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.
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, “Are Differences in Long-Acting Stimulant Formulations Clinically Meaningful?,” Dr. Andrew Babiskin, Dr. Thomas Spencer, Dr. Roberto Gomeni, and Dr. Ann Childress will discuss the newest findings regarding the bioequivalency and clinical implications of brand and generic formulations of extended release methylphenidate drugs, and FDA product-specific guidance on bioequivalent drug development.
Clinician Takeaways:
Clinicians will gain an improved understanding of the clinical implications of differing pharmacokinetic (PK) profiles in extended release methylphenidate (MPH ER) formulations used for ADHD.
Researcher Takeaways:
Researchers will gain familiarity with FDA requirements for Bioequivalence in extended release methylphenidate (MPH ER) formulations.
The Talks:
Dr. Andrew Babiskin, will review the FDA product-specific guidances (PSGs) on how to develop generic drug products that are therapeutically equivalent to specific reference listed drugs. Although rate of absorption (Cmax) and extent of absorption (AUC) are sufficient to establish bioequivalence (BE) for many extended release drugs, MPH ER requires additional partial exposure/AUC (pAUC) measures. This presentation will 1) discuss general principle of BE assessment, 2) present the current BE recommendations in the published PSGs for MPH ER drug products, and 3) delineate the rationales for pAUC recommendations for these products.
Thomas Spencer, MD, will present results of an FDA sponsored study to address BE in pharmacodynamic (PD) effects between MPH ER formulations intended to be similar in PK (OROS MPH (Concerta), and Mallinckrodt generic) compared to a MPH ER formulation with a different PK profile (Quillivant XR). Findings showed similar PD effects for the two compounds with similar PK profiles and intended duration (Concerta and Mallinckrodt generic), but less robust PD effects for the compound with differing PK (Quillivant) and statistically different effects from Concerta in later hours.
Roberto Gomeni, PhD, will present a model based approach maximizing the clinical benefit of MPH formulations. The clinical benefit of a treatment is defined as the ratio between clinical improvement and risk of tolerability and safety. A drug-disease model is described that accounts for pharmacokinetics, the placebo response, the exposure-response relationship, and the tolerability and safety issues. The optimization of the clinical benefit was achieved based on a convolution-based model. The results of the analysis identified an optimized dose and in-vitro/in-vivo release suitable to provide a sustained clinical response and an improved control of the safety and tolerability issues with respect to conventional formulations.
Ann Childress, MD, will discuss pharmacodynamics differences of MPH ER products and impact on patients from a clinician’s perspective. MPH ER formulations contain an immediate-release (IR) MPH component. The percentage of IR to ER MPH varies from approximately 20% to 50% in marketed MPH ER products. Comparative data from MPH studies were compiled along with a list of available generics from the FDA website. Incidental reports from patients were collected. Not all MPH products behave the same, and formulation may have a significant impact on patient outcomes. It is important to know which generics the patients are receiving and to careful assess onset, duration and magnitude of drug effects to determine which generic is best for an individual.
Mar 5, 2018 | Conference Blog
Luke Norman, Ph.D. Postdoctoral Research Fellow University of Michigan
I am very grateful for the opportunity to attend the APSARD conference, and have now become a committed APSARD member! A clear advantage of this conference over other psychiatry conferences is its focus on ADHD, although the broad scope of ideas presented from within the field of ADHD research was equally impressive. A theme underlying sessions at the conference was the extent to which ADHD is a ‘brain disorder’. In the first plenary session, talks by Professor Philip Asherson and Professor Trevor Robbins outlined theoretical models of how brain networks may be dysfunctional in ADHD. Professor Asherson suggested a plausible theory that ADHD may be a disorder of default mode and task positive brain network interplay, with alterations in the interactions of these brain networks underlying dysregulated mind wandering in the disorder, while Professor Robbins presented data suggesting that numerous potentially dissociable fronto-striatal brain networks underlying executive functions may be impacted in ADHD and improved by ADHD medications. However, while these data and theoretical models were plausible and stimulating, presented data from recent large consortium efforts in genetics and structural brain imaging were more humbling. GWAS work presented by Professor Anita Thapar further invalidated previous narratives resulting from candidate gene studies of ADHD, with the influence of each individual genomic hit in the presented work being very small and composite polygenic risk scores having quite a modest predictive power. In a presentation of the recent ENIGMA mega-analysis of gray matter abnormalities in ADHD, Professor Barbara Franke showed that previously reported deficits in striato-limbic gray matter were significant in the large mega-analytic sample, but differences between ADHD and control groups had small effect sizes and there was a substantial overlap between patients and controls and no significant differences at all between adult patients and controls. These findings indicate that biological mechanisms in ADHD may be more diffuse and subtle than anticipated by earlier theorizing, and suggest the need for further large-scale collaborative studies to investigate more sophisticated models of brain alterations in ADHD, which may also include the potential for heterogeneous neuropathophysiology in ADHD as well as greater considerations of neurodevelopment. At times, the questions and answers sessions were even more stimulating than the talks themselves and I enjoyed the discussions of these topics. I look forward to next year’s APSARD!
