Tuesday, November 2, 2010

Everyone Claims To Be An Expert On ADHD: Recognizing Bias

This week's guest blogger is Michael J. Labellarte Sr., MD.

Bias can be an obstacle to getting appropriate help for a child with ADHD. My session at CHADD’s conference will focus on how to recognize and minimize bias among the various professionals and family members involved in the child’s life.

Psychiatrists often discuss bias in terms of research and statistics, in the attempt to protect the scientific integrity of research data from factors that can erode the accuracy of research findings. Psychiatrists rarely discuss bias in terms of factors that can erode accuracy of diagnosis.

With a disorder as controversial as ADHD, a discussion of bias as it pertains to professional educators and treatment personnel is a can of worms. However, a discussion of clinical bias regarding ADHD will help parents navigate a complicated system where everyone claims to be an expert, from grandparents to international scholars. The goal here is illuminate how a variety of individuals tend to think, feel, behave, and make decisions, the better to predict and avoid common mistakes.

As soon as parents, pundits, and ADHD “experts” try to judge someone else’s thoughts, beliefs, and behaviors, they risk the introduction of observer bias. The most important observer bias is called fundamental attribution error which helps drive the controversy around ADHD. Fundamental attribution error describes this observer attitude: that another person’s behavior reflects their character or personality and not their circumstances; whereas the observer’s behavior depends on circumstances and not character or personality.

This kind of bias is lethal to accurate diagnosis and management of ADHD (or any other psychiatric disorder) whether it comes from parents, educators, psychiatrists, or whomever. Bias opens the door to easy distortions (such as oversimplification or overgeneralization) and more destructive factors such as insufficient data, insufficient comprehension, misinterpretations, misattributions, desperation, misinformation, deception, and mistrust between professionals and patients and families.

My conference session will detail steps parents can take to minimize bias in all its various forms as an obstacle to getting appropriate help for their child, including:

1. Assemble an experienced team for short-term consultation and longer-term management.
2. Get the “lay of the land” by identifying all of the various professional and familial “stakeholders” involved in the child’s life.
3. Gather information systematically, through a variety of sources.
4. Focus the information in the medical model style: A consultation begins with a presenting problem, it does not begin with a conclusion to rule in or rule out a diagnosis.
5. Observe for evidence of professional bias, including shortcuts, forced conclusions, and clich├ęs.
6. Demand enough feedback for informed consent before making a decision about treating or not treating ADHD, if it is present. True expertise will manifest during the informed consent process, which usually includes the rationale for diagnosis, a plan for further assessment, treatment options that include medical, psychological, and school-based interventions, the risks and benefits of treatment or withholding treatment, and the expected course of ADHD if treated or if not treated in your child.

I hope you will join me for this important discussion at the CHADD conference in Atlanta from November 11 through November 13.

Michael J. Labellarte Sr., MD, is a board-certified child and adolescent psychiatrist who treats children and families at his CPE Clinic, LLC, in Towson, Columbia, and Severna Park, Maryland, as well as Vero Beach, Florida. He is an assistant professor of psychiatry at the Johns Hopkins University School of Medicine, the University of Maryland School of Medicine, and the University of Florida College of Medicine.

Thursday, October 21, 2010

Can School Be a Positive Turning Point for Children with ADHD?

This week’s guest blogger is Mark Katz, PhD.

School can be a positive turning point in the lives of children with ADHD when we create a school culture that takes the danger out of learning differently. Schools can be places where successes far outweigh failures, where mistakes are seen as learning experiences—and where other children are quick to lend a helping hand, rather than a cruel remark.

One institute at the CHADD conference in Atlanta will share the ways some schools are successfully accomplishing this goal. The panel will discuss the specific practices these schools rely upon as well as how attendees can implement these practices in their local schools and after-school programs.

Joining me on this panel will be Marlene Snyder, PhD, a professor at Clemson University who is the national training director for the Olweus Bullying Prevention Program and the founding president of the International Bullying Prevention Association. Our third panelist, Jeffrey Sprague, PhD, is a professor of special education and director of the University of Oregon Institute on Violence and Destructive Behavior.

We’ll also be talking about proven practices for preventing and reducing bullying at school. The national news media recently reported upon a series of tragic events where children and teens have actually taken their lives as a result of bullying. Many people are just now realizing how widespread bullying is, and how serious the consequences can be.

