Management of adult attention deficit hyperactivity disorder in UK primary care: a survey of general practitioners Clinical and functional outcome of childhood attention-deficit/hyperactivity disorder 33 years later. Multimodal treatment in children and adolescents with attention-deficit/hyperactivity disorder: a 6-month follow-up Predictors of persistence and remission of ADHD into adolescence: results from a four-year prospective follow-up study. Adult outcome of hyperactive boys. Educational achievement, occupational rank, and psychiatric status. Adolescent substance use in the multimodal treatment study of attention-deficit/hyperactivity disorder (ADHD) (MTA) as a function of childhood ADHD, random assignment to childhood treatments, and subsequent medication. Efficacy of theophylline compared to methylphenidate for the treatment of attention-deficit hyperactivity disorder in children and adolescents: a pilot double-blind randomized trial. Childhood predictors of adolescent substance use in a longitudinal study of children with ADHD. Five-fold increase in national prevalence rates of attention-deficit/hyperactivity disorder medications for children and adolescents with autism spectrum disorder, attention-deficit/hyperactivity disorder, and other psychiatric disorders: a Danish register-based study. Characteristics of patients with schizophrenia successive to childhood attention deficit hyperactivity disorder (ADHD). Stimulant treatment in children with attention-deficit/hyperactivity disorder moderates adolescent academic outcome. Atomoxetine treatment in children and adolescents with attention-deficit hyperactivity disorder: what are the long-term health-related quality-of-life outcomes? Randomised controlled study-efficacy of clonidine versus carbamazepine in children with ADHD. The effect of methylphenidate on oppositional defiant disorder comorbid with attention deficit/hyperactivity disorder. The MTA at 8 years: prospective follow-up of children treated for combined-type ADHD in a multisite study. Self-reported efficacy of neurofeedback treatment in a clinical randomized controlled study of ADHD children and adolescents Do Stimulants Protect Against Psychiatric Disorders in Youth With ADHD? A 10-Year Follow-up Study The 4-year course of tic disorders in boys with attention-deficit/hyperactivity disorder. Adult psychiatric status of hyperactive boys grown up. Transmission disequilibrium of polymorphic variants in the tryptophan hydroxylase-2 gene in attention-deficit/hyperactivity disorder Association between Attention-Deficit Hyperactivity Disorder in childhood and schizophrenia later in adulthood. PREVALENCE ESTIMATIONS OF ATTENTION-DEFICIT/HYPERACTIVITY DISORDER: DIFFERENTIAL DIAGNOSES AND COMORBIDITIES IN A COLOMBIAN SAMPLE A double-blind comparison of desipramine and placebo in children and adolescents with chronic tic disorder and comorbid attention-deficit/hyperactivity disorder.
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 CONTEXT Prospect i ve studies of childhood attention-deficit/hyperactivity disorder ( ADHD ) have not extended beyond early adulthood . OBJECTIVE To examine whether children diagnosed as having ADHD at a mean age of 8 years ( prob and s ) have worse educational , occupational , economic , social , and marital outcomes and higher rates of ongoing ADHD , antisocial personality disorder ( ASPD ) , substance use disorders ( SUDs ) , adult-onset psychiatric disorders , psychiatric hospitalizations , and incarcerations than non-ADHD comparison participants at a mean age of 41 years . DESIGN Prospect i ve , 33-year follow-up study , with masked clinical assessment s. SETTING Research clinic . PARTICIPANTS A total of 135 white men with ADHD in childhood , free of conduct disorder , and 136 men without childhood ADHD ( 65.2 % and 76.4 % of original cohort , respectively ) . MAIN OUTCOME MEASURES Occupational , economic , and educational attainment ; marital history ; occupational and social functioning ; ongoing and lifetime psychiatric disorders ; psychiatric hospitalizations ; and incarcerations . RESULTS Prob and s had significantly worse educational , occupational , economic , and social outcomes ; more divorces ; and higher rates of ongoing ADHD ( 22.2 % vs 5.1 % , P < .001 ) , ASPD ( 16.3 % vs 0 % , P < .001 ) , and SUDs ( 14.1 % vs 5.1 % , P = .01 ) but not more mood or anxiety disorders ( P = .36 and .33 ) than did comparison participants . Ongoing