Authors retract, replace highly cited paper on ADHD in kids

Researchers have retracted and replaced a 2014 paper in JAMA Psychiatry, exploring a new way to classify attention deficit hyperactivity disorder (ADHD) in children, after discovering errors in the data.

Some experts have criticized the current diagnostic criteria for ADHD—noting, in some cases, it could inflate the rate of diagnosis. Sarah L. Karalunas, the paper’s corresponding author, told Retraction Watch that the aim of the study was to look beyond current criteria and “demonstrate an approach that could be used to better delineate the boundaries of ADHD and other psychiatric diagnostic categories.”  

In the 2014 paper, the authors reported a new way to classify subgroups of ADHD in children based on their temperament. To better understand the biological factors that may contribute to the disorder, the authors analyzed how children reacted—how their heart rate, breathing and neural function varied—when watching short film clips aimed at eliciting different emotional responses. The 2014 work was highlighted in Live Science as potentially setting the stage for “improving the classification of mental-health disorders.”

But, the authors discovered errors in the data that resulted in “significant changes” to some of the findings.

Karalunas, an assistant professor of psychiatry at Oregon Health and Science University in Portland, explained that a postdoctoral fellow who had been working with some of the data from the 2014 paper noticed inconsistencies in the way that artifacts (or outliers) in the heart rate data had been detected and removed:

She brought it to our attention and we immediately took steps to reprocess and recheck the data. … Unfortunately our routine data checks did not identify the inconsistent application.

According to Karalunas, the reanalysis did not change the main conclusions of the manuscript:

…that temperament profiles may be one promising way to group children with ADHD (or other disorders) and that temperament-based groups show distinct patterns of central and peripheral nervous system response and predict clinical course.

Dost Öngür, the journal’s editor-in-chief, told us:

We did not have a reason to believe that this was more than an honest error.

Öngür said the authors informed him of the errors in late 2017; in early March, the journal retracted the paper and replaced it with a corrected version:

We believe publication of this corrected (replaced) article was the appropriate response given that the study itself is not invalid and the authors have been forthcoming and accountable.

According to the retraction notice for “Subtyping Attention-Deficit/Hyperactivity Disorder Using Temperament Dimensions: Toward Biologically Based Nosologic Criteria:”

The reanalysis of corrected data yielded changes in statistical significance of results reported for some PEP (physiological, sympathetic system) findings, requiring corrected parameter values but without altering primary interpretations of the data. Changes in patterns of statistical significance were also identified in respiratory sinus arrhythmia (physiological, parasympathetic) results, and those did alter the interpretation of those findings. … The main conclusions that temperament profiles in children with ADHD are associated with meaningful differences in both central and peripheral nervous system, and longitudinal course remain unchanged but with additional qualification to the peripheral nervous system findings.

The paper has been cited 74 times, and was deemed highly cited by Clarivate Analytics’ Web of Science, meaning it was ranked in the top 1 percent of all papers in its field for the year it was published.

We asked an outside expert about the potential impact of the work on ADHD diagnosis and treatment. Gretchen LeFever Watson, a psychologist who has researched overtreatment of ADHD, said she does not believe that identifying correlations between physiological measures and behavior will improve ADHD diagnosis in children:

Just because researchers can document correlations between physiological measures and behavior does not mean that the behavior is caused by genetics or immutable neurological abnormalities. … The behaviors associated with ADHD occur in everyone and fluctuate tremendously.

Karalunas, however, explained that although this research has not yet influenced clinical practice, she and her coauthors believe it could eventually help the field revise existing diagnostic categories and improve clinical decision making:

As one example, this work is part of a larger effort in the field to clarify the role of emotion in ADHD and whether emotionality should be formally considered during diagnostic assessment.

Journals are increasingly using retract and replace to correct papers affected by honest but pervasive errors. However, a recent analysis identified problems with how journals and databases manage such cases, citing inconsistencies in indexing practices as a particular concern.

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