Dr.  Bruce McCormick and Associates Medical and Family Psychology 2210 Line Avenue • Shreveport, Louisiana 71104 • (318)865-7500

Diagnosing ADHD/ADD

Recently the American Academy of Pediatrics published guidelines for the diagnosis and treatment of ADHD/ADD.  Among the factors that prompted that clarification is a growing public criticism of the use of stimulant medication. Detractors maintain that the medical community and educational institutions are indiscriminately using medication to “drug” children with an assortment of behavioral and learning problems

While it is true that more children and adults than ever before are taking psycho-stimulants for disorders of attention it is equally true that ADHD/ADD are very real disorders with high prevalence rates.  It is also known that, while a combined medical and psycho-social approach to treatment is optimal, management with stimulant medication remains the single most effective form of treatment currently available. 

Clearly the key to appropriate medical management is an accurate diagnostic picture of each patient. A comprehensive diagnosis should not only identify the signs and symptoms of ADHD/ADD but also recognize learning and behavioral conditions that either mimic or are commonly  comorbid with ADHD/ADD.

An accurate diagnostic picture is often difficult to obtain for children:

·  From families not well known to the

    primary care physician.

·  Who do not meet the classic description

    of ADHD/ADD

·  Who have multiple behavioral or

    cognitive problems

·  Who have personal characteristics such as

     high intelligence or learning disabilities

     that attenuate or exacerbate the

     presentation of ADHD/ADD

Our office offers compressive psychological evaluation of suspected disorders of attention as well as related learning and behavioral problems.  The resulting data meet or exceed current AAP guidelines.

We employ a combination of detailed interviews and actuarial data from home and school, behavioral and personality testing and psycho-educational assessment.  These procedures examine home life, parenting style, individual concerns and self-perceptions of the child, and a comparison of school aptitude, achievement, and typical performance. The resulting data are considered in a comprehensive diagnostic algorithm. Compliance issues and abuse risk are also evaluated.

Diagnostic Algorithm for ADHD/ADD

1.      Are the signs/symptoms of ADHD/ADD present and in how many settings?

2.      Are these signs/symptoms of sufficient severity to warrant clinical concern?

3.      Are these behaviors detracting significantly from the patient’s home, school, or social functioning?

4.      Are there any psychological conditions that could be mimicking ADHD/ADD?

5.      Are there secondary or co-morbid psychological, behavioral, or learning problems that require intervention?

6.      Is there a need for behavior management instruction for the parents or psychotherapy for the child?

Results

The results of our evaluations are presented to parents in a comprehensive but easily understood format.  With their permission a copy is sent to the patient’s primary care physician.  This report includes supporting data and recommendations for school and home activities that supplement medical management.

Follow-up Services

In addition to diagnostic services, we provide a range of follow-up services to include:

1.      Aid in titration of medicine by comparison of performance after medication to that found at the time of assessment

2.      Monitoring of compliance and abuse risk

3.      Integration of medical and environmental treatments.

4.      Parent education regarding ADHD/ADD

5.      Group and individual classes in parenting and behavior management

6.      Individual counseling, psychotherapy, and self-management training.

7.      Coordination with schools

Fee Structure

Fees are determined by the complexity of evaluation activities required.  Evaluations that explore school learning disabilities are more extensive than those for patients who are achieving adequately in school as are evaluations for children who live in two homes due to a divorce visitation plan.  The availability of recent assessment data from a qualified source may allow a cost reduction. 

Insurance

Current Louisiana law requires any company offering indemnity insurance for medical conditions in this state to provide reimbursement for ADHD/ADD evaluation.  (This is the case even if other mental conditions are not covered.)  Tri-Care programs cover these services as well.  Unfortunately, HMOs do not fall under this law and universally do not authorize assessment comprehensive enough to meet AAP or other best practice guidelines.