Challenges and Opportunities in ADHD

Challenges and Opportunities in ADHD

Blandine French, Dr, Anna Price, Dr, Anita Salimi, Abby Russell, Dr


In this letter, we summarize key points of learning from research projects on attention deficit hyperactivity disorder (ADHD) that have had patient and public involvement and engagement (PPIE) as a key part of the research process. We share learning from our experiences in delivering research working with PPIE groups with ADHD as top tips for researchers. Our aim is to highlight the importance of including lived experience in ADHD research, share learning, and highlight some of the (potentially invisible) differences in functioning that someone with ADHD can experience in relation to attentional focus, organization, and time management. Specifically, how these might impact the working practices of PPIE groups that include people with ADHD.

Lay summary: This research discusses the importance of involving individuals with ADHD in research and shares insights gained. It emphasizes the unique challenges faced by those with ADHD in terms of attention, organization, and time management, which might not always be apparent. The paper offers practical tips for researchers to better engage with ADHD groups, aiming to ensure that their experiences and perspectives are considered in the research process. In summary, it highlights the value of including firsthand experiences in ADHD research and provides guidance for researchers to enhance this inclusion.

Peter S Jensen, MD, Tiffany D Brandt, PhD, Christopher Kratochvil, MD, Lisa Hunter Romanelli, PhD, James Jaccard, PhD, and Charles Humble, PhD


Objective: To understand the benefits of an intensive 6-month practice change intervention (with or without the assistance of an embedded care manager) on primary care providers’ (PCPs’) adoption of evidence-based practices for diagnosing and managing Attention-Deficit/Hyperactivity Disorder (ADHD).

Methods: Following an intensive weekend training in primary care pediatric mental health service delivery, 47 PCPs were randomly assigned to 6 months of ongoing educational support via twice-monthly conference calls, either with or without the additional assistance of a care manager.  In addition to the impact of a care manager, basic science-derived predictors of behavior change were examined to explore the impact on PCPs’ initial and subsequent intentions and decisions to adopt 11 specific changes in ADHD practices.  The effects of practice obstacles on PCPs’ practice decisions, both initially and over 6 months, were also examined.   

Results: PCPs’ initial and subsequent decisions to employ program-targeted ADHD evidence-based practices increased over time and were significantly predicted by underlying hypothesized predictors.  Additional support from a care manager had minimal effects on PCPs’ initial and subsequent decisions to apply specific evidence-based ADHD practices.  Of note, PCPs’ initial worries and perceptions concerning practice obstacles decreased significantly over time, likely due to twice-monthly support calls.

Conclusions: With intensive and sustained support, PCPs will adopt most evidence-based practices for ADHD diagnosis and treatment.  Many initially anticipated obstacles dissipated over time. Additional support of care managers had little impact on PCPs’ longitudinal decisions to adhere to ADHD practice guidelines. Basic science predictors of behavior change are robust correlates of PCPs’ practice changes and should be more routinely applied to understand and improve training outcomes in multiple areas of health service delivery.

Argyro Rentzi


In early 2020, the COVID-19 pandemic appeared, due to which strict health measures were announced by the World Health Organization around the world. Among these health measures were strict adherence to hygiene, the use of a protective mask, and social isolation. These measures were immediately implemented in schools worldwide. School, after all, is a living social system that is included in the wider society and interacts with it. For this reason, every important social phenomenon that brings about changes in the way of life of humanity (pandemic, war, etc.) directly affects the school environment, forcing its adaptation to them. Therefore, schools in Greece implemented distance education for all students during the 2020–21 school year, applying inclusive distance education practices for children with special educational needs and disabilities. In Greek schools, children with Attention Deficit Hyperactivity Disorder belong in the category of “students with special educational needs.” Unfortunately, as proven by research, COVID-19 had a negative impact on children diagnosed with Attention Deficit Hyperactivity Disorder, having affected children’s behavior to such an extent that great difficulties are observed in their adapting to the social conditions of school. Because of these results, inclusive pedagogical practices are formed in Greek public primary education to help these children adjust to the school learning environment. This theoretical study will document the above facts and will also present these practices.

