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Feb
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205
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Att
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diso
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its:
prev
a
lence and
diff
er
ential a
ss
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ci
a
tion with
int
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t
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L
a
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R
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Ap
r
10
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2
0
2
5
R
ev
is
ed
Oct
5
,
2025
Acc
ep
ted
No
v
16
,
2
0
2
5
Atten
ti
o
n
-
d
e
ficit/
h
y
p
e
ra
c
ti
v
it
y
d
iso
rd
e
r
(AD
HD
)
traits
in
a
d
u
lt
s
h
a
v
e
g
a
rn
e
re
d
g
l
o
b
a
l
a
tt
e
n
ti
o
n
d
u
e
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th
e
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e
tri
m
e
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tal
e
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c
ts
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iv
i
d
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a
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d
a
il
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f
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n
c
ti
o
n
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g
.
T
o
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a
s
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ted
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n
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d
u
lt
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HD
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n
M
a
lay
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p
a
rti
c
u
larly
a
m
o
n
g
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n
i
v
e
rsity
stu
d
e
n
ts.
Th
e
re
fo
re
,
t
h
is
st
u
d
y
a
ime
d
to
e
x
p
l
o
re
t
h
e
p
re
v
a
len
c
e
o
f
AD
HD
,
e
x
a
m
in
e
th
e
c
o
rre
lati
o
n
a
n
d
p
re
d
ictiv
e
r
e
latio
n
sh
i
p
b
e
twe
e
n
AD
HD
a
n
d
i
n
tern
e
t
a
d
d
ictio
n
,
c
o
m
p
a
re
in
ter
n
e
t
a
d
d
i
c
ti
o
n
b
e
twe
e
n
AD
HD
sc
re
e
n
-
p
o
siti
v
e
a
n
d
sc
re
e
n
-
n
e
g
a
ti
v
e
in
d
iv
i
d
u
a
ls,
a
n
d
d
e
term
in
e
th
e
g
e
n
d
e
r
d
iffere
n
c
e
s
in
AD
HD
.
Th
is
stu
d
y
a
d
o
p
ted
a
c
ro
ss
-
se
c
ti
o
n
a
l
q
u
a
n
ti
tativ
e
d
e
sig
n
,
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n
v
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lv
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n
g
1
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2
0
4
v
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p
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g
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ts.
Da
ta
we
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c
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ll
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u
sin
g
t
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e
In
tern
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t
Diso
rd
e
r
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c
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le
(IDS
-
1
5
)
a
n
d
th
e
Ad
u
lt
AD
HD
S
e
lf
-
Re
p
o
r
t
S
c
a
le
(ASRS
)
v
1
.
1
.
Th
e
fin
d
in
g
s
re
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t
h
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t
m
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th
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n
a
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o
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rti
c
ip
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n
ts
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re
e
n
e
d
p
o
siti
v
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fo
r
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HD
t
ra
it
s.
Ad
d
it
io
n
a
ll
y
,
a
si
g
n
ifi
c
a
n
t
p
o
siti
v
e
c
o
rre
latio
n
a
n
d
p
re
d
icti
v
e
re
latio
n
sh
ip
we
re
id
e
n
ti
f
ied
b
e
twe
e
n
a
d
u
lt
AD
H
D
traits
a
n
d
i
n
tern
e
t
a
d
d
icti
o
n
.
F
u
rth
e
rm
o
re
,
i
n
tern
e
t
a
d
d
ictio
n
le
v
e
ls
we
re
sig
n
ifi
c
a
n
t
ly
h
i
g
h
e
r
a
m
o
n
g
AD
HD
sc
re
e
n
-
p
o
siti
v
e
in
d
iv
id
u
a
ls
c
o
m
p
a
re
d
to
AD
HD
sc
re
e
n
-
n
e
g
a
ti
v
e
i
n
d
i
v
i
d
u
a
ls.
Ho
we
v
e
r,
n
o
si
g
n
if
ica
n
t
g
e
n
d
e
r
d
iffere
n
c
e
s
we
re
o
b
se
rv
e
d
i
n
AD
HD
traits.
Eff
e
c
ti
v
e
in
terv
e
n
ti
o
n
s
sh
o
u
l
d
b
e
d
e
v
e
lo
p
e
d
t
o
m
it
i
g
a
te
th
e
a
d
v
e
rse
e
ffe
c
ts
o
f
AD
HD
traits
o
n
th
e
d
a
il
y
fu
n
c
ti
o
n
i
n
g
o
f
u
n
i
v
e
rsity
stu
d
e
n
ts.
M
o
re
o
v
e
r,
e
ff
o
rts
to
a
d
d
re
ss
in
tern
e
t
a
d
d
ictio
n
sh
o
u
ld
c
o
n
si
d
e
r
th
e
p
re
se
n
c
e
o
f
AD
HD
traits
in
t
h
is
p
o
p
u
latio
n
.
K
ey
w
o
r
d
s
:
Atten
tio
n
-
d
ef
icit/h
y
p
e
r
ac
tiv
ity
d
is
o
r
d
er
Dif
f
er
en
tial a
s
s
o
ciatio
n
I
n
ter
n
et
ad
d
ictio
n
Pre
v
alen
ce
Un
iv
er
s
ity
s
tu
d
en
t
T
h
is i
s
a
n
o
p
e
n
a
c
c
e
ss
a
rticle
u
n
d
e
r th
e
CC B
Y
-
SA
li
c
e
n
se
.
C
o
r
r
e
s
p
o
nd
ing
A
uth
o
r
:
Siaw
Yan
-
Li
Dep
ar
tm
en
t o
f
E
d
u
ca
tio
n
al
Ps
y
ch
o
lo
g
y
an
d
C
o
u
n
s
ellin
g
,
Fa
cu
lty
o
f
E
d
u
ca
tio
n
,
Un
iv
er
s
iti
Ma
lay
a
5
0
6
0
3
Ku
ala
L
u
m
p
u
r
,
Ma
lay
s
ia
E
m
ail:
y
an
li@
u
m
.
ed
u
.
m
y
1.
I
NT
RO
D
UCT
I
O
N
Atten
tio
n
-
d
ef
icit/h
y
p
e
r
ac
tiv
ity
d
is
o
r
d
er
(
ADHD
)
is
a
n
eu
r
o
d
ev
elo
p
m
e
n
tal
an
d
b
e
h
av
io
r
a
l
d
is
o
r
d
er
th
at
o
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ig
in
ates
in
ch
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h
o
o
d
an
d
is
ch
ar
ac
ter
ized
b
y
in
atten
tio
n
,
im
p
u
ls
iv
ity
,
o
r
h
y
p
er
ac
tiv
ity
[
1
]
,
[
2
]
.
T
h
e
s
y
m
p
to
m
s
m
u
s
t
o
cc
u
r
b
ef
o
r
e
twelv
e
y
ea
r
s
o
ld
,
p
e
r
s
is
t
f
o
r
at
least
6
m
o
n
th
s
,
an
d
ca
u
s
e
f
u
n
ctio
n
al
im
p
air
m
en
ts
in
at
least
2
s
etti
n
g
s
to
b
e
d
iag
n
o
s
ed
with
ADHD
[
1
]
.
Nu
m
er
o
u
s
s
tu
d
ies
h
av
e
d
em
o
n
s
tr
ated
th
at
ADHD
s
y
m
p
to
m
s
o
f
ten
p
er
s
is
t
in
to
ad
u
lth
o
o
d
[
3
]
,
[
4
]
,
with
an
esti
m
ated
p
r
ev
alen
c
e
o
f
ap
p
r
o
x
im
ately
4
.
4
0
%
-
7
.
0
0
%
am
o
n
g
ad
u
lts
[
4
]
,
[
5
]
.
Giv
en
th
at
tr
aits
s
u
ch
as
in
atten
tio
n
an
d
im
p
u
ls
iv
ity
ar
e
also
o
b
s
er
v
ed
in
th
e
g
en
e
r
al
ad
u
lt
p
o
p
u
latio
n
,
it
h
as
b
ee
n
s
u
g
g
ested
th
at
ADHD
ex
is
ts
o
n
a
c
o
n
tin
u
u
m
,
with
th
e
d
is
o
r
d
er
r
ep
r
esen
tin
g
th
e
e
x
tr
em
e
en
d
o
f
ADHD
-
r
elate
d
s
y
m
p
to
m
s
[
6
]
.
Fro
m
a
n
eu
r
o
b
io
lo
g
ical
p
er
s
p
ec
tiv
e,
th
is
n
eu
r
o
d
ev
elo
p
m
en
tal
d
is
o
r
d
er
is
co
n
ce
p
t
u
alize
d
as
e
x
is
tin
g
o
n
a
co
n
tin
u
u
m
o
f
b
eh
a
v
i
o
r
al,
co
g
n
itiv
e,
an
d
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
8
2
2
I
n
t
J
E
v
al
&
R
es E
d
u
c
,
Vo
l
.
15
,
No
.
1
,
Feb
r
u
a
r
y
20
2
6
:
205
-
215
206
b
io
lo
g
ical
d
if
f
er
en
ce
s
,
r
ath
e
r
th
an
r
ep
r
esen
tin
g
a
d
is
cr
ete
d
iag
n
o
s
tic
ca
teg
o
r
y
[
7
]
.
I
n
m
an
ag
in
g
t
h
eir
d
aily
r
o
u
tin
es,
ad
u
lts
with
ADHD
o
f
ten
s
tr
u
g
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le
with
f
o
ll
o
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in
s
tr
u
ctio
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s
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ain
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n
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r
em
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er
in
g
ess
en
tial
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etails,
an
d
co
m
p
letin
g
task
s
with
in
d
esig
n
ated
tim
e
f
r
am
es
[
8
]
–
[
1
0
]
.
M
o
r
eo
v
er
,
ADHD
ap
p
ea
r
s
to
im
p
air
e
x
e
cu
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e
f
u
n
ctio
n
in
g
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er
e
b
y
in
cr
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s
in
g
th
e
r
is
k
o
f
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leep
d
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t
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r
b
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s
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r
e,
o
cc
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n
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e
r
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h
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en
t,
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u
n
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al
im
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air
m
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ts
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im
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al
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eh
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io
r
,
a
cc
id
en
ts
,
f
in
an
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d
if
f
icu
lties
,
an
d
m
ar
ital
b
r
ea
k
d
o
wn
[
1
1
]
–
[
1
3
]
.
E
v
en
m
o
r
e
co
n
ce
r
n
in
g
,
p
r
e
v
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u
s
s
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ies
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e
in
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icate
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th
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f
r
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en
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s
u
ch
as
an
x
iety
,
d
ep
r
ess
io
n
,
o
p
p
o
s
itio
n
al
d
e
f
ian
t
d
is
o
r
d
er
,
c
o
n
d
u
ct
d
is
o
r
d
er
,
an
d
s
u
b
s
tan
ce
u
s
e
d
is
o
r
d
er
s
[
1
4
]
–
[
1
6
]
.
Ad
d
itio
n
ally
,
ADHD
h
as
b
ee
n
lin
k
ed
to
in
ter
n
et
ad
d
ictio
n
[
1
7
]
–
[
1
9
]
,
with
r
ep
o
r
ted
co
m
o
r
b
id
ity
r
ates r
an
g
in
g
f
r
o
m
3
7
% to
4
9
%
[
2
0
]
,
[
2
1
]
.
T
h
e
in
ter
n
et
is
a
d
o
u
b
le
-
ed
g
e
d
s
wo
r
d
.
