Search Results (2,130)

Objectives: Attention-deficit hyperactivity disorder (ADHD) is the most prevalent neurodevelopmental disorder diagnosed during childhood, primarily characterized by continuous symptoms of inattention, hyperactivity, and impulsivity. The present study aimed to investigate the genetic association between polymorphisms in the serotonergic system-related genes, HTR1B and HTR2A, and the susceptibility to ADHD in a Korean sample. Methods: The study cohort consisted of 234 children diagnosed with ADHD and 1686 healthy controls. Clinical diagnosis was established based on the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) criteria. Genetic analysis focused on single nucleotide polymorphisms (SNPs) within the serotonergic pathway: rs6296 in HTR1B, and three SNPs (rs6311, rs6313, and rs9534495) in HTR2A. Genotype and allele frequencies were analyzed using Chi-square tests. Risk estimates were calculated as odds ratios (OR) with 95% confidence intervals (CI) across dominant, recessive, and additive inheritance models. Results: A statistically significant association was observed between the HTR2A rs9534495 polymorphism and ADHD. Specifically, significant associations were identified under the dominant (OR 0.67, 95% CI 0.48–0.93, p = 0.017), recessive (OR 0.67, 95% CI 0.48–0.93, p = 0.016), and additive (OR 0.80, 95% CI 0.65–1.00, p = 0.046) models. However, these significant findings did not persist after applying the Bonferroni correction for multiple comparisons. Conversely, no significant associations were detected for the HTR1B (rs6296) and the other HTR2A (rs6311, rs6313) polymorphisms. Conclusions: These findings suggest that genetic variations in the serotonergic system, particularly within the HTR2A gene, may contribute to the genetic susceptibility to ADHD. This study confirmed gene SNIPs associated with the serotonergic system in the pathophysiology of ADHD. Future research involving large-scale multi-ethnic cohorts, functional assays, and gene–environment interaction analyses is warranted to further elucidate the underlying mechanisms of serotonergic genes. Full article

Behavioral parent training (BPT) is a front-line psychosocial treatment for childhood ADHD, yet its real-world effectiveness is often constrained by parents’ ability to consistently implement learned strategies. Parental ADHD is a prevalent and mechanistically important factor shaping both parenting behavior and child treatment response. Among parents with ADHD, deficits in executive functioning and emotion regulation, abilities essential for consistent and effective BPT implementation, often interfere with parents’ ability to apply learned strategies. Consequently, parental ADHD predicts reduced in-home skill use and attenuated child treatment gains, positioning it as a potentially critical, treatment-relevant risk factor. This narrative review synthesizes evidence on the intergenerational transmission of ADHD-related impairments, the impact of parental ADHD on parenting practices, and the role of parental ADHD as a moderator of BPT outcomes. We also examine existing approaches to addressing parental ADHD within the context of child BPT, including both pharmacological and psychosocial strategies, and evaluate their implications for parenting and child response. Building on this, we propose an intergenerational reconceptualization of psychosocial care for childhood ADHD in which parental functioning is routinely assessed and supported within BPT. Promising directions include integrating CBT-informed strategies to scaffold parents’ cognitive and regulatory processes, incorporating digital health tools that provide just-in-time guidance at the point of parenting performance, and tailoring BPT emphasis for families affected by multigenerational ADHD. Ultimately, embedding parent-focused supports within BPT may be essential for strengthening treatment impact, durability, and real-world effectiveness for many children and families. Full article

Background/Objectives: Attention-Deficit/Hyperactivity Disorder (ADHD) is associated with working memory deficits linked to frontoparietal alterations. Non-invasive brain stimulation (NIBS) is a potential intervention to modulate neuroplasticity and improve this executive function. In this study, we aimed to evaluate the clinical efficacy of non-invasive brain stimulation techniques (tDCS/rTMS) for strengthening working memory in children and adolescents with ADHD. Methods: This systematic review adhered to the PRISMA 2020 guidelines, with a search of Scopus and Web of Science conducted to identify relevant studies published between 2011 and 2026. Eligibility criteria, defined a priori, included original empirical studies (RCTs and quasi-experimental designs) focusing on pediatric populations (≤18 years) diagnosed with ADHD. Eligible interventions involved tDCS or rTMS with explicit working memory outcomes. Only peer-reviewed articles published in English or Spanish were included. Reviews, case reports, and studies exclusive to adults were excluded. Data on application parameters, durability, and safety were extracted for narrative synthesis. Results: Six studies met the criteria. Both tDCS and rTMS targeting the left dorsolateral prefrontal cortex showed improvements in working memory, particularly in executive components measured using digit span backward and N-back tasks. High-frequency rTMS (10 Hz) with repeated sessions showed more consistent effects, while tDCS showed modest and variable improvements. Evidence regarding long-term effects was limited. Both techniques were well-tolerated, with mild and transient adverse events. Conclusions: NIBS shows promise as a complementary intervention to improve working memory in pediatric ADHD; however, current evidence is limited. Larger, standardized, longitudinal trials are required to confirm its efficacy and clinical utility. Full article

