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 criteria
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 the PCP works closely with parents, partners, teachers, and the patient to gather information. DSM-5, the authoritative guide to diagnosing mental disorders, contains some key criteria for diagnosing ADHD:
- 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.
DSM-5 specifies that symptoms must be consistent for at least six months and cause significant negative impacts in social and academic/occupational activities.
Treatment plan and monitoring
After a diagnosis is made, it is 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.
Optum/United Behavioral Health and Harvard Pilgrim have developed a set of recommendations for diagnosing and following up with ADHD patients. When prescribing ADHD medication for the first time:
- Schedule the return appointment to occur within 21-28 days after the initial prescription to assess effectiveness and address any side effects.
- Write the initial prescription for the number of days until the follow-up appointment to increase the likelihood that the patient will attend this appointment.
- Utilize screening tools, such as the Vanderbilt Scales, to assist in diagnosing ADHD.
- Schedule at least two more follow-up appointments over the next nine months to ensure that the patient is stabilized on an appropriate dose.
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.