Attention Deficit Hyperactivity Disorder Subtypes Research Articles

A Digital Cognitive-Physical Intervention for Attention-Deficit/Hyperactivity Disorder: Randomized Controlled Trial.

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders among children. Pharmacotherapy has been the primary treatment for ADHD, supplemented by behavioral interventions. Digital and exercise interventions are promising nonpharmacologic approaches for enhancing the physical and psychological health of children with ADHD. However, the combined impact of digital and exercise therapies remains unclear. The aim of this study was to determine whether BrainFit, a novel digital intervention combining gamified cognitive and exercise training, is efficacious in reducing ADHD symptoms and executive function (EF) among school-aged children with ADHD. This 4-week prospective randomized controlled trial included 90 children (6-12 years old) who visited the ADHD outpatient clinic and met the diagnostic criteria for ADHD. The participants were randomized (1:1) to the BrainFit intervention (n=44) or a waitlist control (n=46) between March and August 2022. The intervention consisted of 12 30-minute sessions delivered on an iPad over 4 weeks with 3 sessions per week (Monday, Wednesday, and Friday after school) under the supervision of trained staff. The primary outcomes were parent-rated symptoms of attention and hyperactivity assessed according to the Swanson, Nolan, and Pelham questionnaire (SNAP-IV) rating scale and EF skills assessed by the Behavior Rating Inventory of Executive Function (BRIEF) scale, evaluated pre and post intervention. Intention-to-treat analysis was performed on 80 children after attrition. A nonparametric resampling-based permutation test was used for hypothesis testing of intervention effects. Among the 145 children who met the inclusion criteria, 90 consented and were randomized; ultimately, 80 (88.9%) children completed the study and were included in the analysis. The participants' average age was 8.4 (SD 1.3) years, including 63 (78.8%) male participants. The most common ADHD subtype was hyperactive/impulsive (54/80, 68%) and 23 (29%) children had severe symptoms. At the endpoint of the study, the BrainFit intervention group had a significantly larger improvement in total ADHD symptoms (SNAP-IV total score) as compared to those in the control group (β=-12.203, 95% CI -17.882 to -6.523; P<.001), owing to lower scores on the subscales Inattention (β=-3.966, 95% CI -6.285 to -1.647; P<.001), Hyperactivity/Impulsivity (β=-5.735, 95% CI -8.334 to -3.137; P<.001), and Oppositional Defiant Disorder (β=-2.995, 95% CI -4.857 to -1.132; P=.002). The intervention was associated with significant reduction in the Metacognition Index (β=-6.312, 95% CI -10.973 to -1.650; P=.006) and Global Executive Composite (β=-5.952, 95% CI -10.214 to -1.690; P=.003) on the BRIEF. No severe intervention-related adverse events were reported. This novel digital cognitive-physical intervention was efficacious in school-age children with ADHD. A larger multicenter effectiveness trial with longer follow-up is warranted to confirm these findings and to assess the durability of treatment effects. Chinese Clinical Trial Register ChiCTR2300070521; https://www.chictr.org.cn/showproj.html?proj=177806.

Sleep quality, PIU in adolescents with ADHD. Is there a relationship between sleep quality and problematic internet use in adolescents with attention deficit hyperactivity disorder?

AbstractThis research aimed to compare the sleep quality and problematic internet use (PIU) of adolescents diagnosed with attention deficit hyperactivity disorder (ADHD) compared to the group of healthy control. There were 53 ADHD-diagnosed individuals (19 ADHD- combined type, 34 ADHD- inattentive type) in the research population, ages 12 to 18, and 53 healthy adolescents in the control group. A child psychiatrist applied the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL) to each case, and sociodemographic information was collected. The Pittsburgh Sleep Quality Index (PSQI) and the Internet Addiction Test (IAT) were also applied to all the cases. The Turgay DSM-IV-Based Disruptive Behaviour Disorders, Child and Adolescent Evaluation and Screening Scale (T-DSM-IV-S) was completed by the parents of all the adolescents. The ADHD group's IAT and PSQI total points were found to be statistically significantly higher than those of the healthy control group (p &lt; 0.001). The results of the covariance analysis showed a significant positive correlation between the T-DSM-IV-S subscales and the IAT mood points in the ADHD patients. The T-DSM-IV-S attention deficit points were found to be significantly higher in the ADHD children with PIU (independently of age and gender) compared to those without PIU. The results of the study showed that adolescents with ADHD had greater rates of poor sleep quality and PIU than the control group. The study results also suggested that the severity of the inattentive subtype of ADHD could play a potential role in the development of PIU in children diagnosed with ADHD. Based on this foundation, it is crucial to acknowledge and address poor sleep quality and PIU in adolescents with ADHD.

