People with ADD/ADHD can display a variety of symptoms and may appear to be distracted, impulsive, and inattentive. Dr. Daniel Amen, psychiatrist, has classified the spectrum of the disorder into 7 or more “types” of ADHD based on his studies of SPECT scans
The realization is evolving that ADD/ADHD is not a psychological or disciplinary problem – it’s a brain problem and often treated with stimulant class medications when quantitative EEG assessment and neurofeedback brain training can be a better, healthier, long term alternative.
Medications do not teach a person to cope long-term, the benefits are temporary, and are accompanied by side effects such as:
- Loss of appetite
- Sleep difficulties
- Potential cardiac risks
- Personality changes
The actual evidence is that these treatments fail to result in sustained benefit for the vast majority of children who receive them as demonstrated in the NIMH-funded MTA Cooperative study, the gold standard study in ADHD treatment effectiveness research.
People can also develop a tolerance to medications over time, resulting in increased dosages, additional medications, and potentially more side effects.
The Canadian Medical Association asserts: “While research has conclusively proven Ritalin’s short-term effectiveness, little is known about the long-term efficacy and safety of a drug that some children take for many years. In fact, the average duration of randomized trials of the drug is 3.3 weeks…. There aren’t long-term studies, and that’s of some concern because we don’t know whether the initial positive effects… might diminish over time. Moreover, we don’t know what happens to the side-effects… whether those got worse or maybe they diminish too – we don’t really know.”
Meanwhile, Neurofeedback’s (NFB) evidence-base continues to grow with over 50 peer-reviewed journal articles published to date documenting its effectiveness in treating ADHD’s core symptoms. These are controlled studies published during the past decade evaluating NFB’s effectiveness in treating children and adolescents with ADHD. These studies document that not only has NFB been found to be superior to a variety of experimental control group conditions, but also in three studies NFB was found to be equivalent to stimulant medication in treating the core symptoms of ADHD. Five studies assessed whether or not NFB resulted in sustained benefits after treatment ended, including two studies with two-year follow-up assessments. In each of these follow-up assessments, the gains from NFB were maintained after treatment had ended and in one study had increased further gains during the two-year follow-up showing that half of the children no longer met the diagnostic criteria for ADHD.
ADD and ADHD are conditions that can be easily identified in our Greenville office with a Brain Map. Please call our offices at 252-412-3463 to schedule an appointment today for your $99 Brain Map.
In contrast, stimulant medications’ beneficial effects commonly cease when the medication is stopped, and as found in the MTA Cooperative study, the authors concluded that there was no evidence to support the “long-term advantage of (continued) medication treatment beyond 2 years for the majority of children.”
Unlike medication, neurofeedback actually retrains the brain, resulting in significant improvement in ADHD/ADD symptoms. With neurofeedback, people learn to make long-term improvements in self-control and attention because their brain learns to make healthier patterns.
Randomized controlled trials have found neurofeedback to be equivalent to stimulant medication—and superior to EMG biofeedback, computerized cognitive training, and cognitive behavioral training—in treating the core symptoms of ADHD. Based on this research data and the fact that many parents, patients, health professionals and teachers are desperately looking for alternatives to stimulant medications, it is surprising that more insurers do not reimburse for NFB treatment
Training the brain with neurofeedback helps to address the root of the problem without medications by helping create a healthier brain.
Why is neurofeedback so effective for ADD/ADHD?
If a stimulant literally speeds someone up, why is it prescribed for someone with hyperactivity problems? Why do stimulants seem to help someone with ADD/ADHD slow down and focus?
In a person with ADD or ADHD, the areas of the brain that control attention and focus may have too much slow activity, which can also lead to feeling depressed, worried, and unmotivated. Unconsciously, people with ADD/ADHD increase body movements to stimulate and “wake” their brains. Therefore, stimulants are prescribed to increase brain activity without increasing body movement.
The problem with this strategy is that people with ADHD may already be experiencing too much rapid activity in some regions of the brain, which can lead to other problems like acting aggressively, impulsively, or feeling anxious. A person’s brain can race so fast that it is nearly impossible for them to sit still or listen. In fact, because people with ADD are often quite intelligent, they understand concepts quickly. Their fast mental pace may cause them to move ahead before all the instructions are given, causing them to miss crucial details.
