 At Lake Area Pediatrics, we follow a very specific program to evaluate your child for ADD/ADHD. If you have any questions regarding any of the visits, evaluations, or the Vanderbilt Assessment, please call our office.
Visit 1: Initial History and Physical (1/2 hour)
Information is obtained about the child's symptoms, past medical problems that may be related to ADD/ADHD, school performance and behavior problems. A physical exam is done to determine the physical state of the child and if any neurological or developmental abnormalities are present. Hearing and vision screens are completed.
The Vanderbilt Assessment for Teachers and Parents is given to the parent. The Teacher version is accompanied by a letter and instructions to the teacher to fill it out and return it by mail. We do not want the evaluation shared with the child or the parents before the next meeting. For older students, two teachers are selected in major subjects - one in humanities and the other in math or science. The Parent version is filled out by both parents if possible and brought in at the next visit. The second visit is scheduled for 3-5 days after the teachers have mailed their evaluations so we are certain to have all the evaluations available for scoring and review.
Information is provided on treatment options:
- Stimulants - Ritalin and Adderall
- Non-stimulants - Strattera
In addition, parents are encouraged to get onto the Internet and read about the medications - I recommend the Children & Adults with ADD/ADHD website (www.CHADD.org)
Visit 2: Review of Vanderbilt Assessments (1/2 hour)
Parent and Teacher Vanderbilts are reviewed and it is determined if the child has enough factors to establish the diagnosis of ADD/ADHD. If the diagnosis is confirmed we discuss the options for treatment including medications. A prescription may be dispensed at this time.
All stimulants are Schedule II drugs and require a special license for dispensing and special rules for recording, filling and re-filling. They are written on a special prescription form and must be filled within 7 days or it is invalid. Schedule II prescriptions cannot be faxed or phoned into the pharmacy. Usually the insurance companies will not allow more than 30 days at a time to be filled.
A medication schedule is devised at this visit and a review of side effects. A chart is given to the parent to record side effects (copies for the teachers are provided as well). The medications are almost always started on a Saturday at the lowest dose in order for the parent to be able to monitor side effects. The dose is increased at weekly intervals as needed to get the desired effect. Frequent visits are often needed to establish the correct does for each child.
Visit 3: First follow-up visit on medication (1/4 to 1/2 hour)
We classify this patient as in Phase I of the program at this time of dose adjustment. Once the dose is established with the desired result for at least two months, the child moves into Phase 2.
Subsequent visits: Adjusting the does (Phase I)
These visits will be at least monthly or more frequent if the dose must be altered more often for effect or to decrease side effects.
Subsequent visits: Maintaining the dose (Phase 2)
If the dose is not changed for two months and we are satisfied with the result, the child has moved into Phase 2. Visits are only necessary every other month. Prescriptions can be picked up at the front desk between visits. In order to have these prescriptions ready for pick up, you must call in 24 hours before desired pick up time.
Subsequent visits: Chronic stable dose (Phase 3)
After the child has been on a fixed dose of medication for 6 months, they will progress to Phase 3. Office visits will only be required every 3-4 months and prescriptions can be picked up at the front desk by request between visits. The parents must call 24 hours in advance to pick up the prescription.
Changes in dosage:
If it deemed necessary to change the dose of medication, the child will drop back to Phase I and start the process again, but usually will be able to move up in the Phases more quickly.
J. Stephen Robinson, MD
| 