ADHD was weakly related to ongoing SUDs ( ϕ = 0.19 , P = .04 ) , as well as ASPD with SUDs ( ϕ = 0.20 , P = .04 ) . During their lifetime , prob and s had significantly more ASPD and SUDs but not mood or anxiety disorders and more psychiatric hospitalizations and incarcerations than comparison participants . Relative to comparisons , psychiatric disorders with onsets at 21 years or older were not significantly elevated in prob and s. Prob and s without ongoing psychiatric disorders had worse social , but not occupational , functioning . CONCLUSIONS The multiple disadvantages predicted by childhood ADHD well into adulthood began in adolescence , without increased onsets of new disorders after 20 years of age . Findings highlight the importance of extended monitoring and treatment of children with ADHD 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 OBJECTIVE To evaluate the predictors of persistence and the timing of remission of attention-deficit hyperactivity disorder ( ADHD ) . METHOD Subjects were 6- to 17-year old Caucasian , non-Hispanic boys with and without ADHD . DSM-III-R structured diagnostic interviews and blind raters were used to examine psychiatric diagnoses , cognitive achievement , social , school , and family functioning at a 4-year follow-up assessment . RESULTS At the 4-year follow-up assessment , 85 % of children with ADHD continued to have the disorder and 15 % remitted . Of those who remitted , half did so in childhood and the other half in adolescence . Predictors of persistence were familiality of ADHD , psychosocial adversity , and comorbidity with conduct , mood , and anxiety disorders . CONCLUSIONS The findings prospect ively confirm that the majority of children with ADHD will continue to express the disorder 4 years later . For a minority of children , ADHD was a transient disorder that remits early in development . In addition , we have shown that persistence of ADHD is predictable . Familiality , adversity , and psychiatric comorbidity may be clinical ly useful predictors of which children with ADHD are at risk for a persistent disorder OBJECTIVE The paucity of data concerning the long-term natural history of attention-deficit hyperactivity disorder ( ADHD ) , a common childhood psychiatric disorder , prompted a longitudinal study to investigate the adult sequelae of the childhood disorder . DESIGN Prospect i ve study , follow-up intervals ranging from 13 to 19 years ( mean , 16 years ) , with blind systematic clinical assessment s. SUBJECTS Ninety-one white males ( mean age , 26 years ) , representing 88 % of a cohort systematic ally diagnosed as hyperactive in childhood , and 95 ( 95 % ) of comparison cases of similar race , gender , age , whose teachers had voiced no complaints about their school behavior in childhood . RESULTS Prob and s had significantly higher rates than comparisons of ADHD symptoms ( 11 % vs 1 % ) , antisocial personality disorders ( 18 % vs 2 % ) , and drug abuse disorders ( 16 % vs 4 % ) . Significant comorbidity occurred between antisocial and drug disorders . Educational and occupational achievements were significantly compromised in the prob and s. These disadvantages were independent of psychiatric status . We did not find increased rates of affective or anxiety disorders in the prob and s. CONCLUSIONS Childhood ADHD predicts specific adult psychiatric disorders , namely antisocial and drug abuse disorders . In the adolescent outcome of this cohort , we found that these disturbances were dependent on the continuation of ADHD symptoms . In contrast , in adulthood , antisocial and drug disorders appeared , in part , independent of sustained ADHD . In addition , regardless of psychiatric status , ADHD placed children at relative risk for educational and vocational disadvantage . The results do not support a relationship between childhood ADHD and adult mood or anxiety disorders OBJECTIVE To determine long-term effects on substance use and substance use disorder ( SUD ) , up to 8 years after childhood enrollment , of the r and omly assigned 14-month treatments in the multisite Multimodal Treatment Study of Children with Attention-Deficit/Hyperactivity Disorder ( MTA ; n = 436 ) ; to test whether medication at follow-up , cumulative psychostimulant treatment over time , or both relate to substance use/SUD ; and to compare substance use/SUD in the ADHD sample to the non-ADHD childhood classmate comparison group ( n = 261 ) . METHOD Mixed-effects regression models with planned contrasts were used for all tests except the important cumulative stimulant treatment question , for which propensity score matching analysis was used . RESULTS The originally r and omized treatment groups did not differ significantly on substance use/SUD by the 8-year follow-up or earlier ( mean age = 17 years ) . Neither medication at follow-up ( mostly stimulants ) nor cumulative stimulant treatment was associated with adolescent substance use/SUD . Substance use at all time points , including use of two or more substances and SUD , were each greater in the ADHD than in the non-ADHD sample s , regardless of sex . CONCLUSIONS Medication for ADHD did not protect from , or contribute to , visible risk of substance use or SUD by adolescence , whether analyzed as r and omized treatment assignment in childhood , as medication at follow-up , or as cumulative stimulant treatment over an 8-year follow-up from childhood . These results suggest the need to identify alternative or adjunctive adolescent-focused approaches to substance abuse prevention and treatment for boys and girls with ADHD , especially given their increased risk for use and abuse of multiple substances that is not improved with stimulant medication . Clinical trial registration information-Multimodal Treatment Study of Children With Attention Deficit and Hyperactivity Disorder ( MTA ) ; http:// clinical trials.gov/ ; NCT00000388 Attention-deficit hyperactivity disorder ( ADHD ) is a common disorder of childhood that affects 3 - 6 % of school children . Conventional stimulant medications are recognized as useful symptomatic treatments by both specialists and parents . Nevertheless , approximately 30 % of ADHD children treated with them do not respond adequately or can not tolerate the associated adverse effects . Such difficulties highlight the need for alternative , safe and effective medications in the treatment of this disorder . Theophylline is a psychomotor stimulant most widely used as a broncodilator . Purinergic modulation may be therapeutically beneficial in the treatment of psychiatric disorders . We hypothesized that theophylline would be beneficial for the treatment of ADHD and report results of a trial of theophylline compared with methylpheni date for the treatment of ADHD . A total of 32 children with ADHD as defined by DSM IV were r and omized to theophylline and methylpheni date dosed on an age and weight-adjusted basis at 4 mg/kg/day ( under 12 years ) and 3 mg/kg/day theophylline ( over 12 years ) ( group 1 ) and 1 mg/kg/day methylpheni date ( group 2 ) for a 6-week double-blind and r and omized clinical trial . The principal measure of the outcome was the Teacher and Parent ADHD Rating Scale . Patients were assessed by a child psychiatrist , at baseline and at 14 , 28 and 42 days after start of the medication . No significant differences were observed between theophylline and methylpheni date on the Parent and Teacher Rating Scale scores over the trial ( t = 0.49 , d.f . = 24 P = 0.62 and t = 0.19 , d.f . = 24 P = 0.54 respectively ) . Although the number of dropouts in the methylpheni date group was higher than the theophylline group , there was no significant difference between the two protocol s in terms of the dropouts . In addition , headaches were observed more often in the methylpheni date group . The results suggest that theophylline may be a useful for the treatment of ADHD . In addition , a tolerable side-effect profile is one of the advantages of theophylline in the treatment of ADHD . Nevertheless , our study is small and our results would need to be confirmed in a larger study Children diagnosed with attention-deficit/hyperactivity disorder ( ADHD ; n = 142 ) were prospect ively monitored into adolescence ( 13 - 18 years old ) to evaluate their risk for elevated substance use relative to same-aged adolescents without ADHD ( n = 100 ) . Prob and s reported higher levels of alcohol , tobacco , and illicit drug use than did controls . Group differences were apparent for alcohol symptom scores but not for alcohol or marijuana disorder diagnoses . Within prob and s , severity of childhood inattention symptoms predicted multiple substance use outcomes : childhood oppositional defiant disorder/conduct disorder ( ODD/CD ) symptoms predicted illicit drug use and CD symptoms . Persistence of ADHD and adolescent CD were each associated with elevated