BACKGROUND:Attention-deficit/hyperactivity disorder (ADHD) involves altered neurodevelopment, yet the underlying mechanisms remain elusive. Aperiodic EEG components may reflect neural functions like excitatory/inhibitory balance, but their age-related differences in ADHD and link to default mode network (DMN) dysfunction are unexplored. METHODS:We included 110 medication-naïve children/adolescents with ADHD and 100 matched typically developing peers aged 6-14 years. Aperiodic parameters (exponent, offset) were derived, and source-localized alpha-band DMN coherence was computed. The sample was stratified into middle childhood (6-9 years) and early adolescence (10-14 years) subgroups to delineate age-dependent patterns. RESULTS:ADHD showed globally increased exponent and offset versus controls. Normative age-related decreases were significantly attenuated in ADHD, indicating divergence from typical development. Age-stratified analyses revealed distinct patterns: in middle childhood, increased frontal offset correlated positively with inattention (right hemisphere) and hyperactivity/impulsivity (left hemisphere); in early adolescence, it associated with reduced coherence in two DMN pathways (right mSFG-left hippocampus and left mSFG-right MTG). CONCLUSIONS:Aperiodic activity differences in ADHD are age-dependent. Younger children exhibit focal, symptom-linked frontal abnormalities, whereas adolescents show pervasive network-level dysregulation. Aperiodic measures may capture age-varying ADHD pathophysiology, informing developmentally targeted biomarkers.

Background:Deficits in hot executive functions (EFs), including risky decision-making, delay discounting, and emotion regulation, represent important yet relatively understudied features of attention-deficit/hyperactivity disorder (ADHD). Although physical exercise has been shown to improve cool EFs, its effects on hot EFs remain uncertain. Furthermore, conventional intervention approaches are often limited by accessibility and implementation barriers, underscoring the need for intelligent, home-based alternatives. Methods:In this three-arm randomized controlled trial, 145 children aged 6-10 years with ADHD were randomly assigned to an intelligent exercise group (EG1; n = 53), a traditional offline exercise group (EG2; n = 45), or a wait-list control group (CG; n = 47). Both intervention groups participated in a 12-week program consisting of three sessions per week, each lasting 45-60 minutes and integrating physical and cognitive training. Participants in EG1 completed the intervention through a custom-developed WeChat mini-program ("LeDongYing"), which incorporates computer vision-based motor assessment, dynamically personalized exercise prescriptions, real-time feedback, an artificial intelligence (AI)-assisted guidance agent, and a tailored exercise library. Participants in EG2 received coach-led, face-to-face training sessions. Outcome measures included risky decision-making, delay discounting, and emotion regulation. Intervention effects were evaluated using generalized linear mixed models, with potential confounders included as covariates. Results:For risky decision-making, EG1 demonstrated significantly greater improvements than CG in Block 3 (β = 3.38, p = 0.019), Block 4 (β = 6.89, p < 0.001), and total net score (β = 13.07, p = 0.012). EG2 also showed significantly greater improvements than CG in Block 3 (β = 3.49, p = 0.019) and Block 4 (β = 4.38, p = 0.009). No significant differences were observed between EG1 and EG2 for any risky decision-making outcome (all p > 0.05). For delay discounting, both EG1 (β = 0.12, p < 0.001) and EG2 (β = 0.12, p < 0.001) demonstrated significantly greater improvements than CG, with no significant difference between the two intervention groups (β = 0.00, p = 0.968).For emotion regulation, both EG1 (β = 3.38, p = 0.002) and EG2 (β = 2.71, p = 0.014) improved significantly more than CG, whereas no significant difference was observed between EG1 and EG2 (β = 0.66, p = 0.507). Adherence and participant satisfaction did not differ significantly between EG1 and EG2 (both p > 0.05). Conclusions:The intelligent exercise intervention appears to be an effective, scalable, and accessible non-pharmacological approach for improving hot executive functions in children with ADHD. Its efficacy was comparable to that of traditional face-to-face exercise programs, suggesting that this delivery model may help overcome implementation barriers and expand access to rehabilitation services without implying superiority over conventional approaches. Clinical Trial Registration:The study has been registered on https://www.chictr.org.cn/ (registration number: ChiCTR2200065413; registration link: https://www.chictr.org.cn/showproj.html?proj=182412).

