Attention-Deficit/Hyperactivity Disorder (ADHD) has been linked to altered neurodevelopmental processes, including proliferation and differentiation of neural stem cells (NSC). We aimed to investigate the role of Wnt signaling, a pathway critical for brain development, in ADHD and to determine if modulation of this pathway using ω-3/6 polyunsaturated fatty acids (PUFAs) may provide a beneficial treatment approach. Given the symptom heterogeneity in ADHD and the limited response to conventional therapies for some patients, we examined the effects of ω-3/6 PUFA treatment combined with Methylphenidate (MPH) on neurodevelopmental mechanisms using induced pluripotent stem cell (iPSC)-derived NSCs, comparing controls to ADHD patients. Our results show that ω-3/6 PUFAs differentially regulate Wnt activity in NSCs depending on the patient's condition and the composition of the treatments. These findings highlight the potential of ω-3 PUFA treatment as personalized support for neurodevelopmental processes in ADHD. They also emphasize the importance of investigating ADHD subgroups, including those unresponsive to stimulant treatments, as they may exhibit distinct phenotypes.

ADHD is a brain development disorder that typically starts in early childhood, making it difficult for children to function effectively in daily life. The course of ADHD is negatively influenced by a dysfunctional family environment. Since ADHD affects development early on, involving parents in treatment is crucial for helping children with this condition. This study aims to explore how a group program designed to help families function better can improve the lives of children with ADHD and their parents. The correlational, causal-comparative, and quasi-experimental designs were utilized within the quantitative research approach in this study. The sample comprised 181 participants who have children with ADHD (Female = 131, Male = 48, Unspecified = 2). The Family Assessment Device, the Pediatric Quality of Life Inventory, and the Demographic Information Form were used to gather data. Experimental (7 couples) and control (7 couples) groups were formed for application of the research. A weekly intervention program designed to improve family functioning was applied to the experimental group. Both the group receiving the intervention program and a control group underwent assessments of family functioning at three points: before (pretest), after (posttest), and again later (follow-up). The results suggest that the group intervention program increased the scores for the family functioning. Moreover, the study revealed that this program indirectly improved children's quality of life. This finding suggests that parents who have a better family functioning are better at dealing with the challenges brought on by their children's ADHD symptoms. Accordingly, it is recommended that professionals should consider working with families as well as children with ADHD.

This study investigates the neural underpinnings of cognitive control deficits in attention-deficit/hyperactivity disorder (ADHD), focusing on trial-level variability of neural coding. Using fMRI, we apply a computational approach to single-trial neural decoding on a cued stop-signal task, probing proactive and reactive control within the dual control model. Reactive control involves suppressing an automatic response when interference is detected, and proactive control involves implementing preparatory strategies based on prior information. In contrast to typically developing children (TD), children with ADHD show disrupted neural coding during both proactive and reactive control, characterized by increased temporal variability and diminished spatial stability in neural responses in salience and frontal-parietal network regions. This variability correlates with fluctuating task performance and ADHD symptoms. Additionally, children with ADHD exhibit more heterogeneous neural response patterns across individuals compared to TD children. Our findings underscore the significance of modeling trial-wise neural variability in understanding cognitive control deficits in ADHD.

We conducted an umbrella review of systematic reviews (SRs), with or without meta-analysis (MA), of randomized controlled trials (RCTs) assessing nonpharmacological sleep interventions for children and adolescents across various clinical populations.

We searched multiple electronic databases up to January 24, 2024. Meta-analyzable data from RCTs in the retrieved SRs/MAs were pooled using Metaumbrella. Primary outcomes were subjective/objective child sleep parameters. Additional outcomes included child health/functioning and parental sleep/health. The quality of the MAs/SRs was assessed with Assessment of Multiple Systematic Reviews (AMSTAR-2), and the certainty of evidence using Grading of Recommendations, Assessment, Development and Evaluations (GRADE).

We included 93 SRs/MAs covering 393 RCTs, with 25 (17%, 39%, and 30%: high, moderate, and low quality) providing data for quantitative synthesis. Behavioral interventions, usually multicomponent including parent training, psychoeducation, and/or specific sleep therapy/strategies, showed beneficial effects on night waking, sleep duration, overall sleep disturbance, mood/depression, and maternal sleep quality (standardized mean difference [SMD] = 0.10-0.80) in participants with sleep problems without a formal sleep disorder diagnosis. For those with a formal diagnosis (mainly insomnia), benefits were found for night waking, sleep efficiency (subjective/actigraphically measured), and sleep onset latency (mean SMD = 0.49-0.97). Those with attention-deficit/hyperactivity disorder (ADHD) improved in bedtime resistance, night waking, parasomnias, sleep anxiety, ADHD symptoms, sleep disturbance, and quality of life (mean SMD = 0.18-0.49). For those with autism, sleep disturbance improved (mean SMD = 0.70). However, all findings were of low to very low certainty of evidence.

Among nonpharmacological interventions for sleep difficulties in youth, only behavioral interventions are supported by meta-analytic evidence, yet with small-to-moderate effect sizes and limited certainty of evidence.

This "umbrella review" (a review of reviews) analyzed 93 systematic reviews and meta-analyses of randomized controlled trials examining nonmedication sleep interventions for children and adolescents. The authors found that behavioral interventions, including parent training and psychoeducation, had positive effects on sleep issues like night waking, with effect sizes ranging from small to moderate. Improvements were also seen in children with ADHD and autism. However, the quality of the evidence for these benefits was rated as low to very low. This suggests that while behavioral approaches may help, more robust evidence is needed to confirm their benefits.

The efficacy and tolerability of nonpharmacological interventions for sleep problems in children and adolescents: protocol for an umbrella review of systematic reviews and meta-analyses of randomised controlled trials. https://osf.io; j9qna/.

Brain health is a pressing global concern. Poor diet quality is a recognized major environmental risk factor for brain disorders and one of the few that is modifiable. There is substantial evidence that nutrition impacts brain development and brain health across the life course. So why then is the full potential of nutrition not utilized to improve brain function? This commentary, which is based on discussions of the European Brain Research Area BRAINFOOD cluster, aims to highlight the most urgent research priorities concerning the evidence base in the area of nutrition and brain health and identifies 3 major issues that need to be addressed: (1) increase causal and mechanistic evidence on the link between nutrition and brain health, (2) produce effective messages/education concerning the role of food for brain health, and (3) provide funding to support collaborative working across diverse stakeholders.

