insurance Plans:
Aetna, BCBC, Cigna, United Healthcare, Optum, Oxford.
Initial ADHD evaluation: if you are using insurance, you will be notified of copay fees prior to scheduling the evaluation. You will only pay the copay fee.
Follow-up appt: your follow up for medication changes will be monthly and depends on symptoms and progress.
ADHD Diagnoses
Inattentive type
Hyperactive type
Combined type
ADD is considered an outdated term and the diagnostic manual we use, known as the DSM-5 refers to this condition as ADHD, which is then differentiated into types. Depending upons the symptoms presented some will have ADHD, Inattentive type, while others are diagnosed with ADHD, Combined type. ADHD, Hyperactive type is a diagnosis seen mostly in children, as adults typically outgrow many of the symptoms of hyperactivity.
How ADHD is Diagnosed
Diagnosis of ADD or ADHD is made when reported symptoms have been occurring for longer than 6 months and are found to cause significant distress. DSM-5 (Diagnostic Statistical Manual) has criteria for diagnosing ADD/ADHD, which are a set of guidelines all psychiatric providers follow for establishing this diagnosis. An individual with ADHD must have 5 out of 9 symptoms of inattention and or hyperactivity to meet criteria for the diagnosis. Some symptoms must have been present in childhood or prior to age 12. Another important criteria is that symptoms are reported to be causing distress in 2 areas of function, such as in relationships and work, or relationships and school or work and school.
Adults with ADHD
In adults with ADHD hyperactivity looks differently than in kids. They tend to feel fidgety, they are often seen tapping their feet or hands. They report an internal feeling of hyperarousal which is not being able to relax, constant tension and difficulties with turning off the mind and body prior to sleep. Racing thoughts are commonly reported. Thoughts and emotions are more intense in the ADHD population.
Inattention
Inattention in ADHD can be explained as attention being paid to many things at once and one cannot select where to focus his or her attention. ADHD can also be seen as an intention disorder. You know what needs to be done, but are frozen with procrastination and simply don't do what needs to be done. It is often talked about as a disorder of performance.
Impulsivity
Impulsivity in ADHD manifests as hasty decision making, acting without thinking, reward seeking and inability to delay gratification. It can be seen as interrupting others excessively, or not being able to wait your turn to speak.
Learning
ADHD is not a learning disability and in many cases individuals graduate from high school and college, but often suffer greatly as they take much longer to complete their programs. They are often frustrated with their workload, feel disorganized and impatient.
Self-Esteem
Low self-esteem is developed due to repetitive failure to complete projects, harsh internal dialogue and criticism from others. Many experience guilt and shame. Many experience anxiety, irritability and mood swings.
ADHD TREATMENT
Medication Management
Stimulant medication ( Adderall, Ritalin, Concerta, Vyvanse, Focalin, Modafinil) and non-stimulants like Wellbutrin and Strattera are the first line treatment for ADHD. ADHD is a neurodevelopmental disorder with potentially low levels of Dopamine & Norepinephrine. While the condition is more complicated than neurotransmission alone, it has been the experience of most patients with ADHD that their symptoms dramatically improve when they begin to take stimulant medication. Stimulant and non-stimulant medication does require fine-tuning and adjustment, so it is important to see an experienced psychiatric provider to help you manage this medication. Often patients with ADHD will find advice about medication on the web or on Reddit and will bring up questions and areas of concern. Talking to your psychiatrist or psychiatric nurse practioner about these concerns is much safer than relying on Reddit, Facebook, or other forms of internet information channels.
ADHD Coaching
ADHD coaching is a type of counseling which focuses on symptoms of impairment in ADHD: planning, time management, organization, problem solving and goal setting. An ADHD coach can help you set academic and vocational goals and address emotional, and interpersonal life difficulties. A coach will partner with you to develop practical life skills and begin to make changes in your daily life. Coaches provide support, encouragement and feedback. Most importantly a coach will hold you accountable to follow through on the goal you set. You will meet regularly and check in. If you are interested in setting up an appointment for ADHD coaching, let your psychiatric provider know and we will arrange a referral. Focused Mind Psychiatry has licensed and experienced ADHD therapists who can provide valuable counseling to help you manage your symptoms.
