Topic: Irritable Bowel Syndrome, Gut Health, Lifestyle, and Academic Factors as Predictors of Attention Deficit Hyperactivity Disorder (ADHD) Likelihood: A Cross-sectional Study

Topic: Irritable Bowel Syndrome, Gut Health, Lifestyle, and Academic Factors as Predictors of Attention Deficit Hyperactivity Disorder (ADHD) Likelihood: A Cross-sectional Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Topic: Irritable Bowel Syndrome, Gut Health, Lifestyle, and Academic Factors as Predictors of Attention Deficit Hyperactivity Disorder (ADHD) Likelihood: A Cross-sectional Study Zeeshan Ahmed, Muhammad Asad Raza, Alveena Azeem, Bushra Anwar, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6875240/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract Background: Irritable Bowel Syndrome (IBS) and Attention Deficit Hyperactivity Disorder (ADHD) are prevalent chronic conditions, significantly impacting quality of life. Despite their co-occurrence, potential associations remain underinvestigated, particularly among university students and recent graduates in Pakistan. Understanding this comorbidity and finding other predictors in an underdeveloped country allows timely diagnosis, appropriate intervention, and improved health outcomes. Objectives: 1. To determine the association of ADHD likelihood with IBS. 2. To find the predictors of ADHD including gut health, lifestyle, and academic factors, among university students and graduates in Pakistan. Methods: This cross-sectional study included 163 participants aged 18–35 years, recruited through convenience sampling using an online questionnaire. IBS was assessed using Rome IV criteria, while ADHD symptoms were evaluated with Part A of the Adult ADHD Self-Report Scale (ASRS). Logistic regression was performed to identify associations and adjust for potential confounders using STATA and Python. Results: ADHD likelihood was found among 31.9% students, with protective factors including moderate physical activity (AOR: 0.18; 95% CI: 0.02–0.65, p=0.026) and enrollment in pharmaceutical fields compared to MBBS (AOR: 0.28; 95% CI: 0.10–0.91, p=0.035). No significant association was observed between IBS and ADHD (AOR: 1.08; 95% CI: 0.55–2.10, p=0.831). Strong predictors were light physical activity (1–3 days a week), experiencing pain related to defecation, having a sausage-shaped stool with cracks on the surface, daily caffeine intake and a moderate physical activity. These are divided into academic, lifestyle and gut health factors. Conclusions: This study highlights distinct predictors of ADHD likelihood among university students and graduates in Pakistan. No significant association was found between IBS and ADHD. ADHD likelihood was influenced by other lifestyle and academic variables such as physical activity and field of study. These findings emphasize the importance of addressing diverse academic, lifestyle, and gut-related factors when considering the ADHD management. IBS ADHD prevalence predictors university students risk factors Pakistan Figures Figure 1 Introduction Irritable Bowel Syndrome (IBS) is a prevalent functional gastrointestinal disorder characterized by abdominal pain, discomfort, bloating, and changes in bowel habits, occurring without any identifiable organic cause for a period of more than three months [1]. Meta-analyses and large surveys report that the pooled prevalence of IBS using Rome IV criteria is about 3.8% (95% CI 3.1–4.5%) across 34 countries and over 80,000 individuals[2]. Attention Deficit Disorder (ADD), on the other hand, is a neurodevelopmental behavioral disorder marked by symptoms of inattention, impulsivity, and sometimes hyperactivity, which affects approximately 5% of children, often persisting into adulthood [3]. Attention Deficit Hyperactivity Disorder (ADHD) can persist into adulthood in individuals, with an estimated global prevalence of 3.4% in the 18–44 age group [4]. Although there is evidence linking ADHD to various somatic conditions such as obesity and asthma, the literature on GI comorbidities, especially in adults, is limited and inconsistent [4]. Most existing studies focus on children, with mixed results regarding the association between ADHD and GI symptoms like chronic diarrhea and abdominal pain [4]. IBS not only affects up to 31% of the population but is also chronic, being a major reason for gastroenterology referrals [5]. It significantly impacts patients' quality of life and incurs substantial healthcare costs [5]. ADHD also has profound effects on quality of life and public health, affecting both psychosocial well-being and physical health [6]. Despite extensive research on ADHD's psychiatric comorbidities, somatic comorbid conditions remain underexplored, particularly in adults. There is an established body of literature suggesting a bidirectional relationship between IBS and various mental disorders; however, the specific connection between IBS and ADHD remains underexplored, particularly in adult populations [7]. Existing studies have primarily focused on other neurodevelopmental and psychiatric disorders, linking gastrointestinal hypersensitivity to the gut-brain axis but leaving a gap in the understanding of how IBS may influence the development or exacerbation of ADHD symptoms or vice versa [8][17]. Given that ADHD is associated with a range of somatic health issues, including those affecting quality of life and life expectancy, it is vital to investigate these associations further [9]. Current research primarily emphasizes psychiatric disorders and medication-induced symptoms, with less attention to potential links between ADHD and medical conditions [9]. This research addresses this gap by providing a comprehensive review of associations of ADHD with IBS, gut health and other factors, potentially leading to improved diagnostic practices and treatment approaches that consider both psychiatric and medical aspects of the disorder [9]. We aimed to investigate the association between ADHD likelihood and IBS, and find various predictors of ADHD for its timely diagnosis, including gut health factors (IBS, stool consistency, abdominal pain), academic stress, and lifestyle factors among young adults in higher education settings. Methods This analytical cross-sectional study was conducted among university students and graduates in Pakistan in September 2024. The target population comprised university students and recent graduates aged 18–35 years across Pakistan. Participants were recruited through convenience sampling using multiple channels, including university email lists, social media platforms. Participants were eligible for inclusion if they were currently enrolled in a university program or had graduated within the past five years, were between 18 and 35 years of age, could read and understand either English or Urdu, had access to the internet and a digital device, and provided voluntary informed consent. Individuals were excluded if they had a diagnosed psychiatric condition requiring active pharmacological treatment (except ADHD and mood disorders), suffered from severe chronic medical illnesses known to affect gastrointestinal function, or submitted responses with more than 20% of the questionnaire left incomplete. Based on the expected prevalence of ADHD at 16.8% in the target population, with a 90% confidence level and 5% margin of error, the minimum required sample size was calculated as 152 participants using the formula n = Z²p(1-p)/e² [22]. The required sample size was 152. The final achieved sample of 163 participants, providing adequate power for the primary analysis. Data were collected using a comprehensive, structured online questionnaire developed using Google Forms, comprising five main sections. The first section gathered demographic and academic information including age, gender, field of study, academic level, GPA, and academic stress assessment using a validated 10-point Likert scale. The second section assessed lifestyle factors including physical activity levels categorized using standardized activity classifications, smoking history documented as never, occasionally, regularly, or former smoker, caffeine intake frequency ranging from never to daily consumption, and sleep patterns and quality indicators. The third section focused on gut health and IBS assessment using the Rome IV criteria-based IBS screening questionnaire, history of gastrointestinal disorders and diagnoses, stool consistency assessment using the Bristol Stool Chart, abdominal pain characteristics and associations including timing, triggers, and relief factors, and recurrent gastrointestinal symptoms assessment. The fourth section employed the Adult ADHD Self-Report Scale (ASRS-v1.1) Part A, validated for screening purposes, along with documentation of previous ADHD diagnosis or treatment history and current medication use [13]. The final section included brief anxiety and depression screening questions and self-reported mental health history. In the analysis, ADHD likelihood was defined as positive screening on ASRS Part A with four or more symptoms rated as "often" or "very often". IBS likelihood was determined by meeting Rome IV criteria based on self-reported symptoms. Academic stress was measured on a 10-point scale and categorized as low (less than 5), moderate (5–7), and high (greater than 7). Physical activity levels were categorized as sedentary, lightly active, moderately active, very active, and super active based on frequency and intensity of exercise engagement. Statistical analyses were performed using STATA and Python. Inferential analysis employed chi-square tests for comparing factors among those with ADHD likelihood, no likelihood, and those confirmed with ADHD diagnosis in the past. Logistic