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

Unmet Needs of Children and Young Adults With ADHD: Insights From Key Stakeholders on Priorities for Stigma Reduction

INTRODUCTION

Individuals with ADHD continue to face stigma, which can negatively impact their access to, adherence to, and quality of mental health services, as well as their overall wellbeing. Perspectives of various stakeholders regarding priorities for stigma reduction remain underexplored. This study explores young adult, parent, teacher, and mental health care professional perspectives on unmet needs of children and young adults with ADHD in the Netherlands, in the context of stigma reduction.

METHOD

A total of 24 respondents participated in seven small focus group discussions (FGDs). The FGDs facilitated in-depth discussions exploring stakeholder group perspectives on unmet needs of children and young adults with ADHD in educational, professional, and social settings. Data was analyzed using thematic content analysis.

RESULTS

Three thematic categories of unmet needs were identified: (1) a lack of awareness, knowledge, and understanding of ADHD; (2) insufficient personalized approaches in education and health care; and (3) limited accessibility of information and support services. Within theme 1, respondents primarily highlighted the importance of improving education for primary school teachers and mental health care professionals. Theme 2 underscored the need for increased capacity for personalization and attention to the sociopsychological factors of ADHD, alongside recognizing strengths. Theme 3 emphasized the need for easy access to reliable information and mental health care, including peer networks, as well as proper follow-up and continuity of care.

DISCUSSION AND CONCLUSION

Findings highlight the need for improving our understanding of ADHD as a complex biopsychosocial condition, which requires specific adjustments in education and mental health care. Interventions to improve support and disrupt stigmatization should meet diverse needs, incorporate multi-level strategies, and involve key stakeholders.

Transitioning From Pediatric to Adult Psychiatric Care for ADHD in Sweden: A Nationwide Study

OBJECTIVE

To evaluate care transition and medication use in young adults with ADHD in Sweden.

METHOD

Observational retrospective study of patients with ADHD from the Swedish National Patient Register, Prescribed Drug Register, and Cause of Death Register (2018-2020). Last contact with pediatric psychiatric care, first contact with adult psychiatric care, and medication use were described for ages 18 to 21 years, inclusive.

RESULTS

Of 19,233 patients who had dispensed ADHD treatment, 85.8% had received adult psychiatric care by 21 years of age. The proportion of patients on medication was highest at age 18 years (80.1%), decreasing to 36.1% by age 21 years. By 21 years, there were significantly more patients on versus off ADHD medication who had received healthcare for autism, been prescribed selective serotonin re-uptake inhibitors, and received adult psychiatric outpatient visits (all p < .0001).

CONCLUSION

This study demonstrates declining ADHD medication use during the pediatric-to-adult care transition for patients in Sweden.

Decreased impulsiveness and MEG normalization after AI-digital therapy in ADHD children: a RCT

Attention-deficit/hyperactivity disorder (ADHD) presents with symptoms like impulsiveness, inattention, and hyperactivity, often affecting children's academic and social functioning. Non-pharmacological interventions, such as digital cognitive therapy, are emerging as complementary treatments for ADHD. The randomized controlled trial explored the impact of an AI-driven digital cognitive program on impulsiveness, inattentiveness, and neurophysiological markers in 41 children aged 8-12 with ADHD. Participants received either 12 weeks of AI-driven therapy or a placebo intervention. Assessments were conducted pre- and post-intervention and magnetoencephalography (MEG) analyzed brain activity. Results showed significant reductions in impulsiveness and inattentiveness scores in the treatment group, associated with normalized MEG spectral profiles, indicating neuromaturation. Notably, improvements in inhibitory control correlated with spectral profile normalization in the parieto-temporal cortex. Improvements in inhibitory control, linked to normalized spectral profiles, suggest AI-driven digital cognitive therapy can reduce impulsiveness in ADHD children by enhancing neurophysiological efficiency. This emphasizes personalized, technology-driven ADHD treatment, using neurophysiological markers for assessing efficacy.

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.

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.).

The trajectory of attention deficit hyperactivity disorder symptoms and its dynamic relationship with inhibitory control

BACKGROUND

Attention Deficit Hyperactivity Disorder (ADHD) is a prevalent neurodevelopmental disorder in childhood, characterized by symptoms of inattention, hyperactivity, and impulsivity. Impaired inhibitory control is observed in the majority of individuals with ADHD. Understanding the relationship between inhibitory control and the developmental trajectory of ADHD is essential for informing clinical prognosis and guiding early interventions.

METHODS

We utilized Latent Growth Curve Modeling (LGCM) to map the developmental course of ADHD symptoms using data from the Adolescent Brain Cognitive Development study. Concurrently, we examined the longitudinal correlation between inhibitory control and ADHD symptoms at corresponding time points. Additionally, a Bivariate Latent Change Score Model (BLCSM) was employed to investigate the relationship between changes in inhibitory control and ADHD symptoms. We also integrated Polygenic Risk Scores (PRS) into the LGCM as predictors to explore the impact of genetic factors associated with inhibitory control and ADHD on the trajectory of ADHD symptoms.

RESULTS

The LGCM analysis demonstrated that baseline inhibitory control influenced both the initial state and the rate of change of ADHD symptoms. Inhibitory control exhibited both concurrent and prospective associations with ADHD symptoms. Notably, the BLCSM revealed that changes in inhibitory control could predict future changes in ADHD symptoms, and vice versa. Dynamic changes in inhibitory control were found to affect future changes in ADHD symptoms. Additionally, the PRS for inhibitory control and ADHD were significantly linked to the initial state and rate of change of ADHD symptoms.

CONCLUSIONS

Our findings underscore a sustained correlation between inhibitory control and ADHD symptoms, highlighting the critical association between inhibitory control and the developmental trajectory of ADHD in children. Furthermore, the predictive value of inhibitory control for ADHD suggests a new avenue for early intervention, potentially improving the prognosis for ADHD patients.

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.

Evaluating ADHD medication trial representativeness: a Swedish population-based study comparing hypothetically trial-eligible and trial-ineligible individuals

BACKGROUND

Randomised controlled trials (RCTs) evaluating ADHD medications often use strict eligibility criteria, potentially limiting generalisability to patients in real-world clinical settings. We aimed to identify the proportion of individuals with ADHD who would be ineligible for medication RCTs and evaluate differences in treatment patterns and clinical and functional outcomes between RCT-eligible and RCT-ineligible individuals.

METHODS

We used multiple Swedish national registries to identify individuals with ADHD, aged at least 4 years at the age of diagnosis, initiating pharmacological treatment between Jan 1, 2007, and Dec 31, 2019, with follow-up up to Dec 31, 2020. Hypothetical RCT ineligibility was established using exclusion criteria from the international MED-ADHD dataset, including 164 RCTs of ADHD medications. Cox models evaluated differences in medication switching and discontinuation within 1 year between eligible and ineligible individuals. Quasi-Poisson models compared eligible and ineligible individuals on rates of psychiatric hospitalisations, injuries or accidents, and substance use disorder within 1 year of initiating ADHD medications. People with lived experience of ADHD were not involved in the research and writing process.

FINDINGS

Of 189 699 individuals included in the study cohort (112 153 men and boys [59%] and 77 546 women and girls [41%]; mean age 21·52 years [SD 12·83; range 4-68]) initiating ADHD medication, 53% (76 477 [74%] of 103 023 adults [aged >17 years], 12 658 [35%] of 35 681 adolescents [aged 13-17 years], and 10 643 [21%] of 50 995 children [aged <13 years]) would have been ineligible for RCT participation. Ethnicity data were not available. Ineligible individuals had a higher likelihood of treatment switching (hazard ratio 1·14, 95% CI 1·12-1·16) and a decreased likelihood of medication discontinuation (0·96, 0·94-0·98) compared with eligible individuals. Individuals ineligible for RCTs had significantly higher rates of psychiatric hospitalisations (ncidence rate ratio 9·68, 95% CI 9·57-9·78) and specialist care visits related to substance use disorder (14·78, 14·64-14·91), depression (6·00, 5·94-6·06), and anxiety (11·63, 11·56-11·69).

INTERPRETATION

Individuals ineligible for ADHD medication trials face higher risks of adverse outcomes. This study provides the first empirical evidence for the limited generalisability of ADHD RCTs to real-world clinical populations, by applying eligibility criteria extracted from a comprehensive dataset of RCTs to a large real-world cohort. Triangulating evidence from RCTs and real-world studies is crucial to inform rigorous evidence-based treatment guidelines.

FUNDING

National Institute of Healthcare and Research, European Union's Horizon 2020, and Swedish Research Council.