Research shows that neurofeedback is a successful alternative for treatment of ADD/ADHD.
ADD and ADHD are brain problems. Neurofeedback allows people to work directly on the problem by training the brain to become more calm, more focused, and less impulsive. By reducing the too-fast or too-slow brain patterns that occur in the brain of someone with ADD or ADHD, neurofeedback helps the person learn how to take control.
According to health professionals who use neurofeedback in their practices, over 85% of clients with ADD or ADHD learn to increase focus, reduce impulsivity, and manage their behavior when they train with neurofeedback on a consistent basis.
The ADHD treatment guidelines developed by the American Academy of Child and Adolescent Psychiatry takes a balanced approach by rating ADHD treatments based on the preponderance of the evidence as to whether “the benefits of the recommended approach clearly exceed the harms of that approach”
Using this professional academy’s evaluative standard, neurofeedback for the treatment of children and adolescents with ADHD clearly warrants the highest level of recommendation
Additionally, in October 2012, the company that maintains the American Academy of Pediatrics’ ranking of research support for psychosocial treatments awarded NFB the highest level of evidence-based support for the treatment of ADHD
One reason that neurofeedback is so effective for ADHD and ADD is that it appeals to children and adults alike – it seems just like watching a movie! By subconsciously producing the desired brainwaves they control the playing of the movie with his or her brain. Children and adults seem to enjoy brain training, making it easy to continue with treatment and achieve significant improvements.
ADD and ADHD are conditions that can be easily identified in our Greenville office with a Brain Map. Please call our offices at 252-412-3463 to schedule an appointment today for your $99 Brain Map.
Sources for this material:
The Evidence-Base for Neurofeedback as a Reimbursable Healthcare Service to Treat
Attention Deficit/Hyperactivity Disorder H. Edmund Pigott, Ph.D.,a Lindsay De Biase, Ph.D.,b
Eugenia Bodenhamer-Davis, Ph.D.c & Richard E. Davis, M.S.d
- Schwarz, A. & Cohen, S. (March 31, 2013). A.D.H.D. seen in 11% of U.S. children as diagnoses rise. New York Times, (see: http://www.nytimes.com/2013/04/01/health/more-diagnoses-of-hyperactivity-causing-concern.html?nl=todaysheadlines&emc=edit_th_20130401&_r=1&
- Centers for Disease Control and Prevention. Mental health in the United States: prevalence of diagnosis and medication treatment f o r a t t e n t i o n – d e fi c i t / hyperactivity disorder—United States, 2003. MMWR Morb Mortal Wkly Rep. 2005; 54(34):842– 847.
- Centers for Disease Control and Prevention. Increasing prevalence of parent-reported attention deficit/hyperactivity disorder among children: United States, 2003–2007. MMWR Morb Mortal Wkly Rep. 2010;59(44): 1439 –1443.
- Lofthouse, N., Arnold, LE., Sarah H., Hurt, E., and DeBeus, R. (2011). A review of neurofeedback treatment for pediatric ADH. Journal of Attention Disorders.
- AACAP (2011). ADHD: Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents. Pediatrics 2011;128;1007; DOI: 10.1542/peds.2011-2654.
- The MTA Cooperative Group (1999). A 14-month randomized clinical trial of treatment strategies for attention-deficit/ hyperactivity disorder. Arch Gen Psychiatry, 56(12) 1073–1086.
- The MTA Cooperative Group (2004a), National Institute of Mental Health Multimodal Treatment Study of ADHD Follow-up: 24-Month Outcomes of Treatment Strategies for Attention-Deficit/Hyperactivity Disorder. Pediatrics, 113:754-761.
- The MTA Cooperative Group (2004b), National Institute of Mental Health multimodal treatment study of ADHD follow-up: Changes in effectiveness and growth after the end of treatment. Pediatrics, 113:762-169.
- Jensen PS, Arnold LE, Swanson JM, Vitiello B, et al. (2007). 3-year follow-up of the NIMH MTA study. J Am Acad Child Adolesc Psychiatry, 46(8) 989-1002.
- Molina BS, Hinshaw SP, Swanson JM, et al. (2009). The MTA at 8 years: prospective follow-up of children treated for combined-type ADHD in a multisite study. J Am Acad Child Adolesc Psychiatry, 48(5) 484-5.
