Search Results (1,171)

The relation between Attention Deficit/Hyperactivity Disorder (ADHD) and memory performance has attracted growing interest in recent years. However, one of the more complex memory abilities, object–location memory (OLM), remains scarcely studied within the context of ADHD. In this study, we examine incidental and intentional OLM performance in treated and untreated adults with ADHD and in controls. Fifty-eight adults with ADHD (26 medicated and 32 unmedicated) and 51 neurotypical individuals are assessed in a paper-and-pencil format for incidental and intentional OLM under a divided-attention condition. The results showed that all groups demonstrate higher performance in incidental OLM than in intentional OLM. Furthermore, medicated ADHD participants demonstrate reduced incidental OLM performance relative to unmedicated ADHD participants and controls. However, no group differences between unmedicated participants and controls are observed. This study reveals an overlooked aspect of visuospatial performance in ADHD under mental load and calls for further research on the impact of stimulants on incidental OLM. Full article

Rising recognition of attention deficit hyperactivity disorder (ADHD) in adults and children is reshaping how Australian health systems organise diagnosis, prescribing and long-term management. This has coincided with sharp increases in ADHD medicine dispensing, high private assessment costs and prolonged waiting times for psychiatrists and paediatricians. Australian states and territories have commenced reforms that expand the role of general practitioners (GPs) in ADHD diagnosis, prescribing and long-term management. This commentary assesses whether these reforms can expand timely and equitable access while maintaining diagnostic accuracy, medication safety and specialist referral. It uses the New South Wales (NSW) model as a detailed exemplar because it has developed a staged pathway: trained continuation prescribers support previously diagnosed patients who are stable on psychostimulant treatment, while endorsed prescribers receive further accredited training or recognition of prior learning to assess, diagnose, initiate and adjust psychostimulant treatment. The commentary distinguishes professional specialty status from ADHD-specific competency: specialist registration in general practice establishes the professional status of qualified Australian GPs, whereas safe extension of ADHD diagnosis and psychostimulant prescribing requires condition-specific education, competency assessment, prescribing authority, monitoring and defined referral pathways. It reviews Australian reforms, explains the NSW training and governance pathway, compares overseas approaches, and identifies safeguards needed to avoid diagnostic compression, overdiagnosis, stimulant diversion and widening inequity. The central argument is that GP involvement should be framed as trained, governed primary-care capacity. If adequately funded, audited and linked to specialist escalation pathways, the model may reduce access barriers while preserving diagnostic rigour. Full article

Background: Attention-deficit/hyperactivity disorder (ADHD) is frequently associated with emotional dysregulation, socio-emotional difficulties, and low self-esteem. Narrative-based approaches, including therapeutic writing, may support identity development and promote adaptive self-representations. However, there is limited evidence regarding structured, group-based therapeutic writing interventions for this population, particularly for female subjects. This case series provides preliminary and exploratory evidence regarding the feasibility of and potential changes associated with this approach in female adolescents with ADHD. Methods: This case series included four adolescents (aged 11–14 years) with a clinical diagnosis of ADHD and presenting with emotional and socio-emotional difficulties. Participants underwent a structured group intervention consisting of seven sessions integrating therapeutic writing techniques and cognitive–behavioral principles, supervised by a specialized psychotherapist. The following outcome measures were collected at baseline (t0) and post-intervention (t1): Difficulties in Emotion Regulation Scale (DERS-SF), Difficulties in Emotion Regulation Scale (SSIS-SEL), and Rosenberg Self-Esteem Scale (RSE_TOT). Data were analyzed using linear mixed-effects models, with results interpreted as exploratory estimates of pre–post changes. Results: Following the intervention, positive pre–post changes were observed in socio-emotional competencies and self-esteem. Statistically significant pre–post changes were observed in self-esteem and in socio-emotional competencies, particularly in self-awareness and self-regulation. Reductions were observed in emotional regulation difficulties, although these changes did not reach statistical significance. Conclusions: This case series suggests that a structured group-based therapeutic writing intervention may be associated with improvements in self-esteem and selected aspects of socio-emotional functioning in adolescents with ADHD. Given the small sample size and exploratory design, findings should be interpreted cautiously and require confirmation in larger controlled studies. These findings contribute preliminary evidence to an underexplored area in the underrepresented female ADHD population and highlight the potential value of integrating narrative processes within group interventions to support both individual meaning-making and interpersonal validation. Full article

