"Evil is Real and Attitude is Everything": Applying Shattered Assumptions Theory to Worldview Changes Following Wrongful Conviction.

Attention deficit/hyperactivity disorder (ADHD), a chronic neurodevelopmental disorder, is characterized by persistent inattention, hyperactivity, and impulsivity []. Currently, the pathogenesis of ADHD remains poorly understood. It is worth noting that deficits in executive function are considered one of the core features of ADHD and can be observed across patients of all age groups [–]. Therefore, it is essential to conduct a comprehensive evaluation of executive function in patients with ADHD and to investigate potential neuroimaging markers associated with these cognitive impairments. An increasing body of evidence has revealed the connection between sleep, ADHD, and executive function [–]. One of the key mechanisms may involve the promoting effects of sleep on the function of the Glymphatic System. This system mediates the exchange of cerebrospinal fluid and interstitial fluid through perivascular pathways and is a core mechanism for removing metabolic waste from the brain [–]. The diffusion tensor image-analysis along the perivascular space (DTI-ALPS) method provides an indirect and non-invasive means of evaluating the activity of the glymphatic system in individuals []. The functional clearance efficiency of the glymphatic system highly depends on the normal operation of Neurovascular Coupling (NVC). NVC refers to the precisely matched functional and spatial relationship between neural activity and changes in local Cerebral Blood Flow (CBF), and this coupling mechanism is key to maintaining homeostasis in the brain [, ]. On the one hand, neural activity triggers an increase in local CBF, providing sufficient oxygen and energy substrates for active brain regions; on the other hand, the increase in blood flow also drives the flow of cerebrospinal fluid/interstitial fluid, accelerating the clearance of metabolic waste by the glymphatic system []. Therefore, any abnormality in NVC function may directly or indirectly impair the clearance efficiency of the glymphatic system. Previous studies have successfully evaluated the status and abnormalities of NVC in healthy individuals [] and in diseases such as hypertension, schizophrenia [], and Alzheimer’s disease [, ] by using resting-state functional magnetic resonance imaging (rs-fMRI) combined with three-dimensional pseudo-continuous arterial spin labeling (3D-pCASL) technology []. However, the functional status and integrity of NVC in patients with ADHD have not been systematically studied. Moreover, the potential role of the glymphatic system, which is critical for clearing metabolic waste and is closely linked to NVC function, has never been examined in ADHD. Thus, the present study addresses this gap by simultaneously investigating NVC and glymphatic function in the same ADHD cohort. Accordingly, the primary research question of this study is: whether children with ADHD show altered NVC and glymphatic function compared to typically developing controls. The secondary research question is: whether NVC is associated with glymphatic function and core ADHD symptoms.