Sotos syndrome is characterized by overgrowth features and is caused by alterations in the nuclear receptor binding SET domain protein 1 gene.Attentiondeficit/hyperactivity disorder(ADHD)is considered a neurodevelopme...Sotos syndrome is characterized by overgrowth features and is caused by alterations in the nuclear receptor binding SET domain protein 1 gene.Attentiondeficit/hyperactivity disorder(ADHD)is considered a neurodevelopment and psychiatric disorder in childhood.Genetic characteristics and clinical presentation could play an important role in the diagnosis of Sotos syndrome and ADHD.Magnetic resonance imaging(MRI)has been used to assess medical images in Sotos syndrome and ADHD.The images process is considered to display in MRI while wavelet fusion has been used to integrate distinct images for achieving more complete information in single image in this editorial.In the future,genetic mechanisms and artificial intelligence related to medical images could be used in the clinical diagnosis of Sotos syndrome and ADHD.展开更多
The prevalence of autism and attention deficit/hyperactivity disorders is increasing worldwide.Recent studies suggest the excessive intake of ultra-processed food plays a role in the inheritance of these disorders via...The prevalence of autism and attention deficit/hyperactivity disorders is increasing worldwide.Recent studies suggest the excessive intake of ultra-processed food plays a role in the inheritance of these disorders via heavy metal exposures and nutritional deficits that impact the expression of genes.In the case of the metallothionein(MT)gene,biomarker studies show dietary zinc(Zn)deficits impact MT protein levels in children with autism and are associated with the bioaccumulation of lead and/or mercury in children exhibiting autism/attention deficit/hyperactivity disorders symptomology.The impact of dietary changes on lead and mercury exposures and MT gene behavior could be determined using a randomized test and control group design.Pregnant women serving in the testgroup would participate in a nutritional epigenetics education intervention/course designed to reduce ultra-processed food intake and heavy metal levels in blood while increasing whole food intake and MT and Zn levels.Changes in maternal diet would be measured using data derived from an online diet survey administered to the test and control groups pre-post intervention.Changes in maternal lead,mercury,Zn,and MT levels would be measured via blood sample analyses prior to the intervention and after childbirth via cord blood analyses to determine infant risk factors.展开更多
Attention deficit hyperactivity disorder(ADHD)turns into a common neuro progressional disorder.Although gender identity has obtained increasing attention in ADHD researches,its role in ADHD presentation and treatment ...Attention deficit hyperactivity disorder(ADHD)turns into a common neuro progressional disorder.Although gender identity has obtained increasing attention in ADHD researches,its role in ADHD presentation and treatment response remains underexplored.Our review seeks to mainly delve into the effect of gender identity on ADHD,exploring the unique needs of individuals with various gender identities in the context of ADHD symptoms,diagnostic assessment,and treatment,with the goal of supplying theoretical support and practical recommendations for future research and clinical practice.The primary content includes,specifically:(1)Symptom expression differences:Gender identity significantly affects ADHD symptoms;male-identified individuals commonly perform worse in task orientation and attention stability,while female-identified individuals may demonstrate more variability in attention control and executive functions;(2)Diagnosis and treatment:Clinical practice generally neglects the impact of gender identity on ADHD management,with personalized needs of gender-identified individuals frequently not adequately addressed,potentially,affecting treatment outcomes;and(3)Future research directions:Future studies should further assess how gender identity affects the specific mechanisms of ADHD,conduct researches in multicultural contexts,and engage in long-term follow-up studies to evaluate the long-term impact of gender identity on ADHD progression.Besides,enhanced funding and public education on the relationship between gender identity and ADHD are needed to advance the field.展开更多
Objective: This study investigates the auxiliary role of resting-state electroencephalography (EEG) in the clinical diagnosis of attention-deficit hyperactivity disorder (ADHD) using machine learning techniques. Metho...Objective: This study investigates the auxiliary role of resting-state electroencephalography (EEG) in the clinical diagnosis of attention-deficit hyperactivity disorder (ADHD) using machine learning techniques. Methods: Resting-state EEG recordings were obtained from 57 children, comprising 28 typically developing children and 29 children diagnosed with ADHD. The EEG signal data from both groups were analyzed. To ensure analytical accuracy, artifacts and noise in the EEG signals were removed using the EEGLAB toolbox within the MATLAB environment. Following preprocessing, a comparative analysis was conducted using various ensemble learning algorithms, including AdaBoost, GBM, LightGBM, RF, XGB, and CatBoost. Model performance was systematically evaluated and optimized, validating the superior efficacy of ensemble learning approaches in identifying ADHD. Conclusion: Applying machine learning techniques to extract features from resting-state EEG signals enabled the development of effective ensemble learning models. Differential entropy and energy features across multiple frequency bands proved particularly valuable for these models. This approach significantly enhances the detection rate of ADHD in children, demonstrating high diagnostic efficacy and sensitivity, and providing a promising tool for clinical application.展开更多
Pyrrolizidine alkaloids(PAs)are natural toxins generated as secondarymetabolites in plants,predominantly consisting of unsaturated PAs with diverse toxicities,such as hepatotoxicity.Echimidine,a prominent PA,is believ...Pyrrolizidine alkaloids(PAs)are natural toxins generated as secondarymetabolites in plants,predominantly consisting of unsaturated PAs with diverse toxicities,such as hepatotoxicity.Echimidine,a prominent PA,is believed to exert various toxicological effects,including survival inhibition and induction of apoptosis of hepatocytes.However,the effects of echimidine on development remain unclear.We selected three concentrations of 0.02,0.2,and 2 mg/L to investigate the developmental toxicity of echimidine on zebrafish embryos.After a 7-day exposure,we observed hyperactivity and anxiety-like behavior in zebrafish larvae.Furthermore,we found that echimidine exposure significantly promoted embryonic motor neurodevelopment in geneticallymodified zebrafish.Next,we detected that echimidine exposure significantly increased the content of the excitatory neurotransmitter acetylcholine(ACh),accompanied by a significant decrease in acetylcholinesterase(AChE)activity.Conversely,echimidine led to a significant reduction in the content of the sedative neurotransmitterγ-aminobutyric acid(GABA),accompanied by abnormal gene expression of enzymes related to GABA synthesis.Moreover,we elucidated the strong direct binding of echimidine to zebrafish and human AChE protein through molecular docking.In summary,our study found that echimidine induced ACh accumulation possibly by inhibiting AChE activity,leading to motor neurodevelopmental abnormalities and hyperactivity in zebrafish larvae.This work provides important scientific knowledge on the effects and mechanisms of PAs on neural development,which is helpful for controlling the risk of PAs in food and protecting public health.展开更多
OBJECTIVE:To investigate the efficacy and safety of Angong Jiangya pill(AGJY,安宫降压丸)in the treatment of grade 2 hypertension with liver-fire hyperactivity syndrome.METHODS:This multicenter,randomized,double-blind,...OBJECTIVE:To investigate the efficacy and safety of Angong Jiangya pill(AGJY,安宫降压丸)in the treatment of grade 2 hypertension with liver-fire hyperactivity syndrome.METHODS:This multicenter,randomized,double-blind,placebo-controlled trial was conducted in eight medical institutions.Eligible patients with grade 2 hypertension were randomly allocated to receive AGJY or a placebo for 12 weeks.The primary outcome was the change in blood pressure(BP).The secondary outcomes were BP compliance rate,Traditional Chinese Medicine(TCM)symptoms,and Duchenne Hypertension Quality of Life Scale score.RESULTS:Data were analyzed for 117 participants in the AGJY group and 118 participants in the placebo group.After 12 weeks of treatment,AGJY compared with placebo resulted in a higher and significant reduction in systolic/diastolic BP(-15.58±10.16/-9.72±7.41 vs-8.13±8.28/-4.86±5.68 mm Hg,P<0.0001,<0.0001,respectively).BP compliance rate(31.86%vs 19.13%,P=0.027)was significantly higher in the AGJY group than in the placebo group.The AGJY group showed a significant reduction in TCM symptom score compared with the placebo group(10.82±2.03 vs 7.83±1.24,P<0.0001).Single TCM syndrome clinical control rates of the primary symptoms(dizziness,headache,and irritability)were superior in the AGJY group(71.95%,94.62%,72.53%,respectively)compared with the placebo group(48.39%,68.00%,30.52%,respectively).Scores on the Duchenne Hypertension Quality of Life Scale showed a significant increase in the AGJY group compared with the placebo group(30.65±21.06 vs 9.96±10.72,P=0.000).No serious adverse events occurred.CONCLUSION:AGJY demonstrated efficacy in lowering BP,increasing the rate of BP compliance,and improving TCM symptoms and quality of life in patients with grade 2 hypertension liver-fire hyperactivity syndrome.However,further in-depth studies are required to determine the mechanism of TCM in treating hypertension.展开更多
