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Background: Attention-deficit/hyperactivity disorder (ADHD) affects approximately 5% of children globally, with symptoms often persisting into adulthood. While pharmacological interventions are commonly employed for management, understanding the optimal dosing for efficacy and tolerability remains crucial. This study aims to conduct a dose–response network meta-analysis to estimate the efficacy of pharmacological treatments across different doses, aiming to inform clinical decision-making and improve treatment outcomes. Methods: This updated systematic review will include randomized controlled trials evaluating ADHD medication efficacy in children, adolescents, and adults. An updated search from a 2018 NMA will be conducted across multiple electronic databases with no language restrictions, using specific eligibility criteria focused on randomized controlled trials. The primary outcome will assess the severity of ADHD core symptoms, while secondary outcomes will consider treatment tolerability. A dose–response Bayesian hierarchical model will be used to estimate dose–response curves for each medication, identifying optimal dosing strategies. Discussion: With this dose–response network meta-analysis, we aim to better understand the dose–response relationship of pharmacological treatment in ADHD, which could help clinician to the identification of optimal doses. Systematic review registration: OSF https://doi.org/10.17605/OSF.IO/3MY4A. [ABSTRACT FROM AUTHOR]

Attention deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) are highly comorbid. Many prior investigations have found that ADHD relates to anatomical abnormalities in gray matter. The abnormal gray matter of ADHD comorbid ODD is still poorly understood. This study aimed to explore the effect of comorbid ODD on gray matter volume (GMV) and functional alterations in ADHD. All data were provided by the ADHD‐200 Preprocessed Repository, including 27 ADHD‐only children, 27 ADHD + ODD children, and 27 healthy controls aged 9–14 years. Voxel‐based morphometry (VBM) and functional connectivity (FC) of resting‐state functional magnetic resonance imaging (fMRI) were used to compare the difference in GMV and FC between ADHD + ODD, ADHD‐only, and healthy children. The results showed that ADHD children with comorbid ODD had a more significant reduction in cerebellar volume, mainly in the anterior regions of the cerebellum (Cerebellum_4_5). The Cerebellum_4_5 showed increased functional connectivity with multiple cortical regions. These brain regions include numerous executive functioning (EF) and brain default mode network (DMN) nodes. The GMV abnormalities and excessive connectivity between brain regions may further exacerbate the emotional and cognitive deficits associated with ADHD. [ABSTRACT FROM AUTHOR]

Objective: Children with Attention Deficit/Hyperactivity Disorder (ADHD) suffer from numerous complications, leading to significant psychological and social costs. Therefore, this study aimed to evaluate the effectiveness of cognitiveemotional-social training of working memory on attention bias, executive functions, and academic performance of students with ADHD. Methods and Materials: This quasi-experimental study utilized a pretest-posttest and follow-up design with a control group. A total of 32 children were purposefully selected and randomly assigned to two groups of 16 participants each. Participants were assessed before, after the intervention, and one month later using questionnaires measuring attention bias, executive functions, and academic performance. The intervention group received cognitive-emotional-social training of working memory. Data were analyzed using repeated measures analysis of variance. Findings: The results indicated a significant improvement in attention bias, executive functions, and academic performance in the intervention group compared to the control group. Conclusion: According to the obtained results, cognitive-emotional-social training of working memory is effective in improving attention bias, executive functions, and academic performance of students with ADHD. [ABSTRACT FROM AUTHOR]

Iron deficiency (ID) and restlessness are associated with sleep/wake-disorders (e.g., restless legs syndrome (RLS)) and neurodevelopmental disorders (attention deficit/hyperactivity and autism spectrum disorders (ADHD; ASD)). However, a standardized approach to assessing ID and restlessness is missing. We reviewed iron status and family sleep/ID history data collected at a sleep/wake behavior clinic under a quality improvement/quality assurance project. Restlessness was explored through patient and parental narratives and a 'suggested clinical immobilization test'. Of 199 patients, 94% had ID, with 43% having a family history of ID. ADHD (46%) and ASD (45%) were common conditions, along with chronic insomnia (61%), sleep-disordered breathing (50%), and parasomnias (22%). In unadjusted analysis, a family history of ID increased the odds (95% CI) of familial RLS (OR: 5.98, p = 0.0002, [2.35–15.2]), insomnia/DIMS (OR: 3.44, p = 0.0084, [1.37–8.64]), and RLS (OR: 7.00, p = 0.01, [1.49–32.93]) in patients with ADHD, and of insomnia/DIMS (OR: 4.77, p = 0.0014, [1.82–12.5]), RLS/PLMS (OR: 5.83, p = 0.009, [1.54–22.1]), RLS (OR: 4.05, p = 0.01, [1.33–12.3]), and familial RLS (OR: 2.82, p = 0.02, [1.17–6.81]) in patients with ASD. ID and restlessness were characteristics of ADHD and ASD, and a family history of ID increased the risk of sleep/wake-disorders. These findings highlight the need to integrate comprehensive blood work and family history to capture ID in children and adolescents with restless behaviors. [ABSTRACT FROM AUTHOR]

Prenatal tobacco exposure has been implicated in increased risk of the development of behavioral disorders in children and adolescents. The purpose of the current study was to systematically examine the association between prenatal tobacco exposure and diagnoses of Attention Deficit/Hyperactivity Disorder, Oppositional Defiant Disorder, and Conduct Disorder in childhood and adolescence. We searched Medline, Psychinfo, ERIC, Proquest, Academic Search Complete, PsychArticles, Psychology and Behavioral Sciences Collection, Web of Science, CINAHL Plus, and Google Scholar databases through October 2022. The authors screened studies and extracted data independently in duplicate. Ten clinical studies examining diagnoses of Attention Deficit/Hyperactivity Disorder, Oppositional Defiant Disorder, and Conduct Disorder between the ages of 4 and 18 years old were included. There was insufficient evidence to synthesize outcomes related to Conduct Disorder and Oppositional Defiant Disorder. The meta-analysis found a significant effect of prenatal tobacco exposure in increasing the likelihood of an Attention Deficit/Hyperactivity Disorder diagnosis in childhood and adolescence. Implications for future research are discussed. [ABSTRACT FROM AUTHOR]

An efficient mode of evaluation for eye movements is the use of objective eye tracking systems combined with subjective tests (NSUCO or DEM), which are easily applicable across all age groups and in eye care clinical settings. The objective of this study was to characterize fixations during reading in two groups: a group of children with neurodevelopmental disorders (NDDG, 24 children, age: 6–12 years) and a group of children with oculomotor anomalies but without NDD (OAG, 24 children, age: 6–12 years). The results obtained were compared with those from a control group (CG, 20 children, age: 6–12 years). Specifically, the outcomes obtained with two subjective score systems, the Northeastern State University College of Optometry's Oculomotor (NSUCO) test and the Developmental Eye Movement (DEM) test, were compared with the objective analysis obtained through a commercially available eye tracker (Tobii Eye X, Tobii, Stockholm, Sweden). Specialized analysis software, namely Clinical Eye Tracker 2020 (Thomson Software Solutions, Welham Green, UK), was used. It was found that children with NDD had impaired oculomotor skills. A higher number of regressions, more fixations, and longer durations of fixations appear to be characteristic signs of this population group. Additionally, children with NDD took longer to complete the DEM test, as well as exhibiting more errors. The use of objective videoculographic systems for eye tracking and subjective tests like the NSUCO or DEM are good tools to assess saccadic movements, allowing the detection of oculomotor abnormalities in children with NDD. [ABSTRACT FROM AUTHOR]

Abstract Background Attention-deficit/hyperactivity disorder (ADHD) affects approximately 5% of children globally, with symptoms often persisting into adulthood. While pharmacological interventions are commonly employed for management, understanding the optimal dosing for efficacy and tolerability remains crucial. This study aims to conduct a dose–response network meta-analysis to estimate the efficacy of pharmacological treatments across different doses, aiming to inform clinical decision-making and improve treatment outcomes. Methods This updated systematic review will include randomized controlled trials evaluating ADHD medication efficacy in children, adolescents, and adults. An updated search from a 2018 NMA will be conducted across multiple electronic databases with no language restrictions, using specific eligibility criteria focused on randomized controlled trials. The primary outcome will assess the severity of ADHD core symptoms, while secondary outcomes will consider treatment tolerability. A dose–response Bayesian hierarchical model will be used to estimate dose–response curves for each medication, identifying optimal dosing strategies. Discussion With this dose–response network meta-analysis, we aim to better understand the dose–response relationship of pharmacological treatment in ADHD, which could help clinician to the identification of optimal doses. Systematic review registration OSF https://doi.org/10.17605/OSF.IO/3MY4A .

