Speakers

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Jeffrey Newcorn
Dr Newcorn is currently Professor of Psychiatry and Pediatrics, and Director, Division of ADHD and Learning Disorders at Icahn School of Medicine at Mount Sinai. He is also the director of Pediatric Psychopharmacology for the Mount Sinai Health System.

Dr Newcorn is a highly regarded clinician - researcher with special expertise in the areas of ADHD, aggression, descriptive psychopathology of child and adolescent disorders, and child and adolescent psychopharmacology, whose academic work spans both clinical and translational topics. He has been a member of the steering committee of the NIMH-funded multicenter study “Multimodal Treatment of Children with ADHD (MTA).” He was the primary investigator on an NIMH-funded ADHD Research Infrastructure Network devoted to understanding the neurobiology of ADHD, and has been (and currently is) the principal investigator or co-investigator on several NIMH-funded and industry-funded grants that examine the clinical presentation and neurobiological basis of ADHD and its treatment. His work is frequently cited and well recognized; in 2018, he received the Elaine Schlosser Lewis Award for Research in Attention Deficit Disorder from the American Academy of Child and Adolescent Psychiatry.
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Rick Jarman
Rick is one of Australia’s leading experts in child development and behaviour.

He graduated from Melbourne University MBBS in 1979 and obtained his specialist qualification in Paediatrics FRACP in 1988.

He was chief resident at the Royal Children’s Hospital Melbourne in 1985-1986. He was awarded the Jeannie Poolman scholarship in 1986. He was a Fellow in Developmental & Behavioural Paediatrics at the University of Massachusetts Medical Centre between 1986-1989. He was appointed attending paediatrician and instructor in paediatrics at U Mass Medical Centre and Worcester Memorial Hospitals in 1987. He was given the U Mass excellence in teaching award by the paediatric residents in 1988.

He returned to Australia on the senior medical staff at the RCH in late 1989, was appointed Deputy Director of the Department of Ambulatory Paediatrics in 1991 and Director of Clinical Services in 1994. He founded and headed the Child Behaviour Clinic and Sleep Clinic in the Centre for Community Child Health.

Rick has received a number of competitive research grants. He has 50 scientific publications including original research, review articles and textbook chapters.. He has served as Chairman of the Scientific Program Committees of the Australian College of Paediatrics and the NBPSA. He was a long serving member of the Written Examinations Committee of the RACP. He is a foundation member of the Neurodevelopmental and Behavioural Paediatric Society of Australasia. He is a consultant to the Family Court of Australia. He provides occasional expert commentary for ABC radio and 3AW. His parenting seminars in the community are in high demand and sell out quickly.

He is currently a senior specialist at the Royal Children’s Hospital in the Child Behaviour Clinic and Early Emergency Follow up clinic.

Rick also works in private practice. He is the founding director of Melbourne Developmental and Behavioural Paediatrics in Donvale and partner in Melbourne Paediatric Specialists @ the Children’s in Parkville.
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Christel Middeldorp
Prof Christel Middeldorp has a conjoint appointment with the Child Health Research Centre (CHRC), UQ, and Child and Youth Mental Health Service (CYMHS), Children’s Health Queensland Hospital and Health Service (CHQ HHS). Her research interests involve the role of genetic and other familial influences on the development and persistence of ADHD and other psychopathology across the lifespan. She is the co-PI of the Behavior&Cognition working group of the EAGLE consortium (EArly Genetics and Lifecourse Epidemiology). EAGLE aims to identify genetic variants underlying the development and persistence of childhood psychopathology by using data from population based longitudinal child and adolescent cohorts from over the world. She further investigates associations between parental and offspring psychopathology and the development of these associations over time in a clinical cohort consisting of families with children treated at outpatient psychiatric services, who are followed longitudinally.
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Loretta Giorcelli
Dr Loretta Giorcelli trained as a primary/special education teacher in Queensland in the late 1960s and has taught a range of learners with diverse needs, at pre-school, primary and secondary levels in segregated and integrated settings in both the UK and Australia.

