Reducing Attention-deficit/hyperactivity Disorder Symptoms Research Articles

Chronobiology in Paediatric Neurological and Neuropsychiatric Disorders: Harmonizing Care with Biological Clocks

Background: Chronobiology has gained attention in the context of paediatric neurological and neuropsychiatric disorders, including migraine, epilepsy, autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), and post-traumatic stress disorder (PTSD). Disruptions in circadian rhythms are associated with key symptoms such as sleep disturbances, mood dysregulation, and cognitive impairments, suggesting a potential for chronobiology-based therapeutic approaches. Methods: This narrative review employs a systematic approach to identify relevant studies through searches of three major scientific databases, NCBI/PubMed, ScienceDirect, and Scopus, up to July 2024. We used a combination of broad and condition-specific keywords, such as “chronobiology”, “biorhythm”, “pediatric”, “epilepsy”, “ADHD”, and “ASD”, among others. Articles in English that focused on clinical features, treatments, or outcomes related to circadian rhythms in paediatric populations were included, while non-peer-reviewed articles and studies lacking original data were excluded. Rayyan software was used for article screening, removing duplicates, and facilitating consensus among independent reviewers. Results: A total of 87 studies were included in the analysis. Findings reveal a consistent pattern of circadian rhythm disruptions across the disorders examined. Specifically, dysregulation of melatonin and cortisol secretion is observed in children with ASD, ADHD, and PTSD, with altered circadian timing contributing to sleep disturbances and mood swings. Alterations in core clock genes (CLOCK, BMAL1, PER, and CRY) were also noted in children with epilepsy, which was linked to seizure frequency and timing. Chronotherapy approaches showed promise in managing these disruptions: melatonin supplementation improved sleep quality and reduced ADHD symptoms in some children, while light therapy proved effective in stabilizing sleep–wake cycles in ASD and ADHD patients. Additionally, behaviour-based interventions, such as the Early Start Denver Model, showed success in improving circadian alignment in children with ASD. Conclusions: This review highlights the significant role of circadian rhythm disruptions in paediatric neurological and neuropsychiatric disorders, with direct implications for treatment. Chronobiology-based interventions, such as melatonin therapy, light exposure, and individualized behavioural therapies, offer potential for improving symptomatology and overall functioning. The integration of chronotherapy into clinical practice could provide a paradigm shift from symptom management to more targeted, rhythm-based treatments. Future research should focus on understanding the molecular mechanisms behind circadian disruptions in these disorders and exploring personalized chronotherapeutic approaches tailored to individual circadian patterns.

Use of Bupropion for Attention-Deficit/Hyperactivity Disorder and Depression in Children and Adolescents

Introduction: Attention-deficit/hyperactivity disorder (ADHD) is one of the most common childhood disorders and frequently continues through adolescence and adulthood. Medication is the single most effective treatment for reducing ADHD symptoms and its use is recommended in children with 6 years and older. Nearly two-thirds of children and adolescents with ADHD also have another mental, emotional, or behavioral disorder, including depression disorders. Bupropion is an antidepressant with a mechanism of action potentially relevant to the treatment of ADHD, used in adults for both depression and smoking cessation and eventually as a third line treatment for ADHD. Objective: This review aims to explore the effectiveness, safety and tolerability of bupropion in children and adolescents with ADHD and depression. Method: A scientific review was conducted on a careful analysis of the scientific evidence available on the electronic databases: MEDLINE, Embase and the Cochrane Library. Results: There is little empirical evidence to guide the pharmacological treatment for comorbid ADHD and depression as most treatment studies tend to exclude patients with comorbid disorders. The majority of trials demonstrated bupropion’s efficacy in improving ADHD symptoms in children and adolescents, with effects being superior than placebo and most frequently comparable to methylphenidate. Bupropion also appears to be effective in alleviating depressive symptoms in this population, whether with or without ADHD comorbidity. Side effects did not differ significantly in comparison with stimulants and discontinued medication due to adverse reactions was rare. Conclusions: Current findings have to be interpreted with caution because of the very limited database and frequent use of small sample sizes. Bupropion seems effective and well-tolerated in children and adolescents with ADHD and ADHD-depression comorbidity. It should be considered for treatment of this population, but more randomized controlled trials with larger sample sizes are necessary.

