Pharmacoepigenetic studies are important to understand the mechanisms through which medications influence the developing fetus. For instance, we and others have reported associations between prenatal paracetamol exposure and offspring DNA methylation (DNAm). Additionally, folic acid (FA) intake during pregnancy has been associated with DNAm in genes linked to developmental abnormalities. In this study, we aimed to: (i) expand on our previous findings showing differential DNAm associated with long-term prenatal paracetamol exposure in offspring with attention-deficit/hyperactivity disorder (ADHD), and (ii) examine if there is an interaction effect of FA and paracetamol on DNAm in children with ADHD. We used data from the Norwegian Mother, Father and Child Cohort Study (MoBa) and the Medical Birth Registry of Norway (MBRN). We did not identify any impact of paracetamol or any interaction effect of paracetamol and FA on cord blood DNAm in children with ADHD. Our results contribute to the growing literature on prenatal pharmacoepigenetics, but should be replicated in other cohorts. Replication of pharmacoepigenetic studies is essential to ensure robust findings and to increase the clinical relevance of such studies. There is an increasing interest in understanding how maternal medication use during pregnancy may affect epigenetic patterns and impact fetal development . EpigeneEpidemiological studies have suggested adverse neurodevelopmental outcomes of long-term paracetamol use during pregnancy, including increased risks of attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) . In contBased on these pharmacoepidemiological and -epigenetic findings, we postulated that DNAm could be a plausible biological mechanism of action for the paracetamol-ADHD associations . Therefon = 114,500 children, n = 95,200 mothers and n = 75,200 fathers), including births in Norway between 1998 and 2008  . MoBa isand 2008 . In 40.6and 2008 . This stn = 61), (ii) children with ADHD and unexposed to paracetamol , and (iii) children without ADHD and unexposed to paracetamol . We did not include a paracetamol-control group , as in our prior study we did not identify any significant differences in DNAm between this group and the exposed group , Q3  and Q4 , the Medical Birth Registry of Norway (MBRN) and the Norwegian Patient Registry (NPR). MBRN is a national health registry containing information about all births in Norway and NPR contains diagnoses asserted by specialists in governmental hospitals and outpatient clinics. MoBa was linked to NPR and MBRN using the personal 11-digit identification number unique to every permanent resident of Norway. We included 261 pregnancies from MoBa, divided into three groups: (i) children with ADHD prenatally exposed to paracetamol ≥20 days . The DNAm data was quality controlled using the quality control module implemented in RnBeads (v. 2.8.1) . Low-quality probes either exhibited a detection p-value > 10−6 or a bead count <3. We performed background correction with the ENmix exponential-truncated-normal out-of-band (oob) method , cross-reactive probes  . The final data set included 795,515 probes and 261 samples.DNAm was assessed using the Infinium HumanMethylation EPIC BeadChip (Illumina). Samples were randomly allocated to sample plates and beadchips, and processed as previously described . All ana. 2.8.1) . First, ) method , dye bia) method  and prob) method . We then 14,921)  and probβ values  for visualizations and M values for statistical tests   . We perf] <0.05) . Further] <0.05) .exposed group, consisting of children with ADHD prenatally exposed to paracetamol ≥20 days (n = 61), and two control groups, the ADHD-control group, including children with ADHD and unexposed to paracetamol (n = 100), and the population control group, including children without ADHD and unexposed to paracetamol (n = 100). The samples were selected from MoBa, the same cohort as our previous study was based on, and 17 of the 19 exposed samples in the original study were also included in the present study. We selected model covariates by assessing their contribution to DNAm variation using PCA  2 and 3, and differed between the comparison groups  an adjusted model where we adjusted the crude model for FA intake during pregnancy to investigate the influence of FA status on the variance in DNAm, and (iii) an interaction model where we examined any interaction effect of FA and paracetamol on DNAm. We ran the three models comparing the exposed group to each of the two control groups separately, and also ran sensitivity analyses excluding the CD8+ T cell proportion from the models, which did not change the results (We ran three different models to assess the impact of paracetamol and FA on DNAm in children with ADHD : (i) a c results .p values were largely similar to those observed in the crude model . This analysis did not identify any significant differences between the exposed group and either of the two control groups , and thede model . Finallyde model .p values closer to significance (p ≥ 0.13), but none of these overlap with the significant findings in our previous study. Finally, to assess whether the heightened burden of multiple testing associated with the increased number of probes on the EPIC microarray could explain our null findings, we also ran the crude model only on the probes overlapping between the 450 k and EPIC microarrays . Conducting our analysis using the same normalization methods  and/or the same covariates as in our previous study , we still find no significant CpGs . Yet, soroarrays . This anOverall, we identified no impact of paracetamol nor interaction of paracetamol and FA on cord blood DNAm in children with ADHD in our data. Results from the crude model did not identify any significant differences in DNAm between the exposed group and either of the two control groups. Consequently, we did not replicate our previous results . These fTo explore if differences in the analysis between our present and previous study contributed to our non-replication, we examined whether varying normalization methods, covariates and number of probes on the microarrays would change the results. We did not identify any CpGs significantly associated with prenatal paracetamol exposure in children with ADHD in these analyses.Our findings also differ from two recent studies on prenatal paracetamol exposure and DNAm, which found differential DNAm at some CpGs associated with paracetamol . HoweverWhen assessing whether FA contributed to the variance in DNAm or if there was an interaction effect of paracetamol and FA on DNAm, we did not find any significant CpGs, suggesting that there is no effect of paracetamol and FA intake on DNAm in children with ADHD. Previous studies have reported differential DNAm associated with maternal FA intake during pregnancy in genes linked to developmental abnormalities . Howeverμg/day, starting 1 month prior to pregnancy and lasting throughout the first trimester of pregnancy.While we have improved multiple aspects of our previous study , there aIn conclusion, this study did not replicate previous findings in MoBa or other studies investigating the influence of paracetamol on DNAm, and did not identify any interaction effect of paracetamol and FA on DNAm in children with ADHD. Our results contribute to the growing literature on prenatal pharmacoepigenetics, but should be replicated in other cohorts. Replication of pharmacoepigenetic studies is essential to ensure robust findings and to increase the clinical relevance of such studies.


Understanding social determinants is crucial for implementing preventivestrategies, especially for low birth weight (LBW)—a public health issue thatseverely increases the risk of morbimortality in children.This study aimed to identify the factors associated with LBW among newborns,assisted by the Brazilian Unified Health System.It analyzed data from newborns and their mothers. The sample was selected byconvenience from users of the public health system in Francisco Beltrão.Cases (n = 26) were babies weighing ≤ 2,500 g and controls (n = 52) >2,500 g. All babies were assessed and paired by sex and date of birth in a1:2 proportion. Statistical power was computed a posteriori, revealing apower of 87% (α = 0.05).Strong and significant differences were found in the bivariate analysis, inwhich the number of current smokers or those who quit during pregnancy washigher among mothers of babies with LBW. Moreover, the gestational weekswere lower among these cases. Logistic regression models indicated that thegestational week  and fathers’ educational level  were related to lower chances of low birthweight.Our findings confirm previous investigations on LBW's multi-causality,showing that the gestational week could reduce up to 82% chances of a babybeing born with ≤ 2,500 g. Its association with paternal educationunderlines the importance of comprehensive policies to protect newborns. The present investigation focused on the sociodemographic, behavioral,obstetric, and healthcare variables underpinning LBW.This study explores the factors associated with low birth weight (LBW) in newbornsassisted by the Brazilian Unified Health System (Sistema Único de Saúde [SUS]).Compared with babies with regular weights, LBW newborns are up to 20 times morelikely to die, and preventive efforts include myriad factors. LBW increases the chances of cardiovascular diseases, diabetes, and cognitivedeficits during the baby's life. Thus, it is understood as a public health issue, guiding the development ofhealth actions and setting parameters for the number of neonatal intensive care.For over a century, healthcare professionals have considered newborn weight aparameter for infant care and mortality. The 2,500 g cutoff value for LBW was firstset in 1919, when the difference between LBW and prematurity was not clear-cut. Several factors may be at play in LBW, wherein the most cited ones are theprecocious inducement of birth by cesarean section, multiparity, comorbidities, andthe pregnant woman's lifestyle. Preterm births may increase the risk of LBW by up to 35 times when comparedto term babies.Despite its association with social vulnerability, LBW occurs in both developed anddeveloping countries. In Brazil, the incidence is around 8.5%, which is similar orslightly inferior to data from the state of Paraná. Even in women with eutrophic pregestational weight, controlling weight gainduring pregnancy is essential to reduce diseases and their aggravation. Evidence warns the effects of the habit and exposure to tobacco smoke in theuterine environment and postnatal period, and its relationship with LBW and severaladverse short- and long-term effects, including congenital anomalies, miscarriages,behavioral syndromes, and even childhood cancer. Illegal drug use is harmful in a handful of ways, among which, the reductionof fetal weight gain is significant.Behavioral habits, nutritional factors, smoking, and the use of illicit drugs arerisk factors for LBW and should be the focus of interventions. Maternal obesity isresponsible for complications for the mother, fetus, and during perinatal periods,and it must be controlled in prenatal care. However, the risks and protective factors are not only putative maternalcharacteristics but also paternal influences, and low educational attainment could constitute a risk factor. Nevertheless,we found no studies connecting partners’ education with LBW.A pregnant woman's external environment directly influences her health status andgestational outcomes. Factors such as income, age, age during her first pregnancy,number of pregnancies, education, occupation, marital status, and social situationare strongly associated with quality of life during pregnancy and LBW.thgestational week. The Basic Units of Health  are the first spaces for sheltering pregnant women and screening for possiblegestational risks associated with LBW.One of the most effective ways to minimize the risks involved in pregnancy and LBW isto assist all women of reproductive age through family planning. As advised by theWorld Health Organization, quality prenatal care must include at least six physicianappointments and begin as early as possible, preferably before the 12 Currently, there are few case-control studies that broadly evaluate the individual contributions of various exposurefactors connected to LBW, such as sociodemographic, behavioral, obstetric, andhealthcare characteristics.Understanding the social determinants (exposure outcomes) is crucial for implementingpreventive strategies, especially in the case of LBW, a public health issue thatseverely increases the risk of morbimortality. while behavioral risk factors (such as smoking and using drugs) wouldincrease LBW chances. Based on other investigations, it was also estimated that access tohealthcare – measured by the early start and high number of prenatal appointments –would constitute a protective factor.The present research sought to compare risk factors associated with LBW, as well asto provide useful information for healthcare professionals and policymakers involvedin maternal and infant health, by investigating a far-reaching group of factors andoutcome data of newborns. The main hypothesis was that