Attention deficit Hyperactivity Disorder (ADHD) is the commonest childhood neurodevelopmental disorder, affecting 3 to 9% by school age, and often persists into adulthood. ADHD in children and young people (CYP) has wide ranging multi-modal impacts on the affected CYP, their carers and the society. Co-morbidity with other neurodevelopmental, behavioural and emotional disorders is the rule rather than exception. Pharmacological treatment is not recommended as the sole therapeutic intervention, and several other non-pharmacological interventions have been advocated within a framework of Multi-modal strategy as the norm, to address both the core symptoms as well as the behavioural and other related difficulties. All paediatric professionals need to be familiar with the principles of different modalities of non-pharmacological or behavioural interventions for managing ADHD in CYP. Most published up-to-date evidence for behavioural interventions both for the core ADHD symptoms and other outcome measures are summarized in this article, including the peculiar problems related to their research. The most effective evidence-based strategies for controlling ADHD core symptoms are combination of stimulant medications with Behavioural therapy (BT) or Cognitive behaviour therapy (CBT), as well as group-based parental Psychoeducation. Standalone BT, CBT, Mindfulness, Neurocognitive training and Neurofeedback cannot currently be recommended for controlling core symptoms due to limited evidence. Other Behavioural interventions could lead to improvements in ADHD-related outcomes, including parenting skills, CYP's social skills, academic performance and disruptive behaviours. School-based non-pharmacological interventions have been shown to reduce disruptive behaviours. Executive skills are also significantly improved with use of computer-based Neurocognitive training and regular physical Cardio exercises. It is disappointing that combinations of different types of psychosocial interventions have low efficacy on both the core ADHD symptoms and other related outcomes. The readers are welcome to test their knowledge and learning efficacy through an accompanying quiz. Its core symptoms are persistent and pervasive inattention and/or overactivity/impulsiveness impairing functioning in multiple settings. It is now classified under the umbrella of “Neurodevelopmental disorders” within the DSM-5 and ICD-11 standards. Furthermore, 65–80% of patients with ADHD have conduct problems and other comorbidities, in addition to low academic achievement and poor social and organizational skills. Parents of children and young people (CYP) with ADHD often experience poor self-concept and emotional problems Pharmacological treatment is not recommended as the sole therapeutic intervention, and several other non-pharmacological interventions have been advocated within a framework of Multi-modal strategy as the norm. In the UK, the National Institute for Clinical Excellence - NICE guidance recommends only psychosocial treatment for ADHD CYP with mild or moderate levels of symptoms and impairment, escalating to additional pharmacological treatment for those with severe symptoms and impairment, for those refusing non-pharmacological interventions or if the response is poor We have assessed and summarise here the non-pharmacological interventions for ADHD which could be used as first line treatment for patients with ADHD. The implementation of non-pharmacological strategies has become particularly crucial during the COVID-19 pandemic crisis and thereafter, with restricted contact with healthcare professionals The readers are welcome to test their knowledge and learning efficacy through the accompanying quiz.Clinical Scenario: A 14 year old boy was recently diagnosed with ADHD. He is reluctant to use stimulant medications because he and his parents have reservations about their side-effects. He has come to discuss with the Clinician about the effectiveness of non-pharmacological options for managing his symptoms.2.We conducted a systematic search of the following electronic databases: Pubmed, PMC, CINAHL, Embase, PsycINFO, Ovid, Database of Abstracts and Review and the Cochrane Database of Systematic reviews, with no limitations in terms of language and date of publication from inception to Dec 2021. Search terms included a combination of the following: “non-pharmacolog?”, “childhood”, “psychoeducation”, “behavior?”, “parent?”, “ADHD”, “impairment” or “psycholog?”. The relevant publications were summarised, and the emerging themes are presented. Over 5000 abstracts and titles were retrieved from various databases searched, out of which relevant full text articles were independently identified by each author and included in the review by agreed consensus.3.3.1.Multimodal treatment approaches are recommended by several national and international clinical guidelines Problems of public scepticism/cynicism about ADHD managementPublic opinions have become divided, and several controversies have emerged around the wide variations in medical and non-orthodox practices that have been promoted and implemented in the management of ADHD. Some people have gone as far as querying the existence of ADHD as a bona fide medical diagnosis ADHD medications do not result in universal effective responses.It has been reported that 10–30% of CYP would not respond to ADHD stimulant medications Efficacy of stimulant medications is lower in younger children and is associated with a higher burden of side effects Parental and some Clinicians' perceptionsSome parents and clinicians are reluctant to recommend ADHD medication use due to concerns about undesirable long-term side-effects and express preference for non-medication options Problematic low therapeutic compliance during adolescence.Pharmacotherapy is less effective for the management of commonest co-morbidities of oppositional and conduct problems or challenging behaviour.Pharmacologic treatment is less effective among preschool children Adverse effects of pharmacological treatmentsMild to moderate adverse effects are common with all pharmacological agents used in the treatment of ADHD, including disturbances of sleep, growth, appetite, blood pressure and heart rate. More severe side effects such as psychotic symptoms are also rarely reported. A few observational studies have also reported increased risks of seizures, tics, depression and suicidal attempts associated with pharmacologic treatment of ADHD Higher level of acceptabilitySome studies have confirmed high levels of acceptability Behaviour therapy alone when compared to pharmacology treatment, and there are higher risks of patients discontinuing ADHD medication use compared to placebo 3.2.Four types of Behavioural or Psychosocial interventions are available . Each moBox 1.Psychosocial interventions: Body-focused interventions: Cognitive/neuro-Cognitive Therapy (CT): CT/computer attention training/working-memory training/attention training/Neurofeedback (NF) training/Electromyographic (EMG) biofeedback interventionsCognitive-behavioural training: Box 2.Psychoeducation is defined as an intervention with systematic, structured and didactic knowledge transfer for an illness and its treatment, integrating emotional and motivational aspects to enable patients to cope with the illness and to improve its treatment adherence and efficacy. Psychoeducation empowers patients and families to better understand and cope with the illness more successfully and to commit to more long-term involvement.Neurocognitive training involves repeated practice of ADHD-specific deficient neuropsychological processes such as working memory or attention. Neurocognitive training typically involves digital, automated training exercises for strengthening any deficient neurocognitive function.Neurofeedback enhance beta (15–18 Hz) and inhibit theta (4–7 Hz) brain activity.Neurofeedback uses video visualization or sound representations of brain activity via EEG recording to teach children to increase attention and impulse control. The most frequently used frequencies in Mindfulness-Based Interventions enhance self-regulation and capacity to pay attention to experiences in the present moment through three processes: enhanced attention control, improved emotional regulation and altered self-awareness (meditation).Parent training encourages behaviour control strategies designed to enhance desirable and discourage inappropriate child behaviours, improve positive and constructive adult–child interactions, enhance Parenting self-concept and increase parenting confidence.Behavioural therapy includes interventions aimed at changing child's behaviours (enhancing appropriate behaviours and decreasing undesired behaviours), based on social learning and other cognitive principles.Cognitive Behaviour Therapy (CBT) integrates a combination of both cognitive and behavioural learning principles to teach coping skills and encourage desirable behaviour, emotions and thought patterns.3.3.Several problems have been identified as barriers to efforts in carrying out high quality research into the