Discussion
Anxiety, anxiety, Lactobacillus acidophilus, acidophilus, deficit in the cognitive function, ADHD, depression
CORTEX, SECONDARY, PATHOPHYSIOLOGY
As knowledge of the GBA has risen with emerging research highlighting this bidirectional relationship with a theoretical translation of animal models to human analyses, the core mechanism and which probiotics have a promising or negative result remain ambiguous. To the best of our knowledge, this study is the first randomized controlled trial to use a Twelve-week supplementation with L. acidophilus LB combined with a weight-dependent dose of atomoxetine could improve the symptoms and behavioral problems of ADHD, according to the parental reports of the CPRS-R-L and CBCL, respectively, relative to the control group.Our findings support the results of a recent trial by Ghanaatgar et al. [Another study investigated the effects of probiotics on the psychological health of children with ADHD. The study found that probiotic treatment for 8 weeks, using four bacterial strains, including Lactobacillus acidophilus, significantly improved the severity of ADHD symptoms and anxiety compared to a placebo. The improvement was measured using the ADHD and Hamilton Anxiety Rating scales. However, probiotics did not have an impact on depression. [Contradictory to our findings, Kumperscak et al. [Available reviewing research has broadened our understanding of the link between probiotic supplementation and its impact on ADHD clinical symptoms. However, their findings remain inconclusive to formulate any clinical recommendation or approaches. As the underlying etiopathogenesis of ADHD is still unclear, investigating the role of the complex messaging system between the microbiota, gut, and brain has drawn much attention [Considering that the GBA hypothesis has been linked to the pathophysiological pathways underlying ADHD [Regarding the secondary outcomes under study, our current analysis found that the probiotic group revealed improvement in the target accuracy rate and omission errors compared with the control group (medium effect size), suggesting that Mounting evidence suggests that the cholinergic and dopaminergic systems contribute to the pathophysiology of selective attention [Our results showed improvement in the executive functions in the probiotic group reflected in both perseverative and non-perseverative errors on WCST performance (small-medium effect size); however, this did not reach a significant level of differences between the two groups.Impairments in executive functions (i.e., cognitive flexibility, working memory, sustained attention, inhibitory control, and planning) are considered a core deficit in the cognitive function of ADHD, which may play a crucial role in the challenging adaptation of ADHD [The cognitive regulation of behavior and reward perception is modulated via the norepinephrine and dopamine circuits, which connect to the prefrontal cortex and striatum, and these pathways are considered fundamental in the pathophysiology of ADHD [Until now, limited randomized trials have investigated the impact of probiotic supplementation on cognitive performance [The linkage between ADHD and the microbiota can be understood in terms of how neurotransmitters function in cognition. A recent study has provided insights into the GBA and introduced a new strain that improves cognitive function through this axis. Using healthy mice, Jeon et al. [In the present study, most participants were males. The finding aligns with previous studies indicating that ADHD is more common in boys [