Positive Effects of Methylphenidate on Inattention and Hyperactivity in Pervasive Developmental Disorders: An Analysis of Secondary Measures Aripiprazole in juvenile bipolar disorder comorbid with attention-deficit/hyperactivity disorder: an open clinical trial. A Laboratory School Comparison of Mixed Amphetamine Salts Extended Release (Adderall XR®) and Atomoxetine (Strattera®) in School-Aged Children With Attention Deficit/Hyperactivity Disorder Pharmacokinetics and therapeutic effect of OROS methylphenidate under different breakfast conditions in children with attention-deficit/hyperactivity disorder. A randomized crossover clinical study showing that methylphenidate-SODAS improves attention-deficit/hyperactivity disorder symptoms in adolescents with substance use disorder. Aripiprazole in children and adolescents with bipolar disorder comorbid with attention-deficit/hyperactivity disorder: a pilot randomized clinical trial. Parent and Teacher SNAP-IV Ratings of Attention Deficit Hyperactivity Disorder Symptoms Neurofeedback and Cognitive Attention Training for Children with Attention-Deficit Hyperactivity Disorder in Schools Efficacy and duration of effect of extended-release dexmethylphenidate versus placebo in schoolchildren with attention-deficit/hyperactivity disorder. 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. Efficacy of a new pattern of delivery of methylphenidate for the treatment of ADHD: effects on activity level in the classroom and on the playground. Efficacy of methylphenidate for attention-deficit hyperactivity disorder in children with tic disorder. A double-blind, placebo-controlled trial of dexmethylphenidate hydrochloride and d,l-threo-methylphenidate hydrochloride in children with attention-deficit/hyperactivity disorder. Neurocognitive performance and behavioral symptoms in patients with attention-deficit/hyperactivity disorder during twenty-four months of treatment with methylphenidate. Memantine versus Methylphenidate in Children and Adolescents with Attention Deficit Hyperactivity Disorder: A Double-Blind, Randomized Clinical Trial Atomoxetine, Parent Training, and Their Combination in Children With Autism Spectrum Disorder and 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 Acetyl-L-Carnitine as an Adjunctive Therapy in the Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents: A Placebo-Controlled Trial Efficacy and safety of mixed amphetamine salts extended release (adderall XR) in the management of oppositional defiant disorder with or without comorbid attention-deficit/hyperactivity disorder in school-aged children and adolescents: A 4-week, multicenter, randomized, double-blind, parallel-group, Lisdexamfetamine Dimesylate and Mixed Amphetamine Salts Extended-Release in Children with ADHD: A Double-Blind, Placebo-Controlled, Crossover Analog Classroom Study Selegiline in comparison with methylphenidate in attention deficit hyperactivity disorder children and adolescents in a double-blind, randomized clinical trial. The effect of methylphenidate on oppositional defiant disorder comorbid with attention deficit/hyperactivity disorder. Relative Benefits of Stimulant Therapy With OROS Methylphenidate Versus Mixed Amphetamine Salts Extended Release in Improving the Driving Performance of Adolescent Drivers With Attention-Deficit/Hyperactivity Disorder
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 INTRODUCTION Juvenile bipolar disorder ( JBD ) is a highly impairing chronic mental health condition that affects children and adolescents ' overall functioning . Comorbidity with attention-deficit/hyperactivity disorder ( ADHD ) is extremely prevalent and may determine worse response to treatment . Few investigations have addressed the use of recent atypical antipsychotics in JBD , although several guidelines suggest their use . METHODS We conducted a 6-week open trial with aripiprazole in 10 children and adolescents with JBD comorbid with ADHD to assess impact on mania and ADHD symptoms , respectively , by means of the Young Mania Rating Scale and the Swanson , Nolan and Pelham Scale , as well as on global functioning ( Clinical Global Impressions-Severity ) , and adverse events . RESULTS Significant improvement in global functioning scores ( F=3.17 , P=.01 , effect size=0.55 ) , manic symptoms ( F=5.63 , P<.01 ; ES=0.93 ) , and ADHD symptoms ( t=3.42 , P<.01;ES=1.05 ) were detected . Although an overall positive tolerability was reported , significant weight gain ( F=3.07 , P=.05 ) was observed . CONCLUSION Aripiprazole was