OBJECTIVE:Methylphenidate is the first-line treatment for ADHD, yet its neurocognitive mechanisms remain incompletely understood. Electroencephalography (EEG) has been used to examine methylphenidate's effects on brain function and has been proposed as a potential tool for monitoring treatment response. This systematic review addressed whether EEG can (a) clarify methylphenidate's neurocognitive mechanisms and (b) serve as a biomarker of treatment response. METHODS:A PRISMA-compliant systematic review (PROSPERO: CRD42024538039) searched six databases for English-language studies published after 1994. Included studies involved individuals with ADHD, used within-subject designs with acute methylphenidate administration, and collected resting-state or task-based EEG. Assessment of study quality and risk of bias assessment was conducted. RESULTS:Forty-four studies were included. The most consistent finding was an increase in P3 amplitude following methylphenidate administration, observed in eleven of twenty P3 studies. In contrast, there was little evidence to support effects on early sensory processing, movement planning or response monitoring event-related potentials. Findings from quantitative EEG and event-related spectral perturbation analyses were limited, with either no effect observed, or a paucity of studies in some frequency bands. DISCUSSION:Methylphenidate reliably increased P3 amplitude across tasks, suggesting an improvement in higher order cognitive functioning. However, the P3 does not meet criteria for a pharmacodynamic or surrogate endpoint biomarker in this context, and the current evidence does not support EEG as a treatment-response biomarker for MPH in ADHD. Based on our findings, we make 10 recommendations for future research in this area.
ObjectivesTo evaluate the efficacy of regular monthly follow up in maintaining treatment gains versus follow up as needed in the community for children ages 6 to 12 years with ADHD.MethodsOne hundred and eighty six children, age 6 to 13 with DSM-IV diagnosed Attention Deficit Hyperactivity Disorder (ADHD) (combined presentation) received 3 months of comprehensive treatment which included long-acting stimulant medication titrated to optimal dose (via parent and teacher reports) and weekly parent training groups and child social skills and academic training. After the 3 months of treatment, children were randomized to either monthly follow up by the research team (treatment group) or follow up as usual in the community (control group). Comprehensive evaluations occurred at 3 months at the end of the comprehensive treatment, and at 6, 12, 18, and 24 month follow-up.ResultsChildren in both groups improved significantly in all domains after the 3 months of intensive comprehensive treatment. Treatment gains were maintained during the 2 year follow up period in both groups. However, the Hyperactive/Impulsive rating in Conners scale by parent report and some teacher reports were worse in the community group during the follow-up period.ConclusionThe importance of the initial intensive comprehensive 3 month treatment cannot be underestimated as these treatments resulted in significant improvements which were maintained for 2 years in both groups. Factors such as social economic status and available community treatment which may have influenced these results are discussed.
OBJECTIVE:Although ADHD is characterized as a lifelong condition, emerging evidence indicates that symptom severity can fluctuate day-to-day. In this study, we examined whether these fluctuations are directionally associated with fluctuations in perceived stress, using 28 days of ecological momentary assessment data. METHOD:Participants were 187 undergraduate students (Mage = 19.7 years; 78% women). We estimated temporal, contemporaneous, and between-subject networks. RESULTS:At the sum-score level, ADHD and perceived stress were consistently positively associated across all three network types. In analyses of ADHD symptoms and perceived stress, increases in ADHD-related concentration difficulties and procrastination were associated with higher levels of perceived stress on the following day. Conversely, increases in perceived stress, particularly feelings of lacking control, were associated with elevated ADHD symptoms the next day. In the contemporaneous network, ADHD-related procrastination, restlessness, and concentration difficulties showed the strongest associations with perceived stress. These symptoms were also prominent in the between-person network, which additionally identified dependence on others for organization as a key ADHD-related feature unique to this level of analysis. Negative ADHD-perceived stress relations also appeared in both contemporaneous and between-person networks. CONCLUSION:Overall, findings highlighted specific dynamics that may underlie the overlap between ADHD and perceived stress, particularly during the demanding period of college adjustment, with key elements serving as potential early warning signals and targets for micro-level interventions to disrupt escalating cycles of co-occurrence.
