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Attention Deficit Hyperactivity Disorder (ADHD) is the most commonly diagnosed behavior disorder in children. With the frequency of ADHD diagnoses, primary care providers (PCP) are challenged with managing this chronic and complex concern in an efficient yet effective way, both in terms of time and money. Research indicates behavioral diagnoses and management take approximately five minutes longer than medical-only concerns. This can result in a revenue loss for primary care practices. However, an on- site behavioral health consultant (BHC) can help PCPs provide a high standard of care for children presenting with behavioral concerns without compromising cost effectiveness. This study’s aim was to assess the cost per minute in a small rural primary care practice that utilizes an on-site BHC by comparing data between ADHD appointments when the BHC was utilized versus ADHD appointments when the BHC was not utilized. This study used extant data consisting of a sample of 53 children with ICD-9-CM codes 314.00 or 314.01, indicating an ADHD diagnosis. Of the 53 children with these codes, 40 (75.5%) were billed using E/M codes 99213 or 99214. The first of these indicates a regular office visit with an established patient not exceeding 15 minutes while the latter is used if the visit lasts longer than 25 minutes. Both codes were combined and evaluated together. The database was then recoded to indicate whether or not a BHC was utilized. Using descriptive statistics, it was found that children with ADHD spent a max of 69 minutes (20.19 minutes on average) with the PCP when a BHC was not utilized and a max of 22 minutes (13.67 minutes on average) when a BHC was utilized. Furthermore, an average of $82.79 in insurance reimbursement was received by the practice for these types of visits, regardless of up-coding for physician time spent. Using these statistics, it was determined that the practice makes $4.10 per minute when a BHC is not utilized versus $6.06 per minute when a BHC is utilized for ADHD appointments, due to the time savings ratio. The results indicate that utilization of a BHC increases revenue with respect to minutes spent with the child, while still providing behavioral health time and attention to the patient. These findings have practical implications for the treatment and management of ADHD and support the use of BHCs in pediatric primary care settings. Given the nature of pediatric primary care, it would be more cost effective for PCPs to utilize an on-site BHC with all ADHD visits.

No description available.

No description available.

The adherence to published guidelines for diagnosis and treatment of Attention-Deficit Hyperactivity Disorder (ADHD) by primary care pediatricians (PDs) and family practice physicians (FPs), particularly those in rural areas, has not been well documented. This study examined survey responses from PDs and FPs who serve southern Appalachia (northeast Tennessee, southwest Virginia and Kentucky, and western North Carolina) regarding key practice parameters in line with the current American Academy of Pediatrics guidelines. Results showed that both PDs and FPs reported adhering to most of the diagnosis and treatment guidelines. PDs were more likely than FPs to report using both parent and teacher input in diagnosis and reported prescribing different medications for ADHD to some degree. Both practice areas reported ongoing access to continuing medical education, which is a means to enhancing care of ADHD patients. Implications for primary care are given with attention to the limited availability of PDs in rural areas and future areas of research in rural mental healthcare are suggested.

The effects of sertraline and methylphenidate on attention and behavior in children with attention deficit hyperactivity disorder were compared. Thirty-two children were randomly assigned to treatment with methylphenidate 20 mg per day, sertraline 50 mg per day, or a waiting list control group. Baseline testing included the Wechsler Intelligence Scale for Children, Children's Depression Inventory, Conners Parent and Teacher Rating Scales (CPRS and CTRS), Gordon Diagnostic System (GDS), and the Test of Variables of Attention (TOV A). After at least 2 weeks of medication the CPRS, CTRS, GDS, and TOVA were repeated. Analyses ofthe data using repeated measures ANOVAs revealed no significant main effects of treatment group on any of the primary outcome variables. However, several significant interaction effects of treatment group and trial period were noted. Children given methylphenidate showed significant improvement on measures of both attention and impulsivity/hyperactivity. Children in the sertraline group improved significantly on subscale 3 ofthe CPRS which measures impulsivity/hyperactivity, and showed a trend toward improvement in attention. Children in the control group did not improve significantly on measures of attention or impulsivity/hyperactivity. Both medications were well tolerated. These results suggest that methylphenidate is a more effective medication for ADHD than sertraline. However, the trend toward improvement with sertraline suggests that further clinical trials are warranted.

With this study, we have chosen to continue our B-essay about dual-diagnosis.In the essay we have done some research on how this target group feels about the treatment from the dependent unit, psychiatry unit, social services unit and the housing environment. We wanted to know about the feelings because during the B-essay we found out that individuals whit the dual-diagnosis is skipped between different caregivers. We used a qualitative method with six interviews from two different housings in south of Sweden. The information we got we used in our result and analysis part, where we found out that the caretaker’s thought the treatment were fine and that it was the surroundings they found the most fault with.