effective in improving mania and ADHD symptoms , but neither JBD nor ADHD symptom remission was observed in most of the cases . R and omized placebo-controlled trials for JBD and ADHD are needed Mixed amphetamine salts extended release ( MAS XR ; Adderall XR ® ) and atomoxetine ( Strattera ® ) were compared in children 6 to 12 years old with attention deficit/hyperactivity disorder ( ADHD ) combined or hyperactive/impulsive type in a r and omized , double-blind , multicenter , parallel-group , forced-dose-escalation laboratory school study . Primary efficacy measure was the SKAMP ( Swanson , Kotkin , Agler , M-Flynn , and Pelham ) behavioral rating scale . Changes in mean SKAMP deportment scores from baseline were significantly greater for MAS XR ( n = 102 ) than for atomoxetine ( n = 101 ) overall ( -0.56 and -0.13 , respectively ; p < .0001 ) and at each week ( p < .001 ) . Adverse events were similar for both treatment groups . The extended time course of action and greater therapeutic efficacy  of MAS XR suggests that it is more effective than atomoxetine in children with ADHD OBJECTIVE To examine the pharmacokinetics ( PKs ) and pharmacodynamics ( PDs ) of OROS methylpheni date ( OROS MPH ) dosed once daily ( QD ) versus an early st and ard regimen ( immediate-release [ IR ] MPH dosed three times daily [ TID ] ) under various breakfast conditions . METHODS This single-center , double-blind , double-dummy , r and omized , crossover study of OROS MPH ( NCT00269815 ) in children aged 6 to 12 years with attention-deficit/hyperactivity disorder evaluated the PKs and PDs of MPH given with different breakfast conditions : OROS MPH administered after a high-fat breakfast , after a normal breakfast , or after fasting and IR MPH administered after a normal breakfast or after fasting in the morning and at two subsequent time points during the day . To maximize information , patients were divided into two groups , each receiving three of the five treatments for 1 day in a three-period , r and omized , crossover design . Patients were assigned to 1 of 3 dosage levels ( OROS MPH 18 , 36 , and 54 mg QD , and an assumed equivalent regimen of IR MPH 5 , 10 , and 15 mg given TID ) based on their pre study established clinical dose of IR MPH . PD measurements included Combined-Attention and Deportment scores on a rating scale of school behavior ( the Swanson , Kotkin , Agler , M-Flynn , and Pelham ) , global assessment s of efficacy , and activity monitor levels during academic seatwork . Serial blood sample s for PK analysis were taken predose , and then every 60 to 90 minutes until 11.5 hours postdose . Vital signs were assessed predose , and then every 1.5 to 2.5 hours until 11.5 hours postdose . RESULTS Of the 32 patients enrolled , 31 completed the study . The PK profiles for MPH after OROS MPH administration were similar under all conditions ( with normal , high-fat breakfast , or fasting ) . No bioequivalence tests of OROS MPH and IR MPH under various breakfast conditions were done because there were so few patients in each dose level of treatment . The two IR MPH conditions ( after normal breakfast and fasting ) were not compared . The drug-to-metabolite ratios ( area under the curve ) for all OROS MPH and IR MPH treatments were similar . OROS MPH and IR MPH provided a similar therapeutic effect , irrespective of breakfast conditions , as demonstrated by the Swanson , Kotkin , Agler , M-Flynn , and Pelham Attention and Deportment measures and global assessment s. No serious adverse events , no deaths , and no clinical ly significant changes in vital signs were reported , except for one patient who was discontinued early because of repeated systolic blood pressure elevations on study day 1 . CONCLUSIONS The results of this study demonstrate that in children with attention-deficit/hyperactivity disorder , administering OROS MPH with or without food produces similar PK and PD profiles Our objective was to evaluate the effectiveness of a long-acting formulation of methylpheni date ( MPH-SODAS ) on attention-deficit/hyperactivity disorder ( ADHD ) symptoms in an outpatient sample of adolescents with ADHD and substance use disorders ( SUD ) . Secondary goals were to evaluate the tolerability and impact on drug use of MPH-SODAS . This was a 6-week , single-blind , placebo-controlled crossover study assessing efficacy of escalated doses of MPH-SODAS on ADHD symptoms in 16 adolescents with ADHD/SUD . Participants were r and omly allocated to either group A ( weeks 1 - 3 on MPH-SODAS , weeks 4 - 6 on placebo ) or group B ( reverse order ) . The primary outcome measures were the Swanson , Nolan and Pelham Scale , version IV ( SNAP-IV ) and the Clinical Global Impression Scale ( CGI ) . We also evaluated the adverse effects of MPH-SODAS using the Barkley Side Effect Rating Scale and subject reports of drug use during the study . The sample consisted of marijuana ( N = 16 ; 100 % ) and cocaine users ( N = 7 ; 43.8 % ) . Subjects had a significantly greater reduction in SNAP-IV and CGI scores ( P < 0.001 for all analyses ) during MPH-SODAS treatment compared to placebo . No significant effects for period or sequence were found in analyses with the SNAP-IV and CGI scales . There was no significant effect on drug use .  MPH-SODAS was well tolerated but was associated with more severe appetite reduction than placebo ( P < 0.001 ) . MPH-SODAS was more effective than placebo in reducing ADHD symptoms in a non-abstinent outpatient sample of adolescents with comorbid SUD . R and omized clinical trials , with larger sample s and SUD intervention , are recommended OBJECTIVE To assess response to treatment with aripiprazole in children and adolescents with bipolar disorder comorbid with attention-deficit/hyperactivity disorder ( ADHD ) . METHOD Children and adolescents were extensively assessed according to DSM-IV criteria for bipolar disorder comorbid with ADHD ( n = 710 ) . Those with this comorbidity who were acutely manic or in mixed states were r and omly assigned in a 6-week double-blind , placebo-controlled trial to aripiprazole ( n = 18 ) or placebo ( n = 25 ) . Primary outcome measures were assessed weekly and included the Young Mania Rating Scale ; the Swanson , Nolan , and Pelham Scale-Version IV ; and weight . Secondary outcome measures were the Clinical Global Impressions-Severity of Illness scale , the Child Mania Rating Scale-Parental Version ( CMRS-P ) , the Children 's Depression Rating Scale-Revised , the Kutcher Adolescent Depression Scale , and adverse events . The trial was conducted at the Hospital de Clínicas de Porto Alegre , Rio Gr and e do Sul , Brazil , from January 2005 to November 2007 . RESULTS The group receiving aripiprazole showed a significantly greater reduction in YMRS scores ( P = .02 , effect size [ ES ] = 0.80 ) , CMRS-P scores ( P = .02 ; ES = 0.54 ) , and CGI-S scores ( P = .04 ; ES = 0.28 ) from baseline to endpoint than the placebo group . In addition , higher rates of response ( P = .02 ) and remission ( P = .01 ) were found for the aripiprazole group . No significant between-group differences were found in weight , ADHD symptoms , and depressive symptoms . Adverse events significantly more frequent in the aripiprazole group were somnolence and sialorrhea . CONCLUSION Aripiprazole was effective in reducing manic symptoms and improving global functioning without promoting severe adverse events or weight gain . No significant treatment effect in ADHD symptoms was observed . Studies are needed to assess psychopharmacologic interventions for improving ADHD symptoms in juvenile bipolar disorder comorbid with ADHD . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00116259 To examine Swanson , Nolan , and Pelham — IV ( SNAP-IV ) psychometric properties , parent ( N = 1,613 ) and teacher ( N = 1,205 ) data were collected from a r and om elementary school student sample in a longitudinal attention deficit hyperactivity disorder ( ADHD ) detection study . SNAP-IV reliability was acceptable . Factor structure indicated two ADHD factors and an oppositional defiant disorder ( ODD ) factor . Parent and teacher scores varied by gender and poverty status ( d = .49-.56 ) but not age ; only teacher scores varied by race ( d = .25-.55 ) . Screening and diagnostic utility was evaluated with likelihood ratios ( LRs ) and posttest probabilities . Parent SNAP-IV scores above 1.2 increased probability of concern ( LR > 10 ) and above 1.8 , of ADHD diagnosis ( LR > 3 ) . Teacher hyperactivity/impulsivity scores above 1.2 and inattention scores above 1.8 increased probabilities of concern only ( LR = 4.2 and > 5 , respectively ) .  