Training and Continuing Education on ADHD

Summary:
Recognizing ADHD can be noticeably clear for some and complex for others, in both children and adults. Parents may have a hard time determining if their child has ADHD or if their behavior is common for their age. There are different types of ADHD and ADHD can vary from person to person. There are signs and symptoms that can be determined to recognize ADHD in both children and adults. There are different factors that contribute to the development of ADHD. The diagnosis process consists of different factors as well.

Mary Solanto, PhD
Dr. Solanto is professor of pediatrics and psychiatry at the Hofstra-Northwell School of Medicine. Prior to joining Hofstra, she was director of the ADHD center in the department of psychiatry at the Mount Sinai School of Medicine, and an associate professor of psychiatry at the NYU School of Medicine. Dr. Solanto’s research on the cognitive and behavioral functioning of children with ADHD, the effects of psychostimulants, and the characteristics of the subtypes of ADHD has been supported by grants from NIMH, NICHD, and NINDS. She developed a novel cognitive-behavioral intervention to target problems of executive self-management in adults with ADHD, which was the focus of an NIMH-sponsored treatment efficacy study and published in the American Journal of Psychiatry. She authored the manual for therapists, Cognitive-Behavioral Treatment of Adult ADHD: Targeting Executive Dysfunction.

Learning Objectives:
Listeners will be able to:

1. Identify ADHD symptoms throughout the lifespan.
2. Describe the importance of interprofessional collaboration in treatment of ADHD.

Summary:
Four percent of adults in the US are diagnosed with ADHD. Adults with ADHD experience many of the same symptoms as children, including problems with self-regulation, attention, and behavior. However, adult ADHD has unique characteristics and increasingly co-occurs with other conditions. Dr. Craig Surman explains how ADHD is diagnosed in adults, the challenges they face, and how other conditions can mimic ADHD. He points out that unlike for children with ADHD, there is less support for adults with ADHD.

Craig Surman, MD
Craig Surman, MD, is an associate professor of psychiatry at Harvard Medical School and scientific coordinator of the adult ADHD research program at Massachusetts General Hospital. He is the author of Fast Minds: How to Thrive if You Have ADHD (Or Think You Might) and editor of ADHD in Adults: A Practical Guide to Evaluation and Management. Dr. Surman has directed or facilitated over fifty studies on the impact of ADHD in adults. He is co-chair of CHADD’s professional advisory board.

Learning Objectives:
Listeners will be able to:

1. Discuss the diagnosis of ADHD in an adult.
2. Describe the importance of interprofessional collaboration in treatment of ADHD.

Summary:
Behavioral interventions are one of two evidence-based classes of treatment for ADHD. Behavioral parent training (BPT), classroom behavior management, and interventions that target executive function challenges are examples of behavioral interventions. Key principles of behavior management apply across the different types of behavior treatment, and the age of a child will determine what type of intervention to use. BPT and classroom interventions are typically used for younger children, while older children, including teens, are taught strategies to cope with executive function challenges.

Margaret Sibley, PhD, associate professor of psychiatry and behavioral health at Washington School of Medicine, discusses the ADHD symptoms that children and teens struggle with and the behavioral interventions supported by research that can help to improve these symptoms. She also discusses the best times to implement these behavior therapies and the synergy between these strategies and medication management.

Margaret H. Sibley, PhD
Dr. Sibley, PhD, is an associate professor of psychiatry and behavioral sciences at the University of Washington School of Medicine and Seattle Children's Research Institute. Her work focuses on the diagnosis and treatment of ADHD in adolescents and young adults. She developed a parent-teen therapy for ADHD (Supporting Teens’ Autonomy Daily) that combines motivational interviewing and skills training for parents and teens. She has authored or coauthored more than 80 scientific papers on ADHD and published a book with Guilford Press on treating executive functioning and motivation deficits in teens. She is a member of CHADD’s professional advisory board.

Learning Objectives:
Listeners will be able to:

1. Explain the importance of integrating behavioral and other interventions for people with ADHD.
2. Describe the importance of interprofessional collaboration in treatment of ADHD.

Summary:
Complex ADHD is ADHD that co-occurs with one or more conditions that can complicate the symptoms of ADHD. Two-thirds of children with ADHD have at least one coexisting condition. These coexisting conditions may include oppositional defiant disorder (ODD), anxiety disorders, depression, learning disorders, autism spectrum disorders, intellectual disability, and tics (Tourette Syndrome).

