ADHD Atten Def Hyp Disord DOI 10.1007/s12402-015-0169-y

ABSTRACTS

 Springer-Verlag Wien 2015

5th World Congress on ADHD: From Child to Adult Disorder

28–31 May 2015  Glasgow  Scotland

Editors: Manfred Gerlach, Wu¨rzburg, Germany Peter Riederer, Wu¨rzburg, Germany Luis A. Rohde, Porto Alegre, Brazil Andreas Warnke, Wu¨rzburg, Germany

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Introduction Dear Colleagues and Friends, On behalf of the World Federation of ADHD, we are pleased to welcome you here in Glasgow for the 5th World Congress on ADHD: From Childhood to Adult Disorder. After the incredible success of the Milan meeting in 2013, where 2100 participants from 80 countries attended—Glasgow is the ideal setting to elucidate and discuss the current advances in ADHD diagnosis, treatment and neurobiology, contributing to our understanding of ADHD as a lifespan disorder. We intend to offer exchange forums and give you the chance to debate on the most recent research results as well as clinical issues in the diagnosis and treatment of ADHD. This is one of the key missions of the World Federation of ADHD, and we are happy to remember our tradition of bringing together healthcare specialists from all around the world, dedicated to this challenging and extremely relevant mental disorder. The Scientific Programme Committee has once again created an excellent scientific programme, consisting of outstanding Plenary Lectures and parallel Hot Topic Symposia as well as Research Consortia Present new Designs and Findings, Late Breaking News, and innovative Guided Poster Sessions. In two new formats, the Grand Round and the Historical Case Presentation, clinical cases will be discussed by some of the most reputed ADHD experts. Furthermore, to provide a friendly and interactive atmosphere, eight Educational Seminars and six Meet-the-Expert Sessions will take place in the afternoons. Apart from the professional aspects of the congress, Glasgow is a beautiful city with numerous activities to enjoy. The city is located at the River Clyde, close to the Atlantic Ocean. With approximately 600,000 citizens and roughly 2 million in the greater region, the city invites you to discover its medieval architecture during pleasant strolls. In the city traditional businesses go hand in hand with modern life. If you are interested in art, the city centre is the home to the Gallery of Modern Art (GoMA) and the McLellan Galleries, built in 1855-6, now considered the largest quality, climate-controlled, temporary exhibition gallery in Scotland. In this volume, abstracts are organized day by day. Plenary Lectures (PL) come first, then Hot Topic Symposia (HT) and Research Consortia Briefings (RC) and finally the Poster abstracts (P). Submitted abstracts have not been modified in any way. The PL have been organised in four topics: New Advances in ADHD Diagnosis, New advances in ADHD Neurobiology, Controversies in ADHD, New Advances in the Treatment of ADHD. The 15 HT and 3 RC cover the latest clinical and research developments in the broader field of ADHD and related disorders. We are pleased to have received about 330 poster abstracts. The general quality of the abstracts is much better than in former years. We have organised several Guided Poster Tours so that presentations of the different topic categories can be represented uniformly. The topics are: Aetiology, Basic Science, Clinical Electrophysiology, Co-morbid Disorders, Diagnosis, Epidemiology, Genetics, Neuroimaging, Non-pharmacological Treatment, Quality of Life/Caregiver Burden, Miscellaneous, Pathophysiology, Pharmacological Treatment, Substance Abuse. We would like to encourage you to not only view these selected posters, but to also engage in active discussions and to exchange ideas with our young colleagues. Of all abstracts submitted by young scientists, the top eight have been selected by the Scientific Programme Committee. The authors have been invited to give a presentation during one of the two Young scientist award sessions (YS). With this approach, we intended to highlight the importance of original scientific contributions of young colleagues at the congress. We thank all the speakers, contributors and sponsors of the 5th World Congress on ADHD: From Childhood to Adult Disorder. We thank you for joining this exceptional event and are pleased and honoured to have you with us. Yours sincerely Luis Rohde Congress President President World Federation of ADHD

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Manfred Gerlach Chairmen Scientific Programme Committee

Thursday, 28 May 2015, 15.00 h–16.30 h HT-1 ADHD and comorbidity HT-1-001 The relevance of comorbidity in adult ADHD F. Reimherr* * Salt Lake City, USA Objectives: This report analyses comorbidity with adult ADHD using data from several clinical trials involving generalized anxiety disorder or depression while personality pathology was assessed in two clinical trials of ADHD. The relationship between ADHD emotional dysregulation and comorbidity in adult ADHD is examined as well. Examination of the clinical trials of adult ADHD, revealed that 57 % of adults with ADHD had a personality disorder (cluster A—11 %, cluster B—20 %, cluster C—35 %, and passive aggressive—13 %). More importantly, personality disorders were positively associated with emotional dysregulation at statistically significant levels. A history of childhood ADHD and/or the Wender Utah Rating Scale (WURS) for ADHD were used to evaluate patients participating in clinical trials of major depression and generalized anxiety disorder. The WURS is a widely accepted self-report scale that assesses the childhood symptoms associated adult ADHD. In the depression trials between 9 % (history) and 26 % (WURS) had probable ADHD while ADHD comorbidity in the anxiety trials was between 11 % (history) and 23 % (WURS). In addition, data from these trials mirror our earlier finding with personality disorder; comorbidity with both depression and anxiety was associated with increased levels of ADHDrelated emotional dysregulation.

HT-1-002 Obesity in ADHD S. Cortese* * Verona, Italy Objectives: In the first part of my talk, I will present the results of a meta-analysis of studies that estimated the association between obesity/overweight and ADHD. The meta-analysis included 42 studies assessing a total of total of 728,136 individuals (48,161 ADHD; 679,975 controls) and showed a significant association between ADHD and obesity, regardless of possible confounding factors, study setting, ADHD diagnostic methods, definition of obesity, age, gender, and study quality. In the second part of my presentation, I will discuss evidence on possible psychopathological and neurobiological mechanisms underpinning the association between ADHD and obesity. Finally, in the last part, I will point to the implications of the association between ADHD and obesity in terms of treatment of individuals with both conditions. In particular, I will discuss evidence showing that screening and treating comorbid ADHD in individuals with obesity and a lengthy history of unsuccessful weight loss significantly improves weight loss.

Objectives: ADHD in children and adults is often accompanied by sleep problems and sleep disorders. Sleep problems generally lead to sleepiness during the day and may further impair attentiveness. Sleep problems may also be part of, or induce mood disorders. Sleep debt in the long term is associated with general health problems like obesity, diabetes, cardiovascular disease and cancer. Methods: During this presentation, an overview of the literature on sleep in ADHD will be discussed, as well as recent research on the delayed sleep phase syndrome in ADHD and its possible consequences for health in general in this population. Results: ADHD is comorbid with sleep problems and disorders in the majority of children and adults, like restless legs syndrome, sleep apnea, delayed sleep phase syndrome and other disorders. In 75 % the sleep phase is delayed, as has been shown using melatonin measurements in saliva in children and adults, and by actigraphy measurements of movement patterns. Also body core temperature, that reflects melatonin levels at night, is delayed and slightly decreased. A late sleep pattern is often genetically driven, starts in childhood, and may have several consequences for health in general in the long term, which outcome still has to be studied in ADHD patients. Available evidence for treatment with sleep hygiene, melatonin at night and bright light therapy in the morning will be discussed. Conclusions: ADHD and sleep disorders seem intertwined in the majority of cases. More research of the circadian rhythm in ADHD is needed, measuring melatonin onset and other biomarkers of a delayed biological clock, that influences the timing of many physiological processes. References: Bijlenga D, van der Heijden KB, Breuk M, van Someren EJ, Lie ME, Boonstra AM, Swaab HJ, Kooij JJ. Associations between sleep characteristics, seasonal depressive symptoms, lifestyle, and ADHD symptoms in adults. J Atten Disord. 2013 Apr;17(3):261–75. Bijlenga D, Van Someren EJ, Gruber R, Bron TI, Kruithof IF, Spanbroek EC, Kooij JJ. Body temperature, activity and melatonin profiles in adults with attention-deficit/hyperactivity disorder and delayed sleep: a case–control study. J Sleep Res. 2013 Dec;22(6):607–16. Kooij JJ, Bijlenga D. The circadian rhythm in adult attention-deficit/hyperactivity dis order: current state of affairs. Expert Rev Eurother. 2013 Oct;13(10):1107–16. Owens J, Gruber R, Brown T, Corkum P, Cortese S, O’Brien L, Stein M, Weiss M. Future research directions in sleep and ADHD: report of a consensus working group. J Atten Disord. 2013 Oct;17(7):550–64. Van der Heijden KB, Smits MG, Van Someren EJ, Gunning WB. Idiopathic chronic sleep onset insomnia in attention-deficit/hyperactivity disorder: a circadian rhythm sleep disorder. Chronobiol Int. 2005;22(3):559–70. Van Veen MM, Kooij JJ, Boonstra AM, Gordijn MC, Van Someren EJ. Delayed circadian rhythm in adults with attention-deficit/hyperactivity disorder and chronic sleep-onset insomnia. Biol Psychiatry. 2010 Jun 1;67(11):1091–6.

Thursday, 28 May 2015, 15.00 h–16.30 h HT-2 Treatment and course of ADHD in offenders HT-2-001 Ten-year follow-up in juvenile and young adult offenders

HT-1-003 Sleep disorders and ADHD

F. Philipp-Wiegmann*

S. Kooij*

* Homburg, Germany

* Den Haag, The Netherlands

Abstract not received.

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HT-2-002 Impact of ADHD on the legal prognosis of young offenders: A ten-year follow-up W. Retz* * Homburg, Germany Abstract not received.

HT-2-003 Psychosocial treatment of offenders with ADHD S. Young* * London, UK Objectives: A meta-analysis of rates of ADHD and their clinical comorbidity has reported a five-fold increase in prevalence of ADHD in youth prison populations and a ten-fold increase in adult prison populations. Findings indicated greater risk for developing comorbid pathology in prisoners and an incremental effect in frequency and severity of symptoms with age. Adult ADHD prisoners were at risk for developing a broad range of psychiatric morbidity but this was restricted to mood disorders in youth offenders. Offenders with ADHD may be a difficult group to engage and manage, and they have been associated with higher risk of engaging in critical incidents in custodial settings. Hence offenders with ADHD have a complex presentation. Complex presentations require complex treatments, especially for those who have a history of antisocial attitudes and behavior. There are consistent reports of a greater treatment effect for combined medication and psychological interventions. The R&R2 for ADHD Youths and Adults has been specifically developed for use in this population. A psychological intervention that is being rolled out internationally is the R&R2 for ADHD Youths and Adults, which was developed specifically for use in this population. Disclosure Statement Susan Young has received speakers’ fees and travel honoraria from Janssen, Eli Lilly, Shire, Novartis, HB Pharma and Flynn Pharma, and received research grants from Janssen, Eli Lilly and Shire. She is co-author of R&R2 for ADHD Youths and Adults.

HT-2-004 Pharmacological treatment of offenders with ADHD

demographic data, ADHD symptoms, psychosocial functioning, substance misuse, and criminal reoffending. Results: OROS-MPH was highly effective and safe overall in reducing ADHD symptoms, improving global and executive functioning and quality-of-life, both in the short-term (5 weeks) versus placebo (Cohen’s d = 2.17; NNT = 1.1) and over 52 weeks when delivered as part of multimodal treatment. No misuse of ADHD medication or side abuse of other drugs was detected by repeated urine toxicology throughout the study. The vast majority attended and completed CBT-programs, educational activities and vocational training, aimed at reducing reoffending and increasing societal reintegration. Preliminary data suggest that improvements gained during the RCT persisted and that most (medicated) completers were employed and had not relapsed into offending or substance misuse at the 3-year follow-up. Conclusions: These results suggest that OROS-MPH could be useful as part of multimodal interventions for offenders with ADHD, and that routines and collaboration to ensure continued motivation, support and treatment, might reduce individual and societal injury from criminal (re)offending.

Thursday, 28 May 2015, 15.00 h–16.30 h HT-3 Cross-cultural issues in ADHD HT-3-001 ADHD across cultures: Bona fide mental disorder versus social construction K. W. Lange* * Regensburg, Germany Objectives: An overview and a critical discussion of cross-cultural issues in ADHD will be provided. Methods: A biomedical perspective in regard to ADHD is predominant in Europa and America. Similar prevalence rates for ADHD across cultures would suggest that the disorder is caused by the same neurobiological processes, while different figures may support the hypothesis of cultural influences or even socio-cultural construction. Conclusions: The cross-cultural comparison of the prevalence and symptoms of ADHD may provide further clues regarding the interaction of biological, social and cultural factors in the etiology and therapy of ADHD.

Y. Ginsberg* * Stockholm, Sweden

HT-3-002 Clinical impact of ADHD in South America

Objectives: Evaluate efficacy, effectiveness, safety and long-term outcome of OROS-methylphenidate (OROS-MPH) in adult male offenders with ADHD. Methods: Within a Swedish high-security prison, we conducted a 52-week randomised controlled trial (RCT) of OROS-MPH in 30 male long-term inmates with ADHD and coexistent disorders. Prospectively, we followed 25 trial completers 3 years post-trial. The initial 5-week randomised, double-blind, placebo-controlled, fixeddose (72 mg daily) phase, was followed by a 47-week open-label extension during which all 30 inmates received optimally titrated OROS-MPH (maximum 1.3 mg/kg daily) alongside regularly provided offender treatment programs. Primary outcome was change in ADHD symptoms after 5 weeks (CAARS:O-SV). Secondary outcomes included self-reported ADHD symptoms, global severity, global functioning, cognition, motor activity, quality of life, and safety measures. Outcomes of the follow-up study included

L. Viola*

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* Montevideo, Uruguay Objectives: Understanding of variability about Attention-deficit disorder (ADHD) prevalence around the world is far beyond the various methods used and it may be due to local characteristics. Several factors account to explain these particularities that have a negative impact on life and evolution of the children and adolescents with ADHD In Latin America, about 12 % of the children are born with low weight, that means prematurity, development delay in uterine growth and a strong correlation with socioeconomic, cultural, biological and environmental conditions (1). The low rate and nonhomogeneous distribution of child psychiatrists, difficulties in access to specialized mental health services, difficult availability of medicines, as well as their high cost are against correct attention of

patients. There is no a State Politics promoting a protected scholarship for children and adolescents with ADHD. Some other factors, such as very early onset of marihuana utilization, increases the high rates of comorbidity with externalized disorders. Results: Clinical Impact of ADHD on these patients is shown through poor academic performance, substances abuse, conduct disorders in early adolescence, and in the high rates of self-harm or even suicide. Eight years ago, in Mexico City, was held the first meeting on ADHD, with a group of interested professionals, representing Latin America. It was the kick-off to start some research in our region, because world information and scientific evidence about diagnosis, and comprehensive treatment on ADHD in Latin-American population are limited, and there is a need to create attention model in relationship with our regional reality (3). Conclusions: Latin-Americans ADHD patients and their families have a unique demographic profile, as well as symptoms and treatment response (2) 1. Medina-Pineda AE. Factores de riesgo maternos asociados a recie´n nacidos con bajo peso al nacer. Departamento de La Paz, Honduras Rev Med Hondur 2008;76:12–8. 2. Polancsyk G RL, Szobot C, Schmitz M, Montiel-Nava C, Bauermeister J. ADHD treatment in Latin America and the Caribbean. Journal of the American Academy of Child and Adolescent Psychiatry. 2008;47(6). 3. Palacio JD, de la Pen˜a F, Palacios-Cruz L, Ortiz S. Algoritmo latinoamericano de tratamiento multimodal del trastorno por de´ficit de atencio´n e hiperactividad (TDAH) a trave´s de la vida. Revista Colombiana de Psiquiatrı´a. 2009;38(S1).

HT-3-003 Medical and social aspects of ADHD in Asia Y. Zheng* * Beijing, People’s Republic of China Objectives: Attention-deficit hyperactivity disorder (ADHD) is often poorly defined and treatment practices vary across Asian region. To better understand the burden and management of ADHD, It is very important to review the situation of ADHD influenced by medical and social aspects in Asia. The total population of the World was 7.3 billion in 2014. Nearly two-thirds of the population lives in Asia and is predominantly urban and suburban, with more than 2.5 billion in the countries of China and India combined. About 27 % of the population are children under age 14. The rapid economic development and social reforms that have taken place in recent years all had a great influence on child and adolescent mental health. Though the data on the prevalence of ADHD in Asia are limited, although it has been suggested to be similar to that of Western countries (5.29–7.10 %). This article reviews the current status of ADHD influenced by medical and social aspects in Asia, The influence of culture on the diagnosis and treatment of ADHD. Diagnoses criteria is not unification in Asia and most of ADHD patients visit pediatrician first. There is no Guidelines for Prevention and Treatment of ADHD in most of Asian Countries. Several important social issues are also explored, including the changes in family structures along with the growing competitions in life have weakened the traditional social support system. As a result, Many who suffer from ADHD are not adequately cared for because the scarcity of qualified service providers and pathways to care. This article also lists some challenges and possible solutions, including the multidisciplinary and culture sensitive service model for ADHD and Some Guidelines for ADHD in Asian Countries. Anyway most of ADHD patients visit Pediatrician first in Asian Countries and most of them haven’t got enough treatment. So it is very important to improve awareness and cooperation between Psychiatrist and Pediatrician to treat and

prevent ADHD in Asian Countries. Keywords: ADHD, Culture, Asia, Psychiatry.

HT-3-004 Life course of ADHD for Aboriginals compared to nonAboriginal children D. Silva* * Joondalup, Australia Objectives: To investigate the early environmental risk factors, education outcomes and juvenile justice encounters associated with Aboriginal and non-Aboriginal children prescribed stimulant medication (SM) for ADHD. Results: This study found 2.8 % of non-Aboriginal and 1.8 % of Aboriginal children born between 1981 and 2000 in Western Australia were diagnosed with ADHD and treated with SM. Mothers of children with ADHD were significantly more likely to smoke in pregnancy have preeclampsia and threatened preterm labour irrespective of race or gender. They are more likely to be born premature, and oxytocin induction was protective in girls only. There was no association with acute events around delivery, which included cord around neck, low apgar scores, and fetal distress. The ADHD group irrespective of race had significantly more early hospital admissions, for infections, inflammatory conditions, injury and early anaesthetic under 4 years of age. Having ADHD increased the risk of education failure and juvenile justice encounters at an early age irrespective of race and gender. Conclusions: Data linkage at the population level can be a valuable source of information on determining the precursors of ADHD and their outcomes for Aboriginal and non-Aboriginal children. Further studies need to understand the potential effects of inflammation and general anaesthetic on early brain development.

Thursday, 28 May 2015, 15.00 h–16.30 h RC-1 ADHD and substance abuse: Causes and options for treatment and prevention RC-1-001 ADHD, substance abuse disorders and genetics J. A. Ramos-Quiroga* * Barcelona, Spain Objectives: Attention deficit-hyperactivity disorder (ADHD) is a neuropsychiatric disorder with an average heritability estimated around 76 %. Individuals whose ADHD persists into adulthood have approximately 50 % of the lifetime risk to develop any SUD comorbidity and patients with SUD present a higher prevalence of ADHD than general population. This link between ADHD and SUDs has been documented in family members of both adults and children with ADHD. Despite this high incidence of SUD in subjects with ADHD and the studies that consistently show genetic basis for the overlap, little is known about the specific genetic factors that could be involved in the development of both disorders. Until today, research has mainly focused on candidate genes of the dopamine, serotonin or norepinephrine neurotransmitter systems, showing controversial results. Recently, Carpenter et al. evaluated the association of six candidate genes in ADHD and/or SUDs and identified both shared as well as ADHD-specific vulnerability factors. Among the most vulnerable patients with ADHD to develop SUD later in life are those

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who have co-morbid CD or ODD and evidence suggest that co-occurrence of symptoms for ADHD and CD contribute in an epistatic manner to a more severe form of SUD than individuals with ADHD or CD alone. Most recently, there is growing interest in studying the potential role of post-transcriptional regulatory elements in the susceptibility to different complex disorders. It will be presented the results of the first case–control association study in ADHD that evaluate the role of SNPs within miRNAs or miRNA target sites and, thus, with a potential involvement in the modulation of the miRNAmediated gene expression.

Methods: An outline of the elements of the integrated treatment will be presented, and first experiences with the treatment will be discussed. Results: Although some patients clearly benefit from the integrated CBT, others drop out of treatment in an early stage. Conclusions: Integrated CBT for patients with SUD and ADHD might be a promising treatment option, but final conclusions can only be drawn after completion of the RCT.

RC-1-004 Current practice in Belgium on ADHD and substance abuse disorders RC-1-002 Inhibition deficits and substance abuse disorders development I. Ivanov* * New York, USA Objectives: Impulsivity is described as action without planning and with no consideration for possible consequences. These types of behaviors are often observed in individuals with ADHD and substance use disorders and it has been speculated that impulsivity is one possible mechanism for transition from drug experimentation to problem drug use and abuse particularly in individuals with ADHD. Further, impulsive types of behaviors that may be present constitutionally (as in cases of ADHD) might be further exacerbated by the effects of drugs on the brain functions. This presentation will review the conceptual views on impulsivity emphasizing a theoretical model adopted by the ICASA foundation. This model views impulsivity as comprised of several facets each of which may exhibit independent and unique characteristics and can be measured and defined via the use of specific tests. The presentation will review the relations between ADHD symptom clusters and different facets of impulsivity and will discuss how various ADHD treatments may affect impulsive behaviors. Lastly it will review treatment strategies that may alter the trajectory of SUD development in the context of ADHD.

RC-1-003 Cognitive behavioural therapy for patients with ADHD and substance use disorders K. van Emmerik-van Oortmerssen*, E. Vedel, W. van den Brink, R. Schoevers * The Netherlands Objectives: Attention deficit hyperactivity disorder (ADHD) is present in approximately 23 % of the treatment-seeking patients with a substance use disorder (SUD). Although stimulants have proved their effectiveness in the pharmacological treatment of ADHD, the results in SUD patients with ADHD are not as convincing. Recently, studies on cognitive behavioral therapy (CBT) for ADHD patients showed positive results in reducing ADHD symptoms, but this treatment modality has not yet been studied in patients with SUD. Since ADHD and SUD often exist together, share mutual genetic and neuropsychological characteristics, and make treatments more complicated, a treatment that addresses both disorders simultaneously might improve prognosis. The objective of the current presentation is to present an integrated CBT treatment for SUD and ADHD that has recently been developed in the Netherlands, and is currently being tested in a randomized trial design in Amsterdam.

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F. Matthys* * Belgium Abstract not received.

Thursday, 28 May 2015, 15.00 h–16.30 h YS-1 Young Scientists’ Session I YS-1-001 Cortico-striatal network dysfunction in ADHD M. Oldehinkel*, C. F. Beckmann, E. Van Oort, J. K. Buitelaar, M. Mennes * Nijmegen, The Netherlands Objectives: ADHD has long been associated with abnormalities in cortico-striatal networks. However, results from functional connectivity studies comparing an ADHD to a healthy control group (i.e., categorical analyses) to investigate cortico-striatal network function in ADHD are inconsistent. These inconsistent findings might relate to heterogeneous neurobiological mechanisms underlying ADHD, possibly combining categorical and dimensional effects. We apply both categorical and dimensional analyses to investigate the cortico-striatal networks of nucleus accumbens, caudate, anterior, and posterior putamen in a large ADHD sample. Methods: A 9-min resting-state fMRI scan was acquired from 158 adolescents with ADHD, 87 unaffected siblings of participants with ADHD, and 119 healthy controls (age range 8.53–22.95). Time courses of the four striatal regions were extracted and entered as four independent regressors into one first level, whole brain analysis. We compared the obtained functional connectivity maps between the three groups (categorical analysis) by applying group-level permutation testing (nPerm = 5000, FWE-threshold of p \ 0.01). Similarly, we investigated dimensional ADHD-related effects on striatal connectivity in all participants using two separate linear models respectively including inattention and hyperactivity/impulsivity scores (obtained from the Conners Parent Rating Scale). All analyses were corrected for age, gender, scan location, and comorbid oppositional defiant disorder/conduct disorder. Results: Dimensional analyses revealed widespread inattention and hyperactivity/impulsivity-related increases in connectivity between posterior putamen and cingulate, motor cortex, precuneus and occipital cortex (Figure 1). Post-hoc analysis showed that the hyperactivity/impulsivity-related increase in functional connectivity correlated with decreased motor performance (based on the Developmental Coordination Disorder Questionnaire; r = -0.19, p = 0.001). We found no significant categorical group differences in striatal connectivity.

Conclusions: The dimensional findings support the hypothesis of cortico-striatal network dysfunction in ADHD. We explain the absence of connectivity differences between the ADHD and control group in terms of reduced sensitivity of categorical compared to dimensional analyses, related to heterogeneity within participants with ADHD.

YS-1-002 Double-dissociation between the mechanisms leading to impulsivity and inattention in Attention-Deficit/Hyperactivity Disorder: A resting state functional connectivity study V. Parlatini*, M. Sanefuji, M. Craig, D. Murphy, M. Catani, M. Thiebaut de Schotten * London, UK Objectives: Attention-deficit hyperactivity disorder (ADHD) is a heterogeneous disorder, with three clinical presentations. Research suggests that clinical presentations differ for socio-demographic characteristics, cognitive profile and response to treatment. We investigated whether they also show functional differences in the affected brain networks, such as cortico-striatal and frontoparietal. Methods: Resting state functional connectivity analysis was carried out on a sample of 165 children with ADHD, and differences explored within subtypes. We first conducted a Probabilistic Independent Component Analysis (ICA) in FSL (www.fmrib.ox.ac.uk/fsl). Time series were regressed into the same 4D dataset. This resulted in a set of subject-specific spatial maps, one per group-level spatial map. We then tested for differences between subtypes. Results were corrected for multiple comparisons. Results: Dual regression revealed that the hyperactive-impulsive subtype was associated with increased connectivity in the corticostriatal network, whereas the inattentive subtype was associated with increased connectivity in the ventral fronto-parietal attentive network (VAN). Partial correlation analyses showed that connectivity was strongly correlated with clinical measures, such as the Conner’s rating scale score (CPRS). When covariing out for the inattention CPRS, connectivity of the cortico-striatal network was positively correlated with the severity of hyperactivity (r = 0.466; p \ 0.001). Conversely, when covariing out for the hyperactivity CPRS, connectivity of the VAN was positively correlated with the severity of inattention (r = 0.178; p \ 0.05) (Fig. 1). Conclusions: This study provides novel findings on the biological differences among ADHD subtypes, revealing a double dissociation between networks supporting hyperactivity/impulsivity or inattention in children with ADHD.

YS-1-003 Associations between serotonin transporter gene (SLC6A4) methylation and clinical characteristics and cortical thickness in children with ADHD S. Park* * Seoul, Republic of Korea Objectives: Attention-deficit hyperactivity disorder (ADHD) is a common, highly heritable psychiatric disorder. Additionally, environmental factors such as perinatal stress and early adversities contribute to the occurrence and severity of ADHD. Recently, DNA methylation has emerged as a mechanism that potentially mediates

gene-environmental interaction effects in the etiology and phenomenology of psychiatric disorders. Here, we investigated whether serotonin transporter gene (SLC6A4) methylation patterns were associated with clinical characteristics and regional cortical thickness in children with ADHD. Methods: In 102 children with ADHD (age: 6–15 years), the methylation status of the SLC6A4 promoter was measured, brain magnetic resonance imaging was obtained, and ADHD symptoms (ADHD-rating scale) and neuropsychological characteristics (Continuous Performance Test) were evaluated. Results: A higher methylation status of the SLC6A4 promoter was significantly associated with worse clinical presentations (more hyperactive-impulsive symptoms and more commission errors). Additionally, a negative correlation was observed between SLC6A4 promoter methylation levels and cortical thickness in a right occipitotemporal regions. Conclusions: SLC6A4 methylation status could be a biological marker for certain symptoms of ADHD, such as poor impulse control and behavioral disinhibition, and related brain changes. YS-1-004 (Grey) matter of attention: Cortical morphometry in Attention-Deficit/Hyperactivity Disorder T. Silk*, R. Beare, C. Adamson, V. Vilgis, A. Vance, M. Bellgrove * Melbourne, Australia Objectives: Neuroimaging studies lend support to a neurobiological basis to ADHD, however underlying mechanisms remain poorly understood. Lower brain volume is a consistent finding, however precise morphological contributions of cortical thickness and surface area, which arise from distinct processes, remain unclear. This cross-sectional study aimed to examining differences in cortical morphometry (cortical thickness, surface area and volume) in ADHD, and investigate differences in the developmental pattern over age compared to controls. Methods: MRI data was collected from 35 ADHD-combined type and 35 controls aged 9–17 years. ADHD participants recruited from a specialized clinic at the Royal Children’s Hospital, Melbourne, were defined through the A-DISC. T1-weighted images were acquired on a 3T MRI scanner. FreeSurfer’s surface-based measures were examined on global, lobar and regional atlas-based divisions. Univariate ANCOVA between groups with intracranial volume as covariates were examined for each morphometric domain in global and regional analyses. Regression analyses explored the relationship between age and cortical morphometry. Results: ADHD showed significantly smaller cortical volume and thickness even after controlling for their smaller intracranial volume. Bilateral parietal lobes exhibited the greatest difference in each of volume, surface area and thickness. Bilateral frontal and left temporal lobe also demonstrate significantly lower volume and thickness. Regionally, almost all parietal and many frontal regions including middle frontal and orbitofrontal, showed lower volume and thickness in ADHD. The greatest effects and most consistent difference across measures was bilateral precuneus. Regression analysis revealed ADHD have a similar developmental pattern just significantly lower across ages, with the exception of a potentially normalizing of orbitofrontal regions in adolescence. Conclusions: Abnormalities in cortical morphometry in ADHD are primarily in fronto-parietal regions, key parts of the attention network. Findings suggest that difference in volume a driven primarily by thickness, rather than surface area, contributing to our understanding of the underlying neurobiology of ADHD.

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Thursday, 28 May 2015, 17.00 h–18.30 h HT-4 Real outcomes of ADHD HT-4-001 Neuropsychology of adult ADHD - Searching for the impact on real life O. Tucha*

impaired academic performance/success and ADHD specific treatment does not appear to improve all types of academic achievement uniformly. Conclusions: The most promising routes for future research stress the search for protective factors in individuals with ADHD, the study of causal attributions for academic underachievement as well as the development and evaluation of most efficient treatment strategies. Finally, the presentation will emphasize the relevance and importance of academic success for long-term physical and mental health in adult life.

* Groningen, The Netherlands Objectives: Numerous studies revealed that both children and adults with attention deficit hyperactivity disorder (ADHD) display considerable impairments of various aspects of cognition. The assessment of these impairments is of particular importance in adults with ADHD since cognitive inefficiency is considerably more pronounced in adults with ADHD than overt behavioral disturbances (e.g. symptoms of hyperactivity). Consequently, cognitive impairments of adults with ADHD have been well studied and characterised under controlled conditions in the lab. However, there is only limited knowledge about how these impairments translate into the individuals’ lives. Methods: This lecture will give a brief overview and present new data about the neuropsychology of adults with ADHD and will relate the findings of neuropsychological assessments to the patients’ individual experiences of cognitive (dys)functioning in daily life. Results: While adults with ADHD show but also report considerable impairments in a wide range of cognitive functions, the association between the subjective and more objective measurement is rather weak. Conclusions: Cognitive assessments of adults with ADHD capture different aspects of (dys)functioning than those experienced by patients. This finding might be partly explained by the nature and the limited ecological validity of test procedures applied in neuropsychological assessment.

HT-4-002 School underachievement A. B. M. Fuermaier* * Groningen, The Netherlands Objectives: ADHD is strongly associated with academic underachievement. However, an integration of the findings related to this topic is difficult as available studies differ greatly with regard to their applied methodologies (e.g. cross-sectional or longitudinal studies) and outcome measures (i.e. academic performance or academic success). Conclusions drawn from these studies are therefore partly inconsistent making the picture less clear than initially expected. Methods: This talk will present the latest findings on academic achievement in ADHD by shedding light on relevant topics such as the various applied methodologies, the diversity in outcome measures, the effects of treatment, the reasons for academic underachievement of individuals with ADHD and long-term relevance of academic success. Results: Children, adolescents and adults with ADHD perform considerably worse and achieve considerably less in the academic context than their healthy counterparts. Pharmacological and non-pharmacological ADHD specific treatment is likely to represent an eligible mean to improve academic performance and success for a majority of individuals with ADHD. However, caution and further research is needed as results showed that not all individuals with ADHD show

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HT-4-003 Mortality in children, adolescents and adults with ADHD S. Dalsgaard*, S. D. Ostergaard, J. F. Leckman, P. B. Mortensen, M. G. Pedersen * Denmark Objectives: To examine whether ADHD is associated with increased mortality, and the modifying effect of gender, age at diagnosis and comorbidities on mortality rates. Methods: Using Danish national registers, we followed 1.9 million individuals (32,061 with ADHD), from birth through to 2013. We estimated mortality rate ratios (MRRs), adjusted for calendar year, age, sex, family history of psychiatric disorders, maternal and paternal age, and parental educational and employment status, by Poisson regression, to compare individuals with and without ADHD. Results: ADHD was associated with a fully adj MRR of 2.07, 95 % CI 1.70–2.50; p \ 0.0001). Accidents were the most common cause of death. Compared with individuals without ADHD, the fully adj MRR for individuals diagnosed with ADHD before the age of 6 years was 1.86 (95 % CI 0.93–3.27), and it was 1.58 (1.21–2.03) for those aged 6–17 years, and 4.25 (3.05–5.78) for those aged 18 years or older. After exclusion of individuals with oppositional defiant disorder, conduct disorder, and substance use disorder, ADHD remained associated with increased mortality (fully adj MRR 1.50, 1.11–1.98), and was higher in females (2.85, 1.56–4.71) than in males (1.27, 0.89–1.76). Conclusions: ADHD was associated with significantly increased mortality rates. People diagnosed with ADHD in adulthood had a higher MRR than did those diagnosed in childhood and adolescence. Comorbid oppositional defiant disorder, conduct disorder, and substance use disorder increased the MRR even further. However, ADHD itself remained associated with excess mortality, higher in females with ADHD than in males with ADHD. The excess mortality in ADHD was mainly driven by deaths accidents.

HT-4-004 Risky sexual behaviour and pregnancy in adolescence with ADHD D. E. Sarver* * Oxford, USA Objectives: ADHD in early adulthood has been linked to elevated rates of a range of risky sexual behavior and early pregnancy. Fewer but more recent studies have extended this risk to adolescent populations with ADHD. Important issues are emerging for whether ADHD represents a unique risk factor for negative sexual health outcomes, or raises risk via its influence on other developmental and psychopathological mechanisms. The current presentation provides a comprehensive and up-to-date review on the status of adolescent

ADHD’s influence on negative sexual health outcomes and pregnancy risks. Methods: Particular attention is given to the diversity of sexual risk outcomes and their measurement, evidence on potential developmental timing and sequences and the latest outcome findings in adolescent research. Results: Historically, ADHD is a known risk factor negative sexual health outcomes and risky behavior in general, but its importance may diminish in the presence of specific co-morbid psychopathology. The presentation adopts a developmental psychopathology perspective on this relationship, emphasizes the nascence of the empirical evidence, and outlines the many opportunities for future research to address regarding important clinical issues, methodology and design, and clinical impact on adolescent. Conclusions: ADHD may influence youth to engage in a variety of risky sexual behavior. The presentation will concludes by emphasizing key recommendations to advance the scientific agenda and the clinical care (assessment/intervention strategies) of adolescent ADHD in this area. Because of the developmental impact early ADHD has on later co-morbidity acquisition and associated consequences, it is essential for the field to develop identification, intervention and prevention strategies that will decrease the potential risk and consequences that ADHD portends to negative adolescent sexual health outcomes.

Thursday, 28 May 2015, 17.00 h–18.30 h HT-5 The current state of neurofeedback in ADHD HT-5-001 fMRI neurofeedback in adolescents with ADHD K. Rubia*, A. Alegria, H. Brinson, G. Barker, D. Brandeis, A. David, V. Giampietro * London, UK Objectives: Children with ADHD have consistent neurofunctional impairment in right inferior frontal cortex (rIFC) relative to healthy controls and other pediatric disorders, making it a specific neurofunctional biomarker of ADHD. IFC activation is also consistently upregulated with psychostimulants. This region is hence an optimal target for real-time fMRI-Neurofeedback (rt-fMRI-NF) in ADHD, which has better spatial resolution than EEG-NF to allow selfregulation of deep inferior frontal structures. Methods: Thirty male adolescents with a diagnosis of ADHD are being trained in a randomised controlled trial to either self-upregulate activation in rIFC (active group) or right parahippocampal gyrus (rPHG, control group) via a computer game in which they have to— through upregulation of activation—take off a rocket and move it into the sky to ultimately reach planets in space in 14 sessions of 8 min rtfMRI-NF each (across 4 visits of fMRI scanning within 2 weeks). Outcome measures were clinical, cognitive and fMRI Stop task measures, assessed pre and post intervention. Results: Preliminary findings in 25 adolescents (30 will be presented at the conference) show a significant dissociation of linear rIFC activation increase in the active (15) relative to the control group (where it decreased), and of linear PHG activation increase in the control relative to the active group (where it decreased) (10). Both groups, however, improved significantly in ADHD clinical measures of inattention and hyperactivity as well as trend-wise in cognitive measures of sustained attention (commission errors). Clinical inattention symptom improvement correlated trend-wise with the number of NF sessions. Right IFC activation significantly increased in the fMRI stop task in the active group after fMRI-NF.

Conclusions: Preliminary data show that ADHD adolescents can self-regulate specific brain activation in relatively few NF sessions and this is associated with reduction in ADHD symptoms and improvements in cognitive attention measures and brain activation.

HT-5-002 NIRS neurofeedback in ADHD A. Fallgatter*, B. Barth, A.-C. Ehlis * Tu¨bingen, Germany Objectives: Psychiatric disorders like ADHD are currently mainly treated with pharmacotherapeutic and, to a lesser extent, with psychotherapeutic methods. The success measured as improvement of symptoms under is surprisingly good with high effect sizes ([0.8) in randomized controlled trials, in particular for pharmacological treatment with stimulants. However, there is still room and need for improvement. Methods: Neurofeedback methods based on EEG and fMRI methods are increasingly applied as an alternative or add-on therapeutic approach. The rationale behind these therapies is to show the subjects an immediate feedback of their brain activity. So they can learn how to regulate their brain activity and transfer this ability to real life situations. Results: We established a neurofeedback protocol for regions of the prefrontal cortex based on measurements of brain activity with NearInfrared Spectroscopy (NIRS). This NIRS-neurofeedback was applied in children and adults with ADHD with promising results. Conclusions: Due to its high ecological validity, NIRS-neurofeedback might develop to an alternative or add-on therapy also for ADHD patients in future.

HT-5-003 A randomized controlled multicentre study on the efficacy of slow cortical potential neurofeedback in ADHD D. Brandeis*, M. Holtmann, U. Strehl, D. Wachtlin, P. Aggensteiner, C. Feedback * Mannheim, Germany Objectives: Recent reviews (Arns and Strehl 2013; Sonuga-Barke, Brandeis et al. 2013) emphasize a need for more research and larger randomized controlled studies (RCT) using validated protocols to further clarify efficacy and specificity of neurofeedback treatment in ADHD. The present work addresses this need through a multicenter RCT using validated neurofeedback and a semi-active control conditions. Methods: In a randomized, controlled parallel group multicenter trial (sites: Hamm, Tu¨bingen, Mannheim, Go¨ttingen and Frankfurt), n = 144 children (80 % boys) with ADHD (DSM-IV TR combined subtype) aged 7–10 years were treated for 3 month with 25 sessions of slow cortical potential (SCP) neurofeedback or with 25 sessions of EMG-biofeedback, in addition to treatment as usual. In children taking medication (43 %), a wash-out phase preceded assessments. Primary outcome were changes of core symptoms according to parent ratings (FBB-ADHS); secondary outcomes were clinician and teacher ratings, comorbid symptoms, neurophysiological, neuropsychological measures, self-regulation, Intelligence and life quality. Results: Parent rating of ADHD indicated superiority of neurofeedback over EMG-biofeedback (d = 0.57; p = 0.023). Teachers and clinicians also indicated clinically relevant improvement in both treatment groups but no differential effects. Larger treatment effects were found in more

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severely affected children. The results were independent of age, medication, gender, study site, parenting style and treatment expectations, and self-regulation was confirmed for neurofeedback. Conclusions: Parents but not teachers or clinicians detected a significant superiority of neurofeedback over the semi-active muscular regulation control training. Additional findings also confirmed EEG-self regulation. Transfer, learning, and the relation between learning self-regulation and clinical improvement will be addressed in future analyses, along with additional outcomes and predictors of treatment response. Funded by the DFG HO 2503/4-1 Arns, M. and U. Strehl (2013). Am. J. Psychiat 170(7): 799–800. Sonuga-Barke, E. J. S., D. Brandeis, …M. Holtmann et al. (2013). Am. J. Psychiat 170(3): 275–289.

HT-5-004 Neurofeedback in ADHD: Meta-analysis, current state and future perspectives M. Arns* * Nijmegen, The Netherlands Objectives:Among the clinical applications of neurofeedback, most research has been conducted in ADHD. As an introduction a short overview of the general history of neurofeedback will be given, while the main part of the presentation deals with a review of the current state of neurofeedback in ADHD (1). A meta-analysis on neurofeedback from 2009 found large effect sizes for inattention and impulsivity and medium effects sizes for hyperactivity. Since 2009 several new studies, including four placebo-controlled studies and two meta-analyses, have been published with mixed and sometimes contradictory results. These latest studies and study designs are reviewed and discussed in more detail focusing on studies employing (a) semi-active, (b) active, and (c) placebo-control group designs. The assessment of specificity of neurofeedback treatment in ADHD is discussed specifically related to standard protocols such as theta/beta, SMR (2) and slow cortical potentials neurofeedback. Future controlled clinical trials should focus on such known protocols, and be designed along the lines of learning theory. One such example study will be reviewed in more detail, with the rationale and strategy of the NIMH funded double-blind placebo controlled iCAN study (international Collaborative ADHD Neurofeedback study (3)) that is currently recruiting 140 children with ADHD at Ohio State University and the University of North Carolina. (1) Arns, M., Heinrich, H., & Strehl, U. (2014). Evaluation of neurofeedback in ADHD: The long and winding road. Biological Psychology, 95, 108–15. (2) Arns, M., Feddema, I., & Kenemans, J.L. (2014). Differential effects of theta/beta and SMR neurofeedback in ADHD on sleep onset latency. Frontiers in Human Neuroscience, 8, 1019. (3) The Collaborative Neurofeedback Group, Arnold, L.E., Arns, M., Conners, K., deBeus, R., Hirshberg, L.,… Monastra, V. (2013). A proposed multisite double-blind randomized clinical trial of neurofeedback for ADHD: Need, rationale, and strategy. Journal of Attention Disorders, 17(5), 420–36.

* Nijmegen, The Netherlands Abstract not received.

RC-2-002 Does relative age at the start of school influence the prevalence of ADHD diagnosis, and what are the long-term implications? J. Kuntsi* * London, UK Objectives: Studies in Canada (Morrow et al. 2012) and the USA (Elder 2010; Evans et al. 2010) found that children who were relatively younger than their peers in the same class were significantly more likely to receive a diagnosis and pharmacological treatment for ADHD, raising the possibility that ADHD may be over-diagnosed among the youngest and therefore developmentally least mature children in class. Recently, Halldner et al. (2014) replicated this finding using the Swedish nationwide registers. We now extend the analyses on the Swedish registers to explore whether the strength of the association of ADHD with poor outcomes (low school grades and criminality) varies between those who were youngest versus oldest in class. Methods: We identified 7989 oldest-in-class individuals with ADHD (born January–March) and 9259 youngest-in-class individuals with ADHD (born October–December) in the Swedish National Patient Register and the prescribed drug register between January 1997 and December 2009. All cases were between 3 and 18 years old when diagnosed. We also identified population-matched (1:10 ratio) unaffected comparison individuals. The outcomes were criminal convictions recorded in the national crime register and low summary grade point scores in grade 9 from the national school register. Results: The proportion of males and females was similar for both ADHD groups (about 75 %). Oldest-in-class ADHD cases had a fourfold increased risk of being convicted of crime, compared to controls (OR 4.18, 95 % CI 3.86–4.52). The corresponding risk for the youngest-in-class ADHD cases was significantly lower, though still substantial (OR 2.88, 95 % CI 2.67–3.10). Oldest-in-class ADHD cases had a sevenfold increased risk of low school grades (OR 7.41, 95 % CI 6.61–8.31); the corresponding risk was similar for youngestin-class ADHD cases (OR 8.25, 95 % CI 7.40–9.20). Conclusions: We found a greater risk of criminal convictions—but not of low school grades—among the oldest-in-class, compared to youngest-in-class, ADHD cases.

RC-2-003 A large meta-analysis of neuroimaging data implicates delays in maturation but also increased neurodegeneration in ADHD M. Hoogman*

Thursday, 28 May 2015, 17.00 h–18.30 h RC-2 IMpACT consortium RC-2-001 Consortium science: How can international collaboration move forward our research on psychiatric disorders and ADHD in particular? B. Franke*

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* HB Nijmegen, The Netherlands Objectives: Neuroimaging studies show structural alterations of various brain regions in children and adults diagnosed with ADHD. In part due to inconsistencies in published results, it remains unclear, however, how these differences develop across the lifespan, and whether effects are brain-wide or localized to particular neurological structures and pathways. To clarify brain differences across the lifespan in a large sample, an international ADHD Working Group was formed within the ENIGMA consortium (http://enigma.ini.usc.edu/).

Methods: Within the ENIGMA-ADHD Working Group cohorts from around the world analyzed MRI scans using fully automated and validated neuroimaging segmentation software (FreeSurfer), for which protocols are available on our website. Volumetric summaries of subcortical regions were pooled together and shared across the consortium. Meta- and Mega-analysis for the case–control volume differences of hippocampus, nucleus accumbens, amygdala, caudate nucleus, putamen, pallidum, and thalamus were carried out. Effects of age, sex and medication were studied. Results: The working group comprises 23 international sites including 1544 cases and 1729 controls. This pooled sample has an agerange from 4 to 63 years and includes 66 % males. Our case–control meta-analysis showed subtle but significantly smaller volumes for the amygdala (d: 0.15), caudate nucleus (d: 0.11), and putamen (d: 0.11) for cases compared to controls. The results of the mega-analysis appeared to be more powerful and also found case–control differences for the nucleus accumbens and hippocampus. Several structures had age-dependent effects. Conclusions: Brain structure differences related to ADHD across the lifespan remain largely unexplored. As large, well-powered longitudinal studies are still scarce, the ENIGMA-ADHD Working Group, with a large cross-sectional sample across six decades of the lifespan, is beginning to address this gap.

RC-2-004 Rare genetic variants in (adult) ADHD J. Haavik* * Bergen, Norway Objectives: There is an increasing interest in studying rare coding variants in ADHD. Here we review potential advantages and challenges associated with studies of rare variants and how this is being applied to a large DNA sample provided by the International Multicenter persistent ADHD Consortium (IMpACT). Methods: An exome-wide scan was performed based on Illumina HumanExome BeadChip genotypes, which allows examination of [250,000 common and rare variants. After quality control, 9681 individuals (1,895 cases and 7786 controls) collected in Germany, Spain, Norway, and the Netherlands were analyzed. Association with rare-variants (MAF \ 5 %) was assessed by burden test, variable threshold test, Madsen-Browning test and SKAT. The top hits from these analyses, as well as main signals from single point common (MAF [ 5 %) SNP association tests were further evaluated by enrichment and protein–protein interaction appraisal. To account for multiple testing, either Bonferroni correction or permutation was applied. Results: An initial gene-based analysis revealed 10,652 genes that contained at least two rare variants in at least three of the datasets. The ADHD associated genes appeared to be significantly enriched for genes important for nervous system development and functioning, including such mechanisms as cell adhesion and circadian rhythms. However, interpretation of final results was also influenced by the selected analytical protocols and inclusion criteria. Conclusions: Although the interpretation and functional validation rare coding genetic variants appear more intuitive than for common non-coding variants, there are also multiple challenges associated with the large scale analysis of rare variants. This work is the first large scale systematic examination of rare variants in adult ADHD. As such, it also offers an insight into recent progress of the studies on rare variants in complex disease in general.

Thursday, 28 May 2015, 17.00 h–18.30 h YS-2 Young Scientists’ Session II YS-2-001 Has the prevalence of ADHD increased during the last decade? M. Rydell*, S. Lundstro¨m, P. Lichtenstein, H. Larsson * Stockholm, Sweden Objectives: To clarify if there has been an increase in the prevalence of the ADHD-like traits during a 10-year period. Methods: This study is based on a population-based longitudinal study of 19,358 9-year old Swedish twins, participating in the Child and Adolescent Twin Study in Sweden (CATSS) in 2004–2014. The overall response rate was about 70 %. Rates of ADHD-like traits were assessed using a validated parental telephone interview, the AutismTics, ADHD and other Comorbidities (A-TAC) inventory. The ADHD subscale consists of 19 items, summarized to an index ranging from 0 to 19. A cut-off of 12.5 was used to identify clinically relevant cases. The yearly prevalence rate of ADHD was modeled as a function of birth year, using logistic regression models with robust standard errors (to account for the similarity between twins in a pair). Results: The probability of having a child with ADHD ranged from 2.32 % (95 % confidence interval (CI) 1.40–3.24 %) in 2004 to 3.16 % (95 % CI 2.23–4.09 %) in 2014. There was no significant difference in the prevalence over time (p value 0.10). Conclusions: In this study, we found no evidence of an increase in the prevalence of ADHD-like traits in Sweden during the last decade. While we cannot rule out an increase in the prevalence, such an increase is likely to be small. The increased rates of clinically diagnosed ADHD cases reported in previous studies might therefore be influenced by practical and political factors, such as administrative changes in diagnosis.

YS-2-002 Birth weight predicts adolescent brain volume in participants with ADHD, unaffected siblings and control participants C. Greven*, D. van der Meer, C. Hartman, J. Buitelaar * Nijmegen, The Netherlands Objectives: We aim to examine associations of birth weight with adolescent total brain volume (TBV) and ADHD in a family-based design. Methods: The study included 287 participants with ADHD, 145 of their unaffected siblings and 179 typically-developing control participants from the NeuroIMAGE sample (age: mean = 17.16 years, range 8–28). TBV was derived from structural magnetic resonance imaging (MRI) scans. Birth weight (in grams) was assessed using parent-rated questionnaires. Model fitting analyses were applied to sibling data (selected samples design; familiality of ADHD fixed at 0.40). All analyses corrected for sex, age, age squared and scanner. Results: Birth weight correlated significantly with TBV (phenotypic correlation: rp = 0.19), and TBV correlated significantly with ADHD (rp = -0.10; as reported previously); however the correlation between birth weight and ADHD was non-significant. Additional

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corrections for gestational age, adolescents’ height and IQ did not affect these correlations. Familiality (F) was significant for birth weight (F = 0.58), TBV (F = 0.33) and ADHD (F at 0.40); however, all familial correlations were non-significant, whereas non-shared environmental correlations of TBV with birth weight (rE = 0.20) and ADHD (rE = -0.20) were significant. Conclusions: Findings are consistent with the hypothesis that early perinatal influences, indexed by reduced birth weight, have a lasting impact on brain development, reflected in lower TBV in adolescence. This highlights the importance of providing optimal prenatal care and prevention of low birth weight. Reduced birth weight was unlikely to explain the link between ADHD and TBV. Associations between birth weight and TBV were largely attributable to non-shared environmental influences, as were associations between ADHD and TBV. This could reflect differential exposure to other perinatal influences, such as if the mother smoked or used substances during pregnancy with one sibling, but not the other. Non-significant familial associations could point to the role of non-additive genes, a question directly testable in twin designs.

YS-2-003 Antisocial outcomes and psychiatric, social and familial risk factors - a nationwide controlled Danish registry study C. M. Jensen*, H.-C. Steinhausen * Aalborg, Denmark Objectives: To identify the risk of antisocial involvement and associated risk factors in a large, validated cohort of individuals with ADHD. Secondary outcomes included age at onset of antisocial activities, the types of antisocial acts committed, and risk of recidivism. Methods: The subjects included all children and adolescents aged 4–15 with a first-time diagnosis of ICD-10 defined ADHD (F90.0 and F90.1) in the Danish Psychiatric Central Research Registry during the years 1995–2005 and a random sample taken from the Danish population matched on year of birth and sex. Data was linked to the Danish Central Crime Registry and to social and health-related registries. Data was analysed descriptively and with Cox proportional hazards models. Results: A total of 4333 cases and 15,319 controls were included in the follow-up study. The majority were male (84.7 %) and the mean age at follow-up was 21.1 (SD = 4.0). A total of 35 % of ADHD cases and 21 % of controls had been convicted at least once. The crude risk of conviction associated with ADHD was HR = 1.9 (95 % CI 1.8–2.1), p \ .001. The most frequent criminal acts leading to conviction among ADHD cases were property offenses (e.g. theft) (18.5 %), traffic violations (13.9 %), violence (10.6 %), and drugrelated crimes (8.7 %). The median age of first conviction was lower for ADHD versus controls (Median: 17.7 vs. 18.4; Z = -8.3, p \ .001). The risk and protective effects of comorbidity, medication, perinatal factors, familial psychiatric illness, antisocial histories, and socioeconomic factors on antisocial outcomes were evaluated. Conclusions: ADHD was associated with a crude twofold risk of conviction. Antisocial developmental trajectories were associated with individual, social and familial risk factors. Results will assist clinicians in identifying children and adolescents in special need of intense prevention interventions.

YS-2-004 Functional glucocorticoid receptor gene variants, childhood ADHD and comorbidities

* Trier, Germany Objectives: Stress results in a variety of neuroendocrine, immune and behavioral responses, and represents a risk factor for many physiological and psychological disorders. Following exposure to stress, glucocorticoids are secreted from the adrenal cortex and act via the ligand-activated glucocorticoid receptor (GR). Several polymorphisms of the GR-encoding gene NR3C1 have been described and functionally investigated. However, it is still unclear to what extent the differences in stress reactivity and the impact on complex disorders such as Attention-Deficit/ Hyperactivity Disorder (ADHD) are due to polymorphisms of NR3C1. Methods: In this study, 251 children with ADHD and their parents were genotyped for seven common functional variants of NR3C1 (TtthIII_rs10052957; NR3C1-I_rs10482605; ER22/23EK_rs6189 and rs6190; N363S_rs6195; BclI_rs41423247; GR-9b_rs6198) and analyzed using a family-based association study design. Linear and logistic regressions were calculated with ADHD symptoms as well as comorbidities. Results: After strict correction for multiple testing, none of the single markers or haplotypes was, significantly associated with ADHD or comorbid disorders. However, a three-marker haplotype containing TtthIII, NR3C1-I and E22E showed nominal significance (p = 0.024) of being protective in ADHD due to lower transmission rates to affected children. TtthIII was nominal significantly (p = 0.041) correlated with inattention symptoms. Homozygotes for the major allele of this SNP showed more inattentive symptoms, which might be reflected in the protective effect observed for the haplotype. Carriers of the major allele of the SNP N363S were more likely to show comorbid conduct disorder (CD) than ADHD (p = 0.015) or ADHD plus comorbid oppositional defiant disorder (p = 0.013). Conclusions: These findings point to a role of GR and hypothalamic–pituitary–adrenal axis activation in ADHD and comorbidities. In future studies, attention should be given to the interplay between glucocorticoids and neurotransmitters, e.g. dopamine due to the prominent role of both in the regulation of attention and impulsivity.

Friday, 29 May 2015, 08.30 h–10.30 h PL-1 New advances in ADHD diagnosis PL-1-001 Approaches to improving ADHD subtyping using Research Domain Criteria (RDoC) and clinical intuition J. T. Nigg* * East Lansing, USA Abstract not received. PL-1-002 Should emotional dysregulation be a core feature in the ADHD diagnosis? P. Asherson* * London, UK

A. Schote-Frese*, M. Bonenberger, H. Palmason, C. Seitz, J. Meyer, C. Freitag

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Abstract not received.

PL-1-003 How new ways of analysing neuroimaging data can improve differential diagnosis in ADHD? D. Fair*, J. Nigg, O. Miranda-Dominguez * Portland, USA Objectives: Research and clinical investigations in psychiatry largely rely on the de facto assumption that the diagnostic categories identified in the DSM represent homogeneous syndromes. However, the mechanistic heterogeneity that potentially underlies the existing classification scheme might limit discovery of etiology for most developmental psychiatric syndromes. Another, perhaps less palpable, reality may also be interfering with progress—heterogeneity in typically developing populations. In recent work, we have used a graph theory in combination with resting-state functional connectivity and structural connectivity to characterize large-scale systems in the brain. In our current work we argue that the same methodological tools that identify network phenomena in the brain, can assist in clarifying behavioral and functional heterogeneity not only in children with mental disorders, but in typically developing children as well. In addition, we highlight that traditional approaches to measuring the functional signals and functional relationships between brain regions using MRI, may not be optimal to characterize heterogeneity amongst individuals with and without ADHD. We’ll show how a new model based approach to characterizing measured functional MRI signal (i.e. Connectotyping) has the potential to provide an important advance to the field. The illumination of such approaches, we argue, will have significant practical importance for understanding typical development and to identifying the etiologic underpinnings of atypical developmental trajectories, such as those with ADHD.

PL-1-004 Current status and future perspectives of neurobiological measures/tests in ADHD diagnosis T. Banaschewski* * Mannheim, Germany Objectives: ADHD, like other psychiatric disorders, is a descriptive diagnosis not considering underlying pathophysiological mechanisms. The diagnosis is based on clinical judgment of behavioral symptoms and integration of data gathered from multiple sources and requires a comprehensive assessment which may be complex and time consuming. Criticism has focused on the putative subjectivity of ADHD symptoms, modest agreement between parents and teachers, as well as symptom overlap with other disorders. Thus, identification and validation of biological markers for ADHD that can guide (differential) diagnosis, predict developmental outcomes and treatment response, and guide the development of more individualized therapies would clearly be desirable. Biomarkers for ADHD that are grounded in neuroscience may even provide further insight into etiological mechanisms. Methods: The talk will review selected recent studies on potential biomarkers. Their clinical usefulness depends on high specificity and sensitivity, validity reliability, reproducibility, inexpensiveness, and easy use, and biomarkers need validation by independent confirmatory studies prior to their clinical application. Neurobiological differences between patients with ADHD and controls could be vulnerability markers, indicators of processes related to the onset, chronicity or treatment of ADHD, or reflect consequences or

epiphenomena, e.g., physiological responses to the stress of living with a chronic disorder. Results: A number of candidates (neurophysiology, neuroimaging, neurochemistry, genetics) have been investigated, but the search for ADHD biomarkers, as for most psychiatric disorders, has not yet been successful, and a single such parameter may not exist at all (due to high degree of phenotypic and probably pathophysiological heterogeneity, and frequent occurrence of age-dependent co-morbidities). However, novel approaches investigating biomarker profiles based on complex techniques such as multivariate pattern analysis are starting to be applied in the field of ADHD with some promising preliminary results. Conclusions: Further studies of these putative biomarker profiles in larger sample including additional neuropsychiatric diagnoses are needed.

Friday, 29 May 2015, 14.30 h–16.00 h HT-6 Potential adverse health outcomes in the treatment of ADHD HT-6-001 Does childhood ADHD predict risk-taking and medical illness in adulthood? R. G. Klein* * New York, USA Objectives: There is strong evidence that children and adolescents with ADHD have more accidents requiring medical attention, and that they engage in more risk-taking behavior, than non-ADHD peers. The objective is to examine whether children with ADHD display these behaviors well into adulthood, compared to controls (children free of ADHD), and whether, because of exposure to psychostimulants, they developed more medical illnesses, especially cardiac illness. Method: Prospective 33-year follow-up of 135 boys with ADHD in childhood, free of conduct disorder (mean age, 8 years) (referred to as ‘‘cases’’), and 136 matched children without ADHD (referred to as ‘‘comparisons’’), blindly interviewed by clinicians. We hypothesized positive relationships between childhood ADHD and risky driving (in the past 5 years), risky sex (in the past year), and between risk-taking and medical conditions in adulthood. We report causes of death. Results: In adulthood (mean age, 41 years) cases had significantly more risky driving, sexually transmitted disease, head injury, and emergency department admissions than comparisons (p \ .05–.01), but not more ‘‘other’’ medical illnesses. Over the lifetime, risktaking was associated with negative health histories (p = .01–.001). The significant relationship between ADHD and risk-taking was due to the development of antisocial personality disorders. Cases who did not go on to have antisocial disorders did not differ from comparisons in lifetime rates of risky behaviors (p = .55). Exposure to psychostimulants did not predict cardiac illness (p = .55). More cases than comparisons had died of non-medical causes (p = .01). Conclusions: Overall, among children with ADHD, we found that it is the development of antisocial personality disorder that leads to elevated risk-taking behavior in adulthood. Rates of risk-taking behavior did not differ between comparisons and the cases who never developed antisocial disorder. Findings support long-term safety of psychostimulant treatment during childhood.

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HT-6-002 Cardiovascular safety of psychostimulants in children with ADHD: Findings from a population-based cohort study S. Dalsgaard*, A. P. Kvist, J. F. Leckman, H. S. Nielsen, M. Simonsen * Denmark Objectives: To examine whether stimulant medication is associated with cardiovascular events, comparing users to non-users in both a national cohort and a population-based sample of children and adolescents diagnosed ADHD. Methods: Longitudinal, prospective cohort study of all children born in Denmark 1990–1999, using nationwide register-data. Hazard ratios (HR) for cardiovascular events were estimated using Cox regression, adjusted for other known risk factors. Results: In the total population (n = 714,258 contributing a total of 6,767,982 person-years) use of stimulants increased the risk of a cardiovascular event; adjusted HR = 1.83 (1.10–3.04). In children with ADHD (n = 8300) stimulants also increased the risk of a cardiovascular event (adjusted HR = 2.20 [2.15–2.24]), with a complex time-dependent dose–response relationship. Conclusions: This is the first nationwide cohort study of the cardiovascular safety of stimulants in children and adolescents, and it represents, to our knowledge, the longest prospective follow-up study. Cardiovascular events were rare but twice as likely in stimulant users as in non-users, both in the total national population and in children with ADHD. Our results suggest a safety signal with an increased risk of cardiovascular disease associated with stimulant treatment in children and adolescents, even after adjusting for a number of potential confounders.

Results: The mean observation time varied between 1.3 and 10.8 years for the various drugs. Receiving methylphenidate (MPH) was associated with 89 % decrease in the risk of cancer compared to the no medication subgroup and mixed medication (MX) (including MPH as the largest component) was associated with 83 % decrease in the risk of cancer compared to the no medication subgroup. Finally, receiving antidepressants (AD) was associated with an almost threefold increased risk of cancer in comparison to the no medication subgroup. Although receiving antipsychotics (AP) was associated with a twofold risk of cancer, this result was not significant. When excluding the MX subgroup from the analyses, the protective MPH subgroup effect remained significant whereas the AD and AP subgroup effects were not significant anymore. There was no evidence of confounding by indication. Conclusions: Both MPH and MX were protective of cancer while AD was associated with an almost threefold risk of cancer in comparison to the no medication subgroup.

Friday, 29 May 2015, 14.30 h–16.00 h HT-7 Neurocognitive findings in autism spectrum disorders (ASD) and ADHD - overlap or specific pattern? HT-7-001 Disentangling reward dysfunction in ADHD versus ASD G. Kohls*, B. Herpertz-Dahlmann, K. Konrad * Aachen, Germany

HT-6-003 Psychostimulant treatment and blood pressure: Results from a naturalistic study T. Renner*, S. Mu¨ller, A. Conzelmann, T. Jans, G.-E. Trott, M. Romanos, M. Gerlach * Wu¨rzburg, Germany Abstract not received.

HT-6-004 The association between medication for ADHD and cancer H.-C. Steinhausen* * Aalborg, Denmark Objectives: A study on chromosomal abnormalities has raised concerns that medication with methylphenidate (MPH) for ADHD might increase the risk of cancer. We performed a rigorous test of the association between cancer and various drugs used for ADHD. Methods: Data were linked from five Danish registers containing information on a total of 21,186 patients with ADHD, their drug prescription rates, and associated cancer diagnoses between 1994 and 2010. The cohort included subgroups treated with MPH only, antidepressants only, antipsychotics only, mixed medication, and a control group of un-medicated patients with ADHD. Frequencies of cancer diagnoses in these groups were compared. In addition, hazard risk (HR) ratios for developing cancer, and survival rates in these subgroups, were analyzed.

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Objectives: While ASD and ADHD share certain behavioral (e.g., attention deficits), cognitive (e.g., executive dysfunction) and neurobiological characteristics (e.g., fronto-striatal system dysfunction) and exhibit a high rate of co-occurrence, it has been hypothesized to differentiate both disorders at the brain level based on their reward circuitry reactivity to either social or monetary reward, with greatest differences to be expected for social rewards. Thus, the present fMRI study investigated neural activation in response to both reward types in age and IQ-matched boys with ADHD versus ASD relative to typically controls (TDC). Methods: All included participants were right-handed male children and adolescents between the ages of 9 and 18 years (ADHD group n = 16: 13 combined subtype and three inattentive subtype; ASD group n = 15; TDC group n = 17). Participants were asked to perform an incentive go/no-go task with monetary and social reward contingencies in a blocked-design that was adapted from animal research. Results: While the two disorder groups showed equal subjective motivation ratings as well as behavioral task performances as controls, our fMRI analyses revealed the expected differential patterns of aberrant reward system reactivity in both clinical groups versus TDC, particularly in ventral striatum. In addition, reward circuit responsivity in ASD versus ADHD demonstrated unique (i.e., striatal hypoactivation for monetary reward in ASD, and mPFC hyperactivation for social reward in ADHD) as well as shared neural dysfunction (i.e., fronto-striato-parietal hypoactivation for monetary reward in both clinical groups). Interestingly, lower neural reactivity within the parietal circuitry was associated with higher autistic traits across the entire study sample. Conclusions: While disorder-specific dysfunctions likely give rise to the distinct clinical picture of each of the syndromes, shared aberrations may underlie the phenotypic overlap and co-occurrence of both disorders, possibly mediated by pleiotropic genes.

HT-7-002 Attention processing in inattentive and combined ADHD and ASD J. Volkert*, C. Freitag, S. Ha¨nig, E. Westerwald * Frankfurt am Main, Germany Objectives: Autism spectrum disorder (ASD) and attention-deficit/ hyperactivity disorder (ADHD) show overlapping clinical symptoms with regard to attention problems. However, the underlying neurocognitive abilities have rarely been directly compared. To elicit overlapping and specific neurocognitive impairments in attention abilities, we studied children with ASD without ADHD, children with combined type ADHD-C and children with the inattentive ADHD-IA subtype by the neurocognitive test battery TAP, which differentiates between intensity and selectivity of attention and a supervisory attentional system (SAS), reflecting executive function abilities. Methods: Gender and age matched 8–15 year old individuals with ASD (n = 24), ADHD-C (n = 59); ADHD-IA (n = 26) and typically developing controls (TD, n = 24) completed clinical diagnostic assessment, IQ testing and seven subtests of the TAP test battery. Results: With regard to mean reaction time and reaction time variability, ASD children showed specific impairments in SAS incompatibility and flexibility. ADHD-C showed increased reaction time variability during covert shifts of attention, where they also showed higher commission errors. ADHD-C also showed more false reactions in SAS incompatibility, whereas ASD showed the highest rate of omission errors in divided attention. No differences with regard to intensity of attention were observed. Conclusions: This study reports relatively few, but characteristic differences in neurocognitive abilities between ADHD-C and ASD. The strength of the study is the rigorous control for IQ in statistical analysis to avoid confounding. Power was sufficient to detect a medium effect size, so smaller effects may have been overlooked due to sample size limitations.

HT-7-003 The need for a lifespan approach in studying common mechanisms underlying neurodevelopmental disorders N. Lambregts-Rommelse*, H. Geurts, C. Hartman * Nijmegen, The Netherlands Objectives: Recent literature has been fueled with studies exploring the shared mechanisms underlying Attention-Deficit/Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD). This literature is strongly biased by a focus on childhood age. We plea that is it particularly relevant to also focus on other developmental phases since (1) both symptoms domains are not at all stable across development; (2) the co-occurrence of both symptom domains varies with age; (3) associated cognitive impairments undergo substantial changes with age; (4) strong alterations in brain functioning and wiring with age have been shown in both disorders; (5) genetic mechanisms are strongly age dependent. An illustration of the need and the difficulties encountered when applying a lifespan perspective is given using a quantitative trait approach in ASD and ADHD across a wide age range. Methods: A total of 17,173 ASD and ADHD symptom ratings were combined from respondents aged 0–84 years from a diversity of clinical, high risk, community and healthy samples to chart the correlations between ASD and ADHD symptoms across the lifespan. Results: Findings indicated a cubic association between ADHD and ASD symptoms across the lifespan: the strength of association between ASD and ADHD symptoms was modest in infants and toddlers (r = .06), preschoolers (r = .24), substantial in childhood (r = .50)

and adulthood (r = .39–.50), and high in adolescence (r = .60). Methodological difficulties encountered were combining diverse samples, measurement instruments, and informants. Conclusions: Despite methodological difficulties when applying a lifespan perspective on ASD and ADHD co-occurrence, the data strongly suggest the patterns of association between ASD and ADHD symptoms vary across the lifespan, illustrating the necessity to move our research beyond childhood.

HT-7-004 Shared and unique underpinnings of ASD and ADHD. Pre-/perinatal antecedents and cognitive deficits in the context of familial risk A. Oerlemans*, C. Hartman, B. Franke, J. Buitelaar, N. Rommelse * Nijmegen, The Netherlands Objectives: Autism spectrum disorders (ASD) and attention-deficit/ hyperactivity disorder (ADHD) are two of the most common childhood neuropsychiatric disorders. It is unclear why ASD and ADHD co-occur within some individuals and families, but not in others. An attempt is made to examine the shared and unique involvement of pre-/perinatal and cognitive risk factors, using an approach that stratifies the sample into affected/unaffected offspring and singleincidence (SPX) versus multi-incidence (MPX) families. Methods: ASD and ADHD symptoms, retrospective parent-reported pre-/perinatal data and cognitive tasks measuring IQ, attention, executive functioning, social cognition, motor functioning, and time estimation were collected in 288 children from 31 SPX and 59 MPX ASD families, 476 children from 31 SPX and 171 MPX ADHD families, and 408 control children. The study was approved by the local medical ethics board and parents and children (12 years and older) signed for informed consent. Results: Children with ASD were characterized by impairments in social cognition, whereas children with ADHD displayed mostly deficits in executive functions. Unaffected siblings from MPX ASD and ADHD families displayed behavioral characteristics and cognitive deficits similar to their affected brother/sister. In contrast, unaffected siblings from SPX ASD and ADHD families showed less elevated trait levels and were cognitively unimpaired. No shared pre-/ perinatal risk factors were identified. Conclusions: Both disorders were characterized by impairments in cognitive functions and complications during pregnancy and childbirth, but different cognitive constructs and pre-/perinatal risk factors may play a crucial role in the developmental pathways leading to ASD or ADHD. Further, we found differences between SPX and MPX forms of ASD and ADHD hinting at potentially different underlying causal pathways. Future studies should consider family re-occurrence and comorbidity in studying the etiology of ASD and ADHD.

Friday, 29 May 2015, 14.30 h–16.00 h HT-8 ADHD in the classroom HT-8-001 Measuring and quantifying ADHD classroom behaviour J. Swanson* * Irvine, USA Abstract not received.

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HT-8-002 Do what works: Interventions in the classroom

attention training treatment for children with ADHD and can be administered in schools.

Y. Groen*, G. Gaastra, A. Fuermaier, L. Tucha, O. Tucha * Groningen, The Netherlands Objectives: Children with attention-deficit/hyperactivity disorder (ADHD) often exhibit problem behavior in class, whereas teachers often seem to lack knowledge and skills to manage this behavior. Methods: This presentation takes a teacher perspective on ADHD and provides an overview of the different types of evidence-based classroom interventions promoting on-task behavior in children with ADHD. Results: Meta-analytic results covering 33 years of research are presented and provide evidence that classroom interventions reduce off-task and disruptive classroom behavior in children with ADHD symptoms with large effect size (group studies: k = 24, n = 471, ES = 0.92; case studies: k = 76, n = 156, ES = 3.08). For the group studies, largest effects were obtained for consequence-based interventions (ES = 1.82) compared to antecedent-based, self-regulation, and combined interventions. For the case studies, self-regulation interventions (ES = 3.61) appeared to be most effective. Conclusions: Promoting teachers’ knowledge and skills of evidencebased classroom interventions can help them to reduce off-task and disruptive classroom behavior in children with ADHD. If teachers ‘do what works’ in their classroom, this will be beneficial for all parties in the classroom. It is therefore important to provide teachers with adequate knowledge and training.

Friday, 29 May 2015, 14.30 h–16.00 h HT-9 Treatment options of adult ADHD HT-9-001 Meta-analysis assessing pharmacological and psychosocial interventions for adults with ADHD G. Polanczyk* * Sao Paulo, Brazil Abstract not received.

HT-9-002 Multimodal treatment of adult ADHD: A randomized controlled multicentre trial (COMPAS) A. Philipsen*, T. Jans, S. Matthies, M. Colla, M. Berger, L. Tebartz van Elst, C. Jacob, M. Huss, B. Kis, M. Ro¨sler, E. Sobanski * Bad Zwischenahn-Oldenburg, Germany

HT-8-003 Neurofeedback and cognitive attention training for children with ADHD in schools N. Steiner*, E. C. Frenette, K. M. Rene, R. T. Brennan, E. C. Perrin * Boston, USA Objectives: To evaluate the maintenance of efficacy of computer attention training in the school setting at 6-month follow up. Methods: 104 2nd and 4th graders with ADHD were randomized into three groups: neurofeedback (NF), cognitive training (CT) and waitlist control (WLC). Intervention groups received 40 sessions over 6 months of computer training in school. Changes in parent measures (Conners 3-P and BRIEF) and objective classroom observations (BOSS) were investigated using a multilevel growth modeling approach to assess change from pre-intervention through the 6-month follow-up comparing the intervention conditions respectively to the control. ANOVA assessed community-initiated changes in stimulant medication. Results: At the 6-month follow-up, parent response rates were 90 %. NF participants maintained significant gains at 6-month follow-up on Conners 3-P (Inattention ES = 0.34, Executive Functioning ES = 0.25, Hyperactivity/Impulsivity ES = 0.23) and BRIEF subscales including the composite (ES = 0.31). These gains were significantly greater than gains found among children in CT and control conditions. At 6-month follow up, delayed improvement was found in children in the CT group over immediate post-intervention ratings on Conners 3-P Executive Functioning (ES = 0.18) and two BRIEF subscales. As regards to stimulant medication dosage, NF participants maintained at the 6-month follow-up the same stimulant medication dosage, while participants in both CT and control conditions showed statistically and clinically significant increases (9 mg, p = 0.002 and 13 mg, p \ 0.001 respectively). Conclusions: Six-month follow-up analyses of this randomized control trial show improvement in ADHD symptoms in NF participants sustained at 6-month follow-up, and greater than CT participants or those in the control group. NF presents as a promising

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Objectives: To investigate treatment options for adult ADHD, we conducted a RCT COMPAS to examine the efficacy of psychotherapy (GPT) compared to clinical management (CM) in combination with methylphenidate (MPH) or placebo (Plac) in a four-arm design. Methods: Patients with ADHD according to DSM-IV from seven university study sites in Germany, aged 18–58, were centrally randomised to GPT + MPH (n = 107), GPT + Plac (n = 109), CM + MPH (n = 110), or CM + Plac (n = 107). GPT and CM sessions were held weekly in the first 12 weeks and monthly thereafter for 9 months. The primary outcome (ADHD Index of CAARS Rating Scale) was the change in ADHD symptoms from baseline to the end of the 3-month intensive treatment. A follow-up assessment was carried out two and a half years after baseline (N = 260). Results: The ADHD Index improved from a mean of 20.6 to 17.6 for GPT (effect size [ES] = -.55) and to 16.5 for CM (ES = -.75), with no significant difference. MPH (ES = -.81) was significantly better than Plac (ES = -.50; P = 0.0025). After 1 year MPH achieved the best ES (-1.04) followed by GPT (-.88), CM (-.81) and Plac (-.65). At follow-up (n = 251) stable effects of GPT versus CM with a non-significant difference and a significant benefit for MPH versus Plac was documented. In contrast, in clinical ratings of the effectiveness of intervention GPT was superior to CM at all time points. Conclusions: Against our hypothesis, GPT was not superior compared to CM with regard to the primary outcome after 3 months of intensive treatment, whereas methylphenidate was superior to placebo. Over the study period MPH had the strongest effects.

HT-9-003 Novel treatment strategies C. B. Surman* * Boston, USA Objectives: To review recent exploration of novel pharmacotherapies for treatment of ADHD in adults, with emphasis on level of evidence for each in the published literature.

Methods: Literature review of published clinical trial data exploring evidence for efficacy of agents other than atomoxetine, methylphenidate or amphetamines in Adult ADHD. Results: Recently published studies have extended beyond catecholaminergic agents to explore the efficacy of agents implicated in histaminergic, nicotinic, glutamatergic, and gabaergic activity. The level of evidence for these agents varies, but remains inadequate to support wide use. Conclusions: Further research may clarify whether novel mechanisms may provide relieve for ADHD symptoms, or for dimensions of functional impairment commonly comorbid with ADHD, such as executive function deficits.

HT-9-004 Omega-3 polyunsaturated fatty acids and other food supplements K. W. Lange* * Regensburg, Germany Objectives: An overview of the role of dietary factors in the etiology and therapy of ADHD will be provided. Methods: Results of recent research and controlled studies regarding ADHD and diets are included in this review. Results: Evidence for effects of dietary treatments of ADHD varies widely, from anecdotal evidence to placebo-controlled and doubleblind trials. The results of meta-analyses of the efficacy of dietary intervention (e.g. free fatty acid supplementation) remain inconclusive. Free fatty acid supplementation has been demonstrated to produce small but significant reductions in ADHD symptoms. However, the clinical significance of these effects remains to be determined. Conclusions: A substantial efficacy of diet in the therapy of ADHD remains uncertain and further investigations are needed.

RC-3-003 The psychologist’s perspective S. van der Oord* * Leuven, The Netherlands Objectives: Recently, a meta-analysis has been conducted on the effects of behavioural interventions for ADHD on multiple outcomes (Daley et al. 2014). The questions remains what the implications are of these results for clinical practice. A subgroup of the European ADHD Guidelines Group (Behavioural Intervention workgroup) is currently working on management recommendations for the use of behavioural interventions, using results of this metaanalysis supplemented with other empirical evidence. The current presentation gives implications of this meta-analysis with regards to expected treatment benefits of behavioural treatment (on which outcomes can we expect benefits?), indications of behavioural treatments and the potential of combining behavioural modalities with other non-pharmacological treatments (e.g. cognitive treatment).

RC-3-004 Can a behavioural sleep intervention improve outcomes for children with ADHD? A randomised controlled trial E. Sciberras* * Parkville, Australia Abstract not received.