Higher teacher scores for African American children and race differences in measurement models require future study Objective : To evaluate the efficacy of 2 computer attention training systems administered in school for children with attention-deficit hyperactivity disorder ( ADHD ) . Method : Children in second and fourth grade with a diagnosis of ADHD ( n = 104 ) were r and omly assigned to neurofeedback ( NF ) ( n = 34 ) , cognitive training ( CT ) ( n = 34 ) , or control ( n = 36 ) conditions . A 2-point growth model assessed change from pre-post intervention on parent reports ( Conners 3-Parent [ Conners 3-P ] ; Behavior Rating Inventory of Executive Function [ BRIEF ] rating scale ) , teacher reports ( Swanson , Kotkin , Agler , M-Flynn and Pelham scale [ SKAMP ] ; Conners 3-Teacher [ Conners 3-T ] ) , and systematic classroom observations ( Behavioral Observation of Students in Schools [ BOSS ] ) . Paired t tests and an analysis of covariance assessed change in medication . Results : Children who received NF showed significant improvement compared with those in the control condition on the Conners 3-P Attention , Executive Functioning and Global Index , on all BRIEF summary indices , and on BOSS motor/verbal off-task behavior . Children who received CT showed no improvement compared to the control condition . Children in the NF condition showed significant improvements compared to those in the CT condition on Conners 3-P Executive Functioning , all BRIEF summary indices , SKAMP Attention , and Conners 3-T Inattention subscales . Stimulant medication dosage in methylpheni date equivalencies significantly increased for children in the CT ( 8.54 mg ) and control ( 7.05 mg ) conditions but not for those in the NF condition ( 0.29 mg ) . Conclusion : Neurofeedback made greater improvements in ADHD symptoms compared to both the control and CT conditions . Thus , NF is a promising attention training treatment intervention for children with ADHD OBJECTIVE The aim of this study was to assess changes in symptomatology of attention-deficit/ hyperactivity disorder ( ADHD ) with extended-release dexmethylpheni date ( d-MPHER ) versus placebo in a laboratory classroom setting . METHODS This double-blind , placebo-controlled , crossover study r and omized 54 children 6 - 12 years of age , stabilized on methylpheni date 20 - 40 mg/day . Patients participated in a practice day , then received 5 days of treatment with d-MPH-ER 20 mg/day or placebo . After a 1-day wash-out , they returned to the classroom and received 1 dose of their assigned treatment . Evaluations occurred predose and at postdose hours 1 , 2 , 4 , 6 , 8 , 9 , 10 , 11 , and 12 . Children were then crossed over to the alternate treatment , using identical protocol . Primary efficacy variable was the Swanson , Kotkin , Agler , M-Flynn , and Pelham rating scale (SKAMP)-Combined scores , and primary analysis time point was 1 hour postdose ; secondary efficacy variables over 12 hours included SKAMP-Attention and -Deportment scores and written math test results . Safety was assessed by adverse event ( AE ) recording following each period . Vital signs were recorded at each visit ; laboratory tests were conducted at screening and final visit . RESULTS D-MPH-ER 20 mg/day showed a significant advantage over placebo as early as 1 hour postdose on SKAMP-Combined scores ( p < 0.001 ) . When analyzing the entire sample of 54 children , d-MPH-ER maintained significant superiority over placebo from hours 1 through 12 ( p-values ranged from < 0.001 to 0.046 ) . D-MPH-ER was well tolerated , with no severe AEs reported . CONCLUSIONS D-MPH-ER is safe and effective and improves classroom attention , deportment , and performance in children with ADHD 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 OBJECTIVES To evaluate the pharmacodynamic effects of an experimental ( EXP ) delivery of methylpheni date ( MPH ) in children with attention-deficit/hyperactivity disorder and to investigate the situational nature of effects in laboratory classroom and playground setting s. METHOD A " sipping " study methodology was used to deliver a bolus followed by small but increasing MPH doses as the EXP regimen . A r and omized , double-blind crossover design was used to compare the EXP regimen to a thrice-daily ( TID ) regimen and a placebo ( PLA ) regimen . Measures of efficacy were obtained from a Motionlogger actigraph to quantify activity and from the Swanson , Kotkin , Agler , M-Flynn , and Pelham ( SKAMP ) rating scale to quantify two domains of behavior ( attention and deportment ) . RESULTS Compared with PLA , both EXP and TID delivery of MPH produced large , significant reductions in activity and inappropriate behavior in the classroom , but the two MPH regimens did not differ in onset or duration of effects across the day . The MPH effects were situationally dependent and were smaller for the playground than for the classroom setting s. CONCLUSIONS The findings of