Questions About ADHD
Is ADHD a real disorder?
Yes. Many people think that ADHD was a concept drummed up by psychiatrists and pharmaceutical companies to increase business, but that couldn’t be further from the truth. ADHD is a real disorder that impacts your brain’s growth, development, and chemistry and causes difficult behaviors.
ADHD symptoms often start in early childhood but sometimes are not recognized until adulthood. According to the American Academy of Pediatrics (AAP), ADHD is the most common behavioral condition that is due to changes in the brain and brain chemistry, and is the second most common chronic illness in children.
ADHD can be traced to writings in ancient Greece and since the 1970s, studies have shown the benefits of treatments including stimulant medications. ADHD is recognized by all major health and research institutions, including the Surgeon General of the United States and the National Institutes of Health.
How common is ADHD?
At least 8-9% of adolescents ages 13-18 are affected, and at least 4-5% percent of adults experience ADHD as well. The reason the statistics may be lower for adults is that ADHD is often misdiagnosed or goes undiagnosed in adults.
Can ADHD be cured?
There is no cure for ADHD. Medication and other treatments are tools to manage the disorder. More than 75% of children with ADHD continue to experience symptoms in adulthood. Treatment of ADHD in childhood, positively impacts long term outcomes into adulthood.
Is ADHD my fault for not giving enough discipline to my child?
ADHD is a disorder caused by a combination of genes and environment that impairs normal development of some areas of the brain and impairs the communication in the brain normally accomplished by chemicals called neurotransmitters.
These changes in a person’s brain cause difficulty controlling attention, activity, and impulsivity. This difficulty may have nothing to do with how those people were raised. In fact, ADHD is the most inherited neurologic disorder in the US. Brain development and chemistry imbalances are to blame, not parents!
Does ADHD run in families?
Yes. It is not uncommon that one or both parents also have ADHD or had the full syndrome in the past and now have compensated for these symptoms with fewer problems in functioning. Research shows that around 30% of families who seek out evaluations for their children have at least one parent with ADHD.
Do more boys have ADHD than girls?
In all age groups, males have a consistently higher diagnosis rate but this may simply be due to the fact that girls are less likely to be diagnosed.
According to a National Health Interview Survey (NHIS) 2011–2013 report, girls are half as likely to be diagnosed with ADHD. Girls tend to have lower rates of hyperactivity and external symptoms than boys, but they may have greater impairment in attention and academic accomplishments due to ADHD. As a result, girls may go underdiagnosed with the condition and are often overlooked by teachers because they are not “troublemakers”.
Are children with ADHD less intelligent?
No. This is a myth associated with ADHD since ADHD sometimes interferes with academic achievements. There is absolutely NO evidence that ADHD is related to intelligence. Treated ADHD students are able to demonstrate their true potential and intelligence in school and on achievement/neuropsychological tests.
What’s the difference between ADD and ADHD?
ADD is an outdated medical term meant to describe someone who isn’t hyperactive but has trouble paying attention. ADHD is the correct medical term we use now but it is divided into the following 3 presentations that are not necessarily fixed across the life span:
- ADHD, primarily inattentive type (ADD)
- ADHD, primarily hyperactive-impulsive type
- ADHD, combined type
Unless the specific subset of ADHD is needed for medical or official documents, we just say ADHD.
How can a child who spends hours focused on a video game have ADHD?
The ability to focus attention is strongly driven by motivation. Almost everybody, including the great majority of those affected by ADHD, can pay attention even for long periods of time when motivated. Individuals with ADHD playing videogames frequently focus pretty well due to a flood of a chemical in the brain called dopamine, which increases brain activation and motivation. The problem in ADHD in these individuals, is the lack of ability to focus and inhibit movement in day-to-day activities where the level of dopamine is not high enough to keep the brain activated and motivated.
Isn’t ADHD just a new name for laziness or lack of willpower?
No. People with ADHD are no lazier or less determined than those who have not been diagnosed with the disorder. ADHD is NOT a problem of willpower even though people with ADHD might work better under some optimal level of stress.
Isn’t ADHD over diagnosed?