OBJECTIVE:This study aims to investigate the relationship between children's multilingualism, immigration background, and their attention difficulties, as well as the prevalence of ADHD diagnoses. METHODS:Questionnaire data on 70,102 children from the Norwegian Mother, Father and Child Cohort Study (MoBa), including parental ratings of attention difficulties (Child Behavior Checklist, Parent/Teacher Rating Scale for Disruptive Behavior Disorders) and multilingual language use, was linked with registry data from the Norwegian Patient Registry concerning ADHD diagnoses. RESULTS:Our findings indicate that multilingual children exhibited higher ratings of attention difficulties compared to their monolingual peers. However, the prevalence of ADHD diagnoses did not show significant differences based on multilingualism or parental language background. Nevertheless, there are indications that children with mothers from North Africa, the Middle East, Southeast Asia, East Asia, and Oceania may be at risk of being underdiagnosed for ADHD in Norway. In addition, girls whose mothers spoke a native language other than Norwegian were diagnosed with ADHD significantly later than girls with native Norwegian-speaking mothers. CONCLUSION:Our results raise concerns about the validity of parental questionnaires, such as the Child Behavior Checklist, in assessing attention difficulties across various cultural and linguistic backgrounds, as well as the overall quality of ADHD evaluations for these children. The delayed ADHD diagnoses among daughters of immigrant mothers highlight potential systemic inequalities within the Norwegian healthcare system, emphasizing the need for linguistically and culturally sensitive assessment tools to better support neurodiverse children from diverse backgrounds.
PURPOSE:Behavioral Parent Training (BPT) is a front-line intervention for childhood ADHD, yet its effectiveness is reduced in families where parents also experience ADHD. Prior research suggests this attenuation stems from reduced BPT skill use among parents with ADHD symptoms. Beyond simply recognizing its occurrence, identifying the factors that contribute to poor skill use is essential for enhancing BPT effectiveness among parents with ADHD symptoms. The current study is the first, to our knowledge, to qualitatively examine barriers to BPT skill use in multiplex ADHD families. METHODS:Parents with ADHD symptoms who recently completed a BPT program (n = 16) and BPT clinicians (n = 4) participated in focus groups or interviews. Qualitative data were analyzed to identify common and impairing barriers to consistent skill implementation at home. RESULTS:Four primary themes emerged: (a) executive functioning and ADHD symptoms; (b) intervention fit (e.g., fast pace, poor skill understanding); (c) emotion regulation and motivation; and (d) child and family factors (e.g., multiple children, family communication). CONCLUSIONS:Findings highlight the unique cognitive, emotional, and contextual challenges that parents with elevated ADHD symptoms face when applying BPT skills. Addressing these barriers through intervention modifications, such as cognitive-behavioral strategies for parents, digital tools, and program delivery adaptations, may improve parents' skill use and, in turn, child outcomes.
OBJECTIVE:The purpose of the study was to examine which attention-deficit/hyperactivity disorder (ADHD) symptoms at ages 3 to 5 are most strongly associated with an ADHD diagnosis in a large dataset of preschoolers across the United States. METHODS:Data were drawn from the Environmental Influences on Child Health Outcomes (ECHO) Program, a large national dataset in the United States. Children were included if their caregiver(s) completed at least one of five measures that assessed ADHD symptoms at age 3 (N = 1,430), 4 (N = 1,453), and/or 5 (N = 2,029) years. ADHD diagnosis was determined by medical record and/or caregiver report. A series of logistic regression models were conducted with each symptom included as the independent variable and ADHD diagnosis as the dependent variable. Bootstrapped 99% confidence intervals of odds ratios were compared across symptoms. Next, age and interactions between age and symptoms were added to each logistic regression model. RESULTS:All 10 symptoms assessed were significantly associated with an ADHD diagnosis. Being "on the go" and interrupts or intrudes were most strongly associated with a diagnosis. Associations between symptoms and diagnosis did not significantly differ by age despite significant interactions for difficulty with follow-through, fidgets, and interrupts or intrudes. CONCLUSION:Results suggest that some symptoms may be more useful than others when determining if a preschool-aged child is likely to be diagnosed with ADHD. Providers should consider the context and impairment associated with the symptoms. Future work should build upon limitations to assess all 18 ADHD symptoms in children with and without ADHD diagnoses across developmental periods.
