The World Federation of ADHD International Consensus Statement: 208 Evidence-based conclusions about the disorder

Risk factors for the development of problem gambling in individuals with ADHD symptoms: The mediating roles of gambling engagement and ADHD characteristics

Gambling disorder is a behavioral addiction characterized by impulsivity and problem gambling, and it often cooccurs with ADHD. This study investigated the associations between ADHD symptoms and problem gambling, focusing on the roles of various forms of gambling engagement. Based on data from the JASTIS 2024 survey, which included 29,268 valid respondents, this cross-sectional study explored how ADHD symptoms are related to the prevalence of problem gambling and specific forms of gambling engagement. Problem gambling was assessed using the Problem Gambling Severity Index, and ADHD symptoms were measured with the Japanese version of the Adult ADHD Self-Report Scale. The results revealed that 22.2 % of the participants with ADHD symptoms exhibited problem gambling, this proportion was significantly higher than that reported in the general population. Causal mediation analysis revealed that all types of gambling engagement, except for lottery, mediated the relationship between ADHD symptoms and problem gambling. Among them, bicycle racing and online casinos exhibited the strongest effects. Multiple regression analysis revealed that online casino use was the strongest predictor of problem gambling both in the general population and among individuals with ADHD symptoms. These findings suggest that individuals with ADHD characteristics increase the risk of engaging in gambling activities, particularly casino and online gambling, which have a high potential for addiction. Given the association between problem gambling and casino-related experiences, this study underscores the need for stringent regulatory measures and targeted prevention strategies, particularly as Japan considers expanding casino operations.

Biomarkers for tracking metabolic changes pre-post nutritional epigenetics diet/intervention to prevent autism and attention deficit/hyperactivity disorders in children

The prevalence of autism and attention deficit/hyperactivity disorders is increasing worldwide. Recent studies suggest the excessive intake of ultra-processed food plays a role in the inheritance of these disorders via heavy metal exposures and nutritional deficits that impact the expression of genes. In the case of the metallothionein (MT) gene, biomarker studies show dietary zinc (Zn) deficits impact MT protein levels in children with autism and are associated with the bioaccumulation of lead and/or mercury in children exhibiting autism/attention deficit/hyperactivity disorders symptomology. The impact of dietary changes on lead and mercury exposures and MT gene behavior could be determined using a randomized test and control group design. Pregnant women serving in the test-group would participate in a nutritional epigenetics education intervention/course designed to reduce ultra-processed food intake and heavy metal levels in blood while increasing whole food intake and MT and Zn levels. Changes in maternal diet would be measured using data derived from an online diet survey administered to the test and control groups pre-post intervention. Changes in maternal lead, mercury, Zn, and MT levels would be measured via blood sample analyses prior to the intervention and after childbirth via cord blood analyses to determine infant risk factors.

Comparison of Sprague Dawley with Long Evans rats on a battery of widely used neurobehavioral tests

Genetic knockout (KO) models are valuable tools for understanding biological functions and disease mechanisms. KO models in rats have fallen behind those in mice which limits advances in areas where rats have advantages because they can perform more complex cognitive tasks. Two widely used rat strains are Sprague Dawley (SD) and Long Evans (LE). Creating conditional KO models requires crossing Floxed and Cre lines with the constructs of interest but if they are on different genetic backgrounds, offspring will differ not only on the targeted gene but on genes of the differing background strains. We evaluated strain differences in SD and LE rats for behaviors that included: open-field locomotor activity in familiar and novel contexts, acoustic and tactile startle, egocentric and allocentric learning and memory, conditioned freezing, and working memory. Strain differences were found on open-field activity, startle prepulse inhibition, swimming, Cincinnati water maze (CWM), conditioned freezing, and 72 h home-cage activity. However, in the Morris water maze (MWM), performance was comparable between strains during acquisition and reversal, with LE rats performing slightly better in a third, shift phase with the platform in a third location. These data provide information on similarities and differences between SD and LE rats that may be useful to know when these strains are used to create conditional KO models or in regulatory safety studies.

ADHD and Alcohol Use Disorder: Optimizing Screening and Treatment in Co-occurring Conditions

Attention deficit hyperactivity disorder (ADHD) is notably overrepresented in substance use treatment centers, with an estimated prevalence of 21-23% when screening practices are implemented. Many adults in these settings receive an ADHD diagnosis for the first time, highlighting the frequent underdiagnosis of ADHD among individuals seeking treatment for alcohol and substance use issues. Additionally, those entering treatment programs represent only a small fraction of the broader population with problematic alcohol use. This review explores the research on the prevalence and treatment of co-occurring ADHD and substance use disorders (SUD), with a particular emphasis on alcohol use disorders (AUD) as the most common SUD. It also provides clinical guidelines for the screening and diagnosis of ADHD in patients with active alcohol and substance use and offers recommendations to enhance screening practices and improve access to treatment for individuals with co-occurring ADHD and AUD.

ADHD and Identity Formation: Adolescents' Experiences From the Healthcare System and Peer Relationships

OBJECTIVE

ADHD is often a lifelong condition, and has grown increasingly prevalent over the past few decades. Adolescence is a period characterized by the quest to develop a coherent identity, yet relatively little research has examined the relationship between ADHD diagnosis and identity. The purpose of this study was to explore the importance of experiences of the healthcare system and of peer relationships in the identity formation of adolescents with ADHD.

METHOD

This was investigated through semi-structured interviews with 10 adolescents (n = 8 females and 2 males) aged 15 to 18 years. An inductive thematic analysis was conducted within a narrative framework.

RESULTS

The results revealed seven main themes indicating that ADHD played a central role in the adolescents' self-narratives: (1) limited effect of Child and Adolescent Psychiatry (CAP) contact on identity formation, (2) the ADHD concept as meaning-making, (3) heterogeneity of the role of medication on identity formation, (4) negotiation of identity in relation to others, (5) varying degrees of acceptance in different relationships, (6) perceiving oneself as a troublemaker, and (7) relationship difficulties.

CONCLUSIONS

Overall, the diagnosis constituted an important narrative and symptoms of ADHD rather than the label of ADHD tended to be stigmatizing. Furthermore, medication affected identity, and some felt pressured to medicate to adhere to social norms. A common pattern was that adolescents set aside their individual identity in favor of their relational identity.

Prediction of internalizing and externalizing symptoms in late childhood from attention-deficit/hyperactivity disorder symptoms in early childhood

Limited analyses based on national samples have assessed whether early attention-deficit/hyperactivity disorder (ADHD) symptoms predict later internalizing and externalizing symptoms in youth and the influence of sex and pubertal timing on subsequent psychiatric symptoms. This study analyzed data (n = 2818) from the Environmental influences on Child Health Outcomes Program national cohort. Analyses used data from early childhood (mean age = 5.3 years) utilizing parent-reported ADHD symptoms to predict rates of internalizing and externalizing symptoms from late childhood/adolescence (mean age = 11.9 years). Within a subsample age at peak height velocity (APHV) acted as a proxy to assess pubertal timing from early childhood (mean age = 5.4 years) to adolescence (mean age = 12.3 years). Early-childhood ADHD symptoms predicted later psychiatric symptoms, including anxiety, depression, aggressive behavior, conduct problems, oppositional defiant disorder, and rule-breaking behavior. Earlier APHV was associated with increased Conduct Disorder symptoms from late childhood to adolescence for females only. A stronger relation between ADHD symptoms and later aggression was observed in females with earlier APHV, whereas this same pattern with aggression, conduct problems and depression was observed in males with later APHV. Clinicians should consider that both young girls and boys with elevated ADHD symptoms, particularly with off-set pubertal timing, may be at risk for later psychiatric symptoms.

Dopaminergic medications as a preventive for myopia: insights derived from pediatric patients diagnosed with attention deficit hyperactivity disorder

BACKGROUND/OBJECTIVES

This study investigated the impact of dopaminergic medications on myopia progression by comparing myopia susceptibility in ADHD patients treated with dopaminergic agents to those untreated. A non-ADHD cohort was also established to assess myopia risk compared to individuals with ADHD.

SUBJECTS/METHODS

This population-based cohort study used Taiwan National Health Insurance data (2009-2020), stratifying participants by ADHD status. Myopia was identified using ICD-10 diagnostic codes, while ADHD-related drug usage (methylphenidate, atomoxetine, clonidine) was analyzed. Cox regression models compared hazard ratios (HRs) for myopia, with cumulative incidence curves generated via the Kaplan-Meier method.

RESULTS

Adjusting for sex, age, comorbidities, and follow-up time, the untreated ADHD cohort had a 1.22-fold higher myopia risk (95% CI: 1.21-1.24) compared to the non-ADHD cohort. In contrast, ADHD patients receiving treatment showed a 39% reduced myopia risk (adjusted HR (aHR): 0.61; 95% CI: 0.59-0.62). An increased number of ADHD-related medications correlated with a notable myopia risk reduction: one drug (aHR: 0.50; 95% CI: 0.49-0.51) and two drugs (aHR: 0.28; 95% CI: 0.26-0.31).

CONCLUSIONS

Untreated ADHD in children is linked to a higher myopia risk than both non-ADHD individuals and treated ADHD patients. Dopaminergic treatments may provide a therapeutic avenue for mitigating myopia progression by enhancing dopamine signaling pathways. Key messages What is already known on this topic  Dopamine release in the retina inhibits myopia progression, and ADHD is linked to dopaminergic dysfunction. ADHD treatments like methylphenidate enhance dopamine signaling, but their effect on myopia risk has not been thoroughly studied. What this study adds  This study shows that untreated ADHD children have a higher risk of myopia, while dopaminergic treatments significantly reduce this risk. The use of multiple ADHD medications further strengthens the protective effect. How this study might affect research, practice or policy  These findings suggest that ADHD treatments may serve as a new approach for myopia prevention, encouraging cross-field research and consideration of systemic therapies for managing comorbid conditions.

