What is ADHD? Attention-Deficit/Hyperactivity Disorder (ADHD) is a common chronic condition that starts in childhood and often continues into adulthood. There are three classifications of ADHD that are dependent on which symptoms are present:

• Predominantly Inattentive: Primary symptom is difficulty sustaining attention
• Predominantly Hyperactive/Impulsive: Primary symptoms are hyperactivity and impulsive behavior
• Combined type: A hybrid of the two classifications above
Program Goals Below is an overview of what can be expected at well checks. Depending on the age and risk factors present for any given child, not all items are performed at a given visit.

• Measurements of height, weight, head circumference (infants/toddlers), blood pressure, and calculations of proportions
• Sensory screening for vision and hearing
• Lab testing for anemia, lead exposure, hyperlipidemia, tuberculosis, sexually transmitted diseases
• Developmental/Behavioral Health Screening for global development, autism, mood disorders, anxiety, ADHD, substance use, sexual activity
• Complete physical examination
• Immunizations to protect from communicable diseases
• Anticipatory guidance on a wide range of issues
• Addressing of concerns raised by parent and/or child

For a complete listing of recommended care by age according to the Bright Futures Preventative Pediatric Health Care Guidelines, please view and/or download the schedule here.
Diagnosing ADHD ADHD is generally diagnosed in elementary school. When older children are diagnosed, one of the criteria is that symptoms were present prior to 12 years of age. Diagnosis is based partly on history and observation during the office visit and partly through the use of standardized assessment tools. In our office we utilize Vanderbilt Assessments, though there are others that are validated for such use. The Vanderbilt Assessments should ideally be completed prior to the office visit. There are two parts to Vanderbilt Assessments – one is for the teacher(s), one is for the parent to complete.

When diagnosing ADHD, children are also evaluated for other possible conditions that could either be present along with ADHD or may masquerade as ADHD. Among those considered are cognitive deficits, learning disabilities, dyslexia, processing disorders, mood disorders, anxiety, oppositional defiant disorder (ODD), conduct disorders, autistic spectrum disorders, and tic disorders (such as Tourette’s).
Kids writing ADHD Management ADHD can be managed in multiple ways and each child is considered unique:

• Environmental modifications: There are many modifications that can assist individuals with ADHD. Many of these modifications can be incorporated into the school environment through either a 504 Plan or Individualized Education Plan (IEP).
• Medications: There are a wide array of options including both stimulants and non-stimulants. Each option presents with expected benefits and potential side effects.
• Behavior Therapy: Reward systems, Social skills training, Parenting skills training, and Family therapy are all options to assist
• Medical Devices: There is a new device cleared by the FDA that uses Trigeminal Nerve Stimulation (eTNS)
Additional ADHD Resources There are many ADHD resources available on the internet. These are well regarded and reliable sources. Every child is different, and what can assist one child may hinder another. The care we provide is based on established guidelines but individualized to your child’s specific needs. Children and Adults with Attention Deficit Disorder (CHADD) Understood Center for Disease Control (CDC) Child Mind Institute

View Others Services Offered

Baby getting listened to PREVENTATIVE HEALTH CARE VISITS Preventative Health Care

Preventative Health Care encompasses a wide variety of services to both promote good health and prevent diseases. We provide preventative health care based on the American Academy of Pediatrics Bright Futures Guidelines for Health Supervision.
Click here to learn more about Preventative Health Care.
SAME DAY SICK APPOINTMENTS Same Day Sick Appointments

Peds First Pediatrics is available 7 days a week to provide care for when your child is ill. We limit booking for acute illnesses such as fever, ear pain, sore throat to the day you call for the appointment. We kindly request that you call as early in the day as you recognize that you wish to have your child evaluated.
Click here to learn more about our same day sick appointment availability.
breastfeeding baby BREASTFEEDING SUPPORT Breast Feeding Support

We aim to educate families and encourage breastfeeding. We provide access to an International Board Certified Lactation Consultant to support all families that are attempting to breastfeed. Peds First also seeks to identify and assist mothers who are suffering with post-partum depression.
Click here to learn more about our Breastfeeding Support Services.
Helmets and Lacrosse Sticks CONCUSSION MANAGEMENT Concussion Management
Peds First provides evaluations for concussions in the event an injury is sustained. If concussion is of concern, we provide monitoring of symptom progression and establish appropriate limits on return to activity. When available we utilize individualized baseline performance measurements of physical and cognitive skills to assist with post concussion management.
Click here to learn more about Concussion Management.
Support Sign CARE COORDINATION Care Coordination

