The effectiveness of methylphenidate in the management of Attention Deficit Hyperactivity Disorder (ADHD) in people with intellectual disabilities: A systematic review. How effective and safe is medical cannabis as a treatment of mental disorders? A systematic review Does EEG-neurofeedback improve neurocognitive functioning in children with attention-deficit/hyperactivity disorder? A systematic review and a double-blind placebo-controlled study. The influence of short-chain essential fatty acids on children with attention-deficit/hyperactivity disorder: a double-blind placebo-controlled study. Effect of vitamin D treatment in children with attention-deficit hyperactivity disorder Effect of vitamin D supplementation as adjunctive therapy to methylphenidate on ADHD symptoms: A randomized, double blind, placebo-controlled trial Erratum to: Long-acting methylphenidate formulations in the treatment of attention-deficit/hyperactivity disorder: a systematic review of head-to-head studies Vitamin-mineral treatment of attention-deficit hyperactivity disorder in adults: double-blind randomised placebo-controlled trial. What future research should bring to help resolving the debate about the efficacy of EEG-neurofeedback in children with ADHD Acetyl-L-carnitine (ALC) in attention-deficit/hyperactivity disorder: a multi-site, placebo-controlled pilot trial. A Systematic Review of Global Publication Trends Regarding Long-Term Outcomes of ADHD A double-blind placebo-controlled randomised trial of omega-3 supplementation in children with moderate ADHD symptoms Efficacy of vitamin D supplementation in depression in adults: a systematic review protocol Treatment of Children With Attention-Deficit/Hyperactivity Disorder (ADHD) and Irritability: Results From the Multimodal Treatment Study of Children With ADHD (MTA) Effect of supplementation with long-chain ω-3 polyunsaturated fatty acids on behavior and cognition in children with attention deficit/hyperactivity disorder (ADHD): a randomized placebo-controlled intervention trial. A randomized, double-blind, placebo-controlled trial of docosahexaenoic acid supplementation in children with attention-deficit/hyperactivity disorder. Eicosapentaenoic and docosahexaenoic acids, cognition, and behavior in children with attention-deficit/hyperactivity disorder: a randomized controlled trial. Vitamin D in Pregnancy and Attention Deficit Hyperactivity Disorder-like Symptoms in Childhood Effects of Methylphenidate on Impulsive Responding in Children With Attention-Deficit Hyperactivity Disorder Reduced Symptoms of Inattention after Dietary Omega-3 Fatty Acid Supplementation in Boys with and without Attention Deficit/Hyperactivity Disorder Impulsiveness as a timing disturbance: neurocognitive abnormalities in attention-deficit hyperactivity disorder during temporal processes and normalization with methylphenidate The effect of methylphenidate on oppositional defiant disorder comorbid with attention deficit/hyperactivity disorder. fMRI Neurofeedback Training for Increasing Anterior Cingulate Cortex Activation in Adult Attention Deficit Hyperactivity Disorder. An Exploratory Randomized, Single-Blinded Study
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 We conducted a review of systematic review s ( SRs ) and r and omized-controlled trials ( RCTs ) to analyze efficacy and safety of cannabis-based medication in patients with mental disorders . Five data bases were systematic ally search ed ( 2006—August 2018 ) ; 4 SRs ( of 11 RCTs ) and 14 RCTs ( 1629 participants ) were included . Diagnoses were : dementia , cannabis and opioid dependence , psychoses/schizophrenia , general social anxiety , posttraumatic stress disorder , anorexia nervosa , attention-deficit hyperactivity disorder , and Tourette`s disorder . Outcome variables were too heterogeneous to conduct a meta- analysis . A narrative synthesis method was applied . The study quality was assessed using the risk-of-bias tool and SIGN-checklists . THC- and CBD-based medicines , given as adjunct to pharmaco- and psychotherapy , were associated with improvements of several symptoms of mental disorders , but not with remission . Side effects occurred , but severe adverse effects were mentioned in single cases only . In order to provide reliable treatment recommendations , more and larger RCTs with follow-up assessment s , consistent outcome measures and active comparisons are needed 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 Essential fatty acids ( EFA ) are needed for normal sensory , cognitive , and motor function . The EFA blood profile seems to be different in children with attention-deficit/hyperactivity disorder ( ADHD ) as compared to matched controls . Previous open EFA supplementation trials were successful in demonstrating significant therapeutic effects in this population , whereas most of the r and omized controlled trials failed to show any benefit over placebo . The current r and omized , double-blind , placebo-controlled trial tested the influence of short-chain EFA supplementation on ADHD children , using parent and teacher question naires and a computerized continuous performance test . A total of 73 unmedicated children aged 7 - 13 years with a diagnosis of ADHD participated in the study ; 63 children completed the study . The EFA supplement contained 480 mg of linoleic acid and 120 mg of alpha-linolenic acid , and the placebo contained 1000 mg of vitamin C ( daily amounts ) ; both were given for a 7-week supplementation period . Analysis of variance for repeated measures revealed that both treatments ameliorated some of the symptoms , but no significant differences were found between the groups in any of the treatment effects Background In this research the symptom improvement of attention-deficit hyperactivity disorder ( ADHD ) of children was assessed by oral vitamin D administration  in Tabriz , Iran . Methods In this double-blind , r and omized clinical trials , 96 children ( 2–18 years ) were enrolled to placebo and vitamin D groups . Children took vitamin D pearl ( 50,000 IU/week ) or placebo for 6 weeks . Children , who had the change in methylpheni date dosage and received any anticonvulsants and corticosteroids were excluded from the research . ADHD symptoms were diagnosed by Conners parent rating scale ( CPRS ) test at baseline and after intervention . ADHD Conners divided into inattention ( IA ) , hyperactivity/impulsivity ( H/I ) and combination type ( C ) subscales .  Vitamin D serum level was assessed at baseline and after 8 weeks in both groups . Results The differences between CPRS and its subscales were not significant at baseline ( P > 0.05 ) . The Conners IA score was decreased in vitamin D group ( P < 0.05 ; adjusted with age and baseline values ) . ADHD Conners and all subscale scores reduced remarkably after intervention in patients with insufficient level of vitamin D compared to placebo ( P < 0.05 ) . Conclusions Oral vitamin D  improved ADHD symptoms with a particular effect on inattention symptoms . In addition , symptoms related to all subscales were improved remarkably in patients with insufficient level of vitamin D. Vitamin D treatment in children with ADHD could be considered due to the exp and benefit of vitamin D in body Objectives : Previous studies have shown that serum levels of vitamin D were lower in attention deficit hyperactivity disorder ( ADHD ) children compared to healthy controls . The aim of the study was to determine the effect of vitamin D supplementation as adjunctive therapy to methylpheni date on symptoms of children with ADHD . Methods : Sixty-two children aged 5–12 years with a diagnosis of ADHD based on DSM-IV criteria were r and omly assigned into two groups to receive either 2000IU vitamin D or placebo in addition to methylpheni date for 8 weeks . Symptoms severity was assessed by Conner 's Parent Rating Scale-Revised[S ] ( CPRS ) , ADHD rating scale-IV ( ADHD-RS ) , and Weekly Parent Ratings of Evening and Morning Behavior ( WPREMB ) at weeks 0 , 4 , and 8 . Serum levels of 25(OH)D were measured at baseline and after 8 weeks . Anthropometric variables , dietary intake , physical activity , sun exposure , and side effects were assessed . Results : Fifty-four participants completed the trial . After 8 weeks of supplementation , serum levels of 25(OH)D significantly increased in the vitamin D group . ADHD symptoms decreased significantly in both groups ( P < 0.05 ) . Evening symptoms and total score of WPREMB scale were significantly different at weeks 4 and 8 between the two groups ( P = 0.013 , 0.016 , respectively ) , but no differences were found in symptoms by CPRS and ADHD-RS scales . Discussion : Vitamin D supplementation as adjunctive therapy to methylpheni date improved ADHD evening symptoms . Future research is needed to clarify vitamin D effects as monotherapy in ADHD and its mechanism . The trial was registered in www.i rct .ir is ( I RCT 201404222394N10 ) 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 BACKGROUND The role of nutrition in the treatment of  attention-deficit hyperactivity disorder ( ADHD )  is gaining international attention ; however , treatments have generally focused only on diet restriction or supplementing with one nutrient at a time . AIMS To investigate the efficacy and safety of a broad-based micronutrient formula consisting mainly of vitamins and minerals , without omega fatty acids , in the treatment of ADHD in adults . METHOD This double-blind r and omised controlled trial assigned 80 adults with ADHD in a 1:1 ratio to either micronutrients  ( n = 42 ) or  placebo ( n = 38 ) for 8 weeks ( trial registered with the Australian New Zeal and Clinical Trials Registry : ACTRN12609000308291 ) . RESULTS Intent-to-treat analyses showed significant between-group differences favouring active treatment on self- and