Feb 19, 2018 | Conference Blog
Natalie Miller, Ph.D. Post Doctoral Fellow University of Maryland – College Park
This was my first APSARD conference and I was not sure what to expect. I knew APSARD as a psychiatry conference and assumed many presentations would focus on medication management of ADHD symptoms. Although some symposia addressed medication issues, symposia topics covered the waterfront, from etiological models involving genetics and neuroscience to clinically-oriented sessions about assessment and treatment to big data epidemiological approaches. A resounding theme across many symposia was our struggle to understand how and why ADHD symptoms develop. The causal role of environmental factors in the pathogenesis of ADHD were considered in several symposia. During the Sunday morning plenary session, Drs. Edmund Sonuga-Barke and Anita Thapar addressed the shifting conceptualization of ADHD from a biologically-based disorder to a transactional disorder involving a complex interplay between genetic predisposition and environmental processes. Dr. Sonuga-Barke discussed results from the English and Romanian Adoptee Study, which demonstrated that severe environmental deprivation early in life can cause ADHD symptoms. Dr. Thapar outlined the complexities in parsing genetic from environmental risk given that shared genetic liability for ADHD may be driving maladaptive features of parenting as well as child symptoms. She discussed how longitudinal adoption design studies can isolate genetic from environmental risk and add specificity to how environmental processes contribute to ADHD symptoms (and how ADHD symptoms contribute to environmental processes). These talks, along with many others, highlighted how our conceptualization of ADHD is in flux. There are many unanswered etiological questions and future research is needed to better understand how environmental processes intersect with biological vulnerability. Although I left the conference feeling less certain about what I thought I knew, I also left feeling energized to keep up the search for the how and why of ADHD.
Jan 2, 2018 | Conference Blog
Jodi Sleeper-Triplett, B.A., MCC, BCC JST Coaching & Training
Elizabeth Ahmann, Sc.D., RN, PCC Maryland University of Integrative Health
Lisa Joy Tuttle, M.A., BCC, CSS University of Pennsylvania
Blog by Jodi Sleeper-Triplett, Elizabeth Ahmann, and Lisa Joy Tuttle
Professionals devoted to improving the lives of folks with ADHD know how our clients and patients struggle to carry out their desired objectives. Inconsistent attention and motivation and persistent challenges with organization and implementation perpetually frustrate their efforts to realize their meaningful aspirations.
Medication and cognitive-behavioral therapy adapted to address ADHD issues are highly effective treatment modalities; yet there are individuals who convey a need for additional scaffolding, and who may seek or be professionally advised to pursue such assistance outside of a medical or mental health context. Enter ADHD coaching, a non-clinical behavioral modality that is increasingly recognized in the clinical literature as a potentially valuable and important component of multimodal treatment (e.g., Barkley, 2015; Kooij et al., 2010; Prevatt & Levrini, 2015; Ramsay, 2010).
In the first APSARD symposium dedicated to ADHD coaching, which expands on a poster presented at the 2016 APSARD Annual Meeting (Tuttle et al., 2016), the three of us will give an overview of ADHD coaching, providing a demonstration of its process and a descriptive review of the extant outcomes research (see Ahmann et al., 2017; Ahmann et al., in press).
By design, ADHD coaching provides a high level of structure and accountability to:
a) assist clients in goal identification,
b) foster behavior change and goal attainment,
c) promote improvements in functional arenas, and
d) reinforce gains, including those made in other therapeutic modalities.
This data-driven presentation will examine the strengths and limitations of the literature and explore how coaching holds promise in improving the functional outcomes and quality of life of individuals with ADHD across the lifespan, especially when it is part of a multimodal approach.
References
Ahmann, E., Saviet, M., & Tuttle, L. J. (2017). Interventions for ADHD in children and teens: A focus on ADHD coaching. Pediatric Nursing, 4(3), 121–131.
Ahmann, E., Tuttle, L. J., Saviet, M., & Wright, S. D. (in press). A descriptive review of ADHD coaching research: Implications for college students. Journal of Postsecondary Education and Disability.
Barkley, R. A. (Ed.). (2015). Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment (4th ed.). New York, NY: Guilford.
Kooij, S. J. J., Bejirot, S., Blackwell, A., Caci, H., Casas-Brugué, M., Carpentier, P. J. … & Asherson, P. (2010). European consensus statement on diagnosis and treatment of adult ADHD: The European Network Adult ADHD. BMC Psychiatry, 10(67).
Prevatt, F., & Levrini, A. (2015). ADHD coaching: A guide for mental health professionals. Washington, DC: American Psychological Association.
Ramsay, J. R. (2010). Nonmedication treatments for adult ADHD: Evaluating impact on daily functioning and well-being. Washington, DC: American Psychological Association.
Tuttle, L. J., Ahmann, E., & Wright, S. D. (2016, January). Emerging evidence for the efficacy of ADHD coaching. Poster presented at the Annual Meeting of the American Professional Society for ADHD and Related Disorders (APSARD), Washington, DC.
We will be presenting at the 2018 APSARD Annual Meeting on “Emerging Evidence for the Effectiveness of ADHD Coaching” on Sunday January 14th from 2:30–4:30 p.m. and hope you will join us!
