Background: The role of the norepinephrine transporter (NET) has received increased focus in recent studies on the pathogenesis of attention-deficit/hyperactivity disorder (ADHD). The predictive value for pharmacological treatment and its link to other health or social limitations has been little-studied. This follow-up research on adult patients with ADHD aimed to explore whether the therapy response and health and social impairments depend on baseline individual NET availability. Methods: Data were collected from 10 patients on personal, family and professional situations, mental and physical health and treatments received after baseline via online and telephone surveys and were compared to baseline data to evaluate treatment-related changes. Results: The majority of our ADHD patients did not show therapy responses but showed improvements due to pharmacological treatment. There was no evidence of relationships between pre-treatment NET availability and therapy response or health/social limitations. Conclusions: Pharmacological monotherapy was insufficient to promote symptom remission, especially for participants with extreme insufficiency in NET availability, but improved outcomes in academic and social functioning. Psychotherapy should be considered as an add-on to the standard treatment approach due to its positive outcome in reducing social limitations. The prognostic value of individual NET availability in predicting the response to therapy needs further studies with large sample sizes. Attention-deficit/hyperactivity disorder (ADHD) is a childhood-onset neurodevelopmental disorder characterized by core symptoms of inattention, hyperactivity and impulsivity . Its symThe causes of ADHD are complex, and the underlying etiology and pathophysiology remain unclear. A growing body of evidence support a multifactorial model in which a dopamine (DA) and/or norepinephrine (NE) deficiency in several brain regions is an important risk factor of this disorder ,6. In ouThe exact mechanism of action of ADHD medication is still unclear. The generally believed mechanism of action is the effect of a psychostimulant  or lisdexamfetamine (LDX)) and a non-stimulant ) on the DA system due to their high affinity for the DA transporter (DAT) ,10,11. HThe efficiency and safety of the medication for ADHD was intensively examined. Previous findings suggest that the individual response to medication can vary significantly. About 30% to 42% patients cannot benefit from their medication ,20. In tAdditionally, recent studies show increased comorbidity between ADHD and other psychiatric disorders such as mood disorders, substance abuse and anxiety. With a consideration of the modulating role of NET in autonomic and cognitive functions such as arousal, attention and mood , we aimeIn short, this study aimed to explore the possible answers to the questions of whether (1) the response to treatment and (2) the possible health-related or social limitations are related to individual initial NET availability. To explore our hypotheses in this study, we planned a follow-up study to collect data of participants from our prior study  about peFor the current study, we invited all recruited participants from the prior study  with a dConners’ Adult ADHD Rating Scale (CAARS) [Beck Depression Inventory-II (BDI-II) [Alcohol Use Disorder Identification Test (AUDIT) [Drug Use Disorder Identification Test (DUDIT) [German version of the Patient healthy Questionnaire (PHQ-D) [In order to explore our hypotheses, the existing baseline test battery was adapted. In this study, participants were only provided with the change-sensitive questionnaires as an online survey with a personalized assess code by email. The following questionnaires were used in the online survey: The German version of  (CAARS)  provided(BDI-II)  was appl (AUDIT)  and Drug (DUDIT)  served a (DUDIT)  was used (PHQ-D)  was suppMontgomery–Asberg Depression Rating Scale (MADRS) [After the online survey, a telephone interview was carried out in which possible changes in sociodemographic data and medical anamnesis were able to be queried. Moreover, the German version of the  (MADRS)  was applIn our prior study, diagnosed unmedicated ADHD adults were examined to test the a priori hypothesis that central NET availability is altered in adult ADHD compared to healthy controls . The basIn this study, a therapy response was based on a CAARS concept of symptomatic remission defined by a T-score in the CAARS DSM-Global subscale below 60 . FurtherA health limitation was defined as the existence of diagnosed psychiatric, psychological or physical diseases.The numbers of impaired aspects of each setting of social life according to the DIVA-C were added to produce an impairment score in each setting. The level of social limitations was indicated by the resultant z-scores: no apparent impairments (z > 1.0), low impairments (0 < z < 1), moderate impairments (−1.0 < z < 0) and high impairments (z < −1.0).Due to differences in individual symptoms, treatment options or durations, we briefly describe each participant’s case and summarize several common characteristics from these cases.t-tests are unacceptable in the case of unequal sample sizes and when larger variances come from small samples because these tests could provide high false-positive rates or very low statistical power [t-tests were planned. Detailed results are summarized in the In this study, comparisons of means between different groups were executed, despite the small sample size. However, the regular sample al power . If thesTo minimize the number of comparisons and correlation analyses, we summarized the ROIs of mean DVR into two relevant brain regions based on the finding of a prior study . They arThe final sample involved 10 adults suffering from ADHD who completed both the online and telephone surveys. An overview about their demographic and related clinical profiles prior to the study and at follow-up are provided in ID 01A 26-year-old male participant showed, after MPH treatment at a dose of 80 mg/day for about 26 months, no overall improvement in ADHD symptoms at follow-up. There were no other comorbidities, and no related treatments were requested.ID 02A 26-year-old female participant showed, after MPH treatment at a dose of 20 mg/day for about 21 months, a slight overall worsening in ADHD symptoms. She reported, in the telephone survey, diagnosed comorbid depressive and anxiety symptoms, consistent with the results from BDI, MADRS and PHQ-D. A multimodal approach that combined psychotherapy and pharmacotherapy was required due to comorbidities.ID 03A 53-year-old male participant showed, after MPH treatment at a dose of 40 mg/day for about 8 months, a minimal improvement in ADHD symptoms. There were no other comorbidities, and no related treatments were requested.ID 04A 35-year-old male participant showed, after MPH treatment at a dose of 40 mg/day for about 39 months, an obvious overall improvement in ADHD symptoms, which even reached symptomatic remission as defined by Christiansen et al., 2014. Furthermore, he reported a marked improvement in comorbid depressive symptoms, as determined by the BDI and MADRS, even in the absence of a confirmed diagnosis of depression. No reports about other comorbidities or treatments.ID 05A 36-year-old female participant showed, after MPH treatment at a dose of 20 mg/day for about 37 months, a minimal worsening of ADHD symptoms. She was recognized to have some comorbid depressive symptoms/syndrome and substance use disorders within last 12 months based on the scores of the BDI, PHQ-D and AUDIT/DUDIT, respectively. However, no related treatments were considered.ID 06A 39-year-old female participant showed, after a pharmacological combination of ATX and LDX in respective doses of 40 mg and 70 mg per day for about 22 months, a slight improvement in ADHD symptoms. The reported comorbid depressive symptoms were in line with the results from the BDI, MADRS and PHQ-D. For this comorbidity, she received psychotherapy combined with TMS.ID 07A 26-year-old male participant showed, after an irregular MPH intake at a dose of 10 mg/day with parallel sport and neurofeedback, a slight improvement in ADHD symptoms. Comorbid depressive and anxiety symptoms were present since the prior study; however, no real improvement was reported after a psychotherapy.ID 08A 34-year-old male participant showed, after MPH treatment at a dose of 10 mg/day for about 18 months, a worsening of ADHD symptoms. There was an indication of some depressive symptoms according to MADRS, but this was inconsistent with the BDI and PHQ-D. There were no other comorbidities, and no related treatments were required.ID 09A 34-year-old male participant showed, after a pharmacological combination of MPH at a dose of 30 mg/day, ATX at a dose of 80 mg/day and LDX at a dose of 70 mg/day for about 30 months, a marked improvement in ADHD symptoms, which almost reached symptomatic remission based on Christiansen et al., 2014. He reported some depressive symptoms based on the results from both the BDI and MADRS in the absence of a confirmed diagnosis. No reports about other comorbidities or treatments.ID 10A 38-year-old female participant showed, after MPH treatment at a dose of 60 mg/day for about 40 months, an obvious improvement in ADHD symptoms. Furthermore, she was reported to have some comorbid depressive symptoms, which were clearly reduced after psychotherapy. There were no other comorbidities, and no related treatments were required.In the current study, all 10 participants with ADHD were administered at least one psychostimulant as their treatment for ADHD, and 90% of these cases included MPH. The rate of participants with the administration of a stimulant, i.e., MPH, as a monotherapy was 70%. An additional 20% of the participants were administered a combination of stimulant(s) and ATX. For the remaining 10%, non-psychopharmacological interventions  were further required in the case of the irregular intake of MPH.There was no participant who preferred psychotherapy as a primary or co-treatment for ADHD. A total of 40% of participants required additional