RC-3-005 The influence of comorbid ODD on white matter microstructure in ADHD H. van Ewijk*

Friday, 29 May 2015, 14.30 h–16.00 h * Amsterdam, The Netherlands

RC-3 Eunethydis consortium: The European guideline groups RC-3-001 New findings from the meta-analyses of behavioural and cognitive interventions for ADHD E. J. S. Sonuga-Barke* * Southampton, UK Abstract not received.

RC-3-002 The psychiatrist’s perspective E. Simonoff* * London, UK Abstract not received.

Objectives: Attention-deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) are highly comorbid disorders. ADHD has been associated with altered white matter (WM) microstructure, though the literature is inconsistent, which may be due to differences in the in- or exclusion of participants with comorbid ODD. WM abnormalities in ODD are still poorly understood, and it is unclear whether comorbid ODD in ADHD may have confounded the current ADHD literature. Methods: Diffusion Tensor Imaging (DTI) was used to compare fractional anisotropy (FA) and mean diffusivity (MD) between ADHD patients with and without comorbid ODD. All participants were between 8 and 25 years and groups did not differ in mean age or gender. Follow-up analyses were conducted to examine the role of antisocial behaviour (conduct problems) on FA and MD values in both groups. Results: Comorbid ODD in ADHD was associated with lower FA in left fronto-temporal WM, which appeared independent of ADHD symptoms. FA was negatively associated with antisocial behaviour in ADHD + ODD, but not in ADHD-only. Conclusions: Comorbid ODD is associated with WM abnormalities in individuals with ADHD, which appears to be independent of ADHD symptoms. Altered WM microstructure in comorbid ODD

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may play a role in inconsistencies in the current DTI literature in ADHD. Altered development of these tracts may contribute to socialemotional and cognitive problems in children with oppositional and antisocial behaviour.

Friday, 29 May 2015, 16.00 h–17.30 h P-01 Aetiology I P-01-001 Detection of auto-antibodies to DAT in the serum: Interactions with DAT genotype and psycho-stimulant therapy for ADHD W. Adriani*, E. Romano, M. C. Porfirio, P. Curatolo, G. Laviola * Rome, Italy Objectives: Aetiology of Attention-deficit/hyperactivity disorder (ADHD) is not fully understood, but there is a rising interest for a possible autoimmune contribution. We evaluated the presence of circulating autoantibodies against dopamine transporter (DAT aAbs) in 61 children (46 ADHD patients who met DSM-IV-TR criteria, 15 healthy controls). Methods: ADHD patients were assigned, according to severity, either to a non-pharmacological therapy (NPT, n = 32) or to a pharmacological treatment (PT, n = 14) with methylphenidate (MPH). In ADHD children, blood samples were withdrawn twice, at recruitment (T0 basal) and after 6 weeks (T1); following 16 excluded subjects, DAT genotype was characterized (9-repeat or 10-repeat alleles; n = 15 each). After 18 months of NPT or PT, some patients (carrying at least one 9-repeat allele) were blood sampled again (T2), for comparison with healthy controls (final n = 8). Results: Compared to NPT, basal DAT aAbs titers were higher within most severe patients (then assigned to PT), specifically if carrying a DAT 10/10 genotype. DAT aAbs levels of NPT group resulted highly correlated with distinct subscales of Conners’ Parent/ Teacher Scales (Rs [ 0.34), especially within DAT 10/10 genotype (Rs [ 0.53). While T1 titers were elevated over T0 baseline for NPT children, such an increase was not observed in PT patients carrying at least one 9-repeat allele, who also showed behavioral response to subchronic MPH. After 12–24 months of MPH exposure, DAT aAbs titers in PT subjects were comparable to those of healthy controls, while titers remained significantly elevated in NPT patients. Conclusions: Data warrant further research on serum DAT aAbs, which could be used to confirm ADHD diagnosis and/or to monitor therapeutic efficacy of MPH. In particular, the elevation of serum anti-DAT titers and restoration of basal levels by few weeks of MPH can be proposed as bio-markers, to support diagnosed ADHD and its drug therapy.

P-01-002 The relationship between psychological trauma, parenting attitude and Attention-Deficit/Hyperactivity Disorder symptoms in Korean children J.-H. Bae*, S. Park * Seoul, Republic of Korea

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Objectives: We examined the association between psychological trauma, parenting attitude, and attention-deficit hyperactivity disorder (ADHD) symptoms in Korean children. Methods: Fifty eight school-aged children (mean age 10.3 ± 3.13 years) were recruited from community. They were asked about an experience of psychological trauma using an Early Trauma InventoryShort Form (ETI-SF). Parenting attitude of their mothers was assessed by the Maternal Behavior Research Instrument (MBRI) and attentiondeficit hyperactivity disorder symptoms of children were assessed by the parent version of the ADHD-Rating Scale. Results: Compared to children without psychological trauma, children with psychological trauma showed higher scores on the ADHDRating Scale. Mothers of children with psychological trauma were more likely to experience childhood trauma, and showed less affective and more rejecting parenting attitudes compared with those of children without psychological trauma. After adjusting for the child’s gender, the child’s age, the maternal education level, and socio-economic status, there was a significant interaction for the child’s psychological trauma and mother’s rejecting parenting attitude in relation to the child’s hyperactive-impulsive symptoms (F = 2.89, p = 0.025). Conclusions: Our results suggest a parenting influence on the association between exposure to psychological trauma and the severity of ADHD symptoms in children. Further studies in a larger sample are warranted to evaluate this association.

P-01-004 Predictors of disorder severity and comorbidity may differ among patients with ADHD: Data from a tertiary treatment centre N. Demir*, E. Tufan, Z. Topal, U. Savci, M. A. Cansiz, S. Taskiran, E. Demirbas Cakir, B. Semerci * Bolu, Turkey Objectives: Prenatal problems are reported in 10–20 % of patients with ADHD while postnatal ones are reported among 3–5 % (1). Environmental factors are not causal in etiology of ADHD but are thought to increase severity of symptoms and presence of comorbid diagnoses. Other risk factors may involve marital problems, traditional/extended families, paternal criminality, maternal psychopathology and adoption (1). Data on risk and protective factors and their relationship with disorder severity and comorbidity in clinical samples of ADHD from Turkey are limited (2). Here we aimed to analyze the prevalence of risk factors and their relationships with disorder severity and comorbidity in a clinical sample from a tertiary center. Methods: Cross-sectional, retrospective, chart-review study conducted at Abant Izzet Baysal University CAP. Records of 9000 patients referred between October 2011 and 2014 for hyperactivity/ inattention were screened. 995 patients received a diagnosis of ADHD. Patients were evaluated with rating scales while clinicians rated the severity of disorder with CGI-S. Risk factors were coded as dummy variables and entered into ordinal logistic regression to predict CGI-S scores and number of DSM-IV-TR diagnoses. Results: Only natal problems differed significantly between genders. Both models (for CGI-S and number of diagnoses) were significant (p = 0.00) extended family, maternal psychopathology and past medical problems were shared while gender, prematurity, natal and post-natal problems predicted more DSM-IV-TR diagnoses.

Conclusions: Predictors of disorder severity and comorbid diagnoses may differ partially for patients with ADHD. Our results should be replicated with further studies.

P-01-005 Breastfeeding, protective factor for the development of ADHD A. Ferna´ndez Dı´az*, M. Lado Codesido, M. Gonza´lez Santos * Mugardos, Spain Objectives: Breast milk is the food most recommended for the newborn, for at least the first 6 months of life (Pe´rez-Ruiz et al. 2014). Recent studies have tried to correlate breastfeeding with better cognitive development and lower risk for behavioral problems in childhood (Park et al. 2014), and short periods of breastfeeding have been associated with Attention Deficit-Hyperactivity Disorder (ADHD) (van Dyk et al. 2014). We aimed to study the prevalence of breastfeeding in a cohort of patients with ADHD diagnosis. Methods: Participants consecutively referred to a Department of Child en Adolescence Psychiatry, between June 2014 and February 2015 and meeting ADHD criteria (DSM-IV-TR) comprised the study sample. Breastfeeding data were collected as part of the intake visit, using a locally devised questionnaire. We grouped breastfeeding data: more than 6 months, between 3 and 6 months, less than 3 months and bottle feeding. We compared breastfeeding data between patients with ADHD. All statistical analyses were performed using SAS (9.0). Results: 38 patients (mean age: 11 years old; 84.21 % male; 15.79 % female) with ADHD diagnosis were included in the study. In this sample we found that the prevalence of patients who received breastfeeding over 6 months is 7.89 % (n = 3), between 3 and 6 months 10.54 % (n = 4), less than 3 months 26.31 % (n = 10), and bottle feeding 23.68 % (n = 9). Significant differences were found between patients who received artificial feeding or breastfeeding for a short period of time (less than 6 months), and patients who have been breastfed for more than 6 months (60.53 vs 7.89 %). 31.57 % (n = 12) of cases in our sample were not collected breastfeeding data. Conclusions: There is a high prevalence of artificial feeding and short breastfeeding in our sample. This finding supports the breastfeeding as a possible protective factor for development of ADHD. Future studies should investigate the implication of the duration of breastfeeding in ADHD pathogenesis.

P-01-006 Low serum sphingolipids in Attention-Deficit/ Hyperactivity Disorder (ADHD) M. Henrı´quez-Henrı´quez*, S. Solari, F. Allende, T. Quiroga, B. Kim, T. S. Worgall * New York, USA Objectives: ADHD has been related to a lag in brain maturation. Sphingolipids are essential for brain development and neuronal functioning, but their role in ADHD pathogenesis is unexplored. The aim of this study is to characterize the sphingolipid profiles of ADHD children and typically developing controls. We hypothesized that serum sphingolipid levels distinguish ADHD patients from unaffected subjects.

Methods: We characterized serum sphingolipid profiles of ADHD patients and two control groups: non-affected first degree relatives and non-affected subjects without a family history of ADHD. Sphingolipids were measured by LC–MS/MS in 77 participants (28 ADHD patients, 28 related controls and 21 unrelated controls). ADHD diagnosis was based on the Diagnostic and Statistical Manual of Mental Disorders (DSM IV-TR). Diagnostic criteria were assessed by 2 independent observers. Groups were compared by means of parametric statistics. Results: Serum sphingomyelins C16:0, C18:0, C18:1, C24:1, serum ceramide C24:0 and deoxyceramide C24:1 were significantly decreased in ADHD patients at 20–30 % relative reductions. In our sample, decreased serum sphingomyelin levels distinguished ADHD patients with 79 % sensitivity and 78 % specificity. The Negative Predictive value for Total Sphingomyelins, assuming an ADHD prevalence of 10 %, was 98 %. Conclusions: Our results showed lower levels of all major serum sphingomyelins in ADHD. Longitudinal studies are required to evaluate if these findings reflect an ADHD specific pathomechanisms. Low serum sphingomyelins levels are a potential biomarker for ADHD.

P-01-007 Relation between salivary cortisol level and cognitive impairment in children with Attention-Deficit/Hyperactivity Disorder O. Ibrahim*, W. Haggag, K. Abdelmoez, I. Youssef * Ismailia, Egypt Objectives: Several studies suggested that cortisol level influence the development and functioning of the brain in children and it is implicated in a variety of processes including memory and attention. This study was done to investigate the relation between cortisol level in ADHD children and their cognitive function profile. Methods: Descriptive cross-Sectional study, held in Suez Canal University Hospital in Ismailia, participants recruited from attendance of the childhood and adolescent psychiatry clinic. The study included two groups (74 children), ADHD group (diagnosis set upon DSM-IV TR through a structured clinical interview), composed of 43 children, (pure ADHD children with no co-morbid condition) and Control group composed of 31 typically developing children, participated voluntarily in this study. Age study ranges from 6 to 12 years, both sexes were included. Early morning awakening salivary cortisol levels were collected, on 2 different days, 2 months apart. Stanford– Binet intelligence test 4th edition (SB-4), Wisconsin card sorting test (WCST), Conner test, child behavioral checklist (CBCL), were performed to all participants. Results: Children’s Early Morning Salivary Cortisol levels for both groups results were: difference between scores of the two groups were statistically significant (p value \0.01). (significant lower cortisol levels at awakening). Comparison shows that there was statistically significant difference (p \ .05) between mean scores of total score and subdomain scores of Stanford–Binet test and Wisconsin card sorting test (total number of errors, perseverative errors) between ADHD children and comparison group, and that these results are positively correlated with decrease in mean cortisol awakening response. Conclusions: There are significant associations between salivary cortisol and cognitive and executive function impairment in children with attention deficit hyperactivity disorder (ADHD).

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P-01-008 Association between phthalates and externalizing behaviours and cortical thickness in children with AttentionDeficit/Hyperactivity Disorder

Conclusions: It can be concluded that, despite ADHD receives serious attention all over the world, it is rarely consider as possible diagnosis in adulthood by mental health professionals in Italy.

B.-N. Kim*, J. W. Kim, S.-C. Cho, T. Kang, S. Lee, J. I. Kim * Seoul, Republic of Korea Objectives: Previous studies have implicated the relationship between environmental phthalate exposure and attention deficit hyperactivity disorder (ADHD) symptoms of childhood, but no studies have been conducted in children who have a confirmed diagnosis of ADHD obtained through meticulous diagnostic testing. We aimed to determine whether phthalate metabolites in urine would be higher in children with ADHD than in those without ADHD and would correlate with symptom severity and cortical thickness in ADHD children. Methods: A cross-sectional examination of urine phthalate metabolite concentrations was performed; scores for ADHD symptoms, externalizing problems, and continuous performance tests were obtained from 180 children with ADHD, and brain-imaging data were obtained from 115 participants. For the control group, children without ADHD (N = 438) were recruited. Correlations between phthalate metabolite concentrations and clinical measures and brain cortical thickness were investigated. Results: Concentrations of phthalate metabolites, particularly the di(2-ethylhexyl) phthalate (DEHP) metabolite, were significantly higher in boys with ADHD than in boys without ADHD. Concentrations of the di-n-butyl phthalate (DBP) metabolite were significantly higher in the combined or hyperactive-impulsive subtypes compared to the inattentive subtype, and the metabolite was positively correlated with the severity of externalizing symptoms. Concentrations of the DEHP metabolite were negatively correlated with cortical thickness in the right middle and superior temporal gyri. Conclusions: The results of this study suggest an association between phthalate concentrations and both the diagnosis and symptom severity of ADHD. Imaging findings suggest a negative impact of phthalates on regional cortical maturation in children with ADHD.

Friday, 29 May 2015, 16.00 h–17.30 h P-02 Epidemiology I

P-02-004 Attention-Deficit/Hyperactivity Disorder (ADHD) and socioeconomic deprivation in the United Kingdom A. Hire*, D. Ashcroft, D. Springate, D. Steinke * Manchester, UK Objectives: Research has suggested that an individual’s chance of being diagnosed with ADHD may be influenced by their socioeconomic status. This study aimed to establish if there was an association between ADHD and socioeconomic deprivation in England, Wales, Scotland and Northern Ireland. Methods: The study used coded medical records data provided by the Clinical Practice Research Datalink (CPRD), a database containing patient information from approximately 680 UK general practices. The study population comprised of patients diagnosed with ADHD before the age of 19, between 1/1/2004 and 31/12/2013. Patients with a recorded diagnosis of ADHD were identified and stratified according to the region in which their general practice was based. Each practice has an Index of Multiple Deprivation (IMD) score based on the locality in which it is sited; this relative measure of deprivation provided a surrogate measure of patients’ deprivation status. Results: Between 2004 and 2013 there were 10,284 new diagnoses of ADHD. There were statistically significant differences in incidence rates between the nations of the UK. Northern Ireland had the highest incidence of ADHD [1.33 cases per 1000 person years/PY (95 % CI 1.21–1.47)]; Scotland had the lowest incidence [1.06 cases per 1000 PY (95 % CI 1.0–1.13)]. In England there appeared to be an inverse association between deprivation and ADHD incidence; diagnosis rates decreased in line with increasing deprivation. In the other nations of the UK, this association between ADHD and deprivation was largely absent. Conclusions: Within the UK there were subtle but significant national differences in ADHD incidence. In England, there appeared to be a clear association between socioeconomic deprivation and ADHD incidence. Further research is needed to verify and explain these findings.

P-02-003 ADHD in adulthood: An Italian overview G. Giupponi*, S. Holzer, G. Gatti, E. Duregger, I. Maniscalco, A. Conca * Bolzano, Italy Objectives: Considering our experience in clinical practice and observing that in Italy, compared to other European countries, Attention Deficit Hyperactivity Disorder (ADHD) in adult people receives little attention. We wanted to investigate if ADHD is considered by mental health professionals as possible diagnosis in adults and how frequently and with which methods it is diagnosed and treated. Methods: Between January and September 2014, we contacted a psychiatrist from each of the 167 mental health centres in Italy and sent them the Italian version of a questionnaire about diagnosis and treatment of patients with ADHD (Bistrol et al. 2007). Results: Only 44 psychiatrists took part to the study; among them, only 14 had direct clinical experience with the disorder.

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P-02-005 The course of ADHD domains during the adulthood: A seven-year follow-up study R. Karam*, D. Rovaris, V. Breda, F. Picon, M. Victor, C. Salgado, E. Vitola, N. Mota, K. Silva, P. Guimaraes-da-Silva, M. Meller, P. Belmonte-de-Abreu, L. A. Rohde, E. H. Grevet, C. H. Bau * Porto Alegre, Brazil Objectives: Most evidence about course of ADHD domains comes from follow-up studies with children or adolescents. In these periods, while the hyperactivity/impulsivity domain of ADHD has a sharper decline, inattention remains relatively stable. Little is known about their course during adulthood. This study aims to investigate separately the course of each ADHD domain during adulthood and to determine moderators of symptoms change 7 years after first assessment. Methods: This is a 7-year follow-up study of 344 adults previously evaluated between 2003 and 2007 in the ADHD outpatient clinic of HCPA (mean age at baseline = 34.1 years, SD = 10.9, 48 % males).

Trained psychiatrists blinded to baseline data have carried out face-toface follow-up interviews evaluating social and psychiatric outcomes. Lifetime diagnoses were based on DSM-IV criteria. ADHD and oppositional defiant disorder were evaluated with the K-SADS-E, and other comorbidities with SCID-IV and MINI. The main outcome variable is the number of K-SADS-E ADHD symptoms in each domain at baseline minus the number at follow-up. In this analysis we used two-step forward regression models. Results: Inattention and hyperactivity/impulsivity symptoms declined at a similar rate (21 %). A higher number of both inattention and hyperactivity/impulsivity symptoms at baseline was predictive of steeper decline for each domain. Alcohol abuse/dependence and higher number of inattention symptoms at baseline predict less decline in hyperactivity/impulsivity symptoms, whereas school suspensions predict lower decline in the inattention domain. Conclusions: This is the first prospective study analyzing ADHD domains during adulthood. Differently from the childhood and adolescence patterns, our results suggest that the decline of hyperactivity/ impulsivity symptoms in adults ceases to be steeper than the inattention decline. Characteristics that are possibly amenable to prevention strategies (school suspensions and alcohol abuse/dependence) predict lower decline in inattention and hyperactivity/ impulsivity, respectively.

P-02-006 Knowledge/understanding, perception, and attitude towards Attention-Deficit/Hyperactivity Disorder among medical students at the Faculty of Medicine, University of Indonesia C. A. Liu*, T. Wiguna * Jakarta, Indonesia Objectives: Medical students in FMUI, especially those in clinical level, ought to have good level of knowledge/understanding, perception, and attitude towards ADHD. It is because they have received education about ADHD during their study in clinical level. Thus, this research is aimed to identify the levels of knowledge/understanding, attitude, and perception toward ADHD of preclinical and clinical level students in FMUI. Methods: The research was cross-sectional study. Sample was chosen from 683 preclinical students and 469 clinical students from BEM IKM FMUI by using simple random sampling to get 96 preclinical and 96 clinical students. Questionnaires were distributed to the research subjects from September until December 2013. Questionnaire had been tested for validity (Pearson alpha [0.25) and reliability (Cronbach’s alpha [0.7). Results: The result showed that majority of the respondents had very poor and poor level of knowledge/understanding, perception, and also attitude towards ADHD. Besides, there was significant different in the level of attitude towards ADHD between preclinical and clinical level student (p = 0.016). Conclusions: Therefore, improvement to Psychiatry Clinical Practice Module is necessary to be done by giving chance for the clinical level students to meet real ADHD patients so that they could gain better knowledge about ADHD.

P-02-007 Difference in estimated prevalence of preschool ADHD depending on cut-off points using a screening tool in a population sample in Spain J. J. Marı´n-Me´ndez*, C. Borra-Ruiz, M. J. Alvarez-Go´mez, A. Diez-Suarez, P. de Castro-Manglano, M. Vallejo-Valdivielso, C. Soutullo-Espero´n

* Pamplona, Spain Objectives: The goal is to evaluate differences in prevalence of ‘‘suspected’’ Attention Deficit/Hyperactive Disorder (ADHD) in a Spanish population of preschool children according different diagnosis criteria employed. Methods: We used a multistage sampling technique to obtain a representative sample of children 3 to \7 years old. Both teachers and parents filled the ADHD-RS-IV-Preschool version. Rating each symptom on frequency (0–3). The diagnostic criteria to evaluate ‘‘suspected ADHD’’ were the criteria mainly employed in international research: (a) Ratings ADHD-RS-IV with a cut-off point of percentile 93 (P93); (b) at least six of nine positive inattentive and/ or hyperactive-impulsive items (parents and teacher) (C6 symptoms). Additionally we evaluate other cut-off points (percentile 95 and 97). Results: We evaluate 1426 children (50.4 % females) in schools in Navarra and La Rioja (two regions in northern Spain); average age 4.7 (IC95 % 2.9–6.6) y.o. Prevalence according cut-off points (proportion, (IC95 %))—P93 = 3.8 % (2.761–4.813)—P95 = 2.5 % (1.675– 3.374)—P97 = 1.5 % (0.868–2.218)—C6 symptoms (parents AND teacher ADHD-RS) = 2.5 % (1.690–3.402) When we compare different cut-off points, there are statistical differences between p93 versus p97 (p \ 0.001). There are not statistical differences between use ratings values and presence of symptoms. Conclusions: Prevalence obtained in our sample are similar to internationally research. The use of different criteria (total ADHD-RS score p95 versus Number of symptoms [6) could be equivalent (prevalence 2.5 %), but we must choose carefully an adequate cut-off point. The differences in prevalence reported in several studies could be explained by using different diagnosis criteria. To avoid these differences, we should use unanimous criteria using validated and cross-culturally adapted scales. Different criteria could be an important factor in the failure to replicate results in other fields like genetic research.

P-02-008 Knowledge/understanding, perception and attitude towards Attention-Deficit/Hyperactivity Disorder among community members in Indonesia B. J. Murtani*, T. Wiguna * Jakarta, Indonesia Objectives: ADHD is a common case found in elementary-schoolage children which affects child’s growth and development. During this time, education about ADHD has been done through mass media such as newspaper, popular magazine, tabloid, internet and many more. However, whether the education improves knowledge/understanding, perception and attitude towards ADHD is still questionable. The purpose of this research was to identify the level of knowledge/ understanding, perception, and attitude towards ADHD among Indonesian community members and to elaborate their association with formal education level. Methods: This research used cross sectional design. The samples were Indonesian community members with exclusion criteria of subjects who have job as teacher, doctor, psychologist and medical students. Data was gained by distributing special questionnaire made for this research through googledocs. The research questionnaire was valid with the result of Pearson’s r [ 0.25 and reliable with the result of Cronbach Alpha test = 0.873. From 500 questionnaires collected, simple random sampling method was used to obtain 384 research subjects. Data was analyzed using SPSS 20th version for Mac.

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Results: Result showed that majority of Indonesian community members had very poor and poor level of knowledge/understanding (56.8 %), perception (56 %) and attitude (54.4 %) towards ADHD. There was significant difference in statistic between the level of formal education and attitude towards ADHD (p \ 0.05). Conclusions: Sustainable education about ADHD should be given to all Indonesian community members. Education could be done not only through mass media, but also through direct community approach by giving seminar and workshop about ADHD.

P-02-009 Prevalence of restless legs syndrome in adult ADHD and its subtypes M. Snitselaar*, M. Smits, J. Spijker * Ede, The Netherlands Objectives: The aim of this observational cross-sectional study was to assess restless legs syndrome (RLS) prevalence among adult ADHD sufferers and variation in sub-types. Methods: Forty-nine subjects who were referred to the outpatient ADHD clinic for an ADHD diagnostic assessment (diagnostic interview for ADHD in adults: DIVA 2.0), were assessed for sleep disorders (Holland Sleep Disorders Questionnaire: HSDQ) and ADHD symptoms (ADHD-Rating scale: ADHD-RS). The HSDQ is a validated self-rated diagnostic questionnaire to measure insomnia, parasomnia, hypersomnia, sleep apnea, circadian rhythm sleep disorders and sleep-related movement disorders, based on the International Classification of Sleep Disorders. Results: Twenty-nine received ADHD combined type (ADHD-C) diagnosis and seven inattentive type diagnosis. The prevalence of any sleep disorder (total HSDQ score) was 65.5 %. The total HSDQ score correlated with the total ADHD-RS score (q = 0.437; p = 0.026) particularly with hyperactivity/impulsivity (q = 0.494; p = 0.010). A RLS prevalence of 34.5 % was found, with a higher prevalence rate in the ADHD-C subgroup, although not significantly (p = 0.066). RLS symptoms were correlated with ADHD symptoms (q = 0.678; p: 0.000) particularly hyperactivity/impulsivity (q = 0.742; p: 0.0001) (figure). ADHD patients with positive RLS scores reported higher scores on the ADHD-RS compared with ADHD patients with negative RLS scores (Z: -2.968, p = 0.003), mainly due to higher hyperactivity/impulsivity scores (Z: -3.145; p = 0.002). Conclusions: Our findings show that clinicians need to be aware of RLS among adult ADHD patients, particularly those with severe hyperactivity/impulsivity symptoms. Due to the high correlation of ADHD symptoms and sleep disorders, it is recommended to treat sleep disorders, including RLS first, before ADHD assessment is made, in order to improve the validity of any ADHD diagnosis.

P-02-010 Mental health problems, bullying experience and expression of suicidal ideation in the ADHD risk group K. Nari*, Y. S. Kwack * Jeju, Republic of Korea Objectives: This study aimed to compare mental health problems, bullying experiences and expression of suicidal ideation between the ADHD risk group and non ADHD risk group. Methods: Parents of 102 children and adolescents referred to Jeju mental health service center completed the Korean version of the

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SDQ and ADHD rating scale. And also their children’s bullying experiences and expression of suicidal ideation were assessed by self questionnaire. We divided them into the ADHD risk group (C19 score) and non ADHD risk group (\19 score) according to ADHD rating scale total score. Results: The ADHD risk group (N = 29, 28.4 %) showed significantly high SDQ emotional and conduct problems subscales scores than non ADHD risk group (N = 73, 71.6 %). And the ADHD risk group had statistically significant more bullying experiences than non ADHD risk group. Expression of suicidal ideation was not significantly different between two groups. Conclusions: The ADHD risk group (N = 29, 28.4 %) showed significantly high SDQ emotional and conduct problems subscales scores than non ADHD risk group (N = 73, 71.6 %). And the ADHD risk group had statistically significant more bullying experiences than non ADHD risk group. Expression of suicidal ideation was not significantly different between two groups.

Friday, 29 May 2015, 16.00 h–17.30 h P-03 Diagnosis - Children and adolescence I P-03-001 What is behind ‘‘hyperactivity’’ in child psychiatry? T. Brahim*, A. Guedria, R. Ben Moussa, N. Gaddour, S. Missaoui * Monastir, Tunisia Objectives: To determine diagnosis associated with ‘‘hyperactivity’’ in common practice in the consultation of child psychiatry in Monastir, Tunisia. Methods: It was a retrospective descriptive study. This study covered all cases referred to the consultation as a ground with ‘‘hyperactivity’’. We conducted a record review. The study concerned all archived folders from February 2003 until mid-October 2014, seen at the Child Psychiatry Consultation of Monastir Tunisia. The DSM-IV-TR criteria were used to access the different diagnosis. Results: we found a total of 109 cases. The average age was 8 years (it ranges from 2 to 14 years), with a male predominance (95 % of children). The diagnosis of AD/HD was retained in 47 % of cases, autistic disorder diagnosis in 10 % of cases. In 28 % of cases, mental retardation was confirmed. In 8 % of cases the cause of hyperactivity was educational errors. We also found two cases of depressive disorder, psychotic disharmony and emotional deprivation and only one case of separation anxiety and oppositional defiant disorder. Conclusions: the motive ‘‘hyperactivity’’ is not synonymous with AD/HD. Several other serious diagnosis can hide behind, mainly the cognitive deficits and autistic disorder.

P-03-003 Small bugs throw my body S. Gallego Villalta*, L. Duran Sandoval, C. Bestue Felipe, J. P. Paolini San Miguel, A. Matı´as Sanfrutos, A. Ortiz Martin, E. Vin˜uales Luis, I. Martinez Lausin, P. Bernal Romaguera * Zaragoza, Spain Objectives: Clinical case: how a 7 year-old boy explains ADHD. Methods: Clinical interview. Results: Personal antecedents: The patient came to our CAMHS in 2014 presenting bad behaviour with aggressions against his mother as

well as impulsive behaviour. Family antecedents: Father hyperactive, not present. Actual symptomatology: In early 2014, we found an attentive 7-year old boy, who participated in the interview, showed friendly contact, appropriate language and was paying attention. The patient had great difficulties in remaining seated and stood up very often. He explained that he bullies against his schoolmate, because of his difficulties to control his impulses. He has a good nights sleep and appetite, but can be described as an obsessive personality with inflexible character. He has a very lively imagination. He describes the problem of his difficulties as having ‘‘120 to 1200 bugs in his brain’’, which were responsible for his bad behavior. The bugs tickle his brain. If he hits his head, they disappear. The bugs have a specific way of ‘‘walking’’, and a ‘‘body’’ which the boy recorded in a drawing. These bugs go out of him in the form of faeces. His sais, it is no hallucination, but a description of what is happening to him. Conclusions: After coordinating with his school and an ADHD association, the child improved in many ways. We started methylphenidate (MTF-MR) with great tolerability and great effect. Sometimes it is difficult to discern delusions from imagination in children. We believe that spending time and listening to children, playing with them and coordinating with community psychiatry, is essential and necessary if we want to help young people to function in all areas of life.

P-03-005 Video analysis of ADHD symptoms in simulated classrooms L. Hellwig*, C. Gawrilow, J. Schmid, U. Du¨rrwa¨chter, T. J. Renner * Tuebingen, Germany Objectives: Classroom settings are pivotal for imparting knowledge. At the same time, this is the place where ADHD symptoms exacerbate (Kofler et al. 2008). The expression of ADHD symptoms seems to reduce appropriate learning opportunities in the classroom and is documented in poorer educational outcomes in children with ADHD (Frazier et al. 2007). Today, ADHD symptoms are mainly assessed using questionnaires. However, these measures cannot provide ecologically valid information on symptom expression in classroom situations and are furthermore likely to be affected by self-report biases (e.g. recall bias, social desirability). Hence, this study aims at developing a reliable rating system for hyperactivity, impulsivity and inattention. Methods: The rating system will be based on filmed behavior in simulated classroom settings of children diagnosed with (n = 40) and without ADHD (n = 80). The lesson comprises a mathematics test and a competitive card game. Every participant is recorded by a minicamera, delivering whole-body pictures in a consistent camera perspective. Video material (20 min of each child) will be analyzed by four independent raters with regard to the intensity of hyperactivity, impulsivity and inattention. Results: (1) We expect a positive association between symptoms assessed via video ratings and questionnaires (self-reported and through parents), and (2) a negative association between the performance in a mathematics test and symptom expression as assessed via video ratings. Groups of five to eight children (9–13 years) with and without ADHD will take part in a simulated classroom lesson. Conclusions: A reliable and economic assessment of ADHD symptoms in classroom settings should enhance ecological validity in the diagnostic process and provide information on the association of ADHD symptom expression and achievement in a math test. Frazier, T. W., Youngstrom, E. A., Glutting, J. J., & Watkins, M. W. (2007). ADHD and achievement meta-analysis of the child, adolescent, and adult literatures and a concomitant study with college students. Journal

of Learning Disabilities, 40(1), 49–65. doi: 10.1177/002221940 70400010401. Kofler, M. J., Rapport, M. D., & Alderson, R. (2008). Quantifying ADHD classroom inattentiveness, its moderators, and variability: a meta-analytic review. Journal of Child Psychology & Psychiatry, 49(1), 59–69. doi:10.1111/j.1469-7610.2007.01809.x.

P-03-006 The use of actigraphy in the diagnosis of Attention-Deficit/Hyperactivity Disorder E. Izquierdo Herrero*, S. Alberola Lo´pez, J. M. Andre´s de Llano, J. A. Lo´pez Villalobos, D. Martı´n Martı´nez, C. Alberola Lo´pez * Palencia, Spain Objectives: Attention-deficit hyperactivity disorder (ADHD) is one of the most common mental health problems in childhood and adolescence, whose diagnosis is commonly based by means of subjective methods, generally obtained from the diagnostic and statistical manual of mental disorders (DSM IV-TR). This study was conducted to determine the validity of actigraphy as a complementary objective method in the diagnosis of ADHD. Methods: 67 subjects with ADHD combined type and 71 controls between 6 and 12 years old were recruited. Patients with ADHD were not pharmacology treated. To evaluate children’s activity, an ActiGraph GT3x device was placed on each child’s dominant wrist. A nonlinear analysis of 24-h-long multichannel actigraphic registries was carried out to characterize both activity and sleep patterns. The analysis has been performed on the whole signal as well as on both the activity and the rest intervals of the signal; also the possibility of circannual trend was considered. Results: The most relevant results are represented in Table 1: ADHD-C children show more irregular activity pattern along the 24 h and activity intervals (especially during the afternoon). However, in the rest period, activity pattern is more regular in ADHD-C children than in controls. Combination of the best results show that actigraphy can discriminate between patients and controls with sensibility and specificity values approaching 98 %. Positive and negative likehood ratios result 49 and 0.02 respectively. Conclusions: ADHD-C patients show differences at the circardian activity pattern with respect to controls. Actigraphy is a non-invasive method that is effectively as a complementary method in the diagnosis of ADHD-C.

P-03-007 A continuum paradigm of psychopathology: Narcissism as the core construct of mental illness N. Jacir*, A. Abojdei, N. Abaza, R. Salib * Amman, Jordan Objectives: Recommendations for DSM-V (2013) include complementing the current standard categorical approach with a dimensional approach. The paper proposes that the author’s development of the Narcissistic Spectrum Personality Questionnaire (NSPQ) based on Lowen’s (1985) definition of Narcissism as the ‘‘denial of the true self,’’ may potentially provide the framework for designing a measurement tool to assess psychiatric disorders on a continuum. The scale was not designed to assess extremes of narcissism where Narcissistic Personality Disorder (NPD—DSM-IV) lies, rather, the scale attempted to develop a quantification of ‘continuous Narcissism’. Methods: The authors aimed to expand the definition of narcissism using self-psychology constructs inherent in the original mythological

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conceptualization. By The sample included 112 patients referred to the clinic located in Amman, Jordan for initial assessment and the distribution according to their diagnosis were as follows, Psychotic (6.3 %), ADHD (18.8 %) anxiety disorders (46.4 %) and affective only or mixed affective and anxiety disorders (28.6 %). Results found internal validity for the NSPQ supported by corrected item total correlation as well as item difficulties according to one model item response-theory. The construct validity was further supported by confirmatory factor analysis (CFA) and empirically validated by the three proposed sub-factors (self-denial, guilt, self-destructiveness) into the main construct (narcissism). Conclusions: Data revealed a trend towards supplementing axis I disorders where the NSPQ traversed across various axis I diagnosis in a linear and statistically significant differentiating pattern as revealed by the ANOVA result. The overall result of this research supports the concept of a continuum model that may be used in supplementing the current diagnostic categories of the DSM. The results were discussed and recommendations for implementation and further research were suggested.

P-03-008 Overlapping and disease specific aspects of impulsivity in children and adolescents with schizophrenia spectrum disorders or Attention-Deficit/ Hyperactivity Disorder J. R. M. Jepsen*, J. Rydkjaer, B. Fagerlund, A. K. Pagsberg, B. Glenthoej, B. Oranje * Glostrup, Denmark Objectives: Attention-deficit/hyperactivity disorder (ADHD) and schizophrenia show several associations. For example, an increased rate of ADHD diagnoses is observed in offspring and siblings of patients with schizophrenia. Additionally, ADHD is associated with an increased risk for schizophrenia. Given such cross-diagnostic associations, the purpose is to identify disease specific and overlapping aspects of impulsivity in children and adolescents with early-onset schizophrenia spectrum disorders or ADHD. Methods: Indices of motor impulsivity (Stop Signal Task), reflection impulsivity (Information Sampling Task), and trait impulsivity (Barratt Impulsiveness Scale -11) are compared between three groups of children and adolescents between 12 and 17 years of age: patients with early-onset schizophrenia spectrum disorders (EOS) (N = 29), patients with ADHD (N = 29), and healthy controls (N = 45). Results: In terms of reflection impulsivity, the probability of making a correct response at the point of decision making is significantly decreased in patients with ADHD, whereas the patients with EOS perform non-significantly different from the healthy controls. Neither the ADHD nor the EOS group show significant response inhibition deficits. Both clinical groups show significantly increased trait impulsivity as compared to the healthy controls. Conclusions: Increased reflection impulsivity appears specific to ADHD and may reflect an inability to delay their decision making to gather more information. Both disorders appear to share increased trait impulsivity. The lack of significant response inhibition deficits in the young patients with EOS appears in line with an earlier result.

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Friday, 29 May 2015, 16.00 h–17.30 h P-04 Co-morbidity disorders - Children and adolescence I P-04-002 Sleep functioning in children with ADHD predominantly inattentive type and associations with internalizing, oppositional, and sluggish cognitive tempo symptoms S. Becker*, L. Pfiffner, M. Stein, G. L. Burns, K. McBurnett * Cincinnati, USA Objectives: The objectives of the present study were to (1) describe the sleep functioning of children diagnosed with ADHD Predominantly Inattentive Type (ADHD-I), and (2) examine whether comorbid internalizing, oppositional, and/or sluggish cognitive tempo (SCT) symptoms are associated with poorer sleep functioning in children with ADHD-I. This study extends the current literature by using a large, clinical sample of children with ADHD-I to examine the association between SCT and other comorbid mental health symptoms with children’s sleep functioning. Methods: Participants were 147 children (ages 6–11; 59 % male; 55 % White) carefully diagnosed with ADHD-I. Parents completed measures assessing their child’s sleep functioning as well as comorbid anxiety, depression, oppositionality, and SCT symptoms. Few participants (\5 %) were taking medication. Results: On school nights, children’s bedtime ranged from 7:00 to 11:00 p.m. with the range of school night sleep duration being 7.5–11 h (Median = 9.5). Seventeen percent of parents indicated that their child does not get enough sleep, 27 % indicated that it is difficult to get their child out of bed on school days, and 41 % of parents indicated that their child needs to catch-up on sleep on the weekend at least a little. Regression analyses found anxiety and SCT sleepy/tired symptoms to be the most consistent psychopathology dimensions associated with sleep functioning, with little support for depression or oppositional behaviors predicting sleep functioning. Conclusions: Children with ADHD-I experience impaired sleep— 17 % of children with ADHD-I do not obtain adequate sleep per parent report and a higher percentage need to catch-up on sleep on weekends. Of different psychopathology dimensions, anxiety and SCT sleepy/tired are most consistently associated with the sleep functioning of children with ADHD-I. Further study is needed to determine the treatment and prognostic implications of inadequate sleep and sleep variability on daytime functioning in ADHD with the inattentive presentation.

P-04-003 Connection between developmental language disorders and ADHD N. Gaddour*, Z. Ghattassi, A. Guedria, R. Bourourou, M. Attia * Monastir, Tunisia

Objectives: Based on current knowledge, ADHD and developmental language disorders impair two different fields of development. However, they both rely on factors that cause an abnormal maturation of the development on the central nervous system. There’s already a robust evidence for shared mechanisms between ADHD and written language disorders (or specific learning disorders), but less is known about links with oral language disorders. The aim of this study was to describe association between ADHD and developmental language disorders in a clinical population. Methods: A descriptive and retrospective study was conducted on the consultants of the child and adolescent psychiatry outpatient clinic of University Hospital F. Bourguiba in Monastir (Tunisia) from 2008 to 2014. Data were collected from the semi-structured medical records, regarding: • Medical history as reported by parents and/or documented by medical proofs concerning language development • Diagnosed disorders according to DSM IV made by board certified child and adolescent psychiatrists, especially ADHD (always further documented by Conners parent and teacher scales), and language specific disorders (always further documented by systematic examination of audition and a developmental assessment of language and intelligence). Results: Out of 86 patients diagnosed with a developmental language disorder, 10 (11.6 %) later received a diagnosis of ADHD. ADHD was diagnosed more frequently in persisting dysphasia (or specific language disorder) after 6 years (20 %). Conversely, in patients diagnosed with ADHD, a medical history of a developmental language disorder was found in 33 % of cases. Conclusions: Co-occurrence of ADHD and developmental language disorders is higher than expected with chance, and highlight common etiological factors probably related to processes that alter neurological maturation.

P-04-004 Attentional dysfunction and its impact on reading performance in children with ADHD, dyslexia and the combined condition T. Gu¨nther*, W. Scharke, J. Horbach, K. Peters, C. Kraatz, B. Herpertz-Dahlmann, K. Konrad, T. Vloet * Aachen, Germany Objectives: ADHD and dyslexia are two frequent neurodevelopmental disorders that co-occur more often than expected by chance. The current study aimed to investigate the association between related attentional parameters and the different disorders. We were also interested in the influence of the different attention tasks on reading performance. Methods: We assessed attentional parameters using a model-oriented approach, which included aspects of intensity, selectivity, spatialattention and executive functions as well as reading performance (word reading, pseudo-word reading and measures of decoding skills), in 3rd and 4th grade children in Germany with ADHD (n = 26), dyslexia (n = 22) and the comorbid condition (n = 24) compared to a healthy control group (n = 27). Results: We found significant differences in attentional performance between the four groups. Children with dyslexia were especially impaired on intensity and selectivity parameters of attention whereas children with ADHD showed reduced performance on nearby all attention tasks. Some tasks were more difficult for the children with the comorbid condition compared to the children with only ADHD (e.g. spatial attention). Children with ADHD had a lower decoding performance compared to controls, whereas their word reading and reading comprehension was comparable. Especially the spatial and sustained

attention tasks explained a significant amount of the variation in decoding, reading and comprehension performance in all groups. Conclusions: Our data indicate that attention deficits could be a (partial) cause of reading problems and that attention is at least an important modulator of reading performance. This result could be important for the interpretation of time related reading tests. In addition, we found significant differences between children with ADHD and children with the comorbid condition. Therefore one could speculate that the comorbid condition is a clinical subtype and not only a combination of two independent clinical disorders.

P-04-005 Relationships between neurodevelopmental symptoms and gender variance in children M. Hamada*, H. Ito, Y. Murayama, M. Katagiri, A. Uemiya, M. Tsujii * Hamamatsu, Japan Objectives: Some people with neurodevelopmental disorders express gender variance (Bedard et al. 2010). Many studies have shown a correlation between autism spectrum disorders (ASD) and gender variance; however, Strang et al. (2014) reported that, according to parent reports, gender variance is observed in attention-deficit/hyperactivity disorder (ADHD) as well. The characteristics that affect gender variance are unknown. Therefore, the present study investigated whether ADHD symptoms are related to gender variance in elementary and junior high school students in Japan. Methods: Participants included 5106 students enrolled in all elementary and junior high schools of a single city (2607 boys and 2499 girls), from 4th to 9th grade, and their parents or caregivers. The children completed a gender dysphoria questionnaire to measure their sense of incongruity of gender (Hamada et al. in preparation). Their parents or caregivers completed the Autism Spectrum Screening Questionnaire (ASSQ; Ehlers et al. 1999) for ASD symptoms, the ADHD Rating Scale (ADHD-RS; Dupaul et al. 1998) for inattention/ hyperactivity, the Developmental Coordination Disorder Questionnaire (DCDQ) for DCD symptoms, and nine items for cross-gender behaviour (included the CBCL no. 5 and 110 used in Strang et al. 2014). Results: Correlation and multiple regression analyses were conducted (Table 1). The positive effect of hyperactivity (parent-rated) was significant regarding cross-gender behaviour in boys and girls. The scores on gender dysphoria questionnaire and self-rated inattention had positive effect only in girls. ASD symptoms had a positive effect to the gender variance. DCD symptoms did not have a strong effect. Conclusions: It is indicated that, while self-reported hyperactivity symptoms were not correlated gender dysphoria, they were linked with cross-gender behaviour by parents.

P-04-006 Catatonia in a boy with autism spectrum disorder and Attention-Deficit/Hyperactivity Disorder W. Jaimes-Albornoz*, A. Ballesteros-Prado * San Sebastian, Spain Objectives: Autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) often co-occur and may be associated with several psychiatric comorbidities. Catatonia is a neuropsychiatric syndrome described in a wide variety of medical and psychiatric conditions. We report the case of a boy with ASD

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and ADHD who developed catatonia in the context of a depressive disorder. Methods: Case report and review of published literature. Results: An 11 year-old boy whit previous history of ADHD, oppositional defiant disorder and major depressive episode was referred for episodes of ‘‘blocking’’, aggressive behavior, and difficulties in socialization over the past year. He was taking OROS methylphenidate 36 mg/day and risperidone 1.5 mg/day orally. Clinical and laboratory evaluation, electroencephalogram and brain computed tomography revealed no significant findings. His IQ on the Wechsler Intelligence Scale for Children IV was 136. During the assessment, an episode of ‘‘blocking’’ was observed, in which the patient was stuporous, mute, and motionless, with staring, negativism and stereotypical hand movements. This episode lasted about 7 min and resolved spontaneously. His parents reported that he would also present without any provocation impulsivity, aggression and combativeness as part of these episodes. The patient met DSM 5 diagnostic criteria for ASD (level 1 for both social-communication and restricted-repetitive behaviors, without intellectual or language impairment), ADHD, and recurrent depressive disorder, current episode moderate with catatonia. Treatment with sertraline 50 mg/day orally was started and the catatonia was felt to be secondary to the affective symptoms. After 6 weeks of treatment his depressive episode and catatonic signs had been resolved. This improvement was maintained during the 6-month follow up. Conclusions: Major depression is a common comorbidity in patients with ASD and ADHD and may present with catatonia, an identifiable and treatable condition significantly under-recognized in pediatric patients.

P-04-007 Child abuse history in parents and the presence of comorbid affective disorders in their offspring with ADHD P. Mundo Cid*, J. Aguado Gracia, F. Lopez seco, S. acosta garcı´a, A. M. Gaviria Gomez, E. Vilella, A. Masana Marin * Reus, Spain Objectives: To study the relationship between experiences of abuse suffered by parents during their childhood and the presence of affective disorders in their ADHD affected offspring. Methods: All outpatients who were being treated by our service, with an ADHD diagnosis confirmed by a structured MINI-KID interview1, and their biological parents were asked to participate. A total of 107 children between 7 and 18 years old, 107 mothers and 75 fathers were assessed. Direct parental information and informed consent were required. Patients with intellectual disabilities, autism spectrum disorders or neurological damage were excluded. Parental childhood experiences of abuse were evaluated by the Childhood Trauma Questionnaire (CTQ)2. Comorbidity with affective disorders in children was evaluated by the structured Mini Kid interview. Statistical analysis: The Mann–Whitney U test was applied. Results: We found statistically significant relationships between reports of emotional neglect (U = 428.0; p = 0.004), physical abuse (U = 534,500; p = 0.020) and sexual abuse (U = 551.5; p = 0.026) in mothers and the presence of affective disorders in their ADHD children. We did not find any relationship between a history of child abuse in fathers and the presence of affective disorders in their ADHD children. Conclusions: Child abuse in mothers, but not in fathers, may be related to the presence of affective disorders in their ADHD offspring. If confirmed, children with ADHD and a maternal history of childhood abuse may require special clinical attention. (1) (Sheehan DV, Lecrubier Y, Harnett-Sheehan K, Janavs J, Weiller E, Bonara I,

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Keskiner A, Schinka J, Knapp E, Sheehan MF, Dunbar GC. Reliability and Validity of the MINI International Neuropsychiatric Interview (M.I.N.I.): According to the SCID-P. European Psychiatry. 1997; 12:232–241). (2) (Bernstein DP, Fink L: Childhood Trauma Questionnaire Manual. San Antonio: The Psychological Corporation; 1998).

P-04-008 Neuropsychological and cognitive abilities in ADHD with developmental coordination disorder M. G. Melegari*, A. Costa, R. Sacco, M. Giallonardo, A. M. Persico * Roma, Italy Objectives: Attention deficit/hyperactivity disorder (ADHD) and developmental coordination disorder (DCD) frequently co-occur and have both been independently associated with neuropsychological deficits. The aim of this study was to identify correlations between cognitive and motor ability in an ADHD sample. Methods: 39 males and nine females (mean age 73.7 ± 15.8 months) diagnosed with ADHD according to DSM 5 criteria were enrolled at the Child and Adolescent Psychiatry Service and a Rehabilitation Service in Rome. Cognitive profiles were assessed using the WISCIII; neuropsychological profiles included selective and sustained visual attention, mental planning, inhibitory control task and motor abilities (ABC movement). Correlation analyses were performed using non-parametric Kendall’s s statistics; quantitative analyses were performed by ANOVA and linear regression. Results: 28(58.3 %) ADHD children showed clinical or borderline scores in motor abilities at the ABC movement scale: specific impairment in manual dexterity was found in the clinical and borderline range for 45.0 and 18.8 % of the ADHD sample, respectively. Conclusions: Our preliminary results show that more than 50 % of our ADHD sample is characterized by an impairment in motor skills. Manual dexterity and planning ability display a strong correlation. Either common neuronal networks underlie both motor and executive functions or deficits in one set of functions may influence the other and viceversa. If confirmed, these results will provide further support to interventions aiming to ameliorate executive functions through motor skills and viceversa.

Friday, 29 May 2015, 16.00 h–17.30 h P-05 Clinical electrophysiology P-05-001 A comparison study of the validity of parent- and selfreport of ADHD in adolescents and young adults using cognitive, neurophysiological and actigraph correlates E. Du Rietz*, C. H. M. Cheung, G. McLoughlin, D. Brandeis, T. Banaschewski, P. Asherson, J. Kuntsi * London, UK Objectives: A controversial issue is whether self-report of symptoms and impairment is sufficient for diagnosis of ADHD in adolescents and adults in the absence of other raters, such as parents. The present study aimed to compare the validity of parent- and self-report of ADHD using objective data on cognitive, neurophysiological and actigraph measures, which we previously have shown to discriminate

between ADHD persisters, remitters and controls when using parentreport (Cheung et al. in press: British Journal of Psychiatry). Methods: Parent- and self-reported ADHD symptoms and impairment, together with cognitive, electroencephalogram (EEG) frequency, event-related potential (ERP) and actigraph movement measures were obtained from 110 adolescents and young adults with childhood ADHD and 169 controls. Results: Parents reported higher levels of ADHD symptoms and impairments than participants (p \ 0.05) and the ADHD persistence rate in the clinical sample was almost twice as high when diagnosis was based on parent-report (79 %) than self-report (43 %). Regression analyses showed that the cognitive, neurophysiological and actigraph data did not distinguish between the ADHD persistent and remittent groups based on self-report (p [ 0.05), in contrast to findings based on parent-report (Cheung et al. in press). Correlation analyses revealed that only parent-reported impairment correlated with several of the objective measures (r2 = 0.19–0.39, p \ 0.05), despite parent- and self-reported symptoms showing similar correlations with the measures (r2 = 0.20–0.38, p \ 0.05). Conclusions: The cognitive, neurophysiological and actigraph data better distinguished between the ADHD persistent and remittent groups based on parent-report compared to self-report, suggesting that parent-report has higher criterion validity. Parent- and self-reported symptoms showed similar correlations with the objective measures however only parent-reported impairment correlated with several of these measures. This suggests that self-reported impairment is not well reflected by underlying processes as captured by the cognitive, neurophysiological and actigraph measures. The findings have implications for both clinicians and researchers.

P-05-002 Performance monitoring, response control and posterror adjustments in adults with Attention-Deficit/Hyperactivity Disorder (ADHD): An EEG analysis A. C. Ehlis*, S. Deppermann, A. Fallgatter * Germany Objectives: Our study aimed at characterizing the neurobiological underpinnings of post-error behavioural alterations in adult patients with attention-deficit/hyperactivity disorder (ADHD) and at relating these alterations to other known endophenotypes of ADHD, such as disturbed response control and performance monitoring deficits. To this end, a modified Eriksen flanker task was used that was embedded within a Go-NoGo paradigm. Simultaneously, neurophysiological responses were assessed using a combined electroencephalography (EEG)—near infrared spectroscopy (NIRS) setup. Here, only EEG data will be reported. Methods: 24 healthy controls and 34 ADHD patients participated in the study. Data were recorded using a combined NIRS-EEG cap that covered 21 standard 10–20 electrode positions. During the recording, participants conducted a combined Flanker/Go-NoGo task, indicating the direction of presented arrows via button-press, but only on Go trials (marked by the colour of the stimuli). EEG data were analyzed in terms of event-related potentials elicited by the flanker stimuli (e.g., P300), correct and erroneous button presses (error-related negativity/ERN, error-positivity/Pe) as well as the inter-trial interval. The analysis was conduced separately for correct and incorrect responses as well as for trials following correct and incorrect responses using ANOVAs and t-tests as appropriate. Results: Preliminary results show significant differences between patients and controls for the stimulus-elicited P300 as well as for an early

negativity following erroneous compared to correct button-presses, probably corresponding to the ERN. Moreover, differences were observed with respect to the inter-trial interval, with an opposite effect of previous errors on slow potential shifts in controls versus ADHD patients. Conclusions: Our results further support previous findings on neurophysiological alterations in ADHD that are related to attention and performance monitoring. In addition, preliminary evidence is given on a potential neurobiological correlate of deficient post-error adjustments as indicated by recent behavioural findings.

P-05-003 Neurophysiological index of alerting and orienting impairment in adults ADHD patients A. Galvao-Carmona*, M. Va´zquez-Marrufo, M. C.-J Stehle, E. Ahlers, A. H Neuhaus, M. Garcı´a-Valdecasas * Seville, Spain Objectives: The aim of this study was to study the neural basis of alerting and orienting impairment using the Attention Network Test (ANT) in adults diagnosed with Attention deficit hyperactivity disorder (ADHD). Methods: Sixteen unmedicated combined-type adults ADHD patients and 16 healthy controls participated in the study. All the patients were assessed with neuropsychological tests and performed the ANT task while 64 channels of electroencephalography (EEG) were recorded. Reaction time, Accuracy and the amplitude values of the CNV component (Contingent Negative Variation) were analyzed. Results: The adult ADHD group showed a general slowing (F(1, 30) = 15.94; p \ 0.001) and worse accuracy in the orienting and alerting conditions of the ANT task (p \ 0.001). Moreover, patients showed lower CNV amplitude values for both orienting (F(1, 30) = 17.08; p \ 0.001) (Control group: -4.32 ± 0.6 microvolts; Adult ADHD Group: -0.63 ± microvolts 0.45), and alerting (F(1, 30) = 09.06; p = 0.004) (Control group: -2.81 microvolts ± 0.44; Adult ADHD Group: -0.52 ± 0.41 microvolts) conditions; as well as some differences in the topographical distribution of the CNV (p \ 0.05). Conclusions: Alerting and orienting mechanisms are impaired in adult ADHD patients. Lower CNV amplitude values and its topographical change are shown as physiological index of this impairment in this clinical sample. The CNV amplitude analysis along with the application of the ANT task allow to show several levels of attentional impairment in this clinical population. In addition, this kind of technique can be an useful tool in the cognitive assessment and treatment of adults ADHD patients.

P-05-004 Do cognitive and neurophysiological impairments on a performance monitoring task distinguish between ADHD persisters and remitters? G. Michelini*, G. L. Kitsune, C. H. M. Cheung, D. Brandeis, T. Banaschewski, P. Asherson, G. McLoughlin, J. Kuntsi * London, UK Objectives: Attention-deficit/hyperactivity disorder (ADHD) persists into adolescence and adulthood in a proportion of cases, but the processes underlying persistence and remission are poorly understood. We aimed to examine whether cognitive and neurophysiological impairments on a performance monitoring task distinguish between ADHD persisters and remitters.

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Methods: On average 6 years after initial assessment, 110 adolescents and young adults with childhood ADHD and 169 age-matched controls were compared on cognitive performance measures and event-related potentials (ERPs) of conflict monitoring (N2) and error processing (Ne, Pe) from the Eriksen Flanker Task. ADHD outcome was examined with parent-rated symptoms and functional impairment measures using a categorical and a dimensional approach. Results: ADHD persisters and controls differed on all cognitive performance and ERP measures (all p \ 0.05). ADHD remitters differed from persisters on cognitive measures of attention-vigilance and Ne (all p B 0.05), and from both persisters and controls on omission errors (both p B 0.02). Remitters did not differ from the other groups on executive control measures of inhibition, N2 and Pe (all p [ 0.07). In participants with childhood ADHD, ADHD symptoms and functional impairment at follow up were positively correlated with attentionvigilance measures and omission errors (r between 0.19 and 0.30, p \ 0.05) and negatively with Pe (r = -0.25, p = 0.02). Conclusions: ADHD remitters improved over time in cognitive and ERP measures of attention-vigilance and early error-processing compared to persisters, but not in executive control measures. Remitters also improved compared to persisters in omission errors, but were still impaired relative to controls. Attention-vigilance measures were also associated with the continuum of ADHD symptoms and impairment at follow up. These findings extend our previous results with other tasks (Cheung et al. in press, British Journal of Psychiatry), and confirm attention-vigilance processes as markers of remission and candidates for the development of non-pharmacological interventions.

P-05-005 ERP visual component P300 in children with ADHD: No differences between combined and inattentive subtypes P. Roca*, F. Mulas Delgado, P. Roca Rodrı´guez, P. Ortiz Sa´nchez, R. Gandı´a Beneto´ * Valencia, Spain Objectives: In the study of the neurophysiological correlates in ADHD it has been shown that Combined and Inattentive subtypes could show some differences in EEG and the topography and development of cognitive evoked component P300 (Willcutt et al. 2012; Johnstone et al. 2012). Nevertheless, there’s still controversy about the existence of core differences in latency and amplitude between ADHD subtypes (Brown 2005; Kratz, 2011; Keage et al. 2008). Objectives. Explore differences in latency and amplitude of visual P300, between children diagnosed as ADHD-Combined and Inattentive subtype. Methods: 136 children with ADHD (aged 6–12, mean = 8.94; 72.1 % male, 27.8 % female; 52.2 % ADHD-C, 47.8 % ADHD-I). Component P300 was registered and analysed in Fz-Cz-Pz by a visual oddball task, setting latency msecs. and amplitude in lV. An ANOVA was performed with those variables which had a normal distribution, and a non-parametric contrast (U Mann–Whitney) which had not. Results: We found no statistical meaningful differences between ADHD-C and ADHD-I groups in latency (pFz = .26; pCz = .23; pPz = .16), neither amplitude (pFz = .72; pCz = .61; pPz = .91). Conclusions: Our results let no conclusion about a different profile of visual ERP P300 between ADHD-Combined and Inattentive subtypes.

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P-05-006 Characteristics of working memory in patients with different early adulthood outcomes of Attention-Deficit/ Hyperactivity Disorder L. Sun*, X. Zhao, C. Wang, E. Wang, Y. Wang, Q. Qian * Beijing, People’s Republic of China Objectives: Working memory has been posited to be an endophenotype of attention-deficit/hyperactivity disorder (ADHD) while being distinct from the neural mechanisms associated with recovery. This study investigated the processing of working memory (WM) in a longitudinal sample of young adults with persistent and remittent ADHD from childhood. Methods: Fifty-three young adults diagnosed with ADHD in childhood according to DSM-IV and 23 carefully matched health control subjects were followed longitudinally and recorded with EEG signals while performing a verbal WM n-back task (clinical and demographic characteristics shown in Table 1). These young ADHD adults were reassessed as individuals with persistent (n = 32) or remitted ADHD (n = 21). WM outcomes involving behavioral performances (reaction time, accuracy and reaction time variability) and neuroelectrophysiological components (N1, P2 and P3) were analyzed. Results: No difference in behavioral indexes (Table 2) were observed between ADHD and health controls (only marginal significance in reaction time variability, P = 0.056). Compared to health controls (Table 3), the persistent ADHD group exhibited lower P2 (P = 0.032) and P3 (P = 0.008, Fig. 1), however the remittent group only showed equally decreased amplitude in P2 (P = 0.034). There was no significant difference in P3 amplitude between remittent and health control groups. Additionally, similar N1 amplitudes were presented in all groups. Equally delayed N1 latency were observed in persistent (P \ 0.001) and remittent ADHD groups (P = 0.004). Conclusions: Results demonstrate that the encoding process during WM activity in both ADHD persistent and remittent young adults were impaired, however the post decisional processing and/or the updating of working memory reflected by P3 in remittent group was improved with alleviated clinical symptoms.

P-05-007 Neural correlates of cognitive reappraisal of negative affect in children with Attention-Deficit/Hyperactivity Disorder V. Van Cauwenberge*, K. Hoppenbrouwers, K. Van Leeuwen, J. R. Wiersema * Gent, Belgium Objectives: Epidemiologic studies indicate emotion dysregulation in 25–45 % of children with ADHD (Shaw et al. 2014). The research findings with regard to emotion (dys)regulation in ADHD are however not consistent across studies. To the best of our knowledge, this is the first study that investigates the late positive potential (LPP), an electrophysiological marker of emotion regulation in children with ADHD, during cognitive reappraisal. Methods: So far, 17 typically developing children and 14 children with ADHD aged 8–12 have been tested. They performed a reappraisal task in which 30 negative pictures were followed by an audio recording providing either a neutral or a negative meaning to the

picture. We analyzed the amplitude of the posterior LPP in two timewindows (600–1000 and 1000–2000 ms) with an ANOVA with timewindow, laterality and meaning as within subject variables and group as between subject variable. Results: The typically developing children showed a decreased LPP amplitude after a neutral interpretation compared to a negative interpretation, indicating successful reappraisal. No such difference was observed in the children with ADHD, suggesting that they failed to downregulate negative affect. Conclusions: To conclude, in line with earlier research, the LPP was found to be sensitive for cognitive reappraisal. The absence of modulation of the LPP amplitude in children with ADHD indicates a failure to downregulate negative affect, which may contribute to their emotion regulation difficulties.

P-05-008 Impaired behavioural post-error re-adaption in adult patients with ADHD S. Deppermann*

children by comparing the power spectra and TGC at rest and during a mental arithmetic task. Methods: Nineteen-channel EEGs were recorded from 97 volunteers (including 53 subjects with ADHD) from a camp for hyperactive children under two conditions (rest and task performance). The EEG power spectra and the TGC data were analyzed. Correlation analyses between the Intermediate Visual and Auditory (IVA) continuous performance test (CPT) scores and EEG parameters were performed. Results: No significant difference in the power spectra was detected between the groups at rest and during task performance. However, TGC was reduced during the arithmetic task in the ADHD group compared with the normal group (F = 16.70, p \ 0.001). The TGC values positively correlated with the IVA CPT scores but negatively correlated with theta power. Conclusions: Our findings suggest that desynchronization of TGC appeared during the arithmetic task in ADHD children. TGC, which reflects the degree of neuronal interactions among functional systems, provides information about an individual’s attentional network. Therefore, TGC in ADHD children is expected to serve as a promising neurophysiological marker of network deactivation during attention-demanding tasks.

* Tuebingen, Germany Objectives: The present study was conducted to investigate error monitoring and post-error adaptation processes, respectively, in adults with attention-deficit/hyperactivity disorder (ADHD). In a recent innovative study, Yordanova et al. (2011) showed that children with ADHD are characterised by instable post-error performance in terms of an increase in reaction time (RT) variability (RTV) as well as error rates (ER). Up to date, this instability of behavioural performance after errors has not been shown in adults with ADHD. Methods: 23 healthy controls and 34 adult ADHD patients performed a modified version of the flanker task used by Yordanova et al. which was embedded within a Go-NoGo paradigm. At the same time, cortical activation as well as neurophysiological responses were assessed by means of electroencephalography (EEG) and near infrared spectroscopy (NIRS) [reported elsewhere]. Behavioural performance was analysed regarding RT, RTV and ER overall as well as in post-error opposed to post-correct trials. Results: Preliminary results show an overall increase in RTV in the group of ADHD patients. Moreover, ADHD patients committed significantly more errors exclusively in post-error trials compared to healthy controls. Post-error slowing could be revealed in both groups but there was a trend for even slower RTs in ADHD patients. Conclusions: Our results indicate for the first time that not just children with ADHD but also adults do not only show alterations in behavioural performance during cognitive tasks which require the maintenance of attention, but more specifically are characterised by deficits regarding re-adaptional processes after an error has been committed.

P-05-009 Desynchronization of theta-phase gamma-amplitude coupling appeared during the mental arithmetic task in children with Attention-Deficit/Hyperactivity Disorder J. W. Kim*, Y. S. Lee * Seoul, Republic of Korea Objectives: Recently, theta-phase gamma-amplitude coupling (TGC) measurement has received attention because it is a feasible method of assessing brain functions such as neuronal interactions. The purpose of this electroencephalographic (EEG) study is to understand the mechanisms underlying the deficits in attentional control in ADHD

Friday, 29 May 2015, 16.00 h–17.30 h P-06 Pathophysiology adults P-06-001 Decision-making in adults with ADHD D. F. Bangma*, J. Koerts, E. Claes, A. B. M. Fuermaier, O. Tucha, L. Tucha * Groningen, The Netherlands Objectives: Decision-making requires a complex interplay between higher order cognitive processes and is crucial for independent living (e.g. for financial management or driving). Several studies described deficits in decision-making in adults with Attention Deficit Hyperactivity Disorder (ADHD). However, it remains unclear if adults with ADHD experience decision-making problems in general (i.e. overall deficits in decision-making that are not related to a specific situation) or only in specific aspects (e.g. risky decision-making). A better understanding of the concept of decision-making is necessary to conclude on decision-making capacities of adults with ADHD. Methods: A systematic literature search was conducted in order to review available studies that assessed decision-making in adults with ADHD. Results: Thirteen studies were identified. Decision-making was often measured with gambling tasks (n = 11) and was conceptualized as ‘‘risky decision-making’’, ‘‘social cognition’’, ‘‘cognitive impulsivity’’ or ‘‘impulsive decision-making’’. One of these studies also investigated decision-making from a more general point of view. Two additional studies examined decision-making during driving. Only half of the studies using gambling tasks found significant impairments in adults with ADHD. No impairments were found with regard to decisions or judgments during driving. However, decision-making in general seems to be impaired in adults with ADHD, particularly if decisions demand high-level cognitive operations. Conclusions: Most studies focussing on decision-making in adults with ADHD examined decision-making by using gambling tasks. The results of these studies are, however, inconsistent. Decision-making in more general situations, or during driving, is a largely neglected area. There is some evidence that adults with ADHD suffer from more

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general decision-making deficits, particularly if decisions have a high cognitive load. The latter might be mediated by impairments in working memory or response inhibition.

P-06-002 Assessment of the three attentional networks in adults with Attention-Deficit/Hyperactivity Disorder M. Duarte*, S. Urben, M. Bader * Lausanne, Switzerland Objectives: Scarce study assessed the attentional performance of the Attention Deficit/Hyperactivity Disorder (ADHD) adult patients and controls, using the attention networks theory including alerting, orienting and conflict skills which provides a useful cognitive model for understanding the attentional abilities. Methods: A total of 82 ADHD adults (53 ADHD combined subtype—ADHD-C, mean age = 22.94; 28 ADHD predominantly inattentive subtype, ADHD-I, mean age = 22.68) and 113 controls (mean age = 21.85) performed the adult version of Attention Network Test (ANT), a task specifically designed to assess the three attentional networks. Results: Results indicated that, compared to the control group, ADHD adults were slower and less accurate on all condition of the Adult ANT and presented a deficit in alerting (F(1) = 5.78; p = .017; g p2 = .029) and orienting (F(1) = 7.56; p = .007; gp2 = .37) abilities. The ADHD combined subtype presented significant deficits in orienting (F(2) = 3.84; p = .023; gp2 = .038), comparing to ADHD inattention subtype and controls. ADHD adults without drug treatment presented significant deficits in alerting (F(2) = 3.51; p = .32; g p2 = .035) and orienting (F(2) = 4.47; p = .013; gp2 = .044) comparing to ADHD adults with drug and controls. Conclusions: Based on these results, we concluded that ADHD adults presented a general slower performance than controls and demonstrated impairments to orient the focus of their attention and to be alert to visual stimulus, but they solve normally the conflict between concurrent stimuli. ADHD combined showed deficits in orienting and we found that medication in a subset of ADHD reduced these deficits to controls levels. These results are among the first to document patterns of attentional networks for ADHD adults. This work was supported by Swiss National Science Foundation (Number CR13I1_138032).

P-06-003 Interoceptive ability in adults with ADHD E. Godefroid*, J. R. Wiersema * Ghent, Belgium Objectives: Several etiological models consider ADHD as a disorder in aspects of self-regulation. There is evidence for impaired behavioural adaptation in ADHD after committing errors (decreased post-error slowing; Balogh and Czobor 2014) and in situations inducing a non-optimal arousal state (state regulation deficit; Metin et al. 2012; Wiersema et al. 2006), suggesting a disability to adjust cognitive and energetic resources. Importantly, in order to be able to adapt and to invest the additional effort, it is essential to evaluate or feel when the present state is not matching the required state necessary for the task demands. Interoception is the perception of autonomic bodily changes (Garfinkel et al. 2015) and may provide valuable information on optimality of the present state. Becoming aware of a suboptimal state via evoked bodily changes may thus be a requirement for successful adaptation. Surprisingly, to our knowledge, as of yet interoceptive ability in ADHD has not been investigated.

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Methods: Twenty-four adults with ADHD and 18 typically developed adults were tested. An objective behavioural measure of interoception was gained by administering a heartbeat detection task, in which participants were encouraged to silently count their own heartbeats (Pollatos et al. 2007). The awareness subscale of the Body Perception Questionnaire (BPQ Dutch; Porges 1993) was administered as a subjective measure of interoception. Results: Adults with and without ADHD were able to detect their heartbeats above chance level. Against our expectation, adults with ADHD performed equally well as the adults without ADHD on the heartbeat detection task. In addition, groups did not differ for subjective body awareness as measured with a questionnaire. Conclusions: This is the first study in which interoception was investigated in ADHD by means of an objective and subjective measure. The findings hint at a preserved monitoring of body state in adult ADHD, but need replication and warrant further research.

P-06-004 Skin conductance measured arousal shares familial influences with reaction time variability in ADHD S. James*, C. Cheung, F. Rijsdijk, P. Asherson, J. Kuntsi * London, UK Objectives: Reaction time variability (RTV) captures a significant proportion of the familial influences (combined effects of genes and shared environment) underlying attention-deficit/hyperactivity disorder (ADHD). Increased RTV has been proposed to reflect underlying arousal dysregulation in ADHD; however empirical evidence for this hypothesis is limited. We used skin conductance (SC) as a measure of arousal and explored both its phenotypic and familial association in samples consisting of ADHD probands and control sibling pairs. Methods: SC from 83 participants with ADHD (mean age 17.7 years ± 3.3), 71 of their siblings, 72 controls (mean age 17.6 years ± 1.8) and 60 of their siblings, was measured whilst performing a four-choice RT task. Sib-pair multivariate model fitting was performed to estimate the etiological overlap between SC level (SCL) and RTV, and ADHD. Results: SCL was significantly and negatively associated with ADHD (r = -0.30, p \ 0.01) and RTV (r = -0.21, p \ 0.05). RTV was significantly associated with ADHD (r = 0.34, p \ 0.01). Sibling model fitting demonstrated that the covariance of SCL with ADHD and SCL with RTV is mostly explained by familial factors (51 and 93 %, respectively). Conclusions: This is the first sibling study to date reporting on the associations across SC, RTV and ADHD. Our findings indicate that decreased SCL is associated with increased RTV and ADHD, and that this relationship is largely due to shared familial aetiological factors. Decreased SCL in ADHD is suggestive of hypo-arousal and altered autonomic response, which may underlie the increased RTV in ADHD.

P-06-005 Looking into the eye of Attention-Deficit/Hyperactivity Disorder - first data on photophobia in adults with ADHD S. Kooij*, D. Bijlenga * Den Haag, The Netherlands Objectives: Many adults with Attention-Deficit Hyperactivity Disorder (ADHD) wear sunglasses, also on cloudy days and in winter. Asking about this behaviour, they say they are oversensitive to light. This seems problematic because of the high prevalence of Delayed Sleep Phase Syndrome (78 %) in adults with ADHD. By wearing

sunglasses, during daytime little light may reach their eyes, limiting even further synchronisation of the biological clock to time of the day. To gain more insight into the associations between possible eye dysfunctions and photophobia, and the relationship with the delayed circadian rhythm in adults with ADHD. Methods: Overview of the literature and first data of a short online survey on the oversensitivity to light in adults with ADHD compared to controls. Results: Literature • In 70–80 % of children with ADHD there are difficulties with visual acuity or with the visual system. • In children, visual acuity problems diminish with ADHD medications. • Adults with ADHD also report visual impairments. • The visual problems may correlate with the delayed circadian rhythm in adult ADHD. Online survey • N = 495, of which 47 % had self-reported ADHD (symptoms), and 53 % were controls. • Of those with ADHD (symptoms), 69 % reported oversensitivity to light, versus 28 % of controls, which was controlled for photophobia during episodes of migraine. • People with ADHD also reported to wear sunglasses significantly longer in every season as compared to controls. • After controlling for migraine, oversensitivity to light was associated with ADHD, age, eye problems, wearing glasses or eye lenses, and with chronic fatigue, but not with a delayed sleep phase. Conclusions: Visual function abnormalities and oversensitivity to light are highly frequent in children and adults with ADHD. It is unclear what causes the oversensitivity to light in ADHD. Further study on the functioning of the visual system in adults with ADHD is needed.

P-06-006 Interoceptive awareness in patients with AttentionDeficit/Hyperactivity Disorder K. Kutscheidt*, T. Ethofer, A. J. Fallgatter, A.-C. Ehlis * Tu¨bingen, Germany Objectives: In contrast to earlier assumptions, it is known today that Attention-Deficit/Hyperactivity Disorder (ADHD) persists into adulthood in 33–66 % of the cases (Wender, 2001). It is suggested that core ADHD symptoms are the result of ‘poor self-regulation’ (Westby, 1994), but to which extent poor self-regulation is also related to poor awareness of one’s own bodily signals has not been investigated yet. Interoceptive Awareness (IA) is defined as any ‘afferent information that arises from anywhere and everywhere within the body’ (Cameron 2001). Taking into consideration that adult ADHD patients suffer from impaired self-regulation (Westby 1994), they are likely to show lower IA than healthy controls. Making accurate predictions remains challenging because ADHD is often accompanied by other psychological disorders which have an influence on interoception: While IA is, for instance, lower in eating disorder patients (Pollatos 2008), IA in panic disorder patients is higher (Pollatos 2009). Methods: Interoceptive Awareness will be measured with an established heartbeat detection task (Schandry 1981) in which participants are asked to count their heartbeat without any external help for a certain time. A score will be calculated based on the subjective count and the actual recorded beats. Results: First results will be presented at the conference. We expect generally lower IA scores for patients than for controls. Depending on the extent of comorbidities (e.g. depression, anxiety/eating disorder, Borderline Personality) the scores might be shifted to one or the other direction (cf. Pollatos 2008, 2009). Conclusions: The final goal is to measure IA before a certain therapy, e.g. Neurofeedback (NF) is applied. Considering that NF trains selfregulation of bodily signals, patients with higher IA scores are

probably more successful in learning the method. Thereby, interoception could serve as a predictor for treatment success, helping to individually tailor therapy to every patient.

P-06-007 Attention to dopamine - dopaminergic dysfunction, a study on adult ADHD and schizophrenia J. Le Sommer*, A.-M. Low, T. Habekost, J. R. Møllegaard Jepsen, B. Yding Glenthøj, B. Oranje * Glostrup, Denmark Objectives: ADHD and schizophrenia share certain clinical characteristics, and both disorders have been associated with early neurodevelopmental disturbances in frontal cortical areas of the brain where a dysfunction of the dopaminergic system is assumed. However, this neurotransmitter system appears to be affected in opposite directions in the two disorders. Subsequently, the two conditions are treated with opposite medical treatments, i.e. dopamine antagonists (schizophrenia) versus dopamine releasers (ADHD). It is important to understand how these seemingly opposite treatments can result in reductions of symptoms in both disorders and to a lesser extent, ameliorate cognitive deficits found in the disorders. Methods: The study is a 6 week follow-up study including 50 medication naı¨ve adult patients with ADHD and 50 antipsychotic naı¨ve, first episode patients with schizophrenia. The two patient groups will be compared on psychophysiological parameters of basic information processing, at two time points: immediately before and after a 6 week period of pharmacological treatment. During this period, patients with ADHD will be treated with methylphenidate, while patients with schizophrenia will be treated with aripiprazole. Results: We expect that the group of schizophrenia patients will show more severe deficits in psychophysiological parameters compared to ADHD-patients, who will show more specific deficits, which will be of equal or less severe to those shown by schizophrenia patients. Conclusions: This study will provide valuable insight into a broad range of psychophysiological parameters of basic information processing that are generally believed to underlie the pathophysiology and disturbed cognition of both disorders. Furthermore, the study will provide important information on how two medical treatments with a predominant opposite effect on one of the brain’s major neurotransmitter systems (dopamine) affects these aberrant functioning information processes in both diseases. Furthermore, the study may, indicate if the conditions can be separated at an early stage, and may facilitate development of alternative, more effective, treatments.

P-06-008 Slow learning pattern in risk selection process in adolescents with Attention-Deficit/Hyperactivity Disorder E. Medrano*, J. C. Flores, H. Nicolini * Mexico City, Mexico Objectives: to evaluate and describe the performance in risk-detection, and risk–benefit processing in adolescents diagnosed with ADHD. Methods: 35 ADHD-adolescents (age-average: 13.49) with normal level of intelligence and 26 paired controls participated. Tests: Iowatype developmental-variant test. Comparisons: ADHD versus control group without ADHD using t tests, a block by block performance was analyzed using ANOVA. Results: ADHD adolescents presented lower ability to detect risk selections (avoid risk-bad choices): ADHD 40.34 (8.5), controls 33.31

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(3.4); and a lower risk–benefit processing capacity (approach goodbenefit choices): ADHD 21.74 (9.5), controls 30.43 (11.3), t test p = .001. The main finding was that ADHD-adolescents presented a slower learning pattern to avoid risk choices (they took more trials to identify and avoid risk choices). The ADHD-group initially (block 1) selected more risk-cards and maintained a higher risk-cards selection than the control group until block 2; it was until block 3 when the performance in both groups became similar. Conclusions: literature is scarce concerning studies with Iowa-type paradigm in samples integrated exclusively by adolescents. Learning patterns in ADHD represent a new field of analysis-intervention. Emphasis should be place in executive functions development in adolescents with ADHD to prevent risk-choices.

