UKAAN Conference - 21st to 23rd September 2017
ADHD in the Mainstream
Mermaid Theatre - London Blackfriars
The 7th UK Adult ADHD Network (UKAAN) Congress ‘ADHD in the Mainstream: Impact, Impairment and Innovation’ took place on the 21st – 23rd September 2017 in London. Over three intensive days of presentations and discussion, the Congress provided a vehicle for in-depth shared learning on the many aspects of adult ADHD and effective treatment. In addition to the three days of plenary sessions, parallel sessions and symposia, numerous posters were presented on research projects around the UK.
Delivering effective treatments for adult ADHD – benefits and best practices
ADHD is one of the most treatable and rewarding conditions to work with. Most of the data reported in published studies on ADHD treatment effect is based on the core symptoms of ADHD, but what about the long-term impact of treatment? Ian Wong, Professor of Pharmacy at the UCL School of Pharmacy, presented a review of treatment effects on criminality, violence, drug abuse, accidents and other high-risk outcomes, providing compelling conclusions on the long-term benefits of drug treatment of adult ADHD.
Professor Susan Young, Clinical Senior Lecturer in the Centre for Mental Health, Imperial College London gave a practical workshop on ‘Psychological treatment of aggression in people with ADHD’, providing a psychological framework for understanding and treating anger, aggression and the emotional lability common in individuals with ADHD.
ADHD has now arrived in the mainstream, with greater than 60 adult ADHD clinics and services in the UK, newly updated NICE guidelines on ADHD diagnosis, treatment and serviced across lifespan, adult medication licenses for Strattera and Elvanse adult, RCPsych recognition and better training opportunities. However, adult ADHD clinics are typically not integrated with mainstream healthcare/psychiatry and have very long waiting lists. So, what is the best model of care to take forward and ring the changes? Specialist, Integrated, Neurodevelopmental, Primary or private sector? A panel of experienced ADHD health professionals (Dr Ulrich Muller, Dr Muhammad Arif, Kobus van Rensburg, Mark Pitts, Dr Joe Johnson and Dr Sally Cubbin) representing these five models of care for ADHD diagnosis and treatment service in the UK, reported on how their services operate and their pros and cons to help answer this question.
Updates on pharmacological treatments for ADHD
The congress was a valuable opportunity to host the debate ‘Should medication usually be the first line in adult ADHD’. Professor Wolfgang Retz presented in favour of the current NICE guidelines which state that medication should usually be the first line in adult ADHD, with Dr James Kustow opposing, justifying psychosocial treatment as an alternative first-line, treatment. This sparked an engaging and spirited debate encouraging those present to examine best options.
Shire Pharmaceutical’s symposium on the second day discussed the clinical place for amfetamines in adult ADHD, presenting the hows and whys of prescribing amfetamines and benefits of using amfetamines for treating adult ADHD (David Nutt, Professor of Neuropsychopharmacology at Imperial College London). Updates on the latest clinical trials of ADHD medication, new guideline/consensus recommendations and emerging concepts for medication management in ADHD were provided in a separate session by Dr Ulrich Muller and Mark Pitts including updates on dosing, side effects and possible complications.
Innovation for a better understanding of ADHD and new treatment options
Professor Philip Asherson, Professor of Molecular Psychiatry at the MRC Social, Genetic and Developmental Psychiatry Research Centre, Kings College London and President of UKAAN presented the growing body of research into mind wandering as a key impairment of ADHD. Professor Asherson presented evidence for the physiological mechanisms behind mind wandering, the Task Positive Neural Network and Default Mode Network, and research from several groups uncovering how uncontrolled mind wandering occurs in ADHD and how medication can be effective in targeting these networks to improve symptoms.
Mindfulness-based cognitive treatment (MBCT) is rapidly emerging as a promising psychosocial treatment alongside existing treatment options for ADHD. Professor Anne Speckens, psychiatrist and cognitive behavioural therapist, and founder and director of Radboud UMC Centre for Mindfulness explained mindfulness therapy and summarised research evidence for the effectiveness of mindfulness at reducing the core symptoms of ADHD in adults and maintenance of these benefits longer term.
Dr Jessica Agnew-Blais, Research Fellow at King’s College London, presented findings from several population-based cohorts which suggest that, for some, ADHD may not arise until adolescence or adulthood.
