Effects of executive function deficits on Chinese reading ability in ADHD patients

Effects of executive function deficits on Chinese reading ability in ADHD patients | 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 Effects of executive function deficits on Chinese reading ability in ADHD patients Jia Wei, Wenwu zhang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4230998/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective: To explore the factors affecting the Chinese reading abilities of patients with attention deficit hyperactivity disorder (ADHD) and to provide a basis for the intervention of comorbid Chinese reading disorders in ADHD. Methods: Following the ICD-10 standards, 160 ADHD patients were included in the study, divided into an ADHD group (80 cases) and an ADHD+RD (Reading Disorder) group (80 cases). All participants completed neuropsychological tests such as verbal working memory tasks, visual spatial working memory tasks, and response inhibition tasks. Parents completed the Swanson, Nolan, and Pelham-IV questionnaire (SNAP-IV) and the Dyslexia Checklist for Chinese Children (DCCC). Results: Patients with ADHD + RD demonstrated more significant deficits in executive functions such as working memory and response inhibition. Controlling for the influences of fixed ADHD symptoms, defects in visual spatial working memory and response inhibition had a significant predictive effect on the reading abilities of children with ADHD. Conclusion: The reading process demands a high level of cognitive executive function, especially in tasks involving linguistic and textual processing, where modulation of working memory, response inhibition, and flexibility are needed. For patients with ADHD comorbid with Chinese reading disorders, besides managing core ADHD symptoms, it may be worth considering a focus on strengthening training in working memory. ADHD Chinese reading disorder executive function working memory Figures Figure 1 Figure 2 Figure 3 1. Introduction Attention deficit hyperactivity disorder (ADHD) is a common neuropsychiatric developmental disorder in children and adolescents, with a prevalence rate of approximately 6.4% among school-age children [ 1 ] . Chinese reading disorder (RD) is a specific learning disability that usually begins in school-age children, affects the acquisition and development of reading skills, and cannot be attributed exclusively to intelligence, vision, or poor education. In China, the prevalence of Chinese RD is approximately 3.45%~8%. Studies have shown that the percentage of comorbid RDs in ADHD patients is approximately 18 ~ 45%, which is much greater than that in the general population [ 2 ] , and that children who face problems with the overlap of these two disorders are more likely to experience academic failure, psychosocial consequences, and poor long-term outcomes that persist into adulthood. Executive function (EF), an advanced cognitive control process that includes working memory, response inhibition, and cognitive flexibility, is responsible for planning, organizing, controlling, and regulating an individual's behavior to achieve a goal and plays an important role in the development of reading skills [ 3 ] . EF deficits are likewise a fundamental neuropsychological mechanism of ADHD [ 4 ] . Research suggests that patients with ADHD comorbid with RD may present a more complex and unique EF profile that differs from that of patients with ADHD alone [ 5 , 6 ] . Phenotypic analysis also further supported the hypothesis that both ADHD and RD are caused by multiple cognitive deficits rather than a single primary cognitive deficit [ 7 ] . However, the specific manifestations and differences in EFs of ADHD patients with cooccurring Chinese RD are still unclear; therefore, in-depth studies of this specific group of individuals can help to reveal their cognitive characteristics and neural mechanisms and provide more accurate guidance for personalized treatment plans. 2. Method 2.1. Participants In this study, 160 ADHD patients who attended the child and adolescent psychiatric clinic of Kangning Hospital of Ningbo were included and divided into 80 patients each in the ADHD group and ADHD + RD group according to the tenth edition of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) diagnostic criteria. Individuals with other neurodevelopmental and psychiatric disorders, such as mental retardation and loneliness spectrum disorders, were excluded, those with audiovisual disorders were excluded, and those who had been treated for ADHD or RD in the last 3 months were excluded. This study was approved by the hospital ethics committee, and all participating patients and family members (guardians) provided informed consent. There was no statistically significant difference in age or gender composition between the two groups, as shown in Table 1 . 2.2. Tools 2.2.1. Wechsler Intelligence Scale for Children (WISC) The WISC is a test instrument commonly used to assess the intelligence level of children. The test is for children and adolescents aged 6 to 16 years and 11 months and uses a series of cognitive subtests to assess a child's performance in various areas of intelligence. The WISC consists of a number of standardized subtests, such as vocabulary, reasoning, numerical memory, and spatial ability, which are used to assess children's intellectual and cognitive abilities, and the scoring criteria are based on a system of scores with a mean value of 100 and a standard deviation of 15 [ 8 ] . 2.2.2. Swanson, Nolan, and Pelham-IV (SNAP-IV) The SNAP-IV is a scale used to assess ADHD symptoms in children and adolescents. The scale included 9 inattention (IA) symptom items, 9 hyperactive-impulsivity (IH) symptom items and 8 oppositional defiant disorder (ODD) symptom items, using a 4-point score ranging from 0 to 3. The higher the score is, the more severe the symptoms are. This scale is rated by parents and has good reliability for domestic applications [ 9 ] . 2.2.3. Dyslexia Checklist for Chinese Children (DCCC) The DCCC scale was developed by Professor Hanrong Wu from Huazhong University of Science and Technology. Eight symptom items, including visual perception disorder, auditory perception disorder, meaning comprehension disorder, writing disorder, oral language disorder, written expression disorder, poor reading habits disorder and inattention disorder, used 5-point scores ranging from 1 to 5. The higher the score is, the lower the symptom ability. This scale was evaluated by parents and has good reliability and validity [ 10 ] . 2.2.4. Verbal working memory (VWM) task Based on the N-back task paradigm commonly used in previous studies, inquist software was used to experimentally develop the VWM task. The stimuli were presented on a computer with a screen resolution of 2160 × 1440 (the same for all subsequent tasks). The background was black (0,0,0), and the display language and letters were white (255,255,255). In the VWM task, the subjects were seated 57cm from the computer screen on which the task was presented. Task instruction: In this memory game, you will see the letters appearing one after the other on the screen. The letters quickly disappear from the screen, and you need to concentrate on memorizing the order in which the letters appear. According to Fig. 1 , the task is divided into three zone groups. The first group is 0-back, for a total of 30 rounds. When the letter "m" appears on the screen, the subject needs to quickly press the "A" key, and the rest of the letters do not respond. The second zone is 1-back, for a total of 31 rounds. When the letters appear on the screen at this time are the same as those in the previous round, the subject needs to quickly press the "A" key. The third block is 2-back, for a total of 32 rounds. When the same letter appears on the screen as the same as the round before the previous, the subject needs to press the "A" key quickly. Each letter was presented for 500ms with an interval of 2000ms. Ten trials were conducted in each of the three zone groups, for a total of 30 trials, to ensure that the subject fully understood the task. 2.2.5. Visual spatial working memory (VSWM) task Based on the N-back task paradigm commonly used in previous studies, the same inquiry software was used to experimentally prepare the VSWM task. The stimuli were presented on a computer with a black background (0,0,0), a white display language (255,255,255), blue squares (0,0,255), and a size of (45×45) mm. In the VSWM task, the subjects were seated 57cm from the computer screen on which the task was presented. Task instruction: In this memory game, you will see a series of blue squares appearing one after another in different locations on the computer screen. The squares on the screen are rendered quite quickly, with a new square appearing in a few seconds, and you need to concentrate on memorizing where the blue squares appear. Subjects performed the VSWM task after completing the VWM task. The VSWM task was performed individually only in 2-back block sets for a total of 42 rounds. The "+" gaze point was displayed in the center of the screen, and blue squares appeared randomly in (3×3) blocks (not including the center point) at a total of 8 locations. According to Fig. 2 , When the position of the blue square on the screen matches the position of the blue square in the round before the previous, press the "A" key. Each blue square represents 500ms with an interval of 2500ms. The 2-back zone groups performed 12 trials to ensure that the subject fully understood the task. 2.2.6. Response inhibition task Based on the Go/No-go task paradigm commonly used in previous studies, inquist software was used to experimentally prepare the stimuli for presentation on the computer. In the Go/No-go task, subjects were seated 57cm from the computer screen on which the task was presented. Task instruction: A mole is digging a hole in the garden, your job requires hitting the mole to get it to leave, beautifying the garden, sometimes there will be eggplant in the garden, be careful not to hit it. According to Fig. 3 , the subjects were asked to respond to the "Go" trial and the "No-go" trial on the screen, where the "Go" trial was a "mole" pattern with slightly different shapes, and the "No-go" trial was an "eggplant" pattern. The subjects were asked to quickly hit the space bar when the "mole" pattern appeared and did not hit the space bar when the "eggplant" pattern appeared. The task consisted of a total of 165 trials, including 124 "Go" trials with a response interval of 1800ms and 41 "No-go" trials with a response interval of 1300ms, with a pseudorandomized frequency of occurrence. 