P-06-009 Association between self-control and ADHD symptoms in a German community based sample P. Nemati*, L. Hellwig, C. Gawrilow, J. Schmid * Tuebingen, Germany Objectives: One of the major behavioral deficits in attention-deficit/ hyperactivity disorder (ADHD) frequently named as low self-control (Barkley 1997). Taking a dimensional view on ADHD symptoms, little is known, however, about the differential associations between selfcontrol and the three symptom domains of ADHD (i.e. inattention, hyperactivity and impulsivity). Therefore, the present study investigated these associations in an adult sample from the general population. Methods: N = 279 adults (M-age = 27.82, SD = 11.09; 69 % female; 31 % male), took part in this online survey study. They rated their levels of self-control using the Brief Self-Control Scale (BSCS; Tangney et al. 2004; German translation by Bertrams and Dickhaeuser 2009). Inattention, hyperactivity, and impulsivity were assessed with a German self-rating scale (Ro¨sler et al. 2004) that targets ADHD symptoms according DSM-IV. We computed a multiple regression analysis with self-control as dependent variable, entering inattention, hyperactivity, and impulsivity as continuous predictors simultaneously in one step. Results: Neither self-rated hyperactivity (b = .07, t(275) = 1.21, p = .23), nor impulsivity (b = -.06, t(275) = -1.06, p = .29) predicted self-control. Only inattention (b = -.53, t(275) = -8.80, p \ .001) was a significant predictor. The model explained 27 % of the variance in self-control ratings. Conclusions: Despite many previous studies that have particularly emphasized a strong association between self-control and hyperactivity/impulsivity in childhood (Barkely 2000; Heilman et al. 1991), our study illustrates the significant role of inattention in predicting self-control in adults. Results will be discussed with regard to potential developmental aspects that may underlie differences in associations between self-control and the three symptom domains of ADHD across different age groups.

P-06-010 Risk-taking among people with ADHD - risk seeking or non-optimal decision making? Y. Pollak*, L. Kitrossky, H. Raber * Jerusaelm, Israel Objectives: The present research examined cognitive processes underlying ADHD-related risky behavior. Favorability and probabilities of alternatives’ outcomes were manipulated in order to differentiate between risk seeking and suboptimal decision making.

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Methods: In two studies, subjects with and without ADHD performed gambling tasks, in which they had to serially choose between certain and risky alternatives. In the first experiment, 17 adolescents with ADHD, ages 13–18, were recruited through the Neuropediatric Unit, Shaare Zedek Medical Center, Jerusalem. 16 control subjects were matched for age, gender, IQ and parents’ years of education. Subjects performed a gambling task in which expected value of alternatives was equalized. T-test was used to examine the effect of ADHD on the number of risky choices. In the second experiment, 33 adults with ADHD, ages 20–40, were recruited through the Hebrew University of Jerusalem. 31 control subjects were matched for age, gender and years of education. Participants were assigned into two conditions in which the risky alternative was either less or more favorable compared to the certain one in terms of expected value. ANOVA was designed to test the effects of diagnostic group and task condition of the number of risky choices. Results: In the first experiment, where alternatives were equally favorable, adolescents with ADHD did not choose the risky alternative more often than controls (t(31) = 0.36, p = .724). In the second experiment, a significant group by condition interaction was found (F(1,60) = 4.14, p \ .05). When the risky alternative was less favorable, adults with ADHD chose it more often compared to controls. On the other hand, when the risky alternative was the more favorable one, adults with ADHD chose it less often than controls. Conclusions: These findings challenge the notion that ADHD is associated with risk seeking and suggest that suboptimal decision making underlies ADHD-related risk taking.

P-06-011 Intra-subject variability of ocular motor responses in patients with ADHD and typical controls Y. Schulz-Zhecheva*, M. Vo¨lkle, B. Feige, C. W. N. Saville, M. Biscaldi, C. Klein * Freiburg, Germany Objectives: While increased intra-subject variability (ISV) is among the most robust behavioural abnormalities in patients with attentiondeficit hyperactivity disorder (ADHD; Kofler et al. 2013), with a few exceptions (e.g. Munoz et al. 2003; Karatekin et al. 2010), this phenomenon has so far not been investigated systematically in the oculomotor domain. Based on previous work with ADHD patients (Klein et al. 2003), the present study is the first to characterise ISV of saccadic reaction times (RT) in ADHD patients combining exGaussian and diffusion models of RT. Specifically, we aimed (a) to determine whether the different demands of pro- and antisaccade tasks exert differential effects on the various measures of ISV of saccadic RT in patients and controls; and (b) to determine the incremental validity of (fast) diffusion model (fDM) parameters in discriminating between patients and controls. Methods: Forty-three ADHD patients (age: 11.34 ± 2.04 years), pairwise matched for gender and age with healthy controls, were administered pro- and antisaccade tasks under the overlap and 200-ms gap conditions (100 trials each). Statistical analyses included linear mixed-effect modelling and logistic regression. Results: Compared to healthy controls, children with ADHD showed significant increases in the exGaussian parameters r and s, and the fDM boundary separation parameter, as well as decreased fDM drift rate and nondecision time parameters. Results indicate that (a) differential effects of pro- and antisaccadic tasks can be captured by s which was statistically increased for pro- but not for antisaccades, and to a lesser extent by r which was particularly increased for antisaccades; and that (b) fDM parameters, particularly drift rate, provide

incremental validity in the discrimination of patients and controls for antisaccades but not for prosaccades. Conclusions: These findings confirm increased ISV in ADHD for the oculomotor domain and highlight the utility of exGaussian and fDM models in this research area.

types, the inattentive type samples got a lower mark in working memory. Conclusions: Collectively, behavioural and cognitive interventions for children with different types of ADHD should consider executive function.

P-06-012 Emotional-motivational deficits in healthy students with an increase in ADHD symptoms

P-06-014 Differential attentional impairments in adult ADHD

A. Conzelmann*, E. Werst, S. Schulz, T. Renner, P. Pauli

S. Salomone*, G. R. Fleming, J. Bramham, R. G. O’Connell, I. H. Robertson

* Tu¨bingen, Germany

* London, UK

Objectives: Emotional-motivational deficits are discussed to be one important endophenotype of ADHD. One requirement for an endophenotype is its association with the trait in the healthy population. Therefore, we assessed emotional-motivational reactivity in healthy students scoring low or high in ADHD symptoms according to a questionnaire pre-screening of a larger student population. We expected to find emotional deficits in the subgroup with an increase in ADHD symptoms comparably to results found in ADHD patients. Methods: 27 students with low ADHD symptomatology (1. quartile of the student population) and 27 students with an increase in ADHD symptomatology (4. quartile of a student population) took part. A clinical interview ensured the absence of an ADHD diagnosis. We obtained startle reflex inhibition during pleasant pictures as indicator for the reactivity towards pleasant pictures and startle reflex potentiation during negative pictures as indicator for the reactivity towards unpleasant pictures with electromyogram of M. orbicularis oculi. Additionally, valence and arousal ratings were assessed. Results: We did not observe group differences for the valence and arousal ratings of the pictures. However, we found a reduced startle inhibition during pleasant and increased startle potentiation during unpleasant pictures in students with an increase in ADHD symptomatology. Conclusions: Accordingly, our results show a reduced reactivity towards pleasant and increased reactivity towards unpleasant stimuli in healthy students with an increase in ADHD symptoms. These findings go in line with our previous findings in ADHD patients and speak for emotional-motivational deficits as endophenotype in ADHD.

Objectives: Studies investigating neurpsychological dysfunctions in adults with ADHD have shown inconsistent findings. It is important to better characterize neuropsychological deficits in adult ADHD in order to develop new and more effective interventions. This study examined neuropsychological deficits in adults with ADHD in terms of divided attention, selective attention, sustained attention and executive function in a group of adults with ADHD using a series of neuropsychological tests as well as an electroencephalography (EEG). Subjective ratings of everyday attention and memory problems were also collected. Results: Adults with ADHD showed impairments on divided attention, on all measures of sustained attention and in a task of executive function (Hotel Task) compared to adult matched controls. Performance on selective attention tasks in adults with ADHD was instead no different from control subjects’ performance. Higher subjective ratings of everyday life attentional and memory problems were also found in the ADHD group compared to the control group. EEG results confirmed behavioural findings by showing a selective impairment on P3 event-related potential (ERP) amplitude indicative of sustained attention dysfunctions. A significant negative correlation also emerged between P3 amplitude and subjective attentional ratings. Conclusions: This pattern of results suggests differential impairments of attentional skills in adults with ADHD. The knowledge of the neuropsychological deficits in adults with ADHD can have implication for developing new and more effective interventions for adult ADHD.

Friday, 29 May 2015, 16.00 h–17.30 h P-06-013 The comparison of executive functions in different types of Attention-Deficit/Hyperactivity Disorder (ADHD)

P-07 Neuroimaging I

H. Sabery*, M. Honjani * Roudehen, Iran Objectives: The present research was conducted to compare the executive functions (EF) among children with different types of attention deficit hyperactivity disorder, known as ADHD. Active memory and organizing were chosen as the components of EF and a general assessment of EF was carried out. Methods: The sample of this study consisted of 45 children diagnosed with AHDH in one of the three different types, including combined, hyperactive and inattentive type (15 in each group) in 2013 in Tehran. Wisconsin Card Sorting Test (WCST) and Rey Complex Figure Test were selected to measure the specific components of ADHD. Results: The result indicated a significant difference in general EF in the inattentive type in comparison with the other two types. Although there was no remarkable difference in organizing among different

P-07-001 The executive functions regulated by COMT Val158Met (rs4680) genotype were divergent in children with AttentionDeficit/Hyperactivity Disorder and healthy controls J. Jin*, L. Liu, Q. Gao, R. C. K. Chan, H. Li, Y. Chen, Y. Wang, Q. Qian * Beijing, People’s Republic of China Objectives: Attention-deficit/hyperactivity disorder (ADHD) is a frequent childhood psychiatric disorder and usually display deficits in executive functions (EF), which are primarily mediated by prefrontal cortex (PFC). The functional polymorphism of COMT, Val158Met (rs4680), leads to observed polymorphic differences that the enzyme in Met/Met is reduced to one-quarter of the activity in Val/Val within PFC. In present study, we aimed to explore the effect of rs4680 on EF by case–control study and considering the dynamic development of

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EF, we also attempted to figure out whether the genetic influence by rs4680 changes during development or not. Methods: A total of 597 Chinese Han ADHD children and 154 unaffected controls were recruited. EF were evaluated using ReyOsterrieth Complex Figure Test (RCFT) for working memory, Trail Making Test (TMT) for shifting and Stroop Color-Word Test for inhibition. And intelligence test (IQ) was conducted using the C-WISC. Association between genotype and EF was analyzed using analysis of covariance (ANCOVA). Results: Significant interaction effect of genotype and ADHD diagnoses was found on EF (P values varied from \0.001 to 0.049). However, the genotypic advantage for ADHD and controls were divergent. In ADHD, the Met carriers showed higher scores than Val/ Val on RCFT (P = 0.015), while opposite in controls (P \ 0.001). In addition, genotypic main effect was only detected in controls on TMT, indicating longer time for Met carriers than Val/Val to complete the task (P = 0.001). When investigating the genetic influence during development, the advantageous allele on EF remained stable in both case and control. Conclusions: Our present results suggest the divergent influence of COMT Val158Met (rs4680) on EF in ADHD children compared to healthy controls, and this divergence seems to be stable during development.

P-07-002 NIRS findings in adults with ADHD Y. Okajima*, T. Morita, T. Tokumasu, N. Saga, B. Yamagata, A. Iwanami * Tokyo, Japan Objectives: Dysfunction of the prefrontal cortex has been previously reported in individuals with ADHD. Multi-channel near-infrared spectroscopy (NIRS), a recently developed functional neuroimaging technology, enables the non-invasive detection of spatiotemporal characteristics of brain function near the brain surface. NIRS has enabled bedside measurement of the concentrations of oxygenated ([oxy-Hb]) and deoxygenated hemoglobin ([deoxy-Hb]) in capillary blood vessels. In the present study, we used NIRS to detect changes in the oxygenated hemoglobin concentration ([oxy-Hb]) during two verbal fluency tasks, which are associated with frontal function in adults with ADHD. Methods: The present study was approved by the ethics committee of Faculty of Medicine of Showa University. Subjects of this study were 30 outpatients with ADHD of Showa University Hospital. The diagnosis was made according to the criteria of DSM-IV. The normal control group is comprised 30 adults. The relative [oxy-Hb] in the prefrontal cortex was measured during the category and letter fluency tasks, using multi-channel near-infrared spectroscopy (NIRS). Fiftytwo channel NIRS (ETG-4000, Hitachi Medical) measures relative changes of [oxy-Hb] and [deoxy-Hb] using two wave lengths (695 nm and 830 nm) of infrared light based on the modified Beer– Lambert law. Results: The two groups did not differ significantly in the numbers of correct response on the tasks. Also, the mean total [oxy-Hb] change during the category fluency task did not differ significantly between the groups; however, during the letter fluency task, the mean [oxyHb] change in persons with ADHD was significantly lower than that in controls. Conclusions: These results suggested task-relevant or task-specific prefrontal dysfunction in persons with ADHD.

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P-07-003 Distinct categorical and dimensional neural correlates across functional brain networks in ADHD R. Pruim*, C. Beckmann, J. Buitelaar, M. Mennes * Nijmegen, The Netherlands Objectives: The heterogeneous neurobiological mechanisms underlying ADHD comprise both categorical and dimensional effects. Functional connectivity (FC) research in ADHD however mainly focuses on categorical approaches or does not account for shared variance between categorical and dimensional variables of interest, resulting in potentially incomplete interpretations of obtained findings. Moreover, the research field is shifting towards integrative neural systems-based conceptualizations of ADHD involving multiple cortical networks. We investigate categorical and dimensional FC markers related to ADHD across multiple brain networks using multivariate models. Methods: We acquired resting-state fMRI (rfMRI) data for 179 ADHD, 109 unaffected ADHD-siblings, 31 remitted ADHD, and 90 TDC participants (mean age 17.5 ± 3.3 years). For every participant we obtained spatial maps for 14 resting-state networks (RSN) using a multivariate regression approach. We evaluated these maps for differences between ADHD and TDC participants (categorical) as well as linear effects of inattention and hyperactivity/impulsivity scores (dimensional). By testing differential designs with alternative orthogonalization between variables (i.e. assigning all shared variance to a specific variable) we investigate whether effects relate specifically to the categorical and/or dimensional domain. Results: We found (see Figure 1) FC of the PCC and frontal areas within the default mode network (DMN) to be related to categorical underpinnings of ADHD. Dimensional ADHD-effects were most profoundly located within the cerebellum (inattention), sensorimotor (hyperactivity/impulsivity), DMN (hyperactivity/impulsivity) and visual medial network (both inattention and hyperactivity/impulsivity). Moreover, FC of the ACC and paracingulate cortex within the executive control network was related to both categorical and dimensional ADHD-effects. Conclusions: We identified distinct categorical and dimensional neural correlates of ADHD across functional brain networks. While the identified regions have been implicated in ADHD by previous studies, our multivariate approach uncovers their differential roles in ADHD through improved modeling of the relationship between behavioral observations and the neurobiology underlying the disorder.

P-07-004 A critical review of Magnetic Resonance Spectroscopy (MRS) studies on ADHD A. Reid* * Cambridge, UK Objectives: A critical review of MRS studies of the cerebral neurochemistry in ADHD is presented. Methods: Literature searches using PubMed identified studies published before 2015. Results: 36 papers were found; 10 focused on adults, 24 on children and two involved a meta-analysis. All the results reported are relative to controls. Areas that showed significant differences in metabolites in adults with ADHD, included: the left dorsolateral and right

ventromedial prefrontal cortex, the bilateral anterior and right posterior cingulate, the left caudate, left putamen, left thalamus and left cerebellum. The following regions exhibited significant differences in metabolites in children with ADHD: the bilateral prefrontal and frontal cortices, the dorsolateral frontal areas, the lenticular nucleus, anterior cingulate, basal ganglia, inferior parietal region, left centrum semiovale, right primary somatosensory and motor cortices, and the left cerebellum. The metabolite ratios altered in participants with ADHD encompassed: Cho/Cr, Glx/Cr (adults and children), Glu/Cr and mI/Cr (adults) and Glx/Ino, NAA/Cr, NAA/Cr + PCr and freePME/free-PDE (children). Significant differences between the absolute concentrations of metabolites in participants with ADHD, included: Cr, Glu, Glx and tNAA (adults and children), NAA and Cho (adults) and Cr + PCr, GABA, free-PME and mI (children). Pharmacological studies revealed that treatment altered some metabolites in participants with ADHD. The majority of these studies have shortcomings: small, unrepresentative samples; uncontrolled confounds (ADHD subtypes, medication (type and regime), comorbid deficits, unsystematically investigated gender effects and hormonal influences); reliance on ratios, not absolute concentration, of metabolites; lack of longitudinal studies. Conclusions: Future research needs to address these criticisms. Evidence points to more than one deficient region in ADHD, hence MRS techniques that investigate a number of areas simultaneously are of importance. ADHD is a heterogeneous disorder and focus on individual differences is crucial; Finally, it is important to control for allelic variations that put a person at risk of ADHD.

P-07-005 Emotional recognition and white matter abnormalities in ADHD-I A. Rossi*, V. Hermann, M. V. Alves, C. Mello, O. Bueno * Sa˜o Paulo, Brazil Objectives: Currently, it is established that ADHD individuals show an impaired processing of emotional stimulus. Although this disorder encompass distinct presentations regarding cognitive, behavioral and neuroanatomical features, few studies have analyzed subtypes’ characteristics in emotional processing, and none was found on how white matter may impact on emotional stimulus processing, especially in the inattentive type. This study aimed to compare facial expression recognition between ADHD-I and healthy controls, and also investigate how white matter integrity may impact on emotion recognition. Methods: Twenty-seven ADHD-I children aged seven to 15 years and 28 matched controls answered to the Facial Expressions of Emotions: Stimuli and Tests. Six basic emotions—happiness, sadness, surprise, fear, disgust and anger—were morphed from one emotion to another and should be identified in five stages. Diffusion tensor imaging data were collected at 3.0 Teslan MRI system and Fractional Anisotropy (FA) values were obtained for 20 fiber tracts. Data was standardized and analyzed with t test, pearson’s correlation and linear regression. Results: The results indicated that, compared with controls, ADHD-I children had a worse performance on recognition of fear (t(55) = 2.40, p = 0.02, d = 0.65), surprise (t(55) = 2.20, p = 0.03, d = 0.60) and on an overall score (t(55) = -2.11, p = 0.04, d = 0.57). For ADHD-I, moderate and strong correlations were found between performance on emotional recognition and white matter integrity. Higher FA values of sagittal stratum’s fibers predicted better performance on recognizing of happiness, sadness and angry. Higher FA values of left superior longitudinal fasciculus and cingulum predicted worse recognizing of fear and surprise. Higher FA values of cingulum also predicted a worse overall performance.

Conclusions: Results suggested that ADHD-I individuals have impairments in the emotional processing and white matter abnormalities seem to be one of the determinants of these deficits. Our findings contribute to a better brain-behavior characterization of ADHD-I.

P-07-006 An fMRI study on neural systems for empathy in ADHD J.-W. Son*, J.-e. Kim * Cheongju, Republic of Korea Objectives: The purpose of this study was to investigate the difference of psychological aspects and brain activity between adolescents with and without ADHD from the viewpoint of cognitive and emotional empathy. Methods: A total of 16 adolescents with ADHD and 19 normal adolescents were scanned with functional MRI during an empathy task. Differences in brain activation between adolescents with and without ADHD were assessed by contrasting neural activation during a cognitive empathy task and an emotional empathy task. The ADHDRating Scale, Bryant’s Empathy Index and the children’s version of the Empathy Quotient were also used for clinical measurement. Results: According to the clinical results, adolescents with ADHD showed significantly lower scores on the cognitive empathy component of Bryant’s Empathy Index and the children’s version of the Empathy Quotient than normal adolescents. In fMRI analyses, adolescents with ADHD exhibited greater brain activation than normal adolescents in the bilateral superior frontal gyrus (Brodmann area 6), right orbitofrontal cortex (Brodmann area 11), right middle frontal gyrus (Brodmann area 6), and so on. On the other hand, no differences between two groups in brain activation during the emotional empathy task were found. And, cognitive empathy of all participants exhibited a negative correlation with the activation in the right orbitofrontal cortex (Brodmann area 11), right middle frontal gyrus, and right superior frontal gyrus (Brodmann area 6). Inattentiveness of adolescents with ADHD showed a positive correlation with the activation in the middle occipital gyrus (Brodmann area 19), the right caudate body, and the dorsomedial thalamus. Conclusions: Brain activities of adolescents with ADHD were greater in the brain regions associated with the empathic system than in adolescents without ADHD during a cognitive empathy task. Taken together, it also suggest that adolescents with ADHD might have defects in neural and clinical aspects of cognitive empathy.

P-07-007 Altered serotonin transporter binding in patients with Attention-Deficit/Hyperactivity Disorder/Investigated with PET and [11C]DASB T. Vanicek*, A. Kutzelnigg, H. L. Sigurdardottir, A. Hahn, G. S. Kranz, M. Spies, A. Kautzky, D. Haeusler, T. Traub-Weidinger, M. Hacker, M. Mitterhauser, W. Wadsak, S. Kasper, R. Lanzenberger * Vienna, Austria Objectives: Neuroimaging and genetic findings indicate, next to dopamine and noradrenaline modulation, an additional contribution of a dysregulation of the serotonergic signaling in ADHD. Altered serotonergic neurotransmission has been found to cause impulsive and aggressive behavior, as well as increased motor activity, all exemplifying key symptoms of ADHD. The objectives of this positron emission tomography (PET) study was to investigate the SERT binding potential in adult patients with ADHD using the selective radioligand [11C]DASB.

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Methods: 26 medication-free patients with ADHD (aged 33 ± 10.34, 8F/11 M) and without any psychiatric comorbidity and 26 age and sex matched HC (aged 33 ± 10.47) were measured once with PET and [11C]DASB. The SERT binding potential (BPND) was quantified with a voxel-wise whole-brain and a regions of interest (ROI) approach using the multilinear reference tissue model. SERT BPND maps of patients in fifteen a priori defined ROIs were compared to those of HC by means of a linear mixed model. Results: Patients with ADHD showed an attenuated SERT BPND within the caudate (p = 0.032) and the putamen (p = 0.024) and a tendency towards a reduced binding in the subgenual cingulate cortex (p = 0.052) compared to healthy subjects. None of the clusters or ROIs survived correction for multiple comparisons. Including age or sex as covariate did not alter the main results. Conclusions: Our results demonstrate an attenuated SERT availability in the caudate, putamen and a tendency towards a reduced SERT availability in the subgenual cingulate cortex, suggesting an involvement of altered brain SERT in the pathogenesis of ADHD. The caudate and the putamen represent brain regions key for reward processing, motor and executive functions and are identified to be affected in ADHD. Since all findings are uncorrected for multiple comparisons, interpretations and conclusions must be interpreted with caution. However, the results of this study underline the suggested serotonergic contribution to ADHD7.

P-07-008 Laterality of activation patterns in boys with AttentionDeficit/Hyperactivity Disorder and effects of methylphenidate during verbal working memory task Z. Wu*, M. Hoogman, Q. Cao, L. An, L. Yang, J. Bralten, L. Liu, L. Sun, Q. Qian, B. Franke, Y. Wang * Beijing, People’s Republic of China Objectives: To investigate the laterality of activation patterns during a working memory task and the effects of methylphenidate (MPH) on brain activation in boys with Attention-deficit/Hyperactivity disorder (ADHD). Methods: Boys with ADHD (n = 18) underwent functional magnetic resonance imaging during a working memory task twice, once under MPH and once under placebo, in a randomized, cross-over design. Typically developing boys (n = 28) were also recruited. Lateralization indices was calculated with the LI-toolbox. Left lateralization was defined as LIw [ 0.2. Results: No group difference was found in behavioral performance (all p [ 0.05). Relative to controls, Boys with ADHD under placebo showed over-activation in the median/paracingulate gyrus, bilateral precuneus, angular, left cuneus, inferior frontal gyrus, and cerebellum posterior lobe (Fig. 1a, punc\0.003, k = 40). MPH normalized most of the over-activation, except for bilateral precuneus and left cuneus, induced activation in bilateral olfactory cortex, posterior and anterior cingulum, right orbital middle frontal cortex, and temporal pole (Fig. 1b, punc \0.003, k = 40). The lateralization analysis revealed that the main effect of disease status in frontal lobe and whole brain gray matter was left-lateralized (Fig. 2, LIw = 0.34 and 0.42), while the main effect of MPH was right-lateralized (Fig. 2, LIw = -0.53 and -0.45). Compared to patients under placebo, the frequency of left lateralization during low working memory load was significantly lower in the MPH condition and in healthy controls (PMcNemar = 0.02 and v2 = 6.13, p = 0.01 respectively).

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Conclusions: This study showed left-lateralized activation patterns in boys with ADHD during verbal working memory and right-lateralized effects of MPH. More left lateralization in boys with ADHD may be a consequence of their postulated delay of brain development.

P-07-009 Frequency-specific abnormalities in regional homogeneity among children with Attention-Deficit/Hyperactivity Disorder: A resting-state fMRI study X. Yu*, B. Yuan, Q. Cao, L. An, P. Wang, A. Vance, T. J. Silk, Y. Zang, L. Sun, Y. Wang * Beijing, People’s Republic of China Objectives: Previous neuroimaging studies have decomposed the spontaneous frequency oscillations into different sub-bands and indicated that the neural activities were sensitive to specific frequency bands. The specific frequency properties of neural fluctuations have been identified in patients with certain brain disorders. Methods: Previous neuroimaging studies have decomposed the spontaneous frequency oscillations into different sub-bands and indicated that the neural activities were sensitive to specific frequency bands. The specific frequency properties of neural fluctuations have been identified in patients with certain brain disorders. Results: Compared with controls, the boys with ADHD showed decreased ReHo in medial prefrontal cortex, middle frontal gyrus, angular gyrus and precuneus but increased ReHo in posterior cerebellum (Figure 1A). Significant interactions between frequency band and group were observed predominantly in dorsolateral prefrontal cortex, inferior and middle orbital frontal cortex, supplementary motor area, parietal cortex, inferior occipital cortex, thalamus, and anterior cerebellum (Figure 1B). In particular, we found that the difference in the extra-low frequency (0–0.01 Hz) seemed to be greater than that in the other frequency bands for most brain regions. Conclusions: The findings demonstrate widespread frequencyspecific abnormalities of the fronto–striato–parieto–cerebellar circuits showing in children with ADHD, and suggest that frequency specificity of brain regional activities should be taken into account when investigating brain disorders’ neuromechanisms.

Friday, 29 May 2015, 16.00 h–17.30 h P-08 Non pharmacological treatment - Children and adolescence I P-08-001 Cognitive remediation for adolescents with attention disorder with or without hyperactivity/impulsivity: Neuropsychological aspects S. Ackermann*, S. Urben, E. Fornari, S. Leopizzi, O. Halfon, M. Bader * Lausanne, Switzerland Objectives: Executives functions (including inhibition and working memory abilities) seem particularly affected in children with attention deficit disorder with or without hyperactivity (ADHD). Several

studies have shown that computerized working memory training (CWMT) allows improving working memory in children with ADHD. Very few studies focused on adolescents despite their greater brain plasticity allowing hypothesizing more benefits. Furthermore, the combined effect of drugs and the spread of their impacts on other altered cognitive functions have not been examined which is the objectives of this study. Methods: 60 teenagers were divided into 4 groups depending on whether they were submitted to CWMT and if they were taking drugs. There was also a ‘‘control group’’ with CWMT (Robomemo program). Medications refer to methylphenidate. Working memory was assessed using the digit span of the WISC-IV test in direct order (DO) and indirect order (IO). The Corsi test was used to assess the visualspatial memory. Inhibition abilities were assessed using the Stroop task. The assessments were conducted before the start of the study (T1) and after 5 weeks (T2). Results: Analyses of variance (ANOVA) with the groups as betweensubject factor and considering the performance in T1 as covariates (ANCOVA) were performed on the score at T2. The results show that the phonological loop (span OD) can be improved by a CWMT program. Additionally, at T2 we observe that the performance of adolescents who underwent CWMT is similar to the control group. Conclusions: Regarding Central Administrator (OI span) of the WM, we see greater improvements when the CWMT program is associated with a medication, suggesting the effects of possible interaction between methylphenidate and CWMT. In contrast, the improvement of visual-spatial notebook looks more specifically related to the CWMT. We do not observe a significant difference between the groups on inhibition abilities.

P-08-002 Digital technologies and cyberculture in in-patient psychiatric treatment of adolescents with severe ADHD a technology based therapeutic and pedagogic intervention (SOMOSA MedialabR) O. Bilke-Hentsch*, M. Hartmann * Winterthur, Switzerland Objectives: In the last two decades, the impact of digital and interactive technologies (DIT) on personal and professional life has increased exponentially. Today, the vast majority of the population in industrialized countries uses DIT on a daily basis as their main source of information and as a crucial platform for social exchange. In the near future, body-attached devices will constantly provide the user with data of the world around and within him. Innovative DIT seems to offer endless possibilities. However DIT also influences the manifestation and course of mental illnesses—especially in mediainterested children and adolescents with ADHD and comorbid conditions. Their specific usage of the web 2.0, of interactive games and of social media often reflects the underlying disorder and has to be understood and treated in this context. Methods: A working group consisting of neuropsychologists, clinical psychologists, pedagogic experts, a professional game–tester and adolescent psychiatrists developed the SOMOSA MediaLabR concept. It includes a real life office simulation setting, in depth neuropsychological testing, a set of adequate ‘‘serious games’’ specifically tailored for the individual patient, virtual reality techniques, creative software programs, a high end music recording and producing facility and the possibility to optimise and critically reflect the social media behaviour of the patients preparing personalized websites and social media appearances. Results: The first phase of the implementation of the SOMOSA MediaLabR program in 2014 within the clinical context integrated

patients with ADHD or dissocial developments. The modular concept and the individualised set of methods of DIT provided a well accepted and personalized approach. Conclusions: As adolescents with severe ADHD and comorbid mental disorders show specific problems in age- and content adequate usage of electronic media of all kinds, we advocate an intensified integration of DIT in inpatient therapeutic institutions for children and adolescents. The SOMOSA MediaLabR system seem to be a first step in integrating DIT in multisystemic therapy in this age group.

P-08-003 Biofeedback training in school children with AttentionDeficit/Hyperactivity Disorder (ADHD): Differential effects of a training in a 2D or 3D environment F. Blume*, J. Hudak, T. Dresler, T. Renner, C. Gawrilow, A.-C. Ehlis * Tu¨bingen, Germany Objectives: Following first promising results of a near-infrared spectroscopy (NIRS)-based neurofeedback (NF) training in children with ADHD (Marx et al. 2015), we aim at investigating differential effects of a NIRS-based NF training and an electromyography (EMG)-based biofeedback (BF) training on academic performance, executive functioning (EF), and ADHD symptoms in schoolchildren with ADHD. Additionally, we aim at examining effects of training in a virtual reality (VR) classroom as compared to a 2D classroom visualised on a computer screen. Methods: NF training is a specific intervention targeting deviating brain activity (e.g., Barry et al. 2003; Ehlis et al. 2008) to improve self-regulation on neurophysiological and cognitive-behavioral levels (Gevensleben et al. 2014). In addition, training in a VR classroom facilitates generalisation of self-regulation competences to real-life academic situations. Ninety children with a DSM-IV diagnosis of ADHD will be randomly assigned to three conditions: (1) NIRS-based NF training in 3D, (2) NIRS-based NF training in 2D, (3) EMG-based BF training in 3D. Differential effects of the BF and NF training and effects of training in 2D or 3D will be examined via baseline and follow-up measurements. Results: Training in 3D is expected to lead to greater improvement in academic performance, EF, and ADHD symptoms than training in 2D. Furthermore, we hypothesise these effects to be more pronounced with a NIRS-based NF training than with an EMG-based BF training. The poster we wish to present will display the design of the study and first results from data collected in a pilot study. Conclusions: If the study yields the hypothesised effects, NIRS-based NF training in a 3D environment should be included as a worthwhile option in NF therapy as it might increase the effects found in previous studies (e.g., Meisel et al. 2013) by facilitating the transfer of competences learned in the laboratory to real life.

P-08-004 Behavioural parent training (BPT) group for children with ADHD: Improvement in functional and clinical symptoms C. Boix*, A. Palacio, R. Colome, A. Lopez- Sala, A. Sans-Fito * Esplugues de Llobregat, Spain Objectives: Guidelines for the diagnosis and treatment of attention deficit hyperactivity disorder (ADHD) have claimed the possible benefits of psychoeducational techniques in the comprehensive

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management of ADHD. Behavioural interventions, and specially Behavioural Parent Training group (BPT) are recommended. We evaluate the efficacy of a well-structured psychoeducation programme for parents of children with ADHD. Methods: Parents of 40 children with ADHD participated in the fivesession parent group program, completing on the first and the last session two questionnaires, Family Stress Index (FSI) and Conners’ Index. Measures of the children’s clinical variables such as age, gender, intelligence quotient, internalizing or externalizing problems for parents and teachers, pharmacological treatment at the moment of intervention and parents’ socioeconomic status, were analysed. Results: Parents reported improvements in family stress and also a reduction on child ADHD symptoms at the final session of the Behavioural treatment. Parents of younger children, higher socioeconomic level and higher externalizing problems in CBCL, had better results after the treatment. Conclusions: These findings suggest that brief BPT group programs result in improvements in parenting and child ADHD symptoms. Psychoeducation and other kinds of non-pharmacological approaches need to be regarded not as a substitute, but as a complementary treatment to medications; these approaches might help other very crucial aspects of ADHD including social and familiar outcomes. P-08-005 A novel (pilot) intervention group for parents of children with comorbid ASD and ADHD - showing positive effects on stress levels and ability to manage children better M. Digiuni*, O. Moghraby, J. Mueller, K. Kwan * London, UK Objectives: With the update of the definition of ADHD in DSM-V, ASD is no longer an exclusionary criterion for its diagnosis. Parent training/education programmes have been recommended for ADHD management, however there is little information on what (if any) adaptation are required for programmes that including parents of children with Autism as a co-morbid condition. This parent group intervention was specifically developed to address this area and we present findings of our initial formal evaluation. This group aimed to help parents better understand the overlapping and differentiating features of the two conditions, help develop strategies to address any ADHD-related behavioural challenges and a reminder of the features of ASD. Methods: The ADHD intervention group was delivered in a community CAMHS setting for parents of children (aged 6–12 years), following diagnosis of both ASD and ADHD. The intervention was delivered on two different occasions by clinical psychologists. The programme lasted for seven sessions, which covered psychoeducation, behavioural management strategies, parenting skills training, mindfulness-based exercises, and information on ADHD medication provided by a consultant psychiatrist. 22 parents participated, pre- and post-measures were obtained from 11 parents who received the intervention. Outcomes were measured using the Parenting Stress Index, the ADHD-IV Rating Scale (ADHD-RS), and a questionnaire exploring parents’ confidence on the areas addressed by the group intervention (including. Knowledge/understanding of ADHD and ASD, managing parental stress, managing child’s behaviours& relationship with child). Results: Preliminary data showed significant improvement on parenting stress and all areas covered by the group intervention. No change was reported on the ADHD symptomatology. Conclusions: Initial evaluation on this ASD/ADHD parent training group is promising, but requires further evaluation. Initial results suggest that ADHD management programmes that are sensitive to ASD symptomatology should be available when both conditions coexist. Further direction of research is to be considered.

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P-08-006 Improving executive functioning in children with ADHD: Training multiple executive functions within the context of a computer game. Moderators of outcome in a randomized double-blind placebo controlled trial S. Dovis*, S. Van der Oord, R. Wiers, M. Marija, P. Prins * Amsterdam, The Netherlands Objectives: Executive functioning (EF) training-interventions aimed at ADHD-symptom reduction have yielded mixed results. However, ADHD is a heterogeneous disorder and it is suggested that EF training might be effective for some children, but not for others. Although several assumptions have been made with regards to treatment indications (e.g., provide EF training to those with worse EF), moderators of EF training outcomes in children with ADHD have not been investigated. In this study, multiple EFs were trained within the context of a computer game. Moderators (baseline EF performance, reward responsiveness [using the SPSRQ-C]) of treatment outcome were explored for near (change in trained EFs) and far transfer (change in parent/teacher rated ADHD symptoms). Methods: Eighty-nine children with ADHD (aged 8–12) were randomized to either a full-active condition where visuospatial working memory (WM), inhibition and cognitive-flexibility were trained, a partially-active condition where inhibition and cognitive-flexibility were trained and the WM-training task was presented in placebomode, or to a full placebo condition. Short- and long-term effects of this gamified, 25-session, computer training were evaluated using MANOVAs and moderation analyses. Results: Overall, near transfer effects were specifically related to the type of treatment received, but far transfer effects were nonspecific. Preliminary analyses generated several moderators of treatment outcome: First, inhibition performance at baseline moderated posttreatment change in inhibition performance. Children with poor inhibition at baseline benefited more from the full-active and partially-active condition. Second, baseline WM performance was not a moderator of near transfer, but did moderate change in teacher-rated hyperactive/ impulsive behavior. Children with good WM at baseline benefited more from the full-active condition. Finally, reward responsiveness moderated change in parent-rated hyperactive/impulsive behavior. Children with high reward responsiveness at baseline (higher implies more impairment) benefited more from the full-active condition. Conclusions: Generally, this study disconfirms several assumptions of EF training (e.g., provide EF training to those with worse EF) and suggests that motivational traits are important for treatment outcome.

P-08-007 Comparison of neurofeedback training and working memory training with children who have a non-medicated ADHD. A pilot study, with neuropsychological assessment, questionnaires, and QEEG as effect measurements S. Einarsdottir*, H. M. Taklo, K. Instebø, D. Socanski, M. Bremnes, H. Beneventi * Stavanger, Norway Objectives: Cognitive training, both neurofeedback and working memory training, have shown mixed results when it comes to their effectiveness in treating symptoms of ADHD in children. This pilot study wanted to see what kind of measurements; neuropsychological (NP) assessment, questionnaires’ and QEEG, that could be helpful in evaluating the effect of cognitive training at a Child and Adolescent Unit in Stavanger University Hospital in Stavanger, Norway.

Methods: A total of 10 non-medicated outpatients with ADHD diagnosis, were randomized to either neurofeedback training (Other method) or working memory training (Robomemo). Both training conditions had 25 times training sessions, three times a week. Robomemo were trained at school and neurofeedback were trained in a clinical setting. Before and 4 weeks after training, the patients went through neuropsychological assessment (NP with NEPSY-II and CPT-II), QEEG and their parents and teachers answered questionnaires’ (BRIEF, ADHD-rating scale, 5–15, SDSC and ILC). Results: The pilot study is still in progress. So far we only have predata. The post data are being collected during February/March-15. Conclusions: Both methods are time-consuming training methods. The preliminary results suggest that there is little evidence that either neurofeedback or working memory training has an substantial effect on ADHD symptoms. There is need for more randomized longtime studies to evaluate these methods.

P-08-008 Implementing computer-based working memory training in a regular classroom setting. A pilot study, with reading and arithmetic performance tests as effect measurements K. Instebø*, S. Einarsdottir, H. M. Taklo, D. Socanski, M. Bremnes, H. Beneventi * Stavanger, Norway Objectives: This study has two objectives. The first objective was to study whether it was possible to implement computer-based working memory training (Robomemo) in a whole class. Part two was to investigate whether this method would have an effect on reading and arithmetic skills. Methods: A total of 28 pupils (17 boys and 11 girls) in a Norwegian 5th form (alder) in a regular class were administered a computer based working memory training consisting of 25 trainings distributed over 5 days a week for 5 weeks. 1 pupil was administered the preschool version of the programme. The other pupils were administered the regular school version. Assisting in the implementation were two teachers and 1 assistant. Reading and arithmetic tests were administered in the beginning and at the end of the school year as a part of the schools regular routine of assessing reading and mathematical skills. Results: 17 pupils finished their training. Their average index on the working memory training rose from 73.88 to 101.64, including the pupil who was administered the preschool version. Of the 11 pupils who did not complete the task, 5 lacked only one or two sessions. The reading test measurements showed an average increase in the amounts of word read per minute from 128.24 to 150.55. Their average percentage of mistakes sank from 12.9 to 6.28 %. Correct answers on a spacing word test rose from an average of 33.93 to 39.56. On the arithmetic test there was a large dropout, and only 10 pupils finished both assignments. The average rose from 21.7 to 23.4. Conclusions: This pilot study shows that it is possible to administer this type of training in a classroom setting, but it is a time-consuming training method which needs careful support and administration to see the pupils through all the sessions. Regarding the effect on far-transfer cognitive tests the results shows a positive trend.

P-08-009 Protocol for the Sheffield treatments for ADHD research (STAR) project: Testing the feasibility of the trial design P. Fibert*, C. Relton * High Wycombe, UK Objectives: There is a need to identify treatments achieving positive long term outcomes for all stakeholders (patients and services). Parents report using complementary and alternative medicine (CAM) treatments for their child’s ADHD, however evidence is generally minimal and of poor quality. The overall objective of the STAR project is to design a pragmatic trial with minimal potential for bias (internal validity) testing treatments as experienced in routine clinical practice (external validity) and informing ADHD stakeholders such as decision makers in health, education, social work, criminality and families. A preliminary controlled case series found treatment by a homeopath to be acceptable and associated with sustained improvements. The next objective is to test the feasibility of the cohort multiple randomised controlled trial (cmRCT) design by conducting a three armed pilot trial of the clinical and cost effectiveness of 2 treatments: (a) treatment by homeopaths and (b) poly-unsaturated fatty acids (PUFAs) compared to treatment as usual. Methods: Participants will be recruited to the STAR long term observational cohort and their outcomes of interest (ADHD symptoms, quality of life, school disruption, resource use and criminality) measured every 6 months. A random selection of eligible participants will be offered treatments (a) or (b). The outcomes of those offered treatment will be compared to those not offered treatment using intention to treat (ITT) analysis and complier average causal effect (CACE) analysis. Results: The feasibility of recruiting to the cohort and the trial, delivering the intervention, and measuring the appropriateness, sensitivity and collectability of outcomes will be trialled. Conclusions: The results of this pragmatic trial will provide information about the clinical and cost effectiveness of two potential interventions for ADHD. It will assess the feasibility of the trial design to test interventions for ADHD and provide useful information to stakeholders including service providers.

P-08-010 The use of mindfulness mediation and emotion regulation for children with ADHD N. Leventhal*, D. Almagor * Toronto, Canada Objectives: To evaluate the effectiveness of a skills based therapeutic group built on concepts derived from Mindfulness Meditation and Dialectical Behaviour Therapy in the management of behaviour, symptoms and emotion regulation in children with ADHD. Methods: Using a qualitative research based approach; we conducted a literature review on the effectiveness of Mindfulness Meditation and Dialectical Behaviour Therapy for ADHD. Our clinic is now conducting a 6-week Mindfulness Meditation and Emotion Regulation

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skills based group for children (ages 8–12) with ADHD. We administered qualitative report measures to parents and teachers before the group started, at the third week of the program, and will do so again at the final week and at a 6-week follow-up. Participants will complete the Conners CPT 3 (Continuous Performance Test 3rd Edition) before the program commences, during the final week and at a 6-week follow-up. The sample size (or N number) for our research is 4 individuals. Results: Children with ADHD struggle with impulsivity, hyperactivity, and inattention. The symptoms of ADHD often make it difficult for a child to regulate their emotions and adaptively cope with stressful situations. Concepts from both Mindfulness Meditation and Dialectical Behaviour Therapy are useful interventions for behaviour management, symptom regulation and emotion regulation in kids with ADHD. Conclusions: The aim of mindfulness based therapies can enhance a child’s ability to be present and attentive to the task at hand. Mindfulness also has been proven useful in improving mood, enhancing self-regulation skills, regulating attention and decreasing impulsivity. Dialectical Behaviour Therapy can provide useful tools for emotion regulation and to decrease impulsive reactions to stressful situations.

Friday, 29 May 2015, 16.00 h–17.30 h P-09 Non pharmacological treatment - Children and adolescence II P-09-001 Assessing the effectiveness of the ‘Incredible Years(Ò) parent training’ to parents of school-age children with ADHD

P-09-002 Effects of brain-computer interface based attention training program for ADHD X. Lee*, D. S. Sheng Fung, R. Phillips, C. Guan, T.-S. Lee, C. G. Lim * Singapore, Singapore Objectives: An 8-week brain-computer interface (BCI)-based attention training program was developed for the treatment of ADHD. We investigated the treatment effects on other emotional and behavioral domains in children with ADHD. Methods: This was an exploratory study to investigate any treatment effects and the acceptability of the intervention. Twenty unmedicated ADHD children diagnosed solely with ADHD received the BCI attention training game system over 6 months. Parents and teachers completed the Child Behavior Checklist (CBCL) and Teacher’s Report Form (TRF) respectively at various time points. Results: The CBCL showed improvements in attention problems, aggression and thought problems. Improvement in the thought problems appeared to arise from improvement in obsessive–compulsive symptoms. There was no significant improvement observed on the TRF. A previous study using CBCL and TRF to investigate the prevalence of internalising and externalising problems among local students showed that parents were better than teachers at reporting internalising symptoms. Conclusions: Treatment with the BCI-based attention training game system could reduce externalizing symptoms such as aggression. Further studies involving children who have ADHD and other comorbid condition may shed light on the effects of this treatment program on the comorbid conditions such as obsessive–compulsive disorder.

A. Kerridge*, K. Dawson, S. Schmiedel, M.-P. Vandette, P. Robaey * Ottawa, Canada Objectives: This study examined the effectiveness of an evidencebased parent training program (Incredible Years() Parent Training Program—IYPT) in a real-world Canadian setting. The efficacy of the program has been is established in children diagnosed with disruptive disorder (ADHD and ODD), but in 4–6 year-old. This study aims at assessing effectiveness in order children within a real-world clinical setting. Methods: From January 2005 to December 2014, 197 families with a 5-to-13 year old child diagnosed with ADHD participated in the IYPT through a specialized ADHD and disruptive behavior clinic. It runs for a period of 13 weeks—twelve sessions based on the Incredible Years and a supplementary session on ADHD medications and ADHD through the lifespan. The Conners-3 parent, the Parenting Scale (Arnold et al. 1993), as well as a Parent Satisfaction Questionnaire from the incredible Years program were completed by the parents before and after the training, as well as at the booster session 6 months after the end of the program. Results: Parents reported significant treatment effect on inattention and hyperactivity/impulsiveness. Treatment effects extended to improved peer relationship and decrease in oppositional and defiant behaviors. By comparing pre- and post-training measures, parents reported improvement in reinforcing consistent discipline and a decrease in anger, irritability and meanness in discipline practices. Both ADHD symptoms and parenting improvement were sustained after 6 months. Parents’ satisfaction with the program was high. Conclusions: Findings show that IYPT can be implemented successfully as real-world clinical intervention to families of school-age children with ADHD.

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P-09-003 Emotion control in children with ADHD, examination of self-report, observational, and physiological components S. Li-Yu* * Taipei, Taiwan Objectives: ADHD has historically been viewed as poor sustained attention, impulsiveness, and hyperactivity. Yet, emotional problems have also been concerned as another important issue by clinicians. Children with ADHD are rated as more anger, aggressive by their parents and peers. However, the self-reports of emotional reactivity between children with and without ADHD are no difference. There are discrepancies between different components of child’s emotional control. To address this gap in the literature, the present study investigates the profile of three components of emotional control in children with ADHD: self-report, behavior observation, and physiological response of HRV. Methods: Participants are 42 children with ADHD and 72 typically developing controls, aged 7–12 years. The standard disappointment task is used in which the child received an undesirable prize. The disappointment procedure is divided into three segments: non-disappointing baseline segment, social disappointing segment during which assistant is presented, and non-social disappointing segment during which the child is alone. All procedures are informed consent by their parents. Results: The results indicated that during the baseline stage, the selfreport emotion, emotional expression and HRV response are equivalent between two groups. During the period of disappointment

when they are with person who disappointed them, children with ADHD report more anger emotion and display more negative expression. In private stage, children with ADHD show more emotional dysregulation behavior and significantly increased HRV. These coherence pattern reflect that when children with ADHD are faced with disappointment situation, they display the profile of non-controller group. Conclusions: These findings will be clinically relevant in that they demonstrate the importance of teaching children with ADHD skills in emotion regulation. They have to be thought to monitor their selfreport emotion, their external behavior and their internal physiology for cues they are facing disappointment.

P-09-004 Implementation evaluation of a social skills training programme for children with ADHD in school, community and child psychiatry clinic settings L. Masse´*, C. Verret * Trois-Rivie`res, Canada Objectives: The objective was to evaluate the fidelity of the implementation of a social skills training program for children with ADHD in three different settings: school, community and child psychiatry clinic. Methods: The evaluation process is based on Chen’s theory driven evaluation and focuses on action model and treatment adherence across school, community and child psychiatry clinic settings. The training of each skill follows a particular sequence: (1) explicit teaching of the targeted skill (description of the reasons for change, description of the sequence of actions, modelling, exercises, discussions), (2) practice (role plays, collaborative games or sports, motor skills activities, etc.), (3) generalization activities (behavioral contracts to encourage children to implement new skills in school or home settings). A contingency point system is also used. Each week, parents and teachers received a letter, which indicated how to coach the children to adopt the skill. The program took place over a 12-week period, consisting of 2 h of group therapy for the children, two parent meetings and one activity combining parents and children. Eight trainers and 36 children participated, distributed in nine treatment groups (two in school, four in a child psychiatry clinic, and three in a community setting). Each meeting, trainers completed an evaluation form to assess the integrity of the treatment. Results: All groups completed all activities related to explicit teaching of targeted skills. Treatment adherence was weaker in practice and generalization activities. Treatment fidelity was superior in community settings, followed by child psychiatry clinic. Groups held in school demonstrated the weakest treatment adherence, particularly regarding parents’ participation. Conclusions: Fidelity of implementation was less successful in the school setting. This may explain the weak effects generally observed for social skill training programs in this environment. In regard to differences observed across these settings, it is important to consider the fidelity of implementation in the outcome analysis.

P-09-005 The WHAAM application: An evidence-based application to support behavioural interventions G. Merlo*, C. Giuseppe, M. Sanches-Ferreira, C. McGee, G. Doherty, D. Spachos * Palermo, Italy

Objectives: This poster illustrates the new WHAAM application (WA), a software developed by the EU-funded WHAAM project (Chifari et al. 2013), designed to improve communication between health professionals, teachers and the parents of children with ADHD. It also provides them with an evidence-based set of results to evaluate the efficacy of targeted behavioural treatments. Methods: As in popular social networks such as Facebook, WA users can create a virtual network of people who are directly involved in the care of a child with ADHD. The WA includes the ability to create and securely monitor a range of different behavioural contexts and to share a common set of data about the child. This will help to improve the quality of communication between families, education and health services. Moreover, the WA supports health professionals to plan targeted behavioural interventions aimed at reducing or eliminating inappropriate behaviours. By identifying patterns in the antecedent and/or consequent events that are functionally related to the targeted behaviours the professionals can organise the child’s network to gather quantitative (frequency/duration) and qualitative data (ABC charts) in the specific places that they occur. Using this data they will be able to understand the function of the behaviour and to propose appropriate behaviour modification strategies. Finally, the WA calculates the Parker (2011) TAU-U statistical index in order to estimate the effect size of a treatment on the behaviours occurrences. The WA consists of a web application for accessing data, to plan/evaluate interventions and a mobile app focused on data collection. Results: The WA is currently under test in Italy, United Kingdom, and Portugal. Conclusions: The WA could have a strong impact on the ADHD behavioural managements process, supporting positive active cooperation between the caregivers of children with ADHD, promoting evidence-based behavioural interventions and improving knowledge about common antecedents and consequences related to specific clusters of behaviours.

P-09-006 The role of group parent education on medication adherence in children with Attention-Deficit/Hyperactivity Disorder H. Gao*, D. Zhu * Shanghai, People’s Republic of China Objectives: To investigate how group parent education influence medication adherence in children with Attention-Deficit/Hyperactivity Disorder (ADHD). Methods: 245 children continuously diagnosed with ADHD and initiated with medication prescription whose parents joined the group parent education were retrospectively compared with previous 149 children from the same clinic continuously diagnosed with ADHD without group parent education on medication adherence. The medication adherence were assessed by parent telephone report and medical record review. The criteria of adherence was children regular took prescribed medication during consecutive 6 months The group parent education included two consecutive weekly sessions. One session is outline of ADHD knowledge and another is for behavior intervention. Each session was 2 h included lecture and discussion. Results: out of 245 children with group parent education group, 19(7.8 %) refused to take any medication, 33(14.6 %) took medication less than 6 months, 193(85.4 %) meet adherence criteria. Out of 149 children without group parent education, 30(20.1 %) refused to take medication. 104(87.4) took medication less than 6 months. Only

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15(12.6 %) children meet adherence criteria (Wilcoxon W. z = -12.220, p \ 0.0001). Conclusions: The two sessions group parent education may increase adherence to medication over 6 months in children with ADHD.

P-09-007 Tomatis method as a therapy for children and adults which can improve the quality of life ADHD people S. Kashirina*, Y. Golubeva * Moscow, Russia Objectives: Children and adults with ADHD often have difficulty regulating responses to sensation and stimuli, regulating and organizing the degree, intensity and nature of response to sensory input in a graded and response to sensory input in a graded and adaptive manner that means SMD. A high incidence of sensory processing difficulties exists in children and adults with ADHD. Patients with ADHD have problems with SM. People with ADHD may be—Under responsive (intense and long-lasting sensory input)—or Sensory seeking, craving to a sensory stimuli (actively seek sensation) The other parten of SPD which may be common to ADHD children is SBMD, that describes the dysfunction that occurs when the proprioceptive and vestibular systems are impaired. These atypical sensory reactions suggest poor sensory integration in the central nervous system and could explain impairments in attention and arousal. This incapacity to modulate correctly the sensory input results in self-stimulation to compensate for limited sensory input or to avoid an overloaded sensory input. Symptoms fall into a range of categories, including problems with social interaction, repetitive stereotypical behavior and movements, somatosensory disturbance, atypical developmental patterns, mood disturbances, lack of responsiveness, and problems with attention and safety. Methods: The Tomatis Method is able to regulate the sensory perception and integration of a sensory input with ADHD. The ear delivers to brain about 90 % of sensory information, and at the same time has various functions and influences on the whole body. The objective of the method is to improve the ability of nervious system to use the sound information with a purpose of learning and communication involving the body and emotions in the process. Technics—Electronic gating that brings about a perceptual sound contrast meant to constantly surprise the brain so that it stays awake and attentive.—Bone conduction Sound is transmitted, on the one hand, by bone conduction caused by a vibration in the upper part of the cranium, and on the other hand, by aerial conduction passing through the ear’s auricle.—The timing delay The timing delay of sound perception between the bone and air conduction can changed to slow down the processing of interaction internally and to awaken the individual to attend to incoming information.—Sound Filtering Filtering permits the brain to orient itself toward the acoustic analysis of specific zones, that corresponds to a pre-natal experience.—Latency time Repetition of the gating action over time conditions prepare the ear to operate more efficiently to perceive and analyze sound properly.—Laterality The Electronic Ear provides a control to vary the balance of sound between the right and the left ear. Results: The TOMATIS Method acts on the limbic system in the medial part of the brain, to which the auditory system is linked. Among other things, this part of the brain is responsible for the mechanisms of emotion, memory, and learning. Moreover, an organ in the middle ear known as the cochlea plays the role of a cortical charger. By acting on the limbic system and prefrontal cortex, the TOMATIS Method intervenes in the regulation of emotional

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disorders related to depression and anxiety. And it will also act effectively on the regulation of stress. Conclusions: Method Tomatis regulate and balance the functioning of diencephalon that influence on self-regulation, emotional control, activity, working memory, sequencing.

P-09-008 Addressing disparities between Latinos and non-Latinos accessing a school-home collaborative behavioural treatment for ADHD L. Haack*, E. A. Araujo, M. Capriotti, A. Beaulieu, K. McBurnett, L. Pfiffner * San Francisco, USA Objectives: US Latino youth experience similar rates of AttentionDeficit/Hyperactivity Disorder (ADHD) as non-Latino youth but are less likely to receive services. Limited access to care and/or differential problem recognition (i.e., Latino parents under-recognizing ADHD symptoms compared other informants) may contribute to this disparity. Subsequently, only the most severe Latino ADHD cases appear to receive services. We examined potential disparities between Latinos and non-Latinos with access to a behavioral treatment for ADHD delivered through schools: the Collaborative Life Skills (CLS) program. We predicted that, relative to nonLatinos, Latinos would be less likely to participate in CLS. Also, participating Latinos were predicted to show more discrepant parental problem recognition and more teacher-rated symptoms than non-Latinos. Methods: Information about CLS was presented to all public schools in the San Francisco Unified School District (SFUSD) and 16 schools enrolled; Spanish-language groups were offered in two schools. School personnel identified candidate children and contacted families about participating. Parents and teachers of participating children completed a validated measure of ADHD symptoms. Results: The percentage of Latino students in CLS schools was comparable to the SFUSD population (p = .82). The percentage of Latinos participating in English-cohorts of CLS was comparable to that of the student bodies of CLS schools and significantly greater when Spanish-cohorts are included. Of those participating in CLS, teachers endorsed significantly more inattentive symptoms for Latinos than non-Latinos (p = .03) and discrepancy in parent and teacher reported inattentive symptoms was marginally greater for Latinos than non-Latinos (p = .08); no differences were noted ratings of hyperactive/impulsive symptoms (ps [ .25). Conclusions: Given the comparable rates of Latino and non-Latino participation, recruitment methods used in CLS appear to reduce access disparities for Latinos relative to typical practices. Our findings also suggest that Latino parents may under-recognize inattentive symptoms relative to non-Latino parents, underscoring the need to address potential problem recognition disparities.

P-09-009 Listening therapy as a non-pharmacological treatment, which can reduce ADHD symptoms to children S. Kashirina*, Y. Golubeva * Moscow, Russia Objectives: ADHD known as a complex disorder. Children with ADHD has problems with self-regulation, attention deficit, following verbal command, working memory, motor planning, balance, spatial

orientation, emotional control, social skills. The purpose of the study is to find out the way of non-pharmacological treatment to reduce the ADHD symptoms to children with ADHD and help them to improve their cognitive and social skills. Method: iLs—integrated listening therapy as a system which combines a listening programs and neuromotor correction. The iLs Method achieves its results through the interaction of simultaneous, multisensory input from the motor, visual, vestibular, and auditory systems, and the cerebellum. iLs accomplishes this by combining three distinct program Components: (1) Ear to Brain Component, (2) Visual-Balance-Coordination Component, and (3) Interactive Language Component. The Ear to Brain (EB) Component uses sound stimulation through both air conduction and bone conduction to engage both the auditory and vestibular systems. The Visual-Balance-Coordination (VBC) Component is a set of activities with equipment designed to provide clients with multisensory input. The Interactive Language (IL) Component is a unique program of receptive and expressive language exercises that can follow the Ear to Brain Component, or be interwoven with it, depending on the needs of the client. Methods: We applied this method in our study. We recruited 42 children from the age 4–8 y.o. diagnosed ADHD. Two groups of 20 and 22 children. All of them were exposed to a special assessment BOT II and iLs questionnaire and special iLs listening selectivity test. We were interested first to find out the results in the following areas: self-regulation, directed attention, emotional control, auditory memory and following verbal command. The first group of 20 children had 24 h of iLs therapy 1 h 3 times per week. The second group of 22 children had only regular classes. Results: Three weeks after iLs sessions the follow-up assessment was done which confirmed our expectations, we saw improvements in self-regulation, directed attention, emotional control, auditory memory and following verbal command to children of the 1st Group. In addition, we registered benefits in concentration, cognitive skills, reading and writing, visual, auditory, and motor coordination, processing speed, mood, behavior. Conclusions: We came to conclusion that regular multisensory activity can be additional non-pharmacological treatment and can significantly improve the quality of life to children with ADHD.

Friday, 29 May 2015, 16.00 h–17.30 h P-10 Pharmacological treatment - Children and adolescence I P-10-002 Population pharmacokinetics models to guide prescription combining immediate and modified release methylphenidate G. Bonnefois*, P. Robaey, O. Barrie`re, J. Li, F. Nekka * Montre´al, Canada Objectives: Extended release (ER) MPH aims at reproducing the ideal pharmacokinetic (PK) properties obtained with IR-MPH. Physicians often complement ER forms with IR forms in order to extend the therapeutic window. The combined use of favorable therapeutic time and concentration range, defining a TimeTherapeutic Window (TTW), can lead to the selection of the optimal dosing regimen. Using a Population pharmacokinetic (Pop-PK) approach, we propose here a computational strategy to identify the most efficient IR PK profile for combined regimens. Methods: To investigate the use of PK as an effect surrogate, we based our work on a reported IR and ER Pop-PK model along with available pediatric clinical data for doses and effect scales. Conditional on a

favorable time range for efficacy defined by the child’s daily schedule, a minimum concentration checkpoint before sleep, and an index of roller coaster effect, we were able to determine the best administration time and dosing regimen using our developed methodology. The combined use of favorable therapeutic time and concentration range can lead to the selection of the optimal dosing regimen. Results: Without recourse to blood samplings, the best drug regimens in terms of efficacy are delineated. Therapeutic indices allow an iterative adjustment of the combined regimen. Conclusions: The developed methodology can be used for new drug design. It is also an educational tool for clinicians and patients to improve the prescription of the time and dosing of combined administration of IR and ER MPH.

P-10-003 ADHD stimulant response. Clinical prediction research L. Dun˜o-Ambros*, E. Pujals-Alte´s, X. Estrada-Prat, M. T. Nascimento-Osorio, A. Petrizan-Aleman, S. Batlle Vila, E. Baeza-Tena, E. Camprodon Rosanas, V. Perez-Sola, L. M. Martin-Lopez * Barcelona, Spain Objectives: We investigated whether an indicator of clinical response to methylphenidate could be developed for children with ADHD, using psychopathological, cognitive and social measures. Methods: 77 children with ADHD were included between 5 and 14 years old naı¨ve medication and without psychiatric comorbidity. It was an open study in which all patients were treated with MPH for 4 weeks. Response criteria chosen a priori consisted of (1) CGI Severity Scale \3 and (2) CGAS [70 at 4 weeks. Of 77 subjects, 52 were classified as good responders (67.5 %) and 25 patients (32.5 %) and non-responders to MPH. Clinical variables were assessed using questionnaires completed by parents as The CBCL and CPRS. Neurophychological test used were WISCIV and CPT and Social variables. Results: By regression analysis multivariate to the prediction of clinical response to MPH is obtained that the most important psychopathological variables to classify were anxiety disorders (OR = 6.36; p = 0.016), aggression (OR = 5.50; p = 0.024), externalizing problems (OR = 5.50; p = 0.024), total problems (OR = 3.96; p = 0.046) and severe dysregulation (OR = 4.12; p = 0.048) in the CBCL. The presence ‘‘angry and resentful’’ symptom (OR = 6.56; p = 0.015) and the simultaneity of the three symptoms of severe emotional lability (OR = 6.96; p = 0.013) in the CPRS were significantly associated with poor response to MPH. The age and the institutionalization were significantly associated with poor response to MPH. Regarding cognitive variables, mean baseline scores did not show significantly differences between good response group and poor response group. Conclusions: This study suggests that the prediction of response to MPH in children with ADHD, it is an encouraging step towards the search for a reliable and clinically useful method to reduce the number of children exposed to MPH unnecessarily.

P-10-004 Behavioural investigation of the effect of methylphenidate among children with ADHD in Taiwan: A preliminary study S.-J. Hung*, C.-M. Yu, M.-H. Hsieh, C. Gawrilow, S. S.-Fen Gau * Frankfurt, Germany Objectives: To investigate methylphenidate (MPH) effects on behavioral control measured by the Go/NoGo task (Paul et al. 2007) among children with ADHD in Taiwan.

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Methods: The sample included 10 children with ADHD combined subtype and 14 healthy controls (mean 9.86 ± 1.05 and 10.25 ± 0.88 years, respectively). Participants underwent two separate task sessions, approximately 1 month apart. Children with ADHD were free of medication on the first session and took the regular dosage on the second session. Behavioral data were collected and analyzed with nonparametric methods. Results: Prior to medication children with ADHD were more likely than controls to display lower rates of correct Go responses (Z = -3.250, p = .001) and longer reaction times (Z = -2.225, p = .026) while the two groups continued to differ pronouncedly on rates of correct Go trials (Z = -2.402, p = .016) but not on Go reaction times (Z = -1.522, p = .128) during the second (medicated) session. For the rate of correct NoGo trials, significant differences between the unmedicated ADHD and control groups were not observed in both of the two sessions (1st: Z = -.824, p = .410; 2nd: Z = -.479, p = .632). Conclusions: Previous findings of decreased rates on correct NoGo trials in the un-medicated ADHD group could not be replicated in this study. Several possible factors contributing to this discrepancy are discussed. In sum, the preliminary findings indicate that MPH may be effective for enhancing alertness (i.e., decreased reaction times to Go trials) but not for improving inhibition (i.e., increased rates of correct NoGo trials) in ADHD. The small sample size, however, may preclude a definitive statement. We expect that more studies with larger sample sizes will better reveal the underlying mechanism in ADHD and medication effects on this disorder.

P-10-005 Nationwide data for short- and long-term medication compliance of ADHD in Korea M. Hong*, J. Han, G. H. Bahn, B. Kim, J.-W. Hwang, H.-y. Choi, I. H. Oh, Y. J. Lee * Cheonan, Republic of Korea Objectives: We examined brief- and long-term treatment compliance of attention-deficit hyperactivity disorder (ADHD) from the National Health Insurance (NHI) database in Korea. Methods: We chose subjects aged 6–14 years in 2008, who had at least one medical claim containing an ICD-10 code for diagnosis of ADHD (F90.0) with no medication use in the previous 360 days. Then, we tracked the data for 2008–2011 to determine the treatment compliance of newly diagnosed and medicated patients. Results: The study subjects were 15,133 and boys were 11,934 (78.86 %). The treatment compliance of ADHD patients every 6-month were 59.0, 47.3, 39.9, 34.1, 28.6, and 23.1 %, respectively. Within the first 6 month after the commencement of medication, the drop-out rates every month were 20.6, 6.5, 4.7, 3.7, 3.0, and 2.5 %, respectively. Conclusions: This is the first report of the nationwide data on 36-month treatment compliance of ADHD in the whole population aged 6–14 years. We identified that the beginning of the treatment, especially the 1st 6-month, is critical period in ADHD treatment. Furthermore, as steep drop-out rates were found at the beginning of the treatment, we need more effort to increase treatment adherence. We need further investigation to find the factors to keep pharmacotherapy of ADHD at the beginning of the treatment.

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P-10-005 Clinical efficacy of guanfacine extended release among children with primarily inattentive subtype of Attention-Deficit/Hyperactivity Disorder: Results from four phase 3 studies M. Huss*, K. McBurnett, A. Cutler, A. Hervas, B. Adeyi, B. Dirks * Mainz, Germany Objectives: In a phase-3 study of fixed-dose guanfacine extended release (GXR) in children and adolescents with attention-deficit/hyperactivity disorder (ADHD), similar improvements were observed in inattention and hyperactivity/impulsivity subscales of the ADHDRating Scale-IV (ADHD-RS-IV) (Biederman et al. Pediatrics 2008,121:e73–e84). Here we evaluate the efficacy of GXR in children and adolescents with predominantly inattentive ADHD in two doseoptimized and two fixed-dose, phase-3 studies. Methods: SPD503-316: 10–13 week, randomized, double-blind, placebo and active-controlled study of dose-optimized GXR (1–7 mg/day) in children and adolescents (6–17 years) with ADHD. SPD503-312: 13-week, randomized, double-blind study of dose-optimized GXR (1–7 mg/day) in adolescents (13–17 years) with ADHD. SPD503-301 and SPD503-304: 8–9 week, randomized, double-blind, placebo-controlled studies of fixed-dose GXR (B 4 mg/day) in children and adolescents with ADHD. Results: In the integrated dose-optimized studies (SPD503-312 [N = 314] and 316 [N = 338]), the placebo-adjusted, least-squares (LS) mean change from baseline to endpoint in ADHD-RS-IV total score (95 % confidence interval) in patients with predominantly inattentive ADHD (n = 61) was -5.2 (-9.2, -1.2; p = 0.011; effect size [ES] 0.481), compared with -7.8 (-10.3, -5.4; p \ 0.001; ES 0.624) in the combined or hyperactive-impulsive subtype (n = 210). In the integrated fixed-dose studies (SPD503-301 [N = 345] and 304 [N = 324]), placebo-adjusted LS mean changes from baseline in ADHD-RS-IV total score in the inattentive (n = 127) and combined or hyperactive-impulsive subgroups (n = 363) were, respectively: GXR 1 mg/day (-4.4; p = 0.215; ES 0.4297 and -8.5; p \ 0.001; ES 0.6398); 2 mg/day (-4.8; p = 0.044; ES 0.4633 and -7.1; p \ 0.001; ES 0.5377), 3 mg/day (-6.9; p = 0.007; ES 0.6653 and -8.1; p \ 0.001; ES 0.6074) and 4 mg/day (-5.5; p = 0.021; ES 0.5275 and -10.6; p \ 0.001; ES 0.8012). Conclusions: In patients with predominantly inattentive ADHD, GXR efficacy was demonstrated in two integrated pools of phase-3 studies in children and/or adolescents. These results indicate that there are comparable and consistent treatment effects of GXR across predominantly inattentive, combined and hyperactive-impulsive subtypes. Study funded by Shire Development LLC.

P-10-006 Efficacy and tolerability of lisdexamfetamine (LDX) in children and adolescents with Autism Spectrum Disorders (ASD) and Attention-Deficit/Hyperactivity Disorder (ADHD) symptoms W. Jaimes-Albornoz*, A. Ballesteros-Prado * San Sebastian, Spain

Objectives: To evaluate clinical results and side effects in children and adolescents with ASD and ADHD symptoms treated with (LDX). Methods: Subjects were a total of 14 children and adolescents (12 boys, 2 girls) aged 7–13 years (mean age, 9.9 ± 1.6 years) who simultaneously met DSM-IV TR diagnostic criteria for ASD (nine Asperger’s disorder, five pervasive developmental disorder not otherwise specified) and ADHD (11 combined type, 3 predominantly inattentive type). Patients were treated with LDX in individualized doses between 30 and 50 mg/day (mean dose, 44.3 ± 9.0). All participants were rated using the Clinical Global Impression (CGI) and Swanson, Nolan and Pelham Scale-version IV (SNAP-IV) rating scale. Each evaluation was administered at the time of pre- and postmedication treatment state. Results: Treatment with LDX achieved a significant clinical improvement in ADHD symptoms, supported by a reduction in score SNAP-IV and increased scores on CGI, in all of our patients. Eight patients had mild problems with decrease appetite and six patients had mild transient problems with initial insomnia. One patient discontinued treatment by the emergence of tics. The remaining thirteen continued taking LDX during the 8-week follow-up. Conclusions: LDX was effective in improving ADHD symptoms in all our patients with ASD. For most of them LDX was well tolerated.

P-10-008 Cost-effectiveness of guanfacine extended-release for the treatment of children and adolescents with AttentionDeficit/Hyperactivity Disorder (ADHD) in the UK A. Joseph*, J. Xie, E. Wu, V. Sikirica * Zug, Switzerland Objectives: To assess the cost-effectiveness of a non-stimulant, guanfacine extended-release (GXR), for the treatment of children/ adolescents (aged 6–17 years) with ADHD. Methods: A Markov model was constructed to evaluate the cost-effectiveness of GXR versus atomoxetine (ATX; another non-stimulant) for the treatment of children/adolescents with ADHD, from the UK National Health Service perspective. The base-case included a mix of previously stimulant-treated and stimulant-naı¨ve patients. A 1-year time horizon was used (4-week titration; 48-weeks post-titration). The model used two health states (responder and non-responder), and estimated drug costs, medical costs, quality-adjusted life years (QALYs) and incremental cost-effectiveness ratio (ICER). Transition probabilities between the two health states were derived based on symptom reduction (e.g. efficacy) from a pre-specified analysis of GXR and ATX using the SPD503-316 clinical trial data; utility inputs for health states were from the same trial. Drug costs were estimated based on unit price and daily average consumption. Medical services costs for each state were estimated based on respective resource use and unit costs. Deterministic (DSA) and probabilistic sensitivity analysis (PSA) with 5000 iterations were performed. Subgroup analysis was conducted among those previously treated with stimulants. Results: Among children and adolescents with ADHD, the ICER was £2303/QALY gained comparing GXR with ATX. ICER ranged from GXR being dominant to £51,753 in DSA. The probability of GXR being cost-effective was 76.1 % at a £20,000 willingness-to-pay (WTP) threshold. Among the subgroup of patients previously treated with stimulants, GXR dominates ATX. ICER ranged from GXR being dominant to £12,993 in DSA; the probability of GXR being costeffective was 95.1 % at the same WTP threshold in the subgroup. Conclusions: This analysis indicates GXR is a cost-effective treatment option compared with ATX among children and adolescents with ADHD.

P-10-008 Interaction between dopaminergic genotypes and fronto-striatal volumes predicting methylphenidate response in Attention-Deficit/Hyperactivity Disorder B.-N. Kim*, J. W. Kim, S.-C. Cho * Seoul, Republic of Korea Objectives: Methylphenidate (MPH) is one of the most frequently prescribed first-line therapeutic agents for attention-deficit/hyperactivity disorder (ADHD). However, previous reports on the relationship between dopaminergic genes and response to MPH have been conflicting. We hypothesized that the relationship between dopaminergic candidate gene polymorphisms and MPH response would be moderated by the volume of brain structures. Methods: Seventy-two children and adolescents with ADHD were enrolled in an 8-week, open-label trial of MPH and were grouped as either responders or non-responders according to their Clinical Global Impression-Improvement Scale (CGI-I) score. We examined whether dopamine transporter gene (DAT1), dopamine D4 receptor gene (DRD4), catechol-O-methyltransferase gene (COMT), and dopamine D2 receptor gene (DRD2)/ANKK1 Taq1A polymorphisms interacted with the volume of frontostriatal regions to predict MPH response. FreeSurfer software was used to estimate the volume of frontostriatal regions (orbitofrontal cortex, dorsal frontal cortex, anterior cingulate cortex, caudate nucleus, putamen, globus pallidus, and nucleus accumbens). Results: Significant interactions were found between the DRD4 VNTR polymorphism and frontal volumes in predicting MPH response, while COMT Val108/158Met, DRD2/ANKK1 Taq1A, and DAT1 VNTR polymorphisms interacted with subcortical volumes in predicting MPH response. Conclusions: Investigating the interaction between genotypes and brain volumes in the analysis of pharmacogenetic effects may provide novel insights into treatment response, especially for those psychotropic medications involving chemical neurotransmission.

P-10-010 Factors related to a lower response to methylphenidate in a continuous performance test (CPT) evaluation N. Lourenc¸o*, J. Boavida Fernandes, M. Jero´nimo, C. A. Alfaiate, M. Almeida, S. Nogueira, M. J. Seabra Santos, J. Boavida Fernandes * Coimbra, Portugal Objectives: Continuous Performance Test (CPT) is a practical instrument useful to assess the response to methylphenidate (MPH) in children and adolescents with Attention Deficit Hyperactivity Disorder (ADHD). Our objective was to assess the individual factors that could predict a worst response to MPH, measured on the CPT, in children and adolescents with clinical improvement. Methods: A 100 children and adolescents, all with a clinical positive response to MPH, were included in the study. The age range for admission was 6–18 years. Diagnostic assessments included structured interviews based upon the criteria of Diagnostic and Statistical Manual of Mental Disorders (DSM) IV, Conners and Achenbach questionnaires and the Wechsler Intelligence Scale for Children (WISC III). All children had an ADHD index on Conners questionnaires above 1 SD. Full scale Intelligence Quotient less than 80 and other neurological or psychiatric disorders were exclusion criteria. All children were assessed with CPT II Version 5.2 for Windows before and after treatment with MPH. A decrease in the Confidence Index for the clinical profile, less than 10 %, was considered a low response. Results: Children and adolescents with ADHD performed significantly better on MPH in all measures of CPT test. In our

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preliminary data, the presence of comorbidities, such as Oppositional Defiant Disorder was associated with a lower response on CPT. Further data are being processed and will be available next April. Conclusions: CPT II is very useful to easily demonstrate the response to MPH in children and adolescents with ADHD, but other factors, like comorbidities may be responsible for the failure of CPT to demonstrate improvement, in children and adolescents with a clinical significant improvement on medication.

Friday, 29 May 2015, 16.00 h–17.30 h

P-10-010 Milnacipran and atomoxetine in the treatment of adolescents with Attention-Deficit/Hyperactivity Disorder

D. Quinn*, T. Bode, B. DeSousa, B. Incledon, A. McLean, D. Lickrish

I. Martsenkovsky*, M. Inna

* Saskatoon. Sask, Canada

* Kyiv, Ukraine

Objectives: A novel drug delivery system, HLD100, has been developed with delayed- and extended-release characteristics, enabling night time dosing of dextroamphetamine to provide meaningful control of ADHD symptoms upon awakening and throughout the day. Five different formulations of HLD100 were initially developed, of which three of these candidate formulations were selected for further evaluation in adolescent and pediatric patients in the present study. The primary objective of this study was to evaluate the single-dose pharmacokinetics of HLD100, administered in the evening to children and adolescents with ADHD. The study design allowed pharmacokinetic parameters to be compared. Safety and tolerability was also assessed. Methods: Plasma sampling was performed at time zero and for 48 h (16 total samples). Patients received a single treatment B-HLD100 (15 or 25 mg) at 9 p.m. in the evening. Results: Based on the favourable pharmacokinetic profile of the first formulation evaluated (B-HLD100), subsequent formulations were not assessed in this phase 2 study. The primary study endpoint was to determine rate and extent of dextroamphetamine absorption. Safety and tolerability was also assessed. Twenty-two subjects were enrolled: 10 adolescents and 12 children. Conclusions: Evening dosing of B-HLD100, after 8 h lag time in significant drug exposure, provided a pharmacokinetic profile that would allow for clinically meaningful control of ADHD symptoms in the immediate post-waking morning period and throughout the day. Peak drug exposure was at approximately 3 p.m. PK parameters were equivalent between adolescents and children when adjusted for dose and body weight. AEs were mild in adolescents; no AEs were reported in children.

