Treatment Of ADHD Research Articles

Microdosing psychedelics in the treatment of ADHD and comorbid disorders

AbstractMicrodosing psychedelics has garnered considerable attention within both nonprofessional circles and the scientific community in recent years. This method involves taking small, non-hallucinogenic doses of substances like LSD or psilocybin over weeks or months, purportedly to enhance specific behaviors, emotions, or address psychiatric conditions.Exploring these assertions is crucial given the potential therapeutic value of microdosing, especially in conditions that respond positively to full psychedelic doses, such as depression. The full psychedelic experience might not always be suitable due to various factors like age, capacity to consent or comprehend the experience (e.g., dementia), or individual personality traits that might hinder surrendering to the experience. Microdosing could potentially serve as a maintenance therapy post-full dose administration, aiding specific psychological or biological processes during therapy or therapeutic exercises.Recent studies in healthy individuals highlight that small psychedelic doses have nuanced effects on pain perception, mood, neuroplasticity, sleep duration, brain connectivity, and default mode network synchronicity. However, some parameters show null effects after both single and repeated administration. Our survey research uncovered that individuals with ADHD reported symptom relief through microdosing, deeming it more effective than their conventional treatments. Subsequently, we conducted a naturalistic study following individuals with ADHD across a 4-week microdosing period. Our findings indicated a reduction in symptoms over time, an increase in trait mindfulness, and a decrease in neuroticism compared to baseline. While these results are intriguing, they necessitate validation in a clinical trial. We have recently concluded such a trial and are currently analyzing the data to further explore these effects.Disclosure of InterestK. Kuypers Grant / Research support from: The author is a principal investigator on a research project that is sponsored by Mindmed, a company that is developing psychedelic medicines.

Attention-deficit/hyperactivity symptoms and personal strengths in adults

IntroductionAttention-deficit/hyperactivity disorder (ADHD) is one of the most prevalent chronic neuropsychiatric disorders in children and adolescents; however, it continues into adulthood in 4-77% of the cases. Due to executive dysfunction, adults with ADHD may have deficits in personal strengths, as well as difficulties utilizing existing strengths in challenging situations, which may add to the functional impairments associated with ADHD in adults.ObjectivesTherefore, we aimed to explore the association between personal strengths and ADHD symptoms in a community sample of adults.MethodsFive hundred and twenty-eight adults (mean age = 21.41 years, SD = 2.29, range: 18 ̶ 28, female: N = 488, 92.4%) filled out an online questionnaire after giving their informed consent. Personal strengths were assessed using Bernstein’s Strengths Scale (BSS) which measures sixteen positive attributes grouped into four higher-order factors: self-directedness (Identity, Self-reflection, Self-confidence, Self-assertion, Imagination/Creativity), self-regulation (Emotional balance, Resilience, Self-control, Self-care, Reality testing), connection (Empathy, Compassion, Humour, Responsibility), and transcendence (Gratitude and Wisdom). ADHD symptoms were measured by the screening version (Part A) of the Adult ADHD Self-Report Scale (ASRS).ResultsParticipants who were screened positive in ASRS (N = 247, 46.7%) scored lower in all but four BSS subscales than participants who were screened negative (N = 280, 53.3%). Effect sizes reached the medium level (Cohen’s d > .5) for Self-confidence, Self-care, Responsibility and Wisdom, and were small (Cohen’s d > .2) for Identity, Self-assertion, Imagination, Resilience, Reality-testing, Emotional balance, and Gratitude. However, no group differences were found in the Self-reflection, Empathy, Compassion, and Humour subscales of the BSS.ConclusionsOur results suggest that ADHD symptoms in adults may be associated with deficits in personal strengths; that is, adults with ADHD may have difficulties, especially in trusting in their abilities, qualities, and judgements, in taking care of their own emotional and physical well-being, in taking responsibilities and in being open to learning from their experiences. Addressing personal strengths in psychosocial interventions for adult ADHD may improve patients’ functioning.This research has been supported by the National Research, Development, and Innovation Office, OTKA-PD-134849 and ÚNKP-22-2-I-ELTE-854 grants.Disclosure of InterestNone Declared

