Attention Deficit Hyperactivity Disorder

Attention deficit hyperactivity disorder (ADHD) is the most common psychiatric disorder in children and young people, affecting at least one child in every classroom worldwide on average.  Continued problems with inattention and impulsivity remain in up to 60 – 80 % of children with ADHD when they reach adulthood, demonstrating the chronic nature of this disorder, and also the implications on the well-being of people with ADHD – as ADHD often adversely affects one’s ability to perform in the workplace, and interpersonal relationships, for example.

 

The Brain Dynamics Centre has been involved in three recent research programs on ADHD in children and young people:

 

1.  ARC-linkage study: Press Release (Feb 2010):

- Status: Completed

The accuracy and efficiency of identifying Attention Deficit Hyperactivity Disorder (ADHD) in young people could improve by close to 30 per cent thanks to a new testing method developed by a consortium of researchers with principal investigators at The University of Sydney.

 

With their consortium partners, The University of Sydney researchers, based at the Brain Dynamics Centre at Westmead Millennium Institute, trialed the efficacy of specific brain function related tests in detecting ADHD in 175 children/adolescents with ADHD, and 175 unaffected children/adolescents.  They found they could pinpoint young people with ADHD with 96 per cent accuracy through the tests, which detected variations in sustained attention, impulsivity, inhibition, intrusions and response variability.  This accuracy also means that unaffected children/adolescents are not detected falsely.  Previously, tests that focused solely on attention have only been able to identify ADHD with around 70 per cent accuracy.

 

The tests were conducted using a computer tool (called ‘IntegNeuro’), which has been developed by Brain Resource, based on evidence from a global database.  The tool helps identify patients through game-like tasks that challenge the brain, putting it under increasing load to see how it performs.  With computerization, the variations in ADHD can be detected with much greater efficiency, making this information a lot more accessible to the clinician for their decision-making.

 

The University of Sydney Professor of Cognitive Neuropsychiatry, Leanne Williams, said the research showed for the first time that accurate and efficient assessment of ADHD could be achieved through cognitive testing in a way that can be translated into clinical practice.  This research appears in the February edition of the scientific journal, Pediatric Neurology, and is supported by an ARC linkage grant.  The research study has been expanded to include another 500 young people, and medication trials with NHMRC support.

 

“ADHD is of immense concern with at least one child affected in every classroom worldwide,” Professor Williams said.

 

“Our study has shown for the first time that there is a biological basis to ADHD which can be reliably tested to diagnose it.”

 

“There is currently no consensus on objective medical tests to help doctors and families make diagnostic and treatment decisions for ADHD, which is in stark contrast to many other areas of medical health, such as the oral glucose test for diabetes, and skin biopsies for skin cancer.”

“The success of this research means there could be value in examining whether other mental health issues could be diagnosed through brain-based testing such as anxiety and conduct and learning disorders.”

 

Professor Williams said she hoped her team’s research would provide an effective tool to support doctors in making their clinical decisions:

 

“Many of the concerns we hear about ADHD are around the rights and wrongs of medicating a child.  For clinicians and parents there is great peace of mind knowing that there is evidence that a child has some physical or biological change that makes it necessary to be medicated.  “That’s what we had in mind as we tried to find a highly accurate but still efficient test that could be used,” Professor Williams said.  “Testing hasn’t been prevalent until now because of the question of accuracy and the lack of tests that can be easily done in the clinic”.

 

Professor Williams said tests that are currently available for ADHD focus on problems of attention alone.  In addition to assessing attention, the new testing her team developed also focuses on how variable or ‘scattered’ young people are, as well as how impulsive they are.  By examining all these elements, you improve the overall accuracy of the assessment.  Thus, young people simply disinterested in the testing are not wrongly detected as having ADHD.

This testing method and computer tool is already in use in Sydney and Adelaide, and has recently been adopted for extensive use in Israel.  Future goals will include incorporating the use of these assessment tools in general practice clinics throughout Australia.

 

Brain Resource was the industry partner on the ARC linkage grant supporting this study.

 

Reference:

1. Williams, L. M., Hermens, D. F., Thein, T., Clark, R. C., Cooper, N. J., Clarke, S. D., Lamb, C., Gordon, E., Kohn, M. R. (2010) Using brain-based cognitive measures to support clinical decisions in ADHD. Pediatric Neurology. 42(2): 118-126.

 

This research featured on the following media outlets:

BRAINnet Challenge 2010:

 

2. The ACTION study: A randomized cross-over trial assessing anxiety and Integ Neuro™ (with emotion task) to determine who best responds to a non-stimulant.

- Status: Currently underway

This study is investigating the efficacy of Atomoxetine (ATMX) in improving both cognitive and emotional function, using objective tests and indicators of clinical improvement.  The outcomes of this project will be a significant step towards a “personalized medicine” approach to ADHD, providing clinicians with increased options in the treatment of ADHD.  Should ATMX prove to be efficacious for stimulant non-responders, it would contribute to reducing the significant social and financial burden of this disorder.

 

Participants are invited by the participating clinicians only if non-stimulant treatment is a real and viable option to their care.  Recruitment ended in April 2010.

 

3. iSPOT-A:

- Status: Starting this year

The iSPOT-A study aims to look at which ADHD patients respond best to non-stimulants and stimulants, based on various markers (IntegNeuro™, electroencephalography, and optional DNA and magnetic resonance imaging).  The Brain Dynamics Centre will be recruiting participants for this study over a two-year period.

 

If you would like to take part in the research,  or learn more about it,  please contact  Dr. Tracey Tsang (ADHD Coordinator)  on (02) 9845 8195.

Or email info@brain-dynamics.net for attention to Dr. Tracey Tsang.

 

See more: http://www.pedneur.com/article/S0887-8994(09)00400-7/abstract


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