ADD and Adults

Over the years here have been many news articles and television news shows that have reported that too many children were being diagnosed as having ADHD and that they were excessively being prescribed medication. The facts are that 3-7% of children have these disorders and they do need the help of medication and therapy to deal with the symptoms. In addition, we know that these disorders are neurobiological in nature and that they tend to run in families. Therefore, either siblings or parents of ADHD children may have the disorder. What is more significant is that we know approximately 60% of these children will continue to have symptoms into adulthood. Therefore, approximately 4% of adults may have these disorders.
ADHD is a more complex disorder than most people think. The individual with ADHD can not be just characterized as one who cannot sit still or who is “climbing the walls”. In fact, we now see ADHD as taking several forms. There are those individuals with the disorder who cannot focus and are disruptive to others. There are some individuals who appear in control, but they are actually internally distracted. Some individuals with ADHD become over focused and get stuck on small details that are not that significant to the task at hand. Then there are individuals who have combinations of ADHD, depression, Oppositional Defiant Disorder, or even Bipolar Disorder. In light of the variability of primary and secondary symptoms, proper diagnosis, specific medications, and therapeutic approaches have to be individualized.
The diagnosis of ADHD in children can be somewhat easier than in adults. Children are required to listen to adults, pay attention in school, and while in school they are actually monitored by many adults. There are frequent measures that can help rule out whether the child’s problems are due to ADHD or another issue. In children, learning disabilities, anxiety, or Oppositional Defiant Disorder can make the child appear to have ADHD. Proper diagnosis is important and a good pediatric neurologist or child psychiatrist who specializes in ADHD would be the best route to perform this assessment.
So what are the symptoms in adults? Constant fidgetiness and restlessness can be a sign of ADHD; however, as we age the hyperactivity component of the disorder tends to fade, generally leaving the disorganization piece. Therefore, if they were not properly identified as children, they may slip through the cracks and their ADHD would not be identified. .Other signs that may lead one to suspect ADHD in adults would be concentration difficulties, persistent procrastination, organizational problems, failure to complete tasks, poor time management, poor impulse control, sleep problems, poor management of money, interpersonal relationship problems, anxiety, and depression. These symptoms can be quite diffuse and may be expressions of other disorders, so they may go unrecognized or denied. In adults, the problems may lead to repeated employment failures, tumultuous relationships and poor parental skills. The individual with ADHD may be perceived as a failure or a difficult person to live with but not be recognized as having a disorder. Due to complications of ADHD, adults also may have significant secondary problems with alcohol, drugs, or legal problems.
If ADHD is suspected, what should you do? Given the possible devastation ADHD can have on an adult’s functioning and well being, it would be wise if it is suspected to be assessed for the disorder. The testing for ADHD is not that intrusive or complicated. The assessment is based upon the data obtained from a good review of information regarding the individual, their family (parents, siblings), and their early academic experiences. Self-rating forms and Objective Personality Tests are used to gauge the impact of present symptoms on the individual’s life. An additional test requiring the individual to work on a computer for approximately 14 minutes provides information on impulse controls, attention, and concentration. Lastly, a conference with a psychiatrist who works with ADHD adults would be necessary to asses the proper medications and dosages.
If an individual has had undiagnosed ADHD for years, they have probably developed low self-esteem and negative coping behaviors. Medication can help with the symptoms of the disorder, but therapy would be needed to improve the self-esteem of the individual, improve their interpersonal skills, and help eliminate nonproductive coping skills. For some executives and professionals who can afford frequent one to one services, there is a specialty line of coaches who work individually on assisting these people with enhancing life skills or teaching new organizational skills.

Although we know that ADHD does not go away, we do know with the proper diagnosis and treatment, the disorder can be controlled and the negative effects can be limited.

It Is Not News But It Is Newsworthy

What appears in the media as amazing new discoveries in psychology and health sometimes is really just old news being recycled. Take for example, the announcement of a study that was recently found in the United Press International. The article was on a paper which was presented at the Experimental Biology 2006 Conference, which indicated that even anticipating watching a funny movie may be beneficial to our health. Dr. Lee Berk, from Loma Linda University, reported the results of a study on the effects of humor on health using sixteen young males who were divided into two equal groups. Eight of the male subjects were told that in three days they were going to watch a comedy video while a group of eight comparable males was not provided with any information about the video. Just prior to viewing the video, all of the subjects were tested for Endorphins (a natural pain killer) and Human Growth Hormone levels, HGH (HGH is prevalent during growth and healing). The males who were pre-warned had 27percent more Endorphins than the control group, and they had 87 percent more Human Growth Hormone than did the control group.
This article reinforces the belief that humor and laughter can be good for us and that even the anticipation of experiencing a fun time may be beneficial to our overall well being. This is clearly not new knowledge. The concept that humor and laughter are good for our health has been around since the time of the Bible. In Proverbs 17:22 it was stated, “A merry heart doeth good like a medicine.” Immanuel Kant, a philosopher who lived between 1724 and 1804, stated, “Laughter produces a feeling of health through the furtherance of vital bodily processes.” Robert Burton, English Clergyman and writer, who lived between1747-1825, said “Humor purges the blood making the body young, lively and fit for any manner of employment.” Victor Borge (1909-2000), a comedian, stated, “He who laughs last, lasts.” And of course, Alfred E. Newman, Mad Magazine, always said, “What, me worry?”

