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Article ; Online: Near-Miss Events Detected Using the Emergency Department Trigger Tool.

Griffey, Richard T / Schneider, Ryan M / Todorov, Alexandre A

2023 Volume 19, Issue 2, Page(s) 59–66

Abstract: Objectives: Near misses include conditions with potential for harm, intercepted medical errors, and events requiring monitoring or intervention to prevent harm. Little is reported on near misses or their importance for quality and safety in the ... ...

Abstract	Objectives: Near misses include conditions with potential for harm, intercepted medical errors, and events requiring monitoring or intervention to prevent harm. Little is reported on near misses or their importance for quality and safety in the emergency department (ED). Methods: This is a secondary evaluation of data from a retrospective study of the ED Trigger Tool (EDTT) at an urban, academic ED (data from October 1, 2014, to October 31, 2015; 92,859 eligible visits). All patients 18 years and older completing a visit were eligible. We ran the EDTT, a computerized query for triggers on 13 months of ED visit data, reviewing 5582 selected records using a 2-tiered approach. Events were categorized by occurrence (ED vs present on arrival [POA]), severity, omission/commission, and type, using a taxonomy with categories, subcategories, and cross-cutting modifiers. Results: We identified 1458 ED near misses in 1269 of 5582 records (22.7%) and 80 near misses that were POA. Patient care events represented most ED near misses, including delays in diagnosis, treatment, and failure to monitor, primarily driven by ED boarding and crowding. Medication events were second most common (17%), including 80 medication administration errors. Of 80 POA events, 42% were related to overanticoagulation. We estimate that 19.3% of all ED visits include a near miss. Conclusions: Near-miss events are relatively common (22.7% of our sample, 19.3% in the population) and are associated with an increased risk for an adverse event. Most events were patient care related (77%) involving delays due to crowding and ED boarding followed by medication administration errors. The EDTT is a high-yield approach for detecting important near misses and latent system deficiencies that impact patient safety.
MeSH term(s)	Humans ; Near Miss, Healthcare ; Retrospective Studies ; Medical Errors/prevention & control ; Emergency Service, Hospital ; Patient Safety
Language	English
Publishing date	2023-01-07
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	2394324-5
ISSN	1549-8425 ; 1549-8417
ISSN (online)	1549-8425
ISSN	1549-8417
DOI	10.1097/PTS.0000000000001092
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Article ; Online: Emergency Department Adverse Events Detected Using the Emergency Department Trigger Tool.

Griffey, Richard T / Schneider, Ryan M / Todorov, Alexandre A

Annals of emergency medicine

2022 Volume 80, Issue 6, Page(s) 528–538

Abstract: Study objective: The Emergency Department Trigger Tool (EDTT) is a novel approach to adverse event detection in the ED. We previously described the derivation, validation, and high-level performance of this tool. Here we further detail adverse events ... ...

Abstract	Study objective: The Emergency Department Trigger Tool (EDTT) is a novel approach to adverse event detection in the ED. We previously described the derivation, validation, and high-level performance of this tool. Here we further detail adverse events detected to demonstrate the utility of the EDTT and how it might be used for quality improvement. Methods: This is a secondary analysis of data from a retrospective observational study. We ran the EDTT (a computerized query for triggers) on 13 months of ED visit data, reviewing 5,582 selected records using a typical 2-tiered trigger tool approach. The adverse events detected were categorized by place of occurrence (in the ED versus present on arrival), severity, omission/commission, and type using a taxonomy with categories, subcategories, and up to 3 cross-cutting modifiers. We present adverse event data in detail, focusing in turn on each of these descriptors (severity, event types, and cross-cutting themes) and highlight opportunities identified for targeted improvement. Results: We identified 458 adverse events occurring in the ED for a 13-month period, 10% of which required urgent intervention. Nearly all (90%) were acts of commission. Events resulting in harm were most often related to medications administered and patient care. Common cross-cutting event types included adverse events related to bleeding, opioids, and the use of propofol. Most adverse events (80%) led to temporary harm. Conclusion: The EDTT identifies a broad spectrum of adverse event types, allowing a review by severity, frequency, and type to better understand existing levels of harm in the ED and identify targets for quality improvement. A multicenter study of the EDTT is currently underway, which will contribute additional power and assess generalizability.
MeSH term(s)	Humans ; Emergency Service, Hospital ; Quality Improvement ; Retrospective Studies ; Analgesics, Opioid
Chemical Substances	Analgesics, Opioid
Language	English
Publishing date	2022-08-01
Publishing country	United States
Document type	Observational Study ; Multicenter Study ; Journal Article ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	603080-4
ISSN	1097-6760 ; 0196-0644
ISSN (online)	1097-6760
ISSN	0196-0644
DOI	10.1016/j.annemergmed.2022.05.037
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Article ; Online: The Emergency Department Trigger Tool: Validation and Testing to Optimize Yield.

