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ADHD is associated with impaired executive functioning. Executive functions are a set of mental skills that include working memory, flexible thinking, and self-control. These are skills we use every day to learn, work, and manage daily life. Trouble with executive function can make it hard to focus, follow directions, and handle emotions. 

A Chinese study team searched for studies on non-pharmacological treatments of children and adolescents with ADHD aged 5 to 18 years intended to improve their executive functioning. 

An initial methodological weakness was the decision to combine studies using formal ADHD diagnoses based on professional psychiatric manuals (DSM 3/4/5 and ICD 10/11) and studies relying on other methods such as parent reports.

This lack of rigor in identifying ADHD is surprising given that the team used studies that directly measured executive functioning through neurocognitive tasks, excluding those that relied on parent- or teacher-reported questionnaires. 

67 studies involving 74 training interventions met the criteria. Meta-analysis of all these studies, encompassing a total of 3,101 participants, suggested medium-to-large effect size improvements in executive functioning. There was evidence of publication bias, but trim-and-fill adjustment increased the estimated effect size to large.

Nevertheless, there were further methodological shortcomings:

• The meta-analysis mixed studies of substantially different interventions: cognitive training, executive function-specific curriculum, game-based training, neurofeedback, mindfulness, and physical exercise.
• There was tremendous variation (heterogeneity) between study outcomes. Such inconsistency casts doubt on the outcome unless subgroup analysis can explain it. 

In this case, subgroup analysis mostly failed to explain the heterogeneity, with a single exception. Meta-analysis of the 16 studies with 744 participants that explored executive function-specific curriculum found small-to-medium effect size improvements, with no heterogeneity. 

Unfortunately, the team did not perform a separate publication bias analysis on this subgroup, just as it failed to do so on any of the other subgroups.

By far the strongest evidence of benefit came from meta-analysis of the 17 studies with 558 participants evaluating physical exercise. Here the outcome pointed to very large effect size improvements in executive functioning. Yet once again, heterogeneity was extremely high. Breaking this down further between aerobic exercise and cognitively engaged physical exercise made no difference. Both types had the same very high effect size, with very wide heterogeneity. Again, there was no separate evaluation of publication bias on this group.

Meta-analyses of thirteen studies of neurofeedback combining 444 participants, and fifteen studies of cognitive training encompassing 727 participants, both pointed to just-short-of-large effect size improvements in executive function. Meta-analysis of twelve studies of game-based training with 598 participants indicated medium effect size gains. But again, in all three subgroups there was great variation between studies, and no analysis of publication bias.

While these meta-analyses are suggestive of efficacy, especially for physical exercise interventions, their methodological shortcomings mean we will have to await more rigorous meta-analyses to draw any more settled conclusions. Moreover, these meta-analyses did not evaluate the adequacy of the control groups used in the trials, which is a big shortcoming given prior work showing that the effect of non-pharmacologic treatments are very weak or non-existent when adequate controls are used.

During the COVID-19 pandemic, there were concerns about its disproportionate impact on children with ADHD. Canadian researchers decided to investigate whether symptoms of ADHD—such as inattention, hyperactivity, and impulsivity—had changed over the past three years due to the pandemic.

Research Approach

To explore this question, the researchers conducted a systematic review of peer-reviewed medical literature. They looked for studies that included children and adolescents aged three to eighteen and met the following criteria:

1. Reported ADHD symptoms at least once before the pandemic started (before March 2020) or provided a retroactive report of pre-pandemic symptoms.
2. Reported ADHD symptoms at least once after the pandemic began.

They found 18 studies with a total of 6,491 participants that could be combined for a meta-analysis. These studies were from four continents (North and South America, Asia, Europe) and ten countries (China, Japan, United States, Canada, Brazil, U.K., Germany, Spain, Italy, Lithuania).

Study Quality and Criteria

The researchers assessed the quality of the studies based on three criteria:

1. Clear description of the research setting.
2. Detailed description of data collection procedures.
3. Statistical assessment of the reliability and validity of measurement tools.

