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 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 Training of slow cortical potentials in attention-deficit/hyperactivity disorder: evidence for positive behavioral and neurophysiological effects Exercise impact on sustained attention of ADHD children, methylphenidate effects Differential impact of methylphenidate and atomoxetine on sustained attention in youth with attention-deficit/hyperactivity disorder. Does Methylphenidate Improve Inhibition and Other Cognitive Abilities in Adults with Childhood-Onset ADHD? A context for normalizing impulsiveness at work for adults with attention deficit/hyperactivity disorder (combined type). Effects of two doses of methylphenidate on simulator driving performance in adults with attention deficit hyperactivity disorder. Improving attention-deficit/hyperactivity disorder treatment outcomes through use of a collaborative consultation treatment service by community-based pediatricians: a cluster randomized trial. Does Atomoxetine Improve Executive Function, Inhibitory Control, and Hyperactivity?: Results From a Placebo-Controlled Trial Using Quantitative Measurement Technology Executive Impairment Determines ADHD Medication Response: Implications for Academic Achievement Relationships Between Computer-Based Testing and Behavioral Ratings in the Assessment of Attention and Activity in a Pediatric ADHD Stimulant Crossover Trial Erratum to: Long-acting methylphenidate formulations in the treatment of attention-deficit/hyperactivity disorder: a systematic review of head-to-head studies Treatment of Children With Attention-Deficit/Hyperactivity Disorder (ADHD) and Irritability: Results From the Multimodal Treatment Study of Children With ADHD (MTA) Effects of mindfulness-based cognitive therapy on neurophysiological correlates of performance monitoring in adult attention-deficit/hyperactivity disorder Variability in ADHD Care in Community-Based Pediatrics Acute impact of immediate release methylphenidate administered three times a day on sleep in children with attention-deficit/hyperactivity disorder. A Pilot Twin Study of Psychological Measures of Attention Deficit Hyperactivity Disorder Neuropsychological outcomes across the day in children with attention-deficit/hyperactivity disorder treated with atomoxetine: results from a placebo-controlled study using a computer-based continuous performance test combined with an infra-red motion-tracking device. The effectiveness of methylphenidate in the management of Attention Deficit Hyperactivity Disorder (ADHD) in people with intellectual disabilities: A systematic review. Methylphenidate Normalizes Frontocingulate Underactivation During Error Processing in Attention-Deficit/Hyperactivity Disorder Effects of Methylphenidate on Impulsive Responding in Children With Attention-Deficit Hyperactivity Disorder Computer-Assisted Management of Attention-Deficit/Hyperactivity Disorder
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 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 Learned self-control of slow cortical potentials ( SCPs ) may lead to behavioral improvement in attention-deficit/hyperactivity disorder ( ADHD ) . Hence , training effects should also be reflected at the neurophysiological level . METHODS Thirteen children with ADHD , aged 7 - 13 years , performed 25 SCP training sessions within 3 weeks . Before and after training , the German ADHD rating scale was completed by parents , and event-related potentials were recorded in a cued continuous performance test ( CPT ) . For a waiting-list group of nine children with ADHD , the same testing was applied . RESULTS ADHD symptomatology was reduced by approximately 25 % after SCP training . Moreover , a decrease of impulsivity errors and an increase of the contingent negative variation were observed in the CPT task . CONCLUSIONS This study provides first evidence for both positive behavioral and specific neurophysiological effects of SCP training in children with ADHD Attention deficit hyperactivity disorder ( ADHD ) is related to a deficiency of central catecholamines ( CA ) in cognitive , biochemical , and physical tests , and pharmaceutical intervention may have no effect if it is not accompanied by changes in the environment . The objective of our study was to test the hypothesis that central CA are responsible for the increase in speed reaction seen after physical activity ( PA ) and to measure the impact of high intensity PA on the sustained attention of 25 children diagnosed with ADHD consistent with the Disease Statistical Mental-IV ( DSM-IV ) criteria . It is possible that practicing sports assists in the management of the disorder . The children were divided between users ( US ) and non-users ( NUS ) of methylpheni date ( MTP ) , and the groups were compared to evaluate the effect of the drug on cognition after PA . Post-exercise performance on Conner ’s Continuous Performance Test-II ( CPT ) was not affected by MTP , we observed significant improvements in response time , and we saw normalization