Mobile Phone Apps for Smoking Cessation: Quality and Usability Among Smokers With Psychosis Mobile Application to Promote Adherence to Oral Chemotherapy and Symptom Management: A Protocol for Design and Development Multimodal treatment in children and adolescents with attention-deficit/hyperactivity disorder: a 6-month follow-up An mHealth App for Supporting Quitters to Manage Cigarette Cravings With Short Bouts of Physical Activity: A Randomized Pilot Feasibility and Acceptability Study Breast, Prostate, and Colorectal Cancer Survivors’ Experiences of Using Publicly Available Physical Activity Mobile Apps: Qualitative Study Cognitive-behavioral depression treatment for mothers of children with attention-deficit/hyperactivity disorder. Methods for Evaluating the Content, Usability, and Efficacy of Commercial Mobile Health Apps Parental Knowledge of Attention-Deficit Hyperactivity Disorder and Opinions of Treatment Options: Impact on Enrolment and Adherence to a 12-Month Treatment Trial Assessing the quality and usability of smartphone apps for pain self-management. Treatment of Children With Attention-Deficit/Hyperactivity Disorder (ADHD) and Irritability: Results From the Multimodal Treatment Study of Children With ADHD (MTA) A longitudinal study of risk and protective factors associated with successful transition to secondary school in youth with ADHD: prospective cohort study protocol The 4-year course of tic disorders in boys with attention-deficit/hyperactivity disorder. Protocol investigating the clinical utility of an objective measure of activity and attention (QbTest) on diagnostic and treatment decision-making in children and young people with ADHD—‘Assessing QbTest Utility in ADHD’ (AQUA): a randomised controlled trial Evaluating Diabetes Mobile Applications for Health Literate Designs and Functionality, 2014 Patterns and Predictors of Attention-Deficit/Hyperactivity Disorder Persistence into Adulthood: Results from the National Comorbidity Survey Replication Unexpected effects of methylphenidate in attention-deficit/hyperactivity disorder reflect decreases in core/secondary symptoms and physical complaints common to all children. Apps for IMproving FITness and Increasing Physical Activity Among Young People: The AIMFIT Pragmatic Randomized Controlled Trial Do stimulants reduce the risk for cigarette smoking in youth with attention-deficit hyperactivity disorder? A prospective, long-term, open-label study of extended-release methylphenidate. Analysis of mobile health applications for a broad spectrum of consumers: A user experience approach The effects of attention-deficit/hyperactivity disorder on employment and household income. Effect of a Mobile Phone Intervention on Quitting Smoking in a Young Adult Population of Smokers: Randomized Controlled Trial Study Protocol Do Stimulants Protect Against Psychiatric Disorders in Youth With ADHD? A 10-Year Follow-up Study Management of adult attention deficit hyperactivity disorder in UK primary care: a survey of general practitioners
Background Smoking is one of the top preventable causes of mortality in people with psychotic disorders such as schizophrenia .  Cessation treatment improves abstinence outcomes , but access is a barrier . Mobile phone apps are one way to increase access to cessation treatment ; however , whether they are usable by people with psychotic disorders , who often have special learning needs , is not known . Objective Research ers review ed 100 r and omly selected apps for smoking cessation to rate them based on US guidelines for nicotine addiction treatment and to categorize them based on app functions . We aim ed to test the usability and usefulness of the top-rated apps in 21 smokers with psychotic disorders . Methods We identified 766 smoking cessation apps and r and omly selected 100 for review . Two independent review ers rated each app with the Adherence Index to US Clinical Practice Guideline for Treating Tobacco Use and Dependence . Then , smokers with psychotic disorders evaluated the top 9 apps within a usability testing protocol . We analyzed quantitative results using descriptive statistics and t tests . Qualitative data were open-coded and analyzed for themes . Results Regarding adherence to practice guidelines , most of the r and omly sample d smoking cessation apps scored poorly—66 % rated lower than 10 out of 100 on the Adherence Index ( Mean 11.47 , SD 11.8 ) . Regarding usability , three common usability problems emerged : text-dense content , abstract symbols on the homepage , and subtle directions to edit features . Conclusions In order for apps to be effective and usable for this population , developers should utilize a balance of text and simple design that facilitate ease of navigation and content comprehension that will help people learn quit smoking skills Background Oral chemotherapy is increasingly used in place of traditional intravenous chemotherapy to treat patients with cancer . While oral chemotherapy includes benefits such as ease of administration , convenience , and minimization of invasive infusions , patients receive less oversight , support , and symptom monitoring from clinicians . Additionally , adherence is a well-documented challenge for patients with cancer prescribed oral chemotherapy regimens . With the ever-growing presence of smartphones and potential for efficacious behavioral intervention technology , we created a mobile health intervention for medication and symptom management . Objective The objective of this study was to develop and evaluate the usability and acceptability of a smartphone app  to support adherence to oral chemotherapy and symptom management in patients with cancer . Methods We used a 5-step development model to create a comprehensive mobile app with theoretically informed content . The research and technical development team worked together to develop and iteratively test the app . In addition to the research team , key stakeholders including patients and family members , oncology clinicians , health care representatives , and practice administrators contributed to the content refinement of the intervention . Patient and family members also participated in alpha and beta testing of the final prototype to assess usability and acceptability before we began the r and omized controlled trial . Results We incorporated app components based on the stakeholder feedback we received in focus groups and alpha and beta testing . App components included  medication reminders , self-reporting of medication adherence and symptoms , an education library including nutritional information , Fitbit integration , social networking re sources , and individually tailored symptom management feedback .  