OBJECTIVE:Sleep problems are common among youth with ADHD, and they worsen symptoms as well as day-to-day functioning. As a result, they are of significant concern to caregivers, who are often the ones making treatment decisions. The goal of this study is to understand what caregivers of youth with ADHD and sleep problems want out of treatment. METHODS:One hundred caregivers of clinically-referred youth ages 5 to 18 with a diagnosis of ADHD and reported sleep difficulties completed a 29-item survey covering three domains: (a) the severity of their child's ADHD and sleep symptoms; (b) the importance of improvement in specific ADHD and sleep symptoms; and (c) the degree of improvement in ADHD and sleep symptoms that would be necessary in order for them to feel that treatment was meaningful (i.e., the Minimum Clinically Important Difference or MCID). RESULTS:Overall, improvement in ADHD symptoms, day-to-day functioning, and sleep symptoms were all reported to be at least somewhat important by the majority of caregivers, though they viewed improvements in ADHD symptoms and functioning as more important than sleep symptoms. Among sleep symptoms, longer duration of sleep and maintaining sleep throughout the night were rated as particularly important areas for improvement. The median MCID endorsed by caregivers was 30 min for sleep onset, earlier bedtime, and later waketime, and 48 min for total sleep time; and the median MCID for ADHD symptoms, emotional functioning, and physical health was 50% improvement. Severity of ADHD symptoms and sleep difficulties were positively correlated with caregiver ratings of the importance of improvement across most areas and with the magnitude of the MCID. CONCLUSION:The variability in patient preferences and priorities found in this study highlights the importance of explicitly addressing these issues at the start of treatment and of accounting for them in treatment-focused research.
OBJECTIVES:It remains unclear how much parents with ADHD benefit from standard parenting interventions such as behavioral parent training (BPT). Our objective was to systematically review the literature on BPT aimed at adults with ADHD. As few studies with this focus were identified, we exploratively broadened our scope to quantitatively combine and qualitatively analyze studies of behavioral parenting interventions reporting parental ADHD characteristics. METHOD:A systematic review was conducted of studies evaluating BPT for (targeting) parents with ADHD. The broader literature was explored through meta-regressions and qualitative content analysis. RESULTS:In the systematic review, five studies focusing on parents with ADHD were identified, including two randomized controlled trials. These studies used different strategies to facilitate parents' BPT implementation: treating the parents' ADHD or adapting the BPT itself for adults with ADHD. The number of studies was too small to meta-analyze but narratively suggested that BPT delivered with consideration of parental ADHD functioning and needs can be associated with, for example, increased positive parenting skills. None of our main meta-regressions (5-14 studies) associated parental ADHD with BPT outcomes beyond the trend level. The qualitative literature analysis (54 reports) suggested several ways to adapt the contents and delivery of BPT for parents with ADHD and their contexts. CONCLUSION:This study highlights the potential of tailoring BPT to adults with ADHD. It also emphasizes the need for further research to determine the efficacy of BPT for parents with ADHD and to identify which BPT-related, individual, and contextual factors influence their BPT engagement and outcomes.
OBJECTIVE:Cognitive-behavioral therapy (CBT) for attention-deficit/hyperactivity disorder (ADHD) in adults emphasize the role of dysfunctional cognitions in reinforcing and exacerbating distress and impairment. However, research supporting theorized connections between ADHD symptoms, maladaptive schemas, negative automatic thoughts (NAT; e.g., "I'm stupid"; "It's pointless"), overly-positive avoidant thoughts (OPAT; e.g., "I have plenty of time-I'll do it later"), and impairment is limited. METHODS:The current study sought to evaluate the cognitive behavioral framework for adult ADHD in a community sample of 141 emerging adults (M age = 19.84; 85.5% White; 72.1% female; 20% reported ADHD diagnosis), while controlling for relevant covariates (age, sex, and self-reported symptoms of anxiety and depression). Hierarchical stepwise regressions were used to test theorized relationships between ADHD symptoms, maladaptive schemas, and dysfunctional automatic thoughts, and examine how each of these are related to impairment. RESULTS:ADHD symptoms and two maladaptive schemas (Insufficient Self-Control and Dependence/Incompetence) jointly predicted OPAT: ADHD symptoms and Insufficient Self-Control were positively associated with OPAT, whereas Dependence/Incompetence was negatively associated. Two maladaptive schemas (Insufficient Self-Control and Failure to Achieve) were found to be positively associated with NAT. Finally, ADHD symptoms and NAT were positively related to impairment. CONCLUSIONS:Our results are consistent with the cognitive-behavioral framework for adult ADHD and underscore the importance of CBT clinicians addressing relevant dysfunctional thoughts (i.e., NAT) and underlying core beliefs (i.e., insufficient self-control) held by clients seeking care for ADHD-related impairment.