regression for categorical variables was performed for factors significantly different among the groups. Random Forest Classifier was used to identify key predictors and their relative importance. Statistical significance was set at p less than 0.1 for all tests. Results The study cohort comprised 163 participants with a mean age of 23.5 ± 3.6 years. The sample was predominantly male, with 100 participants (61.3%) compared to 63 females (38.7%). Regarding academic background, the majority were medical students pursuing MBBS degrees (n = 91, 55.8%), followed by those in pharmaceutical fields (n = 60, 36.8%), with a smaller proportion from other academic disciplines (n = 12, 7.4%). Most participants were undergraduates (n = 106, 65%), while 38 (23.3%) were recent graduates within 1–3 years of completion, and 19 (11.7%) were graduates with more than three years since completion. Regarding ADHD status, 19 participants (11.7%) reported a prior ADHD diagnosis. When screened using the Adult ADHD Self-Report Scale (ASRS), 52 participants (31.9%) showed likelihood for ADHD, who can be potential candidates for further evaluation (refer to Table 1 ). IBS frequency was found to be 41.1%. Table 1 Baseline characteristics of study participants (n = 163) Characteristic n (%) Age (mean ± SD) 23.5 ± 3.6 years Gender • Female 63 (38.7%) • Male 100 (61.3%) Field of Study • MBBS 91 (55.8%) • Pharmaceutical Fields 60 (36.8%) • Other Fields 12 (7.4%) Academic level • Under graduate 106 (65%) • Fresh Graduate (1–3 years of graduation) 38 (23.3%) • Old Graduate (beyond 3 years of graduation) 19 (11.7%) ADHD profile Prior ADHD Diagnosis 19 (11.7%) ASRS ADHD Screening Positive 52 (31.9%) IBS profile Prior IBS Diagnosis 26.7% IBS Screening Positive 67 (41.1%) The data compares ADHD likelihood across three groups (no ADHD, suspected ADHD without diagnosis, and past ADHD diagnosis) across multiple variables. No significant differences were found for gender, age, academic performance, smoking, or caffeine intake. However, field of study (p = 0.0111), past IBS diagnosis (p < 0.001), past GI disorders (p = 0.0268), IBD diagnosis (p = 0.0074), pain association (p = 0.0066), recurrent pain (p = 0.0413), and depression (p = 0.0008) showed statistically significant associations. Those with a past ADHD diagnosis were more likely to report IBS, GI comorbidities (particularly IBD), pain with defecation or frequency changes, and depressive symptoms. These patterns support a biopsychosocial link between ADHD and gut-brain axis disturbances (refer to Table 2 ). Table 2 Frequency of various academic, gut health and lifestyle factors compared in relation with ADHD likelihood and diagnosis. Variable Category No ADHD Likelihood (negative on Screening) ADHD Likelihood (positive on Screening) but No Past ADHD diagnosis Diagnosed with ADHD in past p-value Gender Female 36.4% 42.2% 42.1% Male 63.6% 57.8% 57.9% 0.7573 Age 18–24 67.7% 62.2% 57.9% 25–29 21.2% 28.9% 31.6% 0.8848 30–35 3.0% 2.2% 0.0% 36 and above 8.1% 6.7% 10.5% Academic Factors Field of Study MBBS 53.5% 73.3% 26.3% Other(please specify) 7.1% 6.7% 10.5% 0.0111* Pharmaceutical 39.4% 20.0% 63.2% Academic Performance Average (GPA > 2.0–3.0) 35.1% 40.0% 26.3% Below Average (GPA 3.7) 14.4% 11.1% 15.8% Good (GPA > 3.0-3.7) 50.5% 48.9% 52.6% Gut Health Factors Past IBS Diagnosis No 82.8% 75.6% 21.1% Yes 17.2% 24.4% 78.9% 0*** IBS likelihood positive No 62.7% 62.3% 31.6% Yes 37.4% 37.8% 68.4% 0.1269 Past GI disorder No 64.6% 60.0% 31.6% Yes 35.4% 40.0% 68.4% 0.0268* GI conditions (grouped) Dyspepsia 19.2% 22.2% 26.3% IBD 12.1% 6.7% 36.8% 0.0074** IBS 0.0% 6.7% 0.0% None 51.5% 48.9% 21.1% Other 17.2% 15.6% 15.8% Stool consistency (grouped) Hard/Lumpy 16.2% 20.0% 26.3% Loose/Watery 7.1% 2.2% 10.5% 0.4102 Normal 35.4% 28.9% 42.1% Other 41.4% 48.9% 21.1% Pain association (grouped) None 36.4% 48.9% 0.0% Related to defecation 28.3% 20.0% 31.6% 0.0066** Related to frequency 18.2% 22.2% 47.4% Related to stool form 17.2% 8.9% 21.1% Recurrent Pain No 57.6% 56.1% 26.3% Yes 42.4% 43.9% 73.7% 0.0413* Stool consistency Lumpy and sausage-like 6.1% 6.7% 5.3% Other 48.5% 44.4% 31.6% 0.5614 Sausage-shaped with cracks on the surface) 5.1% 13.3% 0.0% Separate hard lumps 7.1% 6.7% 15.8% Smooth, soft sausage or snake 26.3% 22.2% 36.8% Soft blobs with clear-cut edges 7.1% 6.7% 10.5% Lifestyle Factors Physical Activity Lightly active (light exercise/sports 1–3 days a week) 26.3% 42.2% 15.8% Moderately active (moderate exercise/sports 3–5 days a week) 20.2% 11.1% 21.1% 0.0631 Sedentary (little or no exercise) 42.4% 37.8% 36.8% Super active (physical job or twice daily training) 1.0% 6.7% 10.5% Very active (hard exercise/sports 6–7 days a week) 10.1% 2.2% 15.8% Smoking Never 80.8% 91.1% 84.2% Yes but I have stopped now 2.0% 2.2% 0.0% 0.3384 Yes, occasionally 15.2% 2.2% 15.8% Yes, regularly 2.0% 4.4% 0.0% Caffeine Intake Daily 18.2% 28.9% 26.3% Never 22.2% 20.0% 26.3% 0.8655 Often (5–6 times a week) 10.1% 6.7% 5.3% Rarely (1–2 times a week) 31.3% 33.3% 26.3% Sometimes (3–4 times a week) 18.2% 11.1% 15.8% Other Associated Mental Health symptoms Anxiety No 47.5% 33.3% 15.8% No but I think I have anxiety and mood swings 29.3% 40.0% 36.8% 0.0544 Yes 23.2% 26.7% 47.4% Depression No 60.6% 60.0% 15.8% No but I think I am depressed. 21.2% 24.4% 26.3% 0.0008** Yes 18.2% 15.6% 57.9% P-values calculated using chi-square test. The key predictors of ADHD were identified (using Random Forest classifier method) with importance scores exceeding 0.01, revealing distinct patterns across lifestyle, academic, and gut health categories (Fig. 1 ). Physical activity emerged as the strongest predictor, with lightly active individuals (light exercise 1–3 days weekly) showing the highest importance score (> 0.025), followed by moderately active participants. Gut health factors demonstrated strong predictive power, particularly stool consistency patterns, with sausage-shaped stools with surface cracks and smooth, soft sausage or snake-like consistency both ranking among the top predictors. Pain associations, including pain related to defecation and changes in stool frequency, also showed significant importance scores, reinforcing the gut-brain connection in ADHD manifestation. Academic and lifestyle factors were similarly influential, with daily caffeine intake, academic stress levels (particularly stress scores of 6–8), and field of study (MBBS and pharmaceutical fields) emerging as important predictors. Notably, age categories (18–24 and 25–29), gender, and anxiety levels also contributed to the model, suggesting that ADHD manifestation is influenced by a complex interplay of demographic, lifestyle, gastrointestinal, and academic stress factors rather than any single dominant predictor. Logistic regression was performed for variables showing relation with ADHD likelihood. The model with the best fit is presented here, which shows that moderate physical activity may be a significant predictor of ADHD symptoms in this sample. Other factors (caffeine intake, smoking, field of study) did not show statistically robust associations, though occasional smoking may warrant further investigation. Overall, the model fits modestly and suggests potential behavioral correlates of ADHD symptoms, especially physical activity. (Refer to Table 4 for logistic regression results). Table 4 Logistic regression of ADHD likelihood with Caffeine Intake, Physical Activity, Smoking, Field of Study. Variable Category Odds Ratio Std. Err. P>|z| 95% Conf. Interval Caffeine Intake Never 0.3796 0.2279 0.107 0.1170–1.2313 Often (5–6 times a week) 0.3349 0.2788 0.189 0.0652–1.7133 Rarely (1–2 times a week) 0.9902 0.4908 0.860 0.3156–2.6193 Sometimes (3–4 times a week) 0.4689 0.3179 0.264 -0.1242–1.7711 Physical Activity Moderately active 2.2124 1.3888 0.018 0.0590–0.7643 Sedentary 0.4697 0.2113 0.093 0.1944–1.1359 Super active 2.6019 2.7270 0.362 0.1944–2.2907 Very active 2.2961 0.2713 0.184 0.4918–1.7386 Smoking Yes but I have stopped now 2.0628 3.1649 0.637 0.1019–41.7316 Yes, occasionally 1.2460 0.1345 0.054 0.1214–12.7849 Yes, regularly 1.7581 1.9356 0.608 0.2032–15.2290 Field of Study Other 0.9919 0.8419 0.992 0.1879–5.2355 Pharmaceutical 0.5534 0.2421 0.176 -0.2347–2.3084 Recurrent Pain Logistic Regression Model (with n: 152, LR chi2(14): 25.38, Prob > chi2: 0.0310, Pseudo R2: 0.1339, Log likelihood = -82.105211) Discussion This study explored the predictors of ADHD, including gut health, with a focus on IBS, and other lifestyle and academic factors. Mental health is believed to be linked with gut health as the sensory input from the gut, encoded by primary afferent neurons, immune cells, and enteroendocrine cells, contributes to a complex feedback loop that affects both gut and central nervous system functions [16]. Our study reported co-existence of IBS and ADHD, but it was not statistically significant. The lack of association may reflect the distinct pathophysiology of these conditions. While IBS is mediated by gastrointestinal hypersensitivity and the gut microbiota [18], ADHD is neurodevelopmental, involving dopaminergic dysregulation [19]. Furthermore, both disorders have been linked to different genetic predispositions; polymorphisms in the SERT gene have been associated with IBS, while DRD4 and DAT1 polymorphisms are implicated in ADHD, contributing to their distinct etiologies [20,21]. Even though chronic inflammation and dysregulation of the HPA axis are implicated in both conditions, there may not be enough overlap between them to establish a direct pathophysiological link between ADHD and IBS. Moreover, unique cultural norms and pressures of schooling within our sample population could have affected the results noted, which may explain the absence of association