How do you manage ADHD in your clinic?

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Specializes in Cardiology, Research, Family Practice.

Can NPs diagnose ADHD? I live in Texas, and I'm struggling to find scope of practice information specific to ADHD on BON website. I'm curious to know how other practices manage diagnosing and prescribing meds, particularly in states where NPs are not permitted to prescribe schedule II meds.

At my clinic, the makes the diagnosis and initiates treatment. Follow-ups may be done with NP, who may make recommendations to the physician, but the prescription still must be written by the physician. Recently, my physician has said "I trust you", regarding making the diagnosis. I certainly don't want to violate scope of practice. I'm an FNP.

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Specializes in Psychiatric Nursing.

Have you considered referring to Psych? ADHD is a clinical diagnosis and there are criteria in the DSM. Criteria are different for children and adults. Stimulants are abusable. Many children outgrow their childhood add diagnosis. Some clinicians require neuropsych testing. For childhood adhd you need collateral information from parents and the school. Sometimes there are mood issues that should be treated first.

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Specializes in Outpatient Psychiatry.

Read the DSM5. Functional impairment in at least two domains. At least six symptoms of inattentive behavior and/or at least six symptoms of hyperactive/impulsive behavior or five if >/= 17 yoa. Symptoms present for at least six months onset prior to age 12 (used to be 6 or 7, still should be).

There are symptom rating scales for kids, e.g. Vanderbilt and Connor. I do not use them. Assess for comorbities.

If you're uncertain send to neuropsychological testing. Or refer to psychiatry.

Psychostimulants

Strattera

Wellbutrin

guanfacine and/or clonidine formulations

Some people dabble with Effexor or Provigil.

In psych, we live off label.

Inattentive behavior doesn't respond well to psychotherapy.

At my shop, if it's an adult that doesn't do anything then they get nothing but Strattera or Wellbutrin.

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Specializes in Cardiology, Research, Family Practice.

Thank you for your response. I've studied the updated guidelines and DSM-V criteria thoroughly and created comprehensive templates based on age groups. I screen for depression, anxiety, sleep disorders, abuse, etc. I've read the studies on using provigil. I use the Vanderbilt questionnaires for parents and teachers, and an adult symptom self report scale (don't remember the name of it). I've located community resources and some fantastic online resources as well.

So, I'm curious, do you make the diagnosis or does the physician? How do you handle prescription initiation and dose adjustment (or are you in a state that allows NP to write schedule IIs)? Do you recommend dose adjustments to the physician who then signs the script?

One more thing, what is your practice on drug holidays? I've seen some providers absolutely require 1-2 day holidays weekly. However, the literature I've read does not support this practice universally. Thanks again!

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Specializes in Cardiology, Research, Family Practice.

Oh yeah, I refer to psych frequently, but for many pts that is cost prohibitive and in many cases there is a months long wait to get in.

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Read the DSM5. Functional impairment in at least two domains. At least six symptoms of inattentive behavior and/or at least six symptoms of hyperactive/impulsive behavior or five if >/= 17 yoa. Symptoms present for at least six months onset prior to age 12 (used to be 6 or 7, still should be).

There are symptom rating scales for kids, e.g. Vanderbilt and Connor. I do not use them. Assess for comorbities.

If you're uncertain send to neuropsychological testing. Or refer to psychiatry.

Psychostimulants

Strattera

Wellbutrin

guanfacine and/or clonidine formulations

Some people dabble with Effexor or Provigil.

In psych, we live off label.

Inattentive behavior doesn't respond well to psychotherapy.

At my shop, if it's an adult that doesn't do anything then they get nothing but Strattera or Wellbutrin.

Hey man, don't judge, some times its hard to concentrate getting your food stamp money out of the ATM at midnight on the first. Oh wait, its that time.

Watching reruns of duck dynasty while sucking on potato chips also takes concentration.

Psych guy your a menace to society not prescribing these people, their children, their parents, and their dogs Adderall. No wonder society isn't getting anywhere

lol:8)

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Specializes in Outpatient Psychiatry.
Thank you for your response. I've studied the updated guidelines and DSM-V criteria thoroughly and created comprehensive templates based on age groups. I screen for depression, anxiety, sleep disorders, abuse, etc. I've read the studies on using provigil. I use the Vanderbilt questionnaires for parents and teachers, and an adult symptom self report scale (don't remember the name of it). I've located community resources and some fantastic online resources as well.

So, I'm curious, do you make the diagnosis or does the physician? How do you handle prescription initiation and dose adjustment (or are you in a state that allows NP to write schedule IIs)? Do you recommend dose adjustments to the physician who then signs the script?

One more thing, what is your practice on drug holidays? I've seen some providers absolutely require 1-2 day holidays weekly. However, the literature I've read does not support this practice universally. Thanks again!

There isn't a doc here. I diagnose and tell them what med they'll get. Nurse emails company medical director what script I want and it's airmailed. Patients pick it up next business day.

Holidays OK on everything. But if on Vyvanse, Monday morning will be a bit rougher than Tuesday. Doesn't matter to me and I let patents decide. There are pros and cons. If kids don't make weight meds get held.

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Specializes in Outpatient Psychiatry.
Hey man, don't judge, some times its hard to concentrate getting your food stamp money out of the ATM at midnight on the first. Oh wait, its that time.

Watching reruns of duck dynasty while sucking on potato chips also takes concentration.

Psych guy your a menace to society not prescribing these people, their children, their parents, and their dogs Adderall. No wonder society isn't getting anywhere

lol:8)

I offer them another prescription. It reads "1 job QD until retirement."

I've actually had a societal sloth tell me he needed the Adderall to fill on various disability and welfare forms.

My response, " that's probably tough but if you work on one blank each day until you're done you'll be finished in no time."

He was wearing a Philadelphia collar that he took off to get comfortable. (raised eyebrow emoticon)

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Specializes in Cardiology, Research, Family Practice.

Awesome. Thanks again!

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Not enough information to go on here.

What specialty are you in, or are you in general practice? Treating children or adults? There's a big difference.

Unless you are a mental health provider, you should be referring ADHD out.

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Specializes in Outpatient Psychiatry.
Not enough information to go on here.

What specialty are you in, or are you in general practice? Treating children or adults? There's a big difference.

Unless you are a mental health provider, you should be referring ADHD out.

I disagree. I don't think it's an overly complicated diagnosis. Here's my caveat, if you're primary care know how to work the meds. That's the only art to it.

And for some reason pediatricians and peds NPs are nearly phobic of sleep meds.

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people really overthink things on this forum. it has guidelines, and I hope they taught people in nursing school how to read, because that's all that's required to follow guidelines.

And I am pretty sure a guy named psychguy would be a mental health provider, but that doesn't seem obvious to everybody , lol

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