Development of a Mobile-Based Personal Health Record for Pediatric Attention-Deficit/Hyperactivity Disorder Management: Protocol for a Study Based on Action Research Design

BACKGROUND

Attention-deficit/hyperactivity disorder (ADHD) is one of the most widespread neurobehavioral problems during childhood. A child's personal health record (PHR) plays an important role in the controlled routine monitoring of ADHD symptom improvement. Along with the advantages, the convenience offered by mobile technology, and the ubiquity of smartphones in contemporary society, there is a compelling need for PHR to be available in the form of a mobile app.

OBJECTIVE

This study aims to identify stakeholder needs, followed by designing, developing, testing, and evaluating a mobile-based PHR in the context of pediatric ADHD management.

METHODS

This study will adopt an action research design structured into 4 stages: diagnosing, planning, taking, and evaluating action. Stakeholders, including parents, pediatricians, occupational therapists, clinical psychologists, and teachers, will participate actively. In stage 1, stakeholder requirements for the mobile-based PHR will be explored through in-depth interviews, focus group discussions (FGDs), and document reviews. Thematic analysis will be used to identify key needs and challenges. In stage 2, a systematic literature review will be conducted to enhance user requirements analysis by synthesizing insights from existing mobile apps for pediatric ADHD management. A mobile-based PHR prototype will be designed and developed based on user requirements enhanced with systematic review results. In stage 3, the prototype will undergo a 6-week trial with participants to evaluate its functionality and address any identified issues. In stage 4, both quantitative and qualitative methods will be used to assess the app's usability and quality. The System Usability Scale (SUS) and the User Version of the Mobile App Rating Scale (uMARS) will be used for quantitative evaluation, while interviews and FGDs will be conducted for qualitative evaluation.

RESULTS

This study commenced in October 2024. As of December 2024, 13 participants (n=5, 38.5%, parents; n=2, 15.4%, pediatricians; n=2, 15.4%, occupational therapists; n=2, 15.4%, clinical psychologists; and n=2, 15.4%, teachers) have been enrolled, meeting the minimum participant requirements for stage 1. Stage 1 was completed at the end of 2024, with stage 2 expected to be completed by September 2025, stage 3 by December 2025, and stage 4 by February 2026. The findings from each stage will inform iterative refinements to the mobile-based PHR. The final results, including usability and quality assessments, are anticipated for publication by the middle of 2026.

CONCLUSIONS

This study protocol outlines a pivotal initiative to enhance the management of pediatric ADHD. By using an action research methodology and actively engaging stakeholders, the study aims to contribute significantly to the field. The iterative cycles of the research seek to develop a mobile-based PHR that is not only user friendly but also effective and uniquely attuned to the diverse needs of those involved in pediatric ADHD care.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/60216.

Capturing shared fNIRS responses to visual affective stimuli in young healthy women

Functional near-infrared spectroscopy (fNIRS) studies focusing on prefrontal cortex (PFC) have shown mixed results in relating hemodynamic changes to emotional processing, posing a challenge for clinical practice. Concerns related to instrumentation, recruited sample, task design, signal processing, and data analysis have been highlighted. To minimize some biasing factors, we proposed an experimental approach based on: (1) a homogeneous recruited sample, (2) an identical sequence of content-grouped affective pictures for emotion induction, (3) multi-distance forehead fNIRS recordings to separate cerebral from extra-cerebral components, and (4) a model-free frequency-based analysis to capture shared response patterns across individuals. We piloted a study to assess the feasibility of the approach in a sample of 20 young healthy women during an emotional task with affective pictures of neutral, sexual and violence content. We found coherent fNIRS responses to sexual and violence content located in slow fluctuations (0-0.019 Hz), characterized by positive and negative oxygenation patterns of extra-cerebral and cerebral origin, respectively. Additionally, we corroborated the strong interference of surface hemodynamics. This study proves the feasibility of our approach to identify frequency-specific fNIRS response patterns to affective visual stimuli, which holds promise for exploring functional biomarkers of healthy and altered emotional processing.

Systematic Review and Meta-Analysis: Attention-Deficit/Hyperactivity Disorder Symptoms in Children With Neurofibromatosis Type 1

OBJECTIVE

This meta-analysis aimed to robustly estimate differences in attention-deficit/hyperactivity disorder (ADHD) symptoms between children and adolescents with and without neurofibromatosis type 1 (NF1).

METHOD

Systematic literature searches were conducted in Scopus, PsycINFO, Web of Science, PubMed, and ProQuest in September 2022, with a supplemental search conducted in Google Scholar in February 2023. The searches identified 2,153 unique articles. Screening identified 114 academic journal articles that assessed parent/caregiver- or teacher-reported ADHD symptoms for children/adolescents with NF1. Two researchers independently screened articles and extracted data. The primary outcome was group differences in ADHD symptoms between children/adolescents with and without NF1 (Hedges g). Data were analyzed using robust variance estimation and random-effects models.

RESULTS

The meta-analysis included 70 studies (138 effect sizes), involving 3,653 children/adolescents with NF1 (46% female; mean age = 9.69 years, SD = 2.60 years) and 4,895 children/adolescents without NF1 (48% female; mean age = 10.03 years, SD = 3.10 years). According to parent/caregiver reports, children/adolescents with NF1 exhibited more severe inattentive symptoms (g = 1.20; 95% CI = 1.06-1.35), hyperactive/impulsive symptoms (g = 0.85; 95% CI = 0. 68-1.03), and combined ADHD symptoms (g = 1.02; 95% CI = 0.87-1.17) than unaffected controls. Inattentive ADHD symptoms were more elevated than hyperactivity/impulsivity for children/adolescents with NF1. Larger effect sizes for inattention and hyperactivity/impulsivity were associated with older age, lower intelligence quotient (IQ), and parent/caregiver vs teacher reports.

CONCLUSION

NF1 is a monogenic condition that has strong associations with elevated ADHD symptoms. Findings highlight the importance of early intervention and targeted support for ADHD-related problems in children with NF1.

PLAIN LANGUAGE SUMMARY

Increasing evidence has suggested a higher risk for attention-deficit/hyperactivity disorder (ADHD) in individuals with neurofibromatosis type 1 (NF1). In this study of ADHD symptom severity in youth with NF1, the authors analyzed data from 70 articles. The authors found much more severe ADHD symptoms in children and adolescents with NF1 compared to youth without NF1. Inattentive symptoms were more pronounced in children with NIF who were older or had a lower IQ.

STUDY PREREGISTRATION INFORMATION

Compare the ADHD problems between NF1 and control groups; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=462063.

Viloxazine Extended-Release Administered With Psychostimulants in Children and Adolescents With Attention-Deficit/Hyperactivity Disorder: A Phase 4, Open-Label Trial

Introduction: Viloxazine extended-release (VLX-ER) is effective as monotherapy for attention-deficit/hyperactivity disorder (ADHD), and is often tried as an add-on treatment when psychostimulant therapy fails to provide an adequate treatment response. This phase 4, open-label study evaluated safety, tolerability, and efficacy of VLX-ER with optimized psychostimulants in pediatric participants with ADHD. Morning versus evening VLX-ER use was also evaluated. Methods: Children and adolescents (6-17 years) experiencing inadequate psychostimulant response (investigator-assessed ADHD Rating Scale-5 [ADHD-RS-5] score ≥24 and Clinical Global Impression-Severity of Illness [CGI-S] scores ≥3) during a 4-week screening period received flexibly-dosed VLX-ER, taken once daily in the morning (weeks 14) or evening (weeks 5-8), concomitantly with a psychostimulant. Safety (primary outcome) and efficacy were evaluated relative to baseline. Results: Fifty-six participants (26 children; 30 adolescents) enrolled, and 48 (85.7%) completed the study. Combination therapy was well tolerated, with only two participants (3.6%) withdrawing due to adverse events (AEs). The most commonly reported AEs were headache (17.9%), decreased appetite (12.5%), and upper respiratory tract infection (10.7%). Mean ± standard deviation investigator-assessed ADHD-RS-5 scores (baseline: 37.2 ± 8.4) improved progressively by -13.5 ± 9.7 points at week 4 and -18.2 ± 10.0 points at week 8 (p < 0.0001 each). Likewise, CGI-S scores (baseline: 4.4 ± 0.6) improved by -0.9 ± 0.9 at week 4 and -1.4 ± 1.1 at week 8 (p < 0.0001 each). Parent-assessed scales, including ratings of morning and evening ADHD behaviors and sleep disturbances, showed significant improvement relative to baseline regardless of morning (week 4) or evening (week 8) VLX-ER dosing. Conclusion: Combined treatment with VLX-ER and psychostimulant therapy showed acceptable safety and tolerability, with improvement in morning and evening ADHD behaviors and sleep disturbances relative to stimulant monotherapy. Timing of VLX-ER administration (morning or evening) did not appear to affect safety, drug response, or sleep improvement.