Treatment of complex ADHD begins with treating the condition that is most prominent, and may involve behavior therapy, parent training, or medication. When medication is used, stimulants are the first line of treatment. Nonstimulant medications may be considered when stimulants do not work. If learning disorders coexist with ADHD, academic interventions are needed.

In this ADHD 365 podcast, Dr. Tanya Froehlich offers expert information on complex ADHD, focusing on the conditions that often coexist with ADHD. She discusses the recommended treatments based on research for each of the conditions, and the options available when first line treatments don't work.

Tanya Froehlich, MD, MS.
Dr. Tanya Froehlich is a professor of pediatrics at Cincinnati Children’s Hospital Medical Center in the division of developmental and behavioral pediatrics. She is a developmental-behavioral pediatrician and an ADHD clinical specialist. Dr. Froehlich serves on the national ADHD clinical practice guideline development committees for both the American Academy of Pediatrics and the Society for Development and Behavioral Pediatrics.

Learning Objectives:
Listeners will be able to:

1. Identify ADHD symptoms throughout the lifespan.
2. Describe the importance of interprofessional collaboration in treatment of ADHD.

Summary:
There are a number of medical conditions that can coexist with ADHD and complicate the disorder. These conditions include disruptive behavior disorders, like oppositional defiant disorder and conduct disorder; anxiety disorders; tics; mood disorders, including depression and bipolar disorder; developmental coordination disorder; learning disorders that result in difficulties with math and writing; and substance use disorders. Mental health issues are also prevalent in incarcerated populations.

In this podcast, Dr. L. Eugene Arnold discusses the prevalence of these conditions that can coexist with ADHD, how ADHD symptoms by themselves negatively affect functioning, and the negative impacts added to functioning when comorbid conditions are present. He provides diagnostic questions to ask when seeking to identify the presence of these co-occurring conditions, and gives advice on treatment for complicated ADHD.

L. Eugene Arnold, MD, MEd
L. Eugene Arnold, MD, MEd, is CHADD’s resident expert and professor emeritus of psychiatry at Ohio State University, where he was formerly director of the division of child and adolescent psychiatry and vice-chair of psychiatry. He is a co-investigator in the OSU research unit on pediatric psychopharmacology. He has over 38 years of experience in child psychiatric research, including the multi-site NIMH Multimodal Treatment Study of Children with ADHD (“the MTA”), for which he continues as executive secretary and current chair of the steering committee.

Learning Objectives:
Listeners will be able to:

1. Describe complexities of ADHD.
2. Describe the importance of interprofessional collaboration in treatment of ADHD.

Summary:
Are you curious about the natural history of ADHD? How does it manifest and present across the lifespan? We know that people with ADHD may have symptoms throughout their lifetime, but does it look the same from preschool to school-age to adolescence and adulthood? ADHD is often missed and underidentified and therefore undertreated.

In this Pocket MD podcast, Russell Schachar, MD, offers expert insight and advice on the various ADHD presentations found in different stages of human development, the impact of ADHD on life expectancy and quality of life, and understanding how interventions affect ADHD outcomes.

Russell Schachar, MD
Dr. Schachar is a practicing child and adolescent psychiatrist, a professor in the department of psychiatry at the University of Toronto, and senior scientist in the research institute at the Hospital for Sick Children in Toronto, Canada, where he holds the Toronto Dominion Bank Chair in Child and Adolescent Psychiatry. He is the head of a cognitive neurosciences laboratory which focuses on psychiatric disorders of childhood and adolescence.

Learning Objectives:
Listeners will be able to:

1. Identify ADHD symptoms throughout the lifespan.
2. Describe the importance of interprofessional collaboration in treatment of ADHD.

Summary:
The diagnosis of ADHD requires a thorough assessment, and treatment involves a combination of interventions, including medication, family education, and ongoing support.  Medications can improve focus and reduce impulsivity. Additional treatment is needed if a patient has a comorbid condition, such as a learning disorder, anxiety, depression, mood or conduct disorder.

Medication for ADHD should be considered when there is significant academic or social impairment, or there is a risk of accidental injury due to impulsivity or hyperactivity. Treatment for children and adults usually begins with a short-acting stimulant medication at a low dose, with slow adjustments to higher doses if necessary, or an eventual switch to extended-release preparations. Sometimes a combination of stimulant and nonstimulant medication can be effective.

In this Pocket MD podcast, neurologist Max Wiznitzer and psychiatrist Russell Schachar provide expert advice on the use of medication in the treatment of ADHD. They discuss the types of medication used to treat ADHD; when medication is needed; combined interventions; ongoing monitoring of patients; complementary approaches; and the importance of patient, family, and community education.

