Adult ADHD: Beyond Childhood

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Session Summary

Attention Deficit Hyperactivity Disorder is a common neuropsychiatric condition impacting 4.4% of the adult population age 18-44 according to a recent epidemiological survey. As in childhood, the condition is often marked by challenges with attention, organization and forgetfulness, although adults who were hyperactive as children often grow out of physical hyperactivity. There is evidence that ADHD is associated with poorer outcomes in domestic and occupational endeavors, as well as higher rates of motor vehicle accidents.

Assessment requires clinical evaluation of whether the patient meets criteria for the DSM-IV symptoms of ADHD, with adult manifestation. Comorbid mental health conditions are more common in individuals with ADHD, compounding the distress experienced by individuals with the condition. Prominent comorbid mental health conditions may require prioritized management.

Stimulant and non-stimulant pharmacologic interventions have demonstrated efficacy for ADHD management. These agents all share similar side effect patterns (physical discomforts and mild cardiovascular effects) and contraindications (particularly conditions that would be exacerbated by increased sympathetic nervous system activity). Tolerability of these agents is maximized by gradual dose increase, avoidance of other sympathomimetic agents, and trials as needed of different release patterns of an effective agent. Long-acting preparations are preferable to short acting agents due to ease of daylong coverage and evidence for higher rates of diversion or misuse of short acting agents. Adequacy of interventions is optimized by identifying treatment goals related to ADHD symptoms, and serial screening of symptoms. Data is emerging on non-pharmacologic interventions, including cognitive-behavioral approaches as adjuncts to pharmacotherapy interventions.

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Faculty Information

Craig Surman, MD

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Craig Surman, MD
Scientific Coordinator for Adult ADHD Research Program
Massachusetts General Hospital
Cambridge, MA

Biography

Dr. Craig Surman is the Scientific Coordinator for the Adult ADHD Research Program of the Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD at Massachusetts General Hospital and an Instructor in Psychiatry at Harvard Medical School. He is the course director for the Adult ADHD module of the Massachusetts General Hospital PGY3 Psychiatry Residency Psychopharmacology program.

Dr. Surman completed a residency in Psychiatry at the Harvard Longwood Psychiatry Residency Training Program in Boston, as well as a fellowship in Neuropsychiatry at the Division of Cognitive and Behavioral Neurology at Brigham and Women’s Hospital, also in Boston.

Dr. Surman’s research strives to improve the assessment and treatment of ADHD in adulthood, and to better characterize the impact of ADHD as well as its relationship to illnesses that are often comorbid with ADHD. He is author or co-author of several publications, and lectures locally, nationally and internationally.

Grant/Research Support:

Abbott, Alza, Cephalon, Eli Lilly, The Hilda and Preston Davis Foundation, McNeil, Merck, New River, National Institutes of Health, Organon, Pfizer, Shire, Takeda

Consultant:

McNeil, Shire, Takeda

Speakers Bureau/Educational Services:

Janssen-Ortho, McNeil, Novartis, Shire

Presentation will include discussion of off-label, experimental, and/or investigational use of drugs or devices:

Short and long acting methylphenidate in non-FDA approved doses, short and long-acting amphetamine preparations in non-FDA approved doses, atomoxetine in non-FDA approved doses, modafanil, desipramine, imipramine, clonidine, guanfacine in non-FDA approved indications.

Learning Objectives

Compare and contrast the clinical presentation of attention-deficit hyperactivity disorder (ADHD) in children and adults.
Apply evidence-based strategies for screening, diagnosing, and monitoring of ADHD in adult patients.
Evaluate the efficacy and outcomes of traditional and new drug therapies for the management of adult patients with ADHD.

Continuing Education Credit

Activity Dates: 04/20/2009 - 04/20/2012
ACPE Contact Hours: 1.0
ACPE Number: 0284-0000-09-007-H01-P
Nursing Credit Reminder: Note that ACPE and ACCME credit is accepted for certification renewal.

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ACPE The College of Psychiatric and Neurologic Pharmacists is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. This self-study course provides 1.0 contact hours (0.10 CEUs) of knowledge-based continuing education credit from CPNP approved programming. The ACPE universal program number assigned to this course is 0284-0000-09-007-L01-P (1.0 contact hours).

ACPE approved contact hours are accepted for ANCC Certification Renewal (see pages 5 and 6): At least 50% (37.5 hours) of your 75 continuing education hours must be formally approved continuing education hours. Formally approved continuing education hours meet one or more of the criteria listed below:

Continuing nursing education (CNE) approved for nursing contact hours by an accredited provider or approver of nursing continuing education
Continuing medical education (CME) approved for CME hours
Sponsored by organizations, agencies, or educational institutions accredited or approved by the American Nurses Credentialing Center (ANCC) or the Accreditation Council for Continuing Medical Education (ACCME) or the Accreditation Council for Pharmacy Education (ACPE) or the Commission on Dietetic Registration

Course Requirements

This course is provided online at cpnp.org and consists of the speaker audio and slides. A PDF file of the slides is also provided and access is available to participants indefinitely although ACPE credit is available only through the course expiration date.

Participants in this course must complete an examination and achieve a score of 60% or greater. Successful completion of the course also requires the completion of a course evaluation. ACPE statements of credit can be retrieved by participants online at cpnp.org immediately upon successful completion of the course.

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Internet Explorer 6+, Firefox 2+ or Safari 3+
1024x768 resolution or greater
Adobe Flash Player 8+
512MB RAM
Any Operating System capable of the above requirements

Recommended:

Internet Explorer 7+, Firefox 3+ or Safari 3+
1280x768 resolution or greater
Adobe Flash Player 10+
Windows XP/2000/Vista and Mac OS 10.4 or better
512MB of RAM for Windows XP or Mac OS
1GB of RAM for Windows Vista

Target Audience

If you are a pharmacist, nurse practitioner or other healthcare professional involved in the medication therapy management of psychiatric and/or neurological patients, we invite you to participate in this online course.

Grant Support

This programming was supported in part by grants from Bristol-Myers Squibb, Forest Laboratories, Inc., Lilly, Schering-Plough, Cyberonics, Shire, and Janssen, Division of Ortho-McNeil-Janssen Pharmaceuticals, Inc. administered by Ortho-McNeil Janssen Scientific Affairs, LLC.