Standardization of decision-making skills but persistent impulsivity after chronic stimulant exposure in ADHD patients

Attention deficit hyperactivity disorder (ADHD) is commonly associated with deficits in executive function. Even though attention, hyperactivity, and impulsivity are the more distinctive symptoms, impairment in other cognitive processes, for instance memory, could be due to the interferences from these symptoms. However, it remains unclear whether information processing errors made by individuals with ADHD arise primarily from impulsive responding or reflect a more fundamental difference in how they process information, potentially due to compensatory mechanisms developed throughout childhood. This study analyzes pattern separation (distinguishing similar stimuli), recognition memory, decision-making, and impulsivity in both ADHD-diagnosed and non-diagnosed youth population. We further examined possible treatment effects by dividing the ADHD group into three cohorts based on stimulant medication duration. We evaluate their response latency and responses utilizing the signal detection theory method. While ADHD participants exhibited poorer recognition memory compared to controls, this pattern did not show a statistically significant difference in pattern separation. Additionally, both processes improved with longer treatment duration within the ADHD group, leading to decreased error commission. Decision-making analyses revealed sex-specific response strategies within the ADHD group, but both groups showed similar adjustment to task difficulty. However, the ADHD group responses were notably faster, associated with a higher error rate. Additionally, response times varied depending on the stimulus type, suggesting potential differences in how the ADHD group processed information compared to the control group. These findings collectively point towards a possible difference in information management in ADHD, that is also characterized by faster, but less accurate, processing.

Pediatric Attention-Deficit/Hyperactivity Disorder and Disruptive Mood Dysregulation Disorder: Analyzing National Treatment Trends

OBJECTIVE

This study investigated how a disruptive mood dysregulation disorder (DMDD) diagnosis influences treatment selection and sequencing in children with attention-deficit/hyperactivity disorder (ADHD).

STUDY DESIGN

This multicenter, population-based, retrospective cohort study analyzed data from TriNetX Research Network (June 2013 through July 2024). Youth with ADHD (without DMDD) formed the control cohort (n = 631 295). Youth with ADHD + DMDD (n = 24 723) formed the study cohort. Odds ratios (ORs) and relative risks were calculated to analyze associations.

RESULTS

Compared with controls, ADHD + DMDD cohort was more likely to be composed of non-Hispanic ethnicity and exhibited higher rates of psychiatric comorbidities, inpatient and emergency service utilization, and billed psychotherapy (ORs range 1.25-6.95). Youth with ADHD + DMDD were more likely to receive ADHD medications (ORs range 1.55-4.80), as well as antidepressants, mood stabilizers, and antipsychotics (ORs range 5.05-13.16). Hispanic youth with DMDD utilized more psychotropics but less psychotherapy, while White youth used all services more. Before the use of non-ADHD medications for aggression, only 25% of ADHD + DMDD youth had a therapy code, and around 11% showed evidence of optimization of ADHD medication. After a DMDD diagnosis, treatment rates for other psychotropics increased more than those for central nervous system stimulants.

CONCLUSIONS

In youth with ADHD, a DMDD diagnosis is associated with increases in the spectrum of pharmacological and nonpharmacological treatments deployed with patterns varying by race and ethnicity. Antipsychotic and mood stabilizer prescriptions increased most prominently, often before receiving psychotherapy services or efforts to optimize ADHD medication. Future research should address disparities in DMDD treatment patterns and identify the optimal treatment sequences for DMDD.

Impact of high maternal body mass index on fetal cerebral cortical and cerebellar volumes

OBJECTIVES

Maternal obesity increases a child's risk of neurodevelopmental impairment. However, little is known about the impact of maternal obesity on fetal brain development.

METHODS

We prospectively recruited 20 healthy pregnant women across the range of pre-pregnancy or first-trimester body mass index (BMI) and performed fetal brain magnetic resonance imaging (MRI) of their healthy singleton fetuses. We examined correlations between early pregnancy maternal BMI and regional brain volume of living fetuses using volumetric MRI analysis.

RESULTS

Of 20 fetuses, there were 8 males and 12 females (median gestational age at MRI acquisition was 24.3 weeks, range: 19.7-33.3 weeks, median maternal age was 33.3 years, range: 22.0-37.4 years). There were no significant differences in clinical demographics between overweight (OW, 25≤BMI<30)/obese (OB, BMI≥30 kg/m2) (n=12) and normal BMI (18.5≤BMI<25) (n=8) groups. Fetuses in the OW/OB group had significantly larger left cortical plate (p=0.0003), right cortical plate (p=0.0002), and whole cerebellum (p=0.049) compared to the normal BMI group. In the OW/OB BMI group, cortical plate volume was larger relative to other brain regions after 28 weeks.

CONCLUSIONS

This pilot study supports the concept that maternal obesity impacts fetal brain volume, detectable via MRI in living fetuses using quantitative analysis.

Associations of the gut microbiome and inflammatory markers with mental health symptoms: a cross-sectional study on Danish adolescents

Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder that often persists into adulthood and is accompanied by comorbid mental health problems. This cross-sectional cohort study analyzed 411 18-year-olds from the Danish COPSAC2000 birth cohort to investigate the relationship between the gut microbiome, fasting and postprandial systemic inflammation, ADHD symptoms, and symptoms of anxiety, stress, and depression. ADHD was assessed using the Adult ADHD Self-Report Scale (ASRS), while depression, stress, and anxiety were evaluated with the Depression, Anxiety, and Stress Scale 21 (DASS-21). Fecal metagenomic data and inflammation levels, measured as glycosylated protein A (GlycA), were analyzed following a standardized meal challenge. In males, higher ADHD symptom scores correlated significantly with increased abundance of a tryptophan biosynthesis pathway (MetaCyc Metabolic Pathways Database) and elevated fasting and postprandial GlycA levels (p < 0.05). While the severity of depression, anxiety, and stress symptoms showed weak associations with GlycA and the gut microbiome, our findings indicate a significant link between ADHD symptoms and postprandial inflammation, warranting further investigation into underlying mechanisms.

A double-edged hashtag: Evaluation of #ADHD-related TikTok content and its associations with perceptions of ADHD

We aimed to assess the psychoeducational quality of TikTok content about attention-deficit/hyperactivity disorder (ADHD) from the perspective of both mental health professionals and young adults across two pre-registered studies. In Study 1, two clinical psychologists with expertise in ADHD evaluated the claims (accuracy, nuance, overall quality as psychoeducation material) made in the top 100 #ADHD TikTok videos. Despite the videos' immense popularity (collectively amassing nearly half a billion views), fewer than 50% of the claims about ADHD symptoms were judged to align with the Diagnostic and Statistical Manual of Mental Disorders. In Study 2, 843 undergraduate students (no ADHD =  224, ADHD self-diagnosis =  421, ADHD formal diagnosis =  198) were asked about their typical frequency of viewing #ADHD content on TikTok and their perceptions of ADHD and were shown the top 5 and bottom 5 psychologist-rated videos from Study 1. A greater typical frequency of watching ADHD-related TikToks was linked to a greater willingness to recommend both the top and bottom-rated videos from Study 1, after controlling for demographics and ADHD diagnostic status. It was also linked to estimating a higher prevalence of ADHD in the general population and greater challenges faced by those with ADHD. Our findings highlight a discrepancy between mental health professionals and young adults regarding the psychoeducational value of #ADHD content on TikTok. Addressing this is crucial to improving access to treatment and enhancing support for those with ADHD.

Real-world goal-directed behavior reveals aberrant functional brain connectivity in children with ADHD

Functional connectomics is a popular approach to investigate the neural underpinnings of developmental disorders of which attention deficit hyperactivity disorder (ADHD) is one of the most prevalent. Nonetheless, neuronal mechanisms driving the aberrant functional connectivity resulting in ADHD symptoms remain largely unclear. Whereas resting state activity reflecting intrinsic tonic background activity is only vaguely connected to behavioral effects, naturalistic neuroscience has provided means to measure phasic brain dynamics associated with overt manifestation of the symptoms. Here we collected functional magnetic resonance imaging (fMRI) data in three experimental conditions, an active virtual reality (VR) task where the participants execute goal-directed behaviors, a passive naturalistic Video Viewing task, and a standard Resting State condition. Thirty-nine children with ADHD and thirty-seven typically developing (TD) children participated in this preregistered study. Functional connectivity was examined with network-based statistics (NBS) and graph theoretical metrics. During the naturalistic VR task, the ADHD group showed weaker task performance and stronger functional connectivity than the TD group. Group differences in functional connectivity were observed in widespread brain networks: particularly subcortical areas showed hyperconnectivity in ADHD. More restricted group differences in functional connectivity were observed during the Video Viewing, and there were no group differences in functional connectivity in the Resting State condition. These observations were consistent across NBS and graph theoretical analyses, although NBS revealed more pronounced group differences. Furthermore, during the VR task and Video Viewing, functional connectivity in TD controls was associated with task performance during the measurement, while Resting State activity in TD controls was correlated with ADHD symptoms rated over six months. We conclude that overt expression of the symptoms is correlated with aberrant brain connectivity in ADHD. Furthermore, naturalistic paradigms where clinical markers can be coupled with simultaneously occurring brain activity may further increase the interpretability of psychiatric neuroimaging findings.

Retinal fundus imaging as biomarker for ADHD using machine learning for screening and visual attention stratification

Attention-deficit/hyperactivity disorder (ADHD), characterized by diagnostic complexity and symptom heterogeneity, is a prevalent neurodevelopmental disorder. Here, we explored the machine learning (ML) analysis of retinal fundus photographs as a noninvasive biomarker for ADHD screening and stratification of executive function (EF) deficits. From April to October 2022, 323 children and adolescents with ADHD were recruited from two tertiary South Korean hospitals, and the age- and sex-matched individuals with typical development were retrospectively collected. We used the AutoMorph pipeline to extract retinal features and used four types of ML models for ADHD screening and EF subdomain prediction, and we adopted the Shapely additive explanation method. ADHD screening models achieved 95.5%-96.9% AUROC. For EF function stratification, the visual and auditory subdomains showed strong (AUROC > 85%) and poor performances, respectively. Our analysis of retinal fundus photographs demonstrated potential as a noninvasive biomarker for ADHD screening and EF deficit stratification in the visual attention domain.

