Moderators and mediators of treatment response for children with attention-deficit/hyperactivity disorder: the Multimodal Treatment Study of children with Attention-deficit/hyperactivity disorder. Computer-Assisted Management of Attention-Deficit/Hyperactivity Disorder Parental Knowledge of Attention-Deficit Hyperactivity Disorder and Opinions of Treatment Options: Impact on Enrolment and Adherence to a 12-Month Treatment Trial A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. The MTA Cooperative Group. Multimodal Treatment Study of Children with ADHD. Impact of comorbid autism spectrum disorders on stimulant response in children with attention deficit hyperactivity disorder: a retrospective and prospective effectiveness study. Management of adult attention deficit hyperactivity disorder in UK primary care: a survey of general practitioners Clinical evaluation of subjective and objective changes in motor activity and attention in children with attention-deficit/hyperactivity disorder in a double-blind methylphenidate trial. Common and unique therapeutic mechanisms of stimulant and nonstimulant treatments for attention-deficit/hyperactivity disorder. Enhancing Behavioral and Social Skill Functioning in Children Newly Diagnosed with Attention-Deficit Hyperactivity Disorder in a Pediatric Setting Findings from the NIMH Multimodal Treatment Study of ADHD (MTA): Implications and Applications for Primary Care Providers A double‐blind, parallel, multicenter comparison of L‐acetylcarnitine with placebo on the attention deficit hyperactivity disorder in fragile X syndrome boys An efficacy study of a combined parent and teacher management training programme for children with ADHD Computer-Based Attention Training in the Schools for Children With Attention Deficit/Hyperactivity Disorder: A Preliminary Trial Executive Impairment Determines ADHD Medication Response: Implications for Academic Achievement Use of an Internet Portal to Improve Community-Based Pediatric ADHD Care: A Cluster Randomized Trial Clinical symptoms and performance on the continuous performance test in children with attention deficit hyperactivity disorder between subtypes: a natural follow-up study for 6 months A Randomized Trial Examining the Effects of Aerobic Physical Activity on Attention-Deficit/Hyperactivity Disorder Symptoms in Young Children
BACKGROUND Intent-to-treat analyses of the study revealed that medication management , alone or combined with intensive behavioral treatment , was superior to behavioral treatment and community care in reducing attention-deficit/hyperactivity disorder ( ADHD ) symptoms ; but only combined treatment showed consistently greater benefit than community care across other outcome domains ( disruptive and internalizing symptoms , achievement , parent-child relations , and social skills ) . We examine response patterns in subgroups defined by baseline variables ( moderators ) or variables related to treatment implementation ( mediators ) . METHODS We reconducted r and om-effects regression ( RR ) analyses , adding factors defined by moderators ( sex ,  prior medication use  ,  comorbid disruptive or anxiety disorder  , and public assistance ) and a mediator ( treatment acceptance/attendance ) . RESULTS Study outcomes ( N = 579 ) were upheld in most moderator subgroups ( boys and girls , children with and without prior medication , children with and without comorbid disruptive disorders ) . Comorbid anxiety disorder did moderate outcome ; in participants without anxiety , results paralleled intent-to-treat findings . For those with anxiety disorders , however , behavioral treatment yielded significantly better outcomes than community care ( and was no longer statistically different from medication management and combined treatment ) regarding ADHD-related and internalizing symptoms . In families receiving public assistance , medication management yielded decreased closeness in parent-child interactions , and combined treatment yielded relatively greater benefits for teacher-reported social skills . In families with high treatment acceptance/attendance , intent-to-treat results were upheld . Acceptance/attendance was particularly important for medication treatments . Finally , two thirds of children given community care received stimulants . Behavioral treatment did not significantly differ from , but medication management was superior to , this subgroup . CONCLUSIONS Exploratory analyses revealed that our study ( the Multimodal Treatment Study of Children With Attention-Deficit/Hyperactivity Disorder [ MTA ] ) results were confirmed across most baseline variables and treatment acceptance/attendance . In children with ADHD plus anxiety , behavioral treatment surpassed community care and approached medication-based treatments regarding parent-reported ADHD symptoms OBJECTIVES : Medication management of attention-deficit/hyperactivity disorder ( ADHD ) is often suboptimal . We examined whether ( 1 ) brief physician training plus computer-assisted medication management led to greater reduction in ADHD symptoms and ( 2 ) adherence to the recommended titration protocol produced greater symptomatic improvement . METHODS : A r and omized medication trial was conducted that included 24 pediatric practice s. Children who met criteria for ADHD were r and omly assigned by practice to treatment-as-usual or a specialized care group in which physicians received 2 hours of didactic training on medication management of ADHD plus training on a software program to assist in monitoring improvement . Parent and teacher reports were obtained before treatment and 4 , 9 , and 12 months after starting medication . RESULTS : Children in both specialized care and treatment-as-usual groups improved on the ADHD Rating Scales and SNAP-IV , but there were no group differences in improvement rates . Brief physician training alone did not produce improvements . When recommended titration procedures were followed , however , outcomes were better for total and inattentive ADHD symptoms on both the ADHD Rating Scales and SNAP-IV parent and teacher scales . Results were not attributable to discontinuation because of adverse effects or failure to find an effective medication dose . CONCLUSIONS : Brief physician training alone did not lead to reductions in ADHD symptoms , but adherence to a protocol that involved titration until the child 's symptoms were in the average range and had shown a reliable change led to better symptom reduction . Computer-assisted medication management can contribute to better treatment outcomes in primary care medication treatment of ADHD Objective : This study examines the relationship between parents ' knowledge of attention-deficit hyperactivity disorder ( ADHD ) and opinions of treatment and their impact on enrolment in and adherence to both pharmacological and nonpharmacological interventions for children with ADHD . Method : Participants in the study were the parents of 81 children who reached diagnostic criteria for ADHD and who were referred to a treatment study of ADHD involving stimulant medication and parent groups . The mothers completed a modified version of the ADHD Knowledge and Opinion Scale  ( AKOS ) prior to receiving diagnostic feedback and prior to the families ' decisions to participate in a 12-month r and omized trial ( medication [ methylpheni date or placebo ] and parent groups [ training or support ] ) . Treatment enrolment and adherence were monitored over the 12-month trial , and families who remained in the study at 12 months completed another modified AKOS . Results : A higher level of knowledge of ADHD was found to be related to more favourable opinions of parent groups but not of medication . Moreover , parents who were more knowledgeable about ADHD were more likely to enrol in both pharmacological and nonpharmacological treatments . Adherence to pharmacological and nonpharmacological treatments was not predicted by parental knowledge of ADHD or opinions of the treatment . Conclusion :  Parents ' knowledge of ADHD and opinions of treatments play a significant role in enrolment in treatments for their children with ADHD . Providing information to parents regarding ADHD prior to offering treatment modalities could have a favourable impact on treatment enrolment and hence treatment adherence BACKGROUND Previous studies have demonstrated the short-term efficacy of pharmacotherapy and behavior therapy for attention-deficit/hyperactivity disorder ( ADHD ) , but no longer-term ( i.e. , > 4 months ) investigations have compared these 2 treatments or their combination . METHODS A group of 579 children with ADHD Combined Type , aged 7 to 9.9 years , were assigned to 14 months of medication management ( titration followed by monthly visits ) ; intensive behavioral treatment ( parent , school , and child components , with therapist involvement gradually reduced over time ) ; the two combined ; or st and ard community care ( treatments by community providers ) . Outcomes were assessed in multiple domains before and during treatment and at treatment end point ( with the combined treatment and medication management groups continuing medication at all assessment points ) . Data were analyzed through intent-to-treat r and om-effects regression procedures . RESULTS All 4 groups showed sizable reductions in symptoms over time , with significant differences among them in degrees of change . For most ADHD symptoms , children in the combined treatment and medication management groups showed significantly greater improvement than those given intensive behavioral treatment and community care . Combined and medication management treatments did not differ significantly on any direct comparisons , but in several instances ( oppositional/aggressive symptoms , internalizing symptoms , teacher-rated social skills , parent-child relations , and reading achievement )  combined treatment proved superior to intensive behavioral treatment and /or community care while medication management did not . Study medication strategies were superior to community care treatments , despite the fact that two thirds of community-treated subjects received medication during the study period . CONCLUSIONS For ADHD symptoms , our carefully crafted medication management was superior to behavioral treatment and to routine community