Elevated attention-deficit/hyperactivity disorder (ADHD) symptoms in preschoolers are a risk factor for poorer psychiatric health, cognitive deficits, and social and academic impairment across the lifespan. The first-line treatment for these preschoolers, behavioral parent training (BPT), reduces children's disruptive behaviors and parenting stress, yet its impact on core ADHD symptoms is inconsistent. Early interventions targeting biological mechanisms linked to core ADHD pathophysiology are critically needed.

This topical review explores sleep dysregulation as a potential key target for early intervention for ADHD symptoms among preschoolers.

Sleep dysregulation is common in school-aged children with ADHD, and treating sleep improves core ADHD symptoms in older children. Cross-sectional and prospective research with preschoolers offers compelling evidence that sleep dysregulation and ADHD symptoms are closely linked over the course of early development. BPT and behavioral sleep medicine (BSM) interventions share an underlying theoretical framework and could be streamlined to target sleep in addition to daytime behaviors.

Novel early interventions targeting underlying biological mechanisms linked to core ADHD pathophysiology are critically needed to improve the trajectories of ADHD symptoms, comorbidity, and functional deficits for preschoolers with elevated ADHD symptoms. Sleep regulation is a promising mechanistic treatment target for this population, and future interventions may draw from the shared behavioral principles of BPT and BSM to target behaviors across the 24-hr period and employ scalable formats to optimize the number of families who can benefit from parent-based interventions targeting ADHD symptoms and sleep in early development.

Understanding the mechanisms of change and between-family differences in behavioural parenting interventions for children with attention-deficit/hyperactivity disorder (ADHD) may help personalise interventions. Therefore, we examined whether improvements in parenting are associated with changes in child behaviour and functional outcomes, and how these associations vary based on parents' baseline parenting levels.

We collected individual participant data including 19 randomised controlled trials focusing on children with ADHD (n = 1,720). Immediate post-intervention measures of child ADHD and oppositional behaviour severity, reported by parents and functional impairment reported by either the parent or probably masked clinicians, were treated as outcomes. We estimated pathways from intervention (vs. control) to child outcomes, via immediate post-intervention parent reports of constructive parenting (e.g. praise), non-constructive parenting (e.g. physical punishment) and parent-child affection (e.g. warmth), while controlling for baseline values of both child outcomes and parenting levels. Baseline values of each parenting variable were used as moderators of the mediated pathways.

Improvements in parenting behaviours and parent-child affection immediately following the intervention jointly explained concurrent improvements in children's ADHD severity, oppositional behaviour and functional impairment. Furthermore, when reversing the direction of the pathways, improvements in all child outcomes jointly explained improvements in each aspect of parenting. Improvements in non-constructive parenting and parent-child affection uniquely accounted for intervention effects on functional impairment, especially for families with higher baseline levels of non-constructive parenting.

Our findings might indicate that improvements in both the behavioural and affective aspects of parenting are associated with concurrent reductions in child behaviour problems and functional impairment. However, more research is necessary to explore the potential causal directionality between parenting and child outcomes. Nonetheless, supporting families with poorer parenting skills may be especially important, as reductions in non-constructive parenting in these families are linked to stronger treatment effects on child functional impairment.

Studies of non-invasive treatments such as repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) can contribute in an alternative way to the symptoms treatment and changes in sleep patterns in attention deficit hyperactivity disorder (ADHD), due to some scientific evidence of action on cognition and clinical characteristics.

The aim of this systematic review was to evaluate studies of non-invasive brain stimulation using rTMS and tDCS on symptoms and sleep parameters in people with ADHD, in order to synthesize the main findings on intervention effects.

A systematic review was carried out using the PRISMA protocol in the PubMed/Medline, Embase, PsycInfo, CINAHL, PEDro and Central-Cochrane library databases were initially carried out on 14 March 2024 and repeated until September 2024. Randomized clinical trials evaluating the effect of rTMS and tDCS on symptoms and changes in sleep pattern in people with ADHD were included. Primary outcomes were total severity of ADHD symptoms and sleep quality assessed by questionnaires and instrument measures.

The review evidenced only positive findings in five studies for tDCS in some cognitive functions, ADHD symptoms and improvement in sleep parameters, being results with reduced efficacy due to the high heterogeneity in the experimental protocols.

The findings show limited evidence; however, it is suggested that the combined use of non-invasive stimulation with other approaches, such as cognitive training, may improve the intervention effect. It is also important to consider limitations such as heterogeneity in clinical protocols, selection of participants with ADHD, including dosage and frequency. These factors should be explored in future research to optimize the application of these therapies.

Neurofeedback has been proposed for the treatment of attention-deficit/hyperactivity disorder (ADHD) but the efficacy of this intervention remains unclear.

To conduct a meta-analysis of randomized clinical trials (RCTs) using probably blinded (ie, rated by individuals probably or certainly unaware of treatment allocation) or neuropsychological outcomes to test the efficacy of neurofeedback as a treatment for ADHD in terms of core symptom reduction and improved neuropsychological outcomes.

PubMed (MEDLINE), Ovid (PsycInfo, MEDLINE, Embase + Embase Classic), and Web of Science, as well as the reference lists of eligible records and relevant systematic reviews, were searched until July 25, 2023, with no language limits.

Parallel-arm RCTs investigating neurofeedback in participants of any age with a clinical ADHD or hyperkinetic syndrome diagnosis were included.

Standardized mean differences (SMDs) with Hedges g correction were pooled in random effects meta-analyses for all eligible outcomes.

The primary outcome was ADHD total symptom severity assessed at the first postintervention time point, focusing on reports by individuals judged probably or certainly unaware of treatment allocation (probably blinded). Secondary outcomes were inattention and/or hyperactivity-impulsivity symptoms and neuropsychological outcomes postintervention and at a longer-term follow-up (ie, after the last follow-up time point). RCTs were assessed with the Cochrane risk of bias tool version 2.0.

A total of 38 RCTs (2472 participants aged 5 to 40 years) were included. Probably blinded reports of ADHD total symptoms showed no significant improvement with neurofeedback (k = 20; n = 1214; SMD, 0.04; 95% CI, -0.10 to 0.18). A small significant improvement was seen when analyses were restricted to RCTs using established standard protocols (k = 9; n = 681; SMD, 0.21; 95% CI, 0.02 to 0.40). Results remained similar with adults excluded or when analyses were restricted to RCTs where cortical learning or self-regulation was established. Of the 5 neuropsychological outcomes analyzed, a significant but small improvement was observed only for processing speed (k = 15; n = 909; SMD, 0.35; 95% CI, 0.01 to 0.69). Heterogeneity was generally low to moderate.

