How psychiatric genetics can help to guide diagnostic practice and therapy

Recently, professor Stephen Faraone from SUNY Upstate University in the USA gave a webinar about genetic research in psychiatry (especially ADHD) and how this can help to better understand diagnosis and provide better treatment. In this blog I will share with you some highlights from this webinar.

  1. ADHD is a continuous trait in the population

ADHD is not something that you either have or don’t have. Rather, symptoms or characteristics of ADHD are present in the entire population, in varying severity. The system for psychiatric diagnoses is however based on categorical definitions that determine when a certain combination of symptoms and severity can be classified as a particular disorder. Although these categories can be of great help to provide public health data or determine insurance coverage, they often don’t really match individual cases. Hence there arise problems with heterogeneity, subtypes, subthreshold cases and comorbidity.

Genetic research has shown that psychiatric conditions such as ADHD are not caused by a few single genes, but rather by thousands or tens of thousands genetic variants that each contribute slightly to the ADHD risk. These so-called polygenic risk scores form a normal distribution across the entire population, with the majority of people having low polygenic risk scores (so a low to average risk of ADHD), while a small portion of individuals have a very low or very high risk. This adds to our understanding that ADHD is a continuous trait in the population.

Image from the webinar by prof. Stephen Faraone. The higher the number on the x-axis, the higher the genetic risk of having ADHD. Negative numbers mean reduced genetic risk of ADHD.

2. Comorbidity in psychiatry is the norm, rather than the exception

In the webinar, Stephen Faraone explains that in 90’s it was thought impossible that an individual can have both ADHD and depression. Now, we know better than that. There are substantial genetic correlations between different psychiatric disorders, meaning that the genes that increase the risk of for instance ADHD, also increase the risk of schizophrenia, depression, bipolar disorder, autism and tic disorder. This is further evidence that psychiatric conditions are not separate, categorial entities but rather arise from similar biological mechanisms.

3. Personalised medicine and pharmacogenetics are not yet sufficiently established to adopt widely and replace current medication on a broad scale

The second part of the webinar was about pharmacogenetic testing. This means that an individual’s genetic profile is used to determine whether a drug will be effective, and in what dose. Although this sounds promising, there is still a lot of discussion about the validity of such tests. This is due to varying results, differing protocols and large heterogeneity between studies. In some cases, pharmacogenetic testing can help to find the right treatment for an individual, for instance when this person is not responding well to regular treatment, but it is definitely not a fool-proof method yet. Better randomized controlled clinical trials are needed to improve reliability of these tests.

You can watch the full webinar here: https://www.youtube.com/watch?v=DLgqdJWZKIo

The genetics of having multiple mental health conditions

We know that psychiatric conditions have a strong genetic component. This means that genes play an important role in determining an individual’s risk or vulnerability to develop a psychiatric condition. However, there is evidence that there are genetic variants that increase the risk for multiple psychiatric disorders. This is called pleiotropy. Researchers of the “Cross-Disorder Group of the Psychiatric Genomics Consortium” have searched the entire genome of 727,000 individuals (of whom 233,000 were diagnosed with a psychiatric disorder) to identify genetic variants with such pleiotropy.

The researchers found one particular gene – called DCC – that increases vulnerability for all eight disorders that were investigated: ADHD, autism spectrum disorder, anorexia nervosa, bipolar disorder, major depression, obsessive compulsive disorder, schizophrenia and Tourette syndrome.

They also found more than 100 genetic variants that predispose to at least two psychiatric disorders, and around 20 variants that are associated with four or more. This means that the genes that contain these variants can be interesting to further understand why certain individuals are more vulnerable to develop psychiatric illnesses than others.

One of the researchers, professor Bru Cormand, explains more about this research in this blog.

Further reading: Cross-Disorder Group of the Psychiatric Genomics Consortium (2019): Genomic Relationships, Novel Loci, and Pleiotropic Mechanisms across Eight Psychiatric Disorders. Cell, 179(7): 1469-1482.e11. https://www.sciencedirect.com/science/article/pii/S0092867419312760

Professor Cormand is involved in the CoCA research consortium where he investigates the genetic overlap between ADHD, major depression, anxiety disorder, substance use disorder and obesity. To read more about this, see for instance this other blog by him and dr. Judit Cabana Dominguez.