OBJECTIVE:Therapist-guided Internet-delivered Cognitive Behavioral Therapy (iCBT) offers a promising alternative to face-to-face CBT (FTF-CBT) for adults with attention-deficit/hyperactivity disorder (ADHD), but evidence on its comparative efficacy and long-term maintenance mechanisms is limited. This study aimed to analyze the efficacy of group-format therapist-guided iCBT and FTF-CBT in medicated ADHD adults immediately post-treatment and at 1-year follow-up; and explored potential maintenance correlational pathways. METHODS:Secondary analysis of data from two randomized controlled trials (n = 184) comprised participants into three groups: group-format therapist-guided iCBT (n = 43), group-format FTF-CBT (n = 49), and treatment as usual (TAU; n = 92). Outcomes included ADHD core symptoms, anxiety symptoms, dysfunctional attitudes, and psychological quality of life (QoL). Linear Mixed Models were utilized to assess treatment efficacy both at post-treatment and 1-year follow-up, and exploratory structural equation path modeling was used to investigate synchronous correlational patterns of long-term symptom changes between the two active intervention groups. RESULTS:At post-treatment, both group-format interventions demonstrated significant improvements over the TAU group in reducing ADHD core symptoms, alleviating anxiety, and enhancing psychological QoL (|d| = 0.230-0.828). At 1-year follow-up, FTF-CBT maintained benefits for all outcomes and was superior to iCBT across all four domains, while iCBT only retained significant advantages over TAU on ADHD core symptoms (d = -0.483) and psychological QoL (d = 0.217). The exploratory structural equation path model identified three significant correlational patterns: changes in dysfunctional attitudes were directly associated with psychological QoL changes (β = .899), indirectly via anxiety changes (β = .861), and through sequential changes in anxiety and ADHD symptoms (β = .146). CONCLUSION:While both group-format therapist-guided iCBT and FTF-CBT were effective at post-treatment, only FTF-CBT maintained benefits across all outcomes at 1-year follow-up and showed larger effect sizes than iCBT in exploratory comparisons. Exploratory path analyses identified the role of changes in dysfunctional attitudes in synchronous long-term symptom covariation linked to sustained psychological QoL. These findings offer valuable insights into strategies for enhancing the real-world impact of therapist-guided iCBT, highlighting areas for future research and clinical practice.Trial RegistrationChiCTR1900021705, ChiCTR2100044201 (Chinese Clinical Trial Registry, www.chictr.org.cn).

This study investigated the comprehension of relative clauses in Chinese children (aged 6 years 10 months to 12 years 11 months) with developmental dyslexia and/or attention-deficit/hyperactivity disorder (ADHD) and explored associations between relative clause comprehension and various linguistic and cognitive factors to enhance our understanding of syntactic processing in these populations. Twenty-two children with dyslexia, 30 with ADHD, 29 with comorbid dyslexia and ADHD, and 31 chronological age-matched typically developing (TD) controls completed a relative clause comprehension task (measuring both accuracy and response latency) and a battery of tasks assessing linguistic and cognitive abilities. All clinical groups showed more accurate performance on subject relative clauses (SRCs) than object relative clauses (ORCs). Children with dyslexia and those with comorbid dyslexia and ADHD did not differ significantly in accuracy or response latency on either SRCs or ORCs. Moreover, they demonstrated significantly lower ORC accuracy than TD controls, with the comorbid group additionally demonstrating longer SRC response latencies than TD controls. Children with ADHD also exhibited much slower response latency than TD controls, particularly for SRCs. Additionally, morphological awareness predicted relative clause comprehension across the clinical groups, whereas better verbal working memory predicted slower processing in ADHD but faster processing in the comorbid group. The observed SRC advantage aligns with the prediction of featural Relativized Minimality, where structural intervention (i.e. syntactic blocking by an intervening element) critically affects children's relative clause comprehension. The findings confirm the presence of syntactic difficulties in dyslexia and reveal novel evidence of syntactic challenges in ADHD. Morphological awareness and verbal working memory appear to play significant roles in sentence comprehension, highlighting their importance in clinical populations.

