ArticlePDF Available

Specific Central Nervous System Medications Are Associated with Temporomandibular Joint Symptoms

Authors:

Abstract

Aims There is evidence of association between bruxism and the increasingly common central nervous system stimulants prescribed for attention deficit hyperactivity disorder (ADHD), as well as the selective serotonin reuptake inhibitors (SSRIs) often prescribed for depression or anxiety. However, the evidence is not clear on whether these medications inducing bruxism are directly associated with temporomandibular joint disorder (TMD). The aim of this work is to evaluate whether these medications are associated with TMD symptoms. Methods Medical history and participant data were obtained for 469 patients from the University of Pittsburgh School of Dental Medicine, Dental Registry and DNA Repository, dating back to 2006. The chi-square test was used to determine any statistically significant associations. Results There were no statistically significant associations between ADHD stimulant medications or SSRIs and reported TMD symptoms. However, there were significant differences seen between specific brands of medications and reported TMD symptoms. Individuals prescribed methylphenidate (Concerta) were less likely to report temporomandibular joint discomfort (p = 0.01). Conversely, individuals prescribed citalopram (Celexa) were more likely to report temporomandibular joint discomfort (p = 0.04). Conclusion Signs and symptoms of temporomandibular joint dysfunction may be influenced by the use of certain medications prescribed for depression or attention deficit hyperactive disorder.
Research Article
Specific Central Nervous System Medications Are Associated
with Temporomandibular Joint Symptoms
John K. Drisdale III, Monica G. Thornhill, and Alexandre R. Vieira
Department of Oral Biology, University of Pittsburgh School of Dental Medicine, Pittsburgh, PA, USA
Correspondence should be addressed to Alexandre R. Vieira; arv@pitt.edu
Received 23 February 2017; Accepted 24 May 2017; Published 16 July 2017
Academic Editor: Manal Awad
Copyright ©  John K. Drisdale III et al. is is an open access article distributed under the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly
cited.
Aims. ere is evidence of association between bruxism and the increasingly common central nervous system stimulants prescribed
for attention decit hyperactivity disorder (ADHD), as well as the selective serotonin reuptake inhibitors (SSRIs) oen prescribed
for depression or anxiety. However, the evidence is not clear on whether these medications inducing bruxism are directly associated
with temporomandibular joint disorder (TMD). e aim of this work is to evaluate whether these medications are associated
with TMD symptoms. Methods. Medical history and participant data were obtained for  patients from the University of
Pittsburgh School of Dental Medicine, Dental Registry and DNA Repository, dating back to . e chi-square test was used
to determine any statistically signicant associations. Results. ere were no statistically signicant associations between ADHD
stimulant medications or SSRIs and reported TMD symptoms. However, there were signicant dierences seen between specic
brands of medications and reported TMD symptoms. Individuals prescribed methylphenidate (Concerta) were less likely to report
temporomandibular joint discomfort (𝑝 = 0.01). Conversely, individuals prescribed citalopram (Celexa) were more likely to report
temporomandibular joint discomfort (𝑝 = 0.04). Conclusion. Signs and symptoms of temporomandibular joint dysfunction may
be inuenced by the use of certain medications prescribed for depression or attention decit hyperactive disorder.
1. Introduction
As of , more than . million Americans were prescribed
stimulant medications to treat attention decit hyperactivity
disorder (ADHD) []. One out of ten Americans above the age
of  are prescribed antidepressants, selective serotonin reup-
take inhibitors (SSRIs) being the most common []. Central
nervous system- (CNS-) stimulant ADHD medications have
been associated with side eects such as bruxism [] that can
possibly cause TMD-like symptoms []. With the increasing
use of stimulant ADHD medications, it is important to see if
there is a relationship between these prescribed medications
and TMD symptoms [].
TMD can manifest in a variety of symptoms including
pain or tenderness in the face muscles or jaw joint, a limited
range of motion of the jaw, popping and clicking of the jaw,
and headaches []. In addition to the adverse symptoms of
TMD, treatment can oen be extensive as well as expensive.
TMD symptoms are also more commonly seen in the
female population. Of concern could be the recent increase in
use of stimulant ADHD medications in women aged  to 
[]. e inherent predisposition to TMD symptoms in women
combined with an increased use of ADHD medications
could possibly put this patient population at an increased
risk for developing TMD symptoms. Given this information,
we hypothesize that there is an association between ADHD
medications, as well as SSRIs, and the frequency of reported
TMD symptoms.