2.3. Data Analysis The data were analysed using SPSS 23.0 statistical software with two independent sample t-tests, chi-square tests, Person correlation analysis, ANCOVA analysis. The data from the working memory task and Go/No-go task were converted into a correct rate for statistical analysis. 3. Results 3.1. Differences in the SNAP-IV score, DCCC score, Intelligence, and reading ability between the two groups There were no significant differences between the two groups in terms of intelligence score, SNAP-IV Total score or score on any of the 3 subscales. The accuracy of the VWM tasks (0-back, 1-back, 2-back), VSWM task and Go/No-go task in the ADHD + RD group was significantly lower than that in the ADHD group. The DCCC Total score and each factor score of the ADHD + RD group were significantly greater than those of the ADHD group. According to Table 1 . Table 1 Comparison of general information and various assessments between the two groups Group(M ± SD) ADHD group( n = 80) ADHD + RD group( n = 80) t/χ 2 p Gender Male(n%) 65(81.25%) 65(81.25%) 0.00 1.000 Female(n%) 15(18.75%) 15(18.75%) Age 9.91 ± 1.02 9.93 ± 1.02 -0.08 0.938 SNAP-IV Total 36.16 ± 12.41 37.20 ± 13.08 -0.52 0.607 IA 15.95 ± 4.36 15.86 ± 4.69 0.12 0.903 IH 11.21 ± 5.35 12.00 ± 6.10 -0.87 0.387 ODD 9.00 ± 5.44 9.34 ± 4.42 -0.43 0.667 WISC 103.33 ± 7.71 103.05 ± 7.77 0.23 0.822 DCCC Total 145.81 ± 36.77 177.13 ± 31.62 -5.78 < 0.001 DCCC 1 16.79 ± 5.04 22.26 ± 5.49 -6.57 < 0.001 DCCC 2 15.24 ± 4.65 18.80 ± 4.89 -4.72 < 0.001 DCCC 3 23.69 ± 7.54 29.30 ± 5.82 -5.27 < 0.001 DCCC 4 21.56 ± 6.29 25.50 ± 5.75 -4.13 < 0.001 DCCC 5 14.74 ± 5.50 18.23 ± 4.57 -4.36 < 0.001 DCCC 6 20.68 ± 6.46 24.63 ± 4.40 -4.52 < 0.001 DCCC 7 14.71 ± 4.79 17.84 ± 4.13 -4.42 < 0.001 DCCC 8 18.41 ± 4.33 20.58 ± 4.19 -3.21 0.002 VWM 0-back 0.99 ± 0.02 0.97 ± 0.04 2.40 0.018 1-back 0.96 ± 0.05 0.88 ± 0.11 6.17 < 0.001 2-back 0.86 ± 0.06 0.80 ± 0.09 5.06 < 0.001 VSWM 0.88 ± 0.04 0.73 ± 0.09 12.77 < 0.001 Go/No-go 0.97 ± 0.02 0.94 ± 0.04 7.13 < 0.001 DCCC 1 = visual perception disorder; DCCC 2 = auditory perception disorder; DCCC 3 = meaning comprehension disorder; DCCC 4 = writing disorder; DCCC 5 = oral language disorder; DCCC 6 = written expression disorder; DCCC 7 = poor reading habits disorder; DCCC 8 = inattention disorder 3.2. Correlation analysis of DCCC scores with SNAP-IV scores and EF task performance The DCCC Total score and some factor scores were significantly positively correlated with the SNAP-IV Total score, IA symptoms and IH symptoms. Except for the VWM task (0-back, 2-back), the DCCC Total score showed a significant negative correlation with the VWM task (1-back), VSWM task and Go/No-go task scores. According to Table 2 . Table 2 Correlation analysis of DCCC scores with ADHD symptoms and EF task performance DCCC Total DCCC 1 DCCC 2 DCCC 3 DCCC 4 DCCC 5 DCCC 6 DCCC 7 DCCC 8 VWM(0-back) -0.132 -0.228 ** -0.144 -0.073 -0.157 * -0.005 -0.162 * -0.111 0.033 VWM(1-back) -0.247 ** -0.364 ** -0.197 * -0.183 * -0.184 * -0.212 ** -0.213 ** -0.178 * -0.093 VWM(2-back) -0.103 -0.256 ** -0.134 -0.061 -0.021 -0.025 -0.076 -0.155 * 0.045 VSWM -0.332 ** -0.420 ** -0.243 ** -0.308 ** -0.220 ** -0.227 ** -0.304 ** -0.295 ** -0.173 * Go/No-go -0.330 ** -0.333 ** -0.275 ** -0.293 ** -0.216 ** -0.318 ** -0.274 ** -0.295 ** -0.191 * SNAP-IV Total 0.225 ** 0.134 0.314 ** 0.190 * 0.187 * 0.123 0.163 * 0.186 * 0.237 ** IA 0.222 ** 0.183 * 0.324 ** 0.179 * 0.178 * 0.147 0.153 0.087 0.254 ** IH 0.198 * 0.092 0.277 ** 0.170 * 0.144 0.106 0.147 0.199 * 0.224 ** ODD 0.147 0.071 0.191 * 0.127 0.151 0.06 0.108 0.169 * 0.118 * p < 0.05; ** p < 0.01༛ *** p < 0.001 DCCC 1 = visual perception disorder; DCCC 2 = auditory perception disorder; DCCC 3 = meaning comprehension disorder; DCCC 4 = writing disorder; DCCC 5 = oral language disorder; DCCC 6 = written expression disorder; DCCC 7 = poor reading habits disorder; DCCC 8 = inattention disorder 3.3. Effects of ADHD Symptoms, Age, Intelligence, and EF Task Performance on DCCC Scores ANOVA was used to analyse the effect of ADHD symptoms and other factors on the variance in DCCC scale total scores, using DCCC Total as the dependent variable, SNAP-IV Total as the fixed factor, and Age, WISC, VSWM, VWM (0-back, 1-back, 2-back), and Go/No-go task accuracy as covariates. The results showed statistically significant effects of the VSWM task and Go/No-go task on DCCC Total variability. (F = 4.73, p = 0.032; F = 4.56, p = 0.035;), and there was no statistically significant effect of SNAP-IV Total, WISC, Age, or VWM tasks on DCCC Total. According to Table 3 . Table 3 Predictors of DCCC score Type III Sum of Squares df F p Covariate Age 355.66 1 0.33 0.565 WISC 139.60 1 0.13 0.719 VWM(0-back) 3.51 1 0.00 0.954 VWM(1-back) 1550.99 1 1.45 0.231 VWM(2-back) 1584.79 1 1.48 0.226 VSWM 5049.74 1 4.73 0.032 * Go/No-go 4872.37 1 4.56 0.035 * Fixed factor SNAP-IV Total 78782.81 52 1.42 0.068 R 2 = 0.525 ( Adjusted R 2 = 0.245 ) 4. Discussion This study focused on the EF characteristics of Chinese RD patients with cooccurring ADHD and revealed that patients in the cooccurring group had more pronounced deficits in the domains of executive functioning, such as verbal and visuospatial working memory and response inhibition, than did ADHD patients. This finding is consistent with the results of a number of previous studies in which the multiple-deficit hypothesis suggested that the neurocognitive deficits in the comorbid group differed from the simple additive combination of ADHD and RD related deficits in isolation but instead formed a distinct cognitive subtype and showed more prominent impairments clinically [ 11 ] . Gooch [ 12 ] found that children with cooccurring ADHD and RD not only performed poorly on phonological skill tasks but also showed greater deficits in reaction time variability and working memory tasks. It is important to consider the influence of ADHD comorbidities when studying the neuropsychological function of RD patients. The results are also consistent with those of Willcutt's analyses, who proposed the hypothesis that ADHD symptoms are associated with genetic deficits in response inhibition, whereas RD is associated with genetic deficits in phonological awareness, verbal reasoning, and working memory, such that children with concurrent disorders exhibit more dimensional and more pronounced neurocognitive deficits [ 13 ] . Turker's research suggested that EF deficit is not only the core deficit of ADHD but also affects the development of basic language learning ability [ 14 ] . McGrath's exploration of the degree of gray matter overlap associated with reading problems and ADHD symptoms revealed a region of overlap between the two in the right caudate nucleus [ 15 ] . Reduced gray matter volume in the right caudate nucleus may be associated with EF deficits, and these studies explain the high degree of clinical comorbidity between the two groups of disorders and their neural basis. This study also analysed the relationship between Chinese RD symptoms and ADHD-related symptoms and revealed that reading ability was strongly correlated with IA and IH symptoms, while the correlations with the ODD symptoms were not significant. Research in cognitive psychology has shown that basic reading ability is related to the allocation of subjective attentional resources, motivation, and emotion regulation and that patients with comorbidities may have a greater cognitive load and more difficulties in allocating attention during reading tasks. Several studies of ADHD comorbid with RD have also consistently reported a low to moderate significant correlation between reading and ADHD symptoms (r = 0.2 ~ 0.5) [ 16 – 18 ] . Neuroimaging studies have shown that both ADHD and RD are associated with the volume of frontal regions, the size of which correlates with attentional control [ 19 – 21 ] . Early developmental studies based on a large sample of twins showed that reading was genetically correlated with both attention deficits and hyperactive impulsivity and that the former (r = 0.34) was significantly greater than the latter (r = 0.16) after excluding the influence of IQ factors, suggesting that the substantial genetic overlap that occurs in the symptomatic domains of ADHD and dyslexia is driven in large part by attention deficits [ 22 , 23 ] . Overall, findings in familial studies of patients with ADHD and RD suggest a strong phenotypic and genetic correlation between RD and ADHD, especially as it relates to IA and IH symptoms [ 24 ] . Although some studies have pointed out that there may be some correlation between them, the genetic basis is very complex and has not been fully explained, and the specific mechanism needs further research to clarify. Studies have shown that Chinese reading comprehension, because it involves character shape, sound, and meaning, involves more complex neural network coparticipation than does English reading, but few studies have been conducted on the EF of Chinese RDs. Lee's