Attention-Deficit/Hyperactivity Disorder (ADHD) is frequently linked to functional impairments and deficits in executive functioning. This study investigated inter-relationships between executive functions and functional impairments among children with ADHD from a network analysis perspective to identify key domains for targeted intervention research. Children with ADHD, diagnosed using a semi-structured interview, were recruited from a pediatric hospital in China. Executive functions were assessed using the Behavior Rating Inventory of Executive Function - Parent Form (BRIEF). Functional impairments were measured using the Weiss Functional Impairment Scale-Parent Form (WFIRS-P). Network analysis was performed to examine interactions between executive functions and functional impairments, identifying central and bridge nodes through Expected Influence (EI) and bridge EI indices. Of the 225 participating children with ADHD, functional impairments ranged from 0.4% (95% CI: [0.0%, 1.3%]) for risky behavior to 15.1% (95% CI: [10.4%, 19.8%]) for self-concept. Network analysis revealed executive functions of "Monitoring" (EI = 1.11) and "Planning" (EI = 1.07) had the highest centrality values and were the most influential domains in the network model. The most influential bridge nodes linking executive function and functional impairment communities were impairments related to "Family" (bridge EI = 0.41) and the executive function, "Inhibition" (bridge EI = 0.38). This study highlighted the most influential central and bridge domains within a network model of executive functions and functional impairments among children with ADHD. Findings provide plausible hypotheses for risk factors and targeted interventions. Future research should use longitudinal designs and objective assessments to evaluate our findings further.

BACKGROUND:This study aimed to compare the effects of atomoxetine (ATX) and methylphenidate (MPH) on emotional dysregulation (ED) in children with attention deficit/hyperactivity disorder (ADHD), and to explore potential neural correlates underlying treatment-related changes. METHODS:A total of 152 children with ADHD were randomly assigned to receive ATX (n = 76) or MPH (n = 76). After individualized dose titration, participants received a stable dose for 4 weeks. Emotional lability (EL) was the primary outcome, while emotion regulation strategies, ADHD symptoms, and overall illness severity were secondary outcomes. Mixed-effects linear models were applied to examine group differences across three time points (baseline, post-titration, and endpoint). Resting-state functional MRI data were acquired at baseline and endpoint and analyzed using whole-brain functional connectivity (FC) analysis with six amygdala subregions as seeds. TRIAL REGISTRATION:ChiCTR2200062905; approved on August 23, 2022. RESULTS:In both ATX and MPH groups, EL scores decreased significantly over time (β = -1.54, p < .001), with treatment effects in a similar range and no statistically significant between-group difference (MPH: d = -1.46; ATX: d = -0.93). After controlling for ADHD symptom improvement, treatment effects remained significant (β = -0.75, p < .001), suggesting that EL improvement was not solely accounted for by ADHD symptom reduction. Increased FC between the right basolateral amygdala and left orbital middle frontal gyrus (r = -0.46, p = .043), and between the left superficial amygdala and left middle cingulate cortex (r = -0.48, p = .031), was associated with EL changes and remained significant after controlling for ADHD symptom changes. No significant changes were found in self-reported emotion regulation strategies. CONCLUSIONS:ATX and MPH both alleviate ED in children with ADHD, and these effects are not solely accounted for by improvements in ADHD symptoms. Increased amygdala-centered FC may be associated with medication-related ED improvements.

Background Adults with ADHD frequently exhibit significant emotion dysregulation (ED), including emotion impulsivity and impaired emotion regulation abilities. However, ED in ADHD is heterogeneous, and the underlying causes remain unclear. Therefore, this study aims to investigate and validate the presence of emotion regulation profiles in adults with ADHD, and further compare behavioral and neuroimaging differences across profiles. Methods A total of 497 adults with ADHD were recruited. Eight dimensions from Emotion Regulation Questionnaire and Difficulties in Emotion Regulation Scale were used for the latent profile (LP) analysis. Support vector machine classification was performed to verify the model. The internal validity was examined based on differences in emotion regulation, executive function, and brain functional connectivity (FC) of the amygdala. Treatment responses across different LPs were also analyzed. Results We identified three profiles: Well-Adapted (LP1; 29.4%), Moderately Dysregulated (LP2; 49.7%), and Severely Dysregulated (LP3; 20.9%). SVM validation achieved 97.8% accuracy. LP3 exhibited the highest symptom severity and the greatest executive function impairments. In hierarchical regression, only ED symptoms predicted membership in LP2, while comorbidity status, ADHD severity and ED predicted membership in LP3. In addition to significantly improving executive functions (particularly inhibition, shifting, and initiation) in LP3, Cognitive Behavioral Therapy (CBT) also led to marked improvements in emotion regulation strategy use. LP2 displayed weaker postcentral gyrus-amygdala connectivity compared with LP1 and LP3, which may be specific to ED in ADHD. Conclusion Our findings suggest the presence of emotion regulation subphenotypes in adults with ADHD, each with distinct neural correlates, which may help deepen the understanding of the clinical characteristics of different regulatory abilities. Therefore, these emotion regulation subphenotypes may serve as key identifiers for tailoring CBT in adults with ADHD, optimizing improvements in both cognitive and emotional domains.

