To help you find affordable evaluations and treatment when insurance coverage is lacking and fees are too high, the members of Attention‘s editorial advisory board put their heads together. They compiled these tips out of their collective wisdom and experiences.
If you are an adult with ADHD, or a parent surrounded by chaos, this project can be a real challenge. This is a good time to get creative. Perhaps a friend or relative could help you with this research in exchange for something they need done. Don’t be afraid to ask for help. Many people feel that the support they receive from other individuals or parents is the strongest help they have. Take advantage of organizations such as CHADD and its National Resource Center on ADHD, ADDA, NAMI, Learning Disabilities Association, and so forth. These national groups offer valuable support and education, as well as useful educational materials such as books, audiobooks, articles, podcasts, and brochures. They provide services (in-person and online) through support groups, training programs, telephone contact, online communities, blogs, conferences, and newsletters. Much of the help these organizations offer is available free of charge.
How can I get my child evaluated and treated for ADHD? It’s tooexpensive and we can’t afford it. Can somebody help me—please?
Your pediatrician or primary care doctor can do the assessment. However, be aware that expertise in ADHD varies greatly—especially with adults. To make your doctor’s job easier, you and a teacher can fill out an assessment checklist before the visit. The American Academy of Pediatrics has an ADHD Toolkit with an ADHD assessment checklist and treatment recommendations. This toolkit is available to doctors and non-medical people. The AAP toolkit provides Vanderbilt Rating Scales for parents and teachers; you can find the toolkit at AAP.org. You can also download the Vanderbilt Rating Scales from other websites. Doctors for adults vary greatly in using assessment tools for ADHD. For an adult ADHD assessment, you can download checklists such as the Adult ADHD Self-Report Scale (ASRSV1.1) or the ADHD Rating Scale (ADHD-RS-IV).
Your doctor may refer you to another specialist. A psychiatrist or a psychologist can do the assessment. Your doctor may be able to contact a professional colleague who will do a pro bono or sliding scale assessment, or a medication review, or even help with behavioral parent training.
If your child is having significant problems in school, he or she could qualify for extensive psychological and educational testing by the school staff. First,ask through the principal’s office for the education management team. If approved, the school evaluation may include a thorough assessment for ADHD, learning disabilities, and psychosocial difficulties. If your child has significantly impaired availability for learning due to ADHD, then the school is required by federal law to provide necessary accommodations and interventions. Although the school cannot prescribe medication, your doctor could review the school report and possibly follow through with treatment.
Many counties have behavioral clinics that can help an adult or child with evaluation and treatment. Your local county mental health centers and community service boards may be able to provide assessment and treatment services on a sliding scale. The website for the Substance Abuse Mental Health Services Administration lists these nationwide programs. There are also county Early Intervention Programs that will provide services for very young children who need testing and follow up services. Under the US Department of Education, statewide Parent Information and Resource Centers help parents of children with disabilities find resources and provide up-to-date training. For therapy or behavior management, you may find that group therapy or training is more affordable than individual therapy.
Some hospital-based clinics offer services for free or on a sliding scale basis. Hospital clinics are more likely to participate with a wide range of insurance plans. Many hospitals have interns and residents in training who provide treatment under mentor guidance. Some adult and children’s hospitals have specialized ADHD clinics that take finances into consideration. Hospitals that are a part of a large healthcare system can also have outside clinics for low income or uninsured children or adults. Some of these centers will consider sliding scale or free rates.
College and university programs set up training centers for future doctors, psychologists, and social workers. Your local colleges may have such a program. This could make assessment and counseling could be affordable.
Clinical research programs may qualify adults or children for an ADHD assessment and treatment. Check out your local academic hospital or the National Institute of Mental Health to see if one of their studies might be a good fit.
Check ADHD websites such as ADDfreesources.net for information on how to look for resources and free assessment forms.
Treating ADHD in children requires medical, educational, behavioral and psychological interventions. This comprehensive approach to treatment is often called “multimodal” and consists of parent and child education about diagnosis and treatment, behavior management techniques, medication, child and/or family counseling, and school programming and supports. Treatment should be tailored to the unique needs of each child and family.Each person considering medication treatment for ADHD should first have a careful, comprehensive assessment to clarify the diagnosis, identify other medical, psychological or learning problems that may be present with ADHD, and learn about ADHD. After the diagnosis has been made, a treatment plan should be developed in consultation with the physician or other medical professional. In this planning session, the patient, family and medical professional can work together to consider the various options for treatment. If medication is going to be used, the medical professional will prescribe a specific medication.
Frequently asked questions about children taking ADHD medication
The effects of psychostimulant medications are usually noticeable within 30–60 minutes once an appropriate dose for that individual has been found. However, determining the proper dosage and medication schedule for each individual often takes a few weeks. Nonstimulant medications often require several weeks before their full effects can be observed.
Not necessarily. Many adolescents and adults continue to respond well to the same doses of psychostimulant medication. However, many others will require higher doses. Some children may respond well initially to a low dose of medication and then require a modest dose increase after a few weeks or months once a “honeymoon period” has passed.
Not necessarily. These medications can be stopped at any time. However, ADHD is a chronic condition. Its severity and developmental course are quite variable in duration and severity. Up to 60 percent of children with ADHD continue to exhibit problematic symptoms into adolescence and adulthood. For these individuals, continuing effective treatment modalities, including medication, can be helpful.
This should be decided with the prescribing medical professional and the therapeutic team. Children can often benefit from medication outside of school because it can help them succeed in social settings, peer relations, home environment and with homework. Medication can be of help to children who participate in organized sports and activities that require sustained attention, such as musical programs, debate or public speaking activities.
In general, two or three different stimulant medications should be tried before determining that this group of medications is not helpful. Similarly, several different antidepressant medications can also be tried. Most individuals will respond positively to one of these medication regimens. Some individuals, because of the severity of their disability or the presence of other conditions, will not respond. And some individuals will exhibit adverse side effects. In such cases, the entire treatment team—family, physician, mental health professional and educators—must work together to develop an effective intervention plan. Other medications such as clonidine may be helpful, and occasionally, combinations of medication may be needed. When all medication appears to be ineffective, consideration needs to be given to whether the diagnosis of ADHD is accurate, whether other conditions are affecting functioning, whether appropriate criteria for improvement have been established, and whether objective and accurate feedback is being provided regarding the effectiveness of medication.
No. Multiple studies that have followed children with ADHD for 10 years or more support the conclusion that the clinical use of stimulant medications does not increase the risk of later substance abuse. In fact, many studies have shown that individuals with ADHD who are not effectively treated with medication during childhood and adolescence have an increased risk of developing significant alcohol or drug abuse problems later in life. When treated, the risk of later drug or alcohol problems is the same as individuals who do not have ADHD.
Although there is potential for abuse when misused, psychostimulant medications do not cause addictions to develop in those being treated appropriately. Unfortunately, research does show that children who demonstrate conduct disorders (delinquent behaviors) by age 10 and are smoking cigarettes by age 12 are at higher risk for substance abuse in the teenage years, possibly persisting into mid-life. Therefore, it is important to recognize this subgroup early and get them involved in an effective multimodal therapeutic program.