 (ADHD) is crucial in the pursuit of new treatments and updated standards of care.

Unlike other psychiatry conferences where ADHD makes up only a portion of the agenda, during the 

American Professional Society of ADHD and Related Disorders (APSARD) 2021 Annual Conference

Researchers from across the globe logged on to the virtual conference to share data and antidotes on ADHD and related diseases like autism and bipolar disorder.

One such researcher was Matthew Brams, MD, Chief Medical Officer of Cingulate Therapeutics, who presented new data from a phase 2 trial testing CTx-1301 as a viable treatment for adults with ADHD.

, the value of a conference and organization solely focusing on ADHD. He said ADHD is 1 of the most prolific and primary psychiatric diagnosis.

He also said providers have a chance to network with researchers in an intimate setting where everyone has a similar focus.

Brams also said another benefit of APSARD is the organization will work with the US Food and Drug Administration (FDA) and other regulation bodies overseas to promote advocacy for ADHD treatment and care, which is something the larger organizations don’t do as well.

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The American Professional Society of ADHD and Related Disorders

Dr. Matthew Brams presented new data showing the efficacy of CTx-1301 for ADHD.

The Importance of an ADHD-Research Conference: Matthew Brams, MD

Researchers are touting a new treatment formulated in a new delivery system that shrinks the tablet, enabling researchers to put 3 doses of CTx-1301 into the size of 1 pill.

, researchers showed the drug can be effective treating 

, Matthew Brams, MD, Chief Medical Officer of Cingulate Therapeutics, and Shane Schaffer, PharmD, CEO of Cingulate, said the unique formulation could be a boost for treating ADHD over the course of a day.

Bram said most drugs on the market for ADHD work effectively, but the majority have a 8-12 hour duration. CTx-1301 contains an immediate pulse, a pulse 3 hours later, and a 20% proportion that is saved for 7 hours later.

This boost given 7 hours following taking the actual treatment limits the amount of pills needed and prevents a crash.Bram said around 60% of ADHD patients require a booster dose, but with it built right into the tablet it could drastically improve the quality of life of users.

In the phase 2 study, CTx-1301 demonstrated a statistically significant higher concentration (

<0.05) compared to Focalin XR from 9-16 hours in both low and high doses.

CTx-1301's formulation enables 3 different doses within 1 pill for ADHD.

Matthew Brams, MD: A Multidose ADHD Pill

New research presented on a poster during the 

 shows the value in CTx-1301 (dexmethylphenidate) as a beneficial treatment under fasted conditions for adult patients with 

In the randomized, single-dose, four-sequence, four-period, crossover study, a team of researchers compared the drug with Focalin XR in 45 adults with ADHD.

The researchers found the study drug exhibited similar systemic d-MPH exposure to the comparison drug for up to 8 hours following administration. Plasma concentrations at 15-16 hours for CTx-1301 were also similar to the comparison drug at 12 hours.

CTx-1301 demonstrated a statistically significant higher concentration (

<0.05) compared to Focalin XR from 9-16 hours in both low and high doses, while CTx-1301 is expected to have a similar onset of action as the comparison drug (30 minutes).

Overall, the CTx-1301 tablets showed a trimodal pharmacokinetic profile with fast onset, entire active-day duration. This shows the drug has the potential to minimize crash and rebound, while eliminating the need for booster doses.

, Matthew Brams, MD, Chief Medical Officer of Cingulate Therapeutics, and Shane Schaffer, PharmD, CEO of Cingulate, explained the results and what the plans are for a phase 3 trial.

Researchers are prepared a phase 3 trial testing the treatment in adults with ADHD.

Matthew Brams, MD: Positive Results for CTx-1301 for Adults with ADHD

The coronavirus disease 2019 (COVID-19) has changed the role of many across the spectrum of medicine, including psychiatrists.

Many of these clinicians must treat patients now dealing with enhanced feelings of stress, frustration, and self-concern, while also dealing with similar feelings for themselves.

attention deficit/hyperactivity disorder (ADHD)

, Elizabeth Ahmann, Research Director of the Springer Institute and Micah Saviet, Director of the Springer Institute, discussed how the role of the ADHD coach may not have changed much during the ongoing pandemic, but specific of what ADHD individuals need has shifted.

