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BACKGROUND: Problematic Internet use (i.e., Internet use that disrupts functioning in other important domains; PIU) is increasingly prevalent worldwide, particularly among youth. One form of PIU relates specifically to interpersonal interaction and communication, deemed social PIU. Social PIU has been linked to various forms of psychopathology, including attention-deficit/hyperactivity disorder (ADHD). Yet with limited longitudinal research, the direction of this association remains unclear. Moreover, little research investigates whether social PIU is linked to one or both symptom dimensions of ADHD (inattention vs. hyperactivity/impulsivity). METHODS: The present study utilized data from the largest extant longitudinal study of girls with childhood-diagnosed ADHD (N = 228). Linear regression and structural equation models were used to analyze social PIU as both a prospective predictor and outcome of ADHD symptoms. RESULTS: Inattentive ADHD symptoms were positively associated with concurrent social PIU in initial regression models but were non-significant in path analyses. Social PIU was only marginally significant in predicting subsequent inattention six years later. Symptoms of hyperactivity/impulsivity were unrelated to social PIU among girls at either time point. CONCLUSIONS: Inattentive ADHD symptoms were initially positively linked to concurrent problems with social Internet use, but bidirectional associations were non-significant in path analyses. Relations between PIU and ADHD in girls may be less robust than previously thought, although further longitudinal research with clinical samples is needed to clarify which groups of adolescents are particularly vulnerable to social PIU and its long-term effects.

Attention-deficit/hyperactivity disorder (ADHD) is a childhood-onset neurodevelopmental condition characterized by developmentally extreme and impairing symptoms of inattention and/or hyperactivity/impulsivity. Great interest has emerged in the ways ADHD and its underlying symptom dimensions relate to the development of personality traits. Much extant research on this topic is cross-sectional, relying on self-report measures and male samples. Herein, we present data from a prospective, longitudinal study of a socioeconomically and racially diverse sample of girls, including those with ADHD and a matched neurotypical comparison sample. We examined how parent- and teacher-reported ADHD in middle childhood relate to self-reported Big Five personality traits in adolescence. As expected, childhood ADHD diagnosis prospectively predicted lower self-reported Conscientiousness, lower Agreeableness, and higher Neuroticism in adolescence. With ADHD diagnosis covaried, Inattention (IA) predicted only low Conscientiousness, Hyperactivity/Impulsivity (HI) predicted only low Agreeableness, and neither predicted adolescent Neuroticism. An exploratory moderator analysis showed that family income moderated the effects of IA and HI on the negativity of adolescent self-descriptions of their own personalities, with more pronounced negative effects for girls in families with higher (rather than lower) income. Familial pressures to achieve in higher-income families may be linked to more pronounced negative ramifications of ADHD on personality development.

ObjectiveTo evaluate the feasibility and preliminary efficacy of Telehealth Behavioral Parent Training (T-BPT), a school telehealth group intervention for attention-deficit/hyperactivity disorder (ADHD) with a companion training program for school clinicians.MethodsT-BPT was developed in an iterative three-phase design in partnership with community stakeholders during the COVID-19 pandemic. School clinicians (N = 4) delivered T-BPT over 8 weeks to parents (N = 21, groups of 5-6 per school) of children (Grades 2-5) with ADHD while simultaneously receiving training and consultation from PhD-level study trainers. A single-arm open trial was used to assess feasibility, engagement, and preliminary efficacy.ResultsParents and school clinicians endorsed high feasibility, acceptability, and usability of T-BPT. Parent attendance was high (M = 94.6%) and a majority of parents (66.7%) attended all eight sessions. Preliminary outcomes indicate moderate to large reductions in parent-reported ADHD symptoms (ω2 = .36), functional and clinical global impairment (ω2s= .21 and .19, respectively), and distance learning challenges (ω2 = .22).ConclusionsResults were in line with in-person delivery, indicating promising feasibility of school telehealth BPT groups. This study also provided further support for the feasibility of the remote training model for school clinicians. Implications of the commonly endorsed barriers and benefits beyond COVID-19 and relevance to under resourced communities are also discussed.

OBJECTIVE: ADHD is a prevalent neurodevelopmental disorder characterized by symptoms of inattention and hyperactivity-impulsivity. Impairments in executive functioning (EF) are central to models of ADHD, while alpha-band spectral power event-related decreases (ERD) have emerged as a putative electroencephalography (EEG) biomarker of EF in ADHD. Little is known about the roles of EF and alpha ERD and their interactions with symptoms of ADHD. METHOD: We estimated network models of ADHD symptoms and integrated alpha ERD measures into the symptom network. RESULTS: EF emerges as a bridge network node connecting alpha ERD and the hyperactivity/impulsivity and inattention symptoms. We found that EF most closely relates to a subset of symptoms, namely the motoric symptoms, seat (difficulty staying seated), and runs (running or climbing excessively). CONCLUSIONS: EF functions as a bridge node connecting alpha ERD and the ADHD symptom network. Motoric-type symptoms and EF deficits may constitute important nodes in the interplay between behavior/symptoms, cognition, and neurophysiological markers of ADHD.

BACKGROUND: Although the link between alcohol involvement and behavioral phenotypes (e.g. impulsivity, negative affect, executive function [EF]) is well-established, the directionality of these associations, specificity to stages of alcohol involvement, and extent of shared genetic liability remain unclear. We estimate longitudinal associations between transitions among alcohol milestones, behavioral phenotypes, and indices of genetic risk. METHODS: Data came from the Collaborative Study on the Genetics of Alcoholism (n = 3681; ages 11-36). Alcohol transitions (first: drink, intoxication, alcohol use disorder [AUD] symptom, AUD diagnosis), internalizing, and externalizing phenotypes came from the Semi-Structured Assessment for the Genetics of Alcoholism. EF was measured with the Tower of London and Visual Span Tasks. Polygenic scores (PGS) were computed for alcohol-related and behavioral phenotypes. Cox models estimated associations among PGS, behavior, and alcohol milestones. RESULTS: Externalizing phenotypes (e.g. conduct disorder symptoms) were associated with future initiation and drinking problems (hazard ratio (HR)⩾1.16). Internalizing (e.g. social anxiety) was associated with hazards for progression from first drink to severe AUD (HR⩾1.55). Initiation and AUD were associated with increased hazards for later depressive symptoms and suicidal ideation (HR⩾1.38), and initiation was associated with increased hazards for future conduct symptoms (HR = 1.60). EF was not associated with alcohol transitions. Drinks per week PGS was linked with increased hazards for alcohol transitions (HR⩾1.06). Problematic alcohol use PGS increased hazards for suicidal ideation (HR = 1.20). CONCLUSIONS: Behavioral markers of addiction vulnerability precede and follow alcohol transitions, highlighting dynamic, bidirectional relationships between behavior and emerging addiction.

BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) remains underdiagnosed and undertreated in girls. Inattentive symptoms, often predominant in girls with ADHD, represent a key driver of impairment and often persist into adulthood. AKL-T01 is a regulated digital therapeutic targeting inattention. We examined potential sex differences in the efficacy of AKL-T01 in three separate trials for 1) children, 2) adolescents, and 3) adults. METHODS: We conducted secondary analyses of clinical outcomes by sex in three AKL-T01 randomized clinical trials in ADHD (n1 = 180 children 30.6% female, M(SD) age = 9.71 (1.32); n2 = 146 adolescents; 41.1% female, M(SD) age = 14.34 (1.26); n3 = 153 adults; 69.9% female, M(SD) age = 39.86 (12.84)). Active treatment participants used AKL-T01 for 25 min/day over 4-6 weeks. Primary outcomes included change in attention on the Test of Variables of Attention (TOVA) and symptom change on the clinician-rated ADHD Rating Scale (ADHD-RS). To evaluate study hypotheses, we conducted a series of robust linear regressions of TOVA and ADHD-RS change scores by sex, adjusting for baseline scores. RESULTS: In children, girls demonstrated greater improvement in objective attention relative to boys following AKL-T01 (TOVA Attentional Composite Score; Cohens d = .36 and Reaction Time Mean Half; Cohens d = .54), but no significant sex differences in ADHD rating scale change. We did not observe significant sex differences in outcomes in the adolescent or adult trials. Limitations include binary sex categorization and slight study design variation across the three samples. CONCLUSION: AKL-T01 might notably improve attentional functioning in girls with ADHD relative to boys. Objective attention measures may be particularly important in the assessment of attentional improvement in childhood, given known gender biases in ADHD symptom reporting. We emphasize the importance of considering sex and gender-specific factors in ADHD treatment evaluation. TRIAL REGISTRATIONS: STARS ADHD CHILD: ClinicalTrials.gov ID NCT03649074; STARS ADHD ADOLESCENT: ClinicalTrials.gov ID NCT04897074; STARS ADHD ADULT: ClinicalTrials.gov ID NCT05183919.

