Attention deficit hyperactivity disorder (ADHD) is underdiagnosed in the UK and the assessment and diagnosis pathway involves multiple healthcare professionals, often starting with a general ...practitioner (GP) referral to specialist services. GPs’ levels of knowledge and understanding about ADHD is often a significant barrier in patients accessing care. Better understanding of ADHD is needed.MethodA step wise, co-production approach towards developing an online ADHD education intervention for GPs was followed. Preparatory work highlighted the relevant topics to be included in the intervention and workshops were then conducted with GPs, leading to further refinement of the content and the final intervention. A pilot usability study (n= 10 GPs) was conducted to assess the intervention’s acceptability and feasibility, followed by a randomised controlled trial (n= 221 GPs) to assess its efficacy and impact on knowledge and practice.ResultsThe development of the online intervention was greatly facilitated by the involvement of GPs. Having a co-production development process ensured the consistent adaptation of the intervention to meet GPs’ needs. The usability study showed that the content of the intervention was suitable, easily accessible, engaging and delivered at an acceptable level of intensity, validating the development approach taken. The knowledge (P<.001) and confidence (P<.001) of the GPs increased after the intervention, whereas misconceptions decreased (P=.04); this was maintained at the 2-week follow-up. Interviews and surveys also confirmed a change in practice over timeConclusionThis project highlights the importance of co-development in developing educational program that addresses specific needs for GPs. Involving end-users in co-creating interventions enhances their clinical utility and impacts routine clinical practiceDisclosure of InterestNone Declared
Introduction
Attention Deficit Hyperactivity Disorder (ADHD) and Dyslexia are among the most frequent developmental disorders in school-aged students, and both often cause an impact on scholar ...reading performance. Therefore, it is fundamental to trace the differential profile in reading performance in such diagnoses. Competent reading occurs through the interaction of several cognitive processes, such as decoding, fluency, and oral and reading comprehension, that should be assessed in an evaluation.
Objectives
The study aimed to characterize the performance of students with ADHD and dyslexia.
Methods
We assessed 25 adolescents, aged between 11 and 14 years old, from 6th to 9th year of middle school of public and private schools in Brazil, divided into two groups: the group with ADHD (16 students) and the group with dyslexia (9 students). The diagnoses were established by a multidisciplinary center and there were no comorbidities for any case. The instruments used were: Comprehension Test of Words and Pseudowords II (TCLPP II) to assess decoding (indicate if the word is correct or incorrect); Reading Fluency Test (TFL) to assess fluency in single words and in text reading; Cloze Reading Comprehension Test (TCCL) to measure reading comprehension; and the WISC vocabulary subtest to assess auditory comprehension.
Results
Non-parametric analyzes revealed statistically significant differences in measures of textual comprehension, especially in the tasks that involved decoding and fluency processes, evidencing superior performance of the group with ADHD in these tests. Participants with dyslexia had a significantly higher performance in relation to the number of word omissions, that is, they had lower omission errors. There was no significant difference between groups in auditory comprehension.
Conclusions
A differential profile was found in reading performance, consistent with the cognitive deficits classically pointed out in the literature for each diagnosis: phonological deficits in dyslexia, with problems in decoding and fluency; and attentional deficits in ADHD, with omission errors. In the comprehension measures, dyslexic group had significant lower performance than ADHD in the Cloze Reading Comprehension Test, but there was no difference in the Vocabulary subtest-WISC. An explanatory hypothesis is that, to understand the text, it is necessary to recognize the words previously, whereas, in the WISC, it is not necessary to read, since the questions are oral. These results corroborate the hypothesis that deficits in reading comprehension in dyslexia are more related to difficulties in word recognition and fluency skills than in general listening comprehension.
Financial support: CAPES Proex grant 0426/2021, no. 23038.006837/2021-73; CNPq grant 310845/2021-1
Disclosure of Interest
None Declared
Introduction
Social isolation in childhood can be detrimental to physical and mental health. Children with neurodevelopmental disorders, such as attention deficit hyperactivity disorder (ADHD), may ...be particularly at risk for becoming socially isolated. Similarly, isolated children have limited opportunities to observe, model, and learn age-appropriate interpersonal interactions with other children which could increase ADHD behaviours.