Interventions to support adult ADHD in higher education and the workplace
Jane Sedgwick, a tutor in mental health nursing at Kings College London and Poppy Ellis-Logan led a session describing the experiences and issues faced by students with ADHD in higher education and explored what must be done to provide better support. They described how mind wandering, poor working memory, procrastination, forgetfulness and disorganisation impair educational progress and achievement at all levels. ADHD is associated with poor educational outcomes but it remains a hidden disability within institutions of higher education with as many as 20,000 students currently in higher education predicted to have ADHD. There is a need for institutions to become more knowledgeable and personalised in the way that university students with ADHD are supported. Poppy Ellis-Logan, a recent university graduate, provided a compelling insight into life at university with ADHD. She explained the importance of recognition and support and introduced #AttentionUK, raising awareness of ADHD in students.
ADHD impacts many aspects of a person’s life, sometimes adversely. Professor Marios Adamou, Consultant Psychiatrist at South West Yorkshire Partnership NHS Foundation Trust spoke about the impact of ADHD in the workplace and suggestions for reasonable adjustments. He also focused on the highly positive traits that individuals with ADHD can offer employees and the businesses or institutions they work for if the right support is available.
The role and treatment of ADHD with co-occurring disorders
Frances Levin, Professor of Psychiatry at Columbia University provided an overview of the current understanding of the association of substance use disorders and adult ADHD. Adults with ADHD typically find substance abuse treatment difficult, taking longer to go into remission and have higher dropout rates from programs.
Professor Susan Young discussed research on substance misuse in ADHD and the necessity for psychological treatment of ADHD and substance misuse, stressing the need for a combination of pharmacological and psychological interventions.
There was a session on the practicalities of managing co-occurring ADHD and ASD presented by Kobus van Rensburg and Emma Woodhouse, discussing issues of differential diagnosis, prevalence, service development and complex factors mediating developmental trajectories. A session on how to differentiate ADHD from other co-morbidities was presented by Professor Phil Asherson, Dr Muhammad Arif and Dr Sue Cubbin. Hugh Selsick (Consultant in sleep medicine and psychiatry at the Royal London hospital and UCL) ran a workshop explaining the interaction between sleep and ADHD describing how to recognise and manage common sleep disorders.
Living well with ADHD
Melissa Orlov, marriage counsellor and author spoke about ‘Relationships and adult ADHD: family, friends, partners and parenting’. Inconsistency, difficulty reading emotional cues, emotional lability and higher than normal risk of financial problems are just a few of the issues that can add pressure to ADHD relationships and divorce rates are higher. Melissa went through key relationship stressors for adults and families and offered strategies for professionals to help work through them.
Dr Andrew Merwood and Dr James Kustow gave a session promoting wellbeing in adult ADHD, highlighting the advantages of having ADHD such as cognitive dynamism, courage, energy, and resilience. Both speakers emphasized the importance of exercise and nutrition with evidence of its effect on ADHD symptoms, executive function and mood. Dr Kustow introduced new concepts in diet and ADHD such as the ‘Few Foods Diet’ and the role of gut bacteria.
UKAAN - giving a voice to adult ADHD
The UKAAN programme this year provided the opportunity to put the science to one side and listen to the voice of adult ADHD from high-quality art and entertainment. Art with Heart gave a performance of their autobiographical one-woman show Declaration, an honest and emotional exploration of what it is like living with ADHD as a child and as an adult, and the experience of getting diagnosed. There was artwork on display from ADHD artists Jacki Cairns and Dr Kai Syng Tan with Magic Carpet, an interactive display on mind wandering from King’s College London's Artist in Residence. Impressionist and comedian Rory Bremner reflected on the issue of undiagnosed ADHD, describing his own diagnosis and sharing his experience of making the recent BBC Horizon documentary ‘ADHD and me’. ‘‘Life for an ADHDer is getting harder than it ever was – with modern life and social media increasing stimulation and demands on our attention. Science is increasingly able to show to the world that ADHD is real, but we still need to convince a public that is not entirely on board”.
Pushing ADHD firmly into the mainstream, this year’s UKAAN conference delivered a varied and informative programme for a diverse audience of health professionals, education professionals, charities and the public. As with all UKAAN’s meetings and training events, the Congress provided opportunities for practical learning for professionals, shared experience and invaluable information and discussion around diagnosing, treating and living with adult ADHD.
Report Written by Sarah Holme - Editor ADHD News (ADDISS)
Keynpte Speaker Presentations
Pleneary Session Presentations
|Ulrich Muller||Amol Vaze|
|Kobus van Rensburg||Mark Pitts & Joe Johnson|
Parallel Speaker Presentations
|Hugh Selsick||Melissa Orlov|
|Susan Young||Marios Adamou|
|Jane Sedgwick & Poppy Ellis Logan|
|Ulrich Muller & Mark Pitts||Kobus van Rensburg & Emma Woodhouse|
|James Kustow||Andrew Merwood|
Below are a selection of photos taken at the conference.
Photos taken by Kobus van Rensburg
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