A double-blind comparison of desipramine and placebo in children and adolescents with chronic tic disorder and comorbid attention-deficit/hyperactivity disorder. Clinical symptoms and performance on the continuous performance test in children with attention deficit hyperactivity disorder between subtypes: a natural follow-up study for 6 months Randomised controlled study-efficacy of clonidine versus carbamazepine in children with ADHD. Predictors of Boys’ ADHD Symptoms from Early to Middle Childhood: The Role of Father–Child and Mother–Child Interactions Effect of Supplementation with Polyunsaturated Fatty Acids and Micronutrients on Learning and Behavior Problems Associated with Child ADHD Positive Effects of Methylphenidate on Inattention and Hyperactivity in Pervasive Developmental Disorders: An Analysis of Secondary Measures Neurofeedback in ADHD: a single-blind randomized controlled trial Omega-3/Omega-6 Fatty Acids for Attention Deficit Hyperactivity Disorder Association and linkage of alpha-2A adrenergic receptor gene polymorphisms with childhood ADHD. [The prevalence of attention-deficit/hyperactivity disorder (ADHD) among children and adolescents in Germany. Initial results from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS)]. Effect of vitamin D treatment in children with attention-deficit hyperactivity disorder Patterns and Predictors of Attention-Deficit/Hyperactivity Disorder Persistence into Adulthood: Results from the National Comorbidity Survey Replication Sex Differences in Effectiveness of Extended-Release Stimulant Medication among Adolescents with Attention-Deficit/Hyperactivity Disorder Childhood predictors of adolescent substance use in a longitudinal study of children with ADHD. Depression, anxiety and obsessive-compulsive symptoms and quality of life in children with attention-deficit hyperactivity disorder (ADHD) during three-month methylphenidate treatment A Randomized Trial Examining the Effects of Aerobic Physical Activity on Attention-Deficit/Hyperactivity Disorder Symptoms in Young Children Effectiveness of a School-Based Multicomponent Program for the Treatment of Children with ADHD Efficacy of the Incredible Years Basic parent training programme as an early intervention for children with conduct problems and ADHD. Long-acting methylphenidate has an effect on aggressive behavior in children with attention-deficit/hyperactivity disorder. Effects of mindfulness-based cognitive therapy on neurophysiological correlates of performance monitoring in adult attention-deficit/hyperactivity disorder Controlled-release methylphenidate improves attention during on-road driving by adolescents with attention-deficit/hyperactivity disorder. Clonidine extended-release tablets for pediatric patients with attention-deficit/hyperactivity disorder. Evaluation of the Persistence, Remission, and Emergence of Attention-Deficit/Hyperactivity Disorder in Young Adulthood.
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 Background The aims of this study were to determine the time course of improvements in attention deficit hyperactivity disorder ( ADHD ) clinical symptoms and neurocognitive function in a realistic clinical setting , and the differences in ADHD symptom improvement using different classifications of ADHD subtypes . Methods The Child Behavior Checklist ( CBCL ) was completed by parents of ADHD children at the initial visit . The  computerized Continuous Performance Test ( CPT ) , Swanson , Nolan , and Pelham , and Version IV Scale for ADHD ( SNAP-IV ) , and  ADHD Rating Scale ( ADHD-RS ) were performed at baseline , one month , three months , and six months later , respectively . Patient care including drug therapy was performed at the discretion of the psychiatrist . The ADHD patients were divided into DSM-IV subtypes ( Inattentive , Hyperactive-impulsive and Combined type ) , and were additionally categorized into aggressive and non-aggressive subtypes by aggression scale in CBCL for comparisons . Results There were 50 ADHD patients with a mean age of 7.84 ± 1.64 years ; 15 of them were inattentive type , 11 were hyperactive-impulsive type , and 24 were combined type . In addition , 28 of the ADHD patients were grouped into aggressive and 22 into non-aggressive subtypes . There were significant improvements in clinical symptoms of hyperactivity and inattention , and impulsivity performance in CPT during the 6-month treatment . The clinical hyperactive symptoms were significantly different between ADHD patients sub-grouping both by DSM-IV and aggression . Non-aggressive patients had significantly greater changes in distraction and impulsivity performances