The use of new technologies, such as virtual reality (VR), represents a promising strategy in the rehabilitation of subjects with attention-deficit/hyperactivity disorder (ADHD). We present the results obtained by administering the IAmHero tool through VR to a cohort of subjects with ADHD between 5 and 12 years of age. The trial time was approximately 6 months. In order to assess the beneficial effects of the treatment, standardised tests assessing both ADHD symptoms and executive functions  were administered both before and at the end of the sessions. Improvements were observed at the end of treatment in both ADHD symptoms  and executive functions. One of the strengths of the VR approach is related above all to the acceptability of this tool and its flexibility. Unfortunately, to date, there are still few studies on this topic; therefore, future studies are essential to expand our knowledge on the utility and benefits of these technologies in the rehabilitation field. Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterised by persistent patterns of inattention and/or hyperactivity-impulsivity that interfere with functioning or development. This condition is characterized by marked levels of inattention; hyperactivity ; and difficulty in controlling behavioral and verbal impulses. Children with ADHD seem to be always engaged in some activity, although they often do not complete it as they are constantly distracted by new stimuli. The tendency not to listen and/or excessive motor activity result in restlessness, difficulty sitting, and inability to wait their turn. These manifestations  are nothing more than the consequence of the inability of the child with ADHD to control his or her responses to stimuli arising from the environment and to focus his or her attention on a single specific task . The diaSixty children belonging to the Villa delle Ginestre rehabilitation center in Volla (NA) and the U.O.S.D. NPI of the Department of Translational Medical Sciences, University of Naples Federico II took part in the study. The eligibility criteria used are shown in In contrast, the exclusion criteria for the study were the presence of physical impairments and/or known organic syndromes and/or unstabilized pediatric neurocomorbidities  or medical status .Participants were randomly divided into two groups, one experimental and one control, and were given virtual reality therapies with the IAmHero system alternating with traditional therapy and traditional therapies only, respectively. There were 33 male and 27 female participants, and the average age was 8 years. Eighty percent of the participants had a diagnosis of ADHD without comorbidity, while of the remaining 20 percent, 18 percent had comorbidity with specific learning disorders.The study included an initial phase in which participants were enrolled through a diagnostic screening at the U.O.S.D. of Child Neuropsychiatry of the Department of Translational Medical Sciences, University of Naples Federico II. In this phase, the following tests were administered: the Wechsler Intelligence Scale for Children 4th edition (WISC-IV) for the assessment of the cognitive profile; the Italian Battery for ADHD (BIA), aimed at the assessment of attention and concentration skills; the Conners-3 questionnaire for the assessment of ADHD and behavioural disorders; and the Tower of London test (TOL) to assess strategic decision-making and problem-solving skills . These tIamHero was created to bring to life an ambitious project in digital therapy aimed at innovating care processes for patients with neurodevelopmental disorders in pre-school, as well as those who are primary and secondary school age. The structure of the games was designed by Villa delle Ginestre’s multidisciplinary team in collaboration with the University of Naples Federico II  in order to make the content easily accessible and understandable to the 5–12 age group. The IAmHero system is a serious game structured around activities that aim to implement cognitive-behavioural skills impaired in ADHD subjects. Among these, we included attention, planning, critical reasoning, visual perception, visuomotor skills, abstract reasoning, and language skills.(1)Topological Categories:In particular, three different activities were developed:In this serious game, the child is immersed, thanks to a virtual reality viewer, in a scenario chosen from a classroom, a bedroom, or a garden in order to make the setting familiar and put the child at ease. Directional commands to be carried out in relation to topological categories  are depicted on the screen and played as sound. The child is given the opportunity to move in the virtual space in relation to the instructions given and to grasp various objects with the help of the joystick built into the virtual reality viewer.In this way, visual-spatial orientation, motor coordination, planning, and selective auditory attention are stimulated in the child.(2)Infinite Runner:This type of activity is carried out with the help of a motion sensing tool, which allows recognition of the child’s body pattern and movements in order to place the child in a virtual scenario in which the child will have to avoid obstacles and collect rewards. This is to stimulate behavioural inhibition and the ability to control and manage impulses as the child, due in part to the gamification and rewards system, will have to dodge certain obstacles and functionally direct their motor activation.(3)Space Coding:This type of activity can be enjoyed either in VR or as mobile/tablet software. Puzzle-like tasks are proposed that will orient the child to reconstruct sequences or objects, either by manipulating tiles (fine motor skills) or by swiping them. This trains planning, visuospatial and constructive skills, as well as reasoning and problem-solving.The system also contains a platform for therapy session management. This platform consists of an application that allows the therapist to monitor the progress of sessions, assess the achievement of goals, and tailor therapy accordingly. The combined use of these elements allows the patient to enjoy an innovative therapy service, both in the clinic and at home.Regarding the instrumentation used, the type of hardware used was the Oculus Quest 2. Specifically, thanks to an integrated mirroring system (AirLink) and the use of a platform for loading games (Steam), the game was started from the therapist’s PC and projected directly into the virtual reality viewer. By doing so, the therapist was able to visualize in real-time what was happening in the viewer so that interactions could also be directed in a more hands-on and free manner.The results were analysed using IBM Statistical Package for Social Science Software (25th version)  for descThe present study was conducted after approval of the study protocol by the ethics committee of the Federico II University of Naples. Both participants and parents/legal guardians were informed about the modalities of the study as well as the aim and purpose before enrollment. Informed consent was obtained from each of the participants. Participation in the study was free and unconditional; in addition, one’s consent to participate could be withdrawn at any time. The collection and analysis of the data exhibited were conducted anonymously, respecting the privacy of each participant.-Inattention;-Hyperactivity/impulsivity;-Learning problems;-Provocation/aggressiveness;-Relations with family.With regard to the behavioural indicators of the Conners-3 scales, the following variables were identified:Taking advantage of the internal reliability of the test, an initial analysis was carried out to investigate the correlation coefficient between the variables at T0 and T1; results are reported in -A significant positive correlation exists between the scores of the variable “Hyperactivity/impulsivity” at T0 and T1;-A significant positive correlation between the scores related to the variable “Learning problems” at T0 and T1;-A significant positive correlation between the scores related to the variable “Provocation/aggressiveness” at T0 and T1;-A significant positive correlation between the scores related to the variable “Relationship with family members” at T0 and T1.From the analysis conducted, as also summarized in A descriptive analysis of the averages of these variables at T0 and T1 was also conducted ; moreoveLastly, the reliability change index (RCI) was calculated to assess the statistical reliability of the change due to the treatment . In partThe following results emerged:The contribution of treatment is clear considering the change in the respective mean values of the T-scores of variables of the Conners-3 scale, particularly regarding hyperactivity/impulsivity, learning-related problems, and relationships with family members. However, the RCI value is only fully reliable in a range >1.96, so the prospects certainly include the proposal to extend the trial to a larger sample.