W
h
ile
its
ar
ch
itectu
r
e
h
as
r
ev
o
lu
tio
n
ize
d
co
m
m
u
n
i
ca
tio
n
an
d
s
tr
ea
m
lin
ed
d
aily
ac
tiv
ities
,
e
x
ce
s
s
iv
e
in
ter
n
et
u
s
e
ca
n
lea
d
to
u
n
d
esira
b
le
co
n
s
eq
u
e
n
ce
s
,
in
clu
d
in
g
m
en
tal
h
ea
lth
is
s
u
es
s
u
ch
as
d
ep
r
ess
i
o
n
an
d
an
x
iety
[
2
2
]
,
r
ed
u
ce
d
p
r
o
d
u
ctiv
ity
,
p
h
y
s
ical
ailm
en
ts
lik
e
b
ac
k
an
d
n
ec
k
p
ain
,
a
n
d
s
o
cial
with
d
r
awa
l
[
2
3
]
.
Alth
o
u
g
h
in
ter
n
et
ad
d
ictio
n
is
n
o
t
y
et
class
if
ied
as
a
clin
ical
d
is
o
r
d
er
in
t
h
e
Diag
n
o
s
tic
an
d
Statis
tical
M
an
u
al
o
f
Me
n
tal
Dis
o
r
d
er
s
:
f
i
f
th
ed
itio
n
(
DSM
-
5)
[
1
]
,
it
h
as
b
ee
n
a
g
r
o
win
g
g
lo
b
al
c
o
n
ce
r
n
f
o
r
t
h
e
p
ast
t
wo
d
ec
ad
es
d
u
e
to
its
d
etr
im
en
tal
ef
f
ec
ts
o
n
d
aily
f
u
n
ctio
n
in
g
[
2
4
]
,
[
2
5
]
.
T
h
is
b
eh
av
io
r
al
a
d
d
ictio
n
a
n
d
im
p
u
ls
e
co
n
tr
o
l
d
is
o
r
d
e
r
is
ch
ar
a
cter
ized
b
y
an
i
n
ab
ilit
y
to
r
e
g
u
late
in
ter
n
et
u
s
e,
p
r
io
r
itizin
g
o
n
lin
e
ac
tiv
ities
to
th
e
ex
ten
t
t
h
at
o
th
er
life
d
o
m
ain
s
ar
e
n
eg
lecte
d
,
an
d
p
er
s
is
tin
g
in
ex
ce
s
s
iv
e
in
ter
n
et
u
s
e
d
esp
ite
its
n
eg
ativ
e
co
n
s
eq
u
en
ce
s
[
2
5
]
,
[
2
6
]
.
E
v
en
th
o
u
g
h
g
e
n
er
al
in
ter
n
et
ad
d
ictio
n
is
n
o
t
o
f
f
icially
r
ec
o
g
n
ize
d
as
a
clin
i
ca
l
d
is
o
r
d
er
in
th
e
DSM
-
5
[
1
]
,
s
p
ec
if
ic
in
ter
n
et
-
r
elate
d
is
s
u
es,
s
u
ch
as
in
te
r
n
et
g
am
in
g
d
is
o
r
d
er
a
n
d
in
ter
n
et
g
am
b
lin
g
d
is
o
r
d
er
,
h
av
e
b
ee
n
id
en
tifie
d
as
co
n
d
itio
n
s
war
r
an
tin
g
f
u
r
th
er
s
tu
d
y
[
2
7
]
.
Fu
r
th
e
r
r
esear
ch
o
n
in
ter
n
et
ad
d
ictio
n
s
h
o
u
ld
b
e
co
n
d
u
cted
in
Ma
lay
s
ia,
as
p
r
ev
io
u
s
s
tu
d
ies
s
u
g
g
est
th
at
th
e
s
ev
er
ity
o
f
i
n
ter
n
et
ad
d
ictio
n
is
g
r
ea
ter
in
Asi
an
co
u
n
tr
ie
s
co
m
p
ar
ed
t
o
th
e
Un
ited
Stat
es
[
1
7
]
,
[
2
4
]
.
2.
L
I
T
E
R
AT
U
RE
R
E
VI
E
W
2
.
1
.
P
re
v
a
lence
o
f
ADH
D
t
r
a
it
s
in a
du
lt
s
I
n
th
e
Un
ited
States
,
th
e
p
r
ev
alen
ce
o
f
ADHD
in
ad
u
lth
o
o
d
is
esti
m
ated
at
4
.
4
0
%
[
5
]
.
Ho
wev
er
,
in
Asi
an
co
u
n
tr
ies,
p
r
ev
alen
ce
r
ates
m
ea
s
u
r
ed
u
s
in
g
s
elf
-
r
e
p
o
r
ted
s
ca
les
v
ar
y
s
ig
n
if
ican
tly
.
A
s
tu
d
y
co
n
d
u
cted
in
So
u
th
er
n
C
h
in
a
f
o
u
n
d
th
a
t
4
.
5
0
%
o
f
u
n
iv
e
r
s
ity
s
tu
d
en
ts
m
et
th
e
d
iag
n
o
s
tic
cr
iter
ia
f
o
r
ADHD
[
2
1
]
.
I
n
co
n
tr
ast,
s
tu
d
ies
in
J
ap
an
b
y
T
aten
o
et
a
l
.
[
2
8
]
,
[
2
9
]
r
e
v
e
aled
th
at
b
etwe
en
2
0
.
9
0
%
an
d
2
7
.
0
0
%
o
f
c
o
lleg
e
s
tu
d
en
ts
s
cr
ee
n
ed
p
o
s
itiv
e
f
o
r
ADHD
tr
aits
,
as
m
ea
s
u
r
ed
u
s
in
g
th
e
Ad
u
lt
ADHD
Self
-
R
ep
o
r
t
Scale
(
ASR
S)
v
1
.
1
.
T
h
ese
s
tu
d
ies
f
o
c
u
s
ed
o
n
g
en
e
r
al
co
lleg
e
a
n
d
u
n
iv
er
s
i
ty
s
tu
d
en
ts
,
wh
er
ea
s
r
esear
ch
o
n
m
ed
ical
s
tu
d
en
ts
h
as y
ield
ed
d
if
f
er
en
t f
in
d
in
g
s
.
Sh
en
et
a
l
.
[
3
0
]
r
e
p
o
r
ted
th
at
t
h
e
p
r
ev
ale
n
ce
o
f
ADHD
am
o
n
g
m
ed
ical
s
tu
d
en
ts
in
C
h
in
a
was
3
.
5
0
%.
Me
an
w
h
ile,
a
s
tu
d
y
in
I
n
d
ia
f
o
u
n
d
t
h
at
m
o
r
e
th
a
n
h
al
f
o
f
m
e
d
ica
l
s
tu
d
en
ts
(
5
4
.
9
0
%
)
ex
h
ib
ited
ADHD
s
y
m
p
to
m
s
,
as
ass
ess
ed
u
s
in
g
th
e
ASR
S
v
1
.
2
[
3
1
]
.
T
h
ese
d
is
cr
ep
a
n
cies
s
u
g
g
est
th
at
p
r
ev
alen
ce
r
ates
am
o
n
g
u
n
iv
er
s
ity
s
tu
d
en
ts
in
Asi
an
c
o
u
n
tr
ies
s
u
ch
as
C
h
in
a,
J
ap
an
,
an
d
I
n
d
ia
v
a
r
y
s
ig
n
if
ican
tly
.
I
n
Ma
lay
s
ia,
p
r
e
v
io
u
s
s
tu
d
ies
co
n
d
u
cte
d
am
o
n
g
in
m
ates,
m
en
tal
h
ea
lth
in
p
atien
ts
,
an
d
wo
r
k
in
g
ad
u
lts
h
av
e
r
ep
o
r
ted
a
d
u
lt
A
DHD
p
r
ev
alen
ce
r
ates
r
an
g
in
g
f
r
o
m
8
%
to
3
0
%
[
1
5
]
,
[
3
2
]
,
[
3
3
]
.
T
h
e
o
n
l
y
ex
is
tin
g
s
tu
d
y
o
n
lo
ca
l u
n
d
er
g
r
ad
u
ates in
d
icate
d
th
at
as m
an
y
as 3
9
% o
f
s
tu
d
en
ts
ex
h
ib
ited
ADHD
s
y
m
p
to
m
s
[
1
4
]
.
H
o
wev
er
,
th
is
f
in
d
in
g
r
e
f
lects
d
ata
f
r
o
m
a
s
in
g
le
u
n
iv
er
s
ity
in
Pah
an
g
,
o
n
e
o
f
Ma
la
y
s
ia’
s
1
3
s
tates
an
d
3
f
ed
er
al
ter
r
ito
r
ies,
an
d
d
o
es
n
o
t
r
ep
r
esen
t
th
e
co
u
n
t
r
y
as
a
wh
o
le.
Ad
d
itio
n
ally
,
th
e
s
tu
d
y
'
s
s
m
all
s
am
p
le
s
ize
(
n
=1
8
6
)
lim
its
its
g
en
er
aliza
b
ilit
y
.
Giv
en
th
ese
co
n
s
id
er
atio
n
s
,
th
is
s
tu
d
y
aim
ed
to
ex
p
lo
r
e
th
e
p
r
ev
alen
ce
o
f
ADHD
tr
aits
am
o
n
g
u
n
i
v
e
r
s
ity
s
tu
d
en
ts
in
Ma
lay
s
ia
to
r
aise
awa
r
en
ess
o
f
ADHD
-
r
elate
d
ch
ar
ac
ter
is
tics
with
in
th
e
g
en
er
al
u
n
iv
e
r
s
ity
s
tu
d
en
t p
o
p
u
latio
n
.
2
.
2
.
Rela
t
io
ns
hip
bet
wee
n A
DH
D
a
nd
inte
rnet
a
dd
ict
io
n
T
h
e
r
elatio
n
s
h
ip
b
etwe
en
n
o
n
-
clin
ical,
tr
ait
-
lev
el
ADHD
an
d
in
ter
n
et
ad
d
ictio
n
in
a
d
u
lts
h
as
g
ain
ed
s
ig
n
if
ican
t
g
lo
b
al
atten
tio
n
o
v
er
th
e
p
ast
d
ec
a
d
e.
Acc
o
r
d
i
n
g
to
d
u
al
s
y
s
tem
s
th
eo
r
y
,
t
h
e
d
o
m
in
a
n
ce
o
f
t
h
e
im
p
u
ls
iv
e
s
y
s
tem
is
r
ef
lecte
d
in
th
e
h
y
p
er
ac
tiv
ity
a
n
d
im
p
u
ls
iv
ity
o
b
s
er
v
ed
in
th
e
d
aily
f
u
n
ctio
n
in
g
o
f
ad
u
lts
with
ADHD
.
I
n
ter
n
et
en
v
ir
o
n
m
en
ts
o
f
ten
o
f
f
er
in
s
tan
t
g
r
ati
f
icatio
n
,
th
er
e
b
y
r
ein
f
o
r
cin
g
i
m
p
u
ls
iv
e
b
eh
a
v
io
r
s
an
d
b
y
p
ass
in
g
r
ef
lectiv
e
co
n
tr
o
l
[
3
4
]
.
I
n
ex
am
i
n
in
g
t
h
is
co
r
r
elatio
n
,
an
in
cr
ea
s
in
g
n
u
m
b
e
r
o
f
c
r
o
s
s
-
s
ec
tio
n
al
s
tu
d
ies
h
av
e
r
ep
o
r
ted
a
s
ig
n
if
ican
t
p
o
s
itiv
e
ass
o
ciatio
n
b
etwe
en
ADHD
an
d
in
ter
n
et
ad
d
ictio
n
am
o
n
g
u
n
iv
er
s
ity
s
tu
d
en
ts
[
1
0
]
,
[
3
1
]
,
as
well
as
ad
u
lt
s
[
3
5
]
.
Mo
r
e
s
p
ec
if
ically
,
b
o
th
in
atten
tio
n
a
n
d
h
y
p
er
ac
tiv
ity
o
r
im
p
u
ls
iv
ity
h
av
e
b
ee
n
f
o
u
n
d
t
o
b
e
p
o
s
itiv
ely
lin
k
ed
t
o
o
n
li
n
e
g
am
in
g
b
u
t
n
eg
ativ
ely
ass
o
ciate
d
with
o
n
lin
e
lear
n
in
g
a
n
d
in
f
o
r
m
atio
n
d
o
wn
lo
ad
in
g
am
o
n
g
u
n
iv
er
s
ity
s
tu
d
en
ts
[
2
1
]
.
