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. Do stimulants reduce the risk for cigarette smoking in youth with attention-deficit hyperactivity disorder? A prospective, long-term, open-label study of extended-release methylphenidate. 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. Does EEG-neurofeedback improve neurocognitive functioning in children with attention-deficit/hyperactivity disorder? A systematic review and a double-blind placebo-controlled study. Do Stimulants Protect Against Psychiatric Disorders in Youth With ADHD? A 10-Year Follow-up Study An open trial of bupropion for ADHD in adolescents with substance use disorders and conduct disorder. Stimulant treatment in children with attention-deficit/hyperactivity disorder moderates adolescent academic outcome. 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 Stimulant therapy and risk for subsequent substance use disorders in male adults with ADHD: a naturalistic controlled 10-year follow-up study. Impulsiveness as a timing disturbance: neurocognitive abnormalities in attention-deficit hyperactivity disorder during temporal processes and normalization with methylphenidate Aripiprazole in children with attention-deficit/hyperactivity disorder. Neurocognitive effects of neurofeedback in adolescents with ADHD: a randomized controlled trial. Atomoxetine treatment in children and adolescents with attention-deficit/hyperactivity disorder and comorbid oppositional defiant disorder. Slow oscillating transcranial direct current stimulation during non-rapid eye movement sleep improves behavioral inhibition in attention-deficit/hyperactivity disorder Neurocognitive performance and behavioral symptoms in patients with attention-deficit/hyperactivity disorder during twenty-four months of treatment with methylphenidate. Treatment Patterns, Adherence, and Persistence in ADHD: A Canadian Perspective Stimulant medication effects in a summer treatment program among young children with attention-deficit/hyperactivity disorder. Executive functioning in children with attention-deficit/hyperactivity disorder: combined type with and without a stimulant medication history. A Randomized, Double-Blind, Sham-Controlled Trial of Transcranial Direct Current Stimulation in Attention-Deficit/Hyperactivity Disorder Mediators of Methylphenidate Effects on Math Performance in Children with Attention-Deficit Hyperactivity Disorder A randomized, placebo-controlled clinical trial of bupropion for the prevention of smoking in children and adolescents with attention-deficit/hyperactivity disorder. Multimodal treatment in children and adolescents with attention-deficit/hyperactivity disorder: a 6-month follow-up Sustained release methylphenidate for the treatment of ADHD in amphetamine abusers: a pilot study.
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 OBJECTIVE Although attention-deficit hyperactivity disorder ( ADHD ) is a well-known risk factor for cigarette smoking , prospect i ve studies aim ed at reducing smoking risk in this population are critically needed . STUDY DESIGN This was a 2-year , prospect i ve , open-label clinical trial of extended-release methylpheni date for smoking prevention in adolescents with ADHD ( n = 154 ) .  Smoking outcomes were assessed with the Fagerstrom Tolerance Question naire . Comparisons were made using data from a historical , naturalistic sample of ADHD ( n = 103 ) and non-ADHD comparators ( n = 188 ) of similar age and sex assessed with the same assessment battery as that used in subjects participating in the clinical trial . RESULTS The smoking rate at endpoint ( mean , 10 months of methylpheni date treatment ) was low in the clinical trial subjects and not significantly different from that in the non-ADHD comparators or the ADHD comparators receiving stimulants naturalistically ( 7.1 % vs 8.0 % vs 10.9 % ; P > .20 ) . In contrast , the smoking rate was significantly lower in the clinical trial subjects than in the naturalistic sample of ADHD comparators who were not receiving stimulant treatment ( 7.1 % vs 19.6 % ; P = .009 [ not significant ] , adjusting for comorbid conduct disorder and alcohol and drug abuse ) . CONCLUSION Although considered preliminary until replicated in future r and omized clinical trials , the findings from this single-site , open-label study suggest that stimulant treatment may contribute to a decreased risk for smoking  in adolescents with ADHD . If confirmed , this finding would have significant clinical and public health impacts 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 BACKGROUND The number of placebo-controlled r and omized studies relating to