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 Children with attention deficit hyperactivity disorder ( ADHD ) are hyperactive and impulsive , can not maintain attention , and have difficulties with social interactions . Medical treatment may alleviate symptoms of ADHD , but seldom solves difficulties with social interactions . Social-skills training may benefit ADHD children in their social interactions . We want to examine the effects of social-skills training on difficulties related to the children 's ADHD symptoms and social interactions . Methods / Design The design is r and omised two-armed , parallel group , assessor-blinded trial . Children aged 8 - 12 years with a diagnosis of ADHD are r and omised to social-skills training and parental training plus st and ard treatment versus st and ard treatment alone . A sample size calculation estimated that at least 52 children must be included to show a 4-point difference in the primary outcome on the Conners 3rd Edition subscale for ' hyperactivity-impulsivity ' between the intervention group and the control group . The outcomes will be assessed 3 and 6 months after r and omisation . The primary outcome measure is ADHD symptoms . The secondary outcome is social skills . Tertiary outcomes include the relationship between social skills and symptoms of ADHD , the ability to form attachment , and parents ' ADHD symptoms . Discussion We hope that the results from this trial will show that the social-skills training together with medication may have a greater general effect on ADHD symptoms and social and emotional competencies than medication alone . Trial registration Clinical Trials ( NCT ) : This study evaluated the separate and combined effects of behavior modification and 2 doses of methylpheni date ( MPH ; 0.3 and 0.6 mg/kg ) compared with baseline ( no behavior modification and a placebo ) on the classroom behavior and academic performance of 31 ADHD ( attention deficit-hyperactivity disorder ) boys attending a summer treatment program . Results revealed significant effects of both interventions , with the mean effect size of medication being more than twice as great as that of behavior modification . Relatively small incremental value was gained by the higher dose of medication or the addition of behavior modification , compared with the effects of the low dose of MPH . In contrast , the addition of either dose of MPH result ed in improvement beyond the effects of behavior modification alone . These group effects reflected those obtained in analyses of individual differences . Furthermore , comparisons of individual responsiveness showed that boys who responded to one treatment also responded to the other Objective : To examine the rate of psychotic and mood-congruent psychotic side effects of stimulant medications in children treated for attention-deficit hyperactivity disorder ( ADHD ) . Method : A chart review was completed of all children diagnosed with ADHD in an outpatient clinic from January 1989 to March 1995 . Results : Over 5 years , 192 children were diagnosed with ADHD . Ninety-eight children received treatment at the clinic with stimulants .  Six children developed psychotic or mood-congruent psychotic symptoms during treatment . Children on medication were followed for an average of 1 year and 9 months . Conclusions : Awareness of the potential for psychotic side effects from stimulant medications is important when prescribing for children . A large prospect i ve study would be useful to predict the frequency and classification of the side effects in children 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 Background Clinical evidence continues to exp and and is increasingly difficult to overview . We aim ed at conceptualizing a visual assessment tool , i.e. , a matrix for overviewing studies and their data in order to assess the clinical evidence at a glance . Methods A four-step matrix was constructed using the three dimensions of systematic error , r and om error , and design error . Matrix step I ranks the identified studies according to the dimensions of systematic errors and r and om errors . Matrix step II orders the studies according to the design errors . Matrix step III assesses the three dimensions of errors in studies . Matrix step IV assesses the size and direction of the intervention effect . Results The application of this four-step matrix is illustrated with two examples : peri-operative beta-blockade initialized in relation to surgery versus placebo for major non-cardiac surgery , and antiarrhythmics for maintaining sinus rhythm after cardioversion of atrial fibrillation .  