BACKGROUND Attention deficit hyperactivity disorder(ADHD)is a prevalent neurodevelopmental disorder in adolescents characterized by inattention,hyperactivity,and impulsivity,which impact cognitive,behavioral,and emoti...BACKGROUND Attention deficit hyperactivity disorder(ADHD)is a prevalent neurodevelopmental disorder in adolescents characterized by inattention,hyperactivity,and impulsivity,which impact cognitive,behavioral,and emotional functioning.Resting-state functional magnetic resonance imaging(rs-fMRI)provides critical insights into the functional architecture of the brain in ADHD.Despite extensive research,specific brain regions consistently affected in ADHD patients during these formative years have not been comprehensively delineated.AIM To identify consistent vulnerable brain regions in adolescent ADHD patients using rs-fMRI and activation likelihood estimation(ALE)meta-analysis.METHODS We conducted a comprehensive literature search up to August 31,2024,to identify studies investigating functional brain alterations in adolescents with ADHD.We utilized regional homogeneity(ReHo),amplitude of low-frequency fluctuations(ALFF),dynamic ALFF(dALFF)and fractional ALFF(fALFF)analyses.We compared the regions of aberrant spontaneous neural activity in adolescents with ADHD with those in healthy controls(HCs)using ALE.RESULTS Fifteen studies(468 adolescent ADHD patients and 466 HCs)were included.Combining the ReHo and ALFF/fALFF/dALFF data,the results revealed increased activity in the right lingual gyrus[LING,Brodmann Area(BA)18],left LING(BA 18),and right cuneus(CUN,BA 23)in adolescent ADHD patients compared with HCs(voxel size:592-32 mm³,P<0.05).Decreased activity was observed in the left medial frontal gyrus(MFG,BA 9)and left precuneus(PCUN,BA 31)in adolescent ADHD patients compared with HCs(voxel size:960-456 mm³,P<0.05).Jackknife sensitivity analyses demonstrated robust reproducibility in 11 of the 13 tests for the right LING,left LING,and right CUN and in 11 of the 14 tests for the left MFG and left PCUN.CONCLUSION We identified specific brain regions with both increased and decreased activity in adolescent ADHD patients,enhancing our understanding of the neural alterations that occur during this pivotal stage of development.展开更多
BACKGROUND Speech and language therapy(ST)might moderate the prognosis in children with attention deficit and hyperactivity disorder(ADHD)comorbid with speech delay.This study investigated whether ST in children with ...BACKGROUND Speech and language therapy(ST)might moderate the prognosis in children with attention deficit and hyperactivity disorder(ADHD)comorbid with speech delay.This study investigated whether ST in children with ADHD is associated with a decreased risk of subsequent psychiatric disorders.AIM To investigate whether ST in children with ADHD is associated with a decreased risk of subsequent psychiatric disorders.METHODS The population-based National Health Insurance Research Database in Taiwan was used.Hazards of subsequent psychiatric disorders were compared between those who received ST and a propensity-score matched comparison group by Cox regression analyses.RESULTS Of 11987 children with ADHD identified from the dataset,2911(24%)had received ST.The adjusted hazard ratio for any subsequent recorded psychiatric disorder was 0.72(95%confidence interval:0.63-0.82)in children who received ST compared to the matched counterparts.This protective association was only statistically significant in the subgroup that received both medication and behavioral interventions.CONCLUSION ST can moderate the effects of integrated early interventions in ADHD children with speech delay.展开更多
Background Raising a child with attention deficit hyperactivity disorder(ADHD)is a key challenge for the primary caregiver.This systematic review aims to identify major burdens facing the primary caregiver of a child ...Background Raising a child with attention deficit hyperactivity disorder(ADHD)is a key challenge for the primary caregiver.This systematic review aims to identify major burdens facing the primary caregiver of a child with ADHD.Methods The electronic databases CINAHL,PubMed,and Google Scholar were searched for studies published in English from 2017 to 2022 assessing the challenges facing caregivers of a child with ADHD.The Johns Hopkins Nursing Evidence-Based Practice Model was used to assess quality and risk of bias of studies identified for inclusion.Articles were synthesized by evaluating principal themes of burden to caregivers,stress of caregivers,and effectiveness of intervention programs.Results Eleven articles were included in this review and included a total of 2426 participants.Findings revealed that caregivers of children with ADHD have a poor quality of life and high stress levels.Supportive parenting programs can be effective for improved coping and adaptation mechanisms with children with ADHD.However,few interventional studies were identified,increasing potential for bias.No meta-analysis was conducted.Conclusion Caregivers of children with ADHD can benefit from strategies to improve their quality of life and reduce their stress levels.Targeted parenting programs can make a positive difference in the well-being of caregivers and children with ADHD.Additional research is needed to address the evidence-based effectiveness of parenting support programs.展开更多
Attention-deficit/hyperactivity disorder(ADHD)is increasingly conceptualized as a dynamic neurodevelopmental condition,marked by fluctuating symptom trajectories across development rather than the traditional static p...Attention-deficit/hyperactivity disorder(ADHD)is increasingly conceptualized as a dynamic neurodevelopmental condition,marked by fluctuating symptom trajectories across development rather than the traditional static patterns of persistence or remission.This review synthesizes empirical evidence on the varied trajectories of ADHD symptoms-including late-onset,partial remission,and recurrent fluctuation patterns-and underscores their clinical significance in longterm functioning.We adopt a multifactorial framework to explore how genetic,environmental,and gene–environment interactions contribute to the emergence and evolution of ADHD symptoms over time.In addition,we consider how medication-related variables-particularly tolerance and adherence-may influence symptom fluctuation.Characterizing these developmental dynamics offers critical guidance for designing flexible,personalized interventions that align with individual trajectories and transitional vulnerabilities.展开更多
BACKGROUND Hypertension is a significant global health concern and serves as a critical risk factor for cardiovascular diseases,stroke,and renal failure.Traditional Chinese Medicine(TCM)has been utilized for an extend...BACKGROUND Hypertension is a significant global health concern and serves as a critical risk factor for cardiovascular diseases,stroke,and renal failure.Traditional Chinese Medicine(TCM)has been utilized for an extended period to address hypertension,with the syndrome known as Yin deficiency and Yang hyperactivity syndrome(YDYHS)frequently observed in individuals with elevated blood pressure.This syndrome is characterized by symptoms including dizziness,tinnitus,irritability,and insomnia,which are thought to result from an imbalance between Yin,representing the cooling and nourishing aspects,and Yang,denoting the active and warming aspects of the body.Despite the prevalent application of TCM in clinical settings,the metabolic mechanisms underlying the YDYHS in the context of hypertension remain inadequately elucidated.AIM To explore the differential plasma metabolites and associated pathways in hypertensive patients with YDYHS using gas chromatography-mass spectrometry(GC-MS)to elucidate the distinctive blood metabolite pattern in this patient population.METHODS GC-MS was used to analyze plasma samples from 51 hypertensive patients with YDYHS and 20 healthy controls.Chemometric methods,including principal component analysis and partial least squares discriminant analysis,were employed to identify potential biochemical patterns.Simultaneously,the high-quality Kyoto Encyclopedia of Genes and Genomes metabolic pathways database was used to identify associated metabolic pathways.Using variable importance in projection and receiver operating characteristic curve analyses,potential biomarkers were extracted to assess their clinical utility.RESULTS Metabolomic profiling of hypertensive patients with YDYHS identified 20 potential biomarkers(4-hydroxybenzoic acid,pectin,1,2,3-trihydroxybenzene,D-ribose,3-hydroxybutyric acid,quinic acid,L-lysine,oleic acid,2-hydroxybutyric acid,linoleic acid,citric acid,alpha-tocopherol,D-glucuronic acid,glycerol,N-acetyl-L-aspartic acid,betamannosylglycerate,indolelactic acid,L-glutamic acid,D-maltose,L-aspartic acid)and four metabolic pathways(linoleic acid metabolism;alanine,aspartate and glutamate metabolism;D-glutamine and D-glutamate metabolism;arginine biosynthesis).The identified differential metabolites may serve as potential biomarkers for distinguishing hypertensive patients with YDYHS from healthy controls.The area under the curve values ranged from 0.750 to 0.866.Receiver operating characteristic curve analysis showed that these differential metabolites can effectively classify hypertensive patients with YDYHS and healthy individuals.CONCLUSION The metabolomic analysis revealed a distinct blood metabolite pattern in hypertensive patients with YDYHS compared to the healthy control group,highlighting the potential role of the identified 20 biomarkers and four metabolic pathways in these patients.These findings may serve as an important material basis for understanding the occurrence and development of the disease,providing a scientific foundation for future clinical diagnosis.展开更多