in the sociodemographicdimension, parents’ elevated incomes and higher education levels would result inlower chances of LBW, analyzed data from newborns and their mothers. The initial populationconsisted of 432 pregnant women selected by convenience among users of the publichealth system in Francisco Beltrão  between July 2018 and July2019.This community-based case-control study The study had a power of 87%, with a 0.05 alpha for two-tailed tests.During this period, 26 babies born weighing ≤ 2,500 g were considered for this study.Controls were defined as term babies weighing > 2,500 g. Controls were selectedin a 2:1 ratio and paired according to their sex and birth date. This was performedto reduce any bias regarding sex differences in terms of risks for mortality, aswell as to account for environmental and other external factors that could representan important issue with regard to perinatal care. DV was obtained from the Live Birth Certificates  in the Municipality's Health Secretariat.Independent variables were separated into blocks: sociodemographic, behavioral,and obstetric and healthcare characteristics.LBW was taken as the dependent variable (DV), according to the World HealthOrganization criteria, that is less than 2,500 g.The first block included the mother's age ; educationalattainment ; age during the first pregnancy (average); marital status(single/married and/or living with a partner); employed outside the home(no/yes); mother's self-defined race/ethnicity (white/other); residence status(owner/rented/others); income (≤ 1 minimum wage/1 to 3 minimum wages/above 3minimum wages); the number of people living in the house (one or two/three ormore); partner's age ; and partner's educational attainment(elementary/high school and above). the second block of independent variables comprised behavioral data,including pregnancy planning (no/yes); smoking (no/yes/quit during pregnancy);use of illicit drugs (no/stopped while pregnant); physical activity (no/yes);and hours of sleep (average). The third and last block of independent variablesincluded obstetric and healthcare conditions: number of pregnancies (average);number of normal labors and cesarean sections (average); pregestational weight(average); prenatal starting month (average); prenatal appointments (average);complications during pregnancy (no/yes); previous miscarriages (no/yes); rise inblood pressure (no/yes); bleeding episodes (no/yes); iron supplementation(no/yes); folic acid supplementation (no/yes); gestational week at labor(average); and type of delivery . Pregestational weight inkilograms (kg) and height in meters (m) were collected from women's healthdocuments and used to calculate the pregestational body mass index(kg/m2).Following a previous study,This study was approved by the Ethics Committee in Human Research of theUniversidade Estadual do Oeste do Paraná on July 02, 2018 . Selected by convenience, the sample was composed of pregnantwomen assisted by the SUS who resided in the city. They were approached whilewaiting for their prenatal appointments at UBS and invited to answer aquestionnaire administered by previously trained researchers . All women included inthe study agreed to participate and signed consent forms. In cases where womenwere legal minors (less than 18 years old), their legal guardians signed aconsent form.Data on newborns, including sex, weight (g), presence of congenital anomalies,type of delivery, gestational age at birth, number of prenatal appointments, andprenatal starting month, were collected from the DNV. This procedure wasauthorized by the city's Health Secretariat, specifically its SanitarySurveillance and Epidemiology sector. The Secretariat also provided data onfetal deaths and abortions.Infants born alive during twin pregnancies and newborns with congenital anomalieswere excluded from the study. When more than two newborns fulfilled theinclusion criteria in the control group, one newborn was randomly selected bydrawing lots.V and Cohen's d were used. The effectsizes were classified as follows: Cramer's V  andd = 0.20 , d = 0.50 (medium), andd = 0.80 (strong).After completing the questionnaires, the data were tabulated using MicrosoftExcel for Microsoft 365 MSO version 2301 . Data were inspected for incorrect or missing information as well as forextreme cases. A 5% limit was adopted for missing data that was not exceeded.For continuous variables, the normality of data was checked using theShapiro–Wilk test, and significant values were indicative of normalityviolation. In these cases, comparisons were performed using nonparametricstatistics. Welch's t-test was used to compare the means as the low- andnormal-weight groups differed in size. For the comparison of categoricalvariables, the chi-squared tests with and without Yates’ correction forcontinuity were used. As effect size of bivariate analyses, Cramer'st test or nonparametric techniques (Mann-Whitney test).Thus, to respond to the first objective, differences in categorical variablesamong the groups were investigated using the chi-squared tests with and withoutYates’ correction for continuity, and Fisher's Exact test, as defined in eachcase. For the continuous variables presented in  Extreme cases that could compromise the multivariate models were examinedusing Cook's distance with a tolerance of 1. To select the best explanatorymodel for logistic regression, the Hosmer-Lemeshow test (cutoff point > 0.05)and the Omnibus Test of Model Coefficients (cutoff point > 0.05) wereemployed. A smaller Akaike Information Criterion value and increasing explainedvariance (Nagelkerke's R2) were considered when choosing themultivariate final model. Co-variables were established according to a previous study, which also used DNV and showed that premature births represented a 35times higher risk of LBW than term births. Thus, gestational age was included inthe multivariate data analysis model.To fulfill our second objective, we sought to verify the effects of theindependent variables in the LBW outcome through binary logistic regressionmodels, and independent variables with P values of 0.20 or less in bivariateanalyses i.e.,  were insa posteriori. Thus,G*Power version 3.1.9.7  was used, which showed that the study had a power of 87% with 0.05alpha for two-tailed tests.The analyses were carried out in the programs SPSS version 23.0  and JASP version 0.17.1 , 95% confidence interval (CI) and P values of 0.05 or less wereadopted as the criterion of statistical significance. Since all LBW babies bornduring the study were included and paired by sex and date of birth in a 1:2ratio, the statistical power was computed The sample loss included 35 participants; two twins were excluded due to this group'sparticular characteristics in terms of LBW, five babies were excluded due tocongenital anomalies, three due to fetal losses and abortions, and 25 participantsbecause their names were not included in the Health Secretariat's Live BirthCertificates file. Hence, 26 babies were allocated to the experimental group and 52to the control group.V pointed that these differences arevery strong. Welch's t test showed strong, significant differencesbetween gestational weeks, which were smaller among the cases  andfathers’ educational level  wererelated to lower chances of low birth weight. Notably, the findings indicate thatthe strongest predictor was the gestational week, reducing up to 82% the chances ofa baby being born with ≤ 2,500 g. while risk behavioral factors, such as smoking and drug use, would augmentthe odds of LBW. A second hypothesis was that access to health, demonstrated by an earlierstart and a higher number of prenatal care visits, would act as a protective factorfor LBW.This study aimed to verify the association between LBW and sociodemographic andbehavioral factors, as well as obstetric and healthcare characteristics, using acommunity-based case-control design. Thus, our hypothesis was partially confirmed.We assumed that, in sociodemographic terms, parents’ higher income and educationwould reduce the chances of LBW, It is known that the “optimal” stage for reproduction is between 19 and 34,and being a mother before or after these periods increases LBW predisposition. While we did not set any hypotheses about age and LBW's relation, the lack ofevidence of such association in our study may be due to a small number of underagedwomen or those over 35 years.Regarding the sociodemographic variables of the pregnant women, we did not find anydifferences between mothers of babies with LBW and normal-weight newborns. Thus, ourincome-related hypothesis is yet to be confirmed. Moreover, the average age found inour study was approximately 26 years old, both for the case and control groups—asimilar value to those previously reported. According to Souza et al., more than four times the current minimum wages are needed to cover theaverage needs of Brazilian families. However, a favorable income does not ensuregood food choices or food security. It may even contribute to chronicnoncommunicable diseases and complications during pregnancy, such as obesity and diabetes.Pregnancy is a physiological stage during which eating habits are vital for goodoutcomes. Family income greatly influences pregnancies as it allows access to foodand other needs. Notwithstanding, only a few studies associate paternal characteristics withthe outcome birth. For instance, recent evidence showed a relationship between lowpaternal education and prematurity, but did not provide any information regardingpossible links with LBW. Thus, we hypothesized that high education would be a protective factor forLBW.In addition, low education is usually reported in the literature as an importantvariable for LBW, not only when it refers to the mother's education but alsopartners or other people leading the family. The participation of fathers or partners in pregnancy is a subject thatinvolves social and cultural determinants, as the experience of pregnancy isunderstood differently by the pregnant woman and the partner. Prenatal carecontributes to each person's understanding of their roles, responsibilities, andbehavioral impacts on new human beings. The conjugal situation, partner's presence,and participation have positive reflexes throughout pregnancy, birth, the baby'sstimulus, and acceptance of breastfeeding. Thus, it has direct implications on thepregnant woman's mental health.Confirming our assumption, a partner's education (high school or higher)significantly decreased the likelihood of LBW. Elevated educational attainment mightact as a protective factor against LBW during pregnancy, as it increases access toinformation, and consequently health care, and impacts family income. Thus, prenatal care is extremely crucial, which might explain why majority ofpregnant women in Brazil receive prenatal care, despite barriers. According to Cunha et al., less than 25% of Brazilian cities meet the criteria of quality prenatal care,and estimations become more critical as the number of inhabitants increases.Inadequate prenatal care is a risk factor for LBW. Our results showed that mothers in the case group carried out 8.56 prenatalcheckups on average, while mothers in the control group had an average of 9.53checkups. These findings support our hypothesis that a greater adherence to prenatalcare decreases the risk of LBW. In addition, the gestational week was significantlyassociated with LBW, confirming our hypothesis.Women's behavior and lifestyle may foster physiological disorders during pregnancy,reflecting on the development of the baby after birth. Thus, LBW is directly related to the access and use of healthcare services.Mesquita-Costa et al. concluded that fewer than seven prenatal checkups represented a 97% increasein the risk of LBW. However, both cases and controls showed an average number ofprenatal checkups close to that suggested in the literature. Therefore, there mightbe a qualitative rather than a quantitative difference in prenatal careprocedures.Apart from the already discussed hypotheses, this study raised a few additionalissues that must be highlighted from a maternal-infant health research perspective.First, LBW rates have been rising worldwide. This phenomenon is derived from changesin women's social roles, which reflect increasing maternal age and search forassisted reproduction techniques.Although this study presented data obtained from multiple sources relevant tomothers’ and babies’ health, its limitations must be considered. The case-controldesign does not allow for the comprehension of clear-cut causal relationshipsbetween exposure and dependent variables. Nonetheless, common limitations in thistype of study—selection, classification, generalizability, and research biases—weresubstantially reduced, as the criteria for defining LBW were obtained after thecollection of exposure variables.Our findings confirm previous investigations on LBW's multi-causality, showing thatthe gestational week could reduce up to 82% chances of a baby being born with ≤2,500 grams. This association with paternal education underlines the importance ofcomprehensive policies protecting newborns, and suggests that the subsequentdevelopmental stages of these babies may be compromised by low paternaleducation.


