ADHD Complex

Practicing Mental Health in Primary Care

Harlan Gephart

• Publisher: Elsevier
• Year: 2018
• ISBN:
  9780323643054
• Topic: Medicine
• Subtopic: Family Medicine & General Practice

ADHD Complex: Practicing Mental Health in Primary Care, written by Dr. Harlan Gephart, provides a comprehensive review of key subjects of importance for primary care and family practitioners to help them better assess, diagnose, treat, and manage patient populations with ADHD. Dr. Gephart, Emeritus Clinical Professor of Pediatrics at University of Washington, has used his many years of experience and practice with this patient population to put together this helpful guide.

• Rating scales, questionnaires, and behavior checklists
• Identifying, screening, diagnosing, and treating learning problems in children and adolescents
• General principles of multi-modality treatments
• ADHD with coexistent psychiatric and behavioral disorders
• Resources for clinicians, parents, and patients

Chapter 1

Rating Scales, Questionnaires, and Behavior Checklists

Abstract

This chapter describes a variety of useful tools, available free online (for most of them), for the clinician to use in assessing the behavioral and emotional health of children and adolescents. For example, the Guidelines for Adolescent Preventive Services is a questionnaire serving as a time-saving instrument for history taking. If concerns are noted, a Pediatric Symptom Checklist can focus on internalizing and externalizing issues. Finally, a specific rating scale, such as the PHQ-9, can be used to focus on possible depression. None of these tools are diagnostic per se but serve as aids in the diagnostic process.

Keywords

Aids in diagnosis; Time-saving; Useful tools

First some comments about using screening tools, rating scales, behavioral checklists, etc. THEY ARE NOT DIAGNOSTIC OF ANY SPECIFIC CONDITION. They are used as preliminary instruments to gather information that may indicate a potential diagnosis or diagnoses that then need to be confirmed by obtaining more information, perhaps by using a more specific tool for a specific condition, by collecting more data, e.g., school information, by conducting a one-on-one interview with the patient, etc.

In a clinical setting, e.g., a yearly physical examination (PE) for an adolescent, one might use a behavioral checklist, such as the Guidelines for Adolescent Preventive Services (GAPS), that has a lot of questions regarding safety, high-risk behavior, school and social well-being, etc., which then help the clinician to focus on areas where interventions seem indicated.

If mental health concerns are suggested, then one might follow up with another tool mentioned later, the Pediatric Symptom Checklist (PSC). This tool further focuses on emotional and attentional concerns, in the areas of internalizing (anxiety, depression) feelings, externalizing (behavioral) issues, and attention (school progress). The results might then serve as a prompt to further narrow down the concerns by using more specific tools described later: Screen for Child Anxiety Disorders (SCARED, anxiety), Patient Health Questionnaire (PHQ)-9 (depression), and Vanderbilt (academic).

These tools take only a few minutes to complete, can be scored easily by the office staff, and can be optimally obtained prior to the appointment, or while in the waiting room prior to being seen by the clinician. They are immense TIMESAVERS in the evaluation process, and although not totally diagnostic in themselves, they contribute greatly to the diagnostic process.

Obviously if the stated reason for the appointment is a specific issue, such as rule out (R/O) depression or R/O ADHD, then the clinician might choose to go directly to the specific screening tool, along with appropriate history and physical examination.

• PEARL: Rating scales are by and large billable, e.g., Vanderbilt, SCARED, PHQ-9, PSC. Behavior checklists are usually considered to be extensions of the history component of the evaluation and are not billable, e.g., Modified Overt Aggression Scale (MOAS), GAPS.
• PEARL: Most pediatricians in practice are quite familiar and adept at using the Vanderbilt questionnaires for assessing ADHD. This chapter will describe other screening tools that, although not completely diagnostic of certain mental health conditions such as anxiety and depression, are very important to use in the assessment of such conditions. So if the clinician is going to diagnose and/or treat complex ADHD, which basically means the assessment for all the potential coexistent conditions, such as anxiety, depression, aggression, and possible bipolar disorder, he or she must become knowledgeable about and must be able to use other rating scales in addition to the Vanderbilt or Connor scale (that is what this book is all about.). These tools are described fully in this chapte...