Heidi Anne Duerr, MPH

Steven Pliszka, MD, chair of The American Professional Society of ADHD [attention-deficit/hyperactivity disorder] and Related Disorders (APSARD) annual program committee, joined Jeffrey Newcorn, MD, APSARD president, in welcoming attendees to their virtual 2022 Annual Meeting, noting the conference was putting attendees “on the ground floor of exciting developments in the field.” Pliszka said the conference would highlight issues in genetics, neuroimaging, psychological variables, and environmental variables. “I think we’re moving to really integrating all these different aspects so we can think much more broadly about where ADHD fits into psychopathology in general,” he added. “And it will get us thinking more about new ways to intervene and to treat people.”

The 4-day meeting was held January 13 to 16, 2022. In-depth coverage can be found online at 

www.psychiatrictimes.com/conferences/apsard

As separate groups, college students with ADHD and college students who identify as a sexuality and gender minority (SGM) have increased risk for functional impairments, psychiatric comorbidities, and risky behaviors.

 According to Destiny Orantes, PhD, from Syracuse University, and colleagues, previous research had not considered if these outcomes are further increased in SGM students who have ADHD. Orantes shared findings from their recent research in a poster presentation.

The study assessed 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 III were used. The researchers also sought to examine the prevalence of ADHD in SGM college students.

They found ADHD prevalence increased in SGM populations: 15% compared with 8% in non-SGM individuals. Additionally, SGM students with ADHD reported the highest levels of functional impairments, substance use, and psychiatric comorbidities.

The research results suggest, Orantes said, that future studies should consider the underlying reasons for SGM students having high rates of 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; WHO WMH-ICS Collaborators. 

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

“The [APSARD] task force was launched in relation to the amazing societal changes that are happening...in association with the awareness that equity means creating fair, equitable opportunities for all of us,” Martin Katzman, MD, FRCP(C), 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.”

Amy Glasofer, DPN, RN, nurse scientist with Virtua, shared an analysis of 41 studies relating to ADHD, race, ethnicity, and disparity; Catherine Dingley, PhD, RN, FNP, FAAN, associate professor in the Nursing Department of the University of Las Vegas, Nevada, also worked on the project.

They found 66.7% of studies noted 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 α2 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.

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

“ADHD in preschool children is a valid and reliable condition,” reported Ann Childress, MD, president of the Center for Psychiatry and Behavioral Medicine, Inc, in Las Vegas, Nevada.

According to the 2014 National Survey of Diagnosis and Treatment of ADHD and Tourette’s, 30% of children diagnosed with ADHD receive their diagnosis before age 6; 16% receive the diagnosis at 4 years or younger.

 Impairment can be great for these patients, Childress said. For example, an epidemiological review of preschoolers diagnosed with ADHD found more than 40% had been suspended from school or daycare and about 16% had been expelled.

 In comparison, less than 1% of young children without ADHD were suspended.

The actions of young children with ADHD pose safety risks to themselves due the higher levels of hyperactive impulsivity, she said. “These are kids who are running out in traffic. They’re jumping off of things and breaking bones. They’re doing things that are dangerous, and they really need treatment for their safety,” she explained.

Childress reviewed efficacy and safety data for a number of common medications, noting some small behavior improvements as a result of the study medications. However, medications were associated with adverse events, including insomnia, gastrointestinal issues, irritability, sedation, and repetitive behaviors and thoughts. She also noted not all of these medications have been approved for the youngest patients.

Fortunately, there is good evidence for the efficacy of nonpharmacological interventions for preschoolers with ADHD, Childress reported. The New Forest Therapy, Helping the Noncompliant Child, and the Incredible Years series were among the programs she noted that have demonstrated efficacy. Furthermore, she spoke highly of parent training models that foster the implementation of positive reinforcement to promote positive behaviors; ignoring low-level provocative behaviors; and responding in a clear, consistent, and safe manner to unacceptable behaviors.

“You have to carefully consider both developmental aspects and comorbidity when you’re establishing a diagnosis, and the medication efficacy and tolerability profile may not look as good in the little guys as it does in older children,” she concluded.

1. Visser SN, Zablotsky B, Holbrook JR, et al. 

Diagnostic experiences of children with attention-deficit/hyperactivity disorder.

The epidemiology and diagnostic issues in preschool attention-deficit/hyperactivity disorder: a review.

This article was originally published by sister publication Psychiatric Times.

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Catch up on all the latest in ADHD from the The American Professional Society of ADHD (attention-deficit/hyperactivity disorder) and Related Disorders (APSARD) virtual 2022 Annual Meeting. 

