Dec 19, 2019 | Research Updates
NIMH Funded Web Portal That Helps Providers Implement the New ADHD Guideline
The mehealth portal is now available online at www.mehealth.com to pediatric providers, parents and educators working to improve quality of care for people with ADHD. Funded by a four-year, $2.8 million NIMH grant through the Cincinnati Children’s Hospital Medical Center, mehealth is free to users until 2021. Designed as a web-interface to deliver screening and treatment information, the newest updates to the portal incorporate the American Academy of Pediatrics’ (AAP) recently released and updated ADHD clinical practice guidelines, and are designed to help improve evidence-based care delivery in community settings.
In a 2016 trial, tested at 50 community-based pediatrics practices involving 199 physicians and 577 children with ADHD, use of mehealth resulted in improved ADHD medication treatment, and significant behavioral improvement over standard care. The expanded and improved mehealth system has been now allows parents and teachers to develop and implement behavioral treatments as an important piece of integrative care.
During this next year, the mehealth team will be working with an advisory committee improve the portal’s effectiveness, and to work on making the technology available at no cost beyond the 2021 deadline.
Epstein JN, Langberg JM, Lichtenstein PK, Kolb R, Altaye M, Simon JO. Use of an Internet portal to improve community-based pediatric ADHD care: a cluster randomized trial. Pediatrics. 2011;128(5):e1201-e1208.
Dec 18, 2019 | Conference Blog
Role of Neuropsychological Assessment in ADHD
Kevin Antshel, Ph.D.
Professor of Psychology
Director of Clinical Psychology doctoral program
ADHD Lifespan Treatment, Education and Research (ALTER) program
Syracuse University
The role of neuropsychology in the assessment of ADHD is a controversial topic and one that generates considerable discourse on both sides of the argument. On the one hand, psychological assessment is often required by standardized testing agencies and universities for ADHD test accommodation determinations under the Americans with Disabilities Act (ADA). On the other hand, some in the field, most notably Russell Barkley, believe that such testing is not useful for diagnosing ADHD.
While supporting the use of IQ and academic achievement measures, Barkley is opposed to the use of performance based tests of executive functioning (EF) in diagnostic evaluations and suggests that the incremental validity of such tests (e.g., continuous performance tests) is quite low, largely due to high false negative classification rates, inability to differentiate diagnoses among disorders and the ease with which such tests can be feigned. In its’ place, Barkley asserts that EF rating scales are more useful, ecologically valid and cost-effective and should be used instead of EF tests. ADHD diagnostic practice parameters from several associations seem to agree with Barkley and either consider neuropsychological tests optional (American Academy of Child and Adolescent Psychiatry) or make no comment on their use (American Academy of Pediatrics).
Others1 believe that EF tests can make contributions to a comprehensive ADHD assessment. For example, neuropsychological tests could provide information about potential treatment targets (e.g., working memory predicts to reading and math attainment) and treatment approaches (e.g., poor EF response inhibition task performance predicts to better methylphenidate response). Factor scores or poor performance on a certain number of EF tasks seems to be a better predictor than single EF tasks. Others believe that performance-based tests and EF rating scales are both important to include as they provide different types of complementary information (EF tests: efficiency of cognitive abilities; EF rating scales: success in goal pursuit) and are weakly correlated (r=.19)2. Anecdotally, I have heard clinicians report that neuropsychological testing can be helpful to specify the ADHD phenotype, decipher some differential diagnoses, guide families and provide valuable information for interventions.
These diverging opinions leave the practicing clinician in a quandary. Given the clear public health, policy and educational implications of this conversation, my colleagues Russell Barkley, Mark Mahone and Russell Schachar and I will be discussing this issue at the APSARD conference. Please join us for continued conversation on this topic at our Lunch Session and Discussion Group on Sunday, January 19th from 12:30 – 2:30 PM. We hope to provide a thoughtful, balanced discussion of this important topic and welcome the input of others who have an interest in the role of neuropsychology in the assessment of ADHD!
1 Molitor, S.J., & Langberg, J.M. (2017). Using task performance to inform treatment planning for
youth with ADHD: A systematic review. Clinical Psychology Review, 58, 157-173.
2 Toplak, M. E., West, R. F., & Stanovich, K. E. (2013). Practitioner review: Do performance-
based measures and ratings of executive function assess the same construct? Journal of Child Psychology and Psychiatry, 54, 113–224.
Dec 17, 2019 | Conference Blog
The annual meeting of APSARD is an opportunity to bring experts together to share knowledge and build collaborative relationships for improving research and clinical practice. In the symposium, “The Changing Legal Climate of Marijuana use in its Impact for our Patients With ADHD”, Dr. Weerts, Dr. Hill, Dr. Riggs, and Dr. Wang will discuss new developments and key concepts in the changing landscape of marijuana use and misuse among people with ADHD.