Griffey, Richard T / Schneider, Ryan M / Todorov, Alexandre A

Academic emergency medicine : official journal of the Society for Academic Emergency Medicine

2020 Volume 27, Issue 12, Page(s) 1279–1290

Abstract: Objective: Recognized as a premier approach for adverse event (AE) detection, trigger tools have been developed for multiple clinical settings outside the emergency department (ED). We recently derived and tested an ED trigger tool (EDTT) with enhanced ... ...

Abstract	Objective: Recognized as a premier approach for adverse event (AE) detection, trigger tools have been developed for multiple clinical settings outside the emergency department (ED). We recently derived and tested an ED trigger tool (EDTT) with enhanced features for high-yield detection of harm, consisting of 30 triggers associated with AEs. In this study, we validate the EDTT in an independent sample and compare record selection approaches to optimize yield for quality improvement. Methods: This is a retrospective observational study using data from 13 months of visits to an urban, academic ED by patients aged ≥ 18 years (92,859 records). We conducted standard two-tiered trigger tool reviews on an independent validation sample of 3,724 records with at least one of the 30 triggers found associated with AEs in our previous derivation sample (N = 1,786). We also tested three new candidate triggers and reviewed 72 records with no triggers for comparison purposes. We compare derivation and validation samples on: 1) triggers showing persistent associations with AEs, 2) AE yield (AEs detected/records reviewed), and 3) representativeness of AE types detected. We use bivariate associations of triggers with AEs as the basis for trigger selection. We then use multivariable modeling in the combined derivation and validation samples to determine AE risk scores using trigger weights. This allows us to predict occurrence of AEs and derive population prevalence estimates. Finally, we compare yield for detection of AEs under three record selection strategies (random selection, trigger counts, weighted trigger counts). Results: Twenty-four of the 30 triggers were confirmed to be associated with AEs on bivariate testing. Three previously marginal triggers and two of three new candidate triggers were also found to be associated with AEs. The presence of any of these 29 triggers was associated with an AE rate of 10% in our selected sample (compared to 1.1% for none, p < 0.001). The risk of an AE increased with number of triggers. Combining data from both phases, we identified 461 AEs in 429 unique visits in 5,582 records reviewed. Our multivariable model (which emphasized parsimony) retained 12 triggers with a ROC AUC of 82% in both samples. Selecting records for review based on number of triggers improves yield to 14% for 4+ triggers (top 10% of visits) and to 28% for 8+ (top 1%). A weighted trigger count has corresponding yields of 18 and 38%. The method for selecting records for review did not appear to affect event-type representativeness, with similar distributions of event types and severities detected. Conclusions: In this single-site study of the EDTT we observed high levels of validity in trigger selection, yield, and representativeness of AEs, with yields that are superior to estimates for traditional approaches to AE detection. Record selection using weighted triggers outperforms a trigger count threshold approach and far outperforms random sampling from records with at least one trigger. The EDTT is a promising efficient and high-yield approach for detecting all-cause harm to guide quality improvement efforts in the ED.
MeSH term(s)	Adolescent ; Adult ; Aged ; Electronic Health Records ; Emergency Service, Hospital ; Humans ; Medical Errors/prevention & control ; Middle Aged ; Patient Safety ; Quality Improvement ; Retrospective Studies ; Young Adult
Language	English
Publishing date	2020-09-01
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, P.H.S. ; Validation Study
ZDB-ID	1329813-6
ISSN	1553-2712 ; 1069-6563
ISSN (online)	1553-2712
ISSN	1069-6563
DOI	10.1111/acem.14101
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Article ; Online: Adverse Events Present on Arrival to the Emergency Department: The ED as a Dual Safety Net.

