Automated sleep scoring in hibernating and non-hibernating American black bears.

In the United States (U.S.), approximately 11.3% of children have a parent-reported diagnosis of attention deficit hyperactivity disorder (ADHD) []. Medication treatment for ADHD has been widely studied, and robust evidence suggests it is safe and highly effective []. Despite the availability of effective treatment, children with ADHD face long-term challenges that negatively affect educational attainment [–], interpersonal relationships [–], and overall quality of life [,]. Stimulant medications are recommended as first-line treatment for individuals aged six years and older [], although they can be associated with adverse effects including appetite suppression, sleep disturbance, and cardiovascular changes []. Nonstimulant medications, while less commonly used, have also demonstrated efficacy and may be prescribed alone or in combination with stimulants [,]. Early and consistent treatment of ADHD is hypothesized to improve long-term outcomes by reducing negative experiences at home, at school, and with peers during childhood [–]. Consistent with this hypothesis, numerous studies have reported beneficial effects of medication on functional and health outcomes across childhood, adolescence, and adulthood [–]. However, by comparing “medication- naïve” individuals against those with “any history” of stimulant use, current literature overlooks diverse patterns of exposure over time, including age at initiation and consistency of use. Furthermore, the long-term effects of nonstimulant medications remain poorly understood. Evidence from neuroimaging studies also suggests that stimulant effects are age-dependent, with early-onset treatment potentially yielding neurobiological advantages [–]. Although trajectories of ADHD symptom severity during childhood have been described, symptom severity alone does not capture the influence of evolving environmental demands on children’s daily functioning or the cumulative effects of ongoing ADHD-related challenges on children’s self-concept over time [–]. Functional outcome trajectories remain relatively understudied, despite ADHD diagnosis requiring evidence that symptoms interfere with functioning in at least two settings (e.g., at home, at school, or among peers) []. Prior research has identified several areas of functional difficulties among children with ADHD, including family conflict [,,], stigmatization at school [], impaired academic achievement [,,], and impaired prosocial behavior [,,]. Impaired prosocial behavior, in particular, has been associated with peer relationship difficulties and reduced quality of life []. Often, ratings of functional outcomes are provided by parents without taking into account the child’s perspective [,], and are not likely to reflect child functioning outside the home []. Additionally, children desire an increasing level of involvement in the management of their care as they progress into adolescence [], and child-reported experiences provide valuable insight into the challenges they face [,–].