Prenatal tobacco exposure has been implicated in increased risk of the development of behavioral disorders in children and adolescents. The purpose of the current study was to systematically examine the association between prenatal tobacco exposure and diagnoses of Attention Deficit/Hyperactivity Disorder, Oppositional Defiant Disorder, and Conduct Disorder in childhood and adolescence. We searched Medline, Psychinfo, ERIC, Proquest, Academic Search Complete, PsychArticles, Psychology and Behavioral Sciences Collection, Web of Science, CINAHL Plus, and Google Scholar databases through October 2022. The authors screened studies and extracted data independently in duplicate. Ten clinical studies examining diagnoses of Attention Deficit/Hyperactivity Disorder, Oppositional Defiant Disorder, and Conduct Disorder between the ages of 4 and 18 years old were included. There was insufficient evidence to synthesize outcomes related to Conduct Disorder and Oppositional Defiant Disorder. The meta-analysis found a significant effect of prenatal tobacco exposure in increasing the likelihood of an Attention Deficit/Hyperactivity Disorder diagnosis in childhood and adolescence. Implications for future research are discussed.

Background Methods Results Conclusions Symptoms of anxiety and attention‐deficit/hyperactivity disorder (ADHD) are prospectively related from childhood to adolescence. However, whether the two dimensions of ADHD—inattention and hyperactivity‐impulsivity—are differentially related to anxiety and whether there are developmental and sex/gender differences in these relations are unknown.Two birth cohorts of Norwegian children were assessed biennially from ages 4 to 16 (N = 1,077; 49% girls) with diagnostic parent interviews used to assess symptoms of anxiety and ADHD. Data were analyzed using a random intercept cross‐lagged panel model, adjusting for all unobserved time‐invariant confounding effects.In girls, increased inattention, but not hyperactivity‐impulsivity, predicted increased anxiety 2 years later across all time‐points and increased anxiety at ages 12 and 14 predicted increased inattention but not hyperactivity‐impulsivity. In boys, increased hyperactivity‐impulsivity at ages 6 and 8, but not increased inattention, predicted increased anxiety 2 years later, whereas increased anxiety did not predict increased inattention or hyperactivity‐impulsivity.The two ADHD dimensions were differentially related to anxiety, and the relations were sex‐specific. In girls, inattention may be involved in the development of anxiety throughout childhood and adolescence and anxiety may contribute to girls developing more inattention beginning in early adolescence. In boys, hyperactivity‐impulsivity may be involved in the development of anxiety during the early school years. Effective treatment of inattention symptoms in girls may reduce anxiety risk at all time‐points, while addressing anxiety may decrease inattention during adolescence. Similarly, treating hyperactivity‐impulsivity may reduce anxiety risk in boys during late childhood (at ages 8–10). [ABSTRACT FROM AUTHOR]

The purpose of this research was to compare the effectiveness of cognitive rehabilitation training and sensory integration on executive function and memory of hyperactive students referring to educational and clinical centers in district 5 of Isfahan city. The current research was a semi-experimental study with a pre-test and post-test design with a control group with three stages of evaluation (pre-test, post-test and follow-up). The statistical community of all students referring to the educational and clinical centers of Isfahan city in the third quarter of 1400, 200 people who met the entry criteria, responded to the Connors parent questionnaire (hyperactivity). 45 people out of 60 people qualified to enter the study were selected as a sample and were randomly placed in three groups, and during three stages of evaluation, Connors Parent Questionnaire, Continuous Performance Test (CPT), Wisconsin Card Classification Test (WCST), Barat impulsivity scale and numeric span subscale of Wechsler IQ scale for children-revised form answered. The results of descriptive statistics and inferential statistics (multivariate covariance analysis, covariance analysis with repeated measures) with the help of spss-26 statistical software showed that the average age of the students participating in the research in the cognitive rehabilitation groups was 10.33, sensory integration 9.86 and control 10.46 years old. Also, the results showed that there is a difference between the effectiveness of cognitive rehabilitation training and sensory integration on executive functions and memory in three groups (cognitive rehabilitation training effectiveness, sensory integration and control group) in the post-test and follow-up of hyperactive students. . that there is a significant difference between both intervention groups and the control group, but there is no difference between the intervention groups (cognitive rehabilitation training and sensory integration) post-test and follow-up in terms of the effect on attention. As a result, students with hyperactivity/attention deficit often face problems with memory and executive functions. The treatment of sensory integration and cognitive rehabilitation by involving different senses, improving executive functions, memory and performing game-like activities causes coherence and organization in the central nervous system of the brain and controls and regulates sensory processing and behavior management. [ABSTRACT FROM AUTHOR]

Patients with certain psychiatric disorders have increased lung cancer incidence. However, establishing a causal relationship through traditional epidemiological methods poses challenges. Available summary statistics of genome-wide association studies of cigarette smoking, lung cancer, and eight psychiatric disorders, including attention deficit/hyperactivity disorder (ADHD), autism, depression, major depressive disorder, bipolar disorder, insomnia, neuroticism, and schizophrenia (range N: 46,350-1,331,010) were leveraged to estimate genetic correlations using Linkage Disequilibrium Score Regression and assess causal effect of each psychiatric disorder on lung cancer using two-sample Mendelian randomization (MR) models, comprising inverse-variance weighted (IVW), weighted median, MR-Egger, pleiotropy residual sum and outlier testing (MR-PRESSO), and a constrained maximum likelihood approach (cML-MR). Significant positive correlations were observed between each psychiatric disorder and both smoking and lung cancer (all FDR < 0.05), except for the correlation between autism and lung cancer. Both univariable and the cML-MA MR analyses demonstrated that liability to schizophrenia, depression, ADHD, or insomnia was associated with an increased risk of overall lung cancer. Genetic liability to insomnia was linked specifically to squamous cell carcinoma (SCC), while genetic liability to ADHD was associated with an elevated risk of both SCC and small cell lung cancer (all P < 0.05). The later was further supported by multivariable MR analyses, which accounted for smoking. Participants were constrained to European ancestry populations. Causal estimates from binary psychiatric disorders may be biased. Our findings suggest appropriate management of several psychiatric disorders, particularly ADHD, may potentially reduce the risk of developing lung cancer. • Major psychiatric disorders are genetically correlated with both cigarette smoking and lung cancer • Liability to schizophrenia may be associated with increased risk of overall lung cancer • Genetic liability to ADHD may be associated with an elevated risk of both squamous cell carcinoma and small cell lung cancer • These causal associations are unlikely to be mediated solely via smoking [ABSTRACT FROM AUTHOR]

In recent decades, a growing body of evidence has confirmed the existence of rhythmic fluctuations in attention, but the effect of inter-individual variations in these attentional rhythms has yet to be investigated. The aim of this review is to identify trends in the attention deficit/hyperactivity disorder (ADHD) literature that could be indicative of between-subject differences in rhythmic attention. A narrative review of the rhythmic attention and electrophysiological ADHD research literature was conducted, and the commonly-reported difference in slow-wave power between ADHD subjects and controls was found to have the most relevance to an understanding of rhythmic attention. A systematic review of the literature examining electrophysiological power differences in ADHD was then conducted to identify studies with conditions similar to those utilised in the rhythmic attention research literature. Fifteen relevant studies were identified and reviewed. The most consistent finding in the studies reviewed was for no spectral power differences between ADHD subjects and controls. However, the strongest trend in the studies reporting power differences was for higher power in the delta and theta frequency bands and lower power in the alpha band. In the context of rhythmic attention, this trend is suggestive of a slowing in the frequency and/or increase in the amplitude of the attentional oscillation in a subgroup of ADHD subjects. It is suggested that this characteristic electrophysiological modulation could be indicative of a global slowing of the attentional rhythm and/or an increase in the rhythmic recruitment of neurons in frontal attention networks in individuals with ADHD. [ABSTRACT FROM AUTHOR]

