40
issue Winter 2018
The voice of ADDISS - The National ADHD Information and Support Service
Happy New Year
...from ADDISS to all in the THIS ISSUE
ADHD Community
2-5 ADHD in BARNET
CONFERENCE REPORT at the RAF Museum in Hendon
6-8 ADHD in the MAINSTREAM:
Impact, Impairment & Innovation UK Adult ADHD Network (UKAAN) Congress
ADDiSS
is the National Attention Deficit Disorder Information & Support Service.
We provide people-friendly information and resources about Attention Deficit Hyperactivity Disorder (ADHD) to anyone who needs assistance - parents, sufferers, teachers or health professionals. All our activities are supported by our Professional Board of expert advisers.
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CHIEF EXECUTIVE OFFICER Andrea Bilbow OBE
TRUSTEES
Jenny Missen(chair) Jessica Hyams Danny Eastman Dr Kate Meyer-Currey Sharon O’Dell Dr Rashmin Tamhne Bernadette Ashton
EDITOR
Dr Sarah Holme
EDITORIAL BOARD
Prof. Eric Taylor Dr Leon Rozewicz Prof. Peter Hill Therese Glynn Dr Nikos Myttas Dr R Tamhne Prof. Chris Hollis
PROFESSIONAL BOARD Prof. Eric Taylor Prof. Peter Hill Prof. Ian Wong Dr Daphne Keen Prof. Jeremy Turk Dr David Coghill Paul Cooper PhD Dr Val Harpin Dr Nikos Myttas Prof. Amanda Kirby Dr Paramala Santosh
DESIGN & LAYOUT Rohan Nosworthy
ADDISS
1st Floor 79 The Burroughs Hendon, London NW4 4AX Phone: 020 8952 2800 web: www.addiss.co.uk email: info@addiss.co.uk Twitter: @UK_ADHD 2 2 Facebook.com /addiss
a report from the
ADHD in Barnet Conference 10th October 2017 at the Royal Airforce Museum, Hendon
The overarching theme of the day was how parents, scientists, and education and health professionals are all working together to raise awareness of ADHD and bring positive change into the lives of those affected by it.
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NDREA BILBOW, ADDISS founder and CEO opened the conference by welcoming everyone and explaining the exciting new projects that ADDISS is planning within its local borough of Barnet in the very near future. ADDISS was started �� years ago as a local support group by Andrea herself, who has two sons diagnosed with ADHD. The support group grew steadily until it became so large that it became a national charity, all the time lobbying for change and raising awareness both locally and nationally. In recent years, Andrea has worked increasingly with local schools, providing support and education around ADHD as requests for this in the borough have grown. In response to the growing need for this kind of work in Barnet, ADDISS is now committed to working with other local charity organisations, looking at best practices, sharing resources and setting up local projects. Planned projects include weekly drop-in centres, social skills training groups for primary age kids - teaching mindfulness, social skills and building resilience and self-esteem – as well as groups for ADHD teenagers. ADDISS will also be rolling out the ‘�-�-� Magic’ parenting intervention program for parents locally, building on the work they have done training over ��� practitioners nationwide in the program.
by Sarah Holme - ADHDnews Editor - Winter 2018
INTRODUCTION TO 1-2-3 MAGIC FOR PARENTS AND TEACHERS - Andrea Bilbow OBE Andrea gave an overview of the successful �-�-� Magic program. Developed by Thomas Phelan, �-�-� Magic is a behavioural management program that parents can learn and use anywhere with their children. The program was devised primarily to help ADHD children aged between �-�� and their families but is useful for any children. �-�-� Magic asks and answers the question “Who’s in charge of your house?” giving training in three components: �. How to manage obnoxious behaviour
�. How to encourage positive behaviour
�. How to strengthen relationships
Part � teaches us how to manage obnoxious behaviour by moving away from the ‘Talk, persuade, argue, yell, hit’ scenario that so often arises between carers and children when challenging behaviour arises. It provides a ‘�-�-�’ counting method that deals with these behaviours, with minimal, calm communication. Too much talking and emotion is a common pitfall when dealing with challenging behaviour, especially if the parents also have ADHD. This can be very damaging, particularly for an ADHD child. Andrea explained that children like the program because it is non-aggressive and teaches everyone to stop shouting.