Attention-deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by cognitive deficits and/or behavioral disturbances. The symptoms begin before 12 years and must cause an impact in different contexts. It is now recognized that in 40–60% of cases, ADHD symptoms persist into adulthood and old age, representing nearly 4% of adults and seniors.Executive and memory deficits have been described in other neurodevelopmental disorders, such as autism, and older adults with these disorders are observed, later in life, with mild cognitive impairment (MCI) or dementia.MCI is conceptualized as a prodromal stage of a neurodegenerative process, for which the pathological processes are not yet known. The term “MCI” is currently used to designate subjective complaints and performance below expected levels, in any cognitive domain.There is, therefore, an overlap between ADHD and MCI in older adults, related to cognitive and behavioral symptoms. This overlap makes both syndromes difficult to distinguish, particularly in older patients.To highlight the importance of understanding the key processes of ADHD and MCI and how these entities may be related to each other.Pubmed database. Papers were selected according to their relevance.Non-systematic review of the literature using Sleep disturbances are present in about 70% of adults with ADHD, and 59% of those with MCI. Depression and anxiety, respectively, are observed in about 44% and 35% of adults with ADHD, and 27% and 14% of those with MCI.In the literature, the relationship between ADHD and MCI/Dementia remains unclear, although there are some hypotheses: (a) ADHD and MCI represent two points along a single pathophysiological continuum; (b) ADHD increases the risk for MCI and dementia (through an unrelated mediator); (c) ADHD and MCI manifest highly similar neurobehavioral symptoms through fundamentally distinct mechanisms (are unrelated). However, these three hypotheses are not mutually exclusive, i.e. ADHD may share common antecedent causal factors with MCI/Dementia and also increase the risk of MCI/Dementia through an unrelated mediator.Neuroimaging evidence tends to support the hypothesis that neurobehavioral symptoms in ADHD and MCI manifest via distinct processes within the brain, with frontostriatal, frontal-temporo-parietal, and fronto-cerebellar abnormal networks in ADHD and progressive neurodegeneration in MCI.Whether or not ADHD is a phase of a neurodegenerative process, the current criteria for the diagnosis of MCI or Dementia may not be appropriate or valid in individuals with a premorbid history of ADHD.The criteria for the diagnosis of MCI/Dementia in adults with a previous diagnosis of ADHD should therefore be revised to rely more on functional outcomes.Future neurobiological and epidemiological studies are needed, to explore the relationship between MCI/Dementia and ADHD, in older adults.None Declared


Attention Deficit Hyperactivity Disorder (ADHD) affects about 9.4% (6.4 million) children in the United States. Pharmacological treatment, including stimulants, is a known therapy for ADHD. However, its possible subtherapeutic effectiveness, residual symptoms, and adverse effects have prompted us to explore the current evidence of Yoga as an add-on therapy that has shown synergistic effects in recent studies.1) We aim to assess Yoga’s efficacy as an add-on treatment for ADHD.2) Assess the current evidence of Yoga as an add-on therapy for ADHD.We searched PubMed, PubMed Central, Medline, Web of Science, and Biosis databases with the keywords “Attention Deficit Disorder with Hyperactivity” (MeSH) and “ADHD” in the context of “Yoga” (MeSH). Identified 4 relevant studies that were published until September 30, 2022.7 205-216). In another study, children with ADHD showed significant improvement after 8 weeks of 16 Yoga sessions in accuracy rate and reaction time in the Visual Pursuit Test and Determination Test . A nine-year-old male case showed improvement in inattentive and hyperactive-impulsive symptoms on Vanderbilt Assessment Scales from parents and teachers after 6 months of Yoga practice . Another 6-week Yoga intervention randomized trial in pre-school ADHD children showed significant improvement in hyperactivity and inattention with fewer distractibility errors of omission and faster reaction time .A study by Jensen et al. found improvement in impulsivity, hyperactivity, and restlessness in the ADHD with medications patient group after 20 Yoga sessions. Study utilized Conners’ Parents Rating Scales and found improvement in the Yoga group on Oppositional, Global Index Emotional Lability, Global Index Total, Global Index Restless/Impulsive, and ADHD Index scale, changes associated with the number of sessions (Jensen et al. J Atten Disord 2004; The results suggest that Yoga has beneficial effects as an adjunct treatment to pharmacotherapy in ADHD for reducing hyperactivity and inattentiveness. Additionally, studies indicate its effectiveness in managing stress, anxiety, energy levels, and impulse control by staying focused with the help of breath and mind control. To explore the full spectrum of benefits and effectiveness of Yoga as an add-on therapy for ADHD patients, we recommend robust well-design future studies.None Declared


Attention deficit/hyperactivity disorder (ADHD) has been identified as a risk factor for obesity in both children and adolescents. However, the mechanisms underlying the relationship between ADHD and obesity are still unclear. This study aimed to test a theoretical model of whether anxiety/depression is an intermediary factor in the ADHD-obesity relationship.Data were derived from the National Health Interview Survey (NHIS), a principal source of information on the health of the civilian noninstitutionalized population of the United States. A total of 35,108 adolescents aged 12-17 years old from 2010-2015 NHIS and 2016-2018 NHIS representing 46,550,729 individuals in the weighted population, had a parent-reported previous ADHD diagnosis, emotional problems, and height and weight data. Mediation analyses were used to explore whether anxiety/depression is an intermediary factor in the relationship between ever having ADHD and obesity. Mediation analyses were performed using multiple logistic regressions.The findings showed that ADHD was a predictor of obesity. This relationship was partially mediated by depression, as well as anxiety .Our study suggests the hypothetical role of depression and anxiety as underlying mechanisms in the association between ever having ADHD and obesity in adolescents. When treating children with ADHD, clinicians need to be particularly attentive to whether they show emotional problems and use interventions to eliminate anxiety/depression to protect against obesity.The online version contains supplementary material available at 10.1186/s12888-023-04882-x. Obesity has become one of the most important public health problems in the United States and many other countries, affecting ~18% of US children and adolescents , 3. As tPrevious studies have suggested that attention deficit/hyperactivity disorder(ADHD) is a risk factor for obesity in both children and adolescents -8. A lonEmotional problems have been found to be strongly linked to both ADHD and obesity. A longitudinal genetically sensitive study launched out by Adi Stern et al. provided evidence that ADHD symptoms predicted emotional symptoms, including anxiety/depression, from childhood up to young adulthood through shared genetic influences . StudiesSeveral factors have been suggested to influence the association between ADHD and obesity. The link may be explained by genetic overlap , the underdevelopment of the prefrontal cortex, and behaviors that lead to weight gain and interactions with environmental factors -17, suchTherefore, this study intended to further examine the relationship among an earlier diagnosis of ADHD, emotional problems and obesity in adolescents by adopting a comprehensive model. It was hypothesized that emotional problems would mediate the relationship between an earlier diagnosis of ADHD and obesity . It is an annual, cross-sectional, in-person household interview survey. Since 1957, the National Center for Health Statistics has been collecting annual data on a broad range of health topics. Data including basic health information, the sociodemographic information of all household members and more extensive information on one sample adult and one sample child per family, are collected by trained personnel from the U.S. Census Bureau through personal face-to-face interviews conducted throughout the year. A multistage sampling technique is used to obtain a representative sample of the U.S. population from each state and the District of Columbia. One child who is represented by a proxy respondent, typically their parent, is randomly selected from each family by the NHIS. Details on the NHIS sample design are published elsewhere  at or arev.htm) .Whether participants ever had ADHD was ascertained based on whether the parent answered “yes” or “no” to the question “Has a doctor or health professional ever told you that your child has Attention Deficit Hyperactivity Disorder (ADHD) or Attention Deficit Disorder (ADD)?”Anxiety and depression were defined using separate items derived from the short Strengths and Difficulties Questionnaire (SDQ), which asked parents to report whether their child had many worries or often seemed worried, unhappy, depressed or tearful during the past 6 months. A 3-point Likert scale was used to assess compliance with these items, ranging from 0 (not true) to 2 (certainly true). Responses were dichotomized as positive ("somewhat true" or "certainly true") versus negative ("not true") . There iData analyses were executed with the following steps.First, to present the characteristics of the respondents, descriptive analyses were performed, expressed as weighted frequencies and percentages.Second, to assess the association among ever having ADHD, anxiety /depression and obesity, multivariate binary logistic regression models were conducted, with dichotomized outcomes  as independent measures and obesity as the dependent measures and adjustment for sex, age, race/ethnicity , parental education level ,more than high school), family income  and birth weight, based on their known association with obesity from previous studies -29.Finally, to test the mediation effect of emotional problems  on the relationship between ever having ADHD and obesity, we conducted a follow-up analysis using multivariate binary logistic regression adjusting for sex, age, race/ethnicity, parental education level, family income and birth weight, according to the steps to test for in the mediation analysis of categorical variables .Except for the 95% CI of the mediation effect obtained by the “R Mediation” package of R Statistical Software (R version 4.2.2) , all staThe characteristics of the sample and weighted