-Sustained visual attention (identified from the number of omissions in the continuous performance subtest);-Impulsive behavior ;-Inhibitory control (identified with the response time of the MF subtest);-Selective auditory attention (represented by the auditory attention test score);-Motor inhibition (obtained from the frogs test score).With regard to the cognitive indicators measured by mean scores of the BIA and TOL tests, the following variables were identified for BIA:-Organisation and planning (representing the number of moves score);-Problem-solving (obtained from resolution time);-Executive functions .The following variables were identified for TOL:A correlation analysis was conducted between the BIA variables at T0 and T1 and between the TOL variables at T0 and T1. The results are reported in -A significant positive correlation between the values of the scores for the variables “Sustained Visual Attention”, “Impulsive Behaviour”, “Inhibitory Control”, and “Auditory Selective Attention” of the BIA test at T0 and T1;-A significant positive correlation between the values of the scores for the variables “Organisation and planning”, “Problem solving”, and “Executive functions” of the TOL test at T0 and T1.We highlighted the following results:This shows that there is a relationship between the values at the initial and post-treatment time. From this initial observation, we examine the weight of the relationship between the variables at the two different times by analyzing the difference between the mean scores obtained in the tests in order to establish their significance in terms of improvement.A descriptive analysis of the averages of these variables at T0 and T1 was also conducted ; moreoveOur statistical analysis shows a significant improvement in the areas of attentional processes, problem solving, sustained auditory attention, and task planning and organisation and, more generally, an improvement in executive functions. Last, we proceeded to calculate the RCI value for the individual variables .The study, we analysed the benefits of using the serious game approach in the rehabilitation of children with ADHD between the ages of 5 and 12. From what emerged, there are benefits both on the core symptomatology of ADHD and on further neuropsychological functions assessed with standardised instruments. In particular, it is well established that general executive dysfunction is present in subjects with ADHD: the domains most affected are task monitoring, preparatory processing and response inhibition . Related-Expand the reference sample to enjoy a larger dataset and move in the direction of standardizing the instrument;-Provide, in a hypothetical subsequent trial, for the setting of an additional follow-up phase to monitor treatment progress and compare it with the data collected by the management platform;-Conduct the study over a longer time frame in order to monitor the longitudinal effects of the virtual reality intervention. Despite this, for the time being, the results obtained both from our study and from other studies in the literature appear encouraging. We, therefore, consider it useful to continue experiments in this field in order to develop a new resource in the treatment of ADHD;-Evaluate the acceptability of such tools by children and especially better define what contribution they can provide in terms of collaboration in rehabilitation settings.Given the findings from the analysis of the data collected during the experimental phase, we can state that the virtual reality therapeutic tool “IAmHero” results in improvements in the treatment of attention and/or hyperactivity disorder. In particular, improvements can be seen from the behavioural point of view regarding levels of hyperactivity/impulsivity, improvements in learning-related issues, and improvements in relationships with family members. On the cognitive side, there is evidence of many improvements from the perspective of executive functions and, more specifically, improvements in task planning and organization, sustained auditory attention, problem-solving, and management of impulsive behaviours. There also turns out to be a statistically significant RCI in improving selective auditory attention. Given the strong impact of ADHD symptomatology and executive function deficits on the adaptive functioning of individuals with this disorder, it is necessary to provide rehabilitation as early and effectively as possible. A potential improvement in the experimental design could concern expanding the proposed set of activities to include the treatment of additional cognitive functions and to broaden the therapeutic target since, as is also evident from the literature, deficits in executive functions are common and recurrent in different types of neurodevelopmental disorders. However, several weaknesses should be considered that may affect the collected data and, consequently, should be controlled for even more effective future experimentation. In particular, it will be necessary to:


The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM‐5), emphasizes symptoms severity with regard to the diagnosis of attention deficit hyperactivity disorder (ADHD). Many clinicians use neuropsychological test results as objective measures of cognitive functions as part of the diagnostic work‐up. The aim of this study was to investigate whether the psychometric test results regarding verbal working memory and processing speed are useful as indicators of the severity of attention deficits and emotional dysregulation in adults with ADHD.This observational cross‐sectional clinical study included 418 adults diagnosed with ADHD according to the DSM‐5. Attention deficit severity was defined based on the inattentive subscale of the Adult ADHD Self‐Report Scale. Emotional dysregulation was assessed with the Deficient Emotional Self‐Regulation scale. Verbal working memory was measured with the Working Memory Index (WMI), and processing speed was measured with the Processing Speed Index (PSI) from the Wechsler Adult Intelligence Scale, third edition.p = .003). The association between the psychometric test result for verbal working memory and processing speed and that between the severity of attention deficits and emotional dysregulation were weak (R2 < .1) and mostly non‐significant.The full‐scale intelligence quotients of the participants were in the normal range, with expected reductions in verbal working memory and processing speed. Only processing speed was associated with attention deficits  and processing speed (PSI) seem to have limited utility as indicators of the severity of attention deficits and emotional dysregulation in adult ADHD patients. When assessing attention deficit hyperactivity disorder (ADHD), clinicians often use results from neuropsychological tests to obtain objective measures of the patient’s cognitive function to supplement clinical assessments that are based on subjective self‐report questionnaires and interviews. There are several reasons for this. The symptoms constituting ADHD are extreme variants of normal behaviours, and the boundary between normality and pathology is based on clinical judgement. Several studies have shown that the diagnosis of ADHD is highly dependent on the source of the report, thus underscoring the need for objective assessments  attention deficits and (2) emotional dysregulation in adults with ADHD.To broaden our understanding of the topic, we also sought to determine whether each item on the attention deficit and emotional dysregulation scales was correlated with the psychometric test results for verbal working memory and processing speed.This was an observational cross‐sectional clinical study.The study sample consisted of 418 adults aged 18–65 years who fulfilled the criteria for a diagnosis of attention deficit hyperactivity disorder (ADHD) according to the DSM, Fifth Edition  or male (scored as 1) based on patient self‐report. The following sociodemographic information was collected. Marriage or cohabitation was scored as 1, and all other statuses were scored as 0. If the participant was living with children of whom they had at least partial custody, a score of 1 was recorded; otherwise, even if they had no children, or children who lived somewhere else, a score of 0 was recorded. Education level was categorized by the number of years of education as follows: 12 years or fewer was scored as 1, 13–15 years was scored as 2, and more than 15 years was scored as 3. Employment was defined as ‘yes’ and scored as 1 if that employment was reported as the