Multiple pathway models propose that attention deficit hyperactivity disorder (ADHD) arises from dysfunction in separate systems comprised of a "cool" or cognitive pathway versus a "hot" or emotional/reward pathway. Interactions between these pathways and the degree of maturation may further determine functional outcomes for adolescents ranging from those diagnosed with ADHD to typical development (TD). We used a latent profile analysis on rating scales and behavioral task performance assessing emotion, irritability, impulsivity, risk-taking, future orientation, and processing speed (PS) to identify subgroups of TD adolescents and adolescents with ADHD (N = 152) based on the hot and cool pathway model. We identified four classes: 1) High-Complex Challenges; 2) Moderate-Mixed Challenges; 3) Non-Emotive Impulsivity; and 4) High Regulation and Control. A multiple pathway model of ADHD is supported with classes differing in degree of emotional lability and irritability, types of impulsivity, and ability to use future consequences to modulate impulsivity and PS. The classes differed regarding functional behavior, with the High-Complex class demonstrating the most severe functional challenges in academic-related functioning. The Moderate-Mixed class also displayed significant functional challenges but with moderate emotional lability and irritability ratings. The Non-Emotive Impulsivity class exhibited low emotionality and low irritability, yet high impulsivity with limited negative functional consequences, and was composed of a mix of ADHD and TD adolescents. Differences between classes suggest ADHD symptomatology may represent both categorical and dimensional differences. Precision health interventions may be more effective in addressing the specific challenges associated with the classes rather than a one-size-fits-all approach to treating ADHD.

BackgroundDespite the ubiquity of adolescent screen use, there are limited longitudinal studies that examine the prospective relationships between screen time and child behavioral problems in a large, diverse nationwide sample of adolescents in the United States, which was the objective of the current study.MethodsWe analyzed cohort data of 9,538 adolescents (9-10 years at baseline in 2016-2018) with two years of follow-up from the Adolescent Brain Cognitive Development (ABCD) Study. We used mixed-effects models to analyze associations between baseline self-reported screen time and parent-reported mental health symptoms using the Child Behavior Checklist, with random effects adjusted for age, sex, race/ethnicity, household income, parent education, and study site. We tested for effect modification by sex and race/ethnicity.ResultsThe sample was 48.8% female and racially/ethnically diverse (47.6% racial/ethnic minority). Higher total screen time was associated with all mental health symptoms in adjusted models, and the association was strongest for depressive (B = 0.10, 95% CI 0.06, 0.13, p

BackgroundA growing body of literature investigated childhood exposure to environmental chemicals in association with attention-deficit/hyperactivity disorder (ADHD) symptoms, but limited studies considered urinary mixtures of multiple chemical classes. This study examined associations of concurrent exposure to non-persistent chemicals with ADHD symptoms in children diagnosed with autism spectrum disorder (ASD), developmental delay (DD), and typical development (TD).MethodsA total of 549 children aged 2-5 years from the Childhood Autism Risks from Genetics and Environment (CHARGE) case-control study were administered the Aberrant Behavior Checklist (ABC). This study focused on the ADHD/noncompliance subscale and its two subdomains (hyperactivity/impulsivity, inattention). Sixty-two chemicals from four classes (phenols/parabens, phthalates, organophosphate pesticides, trace elements) were quantified in child urine samples, and 43 chemicals detected in > 70% samples were used to investigate their associations with ADHD symptoms. Negative binomial regression was used for single-chemical analysis, and weighted quantile sum regression with repeated holdout validation was applied for mixture analysis for each chemical class and all chemicals. The mixture analyses were further stratified by diagnostic group.ResultsA phthalate metabolite mixture was associated with higher ADHD/noncompliance scores (median count ratio [CR] = 1.10; 2.5th, 97.5th percentile: 1.00, 1.21), especially hyperactivity/impulsivity (median CR = 1.09; 2.5th, 97.5th percentile: 1.00, 1.25). The possible contributors to these mixture effects were di-2-ethylhexyl phthalate (DEHP) metabolites and mono-2-heptyl phthalate (MHPP). These associations were likely driven by children with ASD as these were observed among children with ASD, but not among TD or those with DD. Additionally, among children with ASD, a mixture of all chemicals was associated with ADHD/noncompliance and hyperactivity/impulsivity, and possible contributors were 3,4-dihydroxy benzoic acid, DEHP metabolites, MHPP, mono-n-butyl phthalate, and cadmium.ConclusionsEarly childhood exposure to a phthalate mixture was associated with ADHD symptoms, particularly among children with ASD. While the diverse diagnostic profiles limited generalizability, our findings suggest a potential link between phthalate exposure and the comorbidity of ASD and ADHD.

AbstractObjectivesMethodsResultsConclusions\nKEY POINTSSeveral studies consistently showed that patients with attention deficit hyperactivity disorder (ADHD) have high rates of hoarding disorder (HD) comorbidity. The aim of the present study was to compare the clinical and cognitive features of adult ADHD patients with and without hoarding comorbidity according to a self-report measure, and a sample of healthy controls.Fifty-seven consecutive adult outpatients with a primary diagnosis of ADHD with comorbid hoarding disorder (ADHD+HD), 57 matched ADHD patients without hoarding disorder comorbidity (ADHD-HD), and a control group of 47 healthy controls (HCs) were enrolled. All subjects undergone a comprehensive clinical assessment and a neurocognitive assessment focused on attention, memory, and executive functions.The ADHD groups differed on most of the clinical and cognitive measures compared to HCs. ADHD+HD patients showed similar ADHD symptoms but greater subjective impulsivity, mood and anxiety symptoms, and a greater functional impairment compared to ADHD-HD patients as well as greater attentional and executive functioning impairments.ADHD patients with comorbid hoarding disorder present a more complex clinical and neuropsychological phenotype correlated to a greater functional impairment compared to ADHD patients without this comorbidity. These results further highlight the relevance of assessing and treating hoarding behaviours in adults with ADHD.Hoarding disorder is a frequent comorbidity in adult patients with ADHD.ADHD patients with comorbid hoarding disorder present a more complex clinical and neuropsychological phenotype compared to ADHD patients without this comorbidity.ADHD patients with comorbid hoarding disorder also show a greater functional impairment.Hoarding behaviours in adult ADHD patients should be routinely assessed.Hoarding disorder is a frequent comorbidity in adult patients with ADHD.ADHD patients with comorbid hoarding disorder present a more complex clinical and neuropsychological phenotype compared to ADHD patients without this comorbidity.ADHD patients with comorbid hoarding disorder also show a greater functional impairment.Hoarding behaviours in adult ADHD patients should be routinely assessed. [ABSTRACT FROM AUTHOR]

Attention deficit hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder characterized by symptoms of inattention, hyperactivity, and impulsivity. Individuals with ADHD often encounter heightened emotional and behavioral challenges. This study aims to conduct a meta-analysis of the efficacy of digital interventions in improving symptoms of ADHD. This study searched 6 databases for English articles from database construction until December 4, 2023. Randomized controlled trials employing digital interventions for ADHD were gathered. Following the Cochrane Collaboration criteria, Review Manager 5.3 software was utilized to evaluate the risk of bias present in the included papers. Mean differences for post-intervention and follow-up data were standardized using Stata 18.0 software. Subgroup analysis was employed to investigate the sources of heterogeneity. The study adhered to the PRISMA guidelines and was registered on the PROSPERO platform (CRD42024504134). This review included a total of 25 randomized controlled trials (RCTs). The combined study population comprised 1780 cases. In the digital intervention groups, there was a significant decrease in overall ADHD symptoms (SMD = −0.33; 95 % CI = [−0.51, −0.16]) compared to the control groups. Furthermore, there was a significant reduction in inattention symptoms (SMD = −0.31; 95 % CI = [−0.46, −0.15]) and hyperactivity/impulsivity symptoms (SMD = −0.15; 95 % CI = [−0.29, −0.02]) within the digital intervention groups. The digital interventions proved beneficial for individuals with ADHD by alleviating symptoms of ADHD, inattention, and hyperactivity/impulsivity. • Integrating results from multiple studies to explore the impact of digital interventions on ADHD. • Subgroup analyses were used to explore the effects of digital interventions on attention deficit hyperactivity disorder (ADHD) in different age groups, different intervention durations, and different control groups. • The results of the meta-analysis provide guidance for future research on digital interventions for attention deficit hyperactivity disorder (ADHD) and help researchers to better design digital interventions. [ABSTRACT FROM AUTHOR]