Ad
d
itio
n
ally
,
o
n
lin
e
s
h
o
p
p
in
g
h
as
b
ee
n
ass
o
ciate
d
with
h
y
p
er
ac
tiv
ity
o
r
im
p
u
ls
iv
ity
b
u
t
n
o
t
in
atten
tio
n
[
2
1
]
.
Me
ta
-
an
aly
s
is
s
tu
d
ies
[
2
2
]
,
[
3
6
]
f
u
r
th
er
s
u
p
p
o
r
t
th
e
lin
k
b
e
twee
n
ADHD
s
y
m
p
to
m
s
,
in
clu
d
in
g
atten
tio
n
d
ef
icits
,
h
y
p
er
ac
tiv
ity
,
a
n
d
im
p
u
ls
iv
ity
,
an
d
p
r
o
b
lem
atic
in
ter
n
et
u
s
e.
Ho
wev
e
r
,
wh
ile
Au
g
n
er
et
a
l
.
[
2
2
]
r
e
v
iewe
d
s
tu
d
ies
ac
r
o
s
s
v
ar
io
u
s
ag
e
g
r
o
u
p
s
,
W
an
g
et
a
l
.
[
3
6
]
f
o
cu
s
ed
s
o
lely
o
n
ad
o
lescen
t
an
d
ad
u
lt
s
am
p
les,
ex
clu
d
in
g
ch
ild
r
en
.
Alth
o
u
g
h
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t
J
E
v
al
&
R
es E
d
u
c
I
SS
N:
2252
-
8
8
2
2
A
tten
tio
n
-
d
eficit/h
yp
era
ctivity
d
is
o
r
d
er tr
a
its
:
p
r
ev
a
len
ce
a
n
d
d
iffer
en
tia
l a
s
s
o
cia
tio
n
w
ith
…
(
La
w
Mei
-
Yu
i
)
207
ex
is
tin
g
r
esear
ch
h
ig
h
lig
h
ts
a
co
r
r
elatio
n
b
etwe
en
ADHD
a
n
d
in
ter
n
et
ad
d
ictio
n
,
f
u
r
t
h
er
i
n
v
esti
g
atio
n
with
in
th
e
Ma
lay
s
ian
co
n
tex
t
is
n
ec
e
s
s
ar
y
d
u
e
t
o
th
e
lim
ited
n
u
m
b
er
o
f
lo
ca
l
s
tu
d
ies.
A
d
ee
p
er
u
n
d
er
s
tan
d
in
g
o
f
th
is
r
elatio
n
s
h
ip
is
ess
en
tial
b
ef
o
r
e
ef
f
ec
tiv
e
in
ter
v
e
n
tio
n
s
ca
n
b
e
d
esig
n
ed
an
d
im
p
lem
e
n
ted
f
o
r
u
n
iv
er
s
it
y
s
tu
d
en
ts
.
R
eg
ar
d
in
g
t
h
e
r
o
le
o
f
ADHD
t
r
aits
in
p
r
e
d
ictin
g
in
ter
n
et
ad
d
ictio
n
,
p
r
ev
io
u
s
s
tu
d
ies
h
av
e
s
h
o
wn
t
h
at
ad
u
lt
ADHD
i
s
a
s
ig
n
if
ican
t
p
r
ed
icto
r
o
f
in
ter
n
et
ad
d
ictio
n
[
2
1
]
,
[
3
1
]
.
A
s
tu
d
y
f
o
u
n
d
th
at
u
n
iv
er
s
ity
s
tu
d
en
ts
with
in
atten
tio
n
s
y
m
p
to
m
s
wer
e
twice
as
lik
ely
to
d
ev
e
lo
p
in
ter
n
et
a
d
d
ictio
n
,
wh
er
e
as
th
o
s
e
ex
h
ib
itin
g
h
y
p
er
ac
tiv
ity
s
y
m
p
to
m
s
wer
e
2
.
4
tim
es
m
o
r
e
lik
ely
to
ex
p
er
ien
ce
in
ter
n
et
a
d
d
ictio
n
[
1
9
]
.
Ho
wev
e
r
,
th
e
g
en
er
aliza
b
ilit
y
o
f
th
ese
f
in
d
i
n
g
s
is
lim
ited
,
a
s
th
e
s
tu
d
y
e
x
clu
s
iv
ely
s
u
r
v
ey
ed
r
esp
o
n
d
e
n
ts
f
r
o
m
a
p
u
b
lic
u
n
iv
er
s
ity
in
Selan
g
o
r
,
one
o
f
Ma
lay
s
ia’
s
1
3
s
tates
an
d
3
f
ed
er
al
ter
r
ito
r
ies.
R
esear
ch
co
n
d
u
cted
am
o
n
g
u
n
iv
er
s
ity
s
tu
d
e
n
ts
in
C
h
in
a
a
n
d
T
u
r
k
ey
s
im
ilar
ly
f
o
u
n
d
th
a
t
b
o
th
in
atten
tio
n
an
d
h
y
p
er
ac
t
iv
ity
o
r
im
p
u
ls
iv
ity
s
ig
n
if
ican
tly
p
r
ed
icted
in
te
r
n
e
t
ad
d
ictio
n
,
with
in
atten
tio
n
h
av
in
g
a
g
r
ea
ter
e
f
f
ec
t
s
ize
[
2
1
]
,
[
3
7
]
.
R
eg
ar
d
i
n
g
s
tu
d
ies
o
n
ad
u
lts
,
L
i
et
a
l
.
[
3
8
]
r
ep
o
r
ted
th
at
im
p
u
ls
iv
e
n
ess
an
d
b
eh
a
v
io
r
al
i
n
h
ib
itio
n
wer
e
s
ig
n
if
ican
t
p
r
ed
icto
r
s
o
f
i
n
ter
n
et
ad
d
ictio
n
am
o
n
g
in
d
iv
id
u
als
with
ADHD
tr
aits
.
C
o
n
v
er
s
ely
,
Ay
d
in
et
a
l
.
[
3
5
]
f
o
u
n
d
th
at
in
atten
tio
n
b
u
t
n
o
t
h
y
p
er
a
ctiv
ity
o
r
im
p
u
ls
iv
ity
was
a
p
r
ed
icto
r
o
f
in
te
r
n
et
a
d
d
ictio
n
a
m
o
n
g
y
o
u
n
g
ad
u
lts
.
T
h
ese
in
co
n
s
is
ten
cies
in
p
r
ev
io
u
s
f
in
d
in
g
s
h
ig
h
lig
h
t
th
e
n
ee
d
f
o
r
f
u
r
th
er
r
esear
c
h
.
E
s
tab
lis
h
in
g
wh
eth
er
ADHD
tr
ait
s
s
er
v
e
as
r
i
s
k
f
ac
to
r
s
f
o
r
in
ter
n
et
ad
d
ictio
n
am
o
n
g
u
n
iv
e
r
s
ity
s
tu
d
en
ts
ac
r
o
s
s
v
ar
io
u
s
in
s
titu
tio
n
s
in
Ma
lay
s
ia
wo
u
ld
p
r
o
v
id
e
v
alu
ab
le
in
s
ig
h
ts
.
Su
ch
ev
id
en
ce
co
u
ld
en
ab
le
p
s
y
ch
o
lo
g
is
ts
an
d
co
u
n
s
elo
r
s
to
d
esig
n
an
d
im
p
lem
en
t m
o
r
e
ef
f
ec
tiv
e
s
tr
ateg
ies an
d
tr
ea
tm
en
t p
lan
s
to
m
itig
ate
in
ter
n
et
a
d
d
ictio
n
.
R
eg
ar
d
in
g
th
e
lik
elih
o
o
d
o
f
u
n
iv
er
s
ity
s
tu
d
en
ts
with
ADHD
s
y
m
p
to
m
s
d
ev
elo
p
in
g
in
ter
n
et
ad
d
ictio
n
,
p
r
e
v
io
u
s
r
esear
c
h
c
o
n
d
u
cte
d
in
So
u
th
e
r
n
C
h
in
a,
I
n
d
ia,
a
n
d
J
ap
an
h
as
s
h
o
wn
th
a
t
th
ese
s
tu
d
en
ts
ar
e
s
ig
n
if
ican
tly
m
o
r
e
p
r
o
n
e
to
in
ter
n
et
ad
d
ictio
n
co
m
p
a
r
ed
to
th
eir
p
ee
r
s
with
o
u
t
ADH
D
s
y
m
p
to
m
s
.
T
h
e
p
r
ev
alen
ce
r
ates
am
o
n
g
u
n
iv
e
r
s
ity
s
tu
d
en
ts
with
ADHD
s
y
m
p
to
m
s
wer
e
r
ep
o
r
ted
as
4
8
.
9
0
%,
3
5
.
7
0
%,
an
d
1
8
.
2
0
%
in
So
u
th
er
n
C
h
in
a,
I
n
d
ia,
an
d
J
ap
an
,
r
esp
ec
tiv
el
y
,
wh
er
ea
s
th
eir
co
u
n
ter
p
ar
t
s
with
o
u
t
ADHD
s
y
m
p
to
m
s
ex
h
ib
ited
co
n
s
id
er
ab
ly
lo
wer
r
ates
o
f
1
4
.
3
0
%,
1
1
.
1
0
%,
an
d
1
%,
r
esp
ec
tiv
el
y
[
1
0
]
,
[
2
1
]
,
[
2
9
]
.
Similar
ly
,
T
aten
o
et
a
l
.
[
2
8
]
f
o
u
n
d
th
at
J
ap
an
ese
co
lleg
e
s
tu
d
en
ts
wh
o
s
cr
ee
n
ed
p
o
s
itiv
e
f
o
r
ADHD
s
co
r
ed
s
ig
n
if
ican
tly
h
ig
h
er
o
n
m
ea
s
u
r
es
o
f
in
te
r
n
et
a
d
d
ictio
n
co
m
p
a
r
ed
to
th
o
s
e
wh
o
s
cr
ee
n
ed
n
eg
ativ
e.
Sp
ec
if
ically
,
am
o
n
g
s
tu
d
en
ts
wh
o
test
ed
p
o
s
itiv
e
f
o
r
ADHD
,
6
7
.
9
0
%
wer
e
class
if
ied
as
p
o
s
s
ib
le
a
d
d
icts
,
wh
ile
8
.
3
0
%
wer
e
ca
teg
o
r
ized
as
s
ev
er
e
a
d
d
icts
.
I
n
co
n
t
r
ast,
am
o
n
g
s
tu
d
en
ts
wh
o
s
cr
ee
n
e
d
n
eg
ativ
e
f
o
r
ADHD
,
th
e
p
er
ce
n
tag
es
wer
e
lo
wer
,
with
5
6
.
5
0
%
id
en
tifie
d
as
p
o
s
s
ib
le
ad
d
icts
an
d
o
n
ly
2
%
class
if
ied
as
s
ev
er
e
ad
d
icts
[
2
8
]
.
T
o
d
ate,
n
o
s
im
ilar
s
tu
d
y
h
as
b
ee
n
co
n
d
u
cted
in
Ma
lay
s
ia,
leav
in
g
u
n
ce
r
tain
ty
ab
o
u
t w
h
eth
er
Ma
lay
s
ian
u
n
iv
er
s
ity
s
tu
d
en
ts
with
ADHD
tr
aits
ar
e
m
o
r
e
lik
ely
to
ex
p
er
ien
ce
in
ter
n
et
a
d
d
ictio
n
.
