1. Andrew LM, Zhang I, Saldana L, Santoro B, Lohman N, Ryee MY, Gestricht-Thompson W, Russo K, Willing L, Saleh A. Developing a Novel Coding System for Retrospective Chart Review of Attention-Deficit/Hyperactivity Disorder, Anxiety, and Medication Adherence in Pediatric Psychiatry. J Child Adolesc Psychopharmacol. 2026: 10445463261436795.

OBJECTIVES: Pediatric mental health prevalence rates have increased in recent years, while gaps remain in the number of available providers. Ongoing evaluation and understanding of treatment progress and engagement are critical to psychiatric care, and these details are often documented in the electronic health record (EHR). Given the utility of retrospective chart review (RCR) as a tool for psychiatrists, we developed a coding system examining common comorbid conditions (anxiety and attention-deficit/hyperactivity disorder [ADHD]) and adherence and evaluated interrater reliability. METHODS: We created a coding system with a comprehensive manual and coding instructions that explore both symptom severity domains (anxiety, ADHD, and global) and adherence to medication. Codes were rated using Likert scales, and two independent raters coded all data. RESULTS: RCR was completed for 142 patients with a total of 1139 visits over 2 years. Weighted linear kappa statistics ranged between 0.77 and 0.95, and weighted quadratic kappa statistics ranged between 0.74 and 0.96, suggesting substantial to almost perfect agreement. Interrater agreement was highest for anxiety severity. CONCLUSIONS: We created a novel coding system for RCR and found substantial to almost perfect interrater reliability for assessing ADHD severity, anxiety severity, global severity, and medication adherence using psychiatry encounter notes documented in an EHR. Our coding system explores conditions that are often heterogeneous and have waxing and waning presentations, using a continuum that captures the complexity of symptoms. Future directions include utilization of coding systems to explore emotion and behavior change over time to optimize treatment.

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2. Arı P, Büber A, Şenol H. Disruptive behavior in preschoolers: associations with attention deficit hyperactivity disorder and parental psychopathology. BMC Psychiatry. 2026.

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3. Currie J, Malinovskaya A. Manufacturing Supply Chains and Imports in the ADHD Drug Shortage. JAMA Health Forum. 2026; 7(3): e260041.

IMPORTANCE: The US has faced a nationwide shortage of attention-deficit/hyperactivity disorder (ADHD) medications since 2022, yet the underlying causes remain unclear. Public debate has largely centered on prescribing trends and Drug Enforcement Administration (DEA) quotas, although evidence suggests that quotas were not binding. A sound policy response requires a clear understanding of the drivers behind the shortage. OBJECTIVE: To examine descriptive evidence on the potential causes of the shortage. SETTING AND DESIGN: In this economic evaluation, we use time series data (2015-2025) from multiple sources, such as Symphony Health and the DEA’s Automation of Reports and Consolidated Orders System (ARCOS) summary reports, to characterize US production, consumption, and trade of amphetamine-based and other stimulants, including manufacturer-level production volumes, before and during the shortage period. FINDINGS: The sharp, simultaneous production cutbacks across several medium-sized and smaller manufacturers in late 2022 and early 2023 coincided with a steep contraction in US imports of raw amphetamines and more modest declines in phenylacetone, a key precursor. CONCLUSIONS AND RELEVANCE: These patterns align with manufacturers’ reports to the US Food and Drug Administration citing a shortage of the active ingredient as the cause of backorders. More broadly, this economic evaluation reframes the discussion of ADHD medication shortages beyond DEA quotas, highlighting the vulnerability of US pharmaceutical manufacturing to international supply chain disruptions and underscoring the need for policies that strengthen supply chain resilience.

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4. Dutta D, Keeney M, Matthews N, Peron K, Alali A, Martinez AF, McGivern B, Boring C, Smith SC, Garg R. Clinical manifestations of chromosome 19p13.11 duplication. J Med Genet. 2026; 63(4): 235-43.