She has a Bachelors Degree in Education, a Masters Degree in Educational Leadership, a Masters Degree in Special Education and a PhD (Child Development: Linguistics and Communication Disabilities) from the University of Illinois (USA).

Dr Giorcelli has worked as a teacher, program consultant and school principal in Queensland and London schools before accepting a position as the NSW Director of Special Education and Equity Programs (Aboriginal Education, Migrant Education, ESL, Early Childhood Education, Disadvantaged Schools etc) in the early 1980s.
She has lectured at the tertiary level as a Professor at San Francisco State and Berkeley Universities in their joint doctoral program and at the University of NSW where she established the Certificate of Learning Disabilities and the Certificate of Integration Studies.

Dr Giorcelli has also worked as a consultant for the United Nations (WHO), the European Union (Cyprus, Malta), the ETC (Scotland) and Mindroom (Scotland, Scandinavia), acted as a government advisor in education to Cyprus for 5 years, worked for the Australian Government on AUSAID development projects in Papua New Guinea and was a Linguistic advisor to SOCOG for the Sydney Olympic Games in 2000.

From 2004 – 2007 she was involved in one of the largest national projects investigating the inclusion of students with disabilities in regular classrooms in Australia. Since 2013, she has worked in the MSSD program for the Qld Government (2013-2015) and as part of the Equity Leadership Training of 927 leadership teams.

In 2013 Dr GiorcelliDr Giorcelli authored wrote a comprehensive eBook on Inclusive Schooling Practices with a revised version completed (2018) and an international version “Quality Schools- Inclusive Practices” released in 2017.