T
h
e
u
n
d
e
r
ly
in
g
r
ea
s
o
n
s
wh
y
a
d
u
lts
with
ADHD
ar
e
m
o
r
e
v
u
ln
er
ab
le
to
ex
ce
s
s
iv
e
in
ter
n
et
u
s
ag
e
m
ay
s
tem
f
r
o
m
im
p
air
e
d
in
h
ib
itio
n
,
wh
ich
lead
s
to
a
lack
o
f
s
elf
-
co
n
tr
o
l
[
2
0
]
,
[
3
0
]
,
[
3
6
]
,
a
s
well
as
a
lack
o
f
s
tr
ateg
ic
f
lex
ib
ilit
y
,
r
esu
ltin
g
i
n
p
o
o
r
s
elf
-
r
eg
u
latio
n
[
3
9
]
.
A
d
d
itio
n
ally
,
in
d
iv
id
u
als
with
ADHD
ar
e
p
r
o
n
e
to
b
o
r
ed
o
m
an
d
h
a
v
e
an
av
er
s
io
n
to
d
elay
ed
r
ewa
r
d
s
,
wh
ich
f
u
r
th
er
co
n
t
r
ib
u
tes
to
ex
ce
s
s
iv
e
in
ter
n
et
u
s
e
as
th
ey
s
ee
k
im
m
ed
iate
g
r
atif
icatio
n
a
n
d
r
elief
f
r
o
m
b
o
r
ed
o
m
[
3
6
]
,
[
4
0
]
.
Fu
r
t
h
er
m
o
r
e,
s
in
ce
in
d
iv
id
u
als
with
ADHD
h
av
e
a
d
im
i
n
is
h
ed
ab
ilit
y
to
r
esp
o
n
d
to
p
u
n
is
h
m
en
t,
th
e
y
ten
d
to
d
is
r
eg
a
r
d
th
e
n
eg
ativ
e
co
n
s
eq
u
en
ce
s
o
f
ex
ce
s
s
iv
e
in
ter
n
et
u
s
ag
e
[
1
0
]
.
T
h
ey
ar
e
also
m
o
r
e
lik
ely
to
ex
h
ib
it
s
en
s
atio
n
-
s
ee
k
in
g
p
er
s
o
n
ality
tr
aits
,
ch
ar
ac
ter
ized
b
y
a
d
esire
f
o
r
n
ew
an
d
v
ar
ied
ex
p
e
r
ien
ce
s
[
2
0
]
,
[
4
1
]
.
As
a
r
esu
lt,
th
ey
o
f
t
en
b
r
o
wse
m
u
ltip
le
win
d
o
ws s
im
u
ltan
eo
u
s
ly
an
d
s
wif
tly
ju
m
p
f
r
o
m
o
n
e
o
n
lin
e
a
ctiv
ity
to
an
o
th
e
r
.
2
.
3
.
G
ender
diff
er
ence
s
in a
du
lt
ADH
D
Gen
d
er
d
if
f
er
e
n
ce
s
in
ch
ild
h
o
o
d
ADHD
h
a
v
e
b
ee
n
ex
ten
s
iv
ely
s
tu
d
ied
f
o
r
m
a
n
y
y
ea
r
s
.
Stu
d
ies
h
av
e
g
en
er
ally
f
o
u
n
d
th
at
m
ale
ar
e
3
to
16
tim
es
m
o
r
e
lik
ely
to
b
e
d
iag
n
o
s
ed
with
ADHD
th
an
f
em
ale
[
4
2
]
.
A
m
eta
-
an
aly
s
is
co
n
d
u
cted
b
y
Au
g
n
er
et
a
l
.
[
2
2
]
,
wh
ich
r
ev
iewe
d
p
r
ev
io
u
s
s
tu
d
ies
o
n
ch
i
ld
r
en
,
ad
o
lescen
ts
,
an
d
ad
u
lts
,
r
ev
ea
le
d
s
ig
n
if
ican
t
g
en
d
er
d
i
f
f
er
en
ce
s
in
ADHD
.
Sp
ec
if
ically
,
s
am
p
les
co
n
s
is
t
in
g
p
r
ed
o
m
in
an
tly
o
f
m
ale
r
esp
o
n
d
e
n
ts
ex
h
ib
ited
s
ig
n
if
ican
tly
h
ig
h
er
atten
tio
n
d
ef
icit
an
d
h
y
p
e
r
ac
tiv
ity
[
2
2
]
.
Ho
wev
er
,
r
ec
e
n
t
s
tu
d
ies
f
o
cu
s
in
g
s
o
lely
o
n
a
d
u
lt
s
am
p
les
h
av
e
y
ield
ed
d
if
f
e
r
i
n
g
r
esu
lts
.
Sev
er
al
s
tu
d
ies
[
2
0
]
,
[
3
1
]
,
[
4
2
]
f
o
u
n
d
n
o
s
ig
n
if
ica
n
t
g
e
n
d
er
d
if
f
er
e
n
ce
s
in
ADHD
am
o
n
g
ad
u
lts
.
I
n
Ma
la
y
s
ia,
n
o
p
r
io
r
s
tu
d
ies
h
av
e
e
x
am
in
ed
g
en
d
er
d
if
f
e
r
en
ce
s
in
ad
u
lt
A
DHD
to
d
ate.
Su
ch
r
esear
ch
is
cr
u
cial
to
b
etter
u
n
d
er
s
tan
d
th
e
n
atu
r
e
o
f
g
en
d
er
d
if
f
er
en
ce
s
i
n
ad
u
lt
ADHD
a
n
d
to
g
u
id
e
th
e
d
e
v
elo
p
m
e
n
t
o
f
ef
f
ec
tiv
e
tr
ea
tm
en
t
ap
p
r
o
ac
h
es
f
o
r
m
ale
a
n
d
f
em
ale
ad
u
lts
in
Ma
lay
s
ia.
2
.
4
.
P
re
s
ent
s
t
ud
y
T
h
e
s
tu
d
y
aim
ed
to
i
)
ex
p
lo
r
e
th
e
p
r
ev
alen
ce
o
f
ADHD
tr
aits
am
o
n
g
u
n
iv
e
r
s
ity
s
tu
d
en
ts
in
Ma
lay
s
ia;
ii
)
ex
am
in
e
th
e
r
elatio
n
s
h
ip
b
etwe
en
ADHD
tr
aits
an
d
in
ter
n
et
ad
d
ictio
n
;
iii
)
i
n
v
esti
g
ate
ADHD
tr
aits
as
p
r
ed
icto
r
s
o
f
in
ter
n
et
ad
d
ictio
n
;
iv
)
c
o
m
p
ar
e
in
ter
n
et
ad
d
ict
io
n
b
etwe
en
ADHD
s
cr
ee
n
-
p
o
s
itiv
e
an
d
ADHD
s
cr
ee
n
-
n
eg
ativ
e
in
d
iv
id
u
als;
an
d
v
)
d
eter
m
in
e
th
e
g
en
d
e
r
d
if
f
er
en
ce
s
in
ADHD
tr
aits
am
o
n
g
u
n
iv
er
s
ity
s
tu
d
en
ts
in
Ma
lay
s
ia.
T
h
is
s
tu
d
y
is
am
o
n
g
th
e
f
ir
s
t
to
co
m
p
ar
e
in
ter
n
et
ad
d
ictio
n
b
et
wee
n
ADHD
s
cr
ee
n
-
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
8
2
2
I
n
t
J
E
v
al
&
R
es E
d
u
c
,
Vo
l
.
15
,
No
.
1
,
Feb
r
u
a
r
y
20
2
6
:
205
-
215
208
p
o
s
itiv
e
an
d
ADHD
s
cr
ee
n
-
n
eg
ativ
e
in
d
iv
id
u
als,
as
well
as
to
ex
p
lo
r
e
s
ig
n
if
ica
n
t
g
e
n
d
er
d
if
f
er
e
n
ce
s
i
n
ADHD
tr
aits
am
o
n
g
Ma
lay
s
ia
n
u
n
iv
er
s
ity
s
tu
d
en
ts
.
T
h
e
f
in
d
in
g
s
aim
to
d
ee
p
e
n
o
u
r
u
n
d
e
r
s
tan
d
in
g
o
f
th
e
r
is
k
f
ac
to
r
s
f
o
r
in
ter
n
et
ad
d
ictio
n
an
d
p
r
o
v
id
e
v
al
u
ab
le
in
s
ig
h
ts
in
to
in
ter
v
en
tio
n
s
d
esig
n
ed
to
m
itig
ate
ex
ce
s
s
iv
e
in
ter
n
et
u
s
e
in
ad
u
lts
with
AD
HD
tr
aits
.
Ad
d
itio
n
ally
,
ad
d
r
ess
in
g
ADHD
tr
aits
an
d
in
ter
n
et
ad
d
ictio
n
am
o
n
g
Ma
lay
s
ian
u
n
iv
er
s
ity
s
tu
d
e
n
ts
alig
n
s
with
th
e
Un
ited
Natio
n
s
’
s
u
s
tain
ab
le
d
ev
el
o
p
m
en
t
g
o
al
(
SDG)
3
-
g
o
o
d
h
ea
lth
an
d
well
-
b
ei
n
g
.
Sin
ce
ADHD
tr
aits
an
d
in
ter
n
et
a
d
d
ictio
n
a
r
e
ass
o
ciate
d
with
n
eg
ativ
e
ac
a
d
em
ic,
b
eh
av
io
r
al,
an
d
m
en
tal
h
ea
lth
o
u
tco
m
es,
ef
f
ec
ti
v
ely
m
an
a
g
i
n
g
th
ese
tr
aits
an
d
r
ed
u
cin
g
in
ter
n
et
ad
d
ictio
n
ca
n
co
n
tr
ib
u
te
to
o
v
e
r
all
well
-
b
ein
g
.
3.
M
E
T
H
O
D
3
.
1
.
P
a
rt
icipa
nts a
nd
da
t
a
c
o
llect
io
n
A
to
tal
o
f
1
,
2
0
4
u
n
iv
er
s
ity
s
tu
d
en
ts
f
r
o
m
b
o
th
p
u
b
lic
an
d
p
r
i
v
ate
u
n
i
v
er
s
ities
in
Ma
lay
s
ia
v
o
lu
n
tar
ily
p
ar
ticip
ated
in
th
is
s
tu
d
y
.
Par
ticip
an
ts
ar
e
f
r
o
m
f
o
u
r
m
ain
r
e
g
io
n
s
in
Pen
in
s
u
lar
Ma
lay
s
ia:
No
r
th
er
n
,
C
en
tr
al,
So
u
th
er
n
an
d
E
aster
n
,
an
d
E
a
s
t
Ma
lay
s
ia.
Mo
s
t
p
ar
ticip
an
ts
wer
e
f
em
ale
(
n
=
8
6
4
;
7
1
.
7
5
%
)
co
m
p
ar
ed
to
m
ale
p
ar
ticip
an
ts
(
n
=
3
4
0
;
2
8
.
2
5
%
)
.
T
h
e
av
er
a
g
e
ag
e
o
f
th
e
p
ar
ticip
an
ts
was
2
1
.
8
±
2
.
0
y
ea
r
s
.
T
h
e
r
ac
ial
co
m
p
o
s
itio
n
was
r
ep
o
r
ted
as
:
6
1
.
5
0
%
Ma
lay
s
,
1
7
.
8
0
%
C
h
in
ese,
1
1
.
8
0
%
I
n
d
ian
s
,
an
d
8
.
9
0
%
B
u
m
ip
u
tr
a
g
r
o
u
p
s
.
Ap
p
r
o
v
al
f
o
r
th
e
s
t
u
d
y
was
o
b
tain
ed
f
r
o
m
t
h
e
Un
iv
er
s
iti
Ma
lay
a
R
esear
ch
E
th
ics
C
o
m
m
ittee
(
UM
R
E
C
)
(
UM
.
T
NC
2
/UM
R
E
C
_
2
7
8
5
)
p
r
io
r
to
th
e
d
ata
c
o
llectio
n
.