BACKGROUND: Chromosome 19 is the most gene-dense chromosome in the human genome, with a high frequency of segmental duplications that predispose it to genomic rearrangements. While deletions of chromosome 19 have been associated with various clinical conditions, duplications remain poorly characterised. Here, we report three cases involving 19p13.11 duplication and describe the associated clinical phenotype. METHODS: We describe three unrelated individuals with microduplications at 19p13.11 identified either via clinical whole-exome sequencing or chromosomal microarray. The probands underwent detailed clinical genetic evaluations, and CNVs were confirmed with parental testing when available. Sequencing reads were aligned to the GRCh37/hg19 human genome build. RESULTS: All three probands exhibited neurodevelopmental delays, attention-deficit/hyperactivity disorder and speech delay. Additional overlapping features included joint hypermobility, short stature and craniofacial anomalies. Patient-specific manifestations included haematological abnormalities, musculoskeletal asymmetries and cardiac findings. Duplicated regions spanned 1.2-1.6 Mb and encompassed 41-49 protein-coding genes. Patients 2 and 3 have CNVs that overlap 76% with those of Patient 1. Several genes have predicted high triplosensitivity scores and are associated with autosomal dominant neurodevelopmental and skeletal disorders. Patient 1, with the largest duplication, had more extensive systemic involvement, likely reflecting the broader gene dosage effect. CONCLUSION: This is the first comprehensive clinical and molecular characterisation of 19p13.11 duplications, suggesting a recurring multisystem phenotype driven by gene dosage sensitivity. These findings support the inclusion of 19p13.11 duplications in diagnostic evaluations for neurodevelopmental and multisystem disorders.

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5. Ermis C, Tanskanen A, Corbeil O, Lieslehto J, Vieta E, Correll CU, Mittendorfer-Rutz E, Tiihonen J, Taipale H. Reduced risk of cause-specific hospitalisations and all-cause hospitalisation/mortality during treatment with attention-deficit/hyperactivity disorder medications in the course of bipolar disorder: a Swedish registry-based within-subject cohort study. BMJ Ment Health. 2026; 29(1).

BACKGROUND: Comorbid attention-deficit/hyperactivity disorder (ADHD) increases the burden in bipolar disorder (BD). Concerns about the risk/benefit balance of ADHD treatment have been raised. OBJECTIVE: This study aimed to investigate the association between hospital admissions and add-on ADHD medications to antipsychotics and/or mood-stabilisers (APs/MSs) compared with AP/MS alone in BD. METHODS: Individuals with BD prescribed ADHD medications in Sweden during 2006-2021 were identified from national registers of inpatient care, specialised outpatient care, sickness absence and disability pension. ADHD treatment was defined as stimulants (mostly methylphenidate and lisdexamfetamine, rarely amphetamine, dexamphetamine) and non-stimulants (atomoxetine, modafinil). Add-on ADHD treatment to concomitant AP/MS was compared with treatment periods with AP/MS without ADHD treatment, using within-individual models where individuals acted as their own control. Adjusted HRs (aHRs) and CIs (95% CIs) were calculated for the primary outcome of psychiatric hospitalisation, and for the secondary outcomes: substance-use-related, somatic or mania-related hospitalisations, and all-cause hospitalisation/mortality. RESULTS: Altogether, 17 971 individuals (mean age=32.0±11.6 years, males=37.6%, ADHD=88.9%, follow-up=8.9±4.4 years) with BD who used any ADHD treatment were included. compared with the use of AP/MS alone, add-on stimulant use was related to a lower risk of psychiatric hospitalisations (aHR=0.89, 95% CI 0.85 to 0.93), substance-related hospitalisations (aHR=0.75, 95% CI 0.70 to 0.81) and all-cause hospitalisations/mortality (aHR=0.90, 95% CI 0.87 to 0.93), but was not associated with increased risk for somatic (aHR=1.00, 95% CI 0.90 to 1.12) or mania-related hospitalisations (aHR=0.93, 95% CI 0.72 to 1.20). Of commonly used specific ADHD medications, add-on lisdexamfetamine (aHR=0.81, 95% CI 0.75 to 0.87) and methylphenidate (aHR=0.92, 95% CI 0.88 to 0.97) were associated with decreased risk of psychiatric hospitalisations while add-on atomoxetine was not. Findings on substance-use-related hospitalisations were significant only for stimulants, specifically lisdexamfetamine (aHR=0.70, 95% CI 0.61 to 0.79) and methylphenidate (aHR=0.80, 95% CI 0.74 to 0.86). CONCLUSIONS: Among individuals with BD who received ADHD medications, add-on lisdexamfetamine and methylphenidate were associated with lower risks of psychiatric and substance-use-related hospital admissions, compared with AP/MS use alone. No significant association was found between ADHD medication use and mania-related hospitalisations or somatic admissions when these medications were used together with AP/MS. Larger samples are needed to reach adequate statistical power and conclusive findings on atomoxetine, dexamfetamine and modafinil. CLINICAL IMPLICATIONS: The findings of this study suggested that the treatment of comorbid ADHD could be considered after adequate mood-stabilisation in patients with BD.

