PAL Conference Cle Elum March 2015

Transcription

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3 Source Research Funding Books, Intellectual Property Advisor/ Consultant Speakers Bureau Employee In-kind Services (example: travel) Stock or Equity Honorarium or expenses for this presentation or meeting Disclosure Pfizer, Shire, Ironshore Pharmaceuticals none none none none none none none

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5 DEA Picture Library/De Agostini/Getty Images, Eisenberg DTA, Campbell B, Gray PB, Sorenson MD. Dopamine receptor genetic polymorphisms and body composition in undernourished pastoralists: An exploration of nutrition indices among nomadic and recently settled Ariaal men of northern Kenya. BMC Evolutionary Biology. 2008; 8(173). biomedcentral.com/ /8/173/abstract.

6 Other media: Last Child in the Woods: Saving Our Children From Nature-Deficit Disorder by Richard Louv (2008)

7 Tasks of the healthcare provider How do we help these children function as their brain controls mature? How do we help these adults avoid the dangerous pitfalls of poorly controlled ADHD?

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9 ages/proposedrevision.aspx?rid=383#. Accessed 4/25/12.

10 /Pages/proposedrevision.aspx?rid=383 #. Accessed 4/25/12.

11 n/pages/proposedrevision.aspx?rid=38 3#. Accessed 4/25/12.

12 Groen-Blokhuis M et al. Evidence for a Causal Association of Low Birth Weight and Attention Problems. J. Am. Acad. Child Adolesc. Psychiatry 2011; 50(12): Keenan et al. Early Head Injury and Attention-Deficit/Hyperactivity Disorder. BMJ 2008; 337:a1984. Landgren et al. Prenatal Exposure and Neurodevelopmental Disorders in Children Adopted from Eastern Europe. Pediatrics 2010; May125(5):e Bouchard M et al. Attention-deficit/hyperactivity disorder and urinary metabolites of organophosphate pesticides. Pediatrics 2010;125(6):e1270.

13 Pliszka S. AACAP Work Group on Quality Issues. Practice Parameter. J. Am. Acad. Child Adolesc. Psychiatry 2007; 46(7): Fliers et al. ADHD Is a Risk Factor for Overweight and Obesity in Children; J Develop & Behavior Peds 2013; 34: Ljung et al. ADHD and Suicidal Behavior; JAMA Psychiatry 2014; 71(8):

14 Pliszka S. AACAP Work Group on Quality Issues. Practice Parameter. J. Am. Acad. Child Adolesc. Psychiatry 2007; 46(7):

15 Pliszka S. AACAP Work Group on Quality Issues. Practice Parameter. J. Am. Acad. Child Adolesc. Psychiatry 2007; 46(7):

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17 The MTA Cooperative Group. A 14-month Randomized Clinical Trial of Treatment Strategies for Attention- Deficit/Hyperactivity Disorder. Arch Gen Psychiatry 1999; 56:

18 The MTA Cooperative Group. A 14-month Randomized Clinical Trial of Treatment Strategies for Attention-Deficit/Hyperactivity Disorder. Arch Gen Psychiatry 1999; 56:

19 Greenhill et al. Impairment and Deportment Responses to Different Methylphenidate Doses in Children with ADHD: The MTA Titration Trial. J. Am. Acad. Child & Adol. Psychiatry (2):

20 Molina et al. The MTA at 8 Years. J. Am. Acad. Child Adolesc. Psychiatry 2009; 48(5):

21 Greenhill et al. Efficacy and Safety of Immediate Release Methylphenidate Treatment for Preschoolers with ADHD. J. Am. Acad. Child Adolesc. Psychiatry 2006; 45(11):

22 Greenhill et al. Efficacy and Safety of Immediate Release Methylphenidate Treatment for Preschoolers with ADHD. J. Am. Acad. Child Adolesc. Psychiatry 2006; 45(11): Riddle et al. Preschool ADHD (PATS) 6-Year Follow-up. J. Am. Acad. Child Adolesc. Psychiatry 2013; 52(3):

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25 PCP New Roles Core Program Patient BHP/Care Manager Consulting Psychiatrist Other Behavioral Health Clinicians Additional Clinic Resources Substance Treatment, Vocational Rehabilitation, CMHC, Other Community Resources Outside Resources

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27 Pelham WE, Fabiano GA, Waxmonsky JG, Greiner AR, Gnagy EM, Pelham WE, Coxe S, Verley J, Bhatia I, Hart K, Karch K, Konijnendijk E, Tresco K, Nahum-Shani I, Murphy SA. Treatment Sequencing for Childhood ADHD: A Multiple-Randomization Study of Adaptive Medication and Behavioral Interventions. J Clin Child Adolesc Psychol Feb 16:1-20.

