Abstract Body

Attention deficit and hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in children. Its primary clinical features include symptoms of inattention and hyperactivity/impulsivity, although young people often present with emotional dysregulation, excessive mind-wandering and executive dysfunction. Symptoms of ADHD often persist into adulthood together with high rates of comorbidity and significant psychosocial impairment across the lifespan. Berry, Shaywitz and Shaywitz proposed over 30 years ago that girls with ADHD form a 'silent minority' with greater internalized behavior which leads them to be under-identified. Even when referred for clinical assessment, their ADHD symptoms are missed or misdiagnosed for other conditions such as anxiety, depression and personality disorder. This means they will not receive the treatment they need. Compared with controls, they may be especially vulnerable to childhood adversities and health problems and they may cope with these difficulties with dysfunctional strategies (eg. with substance misuse and/or deliberate self-harming behaviours). If we are to enhance long-term outcomes in girls and women with ADHD, healthcare practitioners need to better understand the presentation of ADHD in females, improve detection and assessment of ADHD in order that they may access appropriate treatment. This workshop will focus on the differences in presentation and outcomes between males and females with ADHD.

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Decades of neuroimaging research in attention/deficit-hyperactivity disorder (ADHD) have yielded a few apparently firm findings and many open questions. The long-term objective of these efforts is to uncover the underlying brain pathophysiology of the disorder, to reveal reliable biomarkers of prognosis and treatment response, striving for personalized medicine. Unfortunately, neuroimaging research in ADHD and other psychiatric disorders is still unable to inform clinical practice.

This presentation will provide an up-to-date overview of neuroimaging in ADHD, highlighting the most promising results and current challenges of structural and functional research with magnetic resonance imaging (MRI). Evidence from large, multicentric studies and from highly-sophisticated resting-state functional MRI techniques will be presented; methodological and reproducibility limitations in current literature will be introduced, and the way forward to bring this area of research closer to clinical practice with patients with ADHD will be discused.

Dr. Pereira-Sanchez is conducting original research using resting-state functional MRI to study potential correlates of treatment response to stimulants in children and adolescents with ADHD; he has also recently published two literature reviews of MRI studies in ADHD.

Abstract Body

Attention-Deficit/Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder, with an estimated prevalence of 2.8% in adults. It is frequently comorbid with other mental disorders and may significantly affect global functioning, leading to stigma and social discrimination. Despite its widespread occurrence in adults, many general psychiatrists do not feel well prepared to diagnose and manage this disorder. Psychiatry training curricula rarely include rotations in specialized ADHD clinics for adults or specialized courses during residency, and in many European countries such specialized clinics for adults or the most recommended medications, are not even available. It makes the recognition and treatment of ADHD often overlooked, unless it has been diagnosed in childhood.

Dr. Gondek will demonstrate the diagnostic process of ADHD in adults and main directions for differential diagnosis in cases of a complex clinical picture.

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Adults with ADHD describe self-medicating with cannabis. A small number of psychiatrists in the US prescribe cannabis medication for ADHD, despite there being no evidence from trials. The EMA-C trial (Experimental Medicine in ADHD-Cannabinoids) was a pilot randomised placebo-controlled experimental study of a cannabinoid medication, Sativex Oromucosal Spray, in 30 adults with ADHD. The primary outcome was cognitive performance and activity level using the QbTest. Secondary outcomes included ADHD and emotional lability (EL) symptoms. From 17.07.14-18.06.15, 30 participants were randomly assigned to the active (n=15) or placebo (n=15) group. For the primary outcome, no significant difference was found in the intent-to-treat analysis although the overall pattern of scores was such that the active group usually had scores that were better than the placebo group (Est=-0.17,95%CI-0.40-0.07, p=0.16, n=15/11 active/placebo). For secondary outcomes Sativex was associated with a nominally significant improvement in hyperactivity/impulsivity (p=0.03) and a cognitive measure of inhibition (p=0.05), and a trend towards improvement for inattention (p=0.10) and EL (p=0.11). Per-protocol effects were higher. Results did not meet significance following adjustment for multiple testing. One serious (muscular seizures/spasms) and three mild adverse events occurred in the active group and one serious (cardiovascular problems) adverse event in the placebo group. Adults with ADHD may represent a subgroup of individuals who experience a reduction of symptoms and no cognitive impairments following cannabinoid use. While not definitive, this study provides preliminary evidence supporting the self-medication theory of cannabis use in ADHD and the need for further studies of the endocannabinoid system in ADHD.