Changed sleep according to weighted blanket adherence in a 16-week sleep intervention among children with attention-deficit/hyperactivity disorder.

To examine differences in sample characteristics and longitudinal sleep outcomes according to weighted blanket adherence. Children with attention-deficit/hyperactivity disorder (ADHD) (n =94), mean age 9.0 (sd 2.2, range 6-14) participated in a 16-week sleep intervention with weighted blankets (WB). Children were classified as WB adherent (use of WB ≥ 4 nights/week) or non-adherent (use of WB ≤ 3 nights/week). Changes in objectively measured sleep by actigraphy, parent-reported sleep problems (Children's Sleep Habits Questionnaire (CSHQ)) and child-reported Insomnia Severity Index (ISI) were evaluated according to adherence with mixed effect models. Gender, age, and ADHD subtype were examined as potential moderators. Children adherent to WBs (48/94) showed an early response in sleep outcomes and an acceptance of the WB after four weeks of use as well as a decrease in parent- (CSHQ) (-5.73, P = .000) and child-reported sleep problems (ISI) (-4.29, P = .005) after 16 weeks. The improvement in sleep was larger among WB adherent vs. non-adherent (between-group difference: CSHQ: -2.09, P = .038; ISI: -2.58, P =.007). Total sleep time was stable for children adherent to WB but decreased for non-adherent (between-group difference: +16.90, P = .019). An early response in sleep and acceptance of the WB predicted later adherence to WBs. Improvements in sleep were more likely among WB adherents vs. non-adherents. Children with ADHD may thus benefit from using WBs to handle their sleep problems.

Determining cutoff scores on the Conners’ adult ADHD rating scales that can definitively rule out the presence of ADHD in a clinical sample

In recent years, the prevalence of Attention Deficit/Hyperactivity Disorder (ADHD) and the number of individuals seeking ADHD assessments has risen significantly, leading to an increased demand for accurate diagnostic tools. This study aimed to identify cutoff scores on the Conners’ Adult ADHD Rating Scales (CAARS-S:L) that can definitively rule out the presence of ADHD. Among 102 clinically diagnosed adult ADHD participants and 448 non-ADHD participants who completed the CAARS-S:L, a receiver operating characteristic curve analysis established a perfectly discriminant cutoff T-score of <44 on the ADHD Symptoms Total subscale when looking at any ADHD diagnosis and <54 on the Inattentive Symptoms subscale when looking at individuals diagnosed with the inattentive subtype of ADHD. Alternative cutoffs of <54 (ADHD Symptoms Total subscale) and <63 (Inattentive Symptoms subscale) were also identified, both with a sensitivity of 0.95 or higher. Furthermore, the analysis found the ADHD Index to be a poor predictor of a negative ADHD diagnosis, suggesting against the use of this scale for cutoff determination. Despite this limitation, these findings indicate that with specific cutoffs, the CAARS-S:L may have the potential to conclusively rule out ADHD, effectively streamlining the diagnostic process and reducing unnecessary comprehensive assessments in clear negative cases.

A study of the interactive mediating effect of ADHD and NSSI caused by co-disease mechanisms in males and females.