EEG-neurofeedback and its effect on neurocognition in attention-deficient/hyperactivity disorder ( ADHD ) is limited . For this reason , a double blind , r and omized , placebo-controlled study was design ed to assess the effects of  EEG-neurofeedback  on neurocognitive functioning in children with ADHD , and a systematic review on this topic was performed . METHODS Forty-one children ( 8 - 15 years ) with a DSM-IV-TR diagnosis of ADHD were r and omly allocated to EEG-neurofeedback or placebo-neurofeedback treatment for 30 sessions , twice a week . Children were stratified by age , electrophysiological state of arousal , and medication use . Neurocognitive tests of attention , executive functioning , working memory , and time processing were administered before and after treatment . Research ers , teachers , children and their parents , with the exception of the neurofeedback-therapist , were all blind to treatment assignment . Outcome measures were the changes in neurocognitive performance before and after treatment . CLINICAL TRIAL REGISTRATION www . clinical trials.gov : NCT00723684 . RESULTS No significant treatment effect on any of the neurocognitive variables was found . A systematic review of the current literature also did not find any systematic beneficial effect of EEG-neurofeedback on neurocognitive functioning . CONCLUSION Overall , the existing literature and this study fail to support any benefit of neurofeedback on neurocognitive functioning in ADHD , possibly due to small sample sizes and other study limitations 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 OBJECTIVE Adolescents with conduct disorder ( CD ) and substance use disorders ( SUD ) have higher rates of comorbid attention-deficit/hyperactivity disorder ( ADHD ) than those without CD and SUD . Comorbid ADHD may contribute to more severe SUD . Treatment of ADHD may enhance effective treatment of substance abuse and behavior problems , yet there are few data regarding pharmacological treatment of ADHD in such youths . METHOD Pilot data are presented from a 5-week , open-label bupropian trial in 13 nondepressed adolescent boys in a residential treatment program focusing on substance and behavioral treatments . All had diagnoses of ADHD , CD , and SUD . Patients ' doses were titrated to a maximum fixed daily dose of 300 mg of bupropion . The Conners Hyperactivity Index and Daydream Attention scores , along with Clinical Global Impressions Severity of Illness ( CGI-S ) ratings , were obtained at baseline and at the fifth week of treatment . RESULTS Subjects ' mean Conners Hyperactivity Index score declined from 75.5 to 65.4 ( p < .01 , Wilcoxon signed rank test ) ( 13 % decline ) . The mean Daydream Attention score declined from 59.5 to 53.6 ( p < .02 , Wilcoxon signed rank test ) ( 10 % decline ) . Mean CGI-S declined from 4.9 to 3.0 ( p < .002 , Wilcoxon signed rank test ) ( 39 % decline ) . CONCLUSIONS These preliminary data suggest that bupropion may be a useful treatment for ADHD in adolescents with CD and SUD ; they suggest the need for a controlled trial of bupropion in such youths 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 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 OBJECTIVE The extant literature does not provide definite answers pertaining to whether stimulant treatment increases , decreases , or does not affect the risk for subsequent substance use disorders in youths with attention deficit hyperactivity disorder ( ADHD ) . The authors examined the association between stimulant treatment in childhood and adolescence and subsequent substance use disorders ( alcohol , drug , and nicotine ) into the young adult years . METHOD The authors conducted a 10-year prospect i ve follow-up study . One hundred forty male Caucasian children with ADHD , ages 6 to 17 , were examined at baseline . Of these , 112 ( 80 % ) were reassessed at the 10-year follow-up  ( mean age at follow-up=22 years ) . Assessment s were made using Cox proportional hazards survival models . All models were adjusted for conduct disorder , since conduct disorder is a potent predictor of subsequent substance use disorders . RESULTS Of the 112 ADHD subjects who were reassessed at the 10-year follow-up , 82 ( 73 % ) had been treated previously with stimulants and 25 ( 22 % ) were undergoing stimulant treatment at the time of the follow-up assessment . There were no statistically significant associations between  stimulant treatment and alcohol , drug , or nicotine use disorders . CONCLUSIONS The findings revealed no evidence that stimulant treatment increases or decreases the risk for subsequent substance use disorders