Focusing on Attention Deficit Disorder

As a telepsychiatry practice we are often asked to help primary care and specialty clinics evaluate and treat patients with attention deficit disorders. ADD is a disorder that occurs frequently among children and adolescents, affecting more than 5.1 million children and teens nationwide according to the Centers for Disease Control.

A significant proportion of these children are not diagnosed or treated. Even among those who are, treatment often does not follow the best practice guidelines of the American Academy of Pediatrics.

Among those psychiatric conditions that most frequently co-occur with Attention Deficit in children are Oppositional Defiant Disorder, Depression/Dysthymia, and Generalized Anxiety. A moment's reflection suggests that these co-occurrences may be less a matter of simple correlation and more of a complex interactive syndrome in which difficulty attending and focusing behavior give rise to, and are exacerbated by other intense behavioral and emotional syndromes.

ADD is not restricted to children and teens. The social, vocational and intrapsychic effects of impaired ability to concentrate and focus can have markedly deleterious effects on the mood and emotional state of affected adults, as shown in the Table to the right.

While many adults learn to contain or cope with the symptoms and consequences of ADD - or deny them - that's not to say that the effects are not still profound.

If you are a healthcare provider, as you go through your practice week, please keep in mind that as many as one in ten of the children you see in your exam room, and one in twenty adults might have ADD, and that these conditions are often missed, or misdiagnosed as childhood anxiety, conduct disorders, or learning disabilities. If you would like assistance and decision support diagnosing and arranging proper treatment for these children and teens, we would welcome an opportunity to help.

A team consisting of primary care practitioners and behavioral health specialists is often an optimal combination for proper diagnosis and treatment and for supporting long term patient engagement, compliance and monitoring for success.

Telepsychiatry service delivery is an efficient and effective way to bring the behavioral health portion of that team into the primary care setting. As just- released research from East Carolina University reaffirms, it is also a great way to reduce patient no-show rates for mental health services from the usual 35-42% of scheduled visits in specialty BH practices to as low as 7-10% in the primary care clinic. If patients show up, they can be treated effectively.