Long-term, open-label study of the safety and efficacy of atomoxetine in adults with attention-deficit/hyperactivity disorder: an interim analysis. OROS methylphenidate in the treatment of adults with ADHD: a 6-month, open-label, follow-up study. A Systematic Review of Global Publication Trends Regarding Long-Term Outcomes of ADHD Atomoxetine treatment in children and adolescents with attention-deficit hyperactivity disorder: what are the long-term health-related quality-of-life outcomes? 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. Impact of comorbid autism spectrum disorders on stimulant response in children with attention deficit hyperactivity disorder: a retrospective and prospective effectiveness study. The MTA at 8 years: prospective follow-up of children treated for combined-type ADHD in a multisite study. Methylphenidate treatment of adult male prison inmates with attention-deficit hyperactivity disorder: randomised double-blind placebo-controlled trial with open-label extension. Long-term stimulant treatment of children with attention-deficit hyperactivity disorder 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 Young adult outcomes in the follow‐up of the multimodal treatment study of attention‐deficit/hyperactivity disorder: symptom persistence, source discrepancy, and height suppression Stimulant treatment in children with attention-deficit/hyperactivity disorder moderates adolescent academic outcome. Effects of mindfulness-based cognitive therapy on neurophysiological correlates of performance monitoring in adult attention-deficit/hyperactivity disorder Clonidine extended-release tablets for pediatric patients with attention-deficit/hyperactivity disorder. Educational and occupational outcome of hyperactive boys grown up. Adult outcome of hyperactive boys. Educational achievement, occupational rank, and psychiatric status. 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 Impact of early school-based screening and intervention programs for ADHD on children's outcomes and access to services: follow-up of a school-based trial at age 10 years. Long-acting methylphenidate has an effect on aggressive behavior in children with attention-deficit/hyperactivity disorder. [The prevalence of attention-deficit/hyperactivity disorder (ADHD) among children and adolescents in Germany. Initial results from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS)]. Symptomatic improvement in children with ADHD treated with long-term methylphenidate and multimodal psychosocial treatment. Long-term effectiveness and safety of lisdexamfetamine dimesylate in school-aged children with attention-deficit/hyperactivity disorder. Academic Achievement in Adults with a History of Childhood Attention-Deficit/Hyperactivity Disorder: A Population-Based Prospective Study
BACKGROUND Attention-deficit/hyperactivity disorder ( ADHD ) is an early-onset neuropsychiatric disorder that affects 3 % to 7 % of school-age children and 4 % of adults . Its pathophysiology is thought to involve the dopaminergic and nor-adrenergic pathways associated with attention control and impulsivity . These symptoms have largely been defined in the childhood population , but the course of the condition and expression in the adult population are not as well characterized . METHOD This is an ongoing , 3-year , open-label study consisting of adults with DSM-IV ADHD who were previously enrolled in 1 of 2 double-blind , acute-treatment studies of atomoxetine .  The results of the interim analysis reported here were derived from the study of 384 patients at 31 sites who had been studied for a period of up to 97 weeks . The primary efficacy measure was the Conners ' Adult ADHD Rating Scale-Investigator Rated : Screening Version ( CAARS-Inv : SV ) total ADHD symptom score . In addition , safety , adverse events , and vital sign measurements were assessed . RESULTS Significant improvement was noted with atomoxetine therapy , with mean CAARS-Inv : SV total ADHD symptom scores decreasing 33.2 % from 29.2 ( baseline of open-label therapy ) to 19.5 ( endpoint of open-label therapy ) ( p < .001 ) . Similar and significant decreases were noted for the secondary efficacy measures . Adverse events consisted primarily of pharmacologically ( noradrenergic ) expected effects , such as increases in heart rate and blood pressure and a slight decrease in weight . CONCLUSION The results of this interim analysis of an ongoing , open-label study of adults with ADHD support the long-term efficacy , safety , and tolerability