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: The purpose of this study was to examine in a controlled trial the effects of atomoxetine on the management of attention deficit-hyperactivity disorder ( ADHD ) symptoms and functional impairments at school and at home . Participants were 153 children ( age 8 to 12 years ) diagnosed with attention-deficit hyperactivity disorder who were r and omized to double-blind treatment with either atomoxetine  ( n = 101 ) or placebo  ( n = 52 ) . Findings revealed significant improvements both for parent and teacher ratings of behavior for children receiving atomoxetine therapy . Children also were reported to evidence a trend toward better response to active medication than to placebo for health-related quality of life as rated by parents . No significant effects were revealed for the teacher ratings of academic productivity . Data were interpreted to provide support for the efficacy of atomoxetine on the symptoms associated with ADHD . The effects of atomoxetine on other functional outcomes including academic performance and health-related outcomes are of interest , albeit less compelling for this particular investigation , than for the effects on overt symptom display BACKGROUND Despite the persistence of attention-deficit/hyperactivity disorder ( ADHD ) into adolescence , little is known about the efficacy and tolerability of stimulant medications in this age group . OBJECTIVE To report the results of a multisite controlled study among adolescents with ADHD evaluating the efficacy and tolerability of osmotic-release oral system ( OROS ) methylpheni date . DESIGN Adolescents ( N = 220 ) having a confirmed Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition diagnosis of ADHD underwent dose titration to identify dosages of OROS methylpheni date that improved symptoms to predefined criteria . Subjects successfully completing the dose titration phase ( n = 177 ) ( ie , tolerated and responded to treatment and adhered to the protocol ) were r and omized to receive 2 weeks ' treatment with their individualized dosage of OROS methylpheni date ( 18 , 36 , 54 , or 72 mg once daily ) or placebo .  Treatment effectiveness was measured using investigator , parent , and adolescent assessment s of ADHD . RESULTS A significant reduction from baseline in the investigator-rated ADHD Rating Scale , the primary efficacy measure , was found with OROS methylpheni date treatment compared with placebo . Similar findings were noted with parent- and adolescent-report measures . Based on a Clinical Global Impression improvement subscale score of much or very much improved , 52 % of subjects in the OROS methylpheni date group improved compared with 31 % receiving placebo . Thirty-seven percent of subjects required the maximum dosage of 72 mg/d . The incidence of drug-related adverse events was similar between the 2 study groups . CONCLUSION In adolescents , once-daily OROS methylpheni date significantly reduced ADHD symptoms and was well tolerated using dosages up to 72 mg/d INTRODUCTION Lisdexamfetamine dimesylate ( LDX ) , a prodrug stimulant , is indicated for attention-deficit/hyperactivity disorder ( ADHD ) in children 6 - 12 years of age and in adults . In short-term studies , once-daily LDX provided efficacy throughout the day . This study presented here was conducted to assess the long-term safety , tolerability , and effectiveness of LDX in 6- to 12-year-olds with ADHD . METHODS This open-label , multicenter , single-arm study enrolled children with Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition-Text Revision criteria for ADHD . Following 1-week screening and washout periods , subjects were titrated to LDX 30 , 50 , or 70 mg/day over 4 weeks and placed on maintenance treatment for 11 months . The ADHD Rating Scale and Clinical Global Impression-Improvement scale measured effectiveness . RESULTS Of 272 subjects receiving LDX , 147 completed the study . Most adverse events were mild to moderate and occurred during the first 4 weeks . There were no clinical ly meaningful changes in blood pressure or electrocardiographic parameters . From baseline to endpoint , mean ADHD Rating Scale scores improved by 27.2 points ( P<.0001 ) . Improvements occurred during each of the first 4 weeks , and were maintained throughout . Based on Clinical Global Impression-Improvement scale scores , > 80 % of subjects at endpoint and > 95 % of completers at 12 months were rated " improved . " CONCLUSION Long-term 30 , 50 , and 70 mg/day LDX was generally well tolerated and effective in 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 The efficacy and safety of dexmethylpheni date extended release ( d-MPH-ER ) was compared to placebo in pediatric patients with attention-deficit/hyperactivity disorder ( ADHD ) . METHOD This multicenter , r and omized , double-blind , placebo-controlled , parallel-group , two-phase