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6. Fitzpatrick CM, McGirr JC, Petersen A, Rickhag M, Gether U, Andreasen JT. Impulsivity and attentional dysfunction in DAT-AAA knock-in mice. Prog Neuropsychopharmacol Biol Psychiatry. 2026; 145: 111630.

Aberrant dopaminergic signaling is implicated in the core symptoms of attention deficit hyperactivity disorder (ADHD), including dysregulated attention, impulsivity, and hyperactivity. In a mouse model with disrupted scaffolding motif of the dopamine transporter (DAT-AAA), we previously reported extensive loss of DAT expression in striatum, resulting in locomotor hyperactivity, dysfunctional reward-driven motivation, and attenuated behavioral response to amphetamine compared to wildtype (WT) controls. Here, we investigated attention and impulsivity in DAT-AAA mice using the 5-choice serial reaction time task (5-CSRTT). Baseline task acquisition was established using a 2-s stimulus duration (SD) and fixed 5-s intertrial interval (ITI). A variable SD probe (0.2-1.8 s with fixed 5-s ITI) was then used to challenge attentional performance and enable Theory of visual attention (TVA)-based modeling. Finally, a variable ITI schedule randomized to 5-, 10-, or 15-s ITI with fixed 2-s SD for 15 consecutive training days probed impulsive action. Training revealed higher rates of premature responding (p < 0.05) in DAT-AAA mice, a finding confirmed in the variable ITI challenge (p < 0.05). DAT-AAA mice demonstrated inattention (p < 0.001) in the variable SD test, and TVA-based modeling revealed a specific deficit in visual processing speed (p < 0.01). Finally, increased anxiety-related behavior was seen in the open field test. These preliminary findings suggest that reduced DAT expression in striatal terminals is associated with inattentive and excessive impulsive behaviors, supplementing our previously reported locomotor hyperactivity finding. The DAT-AAA mouse therefore shows face validity in terms of inattention, impulsivity, and hyperactivity, and may be a new model to study the neurobiology of ADHD.

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7. Kayış H, Gedizlioğlu Ç. Leveraging point-of-view camera and MediaPipe for objective hyperactivity assessment in preschool ADHD. Front Psychiatry. 2026; 17: 1769322.