Overall, neurofeedback did not appear to meaningfully benefit individuals with ADHD, clinically or neuropsychologically, at the group level. Future studies seeking to identify individuals with ADHD who may benefit from neurofeedback could focus on using standard neurofeedback protocols, measuring processing speed, and leveraging advances in precision medicine, including neuroimaging technology.

Attention-Deficit/Hyperactivity Disorder (ADHD) is a lifelong neurodevelopmental condition with a global prevalence of 2.5% to 6.7% among adults. Non-pharmacological interventions have demonstrated effectiveness both as standalone treatments and adjuncts to pharmacotherapy in managing adult ADHD. Nevertheless, the comparative efficacy of these interventions, particularly with respect to diverse ADHD-related outcomes and their long-term impacts, remains insufficiently investigated.

This study aims to evaluate and compare the short-term and long-term effects of various non-pharmacological therapies on core ADHD symptoms (inattention, hyperactivity, and impulsivity) and emotional disorders (depression and anxiety) in adults with ADHD and to rank these therapies accordingly.

A systematic search was conducted for relevant randomized controlled trials (RCTs) in the Web of Science, PubMed, Cochrane Library, and EMBASE databases from inception to Sep 2024. Researchers independently screened and extracted data, and the analysis was performed using R version 4.3.2. Cochrane Risk of Bias tool version 2 (ROB2) and Confidence in Network Meta-Analysis (CINeMA) were used to assess the risk of bias and the certainty of the evidence. Standardized mean differences were estimated using network meta-analyses with random effects.

A total of 37 RCTs involving 2,289 participants and 10 non-pharmacological therapies were included. The risk of bias was classified as low in 24.3%, unclear in 27%, and high in 48.6%, while the CINeMA assessment indicated that confidence in the evidence was "very low" or "low" for most of the remaining treatments. Cognitive behavioral therapy (CBT) showed significantly greater effectiveness than the control group/condition in both the short-term (SMD: -4.43, 95%CI: -5.50 to -3.37) and long-term (SMD: -3.61, 95%CI: -4.66 to -2.56) core symptoms. Additionally, CBT shows both short-term and long-term efficacy for depression (SMD: -4.16, 95%CI: -5.51 to -2.81; SMD: -3.89, 95%CI: -5.95 to -1.83) and anxiety (SMD: -2.12, 95%CI: -3.18 to -1.07; SMD: -7.25, 95%CI: -10.57 to -3.94).

CBT may be the most effective intervention for adults with ADHD and associated emotional disorders, while Mindfulness-based Cognitive Therapy (MC) is recommended as a preferable option for those without comorbidities. Caution is needed in interpreting our results, and high-quality RCTs are urgently required for more reliable insights.

https://www.crd.york.ac.uk/prospero/display_record.php?, identifier CRD42024432912.

Background: Children with attention deficit hyperactivity disorder (ADHD) frequently encounter eating problems. However, qualitative research on the eating problems of these children and the strategies employed by their parents to manage these issues remains limited. This study aimed to explore the eating problems of school-age children with ADHD and the coping strategies used by parents in urban settings like Hong Kong. Methods: A descriptive qualitative design was utilized, employing semi-structured focus group interviews. Purposive sampling was used to recruit 12 parents who voluntarily participated in five focus group sessions. The interviews were conducted in Cantonese, audio-recorded, and transcribed verbatim. Data were analyzed using template thematic analysis to identify key themes and subthemes. Results: Two major themes emerged: challenges affecting ADHD children's eating behaviors and parental coping strategies in Hong Kong. Children's eating difficulties stemmed from ADHD-specific behaviors, compounded by Hong Kong's demanding educational system and urban environmental constraints. In response, parents developed multifaceted coping approaches, ranging from dietary modifications and behavioral management strategies to healthcare resource utilization, while adapting their urban lifestyle to accommodate their children's needs. Conclusions: Children with ADHD face eating challenges that intersect with Hong Kong's sociocultural environment, where educational pressure, limited living spaces, and parents' work schedules influence their eating patterns. Parents adopt integrated Eastern-Western approaches, supported by Hong Kong's comprehensive healthcare resources spanning professional networks and community programs. Evidence-based dietary guidelines are essential to address ADHD-related nutritional misconceptions.

Difficulties in emotional regulation are often observed in children and adolescents with attention-deficit/hyperactivity disorder (ADHD). Innovative complementary treatments, such as video games and virtual reality, have become increasingly appealing to patients. The Secret Trail of Moon (MOON) is a serious video game developed by a multidisciplinary team featuring cognitive training exercises. In this second randomized clinical trial, we evaluated the impact of a 20-session treatment with MOON on emotional regulation, as measured by the Strengths and Difficulties Questionnaire.

We hypothesize that patients with ADHD using MOON will show improvements in (1) emotional regulation, (2) core ADHD symptoms, (3) cognitive functioning, and (4) academic performance, compared to a control group; additionally, we anticipate that (5) changing the platform (from face-to-face using virtual reality to the web) will not affect emotional regulation scores; and (6) the video game will not cause any clinically significant side effects.

This was a prospective, unicentric, randomized, unblinded, pre- and postintervention study with block-randomized sequence masking. Participants included individuals aged between 7 and 18 years who had a clinical diagnosis of ADHD and were receiving pharmacological treatment. They were randomized into 2 groups using an electronic case report form: the MOON group, receiving standard pharmacological treatment plus personalized cognitive training via a serious video game, and the control group, receiving standard pharmacological treatment. We provided both the groups with psychoeducational support on ADHD. Analysis was conducted using the Student 2-tailed t test and 2-factor ANOVA. An independent monitor supervised the study.

A total of 76 patients with ADHD participated in the trial, with an equal randomization (MOON: n=38, 50% and control: n=38, 50%) and a total dropout rate of 7. The primary hypothesis, a 3- or 4-point reduction in the global Strengths and Difficulties Questionnaire score, was not met. However, significant improvements were observed in material organization (P=.03), working memory (P=.04), and inhibition (P=.05), particularly among patients more engaged with the MOON treatment.

Serious video games, when integrated into a multimodal treatment plan, can enhance outcomes for symptoms associated with ADHD.

ClinicalTrials.gov NCT06006871; https://clinicaltrials.gov/study/NCT06006871.

RR2-10.2196/53191.