Attention deficit hyperactivity disorder (ADHD) in adults could be frequently underdiagnosed due to concomitant psychiatric disorders, including depressive symptomatology, which could determine inappropriate treatments. Our study aims at clinically characterizing adult ADHD with or without depressive symptomatology in order to identify the relationship with specific affective temperamental profiles and coping strategies. A total of 225 outpatients consecutively afferent to our outpatient adult ADHD service since September 2019 were retrospectively screened for eligibility and administered Beck Depression Inventory-II (BDI-II), Coping Orientation to Problems Experienced Inventory (COPE-NV) and Temperament Evaluation of the Memphis, Pisa, Paris and San Diego (TEMPS-M). 64.7 % of patients displayed a significant comorbid depressive symptomatology. According to the multivariate linear regression model, depressive levels were positively predicted by TEMPS-M cyclothymic subscale (B = 0.567, p = 0.004) and negatively predicted by COPE-NVI "positive attitude" subscale (B = −0.438, p = 0.024) (R = 0.496, R2 = 0.246, F(2,66) = 10.747, p < 0.001). While considering the results, it should be taken in consideration that: the assessment was carried out only at baseline, our sample is constituted only by adult ADHD patients and mostly without a previous ADHD diagnosis, the presence of a discrepancy between the rates of ADHD subtypes, the absence of a healthy control group and emotional dysregulation was not directly assessed. Affective temperamental profiles and coping strategies could help in clinically characterizing and personalizing treatment in adult comorbid ADHD-depressive symptomatology patients. Further research is warranted to explore the efficacy of targeted psychotherapeutic and pharmacological interventions within this ADHD sub-sample. • ADHD adults experience mainly restlessness, impulsivity and planning difficulties. • Comorbid depressive symptomatology is frequently reported with ADHD in adults. • Depression in ADHD adults is predicted by cyclothymic affective temperament. • Depression in ADHD adults is predicted by low positive attitude coping strategies. • A careful characterization of adult ADHD may help to choose the treatment strategy. [ABSTRACT FROM AUTHOR]

Cognitive impairment and decreased executing functioning represent common symptoms of both ADHD and pregnancy. This study aimed to characterize temporal trends and racial/ethnic disparities in ADHD diagnosis during the perinatal period. In this serial cross-sectional study, we used administrative claims to create a cohort of commercially insured women with a documented live birth between 2008 and 2020 and identified those with an ADHD diagnosis in the year before or after delivery. We applied logistic regression to assess the probability of ADHD diagnosis adjusting for race/ethnicity, age, and comorbid conditions. We used this model to calculate the predicted probability of ADHD diagnosis by racial/ethnic group for each year. We identified 736,325 deliveries from 2008 to 2020. Overall, 16,801 (2.28 %) of deliveries had an ADHD diagnosis in the year before or after delivery. ADHD rates increased 290 % from 101 (95%CI: 92–111) per 10,000 deliveries in 2008 to 394 (95%CI: 371–419) per 10,000 deliveries in 2020. White women experienced the highest rates followed by Black, Hispanic, and Asian, respectively. Increasing ADHD diagnosis rates during the perinatal period may reflect improved detection but racial disparities persist. Additional research is needed to develop equitable outreach strategies to better support women experiencing ADHD during the perinatal period. • Deficits in cognition and executing functioning are common complaints of pregnancy. • ADHD diagnoses among delivering women increased 290 % between 2008 and 2020. • Women of color were less likely to have a perinatal ADHD diagnosis than white women. • Increasing diagnosis may reflect improved detection but racial disparities persist. [ABSTRACT FROM AUTHOR]

Purpose: Neurodevelopmental disorders (ND) have been recognized as the most common and potentially most disabling outcome of congenital diaphragmatic hernia (CDH). Our aim was to evaluate the incidence of ND in patients with a history of CDH referred for ND assessment on the basis of clinically relevant symptoms rather than through a screening process. Methods: The study was a nationwide, population-based prospective nested case–control study within a cohort of newborn children who survived the newborn period in Sweden during the observational period from 1st January 1982 until 31st December 2015. Results: In the study period, 641 non-syndromic CDH survivors were identified, and 3080 control cases were selected. Significantly higher incidence of clinically relevant any ND (11.5% vs 5.6%,p < 0.001), ASD (3.9% vs 2.1%,p:0.011), and intellectual disorder (6.6% vs 0.7%,p < 0.001) were observed in CDH compared to controls. When compared with controls, those with CDH were found to have a 2.179 times higher risk to develop any ND (p < 0.001), 1.867 times higher risk for ASD (p = 0.008), and 10.63 times higher for intellectual disorder (p < 0.001). Conclusion: CDH survivors have a higher risk of clinically relevant ND than the general population, independent of the effect of screening. [ABSTRACT FROM AUTHOR]

Individuals with attention‐deficit/hyperactivity disorder (ADHD) exhibit varied responses to pharmacological treatments (e.g. stimulants and non‐stimulants). Accurately and promptly detecting treatment‐related improvements, response failure, or deterioration poses significant challenges, as current monitoring primarily relies on subjective ratings. In this commentary, we critically evaluate the evidence supporting the use of QbTest for objectively monitoring ADHD treatment response in clinical practice. We also offer recommendations for future research, advocating for rigorous clinical trials and longitudinal studies to further explore the potential utilisation of QbTest and other tools for monitoring treatment responses in individuals with ADHD. [ABSTRACT FROM AUTHOR]

Background: To date, there are no official diagnostic criteria for the frequently reported phenomenon of exercise addiction. Therefore, the aim of the present study was to investigate how mental disorders, specifically depression and attention-deficit hyperactivity disorder (ADHD), are related to exercise addiction (EA). Methods: A total of 173 participants aged between 18 and 70 years, who reported exercising more than 10 h a week and continued to exercise despite injury or illness, answered questionnaires including the Exercise Dependence Scale, the Beck Depression Inventory, and the Homburger ADHD scale for adults. Multiple linear regression analyses were performed adjusting for relevant confounders (age, gender) and stepwise regression was used to identify which of the two mental disorders is the more influential predictor of EA. Results: Pearson correlation analysis showed that depressive symptoms [r (171) = 0.422, p < 0.00] and ADHD symptoms [r (171) = 0.308, p < 0.001] were positively correlated with EA symptoms. The relation between depressive symptoms and EA remained after adjusting for confounders in the regression model (B = 20.531; t(170) = 5.950; 95% CI [13.719, 27.343]; p < 0.001). Similarly, the positive link between ADHD symptoms and EA persisted after controlling for confounders (B = 15.507; t(170) = 3.771; 95% CI [7.389, 23.625]; p < 0.001). Additionally, a stepwise regression model identified that depressive symptoms are a stronger predictor for EA than ADHD symptoms. Conclusion: Depressive symptoms seem to be a stronger predictor for EA compared to ADHD symptoms in frequent exercisers. Although individuals with ADHD May exercise extensively, they might be less at risk for EA than individuals with depression. These results contribute to the complex characterization of the psychiatric profile of individuals with exercise addiction, and underline the need for further research elucidating the interplay between mental disorders and EA. [ABSTRACT FROM AUTHOR]

