Reconstructing Assessment & Treatment of ADHD

By Frank J. Granett R.ph. and Mauren Morel LCSW, Special for USDR


Informative, revealing and groundbreaking, The American Epidemic: Solutions for Over-medicating Our Youth offers compelling insight and knowledge regarding the assessment and treatment of neuro-behavioral disorders including ADHD, OCD, depression and anxiety. This compilation is a benefit to students, parents, educators, and all health care professionals. An individualistic as well as systematic approach in the clinical behavior assessment and treatment process of neuro-behavioral conditions should become the reconstruction mandate.  National and international societies should empower themselves with knowledge prior to premature drugtherapy.

Behavioral challenges diagnosed in children can provide opportunity for early interventions to cope and overcome symptoms. ADHD is the most diagnosed neuro-behavioral disorder in children currently affecting boys by a 2:1 ratio than girls. The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) characterizes ADHD symptoms through behavioral patterns that may present in multiple settings (e.g., school and home), resulting in social, learning and work performance setbacks.  There must be clear evidence of interference with developmentally appropriate social, academic, or occupational functioning prior to a confirmed ADHD diagnosis. Symptoms of ADHD are more prominent in elementary grade children. Symptoms of inattention or hyperactivity affect classroom work and academic performance. Impulsive symptoms can also lead to the breaking of familial, interpersonal, and educational rules which oftentimes lead to other consequences such as school suspensions and in severe cases,expulsion.

Revisions were made in the recent DSM-V, concluding that children with ADHD continue to experience the disorder as adults. The recent revision of the DSM-V missed the opportunity to include underlying risk factors causing neuro-behavioral symptoms prior to treating young children with premature drug therapy. ADHD treatment should not be a “one size fits all”. Comprehensive diagnosis by ruling out nutritional, neuro-physiological and environmental risks factors should be the new mandate for reconstructive reform. Hyperactivity in children unfortunately is immediately labeled as ADHD. In many cases, teachers with no formal training will encourage parents to seek stimulant medication to manage thebehavior.

ADHD symptoms must be present in two different environmental settings for appropriate diagnosis. If a child is hyperactive and restless on the playground but has no impairment in the classroom, ADHD is not a behavioral consideration. The consulting professional should complete a thorough assessment consisting of information gathering and interviews with those that have been caring for the child. Background history is essential to rule out any stressors that may cause interference with behavioral function, including death in the family or parental divorce, as well as symptoms of anxiety ordepression.

Standard evaluation or behavior rating scales completed by parents and teachers are very useful as they provide the healthcare specialist with quantified data for the child’s behavior in multiple settings. This data can later be compared with normal behavioral standards. Other assessments include mental status, social history and complete medical history. A healthcare specialist should make referrals to other professionals, ruling out medical conditions that may contribute to the behavioral symptoms. Beware of a 15 minute behavioral consult culminating in a diagnosis for ADHD with a prescription for medication and no background bio-assessment history. Parents of children who are misdiagnosed with neuro-behavioral conditions including ADHD should demand critical information to determine cause of symptoms prior to premature drugtherapy.

When assisting parents during the management of behavioral symptoms, the Action Plan for Behavioral Conditions as described in The American Epidemic serves as a step-by-step guide to help children return to positive behavioral development. Parents should be empowered with knowledge regarding the risk factor causes of ADHD and should not be encouraged to medicate young children unless all assessments are conducted. Early intervention provided to children, allows them to be involved in the solution and at the same time have a successful academic experience. Additionally, children may require a combination treatment modality of medication management and psychotherapy. They are able to effectively manage their symptoms through behavior management and increase academicperformance.

ADHD symptoms are prematurely treated with medication. Over 12 million children and young adults consume ADHD stimulant and psychoactive medications. This consumption rate represents over 3x times the world’s children combined, according to data collected by Scientific American. However, the National Institute of Mental Health (NIMH) states that when parents are involved and are able to provide children with necessary structure at home and have a better management of their children’s behavior, then there is a better chance of the children being successful at school without the need for medication. ADHD is better managed when a multimodal approach is utilized. This approach involves the use of psycho social treatments, behavior modification therapy, bio-assessment and the use of medication if needed. ADHD affects functional domains. Behavior is the root cause of parents seeking assistance. ADHD affects relationships with parents, siblings, peers, teachers and other adults. ADHD is often associated with poor academic achievement and behavioral functioning atschool.

Medicating children has always brought controversy, as there are parents that do not believe in managing symptoms via medication.  As the primary intervention, parents want their children to learn effective coping skills rather than depending on medication. ADHD has impacted the nation as it generates an economic cost over 54 billion dollars, annually. Children use a wide variety of services including medical services, special diagnosis, behavioral interventions, and educational services and in some instances social services. However, in recent years, there is a shift and more parents are seeking the quick fixed pill to address behavioral issues. Contributing factors for this shift includes insurance coverage as medication therapy is usually covered under medical benefits while other forms of behavioral therapy, depending on the insurance plan, are covered under behavioral health or mental health. There is also a cap on how many sessions they are allowed per year and co-pays and deductibles are often too high for parents to afford, making medication the only affordable treatment available when compared to other treatmentmodalities.

When discussing the possibility of abuse and misuse of medication, the FDA has issued warnings to create awareness. Drug abuse is defined by (DSM-V) as the excessive, maladaptive, or addictive use of drugs for non-medical purposes despite social, psychological, and physical problems. According to the National Institute on Drug Abuse (NIDA), approximately 16 million of American reported abusing prescription drugs in the year 2010. NIDA creates awareness involving the misuse and abuse of prescription drugs.  For example, academic doping and diversion of Adderall on college campuses can have adverse consequences…as students can become addicted.  Stimulants have taken the place of cocaine addiction as some students and young adults are misusing it to stay awake and during exam preparation.  Suicide is the second leading cause of death in the US college studentpopulation.

Contact Mauren Morel & Frank J. Granett for a seminar to strengthen behavioral health at home and in the workplace.  The Price of ADHD Business will feature an upcoming special program involving solutions for The American Epidemic

 

Frank J. Granett R.ph. is a board-certified pharmacist with over 26 years of consultative experience, specializing in attention deficit disorder and psychiatric medications. He is the clinical director of pharmacy operations at a Behavioral Center of Michigan psychiatric hospital in southeast Michigan. As a father of six children, Granett is passionate about recommending the Action Plan for Childhood Behavioral Conditions. He is the founder of the non-profit Coalition Against Overmedicating Our Youth whose mission is to help children and adults by determining the cause of behavioral conditions by providing free bio-assessment recommendations as well as medication counseling for safe protocols.
Mauren Morel is a Licensed Clinical Social Worker in the State of Florida and a Substance Abuse Professional in the United States. She is currently the Clinical Director and Co-Founder at the Core Centers where she assist individuals manage their addiction via behavioral interventions. Mauren is a doctoral candidate in Counseling Psychology from Argosy University in Chicago, Illinois where she is in the process of completing and publishing her research studies in behavioral sciences. In addition, Mauren is currently a behavioral expert appearing in Despierta America morning show where she provides advice to parents on issues affecting children and families in the Hispanic Community.


All opinions expressed on USDR are those of the author and not necessarily those of US Daily Review.

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