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A group of researchers presented on executive dysfunction and altered response to reward and punishment in children with attention-deficit/hyperactivity disorder (

) at the 2022 American Professional Society of ADHD and Related Disorders (APSARD) virtual conference. The presentation, “Reinforcement/Reward Mechanisms, Response to Punishment by Country: Interventions for Executive Functioning,” emphasized the behavioral and cognitive differences in children with ADHD compared to the children without ADHD, and the implications for treatment.

Gail Tripp, PhD, professor and vice president for university community services at Okinawa Institute of Science and Technology (OIST) Graduate University, discussed the neurological basis of behavioral and cognitive difficulties experienced by children with ADHD and suggested some ways behavioral parent training can be revised to more effectively account for these difficulties. She stated that children with ADHD are more sensitive to positive reinforcement than other children, but perform tasks more similarly to other children under continuous reinforcement. Under conditions of partial or discontinuous reinforcement, these children have poorer/slower learning outcomes, demonstrate more variable responding, and experience more frustration.

Tripp added that children with ADHD are less able to adapt their behavior to situational demands; demonstrate slower/poorer behavior adaptation to changing environmental expectations; and tend to give up easily when they perceive tasks as too punishing or difficult. They are also more likely to adapt their behavior based on changes in reward availability and to engage in avoidant behaviors when exposed to punishment. Specifically, they show a greater preference for smaller, sooner rewards than for larger, later rewards; become more frustrated when expected rewards are delayed or do not appear; and are more likely to respond prematurely to reduce wait times for rewards, potentially resulting in suboptimal choices or decision-making.

Tripp recommended that parents, teachers, and caregivers pay particular attention when children with ADHD become less persistent or start refusing to engage in tasks, respond more impulsively, or become emotional or frustrated, especially if the children are also experiencing punishment. Other recommendations included using immediate reinforcement; clearly outlining expectations and any reminders in a calm, non-punitive manner; highlighting the outcomes of children’s behavior with particular attention to rewards; ensuring that waiting times for rewards are within the child’s capacity and that non-immediate rewards are salient; and avoiding the extended use of punishment.

Meanwhile, Adele Diamond, PhD, Canada Research Chair and professor of developmental cognitive neuroscience at the University of British Columbia,, discussed the impact of stress on executive dysfunction in children with ADHD, as well as some interactions between cognitive function and stimulant treatment in these children. She stated that the prefrontal cortex is particularly vulnerable to the effects of even mild stress, which impairs executive functions and causes higher levels of dopamine in the prefrontal cortex. Executive functions have been found to be predictive of academic and career success, but stress can significantly inhibit executive function in children with ADHD, thus potentially impacting their potential.

Diamond offered several suggestions for ways families, caregivers, and teachers may help these children maximize executive function at home and at school, including helping children reduce their stress levels; encouraging them to believe in themselves and do things that give them joy; giving them doable challenges with positive reinforcement; avoiding rushing them during tasks; and ultimately rethinking the purported benefits of stress. Other activities she suggested that may help reduce stress and improve executive function in children with ADHD include being out in nature, exercising, storytelling, asking children to help find creative solutions to problems, and use of mindful movement practices.

1. Molina B, Tripp G, Diamond A, Weiss M. Reinforcement/reward mechanisms, response to punishment by country: interventions for executive functioning. Presented at 2022 APSARD Conference. January 14, 2022.

How do children with ADHD respond differently to reward and punishment, and how can we help them improve their executive functions?

Reinforcement/Reward Mechanisms: Interventions for Executive Functioning

Researchers from the Geha Mental Health Center, Mount Sinai, and Cambridge Health Alliance presented on the connections between attention-deficit/hyperactivity disorder (

) and childhood infectious diseases—as well as 

—at the recent 2022 American Professional Society of ADHD and Related Disorders (APSARD) virtual conference.

Beth Krone, PhD, assistant professor of psychiatry at Mount Sinai’s Icahn School of Medicine, discussed ADHD’s relationship to innate and adaptive immunity among children and adolescents with ADHD. She summarized the key markers and processes of the immune system and the gene proxies that demonstrate how the immune system and the nervous system regulate one another, as well as relevant epidemiological literature and studies of health and diseases among individuals with ADHD.