Developmental dyslexia (DD) and attention-deficit/hyperactivity disorder (ADHD) frequently co-occur, yet their shared cognitive mechanisms remain unclear. Rapid automatized naming (RAN) deficits, a hallmark of both disorders, provide a critical window into the overlapping cognitive underpinnings of DD and ADHD. While previous studies usually attributed RAN deficits to generalized processing speed impairments, the multi-stimulus nature of RAN tasks necessitates a refined framework. Guided by Bundesen's Theory of Visual Attention (TVA) model, the present study dissected multiple-element processing into distinct cognitive subcomponents and examined their associations with rapid naming, reading difficulties and attentional deficits. A sample of 218 children aged 6-14 were divided into four groups: DD-only, ADHD-only, DD + ADHD, and typically developing (TD). A common RAN factor was derived via exploratory factor analysis across multiple RAN tasks. Cognitive subcomponents were quantified using a combi-TVA paradigm to computationally disentangle visual processing parameters. Three TVA subcomponents, including processing speed(C),spatial attentional weight (w), andirrelevance inhibition (α) were found to be impaired in both children with DD and those with ADHD. These impaired subcomponents uniquely contributed to RAN deficits. Furthermore, mediation analyses indicated that the deficits in TVA subcomponents appear to transmit their effects onreading and sustained attention through the bottleneck of impaired rapid naming. By adopting a parameter estimation approach, the present study advances the understanding of RAN deficits from a basic cognitive-process perspective. The findings underscore the utility of TVA-based computational modeling for identifying transdiagnostic biomarker and suggest that interventions targeting these shared cognitive bottlenecks could benefit comorbid cases.

BACKGROUND:Attention-deficit/hyperactivity disorder (ADHD) and developmental dyslexia (DD) are two prevalent neurodevelopmental disorders (NDDs) that frequently co-occur, resulting in comorbidity (COM), which is associated with significant cognitive and behavioral difficulties. These disorders are characterized by considerable clinical and neurobiological heterogeneity. The functional connectivity (FC) patterns within each disorder may consist of both individual-shared and individual-specific components. Disentangling these patterns may provide more in-depth insights into the neural mechanisms underlying these conditions. METHODS:In this study, the common orthogonal basis extraction (COBE) method was applied to the resting state electroencephalography (EEG) FC data from children with ADHD, DD, COM, and age-matched typical development (TD) controls, aiming to separate individual-shared and individual-specific FC patterns. RESULTS:Individual-specific FC could significantly predict clinical symptoms in ADHD, DD, and COM, with distinct predictive connectivity patterns across different groups. The predictive features in ADHD were primarily located in the left central and parietal regions. In DD, they involved the left temporal lobe, left parietal lobe, and right central region. In COM, they involved the left frontal lobe and the right parietal lobe. At the group level, compared with TD, individual-shared FC showed significantly enhanced posterior FC in all clinical groups. The differences in shared FC among the three clinical groups further allowed for the classification of ADHD, DD, and COM with an accuracy of 73.55%. CONCLUSIONS:By disentangling the shared and individualized components of EEG FC, this study provides novel insights into the neural organization of ADHD, DD, and their COM. The results suggest that individual-specific FC is more strongly associated with clinical symptoms, whereas shared FC captures group-level connectivity alterations and differences among clinical groups. This framework may present a promising approach for investigating biological heterogeneity in NDDs.

