Acceptance and Commitment Therapy for Adults with ADHD during COVID-19: An Open Trial

This exploratory study reports the outcomes of a remotely delivered manualised form of Acceptance and Commitment Therapy (ACT) to adults with Attention Deficit Hyperactivity Disorder (ADHD) during the COVID-19 imposed “lockdown”. Adults completing this intervention (N = 12) reported statistically and clinically significant improvements on outcomes relating to self-reported mood F(1.356, 14.917) = 21.64, p < 0.001, η2 = 0.66), anxiety F(2, 22) = 22.93, p < 0.001, η2 = 0.68), psychosocial adjustment (χ2(4) = 26.51, p < 0.001) and treatment acceptability was good. Preliminary findings suggest this cost effective and remotely delivered psychotherapeutic approach might be one appropriate method for supporting the well-being and adjustment of adults with ADHD during future COVID-19 or other pandemic related lockdowns. Further research is urgently required to establish efficacy using larger sample sizes and the implementation of wait list and treatment comparison groups. Future research might also explore the use of this manualised approach in other clinical subgroups and the general population.

Impact of Long-Term Treatment with OROS Methylphenidate on Pubertal Development in Adolescents with ADHD

The objective of this study was to examine whether stimulants impact pubertal development in adolescent Attention Deficit Hyperactivity Disorder (ADHD), an understudied subject. Pubertal staging data were collected during a 2-year open study of extended release methylphenidate in adolescents (N = 111) with ADHD. Tanner stages were compared to national estimates. The sample was primarily male, Caucasian, and a mean age of 14.8 years at baseline. The baseline Tanner stage for 70% of subjects was consistent with chronological age. For the majority of subjects who reached 12 - 20 months (N = 25) or 24 months (N = 21) endpoints, the Tanner stage at respective endpoints was consistent with age. We found that progression in Tanner stage was not associated with OROS MPH duration or dose (p > 0.10). Long-term treatment with extended release methylphenidate did not appear to adversely impact pubertal development in this sample of adolescents with ADHD.

Identification and treatment of individuals with attentiondeficit/ hyperactivity disorder and substance use disorder: An expert consensus statement

Attention-deficit/hyperactivity disorder(ADHD)often co-occurs with substance use(SU)and/or substance use disorder(SUD).Individuals with concurrent ADHD and SU/SUD can have complex presentations that may complicate diagnosis and treatment.This can be further complicated by the context in which services are delivered.Also,when working with young people and adults with co-existing ADHD and SU/SUD,there is uncertainty among healthcare practitioners on how best to meet their needs.In February 2022,the United Kingdom ADHD Partnership hosted a meeting attended by multidisciplinary experts to address these issues.Following presentations providing attendees with an overview of the literature,group discussions were held synthesizing research evidence and clinical experience.Topics included:(1)A review of substances and reasons for use/misuse;(2)identification,assessment and treatment of illicit SU/SUD in young people and adults with ADHD presenting in community services;and(3)identification,assessment and treatment of ADHD in adults presenting in SU/SUD community and inpatient services.Discussions highlighted inter-service barriers and fragmentation of care.It was concluded that a multimodal and multi-agency approach is needed.The consensus group generated a table of practice recommendations providing guidance on:identification and assessment;pharmacological and psychological treatment;and multi-agency interventions.

Brain Signaling in Psychiatric Disorders: What Can They Tell Us in the Absence of Behavioral Differences?

This is a commentary on the often-observed phenomenon of observing task-based brain signaling differences between clinical populations and healthy control participants in the absence of any behavioral decrements in the clinical group. We offer several explanations for why brain-based differences amid normative performance may be of interest to researchers and clinicians. First, neural processing in the clinical group may not be as efficient as that in the control group. Second, differences in activation could reveal important differences in the cognition behind the (normative) behavior. Third, differences in activation may be prognostic biomarkers of injury or decline. In addition, we contend that similar behavior between groups is important in properly interpreting brain data. Finally, we offer caveats and future directions to further clarify brain mechanisms underlying behavior in clinical populations.