When clinical evidence is deemed both internally and externally valid , the size of the intervention effect is to be assessed . Conclusion The error matrix provides an overview of the validity of the available evidence at a glance , and may assist in deciding which interventions to use in clinical practice OBJECTIVE In the intent-to-treat analysis of the Multimodal Treatment Study of Children With ADHD ( MTA ) , the effects of medication management ( MedMgt ) , behavior therapy ( Beh ) , their combination ( Comb ) , and usual community care ( CC ) differed at 14 and 24 months due to superiority of treatments that used the MTA medication algorithm ( Comb+MedMgt ) over those that did not ( Beh+CC ) . This report examines 36-month outcomes , 2 years after treatment by the study ended . METHOD For primary outcome measures ( attention-deficit/hyperactivity disorder [ ADHD ] and oppositional defiant disorder [ ODD ] symptoms , social skills , reading scores , impairment , and diagnostic status ) , mixed-effects regression models and orthogonal contrasts examined 36-month outcomes . RESULTS At 3 years , 485 of the original 579 subjects ( 83.8 % ) participated in the follow-up , now at ages 10 to 13 years , ( mean 11.9 years ) . In contrast to the significant advantage of MedMgt+Comb over Beh+CC for ADHD symptoms at 14 and 24 months , treatment groups did not differ significantly on any measure at 36 months . The percentage of children taking medication > 50 % of the time changed between 14 and 36 months across the initial treatment groups : Beh significantly increased ( 14 % to 45 % ) , MedMed+Comb significantly decreased ( 91 % to 71 % ) , and CC remained constant ( 60%-62 % ) . Regardless of their treatment use changes , all of the groups showed symptom improvement over baseline . Notably , initial symptom severity , sex ( male ) , comorbidity , public assistance , and parental psychopathology ( ADHD ) did not moderate children 's 36-month treatment responses , but these factors predicted worse outcomes over 36 months , regardless of original treatment assignment . CONCLUSIONS By 36 months , the earlier advantage of having had 14 months of the medication algorithm was no longer apparent , possibly due to age-related decline in ADHD symptoms , changes in medication management intensity , starting or stopping medications altogether , or other factors not yet evaluated OBJECTIVE To test that methylpheni date combined with intensive multimodal psychosocial intervention , which includes social skills training , significantly enhances social functioning in children with attention-deficit/hyperactivity disorder ( ADHD ) compared with methylpheni date alone and methylpheni date plus nonspecific psychosocial treatment ( attention control ) . 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 receive ( 1 ) methylpheni date alone , ( 2 ) methylpheni date plus multimodal psychosocial treatment that included social skills training , or ( 3 ) methylpheni date plus attention control treatment . Assessment s included parent , child , and teacher ratings of social function and direct school observations in gym . RESULTS No advantage was found on any measure of social functioning for the combination treatment over methylpheni date alone or methylpheni date plus attention control . Significant improvement occurred across all treatments and continued over 2 years . CONCLUSIONS In young children with ADHD , there is no support for clinic-based social skills training as part of a long-term psychosocial intervention to improve social behavior . Significant benefits from methylpheni date were stable over 2 years In the GRADE approach , r and omized trials start as high- quality evidence and observational studies as low- quality evidence , but both can be rated down if most of the relevant evidence comes from studies that suffer from a high risk of bias . Well-established limitations of r and omized trials include failure to conceal allocation , failure to blind , loss to follow-up , and failure to appropriately consider the intention-to-treat principle . More recently recognized limitations include stopping early for apparent benefit and selective reporting of outcomes according to the results . Key limitations of observational studies include use of inappropriate controls and failure to adequately adjust for prognostic imbalance . Risk of bias may vary across outcomes ( e.g. , loss to follow-up may be far less for all-cause mortality than for quality of life ) , a consideration that many systematic review s ignore . In deciding whether to rate down for risk of bias -- whether for r and omized trials or observational studies -- authors should not take an approach that averages across studies . Rather , for any individual outcome , when there are some studies with a high risk , and some with a low risk of bias , they should consider including only the studies with a lower risk of bias OBJECTIVES This study examines the tolerability and efficacy of methylpheni date ( MPH ) and behavior modification therapy ( BMOD ) in children with attention-deficity/hyperactivity disorder ( ADHD ) and severe mood dysregulation ( SMD ) . METHODS Children ( ages 5 - 12 ) from a summer program for ADHD were screened for SMD and additional manic-like symptoms using structured assessment s and direct clinical interview with the Young Mania Rating Scale ( YMRS ) . The SMD group was comprised of 33 subjects with SMD and elevated YMRS scores ( mean = 23.7 ) . They underwent weekly mood assessment s plus the daily ADHD measures that are part of the program . The comparison group ( n = 68 ) was comprised of the rest of the program participants . Using a crossover