in children and adolescents with ADHD when they reach young adulthood We argue that impulsiveness is characterized by compromised timing functions such as premature motor timing , decreased tolerance to delays , poor temporal foresight and steeper temporal discounting . A model illustration for the association between impulsiveness and timing deficits is the impulsiveness disorder of attention-deficit hyperactivity disorder ( ADHD ) . Children with ADHD have deficits in timing processes of several temporal domains and the neural substrates of these compromised timing functions are strikingly similar to the neuropathology of ADHD . We review our published and present novel functional magnetic resonance imaging data to demonstrate that ADHD children show dysfunctions in key timing regions of prefrontal , cingulate , striatal and cerebellar location during temporal processes of several time domains including time discrimination of milliseconds , motor timing to seconds and temporal discounting of longer time intervals . Given that impulsiveness , timing abnormalities and more specifically ADHD have been related to dopamine dysregulation , we tested for and demonstrated a normalization effect of all brain dysfunctions in ADHD children during time discrimination with the dopamine agonist and treatment of choice , methylpheni date . This review together with the new empirical findings demonstrates that neurocognitive dysfunctions in temporal processes are crucial to the impulsiveness disorder of ADHD and provides first evidence for normalization with a dopamine reuptake inhibitor OBJECTIVE To examine the effectiveness and cognitive effects of aripiprazole ( APZ ) in children with a primary diagnosis of attention-deficit/hyperactivity disorder ( ADHD ) . METHODS Youths , ages 8 - 12 years , with a diagnosis of ADHD combined-type or ADHD predominately inattentive-type were enrolled into a 6-week , open-label pilot trial . Outcome measures included the ADHD Rating Scale-IV ( ARS-IV ) , Clinical Global Impressions Scale ( CGI ) , and Children 's Global Assessment Scale ( CGAS ) . The Conners ' Continuous Performance Test II , Reading and Math Fluency subscales of the Woodcock-Johnson III Tests of Achievement , and the Stroop Color and Word Test  were administered at baseline and end of study . RESULTS Fourteen ( 9 males and 5 females ) youths were diagnosed with ADHD-combined type , while 9 ( 5 males and 4 females ) were diagnosed with ADHD-inattentive type . At a mean dose of 6.7 mg/day , end of study results showed overall significant improvement from baseline on ADHD and functional outcome measures . No significant differences in baseline performance at end of study were found on the cognitive measures . The most frequently reported adverse events were sedation ( n = 18 ; 78.3 % ) and headache ( n = 11 ; 47.8 % ) . CONCLUSIONS Although this was a brief pilot study with a small sample size , in this cohort , APZ led to clinical benefit in reducing ADHD symptoms and improving overall functioning . Of note , cognitive functioning did not appear to be negatively impacted by APZ treatment OBJECTIVE Neurofeedback aims to reduce symptoms of attention-deficit/hyperactivity disorder ( ADHD ) , mainly attention problems . However , the additional influence of neurofeedback over treatment as usual ( TAU ) on neurocognitive functioning for adolescents with ADHD remains unclear . METHOD By using a multicenter parallel r and omized controlled trial ( RCT ) design , male adolescents with a DSM-IV-TR diagnosis of ADHD ( mean age = 16.1 years ; range , 12 - 24 ) were r and omized to receive either a combination of TAU and neurofeedback ( n = 45 ) or TAU ( n = 26 ) . R and omization was computer generated and stratified by age group ( ages 12 through 15 , 16 through 20 , and 21 through 24 years ) . The neurofeedback intervention consisted of approximately 37 sessions over a period of 25 weeks of theta/sensorimotor rhythm training on the vertex ( Cz ) . Primary neurocognitive outcomes included performance parameters derived from the D2 Test of Attention , the Digit Span backward , the Stroop Color-Word Test and the Tower of London , all assessed preintervention and postintervention . Data were collected between December 2009 and July 2012 . RESULTS At postintervention , outcomes of attention and /or motor speed were improved , with faster processing times for both intervention conditions and with medium to large effect sizes ( range , ηp2 = .08-.54 ; P values < .023 ) . In both groups , no improvements for higher executive functions were observed . Results might partly resemble practice effects . CONCLUSIONS