between IBS and ADHD. ADHD likelihood prevalence (31.9%) and past diagnosis with ADHD (11.7%) in our sample was considerably high. The prevalence of confirmed ADHD is 3.4% globally [3]. The high prevalence of symptoms found in our study is due to reliance on self-reported data and maybe due to elevated stress levels commonly experienced by university students. As far as predictors are concerned, moderate physical activity emerged as protective, consistent with evidence supporting exercise as a behavioral modulator of ADHD symptoms [11]. The reduced prevalence of ADHD in pharmaceutical field students compared to MBBS students highlights the role of academic stress and suggests targeted stress-management strategies for high-pressure disciplines. The stronger predictors of ADHD likelihood came out to be light physical activity (1–3 days a week), experiencing pain related to defecation, having a sausage-shaped stool with cracks on the surface, daily caffeine intake and a moderate physical activity. Regression results indicated a significantly decreased likelihood of ADHD in those who perform moderate physical activity compared to those who have no physical activity. There is also a marginally significantly increased likelihood in those who Smoke occasionally compared to those who do not smoke at all. Multiple limitations were recognized in the study design, such as small sample size, self-reported data, cross-sectional design preventing causal inferences. Still, the analysis can be of value since bias minimization methods were also used, with several channels of recruitment lowering selection bias. Additional strengths are standard, validated tools of measurement, anonymous measurement to lower social desirability bias, explicit operational definitions to lower misclassification, and statistical control for known confounders. Conclusion This research showed co-existence of IBS and ADHD in Pakistani university students and graduates; however it was not statistically significant. Almost one third of participants presented with signs of ADHD, and the report of confirmed diagnosis of ADHD in past was higher than ADHD prevalence estimates globally, indicating specific vulnerabilities and stresses for this student group. Moderate physical activity was a protective factor for ADHD. Pharmacy students demonstrated a lower likelihood of ADHD than medical students. Declarations Ethical Considerations The study protocol was reviewed and approved by the Ethics Review Committee of BMY Health. All participants provided informed consent before participation. Data confidentiality was maintained through anonymous data collection without personal identifiers, secure data storage with restricted access, aggregate reporting of results only, and voluntary participation with the right to withdraw at any time. Acknowledgements: We acknowledge the use of AI (Claude and ChatGPT) in writing results summary, and methods section of the manuscript. Consent for publication: Not applicable. Ethics approval and consent to participate: This study was approved by the Ethics Review Committee of BMY Health, Pakistan. All participants provided informed consent before participation. The study was conducted in accordance with the Declaration of Helsinki and the Belmont Report ethical principles. Availability of data and materials: The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request. Consent to participate: Written informed consent was obtained from all participants prior to data collection. Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Clinical trial registration: Not applicable. Corresponding author: Zeeshan Ahmed ( [email protected] ) References Kessler RC, Adler L, Ames M, et al. The World Health Organization Adult ADHD Self-Report Scale (ASRS): a short screening scale for use in the general population. Psychol Med. 2005;35(2):245-256. doi:10.1017/S0033291704002892. Saha L. World J Gastroenterol. 2014;20(22):6759-73. Priya Oka et al.The lancet. Gastroenterology & hepatology (2020);1253(20)30217-x. Sayal K, Prasad V, Daley D, et al. Lancet Psychiatry. 2018;5(2):175-186. Kedem S, Yust-Katz S, Carter D, et al. World J Gastroenterol. 2020;26(42):6626-6637. Yeh TC, Bai YM, Tsai SJ, et al. Int J Environ Res Public Health. 2021;18(9):4679. Lee Y, Yang H, Chen V, et al. Res Dev Disabil. 2016;51-52:160-172. Indian J Forensic Med Toxicol. 2020;14(3):919-924. Huang KY, Wang FY, Lv M, et al. World J Gastroenterol. 2023;29(26):4120-4135. Instanes JT, Klungsøyr K, Halmøy A, et al. J Atten Disord. 2018;22(3):203-228. Koochakpoor G, Salari-Moghaddam A, Keshteli AH, et al. Front Nutr. 2021;8:632469. Ng QX, Ho CYX, Chan HW, et al. Complement Ther Med. 2017;34:123-128. Schmulson M, Drossman DA. J Neurogastroenterol Motil. 2017;23(2):151-163. ASRS v1.1 Symptom Checklist. Available: https://www.caddra.ca/wp-content/uploads/ASRS.pdf Mayer EA. Gut feelings: the emerging biology of gut-brain communication. Nat Rev Neurosci. 2011 Jul 13;12(8):453-66. doi: 10.1038/nrn3071. PMID: 21750565; PMCID: PMC3845678. Günther, C., Rothhammer, V., Karow, M., Neurath, M., & Winner, B. (2021). The Gut-Brain Axis in Inflammatory Bowel Disease—Current and Future Perspectives. International Journal of Molecular Sciences , 22. https://doi.org/10.3390/ijms22168870. Pimentel, M., & Lembo, A. Microbiome and Its Role in Irritable Bowel Syndrome. Digestive Diseases and Sciences. 2020; 65. https://doi.org/10.1007/s10620-020-06109-5. Mortimer, N., Ganster, T., O’Leary, A., Popp, S., Freudenberg, F., Reif, A., Artigas, S., Ribasés, M., Ramos-Quiroga, J., Lesch, K., & Rivero, O. Dissociation of impulsivity and aggression in mice deficient for the ADHD risk gene Adgrl3: Evidence for dopamine transporter dysregulation. Neuropharmacology. 2019; 156. https://doi.org/10.1016/j.neuropharm.2019.02.039. Todd, R., Huang, H., Smalley, S., Nelson, S., Willcutt, E., Pennington, B., Smith, S., Faraone, S., & Neuman, R. Collaborative analysis of DRD4 and DAT genotypes in population-defined ADHD subtypes.. Journal of child psychology and psychiatry, and allied disciplines. 2005; 46 10. https://doi.org/10.1111/J.1469-7610.2005.01517.X. Jin, D., Cao, H., Xu, M., Wang, S., Wang, Y., Yan, F., & Wang, B. Regulation of the serotonin transporter in the pathogenesis of irritable bowel syndrome. World Journal of Gastroenterology. 2016; 22. https://doi.org/10.3748/wjg.v22.i36.8137. Sabir H, Khan M, Imran K, Nisa ZU, Amer SA. The prevalence of undiagnosed attention-deficit/hyperactivity disorder among undergraduate medical students: a survey from Pakistan. BMC Psychiatry . 2024;24(1):845. Published 2024 Nov 25. doi:10.1186/s12888-024-06182-4 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 17 May, 2026 Reviews received at journal 01 Aug, 2025 Reviewers agreed at journal 31 Jul, 2025 Reviewers invited by journal 31 Jul, 2025 Editor assigned by journal 23 Jul, 2025 Editor invited by journal 27 Jun, 2025 Submission checks completed at journal 26 Jun, 2025 First submitted to journal 26 Jun, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6875240","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":494608017,"identity":"0891c021-31e2-433a-aeb4-097112b922c9","order_by":0,"name":"Zeeshan Ahmed","email":"data:image/png;base64,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","orcid":"","institution":"King Edward Medical University","correspondingAuthor":true,"prefix":"","firstName":"Zeeshan","middleName":"","lastName":"Ahmed","suffix":""},{"id":494608018,"identity":"a9e53f68-04b2-48bf-b90d-c15f31824f73","order_by":1,"name":"Muhammad Asad Raza","email":"","orcid":"","institution":"Avicenna Medical College","correspondingAuthor":false,"prefix":"","firstName":"Muhammad","middleName":"Asad","lastName":"Raza","suffix":""},{"id":494608019,"identity":"6437d75b-98c7-408c-ad51-d12d0140d2f7","order_by":2,"name":"Alveena Azeem","email":"","orcid":"","institution":"Bolan Medical College","correspondingAuthor":false,"prefix":"","firstName":"Alveena","middleName":"","lastName":"Azeem","suffix":""},{"id":494608020,"identity":"465b599a-32b1-4f81-98cb-470ebbf8447b","order_by":3,"name":"Bushra Anwar","email":"","orcid":"","institution":"BMY Health","correspondingAuthor":false,"prefix":"","firstName":"Bushra","middleName":"","lastName":"Anwar","suffix":""},{"id":494608021,"identity":"0e5d7353-9d73-4605-9b14-256218d4d71a","order_by":4,"name":"Shafaat Raza","email":"","orcid":"","institution":"BMY Health","correspondingAuthor":false,"prefix":"","firstName":"Shafaat","middleName":"","lastName":"Raza","suffix":""},{"id":494608025,"identity":"763a6412-85ed-491d-b374-9889d9b0ad20","order_by":5,"name":"Rehman Gul","email":"","orcid":"","institution":"University of Balochistan","correspondingAuthor":false,"prefix":"","firstName":"Rehman","middleName":"","lastName":"Gul","suffix":""}],"badges":[],"createdAt":"2025-06-12 00:08:02","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6875240/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6875240/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":88511762,"identity":"fe60ab6e-2c0c-4e19-a08e-e68a9ff45712","added_by":"auto","created_at":"2025-08-07 08:13:41","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":148935,"visible":true,"origin":"","legend":"\u003cp\u003eThe chart reveals the Strongest predictors of ADHD as visualized using Python. The predictors have been divided into 4 categories with distinct color (including Gut Health, Academic, Lifestyle and Other).\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6875240/v1/166d128d3fa214ad0b603c90.png"},{"id":89062848,"identity":"bbf151ea-bb1d-431a-95e4-77390ae88e97","added_by":"auto","created_at":"2025-08-14 09:47:24","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1108819,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6875240/v1/6d022e09-2953-4b84-80cd-bf38cafdf431.