Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder without validated and objective diagnostic procedures. Several neurological dysfunctions in the frontal circuit, in the thalamus, and in the cerebellum have been observed in subjects with ADHD. These cortical and subcortical areas are responsible for eye movement control. Therefore, studying eye movements could be a useful tool to better understand neuronal alterations in subjects with ADHD. The aim of the present study was firstly to compare the quality of pursuit eye movements in a group of 40 children with ADHD (age 8.2 ± 1.2) and in a group of 40 sex-, IQ-, age-matched typically developing (TD) children; secondly, we aimed to examine if a short visuo-attentional training could affect pursuit performances in children with ADHD. Findings showed that children with ADHD presented a greater number of catch-up saccade and lower pursuit gain compared to TD children. Differently to TD children, in children with ADHD, the number of catch-up saccades and the pursuit gain were not significantly correlated with children’s age. Furthermore, a short visuo-attentional training period can only slightly improve pursuit performance in children with ADHD, leading to a decrease of the occurrence of catch-up saccades only, albeit the effect size was small. The absence of any improvement in pursuit performance with age could be explained by the fact that the prefrontal and fronto-cerebellar circuits responsible for pursuit triggering are still immature. Pursuit eye movements can be used as a useful tool for ADHD diagnosis. However, attentional mechanisms controlled by these cortical structures could be improved by a short visuo-attentional training period. Further studies will be necessary to explore the effects of a longer visuo-attentional training period on oculomotor tasks in order to clarify how adaptive mechanisms are able to increase the attentional capabilities in children with ADHD. Attention deficit/hyperactivity disorder (ADHD) represents a neurodevelopmental disorder characterized by hyperactive behaviors and difficulties in controlling motor impulses and paying attention . It affePreliminary evidence suggested that some of the oculomotor abnormalities reported in ADHD could provide detailed information about the function of brain networks, particularly of the executive dysfunctions reported in these kinds of patients . ChildreInterestingly, the training of cognitive functions, even during a short period of time, significantly affects brain networks involved in executive functions, specifically working memory, flexibility, or inhibition capabilities . In subjIn our study, we compared the quality of pursuits in a group of children with ADHD and in a group of sex-, age-, intellectual quotient (IQ)-matched children with typical development. Recall that in the literature, it has been shown that the pursuit system is immature in the first years of life with a progressive maturation until adolescence . ConsequWe also explored the benefit of a short visuo-attentional training on pursuit abilities in the same group of children with ADHD. Our hypothesis is that pursuit performance in children with ADHD could be sensitive to cognitive rehabilitation strategies. Note that we decided to test the effects of shorter training in order to avoid the effects of fatigue, since children with ADHD reported difficulties in focusing their attention for a long time. Recall that we just reported beneficial effects in children with dyslexia when we used short visuo-attentional training .In total, 40 children with ADHD and 40 sex-, IQ-, and age-matched children with TD were recruited at the Child and Adolescent Psychiatry Department, Robert Debré Hospital  . TrainedAll children with typical neurodevelopment were also explored for the absence of main axis I comorbidity. To be included, they needed to have (i) ADHD-RS total raw score ≤10 ; (ii) a p = 0.94 and F(1.38) = 0.05, p = 0.87, respectively). Pursuit movements were realized two times, at T1 and T2, respectively, before and after 10 min of visuo-attentional training for the group G1, and before and after 10 min of rest  for the group G2. Recall that during day life, we make several eye movements to explore the natural world. However, when a subject is asked to fixate a target, attention plays a fundamental role. During the 10 min of rest, children of G2 could look everywhere, but it was not asked of them to specifically fixate on targets.We compared pursuit eye movement performance in children with ADHD and in children with TD. To examine the effect of short training on pursuit eye movements, children with ADHD were then randomly split into two groups (G1 and G2). G1 and G2 did not differ in terms of the chronological age of the subjects and severity of ADHD measured with the ADHD-RS F = 0.006, Note that we proposed the training protocol to the group of children with ADHD only since TD children reported normal behavior during pursuit eye movement performance .The investigation followed the principles of the Declaration of Helsinki and was approved by our Institutional Human Experimentation Committee . Written consent was obtained from the children’s parents after the experimental procedure was explained to them.The pursuit task consisted of following a slowly moving visual target. The stimulus (a red circle of 0.5°) was moved at constant velocity (15°/s) on a 22′ computer monitor. The target was initially placed in the central position (0 deg) and then moved horizontally to one side until it reached the ±20 deg location, where it reversed abruptly and moved to the opposite side. A total of nine cycles were run and included in the analysis. Children were invited to follow the target with their eyes .www.SuriCog.com), was used to record horizontal and vertical eye movements employing an infrared camera (frequency recording of 300 Hz). The mobile EBT has a precision of about 0.25 deg. Calibration under binocular viewing was performed before pursuit recording. The calibration procedure consisted of fixating a grid of 13 points (diameter 0.5 deg) mapping the screen .Children were seated on a chair in a dark room, in front of a flat screen displaying the pursuit eye movements. The head of the child was held straight with a head-rest; viewing was binocular.We used Metrisquare© , a software in which different tests of visual searching were developed ,23. AmonThe cat task consists in a set of four different drawings: a head of cats (0.5 × 1 cm), a flower (0.7 × 0.7 cm), a sunshine (0.7 × 0.7 cm), and a tree (1 × 0.5 cm). Each type is represented 24 times. The 96 drawings are randomly arranged. The child has to cross out only the cat heads.Finally, the space rocket test represents an assemblage of 104 black and white space rockets drawings. All the space rockets have the same size: 2 cm length and 1 cm width. Space rockets are strictly organized in 13 columns and height lines. The child has to cross out the space rockets, which are identical to the given model made of two portholes, three rocket motor propellers, one ladder, and an antenna. Sixteen are identical; the 88 others have different details.Detection of catch-up saccades during pursuit was based on criteria of minimum amplitude (2 deg) and velocity (30°/s). Catch-up saccades were saccades in the direction of the target, allowing a reduction of the position error. The number of these saccades was counted. Pursuit gain was also measured, which is the ratio between the eye velocity and the target velocity .R2) between the number of catch-up saccades and age of the subject at inclusion but also the correlation between gain value of pursuit and age, in the two groups of participants (children with ADHD and children with TD) to explore the impact of age on these variables. We also ran an analysis of variance (one-way ANOVA) between two independent variables, i.e., groups of subjects (children with ADHD and children with TD), and two dependent variables, i.e., the eye movement parameters . Repeated measures ANOVA was performed between the two independent variables, i.e., groups (G1 and G2) of children with ADHD on two dependent variables, i.e., the eye movement parameters  recorded at the two times (T1 and T2) of the training protocol. Post hoc comparisons were made by using the Bonferroni test. We considered our results as significant when the p-value was below 0.05.We estimated the Pearson correlation  and had significantly lower pursuit gains  = 5.98, p < 0.016; η = 0.29) when compared to children with TD. In A one-way ANOVA revealed that children with ADHD made significantly more catch-up saccades (F(1.78) = 36.28, R2 = 0.45 p < 0.001). In contrast, we did not observe a similar correlation for children with ADHD (R2 = 0.001 p = 0.83). R2 = 0.14 p < 0.016). At the opposite, children with ADHD did not display a similar correlation (R2 = 0.02 p = 0.36).We explored the impact of age on pursuit eye movement parameters. p < 0.0002; η = 0.30): the number of catch-up saccades decreased significantly after the short rehabilitation program in the G1 group. The ANOVA revealed a significant interaction between training and group of children  =26.22, p < 0.00001; η = 0.40). A Bonferroni post hoc test showed that for G1, only the number of catch-up saccades decreased significantly at T2 (p< 0.00001).p = 0.3) (T2 vs. T1) nor any specific effect of visuo-attentional training  = 0.17, p = 0.6).The identification of a precise and objective diagnostic tool is a major issue in medical research, specifically in ADHD, and it is clear that the results are still rather weak overall. Through this exploratory study, we wanted to better identify the neuro-visual abnormalities of ADHD patients and identify the presence of atypical pursuit eye movement’s performance. Our goal was to identify these atypical behaviors associated with ADHD, correlated with the intensity of the disorder, not dependent on a developmental effect but sensitive to cognitive remediation. We thus compared the quality of pursuit eye movements in children with ADHD to those with TD and examined the effect of short visuo-attentional training on these movements. We observed (i) pursuit performance was not sensitive to a developmental effect in ADHD, (ii) a greater number of catch-up saccades and lower gain values in children with ADHD with respect to children with TD; and (iii) a slightly but significantly pursuit performance improvement after a short visuo-attentional training period in children with ADHD.In our study, we reported a decrease in the number of catch-up saccades and an increase in the gain values in children with TD with age. Surprisingly, this developmental effect did not occur in children with ADHD. The processes of myelination, synaptic pruning, and maturation of gray matter, which reaches adult levels during adolescence, are correlated with the development of the cortical network responsible for eye movement triggering. Given the several cortical and sub-cortical structures implicated in pursuit triggering , the absn = 7) and matched controls. They also reported an elevated number of catch-up saccades but normal gain values in children with ADHD. The discrepancies in the gain value between this study and ours could be mainly related to the experimental set-up used, which were slightly different. Indeed, while Gargouri-Berrechid et al. [In our study, we fostered previous findings suggesting that children with ADHD displayed visual attention abnormalities . We obsed et al.  stimulatd et al. .In our study, we found a high occurrence of catch-up saccades and lower gain in children with ADHD compared to TD children. This could reflect an alteration in pursuit performance, given that catch-up saccades aim to maintain eye fixation on the target when the eye velocity is reduced . Our finTo further explore the relationship between abnormalities of eye pursuit movement and ADHD, we evaluated the effect of a short visuo-attentional training program on both the gain and the number of catch-up saccades during pursuits. Our results indicated that children with ADHD improved slightly but significantly their pursuit performances. After training, children with ADHD decreased significantly the number of catch-up saccades, but the pursuit gain value failed to show a significant improvement. The decreased number of catch-up saccades in ADHD during this short rehabilitation training program suggested further that catch-up saccades during the pursuit task may represent alterations during eye movement performance that are associated with attention-deficit/hyperactivity disorder, even if it is necessary to extend the duration of our training and test it on multiple different age groups of children with ADHD.According to Strimbu and Tavel, an ideal clinical endpoint should be sensitive to an exposure or intervention, including therapeutic interventions . HoweverTill now, the phenotypic measures with basic clinical information, such as sex, age, handedness, and IQ, remain the best tools to characterize patients with ADHD and to estimate the response to treatment or the prognosis . DespiteThe effort of the scientific community to objectify the procedure of diagnosis and the prognosis or to drive the therapeutic strategies remains unfruitful in ADHD. Children with ADHD showed abnormal pursuit eye movements, specifically a greater number of catch-up saccades and lower pursuit gain.These abnormalities appeared in our study as being independent from a developmental effect, i.e., pursuit abnormalities in children with ADHD were not correlated with the chronological age of the subjects .Finally, we observed in our study that catch up saccadic movements were very sensitive to a short visuo-attentional rehabilitation training. We observed a decreased occurrence of catch-up saccades in patients with ADHD after short cognitive remediation.The atypical pursuit patterns in children with ADHD could represent a promising clinical feature in ADHD and could be due to the immaturity or dysfunction of central structures responsible for pursuit triggering.