Non-suicidal self-injury (NSSI), of which the predisposing factors are complex and diverse, profoundly affects the physical and mental health of young people. Therefore, this work established an NSSI intermediary network model considering the interaction of multiple factors. A mediating effect between attention-deficit/hyperactivity disorder (ADHD) and NSSI, considering the influence of comorbidities, such as depression, anxiety, and impulsive personality, was proposed based on sex differences. A total of 2,689 middle school students in Ningbo City, Zhejiang Province, China, were randomly sampled and participated in this study. Data regarding their demographic characteristics, attention deficit, hyperactivity/impulsivity, NSSI, anxiety, depression, internet addiction, and other comorbid symptoms were collected and analyzed. After initially screening the data, variables were assessed for significance using a single-factor inter-group difference analytic method, and a binary logistic regression analysis was performed. The intermediary effect of factors influencing NSSI in males and females was also analyzed. The overall NSSI rate was 15.16%. The results showed that the impact of individual impulsivity characteristics (impulsiveness, the ADHD with hyperactivity/impulsivity subtype) on NSSI behavior was not significant (regression results, P>0.05). The degree of association between ADHD with attention deficit and ADHD with comprehension deficit subtypes, and other comorbid symptoms (depression, anxiety, and internet addiction disorder) and NSSI, with odds ratios (ORs) of 7.6/6.42/436.68/3.82/1.86, and 95% bootstrap confidence intervals (CIs) of 4.64, 12.87/3.46, 12.67/137.42, 2659.13/2.32, 6.37/1.31, 2.82, respectively. The results also showed significant effects of ADHD subtypes on comorbid symptoms and the path effects of NSSI (P<0.01). Among them, the mediating effect was the strongest when anxiety was the mediating variable, and the mediating effect of girls was higher than that of boys. The results of this work demonstrated the influence of ADHD symptoms on NSSI behavior. Among patients with ADHD, patients with subtypes with obvious attention deficit characteristics were more likely to exhibit NSSI behavior, whereas the hyperactive impulse subtype had no direct impact on NSSI. We conclude that adolescent impulsivity may not be directly related to NSSI behavior and that impulsive characteristics jointly affect NSSI behavior through a series of NSSI comorbid symptoms. Notably, the probability of symptom onset and the degree of comorbidity was significantly higher in girls than in boys of the same age, and girls were more prone to NSSI behavior. These findings provide effective theoretical support for the prevention and treatment of adolescent NSSI behavior.

The effects of working memory training on attention deficit, adaptive and non-adaptive cognitive emotion regulation of Chinese children with Attention Deficit/Hyperactivity Disorder (ADHD).

Attention Deficit/Hyperactivity Disorder (ADHD) poses cognitive and emotional challenges for Chinese children. This study addresses the potential benefits of Working Memory Training for ADHD-affected children. Understanding its impact on Attention, cognitive regulation, and emotional responses is crucial for tailored interventions in the Chinese context. The Trial Registration Number (TRN) for this study is [TRN-2023-123,456], and it was officially registered on July 15, 2023, by Changchun Normal University. This study investigated how Working Memory training influences Attention, adaptive cognitive regulation, and non-adaptive cognitive emotion regulation in Chinese children with ADHD. It also assessed changes in attentional focus, improvements in adaptive cognitive regulation, and alterations in non-adaptive cognitive emotion regulation strategies. This quasi-experimental study aimed to assess the impact of working memory training on Chinese children with ADHD. Using pretest-posttest measures, 120 female students underwent Cogmed software training, targeting attention deficits and cognitive emotion regulation. Three reliable instruments measured outcomes. The procedure involved informed consent, questionnaires, 25 training sessions, and a two-month follow-up. Statistical analyses, including repeated measures ANOVA, assessed training effects. ANOVA revealed a significant impact of Working memory training on attention deficit. Repeated measures ANOVA for cognitive emotion regulation indicated positive changes in adaptive and non-adaptive strategies over time, with sustained improvements in self-blame, rumination, catastrophizing, and blaming others. Bonferroni follow-up tests showed significant differences between pre-test, post-test, and follow-up, favoring the post-test and follow-up tests. In summary, this research sheds light on the positive impact of memory training on Attention and cognitive emotion regulation in children with ADHD. The study underscores the potential of working memory interventions, particularly software-focused approaches, in enhancing attention levels and improving cognitive emotion regulation. The findings align with existing literature emphasizing the role of working memory deficits in ADHD. Practically, incorporating memory training interventions into educational settings emerges as a viable strategy to support children with ADHD. This includes integrating memory training programs into both classroom activities and home-based interventions. Additionally, sustained implementation and long-term follow-up assessments are crucial for maximizing the effectiveness of memory training interventions. Tailoring interventions to specific ADHD subtypes and seamlessly integrating memory training activities into daily routines offer practical and personalized solutions for managing ADHD symptoms in diverse settings.

Assessment of ADHD Subtypes Using Motion Tracking Recognition Based on Stroop Color-Word Tests.

Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder known for its significant heterogeneity and varied symptom presentation. Describing the different subtypes as predominantly inattentive (ADHD-I), combined (ADHD-C), and hyperactive-impulsive (ADHD-H) relies primarily on clinical observations, which can be subjective. To address the need for more objective diagnostic methods, this pilot study implemented a Microsoft Kinect-based Stroop Color-Word Test (KSWCT) with the objective of investigating the potential differences in executive function and motor control between different subtypes in a group of children and adolescents with ADHD. A series of linear mixture modeling were used to encompass the performance accuracy, reaction times, and extraneous movements during the tests. Our findings suggested that age plays a critical role, and older subjects showed improvements in KSWCT performance; however, no significant divergence in activity level between the subtypes (ADHD-I and ADHD-H/C) was established. Patients with ADHD-H/C showed tendencies toward deficits in motor planning and executive control, exhibited by shorter reaction times for incorrect responses and more difficulty suppressing erroneous responses. This study provides preliminary evidence of unique executive characteristics among ADHD subtypes, advances our understanding of the heterogeneity of the disorder, and lays the foundation for the development of refined and objective diagnostic tools for ADHD.

Prevalence of attention-deficit hyperactivity disorder in children, adolescents and adults in the Middle East and North Africa region: a systematic review and meta-analysis

ObjectivesTo systematically estimate the overall prevalence of attention-deficit hyperactivity disorder (ADHD) in children, adolescents and adults across the Middle East and North Africa (MENA) region.DesignSystematic review and meta-analysis conducted according...

Is There a Deficit in Product and Process of Handwriting in Children with Attention Deficit Hyperactivity Disorder? A Systematic Review and Recommendations for Future Research.

Handwriting abnormalities in children with attention deficit hyperactivity disorder (ADHD) have sometimes been reported both (i) at the product level (i.e., quality/legibility of the written trace and speed of writing) and (ii) at the process level (i.e., dynamic and kinematic features, such as on-paper and in-air durations, pen pressure and velocity peaks, etc.). Conversely, other works have failed to reveal any differences between ADHD and typically developing children. The question of the presence and nature of handwriting deficits in ADHD remains open and merits an in-depth examination. The aim of this systematic review was, therefore, to identify studies that have investigated the product and/or process of handwriting in children with ADHD compared to typically developing individuals. This review was conducted and reported in accordance with the PRISMA statement. A literature search was carried out using three electronic databases. The methodological quality of the studies was systematically assessed using the Critical Appraisal Skills Program (CASP) criteria. Twenty-one articles were identified. Of these, 17 described handwriting quality/legibility, 12 focused on speed and 14 analyzed the handwriting process. All the studies (100%) with satisfactory methodology procedures reported an impaired product and process in children with ADHD, while 25% evidenced a difference in the speed of production. Most importantly, the studies differed widely in their methodological approaches. Substantial gaps remain, particularly with regard to ascertaining comorbidities, ADHD subtypes and the medical status of the included children. The lack of overall homogeneity in the samples calls for higher quality studies. We conclude with recommendations for further studies.

An overview of attention-deficit hyperactivity disorder in the pediatrics

Attention-deficit hyperactivity disorder (ADHD), which is a disorder affecting children worldwide, has lasting effects on their behavior and cognitive functions. This review will explore the complexities of ADHD in children, including its classification, manifestations and management strategies. We will discuss the subtypes of ADHD and how they present challenges in various aspects of a child's life. From difficulties with attention to hyperactivity and impulsivity these subtypes have profiles that impact academic performance, social interactions and emotional regulation. The symptoms of ADHD intertwine inattentiveness, hyperactivity, impulsivity, emotional instability and academic struggles in patients. These symptoms significantly affect a child's functioning across areas such as schoolwork, social life and emotions. To effectively manage ADHD in children requires an approach that combines medication options with interventions, educational support systems tailored to individual needs and parental support programs that emphasize collaboration between healthcare professionals and families. This comprehensive approach seeks to address the requirements of children dealing with ADHD. Its goal is not to reduce symptoms but to improve their long-term outcomes and overall quality of life. By explaining the nature of ADHD in children, this analysis aims to provide an understanding of the disorder. It highlights the significance of customized interventions, early detection, and continuous support in order to enhance the well-being and developmental path of affected children.

