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SPECIAL ENCORE PRESENTATION:
Child ADHD: Exploring Complexities of Care, Part 1 of 3
neuroscienceCME Journal Club
Encore Date: Tuesday, February 16, 2010This activity offers CE credit for:
- Physicians (ACCME/AMA PRA Category 1)
- Nurses (CNE) – Pending
- Pharmacists (ACPE)
- Psychologists (APA)
Credit Expiration Date:
Tuesday, November 9, 2010
 | Robert L. Findling, MD Professor of Psychiatry & Pediatrics Case Western Reserve University Director, Child and Adolescent Psychiatry University Hospitals Case Medical Center Cleveland, OH |
 | Gitta H. Lubke, PhD (Featured Author) Associate Professor Department of Psychology University of Notre Dame Notre Dame, IN |
 | L. Eugene Arnold, MD, MEd Professor Emeritus of Psychiatry OSU Nisonger Center Department of Psychiatry College of Medicine The Ohio State University Columbus, OH |
Attention-deficit hyperactivity disorder (ADHD) affects 8% of school age children. It presents with symptoms of inattention, hyperactivity/impulsivity, or both. Currently, three subtypes of ADHD are defined: ADHD inattentive (ADHD/I), ADHD hyperactive/impulsive (ADHD/H) and ADHD combined (ADHD/C). However, in the last decade heated debate has emerged that questions how this disorder should be conceptualized, defined, and categorized. Key questions have been: Is it a category or a continuum? and How do comorbidities relate to currently defined subtypes? In these interactive, evidence-based neuroscienceCME Journal Club sessions, the faculty will explore new data that may re-focus how we view ADHD subtypes. Such exploration will allow clinicians to anticipate how developers of the DSM-V might revise ADHD diagnostic criteria. As a result, clinicians will be in a position of opportunity to achieve better individualization of therapy.
- Faraone SV, Biederman J, Friedman D. Validity of DSM-IV subtypes of attention-deficit/hyperactivity disorder: a family study perspective. J Am Acad Child Adolesc Psychiatry 2000;39:300-307.
- Thapar A, Lewis G. Should we be rethinking how we assess and manage ADHD? J Am Acad Child Adolesc Psychiatry 2009;48:1051-1052.
Featured Article: Lubke GH, Hudziak JJ, Derks EM, van Bijsterveldt TC, Boomsma DI. Maternal ratings of attention problems in ADHD: evidence for the existence of a continuum. J Am Acad Child Adolesc Psychiatry 2009;48:1085-1093.
View Abstract
Download Article (PDF format)
Summary:
The Clinical Question
Is ADHD a categorical disorder (as described in the DSM-IV-TR) or an extreme of a continuous trait?
Why We Asked It
This question has been central to much debate over the last decade and the subject of intense research scrutiny. Its answer is important for developers of subsequent diagnostic manuals (e.g., DSM-V) and clinicians who develop ADHD treatment plans. Depending on the answer, there may be support for strengthening current DSM-defined subtypes or including a quantitative axis. In either case, results can help clinicians tailor therapy.
How We Approached the Question
Our cohort was one of Dutch male twins in a national twin registry. Within this cohort, we analyzed data from mothers’ ratings on the attention problem (AP) scale of the Child Behavior Check List (CBCL) at ages 7, 10, and 12 years. Two different model types were fitted to the data—latent class models, which correspond to categorically different subtypes, and factor mixture models, which permit severity differences. Since both model types are submodels of a general latent variable framework, they can be directly compared using indices of goodness-of-fit. We compared the fit of the models to determine which model type, and hence which corresponding conceptual interpretation (i.e., subtype or continuous severity), was most appropriate.
What We Found
At all 3 ages we studied, the model that corresponded to AP severity provided the best fit. Thus, the CBCL AP syndrome varied along a severity continuum of mild to moderate to severe attention problems. Children diagnosed with ADHD were at the extreme of this continuum.
The Clinical Application
Clinical research scholars: These data can inform the choice of methods and study models for use in future ADHD studies.
Framer of the DSM-V: These data can be used to make decisions about including a quantitative axis that will allow for differences across ages and sexes.
Clinicians: These data present a clear invitation to develop evidence-based interventions that diminish the severity of symptoms within the continuum.
To translate new evidence in the literature into improved diagnosis of ADHD in children and adolescents.
At the end of this CE activity, participants should be able to:
- Interpret data supporting that ADHD is best conceptualized as a continuous trait rather than a categorical diagnosis.
- Identify clinical implications associated with the evidence that ADHD exists on a severity continuum.