research on Chinese-Cantonese RD revealed that children with ADHD comorbid with RD had EF deficits similar to those in children using alphabetic languages and that comorbid children showed more severe deficits in visuospatial working memory than did children with RD or ADHD alone [ 25 ] . The present study consistently revealed that after fixating on the effects of ADHD symptoms, VWM deficits and response inhibition deficits had significant predictive effects on the reading ability of children with ADHD. 5. conclusion In summary, individuals with ADHD comorbid with Chinese RD have more significant deficits in executive functioning, thus leading to poor functional regression. Among ADHD symptoms, the reading levels of comorbid patients are associated with IA and IH symptoms and are also affected by multiple cognitive deficits, such as working memory and response inhibition. There are still some shortcomings in the course of the current study, such as the selection of a sample without including patients with RD alone as a control group, which makes it difficult to distinguish whether these difficulties in executive functioning are due to overlapping manifestations of comorbidities or whether they are inherent features of RD. Future studies could further incorporate separate RD groups while exploring the neural mechanisms underlying these differences, providing a rationale for the development of diverse interventions for this complex clinical problem. Abbreviations ADHD: Attention deficit hyperactivity disorder RD: reading disorder EF: Executive function WISC: Wechsler Intelligence Scale for Children SNAP-IV: Swanson, Nolan, and Pelham-IV DCCC: Dyslexia Checklist for Chinese Children VWM: Verbal working memory VSWM: Visual spatial working memory ICD-10: tenth edition of the International Statistical Classification of Diseases and Related Health Problems Declarations Data availability The datasets used and analyzed during the current study are available from the corresponding author upon reasonable request. Acknowledgements Not applicable. Funding This study was funded by Zhejiang Medical and Health Science and Technology(2021KY330) and Ningbo Natural Science Foundation(202003N4262). Author information Authors and Affiliations Health Science Center, Ningbo University, Ningbo 315211, Zhejiang Province ,China Jia Wei Department of psychiatry,Affiliated Kangning Hospital of Ningbo University,Ningbo 315201,Zhejiang Province ,China Wenwu Zhang Contributions JW and WWZ contributed to the conception and design of the study. JW and WWZ were responsible for organising and supervison data collection extraction. JW and WWZ were responsible for data analyses, and also drafted the manuscript. WWZ revised the manuscript critically. All authors have read and approved the final version of the manuscript. Corresponding author Correspondence to Wenwu Zhang. E-mail: [email protected] Ethics declarations Competing interests The authors declare no competing interests. Ethics Statement This study was carried out in accordance with the recommendations of the Ethics Committee of Kangning Hospital of Ningbo. The protocol was approved by the Ethics Committee of Kangning Hospital of Ningbo. All subjects provided written informed consent in accordance with the Declaration of Helsinki. Patient consent for publication Not applicable. References Li F, Cui Y, Li Y, et al. Prevalence of mental disorders in school children and adolescents in China: diagnostic data from detailed clinical assessments of 17,524 individuals[J]. J Child Psychol Psychiatry, 2022, 63(1): 34-46. doi: 10.1111/jcpp.13445. Germanò E, Gagliano A, Curatolo P. Comorbidity of ADHD and dyslexia[J]. Dev Neuropsychol, 2010, 35(5): 475-493. doi: 10.1080/87565641.2010.494748. Doebel S. Rethinking Executive Function and Its Development[J]. Perspect Psychol Sci, 2020, 15(4): 942-956. doi: 10.1177/1745691620904771. Miklós M, Futó J, Komáromy D, et al. Executive Function and Attention Performance in Children with ADHD: Effects of Medication and Comparison with Typically Developing Children[J]. Int J Environ Res Public Health, 2019, 16(20). doi: 10.3390/ijerph16203822. Moura O, Simões MR, Pereira M. Working Memory in Portuguese Children With Developmental Dyslexia[J]. Appl Neuropsychol Child, 2015, 4(4): 237-248. doi: 10.1080/21622965.2014.885389. Swanson HL, Xinhua Z, Jerman O. Working memory, short-term memory, and reading disabilities: a selective meta-analysis of the literature[J]. J Learn Disabil, 2009, 42(3): 260-287. doi: 10.1177/0022219409331958. Le Cunff AL, Dommett E, Giampietro V. Neurophysiological measures and correlates of cognitive load in attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD) and dyslexia: A scoping review and research recommendations[J]. Eur J Neurosci, 2024, 59(2): 256-282. doi: 10.1111/ejn.16201. Na SD, Burns TG. Wechsler Intelligence Scale for Children-V: Test Review[J]. Appl Neuropsychol Child, 2016, 5(2): 156-160. doi: 10.1080/21622965.2015.1015337. Hall CL, Guo B, Valentine AZ, et al. The Validity of the SNAP-IV in Children Displaying ADHD Symptoms[J]. Assessment, 2020, 27(6): 1258-1271. doi: 10.1177/1073191119842255. Hou F, Qi L, Liu L, et al. Validity and Reliability of the Dyslexia Checklist for Chinese Children[J]. Front Psychol, 2018, 9: 1915. doi: 10.3389/fpsyg.2018.01915. Moura O, Pereira M, Alfaiate C, et al. Neurocognitive functioning in children with developmental dyslexia and attention-deficit/hyperactivity disorder: Multiple deficits and diagnostic accuracy[J]. J Clin Exp Neuropsychol, 2017, 39(3): 296-312. doi: 10.1080/13803395.2016.1225007. Gooch D, Snowling M, Hulme C. Time perception, phonological skills and executive function in children with dyslexia and/or ADHD symptoms[J]. J Child Psychol Psychiatry, 2011, 52(2): 195-203. doi: 10.1111/j.1469-7610.2010.02312.x. Willcutt EG, Betjemann RS, McGrath LM, et al. Etiology and neuropsychology of comorbidity between RD and ADHD: the case for multiple-deficit models[J]. Cortex, 2010, 46(10): 1345-1361. doi: 10.1016/j.cortex.2010.06.009. Turker S, Seither-Preisler A, Reiterer SM, et al. Cognitive and Behavioural Weaknesses in Children with Reading Disorder and AD(H)D[J]. Sci Rep, 2019, 9(1): 15185. doi: 10.1038/s41598-019-51372-w. McGrath LM, Stoodley CJ. Are there shared neural correlates between dyslexia and ADHD? A meta-analysis of voxel-based morphometry studies[J]. J Neurodev Disord, 2019, 11(1): 31. doi: 10.1186/s11689-019-9287-8. Bauermeister JJ, Matos M, Reina G, et al. Comparison of the DSM-IV combined and inattentive types of ADHD in a school-based sample of Latino/Hispanic children[J]. J Child Psychol Psychiatry, 2005, 46(2): 166-179. doi: 10.1111/j.1469-7610.2004.00343.x. Willcutt EG, Pennington BF, Olson RK, et al. Neuropsychological analyses of comorbidity between reading disability and attention deficit hyperactivity disorder: in search of the common deficit[J]. Dev Neuropsychol, 2005, 27(1): 35-78. doi: 10.1207/s15326942dn2701_3. Willcutt EG, Pennington BF, Duncan L, et al. Understanding the complex etiologies of developmental disorders: behavioral and molecular genetic approaches[J]. J Dev Behav Pediatr, 2010, 31(7): 533-544. doi: 10.1097/DBP.0b013e3181ef42a1. Jagger-Rickels AC, Kibby MY, Constance JM. Global gray matter morphometry differences between children with reading disability, ADHD, and comorbid reading disability/ADHD[J]. Brain Lang, 2018, 185: 54-66. doi: 10.1016/j.bandl.2018.08.004. Kibby MY, Newsham G, Imre Z, et al. Is executive dysfunction a potential contributor to the comorbidity between basic reading disability and attention-deficit/hyperactivity disorder?[J]. Child Neuropsychol, 2021, 27(7): 888-910. doi: 10.1080/09297049.2021.1908532. Kibby MY, Dyer SM, Lee SE, et al. Frontal volume as a potential source of the comorbidity between attention-deficit/hyperactivity disorder and reading disorders[J]. Behav Brain Res, 2020, 381: 112382. doi: 10.1016/j.bbr.2019.112382. Greven CU, Harlaar N, Dale PS, et al. Genetic Overlap between ADHD Symptoms and Reading is largely Driven by Inattentiveness rather than Hyperactivity-Impulsivity[J]. J Can Acad Child Adolesc Psychiatry, 2011, 20(1): 6-14. Paloyelis Y, Rijsdijk F, Wood AC, et al. The genetic association between ADHD symptoms and reading difficulties: the role of inattentiveness and IQ[J]. J Abnorm Child Psychol, 2010, 38(8): 1083-1095. doi: 10.1007/s10802-010-9429-7. Cheung CH, Frazier-Wood AC, Asherson P, et al. Shared cognitive impairments and aetiology in ADHD symptoms and reading difficulties[J]. PLoS One, 2014, 9(6): e98590. doi: 10.1371/journal.pone.0098590. Lee CS. Executive functions underlie word reading and reading fluency in Chinese children with attention deficit/hyperactivity disorder, reading disabilities, and comorbid attention deficit/hyperactivity disorder and reading disabilities[J]. Child Neuropsychol, 2024, 30(1): 60-86. doi: 10.1080/09297049.2023.2179981. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted 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-4230998","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":288809432,"identity":"b6867cf6-7bb0-4fe1-9cf4-59d36c2af289","order_by":0,"name":"Jia Wei","email":"","orcid":"","institution":"Ningbo University","correspondingAuthor":false,"prefix":"","firstName":"Jia","middleName":"","lastName":"Wei","suffix":""},{"id":288809433,"identity":"311edda0-c9ab-47f4-a186-3691d0472c59","order_by":1,"name":"Wenwu zhang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAtklEQVRIiWNgGAWjYBACCSgtx8befoA0LcZ8PGcSSNOSOE/CwYA4LZKze8wkf7YdTm+TYEhg+FGxjbAWaZkzZhKSbYdz26QbDzD2nLlNWIucRI6ZhOG227ltMgcSmBnbiNWSuO12OptEggFxWqRBWg5uu51AvBbJGWnFlo3//hu2AQP5IFF+kbiRvPHmjzNp8vLt7Qcf/KggQgsDA4cJLG4YDhCjHgjYH38gUuUoGAWjYBSMVAAARHc68jrkpggAAAAASUVORK5CYII=","orcid":"","institution":"Ningbo Kangning Hospital","correspondingAuthor":true,"prefix":"","firstName":"Wenwu","middleName":"","lastName":"zhang","suffix":""}],"badges":[],"createdAt":"2024-04-07 10:59:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4230998/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4230998/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":54522559,"identity":"dc9b1ecc-f803-4fff-afc5-a8acfda454cb","added_by":"auto","created_at":"2024-04-11 18:32:26","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":142328,"visible":true,"origin":"","legend":"\u003cp\u003eThe VWM flow chart\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-4230998/v1/81c3bd6721ac9a7c0172dc70.png"},{"id":54522557,"identity":"bd292f64-3506-4ade-b1e4-f08c27d49525","added_by":"auto","created_at":"2024-04-11 18:32:26","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":46456,"visible":true,"origin":"","legend":"\u003cp\u003eThe VSWM flow chart\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-4230998/v1/44f644cc56cb0848e501ee0c.png"},{"id":54522558,"identity":"03736a65-70e0-4ef9-b538-a8162be3dc6a","added_by":"auto","created_at":"2024-04-11 18:32:26","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":208532,"visible":true,"origin":"","legend":"\u003cp\u003eThe Go/No-go flow chart\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-4230998/v1/ee24114d5cffc3e1cda4856c.png"},{"id":54677436,"identity":"4fc23573-dff9-4e88-9a82-53dc09b4dc23","added_by":"auto","created_at":"2024-04-15 07:01:07","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":798304,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4230998/v1/3adadf89-e4fd-4cae-90fb-d7026154c146.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Effects of executive function deficits on Chinese reading ability in ADHD patients","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eAttention deficit hyperactivity disorder (ADHD) is a common neuropsychiatric developmental disorder in children and adolescents, with a prevalence rate of approximately 6.4% among school-age children\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. Chinese reading disorder (RD) is a specific learning disability that usually begins in school-age children, affects the acquisition and development of reading skills, and cannot be attributed exclusively to intelligence, vision, or poor education. In China, the prevalence of Chinese RD is approximately 3.45%~8%. Studies have shown that the percentage of comorbid RDs in ADHD patients is approximately 18\u0026thinsp;~\u0026thinsp;45%, which is much greater than that in the general population\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e, and that children who face problems with the overlap of these two disorders are more likely to experience academic failure, psychosocial consequences, and poor long-term outcomes that persist into adulthood.\u003c/p\u003e \u003cp\u003eExecutive function (EF), an advanced cognitive control process that includes working memory, response inhibition, and cognitive flexibility, is responsible for planning, organizing, controlling, and regulating an individual's behavior to achieve a goal and plays an important role in the development of reading skills\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. EF deficits are likewise a fundamental neuropsychological mechanism of ADHD\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e. Research suggests that patients with ADHD comorbid with RD may present a more complex and unique EF profile that differs from that of patients with ADHD alone\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. Phenotypic analysis also further supported the hypothesis that both ADHD and RD are caused by multiple cognitive deficits rather than a single primary cognitive deficit\u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e. However, the specific manifestations and differences in EFs of ADHD patients with cooccurring Chinese RD are still unclear; therefore, in-depth studies of this specific group of individuals can help to reveal their cognitive characteristics and neural mechanisms and provide more accurate guidance for personalized treatment plans.\u003c/p\u003e"},{"header":"2. Method","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1. Participants\u003c/h2\u003e \u003cp\u003eIn this study, 160 ADHD patients who attended the child and adolescent psychiatric clinic of Kangning Hospital of Ningbo were included and divided into 80 patients each in the ADHD group and ADHD\u0026thinsp;+\u0026thinsp;RD group according to the tenth edition of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) diagnostic criteria. Individuals with other neurodevelopmental and psychiatric disorders, such as mental retardation and loneliness spectrum disorders, were excluded, those with audiovisual disorders were excluded, and those who had been treated for ADHD or RD in the last 3 months were excluded. This study was approved by the hospital ethics committee, and all participating patients and family members (guardians) provided informed consent. There was no statistically significant difference in age or gender composition between the two groups, as shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2. Tools\u003c/h2\u003e \u003cdiv id=\"Sec5\" class=\"Section3\"\u003e \u003ch2\u003e\u003cb\u003e2.2.1. Wechsler Intelligence Scale for Children (WISC)\u003c/b\u003e\u003c/h2\u003e \u003cp\u003eThe WISC is a test instrument commonly used to assess the intelligence level of children. The test is for children and adolescents aged 6 to 16 years and 11 months and uses a series of cognitive subtests to assess a child's performance in various areas of intelligence. The WISC consists of a number of standardized subtests, such as vocabulary, reasoning, numerical memory, and spatial ability, which are used to assess children's intellectual and cognitive abilities, and the scoring criteria are based on a system of scores with a mean value of 100 and a standard deviation of 15\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003e2.2.2. Swanson, Nolan, and Pelham-IV (SNAP-IV)\u003c/h2\u003e \u003cp\u003eThe SNAP-IV is a scale used to assess ADHD symptoms in children and adolescents. The scale included 9 inattention (IA) symptom items, 9 hyperactive-impulsivity (IH) symptom items and 8 oppositional defiant disorder (ODD) symptom items, using a 4-point score ranging from 0 to 3. The higher the score is, the more severe the symptoms are. This scale is rated by parents and has good reliability for domestic applications\u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e \u003ch2\u003e2.2.3. Dyslexia Checklist for Chinese Children (DCCC)\u003c/h2\u003e \u003cp\u003eThe DCCC scale was developed by Professor Hanrong Wu from Huazhong University of Science and Technology. Eight symptom items, including visual perception disorder, auditory perception disorder, meaning comprehension disorder, writing disorder, oral language disorder, written expression disorder, poor reading habits disorder and inattention disorder, used 5-point scores ranging from 1 to 5. The higher the score is, the lower the symptom ability. This scale was evaluated by parents and has good reliability and validity\u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section3\"\u003e \u003ch2\u003e2.2.4. Verbal working memory (VWM) task\u003c/h2\u003e \u003cp\u003eBased on the N-back task paradigm commonly used in previous studies, inquist software was used to experimentally develop the VWM task. The stimuli were presented on a computer with a screen resolution of 2160 \u0026times; 1440 (the same for all subsequent tasks). The background was black (0,0,0), and the display language and letters were white (255,255,255).\u003c/p\u003e \u003cp\u003eIn the VWM task, the subjects were seated 57cm from the computer screen on which the task was presented. Task instruction: In this memory game, you will see the letters appearing one after the other on the screen. The letters quickly disappear from the screen, and you need to concentrate on memorizing the order in which the letters appear.\u003c/p\u003e \u003cp\u003eAccording to Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, the task is divided into three zone groups. The first group is 0-back, for a total of 30 rounds. When the letter \"m\" appears on the screen, the subject needs to quickly press the \"A\" key, and the rest of the letters do not respond. The second zone is 1-back, for a total of 31 rounds. When the letters appear on the screen at this time are the same as those in the previous round, the subject needs to quickly press the \"A\" key. The third block is 2-back, for a total of 32 rounds. When the same letter appears on the screen as the same as the round before the previous, the subject needs to press the \"A\" key quickly. Each letter was presented for 500ms with an interval of 2000ms. Ten trials were conducted in each of the three zone groups, for a total of 30 trials, to ensure that the subject fully understood the task.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003ch2\u003e2.2.5. Visual spatial working memory (VSWM) task\u003c/h2\u003e \u003cp\u003eBased on the N-back task paradigm commonly used in previous studies, the same inquiry software was used to experimentally prepare the VSWM task. The stimuli were presented on a computer with a black background (0,0,0), a white display language (255,255,255), blue squares (0,0,255), and a size of (45\u0026times;45) mm.\u003c/p\u003e \u003cp\u003eIn the VSWM task, the subjects were seated 57cm from the computer screen on which the task was presented. Task instruction: In this memory game, you will see a series of blue squares appearing one after another in different locations on the computer screen. The squares on the screen are rendered quite quickly, with a new square appearing in a few seconds, and you need to concentrate on memorizing where the blue squares appear.