Preliminary results of the EPIDIA4Kids study on brain function in children: multidimensional ADHD-related symptomatology screening using multimodality biometry

Attention-deficit hyperactivity disorder (ADHD) occurs in 5.9% of youth, impacting their health and social conditions often across their lifespan. Currently, early diagnosis is constrained by clinical complexity and limited resources of professionals to conduct evaluations. Scalable methods for ADHD screening are thus needed. Recently, digital epidemiology and biometry, such as the visual, emotional, or digit pathway, have examined brain dysfunction in ADHD individuals. However, whether biometry can support screening for ADHD symptoms using a multimodal tech system is still unknown. The EPIDIA4Kids study aims to create objective measures, i.e., biometrics, that will provide a comprehensive transdiagnostic picture of individuals with ADHD, aligning with current evidence for comorbid presentations. Twenty-four children aged 7 to 12 years performed gamified tasks on an unmodified tablet using the XAI4Kids® multimodal system, which allows extraction of biometrics (eye-, digit-, and emotion-tracking) from video and touch events using machine learning. Neuropsychological assessments and questionnaires were administered to provide ADHD-related measures. Each ADHD-related measure was evaluated with each biometric using linear mixed-effects models. In contrast to neuro-assessments, only two digit-tracking features had age and sex effects (p < 0.001) among the biometrics. Biometric constructs were predictors of working memory (p < 0.0001) and processing speed (p < 0.0001) and, to a lower extent, visuo-spatial skills (p = 0.003), inattention (p = 0.04), or achievement (p = 0.04), where multimodalities are crucial to capture several symptomatology dimensions. These results illustrate the potential of multimodality biometry gathered from a tablet as a viable and scalable transdiagnostic approach for screening ADHD symptomatology and improving accessibility to specialized professionals. Larger populations including clinically diagnosed ADHD will be needed for further validation.

Exposure to different types of residential greenness during pregnancy and early childhood and attention-deficit/hyperactivity disorder diagnosis: A nested case-control study

BACKGROUND

Epidemiological studies suggest that exposure to greenness may protect children attention-deficit/hyperactivity disorder (ADHD) diagnosis. However, evidence to date is limited while no previous research has independently investigated exposure to prenatal greenness.

OBJECTIVE

We conducted a nested case-control study with data from Born in Bradford (BiB) and INfancia y Medio Ambiente (INMA) birth cohorts to investigate the association between exposure to various types of residential greenness and ADHD diagnosis, considering both pregnancy and early childhood exposure periods independently. PM2.5 was tested as a potential mediator of the association.

METHODS

Children with ADHD were identified based on a confirmed medical diagnosis. Pregnancy and early childhood exposure to residential greenness were estimated through Normalized Difference Vegetation Index (NDVI) within 300-m, urban green space and natural green space percentages within 300-m, and the linear distance to the closest green space in meters. We performed a conditional logistic regression to analyze the association between the included greenness metrics and ADHD.

RESULTS

We found no statistically significant associations between any of the pregnancy and early childhood greenness metrics and ADHD diagnosis in the BiB cohort. Further analysis on the INMA cohort found that higher urban green space percentage slightly increased the risk of ADHD diagnosis during both pregnancy (total effects: OR 1.04, 95 % CI 1.01 to 1.07, p = 0.012; direct effects: OR 1.06, 95 % CI 1.03 to 1.10, p < 0.001) and early childhood (total effects: OR 1.03, 95 % CI 1.00 to 1.07, p = 0.042; direct effects: OR 1.04, 95 % CI 1.00 to 1.07, p = 0.033). However, these associations were not supported by the sensitivity analyses.

CONCLUSIONS

This study found both null and inconsistent associations between the included greenness metrics and ADHD. Further research is warranted to elucidate the potential role of exposure to different types of greenness in ADHD diagnosis.

The Role of Empathy in ADHD Children: Neuropsychological Assessment and Possible Rehabilitation Suggestions-A Narrative Review

Background and Objectives: Theory of mind (ToM) deficits in children with ADHD are closely related to social difficulties and problems in interpersonal interactions. Evidence suggests that these cognitive deficits negatively affect the ability to understand and respond to others' emotions and intentions, thus contributing to social isolation and a lower quality of life. However, the findings across studies vary, indicating that ADHD subtype and comorbidities, such as anxiety and mood disorders, can significantly influence sociocognitive deficits, modulating the extent of social problems. Materials and Methods: This review examines the relationship among ADHD, ToM, and empathy, analyzing studies comparing children with ADHD with peers with typical development or other neurodevelopmental conditions. A search in PubMed, Scopus, and the Cochrane Library prior to January 10, without time restrictions, using "ADHD", "Cognitive Empathy", and "Theory of Mind" identified relevant studies assessing these abilities through neuropsychological tests or questionnaires. Results: Of the initial 243 studies, 23 studies met the inclusion criteria. Children with ADHD exhibited significant impairments in ToM and empathy, affecting social cognition and interpersonal understanding. Various assessment tools revealed difficulties in understanding beliefs, emotions, and intentions, with executive function deficits playing a crucial role in shaping these social challenges. Conclusions: This review highlights the need for targeted therapeutic interventions that not only address cognitive deficits but consider emotional and metacognitive aspects, such as emotion regulation and self-awareness. Future research should focus on integrating executive function training with approaches that develop metacognitive and emotional skills, thus providing more comprehensive support.

Mapping Children's Social and Motor Skill Profiles to Autistic Traits and Behavioral Tendencies

We used a person-centered approach to: (1) elucidate distinct configurations of social and motor skills across subgroups of children, (2) determine how profiles map to autistic traits and behavioral tendencies, and (3) identify how children with and without different diagnoses are categorized within profiles. Parents/guardians (N = 538) of 5- to 15-year-olds reported on their children's autistic traits, social skills, motor skills, and behavioral tendencies. Factor scores were extracted as indicators for latent profile analysis and a series of profile solutions were generated. After selecting the final profile solution, mean-level differences were examined across each profile, pairing for key measures of interest. Frequency distribution analysis was used to identify the number of children with and without formal diagnoses in each profile. A 6-profile solution was identified, drawing attention to how social and motor competencies combine in qualitatively distinct ways across subpopulations. Whereas several profiles had similar levels of social and motor skills (Profile 2: weak social/motor, Profile 4: average social/motor, Profile 6: exceptional social/motor), other profiles showed divergent levels of social and motor competencies (Profile 1: weak motor but average social, Profile 3: above average social and strong motor, Profile 5: strong social and above average motor). These subpopulations differed in terms of their proportions of diagnoses (i.e., of autism specifically and co-occurring with other diagnoses), autistic traits, and behavioral difficulties. Findings support a person-centered approach that considers the relationships, interactions, and shared mechanisms of multiple developmental domains to better understand child development, optimize interventions, and improve outcomes.

The Use of Novel Stimulants in ADHD Self-Medication: A Mixed Methods Analysis

BACKGROUND

Numerous individuals suffer from attentional issues, such as ADHD. While medication is considered the first-line treatment, it is unavailable to some. As a result, certain individuals are choosing to self-medicate with novel stimulants, a phenomenon that remains poorly understood. We aimed to investigate which NPSs are being used to self-medicate ADHD, evaluate their perceived effectiveness, and explore the experiences and motivations of those self-medicating.

METHODS

Data from respondents (n = 225) (mean age [SD] = 29.5 ± 9.6; male = 83%; female = 12%; non-binary = 5%) were collected via an online survey, with nine participants (mean age = 31.4; male = 5; female = 1; non-binary = 3) undertaking further semi-structured interviews and the data being investigated using a framework analysis.

RESULTS

The most-used NPSs were 4F-MPH and 2-FMA. Some individuals perceived self-medication to be more effective than conventional treatment (p < 0.001). A framework analysis identified the following themes surrounding novel stimulant self-medication: (1) the use of NPS stimulants as a stopgap between treatments; (2) poor access to ADHD treatment; (3) a lack of openness and confidence in psychiatrists and healthcare providers.

CONCLUSION

Novel stimulants are being used when access to ADHD treatment is poor. Interventions should aim to reduce long treatment wait times and issues surrounding geographical access. Careful consideration should be given before denying stimulant medication to individuals with co-occurring substance use and psychiatric comorbidity. Individuals desire a more patient-centred ADHD treatment with broader pharmacotherapies.

Setting a research agenda for examining early risk for elevated cognitive disengagement syndrome symptoms using data from the ABCD cohort

Little research has examined early life risk for symptoms of cognitive disengagement syndrome (CDS) despite a well-established literature regarding co-occurring outcomes (e.g., attention-deficit/hyperactivity disorder). The current study estimated bivariate associations between early life risk factors and CDS in a large and representative sample of U.S. children. We conducted secondary analyses of baseline data from the Adolescent Brain Cognitive Development (ABCD) study (N = 8,096 children, 9-10 years old). Birthing parents reported early life risk factors on a developmental history questionnaire, including parental, prenatal, delivery and birth, and developmental milestone information. They also completed the Child Behavior Checklist, which includes a CDS subscale that was dichotomized to estimate the odds of elevated CDS symptoms (i.e., T-score > 70) in children related to risk indices. We observed significantly elevated odds of CDS related to parental risk factors (i.e., unplanned pregnancy, pregnancy awareness after 6 weeks, teenage parenthood), birthing parent illnesses in pregnancy (i.e., severe nausea, proteinuria, pre-eclampsia/toxemia, severe anemia, urinary tract infection), pregnancy complications (i.e., bleeding), prenatal substance exposures (i.e., prescription medication, tobacco, illicit drugs), delivery and birth risk factors (i.e., child blue at delivery, child not breathing, jaundice, incubation after delivery), and late motor and speech milestones in children. Several early-life risk factors were associated with elevated odds of CDS at ages 9-10 years; study design prevents the determination of causality. Further investigation is warranted regarding early life origins of CDS with priority given to risk indices that have upstream commonalities (i.e., that restrict fetal growth, nutrients, and oxygen).