Music and movement therapy improves quality of life and attention and associated electroencephalogram changes in patients with attention-deficit/hyperactivity disorder

BackgroundAttention-deficit/hyperactivity disorder (ADHD) is the most common neurobehavioral disorder. Treatments for ADHD include pharmacological and nonpharmacological therapy. However, pharmacological treatments have side effects such as poor appetite, sleep disturbance, and headache. Moreover, nonpharmacological treatments are not effective in ameliorating core symptoms and are time-consuming. Hence, developing an alternative and effective treatment without (or with fewer) side effects is crucial. Music therapy has long been used to treat numerous neurological diseases. Although listening to music is beneficial for mood and cognitive functions in patients with ADHD, research on the effects of music and movement therapy in children with ADHD is lacking. MethodsThe present study investigated the effects of an 8-week music and movement intervention in 13 children with ADHD. The Pediatric Quality of Life Inventory (PedsQL) was used to evaluate changes in participants' quality of life. Conners’ Kiddie Continuous Performance Test (K-CPT 2) and the Swanson, Nolan, and Pelham rating scale (SNAP-IV) were used to assess core symptoms. Electroencephalogram (EEG) recordings were analyzed to determine neurophysiological changes. ResultsThe results revealed that the participants' quality of life increased significantly after the 8-week intervention. Furthermore, the participants' hit reaction times in the block 1 and block 2 tests of K-CPT 2 decreased significantly after the intervention. EEG analysis demonstrated an increase in alpha power and Higuchi's fractal dimension and a decrease in delta power in certain EEG channels. ConclusionOur music and movement intervention is a potential alternative and effective tool for ADHD treatment and it can significantly improve patients’ quality of life and attention.

Neurofeedback treatment for Attention Deficit Hyperactivity Disorder in adults

IntroductionAttention-deficit/hyperactivity disorder (ADHD) is one of the most prevalent neurodevelopment disorders in the world. Clinical guidelines for ADHD recommend multimodal treatment approaches, with current evidence suggesting that medication, including methylphenidate and various amphetamine formulations, in conjunction with psychosocial treatment are most effective in the short-term and long term. Over the last decade, an increasing number of studies investigating non-pharmacological treatments have been published, such as cognitive therapy, Neurofeedback (NF), Transcranial direct current stimulation with the aim of treating ADHD patients.ObjectivesWe comprehensively reviewed literature searching for studies on the effectiveness and specificity of NF for the treatment of ADHD. The aim of this review is to understand if there is scientific evidence in using of electroencephalogram (EEG)-Neurofeedback for treating patients with ADHD.Methods We did a non systemathic review using pubmed and google schoolar databases in order to analyze the influence and effects of therapy in patients diagnosed with ADHD and under treatment based on EEG Neurofeedback. We analyzed 18 systhematic reviews and metha-analysis and 2 case control studies.Results Accourding to the systhematic reviews results showed positive and significant effects in the visual memory, attention and visual recognition (spatial working memory). EEG also showed improvement in upper alpha activity in a resting state (open-eyed) measured from the occipital area, which similarly indicated improvement in the cognitive domain (attention). Compared to non-active control treatments, NF appears to have more durable treatment effects, for at least 6 months following treatment.Conclusions In conclusion, it is possible to affirm that a neuromodulating effect of the therapy positively influences cognitive processes, mood, and anxiety levels in patients with ADHD and is associated with significant long-term reduction in symptoms. Though limitations exist regarding conclusions about the specific effects of NF, the review documents improvements in school, social, and family environments. However, future efforts should focus on implementing standard neurofeedback protocols, ensuring learning, and optimizing clinically relevant transfer and more studies are needed for a properly powered comparison of follow-up effects between NF and active treatments and to further control for non-specific effects.Disclosure of InterestNone Declared

ADHD treatment for young children — and older children

Parents may be confused when they first get the news that their child has a problem, especially one that requires medication. On the one hand, they may — and should — be relieved to know that there is a cure for their child's suffering. On the other hand, it is never good news to find out something is “wrong” with your child.

