An increasing number of studies suggest that physical activity can alleviate symptoms of ADHD in children. In adults there are currently insufficient data available on this subject. Interestingly, ADHD and forms of excessive exercising have both been shown to occur more frequently in adult athletes. The aim of the present study was to empirically investigate the association of ADHD and excessive exercising in the adult general population.For diagnosis of adult and childhood ADHD a large representative sample of the German general population  completed a retrospective assessment of childhood ADHD and a self-report assessment of adult ADHD. Excessive exercising as well as putative mediating variables such as eating related psychopathology, depression, and anxiety were assessed using standardized self-rating instruments.Individuals with childhood only ADHD had a significantly higher frequency of excessive exercising (9.0%) than individuals without ADHD (2.7%). Excessive exercising was significantly associated with childhood only ADHD compared to no ADHD with an odds ratio of 3.239 even after controlling for socio-demographic variables, BMI, eating related and general psychopathology.Our data show that excessive exercising is significantly overrepresented in individuals in which ADHD symptoms in childhood have not persisted into adulthood. We thus hypothesize that a subgroup of individuals might suppress ADHD symptoms by excessive sporting activities. Although in healthy adults physical activity has been associated with immediate and long term improvements in cognitive functioning, studies empirically investigating associations between the effects of physical activity and adult ADHD are rare. Further studies are warranted to explore the potential role of physical activity in the treatment of ADHD in adults. Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disease, clinically defined by its characteristic core symptoms of inattention, and/or hyperactivity and impulsive behavior . The symTraditionally, ADHD has been seen as a self-limiting childhood disease, but recent research has revealed that in most cases major symptoms of the disease persist into adulthood ,7. It isThere is a growing body of evidence pointing towards the positive effects of physical activity (PA) on ADHD symptoms and executive function in children ,13. TablThis is the first study empirically investigating the association between ADHD symptoms and excessive exercising in a representative population-based sample. Based on previous research and our own clinical experience, we hypothesized that individuals with positive ADHD screening results will be more likely to meet criteria of excessive exercising. A strong link between excessive forms of exercising and eating disorders e.g. ,36) as w as w36])A representative sample of the German general population was selected with the assistance of a demographic consulting company . The sample was selected to be representative in terms of age, sex and education. A total of 2,520 people aged between 14 and 93 years agreed to participate and completed the self-rating questionnaires  between November 27 and December 16, 2009. A more detailed description of the procedure has been published in . All resStandard self-report screening instruments were used to assess childhood and adult ADHD. The German short version of the Wender Utah Rating Scale (WURS-k)  was usedThe ADHD self-rating scale (ADHD-SR) , was useBoth the WURS-k criteria and the ADHD-SR criteria had to be fulfilled for participants to be rated as likely cases of adult ADHD. We grouped the ADHD diagnoses into three mutually exclusive categories: never met diagnostic criteria (no ADHD), met full childhood criteria with no current symptoms (childhood only ADHD), and met full childhood criteria with current symptoms (adult ADHD).The Exercise Dependence Scale (EDS-21) can be used to identify individuals performing excessive forms of exercising. Originally developed as a screening tool for exercise dependency ,41, a toIn the present study the German version (EDS-G) of the Exercise Dependence Scale was used which has been validated in a German general population sample . The 21 2) was calculated based on the participants’ self-reported height and weight. A BMI ≥ 30 kg/m2 was recorded as obesity.Typical aspects of eating-disorder related psychopathology were assessed using the German version of the Eating Disorder Examination Questionnaire (EDE-Q) ,42. The The German version of the Patient Health Questionnaire (PHQ-4), an ultra-brief 4-item self-report questionnaire, was used as an overall screening tool for depression and anxiety , German All statistical analyses were conducted using the statistical package for social sciences (SPSS V21) for Windows. Individuals without ADHD (noADHD), with childhood only ADHD (coADHD) and with adult ADHD (aADHD) (3 categories) were compared on several variables using chi square tests and pair-wise contrasts with chi-square tests between two groups for categorical variables as well as ANOVAs with Tukey B post-hoc tests for continuous variables.Multinomial logistic regression analyses were conducted with ADHD categories as the dependent variable and excessive exercising as the main independent variable. Regression analyses were carried out in 3 steps: without adjustment, controlling for socio-demographic variables , and controlling for socio-demographic variables as well as BMI, EDE-Q, and PHQ-4 cutoff scores. An alpha-level of 0.05 was adopted for all tests..A description of the total study sample  and by groups is given in Table 2 = 11.252, df = 1, p = 0.001). There was no difference between individuals with coADHD and aADHD (4%)  and between individuals without ADHD and with aADHD  in the frequency of excessive exercising (Table aADHD (37.0) and coADHD (37.5) both showed significantly higher mean scores on the EDS-G compared to the noADHD group (31.5); however, these values are rather low and they are close to the range of the norm population . Mean scMultinomial logistic regression analyses revealed that a mean score on the EDS-G above the proposed cutoff for excessive exercising was significantly associated with coADHD compared to noADHD with an odds ratio of 3.239 even after controlling for socio-demographic variables, BMI, eating related (EDE-Q) and general psychopathology PHQ-4). No significant association could be found between excessive exercising and aADHD  and individuals with adult ADHD (4%). The odds ratio for excessive exercising in the childhood only ADHD group was 3.2 compared to the no ADHD group even after adjusting for putative mediating variables.A first concern may be that the ADHD-SR and EDS-G scales both measure excessive physical activity and associations between results of these questionnaires may therefore be due to an overlap of the questionnaire items. The authors have thoroughly screened and compared the items of the questionnaires and found an only trivial, negligible overlap concerning the measurement of physical activity  . We also found the prevalence rates of adult ADHD symptoms, their persistence into adulthood and of excessive exercising or “at-risk” EXD in the present study to be in line with earlier literature reports ,8,53,54.There are several possible interpretations of the results. It is well known that ADHD has an increased comorbidity with a range of psychiatric disorders such as conduct disorder, mood disorders, anxiety disorders, and substance dependence -57. The This implies that a proportion of coADHD individuals might suppress their ADHD symptoms by excessive sporting activities. Excessive exercising could thus be one possible factor to cope with ADHD symptoms in adulthood. Recent studies have focused on the effects of physical activity on ADHD symptoms in children (e.g. ) and theBäckmann et al.  have proIt is assumed that compensatory behavior to increase functioning in a selected domain is carried out at the expense of functioning in other areas  and thatOn a neurobiological level, research suggests that PA leads to increased cerebral blood flow in animal models  as well The strengths of the present study include the use of standardized questionnaires in a large sample of the general population. By avoiding a self-selected sample or a clinical ADHD cohort, individuals outside of treatment settings and without diagnosed ADHD were acquired. Though, due to the use of screening questionnaires no confirmed diagnoses could be made. With regard to the aADHD sample, sociodemographic variables such as the relatively high proportion of unemployed individuals and the rather low education status seem quite typical for adults with ADHD. Similarly the low rate of female gender among coADHD and the equal balance between men and women among aADHD, is well in line with earlier literature reports . NeverthThis study is the first to investigate the association between adult ADHD and excessive exercising. We found that individuals with childhood only ADHD demonstrated a higher prevalence of excessive exercising, which might help to suppress ADHD symptoms in adulthood in some individuals. Even though the causality of this effect is supported by previous literature it cannot be confirmed due to the applied study design. However, if exercise therapy proves to have a benefit in ADHD patients, this would have important public health implications. This type of therapy is likely to be cost-effective, could be readily disseminated and would have a beneficial influence on many co-occurring psychiatric and non-psychiatric diseases. Further research is therefore encouraged.


The authors performed meta-analyses of randomized controlled trials to examine the effects of cognitive training on attention-deficit/hyperactivity disorder (ADHD) symptoms, neuropsychological deficits, and academic skills in children/adolescents with ADHD.The authors searched Pubmed, Ovid, Web of Science, ERIC, and CINAHAL databases through May 18, 2014. Data were aggregated using random-effects models. Studies were evaluated with the Cochrane risk of bias tool.Sixteen of 695 nonduplicate records were analyzed (759 children with ADHD). When all types of training were considered together, there were significant effects on total ADHD  and inattentive symptoms  for reports by raters most proximal to the treatment setting . These figures decreased substantially when the outcomes were provided by probably blinded raters . Effects on hyperactivity/impulsivity symptoms were not significant. There were significant effects on laboratory tests of working memory  and parent ratings of executive function . Effects on academic performance were not statistically significant. There were no effects of working memory training, specifically on ADHD symptoms. Interventions targeting multiple neuropsychological deficits had large effects on ADHD symptoms rated by most proximal assessors .Despite improving working memory performance, cognitive training had limited effects on ADHD symptoms according to assessments based on blinded measures. Approaches targeting multiple neuropsychological processes may optimize the transfer of effects from cognitive deficits to clinical symptoms. Attention-deficit/hyperactivity disorder (ADHD) is a childhood-onset condition characterized by pervasive patterns of inattention and/or impulsivity-hyperactivity that often persist into later life.In recent years, cognitive training has been investigated as a potential ADHD treatment.et al.et al.,et al.,et al.The efficacy of cognitive training for ADHD was addressed in a meta-analysis of nonpharmacological treatments for ADHD by Sonuga-Barke et al.,A significant number of new RCTs of cognitive training for ADHD, not available for inclusion in these previous 2 meta-analyses,http://www.crd.york.ac.uk/PROSPERO, protocol number: CRD42011001393). The same protocol was followed here.The EAGG protocol for nonpharmacological interventions for ADHD was registered on the International Prospective Register of Systematic Reviews PROSPERO . Disagreement was resolved by the senior author for 3 trials.Two authors independently assessed trial risk of bias using 5 domains of the Cochrane Collaborations tool2 statistic was calculated a posteriori to estimate between-trial SMD heterogeneity. For the most proximal analysis, parent ratings, if available, were used for home-based interventions, and teacher ratings were used for school-based interventions, except when it could be inferred from the manuscript’s text that teachers were less blinded than parents for home-based interventions and parents less blinded than teachers for school-based interventions  met entry criteria  were an outcome in up to 14 trials. Probably blinded measures were available in up to 11 trials .When most proximal assessments were the outcome, there was a moderate but significant effect on total ADHD and inattention symptoms but no effect on hyperactivity/impulsivity . In sensWhen analyses were restricted to probably blinded measures , in geneWhen analysis was restricted to no/low medication trials, effects on total ADHD symptoms were not significant for either most proximal or, when available, probably blinded assessments in any ADHD core symptom–related outcome .Eight trials included laboratory measures of verbal, and 5 trials visual working memory . There wFive trials included standardized measures of reading and 5 of arithmetic. There were no significant effects in either domain . There wp < 0.05 level, suggesting no significant publication bias.Funnel plots and results of Egger’s test are reported in For most proximal or probably blinded assessments of ADHD core symptoms, there was no significant effect of age on SMD . This leaves open the possibility that cognitive training may be effective under specific circumstances in individual trials. Given the limited number of trials available, we were unable to identify specific features of positive trials . Second, only a minority of trials (n = 5) reported using intention-to-treat analyses, a situation that may have inflated the effects for some outcomes, as participants who are more difficult to treat or who perceive the treatment as less beneficial may drop out of trials; however, drop-out was relatively low in most trials. Third, despite the recent substantial increase in the number of available cognitive training trials, there was an insufficient number of trials to evaluate training approaches targeting specific neuropsychological constructs other than working memory training. Fourth, there were insufficient trials to run analyses for some important outcomes , as well as for sensitivity analyses or analyses restricted to probably blinded measures for a number of outcomes. Fifth, too few trials included long-term outcomes  to allowIn summary, the current meta-analysis found limited evidence for the clinical value of cognitive training for children with ADHD outside of the narrow confines of specific targeted neuropsychological processes . Given the evidence for neuropsychological heterogeneity in ADHD, future efforts should be directed at developing protocols to target a broader range of neuropsychological deficits. Furthermore, therapeutic innovation is required to enhance the “far transfer” of specific neuropsychological gains to everyday patterns of functional impairment through more ecologically valid training approaches.


