Executive functioning in adult ADHD: a meta-analytic review

. CONCLUSIONS: Neuropsychological difficulties in adult ADHD may not be confined to executive functioning. The field is in urgent need of better-designed executive functioning tests, methodological improvements, and direct comparisons with multiple clinical groups to answer questions of specificit

Economics and Business Handbook 2009

In recent years a rising amount of randomized controlled trials, reviews, and meta-analyses relating to the efficacy of electroencephalographic-neurofeedback (EEG-NF) in children with attention-deficit/hyperactivity disorder (ADHD) have been published. Although clinical reports and open treatment studies suggest EEG-NF to be effective, double blind placebo-controlled studies as well as a rigorous meta-analysis failed to find support for the efficacy of EEG-NF. Since absence of evidence does not equate with evidence of absence, we will outline how future research might overcome the present methodological limitations. To provide conclusive evidence for the presence or absence of the efficacy of EEG-NF in the treatment of ADHD, there is a need to set up a well-designed study that ensures optimal implementation and embedding of the training, and possibly incorporates different forms of neurofeedback

Реалізація органами влади Автономної Республіки Крим та органами місцевого самоврядування повноважень у сфері адміністративно-територіального устрою України

Досліджено практику реалізації органами влади Автономної Республіки Крим та органами місцевого самоврядування повноважень у сфері адміністративно-територіального устрою України.Исследуется практика реализации органами власти Автономной Республики Крым и органами местного самоуправления полномочий в сфере административно-территориального устройства Украины.The article is devoted to the research of practical realization of powers by the official bodies of Autonomous Republic of Crimea and local self-government bodies in the sphere of Ukrainian administrative-territorial system

Hyperactive night and day? Actigraphy studies in adult ADHD: a baseline comparison and the effect of methylphenidate

Contains fulltext : 52254.pdf (publisher's version ) (Open Access)STUDY OBJECTIVES: To investigate parameters of sleep, activity, and circadian rhythm, as well as the effects of methylphenidate on these variables, in adults with ADHD. DESIGN: 1) Baseline group comparison; 2) Double blind, placebo-controlled, cross-over medication trial. SETTING: Data collection took place during daily lives of participants. PARTICIPANTS: 39 normal controls and 33 adults with ADHD for baseline comparisons; 31 adults with ADHD in medication trial. INTERVENTIONS: Treatment with placebo and methylphenidate during medication trial. MEASUREMENTS AND RESULTS: Actigraphy and sleep log data were collected for 7 consecutive nights and days to obtain baseline values for ADHD and normal controls. Repeated measurements during placebo and methylphenidate treatment were conducted for the ADHD group. Actigraphic sleep estimates showed that ADHD subjects took longer to fall asleep, had lower sleep efficiency, and had shorter within-night periods of uninterrupted sleep. These findings were consistent with subjective complaints. Actigraphic measures of ADHD subjects showed continuously elevated daytime activity levels, resulting in a 24-hour pattern that was more stable and less variable than in controls. Methylphenidate led to a later bedtime, later sleep onset, and reduction in sleep duration. However, number and total duration of nocturnal awakenings decreased, while mean duration of within-night periods of uninterrupted sleep increased, indicating more consolidated sleep. CONCLUSIONS: Our data suggest that sleep problems are inherent in adults with ADHD and that methylphenidate reduced total sleep time but improved sleep quality by consolidating sleep

A Systematic Review of Literatures onFactors Associated with Educational ndAcademic Performance in Attention DeficitHyperactivity Disorder

__Abstract__ Attention Deficit Hyperactivity Disorder (ADHD) has been shown to impair major life activities including educational functioning. However, there is no consensus on the specific cause for the impact on this worse educational outcome. This systematic review aims to identify factors that have been associated with educational and academic underperformance of children and adolescents with ADHD. A literature search was conducted using PubMed and the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). The study focused on articles presenting results of data-based analyses related to ADHD and keywords related to education. The search resulted in 376 records that were screened by title. Of these, 185 articles were screened by abstract and 35 met the eligibility criteria for inclusion in the review. These 35 articles were related to seven domains: educational training, educational environment, pharmacological treatment, ADHD symptoms, associations of ADHD with academic outcomes, self-concept, and specific skills. The main source of educational challenges seems to be related to the inattentive symptoms (or subtype) of ADHD. This outcome is different than expected, since hyperactive symptoms are pronounced more prominently and often refer children to clinical practice. Inattentive symptoms amongst others refer to difficulties in organization skills and can lead to decreased self-efficacy and development of depressive symptoms. This decreased self-efficacy and the depressive symptoms were also found to be related to influence the relation between ADHD and academic performance. Educational outcomes were shown to be improved using small group work, learning via a computer-based service and as a result of coaching and pharmacological treatment. To help children and adults achieve educational goals that now are out of reach, more attention should be spent to the inattentive symptoms of ADHD and possibilities to overcome experienced problems