psychotherapy due to comorbid depression and/or an anxiety disorder diagnosed by their own psychiatrist or psychologist but not due to ADHD.The rate of participants reporting an overall improvement in CAARS DSM-Global total raw scores was 60%, but only 10% of these cases matched the definition of a therapy response with a T-score on the CAARS DSM-Global subscale below 60.Accordingly, all participants with diagnosed ADHD experienced some or considerable limitations: there were five participants classified as having low impairments, four with moderate impairments and one with significant impairments in different settings of life. It was worth noting that all participants who received psychotherapies due to diagnosed comorbidities reported overall less impairments compared to participants without comorbidities/physical disease. Interestingly, the only participant experiencing significant limitations was the one that presented remission based on the CAARS DSM-Global subscale.p ≤ 0.96).Regarding the group difference in DVRs between participants with and without health limitations, independent-sample t-tests were, in this case, acceptable since the variances in the larger sample were higher than in the smaller sample. No significant group difference was found  or the levels of social limitations (0.72 ≤ p ≤ 0.87).Regarding the association between DVRs and health or social limitations, correlational analyses revealed no significant relationships between DVRs and the existence of health limitations  reported developing depressive disorders since the prior study . These tFurthermore, there was one participant (ID 02) who received citalopram due to diagnosed depression see . CitalopIt should be noted that participants with co-occurring comorbidities reported low levels of social limitations compared to those without any comorbidities. We assume that this may be the result of the psychotherapy they received. Psychotherapy, through promoting recovery from depressive disorder, also contributed to an improvement in the quality of life, probably by reducing various impairments in social domains. Although none of the participants in this study considered psychotherapy and the evidence regarding the efficiency and effectiveness of psychotherapy in the sample suffering from ADHD are still preliminary , it shouFailure to demonstrate any associations of NET availability could probably be explained by the large variance due to the small sample size. However, the observation that participants with decreased NET availability tended to show little improvement after treatment might indicate that monotherapy with MPH is not enough for ADHD patients with extremely insufficient NET availability. Other treatment approaches, e.g., stimulation therapy, which directly regulates the activity of neurons at specified brain regions during a stimulation session, could be considered as supplementary therapies for these patients. Additionally, the observation about a potential relationship between NET availability hemisphere imbalances and co-occurred depressive/anxiety disorder might imply that this imbalance could play a role in the presence of mood and anxiety disorders. This issue should be studied further and replicated in a large sample.Some limitations of this study should be mentioned. The main limitation was the inability to generalize our results and the risk of explaining error due to the extremely small sample size. A second limitation was the lack of classification of ADHD subtypes in the prior study, which provided no related information for this follow-up research. Furthermore, the online survey and telephone interview could be seen as methodological limitations due to the lack of intuitive clinical observations. On the other hand, the main contribution of study should also be mentioned, namely, the prominent importance of the individual aspect in the treatment or management of this disorder, and the importance of studying the predictive value of NET availability was highlighted.Although the majority of adult participants with ADHD did not respond to the pharmacological treatment according to our definition of response, they seemed to benefit from the regular treatment by showing reduced burden in the academic and social domains. The issue preventing the effect of pharmacological treatment from reducing comorbidities should be investigated in further studies with sufficient sample sizes. Moreover, some improvements were still observable in ADHD symptoms. A monotherapy with MPH might be not adequate for those patients with extremely insufficient NET availability. A multimodal therapy consisting of ADHD-specific medication and psychotherapy, as recommended by the therapy guidelines for adult ADHD patients, seems to be the better therapeutic option and led, in our study, to a reduction in social limitations and improved the patients’ quality of life. Further studies with proper sample sizes are needed to clarify issues related to the association between NET availability and the therapy response.


The World Health Organization set a Global Nutrition Target of a 30% reduction in LBW by 2025. Maternal malnutrition/undernutrition is among the most important modifiable risk factors for impaired fetal growth. This study investigates the effect of maternal undernutrition on LBW in Sudan.via questionnaire, and their mid-upper arm circumference (MUAC) was measured. Maternal undernutrition was defined as a MUAC of <23 cm.A cross-sectional study was conducted at Saad Abuelela Hospital in Khartoum, Sudan, from May to October 2020. The sociodemographic and obstetric data of the women were gathered In total, 1,505 pairs of pregnant women and their newborns were enrolled in the study. The medians [interquartile (IQR)] of the age, parity, and gestational age were 27.0 (9.0) years, 1.0 (3.0), and 38.0 (2.0) weeks, respectively. The median (IQR) of the birth weight was 3,028.0 (690.0) g. Of the 1,505 participants, 182 (12.1%) delivered LBW infants. Multivariate logistic regression showed that MUAC  and gestational age  were negatively associated with LBW. The level of antenatal care <2 visits  was associated with LBW. Women with undernutrition were at a higher risk of delivering LBW infants .LBW is a health problem in Sudan, and women with undernutrition were at a higher risk of delivering LBW infants. It has been estimated that over 20 million deliveries have resulted in LBW infants LBW; <2,500 g) annually; the vast majority of these LBW deliveries are in low- and middle-income countries . Several00 g annuMaternal undernutrition is a problem in developing countries . The preInvestigating the association between maternal undernutrition and LBW is vital for evidence-based interventions to reduce the burden of LBW. Several studies have assessed the association between birth weight/LBW and maternal undernutrition in African countries –19. LBW This cross-sectional study was conducted at Saad Abuelela Hospital in Khartoum, Sudan, from May to October 2020.Women with a single and alive newborn.Women with multiple pregnancies, intra-uterine fetal death, delivering a baby with one or more congenital anomalies, and women with diseases known to influence the birth weight such as thyroid disease, diabetes mellitus, hypertension, antepartum hemorrhage, or any other chronic disease  were excAfter signing informed consent, data were collected by trained medical officers who graduated from medical schools. The socio-demographic and obstetric data were gathered and recorded face-to-face using a structured questionnaire about obstetric history . Gestational age was calculated using a combination of the dates of the last menstrual period and early pregnancy ultrasound.Newborn weights were recorded within 1 h of delivery. The mother’s mid-upper arm circumference (MUAC) was measured after delivery using a flexible non-stretchable standard tape measure. The circumference was measured at the mid-point between the tip of the acromion process of the scapula and the olecranon process of the ulna. Measurements were taken on the right arm to the nearest 0.1 cm . MaternaA sample size calculation for a cross-sectional study was applied and was estimated as 1,505 women using the recent prevalence (14.5%) of LBW in the study area . Thus, wp < 0.20 univariate analysis were entered to build the multivariable logistic regression models, and backward-stepwise regression was used for adjustment. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. A two-sided p < 0.05 was considered statistically significant.Data were entered into the Statistical Package for Social Sciences (SPSS) version 22 software (SPSS Inc.) for analysis. Continuous data (including MUAC) were checked for normality and were not normally disturbed. Therefore, the median [interquartile (IQR) range] was used to express their values. Categorized data were presented as frequencies and proportions. Multicollinearity  was checked for but not detected. Univariate analyses were performed with LBW as the dependent variable and clinical obstetrics data  as the independent variables. MUAC and undernutrition were entered one by one in each model. Variables with a A total of 1,505 pairs of pregnant women and their newborns were enrolled in the study. The median (IQR) of the age, parity, and gestational age was 27.0 (9.0) years, 1.0 (3.0), and 38.0 (2.0) weeks, respectively. Half of these women were primipara . The vast majority of these women were housewives , and over half  had an education level ≥ secondary school. In total, 106 (7.0%) attended ≥ three antenatal visits, and 328 (21.8%) of the studied women had a history of miscarriage. Three hundred and twelve (20.7%) women had a cesarean delivery.The median (IQR) of the birth weight was 3,028.0 (690.0) g. Of 1,505 participants, 182 (12.1%) delivered LBW infants.The MUAC, gestational age, ANC, and education levels were significantly lower in women who delivered LBW infants. No significant difference was found in age, parity, hemoglobin levels, residence, employment, miscarriage history, and newborn gender between the two groups .p = 0.010) women who did not deliver a LBW infant had