Our Care Coordination Team is constantly evolving in an attempt to minimize "Gaps in Care." We seek to identify the barriers that families face in receiving proper care and assist them in clearing those barriers.
Click Here to Learn More About Our Team
Food, Stethoscope and Heart NUTRITION SUPPORT Nutrition Support

The old adage states “You are what you eat.” To a large extent, this is accurate – optimal nutrition is one factor to help you live a longer and healthier life. However, what is optimal depends on the individual, and this is the focus of our nutrition department.
Click here to learn more about our Nutrition Support services.
Chest x-ray ASTHMA MANAGEMENT Asthma Management

Asthma is a chronic inflammatory condition affecting the smaller airways in the lungs of nearly 1 in 10 children. We actively seek to identify children that are at risk for having asthma so that we may provide the proper education, monitoring, and therapy as needed to minimize both short and long term consequences of poorly controlled asthma.
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Unhappy to Smiley Face MENTAL HEALTH SERVICES MENTAL HEALTH SERVICES

A 2018 study in The Journal of Pediatrics demonstrated that among children ages 3 to 17 years, about 3% suffer from depression and 7% from anxiety. Of great concern is that more than 1 in 5 of these children went untreated for their condition. We seek to identify those children at risk for mental health conditions so that we can provide assistance where appropriate.
Click here to learn about our Mental Health Services.
Kids writing ADHD MANAGEMENT ADHD Management

ADHD is a common condition that affects children more than just academically. It can cause difficulty in all avenues of life, and when severe can contribute to the development of other mental health concerns such as depression and low self esteem. We seek to identify and manage this condition to maximize the success of those affected.
Click here to learn more about our ADHD Management services.

Prevalence and Treatment Rates

  • Anxiety and depression are both very common in children.  A 2018 study in The Journal of Pediatrics stated that among children aged 3-17 years:
    • 3.2% have diagnosed depression (1.9 million children)
    • 7.1% have diagnosed anxiety (4.4 million children)
  • 21.9% (or more than 1 in 5) children with depression went untreated
  • 40.7% (or more than 2 in 5) children with anxiety went untreated

Program Goals

  • To identify children at well child care visits that are at risk for having anxiety and/or depression
  • To further assess those children identified as being at risk
  • To provide consultations for those who have concerns regarding these issues without waiting until their well visit
  • To educate as to treatment options available
  • To help plan and implement selected treatment option
    • Facilitate connections with therapists as needed
    • To initiate medication when appropriate
    • To monitor progress on medications, assess for side effects, and manage dosing as appropriate
    • To refer out to psychiatry when appropriate

Screening

  • Performed at all well visits by asking questions on a wide array of topics that could be concerning (as examples: recent drops in school performance or recent changes in sleep patterns)
  • Through use of standardized screening instruments.  We utilize the Pediatric Symptom Checklist in younger children and the PHQ-9 and SCARED in older children. Use of these instruments is recommended by the AAP as part of the Bright Futures guidelines.
  • Standardized screening instruments may or may not be covered by insurance.  If you choose to opt out of these recommended screens, you will be asked to sign a declination advising that you understand the risks associated with your decision.

Consultations

Consultations for anxiety and depression involve:

  • Obtaining a full history regarding the concern
  • Performing a physical examination to identify potential underlying causes (such as thyroid deficiency) and or manifestations (such as cutting)
  • Ordering of laboratory studies and referrals to specialists if indicated
  • Administration of standardized assessment tools if indicated
  • Making diagnosis and discussing treatment options or scheduling return visit if diagnosis is depending on laboratory studies or consultations with specialists.

Treatment Options

Treatment of anxiety and depression consists of:

  • Cognitive behavior therapy (CBT) alone
  • Medication alone
  • Combination of CBT and Medication

Post Partum Depression

  • Postpartum depression is very common.  1 in 9 women experience symptoms of postpartum depression.
  • We screen for postpartum depression three times during the newborn period using the Edinburgh Postnatal Depression Scale
  • We ask questions at well child care visits to try to identify those that may be at risk
  • We will facilitate treatment for parents as required