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The Many Faces of ADHD: A Window into the Future CADDRA's 2010 annual ADHD Conference November 20-21, 2010 The Marriott Vancouver Pinnacle
Target Audience: An introductory non-accredited ADHD workshop on adult ADHD and on ADHD medications will be offered to attendees Friday evening free of charge. [Workshop details]
Michael Joschko Ph.D., [bio] Adjunct Associate Professor, Department of Psychology, University of Victoria, Victoria, B.C. Diane McIntosh M.D., [bio] Clinical Assistant Professor, Psychiatry, University of British Columbia, Vancouver, BC Candice Murray Ph.D., [bio] Children’s and Women’s Health Centre of B.C, Vancouver, B.C. Joseph Sadek, M.D. [bio] Assistant Professor, Psychiatry, Dalhousie University, Halifax, N.S. Annick Vincent M.D., [bio] Centre Médical l’Hêtrière, Clinique FOCUS, Saint-Augustin-de-Desmaures, Québec, QC Accreditation: Accreditation for family physicians, specialists and American physicians, and approval for psychologists is being arranged, as in past years. Program Committee Dr. Umesh Jain, Dr. Declan Quinn, Dr. Derryck Smith, Dr. Paul Soper, Dr. Dan Ross, Dr. Geraldine Farrelly , Dr. Joan Flood, Dr. Gurdeep Parhar, Heidi Bernhardt R.N. NEW: Poster Sessions The inaugural annual Atilla Turgay Memorial Poster Prize will be presented on the last day of the conference. Poster submissions are due by September 10th. Successful applicants will be notified of their approval by September 28th. Travel and registration confirmations are due by October 12th. Awards will be announced on the last day of the conference. Further details are available on the application form or call 416-637-8583 for more information or to request an application form to be sent to you. Accommodation A block of rooms has been reserved at the special rate of $155.00 until October 18, 2010. Reservations can be made directly through the hotel 604-684-1128 or 1-800-207-4150. Individuals will be required to state that they are attending the CADDRA conference to receive these reduced rates. We encourage you to book your hotel rooms early. Our discounted rate and room block can only be guaranteed until October 18th. Conference fees
Registration Information We strongly encourage you to register online at www.caddra.ca under the register online button. If you are unable to do so, please print the registration form and fax it to 416-385-3232 or call 416-637-8583 for further details. Refund Policy Should you need to cancel your registration, you must do so by sending an email to This e-mail address is being protected from spambots. You need JavaScript enabled to view it before November 1st, 2010. Your tax receipt must be destroyed. Your registration fee, less a $50.00 handling charge, will be refunded. After November 1st, 2010 no refunds will be granted for withdrawal, however the registrant may secure a replacement to fill their spot. Conference Format Topics will be presented in three different formats. Plenary sessions are intended for the entire audience and geared to all disciplines. Workshops may be geared to a specific discipline - physician or psychologist - or be appropriate for both areas of practice. Meet the Expert sessions may be geared to a specific discipline - physician or psychologist - or may be of interest to all disciplines. Please review the Conference Titles and Abstracts table (below) for exact titles and more detailed information on the presentations.
Conference Outline:
Friday, November 19, 2010 Preconference Introductory ADHD Workshops The ABCs of Adult ADHD Laurence Jerome, M.B. This workshop will review recent developments for evidence for ADHD as a neurodevelopmental disorder and look at the profile of functional impairments in ADHD through the lifespan, emphasizing adult impairments. A discussion on psychosocial management of adults with ADHD will also be included.
The ABCs of ADHD Medication This workshop will provide a basic understanding of how stimulant as well as nonstimulant medication can be used safely and effectively to treat ADHD throughout the lifespan. It will include discussion on the effect of co-existing psychiatric disorders on the medical treatment and relevant drug interactions. Factors contributing to the response to stimulant medication will also be included.
