human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background : Treatment for children with attention deficit/hyperactivity disorder ( ADHD ) today is predominantly pharmacological . While it is the most common treatment , it might not always be the most appropriate one . Moreover , long term effects remain unclear . Behavior therapy ( BT ) and non-pharmacological treatments such as neurofeedback ( NF ) are promising alternatives , though there are no routine outpatient care/effectiveness studies yet that have included children with medication or changes in medication . Methods / design : This paper presents the protocol of a r and omized controlled trial to compare the effectiveness of a Slow Cortical Potential ( SCP ) NF protocol with self-management ( SM ) in a high frequent outpatient care setting . Both groups ( NF/SM ) receive a total of 30 high frequent therapy sessions . Additionally , 6 sessions are reserved for comorbid problems . The primary outcome measure is the reduction of ADHD core symptoms according to parent and teacher ratings . Preliminary Results : Untill now 58 children were included in the study ( 48 males ) , with a mean age of 8.42 ( 1.34 ) years , and a mean IQ of 110 ( 13.37 ) . Conners-3 parent and teacher ratings were used to estimate core symptom change . Since the study is still ongoing , and children are in different study stages , pre-post and follow-up results are not yet available for all children included . Preliminary results suggest overall good pre-post effects , though . For parent and teacher ratings an ANOVA with repeated measures yielded overall satisfying pre-post effects ( η2 0.175–0.513 ) . Differences between groups ( NF vs. SM ) could not yet be established ( p = 0.81 ) . Discussion : This is the first r and omized controlled trial to test the effectiveness of a NF protocol in a high frequent outpatient care setting that does not exclude children on or with changes in medication . First preliminary results show positive effects . The rationale for the trial , the design , and the strengths and limitations of the study are discussed . Trial registration : This trial is registered in www . clinical trials.gov as NCT01879644 Abstract Background : Different treatment approaches aim ed at reducing attention-deficit/hyperactivity disorder ( ADHD ) core symptoms are available . However , factors such as intolerance , side-effects , lack of efficacy , high new technology costs , and placebo effect have spurred on an increasing interest in alternative or complementary treatment . Aim : The aim of this study is to explore efficacy of multimodal treatment consisting of st and ard stimulant medication ( methylpheni date ) and neurofeedback ( NF ) in combination , and to compare it with the single treatment in 6-month follow-up in ADHD children and adolescents . Methods : This r and omized controlled trial with 6-month follow-up comprised three treatment arms : multimodal treatment ( NF + MED ) , MED alone , and NF alone .  A total of 130 ADHD children/adolescents participated , and 62 % completed the study .  ADHD core symptoms were recorded pre-/post-treatment , using parents ’ and teachers ’ forms taken from Barkley ’s Defiant Children : A Clinician ’s Manual for Assessment and Parent Training , and a self-report question naire . Results : Significant ADHD core symptom improvements were reported 6 months after treatment completion by parents , teachers , and participants in all three groups , with marked improvement in inattention in all groups . However , no significant improvements in hyperactivity or academic performance were reported by teachers or self-reported by children/adolescents , respectively , in the three groups . Changes obtained with multimodal treatment at 6-month follow-up were comparable to those with single medication treatment , as reported by all participants . Conclusions : Multimodal treatment using combined stimulant medication and NF showed 6-month efficacy in ADHD treatment . More research is needed to explore whether multimodal treatment is suitable for ADHD children and adolescents who showed a poor response to single medication treatment , and for those who want to reduce the use of stimulant medication Background Estimates of the effectiveness of neurofeedback as a treatment for attention-deficit hyperactivity disorder ( ADHD ) are mixed . Aims To investigate the long-term additional effects of neurofeedback ( NFB ) compared with treatment as usual ( TAU ) for adolescents with ADHD . Method Using a multicentre parallel-r and omised controlled trial design , 60 adolescents with a DSM-IV-TR diagnosis of ADHD receiving NFB+TAU ( n=41 ) or TAU ( n=19 ) were followed up .  