Manor also discussed a population-based case-control study in which she and her colleagues examined the rates of infectious disease in children and adolescents with ADHD compared to a non-ADHD control group with similar demographics. They consulted the electronic medical records of 18,756 patients with ADHD and 37,512 controls without ADHD, all aged 5 to 18, with attention to the exposure categories 

. Results showed that the rates for all 3 exposure categories were significantly higher in the patients with ADHD than in the control group. According to Manor, this means children and adolescents with ADHD experience higher occurrences of childhood infectious diseases, receive more prescriptions for anti-infective medications, and have more visits with physicians and other medical experts, suggesting a clear connection between ADHD and childhood infectious diseases.

Manor described this connection as a major public health issue, especially during the COVID-19 pandemic, stating that the physicians who treat this patient population should keep in mind the vulnerability of these patients to infectious diseases. She also suggested that ADHD should be considered as a comorbidity in children and adolescents with ADHD who also suffer from multiple or frequent infectious diseases.

Margaret D. Weiss, MD, PhD, FRCP(C), medical director of inpatient psychiatry at Cambridge Health Alliance, discussed the connection between ADHD and risk of contracting COVID-19. She stated that ADHD is a specific risk factor for acquiring—and for being hospitalized with—COVID-19 in part because COVID-19 safety guidelines may be difficult for individuals with ADHD to follow, as these individuals may exhibit poor attention, hyperactivity, poor sense of social space, inability to follow instructions, and opposition to rules or mandates. She shared a few important take-home notes: Long COVID may have symptoms similar to those of ADHD and may exacerbate ADHD symptoms; Long COVID may lead to ADHD as a neurological syndrome like encephalitis after Spanish flu; and individuals with ADHD may also be more susceptible to experiencing somatic symptoms of COVID-19. According to Weiss, all these risks may be mitigated in part by effectively treating ADHD.

1. Manor I, Krone B, Weiss M. ADHD, infections, and the immune system. Presented at 2022 APSARD Conference. January 14, 2022.

What are the connections between ADHD, infectious diseases, and COVID-19?

ADHD, Infections, and the Immune System

A panel of researchers representing the American Professional Society of ADHD and Related Disorders (APSARD) Health Equity Task Force participated in an invited symposia on the effects of inequity on minority populations in relation to attention-deficit/hyperactivity disorder (ADHD) at the 2022 APSARD virtual conference on January 14.

“The task force was launched in relation to the amazing societal changes that are happening right now in front of us in association with the awareness that equity means creating fair, equitable opportunities for all of us,” explained Martin Katzman, MD, FRCP(C), APSARD board member, presentation chair, and APSARD Health Equity Task Force chair, told attendees. “We’re hoping to build connections within the APSARD community, to enhance diversity of the organization, and to reach out across boundaries as well as to partner within all of our communities to raise awareness and to increase opportunities for treatment for populations that may not get the same access to treatment.” Katzman is clinical director of the START Clinic for Mood and Anxiety Disorders.

On behalf of the task force, Amy Glasofer, DPN, RN, shared an analysis she conducted of 41 studies relating to ADHD, race, ethnicity, and disparity; Catherine Dingley, PhD, RN, FNP, FAAN, associate professor and director of the PhD program in the Nursing Department of the University of Las Vegas, Nevada, also worked on the project. According to Glasofer, a nurse scientist with Virtua, 66.7% of studies found that Black children were significantly less likely than white children to be diagnosed with ADHD, and 65% of Black children with ADHD were significantly less likely than white children to receive medication. In addition, compared to white children, she noted Black children were more likely to discontinue medication and more likely to experience gaps in treatment; less likely to receive an α-2 agonist alone; and more likely to receive significantly lower doses of stimulant. The findings suggest that, although diagnostic disparities have been reduced over time, treatment disparities still exist for minority children with ADHD.

Napoleon Higgins, MD, discussed the school-to-prison pipeline that disproportionately affects Black children and its connection to ADHD. Higgins, CEO and president of Bay Pointe Behavioral Health Service, Inc, explained that Black students are 3.5 times more likely to be suspended or expelled, and 1 in 4 Black children with disabilities are suspended compared to 1 in 11 white children with disabilities. In addition, Black children represent 15% of all youth, but 28% of all arrests; depictions of Black individuals as violent, aggressive, dangerous, and criminal persist and result in unconscious biases and associations. Zero tolerance policies and relegation to alternative schools due to behavioral issues also effectively push children from the classroom to the prison, with punishment prioritized over education and rehabilitation.