effectiveness of non-pharmacological and psychological treatment modalities, which are not encountered in research with pharmacological agents. These problems include difficulties with running truly blinded trials, high costs, a dearth of specialist therapists and homogeneity of ADHD phenotypes Box 3.It is difficult to ensure the principles of gold-standard randomized trials with blinded outcome assessment , with the consequent bias risk of inflated efficacy estimates.Behavioural interventions produce outcomes that are difficult to maintain over long durations, and research projects are generally more expensive to run than pharmacological studies The outcomes of behavioural interventions only affect specific targeted functions, do not appear to be generalised to other behaviours and may not be applicable in other settings There is a general shortage of trained community-based behavioural specialists to match the number of CYP with ADHD.Significant improvement in some key areas of desirable functioning such as academic achievement, social skills, family relationships and executive abilities may not be achievable thorough non-pharmacological therapies There are limited studies to confirm the sustenance of immediate treatment outcomes for many behavioural therapies  ADHD is an heterogeneous condition with impaired functioning in several neurocognitive domains, which are difficult to measure accurately.3.4.I. Treatment of ADHD core symptomsThe research evidence for non-pharmacological / psychological treatment for ADHD core symptoms is summarised in Box 4.Psychoeducation in group of parents improved ADHD symptoms and cognitive levels significantly Behavioural therapy combined with stimulants seems superior to psychostimulants or non-stimulants alone.Stimulants alone seem superior to behavioural therapy, cognitive training and non-stimulants.Positive effects of Behavioural therapy are more likely to be reported for assessments made by unblinded parent ratings.Effectiveness of Cognitive behaviour therapy (CBT) for treating ADHD symptoms and functional impairment is mixed in several studies.Cognitive Behaviour Therapy (CBT) combined with stimulants improves core ADHD symptoms The evidence for the effect of working memory training programmes in producing a significant decrease in ADHD symptomatology is mixed.Effectiveness of Neurocognitive training to improve ADHD symptoms and related functional impairments has been mixed in several studies.Cognitive training had significant effects on total ADHD and inattentive symptoms for reports by raters most proximal to the treatment setting , while the effect size of cognitive training decreased to near 0 and became non-significant for blinded measurements made by observers.Meta-analytic evidence on the efficacy of Neurofeedback for ADHD core symptoms is currently mixed.The reported effectiveness of standalone non-pharmacological or psychological modalities of BT, CBT, working memory training, Mindfulness (meditation), NGT and NF for controlling ADHD core symptoms is mixed, and they currently cannot be recommended as stand-alone therapies.II. Effects on other ADHD-related behavioural problems.The research evidence for non-pharmacological /psychological treatment in controlling other ADHD-related behavioural problems is summarised in Box 5.Cognitive Behaviour Therapy (CBT) improves problematic and antisocial behaviours Combination of stimulants with Computer-based attention training game systems significantly improve attention scores, and evidence of F-MRI captured Functionality of both the salience/ventral attention network (SVN) and dorsal attention network (DAN).Cognitive training improves Executive functions (EF), matching with the healthy control children Behavioural therapy leads to significant improvements in 3 areas of parenting quality: positive parenting, decreased negative parenting and increased parenting self-concept.Parent training and other Behavioural therapies have shown positive results for parental knowledge and children's emotional, social and academic functioning - mostly from unblinded studies.Parent training improves effective parenting skills, reduces oppositional and noncompliant behaviours and may improve other functioning areas.Parent training has no significant treatment effects on self-rated parental mental health .Behavioural interventions are effective with low effect sizes on Child Psychopathology and functionality including conduct problems, social skills and academic performance Meta-analysis of 100 studies showed that classroom interventions reduce off-task and disruptive classroom behaviour in children with symptoms of ADHD, with largest effects for consequence-based and self-regulation interventions Cardio exercise improves executive functions based on event-related brain potentials; attention and Academic performance Parent-led and other adult/child-led Psychosocial interventions are associated with relatively low effect sizes, but they significantly improve Parenting skills, including positive parenting self-concept and improved parental knowledge Box 6.Classroom-based behavioural and teacher-based psychoeducation interventions are reported to reduce disruptive classroom behaviour in CYP with ADHD.Executive functioning in CYP with ADHD including attention and Academic performance are significantly improved with use of digital attention training game systems and other NCT interventions and active involvement in regular Cardio exercises III. Study of combined non-pharmacological modalities.Research studies on combined modalities, e.g., Computer-based Cognitive Training (CT) and parent training and combined CT, physical exercises and classroom behaviour management strategies, have yielded disappointingly no significant improvements on either the ADHD core symptoms or other related outcomes 4.There is an accumulated body of published evidence to prove the efficacy of some behavioural / psychosocial strategies for managing CYP with ADHD, with measurable benefits on several domains of daily patient and parent functioning. The only non-pharmacological intervention that has consistently shown significant benefits in several studies is parent- or teacher-child dyad Behavioural therapy Several ADHD-related outcomes, including parenting skills, child's social skills, academic performances and challenging behaviours, have been shown to respond significantly to non-pharmacological, psychological and Behavioural treatment strategies. School-based non-pharmacological interventions have been shown to reduce disruptive behaviours. Executive skills are also significantly improved with use of computer-based Neurocognitive training and regular physical Cardio exercises It is important to acknowledge that most clinical studies of ADHD in CYP are based on a predominantly male population, which has been partly attributed to gender stereotyping and symptomatology differences 5.Standard procedures for evaluating quality of the published evidence were not applied in this brief paper because it was not designed to be a systematic review. This is partly due to the dearth of high-quality research studies available for many non-pharmacological therapies and interventions. This article is mainly addressed to busy clinicians making daily judgment about appropriate psychosocial interventions for their young ADHD patients and their carers.6.With new advancements in computer science and wider implementation of Artificial Intelligence and Machine learning in many sectors of human endeavours, we could anticipate that more sophisticated neurocognitive enhancement programmes will be based on new advances in ADHD Neurobiology and consequently lead to better targeted improvements in both the core symptoms and other behavioural effects of ADHD We need to explore further ways to individualise optimal treatment for CYP with such a heterogenous condition as ADHD and in the future tackle potential public scepticism and cynicism regarding its management 7.Combining behavioural therapy with stimulants has shown significant effectiveness in enhancing attentional processes, reduces impulsiveness and may potentially lead to reduced dosing and duration of medication treatment and also help to reduce the risk of side effects. It also improves problematic and antisocial behaviours Standalone BT, CBT, Mindfulness, Neurocognitive training and Neurofeedback cannot currently be recommended  for contParenting CYP with ADHD can be very stressful, and targeting parental mental health problems with appropriate additional service provisions may enhance the effects of behavioural interventions The limitation of this paper should be noted because it was not designed as a systematic review, with no strict evaluation of the quality of the published evidence. The recommendations of this article are designed as a quick reference for busy clinicians for making quick day-to-day decisions for managing CYP with ADHD and supporting their carers. The recommendations will continue to evolve in the future as more robust research evidence becomes available.Click here for additional data file.


