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51. Oscillatory neural network alterations in young people with tuberous sclerosis complex and associations with co-occurring symptoms of autism spectrum disorder and attention-deficit/hyperactivity disorder

Author

Shephard, Elizabeth, McEwen, Fiona S., Earnest, Thomas, Friedrich, Nina, Mörtl, Isabelle, Liang, Holan, Woodhouse, Emma, Tye, Charlotte, and Bolton, Patrick F.

Abstract

Tuberous sclerosis complex (TSC) is a genetic disorder caused by mutations on the TSC1/TSC2 genes, which result in alterations in molecular signalling pathways involved in neurogenesis and hamartomas in the brain and other organs. TSC carries a high risk for autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD), although the reasons for this are unclear. One proposal is that TSC-related alterations in molecular signalling during neurogenesis lead to atypical development of neural networks, which are involved in the occurrence of ASD and ADHD in TSC. We investigated this proposal in young people with TSC who have been studied longitudinally since their diagnosis in childhood. Electroencephalography (EEG) was used to examine oscillatory connectivity in functional neural networks and local and global network organisation during three tasks (resting-state, attentional and inhibitory control Go/Nogo task, upright and inverted face processing task) in participants with TSC (n=48) compared to an age- and sex-matched group of typically developing Controls (n=20). Compared to Controls, the TSC group showed hypoconnected neural networks in the alpha frequency during the resting-state and in the theta and alpha frequencies during the Go/Nogo task (p<0.008), as well as reduced local network organisation in the theta and alpha frequencies during the Go/Nogo task (F=3.95, p=0.010). There were no significant group differences in network metrics during the face processing task. Increased connectivity in the hypoconnected alpha-range resting-state network was associated with greater ASD and inattentive ADHD symptoms (rho>0.40, p<0.036). Reduced local network organisation in the theta-range during the Go/Nogo task was significantly associated with higher hyperactive/impulsive ADHD symptoms (rho=-0.43, p=0.041). These findings suggest that TSC is associated with widespread hypoconnectivity in neural networks and support the proposal that altered network function may be involved in the co-occurrence of ASD and ADHD in TSC.

Published
2021
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52. Guidelines for identification and treatment of individuals with attention deficit/hyperactivity disorder and associated fetal alcohol spectrum disorders based upon expert consensus

Author

Young, Susan, Absoud, Michael, Blackburn, Carolyn, Branney, Polly, Colley, Bill, Farrag, Emad, Fleisher, Susan, Gregory, Ges, Gudjonsson, Gisli H., Kim, Keira, O’Malley, Kieran D., Plant, Moira, Rodriguez, Alina, Ozer, Susan, Takon, Inyang, Woodhouse, Emma, Mukherjee, Raja, Young, Susan, Absoud, Michael, Blackburn, Carolyn, Branney, Polly, Colley, Bill, Farrag, Emad, Fleisher, Susan, Gregory, Ges, Gudjonsson, Gisli H., Kim, Keira, O’Malley, Kieran D., Plant, Moira, Rodriguez, Alina, Ozer, Susan, Takon, Inyang, Woodhouse, Emma, and Mukherjee, Raja

Abstract

BACKGROUND: The association of attention deficit/hyperactivity disorder (ADHD) and fetal alcohol spectrum disorders (FASD) results in a complex constellation of symptoms that complicates the successful diagnosis and treatment of the affected individual. Current literature lacks formal guidelines, randomized control trials, and evidence-based treatment plans for individuals with ADHD and associated FASD. Therefore, a meeting of professional experts was organized with the aim of producing a consensus on identification and treatment guidelines that will aid clinicians in caring for this unique patient population. METHODS: Experts from multiple disciplines in the fields of ADHD and FASD convened in London, United Kingdom, for a meeting hosted by the United Kingdom ADHD Partnership (UKAP; www.UKADHD.com ) in June 2015. The meeting provided the opportunity to address the complexities of ADHD and FASD from different perspectives and included presentations, discussions, and group work. The attendees worked towards producing a consensus for a unified approach to ADHD and associated FASD. RESULTS: The authors successfully came to consensus and produced recommended guidelines with specific regards to identification and assessment, interventions and treatments, and multiagency liaisons and care management, highlighting that a lifespan approach to treatment needs to be adopted by all involved. Included in the guidelines are: 1) unique 'red flags', which when identified in the ADHD population can lead to an accurate associated FASD diagnosis, 2) a treatment decision tree, and 3) recommendations for multiagency care management. CONCLUSIONS: While clinically useful guidelines were achieved, more research is still needed to contribute to the knowledge base about the diagnosis, treatment, and management of those with ADHD and associated FASD.