Background The adult attention deficit hyperactivity disorder (ADHD) Self-Report Scale (ASRS) is one of the most widely used patient-reported outcome measures (PROMs) for evaluating ADHD symptom severity and treatment-related changes in clinical trials of adults with ADHD; however, clinically important differences (CIDs) for the ASRS remain poorly defined. Aims This study aimed to review how CIDs for the ASRS have been reported in randomised controlled trials (RCTs) of adult ADHD and to establish ASRS-specific CID values for this population. Methods We first conducted a cross-sectional literature search to examine the reporting of CID values in RCTs of adult ADHD interventions. We then conducted a secondary analysis of an RCT involving 56 adults with ADHD who received either active or sham transcranial alternating current stimulation. The ASRS total score served as the PROM. An anchor-based approach using the Clinical Global Impression-Improvement scale was applied. General linear mixed-effects modelling estimated mean differences across patient-defined improvement levels to identify categorical CID thresholds.Results None of the 11 identified studies reported CID values for the ASRS as a PROM in adults with ADHD. The mixed-effects model indicated that a reduction of approximately 13.39 points in ASRS total score represents a clinically meaningful improvement (CIDwithin-group), and a reduction of 19.51 points represents substantial improvement, corresponding to reductions of 29.2% and 42.6% from the baseline, respectively. Additionally, a between-group difference of 6.13 points in ASRS total score represents a minimal clinically meaningful difference (CIDbetween-group), and a 12.25-point difference represents a moderately meaningful between-group difference. Conclusions This study provides adult-ADHD-specific CID estimates that offer practical benchmarks for interpreting treatment response and informing power calculations in future clinical trials.

Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in school-age children. Abnormal sensory–motor integration, such as concurrent visuomotor selection, is a prominent feature of ADHD. However, underlying pathophysiological substrates of impaired sensory–motor integration in childhood ADHD remain unclear. Identifying neural markers of cognitive impairment in children with ADHD is vital for the early assisted diagnosis and the selection of intervention targets. We collected electroencephalography (EEG) signals from 70 children with ADHD and 65 matched typically developing (TD) children while performing a visual search task. Oscillation-based multivariate pattern decoding was used to investigate visuomotor coordination during spatial attention. Compared with TD children, children with ADHD showed impairments in accuracy, response time, and response time variability. Multivariate machine learning revealed that the ADHD group showed deficits in alpha (visual-related) and beta (motor-related) power-based decoding accuracy, indicating the impaired sensory orienting and motor preparation. Importantly, children with ADHD exhibited a delay between alpha and beta decoding, suggesting a deficit of concurrent visuomotor coordination. However, this visuomotor asynchrony was absent in TD children. Furthermore, the degree of visuomotor asynchrony between alpha and beta decoding was predictive of behavioral impairments and symptom severity in children with ADHD. These observations reveal that impaired concurrent visuomotor coordination might be a potential neural marker of impaired sensory–motor integration in children with ADHD, further advancing the understanding of cognitive deficits, and providing potential research directions for the early diagnosis and optimization of intervention in neurodevelopmental disorders.

Children with ADHD exhibit decision-making deficits characterized by lower efficiency in evidence accumulation and a preference for smaller, sooner rewards in intertemporal choices. This study aimed to explore subtypes of ADHD in children and to investigate differences in prefrontal functional connectivity between ADHD subtypes. A total of 94 children with ADHD and 63 typically developing children matched for gender, age, and IQ were included. All participants completed TCIP and the ADHD Symptom Rating Scale, and 43 children with ADHD underwent resting-state MRI scans. A hierarchical drift-diffusion model was applied to analyze TCIP task performance, followed by second-order cluster analysis to identify decision-making subtypes. Differences in prefrontal functional connectivity among ADHD decision-making subtypes were then compared. The ADHD group showed fewer square selections in the TCIP ( p < 0.001), lower drift rates (pBayes < 0.001), and shorter non-decision times (pBayes = 0.002). The ADHD decision-making deficit subtype exhibited stronger functional connectivity between the left medial superior frontal gyrus and both the right middle frontal gyrus and the right postcentral gyrus, as well as between the right medial superior frontal gyrus and the right postcentral gyrus (all p < 0.05). Our results reveal that children with ADHD exhibit decision-making deficits during intertemporal choice, and these deficits show internal heterogeneity. Abnormal functional connectivity between the medial superior frontal gyrus and the middle frontal gyrus/postcentral gyrus may underlie these decision-making deficits.

