In a randomized case–control trial with 10-years olds suffering from attention deficit/hyperactivity disorder (ADHD) sleep and psychological functioning improved during a 12-week sleep-training program Functional magnetic resonance imaging of methylphenidate and placebo in attention-deficit/hyperactivity disorder during the multi-source interference task. Effects of methylphenidate on working memory functioning in children with attention deficit/hyperactivity disorder. Transcranial Oscillatory Direct Current Stimulation During Sleep Improves Declarative Memory Consolidation in Children With Attention-deficit/hyperactivity Disorder to a Level Comparable to Healthy Controls Methylphenidate normalises activation and functional connectivity deficits in attention and motivation networks in medication-naïve children with ADHD during a rewarded continuous performance task Slow oscillating transcranial direct current stimulation during non-rapid eye movement sleep improves behavioral inhibition in attention-deficit/hyperactivity disorder Acute impact of immediate release methylphenidate administered three times a day on sleep in children with attention-deficit/hyperactivity disorder. Methylphenidate Normalizes Resting-State Brain Dysfunction in Boys With Attention Deficit Hyperactivity Disorder The effects of L-theanine (Suntheanine®) on objective sleep quality in boys with attention deficit hyperactivity disorder (ADHD): a randomized, double-blind, placebo-controlled clinical trial. The effects of methylphenidate on neural systems of attention in attention deficit hyperactivity disorder. Automated diagnoses of attention deficit hyperactive disorder using magnetic resonance imaging Enhanced emotional reactivity after selective REM sleep deprivation in humans: an fMRI study Sleep and neurobehavioral characteristics of 5- to 7-year-old children with parentally reported symptoms of attention-deficit/hyperactivity disorder. Better Nights/Better Days-Distance Intervention for Insomnia in School-Aged Children With/Without ADHD: A Randomized Controlled Trial. Sleep problems predict comorbid externalizing behaviors and depression in young adolescents with attention-deficit/hyperactivity disorder Impulsiveness as a timing disturbance: neurocognitive abnormalities in attention-deficit hyperactivity disorder during temporal processes and normalization with methylphenidate Reduced Symptoms of Inattention after Dietary Omega-3 Fatty Acid Supplementation in Boys with and without Attention Deficit/Hyperactivity Disorder The effectiveness of methylphenidate in the management of Attention Deficit Hyperactivity Disorder (ADHD) in people with intellectual disabilities: A systematic review. Shared and Drug-Specific Effects of Atomoxetine and Methylphenidate on Inhibitory Brain Dysfunction in Medication-Naive ADHD Boys Real‐time fMRI neurofeedback in adolescents with attention deficit hyperactivity disorder Effect of stimulant medication on driving performance of young adults with attention-deficit hyperactivity disorder: a preliminary double-blind placebo controlled trial. Misinterpreting Emotional Expressions in Attention-Deficit/Hyperactivity Disorder: Evidence for a Neural Marker and Stimulant Effects fMRI Neurofeedback Training for Increasing Anterior Cingulate Cortex Activation in Adult Attention Deficit Hyperactivity Disorder. An Exploratory Randomized, Single-Blinded Study
Abstract Objectives . We tested the hypothesis that sleep training would improve emotional , social and behavioural functioning in children with attention-deficit/hyperactivity disorder ( ADHD ) compared to children with ADHD without such intervention and to healthy controls . Methods . Forty children with ADHD were r and omly assigned to intervention and control conditions . Parents of 20 children with ADHD were instructed and thoroughly supervised in improving their children 's sleep schedules and sleep behaviour .  Parents of the other 20 children with ADHD and parents of 20 healthy children  received general information about sleep hygiene . At baseline and 12 weeks later , parents and children completed question naires related to children 's sleep and psychological functioning . Results . Relative to the control groups , children in the intervention group improved sleep quantitatively and qualitatively ( F values < 3.33 , P values < 0.05 ) . The intervention group children reported improvements in mood , emotions , and relationships ( F values < 2.99 , P values < 0.05 ) . Parents reported that their children improved in physical and psychological wellbeing , mood , emotions , relationships , and social acceptance ( F values < 3.02 , P values < 0.05 ) . Conclusions . Training and monitoring parents of children with ADHD in regulating and supervising children 's sleep schedules leads to positive changes in the emotions , behaviour and social lives of these children CONTEXT Previous studies have reported hypofunction , structural abnormalities , and biochemical abnormalities of the dorsal anterior midcingulate cortex ( daMCC ) in attention-deficit/hyperactivity disorder ( ADHD ) . Stimulant medications are effective treatments for ADHD , but their neural effects have not been fully characterized . OBJECTIVE To determine whether the methylpheni date hydrochloride osmotic-release oral system ( OROS ) would increase functional magnetic resonance imaging ( fMRI ) activation , compared with placebo , in the daMCC and other frontoparietal regions subserving attention during the Multi- Source Interference Task ( MSIT ) . DESIGN R and omized , placebo-controlled , 6-week , before-after fMRI study . SETTING Academic medical center ambulatory clinic . PATIENTS Twenty-one adults with ADHD r and omized to 6 weeks of treatment with methylpheni date OROS ( n = 11 ) or placebo ( n = 10 ) . INTERVENTIONS Patients underwent fMRI twice while performing the MSIT ( scan 1 at baseline and scan 2 at 6 weeks ) . MAIN OUTCOME MEASURES Group-averaged , r and om-effects , repeated- measures , general linear model analyses were used to compare daMCC ( and whole-brain ) fMRI activation during the MSIT . Individual-based daMCC volume-of-interest confirmatory analyses and behavioral data are also presented . RESULTS Performance and baseline fMRI measures in the daMCC and other a priori brain regions did not differ between groups . Group comparisons showed a group x scan interaction and t test confirmation of higher activation in the daMCC at 6 weeks in the methylpheni date OROS group than in the placebo group ( P < 1 x 10(-4 ) , cluster corrected for multiple comparisons ) . Individual daMCC volume-of-interest analyses confirmed group-averaged findings and suggested that daMCC activity might be related to clinical response . Methylpheni date OROS also produced higher activation in the dorsolateral prefrontal cortex and the parietal cortex at 6 weeks . CONCLUSION Methylpheni date OROS increased daMCC activation during the MSIT and may act , in part , by normalizing daMCC hypofunction in ADHD BACKGROUND AND AIMS Children with attention deficit/hyperactivity disorder ( ADHD ) often show deficits in working memory performance .  Methylpheni date ( MPH ) is an effective medication to improve these cognitive difficulties . This study aim ed to clarify which effect MPH induces on the underlying functional networks of working memory . METHODS Fourteen boys diagnosed with ADHD and 12 healthy controls were investigated using functional magnetic resonance imaging ( fMRI ) . Each patient was tested twice , once with medication and once without . The fMRI experiments consisted of three verbal N-back tasks with increasing difficulty . Functional images were acquired on a 3 Tesla head scanner . RESULTS On the behavioral level , medicated patients performed similar to healthy controls and significantly better than without medication . On the functional level , patients showed the expected frontal and parietal activations , which were more pronounced in the 2- and 3-back tasks . Healthy controls showed significantly more activation in these regions and additional activation in the cerebellum . Interestingly , patients showed an additional effect of laterality . Left-sided frontal and parietal activation in patients was significantly less pronounced than in controls . CONCLUSION Functional data indicate different activation patterns in verbal working memory tasks between healthy controls and patients with ADHD irrespective of medication condition . Intake of MPH led to a clear improvement on a behavioral level . However , this effect was not reflected by changes in functional brain organization . MPH-induced changes leading to better performance in verbal working memory tasks might be very subtle and therefore not detectable by fMRI BACKGROUND Slow oscillations ( < 1 Hz ) during slow wave sleep ( SWS ) promote the consolidation of declarative memory .  Children with attention-deficit/hyperactivity disorder ( ADHD ) have been shown to display deficits in sleep-dependent consolidation of declarative memory supposedly due to dysfunctional slow brain rhythms during SWS . OBJECTIVE Using transcranial oscillating direct current stimulation ( toDCS ) at 0.75 Hz , we investigated whether an externally triggered increase in slow oscillations during early SWS elevates memory performance in children with ADHD . METHODS 12 children with ADHD underwent a toDCS and a sham condition in a double-blind crossover study design conducted in a sleep laboratory . Memory was tested using a 2D object-location task . In addition , 12 healthy children performed the same memory task in their home environment . RESULTS Stimulation enhanced slow oscillation power in children with ADHD and boosted memory performance to the same level as in healthy children . CONCLUSION These data indicate that increasing slow oscillation power during sleep by toDCS can alleviate declarative memory deficits in children with ADHD BACKGROUND Children with Attention Deficit Hyperactivity Disorder ( ADHD ) have deficits in motivation and attention that can be ameliorated with the indirect dopamine agonist Methylpheni date ( MPH ) . We used functional magnetic resonance imaging ( fMRI ) to investigate the effects of MPH in medication-naïve children with ADHD on the activation and functional connectivity of " cool " attentional as well as " hot " motivation networks . METHODS 13 medication-naïve children with ADHD were scanned twice , under either an acute clinical dose of MPH or Placebo , in a r and omised , double-blind design , while they performed a rewarded continuous performance task that measured vigilant selective attention and the effects of reward . Brain activation and functional connectivity was compared to that of 13 healthy age-matched controls to test for normalisation effects of MPH . RESULTS MPH normalised performance deficits that were observed in children with ADHD compared to controls . Under placebo , children with ADHD showed reduced activation and functional inter-connectivity in bilateral fronto-striato-parieto-cerebellar networks