Reduced Symptoms of Inattention after Dietary Omega-3 Fatty Acid Supplementation in Boys with and without Attention Deficit/Hyperactivity Disorder Neurofeedback, sham neurofeedback, and cognitive-behavioural group therapy in adults with attention-deficit hyperactivity disorder: a triple-blind, randomised, controlled trial. What future research should bring to help resolving the debate about the efficacy of EEG-neurofeedback in children with ADHD Effect of supplementation with long-chain ω-3 polyunsaturated fatty acids on behavior and cognition in children with attention deficit/hyperactivity disorder (ADHD): a randomized placebo-controlled intervention trial. Vitamin-mineral treatment of attention-deficit hyperactivity disorder in adults: double-blind randomised placebo-controlled trial. 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Attention deficit/hyperactivity disorder ( ADHD ) is one of the most common child psychiatric disorders , and is often treated with stimulant medication . Nonpharmacological treatments include dietary supplementation with omega-3 fatty acids , although their effectiveness remains to be shown conclusively . In this study , we investigated the effects of dietary omega-3 fatty acid supplementation on ADHD symptoms and cognitive control in young boys with and without ADHD . A total of 40 boys with ADHD , aged 8–14 years , and 39 matched , typically developing controls participated in a 16-week double-blind r and omized placebo-controlled trial . Participants consumed 10 g of margarine daily , enriched with either 650 mg of eicosapentaenoic acid (EPA)/docosahexaenoic acid ( DHA ) each or placebo . Baseline and follow-up assessment s addressed ADHD symptoms , fMRI of cognitive control , urine homovanillic acid , and cheek cell phospholipid sampling . EPA/DHA supplementation improved parent-rated attention in both children with ADHD and typically developing children . Phospholipid DHA level at follow-up was higher for children receiving EPA/DHA supplements than placebo . There was no effect of EPA/DHA supplementation on cognitive control or on fMRI measures of brain activity . This study shows that dietary supplementation with omega-3 fatty acids  reduces symptoms of ADHD , both for individuals with ADHD and typically developing children . This effect does not appear to be mediated by cognitive control systems in the brain , as no effect of supplementation was found here . Nonetheless , this study offers support that omega-3 supplementation may be an effective augmentation for pharmacological treatments of ADHD ( NCT01554462 : The Effects of EPA/DHA Supplementation on Cognitive Control in Children with ADHD ; http:// clinical trials.gov/show/NCT01554462 ) BACKGROUND Many studies suggest that electroencephalographic ( EEG ) neurofeedback might be beneficial in the treatment of attention-deficit hyperactivity disorder ( ADHD ) . However , numbers of well controlled studies are low and neurofeedback techniques are regarded as highly controversial . The present trial examined the efficacy ( compared with sham neurofeedback ) and efficiency ( compared with meta-cognitive therapy ) of a st and ard EEG neurofeedback protocol in adults with ADHD . METHODS We did a concurrent , triple-blind , r and omised , controlled trial using authorised deception in adults with ADHD from one centre ( University of Tübingen ) in Tübingen , Germany . Participants were eligible if they fulfilled the DSM-IV-TR criteria for ADHD , were aged between 18 years and 60 years , and had no or stable use of medication for at least 2 months with no intention to change . We excluded participants who had comorbid schizophrenia or schizoaffective disorder , bipolar disorder , borderline personality disorder , epilepsy , or traumatic brain injury ; substance abuse or dependence ; or current or planned other psychological treatment . Those eligible were r and omly assigned to three groups : a neurofeedback group which received 30 verum θ-to-β neurofeedback sessions over 15 weeks , a sham neurofeedback group which received 15 sham followed by 15 verum θ-to-β neurofeedback sessions over 15 weeks , or a meta-cognitive group therapy group which received 12 sessions over 12 weeks . Participants were assigned equally to one of the three interventions through a computerised minimisation r and omisation procedure stratified by sex , age , and baseline symptom severity of ADHD . Participants were masked as to whether they were receiving neurofeedback or sham neurofeedback , but those receiving meta-cognitive therapy were aware of their treatment . Clinical assessors ( ie , those assessing outcomes ) and research staff who did the neurofeedback training were masked to participants ' r and omisation status only for neurofeedback and sham neurofeedback . The primary outcome was symptom score on the Conners ' adult ADHD rating scale , assessed before treatment , at midtreatment ( after 8 weeks ) , after treatment ( after 16 weeks ) , and 6 months later . All individuals with at least one observation after r and omisation were included in the analyses . This trial is registered with Clinical Trials.gov , number NCT01883765 . FINDINGS Between Feb 1 , 2013 , and Dec 1 , 2015 , 761 people were assessed for eligibility . 656 ( 86 % ) were excluded and 118 ( 15 % ) were eligible for participation in this study . Eligible participants were r and omly assigned to neurofeedback ( 38 [ 32 % ] ) , sham neurofeedback ( 39 [ 33 % ] ) , or meta-cognitive therapy ( 41 [ 35 % ] ) . 37 ( 97 % ) individuals for neurofeedback , 38 ( 97 % ) for sham neurofeedback , and 38 ( 93 % ) for meta-cognitive therapy were included in analyses . Self-reported ADHD symptoms decreased substantially for all treatment groups ( B=-2·58 [ 95 % CI -3·48 to -1·68 ] ; p<0·0001 ) between pretreatment and the end of 6 month follow-up , independent of treatment condition ( neurofeedback vs sham neurofeedback B=-0·89 [ 95 % CI -2·14 to 0·37 ] , p=0·168 ; neurofeedback vs meta-cognitive therapy -0·30 [ -1·55 to 0·95 ] , p=0·639 ) . No treatment-related or trial-related serious adverse events were reported . INTERPRETATION Our findings suggest that neurofeedback training is not superior to a sham condition or group psychotherapy . All three treatments were equivalently effective in reducing ADHD symptoms . This first r and omised , sham-controlled trial did not show any specific effects  of neurofeedback  on ADHD symptoms in adults . FUNDING German Research Foundation In recent years a rising amount of r and omized controlled trials , review s , and meta-analyses relating to the efficacy of electroencephalographic-neurofeedback ( EEG-NF ) in children with attention-deficit/hyperactivity disorder ( ADHD ) have been published . Although clinical reports and open treatment studies suggest EEG-NF to be effective , double blind placebo-controlled studies as well as a rigorous meta- analysis failed to find support for the efficacy of EEG-NF . Since absence of evidence does not equate with evidence of absence , we will outline how future research might overcome the present method ological limitations . To provide conclusive evidence for the presence or absence of the efficacy of EEG-NF  in the treatment of ADHD , there is a need to set up a well- design ed study that ensures optimal implementation and embedding of the training , and possibly incorporates different forms of neurofeedback OBJECTIVE To determine whether supplementation with the long-chain omega-3 polyunsaturated fatty acids eicosapentaenoic ( EPA ) and docosahexaenoic acid ( DHA ) affects behavioral symptoms and cognitive impairments in children 6 - 12 years of age diagnosed with attention-deficit/hyperactivity disorder ( ADHD ) . STUDY DESIGN The r and omized , double-blind placebo-controlled 16 weeks trial was conducted with 95 children diagnosed with ADHD according to DSM-IV criteria . Behavior was assessed by parents , teachers and investigators using st and ardized rating scales and question naires . Further outcome variables were working memory , speed of information processing and various measures of attention . For a subgroup of 81 participants , erythrocyte membrane fatty acid composition was analyzed before and after the