This cohort study assesses concentrations of γ-aminobutyric acid (GABA) and glutamate in children with attention-deficit/hyperactivity disorder (ADHD) compared with typically developing children. To date, no study has investigated both glutamate and GABA concentrations in the anterior cingulate cortex (ACC) in children with ADHD. We hypothesized that there are greater concentrations of glutamate and of glutamine and glutamate (Glx) and a lower concentration of GABA in children with ADHD compared with typically developing control (TDC) participants.1 We also hypothesized that the longer GABA acquisition is feasible in unmedicated children with ADHD.Studies suggest that dysregulation of excitatory and inhibitory systems plays a role in attention-deficit/hyperactivity disorder (ADHD).This cohort study was approved by the University of Calgary Conjoint Health Research Ethics Board. Participants provided written assent, and parents or caregivers provided written informed consent. We enrolled 26 children with ADHD and 25 TDC participants between the ages of 7 and 18 years from May to December of 2019. To confirm eligibility as either a child with ADHD or a TDC participant, participants completed a structured diagnostic interview using the Mini-International Neuropsychiatric Interview for Children and Adolescents and a cognitive screener  to establish no intellectual disability (standard score >80). Parents or cargivers also completed the third edition of Conners manual that assesses cognitive, behavioral, and emotions problems to support the presence or absence of ADHD. Participants with ADHD received a diagnosis by a health care professional, verified by an experienced developmental pediatrician (J.-F. L.), and underwent a 48-hour stimulant washout. All events occurred at the Alberta Children’s Hospital in Calgary, Alberta, Canada.3 isotropic voxels). For proton magnetic resonance spectroscopy, a short-echo point-resolved spectroscopy (PRESS) acquisition  for glutamate and Glx and a Mescher-Garwood (MEGA)–PRESS acquisition for GABA  were applied to an angulated bilateral ACC voxel . A T1-weighted acquisition was used for voxel placement . Cohen d values were reported to indicate the effect size for potential differences between groups. Bonferroni corrections were used to correct for multiple comparisons . We followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline.Data were inspected for missing values and to meet the assumptions for parametric analysis . Because this is the first study, to our knowledge, of this nature, a sample size of convenience was used. Independent sample 2 = 0.02; P = .86). We found no differences in GABA , glutamate , or Glx  concentrations in the bilateral ACC voxel  mean age of 11.6 (2.5) years; of 25 TDC participants, 13 were male and 12 were female, with a (SD) mean age of 11.2 (2.8) years (χCC voxel . Partici3 Our approach can be replicated in other brain regions, adding critical data to our understanding of the underlying neurobiology of pediatric ADHD, which can allow for the development of targeted treatments and potential biomarkers for ADHD.This study is the first, to our knowledge, to investigate the association of GABA and glutamate concentration in children with ADHD. We found no differences concentration between children with ADHD and TDC participants. We demonstrated feasibility to collect high-quality GABA data from unmedicated children with ADHD. Although the results contrast with our hypotheses, the null findings add valuable information to the current magnetic resonance spectroscopy literature. Our main limitation was the size and composition of the voxels and does not rule out glutamate or GABAergic differences in subregions. Furthermore, to our knowledge, a limited number of studies have investigated the GABA concentration in children with ADHD, with inconclusive findings.


Autism spectrum disorder (ASD) is a neurodevelopmental disorder, mainly characterized by impairment of social communication and restricted interests. ASD is frequently accompanied by attention deficit hyperactivity disorder (ADHD), which is characterized by carelessness, hyperactivity and impulsivity (ASD/ADHD). It has been suggested that ASD and ADHD are associated with oxidative stress, that is, that patients with ASD/ADHD are in a state of increased oxidative stress. There are currenr tly no objective or biological test criteria for evaluating the efficacy of drug therapy in these patients. The purpose of this study was to evaluate whether oxidative stress markers [serum reactive oxygen metabolites (d-ROMs) levels and biological antioxidant potential (BAP)] can be used as objective indicators for evaluating the efficacy of drug treatment in ASD/ADHD patients.The subjects of this study subjects were 50 Japanese patients with ASD/ADHD aged 4 to 14 years old. Serum samples were obtained from the patients to measure the serum levels of d-ROMs and the serum BAP. The study subjects were divided into two age groups: preschool children (4 to 6 years old) and school-age children (7 to 14 years old), and the serum levels of d-ROMs, serum BAP, serum BAP/d-ROMs ratio , and scores on the Parent-interview ASD Rating Scales-Text Revision (PARS-TR) and ADHD Rating Scale (ADHD-RS) were determined before and after drug therapy and compared between the two groups. In addition, changes in the d-ROMs, BAP and BAP/d-ROMs ratio and changes in the scores on the PARS-TR and ADHD-RS after treatment were also analyzed.Significant decrease of the d-ROMs, BAP, and scores on the PARS-TR and ADHD-RS, with a significant increase of the BAP/d-ROMs ratio, was observed after treatment. In addition, a significant correlation was observed between the changes in the d-ROMs and changes in the scores on the PARS-TR and ADHD-RS after treatment in the school-age ASD/ADHD children.Our results suggest the possibility that the serum level of d-ROMs may be useful as an objective assessment marker to supplement the subjective assessment of the effects of drug treatment in school-age children with ASD/ADHD. Autism spectrum disorder (ASD) is a neurodevelopmental disorder, mainly characterized by impairments in social communication and interpersonal interactions, restricted interests, and repetitive behaviors. In the 5th version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) , revisedNeurodevelopmental disorders such as ASD and ADHD have been suggested to be associated with oxidative stress –10 and mThe study subjects were 50 Japanese patients  with ASD/ADHD aged 4 to 14 years old, who had never received any drug treatment intervention. The eligibility criteria for inclusion in the study were patients diagnosed as having ASD/ADHD according to DSM-5-based assessment and clinical symptoms documented by a pediatric neurologist. Patients with underlying diseases other than developmental disorders, and those taking drugs for purposes other than the treatment of ASD or ADHD or than improvement in the symptoms were excluded. In our previous study, younger children had higher oxidative stress levels . And it 2O2 of 0.08 mg/dL.The d-ROMs test is used to measure the serum levels of hydroperoxide. Hydroperoxide is a metabolite generated when proteins, lipids, amino acids, nucleotides, etc., are oxidized by active oxygen or free radicals, and generates free radicals in the presence of metal ions. Therefore, measurement of the hydroperoxide levels in the serum reflects the degree of biological oxidative stress. U.CARR is used for the unit, and 1 U.CARR is equivalent to the HThe BAP test is used to measure the degree to which ferric iron can be reduced to ferrous iron by the antioxidants contained in the blood. Measurement of the reducing ability as a blocking effect against the peroxidation chain reaction induced by reactive oxygen species or free radicals allows assessment of the antioxidant capacity, which is the ability to scavenge free radicals in the body. Μmol/L is used for the unit.Between November 2016 and September 2019, blood samples were collected from the subjects prior to the start of treatment. Within one year after the start of the drug treatment, blood samples were collected again. Blood samples were centrifuged at 1469 g for 10 min, to obtain serum samples. The d-ROMs and BAP were measured using FREE CARRIO DUO , a free radical analyzer.+ and Fe3+ separation from the blood proteins. Fe2+ and Fe3+ act as catalyzers, and result in the degradation of blood hydroperoxide into an alkoxy radical and a peroxy radical. N,N-diethyl-p-phenylenediamine (20 μL) was then placed in the cuvette as a color-developing chromogen, resulting in the oxidation of the chromogen substrate by the free radicals to yield a red-colored radical cation. The cuvette was again overturned and mixed, then placed in a spectrophotometer to measure the radical cations at 505 nm.First, each serum sample (20 μL) was placed in a cuvette filled with a pH 4.8-buffer that had been warmed in an incubator for at least 15 min. Then, the cuvette was gently overturned and mixed to allow Fe2+) for BAP was added to a cuvette to induce red coloration, and the contents were mixed by inversion of the cuvette, followed by spectrophotometric measurement of the coloration. Then, each serum sample (10 μL) was placed into the cuvette and mixed. The cuvette was then placed in a thermostat to allow reaction in the mixture. Finally, the cuvette was placed in a spectrophotometer for measurements at 505 nm.50 μL of a chromogenic reagent  of the patients. In this study, a pediatric neurologist scored the rating scale. The minimum eligible age for assessment by PARS-TR is 3 years. The scale consists of 57 items classified into 6 subscales: interpersonal relations, communication, obsession, stereotyped behaviors, difficulty in living, and hypersensitivity . The severity of each item is rated on a 3-point scale . The higher the total score, the more likely that the assessee child has ASD.ADHD-RS is a rating scale used to assess the presence or absence of ADHD symptoms and their severity through interviewing people around the patients. In this assessment, information is obtained from the mothers  of the subjects. In this study, a pediatric neurologist scored the rating scale. The minimum eligible age for assessment by ADHD-RS is 5 years. The scale consists of 18 items in total: 9 items related to inattention and 9 items related to hyperactivity/impulsivity. The severity of each item is evaluated on a 4-point scale . The higher the total score, the more likely the assessee child has ADHD.p value) set at 0.05. In addition, the Pearson correlation coefficient (r) and p-values were calculated, with the level of significance set at 0.05, to examine the correlations between the pre- and post-treatment changes in the d-ROMs, BAP and BAP/d-ROMs ratio and the pre- and post-treatment changes in the scores on the PARS-TR and ADHD-RS. The statistical analysis software used was R (version 3.6.1).The d-ROMs, BAP and BAP/d-ROMs ratio, and the scores on the PARS-TR and ADHD-RS were compared before and after drug treatment using Wilcoxon signed-rank test, with the level of significance  and ADHD-RS . Figure r = 0.39, P = 0.01) and ADHD-RS . On the other hand, in the preschool children, no significant correlations were observed for any of the items.Table p < 0.001, A vs. C: p < 0.001) [The reported male-to-female ratio in childhood ADHD varies in the