Some schools are intervening early in the lives of children with learning and behavioral challenges in ways that are preventing more serious problems down the road. We’re excited about these advances in the field of prevention and excited about having the opportunity to share them with attendees.

We’ve also set aside time to discuss how to prevent burnout and compassion fatigue among teachers, parents, and other caregivers. We’ll discuss helpful strategies that attendees can implement in their local schools and communities.

And we’ll learn how teachers, parents and others in a child’s circle of support are helping children with ADHD and other challenges find ways to view these challenges in a hopeful new light. We know from the research on resilience how important this is, and we’ll be discussing programs, practices, and resources that can help.

We hope you can join us in Atlanta.

A clinical and consulting psychologist, Mark Katz is the director of Learning Development Services, an educational, psychological, and neuropsychological center located in San Diego. He is a contributing editor to Attention magazine and a member of its editorial advisory board, a former member of CHADD’s professional advisory board, and a recipient of the CHADD Hall of Fame Award.

Thursday, October 14, 2010

What's So Great About ADHD Coaching?

Jodi Sleeper-Triplett, MCC, SCAC, returns as our guest blogger this week.

In my last post, I shared a few coaching tips for families with ADHD. But many of you might still be wondering—what’s so great about ADHD coaching?

ADHD coaching consists of a collaboration between client and coach to help the client move forward with his or her agenda, whether it be general (e.g., feel more satisfied with life, fit in better at school, enjoy work more, experience less daily stress) or specific (e.g., find more time for family, earn a job promotion, get accepted into college, or develop a healthy lifestyle). Coaching involves a free-flowing, creative process driven by the client and supported by the coach.

The coaching process offers a useful time and space for brainstorming options, exploring next steps, and engaging in simple coaching exercises to help the client and client family become more confident and motivated to achieve goals. In addition, coaching may involve accountability check-ins that provide the client with an opportunity to receive support, report progress, and share successes along the way. The sum of the experience for the client is a supportive environment in which he or she can explore new options and have a partner on the journey toward developing the life he or she wants. Ultimately, a trained coach will use his or her skill to evoke thought in the client and encourage the client to identify goals, as well as the actions that need to be taken to reach those goals.

Ready to learn more about coaching? Attend the information-packed preconference session, The Positive Impact of Coaching on Family Dynamics. Join us in Atlanta for CHADD’s annual international conference on ADHD from November 11 to 13!

Considered the founder of the movement for ADHD coaching for youth, Jodi Sleeper-Triplett is the cofounder of the Institute for the Advancement of ADHD Coaching and the director of coach training for the Edge Foundation.

Thursday, October 7, 2010

All Roads Lead to Atlanta

This week’s guest blogger is Rick Lavoie, MA, MEd.

The child with attention deficit disorder faces challenges in all aspects of life. This puzzling condition serves to complicate and compromise the child’s social, academic, and emotional development.

Teachers and professionals must be aware of the pervasive nature of ADHD and be willing to make accommodations and modifications in all activities and areas. ADHD is not simply a “school problem.” It impacts the child’s ability to function at home and in the community as well.

There is currently a virtual explosion of ADHD research being conducted throughout the world. Much of this research is poorly done and biased and is not valuable to parents and teachers who serve these students. However, there is also some research that can make significant, positive change in our schools and households.

So where does a concerned parent or professional get current information on the care and education of students with ADHD? All roads lead to Atlanta.

I am looking so forward to delivering a keynote address at the annual CHADD conference in Atlanta on Friday, November 12, 2010. This conference is widely recognized as one of the most effective and valuable meetings in our field. It provides an opportunity for you to meet with colleagues from all over the world and learn from some of the most accomplished speakers in education. Personally, I find that I learn as much as I teach at CHADD conferences.

See you there.

With every good wish,
Rick Lavoie

Rick Lavoie, MA, MEd, served as an administrator of residential programs for children with special needs for 30 years. He holds three degrees in special education and two honorary doctorates, and has served as a visiting lecturer at numerous universities. His numerous national television appearances include the Today Show, CBS Morning Show, Good Morning America, ABC Evening News, and Walt Disney Presents.