of atomoxetine for the treatment of adult ADHD BACKGROUND This open-label trial followed a previously reported r and omized , placebo-controlled trial of osmotic release oral system ( OROS ) methylpheni date ( MPH ) for the treatment of personality disorder ( PD ) . Important findings from the double-blind phase are reexamined for long-term significance . METHODS Of 41 patients who completed the double-blind , placebo-controlled trial , 34 continued into this open-label phase . The Wender-Reimherr Adult Attention Deficit Disorder Scale ( WRAADDS ) measured outcome . Patients were categorized using previously defined attention-deficit/hyperactivity disorder ( ADHD ) groups : ADHD alone , ADHD with emotional dysregulation ( ADHD + ED ) , and ADHD plus emotional dysregulation plus oppositional symptoms ( ADHD + ED + ODD ) ; and 3 post hoc personality categories : patients with no PD ( PD-negative ) , patients with 1 PD ( PD-positive ) , and patients meeting criteria for 2 or more PDs ( PD-plus ) . RESULTS Three WRAADDS-defined ADHD dimensions improved at similar levels ( attention + disorganization , 61 % ; hyperactivity + impulsivity , 60 % ; and emotional dysregulation , 66 % ) . All ADHD subgroups ( ADHD alone , ADHD + ED , and ADHD + ED + ODD ) improved . ADHD + ED + ODD patients had the highest level of social maladjustment at baseline and showed the most long-term improvement in this area . PD-plus patients were less likely to complete the study or show improvement . Sixty-five percent of treatment responders were on moderate doses ( < or = 54 mg/d ) of OROS MPH .  Vital signs and ECGs did not differ from baseline . CONCLUSIONS Eighteen ( 44 % ) patients completed the trial . All 3 ADHD dimensions showed similar , well-maintained improvement . Patients with several PDs responded poorly to treatment in this small trial 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 Numerous investigations have examined the efficacy of pharmacological treatment for attention-deficit/hyperactivity disorder ( ADHD ) in children . However , relatively few studies have addressed the impact of treatment on long-term subjective , psychosocial outcomes , such as health-related quality of life ( HRQL ) . This study examines the long-term effects of pharmacological treatment with atomoxetine on HRQL in children and adolescents with ADHD . METHODS Participants included 6- to 17-year-old children and adolescents ( n = 912 ) with ADHD enrolled in a 24-month , multicenter , open-label trial of atomoxetine . Outcomes included clinician ratings of ADHD , parent ratings of ADHD , and a widely used measure of HRQL ( The Child Health Question naire ( CHQ ) ) . Treatment response rates were calculated based on a CHQ improvement of at least 1 st and ard error of measurement . RESULTS Significant improvements in HRQL were found following both acute and long-term treatment for psychosocial but not physical health . Of participants who completed treatment ( n = 312 or 34.2 % of those enrolled ) , 81 % responded to acute treatment and 78 % responded to long-term treatment . Improvements noted after acute treatment were maintained during long-term treatment with the majority of participants ( 86 % ) continuing to respond to treatment . CONCLUSIONS Atomoxetine is associated with improvements in HRQL , and the improvements are generally stable over time 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 In the recent past , psychiatrists and paediatricians have avoided prescribing stimulant medication , such as methylpheni date and dexamphetamine to patients with autism spectrum disorders ( ASD ) because of both doubts about efficacy and concern that these medications make stereotypies worse . Recently , a number of small trials have suggested that methypheni date does have a role in the management of hyperactivity in children with autistic spectrum disorders . METHODS Children with ASD and attention deficit hyperactivity disorder ( ADHD ) , and children with ADHD without ASD received st and ard treatment with methypheni date from one specialist centre . A combination of st and ardized and novel outcome tools was used to allow both an exploratory retrospective study of 174 children and then a prospect i ve study of a further 52 children to be carried out . RESULTS After treatment with stimulants , the subjects in both groups showed statistically significant improvements in target symptoms of ' hyperactivity ' , ' impulsivity ' , ' inattention ' , ' oppositionality ' , ' aggression ' and ' intermittent explosive rage ' . The Clinical Global Impression-Improvement and efficacy index measures also improved in each group . In both the retrospective and the prospect i ve studies , there was no statistically significant difference in the degree of improvements between each group . Importantly , neither tics nor repetitive behaviours worsened in either group . Children in the ' ADHD-only ' group who were prescribed stimulants experienced significant ' nausea ' , ' giddiness ' , ' headaches ' and ' sleep difficulties ' , whereas sleep difficulties were the only side effect that emerged in children in the ASD with ADHD group . CONCLUSIONS Both studies presented here support previous findings from smaller studies that show children with autism and ADHD can respond as well to stimulants as children with ADHD alone . Although r and omized controlled trials remain the gold st and ard for efficacy studies , systems like this that allow clinicians to continue rigorous and consistent monitoring for many years have a valuable role to play . Furthermore , such monitoring systems which now exist electronically can easily accumulate large data sets and reveal details about long-term effectiveness and long-term side effects of medication that are unlikely to be discovered in short-term trials OBJECTIVES To determine any long-term effects , 6 and 8 years after childhood enrollment , of the r and omly assigned 14-month treatments in the NIMH Collaborative Multisite Multimodal Treatment Study of Children With Attention-Deficit/Hyperactivity Disorder ( MTA ; N = 436 ) ; to test whether attention-deficit/hyperactivity disorder ( ADHD ) symptom trajectory through 3 years predicts outcome in subsequent years ; and to examine functioning level of the MTA adolescents relative to their non-ADHD peers ( local normative comparison group ; N = 261 ) . METHOD Mixed-effects regression models with planned contrasts at 6 and 8 years tested a wide range of symptom and impairment variables assessed by  parent , teacher , and youth report . RESULTS In nearly every analysis , the originally r and omized treatment groups did not differ significantly on repeated measures or newly analyzed variables ( e.g. , grade s earned in school , arrests , psychiatric hospitalizations , other clinical ly relevant outcomes ) . Medication use decreased by 62 % after the 14-month controlled trial , but adjusting for this did not change the results . ADHD symptom trajectory in the first 3 years predicted 55 % of the outcomes . The MTA participants fared worse than the local normative comparison group on 91 % of the variables tested . CONCLUSIONS Type or intensity of 14 months of treatment for ADHD in childhood ( at age 7.0 - 9.9 years ) does not predict functioning 6 to 8 years later . Rather , early ADHD symptom trajectory regardless of treatment type is prognostic . This finding implies that children with behavioral and sociodemographic advantage , with the best response to any treatment , will have the best long-term prognosis . As a group , however , despite initial symptom improvement during treatment that is largely maintained after treatment , children with combined-type ADHD exhibit significant impairment in adolescence . Innovative treatment approaches targeting specific areas of adolescent impairment are needed BACKGROUND Attention-deficit hyperactivity disorder ( ADHD ) is highly prevalent in prison inmates , but pharmacological treatment has not yet been evaluated in this group . AIMS To evaluate osmotic-release oral system ( OROS ) methylpheni date in adult male long-term prison inmates with ADHD . METHOD R and omised , double-blind , placebo-controlled 5-week trial , followed by 47-week open-label extension in 30 prison inmates with ADHD and comorbid disorders . Primary outcome was level of ADHD symptoms after 5 weeks , evaluated by a masked assessor . Secondary outcomes were self-reported ADHD symptoms , global severity and global functioning throughout the 52-week trial , and post hoc treatment response and numbers needed to treat ( NNT ) ( trial registration : NCT00482313 . ) RESULTS Treatment significantly improved ADHD during the trial ( P<0.001 ; Cohen 's d = 2.17 ) , with reduced symptom severity and improved global functioning . The placebo  response , cardiovascular measures and adverse events were non-significant ; the NNT was 1.1 . Attention-deficit hyperactivity disorder symptoms , global severity and global functioning continued to improve during the open-label extension . CONCLUSIONS