Background/Objectives: Sleep-disordered breathing (SDB), including obstructive sleep apnea, is common in children and is associated with mouth breathing, snoring, and neurobehavioral disturbances. In pediatric orthodontic patients, oral habits and craniofacial imbalances may contribute to airway dysfunction, making orthodontic evaluation a potential setting for early identification of SDB. This study aimed to estimate the prevalence of SDB and to evaluate its associations with parent-reported behavioral symptom profiles in a cohort of pediatric orthodontic patients. Methods: A multicenter cross-sectional study was conducted in 186 children aged 7–13 years attending orthodontic clinics in Oradea and Târgu Mureș, Romania. Parents completed a structured questionnaire on oral habits, the 22-item Pediatric Sleep Questionnaire (PSQ), with SDB defined as 8 or more positive responses, and a parent-reported behavioral screening form assessing ADHD symptom subtypes, oppositional-defiant disorder (ODD), conduct disorder, and anxiety/depression. These behavioral outcomes were based on screening measures and were not intended as clinical psychiatric diagnoses. Associations were analyzed using chi-square or Fisher’s exact tests, and multivariable logistic regression analyses were performed adjusting for age, sex, and weight status. Results: Mouth breathing was reported in 61.8% of participants, snoring in 26.9%, and SDB in 13.4%. Positive screens for ADHD-inattentive (p < 0.001), ADHD-hyperactive/impulsive (p < 0.001), ADHD-combined (p < 0.001), ODD (p < 0.001), and anxiety/depression (p < 0.001) were significantly more frequent among children with SDB. In multivariable analysis, SDB remained independently associated with ADHD-combined subtype (OR = 6.22), ADHD-hyperactive/impulsive symptoms (OR = 5.84), oppositional-defiant disorder (OR = 4.91), and anxiety/depression (OR = 4.38). Conclusions: SDB was identified in a meaningful proportion of pediatric orthodontic patients and was significantly associated with multiple screening-defined behavioral symptom domains. These findings support consideration of brief airway- and sleep-oriented screening during orthodontic assessment, particularly in school-aged children presenting with mouth breathing, snoring, or behavioral concerns. Given the cross-sectional and questionnaire-based design, the findings should be interpreted as associative and warrant confirmation in prospective studies using objective sleep measures. Full article

Background/Objectives: Attention-deficit hyperactivity disorder (ADHD) in adults is often overlooked in refugees, especially those displaced by war and diagnosed with chronic issues such as hypertension and type 2 diabetes mellitus. We sought to provide a preliminary screening to align with ADHD screening and to examine its related demographic and clinical factors. Methods: This cross-sectional study recruited Syrian refugees residing in Jordan. The Adult ADHD Self-Report Scale-V1.1 (ASRS) was employed to provide a preliminary screening of “Consistency with ADHD screening”. Multivariable regression analysis was used to identify the risk factors associated with the “Consistency with ADHD screening”. Results: Data analysis included 345 patients; 179 (51.9%) were females. β-Blockers were used in 151 (43.8%), metformin in 134 (38.8%), and sulfonylurea in 86 (24.9%). In the study, 158 participants (45.8%) reported very consistent results related to ADHD. We used multivariate binary logistic regression, which showed that in our groups that received metformin (OR of 2.08, 95% CI 1.32–3.27, p = 0.001) and insulin (OR of 2.25, 95% CI 1.00–5.04, p = 0.04), we observed a positive association with ADHD symptoms. Also, we noted that high school education was negatively associated with the results of the ADHD screen (OR of 0.58, 95% CI of 0.36–0.94, p = 0.02). Conclusions: This preliminary study guides future steps in addressing ADHD symptoms in war-displaced refugees; proper diabetes management and education seem to be important factors. Full article

