Journal of Attention Disorders最新文献

Background: Since DSM-5, ADHD has been classified as a neurodevelopmental disorder, and this placement has often reinforced dominant models that emphasize neurobiological mechanisms-treating attention as an internal trait shaped by executive dysfunction or dopaminergic imbalance. While these frameworks offer valuable insights, they often marginalize the ecological, relational, and sociomaterial contexts in which attention arises or collapses. Context is too often treated as background rather than condition.

Objective: This paper proposes a field-based reconceptualization of attention: a relational ontology in which patterns of behavior and experience gathered under the ADHD diagnosis are not solely located within the individual but emerge from dynamic tension between organism and environment.

Methods: Drawing from ecological psychology, dynamic systems theory, and phenomenological psychiatry, we develop the notion of fielded attention-a model in which attention is not a fixed trait but a modulation shaped by rhythm, affordance, and environmental curvature. We conduct a conceptual analysis in three stages: (1) critique of trait-based diagnostic frameworks that statistically neutralize context; (2) elaboration of a field ontology of attention that reframes breakdowns as ruptures in relational coherence; and (3) derivation of translational implications for research and care design.

Results: The analysis identifies an epistemic shift in which environmental and social structures are often flattened into reductionist risk factors, and heterogeneity in ADHD symptom expression is reframed as field sensitivity-a signal of developmental plasticity rather than diagnostic noise. Translational implications include the design of learning and care environments (including architectural and temporal structure) and adoption of field-sensitive research methods such as ecological momentary assessment and spatial diaries.

Conclusions: Rather than reject biological models, this framework resituates them within broader ecologies of modulation. By repositioning context as ontologically central, fielded attention advances a more ethically responsive and developmentally situated account of ADHD.

Objective: This study investigates the effectiveness of Cognitive Behavioral Therapy (CBT) for adolescents with ADHD, while focusing on gender differences and comorbid internalizing symptoms.

Method: A quantitative secondary data analysis was performed on 200 adolescents aged 12 to 18 years who participated in randomized control trials in either the Netherlands or Norway.

Results: Overall, CBT significantly reduced ADHD symptoms from pretest to posttest on parent measures; however, treatment response varied based on gender, internalizing symptoms, and treatment formats. Girls with elevated depression showed significantly smaller reductions in ADHD symptoms compared to boys with similar depressive profiles (p = .02), even after controlling for baseline ADHD severity. Effect size analyses revealed that girls benefited from both CBT delivery formats, but symptom improvement was nearly twice as large in individual CBT (d = 0.90, large effect) compared to group CBT (d = 0.49, moderate effect).

Conclusion: These findings suggest that depression may impact treatment response among girls, and that individual CBT may offer enhanced benefits for adolescent girls with ADHD.

Objective: While individual nutrients have shown effects on inflammatory mechanisms, the effects of multinutrients (vitamins + minerals, antioxidants, and amino acids) on inflammation are unknown. We investigated whether 8 weeks of multinutrient supplementation, in a randomized controlled trial of 83 children with ADHD, would alter immune factors compared to placebo.

Methods: Multiplex technology was used to measure 25 immune factors in blood samples collected at baseline and week 8. Immune factors were compared between multinutrient and placebo groups using the Mann-Whitney test. Linear mixed effects models evaluated immune factor change over time. To understand the functional relevance of the immune factors affected by multinutrient supplementation, pathway analysis was performed using the Database for Annotation, Visualization, and Integrated Discovery (DAVID) v6.7 Bioinformatics Resources.

Results: Interleukin (IL)-5 and IL-13 levels differed following multinutrient supplementation versus placebo (p = .005 and .03, respectively). IL-5 decreased by 1.3% in the multinutrient group (95% CI [-8.6%, 6.7%]) and increased by 17.5% in the placebo group (95% CI [6.9%, 29.2%]). IL-13 decreased by 11.4% in the multinutrient group (95% CI [-18.2%, -4.0%]), compared to a 2.4% increase in the placebo group (95% CI [-7.2%, 13.1%]). When comparing immune factors between treatment responders versus non-responders in the multinutrient group, there was a 4.3% increase in IL-15 in multinutrient responders (95% CI [-6.8%, 16.8%]) and a 14.3% decrease in non-responders (p = .03, 95% CI [-24.9%, -2.4%]). Pathway analysis identified T helper type 2 (Th2) signaling pathways affected by multinutrient supplementation, including IL-17 and cytokine-cytokine receptor interaction pathways.

Conclusion: Th2 immune factors may be influenced by multinutrient supplementation and associated with behavioral improvements in ADHD.