Attention-deficit/hyperactivity disorder(ADHD)is one of the most common neurodevelopmental disorders of childhood,yet its diagnosis remains complex and fraught with challenges.Pediatricians,often the first point of co...Attention-deficit/hyperactivity disorder(ADHD)is one of the most common neurodevelopmental disorders of childhood,yet its diagnosis remains complex and fraught with challenges.Pediatricians,often the first point of contact for concerned families,play a pivotal role in the diagnostic process.However,they face numerous obstacles that can hinder accurate and timely diagnosis,particularly in resource-limited or culturally diverse settings such as the Middle East and North Africa(MENA)and Arabian Gulf regions.This narrative review explores the key challenges pediatricians face in diagnosing ADHD and highlights practical and emerging solutions.The article offers both a global perspective and a contextualized view relevant to the MENA region.A narrative literature review was conducted using PubMed,Scopus,and Google Scholar,focusing on peer-reviewed studies,clinical guidelines,and epidemiological data from 2010 to 2025 related to pediatric ADHD diagnosis,especially in MENA regions.The review identifies six major diagnostic barriers:(1)Symptom overlap with other conditions[e.g.,autism spectrum disorder(ASD),anxiety,learning disabilities];(2)Reliance on subjective informant reports;(3)Cultural and societal influences including stigma and gender bias;(4)Variability in ADHD training and time constraints in clinical practice;(5)Limited access to multidisciplinary evaluations;and(6)Systemic referral and communication inefficiencies.Comorbidities are highly prevalent and frequently complicate the diagnostic picture.Delayed or inaccurate diagnosis can lead to academic underperformance,family stress,missed interventions,and long-term psychological consequences.Emerging solutions include digital screening tools,artificial intelligence-assisted analysis,structured reporting platforms,and improved training and referral models.Regional data from the Arabian Gulf highlight variable prevalence rates(1.3%-22%)and underscore the need for culturally sensitive diagnostic strategies.To improve diagnostic accuracy and patient outcomes,pediatricians must be supported through better training,interdisciplinary collaboration,validated tools,and policy-level reforms.Tailoring these approaches to local contexts will be key to addressing the growing burden of ADHD,particularly in the MENA region.展开更多
Sleep disturbances and disorders are commonly associated with attention-deficit/hyperactivity disorder(ADHD),with affected children frequently experiencing delayed sleep onset,frequent nighttime awakenings,morning fat...Sleep disturbances and disorders are commonly associated with attention-deficit/hyperactivity disorder(ADHD),with affected children frequently experiencing delayed sleep onset,frequent nighttime awakenings,morning fatigue,and excessive daytime sleepiness.A bidirectional relationship exists between ADHD and sleep disturbances:Sleep deprivation is linked to increased inattention and emotional dysregulation,while evening hyperactivity and impulsivity may contribute to difficulty falling asleep.Central nervous system stimulants remain the first-line treatment for managing ADHD symptoms;however,insomnia can be a common side effect.Notably,newer and long-acting stimulants formulations have demonstrated extended benefit into evening with limited impact on sleep in recent studies.This narrative review summarizes the various sleep disorders associated with ADHD,outlines clinical approaches for sleep assessment,and evaluates the impact of ADHD treatments on sleep.It also highlights both nonpharmacological and pharmacological interventions for managing sleep problems in children with ADHD.Finally,the review offers practical recommendations to help clinicians optimize both sleep and daytime functioning in patients with ADHD.ADHD should be conceptualized as a 24-hour disorder,requiring integrated treatment strategies that address both daytime symptoms and nighttime sleep challenges.展开更多
Inappropriate levels of hyperactivity,impulsivity,and inattention characterize attention deficit hyperactivity disorder,a common childhood-onset neuropsychiatric disorder.The cognitive function and learning ability of...Inappropriate levels of hyperactivity,impulsivity,and inattention characterize attention deficit hyperactivity disorder,a common childhood-onset neuropsychiatric disorder.The cognitive function and learning ability of children with attention deficit hyperactivity disorder are affected,and these symptoms may persist to adulthood if they are not treated.The diagnosis of attention deficit hyperactivity disorder is only based on symptoms and objective tests for attention deficit hyperactivity disorder are missing.Treatments for attention deficit hyperactivity disorder in children include medications,behavior therapy,counseling,and education services which can relieve many of the symptoms of attention deficit hyperactivity disorder but cannot cure it.There is a need for a molecular biomarker to distinguish attention deficit hyperactivity disorder from healthy subjects and other neurological conditions,which would allow for an earlier and more accurate diagnosis and appropriate treatment to be initiated.Abnormal expression of microRNAs is connected to brain development and disease and could provide novel biomarkers for the diagnosis and prognosis of attention deficit hyperactivity disorder.The recent studies reviewed had performed microRNA profiling in whole blood,white blood cells,blood plasma,and blood serum of children with attention deficit hyperactivity disorder.A large number of microRNAs were dysregulated when compared to healthy controls and with some overlap between individual studies.From the studies that had included a validation set of patients and controls,potential candidate biomarkers for attention deficit hyperactivity disorder in children could be miR-140-3p,let-7g-5p,-30e-5p,-223-3p,-142-5p,-486-5p,-151a-3p,-151a-5p,and-126-5p in total white blood cells,and miR-4516,-6090,-4763-3p,-4281,-4466,-101-3p,-130a-3p,-138-5p,-195-5p,and-106b-5p in blood serum.Further studies are warranted with children and adults with attention deficit hyperactivity disorder,and consideration should be given to utilizing rat models of attention deficit hyperactivity disorder.Animal studies could be used to confirm microRNA findings in human patients and to test the effects of targeting specific microRNAs on disease progression and behavior.展开更多
BACKGROUND Bronchial asthma is closely related to the occurrence of attention-deficit hyperactivity disorder(ADHD)in children,which can easily have adverse effects on children’s learning and social interactions.Studi...BACKGROUND Bronchial asthma is closely related to the occurrence of attention-deficit hyperactivity disorder(ADHD)in children,which can easily have adverse effects on children’s learning and social interactions.Studies have shown that childhood asthma can increase the risk of ADHD and the core symptoms of ADHD.Compared with children with ADHD alone,children with asthma and ADHD are more likely to show high levels of hyperactivity,hyperactive-impulsive and other externalizing behaviors and anxiety in clinical practice and have more symptoms of somatization and emotional internalization.AIM To explore the relationship between ADHD in children and bronchial asthma and to analyze its influencing factors.METHODS This retrospective cohort study was conducted at Dongying People's Hospital from September 2018 to August 2023.Children diagnosed with ADHD at this hospital were selected as the ADHD group,while healthy children without ADHD who underwent physical examinations during the same period served as the control group.Clinical and parental data were collected for all participating children,and multivariate logistic regression analysis was employed to identify risk factors for comorbid asthma in children with ADHD.RESULTSSignificant differences were detected between the ADHD group and the control group in terms of family history ofasthma and allergic diseases, maternal complications during pregnancy, maternal use of asthma and allergymedications during pregnancy, maternal anxiety and depression during pregnancy, and parental relationshipstatus (P < 0.05). Out of the 183 children in the ADHD group, 25 had comorbid asthma, resulting in a comorbidityrate of 13.66% (25/183), compared to the comorbidity rate of 2.91% (16/549) among the 549 children in the controlgroup. The difference in the asthma comorbidity rate between the two groups was statistically significant (P <0.05). The results of the multivariate logistic regression analysis indicated that family history of asthma and allergicdiseases, maternal complications during pregnancy, maternal use of asthma and allergy medications duringpregnancy, maternal anxiety and depression during pregnancy, and parental relationship status are independentrisk factors increasing the risk of comorbid asthma in children with ADHD (P < 0.05).CONCLUSIONChildren with ADHD were more likely to have comorbid asthma than healthy control children were. A familyhistory of asthma, adverse maternal factors during pregnancy, and parental relationship status were identified asrisk factors influencing the comorbidity of asthma in children with ADHD. Clinically, targeted interventions basedon these factors can be implemented to reduce the risk of comorbid asthma. This information is relevant for resultssections of abstracts in scientific articles.展开更多
