw 2002ae Clinic 6 - 12 88 93 47 -- P & T Obs Relational agg. 1.60* 0.64* -- 1.10* -- -- Johnstone 2009 Clinic 8 - 14 15 15 15 -- NS P CBCL 2.04* 0.45 -- 1.53* -- -- Maedgen 2000 Clinic 8 - 11 17 16 14 -- P P RBPC 1.51* 0.38 -- 1.31* -- -- McBurnett 1999 Clinic 3 - 18 -- 424 184 48 P & T P SNAP-IV -- -- -- No ES*f No ES*f No ES*f

Morgan 1996e Clinic 6 - 11 -- 26 30 -- P & T P CBCL -- -- -- 1.31* -- -- Morgan 1996e Clinic 6 - 11 -- 26 30 -- P & T T TRF -- -- -- 1.04* -- -- Nigg 2002ae Comm 7 - 12 41 46 18 -- P & T P BASC 2.13* 1.79* -- 0.75* -- -- Nigg 2002ae Comm 7 - 12 41 46 18 -- P & T P CBCL 1.99* 0.38 -- 1.58* -- -- Paternite 1996 Clinic 6 - 12 -- 59 28 9 P T CBCL -- -- -- No ES*f No ESf No ES*f

van West 2009e Clinic 6 - 12 25 52 23 -- P & S P CBCL 3.64* 0.81* -- 1.09* -- -- van West 2009e Clinic 6 - 12 25 52 23 -- P & S T TRF 2.94* 1.28* -- 2.17* -- -- Vaughn 1997e Clinic 6 - 11 -- 38 16 -- P & T P BASC -- -- -- 0.90* -- -- Vaughn 1997e Clinic 6 - 11 -- 38 16 -- P & T T BASC -- -- -- 1.00* -- -- Vaughn 1997e Clinic 6 - 11 -- 38 16 -- P & T P CBCL -- -- -- 1.25* -- -- Vaughn 1997e Clinic 6 - 11 -- 38 16 -- P & T T TRF -- -- -- 0.96* -- -- Willcutt 2011a Comm 8 - 18 288 135 235 40 P & T P & T CBCL / TRF 1.52* 0.82* 1.25* 0.79* 0.23 -0.56*





AGGRESSION CONTINUED Pooled results Overall Hedges' g: 1.89* 0.72* 1.64* 1.04* 0.32 -0.71*

[95% CI]: [1.45, 2.34] [0.57, 0.88] [1.14, 2.13] [0.84, 1.24] [-0.09, 0.72] [-1.16, -0.26] Number of significant effects / total effects: 12 / 12 7 / 12 4 / 4 19 / 19 2 / 6 5 / 6

Ngroup 1 / Ngroup 2: 598 / 4,524 737 / 4,524 204 / 4,199 926 / 844 253 / 204 563 / 213 Cochrane's Q, I2: 148.1, 93%g 22.9, 52% 29.9*, 90%h 50.6*, 69%i 12.6, 76% 19.8*, 85%h

Classic fail-safe N / Orwin's fail-safe N: 1,373 / 70 579 / 32 225 / 20 1,124 / 59 -- / -- 64 / 16 Egger's regression intercept: ns ns ns ns ns ns

Trim and Fill number of missing studies (higher or lower than point estimate): 0 2 (higher) 0 0 1 (higher) 0 Trim and fill adjusted g: 1.89* 0.76* 1.64* 1.04* 0.44* -0.71*

Note: Summary statistics for the meta-analysis are described in detail in Supplement section 2. BASC = Behavior Assessment Schedule for Children, CBCL = Child Behavior Checklist, CPRS/CTRS = Conners Parent/Teacher Rating Scale, RBPC = Revised Behavior Problem Checklist, SNAP-IV = DSM-IV Swanson, Nolan, and Pelham Rating Scale, TRF = Achenbach Teacher Report Form. aComm = community sample, Clinic = clinic-referred sample. bP = parent, T = teacher, S = self, Obs = observations. cPositive effect sizes indicate that the group listed first had more symptoms of the comorbid disorder than the group listed second, and negative effect sizes indicate that the group listed second had more symptoms. dADHD-C included 81 with ADHD-C and 7 with ADHD-H. emultiple effects reported by the study were combined into a single effect size for meta-analysis (see Supplement section 2). finsufficient data available to calculate effect size. gsignificant heterogeneity due to outlying large effect sizes reported by van West et al. (2009) and Graetz et al. (2001). When these studies were excluded the overall effect size estimate was smaller but remained large and significant (g = 1.63). hheterogeneity due to significant outlier effect sizes reported by Gaub et al. (1997). The overall effect sizes remained significant when these effects was excluded (ADHD-H vs. control g = 1.36; ADHD-H vs. ADHD-I g = -0.53). iheterogeneity due to significant outlier effect size reported by van West et al. (2009). When this study was excluded the overall effect size estimate was smaller but remained significant (g = 0.91).

* = P < .05.





CONDUCT DISORDER Studies of children and adolescents Carlson 2002 Clinic 9 - 12 25 23 13 -- P & T P RBPC 3.40* 1.24* -- 1.63* -- -- Counts 2005 Comm 7 - 12 72 96 38 -- P & T P DISC 1.02* 0.10 -- 0.89* -- -- Eiraldi 1997 Clinic 6 - 12 33 27 26 -- P P, T DSMD No ES*d No ES*d -- No ES*d -- -- Forbes 2001e Clinic 6 - 12 -- 88f 27 -- P & T P CPRS -- -- -- 0.29 -- -- Forbes 2001e Clinic 6 - 12 -- 88f 27 -- P & T T CTRS -- -- -- 0.93* -- -- Gadow 2000 Comm 10 - 12 443 32 72 58 P P CSI 1.27* 0.75* 0.91* 0.28 0.21 -0.08 Gadow 2004ae Clinic 6 - 10 -- 60 81 12 T T CSI -- -- -- 0.82* 0.31 -0.66* Gadow 2004ae Clinic 6 - 10 -- 55 82 11 P P CSI -- -- -- 0.37 0.05 -0.42 Harrington 2010 Clinic 5 - 18 -- 124 81 23 P P DSM-IV -- -- -- 0.59* 0.27 0.36 Lahey 1998 Clinic 4 - 6 130 88 14 27 P & T P DISC-IV 1.34* 0.61* 1.84* 0.78* 0.05 -0.86* Nolan 1999e Clinic 13 - 18 -- 20 45 -- P P ASI -- -- -- 0.45 -- -- Nolan 1999e Clinic 13 - 18 -- 11 31 -- T T ASI -- -- -- 0.35 -- -- Nolan 1999e Clinic 6 - 12 -- 16 22 -- P P CSI -- -- -- 0.07 -- -- Nolan 1999e Clinic 6 - 12 -- 16 15 -- T T CSI -- -- -- 0.71* -- -- Nolan 1999e Clinic 3 - 5 -- 29 16 -- P P ECI -- -- -- 0.86* -- -- Nolan 1999e Clinic 3 - 5 -- 4 5 -- T T ECI -- -- -- 1.03* -- -- Nolan 2001 Comm 13 - 18 914 27 123 9 T T ASI 3.39* 1.47* 3.71* 0.55 0.13 -0.40 Nolan 2001 Comm 6 - 12 1,278 50 157 35 T T CSI 2.63* 0.69* 2.07* 0.90* 0.14 -0.62 Nolan 2001 Comm 3 - 5 338 32 16 27 T T ECI 1.92* 0.34 1.26* 0.99* 0.41 -0.65 Paternite 1996 Clinic 6 - 12 -- 59 28 9 P P / T CPRS / CTRS -- -- -- No ES*d No ESd No ESd

Scheres 2004 Clinic 6 - 12 22 15 8 -- P P DBD 1.61* 1.26* -- 0.65 -- -- Scheres 2010 Clinic 6 - 17 37 25 20 -- P P DSM-IV 1.64* 1.37* -- 0.55 -- -- Willcutt 1999 Comm 8 - 18 95 32 58 15 P & T P DICA-R 1.83* 1.30* 1.74* 0.43 0.49 0.10






Studies of children and adolescents Pooled results Overall Hedges' g: 1.98* 0.90* 1.89* 0.66* 0.22* -0.31*

[95% CI]: [1.47, 2.49] [0.59, 1.20] [1.24, 2.54] [0.53, 0.79] [0.04, 0.40] [-0.61, -0.01] Number of significant effects / total effects: 11 / 11 9 / 11 6 / 6 13 / 18 0 / 9 2 / 9

Ngroup 1 / Ngroup 2: 420 / 3,354 519 / 3,354 171 / 3,198 757 / 792 445 / 206 603 / 206 Cochrane's Q, I2: 138.8, 93%g 70.2*, 87%h 71.4, 93%i 18.3, 18% 2.1, 0% 18.8, 62%

Classic fail-safe N / Orwin's fail-safe N: 599 / 45 651 / 39 175 / 21 504 / 42 5 / 1 15 / -- Egger's regression intercept: ns ns ns ns ns ns

Trim and Fill number of missing studies (higher or lower than point estimate): 0 1 (lower) 0 0 0 1 (higher) Trim and fill adjusted g: 1.98* 0.82* 1.89* 0.66* 0.22* -0.25 Studies of adults Sprafkin 2007j Comm 18 - 75 419 8 15 8 S S ASRI-4 1.33* 0.39 2.19* 0.55* 0.28 0.74* Sprafkin 2007k Comm 18 - 75 421 6 13 10 S S ASRI-4 0.76* 0.40 0.46 0.39 0.23 0.08 Sprafkin 2007 Clinic 18 - 76 -- 74 97 32 S S ASRI-4 -- -- -- 0.37 0.27 0.07 Pooled results Overall Hedges' g: 1.08* 0.40* 1.21* 0.39* 0.27 0.17

[95% CI]: [0.54, 1.63] [0.02, 0.77] [0.74, 1.68] [0.11, 0.66] [-0.29, 0.62] [-0.16, 0.50] Number of significant effects / total effects: 2 / 2 0 / 2 1 / 2 0 / 3 0 / 3 1 / 3


Classic fail-safe N / Orwin's fail-safe N: -- -- -- 3 n/a 0 Egger's regression intercept: -- -- -- ns ns ns

Trim and Fill number of missing studies (higher or lower than point estimate): -- -- -- 0 0 0 Trim and fill adjusted g: -- -- -- 0.39* 0.27 0.17

Note: Summary statistics for the meta-analysis are described in Supplement section 2. ASI = Adolescent Symptom Inventory, ASRI-4 = Adult Self-Report Inventory - 4, CPRS/CTRS = Conners Parent/Teacher Rating Scale, CSI = Child Symptom Inventory, DBD = Disruptive Behavior Disorders Questionnaire, DICA = Diagnostic Interview for Children and Adolescents, DISC-IV = DSM-IV Diagnostic Interview Schedule for Children, DSM-IV = DSM-IV Rating Scale, ECI = Early Childhood Inventory, RBPC = Revised Behavior Problem Checklist. aComm = community sample, Clinic = clinic-referred sample. bP = parent, T = teacher, S = self. cPositive effect sizes indicate that the group listed first had more symptoms of the comorbid disorder than the group listed second, and negative effect sizes indicate that the group listed second had more symptoms. dinsufficient data available to calculate effect size. emultiple effects reported by the study were combined into a single effect size for meta-analysis (see Supplement section 2). fADHD-C included 81 with ADHD-C and 7 with ADHD-H. gheterogeneity due to significant outlier effect sizes reported by Carlson et al. (2002) and Nolan et al. (2001); when these effects were excluded the overall effect size was lower (g = 1.49) but remained significant. hheterogeneity not explained by outliers or tested covariates. iheterogeneity due to the outlying large effect size reported by Nolan et al. (2001), but the overall effect remained significant when this effect was excluded (g = 1.55). jmales. kfemales. * = P < .05.





DELINQUENT / ANTISOCIAL BEHAVIOR Studies of children and adolescents Bauerm. 2005a Comm 6 - 11 29 44 25 -- P & T P CBCL 1.52* 0.78* -- 0.74* -- -- Byun 2006 Clinic 5 - 16 -- 70 22 -- P P CBCL -- -- -- 0.52 -- -- Forbes 2001 Clinic 6 - 12 -- 88d 27 -- P & T P CBCL -- -- -- 0.25 -- -- Gadow 2000 Comm 10 - 12 443 32 72 58 P P CBCL 1.58* 0.88* 0.81* 0.67* 0.60* 0.04 Gaub 1997 Comm 5 - 12 221 51 123 47 T T CBCL 1.75* 0.88* 1.45* 0.70* 0.21 -0.46* Graetz 2001 Comm 6 - 17 3,298 67 133 68 P P CBCL 2.53* 0.83* 1.31* 1.05* 0.61* -0.30 Gr.-Tsur 2006 Clinic 5 - 18 -- 138 64 -- P & T P CBCL -- -- -- 0.48* -- -- Johnstone 2009 Clinic 8 - 14 15 15 15 -- NS P CBCL 2.19* 1.27* -- 0.97* -- -- Morgan 1996e Clinic 6 - 11 -- 26 30 -- P & T P CBCL -- -- -- 1.22* -- -- Morgan 1996e Clinic 6 - 11 -- 26 30 -- P & T T TRF -- -- -- 0.66* -- -- Nigg 2002a Comm 7 - 12 41 46 18 -- P & T P CBCL 1.59* 0.12 -- 1.33* -- -- Paternite 1996 Clinic 6 - 12 -- 59 28 9 P P & T CBCL -- -- -- No ES*f No ES*f No ESf

van West 2009e Clinic 6 - 12 25 52 23 -- P & S P CBCL 4.68* 0.91* -- 1.91* -- -- van West 2009e Clinic 6 - 12 25 52 23 -- P & S T TRF 1.87* 0.69* -- 1.48* -- -- Vaughn 1997e Clinic 6 - 11 -- 38 16 -- P & T P BASC -- -- -- 0.77* -- -- Vaughn 1997e Clinic 6 - 11 -- 38 16 -- P & T T BASC -- -- -- 0.75* -- -- Vaughn 1997e Clinic 6 - 11 -- 38 16 -- P & T P CBCL -- -- -- 0.54* -- -- Vaughn 1997e Clinic 6 - 11 -- 38 16 -- P & T T TRF -- -- -- 0.62* -- -- Willcutt 2011a Comm 8 - 18 288 135 235 40 P & T P & T CBCL / TRF 1.22* 0.73* 0.91* 0.46* 0.30 -0.17





DELINQUENT / ANTISOCIAL BEHAVIOR CONTINUED Studies of children and adolescents Pooled results Overall Hedges' g: 1.92* 0.80* 1.12* 0.77* 0.44* -0.23*


Ngroup 1 / Ngroup 2: 442 / 4,360 644 / 4,360 213 / 4,250 802 / 797 263 / 205 563 / 213 Cochrane's Q, I2: 76.3*, 90%g 8.8, 20% 12.5, 76% 33.8*, 65%h 3.3, 9% 4.4, 32%

Classic fail-safe N / Orwin's fail-safe N: 1,134 / 55 416 / 24 231 / 19 401 / 28 16 / 6 4 / 1 Egger's regression intercept: ns ns ns ns ns ns

Trim and Fill number of missing studies (higher or lower than point estimate): 0 2 (lower) 0 0 0 0 Trim and fill adjusted g: 1.93* 0.76* 1.12* 0.77* 0.44* -0.23 Studies of adults Sprafkin 2007i Comm 18 - 75 419 8 15 8 S S ASRI-4 Antisocial 2.54* 1.91* 2.35* 0.39 0.02 0.26 Sprafkin 2007j Comm 18 - 75 421 6 13 10 S S ASRI-4 Antisocial 0.99* 1.27* 1.84* 0.16 0.43 0.27 Sprafkin 2007 Clinic 18 - 76 -- 74 97 32 S S ASRI-4 Antisocial -- -- -- 0.60* 0.47* 0.09 Pooled results Overall Hedges' g: 1.78* 1.59* 2.06* 0.54* 0.40* 0.15



Classic fail-safe N / Orwin's fail-safe N: -- -- -- 4 / 6 n/a 0 Egger's regression intercept: -- -- -- ns ns ns

Trim and Fill number of missing studies (higher or lower than point estimate): -- -- -- 2 (higher) 0 2 (lower) Trim and fill adjusted g: -- -- -- 0.60* 0.40 0.09

Note: Summary statistics for the meta-analysis are described in detail in Supplement section 2. ASRI-4 = Adult Self-Report Inventory - 4, BASC = Behavior Assessment Schedule for Children, CBCL = Child Behavior Checklist, TRF = Achenbach Teacher Report Form. aComm = community sample, Clinic = clinic-referred sample. bP = parent, T = teacher, S = self. cPositive effect sizes indicate that the group listed first had more symptoms of the comorbid disorder than the group listed second, and negative effect sizes indicate that the group listed second had more symptoms. dADHD-C included 81 with ADHD-C and 7 with ADHD-H. emultiple effects reported by the study were combined into a single effect size for meta-analysis (see Supplement section 2). finsufficient data available to calculate effect size. gHeterogeneity was attributable to a significant outlier effect size reported by Van West et al. (2009); when this effect was excluded the overall effect size was lower but remained significant (g = 1.75). hHeterogeneity was attributable to a significant outlier effect size reported by Van West et al. (2009); when this effect was excluded the overall effect size was lower but remained significant (g = 0.70). imales. jfemales.

* = P < .05.





EXTERNALIZING COMPOSITE Studies of children and adolescents Bauerm. 2005a Comm 6 - 11 29 44 25 -- P & T P CBCL 2.18* 0.80* -- 1.40* -- -- Byun 2006 Clinic 5 - 16 -- 70 22 -- P P CBCL -- -- -- 0.74* -- -- Campbell 2009d Comm 7 - 9 790 57 80 -- P & T P CBCL 1.53* 0.62* -- 0.83* -- -- Campbell 2009d Comm 7 - 9 790 57 80 -- P & T T CBCL 2.49* 0.98* -- 1.34* -- -- Edwards 2007d Clinic 6 - 12 -- 50 33 -- P P CBCL -- -- -- 1.24* -- -- Edwards 2007d Clinic 6 - 12 -- 50 33 -- P T TRF -- -- -- 1.34* -- -- Eiraldi 1997 Clinic 6 - 12 33 27 26 -- P & T P & T DSMD No ES*e No ES*e -- No ES*e -- -- Forbes 2001 Clinic 6 - 12 -- 88f 27 -- P & T P CBCL -- -- -- 0.38 -- -- Gaub 1997 Comm 5 - 12 221 51 123 47 T T CBCL 2.15* 0.67* 2.10* 1.27* 0.05 -1.22 Graetz 2001 Comm 6 - 17 3,298 67 133 68 P P CBCL 3.22* 1.07* 1.85* 1.40* 0.84* -0.52 Gr.-Tsur 2006 Clinic 5 - 18 -- 138 64 -- P & T P CBCL -- -- -- 0.69* -- -- Hinshaw 2002a Clinic 6 - 12 88 93 47 -- P & T P CBCL 2.77* 1.36* -- 1.09* -- -- Morgan 1996d Clinic 6 - 11 -- 26 30 -- P & T P CBCL -- -- -- 1.43* -- -- Morgan 1996d Clinic 6 - 11 -- 26 30 -- P & T T TRF -- -- -- 1.07* -- -- Power 2001d Clinic 5 - 12 -- 22 19 -- P & T P CBCL -- -- -- 1.08* -- -- Power 2001d Clinic 5 - 12 -- 22 19 -- P & T T TRF -- -- -- 0.58* -- -- Power 2004 Clinic 8 - 14 -- 42 45 -- P & T P BASC -- -- -- 1.44* -- -- Sem-Cl 2010ad Clinic 9 - 16 113 76 80 -- BE P BASC-II 1.77* 0.59* -- 1.26* -- -- Sem-Cl 2010ad Clinic 9 - 16 113 76 80 -- BE T BASC-II 1.44* 0.52* -- 0.87* -- -- van West 2009d Clinic 6 - 12 25 52 23 -- P & S P CBCL 3.69* 1.19* -- 2.79* -- -- van West 2009d Clinic 6 - 12 25 52 23 -- P & S T TRF 3.37* 0.77* -- 1.80* -- -- Vaughn 1997d Clinic 6 - 11 -- 38 16 -- P & T P BASC -- -- -- 1.52* -- -- Vaughn 1997d Clinic 6 - 11 -- 38 16 -- P & T T BASC -- -- -- 1.19* -- -- Vaughn 1997d Clinic 6 - 11 -- 38 16 -- P & T P CBCL -- -- -- 1.06* -- -- Vaughn 1997d Clinic 6 - 11 -- 38 16 -- P & T T TRF -- -- -- 1.03* -- --





EXTERNALIZING COMPOSITE CONTINUED Pooled results Overall Hedges' g: 2.47* 0.88* 1.94* 1.14* 0.46 -0.88

[95% CI]: [1.95, 2.99] [0.68, 1.08] [1.69, 2.19] [0.94, 1.34] [-0.23, 1.14] [-1.55, -0.17] Number of significant effects / total effects: 8 / 8 8 / 8 2 / 2 15 / 16 1 / 2 2 / 2

Ngroup 1 / Ngroup 2: 440 / 4,564 511 / 4,564 115 / 3,519 914 / 761 118 / 115 256 / 115 Cochrane's Q, I2: 82.8*, 92%g 19.2, 68% -- 44.0*, 68%h -- --

Classic fail-safe N / Orwin's fail-safe N: 2,108 / 91 436 / 28 -- 1,164 / 60 -- -- Egger's regression intercept: ns ns -- ns -- --

Trim and Fill number of missing studies (higher or lower than point estimate): 0 0 -- 0 -- -- Trim and fill adjusted g: 2.48* 0.88* -- 1.14* -- --

Note: Summary statistics for the meta-analysis are described in detail in Supplement section 2. BASC = Behavior Assessment Schedule for Children, CBCL = Child Behavior Checklist, DSMD = Devereaux Scales of Mental Disorders, TRF = Achenbach Teacher Report Form. aComm = community sample, Clinic = clinic-referred sample. bP = parent, T = teacher, CL = clinician, S = self, BE = best estimate summary from multiple sources of data, Chart = chart review. cPositive effect sizes indicate that the group listed first had more symptoms of the comorbid disorder than the group listed second, and negative effect sizes indicate that the group listed second had more symptoms. dmultiple effects reported by the study were combined into a single effect size for meta-analysis (see Supplement section 2). einsufficient data available to calculate effect size. fADHD-C included 81 with ADHD-C and 7 with ADHD-H. gsignificant heterogeneity not explained by outliers or covariates. hheterogeneity due to significant outlier effects reported by van West et al. (2009) and Forbes (2001). When these effects were excluded the overall effect size did not change.

* = P < .05





OPPOSITIONAL DEFIANT DISORDER Studies of children and adolescents Bauerm. 2005ad Comm 6 - 11 29 44 25 -- P & T T DBRS 2.18* 0.81* -- 1.69* -- -- Bauerm. 2005ad Comm 6 - 11 29 44 25 -- P & T P DBRS 1.76* 1.00* -- 0.66* -- -- Biederman 2008 Clinic 6 - 17 -- 403 187 27 P P CRS -- -- -- 0.89* 0.07 -0.78* Booth 2007 Clinic 7 - 13 24 16 26 -- P & T P DSM-IV 1.52* 0.46 -- 0.93* -- -- Cordier 2010 Clinic 5 - 11 -- 31 46 28 P P CPRS -- -- -- 1.12* 1.00* -0.22 Counts 2005d Mult 7 - 12 52 52 17 -- P P SNAP 1.59* 0.28 -- 1.00* -- -- Counts 2005d Mult 7 - 12 72 96 38 P & T P DISC 1.99* 0.82* -- 1.16* -- -- Gadow 2000 Comm 10 - 12 443 32 72 58 P P CSI 1.74* 0.84* 1.45* 0.75* 0.27 -0.54* Gadow 2004ad Clinic 6 - 10 -- 60 81 12 T T CSI -- -- -- 1.07* 0.59* -0.58* Gadow 2004ad Clinic 6 - 10 -- 55 82 11 P P CSI -- -- -- 0.55* -0.03 -0.56* Gaub 1997 Comm 5 - 12 221 51 123 47 T T SNAP 2.05* 0.53* 1.87* 1.22* 0.16 -1.07* Harrington 2010 Clinic 5 - 18 -- 124 81 23 P P DSM-IV -- -- -- 0.90* 0.05 -0.85* Hastings 2009 Clinic 6 - 11 -- 86 59 25 P P CRS -- -- -- 1.11* 0.15 -0.91* Hinshaw 2002ad Clinic 6 - 12 88 93 47 -- P & T P SNAP 2.24* 1.15* -- 0.91* -- -- Hinshaw 2002ad Clinic 6 - 12 88 93 47 -- P & T T SNAP 1.88* 1.14* -- 0.85* -- -- Johnstone 2009 Clinic 8 - 14 15 15 15 -- NS P CRS 1.87* 0.71* -- 1.12* -- -- Lahey 1998 Clinic 4 - 6 130 88 14 27 P & T P DISC-IV 2.02* 1.33* 1.84* 0.77* 0.31 -0.42 Maedgen 2000 Clinic 8 - 11 17 16 14 -- P T SNAP 2.65* 1.06* -- 1.92* -- -- Nolan 1999d Clinic 13 - 18 -- 20 45 -- P P ASI -- -- -- 0.58* -- -- Nolan 1999d Clinic 13 - 18 -- 11 31 -- T T ASI -- -- -- 0.93* -- -- Nolan 1999d Clinic 6 - 12 -- 16 22 -- P P CSI -- -- -- 0.55* -- -- Nolan 1999d Clinic 6 - 12 -- 16 15 -- T T CSI -- -- -- 1.02* -- -- Nolan 1999d Clinic 3 - 5 -- 29 16 -- P P ECI -- -- -- 0.92* -- -- Nolan 1999d Clinic 3 - 5 -- 4 5 -- T T ECI -- -- -- 2.26* -- -- Nolan 2001 Comm 13 - 18 914 27 123 9 T T ASI 3.99* 1.65* 4.19* 0.78* 0.06 -0.74 Nolan 2001 Comm 6 - 12 1,278 50 157 35 T T CSI 3.44* 0.91* 2.45* 1.43* 0.44* -0.84* Nolan 2001 Comm 3 - 5 338 32 16 27 T T ECI 1.89* 0.51* 1.33* 1.06* 0.46* -0.70* Riley 2008d Clinic 3 - 5 -- 71 -- 31 P & T P CPRS -- -- -- -- 0.08 -- Riley 2008d Clinic 3 - 5 -- 71 -- 31 P & T T CTRS -- -- -- -- -0.30 -- Scheres 2004 Clinic 6 - 12 22 15 8 -- P P DBD 2.49* 2.01* -- 0.50 -- -- Scheres 2010 Clinic 6 - 17 37 25 20 -- P P DSM-IV 2.39* 2.13* -- 0.34 -- --





OPPOSITIONAL DEFIANT DISORDER CONTINUED Studies of children and adolescents Solanto 2007d Clinic 7 - 12 15 27 24 -- P & T P CPRS 1.88* 1.63* -- 0.87* -- -- Solanto 2007d Clinic 7 - 12 15 27 24 -- P & T T CTRS 1.40* 0.46* -- 0.97* -- -- Waschb. 2007 Comm 5 - 12 741 30 43 21 P P ADS-IV 3.22* 1.47* 1.96* 1.12* 0.97* -0.37 Willcutt 1999d Comm 8 - 18 95 32 58 15 P & T T DBRS 2.59* 0.93* 1.59* 1.34* 0.83* -0.34 Willcutt 1999d Comm 8 - 18 95 32 58 15 P & T P DICA-R 1.46* 0.61* 0.67* 0.76* 0.66* -0.03 Pooled results Overall Hedges' g: 2.26* 1.01* 1.99* 1.00* 0.32* -0.66*


Ngroup 1 / Ngroup 2: 748 / 4,536 842 / 4,536 239 / 4,160 1,382 / 1,313 982 / 378 994 / 347 Cochrane's Q, I2: 177.8*, 90%e 102.7*, 83%f 76.6*, 90%g 30.4, 18% 21.8, 40% 17.3, 30%

Classic fail-safe N / Orwin's fail-safe N: 3,631 / 132 2,195 / 73 573 / 43 3,104 / 104 40 / 9 285 / 30 Egger's regression intercept: ns ns ns ns ns ns

Trim and Fill number of missing studies (higher or lower than point estimate): 0 1 (higher) 0 1 (higher) 1 (higher) 4 (lower) Trim and fill adjusted g: 2.26* 1.05* 1.99* 1.02* 0.34* -0.80*

Note: Summary statistics for the meta-analysis are described in detail in Supplement section 2. ADS-IV = Assessment of Disruptive Symptoms DSM-IV, ASI = Adolescent Symptom Inventory, CPRS/CTRS = Conners Parent/Teacher Rating Scale, CSI = Child Symptom Inventory, DBD = Disruptive Behavior Disorders Questionnaire, DICA = Diagnostic Interview for Children and Adolescents, DISC-IV = DSM-IV Diagnostic Interview Schedule for Children, DSM-IV = DSM-IV Rating Scale, ECI = Early Childhood Inventory, SNAP-IV = DSM-IV Swanson, Nolan, and Pelham Rating Scale. aComm = community sample, Clinic = clinic-referred sample. bP = parent, T = teacher. cPositive effect sizes indicate that the group listed first had more symptoms of the comorbid disorder than the group listed second, and negative effect sizes indicate that the group listed second had more symptoms. dmultiple effects reported by the study were combined into a single effect size for meta-analysis (see Supplement section 2). eHeterogeneity due to a large outlying effect size reported by Waschbusch et al. (2007) and Nolan et al. (2001); when these effect was excluded the overall effect size was lower (g = 1.95), but the overall interpretation remained the same. fsignificant heterogeneity not explained by outliers or tested moderators. gheterogeneity due to outlier effect sizes in the child and adolescent samples from Nolan et al. (1999). When these effects were excluded the overall effect size remained significant (g = 1.61).