Clinician Takeaways:
Clinicians will deepen awareness of approaches to assessing and treating adolescents and adults with psychiatric disorders in context of cannabis use and cannabis use disorders. They will develop their understanding of the changing legal landscape of marijuana in the United States and the impact this might have for public health
Researcher Takeaways:
Researchers will review the pharmacologic properties of marijuana and its key constituents.
The Talks:
As more states legalize marijuana for both medical and recreational use, there is an increased need for clinicians to understand the current legislative changes surrounding marijuana, the pharmacology of marijuana, and how the legislative changes and variations in marijuana’s constituents and potency may impact their patients’ psychiatric and medical conditions.
Dr. Weerts will discuss the pharmacology of cannabis and key constituents, Δ9-tetrahydrocannabinol (THC) and cannabidiol, with updates on the regulatory status of these compounds at the federal and state levels.
Dr. Hill will describe medical and psychiatric use of cannabis and cannabis compounds, and the state of the evidence base for medical use.
Dr. Wang will present an international perspective and, using highlights from the Canadian Cannabis Policy, discuss lessons that may be applicable to American providers, practitioners, and policy makers.
Dr. Riggs will present data regarding the use rates among adolescents and college-aged young adults in conjunction with the rapid expansion of marijuana legalization. In context of data describing increased risk for psychosis and other negative impacts among youth using these products, Dr. Riggs will address approaches to treatment of these individuals with ADHD.
Dec 16, 2019 | Conference Blog
The annual meeting of APSARD is an opportunity to bring experts together to share knowledge and build collaborative relationships for improving research and clinical practice. In the symposium, “Sleep Challenges in Adhd”, Dr. Stein, Dr. Sciberras, Dr. Weiss, Dr. Becker, and Dr. Surman will discuss sleep research, and clinical perspectives with potential algorithms for addressing sleep problems in patients with ADHD, using a lifespan perspective.
Clinician Takeaways:
Clinicians will develop skills in assessing sleep problems associated with ADHD and its treatment throughout the lifespan. They will develop a better understanding of behavioral and pharmacological interventions and their relationship to sleep.
Researcher Takeaways:
Researchers will develop their knowledge and understanding regarding the importance of assessing sleep in clinical trials, and practical understanding of the issues involved in capturing sleep as an outcome or adverse event.
The Talks:
Dr. Stein will provide highlight methodological issues in studying sleep and ADHD, including discussions of subjective and objective measures, patient selection, and study design
Dr. Sciberras will discuss behavioral sleep interventions for children with ADHD, as a first line treatment.
Dr. Weiss will present findings from studies of sleep as an adverse event, versus sleep as an outcome. She will address factors related to the heterogeneity of sleep effects found in ADHD studies.
Dr. Becker will discuss his research regarding sleep problems in adolescents with ADHD.
Dr. Surman will present a clinical trial with adults, and discuss the relevance and importance of assessing sleep problems at baseline during clinical trials.
Dec 13, 2019 | Conference Blog
The annual meeting of APSARD is an opportunity to bring experts together to share knowledge and build collaborative relationships for improving research and clinical practice. In the symposium, “Adhd and Autism: New Insights on Their Relationship”, Dr. Steven Pliszka will lead discussants Dr. Rommelse, Dr. Yerys, Dr. Harden in a review of recent work regarding complex relationships between the disorders.
Clinician Takeaways:
Clinicians will discuss recent advances in the psychopharmacology of autism spectrum disorder (ASD), particularly regarding the treatment of inattention and impulsivity in those with ASD.
Researcher Takeaways:
Researchers will review the results of neuroimaging studies relevant to the comorbidity of ADHD and ASD.
The Talks:
Dr. Rommelse will present longitudinal studies mapping both symptom domains during various parts of the lifespan. She will propose that co-occurrence need not originate from shared etiological factors at onset, but also from factors that determine the course of both disorders.
Dr. Yerys will review the neural mechanisms underlying executive function impairments in ADHD and ASD with magnetic resonance imaging (MRI), focusing on the role of the frontoparietal and salience brain systems. She will discuss convergence with innovative treatments targeting and remediating the executive function system.
Dr. Harden will review treatments for core features of ASD, and for associated behavioral disorders, including ADHD. The role of novel pharmacological interventions including oxytocin, arginine vasopressin, N-Acetylcysteine, pregnenolone, and memantine will be discussed. Clinical trials data will be presented, including recent findings involving old and new compounds.