The hypothesis that some children with attention-deficit hyperactivity disorder(ADHD)may show sensitivity or allergic reactions to various food items has led to the development of the the few-foods(or oligoantigenic)d...The hypothesis that some children with attention-deficit hyperactivity disorder(ADHD)may show sensitivity or allergic reactions to various food items has led to the development of the the few-foods(or oligoantigenic)diet.The rationale of the diet is to eliminate certain foods from the diet in order to exclude potential allergens contained either naturally in food or in artificial ingredients with allergenic properties.The oligoantigenic diet attempts to identify individual foods to which a person might be sensitive.First,ADHD symptoms are monitored while multiple foods are excluded from the diet.Subsequently,if symptoms remit,foods are re-introduced,while observing the individual for the return of symptoms.An advantage of the oligoantigenic diet is that it can be tailored to the individual.A growing body of evidence suggests that behavioral symptoms of subgroups of children with ADHD may benefit from the elimination of certain foods.The effect sizes of an oligoantigenic diet regarding improvement of ADHD symptoms have been found to be medium to large.Available evidence suggests that the investigation of the role of food hypersensitivities in ADHD is a promising avenue worthy of further exploration.Further large-scale,randomized controlled studies including assessment of long-term outcome are therefore warranted.展开更多
BACKGROUND Sotos syndrome is an autosomal dominant disorder,whereas attention-deficit/hyperactivity disorder(ADHD)is a neurodevelopmental condition.This report aimed to summarize the clinical and genetic features of a...BACKGROUND Sotos syndrome is an autosomal dominant disorder,whereas attention-deficit/hyperactivity disorder(ADHD)is a neurodevelopmental condition.This report aimed to summarize the clinical and genetic features of a pediatric case of Soros syndrome and ADHD in a child exhibiting precocious puberty.CASE SUMMARY The patient presented with accelerated growth and advanced skeletal maturation;however,she lacked any distinct facial characteristics related to specific genetic disorders.Genetic analyses revealed a paternally inherited heterozygous synonymous mutation[c.4605C>T(p.Arg1535Arg)].Functional analyses suggested that this mutation may disrupt splicing,and bioinformatics analyses predicted that this mutation was likely pathogenic.After an initial diagnosis of Sotos syndrome,the patient was diagnosed with ADHD during the follow-up period at the age of 8 years and 7 months.CONCLUSION The potential for comorbid ADHD in Sotos syndrome patients should be considered to avoid the risk of a missed diagnosis.展开更多
Objective:This study aims to investigate the impact of early intervention on neuropsychological development in children with autism and attention deficit hyperactivity disorder(ADHD),providing effective intervention s...Objective:This study aims to investigate the impact of early intervention on neuropsychological development in children with autism and attention deficit hyperactivity disorder(ADHD),providing effective intervention strategies for clinical practice.Methods:A total of 130 children with autism and ADHD who visited the hospital between June 2023 and June 2024 were selected as study subjects and randomly divided into an intervention group and a control group,with 65 children in each group.The intervention group received a one-year early comprehensive intervention,including behavioral therapy,cognitive training,and family guidance,while the control group only received routine medical care.The neuropsychological development assessment scale was used to evaluate both groups before and after the intervention to compare changes in their neuropsychological development levels.Results:Children in the intervention group showed significant improvements in cognitive function,social skills,language ability,and attention concentration,with an average improvement score of 23.5 points.Children in the control group did not show significant improvements in these areas,with an average improvement score of only 5.8 points.The difference between the two groups was statistically significant(P<0.05).Conclusion:Early comprehensive intervention has a significant promoting effect on the neuropsychological development of children with autism and ADHD.Targeted behavioral therapy,cognitive training,and family guidance can effectively enhance children’s cognitive,social,language,and attention abilities,laying a solid foundation for their future overall development.Therefore,it is recommended to actively promote and apply early intervention strategies in clinical practice.展开更多
BACKGROUND Attention deficit hyperactivity disorder(ADHD)is a common mental and behavioral disorder among children.AIM To explore the focus of attention deficit hyperactivity disorder parents and the effectiveness of ...BACKGROUND Attention deficit hyperactivity disorder(ADHD)is a common mental and behavioral disorder among children.AIM To explore the focus of attention deficit hyperactivity disorder parents and the effectiveness of early clinical screening METHODS This study found that the main directions of parents seeking medical help were short attention time for children under 7 years old(16.6%)and poor academic performance for children over 7 years old(12.1%).We employed a two-stage experiment to diagnose ADHD.Among the 5683 children evaluated from 2018 to 2021,360 met the DSM-5 criteria.Those diagnosed with ADHD underwent assessments for letter,number,and figure attention.Following the exclusion of ADHD-H diagnoses,the detection rate rose to 96.0%,with 310 out of 323 cases identified.RESULTS This study yielded insights into the primary concerns of parents regarding their children's symptoms and validated the efficacy of a straightforward diagnostic test,offering valuable guidance for directing ADHD treatment,facilitating early detection,and enabling timely intervention.Our research delved into the predominant worries of parents across various age groups.Furthermore,we showcased the precision of the simple exclusion experiment in discerning between ADHD-I and ADHD-C in children.CONCLUSION Our study will help diagnose and guide future treatment directions for ADHD.展开更多
BACKGROUND Unhealthy maternal diet leads to heavy metal exposures from the consumption of ultra-processed foods that may impact gene behavior across generations,creating conditions for the neurodevelopmental disorders...BACKGROUND Unhealthy maternal diet leads to heavy metal exposures from the consumption of ultra-processed foods that may impact gene behavior across generations,creating conditions for the neurodevelopmental disorders known as autism and attention deficit/hyperactivity disorder(ADHD).Children with these disorders have difficulty metabolizing and excreting heavy metals from their bloodstream,and the severity of their symptoms correlates with the heavy metal levels measured in their blood.Psychiatrists may play a key role in helping parents reduce their ultra-processed food and dietary heavy metal intake by providing access to effective nutritional epigenetics education.AIM To test the efficacy of nutritional epigenetics instruction in reducing parental ultra-processed food intake.METHODS The study utilized a semi-randomized test and control group pretest-posttest pilot study design with participants recruited from parents having a learning-disabled child with autism or ADHD.Twenty-two parents who met the inclusion criteria were randomly selected to serve in the test(n=11)or control(n=11)group.The test group participated in the six-week online nutritional epigenetics tutorial,while the control group did not.The efficacy of the nutritional epigenetics instruction was determined by measuring changes in parent diet and attitude using data derived from an online diet survey administered to the participants during the pre and post intervention periods.Diet intake scores were derived for both ultra-processed and whole/organic foods.Paired sample t-tests were conducted to determine any differences in mean diet scores within each group.RESULTS There was a significant difference in the diet scores of the test group between the pre-and post-intervention periods.The parents in the test group significantly reduced their intake of ultra-processed foods with a preintervention diet score of 70(mean=5.385,SD=2.534)and a post-intervention diet score of 113(mean=8.692,SD=1.750)and the paired t-test analysis showing a significance of P<0.001.The test group also significantly increased their consumption of whole and/or organic foods with a pre-intervention diet score of 100(mean=5.882,SD=2.472)and post-intervention diet score of 121(mean=7.118,SD=2.390)and the paired t-test analysis showing a significance of P<0.05.CONCLUSION Here we show nutritional epigenetics education can be used to reduce ultra-processed food intake and improve attitude among parents having learning-disabled children with autism or ADHD.展开更多
基金Supported by Natural Science Foundation of Shanghai,No.17ZR1431400National Key R and D Program of China,No.2017YFA0103902.