Objectives
This study examined longitudinal associations between ADHD symptoms and social isolation across childhood. We tested the direction of this association across time, while accounting for pre-existing characteristics, and assessed whether this association varied by ADHD presentation, informant, sex, and socioeconomic status.
Methods
Participants included 2,232 children from the Environmental Risk (E-Risk) Longitudinal Twin Study. ADHD symptoms and social isolation were measured at ages 5, 7, 10, and 12. We used random-intercept cross-lagged panel models to assess the directionality of the association across childhood.
Results
Children with increased ADHD symptoms were consistently at increased risk of becoming socially isolated later in childhood, over and above stable characteristics (β=0.05-0.08). These longitudinal associations were not bidirectional; isolated children were not at risk of worsening ADHD symptoms later on. Children with a hyperactive ADHD presentation were more likely to become isolated, compared to an inattentive presentation. This was evident in the school setting, as observed by teachers, but not by mothers at home.
Conclusions
Our findings highlight the importance of enhancing peer social support and inclusion for children with ADHD, particularly in school settings. We add explanatory value over and above traditional longitudinal methods as our results represent how individual children change over time, relative to their own pre-existing characteristics.
Disclosure of Interest
None Declared
Introduction
Attention deficit/hyperactivity disorder (ADHD) is a prevalent and impairing neurodevelopmental disorder affecting 2-5% of children. These children are at risk of negative health, social ...and educational outcomes; ADHD incurs an estimated £670 million annual cost to health, education and social care in the UK. Children with ADHD often experience severe difficulties at school despite drug treatment: effective psychosocial interventions are needed. There is mixed evidence for the effectiveness of existing school-based interventions for ADHD, which are complex and resource-intensive, contradicting the preferences of teachers for short, flexible strategies that suit a range of ADHD-related classroom-based problems.
Objectives
To develop a prototype of a school-based intervention for ADHD.
Methods
Intervention Mapping, a framework for developing theory- and evidence-informed interventions with explicit consideration of implementation context, was used. Logic models were developed of the behaviour change steps required by each agent in the school system to improve outcomes for students with ADHD.
A comprehensive evidence synthesis was conducted for interventions that targeted the key outcomes of relevance (inattention, impulsivity, hyperactivity, peer and teacher relationships, self-esteem, executive functions and organisation skills); findings were integrated alongside behaviour change theory and theories of the underlying aetiology of ADHD, in order to develop a logic model for the intervention. Components of the intervention were then developed in line with the logic model using evidence-based behaviour change methods, with input from people with ADHD, school staff and other key stakeholders at every stage of the development process.
Results
The development process resulted in a prototype digital platform that can be utilised to deliver a personalised behavioural intervention for children with ADHD within primary schools. It contains some core components that all teachers and children will complete, and then is individualised based on the key problems each child is currently facing. There are six optional modules, each containing a range of behavioural strategies for teachers to implement with the student or the whole class. The toolkit includes a symptom tracking graph that teachers can use to visualise the progress a child is making, and is developed to align with the current resources and capacity of primary schools in the UK.
Conclusions
The prototype intervention is designed explicitly to fit with existing school structures and demands, and to be low cost in terms of delivery and training. It focusses on adapting the school environment to better suit children with high levels of ADHD symptoms. It is now being feasibility tested, and in this talk I will describe the development process using Intervention Mapping, and the initial feedback from the first testing of implementation of the prototype.
Disclosure of Interest
None Declared
Background:
Links between eating disorders (EDs) e.g., anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED) and the major neurodevelopmental disorders of autism spectrum ...disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) have been repeatedly highlighted. In both ASD and ADHD, these links range from an elevated risk for EDs to common symptomatic overlaps and etiological commonalities with EDs.
Methods:
We performed a systematic literature search (through July 2019) with Medline via Ovid for epidemiological data on EDs (AN, BN, and BED) in combination with both ASD and ADHD.
Results:
The reviewed studies showed that, on average, 4.7% of patients with certain ED diagnoses (AN, BN, or BED) received an ASD diagnosis. Reliable data on the prevalence of EDs in ASD samples are still scarce. Comorbid ASD is most commonly diagnosed in patients with AN. The prevalence of ADHD in EDs ranged between 1.6% and 18%. Comorbid ADHD was more often reported in the AN-binge eating/purging subtype and BN than in the AN restrictive subtype. The prevalence of EDs in ADHD ranged between no association and a lifetime prevalence of 21.8% of developing an ED in women with ADHD.