Saturday, November 20, 2010: Plenary Sessions
The History of Stimulant Medication as a Psychiatric Treatment Modality Learning Objectives:
Longitudinal Course of ADHD into Adulthood
Knowledge of the long-term course of childhood Attention Deficit Hyperactivity Disorder (ADHD) is limited by the lack of longitudinal studies that extend beyond age 25. Information about the later adult status of children with ADHD, one of the most common disorders of childhood, is important since the disorder is widely reported to persist throughout adulthood. Findings from a prospective 33 year longitudinal study are presented. We report on the psychiatric status of 135 males at age 41 (on average) who were diagnosed with ADHD at in childhood, compared to 136 non-ADHD males matched for age and SES in adolescence, interviewed blindly by trained clinicians. In addition to psychiatric status, we report on social functioning, and educational and occupational attainment. As expected, at age 41, ADHD was significantly elevated in probands (22% vs.5% in comparisons, p<.001). When the number of ADHD criteria is reduced, as recommended for ADHD in adults, rates rise to 36% , but rate in controls also rises. In addition to ADHD, other disorders significantly more prevalent in probands were: antisocial personality disorder (APD), drug (non-alcohol) disorders, and nicotine dependence. Childhood ADHD was not associated with elevated rates of mood or anxiety disorders in adulthood. Findings pertaining to other functional domains also will be presented. Learning Objectives:
ADHD in the DSM-V
The new edition of the diagnostic manual, the DSM-V, is slated to appear in 2013. The clinical criteria for all disorders have been registered, and field trials are scheduled to begin in the latter part of 2010. It is the general consensus that the diagnosis of ADHD has been useful and appropriate when applied to children. Controversy exists about the appropriateness of the DSM-IV standards for diagnosing adults. The issues raised in the field will be discussed. The new criteria will be presented and their implication for diagnosing ADHD in adults. We will discuss the pros and cons of various options. Dr. Greenhill will be presenting on AACAP's comment to the APA on the DSM-V options. Dr. Tannock will add her views and then lead a discussion on the material presented. Learning Objectives:
Sunday, November 21st
ADHD and Bipolar Disorder: What should you know? Why you should care? Objective: To describe the phenomenology, family genetic and treatment of mania and ADHD Methods: Literature and clinic review, looking not only at criteria but at patient prototypes Results: Errors made in DSM’s defining mania and ADHD have led to some of our current difficulties. However, diagnostic and evidence based treatment strategies are available. Discussion: Implications for how to diagnose, treat, and describe treatment implications for families will be discussed.
Learning Objectives
Preschool ADHD Psychopharmacology
Objective: This presentation will provide information to aide the clinician in the assessment and treatment considerations for preschoolers that present with Attention-Deficit / Hyperactivity Disorder (ADHD). Methods: The pitfalls and challenges of making a diagnosis of ADHD in the preschool developmental phase will be presented, along with data from longitudinal studies showing the stability of core symptoms and impairment (Lahey et al., 2006). Second, the participants will be exposed to a review of the psychosocial and psychopharmacologic treatment literature for preschoolers with ADHD. Third, the data from the Preschool ADHD Treatment Study (PATS) will be reviewed in order to translate the findings about dosing, effect size, and adverse event profile into guidelines useful to a clinician. Fourth, these findings will be couched in the recommendations of the Abramson Working Group on Preschool Psychopharmacology about the benefits and risks of using stimulant medications to treat ADHD in preschoolers, including both recommended practices and practices that are not recommended. Results: Investigators at 6 sites recruited 303 preschoolers, ages 3 to 5.5 years, with moderate to severe ADHD. Over 93% remained in the study for the first phase of the 10 week parent training therapy, but only 189 / 303 agreed to participate in the double-blind, dose-optimization protocol with immediate-release methylphenidate (IR-MPH) (Greenhill et al., 2006). The study revealed that preschoolers mean optimal total daily dose of IR-MPH, 14 mg, was lower than the optimal total daily dose for schoolage children in the MTA, 30 mg/day. More preschoolers (11%) discontinued the study because of medication associated adverse events than had occurred in the MTA Study (1%) (Wigal et al, 2006). The adverse event profile different, with more growth retardation (height acquisition rate -1.5 cm/yr versus -1.0 cm/year in the MTA study) and more children on MPH displayed emotional outbursts while on IR-MPH among the preschoolers. Conclusions: Practitioners need to be cognizant of the higher rate of adverse events, and track growth carefully. Lower stimulant doses should be used to initiate treatment. Learning Objectives
Rages and Mania
Objective: To describe the phenomenology and differential diagnosis of children who present clinically with rages Methods: Outpatient and inpatient data from Stony Brook’s clinical services which have systematically evaluated children with rages will be described. Results: Rages are not diagnostically specific. That is they occur in a number of different conditions including mania, ADHD/ODD, anxiety and autism. Unfortunately, it has not been possible to study them as they have been nested in with a number of other conditions Discussion: The pros and cons of giving rages their own diagnosis (e.g. severe mood dysregulation, temper dysregulation disorder) will be discussed along with how to approach the assessment and treatment of rage behaviors. Learning Objectives:
Lunch Presentations Saturday, November 20, 2010 How To Encourage Health Behaviour Change This session presents an approach to understanding and working with treatment adherence using an integration of practical ideas from the Transtheoretical Model of behaviour change (Prochaska et al, 1992) and Motivational Interviewing (Miller & Rollnick, 1991, 2002). Participants will refine and extend their skills in assessing some key determinants of adherence, and consider strategies that can 1) help clients make informed and intrinsically motivated treatment choices including medication, lifestyle change, and cognitive-behavioural skills, 2) facilitate commitment to agreed-upon treatment plans, and 3) support client’s confidence in adopting and maintaining treatment over time. Learning Objectives After attending this session:
Sunday, November 21, 2010
ADHD: From Adolescence to Adulthood All over the globe where there are established services for ADHD, clinicians are finding that they have followed patients from childhood who have now reached and age of maturity and would, if possible, be transferred to those services mandated for adults. The problem arises that the expertise and the only services available for ADHD lies within pediatrics. For ethical and other reasons this means that pediatricians and child psychiatrists are gradually carrying an increasing number of adults they have known from childhood, and therefore for the first time dealing with the developmental issues that arise during the early adult years. This talk will review those challenges. In particular, we will focus on the issue of developing adaptive skills for independent living, the impact of ADHD on the formation of early adult relationships, and the impact of ADHD on the transition to college. Learning Objectives:
Workshops
Several studies have demonstrated that for children with moderate to severe brain injury, 20% have pre-existing ADHD and another 20% acquire ADHD as a result of damage to the substance of, or interconnections with, the frontal lobes of the brain . This indicates that the risk factor for acquiring a Traumatic Brain Injury (TBI) increases by a factor of about 3, if you have ADHD. Drs Joschko (neuropsychology) and Smith(psychiatry) will discuss the investigation and treatment of ADHD arising in the aftermath of TBI. Adult studies outcomes will be discussed as well. Learning Objectives
ADHD in the Forensic Setting
ADHD and Conduct Disorders are frequently comorbid. In a Youth Detention Center, many teenagers will be medicated based on symptoms that they present. We propose to examine the association between ADHD and antisocial behaviours in terms of etiologies, diagnostic dilemmas and therapeutics available to clinicians. We will present cases that were assessed in a forensic setting and will explore diagnostic procedures based on instruments and observations used in these situations. We will present non-pharmacological interventions and review pharmacological interventions in an evidence-based approach. Learning Objectives
Women and Girls with ADHD: the Saints, the Sinners and the Scholars...True Lives
This workshop will address the facts and myths regarding ADHD in girls and women by outlining the differences between females and males with ADHD, including the differences in co-morbidities and why fewer females are diagnosed and diagnosed at a later age. Environmental and hormonal factors will be addressed and the unique challenges females experience across their lifespan. Particular case studies will be presented as examples. Learning Objectives
Working Memory and ADHD: Assessment and Interventions The overall goal of this interactive workshop is to assist psychologists, clinicians and school professionals understand the challenges and needs of elementary- and secondary-school students with ADHD who also have poor working memory. Current research evidence indicates that not all individuals with ADHD have poor working memory, but those that do have much poorer academic outcomes. Participants will attain the specified learning objectives by actively participating in a mixed format of learning activities, including several brief didactic sessions (10 min) interspersed with small-group activities (10 min), culminating in a general discussion plus questions-and-answers session. Didactic sessions will include an update on evidence linking working memory with ADHD and poor academic outcomes, a critical review of current tools for assessing working memory, and of evidence-based or promising interventions for working memory (classroom instruction, strategy training, computerized training, pharmacological treatment) . Small group activities will include hands-on experience with some of the assessment tools, designing a template for documenting the range of educational accommodations and interventions that might be recommended for a student with ADHD plus working memory problems, as well as problem solving around implementation of interventions within the school setting. Learning objectives