Cognizance and perception of physiotherapy intervention in attention-deficit/hyperactivity disorder amongst clinical physiotherapy students in tertiary institution, Nigeria

BackgroundThis study examines the cognizance and perception of physiotherapy intervention in ADHD amongst clinical physiotherapy students in a tertiary institution and, also, determines the relationship of the study variables on the socio-demographic characteristics.MethodsThis study is a cross-sectional survey and employed a convenient sampling technique to recruit 137 respondents. A cognizance and perception questionnaire was used as the survey instrument to obtain data. Descriptive statistics of frequency, mean, and standard deviation were used to analyse the socio-demographic characteristics. Spearman rank correlation was used to analyse the relationship amongst the variables of cognizance of attention-deficit/hyperactivity disorder (COG-ADHD), perception of attention-deficit/hyperactivity disorder (PERCEP-ADHD), cognizance of physiotherapy intervention (COG-PT_ITV), and perception of physiotherapy intervention (PERCEP-PT_ITV). The Mann-Whitney U test was used to test the influence of socio-demographic characteristics of age and the level of study on the cognizance and perception of ADHD. Variables having a p-value < 0.05 were considered statistically significant.ResultThe majority of the respondents (63.5%) had high cognizance of physiotherapy intervention for ADHD, while the majority of the respondents (60.6%) had a fair perception of physiotherapy intervention for ADHD. A significant proportion of respondents (26.3%) had no source of information on ADHD before the study. Cognizance of ADHD significantly correlated with perception of ADHD, ADHD, perception of physiotherapy intervention in ADHD, and cognizance of physiotherapy intervention in ADHD. There were significant positive correlations between gender and cognizance of physiotherapy intervention in ADHD and between the level of study and perception of ADHD.ConclusionRespondent’s perception of physiotherapy intervention in ADHD was relatively low; in contrast, their cognizance was relatively satisfactory. Strengthening their cognizance and perception is paramount.

Sleep Habits and Behavioral Problems in Preschool-aged Children with ADHD

Objective: This study aimed to investigate the relationship between sleep habits and behavioral problems in preschool-aged children with ADHD. Materials and Methods: A cross-sectional study was conducted in a child developmental clinic at Siriraj Hospital between October and December 2023. Parents of children aged 4-6 years with ADHD completed the Children’s Sleep Habits Questionnaire (CSHQ) and the Strengths and Difficulties Questionnaire (SDQ). Descriptive analysis, Pearson correlation, and multivariate linear regression analysis were used to examine the association between sleep habits and behavioral problems. Results: This study recruited 80 preschoolers with ADHD and 75% were boys. The mean total CSHQ score was 43.76 ± 7.38 and 40% of the participants had sleep problems. 31.3 % had clinically significant behavioral problems. The most common behavioral problems were hyperactivity (33.8%), emotional problems (16.3%), and conduct behavior (10%). More sleep disturbances were highly correlated with all behavioral problems in SDQ, with a Pearson correlation between 0.78 and 0.90. After multivariate regression analysis, the total CSHQ score remained the strongest predictor of all domains of behavioral problems in preschool-aged children with ADHD (p &lt; 0.05). Conclusion: More than 1/3 of preschool children with ADHD were affected by sleep disturbances. Furthermore, sleep problems in these children can contribute to significant behavioral problems. Therefore, the treatment of ADHD in preschoolers should always include the management of sleep disturbances.

Are mindfulness-based interventions effective in the treatment of adult ADHD?

Are mindfulness-based interventions effective in the treatment of adult ADHD?