Max Wiznitzer, MD
Dr. Max Wiznitzer is a pediatric neurologist in the neurologic institute at Rainbow Babies and Children's Hospital in Cleveland, Ohio. He is also a professor of pediatrics and neurology at Case Western Reserve University School of Medicine.

Russell Schachar, MD, FRCPC
Dr. Russell Schachar is a practicing child and adolescent psychiatrist, a professor in the department of psychiatry at the University of Toronto, and senior scientist in the research institute at the Hospital for Sick Children in Toronto, Canada, where he holds the Toronto Dominion Bank Chair in Child and Adolescent Psychiatry. He is the head of a cognitive neurosciences laboratory that focuses on psychiatric disorders of childhood and adolescence.

Learning Objectives:
Listeners will be able to:

1. Explain the considerations of effective ADHD medication management.
2. Describe the importance of interprofessional collaboration in treatment of ADHD.

Summary:
The transition from adolescence to adulthood is a multi-year process. What are some barriers to the adult transition and what components are included in a successful one?  Though most people think of transition as a moment in time when teenagers move from pediatric to adult care, it is actually the final step in a very long process. We know that people with ADHD are more successful when they have the tools for adult independence.

In this Pocket MD podcast, Larry Brown, MD, offers pertinent information from research and real-life examples from his practice to explain how adolescence is the training ground for adult responsibility, particularly for youth with ADHD.

Larry Brown, MD
Lawrence W. Brown, MD, is a pediatric neurologist at Children’s Hospital of Philadelphia and director of CHOP’s pediatric neuropsychiatry program. He is also an associate professor of neurology and pediatrics at the Perelman School of Medicine at the University of Pennsylvania. He specializes in epilepsy and sleep disorders as well as behavioral disorders, including Tourette syndrome and complex ADHD.

Learning Objectives:
Listeners will be able to:

1. Identify ADHD symptoms throughout the lifespan.
2. Describe the importance of interprofessional collaboration in treatment of ADHD.

Summary:
Effectively treating children with ADHD in Black and Brown communities begins with education on the disorder for individual families. Becoming familiar with, and when possible, part of the communities you serve will help you to better meet the needs of your patients and their families. Psychiatrist Napoleon Higgins, Jr., discusses ways to meet families of color where they are and how to develop cultural competency to improve your healthcare practice.

Very often the situation a person is born into plays a determining role in the type and quality of healthcare they will receive. Medical professionals who listen to their patients’ concerns and include family members in treatment coordination; who take the time to educate patients, parents, and extended family members about ADHD; and who actively employ the language of the community they serve can improve long-term outcomes for their patients in diverse communities.

Max Wiznitzer, MD
Max Wiznitzer, MD, is a pediatric neurologist at Rainbow Babies & Children’s Hospital in Cleveland, OH. He is a professor of pediatrics and neurology at Case Western Reserve University. He has a longstanding interest in neurodevelopmental disabilities, especially attention deficit hyperactivity disorder and autism, and has been involved in local, state and national committees and initiatives, including autism treatment research, Ohio autism service guidelines, autism screening, and early identification of developmental disabilities. He is on the editorial board of Lancet Neurology and Journal of Child Neurology and lectures nationally and internationally about various neurodevelopmental disabilities.

Napoleon Higgins, MD
Napoleon Higgins, MD, is a child, adolescent, and adult psychiatrist in Houston, Texas, and the owner of Bay Pointe Behavioral Health Services and South East Houston Research Group. Dr. Higgins also serves as the executive director of Black Psychiatrists of America and CEO of Global Health Psychiatry. He is the author and coauthor of multiple books on ADHD, depression and grief, Black mental health, and physician practice issues. He specializes in nutrition and health to improve the lives of his patients mentally and physically.

Learning Objectives:
Listeners will be able to:

1. Describe health disparities and cultural beliefs in underserved communities that can impact ADHD diagnosis and treatment
2. Describe co-existing conditions in people with ADHD
3. Explain the considerations of effective ADHD medication management in underserved communities
4. Explain the importance of integrating behavioral and other interventions for people with ADHD in underserved communities

Summary:
Teaching organizational skills to children with ADHD, whether they are on medication or not, can be effective for handling their functional problems, including difficulty managing school papers and understanding what they need to do for assignments. Learning organizational skills lasts longer than behavioral approaches and appears to improve brain connections that are needed for attention and behavior control. The skills training needs to be modified according to the age of the child, and teaching smaller groups of children delivers better results. Medication may also help to improve organizational skills for some children.

