The Cambridge Science Festival 2013 hosted the public event “Focusing ADHD” (Attention Deficit Hyperactivity Disorder) on 14th March 2013. The event was a part of the Brain Awareness Week (11th-17th March) campaign. Many public engagement events took place all over the UK to raise awareness for brain and mental health problems. “Focusing ADHD” event was organised by the University of Cambridge Behavioural and Clinical Neuroscience Institute (BCNI) and sponsored by the Wellcome Trust, the British Association for Psychopharmacology and the University of Cambridge.
Professor Trevor Robbins (Head of Department of Psychology and Director of BCNI) was the Chair for the event. Panel members included Dr Sam Chamberlain (MRCPsych, Specialty Registrar at Cambridgeshire & Peterborough Foundation Trust and Senior Clinical Research Fellow at Department of Psychiatry, University of Cambridge), Dr Ulrich Muller (Consultant Psychiatrist for the new Adult ADHD team at Cambridgeshire & Peterborough NHS Foundation Trust) and Mr Terry Laverty (recently diagnosed with ADHD himself and a co-founder of the ADHD support group ADDapt Ability at Cambridge).
The event at the Babbage Lecture Theatre attracted approximately 400 people. Keypads were provided to the audience for a set of interactive questions during the event. According to the feedback from the audience, nearly 80 percent of them were neither staff nor students at the University of Cambridge. Just over a third of the audience had been diagnosed with ADHD or had a relative or friend who had been diagnosed with ADHD. In his introduction Professor Trevor Robbins emphasized that there are different levels of understanding ADHD. He defined these levels as follows: the psychiatric level including the diagnosis and phenomenological aspects of the ADHD, the psychological level incorporating behavioural traits, the brain level in relation to changes in neurons and neural connections, and finally the genetic level regarding heritability and genetic variations making people vulnerable to ADHD. Professor Robbins explained that brain research spanning these levels is crucial for understanding the mechanisms underlying ADHD and its effective treatment.
After this well-structured introduction, Dr Ulrich Muller surveyed historical aspects of ADHD. Although it is an under-recognised problem, clinical observations suggesting the existence of ADHD date from as early as the 18th century. He also mentioned that the treatments available for ADHD (e.g. methylphenidate and amphetamine) are among the oldest drugs in psychiatry and their safety profiles are well known. Then he moved to explain the symptoms suggesting attention deficits and hyperactivity with reference to classification systems such as DSM and ICD. Dr Muller reviewed cross-cultural epidemiological research showing that the prevalence of ADHD in children and adults are quite similar across countries all over the world. He emphasized that consequences of untreated ADHD can be severe, including a higher rate of co-morbid psychiatric conditions, increased risk for drug abuse and criminality. He stressed that the early diagnosis and proper treatment is key to prevent secondary problems due to ADHD; also the untreated people have a higher risk of continued symptoms as adults. Regarding aetiology of the condition, he presented research findings showing the genetic risk factors and other factors such as premature birth and maternal smoking. As an expert on psychopharmacology, he explained the mechanisms of medication on brain structure and showed how these effects can be observed as changes in brain functioning measured by functional and pharmacological neuroimaging. Lastly, he focused on the gene-environment interactions thought to play an important role in this neuro-developmental disorder. He mentioned a striking study which showed an increased rate of ADHD symptoms among children from Romanian orphanages who had experienced severe emotional deprivation.
Dr Sam Chamberlain covered research on the cognitive impairments of ADHD and how these relate to everyday functioning. As an example of modelling neurocognitive functions in the laboratory he described the stop signal reaction time (SSRT) test, which measures response inhibition and impulsivity. Then he continued with brain imaging findings suggesting a frontal network dysfunction underlying such cognitive impairments. Dr Chamberlain emphasized the importance of translational research for understanding the neurochemical substrates of brain mechanisms. Regarding the big controversies covering ADHD treatment, he made practical and clear comments on the benefits and side effects of currently available treatments for ADHD. Firstly, he referred to the NICE (National Institute for Clinical Excellence) Guidelines which suggest psychosocial interventions (i.e. cognitive behavioural therapy and group based interventions) for mild to moderate cases of ADHD in children. He also emphasised the importance of ‘choice of treatment’ for adult patients. He clearly showed that the level of evidence for the efficacy of methylphenidate treatment is robust (level A – best evidence) and meta-analysis of randomised controlled trials also exhibited a clear benefit of this group of drugs. Dr Chamberlain also illustrated recent findings on the comparing the effect sizes of drug treatments in psychiatric and other medical conditions. Perhaps surprisingly, stimulant drug medication had an effect size comparable to that of many other medical treatments for distinct diseases or disorders. Lastly he touched upon the issue of complementary treatments and mentioned evidence suggesting the beneficial effects of complementary omega-3 supplements.
The last panel speaker was Mr Terry Laverty who was himself diagnosed with ADHD at the age of 33. Mr Laverty related his personal story and how he had used his experience in the support group ADDapt Ability. He reminisced about his childhood, notably his vulnerability for bullying and emotional problems that waxed and waned through his primary school and teenage years. He had suffered from depressive mood and at the time neither he nor his psychiatric team realised the link between his emotional problems and ADHD symptoms. In his adult years he stated that “his mood swings felt like a double edged sword”. He often struggled with focusing and concentration, but would nevertheless be strongly motivated. After deciding to study for a degree he found himself enjoying surfing, becoming a surf instructor and building up a very active surfing society during his time at university. Mr Laverty has had a career in teaching, but his ADHD symptoms affected both his relationships and his work. He had often used alcohol as self-medication and was misdiagnosed as depressed. When he first thought that his symptoms might be due to ADHD, his GP responded “You are intelligent, articulate and you have a degree. It is impossible”. This was a striking example of the stigma and misunderstanding of this condition in our society. Through ADDapt Ability Terry had campaigned about under-diagnosis of ADHD, and that it is a huge problem that can lead to a more severe problems in people`s lives. Importantly, he told that Society`s focus on “illness”, not “wellness” has an important effect on this problem. He said “You can only be helped if you are bad enough; otherwise your problems are overlooked until you reach a stage of crisis”. Finally he mentioned that people with ADHD can thrive in stimulating environments and they might have different needs with regards to education.
The event continued with a discussion between the audience and all four panellists. ADHD–related questions sent in advance by the audience were categorised in six groups (i.e. definition, causes, diagnosis, treatment, advice and positive aspects) and most of them were covered along with live questions from the audience. The audience put forward a wide range of excellent questions and the panel members were pleased to interact with such an engaged group. After the formal discussion had concluded, the panel members stayed on for another half an hour to converse further with members of the audience. Overall, the event was all that could be hoped for; expert researchers perfectly covering all aspects of the problem, a personal ‘story’ and how it led to the formation of an influential patient group, and intelligent and fascinated audience with relevant questions and great optimism for better understanding and treatment of ADHD, and better co-operation and coordination for patient groups.