Introduction: Inhibition control, as the core component of executive function, might play a crucial role in the understanding of attention deficit/hyperactivity disorder (ADHD) and specific learning disorders (SLD). Inhibition control deficits have been observed in children with ADHD or SLD. This study sought to test in a multi-modal fashion (i.e., behavior and plus brain imaging) whether inhibition control abilities would be further deteriorated in the ADHD children due to the comorbidity of SLD. Method: A total number of 90 children (aged 6-12 years) were recruited, including 30 ADHD, 30 ADHD+SLD (children with the comorbidity of ADHD and SLD), and 30 typically developing (TD) children. For each participant, a 44-channel functional near infrared spectroscopy (fNIRS) equipment was first adopted to capture behavioral and cortical hemodynamic responses during a two-choice Oddball task (a relatively new inhibition control paradigm). Then, 50 metrics were extracted, including 6 behavioral metrics (i.e., OddballACC, baselineACC, totalACC, OddballRT, baselineRT, and totalRT) and 44 beta values in 44 channels based on general linear model. Finally, differences in those 50 metrics among the TD, ADHD, and ADHD+SLD children were analyzed. Results: Findings showed that: (1) OddballACC (i.e., the response accuracy in deviant stimuli) is the most sensitive metric in identifying the differences between the ADHD and ADHD+SLD children; and (2) The ADHD+SLD children exhibited decreased behavioral response accuracy and brain activation level in some channels (e.g., channel CH35) than both the ADHD and TD children. Discussion: Findings seem to support that inhibition control abilities would be further decreased in the ADHD children due to the comorbidity of SLD. [ABSTRACT FROM AUTHOR]

Background: Approximately 7.6% of children are diagnosed with attention deficit/hyperactivity disorder (ADHD), and sleep impairments affect 25–85%. There is a noticeable lack of research on girls and sex differences. The aim of this study was to examine sex differences in children with uncomplicated ADHD and sleep problems. Methods: Cross-sectional baseline data were retrieved from a randomized controlled trial with weighted blankets (55 boys and 41 girls, 6–14 years) on a cohort recently diagnosed with uncomplicated ADHD and sleep problems. Differences between boys and girls in ADHD symptoms, objectively and subjectively measured sleep, anxiety, and functioning were examined via parent- or self-reported validated instruments. Results: Girls reported significantly lower (worse) satisfaction with well-being, life overall, and school, but not for family. Parents reported more sleep anxiety and night-time wakings among boys, but no sex differences in other measures and also not in self-reported measures or objective sleep measures. Children who reported worry, sadness, or unhappiness had more sleep problems. Conclusions: Boys with ADHD and sleep problems may need support with sleep-related anxiety and night-time wakings, while girls may require support with overall functioning. Additionally, children who express feelings of worry, sadness, or unhappiness alongside their ADHD symptoms should have attention given to their sleep. [ABSTRACT FROM AUTHOR]

Neuroimaging is increasingly widely used in the field of ADHD research, and more and more studies have shown that ADHD patients have structural abnormalities such as reduced cortical volume, thinning thickness, and reduced surface area, which are related to complex clinical symptoms and abnormal brain function in patients. However, the use of neuroimaging to identify biomarkers as an objective diagnostic tool for ADHD still faces many challenges. Multimodal studies can be used to explore the relationship between the structure and function of different brain regions in ADHD patients, and to use neuroimaging to reveal the mechanism of the evolution of clinical symptoms in the whole life cycle of ADHD patients. [ABSTRACT FROM AUTHOR]

Objectives: Online mindfulness-based program (MBP) for parents and families especially in clinical population is limited. Engagement and significant dropout are major issues in MBP implementation. This pilot study examined the effects of an online mindfulness-based program (MBP) on parents of children with Attention Deficit/Hyperactivity Disorder (ADHD). Methods: A mixed methods study was applied to evaluate the effects of the MBP. A total of 43 parents were recruited and were randomly assigned into intervention group and waitlist control group. The online MBP lasted for 28 days, including 20 psychoeducation videos, homework audio guidance, and four instructor-led online group meetings. Purposive sampling was used to recruit parents who completed the program to share their experiences and suggestions for improving the program in semi-structured online interviews. Results: Quantitative data showed that participants from the online MBP reported a medium to large effect on the reduction of child ADHD symptoms. In semi-structured interviews, participants reported positive experiences in their help seeking intention, and personal changes, such as emotion regulation and quality attention to their children. Participants further made suggestions for improvement. Conclusions: The effect of online MBP is promising, and the program should be conducted. A large scale randomized controlled trial should be conducted to investigate the effects of MBP in clinical populations. [ABSTRACT FROM AUTHOR]

Although neurobiologic and genetic factors figure prominently in the development of attention deficit/hyperactivity disorder (ADHD), adverse physical health experiences and conditions encountered during childhood may also play a role. Poor health is known to impact the developing brain with potential lifelong implications for behavioral issues. In attempt to better understand the relationship between childhood physical health and the onset and presence of ADHD symptoms, we summarized international peer-reviewed articles documenting relationships between a select group of childhood diseases or health events (e.g., illnesses, injuries, syndromes) and subsequent ADHD outcomes among children ages 0–17 years. Drawing on a larger two-phase systematic review, 57 longitudinal or retrospective observational studies (1978–2021) of childhood allergies, asthma, eczema, head injury, infection, or sleep problems and later ADHD diagnosis or symptomatology were identified and subjected to meta-analysis. Significant associations were documented between childhood head injuries, infections, and sleep problems with both dichotomous and continuous measures of ADHD, and between allergies with dichotomous measures of ADHD. We did not observe significant associations between asthma or eczema with ADHD outcomes. Heterogeneity detected for multiple associations, primarily among continuously measured outcomes, underscores the potential value of future subgroup analyses and individual studies. Collectively, these findings shed light on the importance of physical health in understanding childhood ADHD. Possible etiologic links between physical health factors and ADHD are discussed, as are implications for prevention efforts by providers, systems, and communities. [ABSTRACT FROM AUTHOR]

Exposure to certain chemicals prenatally and in childhood can impact development and may increase risk for attention-deficit/hyperactivity disorder (ADHD). Leveraging a larger set of literature searches conducted to synthesize results from longitudinal studies of potentially modifiable risk factors for childhood ADHD, we present meta-analytic results from 66 studies that examined the associations between early chemical exposures and later ADHD diagnosis or symptoms. Studies were eligible for inclusion if the chemical exposure occurred at least 6 months prior to measurement of ADHD diagnosis or symptomatology. Included papers were published between 1975 and 2019 on exposure to anesthetics (n = 5), cadmium (n = 3), hexachlorobenzene (n = 4), lead (n = 22), mercury (n = 12), organophosphates (n = 7), and polychlorinated biphenyls (n = 13). Analyses are presented for each chemical exposure by type of ADHD outcome reported (categorical vs. continuous), type of ADHD measurement (overall measures of ADHD, ADHD symptoms only, ADHD diagnosis only, inattention only, hyperactivity/impulsivity only), and timing of exposure (prenatal vs. childhood vs. cumulative), whenever at least 3 relevant effect sizes were available. Childhood lead exposure was positively associated with ADHD diagnosis and symptoms in all analyses except for the prenatal analyses (odds ratios (ORs) ranging from 1.60 to 2.62, correlation coefficients (CCs) ranging from 0.14 to 0.16). Other statistically significant associations were limited to organophosphates (CC = 0.11, 95% confidence interval (CI): 0.03–0.19 for continuous measures of ADHD outcomes overall), polychlorinated biphenyls (CC = 0.08, 95% CI: 0.02–0.14 for continuous measures of inattention as the outcome), and both prenatal and childhood mercury exposure (CC = 0.02, 95% CI: 0.00–0.04 for continuous measures of ADHD outcomes overall for either exposure window). Our findings provide further support for negative impacts of prenatal and/or childhood exposure to certain chemicals and raise the possibility that primary prevention and targeted screening could prevent or mitigate ADHD symptomatology. Furthermore, these findings support the need for regular review of regulations as our scientific understanding of the risks posed by these chemicals evolves. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to illuminate the neuropathological landscape of attention deficit hyperactivity disorder (ADHD) by a multiscale macro–micro‐molecular perspective from in vivo neuroimaging data. Methods: The "ADHD‐200 initiative" repository provided multi‐site high‐quality resting‐state functional connectivity (rsfc‐) neuroimaging for ADHD children and matched typically developing (TD) cohort. Diffusion mapping embedding model to derive the functional connectome gradient detecting biologically plausible neural pattern was built, and the multivariate partial least square method to uncover the enrichment of neurotransmitomic, cellular and chromosomal gradient‐transcriptional signatures of AHBA enrichment and meta‐analytic decoding. Results: Compared to TD, ADHD children presented connectopic cortical gradient perturbations in almost all the cognition‐involved brain macroscale networks (all pBH <0.001), but not in the brain global topology. As an intermediate phenotypic variant, such gradient perturbation was spatially enriched into distributions of GABAA/BZ and 5‐HT2A receptors (all pBH <0.01) and co‐varied with genetic transcriptional expressions (e.g. DYDC2, ATOH7, all pBH <0.01), associated with phenotypic variants in episodic memory and emotional regulations. Enrichment models demonstrated such gradient‐transcriptional variants indicated the risk of both cell‐specific and chromosome‐ dysfunctions, especially in enriched expression of oligodendrocyte precursors and endothelial cells (all pperm <0.05) as well enrichment into chromosome 18, 19 and X (pperm <0.05). Conclusions: Our findings bridged brain macroscale neuropathological patterns to microscale/cellular biological architectures for ADHD children, demonstrating the neurobiologically pathological mechanism of ADHD into the genetic and molecular variants in GABA and 5‐HT systems as well brain‐derived enrichment of specific cellular/chromosomal expressions. [ABSTRACT FROM AUTHOR]

