I employ Best Practice Standards for the diagnosis and treatment of ADHD, as defined by the thought leaders in this field. Adult ADHD care is an emerging area of neuropsychiatry. It was once thought that children outgrew ADHD, but later research showed that symptoms "morph" in adulthood and continue to impact function and quality of life. This finding occurred over 20 years ago, which partly explains the shortage of clinicians trained and confident to provide ADHD care for adults. Sadly, medical and graduate schools spend on average one hour covering ADHD, and most clinicians have not elected to devote the hundreds of hours needed to become competent.
As childhood ADHD was "discovered" long before adult ADHD, many pediatricians have competently cared for children with ADHD for decades. In the transition from childhood to adulthood, it is imperative that teens understand ADHD, learn self-care measures, and assume responsibility for it so that they can optimally navigate the responsibilities of adulthood. I have seen far too many regretful adult patients diagnosed and treated for ADHD in childhood only to stop treatment in adolescence or early adulthood, then fail to achieve their goals and the life they deserve. It's never too late to rectify that.
A survey of 600 people in the US were asked about costs of adult ADHD care. On average, out-of-pocket costs for intial evaluation/diagnosis was $1689, and $1493 annually for cost of ongoing treatment appointments.
(source: ADDitudeMag.com, Summer 2017 issue). I rely on FairHealthConsumer.org to set fees; they collect data about average fees charged for specific services in specific zipcodes.
>> INITIAL CONSULTATION (my fee $442)
The initial consultation appointment takes 90 minutes and includes a comprehensive review of your life circumstances, history of ADHD symptoms, and how those symptoms have impacted your function and quality of life. I screen for any co-occurring behavioral health Conditions like anxiety, depression, substance abuse, etc., and determine if treatment is needed. I will check your Prescription Drug Monitoring Program record to verify controlled substance medication usage. We will review your medical history and health status and take vital signs. If you are already diagnosed and taking medication for ADHD, we will assess effectiveness of your medication. To conclude the consultation, we discuss diagnosis, treatment recommendations, a plan of care, pertinent followup procedures, and any questions you may have. 95% of the time, the first appointment concludes with prescription(s) for medication, the “gold standard” of ADHD treatment, with directions for how to obtain and take the medication. After every appointment, you will also receive a Statement of Services with which you can submit a Claim for reimbursement to your insurance company.
>>AFTER THE FIRST APPOINTMENT, the goal is to minimize ADHD symptoms by finding (for newly diagnosed patients) or maintaining (for previously diagnosed patients) an optimal medication regime. Medication will produce dramatic, life-changing results, but medication alone will not result in optimal, fully stabilized status that is my ultimate goal for each patient.
How do I define a fully stabilized patient?
A fully stabilized patient:
-- is well-informed about ADHD and all Policies and Procedures;
--accepts the limitations and embraces the strengths of their Condition;
--has mastered self-care principles, and is aware of all my policies and procedures that will affect their care;
--has healed from any pre-diagnosis trauma, and re-defined their self-image post-diagnosis and treatment;
--has improved their academic, occupational, interpersonal, and self-care functions; and
--enjoys an improved quality of life.
Achieving this takes time, and varies from patient to patient. Some of you will be previously diagnosed and fully stabilized when you begin services with me, and will need followup appointments every 3 months. Some of you will be newly diagnosed and starting a new path to a better life, requiring more frequent followup appointments; as progress is made, followup appointments rapidly become less frequent.
>> FOLLOWUP APPOINTMENTS are 15-30 minutes, fee $180, and we cover the following:
--- review of life events and changes since last appointment, the effectiveness of medication and treatment(s) for ADHD and any co-occurring physical and mental health conditions, and the status of your physical health. It is important to notify me of any new diagnoses and/or medications;
--- prescription refills and maintenance of Prior Authorizations for medication;
---ongoing assessment of progress toward optimal stabilization, with suggestions and recommendations tailored to your specific needs and circumstances; and
--- your questions and concerns.
I am available to you between appointments for questions, followup, and/or problem resolution. Many problems and questions that arise between appointments can be managed by email; this is included in the above fee, and ensures economic, efficient services while maintaining best clinical practices and safety. I will ask you to make an appointment only if I think it is necessary. If the answer to your question is addressed on this website, I will reply with request that you review website for answer to your question.
Sometimes additional case management services are needed (for example, writing a letter, completing complex Forms, medication changes); when such tasks require more than 5 minutes of my time, I will inform you of the fee beforehand.
Sometimes people need psychotherapy to recover from co-occurring conditions like anxiety, depression, substance abuse, etc, or to heal the trauma associated with undiagnosed ADHD, or to improve coping skills. I am skilled in these areas to a certain extent, but I often refer my patients to colleagues who are expert in these areas and who have taken the time to learn about ADHD; sometimes these colleagues are in network with your health insurance, making such treatment more cost-effective. (The current state of adult ADHD care is that most psychiatric clinicians are not sufficiently knowledgeable or interested in ADHD, thus making adults with ADHD an under-served population.)
Sometimes people need coaching to improve organizational and functional skills. This can be done by ADHD coaches who are trained and certified by ADHD coaching organizations; see www.ADDitudeMag.com 's search engine for excellent discussion of ADHD coaching.
Sometimes students with ADHD need Accommodations when medication alone does not solve their academic performance problems. Schools and testing organizations that administer college entry tests and high-stakes tests for occupational licensure set the requirements for Accommodations. Most require comprehensive neuropsychological testing performed by a qualified psychologist well-versed in ADHD. This is different from the evaluation I do for clinical treatment purposes.
Sometimes people with ADHD need occupational Accomodations. While these are more difficult to obtain than Academic Accomodations, I have had some success in this area and can be a guide through this process.