Ahmann said in the past a common issue for individuals with ADHD was getting to work on time. However, because of the massive shift to a work from home setting across the board, some of the current issues include how to manage the stress and potential distractions in working from home.

There are also differing challenges in terms of socialization and physical activity than there was prior to the pandemic.

However, overall coaches still need to be cognizant of how ADHD can impact the daily life of the individual.

The researchers recently presented data from a focus group on what is needed to improve ADHD coaching during the 

The role of many in psychiatry has changed during the COVID-19 pandemic.

ADHD Coaching During COVID-19

 polygenic risk scores may be the most beneficial of all related mood disorder risk scores in the assessment of 

The American Professional Society of ADHD and Related Disorders (APSARD) 2021 Annual Conference

 this weekend, a team of Massachusetts General Hospital investigators reported that such risk scores may even provide explanation into the significant comorbidity rate of ADHD and other youth mood and emotional dysregulation issues.

Presented by author Joseph Biederman, MD, the study sought to assess the available body of information available on associations between polygenic risk scores for bipolar disorder (BP-PRS) and pediatric bipolar spectrum and related disorders.

As Biederman and colleagues noted, the strong genetic basis of mood disorders could potentially provide clinicians with diagnostic insights when few avenues of care are clear.

“Because the genetic basis of complex disorders such as mood disorders is polygenic, clinically relevant information could emerge from genetic markers in aggregate in the form of polygenic risk scores,” they wrote.

Their research included an online literature search for the following grouped terms:

PRS and Bipolar Disorder, Bipolar, or Bipolar Depression

PRS and Attention, ADHD, Conduct Disorder symptoms, emotional dysregulation, aggression

The investigators additionally screened for predetermined inclusion and exclusion criteria.A litany of variables were extracted from relevant studies, including population age, study size, source of PRSs, source of clinical and genetic data, primary study outcome, assessments used, and main findings.

In their findings, Biederman and colleagues observed bipolar PRSs were significantly associated with deficits in executive functioning, ADHD diagnoses, and associated executive function deficits.

In the lone study to compare depression PRSs to bipolar PRSs directly in youths, investigators noted that, among the 40,000 children aged 6-17 years old, only depression PRSs were associated with ADHD symptoms, internalizing problems, and social problems.

ADHD PRSs, the team reported, were associated with conduct problems, depressive symptomatology, and externalizing disorders symptoms.

“Findings revealed that while higher BP-PRSs were correlated with increased hypomania scores, ADHD-PRSs were more clearly associated with emotional reactivity, emotional dysregulation, and irritability—frequent correlates of pediatric bipolar spectrum disorder,” investigators wrote.

Though depression PRSs were predictive of more severe pediatric trajectories toward major depressive disorder, their contribution toward pediatric bipolar spectrum and related disorders is still unknown; available studies did not examine such risk in observed patients.

Taken together, one form of polygenic risk scores seems to best inform interpretation of pediatric mood disorder risks and progression.

“These finding suggest that ADHD-PRSs may have the most important contribution to the development of mood related problems in youth and may begin to explain the high comorbidity between ADHD with mood and emotional dysregulation problems in the young,” Biederman and colleagues wrote.

The study, “Can Polygenic Risk Scores Help Identify Pediatric Bipolar Spectrum and Related Disorders?” was presented at APSARD 2021.

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Such scores could provide insight into the significant comorbidity rate of ADHD and other youth mood and emotional dysregulation issues.

ADHD Polygenic Risk Scores May Benefit Pediatric Bipolar, Mood Disorder Understanding

A pilot study assessing the use of telemedicine in patient-reported responses to adult 

treatment showed a notable sensitivity to the impact of therapy changes on symptoms and patient functioning.

, investigators from Massachusetts General Hospital reported outcomes from an online survey-based assessment of adults with ADHD asked to gauge real-time response to psychopharmacology.

They observed a likely correlation to patient sensitivity and mobile ADHD symptom monitoring following changes in treatment status.

The Shire and Takeda-supported trial, presented by author Craig Surman, MD, included 90-plus patients aged 18-80 who self-identified a taking stimulant therapy for ADHD. Participants recorded their demographic information, medication use history and patterns, and their symptoms associated with ADHD.

Surman and colleagues used mobile phone surveys and messaging systems from RedCAP to remotely monitor patients. Their hypothesis was that personalized surveys via mobile messaging could be sensitive to ADHD-specific therapy effects.