percent of the population from the 2010-2015 National Health Interview Survey are shown in Table Table Table Table This study included a large cross-sectional sample of adolescents and formulated a mediated model to investigate the influence of ever having ADHD and emotional problems on adolescent obesity. The results provided support for the hypothesis that ever having ADHD was indirectly associated with adolescent obesity through anxiety/depression. These results contribute to a better understanding of the influential factors in the development of obesity in individuals with ADHD, which may be helpful for improving health in this group of population.The association between ADHD and obesity is now well established in adults, while whether it is the same in children and adolescents remains unclear -35. In tA study by Pauli-Pott et al. concluded that the relationship between ADHD symptoms and excessive body weight was accounted for by psychosocial cumulative risks associated with the family environment, including parental education level, parental separation and overcrowed living conditions . Based oThe mechanisms underlying the mediating role of depression or anxiety in the relationship between ADHD and obesity are not well understood. Current evidence suggests the hypothesis of the “psychopathology-to-obesity” pathway.First, shared genetic vulnerability. Recent studies have revealed several pleiotropic genes that might be shared between mood disorders and obesity, such as FTO (encoding fatmass and obesity-associated protein), BDNF (encoding brain-derived neurotrophic factor), POMC (encoding proopiomelanocortin), and IGF1 (encoding insulin-like growth factor 1), as well as shared genetic pathways involving serotonin and dopamine receptor signaling, leptin signaling, circadian rhythm signaling, axonal guidance signaling, and corticotropin-releasing hormone signaling . These aSecond, in terms of brain structure and function, ADHD, emotional problems and obesity have been hypothesized to share common underlying abnormalities in brain reward sections, emotion regulation processes and executive functions . RegardiThird,the psycho-immune-neuro-endocrine network. Accumulating evidence suggests that patients with neurodevelopmental disorders share inherent features of dysregulated homeostasis systems, including the hypothalamic‒pituitary‒adrenal (HPA)-axis, leptin-ghrelin system, insulin resistance, dysbiosis, endocrine and autonomic dysfunctions, and the inflammatory response, which ultimately results in excess adiposity and dysmetabolism . In addiIn addition, obesity and emotional problems share common sociodemographic risk factors, including sex, birth weight, and parental education level, etc -48. BaseSpecific to depression, our mediation analysis further revealed that depression mediated 27.87% of the risk effect of ADHD on obesity. To date, few studies have explored the mediating role of depression in the relationship between ADHD and obesity. In 2009, a cross-sectional study in adults showed that binge eating disorder, but not depression, partially mediated the associations between ADHD and obesity . HoweverA major strength of the NHIS is the ability to generalize findings to populations. Furthermore, using the 2016-2018 data, we found more supporting evidence that ever having ADHD, depression or anxiety increased the risk of obesity in adolescents, as well as the mediating role of depression in the association between ever having ADHD and obesity. Several limitations of this study should be noted. First, we obtained the diagnosis of ADHD/ADD through retrospective parent interviews, which might be subject to recall bias, and we could not differentiate ADHD subtypes. Second, the participating children’s heights and weights were reported by their parents rather than clinically measured. Third, we did not take into account other variables that may affect body weight, such as diet, lifestyle, physical activity, and sleep conditions. Fourth, it is possible that ADHD medications may have weight‐related side effects, which we did not consider in this study.In conclusion, increasing evidence suggests a connection between ADHD and obesity in both children and adolescents. This understanding may strengthen the prevention and treatment of obesity. It is worth noting that recognizing the susceptible factors and populations of obesity can improve the effectiveness of obesity treatment. Based on this, our study indicates that ever having ADHD is associated with an increased risk of obesity in adolescents, and this association is partially mediated by emotional problems (depression/anxiety). The results suggest that emotional problems might be effective areas for interventions aimed at reducing obesity risk in adolescents with ADHD/ADD.Additional file 1:Table 1s. Sample characteristics and weighted percent of the population, 2016-2018 National Health Interview Survey. Table 2s. Results of logistic regression analysis predicting odds of obesity, 2016-2018 National Health Interview Survey. Table 3s.a. Results of logistic regression analysis testing the mediating role of anxiety on the relation between ever having ADHD and obesity, 2016-2018 National Health Interview Survey. Table 3s.b. Results of logistic regression analysis testing the mediating role of depression on the relation between ever having ADHD and obesity, 2016-2018 National Health Interview Survey.


Attention Deficit Hyperactivity Disorder (ADHD) is the second most common psychiatric disorder in childhood, affecting 5-7% of the child population. The same disorder in adults is less documented and is estimated at 2.5% of the population. The mothers of children with ADHD are 24 times more likely to develop ADHD than mothers of children without ADHD. About 17% of mothers of children with ADHD meet criteria for the disorder themselves. The core symptoms of ADHD are inattention, hyperactivity and impulsivity.The objective of this e-poster is to describe the effects of the mother’s ADHD on her parenting roleThe current poster is based on the bibliographic reviews of papers via the ‘PubMed’ search engines.In some studies mothers with ADHD may use ineffective discipline methods in order to limit their children.The mothers with ADHD often have difficulties with executive functions such as planning, organizing and implementing goals and with self-control. Characteristically, in a study with a sample of mothers with children aged 3-6 years were observed difficulties in defining the boundaries of the children, unstable behavior and low self-esteem. Additionally, mothers with ADHD may have difficulty forming and maintaining social relationships and this have a negative effect on children’s social skills. The maternal role is influenced by when the mother suffers from depression, anxiety, uses alcohol or psychotropic substances. In addition, her role is influenced by when there are problems in the marital relationship or she is a single parent. The reactions of the mother with ADHD may be influenced not only by whether she has ADHD but also by whether or not her child has been diagnosed with ADHD. The mother with ADHD and child with ADHD has to deal not only with her own symptoms but also with her child’s symptoms. The coexistence of the specific disorder in both may cause increased levels of stress to the mother. Nevertheless, some research reports that these mothers show empathy towards their children, i.e. they have a more positive and supportive behavior, they are more protective, less irritable and less frustrating (similarity-fit hypothesis). In other studies mothers with ADHD worsen their children’s symptoms with their behavior (similarity-misfit hypothesis). There is a significant correlation between the mother’s ADHD and the child’s emotional, behavioral and social functioning.In conclusion, mothers with ADHD may experience difficulties in all developmental stages of their children. Therefore, the treatment of the disorder  is necessary in order to improve the mothers’ symptoms, the mental condition of their children and the family’s quality of life.None Declared


Attention-deficit/hyperactivity disorder (ADHD) impairs the lives of both children and adults. Undiagnosed and untreated, ADHD may have serious lifelong consequences. Research has identified diagnostic clues, neurotransmitter pathways, and psychiatric comorbidities related to ADHD, as well as effective pharmacologic, behavioral, and psychosocial interventions. Stimulant agents have been the foundation of ADHD therapy for more than 50 years. Availability of new extended-release (XR or ER) and longer-acting (LA) formulations and novel agents allows for wider and more individualized treatment choices. Side effects of stimulants are generally mild, short lived, and responsive to adjustments in dosage or timing.Outcomes in ADHD treatment can be improved with the use of clear treatment guidelines and tools to aid clinicians in implementing them efficiently and effectively. The Texas Children's Medication Algorithm Project (CMAP)provides a system of algorithm-driven treatment decisions that is evidence based and easy to implement.To (1) review the psychological components of attention, the neurotransmitter pathways associated with ADHD, and the array of therapeutic options for ADHD, with an emphasis on the most recent introductions to the therapeutic armamentarium; (2) discuss the rare psychiatric and cardiovascular side effects associated with stimulants; (3) review abuse liability,comorbidities, and suggested approaches to these issues; and (4) review the development and use of CMAP and offer resources for its implementation in clinical practice.The pathophysiology of ADHD is linked to dysfunction of front osubcortical networks and dysregulation of dopaminergic, noradrenergic, and nicotinic neurotransmitter systems. An additive effect of multiple genes as well as environmental influences contributes to the clinical picture.Treatment with stimulants and nonstimulants has proven effective in different subgroups, with the effectiveness of specific agents most likely related to the primary neurotransmitter involved. Availability of XR, ER, LA, and transdermal stimulant formulations, as well as alternative nonstimulantagents, offers new options for the pharmacotherapy of ADHD. Major concerns associated with abuse liability of stimulants have been allayed by the availability of ER formulations, which have reduced reinforcing effects associated with short-acting preparations. Medication outcomes in ADHD can be enhanced by the use of evidence-based algorithms such as CMAP. Keys to success are adequate initial assessment and diagnosis, the use of sustained release products, sufficient dose titration, and the use of clinical rating scales with feedback from caregivers and teachers. Optimal treatment out comes can be achieved by appropriate pharmacotherapy combined with psychosocial interventions.


