Counseling Services

ADD/ADHD Prescriptions

Medication Assessment and Documentation Guidelines

Introduction

Bishop Wellness Center (and many providers in the community) does not prescribe medication to treat ADD or ADHD unless a thorough and current assessment (no more than 4 years old) has been done to establish a clinical diagnosis. Students can obtain this documentation through an assessment in the community.  Bishop Wellness Center can offer referrals to community providers as needed.  Of note is that many resources are outside of the Salem community (Portland, Monmouth, etc.).  As such, students are encouraged to secure an updated evaluation in their home communities prior to arriving at Willamette. 

If a student has been assessed or treated for ADHD in the recent past and wants to secure a prescription through Bishop Wellness Center, she or he should submit this documentation to Bishop Wellness Center (Attn: Director of Counseling). Once Bishop has received and reviewed your documentation, students will be sent a letter indicating whether this information is sufficient. 

Community evaluators are encouraged to advise students that treatment of ADHD is complex, and prescribers take many factors into account when considering the use of medication as part of the treatment plan. While a student with proper documentation may be given a consultation appointment with a Psychiatric Mental Health Nurse Practitioner (PMHNP) in Bishop, treatment decisions are made on an individual basis.  Evaluators are also encouraged to inform students that while recommendations in the report may be helpful, some may be outside the scope of the programs, services, or medical treatment offered by a university, employer, or other governing body. 

Qualifications of the Evaluator 

The professional who conducts the evaluation must be qualified to make the diagnosis of ADHD and to recommend appropriate academic accommodations.  Experience with diagnosing ADHD in adolescents and young adults is essential. The evaluator must also have a current license and training in differential diagnosis of the full range or psychiatric and learning disorders. Professionals typically qualified to make this diagnosis include: Counseling/Clinical Psychologists, Neuropsychologists, and Psychiatrists. 

Developmental and Educational History 

The report must contain evidence to establish a pattern of symptoms and impairment in multiple settings across childhood (e.g. before age 12), adolescence, and adulthood (up to the present) in two or more settings. Obtaining this historical information may involve review of medical/academic records and consultation with other people in the student's life (e.g. parents, roommates, employers, and friends). 

The assessment must include the student's diagnostic history of ADHD and any family history of physical or psychological problems deemed relevant by the examiner (historical education impact). Include information substantiated in medical and educational records, if available. This may include a review of previous psycho-educational or personality testing, including the dates, results, and recommendations. Discuss history of any medication prescribed - both current and past, as well as response, adverse reactions, and side effects. Accommodation history should also be discussed. 

Evidence of Current Symptoms, Including Severity of Impairment in Multiple Settings 

The report should include a thorough clinical history that outlines global performance of the individual and the current impact of ADHD in several major life functions. Life areas to be assessed include: family functioning, educational history, legal history, social functioning, occupational history, and medical/physical history. Additionally, the report should document previous and current substance use, misuse, abuse, or dependence. 

Current functional limitations due to the disability should include information regarding the severity, duration, and impact of the impairment across multiple areas of life (e.g. academic, occupational, and social settings). Discussion should include a rationale for ways in which the student's symptoms are substantially more severe than others of that age. 

Relevant Testing 

Neuropsychological or psycho-educational assessment is required in order to determine the current impact of the disorder on the individual's ability to function. All data must logically reflect a substantial limitation to functioning for which the individual is requesting accommodations or treatment. Norm-referenced checklists and surveys, computerized continuous performance tests, and attention/tracking tests can be used to supplement the diagnostic profile, but are not in and of themselves sufficient. 

Reports should include evaluation of intellectual functioning and information processing, including verbal and perceptual reasoning, processing speed, short and long term memory, auditory and visual perception and processing, and executive functioning. Academic achievement should include current levels of academic functioning in such relevant areas as reading (decoding and comprehension), mathematics, and oral and written language. 

Standard scores and/or percentiles should be provided for all normed measures. Grade equivalents are not useful unless standard scores and/or percentiles are also included. The profile of the student's strengths and weaknesses must be shown to relate to functional limitations that may necessitate accommodations or treatment. 

Current Diagnosis Based on DSM Criteria

The report should include an explicit statement about the presence of the diagnosis. This includes a review of the presence or absence of specific diagnostic criteria for ADD or ADHD based on the DSM. This should also include date(s) for all prior diagnoses and data that were used to establish the diagnosis. Evidence regarding the diagnosis should include an objective method of assessment in addition to self-report by the test-taker. 

Alternative Explanations of Symptoms Must Be Ruled Out

The evaluator must investigate other explanations for symptoms as well as other disorders that may be mistaken for ADHD or co-exist with ADHD. The documentation must investigate and discuss the possibility of situational factors, dual diagnoses and alternative or coexisting mood, behavioral, neurological, and/or personality disorders that may confound the ADHD diagnosis. The evaluator must discuss how these factors may have influenced the testing and diagnosis, as well as prognosis and subsequent treatment. 

Clinical Summary

The report should include an integrative interpretive summary that is based on the comprehensive evaluation. It should support both the diagnosis and the need for accommodations and/or treatment. Professional judgment should be used to interpret and integrate historical information, clinical observations, and test data in order to arrive at a summary of the evaluation and a specific diagnosis. The summary should also include evidence of the disorder across childhood, adolescence, and adulthood, evidence that there is an impact of the disorder in multiple settings, evidence that the ADHD limits learning or major other life activities. The summary should discuss the severity and duration of symptoms as well as the anticipated impact of the ADHD in higher education, work, and social environments 

FAQ’s 

What exactly is ADHD? 

Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common neurobehavioral disorders of childhood and can persist through adolescence and into adulthood. Currently, the causes are unknown. A person with ADHD has a chronic level of inattention, impulsive hyperactivitiy, or both such that it compromises daily functioning. Note: A person with ADHD can have primarily inattentive symptoms and little hyperactivity/impulsivity. The symptoms of the disorder must be present at levels that are higher than expected for a person's developmental stage and must interfere with the person's ability to function in different settings (e.g. in school and at home). A person with ADHD may struggle in important life areas, such as peer and family relationships and school or work performance. 

How long will the assessment take? 

A thorough assessment in the community includes several hours of interviews, formal testing, and a collection of supporting information from other sources.  The assessment generally takes 6-8 weeks to complete.  As such, you are encouraged to begin the assessment process as soon as practicable for you. 

How much does the assessment cost and does my Student Health Insurance cover the cost? 

The cost of the assessment varies, but averages $1200-$1500 before insurance.  If you carry Willamette University’s Student Health Insurance, the cost of the assessmentmay be covered, but there are exceptions.  You can verify current coverage at http://www.willamette.edu/dept/health/insurance/index.html.  Private insurance coverage also varies, so please check with your carrier to determine the rates at which an assessment may be covered. 

I was Diagnosed with LD/ADHD in the past.  Do I have to be tested again? 

Although ADHD can be a lifelong issue, the impact it has on current functioning changes over time. Therefore, your documentation needs to reflect the current status of your functional limitations, and explain why you need specific accommodations or treatment. You will likely need to update documentation if it is more than three to five years old. 

Do I qualify for accommodations through Disability Services because of my ADHD? 

For questions or information related to academic or other accommodations, contact Disability Services at (503)370-6471, or http://www.willamette.edu/dept/disability/index.html.