Neurofeedback treatment consisted of approximately 37 sessions of theta/sensorimotor rhythm (SMR)-training on the vertex ( Cz ) . Outcome measures included behavioural self-reports and neurocognitive measures . Allocation to the conditions was unmasked . Results At 1-year follow-up , inattention as reported by adolescents was decreased ( range ηp2=0.23–0.36 , P<0.01 ) and performance on neurocognitive tasks was faster ( range ηp2=0.20–0.67 , P<0.005 ) irrespective of treatment group . Conclusions Overall , NFB+TAU was as effective as TAU . Given the absence of robust additional effects of neurofeedback in the current study , results do not support the use of theta/SMR neurofeedback as a treatment for adolescents with ADHD and comorbid disorders in clinical practice . Declaration of interest None . Copyright and usage © The Royal College of Psychiatrists 2016 . This is an open access article distributed under the terms of the Creative Commons Non-Commercial , No Derivatives ( CC BY-NC-ND ) licence Neurofeedback ( NF ) could help to improve attentional and self-management capabilities in children with attention-deficit/hyperactivity disorder ( ADHD ) . In a r and omised controlled trial , NF training was found to be superior to a computerised attention skills training ( AST ) ( Gevensleben et al. in J Child Psychol Psychiatry 50(7):780–789 , 2009 ) . In the present paper , treatment effects at 6-month follow-up were studied . 94 children with ADHD , aged 8–12 years , completed either 36 sessions of NF training ( n = 59 ) or a computerised AST ( n = 35 ) . Pre-training , post-training and follow-up assessment encompassed several behaviour rating scales ( e.g. , the German ADHD rating scale , FBB-HKS ) completed by parents . Follow-up information was analysed in 61 children ( ca . 65 % ) on a per- protocol basis . 17 children ( of 33 dropouts ) had started a medication after the end of the training or early in the follow-up period . Improvements in the NF group ( n = 38 ) at follow-up were superior to those of the control group ( n = 23 ) and comparable to the effects at the end of the training . For the FBB-HKS total score ( primary outcome measure ) , a medium effect size of 0.71 was obtained at follow-up . A reduction of at least 25 % in the primary outcome measure ( responder criterion ) was observed in 50 % of the children in the NF group . In conclusion , behavioural improvements induced by NF training in children with ADHD were maintained at a 6-month follow-up . Though treatment effects appear to be limited , the results confirm the notion that NF is a clinical ly efficacious module in the treatment of children with ADHD OBJECTIVE To test the hypotheses that in children with attention-deficit/hyperactivity disorder ( ADHD ) ( 1 ) symptoms of ADHD , oppositional defiant disorder , and overall functioning are significantly improved by methylpheni date combined with intensive multimodal psychosocial treatment compared with methylpheni date alone and with methylpheni date plus attention control and ( 2 ) more children receiving combined treatment can be taken off methylpheni date . METHOD One hundred three children with ADHD ( ages 7 - 9 ) , free of conduct and learning disorders , who responded to short-term methylpheni date were r and omized for 2 years to ( 1 ) methylpheni date alone ; ( 2 ) methylpheni date plus psychosocial treatment that included parent training and counseling , social skills training , psychotherapy , and academic assistance , or ( 3 ) methylpheni date plus attention psychosocial control treatment . Assessment s included parent , teacher , and psychiatrist ratings , and observations in academic and gym classes . RESULTS Combination treatment did not lead to superior functioning and did not facilitate methylpheni date discontinuation . Significant improvement occurred across all treatments and continued over 2 years . CONCLUSIONS In stimulant-responsive children with ADHD , there is no support for adding ambitious long-term psychosocial intervention to improve ADHD and oppositional defiant disorder symptoms . Significant benefits from methylpheni date were stable over 2 years OBJECTIVE : To evaluate sustained improvements 6 months after a 40-session , in-school computer attention training intervention using neurofeedback or cognitive training ( CT ) administered to 7- to 11-year-olds with attention-deficit/hyperactivity disorder ( ADHD ) . METHODS : One hundred four children were r and omly assigned to receive neurofeedback , CT , or a control condition and were evaluated 6 months postintervention . A 3-point growth model assessed change over time across the conditions