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: Electroencephalography (EEG)-neurofeedback has been shown to offer therapeutic benefits to patients with attention-deficit/hyperactivity disorder ( ADHD ) in several , mostly uncontrolled studies . This pilot study is design ed to test the feasibility and safety of using a double-blind placebo feedback-controlled design and to explore the initial efficacy of individualized EEG-neurofeedback training in children with ADHD . Fourteen children ( 8–15 years ) with ADHD defined according to the DSM-IV-TR criteria were r and omly allocated to 30 sessions of EEG-neurofeedback ( n = 8) or placebo feedback ( n = 6 ) . Safety measures ( adverse events and sleep problems ) , ADHD symptoms and global improvement were monitored . With respect to feasibility , all children completed the study and attended all study visits and training sessions . No significant adverse effects or sleep problems were reported . Regarding the expectancy , 75 % of children and their parent(s ) in the active neurofeedback group and 50 % of children and their parent(s ) in the placebo feedback group thought they received placebo feedback training . Analyses revealed significant improvements of ADHD symptoms over time , but changes were similar for both groups . This pilot study shows that it is feasible to conduct a rigorous placebo-controlled trial to investigate the efficacy of neurofeedback training  in children with ADHD . However , a double-blind design may not be feasible since using automatic adjusted reward thresholds may not work as effective as manually adjusted reward thresholds . Additionally , implementation of active learning strategies may be an important factor for the efficacy of EEG-neurofeedback training . Based on the results of this pilot study , changes are made in the design of the ongoing study Neurofeedback treatment has been demonstrated to reduce inattention , impulsivity and hyperactivity in children with attention deficit/hyperactivity disorder ( ADHD ) . However , previous studies did not adequately control confounding variables or did not employ a r and omized reinforcer-controlled design . This study addresses those method ological shortcomings by comparing the effects of the following two matched biofeedback training variants on the primary symptoms of ADHD : EEG neurofeedback ( NF ) aim ing at theta/beta ratio reduction and EMG biofeedback ( BF ) aim ing at forehead muscle relaxation . Thirty-five children with ADHD ( 26 boys , 9 girls ; 6–14 years old ) were r and omly assigned to either the therapy group ( NF ; n = 18 ) or the control group ( BF ; n = 17 ) . Treatment for both groups consisted of 30 sessions . Pre- and post-treatment assessment consisted of psychophysiological measures , behavioural rating scales completed by parents and teachers , as well as psychometric measures . Training effectively reduced theta/beta ratios and EMG levels in the NF and BF groups , respectively . Parents reported significant reductions in primary ADHD symptoms , and inattention improvements in the NF group were higher compared to the control intervention ( BF , dcorr = −.94 ) . NF training also improved attention and reaction times on the psychometric measures . The results indicate that NF effectively reduced inattention symptoms on parent rating scales and reaction time in neuropsychological tests . However , regarding hyperactivity and impulsivity symptoms , the results imply that non-specific factors , such as behavioural contingencies , self-efficacy , structured learning environment and feed-forward processes , may also contribute to the positive behavioural effects induced by neurofeedback training Objective : Preparing for a definitive r and omized clinical trial ( RCT ) of neurofeedback ( NF ) for ADHD , this pilot trial explored feasibility of a double-blind , sham-controlled design and adherence/palatability/relative effect of two versus three treatments/week . Method : Unmedicated 6- to 12-year-olds with Diagnostic and Statistical Manual of Mental Disorders ( 4th ed . ; DSM-IV ) ADHD were r and omized to active NF versus sham-NF and to 2X versus 3X/week treatment frequency . Frequency switch was allowed after Treatment 24 . Results : In two school years , 39 participants were recruited and 34 ( 87 % ) completed all 40 treatments . Child/parent guesses about assigned treatment were no better than chance . At Treatment 24 , 38 % chose 2X/week and 62 % chose 3X/week . Both active NF and sham yielded large pre – post improvement on parent ratings  but NF no more than sham . Conclusion : Blinding appears to work , and sham does not prevent recruitment/retention . Treatment frequency of 3X/week seems preferred over 2X/week and was as effective . A large double-blind RCT is feasible and necessary to test specific NF effectiveness 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 Two functional magnetic resonance imaging ( fMRI ) experiments were undertaken to measure the effect of neurofeedback training ( NFT ) , in AD/HD children , on the neural substrates of selective attention and response inhibition . Twenty unmedicated AD/HD children participated to these experiments . Fifteen children were r and omly assigned to the Experimental ( EXP ) group whereas the other five children were r and omly assigned to the Control ( CON ) group . Only subjects in the EXP group underwent NFT . EXP subjects were trained to enhance the amplitude of the SMR ( 12–15 Hz ) and beta 1 activity ( 15–18 Hz ) , and decrease the amplitude of theta activity ( 4–7 Hz ) . Subjects from both groups were scanned one week before the beginning of NFT ( Time 1 ) and 1 week after the end of NFT ( Time 2 ) , while they performed a “ Counting Stroop ” task ( Experiment 1 ) and a Go/No-Go task ( Experiment 2 ) . At Time 1 , in both groups , the  Counting Stroop task was associated with significant activation in the left superior parietal lobule . For the Go/No-Go task , no significant activity was detected in the EXP and CON groups . At Time 2 , in both groups , the  Counting Stroop task was associated with significant activation of the left superior parietal lobule . This time , however , there were significant loci of activation , in the EXP group , in the right ACC , left cau date nucleus , and left substantia nigra . No such activation loci were seen in CON subjects . For the Go/No-Go task , significant loci of activation were noted , in the EXP group , in the right ventrolateral prefrontal cortex , right ACcd , left thalamus , left cau date nucleus , and left substantia nigra . No significant activation of these brain regions was measured in CON subjects . These results suggest that NFT has the capacity to functionally normalize the brain systems mediating selective attention and response inhibition in AD/HD children 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 Clinical trials have suggested that neurofeedback may be efficient in treating attention-deficit/hyperactivity disorder ( ADHD ) . We compared the effects of a 3-month electroencephalographic feedback program providing reinforcement contingent on the production of cortical sensorimotor rhythm ( 12–15 Hz ) and beta1 activity ( 15–18 Hz ) with stimulant medication . Participants were N = 34 children aged 8–12 years , 22 of which were assigned to the neurofeedback group and 12 to the methylpheni date group according to their parents ' preference . Both neurofeedback and methylpheni date were associated with improvements on all subscales of the Test of Variables of Attention , and on the speed and accuracy measures of the d2 Attention Endurance Test . Furthermore , behaviors related to the disorder were rated as significantly reduced in both groups by both teachers and parents on the IOWA-Conners Behavior Rating Scale . These findings suggest that neurofeedback was efficient in improving some of the behavioral concomitants of ADHD in children whose parents favored a nonpharmacological treatment Attention Deficit Hyperactivity Disorder ( AD/HD ) is a neurodevelopmental disorder mainly characterized by impairments in cognitive functions . Functional neuroimaging studies carried out in individuals with AD/HD have shown abnormal functioning of the anterior cingulate cortex ( ACC ) during tasks involving selective attention . In other respects , there is mounting evidence that neurofeedback training ( NFT ) can significantly improve cognitive functioning in AD/HD children . In this context , the present functional magnetic resonance imaging ( fMRI ) study was conducted to measure the effect of NFT  on the neural substrates of selective attention in children with AD/HD . Twenty AD/HD children -- not taking any psychostimulant and without co-morbidity-participated to the study . Fifteen children were r and omly assigned to the Experimental ( EXP ) group ( NFT ) , whereas the other five children were assigned to the Control ( CON ) group ( no NFT ) . Subjects from both groups were scanned 1 week before the beginning of the NFT ( Time 1 ) and 1 week after the end of this training ( Time 2 ) , while they performed a Counting Stroop task . At Time 1 , for both groups , the Counting Stroop task was associated with significant loci of activation in the left superior parietal lobule . No activation was noted in the ACC . At Time 2 , for both groups , the Counting Stroop task was still associated with significant activation of the left superior parietal lobule . This time , however , for the EXP group only there was a significant activation of the right ACC . These results suggest that in AD/HD children , NFT has the capacity to normalize the functioning of the ACC , the key neural substrate of selective attention BACKGROUND For children with attention deficit/hyperactivity disorder ( ADHD ) , a reduction of inattention , impulsivity and hyperactivity by neurofeedback ( NF ) has been reported in several studies . But so far , unspecific training effects have not been adequately controlled for and /or studies do not provide sufficient statistical power . To overcome these method ological shortcomings we evaluated the clinical efficacy of neurofeedback in children with ADHD in a multisite r and omised controlled study using a computerised attention skills training as a control condition . METHODS 102 children with ADHD , aged 8 to 12 years , participated in the study . Children performed either 36 sessions of NF training or a computerised attention skills training within two blocks of about four weeks each ( r and omised group assignment ) . The combined NF treatment consisted of one block of theta/beta training and one block of slow cortical potential ( SCP 
    Output:
    
agent
Further data on specificity comes from electrophysiological studies reporting that  NF effectively changes brain activity patterns .
No safety issues have emerged from clinical trials and NF seems to be well tolerated and accepted .