undernutrition.The median (IQR) of MUAC was significantly lower in women who gave birth to LBW infants [10.0 (6.5) ng/mL vs. 18.3 (22.1) ng/mL]. In total, 35/182 (19.2%) women with LBW infant and 160/1,323  = 0.91, 95% CI = 0.87–0.96] and gestational age  were negatively associated with LBW. A level of antenatal care <2 visits  was associated with LBW. Women with undernutrition were at a higher risk of delivering LBW infants , In this study, 12% of deliveries resulted in a LBW infant. The prevalence of LBW in our study is comparable with the LBW prevalence (14.3%) which was previously reported in the same hospital  and in dIn the current study, pregnant women who had attended less than two ANC visits were at a 2.10 higher risk of delivering an LBW newborn. This is consistent with the previous studies conducted in Sudan , EthiopiIn the current study, MUAC (AOR = 0.91) was negatively associated with LBW. Women with undernutrition were at a higher risk of delivering LBW (AOR = 1.66) newborns. Several previous studies have shown that maternal undernutrition is associated with LBW –17. In tOur finding of an association between gestational age and LBW is in agreement with the results from neighboring Ethiopia .We reported no association between maternal age, residence, newborn gender, maternal Hb and delivering LBW infants. Previous studies have shown that maternal Hb , maternaThe other assessment tools for the micronutrient deficiencies during pregnancy are costly and technically difficult. Anthropometrics measurements, such as MUAC, are useful in assessing the malnutrition state. Unlike body-mass index, MUAC does not change during pregnancy; therefore, it seems to be the best tool for assessing the nutritional status during pregnancy , 37.The present study has some strengths including its large sample and taking newborn weight within 1 h of delivery. However, our study has limitations such as it was a hospital-based study, which might not reflect what was going on in the community. The study was conducted at a single hospital, the finding might not be generalizable to the entire birth cohort in the area. The cross-sectional nature of the study makes it difficult to draw inferences about the cause–effect relations among study variables. The number of ANC visits was taken from verbal response of respondents. There might be recall bias as respondents had to remember their ANC visits. In addition, important variables like physical activity and dietary diversity were not assessed.LBW is a health problem in Sudan. Women with undernutrition are at a higher risk of delivering LBW infants.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.The studies involving human participants were reviewed and approved by the Research and Ethical Committee of the Department of Obstetrics and Gynecology, Faculty of Medicine, University of Khartoum, Sudan . Informed consent was given by the participants. Written informed consent to participate in this study was provided by the participants’ legal guardian/next of kin.JB designed the research, analyzed the data, and interpreted the results. AA-N and AA designed the research and wrote the manuscript. DR conducted the research, analyzed the data, and wrote the manuscript. IA designed the research, conducted the research, and analyzed the data. All authors read and approved the final manuscript.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Participants with and without ADHD had equal press latencies (p = 0.79). Participants with neurological disorders had a greater press latency compared to their typically developing peers (p < 0.001). Target fixation duration shows a significant association with parent-reported attention problems . We conclude that eye tracking during a distraction task reveals potentially valid clinical information that may contribute to the assessment of dysfunctional attentional processes. Further research on the validity and reliability of this paradigm is recommended.This study aims to investigate distractibility quantified by recording and analyzing eye movements during task-irrelevant distraction in children with and without ADHD and in children with and without neurological disorders. Gaze behavior data and press latencies of 141 participants aged 6–17 that were collected during a computerized distraction paradigm with task-irrelevant stimuli (IDistrack) were analyzed. Children using attention-regulating medication were excluded from participation. Data were analyzed for subgroups that were formed based on the presence of neurological disorders and the presence of ADHD separately. Participants with ADHD and participants with neurological disorders spent less time fixating on the target stimuli compared to their peers without ADHD ( Children and adolescents with neurological disorders  are often diagnosed with attention deficit hyperactivity disorder (ADHD) . One of Traditionally, attentional processes during cognitive tasks are quantified in terms of the speed and accuracy with which task-relevant stimuli  are processed and reacted upon. Similarly, in previous studies, assessment of distractibility is based on the speed and accuracy of information processing during task-irrelevant distraction ,4,5,6. STwo recent studies on this topic in adults showed enhanced correct ADHD classification rates for a validated task-irrelevant distractor test when gaze distribution information was added to the conventional outcome measures  ,13. ThesAssessment of gaze behavior using eye tracking may contribute to a better understanding of distractibility in children with ADHD or neurological disorders. ADHD is presented as a heterogeneous clinical disorder, with patients presenting varying cognitive and behavioral symptoms . Valid aIn the current study, we aimed to assess the clinical utility and validity of an eye-tracking-based cognitive task (IDistrack) we developed to assess the susceptibility of children to task-irrelevant distraction. In the first part of the study, we compared gaze behavior and manual press latencies during task-irrelevant distractor interference between children and adolescents with a formal ADHD diagnosis or neurological disorders and their non-ADHD or typically developing peers, respectively. We also assessed the association between gaze behavior data and parent-reported attention problems. In the second part of the study, we assessed the effects of distractor modality  on the degree of task-irrelevant distraction. We hypothesize children and adolescents with ADHD or a neurological disorder to be most susceptible to task-irrelevant distraction and that the degree of task-irrelevant distraction is most prominent when visual distractors with high semantic salience are used.n = 37) and the Center for Neurological Learning Disabilities in Kempenhaeghe . Typically developing children  were randomly recruited via coworkers at the Kempenhaeghe institute for epilepsy and sleep medicine. Depending on the age of the participants, either the parents/legal guardians (ages 6–11), the participant themselves (ages 16–17), or both the participant and the parents/legal guardians (ages 12–15) provided written informed consent. This is in line with the law on Medical Research Involving Human Subjects in The Netherlands. The study was approved by the local medical ethics committee in Kempenhaeghe (METC 18.01).A total of 177 Dutch children and adolescents aged between 6 and 17 years  were asked to participate in this study. Children with neurological disorders were recruited from two locations: Berkenschutse School for Special Education  their age was below 6 or above 17 years; (2) medications prescribed for attention deficit disorders  were being used.On the day of testing, each participant completed the IDistrack task. A standard neuropsychological assessment was administered preceding the IDistrack task for participants in the NLD group as part of regular clinical care in the outpatient clinic. For the NLD group, additional test data included in this study consisted of the Attention Problems subscale of the Child Behavior Checklist (CBCL), which is a parent-reported questionnaire assessing the degree of attention problems in children and adolescents . ParentsThe Attention Problems subscale of the Child Behavior Checklist (CBCL) was used for quantification of parent-reported attention problems in the daily life functioning of the included participants. The CBCL is a parent-reported questionnaire assessing behavioral and emotional functioning in children aged 6–18 years  . The AttThe diagnosis of ADHD in the NLD group was made on the basis of a standard protocol using the DSM-5, as described by Hendriksen et al. . For theThe measurement setup consisted of a desktop computer, a 23-inch computer screen with a remote eye tracker attached to the center of the bottom edge of the screen, and a computer keyboard. The setup was put on a height-adjustable table in a low-stimulus room. Each participant sat in a comfortable chair with a viewing distance of the remote eye tracker  between 45 cm and 75 cm, as indicated by the eye-tracking software. The height of the monitor was adjusted in such manner that the eyes of each participant were levelled with the center of the screen for optimal tracking of the eyes. The eye tracker recorded the participant’s eye movements at a sampling rate of 60 Hz, and compensated for free head movements. At the distance of 60 cm, the visual angle towards the monitor was approximately 30° × 24° and the system’s latency was in the order of 30 ms. The keyboard was positioned well within reach of each participant. After a standardized five-point calibration procedure, the IDistrack task was administered. The total test duration was four minutes. The IDistrack task is a reaction-time-based task-irrelevant distractor paradigm in which the participants were instructed to fixate on a smiley (target) that was presented in the center of the monitor A. The taThe test was divided into five presentation sequences that were separately and sequentially administered in a fixed order. Each presentation sequence contained one or multiple of the following five distractor