Dr Giorcelli has completed work for the Central Australian authority in the Northern Territory (2015-2017) on a 3-year leadership development program aimed at enhancing schooling practices for some of Australia’s most disadvantaged children. Her work The Invisible Needs of Learners was part of a two-pronged approach aligned with John Hattie’s Visible Learning parallel project in the same jurisdiction. She is currently conductin
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Alison Poulton
Self-rated functional impairment in adults with attention deficit/hyperactivity disorder (ADHD) Poulton, Alison1; Sandhu, Adrian2. 1Nepean Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia 2Dept of Consultation-Liaison Psychiatry, Blacktown Hospital, Blacktown, NSW, Australia; Background and aims: ADHD is frequently life-long and can affect social and occupational functioning in adulthood. We aimed to survey ADHD-affected participants attending educational meetings of ADDults with ADHD, a community charitable support organisation. Method: From 2016 to 2018, demographic and functional data were collected from 100 attendees at 5 educational conferences of ADDults with ADHD. Data were analysed using independent samples t-tests. Results: The 54 men and 43 women (3 did not specify) who returned questionnaires had a mean age of 42±15 and 44±15 years respectively. They reported being diagnosed with ADHD at age 33±17 and 33±13 years respectively, although most reported symptom onset in childhood (mean age 9±9 years and 7±5 years respectively; 93% reported being symptomatic before age 18). Of 98 people who rated their level of impairment while off medication on a scale of 0 (not at all) to 3 (very much), the mean level impairment in each of 5 domains ranged from 2.0 to 2.6, with occupational underachievement and poor self-esteem being the domains most affected. Ratings on medication were received from 80 participants, with mean scores ranging from 1.1 to 1.7. Scores in all domains were significantly lower on medication (all p<0.001). Conclusions: Our results suggest that adults with ADHD experience substantial impairment across multiple domains. They report significant benefit from medication. Although predominantly being diagnosed as adults, most recalled troublesome symptoms dating from childhood. This implies delays in diagnosis and treatment, associated with years of impaired function and poor self-esteem.
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Melissa Mulraney
Persistence and neural correlates of Disruptive Mood Dysregulation Disorder in 10-year-old children with ADHD
Mulraney, Melissa1,2; Silk, Timothy3,1; Efron, Daryl1,4; Hazell, Philip5; Gulenc, Alisha1; Sciberras, Emma3,1,2
1Health Services, Murdoch Children’s Research Institute, Melbourne, Australia
2Department of Paediatrics, University of Melbourne, Melbourne, Australia
3School of Psychology, Deakin University, Geelong, Australia
4The Royal Children’s Hospital, Melbourne, Australia
5Sydney Medical School, University of Sydney, Sydney, Australia
Background and aims: This study aimed to: 1) determine the proportion of children with ADHD with persistent disruptive mood dysregulation disorder (DMDD); and 2) explore differences in cortical thickness and gray matter volume (GMV) between children with ADHD+DMDD and ADHD-DMDD.
Method: Participants were children with ADHD (n=135) participating in a cohort study with data available at age 7 and age 10. DMDD status was ascertained using proxy items from the Diagnostic Interview Schedule for Children, Version IV. Magnetic Resonance Imaging data were collected in a subset (n=77) of participants at age 10. Extracted using Freesurfer, cortical thickness and GMV were compared between children with ADHD+DMDD and ADHD-DMDD using t-tests.
Results: At age 7, 29 (21.5%) children had comorbid DMDD; this decreased to 16 (11.9%) at age 10. Of those with DMDD at age 7, eight (27.6%) had DMDD that persisted at age 10. Compared to ADHD-DMDD, those with ADHD+DMDD at either time point had lower thickness in the right anterior (d=0.6, p=.03) and posterior cingulate (d=0.7, p=.02), right medial orbitofrontal (d=0.6, p=.02), and both the left (d=0.6, p=.04) and right insula (d=0.6, p=.04) cortices. Children with ADHD+DMDD also had reduced GMV in the posterior cingulate (d=0.6, p=.04).
Conclusions: In the first study investigating the longitudinal course of DMDD in ADHD one in four children with ADHD+DMDD at age 7 had persistent DMDD three years later. Several neural correlates of DMDD were found indicating that, although DMDD can be transient, it is associated with structural differences on neuroimaging.
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Sampada Bhide
Attention-Deficit/Hyperactivity disorder and family functioning: A 3-year longitudinal study of community-based primary school children Bhide, Sampada1,2,5, Efron, Daryl2,3,4, Sciberras, Emma1,2,3 1School of Psychology, Deakin University, Geelong, Victoria, Australia; 2Murdoch Children’s Research Institute, Melbourne, Australia; 2School of Psychological Sciences, University of Melbourne, Melbourne, Australia; 3Department of Pediatrics, University of Melbourne, Melbourne, Australia; 4 The Royal Children’s Hospital, Melbourne, Australia; 5Allied Health Department, The Royal Melbourne Hospital, Melbourne, Australia Background and aims: There is a paucity of longitudinal research examining associations between Attention-Deficit/Hyperactivity disorder (ADHD) and family difficulties. This study compared family functioning outcomes between children (62.5% male) with ADHD (n= 179), subthreshold ADHD (ST-ADHD; n= 100) and non-ADHD controls (n= 212). Method: ADHD was assessed at Time 1 (Mage= 7.31; SD= 0.42) using the Conners 3 and Diagnostic Interview Schedule for Children. Three years after initial recruitment (Mage= 10.5; SD= 0.51), parent-rated scales were used to assess parent distress, parent-partner relationship conflict and support, stressful life events, and family quality of life (FQoL) i.e. impact of child factors on family activities (FA), parent’s time (PT) and emotional functioning (PE). Results: Linear regression analyses controlled for school-clustering, child age, child sex, externalising co-morbidities and parent education. FQoL was lower for the ADHD group compared to both non-ADHD (βFA= -.82; βPT= -.83; βPE= -.95; all p< .001) and ST-ADHD (βFA= -.48, p< .001; βPT= -.25, p= .07; βPE= -.34, p= .01) groups; and for the ST-ADHD group compared to the non-ADHD (βFA= -.34, βPT= -.57; βPE= -.61; all p< .01) group. Both ADHD (β= .51, p < .001) and ST-ADHD (β= .31, p= .03) groups reported significantly higher parent distress than the non-ADHD group. There were no group differences in other outcomes. Conclusions: Families of children with ADHD and ST-ADHD experience greater parent distress and poorer QoL over time. Early identification of children with, or at risk of ADHD is needed to facilitate timely support for parents and families.
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Sarah Baggio
ADHD ECHO: Respect, integrity, care and imagination: Consumers as project partners – integrating care via Project ECHO®
Sarah Baggio, Project ECHO Clinical Engagement Officer, and Emma Dunlop, Project ECHO Consumer Representative, will discuss the evolution of the ‘flagship ADHD ECHO program’ from Children’s Health Queensland. This presentation will include how it all began, the consumer experience and the importance of consumer partnerships, lessons learnt along the way, and future plans for the ADHD ECHO program.
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Nicole Stefanac
Dysfunctional evidence accumulation in Developmental Dyslexia: Support for the neural noise hypothesis
Stefanac, Nicole R.1; Zhou, Shou-Han1; Spencer-Smith, Megan M.1; Castles, Anne E.2; O’Connell, Redmond3 and Bellgrove, Mark A.1
1Monash Institute for Cognitive and Clinical Neurosciences and School of Psychological Sciences, Monash University, Melbourne, 3800, VIC, Australia
2Department of Cognitive Science, Macquarie University, NSW, 2109, Australia
3Trinity College Institute of Neuroscience and School of Psychology, Trinity College, Dublin, Ireland.