Impulsivity is a hallmark of two of the three DSM-IV ADHD subtypes and is associated with myriad adverse outcomes. Limited research, however, is available concerning the mechanisms and processes that contribute to impulsive responding by children with ADHD. The current study tested predictions from two competing models of ADHD – working memory (WM) and behavioral inhibition (BI) – to examine the extent to which ADHD-related impulsive responding was attributable to model-specific mechanisms and processes. Children with ADHD (n = 21) and typically developing children (n = 20) completed laboratory tasks that provided WM (domaingeneral central executive [CE], phonological/visuospatial storage/rehearsal) and BI indices (stopsignal reaction time [SSRT], stop-signal delay, mean reaction time). These indices were examined as potential mediators of ADHD-related impulsive responding on two diverse laboratory tasks used commonly to assess impulsive responding (CPT: continuous performance test; VMTS: visual match-to-sample). Bias-corrected, bootstrapped mediation analyses revealed that CE processes significantly attenuated between-group impulsivity differences, such that the initial large-magnitude impulsivity differences were no longer significant on either task after accounting for ADHD-related CE deficits. In contrast, SSRT partially mediated ADHD-related impulsive responding on the CPT but not VMTS. This partial attenuation was no longer significant after accounting for shared variance between CE and SSRT; CE continued to attenuate the ADHD-impulsivity relationship after accounting for SSRT. These findings add to the growing literature implicating CE deficits in core ADHD behavioral and functional impairments, and suggest that cognitive interventions targeting CE rather than storage/rehearsal or BI processes may hold greater promise for alleviating ADHD-related impairments

Hyperactivity is currently considered a core and ubiquitous feature of attention-deficit/hyperactivity disorder (ADHD); however, an alternative model challenges this premise and hypothesizes a functional relationship between working memory (WM) and activity level. The current study investigated whether children s activity level is functionally related to WM demands associated with the domain-general central executive and subsidiary storage/rehearsal components using tasks based on Baddeley s (2007) WM model. Activity level was objectively measured 16 times per second using wrist- and ankle-worn actigraphs while 23 boys between 8 and 12 years of age completed control tasks and visuospatial/phonological WM tasks of increasing memory demands. All children exhibited significantly higher activity rates under all WM relative to control conditions, and children with ADHD (n=12) moved significantly more than typically developing children (n=11) under all conditions. Activity level in all children was associated with central executive but not storage/rehearsal functioning, and higher activity rates exhibited by children with ADHD under control conditions were fully attenuated by removing variance directly related to central executive processes.

Attention-deficit/hyperactivity disorder (ADHD) is highly comorbid with substance use disorders, particularly cocaine. Preclinical studies using the well-validated Spontaneously Hypertensive Rat (SHR) model of ADHD suggest that adolescent treatment with the stimulant methylphenidate increases cocaine abuse risk in adulthood, highlighting the need to identify alternative medications for teenagers with ADHD. Experiments 1-4 tested the hypothesis that atomoxetine, a non-stimulant that improves prefrontal cortex functioning in adolescent SHR, would not increase cocaine abuse risk. The speed to acquire cocaine self-administration, the efficacy and motivating influence of cocaine reinforcement, and reactivity to cocaine cues in adulthood following discontinuation of adolescent atomoxetine treatment were examined in male SHR and two genetic control strains: inbred Wistar-Kyoto (WKY) and outbred Wistar (WIS). Because atomoxetine is not always as clinically efficacious as methylphenidate, Experiments 5-9 tested the hypothesis that an alternative stimulant, d-amphetamine, would improve cognitive performance in adolescent SHR during a strategy set-shifting task and not increase cocaine abuse risk in adult SHR after adolescent d-amphetamine was discontinued. Across experiments, adult SHR acquired cocaine self-administration faster than control strains and also were more sensitive to cocaine’s reinforcing and motivating influence and more reactive to cocaine cues. As hypothesized, adolescent atomoxetine did not increase any measure of cocaine abuse risk in adult SHR and modestly reduced SHR’s reactivity to cocaine cues. In WKY control, however, adolescent atomoxetine accelerated acquisition of cocaine self-administration. d-Amphetamine improved set-shifting deficits in adolescent SHR, demonstrating pro-cognitive effects as hypothesized. When self-administration was acquired, cocaine intake was lower in adult SHR that received adolescent d-amphetamine compared to vehicle-treated SHR, consistent with the hypothesis. Adolescent d-amphetamine slowed acquisition and reduced the efficacy and motivating influence of cocaine reinforcement in WIS control, but accelerated acquisition in WKY control. Collectively, these results highlight the heuristic value of SHR in evaluating comorbid ADHD and cocaine abuse risk, and suggest that atomoxetine and d-amphetamine may be safer medications than methylphenidate for teenagers with ADHD. However, findings in control strains emphasize the need for accurate ADHD diagnosis, as the long-term consequences of treatment could be favorable (d-amphetamine in WIS) or unfavorable (atomoxetine and d-amphetamine in WKY) in misdiagnosed individuals.