Attention Deficit Hyperactivity Disorder Clinic Research Articles

Female-specific pharmacotherapy in ADHD: premenstrual adjustment of psychostimulant dosage.

Attention-Deficit/Hyperactivity Disorder (ADHD) is a common neurodevelopmental condition which is underdiagnosed and undertreated in women. For decades, the ADHD field has called for more insight into female-specific therapy. Preliminary findings postulate that changes in sex hormones during the menstrual cycle may influence the effectiveness of psychostimulant medication. Yet, pharmacotherapeutic interventions tailored to women with ADHD remain scarce. Previously, our group showed an increase in mood symptoms in the premenstrual week in women with ADHD. Premenstrual worsening of depressive and ADHD symptoms represent a treatment challenge. In our adult ADHD clinic, we noted several women describing exacerbation of their ADHD and depressive symptoms in the premenstrual week and/or insufficient effect of their established dosage of psychostimulant. We responded to the need expressed by these women by increasing their stimulant dosage in the premenstrual week, while monitoring the response and side effects. This community case study of nine consecutive women being treated for ADHD and co-occurring conditions (including depression and premenstrual dysphoric disorder), reports our local experience of increasing the individually prescribed psychostimulant dosage during the premenstrual period. We methodically monitored the effect of this increased dosage on ADHD symptoms, mood and somatic symptoms for the following 6-24 months. With premenstrual dose elevation, all nine women experienced improved ADHD and mood symptoms with minimal adverse events. Premenstrual inattention, irritability and energy levels improved, and now resembled the other non-premenstrual weeks more closely. All women decided to continue with the elevated premenstrual pharmacotherapy. Our preliminary results demonstrate potential benefits of increasing premenstrual psychostimulant dosage in women with ADHD, experiencing premenstrual worsening of ADHD and mood symptoms. The results concur with previous findings of diminished response to amphetamines in the late luteal phase. Increased dosage may help combat premenstrual worsening of cognitive and emotional symptoms in women with ADHD, with significant clinical implications. Better management of premenstrual ADHD and mood symptoms in vulnerable women can improve treatment outcome and meet an unmet need. However, implementation should be individually explored. Further investigation of luteal phase psychostimulant dose adjustment is required for safe, optimal and individualised treatment for women with ADHD.

B - 50 The Relationship between Objective and Subjective Measures of Attention.

The relationship between objective and subjective measures of attention is understudied. This study aimed to evaluate the convergence between commonly used measures in the assessment of attention-deficit hyperactivity disorder (ADHD) and to determine whether there is a significant difference between individuals with and without ADHD on subscales related to ADHD symptoms. This study involved an archival data set of Veterans (N = 504) who completed the Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF) or MMPI-3, the Barkley's Adult ADHD Rating Scale or a local DSM-5/TR ADHD diagnostic interview, the Connor Continuous Performance Test 3 (CCPT-3) or the Integrated Visual & Auditory 2, and the Trail Making Test as part of a clinical assessment in a specialty ADHD clinic. Nonparametric comparisons between those with and without ADHD revealed no statistically significant differences across the cognitive measures. Self-reported symptoms of inattention (z = 12.07, p < 0.001, r = 0.57, large effect), hyperactivity (z = 4.70, p < 0.001, r = 0.22, small effect), and impulsivity (z = 5.52, p < 0.001, r = 0.26, small effect), significantly differentiated participants with and without ADHD. Pearson correlations between the two types of measures showed that omission errors on the CCPT-3 were significantly correlated to self-reported inattention symptoms (r = 0.15, p = 0.039). All other correlations between objective and subjective measures were not significant. These results suggest that neuropsychological measures are not strongly correlated to self-reported symptoms of inattention, and as such may be less sensitive to ADHD.