Attention-deficit hyperactivity disorder (ADHD) is a neurobiological condition that affects both children and adults. Microstate (MS) analyses, a data-driven approach that identifies stable patterns in EEG signals, offer valuable insights into the neurophysiological characteristics of ADHD. This review summarizes findings from 13 studies that applied MS analyses to resting-state and task-based brain activity in individuals with ADHD. Relevant research articles were retrieved from electronic databases, including PubMed, Google Scholar, Web of Science, PsychInfo, and Scopus. The reviewed studies applied MS analyses to explore brain activity differences in ADHD populations. Resting-state studies consistently reported alterations in MS organization, with increased duration (MS-D) and changes in temporal dynamics (MS-C), potentially reflecting executive dysfunctions and delayed maturation of the default mode network. Additionally, MS B demonstrated promise in distinguishing between ADHD subtypes based on differences in visual network function. Task-based and event-related potential (ERP) studies, using paradigms like the continuous performance task (CPT) or Go-NoGo Task, identified MS abnormalities (i.e., N2, P2, P3, CNV) linked to inhibition and attentional resource allocation. Preliminary evidence suggests that MS analyses hold potential for distinguishing individuals with ADHD from control groups. The integration of machine learning techniques holds promise for improving diagnostic accuracy and identifying ADHD subtypes, while MS analyses may also help monitor the effects of stimulant medications like methylphenidate by tracking neurophysiological changes. However, this review highlights the need for more standardized methodologies to enhance the generalizability and replicability of findings. These efforts will ultimately contribute to a deeper understanding of the neurobiological mechanisms that underlie ADHD.

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.

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.

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.

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.

To explore the effects of mind-body exercise (MBE) on ADHD through a systematic review and meta-analysis.

After identifying relevant search keywords based on the study's technical terminology, research articles were retrieved from five databases. Two researchers independently screened the results to select studies that met the inclusion criteria. A random-effects model was used to conduct a meta-analysis on the included studies.

The findings indicate that MBE interventions significantly improved attention in individuals with ADHD [SMD=-0.97, 95% CI (-1.56, -0.39), P < 0.05]. However, the meta-analysis found no evidence that MBE improved executive function, emotional issues, or hyperactivity/impulsivity in ADHD patients.

MBE is beneficial for attention improvement in ADHD patients. However, further evidence is needed to support its efficacy as an adjunctive treatment for other symptoms.

https://www.crd.york.ac.uk/prospero, identifier CRD42023447510.

The rise in the number of children diagnosed with attention-deficit/hyperactivity disorder (ADHD) highlights the need for effective interventions targeting attentional control. Although recent research has demonstrated the potential of neurofeedback training (NFT) for children with ADHD, most studies have been conducted in laboratory settings, raising questions about their real-world applicability. To address this issue, virtual reality (VR) may offer a solution to the ecological validity challenges encountered in NFT. By coupling NFT with VR, individuals can engage in self-regulating brain activity within a simulated, realistic environment. This study aims to investigate the efficacy of near-infrared spectroscopy (NIRS)-based NFT combined with VR in alleviating ADHD symptoms among children, addressing the need for interventions with practical relevance and effectiveness.

This study aims to recruit 138 children aged 7-12 diagnosed with ADHD. Following baseline assessment, participants will be randomly assigned to one of three conditions: (1) NIRS-based NFT in a VR classroom setting; (2) conventional computerised cognitive training (active control) or (3) a waitlist control group. On completion of intervention sessions in the two training groups, all groups will undergo an assessment at time 2, with a follow-up assessment scheduled 2 months post-training for all participants. Primary outcomes will include measures of executive function, such as attentional control, response inhibition and working memory, along with changes in oxygenated and deoxygenated haemoglobin levels monitored by functional NIRS. Secondary outcome measures will comprise ratings of children's ADHD symptoms and executive function behaviours in daily life, reported by parents and teachers.

The three-arm randomised controlled trial will address research gaps regarding the effectiveness of NIRS-based NFT for children with ADHD, particularly when integrated with immersive VR technology. By combining NFT and VR, this study aims to simulate a real-world environment, potentially amplifying intervention effects. The findings from the study will provide evidence for the efficacy of this innovative intervention in improving executive function and alleviating ADHD symptoms.

Ethical approval was obtained from the Human Research Ethics Committee at the University of Hong Kong (Reference: EA200247). Results will be published in peer-reviewed journals and presented at conferences.

NCT05906485.

With dual focus on structured, objective quantification of parent observations of child's behavior and identifying behaviors most amenable to change, this report examines Parent Target Problems (PTP) as a secondary outcome in a randomized clinical trial (RCT) of children with attention-deficit/ hyperactivity disorder (ADHD) in which one primary outcome, Clinical Global Impression-Improvement, showed a significant advantage of multinutrients over placebo and the other, Likert-type parent ratings, showed significant improvement in both groups, without significant difference between them.

In a multisite 8-week RCT of broad-spectrum micronutrients ("multinutrients"), parents of children ages 6-12 (N = 126, 73% male, 88% white) with ADHD and emotional dysregulation nominated their child's most concerning problem(s) at baseline and quantified them by frequency, duration, impairment, and consequences. At subsequent visits, parents re-quantified the problem(s). Blinded child psychiatrists independently reviewed the PTPs and rated change at two timepoints compared to baseline. PTPs were grouped into 9 categories. Mean ratings were compared between active and placebo groups and explored by category.

By week 8, a significant separation favored multinutrients: 38% of the multinutrient group were "definitely improved" or better, compared to 25% of the placebo group, and ratings of "no change" or "worse" occurred in 35% with placebo versus 23% with multinutrients (p = 0.04). Inattention (72.2%) and emotional dysregulation (69.1%) were the most frequently reported PTP categories. Inattention and internalizing symptoms improved more with multinutrients than placebo (p = 0.01, d = 0.55; p = 0.03, d = 0.80, respectively). The multinutrient advantage was not significant for 7 other symptoms, including hyperactivity/impulsivity, aggression, autistic symptoms, or emotional dysregulation/irritable oppositionality.

This secondary analysis found that the multinutrients, compared to placebo, were associated with improvements in parental concerns overall, and in two domains specifically: inattention and internalizing symptoms (anxiety/depression), but not in seven domains: hyperactivity/impulsivity, aggression, autistic symptoms or physiological symptoms, peer relationships or emotional dysregulation/irritable oppositionality.