in CPT from baseline to month 6 than aggressive patients . Conclusions We found that ADHD symptoms , which included impulsive performances in CPT and clinical inattention and hyperactivity dimensions , had improved significantly over 6 months under pragmatic treatments . The non-aggressive ADHD patients might have a higher potential for improving in CPT performance than aggressive ones . However , it warrant further investigation whether the different classifications of ADHD patients could be valid for predicting the improvements in ADHD patients ' clinical symptoms and neurocognitive performance 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 This prospect i ve 3 year longitudinal study investigated preschool paternal and maternal parenting predictors of Attention-Deficit/Hyperactivity Disorder(ADHD ) in a community sample of 93 school-age boys . Participants were recruited on the basis of inattention-hyperactivity at age 4 and fathers and mothers were observed interacting with their sons . Teachers , fathers , and mothers reported children 's ADHD symptoms and impairment . Results from dimensional analysis showed that less observed paternal sensitivity and maternal positive regard predicted higher levels of inattentiveness in middle childhood , and that intrusive paternal behavior was predictive of hyperactive-impulsive behavior at school . In categorical analysis , less maternal warmth and sensitivity were predictive of later ADHD . These predictions held after statistical adjustment for the effects of preschool ADHD behaviors and conduct problems . At follow-up , parents of boys with ADHD reported more negative child-parent relationship perceptions than comparison parents . Findings highlight the importance of examining responsive parenting behaviors of both fathers and mothers in relation to multi-informant ratings of ADHD symptoms Methods : Various developmental problems including attention-deficit/hyperactivity disorder ( ADHD ) have been linked to biological deficiencies in polyunsaturated fatty acids ( PUFAs ) . Additionally , there is evidence that symptoms may be reduced with PUFA supplementation . This study investigated effects of supplementation with PUFAs on symptoms typically associated with ADHD . Because nutrients work synergistically , additional effects of micronutrient supplementation were also investigated . A total of 132 Australian children aged 7 to 12 years with scores ≥2 SD above the population average on the Conners ADHD Index participated in a r and omized , placebo-controlled , double-blind intervention over 15 weeks , taking PUFAs alone , PUFAs + micronutrients , or placebo . Due to unreturned question naires , data were only available for 104 children . Results : Significant medium to strong positive treatment effects were found on parent ratings of core ADHD symptoms , inattention , hyperactivity/impulsivity , on the Conners Parent Rating Scale ( CPRS ) in both PUFA treatment groups compared with the placebo group ; no additional effects were found with the micronutrients . After a one-way crossover to active supplements in all groups for a further 15 weeks , these results were replicated in the placebo group , and the treatment groups continued to show significant improvements on CPRS core symptoms . No significant effects were found on Conners Teacher Rating Scales . Conclusion : These results add to preliminary findings that ADHD-related problems with inattention , hyperactivity , and impulsivity might respond to treatment with PUFAs and that improvements may continue with supplementation extending to 30 weeks BACKGROUND Methylpheni date has been shown elsewhere to improve hyperactivity in about half of treated children who have pervasive developmental disorders ( PDD ) and significant hyperactive-inattentive symptoms . We present secondary analyses to better define the scope of effects of methylpheni date on symptoms that define attention-deficit/hyperactivity disorder ( ADHD ) and oppositional defiant disorder ( ODD ) , as well as the core autistic symptom domain of repetitive behavior . METHODS Sixty-six children ( mean age 7.5 y ) with autistic disorder , Asperger 's disorder , and PDD not otherwise specified , were r and omized to varying sequences of placebo and three different doses of methylpheni date during a 4-week blinded , crossover study . Methylpheni date doses used approximated .125 , .25 , and .5 mg/kg per dose , twice daily , with an additional half-dose in the late afternoon . Outcome measures included the Swanson , Nolan , and Pelham Question naire revised for DSM-IV ( ADHD and ODD scales ) and the Children 's Yale-Brown