Change in striatal functional connectivity networks across 2 years due to stimulant exposure in childhood ADHD: results from the ABCD sample.

Widely prescribed for Attention-Deficit/Hyperactivity Disorder (ADHD), stimulants (e.g., methylphenidate) have been studied for their chronic effects on the brain in prospective designs controlling dosage and adherence. While controlled approaches are essential, they do not approximate real-world stimulant exposure contexts where medication interruptions, dosage non-compliance, and polypharmacy are common. Brain changes in real-world conditions are largely unexplored. To fill this gap, we capitalized on the observational design of the Adolescent Brain Cognitive Development (ABCD) study to examine effects of stimulants on large-scale bilateral cortical networks' resting-state functional connectivity (rs-FC) with 6 striatal regions (left and right caudate, putamen, and nucleus accumbens) across two years in children with ADHD. Bayesian hierarchical regressions revealed associations between stimulant exposure and change in rs-FC of multiple striatal-cortical networks, affiliated with executive and visuo-motor control, which were not driven by general psychotropic medication. Of these connections, three were selective to stimulants versus stimulant naive: reduced rs-FC between caudate and frontoparietal network, and between putamen and frontoparietal and visual networks. Comparison with typically developing children in the ABCD sample revealed stronger rs-FC reduction in stimulant-exposed children for putamen and frontoparietal and visual networks, suggesting a normalizing effect of stimulants. 14% of stimulant-exposed children demonstrated reliable reduction in ADHD symptoms, and were distinguished by stronger rs-FC reduction between right putamen and visual network. Thus, stimulant exposure for a two-year period under real-world conditions modulated striatal-cortical functional networks broadly, had a normalizing effect on a subset of networks, and was associated with potential therapeutic effects involving visual attentional control.

Attention Deficit Hyperactivity Disorder (ADHD) Student Facts

The study aimed to analyze facts related to ADHD students through international publication trends based on the Scopus database with publishers Springer, Taylor, Elsevier, and Hindawi. This study used a systematic literature review method with a qualitative approach. Studies have shown a gap between knowledge of early warning signs of ADHD and effective preventive interventions. Early interventions, such as behavioral training, are effective in reducing ADHD symptoms and improving some aspects of executive function. In addition, exposure to psychosocial stress, nutritional stress, immunological stress, and organic pollutants during early development may increase the risk of ADHD. Several treatment strategies, including the use of psychostimulants and psychosocial interventions, are effective in reducing ADHD symptoms. Factors such as age, disorder severity, and underlying health conditions should be considered when selecting a treatment, with periodic evaluations to monitor response to treatment and possible side effects.

Feasibility study of a telehealth school-based behavioral parent training group program for attention-deficit/hyperactivity disorder.

To evaluate the feasibility and preliminary efficacy of Telehealth Behavioral Parent Training (T-BPT), a school telehealth group intervention for attention-deficit/hyperactivity disorder (ADHD) with a companion training program for school clinicians. T-BPT was developed in an iterative three-phase design in partnership with community stakeholders during the COVID-19 pandemic. School clinicians (N = 4) delivered T-BPT over 8 weeks to parents (N = 21, groups of 5-6 per school) of children (Grades 2-5) with ADHD while simultaneously receiving training and consultation from PhD-level study trainers. A single-arm open trial was used to assess feasibility, engagement, and preliminary efficacy. Parents and school clinicians endorsed high feasibility, acceptability, and usability of T-BPT. Parent attendance was high (M = 94.6%) and a majority of parents (66.7%) attended all eight sessions. Preliminary outcomes indicate moderate to large reductions in parent-reported ADHD symptoms (ω2 = .36), functional and clinical global impairment (ω2s= .21 and .19, respectively), and distance learning challenges (ω2 = .22). Results were in line with in-person delivery, indicating promising feasibility of school telehealth BPT groups. This study also provided further support for the feasibility of the remote training model for school clinicians. Implications of the commonly endorsed barriers and benefits beyond COVID-19 and relevance to under resourced communities are also discussed.

A Digital Cognitive-Physical Intervention for Attention-Deficit/Hyperactivity Disorder: Randomized Controlled Trial.

