human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The effect of atomoxetine ( ATX ) on executive function has been assessed by means of question naires only . The aim of this study was therefore to evaluate the efficacy of ATX using st and ard variables of a computer-based continuous performance test ( cb-CPT ) combined with an infra-red motion-tracking device at different times of the day . One hundred twenty-eight girls and boys aged 6 to 12 years with a diagnosis of ADHD according to DSM-IV-TR criteria were r and omized in the study . The primary efficacy measures were the q-scores of the cb-CPT combined with an infra-red motion-tracking device .  The test comprises 13 neuropsychological variables that can be taken to reflect hyperactivity , inattention , or impulsivity .  One hundred five patients completed the study ( ATX group : n=54 ;  placebo  group : n=51 ) . ATX ( target dose 1.2 mg/kg/day ) over 8 weeks was significantly superior to placebo in reducing hyperactivity , inattention , and impulsivity as measured by q-scores of 10 primary variables of the cb-CPT . Both groups of patients showed a circadian pattern of neuropsychological outcomes across the day as reflected by the cb-CPT combined with an infra-red motion-tracking device . In summary , this study demonstrated a positive effect of ATX on some aspects of executive function , inhibitory control , and hyperactivity compared with placebo Twenty-four-hour motor activity was assessed in a naturalistic setting in 12 hyperactive boys for four weeks ( 672 consecutive hours ) . Dextroamphetamine , 15 mg/day , or placebo was administered on alternate weeks , using a double-blind ABAB design . When the boys received dextroamphetamine , motor activity was significantly decreased for about eight hours after drug administration . This decrease was followed by a period of slight but significant increases in activity ( " rebound " ) .  Dextroamphetamine decreased activity most strikingly during structured classroom activity ; during physical education , however , there was a significant drug-induced increase in motor activity Introduction The National Institute for Health and Care Excellence ( NICE ) guidelines for attention deficit/hyperactivity disorder ( ADHD ) state that young people need to have access to the best evidence -based care to improve outcome . The current ‘ gold st and ard ’ ADHD diagnostic assessment combines clinical observation with subjective parent , teacher and self-reports . In routine practice , reports from multiple informants may be unavailable or contradictory , leading to diagnostic uncertainty and delay . The addition of objective tests of attention and activity may help reduce diagnostic uncertainty and delays in initiating treatment leading to improved outcomes . This trial investigates whether providing clinicians with an objective report of levels of attention , impulsivity and activity can lead to an earlier , and more accurate , clinical diagnosis and improved patient outcome . Methods and analysis This multisite r and omised controlled trial will recruit young people ( aged 6–17 years old ) who have been referred for an ADHD diagnostic assessment at Child and Adolescent Mental Health Services ( CAMHS ) and Community Paediatric clinics across Engl and . Routine clinical assessment will be augmented by the QbTest , incorporating a continuous performance test ( CPT ) and infrared motion tracking of activity . The participant will be r and omised into one of two study arms : QbOpen ( clinician has immediate access to a QbTest report ) : QbBlind ( report is withheld until the study end ) . Primary outcomes are time to diagnosis and diagnostic accuracy . Secondary outcomes include clinician 's diagnostic confidence and routine clinical outcome measures . Cost-effective analysis will be conducted , alongside a qualitative assessment of the feasibility and acceptability of incorporating QbTest in routine practice . Ethics and dissemination The findings from the study will inform commissioners , clinicians and managers about the feasibility , acceptability , clinical utility and cost-effectiveness of incorporating QbTest into routine diagnostic assessment of young people with ADHD . The results will be su bmi tted for publication in peer- review ed journals . The study has received ethical approval . Trial registration number NCT02209116 Background The aims of this study were to determine the time course of improvements in attention deficit hyperactivity disorder ( ADHD ) clinical symptoms and neurocognitive function in a realistic clinical setting , and the differences in ADHD symptom improvement using different classifications of ADHD subtypes . Methods The Child Behavior Checklist ( CBCL ) was completed by parents of ADHD children at the initial