The association between Serum Vitamian D Level with Attention Deficit Hyperactivity Disorder (ADHD) : A cross sectional comparative study in a sample of Egyptian Children

The association between Serum Vitamian D Level with Attention Deficit Hyperactivity Disorder (ADHD) : A cross sectional comparative study in a sample of Egyptian Children | 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 The association between Serum Vitamian D Level with Attention Deficit Hyperactivity Disorder (ADHD) : A cross sectional comparative study in a sample of Egyptian Children Heba Elshahawi, Ghada Amin, Sherien Khalil, Amany Mostafa, Rehab Serag, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8585193/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 9 You are reading this latest preprint version Abstract Background Attention-deficit/hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder in childhood and adolescence. Dietary interventions such as omega-3 FA, vitamin and mineral supplementations might affect ADHD symptoms. Aim To compare serum level of vitamin D in children with ADHD with its different subtypes in relation to healthy controls. Methods A cross sectional comparative study was conducted on 108 children divided equally between healthy children and ADHD cases. Vit D was measured. Assessment of habitual vitamin D intake was done by using a vitamin D food frequency questionnaire. Results The median weekly vitamin D intake for the ADHD group was significantly lower than that for the control group, p < 0. 001. The ADHD group had significantly lower 25-Hydroxy Vitamin D level than the control group (p < 0. 001). Vitamin D level was considered independent predictor of ADHD susceptibility. Conclusion Patients with ADHD have lower serum concentrations of 25-hydroxyvitamin D than do healthy children. ADHD Vitamin D 25-Hydroxy Vitamin D Introduction Attention Deficit Hyperactivity Disorder (ADHD) affects children's capacity to function. The DSM IV unified Attention Deficit Disorder and Attention Deficit Hyperactivity Disorder into one disorder with three subtypes: mostly inattentive, predominantly hyperactive, or combination type. These conditions were originally given different diagnoses ( 1 ). The signs frequently appear at a young age and consist of forgetfulness, a lack of focus, disorganization, difficulties finishing chores, and losing things ( 2 ). The aetiology of ADHD is influenced by multiple variables, including both hereditary and environmental factors. The condition's probable causes, including viral infections, smoking during pregnancy, dietary deficits, and alcohol usage, have all been researched ( 3 ). To improve the accuracy of the diagnosis of ADHD, the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5th edition (DSM-5) diagnostic criteria were updated. In order to make a diagnosis, it is crucial to have a persistent impairment caused by or combined with impulsivity, hyperactivity,andinattention( 4 ). During this period of growth in adolescence, the most noticeable symptom, hyperactivity, tends to decrease, but other symptoms including inattention, impulsivity, restlessness, and disorganization continue and become more noticeable ( 5 ). The following characteristics are indicative of ADHD: excessive talking, impatience with waiting for one's turn, inability to wait, interruptions, intrusions, or taking over other people's tasks; hyperactivity and impulsivity; excessive fidgeting; restlessness; inability to play quietly; consistent "on the go"; appearing to be "driven by a motor"; inattention, failure to pay attention to details, careless mistakes; inability to sustain attention in work or play ( 6 ). Based on their medical history, children are diagnosed with ADHD if they exhibit at least six of the nine symptoms mentioned in the DSM-5 criteria. Lack of focus, ignoring little details, rushing through work, acting unresponsive when spoken to, difficulty organizing things, procrastination, dislike for or avoidance of jobs requiring extended mental effort, misplacing objects, or forgetfulness are all signs of inattention ( 7 ). Pharmacological medication is still the cornerstone of treatment for patients with ADHD. It is divided into two primary categories, either stimulant- or non-stimulant-containing. Methylphenidates and amphetamines are further classified as stimulants. Dopamine is prevented from reabsorbing at the postsynaptic and presynaptic membranes by both kinds of stimulants. Amphetamines also directly release dopamine. Stimulant medicine is the cornerstone of treatment for ADHD which is effective in about 70% of patients ( 8 ) The metabolism of calcium and phosphate as well as the preservation of a healthy, mineralized skeleton are both handled by vitamin D. Another name for it is an immunomodulatory hormone. Studies have revealed that 1,25-dihydroxyvitamin D, the active form of vitamin D, has immunologic effects on a number of immune system elements in both the innate and adaptive immune systems as well as endothelial membrane integrity ( 9 ). Through a number of processes, including the control of neurotrophic growth factors, effects on inflammation, and thrombosis, active vitamin D may have an impact on the brain. Vitamin D has become a promising contender in the search for modifiable risk factors for dementia and stroke since optimal serum concentrations can be maintained through supplementation, diet, and solar exposure ( 10 ). Psychiatric conditions like schizophrenia, SAD, depression, and cognitive decline have all been related to vitamin D insufficiency. Because vitamin D has multiple impacts on brain development, synaptic plasticity, neuronal growth, and protective factors against oxidative stress, many studies emphasize the necessity of screening for vitamin D insufficiency in patients with serious psychiatric diseases ( 11 ). It is unclear how vitamin D affects disorders of the nervous system like ADHD. However, research has shown that vitamin D plays a part in controlling how nerve cells form and work. Because vitamin D receptors are found in the brain, particularly in the hypothalamus and dopaminergic neurons of the substantia nigra, and because vitamin D is involved in the functioning of the central nervous system ( 12 ). Subjects and methods Type of the study : A cross sectional comparative study Site of the study : The sample was selected from the Child Psychiatry Outpatient Clinic, Benha Mental Health Hospital , Qalyubia , Egypt. Sample size : 108 subjects age and sex matched divided equally between two groups each was 54 subjects ( cases and control ) which achieves a power of 80% to detect a moderate effect size using Chi square test with level of significance of 0.05. The first group ( case ) included 54 children diagnosed with ADHD according to DSM–V criteria. The second group ( control ) included 54 age and sex matched children without psychiatric disorders Study duration : From August 2022 to January 2023. Inclusion criteria: age ranges between 5 and 16 years, both sexes, Children fulfilled DSM (V) criteria for ADHD confirmed their diagnosis by The Mini International Neuropsychiatric Interview for children and adolescents (M. I. N. I. Kid). Exclusion criteria: Intelligence quotient (IQ) < 90 , presence of other medical conditions as chronic medical disorders, hearing and visual impairment, or medications with side effects that may result in hyperactivity and impaired sleep rhythm, presence of other neuropsychiatric disorders as autism , depression and substance use disorder as identified by The Mini International Neuropsychiatric Interview for children and adolescents (M. I. N. I. Kid), patients on Calcium supplements or vitamin D supplements during the last 6 month before the study, patients with history of epilepsy or anti-epileptic drugs. refusal of the parent to participate or difficulty in drawing blood from very uncooperative subjects. Ethical committee approval : The study was approved by the ethical committee of the department of neurology and psychiatry, Ain Shams University . An informed written consent was obtained from the children’s guardians before participation. Methods All selected children were subjected to A semi-structured interview to their parents or caregivers emphasizing the demographic data as age, sex, residency, school grades, the history of the illness, family history. The Mini International Neuropsychiatric Interview for children and adolescents (MINI KID) Arabic Version (Awaad et al., 2002): The MINI-KID is a structured clinical diagnostic interview designed to assess the presence of current DSM-IV and ICD-10 psychiatric disorders in children and adolescents (Sheehan et al., 1998). The Arabic version of (MINI-KID) used in our study is developed by (Ghanem et al., 1999) and (Awaad et al., 2002) , validated it. To identify psychiatric symptoms/disorders as aggression, conduct disorder, anxiety, mood symptoms and disorders, phobia, delayed speech and tics Conner’s Parent Rating Scale-revised; long version (CPRS-RL) (Conners, 1997): The Arabic versions of the Conner’s rating scales revised, long versions, parent form used in this study were translated and validated through previous research conducted by (El Sheikh et al., 2003) in the institute of psychiatry, Ain Shams University. Aim: It is applied to detect subtypes and severity of ADHD. Stanford Binet Intelligence Scale (the fifth edition), (Roid JH 2003): The Arabic version of the Stanford-Binet Intelligence Scale, 5th Edition (Farag S, 2011) provides a comprehensive coverage of intelligence and cognitive abilities by assessing 5 factors based on the Cattell-Horn-Carroll hierarchical model of general intellectual ability( Fluid reasoning, Knowledge, Quantitative, Visuospatial processing, Working memory ) .These factors include separate subtests grouped into one of 2 domains. A Full-scale IQ composite score, as well as Nonverbal IQ (NVIQ) and Verbal IQ (VIQ) composite scores are then obtained. Assessment of habitual vitamin D intake by using a validated food frequency questionnaire ,A food frequency questionnaire (FFQ) consists of a finite list of foods and beverages with response categories to indicate usual frequency of consumption over the time period queried. The FFQ was designed using information about ‘The composition of Foods’ and ‘Food Portion Sizes’. Foods were grouped into sections within the questionnaire along with portion sizes. Frequency of consumption was measured weekly. Participants were asked to indicate which frequency of consumption best fit each food according to their habitual dietary habits. Vitamin D intake was calculated by multiplying frequency of consumption by the amount of vitamin D in the specified portion size of each food. Measurement of 25 hydroxy vitamin D level was done using Snibe Maglumi 800 Fully Automatic Chemiluminescence Immunoassay (CLIA) System Analyzer. Venous blood samples (5 ml) were collected under sterile conditions from each patient and control subject for assaying of 25 hydroxy vitamin D level. Statistical Analysis Statistical Analysis The collected data was revised, coded, and tabulated using Statistical package for Social Science (IBM Corp. Released 2020. IBM SPSS Statistics for Windows, Version 27.0. Armonk, NY: IBM Corp.). Data were presented and suitable analysis was done according to the type of data obtained for each parameter . The statistical significance of the difference between the means of the two research groups was evaluated using the Student T Test. To investigate the connection between two qualitative variables, the Chi-Square test was performed. The strength and direction of the linear link between two variables are determined by the correlation coefficient. When the dependent variable is categorical, regression analysis was employed to predict risk variables. A p value is deemed significant if it is 0. 05 at a 95% confidence level. Results The demographic and anthropometric data between the ADHD group and the control group were matched. The mean age for the ADHD group was 8. 11 ± 2. 55 years , they were 45 males (83. 3%) and 9 females (16. 7%) . The new diagnosis group ( defined as being diagnosed of less than 1 month duration ) had a mean age of 7. 37 ± 2. 59 years, which was significantly younger than that of the old diagnosis group ( being diagnosed of more than 1 month duration ) , who had a mean age of 8. 85 ± 2. 32 years. The new diagnosis group had 21 males (77. 8%) and 6 females (22. 2%), while the old diagnosis group had 24 males (88. 9%) and 3 females (11. 1%) with no statistically significant difference . Possible allergic condition were found among 16.7% of ADHD patients versus 11. 1% in the control group with no stiatistically significant difference . No statistically significant differences were found between cases and controls regarding BMI . as shown in table (1) . Table 1: Comparison of studied parameters among ADHD patients and healthy controls. Control N = 54 ADHD N = 54 p New diagnosis N = 27 Old diagnosis N = 27 p Male N (%) 39(72. 2%) 45(83. 3%) 0. 165 21 (77. 8%) 24 (88. 9%) 0. 467 Female 15(27. 8%) 9(16. 7%) 6 (22. 2%) 3 (11. 1%) Age (years) Mean ± SD. 8. 87 ± 2. 52 8. 11 ± 2. 55 0. 122 7. 37 ± 2. 59 8. 85 ± 2. 32 0. 031 BMI (kg/m²) Mean ± SD 17. 74 ± 4. 04 16. 70 ± 2. 30 0. 102 15. 85 ± 1. 73 16. 54 ± 2. 51 0. 106 Possible allergic condition N (%) 6 . (11. 1%). 9(16. 7%) 0. 404 6(22. 2%) 3(11. 1%) 0. 467 For the total IQ scores, the ADHD group had a mean score of 96.06 ± 6.57, while the control group had a mean score of 97.18 ± 4.24. The t-test for this comparison yielded a non-significant result (p=0.299) For medical comorbidities, the data shows that 16.7% of ADHD patients had medical comorbidities, while 11.1% of the control group had medical comorbidities. The test for this comparison yielded a non-significant result (p=0.404). For psychiatric comorbidities assessed via the MiniKID, the data shows that 7.4% of ADHD patients had psychiatric comorbidities, while none of the individuals in the control group were positive for psychiatric comorbidities. The test for this comparison yielded a non-significant result (p=0.118). The median weekly vitamin D intake for the ADHD group was 615. 