Rhythms of relief: perspectives on neurocognitive mechanisms of music interventions in ADHD

Attention-deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder characterized by multiple neurocognitive deficits. Research suggests that music interventions, both active and passive, may be an effective complementary method of addressing ADHD challenges. This narrative review discusses seven potential neurocognitive mechanisms through which music interventions may help mitigate or alleviate ADHD symptoms, including executive function enhancement, timing improvement, arousal regulation, default mode network modulation, neural entrainment, affective management, and social bonding facilitation. Our study synthesized evidence from ADHD-specific studies and examined parallels to other populations to identify possible pathways through which music therapy could exert its effect. The paper also discusses the implications of individualized music interventions tailored to specific neurocognitive profiles in ADHD, advocating additional research to refine and optimize these approaches. Overall, music therapy has substantial potential as a complementary treatment for ADHD, offering new avenues for addressing the psychosocial and cognitive aspects of this condition.

Impact of fidget devices on anxiety and physiological responses in adults with ADHD

BACKGROUND

Fidgeting devices are popular for managing ADHD, but their effectiveness remains unclear. This study investigated whether fidgeting modulates self-regulation in adults with ADHD during stress, exploring intrinsic versus extrinsic fidgeting with a fidget ball. We hypothesized that individuals with a fidget ball would demonstrate improved self-regulation under stress, reflected by higher heart rate variability (HRV) and lower anxiety levels.

METHODS

Adults with ADHD were randomly assigned to a fidget ball (n = 49) or no fidget ball (n = 24) group. Physiological stress was measured via HRV and intrinsic fidgeting, that is, ankle and wrist movements, were measured via actigraphy. Physiological data were collected at baseline and during the Trier Social Stress Test (TSST). Self-rated anxiety was measured using the State Anxiety Inventory.

RESULTS

Heart rate and fidgeting increased across TSST stages for both groups, with no significant differences in heart rate, HRV, or intrinsic fidgeting between groups. Notably, the fidget ball group had weaker correlations between fidgeting and HRV compared to the no fidget ball group. At baseline, the no fidget ball group showed a positive correlation between intrinsic fidgeting and HRV, suggesting an association between intrinsic fidgeting and self-regulation, however during stress the no fidget ball group showed a significant negative correlation between intrinsic fidgeting and HRV. The relationship between physiological measures and anxiety differed between groups and TSST stages.

CONCLUSIONS

These results provide preliminary evidence that the fidget ball may disrupt the expected association between intrinsic fidgeting and HRV, emphasizing the need for further studies to explore its impact on self-regulation.

Could Maladaptive Daydreaming Delay ADHD Diagnosis Until Adulthood? Clinical Characteristics of Adults With ADHD Based on Diagnosis Age

INTRODUCTION

Our study aimed to compare the sociodemographic, diagnostic, clinical, and self-report scale data of adults diagnosed with ADHD in childhood/adolescence versus adulthood and to identify risk factors associated with delayed/missed diagnosis for ADHD.

METHOD

Sociodemographic, clinical, and diagnostic data of 214 adults with ADHD, followed at the Adult Neurodevelopmental Disorders Clinic, Selçuk University, between January 2022 and January 2024, were analyzed. The diagnostic evaluations were made using the Structured Clinical Interview for DSM-5 Clinician Version. Clinical data included age, gender, years of education, alcohol/substance use, diagnosis age, and current medication use for ADHD. Data collected from self-report scales included both ADHD-related measurements and comorbidity-related measurements.

RESULTS

The findings revealed that only 34.4% (n = 74) of sample received a formal ADHD diagnosis during childhood/adolescence. Adults diagnosed with ADHD in adulthood were older and had higher education levels, more severe ADHD symptoms, and increased maladaptive daydreaming (MD) scores, compared to those diagnosed in childhood or adolescence. Logistic regression analysis indicated that the severity of MD was associated with being in the group diagnosed with ADHD in adulthood while controlling for other significant parameters from bivariate analyses, such as age, years of education, and current medication use for ADHD. Finally, analyses conducted separately in both groups showed that: (1) increased MD severity was a predictor of higher ADHD symptoms in those diagnosed in adulthood, but not in those diagnosed in childhood/adolescence, and (2) MD severity had a stronger correlation with ADHD symptoms, the number of comorbid psychiatric disorders, and symptoms of excessive mind wandering, depression, and anxiety in those diagnosed in adulthood compared to those diagnosed in childhood/adolescence.

CONCLUSION

MD may delay ADHD diagnosis until adulthood by masking and compensating ADHD symptoms and delay in referral to mental health professionals, and it might also be a predictive symptom for recognizing ADHD in adults who have never been diagnosed; however, longitudinal studies are needed to confirm this.

Symptoms of ADHD and Other Common Mental Disorders Influence Academic Success in South African Undergraduates

OBJECTIVE

ADHD symptoms are highly prevalent among university students. These symptoms, particularly the inattentive cluster, predispose students to poorer academic performance and worse academic adjustment. Moreover, ADHD symptoms are often comorbid with other common mental disorders; this comorbidity also leads to poor outcomes. South African students often have fewer resources to successfully transition to university. Hence, our longitudinal study used data from a sample of South African first-year undergraduate students to investigate (a) associations between ADHD symptoms and academic performance/adjustment, (b) separate influences of the inattentive and hyperactivity-impulsivity clusters on academic performance/adjustment, and (c) the influence of the combination of ADHD and psychiatric comorbidities on academic performance/adjustment.

METHOD

We collected data three times through the first semester of 2023. Predictors within our regression models included sociodemographic variables, psychological variables (self-reported symptoms of ADHD, depression, anxiety, and risky alcohol use), and high school academic performance. Outcomes were first-semester GPA and self-reported academic adjustment (magnitude of change across the semester and overall adjustment at the end of the semester).

RESULTS

Analyses showed that, unlike academic performance (N = 506), magnitude of change in academic adjustment (N = 180) was significantly predicted by ADHD symptoms and the combination of ADHD (p = .02), depression (p < .001), and anxiety symptoms (p = .01). Inattentive ADHD symptoms predicted both academic performance and magnitude of change in academic adjustment.

CONCLUSIONS

Our findings suggest that the presence of ADHD symptoms (both with and without other common mental disorders) is associated with a smaller magnitude of academic adjustment, and that the presence of inattentive symptoms of ADHD is associated with both poorer academic performance and smaller magnitude of academic adjustment. These findings are significant in informing future interventions targeting the academic outcomes of first-year university students.

Parents' Experiences of Raising 7- to 11-Year-Old Children With ADHD and Perception of a Proposed Parenting Program: A Qualitative Study

OBJECTIVE

To examine the experiences of Australian parents raising primary school-aged children with ADHD and gather feedback on a proposed ADHD parenting program.

METHODS

Reflexive thematic analysis of semi-structured interviews undertaken with 11 Australian parents of 7- to 11-year-old children with ADHD. Interviews were conducted over Webex, audio recorded, transcribed verbatim, and analyzed in NVivo Ltd. software.

RESULTS

We identified four themes: (1) "I love my child but their ADHD traits are challenging," (2) "Compliance, control, and completion," (3) "It's hard, burdensome, and exhausting and I can feel like I'm alone," and (4) "What a welcome relief."

CONCLUSION

Parents report that although raising neurotypical children is difficult, the presence of childhood ADHD increases the emotional and support burden placed on them. Parents were also very interested in and supportive of the proposed ADHD parenting program. The program aims to enhance parents' understanding of the neurocognitive implications of ADHD and to foster secure parent-child attachment, attuned parental responsiveness, and age-appropriate development of traits that promote well-being, adaption and recovery in people with ADHD.).

Comorbidity of attention deficit hyperactivity disorder in young adults who had major depressive disorder

BACKGROUND

The comorbidity of Major Depressive Disorder (MDD) and Attention Deficit Hyperactivity Disorder (ADHD) in adults is well recognized. The role of ADHD in the etiology of MDD, as well as the overlap of genetic and environmental factors between these two disorders, is an area of research. ADHD symptoms are considered risk factors for MDD.

OBJECTIVES

The study aimed to examine the relationship between MDD in young adults with history of ADHD.

DESIGN

Retrospective and observational study.

SETTINGS

Outpatient clinic of a tertiary hospital.

PATIENTS AND METHODS

Data of young adults diagnosed with MDD, aged 18-25 years and seen between January 2017 and May 2023, were included. Individuals with comorbidities other than ADHD in adulthood were excluded from the study. The sociodemographic and clinical data of a total of 489 cases, as well as data on childhood psychiatric referrals, diagnoses, and treatment histories, were retrospectively examined.

MAIN OUTCOME MEASURES

ADHD diagnosis history and clinical impact in adults diagnosed with MDD.

SAMPLE SIZE

489.

RESULTS

A total of 489 cases (68.9% female) with a mean age of 21.14 years were included in the study. It was determined that 8% of the cases had ADHD in adulthood, 13.3% in childhood, and 31.9% had at least one mental health diagnosis during childhood. The rate of ADHD diagnosis was significantly higher in males than females in both adulthood and childhood. Additionally, the age of diagnosis of MDD was lower in individuals with ADHD diagnosis and/or those who have discontinued ADHD treatment.

CONCLUSIONS

In young adults diagnosed with MDD, the comorbidity of ADHD should also be considered. It is important to acknowledge that ADHD is not just a childhood disorder but a lifelong disorder due to its negative consequences, and to develop appropriate strategies in this regard.

LIMITATİONS

Retrospective observational design and the single-center setting, which may affect the generalizability of the findings.