文摘Sotos syndrome is characterized by overgrowth features and is caused by alterations in the nuclear receptor binding SET domain protein 1 gene.Attentiondeficit/hyperactivity disorder(ADHD)is considered a neurodevelopment and psychiatric disorder in childhood.Genetic characteristics and clinical presentation could play an important role in the diagnosis of Sotos syndrome and ADHD.Magnetic resonance imaging(MRI)has been used to assess medical images in Sotos syndrome and ADHD.The images process is considered to display in MRI while wavelet fusion has been used to integrate distinct images for achieving more complete information in single image in this editorial.In the future,genetic mechanisms and artificial intelligence related to medical images could be used in the clinical diagnosis of Sotos syndrome and ADHD.
文摘The prevalence of autism and attention deficit/hyperactivity disorders is increasing worldwide.Recent studies suggest the excessive intake of ultra-processed food plays a role in the inheritance of these disorders via heavy metal exposures and nutritional deficits that impact the expression of genes.In the case of the metallothionein(MT)gene,biomarker studies show dietary zinc(Zn)deficits impact MT protein levels in children with autism and are associated with the bioaccumulation of lead and/or mercury in children exhibiting autism/attention deficit/hyperactivity disorders symptomology.The impact of dietary changes on lead and mercury exposures and MT gene behavior could be determined using a randomized test and control group design.Pregnant women serving in the testgroup would participate in a nutritional epigenetics education intervention/course designed to reduce ultra-processed food intake and heavy metal levels in blood while increasing whole food intake and MT and Zn levels.Changes in maternal diet would be measured using data derived from an online diet survey administered to the test and control groups pre-post intervention.Changes in maternal lead,mercury,Zn,and MT levels would be measured via blood sample analyses prior to the intervention and after childbirth via cord blood analyses to determine infant risk factors.
基金Supported by the Central Guiding Local Science and Technology Development Fund Project,No.YDZX2022091。
文摘Attention deficit hyperactivity disorder(ADHD)turns into a common neuro progressional disorder.Although gender identity has obtained increasing attention in ADHD researches,its role in ADHD presentation and treatment response remains underexplored.Our review seeks to mainly delve into the effect of gender identity on ADHD,exploring the unique needs of individuals with various gender identities in the context of ADHD symptoms,diagnostic assessment,and treatment,with the goal of supplying theoretical support and practical recommendations for future research and clinical practice.The primary content includes,specifically:(1)Symptom expression differences:Gender identity significantly affects ADHD symptoms;male-identified individuals commonly perform worse in task orientation and attention stability,while female-identified individuals may demonstrate more variability in attention control and executive functions;(2)Diagnosis and treatment:Clinical practice generally neglects the impact of gender identity on ADHD management,with personalized needs of gender-identified individuals frequently not adequately addressed,potentially,affecting treatment outcomes;and(3)Future research directions:Future studies should further assess how gender identity affects the specific mechanisms of ADHD,conduct researches in multicultural contexts,and engage in long-term follow-up studies to evaluate the long-term impact of gender identity on ADHD progression.Besides,enhanced funding and public education on the relationship between gender identity and ADHD are needed to advance the field.
基金This study received financial support from the Jilin Province Health and Technology Capacity Enhancement Project(Project Number:222Lc132).
文摘Objective: This study investigates the auxiliary role of resting-state electroencephalography (EEG) in the clinical diagnosis of attention-deficit hyperactivity disorder (ADHD) using machine learning techniques. Methods: Resting-state EEG recordings were obtained from 57 children, comprising 28 typically developing children and 29 children diagnosed with ADHD. The EEG signal data from both groups were analyzed. To ensure analytical accuracy, artifacts and noise in the EEG signals were removed using the EEGLAB toolbox within the MATLAB environment. Following preprocessing, a comparative analysis was conducted using various ensemble learning algorithms, including AdaBoost, GBM, LightGBM, RF, XGB, and CatBoost. Model performance was systematically evaluated and optimized, validating the superior efficacy of ensemble learning approaches in identifying ADHD. Conclusion: Applying machine learning techniques to extract features from resting-state EEG signals enabled the development of effective ensemble learning models. Differential entropy and energy features across multiple frequency bands proved particularly valuable for these models. This approach significantly enhances the detection rate of ADHD in children, demonstrating high diagnostic efficacy and sensitivity, and providing a promising tool for clinical application.
基金supported by the Key Project at the Central Government Level:the ability establishment of sustainable use for valuable Chinese medicine resources(No.2060302)the National Natural Science Foundation of China(No.82104389)+2 种基金the Scientific and Technological Innovation Project of China Academy of Chinese Medical Sciences(No.CI2023E002)the High-level Key Discipline Program of National Administration of Traditional Chinese Medicine(No.ZYYZDXK-2023244)China Agricultural Research System of MOF and MARA(No.CARS-21).
文摘Pyrrolizidine alkaloids(PAs)are natural toxins generated as secondarymetabolites in plants,predominantly consisting of unsaturated PAs with diverse toxicities,such as hepatotoxicity.Echimidine,a prominent PA,is believed to exert various toxicological effects,including survival inhibition and induction of apoptosis of hepatocytes.However,the effects of echimidine on development remain unclear.We selected three concentrations of 0.02,0.2,and 2 mg/L to investigate the developmental toxicity of echimidine on zebrafish embryos.After a 7-day exposure,we observed hyperactivity and anxiety-like behavior in zebrafish larvae.Furthermore,we found that echimidine exposure significantly promoted embryonic motor neurodevelopment in geneticallymodified zebrafish.Next,we detected that echimidine exposure significantly increased the content of the excitatory neurotransmitter acetylcholine(ACh),accompanied by a significant decrease in acetylcholinesterase(AChE)activity.Conversely,echimidine led to a significant reduction in the content of the sedative neurotransmitterγ-aminobutyric acid(GABA),accompanied by abnormal gene expression of enzymes related to GABA synthesis.Moreover,we elucidated the strong direct binding of echimidine to zebrafish and human AChE protein through molecular docking.In summary,our study found that echimidine induced ACh accumulation possibly by inhibiting AChE activity,leading to motor neurodevelopmental abnormalities and hyperactivity in zebrafish larvae.This work provides important scientific knowledge on the effects and mechanisms of PAs on neural development,which is helpful for controlling the risk of PAs in food and protecting public health.