Development of a psychological health promotion intervention for ultra-orthodox Jewish mothers of children with ADHD using the intervention mapping protocol

BackgroundAttention Deficit Hyperactivity Disorder (ADHD) is a common neuro-developmental health condition in children and adolescents, in which its associated behavior manifestations are known to negatively affect members of the family unit, especially mothers. Ultra-orthodox Jewish (UOJ) community is growing globally and mothers of children with ADHD in this community are potentially at risk for negative health outcomes. As the UOJ community is culturally conservative, maintaining a distinct separation from outside influences, they often avoid utilizing public mental health services due to stigma and a lack of culturally sensitive treatments. Thus, this study aimed to develop a theory-driven and culturally appropriate psychological health promotion intervention for these mothers using the Intervention Mapping protocol.MethodsA mixed-method design was used. Qualitative content analysis was performed on four focus groups (n=25). Additionally, descriptive statistics including the content validity index was used to measure feedback regarding the developed intervention protocol’s relevance, effectiveness, and appropriateness Theoretical models for behavior change, including the Behavior Change Wheel’s COM-B system and the Theoretical Domains Framework, and literature on ADHD in the general population and the ultra-orthodox community were integrated in the process. Intervention components were systematically derived from findings.ResultsKey determinants of health behavior change were identified, resulting in formulating intervention objectives addressing stigma reduction surrounding ADHD, increasing knowledge about the ADHD condition and treatment, awareness of the school systems’ capabilities in meeting the ADHD child’s needs, enhancing mothers’ advocacy skills, and maternal self-care. Intervention? strategies included a group setting, providing information on health consequences, social support, re-attribution, active learning, goal setting, and promoting an identity associated with the desired behavior change. Mothers’ quantitative feedback confirmed the overall relevance, effectiveness, and appropriateness of the interventions’ content (CVIavg= .86, .85, .87).ConclusionsIntervention Mapping facilitated the development of a culturally sensitive psychological health promotion intervention for ultra-orthodox Jewish mothers of children with ADHD. Further research is warranted to assess intervention feasibility and effectiveness.

Measuring attention of ADHD patients by means of a computer game featuring biometrical data gathering

ADHD is a neurodevelopmental disorder diagnosed mainly in children, marked by inattention and hyperactivity-impulsivity. The symptoms are highly variable, such as different ages of onset and potential comorbidities, contributing to frequent misdiagnoses. Professionals note a gap in modern diagnostic tools, making accurate identification challenging. To address this, recent studies recommend gamification for better ADHD diagnosis and treatment, though further research is essential to confirm its efficacy. This work aims to create a serious game, namely “Attention Slackline", to assess attention levels. The game, designed with expert input, requires players to concentrate on a specific point to recognize specific patterns while managing distractions. A controlled experiment tested its precision, and results were compared with established attention tests by a correlation analysis. Statistical analysis confirmed the game's validity, especially in tracking attention through correct responses and errors. Preliminary evidence suggests that “Attention Slackline" may serve as a credible instrument for the assessment of attentional capacities in individuals with ADHD, given that its outcomes have been empirically shown to correlate with those derived from a well-established attention assessment methodology.

Attention-deficit/hyperactivity disorder.

Attention-deficit/hyperactivity disorder (ADHD;also known as hyperkinetic disorder) is a common neurodevelopmental condition that affects children and adults worldwide. ADHD has a predominantly genetic aetiology that involves common and rare genetic variants. Some environmental correlates of the disorder have been discovered but causation has been difficult to establish. The heterogeneity of the condition is evident in the diverse presentation of symptoms and levels of impairment, the numerous co-occurring mental and physical conditions, the various domains of neurocognitive impairment, and extensive minor structural and functional brain differences. The diagnosis of ADHD is reliable and valid when evaluated with standard diagnostic criteria. Curative treatments for ADHD do not exist but evidence-based treatments substantially reduce symptoms and/or functional impairment. Medications are effective for core symptoms and are usually well tolerated. Some non-pharmacological treatments are valuable, especially for improving adaptive functioning. Clinical and neurobiological research is ongoing and could lead to the creation of personalized diagnostic and therapeutic approaches for this disorder.

