Mediators of Methylphenidate Effects on Math Performance in Children with Attention-Deficit Hyperactivity Disorder Effects of OROS Methylphenidate on Academic, Behavioral, and Cognitive Tasks in Children 9 to 12 Years of Age With Attention-Deficit/Hyperactivity Disorder Methylphenidate in Children With ADHD With or Without Learning Disability Classroom academic performance: improvement with both methylphenidate and dextroamphetamine in ADHD boys. Methylphenidate and children with attention deficit disorder. Dose effects on classroom academic and social behavior. Short term effects of methylphenidate on the cognitive, learning and academic performance of children with attention deficit disorder in the laboratory and the classroom. Once-a-day Concerta methylphenidate versus three-times-daily methylphenidate in laboratory and natural settings. Stimulant medication effects in a summer treatment program among young children with attention-deficit/hyperactivity disorder. The specificity of the effects of stimulant medication on classroom learning-related measures of cognitive processing for Attention Deficit Disorder children Academic achievement and emotional status of children with ADHD treated with long-term methylphenidate and multimodal psychosocial treatment. Symptomatic improvement in children with ADHD treated with long-term methylphenidate and multimodal psychosocial treatment. Neurofeedback Treatment for Attention-Deficit/Hyperactivity Disorder in Children: A Comparison with Methylphenidate Effects of Stimulant Medication, Incentives, and Event Rate on Reaction Time Variability in Children With ADHD Childhood hyperactivity and psychostimulants: a review of extended treatment studies. Physical activity and academic achievement across the curriculum: Results from a 3-year cluster-randomized trial. Multimodal treatment in children and adolescents with attention-deficit/hyperactivity disorder: a 6-month follow-up Stimulant treatment in children with attention-deficit/hyperactivity disorder moderates adolescent academic outcome. Children with ADHD treated with long-term methylphenidate and multimodal psychosocial treatment: impact on parental practices. Common and unique therapeutic mechanisms of stimulant and nonstimulant treatments for attention-deficit/hyperactivity disorder. Impact of comorbid autism spectrum disorders on stimulant response in children with attention deficit hyperactivity disorder: a retrospective and prospective effectiveness study. Physically Active Math and Language Lessons Improve Academic Achievement: A Cluster Randomized Controlled Trial
Objective : Stimulant medications , such as methylpheni date ( MPH ) , improve the academic performance of children with attention-deficit hyperactivity disorder ( ADHD ) . However , the mechanism by which MPH exerts an effect on academic performance is unclear . We examined MPH effects on math performance and investigated possible mediation of MPH effects by changes in time on-task , inhibitory control , selective attention , and reaction time variability . Methods : Children with ADHD aged 7 to 11 years ( N = 93 ) completed a timed math worksheet ( with problems tailored to each individual 's level of proficiency ) and 2 neuropsychological tasks ( Go/No-Go and Child Attention Network Test ) at baseline , then participated in a 4-week , r and omized , controlled , titration trial of MPH . Children were then r and omly assigned to their optimal MPH dose or placebo for 1 week ( administered double-blind ) and repeated the math and neuropsychological tasks ( posttest ) . Baseline and posttest videorecordings of children performing the math task were coded to assess time on-task . Results : Children taking MPH completed 23 more math problems at posttest compared to baseline , whereas the placebo group completed 24 fewer problems on posttest versus baseline , but the effects on math accuracy ( percent correct ) did not differ . Path analyses revealed that only change in time on-task was a significant mediator of MPH 's improvements in math productivity . Conclusions : MPH-derived  math productivity improvements may be explained in part by increased time spent on-task , rather than improvements in neurocognitive parameters , such as inhibitory control , selective attention , or reaction time variability Objective . To assess effects of OROS methylpheni date on cognitive and academic tasks in 9 to 12 year olds with attention-deficit/hyperactivity disorder ( ADHD ) . Methods . A double-blind , within-subject , crossover design was used to compare OROS methylpheni date with placebo in a laboratory classroom setting on several cognitive and academic tasks for 68 children who met r and omization criteria . Results . Performance on the following measures was significantly better when children received individually optimized OROS methylpheni date than placebo :  math fluency and accuracy measured by the Permanent Product Math Test , ADHD symptoms observed in the laboratory setting , computerized indices of attention and impulsivity as measured by the Test of Variables of Attention ( TOVA ) , and visual — spatial working memory ( Finger Windows Backwards ) . Study medication was well tolerated ; adverse events were generally consistent with previous reports . Conclusions . OROS methylpheni date improves performance on measures of attention and vigilance , behavior , and working memory in a laboratory school setting in 9 to 12 year olds with ADHD Objective : To explore treatment response to Osmotic Release Oral System ® ( OROS ) methylpheni date in children with ADHD with and without comorbid learning disability ( LD ) . Method : Data were analyzed from two 6-week , double-blind , r and omized , placebo-controlled , crossover studies evaluating individually determined doses of OROS methylpheni date versus placebo in 135 children ( ages 9 to 12 years ) with ADHD with or without an LD in reading , math , or both . The sample was demographically diverse , with 31 % females and more than 40 % minority , predominantly African American and Hispanic . On two laboratory school days , participants received either OROS methylpheni date or placebo and were given a battery of cognitive and behavioral tests . Results : Treatment with OROS methylpheni date led to improvement in ADHD Rating Scale scores for participants with or without comorbid LD . Both groups performed better during treatment with OROS methylpheni date than placebo on measures of cognitive skills ( i.e. , Test of Variables of Attention , Finger Windows Backwards ) , academically related tasks ( i.e. , Dynamic Indicators of Basic Early Literacy Skills , Test of H and writing Skills – Revised , Permanent Product Math Test ) , and observed classroom behavior ( i.e. , Swanson , Kotkin , Alger , M-Flynn , and Pelham Scale ) . Conclusion : In children with ADHD with or without comorbid LD  , behavior and performance improved during treatment with OROS methylpheni date Daily academic classroom performance was recorded in a day hospital school using a commonly employed reading and math series as part of an 11-week double-blind , placebo controlled , crossover comparison of dextroamphetamine ( d-AMPH ) and methylpheni date ( MPH ) in 33 hyperactive boys . Students attempted more math and reading tasks while on either active drug . The percent correct and the number of attempted problems of the reading series improved with both drugs while the percent correct for the math series occurred with d-AMPH only . No dose-response relationship was found for either stimulant . Moderate , transient adverse effects were common for both drugs The short-term , dose-response effects of methylpheni date hydrochloride were evaluated on academic and social classroom measures in 29 children with attention deficit disorder . In a double-blind , cross-over design with order r and omized , children received a placebo for two weeks and three doses of methylpheni date hydrochloride ( 0.15 mg/kg , 0.3 mg/kg , and 0.6 mg/kg ) for one week each . Dependent measures included the output and accuracy of performance in grade -appropriate reading comprehension workbooks and arithmetic problems , spelling word acquisition , and observations of disruptive and on-task behavior . Beneficial drug effects and linear dose-response curves on all dependent measures were found . The results suggest that beneficial methylpheni date effects on classroom behavior may be accompanied by enhanced academic achievement in some hyperactive children Sixteen children meeting diagnostic criteria for Attention Deficit Disorder with Hyperactivity ( ADD-H ) were tested on methylpheni date ( 0.3 mg/kg ) and placebo on cognitive , learning , academic and behavioral measures in a double-blind study . Assessment s were carried out in the laboratory and in the children 's regular classrooms . Results indicate methylpheni date -induced improvements on a majority of the measures . Drug-induced changes reflected increased output , accuracy and efficiency and improved learning acquisition . There was also evidence of increased effort and self-correcting behaviours . It is argued that review ers have underestimated the potential of stimulants to improve the performance of ADD-H children on academic , learning and cognitive tasks OBJECTIVE Methylpheni date ( MPH ) , the most commonly prescribed drug for attention-deficit/hyperactivity disorder ( ADHD ) , has a short half-life , which necessitates multiple