modalities (see The center of the area of interest (AOI) (with a diameter of five degrees) and the center of the target stimulus (with a diameter of three degrees) were placed in the center of the screen. For every participant, raw gaze points as obtained via the eye tracker were plotted and visually inspected by the researcher (DS). A post-calibration procedure on the raw gaze points was performed when the central cluster of gaze points, assumed to be directed to the central AOI, was (partly) not within the AOI. This procedure was mainly performed when the calibration prior to the test was poorly conducted or when a child had altered their position with respect to the eye tracker too much. To this end, the center of this cluster was selected, as well as the intersection points of the horizontal and vertical gaze traces for each of the corners of the screen. The data points were then rescaled to the known location of the central target stimulus and the known peripheral distractor placeholders in order to account for gaze traces that were not attributable to distraction. Recorded eye movement data were analyzed offline using a Matlab-based software program . To analyze eye movements, gaze data were recalculated as a visual angle between gaze location and the center of the target area, using the average viewing distance of a child . All parameters were averaged per participant and per distractor modality. Subgroup homogeneity for age was analyzed through a non-parametric Mann–Whitney test and subgroup homogeneity for gender; a diagnosis of ADHD and intake of psychoactive medication during IDistrack administration was analyzed using Chi-squared tests. A non-parametric equivalent to analysis of variance (nparLD ) was usep < 0.001; IQ: W = 916, p = 0.01)Eye tracking data of participants were included for analyses based on data quality and comprehension of instruction. These parameters were quantified as the percentage of total gaze samples collected and the number of spacebar presses. To include reliable gaze responses, a cut-off point for the percentage of gaze samples was set at 50% based on visual inspection. The cut-off point for average number of spacebar presses per presentation sequence was established on 20 presses based on the maximum presence of 16 events per sequence (8 target color changes and 8 distractor events). This means that in case the participant pressed the spacebar after all target events and all distractor events, data are still included for analysis. These criteria resulted in the exclusion of 36 of the total of 177 participants: 16 of the 37 SE children (43%), 18 of the 113 NLD children (16%), and 2 of the 27 TD children (7%). The mean age  and mean IQ  of the excluded participants were significantly lower compared to the participants that were included for further analysis . Chi-squared tests for homogeneity show an unequal distribution of gender over the ADHD subgroups  = 3.99, p = 0.046) and an equal distribution of psychoactive medication  < 0.001, p = 1). Available IQ scores for participants with ADHD  and without an ADHD diagnosis  are similar . See A non-parametric Mann–Whitney test was conducted to check for differences in age between the ADHD and non-ADHD subgroups. No significant difference was found , these subgroups did not differ in age. Chi-squared tests for homogeneity show an equal distribution of gender over the SE, NLD, and TD subgroups  = 0.01, p = 0.995) but no equal distribution of ADHD diagnoses  = 11.93, p = 0.003) and no equal distribution of psychoactive medication intake  = 20.66, p < 0.001). IQ testing of the NLD and SE neurological disorder subgroups revealed a low average IQ for both groups , and no significant difference was found . The TD group is assumed to have an average IQ, as they attended regular schooling and no IQ data were available for this group.A non-parametric Kruskal–Wallis test was conducted to check for differences in age between the SE, NLD, and TD subgroups. Besides the mean age of the NLD participants being significantly higher than the TD participants (H(2) = 6.59, ATS = 5.01, p = 0.025), indicating that children diagnosed with ADHD spent less time looking in the AOI, compared to their non-ADHD peers . Post hoc non-parametric pairwise comparisons show that the Cartoon and the combined Cartoon–Audio modalities correspond to significantly lower scores than all other modalities . No significant interaction effect of ADHD diagnosis by distractor modality was found .A significant main effect of ADHD diagnosis was found , indicating that children with and without ADHD had equal manual press latencies . Post hoc non-parametric comparisons show significantly higher manual press latencies for the Cartoon modality compared to all other modalities without Bonferroni correction . After Bonferroni correction for multiple testing, only the difference with the combined Smiley–Audio modality became non-significant. No significant interaction effect of ADHD diagnosis by distractor modality was found .No significant main effect of ADHD diagnosis on PL was found . Post hoc non-parametric pairwise comparisons show that the TD group spent significantly more time in the AOI compared to the NLD group and the SE group. Furthermore, the NLD group spent significantly more time in the AOI than the SE group . Non-parametric post hoc pairwise comparisons show that, irrespective of subgroup, the participants spent significantly less time looking in the AOI when Cartoon distractors or combined Cartoon–Audio distractors were presented, compared to all other distractor modalities . This indicates that irrespective of participant subgroup, visual distractors with high semantic salience have the strongest distracting effect. The results show no significant interactions of participant subgroup by distractor modality . A significant main effect of subgroup on tAOI was found . Post hoc non-parametric pairwise comparisons show that the TD group had significantly lower manual press latencies compared to the NLD group and the SE group. Furthermore, the NLD group had significantly lower manual press latencies than the SE group . Post hoc non-parametric pairwise comparisons show that manual press latencies for the Cartoon modality were significantly higher than for the other modalities, but after Bonferroni correction, the difference with the combined Smileys–Audio modality became non-significant. The results show no significant interactions of participant subgroup by distractor modality . A significant main effect of subgroup on PL was found (Fn = 88). The results show significant negative Spearman’s correlations between the classification score on the CBCL Attention Problems subscale  and tAOI in the Cartoon modality  and the combined Cartoon–Audio modality . The associations between tAOI of the most effective distractor modalities causing the most task-irrelevant distraction (Cartoons and combined Cartoon–Audio) and a validated behavioral questionnaire assessing parent-reported attention problems (CBCL) were analyzed. Data of the CBCL parent-reported questionnaire were available for participants in the NLD and TD subgroups  caused the most distraction compared to auditory distractors and visual distractors with low semantic load . This is in line with previous attempts with eye-tracking-based distractor paradigms in an adult population ,13 and lBased on the results of our study, we conclude that eye tracking during a task-irrelevant distractor paradigm is a feasible, efficient, and valid method for the measurement of distractibility in children. Evidence of elevated levels of distractibility in children with attention deficit disorders or neurological disorders is provided. These findings contribute to the notion of an attention-distractibility trait that is clinically relevant in the assessment of cognitive attention problems in children, and that assessment of distractibility should be taken into account in neuropsychological evaluations of children and adolescent with neurological disorders. The IDistrack paradigm has been shown in the current study to be a suitable and valid paradigm for clinical assessment of distractibility. Eye distraction data may enhance the diagnostic precision of a neuropsychological assessment for the assessment of ADHD in children and adolescents. Further research is needed.The current study may have several shortcomings. First, the IDistrack paradigm lacks an initial set of trials without the presence of distractors that serves as a baseline measurement for manual press latency. Comparing manual press latencies during IDistrack with this baseline would enhance the validity by eliminating confounding factors, such as cognitive processing speed. Second, because of the selection of patients with epilepsy, a considerable proportion (29%) of the SE group used anti-epileptic drugs (AEDs) during the administration of the IDistrack task. Cognitive side-effects of the AEDs could have been a confounding factor by causing high press latencies in this group . MoreoveFurther research is needed on the clinical utility of this procedure. In order to obtain normative scores for the purpose of discriminating between normal and disturbed distractibility levels, data on a larger group of children need to be collected and the effects of age on distractibility need to be investigated . FurtherTo the best of our knowledge, the current study is the first to use eye tracking data in the formal assessment of distractibility in children with ADHD and children with neurological disorders. Eye-tracking technology facilitates accurate and valid assessment of distractibility as a specific attentional process in children. A proof of concept for this eye tracking paradigm has been provided in a clinical population. Data are promising regarding the validity and feasibility of this eye tracking paradigm in clinical practice and merit further research. As the paradigm requires minimal motor function, minimal verbal instruction, and minimal time for the task to be performed, it is a promising instrument to be used in a heterogeneous group of children with and without neurological disorders.