Ten studies met all three criteria, and the remaining eight met two out of three.

Findings

The meta-analysis revealed a small but statistically significant increase in ADHD symptoms after the onset of the pandemic. However, there was a high degree of variability (heterogeneity) in the results between studies. The researchers couldn't identify any reasons for this variability. Factors such as gender, age, study design (prospective vs. retrospective), and the identity of the symptom evaluator (self or caregiver) didn't significantly affect the results. Additionally, the researchers did not report any specific outcomes based on the ten higher-quality studies alone.

Moreover, there was strong evidence of publication bias. The researchers did not perform a trim-and-fill analysis, which could have shown how publication bias might have influenced the effect size. Given the small effect size initially reported, this leaves the overall findings uncertain.

Conclusion

While the study found a slight increase in ADHD symptoms among children during the pandemic, the high variability in results and the evidence of publication bias make it difficult to draw definitive conclusions. More research is needed to understand the true impact of the pandemic on ADHD symptoms in children and adolescents.

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An Iranian study team recently conducted a systematic search of the peer-reviewed medical literature to identify studies using DSM-V, DSM-IV, DSM IV-TR, and ICD10 criteria to estimate the prevalence of ADHD among children under 12, and, separately, among adolescents aged 12 through 17.

Meta-analysis of 53 studies combining almost 97,000 children from every continent except Australia produced a prevalence estimate of 7.6% (with a 95% confidence range of 6.1% to 9.4%). An Iranian study team recently conducted a systematic search of the peer-reviewed medical literature to identify studies using DSM-V, DSM-IV, DSM IV-TR, and ICD10 criteria to estimate the prevalence of ADHD among children under 12, and, separately, among adolescents aged 12 through 17.

Meta-analysis of 53 studies combining almost 97,000 children from every continent except Australia produced a prevalence estimate of 7.6% (with a 95% confidence range of 6.1% to 9.4%). There was extensive variation (heterogeneity) between studies, but no indication of publication bias.

Meta-analysis of 25 studies covering a total of over 40,000 adolescents from every continent except Australia produced a prevalence estimate of 5.6% (with a 95% confidence range of 4% to 7.8%). Again, there was extensive variation (heterogeneity) between studies, but no indication of publication bias.

The authors conceded, “One of the limitations of this study is the high heterogeneity of studies in terms of age group. Since the purpose of this study was to measure the prevalence of children and adolescents separately, studies that report the prevalence of ADHD in children and adolescents combined were removed.”

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ADHD (Attention Deficit Hyperactivity Disorder) is a real medical condition with lots of scientific evidence supporting it. However, people with ADHD often face stigma, which can impact them and their families in many ways. This article explores the different types of stigma related to ADHD and their effects, with insights from two important research studies.

Types of ADHD Stigma

1. Public Stigma: This comes from society's stereotypes and negative attitudes toward ADHD. People with ADHD might face discrimination because others don't understand the condition well.
2. Self-Stigma: Sometimes, people with ADHD internalize these negative societal attitudes. They might feel guilty, embarrassed, or think they're flawed, leading to low self-esteem, depression, and other mental health issues.
3. Label Avoidance: To avoid stigma, some people might not seek help or deny their symptoms, which can make their ADHD worse over time.
4. Associative Stigma: Family members and friends of those with ADHD can also face stigma. They might be judged or excluded because of their connection to someone with ADHD.

Research on ADHD Stigma

A study in Germany looked at public attitudes toward ADHD. It found that about two-thirds of people believed ADHD symptoms exist on a spectrum, and half knew someone with similar issues. However, a quarter of the people surveyed felt annoyed by someone with ADHD. While most were okay with having an adult with ADHD as a colleague or neighbor, a quarter were against renting a room to them or giving them a job recommendation. Personal experience with ADHD was linked to more understanding and acceptance.