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Topic: Irritable Bowel Syndrome, Gut Health, Lifestyle, and Academic Factors as Predictors of Attention Deficit Hyperactivity Disorder (ADHD) Likelihood: A Cross-sectional Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIrritable Bowel Syndrome (IBS) is a prevalent functional gastrointestinal disorder characterized by abdominal pain, discomfort, bloating, and changes in bowel habits, occurring without any identifiable organic cause for a period of more than three months [1]. Meta-analyses and large surveys report that the pooled prevalence of IBS using Rome IV criteria is about 3.8% (95% CI 3.1\u0026ndash;4.5%) across 34 countries and over 80,000 individuals[2]. Attention Deficit Disorder (ADD), on the other hand, is a neurodevelopmental behavioral disorder marked by symptoms of inattention, impulsivity, and sometimes hyperactivity, which affects approximately 5% of children, often persisting into adulthood [3].\u003c/p\u003e\u003cp\u003eAttention Deficit Hyperactivity Disorder (ADHD) can persist into adulthood in individuals, with an estimated global prevalence of 3.4% in the 18\u0026ndash;44 age group [4]. Although there is evidence linking ADHD to various somatic conditions such as obesity and asthma, the literature on GI comorbidities, especially in adults, is limited and inconsistent [4]. Most existing studies focus on children, with mixed results regarding the association between ADHD and GI symptoms like chronic diarrhea and abdominal pain [4].\u003c/p\u003e\u003cp\u003eIBS not only affects up to 31% of the population but is also chronic, being a major reason for gastroenterology referrals [5]. It significantly impacts patients' quality of life and incurs substantial healthcare costs [5]. ADHD also has profound effects on quality of life and public health, affecting both psychosocial well-being and physical health [6]. Despite extensive research on ADHD's psychiatric comorbidities, somatic comorbid conditions remain underexplored, particularly in adults.\u003c/p\u003e\u003cp\u003eThere is an established body of literature suggesting a bidirectional relationship between IBS and various mental disorders; however, the specific connection between IBS and ADHD remains underexplored, particularly in adult populations [7]. Existing studies have primarily focused on other neurodevelopmental and psychiatric disorders, linking gastrointestinal hypersensitivity to the gut-brain axis but leaving a gap in the understanding of how IBS may influence the development or exacerbation of ADHD symptoms or vice versa [8][17].\u003c/p\u003e\u003cp\u003eGiven that ADHD is associated with a range of somatic health issues, including those affecting quality of life and life expectancy, it is vital to investigate these associations further [9]. Current research primarily emphasizes psychiatric disorders and medication-induced symptoms, with less attention to potential links between ADHD and medical conditions [9]. This research addresses this gap by providing a comprehensive review of associations of ADHD with IBS, gut health and other factors, potentially leading to improved diagnostic practices and treatment approaches that consider both psychiatric and medical aspects of the disorder [9]. We aimed to investigate the association between ADHD likelihood and IBS, and find various predictors of ADHD for its timely diagnosis, including gut health factors (IBS, stool consistency, abdominal pain), academic stress, and lifestyle factors among young adults in higher education settings.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis analytical cross-sectional study was conducted among university students and graduates in Pakistan in September 2024. The target population comprised university students and recent graduates aged 18\u0026ndash;35 years across Pakistan. Participants were recruited through convenience sampling using multiple channels, including university email lists, social media platforms.\u003c/p\u003e\u003cp\u003eParticipants were eligible for inclusion if they were currently enrolled in a university program or had graduated within the past five years, were between 18 and 35 years of age, could read and understand either English or Urdu, had access to the internet and a digital device, and provided voluntary informed consent. Individuals were excluded if they had a diagnosed psychiatric condition requiring active pharmacological treatment (except ADHD and mood disorders), suffered from severe chronic medical illnesses known to affect gastrointestinal function, or submitted responses with more than 20% of the questionnaire left incomplete. Based on the expected prevalence of ADHD at 16.8% in the target population, with a 90% confidence level and 5% margin of error, the minimum required sample size was calculated as 152 participants using the formula n\u0026thinsp;=\u0026thinsp;Z\u0026sup2;p(1-p)/e\u0026sup2; [22]. The required sample size was 152. The final achieved sample of 163 participants, providing adequate power for the primary analysis.\u003c/p\u003e\u003cp\u003eData were collected using a comprehensive, structured online questionnaire developed using Google Forms, comprising five main sections. The first section gathered demographic and academic information including age, gender, field of study, academic level, GPA, and academic stress assessment using a validated 10-point Likert scale. The second section assessed lifestyle factors including physical activity levels categorized using standardized activity classifications, smoking history documented as never, occasionally, regularly, or former smoker, caffeine intake frequency ranging from never to daily consumption, and sleep patterns and quality indicators. The third section focused on gut health and IBS assessment using the Rome IV criteria-based IBS screening questionnaire, history of gastrointestinal disorders and diagnoses, stool consistency assessment using the Bristol Stool Chart, abdominal pain characteristics and associations including timing, triggers, and relief factors, and recurrent gastrointestinal symptoms assessment. The fourth section employed the Adult ADHD Self-Report Scale (ASRS-v1.1) Part A, validated for screening purposes, along with documentation of previous ADHD diagnosis or treatment history and current medication use [13]. The final section included brief anxiety and depression screening questions and self-reported mental health history.\u003c/p\u003e\u003cp\u003eIn the analysis, ADHD likelihood was defined as positive screening on ASRS Part A with four or more symptoms rated as \"often\" or \"very often\". IBS likelihood was determined by meeting Rome IV criteria based on self-reported symptoms. Academic stress was measured on a 10-point scale and categorized as low (less than 5), moderate (5\u0026ndash;7), and high (greater than 7). Physical activity levels were categorized as sedentary, lightly active, moderately active, very active, and super active based on frequency and intensity of exercise engagement. Statistical analyses were performed using STATA and Python. Inferential analysis employed chi-square tests for comparing factors among those with ADHD likelihood, no likelihood, and those confirmed with ADHD diagnosis in the past. Logistic regression for categorical variables was performed for factors significantly different among the groups. Random Forest Classifier was used to identify key predictors and their relative importance. Statistical significance was set at p less than 0.1 for all tests.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe study cohort comprised 163 participants with a mean age of 23.5\u0026thinsp;\u0026plusmn;\u0026thinsp;3.6 years. The sample was predominantly male, with 100 participants (61.3%) compared to 63 females (38.7%). Regarding academic background, the majority were medical students pursuing MBBS degrees (n\u0026thinsp;=\u0026thinsp;91, 55.8%), followed by those in pharmaceutical fields (n\u0026thinsp;=\u0026thinsp;60, 36.8%), with a smaller proportion from other academic disciplines (n\u0026thinsp;=\u0026thinsp;12, 7.4%). Most participants were undergraduates (n\u0026thinsp;=\u0026thinsp;106, 65%), while 38 (23.3%) were recent graduates within 1\u0026ndash;3 years of completion, and 19 (11.7%) were graduates with more than three years since completion. Regarding ADHD status, 19 participants (11.7%) reported a prior ADHD diagnosis. When screened using the Adult ADHD Self-Report Scale (ASRS), 52 participants (31.9%) showed likelihood for ADHD, who can be potential candidates for further evaluation (refer to Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). IBS frequency was found to be 41.1%.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBaseline characteristics of study participants (n\u0026thinsp;=\u0026thinsp;163)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCharacteristic\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23.5\u0026thinsp;\u0026plusmn;\u0026thinsp;3.6 years\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026bull; Female\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e63 (38.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026bull; Male\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e100 (61.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eField of Study\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026bull; MBBS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e91 (55.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026bull; Pharmaceutical Fields\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e60 (36.