in the impulsivity and vigilance measures . These results suggest that the improvements in cognition after physical effort are not CA dependent . Additionally , our results suggest that  children ’s attention deficits can be minimized through PA irrespective of treatment with MTP . Additional studies are necessary to confirm that exercise mitigates the harmful symptoms of ADHD BACKGROUND This study examined the effects of atomoxetine ( ATX ) and OROS methylpheni date ( MPH ) on laboratory measures of inhibitory control and attention in youth with attention-deficit/hyperactivity disorder ( ADHD ) . It was hypothesized that performance would be improved by both treatments , but response profiles would differ because the medications work via different mechanisms . METHODS One hundred and two youth ( 77 male ; mean age = 10.5 ± 2.7 years ) with ADHD received ATX ( 1.4 ± 0.5 mg/kg ) and MPH ( 52.4 ± 16.6 mg ) in a r and omized , double-blind , crossover design . Medication was titrated in 4 - 6-week blocks separated by a 2-week placebo washout  . Inhibitory control and attention measures were obtained at baseline , following washout , and at the end of each treatment using Conners ' Continuous Performance Test II ( CPT-II ) , which provided age-adjusted T-scores for reaction time ( RT ) , reaction time variability ( RT variability ) , and errors . Repeated- measures analyses of variance were performed , with Time ( premedication , postmedication ) and Treatment type ( ATX , MPH ) entered as within-subject factors . Data from the two treatment blocks were checked for order effects and combined if order effects were not present . CLINICAL TRIAL REGISTRATION Clinical trials.gov : NCT00183391 . RESULTS Main effects for Time on RT ( p = .03 ) , RTSD ( p = .001 ) , and omission errors ( p = .01 ) were significant . A significant Drug × Time interaction indicated  that MPH improved RT , RTSD , and omission errors  more than ATX ( p < .05 ) . Changes in performance with treatment did not correlate with changes in ADHD symptoms . CONCLUSIONS MPH has greater effects  than ATX on CPT measures of sustained attention in youth with ADHD . However , the dissociation of cognitive and behavioral change with treatment indicates that CPT measures can not be considered proxies for symptomatic improvement . Further research on the dissociation of cognitive and behavioral endpoints for ADHD is indicated We examined the effect of methylpheni date ( Mph ) on inhibition and several other cognitive abilities in 43 adults with Attention Deficit Hyperactivity Disorder ( ADHD ) by use of Conners ’ Continuous Performance Test ( CPT ) and the Change Task ( ChT ) , an extension of the Stop Signal Test ( SST ) . In a double blind , cross-over , placebo controlled study with Mph , tests were administered during the third week of individually titrated treatment with Mph ( maximum dose 1 mg / kg / day ) and during the third week of treatment with placebo . We established large medication effects for commission errors , st and ard error of mean reaction time , and attentiveness on the CPT , as well as moderate medication effects for mean reaction time on the CPT and response re-engagement speed on the ChT. For Stop Signal Reaction Time ( SSRT ) on the ChT , we also established large effects of Mph , but only in a group of participants who showed slow SSRTs on placebo . Mph indeed ameliorates inhibition , which is the core problem of ADHD , and certain other cognitive abilities in adults with ADHD . This research was supported by grants from Mental Health Institute GGZ Delfl and , Health Insurance Company DSW , Nationaal Fonds Geestelijke Volksgezondheid ( National Foundation for Mental Health ) , and De Hersenstichting ( Brain Foundation ) . We thank Alex de Jager , Judith Rietjens , and Susan ter Linden for their help in collecting the data . We thank the Board of Scientific Activities of the Reinier de Graaf Hospital in Delft for their financial contribution to the preparation of the study medication . We thank Paul van der Linden for his help with the r and omization procedure Impaired executive function and impulsiveness or intolerance to boredom in adult attention deficit/hyperactivity disorder ( ADHD ) are thought to compromise performance at work . Several task parameters help people with ADHD to perform better on computerized cognitive tasks , namely reduced response-to-stimulus interval , discriminative feedback , or a format resembling a videogame . However , still very little is known about how these context s might be helpful in a real work environment . We developed a computerized task resembling a fast-paced videogame with no response-to-stimulus interval and constant and diverse discriminative error feedback . The task included several measurements of high-order executive function ( planning , working memory , and prospect i ve memory ) formatted as a single multitask simulating occupational activities ( SOA ) . We also administered the Continuous Performance Test-II ( CPT-II ) , a very simple vigilance task without