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ADHD Program
The Woodlands Behavioral Health and Wellness Center has specialized in the assessment and treatment of ADHD for the past 12 years. Initially as a unique pilot program our multidisciplinary treatment team developed new unique services for the treatment and diagnosis of ADHD when medication used to be the only treatment modality available.
Assessment and Diagnosis of ADHD and Co-Existing Disorders
Our trained doctoral level psychologists administer comprehensive cognitive assessments for school and college students that can include standardized cognitive, psychological and academic testing at our assessment center according to the school or college requirements for academic accommodations.
An adult ADHD Assessment containing standardized tests is also administered to diagnose ADHD in adults. Our services and most primary care providers require this assessment before they prescribe medication for the treatment of ADHD.
Clients receive a comprehensive report containing test results, which may include diagnoses such as ADHD and any co-existing disorders such as depression, anxiety and Oppositional Defiance Disorder. The report also contains recommendations for treatment and academic accommodations.
Individualized Treatment Plan
An individualized treatment plan is developed according to the treatment recommendations in the assessment report. This plan contains treatment services to address the client' specific treatment needs related to ADHD and any co-existing disorders. Services are designed to focus on skills training to help the clients compensate for the emotional impacts, executive skill deficits and poor social skills and family conflict arising for their ADHD. Services may include individual and family therapy, parent counseling, parent child interaction therapy, executive skills coaching, social skills training and counseling to improve the quality of the client's sleep, diet and stress management skills.
Multidisciplinary Treatment team and Specialized Treatment Services
The treatment plan is implemented by a multidisciplinary treatment team all under the same roof. In addition to formal team meetings team members work together to maximize the client's treatment, monitor the clients progress and update the client's treatment plan when needed.
Working with Parents and Teachers
The treatment team works closely with the client's parents if the client is a minor in order to inform the parents what skills we have taught the client and how they can support and prompt the client to implement these skills at home. Parents also provide valuable feedback about the child's everyday progress. Treatment team members also work closely with the client's teachers by keeping them informed about the child's progress in treatment and helping teachers with special strategies to more effectively manage and motivate the child. They also obtain valuable feedback from the teacher which help them determine whether the child is responding to the treatment.
Neuropsychological Aspects of ADHD
The prevailing consensus is that ADHD is a frontal-subcortical circuit disorder. However, most frontal-subcortical circuit disorders (such as, Depression, OCD, ODD) can cause impaired attention. Diagnostic clarity here would suggest that evaluations of both cortical and subcortical regions are needed. ADHD is not just a behavioral dysregulation disorder which suggests behavioral criteria (rating scales) are insufficient for ADHD diagnosis.
Dopamine neurotransmitter concentrations are more variable in the brains of those with ADHD.
Main cortical areas for ADHD include:
- Prefrontal cortex
- Frontal-subcortical circuits (striatum, thalamus).
These govern executive skills such as planning, organizing, strategizing, problem-solving, monitoring, evaluating, and changing behavior.
Other involved brain structures in ADHD include:
- Anterior cingulate
- Corpus callosum
Several comorbid conditions generally accompany ADHD:
- Oppositional defiant disorder in children
- Depressive disorders
- Bipolar disorder
- Anxiety disorders
- Tourette's syndrome
- Specific learning disabilities
There are executive function measures that are effective in helping to differentiate ADHD from comorbid disorders:
- Response inhibition
- Interference control
- Vigilance
- Working memory
- Planning
Understanding the neuropsychological aspects of ADHD allows us to have a more sophisticated understanding of this disorder being more than just a disruptive behavior disorder. Using the traditional clinical/physician interview along with rating scales results in heterogeneous ADHD samples having various characteristics and comorbidities. Instead, multimethod and multi-source evaluations of ADHD should be used and include cognitive, neuropsychological, behavioral, and academic data.
ADHD individuals do not have a primary attention deficit because they can bring attention to certain tasks when properly motivated. What is impaired in this disorder is the executive control of attention. This impairment is likely caused by the hypoactivity of frontal-subcortical circuits (dopamine insufficiency in the striatum) that result in poor executive control of attention. These are the individuals who are more likely to respond well to stimulant medications.