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CAPS adjusts ADHD assessment protocol

This year, Counseling and Psychological Services (CAPS) changed how they would conduct assessments on students for attention deficit hyperactivity disorder (ADHD).

The new protocol’s primary goal is to make the assessment process more efficient and to ensure improved accuracy of diagnosis and treatment, said Julie Tinklenberg B.S. ’90 M.S. ’90, a staff psychiatrist at CAPS involved in changing the guidelines.

SAM GIRVIN/The Stanford Daily

SAM GIRVIN/The Stanford Daily

In recent years, the number of students seeking an ADHD diagnosis has increased, Tinklenberg said. According to CAPS data, 1.8 percent of Stanford undergraduates were diagnosed and/or treated for ADHD in the last twelve months.

The new assessment protocol requires that a student, a close friend or family member and someone who knew them as a child fill out an assessment form.

“What we’re doing through having these forms is getting rating numbers and free text to give specific examples of what did they look like as a child, how exactly are they impaired now,” Tinklenberg said. “We collect all of that information and then when they come in, we have what we need. We don’t have to spend time tracking down the different pieces.”

CAPS Director Ronald Albucher said that the changes in the ADHD assessment were independent of other recent changes at CAPS—including expanding hours and increased staff—caused by increased student demand.

“We’ve spent several years researching this [issue],” Albucher said.

He explained that this research included conversations with staff psychiatrists, looking at the issues of proper stimulant use on college campuses and determining the role of neuropsychological testing as well as CAPS’ relationship with the Office of Accessible Education.

In addition to simplifying the assessment protocol, Tinklenberg explained how the forms would improve the accuracy of diagnoses made by CAPS clinicians by allowing for a more consistent method of gathering information needed for a diagnosis.

“The protocol makes me more comfortable as a clinician because I know that I’m doing a thoughtful, thorough assessment,” Tinklenberg said.

In previous years, clinicians at CAPS would have to gather several pieces of information, including a medical history of the patient from the patient’s parents. The final diagnosis would require three or more visits until clinicians could determine if the information they received was consistent or inconsistent with ADHD criteria found in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V).

According to Tinklenberg, there is no clinical test that can give a definitive answer regarding whether a student has ADHD, but the new system of assessment can help clinicians improve the accuracy of an ADHD diagnosis.

“In assessing someone, you have to know who they were as an elementary school student and if they were having a hard time at school, at home and in social circumstances,” Tinklenberg said. “In two of those areas, there has to be impairment due to these symptoms.”

Tinklenberg described that there must be lifelong symptoms in inattention and hyperactivity to qualify for a diagnosis. This criterion helps rule out other diagnoses, including bipolar disorder, anxiety disorder and substance abuse where individuals may show similar symptoms to that of ADHD.

She also said the new assessment will help clinicians be more careful when prescribing medication.

“In a lot of cases students are interested in starting stimulant treatment, and I am uncomfortable starting on that path for someone unless it makes sense,” Tinklenberg said. “Taking the time to make sure that it makes sense, I think that it’s going to be much better.”

Contact Angelique Dakkak at angeldak ‘at’ stanford.edu.

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