The Cutting Edge of ADHD: Research News, MAHA Commission, and More
ADHD research news today — from emerging treatments to what MAHA means for ADHD care — distilled by an esteemed researcher.
Stephen Faraone, Ph.D., author, researcher, and architect of The ADHD Evidence Project, whose mission is to evaluate and translate the latest scientific findings about ADHD, is setting the tone for how ADHD is understood and treated worldwide. Here, Faraone shares the insights, discoveries, and challenges most likely to impact ADHD care in the coming years.
Q: Where is research expanding our understanding of ADHD diagnosis and treatment, and what developments might we look forward to in the coming years?
The Causes of ADHD
For decades, we thought that genes played a central role in causing ADHD because ADHD runs in families. But new studies of DNA, the biological building blocks of genes, are revealing the polygenic origins of the disorder. Key facts emerging from this research include:
- Thousands of genes are involved in causing ADHD.
- Many of the genes associated with ADHD also increase risk for other disorders commonly diagnosed alongside ADHD.
- Even in the general population of people without an ADHD diagnosis, children with a high polygenic risk for ADHD (based on DNA assays) face elevated risk for experiencing traumatic events such as physical abuse.
At the turn of the century, longitudinal studies suggested that ADHD symptoms diminished with time. By early adulthood, it was thought, only two-thirds of ADHD youth would continue to experience consequential symptoms. New data from the Multimodal Treatment of ADHD study, however, show that remission is often followed by subsequent worsening of ADHD symptoms. ADHD is episodic, ebbing and flowing for some patients.
Advances in Treating ADHD
On the treatment front, extended-release viloxazine is a newly approved non-stimulant medication, and I expect the FDA will approve centanafadine as well. Unlike currently available medications, these new medications affect the serotonergic system, and centanafadine affects dopamine as well as norepinephrine. Prior research suggests that serotonin, which affects impulsivity, mood regulation, and aggression, is involved in many of ADHD’s comorbidities and may play a role in influencing ADHD symptoms.
Research is also aimed at discovering a “neuromechanistic” treatment for ADHD, or one that reduces symptoms by stimulating the brain. The FDA has already cleared external trigeminal nerve stimulation (eTNS) for ADHD in children and adults. But a new study suggests it is not effective. Other methods are being developed but need more work before they can be recommended.
Many apps are being developed for ADHD. One app, hiToco, helps parents apply behavioral psychology methods in real time with their children with ADHD. The app was shown to be effective in a clinical trial. It has been approved by insurance regulators in Germany.
Q: The Make America Healthy Again Commission released a set of strategies for improving children’s health in September. Among other things, it said the U.S. government will collect and analyze data on ADHD in school-age children to establish “prescribing safeguards to address the overuse of medications.” What are your thoughts about this?
It’s good that data will be collected to inform decisions and I hope it will be available to the academic community. I worry that the focus on overprescription of medications will lead to new regulations that decrease access to treatment, especially within disadvantaged communities, given the focus on Medicaid in the report.
The commission claims that ADHD medications don’t work in the long-term, but substantial data indicate that this is not correct. The commission would prefer that non-medication treatments be used. I agree that that is a good goal, but we simply don’t have non-medication treatments that are as effective as medications for ADHD.
Q: The ADHD Evidence Project website says your future work will “fight the war on ADHD.” What do you mean by this?
For decades, ADHD has been stigmatized and attacked by various groups, most notably, the antipsychiatry movement. Such groups flood the Internet with misinformation that makes it difficult for many parents and adults with ADHD to access treatment. I call it a “war on ADHD” because it has casualties: those with ADHD who continue to suffer because they’ve been scared off from seeking appropriate treatment.
ADHD Research: Next Steps
Stephen Faraone, Ph.D., is a distinguished professor of psychiatry and behavioral sciences at SUNY Upstate Medical University in Syracuse, New York. He is the author of Navigating ADHD Care: A Practical Guide of Adults.
Carole Fleck is Editor-in-Chief of ADDitude.
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