title: Multimodal treatment in children and adolescents with attention-deficit/hyperactivity disorder: a 6-month follow-up.
abstract: BACKGROUND
  Different treatment approaches aimed at reducing attention-deficit/hyperactivity disorder (ADHD) core symptoms are available. However, factors such as intolerance, side-effects, lack of efficacy, high new technology costs, and placebo effect have spurred on an increasing interest in alternative or complementary treatment.
  
  
  OBJECTIVE
  The aim of this study is to explore efficacy of multimodal treatment consisting of standard stimulant medication (methylphenidate) and neurofeedback (NF) in combination, and to compare it with the single treatment in 6-month follow-up in ADHD children and adolescents.
  
  
  METHODS
  This randomized controlled trial with 6-month follow-up comprised three treatment arms: multimodal treatment (NF + MED), MED alone, and NF alone. A total of 130 ADHD children/adolescents participated, and 62% completed the study. ADHD core symptoms were recorded pre-/post-treatment, using parents' and teachers' forms taken from Barkley's Defiant Children: A Clinician's Manual for Assessment and Parent Training, and a self-report questionnaire.
  
  
  RESULTS
  Significant ADHD core symptom improvements were reported 6 months after treatment completion by parents, teachers, and participants in all three groups, with marked improvement in inattention in all groups. However, no significant improvements in hyperactivity or academic performance were reported by teachers or self-reported by children/adolescents, respectively, in the three groups. Changes obtained with multimodal treatment at 6-month follow-up were comparable to those with single medication treatment, as reported by all participants.
  
  
  CONCLUSIONS
  Multimodal treatment using combined stimulant medication and NF showed 6-month efficacy in ADHD treatment. More research is needed to explore whether multimodal treatment is suitable for ADHD children and adolescents who showed a poor response to single medication treatment, and for those who want to reduce the use of stimulant medication.
authors.affiliation: a Department of Child and Adolescent Psychiatry , Helse Fonna , Haugesund , Norway.
authors.forename: Nezla S
authors.initials: NS
authors.lastname: Duric
authors.affiliation: b Centre for Clinical Research, Helse Bergen , Norway.
authors.forename: Jørg
authors.initials: J
authors.lastname: Assmus
authors.affiliation: c Department of Research and Innovation , Helse Fonna HF , Haugesund , Norway.
authors.forename: Doris
authors.initials: D
authors.lastname: Gundersen
authors.affiliation: d Department of Clinical Medicine , University of Sarajevo , Bosnia & Herzegovina.
authors.forename: Alisa
authors.initials: A
authors.lastname: Duric Golos
authors.affiliation: e Department of Child and Adolescent Psychiatry , Haukeland University Hospital , Bergen , Norway.|f Department of Clinical Medicine , University of Bergen , Norway.
authors.forename: Irene B
authors.initials: IB
authors.lastname: Elgen
mesh_terms: D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy*; D000697:Central Nervous System Stimulants / Q000627:therapeutic use*; D002648:Child; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008774:Methylphenidate / Q000627:therapeutic use*; D058765:Neurofeedback / Q000379:methods*; D010290:Parents / Q000523:psychology; D011795:Surveys and Questionnaires; D013997:Time Factors
chemical_list: D000697:Central Nervous System Stimulants; D008774:Methylphenidate
keywords: ADHD; medication; multimodal treatment; neurofeedback; self-report