Continuing Medical Education (CME)

Attention-Deficit Hyperactivity Disorder

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. There are accepted standards for diagnosis and treatment. This purpose of this CME activity is to improve care for ADHD by explaining these standards and providing tools and resources to apply this information in practice. Some key aspects of care are:

Diagnosis

• Multiple sources of information are needed. Input from both parents and teachers is required.
• Some psychological rating tools are useful ( e.g., Vanderbilt, Connors).
• No specific test is indicated by ADHD or can make the diagnosis. Diagnostic tests may be ordered for other conditions.

Treatment

• Combine pharmacologic and behavioral treatment to enhance longer term success.
• Stimulants (generally methylphenidate) are the first line of pharmacologic treatment.
• Behavioral treatment 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 common beliefs are untrue and complementary therapy is common.
• Appendix A has management tools and Appendix B has differential diagnosis and treatment resources

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 Leader
	John M. O’Brien, MD Family Medicine
Team Members
	Barbara T. Felt, MD Behavioral Pediatrics Paramjeet K. Kochhar, MD Pediatrics R. Van Harrison, PhD Medical Education Stephanie A. Riolo, MD Child Psychiatry
Consultant
	Nadine Shehab, Pharm D College of Pharmacy
Author Disclosures
	Neither the team lead, the team members, nor the consultant 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 Connie J. Standiford, MD Literature search services: Taubman Medical Library Production of Internet format and web site 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 educational activity for a maximum of 1 AMA/PRA Category 1 Credits™.  Physicians should only claim credit commensurate with the extent of their participation in the activity.

This CME activity was released in September 2005, with credit available through August 2008.  The  activity was reviewed for currency of content in August 2008 and availability of credit extended through August 2011.  The activity was reviewed for currency of content in August 2011 and availability of credit extended through July 2012.  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.

 

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