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Early Morning Functioning Impairments in Children and Adolescents With ADHD

Early Morning Functioning Impairments in Children and Adolescents With ADHD



Time to Complete

1 hour


January 20, 2016


January 20, 2017
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Maximum Credits

1.00 / AMA PRA Category 1 Credit(s)TM
1.00 / CE for Nurses
1.00 / CE for Nurse Practitioners (0.20 pharmacology credit)

Accredited Provider

Provided by Veritas Institute for Medical Education, Inc.

Commercial Supporter

This activity is supported by an educational grant from Ironshore Pharmaceuticals & Development, Inc.

Program Description

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders in children, which affected approximately 11% of children aged 4 to 17 years of age (6.4 million) in 2011.1 ADHD is often diagnosed in childhood and lasts into adulthood in approximately 65% to 75% of cases.2 A recent systematic literature review suggests that the annual incremental costs for the disorder in the United States are between $143 and $266 billion dollars.3

Despite improvements with the drug delivery systems of ADHD medications, early morning functioning (EMF) remains an issue in many children with ADHD. According to a recent survey, the majority of caregivers reported early morning ADHD symptoms (74%) and EMF impairment (76%) as moderate to severe (ADHD symptom score: 5-10).4 Parents reported that they often: felt overwhelmed and exhausted (41%); raised their voice more (37%); and felt constantly stressed (30%) as a result of their child’s ADHD symptoms during the EMR.4 It was also noted that 79% of caregivers had discussed early morning impairments with their child’s physician.4 In light of these figures, a number of coping strategies, including nonpharmacologic and pharmacologic interventions, have been developed. Therefore, it is important for healthcare professionals to become more aware that the early morning is problematic for children with ADHD and their families.
1. Visser SN, Danielson ML, Bitsko RH, Holbrook JR, Kogan MD, Ghandour RM, Perou R, Blumberg SJ. Trends in the parent-report of health care provider-diagnosed and medicated attention-deficit/hyperactivity disorder: United States, 2003–2011. J Am Acad Child Adolesc Psychiatry. 2014;53(1):34-46.
2. Wilens TE, Faraone SV, Biederman J. Attention-deficit/hyperactivity disorder in adults. JAMA. 2004;292(5):619-623.
3. Doshi JA, Hodgkins P, Kahle J, Sikirica V, Cangelosi MJ, Setyawan J, Erder MH, Neumann PJ. Economic impact of childhood and adult attention-deficit/hyperactivity disorder in the United States. J Am Acad Child Adolesc Psychiatry. 2012;51(10):990-1002.
4. Sallee FR. Early morning functioning in stimulant-treated children and adolescents with attention-deficit/hyperactivity disorder, and its impact on caregivers. J Child Adolesc Psychopharmacol. 2015;25(7):558-565.

Intended Audience

The proposed educational activity is designed to reach child and adolescent psychiatrists, primary care physicians, nurse practitioners, registered nurses, and other allied healthcare professionals, who are responsible for the diagnosis, treatment, and ongoing management of patients with ADHD with an emphasis on early morning impairments.

Educational Objectives

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

  • Discuss the concept of early morning ADHD symptoms and related functional impairments as a significant unmet clinical need in school-age children diagnosed with ADHD
  • Examine scales to measure before-school behaviors
  • Discuss current nonpharmacologic strategies for coping with early morning ADHD symptoms in school-age children
  • Discuss existing and emerging medications for managing early morning ADHD symptoms in school-age children

Conflict Of Interest Disclosure Policy

In accordance with the ACCME’s Standards for Commercial Support, all CME providers are required to disclose to the activity audience the relevant financial relationships of the planners, teachers, and authors involved in the development of CME content. An individual has a relevant financial relationship if he or she has a financial relationship in any amount occurring in the last 12 months with a commercial interest whose products or services are discussed in the CME activity content over which the individual has control.


Timothy E. Wilens, MD

Chief, Division of Child and Adolescent Psychiatry
Co-Director, Center for Addiction Medicine
Massachusetts General Hospital
Harvard Medical School
Boston, MA

Dr. Wilens receives or has received grant support from the following source: NIH (NIDA). He is or has been a consultant for: Euthymics/Neurovance, NIH (NIDA), Ironshore Pharmaceuticals & Development, Inc., Sunovion Pharmaceuticals Inc., and TRIS Pharma. He has a published book: Straight Talk About Psychiatric Medications for Kids (Guilford Press); and co-edited the following books: ADHD in Children and Adults (Cambridge Press), and Massachusetts General Hospital Comprehensive Clinical Psychiatry (Sage). Dr. Wilens is co-owner of a copyrighted diagnostic questionnaire (Before School Functioning Questionnaire). Dr. Wilens has a licensing agreement with Ironshore (BSFQ Questionnaire). Dr. Wilens serves as a consultant to the US National Football League (ERM Associates), US Minor/Major League Baseball, Bay Cove Human Services (Clinical Services), and Phoenix House.

Planners' and Managers' Disclosures

The staff of Veritas Institute for Medical Education, Inc., has nothing to disclose.

The independent reviewers from CME Peer Review have no financial relationships to disclose.




AMA PRA Category 1 Credit(s)TM

Accreditation Statement

Veritas Institute for Medical Education, Inc., is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Designation Statement

Veritas Institute for Medical Education, Inc., designates this enduring material for a maximum of 1.00 AMA PRA Category 1 CreditTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.




CE for Nurses

Accreditation Statement

California Board of Registered Nursing (CBRN)
Veritas Institute for Medical Education, Inc., is approved by the California Board of Registered Nursing, Provider #CEP13986, for 1.00 Contact Hour.




CE for Nurse Practitioners

Accreditation Statement

This program was planned in accordance with AANP CE Standards and Policies and AANP Commercial Support Standards.

Designation Statement

Veritas Institute for Medical Education, Inc., is accredited by the American Association of Nurse Practitioners as an approved provider of nurse practitioner continuing education (provider number: 040309). This program has been approved for 1.00 contact hour of continuing education (which includes 0.20 hours of pharmacology).

Participant: Please claim only the portion of this program that you attended/successfully completed.

Disclosure of Unlabeled Use

Participants are advised that this CME/CE activity will contain references to unlabeled/unapproved/investigational uses of drugs to treat patients with ADHD.


The opinions expressed in this activity are those of the presenters and do not necessarily reflect those of Veritas Institute for Medical Education, Inc., or Ironshore Pharmaceuticals & Development, Inc.


This activity is provided free of charge to participants.

In order to receive credit, participants must complete the pre-activity questionnaire, post-test, and program evaluation. Participants must also score at least 75% on the post-test. Certificates will be distributed online at the conclusion of the activity. Your online certificate will be saved on myCME within your Profile/CME History, which you can access at any time.

For information about the accreditation of this program, please contact Catherine Hart, CME Manager Email:

If you have any other questions relating to your certificate or other issues with the activity, please contact


Hardware and Software Requirements
  • A computer with an internet connection
  • Internet Browser: Internet Explorer 7.x or higher, Firefox 4.x or higher, Safari 2.x or higher, or any other W3C standards compliant browser
  • Additional Software: Adobe Flash Player and/or an HTML 5 capable browser maybe required for video or audio playback. PowerPoint or Adobe Acrobat Reader may occasionally be required
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