2 IU (range: 180. 8 – 841. 6 IU), which was lower than the median weekly vitamin D intake for the control group was 664. 0 IU (range: 437. 6 – 1212. 0 IU) with a statistically significant difference (p=0. 001). , Weekly Vitamin D Intake via FFQ and 25-Hydroxy Vitamin D Level (table 2 ). Table (2): Comparison between ADHD group and control group regarding IQ Score, medical comorbidities, psychiatric comorbidities via MiniKID , and weekly vitamin D intake via FFQ IQ Score ADHD N = 54 Control N = 54 Test value P-value Verbal, Mean ± SD 96.31 ± 8.27 96.94 ± 6.47 0.441 ≠ 0.660 Non-Verbal, Mean ± SD 95.81 ± 6.04 97.41 ± 4.67 1.533 ≠ 0.128 Total, Mean ± SD 96.06 ± 6.57 97.18 ± 4.24 1.045 ≠ 0.299 Medical comorbidities, no. (%) Negative 45 (83.3%) 48 (88.9%) 0.697 ∙ 0.404 Possible allergic condition 9 (16.7%) 6 (11.1%) Psychiatric comorbidities Via MiniKID, no. (%) Negative 50 (92.6%) 54 (100.0%) 4.154 ∙ 0.118 Transient tic disorder 4 (7.4%) 0 (0.0%) Weekly Vitamin D Intake via FFQ, Median (Range) 615.2 (180.8 – 841.6) 664.0(437.6 – 1212.0) 2016.5 ◊ 0.001** In terms of 25-Hydroxy Vitamin D level, the ADHD group had a mean level of 18.20 ± 6.46, while the control group had a mean level of 31.72 ± 18.03. The comparison yielded a significant result (p<0.001). In terms of sufficiency of 25-Hydroxy Vitamin D level, 17 participants (31.5%) in the control group had sufficient levels, while only 1 participant (1.9%) in the ADHD group had sufficient levels. Additionally, 36 participants (66.7%) in the control group had insufficient levels of 25-Hydroxy Vitamin D, while 46 participants (85.2%) in the ADHD group had insufficient levels. One participant (1.9%) in the control group had deficient levels of 25-Hydroxy Vitamin D, while 7 participants (13.0%) in the ADHD group had deficient levels. The comparison yielded a significant result (p<0.001) as shown in table (3) Table (3 ): Comparison between ADHD group and control group regarding 25-Hydroxy Vitamin D Level ADHD N = 54 Control N = 54 Test value P-value 25-Hydroxy Vitamin D Level Mean ± SD. 18.20 ± 6.46 31.72 ± 18.03 5.190 <0.001** Median (Range) 18.9 (6.8 – 35.2) 25.5 (9.1 – 89.9) Sufficient 1 (1.9%) 17 (31.5%) 19.942 <0.001** Insufficient 46 (85.2%) 36 (66.7%) Deficient 7 (13.0%) 1 (1.9%) Regarding the vitamin D serum level : 1.9% of the cases versus 31.5 %of the controls were sufficient, 85.2% of the cases versus 66.7% of the control were insufficient , 13% of the cases versus 1.9% of the control were deficient with statistically significant p value <0.001** Regarding the Validity of 25-Hydroxy Vitamin D Level for discrimination between ADHD patients and control group: Cut off: The cut-off value for the 25-Hydroxy Vitamin D level, which is used to distinguish between ADHD patients and the control group. In this case, the cut-off value is <24.57. Sensitivity: The proportion of ADHD patients who test positive for the 25-Hydroxy Vitamin D level test. In this case, the sensitivity is 85.19%, which means that the test correctly identifies 85.19% of ADHD patients. Specificity: The proportion of control group participants who test negative for the 25-Hydroxy Vitamin D level test. In this case, the specificity is 61.11%, which means that the test correctly identifies 61.11% of control group participants as negative. Accuracy: The overall accuracy of the test in distinguishing between ADHD patients and the control group. In this case, the accuracy is 73.15%, which means that the test correctly identifies ADHD patients and control group participants 73.15% of the time. As shown in table (4) Table (4) 25-Hydroxy Vitamin D Level AUC 95% CI P Cut off Sensitivity Specificity PPV NPV Accuracy 0.788 0.703 – 0.873 <0.001** <24.57 85.19% 61.11% 68.66% 80.49% 73.15% AUC, area under ROC curve; CI, confidence interval; PPV, positive predictive value; NPV, negative predictive value. *: Significant ≤0.05 Association between drug intake with vitamin D level and treatment modalities : There was no significant difference between drug therapy, behavioral therapy and a combination of drug therapy with behavioral therapy as regard 25-OH vitamin D levels (p=0.265). as shown in table (5) Table (5) Atomoxetine Atomoxetine & Behavioral therapy Behavioral therapy Test value P-value N=14 N=8 N=5 Hydroxy 25 Vitamin D Level Mean±SD 16.81 ± 6.34 19.41 ± 5.20 16.69 ± 6.85 3.021 ≠≠ 0.265 Median (range) 17.84 (6.8-28.3) 19.83 (9.8-27.71) 18.78 (7.2-24.76) Vit. D. categories Insufficient 12 (85.7%) 8 (100.0%) 4 (80.0%) 2.584∙ 0.859 Deficient 2 (14.3%) 0 (0.0%) 1 (20.0%) Weekly Vitamin D Intake Mean ± SD. 490.2±123.8 667.4± 125.5 591.4±249.4 2.553 ◊◊ 0.145 Median (range) 482.6 (312-685) 688.6 (445-808) 686.8 (182-841) Relation between 25-Hydroxy Vitamin D level with conners parent rating scale among ADHD patients : There is no association between 25-Hydroxy Vitamin D level and Conners Parent Rating Scale among ADHD patients specifically in relation to Oppositional, Hyperactivity, ADHD index, DSM-IV Inattentive symptom Count, DSM-IV Hyperactive-Impulsive Symptom Count , DSM-IV Total Symptom Count. There is significant association (p=0.003) between 25-OH vitamin D and cognitive score. Additionally, there is significant association (p=0.001) between 25-OH vitamin D and Restless-Impulsive score. As shown in table (6) Table (6) Conner’s Parent Rating Scale 25-Hydroxy Vitamin D Level Test value P-value Mean ± SD. Oppositional Slightly, n=3 17.44 ± 8.57 0.268≠≠ 0.848 Mildly, n=5 16.59 ± 6.99 Moderately n=4 16.40 ± 4.80 Markedly, n=42 18.61 ± 6.56 Cognitive problem / inattention Average, n=3 20.26 ± 8.82 3.506≠≠ 0.003* Slightly, n=2 18.77 ± 9.41 Mildly, n=7 18.44 ± 8.09 Moderately, n=9 17.81 ± 5.12 Markedly, n=33 13.56 ± 9.55 Hyperactivity Slightly, n=5 14.96 ± 4.95 1.217≠≠ 0.313 Mildly, n=2 14.43 ± 0.00 Moderately, n=9 16.43 ± 7.67 Markedly, n=38 19.24 ± 6.35 ADHD index Average, n=2 13.60 ± 5.657 0.679≠≠ 0.610 Slightly, n=1 22.40 ± 0.0 Mildly, n=8 18.02 ± 5.064 Moderately, n=15 19.89 ± 8.636 Markedly, n=28 17.52 ± 5.568 CGI Restless-Impulsive Average, n=3 24.77 ± 2.700 5.749≠≠ 0.001* Slightly, n=2 13.56 ± 9.553 Mildly, n=3 28.80 ± 5.543 Moderately, n=3 24.27 ± 7.679 Markedly, n=43 16.79 ± 5.385 DSM-IV Inattentive symptom Count Average, n=6 17.65 ± 7.496 0.499≠≠ 0.685 Slightly, n=2 13.56 ± 9.553 Moderately, n=15 17.63 ± 5.606 Markedly, n=31 18.88 ± 6.664 DSM-IV Hyperactive-Impulsive Symptom Count Average, n=1 24.76 ± 0.0 0.732≠≠ 0.575 Slightly, n=5 14.96 ± 4.946 Mildly, n=3 17.48 ± 8.676 Moderately, n=11 17.16 ± 5.559 Markedly, n=34 18.88 ± 6.802 DSM-IV Total Symptom Count Slightly, n=6 18.26 ± 8.843 0.481≠≠ 0.697 Mildly, n=7 17.74 ± 7.062 Moderately, n=7 15.59 ± 5.175 Markedly, n=34 18.82 ± 6.266 No.: Number; %: Percentage; SD. Standard deviation, Range: Min. – Max. ≠≠: One Way ANOVA The results of a logistic regression analysis for predicting ADHD, using gender, age, BMI, Consanguinity, Family social income, Total IQ Score, Vitamin D Intake, Vitamin D Level, Medical comorbidities, Psychiatric comorbidities as covariates. Vitamin D intake, vitamin D level were associated with risk of ADHD susciptability in univariable analysis. However, in multivariable analysis, only vitamin D level was considered independent predictror of ADHD suceptability. As shown in table (7) Table (7) Univariate Multivariate P OR 95% C.I. P OR 95% C.I. Gender 0.169 1.923 0.758-4.879 Age 0.123 0.887 0.761-1.033 BMI 0.128 0.775 0.642-1.935 Consanguinity 0.633 1.257 0.491-3.217 Family social income 0.126 0.487 0.259-1.917 Total IQ Score 0.297 0.964 0.899-1.033 Vitamin D Intake <0.001* 0.996 0.994-0.998 0.395 0.999 0.998-1.001 Vitamin D Level <0.001* 0.871 0.813-0.933 0.001* 0.923 0.882-0.966 Medical comorbidities 0.407 1.600 0.527-4.856 Psychiatric comorbidities 0.159 2.080 0.751-5.759 Discussion Vitamin D is a skin-produced vitamin after sun exposure. For the health of the musculoskeletal system, the serum calcium content must be kept within the normal physiological range ( 13 ). Especially in youngsters, attention deficit hyperactivity disorder (ADHD) is one of the most prevalent behavioral disorders. Typically beginning in childhood, ADHD frequently lasts a lifetime. Inattention, hyperactivity, and impulsivity are the symptoms ( 14 ). However, little is known about how vitamin D status and ADHD are related. The brain is just one of the many areas of the body where vitamin D is used. ( 15 ). The present investigation found no discernible difference between the ADHD group and the control group in the amount of vitamin D consumed by mothers during pregnancy. The risk that a kid will be diagnosed with ADHD increases when the mother's vitamin D levels are low during pregnancy ( 16 ), This was the first to show a link between low maternal 25(OH)D levels in the first to third trimester of pregnancy and an increased risk for ADHD diagnosis in the child. Furthermore, Sahin et al. discovered that ADHD children had lower serum vitamin D and VDR levels than typically developing kids. Serum Ca, P, and ALP levels did not significantly differ between the ADHD and control groups, though. The levels of serum vitamin D, vitamin D receptor, calcium, phosphorus, and alkaline phosphatase were not significantly different across the ADHD subtypes ( 17 ). In a study, Bener and Kamal discovered that 64% of the individuals with ADHD had severe (10 ng/mL) and moderate (10–20 ng/mL) levels of vitamin D insufficiency ( 18 ). Comparing the ADHD group to the control group, the current study found that the weekly vitamin D intake was significantly lower in the ADHD group. In addition, the ADHD diagnosis group had older average ages than the ADHD diagnostic group with more recent diagnoses. Thus, compared to the control group, ADHD patients had considerably lower amounts of 25-hydroxy vitamin D and were less likely to have insufficient levels of this vitamin. Children with ADHD have lower serum levels of vitamin D than healthy controls, according to several research that support our findings ( 19 ). The proportion of children with vitamin D deficiency in the ADHD group was substantially higher than that of the control group, according to a study by Sharif et al. Additionally, the cases group's mean serum vitamin D level was considerably lower than that of the control (healthy) group. which matched our findings ( 20 ). This result is consistent with the findings of a related investigation, which showed that there was a significant difference in the mean serum vitamin D level between the case and control groups ( 21 ). According to the current study, there was no significant difference in the two groups' weekly vitamin D intake via FFQ. The mean mother intake of vitamin D during pregnancy was highest in the Atomoxetine & Behavioral Therapy group, followed by the Behavioral Therapy group, and lowest in the Atomoxetine group. Additionally, there was no discernible difference in 25-hydroxyvitamin D adequacy between the new and previous diagnoses of ADHD. In contrast, Li et al. found that children with ADHD had considerably lower serum levels of retinol and 25(OH)D than HCs, and that VA and VD deficiencies were more common in ADHD children. Second, there was a link between serum levels of retinol and 25 (OH) D and the unfavorable ADHD symptoms. Third, greater SNAP-IV total scores and ADHD inattention subscale scores were seen in children with ADHD in the VA and VD co-deficiency group, indicating that co-deficiency of VD and VA had a significant association with ADHD symptoms in children ( 22 ); this finding was supported by previous research. The results of the current investigation showed no correlation between the 25-hydroxyvitamin D level and any of the characteristics associated with ADHD cases. Hemamy et al.'s research on children with ADHD showed that supplementation with Vitamin D and magnesium reduced conduct difficulties, social problems, and anxiety/shyness scores compared to placebo intake, but did not significantly impact psychosomatic disorders scores ( 23 ). While Mohammad pour et al. found that after 8 weeks, the vitamin D intervention group significantly outperformed the placebo group in reducing ADHD evening symptoms ( 24 ). In contrast to previous research, the current study found a strong correlation between mothers' intake of vitamin D during pregnancy and ADHD patients' 25-hydroxy vitamin D levels and medical/psychiatric comorbidities. Similar findings were made by Daraki et al. and Morales et al. who discovered a link between childhood ADHD-like symptoms and high vitamin D levels in the mother's blood circulation. However, they used umbilical cord blood samples in their research ( 25 ). However, Gustafsson et al. discovered no link between the findings of ADHD and the levels of vitamin D in the cord blood. The study's main weaknesses, however, were a small sample size and statistical flaws ( 26 ). The results of the current investigation showed that the Vitamin D measure test has poor accuracy in differentiating between existing and new diagnoses of ADHD and moderate accuracy in differentiating between ADHD patients and the control group. Therefore, vitamin D levels and vitamin D intake were linked in a univariable study to the likelihood of ADHD susceptibility. However, only vitamin D levels were thought to be independent predictors of ADHD susceptibility in the multivariable analysis. Age was once thought to be the only predictor of elderly (chronic) ADHD. Additionally, Gan et al. have established that vitamin D supplementation showed a minor but statistically significant improvement in the overall scores for