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026bull; Other Fields\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12 (7.4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAcademic level\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026bull; Under graduate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e106 (65%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026bull; Fresh Graduate (1\u0026ndash;3 years of graduation)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e38 (23.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026bull; Old Graduate (beyond 3 years of graduation)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e19 (11.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eADHD profile\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrior ADHD Diagnosis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e19 (11.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eASRS ADHD Screening Positive\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e52 (31.9%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIBS profile\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrior IBS Diagnosis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e26.7%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIBS Screening Positive\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e67 (41.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe data compares ADHD likelihood across three groups (no ADHD, suspected ADHD without diagnosis, and past ADHD diagnosis) across multiple variables. No significant differences were found for gender, age, academic performance, smoking, or caffeine intake. However, field of study (p\u0026thinsp;=\u0026thinsp;0.0111), past IBS diagnosis (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), past GI disorders (p\u0026thinsp;=\u0026thinsp;0.0268), IBD diagnosis (p\u0026thinsp;=\u0026thinsp;0.0074), pain association (p\u0026thinsp;=\u0026thinsp;0.0066), recurrent pain (p\u0026thinsp;=\u0026thinsp;0.0413), and depression (p\u0026thinsp;=\u0026thinsp;0.0008) showed statistically significant associations. Those with a past ADHD diagnosis were more likely to report IBS, GI comorbidities (particularly IBD), pain with defecation or frequency changes, and depressive symptoms. These patterns support a biopsychosocial link between ADHD and gut-brain axis disturbances (refer to Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eFrequency of various academic, gut health and lifestyle factors compared in relation with ADHD likelihood and diagnosis.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCategory\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo ADHD Likelihood (negative on Screening)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eADHD Likelihood (positive on Screening) but No Past ADHD diagnosis\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eDiagnosed with ADHD in past\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e36.4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e42.2%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e42.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e63.6%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e57.8%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e57.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.7573\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18\u0026ndash;24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e67.7%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e62.2%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e57.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25\u0026ndash;29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21.2%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e28.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e31.6%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.8848\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30\u0026ndash;35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.2%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e36 and above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.7%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e10.5%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAcademic Factors\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eField of Study\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMBBS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e53.5%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e73.3%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e26.3%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOther(please specify)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.7%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e10.5%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.0111*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePharmaceutical\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e39.4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e20.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e63.2%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAcademic Performance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAverage (GPA\u0026thinsp;\u0026gt;\u0026thinsp;2.0\u0026ndash;3.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e35.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e40.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e26.3%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBelow Average (GPA\u0026thinsp;\u0026lt;\u0026thinsp;2.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5.3%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.2007\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eExcellent (GPA\u0026thinsp;\u0026gt;\u0026thinsp;3.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14.4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e15.8%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGood (GPA\u0026thinsp;\u0026gt;\u0026thinsp;3.0-3.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e50.5%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e48.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e52.6%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGut Health Factors\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePast IBS Diagnosis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e82.8%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e75.6%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e21.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17.2%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e24.4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e78.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0***\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIBS likelihood positive\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e62.7%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e62.3%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e31.6%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e37.4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e37.8%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e68.4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.1269\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePast GI disorder\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e64.6%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e60.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e31.6%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e35.4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e40.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e68.4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.0268*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGI conditions (grouped)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDyspepsia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19.2%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e22.2%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e26.3%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIBD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.7%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e36.8%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.0074**\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIBS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.7%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e51.5%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e48.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e21.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17.2%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15.6%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e15.8%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStool consistency (grouped)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHard/Lumpy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16.2%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e20.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e26.3%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLoose/Watery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.2%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e10.5%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.4102\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNormal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e35.4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e28.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e42.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e41.4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e48.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e21.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePain association (grouped)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e36.4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e48.