Introduction: Current evidence suggests that early maladaptive schemas are affected in attention deficit hyperactivity disorder (ADHD). Most of the studies on the subject have been conducted with adults, but the number of studies conducted with adolescents with ADHD is quite limited. The aim of this study was to evaluate early maladaptive schemas in adolescents diagnosed with ADHD. Methods: The study included 66 patients diagnosed with ADHD and 70 healthy adolescents who were similar to the case group in terms of age and gender. Clinical evaluation of the case and control groups were performed with "The Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version, DSM-5 November 2016-Turkish Adaptation (K-SADS-PL-DSM-5-T)". "Conners-Wells Adolescent Self-Report Scale - Revised Short Form (CASS-RS)" and "Set of Early Maladaptive Schema Questionnaires for Children and Adolescents between the ages of 10-16" were administered to all participants. Results: It was determined that the schema scores of "dependence/incompetence", "vulnerability to harm or illness", "entitlement/grandiosity", "insufficient self-control", "subjugation" were significantly higher in the ADHD group than in the control group. A negative, significant relationship was found between age and "enmeshment/undeveloped self", "entitlement/grandiosity" and "insufficient self-control" schema scores. There was no significant difference between schema scores in terms of gender in the ADHD group. Additionally, no significant relationship was found between the education level of the parents, family income levels and schema scores. A significant positive relationship was found between the CASS-RS scores and all schema scores. As a result of the regression analysis, it was determined that CASS-RS scores positively predicted all schema scores, while the age variable negatively predicted only the schema scores of "enmeshment/undeveloped self". Discussion: Results of this study showed that there were significant differences in adolescents in the ADHD group compared to the control group in terms of early maladaptive schemas, and that ADHD symptom levels was associated with early maladaptive schemas. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to estimate prevalence and incidence of attention deficit/hyperactivity disorder (ADHD) and comorbid relationships between ADHD and other psychiatric disorders in Japan. Methods: Using the real-world JMDC Claims Database, we conducted a cross-sectional study (analysis years 2017–2021) and retrospective cohort study (observation 2 years before/after the initial ADHD diagnosis; data collection 2005–2021; enrollment 2017–2019). Patients were male or female, aged 0–57 years. Cross-sectional study patients had an ADHD or other psychiatric disorder diagnosis (with or without medication) and were continuously registered in each analysis year; retrospective study patients had an ADHD diagnosis and ≥2 years' observation before and after diagnosis. Endpoints were annual prevalence and incidence of ADHD in Japan, prevalence and risk ratio of each psychiatric comorbidity in patients with ADHD, prevalence and risk ratios of ADHD in patients with each psychiatric comorbidity, and prevalence of psychiatric disorders before/after the initial ADHD diagnosis. Results: ADHD prevalence in children/adolescents and adults increased each year from 2017 to 2021. Prevalence in boys was 3.5–4.1 times higher than in girls. Prevalence in adults was lower than in children/adolescents, with a small sex difference. ADHD was highly comorbid with various psychiatric disorders. In 2019, the most common comorbidity in children/adolescents with ADHD was autism spectrum disorder (ASD; 54.4%); in adults, it was mood disorders (60.9%). ADHD prevalence in patients with various psychiatric disorders was higher than in the control population. ADHD prevalence was highest in patients with oppositional defiance disorder among both children/adolescents and adults (77.2% and 69.2%, respectively). In the retrospective cohort study (N = 14,940), the most common psychiatric disorders diagnosed prior to ADHD diagnosis were ASD in children/adolescents (33.9% of patients), and mood disorders and sleep disorders in adults (36.9% and 23.8% of patients, respectively). Discussion: ADHD was comorbid with various psychiatric disorders in Japan. In children and adolescents with ADHD, ASD was often diagnosed prior to ADHD. Psychiatric disorders, especially mood disorders and sleep disorders, were frequently diagnosed prior to the initial ADHD diagnosis in adults. The likelihood of comorbid ADHD should be considered when diagnosing adult patients with psychiatric disorders. [ABSTRACT FROM AUTHOR]

The decision-making process involves various cognitive procedures influenced by the interplay between cognition, motivation, and attention, forming a complex neural framework. Attention is a fundamental cognitive element within decision-making mechanisms, and one of the conditions affecting the attentional system is attention deficit hyperactivity disorder (ADHD). Decision-making impairments in ADHD have significant economic consequences, necessitating effective policies and interventions to address this critical issue. Research from computational models and neuroscience suggests how cognitive functions' workings and problems affect decision-making and provide insights into the neural implications of decision-making. This article explores the intersection of decision-making, ADHD, and neuroeconomics, highlighting research gaps, potential contributions, and implications for future policies. [ABSTRACT FROM AUTHOR]

Attention deficit hyperactivity disorder (ADHD) is a common neuropsychiatric condition often persisting into adulthood, characterized by inattention, impulsivity, and hyperactivity. Emerging research suggests a connection between ADHD and gut microbiota, highlighting probiotics as potential therapeutic agents. This study involved a double-blind, randomized controlled trial where college students with ADHD received either a multi-strain probiotic supplement or a placebo daily for three months. ADHD symptoms were evaluated using a computerized performance test (MOXO) and the MATAL questionnaire. Academic records provided performance data. Additionally, eating and sleeping habits, gastrointestinal symptoms, and anthropometrics were assessed through questionnaires before and after the intervention. Fingernail cortisol concentrations (FCC) measured the long-term activity of the hypothalamic–pituitary–adrenal axis. The findings indicated that the probiotic significantly decreased hyperactivity, improved gastrointestinal symptoms, and enhanced academic performance. A multivariate analysis identified age as a significant predictor, with younger participants experiencing greater overall benefits from the intervention. There was also a negative correlation between FCC and symptoms of attention and impulsivity. Furthermore, higher academic grades were associated with lower levels of hyperactivity and impulsivity. These results suggest a beneficial impact of probiotics on ADHD symptoms and lay the groundwork for further studies to evaluate the effects of various probiotic strains on clinical outcomes in ADHD. [ABSTRACT FROM AUTHOR]

Adult ADHD is associated with increased risk for suicide attempts, as indicated by investigations of population- and community-based cohorts. However, there is little data regarding suicide attempts in a clinical setting. To address this, we used a comprehensively phenotyped clinical adult ADHD (aADHD) cohort to assess to which extent comorbidity, psychosocial adversity, personality, and ADHD symptoms contribute to suicidal behavior in ADHD. Furthermore, we investigated a triallelic variation in the serotonin transporter-linked polymorphic region (5-HTTLPR), which has previously been associated with suicidal behavior. Depression, substance use, eating, and posttraumatic stress disorders were independently associated with past suicide attempts, whereas anxiety, somatoform, and obsessive–compulsive spectrum disorders showed no association. Pulmonary diseases also showed an association with suicidal behavior. Psychosocial factors including occupational status, marital status/living situation, externalizing behavior and psychiatric family history were strongly associated with past suicide attempts. ADHD symptoms of inattention and hyperactivity/impulsivity were not associated with past suicide attempts after adjustment for psychiatric comorbidity and psychosocial adversity. However, the personality trait of neuroticism fully mediated the association between depression and suicidal behavior. 5-HTTLPR was not associated with suicidal behavior, but an interaction with ADHD symptoms and subtype was found. Our data suggest that psychiatric comorbidity and psychosocial adversity are key factors for suicidal behavior in aADHD, with neuroticism representing a critical mediator of the association between depression and suicidality. Further research, preferentially with longitudinal study designs is needed to better understand causal factors for suicidal behavior to enable effective preventive action. [ABSTRACT FROM AUTHOR]

Background: The use of medication for Attention-Deficit/Hyperactivity Disorder (ADHD) increased globally throughout the early 2000s. This study examine trends in prevalences and incidences of medication use in Norway from 2006 to 2022. Methods: Data from the Norwegian Prescription Database were used to present one-year-prevalence and incidence rates of ADHD medication (ATC-group N06BA and C02AC02) for the overall population (ages 6–64) and within sex and age subgroups of children (ages 6–17) and adults (ages 18–64). Incident use was defined as the dispensing of medication, with no recorded use in the previous two calendar years. Results: The overall prevalence of ADHD medication use in 6- to 64-year-olds increased from 5.2 to 19.4 per 1000 in the period, most pronounced from 2020 and onwards. While males experienced a nearly threefold increase in use (from 7.3 to 20.6 per 1000), the use among females increased almost sixfold during the study period (from 3.0 to 18.1 per 1000). Consequently, the male-to-female prevalence-ratio decreased from 2.4 to 1. Children exhibited a higher prevalence of use compared to adults throughout the period, although the largest relative increase was observed in adults, particularly in female adults. In children the male-to-female ratio decreased from 3.2 to 2.0, primarily due to an increasing use in 13–17-year-old females. Among adults, prevalences were similar across most age groups, with the highest rates observed among those aged 18–24, where female use exceeded male use by the end of the period. The male-to-female prevalence-ratio in adults decreased from 1.6 to 0.9 during the period. Parallel to prevalent use, overall incident use increased from 1.4 to 5.0 per 1000 during the period, with the most pronounced increase occurring from 2020 and onwards. From this point, incident use among females aged 13–17, 18–24, and 25–34, exceeded that of males. The male-to-female incidence-ratio decreased from 1.8 to 0.9. The overall incidence to prevalence ratio remained similar throughout the period, being 0.27 in 2006 and 0.25 in 2022. Conclusion: A sustained increase in the prevalence of ADHD medication use was observed, with the most pronounced rise occurring among females and adults from 2020 and onwards. By 2022, the overall gender disparity in ADHD medication use had diminished, which should be considered in the context of a steep increase in incident use among adolescent and young adult females starting from 2020. [ABSTRACT FROM AUTHOR]