range of 2:1 to 10:1 , 16 and < 0.001) . And it < 0.001) . Similar< 0.001) , 22. In ASD is often accompanied by emotional disorders, including anxiety disorders, mood disorders, and phobias due to psychological stress . TherefoAtomoxetine hydrochloride, which was prescribed for 18.0% of the study subjects, has been reported to cause mitochondrial dysfunction when used at high concentrations . TherefoIn the present study, significant correlations were observed between the pre- to post-treatment changes in the d-ROMs and the pre- to post-treatment changes in the scores on the PARS-TR and ADHD-RS, suggesting the existence of a correlation between the subjective and objective indicators.The efficacy and safety have not been established of guanfacine hydrochloride, atomoxetine hydrochloride and methylphenidate hydrochloride in ADHD children aged less than 6 years old, of aripiprazole in ASD children aged less than 6 years old, and of risperidone in ASD children aged less than 5 years old. Therefore, use of these drugs in the respective age groups represents off-label use in Japan. Thus, there is a lack of evidence for drug therapy in preschool children with ASD/ADHD. In the present study, in consideration of the impact of age and stress from the living environment, such as the school, the study subjects were classified into two age groups: preschool children and school-age children. However, there was no pre- to post-treatment change in the score on either PARS-TR or ADHD-RS in the preschool children, which may be attributed to the possible need for use of different cutoff values of the PARS-TR score in preschool and school-age children  and alsoThe present study had several limitations. First, since it was impossible to conduct a detailed investigation of the interpersonal relations and living environment of the study subjects, the potential impact of these factors on the study results could not be verified. Secondly, there are many patients in clinical practice who are followed up with only psychological and educational guidance, etc., without drug therapy. It was not possible to collect blood samples from such patients who received only nursing care guidance, and only subjects who received drug treatment were enrolled in the study. Therefore, as a future issue, it is necessary to verify and compare the results between patients receiving drug therapy with nursing care guidance and those receiving nursing care guidance only, in order to demonstrate the usefulness of drug therapy. Thirdly, the sample size was not sufficient. In particular, the number of preschool children was small. Furthermore, many combinations of drugs were used in the study subjects, making it impossible to assess the oxidative stress markers for each drug. Therefore, in the future, it is necessary to examine the impact of each drug on the measured oxidative stress markers and to carry out re-validation in preschool children by further increasing the sample size.In the present study, the d-ROMs and the scores on the PARS-TR and ADHD-RS decreased significantly after drug treatment. In addition, in school-age children with ASD/ADHD, significant correlations were observed between the pre- to post-treatment changes in the d-ROMs and the pre- to post-treatment changes in the scores on the PARS-TR and ADHD-RS. These findings suggest that the serum level of d-ROMs, an oxidative stress marker, may be a useful objective marker to assess effects of drug therapy in school-age children with ASD/ADHD.


Attention-deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder characterised by inattention and hyperactivity-impulsivity that can affect people throughout their life course. A social gradient exists in the prevalence of ADHD in the UK. Studies in other countries have shown that social gradients also exist in the receipt of medication for ADHD. Socioeconomic position is potentially an unrecognised and modifiable factor in children and young people's receipt of medication for ADHD in the UK.The aim of the study was to investigate if socioeconomic position could explain in part whether or not children and young people in Sheffield are receiving medication for ADHD.We used multivariate logistic regression modelling to investigate whether socioeconomic position could explain variation in receipt of medication for ADHD in children and young people in a cross-sectional study. We collected data from 1354 children and young people with a diagnosis of ADHD across three Sheffield centres between January and December 2016. Independent variables were age, gender, religion, ethnicity, comorbidities, and Index of Multiple Deprivation decile (derived from home postcode).P<0.01); an increase in one decile of the Index of Multiple Deprivation was associated with 10% lower odds of receipt of medication for ADHD .Our results showed a social gradient in the receipt of medication for ADHD (Children and young people from more deprived backgrounds are more likely to receive medication for ADHD. This is the first time that a social gradient in children and young people's receipt of medication for ADHD has been shown in a UK sample. Mainstays of treatment are firstly behavioural interventions (such as parent management classes) and secondly medication.4 The causes of ADHD remain a controversial topic6 but key ADHD traits have been shown to be over 70% heritable in meta-analysis.7 Despite core features of ADHD being biologically determined,8 the environment is also important, as this frames the individual and defines how they present and function.9 It is likely that social factors affect the presentation of ADHD,4 contributing to the heterogeneity of ADHD presentation.Attention-deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder10 Even when a social gradient is found, some contend that this is a covariate of ADHD rather than a cause,4 although there is evidence that the effect is causal in severe early deprivation.11 Social gradients have also been found in CYP's receipt of medication for ADHD.12 In a study of over 2 million CYP in Sweden, the risk of ADHD medication was higher for those aged 10–14 years, those with more frequent hospital contact and those taking other psychotropic medication.13 A similar study in British Colombia found that boys are more likely to receive methylphenidate even when controlling for ADHD symptoms and behavioural symptoms, and that prior treatment with methylphenidate was a strong predictor of receipt of treatment.14 A US study found that being male, school-aged, White, living in a rural area, and being in foster care increased the likelihood of being treated with psychotropic drugs.15 Another national study in Sweden found that having a lone parent, receipt of social welfare and a lower level of maternal education were associated with taking medication for ADHD.12 Although several studies worldwide have identified predictors of receiving medication for ADHD, no such research has yet been carried out in the UK. This is an important gap in knowledge, as identification and quantification of a social gradient in the receipt of medication for ADHD in CYP in the UK could make the case for other supportive options to modify this risk factor and improve outcomes in CYP with ADHD. It would provide a rationale for further research into why such a social gradient existed and how it could be alleviated. The objective of our project was to investigate if SEP could explain in part whether or not CYP in Sheffield are receiving medication for ADHD.Large UK studies have demonstrated a social gradient in the prevalence of ADHD, finding that those in a lower socioeconomic position (SEP) were more likely to have a diagnosis of ADHD.16The study was based on a cross-sectional sample of all CYP with a recorded diagnosis of ADHD who were seen in three secondary care centres in Sheffield between January and December 2016. Two centres are part of Child and Adolescent Mental Health Services and one is based in a child development centre (Ryegate Children's Centre). All three offer specialist assessment for ADHD. The three centres' case-load includes the majority of CYP with moderate-severe ADHD in Sheffield and the geographical areas included have wide variation in SEP. Sheffield is an ethnically diverse city in South Yorkshire with over 550 000 inhabitants; 36% of Sheffield households include CYP.Ethical approval was granted by the Research Ethics Committee of the School of Health and Related Research, University of Sheffield.We collected data on CYP's demographics , comorbid conditions and medication status. Medication status was defined as whether or not CYP were receiving stimulant medication (methylphenidate or dexamphetamine in either immediate or modified-release preparations) or atomoxetine. Comorbidities were classified into autism spectrum disorder (ASD), general or specific intellectual disabilities , or other. ASD and intellectual disabilities were chosen as classifications as these were the two most frequent recorded comorbidities in our sample.17 We used the Department for Communities and Local Government's Open Data Communities postcode lookup service to map to each CYP's home postcode to their IMD decile.18The data were extracted from electronic patient records and clinic letters. We used the Index of Multiple Deprivation (IMD) as a measure of CYP's SEP. The IMD is the official measure of relative deprivation for English lower-level super output layers (areas the size of neighbourhoods); it is a weighted aggregate of data on seven domains of deprivation and ranks neighbourhoods into deciles (the first decile being the most deprived 10% of neighbourhoods).The primary outcome for our analysis was medication status. The main exposure variable was IMD decile. Age, gender, religion, ethnicity and comorbidities were considered as potential confounders.t-test or Mann–Whitney U-test depending on the degree of skewness in the data; categorical data were compared using the χ2-test.Analyses were carried out in Stata/IC version 13. Data were presented as mean with standard deviation, or median with interquartile range (IQR), or count with percentage. To detect significant differences between CYP by medication status, numerical data were compared using the Student To evaluate the association between IMD and receipt of medication for ADHD, we used a multivariable logistic regression model controlling for age, gender, ethnicity, religion, ADHD treatment centre and comorbid conditions. The strength and direction of associations were presented using adjusted odds ratios (aORs) with 95% CIs. Multicollinearity among the independent variables was ruled out by examining Spearman's correlations and variance inflation factors. Linearity in the log(odds) for continuous variables (age and IMD), as required by logistic regression, was assessed using restricted cubic splines. We plotted aORs of ADHD medication against the IMD ranks and deciles.The multivariable logistic regression model was validated by examining its discriminatory and calibration abilities. Calibration (agreement between observed and predicted probabilities of receiving medication for ADHD) was assessed by the Hosmer–Lemeshow goodness-of-fit test and by evaluating how much the slope of the calibration line (plotting the predicted against the observed probabilities) deviates from the ideal of 1.0. Discrimination ability (the degree that the model distinguishes