We are conducting a r and omized controlled trial to determine the effectiveness of the app in improving adherence to oral chemotherapy , quality of life , and burden of symptoms and side effects . At every stage in this trial , we are engaging stakeholders to solicit feedback on our progress and next steps . Conclusions To our knowledge , we are the first to describe the development of an app design ed for people taking oral chemotherapy . The app addresses many concerns with oral chemotherapy , such as medication adherence and symptom management . Soliciting feedback from stakeholders with broad perspectives and expertise ensured that the app was acceptable and potentially beneficial for patients , caregivers , and clinicians . In our development process , we instantiated 7 of the 8 best practice s proposed in a recent review of mobile health app development . Our process demonstrated the importance of effective communication between research groups and technical teams , as well as meticulous planning of technical specifications before development begins . Future efforts should consider incorporating other proven strategies in software , such as gamification , to bolster the impact of mobile health apps . Forthcoming results from our r and omized controlled trial will provide key data on the effectiveness of this app in improving medication adherence and symptom management . Trial Registration Clinical Trials.gov NCT02157519 ; https:// clinical trials.gov/ct2/show/NCT02157519 ( Archived by WebCite at http://www.webcitation.org/6prj3xfKA Abstract Background : Different treatment approaches aim ed at reducing attention-deficit/hyperactivity disorder ( ADHD ) core symptoms are available . However , factors such as intolerance , side-effects , lack of efficacy , high new technology costs , and placebo effect have spurred on an increasing interest in alternative or complementary treatment . Aim : The aim of this study is to explore efficacy of multimodal treatment consisting of st and ard stimulant medication ( methylpheni date ) and neurofeedback ( NF ) in combination , and to compare it with the single treatment in 6-month follow-up in ADHD children and adolescents . Methods : This r and omized controlled trial with 6-month follow-up comprised three treatment arms : multimodal treatment ( NF + MED ) , MED alone , and NF alone .  A total of 130 ADHD children/adolescents participated , and 62 % completed the study .  ADHD core symptoms were recorded pre-/post-treatment , using parents ’ and teachers ’ forms taken from Barkley ’s Defiant Children : A Clinician ’s Manual for Assessment and Parent Training , and a self-report question naire . Results : Significant ADHD core symptom improvements were reported 6 months after treatment completion by parents , teachers , and participants in all three groups , with marked improvement in inattention in all groups . However , no significant improvements in hyperactivity or academic performance were reported by teachers or self-reported by children/adolescents , respectively , in the three groups . Changes obtained with multimodal treatment at 6-month follow-up were comparable to those with single medication treatment , as reported by all participants . Conclusions : Multimodal treatment using combined stimulant medication and NF showed 6-month efficacy in ADHD treatment . More research is needed to explore whether multimodal treatment is suitable for ADHD children and adolescents who showed a poor response to single medication treatment , and for those who want to reduce the use of stimulant medication Background While gains in reducing smoking rates in Finl and have been made , prevalence rates are still substantial . Relapse rates among smokers engaged in quit-smoking programs are high . Physical activity has been proposed as one means to help smokers manage cravings . Software and apps on mobile phone and h and held devices offer an opportunity to communicate messages on how to use physical activity to manage cravings as part of quit-smoking programs . Objective We aim ed to test the feasibility , acceptability , usability , and preliminary efficacy of an mHealth mobile phone app , Physical activity over Smoking ( PhoS ) , to assist smokers in quitting smoking in a r and omized controlled trial . The app was design ed to prompt smokers to engage in physical activities to manage their smoking cravings . Methods Regular smokers ( n=44 ) attended a group-based behavioral counselling program aim ed at promoting physical activity as an additional aid to quit . After quit day , participants were r and omly allocated to an intervention ( n=25 ) or to a comparison ( n=19 ) group . Participants in the intervention group were provided with the PhoS app and training on how to use it to assist with relapse prevention . Participants in the comparison condition were provided with generalized relapse prevention training . Results Some participants reported that the PhoS app was useful in assisting them to successfully manage their cigarette cravings , although compliance across the sample was modest and participants reported low levels of usability . Participants receiving the PhoS app did not report greater abstinence than those who did not receive the app . However , participants receiving the app were more likely to report greater abstinence if they did not use pharmacological support , while those who did not receive the app reported greater abstinence when using pharmacological support . Participants receiving the app reported greater levels of