Background: This study aimed to estimate the prevalence and associated demographic factors of autism spectrum disorder (ASD) in children aged 3 to 6 years in Bahrain, as well as to identify co-occurring developmental disorders. Methodology: The study sample comprised 500 children who attended eight health centers across four governorates (Group A) in Bahrain. A second group (Group B) consisted of all children who completed their diagnosis at the Child and Adolescent Psychiatric Unit for ASD from June 2023 to May 2024 to identify associated developmental disorders (n = 232). Group A mothers were interviewed using the M-CHAT-R. For Group B, we used children’s files, the General Intelligence Scale (Stanford-Binet), the M-CHAT-R, the CARS, Conners’ Form, and the Zarit Burden Interview to assess family burden. Additionally, a file review was conducted to determine the presence of intellectual disability (ID) in Group B cases. The Conner-3 Short Forms Test was administered to all cases aged 6 years or older (n = 64), and family burden was assessed using the Zarit Burden Interview Scale for reachable cases (n = 176). Results: Group A findings indicated an overall screen-based/at risk prevalence of ASD of 2.6%, with a higher prevalence in males (1.6%) compared to females (1%). In Group B, there was a78% prevalence of ID and a 17.2% prevalence of attention-deficit/hyperactivity disorder (ADHD). The study also found that the impact of having a child with ASD on the family varied based on the nature and severity of the disorder or disability, with moderate to severe burden reported at approximately 38%. Conclusions: The prevalence of ASD among young children was notably high, particularly among males. The most common comorbidities were ID followed by ADHD. The family burden associated with ASD was significant, with more than one third reporting moderate to severe burden. These data are essential for informing health education and social service planning. Full article

SARS-CoV-2 infection is associated with not only acute respiratory symptoms but is also characterized by strong neurotropism which may contribute to the development of the multisystem post-COVID syndrome (PASC). Patients frequently report chronic neurocognitive disorders such as brain fog, significant attention deficits and increased susceptibility to epileptiform discharges. The aim of this review is to systematize the knowledge regarding deviations in quantitative electroencephalography (QEEG) recordings in convalescents and to evaluate the utility of this method as an objective biomarker. This work constitutes a comprehensive literature review integrating the latest data on neuroinflammation, blood-brain barrier damage and changes in cortical oscillatory dynamics induced by the infection. The literature analysis indicates that the virus may induce a pathological excitation and inhibition imbalance (E/I imbalance) in neuronal networks. In QEEG studies this manifests as excessive activity of slow bands (Theta, Delta), a deficit of rhythms responsible for attention and sensorimotor integration (SMR) and a pathologically elevated Theta to Beta ratio (TBR). In conclusion, QEEG can serve as an objective and highly sensitive tool supporting the diagnosis and stratification of patients with neurocognitive complications of Long COVID. The integration of precise electrophysiological phenotyping with targeted behavioral neuromodulation (e.g., EEG-Biofeedback) fits into the paradigm of personalized medicine and offers a prospective strategy for mitigating long-term neurological burdens. Full article

Background/Objectives: Physical restraints and seclusion remain ethically contested interventions in psychiatric care, raising significant concerns regarding patient safety, dignity, and therapeutic impact. Despite growing international momentum towards restraint-reduction strategies, their use persists across the Eastern Mediterranean Region (EMR), an area that has been the subject of limited systematic attention. This review synthesises evidence on the knowledge, attitudes, and experiences of nurses and individuals with mental illness regarding these practices in EMR psychiatric settings. Methods: Following PRISMA 2020 guidelines (PROSPERO: CRD42023383751), we systematically searched nine electronic databases for studies published up to June 2023, supplemented by backward and forward citation searching. Multiple reviewers independently screened records against predefined eligibility criteria, with disagreements resolved through consensus. Methodological quality was assessed using Joanna Briggs Institute (JBI) Critical Appraisal tools, and reporting quality was evaluated using an adapted CROSS checklist; these two appraisal dimensions were conducted and reported independently. Findings were integrated through narrative synthesis. Results: From 4634 identified records, 19 studies conducted across 11 EMR countries met the inclusion criteria. Nursing knowledge deficits were identified across multiple settings, and attitudes towards restraint practices were predominantly negative. Individuals with mental illness consistently described restraint as humiliating, punitive, and physically distressing. Recurrent challenges identified across studies included inadequate staff training, chronic understaffing, and limited access to restraint-reduction alternatives. Conclusions: Substantial gaps in nursing knowledge and training persist across the EMR. The findings of this review, while derived predominantly from cross-sectional studies with convenience samples, suggest that evidence-based education programmes, standardised restraint-reduction policies, and patient-centred care frameworks warrant prioritisation to safeguard the rights, safety, and dignity of individuals with mental illness in this region. Longitudinal and experimental research is needed to confirm these directions and establish their effectiveness within EMR contexts. Full article