substance use behaviors relative to controls . Further study of the mediating mechanisms that explain risk for early substance use and abuse in children with ADHD is warranted OBJECTIVE The purpose of this study was to estimate the prevalence and time trends in prescriptions of methylpheni date , dexamphetamine , and atomoxetine in children and adolescents , within three diagnostic groups : 1 ) autism spectrum disorder ( ASD ) , 2 ) attention-deficit/hyperactivity disorder ( ADHD ) , and 3 ) other psychiatric disorders . METHODS Data from six different national registers were used and merged to identify a cohort of all children and adolescents born in Denmark between 1990 and 2001 ( n=852,711 ) . Sociodemographic covariates on cohort members and their parents and lifetime prescriptions of methylpheni date , dexamphetamine , and atomoxetine were extracted from the registers . Prescriptions were also stratified by duration ( < 6 months . vs.≥ 6 months ) . RESULTS Sixteen percent of 9698 children and adolescents with ASD ( n=1577 ) , 61 % of 11,553 children and adolescents with ADHD ( n=7021 ) and 3 % of 48,468 children and adolescents with other psychiatric disorders ( n=1537 ) were treated with one or more ADHD medications . There was a significant increase in prescription rates of these medications for all three groups . From 2003 to 2010 , youth 6 - 13 years of age with ASD , ADHD , and other psychiatric disorders had 4.7-fold ( 4.4 - 4.9 ) , 6.3-fold ( 6.0 - 6.4 ) , and 5.5-fold ( 5.0 - 5.9 ) increases , respectively , in prescription rates of ADHD medications . CONCLUSION This is the largest study to date assessing stimulant treatment in children and adolescents with ASD , and is the first prospect i ve study quantifying the change over time in the prevalence of treatment with ADHD medications in a population -based national cohort of children and adolescents with ASD . The prevalence of stimulant treatment in youth with ASD of 16 % is consistent with earlier studies . The past decade has witnessed a clear and progressive increase in the prescription rates of medications typically used to treat ADHD in children and adolescents in Denmark . This increase is not limited to only those with ADHD , but includes others with neuropsychiatric disorders , including ASD . The risks and benefits of this practice await further study The goal of this study was to investigate the characteristics of schizophrenic patients with a history of childhood attention deficit hyperactivity disorder ( ADHD ) . The study was performed on 37 adolescent patients meeting the DSM-III-R criteria for schizophrenia and ADHD and 40 controls with schizophrenia only . Schizophrenic patients who were diagnosed in childhood as suffering from ADHD had more prominent developmental disturbances in infancy , more insidious course of schizophrenia , failed to respond to neuroleptics and had poorer outcome as compared to patients with schizophrenia only . The results of this study indicate that schizophrenia subsequent to childhood ADHD has a poor prognosis as compared to schizophrenia only Treatment with psychostimulant medication has been shown to improve scholastic functioning in children with attention-deficit/hyperactivity disorder ( ADHD ) . However , the extent to which long-term academic gains are apparent in those having received such treatment remains elusive . This study examined prospect ively the relationship of childhood stimulant treatment to academic functioning during adolescence . Children ( n = 169 ) were initially recruited and diagnosed with ADHD when they were 7 - 11 years old . A sub sample of those with childhood ADHD ( n = 90 ) was reevaluated on average 9.13 ( SD = 1.5 ) years later . Prob and s who did and did not receive treatment with stimulant medication were compared to each other and to a never-ADHD comparison group ( n = 80 ) on three subtests from the Wechsler Individual Achievement Test-II ( WIAT-II ) , as well as high school grade point average ( GPA ) and number of retentions in school as derived from school records . Analyses of covariance controlling for severity of childhood ADHD symptoms indicated that prob and s treated with psychostimulant medication achieved better academic outcomes , as measured by WIAT-II subtests and high school GPA , than those not treated with psychostimulants ( p < .05 ) . However , treated prob and s did not fare as well as the never-ADHD comparison group . Psychostimulant treatment for children with ADHD may benefit long-term adolescent academic performance , although the extent of improvement is likely to vary as a function of multiple factors OBJECTIVE Numerous investigations have examined the efficacy of pharmacological treatment for attention-deficit/hyperactivity disorder ( ADHD ) in children . However , relatively few studies have addressed the impact of treatment on long-term subjective , psychosocial outcomes , such as health-related quality of life ( HRQL ) . This study examines the long-term effects of pharmacological treatment with atomoxetine on HRQL in children and adolescents with ADHD . METHODS Participants included 6- to 17-year-old children and adolescents ( n = 912 ) with ADHD enrolled in a 24-month , multicenter , open-label trial of atomoxetine . Outcomes included clinician ratings of ADHD , parent ratings of ADHD , and a widely used measure of HRQL ( The Child Health Question naire ( CHQ ) ) . Treatment response rates were calculated based on a CHQ improvement of at least 1 st and ard error of measurement . RESULTS Significant improvements in HRQL were found following both acute and long-term treatment for psychosocial but not physical health . Of participants who completed treatment ( n = 312 or 34.2 % of those enrolled ) , 81 % responded to acute treatment and 78 % responded to long-term treatment . Improvements noted after acute treatment were maintained during long-term treatment with the majority of participants ( 86 % ) continuing to respond to treatment . CONCLUSIONS Atomoxetine is associated with improvements in HRQL , and the improvements are generally stable over time BACKGROUND Attention deficit hyperactivity disorder ( ADHD ) is one of the most common childhood psychiatric disorder with a prevalence of 8 - 12 % . Even though psychostimulants remain the treatment of choice , its cost and availability in developing countries limits the usage of the drug . In view of free availability and low cost , a R and omized controlled study was carried out using two second line drugs ( clonidine and carbamazepine ) in a tertiary care hospital , Pondicherry , South India . OBJECTIVE To compare the efficacy of clonidine and carbamazepine in children with ADHD . METHOD With approval of ethics committee , a prospect i ve , Double-blind , R and omized controlled study of clonidine and carbamazepine was conducted with 50 children with ADHD ( age group 4 - 12 years ) , over a period of 2 years ( 2005 - 07 ) in a tertiary care hospital , Pondicherry , South India . RESULTS Clonidine was effective in improving the hyperactivity and impulsivity symptoms in children with ADHD as compared to carbamazepine . Statistical significant improvement was not noted with respect to inattention symptoms and other comorbid conditions . CONCLUSION Clonidine can be a safer and cheaper alternative in treatment of children with ADHD , with a predominant effect on their hyperactivity and impulsivity symptoms OBJECTIVE To assess the effect of methylpheni date on the diagnosis of oppositional-defiant disorder ( ODD ) comorbid with attention-deficit hyperactivity disorder ( ADHD ) . METHOD We conducted an open-label study in which 10 children and adolescents with a dual diagnosis of ODD and ADHD were assessed for their ODD symptoms and treated with methylpheni date . At least one month after ADHD symptoms were under control , ODD symptoms were reevaluated with the Parent form of the Children Interview for Psychiatric Syndromes ( P-ChIPS ) . RESULTS Nine of the 10 patients no longer fulfilled diagnostic criteria for ODD after they were treated with methylpheni date for ADHD . CONCLUSION Methylpheni date seems to be an effective treatment for ODD , as well as for ADHD itself . The implication s for the treatment of patients with ODD not comorbid with ADHD needs further investigation OBJECTIVES To determine any long-term effects , 6 and 8 years after childhood enrollment , of the r and omly assigned 14-month treatments in the NIMH Collaborative Multisite Multimodal Treatment Study of Children With Attention-Deficit/Hyperactivity Disorder ( MTA ; N = 436 ) ; to test whether attention-deficit/hyperactivity disorder ( ADHD ) symptom trajectory through 3 years predicts outcome in subsequent years ; and to examine functioning level of the MTA adolescents relative to their non-ADHD peers ( local normative comparison group ; N = 261 ) . METHOD Mixed-effects regression