discriminative feedback and with long response-to-stimulus intervals . We tested 30 adults answering to DSM-IV criteria of ADHD ( combined type ) and 30 IQ-matched adults without ADHD . As has been reported many times , the ADHD participants made significantly more errors of commission than the control participants on the CPT-II , whereas the two groups made the same number of errors of commission on the SOA . The ADHD group also sought discriminative feedback significantly more actively on the SOA than the control group and performed at par with the control group in all respects . There was no speed/accuracy trade-off , nor was there any evidence of other costs of normalization on the SOA . Impulsiveness in adult ADHD is compensable on a task simulating the work environment INTRODUCTION Numerous studies have documented an increased frequency of vehicular crashes , traffic citations , driving performance deficits , and driving-related cognitive impairments in teens and adults with attention deficit hyperactivity disorder . METHOD The present study evaluated the effects of two single , acute doses of methylpheni date ( 10 and 20 mg ) and a placebo on the driving performance of 53 adults with ADHD ( mean age=37 years , range=18 - 65 ) using a virtual reality driving simulator , examiner and self-ratings of simulator performance , and a continuous performance test ( CPT ) to evaluate attention and inhibition . A double-blind , drug-placebo , within-subjects crossover design was used in which all participants were tested at baseline and then experienced all three drug conditions . RESULTS A significant beneficial effect for the high dose of medication was observed on impulsiveness on CPT , variability of steering in the st and ard driving course , and driving speed during the obstacle course . A beneficial effect of the low dose of medication also was evident on turn signal use during the st and ard driving course . An apparent practice effect was noted on some of the simulator measures between the baseline and subsequent testing sessions that may have interacted with and thereby obscured drug effects on those measures . CONCLUSIONS The results , when placed in the context of prior studies of stimulants on driving performance , continue to recommend their clinical use as one means of reducing the driving risks in ADHD teens and adults . IMPACT ON INDUSTRY Given the significantly higher risk of adverse driving outcomes associated with ADHD , industry needs to better screen for ADHD among employees who drive as part of employment so as to improve safety and reduce costs . Use of stimulants to treat the adult ADHD driver may reduce safety risks OBJECTIVE To test whether adoption of a collaborative consultative service model results in improved patient outcomes . DESIGN Twelve pediatric practice s were r and omly assigned to receive access to collaborative consultative services or to a control group . SETTING Community-based pediatric offices . PARTICIPANTS Fifty-two pediatricians and their 377 patients with attention-deficit/hyperactivity disorder ( ADHD ) . Intervention A collaborative consultative service promoting the use of titration trials and periodic monitoring during medication maintenance . Main Outcome Measure Physician practice behaviors and child ADHD symptomatology . RESULTS Using self-report of pediatricians , the collaborative consultative service increased the use of evidence -based practice s by pediatricians , but no difference in children 's ADHD symptomatology was observed between the groups . However , many pediatricians did not fully use the collaborative consultative services . Those children who actually received collaborative consultative services showed significant behavioral improvement compared with children not receiving these services . CONCLUSIONS When actually implemented by pediatricians , the collaborative consultative service appears to be an effective method for facilitating evidence -based treatment procedures for ADHD and use of these procedures appear to improve children 's outcomes . Barriers to implementation of collaborative consultative service in pediatric practice need to be further understood Abstract The primary objective of this study was to evaluate the efficacy of atomoxetine ( ATX ) on attention-deficit/hyperactivity disorder (ADHD)–related symptoms assessed as st and ard variables of a computer-based continuous performance test ( cb-CPT ) combined with a motion-tracking ( MT ) device . This was a 2-arm , 8-week , r and omized , double-blind , placebo-controlled study in patients with ADHD ( 6–12 years ) . Therapy with ATX started with 0.5 mg/kg per day for 1 week , followed by 7 weeks on the target dosage of 1.2 mg/kg per day . Primary outcomes were cb-CPT/MT st and ard scores after 8 weeks using mixed models for repeated measurements . In addition , investigator-rated ADHD Rating Scale ( ADHD-RS ) , Weekly Ratings of Evening and Morning Behavior ( WREMB ) , and Clinical Global Impression – Severity-ADHD ( CGI-S-ADHD ) scores were assessed . Of 128 