Osmotic-release oral system methylpheni date is an effective treatment for adult male prison inmates with ADHD BACKGROUND We wanted to study the effects of amphetamine on symptoms of attention-deficit hyperactivity disorder ( ADHD ) over a longer period than has been reported in previous studies of central stimulants in this condition . METHODS Sixty-two children , aged 6 to 11 years , meeting DSM-III-R symptom criteria for ADHD participated in a parallel-group design , r and omized , double-blind , placebo-controlled study of amphetamine treatment . Treatment was not restricted to children with " pure " ADHD , ie , some had comorbid diagnoses . In the amphetamine group , children received active treatment for 15 months . RESULTS Amphetamine was clearly superior to placebo in reducing inattention , hyperactivity , and other disruptive behavior problems and tended to lead to improved results on the Wechsler Intelligence Scale for Children -- Revised . Treatment failure rate was considerably lower and time to treatment failure was longer in the amphetamine group . Adverse effects were few and relatively mild . CONCLUSION The results of this long-term , placebo-controlled study of the central stimulant amphetamine in the treatment of ADHD indicate that there are remaining positive effects of the drug 15 months after starting treatment 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 Multimodal Treatment Study ( MTA ) began as a 14-month r and omized clinical trial of behavioral and pharmacological treatments of 579 children ( 7 - 10 years of age ) diagnosed with attention-deficit/hyperactivity disorder (ADHD)-combined type . It transitioned into an observational long-term follow-up of 515 cases consented for continuation and 289 classmates ( 258 without ADHD ) added as a local normative comparison group ( LNCG ) , with assessment s 2 - 16 years after baseline . METHODS Primary ( symptom severity ) and secondary ( adult height ) outcomes in adulthood were specified . Treatment was monitored to age 18 , and naturalistic subgroups were formed based on three patterns of long-term use of stimulant medication ( Consistent , Inconsistent , and Negligible ) . For the follow-up , hypothesis-generating analyses were performed on outcomes in early adulthood ( at 25 years of age ) . Planned comparisons were used to estimate ADHD-LNCG differences reflecting persistence of symptoms and naturalistic subgroup differences reflecting benefit ( symptom reduction ) and cost ( height suppression ) associated with extended use of medication . RESULTS For ratings of symptom severity , the ADHD-LNCG comparison was statistically significant for the parent/self-report average ( 0.51 ± 0.04 , p < .0001 , d = 1.11 ) , documenting symptom persistence , and for the parent/self-report difference ( 0.21 ± 0.04 , p < .0001 , d = .60 ) , documenting source discrepancy , but the comparisons of naturalistic subgroups reflecting medication effects were not significant . For adult height , the ADHD group was 1.29 ± 0.55 cm shorter than the LNCG ( p < .01 , d = .21 ) , and the comparisons of the naturalistic subgroups were significant : the treated group with the Consistent or Inconsistent pattern was 2.55 ± 0.73 cm shorter than the subgroup with the Negligible pattern ( p < .0005 , d = .42 ) , and within the treated group , the subgroup with the Consistent pattern was 2.36 ± 1.13 cm shorter than the subgroup with the Inconsistent pattern ( p < .04 , d = .38 ) . CONCLUSIONS In the MTA follow-up into adulthood , the ADHD group showed symptom persistence compared to local norms from the LNCG . Within naturalistic subgroups of ADHD cases , extended use of medication was associated with suppression of adult height but not with reduction of symptom severity 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 OBJECTIVE To examine whether mindfulness-based cognitive therapy ( MBCT ) would enhance attenuated amplitudes of event-related potentials ( ERPs ) indexing performance monitoring biomarkers of attention-deficit/hyperactivity disorder ( ADHD ) . METHODS Fifty adult ADHD patients took part in a r and omised controlled study investigating ERP and clinical measures pre-to-post MBCT .  