Griffey, Richard T / Schneider, Ryan M / Todorov, Alexandre A

Joint Commission journal on quality and patient safety

2020 Volume 46, Issue 4, Page(s) 192–198

Abstract: Background: The emergency department (ED) is the natural venue for the provision of acute unscheduled care. However, little is known about the nature and proportion of this care that goes to addressing adverse events (AEs)-physical injury to a patient ... ...

Abstract	Background: The emergency department (ED) is the natural venue for the provision of acute unscheduled care. However, little is known about the nature and proportion of this care that goes to addressing adverse events (AEs)-physical injury to a patient due to health care that requires some intervention-that are present on arrival (POA) to the ED. Described here are AEs that are POA, and population prevalence estimates for these events. Methods: This retrospective observational study tested the ED Trigger Tool, using data from an urban academic medical center. Patients aged ≥18 completing an ED visit were eligible (N = 92,859). A total of 5,582 visits with triggers (findings that increase the likelihood of an AE) were reviewed using the two-tier trigger approach. AEs were categorized by severity, type, and whether they were POA. POA AEs, and sociodemographic and trigger associations with AEs are described. Results: Of 1,181 AEs identified, 718 (60.8%) were POA to the ED. Patients with POA AEs were more often white (51.1% vs. 39.7%, p < 0.001) and older (median age 62 vs. 50, p < 0.001). The majority of POA AEs were medication-related and patient care-related events. In the population at this center, POA AEs account for an estimated 7.6% of ED visits (95% confidence interval = 6.9%-8.2%). Conclusion: In this single-center study, the majority of AEs detected using the ED Trigger Tool were POA. These findings highlight the importance of the ED as a safety net for harm occurring across the health system.
MeSH term(s)	Emergency Service, Hospital ; Humans ; Middle Aged ; Retrospective Studies
Language	English
Publishing date	2020-01-18
Publishing country	Netherlands
Document type	Journal Article ; Observational Study ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	1189890-2
ISSN	1938-131X ; 1549-425X ; 1553-7250 ; 1070-3241 ; 1549-3741
ISSN (online)	1938-131X ; 1549-425X
ISSN	1553-7250 ; 1070-3241 ; 1549-3741
DOI	10.1016/j.jcjq.2019.12.003
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Article ; Online: The Emergency Department Trigger Tool: A Novel Approach to Screening for Quality and Safety Events.

Griffey, Richard T / Schneider, Ryan M / Todorov, Alexandre A

Annals of emergency medicine

2019 Volume 76, Issue 2, Page(s) 230–240

Abstract: Study objective: Trigger tools improve surveillance for harm by focusing reviews on records with "triggers" whose presence increases the likelihood of an adverse event. We refine and automate a previously developed emergency department (ED) trigger tool ...

Abstract	Study objective: Trigger tools improve surveillance for harm by focusing reviews on records with "triggers" whose presence increases the likelihood of an adverse event. We refine and automate a previously developed emergency department (ED) trigger tool and present record selection strategies to further optimize yield. Methods: We specified 97 triggers for extraction from our electronic medical record, identifying 76,894 ED visits with greater than or equal to 1 trigger. We reviewed 1,726 records with greater than or equal to 1 trigger, following a standard trigger tool review process. We validated query performance against manual review and evaluated individual triggers, retaining only those associated with adverse events in the ED. We explored 2 approaches to enhance record selection: on number of triggers present and using trigger weights derived with least absolute shrinkage and selection operator logistic regression. Results: The automated query performed well compared with manual review (sensitivity >70% for 80 triggers; specificity >92% for all). Review yielded 374 adverse events (21.6 adverse events per 100 records). Thirty triggers were associated with risk of harm in the ED. An estimated 10.3% of records with greater than 1 of these triggers would include an adverse event in the ED. Selecting only records with greater than or equal to 4 or greater than or equal to 9 triggers improves yield to 17% and 34.8%, respectively, whereas use of least absolute shrinkage and selection operator trigger weighting enhances the yield to as high as 52%. Conclusion: The ED trigger tool is a promising approach to improve yield, scope, and efficiency of review for all-cause harm in emergency medicine. Beginning with a broad set of candidate triggers, we validated a computerized query that eliminates the need for manual screening for triggers and identified a refined set of triggers associated with adverse events in the ED. Review efficiency can be further enhanced with enhanced record selection.
MeSH term(s)	Adult ; Aged ; Electronic Health Records ; Emergency Service, Hospital ; Female ; Humans ; Logistic Models ; Male ; Mass Screening ; Medical Errors/statistics & numerical data ; Medication Errors/statistics & numerical data ; Middle Aged ; Patient Harm/statistics & numerical data ; Patient Safety ; Quality Assurance, Health Care ; Risk Assessment ; Young Adult
Language	English
Publishing date	2019-10-14
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	603080-4
ISSN	1097-6760 ; 0196-0644
ISSN (online)	1097-6760
ISSN	0196-0644
DOI	10.1016/j.annemergmed.2019.07.032
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Article ; Online: The emergency department trigger tool: Multicenter trigger query validation.

