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 Protocol investigating the clinical utility of an objective measure of activity and attention (QbTest) on diagnostic and treatment decision-making in children and young people with ADHD—‘Assessing QbTest Utility in ADHD’ (AQUA): a randomised controlled trial 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. Enhancing Behavioral and Social Skill Functioning in Children Newly Diagnosed with Attention-Deficit Hyperactivity Disorder in a Pediatric Setting Computer-Assisted Management of Attention-Deficit/Hyperactivity Disorder Using a Virtual Classroom environment to describe the attention deficits profile of children with Neurofibromatosis type 1. Exercise impact on sustained attention of ADHD children, methylphenidate effects Executive Impairment Determines ADHD Medication Response: Implications for Academic Achievement Methylphenidate effects in attention deficit/hyperactivity disorder: electrodermal and ERP measures during a continuous performance task Attention Deficit Hyperactivity Disorder: Does Cognitive Behavioral Therapy Improve Home Behavior? Evaluation of Neuropsychiatric Function in Phenylketonuria: Psychometric Properties of the ADHD Rating Scale-IV and Adult ADHD Self-Report Scale Inattention Subscale in Phenylketonuria. Can Parent Reports Serve as a Proxy for Teacher Ratings in Medication Management of Attention-Deficit Hyperactivity Disorder? 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. Predictors and consequences of adherence to the treatment of pediatric patients with attention-deficit/hyperactivity disorder in Central Europe and East Asia A 6-month follow-up of an RCT on behavioral and neurocognitive effects of neurofeedback in children with ADHD Moderators and mediators of treatment response for children with attention-deficit/hyperactivity disorder: the Multimodal Treatment Study of children with Attention-deficit/hyperactivity disorder. Neurofeedback and Cognitive Attention Training for Children with Attention-Deficit Hyperactivity Disorder in Schools
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 Introduction The National Institute for Health and Care Excellence ( NICE ) guidelines for attention deficit/hyperactivity disorder ( ADHD ) state that young people need to have access to the best evidence -based care to improve outcome . The current ‘ gold st and ard ’ ADHD diagnostic assessment combines clinical observation with subjective parent , teacher and self-reports . In routine practice , reports from multiple informants may be unavailable or contradictory , leading to diagnostic uncertainty and delay . The addition of objective tests of attention and activity may help reduce diagnostic uncertainty and delays in initiating treatment leading to improved outcomes . This trial investigates whether providing clinicians with an objective report of levels of attention , impulsivity and activity can lead to an earlier , and more accurate , clinical diagnosis and improved patient outcome . Methods and analysis This multisite r and omised controlled trial will recruit young people ( aged 6–17 years old ) who have been referred for an ADHD diagnostic assessment at Child and Adolescent Mental Health Services ( CAMHS ) and Community Paediatric clinics across Engl and . Routine clinical assessment will be augmented by the QbTest , incorporating a continuous performance test ( CPT ) and infrared motion tracking of activity . The participant will be r and omised into one of two study arms : QbOpen ( clinician has immediate access to a QbTest report ) : QbBlind ( report is withheld until the study end ) . Primary outcomes are time to diagnosis and diagnostic accuracy . Secondary outcomes include clinician 's diagnostic confidence and routine clinical outcome measures . Cost-effective analysis will be conducted , alongside a qualitative assessment of the feasibility and acceptability of incorporating QbTest in routine practice . Ethics and dissemination The findings from the study will inform commissioners , clinicians and managers about the feasibility , acceptability , clinical utility and cost-effectiveness of incorporating QbTest into routine diagnostic assessment of young people with ADHD . The results will be su bmi tted for publication in peer- review ed journals . The study has received ethical approval . Trial registration number NCT02209116 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 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 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 The objectives of this study were to describe the nature of the attention deficits in children with Neurofibromatosis type 1 ( NF1 ) in comparison with typically developing ( TD ) children , using the Virtual Classroom ( VC ) , and to assess the utility of this instrument for detecting attention deficits . Twenty-nine NF1 children and 25 age- and gender-matched controls , aged 8 - 16 , were assessed in a VC . Parents ' ratings on the  Conners ' Parent Rating Scales-Revised : Long ( CPRS-R : L ) question naire were used to screen for Attention Deficit-Hyperactivity Disorder ( ADHD ) . Significant differences were found between the NF1 and the control groups on the number of targets correctly identified ( omission errors ) and the number of commissions ( commission errors ) in the VC , with poorer performance by the NF1 children ( p < 0.005 ) . Significant correlations were obtained between the number of targets correctly identified , the number of commission errors , and the reaction time . Significant correlations were also