intervention . RESULTS Supplementation with the omega-3 fatty acid mix increased EPA and DHA concentrations in erythrocyte membranes and improved working memory function , but had no effect on other cognitive measures and parent- and teacher-rated behavior in the study population . Improved working memory correlated significantly with increased EPA , DHA and decreased AA ( arachidonic acid ) BACKGROUND The role of nutrition in the treatment of  attention-deficit hyperactivity disorder ( ADHD )  is gaining international attention ; however , treatments have generally focused only on diet restriction or supplementing with one nutrient at a time . AIMS To investigate the efficacy and safety of a broad-based micronutrient formula consisting mainly of vitamins and minerals , without omega fatty acids , in the treatment of ADHD in adults . METHOD This double-blind r and omised controlled trial assigned 80 adults with ADHD in a 1:1 ratio to either micronutrients  ( n = 42 ) or  placebo ( n = 38 ) for 8 weeks ( trial registered with the Australian New Zeal and Clinical Trials Registry : ACTRN12609000308291 ) . RESULTS Intent-to-treat analyses showed significant between-group differences favouring active treatment on self- and observer- but not clinician-ADHD rating scales . However , clinicians rated those receiving micronutrients as more improved than those on placebo both globally and on ADHD symptoms . Post hoc analyses showed that for those with moderate/severe depression  at baseline , there was a greater change in mood favouring active treatment over placebo . There were no group differences in adverse events . CONCLUSIONS This study provides preliminary evidence of efficacy for micronutrients in the treatment of  ADHD symptoms in adults , with a reassuring safety profile Clinical trials have suggested that neurofeedback may be efficient in treating attention-deficit/hyperactivity disorder ( ADHD ) . We compared the effects of a 3-month electroencephalographic feedback program providing reinforcement contingent on the production of cortical sensorimotor rhythm ( 12–15 Hz ) and beta1 activity ( 15–18 Hz ) with stimulant medication . Participants were N = 34 children aged 8–12 years , 22 of which were assigned to the neurofeedback group and 12 to the methylpheni date group according to their parents ' preference . Both neurofeedback and methylpheni date were associated with improvements on all subscales of the Test of Variables of Attention , and on the speed and accuracy measures of the d2 Attention Endurance Test . Furthermore , behaviors related to the disorder were rated as significantly reduced in both groups by both teachers and parents on the IOWA-Conners Behavior Rating Scale . These findings suggest that neurofeedback was efficient in improving some of the behavioral concomitants of ADHD in children whose parents favored a nonpharmacological treatment Objective : To evaluate the efficacy of 2 computer attention training systems administered in school for children with attention-deficit hyperactivity disorder ( ADHD ) . Method : Children in second and fourth grade with a diagnosis of ADHD ( n = 104 ) were r and omly assigned to neurofeedback ( NF ) ( n = 34 ) , cognitive training ( CT ) ( n = 34 ) , or control ( n = 36 ) conditions . A 2-point growth model assessed change from pre-post intervention on parent reports ( Conners 3-Parent [ Conners 3-P ] ; Behavior Rating Inventory of Executive Function [ BRIEF ] rating scale ) , teacher reports ( Swanson , Kotkin , Agler , M-Flynn and Pelham scale [ SKAMP ] ; Conners 3-Teacher [ Conners 3-T ] ) , and systematic classroom observations ( Behavioral Observation of Students in Schools [ BOSS ] ) . Paired t tests and an analysis of covariance assessed change in medication . Results : Children who received NF showed significant improvement compared with those in the control condition on the Conners 3-P Attention , Executive Functioning and Global Index , on all BRIEF summary indices , and on BOSS motor/verbal off-task behavior . Children who received CT showed no improvement compared to the control condition . Children in the NF condition showed significant improvements compared to those in the CT condition on Conners 3-P Executive Functioning , all BRIEF summary indices , SKAMP Attention , and Conners 3-T Inattention subscales . Stimulant medication dosage in methylpheni date equivalencies significantly increased for children in the CT ( 8.54 mg ) and control ( 7.05 mg ) conditions but not for those in the NF condition ( 0.29 mg ) . Conclusion : Neurofeedback made greater improvements in ADHD symptoms compared to both the control and CT conditions . Thus , NF is a promising attention training treatment intervention for children with ADHD OBJECTIVE To determine whether docosahexaenoic acid ( DHA ) supplementation for 4 months decreases the symptoms of  attention-deficit/hyperactivity disorder ( ADHD ) .  STUDY DESIGN Sixty-three 6- to-12-year-old children with ADHD , all receiving effective maintenance therapy with stimulant medication , were assigned r and omly , in a double-blind fashion , to receive DHA supplementation ( 345 mg/d ) or placebo for 4 months . Outcome variables included plasma phospholipid fatty acid patterns , scores on laboratory measures of inattention and impulsivity ( Test of Variables of Attention , Children 's Color Trails test ) while not taking stimulant medication , and scores on parental behavioral rating scales ( Child Behavior Checklist , Conners ' Rating Scale ) . Differences between groups after 4 months of DHA supplementation or placebo administration were determined by analysis of variance , controlling for age , baseline value of each outcome variable , ethnicity , and ADHD subtype . RESULTS Plasma phospholipid DHA content of the DHA-supplemented group was 2.6-fold higher at the end of the study than that of the placebo group ( 4.85 + /- 1.35 vs 1.86 + /- 0.87 mol % of total fatty acids ; P < .001 ) . Despite this , there was no statistically significant improvement in any objective or subjective measure of ADHD symptoms . CONCLUSION A 4-month period of DHA supplementation ( 345 mg/d ) does not decrease symptoms of ADHD OBJECTIVE The efficacy of neurofeedback as a treatment for attention-deficit/hyperactivity disorder ( ADHD ) , and whether neurofeedback is a viable alternative for stimulant medication , is still an intensely debated subject . The current r and omized controlled trial compared neurofeedback to ( 1 ) optimally titrated methylpheni date and ( 2 ) a semi-active control intervention , physical activity , to account for nonspecific effects . METHODS A multicenter 3-way parallel-group study with balanced r and omization was conducted . Children with a DSM-IV-TR diagnosis of ADHD , aged 7 - 13 years , were r and omly allocated to receive neurofeedback ( n = 39 ) , methylpheni date ( n = 36 ) , or physical activity ( n = 37 ) over a period of 10 - 12 weeks . Neurofeedback comprised theta/beta training on the vertex ( Cz ) . Physical activity consisted of moderate to vigorous intensity exercises . Neurofeedback and physical activity were balanced in terms of number ( ~30 ) and duration of sessions . A double-blind pseudor and omized placebo-controlled crossover titration procedure was used to determine an optimal dose in the methylpheni date intervention . Parent and teacher ratings on the Strengths and Difficulties Question naire ( SDQ ) and Strengths and Weaknesses of ADHD Symptoms and Normal Behavior ( SWAN ) were used to assess intervention outcomes . Data collection took place between September 2010 and March 2014 . RESULTS Intention-to-treat analyses revealed an improvement in parent-reported behavior on the SDQ and the SWAN Hyperactivity/Impulsivity scale , irrespective of received intervention ( ηp² = 0.21 - 0.22 , P ≤ .001 ) , whereas the SWAN Inattention scale revealed more improvement in children who received methylpheni date than neurofeedback and physical activity ( ηp² = 0.13 , P ≤ .001 ) . Teachers reported a decrease of ADHD symptoms on all measures for methylpheni date , but not for neurofeedback or physical activity ( range of ηp² = 0.14 - 0.29 , P < .001 ) . CONCLUSIONS The current study found that optimally titrated methylpheni date is superior to neurofeedback and physical activity in decreasing ADHD symptoms in children with ADHD . TRIAL REGISTRATION Clinical Trials.gov identifier : NCT01363544 OBJECTIVE Electroencephalographic ( EEG ) neurofeedback ( NF ) is considered a nonpharmacological alternative for medication in attention-deficit/hyperactivity disorder ( ADHD ) . Comparisons of the behavioral efficacy of NF and medication have produced inconsistent results . EEG measures can provide insight into treatment mechanisms , but have received little consideration . In this r and omized controlled trial ( RCT ) , effects of NF were compared with methylpheni date ( MPH ) , and physical activity ( PA ) in children with ADHD on event-related potential ( ERP ) indices of response inhibition , which are involved in ADHD psychopathology . METHODS Using a multicenter three way parallel group RCT design , 112 children with a Diagnostic and Statistical Manual of Mental Disorders , 4th ed . ( DSM-IV ) ( American Psychiatric Association 1994 ) diagnosis of ADHD , between 7 and 13 years of age , were initially included .  