Impaired segregation of the attention deficit hyperactivity disorder related pattern in children

BackgroundInattention is a key characteristic of attention deficit hyperactivity disorder (ADHD). Specific brain abnormalities associated with this symptom form a discernible pattern related with ADHD in children (i.e., ADHD related pattern) in our earlier research. The developmental processes of segregation and integration may be crucial to ADHD. However, how brains reconfigure these processes of the ADHD related pattern in different subtypes of ADHD and across sexes remain unclear. MethodsNested-spectral partition method was applied to identify effects of subtype and sex on segregation and integration of the ADHD related pattern, using 145 ADHD patients and 135 typically developing controls (TDC) aged 7–14. Relationships between the measures and inattention symptoms were also investigated. ResultsChildren with ADHD exhibited lower segregation of the ADHD related pattern (p = 1.17 × 10−8) than TDCs. Only the main effect of subtype was significant (p = 1.14 × 10−5). Both ADHD-C (p = 2.16 × 10−6) and ADHD-I (p = 2.87 × 10−6) patients had lower segregation components relative to the TDC. Moreover, segregation components were negatively correlated with inattention scores. ConclusionsThis study identified impaired segregation in the ADHD related pattern of children with ADHD and found shared neural bases among different subtypes and sexes.

Identification of Attention-Deficit-Hyperactivity Disorder Subtypes Based on Structural MRI Grey Matter Volume and Phenotypic Information.

One of the neurodevelopmental disorders widely affecting school-aged children in recent years is attention deficit hyperactivity disorder (ADHD). In many neurodevelopmental disorders, grey matter may be used as a clinical indicator by looking at MRIs. The study aimed to segment grey matter from brain MRI using a proposed fuzzy c-means clustering-based technique for the detection of ADHD and its subtypes (ADHD-Inattentive, ADHDHyperactive, and ADHD-Combined). The grey matter volume, age, gender, and medication status of the subjects were investigated to identify ADHD subtypes. A modified fuzzy c-means with an elbow approach has been proposed to overcome the drawbacks of previous fuzzy c-means methods and improve segmentation performance. The volume of segmented grey matter was included with the phenotypic information of the ADHD-200 dataset for data analysis of typically developing (TD) and ADHD subtypes. The proposed segmentation exhibited a dice similarity index of 95%. ADHD-Inattentive exhibited a loss of grey matter in the prefrontal cortex, while ADHD-hyperactive exhibited a loss of grey matter in the cerebellum when compared to TD. The analysis of ADHD subtypes based on age and gender showed that children transitioning to adolescence are mostly affected by ADHD-inattentive and female kids are less prone to ADHD-hyperactive. The whole grey matter volume of ADHD-inattentive children, on average, was found to be approximately 4% less than ADHD-combined. Furthermore, the whole grey matter volume was less in non-medication naive children. This study may support healthcare providers in giving appropriate occupational therapy based on the identification of different ADHD subtypes.

Identifying ADHD and subtypes through microstates analysis and complex networks.

The diagnosis of attention-deficit hyperactivity disorder (ADHD) is based on the health history and on the evaluation of questionnaires to identify symptoms. This evaluation can be subjective and lengthy, especially in children. Therefore, a biomarker would be of great value to assist mental health professionals in the process of diagnosing ADHD. Event-related potential (ERP) is one of the most informative and dynamic methods of monitoring cognitive processes. Previous works suggested that specific sets of ERP-microstates are selectively affected by ADHD. This paper proposes a new methodology for the ERP-microstate analysis and identification of ADHD patients based on complex networks to model the microstate topographic maps. The analysis of global and local features of ERP-microstate networks revealed topological differences between ADHD and healthy control. The classification using a neural network with a single hidden layer resulted in an average accuracy of 99.72% in binary classification and 99.31% in the classification of ADHD subtypes. The results were compared to the power band spectral densities and the energy of wavelet coefficients. The temporal features of ERP-microstates, such as frequency of occurrence, duration, coverage, and transition probabilities, were also evaluated for comparison proposes. Overall, the selected topological features of ERP-microstate networks derived from the proposed method performed significantly better classification results. The results suggest that topological features of ERP-microstate networks are promising to identify ADHD and its subtypes with a neural network model compared to power band spectrum density, wavelet transform, and temporal features of ERP-microstates.

