Day 2: Late-Breaking Updates From the National Academy of Sciences Conference on Adult ADHD

Greg Mattingly, MD, gives exclusive updates from day 2 of the National Academy of Sciences Adult Attention-Deficit/Hyperactivity Disorder: Diagnosis, Treatment, and Implications for Drug Development Workshop.

Held in conjunction with the CDC, the FDA, the DEA, and the Substance Abuse and Mental health Services Administration (SAMHSA), this workshop brought together the nation’s researchers, educators, and cliniciang (including representatives from The American Professional Society of ADHD and Related Disorders [APSARD]), as well as individuals with lived experience from Children and Adults Living With ADHD (CHADD) and Attention Deficit Disorder Association (ADDA).

Key ipdates include: the critical role of access to adequate treatment and effective medications, clinical takeaways from patient experiences, and the current state of stimulant misuse and diversion in different patient populations.

Updates from Day 1 can be found here.

Read the transcript:

Welcome. This is [Dr] Greg Mattingly and I'm coming to you fresh after being at the National Academy of Sciences Engineering and Medicine for a historic meeting.

This meeting brought together people from governmental agencies such as the FDA, the CDC, the National Institute of Health (NIH), along with our advocacy organizations: The American Professional Society of ADHD and Related Disorders (APSARD), an organization called Children and Adults Living With ADHD (CHADD), and the Attention Deficit Disorder Association (ADDA)—a support organization for adults with ADD. This is Greg Mattingly, the president-elect for the American Professional Society For ADHD and Related Disorders, and co-chair of US Psych Congress.

I'm going to dive into a few of the highlights for clinicians about what we saw at the National Academy of Sciences meeting Focused on adult ADHD.

First of all, it was brought over and over again, something we all know as clinicians, that one of the number one health care crises this past year wasn't depression, wasn't bipolar, wasn't schizophrenia. It was children and adults living with ADHD.

We had a crisis because of the lack of access to care, and that was highlighted by a lack of access to treatments.

I think the winners of the [second meeting] day, some of the most influential people, weren't our individuals coming to us from APSARD, it wasn't the CDC or the FDA, but I think the winning experience was patients talking about their own journey.

I'd like to highlight a woman that I thought was fascinating: Evelyn Polk Green. She's a woman of color living in Chicago who's raised 2 children of color, who herself had a journey to a diagnosis of adult ADHD. She's become an amazing advocate in the space. She's been the past president of CHADD, dedicated to advocacy for children with ADHD, and the past present for ADDA, [focusing on] adults with ADHD. She said some things that are very, very important. She said, [in summary], listen, as a woman of color, she knows she's checked a whole lot of boxes, but it's time to go beyond checking boxes. So, we talk about how ADHD disproportionately affects individuals who are vulnerable. Vulnerable because of their socio-economic background, vulnerable because of the color of their skin, vulnerable because of their educational background, and vulnerable because of lack of access to care.

When we talked about moving the needle forward for advocacy access and holistic treatment. We also had people talk about their experiences about not being able to get ADHD treatment this year.

We had a psychiatrist from the University of Chicago who talked about losing her job this past year because she wasn't able to access the medicine she'd been taking for years that allowed her to be successful in her career.

So, not only in taking care of patients but in her own personal journey as a psychiatrist, her lack of access to treatment made an impact on her life.

A few kinds of cautions that I'd like to bring up. Brooke Molina, PhD, who is the program committee chair for APSARD, [as well as professor of psychiatry, psychology, pediatrics & translational science at the University of Pittsburgh School of Medicine, talked about a few things that we should have on our radar screen when it comes to misuse and diversion when it comes to ADHD treatments.

First of all, those at highest risk for substance misuse of their own ADHD medicines or using it from a friend or a family or a roommate would be in the 18 to 25 year old age range. So, 18 to 25 year olds tend to be the highest risk of misuse or diversion of an ADHD stimulant. S

Surprisingly, she found that people from a caucasian background were actually more likely than those from a minority background to misuse or divert their own stimulant. She found that men were more likely [to misuse or divert] than women, although it can happen with both boys and girls, young women, and young men in this group. She also found some other risk factors for stimulant misuse and diversion. Having ADHD, having lower grades, and having concurrent substance abuse were all risk factors for stimulant misuse and diversion.

I think, a risk factor as a clinician that I want to stick in here that hit me: those that come on to ADHD treatment at an older age, the patients who began ADHD treatment at age 6, 7, 8, or 9 years old, had lower risks of misusing their own stimulant when they went and went to college, when they were moving to being young adults. It was those patients who came into treatment at age 18, 19, 20, or 24 that we have to be a little more careful with. Talk about the risks and benefits and watch their controlled use of ADHD treatments.

Finally, we had a wonderful talk from the CDC.

Lara Robinson, who's been an advocate for ADHD, she has 2 children with ADHD. She talked about the impact of ADHD within her life, but across the US population. She had some really interesting statistics that I think will go home to everyone in the audience, and that is the growing role of nurse practitioners. 

We saw that psychiatrists took care of about 23% of adults with ADHD. We saw the growing role of nurse practitioners for managing ADHD care, and we saw that nurse practitioners had an even bigger role when it came to taking care of those from disadvantaged backgrounds with limited access to more traditional levels of care. 

If we move to a Medicaid population, an economically disadvantaged population, we see the role of nurse practitioners and allied health professionals increasing more and more. We have to work together as a team. We have to work together as an organization.

One of the overall overarching themes was the need for education in ADHD when we asked clinicians, “do you feel like you've had enough education about ADHD?” The vast majority said, “enough? 'Ive had almost no education about adult ADHD. In my residency, in my nurse practitioner classes, in my physician assistant classes, it was a topic that got very little coverage.”

That's why come join us for this year's Psych Congress meetings—Psych NP Institute, the Psych Regionals, Psych Congress Elevate, and our Psych Congress, which is going to be coming to us from Boston this year. Let's share together. Let's learn about the world of adult ADHD. Thank you for joining me for this discussion.

Greg Mattingly, MD
Associate Clinical Professor, Washington University; 
President, Midwest Research Group;
Co-Chair, US Psych Congress;
President-Elect, American Professional Society for ADHD and Related Disorders