INTRODUCING WHAAM AND THE BEHAVE PROJECT - ADDISS and Woodcroft School Over the years, ADDISS has been involved in many ADHD projects and programs nationwide and internationally. Colin McGee, ADDISS’ resident psychotherapist and educationalist introduced the audience to the latest project ADDISS has given input to, the WHAAM project www.whaamproject.eu. WHAAM is a joint project between the UK, Italy, Greece, Portugal and Ireland to produce a web-based health app for monitoring the effectiveness of ADHD behaviour management strategies in ADHD individuals. This breakthrough project uses ICT to help support and monitor behaviour, using tablets and phones. The WHAAM software has been designed to be easy to use, to gather information quickly and display it visually for data sharing between the school, parents and health professionals. It has initially been funded to be used to manage ADHD but could be used for monitoring any challenging behaviour. WHAAM has been running since ���� and it is soon to be succeeded by the BEHAVE project.
Kay Vanner (SENCO) and Mark Russell (Deputy Head) joined the conference from Woodcroft School, Barnet, to explain the project and their joint involvement alongside ADDISS. BEHAVE will use lessons learnt from WHAAM for a research-based project to find the most effective strategies and interventions for helping children with social, emotional and behavioural difficulties and how best to support them. The end goal is to incorporate these strategies into standard teacher training. The new project, which involves � countries including the UK, had its kick-off in Italy last month and will run for � years. Woodcroft is a primary school in Barnet with ��� children and �� staff that have worked with ADDISS for many years and they are helping with the research.
Dr Ellen Littman
Peter Williamson, Young Barnet Foundation
ADHD IN SCHOOLS - Professor Eric Taylor The conference was joined by leading child psychiatrist Professor Eric Taylor, Emeritus Professor of Child and Adolescent Psychiatry at King’s College London Institute of Psychiatry, an honorary consultant at ‘The Maudsley’ and long-term supporter of ADDISS and patient advocacy, presenting on ADHD in schools.
COMMUNITY There is evidence that ADHD diagnosis rates in the UK are much lower than the predicted ADHD incidence rates and that this is partly due to decreases in mental health services available, which are overwhelmed and subject to cuts in
Professor Taylor started by describing what it is like for children to have ADHD and asking the question ‘How can they be helped by their schools’. He explained how, with the correct support, ADHD does not have to be impairing. Our understanding of ADHD and problems for children in the classroom has been revolutionised by technology. We now know that ��-��% of all ADHD has a genetic component. Researchers have identified roughly ��� genes that are involved in the occurrence of ADHD but we still don’t know how these genes interact and the mechanisms involved. ADHD is a disability to be managed - it is not the child’s nor the carer’s fault. ADHD is often complicated because it is not a homogenous condition; not every child or adult experiences the same symptoms and each will have a different combination of the three main components: inattentiveness, impulsivity and hyperactivity. In addition, symptoms also vary between boys and girls, but what has been definitively shown is that symptoms of ADHD directly impact on academic achievement. One key aspect of ADHD that is often not highlighted is that ADHD individuals are emotionally labile, meaning that people with ADHD are susceptible to developing mood disorders later in life. Professor Taylor talked through classroom interventions that help the ADHD child such as proximity to the teacher, managed transitions, clear goals and systematic monitoring. An important step to dealing with ADHD is recognising that ADHD is not laziness or maliciousness on the part of the child and that it is manageable. This simple message can be helpful; and more education for parents about ADHD would be helpful. ADHD children need to become experts in the problems that they face because of ADHD and how to deal with them.
Medication can be useful but it is not the be-all and end-all, and it is still controversial even after many years of use. It is also important to help children understand what the issues are, as this understanding can lead to coping and avoiding ADHD associated problems of anxiety and depression.
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many areas of the UK. The UK is also underprescribing ADHD medication compared to the number of children that will have ADHD and could benefit from medication. With regards to the persistence of ADHD into adulthood, research shows that over half of the children with full-blown ADHD will still have at least some of their symptoms into adulthood, but these are reduced if they have been raised by family and educators in a calm, supportive environment.