models with planned contrasts at 6 and 8 years tested a wide range of symptom and impairment variables assessed by  parent , teacher , and youth report . RESULTS In nearly every analysis , the originally r and omized treatment groups did not differ significantly on repeated measures or newly analyzed variables ( e.g. , grade s earned in school , arrests , psychiatric hospitalizations , other clinical ly relevant outcomes ) . Medication use decreased by 62 % after the 14-month controlled trial , but adjusting for this did not change the results . ADHD symptom trajectory in the first 3 years predicted 55 % of the outcomes . The MTA participants fared worse than the local normative comparison group on 91 % of the variables tested . CONCLUSIONS Type or intensity of 14 months of treatment for ADHD in childhood ( at age 7.0 - 9.9 years ) does not predict functioning 6 to 8 years later . Rather , early ADHD symptom trajectory regardless of treatment type is prognostic . This finding implies that children with behavioral and sociodemographic advantage , with the best response to any treatment , will have the best long-term prognosis . As a group , however , despite initial symptom improvement during treatment that is largely maintained after treatment , children with combined-type ADHD exhibit significant impairment in adolescence . Innovative treatment approaches targeting specific areas of adolescent impairment are needed Background Many non-pharmacological treatments for children and adolescents with attention-deficit/hyperactivity disorder ( ADHD ) have been attempted , but reports indicate that most are ineffective . Although neurofeedback ( NF ) is a treatment approach for children with ADHD that remains promising , a variety of appropriate measures have been used in reporting and evaluating its effect . Objective To report the self-evaluations of NF treatment by children and adolescents with ADHD . Methods R and omized controlled trial in 91 children and adolescents with ADHD , aged less than 18 years ( mean , 11.2 years ) participated in a 30-session program of intensive NF treatment .  Participants were r and omized and allocated by sequentially numbered sealed envelopes into three groups : methylpheni date ( MPH ) as an active control group , and two trial groups NF with MPH , and NF alone .  ADHD core symptoms and school performance were given on a scale of 1 to 10 using a self-reporting question naire , and the changes in these scores after treatment were used as the self-reported evaluation . Basic statistical methods ( descriptive , analyses of variance , exact χ2 test , and paired t-test ) were used to investigate the baseline data . Changes in ADHD core symptoms and treatment effects were investigated using a general linear model for repeated measures . Results Eighty participants completed the treatment study and 73 ( 91 % ) responded sufficiently on the self-reporting question naires . The treatment groups were comparable in age , sex , and cognition as well as in the baseline levels of core ADHD symptoms . All treatments result ed in significant improvements regarding attention and hyperactivity ( P<0.001 ) , and did not differ from each other in effectiveness . However , a significant treatment effect in school performance was observed ( P=0.042 ) , in which only the NF group showed a significant improvement . Conclusion The self-reported improvements in ADHD core symptoms and school performance shortly after treatment indicate NF treatment being promising in comparison with medication , suggesting NF as an alternative treatment for children and adolescents who do not respond to MPH , or who suffer side effects . Further long-term follow-up is needed 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 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 OBJECTIVE Numerous studies have examined the adolescent and young adult fate of children with attention deficit hyperactivity disorder ( ADHD ) .  