ADD

Mid-Ohio Pediatrics & Adolescents is seeing more and more cases of Attention Deficit Disorder, or ADD, among young children and adolescents. If you feel your child has an attention deficit disorder of some type, our physicians and professional medical staff can help.

BEFORE YOUR FIRST VISIT:
All parents need to have a conference with the doctor. This is done at the end of the working day to allow sufficient time. If your child has not had a recent routine exam, we will schedule this exam prior to the conference. In order for the conference to be meaningful for both you and the physician, we will need the following information 48 to 72 hours prior to the scheduled appointment time:
	Psychological testing: This can be requested through your school system or obtained privately.
	ADD questionnaires: We will forward to you questionnaires regarding your child's behavior, for both you and your child's teacher to complete.
	Written observations: Any observations from teachers, coaches, or the school psychologist will be helpful in your child's evaluation. Please include their phone numbers and the best times to contact these individuals.
	Medical Records: If you are a new patient, we must have your child's complete medical records transferred to us prior to the first appointment. We will follow your child for more than attention deficit problems. It is important that we follow all your child's health concerns and routine care in order to provide a continuity of care.

MEDICATIONS
	Stimulant medications are used to treat approximately 750,000 school children in this country who have attention deficits with or without hyperactivity. The most common of these are Ritalin (Methylphenidate), or Dexedrine (Dextroamphetamine.) If medication is recommended, it is very important to follow your child's response based on the following three parameters: target behaviors, overall alertness, and side effects. Your child may not have problems with all target behaviors, but one or two of these types of behaviors may mean a problem exists that needs further attention. Once he/she is on medication, it is important to observe specific target behaviors to see if they are reduced or eliminated. Filling out a rate scale daily lets the physician monitor your child's progress. The overall alertness of the child or adolescent includes his/her spontaneity and general state of arousal. Common side effects to medication include sleeping problems and loss of appetite. Other less frequent side effects may include headaches, stomachaches, irritability, nervousness and muscle twitching. Mid-Ohio Pediatrics wants to stress that these and all other side effects are reversible, and will cease once the medication is terminated.

PATIENT MONITORING
	Stimulant medications are very safe medications. There are no dangerous, irreversible side effects as long as the medication is properly prescribed and the child or adolescent is properly monitored. It is very important that our physicians know if your child or adolescent has any illnesses, seizure problems, emotional problems, allergies or is taking any other medications. The physician must be in close contact and have regular communication with the parent, teacher(s), and child or adolescent to monitor properly the response to medication, including target behaviors and side effects. We will see your child for routine care every six months instead of yearly. Please make sure that you indicate to the person scheduling your appointments that you need a six month check for ADD. This way we will be certain to have your questions answered. It is best to schedule this appointment three months in advance. It is important to maintain these follow-ups as cannot renew the medication without an office visit every six months to monitor your child's progress.

PRESCRIPTIONS
	Prescriptions for Ritalin cannot be called into your pharmacy for renewal. They must be mailed or picked up at our office. Make sure you allow enough time to have the prescription renewed, so your child does not run out of medication. Also please notify our office (899-0000) if you have a change in name, address, telephone number or medical insurance. This can save valuable time for you and our staff. For continuity of care reasons, the doctor who is following your child for ADD is the one who will need to write the prescription each month. Since the doctors do not work every day, make sure you allow yourself a few days to get your prescription renewed. Don't wait until you have only one day's supply and hope that your physician is in the office that day to get a renewal. Prescriptions can now be written for a two-month supply of Ritalin or another drug being used. However, because of the classification of these drugs, the pharmacist is required to fill the entire prescription (i.e., you cannot fill half one month and half the next). Additionally, many pharmacies will fill only a one-month supply. Check with your current pharmacist and let us know if you would like to go to a two-month prescription.

NON-MEDICAL TREATMENT
	We also want to emphasize that not all children who have an attention deficit disorder or learning difficulties require medication. Non-medical treatment can make a huge difference in some children. This non-medical treatment may include the proper educational setting, psychotherapy (either individual or family), appropriate expectations of the child or adolescent, behavior modification, parent support, tutoring, and improved social skills. Other non-medical interventions may include speech and language therapy, physical therapy and occupational therapy.

FEES AND INSURANCE
	The payment policy for ADD services is the same as those for all patients -- payment is due at the time of service. However, different insurance carriers treat ADD differently as far as benefits are concerned. Many carriers will allow only one routine visit per calendar year, and consequently disallow the six-month follow-up. Others consider ADD as part of their "nervous and mental" coverage and will pay according to those benefits (usually higher co-pays). Our office staff can help you by coding your receipt to give you the proper reimbursement. Please check with your carrier or insurance policy manual to determine what benefits you have. We will be happy to assist you in this matter.

SUGGESTED READING FOR PARENTS
	Edna D. Copeland, Ph.D. and Valerie L. Love, M. Ed. Attention Without Tension.
	Mary Cahill Fowler. Maybe You Know My Kid. A Parent's Guide to Identifying, Understanding and Helping Your Child With Attention-Deficit Hyperactivity Disorder.
	Stephen W. Gerber, Ph.D., Marianne Daniels Gerber, Ph.D., Robyn Freedman Spizman. *If Your Child Is Hyperactive, Impulsive, Distractible ...*
	Paul H. Wender, M.D. *The Hyperactive Child, Adolescent, and Adult: Attention Deficit Disorder Through the Lifespan.*
	Barbara Ingersoll, PH.D. *Your Hyperactive Child: A Parent's Guide to Coping With Attention Deficit Disorder.*
	Harvey C. Parker, PH.D. *The ADD Hyperactivity Workbook for Parents, Teachers and Kids.*
	Thomas W. Phalen, Ph.D. *1-2-3 Magic: Training Your Preschooler and Preteen to Do What You Want Them to Do!*

Further information available at National Attention Deficit Disorder Association.