THE POWER OF ADHD AND THE NEUROBIOLOGY OF ADHD - Kevin Roberts Kevin Roberts is an educator and author and holds an M.A. in ADHD studies. He runs ADHD Success-in-School groups for teens, conducts camps for children with ADHD, and is the co-founder of The EmpowerADD Project www.EmpowerADD.org – an organisation that seeks to launch creative ADHD young adults into successful lives. Kevin has ADHD himself, diagnosed as an adult. Kevin gave a lively talk about unlocking the power of the ADHD brain and how ADHD can be fun, asking the audience to transform their understanding of ADHD and take facts from his talk to form part of an arsenal to share with other people about ADHD. He spoke of the importance of this transformation of people’s view on ADHD, citing examples of some of the people with ADHD who have changed the world, such as Arthur Schindler who saved over ���� Jewish people during the Second World War from Nazi extermination. Kevin spoke of the teachers who impacted his life and stressed the importance of teachers in the lives of kids, especially ADHD children and the power they can have to help these individuals.
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Kevin talked through the nature of ADHD describing a number of significant differences in the structure and function of ADHD brains and the ability to concentrate. There was a particularly insightful section on negativity bias in children with ADHD and how individuals with ADHD unconsciously use negativity to increase the activity in their brains.
Kevin Roberts
Jenny Melling (Mencap) • Jeni Osborne (Community Barnet)
“ADHD kids use negativity and argumentativeness as a way of feeling more alive – if we can’t find positive ways to feel alive then we will find a negative way. Kids often finding the joy in opposing their parents and enjoying the power they have over their parents when they make them angry”. It is important to understand that this is braindriven when dealing with ADHD children, particularly in teenagers who are striving for autonomy where this can get exaggerated and out of hand. Family dynamics can become very negative and parents and children must recognise this for what it is, a side-effect of the ADHD and must stop it from becoming damaging. Kevin reminded us all to “take a step back and consider the way their brains are working”. Rather than seeing ADHD as a negative, we should see people with it as movers, dreamers and risk takers’, the title of one of a number of books Kevin has written about ADHD. He shared tricks for dealing with ADHD kids and shared his experiences of working with ADHD kids and their families, helping ADHDers realise their gifts, also telling us about his new website www.kevinjroberts.net
GIRLS AND WOMEN WITH ADHD: WHAT RESEARCH REVEALS ABOUT THEIR INNER LIVES, AND WHAT IT MEANS FOR THE FUTURE - Dr Ellen Littman Dr Ellen B. Littman is a clinical psychologist licensed in New York State. Educated at Brown and Yale Universities, the clinical psychology doctoral program of Long Island University, and the Albert Einstein College of Medicine, she has been involved with the field of attentional disorders for over �� years. In her private practice in Mount Kisco, NY, just north of New York City, Dr Littman focuses on a high IQ adult and adolescent ADHD population. She specialises in identifying and treating complex presentations of ADHD that may be misinterpreted or overlooked.
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Mark Russell • Kay Vanner (Woodcroft School)
ADHD is much more commonly identified, diagnosed and treated in boys compared to girls. It was previously thought this was because prevalence was higher in boys, but now we know that it is just as common in girls as in boys. ADHD in girls generally does not often fit the classic ADHD symptoms of hyperactivity and impulsivity which are so noticeable, instead presenting as the inattentive type which is much harder to spot and often missed altogether. As a result, there is a large gender bias in ADHD diagnosis and research in favour of boys. As little as �% of research into ADHD is conducted in girls. Girls will typically try to hide their symptoms to conform to societal expectations of women and girls, ultimately leading to frustration, anxiety, depression and crushingly low self-esteem and self-confidence. In addition, hormones mediate how girls’ ADHD symptoms are manifested, adding to the complexity of this disorder in females. Unlike boys, symptoms are generally not observable or problematic until they hit puberty at �� and many girls therefore miss out on the standard pre-� diagnostic cut off for ADHD in children. Dopamine, one of the key hormones mediating ADHD is affected by oestrogen levels. Low oestrogen levels result in low dopamine so times of low oestrogen, such as just before a girl’s period will make ADHD symptoms worse. Because of their ADHD, girls often tend to exhibit gender a-typical behaviour:
• Messy • Interruptive • Competitive ADHD girls compare themselves constantly and judge themselves harshly to their peers.
