Prediction of ADHD in Children Using Pedobarographic and Postural Data

Diagnostic accuracy (sensitivity, specificity, overall accuracy, AUC) of a machine learning model developed using postural, balance, pedobarographic, and anthropometric parameters will be evaluated in distinguishing ADHD and control children.

Postural alignment will be assessed using the Mobile Posture App in four views (frontal, sagittal-right, sagittal-left, and posterior). The application provides angular deviations in degrees (°) for multiple anatomical landmarks, including:

Frontal view: ears, shoulders, hips, and trunk inclination (tilt from vertical midline).

Sagittal views (right and left): trunk inclination (forward/backward tilt relative to vertical).

Posterior view: ears, shoulders, hips, and trunk inclination (tilt from vertical midline).

Higher values indicate greater postural deviation or asymmetry, while lower values indicate closer alignment to neutral posture.

Postural alignment will be evaluated with the New York Posture Rating Test. The test yields a total score from 13 to 65 based on visual ratings of multiple body segments in standing posture. Higher scores indicate better postural alignment; lower scores indicate poorer posture.

Plantar pressure distribution will be assessed using the Metisens Static Pedobarography system. The outcome is expressed as % of total load distributed across left vs right foot and forefoot, midfoot, hindfoot regions. Higher asymmetry indicates poorer postural control.

Foot posture will be assessed using the Foot Posture Index (FPI-6), which evaluates six criteria including talar head palpation, supra/inframalleolar curvature, calcaneal frontal plane position, talonavicular bulging, medial arch height, and forefoot abduction/adduction. Each item is scored on a 5-point scale (-2 to +2), yielding a total score from -12 to +12.

Higher positive scores indicate increased pronation.

Negative scores indicate supination.

Scores around 0 indicate neutral foot posture.

Sway path length of the Center of Pressure (COP) will be measured using the Metisens Stabilometry system during 20-second quiet stance. Greater path length indicates poorer postural stability.

Number of COP oscillations will be recorded using the Metisens Stabilometry system during quiet stance. Higher values indicate reduced stability.

APSI will be calculated using the Metisens Stabilometry system, reflecting variability of COP in the anteroposterior direction. Higher values indicate poorer stability.

MLSI will be calculated using the Metisens Stabilometry system, reflecting variability of COP in the mediolateral direction. Higher values indicate poorer stability.

Overall Stability Index (SI) will be calculated using the Metisens Stabilometry system, combining both AP and ML variability. Higher values indicate poorer overall balance.

Dynamic balance will be assessed using the Y-Balance Test. Participants will perform reach trials in the anterior, posteromedial, and posterolateral directions for both right and left legs. Each direction will be tested three times, and the mean reach distance (cm) of the three trials will be recorded for each leg and direction. Longer reach distances indicate better dynamic balance.

Static balance will be assessed using the Flamingo Balance Test, validated for use in children. Participants will perform the test on both the right and left legs. Each trial lasts 30 seconds, and the number of balance errors (e.g., touching the floor, losing balance) will be recorded. The test will be performed three times per leg, and the mean error count will be calculated. Higher number of errors indicates poorer static balance.

Physical activity levels will be assessed using the International Physical Activity Questionnaire - Short Form (IPAQ-SF). The questionnaire records the frequency (days per week) and duration (minutes per day) of walking, moderate-intensity, and vigorous-intensity physical activity, as well as sedentary time, during the last 7 days. Data are converted into MET-minutes/week scores using standardized coefficients (walking: 3.3 METs, moderate: 4.0 METs, vigorous: 8.0 METs, sitting: 1.5 METs).

Higher total MET-min/week indicates higher physical activity level.

Participants are categorized as Inactive (Category 1), Minimally Active (Category 2), or Highly Active (Category 3) based on scoring guidelines.

Measured using the DSM-IV-Based Assessment and Screening Scale for Behavioral Disorders in Children and Adolescents (Atilla Turgay), completed by both parents and teachers.