Extended-release amphetamine (Dyanavel XR) is associated with reduced immediate-release supplementation in adults with ADHD, regardless of baseline patient variables: a retrospective cohort analysis of medical treatment records

BACKGROUND

Adults with ADHD benefit from treatment with extended-release (ER) formulations that provide symptom control for the entire day. Some patients are advised to supplement their extended-release medication with an immediate-release (IR) medication later in the day if they need to prolong its effects. Given that several FDA-approved ER formulations are available and many individual patient variables may affect efficacy, the purpose of this study was to identify reliable predictors of the tendency for patients to supplement their daily ER medication with an IR medication.

METHODS

This retrospective study analyzed data from medical treatment records of adults with ADHD who received at least one ER psychostimulant (amphetamine or methylphenidate preparations) for at least six months between November 2022 and June 2024 (N = 417). Data from their intake evaluations, pre-visit measures of depression, anxiety, and ADHD via validated self-report scales, and post-visit clinician evaluations were compiled from their electronic medical records and the Qualtrics API. The association between Dyanavel XR, IR supplementation, and patient variables were investigated by backward stepwise linear regressions modeled using the variable groupings: (1) side effects reported at baseline, (2) side effects reported after 90 days, and (3) change in depression, anxiety, and ADHD symptoms from baseline to 90 days using assessment scale scores.

RESULTS

Compared to the other amphetamine and methylphenidate ER medications, only Dyanavel XR resulted in lower IR supplementation at 90 days. This relationship held when controlling for baseline IR use. Regardless of whether patients supplemented with an IR, they demonstrated improved ADHD symptoms as measured by the ADHD Symptom and Side Effect Tracking (ASSET) scale after 90 days (d = 0.68 in patients with IR, d = 0.39 in patients without IR). Dyanavel XR was significantly associated with reduced IR supplementation at 90 days compared to the pooled group of patients taking other ER medications (χ2 = 4.320, Nagelkerke R2 = 0.039, p = .038). The CGI-I score at baseline was also significantly associated with supplementation at 90 days (r = .14, p = .010). No other baseline variable was independently associated with IR supplementation. Along with being on Dyanavel XR, improved ADHD and anxiety symptom presentation from the baseline to the 90-day visit predicted reduced IR supplementation (ASSET change: t = 2.377, p = .018; GAD-2 change: t = -2.543, p = .011; Dyanavel XR: t = -2.112, p = .035).

CONCLUSION

These analyses support Dyanavel XR as a monotherapy for the daily management of ADHD in adults compared with other ER medications. Considering its tendency to reduce IR supplementation and its relationship with improved ADHD and anxiety symptoms, Dyanavel XR may simplify treatment regimens and improve outcomes.

CLINICAL TRIAL NUMBER

Not applicable.

Prevalence and correlates of common mental disorders among participants of the Uganda Genome Resource: Opportunities for psychiatric genetics research

Genetics research has potential to alleviate the burden of mental disorders in low- and middle-income-countries through identification of new mechanistic pathways which can lead to efficacious drugs or new drug targets. However, there is currently limited genetics data from Africa. The Uganda Genome Resource provides opportunity for psychiatric genetics research among underrepresented people from Africa. We aimed at determining the prevalence and correlates of major depressive disorder (MDD), suicidality, post-traumatic stress disorder (PTSD), alcohol abuse, generalised anxiety disorder (GAD) and probable attention-deficit hyperactivity disorder (ADHD) among participants of the Uganda Genome Resource. Standardised tools assessed for each mental disorder. Prevalence of each disorder was calculated with 95% confidence intervals. Multivariate logistic regression models evaluated the association between each mental disorder and associated demographic and clinical factors. Among 985 participants, prevalence of the disorders were: current MDD 19.3%, life-time MDD 23.3%, suicidality 10.6%, PTSD 3.1%, alcohol abuse 5.7%, GAD 12.9% and probable ADHD 9.2%. This is the first study to determine the prevalence of probable ADHD among adult Ugandans from a general population. We found significant association between sex and alcohol abuse (adjusted odds ratio [AOR] = 0.26 [0.14,0.45], p < 0.001) and GAD (AOR = 1.78 [1.09,2.49], p = 0.019) respectively. We also found significant association between body mass index and suicidality (AOR = 0.85 [0.73,0.99], p = 0.041), alcohol abuse (AOR = 0.86 [0.78,0.94], p = 0.003) and GAD (AOR = 0.93 [0.87,0.98], p = 0.008) respectively. We also found a significant association between high blood pressure and life-time MDD (AOR = 2.87 [1.08,7.66], p = 0.035) and probable ADHD (AOR = 1.99 [1.00,3.97], p = 0.050) respectively. We also found a statistically significant association between tobacco smoking and alcohol abuse (AOR = 3.2 [1.56,6.67], p = 0.002). We also found ever been married to be a risk factor for probable ADHD (AOR = 2.12 [0.88,5.14], p = 0.049). The Uganda Genome Resource presents opportunity for psychiatric genetics research among underrepresented people from Africa.

"I Found Comfort in Exercising": Exploring Experiences With Exercise for Adults With Attention-Deficit/Hyperactivity Disorder

Little is known about how adults with attention-deficit/hyperactivity disorder (ADHD) experience exercise, resulting in a lack of recommendations for supporting this population. We aimed to explore how adults with ADHD experience exercise as a management tool before and after diagnosis and how and why individuals experience issues related to exercise dependence. Fifteen active adults with a diagnosis of ADHD participated in semistructured interviews. Three overarching themes were identified: (a) exercise as a necessity for ADHD, reflecting the need to exercise before a formal ADHD diagnosis, and use of exercise as a management tool postdiagnosis; (b) goals and achievements to live by, reflecting how exercise patterns revolved around a need to make progress toward targets; and (c) activity or exercise: a roller coaster journey, covering the ups and downs of exercise journeys. This article highlights the importance of exercise for adults to manage ADHD and how this can be encouraged and supported.

Enhancing accessibility and scalability of school-based programs to improve youth attention and behavior: Open feasibility trial of the remote CLS-R-FUERTE program in Mexico

Neurodevelopmental disorders of inattention and disruptive behavior, such as attention-deficit/hyperactivity disorder and oppositional defiant disorder, are among the most common youth mental health conditions across cultures. There is a need to develop more accessible school-based intervention and training programs, as well as create a system with clinical research capacity for scalable school clinician training and evaluation, to support students with attention and behavior concerns worldwide. We adapted the collaborative life skills program for Mexico (i.e., CLS-FUERTE) for remote delivery (i.e., CLS-R-FUERTE) and conducted a three-school open trial with N = 67 participants (n = 7-8 students per school [ages 6-12] and their parents, teachers, and school clinicians). We examined fidelity to program content, attendance and adherence records, in vivo observations of program delivery, and postmeeting feedback informing iterative program changes between each school cohort. We also examined improvements in youth attention and behavior rated by parents and teachers to evaluate the remote program effectiveness. CLS-R-FUERTE feasibility, acceptability, and usability findings were promising. Iterative program changes between each school cohort were minor and included adapted curriculum order, enhanced engagement strategies, and technology adjustments. Many students demonstrated reliable change, and the pre-post program improvements were comparable to outcomes from the in-person CLS-FUERTE trial, indicating preliminary effectiveness. Our pilot CLS-R-FUERTE effort supports the process of iteratively adapting, implementing, and evaluating remote school-based intervention and training programs to enhance potential flexibility, accessibility, and scalability. Challenges emerging from technological problems and in context of the COVID-19 pandemic, as well as solutions, are discussed. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Comparative efficacy and acceptability of pharmacological, psychological, and neurostimulatory interventions for ADHD in adults: a systematic review and component network meta-analysis

BACKGROUND

The comparative benefits and harms of available interventions for ADHD in adults remain unclear. We aimed to address these important knowledge gaps.

METHODS

In this systematic review and component network meta-analysis (NMA), we searched multiple databases for published and unpublished randomised controlled trials (RCTs) investigating pharmacological and non-pharmacological interventions for ADHD in adults from database inception to Sept 6, 2023. We included aggregate data from RCTs comparing interventions against controls or any other eligible active intervention for the treatment of symptoms in adults (ages ≥18 years) with a formal diagnosis of ADHD. Pharmacological therapies were included only if their maximum planned doses were considered eligible according to international guidelines. We included RCTs of at least 1-week duration for medications, of at least four sessions for psychological therapies, and of any length deemed appropriate for neurostimulation. For RCTs of medications, cognitive training, or neurostimulation alone, we included only double-blind RCTs. At least two authors independently screened the identified records and extracted data from eligible RCTs. Our primary outcomes were efficacy (change in ADHD core symptom severity on self-rated and clinician-rated scales at timepoints closest to 12 weeks) and acceptability (all-cause discontinuation). We estimated standardised mean differences (SMDs) and odds ratios (ORs) using random effects pairwise and component NMA, dismantling interventions into specific therapeutic components. This study was registered with PROSPERO (CRD42021265576). People with relevant lived experience were involved in the conduct of the research and writing process.

