Multi-stakeholder perspectives of palliative care needs in advanced COPD: a qualitative study.

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders in childhood, with an estimated worldwide prevalence of approximately 5%-7% [-]. It is characterized by developmentally inappropriate symptoms of inattention, hyperactivity, and impulsivity. Beyond these core behavioral symptoms, children with ADHD frequently present with impairments in executive functions and motor performance, which are associated with difficulties in academic achievement, daily functioning, and social adaptation [-]. Executive dysfunction, particularly in inhibitory control, working memory, and cognitive flexibility, is widely regarded as an important feature of ADHD and a relevant target for intervention [,]. The inattentive presentation of ADHD deserves particular attention because it is closely related to difficulties in sustained attention, task persistence, response monitoring, and goal-directed regulation []. These difficulties are often accompanied by weaknesses in executive control, which may contribute to symptom expression and functional difficulties in daily life []. Motor difficulties are also common in children with ADHD. Previous studies have shown that children with ADHD often perform more poorly than typically developing peers on measures of motor coordination, balance, manual dexterity, and fine motor skills [,-]. Fine motor deficits may be particularly relevant for children with predominantly inattentive symptoms because many everyday tasks require distal hand control, visual-motor coordination, sustained precision, and attention to task demands []. These motor problems are clinically meaningful because they may interfere with handwriting, classroom activities, tool use, self-care routines, and other daily functional activities []. Moreover, executive function difficulties have been linked to both academic writing skills and activities of daily living in children with ADHD, suggesting that cognitive and motor difficulties may jointly shape children’s real-life functioning [,,]. From an occupational performance perspective, fine motor difficulties should not be viewed only as isolated impairments in hand function. Rather, they may restrict children’s participation in meaningful everyday occupations, including schoolwork, play, self-care, and home routines [,]. Activities such as handwriting, drawing, cutting, manipulating small objects, using utensils, organizing learning materials, fastening buttons, and completing classroom tasks require coordinated fine motor control together with attention, inhibition, sequencing, and performance monitoring. Therefore, interventions targeting fine motor skills may have broader translational relevance when they are embedded in meaningful activity contexts and interpreted in relation to children’s functional engagement. This perspective is consistent with occupation-centered pediatric rehabilitation approaches, which emphasize activity performance, goal-directed practice, and transfer of learned skills to daily contexts [,].