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


Managing ADHD Morning, Noon, and Night: New Insights for Patient Care


GOAL
To provide pediatricians, psychiatrists, and child psychiatrists with information on the most recent developments regarding the treatment of attention deficit hyperactivity disorder.

TARGET AUDIENCE
This activity is designed for pediatricians, psychiatrists, and child psychiatrists. 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:

  • Discuss the nature of attention deficit hyperactivity disorder (ADHD) and its symptoms.
  • Evaluate the newest pharmacologic treatments to achieve optimal relief of symptoms.
  • Understand how the symptoms of ADHD affect everyday life for the patient and his/her family.
  • Discuss the method of combining pharmacologic treatment with behavioral management to obtain the best symptom relief.

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

CREDIT DESIGNATION STATEMENT
The Johns Hopkins University School of Medicine designates this educational activity for a maximum of 0.5 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: 0.5 hours.

Release date: March 15, 2004. Expiration date: March 15, 2006.

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.

Full Disclosure Policy Affecting CME Activities:
As sponsors accredited by the Accreditation Council for Continuing Medical Education (ACCME) and the American Council on Pharmaceutical Education (ACPE), it is the policy of Johns Hopkins University School of Medicine and the University of Tennessee College of Pharmacy 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 Directors and Participating Faculty reported the following:

PROGRAM DIRECTOR

    John T. Walkup, MD
    Associate Professor
    Psychiatry and Behavioral Sciences
    Johns Hopkins University
    School of Medicine
    Baltimore, Maryland
    Dr Walkup reports receiving grants/research support and receiving honoraria from Eli Lilly and Company and Pfizer, Inc; and serving as a consultant to Eli Lilly and Company.

PARTICIPATING FACULTY

    Harlan R. Gephart, MD
    Clinical Professor of Pediatrics
    University of Washington
    School of Medicine
    Attending Physician
    Children's Hospital and Medical Center
    Seattle, Washington
    Dr Gephart reports serving as a consultant to and receiving honoraria from Eli Lilly and Company and McNeil Consumer Healthcare.

    Christopher J. Kratochvil, MD
    Associate Professor
    Department of Psychiatry
    Assistant Director
    Psychopharmacology Research Center
    University of Nebraska Medical Center
    Omaha, Nebraska
    Dr Kratochvil reports receiving grants/research support from Cephalon Inc, Eli Lilly and Company, GlaxoSmithKline, and McNeil Consumer Healthcare; serving as a consultant to Eli Lilly and Company; and receiving honoraria from Eli Lilly and Company and Novartis Corporation.

    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 may contain reference(s) to unlabeled or unapproved uses of drugs or devices. The following faculty member has disclosed that his article has referenced the following unlabeled/unapproved uses of drugs or devices:
    Dr Kratochvil - bupropion, monoamine oxidase inhibitors, and tricyclic antidepressants for the treatment of ADHD.

    All others 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.

Managing ADHD Morning, Noon, and Night: New Insights for patient care
John T. Walkup, MD

Including proceedings from a symposium held in conjunction with the American Academy of Pediatrics 2003 National Conference and Exhibition, October 31-November 5, 2003, New Orleans, Louisiana

Attention deficit hyperactivity disorder (ADHD) is a common disorder characterized by inattention and impulsivity, with and without hyperactivity, resulting in significant impairment in educational, behavioral, and social domains. ADHD is also a chronic disorder; approximately 60% of childhood patients have symptoms that extend into adulthood. Although advocacy efforts have been effective in increased identification of children and adults with ADHD, many of the 8% to 10% of children affected with ADHD may not be appropriately assessed and treated. ADHD is often associated with coexisting conditions, such as disruptive behavior, mood, anxiety, and tic disorders. Comorbid problems complicate the clinical picture and may make the assessment and treatment of ADHD less straightforward; this may result in less than optimal outcome with standard ADHD treatment.

This publication is designed for pediatricians, psychiatrists, and child psychiatrists who see and manage patients with ADHD. It offers an overview of the chronic nature of ADHD and the manifestation of symptoms throughout the day. Emphasis is placed on the effects of symptoms on the childÕs family as well as quality of life.

Relief from core symptoms is possible with the use of medication as well as behavioral interventions. Although traditional stimulant treatment is effective for ADHD symptoms, stimulants' short duration of action limits their efficacy for many. Newer extended-release formulations of stimulant medication provide improved symptom coverage without the multiple daytime dosing required with immediate-release stimulants. There are a variety of nonstimulant medications effective for ADHD symptoms that also provide extended symptom coverage. Of these medications, only atomoxetine has undergone extensive safety and efficacy testing resulting in US Food and Drug Administration approval for ADHD in children, adolescents, and adults. The formulation and actions of these drugs are described in the following pages. The American Academy of Pediatrics guidelines on treatment of ADHD, as well as the role of behavioral management in improving outcomes, are also discussed.





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.