patients r and omized , 125 were evaluated ( ATX/placebo : 63/62 ) . Baseline characteristics were comparable in both groups ( overall , 80.2 % boys ; mean [ SD ] age , 9.0 [ 1.79 ] years ; comorbid Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition diagnosis , 40.0 % oppositional defiant disorder/conduct disorder ; prior stimulant treatment , 24.8 % ; ADHD-RS total score , 36.99 [ 11.56 ] ) . At week 8 , all cb-CPT/MT q-scores were significantly reduced versus placebo ( all P < 0.001 ) with effect sizes ( ESs ) of reaction time ( RT ) variation ( ES = 0.71 ) , mean RT ( ES = 0.41 ) , number of microevents ( ES = 1.00 ) , commission error rate ( ES = 0.50 ) , distance of movement ( ES = 0.90 ) , area of movement ( ES = 1.08 ) , omission error rate ( ES = 0.70 ) , time active ( ES = 0.69 ) , motion simplicity ( ES = 0.38 ) , and normalized variance of RT ( ES = 0.50 ) . Secondary end points also improved significantly in favor of ATX : ADHD-RS ( total score ES = 1.30 , P < 0.001 ; hyperactivity/impulsivity subscore ES = 1.37 , P < 0.001 ; inattention subscore ES = 1.07 , P < 0.001 ) , WREMB ( total score ES = 1.00 , P < 0.001 ; morning subscore ES = 0.59 , P = 0.002 ; evening subscore ES = 1.02 , P < 0.001 ) , CGI-S-ADHD ( ES = 1.11 , P < 0.001 ) . The results of this study show that ATX for 8 weeks significantly reduced ADHD-related symptoms as measured by the cb-CPT/MT Methylpheni date ( MPH ) often ameliorates attention-deficit/hyperactivity disorder ( ADHD ) behavioral dysfunction according to indirect informant reports and rating scales . The st and ard of care behavioral MPH titration approach seldom includes direct neuropsychological or academic assessment data to determine treatment efficacy . Documenting “ cool ” executive-working memory ( EWM ) and “ hot ” self-regulation ( SR ) neuropsychological impairments could aid in differential diagnosis of ADHD subtypes and determining cognitive and academic MPH response . In this study , children aged 6 to 16 with ADHD inattentive type ( IT ; n = 19 ) and combined type ( n = 33)/hyperactive-impulsive type ( n = 4 ) ( CT ) participated in double-blind placebo-controlled MPH trials with baseline and r and omized placebo , low MPH dose , and high MPH dose conditions . EWM/ SR measures and behavior ratings/classroom observations were rank ordered separately across conditions , with nonparametric r and omization tests conducted to determine individual MPH response . Participants were subsequently grouped according to their level of cool EWM and hot SR circuit dysfunction . Robust cognitive and behavioral MPH response was achieved for children with significant baseline EWM/SR impairment , yet response was poor for those with adequate EWM/ SR baseline performance . Even for strong MPH responders , the best dose for neuropsychological functioning was typically lower than the best dose for behavior . Findings offer one possible explanation for why long-term academic MPH treatment gains in ADHD have not been realized . Implication s for academic achievement and medication titration practice s for children with behaviorally diagnosed ADHD will be discussed This study investigated the relationships between computer-based testing and behavioral ratings in the assessment of stimulant-induced changes in attention and activity in a pediatric ADHD crossover trial with methylpheni date , dextroamphetamine , and a placebo . Here 36 children between 9 and 14 years old were r and omly and evenly assigned to each of six counterbalanced drug orders . A computer-based continuous performance test combined with a motion-tracking system ( cb-CPT-MTS ) and an ADHD question naire rated by teachers constituted the outcome measures . All outcome measures responded to stimulants in a comparable way at the group level , as shown by significant treatment effects of similar size for the two stimulants compared with a placebo .  Computer-based and rating-based measures were unrelated in the assessment of stimulant-induced changes in attention and activity in individual children ; no significant correlations between these measures in the assessment of change from placebo to stimulant conditions across the sample were detected . Results suggest that computer-based testing and behavioral ratings can not be considered equivalent in the assessment of stimulant-induced changes in attention and activity among ADHD children Background : The stimulant methylpheni date ( MPH ) has been a mainstay of treatment for attention-deficit/hyperactivity disorder ( ADHD ) for many years . Owing to the short half-life and the issues associated with multiple daily dosing of immediate-release MPH formulations , a new generation of long-acting MPH formulations has emerged . Direct head-to-head studies of these long-acting MPH formulations are important to facilitate an evaluation of their comparative pharmacokinetics and efficacy ; however , to date , relatively few head-to-head studies have been performed . The objective of this systematic review was to compare the evidence available from head-to-head