Higgins added that some behavioral issues may be caused by symptoms of ADHD. However, because missed diagnoses are common, the result is these children do not receive treatment, which may have lifelong detrimental consequences.Similarly, Black children with ADHD may not receive appropriate treatment due to treatment hesitancy—specifically, suspicion of the diagnosis, general mistrust of the medical community, lack of access to quality care, and the fear of mind control and potential medication-adverse events—which is common among Black families.

To combat the school-to-prison pipeline and these treatment disparities, Higgins suggested: increased education, interventions and services, flexibility, and understanding of cultural barriers among clinicians and families; an end to zero tolerance policies; and more teachers and counselors and less law enforcement in schools. He also suggested that clinicians conduct full diagnostic interviews with Black individuals, rather than relying solely on checklists or questionnaires, to avoid missing or misidentifying symptoms of ADHD.

J. Faye Dixon, PhD, professor in the University of California, Davis Medical Center, served as presentation cochair, and the symposia was moderated by Katzman; Brooke Molina, PhD, professor of psychiatry, psychology, and pediatrics in the University of Pittsburgh School of Medicine and director of the Youth and Family Research Program; and Roberta Waite, RN, professor and associate dean of community-centered health and wellness & academic integration at Drexel University.

1. Katzman M, Higgins N, Glasofer A, et al. Introducing the APSARD Health Equity Task Force. Presented at 2022 APSARD Conference. January 14, 2022.

How are minority children with ADHD affected by diagnostic, treatment, and educational inequities—and what can we do about it?

Introducing the APSARD Health Equity Task Force

Researchers from Syracuse University contributed a poster presentation discussing their research on the relationship between attention-deficit/hyperactivity disorder (ADHD) diagnosis, sexual health, and substance use among college students at the 2022 American Professional Society of ADHD and Related Disorders (APSARD) virtual conference.

In the poster presentation, “Sex, Drugs, and ADHD: Sexual Health and Moderators of Risk in College Students,” Ashley Rohacek, study coauthor, reviewed previous research suggesting links between ADHD diagnosis with earlier and more frequent sexual activity, and with increased likelihood of using alcohol and cannabis, as well as links between alcohol and cannabis use with more frequent sexual activity among the general population. As not much is known about the sexual health of college students with ADHD specifically, Rohacek stated that she and her coauthors aimed to learn more about it, as well as to consider alcohol and cannabis use as potential moderators of the ADHD-sexual health relationship among college students.

Rohacek et al conducted a secondary data analysis of the National College Health Assessment III. They asked sexually active undergraduate students (N=36,236) to report on their sexual activity (ie, number of sexual partners in the past year, condom use, etc), sexual health outcomes (ie, unplanned pregnancy, sexually transmitted illness [STI] diagnoses, etc), and substance use habits. The investigators used logistic regression models to compare sexual activity and health outcomes in students with ADHD with those of students without ADHD, using substance use as a risk moderator. Results showed that college students with ADHD reported more past-year sexual partners, lower rates of condom use, and higher rates of condom-less sex while drinking, thus significantly raising the risk among students with ADHD for STI diagnoses, unplanned pregnancy, and emergency contraception use.

According to Rohacek, these findings show that substance use is a significant moderator between ADHD and sexual health, and that college students with ADHD are differently impacted by substance use in ways that make them a more vulnerable population to poor sexual health outcomes. The findings also suggest that sexual health prevention strategies should specifically target individuals with ADHD who report substance use, and that future research should consider the impact of ADHD’s common comorbidity with other disorders associated with risky sexual activity.

The study’s additional coauthors included Madison Firkey, MS; Sarah E. Woolf-King, PhD; and Kevin M. Antshel, PhD, ABPP, all affiliated with Syracuse University.

1. Rohacek A, Firkey M, Woolf-King S, Antshel K. Sex, drugs, and ADHD: sexual health and moderators of risk in college students. Presented at 2022 APSARD Conference. January 15, 2022.

What is the connection between ADHD diagnosis with sexual activity and substance use among college students?

Sex, Drugs, and ADHD

Nearly 10% of children aged 2-17 have been diagnosed with attention-deficit/hyperactivity disorder (ADHD), nearly 8.1% of adults aged 18 to 44 in the United States have been diagnosed with ADHD, and 129 million children worldwide have ADHD.