NF training consisted of 30 sessions of theta/beta training at Cz over a 10 week period . PA training was a semiactive control group , matched in frequency and duration . MPH was titrated using a double-blind placebo controlled procedure in 6 weeks , followed by a stable dose for 4 weeks . ERP measures of response inhibition , N2 and P3 , were available for 81 children at pre- and postintervention ( n = 32 NF , n = 25 MPH , n = 24 PA ) . RESULTS Only the medication group showed a specific increase in P3 amplitude compared with NF ( partial eta-squared [ ηp(2 ) ] = 0.121 ) and PA ( ηp(2 ) = 0.283 ) , which was related to improved response inhibition . Source localization of medication effects on P3 amplitude indicated increased activation primarily in thalamic and striatal nuclei . CONCLUSIONS This is the first study that simultaneously compared NF with stimulant treatment and a semiactive control group . Only stimulant treatment demonstrated specific improvements in brain function related to response inhibition . These results are in line with recent doubts on the efficacy and specificity of NF as treatment for ADHD . CLINICAL TRIALS REGISTRATION Train Your Brain ? Exercise and Neurofeedback Intervention for ADHD , https:// clinical trials.gov/show/NCT01363544 , Ref . No. NCT01363544 OBJECTIVE To determine the effects of an eicosapentaenoic acid (EPA)-rich oil and a docosahexaenoic acid (DHA)-rich oil versus an ω-6 polyunsaturated fatty acid-rich safflower oil ( control ) on literacy and behavior in children with attention-deficit/hyperactivity disorder ( ADHD ) in a r and omized controlled trial . METHODS Supplements rich in EPA , DHA , or safflower oil were r and omly allocated for 4 mo to 90 Australian children 7 to 12 y old with ADHD symptoms higher than the 90th percentile on the Conners Rating Scales . The effect of supplementation on cognition , literacy , and parent-rated behavior was assessed by linear mixed modeling . Pearson correlations determined associations between the changes in outcome measurements and the erythrocyte fatty acid content ( percentage of total ) from baseline to 4 mo . RESULTS There were no significant differences between the supplement groups in the primary outcomes after 4 mo . However , the erythrocyte fatty acid profiles indicated that an increased proportion of DHA was associated with improved word reading ( r = 0.394 ) and lower parent ratings of oppositional behavior ( r = 0.392 ) . These effects were more evident in a subgroup of 17 children with learning difficulties : an increased erythrocyte DHA was associated with improved word reading ( r = 0.683 ) , improved spelling ( r = 0.556 ) , an improved ability to divide attention ( r = 0.676 ) , and lower parent ratings of oppositional behavior ( r = 0.777 ) , hyperactivity ( r = 0.702 ) , restlessness ( r = 0.705 ) , and overall ADHD symptoms ( r = 0.665 ) . CONCLUSION Increases in erythrocyte ω-3 polyunsaturated fatty acids , specifically DHA , may improve literacy and behavior in children with ADHD . The greatest benefit may be observed in children who have comorbid learning difficulties The present study is a r and omized controlled trial that aims to evaluate the efficacy of Neurofeedback compared to st and ard pharmacological intervention in the treatment of attention deficit/hyperactivity disorder ( ADHD ) . The final sample consisted of 23 children with ADHD ( 11 boys and 12 girls , 7 - 14 years old ) . Participants carried out 40 theta/beta training sessions or received methylpheni date .  Behavioral rating scales were completed by fathers , mothers , and teachers at pre- , post-treatment , two- , and six-month naturalistic follow-up . In both groups , similar significant reductions were reported in ADHD functional impairment by parents ; and in primary ADHD symptoms by parents and teachers . However , significant academic performance improvements were only detected in the Neurofeedback group . Our findings provide new evidence for the efficacy of Neurofeedback , and contribute to enlarge the range of non-pharmacological ADHD intervention choices . To our knowledge , this is the first r and omized controlled trial with a six-month follow-up that compares Neurofeedback and stimulant medication in ADHD The present study is a r and omized controlled trial that aims to evaluate the efficacy of Neurofeedback compared to st and ard pharmacological intervention in the treatment of attention deficit/hyperactivity disorder ( ADHD ) . The final sample consisted of 23 children with ADHD ( 11 boys and 12 girls , 7 - 14 years old ) . Participants carried out 40 theta/beta training sessions or received methylpheni date .  Behavioral rating scales were completed by fathers , mothers , and teachers at pre- , post-treatment , two- , and six-month naturalistic follow-up . In both groups , similar significant reductions were reported in ADHD functional impairment by parents ; and in primary ADHD symptoms by parents and teachers . However , significant academic performance improvements were only detected in the Neurofeedback group . Our findings provide new evidence for the efficacy of Neurofeedback , and contribute to enlarge the range of non-pharmacological ADHD intervention choices . To our knowledge , this is the first r and omized controlled trial with a six-month follow-up that compares Neurofeedback and stimulant medication in ADHD Attention Deficit Hyperactivity Disorder ( ADHD ) is characterized by poor cognitive control/attention and hypofunctioning of the dorsal anterior cingulate cortex ( dACC ) . In the current study , we investigated for the first time whether real-time fMRI neurofeedback ( rt-fMRI ) training targeted at increasing activation levels within dACC in adults with ADHD leads to a reduction of clinical symptoms and improved cognitive functioning . An exploratory r and omized controlled treatment study with blinding of the participants was conducted . Participants with ADHD ( n = 7 in the neurofeedback group , and n = 6 in the control group ) attended four weekly MRI training sessions ( 60-min training time/session ) , during which they performed a mental calculation task at varying levels of difficulty , in order to learn how to up-regulate dACC activation . Only neurofeedback participants received continuous feedback information on actual brain activation levels within dACC . Before and after the training , ADHD symptoms and relevant cognitive functioning was assessed . Results showed that both groups achieved a significant increase in dACC activation levels over sessions . While there was no significant difference between the neurofeedback and control group in clinical outcome , neurofeedback participants showed stronger improvement on cognitive functioning . The current study demonstrates the general feasibility of the suggested rt-fMRI neurofeedback training approach as a potential novel treatment option for ADHD patients . Due to the study ’s small sample size , potential clinical benefits need to be further investigated in future studies . Trial Registration : IS RCT BACKGROUND An abnormality in long