Data
c
o
llectio
n
was
co
n
d
u
cted
u
s
in
g
an
an
o
n
y
m
o
u
s
o
n
lin
e
s
u
r
v
ey
f
o
r
m
cr
ea
ted
v
ia
Go
o
g
le
Fo
r
m
s
.
Par
ticip
an
ts
wer
e
r
ec
r
u
ited
th
r
o
u
g
h
co
n
v
en
ien
ce
s
am
p
lin
g
,
with
th
e
s
u
r
v
ey
lin
k
d
is
tr
ib
u
ted
ac
r
o
s
s
s
o
cial
m
ed
ia
p
latf
o
r
m
s
an
d
o
n
lin
e
f
o
r
u
m
s
af
f
iliated
with
Ma
lay
s
ian
u
n
iv
er
s
ities
.
T
o
q
u
alif
y
f
o
r
p
a
r
ticip
atio
n
,
in
d
iv
id
u
als
h
ad
t
o
m
ee
t
th
e
f
o
llo
win
g
cr
iter
ia:
i)
b
e
ag
ed
1
8
y
ea
r
s
an
d
a
b
o
v
e
;
ii)
h
o
ld
Ma
lay
s
ian
n
atio
n
ality
;
an
d
iii)
b
e
cu
r
r
en
tly
e
n
r
o
lled
at
a
u
n
i
v
er
s
ity
in
Ma
lay
s
ia.
R
elev
an
t
in
f
o
r
m
atio
n
ab
o
u
t
th
e
s
tu
d
y
,
in
cl
u
d
in
g
its
p
u
r
p
o
s
e
an
d
ass
u
r
an
ce
s
o
f
d
ata
c
o
n
f
id
en
tiality
,
was
p
r
o
v
id
e
d
to
p
ar
ticip
an
ts
.
I
n
f
o
r
m
ed
co
n
s
en
t w
as o
b
tai
n
ed
p
r
io
r
to
s
u
r
v
ey
co
m
p
letio
n
.
3
.
2
.
I
ns
t
rum
ent
s
T
h
is
s
tu
d
y
ad
o
p
ted
a
cr
o
s
s
-
s
ec
tio
n
al
q
u
an
titativ
e
d
esig
n
.
T
h
e
q
u
esti
o
n
n
air
e
in
clu
d
e
d
item
s
o
n
d
em
o
g
r
a
p
h
ics,
th
e
ASR
S
v
1
.
1
,
an
d
th
e
I
n
ter
n
et
Dis
o
r
d
e
r
Sc
ale
(
I
DS
-
1
5
)
.
T
h
e
ASR
S
v
1
.
1
s
y
m
p
to
m
ch
ec
k
lis
t
is
an
1
8
item
s
s
elf
-
r
ep
o
r
t
in
s
tr
u
m
en
t
d
esig
n
ed
to
ass
ess
ADHD
in
ad
u
lts
,
b
ased
o
n
th
e
W
o
r
ld
Hea
lth
Or
g
an
izatio
n
C
o
m
p
o
s
ite
I
n
ter
n
atio
n
al
Diag
n
o
s
tic
I
n
ter
v
iew
an
d
alig
n
ed
with
DSM
cr
iter
i
a
[
4
3
]
.
L
a
r
g
e
-
s
ca
le
cr
o
s
s
-
cu
ltu
r
al
r
esear
ch
in
v
o
lv
in
g
4
2
co
u
n
tr
ies
h
as
co
n
f
ir
m
ed
th
at
th
e
ASR
S
v
1
.
1
m
ain
tain
s
g
o
o
d
in
ter
n
al
co
n
s
is
ten
cy
an
d
p
ar
tial
m
ea
s
u
r
em
en
t
i
n
v
ar
ian
ce
ac
r
o
s
s
d
iv
er
s
e
lan
g
u
ag
es
an
d
n
atio
n
s
[
4
4
]
.
I
n
Ma
lay
s
ia,
ASR
S
v
1
.
1
h
as
d
em
o
n
s
tr
ated
ex
ce
llen
t
in
ter
n
al
co
n
s
is
ten
cy
an
d
p
s
y
ch
o
m
etr
ic
p
r
o
f
iles
[
3
2
]
.
T
h
e
ASR
S
v
1
.
1
co
n
s
is
ts
o
f
two
p
ar
ts
:
p
ar
t
A
(
6
item
s
)
an
d
p
ar
t
B
(
1
2
item
s
)
.
Par
ticip
an
ts
wer
e
ask
ed
to
in
d
icate
h
o
w
o
f
ten
ea
ch
s
y
m
p
to
m
o
cc
u
r
r
ed
o
v
er
th
e
p
r
ev
io
u
s
6
m
o
n
th
s
,
u
s
in
g
f
iv
e
r
esp
o
n
s
e
o
p
tio
n
s
:
n
ev
er
,
r
ar
ely
,
s
o
m
etim
es,
o
f
ten
,
o
r
v
er
y
o
f
ten
.
Fo
r
all
1
8
item
s
,
p
ar
ticip
an
ts
wer
e
class
if
ied
as
p
o
s
itiv
e
if
th
eir
r
es
p
o
n
s
es
wer
e
“
o
f
ten
”
o
r
“
v
er
y
o
f
te
n
”
.
Ad
d
itio
n
ally
,
f
o
r
item
s
1
,
2
,
3
,
9
,
1
2
,
1
6
,
an
d
1
8
,
a
r
esp
o
n
s
e
o
f
“
s
o
m
etim
e
s
”
was
also
s
co
r
ed
as
p
o
s
itiv
e.
Par
t
A
is
r
ec
o
m
m
en
d
ed
as
a
s
cr
ee
n
in
g
to
o
l
f
o
r
ad
u
lt
ADHD
,
an
d
p
ar
ticip
an
ts
ar
e
co
n
s
id
er
ed
p
o
s
itiv
e
o
n
th
e
ASR
S
v
1
.
1
if
th
ey
en
d
o
r
s
e
4
o
r
m
o
r
e
ite
m
s
in
p
ar
t
A
at
th
e
s
p
ec
if
ie
d
th
r
esh
o
ld
lev
els.
Acc
o
r
d
in
g
ly
,
p
ar
ticip
an
ts
in
t
h
is
s
tu
d
y
wer
e
d
iv
id
ed
i
n
to
t
wo
g
r
o
u
p
s
:
p
o
s
itiv
e
ADHD
s
cr
ee
n
an
d
n
eg
ativ
e
ADHD
s
cr
ee
n
.
Alth
o
u
g
h
p
ar
t
B
is
n
o
t
u
s
ed
f
o
r
d
iag
n
o
s
tic
p
u
r
p
o
s
es,
th
e
f
r
eq
u
en
cy
s
co
r
es
f
r
o
m
p
a
r
t
B
ar
e
u
tili
ze
d
to
co
m
p
u
te
ADHD
s
u
b
s
ca
les am
o
n
g
in
d
iv
id
u
als in
th
e
p
o
s
itiv
e
ADHD
s
cr
ee
n
g
r
o
u
p
.
T
h
ese
s
u
b
s
ca
les
ca
n
ass
is
t
in
id
en
tify
in
g
ADHD
s
u
b
ty
p
es
as
d
ef
in
ed
in
th
e
DSM
-
5
.
Acc
o
r
d
in
g
to
Stan
to
n
et
a
l
.
[
4
5
]
,
th
er
e
ar
e
th
r
ee
ADHD
s
u
b
ty
p
es: in
atten
tiv
e,
h
y
p
e
r
ac
tiv
e/im
p
u
ls
iv
e
(
m
o
to
r
)
,
a
n
d
h
y
p
er
ac
tiv
e/im
p
u
ls
iv
e
(
v
er
b
al)
.
Fo
r
I
DS
-
1
5
,
it
co
n
s
is
ts
o
f
1
5
item
s
g
r
o
u
p
ed
in
to
f
o
u
r
f
ac
to
r
s
:
i
)
escap
is
m
an
d
d
y
s
f
u
n
ctio
n
al
em
o
tio
n
al
co
p
in
g
;
ii
)
with
d
r
awa
l
s
y
m
p
to
m
s
;
iii
)
im
p
ai
r
m
en
ts
an
d
d
y
s
f
u
n
ctio
n
al
s
elf
-
r
eg
u
latio
n
;
an
d
iv
)
d
y
s
f
u
n
ctio
n
al
in
ter
n
et
-
r
ela
ted
s
elf
-
co
n
tr
o
l
[
4
6
]
.
Par
ticip
an
ts
wer
e
ask
ed
to
r
ate
th
eir
in
ter
n
et
u
s
ag
e
o
v
e
r
th
e
p
ast
1
2
m
o
n
th
s
,
u
s
in
g
a
4
-
p
o
in
t
L
ik
e
r
t
s
ca
le
r
an
g
in
g
f
r
o
m
“
s
tr
o
n
g
ly
d
is
ag
r
ee
”
to
“
s
tr
o
n
g
ly
a
g
r
ee
”
.
Hig
h
er
s
co
r
es
r
ef
lect
a
g
r
ea
ter
ten
d
e
n
cy
to
war
d
i
n
ter
n
et
a
d
d
ictio
n
.
I
DS
-
1
5
was
d
ev
elo
p
e
d
to
ass
es
s
in
ter
n
et
ad
d
ictio
n
ac
co
r
d
in
g
to
n
in
e
in
ter
n
et
g
am
in
g
d
is
o
r
d
er
(
I
GD)
cr
iter
i
a
as
s
u
g
g
ested
b
y
th
e
Am
e
r
ican
Ps
y
ch
o
lo
g
ical
Ass
o
ciatio
n
in
th
e
latest
ed
itio
n
o
f
th
e
DSM
-
5
.
I
t
r
e
p
o
r
te
d
ex
h
ib
itin
g
a
d
eq
u
ate
lev
els
o
f
v
alid
ity
an
d
b
e
u
s
ed
in
g
lo
b
al
s
tu
d
ies
[
4
7
]
–
[
4
9
]
.
A
s
y
s
tem
atic
r
ev
iew
s
tu
d
y
in
d
icate
d
th
at
th
e
I
DS
-
1
5
ac
h
ie
v
ed
g
o
o
d
r
esu
lts
in
ter
m
s
o
f
p
s
y
ch
o
m
etr
ic
p
r
o
p
e
r
ties
am
o
n
g
c
h
ild
r
en
a
n
d
a
d
o
lescen
ts
[
5
0
]
.
I
n
g
e
n
er
al,
t
h
e
r
eliab
ilit
y
o
f
th
e
I
DS
-
1
5
an
d
t
h
e
ASR
S
v
1
.
1
was
estab
lis
h
ed
,
d
em
o
n
s
tr
ati
n
g
s
tr
o
n
g
i
n
ter
n
al
c
o
n
s
is
ten
cy
,
with
C
r
o
n
b
ac
h
’
s
alp
h
a
co
ef
f
icien
ts
o
f
0
.
8
0
6
an
d
0
.
8
1
6
,
r
esp
ec
tiv
ely
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t
J
E
v
al
&
R
es E
d
u
c
I
SS
N:
2252
-
8
8
2
2
A
tten
tio
n
-
d
eficit/h
yp
era
ctivity
d
is
o
r
d
er tr
a
its
:
p
r
ev
a
len
ce
a
n
d
d
iffer
en
tia
l a
s
s
o
cia
tio
n
w
ith
…
(
La
w
Mei
-
Yu
i
)
209
3
.
3
.
Da
t
a
a
na
ly
s
is
SP
SS
s
tat
is
tic
s
v
er
s
io
n
2
1
.
0
was
u
s
ed
to
an
aly
ze
th
e
d
ata
in
th
is
s
tu
d
y
.
Descr
ip
tiv
e
s
tati
s
tics
,
in
clu
d
in
g
m
ea
n
,
s
tan
d
ar
d
d
e
v
iatio
n
,
f
r
eq
u
e
n
cy
,
an
d
p
er
ce
n
tag
e,
wer
e
u
tili
ze
d
to
ex
p
lo
r
e
th
e
p
r
ev
alen
ce
o
f
ADHD
tr
aits
am
o
n
g
u
n
iv
e
r
s
ity
s
tu
d
en
ts
in
Ma
lay
s
ia.