Obsessive Compulsive Scales for PDD . RESULTS Methylpheni date was associated with significant improvement that was most evident at the .25- and .5-mg/kg doses . Hyperactivity and impulsivity improved more than inattention . There were not significant effects on ODD or stereotyped and repetitive behavior . CONCLUSIONS Convergent evidence from different assessment s and raters confirms methylpheni date 's efficacy in relieving ADHD symptoms in some children with PDD . Optimal dose analyses suggested significant interindividual variability in dose response Neurofeedback treatment has been demonstrated to reduce inattention , impulsivity and hyperactivity in children with attention deficit/hyperactivity disorder ( ADHD ) . However , previous studies did not adequately control confounding variables or did not employ a r and omized reinforcer-controlled design . This study addresses those method ological shortcomings by comparing the effects of the following two matched biofeedback training variants on the primary symptoms of ADHD : EEG neurofeedback ( NF ) aim ing at theta/beta ratio reduction and EMG biofeedback ( BF ) aim ing at forehead muscle relaxation . Thirty-five children with ADHD ( 26 boys , 9 girls ; 6–14 years old ) were r and omly assigned to either the therapy group ( NF ; n = 18 ) or the control group ( BF ; n = 17 ) . Treatment for both groups consisted of 30 sessions . Pre- and post-treatment assessment consisted of psychophysiological measures , behavioural rating scales completed by parents and teachers , as well as psychometric measures . Training effectively reduced theta/beta ratios and EMG levels in the NF and BF groups , respectively . Parents reported significant reductions in primary ADHD symptoms , and inattention improvements in the NF group were higher compared to the control intervention ( BF , dcorr = −.94 ) . NF training also improved attention and reaction times on the psychometric measures . The results indicate that NF effectively reduced inattention symptoms on parent rating scales and reaction time in neuropsychological tests . However , regarding hyperactivity and impulsivity symptoms , the results imply that non-specific factors , such as behavioural contingencies , self-efficacy , structured learning environment and feed-forward processes , may also contribute to the positive behavioural effects induced by neurofeedback training Objective : The aim of the study was to assess omega 3/6 fatty acids ( eye q ) in attention deficit hyperactivity disorder ( ADHD ) . Method : The study included a r and omized , 3-month , omega 3/6 placebo-controlled , one-way crossover trial with 75 children and adolescents ( 8—18 years ) , followed by 3 months with omega 3/6 for all .  Investigator-rated ADHD Rating Scale — IV and Clinical Global Impression ( CGI ) scale were outcome measures . Results : A majority did not respond to omega 3/6 treatment . However , a subgroup of 26 % responded with more than 25 % reduction of ADHD symptoms and a drop of CGI scores to the near-normal range . After 6 months , 47 % of all showed such improvement . Responders tended to have ADHD inattentive subtype and comorbid neurodevelopmental disorders . Conclusion : A subgroup of children and adolescents with ADHD , characterized by inattention and associated neurodevelopmental disorders , treated with omega 3/6 fatty acids for 6 months responded with meaningful reduction of ADHD symptoms . ( J. of Att . Dis . 2009 ; 12(5 ) 394 - 401 Attention-deficit hyperactivity disorder ( ADHD ) is a heritable disorder , prevalent from childhood through adulthood . Although the noradrenergic ( NA ) system is thought to mediate a portion of the pathophysiology of ADHD , genes in this pathway have not been investigated as frequently as those in the dopaminergic system . Previous association studies of one c and i date gene in the NA system , ADRA2A , showed inconsistent results with regard to an MspI polymorphism . In the current study , two nearby single-nucleotide polymorphisms , which define HhaI and DraI restriction fragment length polymorphisms , were also genotyped and were in significant linkage disequilibrium with the MspI RFLP . Transmission disequilibrium tests ( TDTs ) in a sample of 177 nuclear families showed significant association and linkage of the DraI polymorphism with the ADHD combined subtype ( P=0.03 ) , and the quantitative TDT showed association of this polymorphism with the inattentive ( P=0.003 ) and hyperactive-impulsive ( P=0.015 ) symptom dimensions . The haplotype that contained the less common allele of the DraI polymorphism likewise showed a strong relationship with the