Background and aims: Evidence of deficits in visual attention have been widely reported in the Developmental Dyslexia (DD) literature on a range of perceptual decision-making paradigms. However, consensus regarding the precise neural correlates underpinning behavioural patterns and their relationship with reading ability remains elusive.
Method: Thirty-two children with DD (16 females) were compared with 22 age-matched (AM; 11 females) and 16 reading-matched controls (RM; 9 females) on a Random Dot Motion task with concurrent EEG recording.
Results: The DD group were slower overall, had an earlier centro-parietal positivity (CPP) peak time, reduced slope and lower amplitude but did not differ in onset compared with both AM and RM controls. Pre-target alpha amplitude was also lower for the DD group, but only compared with AM controls. These findings were moderately correlated with age-corrected reading ability. No differences were seen in N2pc or motor-evoked potentials for the DD group.
Conclusion: Children with DD demonstrate disorder-specific dysfunction in their evidence accumulation (CPP) in that they have a reduced rate of accumulation and reach thresholds sooner but remain cautious in their responses. This is in keeping the neural noise hypothesis contending that children with DD have weaker sensory representations of coherent motion potentially associated with increased neural noise. While markers of attentional engagement (pre-target alpha) were also reduced, performance was similar to RM controls suggesting that this indexes reading immaturity rather than being a unique contributor to reading dysfunction.
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Alice Garrick
Emergency department experiences of parents of children with comorbid ADHD & autism spectrum disorder
Garrick, Alice1; Lee, Marie1; Scarffe, Carrington1 and Johnson, Beth1
1Monash University, Melbourne, Australia

Background and aims: Children with attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) attend emergency departments (ED) at a greater rate than their typically developing peers. What we know is that ED is a very stimulating and unpredictable environment, bustling with people, noise and bright lights. However the experiences of families attending ED with their child with comorbid ADHD and ASD is unknown, and the unique challenges they may face. We evaluated experiences and perceptions of Australian parents of children with comorbid ADHD and ASD attending ED.
Methods: Parents completed an online self-report survey of 58 mixed-methods questions, qualitative and quantitative, regarding experiences in ED when attending with their child. The survey captured demographics, reason for presentation, child’s communication and sensory needs, child’s communication and sensory experience in the Emergency Department (ED), child’s perception and communication of pain and the resources parents have used to support their child in the Emergency Department. A total of 174 parents who had a child with comorbid ADHD and ASD took part.
Results: Two thirds of children presented with accidental injuries, 24% with gastrointestinal issues, 13% for asthma, 7% for self harm and 5% for infection/virus. Most parents reported barriers to safe and effective care for their children and three quarters described the experience in the ED as very or extremely stressful for their child due to the sensory environment. Sensory overload and emotional dysregulation as a result of prolonged ED stays was common.
Conclusion: Although triage in ED is primarily based on medical need, a prolonged stay in ED can mean that additional mental stress can arise in a child with comorbid ADHD and ASD, which can further complicate their diagnosis and treatment. There was strong interest from parents in an evidence based visual resource that clearly communicates the child’s individual sensory and communication needs to ED staff.
Correspondence: Beth Johnson; beth.johnson@monash.edu
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Mark Ryan
What has sleep got to do with it? The sleep-wake cycle and circadian rhythm dysregulation in ADHD and treatment with neurofeedback
Ryan, Mark1; Arns, Martijn2,3,4 and Brown, Trevor5
1neuroCare group, Sydney, Australia
2neuroCare group, Munich, Germany
3Research Institute Brainclinics, Nijmegen, The Netherlands
4Dept of Experimental Psychology, Utrecht University, Utrecht, The Netherlands
5 neuroCare group, Melbourne, Australia