Why following instructions is essential for treatment success (and why this is really difficult)

 

Clara Hausmann, Mental mHealth Lab / Chair of Applied Psychology, Karlsruhe Institute of Technology



When visiting your doctor due to a simple cold you’ve caught, you will probably get the following advice: Get a rest from work, stay in bed for a week, drink a lot of herbal tea and go for a slow walk once a day. Well, you might follow the advice as you’ve been told. But possibly, you can’t stand tea or you are currently under pressure to finish some urgent work and anyway, you don’t feel that bad anymore after one day in bed. The degree to which a patient correctly follows medical advice is called compliance.

            Compliance is also an important term in the psychological and medical research, we are conducting – especially in our ambulatory settings where patients are treated outside of the hospital. In contrast to doing research in very well controlled laboratory settings, embedding research into everyday life  avoids  a lot of methodological disadvantages. For example, participants’ behavior won’t be biased by the presence of a researcher or the artificial situation in the lab. Another great feature of ambulatory assessment lays within the opportunity to gather real time or near real time data. Participants will be regularly asked about their current state of mind, so researchers don’t have to take into account the inaccuracy of patients’ retrospective reports [1] .  Still, we are facing some difficulties when using ambulatory settings – reaching a good compliance is part of it.

            In the CoCA PROUD study, for instance, we are ambulatorily monitoring our ADHD-diagnosed participants’ mental and physical state. Therefore, they are equipped with a smartphone and a small activity sensor. Participants keep an eDiary, by fulfilling repeated questionnaires on the smartphone while the activity sensor on their wrists measures physical activity. Meanwhile, they will take part in some non-pharmalogical interventions (daily physical exercise training or bright light therapy), which promise to alleviate some core symptoms of ADHD and it’s comorbidities such as depression.

            In this study, „compliance“ is what we call the percentage of prompts, that were answered, in order to fulfill the eDiary. All in all, participants receive four prompts per day, including questions about their current mood, social context and ADHD symptomatology. Furthermore, we can analyze how often the sensor was worn. Additionally, checking for the compliance during the interventions allows us to calculate how much time was spend on actively carrying out the instructions (e.g. doing strengthening and aerobic exercises).

In general, we aim to reach a good compliance. The more our participants contribute, the better the quality of data and the understanding of ADHD can be. However, one can imagine that general facts of life such as situational distraction or simple forgetting can be a hindrance for participants, to answer prompts [2].  Apart from this, researchers must be aware, that ambulatory assessment is inherently disruptive to participants’ daily lives. For instance, the activity trackers that participants wear are quite big, and getting daily prompts from the eDiary can be a real nuisance. The art lies in the design of the research: It is unquestionably essential to find a good balance between participants’ expenditure in time and energy and the amount and quality of data collected [3]. In order to find this balance, we’re always first testing the research study on ourselves to check for the feasibility, comfort, and ease of participation.

            Besides that, there are specific challenges for participants diagnosed with ADHD. For instance, the tendency to show irregularities in the day-and-night-rhythm might not always match the time of the smartphone prompts, that are sent in regular intervals. Furthermore, some patients tend to have problems in keeping their belongings organized. Especially for young patients, it might be challenging to keep the phone both charged and on their person. Inattention and lack of concentration as core symptoms of ADHD, are additional burdens to the conscientious and constant work on the questionnaires. Particularly young patients are expected to be quickly bored by the repeated questions, incoming day by day.

            We encounter those difficulties in multiple ways. An important tool is the smartphone’s chat function. Participants can easily reach a contact person and vice versa. Hence, individual or technical problems can be detected and solved quickly. In order to facilitate the start, we send reminding and motivating messages during the first four days of the measurement. To keep participants’ motivation high, they receive daily feedbacks, visualizing how they have performed when exercising.

            Taken as a whole, compliance, whether good or not, provides a lot of important information about the quality of the intervention. A treatment can only be considered as promising and helpful, when patients are able and motivated to include it into their daily lives. Therefore, the combination of ambulatory assessment and compliance monitoring gives us a realistic idea of a treatment’s actual feasibility and – in the consequence – it’s quality.