What It’s Like Being A Midwife With Attention Deficit Hyperactivity Disorder

Some women with attention deficit hyperactivity disorder (ADHD) may go their entire lives without receiving a diagnosis. This diagnosis gap exists in part because the disorder was once assumed to mostly afflict men but also because women typically exhibit less socially disruptive symptoms than men.1 Most ADHD clinic referrals for nearly a century were for young, hyperactive boys.2 The data characterising boys’ behaviours served as the foundation for early diagnostic standards. Since hyperactivity was demonstrated to be the hallmark, only rarely were young females diagnosed. The primary symptoms of inattention that most girls with ADHD encountered did not meet the diagnostic criteria, therefore ADHD was thought to be a typically male condition. The Nursing and Midwifery Council (NMC) recorded that 99.7% of midwives in the UK are women, while 3.7% of midwives have disclosed a disability.3 This could be suggestive of high numbers of UK midwives working and living with undiagnosed (therefore untreated) ADHD. This article explores the personal experience of being a midwife with ADHD with guidance on how colleagues can be supportive of each other.

Prevalence of Personality Disorders in Adults With Attention Deficit Hyperactivity Disorder (ADHD)

Objective: To estimate the prevalence of PDs according to Millon’s evolution-based model among adult ADHD outpatients. Method: Cross-sectional study of consecutive patients referred to an adult ADHD clinic. PDs were evaluated with Millon Clinical Multiaxial Inventory–III (MCMI-III). Results: One-hundred-eighty-one participants had valid MCMI-III, of whom147 were diagnosed with ADHD. Mean age: 32.97, SD:11.56, females: 74 (50.3%). Among the 147 participants with ADHD, 29 (19.7%) did not meet criteria for any PD, 43 (29.3%) met the criteria for one PD, 34 (23.1%) for two PDs and the rest three or more. Most common PD was Dependent (n = 58) followed by Depressive (n = 45). Inattentive sub-type was associated with dependent PD, while combined type with antisocial, negativistic (passive/aggressive) and sadistic PD. Conclusion: Particular personality profiles were more common with different ADHD subtypes. Given the developmental origins of PD, further research may help identify possible links with childhood difficulties.

Correlation research of susceptibility single nucleotide polymorphisms and the severity of clinical symptoms in attention deficit hyperactivity disorder.

ObjectiveTo analyze the correlation between susceptibility single nucleotide polymorphisms (SNPs) and the severity of clinical symptoms in children with attention deficit hyperactivity disorder (ADHD), so as to supplement the clinical significance of gene polymorphism and increase our understanding of the association between genetic mutations and ADHD phenotypes.Methods193 children with ADHD were included in our study from February 2017 to February 2020 in the Children’s ADHD Clinic of the author’s medical institution. 23 ADHD susceptibility SNPs were selected based on the literature, and multiple polymerase chain reaction (PCR) targeted capture sequencing technology was used for gene analysis. A series of ADHD-related questionnaires were used to reflect the severity of the disease, and the correlation between the SNPs of specific sites and the severity of clinical symptoms was evaluated. R software was used to search for independent risk factors by multivariate logistic regression and the “corplot” package was used for correlation analysis.ResultsAmong the 23 SNP loci of ADHD children, no mutation was detected in 6 loci, and 2 loci did not conform to Hardy-Weinberg equilibrium. Of the remaining 15 loci, there were 9 SNPs, rs2652511 (SLC6A3 locus), rs1410739 (OBI1-AS1 locus), rs3768046 (TIE1 locus), rs223508 (MANBA locus), rs2906457 (ST3GAL3 locus), rs4916723 (LINC00461 locus), rs9677504 (SPAG16 locus), rs1427829 (intron) and rs11210892 (intron), correlated with the severity of clinical symptoms of ADHD. Specifically, rs1410739 (OBI1-AS1 locus) was found to simultaneously affect conduct problems, control ability and abstract thinking ability of children with ADHD.ConclusionThere were 9 SNPs significantly correlated with the severity of clinical symptoms in children with ADHD, and the rs1410739 (OBI1-AS1 locus) may provide a new direction for ADHD research. Our study builds on previous susceptibility research and further investigates the impact of a single SNP on the severity of clinical symptoms of ADHD. This can help improve the diagnosis, prognosis and treatment of ADHD.

Genetics in the ADHD Clinic: How Can Genetic Testing Support the Current Clinical Practice?