study included 97 patients ( ages 6 - 17 years ) with DSM-IV-defined ADHD . The study was carried out between 2001 and 2003 . After a 2-week evaluation phase , patients were r and omized to d-MPH-ER or placebo for 7 weeks . Flexible d-MPH-ER dosing ( 30 mg/day ) was permitted for 5 weeks , then patients remained on their optimal dose during the last 2 study weeks . The primary efficacy measure was change from baseline to final rating in Conners ADHD/DSM-IV Scale-Teacher version ( CADS-T ) total subscale score . Secondary efficacy variables included changes from baseline to final visit in CADS-T Inattentive and Hyperactive-Impulsive subscale scores , CADS-P DSM-IV total subscale score and Inattentive and Hyperactive-Impulsive subscale scores , Clinical Global Impressions-Improvement ( CGI-I ) and CGI-Severity ( CGI-S ) scale scores , and Child Health Question naire Parent Form 50 scores . RESULTS d-MPH-ER improved CADS-T total scores significantly compared with placebo ( p < .001 ) , and 67.3 % of d-MPH-ER patients were rated much improved or very much improved on CGI-I at final visit versus 13.3 % of placebo patients ( p < .001 ) . More patients taking d-MPH-ER ( 49.1 % ) than placebo ( 25.5 % ) spontaneously reported adverse events suspected as drug related . CONCLUSIONS Once-daily d-MPH-ER was more effective than placebo in the treatment of ADHD in children and adolescents Objective : To review the primary and secondary findings from the Multimodal Treatment study of ADHD ( MTA ) published over the past decade as three sets of articles . Method : In a two-part article — Part I : Executive Summary ( without distracting details ) and Part II : Supporting Details ( with additional background and detail required by the complexity of the MTA)—we address confusion and controversy about the findings . Results : We discuss the basic features of the gold st and ard used to produce scientific evidence , the r and omized clinical trial , for which was used to contrast four treatment conditions : medication management alone ( MedMgt ) , behavior therapy alone ( Beh ) , the combination of these two ( Comb ) , and a community comparison of treatment “ as usual ” ( CC ) . For each of the three assessment points we review three areas that we believe are important for appreciation of the findings : definition of evidence from the MTA , interpretation of the serial presentations of findings at each assessment point with a different definition of long-term , and qualification of the interim conclusions about long-term effects of treatments for ADHD . Conclusion : We discuss the possible clinical relevance of the MTA and present some practical suggestions based on current knowledge and uncertainties facing families , clinicians , and investigators regarding the long-term use of stimulant medication and behavioral therapy in the treatment of children with ADHD . ( J. of Att . Dis . 2008 ; 12(1 ) 4 - 14 OBJECTIVE Clinical experience suggests that some ( but not all ) patients with attention-deficit/hyperactivity disorder ( ADHD ) are highly responsive to the nonstimulant atomoxetine . We conducted a retrospective analysis of r and omized controlled trials ( RCTs ) to identify potential baseline ( moderator ) and on-treatment ( mediator ) predictors of responses . METHOD Data from 6 U.S. RCTs among patients aged 6 to 18 years were pooled ( N = 1,069 ; subjects treated with atomoxetine , n = 618 ) . Subjects were categorized as much improved ( > or = 40 % decrease in ADHD Rating Scale-IV-Parent Version : Investigator Administered and Scored total score ) , minimally improved ( 25%- < 40 % decline ) , or nonresponders ( < 25 % decrease ) . Logistic regression , analyses of variance , and repeated- measures analyses were used to explore associations between baseline and on-treatment variables , achieving a much improved response at trial endpoint ( 6 - 9 weeks ) . RESULTS Forty-seven percent of patients showed a much improved clinical response , and 40 % did not respond . Only 13 % of the patients had a minimal response . No baseline characteristics predicted achieving a much improved clinical response ; the only predictor of achieving this response was being at least minimally improved by treatment week 4 ( sensitivity = 81 % , specificity = 72 % , positive predictive value = 75 % , and negative predictive value = 79 % ) . CONCLUSIONS Clinical response to atomoxetine was bimodal , with most subjects being either responders who were much improved or nonresponders . There were no demographic or clinical predictors of response . However , subjects who ultimately achieved a much improved response were likely to be at least minimal responders by week 4 . The recommendation to consider either augmenting or switching treatment in patients who do not achieve at least this level of response to atomoxetine by 4 weeks offers a method for limiting the extended duration of titration to subjects who are most likely to benefit further , while minimizing the duration of exposure in those less likely to achieve an excellent response INTRODUCTION This study compared two atomoxetine titration dosing schedules and two atomoxetine maintenance doses for treating adolescent attention-deficit/hyperactivity disorder ( ADHD ) inattention and hyperactivity/impulsivity .  