BACKGROUND:Developmental dyslexia (DD) and attention-deficit/hyperactivity disorder (ADHD) often co-occur, but the cognitive profile of their comorbidity and the mechanisms supporting reading performance remain unclear. This study aimed to characterize cognitive profiles associated with DD, ADHD, and their comorbidity, and to determine whether different cognitive mechanisms support reading performance across diagnostic groups. METHODS:A matched sample of 200 Mandarin-speaking children was selected from a screened cohort of 2003 students, including four groups: typically developing (TD), DD-only, ADHD-only, and comorbid DD and ADHD (n = 50 per group). Participants completed assessments of reading fluency and accuracy, orthographic knowledge, phonological awareness, morphological awareness, rapid automatized naming (RAN), visual attention, and processing speed. RESULTS:Children with DD showed broad impairments in reading-related measures compared with TD and ADHD-only children. Discriminant analyses revealed that phonological and morphological awareness primarily differentiated DD, whereas non-linguistic measures distinguished ADHD. Notably, RAN uniquely differentiated comorbid DD and ADHD from DD-only, with the comorbid group showing the greatest impairment. However, regression analyses revealed a dissociation between core cognitive deficits and reading mechanisms: the contribution of RAN to reading fluency was reduced in the comorbid group, whereas morphological awareness was a stronger predictor of character reading accuracy in the comorbid group. CONCLUSIONS:These findings suggest a distinct cognitive profile in comorbid DD and ADHD, with altered RAN-reading associations and greater reliance on morphological awareness. This pattern highlights the need for assessment and intervention approaches that address both core deficits and compensatory resources.

ObjectiveBased on the "gene-brain-cognition" model, this study aimed to investigate the association between the rs4860671 polymorphism of the EPHA5 gene and attention-deficit/hyperactivity disorder (ADHD), and to analyze its impact on executive function and resting-state brain activity in affected children.MethodsThis was a case-control study. Children with ADHD attending the outpatient clinic of Peking University Sixth Hospital from 2015 to 2020 and typically developing children from general primary and secondary schools in Beijing during the same period were enrolled as subjects. Genotypes of the EPHA5 rs4860671 polymorphism were determined in both groups. Resting-state functional magnetic resonance imaging was used to assess spontaneous brain activity. In addition, the ADHD Rating Scale and the Behavior Rating Inventory of Executive Function were administered to evaluate ADHD core symptoms and executive function, respectively. Genetic association analysis, analysis of covariance, and mediation analysis were systematically performed to explore the associations of the rs4860671 polymorphism with ADHD clinical symptoms, executive function, and brain functional activity.ResultsA total of 244 children with ADHD and 83 healthy controls were included. Among them, 188 children with ADHD and 70 healthy controls completed MRI scanning. Allelic analysis revealed that the frequency of the G allele of rs4860671 was significantly higher in children with ADHD than in healthy controls (77.5% vs. 69.9%, P=0.049). Genotype distribution analysis also demonstrated a significant difference between the two groups under the dominant model (P=0.031). Regarding executive function, children carrying the GG genotype of rs4860671 had higher scores in emotion control compared with those carrying the A allele (AA+AG) (15.99±4.62 vs. 14.53±4.03, P=0.017), indicating poorer emotion regulation ability. Further mediation analysis showed that emotion control fully mediated the relationship between rs4860671 genotype and core symptoms of ADHD. Neuroimaging analysis revealed that among children with ADHD, carriers of the GG genotype exhibited decreased spontaneous brain activity in the right inferior occipital gyrus and left middle occipital gyrus compared with A allele carriers.ConclusionsThe rs4860671 polymorphism of the EPHA5 gene may be involved in the pathogenesis of ADHD by influencing emotion regulation ability and visual network functional activity. This finding provides new scientific evidence for a deeper understanding of the neurobiological mechanisms underlying ADHD.

Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterized by inattention, hyperactivity, impulsivity, emotion dysregulation, and executive dysfunction. Current treatment guidelines recommend a multimodal approach. Cognitive Behavioral Therapy (CBT) has proven effective for alleviating core symptoms, improving executive functioning, and reducing emotional comorbidities, with benefits sustained for up to one year. Dialectical Behavior Therapy (DBT), an adaptation of CBT that integrates mindfulness and emotion regulation components, has also shown potential benefits in adult ADHD populations. However, no prior studies have directly compared CBT and DBT in Chinese adults with ADHD. This trial aimed to compare the efficacy of group DBT and group CBT in adults with ADHD across multiple dimensions, with follow-up assessments extending to six months post-treatment. Ninety-eight adults with ADHD were randomly assigned to either the DBT (n = 49) or CBT (n = 49) group, and received 12 weeks of group-based intervention. Assessments were conducted at baseline (T0), weeks 4 (T1) and 8 (T2), post-treatment (T3), and at 3-month (T4) and 6-month (T5) follow-ups. Outcome measures included core symptoms (ADHD-RS), emotional symptoms (SAS and SDS), emotion regulation (DERS and ERQ), quality of life (WHOQOL-BREF), global functioning (GSES and SDS), and executive function assessed via both self-report (BRIEF-A) and laboratory-based tasks (TMT, SCWT, SST, and CPT-IP). Linear mixed models (LMM) were employed to examine group-by-time interaction effects. Both the DBT and CBT groups showed improvement over time in core ADHD symptoms and several secondary outcomes at post-treatment and follow-up. No significant group-by-time interactions were observed for core ADHD symptoms and the between-group effect sizes were small at post-treatment (d = 0.06, 95