Probiotics as a Promising Therapy in Improvement of Symptoms in Children With ADHD: A Systematic Review

Background: ADHD is widely recognized as the most prevalent neurodevelopmental disorder in children. Recently, the potential role of gut microbiota as an etiological factor in ADHD has gained attention. This systematic review aims to investigate the potential impact of probiotic supplements on alleviating ADHD symptoms and influencing behavior. Methods: PubMed, Web of Science, Cochrane Library, and SCOPUS were searched from inception to May 2023. Only randomized controlled trials that have suitable data of the effects of probiotics/synbiotics on children with ADHD were enrolled. The risk of bias of the included studies was assessed by Cochrane Collaboration risk of bias tool. Results: Five related randomized controlled trial were evaluated in the current review. Types of interventions ranged from single/multi strain probiotics to synbiotic. The duration of intervention in all of the studies were 2 to 3 months. The assessed outcomes were very diverse and different tools were used to report the symptoms in children. Among those which used Conners’ Parent Rating Scale, a decrease in the total score occurred in the probiotic group, compared to the placebo group. An improvement in both intervention and control groups was seen in one study which used ADHD-Rating Scale. Conclusion: In summary, the combined findings from the reviewed studies suggest that probiotic supplements might potentially serve as a complementary intervention for ADHD. However, given the small number of studies, limited sample sizes, and the diversity of probiotic strains, further research is needed to clarify the effects of probiotics in children with ADHD. The observed tolerability of probiotics is noteworthy as none of the studies report adverse effects.

Viloxazine: A New Non-Stimulant Treatment for Attention-Deficit/Hyperactivity Disorder (ADHD)

&#x0D; IntroductionViloxazine is an antidepressant medication classified as an SNRI (serotonin and norepinephrine reuptake inhibitor). In April 2021, it received FDA approval in the United States for the treatment of ADHD in children aged 6 to 17. Subsequently, in May 2022, it was also approved for the treatment of adults with ADHD [1]. Viloxazine, available in extended-release capsules, represents novel non-stimulant medication option for patients with ADHD.Aim of the studyOur aim was to review the viloxazine in the fields of ADHD treatment, summarize current knowledge and analyze the first treatment results.&#x0D; &#x0D; &#x0D; Methods and materialsA review of the literature available in the PubMed database was performed, using the key words: „Viloxazine" ; „ADHD treatment" ; „ADHD”, „attention deficit hyperactivity disorder”, „attention deficit hyperactivity disorder treatment”; „ADHD non-stimulant treatment”; „ADHD non-stimulant”; „ADHD non-stimulant drugs”, „SPN-812”&#x0D; &#x0D; &#x0D; ConclusionViloxazine presents a promising non-stimulant alternative for ADHD treatment with more favorable pharmacokinetics, new way of possible administration and fewer adverse effects, particularly within the cardiovascular system, than other available ADHD medication options. While these findings are encouraging, continual research is imperative to establish the long-term safety profile.&#x0D;

An Open Trial of a Brief Engagement Program for Caregivers of Children with ADHD

ABSTRACT This open trial evaluated the feasibility, acceptability, and preliminary efficacy of Bootcamp for ADHD (BC-ADHD), a novel, four-session, group intervention designed to prepare caregivers as informed consumers to engage in multimodal evidence-based treatments (EBTs) for ADHD. Participants were 59 primary caregivers (85% biologic mothers) of children recently diagnosed with ADHD within a co-located, subspecialty pediatric clinic (ages 5–11; 73% male). Results indicated BC-ADHD was feasible to deliver, as evidenced by high levels of program usability (i.e. content and process fidelity), and caregiver behavioral engagement (M attendance = 88%; M homework adherence = 2.95 homework, SD = 1.15, 0–4 range). Families were also very satisfied (M = 6.06, 1–7 range). At post-treatment, BC-ADHD resulted in increases in caregiver empowerment and acceptability of behavioral treatment and reductions in concerns about both behavioral (adverse effects and feasibility) and medication (adverse effects) treatments (absolute Cohen’s d = 0.27 to 0.35). At 6-month follow-up, effects were sustained for increases in caregiver empowerment and for reductions in concerns about both behavioral and medication treatments (absolute ds = 0.36 to 0.40). Sleeper effects were observed for increased medication acceptability and decreased affiliate stigma (absolute ds = 0.26 to 0.29). Child impairment was also reduced at follow-up (d = -0.58). The percentage of caregivers who initiated behavior therapy (Kendall’s w = 0.63) or medication (Kendall’s w = 0.15) increased from baseline to 6-month follow-up. These findings provide initial support for BC-ADHD as a promising engagement program to foster positive caregiver attitudes and initiation of EBTs.