ADHD, as well as the inattention, hyperactivity, and behavior scores. Due to the low to extremely low quality of the evidence in the literature, the improvement was probably just marginal. The oppositional scores did not improve statistically significantly. The vitamin D group's reported adverse events were minor and did not differ substantially from the control groups. The need for additional multicenter research on vitamin D supplementation is evident from the rise in serum vitamin D levels and the proportion of patients with adequate vitamin D levels ( 27 ). Between new and old diagnoses of ADHD, the level of oppositional behavior, cognitive problem/inattention, hyperactivity, and ADHD index on Conners Parent Rating Scale score did not significantly differ, according to the current study. Additionally, there was no discernible difference between the two groups in terms of CGI Restless-Impulsive and DSM-IV Total symptom count. In the old diagnosis group, atomoxetine was the most often prescribed drug for ADHD, and a popular treatment strategy included combining atomoxetine with behavioral therapy. In this group, behavioral therapy by itself was less frequently employed as a treatment for ADHD, Although, there were no appreciable variations between the three therapy groups in terms of vitamin D categories, all three treatment groups were identified as having insufficient vitamin D levels. Similar to Michelson et al., atomoxetine groups showed better results in treating ADHD symptoms than placebo groups. The atomoxetine groups also showed a significant improvement in social and familial functions ( 28 ). While An atomoxetine medication led to a moderate improvement in response inhibition but not a significant improvement in sustained attention in a double-blind, randomized, placebo-controlled crossover experiment ( 29 ). It made it easier to recognize terrified faces, especially in younger children. The improvement in ADHD symptoms had a smaller impact size than that shown in a meta-analysis of earlier studies ( 30 ). Limitations The present study's limitations included the small sample size and the fact that vitamin D medication was given to individuals who were not included in the trial but who nevertheless showed improvement in their ADHD symptoms. Conclusion a number of researchers have recently postulated a link between vitamin D and ADHD, although the investigations have produced mixed findings. The current study found that compared to healthy children, children with ADHD have decreased serum concentrations of 25-hydroxyvitamin D. Declarations Ethics approval and consent to participate: The ASU-Faculty of Medicine ethical committee approved the study. Informed Consent: Informed consent was obtained from the gurdians of the participants assuring them that their participation was voluntary and that their refusal to participate would not negatively impact their ongoing or future medical care. Consent to publication: All authors have read the manuscript and approved its publication. Declaration of Competing Interest: The authors report no declarations of interest. Funding: No external funds, grants, or assistance were received to prepare this manuscript. Author Contribution H.E. ,G.A., R.K.,A.M.,S.K. : wrote the main manuscript , prepared the figuresH.E. ,G.A., R.K.,A.M.,S.K. ,R.S. : statistical analysis Acknowledgments: To the children and their families who participated in the study Data Availability The study data can be made available upon request. References Magnus W, Nazir S, Anilkumar AC, et al. Attention Deficit Hyperactivity Disorder. [Updated 2023 Jan 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Matas M. Approach to attention deficit disorder in adults. Can Fam Physician. 2006 Aug;52:961-4. Millichap JG. Etiologic classification of attention-deficit/hyperactivity disorder. Pediatrics. 2008 Feb;121(2):e358-65. Mahone EM, Denckla MB. Attention-Deficit/Hyperactivity Disorder: A Historical Neuropsychological Perspective. J Int Neuropsychol Soc. 2017 Oct;23(9-10):916-929. Holbrook JR, Cuffe SP, Cai B, Visser SN, Forthofer MS, Bottai M, Ortaglia A, McKeown RE. Persistence of Parent-Reported ADHD Symptoms From Childhood Through Adolescence in a Community Sample. J Atten Disord. 2016 Jan;20(1):11-20. American Psychiatric Association. Neurodevelopmental disorders: Attention-deficit/hyperactivity disorder. In: Diagnostic and statistical manual of mental disorders, fifth edition (DSM-5). Washington: American Psychiatric Association, 2013. Weiss M, Murray C. Assessment and management of attention-deficit hyperactivity disorder in adults. CMAJ. 2003 Mar 18;168(6):715-22. Brikell I, Chen Q, Kuja-Halkola R, D'Onofrio BM, Wiggs KK, Lichtenstein P, Almqvist C, Quinn PD, Chang Z, Larsson H. Medication treatment for attention-deficit/hyperactivity disorder and the risk of acute seizures in individuals with epilepsy. Epilepsia. 2019 Feb;60(2):284-293. Charoenngam N, Holick MF. Immunologic Effects of Vitamin D on Human Health and Disease. Nutrients. 2020 Jul 15;12(7):2097. Pilz S, Zittermann A, Trummer C, Theiler-Schwetz V, Lerchbaum E, Keppel MHet al. . Vitamin D testing and treatment: a narrative review of current evidence. Endocrine Connections. 2019;8(2):R27–R43. Mulcahy KB, Trigoboff E, Opler L, Demler TL. Physician Prescribing Practices of Vitamin D in a Psychiatric Hospital. Innov Clin Neurosci. 2016 Jun 1;13(5-6):21-27. Eyles DW, Feron F, Cui X, Kesby JP, Harms LH, Ko P, McGrath JJ, Burne TH. Developmental vitamin D deficiency causes abnormal brain development. Psychoneuroendocrinology. 2009 Dec;34 Suppl 1:S247-57. Chauhan K, Shahrokhi M, Huecker MR. Vitamin D. [Updated 2023 Apr 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan. Khoshbakht Y, Bidaki R, Salehi-Abargouei A. Vitamin D Status and Attention Deficit Hyperactivity Disorder: A Systematic Review and Meta-Analysis of Observational Studies. Adv Nutr. 2018 Jan 1;9(1):9-20. Villagomez A, & Ramtekkar U. Iron, magnesium, vitamin D, and zinc deficiencies in children presenting with symptoms of attention-deficit/hyperactivity disorder. Children, 2014. 1(3), 261–279. Sucksdorff M, Brown AS, Chudal R, Surcel HM, Hinkka-Yli-Salomäki S, Cheslack-Postava K, Gyllenberg D, Sourander A. Maternal Vitamin D Levels and the Risk of Offspring Attention-Deficit/Hyperactivity Disorder. J Am Acad Child Adolesc Psychiatry. 2021 Jan;60(1):142-151. e2. Sahin N, Altun H, Kurutas EB, Balkan D. Vitamin D and vitamin D receptor levels in children with attention-deficit/hyperactivity disorder. Neuropsychiatr Dis Treat. 2018 Feb 19;14:581-585. Bener A, Kamal M. Predict attention deficit hyperactivity disorder? Evidence-based medicine. Glob J Health Sci. 2014;6(2):47–57. Johnson SR, Zelig R, & Parker A (2020). Vitamin D Status of Children With Attention-Deficit Hyperactivity Disorder. Topics in Clinical Nutrition, 35(3), 222–239. Sharif MR, Madani M, Tabatabaei F, Tabatabaee Z. The Relationship between Serum Vitamin D Level and Attention Deficit Hyperactivity Disorder. Iran J Child Neurol. 2015 Fall;9(4):48-53. Goksugur SB, Tufan AE, Semiz M, Gunes C, Bekdas M, Tosun M, Demircioglu F. Vitamin D status in children with attention-deficit-hyperactivity disorder. Pediatr Int. 2014 Aug;56(4):515-9. Li HH, Yue XJ, Wang CX, Feng JY, Wang B, Jia FY. Serum Levels of Vitamin A and Vitamin D and Their Association With Symptoms in Children With Attention Deficit Hyperactivity Disorder. Front Psychiatry. 2020 Nov 23;11:599958. Hemamy M, Heidari-Beni M, Askari G, Karahmadi M, Maracy M. Effect of Vitamin D and Magnesium Supplementation on Behavior Problems in Children with Attention-Deficit Hyperactivity Disorder. Int J Prev Med. 2020 Jan 24;11:4. Mohammadpour N, Jazayeri S, Tehrani-Doost M, Djalali M, Hosseini M, Effatpanah M, Davari-Ashtiani R, Karami E. Effect of vitamin D supplementation as adjunctive therapy to methylphenidate on ADHD symptoms: A randomized, double blind, placebo-controlled trial. Nutr Neurosci. 2018 Apr;21(3):202-209. Daraki V, Roumeliotaki T, Koutra K, Chalkiadaki G, Katrinaki M, Kyriklaki A, Kampouri M, Margetaki K, Vafeiadi M, Gustafsson P, Rylander L, Lindh CH, Jönsson BA, Ode A, Olofsson P, Ivarsson SA, Rignell-Hydbom A, Haglund N, Källén K. Vitamin D Status at Birth and Future Risk of Attention Deficit/Hyperactivity Disorder (ADHD). PLoS One. 2015 Oct 28;10(10):e0140164. Gan J, Galer P, Ma D, Chen C, Xiong T. The Effect of Vitamin D Supplementation on Attention-Deficit/Hyperactivity Disorder: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Child Adolesc Psychopharmacol. 2019 Nov;29(9):670-687. 73. Michelson D, Faries D, Wernicke J, Kelsey D, Kendrick K, Sallee FR, Spencer T; Atomoxetine ADHD Study Group. Atomoxetine in the treatment of children and adolescents with attention-deficit/hyperactivity disorder: a randomized, placebo-controlled, dose-response study. Pediatrics. 2001 Nov;108(5):E83. Griffiths KR, Leikauf JE, Tsang TW, Clarke S, Hermens DF, Efron D, Williams LM, Kohn MR. Response inhibition and emotional cognition improved by atomoxetine in children and adolescents with ADHD: The ACTION randomized controlled trial. J Psychiatr Res. 2018 Jul;102:57-64. Schwartz S, Correll CU. Efficacy and safety of atomoxetine in children and adolescents with attention-deficit/hyperactivity disorder: results from a comprehensive meta-analysis and metaregression. J Am Acad Child Adolesc Psychiatry. 2014 Feb;53(2):174-87. Additional Declarations No competing interests reported. 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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-8585193","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":579650624,"identity":"50a7bdae-5f01-4fad-81db-7fa903d09a8b","order_by":0,"name":"Heba Elshahawi","email":"","orcid":"","institution":"Ain Shams University","correspondingAuthor":false,"prefix":"","firstName":"Heba","middleName":"","lastName":"Elshahawi","suffix":""},{"id":579650626,"identity":"f801f9f7-c293-4c08-9bfe-bdcf00c01c6b","order_by":1,"name":"Ghada Amin","email":"","orcid":"","institution":"Ain Shams University","correspondingAuthor":false,"prefix":"","firstName":"Ghada","middleName":"","lastName":"Amin","suffix":""},{"id":579650629,"identity":"e3cccf0e-743d-4e46-b3f5-8142ef7febc0","order_by":2,"name":"Sherien Khalil","email":"","orcid":"","institution":"Ain Shams University","correspondingAuthor":false,"prefix":"","firstName":"Sherien","middleName":"","lastName":"Khalil","suffix":""},{"id":579650632,"identity":"7f4e6b29-5682-49cb-9a1d-d6aefa6c2543","order_by":3,"name":"Amany Mostafa","email":"","orcid":"","institution":"Ain Shams University","correspondingAuthor":false,"prefix":"","firstName":"Amany","middleName":"","lastName":"Mostafa","suffix":""},{"id":579650634,"identity":"8bebef18-b56c-4030-a10b-0ec57e3a9207","order_by":4,"name":"Rehab Serag","email":"","orcid":"","institution":"Ain Shams University","correspondingAuthor":false,"prefix":"","firstName":"Rehab","middleName":"","lastName":"Serag","suffix":""},{"id":579650635,"identity":"8911752a-cfb8-483e-bedb-157ce5c643a1","order_by":5,"name":"Rania kasem","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9ElEQVRIiWNgGAWjYJCCA0AIBowNFUCSmbmBFC1nQFoYCWthgGtpbIPoxKvYvP3swQM/ztjZ84sdYPs4c15tNH87UMuPim04tcicyUs42HMjOXHm7ATmmRu3Hc+dcZixgbHnzG2cWiQYcgwO8HxgTjC4ncDM+HDbsdwGoBZmxjY8WvjfGBz886He3h6sZc6x3PkEtUjkGBzmuXGYcYM0UMvGhprcDYS1vDE4LHPmeOKM24nNjDOOHcjdCNRyEK9f+HOMP745Vm3PPzv5MGNPTV3uvPOHDz74UYFbCxIAR8dhMPMAMephoI4UxaNgFIyCUTBCAAAX52ErfO94TAAAAABJRU5ErkJggg==","orcid":"","institution":"Ain Shams University","correspondingAuthor":true,"prefix":"","firstName":"Rania","middleName":"","lastName":"kasem","suffix":""}],"badges":[],"createdAt":"2026-01-12 20:38:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8585193/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8585193/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":101398490,"identity":"9a23f0fc-2819-4ed2-8fbd-7a00c2e4d61d","added_by":"auto","created_at":"2026-01-29 09:41:54","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1242090,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8585193/v1/eae80f33-fbb8-4296-b260-9b5564f46dac.