Griffey, Richard T / Schneider, Ryan M / Kocher, Keith E / Kwok, Edmund S H / Salmo, Ellen / Malone, Nora / Smith, Carrie / Guarnacia, Catie / Rick, April / Clavet, Tamara / Asaro, Phil / Medlin, Rich / Todorov, Alexandre A

Academic emergency medicine : official journal of the Society for Academic Emergency Medicine

2024

Abstract: Objectives: We previously described derivation and validation of the emergency department trigger tool (EDTT) for adverse event (AE) detection. As the first step in our multicenter study of the tool, we validated our computerized screen for triggers ... ...

Abstract	Objectives: We previously described derivation and validation of the emergency department trigger tool (EDTT) for adverse event (AE) detection. As the first step in our multicenter study of the tool, we validated our computerized screen for triggers against manual review, establishing our use of this automated process for selecting records to review for AEs. Methods: This is a retrospective observational study of visits to three urban, academic EDs over 18 months by patients ≥ 18 years old. We reviewed 912 records: 852 with at least one of 34 triggers found by the query and 60 records with none. Two first-level reviewers per site each manually screened for triggers. After completion, computerized query results were revealed, and reviewers could revise their findings. Second-level reviewers arbitrated discrepancies. We compare automated versus manual screening by positive and negative predictive values (PPVs, NPVs), present population trigger frequencies, proportions of records triggered, and how often manual ratings were changed to conform with the query. Results: Trigger frequencies ranged from common (>25%) to rare (1/1000) were comparable at U.S. sites and slightly lower at the Canadian site. Proportions of triggered records ranged from 31% to 49.4%. Overall query PPV was 95.4%; NPV was 99.2%. PPVs for individual trigger queries exceeded 90% for 28-31 triggers/site and NPVs were >90% for all but three triggers at one site. Inter-rater reliability was excellent, with disagreement on manual screening results less than 5% of the time. Overall, reviewers amended their findings 1.5% of the time when discordant with query findings, more often when the query was positive than when negative (47% vs. 23%). Conclusions: The EDTT trigger query performed very well compared to manual review. With some expected variability, trigger frequencies were similar across sites and proportions of triggered records ranged 31%-49%. This demonstrates the feasibility and generalizability of implementing the EDTT query, providing a solid foundation for testing the triggers' utility in detecting AEs.
Language	English
Publishing date	2024-03-18
Publishing country	United States
Document type	Journal Article
ZDB-ID	1329813-6
ISSN	1553-2712 ; 1069-6563
ISSN (online)	1553-2712
ISSN	1069-6563
DOI	10.1111/acem.14873
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Book: Social neuroscience

Todorov, Alexander B. / Fiske, Susan T. / Prentice, Deborah A.

toward understanding the underpinnings of the social mind

(Oxford series in social cognition and social neuroscience)

2011

Author's details	ed. by Alexander Todorov ; Susan T. Fiske ; Deborah A. Prentice
Series title	Oxford series in social cognition and social neuroscience
Keywords	Cognitive neuroscience ; Social psychology
Subject code	612.8233
Language	English
Size	XIII, 312 S. : Ill., graph. Darst.
Publisher	Oxford Univ. Press
Publishing place	Oxford u.a.
Publishing country	Great Britain
Document type	Book
Note	Formerly CIP Uk. - Includes bibliographical references and index
HBZ-ID	HT016770305
ISBN	978-0-19-531687-2 ; 0-19-531687-8
Database	Catalogue ZB MED Medicine, Health

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Article ; Online: Post-Acute and Long-Term Care Patients Account for a Disproportionately High Number of Adverse Events in the Emergency Department.