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Andrea Bilbow (ADDISS)
They live with a chronic sense of inadequacy and shame which grows steadily over time if not addressed. ADHD girls often withdraw and avoid social interactions. The biggest problem for the individual is often not having an explanation for this. ADHD is about the struggle to self-regulate in a brain that is not optimally aroused. When the brain is awake it is unstoppable, when it is not then it has no focus. ADHD girls with a high IQ are the least likely to be identified and diagnosed. ADHD girls tend to get diagnosed later, learning to live with their psychological distress. Girls often have sensory sensitivity – finding small sensory disturbances difficult to tune out; this is just one example of the special subtle issues that ADHD girls face. It is important to identify these individuals because of the severe outcomes that can arise. These girls are more likely to develop major depressive disorders; research on this is starting to emerge. ADHD is highly heritable and it is particularly difficult for ADHD mothers dealing with ADHD daughters. Suicide is four times more likely in these women, as is self-harm. They are also at greater risk of outcomes such as early mortality, substance abuse and seeking high-risk activities and relationships. It is important that health professionals are aware of these ‘red flags’, signals that ADHD may be present in females and take it seriously, as many do not. ADHD girls must be helped to define their strengths and understand their weaknesses; we must support their ‘islands of competence’. One of the key messages of Ellen’s talk was that all of the issues and outcomes surrounding female ADHD are avoidable with early recognition, diagnosis and treatment.
THE ROLE OF NUTRITION IN NEURODEVELOPMENT AND BEYOND - Dr Rachel Gow Rachel Gow is a neurodevelopmental specialist and registered nutritionist with a PhD in Child Neuropsychology from King’s College London. Dr Gow works in the emerging field of nutritional neuropsychology and introduced new thinking on the role of nutrition in neurodevelopment. There is growing research and evidence for the role of nutrition in ADHD and associative behaviour disorders. Although currently not a mainstream view, Dr Gow is a champion for this in her work. One example of this is coeliac disease, which can cause many symptoms in common with ADHD.
INTRODUCING VOLUNTARY SECTOR PARTNERS IN BARNET: YOUNG BARNET FOUNDATION, INCLUSION BARNET AND HEALTHWATCH BARNET Closing the conference was a talk from ‘The Young Barnet Foundation’, explaining their organisation’s structure and how they collaborate with local charities to find funding and bring the voluntary sector together. These partnerships
COMMUNITY Two-thirds of the brain is made up of special lipids which have critical functions in cell signalling, myelination and gene expression. Much of her talk was dedicated to explaining the importance of Omega � fats in brain development and the research surrounding their role in mechanisms of brain function. She explained that there needs to be a balance between the levels of Omega � (antiinflammatory) vs Omega � (pro-inflammatory) in our diets. Omega � fatty acids can be found in nuts, seeds and green leafy vegetables and oily fish but supplementing Omega � in our diets is not enough. Western convenience food is flooded with Omega � causing an imbalance in many people and compromising our brain health.
Dr Gow ran through studies showing evidence to support the link between diet and neurological disorders. Her research shows the high significance of levels of Omega � in children with and without ADHD, for example in their effect on callous and unemotional traits.
allow local organisations to make the most of the skills and services on offer and maximise available funding with the ethos ‘stronger together’.
There was also a short video about ‘Healthwatch Barnet’.
There was also an introduction to ‘Inclusion Barnet’, a local pan-disabled person’s organisation that works in numerous ways to support people with disabilities in the community, whether it’s talking with the Police on how best to work with people with learning disabilities or providing a safe space for those who are being affected by hate crimes in the community.
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The take-home message was that if there is too much Omega � in our diet then Omega � cannot perform its vital functions, so we should moderate our intake of Omega �-filled junk and convenience foods. This diet scenario is highly prevalent today and Dr Gow explained possible links to the increase in mental health disorders stressing how important it is to start addressing what we are putting in our bodies and considering nutrition in mental health assessment and treatment.