What does this all mean? Repeatedly, the research findings of many studies seem to identify a constellation of simple concepts. Basically, good common sense in dealing with people and emotions, reasonable living styles, moderation in all things, and finding satisfaction in everyday activities can make one’s life better. Yes, life can be complicated and more difficult at times, but if one has a positive outlook and one seeks out happy situations and happy people, you can weather the storms better and live a longer and healthier life.

Phantom panels

I have been quite successful in developing thriving practice as I have strong referral sources, including prior patients. As a result, I usually get between 25 and 30 new referrals a month. In light of the number of referrals I receive, I have the ability to limit my practice to provide a high quality level of service. The down side is that most of the individuals who call me have to be referred elsewhere. These individuals have continuously told me that they cannot get a therapist on their insurance company list to take them on as new patients. I feel their discomfort and I also have been very frustrated with this situation. In my conversations with these individuals, I have encouraged them to complain to the source of this problem- their insurance companies.

The insurance companies have created this problem for what I think is their own financial gains. Most insurance companies have locked up their provider panels many years ago. They have not let mental health workers join the panels to keep control over their providers. It is my opinion that they have created roadblocks for subscribers to get access to mental health providers in order to reduce usage and ultimately save money.

Insurance companies have also created adversarial relationships with providers which has also served to reduce their costs, since providers would avoid accepting new managed care patients. It has been reported that non-insurance friendly psychologists (or those that do not go along with insurance company policies) have been blackballed or somehow do not come up on the computer screens when subscribers call 800 numbers for therapists in their area. Recently, Oxford Insurance Company audited 300 mental health worker’s (100 psychiatrists, 100 psychologists, and 100 social workers) notes of patients from a few years ago. Oxford reviewed the session notes and demanded money back from almost all of the mental health workers. Oxford claimed they deserved the money back because they questioned the type, or duration of the session. It was very unlikely that almost all of the providers were unethical. After Oxford was threatened with, lawsuits they did back down and rescinded their auditing procedures and demands for reimbursement.

Insurance companies have put restrictions on therapists, required the release of confidential information in order to reimburse for therapy sessions, or have been failing to pay their bills in a timely manner. In addition, most insurance companies have not raised the fee structure since the 1980's. Some companies have not only kept the fees stagnant since the ‘80's but recently one company (GHI) has even reduced the fees for 2004 to an unacceptable level. Their attitude has been: accept our fees or leave the network. Our expenses have increased in the past 20 years and we cannot meet our bills if we cannot keep up with inflation.

Some psychologists have resigned from insurance panels to avoid ethical issues, procedural conflicts, or the low fees. It has been reported that insurance companies have sometimes not taken their names off the provider list to make the list look bigger. Other psychologists who do not resign will just refuse to take on new patients. If prospective clients call them, they claim they are all booked up or have no available spaces. They are essentially removing themselves from the provider list but not officially resigning. The outcome is that the managed care panels are really, what we call, ”phantom panels”. They look big, but they are filled with psychologists who no longer actively take clients. Phantom lists are good for the insurance companies because they can sell employers what looks like a good package of services and providers but not have to actually pay for the services.

It is my perspective that the insurance carriers are picking on the weak. Mental health services represent the smallest portion of the overall health care costs and users of mental health services represent approximately 5% of the total population of health insurance subscribers. Yet, this is the area where the insurers constantly cut. It would appear that mental health does not have true parity with medical health issues. In addition, those who use mental health services are generally not willing to be vocal to advertise their problems.

This problem will continue until employers, and subsequently insurance companies, get the message that subscribers are fed up with their tactics. Providers have no influence, since we do not pay premiums and we cannot financially affect the insurance companies’ bottom line. Subscribers have all of the influence in this area. Subscribers need to call their human relations department, or those responsible for health insurance in their companies, and complain when they cannot find therapists on their respective insurance companies’ provider list. Insurance companies have to realize that making money for their shareholders and executives will not continue if their business plan is built on denying services, restricting availability, or low balling fees.

If this problem continues, it would seem to me that the outcome will be that the that more seasoned, quality providers will drop out of the panels leaving newer or, possibly less capable providers. There could be a two-tier system, with the wealthy, who can afford to pay out of pocket, getting service from the seasoned providers, and the middle class and lower class will be left with the less experienced providers. So, help keep the “health” in mental health services by speaking to your insurance carriers and registering your dissatisfaction with their procedures and policies.