Honorary Clinical Professor of Child and Adolescent Psychiatry
+44 (0)1382 204004
Professor Coghill is a child and adolescent psychiatrist with a particular interest in ADHD, disruptive behaviours and psychopharmacology. He leads the Developmental Research Group within the Division of Neuroscience. The Developmental Research Group has a particular interest in fostering a better understanding of the pathophysiology of ADHD, conduct disorder and depression using a broad range of approaches including neuropsychopharmacology, neuroimaging,genetics and pharmacogenomics. The group is also very involved in clinical trials, pharmacoepidemiology, patient reported outcomes and quality of life and works hard to facilitate a rapid translation of research evidence into routine clinical practice. The group’s research is funded through a range of sources including the European Union, NIHR and Industry and include international collaborations across Europe, North America and Asia.
Professor Coghill is very involved in postgraduate education and regularly presents at international conferences. He is a senior member of the European Network for Hyperkinetic Disorders (EUNETHYDIS). He has taken a leading role within EUNETHYDIS in the development of European guidelines for the assessment and management of ADHD and a programme to aid clinicians implement these guidelines into practice. He represents EUNETHYDIS on the coordinating group of the European Paediatric Research Network at the EMA (ENPR-EMA) as well as chairing EUNETHYDIS International Conferences a charity devoted to providing professional education for clinicians and scientists about ADHD. He is a joint organizer committee of the ECNP School of Child and Adolescent Neuropsychopharmacology, an associate editor for the Journal of Child Psychology and Psychiatry and the senior author of the Oxford Specialist Handbook on Child and Adolescent Psychiatry.
Clinically he is honorary consultant within the NHS Tayside Child and Adolescent Mental Health Services. He has developed evidence based clinical pathways for the assessment and management of ADHD that have been used as a template for other services around the world and has developed several clinical tools including the Dundee Blood Pressure Centile Charts and the Dundee Difficult Time of Day Scale (D-DTODS) which is widely translated and adopted internationally.
The Developmental Research Group’s research focuses on developmental psychiatric disorders in children.
Whilst the main focus is on understanding the various complexities that surround Attention Deficit Hyperactivity Disorder (ADHD), we are also interested in a range of other disorders Conduct Disorder, Depression and Autism Spectrum Disorders. A recent major contribution to the field has been our demonstration through both longitudinal and psychopharmacological studies that there is a dissociation between cognitive and symptomatic aspects of ADHD. Whilst both seem important the relationship between these two aspects of functioning appears to be much more complex than previously assumed.
The Pathophysiology of ADHD
ADHD is a complex developmental psychiatric disorder that affects around 5% of school-age children. Hyperkinetic Disorder represents a severe pervasive and impairing form of ADHD that affects around 1.5% of UK children and young people. ADHD and HKD are highly heritable (h4 ? .74)) and convergent evidence has supported a strong neurobiological basis. Traditional models of ADHD attempted to explain the whole of ADHD as the consequence of a single pivotal neuropsychological deficit (e.g. inhibitory problems, intra-individual variability, delay aversion). More recently our research and that of several other groups has challenged the single pathway models and have demonstrated ADHD to be extremely heterogeneous at the genetic, neurophysiological and neuropsychological levels of analysis. By using a core battery of tasks rooted in neuroscience (CANTAB) alongside other tasks known to demonstrate deficits in ADHD and applying these to carefully selected and rigorously diagnosed cohorts of previously drug treatment naïve boys with ADHD we have confirmed across several linked studies that whilst as a group boys with ADHD have significant neuropsychological deficits they are extremely heterogeneous with only a relatively small proportion of boys having a deficit on any one task. We also highlighted significant deficits in several aspects of non-executive neuropsychological functioning not previously recognised as contributing to ADHD. For example boys with ADHD were found to perform very poorly on several simple pattern recognition tasks that have been demonstrated to be primarily dependent on intact temporal lobe and amygdalo/hippocampal rather than frontostriatal functioning and on cholinergic rather than dopaminergic neurotransmission.
This work has now been extended in studies involving children with oppositional defiant disorder, conduct disorder and Williams’ syndrome. We are also collecting neuroimaging and genetic data and exploring the use of powerful new analytical approaches to combine these data and provide a more integrated understanding of ADHD and related disorders.
Pharmacological treatments of ADHD
ADHD is treated with both psychological and pharmacological therapies. When ADHD is severe pervasive and impairing drug treatments are considered to be the first line of treatment. We have been involved in running clinical trials for several of these including the psychostimulant methylphenidate, the non-stimulant atomoxetine and the amfetamine pro-drug lisdexamfetamine. Methylphenidate (often referred to by one of its trade names Ritalin) is the most commonly prescribed medication for treating ADHD. We have conducted the largest and most comprehensive neuropsychopharmacological study to date into the effects of acute and chronic effects of methylphenidate on clinical and neuropsychological functioning in previously untreated boys with ADHD. We demonstrated that methylphenidate improves performance on several, but not all, neuropsychological measures. But did not find any evidence to suggest that methylphenidate impairs neuropsychological functioning. Our finding that methylphenidate improved performance on several non-executive memory tasks but not on a series of executive tasks. Have challenged the textbook view on how stimulants such as methylphenidate work.
Whilst methylphenidate is generally effective and safe, not everyone responds to the same degree, some are unable to tolerate this medication because of adverse effects. We are leading a large EU funded pharmacological study into the long term safety of methylphenidate and pharmacogenetic and neuroimaging studies to identify predictors of poor response and/or tolerability issues. We are also working on the CES1A gene which codes for the enzyme responsible for the metabolism of methylphenidate. We have identified that variation of this gene results in in vitro differences in the enzymes actions and have started clinical studies to address the real world importance of these novel findings.
Just how much does ADHD actually affect children and young people? – Measuring health related quality of life in ADHD
Recent studies have however demonstrated just how much ADHD interferes with the day to day lives of those who suffer from it. Together with colleagues across Europe we conducted a large prospective 2 year observational study of 1400 newly diagnosed children with ADHD (ADORE) and identified that quality of life was severely impaired. There are however many measurement issues inherent to this type of work and we have developed a programme of work aimed at developing a clearer understanding of the relationships between quality of life, as rated by different raters and instruments, clinical symptoms and impairment.
Translating research findings into clinical practice
We are engaged in a 5 year project with colleagues at Jiao Tung University in Shanghai (BANNANAS) assisting them to enhance clinical practice in China and to develop new models for ADHD care that facilitate accurate assessments to be conducted by non-specialists.
Professor Coghill is Course Leader for the BMSc in medical psychology and Course organizer for Child Psychiatry undergraduate teaching.