ADHD Evaluations

Children with attention-deficit hyperactivity disorder or ADHD have differences in their brains than those who don’t have ADHD. Certain areas of their brain may mature more slowly. Additionally, children with ADHD have imbalances in neural networks and neurotransmitters, the chemicals that nerves use to communicate.

Knowing that ADHD has a neurological basis is important because it helps parents understand that their child isn’t disobedient or oppositional on purpose. Instead, children with ADHD need help to learn to control their behavior.

The brain differences are also important because they occur in specific areas responsible for skills such as self-regulation, organization, working memory, problem-solving, reasoning, and time perception. The brain areas affected determine your child’s ADHD symptoms.

ADHD symptoms fall into three categories: inattentiveness, hyperactivity, and impulsivity. Some children may only struggle with one category, while others have trouble with two or three categories.

Each child has a different range and severity of symptoms. However, their symptoms may be severe enough to affect their performance at school, at home, and when socializing.

When children struggle with inattention, they:

• Can’t pay attention at school or while playing
• Have difficulty organizing tasks
• Avoid tasks requiring mental effort
• Lose important items
• Forget to do homework and chores

When children struggle with hyperactivity and impulsivity, they:

• Fidget, squirm, or get out of their seat during class
• Run or climb when it’s inappropriate
• Talk excessively and interrupt conversations
• Have a hard time waiting for their turn
• Act or speak without thinking

Children and adolescents with ADHD also have problems with working memory. Working memory allows them to hold several pieces of information in their head long enough to use them to plan, do calculations, or to coordinate one activity with another.

Because there are many reasons that may cause children to be inattentive, hyperactive or impulsive, your child will most likely undergo an assessment with a qualified diagnostician; perhaps a psychologist, psychiatrist or other professional, outside our office.  Our ADHD Care Coordinator will help you navigate this process.  She may do a Virtual Visit to gather a lot of information to initiate the process.  She will work together with your pediatrician and any other professionals to expedite the process as much as possible. Often these diagnosticians are booking many months in advance so it may be helpful to start this aspect early. 

To evaluate and diagnose ADHD, a thorough family and patient history, a complete physical exam, possible lab tests to eliminate other medical diseases, using tools such as a checklist of symptoms, talking with parents and children about their challenges, and questionnaires completed by parents and teachers are all involved.

Once your child has an ADHD diagnosis, their pediatrician works with your child to set goals, prescribe medications if indicated and schedules regular follow-up appointments to monitor their progress. Once a child is on medication and is on a stable course, they will be monitored every 4 months, with one of the thrice yearly visits being their routine well visit.  If your child is regressing or having medication side effects they may need to be seen more frequently. We ask that at least one parent accompany their child to their visits.

Your pediatrician may recommend conventional and/or holistic treatments, depending on each child’s needs. For example, your child may improve with a combination of medication, dietary changes, and behavioral support.

Many ADHD medications fall into the category of controlled substances. This means:

• We cannot send more than 1 month supply
• We cannot have refills on a medication
• We cannot call phone orders to a pharmacy
• All medications must be sent to the pharmacy electronically
• We CAN send two separate months worth of prescriptions to the pharmacy but:
• Only one month can be picked up at a time
• The second month will remain at the pharmacy and not be able to be filled until 28 days later (essentially working like a refill)

Due to these restrictions, it works best when your own pediatrician is responsible for the refills and not a different physician in the office. Your pediatrician knows your child well, is familiar with your child's plan and can prescribe the medications most efficiently. However, your physician may be out of the office or already gone for the day when you make your refill request or the following day may be their routine day off. For this reason we ask for 48 business hours to refill prescriptions.  Please help us help you by staying on top of you child's medication needs. Request your medication refills in advance of running out of the medication.  It works best to request refills through your child's portal account.

If we prescribe a medication for your child, then we must see him/her frequently until we have determined that your child is on an effective medication and dosage with minimal or no side effects.  This may be done in person, or, if okay with your doctor, it can also be done virtually.

At a minimum, our ADHD Care Coordinator, will do a phone consultation after your child has been on medication for one week, then the pediatrician will see your child after about two weeks. At the second physician visit, if things are going well, a plan for further rechecks will be established. Your child will then be seen at a minimum of every 4 months. Your physician will ask that you fill out a Vanderbilt Survey prior to your appointment to help manage their care. This will be sent to your portal in advance of your visit.

If you or your child’s teacher are concerned about your child’s inattentive, hyperactive, or impulsive behaviors, call our office to schedule an ADHD evaluation.

Why are these med check appointments necessary?  Read a great summary here.