Objectives: Atomoxetine, the first FDA-approved, non-psychostimulant medication for the treatment of ADHD, was originally developed (as tomoxetine) for the clinical use as antidepressant. Milnacipran is a serotonin and norepinephrine reuptake inhibitor used in the clinical treatment of fibromyalgia and is currently being investigated in the treatment of ADHD and comorbid depression and anxiety in adults. In this study we studied the efficacy of both drugs in adolescents with ADHD. Methods: 46 adolescents with ADHD, aged 11–18 years (SD = 12.32), were recruited. We studied the efficacy and safety of milnacipran (50.0–100.0 mg; MD = 75 mg) and atomoxetine (40.0–60.0 mg; MD = 48.8) during a 8-week double-blind, placebo-controlled study with parallel groups of comparison and flexible doses in adolescents with ADHD. For ADHD and comorbid disorders diagnosing we used DSM-5 and K-SADS-PL, for ADHD symptoms severity—ADHD Rating ScaleIV, at baseline and every 2 weeks. Depressive and anxiety symptom severity were assessed by Children Depressive Inventory and Revised Children’s Manifest Anxiety Scale, behaviour symptom by Child Behavior Check List, tic symptoms—Yale Global Tic Severity Scale, obsessive–compulsive symptoms—Children’s Yale-Brown Obsessive Compulsive Scale before and at the end of the trial. Drug side effects were evaluated each 2 weeks during the study. Results: In the milnacipran group, improvement was observed in the ADHD Rating Scale-IV inattention score (MD from 13.9 to 9.5), hyperactive/impulsive score (MD from 13.1 to 7.7), and total score (MD from 27.5 to 17.1); in the atomoxetine group inattention score (MD from 14.4 to 9.2), hyperactive/impulsive score (MD from 13.7 to 7.2), and total score (MD from 26.5 to 16.4. Milnacipran therapy, unlike atomoxetine therapy, was accompanied by a reduction of comorbid depressive, anxiety, and obsessive symptoms that correlate with improved estimates for ADHD Rating Scale-IV. No serious side effects in both groups were observed. Conclusions: Milnacipran may be as effective as atomoxetine in the treatment of ADHD in adolescent. It is particularly effective in cases of comorbid depression and anxiety. Increased norepinephrine transmission might exert its effects for ADHD symptoms, serotonin transmission—depressive, anxiety and obsessive–compulsive symptoms.

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P-11 Pharmacological treatment - Children and adolescence II P-11-001 A phase 2 pharmacokinetic study of a modified release formulation of dextroamphetamine following evening administration to adolescents and children with ADHD

P-11-002 Sleep problems in ADHD youth before and during treatment with methylphenidate and atomoxetine M. Stein*, M. Garison, A. Hart, J. Newcorn * Seattle, USA

Objectives: To examine the effects of stimulant and non-stimulant medications in children with ADHD participating in a 2-site, double blind crossover study or OROS methylphenidate (MPH) and atomoxetine (ATX) titrated to an optimal dose. Methods: A previously validated, parent completed sleep rating scale was administered to 230 participants in the Methylphenidate-Atomoxetine Crossover (MACRO) study at baseline and after 3–7 weeks of treatment using a flexible dose titration. In addition, at one site parents also completed sleep diaries at baseline and end of treatment. Results: Sleep problems were common, especially prolonged sleep onset latency which occurred in 19 % of the sample at baseline, 23 % during MPH treatment (mean dose = 51 mg), and 11.9& during ATX (mean dose = 1.3 mg). MPH was associated with increased reports of insomnia. Weekend wake times were 21 min later on MPH compared to ATX, and there was a trend toward longer sleep duration on weekends with MPH versus ATX (p = .07). Conclusions: Sleep problems are common in ADHD youth and occurred at least once a week in 42 % of the sample. MPH is associated with longer sleep onset latency relative to ATX, and slightly longer sleep duration on weekends.

P-11-004 Outcome of ADHD treatment in young people age 14–18 years I. Takon*, S. Ozer, A. Khan, R. Beets, M. Atherton * Welwyn Garden City, UK Objectives: To assess outcome of treatment in young people attending ADHD clinic in East and North Herts. Methods: Young people age 14–18 years attending the East and North Herts ADHD clinics were surveyed using self-administered questionnaire between June 2014 and January 2015. Survey was part of audit of the ADHD service. Domains explored included diagnosis, medication use, school support, behaviour, follow up, support in and out of school, career and academic plans. Results: 31 completed questionnaires were analysed. There were 24 male respondents and 6 female respondents with one respondent’s sex being unrecorded. Mean age of respondent was 16 years and average duration on medication was 7 years. 27/31 respondents were on medication with majority treated with long acting stimulants. 27/31 respondents felt medication was helpful in improving their concentration with 12 respondents experiencing side effects from medication. 18/31 respondents reported receiving extra support in school with 12/18 feeling that support was adequate. Smoking was commoner than drinking amongst respondents with nine respondents indicating they smoke cigarette and two reporting that they smoke weed. Treatment with medication did not impact on smoking or drinking habits. 18/31 respondents had some focus regarding future career. Engineering and football were the most popular careers. 12/19 respondents expressed they will need medication long term. Young people expressed the need for a separate clinic for teenagers. Conclusions: Young people’s perception of ADHD treatment was overall positive and majority felt that treatment did make a difference. Views of young people regarding ADHD treatment should be explored regularly to help improve treatment compliance.

P-11-005 Randomized, double-blind, active- and placebocontrolled trials of lisdexamfetamine dimesylate in adolescents with Attention-Deficit/Hyperactivity Disorder J. Newcorn*, P. Nagy, A. Childress, G. Frick, B. Yan, L. Politza, S. Pliszka * New York, USA Objectives: To compare head-to-head the efficacy and safety of lisdexamfetamine dimesylate (LDX) and osmotic controlled-release methylphenidate (OROS-MPH) in adolescents with attention-deficit/ hyperactivity disorder (ADHD) in two clinical trials. Methods: Adolescents (13–17 years) with ADHD Rating Scale IV (ADHD-RS-IV) total score C28 were randomized 2:2:1 to LDX, OROS-MPH or placebo. Study 1 was an 8-week, flexible-dose (30–70 mg LDX; 18–72 mg OROS-MPH) design and study 2 was a 6-week, forced-dose titration (70 mg LDX; 72 mg OROS-MPH) design. The primary efficacy outcome was change from baseline to week 8 (study 1) or week 6 (study 2) in ADHD-RS-IV total score. Safety assessments included treatment emergent adverse events (TEAEs) and vital signs. Results: The safety and full analysis sets comprised, respectively, 459 and 452 participants in study 1 and 547 and 532 participants in study 2. Least squares (LS) mean ± SEM changes from baseline in ADHD-RSIV total scores in studies 1 and 2 were, respectively: placebo, -13.4 ± 1.19 and -17.0 ± 1.03; LDX, -25.6 ± 0.82 and -25.4 ± 0.74; OROS-MPH, -23.5 ± 0.80 and -22.1 ± 0.73. In both studies, LDX and OROS-MPH were statistically superior to placebo (placebo-adjusted LS mean ± SEM differences for studies 1 and 2 were, respectively: LDX, -12.2 ± 1.45 and -8.5 ± 1.27; OROSMPH, -10.1 ± 1.43 and -5.1 ± 1.27; all p \ 0.0001). The difference (LDX minus OROS-MPH) in LS mean ± SEM change was statistically significant in the forced-dose, study 2 (-3.4 ± 1.04; p = 0.0013) but not the flexible-dose, study 1 (-2.1 ± 1.15; p = 0.0717). Consistent with the known effects of stimulants, TEAEs occurring in C10 % of participants were decreased appetite and headache (LDX and OROSMPH in both studies), weight decreased (study 1: LDX and OROSMPH; study 2: LDX), and irritability (study 1: LDX). Conclusions: In adolescents, LDX was statistically superior to OROS-MPH in a study of forced-dose but not flexible-dose design. Safety and tolerability profiles of LDX and OROS-MPH were consistent with previous studies. Study funded by Shire Development LLC.

P-11-006 ADHD medication prescribing among young people with ADHD in the clinical practice research datalink 2005–2013: Analysis of time to cessation T. Newlove-Delgado*, T. Ford, W. Hamilton, K. Stein, O. C. Ukoumunne * Exeter, UK Objectives: Past studies of ADHD prescribing in primary care reported highest rates of medication cessation amongst 16 and 17 year

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olds with ADHD. Examining more recent trends is essential to support service planning and improve outcomes over the vulnerable transition period from child to adult services. Here we describe the time to cessation of ADHD medication amongst young people with ADHD aged 16 in the time period 2005–2014, using primary care prescribing records from the Clinical Practice Research Datalink, a large UK database. Methods: Cases with ADHD aged 16 during the study period (2005–2014) with at least 6 months of prescriptions for ADHD medication before their 16th birthday were included in the analysis. The outcome was time to medication cessation from the age of 16. Cessation of medication was defined as a break of over 6 months in prescriptions. The median time to cessation from the age of 16 was estimated, and Kaplan–Meier estimates were used to calculate the probability of survival (i.e. remaining on medication). Results: 1620 cases were included, of which 1419 (88 %) were male and 64 % had follow-up data for four or more years beyond their 16th birthday. During follow-up 75.9 % (n = 1230) experienced cessation. At 1 year, the probability of remaining on medication was 0.63 (95 % CI 0.61–0.65). At 2 years (i.e. at the age of 18), it was 0.41(95 % CI 0.39–0.43). The median time to cessation was 1.51 years (95 % CI 1.42–1.67). Conclusions: Despite estimated persistence of symptoms in up to 60 % of young adults with ADHD, most stopped medication by the age of 18 in this sample. These results provide further evidence of premature cessation of ADHD medication as they reach adulthood. Whilst young people may themselves choose to stop taking medication, ongoing efforts are needed to encourage medication use among those who still could still benefit.

P-11-007 Objective evaluation of ADHD in special needs settingsexplicating clinical outcomes

P-11-008 Digital follow up for children with ADHD E. Posener* * Netanya, Israel Objectives: To present a digital system using a simple smartphone application to follow up the response and side effect of the pharmacological treatment. Methods: A digital system was developed, (Supported by Janssen), by which the physician can register the patient to a smartphone application. The system can remind the patient to take the medicine as prescribed (Once daily or other), and also reminds him periodically to enter information about the effectivity and side effects (i.e., every second Sunday etc.) The variables for follow up are chosen by the physician with the patient and are presented as 5 point scales for each variable. The physician can see the changes as a diagram with the chosen variable on his private internet site. The information is shared only with the specific physician that registered the patient for the service. Results: 63 patients agreed to be involved in this project during 6 months. Only 20 % of parents that were registered were using the application only 20 % of these used it regularly as planned. Those that received proactive instructions by support team were using regularly the application. Conclusions: the digital system can be a very useful tool to follow up the response of individuals to treatment. It collects data and can present them graphically for convenience of the doctor and patient. Although the system is user friendly and takes 1–2 min each time, most parents did not adhere to using it regularly. We speculate that parents of children with ADHD find it hard to be compliant with the regular use of the system, even though they were reminded to do so each time. A more proactive approach of online support and telephone guided assistance could increase compliance.

S. Perera*, J. Kaleyias * Southend On Sea, UK Objectives: To evaluate the utility of objective evaluations in a School for Children with Severe ADHD and ASD. Methods: Routinely collected, Parent and Teacher rated ADHD, SDQ and ODD scores from a randomly selected sample of 30 children in SEN school for severe ADHD and ASD was analysed at two data points. Comparisons of mean values were performed using paired t-test (SPSS). Results: Median age 13 years (IQR 5.0–18.0). Primary diagnosis ADHD (28.6 %), ASD (50 %), LD (10.7 %), and others (10.7 %). Of patients on medication 28.6 % were on stimulants, 23.1 % non-stimulants and 15.4 % both. The teacher rated ADHD scores during the morning was 25 ± 11 during the first visit (V1) and 18 ± 13 during second visit (V2) (p = 0.033) during the afternoon was 20.7 ± 13 at V1 versus 20 ± 12 (p = ns). The parents rated ADHD symptoms score during the morning was 35 ± 18 at V1 versus 35 ± 11 at V2 (p = 0.033) while during the afternoon was 32 ± 18 at V1 versus 25 ± 15 (p = 0.012). The teacher rated ODD symptoms during morning was 13 ± 8 at V1 versus 10.2 ± 6.5 at V2 (p \ 0.001) and during afternoon was 10.5 ± 7 at V1 versus 9 ± 6 (p = 0.04). The parents rated ODD symptoms during morning was 16 ± 8 at V1 versus 18 ± 12 at V2 (p \ 0.001) and during afternoon was 15 ± 8 at V1 versus 13 ± 9 (p = 0.028). The teacher rated overall stress score was 17 ± 5 at V1 versus 14 ± 6.5 at V2 (p \ 0.037) and the parent rated overall stress was 23 ± 7 at V1 versus 20 ± 6 (p = 0.01). The teacher rated impact scores were not significant but the parents rated scores showed a trend. Conclusions: Objective evaluations are a useful to elucidate clinical outcomes.

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P-11-009 Association of DAT1 gene and clock gene (T3111C) genotypes, family functioning, parental psychopathology and treatment response in ADHD adolescents F. Delapena*, D. Guizar, L. Palacios, C. Cruz, V. Perez * Mexico, Mexico Objectives: To determine the association of comorbidity, poor family functioning, parental psychopathology, adverse events to medication, and polymorphisms at the untranslated region 30 (UTR) of DAT1 gene and T3111C polimorphism at the translated 30 region of clock gene with treatment response in ADHD adolescents. Methods: This is a comparative longitudinal study, conducted in the Adolescents Outpatient Clinic at the National Institute of Psychiatry RFM in Mexico City. Adolescents aged 13–18 years old were included and parents were evaluated after signing inform consent. Clinical evaluations were used to established ADHD diagnosis, comorbidities, family functioning and adverse events to medication. The international MINI interview was used for assessing parental diagnosis; genetic material was obtained by saliva samples. All adolescents were evaluated at baseline, and at 6 and 12 weeks later. Response was defined as reduction [50 % in the SNAP-IV scale at a minimum dose of 1 mg/kg/daily of methylphenidate. Results: Eighty-seven adolescents were evaluated at baseline and 45 subjects completed the 12 week evaluation with at least one parent included; 71.1 % were males. Among the 45 adolescents that completed the trial, 53.3 and 24.4 % presented comorbidity with externalizing and internalizing disorders, respectively. Comorbidity between ADHD and an externalizing disorder (V2 = 8.36, df 3,

p = 0.03), poor family functioning (V2 = 11.24, df 2, p = 0.004), presence of more side effects (V2 = 7.77, df 1, p = 0.005) and parental psychopathology (mainly MDD) (V2 = 5.23, df 1, p = 0.02) were associated with poor response to methylphenidate. No genetic associations were found between those who did or did not responded. Conclusions: Family functioning and parental psychopathology, as environmental factors, and comorbidity with externalizing disorders and great sensitivity to side effects, as individual factors, were associated with poor response to methylphenidate in adolescents with ADHD at this clinical setting. We failed to prove an association between assessed genetic variables and response to methylphenidate treatment, probably due to the sample size.

Friday, 29 May 2015, 16.00 h–17.30 h P-12 Pharmacological treatment - Adults I P-12-001 Predictors of response to atomoxetine for the treatment of adult patients with Attention-Deficit/Hyperactivity Disorder C. Bushe*, E. Sobanski, D. Coghill, L. Berggren, K. DeBruyckere, S. Leppa¨ma¨ki * Windlesham, Surrey, UK Objectives: We recently reported that adults with ADHD, treated for C24 weeks with atomoxetine, can be classified based on their treatment response trajectories. To evaluate background variables that facilitate early identification of those adults with ADHD who are likely to respond to atomoxetine. Methods: We analyzed pooled data from 8 clinical trials with treatment periods C24 weeks in which CAARS-Inv:SV total and CGI-S scores were available for atomoxetine-treated adult ADHD patients. Patients not meeting a robust definition of response (C30 % reduction in CAARS-Inv:SV total score at Week 24 versus baseline, and CGI-S score B3), or who dropped out before Week 24, were defined as non-responders. A resampling-based ensemble tree method (Battioui et al. JSM2013 Proceedings) was used to identify predictors of response. Sensitivity and specificity of identified predictors were calculated from responder rates as a measure of clinical utility. Results: Of 1945 adult ADHD patients, 548 (28.2 %) had a robust response to atomoxetine at Week 24, whereas 911 (46.8 %) discontinued. None of the included baseline parameters (age, sex, prior stimulant use, ADHD subtype, CAARS-Inv:SV, CGI-S) were statistically significant predictors of outcome. However, changes in CAARS-Inv:SV total, subscores and CGI-S at Week 4, or at Week 10, were statistically significant predictors of response at Week 24, e.g. a reduction in CAARS-Inv:SV total of C5.39 at Week 10 was seen for 85.9 % (n = 471/548) of responders but only 63.0 % (n = 566/899) of non-responders (sensitivity 85.9 %, specificity 37.0 %). The respective results for CGI-S at Week 10 were an improvement of C0.98 achieved in 80.8 % (443/548) responders but only 53.2 % (487/915) non-responders (sensitivity 80.8 %, specificity 46.8 %). Conclusions: CAARS-Inv:SV and CGI-S scores at Weeks 4 and 10 are statistically significant predictors of long-term response to atomoxetine in adults with ADHD. However, they are not specific enough for outcome prediction to be useful in routine clinical practice.

P-12-002 Effects of atomoxetine on functional outcomes, and correlation with the core symptoms of Attention-Deficit/ Hyperactivity Disorder in adult patients K. De Bruyckere*, C. Bushe, C. Bartel, L. Berggren, C. C. Kan, S. Stes, R. W. Dittmann * Brussels, Belgium Objectives: Atomoxetine treatment is associated with improvements in functional outcomes in patients with ADHD, although relationships with reductions in core ADHD symptoms have not been comprehensively investigated in adults. To assess relationships between functional outcomes and core ADHD symptoms in adults treated with atomoxetine. Methods: We analyzed data pooled from 7 short-term clinical trials of atomoxetine (N = 1085) versus placebo (N = 1076) in adults with ADHD. At Week 10, effect sizes (ES) were calculated using LOCF ANCOVA (ES [ 0 favor atomoxetine over placebo), and correlations between score changes were assessed using Spearman’s rank correlation coefficient (r). Results: At baseline, patients were impaired in quality-of-life (QoL)/functioning (e.g. Adult ADHD Quality-of-Life Scale [AAQoL] total, mean ± SD 46.2 ± 14.31; Sheehan Disability Scale [SDS] total, 16.8 ± 6.41) and by ADHD symptoms (Conners’ Adult ADHD Rating Scale-Investigator Rated: Screening Version [CAARSInv:SV] total, 35.1 ± 8.08). Baseline characteristics were similar in the atomoxetine and placebo groups. Treatment outcomes in general favored atomoxetine over placebo, and ES were similar for QoL (AAQoL ES = 0.34) and ADHD symptoms (CAARS-Inv:SV total ES = 0.40; inattentive ES = 0.36; hyperactivity-impulsivity ES = 0.38). In atomoxetine-treated patients, reductions in CAARSInv:SV total scores over time correlated with increases in AAQoL total (r = 0.58) and subscores (r range 0.39–0.55), and correlations were numerically stronger than in the placebo group (AAQoL total [r = 0.49] and subscores [r range 0.28–0.47]). Reductions in CAARS-Inv:SV total score with atomoxetine (LSmean ± SE -11.39 ± 0.28 at Week 10) were accompanied by improvements in AAQoL total (11.44 ± 0.60 at Week 10). Conclusions: Atomoxetine-treated adult patients experienced similar levels of improvement in core ADHD symptoms and functional outcomes, which were greater than with placebo. Moreover, the reductions in symptoms appeared to be associated with better QoL over time. These findings suggest that improvements in functional outcomes are related to reductions in core ADHD symptoms during treatment with atomoxetine.

P-12-003 Our experience with lisdexamfetamine dimesylate in southern Spain M. A. Ferna´ndez Ferna´ndez*, M. D. Morillo rojas * Gines, Spain Objectives: analyze the efficacy and safety of Lisdexamfetamine dimesylate in patients of all ages with ADHD. Methods: We present a series of 143 (at the time of sending summary) patients from Seville, Cadiz and Huelva. Data are presented in the following tables.

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Results: Reason to begin treatment:—Initial treatment: 45 %—Optimization of clinical Results: 15 %—Previous intolerance: 32 % Previous Treatment—MTFLR:5.6 %—MTF30/70:17.5 %—MTF50/ 50:22.3 %—MTFOROS:48 %—ATX:6.5 % Starting dose:—15 mg: 35 %—30 mg: 65 % Maintenance dose—15 mg: 5 %—30 mg: 35 %—50 mg: 40 %—70 mg: 8 %—[70 mg: 2 % Effectiveness— No answer 6.2 %—Partial Remission: 35.4 %—Total remission: 37.9 % Adverse effects—Less Appetite: 23.7 %—Headache: 10.3 %—Insomnia: 22.4 %—Rebound Effect: 3.2 %—Short duration of effect. 5.3 %. Conclusions: There are good tolerance initiating treatment with low doses (no problems in drug dissolution) and for newly diagnosed patients. The rates of clinical remission are high and the side effect profile is expected and well tolerated. The appearance of new therapeutic options in our environment helps reduce the percentage of non-responders patients and improve the quality of life of affected families.

P-12-004 Integrated diagnosis and treatment of adults with Attention-Deficit/Hyperactivity Disorder (IDEA) R. Fischer*, M. Ro¨sler, W. Retz * Iserlohn, Germany Objectives: This prospective, non-interventional cohort study observed the use of Medikinet adult (modified-release methylphenidate) in the treatment of adults with newly diagnosed ADHD and the assessment of efficacy, safety, and tolerability under daily routine conditions in Germany. Methods: Adults with newly diagnosed ADHD according to the validated IDA test (Integrated diagnosis of ADHD) were treated with Medikinet adult for 12–14 weeks. Primary outcome was efficacy based on Clinical-Global-Impression (CGI). Secondary outcome measures included patient-reported data (Wender-Reimherr-Interview-Self-Report-Scale—WRI-SRS), safety, tolerability, and dosage. Results: 468 patients from 126 centres were included. Mean age (±SD): 32.5 ± 10.8 years, 57.9 % were male. Psychiatric disorders were the most common (42.1 %) comorbidity (depression: 27.6 %). CGI-Severity-Scale: Severity of disease improved from baseline to 3.0 months (median, range 0.4–18.6 months): (0.5 vs. 0.2 % extremely ill, 13.8 vs. 4.8 % severely ill, 52.1 vs. 20.2 % markedly ill, 26.8 vs. 32.6 % moderately ill, 5.7 vs. 31.2 % mildly ill, 0.7 vs. 7.1 % borderline cases, 0.5 vs. 3.9 % not ill). CGI-Improvement-Scale: 74.5 % of patients were assessed as responders, defined as much and very much improvement in patient’s status. WRI-SRS: 35.4 % of patients were responders, defined by a C30 % reduction in WRI-SRS total score. Median dose at last visit: 40.0 mg/day (range 5.0–80.0 mg/day). Safety: 10.9 % of patients experienced a total of 100 adverse events. Reduced appetite and headache were reported most frequently. All but one (addiction) were not serious. Conclusions: Medikinet adult is effective and well tolerated under daily routine treatment conditions in adults with ADHD.

P-12-005 Adult ADHD treated with methylphenidate modifiedrelease (MPH-LA) maintained functional improvement over a period of 1 year M. Huss*, Y. Ginsberg, T. Arngrim, A. Philipsen, P. Gandhi, C.-w. Chen, V. Kumar

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* Mainz, Germany Objectives: Introduction and Objectives A previous 40-week, randomized, double-blind placebo-controlled core study comprising 3 phases (9-week dose confirmation phase, 5-week real-life dose optimization phase and 6-month maintenance of effect phase) reported that MPH-LA (40–80 mg/day) in adults with childhood-onset ADHD, controlled ADHD symptoms as well as reduced functional impairment, with a good tolerability profile (Huss M, et al. Adv Ther 2014;31:44–65). Herein, we report maintenance of functional improvement in MPH-LA treated adult ADHD patients from a 26-week open-label extension phase of the same study using Sheehan Disability Scale (SDS) total and subscale scores. Methods: All patients entering extension phase (n = 298) were initiated on treatment with MPH-LA (20 mg/day) that was up-titrated in increments of 20 mg/week to reach individual patient’s optimal daily dose of 40, 60 or 80 mg. Functional improvement was determined by decrease in SDS total, subscale (work, social-life and family-life disability), days lost and days underproductive scores at the end of extension study from maintenance of effect baseline and extension baseline. Results: At the end of extension phase, mean change in SDS total, work, social-life and family-life subscale scores from maintenance of effect baseline was -1.4, -0.4, -0.4 and -0.5 points, respectively and from extension baseline was -4.8, -1.8, -1.4 and -1.6 points, respectively. Mean change in days lost from maintenance of effect baseline and extension baseline was -0.2 and -0.5 points, respectively; and in days underproductive was -0.2 and -1.2 points, respectively. The safety results were consistent with the established safety profile for MPH-LA. Conclusions: In adults with childhood-onset ADHD, long-term treatment with MPH-LA maintained functional improvement.

P-12-006 Long-term safety of methylphenidate modified-release in adult ADHD upon continuous exposure up to 66 weeks M. Huss*, Y. Ginsberg, T. Arngrim, A. Philipsen, P. Gandhi, C.-w. Chen, V. Kumar * Mainz, Germany Objectives: Previously we reported the safety and efficacy of methylphenidate modified-release (MPH-LA) in adult attention-deficit/hyperactivity disorder (ADHD) in a 40-week, randomised, double-blind placebo-controlled core study (Huss M, et al. Adv Ther 2014;31:44–65). It was followed by a 26-week, open-label, flexibledose extension study. Here, we report the safety of MPH-LA for the complete 66-week core and extension studies. Methods: Safety was monitored for the complete duration of 66 weeks in terms of adverse events (AEs) and their severity associated with maximum continuous exposure of MPH-LA for various time periods B6, [6, and [12 months. All patients’ randomised at start of the core study were included in this analysis. A total of 341, 354 and 136 patients were continuously exposed to MPH-LA for B6 and [6 and [12 months, respectively throughout the 66-week study. Results: The overall incidence of AEs were 80.6 % (B6 months), 85.3 % ([6 months) and 88.2 % ([12 months). Most AEs reported were mild-to-moderate in severity. The observed increase in incidence of AEs was not greater than the relative increase in the duration of exposure. The incidence of AEs in patients was comparable across groups for most system organ classes including cardiac disorders. A total of 9 (1.3 %) and 2 (0.7 %) SAEs were observed during the core and extension studies. None of these SAEs were suspected to be study

drug related. No clinically meaningful changes were observed between groups with respect to laboratory findings, vital signs or ECGs. No deaths were reported during this 66-week period. Conclusions: The safety profile of MPH-LA did not change with the longer duration of treatment in adult patients with ADHD and was comparable amongst the patients continuously exposed to MPH-LA for various time periods (B6, [6 and [12 months).

Friday, 29 May 2015, 16.00 h–17.30 h P-13 Pharmacological treatment - Adults II P-13-001 Real-world treatment outcomes in adults with AttentionDeficit/Hyperactivity Disorder treated with lisdexamfetamine versus atomoxetine following methylphenidate treatment A. Joseph*, M. Cloutier, A. Guerin, R. Nitulescu, V. Sikirica * Zug, Switzerland Objectives: To compare treatment adherence, discontinuation and daily average consumption (DACON) between adult patients with attention deficit/hyperactivity disorder (ADHD) receiving lisdexamfetamine or atomoxetine as second-line therapy following methylphenidate treatment. Methods: Adult patients with ADHD initiated on either lisdexamfetamine (lisdexamfetamine cohort) or atomoxetine (atomoxetine cohort) as second-line therapy (index date) following methylphenidate were identified in a large US commercial claims database (Q2/ 2009–Q3/2013). Patients were continuously enrolled in their healthcare plan C6 months prior to methylphenidate initiation (washout period; no ADHD medication) and C12 months after index date (study period). Treatment adherence (medication possession ratio [MPR] of C0.8), discontinuation (treatment gap of C60 days) and DACON (number of tablets/capsules per day) were compared between cohorts during the study period. Kaplan–Meier [KM] rates were compared using log-rank tests. Multivariate regression models adjusted for differences in patient characteristics: ordinary least square models for MPR, logistic for the probability of being adherent and DACON [1, and Cox proportional-hazards for discontinuation. Results: A total of 3392 patients were selected (lisdexamfetamine: 2718, atomoxetine: 674). Mean (standard deviation) age was 32 (13) years and 46 % were male. During the study period, the lisdexamfetamine cohort had higher MPR (0.51 vs 0.32; p \ 0.001) and higher probability of being adherent (27 vs 13 %; p \ 0.001) than the atomoxetine cohort (adjusted odds ratio [OR]: 2.73; p \ 0.001). Fewer patients in the lisdexamfetamine cohort discontinued treatment (KM rates: 63 vs 85 %; p \ 0.001) than in the atomoxetine cohort (adjusted hazard ratio: 0.53; p \ 0.001). The DACON was 1.10 and 1.31 for the lisdexamfetamine and atomoxetine cohorts, respectively (adjusted OR 0.20; p \ 0.001). Conclusions: Following methylphenidate treatment, patients receiving lisdexamfetamine as second-line therapy had higher treatment adherence and lower discontinuation and DACON relative to those receiving atomoxetine. Research is needed to confirm the symptomatologic and functional changes that may drive these treatment outcomes.

P-13-002 Complications in a case of adult ADD: Bupropioninduced seizure and a MRI-finding M. Koelle*, G. Groen, N. Kahn, D. Brummer * Ulm, Germany Objectives: Methylphenidate as well as noradrenergic/dopaminergic non-stimulants can be used to treat Attention-Deficit-/-HyperactivityDisorders (ADD/ADHD) in adults. Here we want to demonstrate a diagnostic and therapeutic procedure in an adult ADD patient who first suffered severe complications under bupropion and then was successfully treated with methylphenidate. Methods: Case Report. Results: We here report the case of a 22 year-old patient who suffered from ADD and had been treated with bupropion before admission to our hospital. He had unintentionally overdosed bupropione and had suffered a seizure probably due to bupropione overdose and also due to a left-temporal arachnoid cyst, which was detected by MRI after the first-time seizure. Bupropione-therapy was stopped. We carefully weighed up potential risks and benefits of a treatment with stimulants. Methylphenidate was started under careful observation and showed a significant clinical improvement with respect to ADDsymptoms. There were no further adverse drug effects. Conclusions: The case demonstrates the importance of a careful diagnostic workup before starting a pharmacological therapy. Second important issue highlighted here is the efficiency of methylphenidate therapy compared to non-stimulants even in delicate situations.

P-13-003 Monitoring dose effects of stimulant medication with AQT processing speed in adults with ADHD N. P. Nielsen*, E. H. Wiig, S. Ba¨ck, G. Ege, J. Gustafsson, C. Hornborg, G. Magell * Copenhagen, Denmark Objectives: To evaluate the clinical use of objective processingspeed measures to monitor pharmacological treatment with methylphenidate. Methods: A Quick Test of Cognitive Speed evaluated processing speed with no, low- and high-dose medication (Medikinet) in 69 adults with ADHD in a controlled, multicenter study. Results: Fifty-five participants responded to the experimental treatments. One-way ANOVA with post hoc analysis across treatments indicated statistical differences for color (F 2,162 = 11.67; p \ 0.01; g2 = 0.13), form (F 2,162 = 20.34; p \ 0.001; g2 = 0.20) and color-form naming (F 2,162 = 20.42; p \ 0.001; g2 = 0.20) and effect sizes ranged from medium to high. There were statistical differences between no and high-dose medication, but not between lowand high-dose medication for all measures. Fourteen were non-responders and naming times (s) changed minimally and stayed within the normal range throughout treatment. Thirteen performed within the normal range for all measures and treatment conditions. Intra-individual response variability in color-form naming for no-medication and high-dose medication was calculated by subtracting the shortest from the longest time (s). Wilcoxon matched pairs test indicated

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significantly greater intra-individual variability for the NM than the HD condition for responders (Z = 4.44; p \ 0.001), but not for nonresponders (Z = 0.31; p [ 0.05). Conclusions: Color-form naming and overhead proved most sensitive to treatment effects. Cognitive speed (color-form) and processing efficiency (overhead) differentiated ADHD responders and non-responders (sensitivity 87 % and specificity of 93 %), supporting that AQT may complement traditional methods used for basic assessment of ADHD. Intra-individual response variability was significantly reduced, suggesting that this anomaly might be treatable with stimulant medication.

P-13-004 Eye movements: Good marker of methylphenidate efficiency in ADHD M. Seassau*, F. Duval, A. Erb, T. Weiss, R. Carcangiu * Ivry-Sur-Seine, France Objectives: Attention-Deficit/hyperactivity disorder (ADHD) is characterized by behavioral symptoms of inattention and may include hyperactivity and impulsivity. The impulsivity and inattention suggest deficits in the voluntary control of behavior. Eye movements depend on structures implicated in attention and in motor control, both criteria areas of dysfunction in ADHD. In the present study, objective was to evaluate the effect of methylphenidate (MPH) using eye movements in ADHD patients, naı¨ve to treatment. Methods: Fifty nine ADHD patients (44 adults and 15 children) participated to this study. Saccade and antisaccade tasks were proposed to drug naı¨ve patients during a first examination (V1) early in the morning (T1) and at midday (T2). Same tasks were then proposed during a second examination (V2), just after the first dose of MPH (10 mg per os). MPH efficiency was measured by the comparison of V1 and V2. Test–retest effect was measured between T1 and T2. Latencies, velocities, precision, accuracy and percentage of anticipatory errors were analyzed. Results: We found a positive effect of MPH on percentage of anticipatory (p \ 0.009); on accuracy (p \ 0.0002); on latencies (p \ 0.0008); and on precision (p \ 0.01). Performances were significantly better On-MPH than Off-MPH, particularly on antisaccades tasks. Standard deviations were also shorter On-MPH compared to Off-MPH (p \ 0.0001). Same pattern of performances was observed on adults and on children. Importantly, no test–retest effect was observed between T1 and T2. Conclusions: MPH modified motor planning and response inhibition in ADHD patients. Benefits could be observed using reflexive saccades and antisaccades just after the first dose of MPH. These results suggest that eye movements could be a good marker of MPH efficiency in ADHD.

P-13-005 Long-term open-label treatment with atomoxetine in European adult outpatients with Attention-Deficit/ Hyperactivity Disorder H. Upadhyaya*, Y. Tanaka, D. Williams, R. Escobar, S. Leppa¨ma¨ki * Indianapolis, USA Objectives: To assess the safety and efficacy of open-label atomoxetine in adult outpatients with attention-deficit/hyperactivity disorder (ADHD).

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Methods: This study was the 2-year open-label extension phase of a phase 3, double-blind, maintenance of response (randomized withdrawal) trial of atomoxetine versus placebo in adult outpatients with ADHD (approximately 1 year). The following scales were used: Conners’ Adult ADHD Rating Scale–Investigator Rated: Screening Version (CAARS-Inv:SV), the Behavior Rating Inventory of Executive Function–Adult Version: Self Report (BRIEF-A: SelfReport), and the Adult ADHD Quality of Life scale (AAQoL). The first visit of the open-label extension was used as baseline; all statistics are based upon last observation carried forward data. Results: The majority of patients were Caucasian (99.4 %) and male (52.8 %); mean age was approximately 34 years. Of the 180 patients who entered the final open-label extension phase, 96 (53.3 %) completed the study. In total, 68.3 % of patients reported C1 treatmentemergent adverse event (TEAE). The most common TEAEs were nasopharyngitis (12.2 %), headache (9.4 %), influenza (5.6 %), and nausea (5.0 %). As expected, the least squares (LS) mean change from baseline in the CAARS-Inv:SV total score and subscale scores, as well as the AAQoL total score and subscale scores were not statistically significant. However, the LS mean change (standard error) in the BRIEF-A: Self Report Global Executive Composite index was statistically significant for baseline to 42 weeks (-4.3 [1.68]; p = 0.005) and for weeks 42 through 102 (-4.1 [1.96]; p = 0.003). Conclusions: Improvements in ADHD symptom reduction and quality of life, were maintained with atomoxetine treatment during the 2-year extension phase, but executive function showed further improvement. Safety and tolerability of atomoxetine in this extension study were similar to that in previous studies.

P-13-006 Off-Label use of guanfacine XR in adult ADHD: A clinical experience A. Vincent* * Saint-Augustin-de-Desmaures, Canada Objectives: Treatment options for adult ADHD include psychoeducation, adaptive strategies, specific psychotherapies and medication. This project explores the clinical effects of off-label use of guanfacineXR in adults with ADHD who did not achieve good clinical outcomes with standard ADHD medications. Methods: Retrospective chart review of adults followed at our ADHD clinic who tried guanfacineXR between 2013 and 2014. Results: 33 patients (males: 16, females: 17, mean age: 38 y.o., range 18–57 y.o.) tried guanfacine XR (reason: = sub-optimal response to psychostimulants (21, M: 9, F: 12) or no clinical response after methylphenidate, amphetamines and atomoxetine trials (12, M: 7, F: 5). Most had comorbidities (anxiety: 17, depression: 9, tics: 7, severe behaviors or personality disorders: 6). Atomoxetine (3) and clonidine (1) were stopped before starting guanfacineXR. Most patients (29) took one or more medications (psychostimulants: 17, antidepressants: 19, atypical neuroleptics: 7, antiepileptics: 2, modafinil: 3). GuanfacineXR was started at 1 mg/day and increased at intervals of at least 1 week by 1 mg up to 4 mg. 17 patients stopped guanfacineXR either because of lack of clinical effect (2 females) or significant side effects (15, Males: 6, Females: 9; details: fatigue or sedation: 9, hypotension: 2, worsening of previously existing problems: tics + eczema: 1, arrhythmia: 1, sleep disorder: 1, impulsive behaviors: 1). 16 patients (M: 10, F: 6) continued guanfacineXR (mean dose: 3.7 mg), after experiencing ADHD symptoms reduction with a good tolerability profile. Good clinical outcome permitted a change of other me´dications (reduction psychostimulants: 2, modafinil: 1) or cessation (atomoxetine: 2, clonidine: 1, modafinil: 1, duloxetine: 1).

Conclusions: Guanfacine XR may be an interesting treatment option in adults with complex ADHD who fail standard medication trials. Further research is needed.

P-13-007 Continuity of treatment with methylphenidate in adults with ADHD after seven years V. Breda*, R. Karam, D. Rovaris, F. Picon, M. Victor, C. Salgado, E. Vitola, N. Mota, K. Silva, P. Guimaraes-da-Silva, M. Meller, P. Belmonte-de-Abreu, L. Rohde, E. Grevet, C. Bau * Porto Alegre, Brazil Objectives: Drug treatment of ADHD in adults has high response rates and there is evidence that treatment adherence is associated with better outcomes. However, controlled clinical and naturalistic trials showed low rates of treatment adherence. Within this framework, research on the continuity of medical treatment and individual characteristics that influence the pattern of use for long periods is required. This study aims to identify predictors of treatment continuity and individual motivations for discontinuing the use of methylphenidate in a clinical sample of adults with ADHD. Methods: This is a prospective follow-up study of adults with ADHD (n = 344; mean age of 34.1 years; 49.9 % males) evaluated in an ADHD outpatient Program. Lifetime diagnoses were based on DSMIV criteria through semi-structured interviews by trained psychiatrists blinded to baseline status. ADHD and oppositional defiant disorder were evaluated with the K-SADS-E, and other comorbidities with SCID-IV and MINI. TCI inventory was used to assess temperament. A questionnaire on treatment adherence was applied. The main outcome of this study was the continuation of methylphenidate treatment after 7 years. In this analysis we used forward linear regression models. Results: Seven years after baseline, 24.9 % of patients continued using methylphenidate. Women (b = 0.18, t = 2.80, p = 0.006), to be single at baseline (b = 0.17, t = 2.64, p = 0.009), lower ADHD age of onset (b = 0.02, t = 2.06, p = 0.04), and lower harm avoidance scores (b = 0.01, t = 2.41, p = 0.02) were characteristics that predicted continuity of medication use. The more frequently cited reasons to suspend treatment were side effects (50.4 %), fear of methylphenidate dependence (32.9 %) and cost of medication (27.2 %). Conclusions: Although discontinuity was the most prevalent outcome, a relevant group of patients was still in methylphenidate use after a long period. A profile of these patients was described and may be useful to improve clinical approaches and future research.

Friday, 29 May 2015, 16.00 h–17.30 h P-14 Quality of life/Caregiver burden I P-14-001 The investigation of perception of parental acceptance and rejection In Turkish children with ADHD P. C. Aksu*, O. Surucu, G. Erden * Ankara, Turkey Objectives: The aim of this study was to investigate the relationship between perceived parental acceptance–rejection, parental control and psychological adjustment of the child and personality characteristics of the mother in children with ADHD.

Methods: 41 children with ADHD, between 4th and 8th grade were compared to 50 children with no mental health diagnosis who were matched with the ADHD group on age, gender and levels of parental education and occupation. Data collection was done through demographic information form, Parental Acceptance–Rejection/Control Questionnaire (PARQ/C), Personality Assessment Questionnaire (PAQ), Revised Conners’ Parent Rating Scale-Long/CPRS-R-L, Revised Conner’s Teacher Rating Scale-Long-CTRS-R-L and Basic Personality Traits Inventory. Results: Findings revealed that children with ADHD were more rejected by their parents. Among all the children total score of perceived maternal and paternal acceptance–rejection and scores of subtests do not change according to gender. Personality characteristics of the mother had statistically significant effect on perceived maternal acceptance–rejection. Among the personality characteristics of the mother, being extrovert, responsible, open to development and agreeable decreased the degree of perceived maternal rejection. In addition mother’s personality characteristics influenced child’s psychological adjustment. Conclusions: Our results indicate that degree of perceived maternal and paternal rejection among children with ADHD was higher than those without a diagnosis of any psychological disorder. Overall, findings of the study shed light to the importance of parental rejection in ADHD and therefore draws attention to psychoeducation and including parents in the treatment plan.

P-14-002 Self-concept and quality of life in children with ADHD M. Almeida*, J. Boavida Fernandes, A. R. Fernandes, C. Alfaiate, S. Nogueira, M. J. Seabra Santos * Coimbra, Portugal Objectives: Quality of life (QoL) and self-concept (S-C) have become increasingly important measures of outcome in child mental health clinical work and research. The objective of this study is to assess what is the impact of ADHD on QoL and self-concept of children with ADHD. Methods: 30 children and adolescents referred to the ADHD Clinic of Coimbra Children’s Hospital, Child Development Center, have been included in the study, before treatment. The age range for admission was 8–14 years. Diagnostic assessments included structured interviews based upon DSM 5 criteria, Conners and Achenbach questionnaires, Conners Continuous Performance Test (CPT II) Version 5.2 for Windows and the Wechsler Intelligence Scale for Children (WISC III). As far as IQ is concerned, the full scale IQ had to be 80 or over. All children had an ADHD index on Conners questionnaires above 1 SD, and other neurological or psychiatric disorders were exclusion criteria. To assess QoL and S-C, the following instruments were used: Kidscreen-52 Children and Adolescent Version, Kidscreen-52 Parent Version (The KIDSCREEN Group, 2004; Translation and adaptation: Matos, Gaspar, Calmeiro & KIDSCREEN Group, 2005), Strengths and Difficulties Questionnaire—SDQ Parent Version (Goodman 2005), Piers-Harris Children’s Self-Concept Scale 2 (Piers & Hertzberg 2002; Veiga 2006). Results: Final results are expected next April, but all preliminary data show that children and adolescents with ADHD have significantly lower QoL and S-C scores, when compared with children from the control group. Conclusions: The current published evidence indicates that QoL and S-C are both impaired in children with ADHD. Furthermore, there is evidence to support a relation between severity of symptoms and these 2 measures. Based on final results not yet available, the authors will discuss the implications of findings and identify areas for future studies.

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P-14-003 Is impulsive buying behaviour associated with traits of ADHD in an adult community sample? D. F. Bangma*, J. Koerts, A. B. M. Fuermaier, O. Tucha, L. Tucha * Groningen, The Netherlands Objectives: Problems with financial management are common among adults with Attention Deficit Hyperactivity Disorder (ADHD) and might at least partly be explained by impulsive buying behaviour. The present study examines the association between impulsive buying behaviour and traits of ADHD in a community sample. Methods: Self-reported ADHD symptoms were determined in a sample of 124 healthy participants (age range 19–83 years) using the ADHD Rating Scale. Twenty-four adults reported a clinically significant number (i.e. [6) of ADHD symptoms retrospectively in childhood. Twelve adults reported a clinically significant number (i.e. [5) of ADHD symptoms in adulthood, of which five adults reported persistent ADHD symptoms (i.e. a clinically significant number of symptoms in both childhood and adulthood). The comparison group (n = 86) consisted of individuals who reported no ADHD symptoms, neither in childhood nor in adulthood. Impulsive buying behaviour was assessed with an Impulsive Buying Questionnaire (IBQ). Results: Participants who reported to have symptoms of ADHD in either childhood or adulthood showed significantly higher scores on the IBQ compared to participants reporting no ADHD symptoms. No differences were found between participants who reported to have ADHD symptoms in childhood and participants who reported ADHD symptoms in adulthood. However, participants who reported persistent ADHD symptoms displayed significantly higher scores on the IBQ than participants who reported ADHD symptoms in childhood and participants without ADHD. Conclusions: Adults who report persisting ADHD symptoms from childhood to adulthood appear to be most vulnerable for impulsive buying behaviour. However, impulsive buying behaviour can also be present in adults who report to have non-persistent ADHD. It currently remains unclear whether the self-reported impulsive buying behaviour is associated with (financial) problems in daily life. More research on financial management in adults with ADHD, or in adults with a history of ADHD, is therefore needed.

P-14-005 Healthcare use in children with Attention-Deficit/ Hyperactivity Disorder (ADHD) in France: Results from the QUEST survey H. Caci*, D. Cohen, O. Bonnot, B. Kabuth, J.-P. Raynaud, S. Paille´, L. Valle´e * Nice, France Objectives: Healthcare use in children with ADHD is poorly documented. The objective of this national survey was to identify the successive stages of assessment by healthcare professionals leading to ADHD diagnosis and treatment, and potential areas for improvement. Methods: A cross-sectional survey was conducted in France between 2013/11/04 and 2014/01/31 among a national sample of 61 physicians responsible for children with ADHD, using a self- or parent-report questionnaire. Results: 473 questionnaires were analysed. The first symptoms of ADHD (behavioural disorders and attentional disorders: 78.2 and 70.0 %, respectively) were identified at a mean age of 4.5 years by nonfamily members (predominantly teachers) in most cases. Age at diagnosis was 8.1 years, approximately 4 years after the first symptoms were observed. Prior to ADHD diagnosis, families consulted a mean of

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3.5 healthcare professionals. Psychiatrists/child psychiatrists were most commonly consulted, regardless of the stage of assessment. During the first stage of assessment, only 10.7 % of patients were diagnosed. This delay may partly explain the high rate of repeated school years (31.5 % patients), particularly the first 2 years of primary school, and the high degree of dissatisfaction with care received, mainly during the first stage of assessment (38.6 % dissatisfied). Two profiles of patients were identified by a cluster analysis: the first group (89.9 % boys) presented behavioural problems, restlessness, and family issues; the second group (49.0 % boys), who exhibited less pronounced hyperactivity symptoms, took one additional year to receive an ADHD diagnosis. In our sample, more than two-thirds of patients received pharmacological treatment; methylphenidate in 98.0 % of cases. Delayed diagnosis was the main source of concern for caregivers. Conclusions: From first symptoms to diagnosis, the duration of the healthcare circuit of children with ADHD was approximately 4 years, which may represent a loss of opportunity for these patients.

P-14-006 Voices of experience: A qualitative study of stress, emotion, and coping in the lived experiences of children with ADHD K. Carr-Fanning* * Coventry, UK Objectives: This multi-case children’s voice research project explored the lived experiences of young people with ADHD in an Irish context. A constructionist and transactional approach to stress, emotion, and coping explored ‘‘needs’’, free from ‘‘labels’’, and incorporated a strengths-based perspective, to contribute to understanding of ‘‘what works’’ in practice (Lazarus and Folkman 1984). Methods: The main study included 15 young people with ADHD (aged 7–18 years), their parents, and teachers. Participants took part in a semistructured interview. Child consultations were facilitated using an innovative theory-driven and evidence-based draw-label-dialogue technique. All sessions were recorded, transcribed, and coded using principles of Thematic Analysis (Braun and Clarke 2006), visual materials were subject to Content Analysis (Miles and Huberman 1994). Further triangulation was achieved using other evidence-based sources, which contributed to a highly contextualized understanding of children’s experiences across ecological niches (Bronfenbrenner 2005). Results: Findings address three areas: (a) lay theories of ADHD; (b) problems (factors contributing to negative niches); and (c) what works in practice (factors contributing to positive niches). Conclusions: Young people with ADHD reported experience distress across all contexts (e.g., school, CAMHS, and home), often responding to feelings of stress and overwhelmed by acting out or shutting down. Findings suggest that parents’ and teachers’ lay theories of ADHD and of behaviour, have an impact on the experiences, behaviour, development (including self-perceptions), and self-management of children with ADHD. The importance of positive relationships with adults and adopting a holistic strengths-based approach in understanding and responding to ADHD in practice were identified as a key themes.

P-14-007 Mother–child relationship in siblings of adolescents with Attention-Deficit/Hyperactivity Disorder (ADHD) J. P.-Chen Chang*, S. S.-Fen Gau * Taichung, Taiwan

Objectives: Rate of attention deficit hyperactivity disorder (ADHD) in siblings of probands with ADHD is seven times higher than in general population and impaired mother–child relationship in ADHD probands had been reported. However, there is sparse research on the mother–child relationship in siblings of ADHD adolescents. This work examined mother–child relationship in affected and unaffected siblings of adolescents with ADHD as compared to that of ADHD adolescents and non-ADHD school controls. Methods: The study enrolled 122 probands, aged 10–16, with DSMIV ADHD, 44 affected and 78 non-affected siblings, and 122 nonADHD. Both participants and their mothers received the K-SADS-E interviews and reported on mother–child relationship and family function. Results: Both reports revealed affected siblings and ADHD adolescents had less affection/care and more authoritarian control than unaffected siblings and non-ADHD adolescents. Meanwhile unaffected siblings and non-ADHD adolescents had less impaired mother– child relationship and fewer problems with parents than ADHD adolescents. However, siblings regardless of affected status and ADHD adolescents had lower perceived family support than nonADHD adolescents. Both mothers and adolescents had similar views on reports of maternal overprotection and mother–child relationships, yet disagreed on reports of maternal affection and control, problems with parents and perceived family support. Conclusions: The finding suggested that the presence of ADHD had impact on maternal parenting behaviors toward the children themselves; whereas, having a child with ADHD was associated with decreased perceived family support regardless of ADHD status in the same family.

P-14-008 The impact of comorbid conditions on caregivers’ work, social and family activities: Results from the caregiver perspective on paediatric ADHD (CAPPA) study in Europe K. Chen*, M. Fridman, J. Quintero, V. Harpin, T. Banaschewski, M. H. Erder, V. Sikirica * Wayne, USA Objectives: To evaluate the impact of comorbid conditions in European children/adolescents with attention-deficit/hyperactivity disorder (ADHD) on work and social activities of their caregivers. Methods: CAPPA is a cross-sectional online survey completed between 2012 and 2013 by caregivers of children/adolescents aged 6–17 years with ADHD in 10 European countries. Responses for children/adolescents on ADHD pharmacological treatment at the time of survey completion were analysed. Caregivers were asked about the impact of caring for their child on work, social activities and family relationships, and other diagnosed comorbidities. The number of comorbidities was summarized as 0, 1, 2 or 3+. Comorbidity impact on number of work hours lost was estimated using linear regression. The Cochran–Mantel–Haenszel non-zero correlation test was used to examine the increased comorbidity impact for ordinal variables. Results: Among 2853 respondents, 1394 (49 %) caregivers reported at least one diagnosed comorbidity for their child; 24, 12 and 13 % reported 1, 2 and 3+, respectively. Comorbidities affecting C5 % children included: anxiety (13 %), learning difficulty (12 %), conduct disorder (12 %), aggression (11 %), insomnia (8 %), autism (7 %), Asperger’s syndrome (6 %) and depression (5 %). The incremental work hours lost in a 4-week period compared with children without comorbidities were 1.7 for both 1 and 2 comorbidities, and 3.6 for 3+ comorbidities (p \ 0.01). Increased number of comorbidities correlated with increased caregiver burden in: (1) maintaining their job and

work schedule, (2) participating in social activities and having a social life, (3) enjoyment from social activities when with the child, (4) avoiding taking the child to outside activities, (5) need to plan the day around the child, (6) worrying about the child and (7) relationship with their partner and other children (p \ 0.0001). Conclusions: Comorbidities in children/adolescents receiving ADHD medications significantly impacted caregivers’ work, social and family life. These findings suggest the need for improved overall management of ADHD patients with comorbidities.

P-14-009 Risky sexual behaviour adolescents with ADHD undervalued source problems M. Dabkowski*, M. Dabkowska * Torun, Poland Objectives: Risky sexual behaviours are common in population of adolescents with ADHD with devastating consequences. Impulsiveness, prone to risky behaviour not foreseen the consequences and especially the chronic lack of positive reinforcement from significant others and peers predisposes young people with ADHD to unwanted sexual behaviour. The noxious influences of such behaviours disturb not only personal development of all involved persons but also damage the well-being of the surrounding milieu—especially if the remedial methods (legal and educational) does not take into account the specificity of clinical perpetrators. Methods: During last 8 years of dealing with adolescents revealed troubled sexual behaviours (as forensic psychiatric and psychological experts and in out-patient as well as in-patient settings) the cohort of over 400 girls and boys (age 12–18 y.o.) were observed. Their mental state was assessed and risky sexual behaviours were categorized. The clinical conclusions and proposed therapeutic approaches/educational policies were addressed to Family Courts and to care-givers. Results: The substantial percentage (85 %) of adolescents revealed risky sexual behaviour referred to psychologist and child and adolescent psychiatrist were mentally disturbed. They were mostly with externalized disorders; with more than three-quarters refer to ADHD or ADHD with associated conduct disorder or oppositional defiant disorder. The most common risky behaviours were sexing, dating violence, sexual bullying, sexual abuse (also against much younger people) and even rape. In the legal framework issued appropriate recommendations—Cognitive Behavioural Therapy and pharmacotherapy along with Family Therapy. Conclusions: Insightful diagnostic procedures allow proper identification of sources of risky sexual behaviour; avoid legal restrictions impacts only to punish and serve implement effective remediation methods and finally the seriousness of the Court might render the implementation of recommendations.

P-14-010 Costing adult Attention-Deficit/Hyperactivity Disorder: Impact on the individual and society D. Daley*, R. H. Jacobsen Højbjerg Jacobsen, A. Mette-Lange, J. Walldorf, A. Sørensen * Nottingham, UK Objectives: Few studies have been able to explore the costs associated with ADHD uncontaminated by Diagnosis or comorbidity which can potentially distort the associated costs. This study explores the economic costs of undiagnosed and untreated ADHD.

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Methods: Four thousand four hundred and fifty two adults aged 18–50 with a registered diagnosis of ADHD in adulthood without a diagnosis of ADHD in childhood were identified from the Danish National Patient registers. Patients were over 18 at time of assessment and received a diagnoses between 1995 and 2010 (ICD F90.0, F90.1, F90.8, F90.9, F98.8). Excluding Adults with ADHD and other psychiatric diagnosis reduced the available patient group to 1431 and 365 were matched with a same-sex siblings who had the same biological mother and father, and did not have a diagnosis of ADHD or any other comorbid diagnosis themselves. Results: Analysis focused on a cost-of-illness calculations of adult ADHD. Costs were divided into private costs (disposable income, other private costs) and public costs (income tax and transfers, educational expenses, crime and traffic, public expenses on placements, medical expenses). The private costs of ADHD were large in terms of loss of wage income. Part of this loss was covered by the receipt of incomereplacement transfers and lower tax payments. Compared to their nonADHD siblings, individuals with ADHD experience a loss of approximately 650 euros per month after taxes. The public costs of ADHD were also large, with the largest part being due to loss of income taxes and larger expenses on income transfers, and a smaller part being due to health care. Compared to non-ADHD siblings, individuals with ADHD had a social loss of 17,800 euros per individual per year. Conclusions: ADHD is associated with considerable private and social costs even when adults with ADHD are compared to a control group of their siblings.

P-14-011 ADHD coaching with college students: Implications for practice S. Diers*, F. Prevatt, S. Smith, D. Marshall, J. Coleman, E. Valler, N. Miller, J. Belle * Tallahassee, USA Objectives: College students with ADHD often experience increased academic difficulties, and ADHD coaching can be offered as a treatment option. This study sought to examine the processes involved in ADHD coaching. Four research questions were examined: (1) What is the relationship between setting incentives/consequences and levels of weekly task completion? (2) Can weekly task completion be predicted by therapist- or client-rated levels of client motivation or therapeutic benefit/ enjoyment of the tasks? (3) What are the most common goals utilized by clients? (4) What are the primary barriers to task completion? Methods: Twenty-three participants at a large southeastern university in the United States attended individual ADHD coaching sessions for 8 weeks at a university-based training clinic. There were five different Coaches, all of whom were doctoral level psychology students supervised by a clinical psychologist. Coaches utilized a CBT/psychoeducational orientation. Participants established two to four long-term goals (usually dealing with time management or self-organization), as well as weekly objectives or tasks related to their goals. Participants employed incentives and/or consequences to increase motivation to complete weekly tasks. Results: Analyzed by means of an ANOVA, and found: (1) There was a significant main effect for the use of incentives/consequences on weekly task completion. (2) There was a significant main effect for both therapist-rated client motivation and therapeutic benefit of task on client-rated weekly task completion. However, client ratings of motivation and task enjoyment were not significantly related to task completion. (3) The two most common goals were related to time management and academic performance. (4) The two most common barriers to task completion involved time management and lack of motivation.

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Conclusions: The processes by which ADHD Coaching works in a college student population are important to understand. Our presentation will discuss barriers, successes, and implications for further refinement of ADHD Coaching.

P-14-012 The link between sleep difficulties, social functioning in school and ADHD severity M. Efron*, T. Harel, M. Bar, D. Gothelf, j. Kushnir * Kfar Saba, Israel Objectives: To explore the association between sleep difficulties and social functioning in school among children suffering from attention deficit/hyperactivity disorder (ADHD). A second aim was to explore the link between ADHD severity and sleep difficulties. Methods: We studied 27 children (19 boys and 8 girls) diagnosed with ADHD (Mean age = 10.5, SD = 2.6) recruited from the ADHD and Learning Disorder Clinic in a large tertiary Children’s Hospital in Israel. ADHD severity was determined using the ADHD rating scale IV (ADHD-RS), children’s sleep was assessed using the Children’s sleep Habits Questionnaire (CSHQ) and the Pre Sleep Arousal Scale (PSAS), social functioning in school was assessed using the Colorado Learning Disorders (CLDQ). Results: CSHQ total score was significantly associated with CLDQ social anxiety score (r = 0.49, p \ 0.05), and PSAS cognitive score was significantly associated with CLDQ social cognition score (r = 0.43, p \ 0.05), and CLDQ social anxiety score (r = 0.57, p \ 0.01). In addition, CSHQ total score was significantly associated with ADHD-RS impulsivity score (r = 0.42, p \ 0.05), and PSAS total score was associated with ADHD-RS impulsivity score (r = 0.36, p \ 0.05), and ADHD-RS total score (r = 0.32, p \ 0.05). Finally, CSHQ score was significantly associated with PSAS score (r = 0.58, p \ 0.01). Conclusions: Our results demonstrate the link between sleep problems and difficulties in social functioning in school, and also highlight the link between sleep problems and increased attentional impairment among children suffering from ADHD. Based on these finding we recommend that clinicians and health care providers utilize a more comprehensive assessment of sleep difficulties among children suffering from ADHD.

Friday, 29 May 2015, 16.00 h–17.30 h P-15 Quality of life/Caregiver burden II P-15-001 Teacher supervision in children with ADHD: A classroom observation study L. Imeraj*, I. Antrop, E. Sonuga-Barke, H. Roeyers * Brussels, Belgium Objectives: Due to high educational demands, the classroom is an environment in which problematic behavior in children with ADHD is exacerbated. Despite the finding of laboratory studies that the (oneon-one) presence of an adult has beneficial effects on behavior and task performance of these children, there is little observational data on how teachers individually support children with ADHD in the everyday classroom environment. Methods: Thirty-one children with ADHD and 31 typically developing classmates (matched on age and sex) were observed in their

naturalistic classroom environment during 2 days. Individualized teacher supervision was measured both quantitatively (% of time) as qualitatively (positive vs. neutral vs. negative feedback). Results: Children with ADHD were individually supervised twice as much as their normal developing classmates (7 vs. 4 % of the time spent in the classroom). The balance of negative/positive feedback in children with ADHD was a ratio of 3:1, whereas the opposite pattern was shown in children without ADHD (1:3). Even when children with ADHD were engaged in a task as expected by the teacher, this balance remained negative. Conclusions: Seen the neuropsychological problems described in ADHD (e.g., problems in executive function and motivation), we suggest to ‘qualitatively’ increase supervision in children with ADHD, i.e., more structuring/neutral and more positive feedback, which may increase motivation and experiences of success.

P-15-002 Longitudinal effect of Attention-Deficit/Hyperactivity Disorder symptoms on social relationship H. Ito*, M. Hamada, A. Uemiya, Y. Murayama, M. Katagiri, M. Tsujii

Objectives: To identify and to analyse protective and risk factors related with resilience process in children with Attention-Deficit/ Hyperactivity Disorder (ADHD) and in their families. Methods: The study represents qualitative analyses of 15 ADHD children aged between 7 and 15 years (M = 10.53; SD = 2.78) along with their families, performed in the Child and Adolescent Neurology and Psychiatry Clinic Timis¸ oara, Romaˆnia. All participants had the diagnostic of ADHD combined type, according with DSM-IV criteria. The study was approved by the Ethical Committee of the Hospital and all parents signed the inform consent for participate to the study. We analyzed the individual, parental and familial, school and environmental protective and risk factors related with resilience process in children. Results: Results showed that the most protective factors related with resilience process in children with ADHD were the compliance to treatment, the absence of comorbid symptoms, the consistently educational style of parents and good relationship parent-school. The risk factors included genetic vulnerabilities, presence of anxiety in children, lack of medical treatment, poor relationship with siblings, dysfunctional family and inconsistently educational style of parents. Conclusions: Protective mechanisms related to resilience in children with ADHD involve reducing child symptoms and their comorbidities, reducing child’s rejection in school and community, improving the self efficacy and promoting a consistently educational parents’ style.

* Hamamatsu, Japan Objectives: Children and adolescents with attention deficit hyperactivity disorder (ADHD) have a higher likelihood of experiencing social maladaptation. However, since children and adolescents with ADHD often have symptoms of other developmental disorders, such as autism spectrum disorders (ASD) or developmental coordination disorder (DCD), it is unclear whether social maladaptation is caused by ADHD symptoms or other comorbid symptoms. The present study examined ADHD symptoms’ effect on maladaptation in relationships with peers, family, and teachers using longitudinal data from a school cohort sample, adjusting for other comorbid symptoms. Methods: The sample consisted of 5648 students (2869 boys and 2779 girls from 3rd to 9th grade) from all 13 elementary and juniorhigh schools in a suburban city in Japan. The ADHD symptoms (Inattention and Hyperactivity–Impulsivity) were assessed using the ADHD Rating Scale (DuPaul, 1998). The ASD and DCD symptoms were measured using the Autism Spectrum Screening Questionnaire (Ehlers et al. 1999) and the Developmental Coordination Disorder Questionnaire (Wilson et al. 2009), respectively. Social relationship (Peer, Parents and Teacher) was assessed using the Social Adaptation Scale for Children and Adolescents (Ito et al. 2014). All questionnaires were completed by the students’ parents. Results: In multiple regression analysis adjusting the score of dependent variables measured in the first year, HyperactivityImpulsivity showed a positive longitudinal effect on relationships with peers in the next year (b = .036, p = .037). On the other hand, Inattention showed a negative effect on relationships with parents (b = -.037, p = .046). Both Inattention and Hyperactivity-Impulsivity showed negative longitudinal effects on relationships with teachers (b = -.060, p = .002 and b = -.059, p = .002). Conclusions: Our results suggest that ADHD symptoms are risk factors for maladaptation in relationships with adults such as parents and teachers but may have positive effect on peer relationships.

P-15-003 Protective mechanisms related with resilience process in children with Attention-Deficit/Hyperactivity Disorder A. M. Jurma*, D. L. Morariu * Timisoara, Romania

P-15-005 Lifetime victimization in children and adolescents with ADHD F. Lopez Seco*, A. Masana Marin, J. Aguado Gracia, P. Mundo Cid, S. Acosta Garcı´a, A. M. gaviria Go´mez, E. Vilella * Reus, Spain Objectives: To analyze the association between type of victimization and the severity of ADHD symptoms in a clinical sample of children and adolescents with ADHD who were treated at our Child and Adolescent Mental Health Centers and to determine whether any comorbid disorder of ADHD is associated with victimization. Methods: The sample was composed of 118 children and adolescents with an ADHD diagnosis according to DSM-IV criteria. The exclusion criteria consisted of comorbidity with mental retardation, autism, psychosis and organic brain disorders. Socio-demographic and clinical variables that could affect the results were controlled. Symptom severity was measured by the Conners-3 scale1. ADHD and comorbid diagnostics were evaluated by the Mini Kid interview2. The experiences of victimization were evaluated using the Juvenile Victimization Questionnaire3. Pearson correlations were performed to determine the association between symptom severity and type of victimization. We performed a linear regression to determine the strength of the association between subtype of victimization and symptom severity. The v2 test was performed to analyze the differences between types of victimization and comorbid diagnoses. Results: A history of conventional crime, child abuse and peer victimization were significantly associated with symptom severity. The presence of any comorbidity and depression was associated with a history of child abuse and indirect victimization. Conclusions: Episodes of victimization should be considered in the treatment of children with ADHD.

P-15-006 ADHD and perceived job competence: The role of positive illusionary bias G. Mackenzie*, R. Martinussen, M. Aitken

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* Toronto, Canada Objectives: ADHD is associated with diverse employment problems leading to poor occupational outcomes (Gjervan et al. 2012). How adolescents with ADHD perceive their own levels of job competence has received little attention. Given the association between ADHD and a positive illusionary bias (PIB; Hoza et al. 2002) and overestimations of performance, it is hypothesized that adolescents with ADHD will rate themselves at par or above their peers in this domain. However, factors thought to promote job success including IQ and executive function (EF; Wolf 2010; Sternberg, et al. 2001) are hypothesized to be both lower in youth with ADHD (Biederman et al. 2012; Nigg et al. 2005). Methods: As part of a larger study at Ontario Institute for Studies in Education that examined comprehension processes in adolescents with and without ADHD, this current study included 95 adolescents between the ages of 14 and 16 with (n = 52) and without ADHD (n = 43). Independent samples t-tests were performed. Results: It was confirmed that there was no significant difference in perceived job competence between adolescents with and without ADHD, t (93) = .39, p = [ .05. Furthermore, adolescents with ADHD performed significantly worse compared to controls on the measure of EF, t (93) = -14.67, p = \ .001 and IQ, t (93) = 2.34, p \ .05. There was also a negative relationship between EF, IQ and perceived job competence among the adolescents with ADHD. Conclusions: Previous studies have found evidence of a PIB in adolescents with ADHD in other domains (Owens et al. 2007). Our study extends this work by suggesting that they also have a PIB in the area of perceived job competence. Intervention prior to entering the work force may be needed as well as accommodations in the workplace. Future studies should include a larger sample and objective measures of job competence.

P-15-007 Psycho-education for ADHD medication initiation for children and adolescents in a London Borough: An innovation and improvement project O. Malomo*, O. Moghraby * London, UK Objectives: Over the past few years, the team has had an unprecedented increase in referrals for initiation of ADHD medication. The team consists of 2 consultant psychiatrists, 1 Specialist Registrar, 1 core trainee and 1 clinical nurse specialist who are able to commence initiation, prescribe these agents and monitor for side-effects. Due to sheer number of referrals, the team then decided to offer 1 h 2-monthly didactic/informal information sharing sessions for parents who are often key-decision makers for this age group. It has been documented that often when a child is recently diagnosed, parents often have ambivalent attitudes about potential interventions, particularly medications. It is therefore imperative that the quality of information given about these agents is of a high quality so as to promote adherence. Objectives: (1) To provide information about ADHD medications in a concise, easy to understand manner (2) To ascertain if participants felt they gained enough information to make an informed choice. Methods: Invitation letters were sent out to parents of children on the waiting list for ADHD medication initiation. The 1 h sessions consisted of 30 min powerpoint style presentation followed by informal 30 min information sharing between parents and clinicians. A questionnaire was administered after each session asking 5 main questions in a Likert-scale (1 (being least likely) and 10 (most likely). A satisfaction score of 9 was set for each of the 5 questions.

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Results: 4 sessions were carried out between November 2013 and July 2014. 50 % of participants had a satisfaction score of 9 and above with regards to understanding the information provided and 30 % felt they were able to make an informed choice. Conclusions: The team is currently in the process of working with the IT department of the trust in developing a standardized format for delivering information for ADHD medications.

P-15-008 LINK: The adult Attention-Deficit/Hyperactivity Disorder programme (ADHD): Connecting - educating advancing (Part II) L. Klassen*, A. Fallu * Winkler, Canada Objectives: The program’s main objectives were to increase Primary Care Physicians’ (PCPs) knowledge and level of comfort as it pertains to:—Screening for adult ADHD based on key clinical markers;— Diagnosing adult ADHD including differential diagnosis and comorbidities;—Effectively managing treatment initiation and maintenance in patients with or without comorbidities. Methods: The LINK program was designed as a knowledge and skillbased mentorship program. It offered PCPs the opportunity to liaise with ADHD experts from across Canada via a series of three live sessions and via other media, such as a program website and teleconference sessions. Each group consisted of six to ten PCPs that were comfortable treating patients with mental health issues. The LINK program measured outcomes through questionnaires administered to PCP’S via the program website at the time of entry in the program and at its conclusion. The metrics aimed to determine subjectively whether there were perceived changes in knowledge and level of comfort as it pertains to screening, diagnosing and initiating a treatment regimen for adults with ADHD. Results: It is estimated that the likelihood of treatment for an ADHD adult in Canada is about 10 %. Results demonstrated that after a participation in the program, the frequency with which PCPs screened for adult ADHD in their practices doubled. The program also aimed to determine whether the format could increase the level of comfort of PCPs as it pertains to diagnosing and initiating a treatment regimen. The program metrics demonstrated a significant increase in the level of comfort of PCPs not only in diagnosing uncomplicated cases of ADHD, but also in the presence of comorbid disorders. Conclusions: The LINK program demonstrated that through its format it was able to significantly impact the level of knowledge and comfort of PCPs as it pertains to screening, diagnosing and treating adult ADHD.

P-15-009 A clinical audit of transitional care in adolescents with ADHD at Blakesley Centre CAMHS J. Holmes*, E. Loh * Birmingham, UK Objectives: To examine and attempt to improve the transition process for young people with ADHD, as they move from CAMHS to adult services. I aim to establish whether the NICE clinical guidelines for ADHD transition (2008) are being met at Blakesley Centre CAMHS. Methods: The inclusion criteria was ‘‘young people registered at Blakesley Centre CAMHS with a diagnosis of ADHD, who had their 16th birthday between 1st April 2013 and March 31st 2014’’. Case

notes were selected based on their availability. A total of 21 case notes were available for the audit, which is around 25 % of the total number of young people meeting the inclusion criteria. Data was collected retrospectively. Results: In 85.7 % of cases, there was documented evidence that the young person had been reassessed to establish the need for continuing treatment post their 16th birthday. Of the 16 cases being referred to adult services, just 25 % had documented evidence in their notes that they had received information about adult services prior to transition. 75 % of young people requiring input from adult services were offered a transition appointment. On average, service users were offered a slot 66 days post their 16th birthday for an ADHD transition appointment. Conclusions: Young people with ADHD at Blakesley Centre CAMHS very rarely begin transition to adult services in a timely manner, nor do they receive information about what to expect from adult services. Recommendations include: (1) Education for the MDT (2) Increasing the contact between the ADHD nurse and young person by offering more than one appointment prior to transition (3) Care coordinator using the ‘‘My Health My Life’’ document from age 15.5 (4) New ADHD transition checklist to be followed by care coordinator when a young person being treated for ADHD reaches the age of 15.5

P-15-010 Medication non-adherence, symptom worsening and relapse, and their implications for health-related quality of life in the treatment of Attention-Deficit/Hyperactivity Disorder (ADHD) in Non-Western countries J. Hong*, D. Novick, T. Treuer, W. Montgomery, J. M. Haro * Windlesham, UK Objectives: To examine potential predictors of relapse and symptom worsening, with a particular focus on medication non-adherence, and their implications for health-related quality-of-life (HRQoL) in the treatment of paediatric patients with ADHD in non-Western countries. Methods: Data for this post hoc analysis were taken from a 1-year prospective observational study that included 1068 newly diagnosed paediatric patients with ADHD symptoms in Central Europe and East Asia. Relapse was defined as an increase of at least two points on the Clinical Global Impression-ADHD (CGI-ADHD) among patients who achieved a CGI-ADHD score of B2 (i.e. remission) during the study period (n = 226). Worsening was defined as an increase of at least one point on the CGI-ADHD among patients who achieved a CGI-ADHD score of B3 (n = 540). HRQoL was measured with the Child Health and Illness Profile-Child Edition (CHIP-CE) five dimensions. Descriptive analyses were performed to examine the associations between medication non-adherence, relapse/worsening and HRQoL. Multiple regression analyses were performed only for worsening. Furthermore, a complementary analysis was conducted using data from another similarly designed 1-year observational study conducted in the Middle East, East Asia, and Russian Federation (N = 546). Results: Of the 226 patients with a CGI-ADHD score of B2, 25 (11.1 %) relapsed, and 118 (21.9 %) of the 540 patients with a CGIADHD score of B3 worsened during follow-up. Descriptive analyses revealed higher relapse rates in non-adherent patients than in adherent patients across the visits (p = 0.010). They also exhibited a general tendency of the negative association between relapse and CHIP-CE scores. Multiple regression also showed similar results with worsening. The complementary analysis provided consistent results.

Conclusions: The findings consistently indicate negative implications of relapse/worsening for HRQoL in the treatment of ADHD. Medication non-adherence appeared to be a potential risk factor for relapse/worsening.

Friday, 29 May 2015, 16.00 h–17.30 h P-16 Basic science/Genetics/Experimental models P-16-001 Which parameters differ in the gait of children with ADHD? H. Naruse*, C. Yatsuga, T. Fujisawa, H. Kumazaki, S. Takiguchi, H. Matsuo, M. Kubota, S. Shimada, d. Saito, H. Kosaka, A. Tomoda * Eiheiji-Cho, Yoshida-Gun, Japan Objectives: Motor problem in children with Attention DeficitHyperactivity Disorder (ADHD) has been discussed for years. Especially, when focusing on the gait patterns, previous studies showed a tendency of difference in variability of stride time and high cadence of pediatric patients with ADHD compared to typically developed (TD) subjects. However, there is no study in terms of kinematic and kinetic variables in ADHD patients. The aim of present study was to investigate which parameters differ in ADHD patients. Methods: Participants in present study were 19 male children diagnosed with ADHD according to DSM-5 diagnostic criteria and 17 male TD children as age-matched controls. Gait parameters were assessed at a self-selected speed in the sagittal plane using the motion capture system and the integrated force plates. Gait parameters in children with and without ADHD were compared using unpaired t test and Mann–Whitney U test. The level of significance was set at 0.05. The protocol was approved by the Ethics Committees of University of Fukui and all participants and their parents gave written informed consent for participation in present study. Results: The mean walk ratio of ADHD was significantly lower than TD (p = 0.045). ADHD showed a significantly higher peak forward tilting and peak backward tilting compared with TD (p = 0.013 and p = 0.009, respectively). Peak flexion angle of the hip was significantly higher and peak extension angle of the hip was lower in ADHD compared to TD (p = 0.048 and p = 0.007, respectively). There were no significant differences in other kinematic and kinetic variables between both groups. Conclusions: We found lower walk ratio and forward tilting of the pelvis during gait in ADHD patients. A previous study demonstrated that walk ratio appears maturing feature of the gait patterns beyond age of 7 years. This suggests that the gait patterns in ADHD may be associated with the neurodevelopmental immaturity.

P-16-002 No association of ADHD candidate SNPs with Parkinson’s disease J. Geissler*, M. Romanos, M. Gerlach * Wu¨rzburg, Germany Objectives: Attention-Deficit/Hyperactivity Disorder (ADHD) and Parkinson’s disease are two of the most prevalent neuropsychiatric disorders, predominantly affecting opposite ends of the age spectrum. Characterized by alterations of movement and motor control, both conditions have been linked to brain areas (e.g. the basal ganglia)

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which have been shown to be crucial for control of motor and cognitive behavior and impulsivity. Methods: To investigate potential common genetic pathways within the respective pathophysiologies, nine ADHD candidate single-nucleotide polymorphisms (SNPs) in seven different genes were tested for association with Parkinson’s disease in 5333 cases and 12,019 healthy controls. We extracted information from a meta-analysis of 5 Genome-Wide Association Studies providing information on a total of 7,689,524 successfully imputed SNPs in European samples. Results: No significant associations emerged after correcting for multiple testing. Conclusions: These results do not confirm a substantial role for candidate variants implicated in the etiopathogenesis of ADHD in Parkinson’s disease.

P-16-003 Association between genetic variants of NET1 and emotional lability of ADHD independent of ODD diagnosis or ODD symptoms L. Liu*, L. Sun, X. Yu, H. Li, L. Yang, Q. Qian, Y. Wang

* Seattle, USA Objectives: To evaluate if variation in the dopamine transporter gene (DAT1) and dopamine receptor D4 (DRd4) gene moderates the effect of individual titrated OROS methylphenidate and atomoxetine in children and adolescents with ADHD. Methods: Participants in the methylphenidate-atomoxetine crossover (MACRO) study were genotyped for DAT1 and DRD4 (n = 174). Using a double blind, double dummy titration, children were titrated to their optimal dose and then blind ratings of ADHD symptoms and impairment were obtained. Results: Individuals absent a copy of the 10 repeat allele (9/9 genotype group) displayed a different trajectory of response compared to individuals with the 10/10 or 10/9 gently in block 1 (p = .03). DAT1 was also associated with baseline ADHD symptom severity. DRD4 was not associated with ADHD response. Conclusions: Individuals with the less common 9/9 genotype of DAT1 displayed a different response pattern to methylphenidate titrated to optimal dose. This is consistent with several, but not all, previous dose– response studies of DAT, and only occurred in block 1 suggesting that there are multiple determinants or moderators of response and DAT1 genotype does not play a major role for most individuals.

* Beijing, People’s Republic of China Objectives: In addition to the core symptoms, including inattention and hyperactivity/impulsivity, ADHD also displayed emotional lability (EL). Norepinephrine has been implicated in prefrontal cortex function, which is involved in emotional regulation by both top-down and bottom-up processes. The present study aims to explore the association between genetic polymorphisms of NET1 and EL symptoms of ADHD. Methods: A total of 421 ADHD probands met DSM-IV diagnostic criteria were included and were genotyped for six SNPs of NET1 (rs3785143, rs3785152, rs2279805, rs5569, rs36009, rs2242447) using a Taqman allelic genotyping assay. EL was captured by the items derived from the ‘Emotional Lability’ subscale of Conners’ Parent Rating Scale, including ‘cries often and easily’, ‘have a chip on their shoulder, hot temper’, ‘mood changes quickly and drastically’ and ‘low frustration tolerance-easily frustrated in effort’. Analysis of covariance (ANCOVA) using SPSS 17.0 was conducted to explore the association between genotypes and EL symptoms with age, sex and subtypes as covariates. Considering the frequent co-occurrence between EL and Oppositional Defiance Disorder (ODD) and our previous report of association between ODD and NET1, ODD diagnosis and ODD symptoms (especially ‘Argumentative/Defiant Behavior, ADB’) were further controlled. Results: After control for age, sex and subtypes, we found association between genotype of rs3785143 and EL symptoms (F = 5.05, P = 0.007), indicating severer symptoms in TT genotype than CC (P = 0.002) or CT genotype (P = 0.009), while T allele has been suggested to be the risk allele for ADHD in previous reports. This association remained when we further controlled ODD diagnosis (F = 3.55, P = 0.030) or ADB symptoms (F = 2.76, P = 0.064). Conclusions: Our findings suggested the involvement of NET1 in the genetic mechanism of EL in ADHD. In addition, this association was independent of ODD.