Background/Objectives: Individuals with attention-deficit/hyperactivity disorder (ADHD) often experience communication difficulties (CDs), including challenges with language development, pragmatic communication, and speech processing. While these difficulties are typically associated with cognitive and behavioral symptoms; emerging research suggests that biological and nutritional factors may also contribute. This narrative review aims to explore how diet patterns, gut microbiome changes and oxidative stress might be associated with communication difficulties in ADHD. Methods: This review was performed using the SANRA (Scale for the Assessment of Narrative Review Articles) framework. A structured/comprehensive literature search was performed across major databases including PubMed, Scopus and Web of Science. Google Scholar has been utilized as a complementary database to support emerging studies that have not yet been registered in these databases. The search focused on studies that investigated the connections between nutrition, microbiome dysregulation, oxidative stress, ADHD and communication-related outcomes. Results: Current research indicates that unbalanced diets, micronutrient deficiencies, and changes in the gut microbiome can lead to neuroinflammation and oxidative stress. All these biological processes may disrupt neurotransmission and neural connectivity, which can potentially affect brain regions and networks that are highly important for attention and language processing, including both cortical and subcortical structures. Therefore, communication difficulties in ADHD may, in part, stem from these interconnected neurobiological mechanisms. However, direct clinical evidence linking nutritional factors, gut microbiome alterations, or oxidative stress with communication-specific outcomes in ADHD remains very limited, as most available studies have focused on core ADHD symptoms, attention, executive functioning, or biological markers. Conclusions: Dietary factors, alterations in the gut microbiome, and oxidative stress may collectively contribute to the complex underlying causes of communication disorders in ADHD. This review proposes an integrative framework that links nutrition-related mechanisms to communication outcomes, emphasizing the potential impact of modifiable lifestyle factors. Further longitudinal studies are needed to establish causal relationships and determine the clinical effectiveness of targeted nutritional interventions for communication difficulties in ADHD. Full article

Beyond the well-established roles of serotonin and calcitonin gene-related peptide (CGRP), the contribution of dopamine (DA) to migraine pathophysiology remains a subject of intense investigation. DA acts as a neuromodulator, functioning both as a homeostatic pain filter and a driver of premonitory and autonomic symptoms. This review provides a comprehensive synthesis of DA’s involvement in migraine, proposing an integrated model that spans from molecular signaling to a systemic phenotype. A comprehensive search of the PubMed database (1976–2026) was performed. The analysis evaluates data across receptor signaling, hypothalamic connectivity (specifically the A11 nucleus), genetic susceptibility markers and advanced neuroimaging studies. Current evidence identifies dopamine as a gatekeeper of the trigeminovascular threshold, with the hypothalamic A11 nucleus serving as a modulatory hub. Within this circuit, DA exerts concentration-dependent effects: high-affinity D2 receptor activation promotes antinociception, whereas low-affinity D1-like receptors facilitate nociceptive signaling. Clinically, this manifests as a “dopaminergic phenotype” characterized by yawning, nausea, and reward-system dysfunction. This phenotype extends beyond migraine, showing links to comorbidities such as restless legs syndrome (RLS) and attention-deficit/hyperactivity disorder (ADHD). DA’s role in migraine is state-dependent and interconnected with CGRP and serotonergic pathways. Recognizing the dopaminergic phenotype is essential for capturing the clinical heterogeneity of the disorder and may pave the way for personalized, mechanism-based therapeutic strategies. Full article