Griffey, Richard T / Schneider, Ryan M / Adler, Lee / Todorov, Alexandre

Journal of the American Medical Directors Association

2020 Volume 22, Issue 4, Page(s) 907–912.e1

Abstract: Objectives: High rates of adverse events (AEs) are reported for post-acute and long-term care settings (PA/LTC: skilled nursing facilities, inpatient rehabilitation centers, long-term acute care facilities, and home health). However, emergency ... ...

Abstract	Objectives: High rates of adverse events (AEs) are reported for post-acute and long-term care settings (PA/LTC: skilled nursing facilities, inpatient rehabilitation centers, long-term acute care facilities, and home health). However, emergency department (ED)-based studies in this area are lacking. We describe all-cause harm among patients from PA/LTC settings seen in the ED. Design: Retrospective observational study using the ED Trigger Tool, with dual independent nurse reviews of 5582 ED records with triggers (findings increasing the likelihood of an AE) and confirmatory physician review of putative AEs. Setting and participants: We captured data for all adult patients at an urban, academic ED over a 13-month period (92,859 visits). PA/LTC patients were identified using a computerized ED Trigger Tool and manual review (κ = 0.85). Measures: We characterize the AEs identified by severity and type using the ED Taxonomy of Adverse Events, and whether the AE occurred in the ED or was present on arrival. We estimate population AE rates using inverse probability weighting. Results: Compared with non-PA/LTC patients, PA/LTC patients (4.4% of population; 8.2% of our sample) tended to be older (median age 69 vs 50 years), with comparable sex ratios (54% female overall). PA/LTC patients accounted for 21% of all AEs (26% present on arrival; 13% in ED). Rates of AEs occurring in the ED were comparable after matching on age. Present on arrival AEs from a PA/LTC setting were most commonly related to patient care (39%), medication (34%), and infections (16%). Conclusions and implications: PA/LTC patients account for a small proportion of ED visits but experience a disproportionate number of AEs that are primarily present on arrival and patient-care related, and contribute to an admission rate double that for non-PA/LTC patients. Arguably, this cohort represents PA/LTC patients with the most severe AEs. Understanding these AEs may help identify high-yield targets for quality improvement.
MeSH term(s)	Adult ; Aged ; Cohort Studies ; Emergency Service, Hospital ; Female ; Humans ; Long-Term Care ; Male ; Quality Improvement ; Retrospective Studies
Language	English
Publishing date	2020-08-11
Publishing country	United States
Document type	Journal Article ; Observational Study ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	2171030-2
ISSN	1538-9375 ; 1525-8610
ISSN (online)	1538-9375
ISSN	1525-8610
DOI	10.1016/j.jamda.2020.06.043
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Article ; Online: The impact of a perceptual learning module on novices' ability to visually estimate left ventricular ejection fraction by transesophageal echocardiography: a randomized controlled study.

Champagne, Philippe / Girard, François / Cyr, Véronique / Romanelli, Giovanni / Ruel, Monique / Todorov, Alexandre / Robitaille, Arnaud

Canadian journal of anaesthesia = Journal canadien d'anesthesie

2021 Volume 68, Issue 10, Page(s) 1527–1535

Abstract: Purpose: Echocardiography is a difficult tool to master. Competency requires the supervised interpretation of hundreds of exams. Perceptual learning modules (PLMs) are novel learning tools that aim to speed up this learning process by enabling learners ... ...