Objective: The American Academy of Pediatrics (AAP) recommends behavioral therapy as first-line evidence-based treatment for young children with ADHD, and in combination with medications for children ages 6 years and older. However, a significant percentage of young children are receiving medication treatment for ADHD rather than behavioral treatment. There is limited research capturing parent experiences of barriers to implementing behavioral health services for young children with ADHD diagnoses. This paper seeks to fill this gap by exploring these perceived barriers among parents of children diagnosed with ADHD.

Method: Parents of children with ADHD diagnoses (N = 29) were invited to participate in four focus groups to discuss their experiences with accessing treatment for their child. Focus group participants were recruited from one Southeast city through an ADHD parental support group and nationally from parents attending a conference on ADHD.

Results: Three themes emerged as perceived barriers that impact ADHD treatment. Parents reported barriers that can be conceptualized as (1) misconceptions and stigma; (2) availability of financial and time-related resources; and (3) treatment messaging and provider coordination. These barriers may be more pronounced for parents of young children with ADHD living in the Southeast.

Conclusion: Parent responses about perceived barriers in this study suggest a need for better coordinated care of ADHD across places of service, providers, and families. These findings may inform future efforts to improve access to and utilization of evidence-based treatments for ADHD in the Southeast and nationwide.

Objective: At least a third of U.S. adults with ADHD do not access recommended treatments (medication or cognitive behavioral therapy [CBT]), and those receiving treatment face barriers (e.g., inconsistent availability of medication). We investigated systemic inequities in CBT access for adults with ADHD versus psychiatric diagnoses with similar prevalence.

Method: We accessed and extracted publicly available listings from the Psychology Interjurisdictional Compact (PSYPACT) provider directory (N = 12,898) in April 2025.

Results: Only 26.4% of PSYPACT providers explicitly offer any services for adult ADHD. They were nearly three times more likely to treat adult depression (69.2%) and anxiety (74.0%). CBT for adult ADHD was offered by just 21.3% of providers.

Conclusion: U.S. psychologists are chief CBT providers for adult mental disorders; however, they systemically underserve adults with ADHD. Contributors to this inequity must be identified to advance adult ADHD care, as untreated ADHD is a costly public health burden.

Objective: To estimate the adherence of children and adults to oral stimulant ADHD treatments in Sweden during the period 2015 to 2020.

Methods: This retrospective, nationwide, register-based study evaluated all patients who were dispensed oral formulation stimulants (Anatomical Therapeutic Chemical [ATC] codes: N06BA01, N06BA02, N06BA04, N06BA12) identified in the Swedish Prescribed Drug Register. Treatment episodes were constructed based on drug dispensation data, and treatment adherence was calculated for each treatment episode using a Proportion of Days Covered approach with a modified one-pill-a-day method.

Results: Between 2015 and 2020, 158,413 treatment episodes were recorded in 128,366 patients, corresponding to a median 1.23 treatment episodes per patient. The majority of treatment episodes involved methylphenidate (64.0%), followed by lisdexamfetamine (32.2%), dexamfetamine (3.0%), and amphetamine (0.8%). Overall treatment adherence was high (78.2%), and was similar for patients receiving methylphenidate, lisdexamfetamine, and dexamfetamine. The proportion of patients with ≥80% medication adherence was high (69.3%-71.8%) for adults aged ≥25 years, but was low for adolescents aged 12 to 17 years (49.7%-52.4%).

Conclusions: The overall rates of treatment adherence are high for children and adults receiving ADHD medication in Sweden. We observed lower adherence among adolescents, which warrants further study.

Objective: This study aims to investigate the complex relation between adult ADHD symptoms, procrastination, and mediating factors, in light of leading procrastination theories: the Temporal Motivation Theory (TMT), emotion regulation, and a General Architecture for Modeling the Dynamics of Goal-Directed Motivation and Decision-Making - the GOAL architecture.

Method: The study was preregistered. A survey was conducted with 640 adults recruited online to examine the associations between ADHD symptoms, procrastination, and seven mediating factors. Participants completed measures assessing ADHD symptoms, procrastination tendencies, emotion regulation, motivation, and goal-related behaviors. Structural equation modeling (SEM) was used to test the direct and indirect pathways among the variables.

Results: A positive association was revealed between ADHD inattention symptoms and procrastination tendencies. The mediating factors that significantly contributed to this relations were sensitivity to delay, perceived low value of the task, and flexible goal adjustment. While ADHD inattention symptoms was associated with all seven variables, three variables directly contributed to increased procrastination behavior, thus explaining the link between inattention symptoms and procrastination.

Conclusions: The study highlights the relations between procrastination and adult ADHD symptoms and underscores the need to address mediating factors in intervention strategies. Understanding these mechanisms is essential for developing targeted interventions to improve functional outcomes for individuals with ADHD.