chain-polyunsaturated fatty acid ( LC-PUFA ) levels has been implicated in attention-deficit/hyperactivity disorder ( ADHD ) . Studies evaluating LC-PUFA supplementation for therapeutic efficacy in ADHD have shown mixed and , therefore , inconclusive results . METHODS Seventy-six male adolescents ( age 12 - 16 years , mean = 13.7 ) with ADHD were assessed for the effects of 12 weeks omega-3 and omega-6 supplements on biochemical and psychological outcomes in a r and omized , placebo-controlled , clinical trial . The primary outcome measure was change in the Conners ' Teacher Rating Scales ( CTRS ) following 12 weeks of supplementation of LC-PUFA or placebo . At baseline , the placebo and treatment groups had comparable levels of LC-PUFA as measured by red blood cell phosphatidylcholine . In the treatment group , supplementation enhanced eicosapentaenoic acid ( EPA ) , docosahexaenoic acid ( DHA ) , and total omega-3 fatty acid levels . RESULTS No superiority of LC-PUFAs to placebo was observed on the primary outcome . Further , there were no reliable treatment effects on aggression , impulsivity , depression , and anxiety . CONCLUSIONS Future studies should use larger sample sizes and longer supplementation period to detect small-modest effects for clinical recommendations in ADHD Objective Clinical trials and inconclusive meta-analyses have investigated the effects of omega-3 supplements in children with Attention-Deficit Hyperactivity Disorder ( ADHD ) . We performed a r and omised placebo-controlled trial to evaluate the efficacy of omega-3 fatty acids . Methods Children aged 6–15 years with established diagnosis of ADHD were r and omised 1:1 to receive either supplements containing docosahexaenoic acid ( DHA ) and eicosapentaenoic acid ( EPA ) or a placebo for 3 months . Psychotropic or omega-3-containing treatments were not authorised during the study . The primary outcome was the change in the Attention-Deficit Hyperactivity Disorder Rating Scale version 4 ( ADHD-RS-IV ) . Other outcomes included safety , lexical level ( Alouette test ) , attention ( Test of Attentional Performance for Children — KiTAP ) , anxiety ( 48-item Conners Parent Rating Scale-Revised — CPRS-R ) , and depression ( Children ’s Depression Inventory — CDI ) . Results Between 2009 and 2011 , 162 children were included in five French child psychiatry centres . The mean age was 9.90 ( SD 2.62 ) years and 78.4 % were boys . The inclusion ADHD-RS-IV at was 37.31 ( SD 8.40 ) . The total ADHD-RS-IV score reduction was greater in the placebo group than in the DHA – EPA group : −19 ( −26 , −12 ) % and −9.7 ( −16.6 , −2.9 ) % , respectively , p = 0.039 . The other components of the Conners score had a similar variation but the differences between groups were not significant . Two patients in the DHA – EPA group and none in the placebo group experienced a severe adverse event ( hospitalisation for worsening ADHD symptoms ) . Conclusion This study did not show any beneficial effect of omega-3 supplement in children with mild ADHD symptoms The aim of this study is to assess the efficacy of a restricted elimination diet in reducing symptoms in an unselected group of children with Attention deficit/hyperactivity disorder ( ADHD ) . Dietary studies have already shown evidence of efficacy in selected subgroups . Twenty-seven children ( mean age 6.2 ) who all met the DSM-IV criteria for ADHD , were assigned r and omly to either an intervention group ( 15/27 ) or a waiting-list control group ( 12/27 ) . Primary endpoint was the clinical response , i.e. a decrease in the symptom scores by 50 % or more , at week 9 based on parent and teacher ratings on the abbreviated ten-item Conners Scale and the ADHD-DSM-IV Rating Scale . The intention-to-treat analysis showed that the number of clinical responders in the intervention group was significantly larger than that in the control group [ parent ratings 11/15 ( 73 % ) versus 0/12 ( 0 % ) ; teacher ratings , 7/10 ( 70 % ) versus 0/7 ( 0 % ) ] . The Number of ADHD criteria on the ADHD Rating Scale showed an effect size of 2.1 ( cohen ’s d ) and a scale reduction of 69.4 % . Comorbid symptoms of oppositional defiant disorder also showed a significantly greater decrease in the intervention group than it did in the control group ( cohens ’s d 1.1 , scale reduction 45.3 % ) . A strictly supervised elimination diet may be a valuable instrument in testing young children with ADHD on whether dietary factors may contribute to the manifestation of the disorder and may have a beneficial effect on the children ’s behaviour 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 OBJECTIVE : To evaluate sustained improvements 6 months after a 40-session , in-school computer attention training intervention using neurofeedback or cognitive training ( CT ) administered to 7- to 11-year-olds with attention-deficit/hyperactivity disorder ( ADHD ) . METHODS : One hundred four children were r and omly assigned to receive neurofeedback , CT , or a control condition and were evaluated 6 months postintervention . A 3-point growth model assessed change over time across the conditions on the Conners 3–Parent Assessment Report ( Conners 3-P ) , the Behavior Rating Inventory of Executive Function Parent Form ( BRIEF ) , and a systematic double-blinded classroom observation ( Behavioral Observation of Students in Schools ) . Analysis of variance assessed community-initiated changes in stimulant medication . RESULTS : Parent response rates were 90 % at the 6-month follow-up . Six months postintervention , neurofeedback participants maintained significant gains on Conners 3-P ( Inattention effect size [ ES ] = 0.34 , Executive Functioning ES = 0.25 , Hyperactivity/Impulsivity ES = 0.23 ) and BRIEF subscales including the Global Executive Composite ( ES = 0.31 ) , which remained significantly greater than gains found among children in CT and control conditions . Children in the CT condition showed delayed improvement over immediate postintervention ratings only on Conners 3-P Executive Functioning ( ES = 0.18 ) and 2 BRIEF subscales . At the 6-month follow-up , neurofeedback participants maintained the same stimulant medication dosage , whereas participants in both CT and control conditions showed statistically and clinical ly significant increases ( 9 mg [ P = .002 ] and 13 mg [ P < .001 ] , respectively ) . CONCLUSIONS : Neurofeedback participants made more prompt and greater improvements in ADHD symptoms , which were sustained at the 6-month follow-up , than did CT participants or those in the control group . This finding suggests that neurofeedback is a promising attention training treatment for children with ADHD OBJECTIVE Neurofeedback aims to reduce symptoms of attention-deficit/hyperactivity disorder ( ADHD ) , mainly attention problems . However , the additional influence of neurofeedback over treatment as usual ( TAU ) on neurocognitive functioning for adolescents with ADHD remains unclear . METHOD By using a multicenter parallel r and omized controlled trial ( RCT ) design , male adolescents with a DSM-IV-TR diagnosis of ADHD ( mean age = 16.1 years ; range , 12 - 24 ) were r and omized to receive either a combination of TAU and neurofeedback ( n = 45 ) or TAU ( n = 26 ) . R and omization was computer generated and stratified by age group ( ages 12 through 15 , 16 through 20 , and 21 through 24 years ) . The neurofeedback intervention consisted of approximately 37 sessions over a period of 25 weeks of theta/sensorimotor rhythm training on the vertex ( Cz ) . Primary neurocognitive outcomes included performance parameters derived from the D2 Test of Attention , the Digit Span backward , the Stroop Color-Word Test and the Tower of London , all assessed preintervention and postintervention . Data were collected between December 2009 and July 2012 . RESULTS At postintervention , outcomes of attention and /or motor speed were improved , with faster processing times for both intervention conditions and with medium to large effect sizes ( range , ηp2 = .08-.54 ; P values < .023 ) . In both groups , no improvements for higher executive functions were observed . Results might partly resemble practice effects . CONCLUSIONS Although neurocognitive outcomes