With attention-deficit/hyperactivity disorder (ADHD) being a prevalent disorder in childhood, it is essential to acknowledge the different adverse effects the disorder can have on the quality of life in children. Therefore, this systematic review focuses mainly on children. Medical therapy, especially stimulants, can have many side effects. Our systematic review aims to evaluate the potential of other non-medical treatment options for ADHD, such as yoga or meditation. We used PubMed and Google Scholar as databases for this systematic review. Using different combinations of medical subheadings (MeSH) and key terms, followed by the application of several inclusion/exclusion criteria and filters to narrow down our search. From an initial 51,675 articles, we selected 10 papers that passed our screening process and quality check to analyze in depth. Yoga and meditation positively affect various symptoms in children with ADHD, including attention, hyperactivity, and impulsive behavior. If done in family group sessions, it also benefited the parents and family dynamics, suggesting a potential option for family therapy. Furthermore, other psychological symptoms, such as anxiety or low self-esteem, appeared to be positively impacted by these interventions. Although yoga and meditation positively influenced children with ADHD, a more in-depth research is necessary with a more significant number of participants and over a more extended period of time. The results of the included studies suggest a substantial benefit. Nonetheless, as the number of studies is limited, at present yoga and meditation could be beneficial as supplemental therapy rather than being used alone as a therapy for ADHD. Attention-deficit/hyperactivity disorder (ADHD) belongs to a group of conditions classified as neurodevelopmental disorders. The prevalence is about 5% in children and an estimated 2.5% in adults. Individuals with this diagnosis struggle to pay attention, experience an urge to be constantly active, and are impulsive. ADHD can also be responsible for cognitive difficulties and executive deficits. Many factors can lead to ADHD, and one significant known factor is genetics. However, the disorder is not yet fully understood . ADHD crADHD has a significant impact on different areas of a child’s life. Children with ADHD struggle to fit in socially, find peers, and form interpersonal relationships. The disorder can also negatively affect the dynamics among family members. It affects the child's academic life, leading to learning difficulties and problems with completing tasks in a timely manner, and procrastination, which further leads to poor academic performance .The cost for individuals diagnosed with attention-deficit/hyperactivity disorder (ADHD) and their families is estimated to range from $143 to $266 billion in the United States [Effective therapy options can sometimes be challenging. Adverse long-term effects can occur if children do not receive early or efficient therapy . These iTaking non-medical treatments, such as cognitive behavioral therapy (CBT), into account can be a beneficial way to support children with ADHD . The focTo highlight the importance of this topic, we want to briefly mention ongoing research on ADHD, meditation, and yoga. The National Institutes of Health database for clinical trials reports an ongoing clinical trial, “Mindfulness-Based ADHD Treatment for Children: A Feasibility Study (MBAT-C).” It is a randomized controlled trial that includes 45 children between the ages of seven and 13 with ADHD. The plan is to complete the study by June 2023. The main focus is to assess the effectiveness of mindfulness-based ADHD treatment for children (MBAT-C) by evaluating ADHD symptoms before and after treatment .As there is a relatively small number of clinical trials on meditation and yoga as therapy options for ADHD, we decided to conduct a systematic review to look further into possible therapeutical benefits for ADHD patients . With chMethods This systematic review followed the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines 2020 . The PRISearch StrategyThe two primary databases used were PubMed and Google Scholar. Initially, we searched all key terms individually and came up with a very high number of studies. Therefore, we decided to combine our key terms to come up with more specific results. The key terms "ADHD," "children," "yoga," "meditation," "mindfulness," "therapy," and "treatment" were used in different combinations for each database. For PubMed, we used the following key term combinations: “ADHD children meditation,” “ADHD children yoga,” “ADHD children mindfulness,” “ADHD treatment yoga mindfulness,” “ADHD treatment meditation mindfulness,” “ADHD yoga,” and “ADHD meditation.” For Google Scholar, we used “ADHD children meditation therapy,” “ADHD children yoga therapy,” “ADHD children yoga mindfulness,” and “ADHD children meditation mindfulness” as search terms. In PubMed's advanced search, we used the medical subheadings (MeSH) yoga, meditation, and ADHD in different combinations to search for articles: ADHD AND Yoga AND Meditation, ADHD AND Yoga, and ADHD AND Meditation. We then applied our filters and exclusion/inclusion criteria to the total number of articles found, excluding those that did not meet our specifications. We further screened the remaining articles based on title and abstract and removed duplicates. After further evaluation, we did not retrieve 50 reports based on their content not adding value to our topic. We evaluated the remaining articles and did a quality assessment of those we retrieved. The final number of articles included in our search that met our criteria is 10.Inclusion CriteriaWe included only articles in the English language. Further, we only selected papers from 2002 until the day of our data search on June 10, 2022. We applied the following filter for the population: children ages zero to 18 years old.Exclusion CriteriaWe excluded every article not written in the English language from our data collection. Also, we removed all published articles before 2002 from our PubMed search and excluded all articles that focused on ages other than zero to 18 years old. We did not select articles that were not free for further evaluation.ResultsThe number of articles we found with our search strategy was 315 in PubMed and 51,360 in Google Scholar. After applying our filters and exclusion/inclusion criteria, we excluded 151 articles in PubMed and 44,560 articles in Google Scholar. We further screened the remaining 164 articles in PubMed and 6800 articles in Google Scholar and were able to delete 132 articles in PubMed and 6766 articles in Google Scholar based on title and abstract; we also removed all duplicates. We evaluated the remaining 32 articles in PubMed and 34 articles in Google Scholar. After not retrieving 50 articles, we did a quality assessment on 16 articles and excluded six articles for not meeting our criteria. The final number of articles included in our systematic review is 10. Out of the 10 eligible articles, there was one systematic review, one meta-analysis, one review article, three randomized controlled trials, two clinical trials, and two qualitative studies. For a more detailed description of our selected papers, see Table Quality CheckAfter selecting the final articles, they underwent a quality appraisal tool. For all systematic reviews and meta-analyses, we used the assessment of multiple systematic reviews (AMSTAR) criteria. For reviews or other papers we were not able to further classify, we used the scale for the assessment of narrative review articles (SANRAs) scale for quality assessment. For all randomized controlled trials, the Cochrane risk of bias tool was used to assess quality. For other clinical trials, we used the Newcastle-Ottawa Tool Scale. Finally, we used the Critical Appraisal Skills Programme (CASP) checklist for qualitative studies.DiscussionADHD and Yoga TherapyA randomized controlled trial by Cohen et al. evaluated the effect of yoga therapy on 23 children aged three to five years . The stuADHD and Meditation TherapyA review from Krisanaprakornkit et al. investigated the use of meditation therapy for ADHD. The review selected a total of four randomized controlled trials with 83 participants. Only two studies' data were sufficient for the review's meta-analysis . The stuA qualitative study from Bigelow et al. studied the effects of mindfulness meditation and exercise on executive functions and emotional well-being in children diagnosed with ADHD . IncludeSiebelink et al. conducted a qualitative study on a group-based mindfulness-based intervention (MBI) training named Mymind . The priFurther, Siebelink et al. also conducted a randomized controlled trial for children with ADHD and their parents named Mindfulness Training for Children with ADHD and Mindful Parenting (MindChamp) . The stuA clinical trial from Santonastaso et al. compared the effect of mindfulness-oriented meditation (MOM) to an Emotion Education Program (EEP) as a control . IncludeBarranco-Ruiz et al. conducted a systematic review to evaluate the effectiveness of mind-body therapies (MBTs) on children ages five to 18 with ADHD symptoms . Most stXue et al. conducted a meta-analysis to analyze the impact of mindfulness-based interventions (MBIs) on ADHD . The focEffects of the Combination of Medication and Meditation Thomas et al. investigated the effect of the stimulant modafinil on mindfulness and whether the combination of the drug and mindfulness training, such as meditation, can achieve better results . The stuLimitationsSome limitations of our systematic review include only retrieving studies in the English language since 2002. We decided to only select studies of children from birth until 18 years old. Therefore, we do not know if there are other studies conducted on yoga and meditation therapies with adults. As there is a limited number of studies for either yoga or meditation therapy in children with ADHD, many possible effects are still unclear. A further limitation of this study is that we only chose open-access articles for further evaluation.Our study evaluated yoga and meditation for children with attention-deficit/hyperactivity disorder (ADHD) and assessed the possibility of these interventions substituting or replacing medical therapy. Our included studies showed that yoga could improve ADHD symptoms and has the potential to be an additional therapy. Further, yoga and meditation therapy positively impacted the relationship dynamics within a family with ADHD, considering it a promising option for family therapy. In particular, meditation also positively affected the parents and helped them feel calmer and more mindful when caring for their children with ADHD. Both interventions positively influenced other aspects of mental health, such as anxiety, insecurity, and stress. Meditation had a positive effect on a variety of ADHD symptoms. For example, executive function, inhibitory control, hyperactivity, impulsivity, attention, and management of emotions. In conclusion, as yoga and meditation positively impact various symptoms of ADHD, they have a significant potential to be a bigger part of the therapy in the future. However, as the number of participants in our included studies was primarily small, we cannot conclude that yoga or meditation therapy could replace medication therapy in total. We suggest that it could be a great way to supplement treatment and support children in achieving a better quality of life. Therefore, it would be essential to do more in-depth research, favorable with a higher number of participants and over a more extended period.