Despite the importance of understanding how intelligence is ingrained in the function and structure of the brain in some neurological disorders, the alterations of intelligence‐associated neurological factors in atypical neurodevelopmental disorders, such as attention deficit/hyperactivity disorder (ADHD), are limited. Therefore, we aimed to explore the relationship between the brain functional and morphological characteristics and the intellectual performance of 139 patients with ADHD. Resting‐state functional and T1‐weighted structural magnetic resonance imaging (MRI) data and intellectual‐performance data of the patients were collected. The MRI data were preprocessed to extract four indicators characterizing the participants' brain features: fractional amplitude of low‐frequency fluctuation, regional homogeneity, and gray and white matter volumes. Then, we used a two‐layer feature‐selection method with support vector regression models based on three kernel functions to predict the verbal and performance intelligent quotients of the patients, along with ten fold cross‐validation to evaluate the models' predictive performance. All models showed good performance; the correlation coefficients between the predicted and observed values for each predictive phenotypic variable were >0.41, with statistical significance. The brain features that could best predict the intellectual performance of the patients were concentrated in the superior and inferior frontal gyrus of the prefrontal areas, the angular gyrus and precuneus of the parietal lobe, the inferior and middle temporal gyrus of the temporal lobe, and part of the cerebellar regions. Thus, the voxel‐based brain‐feature indicators could adequately predict the intellectual performance of patients with ADHD, providing a foundation for future neuroimaging studies of this disorder. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the level of parental awareness of Attention deficit/ hyperactivity disorder (ADHD) in children with learning disabilities (LD). A descriptive survey method was used, and the questionnaire was distributed to the study population randomly. The sample consisted of 327 parents of students with learning disabilities in Riyadh. The questionnaire consisted of two parts: the first part was for the demographic data of the sample, and the second part consisted of 29 items, distributed over three main axes: general knowledge about ADHD and its characteristics (14 items), awareness of medical intervention (7 items), and cognitive awareness of behavioral and educational intervention (8 items). The results showed that the awareness level of parents of LD students about ADHD was high, with an average score of 3.91 out of 5.00. The results also showed that the highest level of awareness was in the domain of behavioral and educational intervention, followed by the domain of general knowledge about ADHD, and finally the domain of medical intervention. The results also showed that there were significant differences in the awareness level of parents of LD students about ADHD based on gender, with females having higher awareness scores than males. There were no significant differences based on age, but there were significant differences based on educational qualification in the domain of medical intervention. The study concludes with discussions on practical and research recommendations. [ABSTRACT FROM AUTHOR]

Objective: To investigate the efficacy of repetitive transcranial magnetic stimulation (rTMS) for attention deficit/hyperactivity disorder (ADHD). Methods: Randomized sham-controlled trials were identified in major databases from January 1990 to January 2023. The primary outcome was overall improvement in ADHD symptoms. Subgroup analysis focused on the efficacy of rTMS in different brain regions. Secondary outcomes were the association of rTMS with improvement in different ADHD symptoms. Outcomes were expressed as effect size based on standardized mean difference (SMD)(continuous data), and ORs with 95%CI (categorical data). Results: A meta-analysis of six randomized sham-controlled trials involving 169 participants demonstrated no difference in overall ADHD symptoms between those treated with rTMS and sham controls (SMD = -0.24, p = 0.17). Subgroup analysis revealed that rTMS was more efficacious than sham treatment when targeting the right prefrontal cortex (SMD = -0.49, p = 0.03) but not the left prefrontal cortex (SMD = 0.01, p = 0.67). rTMS treatment was correlated with greater improvement in inattention (SMD = -0.76, p = 0.0002), but not hyperactivity (p = 0.86), impulsivity (p = 0.41), or depression symptoms (p = 0.95). The apparently higher risk of dropout in the rTMS group than the sham control group was not statistically significant (OR = 1.65, p = 0.26). Conclusion: This review found that rTMS only had therapeutic efficacy for ADHD symptoms (particularly inattention) when targeting the right prefrontal cortex. Further large-scale randomized sham-controlled trials are required to verify our findings. Registration number: PROSPERO CRD42023393713.

BackgroundAntioxidants from both supplements and diet have been suggested to potentially reduce oxidative stress in individuals with ADHD. However, there is a lack of studies utilizing the Mendelian randomization (MR) method to explore the relationship between dietary and supplemental antioxidants with ADHD.MethodsThis study employed two-sample mendelian randomization. Various specific antioxidant dietary supplements (such as coffee, green tea, herbal tea, standard tea, and red wine intake per week), along with diet-derived circulating antioxidants including Vitamin C (ascorbate), Vitamin E (α-tocopherol), Vitamin E (γ-tocopherol), carotene, Vitamin A (retinol), zinc, and selenium (N = 2,603–428,860), were linked to independent single nucleotide polymorphisms (SNPs). Data on ADHD was gathered from six sources, comprising 246,888 participants. The primary analytical method utilized was inverse variance weighting (IVW), with sensitivity analysis conducted to assess the robustness of the main findings.ResultsIn different diagnostic periods for ADHD, we found that only green tea intake among the antioxidants was significantly associated with a reduced risk of ADHD in males (OR: 0.977, CI: 0.963–0.990, p

Introduction: Attention deficit/hyperactivity disorder is a neurological condition that often occurs in children. Aim: The purpose of present research was to develop and validate internet neuropsychological training program and investigate its effectiveness on response inhibition and impulsivity of children with attention deficit/hyperactivity disorder. Method: The program was compiled in a meta-synthesis method from data sources articles within 1982 to 2021 and was approved by professors of clinical psychology and psychiatry, Then, in quasi-experimental study with a pretest-posttest control group design, 21 children aged 5 to 6 years with attention deficit/hyperactivity disorder in Alborz province in 2022-2023 were selected by the convenience sampling method and randomly allocated into the experimental and control groups. The internet neuropsychological training program was held in 16 sessions for children and in 8 sessions for parents. Children's Raven Colored Progressive Matrices scales (1938), the Conners Parent Rating scale (1978) and Go/No go test (1984) were used to collect data. The program was analyzed by thematic analysis and the data was analyzed using multivariate analysis of covariance in SPSS version 20. Results: The results showed that the content validity index of the parents' program was 0.87 and the children's program was 1, and the content validity ratio of the parents' program was 1 and the children's program was 0.75. The measured F-values showed significant changes in response inhibition (P

The purpose of this research was to investigate the effectiveness of executive functions training program on sleep quality and moral judgment of children with attention deficit/hyperactivity disorder. The research method was semi-experimental with a pre-test-post-test design and follow-up with a control group. The statistical population of the research included all 9-12-year-old boys with attention deficit/hyperactivity disorder in Urmia city in 2022. The sample size includes 30 subjects from the statistical population were selected by available sampling method and they were placed in two control and experimental groups. The research tools included the Child Sleep Habits Questionnaire and the moral judgment Test. The results showed that the training program of executive functions had a significant effect on improving sleep quality and moral judgment in the post-test and follow-up stages. The findings of this research provide useful information related to the executive functions program, and counselors and psychologists can use this intervention to improve sleep quality and moral judgment in children with attention deficit/hyperactivity disorder.