\u003c/p\u003e \u003cp\u003eSubjects performed the VSWM task after completing the VWM task. The VSWM task was performed individually only in 2-back block sets for a total of 42 rounds. The \"+\" gaze point was displayed in the center of the screen, and blue squares appeared randomly in (3\u0026times;3) blocks (not including the center point) at a total of 8 locations. According to Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, When the position of the blue square on the screen matches the position of the blue square in the round before the previous, press the \"A\" key. Each blue square represents 500ms with an interval of 2500ms. The 2-back zone groups performed 12 trials to ensure that the subject fully understood the task.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e \u003ch2\u003e\u003cb\u003e2.2.6. Response inhibition task\u003c/b\u003e\u003c/h2\u003e \u003cp\u003eBased on the Go/No-go task paradigm commonly used in previous studies, inquist software was used to experimentally prepare the stimuli for presentation on the computer.\u003c/p\u003e \u003cp\u003eIn the Go/No-go task, subjects were seated 57cm from the computer screen on which the task was presented. Task instruction: A mole is digging a hole in the garden, your job requires hitting the mole to get it to leave, beautifying the garden, sometimes there will be eggplant in the garden, be careful not to hit it. According to Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, the subjects were asked to respond to the \"Go\" trial and the \"No-go\" trial on the screen, where the \"Go\" trial was a \"mole\" pattern with slightly different shapes, and the \"No-go\" trial was an \"eggplant\" pattern. The subjects were asked to quickly hit the space bar when the \"mole\" pattern appeared and did not hit the space bar when the \"eggplant\" pattern appeared. The task consisted of a total of 165 trials, including 124 \"Go\" trials with a response interval of 1800ms and 41 \"No-go\" trials with a response interval of 1300ms, with a pseudorandomized frequency of occurrence.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e2.3. Data Analysis\u003c/h2\u003e \u003cp\u003eThe data were analysed using SPSS 23.0 statistical software with two independent sample t-tests, chi-square tests, Person correlation analysis, ANCOVA analysis. The data from the working memory task and Go/No-go task were converted into a correct rate for statistical analysis.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec13\"\u003e\n \u003ch2\u003e3.1. Differences in the SNAP-IV score, DCCC score, Intelligence, and reading ability between the two groups\u003c/h2\u003e\n \u003cp\u003eThere were no significant differences between the two groups in terms of intelligence score, SNAP-IV Total score or score on any of the 3 subscales. The accuracy of the VWM tasks (0-back, 1-back, 2-back), VSWM task and Go/No-go task in the ADHD\u0026thinsp;+\u0026thinsp;RD group was significantly lower than that in the ADHD group. The DCCC Total score and each factor score of the ADHD\u0026thinsp;+\u0026thinsp;RD group were significantly greater than those of the ADHD group. According to Table\u0026nbsp;\u003cspan\u003e1\u003c/span\u003e.\u003c/p\u003e\n \u003cdiv\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 1\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eComparison of general information and various assessments between the two groups\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eGroup(M\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eADHD group(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eADHD\u0026thinsp;+\u0026thinsp;RD group(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003et/\u0026chi;\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale(n%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e65(81.25%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e65(81.25%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale(n%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15(18.75%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15(18.75%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.91\u0026thinsp;\u0026plusmn;\u0026thinsp;1.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.93\u0026thinsp;\u0026plusmn;\u0026thinsp;1.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.938\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSNAP-IV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36.16\u0026thinsp;\u0026plusmn;\u0026thinsp;12.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37.20\u0026thinsp;\u0026plusmn;\u0026thinsp;13.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.607\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15.95\u0026thinsp;\u0026plusmn;\u0026thinsp;4.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15.86\u0026thinsp;\u0026plusmn;\u0026thinsp;4.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.903\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.21\u0026thinsp;\u0026plusmn;\u0026thinsp;5.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12.00\u0026thinsp;\u0026plusmn;\u0026thinsp;6.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.387\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eODD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.00\u0026thinsp;\u0026plusmn;\u0026thinsp;5.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.34\u0026thinsp;\u0026plusmn;\u0026thinsp;4.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.667\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eWISC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e103.33\u0026thinsp;\u0026plusmn;\u0026thinsp;7.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e103.05\u0026thinsp;\u0026plusmn;\u0026thinsp;7.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.822\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDCCC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e145.81\u0026thinsp;\u0026plusmn;\u0026thinsp;36.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e177.13\u0026thinsp;\u0026plusmn;\u0026thinsp;31.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-5.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDCCC\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16.79\u0026thinsp;\u0026plusmn;\u0026thinsp;5.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22.26\u0026thinsp;\u0026plusmn;\u0026thinsp;5.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-6.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDCCC\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15.24\u0026thinsp;\u0026plusmn;\u0026thinsp;4.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18.80\u0026thinsp;\u0026plusmn;\u0026thinsp;4.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-4.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDCCC\u003csup\u003e3\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23.69\u0026thinsp;\u0026plusmn;\u0026thinsp;7.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29.30\u0026thinsp;\u0026plusmn;\u0026thinsp;5.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-5.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDCCC\u003csup\u003e4\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21.56\u0026thinsp;\u0026plusmn;\u0026thinsp;6.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25.50\u0026thinsp;\u0026plusmn;\u0026thinsp;5.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-4.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDCCC\u003csup\u003e5\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14.74\u0026thinsp;\u0026plusmn;\u0026thinsp;5.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18.23\u0026thinsp;\u0026plusmn;\u0026thinsp;4.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-4.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDCCC\u003csup\u003e6\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20.68\u0026thinsp;\u0026plusmn;\u0026thinsp;6.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24.63\u0026thinsp;\u0026plusmn;\u0026thinsp;4.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-4.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDCCC\u003csup\u003e7\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14.71\u0026thinsp;\u0026plusmn;\u0026thinsp;4.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17.84\u0026thinsp;\u0026plusmn;\u0026thinsp;4.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-4.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDCCC\u003csup\u003e8\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18.41\u0026thinsp;\u0026plusmn;\u0026thinsp;4.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20.58\u0026thinsp;\u0026plusmn;\u0026thinsp;4.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-3.