Background: Attention deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder characterised by deficits in attention, hyperactivity, and impulsivity. Current treatments, such as stimulant medication and behavioural therapy, ameliorate symptoms but do not address the core cognitive dysfunctions. This study aimed to investigate the effects of two computerised neurocognitive training programs, attention functions training and executive functions training, in children with ADHD. Methods: Eighty children with ADHD (ages 8-13) were randomly assigned to one of three groups: Attention functions training (AFT), targeting sustained, selective-spatial, orienting, and executive attention; executive functions training (EFT), focusing on working memory, cognitive flexibility, and problem solving; or a passive control group. Training sessions were administered in small groups twice a week for nine weeks. Participants underwent comprehensive assessments of attention (Continuous Performance Test, Conjunctive Visual Search Task), executive functions (Corsi Block-Tapping Tasks), nonverbal reasoning (Raven's Colored Progressive Matrices), parent-rated behavioural symptoms, and arithmetic performance at baseline, post-intervention, and follow-up. Results: The AFT group demonstrated significant improvements in sustained and selective-spatial attention, nonverbal reasoning, inattentive symptoms, and arithmetic performance, and most improvements persisted at follow-up. The EFT group showed gains in nonverbal reasoning and inattentive symptoms, although no improvements were documented in working memory or in parent ratings of executive functions. Conclusions: The AFT program that addressed core attentional functions in children with ADHD produced robust cognitive and behavioural benefits, whereas the EFT program yielded behavioural benefits and a limited improvement in executive functions. Future research should explore different training protocols for broader gains in executive functions. These findings support the potential of theory-driven, structured neurocognitive training targeting basic cognitive functions as an effective small-group intervention for ADHD.

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.

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity. ADHD is commonly treated with medication, such as methylphenidate, but some families and practitioners prefer psychosocial interventions as first line treatments. Many studies have investigated neurofeedback as a potential non-pharmacological treatment for ADHD yielding contradictory findings regarding its efficiency. Qualitative research on neurofeedback in ADHD is limited and can add valuable information on the acceptability and perceived efficacy among service users. This study aimed to explore the perceptions and experiences of children and adolescents with ADHD regarding the use of neurofeedback and methylphenidate. Eleven interviews with children and their parents explored their subjective experiences and perceived changes. Overall, neurofeedback was negatively experienced by those families: the intervention did not meet their expectations, and they reported minimal observed changes. The treatment with methylphenidate, however, was more manageable for families and was perceived to be more efficient despite its side effects.

Attention deficit hyperactivity disorder (ADHD) is a disorder that is prevalent in children and adults, with significant impact on life outcomes. Common treatment strategies include a combination of pharmacological and psychosocial interventions which have recognized limits to their effectiveness. Consequently, there exists interest in additional non-pharmacological interventions. In the current minireview we aim to complement existing surveys by focusing on a complementary approach, namely rooted in metacognition or the training of awareness. We review programs that incorporate metacognitive training of awareness in skill-training, psychosocial interventions, and mindfulness, and discuss existing assessments of metacognitive ability in ADHD. Existing data suggest that metacognitive approaches have potential in supporting symptom management in ADHD, with gains in objective assessments in near and far transfer tasks in educational research and high satisfaction from parents. Further research is warranted in assessment of the relative contribution of metacognitive elements relative to other treatment components, objective assessments of outcomes in psychosocial interventions, and efficacy in adult interventions.

A smartphone app, Parent Positive, was developed to help parents manage their children's conduct and emotional problems during the COVID-19 pandemic. A randomized controlled trial, Supporting Parents and Kids Through Lockdown Experiences (SPARKLE), found Parent Positive to be effective in reducing children's emotional problems. However, app effectiveness may be influenced by a range of child, family, socioeconomic, and pandemic-related factors.

This study examined whether baseline factors related to the child, family, and socioeconomic status, as well as pandemic-related disruption circumstances, moderated Parent Positive's effects on child conduct and emotional problems at 1- and 2-month follow-up.

This study was a secondary exploratory analysis of SPARKLE data. The data set included 646 children (4-10 years of age) with parents randomized to either Parent Positive (n=320) or follow-up as usual (n=326). Candidate baseline moderators included child age, gender, attention-deficit/hyperactivity disorder symptoms, parental psychological distress, family conflict, household income, employment status, household overcrowding, and pandemic-related disruption risk (ie, homeschooling, lockdown status, and isolation status). Child conduct and emotional problem outcomes measured at 1- (T2) and 2-months (T3) post randomization were analyzed using linear mixed-effects analysis of covariance models adjusting for baseline (T1) measure of outcome and including intervention and intervention by time point interaction terms allowing for different effects at the 2 time points. Moderation of intervention effects by baseline factors was assessed by replacing the intervention by time interaction terms with intervention by time point by baseline moderator interaction terms.

Child gender was a significant moderator of the Parent Positive versus follow-up as usual effect on emotional problems (B=0.72, 95% CI 0.12-1.33; P=.02). Specifically, the effect of Parent Positive was close to significant (T2: B=-0.41, 95% CI -0.82 to 0.0004; P=.05) or significant (T3: B=-0.76, 95% CI -1.22 to -0.30; P<.001) in males only when compared with females, and males experienced a significantly larger reduction in emotional problems than females in the Parent Positive arm at the 2-month post randomization time point. None of the other investigated baseline factors moderated effects on emotional problems, and no factors moderated effects on conduct problems.

This study highlights Parent Positive's potential for effectively reducing emotional problems in primary school-aged male children across a wide range of families. However, due to limited variability in the demographic background of the families, cautious interpretation is required, and replications are necessary in diverse samples with longer follow-up times.

ClinicalTrials.gov NCT04786080; https://clinicaltrials.gov/ct2/show/NCT04786080.

Behavioural parent training (BPT) is a psychosocial intervention designed for children with attention deficit hyperactivity disorder (ADHD). BPT programs teach parents to use effective commands or rules whilst encouraging them to pay careful attention to their child's appropriate behaviour. In this study, we will investigate the efficacy of BPT on parental stress, mothers' sense of emotional closeness to their children, and children's attachment security to their mothers. We will also examine the effects of BPT on children's internalising and externalising symptoms, ADHD symptoms, and sensitivity to rewards and punishments compared to usual care alone. The use of bias-prone assessment tools limits the ability of previous studies to assess effectiveness. Therefore, in this study, the child's attachment security will be assessed in a structured interview conducted by assessors blinded to group allocation, and brain changes will be assessed using magnetic resonance imaging.

