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Improving ADHD outcomes

Improving ADHD outcomes

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Published by: Danielle on Feb 20, 2011
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1
EducationalObjectives
After completing this activity, the participant should be betterable to: 
Explain how the proper recognition and management of ADHD inadolescents by MCOs can improve clinical outcomes and reduce theeconomic burden of diseaseIndicate the link between ADHD and the most common psychiatriccomorbiditiesDescribe current ADHD guidelines and treatment protocolsOutline opportunities to maximize health plan performance for theADHD HEDIS measureState examples of ADHD quality improvement strategies for MCOs
Effectively Recognizing and ManagingADHD in Adolescents
Timothy E. Wilens, M.D
Clinical & Research Program in Pediatric PsychopharmacologyMassachusetts General HospitalHarvard Medical School
 
2
Overview
Estimated prevalence:
 –
6 to 8% of children 
 –
6% of adolescents 
 –
4% of adults 
4:1 male to female ratio in children and adolescentsTreatment utilization varies widely within and between cultures,ethnicities, and socioeconomic status
Goldman LS, et al.
JAMA
1998;279:1100-1107.Barkley RA. In: Mash EJ, Barkley RA. eds.
Treatment of Childhood Disorders 
. New York; Guildford Press 1989.
ADHD Subtypes
DSM-IV-TR* ADHD subtypes
 –
Combined subtype (50–75%)
 –
Primarily inattentive (20–30%)
Increases with age 
 –
Primarily hyperactive–impulsive (<15%)
*DSM-IV-TR: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision.American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4
th
Edition, Text Revision. Washington, DC. AmericanPsychiatric Association. 2000;48:85-93.
Etiology
ADHD is a heterogeneous behavioral disorder with multiplepossible etiologies
NeuroanatomicNeurochemical
CNS insultsGeneticoriginsEnvironmentalfactors
ADHD
Biederman J, FaraoneSV.
Lancet 
2005;336:237-48.
 
3
DSM-IV Diagnostic Criteria for ADHD
1.Either (1) Symptoms of inattention, or (2) symptoms of hyperactivity-impulsivity or (3) both2.Onset <7 years of age (childhood-onset)3.>6 months of disturbance4.Cross-situational (home, work, school)5.Impairment in functioning
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4
th
Edition, Text Revision. Washington, DC. AmericanPsychiatric Association. 2000;48:85-93.
Clinical Presentation in an Adolescent(13-18 Years of Age)
May seem restless rather than hyperactiveProblems with attention, task completion, shifting of activitiesprematurelySchool work disorganized and shows poor follow-through; failsto work independentlySeems emotionally immatureHas poor self-esteemHas poor peer relationshipsMay engage in irresponsible or risky behavior 
WolraichML, et al.
Pediatrics.
2005;115:1734-1746.Barkley RA.
Attention-Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment 
. 3rd ed. New York, NY: Guilford Press; 2006.Barkley RA, et al.
J Am Acad Child Adolesc Psychiatry 
. 1991;30:752-761.
MotorichyperactivityLow frustration toleranceImpulsivenessDistractibilityShifting of activitiesFidgetinessImpatienceRestlessnessInattentiveness
ChildrenAdults
ADHD Developmental Trends by Age
Symptoms of ADHD decline and change from childhood toadulthood
Wolraichet al.
Pediatrics 
. 2005;115:1734-1746.Millstein et al. J Attention Disorder 1997.

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