inattentive ( P=0.001 ) and hyperactive-impulsive ( P=0.004 ) symptom dimensions . This study supports the hypothesis that an allele of the ADRA2A gene is associated and linked with the ADHD combined subtype and suggests that the DraI polymorphism of ADRA2A is linked to a causative polymorphism The cardinal symptoms of attention-deficit/hyperactivity disorder ( ADHD ) are inattention , hyperactivity and impulsivity . Etiologically , ADHD is mainly put down to genetic causes ; it entails a considerable range of psychosocial problems for those affected and their social environment . The parents of a total of 7,569 boys ( B ) and 7,267 girls ( G ) aged 3 - 17 who took part in the German Health Interview and Examination Survey for Children and Adolescents ( KiGGS ) answered a self-administered question naire including an ADHD diagnosis question and the  Strengths and Difficulties Question naire ( SDQ )  . In addition behavioural observations of 7,919 children ( aged 3 - 11 ) were carried out during the medical and physical tests . Participants whose parents reported that they had ever been given an ADHD diagnosis by a doctor or psychologist were classified as ADHD cases . Participants were classified as suspected cases of ADHD if they had a value of > or = 7 on the SDQ inattention/hyperactivity scale . ADHD had ever been diagnosed in 4.8 % of the children and adolescents altogether ( B : 7.7 % , G : 1.8 % ) . Another 4.9 % of the participants can be considered as suspected cases . Already 1.8 % of the preschoolers had been given an ADHD diagnosis . At primary school age ( 7 - 10 years old ) the frequency of diagnosis rises sharply . At age 11 - 17 , ADHD had ever been diagnosed in 1 in 10 boys and 1 in 43 girls . ADHD had been diagnosed significantly more frequently among participants of low socio-economic status ( SES ) than among participants of high SES . A diagnosis of ADHD is reported less often for migrants , they rank more frequently among the suspected cases . The discrepancy between confirmed and suspected cases of ADHD among migrants may point to lower diagnosis rates or lower utilization of medical services . The short- and long-term medical , social and health-economic effects of ADHD illustrate the major public health relevance of the disorder . As for prevention , the high share of genetic factors in ADHD etiology primarily suggests secondary prevention ( early support and early diagnosis ) and tertiary prevention measures . Further analysis of the KiGGS data could prospect ively identify risk groups more precisely and refine preventional approaches Background In this research the symptom improvement of attention-deficit hyperactivity disorder ( ADHD ) of children was assessed by oral vitamin D administration  in Tabriz , Iran . Methods In this double-blind , r and omized clinical trials , 96 children ( 2–18 years ) were enrolled to placebo and vitamin D groups . Children took vitamin D pearl ( 50,000 IU/week ) or placebo for 6 weeks . Children , who had the change in methylpheni date dosage and received any anticonvulsants and corticosteroids were excluded from the research . ADHD symptoms were diagnosed by Conners parent rating scale ( CPRS ) test at baseline and after intervention . ADHD Conners divided into inattention ( IA ) , hyperactivity/impulsivity ( H/I ) and combination type ( C ) subscales .  Vitamin D serum level was assessed at baseline and after 8 weeks in both groups . Results The differences between CPRS and its subscales were not significant at baseline ( P > 0.05 ) . The Conners IA score was decreased in vitamin D group ( P < 0.05 ; adjusted with age and baseline values ) . ADHD Conners and all subscale scores reduced remarkably after intervention in patients with insufficient level of vitamin D compared to placebo ( P < 0.05 ) . Conclusions Oral vitamin D  improved ADHD symptoms with a particular effect on inattention symptoms . In addition , symptoms related to all subscales were improved remarkably in patients with insufficient level of vitamin D. Vitamin D treatment in children with ADHD could be considered due to the exp and benefit of vitamin D in body 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 This study examined whether adolescent females with attention-deficit/hyperactivity disorder ( ADHD ) are differentially responsive than their male counterparts to extended-release stimulant medications . This investigation may bear special importance for an adolescent ( as opposed to child ) population , because hormonal and metabolism differences between sexes are most likely to emerge at this time . Male ( n = 19 ) and female ( n = 16 ) adolescents , ages 16–19 with ADHD , participated in a r and omized , double-blind crossover study evaluating the effectiveness of osmotic-release methylpheni date , extended release amphetamine salts , placebo , and routine limited medication regimen . Medication efficacy was evaluated using ADHD symptom ratings from adolescent self-report and parent report , along with objective measures of inattention and hyperactivity/impulsivity during driving performance and neuropsychological tasks . Males and females were largely equivalent in impairment , and medication was similarly effective in reducing symptoms . No interactions were found between sex and medication on any measure of effectiveness or side effects . This finding suggests that the efficacy and tolerability of extended-release stimulant medications is equivalent for male and female adolescents with ADHD 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 The current study was design ed to investigate the changes that occur in depression , anxiety , obsessive — compulsive symptoms and health-related quality of life during methylpheni date ( MPH ) treatment in children with attention-deficit hyperactivity disorder ( ADHD ) . Forty-five treatment naive children with ADHD , aged 8—14 , were assessed based on self , parent and teacher reports at the baseline and at the end of the first and third month of MPH treatment regarding changes in inattention , hyperactivity , impulsivity , depression , anxiety and obsessive — compulsive symptoms . Changes in the quality of life were also noted . Repeated measures of analysis of variance ( ANOVA ) tests with Bonferroni corrections were conducted in order to evaluate the data . Symptoms of inattention , hyperactivity and impulsivity were significantly reduced ( p < 0.017 ) following a three-month MPH treatment . There were significant decreases in depression ( p = 0.004 ) , trait anxiety ( p = 0.000 ) and checking compulsion symptom scores ( p = 0.001 ) . Moreover , parents reported significant improvements in psychosocial ( p = 0.001 ) and total scores ( p = 0.009 ) of quality of life , despite no change in physical health scores ( p > 0.05 ) . Children ’s ratings of quality of life measures showed no significant changes in physical health and psychosocial scores ( p > 0.05 ) , while total scores significantly improved ( p = 0.001 ) after the treatment . Over a three-month MPH treatment , depression , trait anxiety and checking compulsion symptoms decreased and quality of life seemed to improve along with those of inattention , hyperactivity and impulsivity The goal of this study was to compare the effects of before school physical activity ( PA ) and sedentary classroom-based ( SC ) interventions on the symptoms , behavior , moodiness , and peer functioning of young children ( Mage = 6.83 ) at risk for attention-deficit/hyperactivity disorder ( ADHD-risk ; n = 94 ) and typically developing children ( TD ; n = 108 ) . Children were r and omly assigned to either PA or SC and participated in the assigned intervention 31 min per day , each school day , over the course of 12 weeks . Parent and teacher ratings of ADHD symptoms ( inattention , hyperactivity/impulsivity ) , oppositional behavior , moodiness , behavior toward peers , and reputation with peers , were used as dependent variables . Primary analyses indicate that the PA intervention was more effective than the SC intervention at reducing inattention and moodiness in the home context . Less conservative follow-up analyses within ADHD status and intervention groups suggest that a PA intervention may reduce impairment associated with ADHD-risk in both home and school domains ; interpretive caution is warranted , however , given the liberal approach to these analyses . Unexpectedly , these findings also indicate the potential utility of a before school SC intervention as a tool for managing ADHD symptoms . Inclusion of a no treatment control group in future studies will enable further underst and ing of PA as an alternative management strategy for ADHD symptoms The objective of this study was to evaluate the efficacy of a multicomponent program for treating attention-deficit/hyperactivity disorder ( ADHD ) carried out by teachers in a classroom context . Dependent measures included neuropsychological tasks , behavioral rating scales for parents and teachers , direct observation of behavior in the classroom , and academic records of children with ADHD . Fifty children with ADHD participated in the study . The teachers of 29 of the 50 students  were trained in the use of behavior modification techniques , cognitive behavior strategies , and