The aim of this study is therefore twofold, first to accurately examine theADHD-specific attitudes of New South Wales Government school in-serviceteachers using the Scale for ADHD-Specific Attitudes (Authors 2016), andsecond, to determine if any of their socio-demographic features couldpredict their attitudesExploratory factor analysis found a 5-factor structure, and multipleregression analysis was performed to establish the existence of groups ofvariables with respect to teacher attitudes towards ADHD-type behaviours andany demographic predictors of teacher attitudes.The final regression model found significant predictors of each factor withR2 values ranging from .007 to .147.This study illustrated that teachers had generally positive attitudes towardsstudents who display ADHD-type behaviours, however, they found theexternalised behaviours of ADHD irritating in the classroom and foundteaching students with ADHD-type behaviours difficult, and teachers wantmore information about ADHD and how to manage it in the classroom. Globally, approximately 7.2% of school-aged children  arediagResearchers have investigated teacher ADHD-specific attitudes for nearly 30 years. Ofthe existing studies many purport to explore attitudes, yet simply examine teacherknowledge e.g., , 1999,iFurther to these studies, various researchers have used traditional models ofattitude including the Theory of Planned Behavior (TPB) , 2001 tofeelings about teaching students whoexhibit ADHD-type behaviors, (b) knowledge and trainingregarding ADHD, (c) desire for better training regardingADHD, and (d) beliefs about ADHD and its associatedbehaviors. The study by Mulholland et al. is limited due to the smallsample size (111 participants) and therefore its findings were unable to begeneralized to a broader community. However, the instrument was improved upon byWhile many studies either purport to examine the ADHD-specific attitudes of teachers,or use traditional models of attitude to do so, there are studies that haveinvestigated a more multi-faceted view of attitude with respect to ADHD. This improved research instrument has been used in subsequent studies. Similarly, Feelings About Teaching Students Who Exhibit ADHD-TypeBehaviors, which included items indicating negative feelings towardstudents with ADHD . This suggestedthat as teacher’s experience increased, they were more likely to agree with itemsabout this factor, a result that was substantiated by While there has been an increase in literature investigating teacher attitudes towardADHD recently, few investigate the influence of socio-demographics on theADHD-specific attitudes of participants. Of the studies that investigatedsocio-demographic data as predictors of ADHD-specific attitudes, most examined thedifference between pre-service and in-service teachers e.g.,  and founOnly a handful of studies investigated the influence of other socio-demographicfeatures on ADHD-specific attitudes. Results suggested that teaching students withADHD diagnoses increased positive attitudes toward them , asdid A thorough review of the literature revealed limited studies that accurately assessedteacher ADHD-specific attitudes and fewer still which examined the socio-demographicpredictors of these attitudes. The present study examined the attitudes held by NSWgovernment school teachers with respect to ADHD, students who exhibit ADHD-typebehaviors and the teaching thereof, and socio-demographic features that couldpredict these attitudes.As mentioned above, theoretical models of attitudes that have been developed inpsychology in general, describe the well-established link between attitude andbehavior, that attitude informs intention and behavior , 2001. AThe objective of this paper was twofold. The first goal of this paper was toaccurately assess the ADHD-specific attitudes held by NSW Government School in-service teachers using the Scale of ADHD-SpecificAttitudes . While tGiven the strong link between attitudes, behavioral intention, and behavior and thelimitations in many of the previous studies, there is a strong need for a largerscale investigation into ADHD-specific attitudes held by NSW Government schoolin-service teachers.The second goal of this paper was to determine if any of the participants’socio-demographic data could be used to predict their ADHD-specific attitudes, asthere is limited literature that does this, and studies which do, generally comparethe ADHD-specific attitudes of pre-service and in-service teachers. This study wassomewhat unique in its approach, as it investigated the predictive power of varioussocio-demographic aspects of the participants on their ADHD-specific attitudes. Witha greater understanding of teacher ADHD-specific attitudes, policy makers and schoolleadership may further target professional development to improve teacher attitudes,and thus have a positive impact on teacher behavioral intention and teacher behaviorwith respect to students who display ADHD-type behaviors. The research questions thepresent study aimed to answer were:What are the attitudes of NSW Government school in-service teachers towardADHD, the students who exhibit ADHD-type behaviors, and the teachingthereof?Are there any socio-demographic predictors of teachers’ ADHD-specificattitudes?Ethical approval for this study was obtained from the authors’ affiliatedinstitution and the NSW Department of Education. In addition to ethicalapproval, prospective participants were provided with a participant informationform consistent with the National Statement on Ethical Conduct in ResearchGuidelines, Section 2.2.5 .N = 596). To recruit participants, principals fromeach of the 2,245 government schools in NSW were sent a recruitment emailexplaining the study and asking for the school’s participation. One hundredfifty-four (154) principals agreed to have their school involved in the study.Subsequently, they were sent a second email containing information forparticipants, and a link to the online survey, or information regarding the hardcopies of the survey. The survey was distributed to staff by their principal.The number of NSW government school teachers who received the request toparticipate in the study totaled 1,800. Teachers completed the surveyvoluntarily. The sample of teachers were recruited from Greater Sydney Region,including metropolitan Sydney (50.67%), regional cities (20.64%), and ruralareas (24.83%). They were teachers in primary schools (48.15%), high schools(30.70%), and a variety of other educational settings (21.15%). There were morefemale teachers (n = 457) than male teachers(n = 132). The average age of the sample was 44 years old.The average number of years in teaching was 17. Nearly all teachers in thesample  reported having taught a student with ADHDbehaviors. Most of them  also reported that those studentshad been diagnosed with ADHD. Further, the majority of the teachers in thesample  reported that they were currently teaching studentswith ADHD-type behaviors. Finally, the participants reported that the averagenumber of students who exhibited ADHD-type behaviors in their classroom was4.67. The sample of this study was comprised of teachers from government schools in NewSouth Wales (The ADHD-Specific Knowledge and Attitudes of Teachers questionnaire (ASKAT) was usedSection C contained the items of the Scale for ADHD-Specific Attitudes (SASA),consisting of 30 questions related to teacher attitudes toward (a) ADHD itself,(b) students who display ADHD-type behaviors, and (c) their views on theteaching of these students. The response category was a 6-point Likert-scale.The ASKAT has been shown to be valid, reliable, and generalizable  . MulhollDescriptive statistics such as frequency analysis (FA) and means analysis werecarried out on the item responses to the SASA to examine the respondents’agreement/disagreement on their ADHD-specific attitudes. Then, exploratory factoranalysis (EFA) was performed to extract factors of teacher attitudes toward ADHD andto examine the underlying dimensionality of the items by grouping them intomeaningful subsets of items.Finally, multiple regression analysis was performed to identify teachers’socio-demographic characteristics that predict their ADHD-specific attitudes. Theindependent variables were entered into the regression models in the data formatfound in Data from the SASA was analyzed to examine the attitudes NSW teachers held towardADHD itself and students who exhibit ADHD-type behavior see . More thAlthough teachers generally have favorable attitudes toward the students whoexhibit ADHD-type behaviors, they generally have negative attitudes towardADHD-type behaviors themselves. The majority of teachers (70.88%) agreed atleast to some degree that they find “behaviors associated with ADHD irritatingin the classroom,” and just over two-thirds (67.30%) of the respondents agreedto some degree that these students cause them to “experience stress.” Anoverwhelming majority  of teachers felt that they would “like to be moreeffective when teaching students who exhibit ADHD-type behaviors,” while only44.80% of teachers agreed at least to some degree that they “had receivedadequate professional development about managing ADHD-type behaviors.”Negative consequences of ADHD-type behaviors), 2.330, 1.911 (Feelingof knowledgeability), 1.586 (Negative beliefs aboutADHD), 1.105 (Positive consequences of ADHD-typebehaviors). These five factors accounted collectively for 65.03% ofthe total variance of the item responses, above the 60% threshold noted by p < .001) and Kaiser-Meyer-Olkin’s (KMO) measure ofsampling adequacy (0.832) indicated that factor analysis was appropriate. Thefactor loadings are for most part greater than 0.50 with only one exception of0.355. According to EFA was conducted on the item responses of the Scale for ADHD-Specific Attitudes. A five-factor structure was identified with the eigenvalues of5.425  values, ranging from 0.95 toabout 1.0, showed no multicollinearity across the independent variables. A finalset of regression models, which contain statistically significant predictorsonly, are presented in negative consequences of ADHD-typebehaviors (R2 = .045). As can