Dr Peter Collins
Professor Ulrich Ebner-Priemer
New technologies to study ADHD
In a symposium chaired by Professor Chris Hollis (Queens Medical Centre, University of Nottingham, UK), the audience were introduced to the exciting technologies emerging for use in the study of ADHD. Professor Hollis began the session by sharing results from the Assessing QbTest Utility in ADHD (AQUA) trial, which found that access to the computerised Qb test resulted in increased confirmed diagnoses of ADHD and also faster diagnosis, versus diagnosis as usual.1,2
This was followed by an overview of gamification from Dr Sebastiaan Dovis (Department of Clinical Development Psychology, University of Amsterdam, The Netherlands). Dr Dovis highlighted that adding gaming elements to assessment and training tools can improve motivation and training performance in children with ADHD.3,4
The next topic covered a gaze-control training programme, with data from a pilot study presented by Dr Peter Collins (Research Fellow, Division of Psychiatry, Community Health Sciences, University of Nottingham) showing improvements from pre- to post-treatment in inhibitory motor control, attention and reading in children with ADHD.5
Finally, Professor Ulrich Ebner-Priemer (Department of Applied Psychology, Karlsruhe Institute of Technology, Karlsruhe, Germany) presented an argument for the use of e-diaries as a method for gathering real-time momentary data in patients with ADHD. Professor Ebner-Priemer argued that retrospective data cannot capture the real-life momentary heightened reactivity of ADHD6 and instead pointed to smartphone apps, such as the app currently under investigation in the Comorbid Conditions in ADHD PROUD study, which targets comorbid obesity and depression in ADHD.
Dr Collins: “Our early games were like own-brand cereal. Boring and difficult to digest.”
Professor Ebner-Priemer: “With the example of the sloth, we have a prototypical, stereotypical behaviour…which is only exhibited in the zoo and not in the wild. The question is, do we have the same situation in psychiatry?”
Professor Saskia van der Oord
Clinical implementation of scientific evidence
In a symposium at J-EUNETHYDIS, the implementation of clinical evidence in ADHD was discussed. Professor Ute Strehl (University of Tübingen, Tübingen, Germany) began with an overview of a recent meta-analysis investigating the efficacy of neurofeedback in ADHD,7 arguing that meta-analyses cannot provide the full picture due to methodological flaws. This prompted a lively debate regarding study design in the question-and-answer section.
Professor Saskia van der Oord (KU Leuven, Belgium, and the University of Amsterdam, The Netherlands) went on to discuss the evidence for parent training therapies. In particular, she highlighted that we do not currently know which aspects of training programmes are responsible for observed treatment effects, or the situations in which parent training would be most suitable.
Finally, Professor Jan Buitelaar (Radboudumc & Karakter Child and Adolescent Psychiatry, Nijmegen, The Netherlands) discussed the different forms of dietary intervention in ADHD. He concluded that there is currently insufficient evidence to support dietary interventions as anything other than add-on therapies in ADHD. He added that his own study group is conducting a long-term study of elimination diets and hopes to present data in 2019.
Professor van der Oord: “It’s not clear what are the active components of behavioural therapy. Therapists should not use elements of a tool in isolation.”
Professor Barbara Sahakian
On enhancing cognition: ethics and implications for work and society
In a fascinating plenary lecture, Professor Barbara Sahakian (Department of Psychiatry, Cambridge Neuroscience, University of Cambridge, UK) discussed the increasing use of cognitive enhancing drugs or “smart drugs” by healthy adults without ADHD, who are using these drugs for reasons such as gaining a competitive edge over their colleagues, reducing jet lag, staying awake or increasing motivation and enjoyment of tasks.8,9
At this point, the audience was introduced to the concept of neuroethics: the study of the ethical, legal and social questions surrounding neuroscience. Professor Sahakian highlighted key ethical problems that could be associated with use of these drugs, including the lack of long-term safety data, the increase in inequality if access is restricted to the wealthy or the peer pressure people would experience if they felt their contemporaries were using these drugs. Professor Sahakian concluded that now is the time for the government and society to consider how we wish to use these drugs going forward.
Professor Sahakian: “Nobody seems to have a problem with restoration of cognitive function…but where is the grey line? If you’re in your forties, you’re not performing as you were in your twenties. Is this restoration or enhancement?”