P-16-005 Hyper-locomotor activity in the mice lacking in an enzyme synthesizing chondroitin sulfate as an animal model of ADHD

P-16-004 Dopamine transporter (DAT1) and dopamine receptor DRD4) genotype and response to methylphenidate and atomoxetine

J. B. de La Pena*, H. J. Kim, I. dela Pena, C. Y. Shin, J. H. Cheong

M. Stein*, T. Hildebrandt, E. Cook Jr, E. Olson, I. Waldman, J. Newcorn

Objectives: Impulsivity is associated with a number of neuropsychiatric comorbidities, including attention-deficit/hyperactivity

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M. Igarashi*, N. Yoshioka, K. Takeuchi, K. Takao, T. Miyakawa * Niigata, Japan Objectives: Chondroitin sulfate (CS), a glycosaminoglycan, is a major extracellular molecule in the brain and highly concentrated in the perineuronal nets (PNN), which regulate the synaptic activity and the plasticity. CS is attached with several core proteins and composed of proteoglycans (CSPG), such as aggrecan, neurocan, and so on. Among them, neurocan is reported to be genetically linked to human ADHD, and PNN-CS is suggested to be involved in human psychiatric diseases. Methods: We recently produced the knockout mice lacking in a key enzyme for CS synthesis, CSGALNACT1. We analyzed the mice morphologically and biochemically, including behavioral test battery. Results: Although the mice have slightly shorter body lengths by the abnormal development of skeletons, they are viable and fertile. We analyzed the mice morphologically and biochemically, and revealed that PNN was impaired and CS accumulation there was much reduced in various regions of the brain. The amount of CS was decreased by maximally 50 %. We performed the behavioral analysis using the test battery and found that the mice had a hyper-locomotive activity. Conclusions: Taken together, our results suggest that the mice may be an animal model of human ADHD.

P-16-006 Shared prefrontal cortical gene expression profiles in ‘‘impulsive’’ SHR and Wistar rats: Effects of atomoxetine

* Seoul, Republic of Korea

disorder (ADHD). In this study, we identified shared prefrontal cortical gene expression profiles between adolescent spontaneously hypertensive rats (SHR), putative animal model of ADHD, and Wistar rats which showed ‘‘impulsive-like’’ behavior, and common transcripts altered in the prefrontal cortex (PFC) of rats which showed behavioral improvement after treatment with atomoxetine. Methods: ‘‘Impulsive-like’’ behavior was assessed in a delayed-reinforcement paradigm, where animals had to choose between small but immediately available rewards versus larger but increasingly delayed rewards. Effects of atomoxetine on behavior and gene expression in the PFC were examined. Results: Adolescent SHR and Wistar rats showed impulsivity in the delayed-reinforcement paradigm. Commonly altered genes in the PFC include transcription factor encoding genes, neuronal plasticity, inflammation and neuronal apoptosis-associated genes, and also those involved in stress response. Treatment with atomoxetine, which attenuated impulsivity in rats, altered the expression of genes involved in synaptic and neuron differentiation. Conclusions: We have identified prefrontal cortical gene transcripts that might play a role in the impulsive-like behavior in animal models of ADHD. Altered expression of these genes after atomoxetine treatment indicates their potential as atomoxetine genetic targets. Further studies are underway to determine the exact influence of these altered transcripts in the mechanism of impulsivity, through transgenic animal models, and the mechanisms of atomoxetine effect.

P-16-007 Unravelling the effect of methylphenidate on human brain endothelial cells V. Santos*, R. Socodato, C. Portugal, M. Rito, M. Barbosa, P.-O. Couraud, I. A. Romero, B. Weksler, R. Minshall, C. Fontes-Ribeiro, T. Summavielle, J. B. Relvas, A. P. Silva * Portugal Objectives: Methylphenidate (MPH) is widely used in the treatment of attention deficit hyperactivity disorder, one of the most common neurobehavioral disorders of childhood. Nevertheless, the impact of MPH on blood–brain barrier (BBB) function has never addressed. Thus, the goal of this work was to clarify the effect of MPH on brain endothelial cells, the principal component of the BBB. Methods: Primary cultures and a cell line of human brain microvascular endothelial cells (HBMVECs and hCMEC/D3, respectively) were exposed to 100 lM MPH, followed by measurement of transendothelial electrical resistance (TEER), transcellular permeability (horseradish peroxidase, 44 kDa) and reactive oxygen species (ROS) production. Results: MPH increased the macromolecular flux across HBMVEC monolayers, but without TEER alterations, suggesting that MPH-induced permeability does not involve alterations on the paracellular pathway. In fact, we found that MPH triggers caveolae-dependent endocytosis, as well as an oxidative stress response with increased ROS levels. To further unravel the intracellular signalling events mediating MPH-induced transcytosis, we proved that MPH activates c-Src kinase in a ROS-dependent fashion. Accordingly, we found that the vesicular transport mediated by MPH was completely blocked by the pharmacological inhibition or downregulation of Src pathway, with SKI-1 or c-Src shRNA, respectively. Conclusions: Our results show that MPH increases brain endothelial cell permeability by promoting vesicular transport. Specifically, we demonstrated that MPH triggers ROS production that will activate c-Src, and culminating in caveolae-dependent endocytosis.

P-16-008 Expressional profile in fibroblasts of PARK2 CNV carriers with adult ADHD S. Kittel-Schneider*, D. Gersic, M. Frank, C. Lorenz, J. Auer, K.-P. Lesch, S. Winkler, S. Klebe, A. Reif * Frankfurt am Main, Germany Objectives: Recently, more studies have been investigating rare genetic variants as a cause of ADHD, and several copy number variants (CNVs) have been shown to be associated with ADHD. A recent study could show an association of PARK2 CNVs with ADHD. Mutations in the PARK2 gene are the most common causes for early onset Parkinson’s disease (PD). How CNVs in the PARK2 gene may contribute to the pathogenesis of ADHD, however, is still unclear. Methods: We isolated RNA from fibroblasts from 4 adult ADHD PARK2 CNV variant carriers (2 duplication carriers and 2 deletion carriers), 4 matching non-risk variant carriers with ADHD and 4 healthy controls. Expressional analysis of PARK2 and associated genes (PINK1, ATXN3, SNCA, UBB, UBC, UBE3A) was done by quantitative Real Time PCR. The participants were also examined neurologically for early signs of PD by UPDRS, NMSPD, sniffing test and measurement of S. nigra volume with ultrasound was done. Results: The expression of PINK1 and PARK2 showed to be significantly different between CNV carriers and non-carriers with increased expression in CNV carriers compared to wild type carriers with and without ADHD (p \ 0.05). As well in the deletion as in the duplication carriers, the gene expression was increased. Also in the NMPDS test, there were significant differences between the groups which were very likely due to the comorbidity with major depression and the ADHD core symptoms (p = 0.02). Conclusions: Here we could show that a CNV in the PARK2 gene which has been associated with ADHD earlier has functional consequences on the gene expression levels of PARK2 and PINK1 in a fibroblast cell model. The reason for also the deletion causing an increased expression might be due to compensatory mechanism, further studies are needed for replication and to clarify the molecular mechanisms.

P-16-009 Transcranial direct current stimulation improves shortterm memory in an animal model of Attention-Deficit/ Hyperactivity Disorder D. Teixeira Leffa*, V. Scarabelot, A. de Souza, L. Fernandes Medeiros, E. Hora´cio Grevet, D. Onofre Gomes de Souza, L. A. Paim Rohde, I. Lucena da Silva Torres * Porto Alegre, Brazil Objectives: Attention deficit hyperactivity disorder (ADHD) patients have disruptions in declarative memory that might be related to deficits in attentional processes, since the encoding of information is dependent on attention levels. Transcranial direct current stimulation (tDCS) consists on applying an electric current over the scalp to alter cortical excitability. It has been used in many neuropsychiatry disorders, modifying different brain functions including memory and attention. The aim of this study was evaluate the effect of tDCS on behavioral parameters and BDNF levels in a validated animal model of ADHD, the Spontaneous Hypertensive Rats (SHR). Methods: Adult male SHR and their controls, the Wistar Kyoto Rats (WKY), were used. Animals were divided in groups: the first (tA, n = 7–10) received tDCS (0.5 mA, 20 min/day during 8 days, frontal cortex), the second (tS, n = 6–10) received a sham stimulation, the

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third (C, n = 6–10) wasn’t manipulated. TA and tS were immobilized during stimulation. Short-term memory (STM) was evaluated with an object recognition test conducted in an open field. Animals explored 2 identical objects for 3 min, after 30 min one object was replaced with an unfamiliar one. Exploration time and locomotion were recorded. Brain regions were dissected to determine BDNF levels with sandwich-ELISA. Statistics were carried out using two-way ANOVA with Bonferroni’s post hoc test. Results: SHR tS and C spent less time exploring the new object and had increased locomotion compared to WKY with same treatment (p \ 0.05, p \ 0.01 and p \ 0.05, p \ 0.01, respectively). SHR tA spent more time on the new object compared to SHR tS and C (p \ 0.001 and p \ 0.01). WKY tA had increased BDNF in the striatum compared to WKY tS and C (p \ 0.05 and p \ 0.001). Conclusions: Findings show a potential efficiency of tDCS to manage STM deficits of SHR. BDNF, besides being involved in memory formation, was not modified in SHR.

down by morpholino injections. lphn3.1 morphants and control siblings were then exposed to APAP. lphn3.1 loss-of-function caused increased activity seen by longer distance swum during and increased switching between activity modes. Treatment with 100 mg/l APAP of controls or morphants did not significantly add to the activity levels. Conclusions: We conclude that at least in larval zebrafish there is no hyperactivity phenotype associated with embryonic APAP exposure, neither acute nor chronic.

Saturday, 30 May 2015, 08.30 h–10.30 h PL-2 New advances in ADHD neurobiology PL-2-001 New advances in the neurobiology of Attention-Deficit/ Hyperactivity Disorder S. Faraone*

P-16-010 Exposure to acetaminophen during development does not induce hyperactivity in zebrafish larvae C. Drepper*, M. Romanos * Wu¨rzburg, Germany Objectives: Attention-deficit/hyperactivity disorder (ADHD, OMIM # 143465) is the most common childhood-onset behavioral disorder, with an overall prevalence of 7.2 %. In this condition, school-age patients display higher levels of motor activity, impulsivity and inattention. The molecular mechanisms behind this disorder are poorly understood. Besides the well-established genetic contribution to the disease several environmental or other factors during pregnancy have been identified, which may influence the disease prevalence in the next generation. Such factors include low birth weight, delivery complications, food additives and toxin or drug exposure. Recently, three independent epidemiological birth cohort studies were published showing that the maternal use of the over-the-counter analgesic drug acetaminophen (also known as N-acetyl-p-aminophenol or APAP common brand name paracetamol) during pregnancy lead to higher prevalence of developing ADHD-like behavior. Zebrafish has recently emerged as a powerful model organism in molecular psychiatry due to its genetic similarity to mammals (exceeding 70 % compared to human) conserved neural development and a rich behavioral repertoire. Thus, the goal of the current study was to investigate the behavioral consequences of APAP exposure at larval stages. Furthermore, we explored potential additive effects of APAP on a previously described hyperactivity phenotype induced by lphn3.1 loss-of-function. Methods: To investigate the effects of APAP on the development of zebrafish larvae we exposed late blastula stage embryos (4 hpf) to increasing concentrations of APAP and the activity levels of 6 dpf larvae were measured using total distance swum during a period of 5 min and number of times switched between inactivity, small activity and large activity. Results: The effects of both chronic (0–6 dpf) and acute APAP (2 h) exposure were analyzed. In untreated control siblings the total distance swum during 5 min was 78,5 + 21,6 cm and treatment with 2.5–100 mg/l APAP resulted in similar distances (no significant differences were found, p \ 0,05 in all cases). The frequencies of switching between different activity modes were also similar in controls and APAP treated larvae (no significant differences were found, p \ 0.05 in all cases). To test if APAP is causing increased activity in a genetic susceptibility background, lphn3.1 was knocked

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* Syracuse, USA Objectives: In recent years we have learned much about what causes ADHD and how those causes affect the brain. As a result, a blueprint of ADHD’s etiology and pathophysiology is slowly coming into focus. Genome wide molecular genetic studies have yielded solid insights about the role of common and rare genetic variants and studies of the environment and of dietary components have highlighted multiple environmental risk factors. The neuroimaging literature is large and complex, but has been clarified by several meta-analyses. These have confirmed several brain regions as showing changes in structure and function that may mediate the expression of ADHD symptoms. They have clarified the role of stimulant medications in the expression of brain changes and further suggest that brain development can explain why some ADHD youth remit symptoms in adulthood. These data about etiology and pathophysiology converge on the conclusion that ADHD is a multifactorial network disorder, which as implications for future research and for the treatment of ADHD patients.

PL-2-002 25 Years of Neuroimaging: Progress Towards Understanding the Pathophysiology of ADHD F. X. Castellanos* * New York, USA Objectives: To provide a personal overview of the first two ‘‘generations’’ of neuroimaging research on ADHD. Methods: Subjective assessment of emerging themes in the field. Results: Biological systems encompass unimaginable complexity and, once we begin to understand them, elegant simplicity. Quantitative neuroimaging of ADHD has been conducted for a quarter century, and the principles of brain structure and function underlying brain disorders have yet to be clearly elucidated. The relevance of maturational delays in structure and function seem likely to constitute one key pathophysiological element. The proportion of global, i.e., generalized processes, versus those affecting specific functions or circuits remains open. However, some developmentally early global processes are likely involved, given continuing evidence of decreased total brain volume, mean cortical thickness, and mean diffusivity indices. Finally, the application of multi-level network-based analytical methods offers the possibility of linking genetic, brain, phenotypic and environmental exposure networks with the potential

to reveal the neurobiological diversity underlying the clinical heterogeneity of ADHD and related disorders. Conclusions: Meeting the challenge of deciphering the clinical complexity of mental disorders and conditions requires large-scale open science repositories that are beginning to be created along with the evolution of novel methods of performing in silico science.

PL-2-003 Frontiers in the neuropsychology of Attention-Deficit/ Hyperactivity Disorder: Seven important themes E. J. S. Sonuga-Barke* * Southampton, UK Objectives: In recent years there has been a radical change in the way that neuropsychological processes in ADHD are understood. These changes have been driven by accumulating data from experimental studies interpreted in the light of contemporary ideas and new findings from developmental psychopathology, clinical, behavioural and cognitive neuroscience and genetics. Methods: In this talk I will highlight seven emerging themes that are likely to be influential in shaping future thinking and research relating to the nature of neuropsychological deficits in ADHD. Results: These are their; (i) existence during both task-dependent and task-independent processing; (ii) context dependent nature; (iii) status as causal mediators of disorder; (iv) complexity and heterogeneity; (v) developmental character; (vi) diagnostic value as a basis for subtyping and (vii) clinical value as treatment targets. Conclusions: ADHD neuropsychology is entering a fascinating period of growth and change as new research insights open up the possibility for new science based approaches to classification and treatment of the disorder.

PL-2-004 Translating genetic findings into biological mechanisms for ADHD through animal models K.-P. Lesch* * Wu¨rzburg, Germany Objectives: The substantial heritability of ADHD is well documented and recent genome-wide risk gene analyses revealed synaptic cell adhesion molecules (e.g. cadherin-13, CDH13; atrophilin-3, LPHN3), glutamate receptors (e.g. metabotropic glutamate receptor-5, GRM5) and mediators of intracellular signalling pathways (e.g. nitric oxide synthase-1, NOS1). These genes encode principal components of the molecular machinery that connects pre- and postsynaptic neurons, facilitates glutamatergic transmission, modulates GABA-glutamatedopamine system crosstalk, controls synaptic plasticity and empowers intersecting neural circuits to process and refine information. Given the currently high rate of gene discovery it is a desiderate to develop animal models of ADHD in order to better understand its aetiology and improve the treatment options that are available. Here, I will first highlight a mouse model of Cdh13 deficiency. CDH13, a unique GPIanchored member of the cadherin family of cell adhesion molecules, has consistently been identified as a risk gene for ADHD and various comorbid neurodevelopmental and psychiatric conditions, including depression, substance abuse, autism spectrum disorder and violent behavior, while the mechanism whereby CDH13 dysfunction contributes to pathogenesis remains poorly understood. We explored CDH13’s potential role in the inhibitory modulation of brain activity by investigating synaptic function of GABAergic interneurons.

Cellular and subcellular distribution of CDH13 was analyzed in the murine hippocampus and a mouse model with a targeted inactivation of Cdh13 was generated to evaluate how CDH13 modulates synaptic activity of hippocampal interneurons and behavioral domains related to ADHD-like phenotypes. We found that CDH13 expression in hippocampus is confined to distinct classes of interneurons. In particular, CDH13 is expressed by many parvalbumin and somatostatinexpressing interneurons located in the stratum oriens, where it localizes to both the soma and the presynaptic compartment. Findings in Cdh13-/- mice show an increase in basal inhibitory, but not excitatory, synaptic transmission on cornu ammonis field 1 (CA1) neurons. Associated with these alterations in hippocampal function, Cdh13-/- mice display deficits in learning and memory. In addition, I will explore how we can develop zebrafish as a translational model for ADHD. In order to validate the link between the adhesion-G protein-coupled receptor LPHN3 and ADHD, and to understand the function of LPHN3 in the etiology of the disease, we examined its ortholog lphn3.1 during zebrafish development. Loss of lphn3.1 function causes a reduction and misplacement of dopamine-positive neurons in the ventral diencephalon and a hyperactive/impulsive motor phenotype. The behavioral phenotype can be rescued by the ADHD treatment drugs methylphenidate and atomoxetine. Taken together, our results indicate that CDH13 is a negative regulator of inhibitory synapses in the hippocampus and that LPHN3 contributes to the development of the brain dopaminergic circuitry, thus providing new insights into how alterations in CDH13 and LPHN3 function may contribute to the dopamine system-moderated excitatory/inhibitory imbalance observed in ADHD.

Saturday, 30 May 2015, 14.30 h–16.00 h HT-10 Towards an evidence-based taxonomy of nonpharmacologic treatments for ADHD HT-10-001 Integrating pharmacologic and non-pharmacologic treatments: An evidence-based approach, is that OK? S. Faraone* * Syracuse, USA Objectives: Many pharmacologic and non-pharmacologic treatments for ADHD have been proposed. Some have survived the tests of rigorous controlled trials, others have not and many have not been tested sufficiently. This talk presents an evidenced-based guide for the clinicians about the evidence base for ADHD treatments along with a framework for how to integrate pharmacologic and non-pharmacologic treatments. We use the term ‘‘evidenced-based’’ in the strict sense applied by the Oxford Center for Evidenced Based Medicine. The OCEBM guidelines are applied here to clarify the degree to which non-pharmacologic treatments are supported by the scientific literature. We also review the magnitude of the treatment effect expressed as the standardized mean difference effect size (also known as Cohen’s D). We then describe a meta-algorithm to describe how to integrate pharmacologic and non-pharmacologic treatments for ADHD.

HT-10-002 Self-help interventions for ADHD M. Do¨pfner* * Ko¨ln, Germany

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Objectives: Despite the impressive development in psychosocial interventions for children with ADHD, two major problems in the implementation of these treatment approaches persist: (1) many children and adolescent with ADHD do not receive evidenced based treatment for their problems and (2) practical as well as psychological obstacles (stigma, travel time, work schedules, and financial costs) often prevent families from accessing therapist-led face-to-face psychosocial interventions. Self-help-interventions for parents of children with ADHD may be one promising approach to overcome these obstacles. Self-help interventions use written or audio-visual self-help materials either alone or in combination with some form of support or advice either via telephone counselling or via internet. The effectiveness of self-help interventions has been shown in a recent meta-analysis. One approach of telephone-assisted self-help for parents and adolescents with ADHD, developed at the University of Cologne will be presented and the results of six studies on the efficacy and effectiveness of this intervention as well as chances and limitations of this approach will be discussed.

HT-10-003 Lifestyle interventions for ADHD J. Halperin*, S. O’Neill * New York, USA Objectives: Several evidence-based pharmacological and non-pharmacological interventions have been shown to yield symptomatic relief for children with ADHD. However, treatment gains rapidly fade shortly after the active intervention ends and as such enduring longterm gains are rarely achieved. The aim of this presentation is to provide evidence supporting the notion that, in order to alter the adverse trajectory of ADHD and thus yield lasting symptomatic relief, interventions may need to target long-term lifestyle changes as opposed to (or in addition to) short-term symptomatic relief. Methods: A model will initially be presented depicting an array of environmental factors and hypothesized mechanisms by which they influence behavioral trajectories in children with ADHD. Particular attention will be paid to neighborhood and family factors, sedentary lifestyles, educational opportunities and peer relations. Data indicating associations between these factors and ADHD outcomes will be provided. It is proposed that lifestyle changes yielding enduring environmental enrichment, aerobic exercise and stress reduction will promote healthy development in children and improved ADHD trajectories and outcomes. Results: Experimental data from several studies provide support for the acute benefits of aerobic exercise, environmental enrichment and stress reduction on children with ADHD. Further, correlational data indicate that children who routinely exercise, have greater enrichment in their environments, and less stress have reduced rates of ADHD and related impairments. It will be argued that developing these routines in children with ADHD has the potential to yield long-term benefits. Ways to accomplish this will be suggested. In particular, greater incorporation of parents, schools and community centers will be necessary to promote lifestyle changes in children.

HT-10-004 Cognitive training for ADHD: Results, problems and prospects J. Buitelaar* * Nijmegen, The Netherlands Objectives: ADHD is associated with a wide range of cognitive deficits in both executive and non-executive domains, and (some of)

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these cognitive deficits have been claimed to be in the causal chain to develop and maintain ADHD symptoms. From here it has been argued that cognitive training might target these cognitive deficits and reduce ADHD symptoms and improve overall functioning and adaptation. Cognitive training approaches have focused on a range of deficits, e.g., attentional control, working memory, and inhibitory control. Currently, such training is typically delivered via computers using adaptive procedures. Methods: Discuss results of two meta-analyses, and present results from study from our own group. Results: The efficacy of cognitive training for ADHD was addressed in two meta-analyses of non-pharmacological treatments for ADHD on behalf of the European ADHD Guidelines Group The first metaanalysis included six RCTs (Sonuga-Barke et al. 2013). The second meta-analysis was able to include 16 RCTs including data on 759 ADHD children (Cortese et al. 2015). A study from our own group was also negative (van Dongen-Boomsma et al. 2014). Conclusions: Overall, cognitive training did result in improved working memory performance, but effects on ADHD symptoms according to assessments based on blinded measures were very limited and clinically not relevant. In the last part of he talk I will discuss explanations for these negative findings (such as no causal role for cognitive deficits in ADHD) and discuss approaches to optimise the effects of cognitive training (such as building in cognitive training in daily life, targeting multiple neuropsychological processes, enriching sample for baseline deficits in cognition).

Saturday, 30 May 2015, 14.30 h–16.00 h HT-11 Recent data from adult ADHD follow-up studies HT-11-001 Persistence and remission of ADHD during adulthood: A 7-year clinical follow-up study C. Bau* * Brazil Objectives: This presentation will discuss results from a 7-year clinical follow-up study. The main focus will be given to the persistence of the diagnosis and the course of symptoms in each domain, as well as their predictors and moderators. Methods: This is a follow-up study of 344 adults previously evaluated between 2003 and 2007 in the ADHD outpatient clinic of HCPA (mean age at baseline = 34.1 years, SD = 10.9, 48 % males). Lifetime diagnoses were based on DSM-IV criteria. ADHD and oppositional defiant disorder were evaluated with the K-SADS-E, and other comorbidities with SCID-IV and MINI. The main outcome variable is the number of K-SADS-E ADHD symptoms in each domain at baseline minus the number at follow-up. Results: Retention rate was 66 % (n = 227). Approximately a third of the sample (n = 70, 30.2 %) did not maintain ADHD criteria and 28 (12.4 %) presented full remission (\4 symptoms), independently of changes in comorbidity or cognitive demand profiles. Inattention and hyperactivity/ impulsivity symptoms declined at a similar rate (21 %). A higher number of both inattention and hyperactivity/impulsivity symptoms at baseline was predictive of steeper decline for each domain. Alcohol abuse/dependence and higher number of inattention symptoms at baseline predict less decline in hyperactivity/impulsivity symptoms, whereas school suspensions predict lower decline in the inattention domain. Conclusions: Approximately one third of the sample did not keep full DSM-IV diagnosis at follow-up, regardless if at early, middle or older adulthood. Differently from the childhood and adolescence patterns, our results suggest that the decline of hyperactivity/impulsivity

symptoms in adults ceases to be steeper than the inattention decline. Characteristics that are possibly amenable to prevention strategies (school suspensions and alcohol abuse/dependence) predict lower decline in inattention and hyperactivity/impulsivity, respectively.

HT-11-004 Functional MRI findings on persistence of ADHD from childhood onto adulthood J. Biederman* * Boston, USA

HT-11-002 Lacking evidence that DSM-5 adult ADHD is a childhood-onset neurodevelopmental disorder: A 4-decade longitudinal cohort study G. Polanczyk* * Sao Paulo, Brazil Abstract not received.

HT-11-003 Predictors of outcome at age 41 among 8 year olds with ADHD R. G. Klein* * New York, USA Objectives: Longitudinal studies document that the long-term outcome of children with ADHD is variable; a proportion have an unremarkable life course, while others experience lifelong difficulty. Attempts to identify factors accounting for negative versus positive outcomes have yielded inconsistent findings, and none has reported on function beyond early adulthood. We examined predictors of outcome in children who were, on average, 8 years of age when diagnosed with ADHD, followed into adulthood, at mean age 41. Methods: 207 boys (6–12 year-olds, M, 8.4 + 1.4) referred to a child psychiatric clinic were diagnosed with ADHD. Those with a pattern of aggressive or antisocial behavior were excluded. Participants were reassessed three times: in late adolescence (M years, 18.1 + 1.3), (n = 195/207, 94 %), in young adulthood (M years, 25.3 + 1.4) (n = 176/207, 85 %), and in adulthood (M, 41.4 + 2.9), (n = 135/ 207, 65 %). At each follow-up, assessments were conducted by ‘‘blind’’ clinicians. Predictors from childhood and adolescence are a subset from a very large pool. Childhood factors include: Full IQ, reading competence, parent and/or teacher ratings of hyperactivity, inattention, conduct problems, oppositional defiant behaviors, eruptive aggression, immature behavior, and social functioning. Adolescent predictors included: friendships, academic performance, work adjustment, future goals, dropping out of school, antisocial behaviors; antisocial personality disorder (APD) or conduct disorder (CD), parental substance use disorder (SUD); and parental APD. Adult outcomes included: diagnosis of ADHD and APD, education, occupation, social, occupational, and overall functioning. Binary and continuous outcomes were tested with Logistic and linear regressions, respectively. Results: Few factors were predictive of adult clinical outcome. These will be presented in detail. Conclusions: It is unlikely that we can identify childhood and/or adolescent characteristics that are meaningful predictors of long-term outcome. Even with significant, relationships are not strong enough for clinical application.

Objectives: Previous resting state studies examining the brain basis of attention deficit hyperactivity disorder have not distinguished between patients who persist versus those who remit from the diagnosis as adults. Methods: To characterize the neurobiological differences and similarities of persistence and remittance, we performed resting state functional magnetic resonance imaging in individuals who had been longitudinally and uniformly characterized as having or not having attention deficit hyperactivity disorder in childhood and again in adulthood (16 years after baseline assessment). Intrinsic functional brain organization was measured in patients who had a persistent diagnosis in childhood and adulthood (n = 13), in patients who met diagnosis in childhood but not in adulthood (n = 22), and in control participants who never had attention deficit hyperactivity disorder (n = 17). Results: A positive functional correlation between posterior cingulate and medial prefrontal cortices, major components of the default-mode network, was reduced only in patients whose diagnosis persisted into adulthood. A negative functional correlation between medial and dorsolateral prefrontal cortices was reduced in both persistent and remitted patients. Conclusions: The neurobiological dissociation between the persistence and remittance of attention deficit hyperactivity disorder may provide a framework for the relation between the clinical diagnosis, which indicates the need for treatment, and additional deficits that are common, such as executive dysfunctions.

Saturday, 30 May 2015, 14.30 h–16.00 h HT-12 Early life factors as origin of ADHD HT-12-001 Prenatal maternal anxiety and ADHD-related behaviour and cognitive task performance in the adolescent offspring B. van den Bergh* * The Netherlands Objectives: Evidence for non-genetic influences on ADHD is accumulating. However, a great deal of work lies ahead in understanding the mechanisms linking early development risk factors to brain (dys)function and symptom expression. In a study with a prospective design we tested: (1) whether groups of adolescents with a research diagnosis of ADHD and prenatally exposed to high (ADHD/HA) or low-average (ADHD/LA) levels of maternal anxiety showed groupspecific ADHD symptoms (i.e., specific phenotypes); and (2) whether these phenotypes could be discerned from those of groups of adolescents without ADHD and exposed to high (no-ADHD/HA) or lowaverage levels (no-ADHD/LA) of maternal anxiety.

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Methods: Maternal anxiety was measured with the State Trait Anxiety Inventory at 12–14, 23–31 and 32–40 weeks of pregnancy in 86 nulliparous women. Eight well-validated neurocognitive tasks encompassing different aspects of endogenous versus exogenous cognitive control (e.g., continuous performance task, Go/NoGO, Dual and N-back tasks, Iowa Gambling Task) were performed in their 14–15 (N = 64) and 17 year old (N = 49) firstborns. EEG measures were taken in the 17-year olds, and fRMI measures in a subgroup (N = 20) of male 20 year olds. Data were analyzed with a 2 9 2 ANOVA. Results: Compared to the other groups adolescents with ADHD whose mother was highly anxious at 12–22 weeks of pregnancy (ADHD/HA) had a worse performance on tasks measuring endogenous cc control but not on other tasks. EEG and fMRI data confirm these results. Conclusions: Our results indicate that endogenous cognitive control may be a phenotype that differentiates ADHD/HA from ADHD/LA, no-ADHD/LA and no-ADHD/HA. Different interpretation of the results and of the underlying mechanisms will be discussed and illustrated with EEG and fMRI data measured in this cohort as well as with event related potential measured during an auditory oddball paradigm in 9 month olds baby’s exposed to maternal anxiety during pregnancy, revealing similar results.

HT-12-002 Perinatal exposure to nicotine and tobacco smoke in relation to the onset of ADHD C. Tiesler*, J. Heinrich * Mu¨nchen, Germany Methods: To provide an overview on this topic, findings from previous reviews are summarised and complemented with findings from key publications and relevant recent publications which applied specific designs to investigate different aspects of the association. Results from animal studies are briefly mentioned. Furthermore, possible biological mechanisms are described. Results: The majority of studies observed that subjects exposed to nicotine or tobacco smoke in early life are at a higher risk for the development of ADHD or ADHD symptoms, some results even suggest a dose–response relationship. However, both human and animal studies have failed to provide clear evidence of causality and several studies suggest confounding by genetic factors. Nicotine can be transferred from the mother to the foetus across the placenta and a proposed biological mechanism for the observed association with behavioural problems is related to an adverse influence of nicotine on neurotransmitter systems during brain maturation leading to altered brain structure and function. Conclusions: Establishing a final statement on whether the observed relationship between early life exposure to nicotine or tobacco smoke and later development of ADHD is causal remains a challenging task.

HT-12-003 Maternal alcohol consumption during pregnancy and childhood hyperactivity/inattention K. Sayal* * Nottingham, UK Abstract not received.

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HT-12-004 Perinatal exposure to persistent organic pollutants and metals and ADHD M. Strom* * Copenhagen, Denmark Objectives: Over the past years an increase in psychiatric and behavioural disturbances, especially major depressive disorder and attention deficit/hyperactivity disorder (ADHD) has coincided with a marked increase in production and use of industrial chemicals with hormone-like activity, often referred to as endocrine disrupting chemicals (EDCs). The EDCs cover a wide range of structurally unrelated chemicals such as polychlorinated biphenyls (PCBs), organochlorine pesticides and bisphenol-A, which can disrupt the programming of endocrine signaling pathways that are established during prenatal life. Furthermore, low level exposures to EDCs during fetal life have been linked to several adverse health consequences, some of which are not apparent until much later in life. It has been relatively well established that developmental exposures to certain heavy metals, including mercury and lead, may have long lasting consequences on cognitive development and/or mental health. Concerning the EDCs there are some indications that in utero exposure to PCBs may be associated with poorer cognitive functioning in children and behavioral impairments that share significant commonalities with ADHD. Concerning EDCs which in the public seem to be of more current concern, animal and human studies suggest that developmental exposures to perfluoroalkyl acids and bisphenol-A may be associated with offspring risk of ADHD. Overall the evidence for the role of these contaminants in offspring mental health and cognitive performance is weak but long term follow-up studies are needed to evaluate possible latent effects. It must also be kept in mind that the pharmacokinetics and quantification of EDCs is often more complex compared to that of a single metal element such as lead or mercury for which results have been more consistent. Until now few studies have had follow-up beyond childhood, and the challenge in examining combination effects remained enigmatic. We examined the association of maternal serum concentrations of two perfluoroalkyl acids (perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS)), polychlorinated biphenyls (PCBs), dichlorodiphenyldichloroethylene (p,p’-DDE) and hexachlorobenzene (HCB) with offspring behavioural and affective disorders and scholastic achievement in a prebirth cohort study with 20 years of follow up. Methods: Between 1988 and 1989 pregnant women (n = 965) were recruited for the prebirth Danish Fetal Origins of health 1988 (DaFO88) Cohort in Aarhus, Denmark. Perfluoroalkyl acids, PCBs, p,p’-DDE, and HCB were quantified in serum from week 30 of gestation (n = 876 for perfluoroalkyl acids/872 for PCBs, p,p’-DDE, HCB). Offspring were followed up through national registries until 2011. We evaluated associations between maternal serum concentrations of these contaminants and offspring neurodevelopmental outcomes, defined as: first admission diagnosis or prescription of medication until age[20 for (1) ADHD (2) depression; and (3) scholastic achievement defined as mean grade on a standardized written examination given in the 9th grade (final exams of compulsory school in Denmark). Results: Maternal concentrations of organochlorine substances and perfluoroalkyl acids were higher than present day. During the follow up period there were 27 (3.1 %) cases of ADHD and 104 (11.9 %) cases of depression; the mean scholastic achievement was 6.7 (SD 2.3). Overall we found no association for maternal levels of any of the measured pollutants with offspring behavioural and affective disorders or with scholastic achievement.

Conclusions: Our analyses based on biomarkers from a cohort of over 800 pregnant women with long term close to complete follow-up through national registries showed little evidence of a programming effect of PFOA, PFOS, PCBs, p,p’-DDE, and HCB in relation to clinically and functionally relevant offspring neurodevelopmental outcomes.

Saturday, 30 May 2015, 14.30 h–16.00 h

Abstract not received.

HT-13-003 Dopamine transporter genotype and dose–response following treatment with psychostimulants: Implications for optimization of acute and longer-term treatment J. Newcorn*, M. Stein

HT-13 Neurobiological mechanisms underlying drug treatment in ADHD HT-13-001 The effects of stimulant and non-stimulant medication on the ADHD brain K. Rubia*, K. Chantiluke, C. Carlisi, A. Cubillo, A. Alegria, J. Radua, V. Giampietro, M. Brammer * London, UK Objectives: ADHD is effectively treated with the catecholamine-reuptake inhibitors Methylphenidate and Atomoxetine. Serotonin, however, has also been implicated in both ADHD and in impulsiveness with the serotonin-agonist Fluoxetine having positive clinical effects. We conducted a meta-analysis of acute stimulant effects in fMRI and several placebo-controlled fMRI studies on Methylphenidate, Atomoxetine and Fluoxetine effects on ADHD brain function. Methods: The meta-analysis comprised 14 whole brain fMRI studies of acute effects of stimulants versus placebo/off medication in 212 ADHD patients. Two samples of 20 children with ADHD performed several tasks in fMRI in randomised controlled-designs (1) after single doses of Methylphenidate, Atomoxetine and placebo (Stop, working memory (WM) and time discrimination (TD), (2) after single doses of Fluoxetine and placebo (WM; Stop; delay discounting (DD), reversal learning). We assessed within patient upregulation effects as well as normalisation effects of placebo-under activations relative to 20 controls under each drug. Results: The meta-analysis shows that the most consistent effect of stimulants is the upregulation of right inferior frontal/insula (IFC) and striatal activation. The upregulation/normalisation of IFC/insula activation was shared between methylphenidate and atomoxetine for Stop and TD tasks, while Atomoxetine had a drug-specific upregulation/normalisation effect on the dorsolateral prefrontal dysfunction during WM. Fluoxetine upregulated and/or normalised bilateral fronto-insular-striatal and parietal under activations in ADHD children relative to controls during Stop (IFC), WM (DLPFC) and DD (IFC) tasks, but downregulated previously normal medial frontal activation during reversal learning. Conclusions: Stimulants most consistently upregulate IFC which appears to be shared with Atomoxetine, presumably underlying their positive cognitive and behavioural effects. Atomoxetine however had a drug-specific upregulation/normalisation effect on the more noradrenergic innervated dorsal attention network. Fluoxetine, however, also upregulated and/or normalised lateral inferior and dorsolateral fronto-striatal dysfunctions suggesting that indolamine agonists just like catecholamine agonists can modulate and normalise key ADHD brain dysfunctions.

HT-13-002 Nigro-striatal mechanisms underlying ADHD and its treatment with methylphenidate U. Mu¨ller* * Cambridge, UK

* New York, USA Objectives: To examine if variation in the dopamine transporter gene (SLC6A3/DAT1) moderates the dose–response effects of stimulant medication in children with attention-deficit/hyperactivity disorder (ADHD), and to consider possible implications of stimulant effects at DAT1 on acute and long term response to treatment. Methods: Fifty-six children and adolescents (mean age = 11.7 ± 2.2) participated in a double-blind, two period crossover, dose–response study of long-acting d-methylphenidate (i.e., focalin XR) (d-MPH) and long-acting mixed amphetamine salts (i.e., Adderall XR) (MAS) with a randomized placebo week in each 4 week drug period. Each period consisted of sequential week-long exposures to three dose levels (10, 20, 25–30 mg, depending upon weight) of D-MPH or MAS. Results: Doses of 10–20 mg of either D-MPH or MAS had little to no effect on hyperactivity-impulsivity and total ADHD symptom scores in subjects with the 9/9 genotype; this was in contrast to the dose– response curves of subjects with either the 10/10 or 10/9 genotype. Conclusions: ADHD youth with the 9/9 genotype may require higher stimulant doses to achieve adequate symptom control. Implications of these findings for treatment optimization, adherence to treatment, and adaptive changes in brain physiology are discussed in relation to both acute and longer term treatment.

Saturday, 30 May 2015, 14.30 h–16.00 h HT-14 Unstable wakefulness regulation: A common pathogenetic factor in ADHD and manier HT-14-001 The noradrenergic neurotransmitter system in ADHD T. Vanicek*, A. Kautzky, K. Papageorgiou, S. Kasper, R. Lanzenberger * Vienna, Austria Objectives: The pathophysiology of ADHD has long been linked to dysregulations of the cingulo-fronto-parietal circuits [1], which are modulated, among other, mainly by the norepinephrine (NA) neurotransmission [2]. Executive functions as working memory, planning, vigilance and response inhibition, are typically altered in ADHD [3] and are primarily influenced by NA signaling. The most frequently prescribed medication for ADHD are stimulants and non-stimulants, which are thought to improve core symptoms through inhibition of the norepinephrine transporter (NET) and the dopamine (DA) transporter. An increase of NE and DA in central synapses of cortical and subcortical brain regions is detected subsequent to medication administration [5]. To shed light on the underlying etiology of ADHD, essential neurobiological investigations are made possible through PET imaging exploring the noradrenergic system. Due to the difficulties to produce a NET specific radio ligand [6,7], studies targeting the NET are sparse. Over the last years our group has successfully used the highly selective radio ligand (S,S)-[18F]FMeNER-D2

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in vivo in healthy humans[8] and for the first time in ADHD [9]. The results show no significant difference of NET availability in subcortical brain regions, suggesting altered NET availability in cortical regions or involvement of different norepinephrinergic proteins, as alpha-receptors. 1. Bush. G. et al. Neuropsychopharmacology. 2010;35:278–300. 2. Brennan. A.R. et al. Ann N Y Acad Sci. 2008;1129:236–245. 3. Willcutt. E. et al. Biol Psychiatry. 2005;57(11):1336–1346. 4. Del Campo. N. et al. Biol Psychiatry. Jun15 2011;69(12):e145–157. 5. Schou. M. et al. Nuclear medicine and biology. Oct2003;30(7):707–714. 6. Takano. A. et al. Neuroimage. Aug15 2008;42(2):474–482. 7. Rami-Mark. C et al. Nuclear medicine and biology. Nov2013;40(8):1049–1054. 8. Vanicek. T. et al. JAMA Psychiatry. Dec1 2014;71(12):1340–1349.

HT-14-002 Vigilance regulation in adult ADHD M. Strauß*, P. Madlen, S. Christian, H. Ulrich * Leipzig, Germany Objectives: Functional regulation of vigilance or wakefulness is crucial for interaction with the environment and can be described as a unique, situation-dependent characteristic. Disorders of wakefulness regulation manifest themselves as delayed or rash declines in vigilance under calm settings. The vigilance model of affective disorders and ADHS postulate that unstable regulation of vigilance (‘‘CNS arousal’’) is observed not only in overtired children, but also in patients with mania and ADHS. Moreover, sensation and novelty seeking, hyperactivity and impulsivity observed in such persons should be interpreted as an autoregulatory attempt to stabilise vigilance by creating a stimulus incentive environment. As in mania, also in ADHD several EEG-based studies indicate an unstable regulation of wakefulness. Using an EEG-based algorithm (Vigilance Algorithm Leipzig, VIGALL) to assess the transition from high wakefulness to drowsiness until sleep onset, paediatric ADHD as well as manic patients showed an unstable vigilance regulation with rapid declines to lower vigilance stages or sleep onset. We investigated whether the vigilance regulation in adult patients with ADHD is less stable than that of healthy controls by exploring the frequency of EEG-vigilance regulation patterns. Methods: EEG recordings of 15 min under quiet rest with eyes closed were performed. The computer-based Vigilance Algorithm Leipzig (VIGALL) was used to classify 1-s EEG segments into stages on the continuum ranging from full wakefulness to sleep onset. Results: Preliminary results of ADHD patients in comparison to controls will be presented. Conclusions: The investigated vigilance regulation model in ADHD could establish new insights into the neurophysiology of ADHD in adulthood.

HT-14-003 Results of the international multicenter, iSPOT-A study in ADHD: EEG predictors of treatment outcome to methylphenidate M. Arns*, D. Palmer, J. Buitelaar, E. Gordon * Nijmegen, The Netherlands Objectives: A move beyond ‘group averaged’ data to identify the best treatment for an individual, often referred to as Personalized Medicine or Precision Medicine, is well-needed in psychiatry.

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Electroencephalographic (EEG) biomarkers have shown promise in predicting treatment outcome to stimulant medication and in this study we aim to replicate these findings. Methods: In the international Study to Predict Optimized Treatment Response in ADHD (iSPOT-A), a multi-center, international, prospective open-label trial, 336 children and adolescents with ADHD were included and prescribed with methylphenidate. In addition, 158 children were recruited as a control group. Treatment response was established after 6 weeks using the clinician rated ADHD-RS-IV and responders (R) to treatment defined as a [25 % improvement. Resting state EEG was measured at baseline. Results: From the ADHD group 62 % could be classified as a responder to treatment, and no differences between R and NR were found on age and baseline severity. Among R there were significantly more males (63 %) as compared to NR (51 %). No differences in Theta/Beta ratio was found between R and NR, but a gender and age dependent difference occurred for alpha peak frequency (APF), where male adolescent non-responders had a significantly slower APF. Conclusions: We could not replicate previous findings that elevated theta or theta/beta ratio (as a sign of drowsiness) are associated with a favorable response to methylphenidate. However, we could confirm that a slow APF in male adolescents was associated with non-response to methylphenidate. Interestingly, for ADHD non-responders a pattern emerges where the typical maturational changes in EEG seen for ADHD responders and controls are not seen for ADHD nonresponders and start emerging in adolescence. These results warrant replication, but suggest an ADHD subgroup characterized by a maturational stagnation that starts with puberty onset and is associated with non-response to stimulant medication.

HT-14-004 The effects of stimulant medication on vigilance regulation in childhood ADHD J. Geissler*, A. Balsam, K. Peters, D. Hansen, M. Romanos * Wu¨rzburg, Germany Objectives: Expanding on results by Sander et al. (2010), this study aims to examine in greater detail the regulation and stability of vigilance in ADHD and the effects of stimulant medication on vigilance. Furthermore the predictive value of vigilance patterns for medication response will be evaluated. Methods: The final sample will comprise N = 20 in- and outpatients from the Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy at the University of Wu¨rzburg diagnosed with ADHD (8–12 years) and N = 20 age- and sex-matched controls recruited primarily from local schools. An eyes-closed resting-state EEG is recorded in a light- and sound-attenuated room. The recording time has been expanded from Sander et al. (2010) from 2 to 10 min for a more accurate representation of the course of vigilance. Categorization of vigilance regulation and stability will be conducted using the VIGALL 2.0 tool implemented in the BrainVision Analyzer (Brain Products GmbH, Germany) software; statistical analyses will be performed with SPSS22. Results: Data collection is ongoing. We expect to find greater vigilance instability in the ADHD group compared to controls. Our secondary hypothesis is a more unstable vigilance in ADHD to be predictive of a more favourable response to stimulant medication. Conclusions: In the clinical context this non-invasive method may be implemented in the diagnostic process and the evaluation of treatment effectiveness of psychostimulants.

Saturday, 30 May 2015, 14.30 h–16.00 h HT-15 Dopaminergic motor behavioural and behavioural motor disorders HT-15-001 Iron deficiency, sleep disturbances, dopamine and ADHD M. Youdim* * Haifa, Israel Abstract not received.

HT-15-002 ADHD altered dopamine neurotransmission and disrupted reinforcement processes: Implications for smoking and nicotine dependence S. H. Kollins* * Durham, USA Objectives: Individuals with ADHD smoke cigarettes at rates significantly higher than their non-diagnosed peers and the disorder also confers risk for a number of related adverse smoking outcomes including earlier age of initiation, faster progression to regular use, heavier smoking/greater dependence, and more difficulty quitting. Progress in our understanding of dopamine neurotransmission and basic behavioral reinforcement processes in ADHD may help increase our understanding of the ADHD-smoking comorbidity. This review will examine how these areas have been studied and how further work may aid in the development of better prevention and treatment for smoking in those with ADHD. Methods: This quantitative review will first consider historical perspectives on the role of catecholamines in the pathophysiology of ADHD, along with what we know about the molecular genetics of this disorder. We will then consider what is known about altered reward/reinforcement processes in individuals with ADHD. Finally we will consider how dopamine function and reinforcement processes can inform understanding of the ADHD-smoking comorbidity. Conclusions: A clearer understanding of the interconnection among these processes can lead to better prevention and treatment options for the ADHD-smoking comorbidity.

HT-15-003 Dopamine dysregulation syndrome, and impulse control disturbances E. Wolters* * Amsterdam, The Netherlands Objectives: The most widely accepted model of behavioural disorders suggests an activity out of balance within the various loops of the cortico-striato-thalamo-cortical circuits. Within the motor loops, motor behavioural disorders might be induced including parkinsonism, tremor, dystonia, chorea and tics. An imbalance in the cognitive loops might result in cognitive behavioural disorders such as attentional deficit, executive dysfunction, dementia and psychosis, and when the emotional/motivational loops are involved this will result in apathy,

dysphoria and depression, or hyperactivity, euphoria, mania, and obsessive compulsive disorders. Due to dopaminergic denervation of the basal ganglia, motor parkinsonism with bradykinesia and hypokinesia in combination with tremor, rigidity, and/or loss of postural reflexes results with a loss of adapted, goal-directed behaviour in response to new situations, as the role of the basal ganglia comprises the selection of adequate spontaneous or reactive behaviour adapted to each particular situation. As in daily life, reactive behaviour suppresses individual spontaneous behaviour (external cues are applied in situations where uniform behaviour is wanted), in Parkinson’s disease (PD), the loss of adapted spontaneous movements might profit the application of such cues. Due to dopaminergic overstimulation of the basal ganglia, a dopamine dependency syndrome, a dopamine dysregulation syndrome with hyper(dys)kinesia and/or punding, as well as impulse control disorders may arise. The dopamine dependency syndrome is the result of a dependance to the euphoric (mesocortical) gratificational effects of dopamine. The dopamine dysregulation syndrome is rather the consequence of postsynaptic changes due to pulsatile stimulation of the (nigrostriatal) dopaminergic receptors, resulting in hypersensitivity of the receptors, and manifesting with motor (hyperkinesia) or mental (punding) fluctuations. Impulse control disorders (ICD) are considered a (mesolimbic) class effect of dopaminomimetic drugs, which may manifest with a.o. hypersexuality, pathological gambling, pathological shopping and/or binge eating.

HT-15-004 Dopamine dysfunctions in motor abnormalities linked to neurological diseases and psychiatric disorders P. Riederer* * Wuerzburg, Germany Objectives: Dopamine (DA), one of the classic monoaminergic neurotransmitters, is synthetized in several brain regions, thus creating various important DA neuronal pathways, i.e. the nigrostriatal pathway (substantia nigra—striatum), the mesolimbic (ventral tegmental area— nucleus accumbens), the mesocortical (ventral tegmental area—prefrontal cortex), the tuberoinfundibular (hypothalamus—anterior pituitary gland) and a pathway arising from multiple sites and innervating the thalamus. Therefore, dysfunctions in these DA related pathways are suggested to cause a variety of symptomatology. The classic disorder, Parkinson’s disease, primarily suffers from a DA depletion in the substantia nigra pars compacta, thus causing akinesia, rigidity and tremor. L-Dopa (ev. Combined with DDI, MAO-I’s, COMT-I’s) and dopaminergic receptor agonists either directly or indirectly supplement this loss of DA-functions. Hyperactivity as seen in ADHD can be related to disturbed striatal DA function which is— interestingly—amerliorated by methylphenidate or amphetamine. Positive symptoms of schizophrenia seem to be related to malfunctioning of mesolimbic circuits with hyperactivity of DA neurotransmission. Reward and motivation can be linked to both mesolimbic/mesocortical systems which are malfunctioning in schizophrenia and are related to negative symptomatology. Neuroleptic drug treatment inhibits primarily D2-receptors including those oft he striatal tract. In circumstances, this blockade favours so called tardive dyskinesias and reduced motor activity. Disturbed impulse control/ aggression is mediated by malfunction of the orbitofrontal cortex and amygdala, affective symptoms are associated with the ventromedial prefrontal cortex and cognitive symptoms may be related, at least in part, to malfunctioning of the dorsolateral prefrontal cortex. Variation in quality and quantity of such DA related pathology and their interactions with other neurotransmitters systems characterize the main pathology of Parkinson’s disease, schizophrenia and also ADHS.

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Saturday, 30 May 2015, 16.00 h–17.30 h P-17 Aetiology II P-17-001 Children mental health in refugee families: Childhood abuse as a cause of ADHD D. Martsenkovskyi*, I. Martsenkovsky * Kyiv, Ukraine Objectives: The war on the east of Ukraine resulted in a dramatic increase in the flow of refugees, social disadaptation of families and increasing of child abuse cases. Many children experienced trauma from emotional, physical or sexual abuse. Psychical trauma can have negative, life-long repercussions for children’s developing brains if it is not treated properly. Casual link between ADHD and PTSD was the objective of the study. Methods: We compared mental health of adolescents from refugee families with those living in Kyiv. We randomised 116 teenagers with ADHD that exposed different forms of emotional, physical, and sexual abuse (DSM-IV criteria for PTSD and ADHD). Were used structured Interview—Clinician Administered PTSD Scale (CAPS), 36-item normed ADHD-Test, SNAP-IV Rating Scale. Results: There was a statistically significant trend: to be more cases of ADHD among girls refuges with PTSD. Children with PTSD had higher mean scores on impulsivity and inattention scales of the SNAP-IV, but not the hyperactivity scales. There was no significant statistic difference regarding the age of onset of ADHD between the refugee and local group. Boys had a much earlier age of onset than girls. Boys and girls with PTSD had a similar age of onset of ADHD. 74.1 % of children with PTSD had a parent with ADHD versus 37.9 % of without PTSD children, v2 = 5.34, p = 0.02. Conclusions: It is not yet clear is trauma actually a causal factor in ADHD or are post traumatic symptoms merely mimic ADHD symptoms. It is also possible that people with ADHD have a greater tendency to migration in conditions of war.

P-17-002 Life events in the first trimester of pregnancy are related to a poor pregnancy outcome in mothers of ADHD children F. Lopez Seco*, P. Mundo Cid, J. Aguado Gracia, S. Acosta garcı´a, A. Masana Marin * Reus, Spain Objectives: To determine whether life events during pregnancy are associated with a poor outcome of pregnancy in a clinically treated sample of children with attention deficit hiperactivity disorder (ADHD). Methods: All outpatients (and their biological mothers) who had been confirmed with an ADHD diagnosis by a structured MINI-KID interview1 and who were currently being treated by our service were asked to participate. The inclusion criteria for children consisted of age between 7 and 18 years, availability of direct maternal information and informed consent. Patients with Intellectual disabilities, autism spectrum disorders or neurological damage were excluded. The final sample consisted of 116 subjects. Maternal life events were evaluated by the Social Readjustment Rating scale2. In an interview, mothers were asked about life events during the first, second, and third trimesters of pregnancy. Obstetric complications were evaluated

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by gestational age and the total score of the McNeil-Sjostrom scale3 Pearson correlations (r) between life event scores (in every period) and gestational age were calculated. Results: A significant correlation between life events during only the first trimester of pregnancy and gestational age (r = -0.200, p = 0.044) was found. Life event scores during the first trimester of pregnancy and total obstetric complications showed the same correlation (r = 0.208, p = 0.043). Conclusions: First trimester life events can be relevant to pregnancy outcome, even when life events that are not catastrophic are included. This may be an important area for developing prevention strategies for neurodevelopmental disorders such as ADHD.

P-17-003 An association between poor glycemic control among diabetic patients and undiagnosed adult ADHD E. Merzon*, E. Kitai, A. Golan–Cohen * Karnei Shomron, Israel Objectives: It has been shown that psychiatric disorders like depression and anxiety are associated with poor glycemic control. Attention Deficit Hyperactivity Disorder (ADHD), one of the most common chronic psychiatric disorders in general adult population, is associated with poor health statutes. Previous studies described higher prevalence of obesity and type II diabetes mellitus (DM) among young adults with ADHD. The objective of our study was to evaluate whether poor-controlled diabetics have a higher proportion of undiagnosed ADHD. Methods: We conducted a population based case–control study in the Central Region of Israel. 13 cases with poor controlled DM (HgbA1C [9 %) were compared to the 13 controls with good glycemic control (HgbA1C\7 %). ADHD diagnosis was based on DSM-V criteria and assessed by the Wender Utah Rating Scale (WURS). Odds ratios of having ADHD were calculated and adjusted for potential confounders and effect modifiers using multivariable analysis and logistic regression models. Results: Cases, as compared to controls, had higher BMI (37.5 vs. 26.8, P \ 0.01), total cholesterol (208.1 vs. 152.8, P \ 0.01), low density cholesterol (120.8 vs. 81.3, P \ 0.01), triglycerides (243.1 vs. 115.2 P \ 0.01) level and systolic blood pressure (148.7 vs. 128.2 P \ 0.01). Less cases completed 12 year education (19.95 vs. 80.34 %, P \ 0.01). Cases had lower income (12384 NIS vs. 15607 NIS, P = 0.08). 69.3 % of case were diagnosed with ADHD vs. 13.3 % of controls (P \ 0.01). Odds ratio of having ADHD among poor-controlled diabetics as compared to good-controlled was 8.02 (CI 1.64–50.8). Conclusions: We found that among diabetics with poor glycemic control proportion of undiagnosed ADHD was 8 times higher as compared to diabetic patients with good glycemic control.

P-17-004 Executive functioning, emotional intelligence and psychosocial adversity as predictors of ADHD in high risk adolescents L. Palacios-Cruz*, E.-M. Ca´rdenas-Godı´nez, A. Arias-Caballero, C. Benjet, M. d. Carmen Lara Mun˜oz, R. E. Ulloa-Flores, P. Clark, C. Cruz Fuentes, P. Mayer-Villa, F. de la Pen˜a, M. Feria, L. Sosa-Mora, A. Fragoso * Me´xico, Mexico

Objectives: To determine executive functioning, emotional intelligence and psychosocial adversity as predictors of ADHD in high risk adolescents. Methods: Study sample was obtained from 3 outpatient centers and was composed of 84 adolescents who had a sibling with ADHD (ADHD-R Sib). The subjects were evaluated by clinicians with at least 5 years of experience and the diagnostic determination was made by clinical consensus with at least one expert with 15 years of clinical experience. The following instruments were applied by the clinicians, to parents or to the adolescents: a clinical interview based on DSM IV, Attention Deficit Hyperactivity Disorder Rating Scale (ADHD RS) IV, Behavior Rating Inventory of Executive Function (BRIEF) parent version, Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT) and a sociodemographic and clinical data questionnaire. Results: Approximately forty-five percent (n = 38) had ADHD (R sib +). Among those with ADHD versus without ADHD (R sib -) no significant differences were found regarding sex, age, and having an average of 3 or more adversities. Shifting (OR = 3.47, 95 % CI 1.17–10.30), working memory (OR = 3.46, 95 % CI 1.27–9.37) and organization and planning (OR = 7.45, 95 % CI 1.94–28.71) increased the probability of having ADHD. Understanding emotions decreased the risk (OR = 0.32, 95 % CI 0.13–0.79) to ADHD in our sample. In multivariate analysis, adjusting for sex and psychosocial adversity, only the organization and planning (OR = 5.77, 95 % CI 1.06–31.45) and emotional understanding (OR = 0.33, 95 % CI 0.11–0.95) maintained significant (R2 = 0.28; Hosmer–Lemeshow Test x2 = 7.37; gl = 8, p = 0.497). Conclusions: Addressing cognitive predictors, including those related to emotional regulation in high-risk populations such as adolescents siblings of patients with ADHD can help find factors that may even be related to variables such as resilience.

P-17-005 Evidence for a bias towards virtual navigation response strategies in 8-year old children with ADHD symptoms

P-17-006 Comorbidity of allergic diseases among patients with ADHD and Tourette’s disorder: A nationwide populationbased study J. H. Son*, Y. S. Lee, J. Han, G. H. Bahn * Seoul, Republic of Korea Objectives: Our purpose is to investigate the comorbid effect of ADHD and Tourette’s disorder on developing Allergic diseases from 2009 to 2012, using data from the Health Insurance Review and Assessment (HIRA) Service. Methods: Using the HIRA database, children and adolescents with ADHD alone, Tourette’s disorder alone, ADHD comorbid with Tourette’s disorder, and age-/gender-matched (1:4) controls were chosen during 2009–2012. Allergic diseases were identified using the International Classification of Diseases, 10th revision (ICD-10), including Allergic Rhinitis, Asthma, and Atopic dermatitis. Results: Among 39,507 diagnosed patients with ADHD, 20,160 (51.0 %) had allergic rhinitis, 7319 (18.5 %) had asthma, and 5494 (13.9 %) had atopic dermatitis. ADHD with Tourette’s disorder showed a higher prevalence of Allergic diseases, allergic rhinitis (64.2 %), asthma (26.7 %), and atopic dermatitis (16.4 %). Furthermore, ADHD patients with more Allergic diseases (n = 1, 2, 3) had increased Odds ratios of Tourette’s disorder (OR 1.571, 2.122, 2.483), compared with the ADHD alone group. Conclusions: This is the first report of nationwide data on the comorbidity of ADHD in Korea. There was a significant correlation between ADHD, Tourette’s disorder, and Allergic diseases in our study. We have to carry out further research in order to find out more about the mechanisms in comorbid disorders of ADHD.

P-17-007 Circadian rhythm disruption as a link between Attention-Deficit/Hyperactivity Disorder and obesity?

P. Robaey*, S. McKenzie, R. Schachar, M. Boivin, V. Bohbot

S. Vogel*, D. Bijlenga, M. Tanke, T. Bron, K. van der Heijden, H. Swaab, a. Beekman, S. Kooij

* Ottawa, Canada

* Den Haag, The Netherlands

Objectives: Studies in children show that the development of spatial competence emerges between 7 and 8 years of age. Multiple memory systems (hippocampal based-spatial and caudate-based response learning) are involved in parallel processing of spatial information during navigation. It is unknown whether the presence of Attention Deficit Hyperactivity Disorder (ADHD) would change the relative strength of one memory system over another. Methods: In the current study, we tested 285 children on a virtual radial arm maze paradigm in order to investigate this question. Results: Children who displayed at least one ADHD symptom tended to report using a response strategy, as compared to those with no ADHD symptoms (19.4 vs. 11.1 % p = .09). They were also more likely to make no error on the probe trial, which was designed to test the use of spatial landmark: 34.9 vs. 20.9 % (p = 0.01). Despite this paradoxical advantage, the presence of any ADHD symptoms increased the proportion of those failing to learn the task to criterion: 27.3 vs. 16.7 % (p = 0.06). Conclusions: This suggests that children with ADHD symptoms primarily rely on caudate dependent response learning strategies at the expense of hippocampal based spatial strategies. Repetition and reward based learning strategies, which are hallmarks of response learning, may be most effective in children exhibiting ADHD symptoms.

Objectives: Among persons with obesity there is an increased prevalence of Attention-Deficit/Hyperactivity Disorder (ADHD), and vice versa 1.2. A delayed circadian rhythm, which is associated with ADHD, is characterized by a pattern of late and short sleep and it increases risk of Seasonal Affective Disorder (SAD), which all have implications for eating patterns and body weight 3. Therefore, we hypothesized that circadian rhythm disruption may be a mechanism linking obesity to ADHD. Methods: Questionnaires concerning ADHD symptoms, sleep, eating pattern, and seasonal depressive symptoms were completed by obese participants (n = 114), ADHD patients (n = 202), and controls (n = 154). We compared prevalences of ADHD symptoms, sleep problems, unstable eating pattern, and SAD between the obese and ADHD groups, and between the obese and control groups. Linear regression analysis was performed to examine associations between markers of circadian disruption (poor sleep, unstable eating pattern, and seasonal variations in appetite) and ADHD symptoms in the obese group. Results: As expected, obese participants had a lower prevalence of ADHD symptoms and short sleep on free days as compared to ADHD patients, but a higher prevalence of ADHD symptoms, short sleep on free days, and an unstable eating pattern as compared to

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controls. Remarkably, we found that obese participants had a similar prevalence of an unstable eating pattern as compared to ADHD patients, and that the three groups did not differ with respect to the prevalence of SAD. Poor sleep, unstable eating pattern, and seasonal variations in appetite were associated with ADHD symptoms in obese participants. Conclusions: Results from our study support the hypothesis that circadian rhythm disruption is a mechanism linking ADHD to obesity. Further research is needed to determine if treatment of ADHD and circadian rhythm disruption is effective in the prevention and treatment of obesity in patients with obesity and/or ADHD.

P-17-008 Serum ferritin is negatively correlated with inattention in a sample of Egyptian children with Attention-Deficit/ Hyperactivity Disorder M. Seleem*, T. El-Gohary, M. Eid, E. Sroor * Tanta, Egypt Objectives: Iron deficiency was suggested to play a role in the pathophysiology of attention deficit hyperactivity disorder (ADHD) due to the role of iron in the production of dopamine and noradrenaline. The aim of this study was to assess iron status in a sample of Egyptian children with ADHD. Methods: Thirty children with ADHD (6–12 years old) and 15 age and sex matched controls were recruited. Subjects were evaluated using the Mini International Neuropsychiatric Interview for kids (mini-kid) and Conner’s Parent Rating Scale—Revised (CPRS-R). Laboratory measures were also carried out to investigate iron status in all subjects including: complete blood count, serum iron, total iron binding capacity, and serum ferritin. Results: Children with ADHD showed significantly lower levels of hemoglobin and serum ferritin as compared to control groups. A strong negative correlation was found between serum ferritin and ADHD total score and cognitive subscore but not with hyperactivity subscore. No significant differences were found between the two groups as regards other hematological data. Conclusions: Iron deficiency, with or without anemia, might play a role in pathogenesis of ADHD. Further work is needed to confirm the clinical utility of iron supplementation in the treatment of ADHD, especially in developing countries.

P-17-009 Level of polyunsaturated fatty acids and glutathione peroxidase activity in children with Attention-Deficit/ Hyperactivity disorder H. Azouz*, A. Kitat * Alexandria, Egypt Objectives: Attention deficit hyperactivity disorder (ADH) is the most common neurobehavioral disorder of childhood. The aetiology of ADHD remains uncertain. The aim of this work was to study serum level of polyunsaturated fatty acids (PUFAs) and glutathione peroxidase activity and their possible role in clinical manifestations and severity of ADHD in children. Methods: Case control cross-sectional study was conducted on 20 children ranged from 4 to 10 years with ADHD and 20 apparently healthy age and sex matched children as the control group. The

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studied children were subjected to psychometric assessment included DSM-V, assessment of the severity of the disorder using the Arabic translation of ‘‘Conners’ Parent Rating Scale-revised: long version and IQ using Stanford Binet test. Estimation of serum levels of polyunsaturated fatty acids (alpha-linolenic acid LNA, linoleic acid LA, docosahexaenoic acid DHA, and arachidonic acid AA) by using gas liquid chromatography and estimation of plasma activity level of glutathione peroxidase (GPx) enzyme by Modified Pagalian and Valentine method. Results: The serum polyunsaturated fatty acids showed significantly lower levels of DHA (99.24 ± 50.4 lg/mL), LA (24.06 ± 13.76 lg/ mL) and AA in ADHD cases (46.88 ± 20.83 lg/mL) in comparison with the control group (DHA 137.28 ± 56.82 lg/mL, serum LA level 69.32 ± 41.13 lg/mL and serum AA level 104.3 ± 62.22 lg/mL). LNA was insignificantly lower in cases (11.64 ± 7.47 lg/mL) than controls (15.07 ± 5.9 lg/mL). ADHD cases with learning disabilities had lower mean level of DHA than cases without learning disabilities but that was found to be statistically insignificant. Cases with moderate-severe combined presentation, had significantly lower AA levels than cases with mild score. GPx plasma activity level was of no significant difference between ADHD cases and controls. However, cases associated with learning disabilities had significantly lower GPx activity level than cases without learning disabilities. Cases of inattentive presentation with moderate-severe score, had significantly lower GPx activity level than cases with mild score. Conclusions: PUFAs deficiency can play a role in ADHD symptoms. The severity of ADHD symptoms can be affected by the degree of AA deficiency. ADHD children with lower level of GPx activity were more vulnerable to co-existing learning disabilities and severe inattention symptoms.

Saturday, 30 May 2015, 16.00 h–17.30 h P-18 Epidemiology II P-18-002 Reproductive outcomes of women treated with stimulant medication for Attention-Deficit/Hyperactivity Disorder (ADHD) A. Poulton*, R. Nanan * Kingswood, Australia Objectives: To investigate the effect of maternal stimulant medication for ADHD on perinatal outcomes. Methods: Linkage of the statewide New South Wales prescription database for stimulant medication with the statewide perinatal data collection permitted the creation of a cohort of women ever treated with stimulant medication who first gave birth between 1994 and 2012 and of a control cohort (5 controls per treated woman) not treated with stimulant medication and matched by maternal and infant year of birth. Associations of stimulant medication use with perinatal outcomes were analysed using linear modelling controlling for relevant confounders. Results: Out of 5570 women treated with stimulant medication, 4196 were treated for ADHD (mean age for starting treatment: 17.05 ± 10.97 years, range 2–55 years). Of these, 3530 (84 %) were treated before the birth of their first infant. Compared to the 27,820 controls, women ever treated for ADHD were more likely to smoke during pregnancy (25.22 % versus 16.44 % p \ .0001). They had a higher rate of preterm birth before 37 weeks (8.58 % versus 7.45 % p = 0.0083) and birthweight below 2000 g (3.47 % versus 2.69 % p = 0.0035). Within the treatment group, after controlling for smoking and gestational age, there was no independent effect of the number of years of treatment or of treatment (presumed) during

pregnancy on birthweight or 1 or 5 min Apgar. However, there was a significant correlation between age of starting treatment and age of first giving birth (r = 0.60, p \ 0.0001). Conclusions: While there were higher rates of smoking, preterm birth and low birthweight associated with a presumed diagnosis of ADHD, we found no independent association of duration of stimulant treatment or presumed treatment during pregnancy on Apgar or birthweight. Women who start treatment at a younger age, and possibly therefore have more severe ADHD, may be at a higher risk for early or unplanned pregnancy.

P-18-003 Socioeconomic associations with ADHD: Findings from a mediation analysis A. Russell*, T. Ford, G. Russell * Exeter, UK Objectives: Children from disadvantaged socioeconomic backgrounds are at greater risk of a range of negative outcomes throughout their life course than their peers; however the specific mechanisms by which socioeconomic status relates to different health outcomes in childhood are as yet unclear. The current study investigates the relationship between socioeconomic disadvantage in childhood and attention deficit/hyperactivity disorder (ADHD), and investigates putative mediators of this association in a longitudinal populationbased birth cohort in the UK. Methods: Data from the Avon Longitudinal Study of Parents and Children was used (n = 8132) to explore the relationship between different measures of socioeconomic status at birth-3 years and their association with a diagnosis of ADHD at age 7. A multiple mediation model was utilised to examine factors occurring between these ages that may mediate the association. Results: Financial difficulties, housing tenure, maternal age at birth of child and marital status were significantly associated with an outcome of ADHD, such that families either living in financial difficulty, living in council housing, with younger or single mothers’ were more likely to have a child with a research diagnosis of ADHD at age 7. Financial difficulties was the strongest predictor of ADHD (OR 2.28 95 % CI 1.61–3.23). In the multiple mediation model, involvement in parenting at age 6 and presence of adversity at age 2–4 mediated 27.8 % of the association. Conclusions: Socioeconomic disadvantage, conceptualised as reported difficulty in affording basic necessities (e.g. heating, food) has both direct and indirect impacts on a child’s risk of ADHD. Lower levels of parent involvement mediates this association, as does presence of adversity; with children exposed to adversity and those with less involved parents being at an increased risk of having ADHD. This study highlights the importance of home and environmental factors as small but important contributors toward the aetiology of ADHD.

P-18-004 Prevalence of ADHD subtypes, risk factors and relation to sluggish cognitive tempo symptoms in schoolchildren in Crete, Greece

The aim of the present study was to explore the prevalence, the risk factors of ADHD and its relation to SCT symptoms in 6–12 year old children in Crete, Greece. Methods: Following DSM-IV criteria for ADHD, 1165 children, 6–12 year old, randomly selected, were assessed for ADHD and SCT symptoms by using the Teacher’s Report Form and the ADHD-Rating scale-IV. Results: Out of 1165 children, 69 (5.9 %; 95 % CI 4.7–7.4 %) fulfilled the study criteria for ADHD. The estimated prevalence was 7.5 % for boys and 4.1 % for girls (P = 0.018). The most prevalent subtype of ADHD was the combined (3.0 %), followed by the inattentive (2.0 %) and hyperactive-impulsive type (0.9 %). No significant differences were observed regarding age, gender and ADHD subtype distribution. A strong association was found between the ADHD-I type and SCT symptoms. Conclusions: The prevalence of ADHD in schoolchildren in Crete and the risk factors were found to be comparable to those reported in other studies worldwide. Additionally, the ADHD Inattentive type seems to be strongly associated with SCT symptoms.

P-18-005 Mothers with ADHD: Clinical characteristics, comorbidity and treatment history M. Stein*, J. Strickland, A. Chronis-Tuscano * Seattle, USA Objectives: ADHD is highly familial and common in children and adults of both genders. Despite their key role in parenting, mothers with ADHD have only recently been a focus of systematic study. In this preliminary study, we sought to identify mothers with ADHD who are currently not treated with stimulant medication, and describe their current symptoms, impairments, and previous treatment history. Methods: Mothers of children with ADHD symptoms between 4 and 8 who are not being treated with medication who have ADHD symptoms themselves were recruited from clinics and the community, and the mothers were administered diagnostic interviews and measures, including: the Adult ADHD Clinical Diagnostic Scale, an adaptation of the Schedule for Affective Disorders for School-Aged Children (K-SADS) ADHD Module, Structured Clinical Interview for DSM-IV (SCID), Conners Adult ADHD Rating Scale-Self Report (CAARS-SR), the Wender-Reimherr Adult Attention Deficit Disorder Scale (WRAADDS), the Beck Depression Inventory-II (BDI-II), and The Barkley Functional Impairment Scale–Self Report. Results: The study sample included 23 mothers (mean age = 39) who met DSM V criteria for ADHD, and 26 % had previously been treated for ADHD. The majority of mothers (60 %) had graduated college, and 69 % were married. Comorbid depression was present in 26 % and 17 % were currently receiving anti-depressants. A lifetime history of a mood disorders occurred in 52 %. Conclusions: Mothers with ADHD who have children with ADHD who were studied were well educated. They were quite variable in their clinical characteristics and impairments. In terms of previous treatment, they were more likely to be treated for their mood disorders rather than ADHD. Ongoing research will evaluate how to sequence and combine pharmacological and behavioral treatment for mothers with ADHD and their at-risk children.

M. Skounti*, E. Aifanti, E. Parlama, M. Kouvidi, P. Skounti * Heraklion, Greece Objectives: Prevalence of ADHD has been reported with great variations worldwide. The concept of Sluggish Cognitive Tempo (SCT) remains crucial and highly controversial in the ADHD classification.

P-18-006 Knowledge and attitudes towards Attention-Deficit/ Hyperactivity Disorder (ADHD): A cross-cultural comparative study between Scotland and Romania M. Toma*

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* Dundee, UK Objectives: The aim of this study was to investigate the way in which ADHD is currently conceptualised within Romania and Scotland, comparing and contrasting the discourses surrounding the diagnosis within different cultural contexts. Methods: This study employed a two-phased mixed methods design based on a concurrent nested approach. Firstly, Romanian and Scottish parents’ and teachers’ knowledge and attitudes towards ADHD were investigated using a self-report questionnaire designed, piloted and validated for the purpose of this research. The data were further enriched by in-depth interviews co-creating meaning and interrogating perceptions and experiences related to ADHD. Results: For the knowledge test, results showed that both samples scored the highest at symptoms/diagnosis subscale. Romanian parents and teachers scored the lowest at the treatment subscale whereas the Scottish respondents had difficulties in answering questions about the nature, causes and prognosis. In terms of the self-reported attitudes, both samples scored the highest on the affective attitude subscale. Scottish parents and teachers scored the lowest on the behavioural attitude subscale whereas the Romanian participants had the lowest scores on the cognitive subscale. Qualitative data pointed towards both a medical and social conceptualisation of ADHD, themes like medicalising behaviours, educational ‘wrongs’, self-blame or shifting the burden being mentioned interchangeably. Reflecting the uncertainty in the field, hypothesis were continually enriched, expanded, modified or even shifted from one perspective to another. The crosscultural comparisons used the theoretical framework of ‘‘scapes’’ (Appadurai 1996) to explain the recent globalisation of ADHD where children, parents and teachers find themselves caught between disjunctive connections of movements, flows and ideological transfers. Conclusions: This study moves beyond the deficit paradigm, helping parents and teachers to capture the complexities of ADHD, recognising the diagnosis as a spatially, socially and temporally situated phenomenon that is culturally specific and individually experienced.

P-18-008 The first follow-up study of Attention-Deficit/ Hyperactivity Disorder from China Q. Gao*, Y. Qian, X. He, W. Chang, Y. Li, Q. Cao, Y. Wang, Q. Qian * Beijing, People’s Republic of China Objectives: An average 50 % of children with attention-deficit/hyperactivity disorder (ADHD) continue to suffer the disorder during adulthood. However several limitations should be considered in the previous follow-up study: First, most did not differentiate the role of inattention and hyperactivity/impulsivity. Second, most did not control for associated external behaviours. Third, most did not consider the interactions among potential predictors. In the present study, we set out to widely investigate the predictors in a Chinese Han ADHD cohort. Methods: We conducted a 12-year prospective follow-up study of 401 children with ADHD. Logistic regression combined with survival analysis were conducted to study the association of retrospectively reported childhood risk factors with adult persistence including gender, childhood ADHD symptoms, severity, treatment, IQ, comorbid with oppositional defiant disorder (ODD), and conduct disorder (CD). Results: From logistic regression, persistence was strongly related to hyperactivity/impulsivity symptoms (multiple OR = 1.106, P = 0.028), IQ (multiple OR = 0.985, P = 0.033), argumentative/ defiant behaviour (simple OR = 1.142, P = 0.05) and function impairment severity (simple OR = 1.183, P = 0.024). Hyperactivity/ impulsivity symptoms (P \ 0.001) and IQ (P = 0.013) were still significant predictors in survival analysis. Interactive model was found among medication treatment, IQ, hyperactivity/impulsivity, impairment severity, gender, CD and three ODD dimensions. Conclusions: The contributions of ADHD and ODD symptom categories, IQ and function impairment severity are critically important in the persistence course.

Saturday, 30 May 2015, 16.00 h–17.30 h P-18-007 Knowledge/understanding, perception, and attitude towards Attention-Deficit/Hyperactivity Disorder (ADHD) among general practitioners in Jakarta J. A. Wibowo*, T. Wiguna * Newcastle, UK Objectives: To know the level of knowledge/understanding, perception, and attitude towards ADHD among general practitioners in Jakarta, and to identify the association to their length of practice experience. Methods: This research used cross-sectional design. The samples were 384 general practitioners in Jakarta who were selected through simple random sampling method. Data obtained from questionnaires that have been tested for its validity and reliability (Pearson alpha [0.25; Cronbach’s alpha [0.7), and were analyzed utilizing SPSS software 20th version for Macintosh. Results: The result showed that majority of the research subjects were have poor and very poor levels of knowledge/understanding (54.9 %), perception (58.1 %), and attitude (60.7 %) towards ADHD, and there was a significant association with the length of practice experience statistically. Conclusions: In conclusion, the knowledge/understanding, perception, and attitude levels towards ADHD among general practitioners in Jakarta were in poor and very poor levels. Additionally, there was association between practice experience and level of knowledge/understanding, perception, and attitude towards ADHD among general practitioners in Jakarta.

