Attention Deficit Evaluation and Treatment
DEFINITION: Attention deficit hyperactivity disorder — also referred to ADD or ADHD — is a biological ‘brain-based’ condition that is characterized by poor attention and distractibility and/or hyperactive and impulsive behaviors. Although there appears to be a strong genetic basis, the exact cause of ADD is unknown. Researchers are investigating many different genes, particularly ones involved with the brain chemical dopamine. People with ADHD seem to have lower levels of dopamine in the brain.
SYMPTOMS: The most prevalent symptoms of ADHD are inattention and distractibility and/or hyperactive and impulsive behaviors. Difficulties with concentration, mental focus, and inhibition of impulses and behaviors are chronic and pervasive and impair an individual’s daily functioning across various settings — home, school or work, and in relationships. Symptoms may continue into adolescence and adulthood. If left untreated, ADHD can lead to poor school/work performance, poor social relationships and a general feeling of low self-esteem.
PREVALENCE: It is estimated that between 3 and 5 percent of preschool and school-age children have ADHD or approximately two million children in the United States. This means in a class of 25 to 30 students, it is likely that at least one student will have this common condition.
EVALUATION AT PEDI-CARE: Your child’s evaluation for possible ADD/ADHD starts with consulting one of our physicians. Our initial assessment will include a current history, physical exam, discussion of concerns, clinical interview, and review of problematic behaviors as documented on the Vanderbilt parent and teacher questionnaires. We may also recommend additional psychological and educational testing.
VANDERBILT RATING SCALES: The Vanderbilt Rating Scale is a reliable and inexpensive way to gather information about a child. This questionnaire lets parents or primary caregivers and teachers evaluate the child, aged 6-12 years old, in the home or school environment. Observing your child where he/she is most comfortable can contribute to a more accurate diagnosis.
The Vanderbilt Scale it has 55 items which will evaluate your child for ADHD as well as other conditions. The questionnaire gathers information about group interaction, organization habits, as well as general health. The questions are rated on a scale of 0-3, 0 being never and 3 being very often.
TREATMENT AND FOLLOW-UP: Each child’s treatment for ADD is unique and may or may not involve medications. No treatment will be initiated without a thorough assessment and a family discussion.
Our patients are followed closely by regularly scheduled office visits and telephone encounters throughout the evaluation and initiation of a treatment process. Once a plan has been instituted, then progress is monitored by bi-annual follow-up teacher and parent rating scales. Often, treatment adjustments or an office re-consultation is needed. We may also refer your child to a mental health specialist and will then coordinate your child’s care as a team.
APPOINTMENTS: Please call to request an initial doctor telephone intake encounter. This telephone interview will help determine the needs of your child and the appropriate next step. We can then guide you regarding the length of the appointment as well as records that may be helpful to submit prior to your child’s visit.
Autism Screening (M-CHAT)
What is the M-CHAT?
The M-CHAT is the Modified Checklist for Autism in Toddlers, a screening tool developed by the University of Connecticut to help pediatricians and other primary care professionals identify children with autism. The M-CHAT does not provide a diagnosis, but it can indicate if a child is at risk and should receive further evaluation.
At the 18-24 month well-child exam, we will ask you to fill out the M-CHAT questionnaire and the Ages and Stages developmental screening tool. Our office participates in the University of CT’s ongoing developmental study. These questionnaires are scored at UCONN and our physicians are notified if there are any concerns on the screening.
If a concern is identified, we will call you to discuss the findings. On occasion, an abnormal score may be a “false positive” and does not indicate an autistic spectrum disorder– it may point to another developmental issue that needs to be evaluated.
If early intervention is indicated, we will discuss therapies that may be helpful (such as speech, occupational, and physical therapy) and help make those referrals for you.
If you have any concerns about your child’s development, you can speak to our physicians at any time. Child development is an integral part of child health and we are here to answer any questions you have about your child’s speech and language or social skills.
Guided Imagery for Anxiety Disorders
Visualization or Guided Imagery is a relaxation technique designed to help release brain chemicals that act as your body’s natural brain tranquilizers, lowering blood pressure, heart rate, and anxiety levels.