Although neurocognitive outcomes improved in all adolescents receiving treatment for ADHD , no additional value for neurofeedback over TAU was observed . Hence , this study does not provide evidence for using theta/sensorimotor rhythm neurofeedback to enhance neurocognitive performance as additional intervention to TAU for adolescents with ADHD symptoms . TRIAL REGISTRATION Trialregister.nl identifier : 1759 OBJECTIVE To examine ( 1 ) moderating effects of oppositional defiant disorder ( ODD ) on attention-deficit/hyperactivity disorder ( ADHD ) treatment response and ( 2 ) responses of ODD symptoms to atomoxetine . METHOD Children and adolescents ( ages 8 - 18 ) with ADHD were treated for approximately 8 weeks with placebo or atomoxetine ( fixed dosing : 0.5 , 1.2 , or 1.8 mg/kg/day , b.i.d . ) under r and omized , double-blind conditions . Among patients with lifetime diagnostic information ( n = 293 ) , 39 % were diagnosed with comorbid ODD and 61 % were not . Treatment-group differences and differences between patients with and without comorbid ODD were examined post hoc for changes on the Attention-Deficit/Hyperactivity Disorder Rating Scale IV-Parent version , investigator-administered and -scored ; Conners ' Parent Rating Scale-Revised Short Form ; Clinical Global Impressions Severity of ADHD Scale ; and the parent-rated Child Health Question naire . RESULTS Youths with ADHD and comorbid ODD showed statistically significant improvement in ADHD , ODD , and quality -of-life measures . Treatment response was similar in youths with and without ODD , except that the comorbid group showed improvement compared with placebo at 1.8 mg/kg/day but not 1.2 mg/kg/day . In contrast , youths without ODD showed improvement at 1.2 mg/kg/day and no incremental benefit at 1.8 mg/kg/day . CONCLUSIONS Atomoxetine treatment improves ADHD and ODD symptoms in youths with ADHD and ODD , although the comorbid group may require higher doses Background : Behavioral inhibition , which is a later-developing executive function ( EF ) and anatomically located in prefrontal areas , is impaired in attention-deficit and hyperactivity disorder ( ADHD ) . While optimal EFs have been shown to depend on efficient sleep in healthy subjects , the impact of sleep problems , frequently reported in ADHD , remains elusive . Findings of macroscopic sleep changes in ADHD are inconsistent , but there is emerging evidence for distinct microscopic changes with a focus on prefrontal cortical regions and non-rapid eye movement ( non-REM ) slow-wave sleep . Recently , slow oscillations ( SO ) during non-REM sleep were found to be less functional and , as such , may be involved in sleep-dependent memory impairments in ADHD . Objective : By augmenting slow-wave power through bilateral , slow oscillating transcranial direct current stimulation ( so-tDCS , frequency = 0.75 Hz ) during non-REM sleep , we aim ed to improve daytime behavioral inhibition in children with ADHD . Methods : Fourteen boys ( 10–14 years ) diagnosed with ADHD were included . In a r and omized , double-blind , cross-over design , patients received so-tDCS either in the first or in the second experimental sleep night . Inhibition control was assessed with a visuomotor go/no-go task .  Intrinsic alertness was assessed with a simple stimulus response task . To control for visuomotor performance , motor memory was assessed with a finger sequence tapping task . Results : SO-power was enhanced during early non-REM sleep , accompanied by slowed reaction times and decreased st and ard deviations of reaction times , in the go/no-go task after so-tDCS . In contrast , intrinsic alertness , and motor memory performance were not improved by so-tDCS . Conclusion : Since behavioral inhibition but not intrinsic alertness or motor memory was improved by so-tDCS , our results suggest that lateral prefrontal slow oscillations during sleep might play a specific role for executive functioning in ADHD OBJECTIVE This study investigated the trends in neurocognitive function and behavioral symptoms among patients with attention-deficit/hyperactivity disorder ( ADHD ) during 24 months of treatment with methylpheni date in a clinical setting . METHODS Study participants consisted of 181 ADHD patients with a mean age of 13.4±2.5 years ( ages ranged from 8 to 18 years ; 151 boys and 30 girls ) who were prescribed oral short-acting methylpheni date two or three times daily , with each dose ranging between 0.3 and 1.0 mg/kg . At baseline and 6 , 12 , 18 , and 24 months from baseline , neurocognitive function was assessed using the  Test of Variables of Attention ( TOVA ) on the day the