Bartonella encompasses 38 validated species of Gram-negative, facultative intracellular bacteria that colonize the endothelial cells and erythrocytes of a wide spectrum of mammals. To date, 12 Bartonella species have been recorded infecting humans, causing diseases of long historical characterization, such as cat scratch fever and trench fever, and emerging bartonellosis that mainly affect animal health professionals. For this reason, this study aimed to report a documented case of Bartonella bovis infecting a veterinarian from Mexico by the amplification, sequencing and phylogenetic reconstruction of the citrate synthase (gltA) and the RNA polymerase beta-subunit (rpoB) genes, and to report the natural course of this infection. To our knowledge, this work is the first to report the transmission of B. bovis via needlestick transmission to animal health workers in Latin America.The genus  Bartonella encompasses a megadiverse group of Gram-negative, facultative intracellular bacteria that colonize the endothelial cells and erythrocytes of a wide spectrum of mammals. In this host group, these bacteria can generate long-lasting bacteraemia with multiple clinical signs, among which haematological, hepatic, and neurological manifestations stand out, varying in severity depending on the infecting Bartonella species and the host’s immunological status. Various arthropod species—most importantly fleas, lice, sandflies, and mites—are involved in the transmission of these bacteria. To the best of our knowledge, 38 Bartonella validated species have been identified globally, of which at least 12 have been confirmed to be zoonotic. The Bartonella bacteria most commonly found in humans are Bartonella bacilliformis, Bartonella quintana, and Bartonella henselae; however, the zoonotic potential of many other species is as yet unknown.The genus Bartonella-infected vertebrate hosts and their blood-sucking arthropods. Veterinarians are constantly at risk of acquiring species of these bacteria through bites, scratches and/or contact with the fluids of infected animals, as well as through the iatrogenic route. A certain group of Bartonella species is associated with artiodactyls (two toes) and perissodactyls (one or three toes), which have increasingly attracted the interest of public health professionals in recent years. This group includes the Bartonella chomelii and Bartonella bovis, which have been detected in cattle from Algeria, Lithuania, and the USA, generating persistent infections in their hosts. There is also a documented report of B. bovis causing endocarditis in a pregnant Angus cow in the USA. Animal production has increased due to the growing food demand worldwide, which has intensified concerns around the fact that veterinarians who work with livestock may be exposed to Bartonella species associated with these animals, causing diseases that could be underdiagnosed. For this reason, this study aimed to report the first documented case of B. bovis infecting a veterinarian from Mexico and to report the natural course of this infection.Animal health professionals are a risk group for zoonoses, since they are exposed to a wide range of potentially All procedures were carried out in accordance with the ethical standards of the institution or practice at which the studies were conducted. The current report was approved by the Research Ethics Committee of the Medical Faculty of the Universidad Nacional Autonoma de Mexico, FMED/CI/JMO/129/2017). The patient signed a written consent form for the publication of the case.st and were kept that way for the subsequent seven days. The patient self-medicated with 500 mg paracetamol every six hours; zinc; vitamins A, D and C; acetylsalicylic acid; and oral hydration with electrolytes, but his organism did not respond favorably to this type of treatment. All tests for the detection of infectious agents had come back negative up to this point. From 27 and 28 June onward, the patient experienced leukopenia, thrombocytopenia, lymphocytosis and alterations in C-reactive protein and D-dimer. Professionals decided to perform a Giemsa-stained blood smear for the microscopic identification of hemoparasites, and could visualize inclusions in erythrocytes compatible with members of the genera Anaplasma, Bartonella, and Mycoplasma  and the RNA polymerase beta-subunit (rpoB) genes for Bartonella, were amplified and sequenced using primers and thermal conditions previously reported by Martínez-Hernández et al. and Lozano-Sardaneta et al.. PCR products were evaluated on 2% agarose gels stained with SmartGlow. Positive amplicons were sent to Macrogen, Korea for sequencing. The recovered sequences were compared with those of other valid pathogen species using the BLASTn online tool and subsequently used to generate global alignments using the CLUSTAL W paired algorithm. Lastly, a phylogenetic reconstruction was conducted in Mega 11.0 using the Maximum Likelihood method, with 10,000 Bootstrap iterations and removing the gaps. Molecular assays did not detect Anaplasma or Mycoplasma DNA; but the blood sample tested positive for Bartonella. Using BLAST analysis, these sequences were found to be 99% (353/356 bp) and 100% (779/780 bp) identical to the corresponding sequences of the gltA  and rpoB (KF218218) genes, respectively, of B. bovis from Brazil and Guatemala. A Maximum Likelihood analysis confirmed that the bacteria collected from the patient corresponded to B. bovis, because it grouped with other B. bovis sequences detected in cattle from Guatemala and France, with a support value of 100  every 24 hours, for 15 days. A PCR was performed five days after the patient completed his treatment, as well as one month later. Since both tests came back negative and no evidence of symptomatology was found, the patient was discharged.On 14 June 2020, a 35-year-old male veterinarian working at a cattle ranch in the town of Ocotillo, in the municipality of Colipa, Veracruz, Mexico, accidentally inoculated his right pectoral with an implant needle while implanting lactating calves. Immediately afterwards, he washed the wound with soap and water  and resucoplasma . To alloe of 100 . SequencBartonella has increased exponentially in recent years. The frequency and occurrence of infections by species such as B. henselae have increased in veterinary clinics for small companion animals and in large production animal veterinary clinics in Spain and the United States. Additionally, there is a report of a suspected transmission, via needlestick, of Bartonella vinsonii subspecies berkhoffii to a veterinarian through accidental autoinoculation with infected blood from a dog. Given this background and the findings of this study, health professionals must be taught to be aware of the risk of needle stick transmission when handling patients, of the importance of wearing personal protective equipment, and of the immediate attention needed to deal with incidents involving sharp surgical material, as well as the need for post-incident surveillance for signs consistent with bartonellosis.The number of reports of animal health professionals infected with various species of the genus B. bovis infected a veterinarian after a work accident due to inoculation with bovine blood. Bartonella bovis is a microorganism that was first detected in dual-purpose cattle in Europe, in 2002. This species has also been found in countries such as Guatemala and the US, causing lesions consistent with endocarditis in adult cattle.Despite the factors mentioned and the severity of this problem, there are no studies assessing contact or direct work with large species, particularly cattle, as a risk factor of infections by pathogens prevalent in livestock. In this study, sequencing and phylogenetic analysis confirmed that B. bovis in humans and calls attention to the risk of exposure in certain occupations. Bartonella bovis was recently reported in Mexico, specifically in productive cattle farms in central Veracruz. This work demonstrates the need to consider this species a causal agent of febrile illness in animal health professionals, animal handlers, slaughterhouse workers, and by-product handlers.This case is a priority because it demonstrates the infective capacity of