2. Subjects and Methods
All subjects in this study were participants in the Dental
Registry and DNA Repository of the University of Pittsburgh
School of Dental Medicine [–]. All participants sought
treatment at the University of Pittsburgh School of Dental
Medicine dating back to September . In April , data
from , individuals were queried from the registry and
repository for this study and  individuals taking ADHD
and SSRI medications were selected for this study. erecords
Hindawi
International Journal of Dentistry
Volume 2017, Article ID 1026834, 5 pages
https://doi.org/10.1155/2017/1026834
International Journal of Dentistry
T : Comparison of the type of ADHD medication by the presence of TMD symptoms. e results show that Concerta is the ADHD
medication that is signicantly dierent compared to the rest.
TMD diagnosis Total
No discomfort Positive for discomfort
Type o f ADH D medi cation
None
Count   
Expected count . . .
% within type of medication .% .% .%
Adjusted residual . .
Adderall
Count   
Expected count . . .
% within type of medication .% .% .%
Adjusted residual . .
Concerta
Count   
Expected count . . .
% within type of medication .% .% .%
Adjusted residual . 2.7
Ritalin
Count   
Expected count . . .
% within type of medication .% .% .%
Adjusted residual . .
Vy va ns e
Count  
Expected count . . .
% within type of medication .% .% .%
Adjusted residual . .
Adderall and Vyvanse
Count  
Expected count . . .
% within type of medication .% .% .%
Adjusted residual . .
Concerta and Ritalin
Count  
Expected count . . .
% within type of medication .% .% .%
Adjusted residual . .
Total
Count   
Expected count . . .
% within type of medication .% .% .%
Bold highlights the highest adjusted residual.
of these individuals were evaluated to determine if they had
any TMD symptoms (pain or discomfort, cracking or clicking
when opening the mouth).
Chi-square tests were used to determine associations
between being prescribed any stimulant ADHD or SSRI
medications and TMD symptoms. e same was performed
for subjects prescribed any SSRI medication in search of a
signicant association between SSRIs and TMD symptoms.
We used the likelihood ratio for comparisons when we
violated the assumption of minimum expected cell count to
be used for Pearsons chi-square. Alpha was established at %.
Standardized residuals were then compared to determine
which medication in each category was responsible for a
signicantly dierent report rate of TMD symptoms.
International Journal of Dentistry
T : Comparison of the type of SSRI medication by the presence of TMD symptoms. e results show that Celexa is the SSRI that is
signicantly dierent compared to the rest.
TMD diagnosis Total
No discomfort Positive for discomfort
Type o f SSR I
None
Count   
Expected count . . .
% within type of SSRI .% .% .%
Adjusted residual . .
Celexa
Count   
Expected count . . .
% within type of SSRI .% .% .%
Adjusted residual 2.4.
Lexapro
Count   
Expected count . . .
% within type of SSRI .% .% .%
Adjusted residual . .
Prozac
Count   
Expected count . . .
% within type of SSRI .% .% .%
Adjusted residual . .
Luvox
Count  
Expected count . . .
% within type of SSRI .% .% .%
Adjusted residual . .
Paxil
Count   
Expected count . . .
% within type of SSRI .% .% .%
Adjusted residual . .
Zolo
Count   
Expected count . . .
% within type of SSRI .% .% .%
Adjusted residual . .
Lexapro and Zolo
Count  
Expected count . . .
% within type of SSRI .% .% .%
Adjusted residual . .
Lexapro and Prozac
Count  
Expected count . . .
% within type of SSRI .% .% .%
Adjusted residual . .
International Journal of Dentistry
T  : C on t i nued.
TMD diagnosis Total
No discomfort Positive for discomfort
Lexapro and Paxil
Count  
Expected count . . .
% within type of SSRI .% .% .%
Adjusted residual . .
Celexa and Zolo
Count  
Expected count . . .
% within type of SSRI .% .% .%
Adjusted residual . .
Total
Count   
Expected count . . .
% within type of SSRI .% .% .%
Bold highlights the highest adjusted residual.