physical activity than those who did not . Results revealed that the app result ed in better retention . Conclusions The PhoS app showed some potential to reduce abstinence among participants not using pharmacological therapy and to increase physical activity . However , problems with usability and lack of effects on abstinence raise questions over the app ’s long-term effectiveness . Future research should prioritize further development of the app to maximize usability and test effects of the intervention independent of quit-smoking programs . Trial Registration International St and ard R and omized Controlled Trial Number ( IS RCT N ) : 55259451 ; http://www.controlled-trials.com/IS RCT N55259451 ( Archived by WebCite at http://www.webcitation.org/6cKF2mzEI Background Physical activity ( PA ) can improve a range of outcomes following a cancer diagnosis . These include an improvement in experience of side effects of treatment ( eg , fatigue ) and management of comorbid conditions .  PA might also increase survival and reduce recurrence . Digital interventions have shown potential for PA promotion among cancer survivors , but most in a previous review were Web-based , and few studies used mobile apps . There are many PA apps available for general public use , but it is unclear whether these are suitable as a PA intervention after a cancer diagnosis . Objective This study sought posttreatment nonmetastatic breast , prostate , and colorectal cancer survivors ’ opinions of using smartphone apps to promote PA and gathered their views on existing publicly available PA apps to inform a future intervention . Methods Each participant was r and omly assigned to download 2 of 4 apps ( Human , The Walk , The Johnson & Johnson Official 7 Minute Workout , and Gorilla Workout ) . Participants used each app for 1 week consecutively . In-depth semistructured telephone interviews were then conducted to underst and participants ’ experiences of using the apps and how app-based PA interventions could be developed for cancer survivors . The interviews were analyzed using thematic analysis . Results Thirty-two participants took part : 50 % ( 16/32 ) had prostate cancer , 25 % ( 8/32 ) had breast cancer , and 25 % ( 8/32 ) had colorectal cancer . Three core themes were identified . The first theme was that multiple factors affect engagement with PA apps and this is highly personalized . Factors affecting engagement included participants ’ perceptions of ( 1 ) the advantages and disadvantages of using apps to support PA , ( 2 ) the relevance of the app to the user ( eg , in terms of cancer-related factors , their PA goals , the difficulty level of the app , the way in which they interact with their mobile phone , and the extent to which the app fits with their self-identity ) , ( 3 ) the quality of the app ( eg , usability , accuracy , quality of production , and scientific evidence -base ) , and ( 4 ) the behavior change techniques used to promote PA . In the second theme , participants recommended that apps that promote walking are most appealing , as walking removes many barriers to PA . Finally , the participants suggested that PA apps should be integrated into cancer care , as they valued guidance and recommendations from health care professionals . Conclusions This sample of breast , prostate , and colorectal cancer survivors was receptive to the use of apps to promote PA . Although no publicly available PA app was deemed wholly suitable , many suggestions for adaptation and intervention development were provided . The results can inform the development of an app-based PA intervention for cancer survivors . They also highlight the wide-ranging and dynamic influences on engagement with digital interventions , which can be applied to other evaluations of mobile health products in other health conditions and other health behaviors An adaptation of the Coping With Depression Course ( CWDC ) was evaluated in mothers of children with attention-deficit/hyperactivity disorder ( ADHD ) , a population at risk for depression . Mothers were r and omly assigned to receive the CWDC either immediately following an intensive summer treatment program targeting their child 's behavior or after a wait-list period .  Measures of maternal functioning , cognitions about child behavior , parent-child and marital relationship quality , child behavior , and ADHD-related family impairment were obtained at pretreatment , posttreatment , and 5-month follow-up . The CWDC result ed in improvements in maternal depressive symptoms , maternal self-esteem , child-related cognitions , and family impairment at posttreatment compared to a wait-list control group that were maintained at follow-up . Findings suggest that the CWDC is a promising intervention for mothers of children with ADHD , particularly those with current depressive symptomatology Commercial  mobile apps for health behavior change  are flourishing in the marketplace , but little evidence exists to support their use . This paper summarizes methods for evaluating the content , usability , and efficacy of commercially available  health apps .  Content analyses can be used to compare app features with clinical guidelines , evidence -based protocol s , and behavior change techniques . Usability testing can establish how well an app functions and serves its intended purpose for a target population . Observational studies can explore the association between use and clinical and behavioral outcomes . Finally , efficacy testing can establish whether a commercial app impacts an outcome of interest via a variety of study design s , including r and omized trials , multiphase optimization studies , and N-of-1 studies . Evidence in all these forms would increase adoption of commercial apps in clinical practice , inform the development of the next generation of apps , and ultimately increase the impact of commercial apps Objective : This study examines the relationship between parents ' knowledge of attention-deficit hyperactivity disorder ( ADHD ) and opinions of treatment and their impact on enrolment in and adherence to both pharmacological and