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders among children. Pharmacotherapy has been the primary treatment for ADHD, supplemented by behavioral interventions. Digital and exercise interventions are promising nonpharmacologic approaches for enhancing the physical and psychological health of children with ADHD. However, the combined impact of digital and exercise therapies remains unclear. The aim of this study was to determine whether BrainFit, a novel digital intervention combining gamified cognitive and exercise training, is efficacious in reducing ADHD symptoms and executive function (EF) among school-aged children with ADHD. This 4-week prospective randomized controlled trial included 90 children (6-12 years old) who visited the ADHD outpatient clinic and met the diagnostic criteria for ADHD. The participants were randomized (1:1) to the BrainFit intervention (n=44) or a waitlist control (n=46) between March and August 2022. The intervention consisted of 12 30-minute sessions delivered on an iPad over 4 weeks with 3 sessions per week (Monday, Wednesday, and Friday after school) under the supervision of trained staff. The primary outcomes were parent-rated symptoms of attention and hyperactivity assessed according to the Swanson, Nolan, and Pelham questionnaire (SNAP-IV) rating scale and EF skills assessed by the Behavior Rating Inventory of Executive Function (BRIEF) scale, evaluated pre and post intervention. Intention-to-treat analysis was performed on 80 children after attrition. A nonparametric resampling-based permutation test was used for hypothesis testing of intervention effects. Among the 145 children who met the inclusion criteria, 90 consented and were randomized; ultimately, 80 (88.9%) children completed the study and were included in the analysis. The participants' average age was 8.4 (SD 1.3) years, including 63 (78.8%) male participants. The most common ADHD subtype was hyperactive/impulsive (54/80, 68%) and 23 (29%) children had severe symptoms. At the endpoint of the study, the BrainFit intervention group had a significantly larger improvement in total ADHD symptoms (SNAP-IV total score) as compared to those in the control group (β=-12.203, 95% CI -17.882 to -6.523; P<.001), owing to lower scores on the subscales Inattention (β=-3.966, 95% CI -6.285 to -1.647; P<.001), Hyperactivity/Impulsivity (β=-5.735, 95% CI -8.334 to -3.137; P<.001), and Oppositional Defiant Disorder (β=-2.995, 95% CI -4.857 to -1.132; P=.002). The intervention was associated with significant reduction in the Metacognition Index (β=-6.312, 95% CI -10.973 to -1.650; P=.006) and Global Executive Composite (β=-5.952, 95% CI -10.214 to -1.690; P=.003) on the BRIEF. No severe intervention-related adverse events were reported. This novel digital cognitive-physical intervention was efficacious in school-age children with ADHD. A larger multicenter effectiveness trial with longer follow-up is warranted to confirm these findings and to assess the durability of treatment effects. Chinese Clinical Trial Register ChiCTR2300070521; https://www.chictr.org.cn/showproj.html?proj=177806.

Effects of an online mindfulness-based program for parents of children with attention deficit/hyperactivity disorder: a pilot, mixed methods study.

Online mindfulness-based program (MBP) for parents and families especially in clinical population is limited. Engagement and significant dropout are major issues in MBP implementation. This pilot study examined the effects of an online mindfulness-based program (MBP) on parents of children with Attention Deficit/Hyperactivity Disorder (ADHD). A mixed methods study was applied to evaluate the effects of the MBP. A total of 43 parents were recruited and were randomly assigned into intervention group and waitlist control group. The online MBP lasted for 28 days, including 20 psychoeducation videos, homework audio guidance, and four instructor-led online group meetings. Purposive sampling was used to recruit parents who completed the program to share their experiences and suggestions for improving the program in semi-structured online interviews. Quantitative data showed that participants from the online MBP reported a medium to large effect on the reduction of child ADHD symptoms. In semi-structured interviews, participants reported positive experiences in their help seeking intention, and personal changes, such as emotion regulation and quality attention to their children. Participants further made suggestions for improvement. The effect of online MBP is promising, and the program should be conducted. A large scale randomized controlled trial should be conducted to investigate the effects of MBP in clinical populations. ClinicalTrials.gov NCT05480423.

Efficacy and safety of dasotraline in attention-deficit hyperactivity disorder: A systematic review and meta-analysis.