Different types of professionals who have a good understanding of ADHD and are patient with children with ADHD can deliver organizational skills training, including behavior therapists and educators. Parents must be invested in the training for it to succeed, and children can be motivated to learn the skills with rewards and creative training delivery. The treatment is billable as psychotherapy and is more effective when delivered more than once a week.

Margaret Sibley, PhD
Margaret Sibley is an associate professor of psychiatry and behavioral sciences at the University of Washington School of Medicine and a clinical psychologist at Seattle Children’s Hospital. She has authored over 100 scholarly publications on ADHD in adolescence and adulthood, including a comprehensive therapist’s guide to treating ADHD in teens. Dr. Sibley’s research is funded by the National Institute of Mental Health and the Institute of Education Sciences.

Richard Gallagher, PhD
Richard Gallagher is associate professor of child and adolescent psychiatry at the Child Study Center, NYU School of Medicine. He specializes in anxiety disorders, ADHD, and learning disorders. He has been a co-principal investigator on NIMH grants investigating executive function deficits in children with ADHD and how to overcome those deficits. Dr. Gallagher is coauthor on numerous papers, first author of Organizational Skills Training for Children with ADHD: An Empirically-Supported Treatment and The Organized Child (for parents), and coauthor of the Children’s Organizational Skills Scale.

Learning Objectives:
Listeners will be able to:

1. Describe the co-existing functional problems in children with ADHD
2. Explain the considerations of effective ADHD medication management.
3. Explain the importance of integrating organizational skills training for children with ADHD.

Summary:
Figuring out what services are provided by telehealth can be confusing for patients. There are several benefits from the expansion of telehealth in recent years. It is important for providers to carefully consider each patient's needs in determining whether or not telehealth is appropriate, especially when evaluating for ADHD. There are important considerations to make when prescribing stimulant medication and providing continued treatment through telehealth. There are benefits to being able to communicate with patients using technology. Providers using a portal messaging system should communicate with patients so they know when they can expect a response, what types of issues can be handled through messaging, and what requires an in-person or telehealth visit.

Margaret Sibley, PhD
Margaret Sibley, PhD, is an associate professor of psychiatry and behavioral sciences at the University of Washington School of Medicine and a clinical psychologist at Seattle Children’s Hospital. She has authored over 100 scholarly publications on ADHD in adolescence and adulthood, including a comprehensive therapist’s guide to treating ADHD in teens. Dr. Sibley’s research is funded by the National Institute of Mental Health and the Institute of Education Sciences.

Craig Surman, MD
Craig Surman, MD, is an associate professor of psychiatry at Harvard Medical School. He is the Scientific Coordinator of the Adult ADHD Research Program of the Clinical and Research Program in Pediatric Psychopharmacology and Adult ADHD at Massachusetts General Hospital. His work has been published in peer-reviewed journals and presented internationally. Dr. Surman has directed or facilitated over fifty studies related to ADHD in adults. He is co-author of FASTMINDS: How to Thrive If You Have ADHD (or think you might) and editor of ADHD in adults: A Practical Guide to Evaluation and Management.

Learning Objectives:
Listeners will be able to:

1. Explain the considerations of effective ADHD medication management delivered through telehealth
2. Describe the importance of interprofessional collaboration in treatment of ADHD through telehealth
3. Discuss the diagnosis of ADHD in an adult

Summary:
In this episode of the Pocket MD podcast, Laura Knouse, PhD, interviews John Mitchell, PhD, about the use of mindfulness skills to help adults with ADHD. Dr. Mitchell explains that mindfulness is a practice that involves being nonjudgmental, describing things with awareness, and acting with awareness in the present moment. He discusses how mindfulness can help individuals with ADHD by improving their ability to regulate attention and emotions. Dr. Mitchell also shares the findings of several studies that have shown the effectiveness of mindfulness-based interventions in reducing ADHD symptoms and improving executive functioning. He suggests that clinicians can introduce mindfulness to their patients by starting with simple practices, such as focusing on the breath, and gradually incorporating mindfulness into their daily lives. Dr. Mitchell emphasizes the importance of finding a good therapist who can provide guidance and support in integrating mindfulness into treatment. He also recommends resources such as clinician manuals and books on mindfulness for ADHD. Overall, Dr. Mitchell encourages clinicians to give mindfulness a try and explore different ways to incorporate it into their practice.

