Attention-Deficit Hyperactivity Disorder

[2013 update]

Introduction to this self-study CME activity

Purpose

Attention deficit hyperactivity disorder (ADHD) is the most commonly diagnosed behavioral disorder of childhood.  Most patients will present to their primary care provider, generally with concerns about school performance and/or behavioral problems.  ADHD is both under- and over-diagnosed.  The high prevalence of co-morbidities is often confusing.  Diagnosis requires more extensive evaluation than is usually possible in a 15 minute office visit.  Concern has been expressed by some that providers are too quick to label patients with ADHD and prescribe medication.  This self-study activity provides practical guidance to clinicians about diagnosing and treating ADHD based on available empirical evidence. 

 New information in this update includes: 
  • Ages for  diagnosis expanded
-  Children:  The ages for evaluating children for ADHD now includes ages 4-18.
-  Adults:  ADHD extends into adulthood.  The diagnosis and treatment of adults is now addressed.
  • Algorithm for diagnosis and treatment has been expanded  to include more detail
  • Drug treatment tables have been revised
  • Monitoring for drug (stimulant) seeking behavior is addressed. 

 Key aspects of care include:

Diagnosis

  • ADHD is a chronic condition that can persist into adulthood
  • Many other conditions co-exist with ADHD and should be assessed (e.g. depression, anxiety, learning disabilities etc.)
  • No specific test can make the diagnosis of ADHD. The DSM-IV-TR criteria should be met to make the diagnosis, which includes obtaining information from multiple sources when possible

Treatment

  • Combine pharmacologic and behavioral treatment to enhance longer term success. 
  • Stimulants (generally methylphenidate) remain the first line (best researched, safest, and most effective) for pharmacologic treatment.
  • Behavioral treatment for children includes interventions with parents, with child, and with school.

Special issues

  • Special considerations apply to 3 to 5 year olds, mentally retarded, and other groups.
  • Several untrue common beliefs about ADHD are noted. 
  • Evidence is summarized regarding the (often lack of) effectiveness of special diets and complementary therapy commonly used by parents and patients. 
  • Appendix A has management tools and Appendix B has differential diagnosis and treatment resources

Objectives

Participants in this CME activity will understand and be able to implement evidence-based cost-effective clinical strategies for the diagnosis and treatment of attention-deficit hyperactivity disorder in children and young adults age 3 to 30 years.

 

Audience

This self-study activity is appropriate for primary care clinicians and other health care providers diagnosing and treating attention-deficit hyperactivity disorder.

Authors

Team Leaders

  • John M. O’Brien, MD
    Family Medicine
  • Jennifer G. Christner, MD
    Child Behavioral Health

Team Members

  • Bernard Biermann, MD, PhD
    Child/Adolescent Psychiatry
  • Barbara T. Felt, MD
    Behavioral Pediatrics
  • R. Van Harrison, PhD
    Medical Education
  • Paramjeet K. Kochhar, MD
    Pediatrics
  • Stephanie A. Riolo, MD
    Child Psychiatry

Consultants

  • Darcie-Ann Streetman, Pharm D
    College of Pharmacy

Author Disclosures

Neither the team lead, the team members, nor the consultants have financial relationships with commercial companies whose products are discussed in this CME activity.

Other Acknowledgements

UMHS Guidelines Oversight Team

  • Grant M. Greenberg, MD, MA., MHSA
  • R. Van Harrison, PhD

Literature Search Services

  • Taubman Medical Library

Production of Internet Format and Website Maintenance

  • Ellen Patrick-Dunlavey, MA

CME Accreditation and Credit Designation

The University of Michigan Medical School is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The University of Michigan Medical School designates this enduring material for a maximum of 1 AMA PRA Category 1 Credits™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

This CME activity was released in April 2013, with credit available through April 2016. The activity was reviewed for currency of content in April 2016 and availability of credit extended through April 2019. Continuation of credit from that date depends on a thorough review of the content currency and accuracy. 

Method of Participation

  1. View the web pages. You may print the self-study text to read off-line.
  2. Complete the on-line learning assessment test with a score of 70% or higher.  After you initially take the test, the test will be immediately electronically scored. 
    If fewer than 70% of the questions are answered correctly, the questions that were not answered correctly will be noted in red.  Review the CME content related to those topics and retake the test.
    If 70% or more of the questions are answered correctly, the correct and incorrect answers for all questions will be shown along with explanations of the basis for the correct answer.  The link to register and receive credit is shown at the end of the items and explanations. 
  3. Complete the electronic credit request and activity evaluation.  An electronic certificate of participation will be provided immediately.
  4. Print the certificate of participation for your personal records.