Physicians, physician assistants, nurse practitioners, nurses, psychologists, pharmacists, and other healthcare professionals interested in diagnosis and management of ADHD in children and adolescents.
This educational activity is supported by an independent medical educational grant from Shire.
CME Credit (Physicians):
CME Outfitters, LLC, is accredited by the
Accreditation Council for Continuing Medical
Education to provide continuing medical
education for physicians.
CME Outfitters, LLC, designates this educational activity for
a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians
should only claim credit commensurate with the extent of their
participation in the activity.
Note to Physician Assistants: AAPA accepts Category I credit from AOACCME, Prescribed credit from AAFP, and AMA Category I CME credit for the PRA from organizations accredited by ACCME.
CNE Credit (Nurses):
This activity has been submitted to
the New York State Nurses Association for approval to award
contact hours. The New York State Nurses Association is
accredited as an approver of continuing nursing education
by the American Nurses Credentialing Center’s Commission
on Accreditation.
1.0 contact hours will be awarded upon successful
completion.
CEP Credit (Psychologists):
CME Outfitters is approved by
the American Psychological Association to sponsor continuing
education for psychologists. CME Outfitters maintains
responsibility for this program and its content. (1.0 CE credits)
CPE Credit (Pharmacists):
CME Outfitters, LLC, is accredited by
the Accreditation Council for Pharmacy Education as a
provider of continuing pharmacy education.
1.0 contact hours (0.1 CEUs)
Universal Program Number: 376-000-09-029-H01-P
Activity type: Knowledge-based
Post-tests, credit request forms, and activity evaluations can be
completed online at www.neuroscienceCME.com (click on the
Testing/Certification link under the Activities tab–requires free account
activation), and participants can print their certificate or statement
of credit immediately (80% pass rate required). This website supports
all browsers except Internet Explorer for Mac. For complete technical
requirements and privacy policy, visit www.neuroscienceCME.com/technical.asp.
Disclosure Declaration
It is the policy of CME Outfitters, LLC, to ensure independence, balance, objectivity, and scientific rigor and integrity in all of their CE activities. Faculty must disclose to the participants any relationships with commercial companies whose products or devices may be mentioned in faculty presentations, or with the commercial supporter of this CE activity. CME Outfitters, LLC, has evaluated, identified, and attempted to resolve any potential conflicts of interest through a rigorous content validation procedure, use of evidence-based data/research, and a multidisciplinary peer review process. The following information is for participant information only. It is not assumed that these relationships will have a negative impact on the presentations.
Dr. Findling has disclosed that he receives or has received research support, acted as a consultant and/or served on a speaker's bureau for Abbott Laboratories, Addrenex Pharmaceuticals, Inc., AstraZeneca Pharmaceuticals LP, Biovail Pharmaceuticals, Inc., Bristol-Myers Squibb Company, Forest Laboratories, Inc., GlaxoSmithKline, Johnson & Johnson Pharmaceutical Research & Development, L.L.C., KemPharm Inc., Eli Lilly and Company, H. Lundbeck A/S, Neuropharm Group plc, Novartis Pharmaceuticals Corporation, Organon Pharmaceuticals USA Inc., Otsuka America Pharmaceutical, Inc., Pfizer Inc., Sanofi-Aventis, Sepracor Inc., Shire Pharmaceuticals, Solvay Pharmaceuticals, Inc., Supernus Pharmaceuticals, Inc., Validus, and Wyeth Pharmaceuticals.
Dr. Lubke has no disclosures to report.
Dr. Arnold has disclosed that he receives research support from Autism Speaks, Curemark, Eli Lilly and Company, National Institute of Mental Health, Neuropharm, Targacept, and Shire Pharmaceuticals. He serves as a consultant to, or on the advisory boards of, Abbott Laboratories, AstraZeneca Pharmaceuticals LP, Neuropharm, Novartis Pharmaceuticals Corporation, Organon, Shire Pharmaceuticals, and Targacept. He receives speaker honoraria from Shire Pharmaceuticals and Targacept.
Unlabeled Use Disclosure
Faculty of this CE activity may include discussions of products or devices that are not currently labeled for use by the FDA. The faculty have been informed of their responsibility to disclose to the audience if they will be discussing off-label or investigational uses (any uses not approved by the FDA) of products or devices.
CME Outfitters, LLC, the faculty, and Shire Pharmaceuticals do not endorse the use of any product outside of the FDA labeled indications. Medical professionals should not utilize the procedures, products, or diagnosis techniques discussed during this activity without evaluation of their patient for contraindications or dangers of use.
Questions about this activity? Call us at 877.CME.PROS (877.263.7767).
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