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder with a childhood prevalence of 5%. In about two-thirds of the cases, ADHD symptoms persist into adulthood and often cause significant functional impairment. Based on the results of family and twin studies, the estimated heritability of ADHD approximates 80%, suggests a significant genetic component in the etiological background of the disorder; however, the potential genetic effects on disease risk, symptom severity, and persistence are unclear. This article provides a brief review of the genome-wide and candidate gene association studies with a focus on the clinical aspects, summarizing findings of ADHD disease risk, ADHD core symptoms as dimensional traits, and other traits frequently associated with ADHD, which may contribute to the susceptibility to other comorbid psychiatric disorders. Furthermore, neuropsychological impairment and measures from neuroimaging and electrophysiological paradigms, emerging as potential biomarkers, also provide a prominent target for molecular genetic studies, since they lie in the pathway from genes to behavior; therefore, they can contribute to the understanding of the underlying neurobiological mechanisms and the interindividual heterogeneity of clinical symptoms. Beyond the aforementioned aspects, throughout the review, we also give a brief summary of the genetic results, including polygenic risk scores that can potentially predict individual response to different treatment options and may offer a possibility for personalized treatment for the therapy of ADHD in the future.

Study of computerized cognitive training technique for treatment of children with attention deficit hyperactivity disorder: A new treatment modality experience

Background Attention-deficit hyperactivity disorder (ADHD) is the most commonly diagnosed neurodevelopmental disorder of childhood that can profoundly affect the academic achievement, well-being, and social interactions of children. Different treatment modalities are used for the management of ADHD.Aim To determine the value of computerized cognitive training (CCT) programs in improving cognitive functions and core symptoms in ADHD childrenPatients and methods In this study, 60 school-aged children with ADHD were included for the purpose of establishing the effect of cognitive training sessions on the core symptoms of ADHD. Patients’ data were collected as follows: the age and sex of the patients, residence, parental consanguinity, family history, prenatal/perinatal history and data of general examination, and psychometric studies: ‘The diagnostic and statistical manual of mental disorder (DSM-V),’ ‘Conner’s Parent Rating Scale CPRS-93’ revised for assessment of the ADHD and associated comorbid disorders, and The Arabic version of ‘Stanford Binet intelligence test – 5th edition’ for assessment of intelligence quotient.Results A total number of 60 cases with ADHD who attended the Outpatient ADHD Clinic at AUCH were enrolled in the study. Among these, 66% were males, and the age variation was between 6 and 12 years among the three studied groups. All the children had an average intelligent quotient (IQ) more than or equal to 80. The mean intelligent quotient for the 60 studied children was 92.85±11.33. Pre-CCT assessment showed that there was no significant difference according to attention, concentration, hyperactivity, impulsivity, memory, and self-confidence between ADHD children of the three studied groups. There was significant improvement in comparison between the pre-CCT and post-CCT assessment among the three studied groups in regard to the core symptoms of ADHD, including attention and concentration (duration of attention and concentration, order of thinking, and learning from mistakes), hyperactivity (movement within chair, talking, and flight of ideas), topological memory (method of memorizing, recall), and reaction behavior (impulsivity and confidence).Conclusion From the present study, it was concluded that CCT training sessions are effective in improvement of ADHD core symptoms, including inattention hyperactivity, impulsivity, and memory deficits either with or without medical therapy. It results in improvement of confidence, duration and order of thinking, learning from mistakes, excessive movement, flight of ideas, and recall.

Elevated levels of hoarding in ADHD: A special link with inattention

Hoarding Disorder (HD) is under recognised and under-treated. Though HD develops by early adulthood, patients present only later in life, resulting in research based largely on samples of predominantly older females. Whilst formerly associated with Obsessive-Compulsive Disorder (OCD), it is now recognised that individuals with HD often have inattention symptoms reminiscent of Attention Deficit/Hyperactivity Disorder (ADHD). Here, we investigated HD in adults with ADHD. Patients in an ADHD clinic (n = 88) reported on ADHD, HD and OCD-related symptoms, and compared with age, gender and education matched controls (n = 90). Findings were assessed independently in an online UK sample to verify replication using a dimensional approach (n = 220). Clinically significant hoarding symptoms were found in ∼20% versus 2% of ADHD and control groups, respectively, with those with hoarding being on average in their thirties and with approximately half being male. Greater hoarding severity was noted even in the remaining patients compared with controls (d = 0.89). Inattention was the only significant statistical predictor of hoarding severity in patients. Similarly, inattention, alongside depression and anxiety were the greatest predictors of hoarding in the independent sample where 3.2% identified as having clinically significant hoarding. Patients with ADHD had a high frequency of hoarding symptoms, which were specifically linked to inattention. HD should be routinely assessed in individuals with ADHD, as they do not typically disclose associated difficulties, despite these potentially leading to impaired everyday functioning. Research in HD should also investigate adults with ADHD, who are younger and with a greater prevalence of males than typical HD samples.