 But how does a diagnosis of ADHD impact individuals’ lived experiences when they go to college?

Maricla Pirozzi, EdD, of Northeastern University contributed a poster presentation discussing the college experience for students with ADHD at the 2022 American Professional Society of ADHD and Related Disorders (APSARD) virtual conference.

The study discussed in the poster presentation, “The College Experience for Students with ADHD,” was based on semi-structured interviews with 8 students enrolled at Northeastern University who had been diagnosed with ADHD. The interviews prompted participants to answer questions relating to their disability identity and internal and external support systems. Pirozzi used a framework based on the Theory of Self-Determination by Richard Ryan, PhD, and Edward Deci, PhD, and analyzed the data using Interpretive Phenomenological Analysis.

Pirozzi found that early diagnosis and identification of ADHD, as well as strong support systems were very influential factors impacting students’ growth, academic success, self-awareness, and self-confidence during college. She further found that balancing internal and external motivations was key to students’ effectiveness and well-being, with internal motivations having a particular impact on student autonomy.

Pirozzi is associate co-op coordinator and director of Multidisciplinary Masters Co-op Programs in the Northeastern University College of Engineering.

1. Pirozzi M. The college experience for students with ADHD. Presented at 2022 APSARD Conference. January 15, 2022.

How does an ADHD diagnosis affect the college experience? Recent research allows the students to weigh in.

The College Experience for Students with ADHD

Margaret Sibley, PhD, in her session “Adult ADHD: Are We Missing It in Practice?” at the 2022 APSARD Virtual Conference, spoke about adult ADHD and specific diagnostic issues that might help clinicians make more precise diagnoses in clinical practice.

“A lot of people ask this question: Are we overdiagnosing ADHD or are we underdiagnosing ADHD?” said Sibley. “I think the answer to this question is that we're actually often misdiagnosing ADHD. There's both false positive and false negative diagnoses.”

The reasons, Sibley believes, behind the controversy over ADHD diagnoses are numerous and potentially include:

-Symptoms are subjective. No 2 people have the exact same symptoms.

-Symptoms overlap with other mental or physical health diagnoses.

Sibley shared that there are often 2 classes of people who are underdiagnosed: 1) individuals who are overlooked, meaning they come to clinical attention but do not receive an ADHD diagnosis, and 2) individuals who are not referred. Individuals in the second group may include those who were diagnosed with ADHD as children, but are no longer identified as someone with ADHD. This is supported by data from the Pittsburgh ADHD Longitudinal Study, Sibley explained, which demonstrated that when children with ADHD grew up, they expressed they were no longer experiencing ADHD symptoms even though their parents stated they were still observing ADHD symptoms in their children.

“One of the things that this translates into in real life is possibly people underutilizing treatment because they don’t acknowledge that their symptoms are still happening,” said Sibley.

According to longitudinal literature on ADHD, when children with ADHD grow up, they tend to struggle to complete higher education, have unstable employment histories and difficulties performing at work, struggle with substance abuse, have legal and financial problems, and have adulthood difficulties with self-esteem, shared Sibley.

Sibley encourages all clinicians to review the Canadian ADHD Resource Alliance (CADDRA) guidelines

 for treating ADHD and comorbid psychiatric disorders. “This is a really nice sort of framework for thinking about not only do I have the right diagnosis, but when I do have the diagnosis sorted out, what do I do first? What do I treat first? What can I treat at the same time? What modalities of treatment should I use?”



Sibley also views motivational interviewing as a really important tool in the initial treatment arsenal. “It's important for us to frame the symptoms of ADHD during clinical assessment in the proper developmental context for the person that we're sitting across from. The appropriate environmental context considering what their life demands are, and the cultural context that the person lives in. We should feel equipped to be able to recognize ADHD in these contexts.”

1. Molina BSG, Sibley MH, Pedersen SL, Pelham WE. 

The Pittsburgh ADHD Longitudinal Study (PALS).

Attention Deficit Hyperactivity Disorder: Adult Outcome and Its Predictors

2. Canadian ADHD Practice Guidelines, 4.1 Edition. ADHD Institute; 2020. Accessed January 14, 2022. 

https://www.caddra.ca/canadian-adhd-practice-guidelines/

Is ADHD underdiagnosed or overdiagnosed? One doctor emphatically says the former. 