nonpharmacological interventions for children with ADHD . Method : Participants in the study were the parents of 81 children who reached diagnostic criteria for ADHD and who were referred to a treatment study of ADHD involving stimulant medication and parent groups . The mothers completed a modified version of the ADHD Knowledge and Opinion Scale  ( AKOS ) prior to receiving diagnostic feedback and prior to the families ' decisions to participate in a 12-month r and omized trial ( medication [ methylpheni date or placebo ] and parent groups [ training or support ] ) . Treatment enrolment and adherence were monitored over the 12-month trial , and families who remained in the study at 12 months completed another modified AKOS . Results : A higher level of knowledge of ADHD was found to be related to more favourable opinions of parent groups but not of medication . Moreover , parents who were more knowledgeable about ADHD were more likely to enrol in both pharmacological and nonpharmacological treatments . Adherence to pharmacological and nonpharmacological treatments was not predicted by parental knowledge of ADHD or opinions of the treatment . Conclusion :  Parents ' knowledge of ADHD and opinions of treatments play a significant role in enrolment in treatments for their children with ADHD . Providing information to parents regarding ADHD prior to offering treatment modalities could have a favourable impact on treatment enrolment and hence treatment adherence OBJECTIVE To evaluate smartphone apps intended for self-management of pain using quality assessment criteria and usability testing with prospect i ve users . DESIGN 1 ) Survey and content analysis of available apps ; and 2 ) individual usability study of two apps . SETTING University of Leeds , United Kingdom . PARTICIPANTS Forty-one participants ( aged 19 - 59 years ) with experience of chronic or recurrent pain episodes . METHODS We undertook a survey , content analysis , and quality appraisal of all currently available mobile phone apps for self-management of pain . Two apps were then selected and assessed with usability testing . RESULTS Twelve apps met the inclusion criteria . The quality assessment revealed wide variation in their clinical content , interface design , and usability to support self-management of pain . Very little user or clinician involvement was identified in the development of the apps . From the usability testing , participants stated a preference for an interface design employing a lighter color scheme and particular text font . Although very few participants were aware of pain-reporting apps prior to participation , many would consider use in the future . CONCLUSIONS Variation in app quality and a lack of user and clinician engagement in development were found across the pain apps in this research . Usability testing identified a range of user preferences . Although useful information was obtained , it would be beneficial to involve users earlier in the process of development , as well as establishing ways to merge end user requirements with evidence -based content , to provide high- quality and usable apps for self-management of pain Objective Clinical ly impairing irritability affects 25 % to 45 % of children with attention-deficit/hyperactivity disorder ( ADHD ) ; yet , we know little about what interventions are effective in treating children with ADHD and co-occurring irritability . We used data from the Multimodal Treatment Study of Children With ADHD ( MTA ) to address 3 aims : to establish whether irritability in children with ADHD can be distinguished from other symptoms of oppositional defiant disorder ( ODD ) ; to examine whether ADHD treatment is effective in treating irritability ; and to examine how irritability influences ADHD treatment outcomes . Method Secondary analyses of data from the MTA included multivariate analyses , and intent-to-treat r and om-effects regression models were used . Results Irritability was separable from other ODD symptoms . For treating irritability , systematic stimulant treatment was superior to behavioral management but not to routine community care ; a combination of stimulants and behavioral treatment was superior to community care and to behavioral treatment alone , but not to medication alone . Irritability did not moderate the impact of treatment on parent- and teacher-reported ADHD symptoms in any of the 4 treatment groups . Conclusion Treatments targeting ADHD symptoms are helpful for improving irritability in children with ADHD . Moreover , irritability does not appear to influence the response to treatment of ADHD . Clinical trial registration information Multimodal Treatment Study of Children With Attention Deficit and Hyperactivity Disorder ( MTA ) ; http://www . clinical trials.gov ; NCT00000388 Background Attention-Deficit/Hyperactivity Disorder ( ADHD ) has a significant impact on child and adolescent development , especially in relation to school functioning and academic outcomes . Despite the transition to high school being a potentially critical period for children with ADHD , most research in this period has focused on academic outcomes . This study aims to extend previous research by describing academic , school engagement , behaviour and social-emotional outcomes for young people with ADHD in the first and third years of high school and to identify risk and protective factors predictive of differing outcomes across these four domains . Methods and design The Moving Up study is a longitudinal , prospect i ve cohort study of children with ADHD as they transition and adjust to high school ( age 12–15 years ) . Data are collected through direct assessment and child , parent and teacher surveys . The primary outcome is academic achievement , obtained by linking to st and ardised test results . Secondary outcomes include measures of behaviour , ADHD symptoms , school engagement ( attitudes and attendance ) , and social and emotional functioning , including depressive symptoms . The mean performance of the study cohort on each outcome measure will be compared to the population mean for same aged children , using t-tests . Risk and protective factors to be examined using multiple regression include a child , family and school factors know to impact academic and school functioning . Discussion The Moving up study is the first Australian study prospect ively design ed to measure a broad range of student outcomes for children with ADHD during the high school transition period . Examining both current ( cross sectional ) and earlier childhood ( longitudinal ) factors gives us the potential to learn more about risk and protective factors associated with school functioning in young people with ADHD . The richness and depth of this information could lead to more targeted and effective interventions that may alter academic and wellbeing trajectories for young people at risk of poor outcomes .The study is approved by The Royal Children ’s Hospital Melbourne Human Research Ethics Committee ( 33206 ) . Findings will be disseminated through peer- review ed journals and conference presentations BACKGROUND Despite long-st and ing clinical concerns , relatively little is known about the comorbidity between attention-deficit/hyperactivity disorder ( ADHD ) and tic disorders . Therefore , we examined tic disorders in an ongoing prospect i ve follow-up study of male subjects with ADHD , a sample unselected for any comorbid disorder . METHODS One hundred twenty-eight male children and adolescents with ADHD and 110 male controls were comprehensively evaluated at baseline and 4 years later . We characterized tic disorders along with a wide range of neuropsychiatric correlates , including other comorbid disorders and indices of psychosocial function in multiple domains ( school , cognitive , social , and family ) . RESULTS Compared with controls , subjects with ADHD showed more tic disorders at baseline and more new onsets were reported at follow-up . Attention-deficit/hyperactivity disorder and tic disorders appeared to be independent in course : in contrast to low rates of ADHD remission , tic disorders mostly remitted . The age-adjusted rate of ADHD remission was 20 % and that of tic remission , 65 % . Tic disorders had little effect on the psychosocial functioning of subjects with ADHD . CONCLUSIONS These findings suggest that comorbidity with a tic disorder has a limited effect on ADHD outcome . However , because of the relatively small sample of subjects with tic disorders , our conclusions should be considered preliminary until confirmed in larger studies of medicated and unmedicated children with ADHD with and without tic disorders Introduction The National Institute for Health and Care Excellence ( NICE ) guidelines for attention deficit/hyperactivity disorder ( ADHD ) state that young people need to have access to the best evidence -based care to improve outcome . The current ‘ gold st and ard ’ ADHD diagnostic assessment combines clinical observation with subjective parent , teacher and self-reports . In routine practice , reports from multiple informants may be unavailable or contradictory , leading to diagnostic uncertainty and delay . The addition of objective tests of attention and activity may help reduce diagnostic uncertainty and delays in initiating treatment leading to improved outcomes . This trial investigates whether providing clinicians with an objective report of levels of attention , impulsivity and activity can lead to an earlier , and more accurate , clinical diagnosis and improved patient outcome . Methods and analysis This multisite r and omised controlled trial will recruit young people ( aged 6–17 years old ) who have been referred for an ADHD diagnostic assessment at Child and Adolescent Mental Health Services ( CAMHS ) and Community Paediatric clinics across Engl and . Routine clinical assessment will be augmented by the QbTest , incorporating a continuous performance test ( CPT ) and infrared motion tracking of activity . The participant will be r and omised into one of two study arms : QbOpen ( clinician has immediate access to a QbTest report ) : QbBlind ( report is withheld until the study end ) . Primary outcomes are time to diagnosis and diagnostic accuracy . Secondary outcomes include clinician 's diagnostic confidence and routine clinical outcome measures . Cost-effective analysis will be conducted , alongside a qualitative assessment of the feasibility and acceptability of incorporating QbTest in routine practice . Ethics and dissemination The findings from the study will inform commissioners , clinicians and managers about the feasibility , acceptability , clinical utility and cost-effectiveness of incorporating QbTest into routine diagnostic assessment of young people with ADHD . The results will be su bmi tted for publication in peer- review ed journals . The study has received ethical approval . Trial registration number NCT02209116 Introduction The expansion of mobile health technologies , particularly for diabetes-related applications ( apps ) , grew exponentially in the past decade . This study sought to examine the extent to which current mobile apps for diabetes have health literate features recommended by participants in an Institute of Medicine Roundtable and compare the health literate features by app cost ( free or not ) . Methods We used diabetes-related keywords to identify  diabetes-related apps for iOS devices . A r and om sample of 110 apps ( 24 % of total number of apps identified ) was selected for coding . The coding scheme was adapted from the discussion paper produced by participants in the Institute of Medicine Roundtable . Results Most diabetes apps in this sample addressed diabetes management and therapeutics , and paid apps were more likely than free apps to use plain language strategies , to label links clearly , and to have at least 1 feature ( a “ back ” button ) that helps with the organization . Conclusion Paid apps were more likely than free apps to use strategies that should be more useful and engaging for people with low health literacy . Future work can investigate ways to make free diabetes mobile apps more user-friendly and accessible BACKGROUND Despite growing interest in adult attention-deficit/hyperactivity disorder ( ADHD ) , little is known about predictors of persistence of childhood cases into adulthood . METHODS A retrospective assessment of childhood ADHD , childhood risk factors , and a screen for adult ADHD were included in a sample of 3197 18 - 44 year old respondents in the National Comorbidity Survey Replication ( NCS-R ) .  