Development of a novel rodent rapid serial visual presentation task reveals dissociable effects of stimulant versus nonstimulant treatments on attentional processes

The rapid serial visual presentation (RSVP) task and continuous performance tasks (CPT) are used to assess attentional impairments in patients with psychiatric and neurological conditions. This study developed a novel touchscreen task for rats based on the structure of a human RSVP task and used pharmacological manipulations to investigate their effects on different performance measures. Normal animals were trained to respond to a target image and withhold responding to distractor images presented within a continuous sequence. In a second version of the task, a false-alarm image was included, so performance could be assessed relative to two types of nontarget distractors. The effects of acute administration of stimulant and nonstimulant treatments for ADHD (amphetamine and atomoxetine) were tested in both tasks. Methylphenidate, ketamine, and nicotine were tested in the first task only. Amphetamine made animals more impulsive and decreased overall accuracy but increased accuracy when the target was presented early in the image sequence. Atomoxetine improved accuracy overall with a specific reduction in false-alarm responses and a shift in the attentional curve reflecting improved accuracy for targets later in the image sequence. However, atomoxetine also slowed responding and increased omissions. Ketamine, nicotine, and methylphenidate had no specific effects at the doses tested. These results suggest that stimulant versus nonstimulant treatments have different effects on attention and impulsive behaviour in this rat version of an RSVP task. These results also suggest that RSVP-like tasks have the potential to be used to study attention in rodents.

Drivers and Barriers to Tolerable and Effective Treatment for ADHD: The Importance of Treatment Perseverance and Duration of Effect

Objective: To examine treatment outcomes for classes of ADHD drugs in conjunction with physicians’ prescribing rationales and the utility of treatment perseverance in treatment effectiveness. Methods: A retrospective non-interventional study using physician-provided chart data for treated adolescent and adult ADHD patients in the United States (April–June 2019). Multivariable analyses compared the effectiveness and tolerability of drug classes. Results: Among the 1,232 ADHD patients included in this study, 37.7% experienced one, 11.8% two, and 6.7% three treatment changes post their first prescribed regimen. These changes were mostly attributed to lack of rapid onset and duration of effect. Achieving best response correlated with the number of previous treatments for adolescents, but not adults. Maintaining full response correlated with the length of current treatment for adolescents and adults. Conclusion: Physicians’ prescribing rationales targeted duration of effect and tolerability. ER monotherapy demonstrated potential advantages over other regimens. Treatment perseverance is integral to effective ADHD management.

Changes in Cortisol and in Oxidative/Nitrosative Stress Indicators after ADHD Treatment.

Although ADHD is one of the most prevalent diseases during childhood, we still do not know its precise origin; oxidative/nitrosative stress and the hypothalamic-pituitary-adrenal axis are suggested contributors. Methylphenidate, among others, is the main drug used in ADHD patients, but its effects on relevant markers and structures remain unclear. This study, involving 59 patients diagnosed with ADHD according to DSM-5 criteria, aimed to assess changes in cortisol levels (using cortisol awakening response, CAR) and oxidative/nitrosative status with the treatment. Blood samples before and 3 months after treatment with methylphenidate were used to measure oxidative and inflammatory markers, as well as the endogenous antioxidant activity, while saliva samples tracked cortisol awakening response (CAR). The results showed a treatment-related improvement in the redox profile, with the reduction in advanced oxidation protein products (AOPP), lipid peroxidation (LPO), and nitrite plus nitrate (NOx) levels, and the increase in the enzymatic activities of glutathione reductase (GRd) and catalase (CAT). Moreover, the area under the curve (AUC) of CAR increased significantly, indicating increased reactivity of the HPA axis. These results support, for the first time, the involvement of the endogenous antioxidant system in the pathophysiology of ADHD.