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eThe association between Serum Vitamian D Level with Attention Deficit Hyperactivity Disorder (ADHD) : A cross sectional comparative study in a sample of Egyptian Children\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAttention Deficit Hyperactivity Disorder (ADHD) affects children's capacity to function. The DSM IV unified Attention Deficit Disorder and Attention Deficit Hyperactivity Disorder into one disorder with three subtypes: mostly inattentive, predominantly hyperactive, or combination type. These conditions were originally given different diagnoses (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). The signs frequently appear at a young age and consist of forgetfulness, a lack of focus, disorganization, difficulties finishing chores, and losing things (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). The aetiology of ADHD is influenced by multiple variables, including both hereditary and environmental factors. The condition's probable causes, including viral infections, smoking during pregnancy, dietary deficits, and alcohol usage, have all been researched (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). To improve the accuracy of the diagnosis of ADHD, the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5th edition (DSM-5) diagnostic criteria were updated. In order to make a diagnosis, it is crucial to have a persistent impairment caused by or combined with impulsivity, hyperactivity,andinattention(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDuring this period of growth in adolescence, the most noticeable symptom, hyperactivity, tends to decrease, but other symptoms including inattention, impulsivity, restlessness, and disorganization continue and become more noticeable (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). The following characteristics are indicative of ADHD: excessive talking, impatience with waiting for one's turn, inability to wait, interruptions, intrusions, or taking over other people's tasks; hyperactivity and impulsivity; excessive fidgeting; restlessness; inability to play quietly; consistent \"on the go\"; appearing to be \"driven by a motor\"; inattention, failure to pay attention to details, careless mistakes; inability to sustain attention in work or play (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eBased on their medical history, children are diagnosed with ADHD if they exhibit at least six of the nine symptoms mentioned in the DSM-5 criteria. Lack of focus, ignoring little details, rushing through work, acting unresponsive when spoken to, difficulty organizing things, procrastination, dislike for or avoidance of jobs requiring extended mental effort, misplacing objects, or forgetfulness are all signs of inattention (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Pharmacological medication is still the cornerstone of treatment for patients with ADHD. It is divided into two primary categories, either stimulant- or non-stimulant-containing. Methylphenidates and amphetamines are further classified as stimulants. Dopamine is prevented from reabsorbing at the postsynaptic and presynaptic membranes by both kinds of stimulants. Amphetamines also directly release dopamine. Stimulant medicine is the cornerstone of treatment for ADHD which is effective in about 70% of patients (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThe metabolism of calcium and phosphate as well as the preservation of a healthy, mineralized skeleton are both handled by vitamin D. Another name for it is an immunomodulatory hormone. Studies have revealed that 1,25-dihydroxyvitamin D, the active form of vitamin D, has immunologic effects on a number of immune system elements in both the innate and adaptive immune systems as well as endothelial membrane integrity (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Through a number of processes, including the control of neurotrophic growth factors, effects on inflammation, and thrombosis, active vitamin D may have an impact on the brain. Vitamin D has become a promising contender in the search for modifiable risk factors for dementia and stroke since optimal serum concentrations can be maintained through supplementation, diet, and solar exposure (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Psychiatric conditions like schizophrenia, SAD, depression, and cognitive decline have all been related to vitamin D insufficiency. Because vitamin D has multiple impacts on brain development, synaptic plasticity, neuronal growth, and protective factors against oxidative stress, many studies emphasize the necessity of screening for vitamin D insufficiency in patients with serious psychiatric diseases (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). It is unclear how vitamin D affects disorders of the nervous system like ADHD. However, research has shown that vitamin D plays a part in controlling how nerve cells form and work. Because vitamin D receptors are found in the brain, particularly in the hypothalamus and dopaminergic neurons of the substantia nigra, and because vitamin D is involved in the functioning of the central nervous system (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e"},{"header":"Subjects and methods","content":"\u003cp\u003e\u003cstrong\u003e\u003cspan\u003eType of the study\u003c/span\u003e\u003c/strong\u003e\u003cspan\u003e\u0026nbsp;: A cross sectional comparative study\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cspan\u003eSite of the study\u003c/span\u003e\u003c/strong\u003e\u003cspan\u003e\u0026nbsp;: \u0026nbsp; \u0026nbsp;The sample was selected from the Child Psychiatry Outpatient Clinic, Benha Mental Health Hospital , Qalyubia , Egypt.\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cspan\u003eSample size :\u003c/span\u003e\u003c/strong\u003e\u003cspan\u003e\u0026nbsp; 108 subjects age and sex matched \u0026nbsp;divided equally between \u0026nbsp;two groups \u0026nbsp; each was 54 subjects ( cases and control ) which \u0026nbsp;achieves a power of 80% to detect a moderate effect size using Chi square test with level of significance of 0.05.\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan\u003eThe \u0026nbsp;first group ( case ) included 54 children diagnosed with ADHD according to DSM\u0026ndash;V criteria. \u0026nbsp;The second group ( control ) \u0026nbsp;included \u0026nbsp; \u0026nbsp;54 age and sex matched children without psychiatric disorders\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cspan\u003eStudy duration\u003c/span\u003e\u003c/strong\u003e\u003cspan\u003e\u0026nbsp;: \u0026nbsp; From August 2022 to January 2023.\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cspan\u003eInclusion criteria:\u003c/span\u003e\u003c/strong\u003e\u003cspan\u003e\u0026nbsp; \u0026nbsp; age ranges between 5 and 16 years, both sexes, Children fulfilled DSM (V) criteria for ADHD\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u0026nbsp; confirmed their diagnosis by The Mini International Neuropsychiatric Interview for children and adolescents (M. I. N. I. Kid).\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan\u003e\u0026nbsp;\u003cstrong\u003eExclusion criteria:\u003c/strong\u003e\u0026nbsp; \u0026nbsp;Intelligence quotient (IQ) \u0026lt; 90 , presence of other medical conditions as chronic medical disorders, hearing and visual impairment, or medications \u0026nbsp;with side effects that \u0026nbsp;may result in hyperactivity and impaired sleep rhythm, presence of other neuropsychiatric disorders as autism , depression and substance use disorder \u0026nbsp;as identified by\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan\u003eThe Mini International Neuropsychiatric Interview for children and adolescents (M. I. N. I. Kid), patients on Calcium supplements or vitamin D supplements during the last 6 month before the study, patients with history of epilepsy or anti-epileptic drugs. \u0026nbsp; refusal of the parent \u0026nbsp;to participate or difficulty in drawing blood from very uncooperative subjects.\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cspan\u003eEthical committee approval :\u003c/span\u003e\u003c/strong\u003e\u003cspan\u003e\u0026nbsp; The study was approved by the ethical committee of the department of neurology and psychiatry, Ain Shams University . \u0026nbsp;An informed written consent was obtained from the children\u0026rsquo;s guardians before participation.\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cspan\u003eMethods\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan\u003eAll selected children were subjected to\u003c/span\u003e\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003e\u003cspan\u003eA semi-structured interview to their parents or caregivers emphasizing the demographic data as age, sex, residency, school grades, the history of the illness, family history. \u0026nbsp;\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003e\u003cspan\u003eThe Mini International Neuropsychiatric Interview for children and adolescents (MINI KID) Arabic Version \u003cem\u003e(Awaad et al., 2002):\u0026nbsp;\u003c/em\u003e\u003c/span\u003e\u003c/strong\u003e\u003cspan\u003eThe MINI-KID is a structured clinical diagnostic interview designed to assess the presence of \u0026nbsp;current DSM-IV and ICD-10 psychiatric disorders in children and adolescents \u003cstrong\u003e\u003cem\u003e(Sheehan et al., 1998).\u003c/em\u003e\u003c/strong\u003e The Arabic version of (MINI-KID) used in our study is developed by \u003cstrong\u003e\u003cem\u003e(Ghanem et al., 1999)\u003c/em\u003e\u003c/strong\u003e \u003cspan\u003eand \u003cstrong\u003e\u003cem\u003e(Awaad\u0026nbsp;et al., 2002)\u003c/em\u003e\u003c/strong\u003e, validated it.\u003c/span\u003e To identify psychiatric symptoms/disorders as aggression, conduct disorder, anxiety, mood symptoms and disorders, phobia, delayed speech and tics\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003e\u003cspan\u003eConner\u0026rsquo;s Parent Rating Scale-revised; long version (CPRS-RL) (Conners, 1997):\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cspan\u003eThe Arabic versions of the Conner\u0026rsquo;s rating scales revised, long versions, parent form used in this study were translated and validated through previous research conducted by (El Sheikh et al., 2003) in the institute of psychiatry, Ain Shams University.\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan\u003eAim: It is applied to detect subtypes and severity of ADHD.\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003col start=\"4\"\u003e\n \u003cli\u003e\u003cspan\u003e\u0026nbsp; \u003cstrong\u003eStanford Binet Intelligence Scale (the fifth edition),\u003c/strong\u003e \u003cstrong\u003e\u003cem\u003e(Roid JH 2003):\u003c/em\u003e\u003c/strong\u003eThe Arabic version of the Stanford-Binet Intelligence Scale, 5th Edition \u003cstrong\u003e\u003cem\u003e(Farag S, 2011)\u003c/em\u003e\u003c/strong\u003e\u0026nbsp; \u0026nbsp;provides a comprehensive coverage of intelligence and cognitive abilities by assessing 5 factors based on the Cattell-Horn-Carroll hierarchical model of general intellectual ability( Fluid reasoning, Knowledge, Quantitative, Visuospatial processing, Working memory ) .These factors include separate subtests grouped into one of 2 domains. A Full-scale IQ composite score, as well as Nonverbal IQ (NVIQ) and Verbal IQ (VIQ) composite scores are then obtained.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eAssessment of habitual vitamin D intake by using a validated food frequency questionnaire ,A food frequency questionnaire \u003cstrong\u003e(FFQ)\u003c/strong\u003e consists of a finite list of foods and beverages with response categories to indicate usual frequency of consumption over the time period queried. \u0026nbsp;The FFQ was designed using information about \u0026lsquo;The composition of Foods\u0026rsquo; and \u0026lsquo;Food Portion Sizes\u0026rsquo;. \u0026nbsp;Foods were grouped into sections within the questionnaire along with portion sizes. \u0026nbsp;Frequency of consumption was measured weekly. \u0026nbsp;Participants were asked to indicate which frequency of consumption best fit each food according to their habitual dietary habits. \u0026nbsp;Vitamin D intake was calculated by multiplying frequency of consumption by the amount of vitamin D in the specified portion size of each food. \u0026nbsp;\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eMeasurement of 25 hydroxy vitamin D \u0026nbsp;level was done using Snibe Maglumi 800 Fully Automatic Chemiluminescence Immunoassay (CLIA) System Analyzer. \u0026nbsp;Venous blood samples (5 ml) were collected under sterile conditions from each patient and control subject for \u0026nbsp; assaying of 25 hydroxy vitamin D level.\u0026nbsp;\u003c/span\u003e\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cspan\u003eStatistical Analysis\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cspan\u003eStatistical Analysis\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan\u003eThe collected data was revised, coded, and tabulated using Statistical package for Social Science (IBM Corp. Released 2020. IBM \u0026nbsp;SPSS Statistics for Windows, Version 27.0. Armonk, NY: IBM Corp.). Data were presented and suitable analysis was done according to the type of data obtained for each parameter\u003cstrong\u003e.\u003c/strong\u003e The statistical significance of the difference between the means of the two research groups was evaluated using the Student T Test. \u0026nbsp;To investigate the connection between two qualitative variables, the Chi-Square test was performed. The strength and direction of the linear link between two variables are determined by the correlation coefficient. When the dependent variable is categorical, regression analysis was employed to predict risk variables. \u0026nbsp;A p value is deemed significant if it is 0. 05 \u0026nbsp; at a 95% confidence \u0026nbsp;level.\u0026nbsp;\u003c/span\u003e\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cspan\u003eThe demographic and anthropometric data between the ADHD group and the control group were matched. \u0026nbsp; The mean age for the ADHD group was 8. 11 \u0026nbsp;\u0026plusmn; 2. 55 \u0026nbsp; years , they were 45 males (83. 3%) and 9 females (16. 7%) . \u0026nbsp;The new diagnosis group ( defined as being diagnosed \u0026nbsp;of less than 1 month duration ) had a mean age of 7. 37 \u0026plusmn; 2. 59 years, which was significantly younger than that of the old diagnosis group ( being diagnosed of more than 1 month duration ) , who had a mean age of 8. 85 \u0026plusmn; 2. 32 years. \u0026nbsp;The new diagnosis group had 21 males (77. 8%) and 6 females (22. 2%), while the old diagnosis group had 24 males (88. 9%) and 3 females (11. 1%) with no \u0026nbsp; statistically significant difference . \u0026nbsp; Possible allergic condition were found among 16.7% of ADHD patients versus \u0026nbsp;11. 1% in the control group \u0026nbsp;with no stiatistically significant difference \u0026nbsp;. \u0026nbsp;No statistically significant differences were found between cases and controls regarding \u0026nbsp;BMI . as shown in table (1) . \u0026nbsp;\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cspan\u003eTable 1: \u0026nbsp;Comparison \u0026nbsp;of studied parameters among ADHD patients and healthy controls.