design , all subjects in both groups were treated with three varying intensities of BMOD ( no , low , high ) each lasting 3 weeks , with MPH dose ( placebo , 0.15 mg/kg t.i.d . , 0.3mg/kg t.i.d . , and 0.6 mg/kg t.i.d . ) varying daily within each behavioral treatment . RESULTS Groups had comparable ADHD symptoms at baseline , with the SMD group manifesting more oppositional defiant disorder/conduct disorder ( ODD/CD ) symptoms ( p < 0.001 ) . Both groups showed robust improvement in externalizing symptoms ( p < 0.001 ) . There was no evidence of differential treatment efficacy or tolerability . Treatment produced a 34 % reduction in YMRS ratings in SMD subjects ( p - 0.001 ) . However , they still exhibited elevated YMRS ratings , more ODD/CD symptoms ( p < 0.001 ) , and were more likely to remain significantly impaired at home than non-SMD subjects ( p < 0.05 ) . CONCLUSIONS MPH and BMOD are tolerable and effective treatments for children with ADHD and SMD , but additional treatments may be needed to optimize their functioning The aim of this article was to analyze the prevalence of Attention Deficit/ Hyperactivity Disorder ( ADHD ) in Colombian Paisa children and adolescents . A r and omized sample of 4- to 17-year-old children and adolescents--176 males and 154 females -- was selected from schools in Manizales , Colombia . The diagnosis of ADHD was obtained using a semistructured psychiatric and neurological interview , medical histories revision , and neurological or psychiatric evaluations .  Several rating scales and a neuropsychological assessment  were administered in order to confirm the diagnosis . Children with Full Scale Intelligence Quotient ( FSIQ ) between 71 and 84 were recorded as having Borderline Intellectual Functioning ( BIF ) , and those with a history of mild motor retardation , and /or Performance Intelligence Quotient ( PIQ ) lower than 71 , were recorded as having a Developmental Coordination disorder ( DCD ) , after confirmation by neurological and neuropsychological examinations . BIF and DCD children were excluded from the ADHD group . Total prevalence of ADHD adjusted by sex was 16.4 % ( males 19.8 % and females 12.3 % ) . Prevalence of clean ADHD cases was 11.5 % , distrib uted as follows : combined type , 6.4 % ; inattentive , 4.8 % ; and hyperactive-impulsive , 0.3 % . Distribution by sex was as follows : males , 14.8 % ; and females , 7.7 % ; with an odds ratio of 2.1 ( 95 
    Output:
    
agent
The content of the social skills interventions were comparable and based on a cognitive behavioural model .
The review suggests that there is little evidence to support or refute social skills training for adolescents with ADHD .
***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 Children with attention deficit hyperactivity disorder ( ADHD ) are hyperactive and impulsive , can not maintain attention , and have difficulties with social interactions . Medical treatment may alleviate symptoms of ADHD , but seldom solves difficulties with social interactions . Social-skills training may benefit ADHD children in their social interactions . We want to examine the effects of social-skills training on difficulties related to the children 's ADHD symptoms and social interactions . Methods / Design The design is r and omised two-armed , parallel group , assessor-blinded trial . Children aged 8 - 12 years with a diagnosis of ADHD are r and omised to social-skills training and parental training plus st and ard treatment versus st and ard treatment alone . A sample size calculation estimated that at least 52 children must be included to show a 4-point difference in the primary outcome on the Conners 3rd Edition subscale for ' hyperactivity-impulsivity ' between the intervention group and the control group . The outcomes will be assessed 3 and 6 months after r and omisation . The primary outcome measure is ADHD symptoms . The secondary outcome is social skills . Tertiary outcomes include the relationship between social skills and symptoms of ADHD , the ability to form attachment , and parents ' ADHD symptoms . Discussion We hope that the results from this trial will show that the social-skills training together with medication may have a greater general effect on ADHD symptoms and social and emotional competencies than medication alone . Trial registration Clinical Trials ( NCT ) : This study evaluated the separate and combined effects of behavior modification and 2 doses of methylpheni date ( MPH ; 0.3 and 0.6 mg/kg ) compared with baseline ( no behavior modification and a placebo ) on the classroom behavior and academic performance of 31 ADHD ( attention deficit-hyperactivity disorder ) boys attending a summer treatment program . Results revealed significant effects of both interventions , with the mean effect size of medication being more than twice as great as that of behavior modification . Relatively small incremental value was gained by the higher dose of medication or the addition of behavior modification , compared with the effects of the low dose of MPH . In contrast , the addition of either dose of MPH result ed in improvement beyond the effects of behavior modification alone . These group effects reflected those obtained in analyses of individual differences . Furthermore , comparisons of individual responsiveness showed that boys who responded to one treatment also responded to the other Objective : To examine the rate of psychotic and mood-congruent psychotic side effects of stimulant medications in children treated for attention-deficit hyperactivity disorder ( ADHD ) . Method : A chart review was completed of all children diagnosed with ADHD in an outpatient clinic from January 1989 to March 1995 . Results : Over 5 years , 192 children were diagnosed with ADHD . Ninety-eight children received treatment at the clinic with stimulants .  