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Dudukina E, Szépligeti SK, Karlsson P, Asomaning K, Daltveit AK, Hakkarainen K, Hoti F, Kieler H, Lunde A, Odsbu I, Rantanen M, Reutfors J, Saarelainen L, Ehrenstein V, Toft G. Prenatal exposure to pregabalin, birth outcomes and neurodevelopment - a population-based cohort study in four Nordic countries. Drug Saf 2023:10.1007/s40264-023-01307-2. [PMID: 37099261 DOI: 10.1007/s40264-023-01307-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2023] [Indexed: 04/27/2023]
Abstract
INTRODUCTION Pregabalin is an antiepileptic drug frequently prescribed to pregnant women. Risks of adverse birth and postnatal neurodevelopmental outcomes following prenatal exposure to pregabalin are uncertain. OBJECTIVE To investigate the association between prenatal exposure to pregabalin and the risks of adverse birth and postnatal neurodevelopmental outcomes. METHODS This study was conducted using population-based registries in Denmark, Finland, Norway, and Sweden (2005-2016). We compared pregabalin exposure against no exposure to antiepileptics and against active comparators lamotrigine and duloxetine. We obtained pooled propensity score-adjusted estimates of association using fixed-effect and Mantel-Haenszel (MH) meta-analyses. RESULTS The total number of pregabalin-exposed births was 325/666,139 (0.05%) in Denmark, 965/643,088 (0.15%) in Finland, 307/657,451 (0.05%) in Norway, and 1275/1,152,002 (0.11%) in Sweden. The adjusted prevalence ratios (aPRs) with 95% confidence interval (CI) following pregabalin exposure versus no exposure were 1.14 (0.98-1.34) for major congenital malformations and 1.72 (1.02-2.91) for stillbirth, which attenuated to 1.25 (0.74-2.11) in MH meta-analysis. For the remaining birth outcomes, the aPRs were close to or attenuated toward unity in analyses using active comparators. Adjusted hazard ratios (95% CI) contrasting prenatal pregabalin exposure versus no exposure were 1.29 (1.03-1.63) for ADHD and attenuated when using active comparators, 0.98 (0.67-1.42) for autism spectrum disorders, and 1.00 (0.78-1.29) for intellectual disability. CONCLUSIONS Prenatal exposure to pregabalin was not associated with low birth weight, preterm birth, small for gestational age, low Apgar score, microcephaly, autism spectrum disorders, or intellectual disability. On the basis of the upper value of the 95% confidence interval, increased risks greater than 1.8 were unlikely for any major congenital malformation and ADHD. For stillbirth and most groups of specific major congenital malformations, the estimates attenuated in MH meta-analysis.
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Affiliation(s)
- Elena Dudukina
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark.
| | - Szimonetta Komjáthiné Szépligeti
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark
| | - Pär Karlsson
- Centre for Pharmacoepidemiology, Karolinska Institutet, Karolinska University Hospital, 171 76, Stockholm, Sweden
| | - Kofi Asomaning
- Pfizer Inc., 500 Arcola Road, Collegeville, PA, 19426, USA
| | - Anne Kjersti Daltveit
- Department of Global Public Health and Primary Care, University of Bergen, Årstadveien 17, 5009, Bergen, Norway
- Department of Health Registries, Norwegian Institute of Public Health, Bergen, Norway
| | - Katja Hakkarainen
- Global Database Studies, Real World Solutions, IQVIA, Pyramidvägen 7, 169 56, Solna, Sweden
| | - Fabian Hoti
- Global Database Studies, Real World Solutions, IQVIA, Spektri, Duo Building, Metsänneidonkuja 6, 02130, Espoo, Finland
| | - Helle Kieler
- Centre for Pharmacoepidemiology, Karolinska Institutet, Karolinska University Hospital, 171 76, Stockholm, Sweden
| | - Astrid Lunde
- Department of Global Public Health and Primary Care, University of Bergen, Årstadveien 17, 5009, Bergen, Norway
| | - Ingvild Odsbu
- Centre for Pharmacoepidemiology, Karolinska Institutet, Karolinska University Hospital, 171 76, Stockholm, Sweden
- Department of Mental Disorders, Norwegian Institute of Public Health, Sandakerveien 24c, Bygg B, 0473, Oslo, Norway
| | - Matti Rantanen
- Global Database Studies, Real World Solutions, IQVIA, Spektri, Duo Building, Metsänneidonkuja 6, 02130, Espoo, Finland
| | - Johan Reutfors
- Centre for Pharmacoepidemiology, Karolinska Institutet, Karolinska University Hospital, 171 76, Stockholm, Sweden
| | - Laura Saarelainen
- Global Database Studies, Real World Solutions, IQVIA, Spektri, Duo Building, Metsänneidonkuja 6, 02130, Espoo, Finland
| | - Vera Ehrenstein
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark
| | - Gunnar Toft
- Steno Diabetes Center Aarhus, Palle Juul-Jensens Boulevard 11, 8200, Aarhus N, Denmark