during the attention condition , but enhanced activation in the orbitofrontal and superior temporal cortices for reward . MPH within children with ADHD enhanced the activation of fronto-striato-cerebellar and parieto-temporal regions . Compared to controls , MPH normalised differences during vigilant attention in parieto-temporal activation and fronto-striatal and fronto-cerebellar connectivity ;  MPH also normalised the enhanced orbitofrontal activation in children with ADHD in response to reward . CONCLUSIONS MPH normalised attention differences between children with ADHD and controls by both up-regulation of dysfunctional fronto-striato-thalamo-cerebellar and parieto-temporal attention networks and down-regulation of hyper-sensitive orbitofrontal activation for reward processing . MPH thus shows context -dependent dissociative modulation of both motivational and attentional neuro-functional networks in children with ADHD Background : Behavioral inhibition , which is a later-developing executive function ( EF ) and anatomically located in prefrontal areas , is impaired in attention-deficit and hyperactivity disorder ( ADHD ) . While optimal EFs have been shown to depend on efficient sleep in healthy subjects , the impact of sleep problems , frequently reported in ADHD , remains elusive . Findings of macroscopic sleep changes in ADHD are inconsistent , but there is emerging evidence for distinct microscopic changes with a focus on prefrontal cortical regions and non-rapid eye movement ( non-REM ) slow-wave sleep . Recently , slow oscillations ( SO ) during non-REM sleep were found to be less functional and , as such , may be involved in sleep-dependent memory impairments in ADHD . Objective : By augmenting slow-wave power through bilateral , slow oscillating transcranial direct current stimulation ( so-tDCS , frequency = 0.75 Hz ) during non-REM sleep , we aim ed to improve daytime behavioral inhibition in children with ADHD . Methods : Fourteen boys ( 10–14 years ) diagnosed with ADHD were included . In a r and omized , double-blind , cross-over design , patients received so-tDCS either in the first or in the second experimental sleep night . Inhibition control was assessed with a visuomotor go/no-go task .  Intrinsic alertness was assessed with a simple stimulus response task . To control for visuomotor performance , motor memory was assessed with a finger sequence tapping task . Results : SO-power was enhanced during early non-REM sleep , accompanied by slowed reaction times and decreased st and ard deviations of reaction times , in the go/no-go task after so-tDCS . In contrast , intrinsic alertness , and motor memory performance were not improved by so-tDCS . Conclusion : Since behavioral inhibition but not intrinsic alertness or motor memory was improved by so-tDCS , our results suggest that lateral prefrontal slow oscillations during sleep might play a specific role for executive functioning in ADHD OBJECTIVE To determine the impact of immediate release Ritalin , given three times a day , on sleep quality and quantity in medication-naïve , newly diagnosed children with attention-deficit/hyperactivity disorder ( ADHD ) . METHODS Children ( aged 6 - 12 ) rigorously diagnosed with ADHD ( n = 21 ) underwent multiple measurement assessment s ( i.e. , actigraphy , sleep diary , and question naires ) during a 1-week baseline and then during a 3-week blinded r and omized medication trial . RESULTS Although the medication was effective in reducing ADHD symptoms , analyses of actigraphy and sleep diary data found statistically and clinical ly significant changes in the children 's total sleep time and sleep onset latency in the medication compared to the no medication conditions . No effects on sleep were found based on the sleep question naire . CONCLUSIONS Physicians and parents are encouraged to closely monitor children 's sleep when treating ADHD with stimulant medication We used resting-state functional magnetic resonance imaging ( RS-fMRI ) to investigate the acute effects of methylpheni date hydrochloride ( MPH ) on spontaneous brain activity in children with attention deficit hyperactivity disorder ( ADHD ) . In all , 23 boys with ADHD were scanned twice , under either 10 mg dose of MPH or placebo , in a r and omized , cross-over , counterbalanced placebo-controlled design . 32 Matched healthy controls were scanned once for comparison . Seven of the 23 ADHD boys participated in a follow-up 8-week MPH treatment . A regional homogeneity ( ReHo ) method was applied to characterize the local synchronization of spontaneous brain activity .  ADHD boys under placebo compared with controls showed decreased ReHo in bilateral dorsolateral prefrontal cortices and increased ReHo in bilateral sensorimotor and parieto-visual cortices . Relative to placebo , MPH upregulated ReHo in bilateral ventral prefrontal cortices and cerebellar vermis , and downregulated ReHo in right parietal and visual areas that overlapped with the abnormally enhanced activities . When under MPH , ReHo differences between patients and controls were no longer observed . The preliminary prediction analysis revealed that the decreased ReHo in right parietal cortex after the acute MPH was positively correlated with the decreased symptom scores after the 8-week MPH treatment in the seven patients . We show that an acute dose of MPH normalized all fronto-parieto-cerebellar dysfunctions in boys with ADHD during the resting state . Preliminary findings furthermore suggest the potential of RS-fMRI as a