To better serve Temple students, Tuttleman Counseling Services (TCS) has adopted the following policy regarding ADHD diagnosis and treatment and the prescription of stimulant medicine.

Please contact TCS for the following forms (if needed):

"Stimulant Medication - Transfer of Care"

"Stimulant Medication Contract" 

ADHD and Stimulant Medication Policy

Overview

Attention deficit hyperactivity disorder (ADHD) is a neurological condition that affects executive functioning in the brain. Students with this condition can have problems with focus, concentration, hyperactivity, and fidgeting that can lead to problems in school, work, relationships and social activities. The cause of the disorder is not known. There are three main types of ADHD: hyperactive, inattentive and combined. In the hyperactive type, students have problems with hyperactivity, fidgeting, trouble sitting still and impulsive behaviors such as blurting out answers and being intrusive. Students with the inattentive type of ADHD have problems with concentrating, focusing and seem to get lost and have problems completing tasks. The combined type of ADHD has symptoms associated with both the hyperactive and inattentive type. The disorder first manifests itself in childhood. Parents may be confronted by school officials indicating that their child has a problem. For a significant number of children diagnosed with ADHD, their symptoms persist into adulthood. Some students find that as they enter more challenging academic environments (e.g. college, graduate school) their problems become more evident and problematic. Boys tend to have the hyperactive form more than girls who tend to have the inattentive type. With age those affected by the hyperactive form of ADHD become less hyperactive and more inattentive.

Other Conditions That Can Mimic ADHD

Executive function abilities fall on a spectrum from those with excellent organizational and focus skills to those with significant impairments. The impairments must be significant and affect at least two areas of a person’s life in order to meet the criteria to be diagnosed with ADHD. Other problems, too, can cause problems that look like ADHD. For example, other learning disorders can make a student look like they have inattentions problems. Anxiety and depression will affect the ability to concentrate and focus. The use of substance especially marijuana can impair one’s ability to concentrate and focus. Sometimes, more than one problem may be present further
complicating the presentation. Therefore, a careful and thorough evaluation is necessary in order to diagnose the problem.

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 diagnostic testing to determine the nature of the problem as well as a person’s strengths and weaknesses. While there are a number of paper and pencil screening tests for ADHD none of these is absolute for the diagnosis of ADHD. There is no single diagnostic test for ADHD. A referral for formal neuropsychological testing provides information about a student’s strengths and weaknesses and looks at a number of brain functions. The testing is extensive, evaluating multiple brain functions, and typically takes about 6-8 hours to complete. The results of such testing can be invaluable not only with an accurate diagnosis but also in helping a student choose a major and career as well as qualify him or her for academic or testing accommodations under the Americans with Disabilities Act.

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 non-stimulants (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 student’s life;
medications alone are rarely enough for adequate treatment. This can be especially true for students 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 such as how to use a planner, organizational skills, and how to manage stress. TCS offers both individual and group counseling to support students with ADHD. In addition, students with ADHD are encouraged to register with Temple University’s Disability Resources and Services (www.temple.edu/studentaffairs/disability) for possible accommodations and services.

Tuttleman Counseling Services Policy Regarding Diagnosing and Treating ADHD

Three types of students may present to TCS seeking treatment:

1. No established diagnosis of ADHD

Students may present for services related to a number of problems including anxiety, depression, academic problems, relationship problems or difficulties with concentration and focus. TCS clinicians will meet with students and conduct an evaluation. If a concern arises that the student may have an undiagnosed ADHD, the student will be referred to an outside neuropsychologist for formal neuropsychological testing.

2. Students with an established ADHD diagnosis, currently being prescribed stimulant medication wishing to transfer their care to TCS

In order to transfer care of ADHD (i.e. prescription of stimulant medication) the student will need to submit information verifying the diagnosis of ADHD as well as a transfer of care form from the current prescribing physician. A TCS psychiatrist will review the information and determine whether it meets the qualifications to accept the transfer of care. Students are encouraged to obtain a copy of testing results to present to TCS as these will be required. In general, TCS psychiatrists require formal neuropsychological testing supporting a diagnosis of ADHD before they will prescribe stimulant medication. Paper and pencil or computer self-report questionnaires are not acceptable. A student with adequate supporting documentation will be given an appointment with a TCS psychiatrist for a psychiatric evaluation. No guarantee is made that the psychiatrist will prescribe the student’s current medication or medication at all. The appointment is for an evaluation. Alternatively, students may continue to see their current provider or seek a consultation and treatment from a psychiatrist in the Philadelphia area. TCS will provide referral options if asked. If the supporting documentation is insufficient, the TCS psychiatrist will indicate the required information. This may include formal neuropsychological testing. TCS can provide the names of neuropsychologists to obtain testing.

To obtain the "Stimulant Medication - Transfer of Care" form to submit to your current prescribing physician, please contact TCS.

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

Students will need to present documentation to TCS supporting the diagnosis of ADHD. This information will be reviewed by a TCS psychiatrist. If it is found to be adequate, a psychiatric evaluation will be scheduled. The appointment is for an evaluation and no guarantee is made that the psychiatrist will prescribe medication. In general, TCS psychiatrists require recent (within the past 5 years) formal neuropsychological testing supporting a diagnosis of ADHD in order to prescribe stimulant medication. Paper and pencil or computer self-report questionnaires are not acceptable. Alternatively, students may consult their previous physician regarding medication treatment. They may also choose to seek treatment from a physician in the Philadelphia area. TCS will provide referrals if asked. If the supporting documentation is insufficient, the TCS psychiatrist will indicate the required information. This may include formal neuropsychological testing. TCS can provide the names of neuropsychologists to obtain 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 of marijuana and ADHD. Students 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. Students 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, TCS encourages students with ADHD to abstain for marijuana use. When stimulant medication is being prescribed, TCS has a zero tolerance policy and psychiatrists will not prescribe stimulants to students who use marijuana.

Stimulant Medication Policy

Stimulant medications are frequently prescribed to treat ADHD. For many students they are highly effective. However, they are not without their risks. They are controlled substance and carry an abuse potential. This abuse potential can lead to diversion which has been seen on college campuses especially around exam times. Other students use these drugs recreationally. In an attempt to balance the important benefits stimulants can have for students with ADHD and to protect against abuse and diversion, the following policy has been created. Students will be asked to read, adhere to, and sign the policy statement.

• Prescriptions can only be issued at a regularly scheduled appointment.
• Students are expected to keep regular appointments and when necessary give 24 hours notice if cancelling.
• There are no early refills.
• Lost prescriptions will not be replaced.
• Stolen prescriptions will only be replaced if the student presents a police report documenting the theft.
• TCS psychiatrist will prescribe long-acting stimulant as medically appropriate. In general, they do not prescribe short or immediate acting stimulants.
• All students will submit a urine sample for drug of abuse testing before the first prescription is written.
• Students are required to complete an annual urine drug test with more frequent testing if indicated and requested by the TCS psychiatrist.
• Students 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 psychiatrist.

rev. 8/2014 pad

Please contact TCS for the following forms (if needed):

"Stimulant Medication - Transfer of Care"

"Stimulant Medication Contract"