Nutrition & Lifestyle
ADHD can be easier to manage when your diet is free from additives and preservatives. There are certain food dyes that have been implicated to result in increased symptoms, but the research is not definitive. Fish oil supplements have a few studies showing a small effect in improving ADHD symptoms, but this benefit from fish oil supplementation is relatively modest compared to treatment with FDA approved medication such as stimulants ( Adderall, Ritalin). Another important tool is exercise! The brain releases chemicals called neurotransmitters during exercise, including dopamine, which helps with attention and thought processing. It is a theory that people with ADHD often have less dopamine than those without ADHD. The stimulant medicine works by increasing the availability of dopamine in the brain. That is why exercise is highly recommended as an alternative treatment option
ADHD Treatment
Pre-screening
Sign up for your diagnostic evaluation appointment and begin to fill out your ADHD assessment packet.
These questions will ask about ADHD symptoms in your childhood, at school, at work and how ADHD may impact your relationships and work life.
We will ask you about your mood, substance use and other medications you are taking.
Diagnostic Evaluation
Your psychiatric provider will review your packet of information prior to your 1st session and will spend 50-60 minutes discussing your symptoms and collecting additional information that may be needed such as developmental history, social history, mental health history and medical history. Your psychiatric and medical history are an important part of getting a correct diagnosis and treatment.
Monthly Follow up
Monthly appointments are required to fine-tune your medication. Once you do not need medication changes, then your appointments may be scheduled every 2 or 3 months. Part of safe treatment are annual physical exams and laboratory work up. These are important and patients are encouraged to complete labs for ongoing treatment. Laboratory work up or urine drug testing may be requested during treatment.
Telemedicine and ADHD
There are many ADHD treatment providers engaged in telemedicine. Many have been deemed unsafe and are regarded as pill mills. Some of these providers have lost their priviledges and pharmacies are not accepting their prescriptions. Online services use inexperienced providers who are not psychiatric specialists or ADHD specialists. Many offer short 25 minute appointments which are deemed unsafe and are not considered to be the standard of psychiatric care according to APA (American Psychiatric Association). These providers have very little if no psychiatric training. Many telemedicine services have high turn-over. Please use extreme caution when entrusting your mental health care to non-psychiatric providers.
Frequently Asked Questions
How does this work?
1. WE ARE ACCEPTING NEW PATIENTS IN FL AND NY!
2) WE REMAIN COMMITTED TO DIAGNOSIS AND TREATMENT OF ADHD!
3) WE CONTINUE TO USE TELEMEDICINE FOR SAFE AND SECURE ONLINE SESSIONS.
Do you accept health insurance?
Yes, we do! We are in network with Aetna, BCBS, Cigna and United Healthcare in NY state and use Headway.co to bill your insurance.
Health Savings Account: You can use your HSA credit card to pay for appointments.
Cost of Medication: You can use your insurance to pay for your medication, if you have pharmacy benefits. We can help submitting prior authorization if needed.
What are your prices?
ADHD INITIAL ASSESSSMENT $255
ADHD FOLLOW UP $99
What medication can you prescribe?
ADHD management is done with FDA-approved treatments for ADHD such as stimulant and non-stimulant medications. Some examples are: Adderall, Ritalin, Vyvanse, Focalin, Jornay, Straterra, Qelbree. Stimulant medication is only prescribed on individual basis and if found to be appropriate.
How does telemedicine work?
After you are done with your paper work and an evaluation is scheduled, you will have a link to get into your provider's virtual office. You can use your cell phone or your lap top computer to get your visit done. This system meets privacy standards for psychiatric care.
Telemedicine has been a life-saver to people who live in rural towns and must travel long distances to get help. This safe and convenient method of seeing a psychiatrist has become the method of choice for many patients. It is here to stay as we continue our journey together in this digital world.
How is Better Mind NP different?
At Better Mind NP we get the job done and provide follow up until you are feeling content with your treament.
Our nurse practitioners are dedicated to providing top quality care and follow up. Your communication is done directly with your care provider and is confidential.
Monthly appointment fees are $99 and are often needed to monitor for symptom changes and fine-tune treatment.
You will communicate with your provider directly when you have questions or refill requests.
Can I get a refill without an appointment?
We understand you may not have the time for an appointment. We provide 1 refill in between your appointments.
We charge a refill processing fee of $39 to cover the administrative cost of sending refills.
We require that you keep your online appointments every 2 months to obtain a refill on any stimulant medications.