Thursday, September 30, 2010

Coaching and Family Dynamics

This week's guest blogger is Jodi Sleeper-Triplett, MCC, SCAC.

How can coaching help the dynamics of families with ADHD?

ADHD impacts all family members and family dynamics can get complicated. The coaching process helps families improve communication, learn time management and organizational strategies, find new ways to stay connected, and much more! Here are some tips for improving family dynamics:

• Make all family members accountable for household tasks. If everyone pitches in the work gets done faster. Decide in advance how the tasks will be divided and post a schedule where everyone can see it to avoid last minute “must-do” tasks.

• Reduce morning chaos by getting everything "ready to go" for work and school the previous night. This includes selecting clothing, setting out homework, book bags, projects, briefcases and preparing lunches.

• Parents—be curious and ask open-ended questions. Instead of “How was school?” ask “What did you do in school today?” to elicit conversation with your children.

• Hold weekly family meetings to review the past week and plan ahead.

Does this sound valuable for you and your family? Join Nancy Ratey and me for an interactive, thought-provoking preconference session on The Positive Impact of Coaching on Family Dynamics, at 1:30 PM on Thursday, November 11. Our session will be one of the dynamic preconference institutes offered by CHADD’s 22nd Annual International Conference on ADHD in Atlanta this year. See you there!

Considered the founder of the movement for ADHD coaching for youth, Jodi Sleeper-Triplett is the cofounder of the Institute for the Advancement of ADHD Coaching and the director of coach training for the Edge Foundation.

Thursday, September 23, 2010

My Top Ten Reasons to Go Live

This week's guest blogger is Steven Peer.

Every week I'm invited to 2-3 teleconferences or webinars on this or that. Most invitations come from people I've never heard of. If no live conference exists on the topic, I consider the teleconference. But I vastly prefer live conferences, especially CHADD's conferences on ADHD. Why? Here are my top ten reasons.

1. There is little or no barrier to creating a teleconference—anyone can claim to do them. But the truth is that there are thousands of details that only years of experience creating conference events can anticipate.

2. Ask anyone who's attended a live conference: The joy, the fun, and the tears come from what happens before, between, and after conference sessions.

3. Luddites are welcome at live conferences. Even computer pros can find teleconferences daunting.

4. As a teleconference learner, you learn only what is directed at you. There's no overhearing of questions and comments, there's no body language, no inference, no bumping into world-class presenters in the hallway. There's nothing like face-to-face learning.

5. Checking OUT of your routine and IN to a live conference changes everything. No crying, barking, or other distractions from the sessions. Many folks with ADHD learn best in an immersion setting.

6. Airfares and hotel rooms are a deal right now. And Atlanta is a great place to extend your stay for some much-needed R&R.

7. If you have the chance, ask a presenter what he or she thinks of presenting for a teleconference—it's as awkward for them as it is for you.

8. Quit saying 'no' to yourself. This conference was designed to make your life better.

9. If you can't live without technology, we will have all the sessions on MP3 or video for you—taped in front of a LIVE audience.

10. No teleconference operator can claim a 22-year history of international, life-changing events. But CHADD's annual international conference on ADHD can. You owe it to yourself to treat yourself to this conference.

I hope to see you there.

Steven Peer is the president of CHADD’s board of directors. CHADD's 22nd Annual International Conference on ADHD will be held in Atlanta, Georgia, from November 11 to 13. Learn more or register today.

Thursday, September 16, 2010

Countdown to Atlanta

This week's guest blogger is Sharon K. Weiss, MEd.

The CHADD conference is, for me, a labor of love. It is the quintessential opportunity to get together with friends and colleagues to learn so much information that I sometimes think my head will explode because my brain can’t hold it all. Every year I come home with copious notes, great ideas, and greater insight into the challenges of living with ADHD. I’m also anxious to pass along what I’ve learned, with a renewed sense of being able to make a real difference. It doesn’t get better than that.

The speakers and topics are so exciting that it’s always hard to know what to attend. Many of my colleagues and clients get in touch with me and ask who would be the best speaker to hear or which topic would best apply. Every year it’s a difficult call—and this year is no exception.

Flyers from many conferences cross my desk. But the CHADD conference is special. It is the chance to go to one city (and Atlanta is a great city with great food) and hear noted speakers who have the best information on the cutting-edge research and the evidence- based practices.