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Harris BA, Huntington N, Sideridis G, Chan E. Referring Attention-Deficit/Hyperactivity Disorder: Gaining Perspective From Advanced Practice Providers in Primary Care. Clin Pediatr (Phila) 2022:99228221143916. [PMID: 36495191 DOI: 10.1177/00099228221143916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The objective of the current study is to identify provider, patient, and family characteristics associated with pediatric advanced practice provider (APP) decisions to refer to a subspecialist for diagnosis and management of attention-deficit/hyperactivity disorder (ADHD). We conducted a cross-sectional electronic survey of pediatric primary care APPs using member lists of professional organizations. T tests and chi-square analysis were conducted to identify group differences. Most respondents rated themselves as comfortable diagnosing and managing ADHD. We found no significant difference between groups based on comfort level or likelihood to refer. APPs working in suburban settings report significantly lower levels of comfort. Self-designation as the practice's primary provider for behavioral/mental health concerns had significantly higher levels of comfort and were less likely to refer. In a limited sample, most APPs reported comfort diagnosing and managing ADHD. Activities to identify and ameliorate gaps in ADHD knowledge and care need to consider this growing part of the workforce.
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Affiliation(s)
- Brian A Harris
- Division of Developmental Medicine, Boston Children's Hospital, Boston, MA, USA.,Orlando Health Arnold Palmer Hospital Pediatric Behavioral Health and Development Center, Orlando, FL, USA
| | - Noelle Huntington
- Division of Developmental Medicine, Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Georgios Sideridis
- Division of Developmental Medicine, Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Eugenia Chan
- Division of Developmental Medicine, Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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ADHD in children and young people: prevalence, care pathways, and service provision. Lancet Psychiatry 2018; 5:175-186. [PMID: 29033005 DOI: 10.1016/s2215-0366(17)30167-0] [Citation(s) in RCA: 546] [Impact Index Per Article: 91.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 03/30/2017] [Accepted: 03/30/2017] [Indexed: 12/17/2022]
Abstract
Attention-deficit hyperactivity disorder (ADHD) is a common childhood behavioural disorder. Systematic reviews indicate that the community prevalence globally is between 2% and 7%, with an average of around 5%. At least a further 5% of children have substantial difficulties with overactivity, inattention, and impulsivity that are just under the threshold to meet full diagnostic criteria for ADHD. Estimates of the administrative prevalence (clinically diagnosed or recorded) vary worldwide, and have been increasing over time. However, ADHD is still relatively under-recognised and underdiagnosed in most countries, particularly in girls and older children. ADHD often persists into adulthood and is a risk factor for other mental health disorders and negative outcomes, including educational underachievement, difficulties with employment and relationships, and criminality. The timely recognition and treatment of children with ADHD-type difficulties provides an opportunity to improve long-term outcomes. This Review includes a systematic review of the community and administrative prevalence of ADHD in children and adolescents, an overview of barriers to accessing care, a description of associated costs, and a discussion of evidence-based pathways for the delivery of clinical care, including a focus on key issues for two specific age groups-younger children (aged ≤6 years) and adolescents requiring transition of care from child to adult services.
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Duric NS, Assmus J, Gundersen D, Duric Golos A, Elgen IB. Multimodal treatment in children and adolescents with attention-deficit/hyperactivity disorder: a 6-month follow-up. Nord J Psychiatry 2017; 71:386-394. [PMID: 28345387 DOI: 10.1080/08039488.2017.1305446] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Different treatment approaches aimed 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 standard stimulant medication (methylphenidate) 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 randomized 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 questionnaire. 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.
