4.3 Attention-Deficit/Hyperactivity Disorder: From Diagnosis to Pharmacology: What’s New?

• Published in: Journal of the American Academy of Child and Adolescent Psychiatry Vol. 55; no. 10; p. S91
• Main Author: Wilens, Timothy E., MD
• Format: Journal Article
• Language: English
• Published: Baltimore Elsevier Inc 01.10.2016; Elsevier BV
• Subjects: Accuracy; Activity level; Adolescents; Attention deficit hyperactivity disorder; Best practice; Biological markers; Biomarkers; Children; Children & youth; Clinical medicine; Clinical practice guidelines; Cognitive ability; Diagnosis; Dosage; Drugs; EEG; Efficacy; Electroencephalography; Ethics; Hyperactivity; Learning; Lifelong Learning; Literature reviews; Medical diagnosis; Pediatrics; Pharmacology; Physicians; Prescribing; Psychiatry; Public policy; Release; Reliability; Reviews; Safety; Short term memory; Signaling; Statistical analysis; Stimulants; Systematic review; Tics; Training
• ISSN: 0890-8567; 1527-5418
• DOI: 10.1016/j.jaac.2016.07.033

Objectives: The goal of this session is to review articles chosen by the Lifelong Learning Committee addressing current concepts and understanding in the following areas: 1) risk of tics associated with stimulant treatment for ADHD; 2) impact of activity level on working memory and performance in children with ADHD; 3) diagnostic reliability of integrating an EEG biomarker with a clinician's ADHD evaluation; 4) discussion of the ethics and safety related to the use of cognitive enhancers; and 5) the results of a randomized, placebo-controlled trial of guanfacine-extended release for adolescent ADHD. Methods: This presentation reviews articles from the following perspectives: importance/context; participants; hypotheses, study design, and findings; implications for clinical practice; limitations; and recommendations for future practice and research. Results: The studies report the following findings: 1) meta-analysis found no significant increase in the risk of new onset or worsening of tics when comparing stimulants with placebo; 2) higher rates of activity level predicted significantly better but not normalized working memory performance for children with ADHD; 3) integration of the EEG biomarker with a clinician's ADHD evaluation improved diagnostic accuracy; 4) physicians are inarguably the gatekeepers for a class of drugs that have yet to be fully evaluated for safety or efficacy for the purpose of neurological enhancement; and 5) compared with placebo, guanfacine-extended release at doses of up to 7 mg/ day was associated with statistically significant improvements in ADHD symptoms, and no new safety signals were reported. Conclusions: It is noteworthy that new evidence suggests that hyperactivity in ADHD may actually play a compensatory role in improving working memory. A more accurate diagnosis of pediatric and adolescent ADHD might be achieved by combining EEG biomarkers with clinician evaluation. Treatment of ADHD with stimulants does not necessarily increase the risk of new or worsening tics. Higher dose of guanfacine-extended release is effective in adolescents with ADHD. Although public policy may intervene in the near future, it is currently up to the physician to determine what constitutes "best practice" for prescribing stimulant medications.