Pharmacotherapeutic options for attention-deficit hyperactivity disorder (ADHD) are limited due to adverse effects and inadequate efficacy of existing drugs. Clinical trials were conducted on dasotraline in search of a safer and more efficacious alternatives to stimulant agents. This meta-analysis was conducted to evaluate the efficacy and safety of dasotraline in ADHD compared to placebo. The reviewers extracted data from five relevant clinical trials after a literature search on Medline/PubMed, Embase, Scopus, Google Scholar, and Cochrane databases and Clinical Trial Registries. Quality assessment was done using the risk of bias assessment tool, and the random-effects model was used to estimate the effect size. Sub-group analysis, meta-regression, and sensitivity analysis were done as applicable. PRISMA guidelines were followed in the selection, analysis, and reporting of findings. Dasotraline significantly reduced the ADHD total symptom score (SMD: -0.35; 95% CI: -0.55 to -0.15; P < 0.001), hyperactivity/impulsivity subscale score (SMD: -0.27; 95% CI: -0.44 to -0.11; P = 0.001), inattentiveness sub-scale score (SMD: -0.33; 95% CI: -0.53 to -0.14; P < 0.001), and CGI-S (SMD: -0.25; 95% CI: -0.42 to -0.08; P = 0.003). Sub-group analysis showed a significant reduction of ADHD symptoms in both pediatric and adult age groups. Meta-regression showed a significant association between SMD of ADHD symptom score reduction and the duration of dasotraline therapy. The incidence of decreased appetite showed dose dependence but not the incidence of insomnia. Dasotraline 4 mg (in children) and 6 mg (in adults) can improve the clinical outcome in patients with ADHD by improving symptoms and global functioning with acceptable tolerability.PROSPERO Registration number: CRD42022321979.

Serdexmethylphenidate/dexmethylphenidate capsules for children and adolescents with attention-deficit/hyperactivity disorder (ADHD): a plain language summary

What is this summary about? This is a plain language summary of 2 articles published in the Journal of Child and Adolescent Psychopharmacology. It describes a medication called serdexmethylphenidate/dexmethylphenidate, or SDX/d-MPH for short. SDX/d-MPH is marketed under the name Azstarys®. It is in capsule form taken by mouth once a day in the morning and meant for treating patients aged 6 years and older with attention-deficit/hyperactivity disorder, commonly referred to as ADHD. This summary focuses on studies that were done in children and adolescents aged 6 to 12 years with ADHD. The study results showed how SDX/d-MPH reduced the symptoms of ADHD, how fast the medication began to work and for how long it worked in the study patients, as well as the medication's safety during 1 year of treatment. What are the key takeaways? Two main studies were done in patients with ADHD. The first study was conducted in a laboratory classroom, which is a simulated school classroom setting with children and adolescents aged 6 to 12 years with ADHD. The patients received either SDX/d-MPH or a placebo. The results of this study showed that the effect of SDX/d-MPH on reducing ADHD symptoms started approximately 30 minutes after taking the SDX/d-MPH capsule and lasted for approximately 13 hours. The placebo did not have this effect. The most common side effects for those taking SDX/d-MPH were headache, abdominal (belly) pain, insomnia and upper respiratory tract infection. The second study was also done in patients aged 6 to 12 years with ADHD. The purpose was to examine how safe and tolerable SDX/d-MPH was during 1 year of treatment. In this study, no placebo was given. The findings from the second study showed that SDX/d-MPH was safe and tolerable during the 1-year treatment period, with the most common side effects being decreased appetite, upper respiratory tract Scott H. Kollins1,2, Andrea Marraffino3, Andrew J. Cutler4,5, Charles Oh6, Matthew N. Brams7, Rene Braeckman8 &amp; Ann C. Childress9 1 Duke University School of Medicine, Durham, NC, USA; 2 Akili Interactive, Inc., Boston, MA, USA; 3 Accel Research Sites Network, Maitland, FL, USA; 4 SUNY Upstate Medical University, Syracuse, NY, USA; 5 Neuroscience Education Institute, Lakewood Ranch, FL, USA; 6 Corium LLC, Boston, MA, USA; 7 Bayou City Research, Houston, TX, USA; 8 Zevra Therapeutics Inc, Celebration, FL, USA; 9Center for Psychiatry and Behavioral Medicine, Las Vegas, NV, USA Placebo: an inactive substance that has no medication but looks exactly the same as the actual medication and is taken in exactly the same way as the study drug. Side effect: an undesirable effect of a medication. Insomnia: difficulty sleeping. Tolerable: means that a patient can endure a medication even with the some of the side effects. infection, sore throat and nose, decreased weight and irritability. This study also showed that SDX/d-MPH was effective throughout the 1-year treatment period. What were the main conclusions? In the first study, children with ADHD treated with SDX/d-MPH showed noticeable improvements in ADHD symptoms as early as 30 minutes after the medication was given, and those improvements lasted up to 13 hours. SDX/d-MPH was also found to be as safe as other ADHD treatments containing methylphenidate (MPH). Results of the second study showed that children with ADHD could be treated safely with SDX/d-MPH. Clinical Trial Registration: NCT03460652 ( ClinicalTrials.gov )

