Reviewer Report - Philip J Asherson.pdf

Reviewer's report for the meta-analysis "Emotion dysregulation in adults with attention deficit hyperactivity disorder" raises several concerns and suggestions for improvement. The reviewer questions the inclusion of emotion dysregulation (ED) as a symptom for diagnostic classification, citing its non-specificity and presence in other clinical disorders. They also point out inconsistencies in the study's methodology, such as the confusion between randomized controlled trials and case-control analyses. The reviewer requests clarification on the definition of "impulsivity of the emotional reactions" and the identification of the 3 dimensions of ED. Additionally, they suggest that comorbid ASD may be an unmeasured confounder for emotion recognition and note that the 95% CI for emotion recognition does not overlap with the other two dimensions, indicating a significant difference. The reviewer also identifies errors in the discussion section, such as the misinterpretation of Barkley & Fischer's (2012) study and the lack of citation of recent meta-analyses on pharmacological treatment effects of stimulants/atomoxetine on ED in adult ADHD. The reviewer concludes that the methods are appropriate, the work includes necessary controls, and the conclusions are adequately supported by the data, but recommends some language corrections and an assessment of statistics. The reviewer declares competing interests, having received support from pharma companies marketing medications for ADHD.