Trait emotional intelligence（trait EI） is an important individual-difference construct, yet its resting electrophysiological correlates remain poorly specified. We tested whether trait EI was associated with frontocentral theta-beta balance in 337 Chinese undergraduates with usable resting-state EEG. Trait EI was measured with the 33-item Emotional Intelligence Scale. The primary EEG marker was the log theta/beta ratio averaged over frontocentral electrodes. Regression models controlled for age, sex, trait anxiety, depressive symptoms, and somatic anxiety; extended models added affect, emotion-regulation strategies, Big Five traits, general self-efficacy, and Raven reasoning. Higher trait EI was associated with higher frontocentral log theta/beta ratio in the primary model (β = 0.143, 95% CI [0.051, 0.235], p = .002), explaining an additional 2.0% of variance beyond internalizing symptoms. The association remained significant after Big Five adjustment (β = 0.116, p = .023) and after joint adjustment for Big Five traits, affect, and emotion-regulation strategies (β = 0.114, p = .012). Specification-curve analyses showed positive coefficients across 64 reasonable covariate specifications. The association was strongest for emotion awareness and self-management and was driven mainly by frontocentral theta/theta-beta balance rather than beta or alpha power. These findings identify a modest but reliable resting EEG correlate of trait-EI-related individual differences.

BACKGROUND:Children with inattentive attention-deficit/hyperactivity disorder (ADHD) often present with impairments in executive functions and fine motor skills in addition to core inattentive symptoms. However, evidence remains limited regarding structured telerehabilitation-based fine motor training for these outcomes. OBJECTIVE:This study aims to examine the effects of a 12-week telerehabilitation-based fine motor training program on inattention symptoms, executive functions, and fine motor skills in children with inattentive ADHD. METHODS:This randomized controlled trial included 66 children aged 6 to 10 years with inattentive ADHD. Participants were randomly assigned to a telerehabilitation-based fine motor training group (n=33) or a waitlist control group (n=33). The intervention was delivered live online 3 times per week, 60 minutes per session, for 12 weeks. Assessments were conducted at baseline, immediately after the intervention, and at the 3-month follow-up. Outcomes included parent-reported inattention symptoms, executive functions, and fine motor skills. Linear mixed-effects models were used for the primary analysis, and an exploratory mediation analysis was conducted using postintervention values at 12 weeks. RESULTS:Compared with the waitlist control group, the intervention group showed greater reductions in parent-reported inattention symptoms at 12 weeks (mean difference [MD]=-3.85, 95% CI -5.01 to -2.68; Hedges g=-1.13; P<.001) and 24 weeks (MD=-2.00, 95% CI -3.17 to -0.83; Hedges g=-0.59; P<.001). For executive functions, between-group differences favored the intervention group for inhibitory control at 12 weeks (MD=-11.62, 95% CI -19.78 to -3.46; Hedges g=-0.83; P=.006) and 24 weeks (MD=-8.88, 95% CI -17.04 to -0.72; Hedges g=-0.63; P=.03), immediate memory at both time points, and cognitive flexibility at both time points. Delayed memory showed a significant between-group difference only at 12 weeks (MD=3.03, 95% CI 0.57 to 5.49; Hedges g=0.65; P=.02). For fine motor skills, between-group differences favored the intervention group for manual dexterity at 12 weeks (MD=2.97, 95% CI 1.12 to 4.73; Hedges g=1.17; P=.001) and 24 weeks (MD=2.94, 95% CI 1.18 to 4.70; Hedges g=1.16; P=.001), and for hand-eye coordination at 12 weeks (MD=2.48, 95% CI 0.68 to 4.29; Hedges g=1.06; P=.007) and 24 weeks (MD=2.09, 95% CI 0.28 to 3.90; Hedges g=0.89; P=.02). Writing skills improved at 12 weeks but not at follow-up. An exploratory mediation analysis using week-12 postintervention values suggested a statistical indirect association through inhibitory control (β=-0.85, 95% CI -1.85 to -0.08; P=.05). However, post hoc lagged exploratory mediation analyses did not support longitudinal indirect effects through inhibitory control or other executive function outcomes. CONCLUSIONS:A 12-week telerehabilitation-based fine motor training program may be a feasible and potentially beneficial adjunctive intervention for children with inattentive ADHD. The findings suggest potential benefits for parent-reported inattention symptoms, selected executive function outcomes, and fine motor skills but should be interpreted cautiously given the waitlist control design, parent-reported symptom outcome, and exploratory mediation analysis. TRIAL REGISTRATION:Chinese Clinical Trial Registry ChiCTR2200065413; https://www.chictr.org.cn/showproj.html?proj=182412.