on the Conners 3–Parent Assessment Report ( Conners 3-P ) , the Behavior Rating Inventory of Executive Function Parent Form ( BRIEF ) , and a systematic double-blinded classroom observation ( Behavioral Observation of Students in Schools ) . Analysis of variance assessed community-initiated changes in stimulant medication . RESULTS : Parent response rates were 90 % at the 6-month follow-up . Six months postintervention , neurofeedback participants maintained significant gains on Conners 3-P ( Inattention effect size [ ES ] = 0.34 , Executive Functioning ES = 0.25 , Hyperactivity/Impulsivity ES = 0.23 ) and BRIEF subscales including the Global Executive Composite ( ES = 0.31 ) , which remained significantly greater than gains found among children in CT and control conditions . Children in the CT condition showed delayed improvement over immediate postintervention ratings only on Conners 3-P Executive Functioning ( ES = 0.18 ) and 2 BRIEF subscales . At the 6-month follow-up , neurofeedback participants maintained the same stimulant medication dosage , whereas participants in both CT and control conditions showed statistically and clinical ly significant increases ( 9 mg [ P = .002 ] and 13 mg [ P < .001 ] , respectively ) . CONCLUSIONS : Neurofeedback participants made more prompt and greater improvements in ADHD symptoms , which were sustained at the 6-month follow-up , than did CT participants or those in the control group . This finding suggests that neurofeedback is a promising attention training treatment for children with ADHD OBJECTIVES To determine any long-term effects , 6 and 8 years after childhood enrollment , of the r and omly assigned 14-month treatments in the NIMH Collaborative Multisite Multimodal Treatment Study of Children With Attention-Deficit/Hyperactivity Disorder ( MTA ; N = 436 ) ; to test whether attention-deficit/hyperactivity disorder ( ADHD ) symptom trajectory through 3 years predicts outcome in subsequent years ; and to examine functioning level of the MTA adolescents relative to their non-ADHD peers ( local normative comparison group ; N = 261 ) . METHOD Mixed-effects regression models with planned contrasts at 6 and 8 years tested a wide range of symptom and impairment variables assessed by  parent , teacher , and youth report . RESULTS In nearly every analysis , the originally r and omized treatment groups did not differ significantly on repeated measures or newly analyzed variables ( e.g. , grade s earned in school , arrests , psychiatric hospitalizations , other clinical ly relevant outcomes ) . Medication use decreased by 62 % after the 14-month controlled trial , but adjusting for this did not change the results . ADHD symptom trajectory in the first 3 years predicted 55 % of the outcomes . The MTA participants fared worse than the local normative comparison group on 91 % of the variables tested . CONCLUSIONS Type or intensity of 14 months of treatment for ADHD in childhood ( at age 7.0 - 9.9 years ) does not predict functioning 6 to 8 years later . Rather , early ADHD symptom trajectory regardless of treatment type is prognostic . This finding implies that children with behavioral and sociodemographic advantage , with the best response to any treatment , will have the best long-term prognosis . As a group , however , despite initial symptom improvement during treatment that is largely maintained after treatment , children with combined-type ADHD exhibit significant impairment in adolescence . Innovative treatment approaches targeting specific areas of adolescent impairment are needed Abstract To assess the long-term effects of neurofeedback ( NFB ) in children with attention deficit hyperactivity disorder ( ADHD ) , we compared behavioral and neurocognitive outcomes at a 6-month naturalistic follow-up of a r and omized controlled trial on NFB , methylpheni date ( MPH ) , and physical activity ( PA ) .  Ninety-two children with a DSM-IV-TR ADHD diagnosis , aged 7–13 , receiving NFB ( n = 33 ) , MPH ( n = 28 ) , or PA ( n = 31 ) , were re-assessed 6-months after the interventions . NFB comprised theta/beta training on the vertex ( cortical zero ) . PA comprised moderate to vigorous intensity exercises . Outcome measures included parent and teacher behavioral reports , and neurocognitive measures ( auditory oddball , stop-signal , and visual spatial working memory tasks ) . At follow-up , longitudinal hierarchical multilevel model analyses revealed no significant group differences for parent reports and neurocognitive 
    Output:
    
agent
Compared to non-active control treatments , NF appears to have more durable treatment effects , for at least 6 months following treatment .