Attention-Deficit/Hyperactivity Disorder and Teen Self-Report on Health Behaviors and Social-Emotional Wellbeing: United States, July 2021-December 2022

OBJECTIVE

Promoting health during adolescence can support long-term well-being, especially for teens diagnosed with attention-deficit/hyperactivity disorder (ADHD), who face increased risks due to the disorder's impact on development and health behaviors. ADHD is often associated with difficulties in social interactions, a higher likelihood of bullying involvement, and co-occurring mental health conditions. These factors may also be influenced by health factors such as physical activity, sleep quality, and screen time usage. Nationally representative teen self-reports provide a novel perspective on ADHD-related health outcomes compared with relying on parent reports.

METHOD

We used nationally representative data from the National Health Interview Survey (NHIS) and NHIS-Teen from July 2021 to December 2022, to examine teen-reported health and well-being factors, stratified by parent-reported ADHD diagnoses among teens aged 12 to 17 years. Weighted prevalence estimates and adjusted prevalence ratios (aPR) adjusting for teen age, sex, and family income, all with 95% confidence intervals (CIs), were calculated.

RESULTS

Just over 10% of teens had ADHD and they reported higher prevalence of bullying victimization (aPR = 1.64, CI = 1.27-2.11), difficulties making friends (aPR = 1.83, CI = 1.15-2.90), difficulty getting out of bed (aPR = 1.29, CI = 1.02-1.64), irregular wake times (aPR = 2.17, CI = 1.45-3.25), and >4 hours daily screen time (aPR = 1.26, CI = 1.05-1.52) than teens without ADHD; teens with ADHD reported a lower prevalence of lacking peer support (aPR = 0.70, CI = 0.51-0.96).

CONCLUSION

Teens with ADHD face distinct challenges related to social-emotional well-being and health behaviors that support overall wellness. Findings may inform opportunities for health promotion among teens with ADHD.

Pharmaceutical Supply Chains: A Structural Determinant of Health for Children With ADHD

Stimulant medications are a central component of management for youth with attention deficit hyperactivity disorder (ADHD) and their access has been impacted by supply shortages since 2022. Disruptions to treatment can lead to increased morbidity and mortality for youth with ADHD. Factors that contribute to pharmaceutical supply chain shortages include surges in demand, reduced capacity for production or distribution, and failures in coordination. This paper provides an overview of the recent stimulant medication shortage and leverages a framework for building resilience in the supply chain to help pediatric health providers take action and improve health outcomes for for youth with ADHD and their families.

Causal effects of pediatric asthma on psychiatric disorders: a bidirectional Mendelian randomization study

BACKGROUND

Previous studies have suggested a potential link between pediatric asthma and psychiatric disorders. However, the causal relationship between pediatric asthma and psychiatric disorders is unclear. Therefore, we used Mendelian randomization to explore causal relationships between pediatric asthma and depression, anxiety disorders, and attention deficit and hyperactivity disorder (ADHD).

METHODS

Genome-wide association studies (GWAS) meta-analyses with the largest possible sample size and independent individuals from European ancestry were selected. The genetic data for depression and anxiety are from FinnGen consortium, while the genetic data for ADHD is from the Psychiatric Genomics Consortium. Inverse variance weighted (IVW) was the main analysis method. The heterogeneity of the instrumental variables (IVs) was assessed using IVW, and the horizontal pleiotropy of the IVs was assessed using MR-Egger.

RESULT

The IVW results showed a significant causal relationship between pediatric asthma and depression (OR = 1.08, 95% CI = 1.02-1.15; p = 0.013). However, there is no evidence to suggest a causal relationship between pediatric asthma, anxiety, and ADHD. Reverse MR suggests a significant causal relationship (OR = 1.27, 95% CI [1.14-1.41], p = 9.64E - 06) between ADHD and pediatric asthma using the IVW method.

CONCLUSIONS

Our findings suggest a causal relationship between pediatric asthma and an increased risk of depression. Additionally, we found that ADHD is significantly associated with a higher risk of pediatric asthma.

ADHD in Adults with Epilepsy: A Guide for Neurologists

Attention-deficit/hyperactivity disorder (ADHD) and epilepsy have one of the lesser known and yet highly debated relationships in neuropsychiatry. Similar to anxiety and depression, ADHD has a bidirectional relationship with epilepsy, in which individuals with epilepsy are more likely than the general population to have ADHD and vice versa. Most importantly, an untreated psychiatric condition can affect quality of life. Although the management of ADHD in PWE has been debated due to perceived seizure risk related to ADHD medications, a consensus has developed based on early pediatric studies that support the treatment of ADHD. However, the management of adults with ADHD, particularly in PWE, remains relatively unexplored. This critical gap in knowledge will be addressed using an illustrative case study followed by practical tips on the identification and pharmacologic management of ADHD in adults with epilepsy. The management of ADHD in PWE should begin with a thorough history, medication assessment for cognitive risk, and the addition of a brief ADHD screening tool, such as the Adult ADHD Self-Report Scale (ASRS). Treatment with stimulants, such as methylphenidate, and non-stimulants, such as atomoxetine, are effective. Caution, however, should be taken for any patients with history of bipolar disorder, as some ADHD medications may exacerbate symptoms of other psychiatric conditions. Patients can also be referred to psychotherapy, such as cognitive behavior therapy (CBT) for ADHD, in addition to or in lieu of medications, thus further minimizing potential pharmacological risk. Patients who have tried and failed multiple ADHD medications and/or who carry a more complex psychiatric history should be referred to a psychiatrist.

Gene × environment interaction between heterozygous deletion of the ADHD risk gene latrophilin-3 (adgrl3) and developmental deltamethrin exposure in Sprague Dawley rats

The prevalence of attention deficit hyperactivity disorder (ADHD) is 9.8 % in U.S. children. Several variants of Latrophiln-3 (LPHN-3) are associated with ADHD. Using CRISPR/Cas9 we deleted exon 3 in rats to create a global Lphn3 knockout. These rats are hyperactive, startle hyper-reactive, impulsive, and have impaired working, spatial, and egocentric learning and memory. Deltamethrin (DLM) is a widely used pyrethroid insecticide. Several epidemiological studies report an increase in ADHD prevalence in children exposed to pyrethroids. Developmental exposure to DLM in rats results in multiple behavioral deficits. The present experiment tested whether Lphn3 disruption interacts with developmental DLM exposure. Because Lphn3-/- rats are severely impaired, we used Lphn3+/- (Hets) because they have an intermediate phenotype. Rats were treated by gavage once/day from postnatal day 6-20 with DLM resulting in four groups: Lphn3-Het + DLM (1.0 mg/kg), Lphn3-Het + Corn Oil (CO), Lphn3+/+ (wildtype: WT) + DLM, and WT + CO. From 31 litters, 19-27 offspring per genotype per treatment per sex were obtained with not more than 1 rat of each group and sex used from any one litter. Adult offspring were tested for exploration (open-field), 72-h home-cage activity, startle, novel object recognition (NOR), radial water maze (RWM), Morris water maze (MWM), and Cincinnati water maze (CWM). On MWM acquisition trials and the reversal probe trial, Lphn3-Het-DLM rats performed worse than other groups. This group also was impaired learning the CWM. No interactions were found for open-field, home-cage, startle, NOR, or RWM. The results show that the ADHD risk gene Lphn3 in combination with developmental DLM exposure has selective adverse effects compared with either factor alone.

Medication adherence and persistence in children and adolescents with attention deficit hyperactivity disorder (ADHD): a systematic review and qualitative update

Low medication-adherence and persistence may reduce the effectiveness of ADHD-medication. This preregistered systematic review (PROSPERO CRD42020218654) on medication-adherence and persistence in children and adolescents with ADHD focuses on clinically relevant questions and extends previous reviews by including additional studies. We included a total of n = 66 studies. There was a lack of consistency in the measurement of adherence/persistence between studies. Pooling the medication possession ratios (MPR) and using the most common adherence definition (MPR ≥ 80%) indicated that only 22.9% of participants had good adherence at 12-month follow-up. Treatment persistence on medication measured by treatment duration during a 12-month follow-up averaged 170 days (5.6 months). Our findings indicate that medication-adherence and persistence among youth with ADHD are generally poor and have not changed in recent years. Clinicians need to be aware that various factors may contribute to poor adherence/persistence and that long-acting stimulants and psychoeducational programs may help to improve adherence/persistence. However, the evidence to whether better adherence/persistence contributes to better long-term outcomes is limited and requires further research.

Temporal patterns in adolescent psychiatric treatment and outcomes: a nationwide register-based cohort follow-up

The rise in mental health problems among adolescents in high-income countries presents a challenge to service systems. For the development of services, there is a need for better insight into temporal psychiatric treatment-trends and outcomes. This study aims to analyze time-trends in both psychiatric treatment patterns and outcomes, utilizing a national sample of all adolescents receiving psychiatric treatment in Finland from 2003 to 2013. For time-trend-analysis, the sample was divided into two cohorts, using the onset year of 2008 as a cutoff. For each case, information on psychiatric treatment was gathered from registers within a five-year follow-up period from the onset of treatment or to death. The association between the inclusion year and outcome variables was studied via weighted generalized linear models. Adolescents in the latter cohort had a greater proportion (p < 0.001) of mood and anxiety diagnoses, a lower likelihood of hospitalization, a higher average of outpatient visits, and greater usage of psychotropics (excluding benzodiazepines). Those whose treatment began after 2008 were more likely to be alive (baseline characteristic adjusted Odds Ratio (aOR): 0.7, 95%CI: 0.6-0.8) and still in treatment contact (aOR: 1.4, 95%CI: 1.3-1.4) after four years from the onset. There was no difference in the long-term disability ratio. The results indicate favorable developments towards outpatient care in mental health services for adolescents with a significant decrease in mortality. Approaches to further developing cost-effective, personalized mental health services are discussed.