daily doses . The need for multiple doses produces problems with medication administration during school and after-school hours , and therefore with compliance . Previous long-acting stimulants and preparations have shown effects equivalent to twice-daily dosing of MPH . This study tests the efficacy and duration of action , in natural and laboratory setting s , of an extended-release MPH preparation design ed to last 12 hours and therefore be equivalent to 3-times-daily dosing . METHODS Sixty-eight children with ADHD , 6 to 12 years old , participated in a within-subject , double-blind comparison of placebo , immediate-release ( IR ) MPH 3 times a day ( tid ) , and Concerta , a once-daily MPH formulation . Three dosing levels of medication were used : 5 mg IR MPH tid/18 mg Concerta once a day ( qd ) ; 10 mg IR MPH tid/36 mg Concerta qd ; and 15 mg IR MPH tid/54 mg Concerta qd . All children were currently medicated with MPH at enrollment , and each child 's dose level was based on that child 's  MPH dosing before the study . The doses of Concerta were selected to be comparable to the daily doses of MPH that each child received . To achieve the ascending rate of  MPH delivery determined by initial investigations to provide the necessary continuous coverage , Concerta doses were 20 % higher on a daily basis than a comparable tid regimen of IR MPH . Children received each medication condition for 7 days . The investigation was conducted in the context of a background clinical behavioral intervention in both the natural environment and the laboratory setting . Parents received behavioral parent training and teachers were taught to establish a school-home daily report card ( DRC ) . A DRC is a list of individual target behaviors that represent a child 's most salient areas of impairment . Teachers set daily goals for each child 's impairment targets , and parents provided rewards at home for goal attainment . Each weekday , teachers completed the DRC , and it was used as a dependent measure of individualized medication response . Teachers and parents also completed weekly st and ardized ratings of behavior and treatment effectiveness . To evaluate the time course of medication effects , children spent 12 hours in a laboratory setting on Saturdays and medication effects were measured using procedures and methods adapted from our summer treatment program . Measures of classroom behavior and academic productivity/accuracy were taken in a laboratory classroom setting during which children completed independent math and reading worksheets . Measures of social behavior were taken in structured , small-group board game setting s and unstructured recess setting s. Measures included behavior frequency counts , academic problems completed and accuracy , independent observations , teacher and counselor ratings , and individualized behavioral target goals . Reports of adverse events , sleep quality , and appetite were collected . RESULTS On virtually all measures in all setting s , both drug conditions were significantly different from placebo , and the 2 drugs were not different from each other . In children 's regular school setting s , both medications improved behavior as measured by teacher ratings and individualized target behaviors ( the DRC ) ; these effects were seen into the evening as measured by parent ratings . In the laboratory setting , effects of Concerta were equivalent to tid MPH and lasted at least through 12 hours after dosing . Concerta was significantly superior to tid MPH on 2 parent rating scores , and when asked , more parents preferred Concerta than preferred tid IR MPH or placebo . Side effects on children 's sleep and appetite were similar for the 2 preparations . In the lab setting , both medications improved productivity and accuracy on arithmetic seatwork assignments , disruptive and on-task behavior , and classroom rule following . Both medications improved children 's rule following and negative behavior in small group board games , as well as in unstructured recess setting s. Individual target behaviors also showed significant improvement with medication across domains in the laboratory setting . Children 's behavior across setting s deteriorated across the laboratory day , and the primary effect of medication was to prevent this deterioration as the day wore on . Results support the use of background behavioral treatment in clinical trials of stimulant medication , and illustrate the utility of a measure of individualized daily target goals ( ie , the DRC ) as an objective measure of medication response in both the laboratory and natural school setting s. CONCLUSION This investigation clearly supports the efficacy of the Concerta long-acting formulation