INTRODUCTION:Many parents of children with attention-deficit/hyperactivity disorder (ADHD) experience mental health challenges that may hinder engagement in behavioral parent training. This pilot randomized trial evaluated the feasibility and acceptability, and explored preliminary parent-related outcomes, of Parental Friendship Coaching+ (PFC+). PFC+ is an engagement-enhanced adaptation of Parental Friendship Coaching (PFC) for parents with elevated ADHD and/or depressive symptoms raising children with ADHD and peer difficulties. PFC trains parents to support their child's friendships through social coaching. METHOD:Thirty-three Canadian parents (Mage = 38.9 years; 97% mothers) were randomized to 6 weeks of PFC+ (n = 18) or waitlist control (n = 15). Afterward, control parents received PFC+, while PFC+ parents entered naturalistic follow-up. PFC+ included participation-enhancing adaptations (e.g., one-time workshop, flexible coaching, online delivery) and connection-promoting adaptations (e.g., extended intake, treatment menu, peer-pairing). RESULTS:On primary outcomes of treatment engagement, session completion was 97%, homework adherence averaged 81%, and alliance ratings were strong. Exploratory parent-related outcomes included parenting stress, parenting competence, and parenting behavior pre- to post-program. Compared to controls, PFC+ parents reported greater parenting competence and friendship facilitation, and reduced criticism, with medium but nonsignificant effects. In contrast, children reported declines in parents' positive involvement and friendship facilitation, and co-parents reported mixed, nonsignificant effects. Parenting stress declined in both PFC+ and control groups. DISCUSSION:Findings support further evaluation of PFC+ as a potentially scalable, engagement-focused adaptation of behavioral parent training for families facing parent mental health barriers.
OBJECTIVE:This study examined the associations between cognitive disengagement syndrome (CDS), ADHD, and depression in adults to clarify patterns of comorbidity and inform efforts to establish the nosological status of CDS. In addition, the latent structure of adult CDS symptoms was examined, and the clinical relevance of empirically derived CDS dimensions was evaluated. METHOD:Clinically referred adults completed self-report measures of CDS and depressive symptoms and were assessed for ADHD, anxiety, and depression using multi-informant diagnostic procedures. Exploratory factor analysis was conducted to evaluate the dimensional structure of CDS symptoms. Group comparisons examined differences in depressive symptom severity across diagnostic groups, and correlational analyses evaluated associations between CDS factor scores and depression. RESULTS:Exploratory factor analysis supported a two-factor structure of CDS symptoms reflecting cognitive complaints and lethargy. Individuals with CDS reported significantly greater depressive symptom severity than individuals with ADHD. Both CDS factors were significantly associated with depressive symptoms, with lethargy demonstrating a stronger association than cognitive complaints. CONCLUSION:Findings support CDS as a multidimensional construct in adults that is closely linked to depressive symptomatology. The observed factor structure and its associations with depression suggest that CDS symptoms extend beyond attentional dysfunction alone and may reflect broader internalizing processes. Although CDS was rarely observed in isolation, its distinct symptom profile and pattern of associations differentiate it from ADHD. Further research is needed to clarify whether CDS is best conceptualized as a transdiagnostic process, a cross-diagnostic clinical syndrome, an internalizing disorder, or an attentional disorder.
OBJECTIVE:There is evidence to suggest that girls with ADHD are less likely to be diagnosed with and receive treatment for ADHD in childhood compared to boys. However, it is unclear whether there are sex differences in first use health services for ADHD. This study compared the age at which girls and boys first accessed health services for ADHD. METHODS:Participants were 89,587 children followed from birth to age ~18 years with linked administrative health records within a longitudinal population cohort study in New South Wales, Australia. The age at the first use of health services for ADHD was identified from records of subsidised medication prescriptions, ambulatory mental health service use, emergency department presentations and hospital admissions, and examined in relation to the child's sex assigned at birth. RESULTS:In this population cohort, 7,402 (8.3%) children accessed health services for ADHD before their 18th birthday. The percentage of girls with a record of using health services for ADHD (5.5%) was approximately half that for boys (10.9%). Girls were older at their first use of health services for ADHD (median age 13.6 years, modal age 17 years) than boys (median age 9.4 years, modal age 7 years). CONCLUSION:Our findings emphasise the need to improve timely recognition and treatment of ADHD among girls.