found between the total correct hits and the cognitive problems/inattention scale , as well as two other indexes of the CPRS-R : L : the DSM-IV Symptoms Subscale and the ADHD Index . The VC results support the hypothesis that NF1 is marked by inattention and impulsivity and that participants with NF1 are more inattentive ( omission errors ) and impulsive ( commission errors ) than normal controls . The VC appears to be a sensitive and ecologically valid assessment tool for use in the diagnosis of attention deficits among children with NF1 Attention deficit hyperactivity disorder ( ADHD ) is related to a deficiency of central catecholamines ( CA ) in cognitive , biochemical , and physical tests , and pharmaceutical intervention may have no effect if it is not accompanied by changes in the environment . The objective of our study was to test the hypothesis that central CA are responsible for the increase in speed reaction seen after physical activity ( PA ) and to measure the impact of high intensity PA on the sustained attention of 25 children diagnosed with ADHD consistent with the Disease Statistical Mental-IV ( DSM-IV ) criteria . It is possible that practicing sports assists in the management of the disorder . The children were divided between users ( US ) and non-users ( NUS ) of methylpheni date ( MTP ) , and the groups were compared to evaluate the effect of the drug on cognition after PA . Post-exercise performance on Conner ’s Continuous Performance Test-II ( CPT ) was not affected by MTP , we observed significant improvements in response time , and we saw normalization in the impulsivity and vigilance measures . These results suggest that the improvements in cognition after physical effort are not CA dependent . Additionally , our results suggest that  children ’s attention deficits can be minimized through PA irrespective of treatment with MTP . Additional studies are necessary to confirm that exercise mitigates the harmful symptoms of ADHD 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 Rationale Previous research investigating the effects of stimulants , such as methylpheni date ( MPH ) , on children with attention deficit/hyperactivity disorder ( AD/HD ) has rarely included autonomic measures of arousal . Objective Our aim was to clarify the effects of MPH on central and autonomic measures in AD/HD children during a continuous performance task ( CPT ) using a naturalistic open-label study . Method Thirty-six boys ( 18 AD/HD and 18 control ) participated in a CPT over two trial periods , allowing a more valid estimate of the effects of medication , rather than assuming that retesting per se has no substantial impact . MPH was administered to the AD/HD group 1 h prior to the second trial . Errors and reaction time ( RT ) were recorded as measures of performance , electrodermal activity as an autonomic nervous system measure and event-related potentials ( ERPs ) as an index of central nervous system activity . Results AD/HD children made more errors than controls in the first session , but no group differences were found after medication . No significant differences were observed for RT . Skin conductance level was found to be lower in AD/HD children than controls , but this difference was also ameliorated after medication . Conversely , mean skin conductance response to target stimuli was found not to differ between groups during the initial test phase but became significantly different in phase 2 . ERP data showed topographic differences between groups in N1 , P2 , N2 and P3 at the initial test phase , which were reduced at the second test . ConclusionS timulant medication ameliorated some of the dysfunctions in AD/HD children , which are reflected in behavioural and ERP measures . These results , in combination with general differences in electrodermal activity , support a hypoarousal model of AD/HD , which can explain the action of MPH in these children This study evaluates the effectiveness of cognitive behavioral therapy ( CBT ) in improving the home behavior of children with attention deficit hyperactivity disorder ( ADHD ) . Twenty-five boys ( age 7 to 13 ) with a diagnosis of ADHD were r and omized to a CBT or supportive therapy control group . Outcome measures included parent and teacher ratings of the child on the Behavior Problem Checklist-Attention Problem Subscale ( BPC-AP ) , and the Self-Control Rating Scale ( SCRS ) , parent ratings on the Modified Werry Weiss Activity Scale , and child ratings on the Piers Harris Self-Concept Scale and Matching Familiar Figures Task . Data were analyzed using a two-way analysis of variance for main effects . A significant improvement favoring CBT was found on the Werry Weiss Scale , which measures the parent 's perception of the child 's hyperactivity in the home , and the child 's rating of his/her self-esteem on the Piers Harris Self-Concept Scale . Other outcome measures did not demonstrate statistical differences . This research provides support for the use of CBT in children with ADHD .  