Dr. Caitlin Powell and Dr. Kaitlin Vollet Martin


The following study explores the potential impact of COVID-19 on Social Anxiety and Rejection Sensitivity among college students. Over 300 college students completed a survey asking about whether they had contracted COVID-19, and, if they had, additional characteristics (i.e., when they contracted the disease, whether they were symptomatic, whether their symptoms were neurological, how many times they had contracted COVID-19). In addition, they indicated their current levels of Social Anxiety and Rejection Sensitivity, as well as general classroom anxiety. Lastly, participants indicated whether they had been formally diagnosed with related psychological disorders (autism, ADHD, anxiety disorders, mood disorders, rejection sensitivity dysphoria), as well as roughly when they had been diagnosed. Approximately half of the sample reported that they had contracted COVID-19 at least once, and approximately one third of the total sample had been previously diagnosed with anxiety. Results indicated that about one third of those who contracted COVID-19 indicated increases in anxiety or depression post-COVID-19. In addition, females in reported higher Social Anxiety and general classroom anxiety. Results did find that there were higher amounts of Social Anxiety and classroom anxiety among those who had been diagnosed with COVID-19 more recently, these results were no longer significant after controlling for previously diagnosed mental illness. There were otherwise no significant relationships between any aspects of contracting COVID-19 and Social Anxiety, rejection sensitivity, or classroom anxiety. This indicates that while students are reporting increased anxiety and depression, and while recently diagnosed COVID-19 does contribute to Social Anxiety and classroom anxiety, that these increases are likely due to the stress of being ill rather than the virus itself.

Alessio Congiu, Roberta Vesentini, Francesca Locatelli, Lorenzo Zamboni, Rosaria Giordano, Silvia Carli, Isabella Barbon, Rebecca Casari, Silvia Melchiori, Simone Campagnari, Tommaso Bovo Francesca Fusina Giuseppe Verlato, and Fabio Lugoboni


Background: Several scientific studies indicate that Attention Deficit Hyperactivity Disorder (ADHD) is a risk factor for the development of pathological addiction, including Tobacco Use Disorder (TUD). Despite various hypotheses proposed to explain the reasons for this frequent comorbidity, the limited amount of research aimed at describing the characteristics of this population restricts our understanding of the nature of this relationship. Aims: The purpose of our descriptive and retrospective study is to examine the differences between a group of tobacco users with suspected ADHD and those without it, with respect to socio-demographic characteristics, factors related to tobacco addiction, alcohol consumption, past and current use of illicit substances, and comorbid psychiatric symptoms. Methods: A total of 1166 smokers who were referred to the Addiction Medicine Unit of the University Hospital in Verona between 2015 and 2021 were selected. Users for whom it was not possible to obtain all the necessary information were excluded from the sample. The remaining participants were divided into two groups based on their scores on an ADHD screening test. The group that scored negatively on the screening test (n = 964) was then compared to the group that scored positively on the same test (n = 114). Results: Statistically significant differences emerged between the two groups. Specifically, users in the positive group were found to be more likely to have the marital statuses of “Single” and “Separated/Divorced,” as well as the occupational statuses of “Unemployed,” “Student,” “Teacher,” “Housework,” “Casual Worker,” “Worker,” and “Artisan/Trader.” They also exhibited a higher level of nicotine addiction and reported an increase in smoking in the last 12 months. Furthermore, they had a history of both previous and current use of illicit substances and higher overall levels of anxious and depressive symptoms, regardless of gender. Conclusion: Several factors related to sociodemographic characteristics, smoking behavior, past and current use of illicit substances, and current levels of anxiety and depression could potentially mediate the relationship between ADHD and TUD. Clinicians involved in smoking cessation treatments should take comorbidity with adult ADHD into consideration.

Mohammed Abdulrahman Alrabah, Afnan Abdullah AlMarshedi, and  Mansour Abdulaziz E Alharthi


Introduction: Lujan-Fryns syndrome (LFS), a rare genetic anomaly first described in 1984, is characterized by a unique constellation of clinical features primarily attributed to mutations in the MED12 gene. These features include intellectual disability, behavioral complexities, and distinct somatic attributes. Although formal psychiatric criteria are lacking, numerous case studies have revealed a co-occurrence of LFS with psychological manifestations, including attention-deficit/hyperactivity disorder (ADHD). This case report explores the intricate relationship between LFS and ADHD, shedding light on potential diagnostic and therapeutic strategies.

Case Presentation: We present the clinical profile of a 13-year-old male diagnosed with LFS, who exhibited hyperactivity and inattention symptoms, leading to a diagnosis of ADHD. The patient’s history included full-term birth, developmental delays, and speech challenges, necessitating special education. Treatment for ADHD included methylphenidate extended-release, behavioral modification techniques, and clonidine, resulting in significant symptom improvement. Marfanoid features were present, and LFS was confirmed through genetic testing. Comprehensive care with a multi-disciplinary approach addressed the associated medical concerns.

Conclusion: Recognizing and addressing the co-occurrence of LFS and ADHD is crucial. This complex interplay presents diagnostic and therapeutic challenges requiring a multidisciplinary approach. The absence of specific medications for LFS-associated ADHD highlights the need for customized treatments. This case report enhances our understanding of their relationship, paving the way for further research to improve clinical care for individuals with both these conditions.

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