Objective Movement and balance skills of children with attention deficit/hyperactivity disorder are weaker than normal children. The purpose of this study was to investigate the effectiveness of a course of kata exercises on static and dynamic balance in children with attention deficit/hyperactivity disorder. Methods This research was semi-experimental. The statistical population of the current study was all female children aged 10 to 12 years old with attention deficit/hyperactivity disorder in Hamadan city. The subjects of this research were 30 children who were selected by convenience sampling. At first, the characteristics of body measurements and static and dynamic balance pre-tests of children were recorded. After matching, subjects were randomly assigned to two control or experimental groups of 15 individuals. Then the participants of the experimental group participated in the protocol of kata exercises for 12 weeks and three sessions per week. After the last training session, the post-test of static and dynamic balance were measured in the same conditions as the pre-test. Independent and dependent t-tests were used to analyze the data. Results 12 weeks of kata exercises led to a significant increase in static balance with the dominant leg (P

BACKGROUND: Loss of control eating (LOC-E) in youth predicts the later development of full-syndrome binge-eating disorder (BED), and therefore, could be a relevant target for prevention treatments. To develop these treatments, it is important to understand the underlying disease processes and mechanisms. Based on the putative role of neurocognitive impairments in the pathogenesis of LOC-E, treatments that modulate these neurocognitive factors warrant further exploration. For instance, stimulants are an effective treatment for impulsivity in youth with attention deficit/hyperactivity disorder (ADHD) and have been shown to improve symptoms of BED in adults. Notably, stimulants have not been examined as a treatment for LOC-E in youth. To explore this gap, we aim to measure change in LOC-E episodes and secondary outcomes in youth with comorbid ADHD and LOC-E who are being started on stimulants. METHODS: We will collect prospective observational data on forty 8-to-13-year-old youth diagnosed with comorbid ADHD and LOC-E who are initiating a stimulant for ADHD. Prior to stimulant initiation, participants will complete baseline measures including LOC-E episode frequency in the last 3 months (primary outcome), and secondary outcomes including disordered eating cognitions, emotions and behaviors, ADHD symptom severity, parental LOC-E, impulsivity and reward sensitivity, and anxiety/mood severity. Outcome measurements will be gathered again at 3-months after initiating the stimulant. Within-patient standardized effect sizes with 95% confidence intervals will be calculated from baseline to 3-month follow-up for all outcomes. DISCUSSION: Many individuals with LOC-E or binge eating do not fully remit over the course of psychotherapy. Whereas psychotherapy may address psychological and sociocultural domains associated with LOC-E, some individuals with neurocognitive impairments (e.g., ADHD) and neurobiological deficits (e.g., low intrasynaptic dopamine or norepinephrine) may benefit from adjunctive treatment that targets those factors. This will be the first study to provide pilot data for future studies that could examine both the effect of stimulants on LOC-E in youth and underlying mechanisms. TRIAL REGISTRATION: Trial registration number: NCT05592119.

Attention deficit/hyperactivity disorder (ADHD) is a neuropsychological disorder that occurs in children and is characterized by inattention, impulsivity, and hyperactivity. Early and accurate diagnosis of ADHD is very important for effective intervention. The aim of this study is to develop a computer-aided approach to detecting ADHD using electroencephalogram (EEG) signals. Specifically, we explore a Gabor filter-based statistical features approach for the classification of EEG signals into ADHD and healthy control (HC). The EEG signal is processed by a bank of Gabor filters to obtain narrow-band signals. Subsequently, a set of statistical features is extracted. The computed features are then subjected to feature selection. Finally, the obtained feature vector is given to a classifier to detect ADHD and HC. Our approach achieves the highest classification accuracy of 96.4% on a publicly available dataset. Furthermore, our approach demonstrates better classification accuracy than the existing methods. [ABSTRACT FROM AUTHOR]

Attention deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder affecting various aspects of life. Some features of the mental disorders affect people's movement patterns. In the recent decade, researchers have paid attention to the analysis of gait and balance pattern using new technological tools, as well as artificial intelligence algorithms. Therefore, the present study aims to propose an intelligent method to identify ADHD in children using gait and balance pattern features extracted from the person's movements obtained from the skeleton data. Given that designing and extracting effective motor features for diagnosing the aforementioned disorder is the main objective. In the present applied development experimental study, human movement samples related to the gait and balance were recorded in the standard test of perceptual-motor development, from healthy and ADHD-diagnosed children. After preprocessing the data recorded by the Kinect device, effective features for diagnosis are designed and extracted from the appropriate special movement tests. Comparing the features extracted from gait and balance tests by skeleton data, the results indicated that the data based on other types of methods for differentiation into healthy and ADHD groups are in line with those of the present study. The results of diagnosis and separation of healthy children from those with disorders in the different movement tests, standing on the ground with the superior foot, standing on a balance stick with the superior foot, and walking heel forward on a balance stick, to identify ADHD by SVM classification method are 86.4%, 90.2%, and 88.1%, respectively. The obtained significant results have been achieved relying on machine learning-based methods using the effective features obtained from skeleton gait and balance data of children along with analyzing the descriptive statistics of the features of gait and balance tests. [ABSTRACT FROM AUTHOR]

Objective: To review the literature on the utility of the Conners CPT-3 in persons with ADHD. Methods: A systematic review was conducted. Six databases were searched using inclusion criteria: research studies, year 2000+, English, and ages 8+. Two raters independently screened 1,480 title/abstracts and subsequently reviewed 399 full texts. Data extraction and critical appraisal were conducted. Reflective thematic analysis through inductive coding identified qualitative themes. Results: Thirteen studies met inclusion criteria with five themes identified. Five studies found CPT-3 was a weak or poor predictor of ADHD diagnosis while two found it was an adequate predictor. Two studies found CPT-3 could differentiate clients with comorbid ADHD/anxiety from ADHD or ADHD from obsessive-compulsive disorder. One found CPT-3 could not differentiate ADHD from ASD or comorbid ADHD/ASD. Conclusions: Results revealed CPT-3 as a standalone measure is a weak or poor predictor of ADHD. Multiple measures for evaluating persons with ADHD are recommended. [ABSTRACT FROM AUTHOR]

Objective: Attention deficit/ hyperactivity disorder is one of the most common neurodevelopmental disorders. The purpose of this study was to compare the effectiveness of Transcranial Direct Current Brain Stimulation (tDCS) and computerbased cognitive rehabilitation on improving cognitive emotion regulation in children with attention deficit/ hyperactivity disorder. Methods: The current research design was experiment with pre-test-post-test and control group. The statistical population included children with attention deficit/ hyperactivity disorder in Ardabil city who referred to the psychiatric center of Fatemi Hospital in Ardabil city in 2023. From this population, 60 children with attention deficit/ hyperactivity disorder were selected by purposeful sampling and randomly replaced in three groups: experiment 1, experiment 2, and control (20 people in each group). Data were collected using Connors Parent Rating Scale (1978), Raven's Progressive Matrices Test (2000) and cognitive emotion regulation scale (2002). The subjects of the first experimental group received Transcranial Direct Current Brain Stimulation (tDCS) for 10 sessions and twice a week for 20 minutes. The second experimental group also received Captain Log's computerized cognitive rehabilitation intervention for 10 sessions and twice a week for 45 minutes. The control group did not receive any intervention. Data analysis was done with SPSS version 25 software and with covariance analysis and Bonferroni's post hoc test. Results: The results showed that there is a significant difference between the groups in emotion regulation (P<0.05). The experimental groups of transcranial direct current brain stimulation (tDCS) and computer-based cognitive rehabilitation had higher emotion regulation compared to the control group. Also, by controlling the effect of the pre-test in the two experimental groups, there is no significant difference between the two methods of transcranial direct current brain stimulation (tDCS) and computer-based cognitive rehabilitation (P<0.05). Conclusions: According to the results, it can be said that the intervention of transcranial direct current brain stimulation (tDCS) and computer-based cognitive rehabilitation were effective in improving the cognitive regulation of emotion in children with attention deficit/ hyperactivity disorder. Therefore, both interventions can be used to improve the cognitive regulation of emotions in children with attention deficit/ hyperactivity disorder. [ABSTRACT FROM AUTHOR]

A growing understanding of twice-exceptional (2e) students has caused many to consider the possibility of misdiagnosis and missed diagnoses in the gifted student. Despite this, auditory processing disorders (APD) and vision processing disorders (VPD) are seldom examined in the 2e research literature, yet are not uncommon in the 2e population. Because both auditory and vision processing are foundational to the human experience, challenges in these areas may significantly impact higher-order skills such as attention and executive function, as well as academic performance. This article explores what is currently known about these processing disorders, examines potential co-occurring conditions, such as dyslexia and Attention Deficit/Hyperactivity Disorder (ADHD), and presents clinical case file data suggesting how these sensory disorders may appear in the 2e population. Proper identification, management, and support of APD and VPD in 2e students could improve our ability to address student needs at the foundational level. [ABSTRACT FROM AUTHOR]