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background : Treatment for children with attention deficit/hyperactivity disorder ( ADHD ) today is predominantly pharmacological . While it is the most common treatment , it might not always be the most appropriate one . Moreover , long term effects remain unclear . Behavior therapy ( BT ) and non-pharmacological treatments such as neurofeedback ( NF ) are promising alternatives , though there are no routine outpatient care/effectiveness studies yet that have included children with medication or changes in medication . Methods / design : This paper presents the protocol of a r and omized controlled trial to compare the effectiveness of a Slow Cortical Potential ( SCP ) NF protocol with self-management ( SM ) in a high frequent outpatient care setting . Both groups ( NF/SM ) receive a total of 30 high frequent therapy sessions . Additionally , 6 sessions are reserved for comorbid problems . The primary outcome measure is the reduction of ADHD core symptoms according to parent and teacher ratings . Preliminary Results : Untill now 58 children were included in the study ( 48 males ) , with a mean age of 8.42 ( 1.34 ) years , and a mean IQ of 110 ( 13.37 ) . Conners-3 parent and teacher ratings were used to estimate core symptom change . Since the study is still ongoing , and children are in different study stages , pre-post and follow-up results are not yet available for all children included . Preliminary results suggest overall good pre-post effects , though . For parent and teacher ratings an ANOVA with repeated measures yielded overall satisfying pre-post effects ( η2 0.175–0.513 ) . Differences between groups ( NF vs. SM ) could not yet be established ( p = 0.81 ) . Discussion : This is the first r and omized controlled trial to test the effectiveness of a NF protocol in a high frequent outpatient care setting that does not exclude children on or with changes in medication . First preliminary results show positive effects . The rationale for the trial , the design , and the strengths and limitations of the study are discussed . Trial registration : This trial is registered in www . clinical trials.gov as NCT01879644 Abstract Background : Different treatment approaches aim ed at reducing attention-deficit/hyperactivity disorder ( ADHD ) core symptoms are available . However , factors such as intolerance , side-effects , lack of efficacy , high new technology costs , and placebo effect have spurred on an increasing interest in alternative or complementary treatment . Aim : The aim of this study is to explore efficacy of multimodal treatment consisting of st and ard stimulant medication ( methylpheni date ) and neurofeedback ( NF ) in combination , and to compare it with the single treatment in 6-month follow-up in ADHD children and adolescents . Methods : This r and omized controlled trial with 6-month follow-up comprised three treatment arms : multimodal treatment ( NF + MED ) , MED alone , and NF alone .  A total of 130 ADHD children/adolescents participated , and 62 % completed the study .  ADHD core symptoms were recorded pre-/post-treatment , using parents ’ and teachers ’ forms taken from Barkley ’s Defiant Children : A Clinician ’s Manual for Assessment and Parent Training , and a self-report question naire . Results : Significant ADHD core symptom improvements were reported 6 months after treatment completion by parents , teachers , and participants in all three groups , with marked improvement in inattention in all groups . However , no significant improvements in hyperactivity or academic performance were reported by teachers or self-reported by children/adolescents , respectively , in the three groups . Changes obtained with multimodal treatment at 6-month follow-up were comparable to those with single medication treatment , as reported by all participants . Conclusions : Multimodal treatment using combined stimulant medication and NF showed 6-month efficacy in ADHD treatment . More research is needed to explore whether multimodal treatment is suitable for ADHD children and adolescents who showed a poor response to single medication treatment , and for those who want to reduce the use of stimulant medication Background Estimates of the effectiveness of neurofeedback as a treatment for attention-deficit hyperactivity disorder ( ADHD ) are mixed . Aims To investigate the long-term additional effects of neurofeedback ( NFB ) compared with treatment as usual ( TAU ) for adolescents with ADHD . Method Using a multicentre parallel-r and omised controlled trial design , 60 adolescents with a DSM-IV-TR diagnosis of ADHD receiving NFB+TAU ( n=41 ) or TAU ( n=19 ) were followed up .  