* = P < .05.





OPPOSITIONAL DEFIANT DISORDER CONTINUED Studies of adults Sprafkin 2007d Comm 18 - 75 419 8 15 8 S S ASRI-4 ODD 2.03* 0.98* 2.03* 0.79* 0.04 -0.63 Sprafkin 2007e Comm 18 - 75 421 6 13 10 S S ASRI-4 ODD 0.96* 1.75* 1.33* 0.77 0.26 -0.30 Sprafkin 2007 Clinic 18 - 76 -- 74 97 32 S S ASRI-4 ODD -- -- -- 0.87* 0.53* -0.31 Pooled results Overall Hedges' g: 1.51* 1.36* 1.66* 0.85* 0.42* -0.36*



Classic fail-safe N / Orwin's fail-safe N: -- -- -- 18 / 10 1 / 1 1 / 1 Egger's regression intercept: -- -- -- ns ns ns

Trim and Fill number of missing studies (higher or lower than point estimate): -- -- -- 2 (higher) 2 (higher) 0 Trim and fill adjusted g: -- -- -- 0.86* 0.53* -0.36*

Note: Summary statistics for the meta-analysis are described in detail in Supplement section 2. ASRI-4 = Adult Self-Report Inventory - 4. aComm = community sample, Clinic = clinic-referred sample. bS = self. cPositive effect sizes indicate that the group listed first had more symptoms of the comorbid disorder than the group listed second, and negative effect sizes indicate that the group listed second had more symptoms. dmales. efemales.

* = P < .05.





PERVASIVE DEVELOPMENTAL DISORDER Studies of children and adolescents Byun 2006 Clinic 5 - 16 -- 70 22 -- P P KPI Autism Scale -- -- -- 0.74* -- -- Geurts 2005d Comm 6 - 13 -- 16 16 -- P & T P ADI-R Soc. Inter. -- -- -- 0.42 -- -- Geurts 2005d Comm 6 - 13 -- 16 16 -- P & T P ADI-R Commun. -- -- -- 1.02* -- -- Geurts 2005d Comm 6 - 13 -- 16 16 -- P & T P ADI-R Ster. Beh. -- -- -- 0.71* -- -- Reiersen 2007d Comm 8 - 25 812 44 75 14 P P SRS Social Imp. 1.64* 0.89* 0.66* 0.58* 0.78* 0.20 Reiersen 2007d Comm 8 - 25 812 44 75 14 P P SRS Commun. 1.45* 0.78* 0.60 0.53* 0.72* 0.16 Reiersen 2007d Comm 8 - 25 812 44 75 14 P P SRS Ster. Beh. 1.63* 0.88* 0.62 0.51* 0.73* 0.22 Scheres 2004d Clinic 6 - 12 22 15 8 -- P P PDD Screener 3.13* 2.93* -- 0.24 -- -- Scheres 2004d Clinic 6 - 12 22 15 8 -- P P PDD Screener 1.88* 2.71* -- 0.18 -- -- Sem-Cl 2010b Clinic 9 - 16 32 21 28 -- P P Asperger sympt. 1.69* 0.40 -- 1.10* -- -- Pooled results Overall Hedges' g: 1.64* 1.20* 0.63* 0.69* 0.73* 0.22


Ngroup 1 / Ngroup 2: 80 / 866 111 / 866 14 / 812 166 / 149 44 / 14 75 / 14 Cochrane's Q, I2: 1.1, 0% 16.4*, 87%e -- 3.9, 0% -- --

Classic fail-safe N / Orwin's fail-safe N: 102 / 22 46 / 15 -- 34 / 13 -- -- Egger's regression intercept: ns ns -- ns -- --

Trim and Fill number of missing studies (higher or lower than point estimate): 2 (lower) 0 -- 0 -- -- Trim and fill adjusted g: 1.57* 1.20* -- 0.69* -- --

Note: Summary statistics for the meta-analysis are described in detail in Supplement section 2. ADI-R = Autism Diagnostic Interview, Revised, KPI = Korean Personality Inventory, SRS = Social Responsiveness Scale. aComm = community sample, Clinic = clinic-referred sample. bP = parent, T = teacher. cPositive effect sizes indicate that the group listed first had more symptoms of the comorbid disorder than the group listed second, and negative effect sizes indicate that the group listed second had more symptoms. dmultiple effects reported by the study were combined into a single effect size for meta-analysis (see Supplement section 2). eheterogeneity due primarily to large effect size reported by Scheres et al. (2004). Overall effect size without that effect was smaller but remained significant (g = 0.67).

* = P < .05


Supplement Table 11 Frequency of comorbid mental disorders in groups with and without DSM-IV ADHD

Odds Ratio for comparisons between groupsc Samp Age Raterb Sample Size % Comorbid CT IT HT CT CT IT

Study Typea Range ADHD Com Cont CT IT HT Cont CT IT HT vs. Cont. vs. Cont. vs. Cont. vs. IT vs. HT vs. HT

OPPOSITIONAL DEFIANT DISORDER Studies of Children and Adolescents

Adewuya 2007 Comm 6 - 12 P & T P & T -- 29 55 13 -- 31.0 21.8 30.8 -- -- -- 1.6 1.0 0.6 Bauerm. 2005b Comm 6 - 11 P & T P 29 44 25 -- 13.8 45.5 20.0 -- 5.2* 1.6 -- 3.3* -- -- Baumg. 1995 Comm 5 - 12 T T 985 52 97 43 1.3 50.0 7.2 30.2 75.9* 5.9* 32.9* 12.9* 2.3* 0.2* Bedard 2003 Clinic 6 - 12 P & T P & T -- 35 14 8 -- 45.7 35.7 50.0 -- -- -- 1.5 0.8 0.6 Booth 2007 Clinic 7 - 13 P & T P & T 24 16 26 -- 4.2 56.3 19.2 -- 29.6* 5.5 -- 5.4* -- -- Byun 2006 Clinic 5 - 16 P P -- 70 22 -- -- 57.1 27.3 -- -- -- -- 3.6* -- -- Dane 2000 Clinic 7 - 12 P & T P & T -- 22 20 -- -- 50.0 20.0 -- -- -- -- 4.0* -- -- Edwards 2007 Clinic 6 - 12 P P -- 50 33 -- -- 60.0 9.1 -- -- -- -- 15.0* -- -- Eiraldi 1997 Clinic 6 - 12 P P 33 27 26 -- 0.0 48.1 19.2 -- 62.4* 17.1* -- 3.9* -- -- Elia 2008 Clinic 6 - 18 P & S P & S -- 203 106 31 -- 50.7 20.8 41.9 -- -- -- 3.9* 1.4 0.4* Ersan 2004 Comm 6 - 15 P & T P & T 1,310 32 37 46 7.9 65.6 43.2 50.0 22.1* 8.8* 11.6* 2.5 1.9 0.8 Faraone 1998 Clinic 3 - 18 P P 135 182 92 28 8.1 68.1 43.5 46.4 24.1* 8.7* 9.8* 2.8* 2.5* 0.9 Ghaniz. 2009 Clinic 5 - 18 P P -- 73 45 53 -- 54.8 42.2 64.2 -- -- -- 1.7 0.7 0.4* Gorman 2006 Clinic 6 - 12 P & T P & T 34 22 19 -- 0.0 63.6 21.1 -- 117.7* 20.0* -- 6.6* -- -- Gul 2010 Comm 6 - 12 P & T P & T 1,027 10 18 69 10.0 80.0 50.0 56.5 35.6* 9.0* 11.7* 4.0 3.1 0.8 Hastings 2009 Clinic 6 - 11 P P -- 86 59 25 -- 60.5 30.5 64.0 -- -- -- 3.5* 0.9 0.3* Hinshaw 2002a Clinic 6 - 12 P P 88 93 47 -- 6.8 71.0 46.8 -- 33.4* 12.0* -- 2.8* -- -- Hodgens 2000 Clinic 8 - 11 P P 15 15 15 -- 0.0 40.0 26.7 -- 21.2* 12.1 -- 1.8 -- -- Huang-Poll. 2007 Clinic 6 - 12 P & T P & T 36 23 33 -- 0.0 56.5 24.2 -- 93.9* 24.3* -- 4.1* -- -- Huang-Poll. 2010 Comm 8 - 12 P & T P & T 48 32 21 -- 2.1 43.8 28.6 -- 36.6 10.8 -- 1.9 -- -- Klorman 1999 Clinic 7 - 13 P P -- 207 102 -- -- 55.6 29.4 -- -- -- -- 3.0* -- -- Lalonde 1998 Clinic 3 - 17 P P -- 78 15 7 -- 84.6 33.3 100 -- -- -- 11.0* --d --d LaVigne 2009 Comm 4 P P 694 33 14 55 9.1 48.5 21.4 34.5 9.4* 2.7 5.3* 3.5 1.8 0.5 Lee 2008b Clinic 6 - 16 P & T P & T -- 200 113 60 -- 27.0 27.4 28.3 -- -- -- 1.0 0.9 1.0 Levy 2005e Comm 4 - 17 P P 2,014 44 93 38 5.4 52.3 33.3 39.5 19.1* 8.7* 11.4* 2.2* 1.7 0.8 Levy 2005f Comm 4 - 17 P P 1,759 126 216 66 7.6 45.2 33.8 31.8 10.1* 6.2* 5.7* 1.6* 1.8* 1.1 Loe 2009 Clinic 8 - 13 P & T P 33 14 12 -- 0.0 28.6 41.7 -- 28.7* 49.1* -- 0.6 -- -- Maedgen 2000 Clinic 8 - 11 P P 17 16 14 -- 0.0 81.3 50.0 -- 135.0* 35.0* -- 4.3 -- -- Martinuss. 2006 Clinic 7 - 13 P & T P & T -- 60 22 12 -- 46.7 27.3 50.0 -- -- -- 2.3 0.9 0.4 Mikami 2007 Clinic 7 - 12 P & T P 38 33 45 2.6 45.5 17.8 30.8* 8.0* -- 3.9* -- -- Morgan 1996 Clinic 6 - 11 P & T P -- 26 30 -- -- 19.2 3.3 -- -- -- -- 6.9 -- -- Mullins 2005 Clinic 7 - 14 BE P -- 20 19 -- -- 40.0 21.1 -- -- -- -- 2.5 -- -- Nigg 2002a Comm 7 - 12 P & T P 41 46 18 -- 2.4 65.2 16.7 -- 75.0* 8.0 -- 9.4* -- --





OPPOSITIONAL DEFIANT DISORDER CONTINUED Studies of Children and Adolescents

Pasini 2007 Clinic 8 - 14 P P 44 25 25 -- 0.0 48.0 28.0 -- 82.4* 36.1* -- 2.4 -- -- Paternite 1996 Clinic 6 - 12 P / P P -- 59 28 9 -- 79.7 28.6 77.8 -- -- -- 9.8* 1.1 0.1* Power 1998 Clinic 6 - 14 P & T P -- 25 30 -- -- 20.0 20.0 -- -- -- -- 1.0 -- -- Power 2004 Clinic 8 - 14 P & T P -- 42 45 -- -- 78.6 22.2 -- -- -- -- 12.8* -- -- Scheres 2004 Clinic 6 - 12 P P 22 14 9 -- 0.0 57.1 22.2 -- 58.8* 15.0 -- 4.7 -- -- Solanto 2007 Clinic 7 - 12 P & T P 20 34 26 -- 0.0 26.5 19.2 -- 15.3* 10.5 -- 1.5 -- -- Volk 2005 Comm 7 - 19 P P 1,263 180 63 24 5.0 48.3 23.8 33.3 17.8* 6.0* 9.5* 3.0* 1.9 0.6 Weiss 2003 Clinic M = 13 Chart P -- 133 143 -- -- 37.6 16.1 -- -- -- -- 3.1* -- -- Willcutt 2011a Comm 8 - 18 P & T P 288 135 235 40 7.0 51.9 30.6 42.5 13.1* 5.3* 8.9* 3.8* 1.5 0.4* Willcutt 1999 Comm 8 - 18 P & T P & T 95 32 58 15 9.5 65.6 39.7 53.3 18.2* 6.3* 10.9* 2.9* 1.7 0.6 Wolraich 1996 Comm 5 - 11 T T 7315 300 447 196 1.6 54.7 11.2 36.2 72.3* 7.6* 34.1* 9.6* 2.1* 0.2* Wolraich 1998b Comm 6 - 12 T T 3625 205 380 113 1.7 49.8 11.1 36.3 56.0* 7.0* 32.2* 8.0* 1.7* 0.2* Yang 2004b Clinic 6 - 16 P P -- 130 159 19 -- 50.8 25.2 31.6 -- -- -- 3.1* 2.2 0.7 Yang 2007 Clinic 6 - 12 P & T P -- 124 58 -- -- 25.0 1.7 -- -- -- -- 19.0* -- -- Pooled results Studies: 27 47 47 22 %: 4.6% 51.8% 24.9% 42.9% OR: 26.9* 7.1* 12.8* 3.4* 1.6* 0.5*

Total N: 21,124 3,457 3,229 970 CI: 3.2, 6.4 47.5, 56.1 21.4, 28.8 37.6, 48.3 CI: 18.2, 39.7 6.1, 8.2 8.2, 19.9 3.1, 4.3 1.3, 1.9 0.4, 0.6 Q: 402.3* 238.6* 199.8* 48.5* Q: 123.2*g 17.9 65.0*g 138.9*g 18.8 51.4*g I2: 93% 81% 77% 57% I2: 79% 0% 83% 66% 0% 59%

Classic Fail-safe N / Orwin's fail-safe N: 9053 / 472 3203 / 273 2491 / 169 4496 / 279 88 / 35 347 / 60 Egger’s regression intercept: ns ns ns ns ns ns

Trim and Fill missing studies (higher or lower than point estimate): 0 0 0 0 4 (higher) 0 Trim and fill adjusted odds ratio: 26.9* 7.1* 12.8* 3.4* 1.7* 0.5*

Note: Summary statistics for the meta-analysis are described in detail in Supplement section 2. Q = Cochrane's Q. aClinic = clinic-referred sample, Comm = unselected community sample. bP = parent, T = teacher, CL = clinician, S = self, BE = best estimate summary from multiple sources of data, Chart = chart review. cOdds ratios greater than 1 indicate that the group listed first had a higher rate of comorbidity than the group listed second, and odds ratios less than 1 indicate that the group listed second had a higher rate of comorbidity. dOdds ratio could not be calculated. efemales. fmales. gsignificant heterogeneity not explained by tested moderators. When multiple outlier effect sizes were excluded overall odds ratios were lower (ADHD-C vs. Control OR = 17.7, ADHD-H vs. Control = 8.7, ADHD-C vs. ADHD-I = 3.0, ADHD-I vs. ADHD-H = 0.7), but all overall effects remained significant and interpretation remained the same. * = P < .05





OPPOSITIONAL DEFIANT DISORDER CONTINUED Studies of Adults

Grevet 2006 Comm M = 34 S S -- 111 88 -- -- 47.9 39.8 -- -- -- -- 1.4 -- -- Murphy 2002 Clinic 17 - 27 S S 64 60 36 -- 0 45.0 19.4 -- 105.9* 32.8* -- 3.4* -- -- Millstein 1997 Clinic 19 - 60 S S -- 111 35 -- -- 30.6 11.4 -- -- -- -- 3.4* -- -- Pooled results Studies: 1 3 3 0 %: 0.0% 40.8% 23.0% -- OR: 105.9* 32.8* -- 2.2* -- --

Total N: 64 282 159 -- CI: -- 30.1, 52.5 9.9, 44.8 -- CI: 6.3, 1791 1.8, 593.5 -- 1.1, 4.3 -- -- Q: -- 7.5 10.8 -- Q: -- -- -- 3.6 -- -- I2: -- 73% 82% -- I2: -- -- -- 44% -- --

Classic Fail-safe N / Orwin's fail-safe N: -- -- -- 6 / 1 -- -- Egger’s regression intercept: -- -- -- ns -- --

Trim and Fill missing studies (higher or lower than point estimate): -- -- -- 0 -- -- Trim and fill adjusted odds ratio: -- -- -- 2.2* -- --

Note: Summary statistics for the meta-analysis are described in detail in Supplement section 2. Q = Cochrane's Q. aClinic = clinic-referred sample, Comm = unselected community sample. bS = self. cOdds ratios greater than 1 indicate that the group listed first had a higher rate of comorbidity than the group listed second, and odds ratios less than 1 indicate that the group listed second had a higher rate of comorbidity. * = P < .05




Study Typea Range ADHD Com Cont CT IT HT Cont CT IT HT vs. Cont vs. Cont vs. Cont vs. IT vs. HT vs. HT

CONDUCT DISORDER Studies of Children and Adolescents

Adewuya 2007 Comm 6 - 12 P & T P & T -- 29 55 13 -- 13.8 5.5 15.4 -- -- -- 2.8 0.9 0.3 Bauerm. 2005b Comm 6 - 11 P & T P 29 44 25 -- 0.0 0.0 0.0 -- n/ad n/ad -- n/ad -- -- Bedard 2003 Clinic 6 - 12 P & T P & T -- 35 14 8 -- 20.0 14.3 0.0 -- -- -- 1.5 4.5 3.4 Byun 2006 Clinic 5 - 16 P P -- 70 22 -- -- 5.7 0.0 -- -- -- -- 3.1 -- -- Carlson 2002 Clinic 9 - 12 P & T P -- 22 13 -- -- 22.7 0.0 -- -- -- -- 8.5 -- -- Dane 2000 Clinic 7 - 12 P & T P & T -- 22 20 -- -- 27.3 25.0 -- -- -- -- 1.1 -- -- Edwards 2007 Clinic 6 - 11 P P -- 50 33 -- -- 50.0 0.0 -- -- -- -- 67.0* -- -- Eiraldi 1997 Clinic 6 - 12 P P 33 27 26 -- 0.0 44.4 0.0 -- 54.0* n/ad -- 42.7* -- -- Faraone 1998 Clinic 3 - 18 P P 135 182 92 28 3.0 24.2 8.7 10.7 10.4* 3.1* 3.9 3.4* 2.7 0.8 Ghaniz. 2009 Clinic 5 - 18 P P -- 73 45 53 -- 15.1 2.2 9.4 -- -- -- 7.8* 1.7 0.2 Graetz 2005e Comm 6 - 17 P P 1,075 26 52 21 1.1 19.2 5.8 9.5 21.1* 5.4* 9.3* 3.9 2.3 0.6 Graetz 2005f Comm 6 - 17 P P 976 76 108 41 1.5 30.3 14.8 9.8 27.8* 11.1* 6.9* 2.5* 4.0* 1.6 Gul 2010 Comm 6 - 12 P & T P & T 1,027 10 18 69 2.9 30.0 16.7 20.3 14.2* 6.7* 8.5* 2.1 1.7 0.8 Hastings 2009 Clinic 6 - 11 P P -- 86 59 25 -- 27.9 22.0 20.0 -- -- -- 1.4 1.6 1.1 Hinshaw 2002a Clinic 6 - 12 P P 88 93 47 -- 0.0 26.9 10.6 -- 65.9* 22.9* -- 3.1* -- -- Huang-Poll. 2007 Clinic 6 - 12 P 36 23 33 -- 0.0 4.3 0.0 -- 4.9 n/ad 4.5 Huang-Poll. 2010 Comm 8 - 12 P & T P & T 48 32 21 -- 0.0 4.8 0.0 -- 4.6 4.6 -- 0.7 -- -- Lalonde 1998 Clinic 3 - 17 P P -- 78 15 7 -- 7.7 0.0 57.1 -- -- -- 2.8 0.1* 0.1* Lee 2008b Clinic 6 - 16 P & T P & T -- 200 113 60 -- 42.5 20.4 40.0 -- -- -- 2.9 1.1 0.4 Levy 2005e Comm 4 - 17 P P 2,014 44 93 38 0.3 6.8 4.3 5.3 21.0* 12.9* 15.9* 1.6 1.3 0.8 Levy 2005f Comm 4 - 17 P P 1,759 126 216 66 0.6 19.0 2.8 4.5 37.4* 4.5* 7.6* 8.2* 4.9* 0.6 Maedgen 2000 Clinic 8 - 11 P P 17 16 14 -- 0.0 43.8 0.0 -- 27.6* n/ad -- 22.9* -- -- Martinuss. 2006 Clinic 7 - 13 P & T P -- 60 22 12 -- 13.3 4.5 8.3 -- -- -- 3.2 1.7 0.5 Morgan 1996 Clinic 6 - 11 P & T P -- 26 30 -- -- 23.1 3.3 -- -- -- -- 8.7* -- -- Mullins 2005 Clinic 7 - 14 BE P -- 20 19 -- -- 20.0 0.0 -- -- -- -- 10.6 -- -- Nigg 2002a Comm 7 - 12 P & T P 41 46 18 -- 0.0 21.7 0.0 -- 23.9* n/ad -- 10.6 -- -- Paternite 1996 Clinic 6 - 12 P P -- 59 28 -- -- 30.5 10.7 -- -- -- -- 3.7* -- -- Power 1998 Clinic 6 - 14 P & T P -- 25 30 -- -- 12.0 0.0 -- -- -- -- 9.5 -- -- Power 2004 Clinic 8 - 14 P & T P -- 42 45 -- -- 21.4 8.9 -- -- -- -- 2.8 -- -- Volk 2005 Comm 7 - 19 P P 1,263 180 63 24 4.0 16.1 6.3 12.5 4.7* 1.6 3.5* 2.8* 1.3 0.4 Weiss 2003 Clinic M = 13 Chart P -- 133 143 -- -- 10.5 2.1 -- -- -- -- 5.5* Willcutt 1999 Comm 8 - 18 P & T P 95 32 58 15 2.1 46.9 34.5 26.7 41.0* 24.5* 16.9* 1.7 2.4 1.5 Willcutt 2011a Comm 8 - 18 P & T P 288 135 235 40 3.1 31.0 19.9 20.0 14.0* 8.9* 7.8* 1.6* 1.6 0.9





CONDUCT DISORDER CONTINUED Studies of Children and Adolescents continued

Wolraich 1998b Comm 6 - 12 T T 3,625 205 380 113 0.4 21.5 3.7 8.0 65.8* 9.2* 20.8* 7.1* 3.2* 0.4 Wolraich 1996 Comm 5 - 11 T T 7,315 300 447 196 0.4 29.0 4.7 19.9 99.2* 12.0* 60.3* 8.3* 1.6* 0.2* Yang 2004b Clinic 6 - 16 P P -- 130 159 19 -- 10.8 3.1 0.0 -- -- -- 3.7* 4.9 1.4 Pooled results Studies: 18 36 36 19 %: 1.3% 21.6% 7.1% 14.9% OR: 23.2* 7.6* 10.9* 3.5* 1.8* 0.6*

Total N: 19,864 2,757 2,811 848 CI: 0.7, 2.2 18.0, 25.5 5.0, 10.0 10.6, 20.4 CI: 12.1, 44.6 5.3, 11.0 5.6, 21.5 2.6, 4.6 1.3, 2.4 0.4, 0.9 Q: 169.9* 163.7* 174.7* 53.0 Q: 103.2*g 18.8 45.0*h 58.2 26.4 30.7 I2: 89% 79% 80% 66% I2: 84% 36% 78% 42% 32% 41%

Fail-safe N: 918 / 440 615 / 137 298 / 208 1247 / 199 66 / 38 46 / 40 Egger’s regression intercept: ns ns ns ns ns ns

Trim and Fill missing studies (higher or lower than point estimate): 0 0 0 5 (lower) 4 (lower) 1 (lower) Trim and fill adjusted odds ratio: 23.2* 7.6* 10.9* 3.2* 1.5* 0.6*

Studies of Adults Grevet 2006 Comm M = 34 S S -- 117 88 -- -- 29.1 12.5 -- -- -- -- 2.9* -- -- Millstein 1997 Clinic 19 - 60 S S -- 111 35 -- -- 29.7 20.0 -- -- -- -- 1.7 -- -- Murphy 2002 Clinic 17 - 27 S S 64 60 36 -- 0 5.0 2.8 -- 7.9 5.4 -- 1.8 -- -- Pooled results Studies: 1 3 3 0 %: n/a 21.0 12.6% -- OR: 7.9 5.4 -- 2.3* -- --