Another study reviewed various factors contributing to ADHD stigma. It found that uncertainty about the reliability of ADHD diagnoses, perceived dangerousness of people with ADHD, socio-demographic factors, skepticism toward ADHD medication, and whether someone disclosed their diagnosis all contributed to stigma. This stigma can negatively impact treatment adherence, effectiveness, and overall well-being of those with ADHD.

Effects of Stigma on Individuals and Families

Stigma can have serious consequences for people with ADHD and their families:

• Children: Public stigma can lead to social isolation, academic problems, and bullying.
• Adolescents and Adults: Self-stigma can prevent them from seeking help, worsening their symptoms and mental health.
• Families: Associative stigma can lead to parents feeling judged or blamed, causing social isolation and guilt. They also face stress advocating for their child in school and healthcare settings.

Moving Forward

Stigma creates significant barriers to treatment and quality of life for those with ADHD and their families. It's crucial to address these negative attitudes by raising awareness, sharing accurate information, and offering support. Educating healthcare providers, teachers, employers, families, and the public about ADHD can help create a more accepting environment. This way, people with ADHD and their families can live fulfilling lives without the burden of stigma.

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These days, kids in America are using digital devices like smartphones, tablets, computers, and TVs more than ever. Some people worry that this might be linked to ADHD, a condition that makes it hard for kids to pay attention and control impulsive behaviors.

Two new studies tried to find out if there's a connection between screen time and ADHD. They used data from a big survey about kids' health across the U.S. One study looked at nearly 46,000 kids aged six to 17 over two years, from 2019 to 2020. The other study analyzed data from over 101,000 kids aged zero to 17, from 2018 to 2020.

The studies figured out if a child had ADHD by asking their caregivers if a doctor or health care provider ever told them that the child had ADHD.

Findings from the First Study

The first study found that kids who used screens for two to three hours a day were 22% more likely to have ADHD. Kids who used screens for four or more hours a day were 74% more likely to have ADHD compared to kids who used screens for less than two hours a day.

However, when the researchers considered other factors like the child's age, sex, poverty status, parents' education, race, and other health problems, the link between screen time and ADHD disappeared. They did find a small link between screen time and anxiety and depression, but no link at all with ADHD.

Findings from the Second Study

The second study also considered factors that might affect the results, but they didn't look at whether the child had other behavior problems. They found that for kids five years old and under, using screens for up to three hours a day didn't make them more likely to have ADHD. But kids who used screens for four or more hours a day were twice as likely to have ADHD compared to kids who used screens for less than an hour a day.

For kids aged six to 17, those who used screens for two hours a day were 11% more likely to have ADHD. Kids who used screens for three hours a day were 16% more likely, and kids who used screens for four or more hours a day were 32% more likely to have ADHD compared to kids who used screens for less than an hour a day.

Important Points to Remember

There are two key things to keep in mind from these studies:

1. The differences found were pretty small.
2. The first study suggested that anxiety and depression might actually be the reason for the link between screen time and ADHD, not the screen time itself.

Conclusion

Overall, these studies didn't find strong evidence that using digital devices causes ADHD in kids and teenagers. While there might be some small connections, other factors like anxiety and depression could play a bigger role.  Also, this was not a controlled experiment.  It is an observational study that cannot rule out many factors. It is importaant to consider that having ADHD causes one to use digital devices more frequently.

Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental condition that is typically diagnosed in childhood but can persist into adulthood. Its symptoms include inattention, hyperactivity, and impulsivity, and it can significantly affect daily life, academic achievement, and professional success. As scientific understanding of the condition continues to evolve, new research is revealing more insights into the prevalence, comorbidity, treatment, and physiological aspects of ADHD in adults. Here's a roundup of some recent findings:

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Location of Mental Healthcare and ADHD Treatment Prevalence

A recent study assessing the prevalence of treatment for ADHD among US college students found that the location of mental health care significantly affects treatment outcomes. Specifically, students receiving mental healthcare on campus were less likely to receive any medication or therapy for ADHD, suggesting the need to evaluate the quality of mental health services available on college campuses and their effectiveness in treating ADHD.