Maternal wellbeing during pregnancy is an important component of maternal mental health and has implications for both maternal and child outcomes. Although psychological resources such as self-control and social support are generally assumed to promote wellbeing, maternal wellbeing may also be influenced by psychological vulnerabilities, including perceived stress and ADHD (Attention Deficit Hyperactivity Disorder) symptoms. Recent theoretical perspectives further suggest that some beneficial characteristics may exhibit diminishing returns at higher levels. This study examined linear and nonlinear associations among perceived stress, ADHD symptoms, self-control, perceived social support, and maternal wellbeing during the second trimester of pregnancy. A sample of 149 first-time pregnant women from Romania completed measures of maternal wellbeing, perceived stress, ADHD symptoms, self-control, and perceived support from partners, family members, and friends. Hierarchical regression analyses were conducted, including quadratic terms derived from the Too-Much-of-a-Good-Thing framework. Perceived stress emerged as the strongest predictor of lower maternal wellbeing, whereas family support was positively associated with wellbeing. ADHD symptoms were negatively associated with wellbeing at the bivariate level but did not uniquely predict wellbeing after controlling for the remaining study variables. Most importantly, self-control demonstrated a significant nonlinear association characterized by diminishing returns, such that increases in self-control were associated with progressively smaller improvements in wellbeing at higher levels. No comparable nonlinear effects were observed for perceived stress or social support. Overall, the findings suggest that maternal wellbeing is shaped by both psychological vulnerabilities and psychological resources, and that the benefits of some psychological strengths may not increase uniformly across their entire range. Full article

Background: The role of dopamine in brain functions has been well established, and dopamine imbalances can cause problems in working memory and spatial learning. The dopamine transporter (DAT) plays a significant role in dopamine regulation. Rats with a knockout of the dopamine transporter gene (DAT-KO), the model of attention deficit hyperactivity disorder (ADHD), are characterized by hyperdopaminergia and spatial memory impairments. Methods: Rats were trained to manipulate objects and recognize their spatial location and shape using RedBox apparatus. They needed to move a distant object to receive a food reward. After changing the shape and spatial location of objects, the ability to re-learning was evaluated. Results: We demonstrated that including objects to manipulate in the task conditions enables faster and stable learning of DAT-KO rats. The shape of the object did not influence the level of task performance, but changing the spatial location of the object led to the impairment of task performance in hyperactive rats. Conclusions: The data obtained highlight the role of hyperactivity and hyperdopaminergia in DAT-KO rats in spatial learning. We suggest that our findings may help in the further development of new training tasks for individuals with ADHD and spatial memory deficits. Full article

Excessive mind wandering is increasingly recognized as a clinically relevant cognitive feature of adult attention-deficit/hyperactivity disorder (ADHD), yet its relationship with sleep-related characteristics remains insufficiently understood. This cross-sectional study with a control group examined associations between sleep-related characteristics and excessive mind wandering in 316 adults with clinically confirmed ADHD and 121 screened controls. Participants completed measures of ADHD symptoms, mind wandering, anxiety–depressive symptoms, and self-reported sleep-related characteristics adapted from Pittsburgh Sleep Quality Index items; mid-sleep time was calculated from reported sleep onset and final awakening. Group comparisons, correlation analyses, and multiple regression analyses were conducted. Adults with ADHD showed higher mind wandering, greater ADHD symptom severity, anxiety–depressive symptom burden, poorer subjective sleep quality, and later mid-sleep time than controls, whereas sleep duration did not differ between groups. Mind wandering was associated with ADHD symptom severity, anxiety–depressive symptoms, later mid-sleep time, and poorer subjective sleep quality. In regression analysis, ADHD diagnosis was the strongest independent correlate of mind wandering. Anxiety–depressive symptom burden, poorer subjective sleep quality, and later mid-sleep time, but not sleep duration, also remained independently associated with higher mind wandering. Findings suggest that sleep timing and subjective sleep quality may be clinically relevant to excessive mind wandering in adults with ADHD. Full article