this " proof of concept " study support the efficacy of a continuous , ascending delivery of MPH . The situational effects of MPH provide support for the theory of selective effects of stimulants , dependent on the dem and s of the environment BACKGROUND The findings from case reports and patient question naire surveys have been interpreted as indicating that administration of stimulants is ill-advised for the treatment of attention-deficit hyperactivity disorder in children with tic disorder . METHODS Thirty-four prepubertal children with attention-deficit hyperactivity disorder and tic disorder received placebo and three dosages of methylpheni date hydrochloride ( 0.1 , 0.3 , and 0.5 mg/kg ) twice daily for 2 weeks each , under double-blind conditions . Treatment effects were assessed using direct observations of child behavior in a simulated ( clinic-based ) classroom and using rating scales completed by the parents , teachers , and physician . RESULTS Methylpheni date effectively suppressed hyperactive , disruptive , and aggressive behavior . There was no evidence that methylpheni date altered the severity of tic disorder , but it may have a weak effect on the frequency of motor ( increase ) and vocal ( decrease ) tics . CONCLUSION Methylpheni date appears to be a safe and effective treatment for attention-deficit hyperactivity disorder in the majority of children with comorbid tic disorder OBJECTIVE To evaluate the efficacy and safety of dexmethylpheni date hydrochloride ( d-MPH , Focalin ) for the treatment of attention-deficit/hyperactivity disorder ( ADHD ) and to test an a priori hypothesis that d-MPH would have a longer duration of action than d , l-threo-methylpheni date ( d , l-MPH ) . METHOD This was a r and omized , double-blind study conducted at 12 U.S. centers . One hundred thirty-two subjects received d-MPH ( n=44 ) , d , l-MPH ( n=46 ) , or placebo ( n=42 ) twice daily for 4 weeks , with titration of the dose based on weekly clinic visits . The primary efficacy variable was change from baseline to last study visit on teacher-completed Swanson , Nolan , and Pelham Rating Scale ( Teacher SNAP ) . Secondary efficacy measures included the change on parent-completed SNAP ( Parent SNAP ) , Clinical Global Impressions Scale-Improvement ( CGI-I ) score , and Math Test performance . Assessment s at home in late afternoon were included to test the hypothesis that d-MPH would have a longer duration of efficacy than d , l-MPH . Safety was assessed through monitoring occurrence and severity of adverse events and discontinuations related to them . RESULTS Treatment with either d-MPH ( p=.0004 ) or d , l-MPH ( p=.0042 ) significantly improved Teacher SNAP ratings compared with placebo . The d-MPH group showed significant improvements compared with placebo on the afternoon Parent SNAP ratings ( p=.0003 ) and scores on the Math Test ( p=.0236 ) obtained late in the afternoon at 6:00 p.m. Sixty-seven percent of patients showed improvement on d-MPH and 49 % on d , l-MPH based on CGI-I scores . Both d-MPH and d , l-MPH were well tolerated , no patient in the d-MPH group and only two patients each in the d , l-MPH and placebo groups discontinued the study . CONCLUSIONS For the treatment of ADHD , an average titrated dose of 18.25 mg/day of d-MPH is as efficacious and safe as an average titrated dose of 32.14 mg/day of d , l-MPH . Both active treatments have large effect sizes . Thus , d-MPH and d , l-MPH appear to provide similar efficacy , and d-MPH may have longer duration of action after twice-daily dosing , but additional studies are needed to determine the statistical and clinical significance of this possibility 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 Objectives : The aim of this r and omized clinical trial was to assess the efficacy of memantine versus methylpheni date in the treatment of children with attention deficit hyperactivity disorder . Method : Forty participants ( 34 boys and 6 girls ) aged 6 - 11 who were diagnosed with attention deficit hyperactivity disorder based on ( DSM-IV-TR ) criteria were selected for this study . The participants were r and omly assigned to two groups : group one ( n = 22 ) received memantine and the other group ( n = 18 ) received methylpheni date for six weeks . Treatment outcomes were assessed using the Attention Deficit Hyperactivity Rating Scale and Clinical Global Impression- Severity Scale administered at baseline and at weeks 3 and 6 following the treatment . Also , a two-way repeated measures analysis of variance ( time- treatment interaction ) was used . Results : At 6 weeks , methylpheni date produced a signiﬁcantly better outcome on the Parent Rating Scale scores and Clinical Global Impression- Severity than memantine . Side effects were observed more often in the memantine group . However , with respect to the frequency of side effects , the difference between the memantine and methylpheni date groups was not signiﬁcant . The most common side effects associated with memantine  are appetite suppression , headache , vomiting , nausea and fatigue . Conclusion : The results of this study revealed that although memantine was less effective than methylpheni date in the treatment of attention deficit hyperactivity disorder , it may be considered as an alternative treatment OBJECTIVE Impairments associated with attention-deficit/hyperactivity disorder ( ADHD ) and noncompliance are prevalent in children with autism spectrum disorder ( ASD ) . However , ADHD response to stimulants is well below rates in typically developing children , with frequent side effects . Group studies of treatments for noncompliance are rare in ASD . We examined individual and combined-effectiveness of atomoxetine ( ATX ) and parent training ( PT ) for ADHD symptoms and noncompliance . METHOD In a 3-site , 10-week , double-blind , 2 × 2 trial of ATX and PT , 128 children ( ages 5 - 14 years ) with ASD and ADHD symptoms were r and omized to  ATX , ATX+PT , placebo+PT , or placebo . ATX was adjusted to optimal dose ( capped at 1.8 mg/kg/day ) over 6 weeks and maintained for 4 additional weeks . Nine PT sessions were provided . Primary outcome measures were the parent-rated DSM ADHD symptoms on the Swanson , Nolan and Pelham ( SNAP ) scale and Home Situations Question naire ( HSQ ) . RESULTS On the SNAP , ATX , ATX+PT and placebo+PT were each superior to placebo ( effect sizes 0.57 - 0.98 ; p values of .0005 , .0004 , and .025 , respectively ) . For noncompliance , ATX and ATX+PT were superior to placebo ( effect sizes 0.47 - 0.64 ; p values .03 and .0028 , respectively ) . ATX was associated with decreased appetite but was otherwise well tolerated . CONCLUSION Both ATX and PT result ed in significant improvement on ADHD symptoms , whereas ATX ( both alone and combined with PT ) was associated with significant decreases on measures of noncompliance . ATX appears to have a better side effects profile than psychostimulants in the population with ASD . CLINICAL TRIAL REGISTRATION INFORMATION Atomoxetine , Placebo and Parent Management Training in Autism ; http:// clinical trials.gov/ ; NCT00844753 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 The objective of this study was to test whether a previous observed Acetyl-L-carnitine ( ALC ) treatment effect could be repeated in an ALC adjunctive therapy treatment trial of attention-deficit/hyperactivity disorder ( ADHD ) in children and adolescents . This was a six-week , r and omized clinical trial undertaken in an outpatient child and adolescent clinic . Subjects included 40 out patients ( 28 boys and 12 girls ) between the ages of 7–13 who met the DSM-IV-TR diagnostic criteria for ADHD . All study subjects were r and omly assigned to receive treatment using capsules of ALC doses ranging from 500 to 1,500 mg/day depending on the weight of the child plus methylpheni date at a dose of 20–30 mg/day depending on weight or Placebo plus methylpheni date at a dose of 20–30 mg/day depending on weight . The principal measure of outcome was the Teacher and Parent attention deficit/hyperactivity disorder Rating Scale- IV . No difference was observed between the two groups on the Parent and Teacher Rating Scale scores ( df = 1 ; F = 0.10 ; P = 0.74 and df = 1 ; F = 0.22 ; P = 0.63 respectively ) . Side effects consisting of headache and irritability were observed more frequently in the methylpheni date plus placebo group . The results of this study do not support the application of ALC as an adjunctive therapy to methylpheni date in children and adolescents with ADHD BACKGROUND Oppositional defiant disorder (ODD)is associated with a high degree of impairment in social skills , family interaction , and academic functioning . Comorbid ODD is reportedly present in 40 % to 70 % of children and adolescents with attention-deficit/hyperactivity disorder ( ADHD ) . OBJECTIVE The goal of this study was to assess the efficacy and safety of mixed amphetamine salts extended release ( MAS XR ) for the treatment of ODD in children and adolescents aged 6 to 17 years . METHODS This was a 