I
n
f
er
e
n
tial
an
aly
s
es,
s
p
ec
if
ically
th
e
Pear
s
o
n
c
o
r
r
elatio
n
co
ef
f
icien
t
an
d
r
eg
r
ess
io
n
an
aly
s
is
,
wer
e
em
p
lo
y
ed
to
e
x
a
m
in
e
th
e
r
elatio
n
s
h
ip
b
etwe
en
ADHD
tr
aits
an
d
in
ter
n
et
ad
d
ictio
n
,
as
well
as
to
ass
ess
ADH
D
tr
aits
as
p
r
ed
icto
r
s
o
f
in
te
r
n
et
ad
d
ictio
n
am
o
n
g
u
n
i
v
er
s
ity
s
tu
d
en
ts
in
Ma
lay
s
ia.
Ad
d
iti
o
n
ally
,
th
e
in
d
e
p
en
d
e
n
t
s
am
p
les
t
-
te
s
t
was
em
p
lo
y
ed
to
co
m
p
a
r
e
in
ter
n
et
ad
d
ictio
n
b
etwe
en
ADHD
s
cr
ee
n
-
p
o
s
itiv
e
an
d
ADHD
s
cr
ee
n
-
n
eg
ativ
e
in
d
iv
id
u
als,
as
well
as
to
an
aly
ze
g
en
d
er
d
if
f
er
e
n
ce
s
in
ADHD
tr
aits
.
4.
RE
SU
L
T
S AN
D
D
I
SCU
SS
I
O
N
4
.
1
.
P
re
v
a
lence
o
f
ADH
D
t
r
a
it
s
As s
h
o
wn
in
T
ab
le
1
,
th
e
f
in
d
i
n
g
s
in
d
icate
th
at
a
to
tal
o
f
3
3
5
p
ar
ticip
an
ts
(
2
7
.
8
0
%)
s
cr
ee
n
e
d
p
o
s
itiv
e
in
th
e
p
r
esen
t
s
tu
d
y
,
co
m
p
r
is
in
g
1
0
2
m
ales
(
3
0
.
4
0
%)
an
d
2
3
3
f
em
ales
(
6
9
.
6
0
%).
T
h
e
p
r
e
v
alen
ce
o
f
ADHD
tr
aits
f
o
u
n
d
in
th
is
s
tu
d
y
is
s
ig
n
if
ican
tly
h
ig
h
er
t
h
an
th
e
g
lo
b
al
ad
u
lt
p
r
e
v
alen
ce
r
ate
o
f
4
.
4
0
%,
as
r
ep
o
r
te
d
b
y
Kess
ler
et
a
l
.
[
5
]
.
Ho
wev
er
,
th
e
p
r
ev
alen
ce
r
ate
o
b
s
er
v
ed
in
th
is
s
tu
d
y
is
lo
wer
th
an
th
e
3
9
%
r
ep
o
r
ted
am
o
n
g
u
n
d
er
g
r
ad
u
ates
at
a
u
n
iv
er
s
ity
in
Pah
an
g
[
1
4
]
.
I
t
is
im
p
o
r
tan
t
to
n
o
te
th
at
th
is
f
in
d
in
g
is
n
o
t
g
en
er
aliza
b
le,
as
it
f
o
cu
s
es
o
n
o
n
l
y
one
o
f
Ma
l
ay
s
ia’
s
1
3
s
tates,
s
p
ec
if
ically
one
u
n
i
v
er
s
ity
in
Pah
an
g
,
with
a
r
elativ
ely
s
m
all
s
am
p
le
s
ize
(
n
=
1
8
6
)
.
I
n
th
e
co
n
tex
t
o
f
Asi
an
co
u
n
tr
ies,
th
e
p
r
ev
alen
ce
o
f
ADHD
tr
aits
id
en
tifie
d
in
th
is
s
tu
d
y
is
co
n
s
id
er
ab
ly
h
ig
h
er
th
an
th
e
4
.
5
0
%
r
ep
o
r
te
d
am
o
n
g
u
n
iv
er
s
ity
s
tu
d
en
ts
in
So
u
th
er
n
C
h
in
a
[
2
1
]
,
y
et
clo
s
ely
alig
n
s
with
th
e
2
7
%
p
r
e
v
alen
ce
o
b
s
er
v
e
d
am
o
n
g
co
lleg
e
s
t
u
d
en
ts
in
J
ap
a
n
[
2
8
]
.
L
ik
e
t
h
e
r
esear
ch
c
o
n
d
u
cted
b
y
T
aten
o
et
a
l
.
[
2
8
]
,
th
is
s
tu
d
y
ass
ess
ed
ADHD
tr
aits
u
s
in
g
th
e
ASR
S.
Var
iatio
n
s
in
ADHD
p
r
ev
alen
ce
ac
r
o
s
s
s
tu
d
ies
m
ay
b
e
in
f
lu
en
ce
d
b
y
d
if
f
e
r
en
ce
s
in
s
elf
-
r
ep
o
r
ted
ass
ess
m
en
t
to
o
ls
u
s
ed
t
o
ev
alu
ate
ADHD
tr
aits
am
o
n
g
u
n
i
v
er
s
ity
s
tu
d
e
n
ts
.
Ad
d
itio
n
ally
,
s
tig
m
a
an
d
a
lack
o
f
awa
r
en
ess
r
eg
a
r
d
i
n
g
m
en
tal
h
ea
lth
d
is
o
r
d
er
s
m
ay
d
is
co
u
r
a
g
e
M
alay
s
ian
u
n
iv
er
s
ity
s
tu
d
en
ts
f
r
o
m
o
p
e
n
ly
d
is
cu
s
s
in
g
ADHD
-
r
elate
d
co
n
ce
r
n
s
with
th
eir
p
ee
r
s
,
p
ar
en
ts
,
lectu
r
er
s
,
o
r
m
en
tal
h
ea
lth
p
r
ac
titi
o
n
er
s
.
C
o
n
s
eq
u
en
tly
,
th
e
y
m
ay
attem
p
t
to
co
n
ce
al
th
eir
s
y
m
p
to
m
s
in
d
aily
in
ter
a
ctio
n
s
,
p
r
ev
e
n
tin
g
ea
r
ly
d
etec
t
io
n
an
d
in
ter
v
en
tio
n
.
T
ab
le
1
.
Pre
v
ale
n
ce
o
f
ADHD
tr
aits
G
e
n
d
e
r
A
S
R
S
-
v
1
.
1
P
a
r
t
A
scre
e
n
p
o
s
i
t
i
v
e
(
n
=
3
3
5
)
A
S
R
S
-
v
1
.
1
P
a
r
t
A
scre
e
n
n
e
g
a
t
i
v
e
(
n
=
8
6
9
)
F
r
e
q
u
e
n
c
y
%
F
r
e
q
u
e
n
c
y
%
M
a
l
e
1
0
2
3
0
.
4
0
2
3
8
2
7
.
4
0
F
e
mal
e
2
3
3
6
9
.
6
0
6
3
2
7
2
.
6
0
4
.
2
.
Rela
t
io
ns
hip
bet
wee
n AD
H
D
t
ra
it
s
a
nd
inte
rnet
a
dd
ict
io
n
As
s
h
o
wn
in
T
ab
le
2
,
a
s
ig
n
if
ican
t
p
o
s
itiv
e
r
elatio
n
s
h
ip
was
f
o
u
n
d
b
etwe
e
n
ADHD
tr
aits
an
d
in
ter
n
et
ad
d
ictio
n
(
r
=
0
.
2
9
1
,
p
<
0
.
0
1
)
.
Ad
d
itio
n
ally
,
all
in
d
icato
r
s
d
em
o
n
s
tr
ated
a
s
ig
n
if
ican
t
p
o
s
itiv
e
r
elatio
n
s
h
ip
,
e
x
ce
p
t
f
o
r
th
e
r
elatio
n
s
h
ip
b
etwe
en
h
y
p
er
ac
ti
v
e/im
p
u
ls
iv
e
(
b
o
th
m
o
to
r
a
n
d
v
er
b
al)
t
r
aits
an
d
f
ac
to
r
1
an
d
f
ac
to
r
4
.
T
h
e
m
ag
n
itu
d
e
o
f
th
ese
r
elatio
n
s
h
ip
s
r
an
g
ed
f
r
o
m
wea
k
to
m
o
d
e
r
ate.
Acc
o
r
d
in
g
to
C
o
h
en
[
5
1
]
,
th
e
ef
f
ec
t
s
ize
o
f
th
ese
r
elatio
n
s
h
ip
s
r
an
g
ed
f
r
o
m
s
m
all
(
r
=0
.
1
0
)
to
m
ed
iu
m
(
r
=0
.
3
0
)
.
Similar
ly
,
p
r
ev
io
u
s
s
tu
d
ies
[
1
0
]
,
[
2
1
]
,
[
3
1
]
o
n
u
n
i
v
er
s
ity
s
tu
d
en
ts
also
r
ev
ea
led
s
ig
n
if
ican
t p
o
s
itiv
e
a
s
s
o
ciatio
n
s
b
etwe
en
ADHD
tr
aits
an
d
in
ter
n
et
ad
d
ictio
n
.
Am
o
n
g
ADHD
tr
a
its
,
in
atten
tio
n
ap
p
ea
r
s
to
h
av
e
th
e
s
tr
o
n
g
est
co
r
r
elatio
n
with
in
ter
n
et
ad
d
i
ctio
n
,
as
it
was
p
o
s
itiv
ely
ass
o
ciate
d
with
all
f
o
u
r
f
ac
to
r
s
o
f
in
ter
n
et
ad
d
ictio
n
.
I
n
co
n
tr
ast,
m
o
to
r
an
d
v
e
r
b
a
l
im
p
u
ls
iv
ity
o
r
h
y
p
e
r
ac
tiv
ity
wer
e
lin
k
ed
to
o
n
l
y
2
o
u
t
o
f
th
e
4
f
ac
to
r
s
.
A
p
r
im
ar
y
ch
ar
ac
ter
is
tic
o
f
in
atten
tio
n
is
a
ten
d
en
cy
to
b
ec
o
m
e
ea
s
ily
b
o
r
ed
.
T
h
e
in
ter
n
et
ef
f
ec
tiv
el
y
m
itig
ates
b
o
r
ed
o
m
b
y
allo
win
g
u
s
er
s
to
en
g
ag
e
i
n
m
u
lti
p
le
ac
tiv
ities
s
im
u
ltan
eo
u
s
ly
[
3
6
]
,
[
3
7
]
.
W
h
en
b
r
o
wsi
n
g
th
e
web
,
s
tu
d
e
n
ts
with
in
atten
tio
n
al
tr
aits
m
ay
o
p
en
m
u
ltip
le
win
d
o
ws
at
o
n
ce
an
d
r
ap
i
d
ly
s
h
if
t
f
r
o
m
1
o
n
lin
e
item
to
th
e
n
ex
t.
4
.
3
.
ADH
D
t
ra
it
s
a
s
predict
o
rs o
f
inte
rnet
a
dd
ict
io
n
As
s
h
o
wn
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T
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a
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ADH
D
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em
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s
[
3
7
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,
[
5
2
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.
A
d
d
it
io
n
all
y
,
i
n
d
i
v
id
u
als
w
it
h
h
i
g
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im
p
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y
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e
m
o
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o
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h
i
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t
s
y
m
p
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s
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et
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y
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s
e
d
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r
[
5
3
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,
[
5
4
]
.