Total N: 64 288 159 -- CI: -- 11.0, 36.9 6.1, 24.3 -- CI: 0.4, 155.3 0.2, 137.3 -- 1.3, 4.0 -- -- Q: -- 11.5 4.1 -- Q: -- -- -- 0.8 -- -- I2: -- 83% 51% -- I2: -- -- -- 0% -- --

Classic Fail-safe N / Orwin's fail-safe N: -- -- -- 3 / 1 -- -- Egger’s regression intercept: -- -- -- ns -- --

Trim and Fill missing studies (higher or lower than point estimate): -- -- -- 2 (higher) -- -- Trim and fill adjusted odds ratio: -- -- -- 2.9* -- --

Note: Summary statistics for the meta-analysis are described in detail in Supplement section 2. Q = Cochrane's Q. aClinic = clinic-referred sample, Comm = unselected community sample. bP = parent, T = teacher, S = self, BE = best estimate summary from multiple sources of data, Chart = chart review. cOdds ratios greater than 1 indicate that the group listed first had a higher rate of comorbidity than the group listed second, and odds ratios less than 1 indicate that the group listed second had a higher rate of comorbidity. dOdds ratio could not be calculated. efemales. fmales. gHeterogeneity due to significant outlier effect sizes reported by Volk et al. (2005) and Wolraich et al. (1996, 1998b). When these effects were excluded the odds ratio was slightly lower but remained significant (OR = 21.9). hHeterogeneity due to significant outlier effect sizes reported by Volk et al. (2005) and Wolraich et al. (1996). Exclusion of these two studies resulted in a slight increase in the overall odds ratio (OR = 9.9). * = P < .05





ANTISOCIAL PERSONALITY DISORDER Studies of Adults

Conzel. 2009 Clinic 18 - 60 S & P S -- 127 50 20 -- 9.4 6.0 10.0 -- -- -- 1.6 0.9 0.6 Grevet 2006 Comm M = 34 S S -- 117 88 -- -- 11.1 4.5 -- -- -- -- 2.6 -- -- Miller 2007 Comm 18 - 37 S S 211 64 69 -- 3.8 12.5 8.7 -- 3.6* 2.4 -- 1.5 -- -- Millstein 1997 Clinic 19 - 60 S S -- 111 35 -- -- 19.8 20.0 -- -- -- -- 1.0 -- -- Murphy 2002 Clinic 17 - 27 S S 64 60 36 -- 0.0 6.7 0 -- 10.3* n/ad -- 5.8* -- -- Pooled results Studies: 1 5 5 1 %: 3.0% 12.1% 7.9% 10.0% OR: 4.1* 2.4 -- 1.6 0.9 0.6

Total N: 211 479 278 20 CI: 1.0, 8.7 8.4, 17.3 3.9, 15.4 2.5, 32.4 CI: 1.5, 10.7 0.8, 7.2 -- 0.9, 2.7 0.2, 4.5 0.1, 3.2 Q: -- 8.3 9.3 -- Q: -- -- -- 2.4 -- -- I2: -- 52% 57% -- I2: -- -- -- 0% -- --

Classic Fail-safe N / Orwin's fail-safe N: -- -- -- n/a -- -- Egger’s regression intercept: -- -- -- ns -- --

Trim and Fill missing studies (higher or lower than point estimate): -- -- -- 2 (lower) -- -- Trim and fill adjusted odds ratio: -- -- -- 1.3 -- --

Note: Summary statistics for the meta-analysis are described in detail in Supplement section 2. Q = Cochrane's Q. aClinic = clinic-referred sample, Comm = unselected community sample. bP = parent, S = self. cOdds ratios greater than 1 indicate that the group listed first had a higher rate of comorbidity than the group listed second, and odds ratios less than 1 indicate that the group listed second had a higher rate of comorbidity. dOdds ratio could not be calculated. * = P < .05





GENERALIZED ANXIETY DISORDER Studies of Children and Adolescents

Bedard 2008 Clinic 6 - 12 P & T P -- 39 14 3 -- 25.6 0.0 66.7 -- -- -- 10.3 0.2 0.1 Byun 2006 Clinic 5 - 16 P P -- 70 22 -- -- 2.9 0.0 -- -- -- -- 1.6 -- -- Dane 2000 Clinic 7 - 12 P & T P 22 20 0.0 0.0 -- -- -- -- -- -- Edwards 2007 Clinic 6 - 12 P P -- 50 33 -- -- 6.0 12.1 -- -- -- -- 0.5 -- -- Elia 2008 Clinic 6 - 18 P P -- 203 106 31 -- 12.3 17.9 22.6 -- -- -- 0.6 0.5 0.8 Huang-Poll. 2009 Clinic 8 - 12 P & T P 36 23 33 -- 2.8 4.3 6.1 -- 1.6 2.3 -- 0.7 -- -- Huang-Poll. 2010 Comm 8 - 12 P & T P & T 48 32 21 -- 1.1 4.8 6.3 -- 3.1 1.5 -- 1.3 -- -- LaVigne 2009 Comm 4 P P 694 33 14 55 0.3 9.1 0.0 0.0 34.6* 9.6 2.5 3.3 12.7 1.0

Lee 2008b Clinic 6 - 16 P & T P & T -- 200 113 60 -- 11.1 9.7 10.0 -- -- -- 1.1 1.1 1.0 Levy 2005d Comm 4 - 17 P P 2,014 44 93 38 2.3 31.8 16.1 23.7 20.0* 8.2* 13.3* 2.4 1.5 1.6 Levy 2005e Comm 4 - 17 P P 1,759 126 216 66 1.5 12.7 7.4 7.6 9.7* 5.3* 5.5* 1.8 1.8 1.0 Morgan 1996 Clinic 6 - 11 P & T P -- 26 30 -- -- 0.0 6.7 -- -- -- -- 0.2 -- -- Willcutt 1999 Comm 8 - 18 P & T P & S 95 32 58 15 13.7 18.8 20.7 13.3 1.5 1.6 1.0 0.9 1.5 0.6 Willcutt 2011a Comm 8 - 18 P & T P 288 135 235 40 8.0 25.9 15.3 20.0 4.0* 2.1* 2.9* 1.9* 1.4 0.7 Yang 2004b Clinic 6 - 16 P P 130 159 19 3.1 3.8 0.0 -- -- -- 0.8 1.4 0.6 Pooled results Studies: 7 15 15 9 %: 2.9% 11.3% 10.4% 14.6% OR: 6.5* 3.5* 4.2* 1.3 1.2 0.8

Total N: 4,934 1,165 1,167 327 CI: 1.3, 6.3 7.7, 16.4 7.6, 14.1 8.7, 23.4 CI: 2.8, 14.6 1.9, 6.5 1.7, 10.3 0.9, 1.8 0.7, 1.8 0.5, 1.2 Q: 80.6* 58.5** 32.7 18.3 Q: 25.5*f 15.9 11.4 16.2 9.2 6.0 I2: 92% 76% 57% 56% I2: 77% 62% 65% 20% 13% 0%

Classic Fail-safe N / Orwin's fail-safe N: 68 / 91 77 / 43 37 / 41 -- / -- -- / -- -- / -- Egger’s regression intercept: ns ns ns ns ns ns Trim and Fill missing studies (higher or lower than point estimate): 0 0 2 (higher) 1 (higher) 2 (lower) 1 (lower) Trim and fill adjusted odds ratio: 6.5* 3.5* 6.0* 1.3 1.0 0.8 Studies of adults

Grevet 2006 Comm M = 34 S S -- 117 88 -- -- 19.7 15.9 -- -- -- -- 1.3 -- -- Millstein 1997 Clinic 19 - 60 S S -- 111 35 -- -- 20.7 8.6 -- -- -- -- 2.8 -- -- Pooled results Studies: 0 2 2 0 %: 20.2% 14.0% -- OR: -- -- -- 1.6 -- --

Total N: -- 228 123 -- CI: 15.5, 25.9 8.4, 22.3 -- CI: -- -- -- 0.8, 3.1 -- -- [heterogeneity and publication bias analyses not conducted if < 3 studies]

Note: Summary statistics for the meta-analysis are described in detail in Supplement section 2. Q = Cochrane's Q. aClinic = clinic-referred sample, Comm = unselected community sample. bP = parent, T = teacher, S = self. cOdds ratios greater than 1 indicate that the group listed first had a higher rate of comorbidity than the group listed second, and odds ratios less than 1 indicate that the group listed second had a higher rate of comorbidity. dfemales. emales. fheterogeneity due to significant outlier effect sizes reported by Willcutt et al. (1999) and in females in the study by Levy et al. (2004). When these effects were excluded the overall effect was slightly higher (OR = 6.7) and remained significant. * = P < .05





SEPARATION ANXIETY Studies of Children and Adolescents

Byun 2006 Clinic 5 - 16 P P -- 70 22 -- -- 24.3 22.7 -- -- -- -- 1.1 -- -- Dane 2000 Clinic 7 - 12 P & T P -- 22 20 -- -- 13.6 15.0 -- -- -- -- 0.9 -- -- Edwards 2007 Clinic 6 - 12 P P -- 50 33 -- -- 10.0 6.1 -- -- -- -- 1.7 -- -- Elia 2008 Clinic 6 - 18 P P -- 203 106 31 -- 8.9 4.7 3.2 -- -- -- 2.0 2.9 1.5 Ghaniz. 2009 Clinic 5 - 18 P P -- 73 45 53 -- 21.9 11.1 24.5 -- -- -- 2.3 0.9 0.4 LaVigne 2009 Comm 4 P P 694 33 14 55 2.3 30.3 7.1 7.3 18.4* 3.3 3.3* 5.7* 5.5* 1.0

Lee 2008b Clinic 6 - 16 P & T P & T -- 200 113 60 -- 17.6 14.2 6.7 -- -- -- 1.0 3.0 3.6* Levy 2005d Comm 4 - 17 P P 2,014 44 93 38 1.5 18.2 10.8 18.4 14.7* 8.0* 14.9* 1.8 1.0 1.9 Levy 2005e Comm 4 - 17 P P 1,759 126 216 66 1.1 8.7 1.9 6.1 8.3* 1.6 5.6* 5.1* 1.5 3.4 Morgan 1996 Clinic 6 - 11 P & T P -- 26 30 -- -- 0.0 10.0 -- -- -- -- 0.1 -- -- Paternite 1996 Clinic 6 - 12 P P -- 59 9 28 -- 10.2 0.0 14.3 -- -- -- 2.3 0.7 3.5 Willcutt 2011a Comm 8 - 18 P & T P 288 135 235 40 4.2 10.4 10.2 10.0 2.7* 2.6* 2.6 1.0 1.0 1.0 Yang 2004b Clinic 6 - 16 P P -- 130 159 19 -- 1.5 1.9 0.0 -- -- -- 0.8 0.8 1.1 Pooled results Studies: 4 13 13 9 %: 2.0% 13.5% 8.7% 10.6% OR: 8.7* 3.4* 5.5* 1.4* 1.5 0.8

Total N: 4,755 1,171 1,095 390 CI: 1.2, 3.2 9.3, 19.3 5.2, 14.2 6.6, 16.6 CI: 3.7, 20.2 1.6, 7.4 2.4, 12.5 1.0, 2.0 0.9, 2.3 0.4, 1.5 Q: 14.9* 60.1* 60.1* 17.1 Q: 12.6 7.1 7.0 13.4 10.1 12.1 I2: 79% 80% 80% 53% I2: 76% 58% 57% 11% 21% 34%

Classic Fail-safe N / Orwin's fail-safe N: 106 / 43 23 / 25 38 / 36 4 / 9 -- / 9 -- / -- Egger’s regression intercept: ns ns ns ns ns ns Trim and Fill missing studies (higher or lower than point estimate): 0 1 (higher) 0 1 (lower) 0 1 (higher) Trim and fill adjusted odds ratio: 8.7* 4.4* 5.5* 1.4* 1.5 0.8

Note: Summary statistics for the meta-analysis are described in detail in Supplement section 2. Q = Cochrane's Q. aClinic = clinic-referred sample, Comm = unselected community sample. bP = parent, T = teacher. cOdds ratios greater than 1 indicate that the group listed first had a higher rate of comorbidity than the group listed second, and odds ratios less than 1 indicate that the group listed second had a higher rate of comorbidity. dfemales. emales. * = P < .05





MAJOR DEPRESSIVE DISORDER Studies of Children and Adolescents

Bauerm. 2005b Comm 6 - 11 P & T P 25 33 21 -- 0.0 6.1 4.8 -- 4.0 3.7 -- 1.3 -- -- Byun 2006 Clinic 5 - 16 P P -- 70 22 -- -- 11.4 9.1 -- -- -- -- 1.3 -- -- Dane 2000 Clinic 7 - 12 P & T P -- 22 20 -- -- 0.0 0.0 -- -- -- -- 0.9 -- -- Eiraldi 1997 Clinic 6 - 12 P P / S 33 27 26 -- 9.1 22.2 23.1 -- 2.9 3.0 -- 1.0 -- -- Elia 2008 Clinic 6 - 18 P P -- 203 106 31 -- 22.7 20.8 19.4 -- -- -- 1.1 1.2 1.1 Faraone 1998 Clinic 3 - 18 P P 135 182 92 28 1.5 27.5 33.7 7.1 25.2* 33.8* 5.1 0.7 4.9* 6.6* Gorman 2006 Clinic 6 - 11 P & T P 34 22 19 -- 2.9 0.0 5.3 -- 0.5 1.8 -- 0.3 -- -- Graetz 2005d Comm 6 - 17 P P 1,075 26 52 -- 1.0 3.8 11.5 -- 3.9 12.6* -- 0.3 0.8 2.6 Graetz 2005e Comm 6 - 17 P P 976 76 108 21 1.2 18.4 6.5 4.8 18.1* 5.6* 4.8 3.3* 2.1 0.6 Hinshaw 2002a Clinic 6 - 12 P & T P 88 93 47 41 0.0 10.8 4.3 9.8 22.3* 9.7 8.7* 2.7 -- -- Huang-Poll. 2009 Clinic 8 - 12 P & T P 36 23 33 -- 0.0 8.7 0.0 -- 8.5 n/af -- 7.8 -- -- Huang-Poll. 2010 Comm 8 - 12 P & T P & T 48 32 21 -- 0.0 6.2 0.0 -- 8.0 n/af -- 3.5 -- -- LaVigne 2009 Comm 4 P P 694 33 14 55 0.1 0.0 7.1 0.0 6.9 53.3* 4.2 0.1 n/af 12.3 Morgan 1996 Clinic 6 - 11 P & T P -- 26 30 -- -- 11.5 3.3 -- -- -- -- 3.8 -- -- Mullins 2005 Clinic 7 -14 BE P -- 20 19 -- -- 10.0 5.3 -- -- -- -- 2.0 -- -- Paternite 1996 Clinic 6 - 12 P P -- 59 9 28 -- 1.7 11.1 0.0 -- -- -- 0.1 1.5 10.0 Volk 2005 Comm 7 - 19 P P 1,263 180 63 24 5.2 10.0 7.9 8.3 2.0* 1.6 1.6 1.3 1.2 1.0 Weiss 2003 Clinic M = 13 Chart P -- 133 143 -- -- 1.5 6.3 -- -- -- -- 0.2 -- -- Willcutt 1999 Comm 8 - 18 P & T P & S 95 32 58 15 2.1 18.8 24.1 0.0 10.7* 14.8* 1.2 0.7 7.6 10.1* Willcutt 2011a Comm 8 - 18 P & T P 288 135 235 40 2.1 17.8 14.9 5.0 10.2* 8.2* 2.5 1.2 4.1 3.3 Yang 2004b Clinic 6 - 16 P P -- 130 159 19 -- 2.3 0.6 0.0 -- -- -- 3.7 1.1 0.4 Pooled results Studies: 13 21 21 10 %: 1.5% 9.8% 9.5% 7.6% OR: 7.4* 7.2* 3.9* 1.1 2.0* 2.0*

Total N: 4,790 1,557 1,297 302 CI: 0.8, 2.9 (6.9, 13.7) (6.4, 13.9) (4.5, 12.6) CI: 3.5, 15.6 3.8, 13.6 2.0, 7.6 0.8, 1.5 1.2, 3.3 1.0, 3.9 Q: 57.9* 80.6* 75.7* 10.9 Q: 31.2 20.8 4.1 24.6 5.2 12.2 I2: 79% 75% 74% 17% I2: 62% 52% 0% 24% 0% 27%

Classic Fail-safe N / Orwin's fail-safe N: 231 / 110 215 / 107 17 / 46 -- / -- 6 / 25 8 / 23 Egger’s regression intercept: ns ns ns ns ns ns Trim and Fill missing studies (higher or lower than point estimate): 0 1 (higher) 1 (higher) 1 (higher) 0 2 (lower) Trim and fill adjusted odds ratio: 7.4* 7.4* 4.1* 1.1 2.0* 1.8 Note: Summary statistics for the meta-analysis are described in detail in Supplement section 2. Q = Cochrane's Q. aClinic = clinic-referred sample, Comm = unselected community sample. bP = parent, T = teacher, S = self, BE = best estimate summary from multiple sources of data, Chart = chart review. cOdds ratios greater than 1 indicate that the group listed first had a higher rate of comorbidity than the group listed second, and odds ratios less than 1 indicate that the group listed second had a higher rate of comorbidity. dfemales. emales. fOdds ratio could not be calculated. * = P < .05





MAJOR DEPRESSIVE DISORDER CONTINUED Studies of Adults

Conzel. 2009 Clinic 18 - 60 S & P S -- 127 50 20 -- 3.9 4.0 5.0 -- -- -- 1.0 0.8 0.8 Grevet 2006 Comm M = 34 S S -- 117 88 -- -- 22.2 27.3 -- -- -- -- 0.8 -- -- Millstein 1997 Clinic 19 - 60 S S -- 111 35 -- -- 63.1 62.9 -- -- -- -- 1.0 -- -- Murphy 2002 Clinic 17 - 27 S S 64 60 36 -- 3.1 13.3 8.3 -- 10.3* 2.8 -- 1.7 -- -- Sobanski 2008 Clinic 18 - 59 S / O S / O 70 64 30 -- 24.3 42.5 63.3 -- 3.7* 5.4* -- 0.7 -- -- Solanto 2004 Clinic M = 35 S S -- 44 26 -- 34.1 34.6 -- -- -- -- 1.0 -- -- Pooled results Studies: 2 6 6 1 %: 10.1% 26.9% 28.9% 5.0% OR: 3.9* 4.7* -- 0.9 -- --

Total N: 134 522 265 20 CI: 1.2, 51.3 12.3, 49.3 13.6, 51.3 -- CI: 2.2, 7.6 2.1, 10.8 0.6, 1.3 -- -- Q: 8.9 94.8 43.7 -- Q: -- -- -- 1.5 -- -- I2: 89% 94% 89% -- I2: -- -- -- 0% -- --


Trim and Fill missing studies (higher or lower than point estimate): -- -- -- 3 (lower) -- -- Trim and fill adjusted odds ratio: -- -- -- 0.8 -- --

Note: Summary statistics for the meta-analysis are described in detail in Supplement section 2. Q = Cochrane's Q. aClinic = clinic-referred sample, Comm = unselected community sample. bO = other observer, P = parent, S = self. cOdds ratios greater than 1 indicate that the group listed first had a higher rate of comorbidity than the group listed second, and odds ratios less than 1 indicate that the group listed second had a higher rate of comorbidity. * = P < .05





BIPOLAR SPECTRUM DISORDERS Studies of Children and Adolescents

Bauerm. 2005b Comm 6 - 11 P & T P 29 44 25 -- 0.0 0.0 0.0 -- n/ad n/ad -- n/ad -- -- Faraone 1998 Clinic 3 - 18 P P 135 182 92 28 0.0 26.4 8.7 14.3 97.7* 27.3* 49.8* 3.8* 2.1 1.8 Paternite 1996 Clinic 6 - 12 P P -- 59 9 28 -- 3.4 0.0 0.0 -- -- -- 0.8 2.5 0.3 Yang 2004b Clinic 6 - 16 P P -- 130 159 19 -- 6.2 0.0 0.0 -- -- -- 22.1* 2.7 n/ad

Pooled results Studies: 2 4 4 3 %: 0% 6.9% 3.2% 6.4% OR: 97.7* 27.3* 49.8* 4.0* 2.2 0.6 Total N: 164 415 285 75 CI: -- 1.8, 23.7 0.1,13.5 1.5, 24.0 CI: 6.0, 1,601 1.6, 478.5 2.6, 955.2 1.4, 11.8 0.9, 6.0 0.2, 2.1 Q: -- 30.1* 6.3* 3.3 Q: -- -- -- 2.4 0.0 0.0 I2: 90% 52% 39% I2: -- -- -- 16% 0% 0%

Fail-safe N: -- -- -- 5 / 20 n/a -- Egger’s regression intercept: -- -- -- ns ns --

Trim and Fill missing studies (higher or lower than point estimate): 0 2 (lower) -- Trim and fill adjusted odds ratio: 4.0* 2.1 --

Studies of Adults Conzel. 2009 Clinic 18 - 60 S & P S -- 127 50 20 -- 3.1 2.0 0.0 -- -- -- 1.6 1.5 1.2 Grevet 2006 Comm M = 34 S S -- 117 88 -- -- 16.2 11.4 -- -- -- -- 1.5 -- -- Millstein 1997 Clinic 19 - 60 S S -- 111 35 -- -- 17.1 2.9 -- -- -- -- 7.0 -- -- Pooled results Studies: 0 3 3 1 %: -- 11.0% 5.4 0.0% OR: -- -- -- 1.8 -- --

Total N: -- 355 173 20 CI: -- 5.0, 22.4 1.6, 17.1 -- CI: -- -- -- 0.9, 3.8 -- -- Q: -- 11.4 4.5 -- Q: -- -- -- 1.9 -- -- I2: -- 82% 55% -- I2: -- -- -- 0% -- --


Trim and Fill missing studies (higher or lower than point estimate): -- -- -- 0 -- -- Trim and fill adjusted odds ratio: -- -- -- 1.8 -- --

Note: Summary statistics for the meta-analysis are described in detail in Supplement section 2. Q = Cochrane's Q. aClinic = clinic-referred sample, Comm = unselected community sample. bP = parent, T = teacher, S = self. cOdds ratios greater than 1 indicate that the group listed first had a higher rate of comorbidity than the group listed second, and odds ratios less than 1 indicate that the group listed second had a higher rate of comorbidity. dOdds ratio could not be calculated. * = P < .05





SUBSTANCE USE DISORDERS Studies of Children and Adolescents

Faraone 1998 Clinic 3 - 18 P P 135 182 92 28 0.0 26.4 8.7 14.3 97.7* 27.3* 49.8* 3.8* 2.1 1.8 Studies of Adults

Conzel. 2009 Clinic 18 - 60 S & P S -- 127 50 20 -- 11.0 12.0 15.0 -- -- -- 0.9 0.7 0.7 Grevet 2006 Comm M = 34 S S -- 117 88 -- -- 14.9 20.5 -- -- -- -- 1.1 -- -- Miller 2007 Comm 18 - 37 S S 211 64 69 -- 39.8 56.5 50.7 -- 3.3 1.6 -- 2.1* -- -- Millstein 1997 Clinic 19 - 60 S S -- 111 35 -- -- 59.3 42.9 -- -- -- -- 2.9 -- -- Murphy 2002 Clinic 17 - 27 S S 64 60 36 -- 6.3 25.5 27.8 -- 8.7* 4.0* -- 1.5 -- -- Sobanski 2008 Clinic 18 - 59 S / O S / O 70 64 30 -- 7.1 36.5 23.3 -- 12.2* 5.8* -- 3.1* -- -- Solanto 2004 Clinic M = 35 BE S -- 44 26 -- -- 29.5 34.6 -- -- -- -- 1.4 -- -- Pooled results Studies: 3 7 7 1 %: 13.6% 40.5% 29.3% 15.0 OR: 6.4* 2.8* -- 1.7* -- --

Total N: 345 587 344 20 CI: 2.7, 47.5 23.7, 60.0 19.5, 41.5 -- CI: 2.7, 15.4 1.2, 6.7 -- 1.2, 2.4 -- -- Q: 35.4 105.4 27.1 -- Q: 5.6 4.7 -- 7.1 -- -- I2: 94% 94% 78% -- I2: 64% 57% -- 16% -- --

Classic Fail-safe N / Orwin's fail-safe N: 38 / 49 9 / 1 -- 13 / 1 -- -- Egger’s regression intercept: ns ns -- ns -- --

Trim and Fill missing studies (higher or lower than point estimate): 0 2 (lower) -- 0 -- -- Trim and fill adjusted odds ratio: 6.4* 1.6 -- 1.7* -- --

Note: Summary statistics for the meta-analysis are described in detail in Supplement section 2. Q = Cochrane's Q. aClinic = clinic-referred sample, Comm = unselected community sample. bO = other observer, P = parent, S = self, BE = best estimate summary from multiple sources of data. cOdds ratios greater than 1 indicate that the group listed first had a higher rate of comorbidity than the group listed second, and odds ratios less than 1 indicate that the group listed second had a higher rate of comorbidity. * = P < .05



Odds Ratio for comparisons between groupsd Samp Age Raterb Sample Size % Comorbid CT IT HT CT CT IT

Study Typea Range ADHD LDc Cont CT IT HT Cont CT IT HT vs. Cont. vs. Cont. vs. Cont. vs. IT vs. HT vs. HT