prognostic imaging tool to identify response to MPH treatment INTRODUCTION The purpose of this study was to investigate the efficacy and safety of L-theanine as an aid to the improvement of objective ly measured sleep quality in a population of 98 male children formally diagnosed with attention-deficit/hyperactivity disorder ( ADHD ) . METHODS A r and omized , double-blind , placebo-controlled trial was conducted involving boys , ages 8 - 12 years , who had been previously diagnosed with ADHD . An experienced physician confirmed the diagnosis of ADHD in each subject . R and omization was stratified based upon current use of stimulant medication to ensure an equal distribution of stimulant/non-stimulant treated subjects into active and placebo treated groups . Participants consumed two chewable tablets twice daily ( at breakfast and after school ) , with each tablet containing 100 mg of L-theanine ( total 400 mg daily Suntheanine ® , Taiyo Kagaku , Yokkaichi , Japan ) or identical tasting chewable placebo for six weeks . Subjects were evaluated for five consecutive nights using wrist actigraphy at baseline , and again at the end of the six-week treatment period . The Pediatric Sleep Question naire ( PSQ ) was completed by parents at baseline and at the end of the treatment period . RESULTS Actigraph watch data findings indicated that boys who consumed L-theanine obtained significantly higher sleep percentage and sleep efficiency scores , along with a non-significant trend for less activity during sleep ( defined as less time awake after sleep onset ) compared to those in the placebo group . Sleep latency and other sleep parameters were unchanged . The PSQ data did not correlate significantly to the objective data gathered from actigraphy , suggesting that parents were not particularly aware of their children 's sleep quality . L-theanine at relatively high doses was well tolerated with no significant adverse events . CONCLUSIONS This study demonstrates that 400 mg daily of L-theanine is safe and effective in improving some aspects of sleep quality in boys diagnosed with ADHD . Since sleep problems are a common co-morbidity associated with ADHD , and because disturbed sleep may be linked etiologically to this disorder , L-theanine may represent a safe and important adjunctive therapy in childhood ADHD . Larger , long-term studies looking at the wider therapeutic role of this agent in this population are warranted OBJECTIVE Recent studies have suggested that attention deficit hyperactivity disorder ( ADHD ) is associated with abnormalities in basal ganglia and prefrontal cortical functioning . However , these studies have primarily relied upon cognitive tasks that reflect impulse control rather than attentional mechanisms . METHOD The authors used functional magnetic resonance imaging to investigate the neural correlates of selective and divided attention in a r and omized , double-blind , placebo-controlled pharmacological challenge with methylpheni date in 15 adolescents with ADHD ( ages 14 - 17 ) , eight adolescents with reading disorder ( ages 12 - 17 ) , and four adolescents with both reading disorder and ADHD ( ages 14 - 18 ) who were scanned during both a methylpheni date and a placebo session . Fourteen healthy comparison subjects ( ages 12 - 20 ) who were not given methylpheni date served as the primary comparison group . RESULTS During the divided attention task , unmedicated subjects with ADHD or reading disorder  recruited the left ventral basal ganglia significantly less than the healthy comparison subjects . Methylpheni date led to an increase in activation in this region but had no effect on task performance .  Subjects with ADHD also recruited the middle temporal gyrus significantly less than the comparison subjects , but methylpheni date did not have a direct effect on activation in this region . CONCLUSIONS These results suggest that ADHD is associated with abnormal processing in attentional networks , with specific dysfunction in striatal circuitry . Methylpheni date may act to normalize activity within this network Successful automated diagnoses of attention deficit hyperactive disorder ( ADHD ) using imaging and functional biomarkers would have fundamental consequences on the public health impact of the disease . In this work , we show results on the predictability of ADHD using imaging biomarkers and discuss the scientific and diagnostic impacts of the research . We created a prediction model using the l and mark ADHD 200 data set focusing on resting state functional connectivity ( rs-fc ) and structural brain imaging . We predicted ADHD status and subtype , obtained by behavioral examination , using imaging data , intelligence quotients and other covariates . The novel contributions of this manuscript include a thorough exploration of prediction and image feature extraction methodology on this form of data , including the use of singular value decompositions ( SVDs ) , CUR decompositions , r and om forest , gradient boosting , bagging , voxel-based morphometry , and support vector machines as well as important insights into the value , and potentially lack thereof , of imaging biomarkers of disease . The key results include the CUR-based decomposition of the rs-fc-fMRI along with gradient boosting and the prediction algorithm based on a motor network parcellation and r and om forest algorithm . We conjecture that the CUR decomposition is largely diagnosing common population directions of head motion . Of note , a byproduct of this