While causation is not one thing, but many, converging evidence points to an important role of sleep disturbance, most commonly a circadian rhythm sleep disorder in ADHD. A consistent association has been described between ADHD and circadian phase delay, resulting in delayed sleep onset (Coogan and McGowan, 2017), with causality implied for the largest subgroup of ADHD patients (Arns and Kenemans, 2012). The relevant range of consequences of sleep problems and the role of the visual system, retinal ganglion and amacrine cells and the dopaminergic DRD4-7R genotype in the regulation of the sleep-wake cycle will be briefly discussed.
The likelihood of heterogeneous causation in ADHD and the high prevalence of sleep disorders in this patient group encourages personalised medicine methods, specifically assessing sleep and identifying neuromarkers and biomarkers, enabling identification of subgroups of ADHD and thereby allowing for more specific, individualised treatment.
Sleep disorders have an aetiological/pathogenetic role in at least a large subgroup of those with ADHD and specific QEEG informed neurofeedback protocols are emerging as effective and potentially curative treatments for ADHD for the largest subgroup. Psychostimulants, the mainstay of pharmacological treatment for ADHD while helpful in the short and medium terms, do nothing for the sleep problem and in fact can worsen it by increasing sleep onset latency.
Sleep hygiene, CBTi and chronotherapy have an important role in ADHD treatment and neurofeedback, the operant training of EEG activity, has been shown to have a specific effect on sleep and ADHD symptoms. (Arns et al,2013; Arns et al,2014). Arns et al (2009) have reported that at the group level, both frequency band and slow cortical potential neurofeedback for ADHD achieve a large effect size for inattention and impulsivity and medium effect sizes for hyperactivity. A more recent meta-analysis (van Doren et al., 2018) indicates that the effects of neurofeedback are maintained at 3-12 month follow up, su
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Hannah Kirk
The effects of a gamified cognitive training program in reducing inattentive behaviour in the classroom: A randomised controlled trial
Kirk, Hannah E.1; Spencer-Smith, Megan1; Wiley, Joshua F.1 and Cornish, Kim M.1
1School of Psychological Sciences, Monash University, Melbourne, Australia