of MPH for parents who desire to have medication benefits for their child throughout the day and early evening . ( ABSTRACT TRUNCATED OBJECTIVE This study examined the effectiveness of stimulant medication on multiple domains of functioning in 36 young ( 5 to 6 years old ) children diagnosed with attention-deficit/hyperactivity disorder ( ADHD ) . METHOD Five- and 6-year-old children attending a summer treatment program between 1987 and 1997 underwent a r and omized clinical assessment of the effect of two doses of methylpheni date ( 0.3 mg/kg versus 0.6 mg/kg ) and placebo on social behavior and academic performance . RESULTS Methylpheni date had an effect on all four social behaviors and improved two of the three areas of academic functioning . Dose effects were present for three of the seven dependent measures . Individual analyses indicated a therapeutic response rate between 39 % and 100 % across dependent measures . Furthermore , individual analyses of response indicated that across several important dependent measures , 39 % to 98 % of children showed little incremental improvement with the higher dose compared with the lower dose of stimulant medication . CONCLUSIONS Stimulant medication is an effective treatment for young children diagnosed with ADHD ; however , multiple domains of functioning must be assessed to determine the most effective dose for young children with ADHD There appear to be beneficial effects of stimulant medication on daily classroom measures of cognitive functioning for Attention Deficit Disorder ( ADD ) children , but the specificity and origin of such effects is unclear . Consistent with previous results , 0.3 mg/kg methylpheni date improved ADD children 's  performance on a classroom reading comprehension measure . Using the Posner letting-matching task and four additional measures of phonological processing , we attempted to isolate the effects of methylpheni date to parameter estimates of ( a ) selective attention , ( b ) the basic cognitive process of retrieving name codes from permanent memory , and ( c ) a constant term that represented nonspecific aspects of information processing . Responses to the letter-matching stimuli were faster and more accurate with medication compared to placebo . The improvement in performance was isolated to the parameter estimate that reflected nonspecific aspects of information processing . A lack of medication effect on the other measures of phonological processing supported the Posner task findings in indicating that methylpheni date appears to exert beneficial effects on academic processing through general rather than specific aspects of information processing OBJECTIVE To test the hypothesis that intensive multimodal psychosocial intervention ( that includes academic assistance and psychotherapy ) combined with methylpheni date significantly enhances the academic performance and emotional status of children with attention-deficit/hyperactivity disorder ( ADHD ) compared with methylpheni date alone and with methylpheni date combined with nonspecific psychosocial treatment ( attention control ) . METHOD One hundred three children with ADHD ( ages 7 - 9 ) , free of conduct and learning disorders , who responded to short-term methylpheni date were r and omized for 2 years to receive one of three treatments : ( 1 ) methylpheni date alone , ( 2 ) methylpheni date plus psychosocial treatment that included academic remediation , organizational skills training , and psychotherapy as well as parent training and counseling and social skills training , or ( 3 ) methylpheni date plus attention control treatment . Children 's function was assessed through academic testing , parent ratings of homework problems , and self-ratings of depression and self-esteem . RESULTS No advantage was found on any measure of academic performance or emotional status for the combination treatment over methylpheni date alone and over methylpheni date plus attention control . Significant improvement occurred across all treatments and was maintained over 2 years . CONCLUSIONS In stimulant-responsive young children with ADHD without learning and conduct disorders , there is no support for academic assistance and psychotherapy to enhance academic achievement or emotional adjustment . Significant short-term improvements were maintained over 2 years OBJECTIVE To test the hypotheses that in children with attention-deficit/hyperactivity disorder ( ADHD ) ( 1 ) symptoms of ADHD , oppositional defiant disorder , and overall functioning are significantly improved by methylpheni date combined with intensive multimodal psychosocial treatment compared with methylpheni date alone and with methylpheni date plus attention control and ( 2 ) more