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 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 R and omized 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 r and omized and allocated by sequentially numbered sealed envelopes into three groups : methylpheni date ( 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 question naire , and the changes in these scores after treatment were used as the self-reported evaluation . Basic statistical methods ( descriptive , analyses of variance , exact χ2 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 question naires . The treatment groups were comparable in age , sex , and cognition as well as in the baseline levels of core ADHD symptoms . All treatments result ed 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 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 Abstract Attention Deficit Hyperactivity Disorder ( ADHD ) is associated with poor self‐control , underpinned by inferior fronto‐striatal deficits . Real‐time functional magnetic resonance neurofeedback ( rtfMRI‐NF ) allows participants to gain self‐control over dysregulated brain regions . Despite evidence for beneficial effects of electrophysiological‐NF on ADHD symptoms , no study has applied the spatially superior rtfMRI‐NF neurotherapy to ADHD . A r and omized controlled trial tested the efficacy of rtfMRI‐NF of right inferior prefrontal cortex ( rIFG ) , a key region that is compromised in ADHD and upregulated with psychostimulants , on improvement of ADHD symptoms , cognition , and inhibitory fMRI activation . To control for region‐specificity , an active control group received rtfMRI‐NF of the left parahippocampal gyrus ( lPHG ) . Thirty‐one ADHD boys were r and omly allocated and had to learn to upregulate their target brain region in an average of 11 rtfMRI‐NF runs over 2 weeks . Feedback was provided through a video‐clip of a rocket that had to be moved up into space . A transfer session without feedback tested learning retention as a proximal measure of transfer to everyday life . Both NF groups showed significant linear activation increases with increasing number of runs in their respective target regions and significant reduction in ADHD symptoms after neurotherapy and at 11‐month follow‐up . Only the group targeting rIFG , however , showed a transfer effect , which correlated with ADHD symptom reductions , improved at trend level in sustained attention , and showed increased IFG activation during an inhibitory fMRI task . This proof‐of‐concept study demonstrates for the first time feasibility , safety , and shorter‐ and longer‐term efficacy  of rtfMRI‐NF of rIFG in adolescents with ADHD . Hum Brain Mapp 38:3190–3209 , 2017 . © 2017 The Authors Human Brain Mapping Published by Wiley Periodicals , OBJECTIVE The efficacy of neurofeedback as a treatment for attention-deficit/hyperactivity disorder ( ADHD ) , and whether neurofeedback is a viable alternative for stimulant medication , is still an intensely debated subject . The current r and omized controlled trial compared neurofeedback to ( 1 ) optimally titrated methylpheni date and ( 2 ) a semi-active control intervention , physical activity , to account for nonspecific effects . METHODS A multicenter 3-way parallel-group study with balanced r and omization was conducted . Children with a DSM-IV-TR diagnosis of ADHD , aged 7 - 13 years , were r and omly allocated to receive neurofeedback ( n = 39 ) , methylpheni date ( n = 36 ) , or physical activity ( n = 37 ) over a period of 10 - 12 weeks . Neurofeedback comprised theta/beta training on the vertex ( Cz ) . Physical activity consisted of moderate to vigorous intensity exercises . Neurofeedback and physical activity were balanced in terms of number ( ~30 ) and duration of sessions . A double-blind pseudor and omized placebo-controlled crossover titration procedure was used to determine an optimal dose in the methylpheni date intervention . Parent and teacher ratings on the Strengths and Difficulties Question naire ( SDQ ) and Strengths and Weaknesses of ADHD Symptoms and Normal Behavior ( SWAN ) were used to assess intervention outcomes . Data collection took place between September 2010 and March 2014 . RESULTS Intention-to-treat analyses revealed an improvement in parent-reported behavior on the SDQ and the SWAN Hyperactivity/Impulsivity scale , irrespective of received intervention ( ηp² = 0.21 - 0.22 , P ≤ .001 ) , whereas the SWAN Inattention scale revealed more improvement in children who received methylpheni date than neurofeedback and physical activity ( ηp² = 0.13 , P ≤ .001 ) . Teachers reported a decrease of ADHD symptoms on all measures for methylpheni date , but not for neurofeedback or physical activity ( range of ηp² = 0.14 - 0.29 , P < .001 ) . CONCLUSIONS The current study found that optimally titrated methylpheni date is superior to neurofeedback and physical activity in decreasing ADHD symptoms in children with ADHD . TRIAL REGISTRATION Clinical Trials.gov identifier : NCT01363544 BACKGROUND The clinical and neurophysiological effects of neurofeedback ( NF ) as treatment for children with ADHD are still unclear . This r and omized controlled trial ( RCT ) examined electroencephalogram ( EEG ) power spectra before and after NF compared to methylpheni date ( MPH ) treatment and physical activity ( PA ) - as semi-active control group - during resting and active ( effortful ) task conditions to determine whether NF can induce sustained alterations in brain function . METHODS Using a multicentre three-way parallel group RCT design , 112 children with a DSM-IV diagnosis of ADHD , aged between 7 and 13 years , were initially included . NF training consisted of 30 sessions of theta/beta training at Cz over a 10-week period . PA training was a semi-active control group , matched in frequency and duration . Methylpheni date was titrated using a double-blind placebo controlled procedure in 6 weeks , followed by a stable dose for 4 weeks . EEG power spectra measures during eyes open ( EO ) , eyes closed ( EC ) and task ( effortful ) conditions were available for 81 children at pre- and postintervention ( n = 29 NF , n = 25 MPH , n = 27 PA ) . CLINICAL TRIALS REGISTRATION Train Your Brain ? Exercise and Neurofeedback Intervention for ADHD , https:// clinical trials.gov/show/;NCT01363544 , Ref . No. NCT01363544 . RESULTS Both NF and MPH result ed in comparable reductions in theta power from pre- to postintervention during the EO condition compared to PA ( ηp ( 2 ) = .08 and .12 ) . For NF , greater reductions in theta were related to greater reductions in ADHD symptoms . During the task condition , only MPH showed reductions in theta and alpha power compared to PA ( ηp ( 2 ) = .10 and .12 ) . CONCLUSIONS This study provides evidence for specific neurophysiological effects after theta/beta NF and MPH treatment in children with ADHD . However , for NF these effects did not generalize to an active task condition , potentially explaining reduced behavioural effects of NF in the classroom Background A r and omized 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 r and omized into three groups , with 30 in the NF group , 31 controls in a group that was given methylpheni date , and 30 in a group that received NF and methylpheni date .  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 r and omized 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 methylpheni date at treating the attentional and hyperactivity symptoms of ADHD , based on parental reports . Trial registration Current Controlled Trials Neurofeedback ( NFB ) is a potential alternative treatment for children with ADHD that aims to optimize brain activity . Whereas most studies into NFB have investigated behavioral effects , less attention has been paid to the effects on neurocognitive functioning . The present r and omized controlled trial ( RCT ) compared neurocognitive effects of NFB to ( 1 ) optimally titrated methylpheni date ( MPH ) and ( 2 ) a semi-active control intervention , physical activity ( PA ) , to control for non-specific effects . Using a multicentre three-way parallel group RCT design , children with ADHD , aged 7–13 , were r and omly allocated to NFB ( n = 39 ) , MPH ( n = 36 ) or PA ( n = 37 ) over a period of 10–12 weeks . NFB comprised theta/beta training at CZ . The PA intervention was matched in frequency and duration to NFB . MPH was titrated using a double-blind placebo controlled procedure to determine the optimal dose . Neurocognitive functioning was assessed using parameters derived from the auditory oddball- , stop-signal- and visual spatial working memory task . Data collection took place between September 2010 and March 2014 . Intention-to-treat analyses showed improved attention for MPH compared to NFB and PA , as reflected by decreased response speed during the oddball task [ ηp2 = 0.21 , p < 0.001 ] , as well as improved inhibition , impulsivity and attention , as reflected by faster stop signal reaction times , lower commission and omission error rates during the stop-signal task ( range ηp2 = 0.09–0.18 , p values < 0.008 ) . Working memory improved over time , irrespective of received treatment ( ηp2 = 0.1 
    Output:
    
agent
When only trials are considered that include probably blinded ratings or those that are sham-NF or semi-active controlled or those that employed optimally titration procedures , the findings do not support theta/beta NF as a st and alone treatment for children or adolescents with ADHD .
