title: Neuropsychological outcomes across the day in children with attention-deficit/hyperactivity disorder treated with atomoxetine: results from a placebo-controlled study using a computer-based continuous performance test combined with an infra-red motion-tracking device. A naturalistic assessment of the motor activity of hyperactive boys. II. Stimulant drug effects. Protocol investigating the clinical utility of an objective measure of activity and attention (QbTest) on diagnostic and treatment decision-making in children and young people with ADHD—‘Assessing QbTest Utility in ADHD’ (AQUA): a randomised controlled trial Clinical symptoms and performance on the continuous performance test in children with attention deficit hyperactivity disorder between subtypes: a natural follow-up study for 6 months Fenfluramine and dextroamphetamine treatment of childhood hyperactivity. Clinical and biochemical findings. Neurocognitive performance and behavioral symptoms in patients with attention-deficit/hyperactivity disorder during twenty-four months of treatment with methylphenidate. Decreased motor activity of hyperactive children on dextroamphetamine during active gym program Differential impact of methylphenidate and atomoxetine on sustained attention in youth with attention-deficit/hyperactivity disorder. Objective measurement of
  hyperactivity, impulsivity, and inattention in children with
  hyperkinetic disorders before and after treatment with
  methylphenidate Measurements of attention deficits and impulsivity: a Swedish study of the Gordon Diagnostic System Does Atomoxetine Improve Executive Function, Inhibitory Control, and Hyperactivity?: Results From a Placebo-Controlled Trial Using Quantitative Measurement Technology Clinical evaluation of subjective and objective changes in motor activity and attention in children with attention-deficit/hyperactivity disorder in a double-blind methylphenidate trial. Clinical gains from including both dextroamphetamine and methylphenidate in stimulant trials. Relationships Between Computer-Based Testing and Behavioral Ratings in the Assessment of Attention and Activity in a Pediatric ADHD Stimulant Crossover Trial Differential effects of methylphenidate and dextroamphetamine on the motor activity level of hyperactive children.
abstract: The effect of atomoxetine ( ATX ) on executive function has been assessed by means of question naires only . The aim of this study was therefore to evaluate the efficacy of ATX using st and ard variables of a computer-based continuous performance test ( cb-CPT ) combined with an infra-red motion-tracking device at different times of the day . One hundred twenty-eight girls and boys aged 6 to 12 years with a diagnosis of ADHD according to DSM-IV-TR criteria were r and omized in the study . The primary efficacy measures were the q-scores of the cb-CPT combined with an infra-red motion-tracking device .  The test comprises 13 neuropsychological variables that can be taken to reflect hyperactivity , inattention , or impulsivity .  One hundred five patients completed the study ( ATX group : n=54 ;  placebo  group : n=51 ) . ATX ( target dose 1.2 mg/kg/day ) over 8 weeks was significantly superior to placebo in reducing hyperactivity , inattention , and impulsivity as measured by q-scores of 10 primary variables of the cb-CPT . Both groups of patients showed a circadian pattern of neuropsychological outcomes across the day as reflected by the cb-CPT combined with an infra-red motion-tracking device . In summary , this study demonstrated a positive effect of ATX on some aspects of executive function , inhibitory control , and hyperactivity compared with placebo Twenty-four-hour motor activity was assessed in a naturalistic setting in 12 hyperactive boys for four weeks ( 672 consecutive hours ) . Dextroamphetamine , 15 mg/day , or placebo was administered on alternate weeks , using a double-blind ABAB design . When the boys received dextroamphetamine , motor activity was significantly decreased for about eight hours after drug administration . This decrease was followed by a period of slight but significant increases in activity ( " rebound " ) .  