Relative Age Effects on Attention-Deficit/Hyperactivity Disorder Symptoms and Educational Achievement: A Longitudinal UK Cohort Study

Being among the youngest in a school class increases the risk for worse educational outcomes and attention-deficit/hyperactivity disorder (ADHD) symptoms, but questions remain about the nature and persistence of such effects. We investigated this "relative age effect" on educational achievement at age 15 to 16 years and on ADHD symptoms from age 7 to age 21 years. Furthermore, we examined whether being young-in-class is linked to a greater reduction in ADHD symptoms from childhood to adulthood and a lower genetic propensity to ADHD. We identified 3,928 young-in-class and 4,580 old-in-class participants from the Twins' Early Development Study. Educational achievement was measured with mathematics and English examination grades at age 15 to 16 years, and ADHD symptoms were measured using 2 different scales and different raters, from age 7 to 21 years, with effects tested using regression. A relative age effect emerged for English but not mathematics examination grades, and for the majority of parent and teacher ratings on ADHD symptoms, most consistently in middle childhood. Being young-in-class was associated with a greater reduction in parent-rated ADHD symptoms from childhood to adulthood when measured with a brief scale, but the comparable result from a longer scale was non-significant (after multiple testing correction). No interaction emerged between relative age and ADHD polygenic scores. Our results emphasise the need to improve support for the children who start school younger than most, and to ensure that developmental comparisons take children's precise age into account. Future research would benefit from in-depth analyses of individual trajectories and their variability among the young-in-class children.

Mind, brain and education: neuropsychological contributions to executive function training in the classroom with students with ADHD

Attention Deficit Hyperactivity Disorder (ADHD) is one of the neurodevelopmental disorders with the highest incidence in children and adolescents. With multifactorial characteristics, ADHD leads to impairments in executive functioning, for example, in skills related to Executive Functions (EFs) such as behavior control, sustaining attention and mastering activity levels or impulses, usually leading to impairments in learning. The aim of this article was to carry out a literature review as a contribution of neuropsychology to training EFs in the classroom with students with ADHD. An exploratory study was carried out, followed by descriptive or experimental research. Searches were carried out in the Scientific Electronic Library Online (SCIELO), Biblioteca Virtual em Saúde-Psicologia Brasil (BVSPSI), Periódicos Eletrônicos de Psicologia (PEPSIC) databases, in the journals available in the Brazilian Digital Library of Theses and Dissertations (BDTD), in PUBMED and in textbooks. Covering publications from 2017 to 2023, 8 articles were selected for analysis. The bibliographic survey showed the importance of studies on ADHD related to EFs, and it is important for teachers to stimulate these functions, as studies have shown that they have minimized the impact on learning deficits in students with ADHD, and that they can consequently bring about better emotional regulation. This review provided evidence showing that EF training improves executive functioning, reducing ADHD symptoms and leading to improvements in academic functioning. It is suggested that further empirical research into EF intervention by educators for students with ADHD with greater breadth and sampling needs to be carried out.

The Therapeutic Potential of Amphetamine-like Psychostimulants.

