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The Evolving Face of ADHD: From Adolescence to Adulthood

  • Authors: Presenter: Joseph Biederman, MD; Moderator: Otto Ratz, MD
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Target Audience and Goal Statement

This activity was developed for psychiatrists involved in the care of patients with ADHD.

Attention deficit hyperactivity disorder (ADHD) is the most common psychiatric disorder of childhood and one that frequently persists into adulthood. Research has demonstrated that persistence of ADHD from childhood into adulthood is estimated to be between 50% and 80%, meaning that approximately 4% of the adult population has ADHD. There are currently no formal guidelines or standards of care for adolescent into adulthood ADHD patients. Identifying patients in this population remains a challenge for clinicians. If the ADHD was not recognized when the patient was a child, the diagnosis of ADHD is often overlooked in the adolescent into adulthood period. Diagnosis remains clinically based, relying on clinical interviews, symptom rating scales, and subjective reporting from patients, parents, or siblings. Current diagnostic criteria for ADHD are still based on observations of school-aged children. As a result, the DSM-IV criteria have certain limitations when applied to adolescent into adulthood patients. Furthermore, the existence of comorbid conditions is very common in ADHD, affecting up to 3 of every 4 patients. As a result, psychiatrists must typically evaluate for ADHD amidst other psychiatric disorders. Mood disorders (major depression, bipolar disorder, and dysthymia), anxiety disorders, substance abuse, personality disorders, antisocial behavior, and learning disabilities are the chief psychiatric comorbidities. Continued controversies surrounding the use of psychostimulants in the treatment of ADHD have added to misconceptions and confusion within the community. Because of the unique challenges associated with ADHD in adolescent into adulthood patients, there is a clear need for education on management and treatment strategies for these populations so that psychiatrists may confidently and effectively improve the quality of life for patient with ADHD.

Upon completion of this activity, participants should be able to:

  1. Summarize the prevalence and the social and economic burden and consequences of adolescent into adulthood ADHD
  2. Assess the presentation and comorbidities associated with ADHD in adolescent into adulthood patients
  3. Discuss the use of screening instruments to aid in detecting ADHD in adolescent into adulthood patients
  4. List the available treatments for adolescent into adulthood ADHD and their associated risks and benefits
  5. Discuss the clinical applicability of recent studies on ADHD in adolescent into adulthood populations


Authors and Disclosures

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. Postgraduate Institute for Medicine (PIM), SynerMed® and McNeil Pediatrics do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of PIM, SynerMed® and McNeil Pediatrics. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.


Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient's conditions and possible contraindications on dangers in use, review of any applicable manufacturer's product information, and comparison with recommendations of other authorities.

Disclosure of Conflicts of Interest

Postgraduate Institute for Medicine (PIM) assesses conflict of interest with its instructors, planners, managers and other individuals who are in a position to control the content of CME activities. All relevant conflicts of interest that are identified are thoroughly vetted by PIM for fair balance, scientific objectivity of studies utilized in this activity, and patient care recommendations. PIM is committed to providing its learners with high quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.

The faculty and planners and managers reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity:


  • Joseph Biederman, MD

    Chief, Clinical and Research Program in Pediatric Psychopharmacology, Massachusetts General Hospital, Professor of Psychiatry, Harvard Medical School


    Disclosure: Dr Joseph Biederman receives research support from the following sources: Abbott Laboratories, Bristol-Myers Squibb, Cephalon Inc, Eli Lilly and Company, Eli Lilly and Company Foundation, Janssen, McNeil-PPC Inc, National Institute of Child Health and Human Development, National Institute of Mental Health, National Institute on Drug Abuse, Neurosearch, New River Pharmaceuticals, Novartis, Pfizer Inc, Prechter Foundation, Shire Pharmaceuticals, and Stanley Medical Research Institute.

    Dr Biederman is a speaker for the following speaker's bureaus: Cephalon Inc, Eli Lilly and Company, McNeil-PPC Inc, Shire Pharmaceuticals, UCB Pharma Inc, Novartis.

    Dr Biederman is on the advisory board for the following pharmaceutical companies: Cephalon Inc, Eli Lilly and Company, Janssen, McNeil-PPC Inc, Novartis, and Shire Pharmaceuticals.