Blinded adult ADHD clinical re appraisal interviews were administered to a sub- sample of respondents . Multiple imputation ( MI ) was used to estimate adult persistence of childhood ADHD . Logistic regression was used to study retrospectively reported childhood predictors of persistence . Potential predictors included socio-demographics , childhood ADHD severity , childhood adversity , traumatic life experiences , and comorbid DSM-IV child-adolescent disorders ( anxiety , mood , impulse-control , and substance disorders ) . RESULTS Blinded clinical interviews classified 36.3 % of respondents with retrospectively assessed childhood ADHD as meeting DSM-IV criteria for current ADHD . Childhood ADHD severity and childhood treatment significantly predicted persistence . Controlling for severity and excluding treatment , none of the other variables significantly predicted persistence even though they were significantly associated with childhood ADHD . CONCLUSIONS No modifiable risk factors were found for adult persistence of ADHD . Further research , ideally based on prospect i ve general population sample s , is needed to search for modifiable determinants of adult persistence of ADHD Abstract Hypotheses concerning unexpected , psychostimulant-related effects reported in previous studies were examined by separating behavioral/physical complaints highly specific to methylpheni date ( MPH ) from those that ( a ) may mimic core/ secondary symptoms of the disorder , or ( b ) are commonly reported by unmedicated children in the general population . Sixty-five children with attention-deficit/hyperactivity disorder ( ADHD ) participated in a double-blind , placebo-controlled , within-subject ( crossover ) experimental design and received a placebo and four MPH doses in counterbalanced order following baseline assessment . Behavioral and physical complaints were significantly higher under baseline relative to placebo and the four immediate-release MPH conditions ( 5 mg , 10 mg , 15 mg , and 20 mg ) across three symptom categories : ADHD core/ secondary symptoms ; symptoms commonly reported in the general population , including unmedicated children with ADHD ; and symptoms highly specific to MPH . No significant differences were found among active drug conditions . Past unexpected findings of psychostimulant effects in ADHD may be due to the inclusion of scale items that reflect core/ secondary features of ADHD and normally occurring behavioral/physical complaints in children Background Given the global prevalence of insufficient physical activity ( PA ) , effective interventions that attenuate age-related decline in PA levels are needed . Mobile phone interventions that positively affect health ( mHealth ) show promise ; however , their impact on PA levels and fitness in young people is unclear and little is known about what makes a good mHealth app . Objective The aim was to determine the effects of two commercially available smartphone apps ( Zombies , Run and Get Running ) on cardiorespiratory fitness and PA levels in insufficiently active healthy young people . A second aim was to identify the features of the app design that may contribute to improved fitness and PA levels . Methods Apps for IMproving FITness ( AIM FIT ) was a 3-arm , parallel , r and omized controlled trial conducted in Auckl and , New Zeal and . Participants were recruited through advertisements in electronic mailing lists , local newspapers , flyers posted in community locations , and presentations at schools . Eligible young people aged 14 - 17 years were allocated at r and om to 1 of 3 conditions : ( 1 ) use of an immersive app ( Zombies , Run ) , ( 2 ) use of a nonimmersive app ( Get Running ) , or ( 3 ) usual behavior ( control ) . Both smartphone apps consisted of a fully automated 8-week training program design ed to improve fitness and ability to run 5 km ; however , the immersive app featured a game-themed design and narrative . Intention-to-treat analysis was performed using data collected face-to-face at baseline and 8 weeks , and all regression models were adjusted for baseline outcome value and gender . The primary outcome was cardiorespiratory fitness , objective ly assessed as time to complete the 1-mile run/walk test at 8 weeks . Secondary outcomes were PA levels ( accelerometry and self-reported ) , enjoyment , psychological need satisfaction , self-efficacy , and acceptability and usability of the apps . Results A total of 51 participants were r and omized to the immersive app intervention ( n=17 ) , nonimmersive app intervention ( n=16 ) , or the control group ( n=18 ) . The mean age of participants was 15.7 ( SD 1.2 ) years ; participants were mostly NZ Europeans ( 61 % , 31/51 ) and 57 % ( 29/51 ) were female . Overall retention rate was 96 % ( 49/51 ) . There was no significant intervention effect on the primary outcome using either of the apps . Compared to the control , time to complete the fitness test was –28.4 seconds shorter ( 95 % CI –66.5 to 9.82 , P=.20 ) for the immersive app group and –24.7 seconds ( 95 % CI –63.5 to 14.2 , P=.32 ) for the nonimmersive app group . No significant intervention effects were found for secondary outcomes . Conclusions Although apps have the ability to increase reach at a low cost , our pragmatic approach using readily available commercial apps as a st and -alone instrument did not have a significant effect on fitness . However , interest in future use of PA apps is promising and highlights a potentially important role of these tools in a multifaceted approach to increase fitness , promote PA , and consequently reduce the adverse health outcomes associated with insufficient activity . Trial Registration Australian New Zeal and Clinical Trials Registry : ACTRN12613001030763 ; https://www.anzctr.org.au/Trial/ Registration /Trial Review .aspx?ACTRN=12613001030763 ( Archived by WebCite at http://www.webcitation.org/6aasfJVTJ ) OBJECTIVE Although attention-deficit hyperactivity disorder ( ADHD ) is a well-known risk factor for cigarette smoking , prospect i ve studies aim ed at reducing smoking risk in this population are critically needed . STUDY DESIGN This was a 2-year , prospect i ve , open-label clinical trial of extended-release methylpheni date for smoking prevention in adolescents with ADHD ( n = 154 ) .  