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 Oxidative Stress and l-Arginine/Nitric Oxide Pathway in ADHD 

Another study found a correlation between ADHD and the l-Arginine/Nitric oxide (Arg/NO) pathway, a physiological process linked to dopamine release and cardiovascular functioning. The study found that adults with ADHD who were not treated with methylphenidate (a common ADHD medication) showed variations in the Arg/NO pathway. This could have implications for monitoring potential cardiovascular side effects of ADHD medications, as well as for understanding the biochemical changes that occur in ADHD. 

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Chronic Pain in ADHD

ADHD and chronic pain appear to be related, according to a comparative study of clinical and general population samples. Particularly in females with ADHD, the prevalence of chronic and multisite pain was found to be high. This calls for longitudinal studies to understand the complex sex differences of comorbid chronic pain and ADHD in adolescents and the potential impacts of stimulant use on pain.

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ADHD and Violent Behavior

Finally, a study investigated the comorbidity of ADHD and bipolar disorder (BD) and its potential link to violent behavior. The research revealed a positive effect of ADHD symptoms on violence tendency and aggression scores. Moreover, male gender and young age were also found to have significant positive effects on violence and aggression scores, suggesting an association between these disorders and violent behavior.

Noting that the degree of comorbidity (co-occurrence) between epilepsy and ADHD “has never been quantified based on a systematic review with meta-analysis,” a Chinese study team based at Wuhan university has just reported findings based on doing just that. 

Their systematic search of the peer-reviewed medical literature yielded 17 studies examining the prevalence of epilepsy among persons with ADHD, and 49 studies measuring the prevalence of ADHD among persons with epilepsy.

According to the Apple dictionary app, epilepsy is “a neurological disorder marked by sudden recurrent episodes of sensory disturbance, loss of consciousness, or convulsions, associated with abnormal electrical activity in the brain.” Its lifetime prevalence in the general population is about 0.76%, or about one in every 130 persons.

Meta-analysis of 17 studies with a combined total of over 900,000 participants spread over twelve countries on five continents yielded an epilepsy prevalence estimate of 3.4% among individuals with ADHD, or well over four times the prevalence in the general population. There was no sign of publication bias, but variability (heterogeneity) among studies was extremely high.

The worldwide prevalence of ADHD in children, on the other hand, is about 7.2%, affecting roughly one in fourteen.

Meta-analysis of 49 studies with a combined total of 172,206 persons from 16 countries on five continents reported an ADHD prevalence of just over 22% among persons with epilepsy. However, heterogeneity among studies was extremely high, and there was very strong evidence of publication bias. 

Using the trim-and-fill correction for publication bias yielded a reduced estimate of 16%, which is still over twice the prevalence in the general population.

Furthermore, the authors noted, “Given that the large sample studies in this study are basically population-based studies and the small sample studies are hospital-based studies, there is also the possibility of Berkson’s bias. Specifically, patients with comorbidities are more likely to need help or seek medical advice. This possibility would yield a higher comorbidity rate in hospital-based studies.”

And that is exactly what emerged from subgroup analysis. The prevalence of ADHD in epilepsy among the hospital-based studies was 27.1%, over twice the 13.2% prevalence reported from the 13 population-based studies. The largest population-based study, a U.S. study with over 114,000 participants, yielded a prevalence of only 3.5%.

The authors cautioned that the very high degree of heterogeneity between studies indicates “it is inappropriate to consider the summary effect as representative of the real effect.”

ADHD often includes a problem called disinhibition. This means that the brain struggles to control attention, thoughts, emotions, and behavior, which can lead to negative outcomes. Normally, inhibition helps people stay focused and avoid distractions, but when it fails, it's called disinhibition.

Children with ADHD who have problems with inhibition may face issues like substance abuse, self-harm, and antisocial behavior. Improving their inhibition can help them better manage themselves, do well in school, and have better relationships.

A team of researchers from China and South Korea explored whether physical activity could improve inhibition in children with ADHD. They reviewed studies and excluded those without control groups, those with poor quality assessments, and those involving other interventions like cognitive training or supplements. Their final analysis included 11 studies with 713 participants.