patient was off medication , and behavioral symptoms were evaluated using the Swanson , Nolan , and Pelham Version IV Scale for ADHD ( SNAP-IV ) parent form , the SNAP-IV teacher form , and the ADHD-Rating Scale ( completed by a child psychiatrist ) . RESULTS Of the 181 ADHD patients at the initial visit , 103 ( 56.9 % ) completed the study . During the 24-month methylpheni date treatment , only the commission errors in TOVA significantly improved ; however , the omission errors , response time , response time variability , response sensitivity , and ADHD score did not . The behavioral symptoms of ADHD , observed by various informants , all declined substantially , and were significantly correlated with each other during the long-term follow-up . The severity of teacher ratings was lower than that of parent and psychiatrist ratings . However , the teacher-rated inattention symptoms showed the strongest correlations with TOVA performance . CONCLUSIONS Findings suggest that neurocognitive deficits in ADHD patients , except inhibition ability , might be long lasting in realistic setting s. In addition , obtaining behavior profile assessment s from multiple informants , especially from teachers , is vital for establishing a complete underst and ing of ADHD patients Abstract Objective : To underst and attention – deficit/hyperactivity disorder ( ADHD ) treatment patterns and estimate adherence and persistence in Quebec , Canada . Design : This cross – sectional , retrospective prescription cl aims analysis used a r and om sample of 15 838 patients with ADHD from a Quebec data base ( Régie de l'assurance maladie du Québec [ RAMQ ] ) to assess treatment patterns , adherence ( 1–year medication possession ratio in new users ) , and persistence ( proportion persistent at 3 , 6 , and 12 months after index prescription ) . Results : The mean patient age was 14 years ; 72.6 % were male . During the 5–year study period ( 2004–2009 ) , 416 646 ADHD prescriptions were flled .  Short – acting ( SA ) medications declined from 72.8 % to 26.4 % of all cl aims , while stimulant and nonstimulant long – acting ( LA ) medications increased from 27.2 % to 73.6 % . Approximately half of the patients used both  SA and LA medications ( either concomitantly or subsequently ) , and the others used only SA ( 30 % ) or LA ( 19 % ) drugs . Among patients using both , switching from SA to LA was the most frequent ( 27.9 % ) treatment pattern . More patients on LA methylpheni date s ( 6.4 % ) compared with LA amphetamines ( 1.9 % ; P < 0.01 ) required augmentation with an SA drug . Fewer patients on SA stimulants ( 39.4 % ) were ≥ 80 % adherent compared with LA stimulants ( 63 % ; P < 0.001 ) and LA nonstimulants ( 60.2 % ; P < 0.001 ) . More patients on LA stimulants ( 81.1 % ) were persistent at 12 months compared with LA nonstimulants ( 61.7 % ; P < 0.001 ) and SA stimulants ( 59.6 % ; P < 0.001 ) . Similar trends were observed at all time points measured . Conclusions : Switching from SA to LA medications and treatment augmentation are common in ADHD management , with implication s for patient care and health care re source use . This analysis found poor adherence in ADHD treatment , although adherence and persistence were improved with LA stimulant formulations OBJECTIVE This study examined the effectiveness of stimulant medication on multiple domains of functioning in 36 young ( 5 to 6 years old ) children diagnosed with attention-deficit/hyperactivity disorder ( ADHD ) . METHOD Five- and 6-year-old children attending a summer treatment program between 1987 and 1997 underwent a r and omized clinical assessment of the effect of two doses of methylpheni date ( 0.3 mg/kg versus 0.6 mg/kg ) and placebo on social behavior and academic performance . RESULTS Methylpheni date had an effect on all four social behaviors and improved two of the three areas of academic functioning . Dose effects were present for three of the seven dependent measures . Individual analyses indicated a therapeutic response rate between 39 % and 100 % across dependent measures . Furthermore , individual analyses of response indicated that across several important dependent measures , 39 % to 98 % of children showed little incremental improvement with the higher dose compared with the lower dose of stimulant medication . CONCLUSIONS Stimulant medication is an effective treatment for young children diagnosed with ADHD ; however , multiple domains of functioning must be assessed to determine the most effective dose for young children with ADHD Behavioral and neuropsychological functioning in unmedicated children with attention-deficit/hyperactivity