improved in all adolescents receiving treatment for ADHD , no additional value for neurofeedback over TAU was observed . Hence , this study does not provide evidence for using theta/sensorimotor rhythm neurofeedback to enhance neurocognitive performance as additional intervention to TAU for adolescents with ADHD symptoms . TRIAL REGISTRATION Trialregister.nl identifier : 1759 Objective : To investigate effects of omega-3 polyunsaturated fatty acids ( n-3 PUFA ) docosahexaenoic acid ( DHA ) and eicosapentaenoic acid ( EPA ) on attention , literacy , and behavior in children with ADHD . Method : Ninety children were r and omized to consume supplements high in EPA , DHA , or linoleic acid ( control ) for 4 months each in a crossover design . Erythrocyte fatty acids , attention , cognition , literacy , and Conners ’ Parent Rating Scales ( CPRS ) were measured at 0 , 4 , 8 , 12 months . Results : Fifty-three children completed the treatment . Outcome measures showed no significant differences between the three treatments . However , in children with blood sample s ( n = 76 - 46 ) , increased erythrocyte EPA + DHA was associated with improved spelling ( r = .365 , p < .001 ) and attention ( r = −.540 , p < .001 ) and reduced oppositional behavior ( r = −.301 , p < .003 ) , hyperactivity ( r = −.310 , p < .001 ) , cognitive problems ( r = −.326 , p < .001 ) , Diagnostic and Statistical Manual of Mental Disorders ( 4th ed . ; DSM-IV ) hyperactivity ( r = −.270 , p = .002 ) and DSM-IV inattention ( r = −.343 , p < .001 ) . Conclusion : Increasing erythrocyte DHA and EPA via dietary supplementation may improve behavior , attention , and literacy in children with ADHD Neurofeedback has been proposed as a potentially effective intervention for reducing Attention Deficit Hyperactivity Disorder ( ADHD ) symptoms . However , it remains unclear whether neurofeedback is of additional value to treatment as usual ( TAU ) for adolescents with clinical ADHD symptoms . Using a multicenter parallel-r and omized controlled trial design , adolescents with ADHD symptoms were r and omized to receive either a combination of TAU and neurofeedback ( NFB + TAU , n = 45 ) or TAU-only ( n = 26 ) . R and omization was computer generated and stratified for age group ( ages 12 through 16 , 16 through 20 , 20 through 24 ) .  Neurofeedback treatment consisted of approximately 37 sessions of theta/sensorimotor rhythm (SMR)-training on the vertex ( Cz ) . Primary behavioral outcome measures included the ADHD-rating scale , Youth Self Report , and Child Behavior Checklist all assessed pre- and post-intervention . Behavioral problems decreased equally for both groups with medium to large effect sizes , range of partial η2 = 0.08–0.31 , p < 0.05 . Hence , the combination of NFB + TAU was not more effective than TAU-only on the behavioral outcome measures . In addition , reported adverse effects were similar for both groups . On behavioral outcome measures , the combination of neurofeedback and TAU was as effective as TAU-only for adolescents with ADHD symptoms . Considering the absence of additional behavioral effects in the current study , in combination with the limited knowledge of specific treatment effects , it is question able whether theta/SMR neurofeedback for adolescents with ADHD and comorbid disorders in clinical practice should be used . Further research is warranted to investigate possible working mechanisms and ( long-term ) specific treatment effects of neurofeedback BACKGROUND Attention-deficit/hyperactivity disorder ( ADHD ) is associated with difficulties in learning , behaviour and psychosocial adjustment that persist into adulthood . Decreased omega-3 fatty acids and increased inflammation or oxidative stress may contribute to neuro-developmental and psychiatric disorders such as ADHD . The aim of this study was to determine the effect of n-3 supplementation on hyperactivity , oxidative stress and inflammatory mediators in children with ADHD . METHODS In this double blind study , 103 children ( 6 - 12 years ) with ADHD receiving maintenance therapy were assigned r and omly into two groups . The n-3 group received n-3 fatty acids ( 635 mg eicosapentaenoic acid ( EPA ) , 195 mg docosahexaenoic acid ( DHA ) ) , and the placebo group received olive oil capsules which were visually similar to the n-3 capsules . The duration of supplementation was 8 weeks . Plasma C-reactive protein ( CRP ) , interleukin-6 ( IL-6 ) and the activity of glutathione reductase ( GR ) , catalase ( CAT ) and superoxide dismutase ( SOD ) were determined before and after the intervention . Likewise the Conners ' Abbreviated Question naires ( ASQ-P ) was applied . RESULTS After 8-week intervention , a significant reduction was observed in the levels of CRP ( P < 0.05 , 95 % CI = 0.72 - 2.02 ) and IL-6 ( P < 0.001 , 95 % CI = 1.93 - 24.33 ) in the n-3 group . There was also a significant increase in activity of SOD and GR ( P < 0.001 ) . A significant improvement was seen in the ASQ-P scores in the n-3 group ( P < 005 ) . CONCLUSION Eight weeks of EPA and DHA supplementation decreased plasma inflammatory mediators and oxidative stress in the children with ADHD . These results suggest that n-3 fatty acid supplementation may offer a safe and efficacious treatment for children with ADHD ( 1 ) The authors tested the prediction that relative deficiencies in highly unsaturated fatty acids ( HUFAs ) may underlie some of the behavioral and learning problems associated with attention-deficit/hyperactivity disorder ( ADHD ) by study ing the effects of HUFA supplementation on ADHD-related symptoms in children with specific learning difficulties ( mainly dyslexia ) who also showed ADHD features . ( 2 ) Forty-one children aged 8 - 12 years with both specific learning difficulties and above-average ADHD ratings were r and omly allocated to HUFA supplementation or placebo for 12 weeks . ( 3 ) At both baseline and follow-up , a range of behavioral and learning problems associated with ADHD was assessed using st and ardized parent rating scales . ( 4 ) At baseline , the groups did not differ , but after 12 weeks mean scores for cognitive problems and general behavior problems were significantly lower for the group treated with HUFA than for the placebo group ; there were significant improvements from baseline on 7 out of 14 scales for active treatment , compared with none for placebo . Group differences in change scores all favored HUFA , reaching conventional significance levels for 3 out of 14 scales . ( 5 ) HUFA supplementation appears to reduce ADHD-related symptoms in children with specific learning difficulties . Given the safety and tolerability of this simple treatment , results from this pilot study strongly support the case for further investigations Background Current st and ardized treatments for cognitive impairment in attention-deficit/hyperactivity disorder remain limited and their efficacy restricted . Transcranial direct current stimulation ( tDCS ) is a promising tool for enhancing cognitive performance in several neuropsychiatric disorders . Nevertheless , the effects of tDCS in reducing cognitive impairment in patients with attention-deficit/hyperactivity disorder ( ADHD ) have not yet been investigated . Methods A parallel , r and omized , double-blind , sham-controlled trial was conducted to examine the efficacy of tDCS on the modulation of inhibitory control in adults with ADHD . Thirty patients were r and omly allocated to each group and performed a go/no-go task before and after a single session of either anodal stimulation ( 1 mA ) over the left dorsolateral prefrontal cortex or sham stimulation . Results A nonparametric two- sample Wilcoxon rank-sum ( Mann-Whitney ) test revealed no significant differences between the two groups of individuals with ADHD ( tDCS vs. sham ) in regard to behavioral performance in the go/no go tasks . Furthermore , the effect sizes of group differences after treatment for the primary outcome measures —correct responses , impulsivity and omission errors — were small . No adverse events result ing from stimulation were reported . Conclusion According to these findings , there is no evidence in support of the use of anodal stimulation