PURPOSE:To estimate attention-deficit/hyperactivity disorder (ADHD) prevalence across gender identity, transgender status, and sexual identity using whole-population linked data in Aotearoa New Zealand (NZ). METHODS:A nationwide cohort study using the 2023 NZ Census linked to administrative health data within Stats NZ's Integrated Data Infrastructure. Individuals aged 5 to 24 years were included. ADHD was identified from lifetime diagnosis and treatment records. Modified Poisson regression models estimated adjusted incident rate ratios (IRRs) by gender, transgender status, and sexual identity. RESULTS:Among 1,266,456 individuals, 43,095 (3.4%) had ADHD. ADHD prevalence was higher among those identifying with another gender (10.3%) than males (4.6%) or females (2.0%), and among transgender (9.9%) than non-transgender individuals (3.4%). Among those aged 15 to 24 years, ADHD prevalence was higher in non-heterosexual (8.0%) than heterosexual individuals (3.6%). Adjusted analyses showed similarly elevated rates. CONCLUSION:ADHD prevalence was substantially higher among gender-diverse, transgender, and sexual diverse populations, highlighting the need for inclusive and equitable assessment and care pathways.
BACKGROUND:Youth with attention-deficit/hyperactivity disorder (ADHD) are more likely to experience delays in obtaining their driver's license relative to their same-aged peers. However, despite these delays, there is no evidence of improved driving outcomes for these youth. Additionally, graduated driver's licensing laws typically terminate around the age of 18, giving some youth less structure prior to independently transitioning to the road. To date, no study has examined the cognitive and parenting factors that are related to delays in licensure for adolescents with ADHD within the context of an intervention (i.e., Supporting a Teen's Effective Entry to the Roadway; STEER). The current study utilized logistic regression analyses to determine if teen cognitive functioning, parenting, and the intervention were related to licensure status at 12-month follow-up. METHOD:Baseline cognition (i.e., reaction time variability, working memory, inhibitory control), baseline parental monitoring, baseline negative parenting, and licensure status were collected on 172 adolescents with ADHD enrolled in a randomized, controlled trial. RESULTS:There was a significant interaction between reaction time variability and the intervention on licensure status (p = .007), and a marginal interaction between negative parenting and the intervention on licensure status (p = .05). Those in the STEER group with more reaction time variability were more likely to be licensed at the 12-month follow-up. Although not statistically significant, those in the STEER group tended to have higher rates of licensure when negative parenting was lower. CONCLUSIONS:These findings indicate that the STEER intervention may have uniquely benefitted those adolescents who had more difficulties with reaction time prior to the intervention and, to some extent, provided additional support to parents that already had lower levels of negative parenting.
Objective: Accommodations are the most common support for college students with ADHD; however, they are not a treatment and emerging evidence suggests they may not lead to performance improvement. As evidence accumulates for efficacious treatments for college students with ADHD it is increasingly important to assess their intervention preferences and treatment acceptability. Method: This mixed methods study was conducted in the context of a needs assessment of college students with ADHD conducted by advanced undergraduate service learning students. A diverse sample of 40 college students with ADHD completed the Abbreviated Acceptability Rating Profile (AARP) to rate the acceptability of treatment components with accumulating evidence of efficacy among college students with ADHD and completed a semi-structured interview to report preferences for campus intervention. Results: All treatment components met at least the minimum threshold of acceptability. Significant differences emerged such that the behavioral component was rated significantly higher than cognitive, medication, psychoeducation, and emotional but was not significantly different than organizational. Emotional was significantly lower than all treatments except medication. Thematic analysis revealed the following intervention preferences themes: (1) psychoeducation, (2) awareness and education for campus community, (3) community building, (4) “help me help myself,” (5) check-ins, (6) ADHD specific supports, and (7) one size does not fit all. Conclusion: Findings have implications for intervention and treatment development and implementation, as well as ADHD education, support, and advocacy on campuses.