disorder ( ADHD ) who have a history of medication treatment ( Rx ) versus those who are treatment naïve ( TN ) has , to our knowledge , not been previously studied . Ninety-four children in four groups ( ADHD/Rx , ADHD/TN , learning disabilities [ LD ] , and controls ) were evaluated , while unmedicated , on measures of achievement , neuropsychological functioning , and behavior . The ADHD/Rx group performed significantly better than the TN group on writing , Stroop interference , and measures of attention , and performed as well as the control group on executive functioning , verbal working memory , and academics . Behaviorally , the ADHD groups showed more difficulty with mood and externalizing behaviors compared with the LD and control groups , with the ADHD/TN performing the most poorly . Findings suggest that the ADHD/Rx group shows better executive and academic functioning even when unmedicated Background Current st and ardized treatments for cognitive impairment in attention-deficit/hyperactivity disorder remain limited and their efficacy restricted . Transcranial direct current stimulation ( tDCS ) is a promising tool for enhancing cognitive performance in several neuropsychiatric disorders . Nevertheless , the effects of tDCS in reducing cognitive impairment in patients with attention-deficit/hyperactivity disorder ( ADHD ) have not yet been investigated . Methods A parallel , r and omized , double-blind , sham-controlled trial was conducted to examine the efficacy of tDCS on the modulation of inhibitory control in adults with ADHD . Thirty patients were r and omly allocated to each group and performed a go/no-go task before and after a single session of either anodal stimulation ( 1 mA ) over the left dorsolateral prefrontal cortex or sham stimulation . Results A nonparametric two- sample Wilcoxon rank-sum ( Mann-Whitney ) test revealed no significant differences between the two groups of individuals with ADHD ( tDCS vs. sham ) in regard to behavioral performance in the go/no go tasks . Furthermore , the effect sizes of group differences after treatment for the primary outcome measures —correct responses , impulsivity and omission errors — were small . No adverse events result ing from stimulation were reported . Conclusion According to these findings , there is no evidence in support of the use of anodal stimulation over the left dorsolateral prefrontal cortex as an approach for improving inhibitory control in ADHD patients . To the best of our knowledge , this is the first clinical study to assess the cognitive effects of tDCS in individuals with ADHD . Further research is needed to assess the clinical efficacy of tDCS in this population . Trial Registration Clinical Trials.gov Objective : Stimulant medications , such as methylpheni date ( MPH ) , improve the academic performance of children with attention-deficit hyperactivity disorder ( ADHD ) . However , the mechanism by which MPH exerts an effect on academic performance is unclear . We examined MPH effects on math performance and investigated possible mediation of MPH effects by changes in time on-task , inhibitory control , selective attention , and reaction time variability . Methods : Children with ADHD aged 7 to 11 years ( N = 93 ) completed a timed math worksheet ( with problems tailored to each individual 's level of proficiency ) and 2 neuropsychological tasks ( Go/No-Go and Child Attention Network Test ) at baseline , then participated in a 4-week , r and omized , controlled , titration trial of MPH . Children were then r and omly assigned to their optimal MPH dose or placebo for 1 week ( administered double-blind ) and repeated the math and neuropsychological tasks ( posttest ) . Baseline and posttest videorecordings of children performing the math task were coded to assess time on-task . Results : Children taking MPH completed 23 more math problems at posttest compared to baseline , whereas the placebo group completed 24 fewer problems on posttest versus baseline , but the effects on math accuracy ( percent correct ) did not differ . Path analyses revealed that only change in time on-task was a significant mediator of MPH 's improvements in math productivity . Conclusions : MPH-derived  math productivity improvements may be explained in part by increased time spent on-task , rather than improvements in neurocognitive parameters , such as inhibitory control , selective attention , or reaction time variability OBJECTIVE Since attention-deficit/hyperactivity disorder ( ADHD ) is a well-documented risk factor for smoking and bupropion has been shown to be effective for smoking cessation , we tested the