The latter is my area and I’m so honored to have been invited as a plenary speaker. For years, wherever I go people want to know what works—how to make behavioral change with those children whose behavior is a real challenge. In my talk, I’ll cite specific examples of behavior, discuss reasonable expectations for change, and outline the steps to making meaningful change in behavior. If you read my comments on this blog, please come up and introduce yourself!

Sharon K. Weiss, MEd, is a behavioral consultant in private practice who focuses on parent and professional training. She will present the closing keynote speech at the 22nd Annual International Conference on ADHD in Atlanta, November 11-13. Learn more or register today.

Wednesday, July 28, 2010

Preventing Obesity, Part Three: ADHD and Obesity

My two earlier blogs on obesity generated lots of discussion on Facebook and throughout our chapter networks. One chapter leader shared an article by psychcentral.com blogger Zoe Kessler on the connection between undiagnosed and untreated ADHD as a “contributing factor in a significant number of cases of severe obesity,” especially in women.

Two professional journal articles addressing this subject can be found in the online library of the National Resource Center on ADHD, a program of CHADD supported by the Centers for Disease Control and Prevention.

1. Fleming, Levy, and Levitan in a March 2005 issue of Eating Weight Disorders reported that 26.7 percent of severely obese women and girls had significant ADHD.
2. Levy, Fleming, and Klar in the February 17, 2009 issue of the International Journal of Obesity reported significant co-occurring ADHD, obesity, sleep apnea, binge eating, and mood disorder. They recommend that individuals seeking medical or surgical weight loss have an ADHD assessment.

The science has not yet adequately researched and published these relationships. Zoe Kessler speculates that one contributing factor to the relationship between ADHD and obesity is the lack of self-regulation and impulse control in ADHD when related to diet and food consumption. Another contributing factor, Kessler thinks, is the possibility that people who are undiagnosed and untreated for their ADHD seek to increase their dopamine levels in an effort to self-medicate their ADHD. Again, we need much more science to answer the questions about the relationship between ADHD and obesity.

I will continue to blog on this topic.


Thursday, July 22, 2010

Preventing Obesity, Part Two: The Role of Physical Activity

My previous blog described how my 19-year-old son gained 40 pounds during his first year out of high school, even though he was enrolled in a supervised post-high school program for young adults with learning differences. One reason for his weight gain was a significant decline in physical activity.

My son played organized basketball throughout most of his school years. At his high school, he played organized team sports—soccer, basketball, and softball—throughout the school year. Once out of high school, he was unable to locate an arena for team sports. Like many young adults with special needs, my son, when left on his own, tends to stay in his apartment playing electronic games and watching TV. His post-high school program did not deliver on its promises to facilitate group physical activity.

In June, the U.S. Government Accountability Office (GAO) reported that students with disabilities participate in athletics at consistently lower rates than students without disabilities. School officials across the nation indicated a lack of information on ways to expand athletic opportunities, a lack of clarity regarding schools’ responsibilities to provide such opportunities, and budget constraints. The GAO report is titled Students with Disabilities: More Information and Guidance Could Improve Opportunities in Physical Education and Athletics (GAO-10-519, June 23, 2010). GAO recommends that the U.S. Department of Education facilitate information sharing among states and schools in order to promote PE for students with disabilities.

Everyone needs regular physical activity. Our colleagues at the Centers for Disease Control and Prevention (CDC) fund the National Center on Physical Activity and Disability. NCPAD states: "Indoor or outdoor, recreational or competitive, solo or team, easy or intensive, NCAPD has the resources, contacts, and assistance you need." I have worked with the NCPAD executive director for several years, and he is passionate about helping people with disabilities to be physically active.

NCAPD’s slogan is “Exercise is for EVERY body.” There are substantial health benefits to be gained from participating in regular physical activity. The CDC recommends that we examine the National Physical Activity Plan, which was produced by a private-public sector collaboration to promote physical activity in American life.

This is the second in a series of CHADD CEO blogs on preventing obesity and the relationship between obesity and disability.