ADHD highlights from the 2022 ASPARD meeting

Virtual schooling during the pandemic presented challenges that might have long-term effects on children and adolescents, according to 

. Wagner discussed findings from numerous studies looking at the well-being of youth and their parents as a result of virtual instruction at the 

2021 Annual Psychiatric TimesTM World CME Conference

Wagner, who is professor and chair in the Department of Psychiatry and Behavioral Sciences at University of Texas Medical Branch, reported there have been increases in anxiety, obsessive compulsive disorder, conduct problems, pro-social behavioral problems, sleep issues, and worsening of preexisting mental health disorders. This, in turn, resulted in increased mental health related visits to the emergency department. Children at highest risk for increased psychiatric and behavioral problems included youth who were disadvantaged or refugees as well as those who had a chronic disorder, adverse childhood experiences, a preexisting mental health disorder, added Wagner, who also immediate past president of the American Academy of Child and Adolescent Psychiatry and member of 

The impact of virtual schooling went beyond the computer as a classroom and affected other areas of well-being, Wagner said. In a nationwide survey of parents (N = 1290) of children aged 5 to 12, for instance, children who attended virtual school were more likely to have decreased physical activity as compared with those students attending school in-person and combined in-person and virtual school (62.9%, 30.3%, and 52.1%, respectively.1 Virtual students also reported less time spent outdoors, less time spent with friends virtually, and less time spent with friends in person. Similarly, 24.9% of students attending virtual school reported worsened depression and anxiety compared with 24.7% of those in combined schooling and 15.9% of those attending in-person.

The impact was also felt by the parents. In comparison to parents whose children attended in-person or combined schooling, parents whose children attended virtual school were also more likely to report loss of work, child care challenges, conflict between working and providing child care, emotional distress, and difficulty sleeping.1

Negative impact on youth was not seen only in the United States, but also in countries around the world. For instance, Wagner discussed the results of a cross-sectional survey of 367 students in Saudi Arabia.2 The investigators found 55% of respondents had moderate stress while 30.2% had high stress levels.

Youth with attention-deficit/hyperactivity disorder (ADHD) and their parents especially struggled with the virtual schooling world, Wagner added. In one study of 239 adolescents, 118 of whom had ADHD, investigators found those with ADHD had fewer routines and more difficulties with remote learning.3 Parents of adolescents with ADHD reported more difficulty in supporting home learning and home school communication. Even parents whose children with ADHD had an individual education program reported remote learning was more challenging. To help support remote learning, 22% of families incurred financial costs.

As a result of the pandemic, Wagner noted the American Academy of Child & Adolescent Psychiatry and the American Psychiatric Association devised a list of recommendations for virtual schooling.4 The groups noted that education, including school attendance, is an essential component of health development. When classroom-based education is not possible, the groups said it is a priority to find methods that optimize social interaction. Importantly, they noted additional resources should be made available for children with special needs, and the mental health of students must be continually addressed. They also advocated for systems that effectively and efficiently identify issues early and have means for interventions.

Ultimately, there are certain things needed to better support a virtual schooling system. “There needs to be access to mental health services, as well as individual educational programs, there also needs to be resources for disadvantaged youth,” Wagner concluded. “Attention has to be directed toward the importance of physical activity. And also, participation in extracurricular activities, as well as other peer group activities.”

1. Verlenden JV, Pampati S, Rasberry CN, et al. 

Association of children's mode of school instruction with child and parent experiences and well-being during the COVID-19 pandemic - COVID Experiences Survey, United States, October 8-November 13, 2020

. 2021;70(11):369-376. Published 2021 Mar 19.

Perceived stress among students in virtual classrooms during the COVID-19 outbreak in KSA.

3. Becker SP, Breaux R, Cusick CN, et al. 

Remote learning during COVID-19: examining school practices, service continuation, and difficulties for adolescents with and without attention-deficit/hyperactivity disorder

4. American Academy of Child & Adolescent Psychiatry and American Psychiatric Association. American Academy of Child and Adolescent Psychiatry (AACAP) and American Psychiatric Association (APA) Detail Steps Necessary for Safely Reopening Schools This Fall. Press release. July 2020. Accessed September 30, 2021. 

https://www.aacap.org/AACAP/Press/Press_Releases/2020/Needs_Students_During_COVID-19_Era.aspx

The pandemic caused the shut down of schools and resulted in virtual learning for most of the world's children and adolescents. How did they fare?


Heidi Anne Duerr, MPH

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ADHD highlights from the 2022 ASPARD meeting

How did virtual learning impact youth?