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).

Uptake into psychiatry remains modest in many medical education systems, potentially related to limited curricular integration. We implemented an organ-system–based psychiatry module to improve relevance and engagement, evaluating medical students’ satisfaction and subsequent specialty choice. This study was conducted in Peking University’s 8-year clinical medicine program, in which students enter directly after high school, study psychiatry in Year 3, and in Year 6 select their specialty for standardized residency training. Four consecutive Year-3 cohorts exposed to the reformed psychiatry module (entering classes of 2019–2022) completed an anonymous 15-item post-course questionnaire (4-point Likert scale) covering Teaching Content, Teaching Methods, Course-related Learning Outcomes and Personal Growth. Internal consistency was assessed using Cronbach’s α, and student satisfaction was summarized as mean domain scores with item-level percentages. Between-cohort differences were tested using Welch’s ANOVA with Games–Howell post-hoc comparisons. For specialty choice, administrative records were used to compare the proportion of students selecting psychiatry in Year 6 before (Classes of 2014–2018) versus after the reform (Classes of 2019–2020). Specialty choice data are available only for the Classes of 2019–2020. Of 655 eligible students, 502 completed the survey (76.6

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.

This study aimed to investigate factors sustaining interest of Chinese residents in child and adolescent psychiatry (CAP), identify barriers to specialization, and determine how residency training experiences shape career choices, addressing critical workforce shortages in child and adolescent mental health services (CAMHS). A multi-site online survey was conducted among psychiatry residents in China to examine their interest in CAP before residency training, track its changes during training, and identify factors influencing these attitudes. Among the 230 psychiatry residents who responded (response rate = 54.76

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

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.

Objective The study aimed to explore factors influencing Chinese medical students' career choices, especially in choosing child and adolescent psychiatry (CAP) as their specialty. Method A 23-item online survey was conducted among third-year medical students at Peking University Health Science Center to explore the factors currently influencing their career choices, as well as their preferences and factors that influence the choice of CAP as a career specialty. Their preferences for CAP-focused curricula were also surveyed. Results Of the 169 students surveyed, 149 (88.17%) responded. Over 80% of the students began contemplating their future career choices, even before their undergraduate studies commenced. Sixty (40.27%) students showed moderate to high interest in CAP, and the top three factors that rendered CAP most attractive included interest in helping society (58.33%), having opportunities to work with children and adolescents (56.67%), and working in an interesting field (53.33%). The primary obstacle to choosing CAP as a specialty was the burden of working with patients and their parents (70.79%). Among the students interested in CAP, 85.00% were interested in engaging with CAP through clinical internships and practical training. Curricula related to psychotherapy, consultation liaison, and psychopharmacology were identified as the most attractive areas. Conclusions Positive attitudes toward CAP were found among the responders. To better align with the career development needs of medical students and promote workforce development in the CAP specialty, early career exposure to CAP, such as encompassing clinical clerkships, specialized internships, and interdisciplinary education, should be given more consideration in undergraduate curriculum systems.

Objective:This study aimed to elucidate the characteristics of executive function deficits in children with Attention-deficit/hyperactivity disorder (ADHD) comorbid with developmental dyscalculia (ADHD+DD). Methods:Three groups of Chinese children (n = 637) aged from 6 to 16 years were included in this study. Initially, a between-group comparison on both performance-based and scale-based executive function was conducted, controlling for age, Raven score, and gender. Partial correlation analysis and regression analysis were then used to investigate the association between executive function, ADHD symptoms, and arithmetic ability. Furthermore, logistic regression analysis and path analysis were used to differentiate the effect of executive functions on ADHD without developmental dyscalculia (ADHD-DD) and ADHD+DD. Results:Both ADHD groups had more severe executive function impairment than the control group. Compared with the ADHD-DD group, the ADHD+DD group performed worse in performance-based executive functions but similar in scale-based executive functions. ADHD-DD and ADHD were differentiated by inhibition (odds ratio (OR) = 2.00, 95% CI = 1.42; 2.81) and processing speed (OR = 0.90, 95% CI = 0.84; 0.97). In terms of symptom dimensions, verbal working memory had an effect on ADHD symptoms and complex subtraction (pIna = 0.006, pHI = 0.018, pCS = 0.002), processing speed (pIna = 0.002, pCS = 0.001) and working memory factors influenced inattention and complex subtraction (pIna < 0.001, pCS = 0.001), and inhibition (p = 0.004) and cognitive flexibility (p = 0.013) contributed uniquely to complex subtraction. Conclusion:Individuals with ADHD+DD exhibit multiple executive function deficits, with inhibition and processing speed being potential etiological factors. Verbal working memory, processing speed, and working memory factors are shared executive function deficits for ADHD symptoms and arithmetic ability. Cognitive flexibility and inhibition are specific risk factors for arithmetic ability.

