October is Attention Deficit/Hyperactivity Disorder (ADHD) Awareness Month. With the beginning of the new school year, as teachers assess students, primary care providers (PCPs) are likely to see more patients come to their practice with questions about ADHD, which is one of the most commonly diagnosed and extensively studied childhood behavioral health disorders.
Diagnosis and DSM-5 changes
A comprehensive medical evaluation to rule out potential physical conditions is necessary to accurately diagnose ADHD. The reliability of diagnosing ADHD improves when appropriate guidelines are used and additional history is collected from parents and teachers. DSM-5, the authoritative guide to diagnosing mental disorders, includes some updates to the criteria for diagnosing ADHD from the previous version of the guide (DSM-4), including:
- Several of the individual’s symptoms must be present at age 12 or earlier (rather than age 7 or earlier as was specified in DSM-4).
- Adults and teens can now officially be diagnosed with ADHD.'
- To warrant diagnosis, children younger than age 17 must display at least 6 symptoms of inattention or hyperactivity/impulsivity while individuals age 17 or older must display at least 5 symptoms of inattention or hyperactivity/impulsivity.
- A person can have mild, moderate, or severe ADHD, depending on the number of symptoms and their effect on daily life.
As in DSM-4, DSM-V specifies that symptoms must be consistent for at least six months and cause significant negative impacts in social and academic/occupational activities. Harvard Pilgrim’s behavioral health partner, Optum/UBH, is adopting the DSM-5 guidelines on Oct. 14, 2014.
Treatment plan and monitoring
After a diagnosis is made, it important to develop a treatment plan and monitor the patient’s progress. A team approach to treatment works best, with behavioral health clinicians, doctors, the patient, parents, teachers, and other health care professionals working together. The treatment plan usually includes behavioral therapy, medication, parent training and/or education, and school involvement. This combination helps the child focus his or her attention and control behavior issues.
Visits with a behavioral health clinician are recommended at least monthly until optimal results are achieved.
Additionally, Healthcare Effectiveness Data and Information Set (HEDIS®) has established a set of measures to monitor treatment adequacy for patients age 6-12 with ADHD. These measures are based on established research and are reflected in many treatment guidelines, and encourage that:
- Children who have been newly prescribed an ADHD medication have at least three follow-up care visits within a 10-month period, one of which is within 30 days of when the first ADHD medication was dispensed.
- Patients with a new ADHD prescription have one follow-up visit with a practitioner with prescribing authority within 30 days of the initiation of treatment (Initiation Phase).
- Patients taking an ADHD medication remain on the medication for at least 210 days and have at least two additional follow-up visits during the nine months following the Initiation Phase.
How Optum/UBH can help your patients. For complex clinical situations, Optum/UBH is available to provide consultative assistance. Practitioners can call the Optum/UBH Physicians Consultation Service at 800-292-2922. To refer a patient for behavioral health services and to facilitate the coordination of care, call Optum at 888-777-4742.