Evaluation of an attention deficit hyperactivity disorder (ADHD) assessment &amp; treatment service

AimsThe Central and North West London NHS Foundation Trust ADHD clinic offers diagnosis and medication stabilisation for adults with ADHD, in preparation for discharge back to GP for continued prescribing and monitoring. Referral waiting time is shortened by efficiently managing the service and soon transfer of care to GP whilst referrals have been increasingly accepted years on years. A snap shot service evaluation was made to understand characteristics of service exploring its strength and areas to improve.MethodAll 115 patients offered in March and April 2019 for an ADHD specialist assessment were sampled from the new electronic patient record SystmOne in use since 1st March 2019.Data were collected forMale &amp; Female ratioAge range distributionClinical Commissioning Group referral sourceClinic attendance characteristicsADHD diagnosis, sub-types and psychiatric comorbidityADHD Medication prescribedFP10 Prescription duration by prescribersPatient data were anonymously encoded into Microsoft Excel Sheet for sorting, counting, summating and illustrating into tables and pie charts.ResultThe male &amp; female ratio of the sample was 6:5 and nearly half were in age range 20-29 years. Majority were referred from Westminster and West London Clinical Commissioning Groups.107 patients completed the assessment, of which 106 were diagnosed as having an adult ADHD.22% of follow-up clinics were cancelled or not attended (DNA) by patients. The majority of the patients (62%) required 1-2 follow-ups before transfer to GP, whilst 8% did not require or want follow-ups either already being on ADHD medication, not wanting medication or having lost to reviews. Only 3% require six or more follow-ups.Majority were reviewed after two- to five-week prescription, the peak being four-weekly.91% of completion to GP were discharged on ADHD medication, majority being singly on Elvanse (48%) and Concerta XL (25%). Discharge without ADHD medication was due to concerns for its addiction, preference on non-medication treatment, intolerance of medication adverse effect or mental health priority treatment.ConclusionCollaboration with GPs for their pre-treatment physical health screening facilitated prompt prescribing initiation on assessment with most discharges taken place after 1-2 follow-ups, enabling service turn-over with short waiting time (6-9 months in 2018/2019). Service expansion for increasing referral uptake is probably feasible from this baseline by appointing additional sessional clinicians and further efficiency management on clinic scheduling &amp; DNA with a target majority likely requiring 1-2 follow-ups with average four-weekly prescribing.

Implementation of a community-based pharmacist-run attention deficit hyperactivity disorder clinic in a college health center

BackgroundPublished evidence is lacking to describe the pharmacist’s role in medication management within an attention deficit hyperactivity disorder (ADHD) specialty clinic. ObjectivesThe objectives were (1) to measure the growth of an ADHD clinic in a college health center after the integration of clinical pharmacists and (2) to evaluate provider adherence to clinic policies and procedures before and after pharmacist integration.Practice description: In 2017, a pharmacist-run ADHD clinic was established at a college campus. Practice innovationPharmacists conducted collaborative initial visits with psychiatrists and independently provided follow-up appointments for patients with ADHD. Evaluation methodsData were extracted from the electronic health record for patients aged 18 years or older with an ADHD diagnosis who completed a medication evaluation or medication follow-up visit from July 1, 2016 to June 30, 2019. Data were excluded if it was for another visit type, was a non-ADHD clinic provider visit, or if the visit note was classified. Data before the pharmacist integration (July 1, 2016–June 30, 2017) were compared with data after the pharmacist integration (July 1, 2017–June 30, 2019). Chi-square tests of independence evaluated differences in blood pressure monitoring, heart rate monitoring, and stimulant medication contract signature between psychiatrist- and pharmacist-run appointments. ResultsPharmacist presence in the ADHD clinic increased from 0 full-time equivalent (FTE) to 0.2 FTE over 3 years. The number of appointments increased by 1003% (from 26 to 287). Compared with psychiatrist-run appointments, pharmacist-run appointments were more adherent to monitoring blood pressure (11% vs. 77%, P < 0.001) and heart rate (6% vs. 75%, P < 0.001), as well as clinic policy requiring a patient’s signature on a stimulant medication contract (64% vs. 75%, P = 0.019). ConclusionPharmacists can assist psychiatrists in medication management of ADHD in the college health setting. A pharmacist-psychiatrist collaboration increased quality of care and monitoring of medication adverse effects.