Neurofeedback treatment consisted of approximately 37 sessions of theta/sensorimotor rhythm (SMR)-training on the vertex ( Cz ) . Outcome measures included behavioural self-reports and neurocognitive measures . Allocation to the conditions was unmasked . Results At 1-year follow-up , inattention as reported by adolescents was decreased ( range ηp2=0.23–0.36 , P<0.01 ) and performance on neurocognitive tasks was faster ( range ηp2=0.20–0.67 , P<0.005 ) irrespective of treatment group . Conclusions Overall , NFB+TAU was as effective as TAU . Given the absence of robust additional effects of neurofeedback in the current study , results do not support the use of theta/SMR neurofeedback as a treatment for adolescents with ADHD and comorbid disorders in clinical practice . Declaration of interest None . Copyright and usage © The Royal College of Psychiatrists 2016 . This is an open access article distributed under the terms of the Creative Commons Non-Commercial , No Derivatives ( CC BY-NC-ND ) licence Neurofeedback ( NF ) could help to improve attentional and self-management capabilities in children with attention-deficit/hyperactivity disorder ( ADHD ) . In a r and omised controlled trial , NF training was found to be superior to a computerised attention skills training ( AST ) ( Gevensleben et al. in J Child Psychol Psychiatry 50(7):780–789 , 2009 ) . In the present paper , treatment effects at 6-month follow-up were studied . 94 children with ADHD , aged 8–12 years , completed either 36 sessions of NF training ( n = 59 ) or a computerised AST ( n = 35 ) . Pre-training , post-training and follow-up assessment encompassed several behaviour rating scales ( e.g. , the German ADHD rating scale , FBB-HKS ) completed by parents . Follow-up information was analysed in 61 children ( ca . 65 % ) on a per- protocol basis . 17 children ( of 33 dropouts ) had started a medication after the end of the training or early in the follow-up period . Improvements in the NF group ( n = 38 ) at follow-up were superior to those of the control group ( n = 23 ) and comparable to the effects at the end of the training . For the FBB-HKS total score ( primary outcome measure ) , a medium effect size of 0.71 was obtained at follow-up . A reduction of at least 25 % in the primary outcome measure ( responder criterion ) was observed in 50 % of the children in the NF group . In conclusion , behavioural improvements induced by NF training in children with ADHD were maintained at a 6-month follow-up . Though treatment effects appear to be limited , the results confirm the notion that NF is a clinical ly efficacious module in the treatment of children with ADHD OBJECTIVE To test the hypotheses that in children with attention-deficit/hyperactivity disorder ( ADHD ) ( 1 ) symptoms of ADHD , oppositional defiant disorder , and overall functioning are significantly improved by methylpheni date combined with intensive multimodal psychosocial treatment compared with methylpheni date alone and with methylpheni date plus attention control and ( 2 ) more children receiving combined treatment can be taken off methylpheni date . METHOD One hundred three children with ADHD ( ages 7 - 9 ) , free of conduct and learning disorders , who responded to short-term methylpheni date were r and omized for 2 years to ( 1 ) methylpheni date alone ; ( 2 ) methylpheni date plus psychosocial treatment that included parent training and counseling , social skills training , psychotherapy , and academic assistance , or ( 3 ) methylpheni date plus attention psychosocial control treatment . Assessment s included parent , teacher , and psychiatrist ratings , and observations in academic and gym classes . RESULTS Combination treatment did not lead to superior functioning and did not facilitate methylpheni date discontinuation . Significant improvement occurred across all treatments and continued over 2 years . CONCLUSIONS In stimulant-responsive children with ADHD , there is no support for adding ambitious long-term psychosocial intervention to improve ADHD and oppositional defiant disorder symptoms . Significant benefits from methylpheni date were stable over 2 years OBJECTIVE : To evaluate sustained improvements 6 months after a 40-session , in-school computer attention training intervention using neurofeedback or cognitive training ( CT ) administered to 7- to 11-year-olds with attention-deficit/hyperactivity disorder ( ADHD ) . METHODS : One hundred four children were r and omly assigned to receive neurofeedback , CT , or a control condition and were evaluated 