Whether local to Barnet or not, parents, ADHD individuals, health and educational professionals all took part in the ADDISS conference which provided attendees with a day full of information, insight and optimism about improving services, support and understanding for anyone with or affected by ADHD. Thanks from ADDISS to all who took part and supported the conference
MOBILE APPS & TOOLS for ADHD
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obile app technology can support people with cognitive deficits such dyslexia, higherfunctioning ASD individuals and people with attention deficit disorders (ADD/ADHD). In education and work settings, if one finds it difficult to pay attention, the knock-on effect is that they also find it difficult to concentrate. Poor concentration impedes learning and memory processes which in turn increases everyday forgetfulness for things we want or need to do. During the day, we often remember that we are going to do X, Y or Z later when we get home. The problem is that when the right time comes for us to do the task we’ve totally forgotten about it. Apps and other digital tools can help disrupt this vicious cycle by sharing the load of managing the many different things with we need to remember to do throughout the day. They can help us record and remember important tasks to keep us and our families on track more successfully. Memory and task list tools can help lessen friction in the home and school and increase competence and confidence as ADHD users successfully remember what they want and need to do
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ADHD in the Mainstream:
Impact, Impairment, and Innovation
A report from the
7th UK Adult ADHD Network (UKAAN) Congress
‘ADHD in the Mainstream: Impact, Impairment and Innovation’ 21st – 23rd September 2017 - London.
roviding three intensive days of presentations and discussion, the Congress offered in-depth, shared learning on many aspects of adult ADHD
and effective treatment. In addition to the plenary session, parallel sessions and symposia, numerous posters were presented on research projects around the UK.
DELIVERING EFFECTIVE TREATMENTS FOR ADULT ADHD – BENEFITS AND BEST PRACTICES
In short, medication does more than just control symptoms and more self-controlled studies are required to boost evidence for the benefits of longer-term outcomes.
Long-term benefits of ADHD treatment ADHD is one of the most treatable and rewarding conditions to work with. Most of the data reported in published studies on ADHD treatment effect is based on the core symptoms of ADHD, but what about the long-term impact of treatment? Ian Wong, Professor of Pharmacy at the UCL School of Pharmacy, presented a review of treatment effects on criminality, violence, drug abuse, accidents and other high-risk outcomes, providing compelling conclusions on the longterm benefits of drug treatment for adult ADHD. All three core symptoms of ADHD hyperactivity, impulsivity and inattentiveness - predispose individuals to accidental injuries. ADHD treatment is associated with a lower risk of injury-related admissions in children, adolescents and adults (approximately ��% lower). This has important clinical and public health implications. Studies on the link between methylphenidate treatment and suicide risk show no evidence that medication increases the risk of suicidal behaviour long term. There is some indication that treatment may reduce suicide rates but accurately controlled studies are scarce. Finally, beneficial effects of ADHD medication on symptoms of ADHD and associated conduct problems have been shown in some randomized, controlled studies involving children and adults.
Tackling aggression in ADHD Professor Susan Young, Clinical Senior Lecturer in the Centre for Mental Health, Imperial College London, gave a practical workshop on ‘Psychological treatment of aggression in people with ADHD’, providing a psychological framework for understanding and treating anger, aggression and the emotional lability common in individuals with ADHD. Working with the individual, Professor Young explained how it is possible to identify early signals and suggested interventions to help an individual avoid angry episodes getting out of control. She explained that with aggressive outbursts, there is usually an initial build-up phase where irritability, frustration and finally anger are linked to a cycle of thoughts, feelings and behaviour. By managing any one of these, the cycle is broken and aggressive episodes can be diffused or avoided. Models of Care for adult ADHD ADHD has now arrived in the mainstream, with greater than �� adult ADHD clinics and services in the UK, newly updated NICE guidelines on ADHD diagnosis, treatment and services across lifespan, adult medication licenses for Strattera
by Sarah Holme - ADHDnews Editor 6
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and Elvanse adult, RCPsych recognition and better training opportunities. However, adult ADHD clinics are typically not integrated with mainstream healthcare/ psychiatry and have very long waiting lists. So, what is the best model of care to take forward and ring the changes? Specialist, Integrated, Neurodevelopmental, Primary or private sector? A panel of experienced ADHD health professionals (Dr Ulrich Muller, Dr Muhammad Arif, Kobus van Rensburg, Mark Pitts, Dr Joe Johnson and Dr Sally Cubbin) representing these five models of care for ADHD diagnosis and treatment service in the UK, reported on how their services operate and their pros and cons to help answer this question. There was support for a multi-modal approach, a greater role for primary care and the need for local champions to drive service initiatives.