- Barkley RA. Defiant children: A clinician’s manual for parent training. New York, NY: Guilford Press; 1987.
- Pelham WE, Hoza B. Comprehensive treatment for ADHD: A proposal for intensive summer treatment programs and outpatient follow-up. In: Hibbs E, Jensen P, eds. Psychosocial Treatment Research of Child and Adolescent Disorders. Washington DC: American Psychiatric Press; 1996: 311-340.
- Swanson JM. School-based assessments and interventions for ADD students. Irvine, CA: KC Publications; 1992.
- Donhoffer, H., & Lissak, K. (1962). EEG changes associated with the elaboration of conditioned reflexes. Acta Physiologica Academy of Science, Hungary 21, 249-255.
- Roth, S. R., Sterman, M. B., & Clemente, C. D. (1967). Comparison of EEG correlates of reinforcement, internal inhibition and sleep. Electroencephalography and Clinical Neurophysiology, 23, 509-520.
- Sterman, M. B., & Wyrwicka, W. (1967). EEG correlates of sleep: Evidence for separate forebrain substrates. Brain Research, 6, 143-163.
- Wyrwicka, W., & Sterman, M. B. Instrumental conditioning of sensorimotor cortex EEG spindles in the waking cat. Physiology & Behavior, 1968, 3, 703-707.
- Sterman, M. B., LoPresti, R. W., & Fairchild, M. D. Electroencephalographic and behavioral studies of monomethylhydrazine toxicity in the cat. Technical Report AMRL-TR-69-3, Aerospace Medical Research
Laboratories, Aerospace Medical Division Air Force Systems Command, Wright-Patterson Air Force Base, Ohio, 1969.
- Schafer, R.J. & Moore, T. (2011). Selective attention from voluntary control of neurons in prefrontal cortex. Science, 332, 1568‐1571.
- Haas, L.F. Hans Berger (1873‐1941), Richard Caton (1842‐1926), and electroencephalography. (2003). Journal of Neurology, Neurosurgery, and Psychiatry. 74, 9.
- Beatty, J., Greenberg, A., Deibler, W.P. & O’Hanlon, J.F. (1974). Operant control of occipital theta rhythm affects performance in a radar monitoring task. Science, 183, 871‐873.
- Sittenfeld, P., Budzynski, T. & Stoyva, J. (1976). Differential shaping of EEG theta rhythms. Biofeedback and Self-Regulation, 1, 31‐46 (1976).
- Mulholland, T., Runnals, S. (1962). A stimulus‐brain feedback system for evaluation of alertness. Journal of Psychology, 54, 69‐83.
- Paskewitz, D.A. & Orne, M.T. (1973). Visual effects on alpha feedback training. Science, 181, 360‐363.
- Lubar, J.F. & Bahler, W.W. (1976). Behavioral management of epileptic seizures following EEG biofeedback training of the sensorimotor rhythm. Biofeedback and Self‐Regulation, 1, 77‐104 (1976).
- Wyler, A.R., Lockard, J.S., Ward, A.A., Jr. & Finch, C.A. (1976). Conditioned EEG desynchronization and seizure occurrence in patients. Electroencephalography and Clinical Neurophysiology, 41, 501‐512.
- Bird, B.L., Newton, F.A., Sheer, D.E. & Ford, M. (1978). Behavioral and electroencephalographic correlates of 40‐Hz EEG biofeedback training in humans. Biofeedback and Self‐Regulation, 3, 13‐28.
- Bird, B.L., Newton, F.A., Sheer, D.E. & Ford, M. (1978). Biofeedback training of 40‐Hz EEG in humans. Biofeedback and Self‐Regulation, 3, 1‐11.
- Keizer, A.W., Verschoor, M., Verment, R.S. & Hommel, B. (2010). The effect of gamma enhancing neurofeedback on the control of feature bindings and intelligence measures. International Journal of Psychophysiology : Official Journal of the International Organization of Psychophysiology, 75, 25‐32.
- Egner, T. & Gruzelier, J.H. (2001). Learned self‐regulation of EEG frequency components affects attention and event‐related brain potentials in humans. Neuroreport, 12, 4155‐4159.
- Egner, T. & Gruzelier, J.H. (2004). EEG biofeedback of low beta band components: Frequency‐specific effects on variables of attention and event‐related brain potentials. Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology, 115, 131‐139.