care that included medication . Our combined treatment did not yield significantly greater benefits than medication management for core ADHD symptoms , but may have provided modest advantages for non-ADHD symptom and positive functioning outcomes 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 Background Compared to existing literature on childhood attention deficit hyperactivity disorder ( ADHD ) , little published adult data are available , particularly outside of the United States . Using General Practitioner ( GP ) question naires from the United Kingdom , this study aim ed to examine a number of issues related to ADHD in adults , across three cohorts of patients , adults who received ADHD drug treatment in childhood/adolescence but stopped prior to adulthood ; adults who received ADHD drug treatment in childhood/adolescence and continued treatment into adulthood and adults who started ADHD drug treatment in adulthood . Methods Patients with a diagnosis of ADHD and prescribed methylpheni date , dexamfetamine or atomoxetine were identified using data from The Health Improvement Network ( THIN ) . Date s when these drugs started and stopped were used to classify patients into the three cohorts . From each cohort , 50 patients were r and omly selected and question naires were sent via THIN to their GPs . GPs returned completed question naires to THIN who forwarded anonymised copies to the research ers . Data sets were analysed using descriptive statistics . Results Overall response rate was 89 % ( 133/150 ) . GPs stated that in 19 cases , the patient did not meet the criteria of that group ; the number of valid question naires returned was 114 ( 76 % ) . The following broad trends were observed : 1 ) GPs were not aware of the reason for treatment cessation in 43 % of cases , 2 ) patient choice was the most common reason for discontinuation ( 56 % ) , 3 ) 7 % of patients who stopped pharmacological treatment subsequently reported experiencing ADHD symptoms , 4 ) 58 % of patients who started pharmacological treatment for ADHD in adulthood received pharmacological treatment for other mental health conditions prior to the ADHD being diagnosed . Conclusion This study presents some key findings relating to ADHD ; GPs were often not aware of the reason for patients stopping ADHD treatment in childhood or adolescence . Patient choice was identified as the most common reason for treatment cessation . For patients who started pharmacological treatment in adulthood , many patients received pharmacological treatment for comorbidities before a diagnosis of ADHD was made The aim of this study was to determine drug-dependent effects on attention and motor activity in children with attention-deficit/hyperactivity disorder ( ADHD ) in a double-blind methylpheni date ( MPH ) trial using both subjective behavior ratings and objective measures of function . In particular , we were interested in the relationship between changes of those subjective and objective measures . A total of 44 ADHD children with the combined subtype completed a r and omized , double-blind , placebo-controlled , crossover trial with 2 doses of MPH ( 0.25 ; 0.5 mg/kg body weight ) and placebo . In each condition , computerized attention tasks were performed , teacher-behavior ratings were obtained , and actigraph data were collected in both clinical and naturalistic setting s. Trend tests revealed linear effects of MPH dose on actigraph data in the test session ( p = 0.02 ) and at school ( p = 0.001 ) , as well as on sustained attention ( p < 0.001 ) , while inhibitory control showed a quadratic dose-response curve ( p < 0.001 ) . Multivariate regression analyses revealed that changes of both , hyperactive-impulsive symptoms ( 28 % ) and inattentive symptoms ( 23 % ) could be explained by objective changes of motor activity . Thus , for clinical practice , it should be taken into account that behavior ratings of ADHD symptoms seemed to be predominantly influenced by changes of motor activity CONTEXT Attention-deficit/hyperactivity disorder ( ADHD ) is a highly prevalent and impairing psychiatric disorder that affects both children and adults . There are Food and Drug Administration-approved stimulant and nonstimulant medications for treating ADHD ; however , little is known about the mechanisms by which these different treatments exert their therapeutic effects . OBJECTIVE To contrast changes in brain activation related to symptomatic improvement with use of the stimulant methylpheni date hydrochloride vs the nonstimulant atomoxetine hydrochloride . DESIGN Functional magnetic resonance imaging before and after 6 to 8 weeks of treatment with methylpheni date ( n = 18 ) or atomoxetine ( n = 18 ) using a parallel-groups design . SETTING Specialized ADHD clinical research program at Mount Sinai School of Medicine , New York , New York . PARTICIPANTS Thirty-six youth with ADHD ( mean [ SD ] age , 11.2 [ 2.7 ] years ; 27 boys ) recruited from r and omized clinical trials . MAIN OUTCOME MEASURES Changes in brain activation during a go/no-go test of response inhibition and investigator-completed ratings on the ADHD Rating Scale-IV-Parent Version . RESULTS Treatment with methylpheni date vs atomoxetine was associated with comparable improvements in both response inhibition on the go/no-go test and mean ( SD ) improvements in ratings of ADHD symptoms ( 55 % [ 30 % ] vs 57 % [ 25 % ] ) . Improvement in ADHD symptoms was associated with common reductions in bilateral motor cortex activation for both treatments . Symptomatic improvement was also differentially related to gains in task-related activation for atomoxetine and reductions in activation for methylpheni date in the right inferior frontal gyrus , left anterior cingulate/supplementary motor area , and bilateral posterior cingulate cortex . These findings were not attributable to baseline differences in activation . CONCLUSIONS Treatment with methylpheni date and atomoxetine produces symptomatic improvement via both common and divergent neurophysiologic actions in frontoparietal regions that have been implicated in the pathophysiology of ADHD . These results represent a first step in delineating the neurobiological basis of differential response to stimulant and nonstimulant medications for ADHD ABSTRACT . The objective of this study was to evaluate the effectiveness of an 8-week behavioral and social skill ( BSS ) class for children newly diagnosed with attention-deficit hyperactivity disorder ( ADHD ) and their parents , initiating stimulant treatment in primary care . The subjects were 100 children , aged 5 to 12 years , recently diagnosed with ADHD and treated with stimulant medication , and their parents or guardians . Eligible families were r and omly assigned to an intervention group ( IG : n = 59 ) or control group ( CG : n = 41 ) . The BSS function of each child was assessed using DuPaul ’s ADHD Parent Rating Scale ( 18-item ) and Child Attention Profile ( 12-item ) during blinded baseline and follow-up interviews . Parent discipline practice was assessed using a five-item inventory based on Likert-scale ratings during identical periods . Computerized pharmacy records were used to track psychostimulant use over time . IG children exhibited significantly lower parent-rated ADHD symptoms , whereas IG parents reported significantly better and more consistent discipline practice s compared with CG parents across time . No significant differences were found between groups in Child Attention Profile scores across time . Psychostimulant use did not significantly differ between groups across time .  BSS training  was well accepted and seemed to significantly improve BSS functioning among IG children in the home setting only In 1992 , the National Institute of Mental Health and 6 teams of investigators began a multisite clinical trial , the Multimodal Treatment of Attention-Deficit Hyperactivity Disorder ( MTA ) study . Five hundred seventy-nine children were r and omly assigned to either routine community care ( CC ) or one of three study -delivered treatments , all lasting 14 months . The three MTA treatments-monthly medication management ( usually methylpheni date ) following weekly titration ( MedMgt ) , intensive behavioral treatment ( Beh ) , and the combination (Comb)-were design ed to reflect known best practice s within each treatment approach . Children were assessed at four time points in multiple outcome . Results indicated that Comb and MedMgt interventions were substantially superior to Beh and CC interventions for attention-deficit hyperactivity disorder symptoms . For other functioning domains ( social skills , academics , parent-child relations , oppositional behavior , anxiety/depression ) , results suggested slight advantages of Comb over single treatments ( MedMgt , Beh ) and community care . High quality medication treatment characterized by careful yet adequate dosing , three times daily methylpheni date administration , monthly follow-up visits , and communication with schools conveyed substantial benefits to those children that received it . In contrast to the overall study findings that showed the largest benefits for high quality medication management ( regardless of whether given in the MedMgt or Comb group ) , secondary analyses revealed that Comb had a significant incremental effect over MedMgt ( with a small effect size for this comparison ) when categorical indicators of excellent response and when composite outcome measures were used . In addition , children with parent-defined comorbid anxiety disorders , particularly those with overlapping disruptive disorder comorbidities , showed preferential benefits to the Beh and Comb interventions . Parental attitudes and disciplinary practice s appeared to mediate improved response to the Beh and Comb interventions Attention deficit hyperactivity disorder ( ADHD ) is a frequent behavioral problem in young boys with fragile X syndrome ( FXS ) , and its treatment is critical for improving social ability . The short‐term efficacy of stimulant medications like methylpheni date ( MPH ) is well established in children with ADHD . FXS boys treated with MPH have improved attention span and socialization skills ; however their mood becomes unstable at higher doses . Therefore , alternative pharmacological treatment of ADHD