UPDATES ON PHARMACOLOGICAL TREATMENTS FOR ADHD Medication as a first-line treatment The congress was a valuable opportunity to host the debate ‘Should medication usually be the first line in adult ADHD?’. Professor Wolfgang Retz presented in favour of the current NICE guidelines which state that medication should usually be the first line in adult ADHD, with Dr James Kustow opposing, justifying psychosocial treatment as an alternative first-line treatment. This sparked an engaging and spirited debate encouraging those present to re-think the best options. There are many studies which show efficacy in reduction of core symptoms through drug treatment; additionally, demonstrating reductions in ADHD-associated psychopathology such as emotional dysregulation. However, there are downsides to medication as a first line treatment and long-term considerations. There is far less evidence for psychosocial and lifestyle intervention in adulthood, but this does not mean we should disregard its potential. Non-pharmacological treatment options exist such as cognitive behavioural therapy (CBT) mindfulness,
environmental modifications and lifestyle modifications such as exercise and nutrition. In an ideal world, it was concluded that both pharmacological and non-pharmacological treatments would be made available for every patient, though in conclusion the debate motion still held at the end of the session. ADHD medication options Shire Pharmaceutical’s symposium on the second day discussed the clinical place for amfetamines in adult ADHD, presenting the hows and whys of prescribing amfetamines and benefits of using amfetamines for treating adult ADHD (David Nutt, Professor of Neuropsychopharmacology at Imperial College London). There was also an overview of Shire’s adult ADHD medication Elvanse Adult (lisdexamfetamine dimesylate) with an emphasis on sharing clinical experience of treating ADHD individuals with amfetamines from a panel of clinical experts, with comprehensive questioning and contributions from the audience on this mainline treatment. Updates on the latest clinical trials of ADHD medication, new guideline/consensus recommendations and emerging concepts for medication management in ADHD were provided in a separate session by Dr Ulrich Muller and Mark Pitts including updates on dosing, side effects and possible complications.
INNOVATION FOR A BETTER UNDERSTANDING OF ADHD, AND NEW TREATMENT OPTIONS Mind Wandering Professor Philip Asherson, Professor of Molecular Psychiatry at the MRC Social, Genetic and Developmental Psychiatry Research Centre, Kings College London and President of UKAAN presented the growing body of research into mind wandering as a key impairment caused by ADHD. Mind wandering - when the mind drifts away from a task and focuses on internal thoughts and images unrelated to the task or situation at hand - is nothing unusual in the wider population and represents ��-��% of our daily thinking time (Mowlem et al., ����). However, individuals with ADHD often experience excessive mind wandering, with a constant stream of thoughts flitting from one topic to another, often with multiple lines of thoughts at the same time. Such spontaneous, uncontrolled thought is very distracting and impairs cognitive ability. ADHD mind-wandering makes it difficult to follow conversations, hold on to thoughts or perform tasks requiring sustained focus such as calculations or reading. The constant mental activity can cause fatigue, distress and disruption to sleep patterns.
Professor Asherson presented evidence for the physiological mechanisms behind mind wandering, the Task Positive Neural Network and Default Mode Network, and research from several groups uncovering how uncontrolled mind wandering occurs in ADHD and how medication can be effective in targeting these networks to improve symptoms. Mindfulness as therapy Mindfulness refers to the practice of being ‘in the moment’ and paying attention to one’s thoughts and feelings, not reacting to them but observing them objectively to gain greater awareness and self-regulation of one’s actions Mindfulness-based cognitive treatment (MBCT) is rapidly emerging as a promising psychosocial treatment alongside existing treatment options for ADHD. Although pharmacotherapy is effective at treating adult ADHD, there remains a need for evidence-based non-pharmacological treatment options due to unwanted side effects, varied treatment response and the fact that many individuals simply don’t want to take medication even if it is effective. Professor Anne Speckens, psychiatrist, cognitive behavioural therapist, and founder and director of Radboud UMC Centre for Mindfulness explained mindfulness therapy and summarised research evidence for the effectiveness of mindfulness at reducing the core symptoms of ADHD in adults and maintenance of these benefits longer term. Adult-onset ADHD Dr Jessica Agnew-Blais, Research Fellow at King’s College London, presented findings from several population-based cohorts which suggest that, for some, ADHD may not arise until adolescence or adulthood. These findings call into question the conceptualisation of ADHD as a childhood-onset disorder; the extent to which childhood-onset and late-onset adult ADHD may reflect different causes has implications for genetic studies and treatment of ADHD.