LEARNING DISORDERS Bedard 2003 Clinic 6 - 12 P & T RD -- 36 15 8 -- 27.8 26.7 37.5 -- -- -- 1.1 0.6 0.6 Booth 2007 Clinic 7 - 13 P & T RD 24 16 26 -- 0.0 12.5 0.0 -- 8.5 -- -- 9.1 -- -- Booth 2007 Clinic 7 - 13 P & T MD 24 16 26 -- 0.0 0.0 3.8 -- -- 2.9 -- 0.5 -- -- Booth 2007e Clinic 7 - 13 P & T Any 24 16 26 -- 0.0 12.5 3.8 -- 8.5 2.9 -- 3.6 -- -- Capano 2008f Clinic 7 - 12 P & T MD -- 286 126 81 -- 18.2 16.7 16.0 -- -- -- 1.1 1.2 1.1 Capano 2008f Clinic 7 - 12 P & T RD -- 286 126 81 -- 23.1 27.8 28.4 -- -- -- 0.8 0.8 1.0 Carlson 2002 Clinic 9 - 12 P & T MD 22 21 13 -- 4.5 9.5 7.7 -- 2.2 1.8 -- 1.3 -- -- Carlson 2002 Clinic 9 - 12 P & T RD 22 21 13 -- 0.0 9.5 15.4 -- 5.8 9.8 -- 0.6 -- -- Carlson 2002e Clinic 9 - 12 P & T Any 22 21 13 -- 4.5 19.0 23.1 -- 4.9 6.3 -- 0.8 -- -- Dane 2000 Clinic 7 - 12 P & T RD -- 22 20 -- -- 18.2 35.0 -- -- -- -- 0.4 -- -- Faraone 1998 Clinic 3 - 18 P MD 131 180 91 26 9.2 17.8 20.9 15.4 2.1* 2.6* 1.8 0.8 1.2 1.5 Faraone 1998 Clinic 3 - 18 P RD 134 181 91 26 3.0 12.2 8.8 11.5 4.5* 3.1 4.2 1.4 1.1 0.7 Faraone 1998e Clinic 3 - 18 P Any 133 180 91 26 11.5 21.7 22.0 19.2 2.1* 2.2* 1.8 1.0 1.2 1.2 Gr.-Tsur 2006 Clinic 5 - 18 P & T LD -- 138 64 -- -- 24.6 23.4 -- -- -- -- 1.1 -- -- Hale 2009 Clinic M = 9 Clin Any -- 39 17 8 -- 15.4 17.6 0.0 -- -- -- 0.8 1.5* 4.1 Hinshaw 2002a Clinic 6 - 12 P & T RD 88 93 47 -- 4.5 10.8 14.9 -- 2.5 3.7* -- 0.7 -- -- Hodgens 2000 Clinic 8 - 11 P LD 15 15 15 -- 0.0 26.7 53.3 -- 12.1 35.1* -- 0.3 -- -- Lemiere 2010 Clinic 6 - 16 BE LD -- 38 26 -- -- 16 38 -- -- -- -- 0.4 -- -- Lee 2008b Clinic 6 - 16 P & T RD -- 200 113 60 -- 25.5 27.4 31.7 -- -- -- 0.9 0.7 0.8 Levy 2005g Comm 4 - 18 P RD 2,014 44 93 38 10.1 47.7 50.5 13.2 8.1* 9.1* 1.3 0.9 6.0* 6.7* Levy 2005h Comm 4 - 18 P RD 1,759 126 216 66 16.1 53.2 41.7 24.2 5.9* 3.7* 1.7 1.6* 3.5* 2.2* Maedgen 2000 Clinic 8 - 11 P MD 17 16 14 -- 5.9 18.8 0.0 -- 3.7 0.4 -- 7.5 -- -- Maedgen 2000 Clinic 8 - 11 P RD 17 16 14 -- 0.0 6.3 14.3 -- 3.4 7.0 -- 0.4 -- -- Maedgen 2000e Clinic 8 - 11 P Any 17 16 14 -- 5.9 18.8 14.3 -- 3.7 2.7 -- 1.4 -- -- Martinuss. 2006 Clinic 7 - 13 P & T RDi 34 60 22 12 0.0 31.7 36.4 41.7 32.4* 40.5* 50.6* 0.8 0.7 0.8 Morgan 1996 Clinic 6 - 11 P & T MD -- 26 30 -- -- 3.8 40.0 -- -- -- -- 0.1* -- -- Morgan 1996 Clinic 6 - 11 P & T RD -- 26 30 -- -- 15.4 16.7 -- -- -- -- 0.9 -- -- Morgan 1996e Clinic 6 - 11 P & T Any -- 26 30 -- -- 19.2 50.0 -- -- -- -- 0.2* -- -- Solanto 2007 Clinic 7 - 12 P & T MD 20 34 26 -- 0.0 2.9 7.7 -- 1.8 4.1 -- 0.4 -- -- Toplak 2003 Clinic 6 -11 P & T RD -- 39 11 -- -- 38.5 36.4 -- -- -- -- 1.1 -- -- Weiss 2003 Clinic M = 13 Chart LD -- 133 93 -- -- 33.1 44.1 -- -- -- -- 0.6 -- -- Willcutt 2011a Comm 8 - 18 P & T MD 288 135 235 40 5.2 28.1 35.3 10.0 7.1* 9.9* 2.0 0.7 3.5* 4.9* Willcutt 2011a Comm 8 - 18 P & T RD 288 135 235 40 1.7 25.9 28.5 7.0 19.8* 22.6* 4.6 0.9 4.3* 4.9* Willcutt 2011ae Comm 8 - 18 P & T Any 288 135 235 40 5.9 37.0 41.7 12.5 9.4* 11.4* 2.3 0.8 4.1* 5.0*





LEARNING DISORDERS CONTINUED Wolraich 1998b Comm 6 - 12 T LD -- 205 380 113 -- 10.9 13.9 2.7 -- -- -- 0.8 4.4* 5.8* Yang 2004b Clinic 6 - 16 P LD -- 130 159 19 -- 28.5 40.3 10.5 -- -- -- 0.6* 3.4 5.7* Pooled results Studies: 11 23 23 11 %: 8.4% 24.2% 29.1% 17.9% OR: 5.4* 5.7* 1.9* 0.8 1.8* 2.1*

Total N: 4,412 2,032 1,852 471 CI: 5.9, 12.0 19.5, 29.6 23.2, 35.7 11.6, 25.9 CI: 3.6, 8.5 3.4, 9.4 1.1, 3.5 0.7, 1.0 1.0, 3.2 1.2, 3.6 Q: 55.3* 126.5* 146.3* 29.9* Q: 16.9 28.3 5.3 24.1 34.4 27.6 I2: 82% 83% 85% 67% I2: 41% 65% 44% 8% 71% 63%

Classic Fail-safe N / Orwin's fail-safe N: 316 / 94 405 / 90 10 / 12 -- / -- 24 / 15 44 / 28 Egger’s regression intercept: ns ns ns ns ns ns Trim and Fill missing studies (higher or lower than point estimate): 1 (lower) 0 0 3 (higher) 0 2 (lower) Trim and fill adjusted odds ratio: 5.3* 5.7* 1.9* 0.9 1.8* 1.6*

Note: Summary statistics for the meta-analysis are described in detail in Supplement section 2. Q = Cochrane's Q. aClinic = clinic-referred sample, Comm = unselected community sample. bP = parent, T = teacher, CL = clinician, S = self, BE = best estimate summary from multiple sources of data, Chart = chart review. cRD = reading disorder, MD = math disorder, LD = any learning disorder or unspecified learning disorder. dOdds ratios greater than 1 indicate that the group listed first had a higher rate of comorbidity than the group listed second, and odds ratios less than 1 indicate that the group listed second had a higher rate of comorbidity. eeffect included in the meta-analysis. fif a study reported multiple effects and did not report a summary variable indicating any LD, the effects from the study were combined into a single effect size for meta-analysis (see Supplement section 2). gfemales. hmales. iRD group also included individuals with language impairment. * = P < .05





SPEECH/LANGUAGE DISORDERS Studies of Children and Adolescents

Dane 2000 Clinic 7 - 12 P & T Test -- 22 20 -- -- 9.1 25.0 -- -- -- -- 0.3 -- -- Faraone 1998 Clinic 3 - 18 P / P P 134 175 86 26 12.7 38.9 20.9 34.6 4.4* 1.8 3.6* 2.4 1.2 0.5 Hale 2009 Clinic M = 9 Clin SLI -- 39 17 8 -- 0.0 11.8 0.0 -- -- -- 0.1 n/ad 2.7 Hinshaw 2002a Clinic 6 - 12 P & T P 88 93 47 -- 4.5 25.8 29.8 -- 7.3* 8.9* -- 0.8 -- -- Lee 2008b Clinic 6 - 16 P & T SLI -- 200 113 60 -- 8.0 10.5 12.4 -- -- -- 0.6 0.4 0.7 Levy 2005e Comm 4 - 17 P / P P 2,014 44 93 38 8.5 27.3 18.3 10.5 4.0* 2.4* 1.3 1.7 3.2 1.9 Levy 2005f Comm 4 - 17 P / P P 1,759 126 216 66 18.1 33.3 30.1 19.7 2.3* 2.0* 1.1 1.2 2.0 1.8 Weiss 2003 Clinic M = 13 Chart Chart -- 133 93 -- -- 15.0 26.9 -- -- -- -- 0.5 -- -- Wolraich 1998b Comm 6 - 12 T T -- 205 380 113 -- 3.0 6.1 0.9 -- -- -- 0.6 4.0 6.9* Yang 2007 Clinic 6 - 12 P & T P -- 124 58 -- -- 8.9 10.3 -- -- -- -- 0.8 -- -- Pooled results Studies: 4 10 10 6 %: 10.7% 14.8% 17.8% 13.9% OR: 3.6* 2.4* 1.6 0.9 1.4 1.3

Total N: 3,995 1,161 1,123 311 CI: 6.0, 18.2 8.6, 24.4 11.8, 25.9 7.0, 25.7 CI: 2.3, 5.8 1.6, 3.7 0.8, 3.4 0.6, 1.3 0.7, 3.1 0.7, 2.4 Q: 79.0* 109.3* 68.0* 17.1* Q: 6.8 6.3 4.3 22.4 11.1 9.3 I2: 96% 92% 87% 71% I2: 56% 52% 54% 60% 64% 57%

Classic fail-safe N / Orwin's fail-safe N: 68 / 22 37 / 13 -- / -- -- / -- -- / -- -- / -- Egger’s regression intercept: ns ns ns ns ns ns Trim and Fill missing studies (higher or lower than point estimate): 1 (lower) 0 0 2 (higher) 1 (lower) 0 Trim and fill adjusted odds ratio: 3.3* 2.4* 1.6 1.0 1.3 1.2

Note: Summary statistics for the meta-analysis are described in detail in Supplement section 2. Q = Cochrane's Q. aClinic = clinic-referred sample, Comm = unselected community sample. bP = parent, T = teacher, Test = psychometric test, CL = clinician, Chart = chart review. cOdds ratios greater than 1 indicate that the group listed first had a higher rate of comorbidity than the group listed second, and odds ratios less than 1 indicate that the group listed second had a higher rate of comorbidity. dOdds ratio could not be calculated. efemales. fmales. * = P < .05





Tourettes / Tic Disorder Studies of Children and Adolescents

Byun 2006 Clinic 5 - 16 P P -- 70 22 -- -- 17.1 9.1 -- -- -- -- 2.1 -- -- Faraone 1998 Clinic 3 - 18 P P 128 175 88 26 4.7 34.3 18.2 30.8 10.6* 4.5* 9.0* 2.4* 1.2 0.5 Ghaniz. 2009 Clinic 5 - 18 P P -- 73 45 53 -- 15.1 11.1 15.1 -- -- -- 1.4 1.0 0.7 Lemiere 2010 Clinic 6 - 16 P P -- 38 26 -- -- 10.5 3.8 -- -- -- -- 2.9 -- -- Yang 2004b Clinic 6 - 16 P P -- 130 159 19 -- 14.6 11.9 26.3 -- -- -- 1.3 0.5 0.4 Yang 2007 Clinic 6 - 12 P & T P -- 124 58 -- -- 8.1 6.9 -- -- -- -- 1.2 -- -- Pooled results Studies: 1 6 6 3 %: 4.7% 15.8% 12.1% 22.6% OR: 7.1* 3.4* 8.9* 1.7* 0.9 0.5*

Total N: 128 610 398 98 CI: 1.7, 9.9 9.2, 25.9 8.7, 16.5 14.0, 34.4 CI: 3.0, 16.8 1.4, 8.2 2.9, 23.4 1.2, 2.5 0.5, 1.6 0.3, 0.9 Q: 36.9 6.1 2.8 Q: -- -- -- 2.5 1.6 0.5 I2: -- 86% 18% 28% I2: -- -- -- 0% 0% 0%

Classic Fail-safe N / Orwin's fail-safe N: -- -- -- 4 / 1 N/A 1 / 1 Egger’s regression intercept: -- -- -- ns ns ns Trim and Fill missing studies (higher or lower than point estimate): 1 (lower) 0 0 Trim and fill adjusted odds ratio: 1.7* 0.9 0.5*

Note: Summary statistics for the meta-analysis are described in detail in Supplement section 2. Q = Cochrane's Q. aClinic = clinic-referred sample, Comm = unselected community sample. bP = parent, T = teacher. cOdds ratios greater than 1 indicate that the group listed first had a higher rate of comorbidity than the group listed second, and odds ratios less than 1 indicate that the group listed second had a higher rate of comorbidity. * = P < .05


Supplement Table 12 Correlations between DSM-IV symptom dimensions and cognitive measures

Age

ADHD Cognitive Correlation with DSM-IV

Symptom Dimensionc

Significant difference Construct / Study Samplea N Range Raterb Measure Inattention Hyp-Imp between dimensionsd

INTELLIGENCE

Studies of children and adolescents Fuchs 2008 Comm 924 7 - 9 P WASI Matrix Reasoning .36* --e -- Hartman 2004 Comm 286 8 - 18 P & T WISC-R Full Scale IQ .31* .17* ns Kuntsi 2004 Comm 1,106 5 P WISC-III Full Scale IQ .31* .25* ns Molina 2001 Clinic 224 11 - 18 T WISC-III Estimated IQ .38* .39* ns Thorell 2007 Comm 179 5 - 7 T WPPSI Block Design .31* .03 Inatt > Hyp-Imp Willcutt 2011cf Clinic 145 6 - 18 P WISC-IV Full Scale IQ .24* .11 ns Willcutt 2011cg Comm 745 6 - 13 P & T WISC-III Pro-rated FSIQ .23* .14 Inatt > Hyp-Imp Willcutt 2011ch Comm 628 8 - 18 P & T WISC-R Full Scale IQ .33* .21* Inatt > Hyp-Imp Pooled results Overall r [95% CI]: .31 [.28, .34]* .19 [.11, .26]* Inatt > Hyp-Imp

Number of studies (total N): 8 (4,203) 7 (3,279) Cochrane's Q / I2: 9.6, 38% 25.3*, 80%i

Classic fail-safe N / Orwin's fail-safe N: 791 / 18 112 / 6 Egger's regression intercept: ns ns

Trim and fill missing studies (lower or higher than point estimate): 1 (higher) 1 (higher) Trim and fill adjusted r: .32* .18*

Note: Summary statistics for the meta-analysis are described in detail in Supplement section 2. WASI = Wechsler Abbreviated Scale of Intelligence, WISC = Wechsler Intelligence Scale for Children, WPPSI = Wechsler Preschool and Primary Scale of Intelligence. aComm = community sample, Clinic = clinic-referred sample. bP = parent, T = teacher. cAll effects are scaled so that positive correlations indicate that higher ADHD symptoms are associated with greater impairment. dSignificant difference between correlations, P < .05. eOnly inattention symptoms were measured. fUniversity of Colorado Clinic Sample. gColorado community sample. hColorado twin sample. iheterogeneity due to significant outlier effect size reported by Molina et al. (2001); when this effect was excluded the overall correlation was slightly smaller but remained significant r = .16).

* = P < .05



Age


Symptom Dimensionc


RESPONSE INHIBITION Studies of children and adolescents

Egeland 2009e Clinic 132 9 - 16 P CPT commission errors .04 -.01 ns Egeland 2009e Clinic 132 9 - 16 T CPT commission errors .05 -.01 ns Martel 2009 Comm 179 6 - 12 P & T Stop-signal RT .24* .22* ns Martel 2009 Comm 179 13 - 18 P & T Stop-signal RT .20* .15* ns Thorell 2007 Comm 179 5 - 7 T Go no Go Commission Errors .18* .17* ns Wahlstedt 2009 Comm 182 7 - 9 P & T Composite CPT and Stroop .35* .32* nsf

Wiersema 2009 Clinic 26 8 - 13 P Commission Errors .42* .44* ns Willcutt 2011cg Clinic 145 6 - 18 P AX CPT Commission Errors .19* .20* ns Willcutt 2010a Comm 914 8 - 18 P & T SSRT & CPT commissions .33* .24* Inatt > Hyp-imp Pooled results Overall r [95% CI]: .24 [.17, .31]* .20 [.14, .27]* nsh

Number of studies (total N): 8 (1,907) 8 (1,907) Cochrane's Q / I2: 14.9, 53% 11.9, 41%


Trim and Fill missing studies (lower or higher than point estimate) 0 0 Trim and fill adjusted r: .24* .20*

Note: Summary statistics for the meta-analysis are described in detail in Supplement section 2. CPT = continuous performance test, SSRT = stop-signal reaction time. aComm = community sample, Clinic = clinic-referred sample. bP = parent, T = teacher. cAll effects are scaled so that positive correlations indicate that higher ADHD symptoms are associated with greater impairment. dSignificant difference between correlations, P < .05. emultiple effects reported by the study were combined into a single effect size for meta-analysis (see Supplement section 2). fcorrelations were not significantly different, but only inattention symptoms independently predicted performance on the cognitive measure when both dimensions were included in a multiple regression model. gUniversity of Colorado Clinic Sample. hin addition to the studies in the meta-analysis, multiple regression analyses by Clarke et al. (2007) indicated that inattention symptoms independently predicted response inhibition, whereas hyperactivity-impulsivity symptoms did not.

* = P < .05



Age


Symptom Dimensionc


RESPONSE INHIBITION CONTINUED Studies of adults

Cohen 2007 Comm 58 19 - 25 S CPT commission errors .36* .35* ns Nigg 2002b Comm 43 18 - 37 S / O antisaccade .43* .39* ns Nigg 2005 Comm 195 18 - 37 S / O Stop-signal RT .23* .16* ns Solanto 2004 Clinic 93 M = 35 S CPT commission errors .04 .20* ns Willcutt 2011b Comm 328 18 - 25 S / P Inhibition composite .36* .23* nse Pooled results Overall r [95% CI]: .28 [.15, .40]* .23 [.16, .30]* ns

Number of studies (total N): 5 (717) 5 (717) Cochrane's Q / I2: 10.2, 61% 3.3, 0%


Trim and Fill missing studies (lower or higher than point estimate): 1 (lower) 1 (lower) Trim and fill adjusted r: .26* .22*

Note: Summary statistics for the meta-analysis are described in detail in Supplement section 2. CPT = continuous performance test, SSRT = stop-signal reaction time. aComm = community sample, Clinic = clinic-referred sample. bP = parent, S = self, O = other observer. cAll effects are scaled so that positive correlations indicate that higher ADHD symptoms are associated with greater impairment. dSignificant difference between correlations, P < .05. ecorrelations were not significantly different, but only inattention symptoms independently predicted performance on the cognitive measure when both dimensions were included in a multiple regression model.

* = P < .05



Age


Symptom Dimensionc


WORKING MEMORY Studies of children and adolescents

Fuchs 2008 Comm 924 7 - 9 P WJ-III Visual Matching .33* --e -- Lui 2007f Comm 140 7 - 12 P Digits Backward .22* .26* nsg Lui 2007f Comm 140 7 - 12 P Spatial Span Backward .34* .25* nsg McInnes 2003f Clinic 77 9 - 12 P Digits Backward .43* .32* ns McInnes 2003f Clinic 77 9 - 12 T Digits Backward .60* .36* Inatt > Hyp-Imp McInnes 2003f Clinic 77 9 - 12 P Finger Windows Backward .45* .39* ns McInnes 2003f Clinic 77 9 - 12 T Finger Windows Backward .56* .35* ns Thorell 2007h Comm 179 5 - 7 T Pig House (Spatial task) .17* .01 ns Thorell 2007h Comm 179 5 - 7 T Digits Backward .26* .03 ns Wahlstedt 2009h Comm 182 7 - 9 P & T Size ordering and Pig House .25* .16* nsg

Willcutt 2010a Comm 914 8 - 18 P & T composite score .28* .17* Inatt > Hyp-Imp Willcutt 2011ci Clinic 145 6 - 18 P WISC-IV composite .24* .09 ns Willcutt 2011cj Comm 745 6 - 13 P & T Digits Backward .28* .19* ns Pooled results Overall r [95% CI]: .30 [.26, .34]* .17 [.11, .23]* Inatt > Hyp-Impk



Trim and Fill missing studies (lower or higher than point estimate): 1 (lower) 0 Trim and fill adjusted r: .30* .17*

Note: Summary statistics for the meta-analysis are described in detail in Supplement section 2. WISC = Wechsler Intelligence Scale for Children, WJ-III = Woodcock-Johnson III Tests of Achievement. aComm = community sample, Clinic = clinic-referred sample. bP = parent, T = teacher. cAll effects are scaled so that positive correlations indicate that higher ADHD symptoms are associated with greater impairment. dSignificant difference between correlations, P < .05. eOnly inattention symptoms were measured. fmultiple effects reported by the study were combined into a single effect size for meta-analysis (see Supplement section 2). gcorrelations were not significantly different, but only inattention symptoms independently predicted performance on the cognitive measure when both dimensions were included in a multiple regression model. hWahlstedt (2009) is a follow-up of the sample described by Thorell (2007), so a single effect size was computed and included in the meta-analysis. iUniversity of Colorado Clinic Sample. jColorado community sample. kIn addition to the studies in the meta-analysis, multiple regression analyses by Martinussen & Tannock (2006) indicated that inattention symptoms independently predicted verbal and spatial working memory, but hyperactivity-impulsivity symptoms did not. * = P < .05



Age


Symptom Dimensionc


VIGILANCE Studies of children and adolescents

Egeland 2009e Clinic 132 9 - 16 P CPT omission errors .25* .20* ns Egeland 2009e Clinic 132 9 - 16 T CPT omission errors .23* .08 ns Willcutt 2011cf Clinic 145 6 - 18 P & T CPT omission errors .19* .10 ns Willcutt 2011cg Comm 745 6 - 13 P & T CPT omission errors .21* .10* Inatt > Hyp-Imp Willcutt 2011ah Comm 698 8 - 18 P & T CPT omission errors .26* .16* nsi Pooled results Overall r [95% CI]: .23 [.19, .27]* .12 [.08, .16]* Inatt > Hyp-Imp



Trim and Fill missing studies (lower or higher than point estimate): 0 0 Trim and fill adjusted r: .23* .12* Studies of adults

Cohen 2007 Comm 58 19 - 25 S CPT omission errors .21 .16 ns Solanto 2004 Clinic 93 M = 35 S CPT omission errors .15 .08 ns Willcutt 2011b Comm 328 18 - 25 S / P CPT omission errors .26* .13 nsi

Pooled results Overall r [95% CI]: .23 [.15, .32]* .12 [.03, .21]* ns Number of studies (total N): 3 (479) 3 (479) Cochrane's Q / I2: 1.0, 0% 0.3, 0%


Trim and Fill missing studies (lower or higher than point estimate): 2 (higher) 10 Trim and fill adjusted r: .26* .12*

Note: Summary statistics for the meta-analysis are described in detail in Supplement section 2. CPT = continuous performance test. aComm = community sample, Clinic = clinic-referred sample. bP = parent, T = teacher, S = self. cAll effects are scaled so that positive correlations indicate that higher ADHD symptoms are associated with greater impairment. dSignificant difference between correlations, P < .05. emultiple effects reported by the study were combined into a single effect size for meta-analysis (see Supplement section 2). fUniversity of Colorado Clinic Sample. gColorado community sample. hColorado twin sample. icorrelations were not significantly different, but only inattention symptoms independently predicted performance on the cognitive measure when both dimensions were included in a multiple regression model.

* = P < .05



Age


Symptom Dimensionc


RESPONSE VARIABILITY Studies of children and adolescents

Martel 2007 Comm 182 13 - 18 P & T Stop-signal Go RTSD .27* .27* ns Wahlstedt 2009 Comm 182 7 - 9 P & T Go no go RT SD .35* .24* ns

Willcutt 2010a Comm 698 8 - 18 P & T Stop-signal Go RTSD .35* .20* Inatt > Hyp-Imp Pooled results Overall r [95% CI]: .34 [.28, .39]* .22 [.16, .28]* Inatt > Hyp-Imp



Trim and Fill missing studies (lower or higher than point estimate): 0 2 (lower) Trim and fill adjusted r: .34* .20* Studies of adults Cohen 2007 Comm 58 19 - 25 S CPT hit RT SE .32* .32* ns Nigg 2005 Comm 195 18 - 37 S / O Stop-signal RT SD .22* .13* ns Solanto 2004 Clinic 93 M = 35 S CPT hit RT SE .32* .31* ns Willcutt 2011b Comm 328 18 - 25 S / P Composite RT SD .35 .17* nse Pooled results Overall r [95% CI]: .31 [.24, .37]* .20 [.12, .27]* ns

Number of studies (total N): 4 (674) 4 (674) Cochrane's Q / I2: 2.5, 0% 3.4, 0%


Trim and Fill missing studies (lower or higher than point estimate): 2 (lower) 1 (lower) Trim and fill adjusted r: .25* .18*

Note: Summary statistics for the meta-analysis are described in detail in Supplement section 2. CPT = continuous performance test, SSRT = stop-signal reaction time. aComm = community sample, Clinic = clinic-referred sample. bP = parent, T = teacher, S = self, O = other observer. cAll effects are scaled so that positive correlations indicate that higher ADHD symptoms are associated with greater impairment. dSignificant difference between correlations, P < .05. ecorrelations were not significantly different, but only inattention symptoms independently predicted performance on the cognitive measure when both dimensions were included in a multiple regression model.

* = P < .05



Age


Symptom Dimensionc


PROCESSING SPEED Studies of children and adolescents

Fuchs 2008 Comm 924 7 - 9 P WJ-III Visual Matching .41* --e -- Martel 2009 Comm 179 6 - 12 P & T Trailmaking Test Part B .22* .00 ns Martel 2009 Comm 179 13 - 18 P & T Trailmaking Test Part B .25* .09 ns Willcutt 2010a Comm 914 8 - 18 P & T composite score .37* .19* Inatt > Hyp-Imp Willcutt 2011cf Clinic 145 6 - 18 P & T WISC-III Processing Speed .25* .07 ns Willcutt 2011cg Comm 745 6 - 13 P & T WISC-III Processing Speed .29* .18* Inatt > Hyp-Imp Pooled results Overall r [95% CI]: .32 [26, .38]* .14 [.07, .20]* Inatt > Hyp-Imp


Classic fail-safe N / Orwin's fail-safe N: 464 / 16 38 / 3 Egger's regression intercept: ns P = .02

Trim and Fill missing studies (lower or higher than point estimate): 3 (higher) 2 (higher) Trim and fill adjusted r: .35* .17* Studies of adults

Nigg 2005 Comm 195 19 - 25 S Composite .19* -.05 nsh Willcutt 2011b Comm 328 18 - 25 S / P Composite .31* .11 nsh Pooled results Overall r [95% CI]: .26 [.14, .37] .04 [-.12, .19] ns

Number of studies (total N): 2 (523) 2 (523)

Note: Summary statistics for the meta-analysis are described in detail in Supplement section 2. WISC = Wechsler Intelligence Scale for Children, WJ-III = Woodcock-Johnson III Tests of Achievement. aComm = community sample, Clinic = clinic-referred sample. bP = parent, T = teacher, S = self. cAll effects are scaled so that positive correlations indicate that higher ADHD symptoms are associated with greater impairment. dSignificant difference between correlations, P < .05. eOnly inattention symptoms were measured. fUniversity of Colorado Clinic Sample. gcommunity sample. hcorrelations were not significantly different, but only inattention symptoms independently predicted performance on the cognitive measure when both dimensions were included in a multiple regression model.