over the left dorsolateral prefrontal cortex as an approach for improving inhibitory control in ADHD patients . To the best of our knowledge , this is the first clinical study to assess the cognitive effects of tDCS in individuals with ADHD . Further research is needed to assess the clinical efficacy of tDCS in this population . Trial Registration Clinical Trials.gov Abstract Attention Deficit Hyperactivity Disorder ( ADHD ) is associated with poor self‐control , underpinned by inferior fronto‐striatal deficits . Real‐time functional magnetic resonance neurofeedback ( rtfMRI‐NF ) allows participants to gain self‐control over dysregulated brain regions . Despite evidence for beneficial effects of electrophysiological‐NF on ADHD symptoms , no study has applied the spatially superior rtfMRI‐NF neurotherapy to ADHD . A r and omized controlled trial tested the efficacy of rtfMRI‐NF of right inferior prefrontal cortex ( rIFG ) , a key region that is compromised in ADHD and upregulated with psychostimulants , on improvement of ADHD symptoms , cognition , and inhibitory fMRI activation . To control for region‐specificity , an active control group received rtfMRI‐NF of the left parahippocampal gyrus ( lPHG ) . Thirty‐one ADHD boys were r and omly allocated and had to learn to upregulate their target brain region in an average of 11 rtfMRI‐NF runs over 2 weeks . Feedback was provided through a video‐clip of a rocket that had to be moved up into space . A transfer session without feedback tested learning retention as a proximal measure of transfer to everyday life . Both NF groups showed significant linear activation increases with increasing number of runs in their respective target regions and significant reduction in ADHD symptoms after neurotherapy and at 11‐month follow‐up . Only the group targeting rIFG , however , showed a transfer effect , which correlated with ADHD symptom reductions , improved at trend level in sustained attention , and showed increased IFG activation during an inhibitory fMRI task . This proof‐of‐concept study demonstrates for the first time feasibility , safety , and shorter‐ and longer‐term efficacy  of rtfMRI‐NF of rIFG in adolescents with ADHD . Hum Brain Mapp 38:3190–3209 , 2017 . © 2017 The Authors Human Brain Mapping Published by Wiley Periodicals , BACKGROUND For children with attention deficit/hyperactivity disorder ( ADHD ) , a reduction of inattention , impulsivity and hyperactivity by neurofeedback ( NF ) has been reported in several studies . But so far , unspecific training effects have not been adequately controlled for and /or studies do not provide sufficient statistical power . To overcome these method ological shortcomings we evaluated the clinical efficacy of neurofeedback in children with ADHD in a multisite r and omised controlled study using a computerised attention skills training as a control condition . METHODS 102 children with ADHD , aged 8 to 12 years , participated in the study . Children performed either 36 sessions of NF training or a computerised attention skills training within two blocks of about four weeks each ( r and omised group assignment ) . The combined NF treatment consisted of one block of theta/beta training and one block of slow cortical potential ( SCP ) training . Pre-training , intermediate and post-training assessment encompassed several behaviour rating scales ( e.g. , the German ADHD rating scale , FBB-HKS ) completed by parents and teachers . Evaluation ( ' placebo ' ) scales were applied to control for parental expectations and satisfaction with the treatment . RESULTS For parent and teacher ratings , improvements in the NF group were superior to those of the control group . For the parent-rated FBB-HKS total score ( primary outcome measure ) , the effect size was .60 . Comparable effects were obtained for the two NF protocol s ( theta/beta training , SCP training ) . Parental attitude towards the treatment did not differ between NF and control group . CONCLUSIONS Superiority of the combined NF training indicates clinical efficacy of NF in children with ADHD . Future studies should further address the specificity of effects and how to optimise the benefit of NF as treatment module for ADHD Background Omega-3 fatty acids are dietary essentials , and the current low intakes in most modern developed countries are believed to contribute to a wide variety of physical and mental health problems . Evidence from clinical trials indicates that dietary supplementation with long-chain omega-3 may improve child behavior and learning , although most previous trials have involved children with neurodevelopmental disorders such as attention-deficit/hyperactivity disorder ( ADHD ) or developmental coordination disorder ( DCD ) . Here we investigated whether such benefits might extend to the general child population . Objectives To determine the effects of dietary supplementation with the long-chain omega-3 docosahexaenoic acid ( DHA ) on the reading , working memory , and behavior of healthy schoolchildren . Design Parallel group , fixed-dose , r and omized , double-blind , placebo-controlled trial ( RCT ) . Setting Mainstream primary schools in Oxfordshire , UK ( n = 74 ) . Participants Healthy children aged 7–9 years initially underperforming in reading ( ≤33rd centile ) . 1376 invited , 362 met study criteria .  Intervention 600 mg/day DHA ( from algal oil ) , or taste/color matched corn/soybean oil placebo . Main Outcome Measures Age-st and ardized measures of reading , working memory , and parent- and teacher-rated behavior . Results ITT analyses showed no effect of DHA on reading in the full sample , but significant effects in the pre-planned subgroup of 224 children whose initial reading performance was ≤20th centile ( the target population in our original study design ) . Parent-rated behavior problems ( ADHD-type symptoms ) were significantly reduced by active treatment , but little or no effects were seen for either teacher-rated behaviour or working memory . Conclusions DHA supplementation appears to offer a safe and effective way to improve reading and behavior in healthy but underperforming children from mainstream schools . Replication studies are clearly warranted , as such children are known to be at risk of low educational and occupational outcomes in later life . Trial Registration Clinical Trials.gov NCT01066182 and Controlled-Trials.com IS RCT 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 Essential fatty acids ( EFA ) are needed for normal sensory , cognitive , and motor function . The EFA blood profile seems to be different in children with attention-deficit/hyperactivity disorder ( ADHD ) as compared to matched controls . Previous open EFA supplementation trials were successful in demonstrating significant therapeutic effects in this population , whereas most of the r and omized controlled trials failed to show any benefit over placebo . The current r and omized , double-blind , placebo-controlled trial tested the influence of short-chain EFA supplementation on ADHD children , using parent and teacher question naires and a computerized continuous performance test . A total of 73 unmedicated children aged 7 - 13 years with a diagnosis of ADHD participated in the study ; 63 children completed the study . The EFA supplement contained 480 mg of linoleic acid and 120 mg of alpha-linolenic acid , and the placebo contained 1000 mg of vitamin C ( daily amounts ) ; both were given for a 7-week supplementation period . Analysis of variance for repeated measures revealed that both treatments ameliorated some of the symptoms , but no significant differences were found between the groups in any of the treatment effects BACKGROUND Although several clinical trials have evaluated the impact of n-3 polyunsaturated fatty acid ( PUFA ) on patients with attention-deficit hyperactivity disorder ( ADHD ) , changes in plasma PUFA composition were not always assessed following n-3 supplementation . Furthermore , no reports are available on the efficacy of n-3 PUFA in Canadian youth with ADHD . OBJECTIVES To determine fatty acid ( FA ) composition , and the efficacy and safety of n-3 PUFA supplementation on ADHD clinical symptoms in French Canadian primary