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P-19 Diagnosis - Children and adolescence II P-19-002 Specificity of temper tantrums in children with Attention-Deficit/Hyperactivity Disorder J. Maire*, C. Galera, S. Bioulac, M. Bouvard, G. Michel * Bordeaux Cedex, France Objectives: Temper tantrums are a main concern in child psychiatry as they frequently lead to consultations or even hospitalization. Children with ADHD often suffer from emotional dysregulation (for review, see Shaw et al. 2014) but to date little is known about the specificity of temper tantrums in ADHD and their impact on diagnosis. This study aims to investigate temper tantrums in children with ADHD and their association with symptomatology and impairment. Methods: Participants were 40 children aged 7–11 years old diagnosed with ADHD. ADHD and comorbidity were assessed with a semi-structured interview completed with the Conners Rating Scale (Conners et al. 1998). For children currently having temper tantrums, parents’ ratings on the Inventory of Rage Behaviors (Margulies et al. 2012) specify the organization of tantrums, their frequency, duration, context and recovery from them. T-tests were calculated in order to compare children with and without temper tantrums. Results: Half of the children were reported to have temper tantrums. Children with temper tantrums had higher opposition and emotional lability scores compared with those without them. However, ADHD and

internalizing symptomatology were similar between the groups. Familial impairment was reported as higher in children with temper tantrums. Characteristics of temper tantrums in children with ADHD are discussed in the light of preschoolers’ ‘‘normative’’ temper tantrums. Conclusions: Our data indicate that temper tantrums may be a relevant symptom for the diagnosis and treatment of children with ADHD. They seem to be linked with an externalizing profile and an increased familial impairment. Temper tantrums in children with ADHD may be related to an emotional developmental delay.

P-19-003 Neuropsychological measures in the diagnosis of ADHD in preschool J. Merkt*, M. Siniatchkin, F. Petermann * Bremen, Germany Objectives: Behavioral ratings of ADHS symptoms are less reliable in preschool compared to school-aged children or adults but the value of neuropsychological tests in the diagnosis of ADHD over and above other clinical data (e.g., behavioral ratings, observations and interviews) has been debated. Methods: We review 49 neuropsychological measures utilized in preschoolers with ADHD (3–5 years). Additionally, we discuss the extent to which these measures have been tested for their diagnostic capacity (i.e., neuropsychological function assessed, psychometric properties, availability, relation to ADHD diagnoses or symptoms). Results: We found fourteen task assessing working memory, nine tasks of vigilance (i.e., continuous performance tests), eight tasks of interference control, seven tasks of delay aversion, four tasks of response inhibition, four tasks of shifting, and three tasks of visual selective attention. We only found reports of sensitivity, specificity and overall predictive value for three continuous performance and one response inhibition test. Fifteen tasks were available commercially, eight of these were working memory tasks. All tasks of delay aversion showed correlation with ADHD symptoms or group differences between children with and without ADHD symptoms. Conclusions: The diagnostic utility of computerized continuous performance tests and working memory subtests from IQ-batteries has been demonstrated in a number of studies by assessing their psychometric properties, sensitivity and specificity. However, findings from developmental and basic research attempting to describe risk factors that explain variance in ADHD show the most consistent associations of ADHD with measures of delay aversion but these measures have not been tested for their utility in the diagnostic routine. Results from developmental research should inform studies that improve ADHD diagnosis at the individual level. It might be helpful to consider not only the scores that result from neuropsychological testing but also consider testing as a structured situation for behavioral observation by the clinician that triggers typical ADHD behaviors.

P-19-005 Relations of hyperactivity/impulsivity and other behaviour problems in children M. Oros*, I. Jerkovic * Novi Sad, Serbia Objectives: The aim of this study is to determine predictability of hyperactivity and impulsivity problems in children based on other problems on Conners rating scales.

Methods: The sample consists of 415 pairs of children aged 9–11 years (46 % boys and 54 % girls) and one of their parents (69.8 % mothers). Data was gathered in primary schools in Serbia, using Conners self-report and parent report scales—short versions. Regression analysis was performed with self-reported hyperactivity/ impulsivity as the criteria variable. The set of predictor variables included other subscales of self-report scale—inattention, learning problems, aggression and family relations, and all subscales of parent rating scale—inattention, hyperactivity/impulsivity, learning problems, executive functioning, aggression and peer relations. Results: The results of the regression indicated the predictor variables explained 35.2 % of the variance (adj. R2 = .352, F(10,388) = 22.648, p \ .001). Following predictors were found as significant predictors of hyperactivity/impulsivity: self-reported inattention problems (b = .405, p \ .001) and aggression (b = .154, p \ .01), and parent reported hyperactivity/impulsivity problems (b = .227, p B .001). Conclusions: In conclusion, children who perceive experiencing more inattention problems and aggressive behavior and whose parents see them as hyperactive and impulsive, report of having more problems or symptoms of hyperactivity and impulsivity. This study is a part of the project no. III44008 ‘‘Design of Robot as Assistive Technology in Treatment of Children with Developmental Disorders’’, supported by Ministry of education, science and technological development of Republic of Serbia.

P-19-007 Differential diagnosis between Juvenil Huntington disease and Attention-Deficit/Hyperactivity Disorder. Case report J. Paolini*, S. Gallego, P. Bernal, I. Martinez, L. Nikov, E. Mayayo, C. Bestue, L. Duran, M. Serrano, A. Matias * Zaragoza, Spain Objectives: To illustrate the resulting difficulties of differential diagnosis in clinical settings between Attention-deficit hyperactivity disorder and Huntington disease. Highlights the effect of dopamine agonists in patients with history of Huntington Disease. Methods: We report a case of a 13-year-old boy, originally from South America, adopted since the time of 24 months of age, with unknown records of the disease because of limited family background information. Due to hyperactivity, attention difficulties, poor school performance, zero tolerance to frustration, irritability and aggressivity, the patient received psychological monitoring for a period of a year without obtaining symptoms improvement. Later, he was referred to psychiatric treatment because symptoms of attention-deficit hyperactivity disorder became evident and he started on a trial of Methylphenidate. After 2 months, he experienced a rapid decline in fine motor skills, with dysarthria and diffusely increased tone. Despite cessation of Methylphenidate, symptoms persisted and we decided to perform genetic evidence that could make a differential diagnosis. Results: The results showed an expansion in CAG repeats to 71 copies confirming the diagnosis of Juvenile Huntington Disease. In this case we emphasize the spectrum of neuropsychiatric phenomena associated with Huntington Disease, illustrate the resulting difficulties of differential diagnosis in clinical settings and highlights the fact that using dopamine agonists in patients with history of Huntington Disease, can cause significant deterioration in motor symptomatology. Conclusions: The case presented here, emphasize the spectrum of neuropsychiatric phenomena associated with Huntington Disease and illustrate the resulting difficulties of differential diagnosis in clinical settings.

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P-19-008 Latent class analysis of Attention-Deficit/Hyperactivity Disorder (ADHD) symptoms with Korean children and adolescents K. J. Park*, H.-j. Lee, H.-W. Kim

(DLR of 3.7) for screening ADHD-Combined with the CASI-4 Combined in children ages 6–13 seen in outpatient settings. Conclusions: CASI-4 ADHD subscales are clinically useful to screen for ADHD symptoms in children because of their brevity and economy. However, clinicians should be cautious when interpreting results and should include other data to reach an accurate diagnosis.

* Seoul, Republic of Korea Objectives: The objective of this study was to conduct latent class analysis of Attention-Deficit/Hyperactivity Disorder (ADHD) symptoms in order to characterize underlying structures of ADHD. Methods: Participants were recruited from September 2012 to January 2015 at the Department of Psychiatry of Asan Medical Center. ADHD and psychiatric comorbidity were confirmed with KiddieSchedule for Affective Disorders and Schizophrenia-Present and Lifetime Version (K-SADS-PL). We performed latent class analysis of ADHD symptoms with subjects who had ADHD (n = 141, age 8.1 ± 2.3 years, 106 boys) and had not ADHD (n = 82, age 9.1 ± 2.5 years, 40 boys). The participants completed IQ and continuous performance tests. Results: A three-class solution was found to be the best model solution, revealing classes of children with mostly combined and hyperactive/impulsive type of ADHD (class 1), non-ADHD (class 2), and inattentive type of ADHD (class 3),. There were significant differences of estimated IQ, visual and auditory commission errors between class 1 and class 2 (p = 0.005; p = 0.001; p = 0.013). Visual and auditory response time variabilities were highest in the class 1, followed by class 3, and 2 (p = 0.017; p = 0.023). Auditory response time was shortest in the class 1, followed by class 3, and 2 (p = 0.018). Visual omission errors were significantly higher in subjects with class 1 and 3, than class 2 (p = 0.023). Conclusions: The three-class solution with latent class analysis supports two-factor two class structures for ADHD symptoms.

P-19-009 Diagnostic efficiency of the CASI-4 ADHD subscales in the LAMS study: A ROC analysis G. Perez Algorta*, E. A. Youngstrom, A. Van Meter, L. E. Arnold, M. A. Fristad, S. M. Horwitz, T. W. Frazier, H. Taylor, R. L. Findling * Lancaster, UK Objectives: We tested the diagnostic efficiency of the DSM-oriented Child and Adolescent Symptom Inventory (CASI-4) ADHD symptom subscales for screening ADHD Combined, Hyperactive-impulsive and Inattentive subtype in a pediatric outpatient sample. Methods: Participants were 707 first-time utilizer at nine outpatient mental health clinics aged 6.0–12.9 years (M = 9.36, SD = 1.90) who completed the baseline Longitudinal Assessment of Manic Symptoms study assessments. Consensus diagnoses were based on KSADS interviews of both youth and caregivers. Caregivers completed the CASI-4 ADHD subscales Inattention, Hyperactivity and Combined as predictors. To maximize clinical utility we report diagnostic likelihood ratios (DLRs). Results: Using receiver operating characteristic analysis, the Area under the Curve (AUC) for the Combined subscale was .79 (95 % CI .78–.81) for screening ADHD-Combined. CASI-4 Hyperactivity subscale AUCs for screening ADHD-Hyperactive-impulsive and ADHD-Combined were .70 (95 % CI .66–.76) and .82 (95 % CI .80– .84) respectively. CASI-4 Inattentive subscales AUCs for screening ADHD-Inattentive and ADHD-Combined were .77 (95 % CI .74–.79) and .71 (95 % CI .69–.73). ROC curve tests comparisons will be provided. A cut score of 40 + was identified as the optimal threshold

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P-19-008 Diagnostic efficiency of the SDQ total difficulties and hyperactivity/inattention subscales in the UK: A ROC analysis G. Perez Algorta*, E. A. Youngstrom, A. Stringaris * Lancaster, UK Objectives: Using Receiver Operating Characteristic (ROC) analysis, we tested the diagnostic efficiency of the Parent Strengths and Difficulty Questionnaire (SDQ) Total Difficulties (TD) and the Hyperactive/ Inattention (H/I) subscales in a national epidemiological sample. Methods: We evaluated data from 18,232 participants (aged 5–16 years) from ‘‘The British Child and Adolescent Mental Health Survey’’. Consensus diagnoses were based on DAWBA interviews. We used the SDQ-TD and H/I subscales as predictors of Any ADHD diagnosis, and computed diagnostic likelihood ratios (DLRs). Results: The Area under the Curve (AUC) for the SDQ-TD for male subsample was .91, and .93 for females. For the H/I subscale was .92 in males, and .93 in females. A cut score of 11+ (score range 0–39) was observed as the optimal threshold (DLR of 3.4) for screening Any ADHD with the SDQ-TD subscale. A score of 5+ (score range 0–10) in the H/I subscale was associated with a DLR of 2.3, and a score of 10 with a DLR of 21.3, reflecting a large increase in the post-test probability of Any ADHD in this national community sample. Sensitivity analyses were conducted to benchmark against other samples that used different designs. Conclusions: The SDQ-TD and H/I subscales appear clinically useful to screen for ADHD symptoms in children and adolescents. However, clinicians should be cautious when interpreting screening results and should incorporate data from clinical interviews, known base rates, school performance, and other potential risk factors to reach a valid diagnosis.

P-19-009 Differential item function in a rasch-validated emotional dysregulation scale when assessing oppositional defiant disorder in children with ADHD: Implications for clinical practice D. Quinn* * Saskatoon, Canada Objectives: To review the concept of Oppositional Defiant Disorder as a disorder of Emotional Regulation develop a Rating Scale to measure Emotional Regulation. Methods: Background: Children with ADHD comorbid with emotional dysregulation tend to have more severe symptoms and are at greater risk for mood disorders in adulthood (Mick, Spencer et al. 2005, Stringaris, Cohen et al. 2009). We previously argued that Emotional Dysregulation is at the core of ODD, which should be reconceptualised as an affective disorder (Cavanagh, Quinn et al. 2014). Using Rasch analysis, we identified eight symptoms from the SNAP-IV-90 item instrument composing an emotional dysregulation scale. These are: (1) argues with adults, (2) defies adult requests, (3) touchy, (4) spiteful, (5) quarrelsome, (6) negative towards authority figures, (7) changes mood quickly, (8) irritable. In this work, we

examine whether these items perform similarly irrespective of the child’s age group and gender and parent or teacher reporter. A good scale should discriminate only high and low levels of a trait (i.e. emotional dysregulation) and be free of bias with respect to child or reporter characteristics. We performed differential item functioning in a sample of 300 children. Three models were compared and Chi square statistics computed. In the base model, only Trait level was entered as predictor. In a second model, Group was added. In a third model, the interaction Group 9 Trait level was added to model 2. Differential item function was indicated by a significant Chi square statistic in pairwise model comparisons. Results: At the .01 significance level, all items performed similarly across child’s age group and gender and parent or teacher reporter. At the .05 significance level, #s 2, 4, and 6 performed differently by age group, #s 7 and 8 by ender, and #s 1 and 3 by reporter. Conclusions: The use of an 8-item emotional dysregulation scale seems warranted. Subject to replication, our analysis suggests that separate norms may apply depending on child and reporter characteristics.

Saturday, 30 May 2015, 16.00 h–17.30 h P-20 Diagnosis - Adults P-20-001 Influence of depressive symptoms on Qb test performance in adult ADHD patients S. Fischer*, M. Ko¨ber, H. Lehfeld, G. Niklewski, C. Brandl * Nu¨rnberg, Germany Objectives: Comorbid depression is frequently reported by patients suffering from adult ADHD. Furthermore, depression is well known to cause impairment in a variety of cognitive domains, amongst others speed of information processing and attention. The aim of our study was to investigate the impact of depressive symptoms on QbTest performance. Methods: The QbTest is a computer-assisted instrument which combines a continuous performance task with a motion tracking system to assess the core symptoms of ADHD (i.e. hyperactivity, inattention, impulsivity). A total of 69 outpatients with definite diagnoses, who were screened for adult ADHD in our clinic in 2014, were selected from a larger sample of 157 persons. 31 patients were diagnosed as suffering from adult ADHD, 38 patients did not meet the diagnostic criteria. We further subdivided this sample into subgroups of patients suffering from no or only mild depressive symptoms and patients with moderate to severe depressive symptoms as assessed by the BDI II. The resulting four subgroups were compared with respect to the following QbTest parameters—distance, area, omission and commission errors, mean reaction time, normalized reaction time variance—using parametric analyses of variance. Results: When comparing ADHD and no ADHD patients, five out of six QbTest variables showed significant differences or at least a tendency towards significance. After introducing depression as a grouping factor, significant differences (p \ .05) between the 4 sub-groups were only found for commission errors and normalized reaction time variance. Post hoc analyses revealed that in the presence of comorbid depression only commission errors, but not activity measures or reaction time, discriminated between patients with and without ADHD. Conclusions: The majority of the QbTest parameters assessed in the present study were sensitive to ADHD core symptoms, but discrimination between ADHD and no ADHD patients was modulated by self reported depression. Therefore, depressive symptomatology should be considered when interpreting QbTest results.

P-20-003 Detection of feigned adult ADHD A. B. M. Fuermaier*, L. Tucha, J. Koerts, Y. Groen, J. Thome, O. Tucha * Groningen, The Netherlands Objectives: Recent research showed that there is an increasing number of individuals that may purposely feign or exaggerate symptoms of attention deficit hyperactivity disorder (ADHD) to gain external incentives, including access to stimulant drugs or special academic accommodations. There are vast consequences of undetected feigned ADHD such as substantial costs covered by society for unnecessary assessments and treatments, unjustified occupation of limited medical resources and undermining society’s trust in the existence of the disorder or the effectiveness of treatment. In times of economic crisis and cost savings in the medical sector, the detection of feigned ADHD is of importance. Methods: A review was performed describing the research on this topic with an emphasis on the approaches available for detection of feigned ADHD. Results: Several approaches have been considered for the detection of feigned adult ADHD, including self-report questionnaires, personality inventories, cognitive tests used in routine neuropsychological assessment and tests specifically designed for detecting feigned cognitive dysfunction. Conclusions: Though promising approaches and measures are available, most measures were shown to have insufficient sensitivity and specificity for the detection of feigned ADHD, in particular if they were applied as single measures not in combination with others. There is an immediate need for further research, in particular for the development and evaluation of methods specifically designed for the detection of feigned ADHD.

P-20-004 Comparison between ADHD and depressive adult outpatients: Emotional dysregulation and impulsivity I. Javier*, M. Marı´a, B. Jose´ Ma * Arganda Del Rey/Madrid, Spain Objectives: Separate emotional lability in different clinical disorders: borderline personality disorder (BPD), ADHD and depressive disorders, with two different instruments (DERS and CAARS). Methods: Transversal study of 63 outpatients with a diagnosis of ADHD attending Arganda MHC (DSM-IV) before stimulant treatment, or with personality disorders, or both, and depressive patients without depressive episode in last 3 months (as a control clinical group) (14 patients). Measures instruments: (1) self-reported Conners Adult ADHD Rating Scale-long version (CAARS) (2) DERS (Gratz 2003) (3) questionary SCID-II-DSM-IV. (4) Hamilton depression scale (18 items). 5. CAADID . Results: Significative differences between control patients (depressives) and ADHD (alone and with comorbid BPD), and between control and BPD patients in: total DERS, goals, impulse and strategy. And in clarity item between ADHD, BPD and control patients. It has not been found differences between no accept, clarity (in ADHD +BPD) nor aware. • When using CAARS, we observe significative differences in ADHD indices, impulsivity, inattention and hyperactivity between ADHD (alone and associated to BPD) and control group; but not with BPD and. Conclusions: Emotional lability is a significant symptom in adults with ADHD. The presence of comorbid disorders was only related to a major intensity of these EL symptoms. Therefore, it seems that el is a

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specific feature of ADHD and it is not merely a consequence of the presence of other comorbid disorders • Some symptoms of EL can be also present in other psychiatric disorders. This lack of specificity could explain the absence of formal recognition of EL in adult ADHD.

P-20-005 Validity of screening instruments of adult AttentionDeficit/Hyperactivity Disorder H. Kim*, Y.-J. Lee, D.-H. Song, K.-A. Cheon * Seoul, Republic of Korea Objectives: Despite adult attention deficit hyperactivity disorder (ADHD) is increasingly recognized, but little work has been examined clinical subject. This study was conducted in order to determine the validity of screening tools for adult attention deficit hyperactivity disorder (Conner’s Adult ADHD Rating Scale-Korean: CAARS-K, Digit Span, Continuous Performance Test: CPT) in clinical adult subject. Methods: The study group consisted of 38 adults with ADHD-like symptom aged above 18 years who visited Severance Hospital in South Korea. Among them, 38 patients conduct CAARS-K, 31 of digit span, and 22 of CPT. Diagnosis was made according to the Diagnostic and Statistical Manual for mental disorder-IV (DSM-IV) with history. When the T-score was C70 or B2 % (-2SD), we considered that screening tools are abnormal findings. To see validity for each tool, we performed the calculation for the determination of sensitivity and specificity. Results: The mean age of all subjects was 26.37 ± 8.88 years old, male to female ratio 2.8:1 (28:10). Twelve Patients were diagnosed with the ADHD. The sensitivity and specificity of individual tools were CAARS: 0.769/0.50, digit span: 0.048/0.90, and CPT: 0.316/ 0.667. Also the sensitivity of Combined tools were CAARS-K + Digit span: 0.810, CAARS-K + CPT: 0.875 and DS + CPT: 0.417. Conclusions: The result of this study suggests that the CAARS-K, CAARS-K + Digit span and CAARS-K + CPT could serve as a sensitive screening tool to identify adult ADHD patient.

P-20-006 Cognitive functioning in adult Attention-Deficit/ Hyperactivity Disorder (ADHD) A.-M. Low*, J. le Sommer, J. R. Møllegaard Jepsen, S. Vangkilde, T. Habekost * København K, Denmark Objectives: Traditionally seen as a disorder of childhood, recent research has indicated a prevalence rate of (early) adult ADHD of 2.5 %. However, much less is known about the disorder in adults than in children, and the diagnosis of adults with ADHD (AwADHD) is particularly challenging. There is thus a need for research investigating the specific cognitive profiles of AwADHD, with the aim of improving both understanding of ADHD in adults, and accuracy of diagnosis of the disorder. One possible tool for investigating the cognitive profiles of AwADHD is computerised testing based on a theory of visual attention (TVA), supplemented by additional cognitive assessment. Methods: The study is a prospective, 6 week follow-up study with 50 medication naı¨ve adult patients with ADHD, and 50 age and parental SES-matched controls. Patients will be recruited from the ADHD clinic in a regional hospital in Copenhagen, and will be assessed with a range of cognitive and psychopathological measures before and

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6 weeks after commencement of medication (methylphenidate). Cognitive measures will include measures of visual attention and processing speed (TVA-based testing, CANTAB sub-tests), estimation of intelligence (WAIS-IV sub-tests), different types of inhibition/ impulsivity (Delay test, Balloon test, RTI), working memory (WAISIV and CANTAB sub-tests), and everyday executive functioning (BRIEF-A questionnaire). Further, measures of anxiety, depression, and general psychopathology will be undertaken. Results: We hope that TVA-based testing, supplemented by other clinical measures, will provide a comprehensive cognitive profile of stimulant-medication naı¨ve AwADHD. Further, that the described test battery will be sensitive to any changes that may occur (quantitative or qualitative in nature) in the cognitive profile in ADHD after treatment with stimulant medication. Conclusions: This study will provide valuable insight into a range of specific cognitive deficits of medication-naı¨ve AwADHD. Furthermore, the study will provide important information on how these parameters are affected by medication.

P-20-007 Pay time and attention to adult ADHD E. Protti*, P. Negro * Pinerolo, Italy Objectives: following the European consensus statement on diagnosis and treatment of adult ADHD, and according to NICE guidelines research recommendations (cg72), there is evidence that ADHD symptoms can persist into adulthood and cause impairment, but there are non clear conclusions about the level of ADHD symptoms in adult that should be considered as grounds for intervention, or whether symptoms take a different form in adulthood. The cost to society and to the affected people and their families makes it pressing to know whether, and how far, services should be expanded to meet the needs of this group. According to this evidence the purpose of this study is to start a research on adult ADHD evaluating—the prevalence of this diagnosis in adults who ask for a psychological help—how far the core symptoms of inattention, impulsivity and hyperactivity/restlessness cluster together—to what extent are the core symptoms comorbid with other forms of mental disturbance—to what extent are the core symptoms associated with neuropsychological and social impairment. Methods: adult people accessing a local Mental Health Service for any mental disturbance will be—tested by ASRS-v1.1 to find if they can be diagnosed with ADHD and—diagnosed for mental disturbance by DSM V. Results: results are not yet available, the study is in progress and first findings will be on the poster presentation.

P-20-008 Reflection on the clinical profile of late onset and undiagnosed adult ADHD D. Roy* * Glasgow, UK Objectives: To reflect on clinical profile of patients who are likely to be missed being diagnosed with adult ADHD. The adult variant is not prototypical of childhood presentation, hence it is challenging for general psychiatrist to recognize the tell tale sign of the underlying condition particularly in the late onset category. The variability in frequency severity and expression of adult symptoms is not clear in current classification. Therefore patients are likely to be diagnosed wrongly or treated for co morbidity without identification of core

problem. Also developmental nature of ADHD does not help clinician to create definitive clinical impression. However on close observation certain symptom indicators—mood components, social behavior, psycho-social adversaries, coping strategies hint the need for further background exploration to identify antecedents that could be linked to core deficits of ADHD. Methods: Assessment of referrals (not ADHD specific) to highlight how certain presenting features can offer a tip off to rule out underlying ADHD. The clinical interview tested themes like—‘‘can emotional dysregulation be an early warning sign for undiagnosed Adult ADHD’’ and whether ‘‘profile of undiagnosed inattentive subtype closely mimics autistic spectrum disorder in adults’’. Five such cases are discussed to demonstrate the process of assessment differentials and understanding of correlates towards recognition of late onset ADHD. Results: Some of the patients presenting to services with complaints of mood, anxiety and psycho-social difficulties but not typical of mood or anxiety disorder and non responsive to conventional treatment when screened and assessed for ADHD symptoms confirmed features of it. Their problem was an extension of underlying Adhd which was overlooked in childhood and so far have managed to cope using different ways but struggled intermittently experiencing socio— emotional crisis and poor QOL. Conclusions: Adhd can exist in continuum and not recognised until impairment is obvious or associated with co morbid mental health problems.

P-20-009 A heuristic perspective on the clinical application of a systems stability paradigm to the differential diagnosis of ADHD and bipolar disorder I. Szpindel* * Toronto, Canada Objectives: To synthesize a qualitative, intuitive and potentially clinically applicable translation of systems stability theory to aid in the differential diagnosis of ADHD and Bipolar (BPD) Disorder. Methods: An appraisal of the prevailing multidisciplinary neurobehavioural, psychopathological and biomedical systems literature was consolidated to an analogous stability model of human behaviour. The result was tested for coherency with DSM and ICD diagnostic criteria for ADHD and BPD, then applied to assess for differences in the stability characteristics of each diagnosis and their comorbidity. These differentiators were finally tested for coherence with actual clinical finding from a random sample of 10 charts from each category of ADHD, BPD and their comorbidity. Results: A linearized representation of behaviour was simplified from classic systems theory by excising feedback and internal inputs from the model where behaviour remains the system’s output, environmental stimuli its input and central psychosensory processing the system itself. Analogous determinants of stability were systemic and behavioural predictability, time invariance and resilience. When modeled according to this paradigm ADHD emerged as a stable yet consistently inefficient system that remained time invariant, predictable and resilient. Application of the model to BPD identified an unstable, unpredictable, time dependent system lacking in resilience. Systemic inefficiency relapsed and remitted variably over time in BPD, whereas comorbid ADHD/BPD exhibited both the instability of BPD and consistent inefficiency of ADHD. Similar findings resulted from application of the paradigm to diagnostic criteria and in retrospective chart review. Conclusions: Conceptual representation of ADHD and BPD within a systems stability framework may aid by qualitatively informing the process of differentiating between these disorders. Recognition of the stability differences between these two disorders may furthermore

provide conceptual support for their continued nosological separation rather than for their reclassification within the spectrum of the same illness.

P-20-010 Similarity of subjective symptoms in persons with ADHD and Asperger’s disorder T. Tokumasu*, T. Motira, S. Nobuyuki, D. Ikuse, G. Arai, Y. Okajima, A. Iwanami * Tokyo, Japan Objectives: According to DSM-IV criteria, the diagnosis of Attention-deficit/Hyperactivity disorder (ADHD) centers on the attention impairment in combination with impulsivity and hyperactivity. The clinical nature of Autism spectrum disorder (ASD) or Pervasive developmental disorder (PDD) is characterized by a triad of behavioral deficits in the development of reciprocal social interactions and verbal and non-verbal communication, and a restricted patterns of interests and stereotyped behaviors. However, many persons with ASD show attention impairment similar to that observed in persons with ADHD. Moreover, persons with ADHD show frequently ASD like autistic symptoms and they are sometimes misdiagnosed as ASD. Accordingly, the discrimination between ASD and ADHD can be difficult due to the similarity of clinical symptoms, especially in adults. In the present study, we evaluated similarity of subjective symptoms in adults with Asperger’s disorder and ADHD using Autism spectrum Quotient (AQ) and Conners’ Adult ADHD Rating Scales (CAARS) selfreport screening version. Methods: Subjects provided written informed consent prior to completing the questionnaires and testing in the study, which was approved by the ethics committee of the Faculty of Medicine of Showa University. The clinical group of this study was comprised of 40 subjects with ADHD and 40 with Asperger’s disorder according to the criteria of DSM-IV. To confirm that the subjects being highfunctioning, intellectual ability was assessed using the Japanese version of the National Adult Reading Test developed by Nelson and Willison. The normal control group was comprised of 40 healthy adults. The results of AQ and CAARS of the 3 groups were compared. Results: CAARS scores in subjects with Asperger’s disorder were higher than those of controls. AQ score in subjects with ADHD was higher than that of controls. Conclusions: The results of the present study indicated similarity of subjective symptoms in adults with Asperger’s disorder and ADHD.

P-20-011 High-dimensional pattern classification in never-treated adults with Attention-Deficit/Hyperactivity Disorder using morphometric and DTI data T. Avancini*, M. A. Silva, J. Doshi, M. Zanetti, M. Serpa, M. Louza˜, C. Davatzikos, G. Busatto * Sao Paulo, Brazil Objectives: Adult Attention-Deficit/Hyperactivity Disorder (ADHD) is a prevalent disorder, but it has been sparsely investigated with neuroimaging methods. The application of high-dimensional pattern classification methods now appears as a promising auxiliary approach to aid in the clinical diagnosis of psychiatric disorders. Although such strategy is starting to be applied in the investigation of ADHD, still there are few studies, and it has not been applied to the investigation

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of morphometric and diffusion tensor imaging (DTI) data of adult ADHD patients yet. Methods: Fifty-eight adult, never-treated ADHD patients and 58 ageand gender-matched healthy controls underwent T1-MPRAGE and 64-direction DTI acquisitions using a 1.5T MRI scanner. Volumetric maps of gray matter (GM), white matter (WM) and cerebrospinal fluid were generated through a robust routine of deformation-based morphometry, whereas a new DTI analysis approach for spatial normalization of tensor fields was used to generate fractional anisotropy (FA) and mean diffusivity (MD) maps. A previously validated multivariate classification method based on support vector machine was employed and measures of diagnostic performance were obtained to identify the best set of morphological features that discriminate ADHD patients from controls. Results: The best discrimination performance of the classifier was obtained when the WM map was employed in isolation. The diagnostic accuracy was 80 %, sensitivity was 79.31 % and specificity was 81.03 %. Conclusions: These preliminary results suggest that WM measures are important indices of brain dysfunction in pattern classification investigations of adult ADHD using MRI. This reinforces the notion of WM and brain connectivity abnormalities underlying the symptoms of ADHD.

P-20-012 Evidence for adult Attention-Deficit/Hyperactivity Disorder (aADHD) as a neuropsychological and not a cognitive disorder W. Human*, A. Burke * Johannesburg, South Africa Objectives: To determine whether there is a significant difference between non-a(ADHD) and a(ADHD) in their performance on a cognitive test, the Wechsler Adult Intelligence Scale (WAIS III) and a neuropsychological test, the Cambridge Neuropsychological Test Automated Battery (CANTAB). Methods: This study formed part of a larger aADHD research project conducted at the University of Johannesburg (UJ) in South Africa. Participants diagnosed with ADHD during childhood and/or adulthood were recruited to participate in various ADHD studies that formed part of the bigger project. The results of the different tests for this group were contrasted against the results of a non-aADHD group. A number of parametric and non-parametric statistical techniques (e.g. Independent Samples t test, Mann–Whitney U, Chi Square and Fischer exact tests) were selected based on the research question, levels of measurement and sample size to test for significant differences between the two groups. Results: When comparing the results for the WAIS between aADHD (n = 15) and non-ADHD (n = 10) there were significant differences (Mann–Whitney-U test) between the two groups on the Verbal Comprehension-Perceptual Organization index score (p = .045) and the Perceptual Organization-Processing Speed index score (p = 0.011). There were significant differences (independent groups t test) on the CANTAB between aADHD (n = 76) and non-ADHD (n = 182) on the following subtests: Motor Response (p = .043); Rapid Visual Processing (p = .0001), Short Term Working Memory (p = .0001), Stop Signal Task (p = .016). Conclusions: There were no significant differences between the two groups as far as distinct cognitive functions were concerned (e.g. vocabulary, arithmetic, etc.), however, there were significant differences between the two groups regarding neuropsychological processes. The results indicate and confirm that ADHD should be

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viewed as a neurodevelopmental disorder, and that the underlying neuropsychological impairments persist from childhood through to adulthood. Despite this, it would seem as if primary cognitive functions either remain intact, or improve over the lifespan of ADHD adults.

Saturday, 30 May 2015, 16.00 h–17.30 h P-21 Co-morbidity disorders - Children and adolescence II P-21-001 Comorbidity and correlates of disruptive mood dysregulation disorder in 6–8 year old children with ADHD E. Schilpzand*, P. Hazell, J. Nicholson, V. Anderson, D. Efron, T. Silk, E. Sciberras, M. Mulraney * Parkville, Australia Objectives: This study aimed to characterize the nature and impact of Disruptive Mood Dysregulation Disorder (DMDD) in children with attention-deficit/hyperactivity disorder (ADHD) including its co-occurrence with other comorbidities and its independent influence on daily functioning. Methods: Children with ADHD (6–8 years) were recruited through 43 Melbourne schools, using a 2-stage screening (parent and teacher Conners 3 ADHD index) and case confirmation (Diagnostic Interview Schedule for Children, Version IV; [DISC-IV]) procedure. Proxy DMDD diagnosis was confirmed via items from the oppositional defiant disorder (ODD) and major depressive disorder modules of the DISC-IV. Outcome domains included comorbid mental health disorders, academic functioning, social functioning, child and family quality of life, parent mental health and parenting behaviours. Unadjusted and adjusted linear and logistic regression were used to compare children with comorbid ADHD-DMDD and children with ADHD without DMDD. Results: Thirty-nine out of 179 children (21.8 %) with ADHD had comorbid DMDD. Children with ADHD and DMDD had a high prevalence of ODD (89.7 %) and any anxiety disorder (41.0 %). Children with ADHD and DMDD had poorer self-control (p \ 0.001) and elevated bullying behaviors (p \ 0.001) compared to children with ADHD without DMDD. Children with ADHD and DMDD were similar to children with ADHD in the other domains measured when taking into account other comorbidities including ODD. Conclusions: One in five children with ADHD in their second year of formal schooling met criteria for DMDD. The extremely high diagnostic overlap with ODD calls into question the clinical utility of the DMDD diagnosis in children with ADHD.

P-21-002 How does comorbidity affect neuropsychological test performance in youth with ADHD: Single-centre, cross sectional study I. Sanli*, E. Tufan, S. Taskiran, B. Semerci, M. A. Cans#z, U. Savci, N. Demir, Z. Topal * Istanbul, Turkey Objectives: Attention-Deficit/Hyperactivity Disorder (ADHD) is known to be heterogeneous with respect to psychiatric comorbidity and neuropsychological profiles (1,2). Previous studies reported that executive dysfunction and state dysregulation may form independent pathways leading to ADHD (2). Here, we aimed to evaluate a clinical

sample of youths (6–18 years) with ADHD from a single study centre with neuropsychological tests and intended to determine the relationship of test results with comorbid diagnoses. Our two hypotheses were: a) A greater number of comorbid diagnoses would lead to a reduced neuropsychological test performance, and b) The ADHD sample will differ in terms of test performance. Methods: Youths referred to a private study centre in Istanbul between 2014 and 2015 for complaints of ‘‘inattention’’ and/or ‘‘hyperactivity/impulsivity’’ and diagnosed with ADHD according to DSM-5 criteria, were tested with Wisconsin Card Sorting, Stroop Color Word, Judgement of Line Orientation, Cancellation and Digit Span Learning tests. The test scores were compared in those with comorbid diagnoses (predominantly anxiety) and according to age ranges (6–12; 13–18). Patients with comorbid learning disabilities were excluded. P was set conservatively at 0.01. Results: Thirty-nine youths with a median age of 9.7 (IQR = 6.0) years were included. Median number of DMS-5 diagnoses was 1.0 (IQR = 1.0). The most common comorbidity was anxiety disorder (n = 5, 12.5 %). Patients with comorbid diagnoses were significantly older (p = 0.01). The only significant difference found was that patients with comorbidity needed longer to scan both irregular letter and regular shapes subtests of the cancellation test (p = 0.01 for both). Receiving medication at the time of testing did not significantly affect results. Conclusions: In this single-centre, cross-sectional study, patients with ADHD and comorbid diagnoses were found to be older and slower in some cancellation tasks. Clinically based, using a heterogeneous sample from mixed genders showed the limitations of this study. Our results should be replicated with further studies.

P-21-004 Predictors of reading speed among a sample of Turkish patients with ADHD and dyslexia: A preliminary study Z. Topal*, E. Tufan, N. Demir, M. A. Cansiz, U. Savci, S. Taskiran, E. Demirbas Cakir, H. Harmanci, B. Semerci * Bolu, Turkey Objectives: More than half of children with ADHD had a comorbidity. LD comorbidity is reported between 24 and 70 % depending on samples (1). LD comorbidity in clinical samples from Turkey was previously reported as 5.0–15.6 % (2–4). We aimed to determine predictors of reading speed among patients with ADHD and LD. Methods: Cross-sectional, retrospective study conducted at the Abant Izzet Baysal University Medical Faculty. Records of 995 patients with ADHD diagnosed between 2011 and 2014 were screened. 49 had LD comorbidity. Patients were evaluated with rating scales. Clinicians rated severity with CGI-S. Baseline reading speed (words/minute) and WISC-R scores were recorded. Correlates and predictors of reading speed were analyzed. P was set 0.05. Results: Mean age was 8.9 (SD = 1.6) years. Most (% 71.4) were male. All children had slower reading compared to norms (p = 0.00). Mean reading speed was 40.5 (SD = 32.7) words per minute. Mean WISC-R scores (Verbal/Performance/Total) were 76.8 (SD = 14.5), 80.0 (SD = 19.9) and 81.6 (SD = 16.3); respectively. Mean number of DSM-IV diagnoses/patient were 3.0 (SD = 1.2) with no significant difference between genders. Linear regression was used to predict reading speed and number of diagnoses, grade, WISC-R verbal scores and AT-T-HI criteria used as predictors. There was no multi-collinearity (VIF 1.1–1.3). The model was statistically significant (p = 0.01) and explained 38.0 % of the variance. Conclusions: This is the first study on predictors of reading speed on Turkish children with ADHD and LD. Our results should be replicated with further studies.

P-21-005 Longitudinal effect of Attention-Deficit/Hyperactivity Disorder symptoms on depression and aggression M. Tsujii*, H. Ito * Toyota, Japan Objectives: Children and adolescents with attention-deficit hyperactivity disorder (ADHD) have a higher likelihood of experiencing emotional and behavioural disturbances. However, since children and adolescents with ADHD often have symptoms of other developmental disorders, such as autism spectrum disorders (ASD) or developmental coordination disorder (DCD), it is unclear whether emotional and behavioural problems are caused by symptoms of ADHD or other comorbid symptoms. The present study examined the effect of ADHD symptoms on depression and aggression using longitudinal data from a school cohort sample, adjusting for other comorbid symptoms. Methods: The sample consisted of 6228 students (3153 boys and 3075 girls from 2nd to 9th grade) from all 13 elementary and junior-high schools in a suburban city in Japan. The ADHD symptoms (Inattention and Hyperactivity-Impulsivity) were assessed using the ADHD Rating Scale (DuPaul 1998). The ASD and DCD symptoms were measured using the Autism Spectrum Screening Questionnaire (Ehlers et al. 1999) and the Developmental Coordination Disorder Questionnaire (Wilson et al. 2009), respectively. These questionnaires were completed for the students by their parents. Depression and aggression were assessed using the Birleson Depression Self-Rating Scale (Birleson 1978) and the Buss–Perry Aggression Questionnaire (Buss and Perry 1992), respectively; these were completed by the students themselves. Results: In multiple regression analysis adjusting the score of dependent variables measured in the first year, the ADHD symptoms showed no significant longitudinal effect on depression in the following year, though the ASD and DCD symptoms showed significant effects. On the other hand, both Inattention and Hyperactivity-Impulsivity showed significant longitudinal effect on aggression (b = .057 and .073, respectively; p \ .001). Conclusions: Our results suggest that ADHD symptoms are a risk factor of externalizing problems in children and adolescents but not of internalizing problems.

P-21-006 Relationship between academic achievement and developmental disabilities among Japanese elementary and junior high school children A. Uemiya*, H. Ito, Y. Murayama, M. Katagiri, M. Hamada, M. Tujii * Hamamatu, Japan Objectives: Children with Attention Deficit Hyperactive Disorder (ADHD) have significant educational difficulties. Characteristic symptoms such as ‘‘inattention’’ have been found to be negatively associated with academic skills during school years. This study attempted to examine the relationship between academic achievement and the characteristics of developmental disabilities among Japanese elementary and junior high school children. Methods: Participants comprised 7985 children (first to ninth grade; 4064 boys and 3921 girls). The Autism Spectrum Screening Questionnaire (ASSQ) for Autism spectrum disorder symptoms, ADHD Rating Scale-IV (ADHD-RS-IV) for ADHD symptoms, and Developmental Coordination Disorder Questionnaire (DCDQ) for developmental coordination disorder (DCD) symptoms were completed by their parents/guardians. Moreover, academic achievement was calculated using their mathematics, Japanese, English, science, and social studies test scores (English test scores were used only for the 7–9 grade students).

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Results: Participants were divided into three age groups: grades 1–3, 4–6, and 7–9. We conducted multiple regression analyses for each group (Table 1). Inattention (ADHD symptom) had a negative effect for 4–6 and 7–9 grade students (grades 4–6: b = -.137, p \ .001; grades 7–9: b = -.303, p \ .001). The relation appeared to become stronger with age. Furthermore, DCD symptoms negatively affected academic achievement for 1–3 and 7–9 grade students (grades 1–3: b = -.136, p \ .001; grades 7–9: b = -.071, p \ .001). However, ASD symptoms did not have a strong effect on academic achievement. Conclusions: Our results indicated that inattention had a stronger negative effect on academic achievement that increased with age. At higher grades, the syllabus is more complex, requiring greater concentration; this poorer academic performance may be linked to older children’s difficulty with maintaining/sustaining their concentration.

P-21-007 Young people with ADHD: Key clinical, biological and psychosocial predictors of persisting oppositional defiant disorder/conduct disorder A. Vance*, J. Winther * Melbourne, Australia Objectives: ADHD is known to have a greater than chance cross sectional association with ODD/CD, anxiety and depressive disorders, motor, speech and language difficulties, learning difficulties, verbal and visuo-spatial working memory problems, parental psychopathology, parental relationship difficulties and family functioning problems. However, to date, these specific clinical, biological and psychosocial factors have not been examined using a longitudinal study design controlling for known confounding variables. The aim of this study is to investigate these key factors and their influence on persisting ODD/CD symptoms in a larger cohort of pre-pubertal ADHD children followed up post puberty. Methods: A 3 year randomised blinded longitudinal study of prepubertal children with ADHD from the same socioeconomic region was completed. Children with persistent ODD/CD and absent ODD/ CD defined categorically and dimensionally were identified. Prediction of group membership for key clinical, biological and psychosocial measures were examined using logistic regression. Results: The ODD/CD persistent and absent groups did not differ with respect to age, gender of fullscale, verbal or non-verbal IQ. Persistent ODD/CD was predicted by ADHD combined type (OR = 4.12) and not ADHD inattentive type, ODD (OR = 6.16), CD (OR = 5.54) and irritability (OR = 1.27), but not sadness/unhappiness or anxiety. Family dysfunction (OR = 3.44) predicted persistent ODD/CD as did parental psychopathology (OR = 1.03) while parental relationship did not. The biological factors studied did not predict persistent ODD/CD. Conclusions: Early identification and targeted treatment of ADHD combined type, ODD and irritability are needed. Further, these findings suggest family dysfunction should be a specific target for intervention to prevent the persistence of ODD/CD. In future, randomised control trials of novel targeted treatment programs are needed to confirm whether integrating treatment for the above findings into clinical care is useful.

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P-21-008 About variability of comorbidity in ADHD: New findings of comorbidity in a clinically referred sample of children and adolescents with Attention-Deficit/Hyperactivity Disorder in Switzerland A. M. Werling*, S. Walitza * Zurich, Switzerland Objectives: This retrospective study aimed to determine distribution and diversities of psychiatric comorbidities in clinical-referred children and adolescents suffering from attention deficit/hyperactivity disorder (ADHD) in terms of age groups, gender, and subtype. Methods: We included all patients referred to the University Clinics of Child and Adolescent Psychiatry in 2014 and diagnosed with a hyperkinetic disorder according to the ICD-10 classification. Comorbidity was described according to the MAS classification. Results: Patients (n = 562; 72.2 % male) were between 4 and 20 years (mean age 11.45 years) and had an average IQ of 100 (range of 70–137). About 82 % of all patients were diagnosed with the combined (F90.0 or F90.1) and 18 % with the inattentive type (F98.8). The majority (62 %) had at least one comorbidity (axis-I or axis-II) and half (46 %) of the patients were found to have at least one psychiatric axis-I-comorbidity according to the MAS classification. The most prevalent axis-I-comorbidities were conduct disorders (23 %) and adjustment disorders (9 %). However, compared to other studies, oppositional defiant or conduct disorders were only seen in a rather low rate (overall 24 %). Interestingly, we also registered fewer anxiety (7 %) and affective (5 %) disorders. Here, younger children (age group 4–11 years) tend to present with a lesser comorbidity rate (58 vs. 66 %) compared with adolescents (age group 12–20 years). There was no significant difference between the genders in terms of the frequency of psychiatric comorbidities (each 46 %). Developmental disorders were detected in about 32 % of all patients. Conclusions: This study showed lower rates of psychiatric comorbidities, although patients referred to a University hospital often represent more severe cases. Consequently, the prevalence of ADHD in Switzerland is similar to other countries, but its comorbidities may differ. We discuss the point that ADHD prevalence and presentations itself are international much more similar than ADHD comorbidities.

P-21-009 Comorbidity and persistent Attention-Deficit/ Hyperactivity Disorder symptoms from childhood to adolescence in Brazilian sample: A four-year follow-up study S. M. Palma*, A. C. Motta Palma Natale, H. M. Calil * Sa˜o Paulo, Brazil Objectives: The aim of this study was to evaluate the symptoms persistence in Attention Deficit Disorder and Hyperactivity Disorder (ADHD); development of comorbidities and psycho-stimulant usage patterns. Methods: Follow-up study was conducted in 37 patients with Attention Deficit Disorder and Hyperactivity Disorder (ADHD) and 22 healthy controls, aged 10 and 18, after 4 years of their first

assessment. ADHD was rated persistent if participants met all DSM IV criteria for syndromic or sub-threshold persistence, or had functional impairment (functional persistence). Results: Of the 37 ADHD patients re-evaluated, 75 % had persistent symptoms. In the sample, 33.1 % (13/37) had none of the investigated comorbidities, 13.5 % (5) had at least one comorbid disorder, and 51.3 % (19) had two or more disorders. In the persistent ADHD group only 18 % (5/28) did not have comorbidities. Conclusions: These findings highlight the follow-up importance for children and adolescents with ADHD diagnosis due to the high rates of comorbidities, social, and educational difficulties, associated with the persistence of ADHD symptoms.

Saturday, 30 May 2015, 16.00 h–17.30 h P-22 Co-morbidity disorders - Adults P-22-001 Suicidal behaviour in young adults with ADHD history A. L. Chirita*, M. C. Pirlog * Craiova, Romania Objectives: Attention deficit hyperactivity disorder (ADHD) is not limited to children, as 30–70 % of kids with ADHD continue having symptoms when they grow up. Adults with ADHD are more exposed to having problems with self-control, leading to impulsive behaviours, including suicide. In our study, we tried to find to what extent child ADHD can induce suicidal behaviour in young adults. Methods: Participants were young adults, aged from 18 to 30, hospitalized in the University Clinic of Psychiatry Craiova for suicidal attempts. All assessments were conducted in face-to-face interviews between December 2013 and November 2014. Actual psychiatric diagnosis was obtained using the Mini International Neuropsychiatric Interview—Plus (MINI Plus) and validated for ICD-10 diagnosis. All patients gave written informed consent and the study was approved by the Ethics Committee of the University Clinic. Demographic and clinical data included gender, educational, marital and occupational status, diagnosis, relevant psychiatric history. Results: The total sample of young patients with suicidal attempt (N = 78) comprised 49 male and 29 female. Between them, 42 (28 male and 14 female) were diagnosed with ADHD during childhood. More than half (51 %) of the patients with ADHD history and suicidal attempt were diagnosed as adults with personality disorders, 18.2 % with psychosis and 30.8 % with affective disorders. Comorbid substance use disorder was reported by 19 patients, especially alcohol and legal high addictions. Risk factors for suicidal behaviour, starting in childhood and persisting in adulthood were found in various domains (individual level, family, school and employment, community etc.). Conclusions: Suicidal behaviour correlated to ADHD history is still on the periphery on attention of psychiatrists and mental health professionals in many countries. Separation of child ADHD and psychiatric disorders of the adults complicates the problem even further, even if it is well known that ADHD symptoms (especially impulsivity) persisting in the adulthood may influence quality of life.

P-22-003 Sex- and subtype-related differences in the comorbidity of adult ADHD on axis I and axis II S. Gross-Lesch*, C. Jacob, A. Dempfle, S. Reichert, T. Jans, J. Geissler, S. Kittel-Schneider, T. Nguyen, A. Reif, K.-P. Lesch

* Werneck, Germany Objectives: Comorbidity in adult ADHD (aADHD) has been investigated in a large number of studies using varying research approaches with divergent results. In contrast, there is limited information about sex- or subtype-related differences. This study will provide additional information regarding the co-morbidity of Axis I disorders and also Axis II disorders in the currently largest clinical referral sample of 910 patients (452 females, 458 males) recruited at a tertiary referral center. Methods: All probands underwent a four-step procedure for diagnosing aADHD, including the Structured Clinical Interview of Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSMIV) Axis I disorders to assess comorbidity. The comorbidity on Axis II was assessed with the Structured Clinical Interview of DSM-IV and for personality traits with the revised NEO personality inventory, and the Tridimensional Personality Questionnaire. Results: For Axis I affected females show higher rates of mood (61 vs. 49 %), anxiety (32 vs. 22 %), and eating disorders (16 vs. 1 %) than affected males, while substance use disorders were more frequent in affected males (45 vs. 29 %), which mirrors sex differences in prevalence in the general population. Comorbidity in general and substance use disorders in particular, but not sex or subtype, were highly predictive of lower psychosocial status. The most prevalent PDs were narcissistic PD in males and histrionic PD in females. Affected females showed higher Neuroticism, Openness to Experience, and Agreeableness scores as well as Harm Avoidance and Reward Dependence scores. Narcissistic PD and antisocial PD have the highest prevalence in the H-type, while Borderline PD is more frequent in the C-type. Conclusions: Sex- and subtype-related differences in Axis I and II disorder comorbidity as well as impairment-modifying personality traits have to be taken into account in epidemiological studies of persistent ADHD.

P-22-004 Adult ADHD and comorbid somatic disease. A literature review J. Instanes*, J. Haavik * Bergen., Norway Objectives: To perform a systematic literature review focusing on somatic health conditions associated with adult ADHD (aADHD). Methods: We completed an extensive literature search in Embase, PsychInfo and Medline, including studies from January 1994 to January 2015. A total of 4095 references were retrieved, including four references from a manual search. From these references, 156 studies were assessed for eligibility after excluding duplicates, nonEnglish papers and papers with topic of no relevance. Results: Adult ADHD and obesity was the most commonly described comorbid condition. Treatment studies and epidemiological surveys indicate that people with aADHD are at increased risk for obesity or eating disorders, such as binge eating disorder, and that this risk may be causally related to ADHD symptoms. Many studies have described an increased risk of diseases of the nervous system in aADHD, including epilepsy, migraine, sleep disorders and restless legs syndrome. Fewer studies have found evidence for increased risk immune-mediated conditions, including systemic lupus erythematosus, coeliac disease, atopic dermatitis and asthma in adult ADHD. Some evidence has been presented for co-occurring aADHD and fibromyalgia. People with aADHD are also more prone to traumatic injuries, traffic accidents being the most studied. Many rare congenital syndromes/malformations, including Klinefelter syndrome, tuberous sclerosis and Fragile X syndrome are reported to increase the risk of ADHD. However, for these conditions the ADHD symptoms

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may also be considered part of the syndrome itself and not a proper comorbid disorder. Conclusions: Converging evidence from epidemiological and clinical studies suggests that individuals with aADHD have an increased risk of several somatic diseases compared to people without ADHD. When assessing aADHD, clinicians should be aware of common co-occurring conditions. Recognition of comorbid obesity or neurological diseases are of particular importance, as presence of these conditions may have direct implications for treatment of ADHD.

P-22-005 Depression and anxiety influence the Wisconsin card sorting test of elderly patients with and without Attention-Deficit/ Hyperactivity Disorder (ADHD): Preliminary results M. Klein*, A. K. Menezes, T. M. Alves, M. R. Louza˜ * Sa˜o Paulo, Brazil Objectives: To compare elderly patients with ADHD and healthy elderly controls in relation to executive function, through Wisconsin Card Sorting Test (WCST-64:CV). Methods: Fourteen (6 males) elderly outpatients diagnosed with ADHD (DSM-IV-TR), mean age: 67.57 ± 3.78 years; and 17 (3 males) controls, mean age: 69.24 ± 1.99 years and Education (in years): 13.64 ± 4.19/12.18 ± 3.82 (respectively). Instruments: WCST-64:CV; Vocabulary and Matrix Reasoning (WAIS-III)[estimated IQ]; Beck Anxiety Inventory (BAI); Geriatric Depression Scale (GDS). Statistical Analyses: t Student—Independent Samples Test and Univariate Analysis of Variance. Results: The ADHD group showed a significantly higher estimated IQ compared to the control group. This difference was related to a higher Matrix Reasoning (MR) IQ; Vocabulary was similar in both groups. After correcting for IQ, no difference was observed in the WCST scores. The ADHD group showed significantly higher scores both on the GDS and BAI scores (p \ 0.000), but these were still within normal range. When adjusting both as covariate on WCST, depression showed influence (p \ 0.05) on variables ‘‘total correct’’, ‘‘conceptual level responses’’ and ‘‘categories completed’’ and anxiety influence all scores except ‘‘failure to maintain set’’. Conclusions: Depression and anxiety, even in normal levels, can influence results on WCST. Our results suggest the influence of MR on measures of executive function. Regarding the non-differentiation of groups, our results corroborate previous studies with Brazilian children, adolescents and young adults with ADHD, suggesting that WCST can not properly discriminate even elderly patients with ADHD. Funded by FAPESP (Grant 2012/03311-4).

P-22-006 ADHD comorbidity and related factors in adults with generalized anxiety and obsessive compulsive disorders: A preliminary study E. Ozten*, E. Tufan, G. Hizli Sayar, G. Eryilmaz, O. Karamustafalioglu * Istanbul, Turkey Objectives: In our study, it was aimed to investigate comorbid attention deficit hyperactivity disorder (ADHD) and related factors in adults with obsessive compulsive disorder (OCD) or generalized anxiety disorder (GAD) and to assess whether there are any gender differences.

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Methods: This study was carried out between June 2013 and April 2014 at the psychiatry polyclinic of a secondary treatment center. The study included 49 patients admitted to polyclinic within the above mentioned time interval diagnosed with GAD by using SCIDI, 35 patients diagnosed with OCD, and 32 healthy individuals matched in terms of age, gender, education and marital status. Participants were applied DSM-IV-Based Adult ADD/ADHD Diagnosis and Evaluation Inventory and Beck Anxiety Inventory (BAI). Those who gave 2 or 3 points to at least six of nine items on the DSM-IV-Based Adult ADD/ADHD Diagnosis and Evaluation Inventory’s 1st or 2nd part were clinically interviewed again and ADHD diagnosis was investigated. Descriptive statistics, Chi Square, Student’s t, one-way ANOVA and Pearson tests were used in analyses and p was set at 0.05. Results: In psychometric assessments, in OCD, GAD and control groups, there was a significant difference between mean scores of BAI, AT-1 (attention deficit), AT-2 (hyperactivity and impulsivity) and AT-3 (characteristics related to ADHD) and the scores ranked as GAD [ OCD [ controls. There were significant positive correlations between BAI and AT-1, AT-2, AT-3, AT-total scores. Conclusions: In anxiety disorders, comorbid ADHD is common. As adult ADHD is partly a new diagnosis, it could be difficult to be recognized by the clinicians. Comorbid condition may be omitted or misdiagnosed. Comorbid anxiety disorder may increase the impulsivity seen in ADHD, may lead to treatment resistance and more impaired functionality. By being vigilant in this regard, clinician will strengthen the treatment.

P-22-007 Are wandering minds and swinging moods linked to depression in adults with ADHD? C. Ryckaert*, C. Skirrow, F. Rijsdijk, J. Kuntsi, P. Asherson * London, UK Objectives: Adults with ADHD frequently report co-occurring depressive symptoms, with 35–50 % meeting diagnostic criteria for a depressive disorder during their lifetime. This represents a large group of patients who are greatly impaired, show a poor quality of life and a markedly increased risk for suicide. Despite this, findings show this comorbidity often goes unrecognized in clinical services, leaving many patients with unmet clinical needs and compromising their outcome. This highlights the need for a better clinical understanding of this comorbidity. We explored the links between depressive, Emotional Lability (EL) and Mind-Wandering symptoms (MW), and impairment in adult ADHD patients in order to characterize the clinical presentation of depression in adults with ADHD more fully. Methods: This study of 88 male adults (41 ADHD, 37 control) used self-assessments via (1) questionnaires capturing ADHD, depressive, EL & MW symptoms and impairment, and (2) ambulatory electronic diaries to measure mood & mental states and their fluctuations in everyday life. Case–control differences were carried out using Mann– Whitney U or independent samples t-tests, symptom correlations using Pearson correlation products, and to assess the predictive value of EL and MW on depressive symptomatology whilst controlling for ADHD and IQ, a hierarchical multiple regression model was used. Results: Compared with controls, non-comorbid ADHD adults experience more depressive symptomatology. ADHD patients with borderline-clinical depressive symptoms also experience higher levels of EL, MW, and functional impairment than those with lower depressive levels. Depressive symptomatology is more strongly correlated with EL and MW than with inattention and hyperactivity/ impulsivity. Finally, depressive symptoms can be statistically

predicted in adult ADHD patients by EL and MW levels, after controlling for the effects of IQ and inattention-hyperactivity severity. Conclusions: These findings suggest that severely elevated EL and MW are linked to depressive symptoms in adults with ADHD. Incorporating this knowledge during diagnostic assessment should improve the recognition of this comorbidity.

P-22-008 Comorbid symptoms in adults with ADHD N. Saga*, T. Motira, T. Tokumasu, D. Ikuse, G. Arai, Y. Okajima, A. Iwanami * Setagaya-Ku, Tokyo, Japan Objectives: ADHD is highly prevalent in adults as well as in children, and the symptoms of ADHD often causes several problems at school or work, regarding relationships with other persons. Previous studies indicated that persons with ADHD have high levels of clinical comorbidity. Especially, depression and anxiety are often observed in these subjects. However, there are not enough reports regarding comorbid symptoms in adult ADHD subjects. In the present study, we investigated comorbid symptoms (depression and anxiety) in adults with ADHD. Methods: Subjects provided written informed consent prior to completing the questionnaires in the study, which was approved by the ethics committee of the Faculty of Medicine of Showa University. The clinical group of this study was comprised of 31 persons with ADHD according to the criteria of DSM-IV. To confirm that the subjects being high-functioning, intellectual ability was assessed using the Japanese version of the National Adult Reading Test. Conners’ Adult ADHD Rating Scales Self Report: Screening Version (CAARS), Autism Spectrum Quotient (AQ), State-Trait Anxiety Inventory (STAI), and Self-rating Depression Scale (SDS) were used to assess ADHD and comorbid symptoms. At the time of testing, subjects had no other psychiatric disorders. Results: Mean age of the subjects was 29.7 ± 7.1 (mean ± SD) years old and mean estimated IQ with JART was 105.7 ± 8.6, which indicated that the subjects were high-functioning. Mean total score of SDS was 46.9 ± 10.9, which showed that the subjects were slightly or moderately depressive. The results of both STAI scores (mean state anxiety; 55.4 ± 11.1, mean trait anxiety; 61.2 ± 11.1) showed high anxiety in these subjects. The correlations between CAARS and trait anxiety was significant (r = 0.559, p \ 0.01). Conclusions: The results of the present study revealed that depression and anxiety are frequently observed in adults with ADHD.

P-22-009 Adult ADHD and personality disorders: A Spanish sample J. Sevilla*, I. Basurte, L. Serrano, A. Sedano, R. Navarro * Madrid, Spain Objectives: The main objective of this study was to assess personality traits across subgroups of ADHD in a sample of adult patients. As second objective, to observe the influence of these diagnoses of personality and the different subtypes of ADHD. Methods: The sample was collected among patients attending psychiatrist’s office on a specific program for adult ADHD in a metropolitan area of Madrid (Spain). All patients met DSM-5 criteria for ADHD in different subtypes and all of them were adults. Sociodemographic data were obtained. For the diagnosis confirmation the Conners’ Adult ADHD Rating Scales (cutoff [65) was given and

the International Personality Disorder Examination (IPDE) for assessment of personality traits (cutoff [3). We used the Statistical Package for the Social Sciences (SPSS v.20 for Mac OS X). Chi square (v2) for discrete variables. The significance level was set at a = 0.05. Results: We obtained 47 patients with the following demographic characteristics: 53.2 % Men (25), 51.1 % University (24), 53.2 % Singles (25), 80.9 % active (38). The average age was 40.4 years (SD = 8.9) and the following diagnoses of ADHD: inattentive 20 (42.6 %), Combined 22 (46.8 %) and unspecified five (10.6 %). Personality traits in order of frequency are as follows: Limit 37 (78.7 %), Obsessive 31 (66 %), 30 Avoidant (63.8 %), Histrionic 27 (57.4 %), Narcissistic 25 (53.2 %), Dependent 24 (51.1 %), Paranoid 15 (31.9 %), Schizoid 14 (29.8 %), Schizotypical 14 (29.8 %), Antisocial 11 (23.4 %). Crossing ADHD diagnoses with different personality traits we obtain the following significant differences: Schizoid (inattentive (50 %) [ Not Specified (40 %) [ Combined (9.1 %), v2 (2) = 8.6; p \ 0.05), Limit (Combined (90.9 %) [ inattentive (75 %) [ Not specified (40 %), v2 (2) = 6.59; p \ 0.05), dependent (Combined (77.3 %) [ inattentive (35 %), v2 (2) = 13.33; p \ 0.005). Conclusions: Patients with Adult ADHD have a high comorbidity of limit, obsessive, avoidant, histrionic, narcissistic and dependent traits. The inattentive subtype is associated with schizoid personality traits mostly, while the combined subtype is associated with dependent and limits traits.

P-22-010 The association between metabolic syndrome, obesityrelated outcomes and adult Attention-Deficit/Hyperactivity Disorder D. Wynchank*, D. Bijlenga, F. Lamers, S. Kooij, A. Bron, A. Beekman, B. Penninx * Den Haag, The Netherlands Objectives: This is the first study to examine all five risk factors for Metabolic Syndrome (MetSyn) in adult ADHD. The objective is to ascertain whether ADHD confers any added risk for MetSyn, in a large sample, with varying stages and severity of anxiety and depression. Methods: Data of 2303 persons from the Netherlands Study of Depression and Anxiety (NESDA) were used. Three groups were compared (controls; depressive and anxiety disorders without ADHD; depressive and anxiety disorders with ADHD) for presence of MetSyn risk factors, Body Mass Index and Waist-Hip ratio. ADHD symptoms were identified by using a T score [65 on the Conners Adult ADHD Rating Scale (CAARS). High Inattention and Hyperactivity/Impulsivity symptoms of ADHD were distinguished. Analysis included univariable (ADHD) and multivariable models (adjusted for age, sex, education, depressive and anxiety disorders). Results: Overall, effects on obesity-related parameters disappeared after correction, but lower triglycerides and lower blood pressure were significant for high Hyperactivity symptoms and ADHD Sum scores. Once adjusted for age, stratified by sex and using a higher cutoff for ADHD symptoms, no other significant relationships with MetSyn risk factors or obesity-related parameters were found. When frequent use of tricyclic antidepressants, presence of lifestyle factors (smoking, alcohol and physical activity) or number of chronic diseases were added to the regressions, they did not change the relationships between ADHD and any of the MetSyn parameters. We stratified the sample by sex, but found similar results. Conclusions: While there may be a relationship between ADHD and obesity, MetSyn and obesity-related parameters do not appear to be

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increased in those with ADHD at various stages and severity of depressive and anxiety disorders. Some of the MetSyn risk factors may be more influential than others, and the relationship between ADHD and blood pressure should be investigated further. P-22-011 The development of comorbid anxiety in adults with ADHD: Demographic, developmental and psychosocial risk factors and predictors J. Bramham*, K. Grogan * Dublin 4, Ireland Objectives: Anxiety affects up to 50 % of adults with ADHD. However, little is known about why anxiety develops in some individuals with ADHD and not others. This research aimed to investigate demographic, developmental and psychosocial risk factors and predictors of anxiety in the context of ADHD. Methods: Participants included 290 adults with a diagnosis of ADHD (180 male:110 female) and an age range of 16–70 years (M = 30.43 years; SD = 10.03 years). A background interview, parent questionnaire and the Hospital Anxiety and Depression Scale (HADS; Zigmond & Snaith, 1983) were used to gather participant information. A series of correlations, independent t-tests and one-way analysis of variances (ANOVAs) were used to identify demographic, developmental and psychosocial variables that have a significant effect on levels of anxiety. These risk factors were then entered into a regression to analyse predictors of anxiety for adults with ADHD. Results: Potential risk factors for the development of anxiety included childhood aggression, employment status, difficulties making friends, number of children and caffeine intake. Further regression analysis found childhood aggression, difficulties making friends and caffeine intake to be significant predictors of anxiety in adults with ADHD. Conclusions: Clinicians should be aware of these risk factors for anxiety in the context of ADHD in order to minimise the likelihood of the development or maintenance of comorbid anxiety.

Saturday, 30 May 2015, 16.00 h–17.30 h P-23 Pathophysiology - Children and adolescence P-23-002 Psychopathology, executive functioning and functional impairment between referred vs. non referred ADHD adolescent siblings L. Palacios-Cruz*, A. Arias-Caballero, C. Benjet, P. Mayer, C. Cruz Fuentes, R. E. Ulloa, N. Gonza´lez Reyna, A. Fragoso, P. Clark, M. d. Carmen Lara Mun˜oz, J. C. Pe´rez Castro, F. de la Pen˜a, A. Sepu´lveda-Sastre´ * Me´xico, Mexico Objectives: Compare psychopathology, executive functioning and functional impairment between referred (AR) vs non referred ADHD (ANR) adolescent siblings. Methods: Study sample was obtained from 2 outpatient centers and was composed of 83 probands with ADHD and 27 adolescents siblings. The subjects were evaluated by clinicians with at least 5 years of experience and the diagnostic determination was made by clinical

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consensus with at least one expert with 15 years of clinical experience. The following instruments were applied by the clinicians, to parents or to the adolescents: a clinical interview based on DSM IV, Attention Deficit Hyperactivity Disorder Rating Scale (ADHD RS) IV, Behavior Rating Inventory of Executive Function (BRIEF) parent version, Strengths and Difficulties Questionnaire (SDQ) parent version, Weiss functional impairment rating Scale Parent Report (WFIRS-P) and a sociodemographic and clinical data questionnaire. Results: Within the AR 33 % were female versus 52 % ANR (OR = 2.23, 95 % CI = 0.92–5.40; x2 = 3.25). Differences were found in terms of performance difficulties in Familiar (AR = 41 % vs ANR = 18.4 %, OR = 3.07, 95 % CI 1.21–7.79), Academic (AR = 67.5 % vs ANR = 31.64 %, OR = 4.49, 95 % CI 1.97–10.24), life skills (AR = 69.9 % vs ANR = 50 %, OR = 2.32, 95 % CI 1.05–5.11) and Risk behaviours (AR = 27.7 % vs ANR = 10.5 %, OR = 3.26, 95 % CI 1.04–10.21) areas. As to executive functioning, we found a poor performance in behavioral and cognitive meta index. Similar results were found in all sub-scales. Conclusions: Considering the high heritability of ADHD, clinical evaluation and study of non referred subjects is important in order to identify individual and cognitive factors that are associated with a better prognosis. This study highlights the importance of considering the study of cognitive performance from the perspective of a spectrum from where there are shared clinical aspects that share must be considered separately.

P-23-003 Sensory processing difficulties in special education needs (SEN) school children - a preliminary survey S. Perera*, J. Kaleyias, A. Abdussalam * Southend On Sea, UK Objectives: To survey the prevalence and the types of sensory processing difficulties in children with Attention Deficit Hyperactivity Disorder (ADHD, Autistic Spectrum Disorder (ASD) and Learning difficulties (LD) in SEN schools. Methods: Teacher reported sensory profiles of 237 SEN children were compared using the Biel & Peske sensory check list. Statistical analyses were performed using SPSS. Comparison between groups was done using the student t-test and among groups by ANOVA. Results: Fully completed questionnaires were available only for 218 out of 237 children. Median age of the study sample was 10 years (IQR: 8–13 years) and predominantly male (89 %). The primary diagnosis was ADHD (16 %), LD (34 %) and ASD (50 %). 32/34 children with ADHD were on psychopharmacological treatment. 77 % reported sensory problems in vestibular, auditory and taste, 81 % in vision, 85.5 % in proprioception and 90 % in touch. The median sensory score was 23 (IQR: 10–34) There was no correlation between total score and gender (p = 0.26) or age (Pearson = 0.76). The mean total score was 16.5 in ADHD, 21 in LD and 25 in ASD (one-way ANOVA, p = 0.012). A significant correlation was found between diagnosis and touch (p = 0.05) proprioception (p \ 0.001) and vestibular (p = 0.046) but not with auditory (p = 0.146), vision (p = 0.67) or taste (p = 0.265). Conclusions: Sensory processing difficulties in SEN children were reported in 77–90 % in the six modalities tested. ADHD children have less sensory processing difficulties than children with Autistic Spectrum Disorders or Learning Difficulties.

P-23-004 Emotional dysregulation of ADHD in childhood predicts maintenance of hyperactive-impulsive symptoms in earlyadulthood Q. Qian*, W. Chang, X. He, L. Yang, L. Liu, Q. Ma, Y. Li, L. Sun, Y. Wang

rather than situations where they are almost certainly set to fail. We suggest that the BSFT provides a promising basis for developing more complex ecologically valid tests that might help to better identify particular cognitive processes and behavioral impairments associated with ADHD.

* Beijing, People’s Republic of China Objectives: This study is to detect the relationship between emotional dysregulation in childhood and the hyperactive-impulsive symptoms in early-adulthood of participants with ADHD. Methods: Children who met DSM-IV ADHD criteria were followed up into early adulthood. The subjects were divided into two groups (with or without emotional dysregulation) according to the emotion control subscale of Behavior Rating Scale of Executive Function. In the follow-up interview, their clinical outcomes were assessed by the Conner’s Adult ADHD Diagnostic Interview. We compared both the baseline clinical variables and the early-adulthood HI symptoms between ADHD children with and without emotional dysregulation. Results: Sixty-eight individuals were followed up when they reached early adulthood. Their ages ranged from 10 to 15 years at baseline and from 18 to 24 years at follow-up. Logistical analysis showed that emotional dysregulation predicted hyperactive-impulsive symptoms of ADHD both in childhood (OR = 10.28, p \ 0.01) and in earlyadulthood (OR = 4.07, p = 0.01). Conclusions: The current study showed that children with ADHD and emotional dysregulation were more predictable for hyperactiveimpulsive symptoms of ADHD in both childhood and early-adulthood than those with ADHD only.

P-23-005 Are ADHD children efficient foragers? Evidence from the ecologically based ball-search field task M. Rosetti*, R. E. Ulloa, E. Reyes-Zamorano, L. Palacios-Cruz, F. de la Pen˜a, R. Hudson * Mexico City, Mexico Objectives: To compare the performance of subjects with an ADHD diagnosis with an age-matched sample from school settings on the novel Ball-Search Field Task (BSFT). The BSFT is our proposal for a ecologically inspired activity based on searching, a fundamental behavior that underlies many aspects of everyday life and involves cognitive processes such as planning, inhibition and memory. Methods: The performance of 75 treatment-free subjects diagnosed with ADHD and 226 subjects (6–16 year old) from a control school sample was evaluated on the BSFT, which required them to locate and collect balls from underneath an array of safety cones in a large (50 by 70 m) outdoor area. Collection efficiency and number of mistakes (times subjects returned to an ‘‘empty’’ cone) were quantified. Data were analyzed using a general linear model with AGE, SEX and SAMPLE as main factors. Results: The task was well accepted, even by the youngest children, and also by the patients in an unfamiliar hospital setting. Motivation was shown by a willingness to travel considerable distances and continuing to pick up cones at a fast rate despite making mistakes. Although subjects of both groups were equally successful in collecting all the balls within the given time, a larger percentage of ADHDdiagnosed subjects made mistakes (v2 = 12.8, df = 1, p = 0.0004). Also, subjects in the hospital were significantly less efficient in the number of balls obtained (Est. = -0.68 ± 0.32, t = -2.1, p = 0.03). Conclusions: It can be useful to design neuropsychological tasks creating situations where children with ADHD can potentially excel

P-23-006 Presentation modality influences phonological working memory performance in children with ADHD: The impact of auditory, visual, and combined modalities D. E. Sarver*, M. J. Kofler, E. Wells * Oxford, USA Objectives: Phonological working memory (PHWM) problems are associated with ADHD and predict many learning outcomes. Factors influencing PHWM performance (accuracy and consistency) are unknown, but the extent to which performance is impacted positively has significant clinical/educational implications. Stimulus presentation modality represents on possibility and the current study is the first to examine whether auditory, visual or the combined (auditory + visual) presentation impacts ADHD-related PHWM performance, while also examining the impact of cognitive load. Methods: Thirty-six children with ADHD (13 female, 26 male), ages 8–13, diagnosed using DSM-5 criteria based comprehensive, goldstandard assessments. Three conditions of a PHWM task modeled on the WISC-IV Letter-Number Sequencing subtest were administered at four set sizes (3–6). All 3 PHWM conditions identical with the exception the stimuli presentation modality (auditory, visual, combined presentation). Stimuli were presented at 1 s intervals. Each set size included 12 trials presented in ascending order. Dependent variables included (a) accuracy, (b) accuracy consistency, (c) response duration, and (d) response duration consistency. Results: Overall, combining visual and auditory presentation was associated with small-medium magnitude improvements in PHWM performance, as evidenced by increased recall accuracy and consistency relative to both single modalities, and decreased response times and response time variability relative to auditory-only presentation. Auditory presentation was much poorer. Combined presentation produced performance and response durations similar to the best single modality across set sizes, and was associated with more consistent performance than either single modality at higher cognitive loads. Conclusions: Combined presentation optimizes PHWM performance, especially under high cognitive load relative to either single modality. Results have implications for improving cognitive outcomes and educational success for children via curriculum redesign, and suggest that instructional methods that simultaneously combine information modalities may result in improved cognitive performance. Behavioral treatments may also be enhanced when using strategies that maximize PHWM through multi-modal information presentation.

P-23-008 The influence of high trait anxiety on attentional lapses in drug naive children with ADHD L. Sorensen*, D. Wollschla¨ger, H. Eichele, M. F. Høvik, H. v. Wageningen, M. K. Worren, S. Adolfsdottir, O. B. Fasmer, K. J. Plessen * Bergen, Norway

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Objectives: Attentional lapses as measured by high levels of intraindividual variability in reaction times (IIVRT) are highly frequent in children with ADHD, and relate to their inhibitory problems. High trait anxiety is also suggested to associate with high IIVRT (Broyd et al. 2009). However, anxiety in children with ADHD associates with an enhanced inhibitory control. We therefore investigated the specific influence of trait anxiety on attentional lapses in children with ADHD. Following previous studies, we expected that ADHD would lead to high IIVRT and a higher frequency of especially long reaction times (RTs). Further, we expected that high trait anxiety would relate to high IIVRT, but not with the incidence of slow RTs. Methods: Children 8–12 years with ADHD (n = 38) and healthy controls (n = 34) performed the CANTAB Stop Signal Task. Standard deviations in RTs was included as a measure of IIVRT, and the ex-Gaussian parameters sigma and tau as indicators for the frequency of unusually long RTs. Inhibitory control was measured by the stop signal RT (SSRT) and the children reported their level of anxiety on the Spielberg Trait Anxiety inventory. We analyzed the data using ordinal logistic regression analyses. Results: We found a significant between-group effect of ADHD on the IIVRT and on the ex-Gaussian parameter of tau. Higher levels of trait anxiety covaried with the ex-Gaussian parameter of variability (sigma) with no interaction effect between ADHD and high trait anxiety. Higher SSRT covaried with the IIVRT and tau, and not with sigma. Conclusions: The findings support ADHD to increase attentional lapses by in-between slow responses, indicating that attentional lapses in ADHD result from poor inhibitory control. However, higher levels of anxiety were associated with variability in longer RTs, a different pattern of variable performance than that caused by ADHD, which was not associated with inhibitory problems.

P-23-010 Long-term memory for names in ADHD children S. Kiselev* * Ekaterinburg, Russia Objectives: The goal of this research was to examine the hypothesis that children with ADHD have a weakness in long-term memory for names. Methods: The experimental group included 15 Russian-speaking children with ADHD at age 7–8-years (10 boys and 5 girls). The control group included 15 typically developing children. The children from experimental and control group were matched for IQ, gender and age. Children from both groups were assessed with NEPSY using Memory for Names subtest. This subtest is designed to assess the ability to learn the names of children over three trials. A delayed task assesses long-term memory for names. Two-way ANOVA was used to reveal group differences in reproducing the names in immediate and delayed conditions. Results: We have not revealed significant differences between children from experimental and control group in the reproducing the names in immediate condition. However, the interaction of condition type and group was significant (p B 0.05). Children with ADHD were less successful in reproducing the names in delayed condition. Conclusions: Children with ADHD have weakness in long-term memory for names In view of the obtained results, it can be assumed that children with ADHD have a specific deficit in the delayed memory.

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P-23-011 Objectivity in clinical diagnosis of ADHD by means of AULA virtual reality based neuropsychological test: Initial findings U. Diaz-Orueta*, M. A. Fernandez Fernandez, G. Climent * Donostia-San Sebastian, Spain Objectives: To study whether AULA virtual reality (VR) based neuropsychological test may identify subtle differences between different ADHD subtypes in children clinically diagnosed with ADHD on the basis of clinical interviews with children and parents. Methods: 124 children (97 boys and 27 girls) with a mean age of 9.78 years-old (SD = 2.82, age range = 6–16 years old) were recruited from a paediatric neurology institute in Southern Spain; 49 were clinically diagnosed of ADHD inattentive subtype and 75 of ADHD combined subtype. All children underwent a comprehensive evaluation of attention processes using AULA (Climent and Banterla 2011), a test with two differentiated tasks (No-Go, Go) with visual, auditory and mixed distractors. Mean differences for all AULA scores (inattention, impulsivity, reaction time, sustained and divided attention, motor activity, deviation from attention focus, and quality of attention) were analyzed. Due to lack of normality of studied variables, a Mann–Whitney U test was applied to analyse these differences. Results: Statistically significant differences were obtained, showing a worse performance for ADHD combined-type children than for inattentive. In general indexes of AULA, significant differences were found in total commissions—i.e. impulsivity—(p = .026), and sustained attention (p = .029), but more prominently in motor activity (p = .000) and deviation from the focus (p = .001). When comparing specific performance with and without distractors, and between No-go and Go tasks, the most significant differences were persistent in motor activity and deviation from the focus scores. Conclusions: AULA VR test may provide objective information and increase the accuracy of differential diagnosis between ADHD subtypes, especially by measuring motor activity and deviation from the focus, as a low performance in these measures may be more representative of the hyperactivity component. Future studies will be needed to increase the accuracy of AULA and establish cut points to differentiate more accurately between clinical subtypes and non-clinical performance.