 

References:

[1] Trull, T. J., & Ebner-Priemer, U. W. (2013). Ambulatory Assessment. Annual review of clinical psychology, 9, 151–176. doi:10.1146/annurev-clinpsy-050212-185510 

[2] Piasecki et al. (2007). Assessing Clients in Their Natural Environments With Electronic Diaries: Rationale, Benefits, Limitations, and Barriers. Psychological Assessment,19(1), 25-43. doi:10.1037/1040-3590.19.1.25


[3] Carpenter, R. W., Wycoff, A. M., & Trull, T. J. (2016). Ambulatory assessment: New adventures in characterizing dynamic processes. Assessment, 23(4), 414–424. https://doi.org/10.1177/1073191116632341


 

Is it safe to use ADHD medications during pregnancy?

“Should I discontinue stimulants when I am pregnant?” “Is it harmful to my developing baby if I take ADHD medications during my pregnancy?” “What are the risks both to me and my baby if my ADHD goes untreated?” “What is the best way to manage my ADHD during pregnancy?” – For women with ADHD who become pregnant, especially those with moderate or severe ADHD symptoms, the next few months are filled with questions. One important decision for the pregnant women and their clinician is whether to remain on or cease their ADHD medication treatment before or during pregnancy, or while breastfeeding. Unfortunately, there is no clear ADHD treatment guidelines for pregnant women, which further complicates these decisions. Therefore, there is a need for high-quality evidence to support guidelines for the use of ADHD medication during pregnancy.

Given that, it is unethical to include pregnant and breastfeeding women in clinical trials, evidence-based guidelines need to rely on findings from naturalistic studies. So, what does the available findings from naturalistic studies tell us?  

In our newly published paper in CNS Drugs (https://doi.org/10.1007/s40263-020-00728-2), we conducted a systematic review to synthesize all available evidence regarding the safety of ADHD medication use while pregnant, with a focus on how these studies have handled the influence of confounding, which may bias the estimates from observational studies.

We identified eight cohort studies that estimated adverse pregnancy-related and offspring outcomes associated with exposure to ADHD medication during pregnancy. These studies varied a lot in data sources, type of medications examined, definitions of studied pregnancy-related and offspring outcomes etc. Overall, there was no convincing evidence for an association between maternal ADHD medication use during pregnancy and adverse pregnancy and offspring outcomes. Some studies suggested a small increased risk of low Apgar scores, preeclampsia, preterm birth, miscarriage, cardiac malformations, admission to a NICU, and central nervous system (CNS)-related disorder, but other available studies failed to detect similar associations. Because of the limited number of studies and inadequate confounding adjustment, it is currently unclear whether these small associations are due to a causal effect of prenatal exposure to ADHD medication or confounding.

In conclusion, the current evidence does not suggest that the use of ADHD medication during pregnancy results in significant adverse consequences for mother or offspring. However, the data are too limited to make an unequivocal recommendation. Therefore, physicians should consider whether the advantages of using ADHD medication outweigh the potential risks for the developing fetus according to each woman’s specific circumstances.

More information here:

Li, L., Sujan, A.C., Butwicka, A. et al. Associations of Prescribed ADHD Medication in Pregnancy with Pregnancy-Related and Offspring Outcomes: A Systematic Review. CNS Drugs (2020). https://doi.org/10.1007/s40263-020-00728-2

Authors:

Lin Li, MSc, PhD student in the School of Medical Science, Örebro University, Sweden.

Henrik Larsson, PhD, professor in the School of Medical Science, Örebro University and Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Sweden.

The notorious evening chronotype and my master’s thesis

Almost every person, healthy or not, suffers from occasional problems with sleep and circadian rhythm. In the modern days of 24/7 smartphone use and transcontinental flights, our internal body clock is having a hard time adjusting to the external cues. For the persons suffering from mental health issues, their impaired sleep cycle can be one of the cornerstone problems of daily living. Sleep problems have been confirmed to be a first symptom, consequence, or even a cause of such psychiatric conditions as major depression, bipolar disorder, ADHD, autism, substance abuse, and even aggressive behaviour. Their strong relations, however, have not been studied systematically and broadly just yet.

