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Disclaimer: CME certification for these activities has expired. All information is pertinent to the timeframe in which it was released.


Toward A Better Understanding of ADHD: Evaluating New Research and Treatment Strategies


GOAL
To provide physicians with practical information for diagnosing and managing attention-deficit/hyperactivity disorder (ADHD) according to the American Academy of Pediatrics guideline and in the context of new available therapies.

TARGET AUDIENCE
This activity is designed for psychiatrists, primary care physicians, pediatricians, child and adolescent psychiatrists, pharmacy and therapeutic committee members, managed care decision makers, and healthcare policy planners. No prerequisites required.

LEARNING OBJECTIVES
The Johns Hopkins University School of Medicine takes responsibility for the content, quality, and scientific integrity of this CME activity. At the conclusion of this activity, participants should be able to:

  • Review the current ADHD treatment guidelines and available treatment options.
  • Differentiate between ADHD core symptoms and functional impairments.
  • Understand the importance of functional outcomes as a therapeutic target in patients with ADHD.
  • Evaluate new treatment options for ADHD.
  • Recognize the place for current and new therapies in the therapeutic armamentarium.

ACCREDITATION STATEMENT
The Johns Hopkins University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to sponsor continuing medical education for physicians.

CREDIT DESIGNATION STATEMENT
The Johns Hopkins University School of Medicine designates this educational activity for a maximum of 2 category 1 credits toward the AMA Physician's Recognition Award. Each physician should claim only those credits that he/she actually spent in the activity.

The estimated time to complete this educational activity: 2 hour.

Release date: May 31, 2003. Expiration date: May 31, 2005.

DISCLAIMER STATEMENT
The opinions and recommendations expressed by faculty and other experts whose input is included in this program are their own. This enduring material is produced for educational purposes only. Use of Johns Hopkins University School of Medicine name implies review of educational format design and approach. Please review the complete prescribing information of specific drugs or combinations of drugs, including indications, contraindications, warnings, and adverse effects, before administering pharmacologic therapy to patients.

This program is supported by an unrestricted educational grant from Eli Lilly and Company.

Advanced Studies in Medicine (ISSN-1530-3004) is published by Galen Publishing, a division of Advanced Studies in Medicine, an HMG Company. PO Box 340, Somerville, NJ 08876. (908) 253-9001. Copyright ©2003 by Galen Publishing. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, without first obtaining permission from the publisher. Advanced Studies in Medicine is a registered trademark of The Healthcare Media Group, LLC.

Full Disclosure Policy Affecting CME Activities:
As a sponsor accredited by the Accreditation Council for Continuing Medical Education (ACCME), it is the policy of Johns Hopkins University School of Medicine to require the disclosure of the existence of any significant financial interest or any other relationship a faculty member or a sponsor has with the manufacturer(s) of any commercial product(s) discussed in an educational presentation. The Program Director and Participating Faculty reported the following:

PROGRAM DIRECTOR

    Mark A. Riddle, MD
    Professor of Psychiatry & Pediatrics, Division of Child & Adolescent Psychiatry
    Department of Psychiatry & Behavioral Sciences
    Johns Hopkins University School of Medicine
    Baltimore, Maryland
    • Dr Riddle reports receiving grants/and or research support from and serving as a consultant and/or advisor to Best Practice, Eli Lilly and Company, Excerpta Medical/Janssen, Janssen, Pfizer, Inc, Quintiles Pacific, Shire Pharmaceuticals, SmithKline Beecham, and Solvay Pharmaceuticals.

PARTICIPATING FACULTY

    C. Keith Conners, PhD
    Professor Emeritus
    Department of Medical Psychiatry
    Duke University
    Durham, North Carolina
    • Dr Conners reports serving as a consultant to and receiving honoraria from Celltech, Eli Lilly & Co, McNeil Consumer, and Novartis Corporation.

    Christopher J. Kratochvil, MD
    Assistant Professor of Adolescent and Child Psychiatry, Department of Psychiatry
    University of Nebraska Medical Center
    Omaha, Nebraska
    • Dr Kratochvil reports receiving grants and/or research support from Eli Lilly and Company, GlaxoSmithKline, and McNeil Consumer Healthcare; serving as a consultant to Shire Pharmaceuticals Group; and receiving honorarium from Novartis Corporation.

    Thomas J. Spencer, MD
    Associate Professor of Psychiatry
    Department of Child and Adolescent Psychiatry
    Massachusetts General Hospital
    Harvard Medical School
    Boston, Massachusetts
    • Dr Spencer reports receiving grants and/or research support from, and serving on the speakers bureau for, and as a consultant to Abbott Laboratories, Celltech Group, Cephalon Inc, Eli Lilly and Company, GlaxoSmithKline, McNeil Consumer Healthcare, Novartis Corporation, and Shire Pharmaceuticals Group.