Du
e
t
o
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o
g
n
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ti
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e
an
d
m
o
ti
v
at
io
n
a
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d
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u
n
ct
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n
,
u
n
i
v
e
r
s
it
y
s
tu
d
en
ts
wi
th
ADHD
t
r
a
its
a
r
e
p
ar
tic
u
l
ar
ly
d
r
aw
n
t
o
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n
t
er
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et
a
cti
v
it
ies
,
w
h
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o
f
f
er
a
b
u
n
d
a
n
t
s
ti
m
u
li,
in
s
tan
t
r
es
p
o
n
s
es
,
an
d
im
m
e
d
ia
te
r
e
wa
r
d
s
.
T
h
ese
f
ea
tu
r
es
ef
f
ec
ti
v
el
y
m
i
n
im
iz
e
t
h
e
ir
av
er
s
io
n
to
d
el
ay
e
d
r
ew
ar
d
s
[
2
1
]
.
I
n
t
h
e
v
i
r
t
u
a
l
wo
r
l
d
,
a
d
u
lts
wi
th
A
DHD
ca
n
e
x
p
er
ie
n
c
e
p
o
s
it
iv
e
em
o
t
io
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s
a
n
d
b
u
il
d
f
r
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n
d
s
h
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p
s
m
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e
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h
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r
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y
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li
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n
th
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d
y
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in
atten
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f
o
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n
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to
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tr
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te
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o
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ter
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th
a
n
m
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r
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al
im
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ity
o
r
h
y
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ity
.
T
h
is
f
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d
in
g
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s
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p
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ted
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l
.
[
3
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an
d
Z
h
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n
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l
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[
2
1
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,
w
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ed
th
at
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m
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ls
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n
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ap
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s
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ig
n
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Ay
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l
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5
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f
o
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o
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o
t
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tiv
ity
o
r
im
p
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ls
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ity
p
r
e
d
icted
in
ter
n
et
ad
d
ictio
n
.
Fro
m
a
d
ev
elo
p
m
e
n
tal
p
er
s
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ec
tiv
e,
h
y
p
er
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tiv
ity
a
n
d
im
p
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ls
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s
y
m
p
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s
ten
d
to
d
im
in
is
h
o
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e,
wh
er
ea
s
atten
tio
n
d
ef
icits
ar
e
m
o
r
e
lik
ely
to
p
er
s
is
t
in
to
a
d
u
lth
o
o
d
[
3
5
]
.
C
o
n
s
eq
u
en
tly
,
in
atten
tio
n
s
y
m
p
to
m
s
m
ay
b
e
m
o
r
e
p
r
ev
ale
n
t
am
o
n
g
u
n
iv
er
s
ity
s
tu
d
en
ts
an
d
ex
er
t
a
g
r
ea
ter
in
f
lu
en
ce
o
n
th
ei
r
o
n
lin
e
b
eh
av
io
r
s
.
Ho
wev
er
,
th
is
ass
u
m
p
tio
n
r
eq
u
ir
es f
u
r
th
er
test
in
g
an
d
v
er
if
icatio
n
.
T
ab
le
2
.
R
elatio
n
s
h
ip
b
etwe
en
ADHD
tr
aits
an
d
in
ter
n
et
ad
d
ictio
n
I
n
d
i
c
a
t
o
r
s
1
2
3
4
5
6
7
8
ADHD
I
n
a
t
t
e
n
t
i
o
n
0
.
9
0
8
*
*
M
o
t
o
r
0
.
8
1
2
*
*
0
.
5
9
1
*
*
V
e
r
b
a
l
0
.
7
0
2
*
*
0
.
4
5
5
*
*
0
.
4
5
6
*
*
I
n
t
e
r
n
e
t
a
d
d
i
c
t
i
o
n
0
.
2
9
1
*
*
0
.
3
0
4
*
*
0
.
1
7
7
*
*
0
.
1
9
4
*
*
F
a
c
t
o
r
1
0
.
1
0
4
*
*
0
.
1
1
9
*
*
0
.
0
4
6
0
.
0
7
1
0
.
5
5
3
*
*
F
a
c
t
o
r
2
0
.
2
6
1
*
*
0
.
2
4
3
*
*
0
.
2
0
7
*
*
0
.
1
7
6
*
*
0
.
7
9
2
*
*
0
.
3
6
8
*
*
F
a
c
t
o
r
3
0
.
2
1
7
*
*
0
.
2
2
9
*
*
0
.
1
1
3
*
*
0
.
1
6
4
*
*
0
.
6
7
3
*
*
0
.
0
1
1
0
.
3
5
5
*
*
F
a
c
t
o
r
4
0
.
1
5
7
*
*
0
.
1
9
1
*
*
0
.
0
7
7
0
.
0
7
4
0
.
5
4
0
*
*
-
0
.
0
0
4
0
.
2
4
7
*
*
0
.
3
1
6
*
*
*
*
C
o
r
r
e
l
a
t
i
o
n
i
s s
i
g
n
i
f
i
c
a
n
t
a
t
t
h
e
0
.
0
1
l
e
v
e
l
(
2
-
t
a
i
l
e
d
)
.
F
a
c
t
o
r
1
(
e
sc
a
p
i
sm
a
n
d
d
y
sf
u
n
c
t
i
o
n
a
l
e
mo
t
i
o
n
a
l
c
o
p
i
n
g
)
;
f
a
c
t
o
r
2
(
w
i
t
h
d
r
a
w
a
l
s
y
mp
t
o
ms
)
;
f
a
c
t
o
r
3
(
i
mp
a
i
r
me
n
t
s
a
n
d
d
y
sf
u
n
c
t
i
o
n
a
l
s
e
l
f
-
r
e
g
u
l
a
t
i
o
n
)
;
a
n
d
f
a
c
t
o
r
4
(
d
y
sf
u
n
c
t
i
o
n
a
l
i
n
t
e
r
n
e
t
-
r
e
l
a
t
e
d
se
l
f
-
c
o
n
t
r
o
l
)
.
T
ab
le
3
.
ADHD
tr
aits
as p
r
ed
i
cto
r
s
o
f
in
ter
n
et
ad
d
ictio
n
C
o
e
f
f
i
c
i
e
n
t
s
B
t
S
i
g
t
I
n
a
t
t
e
n
t
i
o
n
0
.
0
6
9
0
.
2
8
5
8
.
0
9
8
<
0
.
0
1
M
o
t
o
r
0
.
0
1
1
0
.
0
2
7
0
.
7
6
1
0
.
4
4
7
V
e
r
b
a
l
0
.
0
3
7
0
.
0
7
6
2
.
3
9
5
0
.
0
1
7
ANOVA
S
u
m
o
f
s
q
u
a
r
e
df
M
e
a
n
sq
u
a
r
e
F
S
i
g
R
e
g
r
e
ssi
o
n
3
5
.
9
9
6
3
1
1
.
9
9
9
4
2
.
8
5
6
<
0
.
0
1
R
e
si
d
u
a
l
3
3
5
.
9
6
8
1
2
0
0
0
.
2
8
0
To
t
a
l
3
7
1
.
9
6
4
1
2
0
3
N
o
t
e
:
R
2
=
0
.
0
9
7
(
9
.
7
0
%
)
4
.
4
.
Co
m
pa
riso
n
o
f
inte
rnet
a
d
dict
io
n
bet
wee
n
ADH
D
s
cr
ee
n
-
po
s
it
iv
e
a
nd
ADH
D
s
cr
ee
n
-
neg
a
t
iv
e
ind
iv
id
ua
ls
As
s
h
o
wn
in
Fig
u
r
e
1
,
th
e
f
in
d
in
g
s
in
d
icate
th
at
th
e
m
ea
n
in
ter
n
et
ad
d
ictio
n
test
s
co
r
e
f
o
r
ADHD
s
cr
ee
n
-
p
o
s
itiv
e
in
d
iv
id
u
als
(
3
.
0
0
±
0
.
5
9
)
was
s
ig
n
if
ican
tly
h
ig
h
e
r
t
h
an
th
at
o
f
ADH
D
s
cr
ee
n
-
n
e
g
ativ
e
in
d
iv
id
u
als
(
2
.
7
3
±
0
.
5
2
)
,
t
(
1
2
0
2
)
=
-
7
.
3
7
2
,
p
<
0
.
0
0
1
.
T
h
e
e
f
f
ec
t
s
ize,
ca
lcu
lated
u
s
in
g
eta
s
q
u
ar
ed
,
r
a
n
g
ed
f
r
o
m
0
.
0
1
t
o
0
.
0
4
,
s
u
g
g
esti
n
g
a
s
m
all
to
m
o
d
e
r
ate
d
if
f
e
r
en
ce
i
n
i
n
ter
n
et
ad
d
ictio
n
b
etwe
en
ADHD
s
cr
ee
n
-
p
o
s
itiv
e
an
d
ADHD
s
cr
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eg
ativ
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i
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d
iv
id
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als.
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d
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e
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ativ
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iv
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als.
T
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f
in
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p
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s
tu
d
ies
co
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ct
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Asi
an
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o
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n
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ies,
wh
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em
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tr
ated
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tu
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y
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m
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th
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ee
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[
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[
2
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h
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o
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s
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ch
as
ex
ce
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p
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r
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ewa
r
d
s
,
a
h
eig
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ten
ed
p
r
ef
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ce
f
o
r
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s
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t
g
r
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icatio
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,
a
n
d
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en
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itiv
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ay
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ce
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ter
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ictio
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d
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lts
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D
[
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Dis
in
h
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itio
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o
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o
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if
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eg
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latio
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T
h
u
s
,
in
ter
n
al
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is
in
h
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itio
n
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d
ex
te
r
n
al
im
p
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l
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iv
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b
eh
av
io
r
s
lik
ely
p
lay
a
s
ig
n
if
ican
t
r
o
le
in
ex
ce
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ter
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et
u
s
e
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en
ts
wh
o
s
cr
ee
n
p
o
s
itiv
e
f
o
r
ADHD
tr
aits
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t
J
E
v
al
&
R
es E
d
u
c
I
SS
N:
2252
-
8
8
2
2
A
tten
tio
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d
eficit/h
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ctivity
d
is
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d
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its
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p
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tia
l a
s
s
o
cia
tio
n
w
ith
…
(
La
w
Mei
-
Yu
i
)
211
Fig
u
r
e
1
.
C
o
m
p
a
r
is
o
n
o
f
in
ter
n
et
ad
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ictio
n
b
etwe
en
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cr
ee
n
-
p
o
s
itiv
e
an
d
ADHD
s
cr
ee
n
-
n
e
g
ativ
e
in
d
iv
id
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als
4
.
5
.
G
ender
diff
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ence
s
in A
DH
D
t
ra
it
s
As
s
h
o
wn
in
T
ab
le
4
,
th
e
f
in
d
in
g
s
in
d
icate
th
at
th
er
e
was
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o
s
ig
n
if
ican
t
g
en
d
er
d
i
f
f
er
en
ce
in
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aits
,
t
(
1
2
0
2
)
=
1
.
8
8
,
p
>
0
.
0
5
.
T
h
is
s
u
g
g
ests
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at
th
e
m
ea
n
A
DHD
tr
aits
tes
t
s
co
r
e
f
o
r
m
ale
u
n
iv
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s
ity
s
tu
d
en
ts
was
n
o
t
s
ig
n
if
ican
tly
h
ig
h
er
th
an
f
e
m
ale
u
n
iv
er
s
ity
s
tu
d
e
n
t
s
.
Ad
d
itio
n
ally
,
n
o
s
ig
n
if
ican
t
d
if
f
er
e
n
ce
s
wer
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r
ep
o
r
ted
b
etwe
en
m
ale
a
n
d
f
e
m
ale
u
n
iv
er
s
ity
s
tu
d
en
ts
in
M
alay
s
ia
f
o
r
ea
ch
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tr
ait.
Similar
ly
,
p
r
ev
io
u
s
r
esear
ch
[
2
0
]
,
[
3
1
]
,
[
4
2
]
r
ep
o
r
te
d
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o
s
ig
n
if
ican
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g
e
n
d
er
d
if
f
e
r
en
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am
o
n
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lts
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p
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lan
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w
h
y
m
ales
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lo
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h
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it
s
ig
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if
ica
n
tly
h
i
g
h
e
r
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aits
th
an
f
em
ales
in
ad
u
lth
o
o
d
m
ay
lie
in
th
e
ch
an
g
es
in
s
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m
p
to
m
p
r
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tatio
n
.