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Affiliation(s)
- Nezla S Duric
- a Department of Child and Adolescent Psychiatry , Helse Fonna , Haugesund , Norway
| | - Jørg Assmus
- b Centre for Clinical Research, Helse Bergen , Norway
| | - Doris Gundersen
- c Department of Research and Innovation , Helse Fonna HF , Haugesund , Norway
| | - Alisa Duric Golos
- d Department of Clinical Medicine , University of Sarajevo , Bosnia & Herzegovina
| | - Irene B Elgen
- e Department of Child and Adolescent Psychiatry , Haukeland University Hospital , Bergen , Norway.,f Department of Clinical Medicine , University of Bergen , Norway
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Hassink-Franke LJA, Janssen MMM, Oehlen G, van Deurzen PAM, Buitelaar JK, Wensing M, Lucassen PLBJ. GPs' experiences with enhanced collaboration between psychiatry and general practice for children with ADHD. Eur J Gen Pract 2016; 22:196-202. [PMID: 27261089 DOI: 10.1080/13814788.2016.1177506] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Most general practitioners (GPs) do not feel comfortable with diagnosing and treating children with attention deficit hyperactivity disorder (ADHD). This is problematic since ADHD is a prevalent disorder and an active role of GPs is desired. In the Netherlands a collaborative ADHD programme was established, comprising of shortened diagnostic assessment in specialized mental healthcare followed by psycho-education in mental healthcare and pharmacological treatment by pre-trained GPs. OBJECTIVES To explore the experiences of GPs regarding the diagnosis and treatment of children with uncomplicated ADHD within this programme. METHODS Semi-structured interviews with 15 GPs were conducted. The GPs participated in an evaluation of the collaborative ADHD programme. Data was analysed using the principles of constant comparative analysis. RESULTS Most participating GPs expressed reluctance to diagnose ADHD themselves. The reluctance was due to a lack of time, knowledge and experience. The GPs welcomed the collaborative programme because it met their need for both quick and adequate diagnosis by a specialist. Furthermore, an online ADHD course, offered by the programme, gave them the confidence to start and monitor ADHD medication. Finally, they appreciated the possibility of consulting a specialist when necessary. CONCLUSION GPs preferred that ADHD was diagnosed by a specialist. In the context of the ADHD collaborative programme, they felt competent and comfortable to start and monitor medication in children with uncomplicated ADHD. Key Messages Within a collaborative ADHD programme for children, participating GPs were positive about a quick and specialist diagnostic process within secondary care. After an online course, GPs felt confident to start and monitor ADHD medication in children with uncomplicated ADHD. GPs were content about the collaboration between primary and secondary care.
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Affiliation(s)
- Lieke J A Hassink-Franke
- a Department of Primary and Community Care , Radboud University Medical Centre , Nijmegen , the Netherlands
| | - Mijnke M M Janssen
- b Karakter Child and Adolescent Psychiatry University Centre , Nijmegen , The Netherlands
| | - Guy Oehlen
- a Department of Primary and Community Care , Radboud University Medical Centre , Nijmegen , the Netherlands
| | | | - Jan K Buitelaar
- b Karakter Child and Adolescent Psychiatry University Centre , Nijmegen , The Netherlands ;,c Department of Cognitive Neuroscience , Radboud University Medical Centre , Nijmegen , the Netherlands
| | - Michel Wensing
- d Scientific Institute for Quality of Healthcare, Radboud University Medical Centre , Nijmegen , the Netherlands
| | - Peter L B J Lucassen
- a Department of Primary and Community Care , Radboud University Medical Centre , Nijmegen , the Netherlands
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Russell AE, Ford T, Williams R, Russell G. The Association Between Socioeconomic Disadvantage and Attention Deficit/Hyperactivity Disorder (ADHD): A Systematic Review. Child Psychiatry Hum Dev 2016; 47:440-58. [PMID: 26266467 DOI: 10.1007/s10578-015-0578-3] [Citation(s) in RCA: 215] [Impact Index Per Article: 26.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This systematic review examines associations between parental socioeconomic disadvantage and childhood attention deficit/hyperactivity disorder (ADHD). Socioeconomic status (SES) was measured by parental income, education, occupation and marital status. Results were mixed by measure of SES with no one aspect being differentially related to ADHD. 42 studies were included in the review, of which 35 found a significant univariate association between socioeconomic disadvantage and ADHD. Meta-analyses of dimensions of SES and their association with ADHD indicate that children in families of low SES are on average 1.85-2.21 more likely to have ADHD than their peers in high SES families. In spite of substantial between-study heterogeneity, there is evidence for an association between socioeconomic disadvantage and risk of ADHD measured in different ways. This is likely mediated by factors linked to low SES such as parental mental health and maternal smoking during pregnancy.