    Martin T. Stein, MD
    Professor of Clinical Pediatrics
    Department of Pediatrics
    University of California at San Diego School of Medicine
    La Jolla, California
    • Dr Stein reports receiving a grant from Eli Lilly and Company.

    Mark L. Wolraich, MD
    Shaun Walters Endowed Professor of Developmental and Behavioral Pediatrics
    Department of Pediatrics
    University of Oklahoma Health Sciences Center
    Oklahoma City, Oklahoma
    • Dr Wolraich reports receiving grants and/or research support from Noven Pharmaceuticals, Inc and Shire Pharmaceuticals Group, and serving as a consultant to Celltech Group and Eli Lilly and Company.

Notice:
In accordance with the ACCME Standards for Commercial Support, the audience is advised that one or more articles in this continuing medical education activity contains reference(s) to unlabeled or unapproved uses of drugs or devices. The following faculty members have disclosed that their articles have referenced the following unlabeled/unapproved uses of drugs or products:

Dr Kratochvil - alpha-2 agonists, buproprion, transdermal methylphenidate, and tricyclic antidepressants for the treatment of ADHD. Dr Spencer - tricyclic antidepressants for the treatment of ADHD

All other faculty have indicated that they have not referenced unlabeled/unapproved uses of drugs or devices.

Advanced Studies in Medicine provides disclosure information from contributing authors, lead presenters, and participating faculty. Advanced Studies in Medicine does not provide disclosure information from authors of abstracts and poster presentations. The reader shall be advised that these contributors may or may not maintain financial relationships with pharmaceutical companies.

Toward A Better Understanding of ADHD: Evaluating New Research and Treatment Strategies
Mark A. Riddle, MD*

Although the media often trivializes attention-deficit/hyperactivity disorder (ADHD), medical evidence suggests it is a significant and prevalent neurobiological disorder. As a chronic disorder, ADHD is likely to persist throughout childhood, and for many individuals, into adulthood. Left untreated, it creates a trajectory of symptoms, impairments, and consequences resulting in increased individual suffering and societal healthcare costs.

This issue of Advanced Studies in Medicine highlights clinical recommendations for the diagnosis and treatment of ADHD, based on presentations made at the American Academy of Pediatrics (AAP) National Conference and Exhibition, Boston, Massachusetts, held in October 2002.

Martin T. Stein, MD, notes the wide variation in diagnostic methods and criteria used for ADHD and its medical management. He offers an overview of the AAP guideline for the treatment and diagnosis of ADHD and stresses the importance of continuing monitoring of the disorder and its symptoms over time.

C. Keith Conners, PhD, who developed the widely used Conners' Rating Scales for assessment of ADHD, reviews both risks and protective factors that interact to produce the symptoms and impairments of ADHD. He suggests that a careful assessment of these factors is required to identify targets for treatment, which should take into consideration the effect of core symptoms on home, school, academic, social, and self-related impairments, among others. Dr Conners points out that a thorough understanding of ADHD in individual patients requires consideration of longer-term impairment outcomes when planning treatment.

Mark L Wolraich, MD, also emphasizes the impact of ADHD on the individual and the importance of thinking about ADHD as a chronic illness. He describes efficacious and commonly used interventions in managing patients with ADHD in terms of functional outcomes and approaches to implementing such interventions. Dr Wolraich describes approaches to behavioral interventions and summarizes findings from the Multimodal Treatment Study of Children with ADHD.

Christopher J. Kratochvil, MD, offers an overview of available therapies, newer formulations, and recent advances in drug-delivery systems. Dr Kratochvil reviews nonstimulant therapies sometimes used to treat ADHD, and summarizes the clinical profile of the newly approved noradrenergic drug atomoxetine for the treatment of ADHD.

A paper by Thomas J. Spencer, MD, compares and contrasts properties of the new ADHD therapy with those of existing agents. Dr Spencer reviews clinical data demonstrating the drug's efficacy, safety, and tolerability in children and adults and its impact on ADHD comorbidities.

The following pages offer clinicians an excellent resource for the diagnosis and treatment of a widespread childhood and adult condition, and point to additional tools that may be used in daily practice. Even more importantly, this publication constitutes a call to action in the assessment, treatment, and follow-up of ADHD, a disorder whose seriousness is now widely acknowledged and more thoroughly understood.

*Professor of Psychiatry & Pediatrics, Division of Child & Adolescent Psychiatry, Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland.





Johns Hopkins Advanced Studies in Medicine (ISSN-1558-0334), is published by Galen Publishing, LLC, d/b/a ASiM, PO Box 340, Somerville, NJ 08876. (908) 253-9001. Copyright ©2012 by Galen Publishing. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, without first obtaining permission from the publisher. ASiM is a registered trademark of The Healthcare Media Group, LLC.