53. Females with ADHD: An expert consensus statement taking a lifespan approach providing guidance for the identification and treatment of attention-deficit/ hyperactivity disorder in girls and women

Author

Quinton Deeley, Nicoletta Adamo, Bryndis Bjork Asgeirsdottir, Jack Hollingdale, Susan Young, Jane Sedgwick, Polly Branney, Gisli H. Gudjonsson, Emma Woodhouse, Ozge Kilic, Kevin Tierney, Caroline Skirrow, Sri Perecherla, Eleni Paliokosta, Sally Cubbin, Emad Farrag, William Colley, Kobus van Rensburg, Michelle Beckett, Peter Mason, Tony Lloyd, Peter J. Hill, KILIÇ, ÖZGE, Sálfræðideild (HR), Department of Psychology (RU), Samfélagssvið (HR), School of Social Sciences (RU), Háskólinn í Reykjavík, Reykjavik University, Kılıç, Özge, Young, Susan, Adamo, Nicoletta, Asgeirsdottir, Bryndis Bjork, Branney, Polly, Beckett, Michelle, Colley, William, Cubbin, Sally, Deeley, Quinton, Farrag, Emad, Gudjonsson, Gisli, Hill, Peter, Hollingdale, Jack, Lloyd, Tony, Mason, Peter, Paliokosta, Eleni, Perecherla, Sri, Sedgwick, Jane, Skirrow, Caroline, Tierney, Kevin, van Rensburg, Kobus, Woodhouse, Emma, and Koç University Hospital

Subjects
Male, Identification, Samkomulag, Girls, Psychological intervention, Comorbidity, UKAP The UK ADHD partnership, Presentation, 0302 clinical medicine, Stúlkur, lcsh:Psychiatry, Attention, 030212 general & internal medicine, Konur, Meðferð, Interventions, media_common, Psychiatry, Geðheilsa, Meðvirkni, Psychiatry and Mental health, Identification (information), Attention-deficit/hyperactivity disorder (ADHD), Consensus, Female, Treatment, UKAP, Women, Clinical psychology, Research Article, Referral, lcsh:RC435-571, media_common.quotation_subject, Longevity, 03 medical and health sciences, Geðrækt, mental disorders, medicine, ADHD, Attention deficit hyperactivity disorder, Humans, Snemmtæk íhlutun, Greiningarsálfræði, business.industry, Perspective (graphical), medicine.disease, Mental health, United Kingdom, 030227 psychiatry, Attention Deficit Disorder with Hyperactivity, business
Abstract