\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003ctable\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003eControl\u003c/span\u003e\u003c/p\u003e\n \u003cp\u003e\u003cspan\u003eN = 54\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003eADHD\u003c/span\u003e\u003c/p\u003e\n \u003cp\u003e\u003cspan\u003eN = 54\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cem\u003e\u003cspan\u003ep\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003eNew diagnosis\u003c/span\u003e\u003c/p\u003e\n \u003cp\u003e\u003cspan\u003eN = 27\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003eOld diagnosis\u003c/span\u003e\u003c/p\u003e\n \u003cp\u003e\u003cspan\u003eN = 27\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cem\u003e\u003cspan\u003ep\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003eMale\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cspan\u003eN (%)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e39(72. 2%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e45(83. 3%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e\u003cspan\u003e0. 165\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e21 (77. 8%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e24 (88. 9%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e\u003cspan\u003e0. 467\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003eFemale\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e15(27. 8%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e9(16. 7%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e6 (22. 2%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e3 (11. 1%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003eAge (years)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003eMean \u0026plusmn; SD.\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e8. 87 \u0026plusmn; 2. 52\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e8. 11 \u0026plusmn; 2. 55\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e0. 122\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e7. 37 \u0026plusmn; 2. 59\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e8. 85 \u0026plusmn; 2. 32\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e0. 031\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003eBMI (kg/m\u0026sup2;)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003eMean \u0026plusmn; SD\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e17. 74 \u0026plusmn; 4. 04\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e16. 70 \u0026plusmn; 2. 30\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e0. 102\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e15. 85 \u0026plusmn; 1. 73\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e16. 54 \u0026plusmn; 2. 51\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e0. 106\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003ePossible allergic condition\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cspan\u003eN (%)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e6\u003c/span\u003e\u003cspan\u003e. \u0026nbsp; \u0026nbsp; (11. 1%).\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e9(16. 7%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e0. 404\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e6(22. 2%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e3(11. 1%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e0. 467\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cspan\u003eFor the total IQ scores, the ADHD group had a mean score of 96.06 \u0026plusmn; 6.57, while the control group had a mean score of 97.18 \u0026plusmn; 4.24. The t-test for this comparison yielded a non-significant result (p=0.299)\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan\u003eFor medical comorbidities, the data shows that 16.7% of ADHD patients had medical comorbidities, while 11.1% of the control group had medical comorbidities. The test for this comparison yielded a non-significant result (p=0.404).\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan\u003eFor psychiatric comorbidities assessed via the MiniKID, the data shows that 7.4% of ADHD patients had psychiatric comorbidities, while none of the individuals in the control group were positive for psychiatric comorbidities. The test for this comparison yielded a non-significant result (p=0.118).\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan\u003eThe median weekly vitamin D intake for the ADHD group was 615. 2 IU (range: 180. 8 \u0026ndash; 841. 6 IU), which was lower than the median weekly vitamin D intake for the control group was 664. 0 IU (range: 437. 6 \u0026ndash; 1212. 0 IU) with a statistically significant difference (p=0. 001). \u0026nbsp;, Weekly Vitamin D Intake via FFQ and 25-Hydroxy Vitamin D Level (table 2 ).\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cspan\u003eTable (2): \u003c/span\u003e\u003c/strong\u003e\u003cspan\u003eComparison between ADHD group and control group regarding IQ Score, medical comorbidities, psychiatric comorbidities via MiniKID \u0026nbsp;, and weekly vitamin D intake via FFQ\u003c/span\u003e\u003c/p\u003e\n\u003ctable\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cspan\u003eIQ Score\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cspan\u003eADHD\u003cbr\u003e\u0026nbsp;N = 54\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cspan\u003eControl\u003cbr\u003e\u0026nbsp;N = 54\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cspan\u003eTest value\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cspan\u003eP-value\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cspan\u003eVerbal, \u003c/span\u003e\u003c/strong\u003e\u003cspan\u003eMean \u0026plusmn; SD\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e96.31 \u0026plusmn; 8.27\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e96.94 \u0026plusmn; 6.47\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e0.441\u003csup\u003e\u0026ne;\u003c/sup\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e0.660\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cspan\u003eNon-Verbal, \u003c/span\u003e\u003c/strong\u003e\u003cspan\u003eMean \u0026plusmn; SD\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e95.81 \u0026plusmn; 6.04\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e97.41 \u0026plusmn; 4.67\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e1.533\u003csup\u003e\u0026ne;\u003c/sup\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e0.128\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cspan\u003eTotal, \u003c/span\u003e\u003c/strong\u003e\u003cspan\u003eMean \u0026plusmn; SD\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e96.06 \u0026plusmn; 6.57\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e97.18 \u0026plusmn; 4.24\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e1.045\u003csup\u003e\u0026ne;\u003c/sup\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e0.299\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cspan\u003eMedical comorbidities, \u003c/span\u003e\u003c/strong\u003e\u003cspan\u003eno. (%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003eNegative\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e45 (83.3%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e48 (88.9%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e\u003cspan\u003e0.697\u003csup\u003e∙\u003c/sup\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e\u003cspan\u003e0.404\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003ePossible allergic condition\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e9 (16.7%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e6 (11.1%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cspan\u003ePsychiatric comorbidities Via MiniKID, \u003c/span\u003e\u003c/strong\u003e\u003cspan\u003eno. (%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003eNegative\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e50 (92.6%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e54 (100.0%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e\u003cspan\u003e4.154\u003csup\u003e∙\u003c/sup\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e\u003cspan\u003e0.118\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003eTransient tic disorder\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e4 (7.4%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e0 (0.0%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cspan\u003eWeekly Vitamin D Intake via FFQ,\u003c/span\u003e\u003c/strong\u003e\u003cspan\u003e\u0026nbsp;Median (Range)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e615.2 (180.8 \u0026ndash; 841.6)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e664.0(437.6 \u0026ndash; 1212.0)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e2016.5\u003csup\u003e\u0026loz;\u003c/sup\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e0.001**\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cspan\u003eIn terms of 25-Hydroxy Vitamin D level, the ADHD group had a mean level of 18.20 \u0026plusmn; 6.46, while the control group had a mean level of 31.72 \u0026plusmn; 18.03. The comparison yielded a significant result (p\u0026lt;0.001).\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan\u003eIn terms of sufficiency of 25-Hydroxy Vitamin D level, 17 participants (31.5%) in the control group had sufficient levels, while only 1 participant (1.9%) in the ADHD group had sufficient levels. Additionally, 36 participants (66.7%) in the control group had insufficient levels of 25-Hydroxy Vitamin D, while 46 participants (85.2%) in the ADHD group had insufficient levels. One participant (1.9%) in the control group had deficient levels of 25-Hydroxy Vitamin D, while 7 participants (13.0%) in the ADHD group had deficient levels. The comparison yielded a significant result (p\u0026lt;0.001) as shown in table (3)\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cspan\u003eTable (3 ): \u003c/span\u003e\u003c/strong\u003e\u003cspan\u003eComparison between ADHD group and control group regarding 25-Hydroxy Vitamin D Level\u003c/span\u003e\u003c/p\u003e\n\u003ctable\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cspan\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cspan\u003eADHD\u003cbr\u003e\u0026nbsp;N = 54\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cspan\u003eControl\u003cbr\u003e\u0026nbsp;N = 54\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cspan\u003eTest value\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cspan\u003eP-value\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cspan\u003e25-Hydroxy Vitamin D Level\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cspan\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003eMean \u0026plusmn; SD.\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e18.20 \u0026plusmn; 6.46\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e31.72 \u0026plusmn; 18.03\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e\u003cspan\u003e5.190\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e\u003cspan\u003e\u0026lt;0.001**\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003eMedian (Range)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e18.9 (6.8 \u0026ndash; 35.2)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e25.5 (9.1 \u0026ndash; 89.9)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cspan\u003eSufficient\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e1 (1.9%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e17 (31.5%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\"\u003e\n \u003cp\u003e\u003cspan\u003e19.942\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\"\u003e\n \u003cp\u003e\u003cspan\u003e\u0026lt;0.001**\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cspan\u003eInsufficient\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e46 (85.2%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e36 (66.7%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cspan\u003eDeficient\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e7 (13.0%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e1 (1.9%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cspan\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cspan\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cspan\u003eRegarding the vitamin \u0026nbsp;D serum \u0026nbsp;level : 1.9% \u0026nbsp; of the cases versus 31.5 %of the controls \u0026nbsp;were sufficient, 85.2% of the cases versus 66.7% of the control were insufficient , 13% of the cases versus 1.9% of the control were deficient with statistically significant p value\u0026nbsp;\u003c/span\u003e\u003cspan\u003e\u0026lt;0.001**\u003c/span\u003e\u003cspan\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan\u003eRegarding the Validity of 25-Hydroxy Vitamin D Level for discrimination between ADHD patients and control group:\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan\u003eCut off: The cut-off value for the 25-Hydroxy Vitamin D level, which is used to distinguish between ADHD patients and the control group. In this case, the cut-off value is \u0026lt;24.57.\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan\u003eSensitivity: The proportion of ADHD patients who test positive for the 25-Hydroxy Vitamin D level test. In this case, the sensitivity is 85.19%, which means that the test correctly identifies 85.19% of ADHD patients.\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan\u003eSpecificity: The proportion of\u0026nbsp;control group participants\u0026nbsp;who test negative for the 25-Hydroxy Vitamin D level test. In this case, the specificity is 61.11%, which means that the test correctly identifies 61.11% of control group participants as negative.