Why study the circadian rhythm?

Circadian rhythm is our inner clock that regulates a lot of important processes in the human body, including the sleep/wake cycle, the release of hormones and even the way we process medicines. This clock is run by the brain region called the hypothalamus, which piles up a protein called CLK (referring to “clock”), during the daytime. CLK, in turn, activates the genes which make us stay awake, but also gradually increases the creation of another protein called PER. When we have a lot PER, it turns off CLK production and makes us ready to sleep. As CLK is getting lower, this causes a decrease in PER, so that the process starts again with elevating CLK waking us up. This cycle happens at around 24-hour intervals and is greatly influenced by so-called zeitgebers, or time-givers, like light, food, noise and temperature. When our retina neurons catch light waves, the suprachiasmatic nucleus in our brain stops the production of the hormone called melatonin that induces sleep and starts producing noradrenaline and vasopressin instead to wake us. This is the exact reason why you cannot fall asleep after watching a movie at night.

PER
Figure 1. The smart protein CLK wakes us up and its friend PER gets us to sleep.

Sometimes our body clock fails to function, as in the case of jetlag when we feel bad after changing a time zone or social jetlag when we have to start work early at 8 am. It can go as far as a circadian rhythm disorder meaning you have either a delay or advancement of sleep phases or an irregular or even non-24-hour daily activities preference. However, in the general population, a small variation in the rhythm is quite normal and is usually referred to as a chronotype. It defines your preference of when to go to sleep and do your daily activities and is divided into 3 distinct versions. The radical points of these variations include a morning chronotype, or “larks”, who go somewhat 2-3 hours ahead of the balanced rhythm, and an evening chronotype, or “owls”, who are a little delayed. The larks feel and function better during the first half of the day and go to bed rather early, while the owls prefer to work in the evenings and go to bed and wake up naturally late. The third chronotype is the in-between, balanced version of these two.

arjan-stalpers-itBTNoD1PpA-unsplash
Figure 2. The ‘owls’ seem to have questionable personalities and suffer from psychiatric conditions more often!

What’s my study about?

Previous research has shown that many psychopathologies are linked to an evening circadian preference. For my master thesis research, I am investigating whether we can identify specific profiles in sleep and circadian rhythm problems that are linked to specific mental health problems. There was even a curious study where researchers linked the Dark Triad personalities, which include people with tendencies for manipulation, lack of empathy, and narcissism, to the evening chronotype. Maybe this leaves some evidence for the famous quote that “evil does not rest”. However, there’s a great variation in sleep duration and perceived quality of sleep in patients with various diseases. We hope to divide such persons into more or less accurate groups with a sleep profile that would predict and aid the correct diagnosis of one or the other mental health condition.

The psychopathologies are included in our study as so-called dimensions, which look at each psychiatric syndrome not as with a norm/pathology cut-off but rather as a continuum of symptoms severity. This approach allows us to see if the sleep/circadian profile we identify refers to mental health in general or can be a distinguished part of a certain psychiatric condition. It might be that all dimensions, like depression and autistic spectrum disorders, have an evening chronotype and some non-specific sleep problems. Alternatively, we might find out that a person with symptoms of depression would sleep more or less than average and go to bed later, whereas a person with anxiety would go to sleep later as well but wake up at night very often despite an average summed up sleep duration.

The circadian rhythm changes throughout a lifetime from an early to an evening chronotype towards adolescence and then gradually shift back to the earlier preference with older age. Across the whole lifespan people constantly face varying quality of night sleep. Moreover, each psychiatric condition has a particular age of onset and sometimes changes its character with time. These are the reasons why our study will also look at how the sleep/circadian profiles change within the development phases from children (4-12 years) to adolescents (13-18) to adults (19-64) to the elderly (≥65) and if they affect males and females differently.

Why would it matter?