Treatment Outcomes in an Adult Attention Deficit Hyperactivity Disorder Clinic With a Focus on Executive Functioning and Sluggish Cognitive Tempo.

AimExecutive function (EF) is considered a core attention deficit hyperactivity disorder (cADHD) symptom in adults and, more recently, sluggish cognitive tempo (SCT). Despite considerable controversy around the role of SCT symptoms in the diagnosis of attention deficit hyperactivity disorder (ADHD), some scholars have suggested that SCT symptoms are a subset of the ADHD syndrome, whereas others have suggested that SCT is an entirely unique type of attention disorder. Therefore, we looked to characterize the impact of treatment as usual (TAU) with medication and psychoeducation on the functional impairments related to EF and SCT, and related functional impairments in adults with ADHD. We aim to clarify if the combination of TAU and modular ADHD therapy (TAUTx) further improves these symptoms. The goal is to assess the validity of self-reporting assessment of symptoms adopted in the present for the monitoring of treatment in this population. MethodsWe implemented the inclusion and exclusion criteria at the onset of the clinic. This prospective cohort case series study is designed to see the difference with self-reporting scales for EF, SCT, and cADHD symptoms in TAU and TAUTx. The STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) checklist was used to provide transparency in reporting the data.ResultsAdults with ADHD showed a significant improvement with TAU in EF (p=0.001), cADHD (p=0.007), and SCT (p=0.002). Furthermore, TAUTx improved areas of EF (p=0.001), cADHD (p=0.004), and SCT (p=0.002). We saw a significant benefit from starting/optimizing medications in the treatment of ADHD along with psychoeducation. Self-reporting scales appeared to be reliable for monitoring the symptoms of ADHD and related dysfunction and were consistent with the Clinical Global Impressions Scale.ConclusionsAdult ADHD patients reported significant benefit from TAU for aspects of impairment in EF and SCT. They require ongoing medication prescribing and “tailoring” through optimization. Psychoeducation is an effective form of therapy in these patients with or without the addition of adult ADHD modular therapy. Self-reporting is valid for monitoring and providing transparency in patient care.

Satisfaction And Participant Adherence In A Family Healthy Lifestyle Intervention For Children With ADHD

Consistent evidence demonstrates that healthy lifestyle behaviors (i.e., sleep, nutrition, physical activity, and recreational screen time) are related to neurocognitive development and daily functioning of children with Attention-Deficit/Hyperactivity Disorder (ADHD). However, adopting and sustaining healthy home routines can be difficult for families. Interventions that effectively alter healthy home routines have potential to influence physical and mental health among children with ADHD. PURPOSE: To develop and beta-test the Building Unstoppable families through Intergenerational Lifestyle Transformation (BUILT) program; and assess fidelity, adherence, and satisfaction via attendance rates and post-intervention semi-structured interviews. METHODS: BUILT was offered at the University of Illinois at Chicago campus for six consecutive Saturdays. Two families from a Comprehensive ADHD Clinic, three children with ADHD, were enrolled and participated in sleep, physical activity, and nutrition activities during Family Fun Days and were also provided weekly home challenges related to cooking, physical activity, sleep, and screen time. Children earned tickets for completing home challenges, and these were redeemable for prizes. Attendance was taken at each session and semi-structured interviews were conducted with parents at post-intervention. Interviews were audio-recorded, transcribed, and coded using a thematic analysis approach. RESULTS: Participating families each attended 5 out of the 6 total sessions (83.33%). Thematic analysis of interviews showed positive aspects of the program included: improving routine structure, showing children their ability, keeping kids active, pursuing goals, relating accelerometer measures to activity, and associating nutrition with being strong and sports performance. CONCLUSION: Providing equipment, between session goals, and technology-based physical activity between sessions were beneficial to participant adherence. These findings will inform refinement of the intervention in a second iteration.