Observed heterozygosity levels were comprised from 0.16 to 0.51 and are generalkly lower than expected heterozigosity supporting fixation at some loci. STRUCTURE analysis revealed clear separation between accessions revealing the presence of four ancestral populations. This may be explained by the long reproductive isolation experienced by these materials. Finally, morphological observations confirm the high diversity between landraces revealing that they generally have flint kernels, variable color from yellow to dark red (Châtillon) while Perloz showed kernels with an apical beak. The present work confirms the importance of mountain areas in conserving biodiversity and increases the rich Italian maize germplasm with materials well adapted to marginal areas. Such new genetic variability may be used to breed new materials for more resilient agriculture.While there is a rich collection of maize germplasm from Italy, it lacks genetic resources from the Aosta Valley, an isolated mountain region where landraces have been preserved in the absence of modern germplasm introductions. These local materials, which are still cultivated mainly at household level, can have high importance from a genetic and historical point of view. In the present study, five landraces named, after the collecting sites, Arnad, Arnad-Crest, Châtillon, Entrebin and Perloz, were sampled in Aosta Valley and subjected to historic, morphologic and genetic characterization. This study provided evidence for the landraces’ long presence in Aosta Valley, a significant genetic variability and differentiation among the investigated landraces. Globally, 67 different alleles were detected ranging from 4 for markers  Zea mays L., represents the leading cereal crop in terms of production and yield per hectare in Italy [Maize, in Italy .Looking back in time, the introduction of maize in Italy dates back to 1493 when Christopher Columbus brought this cereal back from his travels . From thIn Italy, maize landraces have been extensively grown until the mid of the twentieth century, when the cultivation of hybrid took place due to their significant agronomic performances. During the years 1949–1950 a formal investigation started to characterize maize cultivation and in 1954 a project for the sampling of Italian maize landraces was activated resulting in the preliminary collection of 562 different accessions. In subsequent years other materials have been collected, increasing the number of landraces currently available in ex situ collections [Interestingly, of the 562 landraces sampled in 1954 or later, none was collected in Aosta Valley being the only Italian region which did not contribute to the maize sampling .Presumably, maize was introduced in Aosta Valley in the 18th century  and its In many cases, suggestions to improve Italian agriculture in the first half of twentieth century, were often addressed to reduce maize cultivation in all the areas where maize could find unfavorable conditions as in the hills or mountain valleys . In thisComice Agricole de l’Arrondissement d’Aoste, an association committed to the promotion of agricultural production, advised against the cultivation of maize in the Middle and Upper Valley as it was not profitable [The ofitable  and Argeofitable , emphasiofitable  underlinHistorical records outline maize cultivation on 12–13 thousand hectares in the period 1939–1944, data are missing in 1945 and 1946 while from 1947 to 1956 maize cultivation decreased progressively from 740 to 696 hectares.Even after the introduction of modern varieties, intensive maize cultivation in Aosta Valley never started, not even in the most favorable areas: since regional agriculture is mainly devoted to the production of hay, maize and other relevant cereal species are rarely present. In 1957, maize hybrids were introduced starting on a surface of 5 hectares while traditional landraces, recorded as “Nostrano”, were cultivated in 685 hectares. Hybrids reached a peak of 152 ha in 1970 followed by a drop to 46 ha in 1971. From that time hybrid cultivation decreased to the actual 6 ha. Official records have the distinction between hybrids and landraces from 1957 to 1974 but from 1973 landrace cultivation seem to be absent on relevant surface remaining at home level for family purposes. The absence of an intensive agricultural system and the peculiar morphology of the region allowed the prosecution of a more traditional farming system, mostly at home level which is still very practiced. These factors allowed the conservation of several landraces, genetic resources that are a lifeline against the erosion of biodiversity [on farm or to characterize what is preserved ex situ in collection as the one held at the Institut Agricole Régional (IAR) in Aosta . In the framework of biodiversity conservation, the importance of mountain areas has been addressed by several authors [Therefore, this region can represent an interesting basin in which to investigate the presence of relict landraces and local populations of agricultural crops which are still in situ/ authors ,17. Moun authors . In the  authors ,5,18,19.In the context of a climate-changing agricultural scenario, there is an urgent need to discover new sources of adaptation to biotic and environmental stresses that may contribute to crop breeding aimed at maintaining productivity and reducing inputs. To address this objective, landraces can be valuable resources since they are characterized by high genetic variability and they can present favorable alleles for increasing the adaptation to harsh conditions and challenging environments that may have been selected through natural and human pressure ,20.Germplasm resources can be characterized at different levels on the base of the objective of biodiversity preservation. For scientific purposes, genetic and morphological characterizations are the most important, with genetic studies being essential to understand the conservation status, risk of genetic erosion and the importance to preserve that genetic material for present or possible future uses.Genetic characterization of crop landraces, particularly maize, is performed by means of molecular markers; among the many that are currently available, the two most used are Single Nucleotide Polymorphisms (SNPs) and Simple Sequence Repeats or Microsatellites (SSRs). In maize, SSRs have been used to investigate the genetic biodiversity and structure of many germplasm collections constituted from few to hundreds of accessions ,24,25,26Trying to fill the gap of knowledge on traditional maize germplasm, the present research was aimed at the genetic and morphological characterization of maize landraces from Aosta Valley preserved ex-situ at the Institut Agricole Régional. In the study, five local varieties—named after the sampling location as it follows: Arnad, Arnad-Crest, Châtillon, Entrebin and Perloz—have been subjected to historical, morphological and genetic characterization.Landrace Arnad is characterized by tall plants, on average from 275 to 300 cm tall, presenting as mean value of the population a small ear/plant insertion ratio. Leaves characters are generally variable; the majority of plants have a semi-erect or horizontal leaf attitude while the insertion angle between leaf and stalk is between 25°–50°. Anthesis and silking occurred at 72 and 78 DAS, respectively. Tassels are characterized by a very high number of medium/long primary branches, i.e., 18; the angle of insertion between the main axis and primary branches is variable, mainly between 50° and 75°, with horizontal and drooping attitude finally; tassels’ length varies from 31 to over 50 cm. Concerning the tassel component, the glume ring is uniform and of absent-weak pigmentation, glumes are variable but mainly of absent or weak pigmentation while anthers pigmentation may vary from absent-very weak to strong, while silks range from absent-very weak to medium pigmentation. Ears are of slightly conical shape of medium-long length (19–24 cm) presenting from 8 to 10 rows of flint or flint-like kernels which vary from yellow-orange to orange color and are inserted on a white cob . Ear andLandrace Arnad–Crest is characterized by very tall plants that are able to reach and pass 300–320 with a medium (46–50%) ear/plant insertion ratio as population average. Anthesis and silking occurred at 80 and 86 DAS, respectively. Leaves are generally of horizontal-dropping attitude while the insertion angle between leaf and stalk is highly variable and comprised between 25°–75°. Tassels are characterized by a very high number of long/very long primary branches of erect semi-erect attitude and medium-high insertion angle. Focusing on Tassel’s traits, high variability was observed. The glume ring can be either of absent pigmentation as well as variably pigmented, glumes have absent of weak pigmentation while anthers have absent, weak or medium pigmentation. Silks are, mainly, of absent-very weak pigmentation.Ears are of slightly conical shape of medium-long length (19–24 cm) presenting from 10 to 16 rows of flint-like kernels which vary from yellow to yellow-orange color and are inserted on a white cob . Ear andFor Arnad and Arnad-Crest, the historical study was not carried out due to a lack of information.Landrace Châtillon is characterized by a medium height of 265 cm and a short ear/plant insertion ratio. Anthesis and silking occurred at 70 and 75 DAS, respectively. Leaf attitude is semi-erect/horizontal while the angle of insertion between leaf and stalk is mainly between 50°–75°. Tassels are characterized by a very high number (24) of primary branches of variable attitude from semi-erect to dropping. The ring at the base of the tassel’s glumes is generally uniform of absent-very weak pigmentation, glumes and anthers are variable from absent-very weak to medium pigmentation. Silk pigmentation is absent-very weak. Ears are of slightly-conical shape bearing from 12 to 16, sometimes 18 rows of flint and flint-like kernels with a characteristic dark red color; also the cob is pigmented  while anthers are of absent-very weak or weak pigmentation. Silk pigmentation