Twenty-six patients were r and omly allocated to MBCT , 24 to a wait-list control . Main outcome measures included error processing ( ERN , Pe ) , conflict monitoring ( NoGo-N2 ) , and inhibitory control ( NoGo-P3 ) ERPs concomitant to a continuous performance task ( CPT-X ) . Inattention and hyperactivity-impulsivity ADHD symptoms , psychological distress and social functioning , and mindfulness skills were also assessed . RESULTS MBCT was associated with increased Pe and NoGo-P3 amplitudes , coinciding with reduced ' hyperactivity/impulsivity ' and ' inattention ' symptomatology . Specific to the MBCT ; enhanced Pe amplitudes correlated with a decrease in hyperactivity/impulsivity symptoms and increased ' act-with-awareness ' mindfulness skill , whereas , enhanced P3 correlated with amelioration in inattention symptoms . CONCLUSIONS MBCT enhanced ERP amplitudes associated with motivational saliency and error awareness , leading to improved inhibitory regulation . SIGNIFICANCE MBCT suggests having comparable modulation on performance monitoring ERP amplitudes as pharmacological treatments . Further study and development of MBCT as a treatment for ADHD is warranted , in addition to its potential scope for clinical applicability to broader defined externalising disorders and clinical problems associated with impairments of the prefrontal cortex OBJECTIVE This study examined the efficacy and safety of clonidine hydrochloride extended-release tablets ( CLON-XR ) in children and adolescents with attention-deficit/hyperactivity disorder ( ADHD ) . METHOD This 8-week , placebo-controlled , fixed-dose trial , including 3 weeks of dose escalation , of patients 6 to 17 years old with ADHD evaluated the efficacy and safety of CLON-XR 0.2 mg/day or CLON-XR 0.4 mg/day versus placebo in three separate treatment arms . Primary endpoint was mean change in ADHD Rating Scale-IV ( ADHD-RS-IV ) total score from baseline to week 5 versus placebo using a last observation carried forward method . Secondary endpoints were improvement in ADHD-RS-IV inattention and hyperactivity/impulsivity subscales , Conners Parent Rating Scale-Revised : Long Form , Clinical Global Impression of Severity , Clinical Global Impression of Improvement , and Parent Global Assessment from baseline to week 5 . RESULTS Patients ( N = 236 ) were r and omized to receive placebo ( n = 78 ) , CLON-XR 0.2 mg/day ( n = 78 ) , or CLON-XR 0.4 mg/day ( n = 80 ) . Improvement from baseline in ADHD-RS-IV total score was significantly greater in both CLON-XR groups versus placebo at week 5 . A significant improvement in ADHD-RS-IV total score occurred between groups as soon as week 2 and was maintained throughout the treatment period . In addition , improvement in ADHD-RS-IV inattention and hyperactivity/impulsivity subscales , Conners Parent Rating Scale-Revised : Long Form , Clinical Global Impression of Improvement , Clinical Global Impression of Severity , and Parent Global Assessment , occurred in both treatment groups versus placebo . The most common treatment-emergent adverse event was mild-to-moderate somnolence . Changes on electrocardiogram were minor and reflected the known pharmacology of clonidine . CONCLUSIONS Clonidine hydrochloride extended-release tablets were generally well tolerated by patients in the study and significantly improved ADHD symptoms in this pediatric population OBJECTIVE Little is known about the adult outcome of attention-deficit hyperactivity disorder ( ADHD ) , a very prevalent childhood disorder that is known to affect deleteriously academic performance and other areas of child functioning . This study represents a third wave of evaluations that examine the long-term educational achievement and occupational rank of children with ADHD . METHOD This is a prospect i ve follow-up of white boys of average intelligence whose ADHD was clinical ly diagnosed according to systematic criteria at an average age of 7 years . Follow-up intervals range from 15 to 21 years ( mean , 17 years ) . At average age 24 years , 85 prob and s ( representing 82 % of the childhood cohort ) and 73 controls ( 84 % ) were directly interviewed by trained clinicians who were blind to group membership . RESULTS First , prob and s completed significantly less formal schooling than controls ( about 2 years less , on average ) . Second , prob and s had lower-ranking occupational positions than controls . Finally , these disadvantages were not accounted for by adult mental status . CONCLUSIONS The present study suggests that childhood ADHD predisposes to specific disadvantages and continues to affect important functional domains unrelated to current psychiatric diagnosis OBJECTIVE The paucity of data concerning the long-term natural history of attention-deficit hyperactivity disorder ( ADHD ) , a common childhood psychiatric disorder , prompted a