INTERVENTIONS TO SUPPORT ADULT ADHD IN HIGHER EDUCATION AND THE WORKPLACE Higher education Jane Sedgwick, a tutor in mental health nursing at Kings College London and Poppy Ellis-Logan led a fantastic session describing the experiences and issues faced by students with ADHD in higher education and explored what must be done to provide better support. They described how mind wandering, poor working memory, procrastination, forgetfulness and disorganisation impair educational progress and achievement at all levels. It is common knowledge that ADHD is associated with poor
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COMMUNITY educational outcomes but it remains a hidden disability within institutions of higher education with as many as ��,��� students currently in higher education predicted to have ADHD. Jane Sedgewick explained that in the UK, young people with ADHD who do go to university often struggle to graduate at the same time as their non-ADHD peers and that this is a significant issue for ADHD individuals, their families and the universities who are teaching and supporting them. University students who obtain good grades but still report symptoms related to ADHD are most at risk of not getting diagnosed and there is a paucity of research about the impact of ADHD on the educational outcomes of university students. There is a need for institutions to become more knowledgeable and personalised in the way that university students with ADHD are supported. Jane Sedgwick described a specialist ADHD service she has developed for these students which provides access to specialist ADHD psychiatry, psycho-social interventions, disabled students allowance and adjustments. Poppy Ellis-Logan, a recent university graduate provided a compelling insight into life at university with ADHD. She described how new students lose support from existing networks, structures and routine at home and face the challenges of maintaining a balanced lifestyle as new demands and responsibilities are placed upon the individual and how this can be overwhelming and damaging for students with ADHD. She explained the importance of recognition and support and introduced the #AttentionUK campaign to raise awareness of adult ADHD www.attentionuk.org. Workplace ADHD impacts many aspects of a person’s life, sometimes adversely. Professor Marios Adamou, Consultant Psychiatrist at South West Yorkshire Partnership NHS Foundation Trust spoke about the impact of ADHD in the workplace and offered suggestions for reasonable adjustments. He described how ADHD can influence the occupation individuals choose to go into and their performance at work. He also focused on the highly positive traits that individuals with ADHD can offer employees and the businesses or institutions they work for if the right support is available.
THE ROLE AND TREATMENT OF ADHD WITH CO-OCCURRING DISORDERS Substance use disorder Frances Levin, Professor of Psychiatry at
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Columbia University, provided an overview of the current understanding of the association of substance use disorders with adult ADHD. Professor Levin explained that adults with ADHD are �-� times more likely to suffer from some form of substance use disorder, whether it is drugs, alcohol or other. They also find substance abuse treatment difficult, taking longer to go into remission and with higher dropout rates from treatment programmes. Professor Levin described the uphill battle of trying to engage the substance abuse community about the prevalence of ADHD with substance use disorders and achieve acceptance of the reported improvements to recovery rates when ADHD is treated, where present. There are specific considerations when treating ADHD and a substance use disorder such as the efficacy of drugs and potential for misuse/ abuse. Substance abuse victims often have additional psychiatric issues such as anxiety and depression and it can be difficult to know what to treat first. Professor Levine stressed the importance of early detection and treatment of ADHD and shared evidence that concerns over nonmedical use and diversion of ADHD medications are unfounded. Professor Susan Young discussed the necessity for psychological treatment of ADHD and substance misuse, stressing the need for a combination of pharmacological and psychological interventions including psychoeducation, motivational interviewing, cognitive behavioural and relapse prevention techniques. Prof. Young presented evidence indicating that self-medication to cope with the symptoms of ADHD is most frequently the motivation for substance misuse rather than the early use of stimulants as a way of thrill-seeking (Young & Sedgwick, ����). Autistic spectrum disorder (ASD) There was a session on the practicalities of managing co-occurring ADHD and ASD presented by Kobus van Rensburg and Emma Woodhouse, discussing issues of differential diagnosis, prevalence, service development and complex factors mediating developmental trajectories. Other mental disorders A session on how to differentiate ADHD from other co-morbidities was presented by Professor Phil Asherson, Dr Muhammad Arif and Dr Sue Cubbin. The co-occurrence of another mental disorder is common and it can be a challenge to decide which to treat first. Professor Asherson explained how ADHD is often underdiagnosed by adult mental health services as it shares characteristics and symptoms with other common adult mental health disorders. Understanding differences
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between adult ADHD and disorders such as anxiety and depression and bipolar disorder are important as they occur at increased rates in adult ADHD and may impact on long-term negative outcomes. The panel described the importance and challenges of knowing which to treat first. Sleep disorders Hugh Selsick (Consultant in sleep medicine and psychiatry at the Royal London hospital and UCL) ran a workshop explaining the interaction between sleep and ADHD describing how to recognise and manage common sleep disorders. Sleep disruption, most commonly getting to sleep or staying asleep, is common in ADHD. Evidence shows that sleep disorders may cause ADHD symptoms, and the role of circadian rhythm disorders in mental health is a growing area of research.