Modelling vehicle emissions from an urban air-quality perspective:testing vehicle emissions interdependencies

Abstract This thesis employs a statistical regression method to estimate models for testing the hypothesis of the thesis of vehicle emissions interdependencies. The thesis at the beginnings, reviews critically the formation of emissions in gasoline-fuelled engines, and also reviews existing and emerging models of automotive emissions. The thesis then, presents the relationships between the urban transport system and vehicle emissions. Particularly, it summarises different types of emissions and the contributory factors of the urban transport system to such emissions. Subsequently, the thesis presents the theory of vehicle emissions interdependencies and the empirical framework for testing the hypothesis of the thesis. The scope of testing the hypothesis of the thesis is only limited to gasoline-fuelled conventional vehicles in the urban transport environment. We use already available laboratory-based testing dataset of 542 passenger vehicles, to investigate the hypothesis of the thesis of vehicle emissions interdependencies. HC, CO, and NOX emissions were collected under six test drive-cycles, for each vehicle before and after vehicles were tuned. Prior to using any application, we transform the raw dataset into actionable information. We use three steps, namely conversion, cleaning, and screening, to process the data. We use classification and regression trees (CART) to narrow down the input number of variables in the models formulated for investigating the hypothesis of the thesis. We then, utilise initial results of the analysis to fix any remaining problems in the data. We employ three stage least squares (3SLS) regression to test the hypothesis of the thesis, and to estimate the maximum likelihood of vehicle variables and other emissions to influence HC, CO, and NOX emissions simultaneously. We estimate twelve models, each of which consists of a system of three simulations equations that accounts for the endogenous relations between HC, CO and NOX emissions when estimating vehicle emissions simultaneously under each test drive-cycle. The major contribution of the thesis is to investigate the inter-correlations between vehicle emissions within a well controlled data set, and to test the hypothesis of vehicle emissions interdependencies. We find that HC, CO, and NOX are endogenously or jointly dependent in a system of simultaneous-equations. The results of the analysis demonstrate that there is strong evidence against the null hypothesis (H0) in favour of the alternative hypothesis (H1) that HC, CO, and NOX are statistically significantly interdependent. We find, for the thesis sample, that NOX and CO are negatively related, whereas HC and CO emissions are positively related, and HC and NOX are positively related. The results of the thesis yield new insights. They bridge a very important gap in the current knowledge on vehicle emissions. They advance not only our current knowledge that HC, CO, and NOX should be predicted jointly since they are produced jointly, but also acknowledge the appropriateness of using 3SLS regression for estimating vehicle emissions simultaneously. The thesis measures the responses of emissions to changes with respect to changes in the other emissions. We investigate emission responses to a one percent increase in an emission with respect to the other emissions. We find the relationship between CO and NOX is of special interest. After vehicles were tuned, we find those vehicles that exhibit a one percent increase in NOX exhibit simultaneously a 0.35 percent average decrease in CO. Similarly, we find that vehicles which exhibit a one percent increase in CO exhibit simultaneously a 0.22 percent average decrease in NOX. We find that the responses of emission to changes with respect to other emissions vary with various test drive-cycles. Nonetheless, a band of upper and lower limits contains these variations. After vehicle tuning, a one percent increase in HC is associated with an increase in NOX between 0.5 percent and 0.8 percent, and an increase in CO between 0.5 percent and one percent Also, for post-tuning vehicles, a one percent increase in CO is associated with an increase in HC between 0.4 percent and 0.9 percent, and a decrease in NOX between 0.07 percent and 0.32 percent. Moreover, a one percent increase in NOX is associated with increase in HC between 0.8 percent and 1.3 percent, and a decrease in CO between 0.02 percent and 0.7 percent. These measures of the responses are very important derivatives of the hypothesis investigated in the thesis. They estimate the impacts of traffic management schemes and vehicle operations that target reducing one emission, on the other non-targeted emissions. However, we must be cautious in extending the results of the thesis to the modern vehicles fleet. The modern fleet differs significantly in technology from the dataset that we use in this thesis. The dataset consists of measurements of HC, CO, and NOX emissions for 542 gasoline-fuelled passenger vehicles, under six test drive-cycles, before and after the vehicles were tuned. Nevertheless, the dataset has a number of limitations such as limited model year range, limited representations of modal operations, and limitations of the measurements of emissions based only on averages of test drive-cycles, in addition to the exclusion of high-emitter emission measurements from the dataset. The dataset has a limited model year range, i.e., between 1980 and 1991. We highlight the age of the dataset, and acknowledge that the present vehicle fleet varies technologically from the vehicles in the dataset used in this thesis. Furthermore, the dataset has a limited number of makes - Holden, Ford, Toyota, Nissan, and Mitsubishi. There are also a limited number of modal operations. The model operations presented in the dataset are cold start, warming-up, and hot stabilised driving conditions. However, enrichment episodes are not adequately presented in the test-drive cycles of the dataset. Moreover, the dataset does not take into account driving behaviour influences, and all measurements are cycle-based averages. The emission measurements of laboratory-based testings are aggregated over a test drive cycle, and the test drive-cycle represents an average trip over an average speed. The exclusion of the measurements of high emitting vehicles from the dataset introduces further limitations. Remote sensing studies show that 20 percent of the on-road vehicle fleet is responsible for 80 percent of HC and CO emissions. The findings of the thesis assist in the identification of the best strategies to mitigate the most adverse effects of air-pollution, such as the most severe pollution that have the most undesirable pollution effects. Also, they provide decision-makers with valuable information on how changes in the operation of the transport system influence the urban air-quality. Moreover, the thesis provides information on how vehicle emissions affect the chemistry of the atmosphere and degrade the urban air-quality