Introduction Emotional disorders are highly prevalent among adolescents, with a high rate of comorbidity. Convenient and effective treatment options are needed to reduce costs and improve effectiveness. The unified protocol for transdiagnostic treatment of emotional disorders in adolescents (UP-A) is an evidence-based transdiagnostic approach aimed at ameliorate emotional symptoms. The objective of this study is to assess the efficacy of the UP-A in Chinese adolescents with emotional disorders using multidimensional evaluations.Methods and analysis This study is a two-armed, randomised controlled trial on the efficacy of 12 week UP-A on adolescents with emotional disorders along with their parents. Forty-eight participants will be randomly assigned to either the treatment as usual (TAU) group or the TAU combined with UP-A (UP-A+TAU) group. We will evaluate the efficacy of the UP-A, through the following primary and secondary outcomes: emotional disorder severity, emotional symptoms, emotion regulation, cognitive patterns, executive function, resilience, quality of life, social and family functioning. Participants will be assessed at baseline (T1), week 4 (T2), week 8 (T3), post-treatment (T4) and 3 month follow-up (T5).Discussion This protocol outlines the first randomised controlled trial investigating the efficacy of the UP-A among Chinese adolescents with emotional disorders. The findings may contribute to providing an effective and feasible transdiagnostic intervention in Chinese clinical settings.Ethics and dissemination This trial has been approved by the Ethics and Clinical Research Committees of Peking University Sixth Hospital and will be performed under the Declaration of Helsinki with the Medical Research Involving Human Subjects Act (WMO). The results will be disseminated in a peer-reviewed journal and a conference presentation.Trial registration number ChiCTR2300069354.

The workforce shortage in child and adolescent psychiatry (CAP) in China greatly restricts patients’ access to child and adolescent mental health services (CAMHS). Implementing CAP training within general or adult psychiatry programs may offer a viable solution; however, such programs are underdeveloped in China. The aim of this study was to gather empirical evidence regarding CAP training needs within Chinese psychiatry residency programs. An exploratory survey was administered online to psychiatry residents and their mentors to assess the application of CAP in clinical practice, satisfaction with existing CAP training, and attitudes towards the expansion of such training. The data were analysed using descriptive statistics, the Mann‒Whitney U test, the t-test, and the χ2 test to explore demographic differences and responses. A total of 230 residents (response rate = 54.76

BACKGROUND:Attention-deficit hyperactivity/impulsivity disorder (ADHD) commonly co-occurs with sensory processing (SP), autistic traits (ATs), and oppositional defiant disorder (ODD). Our aim is to explore the relationships among SP, ADHD symptoms, ATs, and ODD symptoms in a large sample of children with ADHD and elucidate the potential role of sensory dysfunction in ADHD comorbidity patterns using symptomatic network analyses. METHODS:A total of 2676 children with ADHD aged 6 to 11 years were recruited from Peking University Sixth Hospital. For all subjects, the ADHD symptom severity was rated using the ADHD Rating Scale, ODD symptom severity using the related items in the Children's Clinical Diagnostic Interview Scale, SP symptom severity using the Child Sensory Integration Scale, and ATs using related items in the CBCL. R 4.2.1 packages including mgm, qgraph, and bnlearn were used for network analysis. RESULTS:In the Graphical Gaussian Model (GGM), the SP items were connected with ATs and ADHD core symptoms and positioned relatively high in the directed acyclic graph (DAG). ATs_S, located higher in the DAG, played an important role in communication in the network as a node for SP and ODD to exert their influence on ADHD, and ADHD items were downstream nodes seemingly dependent on SP nodes and ATs_S in the network. CONCLUSIONS:SP may be fundamental to the complex manifestations in children with ADHD, especially given its close relationship with ATs profiles. ATs_S might play an essential role in communication in this symptomatic network. These findings may help clarify possible relationships of different symptoms in ADHD and provide potential targeted interventions to improve core symptoms of ADHD as well as ATs and ODD symptoms. CLINICAL TRIAL NUMBER:Not applicable.