Background: Attention-deficit/hyperactivity disorder (ADHD) is associated with cognitive, behavioral, emotional, and social difficulties that may increase vulnerability to bullying during childhood and adolescence. Although previous studies have examined different aspects of this relationship, the available evidence remains limited and heterogeneous, particularly regarding associated factors, profiles of bullying involvement, and implications for prevention and intervention. Objective: To analyze the available evidence regarding bullying involvement in children and adolescents with ADHD, focusing on victimization, perpetration, bully–victim profiles, associated factors, psychological consequences, and implications for prevention and intervention. Methods: A narrative review was conducted using studies identified in PubMed, Scopus, and Web of Science between January and March 2026, with no publication date restrictions. The search was performed in three independent and consecutive stages and included observational studies evaluating the relationship between ADHD and bullying in children and adolescents. Narrative reviews, systematic reviews, meta-analyses, editorials, and studies conducted exclusively in adults were excluded. Results: Seventeen studies were included. The evidence consistently showed that children and adolescents with ADHD have greater involvement in bullying than their peers without ADHD. Victimization was the most consistently reported outcome, although increased perpetration, bully–victim profiles, and cyberbullying were also identified. Bullying involvement appeared to be influenced by multiple interacting factors, including ADHD symptoms, emotional dysregulation, impulsivity, comorbidities, peer relationships, family characteristics, and school-related factors. Victimization was consistently associated with increased anxiety and depressive symptoms, emotional difficulties, and poorer quality of life. Emerging evidence also suggests sex-specific patterns of bullying involvement and bidirectional longitudinal relationships between ADHD symptoms and bullying experiences. Conclusions: Children and adolescents with ADHD may have greater involvement in multiple forms of bullying; however, this relationship appears to be multifactorial rather than solely explained by core ADHD symptoms. Family, peer, and school environments may play important protective roles, highlighting the need for comprehensive prevention and intervention strategies that address both individual and contextual factors. Full article

Background/Objectives: Sex differences in adult attention-deficit/hyperactivity disorder (ADHD) remain insufficiently characterized, particularly in clinically referred samples assessed through multidimensional and multi-informant approaches. This study investigated sex differences in clinical presentation, psychiatric comorbidity, psychometric features, and ADHD severity in adults with ADHD, with a specific focus on emotional dysregulation and rating-source effects. Methods: A total of 212 consecutively recruited adults with ADHD, including 93 females and 119 males, underwent a comprehensive assessment at a tertiary referral service. Sex differences were examined across sociodemographic, clinical, comorbidity, functional, and psychometric domains. ADHD severity was assessed using both self-rated and observer-rated measures. Regression, mediation, and repeated-measures mixed-effects models were fitted to examine the role of emotional dysregulation in the association between sex and ADHD severity. Results: Females showed a higher frequency of predominantly inattentive presentation; higher rates of mood, anxiety, and eating disorders; and more pronounced emotional dysregulation, affective temperamental traits, personality-related impairment, and biological rhythm disturbances. Observer-rated ADHD severity did not differ by sex, while females reported higher self-rated ADHD severity. Emotional dysregulation was associated with both observer-rated and self-rated ADHD severity, with a stronger association for self-rated symptoms. Mediation analysis showed a significant indirect effect of female sex on self-reported ADHD severity through emotional dysregulation, accounting for 79.4% of the total association. Mixed-effects models further indicated that sex differences in ADHD severity varied according to rating source and persisted, although attenuated, after accounting for emotional dysregulation. Conclusions: Adult females with ADHD showed a different clinical profile, characterized by greater internalizing comorbidity, emotional dysregulation, personality-related impairment, and biological rhythm disturbances. Emotional dysregulation accounted for a substantial part of the higher self-reported ADHD severity observed among females, while rating-source effects suggested that sex differences in adult ADHD may partly depend on how symptom severity is assessed. Full article

Attention-deficit/hyperactivity disorder (ADHD) is traditionally defined by symptoms of inattention, hyperactivity, and impulsivity. However, growing evidence suggests that this framework incompletely reflects the underlying neurobiology and clinical heterogeneity of the disorder, particularly in females. Current models of dopaminergic neurotransmission propose that ADHD is characterized not by simple dopamine deficiency but by dysregulation of tonic and phasic dopamine signaling. Theoretical models propose that reduced tonic dopamine activity may coexist with enhanced stimulus-dependent phasic responses in ADHD. Whether such signaling differences produce alternating states of underactivation and hyperactivation within the same individual has not been directly demonstrated and constitutes a central hypothesis of the present framework. In this narrative hypothesis paper, I examine evidence linking dopaminergic dysregulation to a broader ADHD phenotype encompassing four functional domains: energy regulation, attention allocation, behavioral activation, and emotional reactivity and awareness. Within these domains, hyperactivity and hypoactivity, inattention and hyperfocus, impulsive responding and difficulty initiating action, and emotional hyperreactivity and alexithymia are treated as potentially related manifestations rather than established psychometric opposites. Neuroimaging studies report alterations in dopamine transporter and receptor availability, while clinical and behavioral studies document associations between ADHD and different, sometimes contrasting manifestations within the proposed domains. Importantly, internally experienced manifestations such as emotional dysregulation, hypoactivity, procrastination, and hyperfocus appear particularly relevant to female presentations of ADHD. I propose that ADHD should be conceptualized as a multidimensional disorder of dopaminergic regulation. This framework may better explain phenotypic diversity, improve identification of underrecognized presentations, and guide future biomarker-driven and precision-medicine approaches to ADHD. Full article

