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Q & A with Philippe Robaey

What have you discovered doing Attention Deficit Hyperactive Disorder (ADHD) research?
First, that ADHD is not one single disorder, but different symptoms that are generally expressed together, and with different possible causes. Second, that the diagnosis and the treatment of ADHD would be greatly improved if we could translate what we have learned through research into daily clinical care.

How does your research impact clinical care?
Using medication is controversial in the treatment of ADHD. Research shows that a significant portion of children do not respond to medication or are misdiagnosed. For those who benefit from medication, we do not have any valid way of predicting the response. But parents need to know if an ADHD medication is really making a difference before starting a treatment. Based on research protocol, we developed a trial based on a shared decision process. During four weeks, parents and teachers rate the behavior and side effects using a web-based system, but without knowing if the child is taking either a placebo, or a low, medium or high dose during each week. Then, the parents choose their preferred week based on the results during a shared decision meeting.

How is your research innovative?
Turning research into effective delivery of mental health care is innovative in and of itself, as it changes daily practice. For example, WeTakeCare is an interactive communication system aiming at building a shared vision and communicating about it between patients, family and all those involved in the care of a child with a chronic mental health problem. But we have also to better understand the differences between different forms of ADHD beyond the symptoms, as they may have different causes and treatments. For this purpose, we use genetic or brain imaging approaches as functional MRI (f-MRI), or high density electro-encephalography (EEG) and magneto-encephalography (MEG). We are also testing innovative treatment, for example, by combining cognitive training with a brain stimulation technique such as Transcranial Direct Current Stimulation.

Are you doing any research on a large scale?
I’ve completed a large twin study (650 pairs) funded by CIHR. Twin studies allow the identification of the genetic, neuropsychological, psychophysiological and early environmental factors predisposing to the development and or the expression of ADHD symptoms in children. I am also completing a 15-year longitudinal study of children treated for leukemia with treatments that present a risk for brain development and subsequent ADHD. But the main goal at CHEO is to be able to follow up on all the children and the families seen in the ADHD clinic.

Is there a critical theme to your research?
Translating knowledge into practice and engaging parents and children in their treatment is essential for improving care and for getting support for research. Translating everyday challenges in mental health practice into well-formulated research questions is also essential to keep the focus on the more urgent needs. Translation is the critical theme.

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