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRelated to defecation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e28.3%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e20.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e31.6%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.0066**\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRelated to frequency\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18.2%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e22.2%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e47.4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRelated to stool form\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17.2%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e21.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRecurrent Pain\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e57.6%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e56.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e26.3%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e42.4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e43.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e73.7%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.0413*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStool consistency\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLumpy and sausage-like\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.7%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5.3%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e48.5%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e44.4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e31.6%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.5614\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSausage-shaped with cracks on the surface)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13.3%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSeparate hard lumps\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.7%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e15.8%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSmooth, soft sausage or snake\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e26.3%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e22.2%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e36.8%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSoft blobs with clear-cut edges\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.7%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e10.5%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLifestyle Factors\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePhysical Activity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLightly active (light exercise/sports 1\u0026ndash;3 days a week)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e26.3%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e42.2%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e15.8%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eModerately active (moderate exercise/sports 3\u0026ndash;5 days a week)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20.2%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e21.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.0631\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSedentary (little or no exercise)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e42.4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e37.8%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e36.8%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSuper active (physical job or twice daily training)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.7%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e10.5%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVery active (hard exercise/sports 6\u0026ndash;7 days a week)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.2%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e15.8%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSmoking\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNever\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e80.8%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e91.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e84.2%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes but I have stopped now\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.2%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.3384\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes, occasionally\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15.2%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.2%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e15.8%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes, regularly\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCaffeine Intake\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDaily\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18.2%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e28.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e26.3%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNever\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22.2%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e20.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e26.3%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.8655\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOften (5\u0026ndash;6 times a week)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.7%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5.3%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRarely (1\u0026ndash;2 times a week)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e31.3%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e33.3%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e26.3%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSometimes (3\u0026ndash;4 times a week)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18.2%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e15.8%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eOther Associated Mental Health symptoms\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAnxiety\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e47.5%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e33.3%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e15.8%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo but I think I have anxiety and mood swings\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e29.3%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e40.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e36.8%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.0544\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23.2%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e26.7%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e47.4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDepression\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e60.6%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e60.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e15.8%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo but I think I am depressed.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21.2%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e24.4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e26.3%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.0008**\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18.2%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15.6%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e57.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eP-values calculated using chi-square test.\u003c/p\u003e\u003cp\u003eThe key predictors of ADHD were identified (using Random Forest classifier method) with importance scores exceeding 0.01, revealing distinct patterns across lifestyle, academic, and gut health categories (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Physical activity emerged as the strongest predictor, with lightly active individuals (light exercise 1\u0026ndash;3 days weekly) showing the highest importance score (\u0026gt;\u0026thinsp;0.025), followed by moderately active participants. Gut health factors demonstrated strong predictive power, particularly stool consistency patterns, with sausage-shaped stools with surface cracks and smooth, soft sausage or snake-like consistency both ranking among the top predictors. Pain associations, including pain related to defecation and changes in stool frequency, also showed significant importance scores, reinforcing the gut-brain connection in ADHD manifestation. Academic and lifestyle factors were similarly influential, with daily caffeine intake, academic stress levels (particularly stress scores of 6\u0026ndash;8), and field of study (MBBS and pharmaceutical fields) emerging as important predictors. Notably, age categories (18\u0026ndash;24 and 25\u0026ndash;29), gender, and anxiety levels also contributed to the model, suggesting that ADHD manifestation is influenced by a complex interplay of demographic, lifestyle, gastrointestinal, and academic stress factors rather than any single dominant predictor.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eLogistic regression was performed for variables showing relation with ADHD likelihood. The model with the best fit is presented here, which shows that moderate physical activity may be a significant predictor of ADHD symptoms in this sample. Other factors (caffeine intake, smoking, field of study) did not show statistically robust associations, though occasional smoking may warrant further investigation. Overall, the model fits modestly and suggests potential behavioral correlates of ADHD symptoms, especially physical activity. (Refer to Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e4\u003c/span\u003e for logistic regression results).