main source of income; otherwise, it was scored as 0.The level of depression was measured by the Montgomery–Åsberg depression rating scale (MADRS), with all ten items summarized as a total score ranging from 0 to 60  Symptom Check List, v1.1 produced by the World Health Organization  questionnaire, known as the DESR scale Barkley, . The eigVerbal working memory was assessed by the Working Memory Index , and processing speed was assessed with the Processing Speed Index  from the Wechsler Adult Intelligence Scale, 3rd edition (WAIS‐III). was recorded. t Tests were used to compare continuous variables between females and males.Frequencies with per cent proportions are reported for all categorical variables and means with standard deviations are reported for continuous descriptive variables. We performed chi‐square tests or We used linear regression analyses to examine associations between measures of self‐reported attention deficit (the ASRS subscore), or self‐reported emotional dysregulation  as the dependent/outcome variables, and sociodemographic variables, the MADRS score, the Working Memory Index (WMI) and the Processing Speed Index (PSI) as the independent variables. The test scores from the WAIS‐III included in the statistical analyses were the age‐corrected scale scores. We used Cronbach’s alpha to assess the internal consistency and reliability of the eight items from the DESR scale. Cronbach’s alpha for the eight scale items in our sample was .86, indicating high internal consistency.p was < .025. For all association tests, beta ratios with 95% confidence intervals were calculated as the measurement of the effect size. To measure the explained variance, we used the R2‐squared value. If the R2 value was <.30, the effect was considered weak. If the R2 value was between .30 and .50, the effect was considered moderate. If the R2 value was >.50, the effect was considered strong  and the Processing Speed Index (PSI).There were no missing data. All statistical analyses were performed using IBM SPSS version 22 IBM, .n = 188) and males (n = 230) in this study. More females than males lived with children. A total of 61.7% of the participants reported employment as their main source of income, and nearly 51.4% reported that they had received more than 12 years of education. The frequencies of psychiatric comorbidities in this sample were 12.9% for depressive disorders, 31.8% for anxiety disorders, and 13.6% for substance use disorders.Table SD), mean attention deficit score (SD), and mean emotional dysregulation score (SD) are reported. Females in our sample scored higher on all three measures. The table also shows the WAIS profile of our sample. The mean full‐scale intelligence quotient (FSIQ) in our sample was 103.2 (SD: 13.8), and females had an average FSIQ of 101.3, while men had an average FSIQ of 104.8. Both sexes had typical profiles with significantly reduced scores on the Working Memory Index (WMI) and Processing Speed Index (PSI) compared to those expected based on their FSIQ. Significant correlations (p < .001) were found between all four subindex scores on the WAIS (data not shown).The mean hyperactive‐impulsive score (p < .001).The severity of attention deficits, as reflected in the ASRS attention deficit subscale score, was significantly correlated only with the PSI  and all four subindex scores but was not associated with any of the independent variables in the adjusted model (data not shown).The severity of hyperactivity and impulsivity, as measured by the ASRS hyperactivity‐impulsivity subscale, was significantly correlated with the FSIQ  and with all four subindex scores.The severity of emotional dysregulation, as measured by the DESR scale score, was significantly correlated with the FSIQ  but not the WMI  was associated with attention deficits. The R square (explained variance) for the fully adjusted model was .026, that is the model explained only 2.6% of the variance in attention deficits in our sample. None of the covariates were significantly associated.Table p = .041) nor the PSI  were associated with the severity of emotional dysregulation in the adjusted model after the Bonferroni correction, with significance based on p < .025. Depression was associated with the severity of emotional dysregulation . The R‐squared value (explained variance) for the fully adjusted model was .098, that is the model explained only 9.8% of the variance in emotional dysregulation in our sample. Age and education level did not contribute to the explained variance, but being female was significantly associated with emotional dysregulation , and depression was also significantly associated with emotional dysregulation .Table Table Table R2 < .1) and mostly not significant. Only processing speed was associated with the severity of attention deficits . The psychometric WAIS test index scores for verbal working memory (WMI) and processing speed (PSI) seem to have limited utility as indicators of the severity of inattention and emotional dysregulation in adults with ADHD.The main finding in this study was that the correlations between the psychometric tests of verbal working memory and processing speed and the severity of attention deficits and emotional dysregulation were weak (https://www.ssb.no/en/utdanning/statistikker/utniv). Participants in our sample had a 61.7% employment rate, which is lower than the 70.3% in the general population (https://www.ssb.no/en/arbeid‐og‐lonn/statistikker/aku).In our sample, 51.4% of the patients had attained a university degree or graduate degree, which is higher than the proportion of the general Norwegian population  and a visuospatial sketchpad , as measured by the WMI, after adjusting for other covariates Table . This isDo you often have difficulties understanding what people say? Do you often misinterpret what other people say? Do you often have difficulties interpreting the meaning of a sentence spoken to you? Do other people often comment that you have not understood their verbal intention or sentence? These questions would enable us to better understand specific parts of the clinical difficulties involved in a verbal working memory deficit, and these suggested questions are slightly different from the four verbal attention deficit items in the DSM  and PSI . There were correlations between emotional dysregulation and verbal working memory and processing speed, but the causal relations were difficult to assess.In our study, emotional dysregulation was not associated with verbal working memory or the WMI score after adjusting for covariates  or processing speed (PSI) as measured by the WAIS test.In our adult ADHD sample, we found typical reductions in the WMI and PSI, but only the PSI was associated with attention deficits, and the power of this association was limited. It seems that objectively tested verbal working memory and processing speed measure only parts of the subjective experience of attention deficits and emotional dysregulation.Extending the WAIS test battery by including measures of visuospatial working memory could make this psychometric tool more suitable for measuring attention deficits in ADHD.Weak correlations between items of attention deficit (ASRS subscore) and emotional dysregulation (DESR) indicate that the questions on these questionnaires do not fully reflect verbal working memory and processing speed. Alternative questions, as suggested in the paper, may better reflect these parameters.R2 < .1) and mostly not significant. The psychometric WAIS WMI and PSI seem to have limited utility as indicators of the severity of attention deficits and emotional dysregulation in adult ADHD patients.The participants in our adult ADHD sample had normal mean FSIQ score, with the expected typical reduction in verbal working memory, as reflected on the WMI, and processing speed, as reflected on the PSI. Only processing speed was associated with the severity of attention deficits, but the effect size of the association was small. Our results indicate that the correlations between the severity of attention deficits and emotional dysregulation and psychometric tests of verbal working memory and processing speed were weak (EA has received speaker honoraria from Shire, TH and GO report no conflicts of interest.EA and TH designed the study. EA collected and analysed the data. EA and TH actively participated in the writing of the manuscript and all authors approved the final draft. GØ commented on the manuscript draft and suggested changes.The study was approved by the Regional Medical Ethics Committee, South‐East D, Norway, 2015/426. Written consent to participate was obtained from all participants.Not applicable.We confirm that all methods were performed in accordance with relevant guidelines and regulations.