Methylphenidate for ADHD in children and adolescents:throwing the baby out with the bathwater

Item does not contain fulltextA recent Cochrane review assessed the efficacy of methylphenidate for attention-deficit/hyperactivity disorder (ADHD) in children and adolescents. Notwithstanding the moderate-to-large effect sizes for ADHD symptom reduction found in the meta-analysis, the authors concluded that the quality of the evidence is low and therefore the true magnitude of these effects remains uncertain. We identified a number of major concerns with the review, in the domains of study inclusion, approaches to quality assessment and interpretation of data relating to serious adverse events as well as of the clinical implications of the reported effects. We also found errors in the extraction of data used to estimate the effect size of the primary outcome. Considering all the shortcomings, the conclusion in the Cochrane review that the status of the evidence is uncertain is misplaced. Professionals, parents and patients should refer to previous reviews and existing guidelines, which include methylphenidate as one of the safe and efficacious treatment strategies for ADHD

A randomised controlled trial (MindChamp) of a mindfulness-based intervention for children with ADHD and their parents

BACKGROUND: Family mindfulness‐based intervention (MBI) for child attention‐deficit/hyperactivity disorder (ADHD) targets child self‐control, parenting and parental mental health, but its effectiveness is still unclear. METHODS: MindChamp is a pre‐registered randomised controlled trial comparing an 8‐week family MBI (called ‘MYmind’) in addition to care‐as‐usual (CAU) (n = 55) with CAU‐only (n = 48). Children aged 8–16 years with remaining ADHD symptoms after CAU were enrolled together with a parent. Primary outcome was post‐treatment parent‐rated child self‐control deficits (BRIEF); post hoc, Reliable Change Indexes were explored. Secondary child outcomes included ADHD symptoms (parent/teacher‐rated Conners’ and SWAN; teacher‐rated BRIEF), other psychological symptoms (parent/teacher‐rated), well‐being (parent‐rated) and mindfulness (self‐rated). Secondary parent outcomes included self‐ratings of ADHD symptoms, other psychological symptoms, well‐being, self‐compassion and mindful parenting. Assessments were conducted at post‐treatment, 2‐ and 6‐month follow‐up. RESULTS: Relative to CAU‐only, MBI+CAU resulted in a small, statistically non‐significant post‐treatment improvement on the BRIEF (intention‐to‐treat: d = 0.27, p = .18; per protocol: d = 0.33, p = .11). Significantly more children showed reliable post‐treatment improvement following MBI+CAU versus CAU‐only (32% versus 11%, p < .05, Number‐Needed‐to‐Treat = 4.7). ADHD symptoms significantly reduced post‐treatment according to parent (Conners’ and SWAN) and teacher ratings (BRIEF) per protocol. Only parent‐rated hyperactivity impulsivity (SWAN) remained significantly reduced at 6‐month follow‐up. Post‐treatment group differences on other secondary child outcomes were consistently favour of MBI+CAU, but mostly non‐significant; no significant differences were found at follow‐ups. Regarding parent outcomes, significant post‐treatment improvements were found for their own ADHD symptoms, well‐being and mindful parenting. At follow‐ups, some significant effects remained (ADHD symptoms, mindful parenting), some additional significant effects appeared (other psychological symptoms, self‐compassion) and others disappeared/remained non‐significant. CONCLUSIONS: Family MBI+CAU did not outperform CAU‐only in reducing child self‐control deficits on a group level but more children reliably improved. Effects on parents were larger and more durable. When CAU for ADHD is insufficient, family MBI could be a valuable addition