Smoking outcomes were assessed with the Fagerstrom Tolerance Question naire . Comparisons were made using data from a historical , naturalistic sample of ADHD ( n = 103 ) and non-ADHD comparators ( n = 188 ) of similar age and sex assessed with the same assessment battery as that used in subjects participating in the clinical trial . RESULTS The smoking rate at endpoint ( mean , 10 months of methylpheni date treatment ) was low in the clinical trial subjects and not significantly different from that in the non-ADHD comparators or the ADHD comparators receiving stimulants naturalistically ( 7.1 % vs 8.0 % vs 10.9 % ; P > .20 ) . In contrast , the smoking rate was significantly lower in the clinical trial subjects than in the naturalistic sample of ADHD comparators who were not receiving stimulant treatment ( 7.1 % vs 19.6 % ; P = .009 [ not significant ] , adjusting for comorbid conduct disorder and alcohol and drug abuse ) . CONCLUSION Although considered preliminary until replicated in future r and omized clinical trials , the findings from this single-site , open-label study suggest that stimulant treatment may contribute to a decreased risk for smoking  in adolescents with ADHD . If confirmed , this finding would have significant clinical and public health impacts Mobile health ( m-health ) apps can bring health prevention and promotion to the general population . The main purpose of this article is to analyze different m-health apps for a broad spectrum of consumers by means of three different experiences . This goal was defined following the strategic documents generated by the main prospect i ve observatories of Information and Communications Technology for health . After a general exploration of the app markets , we analyze the entries of three specific themes focused in this article : type 2 diabetes , obesity , and breast-feeding . The user experiences reported in this study mostly cover the segments of ( 1 ) chronically monitored consumers through a Web mobile app for predicting  type 2 diabetes  ( Diab_Alert app ) , ( 2 ) information seekers through a mobile app for maternity ( Lactation app ) and partially ( 3 ) the motivated healthy consumers through a mobile app for a dietetic monitoring and assessment ( SapoFit app ) . These apps were developed by the authors of this work CONTEXT Many children with attention-deficit/hyperactivity disorder ( ADHD ) continue to exhibit symptoms of the disorder into adolescence and adulthood . Although ADHD may have a profound impact on activities of daily living , including educational achievement and work performance , limited research exists on ADHD 's impact on individual income loss and overall economic effect . OBJECTIVES Evaluate ADHD 's impact on individual employment and income , and quantify costs of ADHD on workforce productivity for the US population . DESIGN Two telephone surveys were conducted between April 18 , 2003 , and May 11 , 2003 , to collect demographic , educational , employment , and income information . PARTICIPANTS Two groups of adults aged 18 - 64 years were interviewed : those diagnosed with ADHD ( n = 500 ) derived from a national list of mail-paneled members who identified themselves or a household member as having been diagnosed with ADHD , and an age- and gender-matched control group ( n = 501 ) derived from a r and om digital-dialing sample of a national cross-section not diagnosed with ADHD . RESULTS Statistically fewer subjects in the ADHD group achieved academic milestones beyond some high school ( P < .05 ) . In addition , fewer subjects with ADHD were employed full time ( 34 % ) compared with controls ( 59 % ; P < .001 ) . Except for the subgroup of subjects aged 18 - 24 years , average household incomes were significantly lower among individuals with ADHD compared with controls , regardless of academic achievement or personal characteristics . On the basis of these findings , loss of workforce productivity associated with ADHD was estimated between $ 67 billion and $ 116 billion . CONCLUSIONS Decreased individual income among adults with ADHD contributes to substantial loss in US workforce productivity Background Tobacco use remains the number one cause of preventable chronic disease and death in developed countries worldwide . In North America , smoking rates are highest among young adults . Despite that the majority of young adult smokers indicate wanting to quit , smoking rates among this age demographic have yet to decline . Helping young adults quit smoking continues to be a public health priority . Digital mobile technology presents a promising medium for reaching this population with smoking cessation interventions , especially because young adults are the heaviest users of this technology . Objective The primary aim of this trial is to determine the effectiveness of an evidence -informed mobile phone app for smoking cessation , Crush the Crave , on reducing smoking prevalence among young adult smokers . Methods A parallel r and omized controlled trial ( RCT ) with two arms will be conducted in Canada to evaluate Crush the Crave . In total , 1354 young adult smokers ( 19 to 29 years old ) will be r and omized to receive the evidence -informed mobile phone app , Crush the Crave , or an evidence -based self-help guide known as “ On the Road to Quitting ” ( control ) for a period of 6 months . The primary outcome measure is a 30-day point prevalence of abstinence at the 6-month follow-up . Secondary outcomes include a 7-day point prevalence of abstinence , number of quit attempts , reduction in consumption of cigarettes , self-efficacy , satisfaction , app utilization