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ch
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h
o
o
d
,
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is
m
o
r
e
r
ea
d
ily
d
etec
ted
in
m
ale
,
as
th
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ten
d
to
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is
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lay
m
o
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p
u
ls
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e
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io
r
s
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em
ale
o
f
ten
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h
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it
in
atten
tiv
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b
eh
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io
r
s
,
wh
ich
ar
e
m
o
r
e
lik
ely
to
b
e
o
v
er
lo
o
k
ed
.
As
i
n
d
iv
id
u
als
m
atu
r
e,
im
p
u
ls
iv
e
b
eh
av
io
r
s
ten
d
t
o
d
im
in
is
h
,
wh
ile
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atten
tiv
e
tr
aits
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er
s
is
t,
r
esu
lt
in
g
in
a
m
o
r
e
b
alan
ce
d
g
en
d
e
r
d
is
tr
ib
u
tio
n
o
f
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in
ad
u
lth
o
o
d
.
T
ab
le
4
.
Gen
d
er
d
if
f
er
en
ce
s
in
ADHD
tr
aits
G
e
n
d
e
r
M
e
a
n
S
t
a
n
d
a
r
d
d
e
v
i
a
t
i
o
n
t
S
i
g
.
(
2
-
t
a
i
l
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d
)
ADHD
M
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l
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mal
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6
.
4
2
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4
4
.
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3
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1
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8
8
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1
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t
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M
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3
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6
6
3
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4
7
2
.
2
9
2
.
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.
2
6
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2
0
8
M
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M
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2
2
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3
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1
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4
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V
e
r
b
a
l
M
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1
.
2
4
1
.
1
7
1
.
1
2
1
.
8
0
0
.
0
7
2
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
8
2
2
I
n
t
J
E
v
al
&
R
es E
d
u
c
,
Vo
l
.
15
,
No
.
1
,
Feb
r
u
a
r
y
20
2
6
:
205
-
215
212
5.
CO
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r
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t
r
e
g
r
e
s
s
i
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n
m
o
d
e
l
a
c
c
o
u
n
t
s
f
o
r
o
n
l
y
9
.
7
%
o
f
t
h
e
v
a
r
i
a
n
c
e
i
n
i
n
t
e
r
n
et
a
d
d
ic
t
i
o
n
.
T
h
e
f
in
d
in
g
s
o
f
th
is
s
tu
d
y
a
r
e
h
ig
h
ly
v
alu
ab
le
in
r
aisi
n
g
p
u
b
lic
awa
r
en
ess
ab
o
u
t
th
e
im
p
o
r
tan
ce
o
f
ad
d
r
ess
in
g
ad
u
lt
ADHD
.
E
ar
ly
id
en
tific
atio
n
ca
n
s
ig
n
i
f
ican
tly
en
h
a
n
ce
th
e
m
en
tal
h
ea
lth
o
f
u
n
iv
er
s
it
y
s
tu
d
en
ts
s
tr
u
g
g
lin
g
with
in
atten
tio
n
an
d
im
p
u
ls
iv
ity
.
I
n
lig
h
t
o
f
th
is
,
it
is
p
r
o
p
o
s
ed
th
at
ca
m
p
u
s
co
u
n
s
ellin
g
ce
n
ter
s
im
p
lem
en
t
ADHD
s
cr
ee
n
in
g
in
itiativ
es
to
f
ac
il
itate
ea
r
ly
d
etec
tio
n
,
wh
ic
h
ca
n
t
h
en
i
n
f
o
r
m
p
er
s
o
n
alize
d
in
ter
v
en
tio
n
s
.
R
ath
er
th
an
r
el
y
in
g
o
n
o
n
e
-
s
ize
-
f
its
-
all
ap
p
r
o
ac
h
es,
tailo
r
e
d
i
n
ter
v
en
tio
n
s
s
h
o
u
ld
b
e
d
ev
elo
p
ed
to
m
itig
ate
th
e
a
d
v
er
s
e
ef
f
ec
ts
o
f
ad
u
lt
ADHD
o
n
th
e
d
aily
f
u
n
ctio
n
in
g
o
f
u
n
iv
er
s
ity
s
tu
d
en
ts
in
Ma
lay
s
ia.
Ad
d
itio
n
ally
,
b
o
th
th
e
g
o
v
er
n
m
en
t
an
d
u
n
iv
er
s
it
y
m
an
ag
em
e
n
t
s
h
o
u
ld
ac
tiv
el
y
p
r
o
m
o
te
co
p
in
g
s
tr
ateg
ies
an
d
h
elp
-
s
ee
k
in
g
b
eh
av
io
r
s
am
o
n
g
i
n
d
iv
id
u
als
af
f
ec
ted
b
y
n
e
u
r
o
d
ev
el
o
p
m
en
tal
d
is
o
r
d
er
s
.
Ps
y
ch
o
ed
u
ca
tio
n
an
d
in
ter
v
e
n
tio
n
s
tar
g
etin
g
e
x
ce
s
s
iv
e
in
ter
n
et
u
s
e
s
h
o
u
l
d
also
ac
co
u
n
t
f
o
r
th
e
p
r
esen
ce
o
f
ADHD
tr
aits
am
o
n
g
s
tu
d
en
ts
.
Peer
s
u
p
p
o
r
t
g
r
o
u
p
s
an
d
ap
p
r
o
ac
h
es
g
r
o
u
n
d
e
d
in
c
o
g
n
itiv
e
b
eh
av
io
r
al
t
h
er
ap
y
(
C
B
T
)
ca
n
b
e
em
p
lo
y
e
d
to
i
m
p
r
o
v
e
atten
ti
o
n
,
im
p
u
ls
e
co
n
tr
o
l,
an
d
h
ea
lth
y
d
ig
ital
en
g
ag
em
en
t.
Du
r
in
g
th
e
in
ter
v
en
tio
n
p
r
o
ce
s
s
,
d
ig
ital
to
o
ls
s
u
ch
as
s
cr
ee
n
tim
e
tr
ac
k
er
s
m
ay
b
e
u
s
ed
to
m
o
n
ito
r
b
eh
av
io
r
al
ch
an
g
es.
I
n
th
is
tech
n
o
l
o
g
ical
er
a,
p
s
y
ch
o
lo
g
y
ex
p
er
ts
ca
n
co
llab
o
r
ate
with
I
T
s
p
ec
ialis
ts
to
d
ev
elo
p
g
am
if
ied
in
ter
v
en
tio
n
s
th
at
h
elp
m
an
a
g
e
ADHD
tr
aits
an
d
r
ed
ir
ec
t
d
ig
ital
en
g
ag
em
en
t
am
o
n
g
th
ese
tech
-
s
av
v
y
in
d
iv
id
u
als.
Fo
r
in
s
tan
ce
,
co
g
n
itiv
e
tr
ain
in
g
g
am
es
m
ay
b
e
d
esig
n
ed
to
en
h
a
n
ce
atten
tio
n
s
p
an
an
d
im
p
u
ls
e
co
n
tr
o
l
in
ad
u
lts
with
ADHD
.
Ad
d
itio
n
ally
,
d
ig
ital
d
eto
x
g
am
es
co
u
ld
b
e
co
n
s
id
er
e
d
to
r
ed
u
ce
co
m
p
u
ls
iv
e
b
r
o
wsi
n
g
b
eh
av
i
o
r
s
.
Me
n
tal
h
ea
lth
p
r
o
f
ess
io
n
als s
h
o
u
ld
f
u
r
t
h
er
ad
v
o
ca
te
f
o
r
n
eu
r
o
d
ev
elo
p
m
en
tal
liter
ac
y
an
d
d
ig
ital
h
y
g
ien
e
am
o
n
g
s
tu
d
e
n
ts
,
p
ar
en
ts
,
an
d
ed
u
ca
t
o
r
s
.
Fin
ally
,
s
u
b
ject
-
m
atter
ex
p
e
r
t
s
ar
e
en
co
u
r
ag
ed
t
o
co
llab
o
r
ate
with
r
elev
a
n
t
au
t
h
o
r
ities
an
d
th
e
Min
is
tr
y
o
f
Hea
lth
to
d
ev
elo
p
g
u
id
elin
es
f
o
r
h
ea
lth
y
d
ig
ital
en
g
ag
em
e
n
t a
n
d
i
n
clu
s
iv
e
m
e
n
tal
h
ea
lth
p
o
licies.
F
UNDING
I
NF
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R
M
A
T
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h
is
r
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ch
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p
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Un
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213
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[
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eq
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est.
RE
F
E
R
E
NC
E
S
[
1
]
A
meric
a
n
P
sy
c
h
i
a
t
r
i
c
A
ss
o
c
i
a
t
i
o
n
,
D
i
a
g
n
o
s
t
i
c
a
n
d
st
a
t
i
st
i
c
a
l
m
a
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a
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m
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n
t
a
l
d
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s
o
r
d
e
rs
(
D
S
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(
R)
)
,
5
t
h
e
d
.
A
r
l
i
n
g
t
o
n
,
TX
:
A
meric
a
n
P
s
y
c
h
i
a
t
r
i
c
A
sso
c
i
a
t
i
o
n
,
2
0
1
3
.
[
2
]
J.
A
.
S
e
d
g
w
i
c
k
-
M
ü
l
l
e
r
e
t
a
l
.
,
“
U
n
i
v
e
r
s
i
t
y
s
t
u
d
e
n
t
s
w
i
t
h
a
t
t
e
n
t
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d
e
f
i
c
i
t
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p
e
r
a
c
t
i
v
i
t
y
d
i
s
o
r
d
e
r
(
A
D
H
D
)
:
a
c
o
n
se
n
s
u
s
st
a
t
e
me
n
t
f
r
o
m
t
h
e
U
K
a
d
u
l
t
A
D
H
D
n
e
t
w
o
r
k
(
U
K
A
A
N
)
,
”
B
M
C
Ps
y
c
h
i
a
t
r
y
,
v
o
l
.
2
2
,
n
o
.
1
,
p
.
2
9
2
,
2
0
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2
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o
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1
0
.
1
1
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-
z.
[
3
]
S
.
M
a
t
t
h
i
e
s
a
n
d
A
.
P
h
i
l
i
p
s
e
n
,
“
C
o
m
o
r
b
i
d
i
t
y
o
f
p
e
r
s
o
n
a
l
i
t
y
d
i
s
o
r
d
e
r
s
a
n
d
a
d
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l
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t
t
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n
t
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o
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d
e
f
i
c
i
t
h
y
p
e
r
a
c
t
i
v
i
t
y
d
i
s
o
r
d
e
r
(ADHD
)
—
r
e
v
i
e
w
o
f
r
e
c
e
n
t
f
i
n
d
i
n
g
s
,
”
C
u
rre
n
t
P
syc
h
i
a
t
r
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R
e
p
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s
,
v
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l
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s
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-
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-
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6
7
5
-
4.
[
4
]
P
.
S
o
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g
,
M
.
Z
h
a
,
Q
.
Y
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n
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6
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.
[
3
7
]
E.
D
a
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b
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a
k
,
C
.
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r
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n
,
S
.
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:
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2
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0
4
.
0
3
5
.
[
3
8
]
W
.
Li
,
W
.
Z
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n
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,
L
.
X
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N
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,
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,
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0
2
0
.
[
3
9
]
W
.
N
.
A
mo
r
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m
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n
d
S
.
C
.
M
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u
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s,
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:
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1
0
3
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/
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n
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0
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0
0
1
5
6
.
[
4
0
]
R
.
G
h
i
a
c
c
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o
,
A
.
P
a
ss
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r
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,
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.
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,
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M
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,
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.
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,
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n
d
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.
d
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P
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x
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so
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[
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