Saturday, December 2, 2023
This activity is intended for physicians, nurses, psychologists, and healthcare professionals.
The goal of this activity is to provide clinicians with the latest information on the screening and assessment tools for adult ADHD.
Upon completion of this activity, participants will be able to:
Medscape, LLC is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
Medscape designates this educational activity for a maximum of 1.0
category 1 credit(s) toward the AMA Physician's Recognition Award. Each
physician should claim only those credits that he/she actually spent in
the activity.
The American Medical Association has determined that non-US
licensed physicians who participate in this CME activity are eligible
for AMA PRA category 1 credit.
1.2 contact hours of continuing education for RNs, LPNs, LVNs, and NPs.
This activity is cosponsored with Medical Education Collaborative, Inc.
(MEC) and Medscape. MEC is accredited as a provider of continuing
nursing education by the American Nurses Credentialing Center's
Commission on Accreditation.
Board of Nursing, Provider Number FBN 2773.
California Board of Registered Nursing, Provider Number CEP
12990, for 1.2 contact hours.
Medical Education Collaborative, Inc. (MEC) is approved by the American Psychological Association to offer continuing education for psychologists. MEC maintains responsibility for the program. The course provides 1 hour(s) of credit.
For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [email protected]
There are no fees for participating in or receiving credit for this
online educational activity. For information on applicability and
acceptance of continuing education credit for this activity, please
consult your professional licensing board.
This activity is designed to be completed within the time
designated on the title page; physicians should claim only those
credits that reflect the time actually spent in the activity. To
successfully earn credit, participants must complete the activity
online during the valid credit period that is noted on the title page.
Follow these steps to earn CME/CE credit:
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Familiarity with the diagnostic criteria for ADHD is extremely important. Most of the major rating scales used for screening patients are modeled on the criteria laid out in the DSM-IV.[3] There are 3 critical aspects of the diagnosis: (1) at least 6 of 9 symptoms for one of the ADHD subtypes, (2) childhood onset of symptoms, and (3) impairment in at least 2 areas like work/school, home, and social settings.
According to the DSM-IV, ADHD can be divided into 3 subtypes: predominantly inattentive; predominantly hyperactive-impulsive; and the combined type, for which a patient must fully meet the criteria for both of the other 2 subtypes. Inattentive symptoms include failure to pay close attention to detail, difficulty sustaining attention, not listening when spoken to, failure to follow through on instructions or finish tasks, difficulty organizing, reluctance to engage in activities that require sustained mental effort, often losing things, being easily distracted, and often being forgetful. A patient must have at least 6 of these 9 symptoms to be considered to have the inattentive subtype.
The symptoms of the hyperactive-impulsive subtype include frequent fidgeting; frequently leaving one's seat in situations where staying seated is expected; running about, climbing excessively, or a feeling of internal restlessness; difficulty engaging quietly in leisure activities ; often "on-the-go" or acting like one is "driven by a motor"; talking excessively; blurting out answers; having difficulty waiting one's turn; and interrupting or intruding on others. Again, at least 6 of these symptoms must be present for diagnosis of the hyperactive-impulse subtype. Patients who meet all criteria for both the inattentive and hyperactive-impulsive subtypes are diagnosed with the combined subtype.
The symptoms that patients describe cannot be episodic -- they must persist for 6 months or longer and must affect at least 2 areas of functioning (ie, school, work, home, social life). Age of onset is also an important adult ADHD diagnostic criterion. Symptoms must date back to age 7 or younger. If the childhood history is not present, the patient does not meet criteria for a diagnosis. Ways of documenting childhood history include the ADHD module from the Kiddie-SADS and the Connors, Barkley, and Brown diagnostic symptoms scales (see Diagnostic Scales), which are described in detail below.
One must also consider whether the symptoms are ADHD or evidence of another disorder. Comorbidity can occur in as many as 80% of ADHD patients,[4] but one must also consider whether the observed symptoms are comorbid conditions or if they are the result of a mood disorder or anxiety disorder and not due to ADHD.