FINDINGS

Of 32 416 records, 113 unique RCTs encompassing 14 887 participants were eligible for analysis (6787 [45·6%] females, 7638 [51·3%] males, 462 [3·1%] sex not reported). The RCTs encompassed pharmacological therapies (63 [55·8%] of 113 RCTs; 6875 participants), psychological therapies (28 [24·8%] of 113 RCTs; 1116 participants), neurostimulatory therapy and neurofeedback (ten [8·8%] of 113 RCTs; 194 participants), and control conditions (97 [85·8%] of 113 RCTs; 5770 participants). For reduction of ADHD core symptoms at 12 weeks on both self-reported and clinician-reported rating scales, atomoxetine (self-reported scale SMD -0·38, 95% CI -0·56 to -0·21; clinician-reported scale -0·51, -0·64 to -0·37) and stimulants (0·39, -0·52 to -0·26; -0·61, -0·71 to -0·51) had higher efficacy than placebo (Confidence in Network Meta-Analysis [CINeMA] ranging between very low and moderate). Cognitive behavioural therapy (-0·76, -1·26 to -0·26), cognitive remediation (-1·35, -2·42 to -0·27), mindfulness (-0·79, -1·29 to -0·29), psychoeducation (-0·77, -1·35 to -0·18), and transcranial direct current stimulation (-0·78; -1·13 to -0·43) were better than placebo only on clinician-reported measures. Regarding acceptability, all therapeutic components were similar to placebo other than atomoxetine (OR 1·43, 95% CI 1·14 to 1·80; CINeMA moderate) and guanfacine (3·70, 1·22 to 11·19; high), which had lower acceptability compared with placebo. Baseline severity of self-reported ADHD core symptoms, year of publication, percentage of male individuals, and percentage of individuals with ADHD and another mental health condition did not explain the heterogeneity observed in unadjusted non-component models of self-reported ADHD core symptoms. Treatment length had little effect on heterogeneity.

INTERPRETATION

Stimulants and atomoxetine were the only interventions with evidence of beneficial effects in terms of reducing ADHD core symptoms in the short term, supported by both self-reported and clinician-reported ratings. However, atomoxetine was less acceptable than placebo. Medications for ADHD were not efficacious on additional relevant outcomes, such as quality of life, and evidence in the longer term is underinvestigated. The effects of non-pharmacological strategies were inconsistent across different raters. Our network meta-analysis represents the most comprehensive synthesis of available evidence to inform future guidelines in the field.

FUNDING

UK National Institute for Health and Care Research.

Exploring the pathways linking prenatal and early childhood greenness exposure to attention-deficit/hyperactivity disorder symptoms during childhood: An approach based on robust causal inference

BACKGROUND

Epidemiological studies suggest that exposure to greenness during childhood may protect children from developing attention-deficit hyperactivity disorder (ADHD).

OBJECTIVE

We analyzed the effect of both prenatal (pregnancy) and early childhood (4-5-year follow-up) residential greenness exposure and green space availability on ADHD symptoms during childhood (up to the age of 12 years) and further explored the potential mediating role of PM2.5 and physical activity in the association.

METHODS

The study population included participants from the INfancia y Medio Ambiente (INMA) prospective birth cohort (Gipuzkoa, Sabadell, and Valencia). Average Normalized Difference Vegetation Index (NDVI) in buffers of 100-, 300- and 500-m around the residential addresses was used as an indicator of greenness, while green space availability was determined based on the presence of a major green space within 150-m from the residence. Childhood ADHD symptoms were assessed at the 6-8- and 10-12-year follow-ups using Conners Parents Rating Scale-Revised: Short Form.

RESULTS

Although no association was found for the prenatal exposure period, increased early childhood NDVI inversely associated with the OR of clinically significant ADHD symptoms during the 6-8-year follow-up at the 100-m (OR 0.03, 95% CI: 0.003 to 0.44), 300-m (OR 0.04, 95% CI: 0.003 to 0.42) and 500-m (OR 0.08, 95% CI: 0.01 to 0.76) buffers, but exclusively in the context of direct effects. Additionally, the 10-12-year follow-up analysis found moderate to weak evidence of potential total and direct effects of NDVI at both 100- and 300-m buffers on inattention scores, as well as for NDVI at the 300-m buffer on ADHD index scores. The analysis did not reveal evidence of mediation through PM2.5 or physical activity.

CONCLUSIONS

The evidence suggests that early childhood greenness exposure may reduce the risk of developing ADHD symptoms later in childhood, and that this association is not mediated through PM2.5 and physical activity.

Research Review: Pharmacological and non-pharmacological treatments for adolescents with attention deficit/hyperactivity disorder - a systematic review of the literature

BACKGROUND

Attention Deficit/Hyperactivity Disorder (ADHD) demonstrates unique developmental manifestations in adolescence with implications for optimized, age-appropriate treatment. This 10-year update is the third in a series of systematic reviews examining the efficacy and safety of adolescent ADHD treatments. We broadly examined efficacy on ADHD symptoms, impairments, and other reported outcomes. Acute and long-term efficacy, and treatment moderators, were considered.

METHOD

We performed PubMed, EMBASE, and PsycINFO searches for articles published or in press from 2013 to 2024, integrated with hand search and randomized controlled trials (RCTs) identified in this series' earlier reviews. RCTs examining the safety or efficacy of interventions delivered to adolescents (ages 10.0-19.9) with a diagnosis of ADHD were included. Study characteristics were extracted and reviewed, quality of evidence was assessed using GRADE, and effect sizes were calculated for individual studies and illustrated using forest plots.

RESULTS

Sixty-three RCTs were identified. Quality of evidence ranged from high (medication; k = 29) to very low (nutrient supplementation, neurofeedback, occupational therapy; k = 1 each). Medications demonstrated consistent strong impact on ADHD symptoms and inconsistent impact on impairment. Diverse cognitive/behavioral treatments (C/BTs) demonstrated inconsistent impact on ADHD symptoms but strong and consistent impact on impairment and executive function skills, plus moderate benefits on internalizing symptoms. No interventions demonstrated significant safety concerns. Long-term maintenance (up to 3 years post-treatment) was demonstrated for C/BTs, though moderate quality of evidence was noted because participants cannot be fully blinded to receipt of treatment.

CONCLUSIONS

The effects of C/BTs and medication appear complementary, not duplicative. Combining medication and C/BT is advised at treatment outset to maximize engagement, maintenance, and response breadth (i.e. improving both ADHD symptoms/cognitive performance and coping skills/functional impairments). Engagement strategies (e.g. motivational interviewing) may facilitate uptake. Novel treatments do not yet demonstrate effects on ADHD symptoms or impairments in adolescents but remain a promising area for research.

Early-life IL-4 administration induces long-term changes in microglia in the cerebellum and prefrontal cortex

Microglia are crucial for brain development and their function can be impacted by postnatal insults, such as early-life allergies. These are characterized by an upregulation of interleukin (IL)-4 levels. Allergies share a strong comorbidity with Autism Spectrum Disorders (ASD) and Attention-Deficit/Hyperactivity Disorder (ADHD). We previously showed that early-life allergic asthma induces hyperactive and impulsive behaviors in mice. This phenotype was reproduced in animals administered with IL-4 in the second postnatal week. Mechanistically, elevated IL-4 levels prevented microglia-mediated engulfment of neurons in the cerebellum, resulting in a surplus of granule cells and consequent dysfunction in cerebellar connectivity. Here, we aimed to further understand the impact of early IL-4 administration in microglia of the cerebellum and the prefrontal cortex (PFC), two brain regions with protracted developmental programs and susceptible to immune system malfunction after birth. While IL-4 administration induced differential short-term effects on microglia in the cerebellum and PFC, both regions presented similar microglial features in adult mice. Although Sholl analysis did not reveal significant alterations in overall microglia morphology at postnatal day (P)10, the density of microglia was decreased in the cerebellum at this age, especially in the granular layer (GL), but remained unaltered in the PFC. Interestingly, the presence of microglia with phagocytic cups, morphological features important for whole-cell engulfment, was decreased in both regions. When assessing the long-term consequences of IL-4 administration, cerebellar and PFC microglia were hypo-ramified and exhibited increased overall density. Importantly, microglia alterations were exclusive to the GL of the cerebellum and the infralimbic region of the PFC. Our results show that postnatal elevated levels of IL-4 impair the percentage of microglia engaged in cell clearing in two brain regions with protracted developmental programs. Interestingly, IL-4-exposed microglia adapt a similar phenotype in the adult cerebellum and PFC. Our data suggest that this early-life increase in IL-4 levels is sufficient to elicit long-lasting alterations in microglia, potentially increasing cell susceptibility to later insults.