CBT was found to improve the parent 's perception of the child 's hyperactivity in the home as well as the child 's self-esteem BACKGROUND Previous qualitative research among adults and parents of children with phenylketonuria ( PKU ) has identified inattention as an important psychiatric aspect of this condition . The parent-reported ADHD Rating Scale-IV ( ADHD RS-IV ) and the Adult ADHD Self-Report Scale ( ASRS ) have been vali date d for measuring inattention symptoms in persons with attention-deficit/hyperactivity disorder ( ADHD ) ; however , their psychometric attributes for measuring PKU-related inattention have not been established . OBJECTIVE The primary objective of this investigation was to demonstrate the reliability , validity , and responsiveness of the  ADHD RS-IV  and  ASRS inattention symptoms subscales in a r and omized controlled trial of patients with PKU aged 8 years or older . METHODS A post hoc analysis investigated the psychometric properties ( Rasch model fit , reliability , construct validity , and responsiveness ) of the ADHD RS-IV and ASRS inattention subscales using data from a phase 3b , double-blind , placebo-controlled clinical trial in those with PKU aged 8 years or older . RESULTS The Rasch results revealed good model fit , and reliability analyses revealed strong internal consistency reliability ( α ≥ 0.87 ) and reproducibility ( intraclass correlation coefficient ≥ 0.87 ) for both measures . Both inattention measures demonstrated the ability to discriminate between known groups ( P < 0.001 ) created by the Clinical Global Impression-Severity scale . Correlations between the ADHD RS-IV and the ASRS with the Clinical Global Impression-Severity scale and the age-appropriate Behavior Rating Inventory of Executive Function Working Memory subscale were consistently moderate to strong ( r ≥ 0.56 ) . Similarly , results of the change score correlations were of moderate magnitude ( r ≥ 0.43 ) for both measures when compared with changes over time in Behavior Rating Inventory of Executive Function Working Memory subscales . CONCLUSIONS These findings of reliability , validity , and responsiveness of both the ADHD RS-IV and the ASRS inattention scales , in addition to content validation results , support their use for the assessment of inattention symptoms among persons with PKU aged 8 years or older in both clinical and research setting Objective : While American Academy of Pediatrics guidelines recommend obtaining symptom reports from both parents and teachers when treating children with attention-deficit hyperactivity disorder ( ADHD ) , information from parents is easier to obtain and practitioners may prefer to rely solely on parent report when managing medications . There are , however , few empirical data on the relationship between parent and teacher reports during medication management of ADHD . This study examined the relationship between parent and teacher reports of symptoms of ADHD during a clinical trial . Methods : A study to improve medication management of ADHD was conducted in 24 pediatric practice s with 270 children . Children meeting criteria for ADHD were r and omized by practice to treatment-as-usual or specialized care groups , with data combined from the groups to examine parent-teacher agreement . Parent and teacher reports on the ADHD Rating Scale-IV  were obtained at pretreatment , 4 months , and 12 months follow-up . Results : At each assessment , correlations between parent and teacher ratings were statistically significant , but the magnitudes of the correlations were low , accounting for no more than approximately 17 % of the variance between measures . Correlations between change scores on parent and teacher ratings were statistically significant but low for Total and Inattentive scales and not significant for the Hyperactive-Impulsive scale . For agreement on extreme scores , 6 of 9 kappas were statistically significant but all were unacceptably low . Conclusions : Agreement between parent and teacher ratings of symptoms of ADHD is too low for clinicians to rely on parent reports while managing medications . Teacher reports are still needed to ensure optimal management 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 Purpose To assess baseline predictors and consequences of medication non-adherence in the treatment of pediatric patients with attention-deficit/hyperactivity disorder ( ADHD ) from Central Europe and East Asia . Patients and methods Data for this post-hoc analysis were taken from a 1-year prospect i ve , observational study that included a total of 1,068 newly-diagnosed pediatric patients with ADHD symptoms from Central Europe and East Asia .  Medication adherence during the week prior to each visit was assessed by treating physicians using a 5-point Likert scale , and then dichotomized into either adherent or non-adherent . Clinical severity was measured by the Clinical Global Impressions-ADHD-Severity ( CGI-ADHD ) scale and the Child Symptom Inventory-4 ( CSI-4 ) Checklist . Health-Related Quality of Life ( HRQoL ) was measured using the Child Health and Illness Profile-Child Edition ( CHIP-CE ) . Regression analyses were used to assess baseline predictors of overall adherence during follow-up , and the impact of time-varying adherence on subsequent outcomes : response ( defined as a decrease of at least 1 point in CGI ) , changes in CGI-ADHD , CSI-4 , and the five dimensions of CHIP-CE . Results Of the 860 patients analyzed , 64.5 % ( 71.6 % in Central Europe and 55.5 % in East Asia ) were rated as adherent and 35.5 % as non-adherent during follow-up . Being from East Asia was found to be a strong predictor of non-adherence . In East Asia , a family history of ADHD and parental emotional distress were associated with non-adherence , while having no other children living at home was associated with non-adherence in Central Europe as well as in the overall sample . Non-adherence was associated with poorer response and less improvement on CGI-ADHD and CSI-4 , but not on CHIP-CE . Conclusion Non-adherence to medication is common in the treatment of ADHD , particularly in East Asia . Non-adherence was associated with poorer response and less improvement in clinical severity . A limitation of this study is that medication adherence was assessed by the treating clinician using a single item question Abstract To assess the long-term effects of neurofeedback ( NFB ) in children with attention deficit hyperactivity disorder ( ADHD ) , we compared behavioral and neurocognitive outcomes at a 6-month naturalistic follow-up of a r and omized controlled trial on NFB , methylpheni date ( MPH ) , and physical activity ( PA ) .  