\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan\u003eAccuracy: The overall accuracy of the test in distinguishing between ADHD patients and the control group. In this case, the accuracy is 73.15%, which means that the test correctly identifies ADHD patients and control group participants 73.15% of the time. As shown in table (4)\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan\u003eTable (4)\u003c/span\u003e\u003c/p\u003e\n\u003ctable\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"9\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cspan\u003e25-Hydroxy Vitamin D Level\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cspan\u003eAUC\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cspan\u003e95% CI\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cspan\u003eP\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cspan\u003eCut off\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cspan\u003eSensitivity\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cspan\u003eSpecificity\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cspan\u003ePPV\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cspan\u003eNPV\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cspan\u003eAccuracy\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e0.788\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e0.703 \u0026ndash; 0.873\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e\u0026lt;0.001**\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e\u0026lt;24.57\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e85.19%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e61.11%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e68.66%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e80.49%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e73.15%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cspan\u003eAUC, area under ROC curve; \u0026nbsp;CI, confidence interval;\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan\u003ePPV, positive predictive value; NPV, negative predictive value.\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan\u003e*: Significant \u0026le;0.05\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan\u003eAssociation between drug intake with vitamin D level and treatment modalities : There was no significant difference between drug therapy, behavioral therapy and\u0026nbsp;\u003c/span\u003e\u003cspan\u003ea combination of drug \u0026nbsp;therapy with behavioral therapy as regard 25-OH vitamin D levels (p=0.265).\u003cspan\u003e as shown in table (5)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan\u003eTable (5)\u003c/span\u003e\u003c/p\u003e\n\u003ctable\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cspan\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cspan\u003eAtomoxetine\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cspan\u003eAtomoxetine \u0026amp; Behavioral therapy\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cspan\u003eBehavioral therapy\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cspan\u003eTest value\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cspan\u003eP-value\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cspan\u003eN=14\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cspan\u003eN=8\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cspan\u003eN=5\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e\u003cspan\u003eHydroxy 25 \u0026nbsp;Vitamin D Level\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003eMean\u0026plusmn;SD\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e16.81 \u0026plusmn; 6.34\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e19.41 \u0026plusmn; 5.20\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e16.69 \u0026plusmn; 6.85\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e\u003cspan\u003e3.021\u003csup\u003e\u0026ne;\u0026ne;\u003c/sup\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e\u003cspan\u003e0.265\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003eMedian (range)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e17.84 (6.8-28.3)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e19.83 (9.8-27.71)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e18.78 (7.2-24.76)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e\u003cspan\u003eVit. D. categories\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003eInsufficient\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e12 (85.7%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e8 (100.0%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e4 (80.0%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e\u003cspan\u003e2.584∙\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e\u003cspan\u003e0.859\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003eDeficient\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e2 (14.3%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e0 (0.0%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e1 (20.0%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e\u003cspan\u003eWeekly Vitamin D Intake\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003eMean \u0026plusmn; SD.\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e490.2\u0026plusmn;123.8\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e667.4\u0026plusmn; 125.5\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e591.4\u0026plusmn;249.4\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e\u003cspan\u003e2.553\u003csup\u003e\u0026loz;\u0026loz;\u003c/sup\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e\u003cspan\u003e0.145\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003eMedian (range)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e482.6 (312-685)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e688.6 (445-808)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e686.8 (182-841)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cspan\u003eRelation between 25-Hydroxy Vitamin D level with conners parent rating scale among ADHD patients : There is no association between 25-Hydroxy Vitamin D level and Conners Parent Rating Scale among ADHD patients specifically in relation to Oppositional, Hyperactivity, ADHD index, DSM-IV Inattentive symptom Count, DSM-IV Hyperactive-Impulsive Symptom Count , DSM-IV Total Symptom Count.\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan\u003eThere is significant association (p=0.003) between 25-OH vitamin D and cognitive score. Additionally, there is significant association (p=0.001) between 25-OH vitamin D and Restless-Impulsive score. As shown in table (6)\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan\u003eTable (6)\u003c/span\u003e\u003c/p\u003e\n \u003ctable\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cspan\u003eConner\u0026rsquo;s Parent Rating Scale\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cspan\u003e25-Hydroxy Vitamin D Level\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cspan\u003eTest value\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cspan\u003eP-value\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cspan\u003eMean \u0026plusmn; SD.\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cspan\u003eOppositional\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003eSlightly, n=3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e17.44 \u0026plusmn; 8.57\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\"\u003e\n \u003cp\u003e\u003cspan\u003e0.268\u0026ne;\u0026ne;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\"\u003e\n \u003cp\u003e\u003cspan\u003e0.848\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003eMildly, n=5\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e16.59 \u0026plusmn; 6.99\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003eModerately n=4\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e16.40 \u0026plusmn; 4.80\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003eMarkedly, n=42\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e18.61 \u0026plusmn; 6.56\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cspan\u003eCognitive problem / inattention\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003eAverage, n=3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e20.26 \u0026plusmn; 8.82\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\"\u003e\n \u003cp\u003e\u003cspan\u003e3.506\u0026ne;\u0026ne;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\"\u003e\n \u003cp\u003e\u003cspan\u003e0.003*\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003eSlightly, n=2\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e18.77 \u0026plusmn; 9.41\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003eMildly, n=7\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e18.44 \u0026plusmn; 8.09\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003eModerately, n=9\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e17.81 \u0026plusmn; 5.12\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003eMarkedly, n=33\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e13.56 \u0026plusmn; 9.55\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cspan\u003eHyperactivity\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003eSlightly, n=5\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e14.96 \u0026plusmn; 4.95\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\"\u003e\n \u003cp\u003e\u003cspan\u003e1.217\u0026ne;\u0026ne;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\"\u003e\n \u003cp\u003e\u003cspan\u003e0.313\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003eMildly, n=2\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e14.43 \u0026plusmn; 0.00\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003eModerately, n=9\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e16.43 \u0026plusmn; 7.67\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003eMarkedly, n=38\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e19.24 \u0026plusmn; 6.35\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cspan\u003eADHD index\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003eAverage, n=2\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e13.60 \u0026plusmn; 5.657\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\"\u003e\n \u003cp\u003e\u003cspan\u003e0.679\u0026ne;\u0026ne;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\"\u003e\n \u003cp\u003e\u003cspan\u003e0.610\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003eSlightly, n=1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e22.40 \u0026nbsp;\u0026plusmn; 0.0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003eMildly, n=8\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e18.02 \u0026plusmn; 5.064\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003eModerately, n=15\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e19.89 \u0026plusmn; 8.636\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003eMarkedly, n=28\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e17.52 \u0026plusmn; 5.568\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cspan\u003eCGI Restless-Impulsive\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003eAverage, n=3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e24.77 \u0026plusmn; \u0026nbsp;2.700\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\"\u003e\n \u003cp\u003e\u003cspan\u003e5.749\u0026ne;\u0026ne;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\"\u003e\n \u003cp\u003e\u003cspan\u003e0.001*\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003eSlightly, n=2\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e13.56 \u0026plusmn; \u0026nbsp;9.553\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003eMildly, n=3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e28.80 \u0026plusmn; \u0026nbsp;5.543\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003eModerately, n=3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e24.27 \u0026plusmn; \u0026nbsp;7.679\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003eMarkedly, n=43\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e16.79 \u0026plusmn; 5.385\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cspan\u003eDSM-IV Inattentive symptom Count\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003eAverage, n=6\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e17.65 \u0026plusmn; 7.496\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\"\u003e\n \u003cp\u003e\u003cspan\u003e0.499\u0026ne;\u0026ne;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\"\u003e\n \u003cp\u003e\u003cspan\u003e0.685\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003eSlightly, n=2\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e13.56 \u0026plusmn; \u0026nbsp;9.553\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003eModerately, n=15\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e17.63 \u0026plusmn; 5.606\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003eMarkedly, n=31\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e18.88 \u0026plusmn; \u0026nbsp;6.664\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cspan\u003eDSM-IV Hyperactive-Impulsive Symptom Count\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003eAverage, n=1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e24.76 \u0026plusmn; 0.0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\"\u003e\n \u003cp\u003e\u003cspan\u003e0.732\u0026ne;\u0026ne;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\"\u003e\n \u003cp\u003e\u003cspan\u003e0.575\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003eSlightly, n=5\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e14.96 \u0026plusmn; \u0026nbsp; 4.946\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003eMildly, n=3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e17.48 \u0026plusmn; 8.676\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003eModerately, n=11\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e17.16 \u0026plusmn; 5.559\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003eMarkedly, n=34\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e18.88 \u0026plusmn; 6.802\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cspan\u003eDSM-IV Total Symptom Count\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003eSlightly, n=6\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e18.26 \u0026plusmn; 8.843\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\"\u003e\n \u003cp\u003e\u003cspan\u003e0.481\u0026ne;\u0026ne;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\"\u003e\n \u003cp\u003e\u003cspan\u003e0.697\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003eMildly, n=7\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e17.74 \u0026plusmn; 7.062\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003eModerately, n=7\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e15.59 \u0026plusmn; \u0026nbsp;5.175\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003eMarkedly, n=34\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e18.82 \u0026plusmn; 6.266\u003c/span\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\u003cp\u003e\u003cspan\u003eNo.: Number; %: Percentage; SD. Standard deviation, Range: Min. \u0026ndash; Max.