“It raises several societal and ethical questions about how we want to use these drugs…do we just want to be a 24/7 society? Or do we want to use them to finish work and get home early?”
Professor Edmund Sonuga-Barke
Professor Luis Rohde
Adult ADHD is a child onset neurodevelopmental disorder
In this spirited debate, Professor Edmund Sonuga-Barke (Department of Psychology, University of Southampton, UK) argued passionately for the motion that adult ADHD is a child onset neurodevelopment disorder. Professor Sonuga-Barke attacked the methodology of the three key papers, which have suggested that a substantial proportion of adults diagnosed with ADHD do not have childhood symptoms.10-12 In particular, he commented on the subjective reports of self-perceived symptoms and impairment that were used to diagnose ADHD in these studies.
Professor Luis Rohde (Department of Psychiatry, Federal University of Rio Grando do Sul, Porto Alegre, Brazil) then took to the stage to defend the methodology of these recent publications, and to hypothesise that childhood and adult ADHD are not separate diagnoses, but different disease trajectories, with some patients who are first diagnosed in adulthood perhaps having a biological vulnerability that activates in response to stressors in adulthood. Both men agreed that further research is required on the topic; however, the audience overwhelmingly voted in favour of the motion at the end of the debate.
Professor Sonuga-Barke: “The motion that adult ADHD is a child-onset neurodevelopmental disorder is based on a solid body of evidence and the thinking of the best brains in the field.”
Professor Rohde: “We should think about the possibility of having different disease trajectories…adult ADHD is not always a child-onset neurodevelopmental disorder.”
- Hall CL, Selby K, Guo B, et al. Innovations in Practice: an objective measure of attention, impulsivity and activity reduced time to confirm attention deficit/hyperactivity disorder in children – a completed audit cycle. Child Adolesc Ment Health 2016; 21; 175-178.
- Hollis C. QB test: an objective test of activity and attention to aid the diagnosis of ADHD: Results from the AQUA multi-centre diagnostic RCT. Abstract from 4th EUNETHYDIS International Conference on ADHD. 2016; 29.
- Prins PJ, Dovis S, Ponsioen A, et al. Does computerized working memory training with game elements enhance motivation and training efficacy in children with ADHD? Cyberpsychol Behav Soc Netw 2011; 14: 115-122.
- Dovis S, Van der Oord S, Wiers RW, et al. Improving executive functioning in children with ADHD: training multiple executive functions within the context of a computer game. a randomized double-blind placebo controlled trial. PLoS One 2015; 10: e0121651.
- Collins P, Liddle E, Hollis C, et al. A gaze-control training programme for treating ADHD. Abstract from 4th EUNETHYDIS International Conference on ADHD. 2016; 30.
- Skirrow C, Ebner-Priemer U, Reinhard I, et al. Everyday emotional experience of adults with attention deficit hyperactivity disorder: evidence for reactive and endogenous emotional lability. Psychol Med 2014; 44: 3571-3583.
- Cortese S, Ferrin M, Brandeis D, et al. Neurofeedback for Attention-Deficit/Hyperactivity Disorder: Meta-Analysis of Clinical and Neuropsychological Outcomes From Randomized Controlled Trials. J Am Acad Child Adolesc Psychiatry 2016; 55: 444-455.
- Maher B. Poll results: look who’s doping. Nature 2008; 452: 674-675.
- Sahakian BJ. On enhancing cognition: Ethics and implications for work and society. Abstract from 4th EUNETHYDIS International Conference on ADHD. 2016; 20.
- Moffitt TE, Houts R, Asherson P, et al. Is Adult ADHD a Childhood-Onset Neurodevelopmental Disorder? Evidence From a Four-Decade Longitudinal Cohort Study. Am J Psychiatry 2015; 172: 967-977.
- Caye A, Rocha TB, Anselmi L, et al. Attention-Deficit/Hyperactivity Disorder Trajectories From Childhood to Young Adulthood: Evidence From a Birth Cohort Supporting a Late-Onset Syndrome. JAMA Psychiatry 2016; 73: 705-712.
- Agnew-Blais JC, Polanczyk GV, Danese A, et al. Evaluation of the Persistence, Remission, and Emergence of Attention-Deficit/Hyperactivity Disorder in Young Adulthood. JAMA Psychiatry 2016; 73: 713-720.