children receiving combined treatment can be taken off methylpheni date . METHOD One hundred three children with ADHD ( ages 7 - 9 ) , free of conduct and learning disorders , who responded to short-term methylpheni date were r and omized for 2 years to ( 1 ) methylpheni date alone ; ( 2 ) methylpheni date plus psychosocial treatment that included parent training and counseling , social skills training , psychotherapy , and academic assistance , or ( 3 ) methylpheni date plus attention psychosocial control treatment . Assessment s included parent , teacher , and psychiatrist ratings , and observations in academic and gym classes . RESULTS Combination treatment did not lead to superior functioning and did not facilitate methylpheni date discontinuation . Significant improvement occurred across all treatments and continued over 2 years . CONCLUSIONS In stimulant-responsive children with ADHD , there is no support for adding ambitious long-term psychosocial intervention to improve ADHD and oppositional defiant disorder symptoms . Significant benefits from methylpheni date were stable over 2 years 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 This study examined the effects of methylpheni date ( MPH ) on reaction time ( RT ) variability in children with attention deficit hyperactivity disorder ( ADHD ) . Using a broad battery of computerized tasks , and both conventional and ex-Gaussian indicators of RT variability , in addition to within-task manipulations of incentive and event rate ( ER ) , this study comprehensively examined the breadth , specificity , and possible moderators of effects of MPH on RT variability .  A total of 93 children with ADHD completed a 4-week within-subject , r and omized , double-blind , placebo-controlled crossover trial of MPH to identify an optimal dosage . Children were then r and omly assigned to receive either their optimal MPH dose or placebo after which they completed five neuropsychological tasks , each allowing trial-by-trial assessment of RTs . Stimulant effects on RT variability were observed on both measures of the total RT distribution ( ie , coefficient of variation ) as well as on an ex-Gaussian measure examining the exponential portion of the RT distribution ( ie , τ ) . There was minimal , if any , effect of MPH  on performance accuracy or RT speed . Within-task incentive and ER manipulations did not appreciably affect stimulant effects across the tasks . The pattern of significant and pervasive effects of MPH on RT variability , and few effects of MPH  on accuracy and RT speed suggest that MPH primarily affects RT variability . Given the magnitude and breadth of effects of MPH on RT variability as well as the apparent specificity of these effects of MPH on RT variability indicators , future research should focus on neurophysiological correlates of effects of MPH on RT variability in an effort to better define MPH pharmacodynamics ABSTRACT Clinical trials with a treatment duration of at least 3 months were review ed to determine the effect of psychostimulants on the core symptoms of attention-deficit hyperactivity disorder ( ADHD ) and on its commonly associated features . Eighteen studies were identified : 17 were studies of  methylpheni date  , 1 was a study of dextroamphetamine , and none involved  pemoline  or  slow-release stimulants . Eleven of these studies were r and omized controlled trials , whereas seven employed quasi-experimental design s without r and omization . The results of r and omized controlled trials showed that psychostimulants provided greater benefit than did the nonr and omized trials , suggesting that the efficacy of extended treatment may have been underestimated because more seriously disturbed children were assigned to medication treatment than to control treatments in nonr and omized trials . Evidence from the more definitive r and omized controlled trials indicates that stimulants are more effective in ameliorating the core behavioral symptoms of ADHD ( restlessness , inattentiveness , impulsiveness ) than placebos , nonpharmacological therapies , or no treatment-at least in 3 - 7-month trials . During extended psychostimulant treatment , few children become symptom-free , clinical effects may diminish with time , and improvement dissipates rapidly upon discontinuation of medication . There is minimal evidence that extended stimulant treatment improves cognitive deficits or associated problems such as conduct disturbance , low self-esteem , poor peer relationships , or academic underachievement . The belief that stimulants do not improve the long-term prognosis of  children with ADHD  may be based on weakly design ed studies that focus on associated rather than core symptoms . A failure to assign patients of similar clinical severity to different treatment conditions may also have contributed to obscuring the efficacy of extended psychostimulant treatments We compared changes in academic achievement across 3years between children in elementary schools receiving the Academic Achievement and Physical Activity Across the Curriculum intervention ( A+PAAC )  , in which classroom teachers were trained to deliver academic lessons using moderate-to-vigorous physical activity ( MVPA ) compared to a non-intervention control .  