This randomised controlled clinical trial will aim to compare the efficacy of BPT to routine clinical care for 60 children with ADHD. Participants will be randomised, with stratification by medication status for ADHD (medicated or non-medicated). The BPT intervention group will receive parent training weekly for 10 weeks in a group of six or less. The primary outcome measure will be changes in parental stress. Furthermore, the key secondary outcome measure will be the child's attachment security, which will be assessed in an interview conducted by assessors blinded to group allocation. We will also evaluate changes in neural connectivity in both children and mothers using magnetic resonance imaging. Other secondary outcomes will include child behavioural problems, ADHD symptoms, emotional regulation, child sensitivity to rewards and punishments, parental behaviour, and the child and parent's social support network following the completion of 10 sessions.

This study represents the first randomised controlled trial exploring the efficacy of BPT on child attachment security and mothers' sense of emotional closeness to their children. It aims to provide robust evidence to assist parents of children with ADHD in making appropriate treatment decisions.

UMIN000038693. Registered on November 9, 2019.

To provide an updated review of novel and complementary treatment approaches for children and adolescents with attention-deficit/hyperactivity disorder.

The evidence for complementary attention-deficit/hyperactivity disorder treatments is often promising, but limited to small, unblinded studies. Recent evidence from larger, more rigorous studies reveals that most of these treatments have modest efficacy. Omega-3 polyunsaturated fatty acids, saffron, broad spectrum micronutrients, and physical exercise have potential benefits that seem to outweigh known risks. However, neurofeedback, cognitive training, and trigeminal nerve stimulation need further research to determine whether specific sub-groups of children/adolescents with attention-deficit/hyperactivity disorder would benefit long-term with their associated tolerable risks.

There is not sufficient evidence for complementary treatments to be recommended as substitutes for first-line pharmacological and psychosocial treatment options. Nonetheless, some adjuvant therapies to currently recommended attention-deficit/hyperactivity disorder treatments can be safe. Physicians should be familiar with existing and emerging complementary treatments to help guide families.

To provide an overview of treatments in the pipeline for adults with attention-deficit/hyperactivity disorder (ADHD), we searched https://clinicaltrials.gov/and and https://www.clinicaltrialsregister.eu/ from 01/01/2010-10/18/2023 for ongoing or completed phase 2 or 3 randomised controlled trials (RCTs), assessing pharmacological or non-pharmacological interventions for adults with ADHD with no current regulatory approval. We found 90 eligible RCTs. Of these, 24 (27 %) reported results with statistical analysis for primary efficacy endpoints. While several pharmacological and non-pharmacological interventions had evidence of superiority compared to the control condition from a single RCT, centanafadine (norepinephrine, dopamine, and serotonin re-uptake inhibitor) was the only treatment with evidence of efficacy on ADHD core symptoms (small effect size=0.28-0.40) replicated in at least one additional RCT, alongside reasonable tolerability. Overall, the body of ongoing RCTs in adults with ADHD is insufficient, without any intervention on the horizon to match the efficacy of stimulant treatment or atomoxetine and with better tolerability profile. Additional effective and well tolerated treatments for adults with ADHD require development and testing.

In recent years, the relationship between nutrition and mental health has gained considerable interest. We identified, synthesized, and appraised all meta--analyses of randomized controlled trials (RCTs) and observational studies reporting on the efficacy of dietary patterns and nutrient supplements in the prevention and treatment of mental disorders in children and adolescents.

Systematic research in MEDLINE, PsycINFO, Scopus, and Cochrane Database of Systematic Reviews was completed on 8 January 2024.

Our research found 24 meta-analyses: 14 on RCTs, 8 on observational studies, and 2 combining both. Emerging evidence suggests that omega-3, in particular eicosapentaenoic acid, and Vitamin D may have adjunctive benefits in the treatment of attention deficit hyperactivity disorder (ADHD), while no evidence was found for autism spectrum disorder (ASD). Observational data also indicated that prenatal folic acid supplementation (>400 μg daily) was associated with a reduced risk of ASD in offspring. In terms of dietary habits, several meta-analyses of observational data revealed that healthy dietary patterns (rich in fruits, vegetables, and fibre, low in saturated fats) during the prenatal period, childhood, and adolescence were linked to a significantly reduced risk of internalizing disorders and externalizing disorders. Conversely, unhealthy dietary habits (high in sugars, saturated animal fats, and industrial foods, low in fruits, vegetables, and fibre) are associated with an elevated risk of these mental health issues. However, the number of available studies on dietary interventions for the treatment of depression, ASD, and ADHD was limited, and the results obtained were either nonsignificant or contradictory.

Our findings emphasize the need to establish clear causal relationships between dietary habits and the risk of mental illness in children and adolescents. Moreover, further investigation of the benefits observed with some nutrient supplements (such as omega-3 and vitamin D for ADHD) through larger-scale RCTs is imperative to establish more robust conclusions.

Recent research has increasingly emphasized the function of the microbiome in human health. The gut microbiome is essential for digesting food and seems to play a vital role in mental health as well. This review briefly overviews the gut microbiome and its interplay with the central nervous system. We then summarize some of the latest findings on the possible role of the microbiome in psychiatric disorders in children and adolescents. In particular, we focus on autism spectrum disorder, attention-deficit/hyperactivity disorder, anorexia nervosa, bipolar disorder, and major depressive disorder. Although the role of microbiota in mental development and health still needs to be researched intensively, it has become increasingly apparent that the impact of microbiota must be considered to better understand psychiatric disorders.

Individuals diagnosed with attention deficit/hyperactivity disorder (ADHD) have been found to have impairments in multiple aspects of social cognition, thus including the attentional processing of socially relevant stimuli such as eye-gaze. However, to date, it remains unclear whether only the social-specific but not the domain-general directional components, elicited by eye-gaze are affected by ADHD symptomatology. To address this issue, the present study aimed to investigate the impact of ADHD-like traits on the social-specific attentional processing of eye-gaze. To this purpose, we conducted an online experiment with a sample of 140 healthy undergraduate participants who completed two self-reported questionnaires designed to assess ADHD-like traits, and a social variant of an interference spatial task known to effectively isolate the social-specific component of eye-gaze. To make our research plan transparent, our hypotheses, together with the plans of analyses, were registered before data exploration. Results showed that while the social-specific component of eye-gaze was evident in the sample, no significant correlation was found between this component and the measured ADHD-like traits. These results appear to contradict the intuition that the attentional processing of the social-specific components of eye-gaze may be impaired by ADHD symptomatology. However, further research involving children and clinical populations is needed in order to clarify this matter.