Emotion dysregulation and altered interoceptive processing are increasingly recognized as core processes in eating disorder (ED) psychopathology. Difficulties in identifying, tolerating, and regulating negative emotional states may interact with reduced trust in bodily signals and distorted interpretation of hunger and satiety cues, contributing to maladaptive eating behaviors. The aim of this PRISMA-guided qualitative systematic review was to synthesize original empirical evidence on the interaction between emotion dysregulation and interoceptive processing in EDs, with particular attention to how emotional distress may be misinterpreted as physical hunger or food-related urges. A systematic search of PubMed and Scopus identified 78 records; after removal of duplicates and screening procedures, 24 original empirical studies were included in the qualitative synthesis. Across ED presentations, emotion dysregulation consistently emerged as a central transdiagnostic process associated with symptom severity, impulsivity, maladaptive eating behaviors, and related risk outcomes. Interoceptive alterations were widely reported, particularly involving reduced body trust and distorted interpretation of internal sensations rather than a uniform deficit in interoceptive sensitivity. The reviewed studies also showed that emotional states and cognitive expectations may shape the appraisal of hunger and satiety cues, contributing to the misinterpretation of emotional distress as physiological need across restrictive, binge-purge, and binge-eating presentations. The findings support a close interplay between emotion dysregulation and altered interoceptive processing in EDs and highlight the clinical relevance of interventions that integrate emotion regulation and interoceptive awareness to promote more adaptive eating behaviors. Full article

Background/Objectives: Adolescents with attention-deficit/hyperactivity disorder (ADHD) and bipolar spectrum disorders are at increased risk of substance use; categorical diagnoses may not fully explain individual variability in substance-related outcomes. This study examined substance use severity in clinically complex adolescents, focusing on the role of primary diagnosis and transdiagnostic dimensions (emotional dysregulation, impulsivity, cyclothymic-hypersensitive traits). Methods: In this cross-sectional observational study, 47 adolescents (aged 14–17) with DSM-5 diagnoses of ADHD or bipolar spectrum disorders were recruited from two Italian child and adolescent mental health services. Substance use severity was assessed using the Q-PAD Substance Abuse scale and the ABQ. Emotional dysregulation, impulsivity, affective temperament, and emotional-behavioral problems were assessed through RIPOST-Y, BIS-11, CHT-Q, and YSR. Correlation studies and group comparisons based on the Q-PAD Substance Abuse scale were performed to explore associations between clinical features and substance use. Results: Substance use severity was elevated in the overall sample and was not significantly associated with primary diagnostic category, overall illness severity, or global functioning. Higher Q-PAD Substance Abuse scores were significantly associated with impulsivity, emotional dysregulation, and hypersensitivity traits. Later initiation of lithium treatment was also associated with greater substance use severity. Conclusions: In this sample, substance use severity was more related to dimensional transdiagnostic vulnerabilities than to categorical diagnosis. Although preliminary and exploratory, these findings support early identification and targeted intervention on emotional dysregulation and impulsivity as potentially modifiable risk factors for adolescent substance use. Full article