基金the Program of Discipline Backbone of high-level Public Health Talents of Beijing Municipal Health Commission:Epidemiological Survey of Acute Myocardial Infarction Inpatients in Hospital of Traditional Chinese Medicine in Beijing Area(Discipline backbone-02-25)Beijing Municipal Hospital Administration Green Seedling Talent Project:Study on Characteristics of Clinical Syndromes,Status of Traditional Chinese Medicine Treatment and Prognosis of Patients with Chronic Heart Failure in Traditional Chinese Medicine Regional Health Service Center(QML20231006)。
文摘OBJECTIVE:To investigate the efficacy and safety of Angong Jiangya pill(AGJY,安宫降压丸)in the treatment of grade 2 hypertension with liver-fire hyperactivity syndrome.METHODS:This multicenter,randomized,double-blind,placebo-controlled trial was conducted in eight medical institutions.Eligible patients with grade 2 hypertension were randomly allocated to receive AGJY or a placebo for 12 weeks.The primary outcome was the change in blood pressure(BP).The secondary outcomes were BP compliance rate,Traditional Chinese Medicine(TCM)symptoms,and Duchenne Hypertension Quality of Life Scale score.RESULTS:Data were analyzed for 117 participants in the AGJY group and 118 participants in the placebo group.After 12 weeks of treatment,AGJY compared with placebo resulted in a higher and significant reduction in systolic/diastolic BP(-15.58±10.16/-9.72±7.41 vs-8.13±8.28/-4.86±5.68 mm Hg,P<0.0001,<0.0001,respectively).BP compliance rate(31.86%vs 19.13%,P=0.027)was significantly higher in the AGJY group than in the placebo group.The AGJY group showed a significant reduction in TCM symptom score compared with the placebo group(10.82±2.03 vs 7.83±1.24,P<0.0001).Single TCM syndrome clinical control rates of the primary symptoms(dizziness,headache,and irritability)were superior in the AGJY group(71.95%,94.62%,72.53%,respectively)compared with the placebo group(48.39%,68.00%,30.52%,respectively).Scores on the Duchenne Hypertension Quality of Life Scale showed a significant increase in the AGJY group compared with the placebo group(30.65±21.06 vs 9.96±10.72,P=0.000).No serious adverse events occurred.CONCLUSION:AGJY demonstrated efficacy in lowering BP,increasing the rate of BP compliance,and improving TCM symptoms and quality of life in patients with grade 2 hypertension liver-fire hyperactivity syndrome.However,further in-depth studies are required to determine the mechanism of TCM in treating hypertension.
基金Supported by National Natural Science Foundation of China,No.82460282Guizhou Province Science and Technology Plan Project,No.ZK-2023-195+1 种基金Guizhou High-Level Innovative Talent Project,No.gzwjrs2022-013Health Commission of Guizhou Province Project,No.gzwkj2024-475 and No.gzwkj2021-150.
文摘BACKGROUND Attention deficit hyperactivity disorder(ADHD)is a prevalent neurodevelopmental disorder in adolescents characterized by inattention,hyperactivity,and impulsivity,which impact cognitive,behavioral,and emotional functioning.Resting-state functional magnetic resonance imaging(rs-fMRI)provides critical insights into the functional architecture of the brain in ADHD.Despite extensive research,specific brain regions consistently affected in ADHD patients during these formative years have not been comprehensively delineated.AIM To identify consistent vulnerable brain regions in adolescent ADHD patients using rs-fMRI and activation likelihood estimation(ALE)meta-analysis.METHODS We conducted a comprehensive literature search up to August 31,2024,to identify studies investigating functional brain alterations in adolescents with ADHD.We utilized regional homogeneity(ReHo),amplitude of low-frequency fluctuations(ALFF),dynamic ALFF(dALFF)and fractional ALFF(fALFF)analyses.We compared the regions of aberrant spontaneous neural activity in adolescents with ADHD with those in healthy controls(HCs)using ALE.RESULTS Fifteen studies(468 adolescent ADHD patients and 466 HCs)were included.Combining the ReHo and ALFF/fALFF/dALFF data,the results revealed increased activity in the right lingual gyrus[LING,Brodmann Area(BA)18],left LING(BA 18),and right cuneus(CUN,BA 23)in adolescent ADHD patients compared with HCs(voxel size:592-32 mm³,P<0.05).Decreased activity was observed in the left medial frontal gyrus(MFG,BA 9)and left precuneus(PCUN,BA 31)in adolescent ADHD patients compared with HCs(voxel size:960-456 mm³,P<0.05).Jackknife sensitivity analyses demonstrated robust reproducibility in 11 of the 13 tests for the right LING,left LING,and right CUN and in 11 of the 14 tests for the left MFG and left PCUN.CONCLUSION We identified specific brain regions with both increased and decreased activity in adolescent ADHD patients,enhancing our understanding of the neural alterations that occur during this pivotal stage of development.
文摘BACKGROUND Speech and language therapy(ST)might moderate the prognosis in children with attention deficit and hyperactivity disorder(ADHD)comorbid with speech delay.This study investigated whether ST in children with ADHD is associated with a decreased risk of subsequent psychiatric disorders.AIM To investigate whether ST in children with ADHD is associated with a decreased risk of subsequent psychiatric disorders.METHODS The population-based National Health Insurance Research Database in Taiwan was used.Hazards of subsequent psychiatric disorders were compared between those who received ST and a propensity-score matched comparison group by Cox regression analyses.RESULTS Of 11987 children with ADHD identified from the dataset,2911(24%)had received ST.The adjusted hazard ratio for any subsequent recorded psychiatric disorder was 0.72(95%confidence interval:0.63-0.82)in children who received ST compared to the matched counterparts.This protective association was only statistically significant in the subgroup that received both medication and behavioral interventions.CONCLUSION ST can moderate the effects of integrated early interventions in ADHD children with speech delay.
文摘Background Raising a child with attention deficit hyperactivity disorder(ADHD)is a key challenge for the primary caregiver.This systematic review aims to identify major burdens facing the primary caregiver of a child with ADHD.Methods The electronic databases CINAHL,PubMed,and Google Scholar were searched for studies published in English from 2017 to 2022 assessing the challenges facing caregivers of a child with ADHD.The Johns Hopkins Nursing Evidence-Based Practice Model was used to assess quality and risk of bias of studies identified for inclusion.Articles were synthesized by evaluating principal themes of burden to caregivers,stress of caregivers,and effectiveness of intervention programs.Results Eleven articles were included in this review and included a total of 2426 participants.Findings revealed that caregivers of children with ADHD have a poor quality of life and high stress levels.Supportive parenting programs can be effective for improved coping and adaptation mechanisms with children with ADHD.However,few interventional studies were identified,increasing potential for bias.No meta-analysis was conducted.Conclusion Caregivers of children with ADHD can benefit from strategies to improve their quality of life and reduce their stress levels.Targeted parenting programs can make a positive difference in the well-being of caregivers and children with ADHD.Additional research is needed to address the evidence-based effectiveness of parenting support programs.
基金Supported by the Shenzhen Science and Technology Program,No.RCYX20221008092849069The Guangdong High-Level Hospital Construction Fund.
文摘Attention-deficit/hyperactivity disorder(ADHD)is increasingly conceptualized as a dynamic neurodevelopmental condition,marked by fluctuating symptom trajectories across development rather than the traditional static patterns of persistence or remission.This review synthesizes empirical evidence on the varied trajectories of ADHD symptoms-including late-onset,partial remission,and recurrent fluctuation patterns-and underscores their clinical significance in longterm functioning.We adopt a multifactorial framework to explore how genetic,environmental,and gene–environment interactions contribute to the emergence and evolution of ADHD symptoms over time.In addition,we consider how medication-related variables-particularly tolerance and adherence-may influence symptom fluctuation.Characterizing these developmental dynamics offers critical guidance for designing flexible,personalized interventions that align with individual trajectories and transitional vulnerabilities.
基金Supported by the Projects of Design and Statistics of Clinical Trials in Traditional Chinese Medicine,No.A YXC2022-01-0110Exploring the Mechanism by which Pingyang Yuyin Granules Improve Hypertensive Kidney Injury Based on the'Balance'Theory of PPARγ/HGF and TGF-β1/Smads Signaling Pathways,No.Y2022ZR09.