research is a potential automated method for detecting subtle in-scanner motion . The final prediction algorithm , a weighted combination of several algorithms , had an external test set specificity of 94 % with sensitivity of 21 % . The most promising imaging biomarker was a correlation graph from a motor network parcellation . In summary , we have undertaken a large-scale statistical exploratory prediction exercise on the unique ADHD 200 data set . The exercise produced several potential leads for future scientific exploration of the neurological basis of ADHD Converging evidence from animal and human studies suggest that rapid eye movement ( REM ) sleep modulates emotional processing . The aim of the present study was to explore the effects of selective REM sleep deprivation ( REM-D ) on emotional responses to threatening visual stimuli and their brain correlates using functional magnetic resonance imaging ( fMRI ) . Twenty healthy subjects were r and omly assigned to two groups : selective REM-D , by awakening them at each REM sleep onset , or non-rapid eye movement sleep interruptions ( NREM-I ) as control for potential non-specific effects of awakenings and lack of sleep . In a within-subject design , a visual emotional reactivity task was performed in the scanner before and 24 h after sleep manipulation . Behaviorally , emotional reactivity was enhanced relative to baseline ( BL ) in the REM deprived group only . In terms of fMRI signal , there was , as expected , an overall decrease in activity in the NREM-I group when subjects performed the task the second time , particularly in regions involved in emotional processing , such as occipital and temporal areas , as well as in the ventrolateral prefrontal cortex , involved in top-down emotion regulation . In contrast , activity in these areas remained the same level or even increased in the REM-D group , compared to their BL level . Taken together , these results suggest that lack of REM sleep in humans is associated with enhanced emotional reactivity , both at behavioral and neural levels , and thus highlight the specific role of REM sleep in regulating the neural substrates for emotional responsiveness OBJECTIVES This study examined the hypothesis that domains of neurobehavioral function would be selectively affected by sleep-disordered breathing ( SDB ) . Therefore , we assessed potential relationships between objective ly measured sleep disturbances and neurobehavioral function in children with reported symptoms of attention-deficit/hyperactivity disorder ( ADHD ) and also determined the incidence of snoring and other sleep problems in 5- to 7-year-old children in the local community and potential relationships to parental snoring and passive smoking . METHODS Parents of 5- to 7-year-old children in public schools were surveyed about their child 's sleeping habits using a vali date d question naire . The question naire also asked whether they believed their child to be hyperactive or have ADHD . Children with reported symptoms of ADHD and control children were r and omly selected and invited to the Sleep Medicine Center for an overnight polysomnographic assessment and a battery of neurocognitive tests . RESULTS The question naire response rate was 47.6 % ( n = 5728 ) . Frequent and loud snoring was reported for 673 children ( 11.7 % ) . Similarly , 418 ( 7.3 % ) children were reported to have hyperactivity/ADHD , 313 ( 76.5 % ) of which were boys . Eighty-three children with parentally reported symptoms of ADHD were invited for full evaluation at the Sleep Medicine Center together with 34 control children . After assessment with the Conners ' Parent Rating Scale , 44 children were design ated as having " significant " symptoms of ADHD , 27 as " mild , " and 39 design ated as " none " ( controls ) . Overnight polysomnography indicated that obstructive sleep apnea was present in 5 % of those with significant ADHD symptoms , 26 % of those with mild symptoms , and 5 % of those with no symptoms . In the cohort , no sleep variable accounted for more than a negligible proportion of the variance in domains of neurobehavioral function . CONCLUSIONS An unusually high prevalence of snoring was identified among a group of children design ated as showing mild symptoms of ADHD based on the Conners ' ADHD index identified from a community sample . However , whereas SDB is not more likely to occur among children with significant ADHD symptoms , it is significantly highly prevalent among children with mild hyperactive behaviors . Sleep studies further revealed that rapid eye movement disturbances are more likely to occur in children with significant symptoms , and they seem to impose significant but mild effects on daytime neurobehavioral functioning . We conclude that in children with significant symptoms of ADHD , the prevalence of SDB is not different from that of the general pediatric population and that rapid eye movement sleep in these children is disturbed and may contribute to the severity of their behavioral manifestations . Furthermore , SDB can lead to mild ADHD-like behaviors that can be readily misperceived and potentially delay the diagnosis and appropriate treatment OBJECTIVE Better Nights/Better Days , a distance intervention for  insomnia in school-aged children ( with and without attention-deficit/hyperactivity disorder [ ADHD ] ) , was evaluated to determine its effectiveness on  children 's sleep and psychosocial functioning . METHODS A single center , parallel group design r and omized controlled trial ( stratified on ADHD diagnosis ) was conducted . Parents were r and omized to intervention ( n = 31 ) or waitlist control ( n = 30 ) , and completed question naires administered over the phone at baseline , postintervention ( 2 months ) , and follow-up ( 6 months ) . Actigraphy was also collected . The intervention consisted of a five-session manual and weekly telephone coach support . RESULTS The intervention group demonstrated a significant reduction in sleep problems and improved psychosocial functioning at postintervention and follow-up . Actigraphy results indicated improved sleep onset , but not sleep duration .  