Effects of prolonged methylphenidate treatment on amygdala reactivity and connectivity:a randomized controlled trial in stimulant treatment-naive,male participants with ADHD

Background:Problems with emotional processing are widely reported in individuals with attentiondeficit/hyperactivity disorder(ADHD).Although methylphenidate(MPH)effectively alleviates inattention and hyperactivity symptoms in ADHD,its effects on emotional processing and internalizing symptoms have remained elusive.While we previously found that acute MPH administration modulated neural mechanisms underlying emotional processing in an age-dependent manner,the effects of prolonged administration remained unknown.Objectives:Therefore,we investigated:(i)whether prolonged MPH treatment influences neural substrates(amygdala reactivity and connectivity)of emotional processing,and(ii)whether these effects are modulated by age.Methods:The“effects of Psychotropic drugs On Developing brain-MPH”(“ePOD-MPH”)randomized controlled trial was a 16-week double-blind,placebo-controlled,multi-center trial with MPH in 50 boys(10–12 years of age)and 49 men(23–40 years of age),all stimulant treatment-naive and diagnosed with ADHD.Participants performed an emotional face-matching task during functional magnetic resonance imaging.We assessed their symptoms of ADHD and internalizing symptoms at baseline,during the trial(8 weeks),and 1 week after the trial end(17 weeks).Results and Conclusions:We did not find effects of prolonged MPH treatment on emotional processing,as measured by amygdala reactivity and connectivity and internalizing symptoms in this trial with stimulant treatment-naive participants.This differs from our findings on emotional processing following acute MPH administration and the effects of prolonged MPH treatment on the dopamine system,which were both modulated by age.Interestingly,prolonged MPH treatment did improve ADHD symptoms,although depressive and anxiety symptoms showed a medication-independent decrease.Furthermore,our data indicate that baseline internalizing symptoms may be used to predict MPH treatment effects on ADHD symptoms,particularly in(male)adults with ADHD.

Acceptability of an adjunct equine-assisted activities and therapies program for veterans with posttraumatic stress disorder and/or traumatic brain injury

Objective: Equine-assisted activities and therapies(EAATs) have been a growing adjunctive integrative health modality, as they allow participants to practice mindfulness, emotional regulation, and self-mastery or self-esteem building skills. Preliminary evidence suggests that these programs may be helpful in reducing posttraumatic stress disorder(PTSD), anxiety, and depressive symptoms. The current study examines the acceptability of integrating an EAAT program as part of a two-week, intensive clinical program for veterans with PTSD and/or traumatic brain injury(TBI).Methods: A family member or support person could accompany veterans and participate in the program.One hundred and six participants(veteran n = 62, family n = 44) left the urban environment in an intensive outpatient program(IOP) to attend a two-day, weekend EAAT in rural New Hampshire. Satisfaction surveys were conducted on the last day of the program and examined using thematic analysis.Results: The following themes were reported in the surveys: ability of horses to catalyze emotional rehabilitation, effectiveness of immersion in equine-assisted activities, program’s ability to foster interpersonal relationships and necessity of education about PTSD for staff. Participants also reported enjoying the program as highlighted by qualitative feedback, a mean score of 9.76(standard deviation[SD] = 0.61) as reported by veterans and a mean score of 9.91(SD = 0.29) as reported by family members on a 10-point visual analog scale with higher scores indicating a greater overall experience.Conclusion: These data offer preliminary evidence that an adjunct EAAT program is acceptable for veterans with PTSD and/or TBI participating in an IOP.

全民远程会诊 户外散步和交谈形式的心理健康评估

在2019新型冠状病毒肺炎(COVID-19)暴发初期,社区精神卫生服务广泛采用了远程会诊1。Salisbury 解释了为什么远程会诊对许多初级保健患者而言都不理想2。在当今保持社交距离的时代,精神科医生和其他精神卫生从业人员必须发挥创造力.以提供良好的临床护理.同时在评估精神健康时平衡气溶胶感染和沟通问题的风险3。如果无法进行远程会诊(通过视频或电话),通过在户外散步和交谈的形式对患者进行评估可能是最合适的。对于室内会诊而言,气溶胶传播的风险过高,或者患者不能安静的坐着或不想戴口罩。