instructional management strategies . The other 21 students formed the  control group . Parents ' and teachers'ratings detected improvements in primary symptoms ( inattention — disorganization , hyperactivity — impulsivity ) and in behavioral difficulties usually associated with ADHD ( e.g. , antisocial behavior , psychopathological disorders , anxiety ) . Furthermore , the results showed increased academic scores , enhanced classroom behavioral observations , and improved teachers ' knowledge about the strategies directed toward responding to the children 's educational needs BACKGROUND The efficacy of the Incredible Years ( IY ) Basic parent training ( PT ) programme for a community-based sample of families with pre-school children at risk of developing both conduct problems and attention deficit hyperactivity disorder ( ADHD ) was examined . METHODS Pre-school children displaying signs of both early-onset conduct problems and ADHD were r and omly allocated to either IY PT intervention , or to a waiting list ( WL ) control group . Child symptoms were assessed before and after the intervention . RESULTS Post intervention , the intervention group was associated with significantly lower levels of parent-reported inattention and hyperactive/impulsive difficulties , even after controlling for post-intervention changes in child deviance . In addition , 52 % of those in the intervention condition , compared with 21 % in the control condition , displayed clinical ly reliable improvements post intervention , giving an absolute risk reduction of 31 % and a number needed to treat of 3.23 . CONCLUSIONS Findings from this study indicate that the IY PT programme is a valuable intervention for many pre-school children displaying early signs of ADHD INTRODUCTION Aggression is frequently observed in children and adolescents with attention-deficit/hyperactivity disorder ( ADHD ) . The aim of this study was to assess the efficacy with regard to oppositional and aggressive behavior of a new long-acting methylpheni date preparation ( Medikinet retard , MPH-MR ) , with equal portions of the immediate-release and the sustained-release active substance , and especially to look at correlations between either teacher or parent assessment of aggression and ADHD sub-symptomatology . METHODS Eighty five children and adolescents ( 6 - 16 years ) were investigated in a double-blind , r and omized , clinical trial over 5 weeks under a treatment with MPH-MR  using symptom checklists for ADHD , oppositional-defiant and conduct disorder according to the Diagnostic and Statistical Manual of Mental Disorders , 4th edition ( DSM-IV ) . RESULTS A total of 64.9 % of the children showed oppositional defiant disorder/conduct disorder ( ODD/CD ) symptoms . A statistically significant effect was found in the group treated with MPH ( verum-group ) . On the basis of Cohen 's criteria , high effects were found for aggressive symptoms in school ( d = 1.0 ) , but not in the afternoon ( d = 0.4 ) . There were also lower effect sizes for more severe aggressive symptoms . We found characteristic correlations between ODD/CD symptoms and the ADHD subscale hyperactivity/impulsivity compared to the subscale inattention . CONCLUSIONS Long-acting MPH is effective in the treatment of oppositional-defiant and aggressive behavior , especially concerning milder symptoms . The expected correlation between impulsivity and aggressiveness could be confirmed OBJECTIVE To examine whether mindfulness-based cognitive therapy ( MBCT ) would enhance attenuated amplitudes of event-related potentials ( ERPs ) indexing performance monitoring biomarkers of attention-deficit/hyperactivity disorder ( ADHD ) . METHODS Fifty adult ADHD patients took part in a r and omised controlled study investigating ERP and clinical measures pre-to-post MBCT .  Twenty-six patients were r and omly allocated to MBCT , 24 to a wait-list control . Main outcome measures included error processing ( ERN , Pe ) , conflict monitoring ( NoGo-N2 ) , and inhibitory control ( NoGo-P3 ) ERPs concomitant to a continuous performance task ( CPT-X ) . Inattention and hyperactivity-impulsivity ADHD symptoms , psychological distress and social functioning , and mindfulness skills were also assessed . RESULTS MBCT was associated with increased Pe and NoGo-P3 amplitudes , coinciding with reduced ' hyperactivity/impulsivity ' and ' inattention ' symptomatology . Specific to the MBCT ; enhanced Pe amplitudes correlated with a decrease in hyperactivity/impulsivity symptoms and increased ' act-with-awareness ' mindfulness skill , whereas , enhanced P3 correlated with amelioration in inattention symptoms . CONCLUSIONS MBCT enhanced ERP amplitudes associated with motivational saliency and error awareness , leading to improved inhibitory regulation . SIGNIFICANCE MBCT suggests having comparable modulation on performance monitoring ERP amplitudes as pharmacological treatments . Further study and development of MBCT as a treatment for ADHD is warranted , in addition to its potential scope for clinical applicability to broader defined externalising disorders and clinical problems associated with impairments of the prefrontal cortex BACKGROUND Attention-deficit/hyperactivity disorder ( ADHD ) is associated with a 3- to 4-fold increase in both driving-related accidents and associated injuries .  