BACKGROUND:An efficient and accurate diagnosis of MDD in adult ADHD is highly significant. Central symptoms identified through network analysis are considered to play a key role in diagnosis, potentially contributing to the achievement of this goal. METHODS:ADHD and MDD symptoms were assessed using the ADHD Rating Scale and Zung Self-Rating Depression Scale (SDS) in a clinical cohort of 418 adults with ADHD, followed by network estimations. Symptoms with high expected influence (EI) in the network were identified as central symptoms and tested for diagnostic validity via ROC curve analysis. Imaging analyses were further adopted to verify the effectiveness of the identified central symptoms from the perspective of construct validity. RESULTS:A five-symptom model was identified, including: "Depressed affect," "Personal devaluation," "Emptiness," "Agitation," and "Interest loss." The model exhibited strong diagnostic validity for MDD in adult ADHD, showing no significant difference compared to using all 20 SDS items. Moreover, significant functional alterations were detected in the left anterior cingulate cortex between groups classified by this model. CONCLUSION:A five-symptom model comprising "Depressed affect," "Personal devaluation," "Emptiness," "Agitation," and "Interest loss" showed strong diagnostic validity for MDD in adult ADHD, and proven effective in exploring its underlying neural mechanisms. These symptoms should be considered a priority in diagnosing MDD in adults with ADHD.

Background: Working memory (WM) impairments and inattention symptoms are prevalent among adults with attention-deficit/hyperactivity disorder (ADHD). Transcranial photobiomodulation (tPBM) is a promising brain stimulation technique that may enhance cognitive function among adults with ADHD. Objectives: We aimed to explore the effects of tPBM on improving N-back WM and Continuous Performance Test-Identical Pairs (CPT-IP) attention tasks in adults with ADHD, as well as its baseline predictive factors. Methods: Forty-eight adults with ADHD underwent a 7-day tPBM intervention (720 s daily, 1064-nm wavelength, 250 mW/cm2 irradiance). Participants completed the N-back (1-back, 2-back, 3-back) WM, and CPT-IP (cpt-2, cpt-3, cpt-4) attention tasks at baseline (T1), after the first (T2), and seventh (T3) interventions, and during four weekly follow-ups (T4-T7). Safety was assessed using the Treatment Emergent Symptom Scale (TESS). Results: The participants showed significant improvements in the 2-back, 3-back, cpt-3, and cpt-4 tasks (all p < 0.001), with peak effect sizes observed at 2-3 weeks post-intervention (Cohen's d = 0.84-1.26). Lower baseline performance predicted greater improvement. The intervention was well-tolerated; three (6.3%) participants reported mild adverse events (TESS scores ≤2), all of which resolved spontaneously. Conclusions: tPBM is effective and well-tolerated for improving WM and attention in adults with ADHD, suggesting its potential use as a non-pharmacological approach for ADHD management.

BACKGROUND:Integrating neuroimaging genetics data may enhance the diagnosis and understanding of adults with attention-deficit/hyperactivity disorder (ADHD). Here, we employed a population-based graph convolutional network (GCN) model based on multimodal data for predicting adults with ADHD, and performed downstream analyses to elucidate the related pathophysiology. METHODS:Functional MRI and genomics data were collected from 258 adults with ADHD and 243 controls. Multimodal data were fused and trained via an Edge-Variational Graph Convolution Network. Through sensitivity analysis, functional connectivity (FC) and single nucleotide polymorphisms contributing to ADHD were identified and validated by correlating them with clinical manifestations. Downstream association analyses, which included GWAS and transcriptome-neuroimaging association analyses, were conducted to explore the genetic components linked to imaging alterations. RESULTS:Our model achieved an accuracy of 73.55 %, outperforming the other prediction methods. Among the most salient FC, FC between the bilateral precuneus (PCun) and left parahippocampal gyrus as well as right hippocampus were correlated significantly with ADHD core symptoms. Key hubs particularly the left PCun were identified from the salient FC, whose topological properties were associated with hyperactivity/impulsivity and inhibitory control deficits. Notably, deficient PCun-based FC exhibited relations with genetic variants of KDM1A and HSPG2, and with expression profiles of MDGA1. CONCLUSION:These findings highlight the effectiveness and interpretability of the multimodality-based deep learning in discriminating adults with ADHD. Functional alterations in PCun and related genetic profiles may play an important role in adults with ADHD.

