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This Final Program contains information which is not contained in the printed publication or the Web site, i.e., changes of presentation titles speakers, times, meeting rooms where each session will be held, exact schedule and moderators for Roundtable sessions, a final list of sponsors and booth numbers, a list at the end of the program section ; of "By Invitation Only" meetings being held in conjunction with the conference, etc. Please use this program as the most up-to-date guide to the conference. The Program-at-a-Glance will tell you what is scheduled in each time frame. The program section details times for individual presentations, exact location where each session will be held, etc. Math assistants are here to help you understand your math homework, as well as aid in your understanding of math concepts. This is the place where you can bring your short, quick questions, and get prompt responses. We don't want you to get held back in finishing your homework. Sometimes compliance issues are a problem due to misunderstanding, parental worries about medications, family dynamic factors, or other issues. Some parents and patients especially adolescents ; are resistant to the use of medication, and some patients experience unacceptable side effects or limited efficacy. The careful clinician balances the risks of medication, the risks of the untreated disorder, and the expected benefits of medication relative to other treatments. A baseline for target symptoms is useful before starting medication; initial behavioral rating scale data can be very useful for this purpose. Readministering these measures, keeping peaks and troughs in mind, can help monitor treatment efficacy see Appendix F ; . Sometimes medications that are frequently used and known to be effective for ADHD, but off-label in terms of FDA approval, such as Wellbutrin an antidepressant that works on the DA neurotransmitter system ; , can be used in situations where patients or parents are opposed to the use of stimulants, but pharmacotherapy is still warranted. A newer agent, Strattera, is also an alternative that does have FDA approval for the treatment of AD HD. Both of these agents are discussed below in more detail. Some types of medication interventions are being used less commonly than they were years ago. For instance, many practitioners use a combination of a psychostimulant along with an SSRI see Appendix C ; , to treat an AD HD patient with significant symptoms of depression or anxiety. Years ago, the same practitioner might have chosen a TCA, such as imipramine or desipramine, for such a cluster of symptoms in either a child or adult AD HD patient. However, SSRIs are generally better tolerated in both children and adults, and both doctors and families find the need for cardiac monitoring with TCA medicines to be cumbersome an electrocardiogram is necessary before initiating TCA therapy and after the dosage is stabilized ; . Such studies are not needed with SSRIs. Also, TCAs are more toxic in overdose situations, and in the mid 1990s, there were five cases of unexplained death related to the use of desipramine. For TCA therapy, clinicians now favor nortriptyline and imipramine as the first choices among the tricyclics in the treatment of prepubertal children. These agents still require careful monitoring of therapeutic efficacy and of baseline and subsequent vital signs and ECG. Patient history of cardiac disease or arrhythmia or a family history of sudden death, unexplained fainting, cardiomyopathy, or early cardiac disease may be a contraindication to TCA use. In general, all psychotrophics should be avoided in patients following an MI for at least four to six weeks. Earlier, the psychostimulant pemoline Cylert ; , was considered a first-line agent for the treatment of AD HD, and was attractive due to positive treatment impact, its long duration of effect, and the absence of drug abuse potential. Although routine liver function tests have long been needed for patients on Cylert, links between this drug and rapidly developing hepatotoxicity are now known to be a risk. Both common practice and treatment guidelines recommend the use of this medication for AD HD only when other medications have failed. When using pemoline, liver enzymes should be assessed before and during treatment, but because the onset of hepatitis is unpredictable and rapid, routine laboratory follow-up studies are not effective enough. In addition, parents and patients should be alerted to notify the physician immediately in case nausea, vomiting, lethargy, persistent abdominal discomfort, malaise, or jaundice appear. Clonidine Catapres ; is an alpha-2-adrenergic agent with ant-hypertensive efficacy that has been found to be effective in reducing the hyperarousal often seen among younger AD HD children. It also has been shown to reduce distractibility and improve attention span, and is effective in the treatment of chronic tic disorders and Tourette's syndrome. Clonidine comes in a transdermal patch Catapres TTPTM ; as well as in an oral form, although it is an agent that is used off-label with AD HD children. In the last several years, reports of death in children who had received clonidine plus methylphenidate led to heightened concerns about the cardiovascular safety of clonidine. However, due to many mitigating and extenuating circumstances, causality in these cases is uninterpretable. Moreover, in studies monitoring adverse effects of clonidine, no clinically meaningful ECG changes have been identified. At this time, such uncertainty dictates cautious and careful practice when clonidine and methylphenidate are warranted, as might be the case in very hyperactive ADHD children whose behavior is only under partial control with methylphenidate. Guanfacine Tenex ; a similar alpha adrenergic agent, is another option for these types of cases, and is also generally less sedating than clonidine. However, use of these medications for hyperactivity is off-label for both agents. Monitoring Medication Efficacy When assessing medication impact upon AD HD behaviors multiple outcome measures are essential, using more than one source, setting, and method of gathering data. Baseline behavior rating scales that are obtained during the initial assessment can often be re-administered as an instrument to use for follow-up monitoring. The prescribing physician should work closely with parents on dose adjustments and should obtain feedback from any academic testing and frequent reports from.

Twenty-five percent of Hispanic high school students meet the criteria for clinical depression, compared with 18% of African Americans and 12% of whites. For females, the differences are even more striking, with depression affecting 31% of Hispanic women, 22% of African-Americans, and 16% of whites.47 Hispanic adolescent girls had the highest rate of suicide attempts: 16% compared with 10% for African American girls and 10% for white girls.48.

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