- Hanslmayr, S., Sauseng, P., Doppelmayr, M., Schabus, M. & Klimesch, W. (2005). Increasing individual upper alpha power by neurofeedback improves cognitive performance in human subjects. Applied Psychophysiology and Biofeedback, 30, 1‐10.
- Vernon, D., et al. (2003). The effect of training distinct neurofeedback protocols on aspects of cognitive performance. International Journal of Psychophysiology: Official Journal of the International Organization of Psychophysiology, 47, 75‐85.
- Egner, T. & Gruzelier, J.H. Ecological validity of neurofeedback: modulation of slow wave EEG enhances musical performance. Neuroreport, 14, 1221‐1224.
- Rasey, H.W., Lubar, J.F., McIntyre, A., Zoffuto, A.C., Abbott, P.L. (1996). Attentional processing in normal college students. Journal of Neurotherapy.
- Keizer, A.W., Verment, R.S. & Hommel, B. (2010). Enhancing cognitive control through neurofeedback: a role of gamma‐band activity in managing episodic retrieval. NeuroImage, 49, 3404‐3413.
- Mohr, B., Pulvermuller, F. & Schleichert, H. (1998). Learned changes of brain states alter cognitive processing in humans. Neuroscience Letters, 253, 159‐162.
- Pulvermuller, F., Mohr, B., Schleichert, H. & Veit, R. (2000). Operant conditioning of left‐hemispheric slow cortical potentials and its effect on word processing. Biological Psychology, 53, 177‐215.
- Zoefel, B., Huster, R.J. & Herrmann, C.S. (2011). Neurofeedback training of the upper alpha frequency band in EEG improves cognitive performance. NeuroImage, 54, 1427‐1431.
- Lubar, J.F. & Shouse, M.N. (1977). Use of biofeedback in the treatment of seizure disorders and hyperactivity. Advances in Clinical Child Psychology, 1, 204-251.
- Lubar, J. F., & Shouse, M. N. (1976). EEG & behavioral changes in a hyperkinetic child concurrent with training of the sensorimotor rhythm (SMR): A preliminary report. Biofeedback & Self-Regulation, 3, 293-306.
- Shouse, M. N. & Lubar, J. F. (1979). Operant conditioning of EEG rhythms and ritalin in the treatment of hyperkinesis. Biofeedback & Self-Regulation, 4, 299-312.
- Insel, T. R. (2009). Disruptive insights in psychiatry: Transforming a clinical discipline. Journal of Clinical Investigation, 119(4), 700–705.
- Fibiger HC (2012). Psychiatry, the pharmaceutical industry, and the road to better therapeutics. Schizophrenia Bulletin, 38(4), 649–650.
- Hammond DC. (2012). International Society for Neurofeedback and Research Comprehensive Neurofeedback Bibliography. See: http://www.isnr.org/neurofeedback-info/cog.cfm.
- Arns, M, de Ridder, S, Strehl, U, Breteler, M, & Coenen, A. (2009). Efficacy of neurofeedback treatment in ADHD: The effects on inattention, impulsivity and hyperactivity: A meta-analysis. Clinical EEG and Neuroscience, 40(3) 180-189
- Egner T, Sterman MB (2006). Neurofeedback treatment of epilepsy: From basic rational to practical implication. Expert Rev Neurotherapeutics, 6(2) 247-257.
- Gevensleben H, Holl B, Albrecht B, et al. (2009a). Is neurofeedback an efficacious treatment for ADHD? A randomised controlled clinical trial. J Child Psychol Psychiatry, 50(7) 780-789.
- Leins U, Goth G, Hinterberger T, et al. (2007). Neurofeedback for children with ADHD: A comparison of SCP and Theta/Beta protocols. Appl Psychophysiol Biofeedback, 32(2) 73-88.
- Gevensleben, H., Holl, B., Albrecht, B., et al. (2009b). Distinct EEG effects related to neurofeedback training in children with ADHD: A randomized controlled trial. International Journal of Psychophysiology, 74, 149-157.
- deBeus, R. (2006, May). Progress in efficacy studies of EEG biofeedback for ADHD. Paper presented at the meeting of the American Psychiatric Association, Toronto, Canada.