The purpose of this research is to analyze the empirical evidence on the relationship between social cognition and prosocial behavior in children and adolescents with Attention Deficit Hyperactivity Disorder (ADHD). A systematic review was carried out following the PRISMA guidelines of empirical studies found in PubMed and Scopus databases, including a total of 51 research studies. The results indicate that children and adolescents with ADHD have deficits in social cognition and prosocial behavior. For children with ADHD, their deficits in social cognition highlight their difficulty in the process of theory of mind, emotional self-regulation, emotion recognition and empathy, affecting prosocial behavior, evidencing difficulty in personal relationships, and the creation of emotional bonds with their peers. It is currently established that the way in which humans relate to others consists of achieving success in terms of social recognition; thus, identifying the appropriate forms of interaction generates debates that bring modern studies to focus on social cognition, as a neurobiological, psychological, and social process, through which the subject perceives, recognizes, and evaluates social events, in order to build a representation of what happens between interactions, and find the appropriate response to each situation by evaluating the intentions of others, based on language and behavior .There are skills that are linked to social cognition, such as the ability to perceive the emotions of others, identifying facial signals, posture and prosody in others, as well as reasoning regarding mental states (theory of mind—ToM), empathy, and regulation of the emotions of others .One of the population groups most affected in terms of social cognition are individuals with Attention Deficit Hyperactivity Disorder (ADHD), defined as a neurodevelopmental disorder identified by problematic levels of inattention and/or hyperactivity—impulsivity. Inattention implies the inability to follow tasks and lose objects at levels that are incompatible with age and developmental level, while hyperactivity/impulsivity implies excessive activity for age and developmental level, which interferes in the academic, personal, and social spheres of those diagnosed .Neurocognitive deficits in ADHD such as disinhibition, inattention, impulsivity, and hyperactivity have been linked to deficits in social behavior and dimensions of social cognition, such as ToM, emotional processing, empathy, and prosocial behaviors. Children with ADHD are often negligent in identifying socially relevant cues that generate socially inappropriate responses with their peers, teachers, and parents, causing alterations in their adaptive behavior ,5.Social cognition has different dimensions and perspectives from which it can be understood. However, there is a consensus that refers to social cognition as an ability possessed by some species of social animals, including man, which allows them to recognize, manipulate, and behave with respect to information that is socially relevant to them. It is also well established that this ability requires a neural system to carry out the processing of social cues linked to motivational and emotional processes and adaptive behaviors based on the construction of representations of relationships between oneself and others and the flexible use of such representations to guide social behavior .Several terms used to refer to social cognition have been identified in the scientific literature. Empathy has been used in the context of social cognition to designate the abilities to recognize emotional states in others and to relate to the feelings of others. On the other hand, the theory of mind is frequently used to emphasize the idea that we have a metacognitive understanding of our own minds and those of others. Emotional processing involves the way in which each one of us cognitively and effective elaborates the representations of our emotions  and that of others.Emotional processing also involves the implicit attribution that guides the anticipation of emotional and behavioral patterns . All these components of social cognition are closely linked to the regulation of social intentions, the prediction of the behavior of others, and the ability to adapt to the demands of the context ,8.There is empirical evidence on the relationship between social cognition and prosocial behavior in children and adolescents with ADHD; some systematic reviews and meta-analyses on the dimensions of social cognition have been found. Ref.  analyzedThis systematic review extends the aforementioned literature by addressing the relevant dimensions of social cognition  and its relationship with prosocial behavior in children and adolescents with ADHD . This is of great importance for all those researchers who are interested in the subject, since there seems to be a consensus about deficits in social cognition and prosocial behaviors in children and adolescents with ADHD.This information could generate a call for attention to clinical and educational personnel to take into account in the evaluation not only cognitive, behavioral, and neuropsychological symptoms, but also measurements of components in social cognition. Thus, measuring these components could shed light on more comprehensive interventions that involve aspects such as empathy, ToM, emotional awareness, and prosocial behaviors in this population.This systematic review aims to describe the evidence on the relationship between social cognition and prosocial behavior in ADHD in children and adolescents, providing answers for the interaction processes and providing information on the importance of social cognition in human integrality.Some studies ,9,13,14 The objective of this systematic review is to analyze the empirical evidence on the relationship between social cognition and prosocial behavior in children and adolescents with ADHD.A systematic review of the scientific literature published on social cognition, prosocial behavior, and ADHD was carried out. The PRISMA  . We made the decision not to analyze these results because this database collects a lot of information without quality control from the sources and a wide variety of publications such as books, book chapters, communications, and presentations of scientific events, technical reports, theses or degree works, non-scientific works from repositories of different institutions, teachers’ subject guides, PowerPoint presentations, and Word documents, among others, without a filter that categorizes the quality of these products with published research articles in scientific databases.The first searches were performed in February 2021 by combining the terms “social cognition” and “ADHD”, and using the “AND” connector in Google Scholar, PubMed, and Scopus databases. These searches yielded 91,620 research studies, which provide a current overview of the topic to be discussed. Google Scholar was the database that produced the most records . Subsequently, the abstract of each of the articles was read, finally selecting 51 research studies that fully met the established criteria. The 130 excluded articles focused on biological processes of the sample, had little depth in terms of social cognition, prosocial behavior, and ADHD, and were qualitative research or theoretical or systematic reviews.All of the selected research named at least one of the systems of social cognition and/or prosocial behavior and related it to ADHD in children and adolescents, highlighting conclusions about their relationship and importance in the social development of the sample participants. Some articles also created relationships with the positive effects of methylphenidate (MPH) on social cognition processes in children and adolescents with ADHD; the decision was made to include them because their approaches were in line with the other research studies conducted and their conclusions were comparable to the other studies.In most of the research studies, they evaluated theory of mind and emotional regulation; empathy was also important in this review; the other aspects of social cognition identified were social perspective-taking and pragmatic language, but they were not as repetitive in the different research studies .This section discusses the analysis of the research, providing a greater understanding and integration of the results obtained. A summary of the results of the selected studies is provided in n = 2439), 96.4% presented deficits in social cognition. This indicates that the diagnostic condition of the participants is closely related to deficits in social cognition and limitations in prosocial behaviors. The results indicate that the theory of mind (ToM) is the dimension affected most in children and adolescents with ADHD; however, emotional awareness, emotion recognition, and empathy are also deficits that generate a link with prosocial behavior, evidencing implications that affect the social development of children with ADHD.According to the total samples of the reviewed studies .Some reviewed studies exposed the deficits in emotional self-regulation in children with ADHD. Following the application of the Emotional Intensity Scale for Children (EISC), the authors pointed out that children