Children with and without ADHD responded in a similar manner to this intervention . Parents provided high satisfaction ratings . CONCLUSIONS This intervention holds promise as an accessible , sustainable , and effective program to address insomnia in school-aged children Children and adolescents with attention-deficit/hyperactivity disorder ( ADHD ) experience high rates of sleep problems and are also at increased risk for experiencing comorbid mental health problems . This study provides an initial examination of the 1-year prospect i ve association between sleep problems and comorbid symptoms in youth diagnosed with ADHD . Participants were 81 young adolescents ( 75 % male ) carefully diagnosed with ADHD and their parents . Parents completed measures of their child ’s sleep problems and ADHD symptoms , oppositional defiant disorder ( ODD ) symptoms ,  and general externalizing behavior problems  at baseline ( Mage = 12.2 ) and  externalizing behaviors were assessed again 1 year later . Adolescents completed measures of anxiety and depression at both time-points . Medication use was not associated with sleep problems or comorbid psychopathology symptoms . Regression analyses indicated that , above and beyond demographic characteristics , ADHD symptom severity , and initial levels of comorbidity , sleep problems significantly predicted greater ODD symptoms , general externalizing behavior problems , and depressive symptoms 1 year later . Sleep problems were not concurrently or prospect ively associated with anxiety . Although this study precludes making causal inferences , it does nonetheless provide initial evidence of sleep problems predicting later comorbid externalizing behaviors and depression symptoms in youth with ADHD . Additional research is needed with larger sample s and multiple time-points to further examine the interrelations of sleep problems and comorbidity We argue that impulsiveness is characterized by compromised timing functions such as premature motor timing , decreased tolerance to delays , poor temporal foresight and steeper temporal discounting . A model illustration for the association between impulsiveness and timing deficits is the impulsiveness disorder of attention-deficit hyperactivity disorder ( ADHD ) . Children with ADHD have deficits in timing processes of several temporal domains and the neural substrates of these compromised timing functions are strikingly similar to the neuropathology of ADHD . We review our published and present novel functional magnetic resonance imaging data to demonstrate that ADHD children show dysfunctions in key timing regions of prefrontal , cingulate , striatal and cerebellar location during temporal processes of several time domains including time discrimination of milliseconds , motor timing to seconds and temporal discounting of longer time intervals . Given that impulsiveness , timing abnormalities and more specifically ADHD have been related to dopamine dysregulation , we tested for and demonstrated a normalization effect of all brain dysfunctions in ADHD children during time discrimination with the dopamine agonist and treatment of choice , methylpheni date . This review together with the new empirical findings demonstrates that neurocognitive dysfunctions in temporal processes are crucial to the impulsiveness disorder of ADHD and provides first evidence for normalization with a dopamine reuptake inhibitor Attention deficit/hyperactivity disorder ( ADHD ) is one of the most common child psychiatric disorders , and is often treated with stimulant medication . Nonpharmacological treatments include dietary supplementation with omega-3 fatty acids , although their effectiveness remains to be shown conclusively . In this study , we investigated the effects of dietary omega-3 fatty acid supplementation on ADHD symptoms and cognitive control in young boys with and without ADHD . A total of 40 boys with ADHD , aged 8–14 years , and 39 matched , typically developing controls participated in a 16-week double-blind r and omized placebo-controlled trial . Participants consumed 10 g of margarine daily , enriched with either 650 mg of eicosapentaenoic acid (EPA)/docosahexaenoic acid ( DHA ) each or placebo . Baseline and follow-up assessment s addressed ADHD symptoms , fMRI of cognitive control , urine homovanillic acid , and cheek cell phospholipid sampling . EPA/DHA supplementation improved parent-rated attention in both children with ADHD and typically developing children . Phospholipid DHA level at follow-up was higher for children receiving EPA/DHA supplements than placebo . There was no effect of EPA/DHA supplementation on cognitive control or on fMRI measures of brain activity . This study shows that dietary supplementation with omega-3 fatty acids  reduces symptoms of ADHD , both for individuals with ADHD and typically developing children . This effect does not appear to be