beseen, the older respondents  were predicted to have stronger views on negativeconsequences of ADHD-type behaviors (while controlling for theother variable in the model). The respondents who had taught a student withan ADHD diagnosis were less likely to endorse negative consequences of ADHD-typebehaviors (while controlling for the other variable in themodel).The final regression model indicated that age and student diagnostic statuswere significant predictors of teachers’ responses to the items that formedthe factor labeled as desire for professionallearning was not explained by our chosen independent variables(R2 = .007).The regression model for the second factor, feeling knowledgeable about ADHD(R2 = .147). The participants’feeling knowledgeable about ADHD were predicted to bestronger if they had a higher score on the knowledge test and if theyhad taught a student with an ADHD diagnosis .The regression model illustrated that both participants’ knowledge about ADHDscore and whether they had taught a student with an ADHD diagnosis weresignificant predictors of their responses to the items which formed thefactor, negative beliefs about ADHD, theregression model (R2 = .067) predicted that theparticipants’ knowledge on ADHD  and the current number of students taughtwho exhibit ADHD-type behaviors  were found to be significant predictors. Theparticipants whose scores were higher on the knowledge test were less likelyto hold negative beliefs about ADHD. Interestingly, theparticipants who had a greater number of students with ADHD behaviors weremore likely to hold negative beliefs about ADHD.Concerning the factor, positive consequences ofADHD-type behaviors (R2 = .101)showed that the age of participants , whether or not the participants were specialeducation/learning and support teachers , whether or not they had a higher degree and theirADHD-specific knowledge score  were significant predictors.The regression model on the factor, The Scale of ADHD-Specific Attitudes (SASA) is aimed at determining the attitudesof school teachers toward ADHD, students who display ADHD-type behaviors, andthe teaching thereof. The present study had a unique perspective wheninvestigating teacher ADHD-specific attitudes, as the research instrument wascomprised of a sufficiently large number of items to adequately assessADHD-specific attitudes, did not use items that were factual questions, and notonly investigated teacher attitudes toward the teaching of student with ADHD,but also investigated a broader view of teacher ADHD-specific attitudes.In New South Wales, the education system is governed by the overarching AliceSprings (Mparntwe) Education Declaration, which ensures all Australiangovernments are committed to “promoting excellence and equity in Australianeducation” , thus stAs the current study presented a somewhat unique view of teacher ADHD-specificattitudes , it was difficult to draw many meaningfulcomparisons between this work and the existing literature. A variety of previousstudies focused on specific facets of ADHD-specific attitudes, which provided abasis for some comparative discussion. The current study found that more thantwo-thirds of teachers agreed to varying degrees that students who displayADHD-type behaviors caused them to experience stress. This supported research bySeveral studies have investigated teacher ADHD-specific attitudes using atraditional theoretical framework of attitude. These studies designed theirresearch instruments to investigate teacher attitudes toward teaching studentswith ADHD and offer insight into a narrow view of attitudes. Although thecurrent study was designed to have a scope beyond this view, these studies areuseful in the broader discussion of ADHD-specific attitudes held by educationprofessionals. In addition to determining the ADHD-specific attitudes held by NSW Governmentschool teachers, the present study also endeavored to investigate the influence,if any, of the socio-demographic features of teachers on their level ofADHD-specific attitudes, and if these features had any predictive value. Thisapproach of investigating teacher ADHD-specific attitudes is somewhat novel.The previous research that investigated demographic features of teachers aspredictors of their ADHD-specific attitudes, predominantly used eithercorrelation or means testing as the only analytical technique to determine thepredictive value of the socio-demographic data. None of these studies found anysocio-demographic predictors of attitude.negativeconsequences of ADHD-type behaviors, desire for professional learning,feeling of knowledgeability, negative beliefs about ADHD, andpositive consequences of ADHD-type behaviors. It wasdifficult to make significant comparisons between the current research andprevious research in this area, as much of the previous research created globalattitude scores, had different items to determine teacher ADHD-specificattitudes, or grouped the items in different themes. The factor structure thatemerged through EFA was similar to what was expected. It was expected that asixth factor, positive beliefs about ADHD, would also beextracted, which would include items such as “Students who exhibit behaviorsassociated with ADHD perform well in some subjects and not others.” However,some of the items expected to form this factor were omitted from the factorstructure completely or formed part of another factor positiveconsequences of ADHD-type behaviors. A variety of socio-demographicdata was significantly correlated with each factor, and the type of school(school for specific purposes or other school type) in which the participantsworked was significantly correlated with all five factors.To investigate predictors of ADHD-specific attitudes, highly correlated items inthe SASA were grouped together into factors (themes) using exploratory factoranalysis (EFA). A variety of different analytical techniques were then employedto determine if the socio-demographic data had a significant influence on how aparticipant responded to items in the factors. EFA found, through the extractionof factors, the underlying themes from the SASA were positive consequences of ADHD-type behaviors,suggesting that as teachers gain more experience they are less likely to agreewith statements relating to this factor (or theme). Interestingly, olderteachers are more likely to agree with negative consequences ofADHD-type behaviors and disagree with positive consequenceof ADHD-type behaviors. The researchers posited that this could bedue to the notion that as a teacher gets older, their tolerance for behavioroutside the norm is reduced, although the literature suggests that thecorrelation between depersonalization and misbehavior is lower for olderteachers  and schools forspecific purposes  have an ADHD diagnosis.There was a significant difference between the attitudes of special educators(those who work in support classes or SSPs) and learning support teachers; and teachers of othersubjects for four of the five factors. Overall, special educator/learningsupport teachers are more favorable toward and feel more knowledgeable aboutADHD than teachers of other subject areas. Teachers who had taught students with ADHD-type behaviors felt less knowledgeableabout ADHD and the effective management of ADHD-type behaviors than those whohad not. This may indicate that, by teaching a student with ADHD-type behavior,teachers notice gaps in their knowledge when their knowledge of behaviormanagement and ADHD is tested. The present research also found that teachers whohad taught a student with an ADHD diagnosis were less likely to agree withstatements about negative consequences of ADHD than those participants who hadtaught students who displayed ADHD-type behaviors yet did not have a diagnosis.This contradicts previous research  that exafeeling of knowledgeability andpositive consequences of ADHD-type behaviors andsignificantly negatively correlated with negative beliefs aboutADHD. This suggests that the more knowledge a participant had, themore likely they were to feel knowledgeable, to agree with positive statementsabout the consequences of ADHD-type behaviors, and to disagree with negativebeliefs about ADHD.In addition to investigating the influence of the socio-demographic data onADHD-specific attitudes, this study also examined the influence of participantADHD-specific knowledge on their attitudes. Previous research  found thUnderstanding Attention Deficit/HyperactivityDisorder aimed at increasing teacher ADHD-specific knowledge andstrategies to support students who display ADHD-type behaviors. However, thiscourse has only a small number of trainers across the state and a maximum cohortsize of 12 people  of ADHD-specific attitudes among allthe study participants. This suggests that there are a variety of other factorsthat have an impact on teacher ADHD-specific attitudes outside the scope of thisthesis. These factors could include personal experience of people with ADHD,ADHD-specific personal and professional learning, class size, and participantpersonality.negative consequences of ADHD-type behaviors, desirefor professional learning, feeling of knowledgeability, negative beliefs aboutADHD, positive consequences of ADHD-type behaviors. Finally, themultiple regression analyses showed that the socio-demographic data provided by theparticipants (including ADHD-specific knowledge level) are not good predictors ofteacher ADHD-specific attitudes, suggesting that further professional learning isneeded in the area of ADHD across the teaching profession.This study illustrated that teachers had generally positive attitudes toward studentswho display ADHD-type behaviors, however, they found the externalized behaviors ofADHD irritating in the classroom, and found teaching students with ADHD-typebehaviors difficult, as they often lack the knowledge about classroom strategies tosupport them. Further, it was shown that teachers overwhelmingly want moreinformation about ADHD and how to manage ADHD-type behaviors in the classroom,pointing to a need for the development of professional learning modules and moresupport from the Department of Education for teachers in the area