school children . PATIENTS AND METHODS The Strengths and Weaknesses in ADHD and Normal Behaviors ( SWAN ) and Conners ' question naires were used to assess changes in ADHD symptoms in 37 children ( only 26 children completed the study from zero to 16 weeks ) . They were divided into two groups ( A and B ) , and participated in a 16-week , double-blind , one-way , crossover r and omized study . In the first phase , group A received the n-3 PUFA supplement and group B received n-6 PUFA ( sunflower oil ) as a placebo . During the second phase , group B received the active n-3 PUFA supplement that was continued in group A. FA composition and lipid profile were assessed during the phases of the study . RESULTS FA differences between groups were observed in the 26 patients . Supplementation with n-3 PUFA result ed in significant increases in eicosapentaenoic and docosahexaenoic acids in group A , while group B was enriched with alpha-linolenic , gamma-linolenic and homo-gamma-linolenic acids . The n-3 PUFA supplement was tolerated without any adverse effects . A statistically significant improvement in symptoms was noted based on the parent version of the Conners ' question naire from baseline to the end of phase 1 , and this amelioration continued from phases 1 to 2 , although the latter changes from phases 1 and 2 were not statistically significant in any of the subscales except for the subscale measuring inattention in group B. The improvement was greater in patients from group A in phase 1 and in patients from group B in phase 2 . A subgroup of eight patients ( four in each group ) displayed a statistically significant clinical improvement following the administration of the n-3 PUFA supplement , particularly for the inattention and global Diagnostic and Statistical Manual of Mental Disorders , Fourth edition , total Conners ' subscales . CONCLUSIONS A subgroup of children with ADHD who used n-3 PUFA supplements achieved and maintained symptom control . The data of the present study also supported n-3 PUFA  safety and tolerability , but limited changes were noted in the FA profile in French Canadians with 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 Electroencephalography (EEG)-neurofeedback has been shown to offer therapeutic benefits to patients with attention-deficit/hyperactivity disorder ( ADHD ) in several , mostly uncontrolled studies . This pilot study is design ed to test the feasibility and safety of using a double-blind placebo feedback-controlled design and to explore the initial efficacy of individualized EEG-neurofeedback training in children with ADHD . Fourteen children ( 8–15 years ) with ADHD defined according to the DSM-IV-TR criteria were r and omly allocated to 30 sessions of EEG-neurofeedback ( n = 8) or placebo feedback ( n = 6 ) . Safety measures ( adverse events and sleep problems ) , ADHD symptoms and global improvement were monitored . With respect to feasibility , all children completed the study and attended all study visits and training sessions . No significant adverse effects or sleep problems were reported . Regarding the expectancy , 75 % of children and their parent(s ) in the active neurofeedback group and 50 % of children and their parent(s ) in the placebo feedback group thought they received placebo feedback training . Analyses revealed significant improvements of ADHD symptoms over time , but changes were similar for both groups . This pilot study shows that it is feasible to conduct a rigorous placebo-controlled trial to investigate the efficacy of neurofeedback training  in children with ADHD . However , a double-blind design may not be feasible since using automatic adjusted reward thresholds may not work as effective as manually adjusted reward thresholds . Additionally , implementation of active learning strategies may be an important factor for the efficacy of EEG-neurofeedback training . Based on the results of this pilot study , changes are made in the design of the ongoing study Neurofeedback treatment has been demonstrated to reduce inattention , impulsivity and hyperactivity in children with attention deficit/hyperactivity disorder ( ADHD ) . However , previous studies did not adequately control confounding variables or did not employ a r and omized reinforcer-controlled design . This study addresses those method ological shortcomings by comparing the effects of the following two matched biofeedback training variants on the primary symptoms of ADHD : EEG neurofeedback ( NF ) aim ing at theta/beta ratio reduction and EMG biofeedback ( BF ) aim ing at forehead muscle relaxation . Thirty-five children with ADHD ( 26 boys , 9 girls ; 6–14 years old ) were r and omly assigned to either the therapy group ( NF ; n = 18 ) or the control group ( BF ; n = 17 ) . Treatment for both groups consisted of 30 sessions . Pre- and post-treatment assessment consisted of psychophysiological measures , behavioural rating scales completed by parents and teachers , as well as psychometric measures . Training effectively reduced theta/beta ratios and EMG levels in the NF and BF groups , respectively . Parents reported significant reductions in primary ADHD symptoms , and inattention improvements in the NF group were higher compared to the control intervention ( BF , dcorr = −.94 ) . NF training also improved attention and reaction times on the psychometric measures . The results indicate that NF effectively reduced inattention symptoms on parent rating scales and reaction time in neuropsychological tests . However , regarding hyperactivity and impulsivity symptoms , the results imply that non-specific factors , such as behavioural contingencies , self-efficacy , structured learning environment and feed-forward processes , may also contribute to the positive behavioural effects induced by neurofeedback training This study investigated effects of PUFA and micronutrient supplementation on cognition in children with ADHD symptoms . In a r and omised controlled trial , 7 - 12-year-old children with symptoms 2 S.D. on Conners ' ADHD Index were given PUFA , PUFA+multivitamins/minerals ( MVM ) , or placebo for 15 weeks , and then all children were given PUFA+MVM for an additional 15 weeks . After 15 weeks there were improvements in a test of the ability to switch and control attention ( Creature Counting ) in the PUFA groups compared to placebo ( N=129 , p=0.002 ) . This improvement was also observed in the placebo group after taking PUFA from weeks 16 to 30 ( N=104 ) . There were no significant improvements in other cognitive measures , or with additional micronutrient supplementation . However , improvements in cognitive performance mediated previous parent-reported improvements in inattention , hyperactivity and impulsivity [ N. Sinn , J. Bryan , Effect of supplementation with polyunsaturated fatty acids and micronutrients on ADHD-related problems with attention and behaviour , J. Dev . Behav . Pediatr . 28 ( 2 ) ( 2007 ) 82 - 91 ] , suggestive of a common neurological mechanism for these symptoms OBJECTIVE To study the efficacy and safety of phosphatidylserine ( PS ) containing Omega3 long-chain polyunsaturated fatty acids attached to its backbone ( PS-Omega3 ) in reducing attention-deficit/ hyperactivity disorder ( ADHD ) symptoms in children . METHOD A 15-week , double-blind , placebo-controlled phase followed by an open-label extension of additional 15 weeks . Two hundred ADHD children were r and omized to receive either PS-Omega3 or placebo , out of them , 150 children continued into the extension .  