PURPOSE:Attention-deficit/hyperactivity disorder (ADHD) has long been viewed as more prevalent in boys, yet growing attention is directed toward the distinct clinical needs of girls and women. This study aimed to map the development of research on ADHD in girls and women and identify major gaps by visualizing changes in research topics over time. METHODS:Following PRISMA-ScR guidelines, PubMed, Embase, APA PsycINFO, Cochrane Library, and Google Scholar were searched through July 2025, identifying studies published between 1989 and 2024. Peer-reviewed studies explicitly identifying female participants, including quantitative, qualitative, mixed-methods, and review designs, were included. Of 1,838 records screened, 487 met inclusion criteria after removing duplications. Studies were categorized by type and mapped according to their geographic origin. Keywords were extracted using a TF-IDF approach, and co-occurrence network analysis with the Louvain algorithm was used to identify thematic clusters. Time-series analysis detected emerging topics. RESULTS:From 1989 to 2024, publications volume increased approximately six-fold. Observational studies comprised most studies (71.9%), while qualitative studies and systematic reviews expanded in recent years. Most studies originated from North America (53.0%) and Europe (33.3%), with lower representation from Asia (9.4%). Louvain analysis (modularity = 0.131) identified six thematic clusters, including behavioral and social interactions, sex-related differences and comorbidities, life-cycle and family impact, developmental outcomes, pregnancy/birth and pharmacotherapy, and cognitive & executive functions. Emerging topics included pregnancy, medication, stimulants, borderline personality disorder, and autism spectrum disorder. CONCLUSIONS:Research on ADHD in girls and women is increasingly addressing life-course factors, psychiatric comorbidities, pregnancy and medication, and cognitive/emotional functioning beyond childhood behavioral presentations. However, important methodological limitations and content gaps remain such as a need for well-powered, controlled trials and research into later adult life stages, Asian and other underrepresented populations, maternal experiences during pregnancy, and the distinction between sex and gender. Future research should address these gaps across the life course of girls and women with ADHD.
INTRODUCTION:Emotion dysregulation is a core feature of adults with attention-deficit/hyperactivity disorder (ADHD), yet the mechanisms by which affective contexts modulate attentional control remain incompletely understood. METHOD:We investigated how reward and frustration influence behavioral performance and event-related potentials (ERPs) in adults with ADHD using the Affective Posner Task (APT). Fifty-five adults (25 ADHD, 30 typically developing [TD], aged 20-40 years) completed Baseline, Reward, and Frustration APT conditions while a 32-channel EEG was recorded. Stimulus-locked parietal P3 (220-380 ms, Fz, FCz, and Pz) indexed attentional allocation, whereas feedback-locked Feedback-Related Negativity (FRN; 300-400 ms, Fz/FCz) and Late Positive Potential (LPP; 400-750 ms, Cz/CPz) reflected evaluative and sustained affective-motivational processing. RESULTS:Behaviorally, a significant Group × Condition interaction showed that ADHD participants made more errors than controls only under frustration, despite both groups responding fastest in this condition. ERPs revealed larger P3 amplitudes during Frustration than during Baseline or Reward conditions. However, an Electrode × Group × Trial-type interaction indicated reduced P3 in ADHD on incongruent trials at Pz, consistent with impaired attentional allocation under heightened control demands. In feedback processing, FRN did not show a significant group difference; however, the deceptive loss was more negative than the truthful gain on frustration. Critically, only adults with ADHD showed increased (more positive) LPP amplitudes for both truthful gains and deceptive losses during Frustration relative to the Reward condition, suggesting prolonged affective-motivational engagement; this pattern was absent in TD controls. CONCLUSION:Together, these findings indicate that frustration disproportionately disrupts accuracy and elicits distinct neural signatures in adults with ADHD.