studies of long-acting MPH formulations and provide information that can guide treatment selection . Methods : A systematic literature search was conducted in MEDLINE and PsycINFO in March 2012 using the MeSH terms : attention deficit disorder with hyperactivity/drug therapy ; methylpheni date /therapeutic use and All Fields : Concerta ; Ritalin LA ; OROS and ADHD ; Medikinet ; Equasym XL and ADHD ; long-acting methylpheni date ; Diffucaps and ADHD ; SODAS and methylpheni date . No filters were applied and no language , publication date or publication status limitations were imposed . Articles were selected if the title indicated a comparison of two or more long-acting MPH preparations in human subjects of any age ; non- systematic review articles and unpublished data were not included . Results : Of 15,295 references returned in the literature search and screened by title , 34 articles were identified for inclusion : nine articles from pharmacokinetic studies ( nine studies ) ; nine articles from laboratory school studies ( six studies ) ; two articles from r and omized controlled trials ( two studies ) ; three articles from switching studies ( two studies ) and three articles from one observational study . Conclusions : Emerging head-to-head studies provide important data on the comparative efficacy of the formulations available . At a group level , efficacy across the day generally follows the pharmacokinetic profile of the MPH formulation . No formulation is clearly superior to another ; careful consideration of patient needs and subtle differences between formulations is required to optimize treatment . For patients achieving suboptimal symptom control , switching long-acting MPH formulations may be beneficial . When switching formulations , it is usually appropriate to titrate the immediate-release component of the formulation ; a limitation of current studies is a focus on total daily dose rather than equivalent immediate-release components . Further studies are necessary to provide guidance in clinical practice , particularly in the treatment of adults and pre-school children and the impact of comorbidities and symptom severity on treatment response 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 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 : Although many efforts have been made to improve the quality of care delivered to children with attention-deficit/hyperactivity disorder ( ADHD ) in community-based pediatric setting s , little is known about typical ADHD care in these setting s other than rates garnered through pediatrician self-report . METHODS : Rates of evidence -based ADHD care and sources of variability ( practice -level , pediatrician-level , patient-level ) were determined by chart review s of a r and om sample of 1594 patient charts across 188 pediatricians at 50 different practice s. In addition , the associations of Medicaid-status and practice setting ( ie , urban , suburban , and rural ) with the quality of ADHD care were examined . RESULTS :  Parent- and teacher-rating scales were used during ADHD assessment with approximately half of patients . The use of Diagnostic and Statistical Manual of Mental Disorders criteria was documented in 70.4 % of patients . The vast majority ( 93.4 % ) of patients with ADHD were receiving medication and only 13.0 % were receiving psychosocial treatment .  Parent- and teacher-ratings were rarely collected to monitor treatment response or side effects . Further , fewer than half ( 47.4 % ) of children prescribed medication had contact with their pediatrician within the first month of prescribing . Most variability in pediatrician-delivered ADHD care was accounted for at the patient level ; however , pediatricians and practice s also accounted for significant variability on specific ADHD care behaviors . CONCLUSIONS : There is great need to improve the quality of ADHD care received by children in community-based pediatric setting s. Improvements will likely require systematic interventions at the practice and policy levels to promote change OBJECTIVE To determine the impact of immediate release Ritalin , given three times a day , on sleep quality and quantity in medication-naïve , newly diagnosed children with attention-deficit/hyperactivity disorder ( ADHD ) . METHODS Children ( aged 6 - 12 ) rigorously diagnosed with ADHD ( n = 21 ) underwent multiple measurement assessment s ( i.e. , actigraphy , sleep diary , and question naires ) during a 1-week baseline and then during a 3-week blinded r and omized medication trial . RESULTS Although the medication was effective in reducing ADHD symptoms , analyses of actigraphy and sleep diary data found statistically and clinical ly significant changes in the children 's total sleep time and sleep onset latency in the medication compared to the no medication conditions . No effects on sleep were found based on the sleep question naire . CONCLUSIONS Physicians and parents are encouraged to closely monitor children 's sleep when treating ADHD with stimulant medication There has been much