Adult attention deficit hyperactivity disorder clinic: An interprofessional collaboration

ObjectiveTo review the experience of a pharmacist-led interprofessional attention deficit hyperactivity disorder (ADHD) clinic in a large integrated health care system. Practice descriptionKaiser Permanente Northwest (KPNW) is a nonprofit managed health care system that provides integrated care to more than 625,000 members in Oregon and southwest Washington. Most health care encounters occur within KPNW facilities and with KPNW health professionals or support staff using a common electronic medical record. Practice innovationA team-based adult ADHD service was implemented with collaboration among the mental health, primary care, and pharmacy departments. EvaluationThe patients were assessed by a psychiatrist for diagnosis and care guidance. MethodsA pharmacist, working under the collaborative drug therapy management partnership, then initiated and managed the patient’s medications through telephone encounters until the patient was stable. The care of the patient was then transitioned back to primary care and not added to psychiatry’s caseload. ResultsA total of 914 patients were treated by the adult ADHD clinic since the initiation of the service in the fall of 2015. Of these patients, 610 were stabilized successfully by the ADHD clinic pharmacists. The ADHD clinic pharmacists conducted 2634 patient encounters over the study period and averaged 3.7 telephone follow-ups per successful patient, with follow-ups approximately every 2 weeks. The organization realized a cost savings of $761,280 during this time period on the basis of the cost of a mental health provider adjusting and addressing ADHD medications versus pharmacy staff working to stabilize the patient. ConclusionThe implementation of a collaborative adult ADHD service has demonstrated a successful alliance of primary care, mental health, and pharmacy in a large managed care organization. In addition to increased efficiency and evidence-based practice, the adult ADHD clinic resulted in cost savings and improved access to mental health care.

A Comparison of Salivary Mercury Levels in Children with Attention Deficit/Hyperactivity Disorder When Compared to Age-matched Controls: A Case-control Observational Study

The aim of this study was to compare the level of mercury in the saliva of children with attention deficit/hyperactivity disorder (ADHD) as compared to age- and gender-matched controls in specific age groups. A case-control observational study design was used. In school children with ADHD and outpatient dental clinics of a university dental hospital, the participants were schoolchildren diagnosed with ADHD studying in the first grade (6-7 years), sixth grade (12-13 years), and ninth grade (15-16 years) and were gender-matched to children without ADHD attending regular classes in school. Ninety children with ADHD comprised the test group while 90 children without ADHD comprised the control group. In this study, we found that children with ADHD had higher levels of salivary mercury than their age- and gender-matched counterparts; however, this difference was significant only in the 6-7 years of age group. The regression model showed a mild positive association between salivary mercury and ADHD; however, the association was not statistically significant. While there is some indication that salivary mercury may be higher in children with ADHD, there is insufficient evidence to establish a definite association between the two. The study highlights the need to evaluate existing evidence on the role of mercury, especially salivary mercury, in ADHD.

Estrés percibido por los padres de niños con Trastorno por Déficit de Atención con Hiperactividad

El TDAH (trastorno por déficit de atención con hiperactividad) es un trastorno del neurodesarrollo que tiene potencial influencia sobre el estrés paterno. Nuestra investigación estudia las diferencias en estrés percibido por padres (EPP) con / sin hijos con TDAH y analiza el mejor modelo de variables explicativas clínicas, sociales, económicas y académicas asociadas al EPP. Metodología: Diseño de investigación analítico observacional de casos y controles, emparejados por sexo y edad. Muestreo consecutivo de 82 participantes entre 6 y 16 años (41 casos muestra clínica salud mental / 41 controles población general). Evaluación clínica TDAH mediante Escala NICHQ Vanderbilt y estrés de padres mediante la Escala de Estrés Percibido. Resultados: Los padres de hijos con TDAH tienen más estrés percibido (d = .532) y el modelo explicativo que mejor predice EPP está formado por tener hijos con TDAH y tener padres separados (R2 = .303). El mejor modelo de EPP no incluye variables como trastornos de aprendizaje, conducta o emocionales en los hijos, situación de desempleo o edad de los padres. Conclusiones: El EPP está asociado con el TDAH de los hijos y pudiera mejorar con su tratamiento.