METHODS Adolescents ( N = 267 ) were r and omized to a slow or fast titration schedule . Patients who responded continued on a 40-week maintenance treatment , r and omized to either 0.8 or 1.4 mg/kg/day . RESULTS During the acute period , significant benefit was demonstrated with both titration schedules on the ADHD Rating Scale total score . Although patients in both groups maintained benefit relative to week 0 , statistically significant loss of benefit was found for patients maintained on 0.8 mg/kg/day but not on 1.4 mg/kg/day . A similar pattern was observed on the Clinical Global Impressions-ADHD-Severity scores and Life Participation Scale for ADHD-Child Version scores . Mean grade s for most subjects improved for patients in both maintenance treatment groups although most improvements were not statistically significant . CONCLUSIONS In adolescents with ADHD , treatment benefit at 8 weeks was better maintained long-term with 1.4 mg/kg/day than with 0.8 mg/kg/day . Improvement in adaptive functioning and age-appropriate developmental function was also demonstrated . Atomoxetine 0.8 and 1.4 mg/kg/day were equally well tolerated . CLINICAL TRIALS REGISTRY Maintenance of benefit with atomoxetine hydrochloride in adolescents with ADHD , NCT00191035 OBJECTIVES This report presents both age-adjusted and unadjusted statistics from the 2009 National Health Interview Survey ( NHIS ) on selected health measures for children under age 18 , classified by sex , age , race , Hispanic origin , family structure , parent education , family income , poverty status , health insurance coverage , place of residence , region , and current health status . The topics covered are asthma , allergies , learning disability , attention deficit hyperactivity disorder ( ADHD ) , prescription medication use , respondent-assessed health status , school days missed due to illness or injury , usual place of health 
    Output:
    
agent
All included treatments result ed in ADHD improvement .
On the basis of this literature review , a consistent pattern of improvement in pediatric ADHD patients ' core symptoms emerged across studies , study design s , and recommended treatment approaches .
***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: The purpose of this study was to examine in a controlled trial the effects of atomoxetine on the management of attention deficit-hyperactivity disorder ( ADHD ) symptoms and functional impairments at school and at home . Participants were 153 children ( age 8 to 12 years ) diagnosed with attention-deficit hyperactivity disorder who were r and omized to double-blind treatment with either atomoxetine  ( n = 101 ) or placebo  ( n = 52 ) . Findings revealed significant improvements both for parent and teacher ratings of behavior for children receiving atomoxetine therapy . Children also were reported to evidence a trend toward better response to active medication than to placebo for health-related quality of life as rated by parents . No significant effects were revealed for the teacher ratings of academic productivity . Data were interpreted to provide support for the efficacy of atomoxetine on the symptoms associated with ADHD . The effects of atomoxetine on other functional outcomes including academic performance and health-related outcomes are of interest , albeit less compelling for this particular investigation , than for the effects on overt symptom display BACKGROUND Despite the persistence of attention-deficit/hyperactivity disorder ( ADHD ) into adolescence , little is known about the efficacy and tolerability of stimulant medications in this age group . OBJECTIVE To report the results of a multisite controlled study among adolescents with ADHD evaluating the efficacy and tolerability of osmotic-release oral system ( OROS ) methylpheni date . DESIGN Adolescents ( N = 220 ) having a confirmed Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition diagnosis of ADHD underwent dose titration to identify dosages of OROS methylpheni date that improved symptoms to predefined criteria . Subjects successfully completing the dose titration phase ( n = 177 ) ( ie , tolerated and responded to treatment and adhered to the protocol ) were r and omized to receive 2 weeks ' treatment with their individualized dosage of OROS methylpheni date ( 18 , 36 , 54 , or 72 mg once daily ) or placebo .  