Amid Europe’s demographic decline and the intensifying global “war for talent,” migration is increasingly viewed as a critical source of human capital capable of sustaining economic growth and welfare systems. Nevertheless, the literature on Macro-Talent Management (MTM) has primarily focused on the attraction of highly skilled expatriates, paying limited attention to how national integration systems shape the broader capacity of countries to attract and retain migrant talent. Addressing this gap, the present study conceptualizes migrant integration as a strategic component of macro-level talent management and evaluates the “talent attractiveness” of different European welfare and migration regimes. Methodologically, the study develops a multi-criteria evaluation framework based on the PROMETHEE II (Preference Ranking Organization Method for Enrichment of Evaluations) outranking method, enabling the simultaneous assessment of institutional, socio-economic, and administrative dimensions of migration governance. The model integrates nine indicators combining policy inclusiveness (e.g., Migrant Integration Policy Index—MIPEX (Migrant Integration Policy Index), citizenship accessibility), labor market outcomes (employment and gender gaps), and systemic pressures on migration management (asylum applications). By integrating policy indicators with real-world labor market performance and administrative capacity, the proposed framework offers a novel analytical tool for comparative migration policy evaluation and decision support. The empirical application covers six European countries representing distinct migration regimes: Portugal, Sweden, France, Poland, Greece, and Germany. The results challenge the conventional assumption that economic strength alone determines migrant attractiveness. Portugal emerges as the most attractive destination, demonstrating that inclusive rights-based integration policies can offset lower GDP levels. In contrast, Germany ranks last in the sample, revealing signs of systemic overextension due to extreme administrative pressure, while Greece occupies the fifth position characterized by structural integration deficits. The study contributes to the literature by linking migration governance, integration policy effectiveness, and macro-level talent management and by introducing a multi-criteria decision-analytic approach for evaluating national migration systems in Europe. The study offers a reassessment of the ‘talent attractiveness’ of European welfare models in a post-pandemic context (2023). Full article

Background/Objectives: Congenital heart defects (CHDs) are the most common congenital anomalies, and survival into adolescence and adulthood now exceeds 90%. Increasing evidence suggests that children and adolescents with CHD face elevated risks of psychological, psychiatric and neurodevelopmental disorders. This systematic review aims to synthesize recent evidence on mental health outcomes, cognitive profiles, quality of life and associated risk factors in pediatric CHD. Methods: This review was conducted according to PRISMA 2020 guidelines. Five databases (PubMed/MEDLINE, Embase, Scopus, Web of Science, Cochrane Library) were searched for studies published between January 2015 and November 2025. Eligible studies (observational, interventional and neuroimaging) included participants aged 0–18 years with any type of CHD and reported psychological, psychiatric, neurodevelopmental, cognitive or health-related quality-of-life outcomes. Due to substantial heterogeneity, findings were synthesized narratively. Results: Sixty-one studies involving over 120,000 participants were included. Children and adolescents with CHD showed increased prevalence of anxiety, depression, attention-deficit/hyperactivity disorder, autism spectrum disorder and post-traumatic stress symptoms compared with peers without CHD. Neurodevelopmental impairments, particularly in executive functioning, attention and memory, were frequently reported, especially in complex CHD and single-ventricle physiology. Health-related quality of life was consistently reduced, mainly in emotional and social domains. Parental mental health, disease severity and cumulative medical burden were significant correlates. Neuroimaging studies identified structural and functional brain alterations associated with cognitive and emotional vulnerability. Conclusions: Pediatric CHD is associated with substantial psychological and neurodevelopmental burden, particularly in complex disease. Early identification and integration of routine psychological care within multidisciplinary CHD programs are essential to improve long-term outcomes. Full article

Background: Parents of children with attention-deficit/hyperactivity disorder (ADHD) and sleep problems can experience challenges and negative health effects. The aim of this study was to explore parents’ own health-related experiences as their child with ADHD and sleep problems underwent a sleep intervention with a weighted blanket. Methods: A convergent mixed methods design was undertaken. Sociodemographic and questionnaire data were collected from 68 parents at baseline and at the 16-week follow-up. Paired-samples t-tests were used to analyze the data. An inductive qualitative content analysis was used to analyze interviews with 21 parents after the follow-up. An integrative analysis was performed and assessed for confirmation, expansion, or disconfirmation. Results: At the follow-up, parents reported improvements in their own health status (EQ-5D-3L—index 0.83 ± 0.15 vs. 0.87 ± 0.13; p = 0.034), in well-being (Outcome Rating Scale—individual 7.08 ± 2.22 vs. 7.55 ± 1.82; p = 0.045), and in family life (the Brief Child and Family Phone Interview—family comfort score 5.62 ± 1.62 vs. 5.14 ± 1.66; p = 0.003). Parents’ health-related experiences were described as: (1) having a sense of well-being, including being well rested, sustaining energy, reaching a state of calm, and finding hope, (2) balancing family life, including reclaiming personal sphere and nurturing relationships, and (3) managing everyday life, including keeping to the daily schedule and dealing with household chores. The integrative analysis resulted in the overarching themes of health through: (1) inner strength (confirmed), (2) recovery (expanded), (3) close relationships (confirmed), and (4) social engagements (expanded). Conclusions: The findings suggest that sleep interventions for children with ADHD and sleep problems may also be associated with positive changes in aspects of parents’ health, well-being, and family life. Full article