symptoms is desirable . A recent study showed that carnitine has a beneficial effect on the hyperactive – impulsive behavior in boys with ADHD without side effects . Our previous placebo‐controlled trial indicated that L‐acetylcarnitine ( LAC ) reduces hyperactivity in FXS boys . The objective of this study was to determine the efficacy of LAC in a larger sample of FXS boys with ADHD . The study design was r and omized , double blind placebo controlled , parallel , and multicenter ( with eight centers involved in Italy , France , and Spain ) . Sixty‐three FXS males with ADHD ( aged 6–13 years ) were enrolled ; 7 patients dropped out , 56 completed the one‐year treatment , and 51 were included in the statistical analysis . Both groups improved their behavior , showing that psychosocial intervention has a significant therapeutic effect . However , we observed a stronger reduction of hyperactivity and improvement of social behavior in patients treated with LAC , compared with the placebo group , as determined by the Conners ' Global Index Parents and the Vinel and Adaptive Behavior Scale . Our results show that LAC ( 20–50 mg/kg/day ) represents a safe alternative to the use of stimulant drugs for the treatment of ADHD in FXS children . © 2008 Wiley‐Liss , Background : Several parent training programmes and behavioural teacher training programmes built on learning theory have been developed for problem prevention and treatment of attention-deficit/hyperactivity disorder ( ADHD ) and /or oppositional defiant disorder ( ODD ) during the last few decades . Group format has often been used for parent training but single-subject design s are more common in teacher training . More studies have focussed on pre-school children than on older children , and a minority have been conducted in public mental health setting s. Aim : This study aim ed to evaluate a combined parent and teacher manual-based group training programme for children with ADHD conducted by the staff at a child and adolescent psychiatric clinic in Sweden . Method : The intervention was a modified version of Barkley 's programme .  Children were r and omized to an Intervention or a Control group .  Sixty-one parents and 68 teachers answered questions about ADHD and ODD symptoms , and about behavioural problems when the study started and at a 3-month follow-up . Results : Results showed that the intervention result ed in a reduction of the number of children who met DSM-IV criteria for ADHD and /or ODD . Effects were more pronounced in the home setting than in the school setting , and were further accentuated when both parents and teachers of the same child took part in the intervention . Teachers with more problematic classroom situations benefited most from the intervention . Conclusion : The programme , “ Strategies in Everyday Life ” , has , in a regular clinical setting , demonstrated promising effects on children 's disruptive behaviour , and a clinical implication was to recommend involving both parents and teachers in the programme Objective . This study examined the efficacy of 2 computer-based training systems to teach children with attention deficit/hyperactivity disorder ( ADHD ) to attend more effectively . Design / methods . A total of 41 children with ADHD from 2 middle schools were r and omly assigned to receive 2 sessions a week at school of either neurofeedback ( NF ) or attention training through a st and ard computer format ( SCF ) , either immediately or after a 6-month wait ( waitlist control group ) . Parents , children , and teachers completed question naires pre- and postintervention . Results . Primary parents in the NF condition reported significant ( P < .05 ) change on Conners ’s Rating Scales — Revised ( CRS-R ) and Behavior Assessment Scales for Children ( BASC ) subscales ; and in the SCF condition , they reported significant ( P < .05 ) change on the CRS-R Inattention scale and ADHD index , the BASC Attention Problems Scale , and on the Behavioral Rating Inventory of Executive Functioning ( BRIEF ) . Conclusion . This r and omized control trial provides preliminary evidence of the effectiveness of computer-based interventions for ADHD and supports the feasibility of offering them in a school setting Methylpheni date ( MPH ) often ameliorates attention-deficit/hyperactivity disorder ( ADHD ) behavioral dysfunction according to indirect informant reports and rating scales . The st and ard of care behavioral MPH titration approach seldom includes direct neuropsychological or academic assessment data to determine treatment efficacy . Documenting “ cool ” executive-working memory ( EWM ) and “ hot ” self-regulation ( SR ) neuropsychological impairments could aid in differential diagnosis of ADHD subtypes and determining cognitive and academic MPH response . In this study , children aged 6 to 16 with ADHD inattentive type ( IT ; n = 19 ) and combined type ( n = 33)/hyperactive-impulsive type ( n = 4 ) ( CT ) participated in double-blind placebo-controlled MPH trials with baseline and r and omized placebo , low MPH dose , and high MPH dose conditions . EWM/ SR measures and behavior ratings/classroom observations were rank