Laura Knouse, PhD
Laura Knouse, PhD, is a clinical psychologist whose research and clinical expertise focus on the nature, assessment, and treatment of ADHD in adults, specializing in cognitive-behavioral therapy (CBT) for adult ADHD. An associate professor of psychology at the University of Richmond, she earned her PhD from the University of North Carolina at Greensboro and completed clinical internship and postdoctoral fellowships at Massachusetts General Hospital and Harvard Medical School. Her recent research aims to better understand the self-regulation and motivation difficulties of college students with ADHD through the lenses of cognitive and social psychology in order to develop effective interventions. Recent collaborative work with faculty in other disciplines focuses on how leaders can most effectively cope with personal crisis and how growth mindsets are related to mental health and coping.

John Mitchell, PhD
John Mitchell, PhD, is an associate professor of psychiatry and behavioral sciences at Duke University. He earned his PhD from the University of North Carolina at Greensboro in 2009 and completed clinical internship and postdoctoral training at Duke University Medical Center. His research focuses on ADHD treatment development and ADHD-related outcomes into adulthood. Dr. Mitchell has authored or coauthored over eighty scientific papers and book chapters, and he coauthored the book Mindfulness for Adult ADHD: A Clinician’s Guide. He has led grants funded by the National Institutes of Health. In addition to research, Dr. Mitchell is a practicing licensed psychologist in the Duke ADHD Program, working with adolescents and adults with ADHD.

Learning Objectives:
Listeners will be able to:

1. Identify the symptoms of ADHD that mindfulness can help to improve.
2. Explain what mindfulness-based treatment for ADHD looks like.
3. Understand and explain how mindfulness can be practiced throughout a busy workday.
4. Learn how clinicians can get further training or certification to integrate mindfulness into their practice.

Summary:
In this podcast episode, Margaret Sibley, PhD, and Eugene Arnold, MD, MEd, discuss nonpharmacological and pharmacological treatments for ADHD in children and adults. They define the terms nonpharmacological, alternative, and complementary treatments, and discuss the different categories of treatments available. They also highlight the importance of evidence-based research in evaluating the effectiveness of these treatments. The doctors discuss various treatments such as digital therapeutics, neurofeedback, brain stimulation, physical activity interventions, mindfulness meditation, dietary interventions, and sensory tools. They emphasize the need for better research on these treatments and the importance of patient empowerment in decision-making. They also discuss the challenges and potential risks associated with standard medication treatments for ADHD and the potential role of complementary treatments in addressing these challenges. The doctors provide recommendations for healthcare providers and educators in supporting patients and students with ADHD who are using complementary treatments. They also mention resources such as CHADD (Children and Adults with Attention Deficit Hyperactivity Disorder) and various websites for further information on ADHD treatments. Overall, the podcast highlights the importance of individualized treatment approaches and the need for informed decision-making based on evidence and patient preferences.

Margaret H. Sibley, Ph
Margaret H. Sibley, PhD, is an associate professor of psychiatry and behavioral sciences at the University of Washington School of Medicine and Seattle Children's Research Institute. Her work focuses on the diagnosis and treatment of ADHD in adolescents and young adults. She developed a parent-teen therapy for ADHD (Supporting Teens’ Autonomy Daily) that combines motivational interviewing and skills training for parents and teens. She has authored or coauthored more than eighty scientific papers on ADHD and published a book with Guilford Press on treating executive functioning and motivation deficits in teens. She is a member of CHADD’s professional advisory board.

L. Eugene Arnold, MD, MEd
L. Eugene Arnold, MD, MEd, is professor emeritus of psychiatry at The Ohio State University, where he formerly was the director of the division of child and adolescent psychiatry and vice-chair of psychiatry. He is a co-investigator in the OSU Research Unit on Pediatric Psychopharmacology. He has forty-five years of experience in child psychiatric research, including the multi-site NIMH Multimodal Treatment Study of Children with ADHD (“the MTA”), for which he was executive secretary and chair of the steering committee. For his work on the MTA, he received the NIH Director’s Award. A particular interest is alternative and complementary treatments for ADHD. His publications include nine books, seventy chapters, and more than three hundred articles.

Learning Objectives:
Listeners will be able to:

1. Identify the complementary and alternative ADHD treatments that have a higher level of evidence for their effectiveness.
2. Understand how providers can engage in conversation with patients who are interested in trying alternative treatments.
3. Understand the challenges with using standard medication treatments that motivates people to seek alternative treatments.
4. Learn how educators can support students who are using complementary treatments.