This article examines how white British residents of a superdiverse London housing estate learn about—and subsequently deploy—the intra‐ethnic stereotypes used by their British Pakistani and British Bangladeshi neighbours/flatmates. Building on recent attempts to bring together conviviality and boundary making, along with insights into intra‐ethnic othering, we show how, for white British residents, these stereotypes offered the chance to add detail and authenticity to judgements about the “unrespectable” behaviour of British Asian residents and/or visitors. Ultimately, however, white British residents' inappropriate and/or imprecise deployment of these stereotypes in relation to British Bangladeshis and British Pakistanis led to the misidentification of low‐status people and the unfair extension of discrimination faced by low‐status individuals and families. Furthermore, the combination of clumsy application and the positioning of “respectable” British Bangladeshis and British Pakistanis as purveyors of “insider knowledge” about intra‐ethnic stereotypes led to the reinscribing of boundaries between racial groups. We conclude that studying the cross‐racial use of intra‐ethnic stereotypes allows for a subtler appreciation of the complex dynamics of inclusion and exclusion in superdiverse areas. In analyzing such judgments and the inter‐racial exchanges through which they are formulated, we arrive at a subtler appreciation of how convivial labor is implicated in the dynamics of inclusion In the following section we discuss existing research on superdiversity, symbolic boundaries, conviviality and convivial labor. We then describe the context of the ethnographic research together with the mechanics of the fieldwork itself. In presenting the findings of the research we detail two respective intra‐ethnic boundaries that were evident on the estate, then explore how the deployment of these boundaries by white British residents involved processes of inclusion and exclusion.2convivencia—to encompass “happy togetherness” and negotiation, friction and occasional conflict.Back  has noteResearchers have responded by charting complex patterns of inter‐racial and inter‐ethnic engagement in urban space and foregrounding the situated practices through which differences are identified and negotiated. In Hackney, East London, Wessendorf , 2014b dThis relationship between judgments of acceptability and the framing of humor in the multi‐ethnic workplace is akin to the way that judgments about respectability are used to draw symbolic boundaries in diverse urban settings. For Skeggs , respectand inclusion. This makes the approach amenable both to convivial settings, and their showcasing of “happy togetherness” and friction, and superdiversity, and its combination of inter‐ and intra‐ethnic differences and interactions.In the context of superdiverse urban neighborhoods, questions of respectability are often posed in the context of debates about community, belonging and togetherness , while also endorsing stereotypical ideas about South Asian collectivism and insularity  .The estate comprised 148 units ranging from studio‐flats to large two‐bedroom maisonettes. Of the 178 adult residents who responded to a survey, 40 (22%) identified as white British, 25 (14%) as Black African, 25 (14%) as white Irish, 22 (12%) as Bangladeshi, 13 (7%) as Kosovar, 11 (6%) as mixed white‐Black, 9 (5%) as Greek‐Cypriot, 7 (4%) as Pakistani, 7 (4%) as Afghan, 4 (2%) as Black‐Caribbean, 4 (2%) as Arab, 2 (1%) as mixed white‐Asian, 2 (1%) as white French, 2 (1%) as white Spanish, 2 (1%) as Chinese, 1 (1%) as white Italian, 1 (1%) as white Brazilian, 1 (1%) as Jewish. In line with the “diversifying of diversity” identified and explored by Vertovec , there wThroughout the course of the study, both authors were immersed in the social life of the estate and its environs. The first author, who is from a mixed‐race (white‐Asian) background, lived on LG for four years while working as a coach and mentor at a local school and youth club. The second author, who is from a white British background, worked for twenty years as the area's youth worker. This meant that the study's sample was skewed slightly in the direction of young people, plus residents living in the same block as the first author.Of the 84 semi‐structured interviews carried out during the project, 23 pertained to disorder, respectability, and notions of ethnic and racial difference. However, given the specific focus of this paper, we used the findings from 15 interviews as the basis of our analysis. We do not claim that the interviewees who feature here are representative of residents of all superdiverse housing estates in urban areas and do not wish to homogenize any of the groups they belong to. It is very possible that the intra‐ethnic boundaries explored here are not reproduced in other superdiverse areas, and that there are white British people in superdiverse areas—those who grew up in these areas, for example—who engage with intra‐ethnic boundaries differently. We follow a strategy adopted in other studies of conviviality and the metropolitan paradox .We asked him to elaborate on what “fresh” meant in this context.Here being “fresh” is portrayed as a mindset associated with young male migrants who, because of an insecurity born of their newcomer status, would react violently if they felt challenged by other young people. Indeed, Nik's words highlight how a “civility towards diversity”  boys, but not always. 'Cos girls could be violent too … mainly new kids but again not all the time. But (it) was not always the same. So another thing would be, not being aggy (aggressive), but being kind of naive and lagging behind, and this was the thing with some of the Bengali kids who have been here for (a long) time.Other young residents confirmed that while the label tended to be applied to newcomers, it could also refer to young people who had been born and raised in the area but still exhibited a “fresh” mentality. Eighteen‐year‐old Hiba, whose Somalian parents had settled on LG in the 1990s, explained her understanding of the stereotype.So aside from violent potential, social and cultural capital were used to define “fresh” among young people, with British Bangladeshi youngsters  being associated with this deficit. This sliding from general “fresh” criteria to more specific ethnic traits, hinted at by Nik and elaborated by Hiba, played out in the everyday social dynamics of the estate. If a young person known to be “fresh” in the sense of possessing violent potential passed through the estate, young residents tended to avoid engaging with them, beyond exchanging nods or glances. Conversely, a minority of young British Bangladeshi residents labeled fresh in the sense of being naïve and unknowing were treated with benevolence, though occasionally subjected to teasing and mild derision (sometimes from other British Bangladeshi youngsters). Other specific applications of the term came through in discussions about residents and their behavior, with one British Bangladeshi family being positioned outside the bounds of respectability.Jhanvi:They make so much noise. Dad having loud phone calls in the middle of the night—obviously to family back home. Having dinner really late, too, obviously when he finishes work, with the kids running around. Bad English … not bothering to speak to people, Mum hardly leaves that place. It's classic fresh Bengalis, really!The Osmans, who lived in a first‐floor maisonette, were often criticized for their noisy, disorderly behavior, with their “fresh” characteristics being used in the drawing of symbolic boundaries. Jhanvi, a twenty‐six‐year‐old British Bangladeshi teacher who lived in the same block, made reference to these characteristics.Her comments reflect the way that notions of respectability center on the organization of the home, family life and childcare Skeggs, . And thoThe rhythm of family life was oriented around his patterns of work and a mixing of time zones. In this way, his navigation of transnational social fields was considered both unsuccessful and disruptive, while his patriarchal dominance was seen as doubly problematic given it was exercised by a man who had been born in Britain Ahmad, . Indeed,Abdi defended his behavior: “I don't think it's fair … I go to drive, I come home … I do everything I can (to limit noise). But I have just reached (returned) after work all day. So I'm tired and just want to eat.” He also commented on the decision to build close‐knit family relationships: “I come out on Saturday morning with my kids to wash the car. Otherwise I don't need to come out. We don't have so many racist(s) like we did a long time ago. But we stick together still.”He explained the reluctance to venture out of the flat with his family by alluding to experiences of racism in the past. Indeed, the “ethnic capital” Borjas,  he amassSheri:I'm tired of ignorant people at uni(versity) or on nights out asking me about Muslims and Pakistanis. All this stuff about Pakistanis being backward, being terrorist nutters and grooming young girls in Bradford or whatever. If that stuff's even true, these are people from the total backwaters of Pakistan, different rules (apply) there. They're tepis, man. Low caste, illiterate—probably not even here legally—just don't have a clue … There's a load of these boys at the uni down the road. We literally couldn't be more different.It was difficult to identify a stereotype with one ethnic group on the estate. However, there was a term which was used almost exclusively by