Background: Attention Deficit Hyperactivity Disorder (ADHD) is the most prevalent childhood psychiatric condition with profound public health, personal, and family consequences. ADHD requires comprehensive treatment; however, lack of communication and integration across multiple points of care is a substantial barrier to progress. Given the chronic and pervasive challenges associated with ADHD, innovative approaches are crucial. We developed the digital health intervention (DHI)—CoolTaCo [Cool Technology Assisting Co-regulation] to address these critical barriers. CoolTaCo uses Patient-Centered Digital Healthcare Technologies (PC-DHT) to promote co-regulation (child/parent), capture patient data, support efficient healthcare delivery, enhance patient engagement, and facilitate shared decision-making, thereby improving access to timely and targeted mental health intervention for children at significant risk for poor outcomes. The present paper will describe our planned protocol to evaluate the efficacy of CoolTaCo via randomized control trial (RCT). Methods/design: We will recruit 60 children (ages 8–12) with ADHD who will be randomized to either immediate (n = 30) or delayed (n = 30) treatment (i.e., a waitlist control group). Among those randomized to immediate treatment, half will be assigned to DHI (delivered via a smartwatch and smartphone application), the other half to an active control treatment as usual (TAU). Unlike the DHI group, the TAU group will receive the smartwatch with no assigned activities, applications, or interventions on the devices. The intervention period will last 16 weeks; after a participant has been in the delayed treatment group for 16 weeks and has completed the post-waiting period assessment, they will be randomly assigned to either the intervention or active control group. Thus, 30 participants will complete the intervention, and 30 will complete the active control, with half of the total sample completing a waitlist period. Discussion: Individuals with ADHD have complex needs. Despite improvement in outcomes following cognitive behavioral therapies (CBT) and pharmaceutical treatment, long-term maintenance is a challenge often not addressed by traditional medical approaches, and, as we described, ineffective approaches to information sharing across points of care create further barriers to progress. Our research will fill a significant gap in translating early treatment investments and gains into long-term, sustainable outcomes. This study was registered as a clinic trial at ClinicalTrials.gov (Digital Health Intervention for Children With ADHD, ID# NCT06456372) on 06/13/2024. [ABSTRACT FROM AUTHOR]

Attention deficit hyperactivity disorder (ADHD) is a paradigmatic case for childhood medicalisation. Critical studies of medicalisation have pointed to the increasing clinical role of schools, with teachers tending to rely on medical treatment of students with ADHD and are perceived as a primary source of diagnostic information. Based on 27 semi‐structured interviews with teachers working in two Israeli elementary and middle schools, this research explored how teachers mediate the medicalisation process and understand their responsibilities in the classroom amidst the emphasis on inclusion in contemporary Israel. We found that teachers offer a wide range of explanations of the disorder and its prevalence, and their attitudes to medication are ambivalent. We argue that teachers develop pedagogical (lay) expertise in the field of ADHD in parallel with and in opposition to medical solutions. Such expertise is based on practical experience and close interaction with students. A top‐down ideological imperative of inclusion, combined with uncertainty about ADHD, has generated a bottom‐up set of preformative practices of 'containment' of troubled students. Teachers' emerging knowledge and practices raise questions about the relationship between medicalisation, policy, expertise and the pragmatic value of medical categories when applied outside the medical establishment. [ABSTRACT FROM AUTHOR]

The process of referral, assessment, and diagnosis of attention deficit hyperactivity disorder (ADHD) within the UK is often protracted. Given that parents are frequently the instigators of the diagnostic process, understanding the experience of parents is important. Drawing on findings from a longitudinal study, this article explores how the parental experience of the ADHD diagnostic journey includes three significant and distinct forms of 'illness work'. Twenty‐one semi‐structured serial interviews were conducted over a 2‐year period with seven parents of children on the ADHD diagnostic journey in North East England. We present three significant forms of parental illness work: (1) The 'diagnostic quest', parental work recognising and fighting for their children's needs and selfhood, seeking diagnosis and engaging with systems, (2) 'self‐biographical illness work', the personal parental biographical response to the diagnostic journey and (3) 'child biographical illness work and recontextualizing the child', parental biographical adjustment and recontextualisation of their children. We advance Rasmussen et al.'s (2021) model by demonstrating its usefulness in understanding how parents with a personal ADHD diagnosis experience biographical disruption or cohesion in response to their children's diagnosis. That a child's diagnosis leads parents with ADHD to experience a self‐biographical cohesive or disruptive response is a unique and significant finding. [ABSTRACT FROM AUTHOR]

Based on fieldwork in Danish families living with ADHD, we expand on Nielsen's insight that ADHD is experienced as a state of desynchronization by showing how family members' rhythms mutually affect each other. We argue that ADHD is not only a biological and psychiatric condition, but also a temporal and socially responsive phenomenon. The intensity of ADHD is influenced by mutual affect in families and by general life circumstances. Families constitute bodily networks through which sensations, moods, rhythms, and practices spread and are passed down through generations. Yet, families use various time work strategies to manage rhythm affect. [ABSTRACT FROM AUTHOR]

Background/Objectives: The Strengths and Difficulties Questionnaire (SDQ) is a widely used 25-item screening and diagnostic tool for behavioral and emotional problems in young people. Despite its popularity, evaluations of the SDQ's factor structure in adolescent populations have produced disparate results, and its relationships with theoretically related variables are rarely evaluated. In the present study, these two elements of validity were evaluated based on a large sample of Western Australian adolescents. Methods: Participants were 1489 adolescents, n = 623 males with a mean age of 13.79 years (SD = 1.61) and n = 866 females, with a mean age of 14.29 years (SD = 1.51). Participants completed the SDQ alongside measures of loneliness, sense of belonging, depression, bullying, and diagnostic status to evaluate its internal structure and correlations with theoretically related variables. Results: Confirmatory factor analyses supported the internal structure of the SDQ both for males and for females. Relationships between the SDQ subscale scores and those from theoretically related variables were also aligned with the instrument's underpinning framework. Conclusions: Despite the somewhat disparate results of previous studies, overall, this study supported the validity of the SDQ for use in the Western Australian context. [ABSTRACT FROM AUTHOR]

This study undertook neuropharmacological research on the clinical course of controlled medication discontinuation to guide practitioners who are considering stopping medications for youths with attention-deficit hyperactivity disorder (ADHD). This study analyzed the data for 14 ADHD children (12 male and 2 female) in two datasets: The children prescribed methylphenidate (MPH) were at an initial mean age of 7.5 years (SD = 1.70, range: 6–11) with a mean ADHD-Rating Score (ADHD-RS) of 26.6 (SD = 8.64, range 15–40). The children who discontinued MPH based on clinical judgment were at a mean age of 12.21 years (SD = 2.12, range: 8–15) with a mean ADHD-RS of 15.9 (SD = 6.86, range 5–27). The go/no-go task was used to assess response inhibition, while functional near-infrared spectroscopy (fNIRS) was used to measure cerebral hemodynamics. Oxygenated hemoglobin (Oxy-Hb) values from fNIRS data were analyzed for each subject, focusing on past and current measurements. Baseline was set at 10 s pre-task, with interval means from 4 to 24 s analyzed. One-sample t -tests were used to evaluate brain activity magnitude. The results of the study demonstrate that the children who had discontinued the medication exhibited activation in specific brain regions including the frontopolar cortex and the right ventrolateral prefrontal cortex. Activation (t = 2.363, p = 0.034, Cohen's d = 0.632) was found especially in the right dorsolateral prefrontal cortex during the performance of the go/no-go task. These activated areas were consistent with those observed in a previous study comparing brain activity during a go/no-go task between children with ADHD and healthy children. The present study showed differences in cerebral hemodynamics before and after discontinuation of MPH in ADHD children whose ADHD symptoms did not recur after MPH was discontinued. In the near future, further investigations that include control groups will be conducted to demonstrate the effects of MPH prior to discontinuation based on the changes in cerebral blood flow in the right prefrontal cortex, which is involved in behavioral inhibition, as observed in this study. This and future research will facilitate the development of criteria for discontinuing treatment. [ABSTRACT FROM AUTHOR]

Many youths with attention‐deficit/hyperactivity disorder (ADHD) experience significant long‐term impairment and may develop concurrent mental and somatic health difficulties as adults. This is associated with burden and costs for the individual and society which could be prevented through continued support in youth. Yet, only few young people transition to adult mental health services for ongoing care in different countries worldwide. We provide an overview on current transition practices, highlighting the gaps in knowledge and the barriers to effective service transitioning, while considering the large geographical variation in available guidelines and service provision. For ease of use, this review is organized in a question‐and‐answer format covering different aspects of the transition process and considering both service users' and clinicians' perspectives. Consensus is needed to identify those that require continued care, the optimal timing to arrange transition, and the most suitable services. Finally, we discuss cost‐effectiveness of transition practices, consider examples of best practice, and propose recommendations on how to improve transitional care, including the importance of service users' input into transition planning. [ABSTRACT FROM AUTHOR]

Limited qualitative research has examined teachers' understanding of Attention Deficit/Hyperactivity Disorder (ADHD), their attitudes towards the inclusion of children with ADHD in mainstream schools and how they support such learners. To address this, the current study used qualitative methodology to examine teachers' understanding of ADHD, their attitudes towards inclusion and their inclusive behaviours for children with ADHD. Semi-structured interviews were conducted with teachers (n = 10) working in 10 Scottish schools. A thematic analysis identified four themes: ADHD Existence and Importance; Girls Go Under the Radar; The Impact of Limited Training; Working Inclusively. Teachers' perceptions may impact upon ADHD diagnosis and successful inclusion. The findings suggest the need for training to educate teachers about the causes of ADHD and the role of gender in symptoms. Classroom teachers should have access to more support to help them work successfully with children with ADHD. The study provides recommendations for teacher education and professional development surrounding ADHD. [ABSTRACT FROM AUTHOR]

Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental condition that persists into adulthood in the majority of individuals. While the gut-microbiome seems to be relevant for ADHD, the few publications on gut-microbial alterations in ADHD are inconsistent, in the investigated phenotypes, sequencing method/region, preprocessing, statistical approaches, and findings. To identify gut-microbiome alterations in adult ADHD, robust across studies and statistical approaches, we harmonized bioinformatic pipelines and analyses of raw 16S rRNA sequencing data from four adult ADHD case-control studies (N ADHD =312, N NoADHD =305). We investigated diversity and differential abundance of selected genera (logistic regression and ANOVA-like Differential Expression tool), corrected for age and sex, and meta-analyzed the study results. Converging results were investigated for association with hyperactive/impulsive and inattentive symptoms across all participants. Beta diversity was associated with ADHD diagnosis but showed significant heterogeneity between cohorts, despite harmonized analyses. Several genera were robustly associated with adult ADHD; e.g., Ruminococcus_torques_group (LogOdds=0.17, p fdr =4.42 × 10–2), which was more abundant in adults with ADHD, and Eubacterium_xylanophilum_group (LogOdds= -0.12, p fdr =6.9 × 10–3), which was less abundant in ADHD. Ruminococcus_torques_group was further associated with hyperactivity/impulsivity symptoms and Eisenbergiella with inattention and hyperactivity/impulsivity (p fdr <0.05). The literature points towards a role of these genera in inflammatory processes. Irreproducible results in the field of gut-microbiota research, due to between study heterogeneity and small sample sizes, stress the need for meta-analytic approaches and large sample sizes. While we robustly identified genera associated with adult ADHD, that might overall be considered beneficial or risk-conferring, functional studies are needed to shed light on these properties. [ABSTRACT FROM AUTHOR]

Psychodynamic psychotherapy does not feature in current treatment guidelines for attention‐deficit hyperactivity disorder (ADHD) in the United Kingdom. However, there is some psychoanalytic understanding of the disorder, which is corroborated in current neuroscientific theory, and supports clinicians in thinking beyond the behaviourally biased diagnosis and treatment models. One of the core features of ADHD is distortions in chronoception. This clinical paper therefore explores the psychoanalytic and neuroscientific theories of time perception as a way of exploring a discrete element of the complex idea of executive functioning more generally. It supports therapists approaching such executive dysfunction and to reconsider the treatment guidelines. A case example is used to explore how a transference‐, affect‐ and relationally‐focussed therapy can effect lasting change for people with ADHD in a way that behavioural and medication approaches do not. It is argued that such an intervention can improve oscillatory attention between subjective‐ and objective‐time and increase the capacity to self‐contain emotions. This brings patients into alignment with reality and restarts their psychic development towards themselves, others, the parental couple and grieving, which stalled in infancy. The internalised schema of the 50‐minute therapy session also provides a frame of reference for future tasks. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has strained the resources of the world's healthcare systems. Most individuals with neurodevelopmental disabilities (NDDs) experience significant mental health issues and face substantial barriers in accessing appropriate supports which have been exacerbated during the pandemic. It is unknown the extent to which COVID-19 impacted the demand for and effectiveness of inpatient care for those with NDDs. The impact of COVID-19 on the number of admissions of youth with NDDs to pediatric inpatient psychiatry units, as well as their functioning and length of stay during the first two years of the pandemic was analyzed using Bayesian structural time series models. Admission data of youth with NDDs from four pediatric inpatient units in Alberta, Canada (n = 2144) was examined. Inpatient admissions of youth with NDDs significantly increased following the onset of the pandemic. Compared to the period prior to the pandemic, patients with NDDs had significantly worse overall functioning and received fewer days of treatment. These findings highlight the need for increased resources to support the mental health needs of this vulnerable population and are consistent with other studies in the general population examining the utilization of inpatient psychiatric units during the pandemic. [ABSTRACT FROM AUTHOR]

This study investigated whether cognitive function better predicted maths test performance than a clinical diagnosis of attention deficit hyperactivity disorder (ADHD). Forty‐four drug naïve children (Mage = 101.34 months, SD = 19.39; 30% girls) were recruited from clinical ADHD referral waiting lists. Children underwent assessment of Executive Functions (EF), lower‐level cognitive processes, and maths performance. Children were grouped using a categorical approach comprising (1) children with a clinical ADHD diagnosis and (2) children without a diagnosis (i.e., subthreshold ADHD). Secondly, hierarchical cluster analysis generated subgroups of children using EF scores. Children were compared on cognition, maths, and parent‐rated symptoms of ADHD and co‐occurring difficulties. Children's diagnostic outcomes did not differentiate maths performance. By contrast, EF subgroups generated meaningful cognitive clusters which differentiated maths test scores. This suggests that cognitive patterns of performance, rather than children's diagnostic outcomes, are more informative for identifying meaningful groups with variable maths performance which has implications for remedial support. [ABSTRACT FROM AUTHOR]

Objectives: This study investigated the effects of optokinetic stimuli and dual‐task performance on vestibulo‐ocular reflex (VOR) function. The study primarily focused on understanding the effects of attention deficit and hyperactivity disorder (ADHD) and its subtypes. Study Design: A case–control study. Setting: Tertiary medical centre. Methods: Thirty‐eight children diagnosed with ADHD and 40 typically developing (TD) children aged 8–18 were included in the study. According to their diagnostic reports, children diagnosed with ADHD were also examined in three subtypes: predominantly inattentive (ADHD‐PI), predominantly hyperactive–impulsive (ADHD‐HI) and the combined type. Functional head impulse test (fHIT) was applied to all participants in three conditions—with no additional stimulus, optokinetic stimulation and dual‐task. Correct responses (CR) were determined for each group, and the conditions were compared. For the dual‐task test performance, children were given a counting task. Results: The findings of the study are significant. The CR values obtained from the fHIT tests applied under three different conditions were lower in the ADHD group compared to the control group. CR values for all fHIT conditions and all semicircular canals were lower in the ADHD‐PI subtype and higher in the ADHD‐HI subtype compared to other subgroups. Conclusion: This study has significant practical implications underscoring its relevance. fHIT, when applied with different protocols, can provide valuable information about the vestibular and cognitive states of children with ADHD. These results are particularly significant as the diagnosis of ADHD often relies on subjective interpretations, and fHIT offers a more objective and reliable method of evaluation. [ABSTRACT FROM AUTHOR]

Attention Deficit Hyperactivity Disorder (ADHD) is the most common comorbidity in Autism Spectrum Disorder (ASD). ADHD is a risk factor for alcohol misuse whereas ASD is often regarded as protective; however, research on ASD and alcohol use has yielded conflicting findings, sometimes implicating the role of comorbid ADHD. The possibility that certain transdiagnostic features (i.e., characteristics associated with multiple disorders) may underlie relationships of both disorders to alcohol use in adults was examined in the present study. A nonclinical young adult sample of 248 alcohol users (117 men, 131 women) completed validated self-report measures of ASD and ADHD symptoms as well as the transdiagnostic features alexithymia, impulsivity, and negative moods. ASD and ADHD symptoms were normally distributed, suggesting that the respective disorders represent extreme, dysfunctional ends of population distributions of symptoms. Path analysis indicated that the significant positive association between ASD and ADHD symptom measures was fully mediated by alexithymia, impulsivity, and negative moods. Hierarchical regression and path analysis indicated that the positive relationship between ADHD symptoms and alcohol use severity was fully mediated by transdiagnostic features, particularly alexithymia and impulsivity, whereas the relationship between ASD and alcohol use severity was positively mediated by these features (especially alexithymia), with a highly significant and negative direct effect. Present findings may help reconcile previous conflicting evidence on the relationship of ASD to alcohol use, and the role of comorbid ADHD, by emphasizing the roles of alexithymia and impulsivity in both ASD and ADHD as transdiagnostic traits promoting excessive drinking. • ADHD is the most common comorbidity in ASD and is a risk factor for alcohol misuse. • Alexithymia, impulsivity and negative mood mediated the positive association of ADHD symptoms with alcohol use. • Alexithymia, impulsivity and negative mood also mediated a positive indirect association of ASD symptoms with alcohol use. • The direct effect of ASD symptoms indicated a negative relationship to alcohol use severity. • Findings suggest that alexithymia should be taken into account when investigating the relationship of ASD to alcohol use. [ABSTRACT FROM AUTHOR]