* = P < .05



Age


Symptom Dimensionc


SHORT-TERM MEMORY Studies of children and adolescents

Lui 2007e Comm 140 7 - 12 P Digits Forward .18* .24* ns Lui 2007e Comm 140 7 - 12 P Spatial Span Forward .09 .08 ns McInnes 2003e Clinic 77 9 - 12 P Digits Forward .20 .14 ns McInnes 2003e Clinic 77 9 - 12 T Digits Forward .26* .16 ns McInnes 2003e Clinic 77 9 - 12 P Finger Windows Forward .37* .37* ns McInnes 2003e Clinic 77 9 - 12 T Finger Windows Forward .41* .20 ns Willcutt 2007b Comm 1,618 4 - 6 P WRAML Sentence Memory .18* .09 nsf Willcutt 2011cg Clinic 145 6 - 18 P Digits Forward .23* .10 ns Willcutt 2011ch Comm 745 6 - 13 P & T Digits Forward .26* .18* ns Willcutt 2011ci Comm 1,515 6 - 13 P & T Digits Forward .28* .16* Inatt > Hyp-Imp Pooled results Overall r [95% CI]: .23 [.18, .29]* .14 [.10, .18]* Inatt > Hyp-Impj



Trim and Fill missing studies (lower or higher than point estimate): 0 1 (lower) Trim and fill adjusted r: .23* .14*

Note: Summary statistics for the meta-analysis are described in detail in Supplement section 2. WRAML = Wide Range Assessment of Memory and Learning. aComm = community sample, Clinic = clinic-referred sample. bP = parent, T = teacher. cAll effects are scaled so that positive correlations indicate that higher ADHD symptoms are associated with greater impairment. dSignificant difference between correlations, P < .05. emultiple effects reported by the study were combined into a single effect size for meta-analysis (see Supplement section 2). fcorrelations were not significantly different, but only inattention symptoms independently predicted performance on the cognitive measure when both dimensions were included in a multiple regression model. gUniversity of Colorado Clinic Sample. hColorado community sample. iColorado twin sample. jin addition to the studies in the meta-analysis, multiple regression analyses by Clarke et al. (2007) indicated that inattention symptoms independently predicted short-term memory, whereas hyperactivity-impulsivity symptoms did not.

* = P < .05



Age


Symptom Dimensionc


DELAY AVERSION / DISCOUNTING Studies of children and adolescents

Paloyelis 2010a Clinic 68 11 - 20 P & T Delay discounting .23 .20 ns Thorell 2007e Comm 145 5 - 7 T Delay aversion .20 .20 ns Wahlstedt 2009e Comm 182 7 - 9 P & T Delay aversion .16 .19 ns Willcutt 2011a Comm 327 6 - 16 P & T Delay aversion .06 .12 ns Pooled results Overall r [95% CI]: .13 [.03, .23]* .15 [.07, .23]* nsf

Number of studies (total N): 3 (577) 3 (577) Cochrane's Q / I2: 2.7; 26% 0.8, 0%

Classic fail-safe N / Orwin's fail-safe N: 5 / 1 8 Egger's regression intercept: ns ns

Trim and Fill missing studies (lower or higher than point estimate): 2 (lower) 2 (lower) Trim and fill adjusted r: .06 .12*

Note: Summary statistics for the meta-analysis are described in detail in Supplement section 2. aComm = community sample, Clinic = clinic-referred sample. bP = parent, T = teacher. cAll effects are scaled so that positive correlations indicate that higher ADHD symptoms are associated with greater impairment. dSignificant difference between correlations, P < .05. eWahlstedt (2009) is a follow-up of the sample described by Thorell (2007), so a single effect size was computed for these two studies. fOne study found that only inattention symptoms were independently associated with increased delay aversion when both symptom dimensions were included as predictors in a multiple regression model (Paloyelis et al., 2009), but other studies found that only hyperactivity-impulsivity symptoms were independently associated with measures of temporal discounting in children (Scheres et al., 2010) and adults (Scheres et al., 2008).

* = P < .05


Supplement Table 13 Studies that compared the DSM-IV subtypes on dimensional measures of neuropsychological functioning

Sample Age ADHD Sample Size Effect Size (Hedges' g) for comparisons between groupsc

Study Typea range

Raterb

Cont Comb Type

Inatt Type

H-I Type

Measure

ADHD-C vs. Control

ADHD-I vs. Control

ADHD-H vs. Control

ADHD-C vs. ADHD-I

ADHD-C vs. ADHD-H

ADHD-I vs. ADHD-H

INTELLIGENCE Studies of children and adolescents Bauerm. 2005a Comm 6 - 11 P & T 29 44 25 -- WISC-III 0.53* 1.06* -- -0.46 -- -- Bedard 2003 Clinic 6 - 12 P & T -- 36 15 8 WISC-III -- -- -- -0.32 -0.74* -0.41 Booth 2007 Clinic 7 - 13 P & T 24 16 26 -- WISC-III 0.63* 0.84* -- -0.13 -- -- Carlson 2002 Clinic 9 - 12 P & T 22 25 13 -- WISC-III 0.48 1.25* -- -0.53 -- -- Chhabild. 2001 Comm 8 - 18 P & T 82 33 67 14 WISC-III 1.37* 1.38* 0.11 -0.09 1.51* 1.31* Chiang 2008 Clinic 7 - 10 P 52 52 17 -- WISC-III 0.85* 0.53* -- 0.35 -- -- Counts 2005 Comm 7 - 12 P & T 72 96 38 -- WISC-III 0.42* 0.26 -- 0.13 -- -- Dane 2000 Clinic 7 - 12 P & T -- 20 22 -- WISC-III -- -- -- -0.16 -- -- Edwards 2007 Clinic 6 - 12 P -- 50 33 -- K-BIT -- -- -- 0.13 -- -- Egeland 2009 Clinic 9 - 16 P & T 65 40 27 -- WISC-III 0.30 0.55* -- -0.33 -- -- Eiraldi 1997 Clinic 6 - 12 P 33 27 26 -- WISC-III 0.63* 0.10 -- 0.48 -- -- Faraone 1998 Clinic 3 - 18 P 135 182 92 28 WISC-III No ES*e No ES*e No ESe No ESe No ESe No ESe

Geurts 2005 Comm 6 - 13 P & T 16 16 16 -- WISC-III 0.21 0.28 -- -0.05 -- -- Gorman 2006 Clinic 6 - 12 P & T 34 22 19 -- WISC-III 1.34* 0.98* -- 0.18 -- -- Gross-Ts. 2006 Clinic 5 - 18 P & T -- 138 64 -- WISC-III -- -- -- -0.18 -- -- Hale 2009 Clinic M = 9 CL -- 39 17 8 WISC-III -- -- -- -0.86* -0.77* 0.07 Hinshaw 2002a Clinic 6 - 12 P & T 88 93 47 -- WISC-III 0.95* 0.91* -- 0.02 -- -- Houghton 1999 Clinic 6 - 12 CL 28 62 32 -- WISC-III 0.47* -0.04 -- 0.48 -- -- Huang-P. 2010 Comm 8 - 12 P & T 48 32 21 -- WISC-III 0.59* 0.24 -- 0.22 -- -- Johnstone 2009 Clinic 8 - 14 NS 15 15 15 -- Ravens -0.31 -0.08 -- -0.23 -- -- Klorman 1999 Clinic 7 - 13 P 28 207 98 -- WISC-III 1.14* 1.34* -- -0.08 -- -- Kopecky 2005 Clinic 6 - 11 P & T 34 22 19 -- WISC-III 1.32* 1.00* -- 0.16 -- -- Krane 2001 Clinic 6 - 18 P & T 24 94 56 38 WISC-III 1.45* 1.68* 1.17* -0.09 0.16 0.25 Lahey 1998 Clinic 4 - 6 P & T 125 84 14 29 Stanford-Binet IV 0.87* 0.45 0.38 0.44 0.49* 0.07 Lee 2008b Clinic 6 - 16 P & T 47 200 113 60 WISC-III 1.43* 1.46* 1.07* 0.02 0.32 0.28 Lemiere 2010 Clinic 6 - 16 P 76 38 26 -- WISC-III 0.70* 0.79* -- -0.09 -- -- Loo 2007 Comm 16 - 18 P & T 165 66 72 37 WAIS-III 0.85* 0.81* 0.82* 0.01 -0.01 -0.02 Maedgen 2000 Clinic 8 - 11 P 17 16 14 -- WISC-III -0.18 0.09 -- -0.24 -- -- Martinuss. 2006 Clinic 7 - 13 P & T 34 60 22 12 WISC-III 1.30* 1.69* 1.56* 0.00 0.11 0.14 McBurnett 1999 Clinic 3 - 17 P & T -- 126 44 13 WISC-III -- -- -- 0.10 0.61* 0.59*




Study Typea range

Raterb

Cont Comb Type

Inatt Type

H-I Type

Measure

ADHD-C vs. Control

ADHD-I vs. Control

ADHD-H vs. Control

ADHD-C vs. ADHD-I

ADHD-C vs. ADHD-H

ADHD-I vs. ADHD-H

INTELLIGENCE CONTINUED Studies of children and adolescents Mikami 2007 Clinic 7 - 12 P & T 38 33 45 -- WISC-III 0.65* 0.62* -- 0.01 -- -- Montiel 2008 Comm 4 - 12 P 79 96 13 45 WISC-III -0.20 0.00 -0.03 -0.21 -0.19 0.04 Morgan 1996 Clinic 6 - 11 P & T -- 26 30 -- WISC-III -- -- -- 0.05 -- -- Mullins 2005 Clinic 7 - 14 BE 24 20 19 -- WISC-III 0.53* 0.64* -- -0.05 -- -- O'Driscoll 2005 Clinic 11 - 14 P & T 10 10 12 -- WISC-III 0.18 0.13 -- 0.04 -- -- Paternite 1996 Clinic 6 - 12 P -- 59 28 9 WISC-III -- -- -- No ESe No ESe No ESe

Piek 1999 Comm 8 - 11 P 16 16 16 -- WISC-III 0.41 0.05 -- 0.33 -- -- Pitcher 2003 Comm 7 - 12 P 39 38 50 16 WISC-III 0.53* 0.35 0.47 0.16 0.05 -0.11 Pritchard 2008 Clinic 13 - 17 P & T -- 18 23 -- WISC-III -- -- -- 0.18 -- -- Rosenthal 2006 Clinic 9 - 15 BE 27 28 12 -- WISC-III 0.61* 1.06* -- -0.62 -- -- Scheres 2010 Clinic 6 - 17 P 37 25 20 -- WASI 0.48 0.00 -- 0.49 -- -- Scheres 2004 Clinic 6 - 12 P 22 15 8 -- WISC-III 0.51 0.19 -- 0.34 -- -- Schmitz 2002 Comm 12 - 16 P & S 60 10 10 10 WISC-III 0.67* 0.44 0.15 0.15 0.61 0.28 Sem-Cl 2010a Clinic 9 - 16 P & T 113 76 80 -- WISC-III 0.18 0.43* -- -0.25 -- -- Solanto 2007 Clinic 7 - 12 P+T 20 34 26 -- WISC-III 1.08* 0.69* -- 0.46 -- -- Todd 2002 Comm 7 - 17 P 731 149 243 31 WISC-III 0.55* 0.35* 0.22 0.19 0.31 0.14 van West 2009 Clinic 6 - 12 P & S 25 52 23 -- K-BIT 0.46 0.24 -- 0.17 -- -- Vaughn 1997 Clinic 6 - 11 P & T -- 38 16 -- WISC-R -- -- -- -0.70* -- -- Weber 2007 Clinic 4 - 12 P & T -- 88 38 18 Progressive Matrices -- -- -- -0.13 1.04* 0.99* Willcutt 2011a Comm 8 - 18 P & T 288 135 245 40 WISC-R 0.90* 0.99* 0.47* -0.09 0.40* 0.50* Wodka 2008a Clinic 8 - 16 P 69 35d 19 -- WISC-III 0.54* 0.85* -- -0.27 -- -- Yang 2007 Clinic 6 - 12 P & T -- 124 58 -- Full Scale IQ -- -- -- 0.21 -- --




Study Typea range

Raterb

Cont Comb Type

Inatt Type

H-I Type

Measure

ADHD-C vs. Control

ADHD-I vs. Control

ADHD-H vs. Control

ADHD-C vs. ADHD-I

ADHD-C vs. ADHD-H

ADHD-I vs. ADHD-H

INTELLIGENCE CONTINUED Studies of children and adolescents Pooled results Overall Hedges' g: 0.67* 0.65* 0.56* 0.00 0.27* 0.27*

[95% CI]: [0.54, 0.80) [0.50, 0.80) [0.29, 0.83) [-0.07, 0.07) [0.05, 0.49) [0.09, 0.46) Number of significant effects / total effects: 28 / 40 24 / 40 5 / 12 3 / 53 7 / 18 3 / 18

Ngroup 1 / Ngroup 2: 2,131 / 2,750 1,653 / 2,750 332 / 1,674 2,850 / 2,029 1,270 / 395 1,015 / 395 Cochrane's Q, I2: 148.1*, 74%f 159.7*, 76%g 38.6, 74%h 63.5, 21% 47.9*, 69%i 28.9, 48%

Classic fail-safe N / Orwin's fail-safe N: 3,697 / 94 3,008 / 91 115 / 15 -- 62 / 6 51 / 6 Egger's regression intercept: ns ns ns ns ns ns Trim and fill missing studies (lower or higher than point estimate): 0 0 0 0 0 4 (higher) Trim and fill adjusted g: 0.67* 0.65* 0.56* 0.00 0.28* 0.39*

Note: Summary statistics for the meta-analysis are described in detail in Supplement section 2. K-BIT = Kaufman Brief Intelligence Test, WAIS = Wechsler Adult Intelligence Scale, WISC = Wechsler Intelligence Scale for Children. aComm = community sample, Clinic = clinic-referred sample. bP = parent, T = teacher, CL = clinician, S = self, BE = best estimate summary from multiple sources of data. cPositive effect sizes indicate that the group listed first performed worse, and negative effect sizes indicate that the group listed second performed worse. dADHD-C includes 2 individuals with ADHD-H. einsufficient data available to calculate effect size. fNo moderators were significant. After seven significant outlier effect sizes were excluded from analyses heterogeneity was no longer significant, and the overall effect size was nearly identical to the original effect (g = .66). gNo moderators were significant. After five significant outlier effects were excluded from analyses the overall effect size was lower but remained significant (g = .59). hheterogeneity was due primarily to the significant outlier effect size reported by Martinussen et al. (2006); the overall effect size was lower but remained significant when this effect was excluded (g = .48). iheterogeneity due to outlying effect sizes reported by Bedard et al. (2003), Chhabildas et al. (2001), and Hale et al. (2009); the overall effect size increased slightly and remained significant when data were re-analyzed excluding these effects (g = 0.30). * = P < .05




Study Typea range

Raterb

Cont Comb Type

Inatt Type

H-I Type

Measure

ADHD-C vs. Control

ADHD-I vs. Control

ADHD-H vs. Control

ADHD-C vs. ADHD-I

ADHD-C vs. ADHD-H

ADHD-I vs. ADHD-H

INTELLIGENCE CONTINUED Studies of adults Conzel. 2009 Clinic 18 - 60 S & P 128 127 20 20 Mehrfachwahl-Wortschatz 0.35* 0.44* 0.70 -0.34 -0.09 -0.24 Egeland 2007 Clinic 15 - 46 BE -- 51 19 -- WASI / WISC-III -- -- -- -0.44 -- -- Murphy 2002 Clinic 17 - 27 S / P 64 60 36 -- K-BIT 0.75* 0.52* -- 0.23 -- -- Riccio 2005 Clinic 18 - 35 S -- 18 14 -- FSIQ -- -- -- -0.04 -- -- Schweitzer 2006 Clinic M = 34 S & O 18 17 16 -- FSIQ 0.74* 0.42 -- 0.18 -- -- Sobanski 2008 Clinic 18 - 59 S & O -- 64 30 -- Leistungsprüfsystem -- -- -- 0.21 -- -- Tucha 2008 Clinic M = 35 S match 63 19 12 IQ (matched to control) -- -- -- 0.30 -0.15 -0.43 Willcutt 2011b Comm 18 - 24 S / P 110 92 110 16 WAIS Est. FSIQ 0.25 0.29 0.03 -0.02 0.22 0.27 Pooled results Overall Hedges' g: 0.46* 0.39* 0.37 0.01 -0.03 -0.10


Ngroup 1 / Ngroup 2: 296 / 320 212 / 320 36 / 238 492 / 266 282 / 78 85 / 142 Cochrane's Q, I2: 5.9, 49% 1.0, 0% -- 8.4, 17% 1.1, 0% 3.0, 33%

Classic fail-safe N / Orwin's fail-safe N: 27 / 6 15 / 4 -- -- -- -- Egger's regression intercept: ns ns -- ns ns ns Trim and fill missing studies (lower or higher than point estimate): 2 (lower) 2 (lower) -- 1 (lower) 0 4 (higher) Trim and fill adjusted g: 0.31* 0.31* -- 0.01 -0.03 -0.10

Note: Summary statistics for the meta-analysis are described in detail in Supplement section 2. K-BIT = Kaufman Brief Intelligence Test, WAIS = Wechsler Adult Intelligence Scale, WISC = Wechsler Intelligence Scale for Children. aComm = community sample, Clinic = clinic-referred sample. bO = other observer, P = parent, S = self, BE = best estimate summary from multiple sources of data. cPositive effect sizes indicate that the group listed first performed worse, and negative effect sizes indicate that the group listed second performed worse. * = P < .05




Study Typea range

Raterb

Cont Comb Type

Inatt Type

H-I Type

Measure

ADHD-C vs. Control

ADHD-I vs. Control

ADHD-H vs. Control

ADHD-C vs. ADHD-I

ADHD-C vs. ADHD-H

ADHD-I vs. ADHD-H

RESPONSE INHIBITION Studies of children and adolescents Bedard 2003 Clinic 6 - 12 P & T 59 36 15 8 Stop-signal RT 0.83* 0.37 0.00 0.37 0.76* 0.30 Bur-Murph 2007 Clinic 7 - 13 P -- 75 182 -- CPT commission errors -- -- -- -0.07 -- -- Campbell 2009 Pop 7 - 9 P & T 790 57 80 -- CPT commission errors 0.74* 0.36* -- 0.47* -- -- Chhabild. 2001d Comm 8 - 18 P & T 82 33 63 14 Stop-signal RT 0.83* 0.87* 0.63 -0.10 0.12 0.22 Chhabild. 2001d Comm 8 - 18 P & T 82 33 63 14 CPT commission errors 0.86* 0.69* 1.13* 0.21 0.13 -0.08 Chiang 2008 Clinic 7 - 10 P 52 52 17 -- CPT commission errors 0.86* 0.56* -- 0.29 -- -- Collings 2003 Comm 8 - 10 P 24 35 11 -- CPT commission errors 0.27 0.28 -- 0.02 -- -- de Zeeuw 2008 Clinic 6 - 13 P & T 31 21 15 -- Stop-signal RT 1.04* 1.18* -- 0.20 -- -- Desman 2008 Clinic 8 - 12 CL 6 6 6 -- CPT commission errors 1.24* 0.00 -- 1.27* -- -- Egeland 2009 Clinic 9 - 16 P & T 65 40 27 -- CPT commission errors -0.11 0.19 -- -0.35 -- -- Gadow 2004a Clinic 6 - 10 P -- 55 82 11 CPT commission errors -- -- -- 0.46 0.36 -0.06 Geurts 2005 Comm 6 - 13 P & T 16 16 16 -- Stop-signal RT 0.89* 1.65* -- -0.05 -- -- Hinshaw 2002b Clinic 6 - 12 P & T 88 93 47 -- CPT commission errors 0.30* -0.14 -- 0.43* -- -- Huang-Po. 2006 Comm 7 - 12 P & T 46 68 21 -- CPT impulsivity errors 0.55* 0.26 -- 0.37* -- -- Huang-Po. 2007 Clinic 6 - 12 P & T 36 23 33 -- Stop-signal RT 0.38 0.64* -- -0.32 -- -- Johnstone 2009d Clinic 8 - 14 BE 15 13 13 -- Stop-signal RT -0.47 -0.20 -- -0.34 -- -- Johnstone 2009d Clinic 8 - 14 BE 15 15 15 -- Go no go prob. inhibit 1.23* 1.23* -- -0.16 -- -- Keage 2006e Clinic 7 -17 CL 75 42 33 -- Go no go comm. errors 0.85* 0.75* -- 0.28 -- -- Keage 2006f Clinic 7 - 17 CL 54 30 24 -- Go no go comm. errors 0.87* 0.56* -- 0.44 -- -- Lee 2008b Clinic 6 - 16 P & T 47 200 113 60 Stop-signal RT 0.53* 0.49* 0.54* 0.14 0.10 -0.04 Loe 2009 Clinic 8 - 13 P & T 32 14 12 -- antisaccade 0.88* 0.55* -- 0.34 -- -- Loo 2007d Comm 16 - 18 P & T 165 66 72 37 CPT commission errors 0.22 0.10 -0.43 0.11 0.66 0.54* Loo 2007d Comm 16 - 18 P & T 165 66 72 37 Stop-signal RT 0.39* 0.44* 0.41* -0.04 0.03 0.07 Mahone 2009 Clinic 8 - 12 P 60 33 17 -- Multiple measures 0.63* 0.74* -- No ESg -- -- Martel 2007 Comm 13 - 18 P & T 97 42 43 Stop-signal RT 0.96* 0.62* -- 0.27 -- -- Nigg 2002ah Comm 7 - 12 P & T 17 11 6 -- Stop-signal RT 1.05* 1.83* -- -0.54 -- -- Nigg 2002ai Comm 7 - 12 P & T 24 35 12 -- Stop-signal RT 1.01* 0.16 -- 0.68* -- -- O'Brien 2010 Clinic 8 - 13 P --j 35 21 -- Multiple measures -- -- -- .03k -- -- Paternite 1996 Clinic 6 - 12 P -- 59 28 9 CPT commission errors -- -- -- No ESg No ESg No ESg

Riccio 2006 Clinic 9 - 15 P & T -- 27 13 -- CPT commission errors -- -- -- 0.27 -- --




Study Typea range

Raterb

Cont Comb Type

Inatt Type

H-I Type

Measure

ADHD-C vs. Control

ADHD-I vs. Control

ADHD-H vs. Control

ADHD-C vs. ADHD-I

ADHD-C vs. ADHD-H

ADHD-I vs. ADHD-H

RESPONSE INHIBITION CONTINUED

Scheres 2004 Clinic 6 - 12 P 22 15 8 -- Stop-signal RT No ES*g No ES*g -- No ESg -- -- Solanto 2007 Clinic 7 - 12 P+T 20 36 26 -- CPT commission errors 0.51* 0.43 -- 0.08 -- -- Tandon 2009 Clinic 3 - 5 P -- 20 7 21 Commission errors -- -- -- No ESg No ESg No ESg

Willcutt 2011a Comm 8 - 18 OR 288 135 235 40 composite (SSRT & CPT) 0.79* 0.75* 0.38* 0.13 0.68* 0.58* Pooled results Overall Hedges' g: 0.65* 0.53* 0.36* 0.17*l 0.36* 0.21


Ngroup 1 / Ngroup 2: 1,157 / 2,171 979 / 2,169 159 / 641 1,405 / 1,135 525 / 170 580 / 170 Cochrane's Q, I2: 46.1, 51% 53.3*, 59%m 8.7, 54% 32.6, 20% 7.7, 34% 8.2, 38%

Classic fail-safe N / Orwin's fail-safe N: 1,347 / 54 603 / 36 12 / 4 81 / -- 18 / 6 4 / -- Egger's regression intercept: ns ns ns ns ns ns Trim and fill missing studies (lower or higher than point estimate): 4 (lower) 0 0 1 (lower) 0 1 (higher) Trim and fill adjusted g: 0.61* 0.53* 0.36* 0.17* 0.34* 0.24*

Note: Summary statistics for the meta-analysis are described in detail in Supplement section 2. CPT = continuous performance test. aComm = community sample, Clinic = clinic-referred sample. bP = parent, T = teacher, CL = clinician, S = self, BE = best estimate summary from multiple sources of data, Chart = chart review. cPositive effect sizes indicate that the group listed first performed worse on the neuropsychological measure, and negative effect sizes indicate that the group listed second performed worse. dmultiple effects reported by the study were combined into a single effect size for meta-analysis (see Supplement section 2). echild sample. fadolescent sample. ginsufficient data available to calculate effect size. hfemale. imale. jcomparisons between ADHD-C and ADHD-I and the comparison group without ADHD reported by Mahone et al. (2009). keffect size estimated based on reported P value. lIn addition to the studies in the table that provided sufficient information for inclusion in the meta-analysis, Tandon et al. (2009) also did not find significant differences between ADHD-I and ADHD-C on measures of response inhibition. mheterogeneity due to outlier effect sizes reported by Geurts et al. (2005), Nigg et al. (2002), and Hinshaw et al. (2002); the overall effect size increased slightly and remained significant when data were re-analyzed excluding these effects (g = 0.54). * = P < .05




Study Typea range

Raterb

Cont Comb Type

Inatt Type

H-I Type

Measure

ADHD-C vs. Control

ADHD-I vs. Control

ADHD-H vs. Control

ADHD-C vs. ADHD-I

ADHD-C vs. ADHD-H

ADHD-I vs. ADHD-H

RESPONSE INHIBITION CONTINUED Studies of adults Aron 2003 Clinic 18 - 41 S & O 13 8 3 -- SSRT 0.92* 1.23* -- -0.40 -- -- Egeland 2007 Clinic 15 - 46 BE -- 51 19 -- CPT comm. errors -- -- -- 0.27 -- -- Epstein 2001 Clinic 18 - 65 S 30 10 14 1 CPT comm. errors / SSRT -- -- -- No ESd -- -- Murphy 2001 Clinic 17 - 28 P & S -- 60 36 -- CPT comm. errors -- -- -- No ESd -- -- Riccio 2005 Clinic 18 - 35 S -- 18 14 -- CPT comm. errors -- -- -- No ESd -- -- Solanto 2004 Clinic M = 35 S -- 44 26 -- CPT comm. errors -- -- -- -0.43 -- -- Tucha 2008 Clinic M = 35 S varies 63 19 12 mean comm., mult tasks 0.26 1.29* 0.69 -0.20 -0.28 0.14 Willcutt 2011b Comm 18 - 24 P & S 110 92 110 16 composite 0.47* 0.49* 0.16 -0.02 0.31* 0.33 Pooled results Overall Hedges' g: 0.41* 0.94* .34 -0.09 0.04 0.26



Classic fail-safe N / Orwin's fail-safe N: 9 / 3 23 / 11 -- -- -- -- Egger's regression intercept: ns ns -- ns -- -- Trim and fill missing studies (lower or higher than point estimate): 1 (lower) 0 -- 2 (higher) -- -- Trim and fill adjusted g: 0.38* 0.94* -- 0.00 -- --