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVWM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0-back\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.99\u0026thinsp;\u0026plusmn;\u0026thinsp;0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.97\u0026thinsp;\u0026plusmn;\u0026thinsp;0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.018\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1-back\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.96\u0026thinsp;\u0026plusmn;\u0026thinsp;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.88\u0026thinsp;\u0026plusmn;\u0026thinsp;0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2-back\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.86\u0026thinsp;\u0026plusmn;\u0026thinsp;0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.80\u0026thinsp;\u0026plusmn;\u0026thinsp;0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eVSWM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.88\u0026thinsp;\u0026plusmn;\u0026thinsp;0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.73\u0026thinsp;\u0026plusmn;\u0026thinsp;0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eGo/No-go\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.97\u0026thinsp;\u0026plusmn;\u0026thinsp;0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.94\u0026thinsp;\u0026plusmn;\u0026thinsp;0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"6\"\u003e\n \u003cp\u003eDCCC\u003csup\u003e1\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;visual perception disorder; DCCC\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;auditory perception disorder; DCCC\u003csup\u003e3\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;meaning comprehension disorder; DCCC\u003csup\u003e4\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;writing disorder; DCCC\u003csup\u003e5\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;oral language disorder; DCCC\u003csup\u003e6\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;written expression disorder; DCCC\u003csup\u003e7\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;poor reading habits disorder; DCCC\u003csup\u003e8\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;inattention disorder\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec14\"\u003e\n \u003ch2\u003e3.2. Correlation analysis of DCCC scores with SNAP-IV scores and EF task performance\u003c/h2\u003e\n \u003cp\u003eThe DCCC Total score and some factor scores were significantly positively correlated with the SNAP-IV Total score, IA symptoms and IH symptoms. Except for the VWM task (0-back, 2-back), the DCCC Total score showed a significant negative correlation with the VWM task (1-back), VSWM task and Go/No-go task scores. According to Table\u0026nbsp;\u003cspan\u003e2\u003c/span\u003e.\u003c/p\u003e\n \u003cdiv\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 2\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eCorrelation analysis of DCCC scores with ADHD symptoms and EF task performance\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eDCCC Total\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eDCCC\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eDCCC\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eDCCC\u003csup\u003e3\u003c/sup\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eDCCC\u003csup\u003e4\u003c/sup\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eDCCC\u003csup\u003e5\u003c/sup\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eDCCC\u003csup\u003e6\u003c/sup\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eDCCC\u003csup\u003e7\u003c/sup\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eDCCC\u003csup\u003e8\u003c/sup\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVWM(0-back)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.132\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.228\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.144\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.073\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.157\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.162\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.111\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.033\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVWM(1-back)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.247\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.364\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.197\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.183\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.184\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.212\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.213\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.178\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.093\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVWM(2-back)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.103\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.256\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.134\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.061\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.025\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.076\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.155\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.045\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVSWM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.332\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.420\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.243\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.308\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.220\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.227\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.304\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.295\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.173\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGo/No-go\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.330\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.333\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.275\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.293\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.216\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.318\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.274\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.295\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.191\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSNAP-IV Total\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.225\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.134\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.314\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.190\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.187\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.123\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.163\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.186\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.237\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.222\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.183\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.324\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.179\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.178\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.147\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.153\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.087\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.254\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.198\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.092\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.277\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.170\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.144\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.106\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.147\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.199\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.224\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eODD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.147\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.071\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.191\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.127\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.151\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.108\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.169\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.118\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"10\"\u003e\n \u003cp\u003e\u003csup\u003e*\u003c/sup\u003e\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05;\u003csup\u003e**\u003c/sup\u003e\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01༛\u003csup\u003e***\u003c/sup\u003e\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003cp\u003eDCCC\u003csup\u003e1\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;visual perception disorder; DCCC\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;auditory perception disorder; DCCC\u003csup\u003e3\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;meaning comprehension disorder; DCCC\u003csup\u003e4\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;writing disorder; DCCC\u003csup\u003e5\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;oral language disorder; DCCC\u003csup\u003e6\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;written expression disorder; DCCC\u003csup\u003e7\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;poor reading habits disorder; DCCC\u003csup\u003e8\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;inattention disorder\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec15\"\u003e\n \u003ch2\u003e3.3. Effects of ADHD Symptoms, Age, Intelligence, and EF Task Performance on DCCC Scores\u003c/h2\u003e\n \u003cp\u003eANOVA was used to analyse the effect of ADHD symptoms and other factors on the variance in DCCC scale total scores, using DCCC Total as the dependent variable, SNAP-IV Total as the fixed factor, and Age, WISC, VSWM, VWM (0-back, 1-back, 2-back), and Go/No-go task accuracy as covariates. The results showed statistically significant effects of the VSWM task and Go/No-go task on DCCC Total variability. (F\u0026thinsp;=\u0026thinsp;4.73, p\u0026thinsp;=\u0026thinsp;0.032; F\u0026thinsp;=\u0026thinsp;4.56, p\u0026thinsp;=\u0026thinsp;0.035;), and there was no statistically significant effect of SNAP-IV Total, WISC, Age, or VWM tasks on DCCC Total. According to Table\u0026nbsp;\u003cspan\u003e3\u003c/span\u003e.\u003c/p\u003e\n \u003cdiv\u003e\n \u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 3\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003ePredictors of DCCC score\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eType III Sum of Squares\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003edf\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCovariate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e355.