interest in the genetics of attention deficit hyperactivity disorder and molecular genetic studies are now underway . The success of genetic studies will depend on how well the phenotype is defined . Twin studies using parent and teacher rated question naires or interviews all appear to yield highly heritable measures . Nevertheless , there is evidence to suggest that parent measures are subject to rater bias . Consequently there has been much interest in obtaining more objective measures of related traits such as attention span and impulsiveness using , computerised neuropsychological tasks . However there have been few twin studies examining the genetic contribution to these neuropsychological measures . The present study aims to investigate whether performance on the  Matching Familiar Figures Test ( MFFT ) and Continuous Performance Task ( CPT )  is genetically influenced in childhood . 20 monozygotic ( MZ ) and 20 dizygotic ( DZ ) twin pairs were r and omly selected from the Greater Manchester Twin Register . Preliminary data suggest that MZ twins perform more similarly than DZ twins on the MFFT , but not the CPT . Future work needs to examine whether other neuropsychological measures commonly used in research on ADHD are genetically influenced using larger twin sample The effect of atomoxetine ( ATX ) on executive function has been assessed by means of question naires only . The aim of this study was therefore to evaluate the efficacy of ATX using st and ard variables of a computer-based continuous performance test ( cb-CPT ) combined with an infra-red motion-tracking device at different times of the day . One hundred twenty-eight girls and boys aged 6 to 12 years with a diagnosis of ADHD according to DSM-IV-TR criteria were r and omized in the study . The primary efficacy measures were the q-scores of the cb-CPT combined with an infra-red motion-tracking device .  The test comprises 13 neuropsychological variables that can be taken to reflect hyperactivity , inattention , or impulsivity .  One hundred five patients completed the study ( ATX group : n=54 ;  placebo  group : n=51 ) . ATX ( target dose 1.2 mg/kg/day ) over 8 weeks was significantly superior to placebo in reducing hyperactivity , inattention , and impulsivity as measured by q-scores of 10 primary variables of the cb-CPT . Both groups of patients showed a circadian pattern of neuropsychological outcomes across the day as reflected by the cb-CPT combined with an infra-red motion-tracking device . In summary , this study demonstrated a positive effect of ATX on some aspects of executive function , inhibitory control , and hyperactivity compared with placebo BACKGROUND The effectiveness of psychostimulants , primarily methylpheni date ( MPH ) , in the treatment of Attention Deficit Hyperactivity Disorder ( ADHD ) in the general population of typically growing children and adolescents is well established through many R and omised Controlled Trials ( RCTs ) . AIMS AND METHODS We carried out a systematic review of all the RCTs in people with intellectual disabilities ( ID ) that assessed effectiveness of MPH on the core ADHD symptoms . OUTCOMES AND RESULTS We included 15 papers from 13 studies that were all on children and adolescents with ID ( 315 participants were on MPH and placebo respectively ) , 12 of which used a cross over design , and one used a parallel design . On average around 40 - 50 % responded to MPH in the ID group whereas around 70 - 80 % response rate is reported among the non-ID children . Because of the heterogeneity of the outcome data it was not possible to carry out a meta- analysis . Significant adverse events included sleep difficulties and poor appetite along with weight loss and also irritability , social withdrawal and increased motor activities including tic . CONCLUSIONS AND IMPLEMENTATION On the basis of the poor quality evidence that is available , it seems that MPH may be effective in some but not all children and adolescents with ID and ADHD Background Children with attention-deficit/hyperactivity disorder ( ADHD ) have deficits in performance monitoring often improved with the indirect catecholamine agonist methylpheni date ( MPH ) . We used functional magnetic resonance imaging to investigate the effects of single-dose MPH on activation of error processing brain areas in medication-naive boys with ADHD during a stop task that elicits 50 % error rates . Methods Twelve medication-naive boys with ADHD were scanned twice , under either a single clinical dose of MPH or placebo , in a r and omized , double-blind design while they performed an individually adjusted tracking stop task , design ed to elicit 50 % failures . Brain activation was compared within patients under either drug condition . To test for potential normalization effects of MPH , brain activation in ADHD patients under either drug condition was compared with that of 13 healthy age-matched boys . Results During failed inhibition , boys with ADHD under placebo relative to control subjects showed reduced brain activation in performance