Elementary schools in eastern Kansas ( n=17 ) were cluster r and omized to A+PAAC ( N=9 , target ≥100min/week ) or control ( N=8 ) . Academic achievement ( math , reading , spelling ) was assessed using the Wechsler Individual Achievement Test-Third Edition ( WIAT-III ) in a sample of children ( A+PAAC=316 , Control=268 ) in grade s 2 and 3 at baseline ( Fall 2011 ) and repeated each spring across 3years . On average 55min/week of A+PACC lessons were delivered each week across the intervention . Baseline WIAT-III scores ( math , reading , spelling ) were significantly higher in students in A+PAAC compared with control schools and improved in both groups across 3years . However , linear mixed modeling , accounting for baseline between group differences in WIAT-III scores , ethnicity , family income , and cardiovascular fitness , found no significant impact of A+PAAC on any of the academic achievement outcomes as determined by non-significant group by time interactions . A+PAAC neither diminished or improved academic achievement across 3-years in elementary school children compared with controls . Our target of 100min/week of active lessons was not achieved ; however , students attending A+PAAC schools received an additional 55min/week of MVPA which may be associated with both physical and mental health benefits , without a reduction in time devoted to academic instruction Abstract Background : Different treatment approaches aim ed at reducing attention-deficit/hyperactivity disorder ( ADHD ) core symptoms are available . However , factors such as intolerance , side-effects , lack of efficacy , high new technology costs , and placebo effect have spurred on an increasing interest in alternative or complementary treatment . Aim : The aim of this study is to explore efficacy of multimodal treatment consisting of st and ard stimulant medication ( methylpheni date ) and neurofeedback ( NF ) in combination , and to compare it with the single treatment in 6-month follow-up in ADHD children and adolescents . Methods : This r and omized controlled trial with 6-month follow-up comprised three treatment arms : multimodal treatment ( NF + MED ) , MED alone , and NF alone .  A total of 130 ADHD children/adolescents participated , and 62 % completed the study .  ADHD core symptoms were recorded pre-/post-treatment , using parents ’ and teachers ’ forms taken from Barkley ’s Defiant Children : A Clinician ’s Manual for Assessment and Parent Training , and a self-report question naire . Results : Significant ADHD core symptom improvements were reported 6 months after treatment completion by parents , teachers , and participants in all three groups , with marked improvement in inattention in all groups . However , no significant improvements in hyperactivity or academic performance were reported by teachers or self-reported by children/adolescents , respectively , in the three groups . Changes obtained with multimodal treatment at 6-month follow-up were comparable to those with single medication treatment , as reported by all participants . Conclusions : Multimodal treatment using combined stimulant medication and NF showed 6-month efficacy in ADHD treatment . More research is needed to explore whether multimodal treatment is suitable for ADHD children and adolescents who showed a poor response to single medication treatment , and for those who want to reduce the use of stimulant medication Treatment with psychostimulant medication has been shown to improve scholastic functioning in children with attention-deficit/hyperactivity disorder ( ADHD ) . However , the extent to which long-term academic gains are apparent in those having received such treatment remains elusive . This study examined prospect ively the relationship of childhood stimulant treatment to academic functioning during adolescence . Children ( n = 169 ) were initially recruited and diagnosed with ADHD when they were 7 - 11 years old . A sub sample of those with childhood ADHD ( n = 90 ) was reevaluated on average 9.13 ( SD = 1.5 ) years later . Prob and s who did and did not receive treatment with stimulant medication were compared to each other and to a never-ADHD comparison group ( n = 80 ) on three subtests from the Wechsler Individual Achievement Test-II ( WIAT-II ) , as well as high school grade point average ( GPA ) and number of retentions in school as derived from school records . Analyses of covariance controlling for severity of childhood ADHD symptoms indicated that prob and s treated with psychostimulant medication achieved better academic outcomes , as measured by WIAT-II subtests and high school GPA , than those not treated with psychostimulants ( p < .05 ) . However , treated prob and s did not fare as well as the never-ADHD comparison group . Psychostimulant treatment for children with ADHD may benefit long-term adolescent academic performance , although the extent of improvement is likely to vary as a function of multiple factors OBJECTIVE To test the hypothesis that multimodal psychosocial intervention , which includes parent training , combined with methylpheni date significantly enhances the behavior of parents of children with attention-deficit/hyperactivity disorder ( ADHD ) , compared with methylpheni date alone and compared with methylpheni date and nonspecific psychosocial treatment ( attention control ) . METHOD One hundred three children with ADHD ( ages 7 - 9 ) , free of conduct and learning disorders , who responded to short-term methylpheni date therapy were r and omized for 2 years to receive either ( 1 ) methylpheni date treatment alone ; ( 2 ) methylpheni date plus psychosocial treatment that included parent training and counseling , social skills training , academic assistance , and psychotherapy ; or ( 3 ) methylpheni date plus attention control treatment . Parents rated their knowledge of parenting principles and negative and positive parenting behavior . Children rated their parents ' behavior . RESULTS Psychosocial treatment led to significantly better knowledge of parenting principles but did not enhance parenting practice s , as rated by parents and children . Significant improvement in mothers ' negative parenting occurred across all treatments and was maintained . CONCLUSIONS In nonconduct-disordered , stimulant-treated children with ADHD , parent training does not improve self-rated parental behavior . The benefits of brief stimulant treatment for negative parental behavior are sustained with extended treatment CONTEXT Attention-deficit/hyperactivity disorder ( ADHD ) is a highly prevalent and impairing psychiatric disorder that affects both children and adults . There are Food and Drug Administration-approved stimulant and nonstimulant medications for treating ADHD ; however , little is known about the mechanisms by which these different treatments exert their therapeutic effects . OBJECTIVE To contrast changes in brain activation related to symptomatic improvement with use of the stimulant methylpheni date hydrochloride vs the nonstimulant atomoxetine hydrochloride . DESIGN Functional magnetic resonance imaging before and after 6 to 8 weeks of treatment with methylpheni date ( n = 18 ) or atomoxetine ( n = 18 ) using a parallel-groups design . SETTING Specialized ADHD clinical research program at Mount Sinai School of Medicine , New York , New York . PARTICIPANTS Thirty-six youth with ADHD ( mean [ SD ] age , 11.2 [ 2.7 ] years ; 27 boys ) recruited from r and omized clinical trials . MAIN OUTCOME MEASURES Changes in brain activation during a go/no-go test of response inhibition and investigator-completed ratings on the ADHD Rating Scale-IV-Parent Version . RESULTS Treatment with methylpheni date vs atomoxetine was associated with comparable improvements in both response inhibition on the go/no-go test and mean ( SD ) improvements in ratings of ADHD symptoms ( 55 % [ 30 % ] vs 57 % [ 25 % ] ) . Improvement in ADHD symptoms was associated with common reductions in bilateral motor cortex activation for both treatments . Symptomatic improvement was also differentially related to gains in task-related activation for atomoxetine and reductions in activation for methylpheni date in the right inferior frontal gyrus , left anterior cingulate/supplementary motor area , and bilateral posterior cingulate cortex . These findings were not attributable to baseline differences in activation . CONCLUSIONS Treatment with methylpheni date and atomoxetine produces symptomatic improvement via both common and divergent neurophysiologic actions in frontoparietal regions that have been implicated in the pathophysiology of ADHD . These results represent a first step in delineating the neurobiological basis of differential response to stimulant and nonstimulant medications for ADHD BACKGROUND In the recent past , psychiatrists and paediatricians have avoided prescribing stimulant medication , such as methylpheni date and dexamphetamine