We hypothesised that growth hormone (GH) deficiency (GHD) in children with attention deficit hyperactivity disorder (ADHD) is rare. This study aimed to determine any distinct clinical or biochemical parameters, including GH provocation testing, in children with ADHD on psychostimulants or idiopathic short stature (ISS). Retrospective cross-sectional study of children who had GH provocative testing between 1998 and 2013 at one tertiary paediatric endocrine centre. Clinical data included age, sex, anthropometry, pubertal staging, bone age, diagnostic code as per the European Society Paediatric Endocrinology (ESPE), GH provocation test results, thyroid function tests, serum insulin-like growth factor-1 (IGF-1) and insulin-like growth factor-binding protein-3 (IGFBP-3) levels. Four hundred ninety-three subjects underwent GH provocation testing for investigation of short stature to exclude GHD during the study period. Fifty-one children had a diagnosis of ADHD. In the remaining children, the diagnosis was Idiopathic short stature (n=240), GHD +/− hypopituitarism (n=60), and 142 subjects had other causes of short stature. Children with ADHD were older, had higher height and weight SDS and were GH-sufficient. All 51 children with ADHD had a normal serum IGFBP-3, while 20 out of these 51 subjects had a low serum IGF-1. GHD in children with ADHD on psychostimulant medication is rare. GH testing in children with ADHD may not be necessary, particularly if serum IGFBP-3 is in the normal range. We suggest IGFBP-3 could be used as a surrogate marker of GH sufficiency in children with ADHD. However, this needs to be confirmed with a larger study group. [ABSTRACT FROM AUTHOR]

• STAND is an evidence-based treatment for adolescent ADHD that focuses on engagement. • Provides a summary of the development of a community implementation model for STAND. • Features include use of artificial intelligence to monitor fidelity and digitizing clinician resources. • Pilot work in three community agencies suggests acceptability, feasibility, and fidelity to the model. Implementation of behavior therapy for ADHD faces challenges in community settings. We describe development of a community-based implementation model for adolescent ADHD behavior therapy (Supporting Teens' Autonomy Daily; STAND) blended with Motivational Interviewing (MI). A stakeholder-engaged development approach is used based on the Exploration, Preparation, Implementation, Sustainment (EPIS) framework. Resulting model features include: (a) task-shifting supervision from experts to agency supervisors, (b) holding bi-weekly technical assistance drop-ins to provide training and implementation supports, (c) MI integrity monitoring and feedback by artificial intelligence (AI), (d) AI-generated metrics for STAND content fidelity, (e) digitizing resources (manual, worksheets, tips, videos) on a clinician dashboard, (f) creating visual displays of feedback using badges and graphs, and (g) adding a rapport-building session prior to manualized content. We conducted stakeholder focus groups (N = 32) and two pilot studies to evaluate the new STAND AI measurement tool and revised service-delivery model (N = 6 therapists, 7 youth and parents, 3 agency supervisors). Results revealed advantages and disadvantages of the model, supported the promise of a STAND AI fidelity measurement tool, and indicated initial feasibility, acceptability, and agency engagement in STAND's community-based implementation model. We discuss future directions for continued iterative development and testing. Video examples are included as supplementary material. [ABSTRACT FROM AUTHOR]

Family emotional climate is often assessed as expressed emotion (EE) using the five-minute speech sample (FMSS). Parent EE is related to child externalizing behavior, but the relationship with ADHD apart from externalizing is unclear. We report the largest ADHD-non-ADHD study of EE to date, introduce computational scoring of the FMSS to assay parent negative sentiment, and use this to evaluate reciprocal parent-child effects over time in ADHD while considering comorbid ODD. Parents of 810 children (nADHD = 509), aged 7–13 years old, completed the FMSS at three points. The FMSS was expert-coded for EE-Criticism at Time 1 and Time 2, negative sentiment was scored at all three time points. Sentiment and EE-Criticism were moderately correlated (r =.39, p <.001, 95% CI [0.32, 0.46]), and each was similarly correlated with baseline ADHD symptoms (r's range 0.31-0.33, p <.001) and ODD symptoms (r(ODD-EE) = 0.35, p <.001; r(ODD-sentiment = 0.28, p <.001). A longitudinal, cross-lagged panel model revealed that increases over time in parental negative sentiment scores led to increased ODD symptoms. Parent sex (namely fathers, but not mothers) showed an interaction effect of sentiment with ADHD. ADHD and ODD are independently and jointly associated with parental EE-Criticism and negative sentiment assessed by the FMSS cross-sectionally. A recursive effects model is supported for ODD, but for ADHD effects depend on which parent is assessed. For fathers, ADHD was related to negative sentiment in complex manners but for mothers, negative sentiment was related primarily to ODD. Key points: • This study is the largest to date to examine the relationship of expert-coded EE-Criticism with ADHD while controlling for ODD. • Cross sectionally, ADHD is associated with EE-Criticism independently of ODD. • Longitudinally, ADHD and EE-Criticism are not related apart from ODD. • Computer generated negative Sentiment scores based on transcripts of the Five-Minute Speech Sample is also related to ADHD and ODD at similar magnitude as EE-Criticism. • showed a significant predictive relationship with ODD symptom change in younger children but not in older children. • The negative Sentiment score was related to ADHD for fathers but not mothers. • Sentiment scores are a potentially useful addition to the tools available to measure parental implicit representation of their child. [ABSTRACT FROM AUTHOR]

Given the close connection between eye movement and frontal lobe functions and some evidence supporting the effect of eye‐tracking training on enhancing cognitive performance mediated by the frontal lobe, this study aimed to explore if after‐school eye‐tracking training can improve the visuospatial working memory (VSWM) and cognitive flexibility performance in children with attention‐deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). This study is a non‐randomized cluster trial. Forty children from eight primary schools were selected, half receiving eye‐tracking training for 20 sessions over 9 months, while the other half served as a waitlist control. They were matched on demographic characteristics and baseline cognitive performance. Their VSWM and cognitive flexibility were assessed at the beginning and end of the study. Results showed that children who received eye‐tracking training, but not those on a waitlist, exhibited significant improvements in the total score and working memory span of the VSWM tests, and the correct responses in cognitive flexibility tests. Specifically, VSWM performance at higher span levels (5 or above) yielded a greater improvement. The findings suggest that eye‐tracking training can be a feasible and effective after‐school program for improving working memory and cognitive flexibility performance in children with ADHD and ASD. This study was prospectively registered at ClinicalTrials.gov (https://clinicaltrials.gov/, trial number: NCT05428657). Lay Summary: Research studies have shown that using eye‐tracking technology to train the brain can improve cognitive performance of different brain disorders. In this study, we discovered that children with attention‐deficit/hyperactivity disorder (ADHD) and autism improved their ability to remember visual information and became better at thinking flexibly after participating in 20 sessions of eye‐tracking training. This suggests that eye‐tracking training has the potential to help children with ADHD and autism improve their memory and thinking skills. [ABSTRACT FROM AUTHOR]

Background: Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder, for which there are effective pharmacological treatments that improve symptoms and reduce complications. Guidelines published by the National Institute for Health and Care Excellence recommend that primary care practitioners prescribe medication for adult ADHD under shared-care agreements with Adult Mental Health Services (AMHS). However, provision remains uneven, with some practitioners reporting a lack of support. Aim: This study aimed to describe elements of support, and their availability/use, in primary care prescribing for adult ADHD medication in England to improve access for this underserved population and inform service improvement. Design and setting: Cross-sectional surveys were used to elicit data from commissioners, health professionals (HPs), and people with lived experience of ADHD (LE) across England about elements supporting pharmacological treatment of ADHD in primary care. Method: Three interlinked cross-sectional surveys were used to ask every integrated care board in England (commissioners), along with convenience samples of HPs and LEs, about prescribing rates, AMHS availability, wait times, and shared-care agreement protocols/policies for the pharmacological treatment of ADHD in primary care. Descriptive analyses, percentages, and confidence intervals were used to summarise responses by stakeholder group. Variations in reported provision and practice were explored and displayed visually using mapping software. Results: Data from 782 responders (42 commissioners, 331 HPs, 409 LEs) revealed differences in reported provision by stakeholder group, including for prescribing (95% of HPs versus 64% of LEs). In all, >40% of responders reported extended AMHS wait times of ≥2 years. There was some variability by NHS region – for example, London had the lowest reported extended wait time (25%), while East of England had the highest (55%). Conclusion: Elements supporting appropriate shared-care prescribing of ADHD medication via primary care are not universally available in England. Coordinated approaches are needed to address these gaps. [ABSTRACT FROM AUTHOR]