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eLogistic regression of ADHD likelihood with Caffeine Intake, Physical Activity, Smoking, Field of Study.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCategory\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eOdds Ratio\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eStd. Err.\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP\u0026gt;|z|\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e95% Conf. Interval\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCaffeine Intake\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNever\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.3796\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.2279\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.107\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.1170\u0026ndash;1.2313\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOften (5\u0026ndash;6 times a week)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.3349\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.2788\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.189\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.0652\u0026ndash;1.7133\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRarely (1\u0026ndash;2 times a week)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.9902\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.4908\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.860\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.3156\u0026ndash;2.6193\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSometimes (3\u0026ndash;4 times a week)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.4689\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.3179\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.264\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e-0.1242\u0026ndash;1.7711\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePhysical Activity\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eModerately active\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.2124\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.3888\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.018\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.0590\u0026ndash;0.7643\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSedentary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.4697\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.2113\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.093\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.1944\u0026ndash;1.1359\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSuper active\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.6019\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.7270\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.362\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.1944\u0026ndash;2.2907\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVery active\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.2961\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.2713\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.184\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.4918\u0026ndash;1.7386\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSmoking\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes but I have stopped now\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.0628\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3.1649\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.637\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.1019\u0026ndash;41.7316\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes, occasionally\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.2460\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.1345\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.054\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.1214\u0026ndash;12.7849\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes, regularly\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.7581\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.9356\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.608\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.2032\u0026ndash;15.2290\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eField of Study\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.9919\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.8419\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.992\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.1879\u0026ndash;5.2355\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePharmaceutical\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.5534\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.2421\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.176\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e-0.2347\u0026ndash;2.3084\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eRecurrent Pain\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003eLogistic Regression Model (with n: 152, LR chi2(14): 25.38, Prob\u0026thinsp;\u0026gt;\u0026thinsp;chi2: 0.0310, Pseudo R2: 0.1339, Log likelihood = -82.105211)\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study explored the predictors of ADHD, including gut health, with a focus on IBS, and other lifestyle and academic factors. Mental health is believed to be linked with gut health as the sensory input from the gut, encoded by primary afferent neurons, immune cells, and enteroendocrine cells, contributes to a complex feedback loop that affects both gut and central nervous system functions [16]. Our study reported co-existence of IBS and ADHD, but it was not statistically significant. The lack of association may reflect the distinct pathophysiology of these conditions. While IBS is mediated by gastrointestinal hypersensitivity and the gut microbiota [18], ADHD is neurodevelopmental, involving dopaminergic dysregulation [19]. Furthermore, both disorders have been linked to different genetic predispositions; polymorphisms in the SERT gene have been associated with IBS, while DRD4 and DAT1 polymorphisms are implicated in ADHD, contributing to their distinct etiologies [20,21]. Even though chronic inflammation and dysregulation of the HPA axis are implicated in both conditions, there may not be enough overlap between them to establish a direct pathophysiological link between ADHD and IBS. Moreover, unique cultural norms and pressures of schooling within our sample population could have affected the results noted, which may explain the absence of association between IBS and ADHD.\u003c/p\u003e\u003cp\u003eADHD likelihood prevalence (31.9%) and past diagnosis with ADHD (11.7%) in our sample was considerably high. The prevalence of confirmed ADHD is 3.4% globally [3]. The high prevalence of symptoms found in our study is due to reliance on self-reported data and maybe due to elevated stress levels commonly experienced by university students. As far as predictors are concerned, moderate physical activity emerged as protective, consistent with evidence supporting exercise as a behavioral modulator of ADHD symptoms [11]. The reduced prevalence of ADHD in pharmaceutical field students compared to MBBS students highlights the role of academic stress and suggests targeted stress-management strategies for high-pressure disciplines. The stronger predictors of ADHD likelihood came out to be light physical activity (1\u0026ndash;3 days a week), experiencing pain related to defecation, having a sausage-shaped stool with cracks on the surface, daily caffeine intake and a moderate physical activity. Regression results indicated a significantly decreased likelihood of ADHD in those who perform moderate physical activity compared to those who have no physical activity. There is also a marginally significantly increased likelihood in those who Smoke occasionally compared to those who do not smoke at all.\u003c/p\u003e\u003cp\u003eMultiple limitations were recognized in the study design, such as small sample size, self-reported data, cross-sectional design preventing causal inferences. Still, the analysis can be of value since bias minimization methods were also used, with several channels of recruitment lowering selection bias. Additional strengths are standard, validated tools of measurement, anonymous measurement to lower social desirability bias, explicit operational definitions to lower misclassification, and statistical control for known confounders.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis research showed co-existence of IBS and ADHD in Pakistani university students and graduates; however it was not statistically significant. Almost one third of participants presented with signs of ADHD, and the report of confirmed diagnosis of ADHD in past was higher than ADHD prevalence estimates globally, indicating specific vulnerabilities and stresses for this student group. Moderate physical activity was a protective factor for ADHD. Pharmacy students demonstrated a lower likelihood of ADHD than medical students.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical Considerations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study protocol was reviewed and approved by the Ethics Review Committee of BMY Health. All participants provided informed consent before participation. Data confidentiality was maintained through anonymous data collection without personal identifiers, secure data storage with restricted access, aggregate reporting of results only, and voluntary participation with the right to withdraw at any time.