Did You Miss It? Adult ADHD Diagnosis

College students with attention-deficit/hyperactivity disorder (ADHD) and college students who identify as a sexuality and gender minority (SGM), respectively, have an increased risk for functional impairments, psychiatric comorbidities, and engagement in risky behaviors.

 According to Destiny Orantes, PhD, from Syracuse University, and her colleagues, research had not previously considered if these negative outcomes are further increased in SGM students who have ADHD. In a poster presentation at the American Professional Society of ADHD and Related Disorders (APSARD) 2022 virtual conference, Orantes and her colleagues shared their findings from their recent research on the topic.

The study aimed to examine the prevalence of ADHD in SGM college students, on top of assessing functional impairments, psychiatric comorbidities, and engagement in risky behaviors in 4 groups: 1) SGM students with ADHD, 2) SGM students without ADHD, 3) non-SGM students with ADHD, and 4) non-SGM students without ADHD. Data from the American College Health Association-National College Health Assessment 2019-2021 (ACHA-NCHA) III were used.

“This study used measures that collected information about demographic, diagnosis of psychiatric conditions, overall psychological well-being, level of distress, engagement in risky behaviors, and academic performance,” Orantes explained.

Orantes and her colleagues found ADHD prevalence was increased in SGM populations, 15% compared to 8% in non-SGM individuals. Additionally, the group of SGM students with ADHD reported the highest levels of functional impairments, substance use, and psychiatric comorbidities.

The research suggests, Orantes said, that future studies should consider the underlying reasons for high rates of SGM students with ADHD, and how best to reduce these negative outcomes. Specifically, treatment plans should take into account the separate difficulties students face from their ADHD diagnosis and their SGM identities, as well as how best to target the risky behaviors and comorbidities.

1. Auerbach RP, Mortier P, Bruffaerts R, et al. 

Mental disorder comorbidity and suicidal thoughts and behaviors in the World Health Organization World Mental Health Surveys International College Student initiative.

College students who identify as a sexual and gender minority who also have ADHD may be at higher risk of functional impairments, substance use, and psychiatric comorbidities. 

ADHD in Sexual and Gender Minority College Students

Helicopter parenting is understudied, especially in parents of adolescents with attention-deficit/hyperactivity disorder (ADHD). At the American Professional Society of ADHD and Related Disorders (APSARD) 2022 virtual conference, Brooke Molina, PhD, of the University of Pittsburgh and her colleagues presented a poster detailing their findings on the psychometric properties of helicopter parenting in adolescents with ADHD.

“Most people have heard of the over-involved and controlling helicopter parent before, but this is a relatively new field of study,” Molina stated.

Helicopter parenting was established as a distinct form of parental control, separate from behavioral or psychological, in 2012.

 Molina shared that most research on helicopter parenting was conducted with college-aged participants, leaving a gap in knowledge about effects on adolescents—a gap she and her colleagues hoped to fill.

Molina and colleagues evaluated responses from 341 parents and 333 adolescents aged 13 to 18 with ADHD enrolled in a study on efficacy of primary care physician training on stimulant diversion prevention, in the hopes of examining the factor structure of helicopter parenting in adolescents ADHD.

Assessing statements included items like:

-“I make important decisions for my teen (eg, which classes to take, what activities to do, if and where they work).”

-“My parents take over when I have problems with friends.”

-“I manage my teen’s money for them.”

-“My parents solve any crisis or problem I might have.”

-“My parents make plans for me to hang out with friends.”

A 2-component solution best fit their data. The first parenting type, labeled “intervention helicopter parenting,” encapsulated how likely parents were to intervene when their child has a problem or a decision to make. The second parenting type, “monitoring/short-term planning helicopter parenting,” characterizes how likely parents were to provide ongoing oversight or make plans for their child.

Higher averages of both types together were found in single parent homes. Higher averages of intervention helicopter parenting were found in families of a marginalized racial or ethnic identity (t(89.8)=2.73, p <.01), or if the child was assigned male sex at birth (t(157)=2.79, p <.01), and was positively associated with parental warmth (r =.18, p <.01). Monitoring/short-term planning helicopter parenting was higher amongst parents who had younger adolescents.

Both helicopter parenting types were associated with higher parental knowledge of the child’s activities and correlated with positive parenting.

Molina concluded that more research is needed to determine if these behaviors are adaptive.