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.565\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWISC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e139.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.719\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVWM(0-back)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.954\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVWM(1-back)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1550.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.231\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVWM(2-back)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1584.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.226\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVSWM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5049.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.032\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGo/No-go\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4872.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.035\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFixed factor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSNAP-IV Total\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e78782.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.068\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003e\u003cem\u003eR\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.525\u003cem\u003e(\u003c/em\u003eAdjusted \u003cem\u003eR\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.245\u003cem\u003e)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThis study focused on the EF characteristics of Chinese RD patients with cooccurring ADHD and revealed that patients in the cooccurring group had more pronounced deficits in the domains of executive functioning, such as verbal and visuospatial working memory and response inhibition, than did ADHD patients. This finding is consistent with the results of a number of previous studies in which the multiple-deficit hypothesis suggested that the neurocognitive deficits in the comorbid group differed from the simple additive combination of ADHD and RD related deficits in isolation but instead formed a distinct cognitive subtype and showed more prominent impairments clinically\u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e. Gooch\u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e found that children with cooccurring ADHD and RD not only performed poorly on phonological skill tasks but also showed greater deficits in reaction time variability and working memory tasks. It is important to consider the influence of ADHD comorbidities when studying the neuropsychological function of RD patients. The results are also consistent with those of Willcutt's analyses, who proposed the hypothesis that ADHD symptoms are associated with genetic deficits in response inhibition, whereas RD is associated with genetic deficits in phonological awareness, verbal reasoning, and working memory, such that children with concurrent disorders exhibit more dimensional and more pronounced neurocognitive deficits\u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e. Turker's research suggested that EF deficit is not only the core deficit of ADHD but also affects the development of basic language learning ability\u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e. McGrath's exploration of the degree of gray matter overlap associated with reading problems and ADHD symptoms revealed a region of overlap between the two in the right caudate nucleus\u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e. Reduced gray matter volume in the right caudate nucleus may be associated with EF deficits, and these studies explain the high degree of clinical comorbidity between the two groups of disorders and their neural basis.\u003c/p\u003e \u003cp\u003eThis study also analysed the relationship between Chinese RD symptoms and ADHD-related symptoms and revealed that reading ability was strongly correlated with IA and IH symptoms, while the correlations with the ODD symptoms were not significant. Research in cognitive psychology has shown that basic reading ability is related to the allocation of subjective attentional resources, motivation, and emotion regulation and that patients with comorbidities may have a greater cognitive load and more difficulties in allocating attention during reading tasks. Several studies of ADHD comorbid with RD have also consistently reported a low to moderate significant correlation between reading and ADHD symptoms (r\u0026thinsp;=\u0026thinsp;0.2\u0026thinsp;~\u0026thinsp;0.5)\u003csup\u003e[\u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e. Neuroimaging studies have shown that both ADHD and RD are associated with the volume of frontal regions, the size of which correlates with attentional control\u003csup\u003e[\u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e. Early developmental studies based on a large sample of twins showed that reading was genetically correlated with both attention deficits and hyperactive impulsivity and that the former (r\u0026thinsp;=\u0026thinsp;0.34) was significantly greater than the latter (r\u0026thinsp;=\u0026thinsp;0.16) after excluding the influence of IQ factors, suggesting that the substantial genetic overlap that occurs in the symptomatic domains of ADHD and dyslexia is driven in large part by attention deficits \u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e. Overall, findings in familial studies of patients with ADHD and RD suggest a strong phenotypic and genetic correlation between RD and ADHD, especially as it relates to IA and IH symptoms\u003csup\u003e[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e. Although some studies have pointed out that there may be some correlation between them, the genetic basis is very complex and has not been fully explained, and the specific mechanism needs further research to clarify.\u003c/p\u003e \u003cp\u003eStudies have shown that Chinese reading comprehension, because it involves character shape, sound, and meaning, involves more complex neural network coparticipation than does English reading, but few studies have been conducted on the EF of Chinese RDs. Lee's research on Chinese-Cantonese RD revealed that children with ADHD comorbid with RD had EF deficits similar to those in children using alphabetic languages and that comorbid children showed more severe deficits in visuospatial working memory than did children with RD or ADHD alone\u003csup\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e. The present study consistently revealed that after fixating on the effects of ADHD symptoms, VWM deficits and response inhibition deficits had significant predictive effects on the reading ability of children with ADHD.\u003c/p\u003e"},{"header":"5. conclusion","content":"\u003cp\u003eIn summary, individuals with ADHD comorbid with Chinese RD have more significant deficits in executive functioning, thus leading to poor functional regression. Among ADHD symptoms, the reading levels of comorbid patients are associated with IA and IH symptoms and are also affected by multiple cognitive deficits, such as working memory and response inhibition. There are still some shortcomings in the course of the current study, such as the selection of a sample without including patients with RD alone as a control group, which makes it difficult to distinguish whether these difficulties in executive functioning are due to overlapping manifestations of comorbidities or whether they are inherent features of RD. Future studies could further incorporate separate RD groups while exploring the neural mechanisms underlying these differences, providing a rationale for the development of diverse interventions for this complex clinical problem.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eADHD: Attention deficit hyperactivity disorder\u003c/p\u003e\n\u003cp\u003eRD: reading disorder\u003c/p\u003e\n\u003cp\u003eEF: Executive function\u003c/p\u003e\n\u003cp\u003eWISC: Wechsler Intelligence Scale for Children\u003c/p\u003e\n\u003cp\u003eSNAP-IV: Swanson, Nolan, and Pelham-IV\u003c/p\u003e\n\u003cp\u003eDCCC: Dyslexia Checklist for Chinese Children\u003c/p\u003e\n\u003cp\u003eVWM: Verbal working memory\u003c/p\u003e\n\u003cp\u003eVSWM: Visual spatial working memory\u003c/p\u003e\n\u003cp\u003eICD-10: tenth edition of the International Statistical Classification of Diseases and Related Health Problems\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and analyzed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was funded by Zhejiang Medical and Health Science and Technology(2021KY330) and Ningbo Natural Science Foundation(202003N4262).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eAuthor information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAuthors and Affiliations\u003c/p\u003e\n\u003cp\u003eHealth\u0026nbsp;Science\u0026nbsp;Center,\u0026nbsp;Ningbo\u0026nbsp;University, Ningbo 315211, Zhejiang Province ,China\u003c/p\u003e\n\u003cp\u003eJia Wei\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDepartment of psychiatry,Affiliated Kangning Hospital of Ningbo University,Ningbo 315201,Zhejiang Province ,China\u003c/p\u003e\n\u003cp\u003eWenwu Zhang\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eContributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eJW and WWZ contributed to the conception and design of the study. JW and WWZ were responsible for organising and supervison data collection extraction. JW and WWZ were responsible for data analyses, and also drafted the manuscript. WWZ revised the manuscript critically. All authors have read and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eCorresponding author\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCorrespondence to Wenwu Zhang.