is variable with the majority of plants having weak or medium pigmentation (pink and red) but green silks are present as well. The ears’ shape is slightly conical, between 10–16 rows of orange or red-orange flint kernels inserted on a, generally, white cob .Entrebin cultivation dates back to the early 1900s, when the paternal grandmother of the current grower brought the seeds from Signayes (AO) as a dowry. Today, as in the past, the cultivation of maize by the custodian farmer’s family is mainly intended to produce flour and only partially reserved for animal feed. Between the 60s and 70s of the last century, the mill where most of the families in Aosta went for milling closed, and the Entrebin maize was exclusively used for cattle, until the purchase of a small family mill in the early 1980s. The custodian farmer cultivates it according to traditional maize cultivation techniques, placing the crop in rotation and self-producing the seeds. In the period preceding the harvest, the ears from which the seeds will be taken for the following year are chosen, selected from the healthiest and precocious plants. The seed ears are harvested a few days before the harvest time and are left to dry, as in the past, hanging from the balcony of the family house. At the beginning of spring, they are shelled by discarding the ends that have smaller seeds and keeping the central part. Even the remaining part of the harvest is left to dry hanging from the balcony of the house. As per tradition, the ears are tied together in threes, making a knot with the bracts .Landrace Perloz is characterized by tall plants  and a small ear/plant insertion ratio. Anthesis and silking occurred at 73 and 77 DAS, respectively. Leaf attitude is semi-erect/horizontal while the angle of insertion between leaf and stalk is mainly between 25°–50°. Tassels length is comprised between 31–50 cm classifying tassels as medium–long. The number of primary branches is high or very high and they are characterized by horizontal or dropping attitude.The glume ring is generally uniform of absent-very weak pigmentation, both glumes and anthers are of absent-very weak or weak pigmentation sometimes medium while rarely strong. Silks are of variable pigmentation, from absent-very weak to medium.Ears are of slightly conical shape and present between, mainly, 14 to 16 rows of flint yellow-orange orange-red kernels on a white cob . MoreoveThe landrace collection here investigated is characterized by accessions of flint/flint-like kernels, whose color varies from yellow to red with the exception of Châtillon, which is the only accession with dark-red ears, a character not common in landraces sampled in 1954  but veryphi127 and p-bnlg176 to 10 for phi031, with a mean of 6.7 alleles per locus .All loci were polymorphic in the populations with the exception of This may be a consequence of the isolation experienced by landraces and/or of a moment of reduced cultivation that occurred at any time in the last decades. At a household scale of cultivation, it is common to grow few plants and save seeds from a very few number of ears responding to a particular ideotype. It cannot be excluded that some alleles went lost during that time. Similar studies on maize landraces report both high levels of polymorphism at collection/locus as well as the presence of monomorphic loci in some landraces ,24,25,26phi031, umc1786, umc1941), Châtillon , Arnad ; 6 private alleles in Perloz ; 8 private alleles in Arnad-Crest .This collection seems to be particularly rich in private alleles as reported in The high percentage of private alleles over total alleles (39%) may reflect the reproductive isolation of these landraces.phi127 to a maximum of 3.40 of phi076, umc1401, phi031, umc1075, phi084, and umc1941 at locus level; while, at the population level, it ranged from 2.40 for Châtillon to 3.80 for Arnad-Crest. The number of expected alleles (Ne) was lower without any exception than Na spanning: at locus level from 1.39 for phi127 to 2.49 for umc1075; at landrace level from 1.51 to 2.47 in Châtillon and Arnad-Crest, respectively  while the other loci are closed to Hardy-Weinberg equilibrium or outbred  to 1  and markers whose PIC value is greater than 0.5 are considered to be very informative [The number of observed alleles (Na) ranged from a minimum of 2.20 of ectively . To bettectively . Mean va outbred . FST is ormative . The marST and an interesting number of private alleles. Good levels of differentiation have been reported for landraces maintained for decades in situ under reproductive isolation in Emilia Romagna, while traditional germplasm sampled in the ‘50s did not show clear differentiation [Principal Coordinate Analysis (PCoA) provided a good separation of the landraces since the two first principal components account for 21.53% and 14.68% of genotypic variability. The clear separation resulted for landrace Châtillon, Entrebin and Perloz while Arnad and Arnad-Crest, even if easy to identify, were generally overlapped as reported in ntiation . If the The UPGMA phylogenetic tree of individuals shown in ST  while the second at K = 5 (ΔK = 578.82). At K = 4, as shown in The results of structure analysis are consistent with the PCoA and phylogenetic tree  delineatThis strong population-cluster association and differentiation are very interesting if compared to similar works where different levels of admixture have been detected ,21,24,26Probably, the strong reproductive isolation, the almost complete absence of relevant maize cultivation in the last 60 years, and no, or limited, introduction of improved varieties have helped the maintenance of population distinctiveness. The gene flow of these landraces is lower with respect to other local populations of northern Italy sampled where landraces were widely cultivated  and moreThe highest gene flow  is for ALandrace distinctiveness measured for this first set of maize landraces from Aosta Valley encourages the hope to find new accessions, still unknown up to now because hidden in the mountains of this alpine region.Landraces’ seeds used in this work were maintained in the germplasm collection held at IAR, Institut Agricole Régional (La Rochère AO), and they were named after the sampling location as follows: “Arnad”, “Arnad-Crest”, “Châtillon”, “Entrebin” and “Perloz”; sampling location is reported in For each landrace, when it was possible to find information, a historical study was carried out. The methodology adopted integrates different techniques: interviews with custodian farmers, historical-bibliographic, historical-photographic documentation and direct observation of the current agricultural practices, conservation and use of maize.Landraces were grown in an experimental field located in Saint-Marcel, Aosta, Italy  at the Agricultural demonstration center of Regione Autonoma Aosta Valley, sown the 6 May 2022. For each landrace, a plot constituted of four adjacent rows of 5 m in length and spaced 0.8 m apart was sown. Each row accounted for 25 seeds, one every 20 cm. The experimental field was managed according to standard agronomic practices for maize nurseries.Landraces were reproduced according to a random-intermating system in order to avoid selfing and fresh seeds were stored in the germplasm collection held at the IAR and at the Department of Sustainable Crop Production of Università Cattolica del Sacro Cuore .Phenotypic characterization was performed on 40 plants for each variety, according to the UPOV TP/2/3 protocol  in Saint-Marcel (AO) during the growing season. Anthesis and silking were recorded as Days After Sowing (DAS).Young leaf tissues were sampled from the field of Piacenza at the V5 stage (fifth leaf). DNA was extracted with GenElute™ Plant Genomic DNA Miniprep Kit  following manufacturer instructions. The extracted DNA was then visualized and quantified on 1.0% agarose gel electrophoresis stained with Eurosafe nucleic acid stain .Taq polymerase (0.2 µL of 5 U/µL stock), and H2O to final volume of 25 µL. The PCR cycles were performed as reported by Stagnati et al. [Ten SSR markers previously reported for the characterization of Italian maize landraces ,25,26 weFragments of different fluorescence and size were multiplexed and separated using an ABI 3130xl Genetic Analyzer sequencer . PCR fragment visualization and sizing were performed using GeneMapper software version 4.0 (Applied Biosystems).Detected alleles were analyzed with the GenAlEx6 software  to compuupgma function of the Phangorn package [meandistance.matrix available in the polysat [A phylogenetic tree was constructed using the Unweighted Pair Group Method with the Arithmetic mean method applying the  package  starting polysat  package 5 and 106 Markov Chain Monte Carlo replications. The best estimation of K was selected according to the method of Evanno [The population structure of the maize collection was examined using a Bayesian clustering algorithm implemented in STRUCTURE v.2.3.4 . The “adf Evanno ,40 Assigf Evanno .For the first time, five maize landraces from Aosta Valley have been sampled and characterized. Genetic analysis revealed that these landraces present intra-population variability while high levels of differentiation exist between populations. Ancestry analysis revealed that three of the sampled landraces have an independent origin, while the remaining two are more related. The high genetic differentiation finds correspondence at the phenotypic level. Generally, these landraces have flint kernels, a variable color from yellow to dark red. The landrace Arnad is probably a representative of the Eight-rowed Flint ratial complex while the other accessions are of undetermined type. Interestingly, Perloz showed kernels with an apical beak, a common feature of mountain maize landraces, which suggests that this landrace belongs to the “Rostrata” group.Overall, the present work confirms the importance of mountain areas in conserving biodiversity and increases the rich Italian maize germplasm with materials well adapted to marginal areas. Such new genetic variability may be used to breed new materials for more resilient agriculture.