CYP receiving medication from those not receiving medication) was assessed using the area under the receiver operating characteristic curve (c-statistic). Internal validation was performed using the bootstrap method to calculate the c-statistic with correction for ‘optimism’ overfitting based on 200 resamplings. An optimism-corrected c-statistic is reduced by the estimated deterioration that the model is expected to have when applied to new individuals.Overall, 157/1354 CYP (11.6%) had at least one missing value in any of study variables. ADHD medication status had 113/1354 missing values (8.3%) and IMD had 20/1354 (1.5%). Covariates with missing values included gender  and comorbid condition . The multivariable logistic regression analysis was performed on a complete case (listwise) basis and the ADHD centre was included in the model as a covariate to reduce potential bias. Potential impact from missing values on the outcome was assessed by performing sensitivity analyses in the two extreme scenarios that: (a) all missing values in medication status were set to ‘medicated’, and (b) all missing values in medication status were set to ‘not medicated’. No imputation was performed on missing covariate values.The study sample comprised 1354 CYP diagnosed with ADHD, with a mean age of 13.6 years  and 1113 (82.7%) were males. CYP in the study had a median of 1 comorbid condition (IQR 0–2), including ASD , intellectual disabilities  and ‘other’ comorbidities . Some comorbid conditions, for example oppositional defiant disorder, conduct disorder and developmental coordination disorder were not possible to ascertain fully using our data-collection method and it is likely that their prevalence is significantly higher than figures suggested. Most CYP were of White British ethnic origin , and declared a Christian orientation  or ‘no religion’ . The median IMD rank was 4.7  thousand units, corresponding to a median IMD decile of 2 .v. 13.0 years, P = 0.016), more likely to have ASD  and had more comorbid conditions  compared with those who did not receive medication for ADHD. The median IMD ranks and deciles were significantly lower in CYP receiving medication for ADHD compared with those not receiving medication . No significant differences were observed in the distributions of gender, ADHD care centre, ethnic group or religion by medication status.Information on medication status was available for 1241 (91.7%) CYP, of whom 1135 were prescribed ADHD medication . https://doi.org/10.1192/bjo.2019.87). Multivariable logistic regression confirmed that the CYP's receipt of medication for ADHD was significantly and independently associated with age, comorbid ASD and IMD decile (P = 0.370) and the calibration slope  indicated good agreement between predicted and observed probabilities of receiving medication for ADHD. In addition, the calibration plot did not indicate a pattern of either over- or underestimation .A linear relationship with the log odds of receiving ADHD medication was found to be a good approximation for IMD ranks or deciles, but a non-linear relationship was noted for age, which was modelled using a restricted cubic spline with knots at quartiles   assuming CYP with missing data were receiving medication for ADHD, and 0.94  assuming those CYP with missing data were not receiving medication for ADHD.Sensitivity analysis accounting for potential bias from missing values in medication status produced identical results (supplementary Table 1). The aORs of receiving ADHD medication in relation to IMD decile were: 0.90  relationship with many interacting factors, one of which we have shown is comorbid ASD. However, the existence of a social gradient in CYP's medication status is important because ADHD is a common disorder that can lead to serious negative outcomes for CYP.Our data showed that an increase in one decile of IMD (i.e. less deprivation) was associated with 10% lower odds of receipt of medication for ADHD . The finding that CYP from more deprived backgrounds are more likely to be receiving medication has been observed in similar studies in Sweden4 and that deprivation makes it more likely that CYP are exposed to a negative family, school and community environment known to worsen ADHD presentation.20 Secondary analysis of the Millennium Cohort Study data found that family dynamics mediated the relationship between SEP and ADHD symptoms,21 and it may also be the case that the same applies to receipt of medication for ADHD. In this study we do not have a measure of severity of ADHD. The social gradient in receipt of medication for ADHD could be because CYP from deprived backgrounds present with more severe impairment and so are more likely to be receiving medication. It is possible to postulate many reasons for this. Families living in more deprived circumstances may be less likely or even less able to seek help for possible ADHD. If they do seek help, professionals, including teachers  and general practitioners, may be more likely to attribute the reported difficulties to social circumstances and poor parenting rather than ADHD.It is known that social setting influences the presentation of childhood/adolescent ADHDIt is important to consider which CYP are referred for secondary assessment of possible ADHD in Sheffield and therefore constitute our sample – a specialist referral is indicated if moderate/severe impairment is thought to be present. Although it is hoped that CYP with significant mental health comorbidity will be referred to Child and Adolescent Mental Health Services, and those with other neurodevelopmental difficulties to the child development centre, the nature of ADHD is such that CYP often have additional difficulties in both areas, thus all three centres see individuals with complex cases. We did not identify differences in whether CYP with ADHD were receiving medication between centres of care, however, it is possible that there are some differences in practices because of the individual clinicians working in each team.22 Each of these factors are more likely in a deprived household where carers are likely to have lower educational achievement or additional work and family stressors. Not being able to benefit from first-line therapy for ADHD  will lead to an increased chance of receiving pharmacological treatment as a second-line therapy. It is also likely that families in poorer socioeconomic circumstances do not have the finances needed to offer their CYP's additional support that can reduce impairment from ADHD and therefore the need for medication, such as sporting activities, additional educational support and more individual adult support.Access to services has also been shown to be a barrier to ADHD parenting group attendance, along with dislike of group activities, preconceptions of parenting programmes, inability to engage with the programme (lack of understanding or finding the programme unhelpful), or changes in circumstances.5 Thus, adults with ADHD are more likely to live in deprived circumstances. As ADHD traits are highly heritable,7 this effect may have been compounded over many generations, which would lead to more severe impairment from ADHD, and therefore leading to CYP in such a position being more likely to be receiving medication. One previous study did not find any evidence that families with CYP with ADHD were more likely to move to a lower SEP;21 although the study was only over a period of 7 years and may not have run for long enough to detect changes in SEP.It is also possible that ADHD has a part to play in determining an individual's SEP, which could explain in part why those with a lower SEP are more likely to be receiving medication. It is well-known that unrecognised and therefore untreated ADHD leads to a range of negative outcomes including poor educational attainment, fewer occupational opportunities, alcohol and substance misuse, contact with the criminal justice system, and poor mental health.23 and should be considered at particular risk of negative outcomes because of multiple layers of vulnerability.The clinical significance of our secondary finding that CYP with comorbid ASD are more likely to receive medication for ADHD is unclear. This subgroup may also be more likely to be receiving medication as they have a higher level of impairment,4 The review of NICE guidance in March 2018 recommends medication first line for those with moderate and severe ADHD so this finding may change over time.24The simplest explanation of our finding that CYP who are older are more likely to be receiving medication is that the 2008 National Institute for Health and Care Excellence (NICE) guidance recommended medication as the second-line treatment for all but the most severe ADHD and that conservative measures should be tried first.A key limitation in this study is the cross-sectional design – a lack of temporality makes it difficult to infer that SEP is a causal factor of ADHD medication status from our study alone. Severity of ADHD was not recorded and should be included in future work; similarly, educational attainment may be relevant for further work. Our measures of ethnicity could have been more discriminate, which would be important to consider in further work as ethnicity has been shown to be a predictor of whether children are receiving medication. Our study cannot investigate further why such a social gradient exists, which is important to consider when evaluating whether SEP is a modifiable risk factor. More population-based data collection over time is needed. Although our cohort contained a large proportion of CYP with ADHD in Sheffield, it is possible that there was some selection bias in the cohort that cannot be accounted for in the study.Sheffield is a diverse city in terms of ethnicity, income and religion; our sample was a large cross section across these demographic facets, with our study cohort making up a substantial proportion of all CYP with ADHD in Sheffield. These factors make it likely that the findings of this study are generalisable to other cities in the UK.The social gradient in CYP's receipt of medication represents a novel risk factor that clinicians should aim to modify. Because a social gradient in the receipt of medication for ADHD exists, those from more deprived backgrounds should be considered especially vulnerable regardless of causality, with clinicians thinking of social deprivation in the same way as an additional comorbidity. Targeted interventions for those from a lower SEP may be effective, but progress may be difficult unless the wider inequality in our society is addressed. Further research into why the social gradient in CYP's receipt of medication exists would be helpful to determine if interventions are appropriate; and studies of the long-term effects of increased medication use may also aid service development.This social gradient presents a challenge not only to clinicians but even more to politicians, public health professionals and social care, and adds further weight to the argument that tackling the social determinants of health should be a priority for public health professionals and policymakers alike.In conclusion, a social gradient is evident in the prevalence of ADHD and in CYP's receipt of medication in the UK. To the best of our knowledge, this is the first study that has shown a social gradient in ADHD drug treatment outcomes in a UK population.