Conclusions:
Studies on the prevalence rates of EDs in ADHD and ASD and
vice versa
are heterogeneous, but they indicate frequent association. While there is growing evidence of clinical overlaps between the three disorders, it remains difficult to determine whether overlapping characteristics (e.g., social withdrawal) are due to common comorbidities (e.g., depression) or are instead primarily associated with EDs and neurodevelopmental disorders. Furthermore, prospective studies are required to better understand how these disorders are related and whether ADHD and ASD could be either specific or nonspecific predisposing factors for the development of EDs.
Stimulant medication and behaviour therapy are the most often applied and accepted treatments for Attention-Deficit/Hyperactivity-Disorder (ADHD). Here we explore where the non-pharmacological ...clinical intervention known as neurofeedback (NFB), fits on the continuum of empirically supported treatments, using standard protocols. In this quantitative review we utilized an updated and stricter version of the APA guidelines for rating ‘well-established’ treatments and focused on efficacy and effectiveness using effect-sizes (ES) and remission, with a focus on long-term effects. Efficacy and effectiveness are compared to medication and behaviour therapy using benchmark studies. Only recent systematic reviews and meta-analyses as well as multi-centre randomized controlled trials (RCT’s) will be included. Two meta-analyses confirmed significant efficacy of standard neurofeedback protocols for parent and teacher rated symptoms with a medium effect size, and sustained effects after 6–12 months. Four multicenter RCT’s demonstrated significant superiority to semi-active control groups, with medium-large effect sizes end of treatment or follow-up and remission rates of 32–47%. Effectiveness in open-label studies was confirmed, no signs of publication bias were found and no significant neurofeedback-specific side effects have been reported. Standard neurofeedback protocols in the treatment of ADHD can be concluded to be a well-established treatment with medium to large effect sizes and 32–47% remission rates and sustained effects as assessed after 6–12 months.
Symptoms of inattention, hyperactivity, and impulsivity are core features of attention-deficit/hyperactivity disorder (ADHD). However, children with autism spectrum disorder (ASD) often present with ...similar symptoms and may receive a diagnosis of ADHD first. We investigated the relationship between the timing of ADHD diagnosis in children with ASD and the age at ASD diagnosis.
Data were drawn from the 2011-2012 National Survey of Children's Health, which asked parents to provide the age(s) at which their child received a diagnosis of ADHD and/or ASD. Using weighted prevalence estimates, we examined the association between a previous diagnosis of ADHD and the age at ASD diagnosis, while controlling for factors known to influence the timing of ASD diagnosis.
Our study consisted of 1496 children with a current diagnosis of ASD as reported by parents of children ages 2 to 17 years. Approximately 20% of these children had initially been diagnosed with ADHD. Children diagnosed with ADHD before ASD were diagnosed with ASD ∼3 years (95% confidence interval 2.3-3.5) after children in whom ADHD was diagnosed at the same time or after ASD. The children with ADHD diagnosed first were nearly 30 times more likely to receive their ASD diagnosis after age 6 (95% confidence interval 11.2-77.8). The delay in ASD diagnosis was consistent across childhood and independent of ASD severity.
To avoid potential delays in ASD diagnosis, clinicians should consider ASD in young children presenting with ADHD symptoms.