Background: Cognitive behavioral therapy (CBT) is an effective treatment for adults with attention-deficit/ hyperactivity disorder (ADHD), but its use is limited by poor accessibility and time constraints-barriers that internet-based CBT (iCBT) may help overcome. This trial aimed to explore the short- and long-term efficacy of iCBT in medicated adults with ADHD. Methods: Eighty-six adults with ADHD were randomized into two groups: the iCBT combined with medication group (iCBT+M, n = 43) and the medication-only group (n = 43). The iCBT+M group received 12 weeks of iCBT with ongoing medication, while the medication-only group continued with medication alone. The primary outcome was the change in ADHD symptoms. Secondary outcomes included emotional symptoms, executive function, quality of life, and global functioning. Outcomes were assessed at baseline, post-treatment (T1), 6month (T2), and 12-month follow-up (T3). Mixed linear models were used to assess the differences in outcomes between the two groups at each follow-up point. Results: Compared to the medication-only group, the iCBT+M group showed greater improvements in ADHD symptoms (d = 0.50 at T1/T2, 0.59 at T3), executive function (d = 0.87 at T1, 0.49 at T2, 0.25 at T3), quality of life (d = -0.74 at T1, -0.59 at T2, -0.28 at T3), global functioning (d = 0.66 at T1, 0.85 at T2, 0.42 at T3), and anxiety (d = 0.43 at T1). Conclusion: iCBT interventions may benefit medicated adults with ADHD by improving core symptoms, executive function, quality of life, and overall functioning, with effects sustained for 12 months.

Abstract Background The Quick Delay Questionnaire (QDQ) is a short questionnaire designed to assess delay-related difficulties in adults. This study aimed to examine the reliability and validity of the Chinese version of the QDQ (C-QDQ) in Chinese adults, and explore the ecological characteristics of delay-related impulsivity in Chinese adults with attention-deficit/hyperactivity disorder (ADHD). Methods Data was collected from 302 adults, including ADHD (n = 209) and healthy controls (HCs) (n = 93). All participants completed the C-QDQ. The convergent validity, internal consistency, retest reliability and confirmatory factor analysis (CFA) of the C-QDQ were analyzed. The correlations between C-QDQ and two laboratory measures of delay-related difficulties and Barratt Impulsiveness Scale-11 (BIS-11), the comparison of C-QDQ scores between ADHD subgroups and HCs were also analyzed. Results The Cronbach’s α of C-QDQ was between 0.83 and 0.89. The intraclass correlation coefficient of C-QDQ was between 0.80 and 0.83. The results of CFA of C-QDQ favoured the original two-factor model (delay aversion and delay discounting). Significant positive associations were found between C-QDQ scores and BIS-11 total score and performance on the laboratory measure of delay-related difficulties. Participants with ADHD had higher C-QDQ scores than HCs, and female ADHD reported higher scores on delay discounting subscale than male. ADHD-combined type (ADHD-C) reported higher scores on delay aversion subscale than ADHD-inattention type (ADHD-I). Conclusion The C-QDQ is a valid and reliable tool to measure delay-related responses that appears to have clinical utility. It can present the delay-related impulsivity of patients with ADHD. Compared to HCs, the level of reward-delay impulsivity was higher in ADHD.

Background The long-term effectiveness of cognitive behavioural therapy (CBT) in medicated attention-deficit/hyperactivity disorder (ADHD) adults with residual symptoms needs to be verified across multiple dimensions, especially with respect to maladaptive cognitions and psychological quality of life (QoL). An exploration of the mechanisms underlying the additive benefits of CBT on QoL in clinical samples may be helpful for a better understanding of the CBT conceptual model and how CBT works in medicated ADHD. Methods We conducted a secondary analysis of a randomised controlled trial including 98 medicated ADHD adults with residual symptoms who were randomly allocated to the CBT combined with medication (CBT + M) group or the medication (M)-only group. Outcomes included ADHD-core symptoms (ADHD Rating Scale), depression symptoms (Self-rating Depression Scale), maladaptive cognitions (Automatic Thoughts Questionnaire and Dysfunctional Attitude Scale), and psychological QoL (World Health Organization Quality of Life-Brief Version-psychological domain). Mixed linear models (MLMs) were used to analyse the long-term effectiveness at one-year follow-up, and structural equation modeling (SEM) was performed to explore the potential mechanisms of CBT on psychological QoL. Results ADHD patients in the CBT + M group outperformed the M-only group in reduction of ADHD core symptoms ( d = 0.491), depression symptoms ( d = 0.570), a trend of reduction of maladaptive cognitions ( d = 0.387 and 0.395, respectively), and improvement of psychological QoL ( d = − 0.433). The changes in above dimensions correlated with each other (r = 0.201 ~ 0.636). The influence of CBT on QoL was mediated through the following four pathways: 1) changes in ADHD core symptoms; 2) changes in depressive symptoms; 3) changes in depressive symptoms and then maladaptive cognitions; and 4) changes firstly in depressive symptoms, maladaptive cognitions, and then ADHD core symptoms. Conclusions The long-term effectiveness of CBT in medicated ADHD adults with residual symptoms was further confirmed. The CBT conceptual model was verified in clinical samples, which would be helpful for a deeper understanding of how CBT works for a better psychological QoL outcome. Trial registration ChiCTR1900021705 (2019-03-05).