Should we discover distinct links between the profiles of sleep/circadian problems and certain conditions, other studies can then look into whether these profiles could be the reasons behind developing a mental health condition. It’d be interesting to finally learn what is a chicken and an egg in each profile-disease relation. For instance, should we really treat ADHD patients with melatonin and bright-light lamps instead of stimulants?

sabri-tuzcu-KHBvwAnWFmc-unsplash
Figure 3. Maybe if we adopt a typical cat’s lifestyle, we get less mental health problems. 🙂

Dina Sarsembayeva is a neurologist and a research master’s student at the University of Groningen. She is using the data from the CoCa project to learn if the chronotypes and sleep problems can be turned into profiles to predict specific psychiatric conditions.

Further reading

  1. Walker, W. H., Walton, J. C., DeVries, A. C. & Nelson, R. J. Circadian rhythm disruption and mental health. Transl. Psychiatry 10, (2020).
  2. Logan, R. W. & McClung, C. A. Rhythms of life: circadian disruption and brain disorders across the lifespan. Nature Reviews Neuroscience vol. 20 49–65 (2019).
  3. Jones, S. G. & Benca, R. M. Circadian disruption in psychiatric disorders. Sleep Med. Clin. 10, 481–493 (2015).
  4. Taylor, B. J. & Hasler, B. P. Chronotype and Mental Health: Recent Advances. Curr. Psychiatry Rep. 20, (2018).

The genetic architecture of the brain

Genes play a big role in determining the architecture of our brain: the way it’s folded, the thickness of the outer layer, and the way different brain areas are connected. By combining data from all over the world, a large collaboration of researchers from the ENIGMA consortium has now identified almost 200 genetic variants that are involved in this brain architecture. These findings can help us to further understand the genetics of brain disorders. 

Our genes contain the blueprint of our bodies. They contain information about how our cells function, and they determine for instance the colour of our eyes and hair, or whether we like cilantro (coriander) and bitter tastes. For some traits we know very well how they are influenced by genes. Eye color for instance is coded by only a few genes. But for many other traits such as height and personality, many different genes are involved. In addition, other (non-genetic) factors also influence these traits, such as malnutrition that can cause stunted growth.

The architecture of the brain is influenced by a large numer of genes, of which we still know very little. To investigate this, researchers combined genetic data of over 50.000 individuals with MRI-data. MRI-scans can show in detail the thickness of the outer layer of the brain, where all the brain cells are (also called the grey matter). They can also be used to measure how much this layer is folded, which gives information about the total surface of this outerlayer. This brain architecture is unique to every individual. The extent of the folds and the thickness of the outer layer have previously (in other research studies) been linked to cognitive abilities and various neurological and psychiatric disorders, such as Alzheimer’s disease, schizophrenia, depression, autism, and ADHD. It is therefore helpful to understand the genetics of this architecture, because it will help us to better understand the genetic mechanisms of these conditions.

The findings from this research study are also explained in this video:

This important research can only be done by combining a lot of data and collaborating with a large number of scientists and institutes. The ENIGMA consortium has been set upt to facilitate this kind of world-wide collaboration. The research that has now been published is the combined effort of more than 360 scientists from 296 departments across 184 different institutions and universities. They also made their results downloadable so that everyone who is interested can have a closer look.

The full publication can be found here: https://science.sciencemag.org/content/367/6484/eaay6690

See also our previous blogposts about these topics:

 

 

 

Prevalence and cost of ADHD comorbidity

Do individuals with ADHD more often suffer from depression, anxiety, substance abuse or severe obesity, than individuals without ADHD? Are there differences between men and women in how often this is the case? Does having ADHD in addition to one of these conditions result in higher health care costs?

The short answers to these questions, are yes, yes and yes. In the CoCA-project, researchers have investigated these questions using very large datasets including Scandinavian birth registries that contain information of millions of people. This allows us to get a better understanding of how often conditions occor, how often they occur together, and how often they occur in men vs women. Furthermore, we have investigated health insurance data from Germany to study patterns of health care costs associated with ADHD and its comorbid conditions.

The interpretation of these data is however not simple. That is why we have recorded a webinar with dr. Catharina Hartman from Groningen, The Netherlands. She is the leader of these studies and can explain what these findings can and cannot tell us. The webinar ends with implications for policy makers and health care professionals, based on these findings.