Dextroamphetamine decreased activity most strikingly during structured classroom activity ; during physical education , however , there was a significant drug-induced increase in motor activity Introduction The National Institute for Health and Care Excellence ( NICE ) guidelines for attention deficit/hyperactivity disorder ( ADHD ) state that young people need to have access to the best evidence -based care to improve outcome . The current ‘ gold st and ard ’ ADHD diagnostic assessment combines clinical observation with subjective parent , teacher and self-reports . In routine practice , reports from multiple informants may be unavailable or contradictory , leading to diagnostic uncertainty and delay . The addition of objective tests of attention and activity may help reduce diagnostic uncertainty and delays in initiating treatment leading to improved outcomes . This trial investigates whether providing clinicians with an objective report of levels of attention , impulsivity and activity can lead to an earlier , and more accurate , clinical diagnosis and improved patient outcome . Methods and analysis This multisite r and omised controlled trial will recruit young people ( aged 6–17 years old ) who have been referred for an ADHD diagnostic assessment at Child and Adolescent Mental Health Services ( CAMHS ) and Community Paediatric clinics across Engl and . Routine clinical assessment will be augmented by the QbTest , incorporating a continuous performance test ( CPT ) and infrared motion tracking of activity . The participant will be r and omised into one of two study arms : QbOpen ( clinician has immediate access to a QbTest report ) : QbBlind ( report is withheld until the study end ) . Primary outcomes are time to diagnosis and diagnostic accuracy . Secondary outcomes include clinician 's diagnostic confidence and routine clinical outcome measures . Cost-effective analysis will be conducted , alongside a qualitative assessment of the feasibility and acceptability of incorporating QbTest in routine practice . Ethics and dissemination The findings from the study will inform commissioners , clinicians and managers about the feasibility , acceptability , clinical utility and cost-effectiveness of incorporating QbTest into routine diagnostic assessment of young people with ADHD . The results will be su bmi tted for publication in peer- review ed journals . The study has received ethical approval . Trial registration number NCT02209116 Background The aims of this study were to determine the time course of improvements in attention deficit hyperactivity disorder ( ADHD ) clinical symptoms and neurocognitive function in a realistic clinical setting , and the differences in ADHD symptom improvement using different classifications of ADHD subtypes . Methods The Child Behavior Checklist ( CBCL ) was completed by parents of ADHD children at the initial visit . The  computerized Continuous Performance Test ( CPT ) , Swanson , Nolan , and Pelham , and Version IV Scale for ADHD ( SNAP-IV ) , and  ADHD Rating Scale ( ADHD-RS ) were performed at baseline , one month , three months , and six months later , respectively . Patient care including drug therapy was performed at the discretion of the psychiatrist . The ADHD patients were divided into DSM-IV subtypes ( Inattentive , Hyperactive-impulsive and Combined type ) , and were additionally categorized into aggressive and non-aggressive subtypes by aggression scale in CBCL for comparisons . Results There were 50 ADHD patients with a mean age of 7.84 ± 1.64 years ; 15 of them were inattentive type , 11 were hyperactive-impulsive type , and 24 were combined type . In addition , 28 of the ADHD patients were grouped into aggressive and 22 into non-aggressive subtypes . There were significant improvements in clinical symptoms of hyperactivity and inattention , and impulsivity performance in CPT during the 6-month treatment . The clinical hyperactive symptoms were significantly different between ADHD patients sub-grouping both by DSM-IV and aggression . Non-aggressive patients had significantly greater changes in distraction and impulsivity performances in CPT from baseline to month 6 than aggressive patients . Conclusions We found that ADHD symptoms , which included impulsive performances in CPT and clinical inattention and hyperactivity dimensions , had improved significantly over 6 months under pragmatic treatments . The non-aggressive ADHD patients might have a higher potential for improving in CPT performance than aggressive ones . However , it warrant further investigation whether the different classifications of ADHD patients could be valid for predicting the improvements in ADHD patients ' clinical symptoms and neurocognitive performance Twenty boys ( mean age , 9 + /- 2 years ) with attention deficit disorder with hyperactivity received three weeks each of dextroamphetamine sulfate ( 0.5 mg/kg/d ) , fenfluramine hydrochloride ( 0.6 mg/kg/d increased to 2.0 mg/kg/d ) , and placebo in a double-blind , r and om-order , crossover design . Half the boys also met criteria for conduct disorder .  