3. Results
e mean age of the  participants was  years, with %
of participants identifying as male (𝑁 = 179)and%female
(𝑁 = 290). Furthermore, the majority of participants were
White (𝑁 = 394; %). e remaining % were comprised
of Black individuals (𝑁=52), Hispanics (𝑁=6), and other
groups (𝑁=17).
ere was a trend, albeit not statistically signicant, for
being prescribed ADHD medication and reporting TMD
symptoms (𝑝 = 0.065). Likewise, there was no signi-
cant association between taking SSRIs and reporting TMD
symptoms (𝑝 = 0.12). We found dierences in occurrence
of reported TMD symptoms between the dierent ADHD
stimulant medications (𝑝 = 0.04, six degrees of freedom).
e likelihood ratio of . suggested that there is at least one
medication that is statistically signicant among the others
in regard to reported TMD symptoms. Further testing by
means of nding the expected counts and adjusted residuals
for each ADHD medication determined that Concerta was
the statistically signicant medication when compared to the
others (Table ). Additionally, taking the observed counts
versus the expected counts in Table  into consideration also
depicts that subjects prescribed Concerta are less likely to
reportTMDsymptomsthansubjectsprescribedanyother
ADHD stimulant. ere were no dierences based on sex or
ethnic background (data not shown).
Similarly, the group of SSRIs also showed that there is a
medication with a signicant dierence in regard to reported
TMD symptoms (𝑝 = 0.075,  degrees of freedom); thus
the likelihood ratio is of .. Celexa showed a dierence
in expected reporting of TMD symptoms when compared to
the other SSRIs (Table ). Additionally, taking the observed
counts versus the expected counts in Table  into consider-
ation also depicts that subjects prescribed Celexa are more
likelytoreportTMDsymptomsthansubjectsprescribedany
other SSRI. ere were no dierences based on sex or ethnic
background (data not shown).
Being prescribed both an ADHD medication and SSRI
showed a trend, albeit not statistically signicant, for report-
ing TMD symptoms (𝑝 = 0.074).
4. Discussion
e results show that there is no formal signicant dier-
ence in TMD symptoms between those that are prescribed
ADHD medications and those that are not prescribed ADHD
medications. is same statement also holds true for subjects
prescribed SSRIs and those not prescribed SSRIs. However,
theredoesseemtobeasignicantdierencebetween the dif-
ferent medications prescribed. Our data shows that subjects
prescribed Concerta for ADHD are less likely to report TMD
symptoms when compared to subjects taking other ADHD
medications. It is also important to consider that our data
shows that subjects taking the SSRI Celexa are more likely to
report experiencing TMD symptoms than those prescribed
an SSRI other than Celexa.
is could be clinically important when treating patients
who are already at an increased risk for TMD. According to
numerous studies, including the National Institute of Dental
andCraniofacialResearch,womenareathigherriskthan
are men for developing TMD symptoms []. Since TMD is
a multifactorial disorder [], it may be wise to limit the
number of contributing factors targeted for intervention. For
example, a patient that is already predisposed to TMD may
benet from being prescribed Concerta versus other ADHD
stimulants due to Concerta’s lower frequency of reported
TMD symptoms. Similarly, the same patient population that
requires a SSRI prescription may benet from a SSRI other
than Celexa. Understanding better the contributing factors
to this multifactorial disorder could prove benecial to the
patients health and ultimately their quality of life.
In summary, we report here for the rst time that specic
ADNH and SSRI drugs may impact risks for developing
TMD.
International Journal of Dentistry
Conflicts of Interest
eauthorshavenoconictsofinteresttodeclare.
Acknowledgments
e authors thank the individuals that enthusiastically partic-
ipated in this study. e Dental Registry and DNA Repository
project is supported by theUniversity of Pittsburgh School of
Dental Medicine.
References
[] J. Austerman and D. J. Muzina, Turning Attention to ADHD. U.S.
Medication Trends for Attention Decit Hyperactivity Disorder.
An Express Scripts Report, e Express Scripts Laborator y, .
[] National Institute of Mental Health, Attention-Decit/Hyperac-
tivity Disorder (ADHD): e Basics,vol.ofNIH Publication no.
QF-16-3572, U.S. Department of Health and Human Ser vices,
.
[] F. Lobbezoo, R. J. van Denderen, J. G. Verheij, and M. Naeije,
“Reports of SSRI-associated bruxism in the family physician’s
oce,Journal of Orofacial Pain,vol.,no.,pp.,.