with ADHD exhibited a higher emotional intensity response compared to the control group ; they alOn researching emotional awareness, applying the Emotional Intensity Scales, the Contingency Scale: main version , and the Event Scale  and the Leiter International Performance Scale, it was determined that children with ADHD show worse behavior when they are involved in group situations without or with minimal adult supervision, in addition to identifying that the presence of emotional dysregulation among preschoolers with ADHD is associated with considerable levels of behavioral comorbidity and social dysfunction . Other sAmong the dimensions of social cognition, we found the recognition of emotions, identifying that only one research study, which evaluated participants using the Emotion Recognition Task (ERT), concluded that there were no significant differences between the two groups, obtaining a result that the ADHD group was more confident in the recognition of sad and angry faces compared to the control group, in addition to not differing in the accuracy of emotion recognition .The results of the remaining research that studied emotion recognition showed social cognition deficits in the ADHD group. Emotion recognition was assessed using the Emotion Behavior Checklist (EEC), finding that children with ADHD have difficulty interpreting and describing the emotions of others . There iIn another study, it was appliedthe Emotion Recognition Task to their participants, concluding that children with ADHD exhibit deficits in emotion processing, affecting the recognition of facial emotions from contextual information . ThroughBy means of an animated transformation task (Radboud Faces Database)  and SoftAnother dimension of social cognition is empathy, which was studied by means of the Empathy Task and the Empathy Response Task (ERT), determining that children with ADHD are less likely to be empathetic to the emotions of storybook characters compared to the control group . It was Lower levels of empathy are found in children with ADHD versus feelings of sadness in others , but aftEmpathy processes are fundamental for interpersonal relationships and the bonds that develop from them, which is why, when there are deficiencies in empathy, there are difficulties in socializing and maintaining good relationships, directly affecting adaptation to the environment and not having adequate prosocial behavior to respond to it. Therefore, this systematic review also aims to find deficiencies in the prosocial behavior of children and adolescents with ADHD.After reviewing the research on prosocial behavior, all the studies agree that it impacts groups of children with ADHD. The results show that children with ADHD show deficits in social performance in relation to controls; however, the main characteristics of these deficits differ between types of ADHD. For example, children with inattentive ADHD were rated as having more passive behaviors, while children with combined ADHD showed greater social aggressiveness, with passiveness and aggressiveness being the factors that influenced their prosocial behavior . Other rIn another study they used the Child and Adolescent Scale of Participation (CASP) instrument, from which they concluded that children with ADHD exhibit problems of social competence, experiencing social rejection, as well as secondary difficulties with mood. They added to their results that the combined ADHD and inattentive ADHD groups showed significant differences in the interpretation of emotional and nonverbal cues in a direct measure of social perception compared to controls. These findings show a link between inattention and social perception that is separate from impulsivity difficulties .Social behavior was evaluated using the Impairment Rating Scale (IRS) and the methodology of toys that simulate a situation, finding that adolescents with ADHD showed deficiencies in social comprehension and problem-solving skills compared to adolescents without ADHD . In turnTo conclude, the empirical evidence shows that children and adolescents with ADHD exhibit deficits in social cognition, especially in the dimensions of ToM, emotional awareness, emotion recognition, and empathy; these dimensions are the starting point for the prosocial behavior of the ADHD population to exhibit difficulties in creating adequate bonds in addition to responding appropriately to the signals established in the social environment.The aim of this systematic review was to establish the empirical evidence on the relationship between social cognition, prosocial behavior, and ADHD in children and adolescents, in order to verify whether the evidence shows that social cognition and/or prosocial behavior are affected in children with ADHD.The evidence on the relationship between social cognition and prosocial behavior in children and adolescents with ADHD is mostly consistent, and indicates deficits in social cognition and prosocial behavior in this neurodevelopmental disorder. The results of these investigations point to neurocognitive deficits that include emotional processing, empathy, and ToM and conclude that these alterations have a direct impact on social behavior, which causes these children to exhibit negligent responses to the changes they must make in their adaptive behavior and ignore cues. Social skills are important for interactions with peers, teachers, and caregivers.The ToM was studied in 24 articles, and it is among the dimensions of social cognition that are affected in children with ADHD. Through instruments such as Happé’s Strange Stories, the Reading the Mind in the Eyes Test, and the Faux Pas Recognition Task (FPR), among others, it is identified that the ToM is affected in children with ADHD, causing difficulties in reading the thoughts and feelings of others; they also exhibit trouble interpreting the language of others, which generates difficulties with peers. Items that did not show deficits in social cognition were assessed via the NEPSY II, Appearance-Reality (ToM1), and the unexpected location (ToM2) task was modeled after Sally and Anne’s Task and unexpected content (ToM3).In turn, this review finds that children with ADHD respond with the same accuracy to questions that involve the beliefs of others and that the type of ADHD is fundamental to demonstrating participants’ deficits, influencing the children’s answers, and leading to low performance in the understanding of intentional behaviors.Ref.  justify It is considered that scores on instruments assessing ToM may improve so that the results resemble those of the control group after 12 weeks of treatment with methylphenidate ; howeverOne of the dimensions of social cognition affected in ADHD is emotional self-regulation, where it is shown that children and adolescents with ADHD exhibit a more intense response compared to the control groups. They report that children with inattentive ADHD have intact emotional regulation skills, unlike those with hyperactive and combined ADHD who are characterized by more reactive behaviors, preventing them from controlling situations that generate emotional responses .The emotional response of children with ADHD is more intense, especially when facing negative events . It is aTo assess emotional dysregulation in ADHD, several studies applied the Questionnaire on Emotion Regulation in Children and Adolescents (FEEL-KJ) and the Emotion Regulation Checklist (ERC); these instruments contain self-reports, which revealed differences in emotional regulation, confirming the deficit in emotional awareness in children and adolescents with ADHD. There are externalization problems , that inDeficiencies in patients with ADHD regarding emotion are based on their poor ability to reason about the emotions of others, which causes difficulties in expressing and regulating their own emotions; therefore, children with ADHD show worse emotional behavior when they do not have adult supervision and are exposed to reactive situations. The effects on this dimension of social cognition cause significant impacts on the interpersonal relationships of diagnosed participants, associating their emotional dysregulation with social dysfunction.The recognition of emotions in others is impaired in the ADHD population, which indicates a lower likelihood of being empathic with others and also makes it difficult to interpret and describe other people’s feelings . This isThe population with ADHD exhibits obstacles in processing emotional information; therefore, they do not correctly understand the links between emotions, nor are they able to identify the situations in which different emotions occur . There iAccording to this systematic review, empathy was assessed through self-reports and information provided