efficacy of bupropion as a prophylactic agent for the prevention of smoking in children and adolescents with ADHD . METHOD We conducted a longitudinal , r and omized , double-blind , placebo-controlled , parallel-group study of bupropion at a large , urban , outpatient medical center . Recruitment began in April 1999 , and the last subject was followed until September 2004 . Patients were nonsmoking youth , of both sexes , between 9 and 18 years of age , with DSM-IV ADHD . After r and om assignment to either bupropion or placebo , subjects were assessed weekly for 8 weeks , biweekly for 4 weeks , and monthly thereafter for up to 6.5 years ( mean 12 months ) . Also , patients received treatment with psychostimulants for ADHD symptoms as needed . To assess smoking , we used an assay of cotinine in urine . RESULTS Fifty-seven subjects ( 28 receiving bupropion and 29 receiving placebo )  were r and omly assigned and included in the analysis . No differences were found between the bupropion and placebo groups on demographic factors . About half of each group was treated with stimulants for ADHD . Statistical separation between bupropion and placebo in the rate of smoking initiation or continued smoking was not demonstrated . However , secondary post hoc analyses revealed that concurrent stimulant treatment was significantly associated with a lower rate of smoking onset ( hazard ratio [ HR ] = 0.2 , 95 % CI = 0.08 to 0.89 ; z = -2.2 , p = .03 ) and a lower rate of continued smoking ( HR = 0.3 , 95 % CI = 0.11 to 0.85 ; z = -2.3 , p = .02 ) . CONCLUSION While bupropion was not associated with a lower rate of smoking in youth with ADHD , post hoc analyses suggest that stimulant treatment was . Future controlled studies should investigate the role of stimulants in the prevention of smoking in children and adolescents 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 The efficacy of stimulant treatment in patients with substance use disorders and comorbid attention deficit hyperactivity disorder ( ADHD ) has been tested for cocaine and alcohol dependence but so far no studies have been conducted in amphetamine dependent individuals . The present trial was a pilot study aim ing to test the feasibility of treating amphetamine dependent patients with comorbid ADHD with central stimulant medication . The study was a double-blind , placebo controlled trial with parallel groups design comparing the efficacy of a fixed dose ( 72 mg ) of OROS methylpheni date ( MPH ) with placebo ( PL ) in reducing ADHD symptoms in currently abstinent adults with amphetamine dependence and ADHD . Twenty-four treatment seeking patients who met the DSM IV criteria for amphetamine dependence and ADHD were r and omized to MPH/PL . The trial was conducted at an outpatient facility with twice weekly visits , measuring ADHD symptoms and drug use . Patients rated their ADHD symptoms on a weekly basis and provided supervised urine specimens for drug toxicology twice weekly . All patients participated in weekly sessions of a skills training programme . Both the groups significantly reduced their self-rated ADHD symptoms during the 12-week treatment but there was no difference between the two treatment arms . Drug use , both measured by urine toxicology and self-report did not differ between the groups . No difference was found between the two groups with regards to craving for amphetamine or in retention in treatment . Larger studies with higher doses combined with individual dosage and longer follow-up periods are warranted
RESULTS Modafinil appears to improve reaction time ( P ≤ 0.04 ) , logical reasoning ( P ≤ 0.05 ) and problem-solving .
Across all three types of prescription stimulants , research shows improved attention with lack of consensus on whether these improvements are limited to simple versus complex tasks in varying youth population s. CONCLUSIONS The heterogeneity of the non-attention deficit hyperactivity disorder youth population , the variation in cognitive task characteristics and lack of replication of studies makes assessing the potential global neurocognitive benefits of stimulants among non-attention deficit hyperactivity disorder youth difficult ; however , some youth may derive benefit in specific cognitive domains
BACKGROUND AND AIMS Increasing prescription stimulant abuse among youth without diagnoses of attention deficit hyperactivity disorder ( ADHD ) is of concern .
The most frequently cited motive for abuse is improved academic achievement via neurocognitive enhancement .
Our aim in review ing the literature was to identify neurocognitive effects of prescription stimulants in non-ADHD youth .