This review delves into the therapeutic applications of amphetamine-type stimulants such as lisdexamphetamine dimesylate, mixed amphetamine salts, 3,4-methylenedioxymethamphetamine (MDMA), dextroamphetamine, and phentermine. These compounds have been investigated for their potential in treating a range of psychiatric disorders, including attention deficit hyperactivity disorder (ADHD), drug dependence, post-traumatic stress disorder (PTSD), and obesity. Lisdexamphetamine dimesylate has shown promise in effectively treating ADHD symptoms in both children and adults. Additionally, it has been explored as a potential treatment for drug dependency and withdrawal, demonstrating encouraging results. Mixed amphetamine salts have also exhibited efficacy in reducing ADHD symptoms in adults. Future research should explore their potential use in treating bipolar disorder and cocaine dependence, considering the associated risks and benefits. MDMA-assisted psychotherapy has emerged as an innovative approach to treating PTSD, leading to sustained reductions in symptoms and even promoting post-traumatic growth. Furthermore, it has shown promise in managing anxiety related to life-threatening illnesses. Dextroamphetamine and phentermine have demonstrated efficacy in treating cocaine and opioid dependence, ADHD, and obesity. However, careful consideration and monitoring by medical professionals are essential due to the potential risks and benefits associated with them. In conclusion, amphetamine-type stimulants present a promising avenue for therapeutic interventions in various psychiatric conditions. Nevertheless, further research is necessary to comprehensively understand their mechanisms of action, dosage requirements, and long-term effects in different patient populations.

A Parent–child yoga intervention for reducing attention deficits in children with congenital heart disease: the Yoga for Little Hearts Feasibility Study Protocol

IntroductionPreschoolers and school-aged children with congenital heart disease (CHD) are at higher risk of attention deficit hyperactivity disorder (ADHD) compared with the general population. To this day, no randomised controlled...

Attention Deficit Hyperactivity Disorder (ADHD)

This paper explores the impact of Parent-Child Interaction Therapy (PCIT) on ADHD symptoms in children aged 6-12 and the effectiveness of Cognitive-Behavioral Therapy (CBT) in reducing ADHD symptoms in adolescents. The study highlights how PCIT improves parenting skills, reduces disruptive behavior, and enhances academic and social functioning in children with ADHD. For adolescents, CBT is shown to be effective in managing ADHD symptoms through cognitive restructuring and behavioral techniques. The paper also reviews multiple studies demonstrating the positive effects of CBT on inattention, impulsivity, and organizational skills in adolescents with ADHD. Key Words: Child, Parents, Attention Deficit Hyperactivity Disorder (ADHD), Theraphy Proceedings Citation Format Longe, Bankole-Phillips. A. (2023): Attention Deficit Hyperactivity Disorder (ADHD). Proceedings of the 37th iSTEAMS Multidisciplinary Cross-Border Conference. 30th October – 1st November, 2023. Academic City University College, Accra, Ghana. Pp 195-197. dx.doi.org/10.22624/AIMS/ACCRACROSSBORDER2023V2P2P34

START – physical exercise and person-centred cognitive skills training as treatment for adult ADHD: protocol for a randomized controlled trial

BackgroundCore symptoms in attention deficit hyperactivity disorder (ADHD) are inattention, impulsivity and hyperactivity. Many individuals with this disorder also have a sedentary lifestyle, co-morbid mental illness such as depressive and anxiety disorders, and reduced quality of life. People with ADHD often have impaired executive function, which among other things may include difficulty in time management and structuring of everyday life. Pharmacological treatment is often the first-line option, but non-pharmacological treatment is also available and is used in clinical settings. In children and adolescents with ADHD, physical exercise is used as a non-pharmacological treatment. However, the evidence for the effectiveness of exercise in adults is sparse.ObjectiveTo implement the START intervention (START = Stöd i Aktivitet, Rörelse och Träning [Support in activity, movement and exercise]) consisting of a 12-week, structured mixed exercise programme with or without a cognitive intervention, in adults with ADHD, and study whether it has an effect on core symptoms of ADHD as well as physical, cognitive, mental and everyday functioning compared with usual treatment. A secondary aim is to investigate the participants’ experiences of the intervention and its possible benefits, and to evaluate the cost-effectiveness of START compared with usual treatment.MethodsThis is a randomized controlled trial planned to be conducted in 120 adults with ADHD, aged 18–65. The intervention will be given as an add-on to standard care. Participants will be randomized to three groups. Group 1 will be given a physiotherapist-led mixed exercise programme for 12 weeks. Group 2 will receive the same intervention as group 1 with the addition of occupational therapist-led cognitive skills training. Group 3 will be the control group who will receive standard care only. The primary outcome will be reduction of ADHD symptoms measured using the World Health Organization (WHO) Adult ADHD Self-Report Scale (ASRS-v1.1), Clinical Global Impression-Severity scale (CGI-S) and CGI-Improvement scale (CGI-I). The effect will be measured within 1 week after the end of the intervention and 6 and 12 months later.DiscussionData collection began in March 2021. The final 12-month follow-up is anticipated to be completed by autumn 2024.Trial registrationClinicalTrials.gov (Identifier: NCT05049239). Registered on 20 September 2021 (last verified: May 2021).

