1. Alkathiry A, Alrashed R, Alfadhly R, Al-Tannir M. Knowledge, attitude, and performance of primary healthcare physicians toward diagnosis and management of attention deficit hyperactivity disorder at PHC centers in Riyadh second health cluster, Saudi Arabia. J Family Med Prim Care;2026 (Mar);15(3):1322-1330.

BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) remains underdiagnosed and undertreated globally. Primary healthcare physicians (PHCPs) serving as critical gatekeepers for early detection and management. This study assessed the knowledge, attitudes, practices, and barriers among PHCPs regarding ADHD diagnosis and management in Saudi Arabia. METHODS: This cross-sectional study was conducted among primary healthcare physicians in the Riyadh Second Health Cluster from October to December 2024. Data were collected using a validated self-administered questionnaire. The instrument assessed demographic characteristics, ADHD knowledge (12 items), attitudes (four items), practice behaviors, confidence levels, and perceived barriers. Statistical analysis included descriptive statistics, Analysis of Variance (ANOVA), and Pearson correlations. RESULTS: Of the 325 participating PHCPs, 181 (55.7%) were male and 144 (44.3%) female, with 165 (50.8%) aged 20-29 years and 210 (64.6%) with ≤5 years of experience. The mean knowledge score was 7.92 ± 1.84 of 12, with 135 (41.5%) demonstrating good knowledge. However, only 84 (26.0%) had diagnosed ADHD cases in the past year, 19 (6.0%) had prescribed treatment, and 175 (54.0%) referred patients to specialists. The mean confidence level was moderate (2.97 ± 0.91). High barriers were reported by 194 (59.7%) physicians, with predominantly limited training (78.2%), diagnostic complexity (72.0%), and limited resources (61.5%). Seminar attendance significantly improved knowledge scores (8.11 ± 1.84 vs. 7.54 ± 1.80, P = 0.008). Significant correlations emerged between knowledge-attitude (r = 0.156, P < 0.01), diagnosis-referral behavior (r = 0.516, P < 0.001), and confidence-diagnostic experience (r = 0.258, P < 0.001). Female physicians reported significantly higher barrier scores than men (4.08 ± 1.68 vs. 3.70 ± 1.58, P = 0.034). CONCLUSION: Despite moderate ADHD knowledge among primary care physicians, significant knowledge gaps existed, with low diagnostic engagement driven by training deficits and systemic barriers. Targeted educational interventions and system-level support are essential for enhancing the primary care ADHD capacity in Saudi Arabia.

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2. Cai C, Liu R, Zhu Y, Wen Z. Effects of a 12-week mini-basketball exercise intervention on executive function in children with attention-deficit/hyperactivity disorder: a randomized controlled trial. Front Psychol;2026;17:1840290.

BACKGROUND: Executive function (EF) deficits are a core cognitive impairment in children with ADHD. While physical exercise has been shown to benefit EF, the effects of cognitively engaging, sport-based interventions remain insufficiently understood. This study examined the effects of a 12-week mini-basketball intervention on EF in children with ADHD using a randomized controlled trial design. METHODS: Thirty-five children aged 6-11 years meeting DSM-5 criteria for ADHD were randomly assigned to an exercise group (EG, n = 18) or a control group (CG, n = 17). The EG participated in a 12-week moderate-intensity mini-basketball program (3 sessions/week, 45 min/session), whereas the CG maintained usual activities. Inhibitory control (IC), working memory (WM), and global EF were assessed at baseline and post-intervention using the Childhood Executive Functioning Inventory (CHEXI). Between-group differences were analyzed using ANCOVA controlling for baseline values. RESULTS: Compared with the CG, the EG demonstrated significantly greater improvements in IC (F = 15.15, p < 0.001, partial η(2) = 0.35), WM (F = 30.55, p < 0.001, partial η(2) = 0.52), and global EF (F = 40.68, p < 0.001, partial η(2) = 0.59), all indicating large effect sizes. Within-group analyses showed significant improvements across all EF domains in the EG (all p < 0.05), with no significant changes observed in the CG. CONCLUSION: A 12-week mini-basketball intervention significantly enhanced multiple domains of EF in children with ADHD. These findings highlight the potential of cognitively engaging, sport-based exercise as an effective and feasible non-pharmacological strategy for improving executive function in this population. However, the relatively small sample size and reliance on parent-reported measures should be considered when interpreting the results.

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3. Fekih-Romdhane F, Zaouali J, Barketi A, Ghrissi F, Cheour M, Hallit S. The intermediate role of impulsive personality traits between attention-deficit/hyperactivity disorder symptoms and suicidal ideation among patients with schizophrenia. PCN Rep;2026 (Jun);5(2):e70350.