visit . The  computerized Continuous Performance Test ( CPT ) , Swanson , Nolan , and Pelham , and Version IV Scale for ADHD ( SNAP-IV ) , and  ADHD Rating Scale ( ADHD-RS ) were performed at baseline , one month , three months , and six months later , respectively . Patient care including drug therapy was performed at the discretion of the psychiatrist . The ADHD patients were divided into DSM-IV subtypes ( Inattentive , Hyperactive-impulsive and Combined type ) , and were additionally categorized into aggressive and non-aggressive subtypes by aggression scale in CBCL for comparisons . Results There were 50 ADHD patients with a mean age of 7.84 ± 1.64 years ; 15 of them were inattentive type , 11 were hyperactive-impulsive type , and 24 were combined type . In addition , 28 of the ADHD patients were grouped into aggressive and 22 into non-aggressive subtypes . There were significant improvements in clinical symptoms of hyperactivity and inattention , and impulsivity performance in CPT during the 6-month treatment . The clinical hyperactive symptoms were significantly different between ADHD patients sub-grouping both by DSM-IV and aggression . Non-aggressive patients had significantly greater changes in distraction and impulsivity performances in CPT from baseline to month 6 than aggressive patients . Conclusions We found that ADHD symptoms , which included impulsive performances in CPT and clinical inattention and hyperactivity dimensions , had improved significantly over 6 months under pragmatic treatments . The non-aggressive ADHD patients might have a higher potential for improving in CPT performance than aggressive ones . However , it warrant further investigation whether the different classifications of ADHD patients could be valid for predicting the improvements in ADHD patients ' clinical symptoms and neurocognitive performance Twenty boys ( mean age , 9 + /- 2 years ) with attention deficit disorder with hyperactivity received three weeks each of dextroamphetamine sulfate ( 0.5 mg/kg/d ) , fenfluramine hydrochloride ( 0.6 mg/kg/d increased to 2.0 mg/kg/d ) , and placebo in a double-blind , r and om-order , crossover design . Half the boys also met criteria for conduct disorder .  Dextroamphetamine produced immediate and marked improvement in disruptive , overactive behaviors .  Fenfluramine had no effect on any behavioral measure at either the low or high dosage . Both drugs decreased levels of urinary norepinephrine , 3-methoxy-4-hydroxyphenylglycol ( MHPG ) , and vanillylm and elic acid .  Fenfluramine , however , also produced a significant decrease in plasma MHPG levels and a larger decrease in urinary norepinephrine levels . It reduced urinary epinephrine levels as well , an effect opposite to that of dextroamphetamine . These findings suggest that different mechanisms of action are involved in the ability of the two drugs to reduce levels of MHPG and vanillylm and elic acid . Fenfluramine increased plasma prolactin levels and decreased platelet serotonin levels . Despite the structural similarity of the two drugs , some common overall effects on catecholamine metabolism , and similar effects on weight , fenfluramine had none of the motor activity or therapeutic effects of dextroamphetamine OBJECTIVE This study investigated the trends in neurocognitive function and behavioral symptoms among patients with attention-deficit/hyperactivity disorder ( ADHD ) during 24 months of treatment with methylpheni date in a clinical setting . METHODS Study participants consisted of 181 ADHD patients with a mean age of 13.4±2.5 years ( ages ranged from 8 to 18 years ; 151 boys and 30 girls ) who were prescribed oral short-acting methylpheni date two or three times daily , with each dose ranging between 0.3 and 1.0 mg/kg . At baseline and 6 , 12 , 18 , and 24 months from baseline , neurocognitive function was assessed using the  Test of Variables of Attention ( TOVA ) on the day the patient was off medication , and behavioral symptoms were evaluated using the Swanson , Nolan , and Pelham Version IV Scale for ADHD ( SNAP-IV ) parent form , the SNAP-IV teacher form , and the ADHD-Rating Scale ( completed by a child psychiatrist ) . RESULTS Of the 181 ADHD patients at the initial visit , 103 ( 56.9 % ) completed the study . During the 24-month methylpheni date treatment , only the commission errors in TOVA significantly improved ; however , the omission errors , response time , response time variability , response sensitivity , and ADHD score did not . The behavioral symptoms of ADHD , observed by various informants , all declined substantially , and were significantly correlated with each other during the long-term follow-up . The severity of teacher ratings was lower than that of parent and psychiatrist ratings . However , the teacher-rated