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Why Behavioral Health Resources
BHR offers a wide range of both assessment and treatment options that give families a variety of choices that meet their particular needs. We have psychologists who are expertly trained in evaluating ADHD and co-morbid disorders. Depending on the child's needs and the available resources to the family, BHR can offer a range of assessment options. We can provide a brief ADHD diagnostic screen that will help assist other practitioners including primary care physicians and pediatricians make appropriate treatment decisions. We can also offer a more comprehensive evaluation that can assess a range of other disorders to help direct a more comprehensive treatment strategy. If a more comprehensive approach is desired, BHR has a group of well trained clinicians that can assist in providing a treatment strategy that helps improve the child's functioning in a variety of life domains including academic, social, and behavioral. These clinicians have been trained in the most advanced, up to date, evidence based, treatment approaches.
Overview
Attention Deficit Hyperactivity Disorder is one of the most common childhood disorders diagnosed in the United States. The National Institute of Mental Health (NIMH) estimates that between 3 and 5 percent of preschool and school age children have ADHD or approximately two million children in the United States. The Centers for Disease Control and Prevention (CDC) estimates that as of 2003, 4.4 million children ages 4-17 were reported to have a history of ADHD. Of these 2.5 million (56%) were reported to be taking medication for the disorder. Most experts now recognize that ADHD continues into adulthood. Studies estimate that 30-70 percent of children with ADHD will continue to have symptoms into adolescence and adulthood. In 2006, NIMH estimated that 4.1% of adults ages 18-44, in a given year are ADHD. ADHD also seems to effect males differently then females. Studies show that males are approximately 3 times more likely to be diagnosed with ADHD then females. However, some believe this is because females tend to exhibit more symptoms of inattention as apposed to hyperactivity and impulsivity, which tend to be more noticeable and receive more attention.
Purpose
The need for a comprehensive evaluation to diagnose ADHD is clearly indicated in the literature. One of the real challenges in diagnosing ADHD is that the symptoms of ADHD are similar to symptoms of other disorders including learning disabilities as well as other emotional and behavioral disturbances. The American Academy of Pediatricians issued guidelines for diagnosing ADHD. They targeted their guidelines to pediatricians and family practitioners who some studies show are responsible for 60-70 percent of ADHD diagnoses and the majority of the prescriptions. The AAP guidelines reccomends that an ADHD assessment should entail evaluating for coexisting conditions such as mood disorders, anxiety disorders, and learning disabilities. The American Academy of Family Physicians recommends that a psychological evaluation be conducted anytime there appears to be co-morbid emotional and or behavioral disturbance. Without a clear diagnostic evaluation that rules out other co-morbid conditions, the risk of prescribing medication inappropriately is enhanced.
In addition to a comprehensive evaluation, there is also a clear need to provide a comprehensive treatment approach that addresses a wide range of emotional, social, and behavioral challenges. Stimulant medication is one of the most commonly used and effective treatments for ADHD. The literature clearly shows that closely monitored medication management is highly effective in treatment of ADHD. However, there are potential risks related to stimulant medication that need to be considered. One of the risks that have been debated for many years is the possible link between stimulant medications for children and adolescents with ADD and substance abuse later in life. The National Institutes of Health recently funded a study done at New York University School of Medicine. This study found that children and adolescents who began taking stimulant medication when they were younger (6-7 years old) had substance abuse rates no different then from a comparison group that did not have ADHD. However, those who began treatment when they were older (8-12 years old) had higher rates of substance abuse. Given these and other possible risks, it is imperative that other treatment modalities be considered and included within a comprehensive approach. Depending on the child and their particular needs, a combination of medication management and psychotherapy can be highly beneficial. The National Institute of Mental Health in their Multimodal Treatment Study of Children with Attention Deficit Hyperactivity Disorder found that a combination treatment approach including both medication and psychotherapy was superior in helping improve functioning (specifically anxiety symptoms, academic performance, oppositionality, parent-child relations, and social skills) that either separately. In addition, the combined treatment approach also allowed children to be successfully treated with somewhat lower doses of medication, compared to the medication-only group. |
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