These are the world’s most high ranking experts on ADHD

Who are the most knowledgeable people about ADHD in the world? According to the website expertscape.com, these are professors Stephen Faraone (SUNY upstate University), Samuel Cortese (University of Southampton) and Jan Buitelaar (Radboud University Nijmegen).

What’s more, several scientists who are involved in our research consortia that investigate ADHD (i.e. Aggressotype, CoCA, IMpACT, Eat2beNICE) are top-ranked in this list of more than 30.000 possible experts in the field. These include Stephen Faraone, Jan Buitelaar, Philip Asherson, Barbara Franke, Joseph Antoni Ramos-Quiroga, Henrik Larsson, Catharina Hartman and Pieter Hoekstra. What this means is that the ADHD research that we do, and that is often reported on in this blog, is lead by the world’s top ADHD experts.

adhdexperts_pic
‘Our’ top-ranked ADHD experts. From left-to-right: Stephen Faraone, Jan Buitelaar, Philip Asheron, Barbara Franke, Joseph Antoni Ramos-Quiroga, Henrik Larsson, Catharina Hartman, Pieter Hoekstra.

How is an expert defined?

The website expertscape was started by John Sotos when he was looking for an expert on Parkinson’s disease to treat his uncle. This turned out to be more difficult than he thought. As John Sotos was a doctor himself, he luckily had a large network of doctors that he could contact about this. But this made him realise that people who don’t have such a network, would not be able to find out who the most knowledgeable persons are on a particular topic. He therefore created this website expertscape.com

The way the website works is quite simple: it searches for academic, peer-reviewed publications by a certain person on a certain topic. The more someone has published on a topic, the higher this person is ranked. Thus,  “[a]n expert is not just someone who knows a lot about a particular topic. We additionally require that the expert write about the topic, and be involved at the leading edge of investigation of the topic.”

This means that the site is actually not a very good tool to find a good doctor. As the website acknowledges “a great doctor has many important qualities beyond expert knowledge of your very specific medical condition.” However, it does mean that the website is pretty good at providing a simple overview of who has a lot of scientific knowledge about a specific topic.

So are they really experts?

In the past years I have met with most people in the top of this list, and I dare say that they are very knowledgeable indeed. Each of them has been working in the ADHD field for a considerable amount of time and has added important new insights into ADHD through research and publications. What I find most striking from this list however, is that most of these experts work together in consortia and international networks. And that is how the field really moves forward: by combining the knowledge of all these experts.

Several of these experts have also written for this blog:

 

Source: http://expertscape.com/ex/attention+deficit+disorder+with+hyperactivity

 

This blog was written by Jeanette Mostert. Jeanette studied brain connectivity in adult ADHD during her PhD. She is now dissemination manager of the international consortia CoCA and Eat2beNICE. 

 

On a coalmine and an MRI scanner – Is it fun, participating in DELTA? (2)

About two and a half years ago, Dr. Emma Sprooten started the DELTA project. In DELTA, acronym for Determinants of Long-term Trajectories in ADHD, she investigates factors that contribute to the difference in (severity of) symptoms and impairment in people who were diagnosed with ADHD as a child. Previously, these adults participated in a study called NeuroImage when they were a child. We asked them if they were willing to participate one more time in this study. We will post three blogs about the project. This is blog 2.

What happens on a test day?

Back to Essen, autumn 2019. Our participants receive a letter with an indication of the address and a photo of the exact building. Even then, a lot of them seem to be somewhat confused. Is the appointment really here, in this place? Yes, the 7 Tesla MRI scanner that can produce super detailed images happens to be here. On the premises of an old coalmine, that is now a UNESCO world heritage site, as we’ve seen last week.

When everyone has arrived, we start with coffee. Long travels make thirsty, right? While we serve coffee, participants fill in a form with questions about their health. This is to make sure that their health is compliant with the German safety rules to undergo a 7 Tesla MRI scan.

When we enter the scanner room wearing shoes that contain metal parts, we can actually feel that this scanner has a very strong field strength: some shoes make you feel like wading through water! This strong field strength is why participants wear the green or blue clothes that surgeons wear in the operation theatre. A lot of ‘normal’ clothing has metal parts (such as zippers) or invisible metallic microfibers. This would give distortions on the data we gather or, even worse, can cause burns on their skin.