British Pakistani residents, though its field of application was wider than just this ethnic group. This was “tepi,” a term which had similar connotations to “freshie” but elaborated on some key vectors of intra‐ethnic distinction and connected them with uncivil, disorderly behaviors. We first encountered the term during a conversation with flatmates Sheri and Sheena, British Pakistanis who had moved to central London from Manchester and Southall, respectively, to study at a local university. They lived with fellow undergraduate, Amy, whose (white) Scottish parents had settled in the midlands, in a two‐bedroom maisonette where the living room served as a third bedroom.Sheri:I don't know for sure. But you hear these boys when they're round here for house parties. They're so loud and sloppy, and the way they speak. Can't shake that accent even though they're born here … I said caste (before) but I use that (word) when I'm explaining these things to other people. It's more like families and where they're from in Pakistan … plus where they live here.Sheena:There's the religion thing, too.Sheri:Oh yeah. These boys claim to be religious but they will go out with white or Black (non‐Muslim) girls right up until their parents sort them out (via an arranged marriage). We're not about anything being arranged.Sheena:Yeah, totally. As we said before, we'll drink and smoke the odd zoot (joint), but that's discreet. Plus we're not claiming to be strict hijabis.We asked Sheri and Sheena about the origin of “tepi” and to elaborate on its meaning.Like the “freshie” stereotype unpacked by Charsley and Bolognani , “tepi” 5In this section we explain how two white residents learned about and deployed the symbolic boundaries bound up with the “fresh” stereotype, before doing the same for the “tepi” stereotype in the case of a white undergraduate student whose two flatmates were British Pakistani.Ann:We've had issues with the Bangladeshi family upstairs. Noise … eating very late, very late phone calls.Terry:We're not from here so didn't know much about Bangladeshi culture … But from speaking to other teachers plus other colleagues, you could learn.Ann:… the kids will say “fresh”. We would never have used that (word) … it's helpful, because, otherwise we might have said “problem family” or, I don't know, “nuisance family”. But that's too strong anyway and just not accurate really. And the last thing we want to do is start talking about, you know, race. This way just works better all round.Terry:Plus it's nice to feel like you're settling in and learning about the place. I mean, Jhan(vi) has helped us a lot. Not just in explaining why what's happening upstairs might be happening, but in talking with Abdi for us.Ann and Terry, both in their mid‐to‐late twenties, worked as teachers at local schools. The couple had lived in a studio flat beneath Abdi and his family for a number of years since moving to Northtown from suburban locations in the south of England. They described becoming aware of the “fresh” stereotype and learning more about the characteristics attached to it through conversations at work and on the estate.Here inter‐racial engagement is prompted by concerns over conduct that is perceived to be disorderly and unrespectable. Aware that their own attempts to capture the behavior of their British Bangladeshi neighbors—the “problem” or “nuisance” family—were inadequate, and wary of falling back on racial stereotyping, they used convivial labor to learn about a supposed intra‐ethnic distinction. Their resulting judgment was more detailed in that it alluded to intersections between ethnicity, class, and regional differences. Also, having learned about the distinction from a British Bangladeshi, in their eyes the subsequent judgment was more authentic. It was also interesting that their judgment was formulated in the context of everyday constructions of home, in both a material sense—the practical issues of sharing a boundary with other people—and a wider, more symbolic sense—where “settling” into the locale involved learning about their new, superdiverse surroundings. As in the suburban location explored by Tyler , 2020, iJhanvi:Yeah I've gone down and talked with Abdi. I feel (for) them as they're right below all that. So I try to be all diplomatic and explain why the family are a little fresh. But … I'm in that weird in‐out situation. And I do feel a bit uncomfortable about them (Terry and Ann) throwing the term around … it probably helps them make sense of things, but I'm not sure they fully get it. Like, it can be awkward when they assume that because the parents are fresh the kids will be fresh in the way that the kids at school say it. I mean, those kids may miss the odd day (at school), but they aren't trouble at all.That said, there were important implications resulting from Terry and Ann's deployment of the stereotype. Jhanvi explained her discussions with Terry, Ann and Abdi.Here Jhanvi alluded to a situation in which Terry and Ann had wrongly assumed that, as the Osman family had been labeled “fresh,” the children in the family would be prone to misbehave and even act aggressively at home and at school. This was another assertion that connected practical concerns about home life (including complaints about noisy neighbors) with navigation of public and semi‐public space, plus ongoing attempts to adapt to the wider superdiverse locale Tyler, . HoweverJhanvi was also uncomfortable about her ambiguous “in‐out” position within these exchanges. That is, in being asked by Ann and Terry to explain what “fresh” means in the context of respectability among British Asians—and, more narrowly, among the British Bangladeshi community—Jhanvi detected a presumption on her neighbors' part regarding the underlying sameness of all members of that group. As she put it: “It's really, like, ‘Tell me why that person isn't like you’. But, like, you're only asking because of where I'm from.” So while the discussion between Ann, Terry and Jhanvi centered on intra‐ethnic boundaries—with these boundaries ostensibly excluding a low‐status, “fresh” British Bangladeshi family from the bounds of respectability—more subtly it also served to foreground the racial boundary between Jhanvi and her white British neighbors.Amy:I grew up around Birmingham so I get the “fresh” thing. But this was next level. The talking thing, I'm not sure I can even hear it now. It's pretty subtle. They get frustrated with me and try to spell it out: “Ts from the tongue, not from the teeth”. But when you meet these boys it makes sense and it's like “I totally get it” … we would say “wide boy” but that's not it. These girls have it down!The way that Amy, a white British undergraduate student in her early twenties, engaged with the notion of “tepis” teased out certain characteristics of the stereotype while underlining power differentials and again reinforcing the symbolic boundaries that existed both within and between groups. She commented on getting to grips with this stereotype with the help of her British Pakistani flatmates, Sheena and Sheri.Sheri:She didn't get it. But, why would she? Like, we're all Muslim but not strict. Like, no pork but anything else, fine. But we're honest about that. And don't judge. Our parents know that really but we just never talk about it. And never put it on social media. But these boys, they will do all these things but swear to their parents they aren't doing them, and then criticise us for doing the same thing. Same as they have fun with Black girls, white girls then want a “pure” hijabi bride at the end of it. And all the while their parents think they're little angels. This is why we explain it. Plus, if you saw our houses, they're the same, almost. My parents won't borrow money so there, like with Islam, the differences aren't that obvious.As well as underlining the subtlety of the linguistic markers attached to it, Amy's comment pointed to the granularity and assumed authenticity of the “tepi” stereotype  tolerate such behavior, but because they would criticize any young Muslim woman who did not conform strictly to the codes of Islam . This perceived dishonestly, hypocrisy and chauvinism made pointing out the corresponding vectors of intra‐ethnic difference important. For Sheri, the absence of material differences to signal her family's higher status (because of Islamic codes which discourage moneylending at interest) made this a particularly urgent task, with intra‐ethnic boundaries policed more vigilantly and “tepi” characteristics tied to intra‐ethnic vectors of difference in a more specific and strident way.Sheri:Amy will mess it up. Like there'll be male friends over and after they've left she'll say, “Ooh, he's a bit tepi for you”. And I'll have to point out that he's not at all—just a Pakistani boy with an accent. You get mad and think, “Do you really just think we're all the same?”Amy's application of the stereotype did not always take account of these subtleties. This frustrated Sheri, who implied that more “frame negotiation” Wise,  was requAmy:Yeah, that messes things up. I mean, sometimes just other Pakistanis, sometimes Bengalis, too.As with Jhanvi, Sheri was concerned that misuse of the stereotype would extend the discrimination faced by British Asians . She also questioned her true position in relation to the inter‐racial and intra‐ethnic boundaries traced during discussions with Amy about “tepis,” with Amy's occasional misuse of the term serving to highlight the racial divide between flatmates. For Amy herself, the blurring of boundaries was an additional source