Follow-up studies support long-term effects of NF .
In conclusion , NF is a valid option for the treatment for ADHD , but further evidence is required to guide its use
***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: Electroencephalography (EEG)-neurofeedback has been shown to offer therapeutic benefits to patients with attention-deficit/hyperactivity disorder ( ADHD ) in several , mostly uncontrolled studies . This pilot study is design ed to test the feasibility and safety of using a double-blind placebo feedback-controlled design and to explore the initial efficacy of individualized EEG-neurofeedback training in children with ADHD . Fourteen children ( 8–15 years ) with ADHD defined according to the DSM-IV-TR criteria were r and omly allocated to 30 sessions of EEG-neurofeedback ( n = 8) or placebo feedback ( n = 6 ) . Safety measures ( adverse events and sleep problems ) , ADHD symptoms and global improvement were monitored . With respect to feasibility , all children completed the study and attended all study visits and training sessions . No significant adverse effects or sleep problems were reported . Regarding the expectancy , 75 % of children and their parent(s ) in the active neurofeedback group and 50 % of children and their parent(s ) in the placebo feedback group thought they received placebo feedback training . Analyses revealed significant improvements of ADHD symptoms over time , but changes were similar for both groups . This pilot study shows that it is feasible to conduct a rigorous placebo-controlled trial to investigate the efficacy of neurofeedback training  in children with ADHD . However , a double-blind design may not be feasible since using automatic adjusted reward thresholds may not work as effective as manually adjusted reward thresholds . Additionally , implementation of active learning strategies may be an important factor for the efficacy of EEG-neurofeedback training . Based on the results of this pilot study , changes are made in the design of the ongoing study Neurofeedback treatment has been demonstrated to reduce inattention , impulsivity and hyperactivity in children with attention deficit/hyperactivity disorder ( ADHD ) . However , previous studies did not adequately control confounding variables or did not employ a r and omized reinforcer-controlled design . This study addresses those method ological shortcomings by comparing the effects of the following two matched biofeedback training variants on the primary symptoms of ADHD : EEG neurofeedback ( NF ) aim ing at theta/beta ratio reduction and EMG biofeedback ( BF ) aim ing at forehead muscle relaxation . Thirty-five children with ADHD ( 26 boys , 9 girls ; 6–14 years old ) were r and omly assigned to either the therapy group ( NF ; n = 18 ) or the control group ( BF ; n = 17 ) . Treatment for both groups consisted of 30 sessions . Pre- and post-treatment assessment consisted of psychophysiological measures , behavioural rating scales completed by parents and teachers , as well as psychometric measures . Training effectively reduced theta/beta ratios and EMG levels in the NF and BF groups , respectively . Parents reported significant reductions in primary ADHD symptoms , and inattention improvements in the NF group were higher compared to the control intervention ( BF , dcorr = −.94 ) . NF training also improved attention and reaction times on the psychometric measures . The results indicate that NF effectively reduced inattention symptoms on parent rating scales and reaction time in neuropsychological tests . However , regarding hyperactivity and impulsivity symptoms , the results imply that non-specific factors , such as behavioural contingencies , self-efficacy , structured learning environment and feed-forward processes , may also contribute to the positive behavioural effects induced by neurofeedback training Objective : Preparing for a definitive r and omized clinical trial ( RCT ) of neurofeedback ( NF ) for ADHD , this pilot trial explored feasibility of a double-blind , sham-controlled design and adherence/palatability/relative effect of two versus three treatments/week . Method : Unmedicated 6- to 12-year-olds with Diagnostic and Statistical Manual of Mental Disorders ( 4th ed . ; DSM-IV ) ADHD were r and omized to active NF versus sham-NF and to 2X versus 3X/week treatment frequency . Frequency switch was allowed after Treatment 24 . Results : In two school years , 39 participants were recruited and 34 ( 87 % ) completed all 40 treatments . Child/parent guesses about assigned treatment were no better than chance . At Treatment 24 , 38 % chose 2X/week and 62 % chose 3X/week . Both active NF and sham yielded large pre – post improvement on parent ratings  but NF no more than sham . Conclusion : Blinding appears to work , and sham does not prevent recruitment/retention . Treatment frequency of 3X/week seems preferred over 2X/week and was as effective . A large double-blind RCT is feasible and necessary to test specific NF effectiveness 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 Two functional magnetic resonance imaging ( fMRI ) experiments were undertaken to measure the effect of neurofeedback training ( NFT ) , in AD/HD children , on the neural substrates of selective attention and response inhibition . Twenty unmedicated AD/HD children participated to these experiments . Fifteen children were r and omly assigned to the Experimental ( EXP ) group whereas the other five children were r and omly assigned to the Control ( CON ) group . Only subjects in the EXP group underwent NFT . EXP subjects were trained to enhance the amplitude of the SMR ( 12–15 Hz ) and beta 1 activity ( 15–18 Hz ) , and decrease the amplitude of theta activity ( 4–7 Hz ) . Subjects from both groups were scanned one week before the beginning of NFT ( Time 1 ) and 1 week after the end of NFT ( Time 2 ) , while they performed a “ Counting Stroop ” task ( Experiment 1 ) and a Go/No-Go task ( Experiment 2 ) . At Time 1 , in both groups , the  Counting Stroop task was associated with significant activation in the left superior parietal lobule . For the Go/No-Go task , no significant activity was detected in the EXP and CON groups . At Time 2 , in both groups , the  Counting Stroop task was associated with significant activation of the left superior parietal lobule . This time , however , there were significant loci of activation , in the EXP group , in the right ACC , left cau date nucleus , and left substantia nigra . No such activation loci were seen in CON subjects . For the Go/No-Go task , significant loci of activation were noted , in the EXP group , in the right ventrolateral prefrontal cortex , right ACcd , left thalamus , left cau date nucleus , and left substantia nigra . No significant activation of these brain regions was measured in CON subjects . These results suggest that NFT has the capacity to functionally normalize the brain systems mediating selective attention and response inhibition in AD/HD children 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 Clinical trials have suggested that neurofeedback may be efficient in treating attention-deficit/hyperactivity disorder ( ADHD ) . We compared the effects of a 3-month electroencephalographic feedback program providing reinforcement contingent on the production of cortical sensorimotor rhythm ( 12–15 Hz ) and beta1 activity ( 15–18 Hz ) with stimulant medication . Participants were N = 34 children aged 8–12 years , 22 of which were assigned to the neurofeedback group and 12 to the methylpheni date group according to their parents ' preference . Both neurofeedback and methylpheni date were associated with improvements on all subscales of the Test of Variables of Attention , and on the speed and accuracy measures of the d2 Attention Endurance Test . Furthermore , behaviors related to the disorder were rated as significantly reduced in both groups by both teachers and parents on the IOWA-Conners Behavior Rating Scale . These findings suggest that neurofeedback was efficient in improving some of the behavioral concomitants of ADHD in children whose parents favored a nonpharmacological treatment Attention Deficit Hyperactivity Disorder ( AD/HD ) is a neurodevelopmental disorder mainly characterized by impairments in cognitive functions . Functional neuroimaging studies carried out in individuals with AD/HD have shown abnormal functioning of the anterior cingulate cortex ( ACC ) during tasks involving selective attention . In other respects , there is mounting evidence that neurofeedback training ( NFT ) can significantly improve cognitive functioning in AD/HD children . In this context , the present functional magnetic resonance imaging ( fMRI ) study was conducted to measure the effect of NFT  on the neural substrates of selective attention in children with AD/HD . Twenty AD/HD children -- not taking any psychostimulant and without co-morbidity-participated to the study . Fifteen children were r and omly assigned to the Experimental ( EXP ) group ( NFT ) , whereas the other five children were assigned to the Control ( CON ) group ( no NFT ) . Subjects from both groups were scanned 1 week before the beginning of the NFT ( Time 1 ) and 1 week after the end of this training ( Time 2 ) , while they performed a Counting Stroop task . At Time 1 , for both groups , the Counting Stroop task was associated with significant loci of activation in the left superior parietal lobule . No activation was noted in the ACC . At Time 2 , for both groups , the Counting Stroop task was still associated with significant activation of the left superior parietal lobule . This time , however , for the EXP group only there was a significant activation of the right ACC . These results suggest that in AD/HD children , NFT has the capacity to normalize the functioning of the ACC , the key neural substrate of selective attention BACKGROUND For children with attention deficit/hyperactivity disorder ( ADHD ) , a reduction of inattention , impulsivity and hyperactivity by neurofeedback ( NF ) has been reported in several studies . But so far , unspecific training effects have not been adequately controlled for and /or studies do not provide sufficient statistical power . To overcome these method ological shortcomings we evaluated the clinical efficacy of neurofeedback in children with ADHD in a multisite r and omised controlled study using a computerised attention skills training as a control condition . METHODS 102 children with ADHD , aged 8 to 12 years , participated in the study . Children performed either 36 sessions of NF training or a computerised attention skills training within two blocks of about four weeks each ( r and omised group assignment ) . The combined NF treatment consisted of one block of theta/beta training and one block of slow cortical potential ( SCP 
    Output:
    