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 This study examined augmenting atomoxetine with extended-release methylpheni date in children whose attention-deficit/hyperactivity disorder ( ADHD ) previously failed to respond adequately to stimulant medication . Methods Children with ADHD and prior stimulant treatment ( N = 25 ) received atomoxetine ( 1.2 mg/kg/day ) plus placebo . After 4 weeks , patients who were responders ( n = 4 ) were continued on atomoxetine/placebo while remaining patients were r and omly assigned to either methylpheni date ( ATX/MPH ) ( 1.1 mg/kg/day ) or placebo augmentation ( ATX/PB ) for another 6 weeks . Patients and sites were blind to timing of active augmentation . Safety measures included vital signs , weight , and adverse events . Efficacy was assessed by ADHD rating scales . Results Categorical increases in vital signs occurred for 5 patients ( 3 patients in ATX/MPH , 2 patients in ATX/PBO ) . Sixteen percent discontinued the study due to AE , but no difference between augmentation groups . Atomoxetine treatment was efficacious on outcome measures ( P ≤ .001 ) , but methylpheni date did not enhance response . Conclusion Methylpheni date appears to be safely combined with atomoxetine , but conclusions limited by small sample . With atomoxetine treatment , 43 % of patients achieved normalization on ADHD ratings Research participants were 46 adolescents ( mean age = 13.8 years ) who completed an intensive summer treatment program including a  placebo-controlled , double-blind , crossover trial of 3 doses of methylpheni date ( MPH ) totaling 25 , 50 , or 75 mg per day . Dependent measures focused on social behavior and included observed behavior frequencies and ratings completed by counselors and parents , including side effects . Multiple data analytic methods were used with the goal of ( a ) describing the shape of the dose-response curves across multiple measures of social functioning , ( b ) determining the percentage of adolescents whose social behavior improved in response to MPH , and ( c ) assessing the incremental gains that result from increases in dose . The results show that ( a ) the shape of the dose-response curve is influenced by the measurement method , ( b ) the majority of adolescents exhibited improved social behavior when treated with MPH , ( c ) the bulk of the positive effects of MPH were achieved at the lowest dose , and ( d ) there appear to be diminishing positive effects and an increased risk of negative effects with successively higher doses OBJECTIVE Response to atomoxetine , a nonstimulant norepinephrine-specific reuptake inhibitor , was compared with the effect of osmotic-release oral methylpheni date , a long-acting methylpheni date preparation , in patients with attention deficit hyperactivity disorder ( ADHD ) . METHOD In a large placebo-controlled , double-blind study , patients ages 6 - 16 with ADHD , any subtype , were r and omly assigned to receive 0.8 - 1.8 mg/kg per day of atomoxetine ( N=222 ) , 18 - 54 mg/day of osmotically released methylpheni date ( N=220 ) , or placebo ( N=74 ) for 6 weeks . The a priori specified primary analysis compared response ( at least 40 % decrease in ADHD Rating Scale total score ) to osmotically released methylpheni date with response to atomoxetine and placebo . After 6 weeks , patients treated with methylpheni date were switched to atomoxetine under double-blind conditions . RESULTS The response rates for both atomoxetine ( 45 % ) and methylpheni date ( 56 % ) were markedly superior to that for placebo ( 24 % ) , but the response to osmotically released methylpheni date was superior to that for atomoxetine . Each medication was well tolerated , with completion rates and discontinuations for adverse events not significantly different from those for placebo . Of the 70 subjects who did not respond to methylpheni date , 30 ( 43 % ) subsequently responded to atomoxetine . Likewise , 29 ( 42 % ) of the 69 patients who did not respond to atomoxetine had previously responded to osmotically released methylpheni date . CONCLUSION Response was significantly greater with osmotically released methylpheni date than with atomoxetine . One-third of patients who received methylpheni date followed by atomoxetine responded better to one or the other , suggesting that there may be preferential responders Our objective was to evaluate the effectiveness of a long-acting formulation of methylpheni date ( MPH-SODAS ) on attention-deficit/hyperactivity disorder ( ADHD ) symptoms in an outpatient sample of adolescents with ADHD and substance use disorders ( SUD ) . Secondary goals were to evaluate the tolerability and impact on drug use of MPH-SODAS . This was a 6-week , single-blind , placebo-controlled crossover study assessing efficacy of escalated doses of MPH-SODAS on ADHD symptoms in 16 adolescents with ADHD/SUD . Participants were r and omly allocated to either group A ( weeks 1 - 3 on MPH-SODAS , weeks 4 - 6 on placebo ) or group B ( reverse order ) . The primary outcome measures were the Swanson , Nolan and Pelham Scale , version IV ( SNAP-IV ) and the Clinical Global Impression Scale ( CGI ) . We also evaluated the adverse effects of MPH-SODAS using the Barkley Side Effect Rating Scale and subject reports of drug use during the study . The sample consisted of marijuana ( N = 16 ; 100 % ) and cocaine users ( N = 7 ; 43.8 % ) . Subjects had a significantly greater reduction in SNAP-IV and CGI scores ( P < 0.001 for all analyses ) during MPH-SODAS treatment compared to placebo . No significant effects for period or sequence were found in analyses with the SNAP-IV and CGI scales . There was no significant effect on drug use .  MPH-SODAS was well tolerated but was associated with more severe appetite reduction than placebo ( P < 0.001 ) . MPH-SODAS was more effective than placebo in reducing ADHD symptoms in a non-abstinent outpatient sample of adolescents with comorbid SUD . R and omized clinical trials , with larger sample s and SUD intervention , are recommended OBJECTIVE To examine the short-term efficacy of methylpheni date in the treatment of youths with bipolar disorder ( BD ) and comorbid attention deficit/hyperactivity disorder ( ADHD ) . METHOD A 4-week double-blind , placebo-controlled trial in youths ages 5 to 17 years was conducted . Subjects met DSM-IV criteria for bipolar disorder and ADHD , were currently receiving a stable dose of at least one thymoleptic , and while euthymic continued to have clinical ly significant symptoms of ADHD . Patients received 1 week each of placebo , methylpheni date 5 mg twice daily , methylpheni date 10 mg twice daily , and methylpheni date 15 mg twice daily using a crossover design . Subjects were r and omly assigned to receive one of six possible dosing orders . At study 's end , and before the blind being broken , a " best dose week " for each subject was determined . The primary outcome measure was the total score on the parent-completed ADHD Rating Scale-IV . RESULTS Sixteen patients , with a mean age of 10.43 ( SD 3.14 ) years completed the trial . Lower scores during best dose treatment compared to the week of placebo treatment were found on the ADHD Rating Scale-IV ( p < .05 ) , suggesting a therapeutic benefit . A large effect size ( Cohen 's d = 0.90 ) was found for methylpheni date . Treatment was generally well tolerated . CONCLUSIONS Euthymic youths with bipolar disorder and ADHD may benefit from short-term concomitant treatment with methylpheni date Objective : While American Academy of Pediatrics guidelines recommend obtaining symptom reports from both parents and teachers when treating children with attention-deficit hyperactivity disorder ( ADHD ) , information from parents is easier to obtain and practitioners may prefer to rely solely on parent report when managing medications . There are , however , few empirical data on the relationship between parent and teacher reports during medication management of ADHD . This study examined the relationship between parent and teacher reports of symptoms of ADHD during a clinical trial . Methods : A study to improve medication management of ADHD was conducted in 24 pediatric practice s with 270 children . Children meeting criteria for ADHD were r and omized by practice to treatment-as-usual or specialized care groups , with data combined from the groups to examine parent-teacher agreement . Parent and teacher reports on the ADHD Rating Scale-IV  were obtained at pretreatment , 4 months , and 12 months follow-up . Results : At each assessment , correlations between parent and teacher ratings were statistically significant , but the magnitudes of the correlations were low , accounting for no more than approximately 17 % of the variance between measures . Correlations between change scores on parent and teacher ratings were statistically significant but low for Total and Inattentive scales and not significant for the Hyperactive-Impulsive scale . For agreement on extreme scores , 6 of 9 kappas were statistically significant but all were unacceptably low . Conclusions : Agreement between parent and teacher ratings of symptoms of ADHD is too low for clinicians to rely on parent reports