Background and aims: Difficulties in attention are commonly reported in childhood and have a cascading impact on subsequent behavioural regulation and learning. The current randomised controlled trial aimed to determine the immediate and long-term efficacy of a classroom-based attention training program (Tali Train) on attention, inattentive/hyperactive behaviour, working memory and numeracy in primary school children.
Method: A total of 98 children (5–9 years) were randomly assigned to Tali Train, a non-adaptive placebo program or usual classroom education. Classes assigned to Tali Train and placebo program were provided with touchscreen tablets and teachers were instructed to complete their assigned program 5 times a week for a 5-week period. Primary outcome measures included neurocognitive assessments of attention. Secondary outcomes measures included parent/teacher rated questionnaires of ADHD symptoms, assessments of working memory and numeracy. Performance was assessed at the start of the trial, immediately after the 5-week training period, and 6 months after the training period had ceased. The trial was pre-registered with the ANZCTR and analyses were performed on an intention to treat basis.
Results: Latent growth models indicated that children assigned to Tali Train showed significantly greater reductions in ADHD symptoms within the classroom immediately after the training period compared to children in the control arms. Some small gains in selective attention were also observed, however there was no effect of the intervention on working memory, numeracy or sustained attention.
Conclusions: These findings suggest that attention training may have select immediate benefits in reducing ADHD symptoms within the classroom.
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Lindsey Ross
High dose stimulant medication for the management of attention deficit/hyperactivity disorder (ADHD): A retrospective cohort study Ross, Lindsey1; Sapre, Veena1; Stanislaus, Christina2 and Poulton, Alison1,3 1Nepean Hospital, Department of Paediatrics, Penrith, NSW, Australia 2Health Science, University of Sydney, Sydney, Australia 3Nepean Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia Background and aims: Dose titration to optimise functioning in ADHD is limited by a maximum dose. In NSW the Ministry of Health authorises high dose (HD) stimulant use when clinically necessary. The aim of this study is to describe the clinical characteristics of children authorised to receive HD stimulant and to compare them with those on regular doses (RD) within one paediatrician’s practice. Method: Clinical records of children treated by AP with HD stimulant from 2003-2016 were identified using a database of prescription records. Children on RD who were issued a prescription on the same day that a study child commenced HD constituted a RD comparison group. Data were analysed using chi-square and t-tests. Results: Records identified 53 HD and 117 RD children. The HD children were more likely to be male (89% vs 74% p=0.034) and have oppositional defiant disorder (ODD) (81% vs 55%, p=0.001), and started medication at a younger age (6.4±1.7 vs 8.3±2.8 years, p<0.001). HD children were no more likely to take other medications apart from risperidone (38% vs 15%, p=0.001) and melatonin (57% vs 31%, p=0.001). The HD children grew significantly more slowly in height (p=0.001) and weight (p=0.002) over a treatment period of 5.2±3.0 and 4.1±3.2 years respectively. HD treatment was not associated with higher blood pressure. Conclusions: Children on HD stimulant were more likely to be male and on risperidone for ODD but were not otherwise more complex than children on RD. They had more growth attenuation, but no major adverse events. Correspondence: Alison Poulton; email alison.poulton@sydney.edu.au
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Emma Sciberras
Treating anxiety in children with ADHD using cognitive behavioural therapy: A randomized controlled trial
Sciberras, Emma1; Efron, Daryl2; Patel, Pooja2; Mulraney, Melissa2; Lee, Katherine J. 2; Mihalopoulos, Cathy1; Engel, Lidia1; Rapee, Ron M. 3; Anderson, Vicki2; Nicholson, Jan M.4 and Hiscock, Harriet2
1Deakin University, Melbourne, Australia
2Murdoch Children’s Research Institute, Melbourne, Australia
3Macquarie University
4LaTrobe University, Melbourne, Australia

Background and aims: Up to 50% of children with ADHD meet criteria for at least one anxiety disorder. The aim of this randomised controlled trial (RCT) was to examined whether treating anxiety in children with comorbid ADHD and anxiety improves child and family functioning 5 months later compared with usual clinical care.
Method: To be eligible, children needed to be aged 8-13 years and needed to meet full criteria for ADHD and separation, generalised, and/or social anxiety. Consenting families were randomised to receive a modified version of the ‘Cool Kids’ cognitive behavioural therapy program or usual clinical care from their paediatrician. Multi-informant (parent-, child-, teacher-report) measures were collected at baseline and 5 months post-randomisation including blinded assessments of anxiety diagnosis and cognition, and scales assessing child and parent functioning.
Results: 250 children were identified as eligible and of these 232 (77% male) enrolled. Participants met diagnostic criteria for social (79%), generalised (74%), and/or separation anxiety (51%) and in addition, 40% met criteria for oppositional defiant disorder. Most were taking medication for ADHD (96%). Five month outcomes will be collected by March 2018 and will be the focus of the presentation (study tracking for 82% completion of follow-up). Analysis of the primary (anxiety diagnosis) and secondary outcomes will be carried out using mixed effects regression.
Conclusions: Targeting anxiety may be an effective way of improving functional outcomes children with ADHD. This study is the first powered RCT to test whether treating anxiety in children with ADHD leads to improved outcomes.
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Michele Toner
ADHD in the Workplace; The Team Approach
Toner, Michele1
1Michele Toner, ADHD Coach