This review concludes that the present role of NF in treating children diagnosed with ADHD should be considered as complementary in a multimodal treatment approach , individualized to the needs of the child , and may be considered a viable alternative to stimulants for a specific group of patients .
***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 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 R and omized 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 r and omized and allocated by sequentially numbered sealed envelopes into three groups : methylpheni date ( 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 question naire , and the changes in these scores after treatment were used as the self-reported evaluation . Basic statistical methods ( descriptive , analyses of variance , exact χ2 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 question naires . The treatment groups were comparable in age , sex , and cognition as well as in the baseline levels of core ADHD symptoms . All treatments result ed 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 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 Abstract Attention Deficit Hyperactivity Disorder ( ADHD ) is associated with poor self‐control , underpinned by inferior fronto‐striatal deficits . Real‐time functional magnetic resonance neurofeedback ( rtfMRI‐NF ) allows participants to gain self‐control over dysregulated brain regions . Despite evidence for beneficial effects of electrophysiological‐NF on ADHD symptoms , no study has applied the spatially superior rtfMRI‐NF neurotherapy to ADHD . A r and omized controlled trial tested the efficacy of rtfMRI‐NF of right inferior prefrontal cortex ( rIFG ) , a key region that is compromised in ADHD and upregulated with psychostimulants , on improvement of ADHD symptoms , cognition , and inhibitory fMRI activation . To control for region‐specificity , an active control group received rtfMRI‐NF of the left parahippocampal gyrus ( lPHG ) . Thirty‐one ADHD boys were r and omly allocated and had to learn to upregulate their target brain region in an average of 11 rtfMRI‐NF runs over 2 weeks . Feedback was provided through a video‐clip of a rocket that had to be moved up into space . A transfer session without feedback tested learning retention as a proximal measure of transfer to everyday life . Both NF groups showed significant linear activation increases with increasing number of runs in their respective target regions and significant reduction in ADHD symptoms after neurotherapy and at 11‐month follow‐up . Only the group targeting rIFG , however , showed a transfer effect , which correlated with ADHD symptom reductions , improved at trend level in sustained attention , and showed increased IFG activation during an inhibitory fMRI task . This proof‐of‐concept study demonstrates for the first time feasibility , safety , and shorter‐ and longer‐term efficacy  of rtfMRI‐NF of rIFG in adolescents with ADHD . Hum Brain Mapp 38:3190–3209 , 2017 . © 2017 The Authors Human Brain Mapping Published by Wiley Periodicals , OBJECTIVE The efficacy of neurofeedback as a treatment for attention-deficit/hyperactivity disorder ( ADHD ) , and whether neurofeedback is a viable alternative for stimulant medication , is still an intensely debated subject . The current r and omized controlled trial compared neurofeedback to ( 1 ) optimally titrated methylpheni date and ( 2 ) a semi-active control intervention , physical activity , to account for nonspecific effects . METHODS A multicenter 3-way parallel-group study with balanced r and omization was conducted . Children with a DSM-IV-TR diagnosis of ADHD , aged 7 - 13 years , were r and omly allocated to receive neurofeedback ( n = 39 ) , methylpheni date ( n = 36 ) , or physical activity ( n = 37 ) over a period of 10 - 12 weeks . Neurofeedback comprised theta/beta training on the vertex ( Cz ) . Physical activity consisted of moderate to vigorous intensity exercises . Neurofeedback and physical activity were balanced in terms of number ( ~30 ) and duration of sessions . A double-blind pseudor and omized placebo-controlled crossover titration procedure was used to determine an optimal dose in the methylpheni date intervention . Parent and teacher ratings on the Strengths and Difficulties Question naire ( SDQ ) and Strengths and Weaknesses of ADHD Symptoms and Normal Behavior ( SWAN ) were used to assess intervention outcomes . Data collection took place between September 2010 and March 2014 . RESULTS Intention-to-treat analyses revealed an improvement in parent-reported behavior on the SDQ and the SWAN Hyperactivity/Impulsivity scale , irrespective of received intervention ( ηp² = 0.21 - 0.22 , P ≤ .001 ) , whereas the SWAN Inattention