“Technology opens the possibility of using measurements by mobile messaging to inform clinical care,” they wrote. “We know that ADHD symptoms respond rapidly to some forms of psychopharmacology as measured on well-validated rating scales. In clinical practice, individuals may find particular symptoms easier to recognize and report on than others.”

Investigators used the Weiss Functional Impairment Rating Scale (WFIRS) and the Adult ADHD Self Report Scale v1.1 (ASRS) to gauge patient-reported therapy effects.

Participants identified medication-sensitive items, and received such items as queries during selected time periods in the morning and evening. From this, investigators inferred “on” and “off” medication statuses for analyses.

In their outcome, the research observed that data confirmed self-reported ADHD symptom severity discriminated “on” versus “off” stimulant therapy status.

Investigators also noted sensitivity thresholds for symptom reporting, as well as reporting patters: within-day and between-day differences.

“Mobile monitoring of ADHD symptoms and functional impact is likely sensitive to changes in treatment status,” they concluded. “Future research may validate the clinical utility of using personalized self-reported mobile-messaged items in treatment optimization.”

The study, “Sensitivity of Electronic Patient Reported Outcome Measures to Medication Effects in Adult ADHD – A Pilot Study,” was presented at APSARD 2021.

Personalized, daily self-reporting for patients could influence future therapeutic strategies.

ADHD Treatment Change Impacts Remote Patient Monitoring 

Investigators have observed a significant and direct link between pediatric 

 and a likelihood of alcohol problems at adulthood.

 this weekend, a team of US-based investigators report an evolved understanding of developmental-based alcohol problem risks among young patients with ADHD—one which may better inform preventive intervention that would limit alcoholism and other substance abuse into such a patients’ 30s and beyond.

Presented by study author Christine Walther, PhD, of the University of Houston-Clear Lake, the trial was driven by participant- and guardian-reported metrics of ADHD symptoms, education marks, delinquency, social impairment, and alcohol use. All trial participants came from the Pittsburgh ADHD Longitudinal Study, who were interviewed at 3 age-based intervals between 14 and 30.

Past studies have described the mediational pathways in which ADHD symptom persistence, delinquency, and social and academic impairment partially explain the increased risk of substance abuse with pediatric ADHD—with stronger links observed between adolescents with low parental knowledge about their daily activities.

But such research has not expanded to observe risks as patients progress into young adulthood and their 30s.

“This study investigated the extent to which adolescent and young adult mediators continued to account for ADHD-related risk for problematic alcohol use at age 30 and whether the associations differed as a function of parental knowledge in adolescence,” they wrote.

The trial included 142 participants, 53% of whom had pediatric ADHD, 85% were white, and 92% were male. Participants were interviewed during ages 14-17, 25, then age 30.

Investigators measured adolescent and adulthood metrics including:

Age-25 and -30 participant-reported alcohol problems

The team tested adolescent-reported parent knowledge as a moderator of each of the mediated pathways, with adjustments for race, gender, age 17 alcohol use, parent psychopathology, and childhood socioeconomic status.

Walther and colleagues reported a significant association between childhood ADHD and alcohol problem likelihood in adulthood, in assessment of the model with adolescent and young adult delinquency as mediators (

Interaction between childhood ADHD and adolescent parental knowledge was also significantly associated with delinquency in adolescence (

“However, parental knowledge, the interaction between childhood ADHD and parental knowledge, and delinquency were not associated with age 30 alcohol problems,” they wrote.

Childhood ADHD and adolescent social impairment, adolescent and age 25 social impairment, and age 25 social impairment and increased alcohol problems at age 30 were all associated with one another in the model with adolescent and young adult social impairment as mediates.

“These findings suggest that factors explaining ADHD-related risk of alcohol problems appear to shift developmentally,” Walther and colleagues wrote. “In addition, parental knowledge effects in adolescence do not appear to transcend the transition to adulthood.”

The new findings could have significant implication for developing preventive measures of care designed to decrease adulthood drinking risks, such as programs designed to improve social skills for patients with ADHD.

The study, “Problematic Alcohol Use in Adulthood as a Function of Childhood ADHD, Adolescent and Young Adult Impairment, and Parental Knowledge During Adolescence,” was presented at APSARD 2021.

