Question 1

What is ADHD?

Accepted Answer

Attention deficit hyperactivity disorder or ADHD, affects around 8-10% of children and nearly 3-5% of adults in the United States (Centers for Disease Control and Prevention [CDC], 2020). It's a multifaceted neurological condition that interferes with the brain's executive functions. Individuals with ADHD struggle with regulating impulses, maintaining focus, and organizing tasks. Insights from neuroscience, brain imaging, and clinical studies highlight that ADHD should not be classified as a behavioral disorder, mental illness, or specific learning disability (Barkley, 2015). Instead, it's identified as a developmental deficit within the brain's self-regulation mechanisms. Both adults and children can receive diagnoses of ADHD. According to Danielson et al. (2018) and Simon et al. (2009), ADHD is frequently first noticed in school-aged children due to classroom disruptions or difficulties with schoolwork. It is more commonly diagnosed in boys than girls, as the symptoms often manifest differently. Boys typically exhibit hyperactivity and other externalizing behaviors, while girls are more likely to show inactivity (Hinshaw & Scheffler, 2014). However, this does not indicate that boys are more prone to having ADHD.

Question 2

ADHD Symptoms

Accepted Answer

The symptoms of ADHD can differ from person to person. You or your child might encounter all or only some of the symptoms mentioned below, as well as others outlined in the DSM-V. 
 • Short attention span, especially for non-preferred tasks. 
 • Hyperactivity, which may be physical, verbal, and/or emotional. 
 • Impulsivity, which may manifest as recklessness. 
 • Fidgeting or restlessness. 
 • Disorganization and difficulty prioritizing tasks. 
 • Poor time management and time blindness. 
 • Frequent mood swings and emotional dysregulation. 
 • Forgetfulness and poor working memory. 
 • Trouble multitasking and executive dysfunction. 
 • Inability to control anger or frustration. 
 • Trouble completing tasks and frequent procrastination. 
 • Distractibility. 
 • Difficulty awaiting turn.

Question 3

The Three Types of ADHD

Accepted Answer

ADHD is a neurological disorder characterized by a consistent pattern of inattention and/or hyperactive impulsivity, which disrupts daily activities in at least two environments, such as school and home. It affects individuals of all genders, ages, and backgrounds. The symptoms described encompass the diverse range of manifestations linked with ADHD, though the specific symptoms vary across its three subtypes: 
 • Inattentive type 
 • Hyperactive or impulsive type 
 • Combined type

Individuals exhibiting the inattentive subtype of ADHD encounter challenges in maintaining focus, completing assignments, and adhering to directives. They frequently experience distractions and lapses in memory, often characterized by daydreaming and recurrent misplacement of items like homework, mobile devices, and ongoing conversations. Professionals suggest that numerous children with this subtype of ADHD might remain undiagnosed due to their less disruptive behavior within educational settings (Willcutt, 2012). 
Individuals diagnosed with predominantly hyperactive-impulsive ADHD exhibit behaviors akin to being continuously energized, displaying limited impulse regulation. They demonstrate constant movement, restlessness, and verbal expression, often regardless of the appropriateness of the situation. Their actions tend toward impulsivity, impatience, and frequent interruption of others. 
Individuals diagnosed with combined-type ADHD manifest a blend of symptoms encompassing those described previously. A medical professional will identify patients with this subtype if they meet the criteria for both predominantly inattentive ADHD and predominantly hyperactive-impulsive ADHD, requiring the presence of at least six out of the nine symptoms outlined for each subtype.

Question 4

Treatment

Accepted Answer

ADHD treatment typically involves a combination of therapy and medication. For preschool-aged children and younger, the first recommended approach is to use behavioral strategies, including parent management training and school interventions. 
According to current guidelines, psychostimulants (amphetamines and methylphenidate) are the primary pharmacological treatments for managing ADHD (Pliszka, 2007). 
For preschool-aged patients with ADHD, amphetamines are the only FDA-approved medication, although guidelines suggest that methylphenidate, rather than amphetamines, may be helpful if behavioral interventions are insufficient. Other FDA-approved options for treating ADHD include alpha agonists (clonidine and guanfacine) and the selective norepinephrine reuptake inhibitor atomoxetine.  
There are newer FDA-approved medications for ADHD, such as Jornay (methylphenidate extended-release), taken at night to start the medication effect the next morning, Xelstrym (dextroamphetamine), an amphetamine patch, Qelbree (viloxazine), a non-stimulant, Adhansia (methylphenidate hydrochloride), Dyanavel (amphetamine extended-release oral suspension), Mydayis (mixed salts amphetamine product), and Cotempla (methylphenidate extended-release orally disintegrating tablets). Of note, these newer ADHD agents differ mainly from the older ones NOT in the actual medications delivered (methylphenidates and amphetamines), but in newer methods of delivery that may offer patients a wider variety of options for timing of medication ingestion, length of effect, as well as how “smoothly” the patient experiences the medication.