Remote measurement technology (RMT) has the potential to address current research and clinical challenges of attention-deficit/hyperactivity disorder (ADHD) symptoms and its co-occurring mental health problems. Despite research using RMT already being successfully applied to other populations, adherence and attrition are potential obstacles when applying RMT to a disorder such as ADHD. Hypothetical views and attitudes toward using RMT in a population with ADHD have previously been explored; however, to our knowledge, there is no previous research that has used qualitative methods to understand the barriers to and facilitators of using RMT in individuals with ADHD following participation in a remote monitoring period.We aimed to evaluate the barriers to and facilitators of using RMT in individuals with ADHD compared with a group of people who did not have a diagnosis of ADHD. We also aimed to explore participants’ views on using RMT for 1 or 2 years in future studies.In total, 20 individuals with ADHD and 20 individuals without ADHD were followed up for 10 weeks using RMT that involved active (questionnaires and cognitive tasks) and passive (smartphone sensors and wearable devices) monitoring; 10 adolescents and adults with ADHD and 12 individuals in a comparison group completed semistructured qualitative interviews at the end of the study period. The interviews focused on potential barriers to and facilitators of using RMT in adults with ADHD. A framework methodology was used to explore the data qualitatively.health-related, user-related, and technology-related factors across both participant groups. When comparing themes that emerged across the participant groups, both individuals with and without ADHD experienced similar barriers and facilitators in using RMT. The participants agreed that RMT can provide useful objective data. However, slight differences between the participant groups were identified as barriers to RMT across all major themes. Individuals with ADHD described the impact that their ADHD symptoms had on participating , commented on the perceived cost of completing the cognitive tasks (user-related theme), and described more technical challenges (technology-related theme) than individuals without ADHD. Hypothetical views on future studies using RMT in individuals with ADHD for 1 or 2 years were positive.Barriers to and facilitators of using RMT were categorized as Individuals with ADHD agreed that RMT, which uses repeated measurements with ongoing active and passive monitoring, can provide useful objective data. Although themes overlapped with previous research on barriers to and facilitators of engagement with RMT  and with a comparison group, there are unique considerations for people with ADHD, for example, understanding the impact that ADHD symptoms may have on engaging with RMT. Researchers need to continue working with people with ADHD to develop future RMT studies for longer periods. Attention-deficit/hyperactivity disorder (ADHD) is a common psychiatric disorder, with a prevalence of 2.5% among adults . ADHD isIndividuals with ADHD are often assessed in a clinic or research laboratory setting, providing a snapshot of the symptoms and impairments they experience. Recent developments in remote measurement technology  offer new opportunities to address current research and clinical challenges ,6. For rResearch using RMT has been successfully applied to many populations -11. DespHypothetical views and attitudes toward RMT in a population with ADHD have been explored previously . Focus gThe ART pilot study was an observational study involving a 10-week RMT study period, using active (questionnaires and cognitive tasks) and passive (wearable devices and smartphones) monitoring. The ART pilot study involved 2 participant groups: adolescents and adults with ADHD and a comparison group . Semistructured interviews were completed after participating in the study, following a topic guide on the barriers to and facilitators of using RMT in individuals with ADHD and in those without ADHD.Participants were eligible to participate in the ART pilot study if they were aged between 16 and 60 years, able to provide informed consent, fluent in English, and willing to wear a wearable device and use an Android phone during the 10-week remote monitoring period. Participants with ADHD were eligible if they met the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, criteria for ADHD, and participants in the comparison group were eligible if they did not reach the threshold for ADHD on the Barkley symptom and impairment scale . ParticiParticipants attended 2 remote baseline sessions with a research worker using Microsoft Teams. The first remote baseline session with the participants with ADHD included the administration of the Diagnostic Interview for ADHD in adults  to confiThe second session was administered once participants had received their wearable device (Fitbit Charge 3) and Android smartphone via post (if they were not using their own compatible Android device) approximately a week after the first session. It included training on the use of wearable devices and on the smartphone Passive and Active Apps. The participants also received a leaflet summarizing key information (Participant Technology User Guide) and researcher contact details for future reference.All participants then participated in a 10-week remote monitoring period using a wearable device and smartphone. RMT incorporated active (questionnaires and cognitive tasks) and passive (wearable device and smartphone sensors) monitoring. Active monitoring involved the participants completing clinical symptom questionnaires on the smartphone Active App and cognitive tasks on their home PC or laptop during weeks 2, 6, and 10 . ParticiAt the end of the 10-week remote monitoring period, participants were invited to participate in an optional “debrief” session, which included a qualitative interview to investigate their experiences of participating. The data collected during the interviews formed the basis of this study. The interviews, which lasted 25 to 50 minutes, were conducted by 2 research workers (QD and HD) and focused on potential barriers to and facilitators of RMT using a semistructured framework that covers participant experience, enrolling into the study and support, working the study into daily life, experience of using the devices, data privacy and sharing, and future uses.The interview and study procedures were approved by the North East—Tyne and Wear South Research Ethics Committee . Informed consent was obtained from all participants before the assessments started. To maintain participant anonymity, their data were pseudonymized. The participants’ names were replaced with a code. Data collected from apps, wearable devices, and interviews were only associated with this code and stored separately from any personally identifiable information. Participants were compensated £30 (US $37) after the completion of the baseline sessions, £20 (US $25) after the first remote active monitoring follow-up (end of week 5), and a further £50 (US $62) at the study end point (end of week 10). The participants did not receive additional compensation for completing the debrief interviews.Descriptive statistics were calculated for gender, age, and ethnicity. All interviews were audio recorded and transcribed verbatim. A framework methodology was used to qualitatively explore the data : (1) traThe framework methodology is suitable for the analysis of interview data, where it is desired to make comparisons within and between cases . PercentIn total, 20 individuals with ADHD and 20 individuals without ADHD in a comparison group participated in the ART pilot study . Of the For participants with ADHD, RMT provided better insight into their health-related behaviors and lifestyle. For health-related behaviors, RMT  provided better insights into their sleep and physical activity levels, and participants with ADHD described improvements in these health-related behaviors. In terms of lifestyle, RMT provided participants with ADHD better insight into their routines and phone use, and some participants also described an improvement in these areas. For example, 1 participant with ADHD explained as follows:I’ve definitely found it helpful in sort of motivating me to keep a good routine and try and get my steps in every day. So, like exercise and health wise, it’s been really good.ADHD03Participants in the comparison group also agreed that RMT gave them better insight into their sleep and physical activity and noted improvements in these health-related behaviors:Well, having the Fitbit data that’s very helpful...I’ve been using the Fitbit data actively to monitor my exercises or meditation, sleep quality, so that was very useful.COMP21Participants with ADHD commented on the impact of ADHD symptoms on taking part in the study. Participants with ADHD described difficulties with attention, forgetfulness, motivation to complete demanding tasks, and organization, which impacted their experiences in the study. Difficulties with forgetfulness included remembering to complete questionnaires and cognitive tasks and to charge the devices. One participant explained as follows:I’m not really organised with things. Things happen at the spare of the moment...I’m not someone that can pre-think that my Fitbit’s gonna run out of charge, it would be like “oh, now it has now run out of charge.”ADHD01Perceived costs relate to any aspects of RMT that made participation challenging or difficult. The most prominent perceived cost for participants with ADHD was the cognitive tasks. There were also some perceived costs relating to passive monitoring measures, such as charging the devices, adapting to the new study phone, and phone connectivity issues . The comparison group reported fewer personal costs.There was a consensus among participants in both groups that the ART pilot study fit into their daily life. One participant explained as follows:The overall experience was like very easy...I was just carrying on with my normal life.ADHD04“could honestly just go about my daily life and participate, yeah, passively” (ADHD09). Despite the study blending into participants’ daily life, some participants with ADHD mentioned difficulty finding the time to complete the cognitive tasks in a quiet and distraction-free environment. This was also mentioned in the comparison group:Another participant described that they I did sometimes struggle to find like an hour that I could just block off and have no distractions and things, that was a bit more tricky.COMP13There was agreement among participants with ADHD that the benefits of participating outweighed the costs of participating in the study. For example, 1 participant with ADHD explained as follows:Oh no, definitely benefits outweigh, like there wasn’t really any cons, it was very simple and straightforward. But then like benefits, yup definitely more aware of my sleep and my exercise. So really, really outweighed the cons, definitely.ADHD04Participants in the comparison group also agreed that the benefits outweighed the costs, with 1 participant stating, “100%, like, it’s definitely worth taking part” (COMP16)., with 1 participant explaining as follows:All participants with and without ADHD commented on the acceptability and ease of collecting the passive dataYeah, I mean that’s easier to be honest, um, as long as I know what data is being collected and it’s not particularly, um, kind of sensitive data, it’s not looking at kind of what’s going in and out of text message conversations, for example. Um, it’s easier to have that collected passively for me personally, rather than to actively remember to upload something.COMP19Participants explained that they accepted RMT measures as technology nowadays collects these data. Participants with and without ADHD mentioned that the study had been well explained and were reassured that the study had gone through the correct reviews, so they could trust that the study was ethical, that it would be safe for them to take part, and that their data would be kept anonymous.Overall, the participants’ experience using the smartphone and wearable device in the ART system was positive. Participants both with and without ADHD described the study as easy, enjoyable, and interesting. One participant with ADHD explained as follows:You know ’cause it gave me a very new exciting toy to play with...and I mean it was very exciting. You know, the study wasn’t too long that it got boring, you know?ADHD02Participants with and without ADHD also noted that the study period went quickly and that the study was well organized.Few participants with ADHD described the study as demanding or that it required a short-term adjustment period. However, more participants in the comparison group described the study as long, demanding, or requiring an adjustment period. For example, 1 participant in the comparison group explained as follows:I guess it was, it was more of an intensive or like a like a longer study than ones I’ve done before.COMP13Despite these comments, these participants also reported that the overall experience of the study was positive and that the benefits outweighed any costs.There was a consensus among participants that there was value in gathering RMT data. One participant with ADHD explained as follows:I think it’s really great. Um, I think it really, sort of improves the ability to get accurate and up-to-date data. I think it’s great.ADHD10In general, participants described passive data as collecting objective measures of their health and that such data are more accurate than “manually record[ing] it yourself” (ADHD03).Participants with and without ADHD commented that passive monitoring was better than manually providing the data, as it improved the accuracy, the amount of data collected, and the ability to observe behavioral patterns and to compare variables. A participant with ADHD commented as follows:I mean, it certainly made it more accurate ’cause I’m very aware now that if I’d been filling out forms, they would not have been accurate at all because I had absolutely no awareness of how much sleep I was getting.ADHD10Participants with ADHD expressed the view that the passive monitoring aspect made it easier for the participant to participate, for example:With the passive monitoring so like when you’re monitoring sleep, the fact that you’re not kind of having to manually record it yourself, and it is done all automatically, I think that sort of, umm, I think if you