\u0026nbsp;E-mail: [email protected]\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eEthics declarations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCompeting interests\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Ethics Statement\u003c/p\u003e\n\u003cp\u003eThis study was carried out in accordance with the recommendations of the Ethics Committee of Kangning Hospital of Ningbo. The protocol was approved by the Ethics Committee of Kangning Hospital of Ningbo. All subjects provided written informed consent in accordance with the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Patient consent for publication\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eLi F, Cui Y, Li Y, et al. Prevalence of mental disorders in school children and adolescents in China: diagnostic data from detailed clinical assessments of 17,524 individuals[J]. J Child Psychol Psychiatry, 2022, 63(1): 34-46. doi: 10.1111/jcpp.13445.\u003c/li\u003e\n\u003cli\u003eGerman\u0026ograve; E, Gagliano A, Curatolo P. Comorbidity of ADHD and dyslexia[J]. Dev Neuropsychol, 2010, 35(5): 475-493. doi: 10.1080/87565641.2010.494748.\u003c/li\u003e\n\u003cli\u003eDoebel S. Rethinking Executive Function and Its Development[J]. Perspect Psychol Sci, 2020, 15(4): 942-956. doi: 10.1177/1745691620904771.\u003c/li\u003e\n\u003cli\u003eMikl\u0026oacute;s M, Fut\u0026oacute; J, Kom\u0026aacute;romy D, et al. Executive Function and Attention Performance in Children with ADHD: Effects of Medication and Comparison with Typically Developing Children[J]. Int J Environ Res Public Health, 2019, 16(20). doi: 10.3390/ijerph16203822.\u003c/li\u003e\n\u003cli\u003eMoura O, Sim\u0026otilde;es MR, Pereira M. Working Memory in Portuguese Children With Developmental Dyslexia[J]. Appl Neuropsychol Child, 2015, 4(4): 237-248. doi: 10.1080/21622965.2014.885389.\u003c/li\u003e\n\u003cli\u003eSwanson HL, Xinhua Z, Jerman O. Working memory, short-term memory, and reading disabilities: a selective meta-analysis of the literature[J]. J Learn Disabil, 2009, 42(3): 260-287. doi: 10.1177/0022219409331958.\u003c/li\u003e\n\u003cli\u003eLe Cunff AL, Dommett E, Giampietro V. Neurophysiological measures and correlates of cognitive load in attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD) and dyslexia: A scoping review and research recommendations[J]. Eur J Neurosci, 2024, 59(2): 256-282. doi: 10.1111/ejn.16201.\u003c/li\u003e\n\u003cli\u003eNa SD, Burns TG. Wechsler Intelligence Scale for Children-V: Test Review[J]. Appl Neuropsychol Child, 2016, 5(2): 156-160. doi: 10.1080/21622965.2015.1015337.\u003c/li\u003e\n\u003cli\u003eHall CL, Guo B, Valentine AZ, et al. The Validity of the SNAP-IV in Children Displaying ADHD Symptoms[J]. Assessment, 2020, 27(6): 1258-1271. doi: 10.1177/1073191119842255.\u003c/li\u003e\n\u003cli\u003eHou F, Qi L, Liu L, et al. Validity and Reliability of the Dyslexia Checklist for Chinese Children[J]. Front Psychol, 2018, 9: 1915. doi: 10.3389/fpsyg.2018.01915.\u003c/li\u003e\n\u003cli\u003eMoura O, Pereira M, Alfaiate C, et al. Neurocognitive functioning in children with developmental dyslexia and attention-deficit/hyperactivity disorder: Multiple deficits and diagnostic accuracy[J]. J Clin Exp Neuropsychol, 2017, 39(3): 296-312. doi: 10.1080/13803395.2016.1225007.\u003c/li\u003e\n\u003cli\u003eGooch D, Snowling M, Hulme C. Time perception, phonological skills and executive function in children with dyslexia and/or ADHD symptoms[J]. J Child Psychol Psychiatry, 2011, 52(2): 195-203. doi: 10.1111/j.1469-7610.2010.02312.x.\u003c/li\u003e\n\u003cli\u003eWillcutt EG, Betjemann RS, McGrath LM, et al. Etiology and neuropsychology of comorbidity between RD and ADHD: the case for multiple-deficit models[J]. Cortex, 2010, 46(10): 1345-1361. doi: 10.1016/j.cortex.2010.06.009.\u003c/li\u003e\n\u003cli\u003eTurker S, Seither-Preisler A, Reiterer SM, et al. Cognitive and Behavioural Weaknesses in Children with Reading Disorder and AD(H)D[J]. Sci Rep, 2019, 9(1): 15185. doi: 10.1038/s41598-019-51372-w.\u003c/li\u003e\n\u003cli\u003eMcGrath LM, Stoodley CJ. Are there shared neural correlates between dyslexia and ADHD? A meta-analysis of voxel-based morphometry studies[J]. J Neurodev Disord, 2019, 11(1): 31. doi: 10.1186/s11689-019-9287-8.\u003c/li\u003e\n\u003cli\u003eBauermeister JJ, Matos M, Reina G, et al. Comparison of the DSM-IV combined and inattentive types of ADHD in a school-based sample of Latino/Hispanic children[J]. J Child Psychol Psychiatry, 2005, 46(2): 166-179. doi: 10.1111/j.1469-7610.2004.00343.x.\u003c/li\u003e\n\u003cli\u003eWillcutt EG, Pennington BF, Olson RK, et al. Neuropsychological analyses of comorbidity between reading disability and attention deficit hyperactivity disorder: in search of the common deficit[J]. Dev Neuropsychol, 2005, 27(1): 35-78. doi: 10.1207/s15326942dn2701_3.\u003c/li\u003e\n\u003cli\u003eWillcutt EG, Pennington BF, Duncan L, et al. Understanding the complex etiologies of developmental disorders: behavioral and molecular genetic approaches[J]. J Dev Behav Pediatr, 2010, 31(7): 533-544. doi: 10.1097/DBP.0b013e3181ef42a1.\u003c/li\u003e\n\u003cli\u003eJagger-Rickels AC, Kibby MY, Constance JM. Global gray matter morphometry differences between children with reading disability, ADHD, and comorbid reading disability/ADHD[J]. Brain Lang, 2018, 185: 54-66. doi: 10.1016/j.bandl.2018.08.004.\u003c/li\u003e\n\u003cli\u003eKibby MY, Newsham G, Imre Z, et al. Is executive dysfunction a potential contributor to the comorbidity between basic reading disability and attention-deficit/hyperactivity disorder?[J]. Child Neuropsychol, 2021, 27(7): 888-910. doi: 10.1080/09297049.2021.1908532.\u003c/li\u003e\n\u003cli\u003eKibby MY, Dyer SM, Lee SE, et al. Frontal volume as a potential source of the comorbidity between attention-deficit/hyperactivity disorder and reading disorders[J]. Behav Brain Res, 2020, 381: 112382. doi: 10.1016/j.bbr.2019.112382.\u003c/li\u003e\n\u003cli\u003eGreven CU, Harlaar N, Dale PS, et al. Genetic Overlap between ADHD Symptoms and Reading is largely Driven by Inattentiveness rather than Hyperactivity-Impulsivity[J]. J Can Acad Child Adolesc Psychiatry, 2011, 20(1): 6-14. \u003c/li\u003e\n\u003cli\u003ePaloyelis Y, Rijsdijk F, Wood AC, et al. The genetic association between ADHD symptoms and reading difficulties: the role of inattentiveness and IQ[J]. J Abnorm Child Psychol, 2010, 38(8): 1083-1095. doi: 10.1007/s10802-010-9429-7.\u003c/li\u003e\n\u003cli\u003eCheung CH, Frazier-Wood AC, Asherson P, et al. Shared cognitive impairments and aetiology in ADHD symptoms and reading difficulties[J]. PLoS One, 2014, 9(6): e98590. doi: 10.1371/journal.pone.0098590.\u003c/li\u003e\n\u003cli\u003eLee CS. Executive functions underlie word reading and reading fluency in Chinese children with attention deficit/hyperactivity disorder, reading disabilities, and comorbid attention deficit/hyperactivity disorder and reading disabilities[J]. Child Neuropsychol, 2024, 30(1): 60-86. doi: 10.1080/09297049.2023.2179981.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"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":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"ADHD, Chinese reading disorder, executive function, working memory","lastPublishedDoi":"10.21203/rs.3.rs-4230998/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4230998/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003eTo explore the factors affecting the Chinese reading abilities of patients with attention deficit hyperactivity disorder (ADHD) and to provide a basis for the intervention of comorbid Chinese reading disorders in ADHD.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003eFollowing the ICD-10 standards, 160 ADHD patients were included in the study, divided into an ADHD group (80 cases) and an ADHD+RD (Reading Disorder) group (80 cases). All participants completed neuropsychological tests such as verbal working memory tasks, visual spatial working memory tasks, and response inhibition tasks. Parents completed the Swanson, Nolan, and Pelham-IV questionnaire (SNAP-IV) and the Dyslexia Checklist for Chinese Children (DCCC).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Patients with ADHD + RD demonstrated more significant deficits in executive functions such as working memory and response inhibition. Controlling for the influences of fixed ADHD symptoms, defects in visual spatial working memory and response inhibition had a significant predictive effect on the reading abilities of children with ADHD.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e The reading process demands a high level of cognitive executive function, especially in tasks involving linguistic and textual processing, where modulation of working memory, response inhibition, and flexibility are needed. For patients with ADHD comorbid with Chinese reading disorders, besides managing core ADHD symptoms, it may be worth considering a focus on strengthening training in working memory.\u003c/p\u003e","manuscriptTitle":"Effects of executive function deficits on Chinese reading ability in ADHD patients","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-11 18:32:21","doi":"10.21203/rs.3.rs-4230998/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e6bc2711-0507-47ae-b7a1-9a14f9044474","owner":[],"postedDate":"April 11th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-04-15T06:52:42+00:00","versionOfRecord":[],"versionCreatedAt":"2024-04-11 18:32:21","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4230998","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4230998","identity":"rs-4230998","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}