Title translation	L’impact d’un module d’apprentissage perceptuel sur la capacité de débutants à estimer visuellement la fraction d’éjection ventriculaire gauche par échocardiographie transœsophagienne : une étude randomisée contrôlée.
Abstract	Purpose: Echocardiography is a difficult tool to master. Competency requires the supervised interpretation of hundreds of exams. Perceptual learning modules (PLMs) are novel learning tools that aim to speed up this learning process by enabling learners to go online and interpret numerous clinical images, followed systematically by expert feedback. We developed and tested a PLM aimed at improving novices' ability to quickly visually estimate left ventricular ejection fraction (LVEF) on transesophageal echocardiography images, a critical skill in acute care. We hypothesized that using the PLM would improve the accuracy and the speed of learners' estimations. Methods: Learners without echocardiography experience were randomly assigned to a group that used the 96-case PLM (n = 26) or a control group (n = 26) that did not. Both groups took a pre-test and an immediate post-test that measured the accuracy of their visual estimations during a first session. At six months, participants also completed a delayed post-test. Results: In the immediate post-test, the PLM group showed significantly better accuracy than the control group (median absolute estimation error 6.1 vs 9.0; difference 95% CI, 1.0 to 4.6; P < 0.001). Nevertheless, at six months, estimation errors were similar in both groups (median absolute estimation error 10.0 vs 10.0; difference 95% CI, -1.3 to 2.1; P = 0.27). Conclusions: Participation in a short online PLM significantly improved novices' short-term ability to accurately estimate LVEF visually, compared with controls. The effect was not sustained at six months. Trial registration: www.clinicaltrials.gov (NCT03245567); registered 7 August 2017.
MeSH term(s)	Clinical Competence ; Echocardiography ; Echocardiography, Transesophageal ; Humans ; Stroke Volume ; Ventricular Function, Left
Language	English
Publishing date	2021-07-28
Publishing country	United States
Document type	Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
ZDB-ID	91002-8
ISSN	1496-8975 ; 0832-610X
ISSN (online)	1496-8975
ISSN	0832-610X
DOI	10.1007/s12630-021-02066-3
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Article: Exploration of ADHD Subtype Definitions and Co-Occurring Psychopathology in a Missouri Population-Based Large Sibship Sample.

Reiersen, Angela M / Todorov, Alexandre A

Scandinavian journal of child and adolescent psychiatry and psychology

2013 Volume 1, Issue 1, Page(s) 3–13

Abstract: Background: There is some debate regarding the utility of Attention-Deficit/ Hyperactivity Disorder (ADHD) subtypes as currently defined. Differences in co-occurring psychopathology among subtypes would support the validity of subtype definitions.: ... ...

Abstract	Background: There is some debate regarding the utility of Attention-Deficit/ Hyperactivity Disorder (ADHD) subtypes as currently defined. Differences in co-occurring psychopathology among subtypes would support the validity of subtype definitions. Objective: To explore how ADHD subtype relates to co-occurring psychopathology in a large population-based sample of children and adolescents (n=5744). Method: Parents completed the Strengths and Weaknesses of ADHD-symptoms and Normal behavior (SWAN) questionnaire, the Child Behavior Checklist (CBCL) and the Social Responsiveness Scale (SRS). Methods including discriminant analysis, principal components analysis, and fractional polynomial regression were used to examine the relationship between ADHD diagnostic subtypes and co-occurring psychopathology. Results: Children with different ADHD subtypes show differences on several CBCL subscales. A combination of CBCL subscales and SRS score had good ability to discriminate ADHD subtypes. Conversely, for the same overall number of ADHD symptoms, individuals who present with both inattentive and hyperactive/impulsive symptoms exhibit higher severity of co-occurring psychopathology on a summary measure derived from principal components analysis of the CBCL subscales and SRS. This includes some subjects who fail to meet the DSM-IV-TR ADHD symptom criterion due to having less than 6 inattentive and less than six hyperactive-impulsive symptoms, yet have ADHD symptom severity similar to those with the inattentive or hyperactive-impulsive subtype. Conclusions: Several convergent lines of analysis provide support for the continued use of ADHD subtypes (or current presentation symptom profiles), as evidenced by differences in co-existing psychopathlogy. We also found that current diagnostic criteria may fail to identify a potentially impaired group of individuals who have low-to-moderate levels of both inattention and hyperactivity/impulsivity. Under the upcoming DSM-5, it will be important for clinicians to consider the option of giving an ADHD "not elsewhere classified" diagnosis to such children.
Language	English
Publishing date	2013-10-31
Publishing country	United States
Document type	Journal Article
ISSN	2245-8875
ISSN	2245-8875
DOI	10.21307/sjcapp-2013-002
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