Unlocking Potential: The Development and User-Friendly Evaluation of a Virtual Reality Intervention for Attention-Deficit/Hyperactivity Disorder

(1) Background: Attention-Deficit/Hyperactivity Disorder (ADHD) is typically first diagnosed in early childhood. Medication and cognitive behavioural therapy are considered effective in treating children with ADHD, whereas these treatments appear to have some side effects and restrictions. Virtual reality (VR), therefore, has been applied to exposure therapy for mental disorders. Previous studies have adopted VR in the cognitive behavioural treatment for children with ADHD; however, no research has used VR to develop social skills training for children with ADHD. This study aimed to develop a VR-based intervention (Social VR) to improve social skills in children with symptoms of ADHD. Prior to conducting the pilot trial to assess the effectiveness of Social VR, valuable user feedback was gathered regarding the mechanics of Social VR, satisfaction and motion sickness. This study presented the development and preliminary usability of Social VR to enhance social interaction skills among children with ADHD. (2) Methods: The development process of the Social VR intervention was demonstrated. The Social VR intervention consisted of three scenarios, namely MTR, Campus and Market and Restaurant. In the usability study, 25 children with ADHD were recruited to test the Social VR during the preliminary usability stage of a clinical trial at preinclusion. The participants completed a survey about their experience of playing Social VR, satisfaction, and motion sickness. (3) Results: The participants indicated the three conditions had easy-to-follow instructions, were easy to pick up, and that they understood when the situations changed. The control and beauty of the graphics of Market and Restaurant were relatively lower compared with those of MTR and Campus. The three scenarios are applicable to children diagnosed with any subtype of ADHD. (4) Conclusion: The participants were satisfied with Social VR. Social VR was generally considered realistic and immersive. Further trials to assess the feasibility and efficacy were discussed. If proven effective, VR-based intervention can be an adjunctive approach to current multimodal training for children with ADHD.

27 Differentiating Attention-deficit/Hyperactivity Disorder (ADHD) Subtype Using Continuous Performance Tests Among Children with Comorbid ADHD and Anxiety

Objective:Continuous performance tests (CPT) are often considered the gold standard for the diagnosis attention-deficit/hyperactivity disorder (ADHD), particularly when parent and teacher rating scales are inconclusive. Prior work has indicated that CPT can also help differentiate between ADHD subtypes. However, the ability of CPT to differentiate ADHD subtype has not been examined among youth with comorbid ADHD and anxiety (ADHD+A). This is particularly concerning as the extant literature suggests that anxiety symptoms may exacerbate deficits associated with ADHD (e.g.. , working memory, attention) and attenuate others (e.g., inhibition); thus, anxiety may influence expected patterns on the CPT. This study therefore seeks to examine the role of ADHD subtype on the relationship between ADHD+A and performance on a CPT among youth with ADHD+A.Participants and Methods:Participants included 54 children ranging from 6 to 20 years old (Mage=11.83, 54% female) who were diagnosed with ADHD+A via neuropsychological evaluation. In terms of ADHD subtype, 51.9% (n=28) were diagnosed with ADHD combined or ADHD primarily hyperactive and 48.1% (n=26) were diagnosed with ADHD primarily inattentive. Approximately 46.30% (N=25) of participants were medication naive. Analyses were conducted using data from the Conners Kiddie Continuous Performance Test -Second Edition (KCPT-2), Conners Continuous Performance - Second Edition (CPT-2) and the Conners Continuous Performance - Third Edition (CPT-3), which are part of the same family of performance-based attention measures. Independent samples t-tests were conducted to examine performance differences in aspects of attention (e.g., inattentiveness, sustained attention) and hyperactivity (e.g., impulsivity, inhibition).Results:ADHD subtype was not significantly related to measures of inattentiveness. This includes the number of targets missed (omissions; (t(39)=-.532, p=.59)) and variability in response time (variability; (t(39)=-0.30, p=.77)). In terms of sustained attention, ADHD subtype was not related to variability in response speed across blocks (Hit SEBC/HRT Block Change; (t(39)=-0.26, p=.79)). Importantly, these results were consistent regardless of ADHD medication status. ADHD subtype was also not significantly related to impulsivity. This includes responses to nontargets (commissions; (t(39)=-1.05, p=.30)), random or anticipatory responding (perseverations; (t(39)=-0.19, p=.85)), and mean response speed of correct responses (HR; (t(39)=-0.72, p=.48)).Conclusions:The extant literature suggests that CPT can help clinicians differentiate between ADHD subtypes. However, the results of this study indicate that there are no performance differences on the CPT among youth with comorbid ADHD and anxiety. There are several limitations to consider. First, this study had a relatively small sample size, which also limited the ability to examine ADHD primarily hyperactive/impulsive as a distinct subtype. Additionally, this study did not examine the effect of individual anxiety disorders (i.e., generalized anxiety disorder, specific phobias). Finally, these findings may not generalize to other standardized measures of attention or more ecologically valid measures. Despite these limitations, this study is an important step in understanding the relationship between ADHD+A and performance on attention measures. Clinicians should be cautious in using results from CPT to distinguish between ADHD subtype among children with comorbid anxiety.