Resilience levels among adolescents with ADHD using quantitative measures in a family-design study.

To investigate resilience levels in adolescents with attention-deficit hyperactivity disorder (ADHD) using quantitative measures when compared to their non-affected siblings and controls. We also aimed to investigate the correlation between resilience and depression, anxiety, intelligence quotient (IQ) and socioeconomic status, which may affect resilience levels and be potential confounders. Adolescents (n=45) diagnosed with ADHD referred to an outpatient ADHD clinic, and their siblings without ADHD (n=27), with ages ranging from 12 to 17 years, were interviewed along with their parents using a semi-structured interview (Children's Interview for Psychiatric Syndromes - Parent Version). Intelligence was measured with the Block Design and Vocabulary subtests from the Wechsler Battery. Anxiety and depression were investigated using the Children State-Trait Anxiety Inventory (CSTAI) and the Child Depression Inventory (CDI), respectively. Resilience was investigated using the Resilience Scale. A control group (typically developing adolescents [TDA] and their siblings; n=39) was recruited in another outpatient facility and at two schools using the same methodology. Socioeconomic status and intelligence levels, which may affect resilience, were similar in all groups. Adolescents with ADHD showed lower resilience levels compared to siblings and TDA even when controlled for anxiety and depression levels, which were higher in ADHD. Resilience levels were higher in siblings than in adolescents with ADHD, and lower than in TDA - this last result without statistical significance. In our sample, ADHD in adolescents was associated with lower resilience, even when controlled for confounders often seen in association with the disorder.

Reducing antipsychotic medication in ID using QI methodology

PurposeResearch highlights that antipsychotic medications are prescribed more in people with Intellectual Disability (ID) without a diagnosis of severe mental illness. Despite non-pharmacological interventions recommended as alternatives, their application can be challenging due to heterogeneity of the patient group. The purpose of this paper is to discuss application of quality improvement (QI) methodology in adapting interventions, aiming to reduce challenging behaviour of people with ID, thereby reducing use of antipsychotic medication.Design/methodology/approachTwo interventions were introduced as “tests of change”; an “Attention-Deficit Hyperactivity Disorder (ADHD) clinic” and “Positive Behaviour Support (PBS) clinic”. Process (Clinical Global Impression (CGI) and Modified Overt Aggression Scale (MOAS)) and outcome measures (total antipsychotic use) were used to assess the interventions, with each being reviewed as per QI methodology guidelines.FindingsThere was an improvement in CGI scores for both interventions. MOAS scores reduced for those attending the ADHD clinic, resulting in reductions of antipsychotic medication. MOAS scores did not reduce for the PBS clinic, so there was no reduction in medication for this group.Originality/valueBased on the introduction of pilot clinics, this paper provides a commentary on how QI interventions can be used to evaluate and adapt evidence-based interventions, in managing the needs of patients with ID. It further highlights the importance of the diagnosis of ADHD in patients with ID and challenging behaviour. Although PBS is recommended to manage challenging behaviour, this paper demonstrates the importance of continuous evaluation of behavioural interventions. There is currently no existing literature investigating use of QI methodology to reduce challenging behaviour in ID populations, emphasising scope for future research and service evaluation.

Systematic review of the screening, diagnosis, and management of ADHD in children with epilepsy. Consensus paper of the Task Force on Comorbidities of the ILAE Pediatric Commission