BACKGROUND: Attention-Deficit/Hyperactivity Disorder (ADHD) often emerges in early childhood, with hyperactivity and impulsivity constituting the most prominent symptoms during the preschool period. Current assessment approaches rely largely on clinical interviews and behavior rating scales, which are susceptible to subjectivity and contextual bias. Objective, ecologically valid, and low-burden methods for quantifying hyperactivity in preschool settings remain limited. METHODS: This observational, cross-sectional study investigated whether movement-based features extracted from teacher-worn point-of-view (POV) video recordings could differentiate preschool children at risk for ADHD-related hyperactivity from non-hyperactive peers. Fifty-one preschool children (48-60 months) participated in a standardized, three-minute storytelling interaction conducted in a familiar classroom environment. Video recordings were processed using MediaPipe pose estimation to derive region-specific movement indices across multiple body segments. Group differences were examined using statistical analyses. In addition, supervised machine learning models were applied to evaluate classification performance based on movement features. RESULTS: Children in the hyperactivity-risk group exhibited significantly greater movement across several body regions, particularly distal upper- and lower-limb segments, compared to non-hyperactive peers. Machine learning analyses indicated promising classification performance, with the support vector machine achieving an accuracy of 84.31%, sensitivity of 80.0%, specificity of 87.10%, and an area under the receiver operating characteristic curve (AUC) of 0.83. Permutation-based feature importance analyses highlighted distal limb movements as the most informative features for classification. CONCLUSIONS: These findings suggest that POV-based, vision-driven assessment provides a promising, objective, and ecologically valid approach for quantifying hyperactivity-related motor behavior in preschool children. While not intended as a standalone diagnostic tool, this low-burden framework may serve as a valuable complement to existing screening practices and support early identification efforts in educational settings.

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8. Merzon E, Israel A, Salminis-Linzen S, Magen E, Geishin A, Vinker S, Green I, Golan-Cohen A, Ashkenazi S, Faraone SV, Weizman A, Manor I. The association between inflammatory markers in routine blood counts at 1 year and attention-deficit/hyperactivity disorder (ADHD): A case-control study. J Child Psychol Psychiatry. 2026.

BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) is a chronic neurodevelopmental disorder marked by persistent patterns of inattention, disorganization, hyperactivity, and impulsivity. Increasing evidence implicates immune-inflammatory processes in its etiology, with observed associations between ADHD and infectious diseases, allergic conditions, and recent findings involving SARS-CoV-2. This study investigated whether early-life inflammatory markers, as measured by routine complete blood counts (CBCs) in clinically healthy 1-year-old children, were associated with subsequent diagnoses of ADHD. METHODS: A retrospective case-control study was conducted using electronic medical records from Leumit Health Services, encompassing children under 18 years between January 1, 2006, and June 30, 2021. The sample included children who underwent routine CBC testing at age one during a well-child visit, without signs of acute illness. ADHD cases were identified based on ICD-9/10 criteria. Controls, free of any ADHD diagnosis, were randomly selected at a 1:2 ratio and matched for age, sex, socioeconomic status, and cultural sector. Analyses included white blood cell (WBC) subtypes and platelet counts, with the calculation of the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR). RESULTS: Children who were subsequently diagnosed with ADHD demonstrated statistically significant elevated total WBC counts at age one, including higher neutrophil, eosinophil, and lymphocyte levels, and lower basophil counts compared to matched controls (all p < .05). No significant differences were observed in PLR between groups. CONCLUSIONS: Elevated inflammatory markers were detectable in clinically healthy 1-year-old children who were later diagnosed with ADHD. These findings suggest a potential preclinical inflammatory phenotype linked to ADHD risk, highlighting the need for further investigation into early immune dysregulation as a contributing factor in ADHD pathophysiology. Early identification of such biomarkers may inform preventive strategies and targeted interventions in high-risk pediatric populations.

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9. Sun F, Wang Y. The impact of family parenting styles on behavioral and emotional problems in children with attention-deficit/hyperactivity disorder: the mediating role of mobile phone addiction. Front Psychol. 2026; 17: 1729300.