Virtual reality-assisted prediction of adult ADHD based on eye tracking, EEG, actigraphy and behavioral indices: a machine learning analysis of independent training and test samples

Given the heterogeneous nature of attention-deficit/hyperactivity disorder (ADHD) and the absence of established biomarkers, accurate diagnosis and effective treatment remain a challenge in clinical practice. This study investigates the predictive utility of multimodal data, including eye tracking, EEG, actigraphy, and behavioral indices, in differentiating adults with ADHD from healthy individuals. Using a support vector machine model, we analyzed independent training (n = 50) and test (n = 36) samples from two clinically controlled studies. In both studies, participants performed an attention task (continuous performance task) in a virtual reality seminar room while encountering virtual distractions. Task performance, head movements, gaze behavior, EEG, and current self-reported inattention, hyperactivity, and impulsivity were simultaneously recorded and used for model training. Our final model based on the optimal number of features (maximal relevance minimal redundancy criterion) achieved a promising classification accuracy of 81% in the independent test set. Notably, the extracted EEG-based features had no significant contribution to this prediction and therefore were not included in the final model. Our results suggest the potential of applying ecologically valid virtual reality environments and integrating different data modalities for enhancing robustness of ADHD diagnosis.

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.

Cleft palate, congenital heart disease, and developmental delay involving MEIS2 heterozygous mutations found in the patient with attention deficit hyperactivity disorder: a case report

This case is the first reported patient with a MEIS2 gene mutation who primarily exhibits pronounced inattention as the main manifestation and is diagnosed with ADHD, requiring methylphenidate treatment. It is characterized by unique clinical features that set it apart from previously reported cases with mutations in the MEIS2 gene. Here, we report a female child with a diagnosis of ADHD and comorbidities. She received treatment with methylphenidate, starting at a dose of 18 milligrams per day, which was gradually increased to 45 milligrams per day based on her attention performance, while also undergoing physical and language rehabilitation training. In addition, the parents involved the child in reading and retelling stories at home every day. After 2 years of treatment, the scale results indicated that the child still had a moderate degree of attention deficit. Therefore, she underwent whole exome sequencing (WES) showing that her MEIS2 gene carries a de novo frameshift mutation (c.934_937del, p. Leu312Argfs*11). After comparing the patient's features with those of other patients who also had the MEIS2 mutation, we discovered that the patient's cleft palate, heart abnormalities, and minor facial dysmorphism were all extremely comparable. A broad forehead, elongated and arched eyebrows, and a tent-shaped upper lip were examples of mild facial dysmorphic traits. Subtypes with phenotypes such as cleft palate, cardiac anomalies, or facial malformations were presented in all previously reported cases of MEIS2 mutations. Furthermore, less common characteristics include ADHD, learning difficulties, hearing loss, recurring respiratory infections, asthma, rhinitis, enuresis, and dental cavities. This case further supports the critical role of genetic testing in patients with ADHD who exhibit a suboptimal response to methylphenidate and present with multiple comorbidities. Furthermore, this case report expands the clinical symptom spectrum associated with MEIS2 gene mutations, providing a broader understanding of the condition.

Physical activity for children and adolescents with attention deficit hyperactivity disorder: a protocol of a systematic review and meta-analysis

INTRODUCTION

Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder among children and adolescents. The disorder negatively influences their academic performance and social relations, and their quality of life (QoL) is lower than that of peers without ADHD. The majority of children and adolescents with ADHD are treated with medication that potentially has an insufficient effect or frequently occurring adverse events. Physical activity is thought to alter the physiology of ADHD by affecting the same catecholaminergic system in the brain which is targeted by medication.

METHODS AND ANALYSIS

This protocol is written in accordance with the 'Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols' guideline. Randomised clinical trials with participating children and adolescents between the ages of 3 and 18 years with a primary diagnosis of ADHD or hyperkinetic disorder will be included in the systematic review. The main objective of the review is to examine the effect of physical activity on QoL, executive functions, symptoms and functional impairment in this population. Previous systematic reviews on the effect of physical activity in children and adolescents with ADHD have several methodological and conceptual limitations. These reviews, for example, included both randomised and non-randomised clinical trials or had restrictions regarding the frequency and intensity of the physical activity interventions they included. The present review will include the newest studies in the field and follow the main principles outlined in the 'Cochrane Handbook for Systematic Reviews of Interventions'. Furthermore, it will be the first review in the field to include QoL as an outcome and to apply trial sequential analysis as part of the meta-analysis.

ETHICS AND DISSEMINATION

As the systematic review is a secondary analysis of data from primary trials, approval from an ethics committee is not required. The results of the review will be published in a peer-reviewed scientific journal and presented at relevant conferences.

TRIAL REGISTRATION NUMBER

This protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) on 16 August 2024 (CRD42024576670).

Mental imagery for addressing mechanisms underlying motor impairments in children with attention deficit hyperactivity disorder (ADHD)

Children with attention deficit hyperactivity disorder (ADHD) exhibit various degrees of motor and cognitive impairments in fine and gross motor skills. These impairments impact social functioning, while also hindering academic achievement, self-esteem, and participation. Specifically, motor impairments are not fully addressed by current therapies. For example, approximately 50% of children with ADHD exhibit significant motor impairments, as per clinical measures, while the other 50% experience more impairments in motor planning, execution and control than do typically developed (TD) children. Such findings indicate that ADHD-specific mechanisms may be underpinning motor impairments. In this paper, we outline ADHD impairments in motor planning, execution, and control, and the potential role of two such mechanisms: internal motor representation and timing perception. Next, we suggest mental imagery as an approach for treating ADHD motor impairments, potentially through addressing internal motor representation and timing perception.

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 2153 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; Mage = 9.69 years, SD = 2.60 years) and 4,895 children/adolescents without NF1 (48% female; Mage = 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 versus 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.

Exploring the potential of Braingame Brian for executive function improvement in Spanish-speaking children with ADHD: A pilot study

Considering the implications of executive function (EF) in the core symptoms of attention deficit hyperactivity disorder (ADHD), further research is required on strategies such as therapies, treatments, and rehabilitation programs focused on improving EF. This study aimed to assess the potential of an EF training program called "Braingame Brian" in improving working memory, inhibition, and cognitive flexibility in children with ADHD. The programme was developed in the Netherlands and has been shown to be effective in pilot studies of ADHD populations conducted in this country. However, it has not been used before in the Spanish-speaking population. A total of 41 children (aged 8-12 years) were assigned to the EF training or waitlist control groups. The intervention consisted of a 25-session training programme of approximately 45 min per day for nine consecutive weeks. Treatment outcomes were assessed using cognitive tasks of the trained EF, as well as evaluations of EF behaviors by parents and teachers. The initial findings suggest that the implementation of the Braingame Brian programme may be associated with improvements in working memory, inhibition, and cognitive flexibility. These preliminary results also indicate the potential for enhancements in parents' and teachers' perceptions of EF difficulties in children with ADHD.

Predictors of preschool attention-deficit/hyperactivity disorder diagnosis: a population-based study using national registers

BACKGROUND

The diagnosis of attention-deficit/hyperactivity disorder (ADHD) in preschool years (before age 6 years) is a marker of severity and poor prognosis. This study investigated a broad range of predictors of ADHD diagnosis during preschool age.

METHODS

Population-based cohort study using Swedish registers. The final sample consisted of all children born in Sweden between 2001 and 2007 who could be linked to both of their biological parents, excluding those who died or emigrated (n = 631,695). Follow-up was completed December 31, 2013. Cox proportional-hazards models for survival analysis were used to identify the predictors that increased the risk of receiving a clinical diagnosis of ADHD from 3 to 5 years. Hazard ratios (HR) with 95% confidence intervals (CI) were presented for each of the 41 selected predictors covering early-onset psychiatric comorbidities, nonpsychiatric medical conditions, parental history and perinatal factors.

RESULTS

At the end of follow-up, 1,686 preschoolers (2.7% of the whole sample) had received a diagnosis of ADHD. We found that 39 out of 41 predictors were associated with increased risk of a later diagnosis of preschool ADHD. Novel associations with preschool ADHD diagnosis were found for gastroesophageal reflux disease (HR = 3.48), premature contractions during pregnancy (HR = 2.03), and criminal conviction history from any parent (HR = 2.14).

CONCLUSIONS

A large number of novel and well-established predictors of preschool ADHD diagnosis were identified. This broad set of early predictors may direct future clinical research and assist in early identification of preschool ADHD.

Brain Function Characteristics of Children with Attention-Deficit/Hyperactivity Disorder Aged 4-9 Years During a GO/NOGO Task: An Functional Near-Infrared Spectroscopy Study

Purpose

This study investigated whether abnormal cerebral activity observed in adolescents and adults with ADHD also occurs in children during the early developmental stages of executive function.