Frequency characteristics of temporal and spatial concordance among dynamic indices in inattentive and combined subtypes of attention deficit hyperactivity disorder.

Numerous voxel-based resting-state functional magnetic resonance imaging (rs-fMRI) measurements have been used to characterize spontaneous brain activity in attention deficit hyperactivity disorder (ADHD). However, the practical distinctions and commonalities among these intrinsic brain activity measures remain to be fully explored, and whether the functional concordance is related to frequency is still unknown. The study included 25 ADHD, combined type (ADHD-C); 26 ADHD, inattentive type (ADHD-I); and 28 typically developing (TD) children. We calculated the voxel-wise (temporal) and volume-wise (spatial) concordance among dynamic rs-fMRI indices in the slow-5 (0.01-0.027 Hz) and slow-4 (0.027-0.073 Hz) frequency bands, respectively. The spatiotemporal concordance within the slow-4 and slow-5 bands among the ADHD-C, ADHD-I, and TD groups was compared. Although the ADHD-C and ADHD-I groups showed similar volume-wise concordance, comparison analysis revealed that compared with ADHD-C patients, ADHD-I patients exhibited decreased voxel-wise concordance in the right median cingulate and paracingulate gyrus (MCC) and right supplementary motor area (SMA) in the slow-5 band. In addition, the voxel-wise concordance was negatively correlated with the diagnostic scores of ADHD subtypes. Our results suggest that functional concordance is frequency dependent, and dynamic concordance analysis based on specific frequency bands may provide a novel approach for investigating the pathophysiological differences among ADHD subtypes.

B - 04 Evaluating the Efficacy of a Virtual Reality Neuropsychological Assessment in Detecting ADHD Subtypes.

The aim of this study was to investigate the effectiveness of using a virtual reality (VR) continuous performance test (CPT) (i.e., Nesplora Aula) to evaluate various aspects of attention and executive functioning, compared to current assessment tools and diagnostic criteria. The study assessed the validity and reliability of the VR CPT in measuring attentional abilities, and examined whether VR CPT can provide complementary/supplementary information to existing assessment methods. Data was collected from children aged 6-16 with a known or suspected diagnosis of Attention-Deficit/Hyperactivity Disorder (ADHD). In addition to the VR CPT, the battery included standard measures of attention and executive functioning, general cognitive function, and comprehensive corroborating reports completed by their families. Domain correlations were then conducted to determine the convergent and construct validity. Data was also correlated with general functioning domains to attempt to replicate past studies. The study found that results demonstrated moderate-to-strong convergent validity, suggesting acceptable construct validity for VR CPT. Overall, the results were consistent enough to support the concept. Furthermore, post-hoc tests explored convergent and construct validity for each subtype of ADHD, including combined, primarily inattentive, and primarily hyperactive-impulsive. In conclusion, VR CPT (Nesplora Aula) remains a viable tool for assessing ADHD symptoms, particularly in the hyperactive-impulsive subtype. Our findings support the use of VR technology in neuropsychological assessment, as it shows moderate to strong convergent validity with established assessment tools. However, further research is needed to fully evaluate the practicality of using VR CPT as a stand-alone diagnostic tool.