AIM: While there is a general consensus on Attention-Deficit/Hyperactivity Disorder (ADHD) serving as a possible suicide risk factor in a broad range of populations, scant research has been dedicated to addressing ADHD and suicidality in schizophrenia. Therefore, there is a pressing need for studies that clarify these connections within the context of schizophrenia. This study was designed as one of the first to explore how impulsivity may serve as an indirect mediator of the impact of ADHD symptoms on suicidal ideation in patients with schizophrenia. METHODS: This study has a cross-sectional design and was performed between January and June 2025 among Tunisian outpatients with clinically stabilized chronic schizophrenia. RESULTS: 16.9% reported a lifetime personal history of suicidal attempt(s) and 11.3% a lifetime history of self-harm. Impulsivity partially mediated the association between ADHD symptoms and suicidal ideation (indirect effect: Beta = 0.127; Boot SE = 0.033; Boot CI: 0.069; 0.196). Higher ADHD symptoms were significantly associated with greater impulsivity and directly associated with higher suicidal ideation. Additionally, higher impulsivity was significantly associated with higher suicidal ideation. CONCLUSION: The present results stress the importance of paying more attention to the expression of impulsive personality traits in patients with schizophrenia who exhibit prominent ADHD symptoms and suicidal ideation.

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4. Fu Z, Deng J, Kang S, Tian J, Cao Q, Wang Y, Qin Z, Yang L. Establishing clinically important differences in adults with attention deficit/hyperactivity disorder. Gen Psychiatr;2026 (Jun);39(3):e70030.

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 (CID(within-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 (CID(between-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.

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5. Li Y, Ma Z, Falchi W, Huang L, Chen Z, Wang H. Prediction of treatment response and adverse events in pediatric ADHD treated with acupuncture combined with conventional treatment. Complement Med Res;2026 (Jun 8):1-18.

INTRODUCTION: To develop and externally validate machine learning (ML) models for predicting treatment response and adverse events in children with attention-deficit/hyperactivity disorder (ADHD) receiving acupuncture combined with conventional first-line care. METHODS: In this multicentre retrospective study, demographic, clinical, behavioral, and laboratory data from 809 children with ADHD aged 6-12 years were used to develop and evaluate ten ML models. Treatment response was defined as a ≥30% reduction in the Swanson, Nolan and Pelham-IV total score 8-16 weeks after treatment initiation, and adverse events were recorded from parent reports. Model development used repeated 10-fold cross-validation, with evaluation in an internal testing cohort and two external cohorts. Discrimination, calibration, and clinical utility were assessed, and model interpretability was examined using SHapley Additive exPlanations. RESULTS: The extreme gradient boosting model demonstrated the best discriminative performance for predicting treatment response and was retained for further analyses. For treatment response prediction, it achieved an AUROC of 0.83 in the internal testing cohort and showed stable external performance, with AUROCs ranging from 0.78 to 0.87 across both external cohorts. For adverse event prediction, discriminative performance was moderate, with external AUROCs ranging from 0.73 to 0.85. Model interpretability analyses suggested that multiple clinical feature domains contributed to model predictions. CONCLUSION: Using routinely collected clinical data, ML-based models showed reproducible discrimination for predicting treatment response and adverse events in children with ADHD receiving acupuncture as adjunctive therapy. They may support individualized benefit-risk stratification in integrative treatment settings, although prospective assessment of clinical impact is warranted.

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6. Robaey P, Rogers MA, Schachar RJ. Advances in the management of ADHD in children and adolescents. Bmj;2026 (Jun 8);393:e082507.

This review synthesizes evidence on managing attention deficit/hyperactivity disorder (ADHD) in children and adolescents, focusing on studies published between 2019 and 2025. Recent research supports a dimensional, pleiotropic model of ADHD characterized by heterogeneity, developmental fluctuation, and frequent comorbidity. ADHD is a chronic, fluctuating condition, underscoring the need for sustained and individualized care. Diagnostic strategies favor semi-structured interviews over rating scales, with neuroimaging or biological tests offering limited diagnostic utility. Neuropsychological testing situates symptoms within broader cognitive developmental profiles. Psychosocial interventions-particularly behavioral parent training, school focused interventions, and cognitive behavioral therapy-produce small but meaningful improvements in functioning, with outcomes strongly shaped by rater, expectancy, and context. Lifestyle interventions targeting physical activity and sleep show modest adjunctive benefits. Cognitive training does not generalize beyond trained tasks, and effects on neurofeedback are predominantly non-specific and contextual. Digital tools are expanding, but few are rigorously validated. Pharmacological treatment remains central, with stimulants showing robust short term efficacy and non-stimulants providing effective second line options. Advances in titration strategies, formulation design, and pharmacogenetics support movement towards precision oriented and personalized prescribing. Overall, the evidence supports a multimodal, pragmatic approach to care aligned with current international guidelines.