Individuals with ADHD report diminished emotion regulation capacities and adversity in childhood detrimentally affects emotion regulation development; however, how positive childhood experiences (PCEs) and whether and how social support are related to PCEs and emotion regulation for those with ADHD is unknown. Objective: To identify direct and indirect associations between PCEs and social support to emotion regulation outcomes in adults with ADHD. Method: Adults with ADHD (n = 81) reported PCEs, current social support, and emotion regulation. Conditional effects modeling examined the direct and indirect relationships between PCEs and emotion dysregulation through social support. Results: Higher PCEs were indirectly related to improved emotion regulation through increased social support generally (β = −.70, 95% CI [−1.32, −0.17], and specifically through belonging (β = −.43, 95% CI [ −0.87, −0.05], self-esteem (β = −.61, 95% CI [−1.08, −0.27], and tangible social support (β = −.50, 95% CI [−1.07, −0.02]. Conclusions: PCEs may protect emotion regulation in adults with ADHD through social support, possibly through facilitating social connections, increasing access to social support, and sustaining emotion regulation strategies. [ABSTRACT FROM AUTHOR]

Background: ADHD is highly comorbid with Delayed Sleep Phase Syndrome (DSPS). Both are associated with obesity and diabetes, which can be caused by long-term dysregulations of appetite and glucose metabolism. This study explores hormones involved in these processes and the effects of chronotherapeutic interventions in a small sample of adults with ADHD and DSPS. Methods: Exploratory, secondary analysis of data from the PhASE study, a three-armed randomized clinical trial, are presented, including 37 adults (18–53 years) with ADHD and DSPS receiving three weeks of 0.5 mg/day (1) placebo, (2) melatonin, or (3) melatonin plus 30 minutes of bright light therapy (BLT). Leptin (appetite-suppressing), ghrelin (appetite-stimulating), insulin, insulin-like growth factor-1 (IGF-1), and glucose were measured from blood collected at 08:00 hours. Salivary cortisol was collected during the first 30 minutes after awakening and self-reported appetite was assessed. Results: Baseline leptin and IGF-1 levels were higher than reference ranges, and ghrelin and cortisol levels were lower, while insulin and glucose were normal. Melatonin treatment decreased leptin and insulin. Other outcomes remained unchanged and melatonin + BLT had no effects. Conclusion: Due to the small sample size and exploratory nature of the study, results should be interpreted with caution. Overall, these results show no strong indications for dysregulation of appetite and glucose metabolism to suggest high risk of obesity and diabetes in this small sample of adults with ADHD and DSPS. However, baseline appetite was suppressed, likely because measurements took place in the early morning which could be considered the biological night for this study population. Melatonin treatment seemed to cause subtle changes in appetite-regulating hormones suggesting increased appetite. Chronotherapeutic treatment may affect appetite-regulating hormones by advancing the biological rhythm and/or altering eating behaviors, but this remains to be investigated in larger samples using detailed food diaries. [ABSTRACT FROM AUTHOR]

Objective: The current study sought to clarify and harness the incremental validity of emotional dysregulation and unawareness (EDU) in emerging adulthood, beyond ADHD symptoms and with respect to concurrent classification of impairment and co-occurring problems, using machine learning techniques. Method: Participants were 1,539 college students (M age = 19.5, 69% female) with self-reported ADHD diagnoses from a multisite study who completed questionnaires assessing ADHD symptoms, EDU, and co-occurring problems. Results: Random forest analyses suggested EDU dimensions significantly improved model performance (p s <.001) in classifying participants with impairment and internalizing problems versus those without, with the resulting ADHD + EDU classification model demonstrating acceptable to excellent performance (except in classification of Work Impairment) in a distinct sample. Variable importance analyses suggested inattention sum scores and the Limited Access to Emotional Regulation Strategies EDU dimension as the most important features for facilitating model classification. Conclusion: Results provided support for EDU as a key deficit in those with ADHD that, when present, helps explain ADHD's co-occurrence with impairment and internalizing problems. Continued application of machine learning techniques may facilitate actuarial classification of ADHD-related outcomes while also incorporating multiple measures. [ABSTRACT FROM AUTHOR]

Objectives: Previous studies have widely demonstrated that inhibition of return (IOR) with audiovisual targets decreases due to audiovisual integration (AVI). It is currently unclear, however, whether the impaired AVI in children with ADHD has effects on IOR. The present study used the cue-target paradigm to explore differences between the IOR of audiovisual targets and the IOR of visual targets in ADHD and typically developing (TD) children. Method: A total of 81 native Chinese speakers aged 6 to 13 years were recruited, including 38 children with ADHD and 43 age- and sex-matched TD children. Results: The results showed that there was a smaller magnitude of IOR with audiovisual targets as compared with visual targets in the two groups. Importantly, the reduction of IOR in audiovisual conditions was significantly smaller in children with ADHD than in children with TD. Race model analyses further confirmed that differences in IOR between ADHD and TD are due to deficits of audiovisual integration in ADHD. Conclusion: The results indicated that children with ADHD have impaired audiovisual integration, which has a minimal impact on IOR. [ABSTRACT FROM AUTHOR]

Background: White noise stimulation has demonstrated efficacy in enhancing working memory in children with ADHD. However, its impact on other executive functions commonly affected by ADHD, such as inhibitory control, remains largely unexplored. This research aims to explore the effects of two types of white noise stimulation on oculomotor inhibitory control in children with ADHD. Method: Memory guided saccade (MGS) and prolonged fixation (PF) performance was compared between children with ADHD (N = 52) and typically developing controls (TDC, N = 45), during auditory and visual white noise stimulation as well as in a no noise condition. Results: Neither the auditory nor the visual white noise had any beneficial effects on performance for either group. Conclusions: White noise stimulation does not appear to be beneficial for children with ADHD in tasks that target oculomotor inhibitory control. Potential explanations for this lack of noise benefit will be discussed. [ABSTRACT FROM AUTHOR]

Brunner syndrome is a rare genetic disorder that associated with mutations in the MAOA gene. It has been linked to a number of psychiatric disorders. We present detailed information on psychiatric evaluation of a case carrying a novel MAOA gene variant of p.(Thr408Met). The patient was referred to our clinic with a history of attention problems, motor coordination difficulties and a tendency to bite objects. Following a comprehensive psychiatric evaluation, the patient was diagnosed with developmental coordination disorder, articulation disorder and attention deficit hyperactivity disorder (ADHD). MAOA mutations are rarely reported in the literature. To date, a total of 23 MAOA gene variants, mostly missense variants, have been reported through the HGMD database (Professional 2023.4).Neurodevelopmental symptoms may vary in severity and diversity among patients with Brunner syndrome. Different degrees of intellectual disability have been found in previously reviewed cohorts of Brunner syndrome. In our affected patient, cognitive development and academic achievement were at a similar level to his peers. Additionally, our patient exhibited symptoms suggestive of developmental coordination disorder. Our findings show that genetic mutations in MAOA can lead to a wide range of clinical symptoms and underline the need for comprehensive genetic and clinical evaluations. [ABSTRACT FROM AUTHOR]

Background: Bernstein’s heuristic model of personal strengths describes 16 positive attributes of the healthy adult self, grouped into four higher-order factors: self-directedness (identity, self-reflection, self-confidence, self-assertion, imagination/creativity), self-regulation (emotional balance, resilience, self-control, self-care, reality testing), connection (empathy, compassion, humour, responsibility), and transcendence (gratitude and wisdom). The study aimed to explore the factorial validity of Bernstein’s Strengths Scale developed for the assessment of these constructs. Furthermore, we explored the association of strengths with attention-deficit hyperactivity (ADHD) symptoms and mental health in a nonclinical sample using a network approach. Methods: Five hundred and twenty-eight adults filled out an online questionnaire, including Bernstein’s Strengths Scale (BSS), the Mental Health Continuum – Short Form (MHC-SF), and the Adult ADHD Self-Report Scale (ASRS). Results: Though our data showed an acceptable fit to the 16-factor model, the Self-control subscale and item 28 of the Compassion subscale were excluded because of reliability issues. The final model with 15 factors and 44 items showed excellent fit, χ2(797) = 1130.149, p <.001, RMSEA = 0.028, 90% CI [0.024, 0.032], SRMS = 0.049, CFI = 0.993, TLI = 0.991. Principal component analysis revealed three instead of four second-order factors. In the network model, Self-confidence and Wisdom emerged as the most influential nodes. ADHD symptoms were negatively connected to Responsibility, Self-care, Identity, Emotional balance, Self-confidence, and mental health, while they had positive edges with Humor, Self-reflection, and Imagination/creativity. Mental health was positively related to several strengths, with the strongest association being between mental health and Gratitude. Conclusion: The BSS has acceptable factorial validity and is a reliable tool for assessing the personal strengths of the healthy adult self. ADHD symptoms in adults may be associated with deficits in personal strengths, but protective factors could also be identified. Addressing personal strengths in psychosocial interventions for ADHD in adults may improve patients’ emotional well-being and everyday functioning. [ABSTRACT FROM AUTHOR]