observer- but not clinician-ADHD rating scales . However , clinicians rated those receiving micronutrients as more improved than those on placebo both globally and on ADHD symptoms . Post hoc analyses showed that for those with moderate/severe depression  at baseline , there was a greater change in mood favouring active treatment over placebo . There were no group differences in adverse events . CONCLUSIONS This study provides preliminary evidence of efficacy for micronutrients in the treatment of  ADHD symptoms in adults , with a reassuring safety profile In recent years a rising amount of r and omized controlled trials , review s , and meta-analyses relating to the efficacy of electroencephalographic-neurofeedback ( EEG-NF ) in children with attention-deficit/hyperactivity disorder ( ADHD ) have been published . Although clinical reports and open treatment studies suggest EEG-NF to be effective , double blind placebo-controlled studies as well as a rigorous meta- analysis failed to find support for the efficacy of EEG-NF . Since absence of evidence does not equate with evidence of absence , we will outline how future research might overcome the present method ological limitations . To provide conclusive evidence for the presence or absence of the efficacy of EEG-NF  in the treatment of ADHD , there is a need to set up a well- design ed study that ensures optimal implementation and embedding of the training , and possibly incorporates different forms of neurofeedback OBJECTIVE To determine whether acetyl-L-carnitine ( ALC ) , a metabolite necessary for energy metabolism and essential fatty acid anabolism , might help attention-deficit/hyperactivity disorder ( ADHD ) . Trials in Down 's syndrome , migraine , and Alzheimer 's disease showed benefit for attention . A preliminary trial in ADHD using L-carnitine reported significant benefit . METHOD A multi-site 16-week pilot study r and omized 112 children ( 83 boys , 29 girls ) age 5 - 12 with systematic ally diagnosed ADHD to placebo or ALC in weight-based doses from 500 to 1500 mg b.i.d . The 2001 revisions of the Conners ' parent and teacher scales ( including DSM-IV ADHD symptoms ) were administered at baseline , 8 , 12 , and 16 weeks . Analyses were ANOVA of change from baseline to 16 weeks with treatment , center , and treatment-by-center interaction as independent variables . RESULTS The primary intent-to-treat analysis , of 9 DSM-IV teacher-rated inattentive symptoms , was not significant . However , secondary analyses were interesting . There was significant ( p = 0.02 ) moderation by subtype : superiority of ALC over placebo in the inattentive type , with an opposite tendency in combined type . There was also a geographic effect ( p = 0.047 ) . Side effects were negligible ; electrocardiograms , lab work , and physical exam unremarkable . CONCLUSION ALC appears safe , but with no effect on the overall ADHD population ( especially combined type ) . It deserves further exploration for possible benefit specifically in the inattentive type There is increased global recognition of attention deficit hyperactivity disorder ( ADHD ) as a serious medical condition with long-term consequences . Although originally conceived of as a childhood disorder , ADHD is being increasingly recognized in adults . Individual geographic regions may have specific interests and objectives for the study of ADHD . A systematic review of  long-term outcomes ( LTOs ) in ADHD was conducted to evaluate research on ADHD LTOs  on a global scale . Studies that were at least 2 years in duration were examined . A total of 351 studies were identified in the final analysis . We identified nine outcomes of interest and classified studies by specific geographical regions , age groups studied and study design by region and over time . Published studies of LTOs in ADHD have increased in all geographical regions over the past three decades , with a peak number of 42 publications in 2008 . This rise in publications on ADHD LTOs may reflect a rise in global interest and recognition of consequences and impairment associated with ADHD . Although many world regions have published on ADHD LTOs , the majority of studies have emerged from the US and Canada , followed by Europe . While investigators in the US and Canada were predominantly interested in drug addiction as a LTO , European research ers were more interested in antisocial behavior , and Eastern Asian investigators focused on both of these LTOs as well as self-esteem . Geographical differences in the focus of ADHD LTO studies may reflect regional variations in cultural values . Proportionally fewer prospect i ve longitudinal studies and proportionally more retrospective and cross-sectional studies have been published in more recent decades . Finally , more studies focusing on ADHD in adolescents and adults have been conducted in recent years , and particularly adolescents in Eastern Asia . These changes in basic study design may reflect an increase in the recognition that ADHD is a lifetime chronic disorder . This systematic review analysis of publication trends in ADHD LTOs reflects geographically based interests that change over time Objective Clinical trials and inconclusive meta-analyses have investigated the effects of omega-3 supplements in children with Attention-Deficit Hyperactivity Disorder ( ADHD ) . We performed a r and omised placebo-controlled trial to evaluate the efficacy of omega-3 fatty acids . Methods Children aged 6–15 years with established diagnosis of ADHD were r and omised 1:1 to receive either supplements containing docosahexaenoic acid ( DHA ) and eicosapentaenoic acid ( EPA ) or a placebo for 3 months . Psychotropic or omega-3-containing treatments were not authorised during the study . The primary outcome was the change in the Attention-Deficit Hyperactivity Disorder Rating Scale version 4 ( ADHD-RS-IV ) . Other outcomes included safety , lexical level ( Alouette test ) , attention ( Test of Attentional Performance for Children — KiTAP ) , anxiety ( 48-item Conners Parent Rating Scale-Revised — CPRS-R ) , and depression ( Children ’s Depression Inventory — CDI ) . Results Between 2009 and 2011 , 162 children were included in five French child psychiatry centres . The mean age was 9.90 ( SD 2.62 ) years and 78.4 % were boys . The inclusion ADHD-RS-IV at was 37.31 ( SD 8.40 ) . The total ADHD-RS-IV score reduction was greater in the placebo group than in the DHA – EPA group : −19 ( −26 , −12 ) % and −9.7 ( −16.6 , −2.9 ) % , respectively , p = 0.039 . The other components of the Conners score had a similar variation but the differences between groups were not significant . Two patients in the DHA – EPA group and none in the placebo group experienced a severe adverse event ( hospitalisation for worsening ADHD symptoms ) . Conclusion This study did not show any beneficial effect of omega-3 supplement in children with mild ADHD symptoms Background The role of vitamin D in management of depression is unclear . Results from observational and emerging r and omized controlled trials ( RCTs ) investigating the efficacy of vitamin D in depression lack consistency - with some suggesting a positive association while others show a negative or inconclusive association . Methods / Design The primary aim of this study is to conduct a systematic review of RCTs to assess the effect of oral vitamin D supplementation versus placebo on depression symptoms measured by scales and the proportion of patients with symptomatic improvement according to the authors ’ original definition . Secondary aims include assessing the change in quality of life , adverse events and treatment discontinuation . We will conduct the systematic review and meta- analysis according to the recommendations of the Cochrane H and book for Systematic Review s of Interventions . We will search the Cochrane Central Register of Controlled Trials ( CENTRAL ) , MEDLINE ( 1966 to present ) , EMBASE ( 1980 to present ) , CINAHL ( 1982 to present ) , PsychINFO ( 1967 to present ) and Clinical Trials.gov . Unpublished work will be identified by search ing two major conferences : the International Vitamin Conference , the Anxiety Disorders and Depression Conference , while grey literature will be acquired by contacting authors of included studies . We will use the r and om-effects meta- analysis to synthesize the data by pooling the results of included studies . Discussion The results of this systematic review will be helpful in clarifying the efficacy of vitamin D supplementation and providing evidence to establish guidelines for implementation of vitamin D for depression in general practice and other relevant setting s. Study registration Unique identifier : CRD42013003849 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 determine whether supplementation with the long-chain omega-3 polyunsaturated fatty acids eicosapentaenoic ( EPA ) and docosahexaenoic acid ( DHA ) affects behavioral symptoms and cognitive impairments in children 6 - 12 years of age diagnosed with attention-deficit/hyperactivity disorder ( ADHD ) . STUDY DESIGN The r and omized , double-blind placebo-controlled 16 weeks trial was conducted with 95 children diagnosed with ADHD according to DSM-IV criteria . Behavior was assessed by parents , teachers and investigators using st and ardized rating scales and question naires . Further outcome variables were working memory , speed of information processing and various measures of attention . For a subgroup of 81 participants , erythrocyte membrane fatty acid composition was analyzed before and after the intervention . RESULTS Supplementation with the omega-3 fatty acid mix increased EPA and DHA concentrations in erythrocyte membranes and improved working memory function , but had no effect on other cognitive measures and parent- and teacher-rated behavior in the study population . Improved working memory correlated significantly with increased EPA , DHA and decreased AA ( arachidonic acid ) OBJECTIVE To determine whether docosahexaenoic acid ( DHA ) supplementation for 4 months decreases the symptoms of  attention-deficit/hyperactivity disorder ( ADHD ) .  