P-23-012 Executive functions and academic performance in children with ADHD ´ lvarez, U. Diaz-Orueta*, M. V. Gonza´lez-Maya, I. Martı´nez-A P. Martı´n-Lobo * Donostia-San Sebastian, Spain Objectives: During the development of ADHD, low performance of executive functions (EF) can be observed, that may be a consequence of lack of maturity of neural circuits implied or to a poor development of EF themselves. Due to this low performance, academic achievement of affected children is usually compromised as a result of poor working memory, attention and cognitive flexibility. The goal of the current study is to analyze these three cognitive domains in a sample of children with clinical diagnosis of ADHD and to study their performance with regards to academic achievement.

Methods: 30 children clinically diagnosed with ADHD, 22 boys and 8 girls (mean age = 9.26, SD = 1.70, range = 7-12) were recruited. All participants were assessed on their executive function performance using WISC-IV subscales (Letters and Numbers, Direct and Inverse Digit Span, and Arithmetic tests, and Working memory Index), ENI-2 (Child Neuropsychological Evaluation, version 2— Matute et al. 2013), and on their academic performance on a range from low to very high. Due to lack of normality of studied variables, a Spearman rho was calculated to establish correlations between executive functions and academic performance. Results: Students with ADHD show an overall low performance in working memory and attention, and an average performance in cognitive flexibility. A significant direct correlation exists between academic performance and Letters and Numbers (rho = 0.5, p \ .01), Digit Span (rho = 0.5, p \ .01), and Working Memory Index (rho = 0.46, p \ .01). No significant correlations were obtained between academic performance and cognitive flexibility. Conclusions: It is partially evidenced that a lower performance in executive functions (mainly attention and working memory) is significantly related with a low academic performance in children with clinical diagnosis of ADHD. It is relevant to develop early neuropsychological intervention programs to stimulate and improve executive functions in primary school children.

P-23-013 Motor and perceptual-manipulative difficulties in children with ADHD in primary school education U. Diaz-Orueta*, M. d. Carmen Domı´nguez-Hildalgo, A. B. Navarro-Prados, P. Martı´n-Lobo * Donostia-San Sebastian, Spain Objectives: ADHD may present concurrent conditions, such as motor and perceptual-manipulative difficulties. Moreover, the joint development of ADHD and motor dysfunctions implies a greater probability of learning disorders and school failure. However, it is not common to include motor and perceptual-manipulative skills in the consideration of a clinical diagnosis of ADHD. In order to fulfil this gap, the current study aims to explore the relevance of taking into account motor and visual motor abilities of children clinically diagnosed with ADHD and evaluate to what extent deficits in these domains may be a specific problem for these children. Methods: 60 children attending first grade of primary school in three schools from Southern Spain (ages 5 and 6), 30 with ADHD diagnosis (15 diagnosed of ADHD inattentive subtype, 15 diagnosed of combined subtype) and 30 control of their same school grade, were recruited for the study. They were assessed with the McCarthy Scales of Children Abilities (MSCA, McCarthy 2006) and Basic Motor Patterns test (Santiuste et al. 2005). Results: Level of motor and perceptual-manipulative abilities were significantly lower in the ADHD group (inattentive plus combined) when compared to the control group (t(58) = 2.83, p \ .001). Moreover, differences were found between inattentive and combinedtype children for the difficulties addressed. While inattentive children obtained worse results than controls for visual motor tests (t(43) = 2.83, p \ .01), combined-type children performed worse in global motor performance scales (t(43) = 4.83, p \ .001). Conclusions: Children with ADHD show more prominent motor and perceptual-manipulative difficulties than control children. It is necessary to develop early neuropsychological intervention programs that target and try to improve these skills.

P-23-014 AULA virtual reality test and EDAH observation scale: Complementary resources in the identification of ADHD U. Diaz-Orueta*, A. Zulueta, N. Crespo-Eguı´laz * Donostia-San Sebastian, Spain Objectives: Diagnosis of ADHD is mainly based on clinical interviews with the patient and third parties’ observations by means of structured scales like ADHD Conners’ rating scale or EDAH for teachers (Farre´ and Narbona 2010) and DSM interviews with parents. The current study presents initial findings obtained from complementing observations measured by EDAH scale for teachers with cognitive variables assessed with AULA virtual reality (VR) based neuropsychological test, designed for a comprehensive evaluation of attention processes (Climent and Banterla 2011). Methods: 211 children (133 boys, 78 girls), 6–16 years-old, from Northern Spain (41 of them with ADHD diagnosis, 15 inattentive and 26 combined-type) were evaluated using AULA VR test. Pairs of groups were created based on each EDAH individual item from attention deficit and hyperactivity subscales (as each item of these scales represents one different cognitive symptom that may be measured with AULA). Between-group differences of performance in AULA with regards to inattention, impulsivity, processing speed, motor activity and quality of attention focus were analyzed, in different testing conditions comprised in AULA (performance with and without distractors, comparing performance with visual versus auditory stimulation, and no-go versus go task conditions). Results: AULA could significantly differentiate between groups of children showing inattention and hyperactivity symptoms versus those no showing symptoms according to EDAH scale in most measured scores. Hyperactivity items were especially addressed by means of motor activity, deviation from the focus and commissions, and differences between symptoms observed by teachers in EDAH were more significant for AULA testing sections in which distractors were present. Conclusions: AULA Virtual Reality test, by means of quantifiable measures of cognitive symptoms, and third parties’ direct observations of children’s behaviours, collected by means of scales like EDAH, may complement each other and increase the accuracy of clinical diagnosis of ADHD.

Saturday, 30 May 2015, 16.00 h–17.30 h P-24 Neuroimaging II P-24-001 A meta-analysis of fMRI studies in disruptive behaviour disorder J. Radua*, K. Rubia, A. Alegria * Barcelona, Spain Objectives: Findings on neurofunctional deficits in disruptive behaviour disorder (DBD) have been inconsistent. To establish the most consistent brain dysfunctions, a meta-analysis was conducted of all whole-brain functional magnetic resonance imaging (fMRI) studies published so far. Methods: PubMed, ScienceDirect, Web of Knowledge, Google Scholar and Scopus databases were searched for whole-brain fMRI studies of youth with DBD or conduct problems (DBD/CP) up to

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December 2014. Forty two high quality datasets derived from 21 published studies were included in the main meta-analysis comprising 750 DBD/CP youth and 739 healthy controls. Peak coordinates were extracted from significant case–control activation differences and a voxel-based meta-analytic method, Signed Differential Mapping (SDM), was used to examine group differences of functional activation. Results: Youth with DBD/CP have most consistent abnormalities relative to healthy controls in dorsal and ventral medial prefrontal/ anterior cingulate cortex (mPFC/ACC) reaching into caudate, in right dorsolateral prefrontal cortex (DLPFC) and right superior temporal lobe. The sub-meta-analyses showed that the dysfunction in medial fronto-cingulate regions, crucial for top-down motivation control, was triggered by hot EF, in DLPFC by emotion processing and in the attention-mediating right superior temporal lobe by cool EF. DBD with psychopathic traits showed under activation in more cognitive medial frontal regions of the supplementary motor area and dorsal ACC, and temporo-striato-limbic regions including insula, amygdala and caudate. Conclusions: The meta-analytic findings show that the most consistent functional deficit in DBD is in top-down dorsomedial prefrontalstriatal circuitries that are crucial for the control of affect and motivation and reward-based decision making which are typically compromised in the disorder. Psychopathic traits are associated with more prominent striato-limbic dysfunctions in line with evidence for shallow affect and reward-based behaviours.

P-24-002 Neuroimaging analysis for patients with ADHD in South Korea S. M. Bae*, Y.-E. Lee, S.-J. Cho, E.-J. Choi, Y. D. Son * Incheon, Republic of Korea Objectives: The aim of this study is to establish the neuroimaging protocols to define functional landmarks of ADHD. Methods: Subjects were recruited among the third-grade and fourthgrade classes attending elementary schools. The volunteers were classified as a control group or an ADHD group via neuropsychological tests. 3.0T MRI was utilized to acquire a set of functional and anatomical images. Two tasks, attentional task and stroop task, were given to the subjects during functional MRI sessions. We developed the attentional task to have a block design consisting of rest, control and task stimuli. Arrow-word stroop task followed the same design; a 2 9 2 factorial design of ‘conflict’ and ‘switch’ conditions. The task consisted of four conditions: nonswitch-congruent, switch-congruent, nonswitch-incongruent and switch-incongruent. It also used the eventrelated design. Results: During the attentional tasks, the ADHD group showed relatively higher neuronal activation in the anterior cingulate cortex, orbitofrontal cortex, posterior cingulate cortex and bilateral parietal cortex, which are known as the default mode network (DMN), deactivation areas during attention-demanding task (fig 1). We can postulate that this reduced deactivation in the ADHD group is related to their attention deficiency. Button responses collected during the arrow-word stroop task did not show significant group difference. The functional MRI, however, showed some significant activation in each of the conditions. Among them, the ‘Non-switch/Incongruent’ condition showed the most significant difference between the control and ADHD groups. ADHD showed greatly reduced activation than control subjects in the bilateral primary motor cortex, bilateral cerebellum, bilateral hippocampus, bilateral inferior parietal cortex,

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bilateral superior parietal cortex, bilateral orbitofrontal cortex, and superior frontal cortex (fig 2). Conclusions: Between control and ADHD groups, the newly developed attentional task showed significant difference. This fact proposes a new possibility as a functional landmark of ADHD.

P-24-003 Multimodal investigation of the role of the iron metabolism in increased substantia nigra echogenicity in ADHD J. Geissler*, S.-Y. Dang, S. Schaeff, L. Schneider, C. Drepper, S. Neufang, M. Gerlach, M. Romanos * Wu¨rzburg, Germany Objectives: Transcranial sonography (TCS) as a non-invasive method allows for the visualization of deep brain structures via ultrasound waves. Research employing TCS for the study of psychiatric disorders has so far focused mainly on adult populations, with knowledge regarding abnormal echogenicity patterns in children and adolescents remaining scarce. This study investigates the potential role of the iron metabolism in the pathomechanisms of altered substantia nigra echogenicity (SN) in children with ADHD by combining imaging techniques relying on different physical processes (TCS, MRI) with peripheral markers. Methods: B-Mode sonographic images of the mesencephalic scanning plane were acquired bilaterally with the Esaote MyLab Gold ultrasound device (Esaote, Italy) equipped with a 2.5 MHz transducer at a penetration depth of 15 cm and a dynamic range of 45 dB. The current sample comprises N = 28 children with ADHD aged 8–12 and N = 34 matched controls without a history of psychiatric disorders. The planimetric area of the SN was circled manually and calculated off-line by a blinded investigator. Results: Preliminary results in a subsample indicate a higher SN/ brainstem ratio in the ADHD group compared to controls, i.e. in children with ADHD the echogenic area of the SN occupies a larger part of the mesencephalic brainstem. Conclusions: The results of this study confirm previous findings of SN hyper-echogenicity in ADHD. Detailed analyses integrating data from TCS, MRI and peripheral markers will be performed and reported, elucidating the role of central and peripheral iron metabolism in the context of this potential biomarker.

P-24-004 Post-error behaviour in adults with ADHD is mediated by a chronically under-activated prefrontal cortex J. Hudak*, S. Deppermann, F. Haeussinger, A. C. Ehlis * Tu¨bingen, Germany Objectives: The present study aims to underline prefrontal neural activation differences between healthy adults and adults diagnosed with ADHD following errors. In order to achieve this aim, subjects were given a complex Erikson flanker task embedded within a gonogo paradigm. Simultaneously, EEG and functional near infrared spectroscopy (fNIRS) were applied. Reduced cortical activation in ADHD subjects was expected as there is behavioural evidence suggesting they respond with increased errors and higher reaction time variability following an error (Yordanova et al. 2011). Methods: 21 healthy controls (18–41, M = 25.3, 15 Female) and 30 ADHD patients (18–55, M = 29.3, 12 Female) participated in the study. fNIRS was recorded via optodes centered over frontal-temporal regions

of the cortex based on 10–20 EEG electrode positions. Simultaneous EEG was recorded, but this poster will focus only on fNIRS. During the recording, the subjects were given a flanker task in which they needed to respond to the direction of the arrows shown, and the type of the arrows shown with one of four keys. Further complicating this task was its nesting within a go-nogo paradigm wherein subjects should only respond when a go cue was presented, indicated by color. We measured cortical deoxygenated haemoglobin (HHb) following errors and following correct responses, both on ‘go’ trials and ‘nogo’ trials. Results: Preliminary results elucidate a significant difference between healthy controls and ADHD subjects specifically within the right PFC after ROI analysis. This reduced activation occurs specifically at the presentation of ‘go’ trials following errors. Conclusions: This study lends further evidence to marked neurophysiological differences in ADHD patients, and to how these differences may directly reflect or even underlie behavioural outcomes. In addition, it is, to the best of our knowledge, the first study to address the physiology of post-error decision making in adult ADHD.

P-24-005 Norepinephrine transporter binding and personality traits in patients with Attention-Deficit/Hyperactivity Disorder investigated with PET and (S,S)-[18F]FMeNER-D2 A. Kautzky*, K. Papageorgiou, H. Sigurdardottir, A. Hahn, G. Kranz, M. Spies, T. Vanicek, C. Rami-Mark, T. Traub-Weidinger, M. Hacker, M. Mitterhauser, W. Wadsak, S. Kasper, R. Lanzenberger * Vienna, Austria Objectives: The objective of this positron emission tomography (PET) study was to investigate the relation of personality traits to norepinephrine transporter (NET) binding potential (BPND) in adult patients with attention deficit hyperactivity disorder (ADHD). The Five-Factor-Personality-Inventory (NEO-FFI) items were previously associated with ADHD and neuroimaging and genetic findings indicate a major contribution of norepinephrine signaling in ADHD. Additionally, the NET is a central target for often-prescribed medications in ADHD. Methods: 22 medication-free patients with ADHD (aged 32.16 ± 10.86, 12 males) without psychiatric comorbidity and 22 age and sex matched healthy controls (HC; 32.00 ± 10.56) were measured with PET and (S,S)-[18F]FMeNER-D2. Subsequently the NEO-FFI was obtained from all subjects. The NET BPND was quantified with a voxel-wise whole-brain and regions of interest (ROI) approach using the multilinear reference tissue model (MRTM2). NET BPND maps of patients and healthy controls were computed using SPM8 in a priori defined ROIs, including anterior cingulate, hippocampus, putamen, pallidum, thalamus, midbrain with pons, cerebellum and locus coeruleus. Then correlation coefficients for the six NEO-FFI traits and NET BPND were analyzed by regression linear mixed model. Results: We did neither detect significant differences in NET binding nor in personality traits between patients with ADHD and HC. Furthermore, none of the personality traits were associated with NET BPND. Including age or sex as covariate did not alter these results. Conclusions: Neuroticism and extraversion were suggested to be more pronounced in ADHD patients who seemed to be lacking conscientiousness. However, controls and patients did not differ in our analysis and none of the NEO-FFI items were associated with NET BPND, indicating that personality traits do not directly correlate with the NET. Considering the small sample size, the presented data has to be regarded as preliminary and future studies will hopefully shed more light on personality traits and catecholaminergic systems in ADHD.

P-24-006 Microstructural abnormalities in adolescents with ADHD: A diffusion tensor imaging study ¨ . Metin, C. Kan Gu¨rkan, D. Go¨kc¸ay B. G. Kylyc*, M. O * Ankara, Turkey Objectives: This study aimed to identify white matter differences in adolescents with ADHD compared to normal controls. Methods: The study included 16 adolescents with ADHD, aged 15–18 years, and 17 age and gender matched healthy controls. Diagnoses were made according to DSM-IV criteria using K-SADS-PL and behavioral rating scales. Adolescents who have additional medical disorders and severe psychiatric conditions were excluded. T1, T2 and DWI (7 b0, 45 directions) protocols of the Siemens MAGNETOM 3 Tesla scanner are utilized. For eddy current correction, FSL’s Eddy correct tool has been used. Voxelwise statistical analysis of the FA data was carried out using Tract-Based Spatial Statistics (TBSS). Afterwards, each subject’s FA map was nonlinearly registered to the most ‘‘typical’’ subject in the study. An adult atlas is not used, because adolescent brains contain drastic differences on the dorsal cortical surface. This target image is then affine-aligned into MNI152 standard space non-linearly. Finally, the mean FA image is created and thinned, so that a mean FA skeleton is generated. Each subject’s aligned FA data is then projected onto this skeleton and the resulting data is fed into voxel-wise inter-subject statistics utilizing a threshold-free cluster enhancement method. 5000 permutations of the data is used for the t-test and threshold to obtain corrected results for multiple comparisons of p \ 0.001. Results: ADHD adolescents presented reduced FA compared to controls, in cerebellar, fronto-parietal, fronto-limbic, white matter and corona radiata. Right hemisphere specific significant changes are reported at anterior/superior corona radiata, superior longitudinal fasciculus, uncinate fasciculus. Bi-lateral FA differences are found at inferior cerebellar peduncle. Conclusions: The analysis in adolescents with ADHD indicates a similar pattern to children and adults with ADHD. As consistent with the literature, these findings show that microstructural abnormalities in white matter may play a role in pathophysiology of ADHD.

P-24-007 Early cerebellar anomalies show sexual dimorphism in preschool children with ADHD M. Mahone*, D. Crocetti, B. Dirlikov, K. Slifer, M. Denckla, S. Mostofsky * Baltimore, USA Objectives: By school age, children with ADHD have widespread, but sexually dimorphic, reductions cortical and subcortical brain volumes. These differences are hypothesized to underlie the different patterns of cognitive and motor control in boys and girls with ADHD. To understand the neurobiology of ADHD, with the goal of early identification and treatment, brain development should be studied in younger children with ADHD. Methods: High-resolution anatomical (MPRAGE) images, acquired at 3.0T, were analyzed in 85 preschoolers, ages 4–5 years (45 with ADHD, 40 typically developing controls—TD). The ADHD group was diagnosed using modified DSM-IV-TR, and screened for language and psychiatric disorders. Cerebellar volumes were generated using an automated atlas, which was based on a reliable manual

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parcellation protocol with interclass correlation coefficients ranging from .86 to .99 across eleven anatomically-defined subdivisions, including: corpus medullare, hemisphere lobules I-V, VI, crus I, crus II/ VIIB, VIII, IX, and X, vermis lobules I–V, VI–VII, and VIII–X. Tissue segmentation was performed in order to interrogate gray and white matter within each cerebellar label. Results: There were no significant group differences in age (p = 0.82) or sex distribution (p = 0.83). Children with ADHD had significantly reduced total cerebral volume (TCV; p = 0.008), with girls (p = 0.016, gp2 = 0.172) showing greater relative reduction than boys (p = 0.120, gp2 = 0.048). Controlling for TCV, the ADHD group showed significantly reduced volumes in posterior hemisphere—lobule IX [right— gray (p = 0.039), white (p = 0.007); left—white (p = 0.048)], again with girls (but not boys) showing significant reductions in right hemisphere—lobule IX (gray, white—both p \ 0.05). There were no significant group differences in other hemisphere or vermis regions. Within the ADHD group, right lobule IX volume was significantly associated with timed motor exam speed (r = -0.48; p = 0.035). Conclusions: Focal reductions are observed bilaterally in cerebellar lobule IX, among preschoolers with ADHD, with greater relative reduction observed in girls, suggesting earlier trajectory of anomalous development.

P-24-008 Comparative meta-analysis of functional and structural deficits in ADHD and OCD L. Norman*, C. Carlisi, S. Lukito, H. Hart, D. Mataix-Cols, J. Radua, K. Rubia * London, UK Objectives: Impaired inhibitory/cognitive control has been suggested to be a trans-diagnostic endophenotype of attention deficit hyperactivity disorder (ADHD) and obsessive compulsive disorder (OCD), which mediates deficits in restraining impulsive actions in ADHD, and difficulties in inhibiting obsessions and compulsions in OCD. However, it remains unclear whether these similar behavioural phenotypes are mediated by shared or distinct neural underpinnings. We used meta-analytic methods to elucidate disorder-specific structural and functional abnormalities across the two disorders. Methods: A voxel-wise meta-analytic comparison was performed of all whole-brain voxel-based morphometry (VBM) and functional magnetic resonance imaging (fMRI) studies of cognitive control in pediatric and adult ADHD and OCD patients using signed differential mapping (SDM), covarying for age and gender. Multimodal analyses highlighted overlapping functional and structural deficits within each patient group. Results: During fMRI studies of cognitive control, ADHD patients (N of 449) showed disorder-specific reduced activation relative to OCD patients in bilateral insula, basal ganglia, ventrolateral prefrontal cortex, and right premotor and supplementary motor cortices. OCD patients (N of 292) showed disorder-specific underactivation relative to ADHD in ventromedial and dorsomedial prefrontal cortex, dorsal anterior cingulate, caudate, left premotor cortex and cerebellum. In VBM, OCD patients (N of 729) showed disorderspecific grey matter volume decreases relative to ADHD in ventro and dorsomedial prefrontal and anterior cingulate cortices, as well as increases in basal ganglia grey matter, which was decreased in ADHD patients (N of 686) relative to healthy controls and OCD. Multi-modal analyses revealed overlapping functional-structural deficits in ventrolateral-prefronto-insular-striatal regions in ADHD and in dorsomedial-prefronto-cingulo-striatal regions in OCD. Conclusions: Findings show disorder-dissociated patterns of functional and structural abnormalities, with ventrolateral prefronto-

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insular-striatal regions being associated with ADHD and dorsomedial prefronto-cingulo-striatal regions with OCD. The findings suggest different underlying structural and functional brain abnormalities for dysfunctional inhibitory control in the two disorders.

Saturday, 30 May 2015, 16.00 h–17.30 h P-25 Non pharmacological treatment - Children and adolescence III P-25-001 The cognitive training with motivation for children with ADHD symptoms and low working memory K. Rzenca*, B. Mrozinski, G. Sedek, A. Orylska * Warsaw, Poland Objectives: This study evaluated the impact of two types of cognitive training (with motivation and without motivation) on working memory (WM) function in children with ADHD. Methods: In an initial screening of 190 6-year-olds and identified children with ADHD symptoms. The research included groups of children: control (healthy children) and experimental (children with ADHD symptoms). Each group includes children with low versus high working memory capacity (WMC). Each group were divided into two active (training) subgroups, one with motivation enhancement and one without it. Additionally a passive group was created. The training took 8 weeks, 5 times per week, 15 min each session. Cognitive skills (Raven’s Coloured Progressive Matrices, Antisaccades task, Memory Guided Saccades, Test of Working Memory Capabilities) were assessed before, after cognitive training. Results: There were not significant differences in training performance (children with ADHD symptoms) between cognitive training with and without motivation. In contrast, in control group—healthy children with low working memory, training performance was higher in subgroup without motivation (M = 0.71) than in subgroup with motivation (M = 0.66); F(1;57) = 4.60; p \ 0.04, eta2 = 0.08. Conclusions: Motivation elements used in the research do not improved training performance in children with ADHD symptoms. However, in healthy children with low working memory motivation elements were influenced like distractors. The results could serve as a basis for further studies. In cognitive studies, they could serve as a reference point to further studies into the role of motivation in cognitive training. In clinical studies, the effects of the experiment can serve an important role in combining computer cognitive training with another treatment.

P-25-003 Efficacy of a collaborative school-home intervention for Attention-Deficit/Hyperactivity Disorder L. Pfiffner*, M. Rooney, L. Haack, N. Kunin, M. Capriotti, A. Beaulieu, M. Plageman, K. Delucchi, K. McBurnett * San Francisco, USA Objectives: The purpose of this study was to evaluate the efficacy of a novel psychosocial intervention, the Collaborative Life Skills (CLS) program, for primary-school students with ADHD symptoms. CLS is a 12-week program consisting of integrated school (behavioral consultation with teachers), parent (parenting skills groups), and student (skills groups) treatments. The program was delivered in public schools by school-based mental health providers. Using a cluster

randomized design, we evaluated CLS compared to usual school/community services on psychopathology and functional outcomes. Methods: Schools within a large, urban public school district were randomly assigned to CLS (8 schools) or usual services (6 schools). Six students participated at each school, for a total of 84 students (mean age = 8.5 years, grade range = 2nd–5th, 71 % boys). PROC GENMOD (SAS 9.4) was used to estimate and test the difference between the means of CLS and usual services for each outcome measure at the post-treatment assessment point, controlling for baseline scores. To account for clustering effects by school, we used the Generalized Estimating Equation method. Results: Students from schools assigned to CLS (N = 48), relative to those assigned to usual services (N = 36), had significantly greater improvement on standardized parent and teacher ratings of ADHD symptom severity, organizational skills, social/interpersonal skills, and homework problems, and on blinded measures of classroom engagement (all ps \ .05; effect sizes in the medium to large range). Conclusions: These results support the efficacy of CLS relative to typical school and community practices for reducing ADHD symptoms and key areas of functional impairment. These findings show that evidence-based treatments can be successfully exported to school settings for delivery by school-based mental health providers. This model of intervention holds promise for increased access, efficient service delivery, and utilization of evidence-based services.

P-25-004 Stages of sensomotor correction in self-regulation development of children with ADHD E. Sedova*, T. Goryacheva * Moscow, Russia Objectives: Self-regulation underdevelopment is one of the characteristics of children with ADHD. Therefore special efforts for developing this sphere are crucial. This research was based on threelevel self-regulation model introduced by Nikolaeva (1991), including the level of self-regulation of psychic states, the operational and the motivational levels. The aim of the research was to influence on malfunction of the first level of self-regulation of children with ADHD. Methods: The experimental group consisted of 16 children from 6 to 8 years old with ADHD, having 1-h sessions twice a week during 2 years (first year—individual sessions; group sessions during the second year). The control group consisted of 18 children with ADHD of the same age not taking part in the intervention process. Before and after the intervention course the children have been tested with the Luria’s neuropsychological battery of tests, adapted by Semenovitch (2002). The intervention process included four stages. Each stage consisted of special exercises: breathing, locomotory, oculomotor etc. Some basic exercises were performed throughout the whole intervention period. Results: Comparison with the control group has shown that the sufficient positive changes of self-regulation level have taken place in the experimental group. Conclusions: The improving of school results more pronounced in experimental group also confirms that sensomotor correction is a powerful way of self-regulation development.

P-25-005 Developing a culturally appropriate parenting programme for Attention-Deficit/Hyperactivity Disorder in Japan S. Shimabukuro*, M. Thompson, C. Laver-Bradbury, D. Daley, G. Tripp * Onna-Son Okinawa, Japan

Objectives: To develop and pilot test a culturally appropriate, group administered, parenting programme for Japanese parents of schoolaged children with ADHD. Methods: Japanese mothers of a child with ADHD participated in a 6-week generic group parenting programme to evaluate their comfort with the group format, the parenting strategies offered and measures to assess child behavior, parenting practices, and parent emotional wellbeing. Based on participants’ feedback, the New Forest Parenting Programme (NFPP) was adapted for group administration in a Japanese context. This included translation and back translation of programme content together with modification of in session content to ensure consistency with Japanese cultural practices and beliefs. The most significant adaptation was the front loading of the programme with five self-care/coping education sessions to prepare mothers to share their concerns in a group, to modify their parenting practices and challenge myths about ADHD. Seventeen Japanese mothers with a school-aged child with ADHD completed measures of psychological functioning, parenting stress, parenting style and child’s ADHD symptoms before and after completing the 11-week programme and at 3-month followup. Repeated measure ANOVA was utilized for analysis. Results: Completion of the programme was accompanied by significant reductions in mothers’ child domain and total parenting stress scores immediately post-treatment. Participation in the programme also led to improved parenting practices and a reduction in ADHD symptoms. Mother’s over-reactivity declined significantly from preto post-treatment while laxness declined from pre-treatment to follow-up. Parent reported ADHD symptomatology declined from pretreatment to 3-month follow-up. All immediate treatment effects were maintained at the 3-month follow-up. Conclusions: The modified/enhanced NFPP is well tolerated by Japanese mothers. The front loaded psychological readiness sessions are important in preparing the mothers to utilize the NFPP strategies taught in the later sessions. Initial treatment results are very promising and a randomized waitlist control trial is currently underway.

P-25-006 Delivering behavioural parent training in different cultural settings and online: New forest parenting programme M. Thompson*, C. Laver-Bradbury, D. Daley, A.-M. Lange, G. Tripp, S. Shimabukuro, C. Thompson, E. Sonuga-Barke, A. Au * Southampton, UK Objectives: The NFPP was developed for the parents of preschool children with ADHD. To date four trials of NFPP have been carried out (Sonuga-Barke et al. 2001, 2004; Thompson et al. 2009; Abikoff et al. 2014). A RCT of an enhanced version for difficult to treat families is underway (McCann et al. 2014). A self-help version of the programme has been developed and evaluated (Daley and O’Brien 2013. Methods: We will identify how the constructs and principles of the New Forest Parenting Programme (NFPP) were refined to standardise the delivery of the different programmes including mode of delivery (individual, self-help, group, on-line). Results: We will present some of the challenges of presenting the material online, at a level that will be understood by staff who would normally deliver the programme in the community, while at the same time providing higher level knowledge as needed. We will discuss how the programme has been adapted for different cultures and populations and the issues that have arisen; and address the experiences of parents and practitioners with the programme and present recent results from trials or clinical evaluation of the different delivery modes. Conclusions: The successful implementation and dissemination of evidence-based, manualised parent training, requires careful attention to cultural and contextual concerns. Flexibility in delivery, coupled with rigorous attention to programme content, require further

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attention and research in order to ensure that children from a range of backgrounds and cultures can benefit from evidence based psychosocial treatments for ADHD.

P-25-007 Group cognitive-behavioural therapy for adolescents with Attention-Deficit/Hyperactivity Disorder: A randomized controlled trial R. Vidal*, J. Castells, V. Richarte, G. Palomar, M. Garcia, L. Lazaro, M. Casas, J. A. Ramos-Quiroga * Barcelona, Spain Objectives: To determine the efficacy of a group cognitive-behavioral therapy (CBT) on adolescents with ADHD who were in pharmacological treatment but still presented persistent symptoms. Methods: We conducted a multicenter, randomized rater-blinded controlled trial between April 2012 and May 2014 on a cohort of 119 adolescents (15–21 years). Patients were recruited from two ADHD Units in university hospitals. Participants were randomly assigned to 12 manualized group CBT sessions (n = 45) (Vidal R, Casas M, Ramos-Quiroga JA, 2014) or a waiting list control group (n = 44). Primary outcomes were assessed by a blind evaluator (ADHD Rating Scale, Clinical Global Impression Scale for Severity, Global Assessment Functioning) before and after treatment as well as by selfreport and parent informant ratings. Results: Of the initial 119 participants enrolled, 89 completed treatment. A mixed effect model analysis revealed that participants who were assigned to the group CBT sessions experienced significantly reduced ADHD symptoms compared to the control group [ADHD-RS Adolescent: -7.46; (95 % confidence interval, -9.56 to -5.36); p \ 0.001; d = 7.5 and ADHD-RS Parents: -9.11 (95 % CI -11.48 to -6.75); p \ 0.001; d = 8.38], CGI-S [CGI-Self-Report: -0.68; (95 % CI -0.98 to -0.39); p \ 0.001; d = 3.75] and CGI-S Clinician [-0.79 (95 % CI -0.95 to -0.62); p \ 0.001; d = 7.71]. Functional impairment decreased significantly in the CBT group according to parents [Weiss Functional Impairment Scale -4.02 (95 % CI -7.76 to -0.29); p \ 0.05; d = 2.29] and according to the blinded evaluator [GAF: -7.58 (95 % CI -9.1 to -6.05); p \ 0.001; d = 7.51]. Conclusions: Group CBT associated with pharmacological treatment is an efficacious intervention for reducing ADHD symptoms and functional impairment in adolescents.

P-25-008 Efficacy of an integrated behavioural therapy for children with Attention-Deficit/Hyperactivity Disorder: A randomized controlled trial L. Yang*, L. Shuai, M. Chen, Y. Qian, Y. Wang * Beijing, People’s Republic of China Objectives: To evaluate the effect of an integrated behavioral therapeutic program for ADHD children. Methods: The integrated behavioral therapeutic program was designed on the basis of Dawson and Guare’s (2010) executive skill training program, integrated with behavior modification and social skill training. Forty patients were randomized to the intervention group (IG) and the control group (CG). The intervention group received 12 weeks of group training, once a week, targeting time

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management, working memory, organization, planning, and behavior inhibition, etc. The control group waited for 12 weeks. ADHD-Rating Scale, and Behavior Rating Inventory of Executive Function (BRIEF) were used to assess the effect of training. Results: After training, the BRIEF working memory factor of the IG decreased significantly (before training: 22.29 ± 2.65; after training: 19.75 ± 3.23, P = 0.002), whereas the CG did not change. The difference between the IG and the CG was significant on the working memory (2.54 ± 3.66 vs. -1.00 ± 3.48, P = 0.002), meta-cognitive index (6.59 ± 14.84, P = 0.010), and the total score (10.73 ± 26.76 vs. -9.24 ± 19.95, P = 0.014). The scores of the ADHD-rating scale and the inattention subscale of the IG dropped significantly (P \ 0.05), while the hyperactive-impulsive score of the CG increased significantly (P \ 0.01). The changes in the total scores between IG and CG were significant (IG 3.29 ± 7.10, CG -3.50 ± 5.32, P = 0.045). Conclusions: The integrated behavioral therapy for ADHD children might be effective on the executive function and core symptoms of ADHD.

Saturday, 30 May 2015, 16.00 h–17.30 h P-26 Non pharmacological treatment - Adults P-26-002 Psychoeducational groups for adults with ADHD and their significant others (PEGASUS): An open clinical feasibility trial T. Hirvikoski*, E. Waaler, T. Lindstro¨m, S. Bo¨lte, J. Jokinen * Stockholm, Sweden Objectives: There is a great need of interventions that systematically involve significant others of adults with ADHD. The aim of this study was to investigate the feasibility and effectiveness of a new psychoeducative intervention program (PEGASUS) for adults with ADHD and their significant others in a psychiatric outpatient context. Methods: At three outpatient psychiatric clinics, adults with ADHD and their significant others took part in PEGASUS, a psychoeducational program based on theories from cognitive behavioral therapy, neuropsychology, and cross-disciplinary evidence regarding ADHD. In total, 108 adults were allocated to treatment (51 with ADHD and their 57 significant others). Feasibility was evaluated regarding suitability of the intervention at a psychiatric outpatient clinic and treatment completion. Preliminary efficacy was evaluated per protocol from baseline to post-intervention (n = 41 adults with ADHD and 40 significant others). Results: In a feasibility analysis, the intervention was judged to be a suitable treatment option for 94.5 % of all individuals with a primary diagnosis of ADHD at an outpatient psychiatric clinic. In total, 43 out of 51 allocated individuals with ADHD (84.3 %) completed the intervention. The corresponding figures for their significant others were 42 out of 57 (73.7 %). Knowledge about ADHD increased, and both the quality of relationships and psychological well-being improved from baseline to post-intervention, as analyzed for all participants as a group. The significant others reported a reduction in the subjective burden of care, such as worry and guilt. The objective burden of care (such as financial problems) did not change. Conclusions: The findings support the potential value of psychoeducation for adults with ADHD and their significant others. An ongoing randomized controlled trial will generate further evidence concerning the PEGASUS program.

P-26-003 Structured skills training for adults with ADHD in an outpatient psychiatric context: An open feasibility trial T. Hirvikoski*, J. Alfredsson, E. Morgensterns

Conclusions: The sample sizes are very small, so the statistical tests may provide different results with larger numbers of participants. There was increased knowledge on ADHD and relationship quality in both individuals with ADHD and their significant others.

* Stockholm, Sweden Objectives: The aim of the current study was to evaluate the feasibility, acceptability, and effectiveness of Dialectical Behavioral Therapy (DBT)-based skills training groups for adults with ADHD in an outpatient psychiatric context. Furthermore, the purpose was to analyze the impact of clinical characteristics on the effect and completion of treatment. Methods: Ninety-eight adults (out of 102) with ADHD on stable pharmacological treatment or no medication were allocated to the treatment. Self-rating scales were administered as baseline before the first session (T1), post-treatment (T2), and at 3 months follow-up (T3). Data were analyzed using repeated measures ANOVA. Results: Approximately 80 % (74 individuals) attended at least twothirds of the sessions. All five items of the patient evaluation form were rated above 3 (out of max 4), indicating good treatment satisfaction. None of the predictors, i.e., age, comorbidity, ADHD medication status, IQ-level, treatment credibility, or functional impairment at the beginning of treatment, significantly predicted treatment outcome (change in ADHD symptoms from T1 to T2). Likewise, none of the predictors irritability/aggression, comorbidity, and functional impairment were significantly associated with attrition. Conclusions: Due to the difficulties in predicting treatment outcome, as well as attrition, based on clinical characteristics, broad inclusion criteria may be applied in an outpatient psychiatric context.

P-26-004 Edinburgh pilot study of a psychoeducation programme for adults with Attention-Deficit/Hyperactivity Disorder R. Jones* * North Berwick, UK Objectives: The objective was to design and deliver a series of workshops, to provide: (1) Better understanding of the condition (2) Ability to understand risk factors for ADHD in adults (3) Indicators for areas of study for potential future research on psychosocial education. Methods: The Add-Impact programme consisted of 6 workshops for adults with ADHD and their significant others. 36 participants were involved in the project, 18 were male, 18 were female. The mean age for the whole sample was 39.56 years (standard deviation (SD) = 11.56), with the youngest participant being 18, and the oldest 58 years of age. 26 diagnosed with ADHD and 10 without a diagnosis. Results: Participants completed the self reporting evaluations which were carried out prior to commencement of the programme, at the conclusion and 3 months following the last workshop. Evaluation tools used: ASRS-V1.1, WEMWBS, CORE-OM and a Silver Lining Questionnaire (SLQ). WEMWBS There was a significant difference between wellbeing scores at time point one (M = 43.36, SD = 7.87) and time point three (M = 54.43, SD = 9.44) remains: t (13) = -4.46, p \ .01. CORE-OM. The mean score was 13.39 (SD = 6.91) at time point two, and was 10.98 (SD = 7.01) at time point three. This difference is significant: t (18) = 3.64, p \ .01. The mean SLQ score at time point two was 21.33 (SD = 11.17) and at time point three was 21.83 (SD = 9.50). The difference is not significant: t (5) = -.01, p [ .05.

P-26-005 Dialectical behaviourally inspired psychotherapy for adults ADHD: Preliminary results N. Perroud*, P. Prada, J. Zimmermann, J.-M. Aubry, R. Nicastro * Geneva, Switzerland Objectives: Although stimulants have been shown to be effective in adults ADHD, several patients will be poor responders or not want to take medication. Non-pharmacological interventions such as cognitive-behavioral therapy (CBT) or dialectical behavior therapy (DBT) have been shown to be efficient in adults ADHD and are ideally suited for these patients. We here investigated the effectiveness of a DBT approach for adults ADHD. Methods: 33 adults suffering from ADHD were recruited in a specialized center for the treatment and care of these subjects. Subjects were selected if they had remaining ADHD symptoms despite proper psychopharmacological treatment. Other psychopharmacological treatments were adjusted depending on the comorbidities. Patients beneficiated weekly individual psychotherapy and weekly group sessions. We added to the four traditional DBT modules (Mindfulness, Emotion Regulation, Interpersonal Effectiveness and Distress Tolerance) two additional ones (Impulsivity/Hyperactivity and Attention) for a 12 months duration. Adherence to treatment for the therapists was ensured by weekly consultation groups. Each subject was assessed at baseline, months 3 and 6 and at the end of treatment for ADHD severity, level of impairment related to ADHD symptoms, depression severity, hopelessness, mindfulness skills, anger expression and control, and impulsivity. Mixed linear models were used to assess the response to treatment. Results: 6 subjects dropped-out during the follow-up. There was a significant decrease in ADHD symptoms and impairments (b = -0.13; p = 0.01 and b = -0.19; p = 0.005), in depression severity (b = -0.23; p \ 0.0001), in disposition toward anger (b = -0.11; p = 0.02) and motor impulsivity (b = -0.10; p = 0.03) and an increase in the mindfulness skill Accepting without Judgment (b = 0.12; p = 0.02) and in anger control (b = 0.13; p = 0.01). Conclusions: Although of small effect sizes, our study showed that a targeted psychotherapeutic approach might help decreasing core symptoms of ADHD in adults suffering from this disorder and having poor response to psychopharmacological treatment.

P-26-006 CBT for adult ADHD and implementation strategies: An open pilot study R. Ramsay*, A. Rostain * Philadelphia, USA Objectives: Pilot study of cognitive behavioral therapy (CBT) for adult ADHD emphasizing implementation strategies targeting functioning difficulties. Methods: Subjects were recruited from adult patients diagnosed with ADHD who were receiving CBT in a specialty adult ADHD clinic. Of a sample of 29 individuals who consented as part of a larger IRB approved study, 8 subjects (6 M, 2F) who completed both follow up measures [Brown Attention Deficit Disorders Scale (Brown 1996); Conners Adult ADHD Rating Scale (Conners et al. 1999)] were

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included in the analyses, as were measures of mood and anxiety. Individual CBT was administered following an existing published protocol, with an emphasis on implementation strategies to address the executive functioning and motivational deficits characteristic of adult ADHD (Ramsay and Rostain 2008, 2015). Pre-treatment and follow-up scores were analyzed using paired sample t-tests to assess the degree of change on each dependent measure during treatment. In light of the small sample size, two-tail tests were performed to set a more stringent threshold for statistical significance. Results: Although there are significant limitations in this pilot study, there were statistically significant improvements in several domains of the BADDS (activation, attention, effort, affect, total) and of the CAARS (hyperactivity/restlessness, DSM-inattentive, DSM-symptoms total). In particular, the positive results for measures of getting started on and following through on endeavors as well as managing emotions is supportive of the implementation focus of CBT. Conclusions: There is wide ranging empirical support for CBT for adult ADHD. While past studies have documented symptom improvements, CBT actually intervenes at the level of impairments. More specifically, these impairments often result from the selfregulation difficulties that define ADHD, namely, difficulties following through on or implementing various plans and intentions. Thus, the ongoing evolution of CBT for adult ADHD should include a focus on implementation strategies that target domains of functioning.

P-26-007 CBT for adult ADHD: An open pilot study of effects on functional status R. Ramsay*, A. Rostain * Philadelphia, USA Objectives: Pilot study of the impact of cognitive behavioral therapy (CBT) for adult ADHD on measures of functioning and well-being. Methods: Subjects were recruited from adult patients diagnosed with ADHD who were receiving CBT in a specialty adult ADHD clinic. Of a sample of 29 individuals who consented as part of a larger IRB approved study, 12 subjects (7 M, 5F) who completed at least one follow up measure were included in the analyses. Functional status measures administered pre-treatment and at follow up were: Adult ADHD Quality of Life Scale 29 (Brod et al. 2006) and the Weiss Functional Impairment Rating Scale (Weiss 2010) Individual CBT was administered following an existing published protocol (Ramsay and Rostain 2008, 2015) Pre-treatment and follow-up scores were analyzed using paired sample t-tests to assess the degree of change on each dependent measure during treatment. In light of the small sample size two-tail tests were performed to set a more stringent threshold for statistical significance. The use of two different outcomes scales resulted from a change in the standard clinical scales used by the clinic that occurred during the course of the study. Thus, analyses were performed on data for 12 participants who completed a total of 15 measures, 10 AAQoL’s and 5 WFIRS. Results: Although there are significant limitations in this pilot study, there were statistically significant improvements in several domains of quality of life (life productivity, psychological health, life outlook) and in areas of life impairment (home, self-concept) as well as in total scores on both subject-rated measures associated with CBT. Conclusions: Past studies of CBT for adult ADHD have documented symptom improvements. However, CBT actually intervenes at the level of impairments, thus future studies should target functional status as a more accurate measure of treatment effectiveness.

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P-26-008 The effects of a self-alert training (SAT) programme in adults with ADHD S. Salomone*, G. R. Fleming, J. M. Shanahan, M. Castorina, J. Bramham, R. G. O’Connell, I. H. Robertson * London, UK Objectives: Attention-Deficit/Hyperactivity Disorder (ADHD), a neuropsychiatric condition characterised by attention and impulsivity problems, is one of the most common behavioral disorders. The first line of treatment for ADHD is psychostimulant medication, but this has limited effectiveness, particularly in adults, and is often associated with adverse side-effects. Thus, it is imperative that new nonpharmaceutical approaches to treatment are developed. This study aims to evaluate the impact of a non-pharmacological Self-Alert Training (SAT) intervention on ADHD symptom prevalence, psychological and cognitive functioning, and on everyday functional impairment in adults with ADHD. Methods: Fifty-one adult participants with a current diagnosis of ADHD were randomized to either SAT or a Control Training (CT) programme. They were assessed at baseline, immediately following the 5-week training period, and after 3 months using ADHD symptoms scales, as well as a series of neuropsychological tests and psychological questionnaires. Subjective ratings of everyday life attention and memory problems were also collected. Results: The SAT group showed significant improvements in ADHD inattentive and impulsive symptoms, depressive symptoms and in self-efficacy ratings compared to the CT group at both post-training and at the 3-month assessment. Pre-post improvements in SAT participants on untrained cognitive tasks measuring selective attention and executive functions were also observed. Finally, the SAT group reported improved subjective ratings of everyday life attention at both assessment points. Conclusions: This pattern of results suggests that SAT may be beneficial in treating ADHD symptoms as well as psychological and cognitive impairments in adult ADHD. A large-scale randomized controlled trial is needed.

P-26-010 Cognitive behavioral therapy for adults with AttentionDeficit/Hyperactivity Disorder: Protocol of a randomized controlled trial F. Huang*, Q.-J. Qian, Y.-F. Wang * Beijing, People’s Republic of China Objectives: Attention deficit hyperactivity disorder (ADHD) begins in childhood and its adverse outcomes including comorbidities as anxiety and depression, increasing risk of substance abuse, and social function impairments as academic and occupational failures last for adult patients. The recommended treatment of adult ADHD is the combination of medication and psychotherapy, and cognitive behavioral therapy (CBT) is validated as evidence-based psychotherapy. However, there is a lack of efficacy evidence from randomized controlled trials for Chinese population. Moreover, booster sessions of CBT were proved effective in reducing the recurrence rate and benefiting long-term outcomes for depression, bipolar disorder, panic disorder, etc., which was not investigated for adult ADHD. This study will explore the effect of CBT and its booster sessions on adult ADHD.

Methods: It is a three-armed randomized controlled trial. Subjects are outpatients of Peking University Sixth Hospital who fulfill the diagnosis of adult ADHD. The 12 weeks CBT is conducted basing on the published and validated manual, and booster sessions are summarized from it. The Primary efficacy endpoints are the scores of ADHD core symptoms. Secondary endpoints include emotion, executive function, self-esteem, life quality and fMRI data at different time points, and the change within every group will also be analyzed. Conclusions: This is the first study to explore the efficacy of booster sessions of CBT in adult ADHD as far as we know. The results might increase the level of evidence of the CBT for adult ADHD in China, and the efficacy results of booster sessions would also benefit clinical practice.

P-26-011 NIRS-neurofeedback as a treatment method in adult Attention-Deficit/Hyperactivity Disorder B. Barth*, A.-C. Ehlis, K. Mayer, F. Ha¨ußinger, A. Fallgatter, U. Strehl * Tu¨bingen, Germany Objectives: The present study is part of a larger project designed to compare the efficacy of specific biofeedback protocols in adult ADHD patients. One issue is to evaluate changes in primary symptoms as well as cognitive and neurophysiological variables after a trial of near-infrared spectroscopy (NIRS) neurofeedback. On a functional level, the commonly found hypoactivation of the prefrontal cortex (PFC) has been assumed to underlie many of the deficits observed in ADHD. By means of neurofeedback, patients can learn to regulate prefrontal brain activity to induce a state of cortical activity which is associated with a better distribution of attentional resources. Methods: In NIRS-neurofeedback, up-regulation is operationalized as an increase in the concentration of oxygenated hemoglobin (O2Hb) in left and right lateral prefrontal areas. During the deactivation period, subjects should achieve a decrease in O2Hb concentration within the same target region. To generalize acquired regulation skills, 25 % of all trials serve as ‘‘transfer trials’’ in which no visual feedback is presented during the active training phase. Among other things we examine the ability of adult ADHD patients to learn cortical selfregulation within 30 sessions NIRS-neurofeedback (currently N = 12 out of 20). Results: We analyzed amplitudes in activation and deactivation trials in transfer and feedback conditions in the course of 30 NIRS training sessions. More activation in prefrontal regions could be observed in the activation trials and more deactivation could be observed in the deactivation trials. Furthermore, an ANOVA with repeated measures revealed significant improvement in core symptoms, assessed with a self-rating scale (p \ .01). Conclusions: These promising behavioural and neurophysiological outcomes are indicative that NIRS-neurofeedback offers an opportunity for alternative treatment in adult ADHD. Apart from this, NIRS could be a future neurofeedback method as it is supposed to be easier to learn and might require less training sessions compared to EEGneurofeedback.

Saturday, 30 May 2015, 16.00 h–17.30 h P-27 Pharmacological treatment - Children and adolescence III P-27-001 Predictors of relapse or maintenance of response of Attention-Deficit/Hyperactivity Disorder symptoms after discontinuation of long-term treatment with atomoxetine J. Thome*, R. Escobar, S. Lipsius, H. Upadhyaya * Rostock, Germany Objectives: To identify factors that may predict relapse or maintenance of response (MOR) after discontinuation of long-term atomoxetine treatment. Methods: Data from 2 multicenter, randomized, double-blind, placebo-controlled, phase 3 relapse prevention studies in patients with attention-deficit/hyperactivity disorder (ADHD) were analyzed. In each study, child/adolescent (study LYAF, N = 416) or adult (study LYDO, N = 524) patients who responded to 1 year (LYAF) and 24 weeks (12-week, open-label and 12-week, double-blind [LYDO]) of atomoxetine treatment (0.5–1.8 mg/kg/day [LYAF]; 40–100 mg/day [LYDO]) were (re)randomized to continued atomoxetine therapy or placebo for 6 months. In this posthoc exploration, relapse was defined as having at least a 50 % worsening of the symptom improvement the patient had prior to atomoxetine therapy (based on a predefined, age appropriate scale for each study) and increasing at least two levels of severity based on a CGI-S at 2 consecutive visits. MOR was defined as retaining at least a 75 % improvement and CGI-S B2 at all post- re-randomization visits (LYAF) or retaining a C70 % improvement from baseline ADHD symptoms and CGI-S B3 at all post-randomization visits, except for up to 2 excursions (LYDO). Cox proportional hazards models assessed the effect of covariates on time to relapse (LYAF). Logistic regression assessed the effect of covariates on MOR (LYDO). Results: Treatment group differences in relapse (LYAF) and response (LYDO) rates were examined for gender, age, origin, ADHD subtype, CYP2D6 metabolism status (LYDO only), previous stimulant exposure (LYAF), geographic region/country (LYDO only), and prior atomoxetine use (LYDO only) subgroups. There were no statistically significant interactions between treatment and any of the factors analyzed in the studies. Conclusions: No predictors of relapse or MOR were identified. Further analyses are needed to identify other potential predictors of relapse or MOR in pediatric and adult patients with ADHD.

P-27-002 Stroop interference in patients with Attention-Deficit/ Hyperactivity Disorder M. Vallejo*, P. deCastro-Manglano, A. Diez-Sua´rez, A. Figueroa-Quintana, J. J. Marı´n-Me´ndez, C. Soutullo-Espero´n * Pamplona, Spain

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Objectives: The Stroop test assesses in particular the ability to control interference from alternative response tendencies that compete with the one that is adequate given the context. Our aim is to assess the predictive value of Stroop task items for good response with Metilphenidate (MPH). Methods: This is a naturalistic follow-up study of ADHD patients between 7 and 18 years. Patients with IQ \80 and neurological pathology were excluded. All patients were diagnosed through a clinical interview, and the ADHD-Rating Scales and WISC-IV, Stroop Task and CPT were assessed individually. Clinical response to MPH was evaluated as a 30 % reduction in the ADHD rating scale and [2 points in the CGI-scores. Results: 518 patients with ADHD were collected (mean age 11.5 ± 3.6 years old, 79.6 % males) Only 69.9 % had ADHD with other comorbidities. Mean Baseline CGI-S score was 3.85 ± 0.77. Baseline ADHD-rs was 29.94 ± 10.38. Of the patients treated with methylphenidate (MPH), 73.8 % of patients had full remission of symptoms, with a mean dose of 1.2 mg/kg/day. Regarding the Stroop, there were no differences in the Interference score between the responders and no responders (t = 1.77, p = 0.077). A positive correlation between Interference scores and Working Memory and Manipulative IQ was found (OR 0.258, p = 0.001) (OR 0.289, p = 0.000) respectively. Related to the CPT, we found a positive correlation between The Stroop Interference and: Omission Errors (OR -0.174, p = 0.001), Commission Errors (OR -0.173, p = 0.001), variability (OR -0.118, p = 0.030), perseverative commissions (OR -0.133, p = 0.015) Hit RT Std Error (OR 0.118, p = 0.031). Conclusions: Stroop interference is not useful as a predictive variable in treatment response to Metilphenidate. However, it is highly associated with other CPT variables related to inhibitory control and it shows impairment in attentional task in patients with ADHD.

P-27-003 The effect of GXR (guanfacine) as adjunctive treatment with stimulant therapy on executive function and quality of life: A phase IV, single center, randomized, double blind, placebo controlled, crossover evaluation J. van Stralen*, E. Corsi * Ottawa, Canada Objectives: GXR, a selective a2A-adrenergic agonist, is a non-stimulant treatment for ADHD approved in Canada for children aged 6–12 for monotherapy and adjunctive therapy. Although stimulant medications have been shown to have a positive impact on executive function (EF), little has been documented about the effect of GXR on EF, especially as adjunctive therapy in children. The purpose of this study was to evaluate the effect and safety of GXR as adjunct therapy to stimulants in improving EF and quality of life (QoL), and the congruency of this effect from child, parent and teacher perspectives in children aged 6–12 years with a primary diagnosis of ADHD. Methods: Patients (6–12 years), who were treated with a stable stimulant regimen and present with sub-optimal EF (GEC—Global Executive Composite score on BRIEF-P questionnaire t-score [65) were randomly assigned at baseline to receive active treatment or placebo first; as this was a crossover design, each subject received active and placebo treatment with each arm lasting 15 weeks. The primary efficacy measure was the improvement in EF as measured using the GEC on the BRIEF-Parent questionnaire. Key secondary outcome measures include EF as measured by the GEC on the BRIEF-Teacher questionnaire, the congruence between parent and teacher EF ratings, change in QoL completed by the subject and parent and ADHD-RS. Safety assessments included, treatment-emergent adverse events (TEAEs) and vital signs.

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Results: Of the 50 patients randomized, 39 completed both arms of the crossover study (78 %). The mean age was 9.2 years with 84 % of subjects being male. 16 % discontinued due to an adverse event. There were no serious adverse events. Results of the primary and key secondary outcome measures will be presented. Conclusions: GXR was well tolerated adjunctive treatment for ADHD. Effect of adjunctive therapy GXR on EF will be reported.

P-27-004 Clinical response and symptomatic remission in adolescents with Attention-Deficit/Hyperactivity Disorder receiving guanfacine extended release in a phase 3 study T. E. Wilens*, L. Harper, J. L. Young, V. Sikirica, G. Rynkowski, B. Dirks, A. Cutler * UK Objectives: To assess treatment responses to guanfacine extended release (GXR) in adolescents with attention-deficit/hyperactivity disorder (ADHD) in a phase 3, double-blind study (SPD503-312). Methods: Patients (aged 13–17 years) were randomized 1:1 to oncedaily GXR (up to 7 mg/day) or placebo for a 7-week, dose-optimization period followed by a 6-week dose-maintenance phase. At baseline, eligible patients had an ADHD Rating Scale IV (ADHD-RSIV) total score C32 and a Clinical Global Impressions-Severity (CGIS) score C4. This study presents pre-specified, secondary efficacy analyses of clinical response (defined as a C30 % decrease in ADHDRS-IV total score and a CGI-Improvement [CGI-I] score of 1 or 2 relative to baseline) and symptomatic remission (defined as an ADHD-RS-IV total score B18 at endpoint). Endpoint was defined as the last post-baseline, on-treatment and before first dose taper medication assessment. Results: Of 314 patients randomized, 312 were included in the full analysis set and 227 reached week 13 (GXR, 117; placebo, 110). GXR was associated with significantly higher proportions of clinical responders than placebo throughout weeks 3–13 (p B 0.0023). At endpoint, a clinical response was observed in 66.9 % (95 % confidence interval [CI]: 59.5, 74.3) of patients receiving GXR and 45.8 % (38.0, 53.7) of those receiving placebo. Symptomatic remission criteria were met by significantly greater proportions of patients in the GXR group than the placebo group throughout weeks 5–13 (p B 0.045). At endpoint, symptomatic remission criteria were met by 61.7 % (95 % CI 54.0, 69.4) of GXR-treated patients and 41.3 % (33.5, 49.0) of those receiving placebo. Most treatment-emergent adverse events (TEAEs) were mild or moderate and no new safety signals were reported. Conclusions: Statistically significantly greater proportions of adolescents receiving GXR than placebo met clinical response and symptomatic remission criteria in this 13-week, double-blind study. Study funded by Shire Development LLC.

P-27-005 Safety outcomes from a phase 4, open-label, multicentre, 2-year study of lisdexamfetamine dimesylate in children and adolescents with Attention-Deficit/Hyperactivity Disorder A. Zuddas*, T. Banaschewski, P. Nagy, C. Soutullo, B. Yan, B. Caballero, D. R. Coghill * Cagliari, Italy Objectives: To evaluate safety outcomes from a long-term, openlabel study of lisdexamfetamine dimesylate (LDX) in children and adolescents with attention-deficit/hyperactivity disorder (ADHD).

Methods: Study SPD489-404 enrolled participants (aged 6–17 years) meeting Diagnostic and Statistical Manual of Mental Disorders criteria for a primary diagnosis of ADHD. Eligible participants had a baseline ADHD Rating Scale IV total score C28. Participants were to receive open-label treatment with LDX (30, 50 or 70 mg/day) for 104 weeks (4 weeks dose-optimization; 100 weeks dose-maintenance). Safety evaluations included assessments of treatmentemergent adverse events (TEAEs) and vital signs. Results: All of the 314 participants enrolled were included in the safety population and 191 (60.8 %) completed the study. TEAEs occurred in 282 (89.8 %) participants; most were mild or moderate in severity. TEAEs leading to study discontinuation occurred in 39 (12.4 %) participants and serious TEAEs in 28 (8.9 %) participants. No deaths were reported. The TEAEs reported in C10 % of participants were: decreased appetite (54.1 %), nasopharyngitis (23.2 %), headache (21.7 %), weight decreased (20.1 %), insomnia (19.1 %), initial insomnia (12.1 %), irritability (11.5 %) and pyrexia (10.2 %). At the last on-treatment assessment, the mean (SD) increase from baseline was 3.4 (10.33) mm Hg for systolic blood pressure, 3.2 (9.05) mm Hg for diastolic blood pressure, and 7.0 (11.60) bpm for pulse rate. Conclusions: The long-term safety profile of LDX in participants with ADHD was similar to that reported in short term studies. Mean changes in blood pressure were also as expected, while the increase in pulse rate from baseline to endpoint was slightly higher than in previous LDX studies. Study funded by Shire Development LLC.

Saturday, 30 May 2015, 16.00 h–17.30 h P-28 Quality of life/Caregiver burden III P-28-002 Mental health of parents of children with AttentionDeficit/Hyperactivity Disorder in comparison with parents of children with other developmental disabilities T. Takamura* * Tokyo, Japan Objectives: The recognition and support to stressful parenting of children with developmental disabilities is still insufficient in Japan. This study assessed mental health of parents of children with developmental disabilities and compared the features of parents of children with Attention-Deficit/Hyperactivity Disorder (ADHD) to those of parents of children with other developmental disabilities. Methods: Participants in this investigation were members of parents associations of developmental disabilities in various regions of Japan. A total of 133 mothers and 99 fathers completed the questionnaire. The measures for mental health were self-entry questionnaires including WHO- Subjective Well-Being Inventory (SUBI) and the questionnaire on parenting fulfilment and burden consisting of eight items. Results: The result indicated that mothers of children with ADHD significantly scored higher in Negative Affect in SUBI and burdened feeling in the parenting questionnaire than mothers of children with Autism Spectrum Disorders (ASD), Learning Disabilities (LD) (F(2,131) = 10.470, p \ .001, F(2,131) = 4.155, p \ .05). The result indicated no difference in fathers by categories. Also, the group of mothers indicated higher Negative Affect and negative feeling of in parenting (t = 2.472, p \ .05, t = 10.802, p \ .001). Conclusions: It was demonstrated that mothers of children with ADHD experienced more negative feeling in parenting and tended to have insecure well-being. The relationships among mental affects are discussed.

P-28-003 Factors associated to a positive occupational outcome during long-term central stimulant treatment in adult ADHD T. Torgersen*, A. E. Vaaler, S. Krokstad * Trondheim, Norway Objectives: There is a lack of long-term studies of central stimulant (CS) treatment in adult attention-deficit/hyperactivity disorder (ADHD), and studies on functional outcomes like occupational status are rare. The current study investigated occupational status in adult ADHD patients before and after long-term CS treatment (median duration of treatment 33 months) and aimed to identify variables associated with improvement in occupational status. Methods: The collection of data was based on a naturalistic, retrospective approach using the medical records of a sample of all 117 adult ADHD patients consecutively starting treatment with CS in a specific catchment area in Norway in the period 1997 to May 2005. The date of follow-up was December 31, 2008, 43 months after inclusion of the last patients. Results: Most patients did not improve in occupational status during long-term CS treatment. The improved group had significantly higher baseline ADHD symptoms as measured by the general adult ADD symptom checklist (83.7 vs. 76.2, p = 0.024) and had a significantly shorter period from the first contact with adult psychiatry until they got the ADHD diagnosis (11.7 vs. 50.9 months, p = 0.001). Conclusions: The results indicate that long-term CS treatment itself may have limited effect on occupational status in functionally impaired and highly comorbid patients with adult ADHD. This finding underscores the importance of developing additional and more comprehensive treatment methods for the functional impairments related to adult ADHD. However, high baseline ADHD symptom level may be related to a superior outcome in occupational status.

P-28-004 Social-Emotional correlates of ADHD symptomatology in college students T. Mckee*, J. DeVinney, C. Hobgood * Clinton, USA Objectives: Research investigating the relationship between ADHD symptomatology and college students’ social-emotional adjustment over time is sparse. The goal of the present study was to identify whether inattention, hyperactivity/impulsivity, or their combination predicted social-emotional functioning in college students and if those relationships changed over 4 years of college. Methods: College students (N = 613; 382 women, 231 men) completed measures upon entry and at the end of their senior year. ADHD symptomatology was assessed via an 18-item measure based on DSM-IV criteria. Students completed the Cooperative Institutional Research Program (CIRP) Freshman Survey and the College Senior Survey, a follow-up questionnaire that posttests a range of items from the CIRP Freshman Survey. A subset of these students (n = 142) completed scales from the Behavior Assessment System for ChildrenCollege Self Report measuring social stress, anger control problems, sensation seeking, mania, and alcohol abuse in their first and senior years. Statistical analyses included correlations, regressions, and partial correlations. Results: Greater inattention was associated with a wide range of negative outcomes including poorer social self-confidence and emotional health, greater anger control problems, and more cigarette and

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alcohol use (ps \ .01). Greater hyperactivity/impulsivity was associated with more anger control problems, mania, and sensation seeking (ps \ .01). Poorer sense of belonging, lower social selfconfidence, and greater anger control problems were found to partially mediate the relationship between inattention and emotional health (all Sobel tests were significant at p \ .05). We also found that greater anger control problems and mania were associated with all ADHD symptoms getting worse over time than predicted (ps \ .05). Conclusions: Identifying students with a high degree of inattention and providing them with additional support to improve their social functioning and manage their anger may result in more general improvements in emotional health and college adjustment. Future research should explore the mechanisms that contribute to inattention correlating with negative social-emotional outcomes.

P-28-005 Clinical characteristics of adults with ADHD or ASD admitted to emergency psychiatric wards in Japan T. Morita*, A. Iwanami, H. Yamada, D. Ikuse, T. Tokumasu, N. Saga, G. Arai * Tokyo Setagayaku, Japan Objectives: Emergency psychiatric wards focus on the treatment for patients with mental disorders in the acute phase. Showa University Karasuyama Hospital is a mental hospital with two emergency psychiatric wards. This hospital has a department of the outpatient clinic for adults with neurodevelopmental disorders, such as ADHD or ASD. Individuals with neurodevelopmental disorders often have comorbid mental disorders and show problematic behaviors. Therefore, short-term hospitalization is sometimes required. There is a growing need for professional treatment of neurodevelopment disorders, but there are only a few reports concerning the treatment in emergency wards. The purpose of this study is to clarify clinical characteristics and treatment outcome of adults with neurodevelopmental disorders admitted to the emergency psychiatric wards at Showa University Karasuyama Hospital. Methods: We investigated the sociodemographic data, diagnosis, medication status, and the clinical outcome of the patients with neurodevelopmental disorders who admitted to the emergency psychiatric wards between 1 of January, 2010 and 31 of December, 2012. The information about the subjects was gathered retrospectively from the medical records. Results: A total of 38 patients with neurodevelopment disorders (mean age, 25.7 years, SD, 8.7, 32 males and 6 females) were admitted to the emergency psychiatric wards, including 35 patients with ASD (mean age 25.7 years, male: female = 6:1), three patients with ADHD (mean age 29.6 years, male: female = 2:1). At admission, 16 patients had psychomotor excitation, 17 had depression, 3 had hallucinatory delusional states, and 1 had a dangerous problematic behavior. Twenty-seven patients took antipsychotic medication and the mean daily dosage of chlorpromazine equivalent was 229 mg (SD 240). The mean duration of hospitalization in the acute wards was 48.7 days and 78.9 % patients returned home. Conclusions: The results of the present study indicated that emergency hospitalization is available for the treatment of some of the adult patients with neurodevelopmental disorders.

P-28-006 Integrated ADHD clinical care pathways (ICP) can contribute to reduced patient journeys and enhance quality of care: Benefits of an ADHD ICP in a Hertfordshire child development centre (CDC) I. Takon*, S. Ozer

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* Stevenage, UK Objectives: Audits and parental surveys in 2010 identified service gaps and highlighted the need for an ADHD ICP across the East/ North Hertfordshire CDC. Following the ICP launch in 2011, reaudits and surveys of the ADHD pathway were conducted to determine whether there has been an increase in the delivery of quality patient care and improved support for families. Methods: The ADHD referral electronic data base (pre ICP 2010/2011 and post ICP 2013/2014) was examined retrospectively for declined ADHD referrals, numbers of secondary school aged children, ADHD nurse input, information received before first clinic consultation, ADHD 13 week referral to diagnosis waiting list breech times and number of clinic consultations before a final diagnosis of ADHD. Results: ADHD referrals in relation to total CDC referrals in 2010/2011 (pre-ICP) was 27 % compared to 24 % post ICP. ADHD referrals declined were 23 % pre-ICP versus 14 % post ICP. ADHD secondary school aged children with complex psychosocial issues referred were 53 % pre-ICP versus 28 % post-ICP. ADHD Nurse input pre-ICP 0 % versus 16 % post ICP. ADHD 13 week waiting time breeches were 14 % pre-ICP versus 12 % post-ICP. In 2010 and 2014 over a randomly selected 2 month period, majority of children had a final diagnosis of ADHD after two consultations compared to majority receiving their final diagnosis in 1 consultation post-ICP 2014. Over the same 2 month period, ADHD supportive feedback received before the first clinic consultation was 68 % pre-ICP versus 94 % post-ICP. Conclusions: Audits/surveys of the Service post-ICP have shown increase in overall quality of service delivery. The ADHD ICP also led to development of other resources and services and better joint working with local CAMHS Services. ADHD ICPs are integral in the provision of quality care and can contribute to shorter care journeys for children and young people with ADHD.

P-28-008 Sleep-efficiency in adult Attention-Deficit/Hyperactivity Disorder using actigraphy over 5 days S. Schiebler*, L. Kuster, M. Wenke, T. Mu¨ller * Bern, Switzerland Objectives: Sleep disturbances are frequent in adults with attentiondeficit/hyperactivity disorder (ADHD) [Philipsen et al. 2006, Yoon et al. 2012]. The goal of the ongoing study is to test for differences in sleep quality between the ADHD subtypes in adulthood on a longer time period with actigraphy because most studies with actigraphy investigated shorter periods of 1–2 days and therefore might not be able to depict the natural sleep pattern. Methods: We examined 11 subjects (4 female, 7 male) for ADHD in adulthood at the outpatients clinic. We used the German version of the Wender-Utah Rating Scale evaluating childhood ADHD symptoms, the ADHD Self-Report Scale evaluating adulthood symptoms, the Conners’ Adult ADHD Rating Scale-Observer, the semi structured interview manual Diagnostic Interview Voor ADHD 2.0 [Kooij 2012] on the basis of DSM-IV criteria and the ADHD Diagnostic Checklist. We detected sleep disturbances by using a self-report monitoring of sleep/wake behavior and 5-days actigraphy (SenseWear MF armband monitoring system). The daily average sleep efficiency was statistically analyzed by the software of the manufacturer (SenseWear Professional 8.0, BodyMedia). We set the limit at 80 % for a reduced abnormal sleep efficiency. Results: We diagnosed subjects (n = 11; 28.5 yrs. (18–64)) with ADHD combined (ADHD-C) (n = 8), predominately inattentive (ADHD-IA) (n = 1) and hyperactive-impulsive subtype (ADHD-HI) (n = 2). Sleep efficiency was 79.2 % (67.9–97.2). We found reduced

daily average sleep efficiency in 7 subjects (4 ADHD-C, 1 ADHD-IA and 2 ADHD-HI). No differences between the subtypes were found. Conclusions: In this ongoing study, we found a reduced daily average sleep efficiency in 7 of 11 subjects with ADHD across all subtypes with no differences as to the subtype of ADHD. This might due to the small number of participants included until now. More data will be available at the conference.

P-28-009 The children’s attention project: 18-month outcomes from a community-based cohort of children with ADHD and nonADHD controls E. Sciberras*, J. Nicholson, V. Anderson, P. Hazell, B. Jongeling, T. Silk, M. Bisset, O. Ukoumunne, D. Efron * Parkville, Australia Objectives: Few studies have delineated outcomes for communitybased samples of children with Attention-Deficit/Hyperactivity Disorder (ADHD). We aimed to report on the 18 month outcomes (social, emotional, behavioural, quality of life and academic outcomes) for a community-based sample of children with ADHD (those meeting full-criteria and subthreshold cases) and non-ADHD controls. Methods: Participants were (179 ADHD; 86 subthreshold ADHD; 212 non-ADHD controls; mean age: 7.3 years) recruited from 43 schools in Melbourne, Australia following community-based screening (n = 3734). Group status was assessed in two stages: (1) parent and teacher Conners’ 3 ADHD index; and (2) Diagnostic Interview Schedule for Children IV (DISC IV). Children classified as subthreshold ADHD if they screened positive for ADHD by both parent and teacher report but did not meet full criteria on the DISC IV. Outcomes assessed 18 months later included parent and teacher ratings of social, emotional and behavioural functioning (Strengths and Difficulties Questionnaire), quality of life (Pediatric Quality of Life Inventory) and academic functioning (Social Skills Improvement System—Academic Competence subscale). Results: Children with both full and subthreshold ADHD had poorer outcomes at baseline that persisted 18 months later (mean age: 8.9 years) compared with controls including poorer academic functioning, increased social, emotional and behavioural difficulties, and reduced quality of life (p \ 0.001). Although children with ADHD had elevated social, emotional and behavioural difficulties and poorer quality of life compared to the subthreshold group by parent-report (p \ 0.001), they did not differ on most teacher-reported outcomes including academic functioning (p = 0.35), peer problems (p = 0.75) and emotional difficulties (p = 0.98), with the exception of behavioural difficulties (p = 0.04). Conclusions: Children with subthreshold ADHD have comparably poor outcomes to those with full ADHD. School-based outcomes were similar for children with full and subthreshold ADHD, with the exception of behavioural difficulties. Preventive and early intervention approaches may be fruitful for children with both subthreshold and full ADHD.

P-28-010 ADHD Club - a new Portuguese social entrepreneurship initiative F. Silva*, R. Antunes, S. Afonso, C. Rosa, A. Serra˜o Neto * S. Domingos Rana, Portugal

Objectives: To evaluate the first year impact of the ADHD Club—a social entrepreneurship initiative that was developed to help Portuguesespeaking families and schools dealing with the challenges of ADHD. Methods: The program was launched in September 2013, consisting in a website with general information about ADHD and practical advice for the most common challenges, and with specific sections for parents, teachers, education assistants and children. Simultaneously two-module educational sessions for the three adult groups were delivered in selected schools. Participants satisfaction was measured by questionnaire with a 10-points scale. Results: During the first year the website received over 16,140 visits (about half the estimated number of children affected by ADHD in Portugal) and 74,865 page views. The educational sessions were attended by 422 persons. The participants evaluated that these sessions were useful for their personal and/or professional life (average 8.2/10 points), they received practical ideas for strategies (7.9/10 pt), they started facing ADHD children in a more positive way (7.5/10) and they were going to change their action some way after the session (7.1/10). Conclusions: There was a great need for free, reliable information about ADHD in our country that further originated new developments, including an e-learning platform. Social entrepreneurship initiatives have a great potential to mobilize institutions for the benefit of the community.

Saturday, 30 May 2015, 16.00 h–17.30 h P-29 Quality of life/Caregiver burden IV P-29-001 Executive functions and pedestrian safety in children with ADHD M. Toye*, J. Thomson, D. Coghill, S. Rhodes * Glasgow, UK Objectives: Very few studies have addressed pedestrian injury in the ADHD population despite this being one of the most common causes of injury to children with (and without) ADHD. This study aims to establish how EF and child pedestrian safety develop in children with ADHD compared with control children. Methods: 120 children aged 5–12 years took part in this study. 60 medication naive children with ADHD were recruited via an NHS Child and Adolescent Psychiatry service. 60 case matched controls were recruited from mainstream primary schools. Controls were matched on age, BPVS performance and postcode. Participants completed tasks from the CANTAB battery and tasks assessing pedestrian safety and decision making. Results: Children with ADHD have impaired executive functioning and perform less safely on child pedestrian tasks compared with controls. Developmental improvements in both EF and pedestrian safety exist in the healthy child population but these abilities appear to develop at significantly different rates in the ADHD group. Children with ADHD chose fewer safe routes to cross the road safely, used significantly fewer environmental cues to reach decisions and were significantly less able to predict driver intentions compared with controls. Conclusions: Reducing accidental injuries for children with behavioural disorders is an explicit priority for both the Scottish and UK Governments (Ending the Scandal of Complacency: Road Safety Beyond 2010). Findings provide new insights into trends in the ability of children with ADHD to make safe choices about road safety compared with matched healthy controls. They also provide evidence for prospective interventions.

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P-29-002 Driving performance of adults with Attention-Deficit/ Hyperactivity Disorder L. Tucha*, A. B. M. Fuermaier, J. Koerts, S. Aschenbrenner, K. Brookhuis, B. Lewis-Evans, D. de Waard, K. W. Lange, O. Tucha * Groningen, The Netherlands Objectives: Adults with attention deficit hyperactivity disorder (ADHD) suffer from various impairments of cognitive, emotional and social functioning, which can have considerable consequences for many areas of daily living. One of those areas is driving a vehicle. This study seeks to answer whether individuals with ADHD show increased levels of unsafe driving behaviours, which cognitive (dys)functions of individuals with ADHD are related to driving difficulty, and whether pharmacological treatment significantly improves the driving behaviour of individuals with ADHD. Methods: A review of the pertinent literature was conducted using the MEDLINE and WOK databases. Results: The available research provides convincing evidence that individuals with ADHD have different and more adverse driving outcomes than individuals without the condition. However, it appears that not all individuals with ADHD are affected uniformly. Pharmacological treatment of ADHD, in particular stimulant drug treatment, appears to be beneficial to the driving difficulties experienced by individuals with ADHD. Conclusions: Adults with ADHD have a higher likelihood to be involved in traffic accidents. Despite various cognitive functions being related with driving difficulties, these functions do not appear helpful in detecting high risk drivers with ADHD, nor in predicting driving outcomes in individuals with ADHD, since impairments in these functions are defining criteria for the diagnoses of ADHD (e.g. inattention and impulsivity).

P-29-003 The development and implementation of a point-ofreferral educational tool to enhance knowledge transfer about Attention-Deficit/Hyperactivity Disorder J. van Stralen* * Ottawa, Canada Objectives: Access to timely assessments and treatment for Attention Deficit Hyperactivity Disorder (ADHD) is problematic and the delay can lead to more complex treatment requirements. There remains a wide variability to assessments and interventions as well as confidence level in diagnosing and treating ADHD by general practitioners. This project sought to identify the barriers to knowledge transfer and to develop and pilot the efficacy of an educational tool to facilitate such knowledge transfer. Methods: An advisory board was held to understand the barriers to acquire knowledge and confidence in ADHD management. From there a steering committee developed an educational tool comprised of 6 components providing modular educational guidance in increasing detail. Based on the complexity and nature of the referral, a module was sent to the referring physician once a referral was made. Subsequently a survey was sent to the referring doctor to determine if the tool resulted in a shift to the treatment paradigm of the referring physician from a lower to a higher confidence level to diagnose and treat ADHD. Results: 216 modules of the educational tool and surveys were sent out to 159 physicians. 63 surveys (29.2 %) were completed from 56 physicians (35.2 %). 66.6 % of physicians indicated that they were more confident in diagnosing and 60.8 % more confident in treating

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ADHD after reading the material sent. 100 % of those physicians that read the diagnosis module were more confident in diagnosing patients after reading the material. Conclusions: Medical education literature has shown that case based learning is quite effective method of knowledge transfer. This tool builds on that premise, allowing the referring physician to be presented with a learning opportunity when they are faced with a specific case. This tool has been shown to be an effective opportunity for physicians to enhance their knowledge and confidence level in diagnosing and treating ADHD.

P-29-005 Sibling of children with Attention-Deficit/Hyperactivity Disorder’s knowledge and perception on core symptoms and their role in clinical intervention C. Viana*, C. Chasqueira, R. Lopes, P. Cabral, R. Carmona * Cascais, Portugal Objectives: Attention Deficit Hyperactivity Disorder’s (ADHD) is one of the most common childhood disorders and continues throughout adolescence and adulthood. ADHD has a strong impact, not only on the individual but to close relatives. It is well-known that parents of ADHD children show higher stress level, difficulty regulating conflicts and showing affection. On the other hand, few studies aim to assess siblings of children with ADHD’s role in managing this disorder. Sibling relationship is one of the most important bonds for a child’s social development. Positive sibling relationships can predict lower levels of psychopathology and higher social skills, while negative relationships can increase behavioral disruptions. Considering chronic illness, when siblings understand diagnosis their levels of stress decrease as well as family integration. We aim to assess siblings’ knowledge of ADHD core symptoms and the impact on family wellbeing in order to better understand siblings’ role in ADHD intervention. Methods: 20 siblings of ADHD diagnosed children (from CADIn center), between the ages of 12 and 18, were assessed using a Sibling Knowledge semi structured interview. A 15 question questionnaire was applied in order to assess (global) knowledge on ADHD. Results: Siblings showed a good global knowledge about ADHD symptoms but fail to identify non motor symptoms on their ADHD siblings. Nevertheless, they identify covert symptoms, considered to be in close relationship with the disorder but were not previously reported by other family members or teachers. Conclusions: Siblings of children with ADHD not only showed good knowledge about ADHD, but also add new important information, specifically related to emotional distress. Such findings suggest that siblings may have an important role in identifying specific symptoms and in clinical intervention.