Objective: We analyzed adult ADHD symptoms in a cross-cultural context, including investigating the occurrence and potential correlates of adult ADHD and psychometric examination of the Adult ADHD Self-Report Scale (ASRS) Screener. Method: Our analysis is based on a large-scale research project involving 42 countries (International Sex Survey, N =72,627, 57% women, Mage =32.84; SDage =12.57). Results: The ASRS Screener demonstrated good reliability and validity, along with partial invariance across different languages, countries, and genders. The occurrence of being at risk for adult ADHD was relatively high (21.4% for women, 18.1% for men). The highest scores were obtained in the US, Canada, and other English-speaking Western countries, with significantly lower scores among East Asian and non-English-speaking European countries. Moreover, ADHD symptom severity and occurrence were especially high among gender-diverse individuals. Significant associations between adult ADHD symptoms and age, mental and sexual health, and socioeconomic status were observed. Conclusions: Present results show significant cross-cultural variability in adult ADHD occurrence as well as highlight important factors related to adult ADHD. Moreover, the importance of further research on adult ADHD in previously understudied populations (non-Western countries) and minority groups (gender-diverse individuals) is stressed. Lastly, the present analysis is consistent with previous evidence showing low specificity of adult ADHD screening instruments and contributes to the current discussion on accurate adult ADHD screening and diagnosis. [ABSTRACT FROM AUTHOR]

This study aims to identify the sensory characteristics of children with both developmental disabilities such as ASD and ADHD and a history of child maltreatment (DM group), children with developmental disabilities (DD group), and typically developed children (TD group). The sensory characteristics of 24 children were assessed through virtual reality and self-administered questionnaires. The results elucidated that the duration of gazing at the "teacher" (60–75 s) was significantly different with the DM group's gaze being shorter than the DD group's gaze (p = 0.042). The duration of the "others" gaze (45–60 s) was also significantly different with the DM group's gaze being longer than the DD and TD groups' gaze (p = 0.018; p = 0.030). Additionally, the scores for tactile sensitivity, taste/smell sensitivity, under-responsive/seeks sensation, and the total short-term sensory profile were significantly different between the DM-DD and DD-TD groups. The scores of the heart rate perception test and Multidimensional Assessment of Interoceptive Awareness were significantly lower in the DM and DD groups. In conclusion, children who have experienced trauma and developmental disabilities may have different sensory characteristics than children with only developmental disabilities or none, implying the need for further research and tailored care. [ABSTRACT FROM AUTHOR]

Atomoxetine is indicated for the management of attention deficit/hyperactivity disorder (ADHD) in children and adolescents aged 6 to 18 years. Few studies have assessed the safety and tolerability of atomoxetine in younger patients. This retrospective cohort study included 133 children aged 3–6 years who were diagnosed with ADHD comorbid with autism spectrum disorder (ASD). The primary endpoint was the evaluation of the safety profile of atomoxetine. In total, 50 patients (37.6%) experienced adverse events (AEs), which led to treatment discontinuation in 23 patients (17.3%). The most common AEs were gastrointestinal (24.1%), aggression or hostility (12.8%), and increased hyperactivity (9.0%). In the 23 patients who discontinued treatment, all the AEs resolved after treatment ceased. Among the 110 patients who completed at least 6 months' treatment, atomoxetine titrated to a dose of 1.2–1.8 mg/kg/day appeared to be well tolerated and effective. The Clinical Global Impression—Improvement score improved to 1 ("very much improved") and 2 ("much improved") in 62.4% and 20.3% of children, respectively, at their last visit. Overall, atomoxetine appeared to be well tolerated in younger children with comorbid ADHD and ASD. Nevertheless, close patient monitoring remains essential, and the study limitations necessitate caution in generalizing these findings to broader populations. Long-term prospective studies are required. [ABSTRACT FROM AUTHOR]

BackgroundNumerous observational studies have suggested an association between psychiatric traits and carotid intima-media thickness (cIMT). However, whether these associations have a causal relationship remains unknown, largely due to issues of reverse causality and potential confounders. This study aims to elucidate the potential causal role of psychiatric traits in the risk of arterial injury as measured by cIMT.MethodsWe utilized instrumental variables for attention deficit/hyperactivity disorder (ADHD, n = 226,534), bipolar disorder (n = 353,899), major depressive disorder (n = 142,646), post-traumatic stress disorder (n = 174,494), obsessive-compulsive disorder (n = 9,725), autism spectrum disorder (n = 173,773), and anxiety disease (n = 17,310), derived from the largest corresponding genome-wide association studies (GWAS). Summary statistics for cIMT associations were obtained from a meta-analysis combining GWAS data from the Cohorts for Heart and Aging Research in Genomic Epidemiology consortia (n = 71,128) and the UK Biobank study (n = 45,185). The inverse-variance weighted method served as the primary analytical tool, supplemented by additional statistical methods in the secondary analyses to corroborate the findings. Adjustments were made according to the Bonferroni correction threshold.ResultsThe Mendelian randomization analyses indicated a suggestive causal link between genetically predicted ADHD and cIMT (beta = 0.05; 95% confidence interval, 0.01–0.09; p = 0.018). Sensitivity analyses largely concurred with this finding. However, no significant associations were found between other psychiatric traits and cIMT.ConclusionsThis study provides insights into the risk effect of ADHD on cIMT, suggesting that arteriopathy and potential associated complications should be considered during the treatment and monitoring of patients with ADHD.