mediated by cognitive control systems in the brain , as no effect of supplementation was found here . Nonetheless , this study offers support that omega-3 supplementation may be an effective augmentation for pharmacological treatments of ADHD ( NCT01554462 : The Effects of EPA/DHA Supplementation on Cognitive Control in Children with ADHD ; http:// clinical trials.gov/show/NCT01554462 ) BACKGROUND The effectiveness of psychostimulants , primarily methylpheni date ( MPH ) , in the treatment of Attention Deficit Hyperactivity Disorder ( ADHD ) in the general population of typically growing children and adolescents is well established through many R and omised Controlled Trials ( RCTs ) . AIMS AND METHODS We carried out a systematic review of all the RCTs in people with intellectual disabilities ( ID ) that assessed effectiveness of MPH on the core ADHD symptoms . OUTCOMES AND RESULTS We included 15 papers from 13 studies that were all on children and adolescents with ID ( 315 participants were on MPH and placebo respectively ) , 12 of which used a cross over design , and one used a parallel design . On average around 40 - 50 % responded to MPH in the ID group whereas around 70 - 80 % response rate is reported among the non-ID children . Because of the heterogeneity of the outcome data it was not possible to carry out a meta- analysis . Significant adverse events included sleep difficulties and poor appetite along with weight loss and also irritability , social withdrawal and increased motor activities including tic . CONCLUSIONS AND IMPLEMENTATION On the basis of the poor quality evidence that is available , it seems that MPH may be effective in some but not all children and adolescents with ID and ADHD The stimulant methylpheni date ( MPX ) and the nonstimulant atomoxetine ( ATX ) are the most commonly prescribed medications for attention deficit hyperactivity disorder ( ADHD ) . However , no functional magnetic resonance imaging ( fMRI ) study has as yet investigated the effects of ATX on inhibitory or any other brain function in ADHD patients or compared its effects with those of MPX . A r and omized , double-blind , placebo-controlled , crossover pharmacological design was used to compare the neurofunctional effects of single doses of MPX , ATX , and placebo during a stop task , combined with fMRI within 19 medication-naive ADHD boys , and their potential normalization effects relative to 29 age-matched healthy boys . Compared with controls , ADHD boys under placebo showed bilateral ventrolateral prefrontal , middle temporal , and cerebellar underactivation . Within patients , MPX relative to ATX and placebo significantly upregulated right ventrolateral prefrontal activation , which correlated with enhanced inhibitory capacity . Relative to controls , both drugs significantly normalized the left ventrolateral prefrontal underactivation observed under placebo , while MPX had a drug-specific effect of normalizing right ventrolateral prefrontal and cerebellar underactivation observed under both placebo and ATX . The findings show shared and drug-specific effects of MPX and ATX on performance and brain activation during inhibitory control in ADHD patients with superior upregulation and normalization effects of MPX Abstract Attention Deficit Hyperactivity Disorder ( ADHD ) is associated with poor self‐control , underpinned by inferior fronto‐striatal deficits . Real‐time functional magnetic resonance neurofeedback ( rtfMRI‐NF ) allows participants to gain self‐control over dysregulated brain regions . Despite evidence for beneficial effects of electrophysiological‐NF on ADHD symptoms , no study has applied the spatially superior rtfMRI‐NF neurotherapy to ADHD . A r and omized controlled trial tested the efficacy of rtfMRI‐NF of right inferior prefrontal cortex ( rIFG ) , a key region that is compromised in ADHD and upregulated with psychostimulants , on improvement of ADHD symptoms , cognition , and inhibitory fMRI activation . To control for region‐specificity , an active control group received rtfMRI‐NF of the left parahippocampal gyrus ( lPHG ) . Thirty‐one ADHD boys were r and omly allocated and had to learn to upregulate their target brain region in an average of 11 rtfMRI‐NF runs over 2 weeks . Feedback was provided through a video‐clip of a rocket that had to be moved up into space . A transfer session without feedback tested learning retention as a proximal measure of transfer to everyday life . Both NF groups showed significant linear activation increases with increasing number of runs in their respective target regions and significant reduction in ADHD symptoms after neurotherapy and at 11‐month follow‐up . Only the group targeting rIFG , however , showed a transfer effect , which correlated with ADHD symptom reductions , improved at trend level in sustained attention , and showed increased IFG activation during an inhibitory fMRI task . This proof‐of‐concept study demonstrates for the first time feasibility , safety , and shorter‐ and longer‐term efficacy  of rtfMRI‐NF of rIFG in adolescents with ADHD . Hum Brain Mapp 38:3190–3209 , 2017 . © 2017 The Authors Human Brain Mapping Published by Wiley Periodicals , Driving performance of adult males with attention-deficit hyperactivity disorder ( ADHD ) was compared with matched controls in a double-blind ( Ritalin vs. placebo ) cross-over design , using a high-fidelity driving simulator . Seven ADHD and six non-ADHD drivers ( mean age 22 ) were screened to rule out comorbidity and assess for ADHD , and