(1) Background: Previous studies have identified discrepancies in improvements in executive functioning in typically developing children when comparing closed- and open-skill exercise interventions. However, there is limited research on executive functioning in attention deficit hyperactivity disorder (ADHD). This study aims to conduct a systematic review and meta-analysis to explore the impact of closed- and open-skill exercises on ADHD populations. (2) Methods: The PRISMA guidelines for systematic reviews were followed to search seven databases to evaluate and analyze studies published from 2013 to 2023. Prospero: CRD42023460452. (3) Results: A meta-analysis of 578 subjects with ADHD in 11 RCTs (Randomized control trial) and 3 NRS (Non-randomized studies) revealed that closed-skill exercise significantly improved executive function subdomains, including inhibitory control (standardized mean differences (SMD) = -1.00), cognitive flexibility (SMD = -1.33), and working memory (SMD = -0.85). Furthermore, open-skill exercise was found to have a positive effect on inhibitory control (SMD = -1.98) and cognitive flexibility (SMD = -0.97) in ADHD patients. Both types of exercise interventions demonstrated an improvement in executive function compared to controls, with open-skill exercises exhibiting superior effects (Qb = 6.26). (4) Conclusions: The review recommends a 12-week intervention cycle with exercise at least twice a week of moderate or higher intensity as suitable for ADHD individuals. This review also encourages individuals with ADHD to engage in exercises involving multiple motor skill types.

Many adolescents with attention-deficit hyperactivity disorder (ADHD) have executive functioning (EF) difficulties that contribute to academic and social-emotional challenges. This pilot explored adherence to and effectiveness of modified Goal Management Training (GMT), an EF intervention, with ADHD youth. Six adolescents with ADHD (14-17 years, 2 female) participated in a 6-session online group. Adherence was tracked via attendance and homework. Reliable change scores gaged pre-post differences on measures before and after training (primary: everyday EF and goal attainment; secondary: EF task performance, functional impairment, emotional adjustment, and self-concept). All youth attended at least 4 sessions, though homework completion was mixed. Four youth achieved their goal, some demonstrated reliable change on outcome measures, and all evidenced a reduction in impairment. Results support the feasibility of modified GMT in adolescents with ADHD and suggest that youth may benefit from this more personalized and holistic approach to EF intervention.

Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder that is typically managed with pharmacological and psychotherapeutic interventions. In the general population, exposure to nature has been found to have robust beneficial effects on cognitive performance, including attention. With inattention being a factor of the symptomatology of individuals with ADHD, this provides a rationale to investigate the potential benefits of exposure to nature for this population. Four electronic databases (PubMED, PsycINFO, Embase, and Web of Science) were searched for empirical studies investigating the effects of nature on ADHD prevalence and/or symptom severity in populations of school-aged children. Key characteristics, methodologies, and outcomes of included studies were extracted and evaluated. Out of the 458 studies identified, 7 met the inclusion criteria. Despite the large heterogeneity in methodological approaches, the included articles consistently reported that exposure to nature is associated with reduced ADHD diagnoses and symptom severity. Furthermore, when several covariates, such as age, gender, annual household income, parental income, and education level, as well as several pre-natal factors, were controlled for, the relationship between nature and ADHD remained significant. The reviewed literature provides strong support for the benefits of exposure to nature on ADHD in school-aged children.

Attention Deficit Disorder with or without Hyperactivity (ADHD is a neurodevelopmental disorder which affects the day-to-day functioning of children and adults with this condition. Pharmacological treatment can reduce the symptoms associated with ADHD, but it has some limitations. The objective of this symposium is to determine the effects of non-pharmacological approaches on ADHD symptoms. Results indicate that the following intervention are promising approaches: cognitive behavioral therapy (CBT), mindfulness-based interventions (MBI), yoga, cognitive and metacognitive intervention, neurofeedback and parental training programs. Current research advocates multimodal approaches in conjunction with school or work accommodations integrating innovative technologies.

ADHD is widely recognized as the most prevalent neurodevelopmental disorder in children. Recently, the potential role of gut microbiota as an etiological factor in ADHD has gained attention. This systematic review aims to investigate the potential impact of probiotic supplements on alleviating ADHD symptoms and influencing behavior.

PubMed, Web of Science, Cochrane Library, and SCOPUS were searched from inception to May 2023. Only randomized controlled trials that have suitable data of the effects of probiotics/synbiotics on children with ADHD were enrolled. The risk of bias of the included studies was assessed by Cochrane Collaboration risk of bias tool.

Five related randomized controlled trial were evaluated in the current review. Types of interventions ranged from single/multi strain probiotics to synbiotic. The duration of intervention in all of the studies were 2 to 3 months. The assessed outcomes were very diverse and different tools were used to report the symptoms in children. Among those which used Conners' Parent Rating Scale, a decrease in the total score occurred in the probiotic group, compared to the placebo group. An improvement in both intervention and control groups was seen in one study which used ADHD-Rating Scale.

In summary, the combined findings from the reviewed studies suggest that probiotic supplements might potentially serve as a complementary intervention for ADHD. However, given the small number of studies, limited sample sizes, and the diversity of probiotic strains, further research is needed to clarify the effects of probiotics in children with ADHD. The observed tolerability of probiotics is noteworthy as none of the studies report adverse effects.

This study explores the neural underpinnings of cognitive control deficits in ADHD, focusing on overlooked aspects of trial-level variability of neural coding. We employed a novel computational approach to neural decoding on a single-trial basis alongside a cued stop-signal task which allowed us to distinctly probe both proactive and reactive cognitive control. Typically developing (TD) children exhibited stable neural response patterns for efficient proactive and reactive dual control mechanisms. However, neural coding was compromised in children with ADHD. Children with ADHD showed increased temporal variability and diminished spatial stability in neural responses in salience and frontal-parietal network regions, indicating disrupted neural coding during both proactive and reactive control. Moreover, this variability correlated with fluctuating task performance and with more severe symptoms of ADHD. These findings underscore the significance of modeling single-trial variability and representational similarity in understanding distinct components of cognitive control in ADHD, highlighting new perspectives on neurocognitive dysfunction in psychiatric disorders.

We call for a reevaluation of the long-standing dogmatic nutritional principle that "all foods fit" for all cases of eating disorders (EDs) and its corollary, "there are no bad foods" (for anyone ever) during ED treatment. Based on accumulated scientific research, we challenge these ideologies as outdated, confusing, and potentially harmful to many patients. We review the evidence that indicates the folly of these assumptions and show there are a variety of exceptions to these rules, including (1) food allergies, sensitivities, and intolerances, (2) religious and spiritual preferences or doctrines, and (3) the ubiquitous emergence and widespread availability of ultra-processed foods leading to the potential development of addiction-like eating and a higher prevalence of various medical and psychiatric comorbidities, as well as higher mortality. This evidence supports a nutritional psychiatry approach that should be integrated into (rather than dissociated from) ED treatment research and practice.