Key Findings on Physical Activity

1. Frequency and Duration: Physical activity had to be done at least twice a week to show significant improvement in inhibition. Sessions needed to last between 45 minutes to an hour for noticeable benefits, with sessions over an hour showing even greater improvements.
2. Consistency: Regular, long-term physical activity was more effective than single sessions.
3. Intensity: Moderate-to-vigorous activities were better than moderate activities alone.
4. Type of Activity:some text
   • Open-skilled sports (like ping-pong or taekwondo) which involve reacting to changing environments, showed the most significant improvements.
   • Closed-skill sports (like running or swimming) showed smaller improvements.
   • Exergaming (exercise using video games) had moderate benefits.
5. Specific Improvements:some text
   • Improvements in response inhibition (the ability to control impulsive responses) were small to medium.
   • Improvements in interference suppression (preventing distractions from affecting working memory) were large.

Conclusion

The research concluded that physical activity can significantly improve the inhibition in children with ADHD, especially with regular, moderate-to-vigorous, open-skilled exercise done at least twice a week for an hour or more. Future studies should continue to explore this with high-quality methods to confirm these findings.

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Computerized cognitive training (CCT) uses computers to try to strengthen cognitive skills and processes, reduce ADHD symptoms, and improve executive functioning. Executive functions are cognitive processes and mental skills that help individuals plan, monitor, and successfully execute their goals.

CCT programs target one or more cognitive processes such as motor inhibition, interference inhibition, sustained attention, and working memory. They ramp up task difficulty as performance improves. The goal is to harness the brain’s inherent adaptability (neuroplasticity) to boost performance. 

A European study team that previously probed the efficacy of CCT through meta-analysis had been unable to provide a robust estimate of effect size due to an insufficient number of high-quality trials with probably blinded outcomes. Noting that “there have been a considerable number of new RCTs [randomized controlled trials] published, many with larger samples, well-controlled designs and blinded outcomes,” the team performed an updated systematic review and meta-analysis.

They included RCTs with participants of any age who either had a clinical diagnosis of ADHD or were above cut-off on validated ADHD rating scales. RCTs had to have been peer-reviewed and published in an academic journal, and to have reported a validated outcome measure of ADHD symptoms, neuropsychological processes, and/or academic outcomes.

Fourteen RCTs with a combined total of 631 participants had probably blinded outcomes. Meta-analysis of these studies yielded no significant effect on either overall ADHD symptoms or hyperactivity/impulsivity symptoms. There was a marginally significant reduction in inattention symptoms, but the effect size was small. Between-study variation (heterogeneity) was negligible and there was no sign of publication bias.

Regarding academic outcomes, meta-analyses revealed no gain in arithmetic ability or reading fluency. There was a small but not statistically significant improvement in reading comprehension. Heterogeneity was minimal, with no indication of publication bias.

With two related exceptions, meta-analyses of RCTs measuring executive functions likewise reported no significant improvements in attention, interference inhibition (initial stage in controlling impulsive behavior), motor inhibition (follow-up stage in controlling impulsive behavior), non-verbal reasoning, processing speed, and set shifting (the ability to unconsciously shift attention between one task and another).

The exceptions were for working memory tasks. Meta-analysis of 15 RCTs with a combined 753 participants reported a highly significant small-to-medium effect size improvement in verbal working memory. A separate meta-analysis of nine RCTs with a total of 441 participants similarly reported a highly significant improvement in visuospatial working memory, this time with medium effect size.

The team concluded, “There was no empirical support for the use of CCT as a stand-alone intervention for ADHD symptoms based on the largest and most comprehensive meta-analysis of RCTs conducted to date. Small effects, of likely limited clinical importance, on inattention symptoms were found – but these were limited to the setting in which the intervention was delivered. Robust evidence of small- to-moderate improvements in visual-spatial and verbal STM/WM tasks did not transfer to other domains of executive functions or academic outcomes.”