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Affiliation(s)
- Abigail Emma Russell
- Institute of Health Research, University of Exeter Medical School, South Cloisters, St Luke's Campus, Exeter, EX1 2LU, UK.
| | - Tamsin Ford
- Institute of Health Research, University of Exeter Medical School, South Cloisters, St Luke's Campus, Exeter, EX1 2LU, UK
| | - Rebecca Williams
- Department of Psychology, College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | - Ginny Russell
- ESRC Centre for Genomics in Society (Egenis) and Institute of Health Research, University of Exeter Medical School, Exeter, UK
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Baweja R, Mattison RE, Waxmonsky JG. Impact of Attention-Deficit Hyperactivity Disorder on School Performance: What are the Effects of Medication? Paediatr Drugs 2015; 17:459-77. [PMID: 26259966 DOI: 10.1007/s40272-015-0144-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Attention-deficit hyperactivity disorder (ADHD) affects an estimated 5-7 % of schoolchildren worldwide. School functioning and academic achievement are frequently impaired by ADHD and represent one of the main reasons children start ADHD medication. Multiple potential causal pathways exist between ADHD and impaired school performance. In this review, we decompose school performance into three components and assess the impact of ADHD and its treatments on academic performance (assessed by grade point average [GPA], time on-task, percentage of work completed as well as percent completed correctly), academic skills (as measured by achievement tests and cognitive measures), and academic enablers (such as study skills, motivation, engagement, classroom behavior and interpersonal skills). Most studies examined only the short-term effects of medication on school performance. In these, ADHD medications have been observed to improve some aspects of school performance, with the largest impact on measures of academic performance such as seatwork productivity and on-task performance. In a subset of children, these benefits may translate into detectable improvements in GPA and achievement testing. However, limited data exists to support whether these changes are sustained over years. Optimizing medication effects requires periodic reassessment of school performance, necessitating a collaborative effort involving patients, parents, school staff and prescribers. Even with systematic reassessment, behavioral-based treatments and additional school-based services may be needed to maximize academic performance for the many youth with ADHD and prominent impairments in school performance.
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Affiliation(s)
- Raman Baweja
- Department of Psychiatry, Penn State University College of Medicine, 500 University Drive, H073, Hershey, PA, 17033-0850, USA.
| | - Richard E Mattison
- Department of Psychiatry, Penn State University College of Medicine, 500 University Drive, H073, Hershey, PA, 17033-0850, USA
| | - James G Waxmonsky
- Department of Psychiatry, Penn State University College of Medicine, 500 University Drive, H073, Hershey, PA, 17033-0850, USA
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Social adversity and regional differences in prescribing of ADHD medication for school-age children. J Dev Behav Pediatr 2015; 36:330-41. [PMID: 25997081 DOI: 10.1097/dbp.0000000000000170] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To explore whether regional variations in the initiation of attention-deficit hyperactivity disorder (ADHD) medication among school-age children are explained by differences in sociodemographic composition and/or ADHD prescribing practice, especially in children who face social adversity (low parental education and single parenthood). METHODS A cohort of Danish school-age children (ages 5-17) without previous psychiatric conditions (N = 813,416) was followed during 2010-2011 for incident ADHD prescribing in the individual-level Danish registers. Register information was retrieved for both children and their parents. Regional differences were decomposed into contributions from differences in sociodemographic composition and in prescribing practices. Incidence rate ratios (IRR) with 95% confidence interval (CI) of ADHD prescribing were calculated using demographically standardized multivariable Poisson regression models. RESULTS Compared with the Capital, prescribing rates were significantly higher in regions North and Zealand (IRR, 1.19; 95% CI, 1.08-1.32 and 1.17; 1.08-1.28, respectively) and lower in South (IRR, 0.60; 95% CI, 0.54-0.66). After inclusion of the interaction term (region*social adversity), the multivariable analyses revealed a higher rate for the most disadvantaged children in North (IRR, 2.00; 95% CI, 1.51-2.66) and a lower rate in South (IRR, 0.47; 95% CI, 0.3-0.65). Prescribing rates were the highest for disadvantaged children in all regions, demonstrating the steepest social gradient in North and the smoothest in South. Demographic composition explained little of the variation: 3% for North and 13% for Zealand. CONCLUSIONS Differences in sociodemographic composition explain little of regional variation in incident ADHD prescribing for children. However, large regional differences prevail in prescribing practices for children facing social adversity, indicating that local cultures shape the interpretation and handling of children with ADHD-like behaviors.
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Duric NS, Aßmus J, Elgen IB. Self-reported efficacy of neurofeedback treatment in a clinical randomized controlled study of ADHD children and adolescents. Neuropsychiatr Dis Treat 2014; 10:1645-54. [PMID: 25214789 PMCID: PMC4159126 DOI: 10.2147/ndt.s66466] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Many non-pharmacological treatments for children and adolescents with attention-deficit/hyperactivity disorder (ADHD) have been attempted, but reports indicate that most are ineffective. Although neurofeedback (NF) is a treatment approach for children with ADHD that remains promising, a variety of appropriate measures have been used in reporting and evaluating its effect. OBJECTIVE To report the self-evaluations of NF treatment by children and adolescents with ADHD. METHODS Randomized controlled trial in 91 children and adolescents with ADHD, aged less than 18 years (mean, 11.2 years) participated in a 30-session program of intensive NF treatment. Participants were randomized and allocated by sequentially numbered sealed envelopes into three groups: methylphenidate (MPH) as an active control group, and two trial groups NF with MPH, and NF alone. ADHD core symptoms and school performance were given on a scale of 1 to 10 using a self-reporting questionnaire, and the changes in these scores after treatment were used as the self-reported evaluation. Basic statistical methods (descriptive, analyses of variance, exact χ (2) test, and paired t-test) were used to investigate the baseline data. Changes in ADHD core symptoms and treatment effects were investigated using a general linear model for repeated measures. RESULTS Eighty participants completed the treatment study and 73 (91%) responded sufficiently on the self-reporting questionnaires. The treatment groups were comparable in age, sex, and cognition as well as in the baseline levels of core ADHD symptoms. All treatments resulted in significant improvements regarding attention and hyperactivity (P<0.001), and did not differ from each other in effectiveness. However, a significant treatment effect in school performance was observed (P=0.042), in which only the NF group showed a significant improvement. CONCLUSION The self-reported improvements in ADHD core symptoms and school performance shortly after treatment indicate NF treatment being promising in comparison with medication, suggesting NF as an alternative treatment for children and adolescents who do not respond to MPH, or who suffer side effects. Further long-term follow-up is needed.
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Affiliation(s)
- Nezla S Duric
- Department of Clinical Medicine, University of Bergen, Bergen, Norway ; Center for Child and Adolescent Mental Health, University of Bergen, Bergen, Norway ; Department of Child and Adolescent Psychiatry, Helse Fonna Haugesund Hospital, Haugesund, Norway
| | - Jörg Aßmus
- Center for Clinical Research, Haukeland University Hospital, Bergen, Norway
| | - Irene B Elgen
- Department of Clinical Medicine, University of Bergen, Bergen, Norway ; Department of Child and Adolescent Psychiatry, Haukeland University Hospital, Bergen, Norway
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Duric NS, Assmus J, Gundersen D, Elgen IB. Neurofeedback for the treatment of children and adolescents with ADHD: a randomized and controlled clinical trial using parental reports. BMC Psychiatry 2012; 12:107. [PMID: 22877086 PMCID: PMC3441233 DOI: 10.1186/1471-244x-12-107] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Accepted: 07/18/2012] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND A randomized and controlled clinical study was performed to evaluate the use of neurofeedback (NF) to treat attention-deficit/hyperactivity disorder (ADHD) in children and adolescents. METHODS The ADHD population was selected from an outpatient clinic for Child and Adolescent Mental Health in Norway. Ninety-one of the 275 children and adolescents ranging in age from 6 to 18 years (10.5 years) participated in 30 sessions of an intensive NF program. The reinforcement contingency was based on the subjects' production of cortical beta1 activity (15-18 Hz). The ADHD participants were randomized into three groups, with 30 in the NF group, 31 controls in a group that was given methylphenidate, and 30 in a group that received NF and methylphenidate. ADHD core symptoms were reported by parents using the parent form of the Clinician's Manual for Assessment by Russell A. Barkley. RESULTS Ninety-one children and adolescents were effectively randomized by age, sex, intelligence and distribution of ADHD core symptoms. The parents reported significant effects of the treatments, but no significant differences between the treatment groups were observed. CONCLUSIONS NF was as effective as methylphenidate at treating the attentional and hyperactivity symptoms of ADHD, based on parental reports. TRIAL REGISTRATION Current Controlled Trials NCT01252446.
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Affiliation(s)
- Nezla S Duric
- Department of Child and Adolescent Psychiatry, Helse Fonna Haugesund Hospital, Haugesund 5501, Norway.
| | - Jørg Assmus
- Center for Clinical Research, Haukeland University Hospital, Bergen, Norway
| | - Doris Gundersen
- Department of Research, Helse Fonna Haugesund Hospital, Haugesund, Norway
| | - Irene B Elgen
- Department of Child and Adolescent Psychiatry, Haukeland University Hospital, Haukeland, Norway,Department of Clinical Medicine, University of Bergen, Bergen, Norway
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