4-week , multicenter , r and omized , double-blind , parallel-group , placebo-controlled , forced-dose-escalation study . Patients were r and omized to receive active treatment with MAS XR 10 , 20 , 30 , or 40 mg/d or placebo . The primary efficacy end point was the ODD subscale of the Swanson , Nolan , and Pelham-IV ( SNAP-IV ) parent rating . Primary safety measures included adverse events recorded at each visit and for 30 days after study drug discontinuation , and changes in vital signs , 12-lead electrocardiographic ( ECG ) findings , laboratory tests and physical examinations , and body weight . A post hoc efficacy re analysis was completed based on the results for the per- protocol population . For this analysis , patients were divided into high and low baseline severity categories according to the dichotomized baseline ODD parent or teacher score or dichotomized baseline ADHD parent or teacher score ( high defined as scores at the median or greater and low defined as scores less than the median ) . RESULTS A total of 308 children and adolescents ( age range , 6 - 17 years ; 213 males , 95 females ) were r and omized to receive active treatment with MAS XR 10 mg/d ( n = 60 ) 20 mg/d ( n = 58 ) , 30 mg/d ( n = 69 ) , or 40 mg/d ( n = 61 ) or placebo ( n = 60 ) . Of the 308 study patients , 244 ( 79.2 % ) had comorbid ADHD . A significant change from baseline in the ODD symptoms measured with the SNAP-IV parent rating subscale was found for the MAS XR 30-mg/d ( -0.52 ; P < 0.001 ) and 40-mg/d ( -0.56 ; P = 0.002 ) groups in the per- protocol analysis and for the MAS XR 30-mg/d group in the intent-to-treat analysis ( -0.42 ; P < 0.005 ) . Throughout the study , MAS XR was well tolerated in these children and adolescents with ODD , and most adverse events were mild to moderate in intensity . The most frequently reported adverse events occurring in MAS XR-treated patients were anorexia/decreased appetite ( 25.3 % ) , insomnia ( 19.5 % ) , headache ( 18.5 % ) , and abdominal pain ( 10.7 % ) . Statistically , but not clinical ly , significant decreases in body weight were seen with MAS XR ( range , -1.1 to -3.5 lb ; P < 0.001 vs placebo ) . Changes in laboratory values , ECG measurements , and physical and other vital signs were also not clinical ly significant . The post hoc re analysis was based on the per- protocol population ( n = 229 ) . An assessment of the high baseline symptom severity subgroups showed a good response to MAS XR treatment for the SNAP-IV parent and teacher rating scales ( both , P < 0.05 ) . CONCLUSION This study found that higher doses ofMAS XR ( 30 and 40 mg ) were effective and well tolerated in the management of ODD in these school aged children and adolescents in the presence or absence of ADHD BACKGROUND Lisdexamfetamine dimesylate is a therapeutically inactive prodrug in which d-amphetamine is covalently bound to l-lysine , a naturally occurring amino acid . Pharmacologically active d-amphetamine is released from lisdexamfetamine following oral ingestion . METHODS This phase 2 , r and omized , double-blind , placebo- and active-controlled crossover study compared the efficacy and safety of lisdexamfetamine ( LDX : 30 , 50 , or 70 mg ) with placebo , with mixed amphetamine salts extended-release ( MAS XR : 10 , 20 , or 30 mg ) included as a reference arm of the study , in 52 children aged 6 to 12 years with attention-deficit/hyperactivity disorder ( ADHD ) in an analog classroom setting . The primary efficacy measure was the Swanson , Kotkin , Agler , M-Flynn , and Pelham ( SKAMP ) Rating Scale ; secondary efficacy measures included the Permanent Product Measure of Performance ( PERMP ) Derived Measures , and the Clinical Global Impression ( CGI ) Scale . RESULTS LDX treatment significantly improved scores on SKAMP-deportment , SKAMP-attention , PERMP-attempted , PERMP-correct , and CGI-improvement from baseline . Adverse events were similar for both active treatments . CONCLUSIONS In a laboratory classroom environment , LDX significantly improved ADHD symptoms versus placebo in school-age children with ADHD OBJECTIVES The aim of this study was to examine the selegiline treatment compared to methylpheni date ( MPH ) in children and adolescents with attention deficit hyperactivity disorder ( ADHD ) . METHOD Forty subjects , aged 6 - 15 years , boys and girls , who were diagnosed as having ADHD , using the criteria of the Diagnostic and Statistical Manual of Mental Disorders- Fourth Edition ( DSM-IV ) , were r and omly assigned to receive either