Northern Waters Clinic ADHD and Stimulant Medication Policy

Diagnosing ADHD

The accurate way to diagnose ADHD requires a careful history, including information from as far back as elementary school, a psychiatric evaluation, and psychological testing to determine the nature of the problem. While there are several paper and pencil screening tests for ADHD, none of these is absolute for the diagnosis of ADHD. Also, a TOVA computer test alone is not sufficient to diagnose ADHD. There is no single diagnostic test for ADHD. A referral for formal psychological or neuropsychological testing provides information about a person’s strengths and weaknesses and looks at several areas of functioning. The testing is extensive, evaluating multiple brain functions, and typically takes about 4-8 hours to complete.

Treatment of ADHD

ADHD is treated with medication and psychosocial interventions. Medications can include stimulants like amphetamines (e.g., Adderall, Vyvanse) and methylphenidate (e.g., Ritalin, Focalin, Concerta) and nonstimulants (e.g., Strattera, Wellbutrin). While these medications can be extremely helpful, they are not without their side effects, risks, and limitations. ADHD can cause or contribute to a number of problems in a person’s life. Medications alone are rarely enough for adequate treatment. This can be especially true for people with other mental health concerns (e.g., anxiety, depression) in addition to ADHD. Therefore, psychosocial interventions are critical for success. These include education about ADHD, life skills training, organizational skills, and learning ways to manage stress.

Diagnosing and Treating ADHD

Three types of patients may present to NWC seeking treatment:

• No established diagnosis of ADHD.

  Patients may present for services related to several problems, including anxiety, depression, academic problems, relationship problems, or difficulties with concentration and focus. NWC clinicians will meet with the patient and conduct an evaluation. If a concern arises that the patient may have ADHD, the patient will be referred to an outside psychologist for formal psychological testing. NWC does not provide psychological evaluations.

• Patients with an established ADHD diagnosis are currently being prescribed stimulant medication and wish to transfer their care to NWC.

  In order to transfer care of ADHD (i.e., prescription of stimulant medication), the patient will need to submit information verifying the diagnosis of ADHD. Patients are encouraged to obtain a copy of testing results to present to NWC, as these will be required. In general, NWC nurse practitioners require formal psychological testing supporting a diagnosis of ADHD before they will prescribe stimulant medication. Paper, pencil, or computer self-report questionnaires, and a TOVA test alone are not acceptable. No guarantee is made that your provider will prescribe the client’s current medication or medication at all. The appointment is for a psychiatric evaluation. Alternatively, patients may continue to see their current provider or seek consultation and treatment from a different provider. If the supporting documentation is insufficient, the NWC nurse practitioner will indicate the required information. This will include formal psychological testing at an outside clinic.

• Patients who have been diagnosed in the past with ADHD but are not currently being prescribed stimulant medication.

  Patients will need to present documentation to NWC supporting the diagnosis of ADHD. The appointment is for a psychiatric evaluation, and no guarantee is made that the nurse practitioner will prescribe medication. In general, NWC nurse practitioners require recent (within the past 5 years) formal neuropsychological testing supporting a diagnosis of ADHD in order to prescribe stimulant medication. Paper, pencil, or computer self-report questionnaires, and a TOVA alone are not acceptable. Alternatively, patients may consult their previous prescriber regarding medication treatment. They may also choose to seek treatment from another provider. If the supporting documentation is insufficient, the NWC nurse practitioner will indicate the required information. This will include formal psychological testing.

Marijuana and ADHD

As the United States is currently reviewing its policy and laws regarding marijuana, it is especially important to understand the interaction between marijuana and ADHD. Patients with ADHD have problems with attention, concentration, memory, and processing speed. The active psychotropic chemicals in marijuana specifically cause decreases in concentration, attention, memory, and processing speed. People who use marijuana may develop symptoms that mimic ADHD, and for those with ADHD, marijuana may worsen the brain’s already diminished executive functions. Therefore, NWC encourages people with ADHD to abstain from marijuana use. When stimulant medication is being prescribed, NWC has a zero-tolerance policy, and nurse practitioners will not prescribe stimulants to patients who use marijuana.

Stimulant Medication Policy

Stimulant medications are frequently prescribed to treat ADHD. For many people, they are highly effective. However, they are not without their risks. They are controlled substances and carry an abuse potential. This abuse potential can lead to diversion (sharing or selling prescriptions). Some people use these drugs recreationally. This policy was created to balance the important benefits stimulants can have for patients with ADHD and to protect against abuse and diversion. Patients will be asked to read, sign, and adhere to the Controlled Substance policy statement.

• Medication changes will only be made at a regularly scheduled appointment.
• Patients are expected to keep regular appointments. If an appointment needs to be changed, give 48 business hours’ notice if canceling to avoid a late cancellation fee of $100 for a follow-up appointment.
• If an appointment is missed, prescriptions may not be refilled.
• NWC providers will only fill a 30-day supply of stimulants.
• There are no early refills.
• Lost prescriptions will not be replaced.
• Stolen prescriptions will only be replaced if the patient presents a police report documenting the theft.
• NWC nurse practitioners will prescribe long-acting stimulants as medically appropriate. In general, they do not prescribe short or immediate-acting stimulants.
• All patients will submit a urine sample for drug abuse testing before the first prescription is written.
• Patients are required to complete urine drug testing as requested by the NWC nurse practitioner.
• Patients who test positive for marijuana or other illicit substances or negative for the prescribed stimulant will be counseled, and a decision made about continued prescription of the stimulant.
• The final determination about whether to prescribe stimulant medication rests with the prescribing nurse practitioner.