The 7th World Congress on ADHD (Attention Deficit Hyperactivity Disorder) was held 25 – 28 April 2019 in Lisbon. It is an international conference attended by psychiatrists, specialist, researchers and service users (i.e. patients, partners/family members, carers) from all over the world. For Consultants Cyrus Abbasian and Adam Joiner it was their first time attending such a conference, but for Jane Sedgwick, it wasn’t – she’s an old hand and was invited to chair a seminar and speak about the positive aspects of ADHD from both a personal and professional perspective.
There are many specialists worldwide, especially in North America, working in the field of ADHD. Many subjects were covered, including genetics, well-being measures, long-term outcomes, dual diagnosis with drugs and alcohol, whether or not to treat sub-clinical presentations, as well as comorbidity with other mental health and physical health conditions.
ADHD is a neurodevelopmental disorder characterised by impairing levels of inattention, impulsivity and hyperactivity. It begins before the age of 12 years old and can persist for a lifetime. It became apparent that ADHD in adults remains under diagnosed in the UK and the rest of Europe. Due to a lack of services, many patients diagnosed as children or adolescents, transition into adulthood tend to fall through the treatment net.
First line treatment for adults with ADHD
According to the NICE 2018 guidelines, is stimulant medication. However, psychosocial interventions plus general well-being measures remain crucial components of multi-modal treatment approaches. This includes psycho-social support for service users, including psychoeducation, CBT (cognitive behavioural therapy), reasonable adjustments with education and at work. Social prescribing such as a Mediterranean diet, mindfulness and exercise can also help. There are recognised associations with eating disorders such as binge eating disorders, obesity and ADHD, with health benefits gained from weight reduction, tobacco, drugs and alcohol cessation.
Sleep is important. Symptoms of ADHD and stimulant medication can perpetuate sleep problems (i.e. sleepiness during the day and insomnia at night). Sleep hygiene measures such as not smoking or exercising before bedtime should be offered as advice.
Other important areas covered in Lisbon included women being under diagnosed due to different presentations, and on whether subthreshold ADHD should be treated. All patients are different and so it is crucial to evaluate distress and functional impairments associated with symptoms before giving a diagnosis and initiating treatments, using a shared-decision making framework.
A comprehensive lifelong history should be taken and consideration given to preventative measures, including advice to women of childbearing age and well-being during pregnancy. A number of environmental factors are said to precipitate ADHD including complication during pregnancy, prenatal exposure to alcohol, smoking, low birth weight and birth trauma.
Overall ADHD has a large psychosocial and educational aspect. There are merits with attending self-help groups. Some of these are online and and utilisation of digital technology, including new applications can assist in managing the impairments associated with the core symptoms of ADHD, such as disorganisation and procrastination.
In Psychiatry-UK both Cyrus and Adam can arrange an online medical consultation at short notice, and offer recommended treatments. Jane can undertake a more comprehensive needs assessment in accordance with the Equality Act 2010 and offer recommendations for reasonable adjustments within higher education and at work, as well as psycho-social interventions such coaching and CBT.
Dr Adam Joiner – Adult ADHD Clinical Lead for Psychiatry-UK.
Dr Cyrus Abbasian – Addictions Lead for Psychiatry-UK and one of the Adult ADHD specialists.