Even though neonatal mortality reduction is the major goal needed to be achieved by 2030, it is still unacceptably high especially in Ethiopia. In the other hand, low birth weight is the major cause of neonatal mortality and morbidity. More than 10 millions of low birth weight infants occurred as a result of pregnancy induced hypertension. However, in Ethiopia the association between low birth weight and pregnancy induced hypertension was represented with un-updated, inconclusive and different studies. Therefore, this review aimed to estimate the overall pooled impact of pregnancy induced hypertension on low birth weight and its association in Ethiopia.I2 statistic was computed to check the presence of heterogeneity. Publication bias was evaluated using funnel plot asymmetry and Egger’s test. A random effect model was used to estimate the pooled prevalence of low birth weight.articles searched on PubMed/Medline, EMBASE, CINAHL, Cochrane library, Google, Google Scholar and local shelves. Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) was applied for critical appraisal. The I2 statistic estimation evidenced significant heterogeneity across included studies . In addition, the odds of having low birth weight newborns among women who had pregnancy induced hypertension was 3.89 times higher compared to their counterparts .From the total 131 identified original articles, 25 were eligible and included for the final analysis. The overall pooled prevalence of low birth weight among women who had pregnancy induced hypertension in Ethiopia was 39.7% . But, The pooled prevalence of low birth weight among women who had pregnancy induced hypertension was more than two times higher than the pooled estimate of low birth weight among all reproductive aged women. The odds of low birth weight also increased nearly four times among women with pregnancy induced hypertension than normotensive women. Therefore, health policies which provide better and quality antenatal care with more oriented on importance of early detection and management of pregnancy induced hypertension should be implemented. According to the World Health Organization (WHO), Low birth weight (LBW) is defined as a birth weight of less than 2500 g irrespective of the gestational age. It is an important marker of maternal and fetal health and nutrition . GloballLBW is a significant public health problem, frequently associated with neonatal and child morbidity and mortality . LBW newGlobally, maternal nutrition, extreme maternal age, socio-economic status, multiple pregnancies, chronic medical conditions and pregnancy induced hypertension (PIH) are the common causes of LBW –17. PIH Decreased utero-placental perfusion also significantly increases the risk of intrauterine growth restriction, preterm birth and other neonatal comorbidities  and other systemic disturbances , 22. In Reduction in LBW mortality have greatly contribute to the reduction in overall mortality and recognized as a public health priority. World Health Assembly Member States endorsed the target of 30% reduction in LBW globally in 2025 . HoweverIn Ethiopia, several individual studies were done and reported inconsistent findings in the relationship between PIH and LBW, except one review published in 2019 which didn’t include all currently available researches on association of PIH and LBW (studies done after the previous review) . AccordiInitially, systematic review and meta analysis including registered protocols were searched to avoid duplication. Accordingly, there was one systematic review reported on adverse neonatal outcomes of PIH, which was not primary focused on LBW and different search strategies lead to evaluate different researches. In addition, there are studies published after the previous review published. Published articles were systematically searched using major databases: PubMed/Medline, EMBASE, CINAHL, Cochrane library, Google and Google Scholar. In addition to this, the reference lists of already identified articles, grey literature available on local shelves and institutional repositories were used to access unidentified and un-published articles. All articles published till June 11/2020 were included in this systematic review and meta analysis. All fields, MeSH terms and key terms combined with Boolean operators were used to search articles in electronics data bases and advanced PubMed search. The key terms used for searching were “infant” OR “neonatal” OR “child” AND “LBW” OR “abnormal weight” OR “birth weight” OR “very low birth weight” OR “adverse outcomes” OR “underweight” OR “birth outcome” AND “PIH” OR “preeclampsia” OR “gestational hypertension” AND “Ethiopia”. Then identified articles were exported into endnote citation manager software version X7 for Windows to exclude duplicate records. This review is reporting in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA) checklist guidelines    was utilWhereas for case control studies includes: 1.comparable groups, 2.cases and controls matched appropriately, 3.similar criteria used for identification of cases and controls, 4.valid and reliable measurement for exposure, 5.similar exposure measurement, 6.confounding factors identified, 7.strategies to deal with confounding factors, 8.outcomes assessed in valid and reliable way, 9.the exposure period of interest long enough and 10.appropriate statistical analysis used and for cross sectional studies includes: 1.the criteria for inclusion in the sample clearly defined, 2.the study subjects and the setting described in detail, 3.valid and reliable measurement for exposure, 4.standard criteria used for measurement of the condition, 5.confounding factors identified, 6.strategies to deal with confounding factors stated, 7.the outcomes measured in a valid and reliable way and 8.appropriate statistical analysis used. Each individual paper were critically evaluated by two independent reviewers. Disagreements between the reviewers were resolved via consensus. If not third reviewer was involved to resolve inconsistencies in between the two independent reviewers. After quality assessment, studies which scored five and above were included in this review.The outcome of this systematic review and meta analysis was the prevalence of LBW among women who had PIH. LBW is defined as a birth weight of less than 2500 g irrespective of the gestational age.2) were used to assess the existence of statistical heterogeneity and to quantify it. Low, moderate and high heterogeneity were considered at 25, 50 and 75% respectively (23). In addition, p value less than 0.05 was used to confirm the presence of heterogeneity across studies. Also, publication bias was assessed using Egger’s regression test [p value less than 0.05 as a cut point to declare the presence of publication bias and used a funnel plot to represent graphically the bias. The estimated pooled prevalence of LBW was presented using forest plot diagram with their corresponding 95% CI and OR. Finally, subgroup analysis and meta regression were computed to explore those potential heterogeneity across studies.First, the extracted data computed in excel spread sheet were imported to STATA version 14 for further analysis. Forest plot was computed to show the pooled prevalence of LBW and heterogeneity. Cochran’s Q statistic with inverse variance  . FinallyBased on our inclusion criteria, only 25 articles were included and considered for final analysis. From those included studies, eight articles were done in Amhara region , 39–43, I2 test statistics showed a significant level of heterogeneity across included studies  . In this review, As stated above, this systematic review showed significant heterogeneity across included studies. So, subgroup analysis was done using region, publication year, study design, sampling technique and type of PIH. Regarding to regional prevalence, in Addis Ababa (AA) almost half of women who had PIH delivered LBW newborns . Whereas in Amhara and SNNP, more than one third of newborns born from women who had PIH were LBW . In Oromo region, 30.5%  of newborns born from women with PIH experienced LBW.Regarding to study design, studies done using case control design reported more than half of newborn babies born from women who had PIH had LBW . While studies done in cohort and cross sectional indicated 42.59%  and 35.44%  of pooled prevalence of LBW among PIH women respectively. Ones more, studies which evaluate effect on PIH as general on LBW reported pooled prevalence of 39.03%  and studies which taken effect of eclampsia on LBW indicated 45%  of pooled prevalence of LBW .Furthermore, symmetric funnel plot and Egger’s tests were undertaken to assess publication bias. All of them confirmed publication bias was not observed, evidenced with the following symmetric funnel plot Fig. , Egger’sIn addition to estimating the pooled prevalence of LBW among women who had PIH, this meta analysis also evaluate the odds of association between LBW and PIH. Accordingly, the odds of LBW among women who had diagnosed PIH was 3.89 times higher when compared with normotensive women  Fig. .Fig. 4FGenerally, the main aim of this systematic review and meta-analysis was to estimate the pooled prevalence of LBW among women who had PIH and to evaluate the impact of PIH on LBW in Ethiopia. Reduction of neonatal mortality is one of the major Sustainable Developmental Goals needed to be achieved by 2030 worldwide. But, neonatal mortality is still unacceptably high. Specifically in Ethiopia, the Mini Ethiopian Demographic Health Survey 2019 reported that neonatal mortality was still sustained  and LBW This review showed that, more than one-third of neonates born from women who had PIH were LBW. The pooled prevalence ranges from 33.3 to 46.2% with average estimate of 39.7%. This finding is in line with studies conducted in India , Uganda Furthermore, this figure is more than two times higher than the pooled estimate of LBW among the total population in Ethiopia . The difIn regarding to the association between LBW and PIH, the odds of LBW among women who had PIH were higher when compared to normotensive women. This finding is in line with WHO secondary analysis survey conducted in low and middle income countries, which confirmed that the risk of acquiring LBW among women with PIH was double . SimilarGenerally, even though still difficulties are there in middle and low income countries including Ethiopia, low dose aspirin and calcium supplementation, prenatal care, timely diagnosis, proper management, timely delivery and comprehensive intensive neonatal care service were very important. But, in Ethiopia, still three out of four women get antenatal care and less than half of them delivered at health facility . So, impThis systematic review and meta analysis is not without limitation. More than half of included articles were cross sectional study design in which the result might potentially affected by confounding variables and difficult to establish temporal relationship. In addition, the meta analysis didn’t include all regional states of Ethiopia. Finally, presence of significant statistical heterogeneity among studies was considered as limitation of this review. Therefore, further longitudinal country based studies to assess association of LBW and PIH is recommended.This systematic review and meta analysis revealed that, the pooled prevalence of LBW among women who had PIH was more than two times higher than the pooled estimate of low birth among general women. The odds of having LBW among women who had PIH was higher when compared with normotensive women. Even though prevention of PIH is difficult, early detection of women at high risk of having PIH coupled with intensive antenatal care and management could prevent the occurrence of this burden of LBW. In addition, improving the availability of antihypertensive therapy and intensive neonatal care service should be addressed. Therefore, enhancing universal access of comprehensive and quality perinatal care and obstetric emergency care services are needed to improve neonatal health in Ethiopia.


