James G. Waxmonsky
|Institution||College of Medicine|
|Address||500 University Drive,
Hershey, PA 17033|
My research focuses on efforts to improve the long term outcomes of youth with ADHD as there is a paucity of data to support the long term benefits of ADHD treatments. For example, there has been a concern that patients may develop tolerance to CNS stimulants, thereby reducing long term response, yet there has been no formal examination of this process. Likewise, concerns exist that CNS stimulants may lead to meaningful growth suppression. I have led NIMH funded research assessing both of these questions as well as studying interventions aimed to prevent their occurrence. I have also begun to examine the management of insomnia in youth with ADHD and the contributing role of CNS stimulants. My primary means of improving longitudinal outcomes in this population has been the integration of specialized psychosocial interventions with pharmacological treatments to improve medication efficacy and tolerability. We have also developed psychosocial interventions suitable for primary care settings to improve treatment uptake and adherence for ADHD and other common mental health disorders.
Another common side effect concern surrounding ADHD medication is the capacity for these medications to induce adverse emotional responses. Children with preexisting affective lability are thought to be at increased risk for these types of reactions. My interest in this area led me to evaluate the effect of stimulant medication in children with Severe Mood Dysregulation (SMD), which has now been included in DSM 5 as Disruptive Mood Dysregulation Disorder (DMDD). I have published some of the first treatment studies for SMD which documented that youth with SMD and ADHD respond positively to stimulant medication and behavioral interventions; however, these children still remained more impaired than ADHD youth without mood impairments. I then developed a group therapy program that integrated aspects of traditional parent training programs with CBT techniques for pediatric mood disorders and found it to be effective for reducing irritability. Future work is focusing on identifying impaired neural circuits that drive the manifestation or irritability and aggression in children with a range of mental health diagnoses in order to inform treatment development. Targeted domains include impairments in facial affect recognition, reward processing, instrumental learning and physiological arousal.
During my work on all of these projects, I have come to recognize the impact of parental psychopathology on child treatment outcomes. For example, in my treatment study of youth with ADHD and SMD, we found that parental ADHD symptoms reduced the efficacy of the therapy program for improving their child’s mood. In another externally funded trial, we found that reducing parental ADHD symptoms improves parent-child interactions, especially during homework times, by helping parents to better modulate their levels of talkativeness to the task at hand. We are now beginning to examine other neurocognitive domains within parents to assess their influence on parent-child interactions and to inform the development of new treatments for disruptive behavioral disorders in children.
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