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However, the question of whether that symptom threshold represents anything more than an arbitrary cutoff on a continuum of impairment requires further empirical study. Therefore, we present the first study investigating if the relationship between ADHD symptom severity and functional impairment is nonlinear in a way that suggests a discrete, nonarbitrary symptom level threshold associated with a marked step increase in impairment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Parent reports on the ADHD\u2010Rating Scale (ADHD\u2010RS\u2010IV), the Weiss Functional Impairment Rating Scale (WFIRS\u2010P), and the Strengths and Difficulties Questionnaire were collected in a general population sample of 1st, 2nd, and 3rd graders (\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u20091,914\u20132,044).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Piecewise linear regression analyses and nonlinear regression modeling both demonstrated that the relationship between symptom severity (ADHD\u2010RS\u2010IV total score) and impairment (WFIRS\u2010P mean score) was characterized by a gradual linear increase in impairment with higher symptom severity and no apparent step increase or changing rate of increase in impairment at a certain high ADHD\u2010RS\u2010IV total score level. Controlling for socioeconomic status, sex, and co\u2010occurring conduct and emotional symptoms did not alter these results, though comorbid symptoms had a significant effect on impairment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>There was no clear evidence for a discrete, nonarbitrary symptom severity threshold with regard to impairment. The results highlight the continued need to consider both symptoms and impairment in the diagnosis of ADHD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jcpp.13440","type":"journal-article","created":{"date-parts":[[2021,5,27]],"date-time":"2021-05-27T03:02:43Z","timestamp":1622084563000},"page":"229-237","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":37,"title":["How much impairment is required for ADHD? 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S.","family":"Sonuga\u2010Barke","sequence":"additional","affiliation":[{"name":"Department of Clinical Medicine Aarhus University Aarhus Denmark"},{"name":"Department of Child &amp; Adolescent Psychiatry, Institute of Psychiatry, Psychology &amp; Neuroscience King's College London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Per Hove","family":"Thomsen","sequence":"additional","affiliation":[{"name":"Department of Child and Adolescent Psychiatry Aarhus University Hospital, Psychiatry Aarhus N Denmark"},{"name":"Department of Clinical Medicine Aarhus University Aarhus Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne","family":"Virring","sequence":"additional","affiliation":[{"name":"Department of Child and Adolescent Psychiatry Aarhus University Hospital, Psychiatry Aarhus N 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