Over the last 20 to 30 years, evidence has indicated that ADHD runs in families and that genetics play a major role in the continuation of ADHD. It is clear that ADHD is not caused by “modern society demands”. In fact, experts say that ADHD is still largely underdiagnosed and undertreated, and many are not getting the therapy and/or medication they need.
Can an adult have ADHD?
Absolutely, yes. Thirty years ago, there was a belief that ADHD just occurred in childhood. The assumption was that children grew out of their ADHD at some point in early adulthood. That is not the case. The symptoms causing impairment may be different in adults with more prominent inattentive symptoms, impulsivity, emotional regulation, and problems with executive function like procrastination. The majority of people who have ADHD as children will continue to have it as adults.
If I did well in school or my career, does that mean I do not have ADHD?
Grades in school or success in a career are not a part of the criteria we use to diagnose ADHD. There does have to be clear evidence of impairment or reduced quality of social, school, or work functioning. That impairment, however, has to take into account the coping mechanisms a person uses in those areas. An adolescent may get good grades but if it takes hours to get 15 minutes of homework done, that is an impairment. An adult may get promotions at work but if they stay late to get work done when the office is quiet, this is also impairment.
Questions About Diagnosis and Treatment
How is ADHD diagnosed?
Current recommendations for diagnosing ADHD include a comprehensive history and a physical examination including a mental health assessment. Rating scales completed by parents, teachers, and the adolescent if ages 12 and up are also used. QbTest is used as an objective measure of activity, attention, and impulsivity in ages 6 to 60.
What treatments are recommended for ADHD?
Stimulant medications and behavioral interventions are the mainstay for the treatment of ADHD in children. Unfortunately, other interventions including diets, EEG training, and neuropsychological or cognitive training interventions lack evidence as treatments in ADHD. Combined medication and behavioral therapy are the most effective.
Do you offer any treatments other than medication?
Yes. Sometimes additional recommendations are made depending on the individual case. Prescription medication, however, has been proven to be the most effective treatment for ADHD. We may also make referrals as needed for counseling, ADHD coaching, cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), and occupational therapy (OT). Each treatment plan is individualized to your specific needs.
Other treatment options we offer are behavior modification techniques in the home, accommodations at work or in the classroom, and supplements. We sell books, supplements, and CBD products in our office, and you do not have to be an existing patient to purchase them. Please contact us for more information or to purchase.
Do you only treat ADHD, or do you treat other problems too?
We treat ADHD and related conditions typically associated with ADHD, including sleep disorders, anxiety, depression, ODD, autism, learning disorders, Tourette’s syndrome and others. Many times, treatment of ADHD leads to significant improvements of symptoms related to another condition. Once the patient has been evaluated, our clinician may recommend further testing in our office, an evaluation by other professionals, and/or counseling.
Will the testing show if it’s anxiety and not ADHD?
QbTest is a diagnostic test used to assess the core symptoms of ADHD: inattention, hyperactivity, and impulsivity. The QbTest helps our providers to more accurately identify or rule in or out ADHD in patients as well as monitor long term changes in symptoms over time. Pediatric Symptom Checklists or Neuropsychological Questionnaires are screening tools for problems such as anxiety, depression, OCD, etc.
Will the testing show learning disabilities?
QbTest will not indicate whether learning disabilities are present. Learning disabilities are diagnosed by educational testing completed either by public schools or by private psychologists. Since 50% of children diagnosed with ADHD may have some type of learning issue, it is important to treat the ADHD first and then see what learning issues may remain.
If I have already been diagnosed, do I still have to do testing?
Yes. Often the diagnosis of ADHD has been previously determined by subjective methods and the value of objective data through the QbTest is important. We will be happy to review any previous testing you provide to us. Since we are the only office in the upstate who administers the QbTest, we do require that you take the test since it provides unique data different from any other ADHD tests.
If I’m already taking medication for ADHD, should I take it for the testing?
It depends. If you feel the medication is working well, then yes. The results will show if your medication is a good dose for you. If you are unsure about your ADHD diagnosis or have doubts about how effective your medication is, then no. In this case it is best to take the first QbTest without medication to obtain a baseline for assessment.
How often do I have to do the testing?
