PhD Study : Visual and ocular side effects of attention-deficit hyperactivity disorder (ADHD) medication in children and adults/Healthy Communities.

Summary

Across the Western world an increasing trend has been observed in the prescribing of medication to manage conditions such as ADHD, particularly in young males. In the UK, an 800% increase was observed in the prescribing of methylphenidate, dexamphetamine/lisdexamphetamine and atomoxetine between 1995-2015 for ADHD (Renoux et al 2016).  This dramatic increase has been associated with an increase in the number of patients diagnosed with ADHD during this period.  A wide range of systemic side effects are associated with these medications including effects on the visual system.

Limited data exist describing the ocular side effects of these medications and there are suggestions that methylphenidate (most commonly prescribed medication for ADHD, also branded as Ritalin or Concerta) is associated with reduced accommodation (poor focusing leading to reduced near vision), pupil dilation and dry eye in addition to an increased risk of angle closure glaucoma (Larrañaga-Fragoso et al 2015, Tractman 1992, Whitman et al 1997). In one month (August 2017) in NI, 3749 prescriptions for methylphenidate were issued by GPs. It is not clear however, if these were issued for adults or children, however, this medication is licensed only for ADHD and it is likely that a large proportion of these prescriptions were for individuals under 16 years.  In addition to the problems associated with education in children with ADHD, the side effects of medication could compound behavioural problems impacting further on their education.

The proposed project aims to provide comprehensive visual assessments of children and adults with a diagnosis of ADHD who have been prescribed medication and compare those findings with an age and diagnosis matched group who are not taking prescribed medication in addition to a typically developing control group.

These findings will help parents, teachers and children themselves make informed decisions regarding this controversial treatment. It will allow parents, educators and eye professionals of those children who have been prescribed these medications to ensure any visual problems associated are addressed preventing poor near vision impacting on learning.

In order to further investigate the impact of this medication, additional measures of severity of key symptoms and behaviours, such as hyperactivity, conduct disorder, defiance disorder, and  depression and anxiety, will be conducted with all participants,  using the Vanderbilt ADHD Diagnostic Rating Scale (VADRS - Wolraich, et al., 2003) and The Connors 3rd Edition (Connors et al. 2011). Both these psychological assessment tools, completed by parents and teachers of children aged 6-18 years, are designed to measure the severity of ADHD symptoms, and comorbid behaviours such as oppositional defiance disorder and conduct disorder, as well as learning problems, peer relationships and family relationships.

The research questions to be addressed are:

(1) How does the prescribing rate of methylphenidate in NI compare with that in other parts of the UK.

(2) Do children and adults prescribed methylphenidate for ADHD have a similar visual status to those with the condition who have not been prescribed medication?

(3) If visual anomalies are present, could near vision intervention improve visual behaviours?

(4) Does the presence of near vison abnormalities affect symptom and co-morbid behaviour severity?

The applicant must be a GOC registered optometrist.

Essential criteria

Applicants should hold, or expect to obtain, a First or Upper Second Class Honours Degree in a subject relevant to the proposed area of study.

We may also consider applications from those who hold equivalent qualifications, for example, a Lower Second Class Honours Degree plus a Master’s Degree with Distinction.

In exceptional circumstances, the University may consider a portfolio of evidence from applicants who have appropriate professional experience which is equivalent to the learning outcomes of an Honours degree in lieu of academic qualifications.

• Sound understanding of subject area as evidenced by a comprehensive research proposal

Desirable Criteria

If the University receives a large number of applicants for the project, the following desirable criteria may be applied to shortlist applicants for interview.

• First Class Honours (1st) Degree
• Masters at 65%
• Research project completion within taught Masters degree or MRES
• Practice-based research experience and/or dissemination
• Experience using research methods or other approaches relevant to the subject domain
• Work experience relevant to the proposed project
• Publications - peer-reviewed
• Experience of presentation of research findings
• A comprehensive and articulate personal statement
• Relevant professional qualification and/or a Degree in a Health or Health related area

Equal Opportunities

The University is an equal opportunities employer and welcomes applicants from all sections of the community, particularly from those with disabilities.

Appointment will be made on merit.

Funding and eligibility

The University offers the following levels of support:

Vice Chancellors Research Studentship (VCRS)

The following scholarship options are available to applicants worldwide:

• Full Award: (full-time tuition fees + £19,000 (tbc))
• Part Award: (full-time tuition fees + £9,500)
• Fees Only Award: (full-time tuition fees)

These scholarships will cover full-time PhD tuition fees for three years (subject to satisfactory academic performance) and will provide a £900 per annum research training support grant (RTSG) to help support the PhD researcher.

Applicants who already hold a doctoral degree or who have been registered on a programme of research leading to the award of a doctoral degree on a full-time basis for more than one year (or part-time equivalent) are NOT eligible to apply for an award.

Please note: you will automatically be entered into the competition for the Full Award, unless you state otherwise in your application.

Department for the Economy (DFE)

The scholarship will cover tuition fees at the Home rate and a maintenance allowance of £19,237 (tbc) per annum for three years (subject to satisfactory academic performance).

This scholarship also comes with £900 per annum for three years as a research training support grant (RTSG) allocation to help support the PhD researcher.

• Candidates with pre-settled or settled status under the EU Settlement Scheme, who also satisfy a three year residency requirement in the UK prior to the start of the course for which a Studentship is held MAY receive a Studentship covering fees and maintenance.
• Republic of Ireland (ROI) nationals who satisfy three years’ residency in the UK prior to the start of the course MAY receive a Studentship covering fees and maintenance (ROI nationals don’t need to have pre-settled or settled status under the EU Settlement Scheme to qualify).
• Other non-ROI EU applicants are ‘International’ are not eligible for this source of funding.
• Applicants who already hold a doctoral degree or who have been registered on a programme of research leading to the award of a doctoral degree on a full-time basis for more than one year (or part-time equivalent) are NOT eligible to apply for an award.

Due consideration should be given to financing your studies. Further information on cost of living