ADHD: Managing Our Primary Care Impulsivities

Transcription

1 ADHD: Managing Our Primary Care Impulsivities Raul De Villegas-Decker, Psy.D., LCP Managing Founder & Principal Consultant SIM Learning Collaborative December 2017

2 Disclosures Dr. De Villegas-Decker is the managing founder and principal consultant at RDV Executive Consulting Group, LLC Dr. De Villegas-Decker serves as the Director of Integrated Behavioral Health Services at Western Colorado Pediatric Associates a Division of Primary Care Partners Dr. De Villegas-Decker has a small private practice through Behavioral Health & Wellness

3 Presentation Objectives 1. Explore the difficulties of assessing, addressing and managing ADHD in primary care 2. Discuss how our impulsivity to treat ADHD in primary care might lead us down the wrong long-term treatment path 3. Acknowledge the F word in primary care and become comfortable not using it. 4. Provide practical recommendations for how to engage in integrated interventions and follow-up effectively in primary care.

4 Difficulties of ADHD in Primary Care 1. Diagnosing: Who, how, what, why 2. Pressure from parents: For and against labels 3. Pressure from and related to schools: Disciplinary actions, academic failures, peer interactions

5 PCP s Impulsive Responses & Consequences Poll: Is ADHD a medical or psychological condition Primary care physicians do not have the interventions always readily available nor are there qualified mental health professionals to assess and treat young children in rural and non-urban centers. Rarely do pediatricians have training in offering psychosocial or psychological approaches to mental health treatment. The number of U.S. preschoolers diagnosed with ADHD jumped 56% between and , and the number of children ages 2 to 5 taking a psychoactive medication to treat ADHD doubled - according to data from the National Survey of Children s Health

6 The F word of Primary Care Who knows what the F word in primary care is? Resist the Righting Reflex FIX Fixing does not: 1. Encourage self-management 2. Improve education 3. Encourage resiliency and adaptability Fixing does: 4. Increase your role and responsibility

7 Practical Recommendations ADHD Parenting Recommendations: ADHD Model Ability Delay Hold back Discipline Ability: The child may not have the ability to complete tasks as desired by others/environment. Providing multiple prompts for the child to complete the desired tasks in a neutral and inquisitive manner can be essential in decreasing distress, conflict and opposition/defiance.

8 Practical Recommendations ADHD Parenting Recommendations: ADHD Model Ability Delay Hold back Discipline Delay: Parents can minimize their own gratification ( Because I said so and I am the parent ) better than kids with ADHD can manage their symptoms. By delaying our needs as parents we create space and time for children to engage at a pace they can manage and not at the adults frenetic pace.

9 Practical Recommendations ADHD Parenting Recommendations: ADHD Model Ability Delay Hold back Discipline Hold Back: Often times we ask too much of our kids, and those with ADHD have a very difficult time keeping up. Getting dressed in the morning might sound easy for most of us (and kids) however, when there are always shiny things to distract kids, completing tasks becomes challenging. Parents are encouraged to consider decreasing the number of daily expectations so that kids can have successful experiences

10 Practical Recommendations ADHD Parenting Recommendations: ADHD Model Ability Delay Hold back Discipline Discipline: The importance of consistent discipline and reward systems allows the child to engage in expected behaviors that result in expected positive or negative outcomes. This can become an organizing factor for the child, parent, school environment.

11 Intervention Recommendations Integrated behavioral health clinicians An assessment method that relies on parent, school, patient, family, etc. feedback as well as measures that can be employed by a PCP. Behavioral health referrals with warm hand-off Bi-directional communication between PC and BH providers Parent Behavior Training: They have been found to be effective for children under 6, with no reports of complications or harm. Triple P Parent-Child Interaction Therapy (PCIT)

12 Use of Medication Best with therapeutic interventions. Academic Implications: The addition of medication to the behavioral modification plan can positively impact the child s academic performance.

13 ADHD Follow-up in Primary Care 1. Integrated visit 2. Collaborative approach 3. Coordinated services Avoid the silo approach and referral punting

14 Questions Thank you