Background: Neurodevelopmental disorders, including Autism Spectrum Disorder (ASD), Attention-Deficit/Hyperactivity Disorder (ADHD), and Specific Learning Disorder (SLD), as well as neuromuscular conditions such as Duchenne Muscular Dystrophy (DMD), are frequently associated with emotional and behavioral difficulties that may affect children’s functioning and family well-being. However, direct comparisons across these heterogeneous clinical populations remain limited. This study aimed to compare emotional and behavioral profiles across children and adolescents with ASD, ADHD, SLD, and DMD using the Child Behavior Checklist (CBCL/6–18). Methods: This cross-sectional comparative study included 197 children and adolescents (ASD: 47; SLD: 50; ADHD: 50; DMD: 50) assessed at the Clinical Psychology Unit of the Fondazione Policlinico Universitario Agostino Gemelli IRCCS (Rome, Italy) between 2017 and 2024. Emotional and behavioral functioning was evaluated using the parent-report CBCL/6–18. Group differences were examined using one-way ANOVA or Welch’s ANOVA, as appropriate, followed by Tukey’s HSD or Games–Howell post hoc comparisons. Results: Significant group differences emerged for Internalizing Problems, Externalizing Problems, and Total Problems (all p < 0.001). ADHD showed the highest overall emotional and behavioral burden, with 76% of participants scoring in the clinical range for both Internalizing and Total Problems and 60% for Externalizing Problems. Elevated internalizing difficulties characterized ASD and SLD, whereas children with DMD showed generally lower CBCL scores, although 26% fell within the clinical range for Internalizing Problems. Effect sizes were moderate to large (η² = 0.168–0.273), supporting the presence of both shared and disorder-specific emotional and behavioral patterns across heterogeneous developmental conditions. Conclusions: The findings highlight the heterogeneity of emotional–behavioral profiles across neurodevelopmental and neuromuscular conditions. The use of a common standardized assessment framework enabled the identification of both shared and disorder-specific patterns, supporting the potential value of a transdiagnostic approach to individualized assessment. Future longitudinal and multi-informant studies are warranted to clarify developmental trajectories and improve the identification of clinically meaningful emotional and behavioral needs across heterogeneous pediatric populations. Full article

Electroencephalography (EEG) provides a non-invasive means of supporting Attention-Deficit/Hyperactivity Disorder (ADHD) assessment. Nonetheless, existing pipelines often rely on handcrafted descriptors, segment-wise decisions, or deep architectures with limited subject-level generalization. This work introduces Hidden Markov Model-Induced Stationary RKHS Distance Learning (HIS), a probabilistic framework that represents each subject by a Hidden Markov Model with Gaussian-mixture emissions trained directly from frontal EEG recordings. Rather than vectorizing model parameters, each HMM is mapped to its induced stationary observation distribution and embedded into a Reproducing Kernel Hilbert Space (RKHS), where pairwise subject similarities are computed through a closed-form Hilbert embedding distance. These similarities are subsequently exploited by precomputed-kernel classifiers for subject-level prediction. The proposed method was evaluated against the Probability Product Kernel baseline using both a controlled synthetic EEG benchmark and a public pediatric ADHD dataset under progressively more rigorous validation protocols, culminating in repeated nested cross-validation with bootstrap confidence intervals and permutation testing. On the synthetic benchmark, HIS achieved 95.0% held-out accuracy and consistently outperformed the baseline across classifiers. On a real EEG dataset with 121 subjects, the primary evaluation protocol yielded a balanced accuracy of 73.5% (95% CI: 69.8–77.0%), an AUC of 79.6%, and an MCC of 0.483 (permutation p < 0.001) using an SVM with compact subject-specific HMMs. Complementary hyperparameter analyses and t-SNE visualizations demonstrated that HIS induces more stable and discriminative subject representations than the baseline. These results establish stationary RKHS embeddings of subject-specific HMMs as a leakage-aware framework for EEG-based ADHD decision support and underscore the critical influence of statistically rigorous evaluation protocols on reported classification performance. Full article