Going into the scanner is a special experience too. Because of the strong magnetic field, you may feel dizzy when moving into the scanner. One of our participants told afterwards: ‘I was really a bit confused: huh, I didn’t use drugs, what’s happening!?’ Compared to the 3 Tesla scanner in Nijmegen, where we also make an MRI scan, participants are placed quite a bit deeper into the bore of the scanner. Their whole body actually is inside the tunnel. So not having claustrophobia is also important. The participants spend the next 45 minutes in the dark, accompanied by loud rhythmic noise, until the scan is finished.

Time for lunch. During lunch, we transfer the data from the scanner to our hard drive, so that we can take it back to Nijmegen. Because the scanner registers the brain in such a detailed and precise manner, it generates a lot of data. The files that the scanner generates are so big that it lasts about half an hour to transfer the files!

Lunch is also a good time to have an informal chat about how the first day of testing – in Nijmegen – had been. During the first test day in Nijmegen, we also make an MRI. This MRI is made on a 3 Tesla scanner. In Nijmegen the scan consists of a part where you can just lie down and a part where you, still lying down, do some mental exercises. In that first part we measure brain anatomy and the activity of the brain at rest. During the mental exercises, we measure what happens in the brain while performing the exercise. Next to scanning we ask participants to fill in questionnaires, and do some tests to measure their IQ. We also do clinical interviews to assess the presence of ADHD symptoms and possible comorbid disorders.

After lunch we usually schedule one of the clinical interviews that are part of the project. When this is finished, it is time to head back to Nijmegen!

While collecting the data, we learn a lot about how people integrate ADHD in their lives. We feel honored by all these people telling us their life stories and helping us by participating in our project. Some participants tell us that they learned more about themselves or gained new insights. A compliment that makes us grateful.

Next week, we will explain why we drive all the way to Essen with our participants, and provide you with some information on the content of the project.

On a coalmine and an MRI scanner – Is it fun, participating in DELTA?

About two and a half years ago, Dr. Emma Sprooten started the DELTA project. In DELTA, acronym for Determinants of Long-term Trajectories in ADHD, she investigates factors that contribute to the difference in (severity of) symptoms and impairment in people who were diagnosed with ADHD as a child. Previously, these adults participated in a study called NeuroImage when they were a child. We asked them if they were willing to participate one more time in this study. In the coming three weeks, we will post three blogs about the project. This is blog 1.

2019. Somewhere in autumn. Trees have become all shades of brown, yellow and red. We pass forests while driving on a German highway, all the way from Holland. After a while, the landscape changes from the colored forest to an industrial town. It is grey and gloomy, packed with old-fashioned industry buildings. Soon, the navigation sends us into an even more surreal place. We find ourselves surrounded by rusty brown pipes in a place that feels like an abandoned factory. If we would not know better, we would begin to feel a bit worried about what could happen here… 

What brings us here in this desolate area? To put it short, a bunch of people who were diagnosed with ADHD during their childhood, and a hypermodern 7 Tesla MRI scanner. Over ten years ago, as children, our participants first came in together with their parents and siblings. They played games, were interviewed and got an MRI scan, that was presented to them as ‘ a picture of the inside of your brain’. Now, we are repeating these measurements for a third time, with an upgrade from 3 Tesla to 7 Tesla MRI, allowing even more detailed pictures of their brains.

For scientists it is extremely valuable that people are willing to take part in this research. This is one of the few cohorts in the world in which people with ADHD are followed up for such a long time. It makes it possible to investigate which factors influence the different clinical trajectories that ADHD can take:. We are now testing people for already a third time in the NeuroImage project, that started in 2009. The current follow-up is called the DELTA project. More on the content of the project in our third blog. 

Next week, we’ll give you a peek into what a participant experiences during a test day in Essen. 

If you cannot wait to get some information on NeuroImage, see: https://www.ru.nl/donders/vm-site/collaborations/projects/neuroimage/

For a peak into Zollverein, the world heritage site where the 7 Tesla scanner is located, see: https://www.zollverein.de/zollverein-unesco-world-heritage-site/ The photo at the top of this post shows a detail of the coal mine at Zollverein.