Professor Samuele Cortese Hi, my name is Samuele  Cortese. I am an NIHR Research Professor and a   Professor of Child and Adolescent Psychiatry  at the University of Southampton in the UK and,   also, Professor of Child Neuropsychiatry  at the University of Bari in Italy,   and at the University of New  York in the United States. The presentation today will focus on the  “Comorbidity Between ADHD and Medical or Physical   Conditions,” which I think is very exciting topic  and relatively novel. I think many of us who are   familiar with ADHD know very well the so-called  neuropsychiatric, or psychiatric comorbidities,   of ADHD, so we know, of course, that ADHD tend to  be comorbid with oppositional defiant disorder,   anxiety disorder, mood disorders, and so on  and so forth. But there’s been less attention   over the years on the comorbidities with  physical conditions, and I think there is an   emerging literature on this topic, which is also  interesting for the implications for the clinical   practise. So, in this presentation, I will  try to provide an overview of this literature. Alright, so, before moving actually to the  presentation itself, this is the disclosure   of possible conflict of interest for me,  and let’s move then to the presentation,   as such. So, as I mentioned, I think there’s  been really an increasing awareness on the   importance of somatic or physical conditions  associated with psychiatric disorders.   And this is built on the notion that many  conditions, which classically have been   thought to be as a nervous system disorder, so  disorders of the brain, actually include, also,   alterations in other physiological systems, in  other parts of the body. And it will be really   unwise not to consider these comorbidities,  because, of course, we are supposed to treat   the – our patients in a holistic way,  rather than in a very fragmented way. So, based on this understanding, in the past  15 years, or so, there’s been an increasing   number of studies looking at the associations, and  their implications, between ADHD and alterations   in other physiological systems. And it would be  quite challenging for me to summarise all these   studies in this presentation, but fortunately, we  had – we have just published what I think is an   important piece of evidence in this field, which  is what we call an “umbrella review.” So, umbrella   review is a systematic review of meta-analysis,  or systematic reviews in the field, so it’s really   the highest level of evidence synthesis that we  can think of. And in this umbrella review, we were   interested in knowing the associations between  ADHD and comorbid health conditions, in general. So, if you look at the paper,  you will find these graphic apps   that – which hopefully is helpful  to summarise the key findings. So,   as you can see here, we found evidence  for significant associations between ADHD   and a number of conditions in the body  that you see reported in this figure. One of the important aspects of umbrella  reviews is that also gives the certainty of   the evidence so it can grade the certainty  of the evidence around the findings. So,   based on this, we actually concluded  that there are a group of conditions   for which we know there is high-certainty  evidence that they are associated with ADHD,   in a very strong way statistically, but there  are, also, other conditions which are associated   with ADHD with lower level of certainty, but  still statistically significant. And, finally,   some other conditions that – for which there is  low-certainty evidence because of methodological   problems in the included studies. And you will  see all these conditions here in this slide,   so I will not read, of course, for you,  but you have a very comprehensive list. And you can see that, interestingly, many of  these conditions are related to alterations of   the immune system, so immunological alterations  may play a role in the comorbidities. We know,   also, that there are also genetic factors  that may explain the association, but,   also, lifestyle factors that explain the  association between ADHD and other conditions. Right, so, this was an overview  of the evidence, and we know then   that there is a significant association,  but the point for Clinicians I think is,   okay, so what are the implications of these  association in our clinical practice? Well,   I think the obvious implication is  that we need to be mindful of this,   we don’t need – we don’t have to overlook these  associations, and the management of comorbid   condition is important. I will focus now, in  particular, as an example, on the management   of the comorbidity between ADHD and obesity,  because it does have important implications. So, let me show you the result of a study which  was conducted several years ago, and this was a   study conducted in a bariatric clinic for  individuals with severe levels of obesity,   who were refractory to a standard treatment  for obesity. Now, until this study, nobody   had checked how many of these had ADHD. When the  authors, the Researchers in this study, checked   the presence of ADHD with standardised tools,  so in a very rigorous way, they found that out   of 242 individuals with a severe obesity in this  clinic, 32% had ADHD, a formal diagnosis of ADHD.   And when they treated them with a pharmacological  treatment, they found that at the endpoint, after   14 months, those treated with a pharmacological  treatment for ADHD had lost 10% of their weight.   Those who didn’t have ADHD, and hence they  were not treated pharmacologically for ADHD,   unfortunately, they were not able to lose weight,  so they still presented their refractory obesity. Now we may think, of course, one of the  effects, the side effects of stimulants,   pharmacological treatment of ADHD, is weight  loss. But this was not an explanation here,   because these findings were reported after  14 months of treatment, and we know that   usually the weight loss is more pronounced during  the first weeks or months of treatment. So, rather   than thinking that this was a side effect of the  medication, the most plausible explanation is   that the management of ADHD in those individuals  who had obesity and also ADHD allowed a better   control of executive dysfunction. And this, in  turn, allowed them to be able to better follow   the treatment, to adhere to the diet, to have a  healthier lifestyle, and hence to lose weight. So, the key message I think from this study is  that, actually, it is important to be aware of   this comorbidity, and the treatment  of ADHD may have a positive impact,   not only on ADHD itself, but, also,  on the comorbid obesity, which,   as you can imagine, is very important  from a public health point of view. And, finally, I wanted, also, to highlight that  this is not just the case for pharmacological   treatment, it can occur also with  non-pharmacological treatment. So,   this was a study where the authors tested the  effect of executive function training and,   once again, improving executive  functions, via this training,   had a positive effect after 25-session,  in terms of weight loss in these were   children with obesity. So you see there is  clearly a difference in body mass index. So, once again, I think that the overall message  is – from this presentation is, really, we should   be aware of these important links between ADHD  and physical condition, and the treatment of ADHD   may have beneficial effects that go beyond  ADHD itself. Thank you for your attention.