scale revealed more improvement in children who received methylpheni date than neurofeedback and physical activity ( ηp² = 0.13 , P ≤ .001 ) . Teachers reported a decrease of ADHD symptoms on all measures for methylpheni date , but not for neurofeedback or physical activity ( range of ηp² = 0.14 - 0.29 , P < .001 ) . CONCLUSIONS The current study found that optimally titrated methylpheni date is superior to neurofeedback and physical activity in decreasing ADHD symptoms in children with ADHD . TRIAL REGISTRATION Clinical Trials.gov identifier : NCT01363544 BACKGROUND The clinical and neurophysiological effects of neurofeedback ( NF ) as treatment for children with ADHD are still unclear . This r and omized controlled trial ( RCT ) examined electroencephalogram ( EEG ) power spectra before and after NF compared to methylpheni date ( MPH ) treatment and physical activity ( PA ) - as semi-active control group - during resting and active ( effortful ) task conditions to determine whether NF can induce sustained alterations in brain function . METHODS Using a multicentre three-way parallel group RCT design , 112 children with a DSM-IV diagnosis of ADHD , aged between 7 and 13 years , were initially included . NF training consisted of 30 sessions of theta/beta training at Cz over a 10-week period . PA training was a semi-active control group , matched in frequency and duration . Methylpheni date was titrated using a double-blind placebo controlled procedure in 6 weeks , followed by a stable dose for 4 weeks . EEG power spectra measures during eyes open ( EO ) , eyes closed ( EC ) and task ( effortful ) conditions were available for 81 children at pre- and postintervention ( n = 29 NF , n = 25 MPH , n = 27 PA ) . CLINICAL TRIALS REGISTRATION Train Your Brain ? Exercise and Neurofeedback Intervention for ADHD , https:// clinical trials.gov/show/;NCT01363544 , Ref . No. NCT01363544 . RESULTS Both NF and MPH result ed in comparable reductions in theta power from pre- to postintervention during the EO condition compared to PA ( ηp ( 2 ) = .08 and .12 ) . For NF , greater reductions in theta were related to greater reductions in ADHD symptoms . During the task condition , only MPH showed reductions in theta and alpha power compared to PA ( ηp ( 2 ) = .10 and .12 ) . CONCLUSIONS This study provides evidence for specific neurophysiological effects after theta/beta NF and MPH treatment in children with ADHD . However , for NF these effects did not generalize to an active task condition , potentially explaining reduced behavioural effects of NF in the classroom Background A r and omized 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 r and omized into three groups , with 30 in the NF group , 31 controls in a group that was given methylpheni date , and 30 in a group that received NF and methylpheni date .  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 r and omized 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 methylpheni date at treating the attentional and hyperactivity symptoms of ADHD , based on parental reports . Trial registration Current Controlled Trials Neurofeedback ( NFB ) is a potential alternative treatment for children with ADHD that aims to optimize brain activity . Whereas most studies into NFB have investigated behavioral effects , less attention has been paid to the effects on neurocognitive functioning . The present r and omized controlled trial ( RCT ) compared neurocognitive effects of NFB to ( 1 ) optimally titrated methylpheni date ( MPH ) and ( 2 ) a semi-active control intervention , physical activity ( PA ) , to control for non-specific effects . Using a multicentre three-way parallel group RCT design , children with ADHD , aged 7–13 , were r and omly allocated to NFB ( n = 39 ) , MPH ( n = 36 ) or PA ( n = 37 ) over a period of 10–12 weeks . NFB comprised theta/beta training at CZ . The PA intervention was matched in frequency and duration to NFB . MPH was titrated using a double-blind placebo controlled procedure to determine the optimal dose . Neurocognitive functioning was assessed using parameters derived from the auditory oddball- , stop-signal- and visual spatial working memory task . Data collection took place between September 2010 and March 2014 . Intention-to-treat analyses showed improved attention for MPH compared to NFB and PA , as reflected by decreased response speed during the oddball task [ ηp2 = 0.21 , p < 0.001 ] , as well as improved inhibition , impulsivity and attention , as reflected by faster stop signal reaction times , lower commission and omission error rates during the stop-signal task ( range ηp2 = 0.09–0.18 , p values < 0.008 ) . Working memory improved over time , irrespective of received treatment ( ηp2 = 0.1 
    Output:
    