The symptoms of ADHD cause functional impairments across several domains, including the workplace. According to the minimal research in this area people with ADHD tend to quit or lose their jobs more often and take more time off work than their non-ADHD peers. Coaching case studies provide valuable information about the nature of common challenges and potential accommodations.
People with ADHD are reluctant to disclose their diagnosis at the time of employment due to the stigma associated with their condition. This prevents them requesting simple accommodations. They may excel at aspects of their job but be hampered by Executive Function impairments relating to time management, project deadlines, and prioritisation. In addition, they may misread social clues and fail to negotiate the relationships required to be successful at work.
Disclosure often occurs when problems are identified by management and a performance review is put in place. This is a challenging process for individuals with ADHD for several reasons. For example, Human Resources personnel tend to have limited knowledge about ADHD, and often request input from clinicians who are not ADHD experts. Individuals with ADHD may ‘over-disclose’ or agree to performance plans that are unrealistic.
Coaches, clinicians and HR professionals can work together with individuals to ensure the best outcomes in the workplace. Examples of successful team approaches will be provided, along with a model for addressing workplaces issues in a timely manner.
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Monica Hassall
Beyond Fight Flight and Freeze -Is there a Fourth F and the ADHD Mind in Crisis. Supporting those at risk and their significant others.
Hassall, Monica1 and Hunter, Barbara2
1Connect ADHD Coaching, Brisbane QLD, Australia
2Integrated Learning Designs, USA

Background and aims: The evolution of the Neocortex and consequent development of advanced social language and complex thinking has given humanity a new tool in self-preservation, albeit a maladaptive strategy at times. With consideration of the executive function challenges faced by those with ADHD, it has been observed that overwhelming situations may render a new protective mechanism in addition to Fight, flight and Freeze to come into play., and that is “Fib.“

The aim of this presentation is to discuss practical solutions to support people with ADHD and their significant others when at risk. Knowing that the “Fib” response is triggered often by fear, supporting all involved how to address this issue and how to resolve reducing harm to the relationships at risk.
Method: Four case studies are presented-each representing a proposed “protective mechanism”; being Protection, deflection, extension and Self-preservation. These topics are explained in order to understand what elements or means are being employed.
Results: Key strategies have been developed in order to provide parents, partners, clinicians, teachers and other caregivers tools with which to deconstruct the “fib”in order to avoid damage to the relationship .
Conclusion: By reviewing key elements of executive functioning underpinning why “fibbing” occurs and strategies to reduce their impact to the individual
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Florence Levy
Measurement of ADHD: Are we still in the 60’s?
Levy, Florence1,2
1Child and Family East, Prince of Wales Hospital, Randwick, NSW, Australia
2School of Psychiatry, University of New South Wales, Randwick, NSW, Australia

Aim: To critically discuss approaches to the measurement of ADHD
Method: Professor Russell Barkley has previewed an article for the March 2019 Issue of the ADHD Report entitled “Neuropsychological Testing is Not Useful in the Diagnosis of ADHD: Stop It”. While this may or may not be intended to provoke debate, I feel compelled to point out a number of weaknesses in his argument. He claims that “from 35-87% of cases with ADHD can pass neuropsychological tests while otherwise having legitimately documented ADHD according to current diagnostic (DSM) standards”. Also, that “rating scales of executive functioning are far more useful because they are more ecologically valid”. I would like to examine Barkley’s arguments in terms of Developmental norms, What do Executive Function Tests Measure, Whether rating scales and their child, the DSM have accomplished any theoretical understandings and suggest that we do indeed need objective and heuristic approaches to the measurement of ADHD.
Conclusion: if we are to progress our understanding and treatment of ADHD, incorporating objective measures that lead to productive theoretical approaches.
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Andrew Sheridan
Establishing and consolidating a public state-wide ADHD assessment and treatment service in Western Australia
Sheridan, Andrew1 and Cranley, Kirsty1
1Youth and Adult Complex Attention Disorders Service (YACADS), WA Department of Health, Perth, WA