Sustained improvements by behavioural parent training for children with attention-deficit/hyperactivity disorder: Ameta-analytic review of longer-term child and parental outcomes.

Behavioural parent training is an evidence-based intervention for children with attention-deficit/hyperactivity disorder (ADHD), but little is known about the extent to which initial benefits are maintained. This meta-analytic review investigated longer-term (i.e., more than 2months post-intervention) child and parental outcomes of behavioural parent training for children with ADHD. We searched for randomized controlled trials and examined ADHD symptoms, behavioural problems, positive parenting, negative parenting, parenting sense of competence, parent-child relationship quality, and parental mental health as outcomes. We included 27 studies (31 interventions; 217 effect sizes), used multilevel random-effects meta-analyses for between- and within-group comparisons (pre-intervention to follow-up and post-intervention to follow-up), and explored twelve predictors of change. Between pre-intervention and follow-up (M=5.3months), we found significant small-to-moderate between-group effects of the intervention on ADHD symptoms, behavioural problems, positive parenting, parenting sense of competence and parent-child relationship quality. Within-group findings show sustained improvements in the intervention conditions for all outcome domains. There were few significant changes from post-intervention to follow-up. Additionally, the large majority of the individual effect sizes indicated sustained outcomes from post-intervention to follow-up. There were seven significant predictors of change in child outcomes, including stronger reductions in ADHD symptoms of girls and behaviour problems of younger children. In contrast with some meta-analyses on short-term effects, we found no differences between masked and unmasked outcomes on ADHD symptoms at follow-up. We conclude that behavioural parent training has longer-term benefits for children's ADHD symptoms and behavioural problems, and for positive parenting behaviours, parenting sense of competence and quality of the parent-child relationship.

Digital Cognitive Training for Children with Attention Deficit Hyperactivity Disorder.

The present article used a pilot study to determine the effectiveness of digital cognitive mindfulness training developed based on dialectical behavioral therapy (DBT) in reducing attention deficit hyperactivity disorder (ADHD) symptoms in children. The sample consisted of 90 children (8-10 years old) diagnosed with ADHD. The participants were randomized into two groups: an experimental group (n = 45) and a control group (n = 45). Results were assessed at three time points: before, after the study, and one month after the end of the study. Regarding ADHD symptoms, the ANCOVA results showed that there were no statistically significant differences between the study groups for inattention and hyperactivity/impulsivity after testing. One month after completion of the program, there was a significant alleviation in symptoms of inattention, executive functioning, learning problems, aggression, and peer relationships. Hyperactivity was the only variable that showed a decrease both post-test and during follow-up. These results suggest that a DBT-based mindfulness program is a promising method of reducing ADHD symptoms in children.