Remote treatment of developmental dyslexia: how ADHD comorbidity, clinical history and treatment repetition may affect its efficacy.

Tachidino is a web-based platform for remote treatment of reading and spelling disorders. The purpose of the present study was to investigate the possible impact of different clinical conditions on the efficacy of treatment. The focus was on possible ADHD comorbidity-related effects on the outcomes of the Tachidino treatment, and the impact of previous treatments, such as speech and language therapy or the repetition of the same Tachidino program. 136 children with developmental dyslexia received four-weeks treatment via the Tachidino platform. Improvements in reading and writing scores were compared between different subgroups. No gross differences emerged in treatment effectiveness between groups of children. Children receiving treatment improved significantly more than untreated children. Treatment with Tachidino brought significant benefits for all children, irrespective of comorbidity, clinical history or treatment repetition. Comparison with an untreated control group (waiting list) made it possible to exclude that improvement was due to test-retest learning effects.

An Objective Assessment of Effect of Stimulants on Attention in Individuals With ADHD

Introduction: Currently, assessing ADHD treatment response to stimulants relies on rating scales and subjective questionnaires and sometimes a CPT. Such tools fall short of objective, quantifiable measurement of effect, especially in natural settings and can result in inconsistent treatment. Method: We report results from two studies using a novel proof-of-concept approach. A preliminary trial of 10 individuals used a high-fidelity eye tracker; a second study of 100 individuals used webcams at the participants’ homes. Results: Both studies evaluated stimulant effect using reading behavior analysis, being an ADHD symptom that stimulants affect and a major symptom patients want to improve. Both showed a significant change in reading behavior related to medication state, suggesting a clear, objective measure of stimulant effect. Conclusion: Using ubiquitous hardware, investigators created a user-friendly treatment assessment platform where individuals can collect their own objective data within minutes in any setting where they have access to a web camera and computer.

Protocol of a monocentric, double-blind, randomized, superiority, controlled trial evaluating the effect of in-prison OROS-methylphenidate vs. placebo treatment in detained people with attention-deficit hyperactivity disorder (BATIR)

BackgroundAttention-deficit hyperactivity disorder (ADHD) is characterized by difficulty paying attention, poor impulse control, and hyperactive behavior. It is associated with several adverse health and social outcomes and leads to an increased risk of criminality and recidivism. Worldwide, ADHD is thus highly prevalent in prisons. However, ADHD treatment has been neglected in such environments. Stimulant medications such as osmotic-release oral system methylphenidate (OROS-MPH) are first-line treatments in the general population, but they are under-prescribed in prisons due to concerns about abuse, even though such claims are not empirically supported. This project aims to compare the efficacy of a 3-month in-prison OROS-MPH vs. placebo treatment on the severity of core ADHD symptoms and relevant in- and post-prison outcomes.MethodsThis study is a phase III, double-blinded, randomized, superiority, controlled trial of OROS-MPH vs. placebo. After randomization, the participants will receive 3 months of treatment with OROS-MPH or placebo (1:1 ratio) while incarcerated. Upon release, all participants will be offered the treatment (OROS-MPH) for 1 year but will remain blinded to their initial study group. The study will be conducted at the Division of Prison Health, Geneva, Switzerland, among incarcerated men (n = 150). Measures will include (1) investigator-rated ADHD symptoms, (2) acute events collected by the medical and prison teams, (3) assessment of the risk of recidivism, (4) medication side effects, (5) medication adherence, (6) study retention, (7) health care/prison costs, and (8) 1-year recidivism. Analyses will include bivariable and multivariable modeling (e.g., regression models, mixed-effects models, survival analyses) and an economic evaluation (cost-benefit analysis).DiscussionWe expect that early identification and treatment of ADHD in prison will be an important public health opportunity and a cost-effective approach that is likely to reduce the vulnerability of incarcerated individuals and promote pathways out of criminal involvement. The study will also promote standards of care for people with ADHD in prison and provide recommendations for continuity of care after release.Trial registrationClinicalTrials.govNCT05842330. Registered on June 5, 2023.Kofam.ch SNCTP000005388. Registered on July 17, 2023.