Black hawk down?: Establishing helicopter parenting as a distinct construct from other forms of parental control during emerging adulthood.

Helicopter parenting in teens with ADHD: What are the types and how do they affect children?  

Helicopter Parenting & Adolescents With ADHD: Associations and Conclusions

Treatments recently approved by the US Food and Drug Administration (FDA) for pediatric patients with attention-deficit/hyperactivity disorder (ADHD) include 2 medications that address some of the common issues associated with standard stimulant treatments. Another development is use of devices to manage ADHD symptoms (

Methylphenidate hydrochloride (Jornay PM), a delayed-release/extended-release methylphenidate, was approved by the FDA in 2018 and became commercially available in 2019. It differs from the other methylphenidate-based stimulants in that it is administered before bedtime—between 6:30 pm and 9:30 pm—to take effect in the morning when the child rises.

This delayed action addresses a common problem many families face when stimulants are administered upon rising: Patients are focused and ready to work by the time school starts, but 

, which adds burden on caregivers. Results from a randomized controlled trial published in April 2021 found that this formulation does indeed help in that respect. Investigators found a marked decrease in self-reported caregiver strain after 3 weeks of treatment.

 Moreover, data presented by the manufacturer show that the effect of Jornay PM lasts through the school day and into the evening.

In April 2021, the FDA approved viloxazine (Qelbree) for treatment of ADHD in patients aged 6 to 17 years.

 Like atomoxetine hydrochloride (Strattera), Qelbree is a selective norepinephrine reuptake inhibitor (SNRI). These drugs join the alpha-2 agonists (eg, clonidine hydrochloride extended-release [Kapvay], guanfacine extended-release [Intuniv]) as options for families who do not feel comfortable giving children Schedule II stimulants or for patients for whom 

Like other SNRIs used to treat depression, Qelbree and Strattera carry black-box warnings about an increase in 

 in the first months of treatment, particularly among teenaged patients. Psychiatrists should remember that many drugs carry this warning and treatment benefits may well outweigh the risks. 

 show a 2% greater incidence of suicidality than placebo, and use of these medications has been not associated with successful suicide attempts.

 However, these medications are generally less effective than stimulants in treating 

. Patients who are not responsive to either stimulants or nonstimulants alone may be helped by combination therapy.

The FDA has also recently approved 2 devices for treatment of ADHD in children. Clinicians should note that the standard for FDA approval is lower for devices than for drugs. Although drugs must prove both safety and efficacy, devices need only prove safety.

The first device is the Monarch external Trigeminal Nerve Stimulation (eTNS) System, a trigeminal nerve stimulator. Unlike the vagal nerve stimulator used to control epileptic seizures, this therapy does not require surgical insertion. The trigeminal nerve stimulator sits on the face. A small-scale study using data from the device manufacturer suggests that about half of 

 patients responded to use of this device.

In the digital therapeutics category, the FDA has also approved use of a video game called EndeavorRx to treat ADHD. The sensory stimulus and motor challenges of the game target the neural pathways that govern focus and attention. Studies sponsored by the device’s manufacturer suggest that the prescribed use of the game improves attention and has few adverse effects.

Either or both of these devices may prove to be valuable adjuncts to medication and behavior management. More evidence of effectiveness would be helpful in guiding clinical decisions.

One of the most important developments in ADHD treatment is not a device or medication, but the rise of telemedicine. Early in the COVID-19 pandemic, most large private insurance companies and the Centers for Medicare & Medicaid Services (CMS) waived the requirement that patients be seen in person—even when those patients are being started on Schedule II stimulants. 

 visits offer advantages, particularly when it comes to evaluating patients’ functional abilities. Some psychiatrists prefer to see children in their natural setting, where children are often quite a bit more hyperactive than they are in a doctor’s office.

Another odd benefit of the pandemic is that many 

have developed an increased appreciation for going to school. Patients with ADHD tended to struggle more with remote learning than their non-ADHD classmates. There are too many distractions at home, including the option of playing a video game while appearing to be in the virtual classroom. Most children with ADHD simply find it easier to concentrate when they are physically in school, and many patients with ADHD say they are glad to be back in school. That is not something they would have expressed before the pandemic lockdown!

is a practicing child and adolescent psychiatrist in the San Francisco Bay area. As a member of the faculty of 

, he co-leads the institute’s 3-day course that trains pediatric primary care providers to diagnose and manage common mental health conditions.