While Intelligence Quotient (IQ) is widely considered a linear protective factor against attention-deficit/hyperactivity disorder (ADHD), this paradigm fails to capture domain-specific nuances. We investigated whether non-linear relationships between IQ profiles and ADHD symptoms exist in a large cohort of children diagnosed with ADHD using a multidimensional dataset that integrates behavioral assessments, cognitive testing, and neuroimaging data. We examined a cohort of 5138 children aged 6–16 years diagnosed with ADHD, spanning a broad IQ range, and employed Restricted Cubic Spline (RCS) models to characterize the relationships between IQ measures [Full-Scale IQ (FIQ), Verbal IQ (VIQ), and Performance IQ (PIQ)] and core ADHD symptoms [Total scores, Inattention (IA), and hyperactivity/impulsivity subscales (H/IMP)]. This analytical framework was subsequently extended to executive function performance and brain surface area measurements to provide convergent mechanistic evidence. Latent Profile Analysis (LPA) was utilized to validate the non-linear relationship between functional impairments and IQ levels. FIQ demonstrated a linear negative association with total ADHD symptoms (β = −0.026, t = −3.27, p = 0.001). We identified a “double-edged sword” effect for IQ: while VIQ was linearly associated with lower IA scores (β = −0.015, t = −4.10, p < 0.001), it was associated with higher IMP scores (β = 0.007, t = 2.66, p = 0.008). Conversely, PIQ exhibited a dynamic developmental trajectory; the negative correlation between PIQ and IMP observed in childhood inverted into a significant U-shaped relationship in adolescence (p = 0.008). These behavioral findings were substantiated by convergent neuropsychological and neuroanatomical evidence. Finally, LPA validated a distinct “High IQ/High Impulsivity” subtype characterized by unique cognitive profiles. In conclusion, higher IQ appears to be associated with lower levels of inattention but greater impulsivity, potentially through distinct neurocognitive mechanisms. This refutes the model of IQ as a uniform protector and highlights the need to target inhibitory deficits, especially in high-IQ populations.

Attention deficit hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder. While physical exercise is a promising non-pharmacological intervention, the efficacy of integrating cognitive demands with physical activity remains underexplored. This trial compared the effects of integrated cognitive-motor exercise, aerobic exercise, and a minimal intervention on core symptoms and executive functions (EFs) in children with ADHD. In this randomized, controlled, multicenter trial, 107 children with ADHD (aged 6–10 years) were allocated to one of three groups for 12 weeks: (1) integrated cognitive-motor exercise (EG1, n = 36); (2) aerobic exercise (EG2, n = 35); or (3) wait-list control (CG, n = 36). Both EG1 and EG2 performed their respective interventions three times per week in 45-minute sessions. The primary outcomes were inattention and hyperactivity-impulsivity symptoms and EFs (inhibitory control, working memory, and cognitive flexibility). The analysis followed the intention-to-treat principle with linear mixed models. Compared with the CG, both exercise groups presented significant, comparable reductions in inattention and hyperactivity-impulsivity symptoms (all P ≤ 0.01). However, EG1 demonstrated superior improvements in specific EFs. For inhibitory control (Stroop color-word interference), EG1 resulted in a significantly greater reduction in color-word interference time than both EG2 [β = − 6.24, 95