Six children developed psychotic or mood-congruent psychotic symptoms during treatment . Children on medication were followed for an average of 1 year and 9 months . Conclusions : Awareness of the potential for psychotic side effects from stimulant medications is important when prescribing for children . A large prospect i ve study would be useful to predict the frequency and classification of the side effects in children 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 Background Clinical evidence continues to exp and and is increasingly difficult to overview . We aim ed at conceptualizing a visual assessment tool , i.e. , a matrix for overviewing studies and their data in order to assess the clinical evidence at a glance . Methods A four-step matrix was constructed using the three dimensions of systematic error , r and om error , and design error . Matrix step I ranks the identified studies according to the dimensions of systematic errors and r and om errors . Matrix step II orders the studies according to the design errors . Matrix step III assesses the three dimensions of errors in studies . Matrix step IV assesses the size and direction of the intervention effect . Results The application of this four-step matrix is illustrated with two examples : peri-operative beta-blockade initialized in relation to surgery versus placebo for major non-cardiac surgery , and antiarrhythmics for maintaining sinus rhythm after cardioversion of atrial fibrillation .  When clinical evidence is deemed both internally and externally valid , the size of the intervention effect is to be assessed . Conclusion The error matrix provides an overview of the validity of the available evidence at a glance , and may assist in deciding which interventions to use in clinical practice OBJECTIVE In the intent-to-treat analysis of the Multimodal Treatment Study of Children With ADHD ( MTA ) , the effects of medication management ( MedMgt ) , behavior therapy ( Beh ) , their combination ( Comb ) , and usual community care ( CC ) differed at 14 and 24 months due to superiority of treatments that used the MTA medication algorithm ( Comb+MedMgt ) over those that did not ( Beh+CC ) . This report examines 36-month outcomes , 2 years after treatment by the study ended . METHOD For primary outcome measures ( attention-deficit/hyperactivity disorder [ ADHD ] and oppositional defiant disorder [ ODD ] symptoms , social skills , reading scores , impairment , and diagnostic status ) , mixed-effects regression models and orthogonal contrasts examined 36-month outcomes . RESULTS At 3 years , 485 of the original 579 subjects ( 83.8 % ) participated in the follow-up , now at ages 10 to 13 years , ( mean 11.9 years ) . In contrast to the significant advantage of MedMgt+Comb over Beh+CC for ADHD symptoms at 14 and 24 months , treatment groups did not differ significantly on any measure at 36 months . The percentage of children taking medication > 50 % of the time changed between 14 and 36 months across the initial treatment groups : Beh significantly increased ( 14 % to 45 % ) , MedMed+Comb significantly decreased ( 91 % to 71 % ) , and CC remained constant ( 60%-62 % ) . Regardless of their treatment use changes , all of the groups showed symptom improvement over baseline . Notably , initial symptom severity , sex ( male ) , comorbidity , public assistance , and parental psychopathology ( ADHD ) did not moderate children 's 36-month treatment responses , but these factors predicted worse outcomes over 36 months , regardless of original treatment assignment . CONCLUSIONS By 36 months , the earlier advantage of having had 14 months of the medication algorithm was no longer apparent , possibly due to age-related decline in ADHD symptoms , changes in medication management intensity , starting or stopping medications altogether , or other factors not yet evaluated OBJECTIVE To test that methylpheni date combined with intensive multimodal psychosocial intervention , which includes social skills training , significantly enhances social functioning in children with attention-deficit/hyperactivity disorder ( ADHD ) compared with methylpheni date alone and methylpheni date plus nonspecific psychosocial treatment ( attention control ) . 