[]G.A.Malki,K.H.Zawawi,M.Melis,andC.V.Hughes,
“Prevalence of bruxism in children receiving treatment for
attention decit hyperactivity disorder: A pilot study,Journal
of Clinical Pediatric Dentistry,vol.,no.,pp.,.
[] D. M. Laskin, “Etiology of the pain-dysfunction syndrome.,e
Journal of the American Dental Association,vol.,no.,pp.
–, .
[]B.Bagis,E.A.Ayaz,S.Turgut,R.Durkan,andM. ¨
Ozcan,
“Gender dierence in prevalence of signs and symptoms of
temporoman-dibular joint disorders: A retrospective study
on  consecutive patients,International Journal of Medical
Sciences,vol.,no.,pp.,.
[] I. Anjomshoaa, M. E. Cooper, and A. R. Vieira, “Caries is
associated with asthma and epilepsy,European Journal of
Dentistry,vol.,no.,pp.,.
[] L. Johnston and A. R. Vieira, “Caries experience and overall
health status,Oral Health & Preventive Dentistry,vol.,no.
, pp. –, .
[] A. R. Vieira, K. M. Hilands, and T. W. Braun, “Saving more
teeth—a case for personalized care,JournalofPersonalized
Medicine,vol.,no.,pp.,.
[] M. Oakley and A. R. Vieira, “e many faces of the genetics
contribution to temporomandibular joint disorder,Orthodon-
tics and Craniofacial Research, vol. , no. , pp. –, .
... [7] It was reported that signs and symptoms of temporomandibular joint dysfunction may be influenced by the use of medications prescribed for ADHD. [8] In a recent systematic review, psychostimulants were shown to induce xerostomia, salivary gland hypofunction, and sialorrhea. [9] In children and young adults with ADHD, unstimulated salivary flow rate (SSFR) was found to be lower, and microbial dental plaque scores were higher than non-ADHD [10] Obtained data from current research such as inappropriate oral health behaviors, excessive consumption of sugary snacks and beverages, and an increased number of meals in children with ADHD suggest that ADHD may be a risk factor for the development of dental decay. ...
Article
Full-text available
Introduction: This study investigated the dental health problems and saliva characteristics of children under psychostimulant therapy for attention-deficit hyperactivity disorder (ADHD). Materials and methods: One hundred and twenty children aged 7-12 years were divided into three groups. Groups 1-2 comprised children diagnosed with ADHD: those who had not yet started psychostimulant therapy (Group 1) and those already receiving long-term psychostimulant therapy (Group 2). Group 3 comprised healthy, nonmedicated children. Possible side effects of psychostimulants were investigated at the beginning of study in Group 2 and after 3 months drug use in Group 1. Bruxism and dental erosion prevalence, salivary Streptococcus mutans count, buffering capacity, and stimulated salivary flow rate (SSFR) were measured, and salivary α-amylase, calcium, total protein, and proline-rich acidic protein (PRAP) levels were quantified in the beginning of the study. Data were analyzed using the Kruskal-Wallis test. Results: The most frequently reported side effects of psychostimulants were decreased appetite, dry mouth, and increased fluid consumption. The prevalence of bruxism and dental erosion was higher in Groups 1 and 2 than in Group 3, but the differences were not significant (P > 0.05). In Group 2, subjective dry mouth feel was reported by 32.5% of patients and 17.5% had a very low SSFR. Salivary α-amylase, calcium, total protein, and PRAP levels were lower in Group 2 than the others, but the differences were not significant (P > 0.05). Conclusions: ADHD and psychostimulant therapy do not appear to be significantly related to decreasing SSFR or protective saliva components against dental caries. However, a systematic investigation of the long-term safety of psychostimulants is needed. The most effective method of maintaining dental health of children with ADHD is frequent appointments focusing on oral hygiene practices accompanied by dietary analyses.