Treatment effectiveness was measured using investigator , parent , and adolescent assessment s of ADHD . RESULTS A significant reduction from baseline in the investigator-rated ADHD Rating Scale , the primary efficacy measure , was found with OROS methylpheni date treatment compared with placebo . Similar findings were noted with parent- and adolescent-report measures . Based on a Clinical Global Impression improvement subscale score of much or very much improved , 52 % of subjects in the OROS methylpheni date group improved compared with 31 % receiving placebo . Thirty-seven percent of subjects required the maximum dosage of 72 mg/d . The incidence of drug-related adverse events was similar between the 2 study groups . CONCLUSION In adolescents , once-daily OROS methylpheni date significantly reduced ADHD symptoms and was well tolerated using dosages up to 72 mg/d INTRODUCTION Lisdexamfetamine dimesylate ( LDX ) , a prodrug stimulant , is indicated for attention-deficit/hyperactivity disorder ( ADHD ) in children 6 - 12 years of age and in adults . In short-term studies , once-daily LDX provided efficacy throughout the day . This study presented here was conducted to assess the long-term safety , tolerability , and effectiveness of LDX in 6- to 12-year-olds with ADHD . METHODS This open-label , multicenter , single-arm study enrolled children with Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition-Text Revision criteria for ADHD . Following 1-week screening and washout periods , subjects were titrated to LDX 30 , 50 , or 70 mg/day over 4 weeks and placed on maintenance treatment for 11 months . The ADHD Rating Scale and Clinical Global Impression-Improvement scale measured effectiveness . RESULTS Of 272 subjects receiving LDX , 147 completed the study . Most adverse events were mild to moderate and occurred during the first 4 weeks . There were no clinical ly meaningful changes in blood pressure or electrocardiographic parameters . From baseline to endpoint , mean ADHD Rating Scale scores improved by 27.2 points ( P<.0001 ) . Improvements occurred during each of the first 4 weeks , and were maintained throughout . Based on Clinical Global Impression-Improvement scale scores , > 80 % of subjects at endpoint and > 95 % of completers at 12 months were rated " improved . " CONCLUSION Long-term 30 , 50 , and 70 mg/day LDX was generally well tolerated and effective in 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 The efficacy and safety of dexmethylpheni date extended release ( d-MPH-ER ) was compared to placebo in pediatric patients with attention-deficit/hyperactivity disorder ( ADHD ) . METHOD This multicenter , r and omized , double-blind , placebo-controlled , parallel-group , two-phase study included 97 patients ( ages 6 - 17 years ) with DSM-IV-defined ADHD . The study was carried out between 2001 and 2003 . After a 2-week evaluation phase , patients were r and omized to d-MPH-ER or placebo for 7 weeks . Flexible d-MPH-ER dosing ( 30 mg/day ) was permitted for 5 weeks , then patients remained on their optimal dose during the last 2 study weeks . The primary efficacy measure was change from baseline to final rating in Conners ADHD/DSM-IV Scale-Teacher version ( CADS-T ) total subscale score . Secondary efficacy variables included changes from baseline to final visit in CADS-T Inattentive and Hyperactive-Impulsive subscale scores , CADS-P DSM-IV total subscale score and Inattentive and Hyperactive-Impulsive subscale scores , Clinical Global Impressions-Improvement ( CGI-I ) and CGI-Severity ( CGI-S ) scale scores , and Child Health Question naire Parent Form 50 scores . RESULTS d-MPH-ER improved CADS-T total scores significantly compared with placebo ( p < .001 ) , and 67.3 % of d-MPH-ER patients were rated much improved or very much improved on CGI-I at final visit versus 13.3 % of placebo patients ( p < .001 ) . More patients taking d-MPH-ER ( 49.1 % ) than placebo ( 25.5 % ) spontaneously reported adverse events suspected as drug related . CONCLUSIONS Once-daily d-MPH-ER was more effective than placebo in the treatment of ADHD in children and adolescents Objective : To review the primary and secondary findings from the Multimodal Treatment study of ADHD ( MTA ) published over the past decade as three sets of articles . Method : In a two-part article — Part I : Executive Summary ( without distracting details ) and Part II : Supporting Details ( with additional background and detail required by the complexity of the MTA)—we address confusion and controversy about the findings . Results : We discuss the basic features of the gold st and ard used to produce scientific evidence , the r and omized clinical trial , for which was used to contrast four treatment conditions : medication management alone ( MedMgt ) , behavior therapy alone ( Beh ) , the combination of these two ( Comb ) , and a community comparison of treatment “ as usual ” ( CC ) . For each of the three assessment points we review three areas that we believe are important for appreciation of the findings : definition of evidence from the MTA , interpretation of the serial presentations of findings at each assessment point with a different definition of long-term , and qualification of the interim conclusions about long-term effects of treatments for ADHD . Conclusion : We discuss the possible clinical relevance of the MTA and present some practical suggestions based on current knowledge and uncertainties facing families , clinicians , and investigators regarding the long-term use of stimulant medication and behavioral therapy in the treatment of children with ADHD . ( J. of Att . Dis . 