This study conducts a bibliometric analysis on neurofeedback research to assess its current state and potential future developments.

It examined 3,626 journal articles from the Web of Science (WoS) using co-citation and co-word methods.

The co-citation analysis identified three major clusters: "Real-Time fMRI Neurofeedback and Self-Regulation of Brain Activity," "EEG Neurofeedback and Cognitive Performance Enhancement," and "Treatment of ADHD Using Neurofeedback." The co-word analysis highlighted four key clusters: "Neurofeedback in Mental Health Research," "Brain-Computer Interfaces for Stroke Rehabilitation," "Neurofeedback for ADHD in Youth," and "Neural Mechanisms of Emotion and Self-Regulation with Advanced Neuroimaging.

This in-depth bibliometric study significantly enhances our understanding of the dynamic field of neurofeedback, indicating its potential in treating ADHD and improving performance. It offers non-invasive, ethical alternatives to conventional psychopharmacology and aligns with the trend toward personalized medicine, suggesting specialized solutions for mental health and rehabilitation as a growing focus in medical practice.

An Elimination Diet (ED) may be effective in reducing symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD), but has never been compared to an active control condition [i.e., Healthy Diet (HD)]. In a two-armed RCT, a total of N = 165 children (5-12 years) with ADHD were randomized by means of minimization (1:1) to either an ED (N = 84) or HD (N = 81) within two Dutch child and adolescent psychiatry centers. The design included a non-randomized comparator arm including N = 58 children being treated with Care as Usual (CAU). Treatment allocation was unblinded. The primary outcome was a 5-point ordinal measure of respondership based on a combination of parent and teacher ratings on ADHD and emotion regulation, determined after 5 weeks of treatment. Ordinal regression analyses were done on an intention-to-treat basis. Fewer ED (35%) than HD (51%) participants showed a partial to full response, despite overall good-to-excellent treatment adherence (> 88%) and comparable high parental prior believes. A younger age and higher problem severity predicted a better respondership. CAU-preferring participants responded more often favorably (56%) compared to ED-but not HD-participants. Small-to-medium improvements in physical health (blood pressure, heart rate, and somatic complaints) were found in response to ED/HD versus decrements in response to CAU (74% received psychostimulants). The lack of superiority of the ED versus HD suggests that for the majority of children, dietary treatment response is not rooted in food-allergies/-sensitivities. The comparable results for treatment with HD and CAU are remarkable given that CAU participants were probably 'easier to treat' than HD (and ED) participants with proportionally fewer with a (suboptimal/non-response to) prior treatment with medication (4% versus 20%). Further assessment of long-term effects is needed to evaluate the potential place of dietary treatment within clinical guidelines. The trial is closed and registered in the Dutch trial registry, number NL5324 ( https://www.onderzoekmetmensen.nl/en/trial/25997 ).

(1) Objectives: This study aimed to assess the 5-year prevalence and clinical profile of attention deficit hyperactive disorder (ADHD) among adult patients seeking care in a tertiary care hospital in Oman. (2) Methods: The data were analysed using descriptive and inferential statistics and standardised prevalence estimates were calculated. (3) Results: Of the 39,881 hospital visits, 1.77% were made by adults with ADHD. This is equivalent to 17.8 visits per 1000 outpatients. The year 2021 saw the highest prevalence among the five years considered, while 2020 had the lowest prevalence. Although the age distribution indicated that the age group 'under 20' had the highest prevalence, the gender distribution showed that ADHD was more common among adult men. Among the various subtypes of ADHD, inattention was the most common. (4) Conclusions: This study specifically compared the prevalence and associated factors between an adult cohort with ADHD and those other psychiatric clinic attendees during the same period. The study offers important information on the prevalence and clinical profile of adults with ADHD in the population under consideration.

Electroencephalographic neurofeedback (NFB), as a non-invasive form of brainwave training, has been shown to be effective in the treatment of various mental health disorders. However, only few results regarding manualised and standardised NFB trainings exist. This makes comparison as well as replication of studies difficult. Therefore, we developed a standard manual for NFB training in patients with mental health disorders attending a psychosomatic outpatient clinic. The current study aims at investigating the conduction of a standardised manual for NFB training in patients with mental health disorders. If successful, the study provides new opportunities to investigate NFB in a more controlled and comparable manner in clinical practice.

30 patients diagnosed with a mental health disorder will be included. After the educational interview, patients will undergo baseline diagnostics (T0). The subsequent intervention consists of 10 sessions of NFB training aiming at increasing sensorimotor rhythm and alpha-frequency amplitudes and decreasing theta-frequency and high beta-frequency amplitudes to induce relaxation and decrease subjective stress. All patients will undergo a post-treatment diagnostic assessment (T1) and a follow-up assessment 8 weeks following the closing session (T2). Changes in amplitude bands (primary outcome) will be recorded with electroencephalography during pre-assessments, post-assessments and follow-up assessments and during NFB sessions. Physiological (respiratory rate, blood volume pulse, muscle tension) and psychometric parameters (distress, perceived stress, relaxation ability, depressive and anxiety symptoms, insomnia, self-efficacy and quality of life) will be assessed at T0, T1 and T2. Moreover, satisfaction, acceptance and usability will be assessed at T1 after NFB training. Further, qualitative interviews about the experiences with the intervention will be conducted with NFB practitioners 6 months after the study starts. Quantitative data will be analysed using repeated measures analysis of variance as well as mediation analyses on mixed linear models. Qualitative data will be analysed using Mayring's content analysis.

The study was approved by the ethics committee of the Medical Faculty of the University of Duisburg-Essen (23-11140-BO) and patient enrolment began in April 2023. Before participation, written informed consent by each participant will be required. Results will be published in peer-reviewed journals and conference presentations.

Prospectively registered on 28 March 2023 in the German clinical trials register, DRKS00031497.

Effective treatment of attention-deficit/hyperactivity disorder (ADHD) is essential to improving youth outcomes.

This systematic review provides an overview of the available treatment options.

We identified controlled treatment evaluations in 12 databases published from 1980 to June 2023; treatments were not restricted by intervention content.

Studies in children and adolescents with clinically diagnosed ADHD, reporting patient health and psychosocial outcomes, were eligible. Publications were screened by trained reviewers, supported by machine learning.