文摘BACKGROUND Hypertension is a significant global health concern and serves as a critical risk factor for cardiovascular diseases,stroke,and renal failure.Traditional Chinese Medicine(TCM)has been utilized for an extended period to address hypertension,with the syndrome known as Yin deficiency and Yang hyperactivity syndrome(YDYHS)frequently observed in individuals with elevated blood pressure.This syndrome is characterized by symptoms including dizziness,tinnitus,irritability,and insomnia,which are thought to result from an imbalance between Yin,representing the cooling and nourishing aspects,and Yang,denoting the active and warming aspects of the body.Despite the prevalent application of TCM in clinical settings,the metabolic mechanisms underlying the YDYHS in the context of hypertension remain inadequately elucidated.AIM To explore the differential plasma metabolites and associated pathways in hypertensive patients with YDYHS using gas chromatography-mass spectrometry(GC-MS)to elucidate the distinctive blood metabolite pattern in this patient population.METHODS GC-MS was used to analyze plasma samples from 51 hypertensive patients with YDYHS and 20 healthy controls.Chemometric methods,including principal component analysis and partial least squares discriminant analysis,were employed to identify potential biochemical patterns.Simultaneously,the high-quality Kyoto Encyclopedia of Genes and Genomes metabolic pathways database was used to identify associated metabolic pathways.Using variable importance in projection and receiver operating characteristic curve analyses,potential biomarkers were extracted to assess their clinical utility.RESULTS Metabolomic profiling of hypertensive patients with YDYHS identified 20 potential biomarkers(4-hydroxybenzoic acid,pectin,1,2,3-trihydroxybenzene,D-ribose,3-hydroxybutyric acid,quinic acid,L-lysine,oleic acid,2-hydroxybutyric acid,linoleic acid,citric acid,alpha-tocopherol,D-glucuronic acid,glycerol,N-acetyl-L-aspartic acid,betamannosylglycerate,indolelactic acid,L-glutamic acid,D-maltose,L-aspartic acid)and four metabolic pathways(linoleic acid metabolism;alanine,aspartate and glutamate metabolism;D-glutamine and D-glutamate metabolism;arginine biosynthesis).The identified differential metabolites may serve as potential biomarkers for distinguishing hypertensive patients with YDYHS from healthy controls.The area under the curve values ranged from 0.750 to 0.866.Receiver operating characteristic curve analysis showed that these differential metabolites can effectively classify hypertensive patients with YDYHS and healthy individuals.CONCLUSION The metabolomic analysis revealed a distinct blood metabolite pattern in hypertensive patients with YDYHS compared to the healthy control group,highlighting the potential role of the identified 20 biomarkers and four metabolic pathways in these patients.These findings may serve as an important material basis for understanding the occurrence and development of the disease,providing a scientific foundation for future clinical diagnosis.
文摘Attention-deficit/hyperactivity disorder(ADHD)is one of the most common neurodevelopmental disorders of childhood,yet its diagnosis remains complex and fraught with challenges.Pediatricians,often the first point of contact for concerned families,play a pivotal role in the diagnostic process.However,they face numerous obstacles that can hinder accurate and timely diagnosis,particularly in resource-limited or culturally diverse settings such as the Middle East and North Africa(MENA)and Arabian Gulf regions.This narrative review explores the key challenges pediatricians face in diagnosing ADHD and highlights practical and emerging solutions.The article offers both a global perspective and a contextualized view relevant to the MENA region.A narrative literature review was conducted using PubMed,Scopus,and Google Scholar,focusing on peer-reviewed studies,clinical guidelines,and epidemiological data from 2010 to 2025 related to pediatric ADHD diagnosis,especially in MENA regions.The review identifies six major diagnostic barriers:(1)Symptom overlap with other conditions[e.g.,autism spectrum disorder(ASD),anxiety,learning disabilities];(2)Reliance on subjective informant reports;(3)Cultural and societal influences including stigma and gender bias;(4)Variability in ADHD training and time constraints in clinical practice;(5)Limited access to multidisciplinary evaluations;and(6)Systemic referral and communication inefficiencies.Comorbidities are highly prevalent and frequently complicate the diagnostic picture.Delayed or inaccurate diagnosis can lead to academic underperformance,family stress,missed interventions,and long-term psychological consequences.Emerging solutions include digital screening tools,artificial intelligence-assisted analysis,structured reporting platforms,and improved training and referral models.Regional data from the Arabian Gulf highlight variable prevalence rates(1.3%-22%)and underscore the need for culturally sensitive diagnostic strategies.To improve diagnostic accuracy and patient outcomes,pediatricians must be supported through better training,interdisciplinary collaboration,validated tools,and policy-level reforms.Tailoring these approaches to local contexts will be key to addressing the growing burden of ADHD,particularly in the MENA region.
文摘Sleep disturbances and disorders are commonly associated with attention-deficit/hyperactivity disorder(ADHD),with affected children frequently experiencing delayed sleep onset,frequent nighttime awakenings,morning fatigue,and excessive daytime sleepiness.A bidirectional relationship exists between ADHD and sleep disturbances:Sleep deprivation is linked to increased inattention and emotional dysregulation,while evening hyperactivity and impulsivity may contribute to difficulty falling asleep.Central nervous system stimulants remain the first-line treatment for managing ADHD symptoms;however,insomnia can be a common side effect.Notably,newer and long-acting stimulants formulations have demonstrated extended benefit into evening with limited impact on sleep in recent studies.This narrative review summarizes the various sleep disorders associated with ADHD,outlines clinical approaches for sleep assessment,and evaluates the impact of ADHD treatments on sleep.It also highlights both nonpharmacological and pharmacological interventions for managing sleep problems in children with ADHD.Finally,the review offers practical recommendations to help clinicians optimize both sleep and daytime functioning in patients with ADHD.ADHD should be conceptualized as a 24-hour disorder,requiring integrated treatment strategies that address both daytime symptoms and nighttime sleep challenges.
文摘Inappropriate levels of hyperactivity,impulsivity,and inattention characterize attention deficit hyperactivity disorder,a common childhood-onset neuropsychiatric disorder.The cognitive function and learning ability of children with attention deficit hyperactivity disorder are affected,and these symptoms may persist to adulthood if they are not treated.The diagnosis of attention deficit hyperactivity disorder is only based on symptoms and objective tests for attention deficit hyperactivity disorder are missing.Treatments for attention deficit hyperactivity disorder in children include medications,behavior therapy,counseling,and education services which can relieve many of the symptoms of attention deficit hyperactivity disorder but cannot cure it.There is a need for a molecular biomarker to distinguish attention deficit hyperactivity disorder from healthy subjects and other neurological conditions,which would allow for an earlier and more accurate diagnosis and appropriate treatment to be initiated.Abnormal expression of microRNAs is connected to brain development and disease and could provide novel biomarkers for the diagnosis and prognosis of attention deficit hyperactivity disorder.The recent studies reviewed had performed microRNA profiling in whole blood,white blood cells,blood plasma,and blood serum of children with attention deficit hyperactivity disorder.A large number of microRNAs were dysregulated when compared to healthy controls and with some overlap between individual studies.From the studies that had included a validation set of patients and controls,potential candidate biomarkers for attention deficit hyperactivity disorder in children could be miR-140-3p,let-7g-5p,-30e-5p,-223-3p,-142-5p,-486-5p,-151a-3p,-151a-5p,and-126-5p in total white blood cells,and miR-4516,-6090,-4763-3p,-4281,-4466,-101-3p,-130a-3p,-138-5p,-195-5p,and-106b-5p in blood serum.Further studies are warranted with children and adults with attention deficit hyperactivity disorder,and consideration should be given to utilizing rat models of attention deficit hyperactivity disorder.Animal studies could be used to confirm microRNA findings in human patients and to test the effects of targeting specific microRNAs on disease progression and behavior.