Question 5

Testing

Accepted Answer

ADHD Testing: Overview and Importance 
ADHD testing is a comprehensive process designed to accurately diagnose attention deficit hyperactivity disorder (ADHD) in individuals across various age groups. This evaluation is essential because ADHD is a multifaceted neurological condition that manifests differently in each person. Testing typically involves a combination of clinical interviews, behavioral assessments, and standardized questionnaires to gather a holistic view of the individual's symptoms and their impact on daily functioning. The primary goal of ADHD testing is not only to confirm the presence of ADHD but also to differentiate it from other conditions that may present with similar symptoms, such as anxiety, depression, or learning disabilities. Accurate diagnosis is crucial for developing an effective treatment plan tailored to the individual's specific needs (American Psychiatric Association, 2013).

Components of ADHD Testing 
The ADHD testing process usually begins with a thorough clinical interview conducted by a healthcare professional, such as a psychologist, psychiatrist, or pediatrician. This interview involves a detailed exploration of the individual's developmental history, behavior, and academic or work performance. Input from parents, teachers, or significant others is often sought to provide additional perspectives on the individual's symptoms across different settings. Standardized behavior rating scales and questionnaires, such as the Conners' Rating Scales or the ADHD Rating Scale, are commonly used tools that help quantify the severity and frequency of ADHD symptoms. These tools enable clinicians to compare the individual's behavior to normative data, enhancing the accuracy of the diagnosis (DuPaul et al., 2016). Additionally, cognitive and neuropsychological assessments may be employed to evaluate executive functions, attention span, and working memory, which are often impaired in individuals with ADHD. 
 
Challenges and Considerations in ADHD Testing 
Despite the structured approach, ADHD testing faces several challenges that can complicate the diagnostic process. One major challenge is the variability in symptom presentation, which can lead to underdiagnosis or misdiagnosis, especially in populations that exhibit less disruptive behaviors, such as females or adults. Cultural and socioeconomic factors can also influence the perception and reporting of ADHD symptoms, potentially leading to disparities in diagnosis and treatment access. Furthermore, the overlap of ADHD symptoms with those of other psychological or developmental disorders necessitates a careful differential diagnosis to avoid inappropriate treatment. Clinicians must remain vigilant and consider the broader context of the individual's life, including stressors, environmental factors, and co-occurring conditions, to ensure a comprehensive and accurate diagnosis. Continued research and refinement of diagnostic criteria and assessment tools are essential to improving the reliability and validity of ADHD testing (Willcutt, 2012).

Question 6

How we test for ADHD

Accepted Answer

Testing Overview  
 
This evaluation of ADHD is intended for individuals aged 6 through adults who present with academic and/or behavioral problems and symptoms of inattention, hyperactivity, or impulsivity. 
 
We will evaluate if symptoms of ADHD are present and to what extent they cause dysfunction.  
 
For children, information will be obtained via a clinical evaluation which could include reports from parents or guardians, teachers, and other school and mental health clinicians involved in the child’s care.  
 
We will also assess for other conditions that might coexist with ADHD (e.g. anxiety, depressive, oppositional defiant, and conduct disorders, among others). Based on our findings, we could recommend further neuropsychological testing.  
 
Testing Personnel  
 
At our facility, ADHD testing and interpretation are conducted by a team of highly qualified medical professionals, including board-certified doctors and Advanced Practice Providers (APPs). Utilizing the latest diagnostic tools and evidence-based protocols, our experts are committed to providing accurate and comprehensive assessments. Our multidisciplinary approach ensures that you receive a tailored treatment plan to effectively manage and improve symptoms of ADHD.

Testing Fees and appointments 
 
Our fees vary depending on patients' insurance and out-of-pocket expenses. Our testing is composed of two appointments:

1. Testing Appointment:

This appointment is usually about 30 minutes and consists of a task-oriented computerized assessment of attention-related problems called Conners Continuous Performance Test 3rd Edition™ (Conners CPT 3™), or The Conners Kiddie Continuous Performance Test 2nd Edition™. Results are reviewed internally between the examiner and a member of our clinical staff.

