Topic: Irritable Bowel Syndrome, Gut Health, Lifestyle, and Academic Factors as Predictors of Attention Deficit Hyperactivity Disorder (ADHD) Likelihood: A Cross-sectional Study

Background: Irritable Bowel Syndrome (IBS) and Attention Deficit Hyperactivity Disorder (ADHD) are prevalent chronic conditions, significantly impacting quality of life. Despite their co-occurrence, potential associations remain underinvestigated, particularly among university students and recent graduates in Pakistan. Understanding this comorbidity and finding other predictors in an underdeveloped country allows timely diagnosis, appropriate intervention, and improved health outcomes. Objectives: 1. To determine the association of ADHD likelihood with IBS. 2. To find the predictors of ADHD including gut health, lifestyle, and academic factors, among university students and graduates in Pakistan. Methods: This cross-sectional study included 163 participants aged 18–35 years, recruited through convenience sampling using an online questionnaire. IBS was assessed using Rome IV criteria, while ADHD symptoms were evaluated with Part A of the Adult ADHD Self-Report Scale (ASRS). Logistic regression was performed to identify associations and adjust for potential confounders using STATA and Python. Results: ADHD likelihood was found among 31.9% students, with protective factors including moderate physical activity (AOR: 0.18; 95% CI: 0.02–0.65, p=0.026) and enrollment in pharmaceutical fields compared to MBBS (AOR: 0.28; 95% CI: 0.10–0.91, p=0.035). No significant association was observed between IBS and ADHD (AOR: 1.08; 95% CI: 0.55–2.10, p=0.831). Strong predictors were light physical activity (1–3 days a week), experiencing pain related to defecation, having a sausage-shaped stool with cracks on the surface, daily caffeine intake and a moderate physical activity. These are divided into academic, lifestyle and gut health factors. Conclusions: This study highlights distinct predictors of ADHD likelihood among university students and graduates in Pakistan. No significant association was found between IBS and ADHD. ADHD likelihood was influenced by other lifestyle and academic variables such as physical activity and field of study. These findings emphasize the importance of addressing diverse academic, lifestyle, and gut-related factors when considering the ADHD management.