Accreditation Statements

    For Physicians

  • This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the Postgraduate Institute for Medicine (PIM) and SynerMed® Communications. PIM is accredited by the ACCME to provide continuing medical education for physicians.

    Postgraduate Institute for Medicine designates this educational activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

    Estimated time to complete activity: 1 hour

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Follow these steps to earn CME/CE credit*:

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The Evolving Face of ADHD: From Adolescence to Adulthood: Methylphenidate Compounds and Amphetamine Products


Methylphenidate Compounds and Amphetamine Products

  • Over the last several years, we have had the influx of very well designed long-acting stimulants that really completely change the way that we can treat patients with ADHD. The first one that came to market is OROS methylphenidate, or Concerta. This is a very sophisticated tablet, has an osmotic membrane and overcoat of methylphenidate, 2 compartments of methylphenidate, and a push compartment. It also has a laser-drilled hole that allows the release of medication at a prespecified pace.

    This medication was specifically developed to replace 3 doses of immediate-release methylphenidate given 4 hours apart; therefore, this treatment is active for about 12 hours. This treatment really changed the way that we treat children with ADHD, because we recognize that the day does not end in school.

  • Methylphenidate HCI (Concerta) Extended-Release Tablets: Trilayer Capsule-Shaped Tablets

    Slide 46.

    Methylphenidate HCI (Concerta) Extended-Release Tablets: Trilayer Capsule-Shaped Tablets

    (Enlarge Slide)
  • The second methylphenidate reformulation that came to market is this product that is marketed as Metadate CD, has a 30% short-acting bead, 70% long-acting bead. This medication was designed to replace 2 doses of methylphenidate, so this is a medium-acting/long-acting medication designed to avoid taking medication in school.

  • Methylphenidate HCl (Metadate CD) Extended-Release Capsules: Biphasic Release Bead-Delivery System

    Slide 47.

    Methylphenidate HCl (Metadate CD) Extended-Release Capsules: Biphasic Release Bead-Delivery System

    (Enlarge Slide)
  • The third methylphenidate compound that came to market is a reformulation of methylphenidate slow release, or Ritalin SR, called Ritalin LA. It is made by the same manufacturer and has a 50% short-acting bead, 50% long-acting bead, so this medication is designed also to work for 6 to 8 hours to cover the school day, without having to take medication in school.

  • Methylphenidate HCl (Ritalin LA) Extended-Release Capsules: Bimodal Release for Once-Daily Dosing

    Slide 48.

    Methylphenidate HCl (Ritalin LA) Extended-Release Capsules: Bimodal Release for Once-Daily Dosing

    (Enlarge Slide)
  • Recently we had the advent of the d-isomer of methylphenidate, marketed as Focalin. It's a more pure form of methylphenidate.

  • Dexmethylphenidate HCl (Focalin XR) Extended-Release Capsules

    Slide 49.

    Dexmethylphenidate HCl (Focalin XR) Extended-Release Capsules

    (Enlarge Slide)
  • The most recent addition to the armamentarium is the transdermal methylphenidate that has recently come to market. This medication is the only one available that is given through the skin in the form of a patch.

  • Methylphenidate Transdermal System (MTS, Daytrana): DOT MatrixTM

    Slide 50.

    Methylphenidate Transdermal System (MTS, Daytrana): DOT MatrixTM

    (Enlarge Slide)
  • In addition to the methylphenidate compounds that I just reviewed for you, we also have, of course, amphetamine products. The newest amphetamine (we have had dextroamphetamine sulfate [Dexedrine] for a long time), is the product that has a mixture of amphetamine salt, mixed amphetamine salt, otherwise known as Adderall XR; 50% short-acting bead, 50% long-acting bead. This product is also designed to work for about 12 hours. So the longest-acting stimulants that we have are Concerta, Adderall XR, and the patch.

  • Mixed Amphetamine Salts (Adderall XR) Capsules: Pulse-Delivery System

    Slide 51.

    Mixed Amphetamine Salts (Adderall XR) Capsules: Pulse-Delivery System

    (Enlarge Slide)