• To centralize the diagnosis and management of children with ADHD
• To practice a comprehensive approach to diagnosis and management
• To serve as a tertiary referral source for physicians who feel comfortable with routine ADHD cases, but need help with the more complex ones
• To train physicians and professionals in related disciplines in the care and management of ADHD patients
Staffing includes pediatricians, nurses and nurse practitioners, a social worker and half time educator. The cost of the assessment breaks down as follows:
• initial evaluation appointment (2 hours) $357
• summation appointment (1 hour) 227
• learning assessment 615
(rarely covered by insurance)
Social Skills Training
Children with ADHD often have poor social skills, few friends, low self-esteem, and self-control problems, especially with anger management. Some studies suggest that social skills training is not effective, but the author feels classes can be very helpful when coupled with parent training (many parents of ADHD children still struggle with the same self-control issues).
Each child is enrolled in six weekly classes taught by an instructor with a master’s degree in education or counseling. Groups of four to eight children of similar age practice social skills and anger management using such techniques as self evaluation from videotaping, role-playing, and puppetry. Meanwhile, mothers and fathers share their experiences and learn parenting techniques in another room.
Educational Interventions
Parents are encouraged to share with the school, (particularly their child’s teachers) the results of the educational assessment. The author stresses the importance of the educational interventions the child may be entitled to in the local school under the educational classifications of either the Individuals with Disabilities Education Act (which qualifies children with ADHD for special education) or Section 504 of the Rehabilitation Act (which entitles children with ADHD to classroom modifications). Teachers are provided with handouts about classroom management techniques.
If needed, master’s level clinic staff assists (at an hourly fee) with the formulation of an individual education plan or school advocacy. The author arranges tutoring or has clinic staff provide it. He also instructs parents in monitoring homework and sometimes helps parents find private schools.
Medication
A drug is prescribed if ADHD is significantly impacting academic progress or social behavior, but never as a sole intervention.
(Gephart, H. A managed care approach to ADHD. Contemporary Pediatrics 1997; 14(5):123-139)
Comment: It is easy to understand (although not condone) parents and physicians who pursue the elusive quick fix for children with attention disorders-assessment. It is time consuming and expensive, and management is supremely labor intensive. The weak link at this center is communication with the school. They seem to accomplish it exclusively through the parent(s), which creates its own set of problems. The school nurse might take the initiative to dialogue with such a center and assist the teacher in providing feedback. - R.A.