ordered separately across conditions , with nonparametric r and omization tests conducted to determine individual MPH response . Participants were subsequently grouped according to their level of cool EWM and hot SR circuit dysfunction . Robust cognitive and behavioral MPH response was achieved for children with significant baseline EWM/SR impairment , yet response was poor for those with adequate EWM/ SR baseline performance . Even for strong MPH responders , the best dose for neuropsychological functioning was typically lower than the best dose for behavior . Findings offer one possible explanation for why long-term academic MPH treatment gains in ADHD have not been realized . Implication s for academic achievement and medication titration practice s for children with behaviorally diagnosed ADHD will be discussed OBJECTIVE : To determine the effectiveness of a quality improvement program to improve pediatricians ' adherence to existing , evidence -based , attention-deficit/hyperactivity disorder ( ADHD ) practice guidelines . METHODS : Forty-nine community-based pediatricians at 8 practice s participated in a cluster-r and omized trial . Practice s were matched according to the numbers of pediatricians and the proportions of patients receiving Medicaid . The medical charts for a r and om sample of patients with ADHD for each of the participating pediatricians were examined at baseline and 6 months . All practice s participated in 4 sessions of training , including didactic lectures and office flow modification workshops . Practice s were then given access to an ADHD Internet portal that allowed parents , teachers , and pediatricians to input information ( eg , rating scales ) about patients , after which information was scored , interpreted , and formatted in a report style that was helpful for assessment and treatment of patients with ADHD . Physicians evaluated their practice behaviors quarterly and addressed underperforming areas . RESULTS : Pediatricians in the intervention group , compared with those in the control group , demonstrated significantly higher rates of many American Academy of Pediatrics – recommended ADHD care practice s , including collection of parent ( Cohen 's d = 0.69 ) and teacher ( d = 0.68 ) rating scales for assessment of children with ADHD , use of Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition , criteria ( d = 0.85 ) , and use of teacher rating scales to monitor treatment responses ( d = 1.01 ) . CONCLUSION : A quality improvement intervention that can be widely disseminated by using Internet-based information technology significantly improved the quality of ADHD care in community-based pediatric setting 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 goal of this study was to compare the effects of before school physical activity ( PA ) and sedentary classroom-based ( SC ) interventions on the symptoms , behavior , moodiness , and peer functioning of young children ( Mage = 6.83 ) at risk for attention-deficit/hyperactivity disorder ( ADHD-risk ; n = 94 ) and typically developing children ( TD ; n = 108 ) . Children were r and omly assigned to either PA or SC and participated in the assigned intervention 31 min per day , each school day , over the course of 12 weeks . Parent and teacher ratings of ADHD symptoms ( inattention , hyperactivity/impulsivity ) , oppositional behavior , moodiness , behavior toward peers , and reputation with peers , were used as dependent variables . Primary analyses indicate that the PA intervention was more effective than the SC intervention at reducing inattention and moodiness in the home context . Less conservative follow-up analyses within ADHD status and intervention groups suggest that a PA intervention may reduce impairment associated with ADHD-risk in both home and school domains ; interpretive caution is warranted , however , given the liberal approach to these analyses . Unexpectedly , these findings also indicate the potential utility of a before school SC intervention as a tool for managing ADHD symptoms . Inclusion of a no treatment control group in future studies will enable further underst and ing of PA as an alternative management strategy for ADHD symptoms
Conclusions These findings suggest that the apps may not be suitable in meeting the complex needs associated with this condition .
Background Attention-deficit/hyperactivity disorder ( ADHD ) is a complex highly comorbid disorder , which can have a huge impact on those with ADHD , their family , and the community around them .
ADHD is currently managed using pharmacological and nonpharmacological interventions .
However , with advances in technology and an increase in the use of mobile apps , managing ADHD can be augmented using apps specifically design ed for this population .
However , little is known regarding the suitability and usability of currently available apps .
Objective The aim of this study was to explore the suitability of the top 10 listed apps for children and young people with ADHD and clinicians who work with them .
It is hypothesized that mobile apps design ed for this population could be more suitably design ed for this population .