Final Programme 2019

44 MEET-THE-EXPERT-SESSIONS Saturday, 27 April 2019 ME-04 Meet-the-Expert-Session 16:15–17:15 Room 1.03 High severity patients with adult ADHD Chair: F. Reimherr, USA The Wender Utah Rating Scale (WURS) detects a pattern of childhood symptoms and behaviors consistent with ADHD persisting into adulthood. There are over 1,000 references to the scale in Google Scholar including at least 30 reports regarding the scale’s psychometric properties. In contrast to almost all past reports, we simultaneously assessed the psychometric properties of both the full 60 item WURS and the shorter WURS-25. We also used more diverse and clinically relevant populations: Adults with ADHD (n=137), nonclinical controls (n=120) and psychiatric controls with major depression (n=121) or generalized anxiety disorder (n=109). Both versions generated analogous factors that we labeled disruptive mood & behavior, ADHD, and anxiety/dysphoria. The full WURS generated 2 additional factors: Social and Academic. The ADHD, disruptive mood & behavior, and academic factors were highly correlated (r>.8, p<.0001) and differed between the ADHD cohort and the non-ADHD groups (p<.001). In contrast, neither the anxiety/dysphoria or social factors differed between GAD, MDD and ADHD groups. ADHD subjects with high levels of emotional symptoms which we have labeled ADHD emotional dysregulation presentation had significantly higher scores on the disruptive mood & behavior and anxiety/dysphoria factors other ADHD subjects. The WURS-25 scoring system developed by Wender & Reimherr distinguished the ADHD group from the combined depression and anxiety groups (p<.0001) with sensitivity = 62.77% and specificity = 83.93%. The scale successfully separated subjects with ADHD from GAD and MDD. Both WURS versions support a broader conceptualization of ADHD and help to clarify the types of impairment shown by subjects with the disorder. ME-05 Meet-the-Expert-Session 16:15–17:15 Room 1.04 Evidence for treatment of ADHD with psychostimulant medication Chair: J. Swanson, USA The use of stimulant medications (methylphenidate and amphetamine) to treat symptoms of ADHD has remained controversial despite linear increases in this clinical practice for decades, resulting in high percentages of children identified with ADHD and receiving this treatment (e.g., 11% of 4- to 18-year old children in the USA recognized and 7% treated with stimulant medication). Historically, many previous reviews document effectiveness of short-term treatment of ADHD with stimulant medication (Swanson et al, 1994), and recently additional evidence was summarized by two large and very impressive meta-analyses of randomized clinical trials (Storebo et al, 2015 and Cortese et al, 2018). Both conclude there are large benefits (effect size about 0.8) of short-term treatment, and both highlight lack of controlled studies of long-term treatment. Despite very similar estimates of effect size for short-term treatment, these two meta-analyses differed in recommendations for treatment, based on very different evaluations of “Quality of Evidence”. This generated considerable controversy and debate in the literature (Swanson, 2018), which will be summarized and discussed. In addition, recent studies of long-term self-selected use of medication in clinical practice (“treatment as usual”) will be reviewed. The common patterns of use in prospec- tive follow-up studies (e.g., in the MTA; Swanson et al, 2017) and in national registries (e.g., in Sweden; Lichten- stein et al, 2012) will be described. Despite the application of very different methods, these studies indicate that long- term adherence to treatment is poor, and that inconsistent treatment (stopping and starting treatment) is more com- mon that consistent treatment (long durations of conti- nuous or uninterrupted treatment). Recent analyses of reasons for stopping and starting medication will be re- viewed. Speculative hypotheses of pharmacological tole- rance and neural adaptations (possible mechanisms that could undermine or reduce effectiveness of long-term treatment compared to short-term treatment) will be pre- sented and discussed. e Registration fee for Educational Seminars and Meet-the-Expert-Session: EUR 50 per session. Only valid in combination with the congress registration fee.