while managing medications . Teacher reports are still needed to ensure optimal management This pilot study was design ed to assess the short-term effectiveness and side effects of methylpheni date in treating symptoms of attention deficit hyperactivity disorder ( ADHD ) in Native American children ( 5 to 12 years old ) with documented fetal alcohol syndrome ( FAS ) or partial fetal alcohol syndrome . Using strict criteria for the diagnosis of FAS and ADHD , a r and omized double-blind cross-over study of two placebos and a fixed dose of methylpheni date was completed in 4 Native American children in a residential school . Each treatment condition lasted 5 days , and daily observational outcome measures , the Conners Parent Rating Scale ( CPRS-48 ) , and the Conners Teacher Rating Scale ( CTRS-39 ) , were employed . Methylpheni date significantly improved scores of the Hyperactivity Index Scale on the CPRS-48 and the CTRS-39 but not the Daydreaming-Attention score on the CTRS-39 . Side effects were similar to those traditionally found in other population s. The promising preliminary results suggest that a more definitive study of methylpheni date in Native and non-Native children with FAS and ADHD is warranted Thirty-eight boys , referred for psychiatric treatment because of serious problems of behaviour , underwent a double-blind , placebo-controlled , crossover trial of methylpheni date and placebo . Methylpheni date was an effective treatment over a 3-week period . A good response to methylpheni date was predicted by higher levels of inattentive and restless behaviour , impaired performance on tests of attention , clumsiness , younger age and by the absence of symptoms of overt emotional disorder . DSM-III and ICD-9 diagnoses of ' hyperactivity ' were not good predictors . The results support the validity of a construct of hyperactivity in describing childhood psychopathology , but emphasize the need for a refinement of diagnostic criteria OBJECTIVE Methylpheni date ( MPH ) is commonly used to treat attention-deficit/hyperactivity disorder ( ADHD ) in all children , including those with velocardiofacial syndrome ( VCFS ) . Yet concerns have been raised regarding its safety and efficacy in VCFS . The goal of this study was to examine the safety and efficacy of MPH in children with VCFS . METHODS Thirty-four children and adolescents with VCFS and ADHD participated in a r and omized , controlled trial with a 2:1 ratio of MPH versus placebo . All subjects underwent a cardiological evaluation before and after MPH administration . The primary outcome measure was prefrontal cognitive performance following a single dose of MPH or placebo . A follow-up assessment was conducted after a 6-month treatment with MPH . RESULTS Compared with placebo , single MPH administration was associated with a more robust improvement in prefrontal cognitive performance , including achievements in the Hearts and Flowers executive function task and the visual continuous performance task . After 6 months of treatment , a 40 % reduction in severity of ADHD symptoms was reported by parents on the Revised Conners Rating Scale . All subjects treated with MPH reported at least one side effect , but it did not necessitate discontinuation of treatment . MPH induced an increase in heart rate and blood pressure that was usually minor , but was clinical ly significant in two cases . No differences in response to MPH were observed between catechol-O-methyltransferase Met versus Val carriers . CONCLUSION The use of MPH in children with VCFS appears to be effective and relatively safe . A comprehensive cardiovascular evaluation for children with VCFS before and during stimulant treatment is recommended OBJECTIVE To determine the efficacy and safety of clonidine , used alone or in combination with methylpheni date , in treating attention-deficit/hyperactivity disorder ( ADHD ) . METHOD A 16-week , r and omized , double-blind , placebo-controlled clinical trial was conducted in 122 children , ages 7 to 12 , with any subtype of ADHD , r and omly assigned to clonidine , methylpheni date , clonidine in combination with methylpheni date , or placebo according to a 2 x 2 factorial design . In two successive 4-week titration periods , clonidine ( or matching placebo ) and added methylpheni date ( or matching placebo ) were adjusted to optimal dos 
    Output:
    
agent
What this study adds The results suggest that among children and adolescents with a diagnosis of ADHD , methylpheni date may improve teacher reported symptoms of ADHD and general behaviour and parent reported quality of life .