Article
Full-text available
Objectives: To evaluate variables associated with the need of denture by patients with special needs attending the Dental Specialty Center (DSC) in Poá, São Paulo, Brazil. Materials and methods: The total sample consisted of 514 patients, treated at the DSC-Poá, and the dependent variable was need of denture established between January 2011 and December 2016. The analyzed variables were gender, age, main diagnosis, amount of medication used, and behavioral aspects. The physical records were compiled to an electronic form specially developed for this study. Data were tabulated and analyzed. Results: Eighty-eight patients (17.11%) were referred to prosthetic rehabilitation. The female gender prevailed and the need for denture increased with age, in a similar manner as in the general population. Main diagnosis was a relevant variable, with the majority (47.72%) presenting systemic alterations, followed by physical deficiency (18.18%) and psychiatric disorders (11.36%). Regarding the behavior, all individuals were attended as outpatients, the majority (71.59%) had already received anesthesia in previous treatments, and only 7.95% required psychological conditioning. Most of the patients with special needs (89.77%) came to receive and use the prostheses. Conclusions: Main diagnosis and behavioral profile variables influenced the denture indication for those patients at the DSC-Poá. Gender and age also influence indication, as seen in the general population. This study may guide the implementation of projects both in private and public sectors.
Article
Full-text available
Certain risk factors such as tobacco use, diabetes, genetic variations on the IL1 gene, and other inflammatory conditions are hypothesized to predict tooth loss in patients treated in a large medical center. Tooth loss trends are hypothesized to be greater in patients with more risk factors. DNA samples for 881 individuals were taken from the Dental Registry and DNA Repository at University of Pittsburgh School of Dental Medicine. Clinical data for all 4137 subjects in the registry were also available. SNP genotyping was performed on the samples for IL1α (rs1800587) and IL1β (rs1143634). IL1 positive status was determined as having one or more of the recessive alleles for either SNP. Tooth loss status was determined based on dental records and data gathered for age, sex, ethnicity, and self-reported medical history. Various statistical analyses were performed on the data including genetic association analysis by the PLINK software, chi-square, Mann-Whitney U, and ANOVA tests to determine significance. Tooth loss averages increased with age by all risk factors (smoking, diabetes, hypertension, and interleukin genotypes; p = 4.07E-13) and by number of risk factors (p = 0.006). Increased tooth loss is associated with age and number of risk factors including diabetes, tobacco use, IL1+, and cardiovascular disease. These trends suggest that older patients and those with more risk factors should seek further preventive care to reduce future tooth loss.
Article
Full-text available
BACKGROUND: This study evaluated the prevalence of the signs and symptoms of temporomandibular joint disorder (TMD) among patients with TMD symptoms. METHODS: Between September 2011 and December 2011, 243 consecutive patients (171 females, 72 males, mean age 41 years) who were referred to the Department of Prosthodontics, Faculty of Dentistry, Karadeniz Technical University, Trabzon were examined physically and completed a questionnaire regarding age, gender, social status, general health, antidepressant drug usage, dental status, limited mouth opening, temporomandibular joint (TMJ) sounds, and parafunctions (bruxism, clenching). The data were analyzed using the chi-square test and binary logistic regression model (alpha = 0.05). RESULTS: With a frequency of 92%, pain in the temporal muscle was the most common symptom, followed by pain during mouth opening (89%) in both genders. TMJ pain at rest, pain in the masseter muscle, clicking, grinding, and anti-depressant use were significantly more frequent in females than males. Age (p=0.006; odds ratio 0.954; 95% CI 0.922-0.987) and missing teeth (p=0.003; odds ratio 3.753; 95% CI 1.589-8.863) had significant effects on the prevalence of TMD. CONCLUSION: Females had TMD signs and symptoms more frequently than males in the study population. The most common problem in both genders was pain.
Article
Full-text available
There is evidence of association between systemic diseases and oral conditions, although it is not clear if these are direct or mediated by underlying factors such as health behaviors. The aim of this work was to evaluate whether self-reported systemic diseases were associated with caries experience. Medical history data and caries experience (DMFT and DMFS; Decayed, Missing due to caries, Filled Teeth/Surface) were obtained from the University of Pittsburgh School of Dental Medicine Dental Registry and DNA Repository. Information on 318 subjects (175 females and 143 males) was evaluated. Regression analysis was used to test for association between caries experience and disease status. The stronger associations were found between caries experience and asthma and epilepsy. With respect to asthma, DMFT above 15 (R(2) = 0.04) and DMFS above 50 (R(2) = 0.02) were associated. After controlling for gender differences in asthma, the associations remained strong (R(2) = 0.05 for both DMFT and DMFS). For epilepsy, DMFT above 15 (R(2) = 0.18) and DMFS above 50 (R(2) = 0.14) were associated. Asthma and epilepsy are associated with higher caries experience.