文摘BACKGROUND Bronchial asthma is closely related to the occurrence of attention-deficit hyperactivity disorder(ADHD)in children,which can easily have adverse effects on children’s learning and social interactions.Studies have shown that childhood asthma can increase the risk of ADHD and the core symptoms of ADHD.Compared with children with ADHD alone,children with asthma and ADHD are more likely to show high levels of hyperactivity,hyperactive-impulsive and other externalizing behaviors and anxiety in clinical practice and have more symptoms of somatization and emotional internalization.AIM To explore the relationship between ADHD in children and bronchial asthma and to analyze its influencing factors.METHODS This retrospective cohort study was conducted at Dongying People's Hospital from September 2018 to August 2023.Children diagnosed with ADHD at this hospital were selected as the ADHD group,while healthy children without ADHD who underwent physical examinations during the same period served as the control group.Clinical and parental data were collected for all participating children,and multivariate logistic regression analysis was employed to identify risk factors for comorbid asthma in children with ADHD.RESULTSSignificant differences were detected between the ADHD group and the control group in terms of family history ofasthma and allergic diseases, maternal complications during pregnancy, maternal use of asthma and allergymedications during pregnancy, maternal anxiety and depression during pregnancy, and parental relationshipstatus (P < 0.05). Out of the 183 children in the ADHD group, 25 had comorbid asthma, resulting in a comorbidityrate of 13.66% (25/183), compared to the comorbidity rate of 2.91% (16/549) among the 549 children in the controlgroup. The difference in the asthma comorbidity rate between the two groups was statistically significant (P <0.05). The results of the multivariate logistic regression analysis indicated that family history of asthma and allergicdiseases, maternal complications during pregnancy, maternal use of asthma and allergy medications duringpregnancy, maternal anxiety and depression during pregnancy, and parental relationship status are independentrisk factors increasing the risk of comorbid asthma in children with ADHD (P < 0.05).CONCLUSIONChildren with ADHD were more likely to have comorbid asthma than healthy control children were. A familyhistory of asthma, adverse maternal factors during pregnancy, and parental relationship status were identified asrisk factors influencing the comorbidity of asthma in children with ADHD. Clinically, targeted interventions basedon these factors can be implemented to reduce the risk of comorbid asthma. This information is relevant for resultssections of abstracts in scientific articles.
文摘The hypothesis that some children with attention-deficit hyperactivity disorder(ADHD)may show sensitivity or allergic reactions to various food items has led to the development of the the few-foods(or oligoantigenic)diet.The rationale of the diet is to eliminate certain foods from the diet in order to exclude potential allergens contained either naturally in food or in artificial ingredients with allergenic properties.The oligoantigenic diet attempts to identify individual foods to which a person might be sensitive.First,ADHD symptoms are monitored while multiple foods are excluded from the diet.Subsequently,if symptoms remit,foods are re-introduced,while observing the individual for the return of symptoms.An advantage of the oligoantigenic diet is that it can be tailored to the individual.A growing body of evidence suggests that behavioral symptoms of subgroups of children with ADHD may benefit from the elimination of certain foods.The effect sizes of an oligoantigenic diet regarding improvement of ADHD symptoms have been found to be medium to large.Available evidence suggests that the investigation of the role of food hypersensitivities in ADHD is a promising avenue worthy of further exploration.Further large-scale,randomized controlled studies including assessment of long-term outcome are therefore warranted.
文摘BACKGROUND Sotos syndrome is an autosomal dominant disorder,whereas attention-deficit/hyperactivity disorder(ADHD)is a neurodevelopmental condition.This report aimed to summarize the clinical and genetic features of a pediatric case of Soros syndrome and ADHD in a child exhibiting precocious puberty.CASE SUMMARY The patient presented with accelerated growth and advanced skeletal maturation;however,she lacked any distinct facial characteristics related to specific genetic disorders.Genetic analyses revealed a paternally inherited heterozygous synonymous mutation[c.4605C>T(p.Arg1535Arg)].Functional analyses suggested that this mutation may disrupt splicing,and bioinformatics analyses predicted that this mutation was likely pathogenic.After an initial diagnosis of Sotos syndrome,the patient was diagnosed with ADHD during the follow-up period at the age of 8 years and 7 months.CONCLUSION The potential for comorbid ADHD in Sotos syndrome patients should be considered to avoid the risk of a missed diagnosis.
文摘Objective:This study aims to investigate the impact of early intervention on neuropsychological development in children with autism and attention deficit hyperactivity disorder(ADHD),providing effective intervention strategies for clinical practice.Methods:A total of 130 children with autism and ADHD who visited the hospital between June 2023 and June 2024 were selected as study subjects and randomly divided into an intervention group and a control group,with 65 children in each group.The intervention group received a one-year early comprehensive intervention,including behavioral therapy,cognitive training,and family guidance,while the control group only received routine medical care.The neuropsychological development assessment scale was used to evaluate both groups before and after the intervention to compare changes in their neuropsychological development levels.Results:Children in the intervention group showed significant improvements in cognitive function,social skills,language ability,and attention concentration,with an average improvement score of 23.5 points.Children in the control group did not show significant improvements in these areas,with an average improvement score of only 5.8 points.The difference between the two groups was statistically significant(P<0.05).Conclusion:Early comprehensive intervention has a significant promoting effect on the neuropsychological development of children with autism and ADHD.Targeted behavioral therapy,cognitive training,and family guidance can effectively enhance children’s cognitive,social,language,and attention abilities,laying a solid foundation for their future overall development.Therefore,it is recommended to actively promote and apply early intervention strategies in clinical practice.
文摘BACKGROUND Attention deficit hyperactivity disorder(ADHD)is a common mental and behavioral disorder among children.AIM To explore the focus of attention deficit hyperactivity disorder parents and the effectiveness of early clinical screening METHODS This study found that the main directions of parents seeking medical help were short attention time for children under 7 years old(16.6%)and poor academic performance for children over 7 years old(12.1%).We employed a two-stage experiment to diagnose ADHD.Among the 5683 children evaluated from 2018 to 2021,360 met the DSM-5 criteria.Those diagnosed with ADHD underwent assessments for letter,number,and figure attention.Following the exclusion of ADHD-H diagnoses,the detection rate rose to 96.0%,with 310 out of 323 cases identified.RESULTS This study yielded insights into the primary concerns of parents regarding their children's symptoms and validated the efficacy of a straightforward diagnostic test,offering valuable guidance for directing ADHD treatment,facilitating early detection,and enabling timely intervention.Our research delved into the predominant worries of parents across various age groups.Furthermore,we showcased the precision of the simple exclusion experiment in discerning between ADHD-I and ADHD-C in children.CONCLUSION Our study will help diagnose and guide future treatment directions for ADHD.
文摘BACKGROUND Unhealthy maternal diet leads to heavy metal exposures from the consumption of ultra-processed foods that may impact gene behavior across generations,creating conditions for the neurodevelopmental disorders known as autism and attention deficit/hyperactivity disorder(ADHD).Children with these disorders have difficulty metabolizing and excreting heavy metals from their bloodstream,and the severity of their symptoms correlates with the heavy metal levels measured in their blood.Psychiatrists may play a key role in helping parents reduce their ultra-processed food and dietary heavy metal intake by providing access to effective nutritional epigenetics education.AIM To test the efficacy of nutritional epigenetics instruction in reducing parental ultra-processed food intake.METHODS The study utilized a semi-randomized test and control group pretest-posttest pilot study design with participants recruited from parents having a learning-disabled child with autism or ADHD.Twenty-two parents who met the inclusion criteria were randomly selected to serve in the test(n=11)or control(n=11)group.The test group participated in the six-week online nutritional epigenetics tutorial,while the control group did not.The efficacy of the nutritional epigenetics instruction was determined by measuring changes in parent diet and attitude using data derived from an online diet survey administered to the participants during the pre and post intervention periods.Diet intake scores were derived for both ultra-processed and whole/organic foods.Paired sample t-tests were conducted to determine any differences in mean diet scores within each group.RESULTS There was a significant difference in the diet scores of the test group between the pre-and post-intervention periods.The parents in the test group significantly reduced their intake of ultra-processed foods with a preintervention diet score of 70(mean=5.385,SD=2.534)and a post-intervention diet score of 113(mean=8.692,SD=1.750)and the paired t-test analysis showing a significance of P<0.001.The test group also significantly increased their consumption of whole and/or organic foods with a pre-intervention diet score of 100(mean=5.882,SD=2.472)and post-intervention diet score of 121(mean=7.118,SD=2.390)and the paired t-test analysis showing a significance of P<0.05.CONCLUSION Here we show nutritional epigenetics education can be used to reduce ultra-processed food intake and improve attitude among parents having learning-disabled children with autism or ADHD.