Methylpheni date is associated with an increased risk of non-serious but not serious adverse events .
***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 This study examined augmenting atomoxetine with extended-release methylpheni date in children whose attention-deficit/hyperactivity disorder ( ADHD ) previously failed to respond adequately to stimulant medication . Methods Children with ADHD and prior stimulant treatment ( N = 25 ) received atomoxetine ( 1.2 mg/kg/day ) plus placebo . After 4 weeks , patients who were responders ( n = 4 ) were continued on atomoxetine/placebo while remaining patients were r and omly assigned to either methylpheni date ( ATX/MPH ) ( 1.1 mg/kg/day ) or placebo augmentation ( ATX/PB ) for another 6 weeks . Patients and sites were blind to timing of active augmentation . Safety measures included vital signs , weight , and adverse events . Efficacy was assessed by ADHD rating scales . Results Categorical increases in vital signs occurred for 5 patients ( 3 patients in ATX/MPH , 2 patients in ATX/PBO ) . Sixteen percent discontinued the study due to AE , but no difference between augmentation groups . Atomoxetine treatment was efficacious on outcome measures ( P ≤ .001 ) , but methylpheni date did not enhance response . Conclusion Methylpheni date appears to be safely combined with atomoxetine , but conclusions limited by small sample . With atomoxetine treatment , 43 % of patients achieved normalization on ADHD ratings Research participants were 46 adolescents ( mean age = 13.8 years ) who completed an intensive summer treatment program including a  placebo-controlled , double-blind , crossover trial of 3 doses of methylpheni date ( MPH ) totaling 25 , 50 , or 75 mg per day . Dependent measures focused on social behavior and included observed behavior frequencies and ratings completed by counselors and parents , including side effects . Multiple data analytic methods were used with the goal of ( a ) describing the shape of the dose-response curves across multiple measures of social functioning , ( b ) determining the percentage of adolescents whose social behavior improved in response to MPH , and ( c ) assessing the incremental gains that result from increases in dose . The results show that ( a ) the shape of the dose-response curve is influenced by the measurement method , ( b ) the majority of adolescents exhibited improved social behavior when treated with MPH , ( c ) the bulk of the positive effects of MPH were achieved at the lowest dose , and ( d ) there appear to be diminishing positive effects and an increased risk of negative effects with successively higher doses OBJECTIVE Response to atomoxetine , a nonstimulant norepinephrine-specific reuptake inhibitor , was compared with the effect of osmotic-release oral methylpheni date , a long-acting methylpheni date preparation , in patients with attention deficit hyperactivity disorder ( ADHD ) . METHOD In a large placebo-controlled , double-blind study , patients ages 6 - 16 with ADHD , any subtype , were r and omly assigned to receive 0.8 - 1.8 mg/kg per day of atomoxetine ( N=222 ) , 18 - 54 mg/day of osmotically released methylpheni date ( N=220 ) , or placebo ( N=74 ) for 6 weeks . The a priori specified primary analysis compared response ( at least 40 % decrease in ADHD Rating Scale total score ) to osmotically released methylpheni date with response to atomoxetine and placebo . After 6 weeks , patients treated with methylpheni date were switched to atomoxetine under double-blind conditions . RESULTS The response rates for both atomoxetine ( 45 % ) and methylpheni date ( 56 % ) were markedly superior to that for placebo ( 24 % ) , but the response to osmotically released methylpheni date was superior to that for atomoxetine . Each medication was well tolerated , with completion rates and discontinuations for adverse events not significantly different from those for placebo . Of the 70 subjects who did not respond to methylpheni date , 30 ( 43 % ) subsequently responded to atomoxetine . Likewise , 29 ( 42 % ) of the 69 patients who did not respond to atomoxetine had previously responded to osmotically released methylpheni date . CONCLUSION Response was significantly greater with osmotically released methylpheni date than with atomoxetine . One-third of patients who received methylpheni date followed by atomoxetine responded better to one or the other , suggesting that there may be preferential responders Our objective was to evaluate the effectiveness of a long-acting formulation of methylpheni date ( MPH-SODAS ) on attention-deficit/hyperactivity disorder ( ADHD ) symptoms in an outpatient sample of adolescents with ADHD and substance use disorders ( SUD ) . Secondary goals were to evaluate the tolerability and impact on drug use of MPH-SODAS . This was a 6-week , single-blind , placebo-controlled crossover study assessing efficacy of escalated doses of MPH-SODAS on ADHD symptoms in 16 adolescents with ADHD/SUD . Participants were r and omly allocated to either group A ( weeks 1 - 3 on MPH-SODAS , weeks 4 - 6 on placebo ) or group B ( reverse order ) . The primary outcome measures were the Swanson , Nolan and Pelham Scale , version IV ( SNAP-IV ) and the Clinical Global Impression Scale ( CGI ) . We also evaluated the adverse effects of MPH-SODAS using the Barkley Side Effect Rating Scale and subject reports of drug use during the study . The sample consisted of marijuana ( N = 16 ; 100 % ) and cocaine users ( N = 7 ; 43.8 % ) . Subjects had a significantly greater reduction in SNAP-IV and CGI scores ( P < 0.001 for all analyses ) during MPH-SODAS treatment compared to placebo . No significant effects for period or sequence were found in analyses with the SNAP-IV and CGI scales . There was no significant effect on drug use .  MPH-SODAS was well tolerated but was associated with more severe appetite reduction than placebo ( P < 0.001 ) . MPH-SODAS was more effective than placebo in reducing ADHD symptoms in a non-abstinent outpatient sample of adolescents with comorbid SUD . R and omized clinical trials , with larger sample s and SUD intervention , are recommended OBJECTIVE To examine the short-term efficacy of methylpheni date in the treatment of youths with bipolar disorder ( BD ) and comorbid attention deficit/hyperactivity disorder ( ADHD ) . METHOD A 4-week double-blind , placebo-controlled trial in youths ages 5 to 17 years was conducted . Subjects met DSM-IV criteria for bipolar disorder and ADHD , were currently receiving a stable dose of at least one thymoleptic , and while euthymic continued to have clinical ly significant symptoms of ADHD . Patients received 1 week each of placebo , methylpheni date 5 mg twice daily , methylpheni date 10 mg twice daily , and methylpheni date 15 mg twice daily using a crossover design . Subjects were r and omly assigned to receive one of six possible dosing orders . At study 's end , and before the blind being broken , a " best dose week " for each subject was determined . The primary outcome measure was the total score on the parent-completed ADHD Rating Scale-IV . RESULTS Sixteen patients , with a mean age of 10.43 ( SD 3.14 ) years completed the trial . Lower scores during best dose treatment compared to the week of placebo treatment were found on the ADHD Rating Scale-IV ( p < .05 ) , suggesting a therapeutic benefit . A large effect size ( Cohen 's d = 0.90 ) was found for methylpheni date . Treatment was generally well tolerated . CONCLUSIONS Euthymic youths with bipolar disorder and ADHD may benefit from short-term concomitant treatment with methylpheni date Objective : While American Academy of Pediatrics guidelines recommend obtaining symptom reports from both parents and teachers when treating children with attention-deficit hyperactivity disorder ( ADHD ) , information from parents is easier to obtain and practitioners may prefer to rely solely on parent report when managing medications . There are , however , few empirical data on the relationship between parent and teacher reports during medication management of ADHD . This study examined the relationship between parent and teacher reports of symptoms of ADHD during a clinical trial . Methods : A study to improve medication management of ADHD was conducted in 24 pediatric practice s with 270 children . Children meeting criteria for ADHD were r and omized by practice to treatment-as-usual or specialized care groups , with data combined from the groups to examine parent-teacher agreement . Parent and teacher reports on the ADHD Rating Scale-IV  were obtained at pretreatment , 4 months , and 12 months follow-up . Results : At each assessment , correlations between parent and teacher ratings were statistically significant , but the magnitudes of the correlations were low , accounting for no more than approximately 17 % of the variance between measures . Correlations between change scores on parent and teacher ratings were statistically significant but low for Total and Inattentive scales and not significant for the Hyperactive-Impulsive scale . For agreement on extreme scores , 6 of 9 kappas were