of ADHD. Thispaper provided evidence to suggest that the Theory of Planned Behavior (TPB) doesnot provide a strong basis for a comprehensive and in-depth analysis of attitudestoward disability due to the multi-faceted nature of attitude itself. As such, aresearch instrument based on a new approach to a theoretical framework of attitudewas used. The exploratory factor analysis of teachers’ attitudes toward ADHD,students who exhibit ADHD-type behaviors and the teaching thereof, revealed afive-factor solution: There are several limitations to this study that could have an impact on furtherresearch in this area. One methodological limitation of this study is that teachers’participation was voluntary. As teachers self-selected to participate in this study,there may have been some inherent differences between the ADHD-specific knowledgeand attitudes of those who chose to participate and those who did not.A second methodological limitation of this study is the scope of demographicpredictors surveyed. The scope of the socio-demographic data was limited to ensurethat the research instrument was not prohibitively time consuming and thus maximizedparticipation and completion rates. The final analysis showed that, although some ofthe socio-demographic data collected were significant predictors of teacherADHD-specific attitudes, they accounted for very little of the variance inADHD-specific knowledge and attitudes. This indicated that other variables may beassociated with teacher ADHD-specific knowledge and attitudes. The authorshypothesize that variables such as personal family experience with ADHD, severity ofstudent ADHD-type behavior, country of initial teacher education, and teacherpersonality and temperament could have a statistically significant impact onknowledge and attitudes of ADHD, thus further research in this area is needed.The final methodological limitation of this study was the potential forexperiment-wise errors to occur, given the number of analytical techniques appliedto the data. However, in the current dataset, there were only a fewsocio-demographic variables that were significant at the conventional alpha level.Thus, committing Type I errors was not particularly concerning, as most statisticaltesting using the conventional alpha level, yielded non-significant results andtherefore, statistical adjustments of significance levels would not lead todifferent results and would lead to Type II errors.A variety of legislation and NSW Department of Education policies outline that everystudent deserves a meaningful and appropriate education. It is widely known thatknowledge and attitudes of teachers directly impact their behavior in the classroom, therefoThe present research focused on teachers from NSW government schools. Furtherresearch into teacher ADHD-specific attitudes could include both Catholic andIndependent schools and/or could include research of teachers from countries otherthan Australia to determine if ethnicity and/or school educational ethos is asignificant predictive factor. The current study found only weak to moderatecorrelations between the various teacher demographics and ADHD-specific attitudes,and the regression models accounted for a small percent of the variance. As such,further research should include independent variables such as time constraints,class size, available resources, severity of student behavior, teachers’ familialexperience of children with ADHD, and the extent to which teacher have engaged inADHD-specific professional learning.In addition to investigating additional demographic characteristics, further workcould include the examination of student and parent perceptions of their teacher’sADHD-specific knowledge and attitudes. As literature suggests knowledge andattitudes have a direct impact on teacher behavior in the classroom , thisco


Blumeria graminis. While PM is one of the most important wheat leaf diseases globally, rye is highly tolerant to PM. It has been reported that in barley infected with PM, polyamine oxidase (PAO) activity related to the production of hydrogen peroxide (H2O2) has increased, which may promote defense against biotrophic or hemibiotrophic pathogens. The current study aimed to assess the relationship between the segregation of the polymorphic marker for rye PAO (ScPAO) and the level of PM infection in plants. The genetic mapping in two interline populations shows that ScPAO is located on chromosome 7R. Further analysis comparing ScPAO location to mapped wheat (Triticum aestivum L.) PAO duplicates suggests the ScPAO homology with TaPAO6 or TaPAO7. A possible association of ScPAO from 7R with PM resistance is demonstrated in the recombinant inbred lines (RIL)-L population phenotyped for PM infection. Finally, three novel QTLs for PM resistance on the 7R chromosome of rye are detected.Powdery mildew (PM), a common cereal disease in cultivated areas, including Europe and other temperate regions, is caused by the fungus The online version contains supplementary material available at 10.1007/s13353-022-00723-x. Secale cereale L.) is a cultivated plant of great agronomic importance. Along with wheat, barley, and oats, rye is one of the main crops grown in Poland and other European countries with a temperate climate, although to a lesser extent, rye is also grown in Canada, the northern USA, Japan, Australia and the Republic of South Africa. From the economic point of view, the most important features of rye are good tolerance to low temperatures and other stresses, low soil requirements, and thus also low requirements for the use of fertilizers and pesticides. The size of the rye cultivation area in the world results from its versatile use in baking, fodder, brewing, and distilling industries. In 2020, the area of rye cultivation in Europe accounted for 81% of the total rye cultivated area , while the rye cultivation area in Poland accounted for 23% (8.4 × 105 ha) of the European crops. Rye production in 2020 was correlated with the cultivated area, so European production accounted for 86% of world production, 1.2 × 1010 and 1.5 × 1010 kg, respectively, while Polish production accounted for 22% (2.9 × 109 kg) of the European production (www.fao.org/faostat).Rye (Triticum aestivum L.), indicated by the partial homology of the chromosomes of both rye and wheat , with seven chromosomes designated as 1R–7R, closely related to wheat   was used to search for rye PAO genes. Primers were designed using Primer3 (https://www.ncbi.nlm.nih.gov/tools/primer-blast/).Transcriptomic data  of various origins were used for detecting the polymorphic markers. In addition, two mapping populations of recombinant inbred lines (RIL), RIL-K and RIL-L , were used for ScPAO mapping was performed using the dense genetic maps constructed with DArT (diversity array technology) markers . MapChart 2.32 software was used to draw the genetic maps.The phenotypic analysis of PM infection was performed over two different years , in two replicates each year, using the RIL-L population. Each genotype was represented by 3–5 biological replication grown in an experimental field (in 80 cm long rows separated by 17 cm) and greenhouse (in pots filled with the soil mass of 3.8 kg) of the ZUT. Phenotyping was performed four times; the symbols PM05a, PM05b, PM06a, and PM06b represent repetitions of experiments . The experiment was conducted without artificial inoculation and without fungicide spraying. Infection was assessed using a 9-point scale, where 1 refers to the most severe infection and 9 to no signs of infection.t-test and non-parametric U Mann–Whitney test) were performed using STATISTICA v13.0 (www.statsoft.com).Statistical tests for significance of differences  encoding putative PAOs were identified. These enzymes exhibit different subcellular localization, substrate specificity, and functional diversity  transcripts. ScPAO1 (1848 nt transcript) was selected for further study as the only one identified in two of four NILs . Gene ontology (GO) analysis indicated Arabidopsis AtPAO1, while NCBI BLAST analysis identified TaPAO6, TaPAO1, and TaPAO7 of wheat as the most similar sequences to this transcript . Since the identity of ScPAO could not be established, the gene has not been assigned a number in the next part of the study.The idea behind the current study is to locate the PAO gene on rye’s genetic map and evaluate its relationship with PM. The ScPAO fragment (approx. 170nt) was longer than that predicted from the transcript sequence (97nt), suggesting the presence of an intron sequence. This polymorphic marker was amplified in three of 12 inbred lines. The amplicon presence in lines 541 and RXL10, allowed for linkage analysis in two immortal populations (RIL-K and RIL-L). In both cases, ScPAO was assigned to 7R  was selected to show interline polymorphism. The length of the amplified  approx. 70nt was ScPAO marker sequences) are reported in supplementary material (SMTab.1). The use of only physically verified markers resulted in an approximately consensus marker order on the genetic and physical maps of 7R with minor rearrangements , the other with the “b” allele—from parental line RXL10 (with amplicon). Comparison of the PM infections level in these two groups of plants, using both the t-test and the U Mann–Whitney test, showed a statistically significant difference for PM06b (P = 0.04); however, the trend was the same for all 4 replicates , 126.4  and 172.9 cM . ScPAO locus was not within any of the QTL intervals but was close to that with a peak at 126.4 cM . The possible association of ScPAO with the response to PM confirms the obtained results with barley , and the trait segregation in RIL-L ranged from 1 to 9 points, suggesting the transgression. Therefore, plants were conventionally divided into two groups in terms of polymorphism of PCR markers for the Pm resistance genes located on 1RS, 2RL, 3RS, 4R, 5RL, and 6RL were detected for rye . Until the recent detection of the PmNOS1 PM resistance locus on the distal arm of chromosome 7RL . The analysis of the chromosomal location of the wheat TaPAOs Supplementary file2 (XLSX 136 KB)Below is the link to the electronic supplementary material.