The association between anthropogenic heat and parent-report symptoms of childhood attention deficit hyperactivity disorder in China: A novel perspective reflecting climate change

Anthropogenic climate change will have a negative impact on worldwide well-being over and above the direct consequences of rising average temperatures. But anthropogenic heat (AH) relationship with childhood attention deficit hyperactivity disorder (ADHD) is unknown. To assess the relationship with AH exposure and childhood ADHD symptoms in the context of global climate change, this study was conducted in a cross-sectional survey from April 2012 to May 2018 in the northeastern, northwestern, and southern regions of China, with a total enrollment of 179,846 children aged 6-18 years. Exposure to AH was evaluated by gathering socioeconomic and energy usage data along with nighttime light data from satellites and data on the Normalized Difference Vegetation Index. This encompassed four types of AH exposure: industrial processes, transportation, buildings, and human metabolism. The statistical analysis used generalized linear mixed-effects modeling to determine the association between the types of AH exposure and childhood ADHD symptoms. The mean (SD) age of the 179,846 study participants was 11.7 (2.9) years, and 7343 participants (4.1%) had ADHD symptoms. In adjusted models, increased levels of AH exposure per IQR from total AH, industry, transportation, buildings, and human metabolism all increased the odds of ADHD (odds ratios, 3.60 [95% CI, 3.42, 3.80]; 5.71 [95% CI, 5.32, 6.14]; 1.79 [95% CI, 1.75, 1.84]; 2.10 [95% CI, 2.03, 2.17]; 1.95 [95% CI, 1.89, 2.02]). The association remained robust after various sensitivity analyses. Prolonged exposure to AH is associated with the development of ADHD symptoms in children.

Digital health interventions with healthcare information and self-management resources for young people with ADHD: a mixed-methods systematic review and narrative synthesis

Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental condition. Young people face challenges accessing ADHD healthcare in the UK, especially when transitioning between child and adult services. Digital health interventions (DHIs), as an adjunct to usual care, could improve access to healthcare information and condition-management support for this underserved group. This systematic review aimed to identify and synthesise evidence on DHIs suitable for young people aged 16-25 with ADHD, focussing on UK healthcare settings. We searched MEDLINE, Embase, PsycINFO, IEE Xplore, ACM Digital Library, Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials, Scopus, Web of Science Core Collection, ProQuest Dissertations & Theses Global from inception to December 2023 for studies about DHIs for ADHD which provided healthcare and self-management information, and which included at least one participant aged 16-25 years. Studies were grouped by intervention type (healthcare & self-management information, symptom monitoring, and management tools), appraised using the Quality Assessment with Diverse Studies (QuADS) tool. A narrative synthesis was conducted. Nineteen papers representing 15 interventions and comprising 2651 participants were identified. Research studies spanned intervention development, feasibility/usability, pilots exploring preliminary effectiveness, and trials. QuADS scores ranged from 13 to 34 out of 39. Preliminary evidence of feasibility and acceptability was strongest for co-produced interventions. Limited evidence of effectiveness was found, except for psychoeducation DHIs which may be effective in reducing ADHD symptoms. Future research should build on this emerging evidence-base, emphasising co-produced DHIs tailored to young people with ADHD.

A western dietary pattern during pregnancy is associated with neurodevelopmental disorders in childhood and adolescence

Despite the high prevalence of neurodevelopmental disorders, the influence of maternal diet during pregnancy on child neurodevelopment remains understudied. Here we show that a western dietary pattern during pregnancy is associated with child neurodevelopmental disorders. We analyse self-reported maternal dietary patterns at 24 weeks of pregnancy and clinically evaluated neurodevelopmental disorders at 10 years of age in the COPSAC2010 cohort (n = 508). We find significant associations with attention-deficit hyperactivity disorder (ADHD) and autism diagnoses. We validate the ADHD findings in three large, independent mother-child cohorts (n = 59,725, n = 656 and n = 348) through self-reported dietary modelling, maternal blood metabolomics and foetal blood metabolomics. Metabolome analyses identify 15 mediating metabolites in pregnancy that improve ADHD prediction. Longitudinal blood metabolome analyses, incorporating five time points per cohort in two independent cohorts, reveal that associations between western dietary pattern metabolite scores and neurodevelopmental outcomes are consistently significant in early-mid-pregnancy. These findings highlight the potential for targeted prenatal dietary interventions to prevent neurodevelopmental disorders and emphasise the importance of early intervention.

Increasing Health Literacy on ADHD: A Cross-Disciplinary Integrative Review Examining the Impact of ADHD on Brain Maturation, Composition and Function and Cognitive Processes Across the Life Course

There is a significant need to improve ADHD health literacy. This cross-disciplinary integrative review was conducted to synthesise the evidence on the impact ADHD has on brain maturation, composition and function as well as cognitive processes, across the life course. Although results are highly heterogenous, ADHD appears to be associated with (1) a significant delay in cortical maturation and differences in neuroanatomy that do not appear to fully resolve in adulthood, (2) atypical brain function, and (3) atypical cognitive processes. The cognitive processes implicated include working memory, inhibitory control, cognitive flexibility, alerting attention, reward processing, long-term memory, reaction time, time perception and estimation, planning, and complex decision making/problem-solving. We aim to use this data to develop a 'framework/checklist" that parents, adults and clinicians can use to identify the possible mechanisms that may be contributing to an individual with ADHD's challenges. This information can also be used to inform the content of ADHD education programs to ensure participants receive empirically-determine information from high quality review studies and meta-analysis that accurately reflects the rigor and limitations of study findings.

Optimizing Attention and Sleep Intervention Study (OASIS): a protocol for a pilot randomized controlled trial to compare parent behavioral interventions with and without sleep strategies delivered in pediatric primary care for preschool-aged children at risk of childhood ADHD

BACKGROUND

Attention-deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder that presents as early as preschool. Inattention and hyperactivity in childhood interfere with developing social and preacademic skills, leading to lifelong impairment. Evidence-based treatments for children with ADHD exist, including parent behavioral interventions (PBIs). However, current treatments have failed to substantially change the long-term trajectory of symptoms and impairment for individuals with ADHD, suggesting the need to enhance treatment approaches and intervene earlier. Given that sleep is a modifiable factor linked to ADHD symptom persistence and exacerbation, it may be a useful target in addressing ADHD among preschool children (ages 3-5 years). The most common sleep problems among preschoolers are behavioral and amenable to PBIs. However, sleep strategies have not been included within PBIs to address ADHD symptoms in young children. Thus, this pilot trial aims to assess the feasibility, acceptability, and appropriateness of a novel sleep-focused PBI (SF-PBI). Moreover, given the barriers to accessing care for sleep-related issues, this pilot trial aims to increase access to evidence-based care by partnering with behavioral health therapists embedded in pediatric primary care to deliver intervention.

METHODS

A pilot randomized clinical trial is being conducted in 5 pediatric primary care offices by embedded behavioral health therapists with 50 families of 3- to 5-year-old children with elevated ADHD symptoms and behavioral sleep problems. Families are randomized (1:1) to six sessions of either standard PBI or SF-PBI, informed by focus groups with caregivers, therapists embedded in pediatric primary care, and pediatric providers. Primary outcomes at post-intervention will be therapist and caregiver report on the intervention's acceptability, appropriateness, and feasibility.

DISCUSSION

Primary outcomes will inform the decision to transition to a definitive trial testing SF-BPI targeting sleep among preschool-aged children at elevated risk for ADHD via accessible, primary care-based intervention that harnesses parenting strategies. Ultimately, the SF-PBI has the potential to improve outcomes for children at risk for ADHD by increasing access to early intervention for behavioral sleep issues to reduce the prevalence, symptoms, and associated impairments of ADHD among children and families.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05683756 (prospectively registered, date registered 4 January 2023): https://clinicaltrials.gov/study/NCT05683756.

C. G. Jung's Concept of "Manic Mood" From 1904: An Early Contribution to the Disorder of the Adult Form of ADHD?

BACKGROUND

Adult ADHD has increasingly become a focus in adult psychiatry. Despite well-established diagnostic criteria and specific therapeutic approaches, contemporary discussions often dismiss ADHD as a "fad." This study examines Carl Gustav Jung's 1904 concept of "manic mood" and its potential alignment with the modern understanding of ADHD in adults.

OBJECTIVE

The aim of this paper is to investigate and discuss whether Jung's concept of "manic mood" can be considered part of the intellectual history of adult ADHD.

METHOD

Jung's concept of "manic mood" is analyzed and presented using the literary-historical method of "close reading," placing the analysis within the context of the early 20th-century discussion of "chronic-manic concepts." This analysis is compared with the current diagnostic criteria for adult ADHD.

RESULTS AND CONCLUSION

Jung's concept of "manic mood," described in 1904, has clear parallels to diagnostic criteria used for adult ADHD. It is conceivable that the patients presented by Jung would be diagnosed with adult ADHD today. Jung's work fits into the discussion of "chronic-manic concepts" of the early 20th century and thus makes a relevant original contribution to the nosological-diagnostic classification of forms in the spectrum of ADHD-affective disorders-personality disorders. The parallel between Jung's disease construct of "manic mood" and the current view of ADHD supports our hypothesis that the adult form of ADHD represents a consistent disease phenomenon and should therefore not be degraded as a "fad."