OBJECTIVE:Although cross-cultural disparities in teachers' ADHD reports are well documented, the factors underlying these differences remain poorly understood. Accordingly, this study examined the unique and combined contributions of teachers' experience and training, cultural orientation, ADHD knowledge, and attitudes to their endorsement and severity ratings of ADHD. METHOD:Four hundred and eighteen currently employed K-12 teachers from 15 culturally distinct nations (Australia, Brazil, Canada, Chile, Greece, India, Ireland, Italy, Mexico, Poland, Portugal, South Africa, Spain, the United Kingdom, and the United States) viewed four videos depicting children exhibiting inattentive-type behaviors, hyperactive-impulsive-type behaviors, and two control videos depicting typical development. Following each video, teachers rated the likelihood that the child displayed ADHD behavior (endorsement) and the severity of their symptoms. Teachers also reported their professional background and completed measures assessing their cultural values, ADHD-specific knowledge, and attitudes. Hierarchical regression analyses were used to identify predictors of ADHD endorsement and symptom severity ratings. RESULTS:Reliable differences emerged in teachers' ADHD ratings of identical behaviors. Teaching experience and training, individualism-collectivism, perceived ADHD knowledge, and negative ADHD beliefs significantly predicted the likelihood of endorsing an ADHD label and symptom severity ratings, though the strength and pattern of these effects varied across behavioral presentations. CONCLUSIONS:Teachers' ADHD ratings of identical behaviors are shaped, in part, by their professional experience, cultural orientation, and attitudes about ADHD, which may lead to disparities in identifying students with ADHD. Improving equity in school-based assessments may therefore require approaches that address teachers' beliefs, diagnostic confidence, and culturally informed expectations of classroom behavior. Directions for future research, including the need to replicate these findings using observational methodologies to assess whether similar patterns emerge in teachers' real-world assessments, are discussed.
OBJECTIVE:Attention-Deficit/Hyperactivity Disorder (ADHD) has gained increasing visibility in public discourse on mental health, particularly in adulthood, while remaining associated with stigma, oversimplification, and misinformation. The present study aimed to identify mental representations of ADHD among Brazilian adults with and without a diagnosis. METHOD:This qualitative, exploratory, cross-sectional study included a non-probabilistic sample of 805 adults, comprising 463 participants with ADHD and 342 without a diagnosis. Data were collected online using the Free Word Association Technique, based on the inductive stimulus "ADHD." Analyses were conducted using IRaMuTeQ software, including word cloud analysis, Descending Hierarchical Classification, and specificity analyses, complemented by thematic content analysis. RESULTS:Results were primarily organized into four classes: (a) Stigma and delegitimization of ADHD, characterized by pejorative labels and simplified understandings of the condition; (b) Distress and Insecurity, reflected in feelings of insecurity, frustration, and low self-esteem; (c) Technical-Diagnostic Perspective on ADHD, centered on symptoms such as inattention, deficits, and hyperactivity; and (d) Dysfunctional behaviors, related to difficulties with organization, procrastination, and overload. Overall, more similarities than differences were observed in how participants with and without ADHD represented the disorder. CONCLUSIONS:These findings suggest that ADHD is socially constructed as an experience that extends beyond its clinical definition, shaped by symbolic, normative, and affective processes. Accordingly, there is a need for clinical and psychoeducational practices that integrate diagnostic knowledge with subjective experiences and the sociocultural conditions that influence distress and daily functioning in the Brazilian context.
OBJECTIVE:Research suggests there is a higher prevalence of anxiety in individuals with ADHD compared to those without ADHD. However, estimated prevalence rates vary greatly due to differences in methodologies used across studies. This study is the first meta-analysis investigating differences in anxiety measure scores between adults with and without ADHD, and possible moderators of this effect. METHOD:Our analysis included 58 studies that compared anxiety scores in adults with/without ADHD (N = 18,821; k = 112). RESULTS:The average effect size (Hedges's g) of anxiety scores in those with ADHD relative to controls was 0.77 (SE = 0.066); a medium effect. The only significant moderator was the type of comparison group used, with comparisons to non-clinical control groups (g = 0.954, SE = 0.08) yielding significantly larger effects than comparisons to clinical control groups (g = 0.437, SE = 0.09). None of the other moderator variables examined (Method of characterising ADHD, Anxiety Measure Type, Anxiety Measure Focus, Age or Gender) moderated the effect. There was some evidence of publication bias, therefore results should be interpreted with this in mind. CONCLUSION:Overall, this study indicates that ADHD is associated with higher levels of anxiety symptomology. This has important implications in the diagnosis and treatment of individuals presenting with ADHD or anxiety, including the consideration and screening of each of these conditions as potentially co-occurring with the other. Adaptions made to clinical practice in line with this would better support this population, improve symptom management and overall quality of life. Suggestions for future research are discussed.