to patients with autism spectrum disorders ( ASD ) because of both doubts about efficacy and concern that these medications make stereotypies worse . Recently , a number of small trials have suggested that methypheni date does have a role in the management of hyperactivity in children with autistic spectrum disorders . METHODS Children with ASD and attention deficit hyperactivity disorder ( ADHD ) , and children with ADHD without ASD received st and ard treatment with methypheni date from one specialist centre . A combination of st and ardized and novel outcome tools was used to allow both an exploratory retrospective study of 174 children and then a prospect i ve study of a further 52 children to be carried out . RESULTS After treatment with stimulants , the subjects in both groups showed statistically significant improvements in target symptoms of ' hyperactivity ' , ' impulsivity ' , ' inattention ' , ' oppositionality ' , ' aggression ' and ' intermittent explosive rage ' . The Clinical Global Impression-Improvement and efficacy index measures also improved in each group . In both the retrospective and the prospect i ve studies , there was no statistically significant difference in the degree of improvements between each group . Importantly , neither tics nor repetitive behaviours worsened in either group . Children in the ' ADHD-only ' group who were prescribed stimulants experienced significant ' nausea ' , ' giddiness ' , ' headaches ' and ' sleep difficulties ' , whereas sleep difficulties were the only side effect that emerged in children in the ASD with ADHD group . CONCLUSIONS Both studies presented here support previous findings from smaller studies that show children with autism and ADHD can respond as well to stimulants as children with ADHD alone . Although r and omized controlled trials remain the gold st and ard for efficacy studies , systems like this that allow clinicians to continue rigorous and consistent monitoring for many years have a valuable role to play . Furthermore , such monitoring systems which now exist electronically can easily accumulate large data sets and reveal details about long-term effectiveness and long-term side effects of medication that are unlikely to be discovered in short-term trials OBJECTIVES : Using physical activity in the teaching of academic lessons is a new way of learning . The aim of this study was to investigate the effects of an innovative physically active academic intervention ( “ Fit & Vaardig op School ” [ F&V ] ) on academic achievement of children . METHODS : Using physical activity to teach math and spelling lessons was studied in a cluster-r and omized controlled trial . Participants were 499 children ( mean age 8.1 years ) from second- and third- grade classes of 12 elementary schools . At each school , a second- and third- grade class were r and omly assigned to the intervention or control group . The intervention group participated in F&V lessons for 2 years , 22 weeks per year , 3 times a week . The control group participated in regular classroom lessons .  Children ’s academic achievement was measured before the intervention started and after the first and second intervention years . Academic achievement was measured by 2 mathematics tests ( speed and general math skills ) and 2 language tests ( reading and spelling ) . RESULTS : After 2 years , multilevel analysis showed that children in the intervention group had significantly greater gains in mathematics speed test ( P < .001 ; effect size [ ES ] 0.51 ) , general mathematics ( P < .001 ; ES 0.42 ) , and spelling ( P < .001 ; ES 0.45 ) scores . This equates to 4 months more learning gains in comparison with the control group . No differences were found on the reading test . CONCLUSIONS : Physically active academic lessons significantly improved mathematics and spelling performance of elementary school children and are therefore a promising new way of teaching
None of the mediators or moderators tested affected methylpheni date efficacy .
Academic improvements were small compared to symptom improvements ; qualitative changes limited to math .
Academic improvement is amongst the most common treatment targets when prescribing stimulants to children with ADHD .
Previous review s on stimulant-related academic improvements are inconclusive and focus on task engagement .
Recent literature suggests outcome -domain-specific medication effects that are larger for productivity than for accuracy .
The aims of this study are quantifying methylpheni date effects on academic productivity and accuracy for math , reading , spelling ; exploring the mediating or moderating effects of symptom improvements , demographic- , design - and disorder-related variables .