STUDY DESIGN Sixty-three 6- to-12-year-old children with ADHD , all receiving effective maintenance therapy with stimulant medication , were assigned r and omly , in a double-blind fashion , to receive DHA supplementation ( 345 mg/d ) or placebo for 4 months . Outcome variables included plasma phospholipid fatty acid patterns , scores on laboratory measures of inattention and impulsivity ( Test of Variables of Attention , Children 's Color Trails test ) while not taking stimulant medication , and scores on parental behavioral rating scales ( Child Behavior Checklist , Conners ' Rating Scale ) . Differences between groups after 4 months of DHA supplementation or placebo administration were determined by analysis of variance , controlling for age , baseline value of each outcome variable , ethnicity , and ADHD subtype . RESULTS Plasma phospholipid DHA content of the DHA-supplemented group was 2.6-fold higher at the end of the study than that of the placebo group ( 4.85 + /- 1.35 vs 1.86 + /- 0.87 mol % of total fatty acids ; P < .001 ) . Despite this , there was no statistically significant improvement in any objective or subjective measure of ADHD symptoms . CONCLUSION A 4-month period of DHA supplementation ( 345 mg/d ) does not decrease symptoms of ADHD OBJECTIVE To determine the effects of an eicosapentaenoic acid (EPA)-rich oil and a docosahexaenoic acid (DHA)-rich oil versus an ω-6 polyunsaturated fatty acid-rich safflower oil ( control ) on literacy and behavior in children with attention-deficit/hyperactivity disorder ( ADHD ) in a r and omized controlled trial . METHODS Supplements rich in EPA , DHA , or safflower oil were r and omly allocated for 4 mo to 90 Australian children 7 to 12 y old with ADHD symptoms higher than the 90th percentile on the Conners Rating Scales . The effect of supplementation on cognition , literacy , and parent-rated behavior was assessed by linear mixed modeling . Pearson correlations determined associations between the changes in outcome measurements and the erythrocyte fatty acid content ( percentage of total ) from baseline to 4 mo . RESULTS There were no significant differences between the supplement groups in the primary outcomes after 4 mo . However , the erythrocyte fatty acid profiles indicated that an increased proportion of DHA was associated with improved word reading ( r = 0.394 ) and lower parent ratings of oppositional behavior ( r = 0.392 ) . These effects were more evident in a subgroup of 17 children with learning difficulties : an increased erythrocyte DHA was associated with improved word reading ( r = 0.683 ) , improved spelling ( r = 0.556 ) , an improved ability to divide attention ( r = 0.676 ) , and lower parent ratings of oppositional behavior ( r = 0.777 ) , hyperactivity ( r = 0.702 ) , restlessness ( r = 0.705 ) , and overall ADHD symptoms ( r = 0.665 ) . CONCLUSION Increases in erythrocyte ω-3 polyunsaturated fatty acids , specifically DHA , may improve literacy and behavior in children with ADHD . The greatest benefit may be observed in children who have comorbid learning difficulties Background : Vitamin D status during prenatal brain development may influence risk of  attention deficit and hyperactivity disorder ( ADHD ) symptoms in childhood . However , there are no prospect i ve studies addressing this hypothesis . We aim ed to examine whether maternal vitamin D status in pregnancy is associated with risk of  ADHD-like symptoms in offspring . Methods : We conducted a prospect i ve study analyzing data from 1,650 mother – child pairs from five birth cohorts embedded in the INMA Project ( Spain , 1997–2008 ) . Maternal vitamin D status in pregnancy was estimated by measuring plasma concentration of 25-hydroxyvitamin D3 [ 25(OH)D3 ] at 13 weeks of gestation . Children were assessed by teachers for ADHD-like symptoms at ages 4–5 years using the Diagnostic and Statistical Manual of Mental Disorders ADHD form list . Results : After adjustment , the number of total ADHD-like symptoms in children decreased by 11 % per 10 ng/ml increment of maternal 25(OH)D3 concentration ( incidence rate ratio [ IRR ] = 0.89 ; 95 % confidence interval [ CI ] = 0.80 , 0.98 ) . Similarly , the number of symptoms in the ADHD subscales decreased in relation to higher maternal 25(OH)D3 concentration ( IRR per 10 ng/ml increment = 0.89 ; 95 % CI = 0.79 , 0.99 for the inattention scale ; and IRR = 0.88 ; 95 % CI = 0.78 , 0.99 for the hyperactivity – impulsivity scale ) . Using diagnostic criteria , we found an association of increasing maternal 25(OH)D3 with a lower risk of ADHD DSM-IV ( relative risk ratio per 10 ng/ml increment = 0.87 ; 95 % CI = 0.72 , 1.06 ) and ICD-10 hyperkinetic disorder ( relative risk ratio = 0.72 ; 95 % CI = 0.49 , 1.04 ) in children . Conclusion : Higher maternal circulating levels of 25(OH)D3 in pregnancy are associated with lower risk of developing ADHD-like symptoms in childhood 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 ) Attention deficit/hyperactivity disorder ( ADHD ) is one of the most common child psychiatric disorders , and is often treated with stimulant medication . Nonpharmacological treatments include dietary supplementation with omega-3 fatty acids , although their effectiveness remains to be shown conclusively . In this study , we investigated the effects of dietary omega-3 fatty acid supplementation on ADHD symptoms and cognitive control in young boys with and without ADHD . A total of 40 boys with ADHD , aged 8–14 years , and 39 matched , typically developing controls participated in a 16-week double-blind r and omized placebo-controlled trial . Participants consumed 10 g of margarine daily , enriched with either 650 mg of eicosapentaenoic acid (EPA)/docosahexaenoic acid ( DHA ) each or placebo . Baseline and follow-up assessment s addressed ADHD symptoms , fMRI of cognitive control , urine homovanillic acid , and cheek cell phospholipid sampling . EPA/DHA supplementation improved parent-rated attention in both children with ADHD and typically developing children . Phospholipid DHA level at follow-up was higher for children receiving EPA/DHA supplements than placebo . There was no effect of EPA/DHA supplementation on cognitive control or on fMRI measures of brain activity . This study shows that dietary supplementation with omega-3 fatty acids  reduces symptoms of ADHD , both for individuals with ADHD and typically developing children . This effect does not appear to be mediated by cognitive control systems in the brain , as no effect of supplementation was found here . Nonetheless , this study offers support that omega-3 supplementation may be an effective augmentation for pharmacological treatments of ADHD ( NCT01554462 : The Effects of EPA/DHA Supplementation on Cognitive Control in Children with ADHD ; http:// clinical trials.gov/show/NCT01554462 ) 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 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 Attention Deficit Hyperactivity Disorder ( ADHD ) is characterized by poor cognitive control/attention and hypofunctioning of the dorsal anterior cingulate cortex ( dACC ) . In the current study , we investigated for the first time whether real-time fMRI neurofeedback ( rt-fMRI ) training targeted at increasing activation levels within dACC in adults with ADHD leads to a reduction of clinical symptoms and improved cognitive functioning . An exploratory r and omized controlled treatment study with blinding of the participants was conducted . Participants with ADHD ( n = 7 in the neurofeedback group , and n = 6 in the control group ) attended four weekly MRI training sessions ( 60-min training time/session ) , during which they performed a mental calculation task at varying levels of difficulty , in order to learn how to up-regulate dACC activation . Only neurofeedback participants received continuous feedback information on actual brain activation levels within dACC . Before and after the training , ADHD symptoms and relevant cognitive functioning was assessed . Results showed that both groups achieved a significant increase in dACC activation levels over sessions . While there was no significant difference between the neurofeedback and control group in clinical outcome , neurofeedback participants showed stronger improvement on cognitive functioning . The current study demonstrates the general feasibility of the suggested rt-fMRI neurofeedback training approach as a potential novel treatment option for ADHD patients . Due to the study ’s small sample size , potential clinical benefits need to be further investigated in future studies . Trial Registration : IS RCT
Vitamin D supplementation demonstrated a small but statistically significant improvement in ADHD total scores , inattention scores , hyperactivity scores , and behavior scores .
There was no statistically significant improvement in oppositional scores .
Reported adverse events in the vitamin D group were mild and not significantly different from the control group .
Vitamin D supplementation increased serum vitamin D levels and the ratio of patients with sufficient vitamin D levels .
Conclusions : Vitamin D supplementation as adjunctive therapy to methylpheni date appeared to reduce ADHD symptoms without serious adverse events , associated with improved vitamin D status .
Objective : A systematic review and meta- analysis of r and omized controlled trials ( RCTs ) were conducted to assess the benefits and harms of vitamin D supplementation for attention-deficit/hyperactivity disorder ( ADHD ) patients .