They were divided into four latent classes based on the SCQ and CPRS-R:L data. These classes were: without behavioral problems ‘Normal-class’ (n = 154), with only ADHD symptoms ‘ADHD-class’ (n = 49), and two classes with both ASD and ADHD symptoms; ADHD(+ASD)-class (n = 39) and ASD(+ADHD)-class (n = 41). The pure ADHD-class did not deviate from the Normal class on any of the motor timing measures . The comorbid ADHD(+ASD) and ASD(+ADHD) classes were significantly less accurate (more time underestimations) compared to the Normal class . Variability in motor timing was reduced in the younger children in the ADHD(+ASD) class, which may reflect a tendency to rush the tedious task. Only patients with more severe behavioral symptoms show motor timing deficiencies. This cannot merely be explained by high ADHD severity with ASD playing no role, as ADHD symptom severity in the pure ADHD-class and the ASD(+ADHD) class was highly similar, with the former class showing no motor timing deficits.Children with attention-deficit/hyperactivity disorder (ADHD) have motor timing difficulties. This study examined whether affected motor timing accuracy and variability are specific for ADHD, or that comorbidity with autism spectrum disorders (ASD) contributes to these motor timing difficulties. An 80-trial motor timing task measuring accuracy ( These measures may differentially affect cognitive functions that rely on accurate motor timing [timing processes rather than to general deficient motor functioning in children and adolescents who suffer from ADHD [Attention deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder that is typified by developmentally inappropriate degrees of inattention, impulsivity, and hyperactivity . Broad pr timing –9. Reducr timing , 10–13. rom ADHD .Despite this compelling evidence for motor timing difficulties in ADHD, reduced time processing has not exclusively been found in ADHD. It has also been observed in other disorders including autism spectrum disorders (ASD) –18. ADHDWe previously reported on the advantages of more homogeneous subgroups of comorbid ASD–ADHD children when studying shared substrates in a clinic and population-based sample . In thatμ, σ, and τ, respectively. In sum, the aims were to examine whether the (1) accuracy, (2) variability, and (3) infrequent long response times differed across the four homogeneous ADHD-ASD symptom classes. Given the previous findings in more homogeneous subgroups [The cognitive domain of time processing is an additional candidate for furthering our understanding of these more homogeneous subgroups of children affected with pure ADHD or affected with both ASD and ADHD symptomatologies. The current study was set out to examine the overlap and distinctiveness in motor timing abilities between these homogeneous subgroups with the use of a well-validated motor timing paradigm , 14, 31.ubgroups , we hypoThe task was randomly assigned to 283 participants between 8 and 17 years of age from a population- and clinic-based sample. This sample originally consisted of 644 participants ; becauseT-scores of the following ten scales of the CPRS-R:L: social problems, inattention, restlessness, cognitive problems, hyperactivity, oppositional behavior, emotional lability, anxiety, perfectionism, and psychosomatic complaints  or corrected for the influence of age (CPRS), limiting the impact of age on the definition of the latent classes. Five classes had the best fitting BIC and SSA BIC values and entropy (0.914), combined with informative class profiles [p’s > 0.06), ADHD symptom severity , sex , and IQ . Consequently, the current sample was older (M (SD) 11.57 (2.5)) than the complete sample (M (SD) 9.5 (2.4)). The distribution of children across the distinct homogeneous symptom classes, as well as the ASD and ADHD symptom severity, age, sex, population, and IQ distributions are provided in Table In the previous study, participants were divided in homogeneous symptom classes with the use of a LCA on the raw subscale outcomes of the SCQ  and the ion, see ). The raprofiles . Betweentropy 0.94, combinn = 154). Next, class ‘ADHD’ contained children with only ADHD symptoms (n = 49) without comorbidities. Here both DSM-IV-oriented CPRS subscales for ADHD (Inattentive and Hyperactive-Impulsive behavior) were above clinical cut-off, whereas the SCQ total score was substantially below cut-off (see Table n = 39). Finally, children in the class ‘ASD(+ADHD)’ scored at/above clinical cut-off on both ADHD and ASD symptoms, with the ASD symptoms more prominent than the ADHD symptoms (n = 41). No class with only ASD behavior was identified. All children were of Caucasian descent and had an estimated total IQ of at least 70 on the Wechsler Intelligence Scale (WISC-III) or Wechsler Adult Intelligence Scale (WAIS-III) [For the sake of clarity, the classes were labeled. Children in class ‘Normal’ showed hardly any problems on ASD and ADHD behavioral domains n = 54. Next,AIS-III) , 35. ExcThis 1 s time production task measured the accuracy, variability, and infrequent long response times of (motor) timing , 14, 28.μ and the mean of time productions in ms, corrected for the tail of the distribution (infrequent long response times). Variability in timing was represented by σ and the variability of motor time productions in ms, corrected for the tail of the distribution (infrequent long response times). Infrequent long response times were represented by τ, the mean of the exponential part of the distribution [μ (mu), σ (sigma), and τ (tau) were calculated with the use of ex-Gaussian analyses performed in MATLAB.Accuracy of motor timing was represented by ribution . DependeThe task described was part of the broader neuropsychological assessment batteries used in the SPIDER and BOA projects. These studies have been approved by the Committee on Research involving Human Subjects (CMO) and participants were enrolled between January 2009 and July 2011. After complete description of the study to the parents and adolescents, written informed consent was obtained. Parents were invited to fill in several questionnaires concerning their youngster’s behavior.τ, the mean of the exponential part of the distribution. Since τ-data were positively skewed, normalized z-scores for τ were used in all analyses. These z-scores were obtained by Van der Waerden transformations (SPSS version 20). Effect sizes were defined in terms of percentage of variance explained (ηp2). Small, medium, and large effects were defined as explained variances of 0.01, 0.06, and 0.14, respectively [Raw responses higher or lower than 4 SD from a subject’s mean, with a minimum response time of 200 ms, were considered outliers and excluded, which was <0.1 % of the data . Slow reectively .2 as covariates. Dependent variables were μ, σ, and τ, respectively. Age2 was included to adjust for possible nonlinear improvement in tasks performance across age. Interaction effects were examined and, if nonsignificant, dropped from the model. Post hoc analyses were repeated with IQ and the measures for ADHD, oppositional behavior, emotional lability, anxiety, perfectionism, and psychosomatic complaints as covariates to examine whether results changed when correcting for between-classes differences in these domains. Correction for multiple comparisons was applied according to the false discovery rate (FDR) controlling procedure to the post hoc analyses with a p value setting of 0.05 [The classes were compared using Repeated Measures ANCOVAs with class membership and sex as a fixed factor, age, and age of 0.05 . Only thclass effect, however with small effect size, was found for μ (F(3282) = 4.20, p = 0.006, ηp2 = 0.04). All classes seem to underproduce the 1-s interval  and ASD(+ADHD) (M = 870 ms) classes deviated significantly from that of the Normal class (M = 925 ms) , while the accuracy of the only ADHD class did not differ from that of the other classes (M = 916 ms). No significant class by age interaction effect was found for μ (F(3282) = 1.71, p = 0.16, ηp2 = 0.02). A significant positive linear age effect, however with small effect size, was found for μ (F(1282) = 10.37, p = 0.001, ηp2 = 0.04), with more accurate responses in older than younger children.A significant class effect was found for the σ (F(3282) = 0.86, p = 0.46, ηp2 = 0.01). A significant class by age interaction effect with a medium effect size, was found for σ (F(3282) = 5.58, p = 0.001, ηp2 = 0.06), see also Fig. μ in the ADHD(+ASD) class indeed indicated 9.8 % lower mean response times for less variable children (M = 809.72) compared to their more variable counterparts (M = 897.56).No significant the σ (F382 = 0.86class effect nor significant class by age interaction effect was found for the τ (F(3282) = 1.53, p = 0.21, ηp2 = 0.02 and F(3282) = 0.20, p = 0.90, ηp2 = .00, respectively). A significant positive linear effect of age with medium effect size and a significant effect of age2 with a small effect size were found for these infrequent long response times (F(1282) = 36.42, p < 0.001, ηp2 = 0.12 and F(1282) = 5.50, p = 0.02, ηp2 = 0.02, respectively), see also Fig. No significant  the τ (F282 = 1.5μ (p = 0.17), suggesting severity of inattention was related to a stronger tendency to underproduce the 1-s interval. Covarying for other symptom domain measures did not influence the results.Findings were similar when analyses were controlled for the influence of IQ. Covarying for inattention—but not hyperactivity/impulsivity—symptom severity attenuated the class main effect for Finally, as a check on the interpretation of our findings, analyses were repeated without unaffected siblings of ASD, ADHD, and ASD+ADHD-affected participants in the Normal class. This resulted in minor changes in outcome, which could not explain the absence of a difference between the ADHD-only class and the Normal class. Thus, the presence of unaffected siblings in the Normal class did not change the conclusions.μ, σ, and τ). In fact, motor timing difficulties were found only in classes where both ADHD and ASD symptoms were present. The ADHD(+ASD) and ASD(+ADHD) classes showed a reduced motor timing accuracy  compared to the Normal class. In addition, the younger children in the ADHD(+ASD) class had a reduced variability in motor timing when compared to the younger children in the Normal and ASD(+ADHD) classes, a pattern which was diminished across the older children.The present study examined whether reduced motor timing accuracy, increased timing variability, and infrequent long response times are specific for ADHD, or in part due to comorbidity with ASD. We compared motor timing difficulties across four homogeneous ASD–ADHD and unaffected latent classes derived from a clinic- and population-based sample. These homogeneous classes presented either no behavioral problems, purely ADHD behavior without any comorbidity, or both ASD and ADHD symptomatologies. In contrast to our hypotheses, the pure ADHD class did not deviate from the Normal class on any of the motor timing abilities , and adults with clinical control groups . FindingEvaluation of the significance of timing differences and commonalities in pure ADHD and ASD with comorbid ADHD can be further elucidated by analyzing brain–behavior relationships. The extent to which substrates of timing related to pure ADHD are also related to ASD with comorbid ADHD, and vice versa, can increase our understanding of the role of time processing for the development of behavioral symptoms in ASD and ADHD. It has been suggested that time processing deficits in ASD are due to an abnormal cortical connectivity and synchrony as well as more diffuse and widespread neural abnormalities, with reduced volumes reported in the parietal lobe, limbic and cortical regions, and white matter tracts –43. FuncThere are some limitations worthy of note. First, boys were overrepresented in the three affected classes, whereas they were underrepresented in the Normal class. This is because the symptoms of ASD and ADHD are more frequently seen in boys than in girls . Note th


Attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) often co-occur and share genetic risks. The aim of this analysis was to determine more broadly whether ADHD and ASD share biological underpinnings.We compared copy number variant (CNV) data from 727 children with ADHD and 5,081 population controls to data from 996 individuals with ASD and an independent set of 1,287 controls. Using pathway analyses, we investigated whether CNVs observed in individuals with ADHD have an impact on genes in the same biological pathways as on those observed in individuals with ASD.The results suggest that the biological pathways affected by CNVs in ADHD overlap with those affected by CNVs in ASD more than would be expected by chance. Moreover, this was true even when specific CNV regions common to both disorders were excluded from the analysis. After correction for multiple testing, genes involved in 3 biological processes  showed significant enrichment for case CNV hits in the combined ADHD and ASD sample.The results of this study indicate the presence of significant overlap of shared biological processes disrupted by large rare CNVs in children with these 2 neurodevelopmental conditions. Attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) show strong comorbidity at the level of both symptoms and disorder.5Although shared common risk variants for ADHD and ASD have not been identified thus far,In this study, we set out to investigate whether large rare CNVs found in individuals with each of these clinical phenotypes index disruption of shared biological pathways in the disorders. The first aim was to determine whether biological pathways disrupted by CNVs in individuals with ADHD, as compared with ethnically matched controls, showed statistically significant enrichment for CNV hits in participants with ASD, as compared to a separate set of controls. The second aim was to meta-analyze the ADHD and ASD samples to increase the power of detecting specific shared biological pathways disrupted in individuals with these 2 neurodevelopmental conditions.DSM-IV/DSM-III-R ADHD or International Statistical Classification of Diseases and Related Health Problems–Tenth Revision (ICD-10) hyperkinetic disorder. Exclusion criteria were intellectual disability , major medical or neurological conditions, ASD, psychosis, and bipolar disorder. Approval was obtained from North West England, Wales, National Health Service Tayside, and Eastern Regional Health Authority research ethics committees. Written informed consent was obtained from parents, and assent/consent was gained from the young persons.The sample consisted of 799 young persons of white ethnicity from Cardiff, Wales (n = 559), St. Andrews, Scotland (n = 44), and Dublin, Ireland (n = 196). All children were recruited from community clinics and had a diagnosis of ADHD and other psychiatric diagnoses were assessed by trained psychologists using the Child and Adolescent Psychiatric Assessment (CAPA) parent version,DNA for all participants with ADHD was extracted from saliva or peripheral blood samples, as described previously.CNVs for participants with ASD and independent controls were obtained from the publicly available supplementary data of a study comparing CNVs in 996 individuals of white ethnicity with ASD to 1,287 matched controls.The following 5 sets of pathways were used in the enrichment analyses . Furthermore, pathways required at least 10 hits in the total sample to be counted . This was to reduce the chance of small pathways showing apparent enrichment based on a small number of CNV hits.Each CNV was assigned a binary variable (“participant” or “control”) according to whether it came from a participant with ADHD or ASD or from a control. A CNV was considered to “hit” a gene if any part of the CNV lay between the start and end points of the longest transcript of the gene . Both CNV and gene positions use build 36.3.participants with ADHD or ASD/control ∼ CNV length + number of genes hit outside pathway + hit gene(s) in pathway (yes/no), and the deviance was compared to the following: participants with ADHD or ASD/control ∼ CNV length + number of genes hit outside pathway to give a (1-sided) test of enrichment of case CNV hits on genes in the pathway.The following logistic regression model was fitted to the sample of CNVs for each pathway separately: This method is similar to that proposed by othersCNV length is fitted in the model because long CNVs are more likely to hit any set of genes than small ones, and CNV length may differ systematically between participants with ADHD or ASD and controls. The number of genes hit outside pathway is fitted to allow for case CNVs influencing disease status by hitting genes other than those in the pathway being tested. A binary variable (yes/no) is used to indicate whether a CNV hits gene(s) in a pathway rather than the number of genes in the pathway hit by the CNV, to allow for some pathways having several genes that are physically close together (and thus likely to be hit by the same CNV).The same analysis approach was also used to obtain tests of gene-specific enrichment for participant CNV hits, by defining pathways containing single genes.p < .05, p < .01, p < .001) in the ADHD sample. The number of enriched pathways in the ASD sample at the same significance level as that used to select pathways from the ADHD sample was compared to that obtained when the participant/control labels were randomly permuted in the ASD sample. This procedure was repeated 1,000 times, and the p value for the number of pathways significantly enriched in both samples was estimated as the proportion of replicates, where the number of significantly enriched pathways was at least as great as that observed in the actual data. This analysis allows for overlap between pathways in terms of their gene membership. Analyses were carried out using all participants with ASD CNVs (versus control CNVs), and also for de novo and inherited CNVs , separately.To test whether the pathways with nominally significant enrichment in the ADHD sample showed greater than expected enrichment for case CNV hits in the ASD sample, enrichment analyses were run in the ASD sample restricted to the pathways enriched at various levels  to the regression models  and applying these to the combined ADHD and ASD data.A combined pathway enrichment analysis was performed by meta-analyzing the ADHD and ASD case CNVs compared to their corresponding control CNVs. Enrichment To assess the extent to which the observed overlap in enriched pathways is driven by known loci for autism susceptibility, the enrichment analysis was repeated on the complete pathway set, omitting genes in 14 autism loci from previous studies . Note that these loci have previously been shown to overlap with CNVs in a portion (n = 366) of the current ADHD sample.Overlap (y/n) ∼ participants with ADHD or ASD/control + CNV length. A CNV was defined as overlapping if any part of that CNV overlapped any case CNV from the other sample. A significant positive regression coefficient for the case/control term is taken as evidence that case CNVs in 1 sample are more likely than their corresponding control CNVs to overlap case CNVs in the other sample, allowing for CNV size . This analysis was initially carried out genome-wide, using all CNVs, and then repeated omitting CNVs in the autism regions listed above to see if these regions accounted for any significant overlap.Moreover, it is possible that any observed overlap in pathways enriched in both samples is due to the physical overlap between case CNVs from the 2 samples, rather than shared biology per se . We tested whether ASD participants' CNVs are more likely than their control peers' CNVs to overlap participants with ADHD participants' CNVs, and vice versa, by fitting the following logistic regression model to the CNVs from each sample: The pathway enrichment analyses were repeated on the complete pathway set after removing from both sets of cases any CNV occurring in a participant with ADHD that overlapped a CNV in the ASD sample (leaving 102 ASD CNVs and 55 ADHD CNVs). A significant excess of pathways enriched in both samples would provide evidence of shared biology even among CNVs that do not hit the same genes.To determine whether any observed overlaps in significant pathways were driven primarily by deletions or duplications, the pathway enrichment analyses were repeated on the complete pathway set, using deletions or duplications alone.p < .05, p < .01, p < .001) in the ASD sample that were also significant at the same significance level in the ADHD sample. It can be seen that a significant overlap in enriched pathways for ASD and ADHD is observed for both ASD de novo and inherited CNVs, with the most significant overlap being observed in the analysis of all ASD CNVs together.p < .05) enriched for case CNV hits in both the ADHD and ASD samples, the 20 pathways that were most significantly enriched in the combined ADHD and ASD  samples are shown in p < .05) enriched for case CNV hits in the combined ADHD and ASD sample. Note that 3 of these pathways  have enrichment p values in the combined ADHD and ASD data that are significant even after Bonferroni correction for 10,240 pathways tested (p < 4.88 × 10−6). This correction is conservative, as the tested pathways are not independent because of shared genes. The genes hit by case CNVs in these 3 pathways are listed in Of the 100 pathways that were significantly (p = 4.77 × 10−3), even when 14 specific ASD susceptibility loci were excluded (p = 8.28 × 10−3). Similarly, ADHD case CNVs were significantly more likely to overlap with ASD case CNVs than ADHD control CNVs .ASD case CNVs were significantly more likely than ASD control CNVs to overlap with ADHD case CNVs  enriched in both ADHD and ASD when all CNVs were analyzed . Removing the known ASD regions makes little difference to the pathway enrichment, whereas removing case CNVs that physically overlap with case CNVs from the other disorder generally reduces enrichment significance considerably. Thus, most of the overlap in enriched pathways can be attributed to case CNVs in the disorders hitting the same loci (and thus genes) but not necessarily in regions previously implicated in ASD.Pathway enrichment p values for the 100 pathways significantly enriched (p < .05) in both ADHD and ASD when deletions and duplications are analyzed separately are shown in Of the 85 case CNVs in the ADHD sample, 21 were deletions and 64 were duplications. Among the 78 control CNVs in the ADHD dataset, 13 were deletions and 65 were duplications. Of the 133 case CNVs in the ASD dataset, 34 were deletions and 99 were duplications. Among the control CNVs in the ASD dataset, 65 were deletions and 150 were duplications. The numbers of pathways significantly enriched in both ADHD and ASD are provided in A complete list of the case CNVs >500 kb (ADHD and ASD) used in the analyses is given in p < .05) for CNVs in the ADHD sample (relative to controls) as a group show more enrichment for CNVs in the ASD sample (relative to an independent set of controls) than expected by chance. A similar enrichment was observed (results not shown) when the analyses were performed in the reverse direction . This finding indicates the presence of common biological liability for ADHD and ASD. Significant overlap was observed for both de novo and inherited CNVs in the ASD sample, although these results are not independent because the same control CNVs were used.The results show that the biological pathways enriched , and a significant (or nearly significant) gene from the same region on chromosome 17 . It is unclear which gene(s) in these regions is responsible for the CNV enrichment. It should be noted that even when these regions are removed from the analysis, all 3 pathways still show significant enrichment .To highlight which specific pathways contain enrichment evidence in both ADHD and ASD, the 2 samples were combined in a joint analysis. Three pathways showed significant enrichment after correction for multiple testing . Owing to the definition of pathway categories, many of the analyzed pathways overlap with one another, including pathways embedded in one another. The 3 significant pathways contain different significant genes  and rare (CNVs) variants.Interestingly, the current analysis has not implicated the types of biological pathways previously reported in pathway analyses in ASD samples that are related to synaptic and neuronal plasticity and those involved in neurotransmission or synapse formation and maintenance.Given the very high level of comorbidity and symptom correlation between ADHD and ASD,Although the participants with ADHD and the WTCCC2 controls were genotyped on different chips, CNV calling used only the SNPs common to both genotyping chips, with the same QC procedures used to filter the SNPs. Thus, the CNV calls are comparable between participants with ADHD or ASD and controls, particularly for large (>500-kb) CNVs that are called with high accuracy and reliability. The participants with ASD and controls were genotyped on the same chips, using the same QC protocols, so again the CNV calls are directly comparable between participants with ASD and controls. The participants with ADHD and WTCCC controls are of similar ethnic backgrounds , as are the participants with ASD and controls . Note that, in the combined analysis, differences in ethnicity and CNV calling between the ADHD and ASD samples are controlled by including “sample” as a covariate. Thus, significant pathway enrichments are unlikely to have arisen because of population stratification or differences in CNV calling.One limitation of this study is that the biological pathway categories were defined based on the GO, KEGG, PANTHER, MGI, and MSigDB databases, which depend on the accuracy of the annotations in these databases. As the contents of these databases come to reflect the growing knowledge of these processes, pathway analyses such as those described in this article will be better able to implicate specific biological processes in disease etiology. Furthermore, future studies need to assess the functional effects of genes implicated in specific overlapping pathways, to determine the exact nature and extent of the shared underlying biology of ADHD and ASD.It is of note that the overlap in pathways was detected for de novo as well as inherited CNVs. Both inherited and de novo CNVs are enriched in participants with ASD relative to controls, with a higher frequency of de novo CNVs in females than in males and in sporadic ASD cases  than in “multiplex” families .Although the majority of the CNVs in this sample (both in participants with ADHD or ASD and in controls) were duplications, the strength of the signal was reduced by analyzing deletions and duplications separately. This suggests that both types of CNVs likely contribute to disrupting biological processes underlying ADHD and ASD.There is evidence that large, rare CNVs are more likely to occur in children with ADHD who have comorbid ID (IQ <70).In conclusion, this study provides evidence that ADHD and ASD show significant overlap of shared biological processes being disrupted by CNVs. This finding gives preliminary evidence of the mechanisms that may underpin observed phenotypic overlap


The mean patient age at the time of presentation was 53 years. A total of 24 EGISTs were detected, originating in the omentum (n=4), mesentery (n=19) and retroperitoneum (n=1), respectively. The EGISTs displayed a predominantly spindle cell subtype . The majority of the EGISTs appeared as large , round or oval , cystic-solid  and ill-defined  soft-tissue masses. The EGISTs were hypodense  or isodense  on CT images, hypointense , isointense  or hyperintense  on T1-weighted imaging (T1WI), and hyperintense on T2WI  and diffusion-WI . A total of 54.2% (13/24) of the EGISTs displayed tumor vessels. Overall, 95.8% (23/24) of the masses showed marked enhancement and 87.5% (21/24) demonstrated heterogeneous enhancement. Calcification, hemorrhage, ascites and lymphadenopathy were rare characteristics in the EGISTs. Distant metastases were present in 10 patients (41.7%). The size, borders, tumor vessels and distant metastasis correlated with high-grade EGISTs [>5 mitoses/50 high-power fields (HPFs)] (P<0.05). The results of the present study indicated that clinical and radiological features, including advanced age, a large tumor size, cystic-necrotic components, rare lymphadenopathy, a heterogeneous enhancement pattern and hepatic metastasis may aid in the diagnosis of EGISTs. Radiological characteristics, such as a large size (>10 cm), ill-defined borders, tumor vessels and distant metastasis, can provide useful information in identifying the malignant behavior of EGISTs.Extragastrointestinal stromal tumors (EGISTs) are rare mesenchymal tumors that originate outside the gastrointestinal tract. The aim of the present study was to investigate the computed tomography (CT) and magnetic resonance imaging (MRI) features of EGISTs and analyze the correlations between radiological findings and pathological features. CT and MRI images of 24 patients with EGISTs were reviewed retrospectively. Patient demographics and tumor characteristics, including localization, size, contours, borders, cystic-necrotic components, calcification, hemorrhage, tumor vessels, attenuation and intensity, degree and pattern of enhancement, ascites, tumor invasion, lymphadenopathy and distant metastasis were recorded. Statistical analyses to compare the radiological characteristics of low- and high-grade EGISTs were performed with χ Gastrointestinal stromal tumors (GISTs) are the most prevalent mesenchymal neoplasms of the GI tract. The annual incidence of GISTs is reported to be 7–19 cases per million individuals . The stoThe computed tomography (CT) and magnetic resonance imaging (MRI) features of GISTs have been reported previously. Numerous studies have identified malignant imaging signs for GISTs, such as a large size, irregular surface, ill-defined margins, tissue invasion, distant metastasis, peritoneal dissemination and satellite nodules –10. HoweThe clinical, pathological and radiological findings of 24 patients with primary EGISTs who were treated at East Hospital, Tongji University School of Medicine  and Shanghai Tenth People’s Hospital, Tongji University School of Medicine  between May 2004 and August 2013 were reviewed. All EGISTs were histologically proven by surgery. The criteria for diagnosing the EGISTs were as follows: i) The mass had no definite connection with the GI tract wall by intraoperative or pathological observations; ii) the mass had typical GIST morphology, as observed by light microscopy; and iii) the mass expressed KIT and/or CD34. Written informed consent was obtained from all patients.In total, 23 of the 24 patients underwent CT scans of the abdomen and/or pelvis at the time of presentation. CT examinations were performed with a 16-slice spiral CT scanner  or a 64-sclice spiral CT scanner . The main parameters of the CT scans were as follows: Tube voltage, 120 kVp; tube current, 250 mAs; slice thickness, 3–8 mm; field of view, 350 mm; matrix, 512×512; gantry speed, 0.75 sec/rotation; and pitch, 1.0–1.2. Oral diatrizoate meglumine  was administered to ten patients prior to the scans. Dual-phase dynamic contrast enhancement was performed to obtain images of the arterial phase (30–35 sec) and venous phase (65–70 sec) subsequent to the intravenous administration of contrast agent . Multiplanar reformation and maximum intensity projection images were achieved at an affiliated workstation.2) were obtained in the axial plane, and T2-weighted short time inversion recovery images  were obtained in the axial, coronal and sagittal planes. Following the intravenous administration of gadopentetate dimeglumine , dual-phase dynamic contrast enhancement was performed to obtain fat-saturated T1WI  of the arterial phase (30 sec) and venous phase (60 sec) in the axial, coronal and sagittal planes. In five out of 24 patients, both CT and MRI images were available.Six out of 24 patients underwent abdominal and/or pelvic examinations with a 3.0-Tesla MRI scanner  using a body coil. The main parameters of the MRI examination were as follows: Field of view, 375 mm; matrix size, 252×192; and slice thickness, 3–6 mm. T1WI , T2WI  and DWI  on contrast-enhanced images or water-like signal without enhancement on MRI images. The radiological images were used to measure the largest dimension of each tumor. The degree of tumor enhancement was classified as mild (<30 HU) or marked (≥30 HU). The enhancement patterns were recorded as homogeneous or heterogeneous. Tumor vessels were defined as engorged vascular structures within the mass. Lymphadenopathy was determined as present if a nodular soft-tissue lesion existed that was >10 mm in the short-axis diameter.Two experienced radiologists who were blinded to the pathological results of the EGISTs retrospectively reviewed the radiological images, and the findings were reported as a consensus of opinion. Tumor characteristics, including localization, size, contours, borders, cystic-necrotic components, calcification, hemorrhage and tumor vessels, were recorded. The attenuation and intensity, as well as the degree and pattern of enhancement of the EGISTs were evaluated. Radiological findings were also evaluated for ascites, tumor invasion, lymphadenopathy and distant metastasis.The pathological findings in the surgical specimens were retrospectively reviewed by one experienced pathologist, with a particular emphasis on the presence of morphology, mitotic activity and the immunoreactivity of KIT and CD34. On light microscopy, ≤5 mitoses/50 high-power fields (HPFs) is generally considered to indicate a low-grade EGIST, whereas >5 mitoses per 50 HPFs is generally considered to indicate a high-grade EGIST ,7. This 2 or Fisher’s exact tests . P<0.05 was considered to indicate a statistically significant difference.Quantitative variables are expressed as the mean ± standard deviation (SD) and categorical variables are expressed as frequencies or percentages. Statistical analyses to compare the radiological characteristics of EGISTs of differing grades were performed with χBased on the diagnostic criteria, 24 surgically resected EGISTs were identified. A slight male predominance  existed within the study group. The mean age at the time of presentation was 53 years . The mean tumor size was 12.8 cm . The clinical symptoms were an abdominal or pelvic mass (n=14); abdominal pain (n=8) and abdominal distension (n=7). The primary EGISTs occurred in the omentum , mesentery  and retroperitoneum . The pathological subtype of the 24 EGISTs was classified as spindle cell , epithelioid cell  and mixed cell . Immunohistochemistry showed that 91.7% (22/24) and 70.8% (17/24) of the tumors were positive for KIT and CD34, respectively. Two KIT-negative EGISTs were both of mesenteric origin and epithelioid or mixed cell subtype. The clinical data, pathological subtypes and immunohistochemical results are shown in On the CT  and MRI  images, 16 tumors (66.7%) exhibited round or oval contours and eight (33.3%) showed an irregular appearance. The masses were regarded as ill-defined in 16 patients (66.7%). The tumors appeared as a hypodensity (n=7), slight hypodensity (n=9) or isodensity (n=7) on precontrast CT images, as a slight hypointensity (n=3), isointensity (n=2) or slight hyperintensity (n=1) on T1WI, and as a hyperintensity (n=6) on T2WI and DWI  and 2. AStatistical analyses showed that tumor size (P=0.041), tumor borders (P=0.021), tumor vessels (P=0.023) and distant metastasis (P=0.019) correlated with high-grade EGISTs. However, tumor localization, tumor contours, cystic-necrotic components, calcification, hemorrhage, degree and pattern of enhancement, ascites and lymphadenopathy did not exhibit significant differences (P>0.05) between the low- and high-grade EGISTs. The radiological findings of the EGISTs of differing grades are summarized in The interstitial cells of Cajal, pace-maker cells that control GI track peristalsis and express the KIT antigen, are believed to be the origin of GISTs. The occurrence of GISTs as primary tumors in extragastrointestinal intra-abdominal tissues, such as the mesentery, omentum, retroperitoneum, abdominal wall, gallbladder, pancreas and rectovaginal septum, occurs rarely ,4,11–13.et al , which is consistent with previous studies ,16,17. K1/24, whiet al . The accet al . Howeverl , ill-defined borders, tumor vessels and distant metastasis, can provide useful information in identifying the malignant behavior of EGISTs.


Attention Deficit Hyperactivity Disorder (ADHD) mainly affects the academic performance of children and adolescents. In addition to bringing physical and mental health benefits, physical activity has been used to prevent and improve ADHD comorbidities; however, its effectiveness has not been quantified. In this study, the effect of physical activity on children's attention was measured using a computer game. Intense physical activity was promoted by a relay race, which requires a 5-min run without a rest interval. The proposed physical stimulus was performed with 28 volunteers: 14 with ADHD (GE-EF) and 14 without ADHD symptoms (GC-EF). After 5 min of rest, these volunteers accessed the computer game to accomplish the tasks in the shortest time possible. The computer game was also accessed by another 28 volunteers: 14 with ADHD (GE) and 14 without these symptoms (GC). The response time to solve the tasks that require attention was recorded. The results of the four groups were analyzed using D'Agostino statistical tests of normality, Kruskal-Wallis analyses of variance and post-hoc Dunn tests. The groups of volunteers with ADHD who performed exercise (GE-EF) showed improved performance for the tasks that require attention with a difference of 30.52% compared with the volunteers with ADHD who did not perform the exercise (GE). The (GE-EF) group showed similar performance (2.5% difference) with the volunteers in the (GC) group who have no ADHD symptoms and did not exercise. This study shows that intense exercise can improve the attention of children with ADHD and may help their school performance. Attention Deficit Hyperactivity Disorder (ADHD) is primarily characterized by inattention, restlessness (hyperactivity) and impulsivity. Children and adolescents with ADHD have some impairment in their social and school life throughout development such as poor academic performance, repetition, suspension, difficult relationship with family and peers and low tolerance for frustration .Among the comorbidities, studies relate the body weight , cognitiTreatment usually consists of guidelines for parents and teachers with or without drug administration , 7, 8. HSeveral researchers have sought to determine the influence of external stimuli on attention in children with ADHD. Studies have shown that specific colors  and evenTherefore, the hypothesis that the attention of ADHD children can be improved using physical activity has been proposed. Therapists have indicated physical activity to prevent several comorbidities , 13; howThus, this work aims to quantify the effect of physical activity on the attention of children with ADHD.Approval was obtained from the Ethics Committee in Research to involve humans at the University of Mogi das Cruzes  as the participants. They were informed about the methodology and confidentiality of their personal information. All procedures were performed after the informed consent was written by the school’s director and the guardians on behalf of the children according to the institutional ethics guidance.Sixty-six volunteers of 10–16 years of age participated in the selection of City College São Simão—Goiás. This age group was chosen because of the ease of performing intense exercise. Among these volunteers, 38 were diagnosed with ADHD.The ADHD diagnosis was conducted by a psychologist with expertise in clinical psychology, who evaluated the reports of school performance, history of the students, parents’ reports and test results , 15.The choice of the volunteers strictly followed the criteria for inclusion or exclusion in the study, which are described below.The criteria for inclusion of volunteers with ADHD are as follows:have parental consent to participate in the study;be of an age between 10 and 16 years;be regularly enrolled in an educational institution;have no comorbidities that are not related to ADHD ;not currently have drug treatment;have ADHD diagnosis for more than six months;have a medium level of performance (300 sec ± 5%) in the commercial computer game “Prince of Persia”.The volunteers were selected by evaluating their computer skills in executing one introductory level of the commercial computer game “Prince of Persia”  with simAmong the 38 volunteers with ADHD, one was dismissed for having other comorbidities, and two left the school after the interviews. Seven were dismissed because of problems in playing the game “Prince of Persia” to avoid repetition from affecting the final results.Twenty-eight volunteers were selected for the control group: volunteers with notably good grades in all subjects, without reports about behavior problems and a good social life at school and at home.The criteria for inclusion of volunteers without ADHD are as follows:have parental consent to participate in the study;be between 10 and 16 years;be regularly enrolled in an educational institution;have a report on good behavior and interest in the classroom;not have his/her name included in school reports about behavior problems;have parents' reports about a good social life at school and at home.have a medium level of performance (300 sec ± 5%) in the commercial computer game “Prince of Persia”.The volunteers were divided into two groups: 28 volunteers in the group with ADHD and 28 without symptoms in the control group. The group of students with ADHD was divided into two groups: GE-EF, who were volunteers with ADHD and performed physical activity, and GE ADHD, who were volunteers with no physical activity. The control group was subdivided into GC-EF, which was the control group with physical activity, and GC, which was the control group with no physical activity, both of which had 14 volunteers.The following protocol was used to verify whether physical exercise improves the attention of the students with ADHD:Initially, each volunteer was interviewed while accompanied by his or her parents. The objectives and procedures of the study were explained to the volunteers, and they were asked to sign the ethical terms. Additionally, some identification data of the volunteers were collected to characterize the sample, such as age and sex, and the basal heart rate was measured to calculate the target training zone. A pilot test was conducted to characterize whether the selected physical stimulus was sufficient to achieve the training-zone heart rate. Thus, the volunteers underwent a simplified relay race with pulse measurement 3 and 5 min after the activity. This measurement was performed for all volunteers, even those who were not involved in the physical test.A month after the basal heart rate record was measured, a relay race was proposed as the intense physical activity. The GE-EF and GC-EF groups attended the proposed physical activity and subsequently performed the computer game “Raiders of the Lost Treasure,” which evaluated the level of attention. The volunteers from groups GE and GC did not participate in the proposed physical activity and only used the computer game “Raiders of the Lost Treasure” to test their attention span. The material in the relay race was inflatable balloons and large plastic bags. The volunteers were lined up at one end of the court, and inflatable balloons were placed opposite to them. Each volunteer had a plastic bag set in a holder at his side. Each volunteer had to run and catch an inflatable balloon, bring and put it in his plastic bag and return to catch another balloon. The winner was the one who gathered the greatest amount of balloons in 5 min.The volunteers rested for 5 min and played the computer game “Raiders of the Lost Treasure,” which was developed in a previous study , to quanThis game was divided into two phases: the 1st phase was set in an island  , and theThe game was strategically developed into sequential modules with embedded tasks, which followed a predefined and gradual logical order .To calculate the aerobic threshold of each volunteer, Karvonen method was used , 16. ForA normality test was applied to evaluate the data sampling distribution. In addition, analyses of variance allowed us to identify differences among the groups . The test post-hoc was used to define which group differs from the remainder of the sample.The programming module of the Matlab software was used to analyze the complete game data as a function of time, with which the routine had to generate continuity of pre-written results because these information is discretely store.The task of the relay race was performed with GE-EF and GC-EF on different days but at the same hour. Each volunteer ran without rest for 5 min and took an average of 15 balloons. After the physical exercise, the volunteers underwent a test match, and the time was recorded. The GE-EF and CG groups showed approximately the identical performance compared to the complete game, with a small standard deviation, which proves the sample homogeneity. The group with ADHD and that participated in the proposed physical activity (GE-EF) obtained 30.52% better performance than the group with signs of ADHD that did not participate in physical activity (GE) and 40.36% better than the group without characteristic of ADHD that participated in physical activity (GC-EF). The group that more rapidly reached the goal proposed by the assessment game was that group without characteristic of ADHD and not involved in physical activity proposed (GC), ending the testing game 2.5% faster than the GE-EF group.Regarding the normal distribution analysis, D'Agostino test was applied allowing that the investigators identify that the sampling distribution is non-parametric. In addition, Kruskal-Wallis test was used showing significant differences between groups . It was followed by the Post-hoc Dunn test, where significant differences between groups were also identified. See As the time for performing each task was obtained discretely, the Matlab software was used to construct computational routines that allow generating continuity depending on time .The results of this study showed that the GE-EF and GC groups overall had similar performances. The software's second stage (tasks 9 to 18) was contextualized in a minefield, where the player with better concentration throughout the tasks is favored (in this case GC had high-performance). Therefore, the volunteers from the GE-EF presented better results in the software's first stage (tasks 1–9), which suggests that this phase is favored by an exploratory behavior, which is an intrinsic characteristic of the subjects with ADHD.Many variables can affect the collected information in computer games, such as ability to use the command interface, intensive practice in computer games or even lack of collaboration and intellectual level of participants . In our The results of this study also show that the GC group has a performance that is 42% better than the GC-EF group. These data seem indicate that after an intense physical exercise, people without ADHD show impairment in attention performance. However, this hypothesis requires further studies, which include the assessment of the duration of this effect.The computer game “Raiders of the Lost Treasure”  allowed Lim et al.  used a tFuermaier et al.  exploredA physical education survey  observedMedina et al.  examinedThis study confirms the hypothesis of Medina et al.  and KoehPhysical exercises help improve children's attention and provide greater impulse control; these additional effects appear almost immediately, as confirmed in this study, which helps the concentration of children with ADHD.


Social network analysis has emerged as a promising tool in modern social psychology. This method can be used to examine friend-based social relationships in terms of network theory, with nodes representing individual students and ties representing relationships between students . Using social network analysis, we investigated whether greater severity of ADHD symptoms is correlated with weaker peer relationships among elementary school students.A total of 562 sixth-graders from two elementary schools  provided the names of their best friends (maximum 10 names). Their teachers rated each student’s ADHD symptoms using an ADHD rating scale.The results showed that 10.2% of the students were at high risk for ADHD. Significant group differences were observed between the high-risk students and other students in two of the three network parameters  used to assess friendship quality, with the high-risk group showing significantly lower values of degree and closeness compared to the other students. Moreover, negative correlations were found between the ADHD rating and two social network analysis parameters.Our findings suggest that the severity of ADHD symptoms is strongly correlated with the quality of social and interpersonal relationships in students with ADHD symptoms. Attention-deficit/hyperactivity disorder (ADHD) is characterized by inattentiveness, hyperactivity, impulsivity, or a combination of these features. ADHD is one of the most common psychiatric disorders among children and adolescents . A studyPeer relationships and friendships are important to children’s social development . AlthougPeer-relationship problems, such as peer rejection and an absence of mutual friendship, are among the causes of poorer long-term outcomes in children with ADHD, despite adequate treatment . The 14-The aim of this study was to investigate the sociocultural backgrounds, mental-health problems and difficulties in peer relationships of children with ADHD symptoms to elucidate the correlation between ADHD symptoms and the quality of their social relationships. To this end, previous studies have used concepts such as peer rejection, peer neglect and social isolation. Another alternative concept is friendship nomination, which is widely used to identify mutual friendships. In this method, a child makes a list of close friends, and the close friends included in the list then make their own lists; children who nominate each other are considered mutual friends . This teWe used social network analysis to measure popularity, mediating roles (such as introducing and grouping between friends with awkward relationships), and social position within a group. We investigated the correlation between ADHD symptoms and social relationships using quantitative parameters rather than self-reports. To the best of our knowledge, there are no studies on the peer relationships of children with ADHD symptoms using social network analysis. The second purpose of this study was to elucidate the correlation between peer relationships and common comorbidities of ADHD, such as impulsiveness, learning disorders, and oppositional defiant disorder.In summary, the aim of this study was to investigate the ADHD tendencies of community elementary school students and the association between these tendencies and impulsiveness, learning disorders, oppositional defiant disorder, and social-relationship difficulties to better understand the burden of ADHD in South Korea. We hypothesized that the measures of relationship quantity and quality calculated by social network analysis would decrease as ADHD symptoms and comorbidities increased in severity. This study analyzed the quality of peer relationships using a social-science technique known as “social network analysis,” a quantitative tool based on others’ assessments rather than self-reports.We selected schools with attention to the differences in school cultures between the metropolitan area and rural areas, as a school with strong regional characteristics might not be representative of the general population. We chose the Chungcheongnam-do district for reasons of accessibility and the city of Gongju for its high educational standards. There, we chose the two elementary schools with students of similar socioeconomic status that expressed the most interest in participation. Detailed information about the study was given to parents and children, and then written informed consent was obtained from parents, children, and homeroom teachers before the study entry. The study protocol was approved by the institutional review board of the Gongju National Hospital.To ensure a sufficient number of participants, two schools were chosen, and the investigation was conducted simultaneously among sixth-graders at both schools. Sixth-graders were chosen because these students had attended school for the longest duration and therefore had time to establish relationships with other students. Additionally, these students were old enough to comprehend the content of the screening tools. There were no participants with suspected intellectual disabilities at either school, and there were no missing data in the questionnaires due to the active cooperation of the homeroom teachers, which made it possible to enroll the entire sixth-grade class in both schools. A total of 307 sixth-grade students were sampled from School A, and 255 were sampled from School B. The mean age was not significantly different between the two schools . School A had slightly more students, but the gender ratios of the two schools were similar .Basic demographic questionnaires and the ADHD screening test were given to all participants. Data were obtained from homeroom teachers, who were likely to have the most information about the students. Students completed self-rated questionnaires with questions about their families, religion, and other social relationships, as well as clinical scales to assess impulsiveness, depression, and internet use. The homeroom teacher completed the scales used to assess ADHD, learning disorders and oppositional defiant disorder for each student.This study used five self-rated scales and three teacher-rated scales. The self-rated scales included the Korean version of the Barratt Impulsiveness Scale (BIS) , the KorThe teacher-rated screening tools included the Korean parent and teacher ADHD Rating Scale (K-ARS) , the eigThe BIS-11 is a self-report questionnaire designed by Patton 1995) to assess impulsivity and is composed of three subcategories, including six attention-impulsiveness items, eight motor-impulsiveness items, and nine non-planning-impulsiveness items. This questionnaire uses a four-point Likert scale to measure the frequency of each item , and the total score is the sum of the 23 items . Cognitive impulsiveness assesses the tendency to respond or make decisions without deep thought, motor impulsiveness assesses the lack of inhibition of spontaneous behaviors, and non-planning impulsiveness assesses the tendency towards non-planning and non-consideration of safety issues before acting [95 to assThe CDI is a modified version of the Beck Depression Inventory developed by Kovacs (1983) to assess depressive symptoms in children. It includes 27 items that assess the mood status of a child for the past two weeks using a self-report form. Each item is graded on a scale of 0–2, and the total score ranges from 0 to 54 .The SBSRQ was developed by Kim (2007) to assess school bullying using a self-report questionnaire. The questionnaire contains 12 questions related to one’s experience of harassment and close peer relationships and is used to assess group bullying at school. All items are rated on a four-point Likert scale from 1  to 4 (strongly agree), and the total score ranges from 12 to 48, with a higher total score indicating greater severity of being the victim of school bullying .CASS(S) is used to assess ADHD symptoms in adolescent students. Twenty-seven items are graded on a scale from 1 to 4, and the total score ranges from 27 to 108, with a higher total score indicating a higher risk of ADHD. This measure consists of four subscales, including conduct problems (six items), cognitive problems (six items), hyperactive-impulsive (six items), and ADHD index (12 items) scales .The LSNS is a self-report questionnaire developed by Lubben (1988). It measures five aspects of social networks: family network, friendship network, helping others, confidant relationships, and living arrangements. Ten items are graded on a scale from 0 to 5, and the total score ranges from 0 to 50, with a higher total score indicating higher social support. This study used only the six items regarding family and peers that are appropriate for adolescents .K-SARS was developed by DuPaul (1991) to evaluate ADHD symptoms in school-age children. It consists of 18 items based on the DSM-IV ADHD diagnostic criteria. Each item is rated on a four-point Likert scale of 0 (never) to 3  according to the frequency of the problem behavior. The sum of scores of odd-numbered items represents inattentive symptoms, and the sum of scores of even-numbered items reflects hyperactive-impulsive symptoms, with nine items in each category. The total score ranges from 0 to 54. In this study, the teacher-rated form was used to increase reliability .The DBDS was designed for a caretaker to evaluate a child’s behavior based on the DSM-IV ADHD, oppositional defiant disorder (ODD), and conduct disorder (CD) diagnostic criteria. It includes 18 ADHD items, 8 ODD items, and 15 CD items, for a total of 41 items. In this study, we used only the 23 items assessing ODD and CD, and each item is rated on a four-point Likert scale of 0 (never) to 3 . The total score ranges from 0 to 69 .The K-LDES is an 88-item questionnaire developed by McCarney (1983). It was translated and standardized in Korean in 1998. The seven standardized subscales  provide education-related assessments for learning disorders. The Learning Quotient (LQ) is the score of the sum of the seven subscales, adjusted to fit an average of 100 and a standard deviation of 15 .Social network analysis was developed in 1967 based on Stanley Milgram’s finding that “in American society, two strangers can be connected by an average of 5.2 acquaintances.” This method measured societal relationships not by subjective judgments but by mathematical equations . Social A peer relationship network was constructed using the survey question, “Write down the names of 10 friends in the sixth grade of this school whom you have met outside of class, whose home you have visited or whom you frequently call on the phone.” In the social network analysis, among the many variables available, we selected the three that were most likely to represent peer relationships. The first variable was “degree,” which corresponds to how many other students selected the individual as a close friend. This variable is similar to “in-degree,” which is commonly used in social network analysis to show the degree of connection from outside. While “out-degree” is used to represent the number of connections going out from the individual, “in-degree” indicates how many friends regard that student as a close friend. The second variable was “centrality,” also called “betweenness centrality.” This variable calculates the possibility that when A and B are connected via the shortest distance possible, C exists somewhere along the path. Here, this variable indicates how often a student connected two other students in the friendship network. The third variable was “closeness,” which is decided by the total theoretical distance to all other nodes. This variable is similar to “in-closeness,” which is commonly used in social network analysis and summarizes the inverse of all of the lengths from all students to a particular student. Here, “in-closeness” indicates how closely a student is connected to all other students in the friendship network. A high “closeness” score indicates that the student has broad peer relationships, while a low score indicates the opposite . Anotherhttp://pajek.imfm.si/doku.php?id=pajek) and Netminer version 4.0  were used.The social network analysis tools Pajek version 2.04  with a significance level of 0.05. A total of 562 participants were analyzed. The N was large enough for a normal distribution, so parametric methods were used. The children were divided using the K-ARS scores assessed by homeroom teachers into a normal group and a high-risk group. The cutoff score was 17, which is the score generally used in clinical settings . The demThe teacher-rated K-ARS score was significantly higher among male students. Male students also scored significantly higher than female students on the DBDS and the K-LDES. Female students scored significantly higher than male students on the CDI, suggesting a higher prevalence of depressive symptoms among female students than among male students. No significant differences were observed between male and female students with regard to degree, centrality and closeness .Fifty-seven children were included in the ADHD high-risk group, and 505 children were included in the normal group. The high-risk group scored significantly higher than the normal group on the CASS(S), DBDS, and K-LDES. The high-risk group had significantly lower LSNS, degree, and closeness scores than the normal group .The severity and extent of ADHD symptoms were measured using the teacher-rated K-ARS. The K-ARS score was significantly correlated with the other 9 scales, including impulsiveness, depression, inattention-hyperactivity, social relationships, school bullying, oppositional defiant disorder, learning disorders, as well as decreased degree and closeness, but it was not correlated with centrality . The scaThe Kamada-Kawai layout algorithm can be used to present a network map to facilitate quick understanding of the peer relationships in a group . In Fig The current study has several strengths. First, all sixth-grade students in two schools were included. If the elementary schools chosen in this study are representative of regional or national populations, then these data can be used to estimate the prevalence of ADHD or the high-risk population nationwide. However, these data might not be sufficient to generalize to the national population based on the sample characteristics. According to our results, Schools A and B have different proportions of students at high risk of ADHD and different demographic characteristics, all of which must be considered before the results can be used to draw more general conclusions. However, the schools are located in an urban area with high academic standards, where schools are prioritized. We therefore believe that these data are sufficiently representative of South Korea’s urban population. Second, we used teacher ratings, which might be more objective than ratings by parents . FinallyOur results are summarized below. In accordance with previous studies, we found that ADHD symptoms were more common in male students than in female students . FurtherComparisons between the high-risk group and the normal group revealed characteristic differences in several areas. The high-risk group scored significantly higher than the normal group on the oppositional defiant disorder and learning disorder scales. These results align with those of previous studies reporting that people at high risk for ADHD are at increased risk for comorbid oppositional defiant disorder or learning disorders . AccordiThe ADHD scale was significantly correlated with the other nine scales but not with centrality. This result implies that fewer people consider students with higher scores on the ADHD scale close friends, and they are at higher risk of being located at the periphery rather than in the center in peer relationships compared to other children. Interestingly, the correlation analysis also revealed that the in-degree and closeness scores in the social network analysis were significantly associated with five scales, including the ADHD scale, depression scale, social network scale, school bullying scale, and leaning disorder scale. These results suggest that students who have narrow relationships and are located at the periphery have higher rates of ADHD tendencies, experience more depressive symptoms, have limited relationships with their friends and family and are more likely to show perform poorly in school. However, because correlation analyses cannot detect causal relationships, it is not possible to determine whether or how these differences are causally related.Finally, we generated a network map using the Kamada-Kawai layout algorithm, a common visualization method in social network analysis. This map shows separations in the peer connections between male and female students. Students at high risk for ADHD were concentrated among the males, and most were located at the periphery in both schools. These results are similar to those observed in the scale-scores analysis, again showing that the high-risk students were more likely than their peers to have weak peer relationships and to be treated distantly by other classmates. ADHD symptoms typically appear before age seven; however, behavioral problems more clearly manifest as children begin school. Therefore, ADHD is commonly diagnosed among school-aged children. Elementary school is an important period for peer relationship formation because students evaluate themselves through the eyes of their peers, who influence their forming self-image . The forThis study has several limitations. First, as previously mentioned, peer relationships, scores on mental-health screening tools, and the percentage of students at high risk for ADHD vary across sociocultural backgrounds. As a result, it is difficult to determine whether these results can be generalized to the South Korean population. Second, our participants were not patients but were students attending school, and the proportion of students classified into the ADHD high-risk group was relatively small (n = 57). This sample size limits the generalizability of our findings. Third, the current study was cross-sectional and did not use diagnostic tools with structured interviews. However, we used teacher-rated scales rather than self-report questionnaires or parent-rated scales to compensate for this limitation . FinallyDespite these limitations, we investigated mental-health problems among elementary school children using social network analysis to assess the association between ADHD tendencies and peer relationships. ADHD symptoms are highly related to impulsivity, depression, oppositional defiant disorder, learning disorders and the quality of peer relationships. In conclusion, screening for ADHD among young patients and intervening to actively manage and prevent peer problems might be helpful in enabling children to occupy a more central status among their peers and to grow into individuals who have broader relationships with others.S1 DatasetIn this zip-compressed file, we provide two files: School_Data.xlsx; spss result_School.xls.(ZIP)Click here for additional data file.


EMBO Molecular Medicine, D'Andrea et al (Attention-deficit/hyperactivity disorder (ADHD) is a developmental disorder characterized by hyperactivity, inattention, and impulsive behaviors and has significant societal impact. ADHD is recognized as a heterogeneous disease, and genetic and/or environmental factors underlying pathogenesis remain largely unknown. There is an obvious need to increase knowledge on molecular signaling and brain pathways underlying disease development, and genetic mouse models are key to this goal. In this issue of ea et al  combine  Also, as neuroimaging methods progress in animal research, it will be interesting to determine whether PI3Kγ-mediated regulation of LC neuron activities impact brain connectivity patterns, in a manner that could be reminiscent to whole-brain alterations observed in some ADHD patients (Konrad & Eickhoff,


We report the case of a 10 year old patient diagnosed with attention deficit hyperactivity disorder (ADHD) and comorbid video game addiction, who was treated with medication combined with a novel cognitive training method based on video games called TCT method. A great risk of developing video game or internet addiction has been reported in children, especially in children with ADHD. Despite this risk, we hypothesize that the good use of these new technologies might be useful to develop new methods of cognitive training. The cognitive areas in which a greater improvement was observed through the use of video games were visuospatial working memory and fine motor skills. TCT method is a cognitive training method that enhances cognitive skills such as attention, working memory, processing speed, calculation ability, reasoning, and visuomotor coordination. The purpose of reviewing this case is to highlight that regular cognitive computerized training in ADHD patients may improve some of their cognitive symptoms and might be helpful for treating video game addiction. ADHD is characterized by distractibility, hyperactivity and impulsivity. The standard treatment for ADHD includes mainly medication, psychosocial and behavioral treatment, and cognitive training exercises.Attention deficit hyperactivity disorder (ADHD) is the most commonly diagnosed neurodevelopmental disorder in childhood, which affects 3% to 7% of the population worldwide2. Studies in participants with cognitive impairment have shown that regular and daily cognitive training can improve some of their cognitive symptoms4. In addition, recent studies have demonstrated that computerized working memory and executive function training programs lead to better results than ordinary cognitive training methods in children with ADHD7.Cognitive training exercises are especially useful when cognitive impairment is observed and when a regular and personalized cognitive training is performed6, several other pathologies have been proposed including pathological gambling and dependence7. Despite extensive research literature available, the prevalence and proper diagnostic criteria for pathological gaming are still debated among the scientific community8. Gaming addiction represents part of the postulated construct of Internet addiction, and is the most widely studied specific form of Internet addiction to date9. Prevalence estimates range from 2%10 to 15%11, depending on the respective socio-cultural context, sample, and assessment criteria utilized. A great risk of developing video game or Internet addiction has been reported in children, and especially in those with ADHD8. Stimulants such as methylphenidate (MPH), given to treat ADHD, and video game play have been found reduce Internet use in subjects with co-occurring ADHD and Internet video game addictions9.Children’s use of electronic devices, Internet and video games, has noticeably increased in the last 10 years. Since the first case of Internet addiction was described in 1996 by YoungDespite the risk of Internet addiction we hypothesize that good use of these new technologies can be useful to develop new methods of cognitive training useful in to treat ADHD an Internet addiction.This case study involves a 10 year old child born in Madrid (Spain) who received treatment in a childhood psychiatry unit for 2 years due to behavioral disorders and ADHD. No other previous medical history was reported. His mother, aged 35, received psychological treatment for anxiety 3 years ago. His father, aged 36, works as an engineer and presented no relevant medical history. The patient was their only son. The parents described a great addiction to video games in the last year, referring 4 hours per day of video game playing, affecting his social interaction, and causing a lack of imaginative play and poor academic scores. Teachers at the school reported deterioration in his academic performance over the past year. At that time, the child was treated with methylphenidate 40 mg per day. The patient’s parents reported to the psychiatrist that the only significant change from the previous year was a major addiction to a war videogame.To reduce the exposure to video games, we used a novel technique, based on the Tajima Cognitive Method (TCT) called “ADHD Trainer”. It consists in a cognitive stimulation program with a mobile/tablet application designed specifically to treat ADHD.Behavioral and academic improvements were rated on the Conners Parent and Teacher Rating Scales (brief version) and Barkley School Situations Questionnaire.11. Attention was rated with CPT Conners Conners Continuous Performance Test.ADHD diagnosis was made according to DSM V criteriaDifferential diagnosis between oppositional defiant disorder and ADHD disorder was considered, because most of the symptoms were observed at home, however not angry or irritable mood was observed.The patient was treated with a combination of methylphenidate and cognitive training method based in the TCT method. The patient received daily treatment with 40 mg of methylphenidate, and at least 10 minutes of daily cognitive training with the “ADHD Trainer” app.The TCT is a type of computer adaptive test (CAT), as it adapts to the individual’s cognitive strengths and weaknesses, based on his own scores over time, as well as those of his peers. Users receive separate scores in different cognitive areas, including simple calculation, attention, perceptual reasoning, and visuomotor coordination . The goaDuring the first month of cognitive training therapy, the patient was only allowed to play with specific games based on the TCT Method, using the “ADHD Trainer” . The patIn less than two months the video games abuse was substantially reduced, limiting their use to weekends, and always for periods not exceeding 4 hours in total. Although 4 hours a day might is a an important amount of time for a single day, the global reduction of the time wasted in videogames and its limitation to the weekend means a significant improvement in this particular case.Behavioral and academic improvement was rated on the Conners Parent and Teacher Rating Scales and Barkley School Situations Questionnaire. The initial score of the Conners was 19 for the teachers and 20 for the parents, and after the cognitive training the scores were 15 for the teachers and 16 for the parents. The main severity score for the Barkley School Situations Questionnaire was 70 before starting the training, and after the cognitive training the score was 66.Both the school and the family reported a significant improvement in the patient after 6 months of TCT cognitive training, which included important improvements of both academic and behavioral outcomes.12. It is also known that the new technologies may affect children's academic performance by reducing the number of hours that they dedicate to studying.Most of the studies reported so far emphasize the potential addictive risk of new technologies and the influence they have on children's interpersonal development, by reducing the time children spend outside home and increasing the time they spend alone playing in front of a television or a computer screenThere are few studies which focus on the positive aspects of new technologies and the opportunities that they offer new ways of interaction between professionals and users as well as the development of new therapeutic methods, capable of reaching the young.7. As they generate greater motivation in children and adolescents they will increase the frequency of performing cognitive tasks oriented to enhance executive functions, especially the working memory. Previous computerized methods have been purposed and have shown to be better than traditional ones14.New technologies, in particular video games, can be used as therapeutic tools to train executive functionsThere are key advantages for children practicing the TCT Method relative to traditional cognitive training therapies which include:15.1) Increased motivation in children for completing cognitive training therapy. This increase in motivation comes from: entertainment value (these games are designed to be similar to regular video games that children enjoy) and feedback on performances relative to own and peer scores 2) Ease of accessing the application. Children can play the games at any place or time, day and night.ADHD patients are especially vulnerable to develop video gaming addition. ADHD patients often suffer from working memory and executive function dysfunctions, but we have observed that very few cognitive training techniques have been developed for ADHD patients in the last years. Poor completion rates of cognitive training in children with ADHD have been observed. We suggest that a daily cognitive computerized training in ADHD patients may improve some of their cognitive symptoms, and might be helpful for treating the video gaming addition.Written informed consent to publish this report was obtained by the patient’s parents.Dr. Tajima takes responsibility for the integrity of the data and informed consent. The authors have addressed points #1 and 4 from my previous review, but the following issues remain.Comma placement:  Do the authors mean that video game play reduces Internet use, or do they mean that MPH is given for both ADHD and video game play?"found reduce" -> "found to reduce", we hypothesize thatgood use of these new technologies can be usefulto develop as new methods of cognitive traininguseful in to treat ADHD and Internet addiction." Here is one potential way to edit the last sentence .  "Despite the risk of Internet addiction2. The paper still needs copy editing to reflect standard written English. The last 2 sentences of the Introduction provide an example.3a. The exercises comprising "ADHD Trainer" are not described in any detail beyond listing the categories of mental functioning that each task is thought to reflect. For instance, what task is used for "Attention"? Has this implementation of the task been validated elsewhere, or adapted with unpublished modifications from a published task? And so on for each of the categories listed in the Table.3b. As with any method, the authors need to provide some kind of information about where the reader can obtain "ADHD Trainer".I have one additional comment that I forgot to add to the previous review.5. The authors should acknowledge, perhaps in Conclusion, that behavioral interventions other than ADHD Trainer itself may account in part or in whole for the clinical improvement. Other interventions the child received include the following. "The patient was only allowed to play with" ADHD Trainer. "The patient had to use the app every day at the same time." The patient had to meet "the other targets that were assigned in therapy" including a "progressive reduction in the number of hours to play other games" and limiting other game play to once a week.I have read this submission. I believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. One case provides very limited evidence for efficacy and even less for safety. In this light, a couple of statements, including the following, are too enthusiastic and need to be toned down:"regular cognitive computerized training in ADHD patients can improve some of their cognitive symptoms and can help treating video game addiction""We conclude that a daily cognitive computerized training in ADHD patients can improve some of their cognitive symptoms, and can help treating the video gaming addiction."The manuscript is understandable, but needs copy editing by a native English speaker. For instance, the first sentence of the abstract has 2 errors, and the following phrase is really hard to parse: "the method of Tajima Cognitive Method (TCT) cognitive training called 'ADHD Trainer'."The exercises comprising "ADHD Trainer" are not described in any detail beyond listing the categories of mental functioning that tasks were thought to reflect. If another publication or thesis describes it, a reference would suffice; otherwise a list of tasks would be a first step. Similarly, as with any method, the authors need to provide some kind of information about where the reader can obtain the TCT. The Barkley School Situations Questionnaire was administered, but the scores are not reported.This is an interesting and encouraging report, but I have the following reservations.I have read this submission. I believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. According to the reviewer commentsWe have included a table showing the cognitive training areas that are trained everyday.We have made a overall review of the grammar.We have included the scores of the school situations questionnaire.Thanks for your review Mr. Black, and best regards. The authors have revised the manuscript to my full satisfactionI have read this submission. I believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Thanks for your comments and your review. Best regards. This is an interesting case report on the usefulness of cognitive computer training for a child who is diagnosed with ADHD and concurrent videogame addiction. The rationale for the study, methods and findings are fine but I would like to make some additional comments.et al., 2009Han D , please add it to the introduction.First, the usefulness of treatment of ADHD and internet addiction by using methylphenidate was reported bySecond, what evidence have you got that the child is not addicted to the educational game?Third, 4 hours of play of a videogame post-treatment is still a lot, this should be mentioned as a limitation.Fourth,  why were the Conners ratings after treatment for parents and teachers lower compared with pre-treatment?et al., 2013Mishra) and  the game reported byet al., 2011.Prins PJ Fifth, the authors should be commended for the use of advanced computer games for treatment for ADHD. There are other tools for this purpose that are worthwhile mentioning such as ONTRAC :38Prins PJ, Dovis S, Ponsioen A, ten Brink E, van der Oord S. Does computerized working memory training with game elements enhance motivation and training efficacy in children with ADHD? Cyberpsychol Behav Soc Netw. 2011 Mar;14(3):115-22.Han DH1, Lee YS, Na C, Ahn JY, Chung US, Daniels MA, Haws CA, Renshaw PF.The effect of methylphenidate on Internet video game play in children with attention-deficit/hyperactivity disorder. We have included the following new references and made the changes according to the reviewer comments.  Mishra J, Merzenich MM, Sagar R. Accessible online neuroplasticity-targeted training for children with ADHD. Child Adolesc Psychiatry Ment Health. 2013 Nov 14;7(1):38Prins PJ, Dovis S, Ponsioen A, ten Brink E, van der Oord S. Does computerized working memory training with game elements enhance motivation and training efficacy in children with ADHD? Cyberpsychol Behav Soc Netw. 2011 Mar;14(3):115-22.Han DH1, Lee YS, Na C, Ahn JY, Chung US, Daniels MA, Haws CA, Renshaw PF.The effect of methylphenidate on Internet video game play in children with attention-deficit/hyperactivity disorder.