Publisher's version (útgefin grein), Background There is evidence to suggest that the broad discrepancy in the ratio of males to females with diagnosed ADHD is due, at least in part, to lack of recognition and/or referral bias in females. Studies suggest that females with ADHD present with differences in their profile of symptoms, comorbidity and associated functioning compared with males. This consensus aims to provide a better understanding of females with ADHD in order to improve recognition and referral. Comprehensive assessment and appropriate treatment is hoped to enhance longer-term clinical outcomes and patient wellbeing for females with ADHD. Methods The United Kingdom ADHD Partnership hosted a meeting of experts to discuss symptom presentation, triggers for referral, assessment, treatment and multi-agency liaison for females with ADHD across the lifespan. Results A consensus was reached offering practical guidance to support medical and mental health practitioners working with females with ADHD. The potential challenges of working with this patient group were identified, as well as specific barriers that may hinder recognition. These included symptomatic differences, gender biases, comorbidities and the compensatory strategies that may mask or overshadow underlying symptoms of ADHD. Furthermore, we determined the broader needs of these patients and considered how multi-agency liaison may provide the support to meet them. Conclusions This practical approach based upon expert consensus will inform effective identification, treatment and support of girls and women with ADHD. It is important to move away from the prevalent perspective that ADHD is a behavioural disorder and attend to the more subtle and/or internalised presentation that is common in females. It is essential to adopt a lifespan model of care to support the complex transitions experienced by females that occur in parallel to change in clinical presentation and social circumstances. Treatment with pharmacological and psychological interventions is expected to have a positive impact leading to increased productivity, decreased resource utilization and most importantly, improved long-term outcomes for girls and women., The meeting was funded by the UK ADHD Partnership (UKAP), who has been in receipt of unrestricted educational donations from Takeda. Takeda had no influence or involvement in determining the topic and arrangements of the day, the consensus process and outcomes, or writing the final manuscript. Other than reimbursement of travel expenses to attend the meeting, none of the authors received any financial compensation for attending the meeting or writing the manuscript, aside from CS who received funds for medical writing assistance., "Peer Reviewed"

Published
2020

54. Letters.

Author

Coles, Jonathan A., Alexander, Colin, Cox, Peter, Wendt, Robin, Lord Sainsburyof Preston Candover Kg, Treuherz, Julian, Brook, David, Chainey, Graham, Leckebusch, Martin, Knight, Timothy, Doak, Tom, Leppard, M. J., Napier, Msr, Woodhouse, Emma, and Bunbury, Andrew

Subjects
*ELECTRIC automobiles
Published
2014

55. A Pilot Study Examining ADHD and Behavioural Disturbance in Female Mentally Disordered Offenders.

Author

Hollingdale J, Woodhouse E, Asherson P, Gudjonsson GH, and Young S

Abstract

Compared with general population rates, prevalence rates of ADHD have been consistently reported to be higher in both male and female offender populations, the latter estimated to range between 10-29%. Research in forensic institutional settings has reported that aggressive behaviour is a particularly prominent source of impairment among men with ADHD. However there is a paucity of research investigating the type of behavioural incidents that may arise in female offenders with ADHD. This pilot study therefore aimed to further our understanding of ADHD within a cohort of female mentally disordered offenders by ascertaining estimated rates of ADHD and associated functional disturbance presenting in this population. Fifty female offenders completed the Barkley ADHD rating scales. Data on aggressive and self-harming behaviours were obtained from patients' clinical records. Almost one-third of patients (28%) screened positive for ADHD, most commonly hyperactive/impulsive and combined subtypes. They were significantly younger than their peers and there were no significant differences in behavioural disturbance records between groups. When controlling for age, hyperactive/impulsive symptoms and combined symptoms were significantly and positively correlated with measures of behavioural disturbance. ADHD symptoms correlated more strongly with self-harm than outward aggression, which is a novel finding. This pilot study has contributed to the knowledge base about the rate and functional problems of female offenders with ADHD. Future research should replicate the study using a larger sample and explore the effect of treatment (pharmacological and psychological) on the reduction of ADHD symptoms, behavioural disturbance, length of stay and quality of life., Competing Interests: Conflict of interest: SY, GG and PA have received honoraria for consultancy, travel, educational talks and/or research from Janssen-Cilag, Eli-Lilly, Shire, Flynn-Pharma, Novatis and/or HB Pharma. All honoraria for PA are paid to Kings College London. SY and PA were members of the NICE guideline development group for ADHD. Other authors have no conflicts of interest in this paper.

Published
2014
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