Investigators have observed a development-related shift in risks from teenaged ADHD and alcohol use risks in the patients' 30s.

Adulthood Alcohol Problems Linked to Adolescent ADHD

As an emerging field, there is plenty of positives in the value of 

However, because it is emerging there still need to be some guidelines and best practices developed in how the ADHD coach is supposed to collaborate and communicate with other professionals, as well as the patient in striking the best balance needed to succeed.

Recently, a team of researchers presented data from an ADHD coaches focus group during the 

 showing that many in the field believe it is necessary to iron out some communication issues to better collaborate and aid the patient.

, Elizabeth Ahmann, Research Director of the Springer Institute and Micah Saviet, Director of the Springer Institute, explained the next steps needed to implement what has been learned into the field.

Ahmann said 1 thing that is needed is more training for coaches on interprofessional communication. She also said the existing framework needs to be better disseminated to coaches so that the communication skills can be better developed.

Overall, Ahmann believes more collaboration is the main priority that will ultimately help all the professionals and the patient involved.

A pair of researchers present plans to improve collaboration with other professionals in ADHD.

Better Interprofessional Communication Needed in ADHD Coaching

Early smoking behavior among adolescents and young adults with ADHD is associated with a greater risk of inattention, impulsivity, and delay discounting, according to new findings presented at 

In new data presented at the meeting this weekend by investigators from the MIND Institute at the University of California Davis School of Medicine, a link between multiple cognitive systems and smoking experimentation among young patients with 

 appears pronounced. Now, the research team believes the findings could inform measured interventions for at-risk populations.

The research, presented by Prerona Mukherjee, PhD, is driven by the fact that early smoking experimentation—already increased among those with ADHD—could become habitual, dependent on an individual’s ability to delay gratification for longer-term rewards. 

Such a trait, along with impulsivity, is key in ADHD, and could be actually driving smoking experimentation in young patients, investigators hypothesize.

“Furthermore, inattention, also important in ADHD, is linked to nicotine, but may be less important for early experimentation, than sustained consumption,” investigators wrote.

Mukherjee and colleagues conducted a comparison of impulsivity and inattention, and delay discounting between individuals had and had not ever smoked in a cohort of 66 ADHD patients and 88 neurotypical (NT) individuals.

Impulsivity and inattention were measured via Conners, Parent and Conners’ Adult ADHD Rating Scale (CAARS) self-reporting. Delay discounting was measured by intertemporal preferences, or choices between immediate and delayed rewards, from a paradigm previously published by the research group. Individual smoking status was gauged via the Youth Risk Behavior Survey.

Investigators observed greater impulsivity (

 = .068) among those with ADHD who smoked, versus those who did not. No such significant difference was observed among NT individuals.

“These findings illustrate that inattention, as well as impulsivity and delay discounting are correlated with early smoking behavior in the ADHD, but not NT group, suggesting multiple cognitive systems are linked to experimentation with smoking in ADHD,” they wrote.

From this, Mukherjee and colleagues believe targeted early interventions could be conceived for young, at-risk ADHD patients based on this observation.

“Furthermore, data from our multi-dimensional longitudinal study will lead us to investigation of neural basis and long-term impact of these relationships,” they concluded.

The study, “Impulsivity and the Likelihood of Smoking in ADHD,” was presented at APSARD 2021.

The likelihood of smoking addiction is associated with traits also closely associated with worsened ADHD.

Smoking Linked to Teenage ADHD Impulsivity, Inattention

 (ADHD) could be a game changer in supplementing the existing strategies of therapy and medication to further help this patient population.

, a team of researchers presented data from a focus group looking at ADHD coaching as an emerging tool for both pediatric and adult patients with the disorder.

, Elizabeth Ahmann, Research Director of the Springer Institute and Micah Saviet, Director of the Springer Institute, explained how the results of the focus group show what the role of ADHD might be moving forward.

The researchers believe the role of ADHD coaching ultimately is to work on personalized goal oriented plans with the individual and craft a way to achieve those goals. It ideally will be used in conjunction and coordination with the clinician and psychiatrists.

One of the aims of the focus group is to come up with guidelines for how ADHD coaches can best communicate with clients and better understand how to network with other professionals involved in the process.

However, the research team believes further research is needed to better explore interprofessional communication among other professionals.

An ADHD coach can work on more goal-based plans for individuals with ADHD.

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