then admitted to the General Clinical Research Center to control diet and sleep before testing . At 0800 and 1530 , subjects consumed either a placebo or Ritalin pill in a counter-balanced manner , and at 0930 and 1700 , subjects drove the simulator . After both drives , subjects rated their driving performance . Compared with non-ADHD subjects , ADHD subjects had more career driving accidents ( p < .04 ) and motor vehicle violations ( p = .059 ) , drove worse on the simulator under placebo condition ( p < .05 ) , demonstrated significant improvement under the Ritalin condition ( p < .05 ) , rated themselves as driving poorer during the placebo condition ( p = .05 ) , and tended to perceive their driving to be better during the Ritalin condition ( p = .07 ) . This would suggest that individuals with ADHD should have the therapeutic benefit of a stimulant medication when operating a vehicle BACKGROUND In addition to cognitive impairment , there are disruptions to mood and emotion processing in attention-deficit/hyperactivity disorder ( ADHD ) but little is known about their neural basis . We examined ADHD disturbances in mood and emotion recognition and underlying neural systems before and after treatment with stimulant medication . METHODS Participants were 51 unmedicated ADHD adolescents and 51 matched healthy control subjects rated for depressed and anxious mood and accuracy for identifying facial expressions of basic emotion . Brain function was recorded using event-related potentials ( ERPs ) while subjects viewed these expressions . ADHD subjects were retested after 4 weeks , following treatment with methylpheni date ( MPH ) . RESULTS ADHD subjects showed a profile of emotion-related impairment : higher depression and anxiety , deficits in identifying threat-related emotional expressions in particular , and alterations in ERPs . There was a pronounced reduction in occipital activity during the early perceptual analysis of emotional expression ( within 120 msec ) , followed by an exaggeration of activity associated with structural encoding ( 120 - 220 msec ) and subsequent reduction and slowing of temporal brain activity subserving context processing ( 300 - 400 msec ) . Methylpheni date normalized neural activity and produced some improvement of emotion recognition but had no impact on negative mood . Improvements in neural activity with MPH were consistent predictors of improvement in clinical features of emotional lability and hyperactivity . CONCLUSIONS Objective behavioral and brain function measures of emotion processing may provide a valuable addition to the clinical armamentarium for assessing emotional disturbances in ADHD and the efficacy of stimulants for treating these disturbances Attention Deficit Hyperactivity Disorder ( ADHD ) is characterized by poor cognitive control/attention and hypofunctioning of the dorsal anterior cingulate cortex ( dACC ) . In the current study , we investigated for the first time whether real-time fMRI neurofeedback ( rt-fMRI ) training targeted at increasing activation levels within dACC in adults with ADHD leads to a reduction of clinical symptoms and improved cognitive functioning . An exploratory r and omized controlled treatment study with blinding of the participants was conducted . Participants with ADHD ( n = 7 in the neurofeedback group , and n = 6 in the control group ) attended four weekly MRI training sessions ( 60-min training time/session ) , during which they performed a mental calculation task at varying levels of difficulty , in order to learn how to up-regulate dACC activation . Only neurofeedback participants received continuous feedback information on actual brain activation levels within dACC . Before and after the training , ADHD symptoms and relevant cognitive functioning was assessed . Results showed that both groups achieved a significant increase in dACC activation levels over sessions . While there was no significant difference between the neurofeedback and control group in clinical outcome , neurofeedback participants showed stronger improvement on cognitive functioning . The current study demonstrates the general feasibility of the suggested rt-fMRI neurofeedback training approach as a potential novel treatment option for ADHD patients . Due to the study ’s small sample size , potential clinical benefits need to be further investigated in future studies . Trial Registration : IS RCT
RESULTS Conjunction analyses revealed overlapping hypoactivations between ADHD and sleep loss in executive function regions , notably the dorsal anterior cingulate cortex .
Sleep deprivation , however , was associated with significantly exaggerated hyperactivation in the thalamus .
Our study indicates that ADHD and sleep deprivation share a common neural signature : hypoactivation of executive function neuroanatomy .
In contrast , sleep loss , but not ADHD , was associated with thalamic hyperactivations , intimating a potential compensatory response in sleep loss not present in ADHD .
STUDY OBJECTIVES Sleep disruption is common in attention deficit hyperactivity disorder ( ADHD ) .
Likewise , deficits in attention are a hallmark of sleep deprivation in healthy individuals .
Whether ADHD and sleep deprivation modulate common , or disparate , neural systems is unknown .
No study has yet utilized functional magnetic resonance imaging ( fMRI ) to investigate sleep loss in ADHD .
We address this gap by performing a novel meta- analysis to compare patterns of fMRI activation during sleep deprivation and ADHD .