Methods

The study included 52 children with ADHD aged 4.0-9.0 years and 34 healthy control children. Changes in oxygenated hemoglobin (HbO) levels were measured while participants completed GO/NOGO tasks to assess brain activation and connectivity.

Results

Children with ADHD demonstrated a stable prefrontal activation deficit during the GO/NOGO tasks (p FDR < 0.05). Additionally, hyperconnectivity was observed between the motor area and the prefrontal lobe in these children (uncorrected p <0.01). The logistic regression model incorporating brain activation and connectivity features achieved an area under the ROC curve of 0.86 (95% CI, [0.78, 0.95]), with a sensitivity of 0.79 and specificity of 0.85.

Conclusion

The findings suggest that prefrontal region abnormalities are present in children with ADHD at early developmental stages. This underscores the importance of targeting the prefrontal cortex in interventions and highlights the role of multi-network coordination in ADHD-related brain abnormalities. Limitations include the cross-sectional design and relatively small sample size, which should be addressed in future longitudinal studies.

Transcutaneous auricular vagus nerve stimulation as a potential therapy for attention deficit hyperactivity disorder: modulation of the noradrenergic pathway in the prefrontal lobe

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by developmental impairments, inattention, motor hyperactivity, and impulsivity. Currently, there is no effective intervention that can completely cure it. One of the pathogenic mechanisms of ADHD involves abnormalities in the norepinephrine (NE) pathway within the prefrontal cortex (PFC). In recent years, transcutaneous auricular vagus nerve stimulation (taVNS), a non-invasive neuromodulation technique, has demonstrated promising potential in the treatment of neurological and psychiatric disorders. However, its application in the management of ADHD remains relatively unexplored. Previous studies have shown that taVNS exerts therapeutic effects on attention, cognition, arousal, perception, and behavioral regulation primarily through activating the vagus nerve conduction pathway, specifically targeting the nucleus tractus solitarius - locus coeruleus - NE pathway. These findings have led to the hypothesis that taVNS may be an effective intervention for ADHD, with NE and its pathway playing a pivotal role in this context. Therefore, this review comprehensively examines the correlation between NE pathway alterations in the PFC and ADHD, the mechanism of action of taVNS, and the potential role of the NE pathway in treating ADHD with taVNS, aiming to provide a theoretical foundation for clinical applications.

Childhood risk factors and clinical and service outcomes in adulthood in people with intellectual disabilities

BACKGROUND

Adults with intellectual disability experience increased rates of mental health disorders and adverse mental health outcomes.

AIM

Explore childhood risk factors associated with adverse mental health outcomes during adulthood as defined by high cost of care, use of psychotropic medication without a severe mental illness and psychiatric hospital admissions.

METHOD

Data on 137 adults with intellectual disability were collected through an intellectual disability community service in an inner London borough. Childhood modifiable and non-modifiable risk factors were extracted from records to map onto variables identified as potential risk factors. Logistic and linear regression models were employed to analyse their associations with adverse outcomes.

RESULTS

We showed that the co-occurrence of intellectual disability with autism spectrum disorder and/or attention-deficit hyperactivity disorder (ADHD) were associated with psychotropic medication use and high-cost care packages. However, when challenging behaviour during childhood was added, ADHD and autism spectrum disorder were no longer significant and challenging behaviour better explained medication prescribing and higher cost care. In addition, the severity of intellectual disability was associated with higher cost care packages. Ethnicity (Black and mixed) also predicted higher cost of care.

CONCLUSIONS

Challenging behaviour during childhood emerged as a critical variable affecting outcomes in young adulthood and mediated the association between adult adverse mental health outcomes and co-occurring neurodevelopmental conditions, that is, ADHD and autism. These findings emphasise the need for effective early intervention strategies to address challenging behaviour during childhood. Such interventions for challenging behaviour will need to take into consideration autism and ADHD.

Effects of fMRI neurofeedback of right inferior frontal cortex on inhibitory brain activation in children with ADHD

We aimed to replicate previous effects of functional magnetic resonance imaging neurofeedback (fMRI-NF) in right inferior frontal cortex (rIFC) on IFC activation during a Stop Task in a larger group of boys with attention-deficit/hyperactivity disorder (ADHD). The present double-blind, randomized controlled trial tested the effects of 15 runs of active versus sham fMRI-NF of rIFC on performance and activation associated with successful and failed inhibition versus Go trials during a tracking Stop task in 88 boys with ADHD (44 active; 44 sham), controlling for age and medication status. No significant group-by-time interaction effects were observed for performance or brain activation during the successful stop trials, and post hoc analysis showed very low numbers of active fMRI-NF learners. Nevertheless, during error monitoring, there was a significant group-by-time interaction effect on post-error reaction time slowing and in left IFC activation, which were both increased after active compared to sham fMRI-NF. The findings are in line with our previous observation of left IFC upregulation after fMRI-NF of rIFC relative to active fMRI-NF of parahippocampal gyrus. This highlights the potentially wider regional effects that fMRI-NF of a particular self-control target region has on other self-regulatory regions in ADHD. This article is part of the theme issue 'Neurofeedback: new territories and neurocognitive mechanisms of endogenous neuromodulation'.

The risk of attention deficit hyperactivity disorder symptoms in offspring of mothers with perinatal depression: A systematic review and meta-analysis

BACKGROUND

The existing epidemiological evidence on the link between maternal depression and the risk of attention deficit and hyperactivity disorder (ADHD) symptoms in children lacks consistency. This systematic review and meta-analysis aimed to comprehensively synthesise the existing evidence on the relationship between maternal depression during the antenatal and postnatal periods and the risk of ADHD symptoms in offspring.

METHODS

We systematically searched PubMed, Medline, Embase, Scopus, CINAHL, and PsychINFO to identify relevant articles. Random-effects meta-analysis models were employed to estimate the pooled odds ratio (OR) along with 95 % confidence intervals (CI). Statistical heterogeneity was assessed using Cochrane's Q-test and I2-test. Subgroup analysis was conducted to explore potential sources of variation within the included studies. Publication bias was assessed using a funnel plot and Egger's test for regression asymmetry.

RESULTS

Twenty-one observational studies, comprising 796,157 mother-offspring pairs, were included in the final analysis. Our meta-analysis found a 67 % (OR = 1.67, 95 % CI = 1.35-2.00) and a 53 % (OR = 1.53, 95 % CI = 1.27-1.78) increased risk of ADHD symptoms in the offspring of mothers experiencing antenatal and postnatal depression, respectively.

CONCLUSION

Our systematic review and meta-analysis identified an elevated risk of ADHD symptoms in the offspring of mothers who experienced both antenatal and postnatal depression. These findings underscore the importance of early screening and targeted intervention programs for at-risk children and adolescents.

Vitamin D status in pregnancy and cord blood is associated with symptoms of attention-deficit hyperactivity disorder at age 5 years: Results from Odense Child Cohort

BACKGROUND

Vitamin D status in pregnancy may affect offspring neurodevelopment.

OBJECTIVE

The objective was to investigate the association between serum 25-hydroxyvitamin D in cord blood and pregnancy and symptoms of attention-deficit hyperactivity disorder in 5-year-old offspring.

METHOD

In Odense Child Cohort, Denmark, 944 mother-child pairs had data on pregnancy or cord serum 25-hydroxyvitamin D and parent-rated attention-deficit hyperactivity disorder symptom score by Child Behavior Checklist for ages 1.5-5 years. Adjusted multiple linear regression and two-stage exposure analyses were performed for serum 25-hydroxyvitamin D associations to the attention-deficit hyperactivity disorder symptom score.

RESULTS

The mean (standard deviation) serum 25-hydroxyvitamin D in cord blood was 48.0 (21.8) nmol/L; early pregnancy was 65.5 (20.2) nmol/L and late pregnancy was 79.3 (25.7) nmol/L. The median (interquartile range) age of child at examination was 5.2 (5.1-5.4) years and median (interquartile range) attention-deficit hyperactivity disorder symptom score was 2 (0-3) points. In adjusted analyses, serum 25-hydroxyvitamin D of <25 nmol/L and <32 nmol/L in cord blood and <25 nmol/L in early pregnancy was associated with 0.9 [95% confidence interval: 0.4, 1.3], 0.5 [0.1, 0.9] and 2.1 [0.8, 3.4] points higher attention-deficit hyperactivity disorder symptom score vs reference. In the two-stage exposure analysis, attention-deficit hyperactivity disorder symptom score decreased by 0.4 points per 25 nmol/L increase in serum 25-hydroxyvitamin D. Moreover, serum 25-hydroxyvitamin D of <25 nmol/L in early pregnancy and cord was associated with a five-fold and a two-fold risk of attention-deficit hyperactivity disorder symptom score ⩾90th percentile, adjusted odds ratio [95% confidence interval] = 4.9 [1.3, 19.0] and 2.2 [1.2, 3.9].