metrics , and use of smoking cessation services . A cost-effectiveness analysis is included . Results This trial is currently open for recruitment . The anticipated completion date for the study is April 2016 . Conclusions This r and omized controlled trial will provide the evidence to move forward on decision making regarding the inclusion of technology-based mobile phone interventions as part of existing smoking cessation efforts made by health care providers . Evidence from the trial will also inform the development of future apps , provide a deeper underst and ing of the factors that drive change in smoking behavior using an app , and improve the design of cessation apps . This trial is among the first to assess the effect of a comprehensive and evidence -informed mHealth smoking cessation app on a large sample of young adult smokers . Strengths of the trial include the high- quality research design and in-depth assessment of the implementation of the intervention . If effective , the trial has the potential to demonstrate that including mHealth technology as a population -based intervention strategy can cost-effectively reach a greater proportion of the population and help young adult smokers to quit . Trial Registration Clinical Trials.gov NCT01983150 ; http:// clinical trials.gov/ct2/show/NCT01983150 ( Archived by WebCite at http://www.webcitation.org/6VGyc0W0i ) OBJECTIVE : Little is known about the effect of stimulant treatment in youth with attention-deficit/hyperactivity disorder ( ADHD ) on the subsequent development of comorbid psychiatric disorders . We tested the association between stimulant treatment and the subsequent development of psychiatric comorbidity in a longitudinal sample of patients with ADHD . METHODS : We conducted a case-control , 10-year prospect i ve follow-up study into young-adult years of youth with ADHD . At baseline , we assessed consecutively referred white male children with ( n = 140 ) and without ( n = 120 ) ADHD , aged 6 to 18 years . At the 10-year follow-up , 112 ( 80 % ) and 105 ( 88 % ) of the children in the ADHD and control groups , respectively , were reassessed ( mean age : 22 years ) . We examined the association between stimulant treatment in childhood and adolescence and subsequent comorbid disorders and grade retention by using proportional hazards survival models . RESULTS : Of the 112 participants with ADHD , 82 ( 73 % ) were previously treated with stimulants .  Participants with ADHD who were treated with stimulants were significantly less likely to subsequently develop depressive and anxiety disorders and disruptive behavior and less likely to repeat a grade compared with participants with ADHD who were not treated . CONCLUSIONS : We found evidence that stimulant treatment decreases the risk for subsequent comorbid psychiatric disorders and academic failure in youth with ADHD Background Compared to existing literature on childhood attention deficit hyperactivity disorder ( ADHD ) , little published adult data are available , particularly outside of the United States . Using General Practitioner ( GP ) question naires from the United Kingdom , this study aim ed to examine a number of issues related to ADHD in adults , across three cohorts of patients , adults who received ADHD drug treatment in childhood/adolescence but stopped prior to adulthood ; adults who received ADHD drug treatment in childhood/adolescence and continued treatment into adulthood and adults who started ADHD drug treatment in adulthood . Methods Patients with a diagnosis of ADHD and prescribed methylpheni date , dexamfetamine or atomoxetine were identified using data from The Health Improvement Network ( THIN ) . Date s when these drugs started and stopped were used to classify patients into the three cohorts . From each cohort , 50 patients were r and omly selected and question naires were sent via THIN to their GPs . GPs returned completed question naires to THIN who forwarded anonymised copies to the research ers . Data sets were analysed using descriptive statistics . Results Overall response rate was 89 % ( 133/150 ) . GPs stated that in 19 cases , the patient did not meet the criteria of that group ; the number of valid question naires returned was 114 ( 76 % ) . The following broad trends were observed : 1 ) GPs were not aware of the reason for treatment cessation in 43 % of cases , 2 ) patient choice was the most common reason for discontinuation ( 56 % ) , 3 ) 7 % of patients who stopped pharmacological treatment subsequently reported experiencing ADHD symptoms , 4 ) 58 % of patients who started pharmacological treatment for ADHD in adulthood received pharmacological treatment for other mental health conditions prior to the ADHD being diagnosed . Conclusion This study presents some key findings relating to ADHD ; GPs were often not aware of the reason for patients stopping ADHD treatment in childhood or adolescence . Patient choice was identified as the most common reason for treatment cessation . For patients who started pharmacological treatment in adulthood , many patients received pharmacological treatment for comorbidities before a diagnosis of ADHD was made
Conclusions These findings suggest that the apps may not be suitable in meeting the complex needs associated with this condition .
Background Attention-deficit/hyperactivity disorder ( ADHD ) is a complex highly comorbid disorder , which can have a huge impact on those with ADHD , their family , and the community around them .
ADHD is currently managed using pharmacological and nonpharmacological interventions .
However , with advances in technology and an increase in the use of mobile apps , managing ADHD can be augmented using apps specifically design ed for this population .
However , little is known regarding the suitability and usability of currently available apps .
Objective The aim of this study was to explore the suitability of the top 10 listed apps for children and young people with ADHD and clinicians who work with them .
It is hypothesized that mobile apps design ed for this population could be more suitably design ed for this population .