Information about Preparing for Evaluation and Treatment of ADHD
Attention Deficit/Hyperactivity Disorder (ADHD) is a Developmental Disorder with symptoms starting before the age of 12 years old which includes inattention, impulsivity and /or hyperactivity in 2 or more settings and these interfere with or reduce the quality of social, academic or occupational functioning. ADHD is not a disorder that starts in college after years of success in school. ADHD diagnosis depends on self-report and collateral information. In a child, information from parents, teachers, and other community members is obtained. Obtaining collateral information about one's childhood in a college student is understandable more difficult. If a student is seeking ongoing treatment of ADHD who has been treated previously, then those records will be required by the treating psychiatrist at CPS before prescriptions are continued. It would be best if the student requests (signing a release of information) by the previous providers to be sent to CPS. These records will include the first evaluation leading to the diagnosis of ADHD and any future confirmations. These would most likely come from a psychologist, psychiatrist, or the school. Typically primary care providers do not provide detailed records confirming ADHD, though they might. Records should also be sent from the provider of any psychiatric medication and response to medication. The pharmacy may be able to print out a list of medications that has been prescribed.
If a student is requesting an evaluation for ADHD for the first time, the diagnosis becomes more difficult and requires more scrutiny as ADHD by definition has symptoms prior to the age of 12. Therefore either a parent or parental figure will need to provide information about symptoms prior to the age of 12. The psychiatrist and the student may discuss and agree on the possibility of a parent or parental figure accompanying the student to the evaluation. There is also a questionnaire (Parental/ Parental Figure Questionnaire) that we may ask to be filled out by a parent or parental figure.
A standard part of the evaluation is doing a cognitive or neuropsychological testing to support a diagnosis of ADHD. For this test report to be valid, it should be done within the last 3 years. The specific tests may vary, but we require an IQ testing (such as WAIS or WISC), achievement testing (such as Woodcock Johnson Tests of Achievement or Wechsler Individual Achievement Test), testing for attention span or distractibility, and tests of executive functioning. The report should have a formal diagnosis. CPS does not conduct cognitive and/or neuropsychological testing. These have to be done at another facility. Students who come to CPS and want to get tested for ADHD will be referred to local or home communities for these tests. CPS generally refers students to Psychology and Social Work Clinic who administer these tests. Having this done prior to the psychiatric evaluation, and having the results sent to CPS, will expedite treatment. Cognitive and/or neuropsychological testing is done at the student's expense.
During the psychiatric evaluation at CPS a thorough evaluation is conducted, including questions about ADHD (inattention, hyperactivity and impulsivity), but also questions about other diagnosis both medical and psychiatric that could influence ADHD as well as mimic ADHD and therefore require a different treatment.
The student with ADHD is best treated with a combination of services depending on need. These may include therapy, coaching, registering with Student Accessibility Services to provide accommodations, Tutoring, and Medication. CPS often refers students to other campus resources such as:
Student Accessibility Services (SAS) 348 Baker Center, University, Athens, OH 45701 740-593-2620 (accommodations can be made to help the student academically. Such as longer test time, taking test in quieter setting, obtaining copy of notes, etc.)
The Academic Advancement Center (AAC): Alden Library 101, Athens, OH 45701 740-593-2644, which includes: Supplemental Instruction (SI), Tutoring Services, Student Writing Center, Academic Skill Development Courses, and the College Adjustment Program (CAP)
Attentional Differences Group, a psycho-educational support group held at Counseling and Psychological Services. Contact CPS for more information.
First line medications for ADHD are stimulant medications. These include methylphenidate products, (brand names include Ritalin, Metadate and Concerta) and amphetamines (brand names include: Adderall, Dexedrine, and Vyvanse). The FDA has placed these on the Schedule II Controlled Substance List. They can and are abused and diverted. This is potentially problematic on a college campus. For this reason we are careful in prescribing these medications only to students with ADHD. Stimulant medications are not prescribed to enhance academic performance in those who do not have a diagnosis of ADHD. We require abstinence of marijuana and other illegal/unprescribed drugs to receive stimulants. A prior history of substance abuse is also likely to prevent a prescription from being written. We require certain routines when prescribing these medications. Examples include, thorough diagnosis of ADHD, clean urine drug screens before start of medication, randomly, if concerns arise, and at least annually. Drug screens are done at the student's expense. We recommend an annual physical. A referral to a Primary Care provider, cardiologist, or neurologist, may be needed if a medical concern arises. Blood pressure needs to be maintained in the normal range. We measure Height, weight, BP, and Pulse.
Ohio Automated, RX Reporting System, (OARRS) is a site which provides a list of all prescriptions of controlled substances filled by a patient, as well as where these prescriptions were filled (pharmacy) and the name of the physician who prescribed them. We are required to review the OARRS by law, which shows all controlled prescriptions filled by the patient, the physician that prescribed them and the pharmacy that fills them. The CPS psychiatrist may review the information that is available on this site on a student prior to writing prescriptions as well as regularly during the course of the treatment, and when there is a concern that the stimulants are abused. If illegal activity is suspected we may be obligated to report to law enforcement.
When a controlled substance is prescribed, the written prescription is taken by the patient to the pharmacy. We are not allowed to phone in, fax or email prescriptions. If the paper prescription or bottle of pills is lost, we cannot replace them.
There are other medications used to treat ADHD as well. The psychiatrist will discuss with the student various medication options as well as alternative non-pharmacological treatments.