Presented by the

National Resource Center on ADHD

Timothy E. Wilens, M.D.

Massachusetts General Hospital Harvard Medical School

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Timothy E. Wilens, M.D.

Massachusetts General Hospital Harvard Medical School

Disclaimer: The information provided here is supported by Cooperative Agreement Number CDC-RFA-DD13-1302 from the

Centers for Disease Control and Prevention (CDC). The Ask the Expert webinars’ contents are solely the responsibility of the

invited guest Expert and do not necessarily represent the official views of CDC. Neither CHADD, the National Resource Center on

ADHD, nor the CDC endorses, supports, represents or guarantees the accuracy of any material or content presented in the Ask the

Expert webinars, nor endorses any opinions expressed in any material or content of the webinars. CHADD and the National

Resource Center on ADHD offer webinars for educational purposes only; the information presented should not be regarded as

medical advice or treatment information.

To Ask A Question:

Send us your feedback about today’s webinar! An email will arrive shortly with a link to take the survey.

Thank you for helping us plan future webinars that meet the interests of the ADHD community!

Timothy E. Wilens, M.D.

Massachusetts General Hospital Harvard Medical School

Dr. Wilens has served as a consultant, speaker, or has received grant support

from the following (past 3 years) NIH (NIDA) Pharmaceuticals: Euthymics, Shire, Theravance, Tris National Football League (ERM Associates) and Minor/Major League Baseball

Dr. Wilens authored Straight Talk About Psychiatric Medications for Kids

(Guilford Press 2008 most recent ed.); and co-edited MGH Comprehensive Clinical Psychiatry (Mosby-Elselvier 2014/2015 release) and ADHD Across the Lifespan (Cambridge Press, 2014/2015 release)

Some of the products discussed are not FDA approved for ADHD or other psychopathology; others may not be FDA approved in the manner discussed (e.g. dosing, combination therapy)

ADHD is the most commonly diagnosed neurobehavioral disorder of childhood

Increase in prevalence & treatment over past decade

Continues into adulthood in about ½ of cases

Untreated ADHD related to academic/occupational difficulties and sequalae

Treatment of ADHD should include consideration of educational evaluation and accommodation, psychosocial treatments for the individual and family

Medication (pharmacotherapy) is also considered among first line treatments

(ADHD Practice Parameters. JAACAP 1997;36:89S 2007: Greenhill L et al., JAACAP 2002

Wilens & Spencer, Postgraduate Medicine, 2011; Visser et al. JAACAP 2013)

CH2 CH2 NH2 OH

OH

Dopamine

OH

CH CH2 NH2 OH

OH

Norepinephrine

CH2 CH NH2

CH3

Amphetamine

Methylphenidate

COCH3

O

NH

Bupropion

Prospective study utilizing two MRI scans in 43 youths (age 9-20 years) with ADHD.

Shaw et al. Am J Psychiatry. 2009;166:58-63.

Mean baseline and endpoint raw cortical thickness (±SEM)

in the left middle/inferior frontal gyrus

Thic

kness (

mm

)

4.8

4.1

3.8 Time 1

(mean age, 12.5 years)

Time 2 (mean age, 16.4 years)

For most participants, cognitive data was not collected at both timepoints. Increased cortical thinning in the group

that stopped taking stimulants was not associated with any difference in clinical outcome. Effects of treatment with

nonstimulants cannot be excluded, although prevalence of nonstimulant use was low

*Derived from 620 scans of 294 typically developing youths

On psychostimulants (n = 19)

Typically developing cohort*

Off psychostimulants (n = 24)

ADHD Stimulant Dosing (Dosing may exceed FDA approved limits*)

Medication Starting Dose Usual Dosing (hours they last)

Methylphenidate

Ritalin® 5 mg QD/BID 3x’s/day (4 hr)

Focalin® 2.5 mg Twice daily (5-6hr?)

Dexedrine® 2.5 to 5 mg QD 2-3’x /day (4hr)

Dex Spansule 5 mg Twice daily (6 hr)

Vyvanse 20-30 mg Daily (12-14 hr)

(Wilens, Spencer, Biederman, Ann Review Medicine 53:2002; Wilens CNS Drug 2008; Wilens and Spencer, PostGraduate Medicine 2011)

Concerta® 18 mg QD Daily (12h)

MetadateCD® 10 mg QD Daily (8-10h)

Ritalin LA 10 mg QD Daily (10-12hr) Focalin (XR) 5 mg QD Daily (10-12 hr)

MTS patch 10 mg Daily (8-16 hr)

Amphetamine

0 5 10 15 20 25 30

anorexia

insomnia

headache

abdominal pain

nervousness

emotional lability

Placebo

Add XR 10

Add XR 20

Add XR 30

% of Subjects Reporting

Cardiovascular problems

Growth suppression

Development of tics

Substance abuse

Atomoxetine = Strattera*

Alpha Agonists (extended-release [XR] guanfacine

= Intuniv; clonidine = Kapvay)

Combination stimulant + alpha agonists XR*

Antidepressants ◦ Bupropion = Wellbutrin ◦ Tricyclics

Modafinil = Provigil

Research ◦ Natural agents (fish oils, metadoxine) ◦ Combined (e.g. atomoxetine + stimulants) ◦ Research

(Wilens and Spencer, Postgraduate Med, 2011)

* Denotes FDA-approved

ADHD Antisocial

Substance Abuse

Anxiety

Mood

When treating disorders along with ADHD, consider treating the most severe disorder first

Untreated ADHD is problematic

Medications effective in treating ADHD

Many stimulant preparations and nonstimulants

Largely predictable side effects

Safe longer term effects, but ongoing studies

Data on combination with other medications emerging

Stay tuned for new research in this area

To Ask A Question:

Timothy E. Wilens, M.D.

Massachusetts General Hospital Harvard Medical School

www.Help4ADHD.org 800.233.4050

The information provided in this episode of Ask the Expert is supported by Cooperative Agreement Number 5U38DD000335-05

from the Centers for Disease Control and Prevention (CDC). The Ask the Expert webinars’ contents are solely the responsibility of the invited guest Expert and do not necessarily represent the official

views of CDC. Neither CHADD and the National Resource Center on ADHD, nor the CDC endorses, supports, represents or guarantees the accuracy of any material or content presented in the Ask the

Expert webinars, nor endorses any opinions expressed in any material or content of the webinars. CHADD and the National

Resource Center on ADHD offer webinars for educational purposes only; the information presented should not be regarded as medical

advice or treatment information.