LIVING WELL WITH ADHD Relationships Melissa Orlov, marriage counsellor and author of two award-winning books on the impact of ADHD in relationships www.ADHDmarriage.com spoke about ‘Relationships and adult ADHD: family, friends, partners and parenting’. She described how many ADHD relationships are often maladjusted and divorce is almost twice as likely. ADHD can cause distress in close relationships of all types. Inconsistency, difficulty reading emotional cues, emotional lability and higher than normal risk of financial problems are just a few of the issues that can add pressure to these relationships, and divorce rates are higher where is present. Melissa went through key relationship stressors for adults and families and offered strategies for professionals to help work through them. Melissa Orlov explained how many couples are experiencing relationship issues caused by ADHD where it is not diagnosed, and the importance of getting a diagnosis to allow treatment and open the door to understanding the challenges and how to tackle them. She stressed the value of a multi-modal, strengthbased approach to tackling ADHD and relationship issues, sharing the responsibility on both sides of any ADHD-impacted relationship and setting aside blame, guilt and frustration. Wellbeing Dr Andrew Merwood and Dr James Kustow gave a session promoting wellbeing in adult ADHD. Dr Merwood highlighted the advantages of having ADHD such as cognitive dynamism, courage, energy, and resilience, making the point that having ADHD enriches life and existence.
- Winter 2018
He compared having ADHD to growing an orchid – something that is rare and beautiful but needs specific care to flourish. Both speakers emphasized the importance of exercise and nutrition and presented evidence that these improve unwanted ADHD symptoms, executive function and mood. Dr Kustow explained how a healthy diet can be a challenge to sustain for people with ADHD and introduced new concepts in diet and ADHD such as the ‘Few Foods Diet’, which is generating interest with measurable improvements in child ADHD symptoms; also the increasing evidence that gut bacteria may have a role in the development of mental health disorders.
UKAAN - GIVING A VOICE TO ADULT ADHD The UKAAN program this year provided the opportunity to put the science to one side and listen to the voice of adult ADHD from highquality art and entertainment. Art with Heart gave a performance of their autobiographical one-woman show Declaration, an honest and emotional exploration of what it is like living with ADHD as a child and as an adult, and the experience of getting diagnosed. There was artwork on display from ADHD artists Jacki Cairns, and Dr Kai Syng Tan with Magic Carpet, an interactive display on mind wandering from King’s College London’s Artist in Residence. Impressionist and comedian Rory Bremner reflected on the issue of undiagnosed ADHD, describing his own diagnosis and sharing his experience of making the recent BBC Horizon documentary ‘ADHD and me’. Laced with impersonations and sharp wit, Rory highlighted the stark reality that only � in � adults with ADHD get diagnosed and even fewer get medication. He also stressed the importance of continuing to raise awareness of ADHD so that more people understand adult ADHD and to reduce stigma. ‘‘Life for an ADHDer is getting harder than it ever was – with modern life and social media increasing stimulation and demands on our attention. Science is increasingly able to show to the world that ADHD is real, but we still need to convince a public that is not entirely on board”. Pushing ADHD firmly into the mainstream, this year’s UKAAN conference delivered a varied and informative program for a diverse audience of health professionals, education professionals, the voluntary sector and the public.
For more information visit: www.ukaan.org .