inattention symptoms showed the strongest correlations with TOVA performance . CONCLUSIONS Findings suggest that neurocognitive deficits in ADHD patients , except inhibition ability , might be long lasting in realistic setting s. In addition , obtaining behavior profile assessment s from multiple informants , especially from teachers , is vital for establishing a complete underst and ing of ADHD patients The motor activity of 10 hyperactive boys was measured during eight 1-hour active gym classes . Children received either dextroaomphetamine ( 0.5 mg/kg ) or placebo elixir before each class , in a double-blind design . The program for each of the classes was participation in the active sports : hockey , basketball , and /or roller skating ; the " task " throughout each hour was to play vigorously and continuously . The boys ' mean hourly activity following amphetamine was slightly but significantly less than that following placebo . This finding is contradictory to the hypothesis that improved attention to an active task on stimulant would result in increased motor activity , and suggests the possibility of an independent direct effect of amphetamine on the motor system BACKGROUND This study examined the effects of atomoxetine ( ATX ) and OROS methylpheni date ( MPH ) on laboratory measures of inhibitory control and attention in youth with attention-deficit/hyperactivity disorder ( ADHD ) . It was hypothesized that performance would be improved by both treatments , but response profiles would differ because the medications work via different mechanisms . METHODS One hundred and two youth ( 77 male ; mean age = 10.5 ± 2.7 years ) with ADHD received ATX ( 1.4 ± 0.5 mg/kg ) and MPH ( 52.4 ± 16.6 mg ) in a r and omized , double-blind , crossover design . Medication was titrated in 4 - 6-week blocks separated by a 2-week placebo washout  . Inhibitory control and attention measures were obtained at baseline , following washout , and at the end of each treatment using Conners ' Continuous Performance Test II ( CPT-II ) , which provided age-adjusted T-scores for reaction time ( RT ) , reaction time variability ( RT variability ) , and errors . Repeated- measures analyses of variance were performed , with Time ( premedication , postmedication ) and Treatment type ( ATX , MPH ) entered as within-subject factors . Data from the two treatment blocks were checked for order effects and combined if order effects were not present . CLINICAL TRIAL REGISTRATION Clinical trials.gov : NCT00183391 . RESULTS Main effects for Time on RT ( p = .03 ) , RTSD ( p = .001 ) , and omission errors ( p = .01 ) were significant . A significant Drug × Time interaction indicated  that MPH improved RT , RTSD , and omission errors  more than ATX ( p < .05 ) . Changes in performance with treatment did not correlate with changes in ADHD symptoms . CONCLUSIONS MPH has greater effects  than ATX on CPT measures of sustained attention in youth with ADHD . However , the dissociation of cognitive and behavioral change with treatment indicates that CPT measures can not be considered proxies for symptomatic improvement . Further research on the dissociation of cognitive and behavioral endpoints for ADHD is indicated Abstract . Purpose : The purpose of this study was to investigate whether values of the respective parameters of the OPTAx test dependently differ due to the medication with methylpheni date ( MPH ) in children with hyperkinetic disorders ( HD ) suffering from hyperactivity , impulsivity , and attention deficits . Methods : The OPTAx test is an infrared motion analysis to record the movement pattern during a continuous performance test . We tested 25 children between 6 and 12 years with HD ( ICD-10 : F90.0 or F90.1 ) before and after treatment with MPH .  The parameters under investigation were activity ( microevents and spatial scaling ) , impulsivity ( errors of commission ) , and attentiveness ( accuracy and variability ) . For statistical analysis a one-tailed matched pairs test ( adj . p = 0.01 ) was conducted to discriminate differences found from those occurred at r and om . A post hoc partial correlation of absolute differences in the respective parameters and the daily dose of MPH ( adj . for BMI ) was performed if p < 0.01 . Results : Statistically significant results were found for microevents , spatial scaling , errors of commission , accuracy , and variability . The partial correlation showed significant results for microevents and variability . Conclusion : The mean pre – post changes found in all parameters investigated consistently correspond with benefits 
    Output:
    
agent
There were mixed findings with regard to the use of CPTs to assess and manage medication , with contrasting evidence on their ability to support clinical decision-making .