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 receive ( 1 ) methylpheni date alone , ( 2 ) methylpheni date plus multimodal psychosocial treatment that included social skills training , or ( 3 ) methylpheni date plus attention control treatment . Assessment s included parent , child , and teacher ratings of social function and direct school observations in gym . RESULTS No advantage was found on any measure of social functioning for the combination treatment over methylpheni date alone or methylpheni date plus attention control . Significant improvement occurred across all treatments and continued over 2 years . CONCLUSIONS In young children with ADHD , there is no support for clinic-based social skills training as part of a long-term psychosocial intervention to improve social behavior . Significant benefits from methylpheni date were stable over 2 years In the GRADE approach , r and omized trials start as high- quality evidence and observational studies as low- quality evidence , but both can be rated down if most of the relevant evidence comes from studies that suffer from a high risk of bias . Well-established limitations of r and omized trials include failure to conceal allocation , failure to blind , loss to follow-up , and failure to appropriately consider the intention-to-treat principle . More recently recognized limitations include stopping early for apparent benefit and selective reporting of outcomes according to the results . Key limitations of observational studies include use of inappropriate controls and failure to adequately adjust for prognostic imbalance . Risk of bias may vary across outcomes ( e.g. , loss to follow-up may be far less for all-cause mortality than for quality of life ) , a consideration that many systematic review s ignore . In deciding whether to rate down for risk of bias -- whether for r and omized trials or observational studies -- authors should not take an approach that averages across studies . Rather , for any individual outcome , when there are some studies with a high risk , and some with a low risk of bias , they should consider including only the studies with a lower risk of bias OBJECTIVES This study examines the tolerability and efficacy of methylpheni date ( MPH ) and behavior modification therapy ( BMOD ) in children with attention-deficity/hyperactivity disorder ( ADHD ) and severe mood dysregulation ( SMD ) . METHODS Children ( ages 5 - 12 ) from a summer program for ADHD were screened for SMD and additional manic-like symptoms using structured assessment s and direct clinical interview with the Young Mania Rating Scale ( YMRS ) . The SMD group was comprised of 33 subjects with SMD and elevated YMRS scores ( mean = 23.7 ) . They underwent weekly mood assessment s plus the daily ADHD measures that are part of the program . The comparison group ( n = 68 ) was comprised of the rest of the program participants . Using a crossover design , all subjects in both groups were treated with three varying intensities of BMOD ( no , low , high ) each lasting 3 weeks , with MPH dose ( placebo , 0.15 mg/kg t.i.d . , 0.3mg/kg t.i.d . , and 0.6 mg/kg t.i.d . ) varying daily within each behavioral treatment . RESULTS Groups had comparable ADHD symptoms at baseline , with the SMD group manifesting more oppositional defiant disorder/conduct disorder ( ODD/CD ) symptoms ( p < 0.001 ) . Both groups showed robust improvement in externalizing symptoms ( p < 0.001 ) . There was no evidence of differential treatment efficacy or tolerability . Treatment produced a 34 % reduction in YMRS ratings in SMD subjects ( p - 0.001 ) . However , they still exhibited elevated YMRS ratings , more ODD/CD symptoms ( p < 0.001 ) , and were more likely to remain significantly impaired at home than non-SMD subjects ( p < 0.05 ) . CONCLUSIONS MPH and BMOD are tolerable and effective treatments for children with ADHD and SMD , but additional treatments may be needed to optimize their functioning The aim of this article was to analyze the prevalence of Attention Deficit/ Hyperactivity Disorder ( ADHD ) in Colombian Paisa children and adolescents . A r and omized sample of 4- to 17-year-old children and adolescents--176 males and 154 females -- was selected from schools in Manizales , Colombia . The diagnosis of ADHD was obtained using a semistructured psychiatric and neurological interview , medical histories revision , and neurological or psychiatric evaluations .  Several rating scales and a neuropsychological assessment  were administered in order to confirm the diagnosis . Children with Full Scale Intelligence Quotient ( FSIQ ) between 71 and 84 were recorded as having Borderline Intellectual Functioning ( BIF ) , and those with a history of mild motor retardation , and /or Performance Intelligence Quotient ( PIQ ) lower than 71 , were recorded as having a Developmental Coordination disorder ( DCD ) , after confirmation by neurological and neuropsychological examinations . BIF and DCD children were excluded from the ADHD group . Total prevalence of ADHD adjusted by sex was 16.4 % ( males 19.8 % and females 12.3 % ) . Prevalence of clean ADHD cases was 11.5 % , distrib uted as follows : combined type , 6.4 % ; inattentive , 4.8 % ; and hyperactive-impulsive , 0.3 % . Distribution by sex was as follows : males , 14.8 % ; and females , 7.7 % ; with an odds ratio of 2.1 ( 95 
    Output:
    