ADHD Collaborative: We could learn something from this very simple program.

About the ADHD Collaborative, a program at Cincinnati Children's Medical Center: The goal of the ADHD Collaborative is to improve functioning, quality of life, and access to care for children with ADHD. This is accomplished by training community primary care providers to implement the American Academy of Pediatrics (AAP) and Cincinnati Children's Hospital Medical Center evidence-based guidelines for the diagnosis and treatment of this disorder.

As a process improvement initiative, the Collaborative emphasizes using best – practice recommendations and quality improvement science to achieve desired long-term outcomes.ADHD
Best-practice means using those interventions, tests, techniques that are scientifically supported, and taking a close look at how they are working. Here are the simple steps they have taken. They are SO simple, yet most of the time they aren't followed by physicians or psychologists:

Guideline Summary
For the diagnosis of ADHD, the guidelines recommend:
␣ PCP initiates an evaluation for ADHD in a child 6-12 years old
␣ Child must meet DSM-IV criteria.
␣ The assessment requires evidence obtained from parents or caregiver AND classroom teacher.
␣ Evaluation should include assessment for coexisting conditions. (This is the differential diagnosis issue I often write about. Do these symptoms mean ADHD, or might they mean something else that we are missing because we jump on the ADHD bandwagon?) Other diagnostic test are not routinely indicated to establish the diagnosis of ADHD, but may be used for the assessment of other coexisting conditions.

For treatment of ADHD, the guidelines recommend that primary care clinicians:
␣ Establish a treatment program that recognizes ADHD as a chronic condition
(Chronic means long term, not going away, BUT something we can treat and do something about)
␣ Specify appropriate target outcomes to guide management
(Determine what the goals of treatment are. What are we to expect from the treatment? How long should it take? How will we know it's working? This means follow-up forms and maybe testing that pinpoints performance levels in specific cognitive areas. This is often better than simple self reports.)
␣ Recommend stimulant medication and/or behavioral therapy as appropriate to improve target outcomes.
(Always ask, when medication is suggested, what symptoms is this medication for? How long will it take to work? What should I see as a result of it working? And what will it not help with?)
␣ Provide a systematic follow-up for the child with ADHD. When a child has not met target outcomes, evaluate: the original diagnosis, medication, and/or behavioral therapy as appropriate to improve target use of all appropriate treatments, adherence to the treatment plan presence of coexisting conditions when a child has not met target outcomes.
(This is THE critical part of their program. If you go to the hospital's web site you will find they supply doctors with forms to TRACK changes in behaviour. Those initial self-reports and parent reports you might have filled out were often originally designed to be used to track the effects of treatment interventions or medication. You were suppose to fill them out weekly, so you could track change. Without some structured way to track change we end up relying upon verbal reports from parents and teachers which might suffer from what we call "confirmation bias," see what you expect or want to see. OR they may be influenced by the environment, a change in teacher, holidays, home situation. Without ongoing assessment of treatment, including medication, we really don't know how things are going.)

Besides their ADHD Collaborative program the hospital has a great ADHD information page. Click here to view it.

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This blog is not offered as medical advice or as a means of diagnosing or treating ADHD or any other disorder. Don't go on line and take an ADHD "test." The diagnosis is complex, and it involves not just looking for symptoms of ADHD, but also ruling out other disorders that might look just like ADHD. So avoid these on line "tests" which are nothing more than a collection of symptoms. You need to see a licensed or registered professional for that. Medical doctors can diagnose ADHD, but the diagnosis is complex and often they will make a referral to a Registered Psychologist. You can obtain a referral from the British Columbia Psychological Association for a psychologist near you.

My web page lists a number of resources you can make use of yourself in dealing with Attention Deficit Hyperactivity Disorder (ADHD). Please visit it at www.adhdhelp.ca or one of my other sites at either Psychology Today, AAMFT, PSYRIS or my professional site.

Attention Deficit Hyperactivity Disorder (ADHD) assessment and treatment services are offered for individuals, couples, families, children and adolescents in the Burnaby, Vancouver, Coquitlam, Port Moody, New Westminster and Maple Ridge areas of the lower mainland. This includes neuro-developmental assessments, psycho-education and cognitive behaviour therapy. I also provide diagnostic assessments for autism and Asperger's Disorder in my Burnaby office.

Dr. Jim Roche
Registered Psychologist, British Columbia 01610
778.998-7975
www.relatedminds.com