Note: Summary statistics for the meta-analysis are described in detail in Supplement section 2. CPT = continuous performance test, SSRT = stop-signal reaction time. aComm = community sample, Clinic = clinic-referred sample. bP = parent, S = self, O = other observer, BE = best estimate summary from multiple sources of data. cPositive effect sizes indicate that the group listed first performed worse on the neuropsychological measure, and negative effect sizes indicate that the group listed second performed worse. dinsufficient data available to calculate effect size. * = P < .05




Study Typea range

Raterb

Cont Comb Type

Inatt Type

H-I Type

Measure

ADHD-C vs. Control

ADHD-I vs. Control

ADHD-H vs. Control

ADHD-C vs. ADHD-I

ADHD-C vs. ADHD-H

ADHD-I vs. ADHD-H

PROCESSING AND NAMING SPEED Studies of children and adolescents Bauerm. 2005a Comm 6 - 11 P & T 25 33 21 -- Stroop correct 0.79* 0.98* -- -0.20 -- -- Chhabild. 2001d Comm 8 - 18 P & T 82 33 63 14 Trails A+B time 0.54* 1.02* -0.23 -0.52* 0.81* 1.16* Chhabild. 2001d Comm 8 - 18 P & T 82 33 63 14 WISC-R Coding 1.59* 1.32* -0.01 0.08 1.57* 1.20* Chiang 2008 Clinic 7 - 10 P 52 52 17 -- Trails A time 0.67* 0.36 -- 0.39 -- -- Hinshaw 2002a Clinic 6 - 12 P & T 88 93 47 -- WISC-III Proc. Speed 0.52* 0.59* -- -0.05 -- -- Hinshaw 2002b Clinic 6 - 12 P & T 88 93 47 -- RAN proportion correct 0.53* 0.37* -- 0.18 -- -- Houghton 1999d Clinic 6 - 12 CL 28 62 32 -- Trails A time -0.06 0.12 -- -0.21 -- -- Houghton 1999d Clinic 6 - 12 CL 28 62 32 -- Stroop word naming 0.57* 0.68* -- -0.04 -- -- Houghton 1999d Clinic 6 - 12 CL 28 62 32 -- Stroop color naming 0.70* 0.32 -- 0.40 -- -- Keage 2006e Clinic 7 - 17 CL 75 42 33 -- Trails A time 0.33 0.44* -- -0.12 -- -- Keage 2006f Clinic 7 - 17 CL 54 30 24 -- Trails A time 0.61* 0.34 -- 0.25 -- -- Krane 2001 Clinic 6 - 18 P & T 24 94 56 38 WISC-III Proc. Speed 0.72* 0.90* 0.55* -0.13 0.15 0.28 Lockwood 2001d Clinic 6 - 12 CL -- 20 20 -- Trails A time -- -- -- 0.28 -- -- Lockwood 2001d Clinic 6 - 12 CL -- 20 20 -- Trails A time -- -- -- 0.15 -- -- Loo 2007d Comm 16 - 18 P & T 165 66 72 37 Trails A time 0.60* 0.65* 0.31 -0.08 0.30 0.35* Loo 2007d Comm 16 - 18 P & T 165 66 72 37 WAIS-III Coding 0.84* 1.09* 0.61* -0.28 0.18 0.42 Loo 2007d Comm 16 - 18 P & T 165 66 72 37 WAIS-III Symbol Search 0.42* 0.77* 0.65* -0.34* -0.22 0.13 Nigg 2002ad Comm 7 - 12 P & T 41 46 18 -- Trails A time 0.41* 0.79* -- -0.31 -- -- Nigg 2002ad Comm 7 - 12 P & T 41 46 18 -- Stroop color naming 0.83* 0.67* -- 0.10 -- -- Nigg 2002ad Comm 7 - 12 P & T 41 46 18 -- Stroop word naming 1.14* 1.12* -- -0.01 -- -- Pasini 2007d Clinic 8 - 14 P 44 25 25 -- Trails A time 0.40 -0.21 -- 0.53 -- -- Pasini 2007d Clinic 8 - 14 P 44 25 25 -- Stroop color naming -0.05 0.29 -- -0.37 -- -- Riccio 2006 Clinic 9 - 15 P & T -- 27 13 -- WISC-III Proc. Speed -- -- -- -0.31 -- -- Schmitz 2002d Comm 12 - 16 P & S 60 10 10 10 Stroop word naming 0.10 0.62 -0.25 -0.32 0.35 0.46 Schmitz 2002d Comm 12 - 16 P & S 60 10 10 10 Stroop color naming 0.08 1.29* 0.14 -0.81* -0.06 0.78* Sem-Cl 2010a Clinic 9 - 16 BE 113 74 78 -- D-KEFS Color Naming -0.03 0.39 -- -0.47 -- -- Willcutt 2011a Comm 8 - 18 P & T 288 135 235 40 Proc. Speed composite 1.12* 1.05* 0.33 0.11 0.76* 0.72* Wodka 2008a Clinic 8 - 16 P -- 33 19 -- D-KEFS Trails -- -- -- -0.84* -- --




Study Typea range

Raterb

Cont Comb Type

Inatt Type

H-I Type

Measure

ADHD-C vs. Control

ADHD-I vs. Control

ADHD-H vs. Control

ADHD-C vs. ADHD-I

ADHD-C vs. ADHD-H

ADHD-I vs. ADHD-H

PROCESSING AND NAMING SPEED CONTINUED Studies of children and adolescents Pooled results Overall Hedges' g: 0.61* 0.67* 0.31* -0.04 0.45* 0.57*


Ngroup 1 / Ngroup 2: 742 / 1,058 681 / 1,058 139 / 619 844 / 753 338 / 139 436 / 139 Cochrane's Q, I2: 37.8*, 65%g 37.4*, 65%h 5.9, 32% 20.3, 21% 16.8, 76% 8.7, 53%

Classic fail-safe N / Orwin's fail-safe N: 273 / 25 545 / 40 6 / 3 -- 17 / 7 33 / 10 Egger's regression intercept: ns ns ns ns ns ns Trim and fill missing studies (lower or higher than point estimate): 0 0 1 (higher) 0 0 0 Trim and fill adjusted g: 0.61* 0.67* 0.38* -0.04 0.45* 0.57* Studies of adults Riccio 2005 Clinic 18 - 35 S -- 18 14 -- WAIS III Proc. Speed -- -- -- no SDi -- -- Willcutt 2011b Comm 18 - 24 P & S 110 92 110 16 composite 0.61* 0.52* 0.00 -0.15 0.60* 0.75* Pooled results Overall Hedges' g: 0.61* 0.52* 0.00 -0.15 0.60* 0.75*

[95% CI]: [0.34, 0.88] [0.27, 0.77] [-0.95, 0.95] [-0.43, 0.13] [0.07, 1.13] [0.23, 1.27] Number of significant effects / total effects: 1 / 1 1 / 1 0 / 1 0 / 2 1 / 1 1 / 1

Ngroup 1 / Ngroup 2: 92 / 110 110 / 110 16 / 110 92 / 110 92 / 16 110 / 16

Note: Summary statistics for the meta-analysis are described in detail in Supplement section 2. D-KEFS = Dellis-Kaplan Executive Function System, RAN = rapid automatized naming, WAIS = Wechsler Adult Intelligence Scale, WISC = Wechsler Intelligence Scale for Children. aComm = community sample, Clinic = clinic-referred sample. bP = parent, T = teacher, CL = clinician, S = self, BE = best estimate summary from multiple sources of data, Chart = chart review. cPositive effect sizes indicate that the group listed first performed worse on the neuropsychological measure, and negative effect sizes indicate that the group listed second performed worse. dmultiple effects reported by the study were combined into a single effect size for meta-analysis (see Supplement section 2). echild sample. fadolescent sample. gheterogeneity due to significant outlier effect size reported by Willcutt (2011a); the overall effect size was lower (g = 0.56) but remained significant when this effect was excluded from the analysis. hheterogeneity due to significant outlier effect size reported by Pasini et al. (2007); the overall effect size was higher (g = 0.73) and significant when this effect was excluded from the analysis. iinsufficient data available to calculate effect size. * = P < .05




Study Typea range

Raterb

Cont Comb Type

Inatt Type

H-I Type

Measure

ADHD-C vs. Control

ADHD-I vs. Control

ADHD-H vs. Control

ADHD-C vs. ADHD-I

ADHD-C vs. ADHD-H

ADHD-I vs. ADHD-H

REACTION TIME Studies of children and adolescents Bedard 2003 Clinic 6 - 12 P & T 59 36 15 8 Stop-sig. go trial mean RT -0.09 -0.20 0.08 0.14 -0.21 -0.45 Bur-Murph 2007 Clinic 7 - 13 P --d 182 77 -- mean RT -- -- -- 0.16 -- -- Chiang 2008 Clinic 7 - 10 P 52 52 17 -- CPT hit RT 0.59* 0.40 -- 0.22 -- -- de Zeeuw 2008 Clinic 6 - 13 P & T 31 21 15 -- Stop-sig. go trial mean RT -1.57* -1.82* -- 0.67 -- -- Desman 2008 Clinic 8 - 12 P 6 6 6 -- CPT hit RT -1.04* 0.64 -- -1.41* -- -- Geurts 2005 Comm 6 - 13 P & T 16 16 16 -- Change task mean RT 0.14 -0.47 -- 0.52 -- -- Huang-Po. 2006 Comm 7 - 12 P & T 46 68 21 -- CPT hit RT 0.31 0.48 -- -0.15 -- -- Huang-Po. 2007 Clinic 7 - 12 P & T 36 23 33 -- Stop-sig. go trial mean RT -0.20 -0.17 -- -0.03 -- -- Johnstone 2001 Clinic 8 - 17 CL 50 50 50 -- auditory oddball hit RT 0.40* 0.24 -- 0.19 -- -- Johnstone 2007e Clinic 8 - 14 BE 15 13 13 -- Stop-signal Go RT 0.54 0.15 -- 0.41 -- -- Johnstone 2009e Clinic 8 - 14 BE 15 15 15 -- Go no go hit RT 0.30 0.04 -- 0.32 -- -- Keage 2006f Clinic 7 - 17 CL 75 42 33 -- Go no go mean RT 0.97* 0.56* -- 0.32 -- -- Keage 2006g Clinic 7 - 17 CL 54 30 24 -- Go no go mean RT 0.52* 0.21 -- 0.35 -- -- Loo 2007 Comm 16 - 18 P & T 165 66 72 37 Stop-sig. go trial mean RT -0.02 -0.24 -0.15 0.24 0.16 -0.10 Mullins 2005 Clinic 7 - 14 BE -- 10 7 -- SART mean RT -- -- -- 0.90 -- -- Nigg 2002a Comm 7 - 12 P & T 41 46 18 -- Stop-sig. go trial mean RT 0.44 0.63* -- -0.24 -- -- Querne 2009 Clinic 7 - 13 P & S 16 16 16 16 Mean RT 0.98* 0.97* 0.05 -0.10 1.02* 1.06* Solanto 2007 Clinic 7 - 12 P & T 20 36 26 -- CPT hit rt -0.19 -0.28 -- 0.09 -- -- Willcutt 2011a Comm 8 - 18 P & T 288 135 235 40 Stop-sig. go trial mean RT 0.25* 0.40* 0.14 -0.26 0.12 0.26




Study Typea range

Raterb

Cont Comb Type

Inatt Type

H-I Type

Measure

ADHD-C vs. Control

ADHD-I vs. Control

ADHD-H vs. Control

ADHD-C vs. ADHD-I

ADHD-C vs. ADHD-H

ADHD-I vs. ADHD-H

REACTION TIME CONTINUED

Pooled results Overall Hedges' g: 0.28* 0.22* 0.02 0.10 0.23 0.25 [95% CI]: [0.09, 0.47] [0.03, 0.41] [-0.20, 0.23] [-0.04, 0.24] [-0.15, 0.61] [-0.17, 0.67]

Number of significant effects / total effects: 8 / 15 4 / 16 0 / 4 1 / 18 1 / 4 1 / 4 Ngroup 1 / Ngroup 2: 637 / 939 597 / 939 101 / 528 850 / 709 253 / 101 348 / 101 Cochrane's Q, I2: 39.1,64%h 35.1, 60%h 1.4, 0% 24.6, 35% 6.4, 54% 7.9, 62%

Classic fail-safe N / Orwin's fail-safe N: 75 / 6 42 / 2 -- -- -- -- Egger's regression intercept: ns ns ns ns ns ns Trim and fill missing studies (lower or higher than point estimate): 0 0 2 (lower) 3 (lower) 1 (higher) 2 (higher) Trim and fill adjusted g: 0.29* 0.22* -0.10 0.07 0.34 0.26

Note: Summary statistics for the meta-analysis are described in detail in Supplement section 2. CPT = continuous performance test. aComm = community sample, Clinic = clinic-referred sample. bP = parent, T = teacher, CL = clinician, S = self, BE = best estimate summary from multiple sources of data. cPositive effect sizes indicate that the group listed first performed worse on the neuropsychological measure, and negative effect sizes indicate that the group listed second performed worse. dno control group without other disorders. emultiple effects reported by the study were combined into a single effect size for meta-analysis (see Supplement section 2). fchild sample. gadolescent sample. hSummary effect sizes do not include the outlying negative effect sizes reported by de Zeeuw et al. (2008) for comparisons of both ADHD-C and ADHD-I versus the control group; when these effects were included there was significant heterogeneity among the effects for both of these comparisons, and the estimated effect sizes were not significant (ADHD-I vs. control g = 0.13 and ADHD-C vs. control g = 0.04). * = P < .05




Study Typea range

Raterb

Cont Comb Type

Inatt Type

H-I Type

Measure

ADHD-C vs. Control

ADHD-I vs. Control

ADHD-H vs. Control

ADHD-C vs. ADHD-I

ADHD-C vs. ADHD-H

ADHD-I vs. ADHD-H

REACTION TIME CONTINUED

Studies of adults Egeland 2007 Clinic 15 - 46 BE -- 51 19 -- CPT hit RT -- -- -- -0.82* -- -- Epstein 2001 Clinic 18 - 65 S 30 10 14 1 CPT hit RT -- -- -- No ESd -- -- Murphy 2001 Clinic 17 - 28 P & S -- 60 36 -- CPT hit RT -- -- -- No ESd -- -- Riccio 2005 Clinic 18 - 35 S -- 18 14 -- CPT omission errors -- -- -- No ESd -- -- Solanto 2004 Clinic M = 35 S -- 22 14 -- CPT hit RT -- -- -- 0.44 -- -- Tucha 2008 Clinic M = 35 S varies 63 19 12 mean RT, mult tasks 0.67* 1.02* 0.61 0.09 0.02 0.11 Pooled results Overall Hedges' g: 0.67* 1.02* 0.61 -0.13 0.02 0.11




Trim and fill missing studies (lower or higher than point estimate): -- -- -- 0 -- -- Trim and fill adjusted g: -- -- -- -0.13 -- --

Note: Summary statistics for the meta-analysis are described in detail in Supplement section 2. CPT = continuous performance test. aComm = community sample, Clinic = clinic-referred sample. bP = parent, S = self, BE = best estimate summary from multiple sources of data. cPositive effect sizes indicate that the group listed first performed worse on the neuropsychological measure, and negative effect sizes indicate that the group listed second performed worse. dinsufficient data available to calculate effect size. * = P < .05




Study Typea range

Raterb

Cont Comb Type

Inatt Type

H-I Type

Measure

ADHD-C vs. Control

ADHD-I vs. Control

ADHD-H vs. Control

ADHD-C vs. ADHD-I

ADHD-C vs. ADHD-H

ADHD-I vs. ADHD-H

RESPONSE VARIABILITY Studies of children and adolescents Bedard 2003 Clinic 6 - 12 P & T 59 36 15 8 Stop-signal Go trial RTSD 0.68* 0.53 0.82* 0.16 -0.06 0.22 Bur-Murph 2007 Clinic 7 - 13 P -- 182 77 -- ERP task mean RT -- -- -- 0.22 -- -- de Zeeuw 2008 Clinic 6 - 13 P & T 31 21 15 -- Coefficient of variability 2.01* 0.70* -- 0.85* -- -- Desman 2008 Clinic 8 - 12 P 6 6 6 -- CPT hit SD of RT 0.44* 1.28* -- -0.79 -- -- Geurts 2005 Comm 6 - 13 P & T 16 16 16 -- Stop-signal Go trial RTSD 0.65 -0.14 -- 0.75* -- -- Huang-Po. 2006 Comm 7 - 12 P & T 46 68 21 -- CPT hit SD of RT 0.64* 0.66* -- 0.00 -- -- Huang-Po. 2007 Clinic 6 - 12 P & T 36 23 33 -- Stop-signal Go trial RTSD 0.31 0.39 -- -0.07 -- -- Johnstone 2007 Clinic 8 - 14 BE 15 13 13 -- Stop-signal Go RT 0.74 0.15 -- 0.62* -- -- Keage 2006d Clinic 7 - 17 CL 75 42 33 -- Go no go SD of RT 1.33* 0.69* -- 0.50* -- -- Keage 2006e Clinic 7 - 17 CL 54 30 24 -- Go no go SD of RT 0.29 0.32 -- -0.05 -- -- Loo 2007 Comm 16 - 18 P & T 165 66 72 37 Stop-signal Go trial RTSD 0.62* 0.43* 0.40* 0.14 0.20 0.04 Martel 2007 Comm 13 - 18 P & T 97 42 43 -- Stop-signal Go trial RTSD 0.75* 0.39* -- 0.31 -- -- Pasini 2007 Clinic 8 - 14 P 44 25 25 -- CPT II Variability 0.87* 0.37 -- 0.36 -- -- Querne 2009 Clinic 7 - 13 P & S 16 16 16 16 Mean RTSD 1.46* 1.46* 0.34 0.10 0.98* 0.97* Solanto 2007 Clinic 7 - 12 P+T 20 36 26 -- CPT hit SD of RT 0.81* 0.69* -- 0.12 -- -- Willcutt 2011a Comm 8 - 18 P & T 288 135 235 40 Stop-signal Go trial RTSD 0.88* 0.82* 0.52* 0.01 0.34* 0.32* Pooled results Overall Hedges' g: 0.81* 0.55* 0.48* 0.18* 0.33* 0.32*

[95% CI]: [0.62, 1.00] [0.40, 0.71] [0.26, 0.70] [0.05, 0.31] [0.02, 0.65] [0.00, 0.65] Number of significant effects / total effects: 11 / 15 8 / 15 3 / 4 3 / 17 2 / 4 2 / 4

Ngroup 1 / Ngroup 2: 575 / 968 593 / 968 101 / 528 773 / 686 453 / 161 338 / 101 Cochrane's Q, I2: 34.1, 59% 24.1, 42% 1.2, 0% 18.6, 19% 4.7, 36% 5.1, 41%

Classic fail-safe N / Orwin's fail-safe N: 689 / 46 333 / 29 15 / 6 24 / -- 4 / 3 1 / 3 Egger's regression intercept: ns ns ns ns ns ns Trim and fill missing studies (lower or higher than point estimate): 3 (higher) 0 0 0 0 0 Trim and fill adjusted g: 0.92* 0.54* 0.48* 0.19* 0.33* 0.32*

Note: Summary statistics for the meta-analysis are described in detail in Supplement section 2. CPT = continuous performance test. aComm = community sample, Clinic = clinic-referred sample. bP = parent, T = teacher, CL = clinician, S = self, BE = best estimate summary from multiple sources of data. cPositive effect sizes indicate that the group listed first performed worse on the neuropsychological measure, and negative effect sizes indicate that the group listed second performed worse. dchild sample. eadolescent sample. * = P < .05




Study Typea range

Raterb

Cont Comb Type

Inatt Type

H-I Type

Measure

ADHD-C vs. Control

ADHD-I vs. Control

ADHD-H vs. Control

ADHD-C vs. ADHD-I

ADHD-C vs. ADHD-H

ADHD-I vs. ADHD-H

RESPONSE VARIABILITY CONTINUED Studies of adults Egeland 2007 Clinic 15 - 46 BE -- 51 19 -- CPT hit RT SE -- -- -- 0.95* -- -- Epstein 2001 Clinic 18 - 65 S 30 10 14 1 CPT RT SE -- -- -- No ESd -- -- Murphy 2001 Clinic 17 - 28 P & S -- 60 36 -- CPT hit RT SE -- -- -- No ESd -- -- Riccio 2005 Clinic 18 - 35 S -- 60 36 -- CPT hit RT SE -- -- -- No ESd -- -- Solanto 2004 Clinic M = 35 S -- 22 14 -- CPT hit RT SE -- -- -- -0.65* -- -- Tucha 2008 Clinic M = 35 S varies 63 19 12 mean RT SD, mult tasks 0.63* 0.95* 0.33 0.00 -0.03 0.02 Willcutt 2011b Comm 18 - 24 P & S 110 92 110 16 composite 0.59* 0.40* 0.01 0.05 0.56* 0.39 Pooled results Overall Hedges' g: .60* 0.48* 0.11 0.08 0.29 0.26

[95% CI]: [.38, .82] [0.23, 0.73] [-0.33, 0.55] [-0.47, 0.62] [-0.29, 0.97] [-0.16, 0.68] Number of significant effects / total effects: 2 / 2 2 / 2 0 / 2 2 / 4 1 / 2 0 / 2



Trim and fill missing studies (lower or higher than point estimate): -- -- -- 1 (higher) -- -- Trim and fill adjusted g: -- -- -- 0.31 -- --





Study Typea range

Raterb

Cont Comb Type

Inatt Type

H-I Type

Measure

ADHD-C vs. Control

ADHD-I vs. Control

ADHD-H vs. Control

ADHD-C vs. ADHD-I

ADHD-C vs. ADHD-H

ADHD-I vs. ADHD-H

VIGILANCE Studies of children and adolescents Bauerm. 2005a Comm 6 - 11 P & T 25 33 21 -- Omission errors No ESd No ESd -- No ESd -- -- Bur-Murph 2007 Clinic 7 - 13 P -- 75 182 -- Omission Errors -- -- -- 0.08 -- -- Campbell 2009 Pop 7 - 9 P & T 790 57 80 -- Omission errors 0.52* 0.49* -- 0.11 -- -- Chhabild. 2001 Comm 8 - 18 P & T 82 33 63 14 Omission errors 1.05* 0.99* 0.61 -0.19 0.43 0.47* Collings 2003 Comm 8 - 10 P 24 35 11 Omission errors 0.57* -0.14 -- 0.56 -- -- Desman 2008 Clinic 8 - 12 P 6 6 6 -- Omission errors 1.02* 0.59 -- 0.72 -- -- Egeland 2009 Clinic 9 - 16 P & T 65 40 27 -- Omission errors 0.70* 0.45 -- 0.25 -- -- Hinshaw 2002b Clinic 6 - 12 P & T 88 93 47 Omission errors 0.51 0.38 -- 0.21 -- -- Huang-Po. 2006 Comm 7 - 12 P & T 46 68 21 -- Omission errors 0.75* 0.91* -- -0.23 -- -- Johnstone 2007 Clinic 8 - 14 CL 15 13 13 -- Omission errors 1.19* 1.33* -- 0.17 -- -- Keage 2006e Clinic 7 - 17 CL 75 42 33 Omission errors 1.06* 0.43* -- 0.50* -- -- Keage 2006f Clinic 7 - 17 CL 54 30 24 Omission errors 0.63* 0.46 0.11 Loo 2007 Comm 16 - 18 P & T 165 66 72 37 Omission errors 0.17 -0.03 -0.24 0.19 0.35* 0.34* Pasini 2007 Clinic 8 - 14 P 44 25 25 -- Detectability 0.53 0.28 -- 0.24 -- -- Paternite 1996 Clinic 6 - 12 P -- 59 28 9 Omission errors -- -- -- No ESd No ESd No ESd

Solanto 2007 Clinic 7 - 12 P & T 20 31 25 -- Attentiveness (d') 0.46 0.37 -- 0.10 -- -- Tandon 2009 Clinic 3 - 5 P -- 20 7 21 Omission errors -- -- -- No ESd No ESd No ESd

Willcutt 2011a Comm 8 - 18 P & T 288 135 235 40 Omission errors 0.63* 0.76* 0.27 -0.13 0.37* 0.50* Pooled results Overall Hedges' g: 0.64* 0.51* 0.17 0.09 0.37* 0.44*

[95% CI]: [0.50, 0.78] [0.32, 0.69] [-0.28, 0.63] [-0.02, 0.20] [0.13, 0.62] [0.21, 0.67] Number of significant effects / total effects: 11 / 15 7 / 15 0 / 3 1 / 18 2 / 5 3 / 5

Ngroup 1 / Ngroup 2: 679 / 1,762 682 / 1,762 91 / 535 861 / 760 234 / 91 370 / 91 Cochrane's Q, I2: 23.4, 45% 38.1*, 66%g 7.5, 73% 15.3, 9% 0.0, 0% 0.4, 0%

Classic fail-safe N / Orwin's fail-safe N: 513 / 33 320 / 27 -- 5 / -- 4 / 4 7 / 5 Egger's regression intercept: ns ns ns P = .03 ns ns Trim and fill missing studies (lower or higher than point estimate): 2 (lower) 0 1 (lower) 4 (lower) 1 (lower) 0 Trim and fill adjusted g: 0.62* 0.51* 0.01 0.04 0.36 0.44*

Note: Summary statistics for the meta-analysis are described in Supplement section 2. aComm = community sample, Clinic = clinic sample. bP = parent, T = teacher, CL = clinician. cPositive effect sizes indicate that the group listed first performed worse, and negative effect sizes indicate that the group listed second performed worse. dinsufficient data available to calculate effect size. echild sample. fadolescent sample. gheterogeneity due to significant outlier effect sizes from studies by Johnstone et al. (2009) and Loo et al. (2007); when these effects were excluded g = .57. * = P < .05




Study Typea range

Raterb

Cont Comb Type

Inatt Type

H-I Type

Measure

ADHD-C vs. Control

ADHD-I vs. Control

ADHD-H vs. Control

ADHD-C vs. ADHD-I

ADHD-C vs. ADHD-H

ADHD-I vs. ADHD-H

VIGILANCE CONTINUED Studies of adults Egeland 2007 Clinic 15 - 46 BE -- 51 19 -- CPT omission errors -- -- -- -0.96* -- -- Epstein 2001 Clinic 18 - 65 S 30 10 14 1 CPT hit RT SE -- -- -- No ESd -- -- Murphy 2001 Clinic 17 - 28 P & S -- 60 36 -- CPT omission errors -- -- -- No ESd -- -- Riccio 2005 Clinic 18 - 35 S -- 18 14 -- CPT omission errors -- -- -- No ESd -- -- Solanto 2004 Clinic M = 35 S -- 22 14 -- CPT omission errors -- -- -- -0.75* -- -- Tucha 2008 Clinic M = 35 S varies 63 19 12 mean across measures 0.67* 0.86* 0.63 0.09 -0.34 -0.48 Willcutt 2011b Comm 18 - 24 P & S 110 92 110 16 composite 0.49* 0.77* 0.10 -0.12 0.36 0.35 Pooled results Overall Hedges' g: .56* 0.78* 0.27 -0.41 0.06 -0.03