6 months postintervention . A 3-point growth model assessed change over time across the conditions on the Conners 3–Parent Assessment Report ( Conners 3-P ) , the Behavior Rating Inventory of Executive Function Parent Form ( BRIEF ) , and a systematic double-blinded classroom observation ( Behavioral Observation of Students in Schools ) . Analysis of variance assessed community-initiated changes in stimulant medication . RESULTS : Parent response rates were 90 % at the 6-month follow-up . Six months postintervention , neurofeedback participants maintained significant gains on Conners 3-P ( Inattention effect size [ ES ] = 0.34 , Executive Functioning ES = 0.25 , Hyperactivity/Impulsivity ES = 0.23 ) and BRIEF subscales including the Global Executive Composite ( ES = 0.31 ) , which remained significantly greater than gains found among children in CT and control conditions . Children in the CT condition showed delayed improvement over immediate postintervention ratings only on Conners 3-P Executive Functioning ( ES = 0.18 ) and 2 BRIEF subscales . At the 6-month follow-up , neurofeedback participants maintained the same stimulant medication dosage , whereas participants in both CT and control conditions showed statistically and clinical ly significant increases ( 9 mg [ P = .002 ] and 13 mg [ P < .001 ] , respectively ) . CONCLUSIONS : Neurofeedback participants made more prompt and greater improvements in ADHD symptoms , which were sustained at the 6-month follow-up , than did CT participants or those in the control group . This finding suggests that neurofeedback is a promising attention training treatment for children with ADHD OBJECTIVES To determine any long-term effects , 6 and 8 years after childhood enrollment , of the r and omly assigned 14-month treatments in the NIMH Collaborative Multisite Multimodal Treatment Study of Children With Attention-Deficit/Hyperactivity Disorder ( MTA ; N = 436 ) ; to test whether attention-deficit/hyperactivity disorder ( ADHD ) symptom trajectory through 3 years predicts outcome in subsequent years ; and to examine functioning level of the MTA adolescents relative to their non-ADHD peers ( local normative comparison group ; N = 261 ) . METHOD Mixed-effects regression models with planned contrasts at 6 and 8 years tested a wide range of symptom and impairment variables assessed by  parent , teacher , and youth report . RESULTS In nearly every analysis , the originally r and omized treatment groups did not differ significantly on repeated measures or newly analyzed variables ( e.g. , grade s earned in school , arrests , psychiatric hospitalizations , other clinical ly relevant outcomes ) . Medication use decreased by 62 % after the 14-month controlled trial , but adjusting for this did not change the results . ADHD symptom trajectory in the first 3 years predicted 55 % of the outcomes . The MTA participants fared worse than the local normative comparison group on 91 % of the variables tested . CONCLUSIONS Type or intensity of 14 months of treatment for ADHD in childhood ( at age 7.0 - 9.9 years ) does not predict functioning 6 to 8 years later . Rather , early ADHD symptom trajectory regardless of treatment type is prognostic . This finding implies that children with behavioral and sociodemographic advantage , with the best response to any treatment , will have the best long-term prognosis . As a group , however , despite initial symptom improvement during treatment that is largely maintained after treatment , children with combined-type ADHD exhibit significant impairment in adolescence . Innovative treatment approaches targeting specific areas of adolescent impairment are needed Abstract To assess the long-term effects of neurofeedback ( NFB ) in children with attention deficit hyperactivity disorder ( ADHD ) , we compared behavioral and neurocognitive outcomes at a 6-month naturalistic follow-up of a r and omized controlled trial on NFB , methylpheni date ( MPH ) , and physical activity ( PA ) .  Ninety-two children with a DSM-IV-TR ADHD diagnosis , aged 7–13 , receiving NFB ( n = 33 ) , MPH ( n = 28 ) , or PA ( n = 31 ) , were re-assessed 6-months after the interventions . NFB comprised theta/beta training on the vertex ( cortical zero ) . PA comprised moderate to vigorous intensity exercises . Outcome measures included parent and teacher behavioral reports , and neurocognitive measures ( auditory oddball , stop-signal , and visual spatial working memory tasks ) . At follow-up , longitudinal hierarchical multilevel model analyses revealed no significant group differences for parent reports and neurocognitive 
    Output:
    