P-29-006 Experiences of adolescents and young adults with ADHD in Hong Kong: Treatment services and clinical management I. Wong*, K. Cheung, P. Ip, P. Chan, C. Lin, L. Wong, E. Chan * Hong Kong, People’s Republic of China Objectives: Specialist service for the treatment of attention deficit hyperactivity disorder (ADHD) in adulthood in Hong Kong is yet to be developed. This study aims to explore the experiences of adolescents and young adults with ADHD in accessing treatment and

services, coping with ADHD-related impairment, and their expectations of future treatment in Hong Kong. Methods: Qualitative interviews were conducted with a semi-structured guide. Forty young adult patients aged between 16 and 23 were included in the study. The interview recordings were transcribed verbatim and anonymised. Data were analysed with a thematic approach based on key principles of Grounded Theory. Results: Four meta-themes were developed: Accessing ADHD diagnosis and treatment services; ADHD-related impairment; Experience of ADHD treatments; and Attitudes and expectations of future ADHD treatment. The role of parents and schools were highly significant in accessing services for patients diagnosed with ADHD in childhood. In general, ADHD affected every aspect of patients’ lives including academic outcome, employment, family and social relationships. Medications were the principal treatment for ADHD amongst the interviewees and were reported to be generally effective. Half of the patients received non-pharmacological treatments in childhood but these effects were reported to be temporary. There was general consensus that the needs of patients with ADHD could not be met in current service particularly lack of specialist service for adults with ADHD, follow-up by different clinicians, insufficient provision of non-pharmacological treatments. Conclusions: The findings suggest that further development of specialist ADHD services and non-pharmacological options for young adults are essential to meet their diverse needs with a holistic approach.

P-29-007 Mothers’ involvement in assisting with homework in relation to children’s ADHD symptoms and mothers’ self-efficacy beliefs M. Wozniak-Prus*, M. Gambin, M. Florczak-Perchel, M. Swiecicka * Warsaw, Poland Objectives: One of the important aspect of parents’ home-based involvement in schooling is assisting children with homework. Helping children in homework is especially difficult for parents of children with ADHD symptoms. These group of parents have tendency to over control and to display negative emotions during interactions with their impulsive and inattentive children. The aim of the presented study was to explore relationships of mothers’ involvement in assisting children with homework to ADHD and ODD symptoms of their children and to their parental self-efficacy beliefs. The questionnaire assessing parents’ involvement in assisting children with homework was constructed. Methods: Participants were 170 mothers of children aged 8–10 years attending primary schools. They completed three questionnaires constructed at the University of Warsaw: 1) the Rating Scale for Parents measuring the intensity of children’s ADHD and ODD symptoms, 2) The Parental Self-Efficacy Questionnaire consisting of two subscales: self-efficacy for control over child’s activities and selfefficacy for supporting close relationship with child and 3) The Parents’ Involvement in Assisting with Homework Questionnaire (PIAH). Explanatory factor analysis of PIAH questionnaire revealed two types of parental involvement at assisting with homework: negative control (restrictions, constraints, punishments) and supportive control (supervising child’s performance of homework). Results: Both types of mothers’ involvement in assisting with homework are positively correlated with the intensity of children’s ADHD and ODD symptoms. Stepwise linear regression revealed that the best predictors of mothers’ supportive control are high intensity of inattention symptoms and high mothers’ self-efficacy beliefs for control over child’s activities. Negative control is best predicted by

high intensity of children’s inattention and ODD symptoms and low mothers’ self-efficacy beliefs for supporting close relationship with child. Conclusions: Obtained outcomes suggest that parents’ involvement varies according to children’s pattern of ADHD and ODD symptoms. These results emphasize also the impact of parental self-efficacy beliefs.

P-29-008 Contemporary challenges faced by Canadian physicians in ADHD management J. F. Yaremko*, D. T. Duncan, S. S.-K Kao, R. Kronfli * Westmount, Canada Objectives: To identify the challenges in ADHD management in Canada. Methods: Between December 2013 and June 2014, 40 specialists and 10 primary care physicians (PCPs) from across Canada participated in the online REFLECT survey (pilot project) that assessed their perceptions regarding their ADHD practice. Actual practice was evaluated via 414 chart audits—3 visits/patient over 5 months. The cumulative loss to follow up (n = 414) was 38 by Visit 1 and 119 by Visit 2. Results: Pediatricians, child/adolescent psychiatrists and PCPs comprised 48, 22 and 20 % of the respondents respectively; 76 and 48 % had been in practice and treating ADHD for [20 years respectively. The survey revealed that most respondents perceived themselves to closely follow best practices and guidelines; however, while 78 % reported using rating scales to monitor response and all prioritized duration of efficacy as predominantly dictating the choice of pharmacotherapy, the review of the chart audits suggest otherwise. Figure 1 summarises the perceived versus actual use of rating scales in establishment of patient-defined treatment goals at each visit stratified by speciality. Pharmacotherapy was changed for 40 and 37 % of patients at Visits 1 and 2 respectively. Suboptimal symptom control resulted in intensification (up-titration; Visit 1 73 %; Visit 2 68 % or addition of another agent; Visit 1 44 %; Visit 2 30 %) or discontinuations without replacement (Visit 1 43 %, Visit 2 32 %). Side effects triggered down-titration for 55 and 45 % of patients at both Visits 1 and 2 respectively. Conclusions: The pilot phase of the REFLECT survey and chart audit suggest wide inconsistencies in the assessment and management of ADHD in Canadian specialist and primary care practices that are likely contributing to the persistent care gap. The national IRB approved REFLECT survey study should confirm these findings in 2015.

P-29-009 Academic outcomes for young people with ADHD transitioning to secondary school: The moving up study N. Zendarski*, E. Sciberras, F. Mensah, H. Hiscock * Parkville, Australia Objectives: A limited body of research has examined children’s functioning during the critical early years of high school across a broad range of academic domains. We aimed to describe the academic outcomes for young people with ADHD in the first and third years of high school. Methods: The Moving Up study is following two waves of children who are in early high school (Wave 1: 2014; Wave 2: 2015). Children were originally recruited from 21 state paediatric practices and met DSM-IV criteria for ADHD. Academic outcomes are measured on standardised

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tests (National Assessment Program—Literacy and Numeracy (NAPLAN)) across 5 test domains, through data linkage with the Australian Curriculum, Assessment and Reporting Authority (ACARA). Results: 67 participants (84 % male) enrolled in Wave 1; 44 in year 7 (mean age: 12.9; SD: .4) and 23 in year 9 (mean age: 14.9; SD: .5). 54 participants (80.6 %) completed NAPLAN testing in 2014. Data are summarised below. Conclusions: Students with ADHD demonstrated poorer academic functioning in their first year of high school compared with controls. Fewer students in both years meet minimum standards. Findings highlight the large achievement gap in this critical period. Future research will explore risk and protective factors for academic achievement.

P-29-010 Prospective study on cognitive function, academic, performance and tolerability of OROS-methylphenidate in children with Attention-Deficit/Hyperactivity Disorder Y. Zheng*, J.-m. Liang, H.-y. Gao * Beijing, People’s Republic of China Objectives: This study evaluated the effect of OROS-methylphenidate on cognitive function and academic performance of Chinese school-aged children with ADHD. Methods: This 12-week, prospective, multicenter, open-labeled, selfcontrolled clinical study enrolled 153 Chinese school-aged children with ADHD and 41 non-ADHD children. Children with ADHD were treated with once-daily OROS-MPH. The primary endpoints were Inattention/Overactivity (I/O) With Aggression Conners Behavior Rating Scale (IOWA) and Digit Span Test at Week 12 compared with baseline. Secondary endpoints included opposition/defiant (O/D) subscale of IOWA, Clinical Global Impression (CGI), Coding Test, Stroop Color-word Test, Wisconsin card Sorting Test (WCST), academic performance on teacher-rated school examinations, and safety at Week 12 compared with baseline. Both non-ADHD and ADHD children received the same frequency of cognitive operational test to avoid the possible bias caused by training. Results: A total of 128 patients were evaluated with cognitive assessments. The OROS-MPH treatment significantly improved IOWA Conners I/O subscale scores at Week 12 (3.8 ± 2.35) versus baseline (10 ± 2.4; P \ 0.0001). Digit Span Test scores improved significantly (P \ 0.0001) with a high remission rate (81.10 %) at Week 12 versus baseline. A significant (P \ 0.0001) improvement was observed in: O/D subscale of IOWA, CGI, Coding Test, Stroop Color-word Test, WCST, and academic performance at Week 12 versus baseline. Very few practice related improvements were noticed in the non-ADHD group at Week 12 compared to baseline. No serious adverse events and deaths were reported during the study. Conclusions: The OROS-MPH treatment effectively controlled symptoms of ADHD and significantly improved academic and cognitive function of Chinese school-aged children with ADHD. The treatment was found to be safe and generally well-tolerated over 12 weeks.

P-29-011 Association between parenting style and socio-emotional and academic functioning in children with and without ADHD: A community-based study S. Bhide*, E. Sciberras, V. Anderson, J. Nicholson * Melbourne, Australia Objectives: In community-based children with and without ADHD, to investigate (1) group differences in parenting style; and (2) the

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differential relationship between parenting style and child socio-emotional and academic functioning. Methods: Participants were 179 children with ADHD and 212 nonADHD controls (aged 6–8 years). The Conners 3 ADHD Index and Diagnostic Interview Schedule for Children IV were used to assess ADHD. Parenting style was assessed via parent-reported measures of warmth, consistency and anger. Parents and teachers completed child socio-emotional and academic functioning measures, including the Social Skills Improvement System, Strengths and Difficulties Questionnaire and Wide Range Achievement Test 4. Results: All analyses controlled for socio-demographic variables and externalising co-morbidities. Parents reported less consistency (Cohen’s d = -0.31; p \ .05) and more anger (Cohen’s d = 0.66; p \ .001) in the ADHD group compared to non-ADHD controls, with no differences in warmth. In the ADHD group, higher warmth and lower anger was associated with better child social functioning including pro-social behaviour (b = .26, p = .001; b = -.26, p = .001), self-control (b = .14, p = .06; b = -.26, p = .001) and responsibility (b = .20, p = .01; b = -.46, p \ .001). Higher consistency was associated with fewer parent-reported peer problems (b = -.22, p = .003), emotional problems (b = -.17, p = .03), and higher pro-social behaviour (b = .16, p = .04). No relationship between parenting style and academic functioning was found. Results were largely similar for non-ADHD controls. Conclusions: Relative to typically developing children, parenting style of children with ADHD comprised of less consistent discipline and more anger. For both groups, parenting style was associated with socio-emotional functioning. Interventions assisting parents to maintain warm, consistent and calm interactions with their child with ADHD, may help alleviate some ADHD-associated socio-emotional impairments.

Saturday, 30 May 2015, 16.00 h–17.30 h P-30 Substance abuse P-30-001 ADHD in the context of clients initiating treatment in therapeutic communities in the Czech Republic L. Cablova*, M. Miovsky, L. Stastna, K. Kalina * Prague, Czech Republic Objectives: The aim of the poster is to present an epidemiological profile of the clients who initiate their treatment in eight therapeutic communities in the Czech Republic. These are the first results presented within the study/project focused on the diagnosis of ADHD in adulthood among the clients undergoing treatment in TCs in the Czech Republic. Methods: The research sample consisted of 120 clients entering into treatment, who have been examined by psychological and addictological methods within the first 2 weeks of the program. Epidemiological data analyses were conducted on the basis of data obtained from EuroASI, clinical history, DIVA 2.0 interview and questionnaire CTQ. Results: According to this data, it was possible to construct the client’s profile both in relation to ADHD comorbidity and from the perspective of the clients undergoing treatment in TCs in the Czech Republic. The resulting profile was constructed based on the variables such as gender, age, psychosocial status, and the duration of previous substance use and therapies. Conclusions: Our results indicate there is a psychosocial relationship between ADHD comorbidity and substance use among clients in the TCs. In a follow-up research and clinical practice it could be useful to

focus both on early diagnostics/screening of this comorbidity and on the application of a suitable therapeutic intervention for the clients.

P-30-002 Risk of abuse of tobacco, alcohol and illegal drugs in a Spanish sample of young adults with ADHD: Relationship with manifestations of comorbid problems C. Colomer*, A. Miranda, R. Rosello´, C. Berenguer, B. Rosello´ * Castello´n, Spain Objectives: ADHD is a risk factor for substance abuse, probably increased by the presence of other psychopathologies. This study has two objectives: (1) To compare the risk of abuse of alcohol, tobacco, marihuana and other illegal drugs in adults diagnosed with ADHD with the risk in adults with typical development (TD) and with population data. (2) To compare the comorbid problems of adults with ADHD with high and low risk of substance, and analyze the specific manifestations related to the possible differences found between the two groups. Methods: Ninety-three young adults, 43 without ADHD and 50 with ADHD, who were part of the Spanish sample of the Multicenter ADHD Genetics (IMAGE) study, collaborated in a follow-up evaluation 10.1 years later. 76 % continued to meet the criteria for ADHD. The two groups were balanced on age and IQ, and 96 % were men. Manifestations of comorbid disorders and patterns of substance use were evaluated: low risk (never, occasional), high risk (frequent and quite frequent for alcohol and tobacco; occasional for cannabis and other illegal drugs). Results: Statistically significant differences were found between young adults with and without ADHD in their use of tobacco, cannabis and alcohol. Comparing them to population data, adults with ADHD used/ abused tobacco twice as much, cannabis three times as much, and cocaine four times as much as young adults without ADHD. A statistically significant association was found between externalization problems, ODD and CD, and a greater risk of substance abuse. Conclusions: The findings are consistent with other studies that highlight the association between externalizing problems and substance abuse, and they provide new evidence for the need to consider problems associated with ADHD as a fundamental part of treatments.

P-30-003 International rates of ADHD and substance use disorder symptoms among prison inmates: Individual-data and pooled effects R. Gonzalez*, M. Velez-Pastrana, G. Gudjonsson, Y. Ginsberg, M. Konstenius, A. Alicea, C. Albizu, S. Young * San Juan, Puerto Rico Objectives: Prison inmates have increased rates of psychiatric disorders and comorbidity. Substance use disorders (SUD) are considerably high among adults with ADHD, and both disorders often coexist in incarcerated populations. Most studies on ADHD/SUD in prison have been conducted on Europeans. A question remains on whether rates differ internationally and across diverse ethnic groups. This study aims to contrast the prevalence of SUD and intravenous drug use (IDU) associated with ADHD symptoms across international prison inmates’ samples. We also tested whether ADHD symptom domains are differentially associated with SUD. Methods: The Composite International Diagnostic Interview (CIDI) SUD module and the WURS, a measure of retrospective ADHD

symptoms, were completed by 1330 male inmates: 72 % Latino (PR), 15 % British (UK) and 13 % Nordic (Sweden and Iceland). Scores for 3 symptom domains (cognitive, internalizing and externalizing) were derived through CFA. Logistic regression models tested associations between total ADHD scores, and scores for each symptom domain with lifetime alcohol and drug dependence. We conducted metaanalysis on independent samples’ results to test the overall effect size of the association. Results: Nordic, British and Latino alcohol dependence (AD) rates were 54.5, 16.8 and 28.4 %, respectively, and 79.0, 47.5 and 50.5 % for drug dependence (DD). All ADHD symptom domains were significantly associated with drug dependence on all samples, whereas for alcohol dependence there was no association among Nordic offenders. We found a significant pooled effect for lifetime IDU, but only for the internalized ADHD symptoms domain. Conclusions: Associations between ADHD symptoms and SUD seem consistent across samples, with a few exceptions. However, rates of SUD differ substantially. We discuss implications of our findings for treatment of ADHD and SUD within the criminal justice system and address how different international approaches to criminal justice policies for drug offenses may affect rates and outcomes.

P-30-004 Retrospective observational study on the effect of specific psychopharmacological treatment of ADHD in childhood related to the presence of substance use disorder in adulthood L. Llopart*, G. Espan˜ol, V. Valles, e. Jovell, B. Pineiro-Dieguez * Terrassa, Spain Objectives: Substance use disorders (SUD) have a clear relationship with ADHD, fact can complicate the treatment of both illnesses. The aim of our study is to observe the effect of specific pharmacological treatment of ADHD during childhood (up to age 17) in the consumption of toxic in adulthood, by assessing the time and type of treatment, percentage of treated illness, treatment in adolescence and analyze if there’s an increased probability of SUD in ADHD adults. Methods: We analyze a sample of adults who met ADHD DSM-5 criteria and we compare if there is toxic consumption in adulthood related to psychopharmacological treatment during childhood. The analysis takes into account potentially confounding factors that may increase the risk of toxic consumption. Results: The sample had 155 patients (90 combined, 62 inattentive, 3 hyperactive), of which 112 are male and 43 female. Mean age was 24.17 years. 75.5 % patients received psychopharmacological treatment in childhood (20 % less than 4 years, 55.5 % more than 4 years). Among them, 23.7 % received short-acting stimulants, 67.82 % long-acting stimulants and 8.5 % non-stimulant medication. 67.7 % continued treatment during adolescence. Referring to substance use prevalence was 52.9 % alcohol, 52.6 % nicotine and 28.4 % cannabis. In patients treated during childhood had less consumption of alcohol, cannabis and nicotine (50.42 % (v221.103, p \ 0.05), 76.92 % (v225.50, p \ 0.05), 61.53 % (v215.619, p \ 0.05) respectively). In the same line, patients treated during adolescence had a higher prevalence of remission in consumption. Conclusions: We observed a direct association between treatment in childhood and adolescence and substance use reduction. This reduction was more important in patients treated for more than 4 years. Early diagnosis and treatment is important to prevent dysfunction and comorbidities in ADHD patients.

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P-30-005 Attention-Deficit/Hyperactivity Disorders among stable heroin dependent patients in opioid substitution treatment J. Martinez-Raga*, M. Min˜ano Meneres, J. Cebria´n Gallardo, N. Garcia Sanchez, J. Vivas Lalinde, F. Andre´s Espan˜a, G. Legazpe Garcı´a, A. Lopez de Haedo, M. Herrero Casanova, R. Calabuig Crespo, A. Torregrosa Vales * Valencia, Spain Objectives: Substance use disorders disorders are among the most common comorbid psychiatric disorders in adolescents and adults with attention-deficit hyperactivity disorder (ADHD). The association between ADHD and opioid use disorders has been less studied. In the present study aimed to screen for a comorbid ADHD among stable patients with a primary diagnosis of heroin dependence attending an outpatient Opioid Substitution Program (OSP). Methods: A consecutive sample of 146 heroin dependent patients attending the Unidad de Conductas Adictivas in Gandia (Valencia, Spain), a specialist outpatient unit, were recruited and agreed to participate in the study. Patients were stable and abstinent at the time of enrolment, participating at an OSP. Screening of ADHD was conducted using the ASRS (Adult ADHD Self-Report Scale), which has been validated in Spanish substance abusing population. In addition, to sociodemographic variables, patients were assessed for other comorbid psychiatric disorders using the Mini-International Neuropsychiatric Interview (M.I.N.I.). Results: A total of 146 consecutive patients, 114 (78 %) males and 32 (22 %) females, with a mean age of 38 years (SD: 7.7); 93 (63.7 %) were in methadone maintenance, 36 (24.7 %) were receiving buprenorphine–naloxone, 4 (2.7 %) were taking naltrexone, and the remaining 13 (8.9 %) were off medication at the time of the assessment. In this sample, 45 (30.8 %) screened positive for ADHD (ADHD+), 37 males (82.2 %) y 8 females (17.8 %). None of the participants had been previously diagnosed of ADHD. Both groups of patients were very similar in most clinical and socio-demographic variables. However, ADHD+ patients were significantly more likely to be Hepatitis C positive (36.4 vs. 19.4 %; p \ 0.05). In addition, 23 individuals (16.1 %) of the total sample was HIV positive. The majority of the sample was employed, were smokers, had a history of legal problems and other comorbid psychiatric disorders. Conclusions: Albeit only a screening of ADHD among opioid dependent patients, the rates were similar to that reported in previous studies. The study underpins the importance of screening and adequately assessing for ADHD among all patients with a substance use disorder.

P-30-006 Is alcohol, smoking and substance involvement screening test (ASSIST) a good screening instrument for patients with Attention-Deficit/Hyperactivity Disorder (ADHD)? C. S. Miguel*, M. A. Silva, T. Chaim-Avancini, M. R. Louza˜ * Sa˜o Paulo, Brazil Objectives: Substance abuse and dependence (SUD) are frequent comorbidities of Attention Deficit Hyperactivity Disorder (ADHD). Nevertheless, there is a lack of information on the use of scales designed to detect SUD in the ADHD population. The aim of the present study is to evaluate the ability of the Alcohol, Smoking and Substance

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Involvement Screening Test (ASSIST) to detect SUD in patients with ADHD. Methods: Forty-four adults (31 males, mean age: 28.73 ± 8.61 years) diagnosed with ADHD (DSM-IV) responded to the ASSIST and the Mini International Neuropsychiatric Interview 5.0.0 (MINI) for screening of drug use and diagnosis of abuse or drug dependence respectively. The MINI was considered ‘‘gold standard’’ to obtain the following characteristics of the ASSIST for each of the various SUDs: sensibility, specificity, positive predictive value (PPV) and negative predictive value (NPV). Results: In our sample few patients with ADHD had SUD. The ASSIST achieved very high percentages of sensibility, specificity, PPV and NPV compared to the MINI in relation to cocaine dependence, cocaine abuse, alcohol dependence, alcohol abuse, marijuana dependence, marijuana abuse. All results showed confidence intervals (CIs) with a wide range of values. Conclusions: Even though the ASSIST reached high values of sensitivity, specificity, PPV and NPV for all SUDs, the low prevalence of SUDs in our sample may compromise the results. It should be also be taken into account that the MINI considers a 12-month period of investigation, while the ASSIST investigates only the last 3 and 6 months. This suggests that the ASSIST should extend the time period of investigation to the last 12 months to improve its accuracy in the detection of SUDs in the ADHD population.

P-30-007 Correlates of everyday executive functioning in ADHD and substance abuse R. Rosello´*, A. Miranda, C. Colomer, C. Berenguer, J. Mercader * Valencia, Spain Objectives: The attention deficit with hyperactivity disorder and the executive functioning dysfunctions are associated with a greater risk of use and later abuse of substances. The objective of this study is to analyze the relationship between executive functioning in daily life and the use of substances in young adults with high/ low risk of substance abuse in general and in adults with typical development. Methods: This study includes two groups of young adults, 50 with ADHD and 43 without ADHD. In the ADHD group, 24 had a high risk of substance abuse and 26 had a low risk of substance abuse. The groups were balanced on age and IQ. The ADHD group was part of the Spanish sample from the Multicenter ADHD Genetics (IMAGE) study and collaborated in a follow-up evaluation 10.1 years later. 76 % continued to meet the criteria for ADHD. The executive functioning was evaluated with the BRIEF. Results: The analyses of variance conducted yielded statistically significant different between adults with high risk of substance abuse and TD adults in all the executive functioning domains. However, some scales related to meta-cognition, such as planning/organization and monitoring and the general index, also revealed significant differences between the two ADHD groups with high and low risk of substance abuse. Conclusions: The findings suggest a possible association between the executive deficits, especially some meta-cognitive domains, and a greater risk of substance abuse. However, there is a need for further studies that can identify the neuropsychological vulnerabilities that predispose individuals with ADHD to greater substance use, as the research to date is not conclusive.

P-30-008 Long-term outcomes of pharmacologically treated versus non-treated adults with ADHD and substance use disorder: A naturalistic study B. Bihlar Muld*, J. Jokinen, S. Bo¨lte, T. Hirvikoski * Stockholm, Sweden Objectives: Pharmacological treatment of individuals ADHD and SUD is controversial, and few studies have examined long-term psychosocial outcome in this population. The aim of present study was to investigate whether pharmacological treatment was associated with long-term psychosocial outcomes. Methods: An observational long-term follow-up study was conducted of 60 male patients with ADHD who had previously received compulsory inpatient treatment due to severe substance abuse. The average interval between inpatient discharge and follow-up was 18.4 months. Thirty patients had received pharmacological treatment for ADHD, and 30 patients were pharmacologically untreated. The groups were compared with respect to mortality and psychosocial outcomes operationalized as substance abuse status, ongoing voluntary rehabilitation, current accommodation and employment status. Results: The pharmacologically treated and non-treated groups were comparable with regard to the demographic and background characteristics. At the time point of follow-up, mortality risk was high and did not differ between the groups (8.3 %). The group that received pharmacological treatment for ADHD had lower risk of substance abuse relapses, received more frequently voluntary treatments in accordance with a rehabilitation plan, required less frequently compulsory care, were more frequently accommodated in supportive housing or a rehabilitation center, and displayed a higher employment rate than the non-treated group. Conclusions: The recommendations for the close clinical monitoring of high-risk populations and the prevention of misuse and drug diversion were fulfilled during the treatment onset in the structured environment of compulsory care. Pharmacological treatment of ADHD in individuals with severe SUD may decrease the risk of relapse and increase these patients’ ability to follow a non-pharmacological rehabilitation plan, thereby improving their long-term outcomes.

Saturday, 30 May 2015, 16.00 h–17.30 h P-31 Miscellaneous I P-31-001 Relationship between emotional intelligence and selfconcept in ADHD U. Diaz-Orueta*, I. Pe´rez-Tamargo, D. Ribes, P. Martı´n-Lobo * Donostia-San Sebastian, Spain Objectives: To analyse the relationship between self-concept and inter and intrapersonal intelligences, based on Gardner’s Multiple Intelligences, in individuals diagnosed with ADHD compared to a control group. Methods: 62 participants, 30 male and 32 female, aged between 7 and 21 years, with a mean age of 12.82 years, were recruited. 32 subjects with ADHD (21 male and 11 female, aged 9–21, mean age = 12.68) attended the ADHD relatives association of Zamora

(Spain). The control group with no ADHD diagnosis was composed of 9 boys and 21 girls, aged between 7 and 17 years (mean age = 12.96), formed by siblings, friends and school peers of those belonging to the ADHD group. All of them were administered two different self concept questionnaires (Garcia and Musitu 2008; PierHarris 1964) and two Multiple Intelligences assessment questionnaires (Armstrong 1999; McKenzie 1999). Results: Pearson correlation analyses showed significant relationships between interpersonal intelligence and social self-concept (r = 0.409, p \ .01), both in children with and without ADHD. Moreover, emotional and social self only correlated for controls (r = 0.622, p \ .001). Comparison of children with ADHD by age (7–12, versus 12–21 yearsold) by means of Mann–Whitney U showed significant differences in favour of the eldest children with regards to emotional self-concept (U = 41, p \ .05). Finally, comparing children aged 12–21 with and without ADHD showed significant differences in favour of ADHD children for emotional self-concept (U = 161.5, p \ .05) and for intrapersonal self-concept in controls (U = 117.5, p \ .01). Conclusions: Emotional and intrapersonal self-concept may be key targets for early preventive interventions in children with clinical diagnosis of ADHD. Clinical, cognitive, and emotional factors should all be considered in the development of future intervention plans in ADHD.

P-31-002 Knowledge about Attention-Deficit/Hyperactivity Disorder among teachers G. Gaastra*, Y. Groen, A. Fuermaier, L. Tucha, O. Tucha * Groningen, The Netherlands Objectives: Teachers play a major role in the diagnostic process of attention-deficit/hyperactivity disorder (ADHD) and in supervising students with ADHD. Therefore, it is of importance that teachers have accurate knowledge about ADHD. The aim of this study was to assess knowledge about ADHD among primary and secondary school teachers (general education) and the role of teaching experience. Methods: Dutch primary school teachers (n = 95), secondary school teachers (n = 63), and comparison participants (n = 92) completed a questionnaire containing 39 statements about ADHD. Participants had to indicate whether the statements are true, false or that they do not know. ANOVA was used to test for group differences and correlation was used to explore the association with teaching experience. Results: Primary school teachers showed more knowledge about ADHD (M = 52 % correct, SD = 12) than both secondary school teachers (M = 41 % correct, SD = 14, p \ .001) and comparison participants (M = 44 % correct, SD = 15, p \ .001). Secondary school teachers and comparison participants did not differ from each other (p = .697). Years of teaching experience was positively correlated to knowledge about ADHD (r = .27, p = .001). Conclusions: Dutch primary school teachers scored correctly in half of the knowledge items about ADHD and had more knowledge than comparison participants. This is important information because primary school teachers play an important role in diagnosing and supervising students with ADHD. However, Dutch secondary school teachers had similar knowledge as comparison participants. Across teachers, more teaching experience was associated with higher knowledge of ADHD. The results indicate that the questionnaire can be regarded as difficult, leaving room for improvement. The questionnaire might therefore be suited for the evaluation of educational interventions for teachers.

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P-31-003 Ethical relevant issues concerning ADHD. Opinions of psychiatrists, pharmacists and medical practitioners: Does background matter? W. Go¨ttgens-Jansen*, E. van Leeuwen * Beuningen, The Netherlands Objectives: To determine the assessment of ethical relevant primary issues concerning the diagnosis and treatment of children and adolescents with ADHD of psychiatrist pharmacists or medical practitioners. A second objective was to learn if practitioners of different educational background hold different views on the ethical relevance of specific issues within this research. Methods: A questionnaire was distributed among congress participants on international congresses on the subject of child psychiatry, (medical) ethics, and pharmaceutical care in 2011 and 2012. Questionnaires were handed over personally or sent in advance of the conference by post or as attachment to a digital newsletter. The questionnaire consisted of a list of 16 primary issues that are connected with diagnosis and treatment of children and adolescents with ADHD. The participants were asked to assess the ethical relevance of the different issues on a 5 point Likert-scale from ‘not relevant at all’ to ‘very relevant’. Participants could also choose a neutral option ‘I don’t know’ and add issues that were missing in the list form their own point of view. Results: A total of 135 questionnaires was returned. The response rate varied from 1 to 50 % depending on the mode of distribution. Responders represented 18 nationalities and were sufficiently distributed over different relevant categories of educational background (psychiatry, pharmacy, philosophy, medicine) . Conclusions: The correlations of the different primary issues of the questionnaire were good. All primary issues were considered relevant tot very relevant (mean score [3 on a 5-point Likert scale) by all responders, irrespective of educational background or societal function. Statements of the questionnaire addressed issues concerning diagnosis and therapy. Some issues were judged more relevant by women than by men (statistically significant). Pharmacist scored the diagnostic issues as relevant as psychiatrists and more relevant than responders with medical or philosophical background. Psychiatrist assigned the lowest score and pharmacists assigned the highest score to therapeutic issues.

P-31-004 Child maltreatment and associated parental factors among children with ADHD: A comparative study C. K. Gurkan*, H. Gu¨l * Ankara, Turkey Objectives: This study aimed to examine whether children with ADHD have increased risk of child maltreatment compared to healthy controls and to assess the associated parent and child-related risk factors for types of abuse. Methods: We recruited 100 children with ADHD, aged 6–11 years, and 100 age and gender matched normal controls. All of the children in both groups were interviewed by a standardized form about the type and frequency of parental abusive behaviors. Psychiatric diagnoses of the children in both groups were made by K-SADS-PL based on DSM-IV. Childhood Trauma Questionnaire, DSM-IV based adult ADD/ADHD diagnosis and assessment inventory and Conners rating scales were applied to parents. Chi square, Fisher exact, Student’s t, Mann-Whitney U tests and a logistic regression analyses were used to identify variables associated with the type of child maltreatment, where appropriate.

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Results: Rates of maltreatment/neglect in children with ADHD were significantly higher than healthy controls. Parents of children with ADHD had higher ADHD symptom and childhood trauma scores compared to normal controls’ parents. In ADHD group, there were some significant associations between types of maltreatment/neglect and duration of maternal education, male gender, having siblings, birth order, presence of physical neglect/emotional abuse during mother’s childhood, severity of paternal attention deficit and ADHDassociated traits in the mothers. Logistic regression analysis revealed that presence of ADHD-associated traits in mothers and severe attention deficit in fathers predicted the child neglect; presence of hyperactivity, impulsivity in mothers predicted the emotional abuse; and maternal exposure to emotional abuse and paternal exposure to physical neglect in their childhood predicted the presence of sexual abuse in children with ADHD. Conclusions: The study’s findings suggest that all maltreatment types are seen at higher rates in children with ADHD compared to healthy children and maltreatment is more associated with parental factors rather than ADHD symptom severity of the children.

P-31-005 Partial agenesis of corpus callosum (ACC) in adult Attention-Deficit/Hyperactivity Disorder (ADHD) W. Jaimes-Albornoz*, A. Ballesteros-Prado * San Sebastian, Spain Objectives: ACC is a rare birth defect associated with a wide variety of syndromes and conditions. The corpus callosum—especially the splenium—is one of the brain regions most frequently reported as abnormally reduced in volume in patients with ADHD. We describe an adult patient with a partial ACC and secondary ADHD symptoms associated with deafness. Methods: Case report and review of published literature. Results: E. is a 24 year-old female who comes with us complaining about memory problems and difficulties in concentration which has since childhood. At 2 year-old she was diagnosed of deafness and partial ACC. She improved the hearing and speech comprehension with hearing aids. E. had no major problems with language development. Her school story describes multiple difficulties maintaining attention in class with a great distractibility and generally poor academic performance. These inattention symptoms persist into adulthood and have a negative impact on her working life. The Wender-Utah Rating Scale (WURS) Spanish version showed multiple symptoms of inattention. Their parents confirmed this information. The patient fulfilled the DSM 5 criteria for ADHD, predominantly inattentive presentation. Routine clinical and laboratory examination did not show any significant findings. Brain magnetic resonance imaging (MRI) mainly showed a severe form of partial ACC (Figure 1). Treatment was started with ascending doses of immediate release methylphenidate up to 40 mg TID and then it was replaced by lisdexamfetamine 50 mg/day. She reported a significant improvement in her inattentive symptoms and her family described that she was more organized and concentrated. No side effects were observed. Conclusions: Our case shows the potential role of the corpus callosum in the pathogenesis of ADHD. The clinician should consider the possible presence of this condition in patients with this congenital disorder.

P-31-007 Psychohistory: What can we learn about ADHD from the Old Testament? E. Merzon*, T. Merzon, E. Kitai, A. Golan –Cohen * Karnei Shomron, Israel

Objectives: For many years the Bible has been studied from a medical point of view offering diagnoses for the symptoms and signs that appear among prominent biblical characters. Attention-Deficit/ Hyperactivity Disorder (ADHD) is probably the most common chronic undiagnosed psychiatric disorder among adults. It is characterized by inattention, distractibility, restlessness, labile mood, quick temper, overactivity, disorganization, and impulsivity. Prominent theories about ADHD suggest these symptoms are a clinical presentation of underlying deficits in executive functioning. The executive functions are a set of processes that all have to do with managing oneself and one’s resources in order to achieve a goal. That is why the main presentation of ADHD in adulthood is academic and professional underachievement and unrealized potential. The objective of our study was to correlate behavioral patterns of biblical personages with sings of ADHD and executive dysfunction. Methods: We restrict our study to the male Jews who were on leaders positions demanded good executive functioning. We review the Old Testament in attempt to find the evidence of ADHD symptoms and executive dysfunction among ancient Jewish patriarchs, judges and kings. Results: According to our findings we suggested that Esau the first son of Isaac and Rebecca (Genesis, 25–36), Samson son of Manoah and one of the Judges of Israel (Judges, 13–16) and Saul the first king of Israel (Samuel 1, 9–31) had a clear signs of executive dysfunction and resulted from ADHD. Conclusions: We found evidence that some ADHD sings have been described clearly in Old Testament.

Saturday, 30 May 2015, 16.00 h–17.30 h P-32 Miscellaneous II P-32-002 PISTTA project: A telematic longitudinal study of ADHD in Spain I. Onandia*, Z. Garcia * Amorebieta-Etxano, Spain Objectives: The objective of this study is to measure and analyse the special characteristics of the ADHD population in Spain. So, we are going to enrol volunteers who suffer from ADHD, but also a counterbalanced control group. Methods: We use telematic methods, using online questionnaires and emails to collect all our variables. We are going to measure anxiety and depression (including self-concept), the family history of ADHD, academic/working performance, leisure activities, ADL, QL and QLRH, learning difficulties, social relationships, caregiver burden, the grief process of having ADHD, sleep disorders, victimization and abuse, attention/inhibition/reaction performance, abuse disorders (with and without substances) and creativity. We have the support of the FEAADAH and its attached associations. Results: This is a project, which will be carried out in 2015. This is why we cannot present results yet. However, the aim of this presentation is to expose our methodology and our large sample. Conclusions: Due to the same reason mentioned above, we cannot present conclusions yet.

P-32-004 Validity of the computer-based cognitive tasks for school-aged children: Memory and working memory tasks M.-S. Shin*, S. J. Oh, J. J. Lee

* Seoul, Republic of Korea Objectives: A computerized neuropsychological task is an economic and convenient method for assessing children’s cognitive abilities in general population, and it’s especially valuable for screening children who have subclinical neurocognitive dysfunction (e.g. highrisk ADHD children), which helps to provide a preventive intervention for them. Given that memory and working memory (WM) function are important cognitive abilities since those are linked to academic achievement, this study aimed to evaluate the validity of newly developed memory and WM tasks using computer-based multimedia. Methods: One-hundred school-aged (8- to 10-year-old, the lower grades in elementary school) children were recruited. The newly developed, computer-based cognitive tasks consist of four domains: (1) auditory-verbal memory, (2) visual-spatial memory, (3) auditoryverbal WM, and (4) visual-spatial WM. We examined the construct validity of the tasks through examining the developmental trend of the memory and WM abilities with age. To determine the concurrent validity of those tasks, we conducted correlation analyses between the participants’ scores and their scores on well-known measures of memory and WM; Auditory-verbal memory subtests of Korean LuriaNebraska Neuropsychological Battery for Children (Korean LNNBC), Korean Rey-Osterrieth Complex Figure Test (K-ROCF), Digit span and arithmetic subtest of Korean Educational Development Institute Wechsler Intelligence Scale for Children Revised (KEDI WISC), and Corsi block test. Results: Memory and WM abilities measured by the newly developed tasks tended to increase with age among the children. Further, there were high correlations between the scores of four cognitive tasks and the corresponding scores of standardized assessment tools. Results also revealed that the computer-based cognitive tasks are valid instruments for assessing memory and WM abilities in school-aged children. Conclusions: This study shows promising evidence for the validity of computer-based multimedia cognitive tasks assessing memory and WM, which might have the utility for school-aged children in research and clinical settings.

P-32-005 Development of the computerized test to diagnose dyscalculia in Korean children and adolescents C. Suh*, H. Yoo, Y. Y. Kim, J. Jung * Seoul, Republic of Korea Objectives: This study was conducted in order to develop the computerized test to identify dyscalculia of children and adolescents in South Korea. To validate the test, we investigated the reliability and validity. The normative data of Korean children and adolescents were also obtained. Methods: We developed the computerized Comprehensive Learning Test-Mathematic (CLT-M). The test consists of the whole number computation test, enumeration of dot group test, numberline estimation test, numeral comparing test (magnitude/distance), digit span test, and working memory test. To obtain the normative data and to investigate the reliability and validity of the test, 399 children and adolescents (aged 5–14 years, male 48.9 %) from kindergarten to middle school dwelling in Seoul and Gyeonggi province were recruited. Results: The internal consistency reliability of the CLT-M was high (Cronbach’s alpha = 0.76). Construct validity was computed by principal constant analysis using oblique rotation method. Four factors explained 76.0 % of the cumulative variances. In addition, normative data for all the CLT-M subtests were obtained.

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Conclusions: The computerized CLT-M can be used as a reliable and valid tool to evaluate children and adolescents with mathematical problems and to diagnose dyscalculia at schools, clinics, and research institutes in Korea.

P-32-006 ‘The feeling distracts me and I forget the question’ A qualitative study of premonitory urges in children with tic disorders

information during the diagnostic assessment in 36 and 25 % respectively while 65 % of medical doctors include the teacher’s information and 54 % reported the use of rating scales. Regarding treatment only 28 % of psychologists considered methylphenidate as the first choice, in contrast to 88 % of medical doctors. Conclusions: Most of the surveyed people said knowing what ADHD is. However some of their beliefs are not evidence based. The psychologist is the health professional that Mexican general population would seek for help. More education is needed regarding the efficacy of drug treatment.

I. Takon*, H. Rickards, U. Chowdhury, S. Sharma * Welwyn Garden City, UK Objectives: To explore whether children affected by tic disorders experience, recognize and are able to describe premonitory urges. Methods: Semi-structured interviews were carried out with children to unearth their experiences of living with a tic disorder alongside exploring whether or not children recognize and are able to describe associated premonitory urges. Participants included 10 children, (4 female and 6 male) referred to the Paediatrics department at the QEII Hospital who had motor/vocal tics for at least 1 year. Ethics approval was obtained alongside written consent from parents and children. Interviews were digitally recorded, transcribed verbatim and analysed using thematic analysis. Results: Parents report showed that 50 % of study sample experienced combination of motor and vocal tics with 60 % of children having moderate impairment from tics. Two overarching themes were identified relating to awareness of tics and lived experience of premonitory urges. Majority of the children experienced annoyance and discomfort as a result of the premonitory urge. Some participants described fidgetiness and poor focusing in an attempt to suppress the tics. The child’s age did not influence ability to report the sensory urges. Conclusions: The presence of premonitory urges can result in significant discomfort and annoyance. Poor concentration and fidgetiness can be an expression of children trying to suppress the sensory urges. Children with tic disorders are at risk of developing ADHD but not all fidgeting and poor concentration is due to ADHD.

P-32-008 Development of the comprehensive learning test-reading for the Korean children and adolescents H. Yoo*, J. Jung, I. Choi * Seoul, Republic of Korea Objectives: This study aimed to develop the computerized Comprehensive Test-Reading (CLT-R) to evaluate the cognitive processes and achievements related to basic reading ability and to identify dyslexia in children and adolescents in South Korea. We also obtained the normative data and evaluated the reliability and validity of the test. Methods: We developed the computerized CLT-R which includes the word attack/nonword decoding test, paragraph reading fluency test, sound blending test, nonword repetition test, rapid automatized naming test, letter-sound matching test, visual attention test, orthography awareness test, and digit span test. We investigated the reliability and validity of the test and gathered the normative data of 399 subjects (male 48.9 %), aged 5–14 years, from last grade in kindergarten to middle school, dwelling in Seoul and Gyeonggi province, South Korea. Results: The mean Cronbach’s alpha of the CLT-R was 0.75. According to construct validity test calculated by principal constant analysis using oblique rotation method, 4 factors explained 70.0 % of the cumulative variances. In addition, normative data for all the CLTR subtests were obtained. Conclusions: The computerized CLT-R can be used as a reliable and valid tool to detect and evaluate Korean children and adolescents with or without dyslexic condition in schools, clinics, and research institutes.

P-32-007 Knowledge and beliefs of parents, teachers and mental health professionals in Mexico about ADHD

Sunday, 31 May 2015, 08.30 h–10.30 h E. Ulloa*, L. Palacios, F. De la Pen˜a, G. Victoria, A. Novelo * Mexico City, Mexico Objectives: To examine the knowledge and beliefs about ADHD in Mexican parents, teachers and health professionals. Methods: A sample of 288 parents, 84 teachers, 183 psychologists and 294 medical doctors (76 family physicians, 166 pediatricians or neurologists and 52 child psychiatrists or child neurologists) completed the CASOTDAH, a questionnaire examining their knowledge and beliefs regarding clinical characteristics, diagnosis and treatment of ADHD. Descriptive statistics were used for data analysis. Results: About 80 % of all the participants considered ADHD as an illness. However, 10 % of teachers considered it as a parenting problem and only 20 % request a clinical evaluation for symptomatic children. Parents and teachers considered the psychologist as the competent health professionals for the diagnosis and treatment and the combined treatment as the most effective, although 50 % believed that the psychopharmacologic treatment lack of effectiveness and only support the psychological treatment. Among health professionals, psychologists referred to include rating scales and the teacher’s

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PL-4 Controversies in ADHD PL-4-001 Are we facing a worldwide ADHD epidemic? E. Taylor* * London, UK Objectives: Great increases in the diagnosis of ADHD and the use of medication have created public concern about an ‘‘ADHD explosion’’. USA and Europe differ remarkably, but European journalism and sociology often confuse the two and bring in concerns about the influence of drug companies and harmful attitudes to children. This review will bring together epidemiological studies from different regions and different times. Point prevalence studies apply research criteria for ADHD to representative populations. The results differ wildly, but are determined by the methods and criteria applied, not by the year in which they are performed—and only to a limited extent by the country in which they were done. They do not

indicate a major increase in the rate of the disorder in the population. Indeed, successive cohorts of teenagers studied in the UK suggest that hyperactive behaviour has not increased over the years, even though most common mental health problems have increased substantially in young people. Administrative prevalence studies use data from surveys or administrative returns about the rate with which the diagnosis is made in the population in current practice. By contrast with research on ‘‘true’’ prevalence, they show substantial increases in the USA. Successive revisions of the DSM criteria are unlikely to be responsible. Data from other countries are sparse, but within the limits of methodology they do suggest an increase in Europe too. Prevalence of medication for ADHD can be derived from more reliable estimates, because national records are more satisfactory than for diagnosis, and because surveys have been funded because of public concerns about over-medicalisation. They indicate a real increase over time in most of the European countries in which the research has been done, even allowing for the general increase in service provision and medication in particular. The use in Europe, however, is very infrequent by comparison with USA. While the increase in drug treatment might be considered as an ‘‘epidemic’’, it seems likely that the European increase is correcting a previous under-treatment and still has some way to go to reach the desirable levels implied by national and European guidelines. By contrast, the USA rates are so high that they could indicate an overuse of medication, perhaps driven by changes in management and reimbursement.

which have used quantitative variables, such as neuropsychological or brain imaging measures, as surrogate endpoints of treatment response are also highlighted. Results: The biggest contribution to the pharmacogenetics literature of ADHD comes from candidate gene studies that have focused on the ability of monoamine gene variants to predict methylphenidate response. Although this focus has been warranted given the critical modulation of monoamines by methylphenidate, in general this literature has yielded few reliable associations. Few studies have employed GWAS and sample sizes are insufficient to yield reliable associations. This presentation reviews a range of methodological shortcomings that must be attended to in future studies. These include adequate sample sizes and appropriate control for multiple comparisons; adherence to placebo-controlled RCT methodologies; use of biomarkers of treatment response that are grounded in the neuroscience of the disorder and control for patient factors that might influence response. Conclusions: Although the pharmacogenetics literature of ADHD is not yet at the point where it can inform clinical-decision making, there is hope for the future. The international ADHD research community has come together to identify reliable genetic associations and to identify candidate endophenotypes. This unified, multi-centre approach is now required to identify reliable pharmacogenetic predictors of treatment response in ADHD.

Sunday, 31 May 2015, 11.00 h–13.00 h PL-4-002 Do prenatal environmental factors contribute to the risk for ADHD? D. Coghill*

PL-5 New advances in the treatment of ADHD PL-5-001 Beyond stimulants and behaviour modification: New directions for treatment development in ADHD: The next 20 years

* Dundee, UK Abstract not received.

J. Halperin* * New York, USA

PL-4-003 Is ADHD only a neurodevelopmental disorder? G. Polanczyk* * Sao Paulo, Brazil Abstract not received.

PL-4-004 Should available pharmacogenetic tests be used to inform clinicians on deciding about treatment? M. Bellgrove* * Australia Objectives: The identification of objective biomarkers of treatment response is a major goal of biological psychiatry. Pharmacogenetics is the study of how individual differences in genes can affect drug response, both in terms of positive therapeutic as well as adverse effects. This presentation will review the current state-of-the-art of pharmacogenetics as it relates to ADHD and asks whether it can be used as a tool to aid clinical-decision making. Methods: The extant literature on the pharmacogenetics of ADHD is reviewed, focusing on candidate gene and GWAS methodologies, as well measures of therapeutic response and adverse effects. Studies

Objectives: Stimulant medications and behavior modification are the most commonly-used interventions for children with ADHD. Both have been shown to provide significantly greater symptomatic relief and reductions in functional impairment relative to control interventions. However, these treatment approaches were developed in an era when little was known about the etiological determinants of ADHD or its underlying neural substrates. As such, they were designed to target overt symptoms rather than underlying etiological factors. Perhaps, in part, because they target overt symptoms rather than etiological mechanisms, these interventions tend to provide short-term symptomatic relief, but benefits rarely persist beyond the period of active treatment. Yet recent advances in our understanding of underlying mechanisms that lead to or sustain ADHD across the lifespan have the potential to open-up an array of new directions for treatment development. Emerging findings in diverse fields including genetics, neurobiology, neuropsychology, developmental psychology and family/environmental factors provide key insights into risk and protective factors that lead to the emergence and/or persistence of ADHD. Data from these diverse fields will be reviewed with particular attention paid to their applicability to ADHD and their potential for opening up new avenues for treatment development. While considering new directions for treatment development in the context of emerging data, particular attention will be paid to the considerable heterogeneity of ADHD and the likelihood that emerging treatments may require a more dimensional conceptualization of the disorder. Proposed directions for treatment development will include personalized approaches targeting specific

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neurobiological, genetic, cognitive, behavioral and environmental profiles, as well as more generalized approaches that promote healthy living and can often be delivered through schools, community centers and family settings. Emerging research has the potential to drastically alter the quality of treatment for individuals with ADHD by altering the target from symptomatic relief to underlying etiological mechanisms.

PL-5-002 Cognitive behaviour therapy interventions for adults with ADHD M. Solanto* * New York, USA Objectives: The objective of this presentation is to provide a review of the ‘‘state of the art’’ of cognitive behavior therapies for adult ADHD. Methods: The primary method was a review of the clinical scientific literature to the present, that enabled a categorization of results according to the methodological rigor of the corresponding clinical trial(s). The literature review was augmented by personal correspondence with the principal investigators in this field. Results: The cognitive-behaviour therapies that have been developed and tested for efficacy in adult ADHD include CBT for executive dysfunction, adapted dialectical-behavioural therapy (DBT) and mindfulness-based CBT. Both group and individual modalities have been employed. Conclusions: Evidence to date most strongly supports the efficacy of CBT for executive dysfunction in ADHD. Preliminary studies suggest the utility of adapted DBT for the impulsive behaviors, affective instability and interpersonal difficulties of adults with ADHD. A rigorous multi-site trial of DBT compared to stimulant medication is currently nearing completion. Open trials suggest the potential benefit of mindfulness interventions. Studies to date yield no evidence that concurrent medication impacts clinical response to CBT. Further research is needed to ascertain the relative benefits of CBT and medication, as well as to assess the long-term maintenance of gains in CBT. Effectiveness studies are needed to demonstrate and facilitate treatment delivery in ‘‘real-world’’ clinical settings. PL-5-003 What future research should bring to help resolving the debate about the efficacy of EEG-neurofeedback in children with ADHD? J. Buitelaar* * Nijmegen, The Netherlands Objectives: In recent years a rising amount of randomized controlled trials, reviews, and meta-analyses relating to the efficacy of electroencephalographic-neurofeedback (EEG-NF) in children with attention-deficit/hyperactivity disorder (ADHD) have been published. Methods: I will review results of meta-analyses and discuss the future of EEG-NF treatment in ADHD. Results: Although clinical reports and open treatment studies suggest EEG-NF to be effective, double blind placebo-controlled studies (Perreau-Linck et al. 2010; Lansbergen et al. 2011; Arnold et al. 2012; van Dongen-Boomsma et al. 2013) as well as a rigorous meta-

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analysis (Sonuga-Barke et al. 2013) failed to find support for the efficacy of EEG-NF. The meta-analysis of randomized controlled trials (RCTs) of non-pharmacological interventions in children with ADHD including EEG-NF studies, reported non-significant results for the blind rating of symptoms (ES 0.29, p = .07; CI = -0.02, 0.61) (Sonuga-Barke et al. 2013). Conclusions: However, absence of evidence does not equate with evidence of absence! How might future research overcome the present methodological limitations? These include the following: (1) can EEGNF treatment be fully blinded, and if so, how? (2) dealing with reward/positive feedback during active EEG-NF and control treatment; (3) alternative designs such as the interrupted time series analysis; (4) equipoise designs; (5) links with mental exercises in daily life; (6) registration of EEG measures and learning curves during the sessions, and (7) more advanced methods for EEG-NF, such as based on connectivity indices, alpha-gating. Vollebregt MA, van Dongen-Boomsma M, Slaats-Willemse D, Buitelaar JK. What future research should bring to help resolving the debate about the efficacy of EEG-neurofeedback in children with ADHD. Front Hum Neurosci. 2014 May 15;8:321.

PL-5-004 The potential role of transcranial magnetic stimulation in the treatment of ADHD R. Zaman* * UK Objectives: Inattention, hyperactivity and impulsivity in ADHD cause impairment in social, academic and occupational functioning leading to poor educational and vocational outcomes, increased risk for antisocial behaviour and drug abuse. Attention deficits, impulsiveness and hyperactivity appear to relate to disordered executive functions, disturbed motor control with abnormalities in the fronto-striatalcerebellar circuits. PET, fMRI and Evoked Potential studies suggest right frontal dysfunction in ADHD. Dopamine neuromodulation abnormalities have been reported. Methylphenidate (MPH), most prescribed drug for ADHD has response rate of 80 %. MPH increases the striatal and frontal activation capturing DA transporter. Transcranial Magnetic Stimulation (TMS)/repetitive TMS (rTMS) is noninvasive, safe tool to detect pathophysiological abnormalities in neuropsychiatric disorders with latter having therapeutic potential. Rarely used in ADHD, however, TMS has demonstrated a delay in the maturation of the cortico-motoneuronal system (1). Moll et al. (2000) reported ADHD children having significantly reduced intra-cortical inhibition with normal intra-cortical facilitation compared to normal controls that improved with MPH (2). Numerous studies have explored therapeutic use of rTMS in neuropsychiatric disorders, yet in ADHD they can be counted on one hand. Weaver et al. (2008) reported randomized, sham-controlled, crossover study of 9 adolescents and adult ADHD sufferers. Application of 10 Hz rTMS over 2 weeks on the right DLPFC led to improvement of clinical global impression and the ADHD-IV scales for both active and sham rTMS (3). Niederhofer (2008) utilized low frequency rTMS (1 Hz), for 5 days on the ‘‘impending scalp additional motor area’’, in ADHD subjects and reported ‘‘significant improvement’’ that lasted 4 week, however, the placebo control did not show any improvement (4) Bloch et al. (2010) reported crossover double blind randomized, sham controlled pilot study improving attention with high frequency rTMS in 13 adult ADHD (5). Clearly, there is need to further explore the therapeutic potential of rTMS in ADHD.

AUTHOR INDEX

Abaza, N. P-03-012 Abdelmoez, K. P-01-007 Abdussalam, A. P-23-003 Abojdei, A. P-03-012 Ackermann, S. P-08-001 acosta garcı´a, S. P-04-007 Acosta Garcı´a, S. P-15-005 Acosta garcı´a, S. P-17-002 Adamson, C. YS-1-004 Adeyi, B. P-10-005 Adolfsdottir, S. P-23-008 Adriani, W. P-01-001 Afonso, S. P-28-010 Aggensteiner, P. HT-5-003 Aguado Gracia, J. P-04-007, P-15-005, P-17-002 Ahlers, E. P-05-003 Ahmed, T. P-25-009 Aifanti, E. P-18-004 Aitken, M. P-15-006 Aksu, P. P-14-001 Alberola Lo´pez, C. P-03-011 Alberola Lo´pez, S. P-03-011 Albizu, C. P-30-003 Alegria, A. HT-13-001, HT-5-001, P-24-001 Alfaiate, C. P-10-010, P-14-002 Alfredsson, J. P-26-003 Alicea, A. P-30-003 Alimohammadi Malayeri, S. P-16-011, P-16-012 Allende, F. P-01-006 Almagor, D. P-08-010 Almeida, M. P-10-010, P-14-002 Alvarez-Go´mez, M. P-02-008 Alves, M. P-07-005 Alves, T. P-22-005 An, L. P-07-008, P-07-009 Anderson, V. P-21-001, P-28-009, P-29-011 Ando, S. P-28-001 Andre´s Espan˜a, F. P-30-005 Andre´s de Llano, J. P-03-011 Antrop, I. P-15-001 Antunes, R. P-28-010 Arai, G. P-20-011, P-22-008, P-28-005 Araujo, E. P-09-008 Arias-Caballero, A. P-17-004, P-23-002 Arngrim, T. P-12-005, P-12-006 Arnold, L. P-19-009 Arns, M. HT-14-003, HT-5-004 Aschenbrenner, S. P-29-002 Ashcroft, D. P-02-004 Asherson, P. P-05-001, P-05-004, P-06-004, P-22-007, PL-1-002 Atherton, M. P-11-004 Attia, M. P-04-003 Au, A. P-25-006 Aubry, J. P-26-005 Auer, J. P-16-008 Avancini, T. P-20-012 Azouz, H. P-01-003, P-17-009 Bader, M. P-06-002, P-08-001

Bae, J. P-01-002 Bae, S. P-24-002 Baeza-Tena, E. P-10-003 Bahn, G. P-10-005, P-17-006, P-20-002 Ballesteros-Prado, A. P-04-006, P-10-006, P-31-005 Balsam, A. HT-14-004 Banaag, C. P-02-001 Banaschewski, T. P-05-001, P-05-004, P-14-008, P-27-005, PL-1-004 Bangma, D. P-06-001, P-14-003 Bar, M. P-14-012 Barbosa, M. P-16-007 Barker, G. HT-5-001 Barrie`re, O. P-10-002 Bartel, C. P-12-002 Barth, B. HT-5-002, P-26-011 Basurte, I. P-22-009 Batlle Vila, S. P-10-003 Bau, C. HT-11-001, P-02-006, P-13-007 Beare, R. YS-1-004 Beaulieu, A. P-09-008, P-25-003 Becker, S. P-04-002 Beckmann, C. P-07-003, YS-1-001 Beekman, A. P-22-010 Beekman, a. P-17-007 Beets, R. P-11-004 Belle, J. P-14-011 Bellgrove, M. PL-4-004, YS-1-004 Belmonte-de-Abreu, P. P-02-006, P-13-007 Ben Moussa, R. P-03-001 Beneventi, H. P-08-007, P-08-008 Benjet, C. P-17-004, P-23-002 Berenguer, C. P-30-002, P-30-007 Berger, M. HT-9-002 Berggren, L. P-12-001, P-12-002 Bernal Romaguera, P. P-03-007 Bernal, P. P-19-007 Bestue Felipe, C. P-03-007 Bestue, C. P-19-007 Bhide, S. P-29-011 Biederman, J. HT-11-004 Bihlar Muld, B. P-30-008 Bijlenga, D. P-06-005, P-17-007, P-22-010 Bilke-Hentsch, O. P-08-002 Bioulac, S. P-19-002 Biscaldi, M. P-06-011 Bisset, M. P-28-009 Blume, F. P-08-003 Boavida Fernandes, J. P-10-010, P-14-002 Bode, T. P-11-001 Bohbot, V. P-17-005 Boivin, M. P-17-005 Boix, C. P-08-004 Bonenberger, M. YS-2-004 Bonnefois, G. P-10-002 Bonnot, O. P-14-005 Boon-yasidhi, V. P-28-007 Borra-Ruiz, C. P-02-008 Bourourou, R. P-04-003 Bouvard, M. P-19-002 Brahim, T. P-03-001

Bralten, J. P-07-008 Bramham, J. P-06-014, P-22-011, P-26-008 Brammer, M. HT-13-001 Brandeis, D. HT-5-001, HT-5-003, P-05-001, P-05-004 Brandl, C. P-20-001 Breda, V. P-02-006, P-13-007 Bremnes, M. P-08-007, P-08-008 Brennan, R. HT-8-003 Brinson, H. HT-5-001 Bron, A. P-22-010 Bron, T. P-17-007 Brookhuis, K. P-29-002 Brummer, D. P-13-002 Bueno, O. P-07-005 Buitelaar, J. HT-10-004, HT-14-003, HT-7-004, P-07-003, PL-5-003, YS-1-001, YS-2-002 Burke, A. P-20-012 Burns, G. P-04-002 Busatto, G. P-20-012 Bushe, C. P-12-001, P-12-002 Ba¨ck, S. P-13-003 Bo¨lte, S. P-26-002, P-30-008 C. Kan, C. P-12-002 Caballero, B. P-27-005 Cablova, L. P-30-001 Cabral, P. P-29-005 Caci, H. P-14-005 Calabuig Crespo, R. P-30-005 Calil, H. P-21-009 Camprodon Rosanas, E. P-10-003 Cans#z, M. P-21-002 Cansiz, M. P-01-004, P-21-004 Cao, Q. P-07-008, P-07-009, P-18-008 Capriotti, M. P-09-008, P-25-003 Carcangiu, R. P-13-004 Cardelle Garcia, F. P-25-002 Carlisi, C. HT-13-001, P-24-008 Carmona, R. P-29-005 Carr-Fanning, K. P-14-006 Casas, M. P-25-007 Castellanos, F. PL-2-002 Castells, J. P-25-007 Castorina, M. P-26-008 Catani, M. YS-1-002 Cebria´n Gallardo, J. P-30-005 Chaim-Avancini, T. P-30-006 Chan, E. P-29-006 Chan, P. P-29-006 Chan, R. P-07-001 Chang, J. P-14-007 Chang, W. P-18-008, P-23-004 Chantiluke, K. HT-13-001 Chasqueira, C. P-29-005 Chen, C. P-12-005, P-12-006 Chen, K. P-14-008 Chen, M. P-25-008 Chen, Y. P-07-001 Cheon, K. P-20-005 Cheong, J. P-16-006

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Cheung, C. P-05-001, P-05-004, P-06-004 Cheung, K. P-29-006 Childress, A. P-11-005 Chirita, A. P-22-001 Cho, S. P-01-008, P-10-008, P-24-002 Choi, E. P-24-002 Choi, H. P-10-005 Choi, I. P-32-008 Chou, W. P-22-002 Chowdhury, U. P-32-006 Christian, S. HT-14-002 Chronis-Tuscano, A. P-18-005 Claes, E. P-06-001 Clark, P. P-17-004, P-23-002 Climent, G. P-23-011 Cloutier, M. P-13-001 Coghill, D. P-12-001, P-27-005, P-29-001, PL-4-002 Cohen, D. P-14-005 Coleman, J. P-14-011 Colla, M. HT-9-002 Colome, R. P-08-004 Colomer, C. P-30-002, P-30-007 Conca, A. P-02-003 Conzelmann, A. HT-6-003, P-06-012 Cook Jr, E. P-16-004 Corr, P. P-27-008 Corsi, E. P-27-003 Cortese, S. ES-5-001, HT-1-002 Costa, A. P-04-008 Couraud, P. P-16-007 Craig, M. YS-1-002 Crespo-Eguı´laz, N. P-23-014 Crocetti, D. P-24-007 Cruz Fuentes, C. P-17-004, P-23-002 Cruz, C. P-11-009 Cubillo, A. HT-13-001 Curatolo, P. P-01-001 Cutler, A. P-10-005, P-27-004 Ca´rdenas-Godı´nez, E. P-17-004 Dabkowska, M. P-14-009 Dabkowski, M. P-14-009 Daley, D. P-14-010, P-25-005, P-25-006 Dalsgaard, S. HT-4-003, HT-6-002 Dang, S. P-24-003 Davatzikos, C. P-20-012 David, A. HT-5-001 Dawson, K. P-09-001 de Castro-Manglano, P. P-02-008 de La Pena, J. P-16-006 de Oliveira, C. P-16-010 de Souza, A. P-16-010 de Waard, D. P-29-002 de la Pen˜a, F. P-17-004, P-23-002, P-23-005 deCastro-Manglano, P. P-27-002 dela Pena, I. P-16-006 De Bruyckere, K. P-12-002 De la Pen˜a, F. P-32-007 DeBruyckere, K. P-12-001 DeSousa, B. P-11-001 DeVinney, J. P-28-004 Delapena, F. P-11-009 Delgado-Hernandez, A. P-29-004 Delucchi, K. P-25-003

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Demir, N. P-01-004, P-21-002, P-21-004 Demirbas Cakir, E. P-01-004, P-21-004 Dempfle, A. P-22-003 Denckla, M. P-24-007 Deppermann, S. P-05-002, P-05-008, P-24-004 Diaz-Orueta, U. P-23-011, P-23-012, P-23-013, P-23-014, P-31-001 Diers, S. P-14-011 Diez-Suarez, A. P-02-008 Diez-Sua´rez, A. P-27-002 Digiuni, M. P-08-005 Dirks, B. P-10-005, P-27-004 Dirlikov, B. P-24-007 Dittmann, R. P-12-002 Doherty, G. P-09-005 Domı´nguez-Hildalgo, M. P-23-013 Doshi, J. P-20-012 Dosil Dı´az, J. P-25-002 Dovis, S. P-08-006 Drepper, C. P-16-010, P-24-003 Dresler, T. P-08-003 Du Rietz, E. P-05-001 Du, Y. P-23-001 Duarte, M. P-06-002 Duncan, D. P-29-008 Duran Sandoval, L. P-03-007 Duran, L. P-19-007 Duregger, E. P-02-003 Duval, F. P-13-004 Dun˜o-Ambros, L. P-10-003 Do¨pfner, M. HT-10-002 Du¨rrwa¨chter, U. P-03-009 Efron, D. P-21-001, P-28-009 Efron, M. P-14-012 Ege, G. P-13-003 Ehlis, A. ES-6-001, HT-5-002, P-05-002, P-06-006, P-08-003, P-24-004, P-26-011 Eichele, H. P-23-008 Eid, M. P-17-008 Einarsdottir, S. P-08-007, P-08-008 El-Gohary, T. P-17-008 Erb, A. P-13-004 Erden, G. P-14-001 Erder, M. P-14-008 Eryilmaz, G. P-22-006 Escobar, R. P-13-005, P-27-001 Espan˜ol, G. P-30-004 Estrada-Prat, X. P-10-003 Ethofer, T. P-06-006 Fagerlund, B. P-03-013 Fair, D. PL-1-003 Fallgatter, A. HT-5-002, P-05-002, P-06-006, P-26-011 Fallu, A. P-15-008 Faraone, S. HT-10-001, PL-2-001 Fasmer, O. P-23-008 Feedback, C. HT-5-003 Feige, B. P-06-011 Feria, M. P-17-004 Fernandes Medeiros, L. P-16-010 Fernandes, A. P-14-002 Fernandez Fernandez, M. P-23-011 Ferna´ndez Dı´az, A. P-01-005

Ferna´ndez Ferna´ndez, M. P-12-003 Fibert, P. P-08-009 Figueroa-Quintana, A. P-27-002 Findling, R. P-19-009 Fischer, R. P-12-004 Fischer, S. P-20-001 Fleming, G. P-06-014, P-26-008 Florczak-Perchel, M. P-29-007 Flores, J. P-06-008 Fontes-Ribeiro, C. P-16-007 Ford, T. P-11-006, P-18-003 Fornari, E. P-08-001 Fragoso, A. P-17-004, P-23-002 Frank, M. P-16-008 Franke, B. HT-7-004, P-07-008, RC-2-001 Frazier, T. P-19-009 Freitag, C. HT-7-002, YS-2-004 Frenette, E. HT-8-003 Frick, G. P-11-005 Fridman, M. P-14-008 Fristad, M. P-19-009 Fuermaier, A. HT-4-002, HT-8-002, P-06-001, P-14-003, P-20-003, P-29-002, P-31-002 Fujikawa, S. P-28-001 Fujisawa, T. P-16-001 Fung, D. P-09-002 Furuhashi, S. P-26-001 Furuhashi, Y. P-26-001 Gaastra, G. HT-8-002, P-31-002 Gaddour, N. P-03-001, P-04-003 Galera, C. P-19-002 Gallego Villalta, S. P-03-007 Gallego, S. P-19-007 Galvao-Carmona, A. P-05-003 Gambin, M. P-29-007 Gandhi, P. P-12-005, P-12-006 Gandı´a Beneto´, R. P-05-005 Ganjiwale, D. P-02-002 Gao, H. P-09-006, P-29-010 Gao, Q. P-07-001, P-18-008 Garcia Sanchez, N. P-30-005 Garcia, M. P-25-007 Garcia, Z. P-32-002 Garcı´a-Valdecasas, M. P-05-003 Garison, M. P-11-002 Gatti, G. P-02-003 gaviria Go´mez, A. P-15-005 Gau, S. P-10-004, P-14-007 Gaviria Gomez, A. P-04-007 Gawrilow, C. ES-2-001, P-03-009, P-06-009, P-08-003, P-10-004 Geissler, J. ES-6-001, HT-14-004, P-16-002, P-22-003, P-24-003 Gerardin, P. P-32-001 Gerlach, M. HT-6-003, P-16-002, P-24-003 Gersic, D. P-16-008 Geurts, H. HT-7-003 Ghattassi, Z. P-04-003 Giallonardo, M. P-04-008 Giampietro, V. HT-13-001, HT-5-001 Ginsberg, Y. HT-2-004, P-12-005, P-12-006, P-30-003 Giupponi, G. P-02-003

Giuseppe, C. P-09-005 Glenthoej, B. P-03-013 Godefroid, E. P-06-003 Golan -Cohen, A. P-17-003, P-31-007 Golubeva, Y. P-09-007, P-09-009 Gonzales, B. P-32-001 Gonzalez, R. P-30-003 Gonza´lez Reyna, N. P-23-002 Gonza´lez Santos, M. P-01-005 Gonza´lez-Maya, M. P-23-012 Gordon, E. HT-14-003 Goryacheva, T. P-25-004 Gothelf, D. P-14-012 Greven, C. YS-2-002 Grevet, E. P-02-006, P-13-007 Groen, G. P-13-002 Groen, Y. HT-8-002, P-20-003, P-31-002 Grogan, K. P-22-011 Gross-Lesch, S. P-22-003 Guan, C. P-09-002 Gudjonsson, G. P-30-003 Guedria, A. P-03-001, P-04-003 Guerin, A. P-13-001 Guimaraes-da-Silva, P. P-02-006, P-13-007 Guizar, D. P-11-009 Gurkan, C. P-31-004 Gustafsson, J. P-13-003 Go¨kc¸ay, D. P-24-006 Go¨ttgens-Jansen, W. P-31-003 Gu¨l, H. P-31-004 Gu¨nther, T. P-04-004 Gu¨rkan, C. P-24-006 H. Neuhaus, A. P-05-003 Haack, L. P-09-008, P-25-003 Haavik, J. P-22-004, RC-2-004 Habekost, T. P-06-007, P-20-006 Hacker, M. P-07-007, P-24-005 Haeusler, D. P-07-007 Haeussinger, F. P-24-004 Haggag, W. P-01-007 Hahn, A. P-07-007, P-24-005 Halfon, O. P-08-001 Halperin, J. HT-10-003, PL-5-001 Hamada, M. P-04-005, P-15-002, P-21-006 Hamilton, W. P-11-006 Han, J. P-10-005, P-17-006 Hansen, D. HT-14-004 Harby, O. P-01-003 Harel, T. P-14-012 Harmanci, H. P-21-004 Haro, J. P-15-010 Harper, L. P-27-004 Harpin, V. P-14-008 Hart, A. P-11-002 Hart, H. P-24-008 Hartman, C. HT-7-003, HT-7-004, YS-2-002 Hartmann, M. P-08-002 Hasegawa, M. P-28-001 Hazell, P. P-21-001, P-28-009 He, X. P-18-008, P-23-004 Heinrich, J. HT-12-002 Hellwig, L. P-03-009, P-06-009 Henrı´quez-Henrı´quez, M. P-01-006 Hermann, V. P-07-005

Herpertz-Dahlmann, B. HT-7-001, P-04-004 Herrero Casanova, M. P-30-005 Hervas, A. P-10-005 Hildebrandt, T. P-16-004 Hire, A. P-02-004 Hirvikoski, T. P-26-002, P-26-003, P-30-008 Hiscock, H. P-29-009 Hizli Sayar, G. P-22-006 Hobgood, C. P-28-004 Holmes, J. P-15-009 Holtmann, M. HT-5-003 Holzer, S. P-02-003 Hong, J. P-15-010 Hong, M. P-10-005, P-20-002 Honjani, M. P-06-013 Hoogman, M. P-07-008, RC-2-003 Hoppenbrouwers, K. P-05-007 Horbach, J. P-04-004 Hornborg, C. P-13-003 Horwitz, S. P-19-009 Hora´cio Grevet, E. P-16-010 Hsieh, M. P-10-004 Huang, F. P-26-010 Hudak, J. P-08-003, P-24-004 Hudson, R. P-23-005 Hughes, G. P-19-001 Human, W. P-20-012 Hung, S. P-10-004 Huss, M. HT-9-002, P-10-005, P-12-005, P-12-006 Hwang, J. P-10-005 Ha¨nig, S. HT-7-002 Ha¨ußinger, F. P-26-011 Højbjerg Jacobsen, R. P-14-010 Høvik, M. P-23-008 Ibrahim, O. P-01-007 Igarashi, M. P-16-005 Ijaz-Ul-Haq, R. P-29-004 Ikuse, D. P-20-011, P-22-008, P-28-005 Imeraj, L. P-15-001 Incledon, B. P-11-001 Inna, M. P-10-010 Instanes, J. P-22-004 Instebø, K. P-08-007, P-08-008 Ip, P. P-29-006 Ito, H. P-04-005, P-15-002, P-21-005, P-21-006 Ivanov, I. RC-1-002 Iwanami, A. P-07-002, P-20-011, P-22-008, P-28-005 Izquierdo Herrero, E. P-03-011 Jacir, N. P-03-012 Jacob, C. HT-9-002, P-22-003 Jaimes-Albornoz, W. P-04-006, P-10-006, P-31-005 James, S. P-06-004 Jans, T. HT-6-003, HT-9-002, P-22-003 Javier, I. P-20-004 Jensen, C. YS-2-003 Jepsen, J. P-03-013, P-20-006 Jerkovic, I. P-19-005 Jero´nimo, M. P-10-010 Jin, J. P-07-001

Jokinen, J. P-26-002, P-30-008 Jones, R. P-26-004 Jongeling, B. P-28-009 Joseph, A. P-10-008, P-13-001 Jose´ Ma, B. P-20-004 Jovell, e. P-30-004 Jung, J. P-32-005, P-32-008 Jung, Y. P-32-003 Jurma, A. P-15-003 Kabuth, B. P-14-005 Kahn, N. P-13-002 Kaleyias, J. P-11-007, P-23-003 Kalina, K. P-30-001 Kanata, S. P-28-001 Kang, T. P-01-008 Kao, S. P-29-008 Karam, R. P-02-006, P-13-007 Karamustafalioglu, O. P-22-006 Kasai, K. P-28-001 Kashirina, S. P-09-007, P-09-009 Kasper, S. HT-14-001, P-07-007, P-24-005 Katagiri, M. P-04-005, P-15-002, P-21-006 Kautzky, A. HT-14-001, P-07-007, P-24-005 Kerridge, A. P-09-001 Kesic, A. P-15-004 Khan, A. P-11-004 Kim, B. P-01-006, P-01-008, P-10-005, P-10-008 Kim, H. P-16-006, P-19-008, P-20-005 Kim, J. P-01-008, P-05-009, P-07-006, P-10-008 Kim, Y. P-32-005 Kis, B. HT-9-002 Kiselev, S. P-23-010 Kitai, E. P-17-003, P-31-007 Kitat, A. P-17-009 Kitrossky, L. P-06-010 Kitsune, G. P-05-004 Kittel-Schneider, S. P-16-008, P-22-003 Klassen, L. P-15-008 Klebe, S. P-16-008 Klein, C. P-06-011 Klein, M. P-22-005 Klein, R. HT-11-003, HT-6-001 Koelle, M. P-13-002 Koerts, J. P-06-001, P-14-003, P-20-003, P-29-002 Kofler, M. P-23-006 Kohls, G. HT-7-001 Koike, S. P-28-001 Kolevzon, A. P-03-008 Kollins, S. HT-15-002 Konrad, K. HT-7-001, P-04-004 Konstenius, M. P-30-003 Kooij, S. HT-1-003, P-06-005, P-17-007, P-22-010 Kosaka, H. P-16-001 Kouvidi, M. P-18-004 Kraatz, C. P-04-004 Kranz, G. P-07-007, P-24-005 Krokstad, S. P-28-003 Kronfli, R. P-29-008 Kubota, M. P-16-001

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123

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Newcorn, J. HT-13-003, P-11-002, P-11-005, P-16-004 Newlove-Delgado, T. P-11-006 Nguyen, T. P-22-003 Nicastro, R. P-26-005 Nicholson, J. P-21-001, P-28-009, P-29-011 Nicolini, H. P-06-008 Niederhofer, H. P-26-009 Nielsen, H. HT-6-002 Nielsen, N. P-13-003 Nigg, J. PL-1-001, PL-1-003 Niklewski, G. P-20-001 Nikov, L. P-19-007 Nishida, A. P-28-001 Nitulescu, R. P-13-001 Nobuyuki, S. P-20-011 Nogueira, S. P-10-010, P-14-002 Norman, L. P-24-008 Novelo, A. P-32-007 Novick, D. P-15-010 O’Neill, S. HT-10-003 Oerlemans, A. HT-7-004 Oh, I. P-10-005 Oh, S. P-32-004 Okajima, Y. P-07-002, P-20-011, P-22-008 Oldehinkel, M. YS-1-001 Olson, E. P-16-004 Onandia, I. P-32-002 Onofre Gomes de Souza, D. P-16-010 Oranje, B. P-03-013, P-06-007 Oros, M. P-19-005 Ortiz Martin, A. P-03-007 Ortiz Sa´nchez, P. P-05-005 Orylska, A. P-25-001 Ostergaard, S. HT-4-003 Ozcan, A. P-19-012 Ozer, S. P-11-004, P-28-006 Ozten, E. P-22-006 O’Connell, R. P-06-014, P-26-008 O’Hanrahan, S. P-19-001 Pagsberg, A. P-03-013 Paille´, S. P-14-005 Paim Rohde, L. P-16-010 Palacio, A. P-08-004 Palacios, L. P-11-009, P-32-007 Palacios-Cruz, L. P-17-004, P-23-002, P-23-005 Palma, S. P-21-009 Palmason, H. YS-2-004 Palmer, D. HT-14-003 Palomar, G. P-25-007 Paolini San Miguel, J. P-03-007 Paolini, J. P-19-007 Papageorgiou, K. HT-14-001, P-24-005 Parand, A. P-16-012 Park, K. P-19-008 Park, S. P-01-002, YS-1-003 Parlama, E. P-18-004 Parlatini, V. YS-1-002 Parmar, B. P-02-002 Pauli, P. P-06-012 Pedersen, M. HT-4-003 Penninx, B. P-22-010 Perera, S. P-11-007, P-23-003

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