28 Biederman et al. Do stimulants protect against psychiatric disorders in youth with adhd? Pediatrics Jul:124(1): Pliszka S. AACAP Work Group on Quality Issues. Practice Parameter. J. Am. Acad. Child Adolesc. Psychiatry 2007; 46(7):

29 Efron et al. Side effects of methylphenidate and dexamphetamine in children with attention deficit hyperactivity disorder. Pediatrics 1997; Oct 100(4):

30 Name Duration of Action Notes Methylphenidate (Ritalin, Methylin) D-methylphenidate (Focalin) Mixed amphetamine salts (Adderall) D-amphetamine (Zenzedi, ProCentra) Methamphetamine Desoxyn Amphetamine (Evekeo) 4-6 h 4-6 h *2x potency of methylphenidate 4-6 h 4-6 h Liquid 5 mg/5 ml Approved ages h FDA-indicated for ADHD and obesity 4-6 h Approved ages 3-5 FDA-indicated for ADHD, obesity, and narcolepsy Epocrates, accessed 3/2/2016.

31 Name Mode of Delivery Duration of Action Ritalin SR, Metadate ER, Methylin ER Gradual release 4-8 h Metadate CD 30% IR, 70% 3 h later 7-9 h Ritalin LA 50% IR, 50% 4 h later 7-9 h Quillivant XR 20% IR, 80% gradual release 8-10h Focalin XR 50% IR, 50% 4 h later Up to 12 h Concerta 22% IR, pump Up to 12 h Daytrana patch Gradual release 3-5 h after removal Adderall XR 50% IR, 50% 4 h later 8-12 h Dexedrine spansule (dextroamphetamine) 50% IR, 50% gradual 10 h Vyvanse Activated in GI tract 10 h Aptensio XR (methylphendiate) 40% IR, 60% ER (may be sprinkled) 12 h Epocrates, accessed

32 Biederman J. Spencer TJ. Monuteaux MC. Faraone SV. A naturalistic 10-year prospective study of height and weight in children with attention deficit hyperactivity disorder grown up. Journal of Pediatrics 2010; 157 (4): Pliszka S. AACAP Work Group on Quality Issues. Practice Parameter. J. Am. Acad. Child Adolesc. Psychiatry 2007; 46(7):

33 Cooper at al. ADHD Drugs and Serious Cardiovascular Events in Children and Young Adults. NEJM 2011; 365 (20):

34 Perrin et al. Cardiovascular Monitoring and Stimulant Drugs for Attention-Deficit/Hyperactivity Disorder. Pediatrics 2008; 122(2):

35 Charach A, et al. Childhood attention-deficit/hyperactivity disorder and future substance use disorders: comparative meta-analyses. J Am Acad Child Adolesc Psychiatry 2011; 50:9 21. Wilens TE et al. Effect of prior stimulant treatment for attention-deficit/hyperactivity disorder on subsequent risk for cigarette smoking and alcohol and drug use disorders in adolescents. Arch Pediatr Adolesc Med 2008; 162: ; Molina Et al. Adolescent Substance Use in the Multimodal Treatment Study of Attention-Deficit/Hyperactivity Disorder. J Am Acad Child Adolesc Psychiatry 2013; 52:

36 Wilens TE, Adler LA, Adamson J, et al. Misuse and diversion of stimulants prescribed for ADHD: a systematic review of the literature. J Am Acad Child Adolesc Psychiatry 2008; 47:21 31.

37 Freeman RD, Fast DK, Burd L, Kerbeshian J, Robertson MM, Sandor P. An international perspective on Tourette syndrome: selected findings from 3500 individuals in 22 countries. Developmental Medicine and Child Neurology 2000; 42(7): Pringsheim T. Steeves T. Pharmacologic Treatment for ADHD in Children with Comorbid Tic Disorders. Cochrane Database of Systemic Reviews 2011: (4):CD

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39 Intervention Effect Size Combined treatment 0.82 Medication management 0.63 Community comparison 0.48 Behavioral treatment 0.42 Fernandez de la Cruz, et al. Treatment of Children with ADHD: Results from the MTA. Journal of the American Academy of Child & Adolescent Psychiatry 2015;54(1):62-70.

40 Kidwell KM, Van Dyk TR, Lundahl A, Nelson TD. Stimulant Medications and Sleep for Youth With ADHD: A Meta-analysis. Pediatrics Dec;136(6): doi: /peds Review.