longitudinal study to investigate the adult sequelae of the childhood disorder . DESIGN Prospect i ve study , follow-up intervals ranging from 13 to 19 years ( mean , 16 years ) , with blind systematic clinical assessment s. SUBJECTS Ninety-one white males ( mean age , 26 years ) , representing 88 % of a cohort systematic ally diagnosed as hyperactive in childhood , and 95 ( 95 % ) of comparison cases of similar race , gender , age , whose teachers had voiced no complaints about their school behavior in childhood . RESULTS Prob and s had significantly higher rates than comparisons of ADHD symptoms ( 11 % vs 1 % ) , antisocial personality disorders ( 18 % vs 2 % ) , and drug abuse disorders ( 16 % vs 4 % ) . Significant comorbidity occurred between antisocial and drug disorders . Educational and occupational achievements were significantly compromised in the prob and s. These disadvantages were independent of psychiatric status . We did not find increased rates of affective or anxiety disorders in the prob and s. CONCLUSIONS Childhood ADHD predicts specific adult psychiatric disorders , namely antisocial and drug abuse disorders . In the adolescent outcome of this cohort , we found that these disturbances were dependent on the continuation of ADHD symptoms . In contrast , in adulthood , antisocial and drug disorders appeared , in part , independent of sustained ADHD . In addition , regardless of psychiatric status , ADHD placed children at relative risk for educational and vocational disadvantage . The results do not support a relationship between childhood ADHD and adult mood or anxiety disorders 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 OBJECTIVES To investigate the impact of early school-based screening and educational interventions on longer-term outcomes for children at risk for attention-deficit/hyperactivity disorder ( ADHD ) and the predictive utility of teacher ratings . DESIGN A population -based 5-year follow-up of a r and omized , school-based intervention . SETTING Schools in Engl and . PARTICIPANTS Children between 4 and 5 years of age with high teacher-rated hyperactivity/inattention scores . Follow-up data were collected on 487 children in 308 schools . INTERVENTIONS Following screening , using a 2 x 2 factorial design , schools r and omly received an educational intervention ( books about ADHD for teachers ) , the names of children with high hyperactivity/inattention scores between ages 4 and 5 years ( identification ) , both educational intervention and identification , or no intervention . OUTCOME MEASURES Parent-rated hyperactivity/inattention , impairment in classroom learning , and access to specialist health services for mental health or behavioral problems . RESULTS None of the interventions were associated with improved outcomes . However , children receiving the identification -only intervention were twice as likely as children in the no-intervention group to have high hyperactivity/inattention scores at follow-up ( adjusted odds ratio , 2.11 ; 95 % confidence interval , 1.12 - 4.00 ) . Regardless of intervention , high baseline hyperactivity/inattention scores were associated with high hyperactivity/inattention and specialist health service use at follow-up . CONCLUSIONS We did not find evidence of long-term , generalizable benefits following a school-based universal screening program for ADHD . There may be adverse effects associated with labeling children at a young age INTRODUCTION Aggression is frequently observed in children and adolescents with attention-deficit/hyperactivity disorder ( ADHD ) . The aim of this study was to assess the efficacy with regard to oppositional and aggressive behavior of a new long-acting methylpheni date preparation ( Medikinet retard , MPH-MR ) , with equal portions of the immediate-release and the sustained-release active substance , and especially to look at correlations between either teacher or parent assessment of aggression and ADHD sub-symptomatology . METHODS Eighty five children and adolescents ( 6 - 16 years ) were investigated in a double-blind , r and omized , clinical trial over 5 weeks under a treatment with MPH-MR  using symptom checklists for ADHD , oppositional-defiant and conduct disorder according to the Diagnostic and Statistical Manual of Mental Disorders , 4th edition ( DSM-IV ) . RESULTS A total of 64.9 % of the children showed oppositional defiant disorder/conduct disorder ( ODD/CD ) symptoms . A statistically significant effect was found in the group treated with MPH ( verum-group ) . On the basis of Cohen 's criteria , high effects were found for aggressive symptoms in school ( d = 1.0 ) , but not in the afternoon ( d = 0.4 ) . There were also lower effect sizes for more severe aggressive symptoms . We found characteristic correlations between ODD/CD symptoms and the ADHD subscale hyperactivity/impulsivity compared to the subscale inattention . CONCLUSIONS Long-acting MPH is effective in the treatment of oppositional-defiant and aggressive behavior , especially concerning milder symptoms . The expected correlation between impulsivity and aggressiveness could be confirmed The cardinal symptoms of attention-deficit/hyperactivity disorder ( ADHD ) are inattention , hyperactivity and impulsivity . Etiologically , ADHD is mainly put down to genetic causes ; it entails a considerable range of psychosocial problems for those affected and their social environment . The parents of a total of 7,569 boys ( B ) and 7,267 girls ( G ) aged 3 - 17 who took part in the German Health Interview and Examination Survey for Children and Adolescents ( KiGGS ) answered a self-administered question naire including an ADHD diagnosis question and the  Strengths and Difficulties Question naire ( SDQ )  . In addition behavioural observations of 7,919 children ( aged 3 - 11 ) were carried out during the medical and physical tests . Participants whose parents reported that they had ever been given an ADHD diagnosis by a doctor or psychologist were classified as ADHD cases . Participants were classified as suspected cases of ADHD if they had a value of > or = 7 on the SDQ inattention/hyperactivity scale . ADHD had ever been diagnosed in 4.8 % of the children and adolescents altogether ( B : 7.7 % , G : 1.8 % ) . Another 4.9 % of the participants can be considered as suspected cases . Already 1.8 % of the preschoolers had been given an ADHD diagnosis . At primary school age ( 7 - 10 years old ) the frequency of diagnosis rises sharply . At age 11 - 17 , ADHD had ever been diagnosed in 1 in 10 boys and 1 in 43 girls . ADHD had been diagnosed significantly more frequently among participants of low socio-economic status ( SES ) than among participants of high SES . A diagnosis of ADHD is reported less often for migrants , they rank more frequently among the suspected cases . The discrepancy between confirmed and suspected cases of ADHD among migrants may point to lower diagnosis rates or lower utilization of medical services . The short- and long-term medical , social and health-economic effects of ADHD illustrate the major public health relevance of the disorder . As for prevention , the high share of genetic factors in ADHD etiology primarily suggests secondary prevention ( early support and early diagnosis ) and tertiary prevention measures . Further analysis of the KiGGS data could prospect ively identify risk groups more precisely and refine preventional approaches OBJECTIVE To test the hypotheses that in children with attention-deficit/hyperactivity disorder ( ADHD ) ( 1 ) symptoms of ADHD , oppositional defiant disorder , and overall functioning are significantly improved by methylpheni date combined with intensive multimodal psychosocial treatment compared with methylpheni date alone and with methylpheni date plus attention control and ( 2 ) more children receiving combined treatment can be taken off methylpheni date . METHOD One hundred three children with ADHD ( ages 7 - 9 ) , free of conduct and learning disorders , who responded to short-term methylpheni date were r and omized for 2 years to ( 1 ) methylpheni date alone ; ( 2 ) methylpheni date plus psychosocial treatment that included parent training and counseling , social skills training , psychotherapy , and academic assistance , or ( 3 ) methylpheni date plus attention psychosocial control treatment . Assessment s included parent , teacher , and psychiatrist ratings , and observations in academic and gym classes . RESULTS Combination treatment did not lead to superior functioning and did not facilitate methylpheni date discontinuation . Significant improvement occurred across all treatments and continued over 2 years . CONCLUSIONS In stimulant-responsive children with ADHD , there is no support for adding ambitious long-term psychosocial intervention to improve ADHD and oppositional defiant disorder symptoms . Significant benefits from methylpheni date were stable over 2 years INTRODUCTION Lisdexamfetamine dimesylate ( LDX ) , a prodrug stimulant , is indicated for attention-deficit/hyperactivity