This varies for each patient. Repeating the QbTest is important because it shows exactly how well the medication is working and if there is any room for improvement. We ask some patients to take the test again at their first follow up appointment. At each appointment, patients will answer rating scales to help providers monitor long term changes in symptoms over time.
How frequently are follow up visits scheduled?
Initially while the patient’s treatment plan is being developed, patients usually follow up every 2 to 4 weeks. Once a patient’s medication is working well, we are required to see patients once every 3 months. We do offer Telemedicine appointments through confidential HIPAA compliant service. Telemedicine appointments allow our providers to treat patients remotely either through an app on your phone or on a computer.
Do I have to come to your office every time I need a refill?
Once a patient’s medication is working well, the providers will write 3 months of prescriptions to last until the next appointment.
Questions About Prescriptions
What medications are most commonly prescribed for ADHD?
Stimulant medications are the GOLD STANDARD in the treatment of all types of ADHD.
Are stimulant medications a type of narcotic or opioid?
No. Stimulant medications are classified by the DEA as controlled substances, also known as Schedule 2 medications or Class 2 (C-2) medications. Stimulants are NOT OPIOIDS and are NOT NARCOTICS even though they are in the same Class/Schedule.
What is titration and why are titration directions necessary for stimulant medications?
Titration directions are instructions to the patient on how to increase the dosage of your medication, if necessary, to achieve the best dose possible. This requires starting at a low dose and increasing the dose slowly to reach the optimal dose. This is the standard of care in using stimulant medications.
Why do I have to pick up stimulant medication every 30 days?
Federal law through the DEA dictates that controlled substances can be prescribed FOR 30 DAYS WITH NO REFILLS unless the dosage changes in less than the 30 days. South Carolina law dictates that stimulant medication prescriptions expire in 90 days and allows us to provide 3 months or 3 (three) 30-day prescriptions at a visit once you are comfortable with a dosage. If you fill your prescription every 30 days, you will be able to have an uninterrupted supply of your medication. If you fall behind in picking up prescriptions, your future prescriptions may expire.
How are prescriptions for stimulant medications received by pharmacies?
Medication prescriptions for stimulant medications can be printed by your clinician or can be sent electronically from our Electronic Medical Record to the pharmacy of your choice.
It is recommended that you contact the pharmacy and request that they fill your prescription because most pharmacies will not automatically fill prescriptions for controlled substances even if it is sent the same day you wish to fill that prescription. If your clinician sends 3 (three) 30-day prescriptions electronically to your pharmacy, you will need to call the pharmacy every 30 days to request that they fill your prescription. Pharmacies do NOT put stimulant medications on automatic refill.
Can prescriptions for stimulant medication be transferred from one pharmacy to another?
No. If you gave the pharmacy a paper prescription, you will have to pick it up and take it to the new pharmacy. If the office sent your prescription to the pharmacy electronically, you must call us and request we send it to a different pharmacy.
How does your clinician know when you last filled your medication?
All Schedule 2 medications filled by any pharmacy are recorded by patient name and birth date on the confidential DHEC Prescription Monitoring Program website. We are required to check this site for every single patient at every single visit. We can follow when and where you filled your stimulant prescriptions.
Will I become addicted to my stimulant medication?
You will NOT become addicted to your ADHD medication unless you abuse or ignore the dose that we have recommended. Your ADHD medication is providing DOPAMINE REPLACEMENT to your brain as needed in ADHD. People who become addicted to ADHD medications are people who ABUSE DOSE recommendations or DO NOT NEED DOPAMINE REPLACEMENT because they DO NOT have ADHD.
Why do some people want to judge my decision to take medication or place my child on medication?
You will need to ignore the “judgements” and “comments” that may come your way from family, friends, and even pharmacy staff. Unfortunately, there is still a lot of ignorance regarding ADHD. These episodes may be an opportunity to educate others about ADHD.
Do clinicians receive “kickbacks” for prescribing medication?
No. Doctors and nurse practitioners do not receive “kickbacks” of any kind for any prescription for any medication.
Do clinicians receive incentives to use coupon/discount cards?
No. We do not receive any incentives or kickbacks to use manufacturer coupon/discount cards. We are very conscious of the costs of medication and will utilize these cards in order to decrease the costs of your medication.
