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To examine delayed effects of theta-beta ratio (TBR) neurofeedback (NF) for attention-deficit/hyperactivity disorder (ADHD) 25 months after baseline, ∼21 months after end of treatment.Children aged 7-10 with rigorously diagnosed ADHD had been randomized to 38 sessions of TBR NF (n=84) or control treatment (n=58) of identical appearance, intensity/frequency, and duration, differing only in that reinforcement for controls was based on a pre-recorded EEG of another child. Child, parent, and all site staff were blind until after 25-month assessments, with only one-fourth able to guess the control treatment correctly. Baseline assessments were repeated off medication after 25 months.Of the 142, 120 had 25-month follow-up (84.5% retention). Only 12 (6 controls) had NF after the study treatment, greatly retaining the randomization. The primary outcome, parent-rated inattention, was not significantly different between treatments despite large pre-post effect sizes (NF, d=1.63; controls, d=1.42). Most secondary measures showed the same pattern. Response rates (CGI-I≤2) were 58.6% of NF and 66% of controls (non-significant). Marginally more controls than NF recipients needed medication (57.1% vs 38.6%, p=0.059); specifically, 7.1% of NF and 4% of controls had reduced medication need while 34.3% of NF and 50% of controls needed more medication (p=0.084).Most of the large within-group improvement from the NF treatment package reported by unblinded studies and replicated in this blinded study reflects nonspecific effects, not specific effects of deliberate downtraining of EEG theta-beta power ratio. At 25-month follow-up it appears comparable to the evidence-based MTA treatments, suggesting a psychotherapeutic/behavioral effect.

We examined seasonal and geographic effects on vitamin D [25(OH)D] levels, association with attention-deficit/hyperactivity disorder (ADHD) symptom severity, and effects of supplementation in 222 children age 7-10 with rigorously diagnosed ADHD. 25(OH)D insufficiency rates were 47.2 % in Ohio and 28.5 % 400 miles south in North Carolina. Nadir of 25(OH)D levels was reached by November in Ohio, not until January in NC. Thirty-eight children with insufficiency/deficiency took vitamin D (1000-2000 IU/day for a month); levels rose 52 %. Although inattention did not correlate with 25(OH)D at screen nor improve significantly with supplementation, inattention improvement after supplementation correlated with 25(OH)D increase (rho = 0.41, p = 0.012). A clinically significant proportion of children with ADHD have insufficient 25(OH)D even at summer's end, more so in the winter and north of the 37th parallel. The significant correlation of inattention improvement with 25(OH)D increase suggests further research on 25(OH)D as ADHD treatment.