of confusion, with her flatmate Sheena sometimes applying the stereotype to British Bangladeshi residents of the estate.Sheena:I'm not like these boys, (our) families (are) different as well. But we're not massively different. I grew up with boys like that, but now our paths aren't the same at all. Plus, you know, this area isn't very Pakistani anyway. Just loads of Bengalis … Yeah, they're Muslim like us. (But) they don't really speak English. And just stick to their own. Not like us at all.Sheena explained the slippage in terms of social distance and, more specifically, feeling less assured than Sheri about applying the term to British Pakistanis.Here Sheena blurs and shifts boundaries in ways that partially account for Amy's confusion, with context and relational differences coming into play.6Building on recent attempts to bring together conviviality and boundary making  by her flatmates Sheri and Sheena. This labor was performed with a view to understanding the conversations that took place in her flat and the judgments her flatmates made about the behavior of low‐status visitors and acquaintances.However, despite their proud use of convivial labor to “settle in” at home, which seemed to correspond with a desire to distance themselves from extreme whiteness Lawler, —in favorand exclusion. Ostensibly these inter‐racial exchanges seemed to unite white British and British Asian residents within the bounds of respectability (through the exclusion of “unrespectable” British Bangladeshi and British Pakistani residents/visitors). However, white British residents' attempts to avoid making sweeping and potentially racist statements by borrowing from intra‐ethnic stereotypes, especially when these stereotypes were deployed imprecisely, could still convey assumptions about the underlying sameness of British Asian communities, thereby distancing and offending even those they sought to include.Our findings add to the literature on conviviality and the realities of the metropolitan paradox by showing how intra‐ethnic stereotypes are used in cross‐racial judgments about respectability. Just as Wise's  intervie


To describe the influence of attention-deficit hyperactivity disorder (ADHD) and comorbid mental health conditions on the risk of selected injuries.  A retrospective cohort study design was employed using medical claim data from the Deseret Mutual Benefit Administrators (DMBA). Mental health conditions, injury, medication, and demographic data were extracted from claim files for ages 4-64, years 2016-2020.  Approximately 51.8% of individuals with ADHD had one or more comorbid mental health conditions  [3.6%], bipolar disorder [4.7%], obsessive compulsive disorder (OCD) [2.4%], schizophrenia [0.9%], and manic disorder [0.2%]). The rate of injury was 1.33 (95% CI 1.27–1.39) for ADHD only versus no ADHD and 1.62 (95% CI 1.56–1.68) for ADHD and comorbid mental health conditions versus no ADHD, after adjusting for age, sex, salary, and year. Cases with ADHD but no comorbid mental health conditions versus no ADHD were at increased risk of each of 12 types of injury. The increased risk was noticeably more pronounced for ADHD cases with one or more comorbid mental health conditions versus no ADHD. The greatest increased risk of injury was among ADHD cases with comorbid schizophrenia, followed by bipolar disorder and OCD. Comorbid autism disorder does not increase the risk of injury, but lowers it. Finally, the number of comorbid mental health conditions among ADHD cases was positively associated with increased injury rates .  ADHD is positively associated with an increased risk of injury. Comorbid mental health conditions further increase the risk of injury among those with ADHD. The American Psychiatric Association characterizes attention-deficit hyperactivity disorder (ADHD) as “a neurodevelopmental disorder defined by impairing levels of inattention, disorganization, and/or hyperactivity-impulsivity” . Until rADHD is often diagnosed with at least one other mental, behavioral, or personality disorder, which complicates the clinical picture, assessment, and treatment –9. BecauASD is an intriguing codiagnosis with ADHD because ASD cases often share some of the core symptoms of ADHD . However, many of the core symptoms of ASD are not shared with ADHD cases, thus helping to distinguish the two disorders . In a reResearch has shown that ADHD is positively associated with emergency services, hospitalization, and healthcare claims for injuries –22. A stThe rate of comorbid mental health conditions with ADHD and ADHD associated injury will be assessed according to age, sex, and salary. Twelve specific types of injury rates will be compared between no ADHD, ADHD only, and ADHD and comorbid mental health conditions.The study population involves individuals receiving health insurance from a large company called the Deseret Mutual Benefit Administrator (DMBA). The company was established in 1970 to provide health insurance and retirement income to employees and their families of the Church of Jesus Christ of Latter-day Saints. Electronic claim data were available for the years 2016 through 2020. Enrollees during this time resided in Utah (73%), Idaho (10%), other mountain states (4%), pacific states (8%), central states (4%), and eastern states (1%).Each year, the cohort consists of approximately 27% contract holders, 21% spouses, 48% dependent children, and 4% other . Among contract holders, 34% work in the Church Education System, seminaries, and institutes; 31% work as manual laborers; 10% work in other companies; 6% are retired; and the remaining 19% work in other capacities. Employee retention is about 92%  from year to year. The high percentage of contract holders who are no longer insured through DMBA in the ages 65 or older is because they become eligible for Medicare, a program under the U.S. Social Security Administration that reimburses hospitals and physicians for medical care provided to qualified individuals ages 65 or older.We examined employee eligibility data and matched automated claims records from January 1, 2016, to December 31, 2020. The International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes were used to classify injuries and ADHD . RecordsThe ICD-10-CM codes used to classify injuries were S00-S09 (head), S10-S19 (neck), S20-S29 (thorax), S30-S39 , S40-S49 (shoulder and upper arm), S50-S59 (elbow and forearm), S60-S69 , S70-S79 (hip and thigh), S80-S89 (knee and lower leg), S90-S99 (ankle and foot), T20-T28 and T30-T32 (burns and corrosions), and T36-T50 (poisoning).Individuals with an ICD-10-CM code of F90 were suspected to have ADHD. However, as with most insurance claims, the DMBA claims do not differentiate between a visit where ADHD is suspected and one where a physician diagnosis is made. For this reason, persons were defined as having ADHD if they (a) had two or more visits with an ADHD diagnosis, (b) had a prescription of a drug used to treat ADHD, or (c) had a combination of diagnosis and ADHD drug. Drugs used to treat ADHD included nonstimulants  and stimulants . Other mental health disorders considered in this study were anxiety , depression , bipolar disorder (F31), obsessive compulsive disorder (OCD) (F42), schizophrenia (F20–F29), and autism (F840).Analyses were limited to ages 4 through 64 years. Numbers of enrollees in the DMBA database in this age range were 74,169 in 2016, 76,063 in 2017, 78,302 in 2018, 75,505 in 2019, and 78,449 in 2020. Numbers classified with ADHD in these years were 2,936 (4.0%), 3,199 (4.2%), 3,564 (4.6%), 3,417 (4.5%), and 3708 (4.7%), respectively. A relatively small number of individuals had a single ICD-10-CM code for ADHD and did not receive one of the medication schemes listed above for treating ADHD: 154 in 2016, 125 in 2017, 123 in 2018, 137 in 2019, and 181 in 2020. For these individuals, it appears that the initial workup for ADHD did not confirm the disorder. Hence, they were not included in the ADHD group.The rate of ADHD consisted of all individuals classified with ADHD in a given year divided by the number of enrollees in that year. If an injury occurred in the same year as a diagnosis with ADHD, we assumed that ADHD influenced the incidence of that injury. Multiple injuries were possible and included in the analyses per year. For example, if a person experienced a head injury and a burn in the same year, they were included in the rate calculation for both head injury and for a burn. If any type of injury (see list above) occurred in a given year, then that person was included in an overall injury rate calculation.The rate of ADHD (per 100) was presented according to age, sex, salary (of contract holder), and year and evaluated for statistical significance using the chi-square test. Poisson regression was used to compute rate ratios, adjusted for age, sex, salary, and year. Rate ratios measured the association between ADHD status (yes vs. no) and the demographic variables, with interaction terms evaluated. Rate ratios also measured the association between ADHD status (yes vs. no) and each of the other selected mental health conditions, with interaction terms assessed in each model. Analyses then considered how injuries might be influenced by ADHD and comorbid conditions. Specifically, rate ratios measured the association between ADHD status  and the presence (yes vs. no) of each of the 14 types of injury; any injury (yes vs. no) among ADHD cases and each of the comorbid mental health conditions (yes vs. no); and any injury (yes vs. no) among ADHD cases and the number of comorbid mental