Selective attention and sensitivity to auditory disturbances in a virtually-real Classroom: Comparison of adults with and without AD(H)D

Many people, and particularly individuals with Attention Deficit (Hyperactivity) Disorder (AD(H)D), find it difficult to maintain attention during classroom learning. However, traditional paradigms used to evaluate attention do not capture the complexity and dynamic nature of real-life classrooms. Using a novel Virtual Reality platform, coupled with measurement of neural activity, eye-gaze and skin conductance, here we studied the neurophysiological manifestations of attention and distractibility, under realistic learning conditions. Individuals with AD(H)D exhibited higher neural responses to irrelevant sounds and reduced speech tracking of the teacher, relative to controls. Additional neurophysiological measures, such the power of alpha-oscillations and frequency of gaze-shifts away from the teacher, contributed to explaining variance in self-reported AD(H)D symptoms across the sample. These ecologically-valid findings provide critical insight into the neurophysiological mechanisms underlying individual differences in the capacity for sustained attention and the proneness to distraction and mind-wandering, experienced in real-life situations.

Metabolomic and lipidomic profiling reveals convergent pathways in attention deficit hyperactivity disorder therapeutics: Insights from established and emerging treatments

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder with unclear pathological mechanisms. ADHD is treated with both stimulant and nonstimulant medications, but their therapeutic mechanisms and impact on brain metabolites are not fully understood. This study employed an untargeted metabolomics approach with liquid chromatography mass spectrometry to investigate the pathogenesis of ADHD, as well as the effects of established and novel therapeutics. We characterized the metabolomic signatures of the adgrl3.1 mutant zebrafish ADHD model and examined the impact of methylphenidate, guanfacine, atomoxetine, and 5 novel putative therapeutics identified in a prior screen, including amlodipine. Our analysis revealed that the drugs commonly affect pathways related to amino acid and lipid metabolism, specifically involving glycine, serine, threonine, phenylalanine, lysophosphatidylcholine, and sphingomyelin. This convergence on similar metabolic targets was unexpected and suggests a broader, systemic effect of ADHD therapeutics, challenging the traditional view of distinct drug mechanisms. Amlodipine exhibited metabolic effects consistent with established treatments, indicating its potential as a viable alternative or adjunct therapy. These findings provide new insights into the metabolic underpinnings of ADHD and highlight potential targets for developing improved therapeutic strategies. SIGNIFICANCE STATEMENT: This study explores the metabolic pathways affected by attention deficit hyperactivity disorder treatments using a zebrafish adgrl3.1 mutant model. Untargeted metabolomics revealed that both established and novel attention deficit hyperactivity disorder medications influence common amino acid and lipid metabolism pathways, suggesting systemic effects. Notably, amlodipine showed similar impacts as current drugs, offering promise as an alternative therapy.

[Socioeconomic impact of neurodevelopmental disorders in France]

INTRODUCTION

This study aims to assess the economic impact of delays and inadequate diagnosis and treatment for neurodevelopmental disorders (NDDs) in France, affecting 2 to 3 million individuals. Neurodevelopmental disorders, including autism spectrum disorder (ASD), learning disabilities, and attention deficit hyperactivity disorder (ADHD), are often described as "invisible" disabilities, but they generate significant societal costs.

METHOD

The study was conducted with the support of Ashoka France as part of a collaboration between Goodwill-Management and the Aloïs Association. Goodwill-Management, a firm specializing in support for social economy organizations, offers pro bono assistance each year for social impact assessment. In 2022, it selected the project of the Aloïs Association, a center of expertise on cognitive disorders at all stages of life, based in Paris, to conduct the first medico-economic study on NDDs in France. The methodological approach comprised a thorough literature review, data collection from public organizations, and detailed economic analysis. The study sought to identify the potential cost-saving levers and highlight the economic burden of late diagnosis and variable care pathways for NDDs.

RESULTS

The study revealed that the economic cost of NDDs in France is estimated at approximately 28 billion euros per year. In comparison, the estimated costs are 74 billion dollars in the United States and 37 billion dollars in Canada. A major contributor to these costs is the delay in diagnosis, coupled with the heterogeneity of care, which significantly impacts the professional lives of individuals with NDDs and their caregivers.

CONCLUSION

The findings underscore the importance of early diagnosis and standardized care pathways to reduce societal costs and improve the quality of life for affected individuals. To reduce societal costs and improve the quality of life for those affected, the proposed recommendations emphasize the importance of early diagnosis, increasing access to care methods recommended by the HAS (French National Health Authority), and promoting targeted prevention and psychoeducation interventions within companies, aimed at supporting employees suffering from these disorders as well as employee caregivers. Implementing these measures is expected to generate substantial economic savings and support the inclusion and well-being of individuals with neurodevelopmental conditions.

Drug detection in oral fluid and urine after single therapeutic doses of dexamphetamine, lisdexamphetamine, and methylphenidate in healthy volunteers

Dexamphetamine, lisdexamphetamine, and methylphenidate are central stimulant drugs widely used to treat attention-deficit/hyperactivity disorder (ADHD), but poor adherence may lead to treatment failure, and the drugs are also subject to misuse and diversion. Drug analysis in oral fluid may thus be useful for monitoring adherence and misuse. We measured drug concentrations in oral fluid and urine after controlled dosing to investigate detection windows and evaluate the chosen cutoffs. Healthy volunteers ingested single oral doses of 10 mg dexamphetamine (n = 11), 30 mg lisdexamphetamine (n = 11), or 20 mg methylphenidate (n = 10), after which they collected parallel oral fluid and urine samples every 8 h for 4-6 days. Amphetamine (analytical cutoff, oral fluid: 1.5 ng/mL; urine: 50 ng/mL), methylphenidate (oral fluid: 0.06 ng/mL), and ritalinic acid (urine: 500 ng/mL) were analyzed using fully validated chromatographic methods. The median time from ingestion to the last detection in oral fluid was 67 ± 4.9 h (lisdexamphetamine) and 69 ± 8.8 h (dexamphetamine) for amphetamine and 36 ± 2.5 h for methylphenidate. This was comparable to urine (77 ± 5.1 h for lisdexamphetamine, 78 ± 4.5 h for dexamphetamine, and 41 ± 2.4 h for ritalinic acid). The interindividual variability in detection times was large, probably in part due to pH-dependent disposition. Using a logistic regression approach, we found similar detection rates as a function of time since intake in urine and oral fluid with the chosen cutoffs, with a high degree of probability for detection at least 24 h after intake of a low therapeutic dose. This demonstrates the usefulness of oral fluid as a test matrix to assess adherence to ADHD medications, provided that the analytical method is sensitive, requiring a cutoff as low as 0.1 ng/mL for methylphenidate. Detection windows similar to those in urine may be achieved for amphetamine and methylphenidate in oral fluid.

Somatic comorbidities and health related uncertainty among Swedish adolescents with ADHD

Introduction

Attention-deficit/hyperactivity disorder (ADHD) frequently exists alongside psychiatric comorbidities. The coexistence of somatic diseases and ADHD constitutes a growing field of research.

Method

This study aimed to examine the prevalence of common somatic diseases in adolescents with ADHD and compare them with those in adolescents without any psychiatric diagnoses. A cross-sectional study was conducted among a convenient sample of Swedish upper secondary school students aged 15 to 19 years. Data were collected using an electronic version of the "Mental and Somatic Health without borders" survey. In 2020, 1608 adolescents completed the survey and provided self-reports of their psychiatric and somatic diagnoses.

Results

Among the sample of Swedish adolescents, 5.5% reported having ADHD diagnoses. These adolescents reported more somatic comorbidities than those without any psychiatric diagnosis (comparison group). The most common somatic comorbidities among those with ADHD were allergies (43.4%), asthma (24.7%), and skin diseases (16.7%), which prevalences were significantly higher than those reported by adolescents in the comparison group. However the effect sizes of these differences were negligible (allergies: p=0.002, Cramer's V=0.08; asthma: p=0.041, Cramer's V=0.06; skin diseases: p=0.007, Cramer's V=0.08), raising questions about the practical implications of these findings. Allergies were significantly more common in both genders with ADHD (p=0.038, Cramer's V=0.08 in women and p=0.038, Cramer's V=0.09 in men). Additionally, men with ADHD showed a significant association with skin diseases (p=0.007, Cramer's V=0.12) while women with ADHD were significantly more likely to have migraine (p=0.038, Cramer's V=0.08). Notably, adolescents with ADHD reported significantly higher rates of uncertainty regarding the existence of diabetes, rheumatoid diseases, asthma (with negligible effect sizes), and thyroid diseases (with a small effect size) than those without any psychiatric diagnoses, suggesting heightened health related anxiety within this group.

Conclusions

Adolescents with ADHD reported more somatic comorbidities and greater uncertainty about the potential presence of additional somatic conditions compared to adolescents without psychiatric diagnoses. These findings highlight the importance of addressing both health literacy and access to healthcare. By focusing on this group, we cannot only improve their ability to understand and navigate the healthcare system but also strengthen their confidence in managing their own health.

Adult ADHD predicts intimate partner violence perpetration and victimization irrespective of gender and age

Understanding the determinants of intimate partner violence (IPV) from perpetrator and victim perspectives has become a major objective of behavioral science. Empirical evidence suggests that adults at risk for Attention-Deficit/Hyperactivity Disorder (ADHD), compared to the general population, tend to have more conflictual partnerships, and the presence of ADHD increases the risk of aggressive behavior. Possible influences of gender have not been sufficiently investigated yet. Using data from an anonymous online survey, this study examined the relationship between ADHD and IPV in 316 male and female individuals with (n = 131) and without (n = 185) ADHD. Multiple linear regression analyses showed that adults at risk for ADHD had more frequently become both victims and perpetrators of IPV compared to the healthy control group. ADHD achieved significant incremental variance over gender and age. Thus, the presence of ADHD seems to be an important risk factor for IPV irrespective of gender and age. Accordingly, research and treatment approaches focusing on ADHD must not neglect the risk of IPV among patients but should offer specific psychological support.