Efficacy was assessed using Conners ' parent and teacher rating scales ( CRS-P , T ) , Strengths and Difficulties Question naire ( SDQ ) , and Child Health Question naire ( CHQ ) . Safety evaluation included adverse events monitoring . RESULTS The key finding of the double-blind phase was the significant reduction in the Global : Restless/impulsive subscale of CRS-P and the significant improvement in Parent impact-emotional ( PE ) subscale of the CHQ , both in the PS-Omega3 group . Exploratory subgroup analysis of children with a more pronounced hyperactive/impulsive behavior , as well as mood and behavior-dysregulation , revealed a significant reduction in the ADHD-Index and hyperactive components . Data from the open-label extension indicated sustained efficacy for children who continued to receive PS-Omega3 . Children that switched to PS-Omega3 treatment from placebo showed a significant reduction in subscales scores of both CRS-P and the CRS-T , as compare to baseline scores . The treatment was well tolerated . CONCLUSIONS The results of this 30-week study suggest that PS-Omega3 may reduce ADHD symptoms in children . Preliminary analysis suggests that this treatment may be especially effective in a subgroup of hyperactive-impulsive , emotionally and behaviorally-dysregulated ADHD children OBJECTIVE A double-blind , r and omized , placebo-controlled study was design ed to assess the efficacy and safety of electroencephalographic ( EEG ) neurofeedback in children with attention-deficit/hyperactivity disorder ( ADHD ) . The study started in August 2008 and ended in July 2012 and was conducted at Karakter Child and Adolescent Psychiatry University Centre in Nijmegen , The Netherl and s. METHOD Forty-one children ( aged 8 - 15 years ) with a DSM-IV-TR diagnosis of ADHD were r and omly assigned to treatment with either EEG neurofeedback ( n = 22 ) or placebo neurofeedback ( n = 19 ) for 30 sessions , given as 2 sessions per week . The children were stratified by age , electrophysiologic state of arousal , and medication use . Everyone involved in the study , except the neurofeedback therapist and the principal investigator , was blinded to treatment assignment . The primary outcome was severity of ADHD symptoms on the ADHD Rating Scale IV , scored at baseline , during treatment , and at study end . Clinical improvement as measured by the Clinical Global Impressions-Improvement scale ( CGI-I ) was a secondary outcome . RESULTS While total ADHD symptoms improved over time in both groups ( F1,39 = 26.56 , P < .001 ) , there was no significant treatment effect , ie , group × time interaction ( F1,39 = 0.36 , P = .554 ) ; the same was true for clinical improvement as measured by the CGI-I ( P = .092 ) . No clinical ly relevant side effects were observed . Among the children and their parents , guessing treatment assignment was not better than chance level ( P = .224 for children , P = .643 for parents ) . CONCLUSION EEG neurofeedback was not superior to placebo neurofeedback in improving ADHD symptoms in children with ADHD . TRIAL REGISTRATION Clinical Trials.gov identifier : NCT00723684 Background Estimates of the effectiveness of neurofeedback as a treatment for attention-deficit hyperactivity disorder ( ADHD ) are mixed . Aims To investigate the long-term additional effects of neurofeedback ( NFB ) compared with treatment as usual ( TAU ) for adolescents with ADHD . Method Using a multicentre parallel-r and omised controlled trial design , 60 adolescents with a DSM-IV-TR diagnosis of ADHD receiving NFB+TAU ( n=41 ) or TAU ( n=19 ) were followed up .  Neurofeedback treatment consisted of approximately 37 sessions of theta/sensorimotor rhythm (SMR)-training on the vertex ( Cz ) . Outcome measures included behavioural self-reports and neurocognitive measures . Allocation to the conditions was unmasked . Results At 1-year follow-up , inattention as reported by adolescents was decreased ( range ηp2=0.23–0.36 , P<0.01 ) and performance on neurocognitive tasks was faster ( range ηp2=0.20–0.67 , P<0.005 ) irrespective of treatment group . Conclusions Overall , NFB+TAU was as effective as TAU . Given the absence of robust additional effects of neurofeedback in the current study , results do not support the use of theta/SMR neurofeedback as a treatment for adolescents with ADHD and comorbid disorders in clinical practice . Declaration of interest None . Copyright and usage © The Royal College of Psychiatrists 2016 . This is an open access article distributed under the terms of the Creative Commons Non-Commercial , No Derivatives ( CC BY-NC-ND ) licence OBJECTIVE Little attention has been paid to the possible protective role of ω-3 polyunsaturated fatty acids ( PUFAs ) on the visual acuity of school-age children with lower IQs or attention-deficit hyperactivity disorder ( ADHD ) . The aim of this study was to evaluate the effect of dietary ω-3 PUFAs on the visual acuity and red blood cell ( RBC ) fatty acid compositions of these children . METHODS We r and omly assigned 179 children with lower IQs or ADHD to receive ordinary eggs ( control group , n = 90 ) or eggs rich in C18:3 ω-3 , eicosapentaenoic acid ( EPA , 20:5 ω-3 ) and docosahexaenoic acid ( DHA , 22:6 ω-3 ) for 3 mo ( study group , n = 89 ) . Before and after the intervention , distance visual acuity was tested using an E chart and the RBC fatty acid composition was determined using capillary gas chromatography . RESULTS Three months later , 171 children completed the follow-up with the exception of 8 children who were unavailable during follow-up . Both groups of children showed a significant improvement in visual acuity ( P < 0.05 ) , however , visual acuity in the study group was significantly better than that of the control group ( P = 0.013 ) . The C18:3 ω-3 ( P = 0.009 ) , DHA ( P = 0.009 ) and ∑ω-3 ( P = 0.022 ) levels of the intervention group were significantly higher than those of the control group , while the C20:4 ω-6 ( P = 0.003 ) , C22:4 ω-6 ( P = 0.000 ) , ∑ω-6 ( P = 0.001 ) , ∑ω-6/∑ω-3 ( P = 0.000 ) and arachidonic acid/DHA ( P = 0.000 ) of the study group were significantly lower than those of the control group . No significant differences in the levels of C18:2 ω-6 ( P = 0.723 ) , C20:2 ω-6 ( P = 0.249 ) , C20:3 ω-6 ( P = 0.258 ) , C20:5 ω-3 ( P = 0.051 ) , or C22:5 ( P = 0.200 ) were found between the two groups . CONCLUSIONS Dietary supplementation with ω-3 PUFAs improves both visual acuity and  the  RBC fatty acid profile in school-age children with lower IQs or ADHD Neurofeedback ( NF ) could help to improve attentional and self-management capabilities in children with attention-deficit/hyperactivity disorder ( ADHD ) . In a r and omised controlled trial , NF training was found to be superior to a computerised attention skills training ( AST ) ( Gevensleben et al. in J Child Psychol Psychiatry 50(7):780–789 , 2009 ) . In the present paper , treatment effects at 6-month follow-up were studied . 94 children with ADHD , aged 8–12 years , completed either 36 sessions of NF training ( n = 59 ) or a computerised AST ( n = 35 ) . Pre-training , post-training and follow-up assessment encompassed several behaviour rating scales ( e.g. , the German ADHD rating scale , FBB-HKS ) completed by parents . Follow-up information was analysed in 61 children ( ca . 65 % ) on a per- protocol basis . 17 children ( of 33 dropouts ) had started a medication after the end of the training or early in the follow-up period . Improvements in the NF group ( n = 38 ) at follow-up were superior to those of the control group ( n = 23 ) and comparable to the effects at the end of the training . For the FBB-HKS total score ( primary outcome measure ) , a medium effect size of 0.71 was obtained at follow-up . A reduction of at least 25 % in the primary outcome measure ( responder criterion ) was observed in 50 % of the children in the NF group . In conclusion , behavioural improvements induced by NF training in children with ADHD were maintained at a 6-month follow-up . Though treatment effects appear to be limited , the results confirm the notion that NF is a clinical ly efficacious module in the treatment of children with ADHD
Free fatty acid supplementation produced small but significant reductions in ADHD symptoms even with probably blinded assessment s , although the clinical significance of these effects remains to be determined .
Artificial food color exclusion produced larger effects but often in individuals selected for food sensitivities .
OBJECTIVE Nonpharmacological treatments are available for attention deficit hyperactivity disorder ( ADHD ) , although their efficacy remains uncertain .
The authors undertook meta-analyses of the efficacy of dietary ( restricted elimination diets , artificial food color exclusions , and free fatty acid supplementation ) and psychological ( cognitive training , neurofeedback , and behavioral interventions ) ADHD treatments .