by parents and teachers, where it was identified that children and adolescents, due to the desire for social approval, qualify themselves as empathetic children; however, parents and teachers determine that children with ADHD are less empathetic than the control group, identifying a deficiency in the recognition of anger and sadness in others, which generates a low perception of others’ feelings. The review does not distinguish between cognitive empathy and emotional empathy, considering that there was no separation when applying the instruments. In this dimension, the effects of methylphenidate were evaluated in two studies, confirming that after a certain period of time under pharmacological treatment, the sample managed to improve their empathy levels.The review identifies deficits in prosocial behavior as a result of difficulties in social cognition, regardless of the type of ADHD. This dimension was evaluated by teachers and parents, who stated that the type of ADHD determines the severity of these deficits. Children with combined ADHD are more socially aggressive, while children with inattentive ADHD exhibit more passive behaviors; however, neither group, given their deficits, adapts well to the environment or builds social relationships competently, due to their difficulty in generating problem-solving strategies, which leads them to experience social rejection, which may be related to mood difficulties . It is cAdolescents with ADHD exhibit deficiencies in social understanding and problem-solving skills compared to a control group; in addition, less accurate performance is identified when basing their decisions on someone else’s feelings, as well as a difficulty in recognizing sarcasm, showing that the impacts on prosocial behavior affect the quality of life for school-age ADHD patients.The results and discussion of this systematic review allow us to initially understand the relationships between social cognition and prosocial behaviors in ADHD, and this understanding allows us to consider the importance of evaluating dimensions such as theory of mind and emotional self-regulation to establish intervention processes that can improve prosocial behaviors at home and at school for children and adolescents with ADHD.It is important to highlight the importance of carrying out studies with longitudinal designs that allow for not only knowing the relationships between dimensions of social cognition and prosocial behaviors, but also generating explanations about the nature of these relationships in ADHD. On the other hand, studies are needed that use not only reported or self-reported measures of the dimensions of social cognition and prosocial behavior, but also experimental tasks, behavioral measurements, and neurophysiological measures, which allow a more objective approach to be taken toward these variables.The evidence indicates that children with ADHD have a deficit in social cognition and prosocial behavior, which affects their social interactions and interferes with their communication with others. It is concluded that when the social dimension is affected, it has an impact on other dimensions, showing impacts in terms of quality of life and educational processes. In samples of children with ADHD, the importance of establishing the type of ADHD is identified, in addition to involving their family members or teachers, who are the ones who guide their processes during childhood and adolescence.The research methodology of this systematic review was based on a quantitative approach, linking cross-sectional and longitudinal studies, and some of these studies were mediated by pharmacological treatment in the participants, making it possible to demonstrate, thanks to the inclusion of control groups, how social cognition and prosocial behavior are affected in children with ADHD, which is a successful outcome for the purpose of this review, highlighting in turn the positive influence of methylphenidate on improvements in the different dimensions evaluated.The systematic review was performed using research between the years 2000 and 2021, where an increase in the interest of researchers to dive deeper into the subject was identified, thus strengthening the precepts that are developed based on affective neuroscience, expanding the research field not only in social cognition and prosocial behavior, but also increasing the focus on ADHD. These concepts and their relationships are highlighted, thus contributing in theoretical terms to the field of research.In addition to the main objective of understanding the relationship between social cognition, prosocial behavior, and ADHD, it is also intended to contribute to the field of research influencing the quality of life of children with ADHD, which opens doors to research that becomes part of the educational dimension, assertively building knowledge from a holistic standpoint. The most common limitation of the studies reviewed was the number of participants, which may limit the validity of the studies analyzed. In turn, some of the instruments used are not suitable for the assessment of social cognition, calling into question the reliability and validity of the conclusions.The cross-sectional studies provide much of the evidence in this review, showing little approach from research with a longitudinal design, which does not allow the understanding of ADHD symptoms or the evolution of deficits in social cognition, so they do not find evidence concerning whether brain maturity or life cycle contribute to the modification of symptoms over time.Finally, after the effort to integrate the results analyzed in this review, it seems accurate to state that social cognition and prosocial behavior are affected in children and adolescents with ADHD. Although it is unclear whether gender, environment, and type of ADHD influence this deficit, what does seem evident is the social implication that these difficulties cause for the affected participant.


Executive dysfunction in children with attention deficit hyperactivity disorder (ADHD) is thought to be closely related to the prefrontal cortex (PFC). However, there is controversy over the activation of the PFC in children with ADHD. Differences could be related to the subtype. Meanwhile, no study to date has used functional near-infrared spectroscopy (fNIRS) to explore the differences between subtypes. Thus, this study aimed to explore the activation of the PFC in children with different subtypes of ADHD during executive function task.n = 28), ADHD-predominantly inattentive (ADHD-PI) (n = 39) and ADHD-combined (ADHD-C) (n = 24). To examine the executive function of ADHD, the Go/No-go task is chosen to assess the response inhibition function. The activation of PFC in all participants during the Go/No-go task was recorded by fNIRS. Meanwhile, behavioral data were also recorded.Participants in this study include typically developing (TD) children  and inferior frontal gyrus (IFG)] during response inhibition. However, the range and degree of activation differed among these groups. Compared with TD children, those with ADHD-PI had a smaller extent of activation in the right PFC, and those with ADHD-C only had a tendency to enhance activation. In addition, children with ADHD-PI and ADHD-C had impaired activation of the temporal gyrus. Besides, compared with ADHD-C and TD, those with ADHD-PI also had impaired activation of the right precentral gyrus (PG), and the supplementary motor area (SMA). Compared with ADHD-PI, ADHD-C showed decreased activation of the right MFG. The activation of Ch34  in children with ADHD-PI and ADHD-C was negatively correlated with their clinical symptoms.The activation of the PFC in children with different subtypes of ADHD has both commonalities and differences. The degree of activation of the right PFC Ch34 in children with ADHD is negatively correlated with clinical symptoms. fNIRS could be served as a candidate hemodynamic biomarker for the diagnosis of ADHD. Attention deficit hyperactivity disorder (ADHD) is a common chronic neurodevelopmental disorder in children and adolescents that affect approximately 7.2% of children worldwide . Around Despite its complex and unknown etiology, ADHD is related to cognitive deficits, especially executive dysfunction. Children with different subtypes of ADHD differ not only in clinical presentation, comorbidities, and response to treatment, but also in pathogenesis . ChildreFunctional near-infrared spectroscopy (fNIRS) is a non-invasive optical brain function detection technique that can indirectly detect changes in oxygenated hemoglobin (oxy-Hb) and deoxygenated hemoglobin (deoxy-Hb) concentrations in the cerebral cortex over time. fNIRS has several advantages over fMRI, including insensitivity