What if a pharmacy refuses to honor the coupon/discount cards?
On occasion, pharmacy staff may not understand how to “run” the coupon/discount card. They may tell you that you cannot use it, or they will not honor it. If this happens, please ask the pharmacy to call us.
What if a pharmacy refuses to fill my prescription?
Pharmacists are allowed by SC law to refuse to fill a prescription. If this happens to you, please go to a different pharmacy or ask the pharmacist to call our office at 864-305-1662. We are always happy to discuss a pharmacist’s concerns. On occasion, pharmacists may still refuse to fill a prescription, and in that case, you will need to take your prescription to a different pharmacy.
Unfortunately, pharmacists and their staff may not always agree with our treatment plan or may not understand titration directions. Remember, our clinicians are experts in the treatment of ADHD and pharmacists are not trained to be clinicians nor are they trained to make medical recommendations. You should feel 100% confident that we will only prescribe what our clinicians, along with your input, decide is best for you.
What if a pharmacy can only fill part of my prescription for a stimulant?
If you fill only part of the prescription, the rest is cancelled because it is a controlled substance. This means in order to get the remainder of the prescription filled, you will have to call our office and request another prescription for the remaining amount needed.
What if my insurance company states I can receive a 90-day supply of medication?
Some states may allow 90-day supplies of stimulant medications, but SC is NOT one of those states. It is against the law in South Carolina.
Questions About Office Policies
Is a referral required to be seen at Greenville ADHD Specialists?
No, referrals are not required. We welcome self-referrals and referrals from other professionals.
How do I make an appointment?
For new patient appointments, we ask that you complete and return the new patient paperwork. Once the paperwork is received, reviewed, and accepted, we will contact you to schedule an appointment.
If you have any questions, please contact our office at 864-305-1662, select option 3 to listen to the new patient information which answers most questions.
You can also speak to a member of our staff if you have any additional questions.
How long is the wait for a new patient appointment?
Currently we are scheduling 2-4 weeks out depending on the clinician.
How long does a new patient appointment take?
New patient appointments generally last about 2 hours and consist of the QbTest, rating scale assessments, and a clinical interview with the clinician. You will leave with a diagnosis, treatment plan options and prescriptions when needed.
Why is your practice self-pay?
First and most importantly, we focus on providing exceptional patient care by spending time and listening to patients. This ensures that we fully understand the patient’s issues to develop an individualized treatment plan and explain available treatment options.
Unfortunately, medical insurance dictates the time that providers spend with their patients. It was essential to our vision of patient care to go self-pay in order to provide expertise in the diagnosis and management of ADHD and related conditions in our community. We need that time to listen to you. As of February 1, 2019, insurance is no longer accepted. We are considered an out-of-network provider.
Can I file my own insurance claim?
We can provide a detailed receipt that contains the CPT and diagnosis codes necessary to file a claim with your medical insurance. You are welcome to file your own claim, however, your insurance company may or may not reimburse you for the visit depending on your specific plan.
What forms of payment do you accept?
We accept cash, credit card, check, or HSA and/or Flex Account card that you may have through your work. We do not accept Care Credit. We do offer payment plans.
Why do you need my insurance information?
We need your insurance information to help you obtain the medication(s) your clinician feels are best for you. Our interaction with your prescription coverage includes submitting Prior Authorization paperwork; submitting records; submitting letters of medical necessity plus MANY phone calls to insure you receive your needed prescription(s).
What are the costs and how does the cost of our service compare to comparable services?
The cost of an initial visit is $625 and includes all testing as well as an evaluation with one of our clinicians. We spend 2 hours at an initial visit and usually 30 minutes at follow-up visits. Our follow-up visits range from $125-$275 depending on complexity and time. We do offer a 20% discount if you pay in full on the day of service. We are a bargain compared to other services that charge thousands of dollars for testing.
There are no other clinicians in the upstate of South Carolina who utilize evidence-based testing, specifically the QbTest for diagnosis. Sometimes the diagnosis of ADHD is made through Psychoeducational testing with private PhD clinicians at a cost of >$2000, and that does not include treatment. There are also some services that take drug-free approaches to treat ADHD, costing thousands of dollars.