Ninety-two children with a DSM-IV-TR ADHD diagnosis , aged 7–13 , receiving NFB ( n = 33 ) , MPH ( n = 28 ) , or PA ( n = 31 ) , were re-assessed 6-months after the interventions . NFB comprised theta/beta training on the vertex ( cortical zero ) . PA comprised moderate to vigorous intensity exercises . Outcome measures included parent and teacher behavioral reports , and neurocognitive measures ( auditory oddball , stop-signal , and visual spatial working memory tasks ) . At follow-up , longitudinal hierarchical multilevel model analyses revealed no significant group differences for parent reports and neurocognitive measures ( p = .058–.997 ) , except for improved inhibition in MPH compared to NFB ( p = .040 ) and faster response speed in NFB compared to PA ( p = .012 ) during the stop-signal task . These effects , however , disappeared after controlling for medication use at follow-up . Interestingly , teacher reports showed less inattention and hyperactivity/impulsivity at follow-up for NFB than PA ( p = .004–.010 ) , even after controlling for medication use ( p = .013–.036 ) . Our findings indicate that the superior results previously found for parent reports and neurocognitive outcome measures obtained with MPH compared to NFB and PA post intervention became smaller or non-significant at follow-up . Teacher reports suggested superior effects of NFB over PA ; however , some children had different teachers at follow-up . Therefore , this finding should be interpreted with caution . Clinical trial registration Train your brain and exercise your heart ? Advancing the treatment for Attention Deficit Hyperactivity Disorder ( ADHD ) , Ref . no. NCT01363544 , https:// clinical trials.gov/show/NCT01363544 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 Objective : To evaluate the efficacy of 2 computer attention training systems administered in school for children with attention-deficit hyperactivity disorder ( ADHD ) . Method : Children in second and fourth grade with a diagnosis of ADHD ( n = 104 ) were r and omly assigned to neurofeedback ( NF ) ( n = 34 ) , cognitive training ( CT ) ( n = 34 ) , or control ( n = 36 ) conditions . A 2-point growth model assessed change from pre-post intervention on parent reports ( Conners 3-Parent [ Conners 3-P ] ; Behavior Rating Inventory of Executive Function [ BRIEF ] rating scale ) , teacher reports ( Swanson , Kotkin , Agler , M-Flynn and Pelham scale [ SKAMP ] ; Conners 3-Teacher [ Conners 3-T ] ) , and systematic classroom observations ( Behavioral Observation of Students in Schools [ BOSS ] ) . Paired t tests and an analysis of covariance assessed change in medication . Results : Children who received NF showed significant improvement compared with those in the control condition on the Conners 3-P Attention , Executive Functioning and Global Index , on all BRIEF summary indices , and on BOSS motor/verbal off-task behavior . Children who received CT showed no improvement compared to the control condition . Children in the NF condition showed significant improvements compared to those in the CT condition on Conners 3-P Executive Functioning , all BRIEF summary indices , SKAMP Attention , and Conners 3-T Inattention subscales . Stimulant medication dosage in methylpheni date equivalencies significantly increased for children in the CT ( 8.54 mg ) and control ( 7.05 mg ) conditions but not for those in the NF condition ( 0.29 mg ) . Conclusion : Neurofeedback made greater improvements in ADHD symptoms compared to both the control and CT conditions . Thus , NF is a promising attention training treatment intervention for children with ADHD
There were mixed findings with regard to the use of CPTs to assess and manage medication , with contrasting evidence on their ability to support clinical decision-making .
There was a strong evidence base for the use of objective measures of activity to aid ADHD/non-ADHD group differentiation , which appears sensitive to medication effects and would also benefit from further research on their clinical utility .
Attention-deficit hyperactivity disorder ( ADHD ) is typically diagnosed using clinical observation and subjective informant reports .
Once children commence ADHD medication , robust monitoring is required to detect partial or non-responses .
The extent to which neuropsychological continuous performance tests ( CPTs ) and objective measures of activity can clinical ly aid the assessment and titration process in ADHD is not fully understood .
This review describes the current evidence base for the use of CPTs and objective ly measured activity to support the diagnostic procedure and medication management for children with ADHD .
Four data bases ( PsycINFO , Medline , Allied and Complementary Medicine ( AMED ) , and PsycARTICLES ) were systematic ally search ed to underst and the current evidence base for ( 1 ) the use of CPTs to aid clinical assessment of ADHD ; ( 2 ) the use of CPTs to aid medication management ; and ( 3 ) the clinical utility of objective measures of activity in ADHD .