Methylpheni date ( MPH ) is the most commonly prescribed psychostimulant medication for ADHD . It has been demonstrated to improve performance on a driving simulator . This study investigated whether a once-daily , long-acting , osmotic , controlled-release MPH formulation improves the driving performance of ADHD adolescents while driving their own car on an actual road segment . METHODS Twelve ADHD-diagnosed male adolescent drivers ( mean age , 17.8 years ) prescribed a st  and ard  dose of 1.0 mg/kg ( if they were not already taking methylpheni date ) of controlled-release MPH participated in this repeated- measures crossover study . On 2 separate occasions ( off/on medication r and omized ) , participants drove a st and ard 16-mile road course incorporating rural , highway , and urban streets . A rater , blind to medication conditions , sat in the back seat and rated impulsive ( eg , " cutting off " another driver ) and inattentive ( eg , drove past design ated turn ) driving errors . RESULTS Impulsive driving errors were observed to occur rarely under both medication and no medication conditions . Inattentive driving errors were more common and were significantly reduced while the subject was on medication ( 4.6 versus 7.8 ; P < .01 ) . The improvement in driving performance ( change in number of errors recorded ) from first to second testing was positively correlated with medication dosage ( r = 0.60 ; P < .01 ) . CONCLUSIONS Once-daily controlled-release MPH improves real-life driving performance of adolescent males diagnosed with ADHD . In particular , it significantly reduces driving errors arising from inattention OBJECTIVE This study examined the efficacy and safety of clonidine hydrochloride extended-release tablets ( CLON-XR ) in children and adolescents with attention-deficit/hyperactivity disorder ( ADHD ) . METHOD This 8-week , placebo-controlled , fixed-dose trial , including 3 weeks of dose escalation , of patients 6 to 17 years old with ADHD evaluated the efficacy and safety of CLON-XR 0.2 mg/day or CLON-XR 0.4 mg/day versus placebo in three separate treatment arms . Primary endpoint was mean change in ADHD Rating Scale-IV ( ADHD-RS-IV ) total score from baseline to week 5 versus placebo using a last observation carried forward method . Secondary endpoints were improvement in ADHD-RS-IV inattention and hyperactivity/impulsivity subscales , Conners Parent Rating Scale-Revised : Long Form , Clinical Global Impression of Severity , Clinical Global Impression of Improvement , and Parent Global Assessment from baseline to week 5 . RESULTS Patients ( N = 236 ) were r and omized to receive placebo ( n = 78 ) , CLON-XR 0.2 mg/day ( n = 78 ) , or CLON-XR 0.4 mg/day ( n = 80 ) . Improvement from baseline in ADHD-RS-IV total score was significantly greater in both CLON-XR groups versus placebo at week 5 . A significant improvement in ADHD-RS-IV total score occurred between groups as soon as week 2 and was maintained throughout the treatment period . In addition , improvement in ADHD-RS-IV inattention and hyperactivity/impulsivity subscales , Conners Parent Rating Scale-Revised : Long Form , Clinical Global Impression of Improvement , Clinical Global Impression of Severity , and Parent Global Assessment , occurred in both treatment groups versus placebo . The most common treatment-emergent adverse event was mild-to-moderate somnolence . Changes on electrocardiogram were minor and reflected the known pharmacology of clonidine . CONCLUSIONS Clonidine hydrochloride extended-release tablets were generally well tolerated by patients in the study and significantly improved ADHD symptoms in this pediatric population IMPORTANCE Attention-deficit/hyperactivity disorder ( ADHD ) is now recognized to occur in adulthood and is associated with a range of negative outcomes . However , less is known about the prospect i ve course of ADHD into adulthood , the risk factors for its persistence , and the possibility of its emergence in young adulthood in non clinical population s. OBJECTIVE To investigate childhood risk factors and young adult functioning of individuals with persistent , remitted , and late-onset young adult ADHD . DESIGN , SETTING , AND PARTICIPANTS The study sample was the Environmental Risk ( E-Risk ) Longitudinal Twin Study , a nationally representative birth cohort of 2232 twins born in Engl and and Wales from January 1 , 1994 , to December 4 , 1995 . Evaluation of childhood ADHD ( ages 5 , 7 , 10 , and 12 years ) included prenatal and perinatal factors , clinical characteristics , and aspects of the family environment .  