statistically significant but all were unacceptably low . Conclusions : Agreement between parent and teacher ratings of symptoms of ADHD is too low for clinicians to rely on parent reports while managing medications . Teacher reports are still needed to ensure optimal management This pilot study was design ed to assess the short-term effectiveness and side effects of methylpheni date in treating symptoms of attention deficit hyperactivity disorder ( ADHD ) in Native American children ( 5 to 12 years old ) with documented fetal alcohol syndrome ( FAS ) or partial fetal alcohol syndrome . Using strict criteria for the diagnosis of FAS and ADHD , a r and omized double-blind cross-over study of two placebos and a fixed dose of methylpheni date was completed in 4 Native American children in a residential school . Each treatment condition lasted 5 days , and daily observational outcome measures , the Conners Parent Rating Scale ( CPRS-48 ) , and the Conners Teacher Rating Scale ( CTRS-39 ) , were employed . Methylpheni date significantly improved scores of the Hyperactivity Index Scale on the CPRS-48 and the CTRS-39 but not the Daydreaming-Attention score on the CTRS-39 . Side effects were similar to those traditionally found in other population s. The promising preliminary results suggest that a more definitive study of methylpheni date in Native and non-Native children with FAS and ADHD is warranted Thirty-eight boys , referred for psychiatric treatment because of serious problems of behaviour , underwent a double-blind , placebo-controlled , crossover trial of methylpheni date and placebo . Methylpheni date was an effective treatment over a 3-week period . A good response to methylpheni date was predicted by higher levels of inattentive and restless behaviour , impaired performance on tests of attention , clumsiness , younger age and by the absence of symptoms of overt emotional disorder . DSM-III and ICD-9 diagnoses of ' hyperactivity ' were not good predictors . The results support the validity of a construct of hyperactivity in describing childhood psychopathology , but emphasize the need for a refinement of diagnostic criteria OBJECTIVE Methylpheni date ( MPH ) is commonly used to treat attention-deficit/hyperactivity disorder ( ADHD ) in all children , including those with velocardiofacial syndrome ( VCFS ) . Yet concerns have been raised regarding its safety and efficacy in VCFS . The goal of this study was to examine the safety and efficacy of MPH in children with VCFS . METHODS Thirty-four children and adolescents with VCFS and ADHD participated in a r and omized , controlled trial with a 2:1 ratio of MPH versus placebo . All subjects underwent a cardiological evaluation before and after MPH administration . The primary outcome measure was prefrontal cognitive performance following a single dose of MPH or placebo . A follow-up assessment was conducted after a 6-month treatment with MPH . RESULTS Compared with placebo , single MPH administration was associated with a more robust improvement in prefrontal cognitive performance , including achievements in the Hearts and Flowers executive function task and the visual continuous performance task . After 6 months of treatment , a 40 % reduction in severity of ADHD symptoms was reported by parents on the Revised Conners Rating Scale . All subjects treated with MPH reported at least one side effect , but it did not necessitate discontinuation of treatment . MPH induced an increase in heart rate and blood pressure that was usually minor , but was clinical ly significant in two cases . No differences in response to MPH were observed between catechol-O-methyltransferase Met versus Val carriers . CONCLUSION The use of MPH in children with VCFS appears to be effective and relatively safe . A comprehensive cardiovascular evaluation for children with VCFS before and during stimulant treatment is recommended OBJECTIVE To determine the efficacy and safety of clonidine , used alone or in combination with methylpheni date , in treating attention-deficit/hyperactivity disorder ( ADHD ) . METHOD A 16-week , r and omized , double-blind , placebo-controlled clinical trial was conducted in 122 children , ages 7 to 12 , with any subtype of ADHD , r and omly assigned to clonidine , methylpheni date , clonidine in combination with methylpheni date , or placebo according to a 2 x 2 factorial design . In two successive 4-week titration periods , clonidine ( or matching placebo ) and added methylpheni date ( or matching placebo ) were adjusted to optimal dos 
    Output:
    