Article
Full-text available
The objective of this study was to evaluate reported bruxism among children affected by attention deficit hyperactivity disorder (ADHD). Thirty children diagnosed with ADHD and 30 healthy age and gender matched controls participated in the study. All subjects were examined for dental attrition, and the parents were asked for signs and symptoms of bruxism in their children using a questionnaire. Prevalence of oral parafunction was evaluated comparing ADHD children taking medications, ADHD children not taking medications, and controls. Subjects affected by ADHD and pharmacologically treated showed higher occurrence of bruxism compared to subjects affected by ADHD not taking medicines and controls; and within the ADHD group taking medications, CNS-stimulants have been associated with such side effect more frequently than the other drugs.
Article
Purpose: The aim of this work was to evaluate whether self-reported systemic diseases were associated with caries experience. Materials and methods: Medical history data and caries experience (DMFT and DMFS; Decayed, Missing due to caries, Filled Teeth/Surface) were obtained from the University of Pittsburgh School of Dental Medicine dental registry and DNA repository. Information on 1,281 subjects was evaluated (839 with primary caries and 492 with secondary caries experience). Regression analysis was used to test for association between caries experience and disease status. Results: Associations were found between caries experience and specific conditions: stroke (R2 = 0.007, P = 0.001), asthma (R2 = 0.003, P = 0.025), hepatitis (R2 = 0.009, P = 0.0001), liver disease (R2 = 0.009, P = 0.00001), high blood pressure (R2 = 0.072, P = 0.00001) and diabetes (R2 = 0.03, P = 0.00001). We found primary caries to be associated with hepatitis (DMFT with R2 = 0.011, P = 0.002 and DMFS with R2 = 0.008, P = 0.006). We also found an association between secondary caries and asthma (DMFS with R2 = 0.006, P = 0.04), high blood pressure (DMFT with R2 = 0.014, P = 0.005 and DMFS with R2 = 0.043, P = 0.00001) and diabetes (DMFT with R2 = 0.013, P = 0.007 and DMFS with R2 = 0.023, P = 0.00001). Conclusion: Hepatitis, asthma, high blood pressure, stroke, liver disease and diabetes are associated with higher caries experience.
Article
Review the literature on candidate genes for temporomandibular joint disorder (TMD). Setting and Sample Population - Literature review. Two basic approaches were used to obtain literature in any language regarding genes and TMD. First, Medline, Embase, and Science Citation Index databases were searched using the keywords 'temporomandibular joint disorder' and 'temporomandibular joint dysfunction' for studies published from 1966 to 2007. Then, the references list of the studies obtained in the database was also considered. Candidate genes for TMD include genes for individual variations in pain perception, gender and ethnicity, proinflammatory cytokines, female hormones, breakdown of extracellular matrix, and syndromic forms of TMD. Most of the studies on genetic variation contributing to TMD are approaching the disease mainly from an immune-inflammatory perspective. Recent investigations of the genetic variables which may predict identifiable levels of pain perception may uncover new approaches to our traditional treatment modalities for the chronic pain patient.
Article
According to the psychophysiologic theory, masticatory muscle spasm is the primary factor in the myofascial pain-dysfunction syndrome. Emotional, rather than mechanical, factors are the prime etiologic agents in stimulating chronic oral habits that produce muscle fatigue.
Article
Recently, the use of selective serotonin reuptake inhibitors (SSRIs) has been associated with the occurrence or worsening of bruxism. The aim of this study was to obtain a first indication of the prevalence of SSRI-associated bruxism reported to family physicians, the main prescribers of SSRIs. A questionnaire, with questions about prescription rate, already registered adverse reactions, and bruxism-related side effects of 4 different types of SSRIs, was sent to all family physicians in greater Amsterdam (n = 391). With a response rate of 42.5%, frequent observations of already registered side effects were found. In addition, 5 family physicians (3.2%) reported the occurrence of bruxism in relation to the use of SSRIs. The use of SSRIs might be associated with the occurrence of bruxism. A case report is provided that corroborates this suggestion.
Turning Attention to ADHD. U.S. Medication Trends for Attention Deficit Hyperactivity Disorder
  • J Austerman
  • D J Muzina
J. Austerman and D. J. Muzina, Turning Attention to ADHD. U.S. Medication Trends for Attention Deficit Hyperactivity Disorder. An Express Scripts Report, The Express Scripts Laboratory, 2014.