1. López FA, Faraone SV, Newcorn JH, et al. 

Effect of delayed-release and extended-release methylphenidate on caregiver strain and validation of psychometric properties of the Caregiver Strain Questionnaire: results from a phase 3 trial in children with attention-deficit/hyperactivity disorder

2. Gomeni R, Komolova M, Incledon B, Faraone SV. 

Model-based approach for establishing the predicted clinical response of a delayed-release and extended-release methylphenidate for the treatment of attention-deficit/hyperactivity disorder

3. D’Arrigo T. FDA approves Qelbree for ADHD. News release. American Psychiatric Association; May 20, 2021. Accessed November 20, 2021. 

https://psychnews.psychiatryonline.org/doi/full/10.1176/appi.pn.2021.6.12

Do antidepressants increase the risk of suicide in children and adolescents?

5. Treuer T, Gau SS-F, Méndez L, et al. 

A systematic review of combination therapy with stimulants and atomoxetine for attention-deficit/hyperactivity disorder, including patient characteristics, treatment strategies, effectiveness, and tolerability

Trigeminal nerve stimulation for attention-deficit/hyperactivity disorder: cognitive and electroencephalographic predictors of treatment response

7. Kollins SH, DeLoss DJ, Cañadas E, et al. 

A novel digital intervention for actively reducing severity of paediatric ADHD (STARS-ADHD): a randomised controlled trial

What treatments were recently approved by the US Food and Drug Administration for pediatric patients with ADHD?

Advances in Treatments for ADHD

According to a new nationally representative study, 1 in 4 adults aged 20 to 39 with attention deficit hyperactivity disorder (ADHD) have 

 (GAD), and individuals with ADHD are 4 times more likely to have GAD at some point in their life, when compared to those without 

Other relevant factors, such as sociodemographics, adverse childhood experiences, and a lifetime history of substance use disorders and major depressive disorders were controlled; individuals with ADHD were still more than twice as likely to have GAD.

“These findings underline how vulnerable adults with 

 are to generalized anxiety disorders. There are many studies linking adult ADHD to depression and suicidality, but less attention has been paid to generalized activity disorders and other adverse outcomes across the life course,” lead author Esme Fuller-Thomson said. Fuller-Thomson is a professor at the University of Toronto’s Factor-Inwentash Faculty of Social Work and Director of the Institute for Life Course & Aging.

Investigators examined a nationally representative sample of 6898 respondents from the Canadian Community Health Survey-Mental Health aged 20 to 39. Of those surveyed, 272 had ADHD and 682 had GAD. They found female respondents with ADHD had nearly 5 times higher odds of GAD, even after controlling for other covariates.

“ADHD has been severely underdiagnosed and undertreated in girls and women,” said coauthor Andie MacNeil, a Master of Social Work graduate from the University of Toronto. “These findings suggest that women with ADHD may also be more susceptible to experiencing anxiety, emphasizing the need for greater support for women with ADHD.”

Additionally, adults who had experienced adverse childhood experiences such as childhood sexual or physical abuse or chronic parental 

 were 3 times more likely to have GAD, and 60% of those with ADHD who had anxiety disorders had experienced at least 1 of these adverse childhood experiences.

Having an income below $40,000, having fewer close relationships, and having a lifetime history of major depressive disorder were amongst the other factors associated with GAD among adults with ADHD. The odds of GAD for individuals with ADHD were 6-fold if they had a lifetime history of major depressive disorder.

“These results highlight the importance of screening for mental illness and addressing depressive symptoms when providing support to those with ADHD,” said Lauren Carrique, a recent graduate of University of Toronto's MSW program who is a social worker at Toronto General Hospital. “Individuals experiencing ADHD, GAD, and depression are a particularly vulnerable subgroup that may need targeted outreach by health professionals.”

1. Fuller-Thomson E, Carrique L, MacNeil A. 

Generalized anxiety disorder among adults with attention deficit hyperactivity disorder.

2. University of Toronto. Adults with ADHD four times more likely to have generalized anxiety disorder. News release. November 18, 2021. Accessed December 13, 2021. 

https://www.eurekalert.org/news-releases/935302

Individuals with ADHD are 4 times more likely to have generalized anxiety disorder at some point in their life. 

ADHD