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe acknowledge the use of AI (Claude and ChatGPT) in writing results summary, and methods section of the manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConsent for publication: Not applicable.\u003c/p\u003e\n\u003cp\u003eEthics approval and consent to participate: This study was approved by the Ethics Review Committee of BMY Health, Pakistan. All participants provided informed consent before participation. The study was conducted in accordance with the Declaration of Helsinki and the Belmont Report ethical principles.\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials: The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003eConsent to participate: Written informed consent was obtained from all participants prior to data collection.\u003c/p\u003e\n\u003cp\u003eFunding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003eClinical trial registration: Not applicable.\u003c/p\u003e\n\u003cp\u003eCorresponding author: Zeeshan Ahmed ([email protected])\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eKessler RC, Adler L, Ames M, et al. The World Health Organization Adult ADHD Self-Report Scale (ASRS): a short screening scale for use in the general population. Psychol Med. 2005;35(2):245-256. doi:10.1017/S0033291704002892.\u003c/li\u003e\n\u003cli\u003eSaha L. World J Gastroenterol. 2014;20(22):6759-73.\u003c/li\u003e\n\u003cli\u003ePriya Oka et al.The lancet. Gastroenterology \u0026amp; hepatology (2020);1253(20)30217-x.\u003c/li\u003e\n\u003cli\u003eSayal K, Prasad V, Daley D, et al. Lancet Psychiatry. 2018;5(2):175-186.\u003c/li\u003e\n\u003cli\u003eKedem S, Yust-Katz S, Carter D, et al. World J Gastroenterol. 2020;26(42):6626-6637.\u003c/li\u003e\n\u003cli\u003eYeh TC, Bai YM, Tsai SJ, et al. Int J Environ Res Public Health. 2021;18(9):4679.\u003c/li\u003e\n\u003cli\u003eLee Y, Yang H, Chen V, et al. Res Dev Disabil. 2016;51-52:160-172.\u003c/li\u003e\n\u003cli\u003eIndian J Forensic Med Toxicol. 2020;14(3):919-924.\u003c/li\u003e\n\u003cli\u003eHuang KY, Wang FY, Lv M, et al. World J Gastroenterol. 2023;29(26):4120-4135.\u003c/li\u003e\n\u003cli\u003eInstanes JT, Klungs\u0026oslash;yr K, Halm\u0026oslash;y A, et al. J Atten Disord. 2018;22(3):203-228.\u003c/li\u003e\n\u003cli\u003eKoochakpoor G, Salari-Moghaddam A, Keshteli AH, et al. Front Nutr. 2021;8:632469.\u003c/li\u003e\n\u003cli\u003eNg QX, Ho CYX, Chan HW, et al. Complement Ther Med. 2017;34:123-128.\u003c/li\u003e\n\u003cli\u003eSchmulson M, Drossman DA. J Neurogastroenterol Motil. 2017;23(2):151-163.\u003c/li\u003e\n\u003cli\u003eASRS v1.1 Symptom Checklist. Available: https://www.caddra.ca/wp-content/uploads/ASRS.pdf\u003c/li\u003e\n\u003cli\u003eMayer EA. Gut feelings: the emerging biology of gut-brain communication. Nat Rev Neurosci. 2011 Jul 13;12(8):453-66. doi: 10.1038/nrn3071. PMID: 21750565; PMCID: PMC3845678.\u003c/li\u003e\n\u003cli\u003eG\u0026uuml;nther, C., Rothhammer, V., Karow, M., Neurath, M., \u0026amp; Winner, B. (2021). The Gut-Brain Axis in Inflammatory Bowel Disease\u0026mdash;Current and Future Perspectives. \u003cem\u003eInternational Journal of Molecular Sciences\u003c/em\u003e, 22. https://doi.org/10.3390/ijms22168870.\u003c/li\u003e\n\u003cli\u003ePimentel, M., \u0026amp; Lembo, A. Microbiome and Its Role in Irritable Bowel Syndrome. \u003cem\u003eDigestive Diseases and Sciences.\u003c/em\u003e 2020; 65. https://doi.org/10.1007/s10620-020-06109-5.\u003c/li\u003e\n\u003cli\u003eMortimer, N., Ganster, T., O\u0026rsquo;Leary, A., Popp, S., Freudenberg, F., Reif, A., Artigas, S., Ribas\u0026eacute;s, M., Ramos-Quiroga, J., Lesch, K., \u0026amp; Rivero, O. Dissociation of impulsivity and aggression in mice deficient for the ADHD risk gene Adgrl3: Evidence for dopamine transporter dysregulation. \u003cem\u003eNeuropharmacology.\u003c/em\u003e 2019; 156. https://doi.org/10.1016/j.neuropharm.2019.02.039.\u003c/li\u003e\n\u003cli\u003eTodd, R., Huang, H., Smalley, S., Nelson, S., Willcutt, E., Pennington, B., Smith, S., Faraone, S., \u0026amp; Neuman, R. Collaborative analysis of DRD4 and DAT genotypes in population-defined ADHD subtypes.. \u003cem\u003eJournal of child psychology and psychiatry, and allied disciplines.\u003c/em\u003e 2005; 46 10. https://doi.org/10.1111/J.1469-7610.2005.01517.X.\u003c/li\u003e\n\u003cli\u003eJin, D., Cao, H., Xu, M., Wang, S., Wang, Y., Yan, F., \u0026amp; Wang, B. Regulation of the serotonin transporter in the pathogenesis of irritable bowel syndrome. \u003cem\u003eWorld Journal of Gastroenterology.\u003c/em\u003e 2016; 22. https://doi.org/10.3748/wjg.v22.i36.8137.\u003c/li\u003e\n\u003cli\u003eSabir H, Khan M, Imran K, Nisa ZU, Amer SA. The prevalence of undiagnosed attention-deficit/hyperactivity disorder among undergraduate medical students: a survey from Pakistan. \u003cem\u003eBMC Psychiatry\u003c/em\u003e. 2024;24(1):845. Published 2024 Nov 25. doi:10.1186/s12888-024-06182-4\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-psychiatry","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bpsy","sideBox":"Learn more about [BMC Psychiatry](http://bmcpsychiatry.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bpsy/default.aspx","title":"BMC Psychiatry","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"IBS, ADHD, prevalence, predictors, university students, risk factors, Pakistan","lastPublishedDoi":"10.21203/rs.3.rs-6875240/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6875240/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Irritable Bowel Syndrome (IBS) and Attention Deficit Hyperactivity Disorder (ADHD) are prevalent chronic conditions, significantly impacting quality of life. Despite their co-occurrence, potential associations remain underinvestigated, particularly among university students and recent graduates in Pakistan. Understanding this comorbidity and finding other predictors in an underdeveloped country allows timely diagnosis, appropriate intervention, and improved health outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjectives:\u003c/strong\u003e 1. To determine the association of ADHD likelihood with IBS. 2. To find the predictors of ADHD including gut health, lifestyle, and academic factors, among university students and graduates in Pakistan.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e This cross-sectional study included 163 participants aged 18–35 years, recruited through convenience sampling using an online questionnaire. IBS was assessed using Rome IV criteria, while ADHD symptoms were evaluated with Part A of the Adult ADHD Self-Report Scale (ASRS). Logistic regression was performed to identify associations and adjust for potential confounders using STATA and Python.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e ADHD likelihood was found among 31.9% students, with protective factors including moderate physical activity (AOR: 0.18; 95% CI: 0.02–0.65, p=0.026) and enrollment in pharmaceutical fields compared to MBBS (AOR: 0.28; 95% CI: 0.10–0.91, p=0.035). No significant association was observed between IBS and ADHD (AOR: 1.08; 95% CI: 0.55–2.10, p=0.831). Strong predictors were light physical activity (1–3 days a week), experiencing pain related to defecation, having a sausage-shaped stool with cracks on the surface, daily caffeine intake and a moderate physical activity. These are divided into academic, lifestyle and gut health factors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eThis study highlights distinct predictors of ADHD likelihood among university students and graduates in Pakistan. No significant association was found between IBS and ADHD. ADHD likelihood was influenced by other lifestyle and academic variables such as physical activity and field of study. These findings emphasize the importance of addressing diverse academic, lifestyle, and gut-related factors when considering the ADHD management.\u003c/p\u003e","manuscriptTitle":"Topic: Irritable Bowel Syndrome, Gut Health, Lifestyle, and Academic Factors as Predictors of Attention Deficit Hyperactivity Disorder (ADHD) Likelihood: A Cross-sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-07 08:13:36","doi":"10.21203/rs.3.rs-6875240/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"257854110134713795177355132243588804362","date":"2026-05-18T01:15:47+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-01T16:26:09+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"65438138385068767248604455885705492220","date":"2025-07-31T04:41:12+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-07-31T04:26:50+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-23T18:03:47+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-06-27T04:51:35+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-06-26T20:19:16+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Psychiatry","date":"2025-06-26T20:16:42+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-psychiatry","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bpsy","sideBox":"Learn more about [BMC Psychiatry](http://bmcpsychiatry.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bpsy/default.aspx","title":"BMC Psychiatry","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"06f31fbf-9a22-4bbc-ae31-6cc5b5346578","owner":[],"postedDate":"August 7th, 2025","published":true,"recentEditorialEvents":[{"type":"reviewerAgreed","content":"257854110134713795177355132243588804362","date":"2026-05-18T01:15:47+00:00","index":96,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-08-07T08:13:37+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-07 08:13:36","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6875240","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6875240","identity":"rs-6875240","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}