Attention-deficit/hyperactivity disorder (ADHD) is a common and challenging comorbidity affecting many children with epilepsy. A working group under the International League Against Epilepsy (ILAE) Pediatric Commission identified key questions on the identification and management of ADHD in children with epilepsy. Systematic reviews of the evidence to support approaches to these questions were collated and graded using criteria from the American Academy of Neurology Practice Parameter. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) requirements were followed, with PROSPERO registration (CRD42018094617). No increased risk of ADHD in boys with epilepsy compared to girls with epilepsy was found (Level A). Valproate use in pregnancy is associated with inattentiveness and hyperactivity in offspring (1 class I study), and children with intellectual and developmental disabilities are at increased risk of ADHD (Level A). Impact of early seizure onset on development of ADHD was unclear (Level U), but more evident with poor seizure control (Level B). ADHD screening should be performed from 6 years of age, or at diagnosis, and repeated annually (Level U) and reevaluated after change of antiepileptic drug (AED) (Level U). Diagnosis should involve health practitioners with expert training in ADHD (Level U). Use of the Strength and Difficulties Questionnaire screening tool is supported (Level B). Formal cognitive testing is strongly recommended in children with epilepsy who are struggling at school (Level U). Behavioral problems are more likely with polytherapy than monotherapy (Level C). Valproate can exacerbate attentional issues in children with childhood absence epilepsy (Level A). Methylphenidate is tolerated and effective in children with epilepsy (Level B). Limited evidence supports that atomoxetine is tolerated (Level C). Multidisciplinary involvement in transition and adult ADHD clinics is essential (Level U). In conclusion, although recommendations could be proposed for some of the study questions, this systematic review highlighted the need for more comprehensive and targeted large-population prospective studies.

Parent Training for Preschool ADHD in Routine, Specialist Care: A Randomized Controlled Trial

Parent training is recommended for attention-deficit/hyperactivity disorder (ADHD) in preschool children. Evidence-based interventions are important, but only if they produce better outcomes than usual care. The authors conducted a multicenter, 2-arm, parallel-group, randomized controlled trial in routine specialist ADHD clinics in the Danish Child and Adolescent Mental Health Services. Children (N= 164, 3-7 years old) with ADHD received a well-established parent training program (New Forest Parenting Programme; n= 88) or treatment as usual (n= 76). The primary outcome was parent ratings of child ADHD symptoms. Secondary outcomes included teacher ratings and direct observations of ADHD symptoms. Outcomes were measured at baseline, after treatment, and at follow-up (36 weeks later). Representativeness of participants was evaluated against the total national cohort of children (N= 1,378, 3-7 years old) diagnosed with ADHD during the same period using the Danish Civil Registration System. Statistical analysis used a repeated measure model. After treatment, the parent training program was superior to treatment as usual on parent-rated ADHD symptoms (p= .009; effect size d=0.30) and on parenting self-efficacy and family strain. Effects persisted to 36 weeks after treatment. There were no effects on teacher ratings or direct observations of ADHD or on ratings of conduct problems or parenting. The clinical sample was similar to the national cohort of young children with ADHD. Evidence-based parent training has value as an intervention for preschool ADHD in routine clinical settings. As in previous trials, effects were restricted to parent-reported outcomes. Surprisingly, there were no effects on child conduct problems. A Controlled Study of Parent Training in the Treatment of ADHD in Young Children (D'SNAPP). http://clinicaltrial.gov/;NCT01684644.

Persistence and Adherence to Psychostimulants, and Psychological Well-Being Up to 3 Years After Specialized Treatment of Adult Attention-Deficit/Hyperactivity Disorder: A Naturalistic Follow-Up Study.

Little is known about the long-term persistence and adherence of psychostimulant use in adults with attention-deficit/hyperactivity disorder (ADHD) and its relationship to their psychological well-being. The persistence and adherence to psychostimulants and psychological well-being were examined in adults with ADHD in a naturalistic follow-up, starting directly after discharge from their specialized treatment of ADHD at an outpatient ADHD clinic. Ninety-six patients were included at the time of discharge, who were interviewed by telephone at 6 months, 1 year, and 3 years after discharge. At the time of discharge, 78% used a psychostimulant prescribed by a psychiatrist. Of those on psychostimulants at the time of discharge, approximately half still used any of these psychostimulants 3 years after discharge. However, adherence rates were good for those who persisted to use psychostimulants. The female sex and middle educational level (relative to a higher educational level) were near-significantly related to nonpersistence, and having a higher educational level and the combined ADHD subtype were related to nonadherence. In turn, nonadherence was related to worse general functioning, lower mood, and poorer sleep quality. The importance of adherence should be discussed at the time of discharge, especially with female ADHD patients, those with a higher educational level, and those with a combined ADHD subtype, because nonadherence is associated with poorer outcomes.