The pathophysiology of attention-deficit/hyperactivity disorder (ADHD) involves deficits in performance monitoring and adaptive adjustments. Yet, the developmental trajectory and underlying neural correlates of performance monitoring deficits in youth with ADHD remain poorly understood. To address the gap, this study recruited 77 children and adolescents with ADHD and 77 age- and gender-matched healthy controls (HC), ages 8–18 years, who performed an arrow flanker task during electroencephalogram recording. Compared to HC, participants with ADHD responded more slowly and showed larger reaction time variability (RTV) and reduced post-error slowing; they also exhibited reduced error-related negativity (ERN) and error positivity effects, and reduced N2 and P3 congruency effects. Age effects were observed across groups: with increasing age, participants responded faster, with less variability, and with increased post-error slowing. They also exhibited increased ERN effects and increased N2 and P3 congruency effects. Increased RTV and reduced P3 amplitude in incongruent trials were associated with increased ADHD Problems Scale scores on the Child Behavior Checklist across groups. The altered behavioral and ERP responses in ADHD are consistent with the pattern associated with younger age across groups. Further research with a longitudinal design may determine specific aspects of developmental alteration and deficits in ADHD during performance monitoring.  Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder with symptoms including sustained attention problems, impulsivity, and hyperactivity, affecting ~5% of children and adolescents . SeveralPrevious research has shown that children with ADHD perform poorly in a wide range of tasks involving conflict monitoring and inhibitory control . In genIn studies using event-related potential (ERP) measures, children with ADHD have also shown deficits in neurocognitive processes of response inhibition and performance monitoring. Error-related negativity (ERN) and error positivity (Pe) are two reliable ERP indices of performance monitoring. Both components are time-locked to responses. The ERN has been observed in a variety of tasks; its onset coincides with response initiation, and it peaks 50–100 milliseconds (msec) thereafter . The ERNIn addition to the response-locked ERN and Pe, the N2 and P3 are two main ERP components elicited during stimulus processing, reflecting processes involved in stimulus evaluation and response selection. Specifically, the N2 is a fronto-central negative voltage deflection peaking between 200 and 400 msec after stimulus onset; in cognitive control tasks, a larger N2 is elicited by high conflict trials  relative to low cognitive conflict trials , reflecting adaptive conflict monitoring ,27,28. TVariability of behavioral and ERP findings might be accounted for by several factors, including participant heterogeneity, sample size, age range, task paradigms and analysis strategies across laboratories . Many stn = 77 in each group) sample of children and adolescents with ADHD with a broad age range (8–18 years), and age- and gender-matched HC in an arrow flanker task. Participants’ behavioral performance and ERP correlates of performance monitoring and conflict processing were compared between groups, and these measures were related to ADHD symptom severity measured by the DSM-Oriented ADHD Problems Scale from the Child Behavior Checklist (CBCL) as a continuous measure within and across groups. We hypothesized that youth with ADHD would display slower reaction times, more reaction time variability (RTV), and reduced post-error slowing relative to healthy controls. Considering the inconsistent findings in the ERN, Pe, N2, and P3 in ADHD, we reported ERN and Pe on both error and correct trials and N2 and P3 on both congruent and incongruent trials [In the present study, we tested a relatively large  and 77 age- and gender-matched healthy controls (HC), ranging in age from 8 to 18 years. Patients were recruited through the Section of Child and Adolescent Psychiatry within the Department of Psychiatry at the University of Michigan. Comparison subjects were recruited from the surrounding community. After a complete description of the study, written informed consent was obtained from at least one parent of the participant and written informed assent from the participant. Participants were paid for their interviews and psychophysiological recordings. All tasks and procedures were approved by the University of Michigan Medical School Institutional Review Board. DSM-5 criteria [n = 43) were asked to stop taking the medication for 48 hours prior to the EEG. Cases and HC were taking no other psychotropic medications. For the error analyses, two participants with ADHD and one healthy control were excluded due to commission of fewer than six errors, leaving a total of 151 participants. All participants were interviewed with the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Aged Children-Present and Lifetime Version (K-SAD-PL)  and the criteria  using alcriteria . The clicriteria . The WASParticipants performed a modified Eriksen flanker task in which arrows appeared on a personal computer display with congruent  and incongruent  conditions . They weEach participant was seated 65 centimeters directly in front of the computer monitor and told to place equal emphasis on speed and accuracy in responding. Following 40 practice trials, each subject completed eight blocks of 64 trials for a total of 512 trials. Performance feedback was provided after every block to yield an error rate of approximately 10%, with encouragement to focus on speed if there were fewer than four errors or to focus on accuracy if there were more than 10 errors .http://www.biosemi.com/ faq/ cms&drl.htm), and re-referenced offline to the average of the two mastoid electrodes. Data were bandpass filtered 0.1–30 Hz using zero-phase shift filters. EEG data were screened using automated algorithms that rejected epochs in which the absolute voltage exceeded 500 μV and epochs containing peak to peak activity greater than 500 μV within 200 msec, with a 100 msec moving window, for midline channels . Ocular movement artifacts were then corrected using a regression-based algorithm [The electroencephalogram (EEG) was recorded from 64 Ag/AgCl scalp electrodes embedded in a nylon mesh cap, two mastoid electrodes, and two vertical and two horizontal electro-oculographic electrodes using the BioSemi ActiveTwo system . Data were digitized at 512 Hz, referenced to a ground formed from a common mode sense active electrode and driven right leg passive electrode  for each participant. Premature responses faster than 150 ms, slow responses longer than 3000 ms, and reaction times beyond three standard deviations from the mean were not considered in the ERP and behavioral analyses. Intra-individual reaction times variability was estimated as the standard deviation across congruent and incongruent trials. Reaction times after errors were evaluated to determine if there were group differences in post-error behavioral adjustments. Accuracy and mean reaction times on correct trials were further analyzed using analysis of variance (ANOVA) with group (ADHD vs. HC) as a between-subject factor and stimulus type (congruent vs. incongruent) as a within-subject factor. The ERN was quantified using mean amplitude relative to a pre-response baseline (of −200 to −50 msec). The mean amplitude of the ERN was computed on error trials in a window from 0 to 80 msec following the incorrect response. The correct response negativity (CRN) consisted of the same measure computed on correct trials. The ERN effect was defined as the difference between the ERN and CRN (dERN), calculated by subtracting the CRN from the ERN, since it may isolate activity unique to error processing from activity more broadly related to response monitoring [One-way ANOVAs were conducted to compare group difference on behavioral and ERP measures. Regression analyses were used to examine (1) correlations of behavioral, ERP measures, and age; (2) group difference on correlations of behavioral, ERP measures and age; (3) behavioral and ERP predictors of ADHD symptom severity. All statistical tests were two-tailed with the alpha level set at 0.05 if not otherwise specified.p < 0.01) but as accurately (p = 0.77) as HC. Two (congruency: congruent vs. incongruent) by two (group: ADHD vs. HC) repeated-measures ANOVA on correct RT and accuracy revealed main effects of congruency  = 352.4, p < 0.001; accuracy: F  = 470.4, p < 0.001) and a trend-level significance of interaction between congruency and group for reaction times  = 3.22, p = 0.08), but no such interaction in accuracy  = 0.88, p = 0.35). Incongruent trials were completed more slowly and less accurately than congruent trials in both groups. Participants with ADHD tended to have a larger RT congruency effect . Moreover, participants with ADHD exhibited smaller post-error slowing (p = 0.006) and larger RTV (p = 0.005) than HC (Participants’ reaction times and accuracy data are presented in  than HC . p < 0.001), RTV  and RT congruency effect , and was positively correlated with post-error slowing  and overall accuracy . With age increasing, participants responded faster and more accurately, and showed smaller RT congruency effects and RTV. A correlation of age with post-error slowing was evident in ADHD but not in HC . There was no correlation of age with the accuracy congruency effect. Correlation of age with behavioral measures in individual groups is presented in Age in all subjects was negatively associated with overall RT  and an interaction between response type and group  = 4.72, p = 0.031). Error trials elicited a larger ERN (more negative) than correct trials; the ERN effect  was smaller in participants with ADHD than in HC (p = 0.449).The two (response type: error vs. correct) by two (group: ADHD vs. HC) repeated-measures ANOVA revealed a main effect of response type  = 118.46, an in HC . There wr = −0.286, p < 0.001) and dERN , and positively correlated with CRN (r = 0.167 p = 0.040) across all subjects. There was no significant group difference in correlations with age. With age increasing, participants showed a larger ERN, smaller CRN, and larger ERN effect. When covarying age, CRN was negatively correlated with overall RT , RTV , accuracy , and positively correlated with post-error slowing ; the ERN effect was positively correlated with overall RT  and RTV  and negatively correlated with post-error slowing . There was no ERN correlation with behavioral performance and no group difference in the correlation between ERN/CRN/dERN and behavioral performance. Age was negatively correlated with ERN amplitude (p < 0.001) and interaction between response type and group  = 8.37, p = 0.004). Error trials elicited a larger Pe than did correct trials (Pc); the Pe effect  was smaller in participants with ADHD than in HC (p = 0.179).The two (response type: error vs. correct) by two (group: ADHD vs. HC) repeated-measures ANOVA revealed a main effect of response type  = 502.62, an in HC . There wr = 0.182 p = 0.026); there was