Abstract Introduction Although psychoeducational group interventions are increasingly used for adults diagnosed with attention-deficit/hyperactivity disorder (ADHD), a comprehensive review focused on ...the feasibility and acceptability indicators of these interventions remains lacking. Furthermore, although previous research has explored various aspects of psychoeducation for ADHD, such as its definition and approaches, limited research has focused on the synthesis for outcome measures and patients’ experiences related to these interventions. Therefore, this scoping review aims to map the existing evidence reported on psychoeducational group interventions for adults diagnosed with ADHD. The objective is to provide a comprehensive overview of feasibility indicators, acceptability, and outcome measures used in psychoeducational group interventions. Method A comprehensive structured literature search on the topic was performed in seven bibliographic databases, and the resulting records were independently screened, and their data extracted by two reviewers. We followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-S) to ensure the transparency and rigor of this scoping review. Results The searches yielded 7510 records. Eight studies met the inclusion criteria. These included studies were conducted in European countries and the United States. Among these, six studies used a randomized control design, one an open feasibility trial, and one a pre-post intervention design. All the studies reported some feasibility and acceptability indicators. While all the studies reported on the severity of symptoms of ADHD as an outcome measure, some also reported on outcomes related to psychological or mental-health problems, quality of life, changes in knowledge regarding ADHD, or the level of self-esteem, functioning, and impairment. Conclusion This scoping review revealed that psychoeducational group interventions are generally acceptable for patients in terms of patient satisfaction with the group intervention. All included studies reported some feasibility indicators, with some reporting good attendance and relatively low dropout rates. Most studies reported positive effects on ADHD and mental health symptoms, suggesting that these interventions are beneficial for adults with ADHD. However, several gaps exist regarding the reporting on the feasibility indicators, acceptability, and outcome measures employed across studies.
ADHD Medications Stolberg, Victor
2017, 2017-10-31, 2017-10-27
eBook
The treatment of attention deficit/hyperactivity disorder (ADHD) is a complex challenge. This book provides comprehensive, scientific coverage of the numerous different types of drugs that are used ...to treat ADHD, and it examines the historical, sociological, and policy-related factors involved in the use of ADHD medications. A national study indicated that 11 percent of U.S. children and teens were diagnosed with attention deficit/hyperactivity disorder (ADHD) in 2011—a figure 43 percent higher than in 2003. The incidence of ADHD diagnoses among females has also increased significantly. For the millions of Americans of all ages who are diagnosed with ADHD, the proper treatment of this disorder is critically important. ADHD Medications: History, Science, and Issues provides readers with the complete story of ADHD drugs. The book discusses the pharmacological basis of the effects of these powerful drugs; examines the myriad social dimensions of the use, misuse, and abuse of these substances; and identifies the range of issues that affect the recognition, diagnosis, and treatment of ADHD. After an introductory case study of an individual with ADHD and this individual's problems and successes with ADHD medicines, this new book in the Story of a Drug series provides an overview of ADHD and its various symptoms, as well as the causes, prevalence, and diagnosis of ADHD. Various treatment approaches—including information about the many medications used—are discussed in detail, as well as other substances and alternative ways used to treat individuals with ADHD. Readers will also gain an understanding of neurotransmission and the specific mechanism of action of ADHD medications; the effects and applications of these drugs, plus their associated risks, misuse, and abuse; as well as related policy issues, with special focus on the controversial issues regarding ADHD drug scheduling (categorization).
Rationale
Use of psychotropics is relatively prevalent amongst motor vehicle drivers because mobility is also important for persons suffering from psychiatric illness. However, medication side ...effects may increase the likelihood of being involved in traffic crashes.
Objectives
This study aimed to assess the association between the use of four types of medication (antipsychotics, benzodiazepines and z-hypnotics, antidepressants and stimulants of ADHD treatment) and the risk of traffic crashes, in general, and single crashes subsequently.
Method
We conducted a case–control study of data from 130,000 drivers involved in traffic crashes with personal injury and prescription data from all of Denmark during the period 1996–2018.
Results
For antipsychotics, we found odds ratios of 0.86 and 1.29 for traffic crashes and single crashes, respectively; for benzodiazepines and z-hypnotics, 1.29 and 2.49, respectively; for antidepressants, 1.30 and 2.25, respectively; and for stimulants of ADHD treatment, 1.62 and 1.95, respectively. All
p
values were below 0.001.
Conclusions
Based on our results on twofold increased risks of single crashes and moderately increased risks in persons with ADHD, it might seem tempting to ban psychotropic medication in traffic. Conversely, we accept increased risks of traffic crashes in young drivers and in the physically disabled with special aids and, to some extent, with exposure to alcohol. In the end, it is the authorities who must review the evidence and decide whether to prohibit (some types of) psychotropic medication in traffic. Finally, underlying disease and not the drug may increase the risk of being involved in a traffic crash.
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