Background: Attention-deficit/hyperactivity disorder (ADHD) has traditionally been understood through executive and frontostriatal models, but increasing evidence suggests that metabolic, inflammatory, circadian, and neuroendocrine mechanisms may also contribute to clinical heterogeneity. The hypothalamus is a central regulatory hub for appetite, sleep–wake organization, stress responsivity, autonomic function, and endocrine signalling. Objective: This review evaluated evidence linking ADHD with hypothalamic inflammation and related metabolic, inflammatory, circadian, and neuroendocrine dysregulation, with particular emphasis on appetite regulation, sleep and circadian function, stress reactivity, and pharmacological treatment response and tolerability. Methods: A systematic literature search was conducted in PubMed/MEDLINE, Embase, PsycINFO, Scopus, and Web of Science Core Collection from database inception to 31 May 2026. Human observational and intervention studies formed the primary evidence base. Evidence was synthesized narratively. Where available, quantitative findings from previously published meta-analyses were summarized to provide an overview of the strength and consistency of the evidence. Results: The reviewed evidence indicates that ADHD is associated with increased obesity risk, altered appetite-related hormones, immune-inflammatory changes, delayed circadian timing, atypical cortisol responsivity, and treatment-related effects on appetite, sleep, cardiovascular physiology, and tolerability. The strongest quantitative evidence concerned obesity, inflammatory markers, appetite hormones, and type 2 diabetes risk. Direct evidence for hypothalamic inflammation in ADHD remains limited, but converging indirect findings support hypothalamic and neuroendocrine mechanisms as biologically plausible contributors in a subgroup of individuals with ADHD. Conclusions: ADHD appears to be associated with broader metabolic, inflammatory, circadian, and neuroendocrine vulnerabilities beyond its core attentional and behavioural symptoms. Hypothalamic pathways should be interpreted as a mechanistic hypothesis rather than an established causal mechanism. Future longitudinal and multimodal studies are needed to clarify causality and identify biologically defined ADHD subgroups. Full article

Background: Duchenne muscular dystrophy (DMD) is an X-linked disorder caused by out-of-frame variants in the DMD gene, resulting in dystrophin deficiency and progressive muscle degeneration. Beyond motor involvement, evidence links DMD to cognitive impairment and an emotional–behavioral (EB) burden, potentially related to the altered expression of brain dystrophin isoforms (Dp71, Dp140, Dp427). Objectives: To screen for major neurodevelopmental, cognitive and/or EB difficulties in a monocentric cohort of children with DMD. Methods: This cross-sectional study included 21 children with DMD. Neuropsychiatric difficulties were assessed using a multimodal psychometric battery. Cognitive, neurodevelopmental and genetic data were retrospectively collected and analyzed. Results: In the cohort, attention-deficit/hyperactivity disorder (ADHD)-related findings were predominantly inattentive, with 3/20 children (15.0%) scoring within the clinical range on at least one inattention subscale. For measures assessing autism spectrum disorder (ASD)-related features, scores above the normative cutoff emerged in 7/20 children (35.0%), while only 2/20 (10.0%) scored within the clinical range. Internalizing problems represented the predominant EB difficulties, and emotional dysregulation (ED) emerged as a plausible area of vulnerability in the cohort. Among the 11 of 21 children with available Full-Scale Intelligence Quotient (FSIQ) data, five (45.5%) had an FSIQ below 85. Of these, four of five (80.0%) presented the predicted Dp140−/Dp71+ brain dystrophin isoform expression pattern, whereas one of five (20.0%) presented the Dp140+/Dp71+ pattern. Conclusions: Children with DMD showed heterogeneous neuropsychiatric and cognitive features in the employed screening battery. These preliminary findings, if confirmed in larger cohorts, support the potential of a broader neuropsychiatric screening assessment to optimize care pathways. Full article