to head movement, cost-effectiveness, portability, and high time resolution . In addiNo research was conducted on response inhibition in different ADHD subtypes by using fNIRS. In the current study, fNIRS was utilized to explore the activation of the PFC during response inhibition (Go/No-go task) in children with different ADHD subtypes (ADHD-PI and ADHD-C). ADHD-H was excluded due to its small population and poor cooperation. We hypothesized that ADHD-PI and ADHD-C differ in their response inhibition function and cortical activation levels.63 children with ADHD and 28 typically developing children  were recruited from the Children’s Hospital affiliated to the Capital Institute of Pediatrics in China. Among the children with ADHD, 39 had ADHD-PI  and 24 had ADHD-C . Demographic information is shown in Inclusion criteria for ADHD were as follows: ➀ 6–12 years old; ➁ ADHD diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5); ➂ no pharmacological and non-pharmacological treatment of ADHD; ➃ IQ ≥ 80 on the Chinese version of Wechsler Intelligence Scale for Children Revised (WISC-CR); ➄ right-handedness; ➅ good experimental cooperation; and ➆ no chronic physical illness and psychiatric disorders. All parents of children with ADHD completed the Chinese version of the Swanson, Nolan, and Pelham Questionnaire  and the ADHD Rating Scale IV (ADHD-RS-IV).Inclusion criteria for TD children were as follows: ➀ 6–12 years old; ➁ IQ ≥ 80 on the Chinese version of WISC-CR; ➂ right-handedness; ➃ good experimental cooperation; and ➄ no chronic physical illness and psychiatric disorders.The Go/No-go task in this study was similar to that used by In the Go block, a random sequence of “elephant” and “tiger” pictures was presented on the screen. Subjects were asked to press a button as soon as they saw the “elephant” and “tiger”. In the Go/No-go block, a random sequence of “lion” and “giraffe” pictures was presented on the screen (lion: giraffe = 1:1), as shown in This study used multi-channel fNIRS  utilizing two wavelengths of near-infrared light, namely, 695 and 830 nm. Detection depth was 20–30 nm below the scalp, and collecting frequency was 10 Hz. Changes in near-infrared (NIR) light absorption through the cerebral cortex and the modified Beer-Lambert law were calculated to indirectly determine the concentrations of oxyhemoglobin and deoxyhemoglobin in the cerebral cortex under 10 Hz collecting frequency .In brief, 33 probes (17 sources and 16 detectors) were placed in the subject’s prefrontal lobe through a 3 × 11 probe holder. A channel was formed between two adjacent probes (spaced 3 cm apart) to obtain a total of 52 channels . The proThis work adopted a multilevel model analysis of oxyhemoglobin, which is more sensitive to changes in cerebral blood flow than deoxyhemoglobin . HOMER2 p < 0.05, and test results were corrected with the FDR method. Paired t-test was applied to compare differences in cortical activation between the Go/No-go block and the Go block. One-way ANOVA was employed to compare between-group differences in cortical activation during Go/No-go task in ADHD-PI, ADHD-C, and TD children. Data from behavior were also assessed by one-way ANOVA.At the first level, fNIRS data were analyzed using General Linear Models. The beta (β) values representing the amplitude of the task response were obtained based on the hemodynamic response modeling of the fNIRS channel. At the second level, a one-sample t-test  was performed on the beta (β) values. Differences were considered significant when post hoc test.Correlations between cortical activation and clinical scales in children with ADHD were analyzed using Spearman’s correlation. Intergroup gender distribution was analyzed with chi-square test, the other intergroup differences were analyzed by one-way ANOVA with 2 = 8.742, and p = 0.013) but not in age  was found among the subjects  is roughly in line with the average head circumference (52.21 ± 1.86 cm), biparietal diameter (30.97 ± 1.60 cm) and occipitofrontal diameter (28.73 ± 1.69 cm) of the children enrolled in the group.The MNI coordinates and the maximum occupied brain area of each channel coded in a macro anatomical brain atlas LBPA40  and Brodp < 0.05).t = 3.713, p-corrected = 0.024), 25 , 34 , and 35  of TD children was significantly enhanced. The activation of channels 14 , 25 , and 35  of children with ADHD-PI was significantly enhanced. A trend of enhanced activation was observed for channel 25  of ADHD-C, but this result was not significant (0.1 > p > 0.05). TD children and those with ADHD-PI and ADHD-C showed differences in the channels activated during response inhibition (Go/No-go block minus Go block). The activation of channels 14 (p < 0.05). The activation of channel 44, 51, and 52 in children with ADHD-C was significantly diminished compared with that in TD children (p < 0.05). Compared with ADHD-C, ADHD-PI showed increased activation of channel 4 and decreased activation of channel 23 . The activation of Ch34 in ADHD-C was negatively correlated with the total score of ADHD-RS- IV .This study used fNIRS to explore the similarities and differences of cortical hemodynamics among TD children and those with ADHD-PI and ADHD-C. The right PFC is the core brain region for response inhibition, and the range of PFC activation on the right side of ADHD-PI and ADHD-C is reduced compared with that in TD children. The activation of the PFC in children with different subtypes of ADHD has both commonalities and differences.In the fNIRS analysis, the contrast of Go/No-go block against Go block was adopted. Previous fMRI studies of response inhibition have consistently revealed the activation of the frontal lobes . TherefoThis finding is consistent with the majority of fNIRS studies , which aThis study showed that the activation of the left middle temporal gyrus (BA21) and the right superior temporal gyrus (BA38) was significantly reduced both in children with ADHD-PI and ADHD-C compared with that in TD children. A meta-analysis showed that the ventral attentional network and frontoparietal network are reduced in ADHD . The midThe activation of the right precentral gyrus (PG) and supplementary motor area (BA6) was impaired in children with ADHD-PI compared with that in TD and ADHD-C subjects. The precentral gyrus (PG) consists of the primary motor cortex and plays a critical role in the final processing phase of response inhibition . The supSpearman’s correlations showed that oxy-Hb changes in Ch34  negatively correlated with attention deficit scores in ADHD-PI, and total ADHD-RS- IV scores in ADHD-C. This finding suggested that with low rPFC activation, the symptoms in children with ADHD become severe. The right inferior frontal gyrus may be the core brain region for response inhibition function in ADHD. Monden et al. used the border of inferior and middle frontal gyri to measure the activation levels that can distinguish between ADHD and TD. The area under the receiver operating characteristic curve was 0.85, and the sensitivity was 0.9 . In the This study has several limitations. First, ADHD-H was excluded due to its small population and poor cooperation. A comparison between ADHD-H and the other two subtypes was not performed. Second, the age span of participants was large. Frontal lobe function in children with ADHD changes with their age . ThirdlyThis study provides preliminary evidence on the similarities and differences in cortical hemodynamics among TD children and those with ADHD-PI and ADHD-C during response inhibition tasks. All three groups activated the right PFC (MFG and IFG) during response inhibition. However, the extent of activation differed among these groups. Compared with TD children, those with ADHD-PI had a smaller extent of activation in the right prefrontal lobe, and those with ADHD-C only had a tendency to enhance activation. In addition, children with ADHD-PI and ADHD-C had impaired activation of the temporal gyrus, and those with ADHD-PI also had impaired activation of the right PG and SMA. The activation of Ch34  in children with ADHD-PI and ADHD-C was negatively correlated with their clinical symptoms. These findings partly explain the phenotypic differences between ADHD-PI and ADHD-C.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.The studies involving human participants were reviewed and approved by Ethics Committee of Capital Institute of Pediatrics. Written informed consent to participate in this study was provided by the participants or their legal guardian/next of kin.YZ: manuscript writing and data collection. SL, FZ, YR, JS, XW, and LW: data collection. TZ: data analysis. JY: experimental design and reviewing and revising the manuscript. All authors have read and agreed to the manuscript.