CONCLUSION

In this cohort, serum 25-hydroxyvitamin D <25 nmol/L in cord blood and early pregnancy were risk factors for higher attention-deficit hyperactivity disorder symptom score in 5-year-old children, suggesting a protective effect of vitamin D on attention-deficit hyperactivity disorder traits at preschool age.

Increased purchases of prescription medicines in offspring of women with type 1 diabetes: a Finnish register-based cohort study between 1995 and 2018

OBJECTIVE

This study aimed to assess whether in utero exposure to hyperglycemia influences prescription medicine purchases in the offspring of women with type 1 diabetes (exposed offspring).

PATIENTS/MATERIALS AND METHODS

We identified all singleton exposed offspring born in the hospital district of Helsinki and Uusimaa, Finland, between 1988 and 2011 from the Finnish Medical Birth Register, maintained by the Finnish Institute for Health and Welfare. For each exposed offspring, we obtained five age- and province-matched offspring of women without diabetes (reference offspring), from the Finnish Medical Birth Register. By combining data from three national registers, this longitudinal cohort study assessed prescription medicine purchases in exposed offspring (n = 1,725) and reference offspring (n = 8,755) from seven to thirty years of age. Prescription medicine purchases were grouped according to the Anatomical Therapeutic Chemical (ATC) classification system.

RESULTS

Between 1995 and 2018, a total of 211,490 prescription medicines were purchased. After a median follow-up of 10.9 (interquartile range 4.9,17.6) years, we observed higher incidence risk ratios (IRR) of prescription medicine purchases for several ATC main groups in exposed offspring compared to reference offspring, with the highest IRR of 4.06 (95% CI: 2.78 to 5.94) for medicines affecting metabolism (e.g. diabetes medicines).

CONCLUSION

Our findings suggest that exposed offspring purchase more reimbursable prescription medicines than reference offspring from age seven to thirty years. More research is needed to examine the effects of intrauterine exposure to hyperglycemia on long-term health in offspring.

Camouflaging in neurodivergent and neurotypical girls at the transition to adolescence and its relationship to mental health: A participatory methods research study

Background

Adolescent girls with diagnoses of autism, ADHD and/or developmental coordination disorder (DCD) are at higher risk for mental health problems than boys with the same diagnoses and neurotypical girls. These girls are called neurodivergent here, though neurodivergence includes a broader range of diagnoses. One possible reason for this mental health disparity could be camouflaging, a coping strategy used more by girls. Camouflaging is when the individual pretends to be neurotypical, often involving substantial effort. This study aims to understand: (a) if the use of camouflaging has started by early adolescence, (b) how components of camouflaging (assimilation, masking, and compensation) present at this age, (c) if age predicts camouflaging and (d) what is the relationship with mental health.

Methods

Participatory methods: A co-production team of 15 adult neurodivergent women co-produced the project and ranked camouflaging as their most important research theme.

Main Study: Participants were 119 girls (70 neurodivergent, 49 neurotypical) aged 11-14 years. A transdiagnostic approach was adopted and the neurodivergent group had a diagnosis of autism, ADHD and/or DCD. Girls completed self-report measures of camouflaging, anxiety, and depression in an online meeting with a researcher.

Results

Neurodivergent and neurotypical girls presented similarly on two components of camouflaging namely masking and compensation, components related to presenting in a socially acceptable way and mimicry. Groups differed on the assimilation component, which is related to trying to fit in and involves the feelings of pretending/acting. Age had a medium effect on camouflaging with higher levels of camouflaging observed in older girls. Camouflaging scores strongly predicted anxiety and depression scores in both groups.

Conclusions

The use of camouflaging, specifically assimilation, is evident in a transdiagnostic sample of 11-14 year old neurodivergent girls. Importantly, the strong relationship between camouflaging and poor mental health is present at this early age, substantiating the co-production team's insights.

Depressive Symptoms and Quality of Life Among Women Living With a Partner Diagnosed With ADHD

Objective: This study explores the depressive symptoms and quality of life (QoL) of women in relationships with partners diagnosed with ADHD, as well as the role of engagement in health-promoting activities (HPA) on these outcomes, spotlighting the often-neglected perspective of these women. Methods: Employing a cross-sectional approach, the study used Structural Equation Modeling (SEM) to explore associations between partners' ADHD functional impairment, women's involvement in HPA, and their depressive symptoms and QoL. Results: Functional impairment in partners with ADHD was positively associated with women's depressive symptoms and negatively associated with their QoL, whereas women's engagement in HPA was positively associated with their QoL and negatively associated with their depressive symptoms. Conclusions: The findings suggest that women partnered with individuals diagnosed with ADHD may face an elevated risk of depressive symptoms and lowered QoL. The results highlight the potential need for a more comprehensive clinical approach to adult ADHD treatment that considers functional impairments and the experiences of partners. Incorporating HPA into therapeutic strategies appears beneficial. However, longitudinal research is needed to examine the direction of these associations and to develop potential interventions to support these women.

Cognitive Impairment, Associated Clinical Factors, and MR Volumetric Measures in Myelin Oligodendrocyte Glycoprotein-IgG-Associated Disease

BACKGROUND AND OBJECTIVES

Cognitive impairment is a common and challenging symptom in multiple sclerosis and neuromyelitis optica spectrum disease; however, data in myelin oligodendrocyte glycoprotein-IgG-associated disease (MOGAD) remain scarce. In this cross-sectional study, we investigated the frequency of cognitive impairment, associated clinical factors, and MRI volumetric measures in MOGAD.

METHODS

Participants were investigated in a single center by certified psychologists and underwent a standardized 3-T-MRI protocol. MRI data were processed with FreeSurfer for gray and white matter volume estimation, presented as a fraction of total intracranial volume. Sera screening for antineural antibodies has been conducted using cell-based assays. The following clinical factors were included in the multivariate logistic regression analysis: sex, age, overall number of previous relapses, and specifically the history of acute disseminated encephalomyelitis (ADEM)/ADEM-like episodes and other brain relapses.

RESULTS

Thirty-two patients with MOGAD (19 female, median age 29.4 years) after a median of 2 relapses with a median EDSS of 1.0 were recruited. Seven patients (21.9%) demonstrated cognitive impairment with the most prevalent deficits in mental flexibility (16.7%), attention (11.1%-14.8%), and verbal working memory (10.3%). 72.4% suffered from fatigue and 42.9% from signs of depression, moderate to severe in 28.6%. The overall number of previous relapses (odds ratio [OR] 1.789, 95% CI 1.041-3.074) and specifically ADEM/ADEM-like episodes (OR 16.929, 95% CI 1.228-233.427) were the only clinical factors associated with cognitive impairment in a multivariate logistic regression model. Screening for antineuronal antibodies remained negative. Cerebral white matter (WM) (0.300 vs 0.317, p = 0.003) and deep gray matter (DGM) (0.036 vs 0.038, p = 0.002) volumes were reduced in patients with MOGAD compared with healthy controls (n = 32). Both cognitive impairment (0.031 vs 0.036, p = 0.003) and history of ADEM/ADEM-like episodes (0.032 vs 0.036, p = 0.006) were associated with reduced DGM volume compared with unaffected patients with MOGAD.

DISCUSSION

Despite a low overall disability, every 5th patient with MOGAD experiences cognitive impairment. Cognitive impairment is associated with a higher number of relapses and particularly ADEM/ADEM-like attacks. Although both WM and DGM atrophies are apparent in MOGAD, the latter only seems to have an association with cognitive impairment.

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.

Frequent Pain is Common Among 10-11-Year-Old Children with Symptoms of Attention Deficit Hyperactivity Disorder

Purpose

Adults with neurodevelopmental disorders have an increased risk for chronic pain. This study aimed to describe the prevalence of frequent and multisite pain among children with symptoms of attention deficit hyperactivity disorder (ADHD) and explore potential sex differences in pain prevalence.

Participants and Methods

Children born in 2008 included in the "Halland Health and Growth Study" were invited to a follow-up (n = 1186) in 2018-19. Parents received a digital screening questionnaire, the Swanson, Nolan and Pelham Rating Scale (SNAP-IV) for ADHD, and the children answered a pain questionnaire that included a pain mannequin. The main outcome was pain experience, and children with symptoms of ADHD were compared to children without these symptoms.

Results

In this general population of 10-11-year-old Swedish children, weekly pain was reported in 52.5% of children with symptoms of ADHD combined type, compared to 36.2% of children without these symptoms (p < 0.05). Hyperactivity and impulsivity were significant contributors to the increased risk for frequent pain (OR 2.33 95% CI 1.30 to 4.17, p = 0.004), but inattention was not a significant contributor (OR 1.17 95% CI 0.74 to 1.87, p = 0.497). Multisite pain was more common among girls with hyperactivity compared to boys with hyperactivity (51.4 vs 27.9%, p = 0.036). Weekly headache and/or abdominal pain was reported by a quarter of girls with symptoms of ADHD combined type, and up to a fifth of boys, compared to 11-13% of children without these symptoms.