Background and aims: YACADS was set up with the aim of providing a comprehensive assessment to adults with complex mental health issues and suspected ADHD (or previously diagnosed ADHD and difficulties with accessing treatment); and providing treatments and recommendations for improving clients’ functioning.
Method: We provide a Psychiatry and Neuropsychology assessment, including collateral interview/reports/questionnaires, followed by Neuropsychological recommendations and Psychiatric medication management. We are also working towards establishing a group psychosocial intervention for those with ADHD symptoms, focused on improving inattentive, dysexecutive, and impulsive symptoms and everyday adaptive functioning.
Results: We have established a steady stream of referrals, maintained a low-medium waiting list time, and provided a service with high levels of client satisfaction (though of course challenges and opportunities for improvement exist, and for example we are hoping that providing a group intervention will fill some of the service ‘gaps’).
Conclusions: The service continues to evolve over time, and while the initial phases of establishing the service have been positive, there are opportunities to improve the work that we do in order to provide the best possible service within the constraints that we have. As a small service there are limitations inherent in what we can provide, but we are often looking for ways that we can improve the quality of what we offer to clients.
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Edwina Birch
AHDH and NDIS
Birch, Edwina1
1ADHD Foundation

The NDIS can be a game changer for people who have moderate to severe functional impairment as a result of ADHD. It provides opportunities which have never been available before. However, it can be difficult to access. This presentation will primarily address the needs of adults with ADHD, although its role for children will be discussed.
This paper aims to address:
The disability status of ADHD
The eligibility criteria for entry to the NDIS
How it works
What documentation is required from professionals
What the NDIS can provide for those with ADHD
Limitations and troubleshooting
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Lindsay Martin
Background: Attention Deficit Hyperactivity Disorder (ADHD) represents a heterogeneous and multifactorial clinical disorder, defined by a complex aetiology and a group of shared core symptoms, namely, hyperactivity, impulsivity, and inattention. More recent models emphasize deficient response inhibition, executive dysfunction, and poor reward sensitivity as the main underlying causes of ADHD. Once thought to be a disorder that mainly occurred in boys, it is now widely recognized that a large number of girls and women suffer from ADHD, and that it persists into adulthood in up to 70% of cases.
Yet, the diagnostic criteria and the general understanding of ADHD today remains based upon observations of how the disorder manifests in boys. Our knowledge about the impact and expression of ADHD in girls and women remains sparse.
Interestingly, the gender ratio of male:female diagnosed cases of ADHD is approximately 3:1 during childhood, the gender ratio approaches 1:1 by adulthood. This discrepancy suggests ADHD is theoretically underdiagnosed in girls, and/or that girls are more likely than boys to display more subtle symptomatology. These observations support the many examples of women we see, who often presents histories of misdiagnoses and failed treatments before eventually receiving the diagnosis of ADHD as adults. What are the factors underpinning this?
Is it because hyperactive behaviour is commonly judged as less socially acceptable in girls than in boys? Does it manifest in ways that does not make the surroundings consider them signs of ADHD?
Aims: To highlight the presentation of women in routine practice; to increase awareness.
Method: Each practitioner has picked two female patients from their practice; we have compared the psychopathology using tables/reference scales to develop representative case descriptions.
Results: Common symptoms of hyperactivity include overeating, garrulousness, high arousal, fidgeting, flight of thoughts, internal restlessness, and emotional reactivity. Common symptoms of inattention in females include forgetfulness, low arousal, internalizing symptoms, daydreaming, and disorganization, while impulsivity may manifest as a tendency to interrupt others, say whatever comes to mind, act out on impulses, and suddenly change directions in life. Eating disorders, low self-esteem and obsessive symptoms are common.
Conclusions: There is notable differences along gender lines which we hope to be able to highlight
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Heidi Sumich
ADHD Solutions: An Interactive Workshop on Behavioural & Cognitive Strategies
Heidi Sumich, Madeline O’Reilly & Jonathan Hassall

This workshop will present a cognitive-behavioural/coaching model of procrastination and task failure in ADHD. The model aims to assist clinicians to help their patients identify the barriers to successful task completion, with discussion and collaborative brain-storming of various therapeutic strategies that can be employed based on the nature of the barrier. Of particular importance are the roles of emotional evaluation, organisational capability evaluation, and time/consequence evaluation on one’s willingness to approach and persist with a task.
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