Objective: Cognitive Disengagement Syndrome (CDS) is increasingly viewed as a distinct childhood condition. Although it overlaps with ADHD in some features, emerging evidence suggests a unique behavioral and cognitive profile. However, research examining social functioning and emotion recognition in children with pure CDS remains limited.

Methods: This study compared social competence and facial emotion recognition abilities among children aged 8 to 12 years across three groups: those with elevated CDS symptoms (n = 43), those with ADHD (n = 40), and healthy controls (n = 43). Social functioning and peer relationships were evaluated using parent- and child-report social skills scales and peer interaction questionnaires. Emotion recognition was measured with the Reading the Mind in the Eyes Test (RMET).

Results: Children with CDS showed significantly lower social skills and RMET scores than both ADHD and control groups (p < .001). Teachers reported fewer school friendships for the CDS group compared to ADHD and controls (p < .001), and CDS children also reported fewer out-of-school friendships than peers in the other groups (p = .035). Both child and teacher reports noted greater peer relationship difficulties in the CDS group compared to the other groups (p < .001). Teachers also observed more solitary behavior and lower group participation among CDS children (p < .001). Within the CDS group, social skills were negatively associated with oppositionality (r = -.347) and positively associated with inattention severity (r = .346). Regression analysis identified social skills scores as independent predictors of peer relationships across the full sample (p < .001).

Conclusion: These findings suggest that children with elevated CDS symptoms experience greater social difficulties and more pronounced emotion recognition impairments than both ADHD and typically developing peers, reflecting a distinct social-cognitive profile that extends beyond overlapping ADHD symptoms. The results underscore the importance of early recognition and targeted interventions.

Objective: ADHD is a common neurodevelopmental disorder of childhood characterized by altered projections of dopaminergic neurons and connectivity issues in various brain regions. In our study, we aim to investigate the potential effects of axon guidance molecules, Netrin-1 and Semaphorins 3A, 4D, and 7A, on these connectivity problems by examining the levels of these molecules in the peripheral blood of children with ADHD compared to healthy controls.

Methods: A total of 43 children with ADHD and 40 healthy controls 6 to 12 years of age were included in the study. The K-SADS-PL was administered to exclude any additional psychopathologies (excluding ODD in the ADHD group). The Revised Child Anxiety and Depression Scale was provided to the children, while parents completed the revised Conners' Parent Rating Scale (CPRS-R), the Social Responsiveness Scale (SRS), and the Behavior Rating Inventory for Executive Functioning (BRIEF). Additionally, teachers of the ADHD group were given the Conners' Teacher Rating Scale. Furthermore, the WISC-4 was administered to assess the IQ profile of 35 children in the ADHD group.

Results: Netrin-1 was found to be statistically higher in the ADHD group. When the R-CADS scores were recalculated taking the covariate into account, the significant increase in the ADHD group remained. There was no statistically significant difference between the two groups for semaphorin 3A, 4D, and 7A. The positive correlation of Netrin-1 with the hyperactivity subscores on the CPRS-R and the Global Executive Score on the BRIEF scale is noteworthy.

Conclusion: Netrin-1 may play a role in the etiopathogenesis of ADHD. Further studies are needed to clarify the relationship between Netrin-1 and ADHD.

Objective: Learning unfolds in distinct stages-acquisition, consolidation, and maintenance-shaped by cognitive mechanisms such as saliency processing, interference control, and sustained attention. ADHD in adults is associated with deficits in these cognitive processes, which in turn might lead to learning difficulties.

Method: Using a novel protocol that incorporates a visual attention task with gestalt-image targets and primer distractors, we investigated these cognitive mechanisms across different stages of learning in 53 adults diagnosed with ADHD and 18 neurotypical Controls.

Results: Our findings reveal that adults with ADHD exhibit reduced neural activations in the occipital and parietal areas, indicating diminished bottom-up visual processing and challenges in handling distractions. Nevertheless, individuals with ADHD demonstrate increased frontal activity in the late stages of visual processing, suggesting compensatory mechanisms employed by the group. Behaviorally, both groups achieve comparable performance, though ADHD participants do so at the expense of greater variability and attentional lapses. Furthermore, while Controls reach the plateau already after the acquisition phase, the ADHD group is gradually improving its performance throughout the experiment.

Conclusion: These findings demonstrate that adults with ADHD can acquire and retain new skills but do so through different-and usually more effortful-pathways. By mapping neural and behavioral dynamics onto learning stages, this study offers a more nuanced framework for learning in ADHD and supports the development of phase-specific intervention strategies.