Athletes use imagery to enhance their performance, sometimes without realizing it. A golfer may form a mental map of the fairway, imagining precisely where he will place the ball on each shot; a high jumper may visualize every split second of his approach to and leap over the bar; a baseball pitcher may run a mental film of the ball from the time it leaves his hand until it lands in the catcher’s glove.
Although it isn’t always curative, imagery can be helpful for many stress-related problems. Once medically cleared, a variety of conditions including anxiety disorders, reactive depression, phobias, sleep disorders, smoking cessation, weight and exercise management and many types of self-improvement for school, work and play can be treated.
Dr. Mongillo has studied guided imagery for over twenty years, under the tutelage of certified hypnotherapists. If you feel your child may benefit from learning relaxation techniques, please call the office and request an initial telephone consultation with Dr. Mongillo. Evening appointments of one-hour duration can subsequently be scheduled.
We participate with most major insurance plans, including:
- ANTHEM BC/BS
- MEDICAID/HUSKY A AND B (CLOSED PANEL ONLY)
- OXFORD/UNITED HEALTH CARE
- TRICARE (LIMITED PLANS)
Smaller participating plans may not be listed, call us for confirmation. We recommend you make every effort to understand your insurance coverage, benefits are often specific to each employer. Please contact your insurance company before your visit to confirm your eligibility for services as well as copays, deductibles and any other questions you may have. It is not possible for our office staff to know each individual plan.
**Please note that there will be an additional monthly fee of $15 if payment in full is not received within 30 days of statement date.**
Helping a child with special needs realize their full potential is a journey. It will require a team of professionals, family, and friends. It will take time. It will take patience and perseverance. It is not only possible but holds the promise of many triumphs. It is important to know that you do not need to journey alone. We encourage you to seek the answers and help you and your child need.
Pedi-Care utilizes the developmental screen, MCHAT, at 18 and 24 months, in conjunction with The University of Connecticut’s department of psychology, to aid early identification of developmental disabilities. Once concerns have been identified, proper diagnostic evaluation is essential. We will consider your family’s priorities and unique perspective when assisting with case management and multidisciplinary referrals.
We encourage parents to prepare their child prior to the first office visit, and as needed with future visits, as follows:
- Come in for consultation without your child to review records, history, and concerns
- Take photographs of the office and physicians to show your child prior to the visit.
- Compose a brief social story about what will be expected at the time of the visit. This can be very helpful for most children. See the “A Visit to Pedi-Care” for an example. More information is available in “Sample Social Story.”
- Schedule your child’s first visit when they are not sick and do not require immunizations – this will allow a positive association to take place and assist with future office visits.
Vaccines are a safe and important component of your child’s preventative health care. As Board Certified pediatricians, we adhere to the vaccination guidelines set forth by the American Academy of Pediatrics. With this in mind, and with concern for our newborn and immune compromised patients, we require that our patients comply with these recommendations. HealthyChildren.org has more information on vaccination schedules and safety.
MENTAL HEALTH EVALUATIONS:
There are times when a child or teen demonstrates difficulties with mood, behavior, or attention. We are here, along with the rest of the team, to help address your concerns. It is important to remember that your child is a child first and that some behaviors may be typical and part of the normal progression through infancy, childhood, and adolescence. Once any underlying medical factors are eliminated, an evaluation with a mental health professional may be recommended.
Monitoring progress, coordinating specialty evaluations and assisting with finding appropriate resources, services, and support, as well as ensuring proper medical evaluation are essential to our approach. In turn, it is important for our office to receive copies of any evaluations and testing that is done outside of our referral system. (e.g.: school evaluations, parent initiated specialty evaluations). We also strongly encourage families who have a child on the autism spectrum to enroll any newborn family members in the Yale Baby-Sib Project: www.childstudycenter.yale.edu / 203-785-6237 for closer monitoring of development and behavior.
Did You Know? Pedi-Care provides:
M-CHAT Developmental Screening
ImPACT pre-concussion testing
Guided Imagery for Anxiety Disorders