Among participants aged 18 years , ADHD symptoms and associated impairment , overall functioning , and other mental health disorders were examined . Data analysis was conducted from February 19 to September 10 , 2015 . MAIN OUTCOMES AND MEASURES Attention-deficit/hyperactivity disorder according to DSM-IV diagnostic criteria in childhood and DSM-5 diagnostic criteria in young adulthood . RESULTS Of 2232 participants in the E-Risk Study , 2040 were included in the present analysis . In total , 247 individuals met diagnostic criteria for childhood ADHD ; of these , 54 ( 21.9 % ) also met diagnostic criteria for the disorder at age 18 years . Persistence was associated with more symptoms ( odds ratio [ OR ] , 1.11 [ 95 % CI , 1.04 - 1.19 ] ) and lower IQ ( OR , 0.98 [ 95 % CI , 0.95 - 1.00 ] ) . At age 18 years , individuals with persistent ADHD had more functional impairment ( school/work : OR , 3.30 [ 95 % CI , 2.18 - 5.00 ] , home/with friends : OR , 6.26 [ 95 % CI , 3.07 - 12.76 ] ) , generalized anxiety disorder ( OR , 5.19 [ 95 % CI , 2.01 - 13.38 ] ) , conduct disorder ( OR , 2.03 [ 95 % CI , 1.03 - 3.99 ] ) , and marijuana dependence ( OR , 2.88 [ 95 % CI , 1.07 - 7.71 ] ) compared with those whose ADHD remitted . Among 166 individuals with adult ADHD , 112 ( 67.5 % ) did not meet criteria for ADHD at any assessment in childhood . Results from logistic regressions indicated that individuals with late-onset ADHD showed fewer externalizing problems ( OR , 0.93 [ 95 % CI , 0.91 - 0.96 ] ) and higher IQ ( OR , 1.04 [ 95 % CI , 1.02 - 1.07 ] ) in childhood compared with the persistent group . However , at age 18 years , those with late-onset ADHD demonstrated comparable ADHD symptoms and impairment as well as similarly elevated rates of mental health disorders . CONCLUSIONS AND RELEVANCE We identified heterogeneity in the DSM-5 young adult ADHD population such that this group consisted of a large , late-onset ADHD group with no childhood diagnosis , and a smaller group with persistent ADHD . The extent to which childhood-onset and late-onset adult ADHD may reflect different causes has implication s for genetic studies and treatment of ADHD
Desipramine appeared more efficacious than clonidine in reducing ADHD symptoms as rated by parents ( SMD -0.90 , 95 % CI -1.40 to -0.40 , 1 trial , 68 participants , very low quality evidence ) in participants with ADHD and comorbid tics or Tourette syndrome .
Although this Cochrane Review did not identify serious adverse effects in patients taking TCAs , it did identify mild increases in diastolic blood pressure and pulse rates .
Also , patients treated with desipramine had significantly higher rates of appetite suppression compared to placebo whilst nortriptyline result ed in weight gain .
Other reported adverse effects included headache , confusion , sedation , tiredness , blurred vision , diaphoresis , dry mouth , abdominal discomfort , constipation , and urinary retention .
AUTHORS ' CONCLUSIONS Most evidence on TCAs relates to desipramine .
Findings suggest that , in the short term , desipramine improves the core symptoms of ADHD , but its effect on the cardiovascular system remains an important clinical concern .
BACKGROUND Attention deficit hyperactivity disorder ( ADHD ) is a chronic neurodevelopmental disorder of childhood onset , which may persist into adulthood .
ADHD has a significant impact on a child 's daily life , affecting relationships and academic performance .
Its core symptoms include developmentally inappropriate levels of inattention , hyperactivity , and impulsive behaviour .
Tricyclic antidepressants ( TCAs ) are sometimes used as second line of treatment in the reduction of ADHD symptoms in children and adolescents with ADHD .
However , their efficacy is not yet known .
OBJECTIVES To assess the efficacy of TCAs in the reduction of ADHD symptoms within the broad categories of hyperactivity , impulsivity , and inattentiveness in young people aged 6 to 18 years with established diagnoses of ADHD .