Commercial mindfulness aid does not aid short-term stress reduction compared to unassisted relaxation.

Increased public interest in mindfulness has generated a burgeoning market in new consumer technologies. Two exploratory studies examined effects of InteraXon's "Muse" electroencephalography (EEG)-based neurofeedback device and mobile application on mindfulness-based relaxation activities. Psychophysiological outcomes (heart rate variability (HRV), electro-dermal activity (EDA), saliva amylase activity (sAA) and Muse application EEG "calm percent") were collected for two 7-minute conditions: Muse-assisted relaxation exercise (MARE), and unassisted relaxation exercise (URE). In the first study, participants (n = 99) performed both conditions in a randomized sequential design. A follow-up study used a randomized parallel condition (n = 44) to test for differences in HRV effects between the two conditions and extended follow-up observation. Generalized estimating equation models demonstrated a moderate increase in HRV following relaxation exercises, with no observable difference between MARE and URE conditions. Both MARE and URE conditions produced equally effective short-term increases in heart rate variability, without additional benefit from neurofeedback.

Pharmacotherapy for incident attention-deficit/hyperactivity disorder: practice patterns and quality metrics.

INTRODUCTION: This study examines incident treatment patterns for attention-deficit/hyperactivity disorder (ADHD) in children seen in eight integrated healthcare delivery systems and identifies factors associated with adherence to Healthcare Effectiveness Data and Information Set (HEDIS) quality measures developed by the National Committee for Quality Assurance (NCQA). METHOD: A retrospective cohort analysis using electronic healthcare data from children aged 3 through 17 years with newly diagnosed ADHD between January 1, 2009 and December 31, 2010 was conducted. NCQA quality definitions for initiation and for continuation and maintenance (C&M) of ADHD medications were expanded to include preschoolers and adolescents. Poisson regression models with robust error variance were used to evaluate the association between NCQA HEDIS adherence measures, provider type, patient characteristics and care process measures. RESULTS: Of 6864 children aged 3-17 years old qualifying for incident treatment analyses, 5538 (80.7%) were started on ADHD medication within a year of diagnosis. Adherence to NCQA HEDIS measures was 49.8% for initiation and 45.8% for C&M, with adherence rates higher for mental health than non-mental health providers, school-aged children than adolescents, and for patients concurrently on other psychotropic medications than those who were not. Of those started on ADHD medication, 62.3% were not eligible for C&M analyses according to HEDIS guidelines, because they did not receive continuous (210 of 300 days) ADHD medication treatment, with adolescents less likely than school-aged children to persist with medications. CONCLUSION: Study limitations must be considered, including reliance on electronic medical record data, absence of patient race and sociodemographic data, and limited generalizability to other care contexts. Nevertheless, findings suggest novel strategies are needed to improve the quality of ADHD care processes for children of all ages, because even within integrated delivery systems less than half of children with ADHD received care consistent with NCQA HEDIS standards for initiation and C&M care. RESULTS suggest the need to refine quality measures by including follow-up care in those children not receiving or discontinuing medication treatment, a considerable quality concern not currently captured in NCQA HEDIS standards.

Use of complementary and alternative medicine for symptoms of attention-deficit hyperactivity disorder.

OBJECTIVE: Attention-deficit hyperactivity disorder (ADHD) is a common childhood psychiatric condition for which evidence-based treatments have been established. This study describes use of complementary and alternative medicine among children with ADHD or at risk of having ADHD and explores possible predictors of use of such treatments. METHODS: A sample of 1,615 parents of elementary school students in a public school district were interviewed in a telephone screening survey of ADHD symptoms and use of traditional and nontraditional ADHD treatment. A total of 822 parents had a child with a diagnosis of ADHD, had a child in whom ADHD was suspected, or had a child about whose emotions or behavior the parents or school staff had general concerns. RESULTS: Use of complementary and alternative medicine was significantly higher among children who had received a diagnosis of ADHD (12 percent) or in whom ADHD was suspected (7 percent) than among those about whom parents or school staff had general concerns (3 percent). Faith healing had been used for 4 percent of the 822 children. Nontraditional treatments were more likely to have been used among children with a diagnosis or a suspected diagnosis of ADHD and those whose parents used the Internet as a source of information than among other children. CONCLUSIONS: Providers should inquire about nontraditional interventions and educate families about evidence-based approaches when treating children with ADHD.