[95% CI]: [.34, .78] [0.53, 1.03] [-0.24, 0.78] [-0.87, 0.04] [-0.34, 0.47] [-0.83, 0.78] Number of significant effects / total effects: 2 / 2 2 / 2 0 / 2 2 / 4 0 / 2 0 / 2



Trim and fill missing studies (lower or higher than point estimate): -- -- -- 1 (higher) -- -- Trim and fill adjusted g: -- -- -- -0.25 -- --





Study Typea range

Raterb

Cont Comb Type

Inatt Type

H-I Type

Measure

ADHD-C vs. Control

ADHD-I vs. Control

ADHD-H vs. Control

ADHD-C vs. ADHD-I

ADHD-C vs. ADHD-H

ADHD-I vs. ADHD-H

MOTOR Studies of children and adolescents Bauerm. 2005a Comm 6 - 11 P & T 25 33 21 -- Kaufman SS 0.96* 0.85* -- 0.17 -- -- Hinshaw 2002bd Clinic 6 - 12 P & T 88 93 47 -- Pegboard time 0.44* 0.56* -- -0.13 -- -- Hinshaw 2002bd Clinic 6 - 12 P & T 88 93 47 -- TTD-20 time 0.35* 0.47* -- -0.16 -- -- Loo 2007 Comm 16 - 18 P & T 165 66 72 37 NEPSY Tapping speed 0.02 0.36* 0.27 -0.34* -0.26 0.10 Piek 1999d Comm 8 - 11 P 16 16 16 -- MABC manual dexterity 0.61* 1.28* -- -0.55 -- -- Piek 1999d Comm 8 - 11 P 16 16 16 -- MABC balance 1.60* 0.86* -- 0.41 -- -- Piek 1999d Comm 8 -11 P 16 16 16 -- MABC ball skills 0.77* 0.83 -- 0.37 -- -- Pitcher 2003d Comm 7 - 12 P 39 38 50 16 mean for motor tasks 0.55* 0.71* 0.43 -0.10 0.29 0.40 Reiersen 2008e Comm 7 - 19 P 312 3 12 3 CBCL items 0.53 1.12* 1.01 -0.35 -0.18 0.06 Reiersen 2008f Comm 7 - 19 P 410 39 61 11 CBCL items 0.96* 0.55* 0.24 0.30 0.57 0.26 Sem-Cl 2010cd Clinic 9 - 16 BE 113 76 80 -- Purdue Pegboard 0.30* 0.41* -- -0.10 -- -- Sem-Cl 2010cd Clinic 9 - 16 BE 113 76 80 -- Tapping -0.26 0.07 -- -0.39 -- -- Pooled results Overall Hedges' g: 0.51* 0.55* 0.34* -0.10 0.06 0.21

[95% CI]: [0.20, 0.82] [0.38, 0.73] [0.07, 0.60] [-0.26, 0.07] [-0.34, 0.46] [-0.04, 0.42] Number of significant effects / total effects: 5 / 8 7 / 8 0 / 4 1 / 8 0 / 4 0 / 4

Ngroup 1 / Ngroup 2: 364 / 1,168 359 / 1,168 67 / 926 364 / 359 146 / 67 195 / 67 Cochrane's Q, I2: 31.4, 77%g 11.8, 41% 1.7, 0% 8.1, 14% 4.6, 34% 1.1, 0%

Classic fail-safe N / Orwin's fail-safe N: 77 / 13 131 / 14 4 / 3 -- -- -- Egger's regression intercept: ns P = .02 ns ns ns ns Trim and fill missing studies (lower or higher than point estimate): 0 3 (lower) 1 (lower) 0 0 0 Trim and fill adjusted g: 0.51* 0.46* 0.30 -0.10 0.06 0.21

Note: Summary statistics for the meta-analysis are described in detail in Supplement section 2. CBCL = Child Behavior Checklist, MABC = Movement Assessment Battery for Children, NEPSY = A Developmental NEuroPSYchological Assessment, TTD-20 = Time To Do 20. aComm = community sample, Clinic = clinic-referred sample. bP = parent, T = teacher, BE = best estimate summary from multiple sources of data. cPositive effect sizes indicate that the group listed first performed worse on the neuropsychological measure, and negative effect sizes indicate that the group listed second performed worse. dmultiple effects reported by the study were combined into a single effect size for meta-analysis (see Supplement section 2). efemale. fmale. gheterogeneity due to significantly larger effects on measures of gross motor or overall motor functioning (g = .71) versus fine-motor functioning (tapping, pegboard; g = .14). * = P < .05




Study Typea range

Raterb

Cont Comb Type

Inatt Type

H-I Type

Measure

ADHD-C vs. Control

ADHD-I vs. Control

ADHD-H vs. Control

ADHD-C vs. ADHD-I

ADHD-C vs. ADHD-H

ADHD-I vs. ADHD-H

PLANNING Studies of children and adolescents Bauerm. 2005a Comm 6 - 11 P & T 25 33 21 -- TOH points 0.93* 0.64* -- 0.32 -- -- Campbell 2009 Comm 7 - 9 P & T 790 57 80 -- TOH Solutions 0.71* 0.54* -- 0.18 -- -- Geurts 2005 Comm 6 - 13 P & T 16 16 16 -- TOL beta exec. 0.32 0.43 -- -0.06 -- -- Harrier 2005 Comm 8 - 12 Sch 85 31 33 28 WJ-III Planning 0.22 0.35 0.12 -0.01 0.13 0.35 Hinshaw 2002b Clinic 6 - 12 P & T 88 93 47 -- Porteus Mazes test age 0.58* 0.60* -- 0.00 -- -- Houghton 1999 Clinic 6 - 12 CL 28 62 32 -- TOL raw 0.41 0.28 -- 0.13 -- -- Klorman 1999 Clinic 7 - 13 P 28 66 51 -- TOH solutions No ES*d No ESd -- No ES*d -- -- Kopecky 2005e Clinic 6 - 12 P & T 34 22 19 -- TOH Rule Violations 1.15* 0.68* -- 0.47 -- -- Kopecky 2005e Clinic 6 - 12 P & T 34 22 19 -- TOH Solutions 1.87* 0.89* -- 1.01* -- -- Nigg 2002a Comm 7 - 12 P & T 41 46 18 -- TOL points 0.76* 0.59* -- 0.14 -- -- O'Brien 2010 Clinic 8 - 13 P -- 35 21 -- Multiple measures -- -- -- 0.38f -- -- Pasini 2007 Clinic 8 - 14 P 44 25 25 -- TOL total 0.67* 0.41 -- 0.21 -- -- Riccio 2006 Clinic 9 - 15 P & T -- 27 13 -- Tower of London -- -- -- 0.25 -- -- Scheres 2004 Clinic 6 - 12 P 22 15 8 -- Tower of London No ES*d No ES*d -- No ESd -- -- Sem-Cl 2010a Clinic 9 - 16 BE 32 21 28 -- D-KEFS Tower -0.09 0.43 -- -0.45 -- -- Solanto 2007e Clinic 7 - 12 P+T 20 36 26 -- TOL move score 0.73* 0.38 -- 0.35* -- -- Solanto 2007e Clinic 7 - 12 P+T 20 36 26 -- TOL execution time 0.85* 0.88* -- -0.03 -- -- Solanto 2007e Clinic 7 - 12 P+T 20 36 26 -- TOL rule violations 0.79* -0.14 -- 0.93* -- --




Study Typea range

Raterb

Cont Comb Type

Inatt Type

H-I Type

Measure

ADHD-C vs. Control

ADHD-I vs. Control

ADHD-H vs. Control

ADHD-C vs. ADHD-I

ADHD-C vs. ADHD-H

ADHD-I vs. ADHD-H

PLANNING CONTINUED

Pooled results Overall Hedges' g: 0.61* 0.51* 0.12 0.12 0.13 0.35 [95% CI]: [0.41, 0.81] [0.38, 0.64] [-0.31, 0.55] [-0.02, 0.26] [-0.38, 0.64] [-0.15, 0.85]

Number of significant effects / total effects: 10 / 13 6 / 13 0 / 1 4 / 16 0 / 1 0 / 1 Ngroup 1 / Ngroup 2: 442 / 1,203 345 / 1,192 28 / 85 574 / 439 31 / 28 33 / 28 Cochrane's Q, I2: 22.4, 55% 3.3, 0% -- 23.2, 27% -- --

Classic fail-safe N / Orwin's fail-safe N: 216 / 27 129 / 21 -- -- -- -- Egger's regression intercept: ns ns -- ns -- --

Trim and fill missing studies (lower or higher than point estimate): 0 0 -- 5 (lower) -- -- Trim and fill adjusted g: 0.61* 0.51* -- 0.01 -- --

Studies of adults Riccio 2005 Clinic 18 - 35 S -- 18 14 -- TOL Total -- -- -- no SD -- --

Note: Summary statistics for the meta-analysis are described in Supplement section 2. D-KEFS = Dellis-Kaplan Executive Function System, TOH = Tower of Hanoi. TOL = Tower of London, WJ-III = Woodcock-Johnson Tests of Achievement , Third Edition. aComm = community sample, Clinic = clinic-referred sample. bP = parent, T = teacher, CL = clinician, S = self, BE = best estimate summary from multiple sources of data. cPositive effect sizes indicate that the group listed first performed worse on the neuropsychological measure, and negative effect sizes indicate that the group listed second performed worse. dinsufficient data available to calculate effect size. emultiple effects reported by the study were combined into a single effect size for meta-analysis (see Supplement section 2). feffect size estimated based on reported P value. * = P < .05




Study Typea range

Raterb

Cont Comb Type

Inatt Type

H-I Type

Measure

ADHD-C vs. Control

ADHD-I vs. Control

ADHD-H vs. Control

ADHD-C vs. ADHD-I

ADHD-C vs. ADHD-H

ADHD-I vs. ADHD-H

SET SHIFTING Studies of children and adolescents Chiang 2008 Clinic 7 - 10 P 52 52 17 -- Trails B time 0.55* 0.53* -- 0.05 -- -- Geurts 2005d Comm 6 - 13 P & T 16 16 16 -- Change task errors 0.86* 0.43 -- 0.54 -- -- Geurts 2005d Comm 6 - 13 P & T 16 16 16 -- WCST % pers. Errors 0.66* 0.18 -- 0.48 -- -- Hale 2009 Clinic M = 9 P 306 39 17 -- Trails B Errors 1.03* 0.39 -- 0.44 -- -- Houghton 1999d Clinic 6 - 12 CL 28 62 32 -- Trails B errors 0.11 0.24 -- -0.21 -- -- Houghton 1999d Clinic 6 - 12 CL 28 62 32 -- WCST pers. errors 0.42 0.16 -- 0.25 -- -- Keage 2006e Clinic 7 - 17 CL 75 42 33 -- Trails B errors 0.73* 0.40 -- 0.31 -- -- Keage 2006f Clinic 7 - 17 CL 75 42 33 -- Trails B errors 0.45* 0.34 -- 0.08 -- -- Klorman 1999 Clinic 7 - 13 P 28 66 51 -- WCST pers. errors 0.00 0.19 -- -0.20 -- -- Lockw. 2001d,g Clinic 6 - 12 CL -- 20 20 -- COWA rule violations -- -- -- 0.61* -- -- Lockw. 2001d,h Clinic 6 - 12 CL -- 20 20 -- COWA rule violations -- -- -- 1.18* -- -- Lockw. 2001d,g Clinic 6 - 12 CL -- 20 20 -- Trails B errors -- -- -- -0.21 -- -- Lockw. 2001d,h Clinic 6 - 12 CL -- 20 20 -- Trails B errors -- -- -- 1.03* -- -- Martel 2007 Comm 13 - 18 P & T 97 42 43 WCST Pers. Errors 0.43* 0.31* -- 0.10 -- -- Nigg 2002a Comm 7 - 12 P & T 41 46 18 -- Trails B time 0.52* 0.41* -- 0.21 -- -- Pasini 2007 Clinic 8 - 14 P 44 25 25 -- WCST pers. errors 0.55 0.54 -- 0.16 -- -- Riccio 2006 Clinic 9 - 15 P & T -- 27 13 -- Trails A and WCST -- -- -- -0.51 -- -- Scheres 2004 Clinic 6 - 12 P 22 15 8 -- WCST % pers. Errors -- -- -- No ESi -- -- Schmitz 2002 Comm 12 - 16 P & S 60 10 10 10 WCST pers. responses 0.07 -0.33 -0.14 0.52 0.27 -0.27 Sem-Cl 2010a Clinic 9 - 16 BE 113 74 78 -- D-KEFS Shifting 0.03 0.37 -- -0.33 -- -- Solanto 2007 Clinic 7 - 12 P & T 20 36 26 -- WCST pers. responses 0.54* 0.47 -- 0.06 -- -- Willcutt 2011a Comm 8 - 18 P & T 185 94 143 30 WCST pers. errors 0.48* 0.47* 0.01 -0.01 0.40* 0.40*




Study Typea range

Raterb

Cont Comb Type

Inatt Type

H-I Type

Measure

ADHD-C vs. Control

ADHD-I vs. Control

ADHD-H vs. Control

ADHD-C vs. ADHD-I

ADHD-C vs. ADHD-H

ADHD-I vs. ADHD-H

SET SHIFTING CONTINUED

Pooled results Overall Hedges' g: 0.46* 0.37* -0.03 0.11 0.38* 0.17 [95% CI]: [0.31, 0.61] [0.26, 0.48] [-0.36, 0.31] [-0.04, 0.25] [0.01, 0.75] [-0.46, 0.80]

Number of significant effects / total effects: 9 / 14 2 / 14 0 / 2 1 / 18 1 / 2 1 / 2 Ngroup 1 / Ngroup 2: 581 / 1,038 483 / 1,038 48 / 551 648/ 536 143 / 48 170 / 48 Cochrane's Q, I2: 22.2, 41% 7.0, 0% -- 22.3, 28% -- --


Trim and fill missing studies (lower or higher than point estimate): 0 0 -- 5 (lower) -- -- Trim and fill adjusted g: 0.46* 0.38* -- 0.00 -- --

Studies of adults Riccio 2005 Clinic 18 - 35 S -- 18 14 -- WCST Pers. Errors -- -- -- no SDi -- --

Note: Summary statistics for the meta-analysis are described in detail in Supplement section 2. COWA = Controlled Oral Word Association, D-KEFS = Dellis-Kaplan Executive Function System, WCST = Wisconsin Card Sorting Test. aComm = community sample, Clinic = clinic-referred sample. bP = parent, T = teacher, CL = clinician, S = self, BE = best estimate summary from multiple sources of data. cPositive effect sizes indicate that the group listed first performed worse on the neuropsychological measure, and negative effect sizes indicate that the group listed second performed worse. dmultiple effects reported by the study were combined into a single effect size for meta-analysis (see Supplement section 2). echild sample. fadolescent sample. gfemale. hmale. iinsufficient data available to calculate effect size. * = P < .05




Study Typea range

Raterb

Cont Comb Type

Inatt Type

H-I Type

Measure

ADHD-C vs. Control

ADHD-I vs. Control

ADHD-H vs. Control

ADHD-C vs. ADHD-I

ADHD-C vs. ADHD-H

ADHD-I vs. ADHD-H

SHORT-TERM MEMORY Studies of children and adolescents Bauerm. 2005a Comm 6 - 11 P & T 25 33 21 -- Simon 0.48 0.28 -- 0.18 -- -- Chiang 2008 Clinic 7 - 10 P 52 52 17 -- Digits Forward 0.45* 0.76* -- 0.16 -- -- Egeland 2009 Clinic 9 - 16 P & T 69 41 27 -- Digits Forward 0.04 0.44 -- -0.37 -- -- Geurts 2005d Comm 6 - 13 P & T 16 16 16 -- Benton Visual Retention 0.70* -0.34 -- 0.87* -- -- Geurts 2005d Comm 6 - 13 P & T 16 16 16 -- Corsi Blocks 0.42 0.53 -- -0.10 -- -- Hinshaw 2007 Clinic M = 14 P & T 80 83 39 -- Digits Forward 0.69* 0.47* -- 0.14 -- -- Huang-Po. 2009 Clinic 8 - 12 P & T 38 33 45 -- Digit Span 0.53* 0.30 -- 0.22 -- -- Lockwood 2001 Clinic 6 - 12 CL -- 20 20 -- Digits Forward -- -- -- 0.35 -- -- Lockwood 2001 Clinic 6 - 12 CL -- 20 20 -- Digits Forward -- -- -- 0.11 -- -- Loo 2007d Comm 16 - 18 P & T 165 66 72 37 Digit Span 0.51* 0.73* 0.41 -0.21 0.08 0.30 Loo 2007d Comm 16 - 18 P & T 165 66 72 37 Spatial Span 0.20 0.41* 0.34* -0.22 -0.14 0.08 Martin. 2006d Clinic 7 - 13 P & T 34 60 22 12 Spatial short-term mem. 1.01* 0.69* 0.64 0.23 0.33 0.07 Martin. 2006d Clinic 7 - 13 P & T 34 60 22 12 Verbal short-term mem. 0.44* 0.39 0.14 0.04 0.29 0.24 Pasini 2007 Clinic 8 - 14 P 44 25 25 -- Digits Forward 0.37 0.14 -- 0.22 -- -- Pasini 2007 Clinic 8 - 14 P 44 25 25 -- Corsi Blocks 0.17 -0.02 -- 0.15 -- -- Rosenthal 2006 Clinic 9 - 15 P & T 27 28 12 -- Digits Forward 0.20 -0.22 -- 0.40 -- -- Scheres 2004 Clinic 6 - 12 P 22 15 8 -- Corsi Blocks -- -- -- No ESe -- -- Schmitz 2002d Comm 12 - 16 P & S 60 10 10 10 Digit Span 1.45* 0.74* 0.18 0.98* 1.42* 0.54 Schmitz 2002d Comm 12 - 16 P & S 60 10 10 10 Word Span 0.45 0.00 -0.17 0.42 0.58 0.15 Solanto 2007 Clinic 7 - 12 P & T 20 31 25 -- Sternberg task -0.25 -.11 -- -.17 -- -- Weber 2007d Clinic 4 - 12 P & T -- 88 38 18 Digit Span -- -- -- -0.26 0.56* 0.86* Weber 2007d Clinic 4 - 12 P & T -- 88 38 18 Spatial Memory -- -- -- -0.23 0.75* 0.97* Willcutt 2011a Comm 8 - 18 P & T 288 145 235 40 Digits Forward 0.49* 0.46* 0.17 0.04 0.32 0.29




Study Typea range

Raterb

Cont Comb Type

Inatt Type

H-I Type

Measure

ADHD-C vs. Control

ADHD-I vs. Control

ADHD-H vs. Control

ADHD-C vs. ADHD-I

ADHD-C vs. ADHD-H

ADHD-I vs. ADHD-H

SHORT-TERM MEMORY CONTINUED Studies of children and adolescents Pooled results Overall Hedges' g: 0.42* 0.41* 0.25* 0.03 0.35* 0.35*


Ngroup 1 / Ngroup 2: 603 / 916 555 / 916 99 / 547 691 / 640 359 / 117 377 / 117 Cochrane's Q, I2: 18.3, 34% 13.4, 3% 1.4, 0% 13.9, 0% 6.6, 40% 4.7, 14%

Classic fail-safe N / Orwin's fail-safe N: 166 / 16 122 / 15 1 / 1 -- 9 / 4 8 / 4 Egger's regression intercept: ns ns ns ns ns ns Trim and fill missing studies (lower or higher than point estimate): 0 5 (higher) 0 4 (lower) 0 1 (higher) Trim and fill adjusted g: 0.42* 0.49* 0.25* -0.01 0.35* 0.36* Studies of adults Murphy 2001 Clinic 17 - 28 P & S -- 60 36 -- Simon -- -- -- No ESe -- -- Murphy 2001 Clinic 17 - 28 P & S -- 60 36 -- WAIS-III Digit Span -- -- -- No ESe -- -- Quinlan 2003 Clinic 16 - 69 S & O -- 68 96 12 WMS-R Prose Memory -- -- -- No ESe No ESe No ESe

Schweitz. 2006d Clinic M = 34 S & O 18 17 16 -- Digit Span 0.62* 0.82* -- -0.22 -- -- Schweitz. 2006d Clinic M = 34 S & O 18 17 16 -- Spatial Span 0.11 0.46 -- -0.18 -- -- Pooled results Overall Hedges' g: 0.34 0.64 -- -0.20 -- --

[95% CI]: [-0.31, 1.00] [-0.04, 1.31] -- [-0.85, 0.45] -- -- Number of significant effects / total effects: 0 / 1 1 / 1 -- 0 / 3 0 / 1 0 / 1

Ngroup 1 / Ngroup 2: 17 / 18 16 / 18 -- 17 / 16 -- -- Cochrane's Q, I2: [heterogeneity and publication bias analyses not conducted if < 3 studies]

Note: Summary statistics for the meta-analysis are described in detail in Supplement section 2. WAIS = Wechsler Adult Intelligence Scale, WMS-R = Wechsler Memory Scale, Revised. aComm = community sample, Clinic = clinic-referred sample. bO = other observer, P = parent, T = teacher, CL = clinician, S = self. cPositive effect sizes indicate that the group listed first performed worse on the neuropsychological measure, and negative effect sizes indicate that the group listed second performed worse. dmultiple effects reported by the study were combined into a single effect size for meta-analysis (see Supplement section 2). einsufficient data available to calculate effect size. * = P < .05




Study Typea range

Raterb

Cont Comb Type

Inatt Type

H-I Type

Measure

ADHD-C vs. Control

ADHD-I vs. Control

ADHD-H vs. Control

ADHD-C vs. ADHD-I

ADHD-C vs. ADHD-H

ADHD-I vs. ADHD-H

WORKING MEMORY Studies of children and adolescents Chiang 2008 Clinic 7 - 10 P 52 52 17 -- Digits Backward 0.35 0.35 -- 0.00 -- -- Geurts 2005 Comm 6 - 13 P & T 16 16 16 -- Self-ordered pointing 0.64 0.15 -- 0.48 -- -- Hinshaw 2007 Clinic M = 14 P & T 80 83 29 -- Digits Backward 0.40* 0.42* -- 0.05 -- -- Huang-Po. 2010 Comm 8 - 12 P & T 39 32 21 -- mean ES on multiple 0.78* 0.63* -- 0.22 -- -- Krane 2001 Clinic 6 - 18 P & T 24 94 56 38 WISC-III Free. From Dist. 1.09* 1.25* 0.91* 0.09 0.16 0.09 Lee 2008b Clinic 6 - 16 P & T 47 200 113 60 Digits Backward 0.84* 0.91* 0.81* -0.07 0.07 0.13 Lockwood 2001d Clinic 6 - 12 CL -- 20 20 -- Digits Backward -- -- -- 0.36 -- -- Lockwood 2001e Clinic 6 - 12 CL -- 20 20 -- Digits Backward -- -- -- 0.23 -- -- Loo 2007 Comm 16 - 18 P & T 165 66 72 37 WAIS Letter-Num Seq. 0.71* 0.63* 0.43* 0.07 0.24 0.17 Martinuss. 2006f Clinic 7 - 13 P & T 34 60 22 12 Verbal WM Task 0.73* 0.77* 0.55 0.00 0.10 0.11 Martinuss. 2006f Clinic 7 - 13 P & T 34 60 22 12 Spatial Working Memory 1.35* 0.94* 0.75 0.27 0.56 0.22 O'Brien 2010 Clinic 8 - 13 P -- 35 21 -- Multiple measures -- -- -- 0.38h -- -- Pasini 2007f Clinic 8 - 14 P 44 25 25 -- Digits Backward 0.72* 0.69* -- -0.04 -- -- Pasini 2007f Clinic 8 - 14 P 44 25 25 -- Phonological N Back 0.58* 0.69* -- -0.08 -- -- Pasini 2007f Clinic 8 - 14 P 44 25 25 -- Spatial N Back 0.31 0.14 -- 0.12 -- -- Pasini 2007f Clinic 8 - 14 P 44 25 25 -- Visual N Back 0.78* 0.40 -- 0.39 -- -- Rosenthal 2006 Clinic 9 - 15 P & T 27 28 12 -- Digits Backward 0.69* 0.31 -- 0.80* -- -- Scheres 2004 Clinic 6 - 12 P 22 15 8 -- Self-ordered pointing -- -- -- No ESg -- -- Willcutt 2011a Comm 8 - 18 P & T 288 135 235 40 composite 0.77* 0.92* 0.51* -0.10 0.27 0.41*




Study Typea range

Raterb

Cont Comb Type

Inatt Type

H-I Type

Measure

ADHD-C vs. Control

ADHD-I vs. Control

ADHD-H vs. Control

ADHD-C vs. ADHD-I

ADHD-C vs. ADHD-H

ADHD-I vs. ADHD-H

WORKING MEMORY CONTINUED Studies of children and adolescents Pooled results Overall Hedges' g: 0.71* 0.68* 0.61* 0.06 0.18* 0.21*


Ngroup 1 / Ngroup 2: 791 / 825 628 / 825 187 / 558 821 / 697 555 / 187 498 / 187 Cochrane's Q, I2: 13.0, 23% 19.0, 47% 3.7. 0% 12.2, 0% 1.2, 0% 2.1, 0%

Classic fail-safe N / Orwin's fail-safe N: 402 / 28 334 / 27 51 / 11 -- 2 / -- 2 / 1 Egger's regression intercept: ns ns ns P = .001 ns ns Trim and fill missing studies (lower or higher than point estimate): 2 (lower) 2 (higher) 2 (lower) 7 (lower) 2 (lower) 1 (higher) Trim and fill adjusted g: 0.65* 0.74* 0.50* -0.01 0.13 0.24* Studies of adults Riccio 2005 Clinic 18 - 35 S -- 18 14 -- WMS Working Memory -- -- -- No ESg -- -- Schweitz. 2006f Clinic M = 34 S & O 18 17 16 -- Letter-Number Seq. 0.94* 1.04* -- -0.12 -- -- Schweitz. 2006f Clinic M = 34 S & O 18 17 16 -- PASAT 0.84* 0.44 -- -0.40 -- -- Willcutt 2011b Comm 18 - 24 P & S 110 92 110 16 Composite 0.52* 0.46* 0.17 0.05 0.40 0.31 Pooled results Overall Hedges' g: 0.57* 0.49* 0.17 0.01 0.40 0.31


Ngroup 1 / Ngroup 2: 109 / 128 126 / 128 16 / 110 109 / 126 92 / 16 110 / 16 Cochrane's Q, I2: [heterogeneity and publication bias analyses not conducted if < 3 studies]