no significant correlation of age with the Pe or the Pe effect, and there was no group difference in these correlations with age. When covarying age, the Pe and Pe effect were negatively correlated with overall RT , RTV , positively correlated with accuracy  and post-error slowing . There was no Pc correlation with behavioral performance or group difference in correlation between Pe/Pc/Pe effect and behavioral performance. Age was positively correlated with Pc on correct trials (p < 0.001) and an interaction between congruency and group  = 4.99, p = 0.027). Incongruent trials elicited a larger N2 (more negative) than congruent trials; the N2 congruency effect was smaller in participants with ADHD than in HC (p = 0.992).The two (congruency: congruent vs. incongruent) by two (group: ADHD vs. HC) repeated-measures ANOVA revealed a main effect of congruency  = 46.23, an in HC . There wr = 0.395, p < 0.001) and incongruent trials , and negatively correlated with the N2 congruency effect . There was no significant group difference in correlations with age. With age increasing, participants showed larger N2 congruency effect (more negative), which was evident in HC but not in ADHD cases . When covarying age, there was no significant correlation or group difference in the correlation between N2 and behavioral performance . Age was positively correlated with N2 on both congruent (p < 0.001) and group  = 13.12, p < 0.001), a significant interaction between congruency and group  = 6.26, p = 0.013). Incongruent trials elicited larger P3 than congruent trials. Participants with ADHD had smaller P3 amplitudes, and also showed smaller P3 congruency effects than HC (The two (congruency: congruent vs. incongruent) by two (group: ADHD vs. HC) repeated-measures ANOVA revealed main effects of congruency  = 84.24,  than HC . r = −0.151, p = 0.062) or incongruent P3  amplitudes, but was positively correlated with the P3 congruency effect . There was no significant group difference in the correlation of age with P3 congruency effect. With age increasing, participants showed larger P3 congruency effects. When covarying age, RT on congruent and incongruent trials were negatively correlated with P3 at congruent  and incongruent trials  respectively. The RT congruency effect was negatively correlated with the P3 congruency effect . There was no significant association between accuracy and P3, and there was no group difference in the correlation of P3 with behavioral performance. Age was not correlated with congruent  and hyperactivity/impulsive score . Older youth with ADHD in our sample had reduced symptom severity in total and hyperactivity/impulsive scores; there was no correlation of age with the inattention score . When covarying age, there was no correlation between any ADHD symptom scores  and behavioral performance . There was no correlation between ADHD symptom scores and ERP measures, except that the P3 congruency effect was found positively correlated with the inattention subscale . In ADHD, age was negatively correlated with ADHD total score . The age correlation with symptom severity was more significant in ADHD patients than in HC . When covarying age, ADHD Problems Scale scores were correlated with overall RT , RTV , post-error slowing  and the RT congruency effect . When age and these significant behavioral measures were included in a backward stepwise regression model, only RTV was found positively correlated with ADHD Problems Scale scores . When covarying age, ADHD Problems Scale scores were correlated with the CRN , ERN effect , Pe , Pe effect , and P3 on congruent  and incongruent  trials. When age and these significant ERP measures were included in a backward stepwise regression model, only P3 on incongruent trials was found negatively correlated with ADHD Problems Scale scores . In the ADHD or HC group alone, there was no correlation of ADHD Problems Scale scores with any behavioral or ERP measures when covarying age. Across all subjects, age was negatively correlated with CBCL ADHD Problems Scale scores (p < 0.001), and patients with the hyperactive/impulsive type . When controlling age, there were no group differences on any behavioral or ERP measures among the three subtypes of ADHD . For patients included in our sample, participants with ADHD inattentive type (14.7 ± 2.8 years) were older than patients with combined type  and broader age range (ages 8–18) than has been typical in the literature, and in addition, our control group was closely matched in age and matched in gender. While the broad age range allowed us to investigate age effects on performance monitoring, the sample was less homogenous and sample size was small for any given age, preventing us from analyzing the effects of other factors, such as gender, comorbidity and medication [The current study investigated performance monitoring and its development in ADHD. Our study used a larger sample size (dication . Moreovedication ; furtherdication , effectsThis study using ERPs to investigate performance monitoring and its development in ADHD adds to our knowledge of alterations and developmental delays in conflict processing and error monitoring in children with ADHD. Future research should be longitudinal and should include participants across the life span to determine developmental course of performance monitoring and its neural correlates in ADHD. It will also be important to identify behavioral and neural targets for intervention, both for clinical benefit as well as to develop better causal models of the development of ADHD symptoms.


Attention Deficit Hyperactivity Disorder (ADHD) is commonly associated with poor organizational skills, as per the definition of ADHD. However, the contribution of each of the following factors (and their interactions) to the aforementioned poor organization, while comparing individuals with and without ADHD, has not been analyzed in-depth: Work Organization; Communication Clarity; Punctuality; Goal-oriented behaviour; Assiduity; Workspace Organization; Strategies; and Attentiveness. The purpose is to examine the self-reported levels of organizational skills in adults with and without ADHD.n = 303 with a diagnosis of ADHD) adults from the community were recruited online. Participants completed a measure of organizational skills and a screening measure of ADHD.Seven hundred seventy-four (Participants with a diagnosis of ADHD displayed lower scores than individuals without a diagnosis of ADHD on all organizational skills with the exception of using strategies to remain organized and learn new information. Higher levels of education were associated with higher levels of organizational skills. While there was no difference between males and females with ADHD, females without ADHD scored higher than males without ADHD.This study supports that individuals with ADHD can efficiently develop strategies, but may have difficulties using those strategies in a continuous manner. Suggestions to increase organizational skills in adults with ADHD are presented. The term ‘organizational skills’ refers to a functional set of cognitive abilities which facilitate goal-oriented behaviour . PreviouAttention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterized by chronic inattention, hyperactivity, and impulsivity, the severity of which determines the individual’s ADHD presentation as either inattentive presentation (ADHD-IA), hyperactive-impulsive presentation (ADHD-HI), or combined presentation (ADHD-C) . In prevAccording to the functional working memory model of ADHD, impaired working memory is a core feature of ADHD, while inattention, hyperactivity, and impulsivity are secondary features . In thisIn addition, some research has shown positive relationships between the occurrence of hyperactive behaviours and the cognitive demand of a task, which suggests that hyperactive motor engagement may serve as a functional compensation for ADHD’s deficits in the executive functions necessary for organizational behaviour . ExplanaAlternatively, the multiple-pathway model of ADHD identifies motivation/delay aversion as an additional factor which works alongside executive function deficits—such as working memory deficits—in contributing to the exhibition of behaviours and impairments symptomatic of ADHD . In thisTherefore, working memory function is an important consideration for organizational skills in general and particularly for those with ADHD. In addition to cognitive factors, motivation and neurobiology also impact organizational skills in this population. The literature therefore suggests that organizational skills are less developed overall in those with ADHD, with no specification as to what organizational skills are less developed.Equally important to the functional intricacies of ADHD are the ways in which they impact personal success in adolescence and adulthood. In previous research, measuring the ability to implement organizational skills for time, task, and material management surpassed intelligence as an accurate predictor of future grade point average (GPA), demonstrating a negative relationship between organizational difficulty and academic success . ADHD itLikewise, impaired organizational skills in ADHD produce behaviours detrimental to success in both finances and occupation by manifesting as habitual forgetfulness, tardiness, failure to complete tasks, failure to follow instructions, and a lack of adaptability . In addiThere is evidence that men are diagnosed with ADHD more frequently than women e.g., . HoweverBecause of these postulated gender differences, some research suggests that targeted coping strategies to manage ADHD symptoms—such as lack of organizational skills—may be particularly helpful for women with ADHD while men may benefit more from affiliating with prosocial peers . While gThe present study investigates organizational skills deficiencies commonly reported in individuals with ADHD. More specifically, we are interested in determining if individuals diagnosed with ADHD report lower scores on all organizational skills or only a select few. We hypothesize that adults with a diagnosis of ADHD will report lower scores on all organizational skills. We also hypothesize that individuals with higher levels of education will report higher levels of organizational skills. Finally, we will explore gender differences (that we hypothesize to be an important factor to be explored in future research), as well as the relative contribution of organizational skills on mean score of a self-reported measure of ADHD.N = 774) participants were recruited online on reddit/r/SampleSize and Facebook groups for individuals with ADHD. Participants were 31% males and 69% females. A total of 303 participants (39% of the sample) reported having received an official diagnosis of ADHD from a physician, a psychiatrist, or a psychologist. Most participants were native English speakers (80%). Most participants had high school or college education (44%), followed by bachelor education (34%) and post-bachelor education (22%). Almost half (44%) of the participants reported currently being enrolled as a student in a university. Most participants were located