monitoring areas of dorsomedial and left ventrolateral prefrontal cortices , thalamus , cingulate , and parietal regions . MPH , relative to placebo , upregulated activation in these brain regions within patients and normalized all activation differences between patients and control subjects . During successful inhibition , MPH normalized reduced activation observed in patients under placebo compared with control subjects in parietotemporal and cerebellar regions . Conclusions MPH normalized brain dysfunction in medication-naive ADHD boys relative to control subjects in typical brain areas of performance monitoring , comprising left ventrolateral and dorsomedial frontal and parietal cortices . This could underlie the amelioration of MPH of attention and academic performance in ADHD The present investigation examined the effects of methylpheni date on impulsivity in children with attention-deficit hyperactivity disorder ( ADHD ) . A task was design ed to measure empirically the ADHD child 's proclivity to blurt out incorrect answers before giving a final and /or correct response . Twenty-six ADHD children referred for double-blind placebo-controlled assessment of medication responsiveness and 14 non-ADHD controls were given a visual search word-matching task to assess impulsive responding . An analysis of covariance showed that ADHD children on methylpheni date made fewer impulsive errors than ADHD children on placebo . The control group made fewer impulsive errors than the ADHD children in the placebo condition , but the performance of the ADHD children on medication approximated the performance of the children without ADHD . These preliminary findings suggest that the word-matching task may be a useful tool for assessing impulsive responding and determining the benefits of stimulant medication on impulsivity . ( J Child Neurol 1993;8:157 - 163 ) OBJECTIVES : Medication management of attention-deficit/hyperactivity disorder ( ADHD ) is often suboptimal . We examined whether ( 1 ) brief physician training plus computer-assisted medication management led to greater reduction in ADHD symptoms and ( 2 ) adherence to the recommended titration protocol produced greater symptomatic improvement . METHODS : A r and omized medication trial was conducted that included 24 pediatric practice s. Children who met criteria for ADHD were r and omly assigned by practice to treatment-as-usual or a specialized care group in which physicians received 2 hours of didactic training on medication management of ADHD plus training on a software program to assist in monitoring improvement . Parent and teacher reports were obtained before treatment and 4 , 9 , and 12 months after starting medication . RESULTS : Children in both specialized care and treatment-as-usual groups improved on the ADHD Rating Scales and SNAP-IV , but there were no group differences in improvement rates . Brief physician training alone did not produce improvements . When recommended titration procedures were followed , however , outcomes were better for total and inattentive ADHD symptoms on both the ADHD Rating Scales and SNAP-IV parent and teacher scales . Results were not attributable to discontinuation because of adverse effects or failure to find an effective medication dose . CONCLUSIONS : Brief physician training alone did not lead to reductions in ADHD symptoms , but adherence to a protocol that involved titration until the child 's symptoms were in the average range and had shown a reliable change led to better symptom reduction . Computer-assisted medication management can contribute to better treatment outcomes in primary care medication treatment of ADHD
There were mixed findings with regard to the use of CPTs to assess and manage medication , with contrasting evidence on their ability to support clinical decision-making .
There was a strong evidence base for the use of objective measures of activity to aid ADHD/non-ADHD group differentiation , which appears sensitive to medication effects and would also benefit from further research on their clinical utility .
Attention-deficit hyperactivity disorder ( ADHD ) is typically diagnosed using clinical observation and subjective informant reports .
Once children commence ADHD medication , robust monitoring is required to detect partial or non-responses .
The extent to which neuropsychological continuous performance tests ( CPTs ) and objective measures of activity can clinical ly aid the assessment and titration process in ADHD is not fully understood .
This review describes the current evidence base for the use of CPTs and objective ly measured activity to support the diagnostic procedure and medication management for children with ADHD .
Four data bases ( PsycINFO , Medline , Allied and Complementary Medicine ( AMED ) , and PsycARTICLES ) were systematic ally search ed to underst and the current evidence base for ( 1 ) the use of CPTs to aid clinical assessment of ADHD ; ( 2 ) the use of CPTs to aid medication management ; and ( 3 ) the clinical utility of objective measures of activity in ADHD .