There was a strong evidence base for the use of objective measures of activity to aid ADHD/non-ADHD group differentiation , which appears sensitive to medication effects and would also benefit from further research on their clinical utility .
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The effect of atomoxetine ( ATX ) on executive function has been assessed by means of question naires only . The aim of this study was therefore to evaluate the efficacy of ATX using st and ard variables of a computer-based continuous performance test ( cb-CPT ) combined with an infra-red motion-tracking device at different times of the day . One hundred twenty-eight girls and boys aged 6 to 12 years with a diagnosis of ADHD according to DSM-IV-TR criteria were r and omized in the study . The primary efficacy measures were the q-scores of the cb-CPT combined with an infra-red motion-tracking device .  The test comprises 13 neuropsychological variables that can be taken to reflect hyperactivity , inattention , or impulsivity .  One hundred five patients completed the study ( ATX group : n=54 ;  placebo  group : n=51 ) . ATX ( target dose 1.2 mg/kg/day ) over 8 weeks was significantly superior to placebo in reducing hyperactivity , inattention , and impulsivity as measured by q-scores of 10 primary variables of the cb-CPT . Both groups of patients showed a circadian pattern of neuropsychological outcomes across the day as reflected by the cb-CPT combined with an infra-red motion-tracking device . In summary , this study demonstrated a positive effect of ATX on some aspects of executive function , inhibitory control , and hyperactivity compared with placebo Twenty-four-hour motor activity was assessed in a naturalistic setting in 12 hyperactive boys for four weeks ( 672 consecutive hours ) . Dextroamphetamine , 15 mg/day , or placebo was administered on alternate weeks , using a double-blind ABAB design . When the boys received dextroamphetamine , motor activity was significantly decreased for about eight hours after drug administration . This decrease was followed by a period of slight but significant increases in activity ( " rebound " ) .  Dextroamphetamine decreased activity most strikingly during structured classroom activity ; during physical education , however , there was a significant drug-induced increase in motor activity Introduction The National Institute for Health and Care Excellence ( NICE ) guidelines for attention deficit/hyperactivity disorder ( ADHD ) state that young people need to have access to the best evidence -based care to improve outcome . The current ‘ gold st and ard ’ ADHD diagnostic assessment combines clinical observation with subjective parent , teacher and self-reports . In routine practice , reports from multiple informants may be unavailable or contradictory , leading to diagnostic uncertainty and delay . The addition of objective tests of attention and activity may help reduce diagnostic uncertainty and delays in initiating treatment leading to improved outcomes . This trial investigates whether providing clinicians with an objective report of levels of attention , impulsivity and activity can lead to an earlier , and more accurate , clinical diagnosis and improved patient outcome . Methods and analysis This multisite r and omised controlled trial will recruit young people ( aged 6–17 years old ) who have been referred for an ADHD diagnostic assessment at Child and Adolescent Mental Health Services ( CAMHS ) and Community Paediatric clinics across Engl and . Routine clinical assessment will be augmented by the QbTest , incorporating a continuous performance test ( CPT ) and infrared motion tracking of activity . The participant will be r and omised into one of two study arms : QbOpen ( clinician has immediate access to a QbTest report ) : QbBlind ( report is withheld until the study end ) . Primary outcomes are time to diagnosis and diagnostic accuracy . Secondary outcomes include clinician 's diagnostic confidence and routine clinical outcome measures . Cost-effective analysis will be conducted , alongside a qualitative assessment of the feasibility and acceptability of incorporating QbTest in routine practice . Ethics and dissemination The findings from the study will inform commissioners , clinicians and managers about the feasibility , acceptability , clinical utility and cost-effectiveness of incorporating QbTest into routine diagnostic assessment of young people with ADHD . The results will be su bmi tted for publication in peer- review ed journals . The study has received ethical approval . Trial registration number NCT02209116 Background The aims of this study were to determine the time course of improvements in attention deficit hyperactivity disorder ( ADHD ) clinical symptoms and neurocognitive function in a realistic