in North America (64%) or Europe (27%). The mean age was 27.02 years old (SD = 8.38). All participants provided informed consent prior beginning the online study. Participants were not compensated for completing the present study. The study was approved and given ‘exempt’ status by the IntegReview Ethical Review Board , under protocol number 11022016.A total of seven hundred seventy-four , Communication Clarity , Punctuality , Goal-oriented behaviour , Assiduity , Workspace Organization , Strategies , and Attentiveness . Each item is rated on a 6-point rating scale ranging from During its development, the initial version of the DOSQ contained 200 items, whereas half were related to organization at work and the other half reflecting organization in life outside work. Item reduction was first performed by having a panel of experts rate the relevance of each item to organizational skills, which reduced the number of items to 87. Subsequently, a series of exploratory factor analysis  were conducted on all items of the DOSQ. Items were kept when loading .3 or higher on their target factor without loading .3 or higher on any other factor. A 9-factor solution emerged accounting for 66.46% of the variance. After inspection of intercorrelation of each scale to the total score, one factor was dropped, leaving the total to 38-item.N = 542), a confirmatory factor analysis (CFA) supported the 8-factor structure of the DOSQ. The fit statistics were as follows: χ2 = 1459.516, df = 616, χ2/ df = 2.369, NFI = 0.87, NNFI = 0.91, CFI = 0.92, SRMR = 0.063, RMSEA = 0.050. Out of the 542 participants, a total of 262 also completed the Satisfaction with Life Scale  and SSES (r = .25). A second study examined the association between the DOSQ and the Flourishing Scale  and THS (r = .47), as well as a weak association with rational ability (r = .28). Overall, while additional studies focusing on the convergent and divergent validity of the DOSQ are needed, these results support the psychometric properties and the utility of the DOSQ as a measure of organizational abilities, as observed by its relationship with analytical thinking, focusing and planning to meet goals, and an overall feeling of competence and positivity.Subsequent to its development, the DOSQ’s psychometric properties were examined in two follow-up studies . In the le SWLS;  and the le SWLS; . The DOScale FS; , the Hopcale FS; , and thecale FS; . The DOSThe ASRS is a DSM-IV-based measure including 18 questions related to the frequency of the DSM-IV Criterion A symptoms of adult ADHD from the past six months. This self-report is rated on a 5-point scale, ranging from Never to Very Often. In addition to a screening score consisting of the total of the first six items, the ASRS provides a score on two subscales, namely Inattention and Hyperactivity-Impulsivity. The ASRS has demonstrated good psychometric properties across numerous studies .d effect size on each scale between condition. A series of analysis of variance (ANOVA) supported mean differences between conditions on all scales at the exception of DOSQ-Strategies. The ANOVA results are as follow: DOSQ Total  = 106.760, p < .001), Work Organization  = 45.391, p < .001), Communication Clarity  = 49.304, p < .001), Punctuality  = 51.557, p < .001), Goal-Oriented behaviour  = 8.807, p = .003), Assiduity  = 190.181, p < .001), Workspace Organization  = 9.076, p = .003), Attentiveness  = 217.864, p < .001), ASRS screening  = 251.877, p < .001), Inattention  = 294.498, p < .001), and Hyperactivity Impulsivity  = 168.528, p < .001).All analyses were performed by condition (no-ADHD/ADHD). Examination of Kurtosis and Skewness support a normal distribution on both the DOSQ and the ASRS, as well as their respective subscales. F  = 17.575, p < .001). More specifically, participants in the post-bachelor category scored higher than those in the high school and college category (p < .001) as well as higher than those in the bachelor level category (p < .001). Within participants with ADHD, higher levels of education was also reflecting higher levels of organizational skills  = 8.050, p < .001). Participants in the bachelor level category (p = .005), as well as those in the post-bachelor level category (p < .001) scored higher than participants in the high school and college category. For gender, while there was no difference between males and females with an ADHD diagnosis on the DOSQ, a difference was observed in the no-ADHD category  = 4.916, p = .027), whereas females scored higher than males. To examine potential interactions, a Univariate ANOVA with DOSQ Total as dependent variable and education, gender, and ADHD diagnosis as fixed factors was performed. There was no significant interaction between education and gender  = 0.676, p = .509), between education and ADHD diagnosis  = 0.857, p = .425), between gender and ADHD diagnosis  = 3.050, p = .081) and between education, gender, and ADHD diagnosis  = 1.641, p = .194).Organizational skills were examined between and within conditions. F  = 147.233, p < .001, 2R = .606, adjusted R2 = .602) predicting 60.2% of the variance. Only Communication Clarity, Assiduity, and Attentiveness were significant predictors. The second model examined the DOSQ factors and education against ASRS Inattention, which resulted in a significant model  = 300.113, p < .001, 2R = .758, adjusted R2 = .756) predicting 75.6% of the variance. Only Communication Clarity, Assiduity, and Attentiveness were significant predictors. The third model examined the DOSQ factors and education against ASRS Hyperactivity-Impulsivity, which resulted in a significant model  = 42.382, p < .001, 2R = .307, adjusted R2 = .300), predicting 30.0% of the variance. Only Communication Clarity, Goal-Oriented behaviour, Assiduity, Strategies, and Attentiveness were significant predictors.As shown in A proper understanding of ADHD and its relationship to organizational skills is necessary to devise proper interventions for the ADHD population. Indeed, the current findings support the initial hypotheses that (1) organizational skills differ between ADHD and non-ADHD groups; (2) educational attainment is related to better organizational skills, and (3) that organizational skills are affected by gender (though the precise relationship remains to be clarified in future research).Strategies subscale, which shows that both groups are more or less equally able to develop organizational strategies. Upon further investigation of the subcomponents, the ASRS screener and DOSQ show the following relationships: a higher score on the inattention subscale (from the ASRS screener) is associated with lower levels on both DOSQ’s Assiduity and DOSQ’s Attentiveness scores, and to a lesser extent, on DOSQ’s Communication Clarity. Also, a higher score on the hyperactivity-impulsivity subscale (from the ASRS screener) is related to lower levels on the DOSQ’s Attentiveness, Communication Clarity, and Assiduity. However, a higher score on the hyperactivity-impulsivity subscale (from the ASRS screener) is also associated with higher levels on Strategies and Goal-Oriented behaviour.Overall, both questionnaires (ASRS screener and DOSQ) differentiate between ADHD and non-ADHD groups. Even when looking at the questionnaires’ subcomponents, ADHD and non-ADHD groups are clearly differentiated. The only exception to this broad differentiation is the DOSQ’s Assiduity and ASRS’ hyperactivity-impulsivity matches previous findings suggesting that hyperactive symptoms may act to enhance one’s executive functioning  when engaged in organizational-type activities (assiduity that is particularly enhanced by such hyperactivity-impulsivity symptoms.This pattern of results is consistent with the hypothesis according to which ADHD causes executive functioning deficits (where executive functioning is defined as the arrangement of one’s behaviour and thinking in a manner that will lead to the desired result) rather than deficits in overall problem-solving  . Furthertivities . While htivities , this stCommunication Clarity, Assiduity and Attentiveness are the primary predictors of ADHD, targeting these areas is likely to be most beneficial.In addition, organizational skills relate to higher educational attainment, suggesting that those with ADHD may have more difficulty attaining higher education, particularly at the post-bachelor level. It is also possible that organizational skills may even be necessary to attain higher education. Therefore, interventions targeting organizational skills in those with ADHD are likely to be very beneficial in a higher education setting. Since DOSQ’s subscales of However, the pattern of results (described thus far) should factor in gender.. Mirroring previous research, the present findings suggest that men and women with ADHD experience different challenges . For exaWith the caveat of gender still needing to be addressed in future research, the following indications for organizational skills’ interventions are suggested based on this study’s results: 1.Focus on enhancing communication clarity, assiduity, and attentiveness. This can be done through behavioural modeling and proper reinforcement procedures. 2.Manage brain hyperactivity. This may include methods to manage emotional dysregulation  and ways to “burn off” extra energy . 3.Introduce help at the moment of the performance itself. That is, instead of a counselor being present to suggest overall organizational strategies, someone should be there to help the individual with ADHD implement the behaviour when it needs to be implemented.The present study has several limitations. First, the study focused on biological sex rather than gender. While biological sex has a significant impact on a wide range of psychological disorders, obtaining additional information regarding the gender-identification of the participants could provide additional insights regarding the role of sex and gender in ADHD. Second, additional information regarding the diagnosis of ADHD, such as the time since the diagnosis or comorbidity, was not reported by the participants. Third, as mentioned previously, there is only minimal information regarding the psychometric properties of the DOSQ, especially regarding its convergent and discriminant validity. Additional research should specifically focus on examining the properties of this instrument.In conclusion, the current findings support that, while individuals with a diagnosis of ADHD may report lower organizational skills, they nevertheless attempt to use various strategies to remain organized. Our study provides a necessary insight into the organizational skills’ interventions needed for people with ADHD. It should be emphasized that people with ADHD oftentimes have many gifts and can be exceptionally creative as well as very productive in their areas of interest. To support and help individuals with ADHD and society benefit from these gifts, organizational skills are needed. This study therefore provides a crucial insight into organizational skills that will help those with ADHD reach their full potential.10.7717/peerj.9844/supp-1Supplemental Information 1Click here for additional data file.