The prevalence of SCT in China, its comorbidity with ADHD and its association with life events and parental-rearing behaviors

Although sluggish cognitive tempo (SCT) symptoms are often observed in children with attention deficit hyperactivity disorder (ADHD), an increasing number of studies have highlighted its uniqueness. Nevertheless, no national survey on SCT among children and adolescents has been conducted in China. Hence, this research aims to study SCT in China and to evaluate the differences between SCT and ADHD symptoms by comparing their risk factors in terms of life events (LE) and parental rearing behaviors (PRB). This cross-sectional study used data from a survey on 71,929 children and adolescents in 5 province-level regions in China to study the incidence and demographic information of SCT in the Chinese population. Subsequently, the study investigated the comorbidity of ADHD and SCT, and conducted three logistic regressions on the LE and PRB scores to predict whether participants develop symptoms of ADHD or SCT, or neither symptom. 6658 participants were allocated into the SCT group, and the weighted point prevalence of SCT was 9.78%. 36.34% of participants with ADHD (n = 676) were found to demonstrate SCT symptoms, whereas no statistically significant difference was observed in its comorbidity to the three ADHD subtypes (χ2 = 1.668, p > 0.05, Δ = 2). The regression results on the presence or absence of ADHD revealed paternal excessive-interference and rejection, and maternal favoring were associated with ADHD diagnosis, whereas paternal punishment and favoring and maternal emotional warmth was related to the absence of ADHD symptoms. Academic stress and maternal excessive-interference were associated with SCT symptoms, and maternal emotional warmth associated with SCT absence. Concerning the presence of ADHD-only or SCT-only symptoms, LE adaptation was found to relate to SCT-only symptoms, while PRB paternal rejection and maternal favoring were associated with ADHD-only symptoms. While evidencing the high prevalence of SCT in China, our findings supported that although ADHD and SCT were highly comorbid, they may be considered two independent disorders with different risk factors. Specifically, participants with SCT symptoms are more vulnerable to stress from LE and tend to face more maladjustment than ADHD and normally-developing participants, and maternal rearing behaviours are the key factors to SCT symptoms. SCT brings global challenges in its diagnosis and treatment, and the challenge is more severe in a mentally stressful environment. Therefore, stress management and SCT etiology studies are recommended.

Subtype classification of attention deficit hyperactivity disorder with hierarchical binary hypothesis testing framework

Objective. The diagnosis of attention deficit hyperactivity disorder (ADHD) subtypes is important for the refined treatment of ADHD children. Although automated diagnosis methods based on machine learning are performed with structural and functional magnetic resonance imaging (sMRI and fMRI) data which have full observation of brains, they are not satisfactory with the accuracy of less than for the ADHD subtype diagnosis. Approach. To improve the accuracy and obtain the biomarker of ADHD subtypes, we proposed a hierarchical binary hypothesis testing (H-BHT) framework by using brain functional connectivity (FC) as input bio-signals. The framework includes a two-stage procedure with a decision tree strategy and thus becomes suitable for the subtype classification. Also, typical FC is extracted in both two stages of identifying ADHD subtypes. That means the important FC is found out for the subtype recognition. Main results. We apply the proposed H-BHT framework to resting state fMRI datasets from ADHD-200 consortium. The results are achieved with the average accuracy and an average kappa score 0.947. Discriminative FC between ADHD subtypes is found by comparing the P-values of typical FC. Significance. The proposed framework not only is an effective structure for ADHD subtype classification, but also provides useful reference for multiclass classification of mental disease subtypes.

Vocal emotion recognition in attention-deficit hyperactivity disorder: a meta-analysis

ABSTRACT There is debate within the literature as to whether emotion dysregulation (ED) in Attention-Deficit Hyperactivity Disorder (ADHD) reflects deviant attentional mechanisms or atypical perceptual emotion processing. Previous reviews have reliably examined the nature of facial, but not vocal, emotion recognition accuracy in ADHD. The present meta-analysis quantified vocal emotion recognition (VER) accuracy scores in ADHD and controls using robust variance estimation, gathered from 21 published and unpublished papers. Additional moderator analyses were carried out to determine whether the nature of VER accuracy in ADHD varied depending on emotion type. Findings revealed a medium effect size for the presence of VER deficits in ADHD, and moderator analyses showed VER accuracy in ADHD did not differ due to emotion type. These results support the theories which implicate the role of attentional mechanisms in driving VER deficits in ADHD. However, there is insufficient data within the behavioural VER literature to support the presence of emotion processing atypicalities in ADHD. Future neuro-imaging research could explore the interaction between attention and emotion processing in ADHD, taking into consideration ADHD subtypes and comorbidities.