In marked contrast , relatively little is known about the adult outcome of these children . There have been only two controlled , prospect i ve studies of psychiatric status into adulthood . The present study was conducted to gain further underst and ing of the natural course of this common childhood condition . METHOD This was a prospect i ve follow-up of clinical ly diagnosed , white boys of average intelligence who were referred by teachers to a child psychiatric research clinic at an average age of 7.3 years . At a mean age of 24.1 years , 85 prob and s ( 82 % of the childhood cohort ) and 73 comparison subjects ( 94 % of adolescent comparison subjects ) were directly interviewed by trained clinicians who were blind to group status . RESULTS Evaluations of the prob and s and comparison subjects indicated significantly higher prevalences of antisocial personality disorder ( 12 % versus 3 % ) and nonalcohol substance abuse ( 12 % versus 4 % ) in the prob and s , whereas mood disorders ( 4 % versus 4 % ) and anxiety disorders ( 2 % versus 7 % ) were not significantly different . At adult follow-up , ADHD was rare , occurring in only 4 % of the prob and s ( no comparison subjects ) . CONCLUSIONS The results of the present study are consistent with the authors ' previously reported major findings . They strongly suggest that children with ADHD are at significantly higher risk for a specific negative course marked by antisocial and substance-related disorders Attention-deficit/hyperactivity disorder ( ADHD ) is the most common behavioral disorder in childhood with substantial heritability . Pharmacological and molecular genetic studies as well as characterization of animal models have implicated serotonergic dysfunction in the pathophysiology of ADHD . Here , we investigated the effect of polymorphic variants in the gene of the tryptophan hydroxylase-2 ( TPH2 ) , the rate-limiting enzyme of serotonin ( 5-HT ) synthesis in the brain , in children and adolescents with ADHD . We analyzed three single nucleotide polymorphisms ( SNPs ) in and downstream of the transcriptional control region of the TPH2 gene in 103 families with 225 affected children .  Allelic association in families with more than one affected child was assessed using the pedigree disequilibrium test . Preferential transmissions were detected for the two SNPs in TPH2 's regulatory region ( rs4570625 , P=0.049 ; rs11178997 , P=0.034 ) , but not for the third SNP in intron 2 ( rs4565946 , P=0.3517 ) . Haplotype analysis revealed a strong trend of association between the regulatory region SNPs ( rs4570625 , rs11178997 ) and ADHD ( P=0.064 ) . Our results link potentially functional TPH2 variations to the pathophysiology of ADHD , and further support the relevance of 5-HT in disorders related to altered motor activity and cognitive processes PURPOSE To estimate the risk of schizophrenia in adulthood among children and adolescents with ADHD compared to the background population . SUBJECTS/ MATERIAL S AND METHODS Two hundred and eight youths with ADHD ( 183 boys ; 25 girls ) were followed prospect ively . Diagnoses of schizophrenia were obtained from The Danish Psychiatric Central Register . The relative risk ( RR ) of schizophrenia for cases with ADHD , compared to the normal population , was calculated as risk ratios . Hazard ratios ( HR 's ) by Cox regression were calculated in the predictor analyses . RESULTS Mean age for ADHD cases at follow-up was 31.1years . Schizophrenia diagnoses were given to 3.8 % of these cases . Compared to the general population , RR of schizophrenia in cases with ADHD was 4.3 ( 95 % CI 1.9 - 8.57 ) . DISCUSSION AND CONCLUSION This prospect i ve follow-up study found children with ADHD to be at higher risk of later schizophrenia than controls . If replicated , these results warrant increased focus on the possible emergence symptoms of schizophrenia or schizophreniform psychosis during clinical follow-up of patients with ADHD The aim of this article was to analyze the prevalence of Attention Deficit/ Hyperactivity Disorder ( ADHD ) in Colombian Paisa children and adolescents . A r and omized sample of 4- to 17-year-old children and adolescents--176 males and 154 females -- was selected from schools in Manizales , Colombia . The diagnosis of ADHD was obtained using a semistructured psychiatric and neurological interview , medical histories revision , and neurological or psychiatric evaluations .  Several rating scales and a neuropsychological assessment  were administered in order to confirm the diagnosis . Children with Full Scale Intelligence Quotient ( FSIQ ) between 71 and 84 were recorded as having Borderline Intellectual Functioning ( BIF ) , and those with a history of mild motor retardation , and /or Performance Intelligence Quotient ( PIQ ) lower than 71 , were recorded as having a Developmental Coordination disorder ( DCD ) , after confirmation by neurological and neuropsychological examinations . BIF and DCD children were excluded from the ADHD group . Total prevalence of ADHD adjusted by sex was 16.4 % ( males 19.8 % and females 12.3 % ) . Prevalence of clean ADHD cases was 11.5 % , distrib uted as follows : combined type , 6.4 % ; inattentive , 4.8 % ; and hyperactive-impulsive , 0.3 % . Distribution by sex was as follows : males , 14.8 % ; and females , 7.7 % ; with an odds ratio of 2.1 ( 95 % CI : 1 - 4.5 , h 2 = 4.0 , p < . 