1. Intake Appointment:

This appointment is a 60-minute to one-hour session for a clinical interview and assessments. Data collection surveys are due from families and teachers (for children) at this session. If the examinee is a minor, parents are responsible for ensuring that the teacher’s form is completed and provided to the examiner before this appointment. Our providers screen for ADHD, Anxiety, Depression, OCD and other mood disorders as all these diagnosis can present similar symptoms. 
 
An explanation of the results will be provided in the clinical report.
 
It is encouraged that all parties, including the examinee, attend this appointment to review the diagnostic results and clinical recommendations.  
 
The CPT-3 (Continuous Performance Test, Third Edition) is an essential component of our comprehensive ADHD evaluation process. Please note the following important information regarding the cost and billing of this part of the test: 
 • Cost of CPT-3 Testing appointment: The fee for the Conners CPT-3 test $0. PFBH offers a zero dollar cost for the administration and analysis of this CPT-3 test if scheduled along a Psychiatric Intake appointment that screens for ADHD, Anxiety, Depression, OCD and other mood disorders, which we will billed to the patient's insurance.

Disclaimer: The Intake appointment, and Follow-up appointment services may or may not be covered by medical insurance policies. The patient is responsible for understanding their insurance coverage and payment for services. Both visits will receive a good faith estimate which is not a guarantee of coverage nor reimbursement from the patient insurance.

Question 7

Links of Interest and Resources

Accepted Answer

What is ADHD? https://www.psychiatry.org/patients-families/adhd/what-is-adhd (https://www.psychiatry.org/patients-families/adhd/what-is-adhd)
DSM-V https://www.psychiatry.org/psychiatrists/practice/dsm (https://www.psychiatry.org/psychiatrists/practice/dsm)
ADHD medications parent guide https://www.aacap.org/App_Themes/AACAP/docs/resource_centers/resources/med_guides/ADHD_Medication_Guide-web.pdf (https://www.aacap.org/App_Themes/AACAP/docs/resource_centers/resources/med_guides/ADHD_Medication_Guide-web.pdf)
What is ADHD? Video by the American Psychiatric Association	https://www.youtube.com/watch?v=9TcNQkyxMj8&t=119s (https://www.youtube.com/watch?v=9TcNQkyxMj8&t=119s)
ADDitude website https://www.additudemag.com/ (https://www.additudemag.com/)

Question 8

Citations

Accepted Answer

• American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Publishing. 
 • Barkley, R. A. (2015). Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment. Guilford Publications. 
 • Centers for Disease Control and Prevention. (2020). Data and statistics about ADHD. Retrieved from https://www.cdc.gov/ncbddd/adhd/data.html (https://www.cdc.gov/ncbddd/adhd/data.html)
 • Danielson, M. L., Bitsko, R. H., Ghandour, R. M., Holbrook, J. R., Kogan, M. D., & Blumberg, S. J. (2018). Prevalence of Parent-Reported ADHD Diagnosis and Associated Treatment Among U.S. Children and Adolescents, 2016. Journal of Clinical Child & Adolescent Psychology, 47(2), 199-212. https://doi.org/10.1080/15374416.2017.1417860 (https://doi.org/10.1080/15374416.2017.1417860)
 • DuPaul, G. J., Reid, R., Anastopoulos, A. D., & Power, T. J. (2016). Assessing ADHD symptoms in children and adults: Development and validation of the ADHD Rating Scale-IV. Journal of Psychopathology and Behavioral Assessment, 38(1), 25-35. https://doi.org/10.1007/s10862-015-9518-7 (https://doi.org/10.1007/s10862-015-9518-7)
 • Hinshaw, S. P., & Scheffler, R. M. (2014). The ADHD explosion: Myths, medication, money, and today's push for performance. Oxford University Press. 
 • Pliszka, S. R. (2007). Pharmacologic Treatment of Attention-Deficit/Hyperactivity Disorder: Efficacy, Safety and Mechanisms of Action. Neuropsychology Review, 17(1), 61-72. https://doi.org/10.1007/s11065-007-9037-9 (https://doi.org/10.1007/s11065-007-9037-9)
 • Simon, V., Czobor, P., Bálint, S., Mészáros, Á., & Bitter, I. (2009). Prevalence and correlates of adult attention-deficit hyperactivity disorder: meta-analysis. The British Journal of Psychiatry, 194(3), 204-211. https://doi.org/10.1192/bjp.bp.107.048827 (https://doi.org/10.1192/bjp.bp.107.048827)
 • Willcutt, E. G. (2012). The prevalence of DSM-IV attention-deficit/hyperactivity disorder: a meta-analytic review. Neurotherapeutics, 9(3), 490-499. https://doi.org/10.1007/s13311-012-0135-8 (https://doi.org/10.1007/s13311-012-0135-8)

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