Attention Deficit Hyperactivity Disorder, eller ADHD, är en neuropsykiatrisk funktionsnedsättning som kan ha stor inverkan på elevers skolgång. Den svenska skolans kompensatoriska uppdrag syftar dock till att bland annat minska diagnosernas påverkan på elevers skolgång med hjälp av olika stödinsatser så att elever ska kunna ta till sig utbildningen på bästa sätt. Detta kan ske på olika vis, men en faktor är de anpassningar som görs av lärare i undervisningen. Syftet med denna studie är att undersöka vilka anpassningar gymnasielärare har erfarenhet av att använda i sin undervisning i relation till ADHD, samt deras attityd till detta arbete. Data samlades in via inspelade semistrukturerade intervjuer som sedan transkriberades och analyserades med reflexiv tematisk analys. Samtliga moment genomfördes av båda författarna. I analysen framkom det att lärare genomför anpassningar som vi delade in i två huvudteman:individanpassningar och klassövergripande anpassningar. Detta beroende på om anpassningen endast var till nytta för individen eller om hela klassen kunde dra nytta av anpassningen. Det uppmärksammades även att lärarnas attityder formas av deras olika infallsvinklar och upplevelser till arbetet med anpassningar för elever med diagnoser som ADHD. Några av slutsatserna som framkom i studien är bland annat att gymnasielärare har erfarenhet av attanvända sig av en rad olika anpassningar, både för specifika individer men även anpassningar som gynnar hela klassen. Lärarnas attityd till arbetet med anpassningar är både komplext och varierande i relation till deras upplevelser och infallsvinklar till anpassningar.

Diverse clinical presentation in neurodevelopmental disorders (NDDs) leads to difficulty in matching individuals with effective treatments. Autism spectrum disorders (ASD) and attention deficit hyperactivity disorder (ADHD) are the two most prevalent neurodevelopmental disorders (NDDs), characterized by deficits in communication, social interactions, and behaviours. There is high within-diagnosis heterogeneity and striking overlap between diagnoses. The literature suggests that current diagnostic criteria do not align well with behaviour metrics. Therefore, identifying novel biomarkers underlying behaviour in NDDs may provide a reliable way to group individuals with similar behavioural phenotypes. This thesis examines how gut-immune biology is linked to clinical heterogeneity in children with NDDs. The first study used unsupervised machine learning to cluster typically developing (TD), ADHD, and ASD participants by their behaviour metrics in a diagnosis-agnostic approach. The results produced a six-cluster solution, five of which were a mix of all diagnostic categories. Further, gastrointestinal (GI) symptoms were mapped to the clusters, revealing a link between constipation, social communication deficits and restrictive-repetitive behaviours. The second study used hierarchical clustering to group TD and NDD participants based on a profile of gut and inflammatory markers. Participants clustered into two biotypes, both containing TD and NDD participants. Additionally, using regression analysis, novel markers were linked to anxiety. The third study evaluated the multisite biospecimen collection protocol of the Province of Ontario Neurodevelopmental Disorders (POND) Network. The final study used biospecimens collected from the POND network to phenotype peripheral blood mononuclear cells in TD and NDD participants. In NDD groups, monocyte and B cell activation markers were differentially expressed compared to TD. Overall, this thesis demonstrates that gut-immune mechanisms contribute to clinical heterogeneity in a subset of people and contribute to the search for biomarkers in NDDs. / Thesis / Doctor of Philosophy (PhD) / Autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) are diagnosed based on behavioural symptoms. However, symptoms can vary a lot from person to person, and some symptoms are shared between ASD and ADHD. Understanding the biological reasons for symptom differences between people can help pinpoint treatments which work best for an individual. This thesis looks at the role of the gut and immune system in ASD and ADHD. Blood samples and behaviour questionnaires were collected to study how immune cells, inflammation, and intestinal permeability shape behaviour symptoms. The results show that diagnosis is not the most accurate way to group people. Anxiety symptoms were different when people were grouped based on their inflammation levels. Also, specific immune cells appear to work differently in people with ASD and ADHD. These findings clarify some of the biology that affects behavioural symptoms in ASD and ADHD.

Introduction: Patients with autism spectrum disorders (ASD) and attention-deficit/hyperactivity disorder (ADHD) show more symptoms of ADHD. Since there are more adverse events caused by psychostimulants compared to non-psychostimulants, the use of a non-psychostimulant such as atomoxetine might prove more beneficial for younger patients and/or those with comorbid ADHD. Objective: The aim of this thesis is to determine the efficacy and tolerability of atomoxetine in ASD patients presenting with ADHD, by examining (a) differences in ADHD symptoms for participants receiving atomoxetine versus those receiving placebos, and (b) risk differences in adverse events between these participants. Methods: An electronic search of both PubMed.gov and ClinicalTrials.gov were conducted. To be deemed eligible, studies had to (a) be randomized, double-blind, placebo-controlled trials comparing atomoxetine with a placebo, (b) administer atomoxetine for at least 1 week, and (c) include data on either ADHD outcomes or adverse events. Effect sizes for ADHD outcomes were calculated using Cohen's d, whereas risk differences were calculated for adverse events. For each of these two meta-analyses, effect sizes were aggregated across studies using a random effects method. Results: Overall ADHD outcomes were better for participants who received atomoxetine than for participants who received placebo, =0.297. Participants who received atomoxetine also demonstrated better outcomes in terms of attention and hyperactivity-impulsivity symptoms, =0.345 and 0.393, respectively. Though there were more adverse events for patients taking atomoxetine than placebo, the results were not statistically significant. Discussion: This thesis extends the findings of previous meta-analyses of pharmacological treatments for ASD and ADHD, while addressing the concerns raised in the critique of existing meta-analyses presented in this thesis, e.g., limited studies, length of treatment weeks, and dichotomization of data. It provides evidence that atomoxetine improves ADHD symptoms, with an overall frequency of adverse events that did not sufficiently differ from placebo beyond chance.

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Prevalence rates for males and females with ADHD range from 2:1 to 9:1 depending on ADHD subtype and setting (APA, 2000). The purpose of the current study was to empirically review articles published between 2001-2010 from discipline-representative (psychology, pediatrics, and interdisciplinary) high- impact journals (JACP, JCCP, Pediatrics) to identify potential differences in the sampling or procedures of ADHD studies involving females and males. Results indicate females and minorities were both well represented across the three discipline-representative journals. However, no meaningful data were provided on minority ADHD females (0.04% of the overall N = 107,144 ADHD participants included in 212 studies). Recommendations to researchers and editors include a) increasing inclusion of minority ADHD females, b) requesting better documentation of overall inclusionary/exclusionary criteria, and c) increasing attention to potential biases in sampling procedures, referral practices, and data presentation approaches that hinder development of the literature concerning ADHD in minority females.

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