\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan\u003e\u0026ne;\u0026ne;: One Way ANOVA\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan\u003eThe results of a logistic regression analysis for predicting ADHD, using gender, age, BMI, \u0026nbsp;Consanguinity, Family social income, Total IQ Score, Vitamin D Intake, Vitamin D Level, Medical comorbidities, Psychiatric comorbidities as covariates. Vitamin D intake, vitamin D level were associated with risk of ADHD susciptability in univariable analysis. However, in multivariable analysis, only vitamin D level was considered independent predictror of ADHD suceptability. As shown in table (7)\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan\u003eTable (7)\u003c/span\u003e\u003c/p\u003e\n \u003ctable\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\"\u003e\n \u003cp\u003e\u003cspan\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cspan\u003eUnivariate\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cspan\u003eMultivariate\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cspan\u003eP\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cspan\u003eOR\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cspan\u003e95% C.I.\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cspan\u003eP\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cspan\u003eOR\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cspan\u003e95% C.I.\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003eGender\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e0.169\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e1.923\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e0.758-4.879\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003eAge\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e0.123\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e0.887\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e0.761-1.033\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003eBMI\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e0.128\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e0.775\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e0.642-1.935\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003eConsanguinity\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e0.633\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e1.257\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e0.491-3.217\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003eFamily social income\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e0.126\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e0.487\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e0.259-1.917\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003eTotal IQ Score\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e0.297\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e0.964\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e0.899-1.033\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003eVitamin D Intake\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e\u0026lt;0.001*\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e0.996\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e0.994-0.998\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e0.395\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e0.999\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e0.998-1.001\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003eVitamin D Level\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e\u0026lt;0.001*\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e0.871\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e0.813-0.933\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e0.001*\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e0.923\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e0.882-0.966\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003eMedical comorbidities\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e0.407\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e1.600\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e0.527-4.856\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003ePsychiatric comorbidities\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e0.159\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e2.080\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e0.751-5.759\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cspan\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eVitamin D is a skin-produced vitamin after sun exposure. For the health of the musculoskeletal system, the serum calcium content must be kept within the normal physiological range (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Especially in youngsters, attention deficit hyperactivity disorder (ADHD) is one of the most prevalent behavioral disorders. Typically beginning in childhood, ADHD frequently lasts a lifetime. Inattention, hyperactivity, and impulsivity are the symptoms (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). However, little is known about how vitamin D status and ADHD are related. The brain is just one of the many areas of the body where vitamin D is used. (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). The present investigation found no discernible difference between the ADHD group and the control group in the amount of vitamin D consumed by mothers during pregnancy. The risk that a kid will be diagnosed with ADHD increases when the mother's vitamin D levels are low during pregnancy (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e), This was the first to show a link between low maternal 25(OH)D levels in the first to third trimester of pregnancy and an increased risk for ADHD diagnosis in the child. Furthermore, Sahin et al. discovered that ADHD children had lower serum vitamin D and VDR levels than typically developing kids. Serum Ca, P, and ALP levels did not significantly differ between the ADHD and control groups, though. The levels of serum vitamin D, vitamin D receptor, calcium, phosphorus, and alkaline phosphatase were not significantly different across the ADHD subtypes (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). In a study, Bener and Kamal discovered that 64% of the individuals with ADHD had severe (10 ng/mL) and moderate (10–20 ng/mL) levels of vitamin D insufficiency (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eComparing the ADHD group to the control group, the current study found that the weekly vitamin D intake was significantly lower in the ADHD group. In addition, the ADHD diagnosis group had older average ages than the ADHD diagnostic group with more recent diagnoses. Thus, compared to the control group, ADHD patients had considerably lower amounts of 25-hydroxy vitamin D and were less likely to have insufficient levels of this vitamin. Children with ADHD have lower serum levels of vitamin D than healthy controls, according to several research that support our findings (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe proportion of children with vitamin D deficiency in the ADHD group was substantially higher than that of the control group, according to a study by Sharif et al. Additionally, the cases group's mean serum vitamin D level was considerably lower than that of the control (healthy) group. which matched our findings (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). This result is consistent with the findings of a related investigation, which showed that there was a significant difference in the mean serum vitamin D level between the case and control groups (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). According to the current study, there was no significant difference in the two groups' weekly vitamin D intake via FFQ. The mean mother intake of vitamin D during pregnancy was highest in the Atomoxetine \u0026amp; Behavioral Therapy group, followed by the Behavioral Therapy group, and lowest in the Atomoxetine group.\u003c/p\u003e \u003cp\u003eAdditionally, there was no discernible difference in 25-hydroxyvitamin D adequacy between the new and previous diagnoses of ADHD. In contrast, Li et al. found that children with ADHD had considerably lower serum levels of retinol and 25(OH)D than HCs, and that VA and VD deficiencies were more common in ADHD children. Second, there was a link between serum levels of retinol and 25 (OH) D and the unfavorable ADHD symptoms. Third, greater SNAP-IV total scores and ADHD inattention subscale scores were seen in children with ADHD in the VA and VD co-deficiency group, indicating that co-deficiency of VD and VA had a significant association with ADHD symptoms in children (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e); this finding was supported by previous research.\u003c/p\u003e \u003cp\u003eThe results of the current investigation showed no correlation between the 25-hydroxyvitamin D level and any of the characteristics associated with ADHD cases. Hemamy et al.'s research on children with ADHD showed that supplementation with Vitamin D and magnesium reduced conduct difficulties, social problems, and anxiety/shyness scores compared to placebo intake, but did not significantly impact psychosomatic disorders scores (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). While Mohammad pour et al. found that after 8 weeks, the vitamin D intervention group significantly outperformed the placebo group in reducing ADHD evening symptoms (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). In contrast to previous research, the current study found a strong correlation between mothers' intake of vitamin D during pregnancy and ADHD patients' 25-hydroxy vitamin D levels and medical/psychiatric comorbidities. Similar findings were made by Daraki et al. and Morales et al. who discovered a link between childhood ADHD-like symptoms and high vitamin D levels in the mother's blood circulation. However, they used umbilical cord blood samples in their research (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). However, Gustafsson et al. discovered no link between the findings of ADHD and the levels of vitamin D in the cord blood. The study's main weaknesses, however, were a small sample size and statistical flaws (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). The results of the current investigation showed that the Vitamin D measure test has poor accuracy in differentiating between existing and new diagnoses of ADHD and moderate accuracy in differentiating between ADHD patients and the control group. Therefore, vitamin D levels and vitamin D intake were linked in a univariable study to the likelihood of ADHD susceptibility. However, only vitamin D levels were thought to be independent predictors of ADHD susceptibility in the multivariable analysis. Age was once thought to be the only predictor of elderly (chronic) ADHD. Additionally, Gan et al. have established that vitamin D supplementation showed a minor but statistically significant improvement in the overall scores for ADHD, as well as the inattention, hyperactivity, and behavior scores. Due to the low to extremely low quality of the evidence in the literature, the improvement was probably just marginal. The oppositional scores did not improve statistically significantly. The vitamin D group's reported adverse events were minor and did not differ substantially from the control groups. The need for additional multicenter research on vitamin D supplementation is evident from the rise in serum vitamin D levels and the proportion of patients with adequate vitamin D levels (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eBetween new and old diagnoses of ADHD, the level of oppositional behavior, cognitive problem/inattention, hyperactivity, and ADHD index on Conners Parent Rating Scale score did not significantly differ, according to the current study. Additionally, there was no discernible difference between the two groups in terms of CGI Restless-Impulsive and DSM-IV Total symptom count. In the old diagnosis group, atomoxetine was the most often prescribed drug for ADHD, and a popular treatment strategy included combining atomoxetine with behavioral therapy. In this group, behavioral therapy by itself was less frequently employed as a treatment for ADHD, Although, there were no appreciable variations between the three therapy groups in terms of vitamin D categories, all three treatment groups were identified as having insufficient vitamin D levels. Similar to Michelson et al., atomoxetine groups showed better results in treating ADHD symptoms than placebo groups. The atomoxetine groups also showed a significant improvement in social and familial functions (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). While An atomoxetine medication led to a moderate improvement in response inhibition but not a significant improvement in sustained attention in a double-blind, randomized, placebo-controlled crossover experiment (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). It made it easier to recognize terrified faces, especially in younger children. The improvement in ADHD symptoms had a smaller impact size than that shown in a meta-analysis of earlier studies (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eLimitations\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eThe present study's limitations included the small sample size and the fact that vitamin D medication was given to individuals who were not included in the trial but who nevertheless showed improvement in their ADHD symptoms.