VIRTUAL REALITY, DIGITAL TECHNOLOGIES AND BRAIN REWIRING TECHNIQUES FOR INTERVENTION IN ATTENTION-DEFICIT/HYPERACTIVITY DISORDER (ADHD)

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder that affects cognitive function, behavior, and social interaction. While medication and behavioral therapy are the standard of care for ADHD, complementary and alternative interventions that leverage the brain's neuroplasticity, such as brain rewiring techniques and digital technologies, have emerged. These techniques, including cognitive-behavioral therapy, mindfulness-based interventions, neurofeedback, Neuro-Linguistic Programming, clinical hypnosis, exercise, yoga, music therapy, and working memory exercises, aim to modify the function and structure of the brain to improve cognitive function, self-regulation, and overall quality of life in individuals with ADHD. Additionally, virtual reality has shown promise as a potential tool for improving attentional control and reducing ADHD symptoms. This literature review provides an overview of the effectiveness of brain rewiring techniques, including NLP and clinical hypnosis, as well as exercise, yoga, music therapy, and working memory exercises for ADHD, and the potential utility of virtual reality for treating ADHD.

Efficacy of stimulants for preschool attention-deficit/hyperactivity disorder: A systematic review and meta-analysis.

Robust synthesis of evidence to support treatment recommendations for preschoolers with attention-deficit/hyperactivity disorder (ADHD) is lacking. The aim of this systematic review and meta-analysis was to review currently available evidence to evaluate the efficacy and acceptability of stimulants for preschool children with ADHD. We searched electronic databases (CENTRAL, Embase, PubMed) from the database inception to March, 2022; and clinical trial registries through WHO ICTRP from the database inception to July, 2022, and selected double-blinded randomized controlled trials (RCTs) that compared stimulants against placebo for the treatment of preschoolers (age≤7years) with ADHD. Change in ADHD symptom severity was the primary outcome (efficacy) and all-cause dropout rates (acceptability) was the secondary outcome. Data were pooled with random-effects models weighted by theinverse of the variance. Risk of bias of individual studies were assessed with the Cochrane Risk of Bias tool version 2. The Grading of Recommendations Assessment, Development, and Evaluation approach was used to assess the quality of evidence. This study is registered with PROSPERO (CRD42022348597). Five RCTs (three methylphenidate immediate-release, one methylphenidate extended-release, and one lisdexamfetamine) were included. The analysis of efficacy was based on 489 participants. Meta-analysis of change in ADHD symptom severity demonstrated a significant effect in favor of stimulants over placebo (standardized mean difference=-0.59; 95% CI -0.77, -0.41; p<0.0001). There was no evidence of heterogeneity but some concerns about publication bias. Regardless, the confidence of evidence was considered moderate. For acceptability, stimulants did not lead to an increased rate of all-cause discontinuation rates in comparison to placebo (OR=0.59; 95% CI 0.15, 2.37; p=0.45) but the confidence of estimate was very low. Our findings demonstrated that stimulants are efficacious in reducing ADHD symptoms among preschool children. Clinicians should consider the use of stimulants when making treatment recommendations for preschoolers with ADHD.

The impact of neurofeedback training on midbrain activity and symptoms of attention- deficit/hyperactivity disorder (ADHD) in early childhood: a review study

Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterized by hyperactivity, inattention, and impulsivity symptoms that can significantly impair a child's functioning and quality of life. Neurofeedback, a form of biofeedback, has emerged as a promising therapeutic approach for ADHD, utilizing real-time feedback of brain activity to help individuals self-regulate their brain function. This review paper examines the existing literature on the impact of neurofeedback training on midbrain activity and symptoms of ADHD in young children. The review begins with an overview of ADHD and its current treatment approaches, including medication and behavioural interventions. Then it delves into neurofeedback and how it works, focusing on targeting midbrain activity as a potential modality for ADHD treatment. The review discusses findings from empirical studies that have investigated the impact of neurofeedback training on midbrain activity and symptoms of ADHD in young children, including randomized controlled trials (RCTs), quasi-experimental studies, and case studies. Further, critically evaluated the methodological rigor and limitations of the studies, including sample size, study design, and outcome measures used. It also highlights the findings and trends in the literature, including the potential benefits of neurofeedback training in improving midbrain activity and reducing ADHD symptoms in young children. Then, underlying mechanisms of neurofeedback and its potential as a non- pharmacological intervention for ADHD, including long-term effects and the need for further research are discussed. Finally, the researcher summarizes the findings and implications for clinical practice, highlighting the potential of neurofeedback training as an adjunct or alternative treatment for ADHD in young children. The limitations and future directions for research in this area are discussed to establish the efficacy and safety of neurofeedback training for young children with ADHD.)