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7. Shetty S, Kaikure MK, AM DC. Behavioral and oral health interaction: Evaluating ADHD symptoms, dentofacial anomalies and trauma among mouth breathing children aged 6-12 years. J Oral Biol Craniofac Res;2026 (May-Jun);16(3):101468.

OBJECTIVES: To determine the prevalence of dentofacial anomalies and the association of dental trauma and symptoms of ADHD as measured by DSM-5 criteria in a cohort of children aged 6-12 years with mouth breathing habit. METHODS: A cross-sectional study based on results of a mouth-breathing test was conducted on 109 consecutively selected children, aged 6-12 years. The children were screened for symptoms suggestive of ADHD based on the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM 5) criteria, and were referred to a pediatrician for a confirmatory final diagnosis of ADHD. Dentofacial anomalies were assessed using the ROMA Index, and the dental trauma was assessed by a single calibrated examiner. Descriptive statistics were reported as frequencies, percentages, means, and standard deviations. Chi-square test was used to assess associations between categorical variables. A p-value of <0.05 was considered statistically significant. RESULTS: Out of 109 children, 71 were males, and 38 were females. About 46.8 % of mouth breathers showed symptoms of hyperactivity, and 34.9% showed inattention. Class I malocclusion was observed in the majority of participants (84.4%), while 15.6% had Class II malocclusion. A high proportion of children exhibited increased overjet (83.5%) and lip incompetence (83.5%). The prevalence of anterior dental trauma was 15.6%. A significant association was observed between dental trauma and inattention. CONCLUSION: The present study demonstrated a high prevalence of dentofacial anomalies and ADHD symptoms among mouth-breathing children, with a statistically significant association between inattention and an increased risk of dental trauma.

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8. Young JL, Powell RN, Powell A, Welling LLM, Granata L, Saal J, Nash M, Corliss M. Real-world evaluation of attention deficit hyperactivity disorder symptoms and side effects in patients prescribed serdexmethylphenidate/dexmethylphenidate or other stimulants. Front Pharmacol;2026;17:1769333.

BACKGROUND: Serdexmethylphenidate/dexmethylphenidate (SDX/d-MPH) (Azstarys®) is an FDA-approved treatment for ADHD in patients aged 6 years and older. With its prodrug formulation, SDX/d-MPH provides rapid and sustained efficacy. METHODS: This study compared the tolerability of SDX/d-MPH with other approved extended-release (ER) stimulant medications by evaluating patient-reported side effects in a real-world sample of patients with ADHD prescribed SDX/d-MPH, lisdexamfetamine (LDX), amphetamine ER (AMP), or methylphenidate ER (MPH). Digital survey responses from 1,395 patients (age: M ± SD = 32.5 ± 14.1 years, range = 7-78 years) treated for ADHD at a single large outpatient psychiatric practice were analyzed. Patients completed the ADHD Symptom and Side Effect Tracking (ASSET) scale in digital pre-visit surveys. Analyses focused on a filtered subset of 697 surveys reflecting early treatment (≤90 days) and ER stimulant monotherapy. Multinomial logistic regressions were conducted to examine associations between side effect frequency and prescription type. Differences in side effect frequency across prescription types were examined using one-way ANOVA with Tukey-adjusted comparisons and ANCOVA controlling for age and time since treatment initiation. To account for within-patient clustering, a MANCOVA including patient as a fixed effect was conducted as a robustness check. RESULTS: Prescription type was associated with all four side effects (all p < 0.05). Logistic regression analyses indicated that insomnia (p = 0.006), end-of-dose crash (p = 0.046), and return of symptoms (p = 0.036) were associated with prescription type, although effect sizes were modest. Pairwise comparisons showed that patients taking SDX/d-MPH reported lower frequency of insomnia compared to AMP ER (p = 0.024) and LDX (p = 0.006), and lower frequency of end-of-dose crash compared to AMP ER (p = 0.046). MANCOVA found significant differences between prescription types were observed for insomnia (p = 0.036) and end-of-dose crash (p = 0.021), but not for poor appetite or return of symptoms. CONCLUSION: In this single-center retrospective analysis of patient surveys, patients with ADHD taking SDX/d-MPH reported reduced frequency of insomnia compared to AMP ER and LDX, and lower frequency of end-of-dose crash compared to AMP ER. This real-world tolerability analysis highlights the importance of considering side effects in ADHD treatment.

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