The scientific literature highlights the risk of the appearance of internalizing and externalizing symptoms, together with difficulties in the academic area, linked to diagnosis of Attention Deficit Hyperactivity Disorder (ADHD). This is normally assessed by teachers and primary caregivers, disregarding the self-perception of the adolescents themselves, which limits detection of this disorder at an evolutionary stage. Our aim was to analyze the psychometric properties of a self-report for ADHD in adolescence and its relationship with psychopathology and academic performance. This study assessed an incidental sample of 267 students from secondary schools in the Region of Murcia, Spain, using the EDAH questionnaire adapted for self-report, in order to analyze its psychometric properties in assessing ADHD. The Youth Self-Report (YSR) and the Brief Self-Control Scale (BSCS) were also used to determine their association with psychopathological, self-control and academic performance variables. An ADHD prevalence of between 3.7 and 13.1% was observed depending on the established cut-off point. The adapted EDAH showed adequate reliability indices  and explained a high variance percentage (50.655%). Adolescents with anxiety/depression difficulties, dissocial behavior, aggressiveness, and poor performance in mathematics showed a higher amount of ADHD symptoms. Moreover, self-control, dissocial behavior, age, and performance in Social Sciences acted as predictors of the disorder. The good psychometric properties of this questionnaire and its adequate correspondence with other variables of interest suggest it is an appropriate self-report instrument to assess ADHD in adolescence. Several studies show prevalence’s of Attention Deficit Hyperactivity Disorder (ADHD) ranges between 8.8 and 10–12% in the general population of adolescents aged between 11 and 19 years old , higher OR) = 2.39] and a negative parental relationships (OR = 16.43) appear as possible risk factors for onset of ADHD, as well as a personal history of psychopathological problems (OR = 12.16) and exposure to abuse (OR = 3.16). OR = 2.21), change of school (OR = 1.78), and expulsion rate (OR = 6.98). OR = 0.87 in the inattentive subtype; OR = 0.68 hyperactive subtype) and poor school performance . In this study, ADHD was also significantly linked to greater externalizing problems and lower family adjustment. Research by As regards ADHD diagnosis, For ADHD assessment and diagnosis, various scales have been developed to detect symptoms and/or inattentive behaviors and hyperactivity/impulsivity, as well as structured interviews based on DSM diagnostic criteria. This detection is normally by observers close to the children and adolescents, mainly teachers and parents or principal caregivers, as these best understand the minors habitual behavior pattern . Data prWith this scenario, it seems reasonable to consider the number and nature of informants who can participate in the ADHD diagnostic process, valuing the inclusion of minors’ self-perception as an element which can broaden professional’s vision during assessment. ”Scale for assessment of attention deficit hyperactivity disorder, EDAH”  was selected between the 1st and 4th ESO Compulsory Secondary/High School Education courses. Ages ranged between 12 and 18 years due to the presence of repeating students. The mean (M) age of the sample was 14.18 years, with a standard deviation (SD) of 1.497. Distribution by sex and by course of the sample is presented . The original EDAH  by The University of Murcia approved this study. In addition, permission from the school headteachers and written informed consent from the parents of the children was required.After requesting permission from school headteachers, informed consents were provided to the parents of the minors.Participants who had received provided signed consent from parents or legal guardians of the child took part in research within 15 days. The groups were given questionnaires in the presence of the researcher. No semantic clarification was provided on items.Students provided all data voluntarily; confidentiality and anonymity were guaranteed by assigning a code to each participant. The time invested per class in application of questionnaires was around 30°min.alpha and McDonald’s omega coefficient.Exploratory factorial analysis of the adapted EDAH questionnaire was carried out using the principal component extraction method with varimax rotation, as it offered higher communalities and more satisfactory factor loadings. Two factors were extracted. Choice of number of factors was based on three criteria: (1) Analysis of sedimentation graph; (2) The first two factors explained over half of total variance and were the only ones which obtained eigenvalues greater than 1; (3) This decision was based on previous theoretical research . The corDescriptive statistics of new factors and normality of distribution of scale scores were analyzed. Differences in scores of scales according to gender and course were analyzed.Percentiles, median and interquartile range were calculated by courses and for the total sample. Cut-off points were calculated, with the 90th percentile as an indicator of moderate risk of ADHD and the 95th percentile as high risk, as shown in the EDAH questionnaire manual (17). Prevalences were calculated based on these cut-off points.As a measure of external validity, correlations between the new adapted EDAH scales and the empirical and DSM-oriented scales of the YSR questionnaire were analyzed together with the correlation between this questionnaire and the self-control one.A multiple linear regression model was conducted to determine the possible effect of the YSR psychopathological variables , academic performance, and self-control on the total ADHD symptom score.A binary logistic regression model was finally calculated to analyze which psychopathological, self-control, and school performance variables are associated as either a risk or protective factor with ADHD symptoms measured with the adapted EDAH questionnaire.All analyzes were performed using the IBM SPSS V25 for Windows program.X2 = 777.273; gl = 45; p < 0.001). The adequacy of the sample was also analyzed and a high KMO index was observed (KMO = 0.829). The two factors, with eigenvalues greater than 1, explained 50.655% of total variance. Inclusion criteria for an item in each factor were that its factorial load was above 30 . The second factor explained 24.269% of variance. Regarding content, this factor analyzes attention deficit problems and comprised items 7, 6, 4, 2, and 3, with adequate reliability . Total reliability of the questionnaire was high .Z = 0.158; gl = 267; p < 0.001), hyperactivity-impulsivity  and total scale  did not follow normal distribution, therefore the non-parametric Kruskal-Wallis test was used in order to analyze differences regarding gender and academic course of these scales  were calculated with the Brief Self-Control questionnaire and the empirical Achenbach and DSM-oriented scales of the YSR questionnaire. Among the adapted EDAH scales, high correlations were seen with the total scale (ρ = 0.894 for Hyperactivity-Impulsivity and ρ = 0.847 for Attention Deficit) and moderate ones between the Hyperactivity-Impulsivity scale and Attention Deficit (ρ = 0.535). Significant correlations were observed in all questionnaires, ranging from ρ = 0.162 minimum to ρ = 0.732 maximum. Scales which obtained best correlations were the Total EDAH Scale , Hyperactivity-Impulsivity  and Attention Deficit  .A multiple linear regression model was calculated to determine the possible effect of the psychopathological variables of the empirical YSR scales, school performance, age, and self-control on students’ total ADHD scores. Since the full-scale variable of the adapted EDAH was not normally distributed which is a requirement to perform a linear regression model, scores were standardized to perform said model. Variables which were significant predictors of ADHD were self-control, antisocial behavior, age, school performance in Social Sciences and History, and anxiety/depression .OR) = 0.834; and OR = 0.863 for the Attention Deficit scale) that it eliminated the rest of the variables of the model , dissocial behavior (B = 0.047), age (B = 0.108), academic performance in Social Sciences (B = −0.255), and anxiety/depression symptoms (B = 0.023), are significant predictors of ADHD symptoms. Furthermore, anxiety/depression problems , presenting dissocial behavior , aggressive behavior , inadequate performance in mathematics , not showing symptoms of withdrawal/depression (OR = 0.784), and not manifesting somatic complaints (OR = 0.778) are risk factors linked with a greater number of ADHD symptoms. In addition, manifesting thought problems (OR = 1.157) and aggressive behaviors (OR = 1.138) are risk factors associated with a greater number of Hyperactivity-Impulsivity symptoms. Moreover, symptoms of anxiety/depression (OR = 1.125), dissocial behavior (OR = 1.256) and inadequate performance in subjects related to Social Sciences (OR = 6.988), are more probability with a greater number of attention deficit symptoms. These results coincide with those from other research, that poor academic performance, psychopathological problems, somatizations, sleep disorders, and behaviors related to poor self-control, such as internet abuse, video games or alcohol (It is observed that self-control ( alcohol , are facThese data expand extensive research related to ADHD and provide psychometric validation of a questionnaire administered in self-report format, and how this relates to variables of academic performance, self-control and externalizing, and internalizing problems. This questionnaire can be applied to minors at the secondary educational stage, one in which these questionnaires are quite scarce , thus prThis study contains some limitations, particularly in incidental sampling, which focused on only two secondary schools in San Javier, which may limit replicability and generalization of research results. A further limitation is that there are no data from informants other than the minors themselves, such as from teachers or parents, to assess agreement between these three types of informants.In future research, it would be convenient to assess how this questionnaire relates to other variables of interest, such as its relationship with interaction with parents and relatives of minors, since other research shows significant results in this area . It is aIn conclusion, adequate psychometric reliability data, high percentage of variance explained by questionnaire factors, and its relationship and consistency with data found by other researchers all suggest that application of this questionnaire, following this distribution of items and cut-off points, is a reliable and valid measure to evaluate symptoms of total ADHD, Hyperactivity-Impulsivity, and Attention Deficit in minors enrolled in the Compulsory Secondary Education stage.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.The studies involving human participants were reviewed and approved by University of Murcia. Written informed consent to participate in this study was provided by the participants or their legal guardian/next of kin.PS-G, JV-E, SC, and CL-S have contributed to the conceptualization, formulation and evolution of the research goals and objectives and to the administration, and coordination of the research activity. PS-G, VF, and MA have contributed to the curation and formal analysis of the research data. PS-G, JV-E, and SC contributed to the collection of the research data. SC, MC, and AM were responsible for the provision of research resources and methodology development. JV-E, SC, and CL-S were responsible for writing the initial draft of the manuscript. All authors have contributed substantially to the development, drafting, and final approval of the version to be published.