OBJECTIVE: This study examined the relationships between parenting styles and behavioral-emotional problems in children with Attention-Deficit/Hyperactivity Disorder (ADHD), investigating mobile phone addiction as a potential mediating mechanism. METHODS: A cross-sectional design was employed with 232 children diagnosed with ADHD (aged 6-17 years) and their parents. Participants completed the Swanson, Nolan, and Pelham-IV (SNAP-IV) Rating Scale for ADHD symptoms, the Mobile Phone Addiction Self-Rating Scale, the Child Behavior Checklist (CBCL) Brief Form, and the Egna Minnen Beträffande Uppfostran (EMBU) Parenting Style Scale. Mediation analyses were conducted using Hayes’ PROCESS macro with 5,000 bootstrap samples. RESULTS: Negative parenting styles (rejection, overprotection) were significantly associated with increased behavioral-emotional problems (r = 0.41-0.56, p < 0.001), while positive parenting (emotional warmth) showed negative correlations (r = -0.38 to -0.36, p < 0.001). Mobile phone addiction partially mediated these relationships. The indirect effects were significant (negative parenting: ab = 0.22, 95% CI [0.14, 0.31], accounting for 32.4% of the total effect; positive parenting: ab = -0.16, 95% CI [-0.24, -0.09], accounting for 27.6% of the total effect). CONCLUSION: Mobile phone addiction serves as a significant mediator between parenting styles and behavioral-emotional problems in ADHD children. Interventions targeting both parenting practices and digital device management may be beneficial for improving outcomes in this population.

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10. Tang Q, Xie X, Xiong P, He Y, Yang Y, Tang R, Xiang B, Zhu H. Association between complete blood count-derived inflammatory markers and ADHD symptom trajectories in childhood: A prospective cohort study. J Affect Disord. 2026; 405: 121611.

OBJECTIVE: This study aimed to identify distinct trajectories of inattention (IA), hyperactivity-impulsivity (HI), and oppositional defiant (OD) symptoms in children with ADHD and examine their associations with complete blood count (CBC)-derived inflammatory markers. METHODS: A total of 757 children aged 6-16 years with ADHD were followed for two years. ADHD symptoms were assessed using the SNAP-IV parent rating scale at baseline, 12, and 24 months. Group-based trajectory modeling (GBTM) identified distinct trajectories. Fasting venous blood was used to calculate inflammatory indices, including neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and systemic immune-inflammation index (SII). Multivariable logistic regression examined associations between these markers and trajectories. RESULTS: Four trajectories were identified per domain. IA: moderate-declining (58%), stable-moderate (22%), persistent-mild (15%), and persistent-severe (5%). HI: moderate-high declining (37%), stable-mild (34%), sub-clinical stable (22%), and rapidly-improving (7%). OD: asymptomatic (28.3%), high-severity declining (27.9%), stable-moderate (25.6%), and persistent-mild (18.2%). Compared to the persistent-mild trajectory, both stable-moderate and persistent-severe IA trajectories were associated with higher baseline NLR (stable-moderate: OR = 1.58, 95% CI: 1.11, 2.26; persistent-severe: OR = 1.74, 95% CI: 1.06, 2.85) and SII (stable-moderate: OR = 1.47, 95% CI: 1.02, 2.11; persistent-severe: OR = 1.81, 95% CI: 1.07, 3.05). For OD, the stable-moderate trajectory (vs. asymptomatic) was associated with higher MLR (OR = 1.70, 95% CI: 1.01, 2.88) and SII (OR = 1.52, 95% CI: 1.01, 2.31). No significant associations were observed for HI trajectories (all P > 0.05). CONCLUSION: Distinct ADHD symptom trajectories were identified. NLR and SII were associated with specific IA trajectories, suggesting a potential link between systemic inflammation and ADHD symptom persistence.

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11. Zhao Y, Zhang Y, Li T. Causal relationships between ADHD, ASD and brain structure: A mendelian randomization study. Prog Neuropsychopharmacol Biol Psychiatry. 2026; 145: 111631.