Note: Summary statistics for the meta-analysis are described in detail in Supplement section 2. PASAT = Paced Auditory Serial Addition Test, WAIS = Wechsler Adult Intelligence Scale, WISC = Wechsler Intelligence Scale for Children, WMS = Wechsler Memory Scale aComm = community sample, Clinic = clinic-referred sample. bP = parent, T = teacher, CL = clinician, S = self, BE = best estimate summary from multiple sources of data, Chart = chart review. cPositive effect sizes indicate that the group listed first performed worse on the neuropsychological measure, and negative effect sizes indicate that the group listed second performed worse. dfemales. emales. fmultiple effects reported by the study were combined into a single effect size for meta-analysis (see Supplement section 2). ginsufficient data available to calculate effect size. heffect size estimated based on reported P value. * = P < .05




Study Typea range

Raterb

Cont Comb Type

Inatt Type

H-I Type

Measure

ADHD-C vs. Control

ADHD-I vs. Control

ADHD-H vs. Control

ADHD-C vs. ADHD-I

ADHD-C vs. ADHD-H

ADHD-I vs. ADHD-H

INTERFERENCE CONTROL Studies of children and adolescents Houghton 1999 Clinic 6 - 12 BE 28 62 32 -- Stroop 0.11 0.29 -- -0.15 -- -- Martel 2007 Comm 13 - 18 P & T 97 42 43 -- Stroop 0.42* 0.40* -- -0.02 -- -- Nigg 2002a Comm 7 - 12 P & T 41 46 18 -- Stroop No ESd No ESd -- No ESd -- -- Pasini 2007 Clinic 8 - 14 P 44 25 25 -- Stroop 0.72* 0.65* -- 0.32 -- -- Riccio 2006 Clinic 9 - 15 P & T -- 27 13 -- Stroop -- -- -- -0.46 -- -- Scheres 2004 Clinic 6 - 12 P 22 12 12 -- Stroop -- -- -- No ESd -- -- Solanto 2007 Clinic 7 - 12 P & T 20 36 26 -- Stroop 0.66* 0.03 -- 0.63* -- -- Willcutt 2011a Comm 8 - 18 P & T 288 135 235 40 Stroop 0.09 0.07 0.20 0.02 -0.11 -0.12 Pooled results Overall Hedges' g: 0.34* 0.25* 0.20 0.06 -0.11 -0.12


Ngroup 1 / Ngroup 2: 300 / 477 361 / 477 40 / 288 327 / 374 135 / 40 235 / 40 -- Cochrane's Q, I2: 8.8, 54% 6.9, 42% N/A 9.2, 45% -- --


Trim and fill missing studies (lower or higher than point estimate): 2 (lower) 0 -- 0 -- -- Trim and fill adjusted g: 0.19 0.25* -- 0.04 -- --

Studies of adults Riccio 2005 Clinic 18 - 35 S -- 18 14 -- Stroop -- -- -- no ESd -- --

Note: Summary statistics for the meta-analysis are described in detail in Supplement section 2. aComm = community sample, Clinic = clinic-referred sample. bP = parent, T = teacher, BE = best estimate summary from multiple sources of data. cPositive effect sizes indicate that the group listed first performed worse on the neuropsychological measure, and negative effect sizes indicate that the group listed second performed worse. dinsufficient data available to calculate effect size. * = P < .05




Study Typea range

Raterb

Cont Comb Type

Inatt Type

H-I Type

Measure

ADHD-C vs. Control

ADHD-I vs. Control

ADHD-H vs. Control

ADHD-C vs. ADHD-I

ADHD-C vs. ADHD-H

ADHD-I vs. ADHD-H

DELAY AVERSION / DISCOUNTING Studies of children and adolescents Scheres 2010 Clinic 6 - 17 P 22 20 23 -- Temporal Discounting 0.61*d 0.04d -- 0.67*d -- -- Solanto 2007 Clinic 7 - 12 P & T 20 36 26 -- Choice Delay Task -0.09 -- 0.08 -- -- Willcutt 2011a Comm 8 - 18 P & T 144 63 103 19 Choice Delay Task 0.20 0.10 0.13 0.18 0.20 -0.02 Pooled results Overall Hedges' g: 0.24 0.11 0.13 0.25 0.20 -0.02

[95% CI]: [-0.09, 0.57] [-0.11, 0.32] [-0.32, 0.58] [-0.04, 0.53] [-0.29, 0.69] [-0.51, 0.47] Number of significant effects / total effects: 1 / 3 0 / 3 0 / 1 1 / 3 0 / 1 0 / 1


Classic fail-safe N / Orwin's fail-safe N: -- / 1 -- / -- -- -- / 1 -- -- Egger's regression intercept: ns ns -- ns -- --

Trim and fill missing studies (lower or higher than point estimate): 0 1 (lower) -- 0 -- -- Trim and fill adjusted g: 0.24 0.09 -- 0.25 -- --

Note: Summary statistics for the meta-analysis are described in detail in Supplement section 2. aComm = community sample, Clinic = clinic-referred sample. bP = parent, T = teacher. cPositive effect sizes indicate that the group listed first performed worse on the neuropsychological measure, and negative effect sizes indicate that the group listed second performed worse. deffect size estimated based on reported P value. * = P < .05


Supplement Table 14 Candidate gene studies of DSM-IV ADHD subtypes and symptom dimensions

Studies of DSM-IV Symptom Dimensions Studies of DSM-IV Subtypes Inatt Symptoms Hyp-Imp Symptoms ADHD-C ADHD-I ADHD-H

Significant Not Significant Significant Not Significant Significant Not Significant Significant Not Significant Not Siga

Adrenergic Receptor Genes

Adrenergic receptor α-1A (ADRA1A) 27 27 4

Adrenergic receptor α-1B (ADRA1B) 27 27 4

Adrenergic receptor α-2A (ADRA2A) 51,52,60,63,44 27 44,51 27,52,60 51,77 4,8,15,60,63 7b,66 8,15,51,60,63,77 8

Adrenergic receptor α-2C (ADRA2C) 27 27 15 4 15

Adrenergic receptor β-1 (ADRB1) 27 27 4



Dopamine System Genes

dopa decarboxylase (DDC) 27 27 4,59c,59d 15 15,59d 59c

Dopamine beta-hydroxylase (DBH) 27 27 15,62 3,4 15 3 3

Dopamine D1 receptor (DRD1) 41,48 27 27,41,48 4,15 15

Dopamine D2 receptor (DRD2) 27,65 27,65 4,15,53,72 15,50,72 53,72

Dopamine D3 receptor (DRD3) 27 27 15 4 15 Dopamine D4 receptor (DRD4) 13e,26,64 1,2,13f,21,47,70 1,24,64 2,13e,f,21,47,70 24,55,64 5,15,18,21,49,68,74,

70,80 5,46,55,64 15,18,21,49,68,

74,70,80 18,21,74,

67,80 Dopamine D5 receptor (DRD5) 27,70 27,70 18g,40h 18g,40h 18,40h

Dopamine Transporter (DAT1) 13e,50 1,13f,19,26,27,28, 34,61,76,79

1,34,50,76 13e,19,26,27,28,61,79

4,12,55,76 6,15,18,23,26,49,71 55 12,15,18,23,49,71,76

18,23,71,

Serotonin System Genes

Serotonin receptor 1A (5-HT1A) 59c,59d 59c,59d

Serotonin receptor 1B (5-HT1B) 17,27 17,27 59d 15,38,59c,69 15,38,59c,59d,69

Serotonin receptor 1D (5-HT1D) 39,59d 59c 59c 39,59c

Serotonin receptor 1E (5-HT1E) 27 27 4, 59c,59d 59c,59d

Serotonin receptor 1F (5-HT1F) 59c,59d 59c 59d

Serotonin receptor 2A (5-HT2A) 27 27 59c,59d 4 59c,59d

Serotonin receptor 2B (5-HT2B) 59c,59d 59c,59d

Serotonin receptor 2C (5-HT2C) 27 27 35 4, 15, 59c,59d 15,35,59c,59d

Serotonin receptor 3A (5-HT3A) 59c,59d 59c 59d

Serotonin receptor 3B (5-HT3B) 27 27 59c 4,59d 59c,59d

Serotonin receptor 3C (5-HT3C) 27 27 4

Serotonin receptor 4 (5-HT4) 59c,59d 59c,59d

Serotonin receptor 5A (5-HT5A) 59c,59d 59c,59d





Serotonin receptor 6 (5-HT6) 59c,59d 59d 59c

Serotonin receptor 7 (5-HT7) 59c 59d 59c,59d

Serotonin Transporter (SLC6A4) 14,20,27,42,78,82 14,20,27,37,42,78,82 42 59d 37,59c,59d

neurotr. tyrosine rec. kinase 1 (NTRK1) 58c 58d 58c 58d 58c,58d

neurotr.tyrosine rec. kinase 2 (NTRK2) 58c,58d 58d 58c 58c,58d

neurotr. tyrosine rec. kinase 3 (NTRK3) 58c 58d 58c 58d 58c,58d

neurotrophin 3 (NTF3) 58d 58c 58d 58c 58c,58d

neurotrophin 4/5 (NTF4/5) 58c, 58d 58c, 58d 58c,58d

Tryptophan hydroxylase 1 (TPH1) 36,59d 59c 36,59c,59d 36

Tryptophan hydroxylase 2 (TPH2) 27 27 4,44 44 Other Candidate Genes

Beta-adren. rec. kinase 1 (ADRBK1) 27 27 4

Beta-adren. rec. kinase 2 (ADRBK2) 27 27 4

arrestin, β-1 (ARRB1) 27 27 4

arrestin, β-2 (ARRB2) 27 27 4

brain-derived neurotroph. fact. (BDNF) 25,33 27 27,33 25 4,15,58c,58d 58c, 58d 15 58c, 58d

Calcyon (DRD1IP) 31 31 15 15 catechol-O-methyltransferase (COMT) 16,27,57 16,27 57 4,15,43,53,54,56 56,54i 15,53,54j 53,54j Choline Transporter (SLC5A7) 10 10

Ciliary neurotroph. factor rec. (CNTFR) 58d 58c 58c, 58d 58c, 58d

Circadian locomotor output cycles prot. 22 22

Ciliary neurotrophic factor (CNTF) 58c 58d 58cc, 58d 58c, 58d

Casein kinase 1 epsilon (CSNK1E) 27 27 4

DARPP-32 30 30

Fatty acid desaturase 1 (FADS1) 27 27 4

Fatty acid desaturase 2 (FADS2) 27 27 4

G protein subunit Gαolf (GNAL) 29 29

GABA transporter (SLC6A1) 27 27 4

Transcription factor HES-1 (HES1) 27 27 4

Transcription factor HES-6 (HES6) 27 27 4

Monoamine oxidase A (MAOA) 4 15,56,59c,59d 15 56,59c,59d Monoamine oxidase B (MAOB) 59c 4,15,59d 59c 15,59d Nerve growth factor (NGF) 58c,58d 58c,58d 58c, 58d





Nerve growth factor receptor (NGFR) 58c,58d 58c, 58d 58c, 58d

Nuclear receptor subfam. 4, A2 (NR4A2) 27 27 4

Nicotinic acetylchol. rec. α-4 (CHRNA4) 27 32 32 27 4,32 15,73 15,73 32

NMDAR 2B subunit (GRIN2B) 9 9

Norepinephrine transporter (SLC6A2) 27 57,81 81 27,57 4,15 15

interleukin-3 (NFILS) 27 27 4

Period circadian prot. homolog 1 (PER1) 27 27 4

Period circadian prot. homol. 2 (PER2) 27 27 4

Phenylethanol. N-methyltransf. (PNMT) 27 27 4

Solute carrier fam. 9, mem. 9 (SLC9A9) 27 45 27,45 4

Solute carr. fam. 18, mem. 2 (SLC18A2) 27 27 4

Synaptophysin (SYP) 27 27 4 15 15

Synaptosomal-assoc. prot. 25 (SNAP-25) 11, 27 26 11, 27 26 4,11,15 15 11 11

Synaptotagmin-1 (SYT1) 27 27 15 4 15

Syntaxin 1A (STX1A) 27 27 4,15 15 Vesicle-assoc. memb. protein 2 (VAMP2) 27 27 4,15 15

Note: Numbers indicate specific studies: 1. Auerbach 2010, 2. Bellgrove 2005, 3. Bellgrove 2006, 4. Brookes 2006, 5. Cheuk 2006a, 6. Cheuk 2006b, 7. da Silva 2008, 8. Deupree 2006, 9. Dorval 2007, 10. English 2009, 11. Feng 2005, 12. Genro 2007, 13. Gizer 2008, 14. Grevet 2007, 15. Guan 2009, 16. Halleland 2009, 17. Ickowicz 2007, 18. Johansson 2008, 19. Kahn 2003, 20. Kim 2005, 21. Kirley 2004, 22. Kissling 2008, 23. Langley 2005, 24. Lasky-Su 2007a, 25. Lasky-Su 2007b, 26. Lasky-Su 2008a, 27. Lasky-Su 2008b, 28. Laucht 2007, 29. Laurin 2008a, 30. Laurin 2008b, 31. Laurin 2005, 32. Lee 2008, 33. Lee 2007b, 34. Lee 2007a, 35. Li 2006a, 36. Li 2006b, 37. Li 2007, 38. Li 2005, 39. Li 2006, 40. Lowe 2004, 41. Luca 2007, 42. Manor 2001, 43. Manor 2000, 44. Manor 2008, 45. Markunas 2010, 46. McCracken 2000, 47. Mill 2002, 48. Misener 2004, 49. Neuman 2007, 50. Ouellet-Morin 2008, 51. Park 2004, 52. Polanczyk 2007, 53. Qian 2007, 54. Qian 2003, 55. Qian 2004, 56. Qian 2009, 57. Retz 2008, 58. Ribases 2008, 59. Ribases 2009, 60. Roman 2006, 61. Roman 2001, 62. Roman 2002, 63. Roman 2003, 64. Rowe 1998, 65. Rowe 1999, 66. Schmitz 2006, 67. Smalley 1998, 68. Smalley 2000, 69. Smoller 2006, 70. Tahir 2000, 71. Todd 2001a, 72. Todd 2002, 73. Todd 2003, 74. Todd 2001b, 75. Waldman 2006, 76. Waldman 1998, 77. Wang 2006, 78. Wigg 2006, 79. Wohl 2008, 80. Yang 2008, 81. Yang 2004a, 82. Zhao 2005. aNo studies reported a significant association of any gene with ADHD-H. bGenotype predicted medication response. cadult sample. dchild sample. eparent ratings. fteacher ratings. gsignificant pooled effect for ADHD-C and ADHD-I when ADHD-H was excluded. hpooled result from a meta-analysis of 14 studies. imales. jfemales.


Supplement Table 15 Factor analytic studies of DSM-IV ADHD symptoms and putative sluggish cognitive tempo items

Study Description

Studya 1 2 2 3 3 4 5 5 6b 6c 7 7

Age range

Rater Parent Parent Teacher Parent Teacher Parent Parent Teacher Parent Parent Parent Teacher

Sample Size

Initial pool of potential SCT items 3 4 5 7 7 14 14 3 3 12 12

Items on final SCT factor 3 3 4 5 5 --d 8 7 3 --d 7 7

Potential SCT item Primary factor loading of potential SCT itemse

Forgetful (DSM-IV inatt. symptom) SCT -- -- Inatt Inatt -- Inatt Inatt Cross Inatt Inatt Inatt

Sluggish SCTf -- -- SCTg SCTg -- SCTh SCT SCTf Inattf SCTg SCTf

drowsy, sleepy SCTf -- -- SCT SCT -- SCTh,i SCTi SCTf Inattf SCT SCT

daydreams SCT SCTj SCTj SCTk SCTk Inattj SCTl SCT SCTk Inattk Crossk Crossj

stares blankly -- SCT SCT SCTk SCTk Inatt -- -- SCTk Inattk Crossk Crossj

Easily confused -- SCTm SCTm SCT SCT -- -- -- -- -- Cross SCT

Seems to be "in a fog" -- SCTm SCTm SCT SCT -- -- -- -- -- SCT SCT

Gets lost in own thoughts -- SCTj SCTj Inattj SCTl SCT -- -- -- --

low energy -- -- -- -- -- -- SCTl,n SCTn SCTo Inatto SCTn SCTm

apathetic -- -- SCTp -- -- -- Inattq Crossq -- -- SCTp SCTn

unmotivated -- -- SCTp -- -- -- Inatt Cross -- -- SCTp SCTn

underactive, slow moving -- -- -- -- -- -- SCTh,n SCTn -- -- SCTn SCTm

lethargic -- -- -- -- -- -- SCTh,p SCTr -- -- SCT SCT

yawning / stretching / sleepy-eyed -- -- -- -- -- -- SCTh SCT -- -- -- --

Slow in completing tasks -- -- -- SCTg SCTg Inatt Inatt SCT -- -- -- --

In a world of his/her own -- -- -- -- -- -- Cross SCT -- -- -- --

a1. McBurnett 2001; 2. Garner 2010; 3. Hartman 2004; 4. Lahey 2004a, 5. Penny 2009; 6. Todd 2004, 7. Willcutt 2011. bmales. cfemales. dno separate SCT factor emerged. eprimary factor loading of the item. Inatt = DSM-IV inattention, SCT = sluggish cognitive tempo. Cross = cross-loaded on inattention and SCT factors. f"sluggish, drowsy" administered as a single item. gItem was "sluggish, slow to respond". hSCT factor = "sleepy". iPenny 2009 item was "drowsy". j"daydreams, gets lost in thoughts" were administered as a single item. k"daydreams, stares blankly" administered as a single item.lSCT factor = "daydreamer". m"confused, in a fog" administered as a single item. n"underactive, slow moving, lacks energy" administered as a single item. oincluded as part of item with "sluggish and drowsy".

Supplemental Materials, Validity of DSM-IV ADHD, Willcutt et al. 178 p"apathetic, unmotivated" administered as a single item. qitem was "apathetic, shows little interest in things or activities". rItem also included "tired".

Supplement Table 16 Studies of the relation between DSM-IV ADHD and ratings of sluggish cognitive tempo

Correlations between parent and teacher ratings of SCT and DSM-IV inattention and hyperactivity-impulsivity

Age

SCT Correlation with DSM-IV

Symptom Dimensionc Significant difference Study Samplea N Range Raterb Inattention Hyp-Imp between dimensionsd

Garner 2010e Clinic 258 7 - 9 P .42* .25* Inatt > Hyp-Imp Garner 2010e Clinic 276 7 - 9 T .55* .03 Inatt > Hyp-Imp Hartman 2004e Comm 286 8 - 18 P .75* .51* Inatt > Hyp-Imp Hartman 2004e Comm 286 8 - 18 T .76* .18* Inatt > Hyp-Imp Penny 2009e Comm 325 4 - 13 P .85* .45* Inatt > Hyp-Imp Penny 2009e Comm 266 4 - 13 T .85* .35* Inatt > Hyp-Imp Todd 2004 Comm 1,414 6 - 14 P .36* .21* Inatt > Hyp-Imp Willcutt 2011 Comm 698 8 - 18 P & T .58* .30* Inatt > Hyp-Imp

Overall r [95% CI] .64 [.43, .79]* .29 [.20, .37]* Inatt > Hyp-Imp k (total N) 5 (2,999) 5 (2,999)

Cochrane's Q / I2 256.1, 98% 23.4, 82% Fail-safe N: 1,652 / 26 279 / 9

Egger's regression intercept: ns ns Trim and fill number of missing studies: 0 0

Trim and fill adjusted r: .64* .29*

aComm = community sample, Clinic = clinic-referred sample. bP = parent, T = teacher. cAll effects are scaled so that positive correlations indicate that higher ADHD symptoms are associated with higher levels of SCT. dSignificant difference between correlations, P < .05. emultiple effects reported by the study were combined into a single effect size for meta-analysis (see Supplement section 2).

* = P < .05


Supplement table 17

Mean levels of SCT symptoms in groups with and without DSM-IV ADHD

Sample Age Sample Size Effect Size (Hedges' g) for comparisons between groups

Study Typea Range SCT

Raterb

Cont Comb. Type

Inatt. Type

H-I Type

ADHD-C vs. Control

ADHD-I vs. Control

ADHD-H vs. Control

ADHD-C vs. ADHD-I

ADHD-C vs. ADHD-H

ADHD-I vs. ADHD-H

Bauerm. 2005ad Comm 6 - 11 P 29 44 25 -- 1.14* 1.79* -- -0.56* -- -- Bauerm. 2005ad Comm 6 - 11 T 29 44 25 -- 1.97* 5.12* -- -1.24* -- -- Harrington 2010 Clinic 5 - 18 P 63 124 81 23 1.78* 2.65* 0.40 -0.06 1.39* 2.05* Hartman 2004d Comm 8 - 18 P 210 21 45 10 2.36* 2.64* 0.33 -0.23 1.27* 1.59* Hartman 2004d Comm 8 - 18 T 210 21 45 10 1.22* 2.21* 0.16 -0.84 1.05* 1.51* Mikami 2007 Clinic 7 - 12 P 38 23 45 -- 1.28* 1.92* -- -0.55* -- -- McBurnett 2001 Clinic 3 - 17 P & T 82 33 67 14 No ES*e No ES*e No ESe No ES*e No ES*e No ES*e

Willcutt 2011 Comm 8 - 18 P & T 288 135 235 40 1.79* 1.68* 0.33 -0.16 1.14* 1.16* Overall g: 1.71* 2.34* 0.34* -0.26* 1.23* 1.56* [95% CI]: [1.55, 1.87] [1.81, 2.88] [0.09, 0.59] [-0.41, -0.12] [0.96, 1.51] [0.98, 2.15]

Number of significant effects / total effects 6 / 6 6 / 6 0 / 4 4 / 6 4 / 4 4 / 4 Ngroup 1 / Ngroup 2: 347 / 628 431 / 628 73 / 561 347 / 431 280 / 73 361 / 73 Cochrane's Q, I2 3.5, 0% 34.3, 88%f 0.0, 0% 11.5, 65% 0.7, 0% 7.6, 74%

Fail-safe N: 471 / 46 802 / 65 3 / 2 20 / 2 53 / 21 83 / 28 Egger's regression intercept: ns ns ns ns ns ns Trim and fill missing studies: 1 (higher) 0 1 (higher) 2 (higher) 0 0

Trim and fill adjusted g: 1.75* 2.36* 0.36* -0.19* 1.23* 1.57*

Note: Summary statistics for the meta-analysis are described in detail in Supplement section 2. aComm = community. bP = parent, T = teacher. cPositive effect sizes indicate that the group listed first had higher levels of SCT, and negative effect sizes indicate that the group listed second had higher levels of SCT. dmultiple effects reported by the study were combined into a single effect size for meta-analysis (see Supplement section 2). einsufficient data available to calculate effect size. fsignificant heterogeneity due to the outlying large effect size reported for teacher ratings in the study by Bauermeister et al. (2005). The overall effect size was reduced when this effect was excluded (g = 2.16), but the overall effect remained significant and all interpretation remained the same.

* = P < .05


SUPPLEMENT SECTION 5: CITATIONS FOR ALL STUDIES INCLUDED IN THE REVIEW Acosta, M. T., Castellanos, F. X., Bolton, K. L., Balog, J. Z., Eagen, P., Nee, L., . . . Muenke, M. (2008). Latent class subtyping of

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Adams, Z. W., Milich, R., & Fillmore, M. T. (2010). Examining Manual and Visual Response Inhibition Among ADHD Subtypes. Journal of Abnormal Child Psychology, 38, 971-983.

Adewuya, A. O., & Famuyiwa, O. O. (2007). Attention deficit hyperactivity disorder among Nigerian primary school children: prevalence and co-morbid conditions. European Child and Adolescent Psychiatry, 16, 10-15.

Adler, L. A., Faraone, S. V., Spencer, T. J., Michelson, D., Reimherr, F. W., Glatt, S. J., . . . Biederman, J. (2008). The reliability and validity of self- and investigator ratings of ADHD in adults. Journal of Attention Disorders, 11, 711-719.

Alexander, D. M., Hermens, D. F., Keage, H. A., Clark, C. R., Williams, L. M., Kohn, M. R., . . . Gordon, E. (2008). Event-related wave activity in the EEG provides new marker of ADHD. Clinical Neurophysiology, 119, 163-179.

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Althoff, R. R., Copeland, W. E., Stanger, C., Derks, E. M., Todd, R. D., Neuman, R. J., . . . Hudziak, J. J. (2006). The latent class structure of ADHD is stable across informants. Twin Research and Human Genetics, 9, 507-522.

Amador-Campos, J. A., Forns-Santacana, M., Guardia-Olmos, J., & Pero-Cebollero, M. (2006). DSM-IV attention deficit hyperactivity disorder symptoms: Agreement between informants in prevalence and factor structure at different ages. Journal of Psychopathology and Behavioral Assessment, 28, 23-32.

Angold, A., & Costello, E. J. (1995). A test-retest reliability study of child-reported psychiatric symptoms and diagnoses using the Child and Adolescent Psychiatric Assessment (CAPA-C). Psychological Medicine, 25, 755-762.

Antshel, K. M., & Remer, R. (2003). Social skills training in children with attention deficit hyperactivity disorder: a randomized-controlled clinical trial. Journal of Clinical Child and Adolescent Psychology, 32, 153-165.

Arabgol, F., Panaghi, L., & Hebrani, P. (2009). Reboxetine versus methylphenidate in treatment of children and adolescents with attention deficit-hyperactivity disorder. European Child and Adolescent Psychiatry, 18, 53-59.

Arnold, L. E., Amato, A., Bozzolo, H., Hollway, J., Cook, A., Ramadan, Y., . . . Manos, M. (2007). Acetyl-L-carnitine (ALC) in attention-deficit/hyperactivity disorder: a multi-site, placebo-controlled pilot trial. Journal of Child and Adolescent Psychopharmacology, 17, 791-802.

Aron, A. R., Dowson, J. H., Sahakian, B. J., & Robbins, T. W. (2003). Methylphenidate improves response inhibition in adults with attention-deficit/hyperactivity disorder. Biological Psychiatry, 54, 1465-1468.

Auerbach, J. G., Atzaba-Poria, N., Berger, A., Landau, R., Arbelle, S., Raz, Y., & Ebstein, R. (2010). Dopamine risk and paternal ADHD symptomatology associated with ADHD symptoms in four and a half-year-old boys. Psychiatric Genetics, 20, 160-165.

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Baldwin, J. S., & Dadds, M. R. (2008). Examining Alternative Explanations of the Covariation of ADHD and Anxiety Symptoms in Children: A Community Study. Journal of Abnormal Child Psychology, 36, 67-79.

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Bauermeister, J. J., Canino, G., Polanczyk, G., & Rohde, L. A. (2010). ADHD across cultures: Is there evidence for a bimodal organization of symptoms? Journal of Clinical Child and Adolescent Psychology, 39, 362-372.

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Biederman, J., Melmed, R. D., Patel, A., McBurnett, K., Donahue, J., & Lyne, A. (2008). Long-term, open-label extension study of guanfacine extended release in children and adolescents with ADHD. CNS Spectrums, 13, 1047-1055.

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Biederman, J., & Pliszka, S. R. (2008). Modafinil improves symptoms of attention-deficit/hyperactivity disorder across subtypes in children and adolescents. Journal of Pediatrics, 152, 394-399.

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