AbstractThe aim of this study is to investigate the mediating role of the dimensions of reflective functioning in the relationship between insecure attachment styles and parenting stress in parents of child with attention deficit/hyperactivity disorder. The method of the current research was correlation-structural equation modeling and the research population included parents of children with attention deficit/hyperactivity disorder in Yazd city in 1401. Among them, the sample consisted of 295 fathers and mothers of these children selected using convenient method and fulfilled the questionnaires of experience of close relationships by Brennan et al. (1998), Parental reflective functioning by Luyten et al. (2017) and parents stress by Abidin (1995), in person or online. In the next step the data was analyzed using the statistical method of path analysis and multi-group analysis. The findings of the research showed that in both groups of mothers and fathers, pre-metallization can play a mediating role in the relationship between insecure anxious attachment style and parenting stress in fathers and mothers of children with attention deficit/hyperactivity disorder. Also, multi group analysis confirmed the role of parents' gender, and in the difference between these two groups, the path of avoidant attachment to parenting stress was significant in the mothers' group as opposed to the fathers' group. As a result, according to the findings, it can be said that in both groups of mothers and fathers, anxious attachment plays an important role in increasing pre-mentalization about children with disorders and thus increases the stress of parenting.Keywords: attention deficit/hyperactivity disorder, parenting stress, Parental reflective functioning, insecure attachment style. Extended Abstract IntroductionAttention deficit hyperactivity disorder (ADHD) is one of the most common developmental neurodevelopmental disorders in childhood. Children with ADHD show more and more vigorousness, hyperactivity, neglect and sudden behaviors than normal children, and parents of these children often report high hopelessness in trying to manage their behavior. The researchers found that parents with children with attention deficit hyperactivity disorder experienced significantly more parental stress than parents with a child with normal development. In addition to these factors, parental attachment style affects their ability to cope with stress, and consequently these styles may also affect the stress of parents.At the same time, one of the important variables that can play a role in the relationship between parental attachment style and parenting stress is reflective functioning. It combines the concept of psychoanalysis of mind-set and attachment theories and refers to the ability of parents or caregivers to imagine their child's mental states such as their feelings, wishes, and desires.In general, the research question is whether the dimensions of reflective functioning can play the mediating role in the relationship between insecure attachment styles and parental stress in parents of children with attention deficit hyperactivity disorder? Literature Research The dominant model of parental stress identifies two main components: the child's domain, which originates directly from the child's characteristics, and the parent domain, which is most influenced by the parents' own performance. Overall stress is a combination of parent and child stress. Studies on families of children with ADHD show that parental stress increases in both areas. Parents who experience extreme levels of parental stress may be less able to take steps to help their child.Attachment theory holds that people's attachment systems are activated in stressful situations, such as when a child is afraid, or in pain, seeks to be close to his or her parent and feels relaxed in this way. Adult attachment can be described by two dimensions, anxious attachment and avoidance attachment. According to research, low maternal score in avoidant and anxious attachment styles is associated with higher resiliency against children with attention deficit hyperactivity disorder.The concept of reflective functioning combines the concept of psychoanalytic mentalization and attachment theories and refers to the ability of parents or caregivers to imagine their child's mental states such as their feelings, wishes, and desires. The three key dimensions of parental reflective functioning include: methods of pre-mentalization, confidence in state of mind and interest and curiosity.The first dimension, the state of pre-mentalization, refers to a non-subjective position that is often characteristic of parents with severe impairments in parental reflective functioning. The second dimension, certainty of mental states , refers to parents' ability to recognize that mental states are inherently ambiguous. The third dimension refers to the parents' curiosity and interest in the child's state of mind, i.e., the parents' willingness to understand the child. Studies that have evaluated parents' reflective capacity indicate that parents' ability to mentalize can be an important factor for tolerance of neonatal distress, reinforcement of more positive discipline strategies and less parental stress perception. Regarding the difference between parents and mothers, in some studies, mothers were more likely than fathers to believe that their children with attention deficit hyperactivity disorder were stressful. MethodologyThe present study was conducted by correlation-structural equation modeling. The statistical population consisted of mothers and fathers of children with attention deficit hyperactivity disorder living in Yazd city in 1401 and the sample consisted of 295 parents who were selected using convenient method. After collecting the questionnaires, AMOS-24 and SPSS-24 software were used for data analysis. In addition, descriptive statistics (mean, standard deviation), correlation coefficients, multi-group analysis and index of fit were used to investigate the research question. The research instruments included the Experiences of Close Relationships, Parental Reflective Functioning Questionnaire and Parents Stress Questionnaire. ResultsThe results showed that in both groups of mothers and fathers, only the correlation coefficients of pre-mentalization scale with parenting stress (r=0.55 and fathers: r=0.50) were significant. Also, the correlation coefficient of insecure attachment anxiety with parenting stress was significant for both groups (r=0.56 and fathers: r=0.40) while insecure avoidance attachment correlation coefficient (mothers: r=0.22) was significant only for mothers. Therefore, for better fit, non-significant pathways were removed from the model and without these two subscales the models were fitted. Then, in the form of mediation model, pre-mentalization was shown in relation between the variables of the research.Mediation Model of Parental Pre-Mentalization in the Relationship between Insecure Attachment Styles (Anxiety/Avoidance) and Fathers' Parenting Stress According to the form of avoidance, attachment pathway to parental stress (β =-0.04) and pre-mentalization (β =-0.09) is non-significant. On the other hand, the attachment pathways of anxiety to pre-mentalization (β=0.47), anxiety attachment to parenting stress (β=0.26) and pre-mentalization to parenting stress (β=0.38) are significant.Mediation Model of Parental Pre-mentalization in the Relationship between Insecure Attachment Styles (Anxiety/Avoidance) and Parental Stress of Mothers According to mothers' model, avoidance attachment to pre-mentalization (β=0.05) is not significant. On the other hand, avoidant attachment pathways to parenting stress (β=0.17), anxiety attachment to pre-mentalization (β=0.53), anxiety attachment to parenting stress (β=0.37) and pre-mentalization to parenting stress (β=0.36) are significant. In order to improve the overall fitness of two models of parents and mothers, the model was modified by applying the covariance between avoidant attachment and anxious attachment and the results of fitting the model before and after the modification were brought. According to the results of fit, it seems that regression weights make a difference in at least some pathways between the fit of mothers and fathers. Therefore, the role of parents' gender in the research model was confirmed. DiscussionIn explaining this finding, it can be said that considering that reflective functioning is the operationalization of mental processes that reinforces the capacity of mentalization. When parents are able to understand the meaning and purpose of their child's signals, it gives a more appropriate response, thus forming a reflective functioning or ability to perceive oneself and others in mental states such as thoughts, feelings, and intentions. So parents who reflect are able to understand their child's behaviors according to mental states. Similarly, in dealing with children, they experience less stress caused by confusion in behavior and dealing with the child. Parents who are not able to build capacity in this area will have more stress. ConclusionInsecure attachment (especially anxious attachment) seems to cause serious disorders in parental pre-mentalization and because parents with this style cannot understand a child with attention deficit hyperactivity disorder, they experience high stress. AcknowledgementWe need to thank all the people who helped us in this study, especially parents of children with ADHD and also members of Dr. Tahereh Sadeghiye Psychiatric Clinic. * Corresponding Author: zahra.naderi@yazd.ac.irHow to Cite: Saeed, M., Saeed, M., Saeed, M. ‌(2024). The Mediating Role of Parental Reflective Functioning Dimensions in the Relationship Between Parental Insecure Attachment Styles and Parenting Stress in Parents of Children With Attention Deficit-Hyperactivity Disorder, Journal of Psychology of Exceptional Individuals, 13(52), 1-29. DOI: 10.22054/jpe.2023.74893.2602

Iron deficiency (ID) and restlessness are associated with sleep/wake-disorders (e.g., restless legs syndrome (RLS)) and neurodevelopmental disorders (attention deficit/hyperactivity and autism spectrum disorders (ADHD; ASD)). However, a standardized approach to assessing ID and restlessness is missing. We reviewed iron status and family sleep/ID history data collected at a sleep/wake behavior clinic under a quality improvement/quality assurance project. Restlessness was explored through patient and parental narratives and a ‘suggested clinical immobilization test’. Of 199 patients, 94% had ID, with 43% having a family history of ID. ADHD (46%) and ASD (45%) were common conditions, along with chronic insomnia (61%), sleep-disordered breathing (50%), and parasomnias (22%). In unadjusted analysis, a family history of ID increased the odds (95% CI) of familial RLS (OR: 5.98, p = 0.0002, [2.35–15.2]), insomnia/DIMS (OR: 3.44, p = 0.0084, [1.37–8.64]), and RLS (OR: 7.00, p = 0.01, [1.49–32.93]) in patients with ADHD, and of insomnia/DIMS (OR: 4.77, p = 0.0014, [1.82–12.5]), RLS/PLMS (OR: 5.83, p = 0.009, [1.54–22.1]), RLS (OR: 4.05, p = 0.01, [1.33–12.3]), and familial RLS (OR: 2.82, p = 0.02, [1.17–6.81]) in patients with ASD. ID and restlessness were characteristics of ADHD and ASD, and a family history of ID increased the risk of sleep/wake-disorders. These findings highlight the need to integrate comprehensive blood work and family history to capture ID in children and adolescents with restless behaviors.

Introduction: Attention-deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder a ecting children worldwide; however, diagnosing ADHD remains a complex task. Theta/beta ratio (TBR) derived from electroencephalography (EEG) recordings has been proposed as a potential biomarker for ADHD, but its e ectiveness in children with ADHD remains controversial. Behavioral assessments, such as the Conners Continuous Performance Test--3rd edition (CPT-3), have been utilized to assess attentional capacity in individuals with ADHD. This study aims to investigate the correlation between TBR and CPT-3 scores in children and adolescents with ADHD. Methods: In a retrospective analysis, we examined patients regularly monitored for ADHD at Taipei Tzu Chi Hospital, who underwent both EEG and CPT-3 assessments. Severity of ADHD was evaluated using parent- and teacher- completed Swanson, Nolan, and Pelham (SNAP)-IV rating scales. Results: The study encompassed 55 ADHD patients (41 with abnormal CPT-3 scores, 14with normal CPT-3 scores) and 45 control subjects. TBR demonstrated elevation in ADHD patients with abnormal CPT-3 scores, indicating its potential to represent attentional capacity akin to behavioral assessments like CPT-3. However, significant correlations between TBR values and CPT-3 variables or SNAP-IV rating scales were not observed. Moreover, TBR values exhibited considerable overlap across the groups, leading to diminished sensitivity and negative predictive value as a potential neurophysiological ADHD biomarker. Discussion: While our study underscores the utility of both TBR and CPT-3 in assessing attentional capacity, their sensitivity in diagnosing ADHD is limited. A comprehensive evaluation, integrating clinical expertise, parental input, and detailed neuropsychometric tests, remains pivotal for a thorough and precise diagnosis of ADHD. [ABSTRACT FROM AUTHOR]