Neurodevelopmental disorders (NDDs) are debilitating conditions that impose significant burdens on individuals, families, and society. Despite evidence demonstrated altered brain structure in NDDs, definitive conclusions remain elusive. Using two-sample mendelian randomization (MR) and the latest GWAS findings, the current study aimed to elucidate the causal relationships between grey matter (GM), white matter (WM), subcortical regions, and two prevalent NDDs: attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). Our findings identified two frontal regions as key neural substrates in NDDs. Specifically, an increased surface area (SA) of the superior frontal gyrus (SFG) was significantly associated with an enhanced risk of ADHD (P = 2.04E-13, β = 4.28E-02, SE = 5.82E-03), while a larger SA of the orbital frontal gyrus (OFG) was associated with a reduced risk of ASD (P = 1.98E-42, β = -9.8E-02; SE = 0.007). Regarding WM tracts, the mode of anisotropy (MO) in the inferior fronto-occipital fasciculus (IFO) emerged as a causal factor for ADHD (P = 3.36E-70, β = -18.35; SE = 1.04), whereas the MO in the retro-lenticular part of the internal capsule (RLIC) was implicated in ASD (P = 1.37E-04, β = -12.73, SE = 3.34). No reverse causal link, i.e., brain alteration caused by NDDs was identified. Further mediation analyses using functional MRI (fMRI) GWAS data revealed that brain functional activities mediated the relationship between structural brain changes and NDDs risk. In conclusion, our findings underscored the critical role of the frontal lobe and association and projection fibers in the pathophysiology of NDDs, provide novel insights into the neural mechanisms underlying ADHD and ASD.

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12. Zinnow T, Retz W, Kaiser A, Sobanski E, Brandeis D, R DA, Davydenko S, Ethofer T, Ehlis AC, Fallgatter AJ, Groß S, Krecklow B, Retz-Junginger P, Praus P, Schulze M, Thome J, Millenet S, Banaschewski T, Philipsen A, Rösler M. Efficacy of a Stepped Care Approach for Adolescents and Adults with Attention-Deficit/Hyperactivity Disorder (ADHD): An Adaptive Intervention Study Including Randomized Controlled Trials (ESCAlate). Psychother Psychosom. 2026: 1-32.

INTRODUCTION: This study evaluated the effectiveness of a stepped-care approach – a staged model that escalates from lower- to higher-intensity treatments according to clinical response – for the treatment of adolescents and adults with ADHD, taking into account symptom severity and prior treatment response. METHODS: In a multicenter study, adolescents and adults with ADHD (16-45y) participated in a two-step treatment program including randomized controlled trials. Step1: Patients were (block-)randomized to 3 months of Psychoeducation (PE), Telephone-assisted self-help (TASH), or waiting control (WC). Step2: Based on Step1-response (full, partial, none), patients received either counseling or were randomized to counseling with/without neurofeedback (NF) or pharmacological treatment (with/without NF) for 6 months. The primary outcome was change in clinician-rated ADHD symptoms, analyzed using linear (mixed-)effects models for repeated measures to account for correlations within participants over time. RESULTS: Between 01/2015-09/2020, N=299 (mean age=28y, 55.2% male) patients were randomized in Step1. The primary outcome showed no significant between-group differences (PE vs. TASH: d=-0.12, 95%-CI [-3.18,1.19], p=0.64; PE vs. Control: d=-0.26, 95%-CI [-4.25,0.05], p=0.13; TASH vs. Control: d=-0.14, 95%-CI [-3.24,1.04], p=0.57). However, significant within-group effects emerged (PE: d=-0.60; TASH: d=-0.48; WC: d=-0.34; p<0.001). Step2 also showed no between-group differences but significant within-group effects (MPH: d=-0.59; MPH+NF: d=-0.76; counseling: d=-0.57/-1.35, p=0.01/p<0.001). Mixed-models revealed symptom reduction in all Step1 responders and Step1 non-responders in Step2. CONCLUSION: The lack of Step1-RCT differences questions the specific effects of PE/TASH. Similar patterns emerged in Step2, but intensified treatment for Step1 non-responders improved outcomes in MPH groups. Step1 response influenced later treatment success. Some stepped-care combinations did not further reduce symptoms, but no rebound effects occurred. The main limitations of this study are the two-step design complexity, limited information on certain (additional) psychosocial components, and the need to make assumptions about missing data. Nevertheless, findings support the feasibility and partial effectiveness of a stepped-care approach.

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