disorder ( ADHD ) in children 6 - 12 years of age and in adults . In short-term studies , once-daily LDX provided efficacy throughout the day . This study presented here was conducted to assess the long-term safety , tolerability , and effectiveness of LDX in 6- to 12-year-olds with ADHD . METHODS This open-label , multicenter , single-arm study enrolled children with Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition-Text Revision criteria for ADHD . Following 1-week screening and washout periods , subjects were titrated to LDX 30 , 50 , or 70 mg/day over 4 weeks and placed on maintenance treatment for 11 months . The ADHD Rating Scale and Clinical Global Impression-Improvement scale measured effectiveness . RESULTS Of 272 subjects receiving LDX , 147 completed the study . Most adverse events were mild to moderate and occurred during the first 4 weeks . There were no clinical ly meaningful changes in blood pressure or electrocardiographic parameters . From baseline to endpoint , mean ADHD Rating Scale scores improved by 27.2 points ( P<.0001 ) . Improvements occurred during each of the first 4 weeks , and were maintained throughout . Based on Clinical Global Impression-Improvement scale scores , > 80 % of subjects at endpoint and > 95 % of completers at 12 months were rated " improved . " CONCLUSION Long-term 30 , 50 , and 70 mg/day LDX was generally well tolerated and effective in children with ADHD Objective : Previous research on the developmental course of attention-deficit/hyperactivity disorder ( ADHD ) is limited by biased clinic-referred sample s and other method ological problems . Thus , questions about adult academic outcomes associated with childhood ADHD remain unanswered . Thus , the objective of this study was to describe academic outcomes in adulthood among incident cases of research -identified childhood ADHD versus non-ADHD referents from a population -based birth cohort . Method : Young adults with research -identified childhood ADHD ( N = 232 ; mean age 27.0 yr ; 72.0 % men ) and referents ( N = 335 ; mean age 28.6 yr ; 62.7 % men ) from a 1976 to 1982 birth cohort ( N = 5699 ) were invited to participate in a followup study and were administered an academic achievement battery consisting of the basic reading component of the Woodcock-Johnson III Tests of Achievement ( WJ-III ) and the arithmetic subtest of the Wide Range Achievement Test — Third Edition ( WRAT-3 ) . Outcomes were compared between the 2 groups using linear regression models , adjusted for age , sex , and comorbid learning disability status . Results : Childhood ADHD cases scored from 3 to 5 grade equivalents lower on all academic tests compared with referents , with mean ( SD ) st and ard scores of 95.7 ( 8.4 ) versus 101.8 ( 8.1 ) in basic reading ; 95.0 ( 9.3 ) versus 101.9 ( 8.5 ) in letterword identification ; 98.2 ( 8.6 ) versus 103.2 ( 9.2 ) in passage comprehension ; 95.7 ( 9.1 ) versus 100.9 ( 9.0 ) in word attack ; and 87.8 ( 12.9 ) versus 98.0 ( 12.0 ) in arithmetic . Conclusion : This is the first prospect i ve , population -based study of adult academic outcomes of childhood ADHD . Our data provide evidence that childhood onset ADHD is associated with long-term underachievement in reading and math that may negatively impact ultimate educational attainment and occupational functioning in adulthood
The following broad trends emerged : ( 1 ) without treatment , people with ADHD had poorer long-term outcomes in all categories compared with people without ADHD , and ( 2 ) treatment for ADHD improved long-term outcomes compared with untreated ADHD , although not usually to normal levels .
Conclusions This systematic review provides a synthesis of studies of ADHD long-term outcomes .
Current treatments may reduce the negative impact that untreated ADHD has on life functioning , but does not usually ' normalize ' the recipients
Background In childhood , attention deficit/hyperactivity disorder ( ADHD ) is characterized by age-inappropriate levels of inattentiveness/disorganization , hyperactivity/impulsiveness , or a combination thereof .
Although the criteria for ADHD are well defined , the long-term consequences in adults and children need to be more comprehensively understood and quantified .
We conducted a systematic review evaluating the long-term outcomes ( defined as 2 years or more ) of ADHD with the goal of identifying long-term outcomes and the impact that any treatment ( pharmacological , non-pharmacological , or multimodal ) has on ADHD long-term outcomes .