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42 Pliszka S. AACAP Work Group on Quality Issues. Practice Parameter. J. Am. Acad. Child Adolesc. Psychiatry 2007; 46(7):

43 Pliszka S. AACAP Work Group on Quality Issues. Practice Parameter. J. Am. Acad. Child Adolesc. Psychiatry 2007; 46(7):

44 Newcorn et al. Clinical Responses to Atomoxetine in Attention- Deficit/Hyperactivity Disorder. J. Am. Acad. Child Adolesc. Psychiatry 2009; 48 (5):

45 Micromedex, accessed 5/4/12.

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47 Guanfacine Starting dose <45kg, 0.5 mg qhs; >45 kg, 1 mg qhs Maximum dose 2 mg (27-40 kg); 3 mg (40-45 kg); 4 mg (>45 kg) Half life FDA 14 h Not approved Guanfacine extended release (Intuniv) 1 mg daily 4 mg 16 h Approved 6-17yo Wait one week between dose increases. Pliszka S. AACAP Work Group on Quality Issues. Practice Parameter. J. Am. Acad. Child Adolesc. Psychiatry 2007; 46(7):

48 Starting dose Clonidine <45kg, 0.05 mg qhs >45 kg, 0.1 mg qhs Clonidine extended release (Kapvay) 0.1 mg qhs; doses greater than 0.1 mg should be bid Maximum dose 0.2 mg (27-40 kg); 0.3 mg (40-45 kg); 0.4 mg (>45 kg). Half life 0.4 mg h FDA 12 h Not approved Approved 6-17yo Wait one week between dose increases. Pliszka S. AACAP Work Group on Quality Issues. Practice Parameter. J. Am. Acad. Child Adolesc. Psychiatry 2007; 46(7):

49 Prescribing information.

50 Pliszka S. AACAP Work Group on Quality Issues. Practice Parameter. J. Am. Acad. Child Adolesc. Psychiatry 2007; 46(7): Lexicomp Inc. Guanfacine: Pediatric Drug Information Accessed 8/13/12.

51 Micromedex, accessed 5/4/12.

52 Kratochvil CJ, Daughton JM. Review of ADHD Pharmacotherapies: Advantages, Disadvantages, and Clinical Pearls. J. Am. Acad. Child Adolesc. Psychiatry 2009; 48:

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55 Bloch M, Qawasami A. Omega-3 Fatty Acid Supplementation for the Treatment of Children With Attention-Deficit/Hyperactivity Disorder Symptomatology: Systematic Review and Meta-Analysis. J. Am. Acad. Child and Adolesc. Psychiatry 2011; 50: Sonuga-Barke et al. Nonpharmacological Interventions for ADHD: Systematic Review and Meta-Analyses of Randomized Controlled Trials of Dietary and Psychological Treatments. Am J Psychiatry 2013:170(3)p;

56 Sonuga-Barke et al. Nonpharmacological Interventions for ADHD: Systematic Review and Meta-Analyses of Randomized Controlled Trials of Dietary and Psychological Treatments. Am J Psychiatry 2013:170(3);

57 Arns et al. Efficacy of Neurofeedback Treatment in ADHD. Clinical EEG and Neuroscience 2009; 40 (3): Sonuga-Barke et al. Nonpharmacological Interventions for ADHD: Systematic Review and Meta-Analyses of Randomized Controlled Trials of Dietary and Psychological Treatments. Am J Psychiatry 2013:170(3);

58 Amonn, et al. Evaluation of computer-based neuropsychological training in children with ADHD. NeuroRehabilitation 2013:32(3). Klingberg T, et al. Computer training of working memory in children with ADHD a randomized controlled trial 2005:44(2). Steiner N, et al. Computer-based attention training in the schools for children with ADHD: a preliminary trial. Clinical Pediatrics 2011:50(7). Rabiner DL, et al. A randomized trial of two promising computer-based interventions for students with attention difficulties. J Abnorm Child Psychol 2010: 38(1).

59 QbTest is a test to evaluate the symptoms of ADHD for children and adults that combines motion-tracking analysis with a uniquely designed continuous performance task. During the minute task, the patient is instructed to respond as quickly and accurately as possible to certain geometric shapes appearing on a computer screen by pressing a responder button. As the patient performs the task, a camera located above the computer records movement from a reflector located on the patient's forehead.

60 Rommel et al. Protection from Genetic Diathesis in ADHD. JAACAP 2013; 52(9):

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