clinical setting , and the differences in ADHD symptom improvement using different classifications of ADHD subtypes . Methods The Child Behavior Checklist ( CBCL ) was completed by parents of ADHD children at the initial visit . The  computerized Continuous Performance Test ( CPT ) , Swanson , Nolan , and Pelham , and Version IV Scale for ADHD ( SNAP-IV ) , and  ADHD Rating Scale ( ADHD-RS ) were performed at baseline , one month , three months , and six months later , respectively . Patient care including drug therapy was performed at the discretion of the psychiatrist . The ADHD patients were divided into DSM-IV subtypes ( Inattentive , Hyperactive-impulsive and Combined type ) , and were additionally categorized into aggressive and non-aggressive subtypes by aggression scale in CBCL for comparisons . Results There were 50 ADHD patients with a mean age of 7.84 ± 1.64 years ; 15 of them were inattentive type , 11 were hyperactive-impulsive type , and 24 were combined type . In addition , 28 of the ADHD patients were grouped into aggressive and 22 into non-aggressive subtypes . There were significant improvements in clinical symptoms of hyperactivity and inattention , and impulsivity performance in CPT during the 6-month treatment . The clinical hyperactive symptoms were significantly different between ADHD patients sub-grouping both by DSM-IV and aggression . Non-aggressive patients had significantly greater changes in distraction and impulsivity performances in CPT from baseline to month 6 than aggressive patients . Conclusions We found that ADHD symptoms , which included impulsive performances in CPT and clinical inattention and hyperactivity dimensions , had improved significantly over 6 months under pragmatic treatments . The non-aggressive ADHD patients might have a higher potential for improving in CPT performance than aggressive ones . However , it warrant further investigation whether the different classifications of ADHD patients could be valid for predicting the improvements in ADHD patients ' clinical symptoms and neurocognitive performance Twenty boys ( mean age , 9 + /- 2 years ) with attention deficit disorder with hyperactivity received three weeks each of dextroamphetamine sulfate ( 0.5 mg/kg/d ) , fenfluramine hydrochloride ( 0.6 mg/kg/d increased to 2.0 mg/kg/d ) , and placebo in a double-blind , r and om-order , crossover design . Half the boys also met criteria for conduct disorder .  Dextroamphetamine produced immediate and marked improvement in disruptive , overactive behaviors .  Fenfluramine had no effect on any behavioral measure at either the low or high dosage . Both drugs decreased levels of urinary norepinephrine , 3-methoxy-4-hydroxyphenylglycol ( MHPG ) , and vanillylm and elic acid .  Fenfluramine , however , also produced a significant decrease in plasma MHPG levels and a larger decrease in urinary norepinephrine levels . It reduced urinary epinephrine levels as well , an effect opposite to that of dextroamphetamine . These findings suggest that different mechanisms of action are involved in the ability of the two drugs to reduce levels of MHPG and vanillylm and elic acid . Fenfluramine increased plasma prolactin levels and decreased platelet serotonin levels . Despite the structural similarity of the two drugs , some common overall effects on catecholamine metabolism , and similar effects on weight , fenfluramine had none of the motor activity or therapeutic effects of dextroamphetamine OBJECTIVE This study investigated the trends in neurocognitive function and behavioral symptoms among patients with attention-deficit/hyperactivity disorder ( ADHD ) during 24 months of treatment with methylpheni date in a clinical setting . METHODS Study participants consisted of 181 ADHD patients with a mean age of 13.4±2.5 years ( ages ranged from 8 to 18 years ; 151 boys and 30 girls ) who were prescribed oral short-acting methylpheni date two or three times daily , with each dose ranging between 0.3 and 1.0 mg/kg . At baseline and 6 , 12 , 18 , and 24 months from baseline , neurocognitive function was assessed using the  Test of Variables of Attention ( TOVA ) on the day the patient was off medication , and behavioral symptoms were evaluated using the Swanson , Nolan , and Pelham Version IV Scale for ADHD ( SNAP-IV ) parent form , the SNAP-IV teacher form , and the ADHD-Rating Scale ( completed by a child psychiatrist ) . RESULTS Of the 181 ADHD patients at the initial visit , 103 ( 56.9 % ) completed the study . During the 24-month methylpheni date treatment , only the commission errors in TOVA significantly improved ; however , the omission errors , response time , response time variability , response sensitivity , and ADHD score did not . The behavioral symptoms of ADHD , observed by various informants , all declined substantially , and were significantly correlated with each other during the long-term follow-up . The severity of teacher ratings was lower than that of parent and psychiatrist ratings . However , the teacher-rated inattention symptoms showed the strongest correlations with TOVA performance . CONCLUSIONS Findings suggest that neurocognitive deficits in ADHD patients , except inhibition ability , might be long lasting in realistic setting s. In addition , obtaining behavior profile assessment s from multiple informants , especially from teachers , is vital for establishing a complete underst and ing of ADHD patients The motor activity of 10 hyperactive boys was measured during eight 1-hour active gym classes . Children received either dextroaomphetamine ( 0.5 mg/kg ) or placebo elixir before each class , in a double-blind design . The program for each of the classes was participation in the active sports : hockey , basketball , and /or roller skating ; the " task " throughout each hour was to play vigorously and continuously . The boys ' mean hourly activity following amphetamine was slightly but significantly less than that following placebo . This finding is contradictory to the hypothesis that improved attention to an active task on stimulant would result in increased motor activity , and suggests the possibility of an independent direct effect of amphetamine on the motor system BACKGROUND This study examined the effects of atomoxetine ( ATX ) and OROS methylpheni date ( MPH ) on laboratory measures of inhibitory control and attention in youth with attention-deficit/hyperactivity disorder ( ADHD ) . It was hypothesized that performance would be improved by both treatments , but response profiles would differ because the medications work via different mechanisms . METHODS One hundred and two youth ( 77 male ; mean age = 10.5 ± 2.7 years ) with ADHD received ATX ( 1.4 ± 0.5 mg/kg ) and MPH ( 52.4 ± 16.6 mg ) in a r and omized , double-blind , crossover design . Medication was titrated in 4 - 6-week blocks separated by a 2-week placebo washout  . Inhibitory control and attention measures were obtained at baseline , following washout , and at the end of each treatment using Conners ' Continuous Performance Test II ( CPT-II ) , which provided age-adjusted T-scores for reaction time ( RT ) , reaction time variability ( RT variability ) , and errors . Repeated- measures analyses of variance were performed , with Time ( premedication , postmedication ) and Treatment type ( ATX , MPH ) entered as within-subject factors . Data from the two treatment blocks were checked for order effects and combined if order effects were not present . CLINICAL TRIAL REGISTRATION Clinical trials.gov : NCT00183391 . RESULTS Main effects for Time on RT ( p = .03 ) , RTSD ( p = .001 ) , and omission errors ( p = .01 ) were significant . A significant Drug × Time interaction indicated  that MPH improved RT , RTSD , and omission errors  more than ATX ( p < .05 ) . Changes in performance with treatment did not correlate with changes in ADHD symptoms . CONCLUSIONS MPH has greater effects  than ATX on CPT measures of sustained attention in youth with ADHD . However , the dissociation of cognitive and behavioral change with treatment indicates that CPT measures can not be considered proxies for symptomatic improvement . Further research on the dissociation of cognitive and behavioral endpoints for ADHD is indicated Abstract . Purpose : The purpose of this study was to investigate whether values of the respective parameters of the OPTAx test dependently differ due to the medication with methylpheni date ( MPH ) in children with hyperkinetic disorders ( HD ) suffering from hyperactivity , impulsivity , and attention deficits . Methods : The OPTAx test is an infrared motion analysis to record the movement pattern during a continuous performance test . We tested 25 children between 6 and 12 years with HD ( ICD-10 : F90.0 or F90.1 ) before and after treatment with MPH .  The parameters under investigation were activity ( microevents and spatial scaling ) , impulsivity ( errors of commission ) , and attentiveness ( accuracy and variability ) . For statistical analysis a one-tailed matched pairs test ( adj . p = 0.01 ) was conducted to discriminate differences found from those occurred at r and om . A post hoc partial correlation of absolute differences in the respective parameters and the daily dose of MPH ( adj . for BMI ) was performed if p < 0.01 . Results : Statistically significant results were found for microevents , spatial scaling , errors of commission , accuracy , and variability . The partial correlation showed significant results for microevents and variability . Conclusion : The mean pre – post changes found in all parameters investigated consistently correspond with benefits 
    Output:
    