health conditions. In models assessing the rate of injury among ADHD cases and each of the comorbid conditions, interaction terms were included and evaluated. Interaction terms were assessed for ignificance using the Wald chi-square test. Adjusted rate ratios were presented along with their corresponding 95% confidence intervals. Confidence intervals not containing 1 were statistically significant at the 0.05 level. Two-sided tests of significance were used, based on the 0.05 level. Statistical analyses were derived from Statistical Analysis System (SAS) software, version 9.4 .During 2016-2020, the average number of DMBA enrollees ages 4-64 each year was 76,498 . Mean age each year was 30.8 (SD = 18.0). The average number with ADHD each year was 3,365 (4.4%).ADHD significantly varies according to age, sex, salary, and year . The ratThe rate of ADHD for males compared with females significantly varies across age groups . For theAmong ADHD cases, 51.8% had one or more other mental health conditions. The distribution of ADHD and comorbid mental health conditions is shown in Higher rates of each of the mental health conditions (yes vs. no) among those with ADHD (vs. otherwise) significantly varied according to age. Higher rates for each of the mental health conditions are significantly greater in ages 4-9, followed by 10-14, and then 15-64. More specific age groups in the later ages were combined into the last age group because the rate ratios for each mental health condition were similar (data not shown). To illustrate how the rate ratios are associated with age, the increased rate of autism, OCD, and anxiety for those with ADHD versus otherwise are shown in The greater rate of depression for ADHD cases was significantly more pronounced in males than females (5.05 [95% CI 4.85–5.24] vs. 4.12 [95% CI 3.98–4.26]). There was inconclusive evidence of the greater positive association between ADHD and depression in males compared with females in ages 4-14 years, but there was in ages years 15-64: .The rate of injury in ADHD cases without comorbid mental health conditions is 19.0%, in ADHD cases with comorbid mental health conditions is 22.7%, and in non-ADHD cases is 13.7%. The rate of injury (yes vs. no) for ADHD cases without comorbid mental health conditions versus those without ADHD is 1.39 (95% CI 1.33–1.45), and those with ADHD and comorbid mental health conditions versus those without ADHD is 1.66 (95% CI 1.60–1.73). Corresponding rate ratios adjusted for age, sex, salary, and year are 1.33 (95% CI 1.27–1.39) and 1.62 (95% CI 1.56–1.68), respectively.ADHD cases have significantly higher rates of several selected types of injury, after adjusting for age, sex, salary, and year . ADHD caFor no ADHD, ADHD only, and ADHD with one or more comorbid mental health conditions, the rates (per 100) are 0.30, 0.54, and 2.26 for poisoning, 0.14, 0.26, and 0.36 for burns, and 2.02, 3.34, and 4.24 for head injuries, respectively. The rate ratio for ADHD with one or more comorbid mental health conditions versus ADHD only is 4.19 for poisoning, 1.38 for burns, and 1.27 for head injuries. Rates of poisoning, burns, and head injuries were 41.10 (95% CI 33.69-50.14), 10.25 (95% CI 5.51-19.07), and 3.14 (95% CI 2.36-4.18) for schizophrenia cases, respectively. Corresponding rate ratios measuring the association between poisoning, burns, and head injuries and bipolar disorder are lower . Other rate ratios measuring the association between poisoning, burns, and head injuries and OCD or depression or anxiety are even lower, albeit positively significant (data not shown).Rates of injury among ADHD cases increases with comorbid schizophrenia, bipolar disorder, OCD, depression, and anxiety . Among tp = 0.0410). The rate of injury for ADHD cases with comorbid anxiety (vs. no anxiety) was 28% higher for males but 12% higher for females (p = 0.0342).The increased rate of injury for selected comorbid mental health conditions  among ADHD cases did not significantly vary according to age group. However, the increased rate of injury for ADHD cases with comorbid bipolar disorder or anxiety significantly varied by sex . SpecifiThe number of comorbid mental health conditions among ADHD cases is positively associated with increased risk of injury . For ADHThis study showed the incidence rate of ADHD by selected variables, being greatest in the age groups 10-14 and 15-19, among males, and where the contract holder's salary was $100,000 or more. These results are consistent with other studies –6. The cThe majority of ADHD cases have comorbid mental health problems. Other studies have also observed a high level of comorbid mental illness among ADHD cases –16. BecaConsistent with findings in the current study, previous research has observed an increased rate of injury among ADHD cases –22. We oWe further observed that the significantly increased rate of injury among ADHD cases was 1.33 (95% CI 1.27–1.39) for ADHD alone and 1.62 (95% CI 1.56–1.68) for ADHD and comental health problems, after adjusting for age, sex, salary, and year. This is also consistent with previous research . HoweverThe rate of injury among ADHD cases significantly increased with comorbid schizophrenia, bipolar disorder, OCD, depression, and anxiety. Hence, features of the disorder, which increase the rate of injuries, are compounded with the comorbidity of these other mental health conditions. The increased rate of injury was most pronounced in ADHD cases with comorbid schizophrenia, and the increased rate was least pronounced for ADHD cases with comorbid anxiety. Schizophrenia was more strongly associated with poisoning and burns, followed by head injuries, than the other mental health conditions.When an ADHD case also had autism, their rate of injury decreased. Understanding which autism symptoms may be protective against injury deserves further investigation. In addition, the increased rate of injury for bipolar disorder and anxiety varied by sex, being more pronounced for males than females. Our data limits us from being able to explain these findings, especially given that injuries like traumatic brain injury may both be the cause and the result of these mental health disorders, at different levels for males and females.The number of comorbid mental health conditions among ADHD cases is positively associated with increased risk of injury. This is consistent with results from previous research . It may The study was based on medical and pharmaceutical claims from contract holders and their dependents in the DMBA databased during 2016 through 2020, so no selection of subgroups that might have resulted in bias was present. However, generalization of the results is limited because the contract holders (27% of enrollees) are employees, so that they and their dependents are less likely to represent lower income individuals in the general U.S. population. Unemployed, lower-income families may represent different levels of ADHD. In addition, the specific religious preference of the individuals in this study was not available, but the nature of the database and known job types suggests that most were members of the Church of Jesus Christ of Latter-day Saints. This religious group is known for their relatively low use of tobacco smoking, alcohol drinking, and illicit drug use –31. ReseAll contract holders, regardless of salary, were eligible to receive comprehensive insurance coverage. An ADHD diagnosis would not lead to losing insurance so making selective underreporting of ADHD claims for this reason unlikely. However, it may be that some ADHD cases were not identified by the criteria used in this study. Incorrect diagnosis and treatment of ADHD is also possible. The available data did not allow us to identify the level of under or over reporting of ADHD due to these potential influences.A small number of individuals who visited the doctor for an ADHD workup failed to receive a confirmation of the disorder. We assumed this because they neither received medication nor a follow-up visit for ADHD. Yet, it is possible that some of these people did have ADHD, and including them in the non-ADHD group could have created a conservative positive relationship between ADHD and injury. Furthermore, the fact that some minor injuries may not have been included in the claim database could have dampened the observed association between ADHD and injury.The majority of ADHD cases have one or more comorbid mental health conditions. ADHD is significantly associated with increased risk of autism, manic disorder, bipolar disorder, schizophrenia, OCD, anxiety, and depression . Increased rates of these conditions in ADHD cases is the highest in ages 4-9 and lowest in ages 15-64. Greater risk of depression for ADHD cases is more pronounced in males than females but only in ages 15-64.While ADHD cases have an increased risk of 12 general types of injury, the addition of comorbid mental health problems significantly increases the already increased risk, especially for poisoning. The combination of ADHD and each of the mental health conditions considered increased the risk of injury, irrespective of age, with the addition of schizophrenia, bipolar disorder, or OCD most dangerous in terms of increasing the risk of injury. When ADHD was combined with bipolar disorder or anxiety, the increased risk was more pronounced for males versus females. ADHD cases with autism have significantly lower risk of injury than ADHD cases without autism. The number of comorbid mental health conditions in ADHD cases increases the risk of injury, irrespective of age and sex.