2008 ; 12(1 ) 4 - 14 OBJECTIVE Clinical experience suggests that some ( but not all ) patients with attention-deficit/hyperactivity disorder ( ADHD ) are highly responsive to the nonstimulant atomoxetine . We conducted a retrospective analysis of r and omized controlled trials ( RCTs ) to identify potential baseline ( moderator ) and on-treatment ( mediator ) predictors of responses . METHOD Data from 6 U.S. RCTs among patients aged 6 to 18 years were pooled ( N = 1,069 ; subjects treated with atomoxetine , n = 618 ) . Subjects were categorized as much improved ( > or = 40 % decrease in ADHD Rating Scale-IV-Parent Version : Investigator Administered and Scored total score ) , minimally improved ( 25%- < 40 % decline ) , or nonresponders ( < 25 % decrease ) . Logistic regression , analyses of variance , and repeated- measures analyses were used to explore associations between baseline and on-treatment variables , achieving a much improved response at trial endpoint ( 6 - 9 weeks ) . RESULTS Forty-seven percent of patients showed a much improved clinical response , and 40 % did not respond . Only 13 % of the patients had a minimal response . No baseline characteristics predicted achieving a much improved clinical response ; the only predictor of achieving this response was being at least minimally improved by treatment week 4 ( sensitivity = 81 % , specificity = 72 % , positive predictive value = 75 % , and negative predictive value = 79 % ) . CONCLUSIONS Clinical response to atomoxetine was bimodal , with most subjects being either responders who were much improved or nonresponders . There were no demographic or clinical predictors of response . However , subjects who ultimately achieved a much improved response were likely to be at least minimal responders by week 4 . The recommendation to consider either augmenting or switching treatment in patients who do not achieve at least this level of response to atomoxetine by 4 weeks offers a method for limiting the extended duration of titration to subjects who are most likely to benefit further , while minimizing the duration of exposure in those less likely to achieve an excellent response INTRODUCTION This study compared two atomoxetine titration dosing schedules and two atomoxetine maintenance doses for treating adolescent attention-deficit/hyperactivity disorder ( ADHD ) inattention and hyperactivity/impulsivity .  METHODS Adolescents ( N = 267 ) were r and omized to a slow or fast titration schedule . Patients who responded continued on a 40-week maintenance treatment , r and omized to either 0.8 or 1.4 mg/kg/day . RESULTS During the acute period , significant benefit was demonstrated with both titration schedules on the ADHD Rating Scale total score . Although patients in both groups maintained benefit relative to week 0 , statistically significant loss of benefit was found for patients maintained on 0.8 mg/kg/day but not on 1.4 mg/kg/day . A similar pattern was observed on the Clinical Global Impressions-ADHD-Severity scores and Life Participation Scale for ADHD-Child Version scores . Mean grade s for most subjects improved for patients in both maintenance treatment groups although most improvements were not statistically significant . CONCLUSIONS In adolescents with ADHD , treatment benefit at 8 weeks was better maintained long-term with 1.4 mg/kg/day than with 0.8 mg/kg/day . Improvement in adaptive functioning and age-appropriate developmental function was also demonstrated . Atomoxetine 0.8 and 1.4 mg/kg/day were equally well tolerated . CLINICAL TRIALS REGISTRY Maintenance of benefit with atomoxetine hydrochloride in adolescents with ADHD , NCT00191035 OBJECTIVES This report presents both age-adjusted and unadjusted statistics from the 2009 National Health Interview Survey ( NHIS ) on selected health measures for children under age 18 , classified by sex , age , race , Hispanic origin , family structure , parent education , family income , poverty status , health insurance coverage , place of residence , region , and current health status . The topics covered are asthma , allergies , learning disability , attention deficit hyperactivity disorder ( ADHD ) , prescription medication use , respondent-assessed health status , school days missed due to illness or injury , usual place of health 
    Output:
    