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 Attention Deficit Disorder

     The diagnosis of Attention Deficit Disorder (ADD) is surrounded with controversy. For many years children who experienced problems in attention and executive functioning were given labels such as minimal brain dysfunction or developmentally delayed. The percentage of children diagnosed stayed around the same amount for years.

     With the rise in awareness of Attention Deficit Disorder it is important that individuals seeking this evaluation from Dr. Carr be aware of the commitment required. To review his policy on ADHD evaluation you can review the protocol by clicking here (requires Adobe Reader).

     Insurance carriers are likely to have restrictions governing the use of psychological testing. To read Dr. Carr's position statement on this please click here.

     However in the last 10 to 15 years there has been an explosion of children and adolescents diagnosed with ADD and growing alarm that we are needlessly medicating our youth because we do not dedicate sufficient support to our schools or find ourselves unable to have the time to structure their environment for effective learning.

     As to my position on the question of whether the syndrome of ADD exists I am clearly of the view that there is such a problem. For the person experiencing the cognitive problems of ADD the medications that are available can work wonders and I believe that their use is entirely appropriate. However, with that said, I would observe that there are many forces in our society that "want" the diagnosis to be made. The schools want it for the purpose of how the medication can calm or restrict the child in behavior thereby requiring less attention from the teacher and school system that is overworked and underpaid. As long as a teacher makes less than a prison guard there is something terribly wrong with our system.

     The pharmaceutical companies enjoy significant profit in the medications they market for ADD and other behavioral problems of our children. Flip through any psychiatric journal and count the endless pages devoted to ads showing the effectiveness of their agent for ADD.

     Among my fellow practitioners there is a coercion to give the diagnosis because of pressure from the schools, the pharmaceutical companies, other practitioners and the parents who are seeking a solution that is less demanding. Again I will note that many parents make tremendous effort to help their child but there is a growing number of parents who are so overwhelmed with financial problems, two jobs, lack of extended family support, or just plain fatigue that they cannot make it happen for their children. What is needed NOW is that we as a people pressure our government to not just give lip service to "leaving no children behind" but to actually do what is needed in helping parents help their children. In the final analysis it is cheaper to support after school programs and offer education classes to our families than what it takes to house a person in prison.

     The central part of my evaluation for ADD is to approach the question from the view that past history is important but that the first priority is to establish a controlled structure in the child's home and school environment and then judge their response to this rule-setting. I view ADD as a neurological condition (i.e., seizures, memory disorders) that should not be altered by changing the conditioning factors in the environment. In other words the child should continue to display problems even if properly reinforced.

     I obtain the historical information by asking the school to complete standardized testing used in distinguishing between an ADD and general youth population. I also collect information about executive function capacity and an extensive developmental history questionnaire is completed. I obtain "real-time" data about the child through direct observation in the office and also administer a computerized test battery that establishes baseline measures of attention and other cognitive features. The parents are guided in a discussion about the principles of learning and extensive handouts are used for home reference and to assist the teachers and others involved with the child so that standardization is obtained.

     The program is allowed to run for approximately 4-6 weeks and communication is maintained with all members of the team. If the child is found to not have altered their behavior and other indices suggest to me that other possible problems have been ruled out then a diagnosis of ADD is made. I recognize that my requirements for the diagnosis are high and that most other practitioners would be much easier to work with, however I am committed to the child and want to be as sure as possible as to the diagnosis. If you are found to have ADD from my office you can rest assured that there is no better explanation.

     For those adolescents and young adults I find to have ADD I will usually refer back to their primary care physician for medication trials. In some cases I will also refer to Ashot Azatian, M.D. a psychiatist who is well-versed in issues of medication. For teenagers and children below the age of 16 I will usually refer back to their treating physician for medication management. I have worked for over twenty five years in the local health care community and have good working relationships with the majority of physicians in Lubbock and West Texas.

 


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Resources

ADHD Evaluation   (MS Word)    
(Adobe PDF)

Behavior Modification Program
(MS Word)  
(Adobe PDF)


Giving Commands  (MS Word)
(Adobe PDF)

Time Out Instructions
(MS Word)
(Adobe PDF)