Dextroamphetamine produced immediate and marked improvement in disruptive , overactive behaviors .  Fenfluramine had no effect on any behavioral measure at either the low or high dosage . Both drugs decreased levels of urinary norepinephrine , 3-methoxy-4-hydroxyphenylglycol ( MHPG ) , and vanillylm and elic acid .  Fenfluramine , however , also produced a significant decrease in plasma MHPG levels and a larger decrease in urinary norepinephrine levels . It reduced urinary epinephrine levels as well , an effect opposite to that of dextroamphetamine . These findings suggest that different mechanisms of action are involved in the ability of the two drugs to reduce levels of MHPG and vanillylm and elic acid . Fenfluramine increased plasma prolactin levels and decreased platelet serotonin levels . Despite the structural similarity of the two drugs , some common overall effects on catecholamine metabolism , and similar effects on weight , fenfluramine had none of the motor activity or therapeutic effects of dextroamphetamine OBJECTIVE This study investigated the trends in neurocognitive function and behavioral symptoms among patients with attention-deficit/hyperactivity disorder ( ADHD ) during 24 months of treatment with methylpheni date in a clinical setting . METHODS Study participants consisted of 181 ADHD patients with a mean age of 13.4±2.5 years ( ages ranged from 8 to 18 years ; 151 boys and 30 girls ) who were prescribed oral short-acting methylpheni date two or three times daily , with each dose ranging between 0.3 and 1.0 mg/kg . At baseline and 6 , 12 , 18 , and 24 months from baseline , neurocognitive function was assessed using the  Test of Variables of Attention ( TOVA ) on the day the patient was off medication , and behavioral symptoms were evaluated using the Swanson , Nolan , and Pelham Version IV Scale for ADHD ( SNAP-IV ) parent form , the SNAP-IV teacher form , and the ADHD-Rating Scale ( completed by a child psychiatrist ) . RESULTS Of the 181 ADHD patients at the initial visit , 103 ( 56.9 % ) completed the study . During the 24-month methylpheni date treatment , only the commission errors in TOVA significantly improved ; however , the omission errors , response time , response time variability , response sensitivity , and ADHD score did not . The behavioral symptoms of ADHD , observed by various informants , all declined substantially , and were significantly correlated with each other during the long-term follow-up . The severity of teacher ratings was lower than that of parent and psychiatrist ratings . However , the teacher-rated inattention symptoms showed the strongest correlations with TOVA performance . CONCLUSIONS Findings suggest that neurocognitive deficits in ADHD patients , except inhibition ability , might be long lasting in realistic setting s. In addition , obtaining behavior profile assessment s from multiple informants , especially from teachers , is vital for establishing a complete underst and ing of ADHD patients The motor activity of 10 hyperactive boys was measured during eight 1-hour active gym classes . Children received either dextroaomphetamine ( 0.5 mg/kg ) or placebo elixir before each class , in a double-blind design . The program for each of the classes was participation in the active sports : hockey , basketball , and /or roller skating ; the " task " throughout each hour was to play vigorously and continuously . The boys ' mean hourly activity following amphetamine was slightly but significantly less than that following placebo . This finding is contradictory to the hypothesis that improved attention to an active task on stimulant would result in increased motor activity , and suggests the possibility of an independent direct effect of amphetamine on the motor system BACKGROUND This study examined the effects of atomoxetine ( ATX ) and OROS methylpheni date ( MPH ) on laboratory measures of inhibitory control and attention in youth with attention-deficit/hyperactivity disorder ( ADHD ) . It was hypothesized that performance would be improved by both treatments , but response profiles would differ because the medications work via different mechanisms . METHODS One hundred and two youth ( 77 male ; mean age = 10.5 ± 2.7 years ) with ADHD received ATX ( 1.4 ± 0.5 mg/kg ) and MPH ( 52.4 ± 16.6 mg ) in a r and omized , double-blind , crossover design . Medication was titrated in 4 - 6-week blocks separated by a 2-week placebo washout  . Inhibitory control and attention measures were obtained at baseline , following washout , and at the end of each treatment using Conners ' Continuous Performance Test II ( CPT-II ) , which provided age-adjusted T-scores for reaction time ( RT ) , reaction time variability ( RT variability ) , and errors . Repeated- measures analyses of variance were performed , with Time ( premedication , postmedication ) and Treatment type ( ATX , MPH ) entered as within-subject factors . Data from the two treatment blocks were checked for order effects and combined if order effects were not present . CLINICAL TRIAL REGISTRATION Clinical trials.gov : NCT00183391 . RESULTS Main effects for Time on RT ( p = .03 ) , RTSD ( p = .001 ) , and omission errors ( p = .01 ) were significant . A significant Drug × Time interaction indicated  that MPH improved RT , RTSD , and omission errors  more than ATX ( p < .05 ) . Changes in performance with treatment did not correlate with changes in ADHD symptoms . CONCLUSIONS MPH has greater effects  than ATX on CPT measures of sustained attention in youth with ADHD . However , the dissociation of cognitive and behavioral change with treatment indicates that CPT measures can not be considered proxies for symptomatic improvement . Further research on the dissociation of cognitive and behavioral endpoints for ADHD is indicated Abstract . Purpose : The purpose of this study was to investigate whether values of the respective parameters of the OPTAx test dependently differ due to the medication with methylpheni date ( MPH ) in children with hyperkinetic disorders ( HD ) suffering from hyperactivity , impulsivity , and attention deficits . Methods : The OPTAx test is an infrared motion analysis to record the movement pattern during a continuous performance test . We tested 25 children between 6 and 12 years with HD ( ICD-10 : F90.0 or F90.1 ) before and after treatment with MPH .  The parameters under investigation were activity ( microevents and spatial scaling ) , impulsivity ( errors of commission ) , and attentiveness ( accuracy and variability ) . For statistical analysis a one-tailed matched pairs test ( adj . p = 0.01 ) was conducted to discriminate differences found from those occurred at r and om . A post hoc partial correlation of absolute differences in the respective parameters and the daily dose of MPH ( adj . for BMI ) was performed if p < 0.01 . Results : Statistically significant results were found for microevents , spatial scaling , errors of commission , accuracy , and variability . The partial correlation showed significant results for microevents and variability . Conclusion : The mean pre – post changes found in all parameters investigated consistently correspond with benefits desired from medication with MPH in children with HD . Absolute differences in microevents and variability seem to depend on the daily dose of MPH after adjustment for BMI The Gordon Diagnostic System ( GDS ) is a portable easily operated computerized tool developed to measure impulse control , attention and vigilance . In 1988 , it was st and ardized for use among American children . The aim of this study was to evaluate the GDS for use among Swedish children . A clinical sample of 71 Swedish children , mean age 10.5 y , fulfilling the ADHD criteria according to the DSM‐IV was compared with a control sample of 88 children , mean age 10.2 y , with no known psychiatric diagnosis . The clinical sample showed lower GDS scores in all age groups , with some exceptions . The GDS scores were not associated with gender , but strongly associated with age , especially in the control sample . The accuracy of the  GDS referring a specific child to either of the sample s was , as expected , not impressive . With respect to the practical usefulness , the GDS was well accepted by the children and parents in both sample s. The findings in age variation and when comparing children with ADHD and controls are in agreement with results from other studies Abstract The primary objective of this study was to evaluate the efficacy of atomoxetine ( ATX ) on attention-deficit/hyperactivity disorder (ADHD)–related symptoms assessed as st and ard variables of a computer-based continuous performance test ( cb-CPT ) combined with a motion-tracking ( MT ) device . This was a 2-arm , 8-week , r and omized , double-blind , placebo-controlled study in patients with ADHD ( 6–12 years ) . Therapy with ATX started with 0.5 mg/kg per day for 1 week , followed by 7 weeks on the target dosage of 1.2 mg/kg per day . Primary outcomes were cb-CPT/MT st and ard scores after 8 weeks using mixed models for repeated measurements . In addition , investigator-rated ADHD Rating Scale ( ADHD-RS ) , Weekly Ratings of Evening and Morning Behavior ( WREMB ) , and Clinical Global Impression – Severity-ADHD ( CGI-S-ADHD ) scores were assessed . Of 128 patients r and omized , 125 were evaluated ( ATX/placebo : 63/62 ) . Baseline characteristics were comparable in both groups ( overall , 80.2 % boys ; mean [ SD ] age , 9.0 [ 1.79 ] years ; comorbid Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition diagnosis , 40.0 % oppositional defiant disorder/conduct disorder ; prior stimulant treatment , 24.8 % ; ADHD-RS total score , 36.99 [ 11.56 ] ) . At week 8 , all cb-CPT/MT q-scores were significantly reduced versus placebo ( all P < 0.001 ) with effect sizes ( ESs ) of reaction time ( RT ) variation ( ES = 0.71 ) , mean RT ( ES = 0.41 ) , number of microevents ( ES = 1.00 ) , commission error rate ( ES = 0.50 ) , distance of movement ( ES = 0.90 ) , area of movement ( ES = 1.08 ) , omission error rate ( ES = 0.70 ) , time active ( ES = 0.69 ) , motion simplicity ( ES = 0.38 ) , and normalized variance of RT ( ES = 0.50 ) . Secondary end points also improved significantly in favor of ATX : ADHD-RS ( total score ES = 1.30 , P < 0.001 ; hyperactivity/impulsivity subscore ES = 1.37 , P < 0.001 ; inattention subscore ES = 1.07 , P < 0.001 ) , WREMB ( total score ES = 1.00 , P < 0.001 ; morning subscore ES = 0.59 , P = 0.002 ; evening subscore ES = 1.02 , P < 0.001 ) , CGI-S-ADHD ( ES = 1.11 , P < 0.001 ) . The results of this study show that ATX for 8 weeks significantly reduced ADHD-related symptoms as measured by the cb-CPT/MT The aim of this study was to determine drug-dependent effects on attention and motor activity in children with attention-deficit/hyperactivity disorder ( ADHD ) in a double-blind methylpheni date ( MPH ) trial using both subjective behavior ratings and objective measures of function . In particular , we were interested in the relationship between changes of those subjective and objective measures . A total of 44 ADHD children with the combined subtype completed a r and omized , double-blind , placebo-controlled , crossover trial with 2 doses of MPH ( 0.25 ; 0.5 mg/kg body weight ) and placebo . In each condition , computerized attention tasks were performed , teacher-behavior ratings were obtained , and actigraph data were collected in both clinical and naturalistic setting s. Trend tests revealed linear effects of MPH dose on actigraph data in the test session ( p = 0.02 ) and at school ( p = 0.001 ) , as well as on sustained attention ( p < 0.001 ) , while inhibitory control showed a quadratic dose-response curve ( p < 0.001 ) . Multivariate regression analyses revealed that changes of both , hyperactive-impulsive symptoms ( 28 % ) and inattentive symptoms ( 23 % ) could be explained by objective changes of motor activity . Thus , for clinical practice , it should be taken into account that behavior ratings of ADHD symptoms seemed to be predominantly influenced by changes of motor activity OBJECTIVE The purpose of this study was to investigate clinical gains from including both dextroamphetamine and methylpheni date in stimulant trials . METHOD Thirty-six medication-naïve children ages 9 - 14 years diagnosed with attention-deficit/hyperactivity disorder ( ADHD ) were enrolled for 6 weeks in a crossover trial , with 2 weeks of methylpheni date , dextroamphetamine , and placebo , in a r and omly assigned , counterbalanced sequence . Outcome measures constituted a computer-based continuous performance test combined with a motion tracking system ( Qb Test ) and an ADHD question naire rated by parents and teachers . RESULTS Group analyses found significant treatment effects of similar size for the two stimulants on both outcome measures . Single-subject analyses revealed that each stimulant produced a favourable response in 26 children ; however , an individual child frequently responded qualitatively or quantitatively differently to the two stimulants . By including both stimulants in the trial , the number of favorable responders increased from 26 ( 72 % ) to 33 ( 92 % ) . In children with favorable responses of unequal strength to the two stimulants , a shift from inferior drug to best drug was associated with a 64 % mean increase in the overall response strength score , as measured by the ADHD question naire . CONCLUSIONS The likelihood of a favorable response and optimal response strength is increased by including both stimulants in the stimulant trial . The study was first registered in clinical trials 28 September 2010 . Clinical Trials.gov Identifier : NCT01220440 This study investigated the relationships between computer-based testing and behavioral ratings in the assessment of stimulant-induced changes in attention and activity in a pediatric ADHD crossover trial with methylpheni date , dextroamphetamine , and a placebo . Here 36 children between 9 and 14 years old were r and omly and evenly assigned to each of six counterbalanced drug orders . A computer-based continuous performance test combined with a motion-tracking system ( cb-CPT-MTS ) and an ADHD question naire rated by teachers constituted the outcome measures . All outcome measures responded to stimulants in a comparable way at the group level , as shown by significant treatment effects of similar size for the two stimulants compared with a placebo .  Computer-based and rating-based measures were unrelated in the assessment of stimulant-induced changes in attention and activity in individual children ; no significant correlations between these measures in the assessment of change from placebo to stimulant conditions across the sample were detected . Results suggest that computer-based testing and behavioral ratings can not be considered equivalent in the assessment of stimulant-induced changes in attention and activity among ADHD children An acceleration-sensitive device was used to measure motor activity continuously through the day in 18 hyperactive boys in a day hospital program . The children received methylpheni date , dextroamphetamine , or placebo daily after breakfast and lunch in an 11-week double-blind crossover trial . Differential effectiveness of the two drugs in lowering motor activity was found . Methylpheni date significantly lowered activity measurements in a morning structured classroom and in less structured activities in the afternoon . Dextroamphetamine  effects on activity were similar , although they did not differ significantly from placebo effects between 11:00 AM and noon in our classroom setting . Methylpheni date produced a greater decrement in motor activity than did dextroamphetamine between 11:00 AM and 1:00 PM . There were no significant differences in activity level between drug doses within each drug phase across the dose ranges used ( for methylpheni date 0.45 to 1.25 mg/kg given twice daily , and for dextroamphetamine 0.2 to 0.6 mg/kg given twice daily ) . Plasma drug concentrations did not correlate with decrements in activity for either drug
target: There were mixed findings with regard to the use of CPTs to assess and manage medication , with contrasting evidence on their ability to support clinical decision-making .
  There was a strong evidence base for the use of objective measures of activity to aid ADHD/non-ADHD group differentiation , which appears sensitive to medication effects and would also benefit from further research on their clinical utility .
background: Attention-deficit hyperactivity disorder ( ADHD ) is typically diagnosed using clinical observation and subjective informant reports .
  Once children commence ADHD medication , robust monitoring is required to detect partial or non-responses .
  The extent to which neuropsychological continuous performance tests ( CPTs ) and objective measures of activity can clinical ly aid the assessment and titration process in ADHD is not fully understood .
  This review describes the current evidence base for the use of CPTs and objective ly measured activity to support the diagnostic procedure and medication management for children with ADHD .
  Four data bases ( PsycINFO , Medline , Allied and Complementary Medicine ( AMED ) , and PsycARTICLES ) were systematic ally search ed to underst and the current evidence base for ( 1 ) the use of CPTs to aid clinical assessment of ADHD ; ( 2 ) the use of CPTs to aid medication management ; and ( 3 ) the clinical utility of objective measures of activity in ADHD .