05 ) . Clean prevalence of ADHD adjusted by equal sex distribution was 11.3 % . Prevalence of BIF was 5.8 % , DCD 3.0 % , and mild mental retardation 3.9 % . Prevalence of ADHD did not show differences by socioeconomic status ( SES ) , in contrast to mild mental retardation in which BIF and DCD were significantly more frequent in the lower SES BACKGROUND Currently , there is no consensus on the best therapeutic approach to chronic tic disorders and comorbid attention-deficit/hyperactivity disorder ( ADHD ) . To address this issue , we evaluated the tolerability and efficacy of the noradrenergic tricyclic antidepressant desipramine hydrochloride in the treatment of children and adolescents with chronic tic disorders and comorbid ADHD . METHODS Forty-one children and adolescents with chronic tic disorders , including Tourette disorder and comorbid ADHD , were studied in a 6-week , double-blind , placebo-controlled , parallel trial . Desipramine was titrated weekly up to 3.5 mg/kg per day . We rated ADHD and tic symptoms weekly and monitored adverse effects , laboratory findings , and cardiovascular parameters . RESULTS Treatment with desipramine ( mean total daily dose , 3.4 mg/kg per day ) was well tolerated without meaningful adverse effects . Desipramine significantly reduced core symptoms of ADHD ( ADHD Rating Scale ; 42 % decrease from baseline relative to placebo , P<.001 ) , with equal response in inattentive symptoms and hyperactive/impulsive symptoms ( P<.001 for both ) . The ADHD response rate was robust ( 71 % vs 0 % ; desipramine vs placebo , P<.001 ) . Likewise , desipramine significantly reduced tic symptoms ( Yale Global Tic Severity Scale ; 30 % decrease from baseline relative to placebo , P<.001 ) , with equal response in motor and phonic tic symptoms ( P<.01 for both ) . The tic response rate was substantial ( 58 % vs 5 % ; desipramine vs placebo , P<.001 ) . There were small but statistically significant differences between desipramine and placebo in heart rate and blood pressure . CONCLUSIONS Treatment with desipramine was well tolerated and was associated with robust clinical ly significant reductions in tic and ADHD symptoms in children and adolescents with chronic tic disorders and ADHD diagnoses
At the class level , behavioural therapy ( alone or in combination with stimulants ) , stimulants , and non-stimulant seemed significantly more efficacious than placebo .
Behavioural therapy in combination with stimulants seemed superior to stimulants or non-stimulants .
Stimulants seemed superior to behavioural therapy , cognitive training and non-stimulants .
Behavioural therapy , stimulants and their combination showed the best profile of acceptability .
Stimulants and non-stimulants seemed well tolerated .
Among medications , methylpheni date , amphetamine , atomoxetine , guanfacine and clonidine seemed significantly more efficacious than placebo .
Methylpheni date and amphetamine seemed more efficacious than atomoxetine and guanfacine .
Methylpheni date and clonidine seemed better accepted than placebo and atomoxetine .
Most of the efficacious pharmacological treatments were associated with harms ( anorexia , weight loss and insomnia ) , but an increased risk of serious adverse events was not observed .
There is lack of evidence for cognitive training , neurofeedback , antidepressants , antipsychotics , dietary therapy , fatty acids , and other complementary and alternative medicine .
Clinical differences may exist between the pharmacological and non-pharmacological treatment used for the management of ADHD .
BACKGROUND Attention deficit hyperactivity disorder ( ADHD ) is one of the most commonly diagnosed psychiatric disorders in childhood .
A wide variety of treatments have been used for the management of ADHD .
We aim ed to compare the efficacy and safety of pharmacological , psychological and complementary and alternative medicine interventions for the treatment of ADHD in children and adolescents .