Treating Adult ADHD in the Primary Setting Family doctors and psychiatrists commonly see ADHD adults whether they know it or not. They are lurking in the population with a presumed prevelance rate of almost 5%. This session is to identify at-risk clients, to initiate a proper assessment and to begin a protocol of treatment. This program relies heavily on clinical practice skils including videos of patients to help differentiate ADHD from the primary co-morbid disorders like depression and anxiety. The treatment component will look at more holistic interventions and practical strategies to access relevant services for the patients. A heavy emphasis will be in educating patients to empower them to take charge of their own problems. Learning objectives:
Group Therapy as a Treatment Modality for Adults with ADHD Research studies have demonstrated that cognitive-behavioural therapy for adults with ADHD has benefits beyond the effects of medication and support groups alone. A ten session cognitive-behavioural treatment group for adults with ADHD was developed that focuses on developing specific goals, monitoring problematic behaviours, and integrating cognitive-behavioural strategies into daily life. Results: Feedback from clients in the group and referring physicians has been consistently positive. A primary advantage of participating in the group has been a deeper understanding about ADHD symptoms and how they are manifested in everyday life. There is also a greater acceptance of ADHD as a legitimate disorder. Clients have reported an improvement in their ability to monitor their behaviour and implement learned strategies. Learning Objectives
Managing ADHD with Co-morbid Mood Disorder: a clinical workshop This workshop will address issues related to managing ADHD in adult patients with a co-morbid mood disorder. There is little in the literature to guide management of co-morbid ADHD. Treatment algorithms are based primarily of clinical experience rather than empirical evidence. The workshop will include a discussion of the neurobiological differences between mood disorders and ADHD, and the epidemiology associated with a co-morbid presentation. The goal of the workshop is to share clinical experiences, while reflecting rational treatment choices based on the current understanding of the neurochemical alterations associated with both disorders. Learning Objectives:
ADHD in Post-Secondary Education: Implications for Clinical Practice The overall goal of this interactive workshop is to help clinicians understand the challenges and needs of youth-in-transition with ADHD who are applying to or attending post-secondary education (PSE). PSE refers to the skills and knowledge acquired through academic, technical and vocational courses and programs provided by universities, colleges and trade schools, including apprenticeships. The format of the workshop will consist of several brief (10 min) didactic sessions interspersed with small-group activities (10 min) and will end with a general discussion plus question-and-answers session (20 min). Didactic sessions will include a review of the estimated prevalence rates of students with ADHD in PSE environments, definitions of key terms and concepts for PSE (disability, permanent disability, impairment), specific challenges of PSE environments for students with PSE, the range of Disability Services provided in PSE, and the required documentation for students with ADHD to access these Disability Services in PSE. Small group activities will focus on delineation of diagnostic challenges and the range of impairments for youth-in-transition with ADHD, identification of current practices for providing documentation for PSE requested by a patient/client with ADHD, and development of a template for the documentation required by PSE for patient/client with ADHD as well as delineation of necessary clinical support services for PSE students with ADHD. Learning Objectives:
Meet the Expert Sessions
Managing ADHD and Bipolar Disorder
This meet the expert session will address issues related to managing ADHD and Bipolar disorder. The discussion will target the specific concerns that are brought up by participants during this session. Participants are encouraged to present challenging clinical situations on diagnosis, treatment and the impact of this disorder on their patients and their families for discussion. Learning Objectives
Managing ADHD and Depression In this meet the expert session complex cases of ADHD and comorbid depression will be discussed. Participants will be encouraged to present treatment questions and challenges in diagnosing and treating these potentially complex cases. Learning Objectives:
Managing Complex Adult ADHD In this meet-the-expert format, participants will be invited to discuss complex clinical aspects of adult ADHD. Complexity may be associated with comorbidities, sub-optimal treatment response, adherence to treatment or specific aspects of adult life impaired by ADHD. Learning Objectives:
Medication Management of ADHD and Various Comorbidities The presentation will review medication algorithms for patients with ADHD and a variety of comorbid conditions which will include depression, anxiety, Tourettes Syndrome, substance abuse and bipolar disorder. Issues of aggression and Oppositional Defiant Disorder will also be addressed. Finally, challenging clinical situations will be solicited from participants and various possible approaches will be discussed with the group. Learning Objectives:
Problem Solving Parenting in Office Situations Umesh Jain
Participants are encouraged to present their cases and will have the opportunity to discuss common behavioural problems and how to approach them in a minimal amount of office time. Behavioural problems from behavioural theories to complex cases of aggression will be covered. Learning Objectives:
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