- deBeus, R., & Kaiser, D. A. (2011). Neurofeedback with children with attention-deficit hyperactivity disorder: A randomized double-blind placebo-controlled study. In R. Coben & J. R. Evans (Eds.), Neurofeedback and neuromodulation techniques and applications (pp. 127-152). London, England: Academic Press.
- Strehl, U., Leins, U., Goth, G., Klinger, C., Hinterberger, T., & Birhaumer, N. (2006). Self-regulation of slow cortical potentials: A new treatment for children with attention-deficit/hyperactivity disorder. Pediatrics, 118, 1530-1540.
- Drechsler, R., Straub, M., Doehnert, M., Heinrich, H., Steinhausen, H., & Brandeis, D. C. (2007). Controlled evaluation of a neurofeedback training of slow cortical potentials in children with attention deficit/hyperactivity disorder. Behavioral and Brain Functions, 3, 35.
- Monastra, V.J., Monastra, D.M. & George, S. The effects of stimulant therapy, EEG biofeedback, and parenting style on the primary symptoms of attention‐deficit/hyperactivity disorder. Applied Psychophysiology and Biofeedback, 27, 231‐249 (2002).
- Fuchs, T., Birbaumer, N., Lutzenberger, W., Gruzelier, J.H., & Kaiser, J. (2003). Neurofeedback treatment for attention-deficit/hyperactivity disorder in children: A comparison with methylphenidate. Applied Psychophysiology and Biofeedback, 28(1), 1-12.
- Heinrich H, Gevensleben H, Freisleder FJ, et al. (2004). Training of slow cortical potentials in attention-deficit/hyperactivity disorder: Evidence for positive behavioral and neurophysiological effects. Biological Psychiatry, 55(7) 772-775.
- Rossiter T. (2004). The effectiveness of neurofeedback and stimulant drugs in treating AD/HD: Part II. Replication. Appl Psychophysiol Biofeedback, 29(4) 233-243.
- Levesque, J., Beauregard, M., & Mensour, B. (2006). Effect of neurofeedback training on the neural substrates of selective attention in children with attention-deficit/hyperactivity disorder: A functional magnetic resonance imaging study. Neuroscience Letters, 394, 216-221.
- Holtmann, M., Grasmann, D., Cionek-Szpak, E., Hager, V., Panzer, N., Beyer, A., & Stadler, C. (2009). Specific effects of neurofeedback on impulsivity in ADHD. Kindheit und Entwicklung, 18, 95-104.
- Bakhshayesh, A.R., Hansch, S., Wyschkon, A., Rezai, M.J. & Esser, G. (2011). Neurofeedback in ADHD: a single-blind randomized controlled trial. European Child & Adolescent Psychiatry, 20, 481‐491.
- Duric NS, Assmus J, Gundersen DI, Elegen IB. (2012). Neurofeedback for the treatment of children and adolescents with ADHD: A randomized and controlled clinical trial using parental reports. BMC Psychiatry, 12:107 doi:10.1186/1471-244X-12-107.
- Carmondy, D.P., Radvanski, D.C., Wadhwani, S., Sabo, J.J., Vergara, L. (2001). EEG biofeedback training and attention‐deficit/hyperactivity disorder in an elementary school setting. Journal of Neurotherapy, 4, 5‐27.
- Gevensleben, H., Holl, B., Albrecht, B., Schlamp, D., Kratz, O., Studer, P., & Heinrich H. (2010). Neurofeedback training in children with ADHD: 6-Month follow-up of a randomized controlled trial. European Child & Adolescent Psychiatry, 19, 715-724.
- Monastra VJ (2005). Electroencephalographic biofeedback (neurotherapy) as a treatment for attention deficit hyperactivity disorder: rationale and empirical foundation. Child Adolesc Psychiatric Clin N Am, 14, 55– 82.
- Gani C, Birbaumer N, Strehl U (2008). Long term effects after feedback of slow cortical potentials and of theta-beta-amplitudes in children with attention-deficit/hyperactivity disorder (ADHD). International Journal of Bioelectromagnetism, 10(4) 209-232.
- Hodgson, K. et al (2012). Nonpharmacological treatments for ADHD: a meta-analytic review. Journal of Attention Disorders, published online May 29, 2012, doi:10.1177/1087054712444732
- See Biofeedback now a “Level 1—Best Support” Intervention for Attention & Hyperactivity Behaviors, October 5, 2012, http://www.sharpbrains.com/blog/2012/10/05/biofeedback-now-a-level-1-best-support-intervention-for-attention-hyperactivity-behaviors/.