Objective: Attention-Deficit/Hyperactivity Disorder (ADHD) is a common neurodevelopmental condition which is underdiagnosed and undertreated in women. For decades, the ADHD field has called for more insight into femalespecific therapy. Preliminary findings postulate that changes in sex hormones during the menstrual cycle may influence the effectiveness of psychostimulant medication. Yet, pharmacotherapeutic interventions tailored to women with ADHD remain scarce. Previously, our group showed an increase in mood symptoms in the premenstrual week in women with ADHD. Premenstrual worsening of depressive and ADHD symptoms represent a treatment challenge. In our adult ADHD clinic, we noted several women describing exacerbation of their ADHD and depressive symptoms in the premenstrual week and/or insufficient effect of their established dosage of psychostimulant. We responded to the need expressed by these women by increasing their stimulant dosage in the premenstrual week, while monitoring the response and side effects. Methods: This community case study of nine consecutive women being treated for ADHD and co-occurring conditions (including depression and premenstrual dysphoric disorder), reports our local experience of increasing the individually prescribed psychostimulant dosage during the premenstrual period. We methodically monitored the effect of this increased dosage on ADHD symptoms, mood and somatic symptoms for the following 6–24  months. Results: With premenstrual dose elevation, all nine women experienced improved ADHD and mood symptoms with minimal adverse events. Premenstrual inattention, irritability and energy levels improved, and now resembled the other non-premenstrual weeks more closely. All women decided to continue with the elevated premenstrual pharmacotherapy. Discussion: Our preliminary results demonstrate potential benefits of increasing premenstrual psychostimulant dosage in women with ADHD, experiencing premenstrual worsening of ADHD and mood symptoms. The results concur with previous findings of diminished response to amphetamines in the late luteal phase. Increased dosage may help combat premenstrual worsening of cognitive and emotional symptoms in women with ADHD, with significant clinical implications. Better management of premenstrual ADHD and mood symptoms in vulnerable women can improve treatment outcome and meet an unmet need. However, implementation should be individually explored. Further investigation of luteal phase psychostimulant dose adjustment is required for safe, optimal and individualised treatment for women with ADHD. [ABSTRACT FROM AUTHOR]

Autism Spectrum Disorder (ASD) and Attention Deficit Hyperactivity Disorder (ADHD) are two often co-occurring neurodevelopmental conditions. Nevertheless, there is limited research about symptom differences between ASD and ASD + ADHD groups. This study examined differences in social interaction and communication between children and adolescents with ASD and with ASD + ADHD. A total of 112 participants were identified from two clinical trials. Fifty-six children and adolescents with ASD aged 8–17 years were matched for age, gender and general intelligence quotient with fifty-six children and adolescents with ASD + ADHD. Group differences in scores on the Autism Diagnostic Observation Schedule were analysed. Our results showed that participants with ASD and with ASD + ADHD had similar profiles of social communication interaction challenges and restricted behaviour. However, items assessing gestures: Conventional, Instrumental or Informational Gestures and Empathic or Emotional gestures showed significant differences between the groups suggesting that the ASD + ADHD group used descriptive gestures to communicate to a greater extent than the ASD group. These findings suggest that children and adolescents in both groups have similar difficulties in social communication and interaction with observed differences in the use of gestures. Possible reasons and implications for the differences in the use of gestures are discussed. [ABSTRACT FROM AUTHOR]

Introduction: Attention deficit/hyperactivity disorder is a neurological condition that often occurs in children. Aim: The purpose of present research was to develop and validate internet neuropsychological training program and investigate its effectiveness on response inhibition and impulsivity of children with attention deficit/hyperactivity disorder. Method: The program was compiled in a meta-synthesis method from data sources articles within 1982 to 2021 and was approved by professors of clinical psychology and psychiatry, Then, in quasi-experimental study with a pretest-posttest control group design, 21 children aged 5 to 6 years with attention deficit/hyperactivity disorder in Alborz province in 2022-2023 were selected by the convenience sampling method and randomly allocated into the experimental and control groups. The internet neuropsychological training program was held in 16 sessions for children and in 8 sessions for parents. Children's Raven Colored Progressive Matrices scales (1938), the Conners Parent Rating scale (1978) and Go/No go test (1984) were used to collect data. The program was analyzed by thematic analysis and the data was analyzed using multivariate analysis of covariance in SPSS version 20. Results: The results showed that the content validity index of the parents' program was 0.87 and the children's program was 1, and the content validity ratio of the parents' program was 1 and the children's program was 0.75. The measured F-values showed significant changes in response inhibition (P<0.01) and impulsivity (P<0.00). Conclusion: The results of the research showed that the internet neuropsychological training program was effective on impulsivity and response inhibition; Therefore, this program can be used as an effective program in improving response inhibition and impulsivity of children with attention deficit/hyperactivity disorder. [ABSTRACT FROM AUTHOR]

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Many children diagnosed with attention deficit/hyperactivity disorder (ADHD) do not receive appropriate services following diagnosis. Although information about ADHD is widely available and abundant, sometimes conflicting information may impede parent help-seeking. The present study examined parent knowledge of ADHD and attributions of child behavior as predictors of interest in formal and informal help seeking at the point of child evaluation for possible ADHD. Participants (89 caregivers of children ages 5–12) completed a measure of ADHD knowledge, rated attributions of child behavior in response to vignettes depicting ADHD symptoms, and indicated their interest in a range of formal and informal services that could be recommended following the child's evaluation. Parents reported strongest interest in academic services followed by medication, child focused therapy, and informal services (e.g., seeking information about ADHD). Family income, ADHD knowledge and attributions that child behavior will persist over time were associated with all types of help-seeking interest except academic services. Perceptions of child control over behavior predicted greater interest in medication. Findings suggest that increasing parent knowledge of ADHD and exploring parent goals and preferences for treatment may increase service utilization for children following assessment/diagnosis of ADHD. [ABSTRACT FROM AUTHOR]

Recently, there has been an increase in telemedicine applied to child neuropsychiatry, such as the use of online platforms to collect remotely case histories and demographic and behavioral information. In the present proof-of-concept study, we aimed to understand to what extent information parents and teachers provide through online questionnaires overlaps with clinicians' diagnostic conclusions on attention-deficit/hyperactivity disorder (ADHD). Moreover, we intended to explore a possible role that autism spectrum disorders (ASD) symptoms played in this process. We examined parent- and teacher-rated questionnaires collected remotely and an on-site evaluation of intelligence quotients from 342 subjects (18% females), aged 3–16 years, and referred for suspected ADHD. An easily interpretable machine learning model—decision tree (DT)—was built to simulate the clinical process of classifying ADHD/non-ADHD based on collected data. Then, we tested the DT model's predictive accuracy through a cross-validation approach. The DT classifier's performance was compared with those that other machine learning models achieved, such as random forest and support vector machines. Differences in ASD symptoms in the DT-identified classes were tested to address their role in performing a diagnostic error using the DT model. The DT identified the decision rules clinicians adopt to classify an ADHD diagnosis with an 82% accuracy rate. Regarding the cross-validation experiment, our DT model reached a predictive accuracy of 74% that was similar to those of other classification algorithms. The caregiver-reported ADHD core symptom severity proved the most discriminative information for clinicians during the diagnostic decision process. However, ASD symptoms were a confounding factor when ADHD severity had to be established. Telehealth procedures proved effective in obtaining an automated output regarding a diagnostic risk, reducing the time delay between symptom detection and diagnosis. However, this should not be considered an alternative to on-site procedures but rather as automated support for clinical practice, enabling clinicians to allocate further resources to the most complex cases. [ABSTRACT FROM AUTHOR]

The purpose of this research was the effectiveness of mentalization-based drama therapy on the sustained attention of children with attention deficit/hyperactivity disorder. The research method was semi-experimental with a pre-test-post-test design and follow-up with a control group. The statistical population of the research included all students aged 9 to 11 years old with attention deficit/hyperactivity disorder in Zanjan city in 2023. The sample size includes 30 subjects (15 subject in the experimental group and 15 subject in the control group) from the statistical population were selected by purposeful sampling and were placed in two control and experimental groups. For the experimental group, the developed drama-therapy package based on mentalization was implemented, while the control group remained on the waiting list. The research tools included Connors Attention Deficit Hyperactivity Disorder Questionnaire (2007) and integrated visual and auditory continuous performance test (1995). The results showed that the drama therapy package based on mentalization had a significant effect on improving sustained attention in the post-test and follow-up stages. The findings of this research provide useful information regarding the drama therapy package based on mentalization, and counselors and psychologists can use this intervention to improve sustained attention in children with attention deficit/hyperactivity disorder. [ABSTRACT FROM AUTHOR]