Conclusion

Frequent pain was more common for children with symptoms of ADHD compared to children without symptoms of ADHD. Hyperactivity and impulsivity had a stronger association to pain than had inattention-related problems. Clinicians should be aware of the frequent occurrence and the association between pain and neurodevelopmental disorders among children, and that it could complicate both the clinical picture and the treatment.

Is exposure to Bisphenol A associated with Attention-deficit hyperactivity disorder (ADHD) and associated executive or behavioral problems in children? A comprehensive systematic review

Numerous studies have investigated environmental risk factors in ADHD, and Bisphenol A (BPA), an endocrine disruptor, is suspected by several reviews. However, the quality of the studies has never been carefully assessed, leading us to rigorously examine associations between BPA exposure and ADHD and associated symptoms in children. Using PRISMA criteria, we conducted a systematic review on the MEDLINE/PubMed, Web of Science, EBSCOhost, PsycINFO, PsycARTICLES and Cochrane databases. We used the ROBINS-E tool to assess the quality, and the GRADE Approach. This study was registered with PROSPERO, CRD42023377150. Out of 10446 screened articles, 46 were included. Unlike pre-existing reviews, most studies failed to find clear links with ADHD or associated symptoms, with a high risk of bias and a very low level of certainty. Our systematic review reveals insufficient evidence regarding the impact of BPA on ADHD, despite some behavioral results that cannot be generalized. Future studies will require improved consideration of confounding factors and more precise sampling methods. This study did not receive specific funding.

Pain-Associated Diagnoses in Childhood Before the Diagnosis of Attention-Deficit/Hyperactivity Disorder: A Population-Based Study

Background: Pediatric pain significantly affects children's lives, leading to school absenteeism, impaired social interactions, and psychological distress. The perception of sensory signals as pain is influenced by the brain's noradrenergic system, and recent evidence suggests that chronic pain may impact cognitive functioning and emotional regulation. Attention-Deficit/Hyperactivity Disorder (ADHD) is associated with alterations in the dopaminergic/noradrenergic systems, which could affect pain perception. Pain-associated conditions and frequent analgesic use in childhood may be linked to ADHD development and could serve as early indicators, yet data on this potential association remain limited. Study Aim: This population-based case-control study in Israel aimed to assess the prevalence of pain-related diagnoses prior to ADHD diagnosis in children aged 5 to 18. The study included children registered with Leumit Health Services (LHS) between 1 January 2006, and 30 June 2021. Children diagnosed with ADHD were compared to matched controls, selected based on age, gender, socioeconomic status, and other sociodemographic factors, who were never diagnosed with ADHD during the study period. Results: Children with ADHD (N = 18,756) and controls (N = 37,512) were precisely matched for sociodemographic characteristics. Individuals with ADHD exhibited significantly higher frequencies of diverse pain conditions, including those associated with illness [headache, earaches, and throat pain (odds ratios [OR] = 1.156 [95%CI 1.085, 1.232], 1.295 [95%CI 1.217, 1.377], and 1.080 [95%CI 1.019, 1.145], respectively; p < 0.01)] and injury [sprains and strains (OR = 1.233 [95% CI 1.104,1.376)]. Analgesics were more frequently purchased by individuals with ADHD, particularly paracetamol (OR = 1.194 [95%CI 1.152, 1.237], p < 0.001) and ibuprofen (OR = 1.366 [95%CI 1.318, 1.416], p = 0.001). Conclusions: This study highlights a potential connection between ADHD and pediatric pain. The elevated rates of pain diagnoses and analgesic usage among children with ADHD underscore the need for further research.

Self-rated costs and benefits of conventional and alternative adult ADHD treatments

Conventional treatments offered by healthcare providers for adult ADHD include pharmacological and non-pharmacological approaches or a combination of both. Both treatment types may have downsides like side effects or low efficacy, potentially leading to treatment dissatisfaction. Also, adults with ADHD explore non-prescribed, complementary and/or alternative medicine (CAM) on their initiative, including substances such as dietary supplements and activities such as physical exercise. This survey study aimed to investigate the types of conventional and CAM treatments adults with ADHD use and their self-rated effectiveness. Also, lifetime experience of negative effects across all treatment types and the motives to use CAM were explored. In total, 227 adults diagnosed with ADHD or reporting clinically elevated ADHD symptoms (without official ADHD diagnosis) were included in the analyses. Both lifetime and current use and experiencing negative effects were highest for conventional pharmacological treatments, followed by CAM activities, CAM substances, and conventional non-pharmacological approaches. The most common reason for using CAM was overall well-being. Conventional treatments were rated more effective in influencing cognition than CAM, but their self-rated effectiveness did not differ in other assessed domains. CAM activities were rated more effective than CAM substances in all assessed domains. This study highlights the high prevalence of CAM use by adults with ADHD, implying that some patients find value in such alternative treatments. Future studies should consider investigating alternative and/or complementary treatments for adult ADHD, alone or in combination with conventional treatments.

Commentary: Using QbTest for monitoring pharmacological treatment response in ADHD - are we there yet?

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

The Interaction Between Attention Deficit and Hyperactivity Disorder and Nutrition

PURPOSE OF REVIEW

This review aims to explore the relationship between Attention Deficit Hyperactivity Disorder (ADHD) and nutrition. ADHD, a neurodevelopmental disorder, has been examined in relation to dietary factors through various metabolic pathways, with a focus on the role of nutrition in symptom management. Unhealthy dietary patterns, particularly those characteristics of Western diets, are believed to exacerbate ADHD symptoms through these mechanisms. In contrast, dietary interventions such as intermittent fasting, which offer greater flexibility in application, have been proposed as potential strategies to alleviate ADHD symptoms. While further research in this area is expected to contribute significantly to the field, this review also provides researchers with a brief perspective on the challenges and limitations associated with experimental ADHD studies. Therefore, this study aims to offer a comprehensive evaluation of the interaction between ADHD and nutrition, providing researchers with an integrative approach to the topic.

RECENT FINDINGS

Western dietary patterns have been found to negatively impact gut barrier integrity, synaptic plasticity, insulin resistance, and oxidative stress. On the other hand, the intermittent fasting diet model, which offers practical flexibility, is thought to be a potentially supportive treatment in managing ADHD. Furthermore, it has been concluded that various experimental models are available for ADHD research, and researchers must work within these limitations. Western diets, particularly in their negative impact on synaptic plasticity and other key metabolic pathways involved in ADHD, can worsen the disorder's symptoms. Intermittent fasting emerges as a promising dietary alternative that may mitigate these adverse effects.

Physiological parameters to support attention deficit hyperactivity disorder diagnosis in children: a multiparametric approach

Introduction

Attention deficit hyperactivity disorder (ADHD) is a high-prevalent neurodevelopmental disorder characterized by inattention, impulsivity, and hyperactivity, frequently co-occurring with other psychiatric and medical conditions. Current diagnosis is time-consuming and often delays effective treatment; to date, no valid biomarker has been identified to facilitate this process. Research has linked the core symptoms of ADHD to autonomic dysfunction resulting from impaired arousal modulation, which contributes to physiological abnormalities that may serve as useful biomarkers for the disorder. While recent research has explored alternative objective assessment tools, few have specifically focused on studying ADHD autonomic dysregulation through physiological parameters. This study aimed to design a multiparametric physiological model to support ADHD diagnosis.

Methods

In this observational study we non-invasively analyzed heart rate variability (HRV), electrodermal activity (EDA), respiration, and skin temperature parameters of 69 treatment-naïve ADHD children and 29 typically developing (TD) controls (7-12 years old). To identify the most relevant parameters to discriminate ADHD children from controls, we explored the physiological behavior at baseline and during a sustained attention task and applied a logistic regression procedure.

Results

ADHD children showed increased HRV and lower EDA at baseline. The stress-inducing task elicits higher reactivity for EDA, pulse arrival time (PAT), and respiratory frequency in the ADHD group. The final classification model included 4 physiological parameters and was adjusted by gender and age. A good capacity to discriminate between ADHD children and TD controls was obtained, with an accuracy rate of 85.5% and an AUC of 0.95.

Discussion

Our findings suggest that a multiparametric physiological model constitutes an accurate tool that can be easily employed to support ADHD diagnosis in clinical practice. The discrimination capacity of the model may be analyzed in larger samples to confirm the possibility of generalization.

Nationwide trends in the use of ADHD medications in the period 2006-2022: a study from the Norwegian prescription database

BACKGROUND

The use of medication for Attention-Deficit/Hyperactivity Disorder (ADHD) increased globally throughout the early 2000s. This study examine trends in prevalences and incidences of medication use in Norway from 2006 to 2022.