Background: The association between emotional dysregulation (ED) and attention-deficit/hyperactivity disorder (ADHD) has been widely documented. However, a consensus has yet to be reached on how to conceptualize this domain within ADHD. Particularly, ADHD + ED may represent a distinct condition, a more severe ADHD, or a comorbidity. We explored these three main hypotheses, investigating clinical differences between patients with ADHD, ADHD + ED, and ED. Methods: In total, 101 participants (ages 18–50) were recruited and divided into four groups: ADHD (N = 23), ED (N = 28), ADHD + ED (N = 27), and HC (N = 23). ADHD and ED were assessed using the Diagnostic Interview for ADHD in adults (DIVA-5) and the Wender–Reimherr Adult Attention Deficit Disorder Scale (WRAADDS). Sociodemographic and clinical variables were compared among the groups. Results: Participants with ADHD and ADHD + ED exhibited comparably high ADHD severity and executive dysfunction ratings. While participants with ADHD + ED shared elevated negative emotionality and higher rates of mood disorders and anxiety disorders with participants with ED compared with those with ADHD, they showed specifically increased developmental and disruptive comorbidities, as well as earlier onset and greater cyclicity of comorbid mood disorders. Psychosocial functional impairments were similarly elevated on average in ADHD + ED and ADHD, but ADHD + ED showed more pronounced and widespread deficits across multiple domains. Conclusions: ADHD + ED is unlikely to represent a more severe form of ADHD but may be more appropriately conceptualized as either a distinct entity or a “comorbid” phenotype. Comparisons with ED without ADHD highlighted clinical features specific to ADHD + ED, including a higher neurodevelopmental load, impulse-control disorders, and a poorer course of mood disorders. Full article

With the rapid advancement in Generative Artificial Intelligence (GenAI), AI-generated content (AIGC) lacking human cognitive oversight is increasingly permeating open web environments and academic communication systems. This study integrates longitudinal retraction data (Retraction Watch Database, 1990–2026), web-scale analyses of AI-content penetration (Common Crawl, 2013–2026), and bibliometric mapping of governance scholarship (Web of Science Core Collection, Scopus, Google Scholar, 2020–2026) to diagnose the cross-level misalignment between synthetic-content diffusion, AI-related misconduct pressure, and governance attention. On this basis, it proposes a Normalized Coverage Index (NCI) to measure the relative relationship between scholarly attention to AI-related academic misconduct governance and the level of misconduct pressure observed through retraction data across disciplines. The results reveal pronounced asymmetries at the disciplinary level. Fields such as chemistry (0.04), physics, mathematics & statistics (0.11), and life sciences & biology (0.34) exhibit clear governance gaps, whereas Education shows a comparatively excessive level of attention (NCI = 29.26). Since 2022, AIGC has expanded rapidly across open web corpora, accompanied by a sharp rise in AI-related retractions, which also exhibit a longer detection lag than traditional forms of misconduct (2.77 years vs. 1.91 years). Although the volume of academic governance-related research has grown rapidly, its proportion within the broader body of AI-related research has declined, suggesting that scholarly attention to governance has not kept pace with technological diffusion. Consequently, a structural misalignment in governance—closely tied to the allocation of attention—has emerged within the academic system in the era of GenAI. This misalignment may pose potential risks to the robustness of the knowledge production system. Addressing it requires rebuilding epistemic infrastructure through provenance transparency, auditable workflows, and governance-aware seed corpora aligned with empirically concentrated risks. Full article