This approach converts the governing partial differential equations into ordinary differential equations. In this particular investigation nano-particles of copper, copper oxide, titanium dioxide, and aluminium oxide are studied by considering CMC/water as a base fluid with the effect of magnetic field on the classical Blasius and Sakiadis flows of nano-fluids. Validation is carried out using the previously obtained numerical findings. We looked at the power-law index ( Non-Newtonian fluids have been the focus of study on drag force and energy transfer over the last half century. This is because, the widespread usage trend of applications using Non-Newtonian and Newtonian fluids within the manufacturing sector, such as molten polymers, slurries, pulps and emulsions. The increasing demands of contemporary technologies, in the realms of petrochemicals, electricity generation, and microelectronics need to create more efficient fluids of different sorts for according to the efficiency of the heat transfer. Nano-fluids are made by dispersing solid particles on the nano-scale scale into low viscosity base liquids such as water, ethylene glycol (EG), and oils all have high heat conductivity. Therefore, it has become difficult to find appropriate nano-fluids with enhanced heat transfer capabilities and high thermal conductivity. Thermal conductivity of oxide nano-fluids has been the subject of several published investigations such as, effects) ,5,6.Sui et al.  studied a et al.  took inta et al.  considera et al.  to solvea et al. ,14.Ram Reddy et al.  considerNano-fluids flow over horizontal plate with Sakiadis and Blasius effects, are the focus of all of the investigations that have been discussed so far. However, as of yet, no contribution has been made on non-Newtonian (NN) nano-fluids (NFs) considering magnetic field over surface which is a porous, because of the nano-particles that consist of Solids dispersed in liquids enhance heat conductivity, since from 1900s, scientists and engineers have added solid particles to liquids to increase their low heat conductivity. The increment in thermal conductivity of solid-dispersed liquids in which size of particles was restricted to microns or millimetres and solid particle concentration was predicted by Maxwell and Yang ,45,46. Op et al. , nano-flWater, ethylene glycol, and transformer oil have lower thermal conductivity than nano-structures. Researchers previously reported that the thermal conductivity of nano-fluids was influenced by several parameters. Base fluids type, particle size, particle shape, fluids and temperature are some examples of such parameters ,50,52,53For nano-fluids used in heat exchange equipment, heat transfer coefficient is superior than thermal conductivity using different nano-particles and base fluids. Therefore, nano-fluids heat transfer has two theories in which the first school of thoughts says that the heat transfer coefficient may be increased without compromising pumping power. The second school of thinking says heat transfer coefficient increases are restricted and mitigated by increased pumping power. MIT and Helmut Schmidt University reflect the second school of thinking. Both groups’ findings are in Shriram et al.  exploredl et al.  tested ng et al.  evaluateConsider the two dimensional and steady state boundary layer (BL) flow over a plate which is flat and permeable. Therefore, the plate is immersed in sodium carboxymethyl cellulose (CMC) nano-fluid, considered as base fluid. The temperature and velocity of the free stream are denoted by x and y directions respectively. The power-law number is indicated by the letter n in the exponent, which is connected to the base fluid. Both Newtonian fluids and pseudo-plastic fluids have n values that are either 1 or between 0 and 1, depending on the kind of fluids. Additionally, the value of n for dilatant fluids is greater than 1. The mass transfer velocity, denoted here by In the governing system, the flow velocity is presented by Governing Blasius flow:Boundary conditions for Blasius flow:Boundary conditions for Sakiadis flow:Nano-fluids density is represented by The following similarity transformations have been developed in order to facilitate a more straightforward mathematical analysis of our research:Therefore, Blasius and Sakiadis’ momentum and energy equations with constitutive boundary conditions are;Governing Blasius flow:whereBoundary conditions:Governing Sakiadis flow:Boundary conditions:where In this investigation, the local skin friction coefficient By employing similarity transformation, the obtained results are as follows:In this part, the effects of several factors, such as different kind of nano-material, permeability, volume fraction (VF) related to solid particles, index for the power law, magnetic strength, and the source term parameter, has been discussed. For each nano-fluid, the findings are presented with regard to the non-dimensionlized temperature and the velocity fields. The following contains an analysis as well as a discussion of the aforementioned findings.Results from the present experiment are compared and analysed against those from the studies conducted by Maleki and Ishak ,60, for surfaces ,31,32,60M to analyse non-dimensional velocity, can be seen from M is increased, the flow will be described as being in a Blasius configuration.The Blasius flow of Newtonian and non-Newtonian nano-fluids for different values of the magnetic interaction parameter M affects the dimensionless velocity when the Sakiadis flow is considered for both the nano-fluids under consideration. It has been shown that an increase in the magnetic field has the effect of slowing down the velocity. This is due to the fact that the magnetic field in transverse direction generates a resistive force, known as Lorentz force which cut down the hydrodynamic BL thickness for both nano-fluids.Temperature profiles are shown for an impermeable surface, as well as for suction, as seen in the n which is related to the power law for an impermeable surface, suction, and injection. It can be shown that the non-dimensional temperature rises with increasing n for suction and impermeable surface, but this tendency is not apparent for injection. Injection temperatures do not follow this pattern. Additionally, the thickness of the BL grows in every circumstance as the power-law index rises.a, which is a convective parameter, on temperature profile in which the effect is seen for both types of nano-fluids. As a increases, the surface temperature Different nano-particles have a noticeable effect on the local friction factor for both Newtonian and non-Newtonian nano-fluids, in case of Blasius and Sakiadis flows, as shown in In Sakiadis flow, For suction and impermeable surfaces, nano-particles increase fluid velocity in case of Blasius flow, whereas for injection the tendency is reversed for Sakiadis flow. Also, increasing suction reduced boundary layer thickness.n while it rise up due to parameter related to suction which affects the surface temperature and thermal boundary layer thickness.Large nano-particle VF reduced plate surface temperature for impermeable surfaces by using fluid which is related to non-Newtonian. For suction, nano-particle volume fraction does not affect the temperature which is on the surface in case of low value of Nano-particle volume fraction does not always boost heat transfer. In suction, increasing Non-Newtonian fluid injection reduces heat transfer and increases friction.In circumstances that are otherwise identical, the value of the local friction factor is found to be greater for non-Newtonian nano-fluids than it is for Newtonian fluids.When compared to other nano-particles, the copper nano-particle has a local friction factor that is much greater but in case of alumina nano-particles, it is much lower.The impact of the magnetic field in the Blasius flow is to decrease the temperature while increasing the skin friction coefficient, velocity and reduced Nusselt number for both non-Newtonian & Newtonian nano-fluids. On the other hand, this pattern runs in the opposite direction when Sakiadis flow is considered for either the non-Newtonian & Newtonian nano-fluids.In Blasius flow, copper nano-particles enhance nano-fluid velocity, whereas alumina nano-particles have the opposite effect. Sakiadis flow over velocity has the opposite effect. In Blasius flow, increasing Non-Newtonian & Newtonian nano-fluids have greater values for both the skin friction coefficient and the reduced Nusselt number in Blasius flow but for Sakiadis flow, such tendency is inverted.This study examined the boundary layer flow of Newtonian and non-Newtonian nano-fluids across a permeable flat plate in a laminar steady state for Blasius and Sakiadis flows. The numerical solution to the governing partial differential equations was achieved by translating them to ordinary differential equations (ODEs) using the similarity approach. These ODEs, then numerically solved. Alumina, copper, titanium, and cupric oxide nano-particles were used in the research in which CMC-water served as the base fluid. Some of the study’s most significant findings are as follows: