The link between ADHD symptoms and antisocial behavior was significantly weaker for high than low SOC participants, regardless of age group. The current study found that people with high SOC are protected against the effect of ADHD symptoms on one of the most serious functional impairments, antisocial behavior. These findings suggest that SOC is a protective factor from the adverse effects of ADHD symptoms, justifying further prospective and intervention studies.Numerous studies have established the link between ADHD and antisocial behavior, one of the most serious functional impairments caused by the disorder. However, research on protective factors that mitigate this link is still lacking. The Salutogenic Model of Health offers the “Sense of Coherence” (SOC), establishing that individuals who see their lives as logical, meaningful, and manageable are more resistant to various risk factors and diseases. The present study examines for the first time whether SOC is also a protective factor against different ADHD-related types of antisocial behaviors . A total of 3180 participants aged 15–50 completed online questionnaires assessing the level of ADHD symptoms, antisocial behaviors, and SOC. Structural equation modeling was applied to examine the research hypothesis. An interaction between ADHD symptoms and SOC was found in predicting each type of antisocial behavior (beta = −0.06–−0.17,  ADHD is a common neurodevelopmental condition defined by symptoms of inattention, hyperactivity, and impulsivity, accompanied by academic, occupational, or social functional impairment . The funNumerous studies have indicated that ADHD is associated with antisocial behavior and delinquent acts . The resThe prevalence of ADHD among incarcerated people is high and estimated at around 25–45%, varying depending on the measurement method . In the Various variables that interact with ADHD symptoms in the prediction of antisocial behavior have been examined in the research literature. For example, it was found that targeted drug therapy for ADHD decreases antisocial behavior by 30–40% ,9,10. NoSeveral studies focused on religiosity as a potential moderator, yielding inconsistent results. In one study, religiosity increased the risk of antisocial behavior such that, for religious people, ADHD was a weaker predictor of antisocial behavior. In another study, high ADHD symptoms combined with high religious participation predicted increased levels of antisocial behavior . A prospIn contrast, among adolescents whose parents showed a more considerable or no decrease in parental involvement, increases in hyperactivity/impulsivity symptoms did not predict antisocial behaviors . AnotherTo summarize, a literature review demonstrates the paucity of research on psychosocial factors that do not constitute antisocial behavior by themselves but moderate the relation between ADHD symptoms and antisocial behavior. The present study aims to fill in this gap.The Salutogenic Model of Health focuses on health promotion, setting out against what is termed the “pathogenic approach”: the assumption that the basic human condition is health, hence focusing on risk factors involved in disease generation ,17,18. Ocomprehensibility (the cognitive component)—the degree to which one perceives the world as logical, consistent, and predictable; meaningfulness —the degree to which one sees her or his life as meaningful and worthy of effort; and manageability —the degree to which one views oneself as competent and capable of influencing reality [The Salutogenic Model of Health offers the concept of the “Sense of Coherence” (SOC) as a protective factor. SOC consists of three components :  reality ,23. The Numerous studies highlighted the relation between SOC and normative behavior . For exaOnly a few studies examined SOC in the context of ADHD. A longitudinal study demonstrated both an association and an interaction between SOC and ADHD. Thus, 16-year-old adolescents with ADHD reported lower SOC. Moreover, ADHD scores at age 16 predicted ADHD scores at age 21 more strongly for people with lower SOC . It was To summarize, the literature suggests that high SOC constitutes a protective factor against antisocial behavior. Furthermore, it may moderate various risk factors, including ADHD symptoms, and adverse outcomes, including antisocial behavior. Therefore, the research hypothesis is that the association between ADHD symptoms and antisocial behavior will be moderated by the level of coherence and reduced among subjects with high SOC.The study was authorized by the Hebrew University School of Social Work and Social Welfare’s ethics committee. The participants were recruited by convenience sampling, using an online questionnaire distributed on social networks  in Israel in October–November 2020. We explained that our research goal was to understand individuals’ thoughts, feelings, behaviors, and coping strategies in various life situations. For those interested in participating, we offered a lottery of purchase tickets in a separate link . We also asked the participants to answer the questionnaires and further distribute it. A total of 3415 participants between the ages of 15 and 50 responded to the questionnaire. A total of 235 participants were excluded since they did not answer any questionnaires or answered the questionnaires randomly, resulting in 3180 that were included in the statistical analyses. Participants were asked to complete scales that measure behavior, emotions, and perceptions in different life domains. Participants were provided information regarding the study procedures and how their privacy and confidentiality will be secured.ω = 0.729), mild physical assault , verbal assault , and indirect violence ); property crimes ; and crimes against the public order . As the internal consistency of the indirect violence scale was poor, this scale was not further analyzed.Antisocial behavior was measured using a scale based on the Self-Report Antisocial behavior (SRD) . In its ω = 0.756).Drug use was measured using a scale developed by Johnston, O’Malley, and Bachman (1995), widely used in Hebrew translation in Israel . Particiω = 0.887). The convergent validity of the scale was confirmed by a strong correlation (r = 0.655) with the Hyperactivity Problems subscale of the Strengths and Difficulties Questionnaire (see below).The Hebrew version of the Adult ADHD Self-Report Scale (ASRS-v1.1) was used to measure the level of ADHD symptoms . A totalω = 0.888) [A 13-item version of the SOC was used. The original scale has a high consistency and validity, and the internal consistency in the current study was good as well (= 0.888) ,17. The = 0.888) .Emotional problems were measured by the Strengths and Difficulties Questionnaire, which measures emotional and social adaptation (SDQ) . The queThe participants filled out a socio-demographic questionnaire that included variables related to antisocial behavior and that were comparable between adolescents and adults: age, gender, and religiosity. Religiosity was measured by the question, “what is the level of your religiosity from 0 to 6? ”. Age was categorized as late adolescence (15–18 years), young adulthood (19–30 years), and mid-adulthood (31–50 years).The overall score of each scale was obtained by averaging the items of each respondent. We computed descriptive statistics of the dependent, independent, and covariates and the first-order correlations among the variables. We applied a structural equation modeling (SEM) using AMOS 26  with a mThe means, standard deviations, medians, and minimum–maximum values of the demographic characteristics, ADHD symptoms, coherence, and antisocial behavior types are presented in Spearman’s rho correlation coefficients were computed between demographic variables and ADHD symptoms, antisocial behavior types, and coherence see . ADHD sySpearman’s rho correlation coefficients were also computed between ADHD, antisocial behavior types, and coherence . ADHD syWe used SEM to conduct moderation analyses on the six facets of antisocial behavior. To allow an easier-to-follow presentation of the complex tested model , we herein present the results per each of the six dependent variables.The model accounted for 15% of the severe physical antisocial behavior variance. As shown in With regard to mild physical antisocial behavior, the model accounted for 20% of the variance. As shown in The SEM model accounted for 22% of the variance in verbal antisocial behavior. As shown in The tested model accounted for 12% of the variance in property crimes. As shown in With regard to public order antisocial behavior, the model accounted for 20% of the variance. As shown in The SEM model accounted for 18% of the drug’s antisocial behavior variance. As shown in p = 0.168). This suggests that the age group does not significantly modify the moderation effect of coherence and that the reported conditional effects of ADHD symptoms on the six facets of antisocial behavior are similar across age groups.We tested an additional model in which we added the age group as a moderating variable to examine whether the ADHD symptoms by coherence interaction is stable across age groups. Using a multigroup approach in SEM, we contrasted the fit indices of a free model versus a constrained model in which the ADHD symptoms by coherence interaction was forced to equality across age groups. Results indicated that the difference between the model was not significant  in predicting various types of antisocial behavior. The research hypothesis was that SOC, which constitutes a protective factor in coping with diseases and neutralizing other risk factors, will also be a protective factor moderating the antisocial behavior risk that stems from ADHD symptoms .This study examined several types of antisocial behavior and found that SOC moderated the relation between ADHD symptoms and antisocial behavior; for people with a strong SOC, the relation between ADHD symptoms and antisocial behavior decreased; in certain types of antisocial behavior, it was neutralized; and, in some cases, a negative association was found between ADHD symptoms and antisocial behavior. The research findings suggest that SOC constitutes a protective factor for the antisocial behavior risk of ADHD symptoms, similar to its ability to moderate another kind of risk for antisocial behavior, namely, peer influence. Specifically, the peer group’s patterns of substance use predicted adolescents’ substance use better in subjects with low SOC than in subjects with high SOC .Assuming that SOC indeed decreases the levels of antisocial behavior, the generalizability question arises, i.e., whether SOC specifically protects against antisocial behavior or constitutes a general protective factor that decreases all functional impairments related to ADHD symptoms, including the impairment in well-being. The moderating role of coherence in protecting against other risks to well-being has been examined in many studies . For exaimpairments—problems in body function and structure, such as significant deviation or loss; activity limitation—difficulties an individual may have in executing activities; and participation restriction—problems an individual may experience in involvement in life situations. The individual’s functioning and health consist of the interactions between these three components with personal and developmental factors [The main contribution of this study is showing that ADHD symptoms constitute a risk factor for antisocial behavior only when combined with further factors. This approach corresponds to the WHO’s International Classification of Functioning, Disability and Health (ICF) manual . The ICF factors . The ICF factors ,45,46. TAntisocial behavior can be defined as one of the central functional impairments associated with ADHD, which creates a participation restriction in normative society. The findings call for the application of the ICF model in the domain of ADHD and antisocial behavior, suggesting that the antisocial behavior stemming from ADHD is a product of the interaction between ADHD symptoms and a personal factor (SOC). This finding is consistent with the growing trend in the research literature calling for examining resilience factors for the risks for functional impairments associated with ADHD ,49,50,51Notably, since this research is cross-sectional, one cannot infer causality, and this issue needs to be examined using longitudinal and interventional designs. Findings of previous longitudinal studies indicate that SOC constitutes a protective factor for other outcome variables. For example, it was found that a strong SOC moderates the risk for long-term persistence of ADHD . In addiThe measuring of antisocial behavior relied on participants’ self-report without collateral support from other sources, such as partners’ reports or criminal records. However, it allows referring to antisocial behaviors that are not documented in criminal records. Notably, criminal records might contain a certain rate of false convictions due to false confessions, which are more prevalent among individuals with ADHD .Another limitation is that the study examined ADHD symptoms in the past six months. Referring only to adulthood ADHD symptoms might supply a partial picture, since ADHD symptoms tend to be less conspicuous in adults . AdditioOur study highlights the SOC as a protective factor that can be influenced by therapeutic intervention, similarly to what has been performed in the context of other disorders ,59,60,61


The use of polyunsaturated fatty acids in Attention-Deficit/Hyperactivity Disorder (ADHD) and developmental disorders has been gaining interest with preparations containing different dosages and combinations. Gamma-linolenic acid (GLA) is an ω-6 fatty acid of emerging interest with potential roles as an adjuvant anti-inflammatory agent that could be used with ω-3 PUFAs in the treatment of ADHD and associated symptoms. A narrative review was undertaken to examine the potential role(s) of the ω-6 fatty acid GLA. PubMed, Google Scholar, and Scopus were searched to examine the potential role(s) of the ω-6 fatty acid GLA as (1) an antioxidant and anti-inflammatory agent, (2) a synergistic nutrient when combined with ω-3 PUFAs, and (3) a potential etiological factor in ADHD and its treatment. The results show that GLA exerts anti-inflammatory effects by increasing dihomo-gamma-linolenic acid in immune cells. ω-3 PUFAs, such as EPA and DHA, are often co-administered with GLA because these ω-3 PUFAs may prevent the accumulation of serum arachidonic acid in response to GLA administration without limiting the storage of DGLA in immune cells. The administration of ω-3 PUFAs alone might not be sufficient to effectively treat patients with ADHD and developmental disorders. Overall studies point towards a combination of EPA and DHA with GLA in a 9:3:1 ratio appearing to be associated with ADHD symptom improvement. A combination of PUFAs may lead to better outcomes.  Polyunsaturated fatty acids (PUFAs) include two pathways of fatty acids—ω-3 and ω-6—which are both known to play major biological roles as structural and functional components of cell membranes and have a profound influence on the development of the central nervous system . As showHomo [Studies on evolutionary aspects of human diets indicate that major changes have taken place concerning types and profiles of dietary essential fatty acids obtained ,5. GenetHomo . This isHomo . It has Homo .According to the Diagnostic and Statistical Manual of Mental Disorders V Edition (DSM-V), neurodevelopmental disorders (NDDs) are defined as a group of conditions with onset in the developmental period, inducing deficits that produce impairments of functioning ,9. NDDs According to the DSM-V, ADHD diagnosis is based on some age-dependent symptoms of inattention and/or hyperactivity/impulsivity that interfere with functioning of development and should occur for at least 6 months . ADHD isThese disorders typically manifest early in development, typically before a child begins school, and are characterized by developmental deficits that can impact social, personal, educational, or occupational functioning . The devThe ω-3 PUFAs EPA and DHA have been considered for their potential roles in the treatment of symptoms in those affected by ADHD ,17. In tIn this narrative review, we examine the potential role(s) of the ω-6 fatty acid GLA as (1) an antioxidant and anti-inflammatory agent, (2) a synergistic nutrient when combined with EPA, and (3) a potential etiological factor in ADHD and its treatment.Borago officinalis L., 20–26% GLA), black currant , and evening primrose  [GLA is composed of 18 carbon atoms with three double bonds and belongs to the category of ω-6 PUFAs . GLA is , 8–12%) . Some fo, 8–12%) .Metabolically, as shown in Upon cell activation, DGLA is then released as free fatty acids (FAs) by phospholipase A2 and converted to several anti-inflammatory metabolites through competition with ARA for the enzymes cyclooxygenase (COX) and lipoxygenase (LOX) . COX proGLA and its metabolites have also been found to influence the expression of several genes, regulating levels of gene products including matrix proteins . Such geARA can also be synthesized from DGLA through Δ-5 desaturase, encoded by fatty acid desaturase 1 (FADS1) within the FADS gene cluster . ARA andTo counterbalance these pathways and make full use of the anti-inflammatory mechanisms of the molecule, the ω-3 long-chain-PUFAs (LC-PUFAs) EPA and DHA are often co-administered with GLA . Humans Echium plantagineum L.) abundant in ω-3 PUFAs  enhanced the conversion of dietary GLA to DGLA whilst inhibiting the further conversion of DGLA to ARA [Evidence shows that 0.25 g/d EPA + DHA can block GLA-induced elevations in plasma ARA levels, while supplementation with borage + fish oil combinations inhibit leukotriene generation ,41 and aA to ARA . Such suThis has been observed to directly translate into a clinical benefit in various therapeutic areas. For example, when enteral diets were enriched with marine oils containing EPA, DHA, and GLA, cytokine production and neutrophil recruitment in the lung were reduced, resulting in fewer days on ventilation and Intensive Care Unit stay-in patients with acute lung injury or acute respiratory distress syndrome (ARDS) . Other rEven though the pathogenetic pathways of NDDs are still not completely clear, growing scientific evidence points to oxidative stress and neuroinflammation as triggers for their genesis, and might be pivotal in their clinical pattern and evolution ,48. ω-6 The etiology of ADHD is multifactorial and still not fully understood. Evidence indicates that ADHD is heritable, however, no genes of major effect have been detected so far . Pre- anThe hypothesis that inflammation is part of the pathway to ADHD and more in general to NDDs is consistent. Neuroinflammation influences brain development and subsequent risk of neurodevelopmental disorders through mechanisms such as glial activation , increasHigher levels of antibodies against basal ganglia  and dopaA lack of dopamine in ADHD pathogenesis has been supported by the evidence that medications like methylphenidate and amphetamines, which increase the levels of dopamine in the synaptic cleft, can temporarily improve symptoms . HoweverRelevantly, some ω-3 PUFAs and some ω-6 PUFAs such as GLA are directly involved in the synthesis, release, and re-uptake of neurotransmitters , SubsequAs previously described, ADHD is a multifactorial condition, which depends on genetic and environmental factors ,78. DietThe human brain is comprised of around 60% of lipids and essential PUFAs play a key role in its structure and functions . PostmorOver the last decade, several systematic reviews and meta-analysis publications have focused on the roles of ω-6 and ω-3 PUFA supplementation as adjunctive therapy for ADHD ,85,86. DA growing number of trials have also been published. A PubMed search limited to the last 10 years and focusing on studies in childhood and adulthood yielded the following main publications. Döpfner et al. (2021) found that a 4-month intervention with ω-6/ω-3 fatty acids in preschool children at risk of ADHD had some positive effects on symptoms although larger studies are warranted . Chang eTaken together ADHD is a prevalent condition, often persisting into adulthood that if left without intervention could become a risk factor for educational underachievement, unemployment, mental health disorders, and criminality . CertainGiven this, these fatty acids must be provided from alternative sources. This is particularly relevant to those with conditions such as ADHD who may have different physiological requirements for these PUFAs. For example, LaChance et al. (2016) found that children and young people with ADHD had elevated ratios of blood ω-6/ω-3 and ARA/EPA fatty acids suggesting an underlying metabolic disturbance in essential fatty acid levels in these individuals . Common As discussed in the present publication, the pathogenetic mechanisms of NDDs including ADHD are not yet fully understood but clinical evidence points to oxidative stress and inflammation as potential triggering factors ,65,72. SThere is a growing body of studies indicating that specific combinations of PUFAs may be of benefit to ADHD management, potentially acting as an adjunctive to conventional medicines, possibly even lowering the dosage needed from these ,84,87. IIt is, however, recognized that ongoing research is needed. As mentioned, wide variability in sample sizes, selection criteria, intervention timeframes, and the form and dosage of supplement makes comparing results between studies challenging and could have skewed results . The n-6In general, when interventions were shorter than 12-weeks duration and used lower supplement dosages findings are less highly regarded . ErythroFinally, it is important to consider that there is growing interest in natural and sustainable vegan and vegetarian dietary sources of n-3 PUFAs . For exaIn summary, PUFAs have been gaining attention in terms of their role in the etiology, treatment, and management of NDDs including ADHD. The evidence for ω-3 PUFAs is well documented but the role(s) of GLA are less well known. The present narrative review has explained that GLA appears to have anti-inflammatory properties that could be used with ω-3 PUFAs in the treatment of ADHD and associated symptoms. In particular, a combination of EPA and DHA with the addition of GLA in a 9:3:1 ratio appears to be associated with improvements in ADHD symptoms. It is possible that ω-3 long-chain PUFAs may prevent the accumulation of serum ARA in response to GLA. While evidence broadly supports these findings, ongoing research is needed in the form of mechanistic studies and rigorous clinical trials.


A 1 µg m−3 increase in PM2.5 was associated with a 0.03%  increase in the percentage of LBW infants in a census tract. The association between PM2.5 and LBW was stronger in census tracts with the majority living in poverty  compared to those with fewer people living in poverty . Our results show that exposure to outdoor PM2.5 is associated with a small increase in the percentage of LBW infants in a census tract, with a further increase in tracts with high poverty. The results for effect modification by race/ethnicity were less conclusive.Previous studies have shown associations between air pollutants and low birth weight. However, few studies assess whether poverty and race/ethnicity are effect modifiers for this relationship. We used publicly available data on 7785 California census tracts from the California Communities Environmental Health Screening Tool . Multivariable linear regression was used to examine the association between outdoor PM In 2019, approximately 7% of live births in California were classified as low birth weight (less than 2500 g or ~5.5 pounds) . Address2.5) is an air pollutant that is associated with adverse birth outcomes, including LBW, preterm birth, and still birth [2.5 and LBW, and the majority of the epidemiological evidence shows that prenatal exposure to PM2.5 is associated with an increased risk of this outcome [−3 increase in PM2.5 was associated with a 20%, 18%, and 20% increase in the hazard of LBW for trimester 1, 2, and 3, respectively [2.5 slightly increased the odds of low birth weight where PM2.5 was assessed by distance from stationary monitors used for compliance with U.S. Environmental Protection Agency (EPA) air quality standards [2.5 and LBW. One systematic review found that birth weight decreased by 27.55 g for every 10 µg m−3 increase in PM2.5 exposure [−3 of PM2.5 was associated with 15.58 g decrease in term birth weight while exposure to greater than 10 µg m−3 of PM2.5 was associated with 16.58 g decrease in term birth weight [Particulate matter less than 2.5 microns in diameter  is created by the California Office of Environmental Health Hazard Assessment (OEHHA). Using data from federal and state government sources, this tool identifies and maps communities in California that are most vulnerable to pollution. It contains data on various sources of pollution, health outcomes, and sociodemographic measures at the census tract level and has been updated 4 times to reflect secular trends . Governm2.5 and LBW across the state of California at the census tract level, as well as investigate whether the relationship is modified by neighborhood-level poverty or percentage of people in different racial/ethnic groups . We hypothesized that there would be a greater effect of PM2.5 on the percentage of infants with LBW among census tracts with higher proportions of households in poverty and for census tracts with higher percentages of underrepresented minorities compared to census tracts with lower percentages of either factor.In this study, we examine the relationship between ambient PM2.5) in CalEnviroScreen 3.0 (which were collected from 2012 to 2014). In contrast, the LBW data in CalEnviroScreen 3.0 are from a time period before the exposure data. CalEnviroScreen contains information on 8035 census tracts in California. We excluded 250 census tracts (3.1%) that did not have data on PM2.5, percentage of low birth weight infants, or percentage of the population living in poverty. The final analytic sample contained 7785 census tracts  in CalEnviroScreen 4.0 were collected from 2009 to 2015, which most closely corresponds to the data for the exposure  air monitoring network. To obtain measurements for each census tract, ordinary kriging was used to estimate the mean concentration at the center of the census tract. Quarterly estimates were averaged to obtain the annual mean and the annual means from 2012 to 2014 were averaged to obtain a single estimate of PM2.5 exposure for the census tract. For census tracts that did not have air monitors within 50 km, PM2.5 concentrations were obtained from satellite observations from the years 2006 to 2012 and averaged over that period to obtain the single estimate of PM2.5 exposure for the census tract. PM2.5 was measured in micrograms per cubic meter (µg m−3).The annual mean concentration of PM2.5 data. OEHHA obtained data on births from the California Department of Public Health and geocoded them based on the mother’s residential address at the time of the birth.The percent of LBW infants averaged over the years 2009 to 2015 for the 7785 census tracts were collected from CalEnviroScreen 4.0. Data on the percentage of low birth weight infants in a census tract were obtained from CalEnviroScreen 4.0 to ensure that most of the outcomes occurred concurrent with or after the reported PM2.5 level and LBW were identified using a directed acyclic graph. Covariates included percentage of households in poverty, percentage of race/ethnicity, and toxic releases from nearby facilities. All data for the covariates, except for the percentage of race/ethnicity, were from CalEnviroScreen 3.0 because race/ethnicity data were not available in CalEnviroScreen 3.0. Percentage of households in poverty was used as defined by CalEnviroScreen . Data on the percentage of race/ethnicity in a census tract were from CalEnviroScreen 4.0. Data on toxic releases from facilities were an average of toxicity-weighted concentrations of modeled chemical releases to air from facility emissions and off-site incineration from 2011 to 2013 in the census tract.Covariates that could potentially confound the association between ambient PM2.5, LBW, and percentage of the population in poverty in California using QGIS Version 3.16.16.We mapped the spatial distribution of PM2.5 and LBW adjusted for percentage of the population in poverty, percentage of each racial/ethnic group, excluding white, and toxic releases from facilities in the census tract for the relationship between PM2.5 and LBW.We used multivariable linear regression to analyze the relationship between PMTo examine poverty as an effect modifier, we used two times the federal poverty level as our threshold and stratified the data into census tracts with <50% of the population living below this level and census tracts with ≥50% of the population living below this level.To look at race/ethnicity as an effect measure modifier, we created binary variables for the four largest race/ethnicity groups  in California, identifying census tracts that were above the median for each race/ethnicity category. We conducted four stratified analyses in which we stratified the data into census tracts that were above and below or equal to the median for each of the four largest race/ethnicity groups. All stratified models were adjusted for the other race/ethnicity groups being above the median, the percentage of households in poverty, and toxic releases from facilities.All analyses were conducted in R Version 4.1.1.2.5 over three years across the census tracts was 10.4 micrograms per cubic meter (µg m−3), which is less than the current annual standard set by the U.S. EPA of 12 µg m−3 but higher than the World Health Organization’s annual guideline of 5 µg m−3 [5 µg m−3 ,17. Figu2.5 was positively associated with low birth weight (LBW) in both adjusted and unadjusted models. After adjusting for percentage of the population living in poverty, percentage race/ethnicity, and toxic releases from facilities, the association between PM2.5 and LBW remained significantly positive. There was a 0.03%  increase in the percentage of LBW infants for every 1 µg m−3 increase in average annual mean concentration of PM2.5 in a census tract after adjustment  increase in the percentage of LBW infants for every 1 µg m−3 increase in average annual mean concentration of PM2.5, while for census tracts with <50% of the population living in poverty was associated with a 0.02%  increase in the percentage of LBW infants after adjustment . Comparing census tracts that are above the median for the percent White population to those below the median, the tracts with a larger White population were associated with a 0.04%  increase in LBW per 1 µg m−3 change in PM2.5 while tracts with a smaller White population were associated with a 0.01%  increase in LBW. There was a 0.03%  increase in the percentage of LBW infants for every 1 µg m−3 increase in the average annual mean concentration of PM2.5 in a census tract with below the median percentage of African Americans and a 0.01%  increase in the percentage of LBW infants for census tracts with above the median percentage. Lastly, for census tracts with below the median percentage of Asian Americans, for every 1 µg m−3 increase in PM2.5, there was a 0.02%  increase in the percentage of LBW infants while for census tracts with below the median, there was a 0.03%  increase. In this analysis, the percentage of Hispanics, Whites, and African Americans in a census tract may be potential effect modifiers.2.5 and low birth weight (LBW) in California and investigate whether poverty and race/ethnicity  modified that relationship. Although multiple studies have examined the relationship between PM2.5 and low birth weight, few studies have been in a statewide representative sample or assessed for effect modification by poverty or race/ethnicity on that relationship [2.5 and LBW which is consistent with the results from previous studies [2.5 in the U.S. [2.5 and LBW was modified by poverty but not by race/ethnicity at the census tract level.This study aimed to understand the relationship between PMtionship . We foun studies ,7,8. A rthe U.S. . Our stu2.5 and LBW for census tracts with a high percentage of Hispanics and African Americans, but instead found a stronger association in census tracts with a low percentage of Hispanics and African Americans. The percentage of White people in a census tract appears to have an additive effect on the association between PM2.5 and LBW. While this is counterintuitive, it may be an artifact of census tracts with a high percentage of White people having lower levels of PM2.5 exposure compared to other racial/ethnic groups. Another possible explanation for these surprising results is that we did not have individual-level data on maternal race and only had data on the percentage of each race/ethnicity group in a census tract. Aggregated population estimates might obscure the true effect of race/ethnicity at the individual level. Lastly, there might also be residual confounding within our model, by factors such as maternal age, which increases the odds of LBW [The results for effect modification by race/ethnicity in this ecological analysis were surprising, given the results of prior studies showing communities of color having higher exposure to air pollution and being at increased risk of LBW ,10. We es of LBW , or beca2.5 on LBW is not fully understood, but several theories have been proposed. One theory is that maternal exposure to fine particulate matter can contribute to oxidative stress, which can damage DNA [2.5 may lead to pulmonary and placental inflammation [The biological mechanism for the effect of PMmage DNA . In addiammation . The effammation . FurtherOne strength of this study was that it is representative of the entire state of California, with data for almost all (97%) census tracts in California being used. We also used census tracts as the unit of analysis, which is a smaller unit of analysis than other ecological studies conducted at the zip code or county level. In addition, we leveraged a unique, publicly available dataset that compiled disparate data into one platform. Lastly, this study assessed for effect modification by both socioeconomic status and race/ethnicity.2.5 and LBW were aggregated over space and time. Because data were collected at the census tract level, the results from this study cannot be extrapolated to the individual level. PM2.5 was measured as the mean concentration over three years and did not take into account variations over time. Although some of the data on percent LBW were collected before the data on PM2.5, prior studies have shown the spatial distribution of air pollution typically does not change significantly over periods of 10 years [2.5, with no information on the specific chemical components of PM2.5, which might have differential effects on LBW.This study had several limitations. Data on both PM10 years . In addi2.5. The data included only measurements for outdoor air pollution and did not include any information regarding air pollution indoors, where pregnant women spend most of their time. Ambient PM2.5 was used as a proxy for maternal exposure. Percentage of LBW in a census tract was found by geocoding births to maternal residential addresses, thus we could not take into account residential mobility. Exposure misclassification would likely result in an underestimate of the effect of PM2.5 on low birth weight.Like many other air pollution studies, this study faced possible exposure misclassification due to measurement error for PM2.5 and LBW, and should assess whether interventions to decrease PM2.5 exposures result in decreases in LBW.Because this was an ecologic study, future research should use individual-level data to further examine whether income and race/ethnicity modify the relationship between maternal exposure to PM2.5 is associated with an increase in the percentage of low birth weight (LBW) infants in a census tract. Although the apparent effect of PM2.5 on the percentage of LBW infants was small, air pollution is a ubiquitous exposure, so the population attributable risk is more substantial than what it might appear at first glance. These study results add to the increasingly robust evidence that PM2.5 can have adverse effects on birth outcomes and that low-income communities are more vulnerable. Improving air quality, especially in low-income communities, could potentially improve maternal and child health outcomes.This study shows that exposure to PM


We aimed to investigate the relationship between childhood trauma, dissociative experiences, and internet gaming disorder in male university students with probable attention-deficit hyperactivity disorder determined by both childhood and current attention-deficit hyperactivity disorder symptoms.Volunteers were 376 university students who completed a test battery that included a sociodemographic form as well as the Adult ADHD Severity Rating Scale, Wender Utah Rating Scale, Childhood Trauma Questionnaire, Dissociative Experiences Scale, Somatoform Dissociation Questionnaire, and Internet Gaming Disorder Scale—Short Form. Volunteers were divided into 2 groups as with and without probable attention-deficit hyperactivity disorder D based on both childhood and current attention-deficit hyperactivity disorder symptoms.t = −3.94; P < .01), Dissociative Experiences Scale , Somatoform Dissociation Questionnaire , and Internet Gaming Disorder Scale—Short Form  scores were significantly higher in the group with probable attention-deficit hyperactivity disorder than in those without. Two different hierarchical regression analysis models in which internet gaming disorder scores were dependent variables showed that dissociative experiences in first model  and dissociative absorption in second model  were associated with internet gaming disorder after controlling for childhood trauma and attention-deficit hyperactivity disorder symptoms.Childhood Trauma Questionnaire (Dissociative absorption may contribute to internet gaming disorder independent of childhood trauma and attention-deficit hyperactivity disorder symptoms, however further studies are needed to investigate this claim. Childhood trauma, both psychoform and somatoform dissociation, and internet gaming disorder scores were higher in the group with probable attention-deficit hyperactivity disorder (ADHD) than in those without.Dissociative experiences were associated with internet gaming disorder scores independent of childhood trauma and ADHD symptoms.Dissociative absorption was the most associated dissociative subfactor with internet gaming disorder.1 In adults, the prevalence of ADHD ranges from 2.5% to 5.2%. Unlike the clinical sample, where female: male ratios as high as 1 : 10 were observed, community samples represented a less extreme sex ratio  in ADHD prevalence in childhood.2 Compared to studies on child and adolescent ADHD, adult studies usually showed a more balanced distribution of ADHD prevalence in males and females. Attention-deficit hyperactivity disorder is a predisposing factor for many psychiatric disorders, including anxiety, mood, eating, trauma-related, and substance-related disorders.5Attention-deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by attention deficit, hyperactivity, and impulsivity, that is childhood-onset. Although ADHD symptoms tend to decrease in adulthood, a considerable proportion of adults with ADHD remain symptomatic, which negatively affects their academic performance, interpersonal relationships, and social functioning.6 It has also been stated that childhood ADHD can be a risk factor for exposure to trauma. Trauma-related symptoms such as motor restlessness, emotional lability, and attention problems can mimic, trigger, or reveal ADHD symptoms. While it has been suggested that dissociative experiences and inattention can overlap in the association between ADHD and traumatic symptoms, there are not enough dissociative experience studies to evaluate this claim in individuals with ADHD.7Studies investigating the relationship between childhood traumatic events and ADHD have suggested that traumatic experiences in childhood may make trauma victims more vulnerable to aggravation of ADHD symptoms.8 Generally, “pathological gaming” can be defined as repeated, persistent and excessive participation that cannot be controlled, in spite of gaming-related negative outcomes. Studies have reported prevalence rates for IGD ranging from 0.7% to 11.6%, and the male gender is the most prominent risk factor for IGD.10Internet gaming disorder (IGD) is becoming increasingly common today. If gaming becomes harming a person’s social, job-related, family, school, and psychological functioning, this activity can be defined as pathological.11 Moreover, IGD has been linked to multiple comorbidities, such as depression, anxiety, aggression, and obsessive-compulsive symptoms. Attention-deficit hyperactivity disorder is both a major comorbidity and risk factor for IGD. It has been suggested that both disorders share common clinical features and neuronal functional connectivity.12 Some of the studies have shown that childhood traumatic experiences and dissociative experiences may contribute to IGD in gamers.14Internet gaming disorder has also been associated with depression, social difficulties, ADHD, and substance abuse.While studies on IGD are increasing, it is being investigated why gamers are more prone to dissociative experiences and the role of traumatic experiences at this point. In this study, we aimed to compare childhood trauma, dissociative experiences, and IGD symptoms in male young adults who were divided into 2 groups according to the probability of individuals having ADHD determined by current and childhood ADHD symptoms. In addition, we aimed to investigate the association between dissociative experiences and IGD after controlling for childhood trauma and ADHD symptoms.This study was conducted in a cross-sectional design and using the online survey method, in Selçuk University Central Campus between June 1, 2020, and September 1, 2020. To carry out the study, permission was provided from the Selçuk University Rectorate and approval from the Local Ethics Committee of Selçuk University Faculty of Medicine (decision number: 2020/130).The participants completed an online survey including a consent form regarding voluntary participation, the socio-demographic form, Wender Utah Rating Scale (WURS), Adult ADHD Severity Rating Scale (ASRS), Dissociative Experiences Scale (DES), Childhood Trauma Questionnaire (CTQ), Somatoform Dissociation Questionnaire (SDQ), and Internet Gaming Disorder Scale—Short Form (IGDS9-SF).University students studying at Selçuk University Central Campus were included in the study. When the data collection process was over, 454 university students completed the online survey. Since cognitive abilities and executive function may be affected, participants who reported substance use, regular alcohol use, and any current diagnosis of psychiatric disorders were excluded from the research. Three hundred seventy-six participants’ data were subjected to analysis.15 The cut-off value was determined as 36 points for childhood ADHD symptoms in this study. The study on the reliability and validity of the Turkish scale was conducted by Öncü et al.16Wender Utah Rating Scale is a 25-item, self-report 5-point Likert type scale that retrospectively questions childhood ADHD symptoms. It consists of 5 subscales: irritability (7 questions), affect (5 questions), academic problems (3 questions), behavioral problems/impulsivity (5 questions), and attention deficit (5 questions). The total score of the scale is acquired by adding the scores from all questions.15 The reliability and validity of the Turkish form have been demonstrated.17 Higher scores indicate higher ADHD symptoms. It is suggested that the cut-off score should be determined as 30, and this cutoff score is reported to correspond to sensitivity= 0.75, specificity= 0.79, Kappa= 0.44, positive predictive value= 0.46, and negative predictive value= 0.93.18 The ASRS is also used as a 6-item screening tool, shows robust psychometric properties, and displays strong concordance with clinicians’ diagnoses. Adult ADHD Severity Rating Scale 6-item, 5-point Likert type scale ranges from 0 (never) to 4 (very often). On screening items 1-3, each response of 2 or more equated to 1 point; each response of 3 or more on screening items 4-6 scored a point. A total score of 4 or more indicated probable ADHD.19It is an 18-question self-report scale that measures ADHD symptoms in adults based upon the criteria of the Diagnostic and Statistical Manual of Mental Disorders: Fourth Edition.20 Therefore, in this study, we used both the ASRS 6-item, which questions the current ADHD symptoms, and the WURS, which queries the ADHD symptoms in childhood, while determining the probability of ADHD.Additionally, it is known that ADHD symptoms should begin in childhood. Therefore, a cross-sectional symptom screening in adulthood is not sufficient for the diagnosis of ADHD according to DSM 5.21 consists of 28 questions and 5 subscales as emotional abuse, physical neglect, physical abuse, sexual abuse, and emotional neglect. Validity and reliability of CTQ’s Turkish version have been performed with a Cronbach’s alpha value as 0.93.22The CTQ is a functional and easy-to-use measurement tool that evaluates early life interpersonal traumas retrospectively and quantitatively. The scale developed by Bernstein et al23 Validity and reliability of Turkish version of DES has been performed and was showed to have great reliability and validity, with a Cronbach’s alpha of α = 0.91.24The DES evaluates a broad variety of types of dissociation including both problematic dissociative experiences such as depersonalization–derealization (the feeling of being an outside observer of one’s life—the feeling of being detached from one’s surroundings), absorption  and amnesia , and normal dissociative experiences .25 Sar et al26 conducted the Turkish validity and reliability study.The SDQ is a self-report scale used to assess somatoform dissociation. It contains 20 items. The scale investigating negative symptoms  and positive symptoms  can be scored in the range of 20-100.27 by applying it to gamers from 58 different countries. It was adapted to Turkish by Evren et al28 and was found to be reliable with a Cronbach’s alpha of 0.89.Internet Gaming Disorder Scale–Short Form is a self-report, 5-point Likert-type scale that evaluates the severity of IGD symptoms, questions 9 IGD criteria  according to DSM 5. It was developed by Pontes and Griffithst-tests were used to compare the 2 groups’ numerical data. Finally, 2 hierarchical multiple regression analyses were performed to evaluate the contribution of dissociative experiences to IGD after controlling for age, ADHD symptoms, and childhood trauma. The risk values were calculated within a 95% CI. The significance threshold was accepted as P < .05.The data were analyzed using the Statistical Package for the Social Sciences 22  package program. First, descriptive statistics were calculated. Pearson correlation analyses were then performed to investigate correlations among the scale scores. Volunteers were divided into 2 groups as with and without ADHD probability according to ASRS 6-item screening for current ADHD symptoms and WURS screening for childhood ADHD symptoms. Independent variable t-tests revealed that ASRS , WURS , CTQ , DES , SDQ , and IGDS9-SF  scores were remarkably higher in the group with probable ADHD than in those without. Comparisons of the 2 groups’ demographic data and test scores are presented in Participants’ ages ranged from 18 to 57 (mean of 21.83 ± 4.05), and 35.1% (n = 132) reported that they smoked, and 59.8% (n = 225) consumed coffee daily. Independent samples P < .01).As presented in F value  = 11.75, P < .001). The first step of the hierarchical regression analysis, which included probable ADHD, was statistically significant and participants with probable ADHD  were at greater risk of IGD. Childhood trauma was controlled in the second step, revealing no significant effect on IGDS9-SF scores . In the third step, psychoform and somatoform dissociation scores were included in the analysis. It was determined that DES score , which reflects psychoform dissociation, significantly contributed to variance in IGDS9-SF scores.In the first hierarchical regression analysis to test the relationship between dissociative experiences and internet gaming disorder, IGDS9-SF score was considered the dependent variable. The hierarchical regression model yielded a significant F value  = 5.45, P < .001). In the second step, no relationship was found between CTQ subscales and IGD scores. In the third step, it was shown that the amnesia  and absorption  subscales of DES were significantly associated with IGD. These hierarchical regression analyses findings are presented in After the associations were revealed in the first regression analysis, a second regression analysis including the subscales of CTQ and DES was performed and yielded a significant Our aim in this study is to examine the relationship between childhood trauma, dissociative experiences, and internet gaming disorder in male university students with probable ADHD. The group with probable ADHD had higher CTQ, DES, SDQ, and IGD scores compared to those without. Hierarchical regression analysis revealed that dissociative experiences are associated with IGD independent of childhood trauma and ADHD probability.29 In our study, internet gaming scores were significantly higher in the group with probable ADHD than in those without. Additionally, having probable ADHD in hierarchical regression analysis was a strong predictor for IGD. Moreover, IGD and ADHD have been found to have common brain connections. It has been reported that the concept of hyperfocus, which was previously defined in individuals with ADHD, the mental state with the increased attention that decreases the awareness of the environment and time while engaging with their interests (like a hypnotic spell), also experienced in individuals with IGD during gaming activities.31 This may be a common phenomenon in both ADHD and IGD, but empirical studies are needed, preferably involving brain connectivity analyses.The relationship between ADHD and IGD has been well defined in children, adolescents, and adults.32 Although our study revealed that increased childhood trauma scores in the group with probable ADHD compared to those without, regression analyzes did not show a relationship between childhood traumas total and sub-scores with IGD. This may be because childhood trauma predicts IGD by only indirectly increasing dissociative symptoms.It is thought that childhood traumas contribute to IGD and gaming activities help individuals to escape negative cognitions associated with trauma.33 Our study reveals that both psychoform and somatoform dissociation scores as well as childhood trauma scores were higher in the probable ADHD group than in those without. Considering the bidirectional relationship between ADHD and childhood trauma, these results were consistent with the literature.7Dissociation is defined as the disruption and/or discontinuity in memory, consciousness, identity, behavior, environment, and body perception that is expected to function synchronously to protect the ego from trauma-related outcomes such as negative cognitions and disturbing emotions. This defense mechanism can affect body perception/representation (somatoform dissociation) as well as executive functions and mentation (psychoform dissociation).34 This may represent an increased focus (hyperfocus) on certain activities, a facilitating mental process for IGD.Although there are studies on the relationship between dissociative experiences and IGD in the literature, this study is the first to investigate the association between dissociation and IGD in healthy volunteers after controlling for childhood traumas and ADHD symptoms. The novel finding is that psychoform dissociation (not somatoform) was associated with IGD after controlling for childhood trauma and ADHD probability. Moreover, further analysis showed that in particular dissociative absorption was associated with IGD. Absorption is a tendency to become immersed in a single stimulus, either internal  or external  while neglecting other stimuli.The study also has several limitations, however. Participants were not subjected to psychiatric examination, and psychological parameters were evaluated through self-report scales, which may include bias . Additionally, the study was conducted in a single center and was cross-sectional in design, making it difficult to generalize its findings. Longitudinal studies with large sample sizes that use functional brain connectivity analyses and objective neurocognitive tests  would provide more comprehensive findings.This study found that male university students with probable ADHD, determined by both childhood and current ADHD symptoms, had higher childhood trauma, dissociative experiences, and internet gaming disorder scores than those without. The novel finding of our study was that dissociative absorption were associated with IGD after controlling for childhood trauma and ADHD symptoms. To better understand the associations between gaming mental states and dissociative experiences, studies that use objective evaluations such as neurocognitive tests and functional brain connectivity analyses are needed.


IGD played a mediating role in increasing the risk of disruptive mood dysregulation in ADHD youths; (4) Conclusions: The findings suggest that IGD mediates ADHD’s progression to disruptive mood dysregulation. Intensive biopsychosocial interventions are warranted for ADHD youths with IGD. More children and adolescents became mood-dysregulated after excessive gaming during the COVID-19 pandemic; this study’s results suggest that child mental health experts develop earlier detection and prevention strategies for children and adolescents hidden behind internet addiction.(1) Background: Internet gaming disorder (IGD) in youths likely leads to disruptive mood dysregulation, especially among those with attention-deficit/hyperactivity disorder (ADHD). Whether IGD mediates the pathways leading ADHD to disruptive emotional dysfunction remains unclear. This study aims to elucidate the direct or indirect influence of IGD on ADHD; (2) Method: The Swanson, Nolan, and Pelham Version IV questionnaire was used to evaluate symptoms of ADHD and oppositional defiant disorder, and the Chen gaming disorder scale was used to measure IGD. A psychiatrist diagnosed ADHD, IGD, and disruptive mood dysregulation disorder (DMDD)-like symptoms. Structural equation modeling was applied to evaluate the role of IGD in mediating ADHD progression to disruptive mood dysregulation; (3) Results: Among a total of 102 ADHD youths, 53 (52%) of them with IGD were significantly more likely to have poor interpersonal relationships ( Internet gaming disorder (IGD), a new mental disorder, has become prevalent among children and adolescents recently, especially during the outbreak of the coronavirus disease COVID-19). Under the lockdown crisis, many adolescents increasingly engaged in internet gaming 9. Under , therebyThere is some overlap between children and adolescents with pathological internet gaming disorder compared to internet addiction. Following a developmentally oriented approach, researchers recently indeed found that internet addiction among children and adolescents is closely correlated with their specific emotional–psychopathological characteristics . Those cIGD was reported to play a mediating role in leading children with ADHD to escape from tedious learning processes . ADHD anIGD had high prevalence rates among children and adolescents, ranging from 4–6% (in European countries) to 13.5% (in China) . It causIn summary, ADHD is a neurodevelopmental disorder commonly noticed among children and adolescents, with prevalence of 9%. IGD is a new formal mental disorder and is also very commonly seen recently among children and adolescents with prevalence ranging from 4–6% (in European countries) to 13.5% (in China). This study result highlights that if children and adolescents with untreated ADHD are internet-addicted, they will experience a mood-disrupted state instead of depression. Depression is a mood disorder commonly noticed among adults instead of children and adolescents. Here, we suggest that people of children’s mental health expertise face this recent surge in youth with IGD properly by providing early preventive intervention in IGD to prevent untreated ADHD from becoming DMDD, which brings about negative influences on their personality development.IGD possibly mediated ADHD youth’s development of DMDD-like symptoms and more psychiatric disorders, such as more severe ADHD, mood disorders, self-injury, eating disorders, ODD, conduct disorder (CD), personality disorders, and substance use disorders during the critical period of the COVID-19 pandemic . For theHow IGD leads children with ADHD to become irascible and display DMDD-like symptoms deserves study. We hypothesized that IGD may play a mediating role in leading children with ADHD to develop DMDD-like symptoms and tested this hypothesis using structural equation modeling (SEM). To our knowledge, this is the first study to examine whether DMDD may be a consequence for ADHD adolescents with gaming disorders. The results may help mental health experts to develop an early detection and prevention strategy for ADHD, IGD, and DMDD among children and adolescents.Patients were recruited from the outpatient units of Mackay Memorial Hospital (MMH), a major medical center in Taipei, Taiwan. The research protocol was approved by the MMH Institutional Review Board (IRB). Written informed consent was obtained in line with the IRB’s guidelines after complete description of the study to the children with ADHD and their parents. Subjects included children aged 7–18 years with a diagnosis of ADHD.A child-and-adolescent psychiatrist confirmed the diagnoses of ADHD and other comorbid mental disorders using the criteria of the Diagnostic and Statistical Manual of Mental Health Disorders, 5th Edition (DSM-5) . Other comorbid psychiatric disorders included ODD, CD, unspecified anxiety disorder, unspecified depressive disorder, adjustment disorder, somatic symptom disorder, persistent (chronic) motor or vocal tic disorder, Tourette’s disorder, language disorder, and speech sound disorder.In the DSM-5, IGD has been recognized as a condition for further research . While diagnosis of DMDD needs to fulfill the criteria of unreasonable mood dysregulation and the age at onset is before 10 years, we regarded our subjects as having DMDD-like symptoms because they had disruptive mood dysregulation but no history of mood dysregulation starting before 10 years old.The exclusion criteria were as follows: pediatric patients or their parent(s)/caregiver(s) with known or suspected psychotic disorders, intellectual disabilities, or other severe mental conditions that would prevent them from completing the study.This study’s recruitment was at the beginning of the COVID-19 situation in Taiwan. We performed a a special statistical analysis called structural equation modeling (SEM) applied to evaluate the role of IGD in mediating the development of disruptive mood dysregulation in children and adolescents with ADHD. We have no data detailing how severe the COVID-19 situation in Taiwan was during the study period to influence this study result.Baseline characteristics of the ADHD children with or without IGD included: gender, school performance, interpersonal relationships, comorbidity , ADHD subtype, family psychiatric history, sibling suffering from ADHD, parent suffered from ADHD in childhood, the strategy of parents to deal with stress, parental understanding of ADHD, parental marital satisfaction, online chatting or playing games on working days ≥ 1 h, online chatting or playing games ≥ 3 h on holidays, drug response, parenting group therapy, compliance, age, height, weight, age of the father and mother, and the number of comorbidities.Each subject recruited for this study was invited to participate in the following programs and was interviewed to derive the following measures.The CIAS is a self-reported questionnaire consisting of 26 questions on a four-point scale that assesses the five dimensions of internet use-related problems with good reliability and validity . These dThe SNAP-IV is a widely used rating scale used to screen for ADHD. The SNAP-IV-26 screens for nine symptoms of ADHD’s hyperactive-impulsive type, nine symptoms of the inattentive ADHD type, and eight symptoms of oppositional defiant disorder as defined in the DSM-IV. The Chinese SNAP-IV demonstrated the satisfactory test–retest reliability (intraclass correlation = 0.59 to approximately 0.72) for the parent form. All subscales of both the parent and teacher forms displayed excellent internal consistency  .DMDD is a new mental disease without any questionnaire or measurement scale at the time of this study. Therefore, we used a Likert scale, 0 to 3, to express the symptom severity of the DMDD criteria of the DSM-5.Structural equation modeling (SEM) was performed using AMOS software version 22.0 (maximum-likelihood method) to examine the direct or indirect relationships among ADHD, DMDD, and IA. The latent variable ADHD was indexed with three antecedent indicator variables: inattention, hyperactivity/impulsivity, and oppositional symptoms.p > 0.05), standardized root-mean-square residual (SRMR) less than 0.05, root-mean-squared error of approximation (RMSEA) less than 0.06, GFI statistic greater than 0.95, incremental fit index (IFI) greater than 0.95, comparative fit index (CFI) greater than 0.95, normed fit index (NFI) greater than 0.95, and Tucker–Lewis index (TLI) greater than 0.95. The guidelines of these indices for determining model fitness were based on a previous study [SEM was conducted to verify whether the proposed mediation model was suitable for the collected data. We used two models to estimate potential mediation effects: a basic model positing a direct relationship between ADHD and inattention, hyperactivity/impulsivity, and oppositional symptoms, and a mediation model positing a direct or indirect relationship among ADHD, DMDD, and IGD. The model fit indices were compared to recommend appropriate model fit indices in line with the effects of these factors. Model fits that represent how a SEM performance fits the sample data were assessed by five indices: the chi-square test (χ2), the goodness-of-fit index (GFI), the Tucker–Lewis Index (TLI), the comparative fit index (CFI), and the root-mean-squared error of approximation (RMSEA) . The goous study .For SEM analysis, a minimum sample of 100 has been recommended by some experts . Anotherp = 0.008) group. Further, the gaming disorder group also had significantly higher comorbid diagnoses of DMDD and IGD than the non-addicted group . The zero-order correlations of the indicator variables are illustrated in A total of 105 eligible ADHD children were enrolled, of whom 102 participants completed the baseline data of the three evaluation forms. The comparison of the baseline characteristics of ADHD with IA and non-IA groups is presented in p-value < 0.001). This model provided a good fit for the data, as suggested by the non-significant chi-square (p = 0.571) and seven other goodness-of-fit indices .The basic model depicted the direct relationship between ADHD and DMDD . The resp = 0.001). In addition, the standardized indirect (mediated) effect of ADHD on DMDD was 0.044 (=0.21 × 0.21). That is, due to the indirect (mediated) effect of ADHD on DMDD, when ADHD increases by 1 standard deviation, DMDD increases by 0.044 standard deviations. The GFIs of this mediation model provided an excellent fit for the data . Notably, the standardized direct effect of CIAS on DMDD was 0.21 (p = 0.005) after adjusting for the direct effect of ADHD on DMDD.The mediation models, as depicted in The concept of IGD mediating ADHD pathways leading to DMDD has not been entirely clear before. In this study, we demonstrated how gaming disorders drive ADHD to DMDD. Gaming plays a mediating role to escalate the effects of ADHD to DMDD. Under the hypothesis, the SEM analysis  found gaming disorders worsen the symptoms of ADHD to DMDD. IGD was a risk factor and was associated with emotional dysregulation among ADHD youths.If we explain this finding using the research-domain-criteria-dimensions-model perspective, children with ADHD have a deficit in the domain of cognition  and positive valence (in rewarding anticipation/delay/receipt) . ChildreWe explain below a vicious cycle that illustrates why IGD plays a mediating role and worsens the symptoms of ADHD, even developing negative moods. A vicious cycle starts with gaming-addicted ADHD youths characterized in our descriptive analysis: these youths that are more likely to have poor interpersonal relationships are clinically more comorbid with DMDD, have older parents, and have parents with more marital discord and a poorer parenting strategy for managing stress compared with ADHD youth without IGD. This implies that such youths live in a vulnerable state with their severe symptoms of ADHD and emotional irritability, coupled with poor interpersonal relationships. Through the process of long-term addiction to gaming, these vulnerable youths become affected by DMDD. The cycle becomes vicious, as IGD might lead ADHD youth to spend more time gaming to avoid family or social interactions; gradually, gaming addiction leads them to become lonelier and more irritable, especially when their excessive gaming behavior is curtailed.One study named “The association between internet addiction and psychiatric co-morbidity: a meta-analysis” by Roger C Ho et al. from Singapore in 2014  found thOur findings detail the etiology from the genetic and environmental aspects regarding the development of gaming disorder. For youths with IGD, the untreated ADHD was genetic loading that led youths with IGD to exhibit severe symptoms of ADHD, impulsivity, and irritability. Gradually, IGD might enhance the genetic risk of untreated ADHD youths further, presenting more severe symptoms similar to DMDD. In addition, the environmental and family risks include untreated ADHD, living in an environment of low family cohesion, family conflicts, and poor family relationships and family functioning . ThroughIn the last two decades, more scholars have focused on other comorbid psychiatric disorders among gaming-addicted adolescents, such as IGD co-occurring more with depression , social This study has the following limitations. First, in this study, DMDD was diagnosed by a psychiatrist according to the new criteria in the DSM-V; however, the stability of the DMDD diagnosis after the gaming disorder was not followed up after this study. Additionally, the diagnosis of DMDD needs to fulfill the criteria of unreasonable mood dysregulation and the age at onset being before 10 years. Thus, we regarded our subjects having DMDD-like symptoms because they had disruptive mood dysregulation recently, but we had no history of mood dysregulation starting before 10 years old. This is why we used the term “DMDD-like symptoms”. Therefore, the differentiation between the real DMDD and withdrawal symptoms of gaming disorders resembling DMDD symptoms need to be considered. In addition, DMDD is a disease without any questionnaire or measurement at the time of this study. We used a Likert scale, 0 to 3, to express the symptom severity of the DMDD criteria of the DSM-5. In the future, a more validated DMDD questionnaire is crucially needed to study more about DMDD and withdrawal symptoms of internet gaming disorder on children and adolescents. Second, for convenience, only children and adolescents with ADHD diagnostic antecedents were selected as risks. Other risks, such as socially accepted internet overusing behavior leading to both parents and children being IGD victims, may also lead ADHD children with IGD to develop DMDD-related symptoms. One recent study named “What Factors Are Most Closely Associated With Mood Disorders in Adolescents During the COVID-19 Pandemic? A Cross-Sectional Study Based on 1771 Adolescents in Shandong Province, China” by Ziyuan Ren from China in 2021  found thOur future society is likely to contain more youths with IGD . Child pIn summary, ADHD should be treated early to prevent serious consequences such as antisocial personality disorder and substance-related and addictive disorders . IGD amoThe findings suggest that IGD mediates ADHD’s progression to disruptive mood dysregulation. Intensive biopsychosocial interventions are warranted for ADHD youths with IGD. More children and adolescents became mood-dysregulated after excessive gaming during the COVID-19 pandemic; this study’s results suggest that child mental health experts develop earlier detection and prevention strategies for children and adolescents hidden behind internet addiction.


Intrauterine exposures influence offspring health and development. Here we investigated maternal intake of sweetened carbonated beverages (SCB) during pregnancy and its association with ADHD symptoms in the offspring.n = 39,870). The exposure was defined as maternal intake (daily servings) of SCB, using no daily intake as reference. Outcome was offspring ADHD symptoms, evaluated as a continuous standardized ADHD score and as a binary outcome of six or more ADHD symptoms vs. five symptoms or less. Associations were analysed using log-binomial regression and linear mixed regression models with adjustment for covariates.This study was based on the Norwegian Mother, Father and Child Cohort Study (MoBa) and the Medical Birth Registry of Norway. Maternal diet mid-pregnancy was assessed using a food frequency questionnaire (FFQ). All mothers who responded to the FFQ and a questionnaire when their child was 8 years of age were included ] and 0.46  for maternal daily intake of ≥ 1 glasses of SCB, when the models included adjustments for total energy intake or energy intake from other sources than SCBs and sweet drinks, respectively. The corresponding adjusted relative risks were 1.16  and 1.21.  for drinking ≥ 1 glasses daily.In a large pregnancy cohort with offspring followed until 8 years of age, we found an association between maternal daily intake of SCB and offspring ADHD symptoms. These results suggest a weak positive relationship between prenatal exposure to SCB and offspring ADHD.The online version contains supplementary material available at 10.1007/s00394-022-02798-y. Neurodevelopmental disorders typically become apparent during childhood but are also an important cause of long-term disability . AttentiADHD is a complex multifactorial disorder where heritability is estimated to be approximately 74% based on twin studies . In termThe high dietary intake of sugar in food and beverages in Western diets has raised much concern. Soft drinks (soda or fizzy drinks) are non-alcoholic carbonated beverages either sugar-sweetened or artificially sweetened. In Norway, sales of carbonated beverages have increased tenfold since the 1950s. The sales of sugar-sweetened soft drinks increased until the millennium after which it decreased, while sales of artificially sweetened carbonated beverages have gradually increased . High maBased on data from a large cohort study, we aimed to investigate whether intake of sugar- or artificially sweetened carbonated beverages (SCB) during pregnancy is associated with increased ADHD symptoms in offspring at 8 years of age. Previous studies have not been able to account for unobserved confounding factors that could affect the association between maternal intake of SCBs and hyperactivity in children. By using a sibling comparison design, thus controlling for shared characteristics that remain stable between pregnancies, it is possible to better assess the role of such confounding factors.This study was based on data from the Norwegian Mother, Father and Child Cohort Study (MoBa) and the Medical Birth Registry of Norway (MBRN). MoBa is a large prospective population-based pregnancy cohort study conducted by the Norwegian Institute of Public Health. Participants were recruited from across Norway during 1999–2008 [Mother–child pairs in singleton births, who had answered the FFQ during pregnancy as well as completed a questionnaire when the child was 8 years of age (Q8) were included in our study sample. Exclusions from the total study population of 114,731 mother–child pairs were made for one or more of the following reasons: children born in plural births (4%), missing FFQ (22%), calculated daily energy intake < 0.5 percentile  or > 99.75 percentile  (0.6% of FFQs among singleton mothers), missing follow-up when child was 8 years (52%). In the main analyses we also excluded mothers who reported own ADHD/ADHD symptoms (3%), to exclude obvious genetic contribution to their child’s ADHD symptoms. Women report their own ADHD/ADHD symptoms in questionnaire 6  by the Adult ADHD Self-Report Scale (ASRS) and in Q8 (when the child is 8 years of age) by answering either having had or having the ADHD diagnosis. In the main analyses, we excluded women reporting ever having had an ADHD diagnosis and/or having a score ≥ 14 on the ASRS, as well as women missing information on maternal ADHD (from both Q8 and Q6). In secondary analyses, these women were included, and maternal ADHD was adjusted for in the statistical model. These exclusions resulted in a final study population of 35,309 unique mothers contributing 39,987 mother–child pairs for the main analyses  focused on the child’s behaviour and was mailed to the mothers when the child was approximately 8 years of age. Child ADHD symptoms were assessed by 18 questions from the Parent/Teacher Rating Scale for Disruptive Behaviour Disorders (RS-DBD) addressing ADHD symptoms . ADHD syk et al. . We requ2 or more (obesity). Maternal depression and anxiety symptoms were assessed around gestational week 30 (Questionnaire 3) using selected items from the Hopkins Symptoms Checklist-25 where four questions concern symptoms of anxiety and four concern symptoms of depression. Response categories are "not bothered" "a little bothered" "quite bothered" and "very bothered" and we used the mean score as a continuous adjustment variable. Maternal age was categorised into < 20, 20–24, 25–29, 30–34 and 35 years or older. Parity was categorized into nulliparous, 1 and 2 or more previous pregnancies. Birth season was categorized into January–March, April–June, July–September, October–December. Offspring sex (obtained from MBRN) was used for stratified analyses.Maternal educational level, maternal pre-pregnancy body mass index (BMI), maternal depression and anxiety, components of the maternal diet (obtained from MoBa) and maternal age at delivery, parity, birth year and season (obtained from the MBRN) were a priori considered as possible confounders for the association between maternal intake of SCB and offspring ADHD symptoms. Maternal educational level was categorised into low (less than high school), middle (high school), or high (4 years or more of college/university). Pre-pregnancy BMI was categorized into < 18.5 (underweight), 18.5–24.9 , 25–29.9 (overweight) and 30 kg/mOther components of the maternal diet were added as adjustment variables. Calculated total maternal fiber intake (continuous variable) served as a proxy for a healthy diet . We alson = 5739) or the specific variable on child’s intake of beverages in Q6 were excluded from this analysis.Household behaviour relating to SCBs could be a possible confounder for the relation between intake during pregnancy and child ADHD symptoms. The child’s intake of sweet beverages in early childhood could be viewed as a proxy for household behaviour. The questionnaire at child’s age 3 years (Q6) included questions about the child’s diet, of which two asked about frequency (but not volume) of intake of sugar-sweetened and artificially sweetened beverages. These questions did not distinguish between carbonated and non-carbonated beverages . The child’s intake of sugar-sweetened beverages and artificially sweetened beverages was categorized into two separate variables  and included as adjustment variables in secondary analyses. Mother–child units that either missed the whole questionnaire  with 95% confidence intervals (CI). Clustered robust standard errors were used to account for women participating with multiple pregnancies. The reference category was non-drinkers of SCB . Due to convergence problems with the log-binomial regression model, we used a modified Poisson regression approach with a robust error variance procedure  to estimCrude and adjusted models with different sets of adjustment variables are presented in the tables to illustrate how various covariates influenced the estimates. Adjustments for total energy intake was evaluated in a separate model. SCBs are part of the total composition of the diet. Models without adjustments for total energy intake estimate the total effect of our exposure  on the outcome (offspring ADHD symptoms), while adjusting for total energy intake confers a situation where the exposures were substituted by other nutritional components but still result in the same total energy intake . BecauseThere is a loss to follow-up from pregnancy (Q2) to the child is 8 years of age (Q8) in MoBa. We therefore used inverse probably weighting, previously suggested as a method to account for attrition bias , 31, to n = 913 siblings), using a sibling comparison design with a fixed-effect model (xtreg command with fe option in Stata). We included all maternal siblings among mothers participating with at least two pregnancies, identified by mothers’ study identification number . For the sibling analyses, we examined the associations with the outcome as a continuous variable (standardized), and present estimates adjusted for covariates.Several women participated in MoBa twice or more, which made it possible to correct for unmeasured confounding shared by siblings. We analysed the association among siblings who were discordant on the exposure  in the main analyses, but we report this as a secondary analysis. The relationship between the described factors is presented graphically in a directed acyclic graph (DAG) in Supplementary Fig. 1.We evaluated maternal alcohol intake in pregnancy as a potential confounder and found that women drinking alcohol “monthly or more often” had a relative risk of 0.84 (0.77–0.92) for drinking “1 serving or more daily” of SCB and a regression coefficient of 0.99 (0.68–1.30) for offspring ADHD symptoms at 8 years of age. In secondary analyses we therefore adjusted for maternal intake of alcohol.To evaluate whether the association with offspring ADHD symptoms differed between maternal intake of sugar-sweetened and artificially sweetened carbonated beverages, we divided SCB into sugar-sweetened and artificially sweetened carbonated beverages, and analysed their association with offspring ADHD symptoms, using no intake of the specific beverage as reference group, and additionally adjusting for the other beverage.In a further secondary analysis, we examined a possible association to sweet not-carbonated drinks. While other sweet beverages, such as nectars and fruit syrup, were one covariate in our adjusted models, we also included a model were SCBs were combined with these drinks in a combined exposure variable.In a final secondary analysis, we included 1013 women who reported having past or present an ADHD diagnoses or ADHD symptoms. In the models, we adjusted maternal ADHD as a confounding factor.The main analyses were conducted in STATA version 16.1 , while the weights created for the inverse probability weighting were made using RStudio version 1.4.1717 and R version 3.4.4 .n = 39,970), 87%  of the mothers reported no daily intake of SCB during pregnancy, while 13% (n = 5299) reported 1 serving or more of SCB  of mothers were older than 30 years when they gave birth, 45.8% were nulliparous and 69.0% had higher education (4 years or more of college/university). Mothers with one or more daily servings of SCB where younger, had lower education, higher BMI and a lower proportion of nulliparous mothers compared to mothers with less than one daily serving. Mothers with one or more daily servings of SCB also slightly less often drank alcohol monthly or more often than mothers with less than one daily serving of SCB  0.57–1.17). Adjusting for covariates attenuated the regression coefficients, and further attenuation was observed when also adjusting for total energy intake Table . HoweverIn women who reported no daily intake of SCB, the absolute risk of the child having six or more ADHD symptoms at 8 years of age was 3.4%, while the absolute risks in women drinking 1 or more servings daily of SCB was 4.5%  to Q8. The distribution of various characteristics for women with singleton pregnancies completing Q1, Q2 and Q8 is described in Supplementary Table 3. Mothers who completed both Q2 and Q8 were more often nulliparous, older and had high education compared to population who answered the baseline Q1. However, when we reanalysed the association between maternal intake of SCB and offspring ADHD symptoms using inverse probability weighting for loss to follow-up, results were very similar to the overall adjusted relative risk analyses , the adjusted regression coefficient for the association between SCB intake and offspring standardized ADHD scores were in the same direction and even larger than in the main analyses; however, given the low statistical power in this analysis, the estimate for women drinking 1 servings or more had a confidence interval that included zero ; see Table Adjusting for offspring’s intake of sweetened beverages at 3 years of age, the beta coefficients for women drinking 1 serving or more was 0.08  when the full model was adjusted for total energy intake and 0.22  when the full model was adjusted for other sources of energy than SCBs, nectars and fruit syrup. The corresponding RR estimate for women with 1 or more serving SCB daily was 1.10  adjusted for the same variables as above  and total maternal energy intake (data not tabulated).We included maternal intake of alcohol during pregnancy as an adjustment variable in addition to intake of other sweet beverages, total fiber intake, maternal education, age at delivery, parity, pre-pregnancy BMI, birth year and birth season, total energy and maternal depression and anxiety, with hardly any change to the regression coefficients. After adjustment, the regression coefficient was 0.33  for 1 or more daily servings of SCB compared to less than one daily SCB serving. When adjusting for energy from other sources than SCBs, nectars or fruit syrup instead of total energy, the estimate was 0.47 .We also split maternal intake of SCB into sugar-sweetened and artificially sweetened carbonated beverages to compare their associations with offspring ADHD symptoms, using less than daily intake of the specific beverage as reference group, and additionally adjusting for the other beverage Table . Among wIn further secondary analyses, we included SCBs, nectars and fruit syrup as a combined exposure (Supplementary table 4). In a fully adjusted model , there was no evident association between daily servings of 1 or more sweet beverage and offspring ADHD symptoms at 8 years of age .Finally, we included mothers with present or previous ADHD symptoms or diagnosis in the study population and adjusted for maternal ADHD. The fully adjusted  regression coefficients for offspring ADHD symptoms at 8 years of age were 0.36  for women drinking 1 or more serving of SCB daily, compared to mothers who drank less than 1 serving SCB daily. The corresponding RR estimate for offspring having six or more symptoms at 8 years for mothers drinking 1 or more SCB daily was 1.19  (data not tabulated).In this large population-based cohort study, we found that daily intake of 1 or more serving of SCB as compared to less than 1 serving daily during mid-pregnancy was associated with a weak increase in ADHD symptom score and an increased risk of offspring having six or more ADHD symptoms at 8 years of age. Given that the standardized ADHD score had a mean of 50 and a standard deviation of 10 in the total study population, estimated regression coefficients in the range of 0.3–0.8 for difference between exposed women in different adjustment models should be considered as weak effects. The adjusted relative risks of offspring having 6 or more ADHD symptoms were around 1.2, with crude absolute risks at 4.5 and 3.4% in offspring to mothers who drank 1 or more servings SCB daily and less than 1 serving daily, respectively. In comparison, preterm birth, which is an established perinatal risk factor for ADHD, has a reported odds ratio of offspring receiving ADHD medication of 2.1  for infants born between 23 and 28 gestational weeks and 1.6  for those born between 29 and 36 weeks, compared to infants born at 39–41 weeks' gestation . RelativAfter taking demographic and socioeconomic factors into account, the association between maternal intake of 1 or more serving of SCB daily and a continuous, standardized ADHD score in the offspring was still evident, as was the association with risk of offspring having 6 or more ADHD symptoms. Adjusting for maternal dietary fiber intake did not change the effect estimates. High level of fiber intake has been suggested as a proxy for healthy diet ; howeverA sibling analyses comparison based on discordant exposure  yielded somewhat higher coefficients, but less precise estimates than in the main analysis, with confidence intervals including zero for women drinking 1 or more servings SCB daily. Limitations of a sibling analysis comparison model include lower statistical power due to lower number of participants in these analyses, as the only sibling pairs that contribute to the estimate are pairs discordant on the exposure. Also, for MoBa, it required that the mother participated in MoBa with more than one pregnancy, and completed all the needed questionnaire data for this analysis (Q2 and Q8). This was reflected in the analysis by the wide confidence intervals. The possibility of non-shared confounding between siblings, where the sibling pairs discordant on the exposure also differ on other confounding variables, might further bias the analysis . HoweverOur main aim was to study the potential effect of maternal intake of SCBs during pregnancy on offspring ADHD symptoms. The MoBa FFQ assessed habitual diet during the first half of pregnancy . HoweverOur results did attenuate somewhat when adjusting for maternal pre-pregnancy BMI and other maternal characteristics; however, the intake of 1 or more servings of SCB daily was still associated with ADHD symptoms. Intake of sugar-sweetened SCB contribute to the total energy intake. We adjusted for total energy intake to account for an overall higher energy intake among women with high SCB intake, which could possibly affect the outcome. The estimates were more profoundly attenuated when adjusting for total energy intake, indicating that for women with a similar total energy intake, high intake of SCB did possibly not contribute as much to further increase the risk of offspring ADHD symptoms compared to women with lower energy intake. However, while adjusting for energy intake estimated from FFQs could possibly infer some control for measurement error, the effects of this adjustment could be unpredictable . When adIntake of SCB is a common dietary exposure, also in pregnancy, which makes it relevant for investigating potential effects on offspring health. Intake of sugar-sweetened beverages in the Norwegian population was historically high before and during the period of recruitment to MoBa, reaching a peak in 1997. After the millennium, the intake of artificially SCB has gradually increased, and in 2018, sales of artificially SCB made up 52% of the total SCB sales in Norway . The obsStrengths of the study include the large sample size with detailed data both for the exposure and the outcome variables, the prospective design, minimizing recall bias and possible reverse causation, and the possibilities of additional sibling comparison analyses. The registration of ADHD symptoms in MoBa provides a continuous measured outcome. Previously, a high agreement between maternally reported offspring ADHD scores and registered offspring ADHD diagnoses from the Norwegian Patient Registry has been published . The matOne of the limitations of the study is the inherent uncertainty linked to measures of dietary intake. There is no dietary assessment method without errors and measuring the true habitual intake is not feasible . In MoBaMaternal risk alleles for ADHD could be a potential confounder for the association between maternal diet and offspring ADHD. If the association between exposure and outcome seen in this study was confounded by genetics factors, associations could be evident without exposures being causal. The sibling comparison design would control for such genetic confounding. Further, we were able to exclude women reporting ADHD symptoms or having been diagnosed with ADHD to remove some of the possible genetic contribution to the associations. When including mothers with ADHD or ADHD symptoms, the estimates were somewhat stronger than the estimate from the main analyses adjusted for total energy, which might indicate some familiar confounding in the estimates or an interaction effect.Women who consented to participate in the MoBa Cohort are older, more often nulliparous, higher educated and smoke less than Norwegian pregnant women in general . In spitFinally, MoBa is an observational study and conclusions about causality cannot be drawn with certainty, and residual confounding by for instance life-style factors or medical conditions not accounted for may be present. On the other hand, the longitudinal design with prospectively collected data, strengthens the results and their interpretation.In humans, maternal diet and dietary components have previously been shown to be linked to neurodevelopmental outcomes in the offspring. In accordance with our finding, a systematic review and meta-analysis of 18 observational studies found that better maternal diet quality during pregnancy had a small positive association with child neurodevelopment . A previIn conclusion, in this large population-based cohort study, we found that maternal intake of SCB in pregnancy was associated with an increase in ADHD symptoms among offspring at 8 years of age. Attempting to control for unmeasured familiar factors in sibling analyses strengthened the evidence for an association between daily SCB intake and ADHD symptoms, but with wide confidence intervals. The magnitudes of associations in this study are weak, suggesting SCB only plays a minor role in the aetiology of ADHD. However, further research into causal agents is warranted, as SCBs are common exposures, and even a little reduction of risk may still be of importance for children’s ADHD symptoms at the population level.Supplementary file1 (DOCX 92 KB)Below is the link to the electronic supplementary material.


Attention deficit hyperactivity (ADHD) disorder is a common childhood neurodevelopmental disorder, and Methylphenidate (MPH) is a first-line therapeutic option for treating ADHD.However, how brain connectivity changes with methylphenidate treatment have yet to be studied.This study investigates how the MPH treatment affects the connectivity in the brain of children with ADHD by coherence-based qEEG analysis during rest.During eyes-open resting, EEG signals were recorded from 25 boys with ADHD-combined type before MPH administration and at the end of the 1st month of the treatment. Mutual Information (MI),Coherence Function (COH) and Phase Locking Value (PLV) were used to analyse the changes in brain connectivity.A statistically significant increase in connectivity level was found with MPH treatment between the F3-F4 channels, P3-P4 channels, F7-F8 channels and T5-T6 channels according to PLV, COH and MI analysis (p<0.001).This is the first study to investigate how MPH treatment affects the connectivity of the brain of children with ADHD. Coherence-based qEEG analysis may be a new method that can be used in diagnostic, clinical and prognostic predictions in ADHD.No significant relationships.