were having to like manually record it and go to that effort, you would, I think it would have an influence on your, sort of, approach to kind of going to sleep and things like that. Whereas when it’s done passively, like you’re not having that kind of, um, that you’re not putting that input in yourself.ADHD03Participants in the comparison group also commented that passive monitoring made it easier for them to participate.Cognitive tasks were described as the most intrusive aspect of technology-related barriers to RMT. All participants with ADHD described the cognitive tasks as tedious, for example:Yeah, I’m not sure if there’s anything that can be done about it...but the tasks were really difficult...I’m not sure how like a neurotypical person would find it, but sort of sitting and looking at a screen with no stimulation other than it for close to an hour was really hard!ADHD10In general, participants with ADHD viewed cognitive tasks as being too long or commented that the frequency of completing the tasks was too often. The cognitive tasks were also described by the participants in the comparison group as tedious, the tasks were viewed as too long, and participants commented on the frequency of the tasks being too often.Some participants expressed concerns over monitoring; for example, they had initial concerns that the research team would be monitoring their location. In total, 3 participants questioned the relevance of the aggression questionnaire they were asked to complete.Participants described in detail the usability of the Active App, Fitbit wearable device, and study Android phone. For the Fitbit, participants with ADHD noted that it was comfortable; however, they reported some adherence difficulties and technical issues during the study period. Adherence difficulties included remembering to charge and remembering to wear the Fitbit again after charging or showering. Technical issues described by participants with ADHD were related to charging issues and syncing the Fitbit with the smartphone. Participants in the comparison group also commented on their comfort, adherence difficulties, and technical issues.Technical challenges with the study Android phone were reported by individuals with ADHD; these included problems with the Passive App including synchronizing and transfer issues. Despite reporting some technical issues with the Passive App, participants with ADHD mentioned that the phone was easy to use and that they were able to use the phone normally. The questionnaires on the Active App were described as being easy to complete.Participants were asked for their views on using the ART system in the longer term. Overall, participants with ADHD were positive about using the system for 1 or 2 years. One participant explained as follows:Yeah, I think because it was so behind the scenes, I didn’t have to do anything. You were just sort of looking at what I’m doing on my normal day-to-day. Yeah, it wouldn’t bother me [to take part for] a year.ADHD04Participants in the comparison group also agreed with this; for example, 1 participant explained as follows:Yes,...I wouldn’t find it like a very big strain to participate in the study if it was exactly as it was for a longer period of time.COMP20Participants were asked to consider how they would feel about RMT data being shared with the general practitioner (GP). There was some discrepancy among participants with ADHD regarding whether they would find it acceptable to share these data with GPs, whereas the comparison group agreed that this would be acceptable. In general, those who would be willing to share RMT data felt it could benefit the care they received, as it would provide GPs real-time access to objective data that they could then take action on. One participant with ADHD explained as follows:I think that could be sort of quite beneficial ’cause then it would then help, say the GP or whoever, to understand a bit better exactly what’s going on...They can kind of see from the data...what you’re saying is, is how it is.ADHD03Those who would be less willing to share RMT data with GPs questioned whether all RMT data would be relevant to share with their GPs. Despite this, participants with ADHD emphasized they would find it more acceptable if they had a choice in what aspects of RMT would be shared, for example:I would prefer to choose as some of it obviously, I would feel isn’t relevant to me and they don’t need to [know].ADHD09Only 1 participant in the comparison group expressed concerns about whether the data collected were relevant to their health care.Participants with and without ADHD described improvements that could be made to the ART system for future long-term studies. This included additional feedback during the study period. Participants suggested that feedback should be given on both active and passive monitoring data in either a visual or verbal format, which would be shared both during and at the end of the study.Some participants with ADHD suggested that providing more information would be beneficial for future studies, such as information on adapting to the Android phone, data use, video explanations, and leaflets for technology instructions. However, 1 participant with ADHD commented that the information sheets contain too much information and should be shortened.“anything that could be done, just like you know shorter but more frequent—that would’ve been great!” (ADHD10); and (2) less-frequent administration, for example, “Yeah, I think if you’re doing it for a much longer period, I would definitely say needs to be a longer gap between them” (ADHD03). Participants in the comparison group also agreed with these suggestions; for example, 1 participant in the comparison group explained as follows:The participants suggested changes specific to the active and passive monitoring aspects of ART system, including cognitive tasks (active monitoring) and the smartphone (passive monitoring). The participants with ADHD suggested two ways to improve the administration of the cognitive tasks: (1) shortening the length, for example, 1 participant explained, You know, maybe if you did a yearlong study, you maybe wouldn’t need to do [the cognitive tasks] quite so often.COMP13Improvements in passive monitoring aspects of the ART system were related to the study smartphone. Participants with ADHD suggested improving syncing issues of the Passive App and that it would be better to be able to use their own phone during the study period, instead of a study Android phone. Participants in the comparison group also made these suggestions.When comparing themes that emerged across the participant groups , individIn the user-related theme, more individuals with ADHD noted that the cognitive tasks (active monitoring) were a perceived cost compared with the comparison group. This would be expected because of the demand of the cognitive tasks in individuals who have difficulties with attention to demanding tasks, that is, the cognitive tasks have been specifically designed to be challenging for individuals with ADHD in order for them to be informative about the differences between people with and without ADHD. Another perceived cost for individuals with ADHD was the charging of the devices, whereas participants in the comparison group did not mention this. In the overall experience minor theme, the negative subtheme highlighted some differences between individuals with and without ADHD. Compared with participants with ADHD, more participants in the comparison group described the study as long, demanding, or requiring an adjustment period.In the technology-related theme, individuals with ADHD described more technical challenges related to the study Android phone, compared with those in the comparison group. In the future studies theme, there was disagreement among the individuals with ADHD about sharing RMT data with the GP, whereas participants in the comparison group found this acceptable.This study builds on a growing number of RMT studies in clinical populations. Our findings provide novel insights into the barriers to and facilitators of using RMT in individuals with ADHD who have completed a remote monitoring study period that uses repeated measurements with ongoing active  and passive  monitoring. This study highlights the similarities and some, albeit few, differences between individuals with and without ADHD interpreted as barriers to and facilitators of RMT. The ART pilot study also shares similar methods and measures as the RMT in individuals with depression and epilepsy ,26, and Individuals with ADHD, as well as the comparison group, commented on the benefits of using the wearable device, including them obtaining better insight and being able to observe improvements in their sleep and physical activity. Although these insights may have helped maintain participant engagement with the study, we note that using the devices to change behavior was not an aim in the ART pilot study . The ART pilot study involved a remote monitoring period of 10 weeks, and over a longer remote monitoring period, these effects may be reduced, as participants have longer to acclimatize to wearing and using the devices, so its novelty of receiving insight into health-related behaviors may reduce. Future research should consider the type of feedback provided by the wearable devices.Owing to individuals with ADHD often reporting difficulties with following through on instructions, remembering daily tasks, and maintaining attention on demanding tasks , we hypoBarriers to using RMT in individuals with ADHD are mainly related to the perceived cost and intrusiveness of cognitive tasks (the frequency of administration and time taken to complete them). The tasks were completed during weeks 2, 6, and 10; this is the first study in which multiple measurements using cognitive tasks were collected in a 10-week period. Future studies should allow more time between the tasks to ensure participants are not fatigued and their continued participation in the study.Participants noted that the benefits of participating in an RMT study outweighed any costs. This finding is positive for future studies using RMT in individuals with ADHD. Despite initial concerns that using RMT with individuals with ADHD relies on the participant to engage with the technology and researchers, all participants with ADHD described the study as fitting into their daily lives. The compatibility of RMT was also described by all individuals in the comparison group. The importance of compatibility with one’s existing routine was also described in individuals with major depressive disorder .As RMT collects vast amounts of data on a variety of different measures, it is expected that concerns about data privacy may arise. Privacy concerns have also been raised in other RMT studies, including individuals with depression and epilepsy ,28. AlthIndividuals with epilepsy have reported interest in using RMT as a method to remember and communicate with health care professionals . IndividBuilding on the barriers to and facilitators of RMT described by individuals with ADHD, future research using RMT should incorporate our suggestions for long-term monitoring of individuals with ADHD . These rAt a group level, individuals with ADHD were positive about using the ART system for 1 or 2 years. There was agreement that despite some technical issues, RMT collected objective data and had the potential to help provide evidence about their ADHD symptoms or co-occurring health behaviors to their GP or health care professionals. On the basis of the reports that individuals with ADHD felt their symptoms impacted their study experience, future research should incorporate ADHD-specific support from researchers to help with the core symptoms of ADHD  to promote with adherence. There was consensus that future studies using cognitive tasks should be conducted less frequently.Privacy concernsEmphasis should be placed on the participants’ control over their data and their choice to share data with health care professionals.Technical issuesTechnical issues will happen, but the overall consensus is that the smartphone apps and wearable devices allow for objective and accurate data collection.Adjustment periodAllow for an adjustment period while the participant becomes familiar with the new devices. In addition, provide self-help guides and videos to aid with the introduction of new devicesFeedbackFeedback to individuals with attention-deficit/hyperactivity disorder should be personalized based on the types of RMT data that individual would like to see and in the form they would find most useful .AdherenceReminders throughout the study period, including to complete questionnaires, are vital for successful completion rates, but reminders should also be extended to reminding the participant to replace the wearable device after it is removed for charging or showering.Cognitive tasksFewer cognitive tasks during a study period with longer completion timesThe use of qualitative methods allows for an in-depth exploration and discussion of the potential barriers to and facilitators of using RMT, such as smartphone apps and wearable devices, for a remote assessment and monitoring system that can be applied to both research and clinical long-term monitoring of symptoms, impairments, and health-related behaviors associated with ADHD.Previous qualitative research has relied on hypothetical views of using RMT ,28,29. AThe gender imbalance in this study is also a limitation that should be acknowledged. In adulthood, the prevalence rate of ADHD is similar for male individuals and female individuals ; howeverThis study builds on emerging research on the barriers to and facilitators of using RMT in psychiatric disorders in health care and long-term monitoring. We have shown the barriers to and facilitators of using RMT in people with ADHD following a 10-week remote monitoring study period. The themes that emerged during this qualitative analysis suggest that people with ADHD agree that RMT can provide useful objective data that uses repeated measurements with ongoing active  and passive  monitoring. Although themes overlapped with previous research on barriers and facilitators of engagement with RMT  and with a comparison group, there are unique considerations for people with ADHD, for example, understanding the impact of ADHD symptoms has with using RMT and reducing the frequency of cognitive task administration. Researchers need to continue to work with people with ADHD to develop future RMT studies for longer periods.