\u003c/p\u003e \u003cp\u003e\u003c/p\u003e \u003cp\u003e\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003ea number of researchers have recently postulated a link between vitamin D and ADHD, although the investigations have produced mixed findings. The current study found that compared to healthy children, children with ADHD have decreased serum concentrations of 25-hydroxyvitamin D.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe ASU-Faculty of Medicine ethical committee approved the study. Informed Consent: Informed consent was obtained from the gurdians of the participants assuring them that their participation was voluntary and that their refusal to participate would not negatively impact their ongoing or future medical care.\u003c/p\u003e\n\u003ch2\u003eConsent to publication:\u003c/h2\u003e\n\u003cp\u003eAll authors have read the manuscript and approved its publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of Competing Interest:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors report no declarations of interest.\u003c/p\u003e\n\u003ch2\u003eFunding:\u003c/h2\u003e\n\u003cp\u003eNo external funds, grants, or assistance were received to prepare this manuscript.\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eH.E. ,G.A., R.K.,A.M.,S.K. : wrote the main manuscript , prepared the figuresH.E. ,G.A., R.K.,A.M.,S.K. ,R.S. : statistical analysis\u003c/p\u003e\n\u003ch2\u003eAcknowledgments:\u003c/h2\u003e\n\u003cp\u003eTo the children and their families who participated in the study\u003c/p\u003e\n\u003ch2\u003eData Availability\u003c/h2\u003e\n\u003cp\u003eThe study data can be made available upon request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eMagnus W, Nazir S, Anilkumar AC, et al. Attention Deficit Hyperactivity Disorder. [Updated 2023 Jan 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. \u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eMatas M. Approach to attention deficit disorder in adults. Can Fam Physician. 2006 Aug;52:961-4. \u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eMillichap JG. Etiologic classification of attention-deficit/hyperactivity disorder. Pediatrics. 2008 Feb;121(2):e358-65. \u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eMahone EM, Denckla MB. Attention-Deficit/Hyperactivity Disorder: A Historical Neuropsychological Perspective. J Int Neuropsychol Soc. 2017 Oct;23(9-10):916-929. \u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eHolbrook JR, Cuffe SP, Cai B, Visser SN, Forthofer MS, Bottai M, Ortaglia A, McKeown RE. Persistence of Parent-Reported ADHD Symptoms From Childhood Through Adolescence in a Community Sample. J Atten Disord. 2016 Jan;20(1):11-20. \u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eAmerican Psychiatric Association. Neurodevelopmental disorders: Attention-deficit/hyperactivity disorder. In: Diagnostic and statistical manual of mental disorders, fifth edition (DSM-5). Washington: American Psychiatric Association, 2013. \u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eWeiss M, Murray C. Assessment and management of attention-deficit hyperactivity disorder in adults. CMAJ. 2003 Mar 18;168(6):715-22. \u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eBrikell I, Chen Q, Kuja-Halkola R, D\u0026apos;Onofrio BM, Wiggs KK, Lichtenstein P, Almqvist C, Quinn PD, Chang Z, Larsson H. Medication treatment for attention-deficit/hyperactivity disorder and the risk of acute seizures in individuals with epilepsy. Epilepsia. 2019 Feb;60(2):284-293. \u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eCharoenngam N, Holick MF. Immunologic Effects of Vitamin D on Human Health and Disease. Nutrients. 2020 Jul 15;12(7):2097. \u003c/span\u003e\u003c/li\u003e\n\u003cli\u003ePilz S, Zittermann A, Trummer C, Theiler-Schwetz V, Lerchbaum E, Keppel MHet al. . Vitamin D testing and treatment: a narrative review of current evidence. Endocrine Connections. 2019;8(2):R27\u0026ndash;R43. \u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eMulcahy KB, Trigoboff E, Opler L, Demler TL. Physician Prescribing Practices of Vitamin D in a Psychiatric Hospital. Innov Clin Neurosci. 2016 Jun 1;13(5-6):21-27. \u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eEyles DW, Feron F, Cui X, Kesby JP, Harms LH, Ko P, McGrath JJ, Burne TH. Developmental vitamin D deficiency causes abnormal brain development. Psychoneuroendocrinology. 2009 Dec;34 Suppl 1:S247-57. \u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eChauhan K, Shahrokhi M, Huecker MR. Vitamin D. [Updated 2023 Apr 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan. \u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eKhoshbakht Y, Bidaki R, Salehi-Abargouei A. Vitamin D Status and Attention Deficit Hyperactivity Disorder: A Systematic Review and Meta-Analysis of Observational Studies. Adv Nutr. 2018 Jan 1;9(1):9-20. \u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eVillagomez A, \u0026amp; Ramtekkar U. Iron, magnesium, vitamin D, and zinc deficiencies in children presenting with symptoms of attention-deficit/hyperactivity disorder. Children, 2014. 1(3), 261\u0026ndash;279. \u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eSucksdorff M, Brown AS, Chudal R, Surcel HM, Hinkka-Yli-Salom\u0026auml;ki S, Cheslack-Postava K, Gyllenberg D, Sourander A. Maternal Vitamin D Levels and the Risk of Offspring Attention-Deficit/Hyperactivity Disorder. J Am Acad Child Adolesc Psychiatry. 2021 Jan;60(1):142-151. e2. \u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eSahin N, Altun H, Kurutas EB, Balkan D. Vitamin D and vitamin D receptor levels in children with attention-deficit/hyperactivity disorder. Neuropsychiatr Dis Treat. 2018 Feb 19;14:581-585. \u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eBener A, Kamal M. Predict attention deficit hyperactivity disorder? Evidence-based medicine. Glob J Health Sci. 2014;6(2):47\u0026ndash;57. \u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eJohnson SR, Zelig R, \u0026amp; Parker A (2020). Vitamin D Status of Children With Attention-Deficit Hyperactivity Disorder. Topics in Clinical Nutrition, 35(3), 222\u0026ndash;239. \u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eSharif MR, Madani M, Tabatabaei F, Tabatabaee Z. The Relationship between Serum Vitamin D Level and Attention Deficit Hyperactivity Disorder. Iran J Child Neurol. 2015 Fall;9(4):48-53. \u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eGoksugur SB, Tufan AE, Semiz M, Gunes C, Bekdas M, Tosun M, Demircioglu F. Vitamin D status in children with attention-deficit-hyperactivity disorder. Pediatr Int. 2014 Aug;56(4):515-9. \u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eLi HH, Yue XJ, Wang CX, Feng JY, Wang B, Jia FY. Serum Levels of Vitamin A and Vitamin D and Their Association With Symptoms in Children With Attention Deficit Hyperactivity Disorder. Front Psychiatry. 2020 Nov 23;11:599958. \u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eHemamy M, Heidari-Beni M, Askari G, Karahmadi M, Maracy M. Effect of Vitamin D and Magnesium Supplementation on Behavior Problems in Children with Attention-Deficit Hyperactivity Disorder. Int J Prev Med. 2020 Jan 24;11:4. \u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eMohammadpour N, Jazayeri S, Tehrani-Doost M, Djalali M, Hosseini M, Effatpanah M, Davari-Ashtiani R, Karami E. Effect of vitamin D supplementation as adjunctive therapy to methylphenidate on ADHD symptoms: A randomized, double blind, placebo-controlled trial. Nutr Neurosci. 2018 Apr;21(3):202-209. \u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eDaraki V, Roumeliotaki T, Koutra K, Chalkiadaki G, Katrinaki M, Kyriklaki A, Kampouri M, Margetaki K, Vafeiadi M, \u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eGustafsson P, Rylander L, Lindh CH, J\u0026ouml;nsson BA, Ode A, Olofsson P, Ivarsson SA, Rignell-Hydbom A, Haglund N, K\u0026auml;ll\u0026eacute;n K. Vitamin D Status at Birth and Future Risk of Attention Deficit/Hyperactivity Disorder (ADHD). PLoS One. 2015 Oct 28;10(10):e0140164. \u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eGan J, Galer P, Ma D, Chen C, Xiong T. The Effect of Vitamin D Supplementation on Attention-Deficit/Hyperactivity Disorder: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Child Adolesc Psychopharmacol. 2019 Nov;29(9):670-687. 73. \u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eMichelson D, Faries D, Wernicke J, Kelsey D, Kendrick K, Sallee FR, Spencer T; Atomoxetine ADHD Study Group. Atomoxetine in the treatment of children and adolescents with attention-deficit/hyperactivity disorder: a randomized, placebo-controlled, dose-response study. Pediatrics. 2001 Nov;108(5):E83. \u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eGriffiths KR, Leikauf JE, Tsang TW, Clarke S, Hermens DF, Efron D, Williams LM, Kohn MR. Response inhibition and emotional cognition improved by atomoxetine in children and adolescents with ADHD: The ACTION randomized controlled trial. J Psychiatr Res. 2018 Jul;102:57-64. \u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eSchwartz S, Correll CU. Efficacy and safety of atomoxetine in children and adolescents with attention-deficit/hyperactivity disorder: results from a comprehensive meta-analysis and metaregression. J Am Acad Child Adolesc Psychiatry. 2014 Feb;53(2):174-87. \u003c/span\u003e\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"middle-east-current-psychiatry","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"mecp","sideBox":"Learn more about [Middle East Current Psychiatry](http://mecp.springeropen.com)","snPcode":"43045","submissionUrl":"https://submission.nature.com/new-submission/43045/3","title":"Middle East Current Psychiatry","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Open","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"ADHD, Vitamin D , 25-Hydroxy Vitamin D","lastPublishedDoi":"10.21203/rs.3.rs-8585193/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8585193/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground\u003c/b\u003e\u003c/p\u003e \u003cp\u003eAttention-deficit/hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder in childhood and adolescence. Dietary interventions such as omega-3 FA, vitamin and mineral supplementations might affect ADHD symptoms.\u003c/p\u003e\u003cp\u003e\u003cb\u003eAim\u003c/b\u003e\u003c/p\u003e \u003cp\u003eTo compare serum level of vitamin D in children with ADHD with its different subtypes in relation to healthy controls.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e \u003cp\u003eA cross sectional comparative study was conducted on 108 children divided equally between healthy children and ADHD cases. Vit D was measured. Assessment of habitual vitamin D intake was done by using a vitamin D food frequency questionnaire.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe median weekly vitamin D intake for the ADHD group was significantly lower than that for the control group, p\u0026thinsp;\u0026lt;\u0026thinsp;0. 001. The ADHD group had significantly lower 25-Hydroxy Vitamin D level than the control group (p\u0026thinsp;\u0026lt;\u0026thinsp;0. 001). Vitamin D level was considered independent predictor of ADHD susceptibility.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e\u003c/p\u003e \u003cp\u003ePatients with ADHD have lower serum concentrations of 25-hydroxyvitamin D than do healthy children.\u003c/p\u003e","manuscriptTitle":"The association between Serum Vitamian D Level with Attention Deficit Hyperactivity Disorder (ADHD) : A cross sectional comparative study in a sample of Egyptian Children","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-28 18:49:51","doi":"10.21203/rs.3.rs-8585193/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-01T16:34:28+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-29T21:29:10+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-24T04:21:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"277637979807875268852493945885294038523","date":"2026-01-24T04:02:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"333187987018379059614311486605041741335","date":"2026-01-22T12:50:10+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-22T12:02:34+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-22T04:59:07+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-22T04:57:00+00:00","index":"","fulltext":""},{"type":"submitted","content":"Middle East Current Psychiatry","date":"2026-01-12T20:30:18+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"middle-east-current-psychiatry","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"mecp","sideBox":"Learn more about [Middle East Current Psychiatry](http://mecp.springeropen.com)","snPcode":"43045","submissionUrl":"https://submission.nature.com/new-submission/43045/3","title":"Middle East Current Psychiatry","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Open","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"d849fb63-12e8-443d-9441-8c0e7b4b1c12","owner":[],"postedDate":"January 28th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-02-01T16:38:23+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-28 18:49:51","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8585193","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8585193","identity":"rs-8585193","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}