- Benson, K. & Hartz, A.J. (2000). A comparison of observational studies and randomized, controlled trials. The New England Journal of Medicine, 342, 1878‐1886.
- Britton, A., et al. (1998). Choosing between randomised and non‐randomised studies: a systematic review. Health Technol Assess 2, i‐iv, 1‐124.
- Olfson, M. et al. (2012). National trends in the office-based treatment of children, adolescents, and adults with antipsychotics. Arch Gen Psychiatry, Published online August 6, 2012, doi:10.1001/archgenpsychiatry.2012.647
- Wangler, S., Gevensleben, H., Albrecht, B., Studer, P., Rothenberger, A., Moll, G.H., & Heinrich, H. (2011). Neurofeedback in children with ADHD: Specific event related potential findings of a randomized controlled trial. Clinical Neurophysiology, 122, 942-950.
- Loo, S., Barkley, R. (2005). Clinical utility of EEG in Attention Deficit Hyperactivity Disorder. Applied Neuropsychology, 12(2), 64–76.
- FDA website: http://www.accessdata.fda.gov/drugsatfda_docs/label/2003/21475_methylin_lbl.pdf.
- Barkley, R. (1997). Defiant children: A clinician’s manual for assessment and parent training. Guilford Press.
- Barkley, R. website: http://www.russellbarkley.org/content/adhd-facts.pdf
- Loo, S., Makeig, S. (2012). Clinical utility of EEG in attention-deficit/hyperactivity disorder: a research update. Neurotherapeutics, doi: 10.1007/s13311-012-0131-z
- Lofthouse N., et al. (2011). Biofeedback and neurofeedback treatment for ADHD. Psychiatric Annals, 41 (1), 42-48.
- Lofthouse N, Arnold LE, Hersch S, Hurt E. (2012) Current status of neurofeedback for Attention-Deficit/Hyperactivity Disorder. Current Psychiatry Report, DOI 10.1007/s11920-012-0301-z.
- Lofthouse N, Arnold LE, Hersch S, Hurt E, Debeus R. (2012). A review of neurofeedback treatment for pediatric ADHD. Journal of Attention Disorders, 16, 351-372.
- Lansbergen M.M., et al. (2011). ADHD and EEG-neurofeedback: a double-blind randomized placebo-controlled feasibility study. J Neural Transm, 118, 275-284.
- Arnold LE, Lofthouse N, Hersch S, et al. EEG Neurofeedback for ADHD: double-blind sham-controlled randomized pilot feasibility trial. Journal of Attention Disorders, doi:10.1177/1087054712446173.
- Sherlin, L.H., Arns, M., Lubar, J., Heinrich, H., Kerson, C., Strehl, U., Sterman, M.B. (2011). Neurofeedback and basic learning theory: implications for research and practice. Journal of Neurotherapy, 15 (4), 292-304.
- Egner, T., & Sterman, M. B. (2006). Neurofeedback treatment of epilepsy: From basic rationale to practical application. Expert Review of Neurotherapeutics, 6, 247–257.
- Kirsch, I. (2009). The Emperor’s New Drugs: Exploding the Antidepressant Myth. London: The Bodley Head.
- Fava, M., et al. (2003). The problem of the placebo response in clinical trials for psychiatric disorders: culprits, possible remedies, and a novel study design approach. Psychotherapy and Psychosomatics, 72, 115–127.
- Otto, M.W. and Nierenberg, A.A. (2002). Assay sensitivity, failed clinical trials and the conduct of science. Psychotherapy and Psychosomatics, 71, 241–243.
- Hooper M. and Amsterdam, J.D. (June 1998). Do clinical trials reflect drug potential? A review of FDA evaluation of new antidepressants. NCDEU 39th Annual Meeting, Boca Raton, Florida.
- Hammond, D.C. (2011). What is neurofeedback: An update. Journal of Neurotherapy, 15, 305–336.
90. Riddle, M., Yershova, K., Lazzaretto, D., et al. (2013). The preschool attention-deficit/hyperactivity disorder treatment study (PATS) 6-YearFollow-Up. Journal of the American Academy of Child & Adolescent Psychiatry, published online.