selegiline or MPH for 60 days . Treatment outcomes were assessed using the Attention Deficit Hyperactivity Scale ( ADHS ) administered at baseline and on days 14 , 28 , 42 , and 60 following the commencement of treatment . Side effects were also rated . RESULTS There were no significant differences between sex , age , weight , and ethnicity of participants in the 2 groups . Both groups showed a significant improvement over the 60 days of treatment result ing from the teachers ' and parents ' ADHS scores across the treatment . CONCLUSION Following the trial , MPH did not effect greater mean improvement as a result of the parents ' or teachers ' ADHS scores than selegiline . Thus , selegiline appears to be effective and well tolerated for ADHD in children and adolescents OBJECTIVE To assess the effect of methylpheni date on the diagnosis of oppositional-defiant disorder ( ODD ) comorbid with attention-deficit hyperactivity disorder ( ADHD ) . METHOD We conducted an open-label study in which 10 children and adolescents with a dual diagnosis of ODD and ADHD were assessed for their ODD symptoms and treated with methylpheni date . At least one month after ADHD symptoms were under control , ODD symptoms were reevaluated with the Parent form of the Children Interview for Psychiatric Syndromes ( P-ChIPS ) . RESULTS Nine of the 10 patients no longer fulfilled diagnostic criteria for ODD after they were treated with methylpheni date for ADHD . CONCLUSION Methylpheni date seems to be an effective treatment for ODD , as well as for ADHD itself . The implication s for the treatment of patients with ODD not comorbid with ADHD needs further investigation OBJECTIVE . Automobile accidents are the leading cause of death among adolescents , and collisions are 2 to 4 times more likely to occur among adolescents with attention-deficit/hyperactivity disorder . Studies have demonstrated that stimulants improve driving performance . This study compared 2 long-acting stimulant medications during daytime and evening driving evaluations . METHODS . Adolescent drivers with attention-deficit/hyperactivity disorder were compared on a driving simulator after taking 72 mg of OROS methylpheni date , 30 mg of mixed amphetamine salts extended release , or placebo in a r and omized , double-blind , placebo-controlled , crossover study design . During laboratory testing , adolescents drove a driving simulator at 5:00 pm , 8:00 pm , and 11:00 pm . Driving performance was rated by adolescents and investigators . RESULTS . The study included 35 adolescent drivers with attention-deficit/hyperactivity disorder ( 19 boys/16 girls ) . The mean age was 17.8 years . The overall Impaired Driving Score demonstrated that OROS methylpheni date led to better driving performance compared with placebo and mixed amphetamine salts extended release , whereas mixed amphetamine salts extended release demonstrated no statistical improvement over placebo . Specifically , relative to placebo , OROS methylpheni date result ed in less time driving off the road , fewer instances of speeding , less erratic speed control , more time executing left turns , and less inappropriate use of brakes .  OROS methylpheni date and mixed amphetamine salts extended release worked equally well for male and female adolescents and equally as well with teenagers who have combined and inattentive subtypes of attention-deficit/hyperactivity disorder . CONCLUSIONS . This study vali date s the use of stimulants to improve driving performance in adolescents with attention-deficit/hyperactivity disorder . In the study , OROS methylpheni date promoted significantly improved driving performance compared with placebo and mixed amphetamine salts extended release
The results revealed that findings are becoming increasingly nuanced with variations in levels of evidence related to ages of the children and characteristics of the specific treatment .
In addition , we focused our critique on generalization of treatment effects across setting s and time and on sample diversity ( with regard to ethnicity and levels of parent education ) in relation to the population .
Children of parents with higher levels of education than average appear to be overrepresented in the literature .
The purpose of this research was to up date the series of articles on evidence -based treatment for children and adolescents with attention deficit/hyperactivity disorder that have appeared in this journal ( Evans , Owens & Bunford , 2014 ; Pelham & Fabiano , 2008 ; Pelham , Wheeler , & Chronis , 1998 ) .