METHODS

Data from the Norwegian Prescription Database were used to present one-year-prevalence and incidence rates of ADHD medication (ATC-group N06BA and C02AC02) for the overall population (ages 6-64) and within sex and age subgroups of children (ages 6-17) and adults (ages 18-64). Incident use was defined as the dispensing of medication, with no recorded use in the previous two calendar years.

RESULTS

The overall prevalence of ADHD medication use in 6- to 64-year-olds increased from 5.2 to 19.4 per 1000 in the period, most pronounced from 2020 and onwards. While males experienced a nearly threefold increase in use (from 7.3 to 20.6 per 1000), the use among females increased almost sixfold during the study period (from 3.0 to 18.1 per 1000). Consequently, the male-to-female prevalence-ratio decreased from 2.4 to 1. Children exhibited a higher prevalence of use compared to adults throughout the period, although the largest relative increase was observed in adults, particularly in female adults. In children the male-to-female ratio decreased from 3.2 to 2.0, primarily due to an increasing use in 13-17-year-old females. Among adults, prevalences were similar across most age groups, with the highest rates observed among those aged 18-24, where female use exceeded male use by the end of the period. The male-to-female prevalence-ratio in adults decreased from 1.6 to 0.9 during the period. Parallel to prevalent use, overall incident use increased from 1.4 to 5.0 per 1000 during the period, with the most pronounced increase occurring from 2020 and onwards. From this point, incident use among females aged 13-17, 18-24, and 25-34, exceeded that of males. The male-to-female incidence-ratio decreased from 1.8 to 0.9. The overall incidence to prevalence ratio remained similar throughout the period, being 0.27 in 2006 and 0.25 in 2022.

CONCLUSION

A sustained increase in the prevalence of ADHD medication use was observed, with the most pronounced rise occurring among females and adults from 2020 and onwards. By 2022, the overall gender disparity in ADHD medication use had diminished, which should be considered in the context of a steep increase in incident use among adolescent and young adult females starting from 2020.

Asymmetry of attentive networks contributes to adult Attention-deficit/hyperactivity disorder (ADHD) pathophysiology

Diffusion imaging studies in Attention-deficit/hyperactivity disorder (ADHD) have revealed alterations in anatomical brain connections, such as the fronto-parietal connection known as superior longitudinal fasciculus (SLF). Studies in neurotypical adults have shown that the three SLF branches (SLF I, II, III) support distinct brain functions, such as attention and inhibition; and that their pattern of lateralization is associated with attention performance. However, most studies in ADHD have investigated the SLF as a single bundle and in children; thus, the potential contribution of the lateralization of the SLF branches to adult ADHD pathophysiology remains to be elucidated. We used diffusion-weighted spherical deconvolution tractography to dissect the SLF branches in 60 adults with ADHD (including 26 responders and 34 non-responders to methylphenidate, MPH) and 20 controls. Volume and hindrance modulated orientational anisotropy (HMOA), which respectively reflect white matter macro- and microstructure, were extracted to calculate the corresponding lateralization indices. We tested whether neurotypical controls differed from adults with ADHD, and from treatment response groups in sensitivity analyses; and investigated associations with clinico-neuropsychological profiles. All the three SLF branches were lateralized in adults with ADHD, but not in controls. The lateralization of the SLF I HMOA was associated with performance at the line bisection, not that of the SLF II volume as previously reported in controls. Further, an increased left-lateralization of the SLF I HMOA was associated with higher hyperactivity levels in the ADHD group. Thus, an altered asymmetry of the SLF, perhaps especially of the dorsal branch, may contribute to adult ADHD pathophysiology.

Emotional Dysregulation in Emerging Adult ADHD: A Key Consideration in Explaining and Classifying Impairment and Co-Occurring Internalizing Problems

OBJECTIVE

The current study sought to clarify and harness the incremental validity of emotional dysregulation and unawareness (EDU) in emerging adulthood, beyond ADHD symptoms and with respect to concurrent classification of impairment and co-occurring problems, using machine learning techniques.

METHOD

Participants were 1,539 college students (Mage = 19.5, 69% female) with self-reported ADHD diagnoses from a multisite study who completed questionnaires assessing ADHD symptoms, EDU, and co-occurring problems.

RESULTS

Random forest analyses suggested EDU dimensions significantly improved model performance (ps < .001) in classifying participants with impairment and internalizing problems versus those without, with the resulting ADHD + EDU classification model demonstrating acceptable to excellent performance (except in classification of Work Impairment) in a distinct sample. Variable importance analyses suggested inattention sum scores and the Limited Access to Emotional Regulation Strategies EDU dimension as the most important features for facilitating model classification.

CONCLUSION

Results provided support for EDU as a key deficit in those with ADHD that, when present, helps explain ADHD's co-occurrence with impairment and internalizing problems. Continued application of machine learning techniques may facilitate actuarial classification of ADHD-related outcomes while also incorporating multiple measures.

The neurodivergent perinatal experience - A systematic literature review on autism and attention deficit hyperactivity disorder

BACKGROUND

Neurodivergent individuals often face unique challenges during the perinatal period, which can significantly impact their experiences of pregnancy, childbirth, and early parenting. Despite growing awareness of neurodiversity, there remains a gap in perinatal care that fully addresses the lived experiences and needs of those with neurodivergent conditions such as Autism (ASD) and Attention-Deficit/Hyperactivity Disorder (ADHD).

OBJECTIVE

To compile and analyse recent literature on the perinatal experiences of neurodivergent parturients. To provide an overview of current knowledge, identify prevalent challenges, and suggest opportunities for improving perinatal services. Additionally, we aim to highlight research gaps that guide future studies and enhance care quality for neurodivergent individuals during the perinatal period.

METHODS

The Systematic Reviews methodological process was utilised to search relevant scientific databases to gather current research articles on neurodivergent perinatal experiences. Eleven studies met the inclusion criteria and were appraised using a rigorous quality checklist. Thematic analysis identified recurring themes across the selected papers.

RESULTS

Three major themes emerged: Care provider support, Perinatal mental health needs, and Resilience and growth of neurodivergent parturients. These themes highlight significant differences in perinatal experiences between neurodivergent and neurotypical individuals, underscoring the need for tailored care approaches.

CONCLUSION

The findings reveal that current perinatal care practices do not adequately address the specific challenges faced by perinatal neurodivergent individuals. There is a critical need for perinatal care systems to integrate neurodiversity-affirming practices. Future research should consider intersectionality to include marginalised and underrepresented neurodivergent voices.

Siamese based deep neural network for ADHD detection using EEG signal

BACKGROUND

Detecting Attention-Deficit/Hyperactivity Disorder (ADHD) in children is crucial for timely intervention and personalized treatment.

OBJECTIVE

This study aims to utilize deep learning techniques to analyze brain maps derived from Power Spectral Density (PSD) of Electroencephalography (EEG) signals in pediatric subjects for ADHD detection.

METHODS

We employed a Siamese-based Convolutional Neural Network (CNN) to analyze EEG-based brain maps. Gradient-weighted class activation mapping (Grad-CAM) was used as an explainable AI (XAI) visualization method to identify significant features.

RESULTS

The CNN model achieved a high classification accuracy of 99.17 %. Grad-CAM analysis revealed that PSD features from the theta band of the frontal and occipital lobes are effective discriminators for distinguishing children with ADHD from healthy controls.

CONCLUSION

This study demonstrates the effectiveness of deep learning in ADHD detection and highlights the importance of regional PSD metrics in accurate classification. By utilizing Grad-CAM, we elucidate the discriminative power of specific brain regions and frequency bands, thereby enhancing the understanding of ADHD neurobiology for improved diagnostic precision in pediatric populations.

Practitioner Review: Continuity of mental health care from childhood to adulthood for youths with ADHD - who, how and when?

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

No Effects of Auditory and Visual White Noise on Oculomotor Control in Children with ADHD

BACKGROUND

White noise stimulation has demonstrated efficacy in enhancing working memory in children with ADHD. However, its impact on other executive functions commonly affected by ADHD, such as inhibitory control, remains largely unexplored. This research aims to explore the effects of two types of white noise stimulation on oculomotor inhibitory control in children with ADHD.

METHOD

Memory guided saccade (MGS) and prolonged fixation (PF) performance was compared between children with ADHD (N = 52) and typically developing controls (TDC, N = 45), during auditory and visual white noise stimulation as well as in a no noise condition.

RESULTS

Neither the auditory nor the visual white noise had any beneficial effects on performance for either group.

CONCLUSIONS

White noise stimulation does not appear to be beneficial for children with ADHD in tasks that target oculomotor inhibitory control. Potential explanations for this lack of noise benefit will be discussed.