The candidate Tanya Froehlich, MD is a board-certified Developmental and Behavioral Pediatrician who completed an NRSA research fellowship and an MS in Epidemiology. Her career goal is to become an independent investigator focused on improving treatment delivery and outcomes for children with ADHD. The project Mentor Jeff Epstein, PhD is an established investigator with nationally;recognized expertise in ADHD treatment outcomes research. Dr. Froehlich has assembled an outstanding mentorship team, including NIH- funded investigators with expertise in ADHD treatment and pharmacogentics . Her research environment - Cincinnati Children's Hospital - is exceptional, and includes a dedicated clinical and research Center for ADHD as well as the only Genetic Pharmacology Program at a U.S. pediatric hospital. Proposed Research: Robust data show that stimulant medications reduce ADHD symptoms and impairment, but it is unclear whether their efficacy differs across the ADHD subtypes. Predominantly inattentive type (PIT) is the most prevalent ADHD subtype in U.S. population-based studies, but few studies have examined stimulant response in this subtype. Instead, PIT medication guidelines have largely been extrapolated from studies enrolling all or mostly ADHD-combined type (CT). Thus, this proposal seeks to further understanding of stimulant response and its predictors in children with PIT. We will evaluate participants'response to methylphenidate (MPH), the most widely prescribed stimulant, via a prospective, double-blind, placebo- controlled crossover trial with 3 dose conditions. Our first specific aim is to examine MPH medication and dose response in children with PIT (n=120) and CT (n=45) to test the hypotheses that participants with PIT have a diminished MPH response (amount of symptom change on the most effective dose) and derive less benefit from higher doses compared to those with CT. Since only one prior study has examined genetic predictors of MPH response within a PIT-only sample, our second specific aim (exploratory) is to determine the potential role of genetic polymorphisms (i.e., DRD4 and ADRA2A) on MPH response in children with PIT (n=120), examining both magnitude of symptom change and dose response curves .

Public Health Relevance

If subtype differences in stimulant response are identified, our findings may suggest more effective treatment strategies (i.e., different dosing guidelines) for children with ADHD-predominantly inattentive type (PIT). This study may also yield pharmacogenetic findings that, in the future, could enable doctors to tailor individual treatment plans for children with PIT, ameliorating the current practice of prescribing by trial and error.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Mentored Patient-Oriented Research Career Development Award (K23)
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Special Emphasis Panel (ZMH1-ERB-E (01))
Program Officer
Sesma, Michael A
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Cincinnati Children's Hospital Medical Center
United States
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Tewar, Shruti; Auinger, Peggy; Braun, Joseph M et al. (2016) Association of Bisphenol A exposure and Attention-Deficit/Hyperactivity Disorder in a national sample of U.S. children. Environ Res 150:112-118
Becker, Stephen P; Froehlich, Tanya E; Epstein, Jeffery N (2016) Effects of Methylphenidate on Sleep Functioning in Children with Attention-Deficit/Hyperactivity Disorder. J Dev Behav Pediatr 37:395-404
Wagner-Schuman, Melissa; Richardson, Jason R; Auinger, Peggy et al. (2015) Association of pyrethroid pesticide exposure with attention-deficit/hyperactivity disorder in a nationally representative sample of U.S. children. Environ Health 14:44
Brinkman, William B; Epstein, Jeffery N; Auinger, Peggy et al. (2015) Association of attention-deficit/hyperactivity disorder and conduct disorder with early tobacco and alcohol use. Drug Alcohol Depend 147:183-9
Froehlich, Tanya E; Antonini, Tanya N; Brinkman, William B et al. (2014) Mediators of methylphenidate effects on math performance in children with attention-deficit hyperactivity disorder. J Dev Behav Pediatr 35:100-7
Froehlich, Tanya E; Delgado, Sergio V; Anixt, Julia S (2013) Expanding medication options for pediatric ADHD. Curr Psychiatr 12:20-29
Chirdkiatgumchai, Vilawan; Xiao, Hong; Fredstrom, Bridget K et al. (2013) National trends in psychotropic medication use in young children: 1994-2009. Pediatrics 132:615-23
Zhu, Hao-Jie; Brinda, Bryan; Froehlich, Tanya E et al. (2012) A discriminative analytical method for detection of CES1A1 and CES1A2/CES1A3 genetic variants. Pharmacogenet Genomics 22:215-8
Froehlich, Tanya E; Epstein, Jeffery N; Nick, Todd G et al. (2011) Pharmacogenetic predictors of methylphenidate dose-response in attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 50:1129-1139.e2
Saldana, Shannon N; Hooper, David K; Froehlich, Tanya E et al. (2011) Characteristics of successful recruitment in prospective pediatric pharmacogenetic studies. Clin Ther 33:2072-81

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