Friday, July 16, 2010

Preventing Obesity

My 19-year-old son came home from his first year in a structured post-high school program having gained 40 pounds. This was in a structured program, where once a week each apartment resident prepares a supervised dinner for his or her roommates—and where students participate in a wellness program. A 2008 National Center on Health Statistics report documented that among adults with a disability, 35.6 percent were obese, compared with 22.7 percent of adults without a disability.

Reducing and preventing obesity is a priority of First Lady Michelle Obama. On June 29, Trust for America's Health and the Robert Wood Johnson Foundation released their seventh annual obesity report, F as in Fat: How Obesity Threatens America's Future 2010.

CHADD is recognized and financed by the Centers for Disease Control and Prevention (CDC) to operate the National Resource Center on ADHD (NRC). Reducing and preventing obesity is a priority public health objective of the current CDC director. I will prepare my next several blogs on the connection between obesity and disability. One of the situations I will spend some time discussing is the relationship between consumption of unhealthy products and social isolation experienced by many people with ADHD and other disabilities.

At home this summer, my son has lost 13 pounds, participates in a regular exercise program with a trainer, and is practicing healthier eating. Whether these habits can be sustained when he returns to school in late August will be a challenge.

We all need to better focus on good health habits. Their relationship to ADHD and disability will be discussed in coming blogs.


Tuesday, June 8, 2010

Young Adults Now Have Health Insurance Coverage

The new health reform law (Public Law 111-148) requires that health insurance coverage be available until an individual reaches the age of 26. This provision is very important to young adults with disabilities, given the many transition challenges to meaningful work.

The legal effective date of this availability is September 23, 2010. Many health plans have already implemented the availability. The Department of Health and Human Services resource cited in this blog lists those health plans already implementing this availability.

The law allows young adults up to the age of 26, married or single, to enroll in their parents’ health plan. Beginning in 2014, all U.S. citizens and legal residents will be required to maintain minimum essential health insurance coverage. The parent enrollment option will cease in 2014. There is litigation challenging the legality of the “individual mandate.” For now, young adults can be covered under their parents’ plan.

Young adults between the ages of 19 and 29 represent one of the largest segments of the population that is currently uninsured. Approximately 13.7 million young adults were uninsured in 2008. Of these individuals, 52 percent of the uninsured ages 19 to 29 were under 133 percent of the federal poverty level. Many of these individuals will require premium subsidies, as authorized by the new law.

We recommend two particular resources providing detailed information on this topic:

HHS.gov factsheet:
Young Adults and the Affordable Care Act: Protecting Young Adults and Eliminating Burdens on Families and Business
Commonwealth Fund publication:
Rite of Passage? Why Young Adults Become Uninsured and How New Policy Can Help.


Wednesday, March 31, 2010

Health Reform: Enactment Status of CHADD’s 13 Principles

The Patient Protection and Affordable Care Act is now Public Law 111-148. The Health Care and Education Reconciliation Act (HR 4872) was signed into law on March 30. Through these two pieces of legislation, Congress and President Obama have succeeded in enacting comprehensive health reform.

On August 13, 2009, CHADD issued 13 principles to consider in health care reform. On October 15, CHADD and five national sister organizations (AACAP, ASA, CABF, MHA, and NAMI) issued five principles to consider. The five are a merged and consistent statement with the previous 13.

CHADD’s 13 principles and their enactment status are as follows:

1. Provide health care coverage for all Americans

The Congressional Budget Office (CBO), the financial scorekeeper for the Congress, estimates that health reform will cover 32 million currently uninsured Americans by 2019. However, CBO also estimates that 23 million Americans will remain uninsured by 2019. The 2019 uninsured group includes seven million undocumented immigrants and 16 million who will choose not purchase insurance, despite the individual mandate to purchase insurance.

Health reform requires all Americans to purchase insurance by 2014, with financial penalties assigned to those who don’t. Penalties are $95 in 2014; $325 in 2015; $695 in 2016 and indexed thereafter. However, low-income individuals who would have to spend more than 8 percent of their salaries for health insurance are not subject to the penalty. People who make too little to file an income tax return also are excused ($18,700 for a couple). A number of the young, healthy people may prefer to pay the $95 fine in 2014 rather than purchase insurance. Health-plan enrollment by these individuals would likely increase as the penalty amount increases to $695 (or 2.5 percent of the person’s income, whichever is higher) in 2016. A coalition of state attorney generals have filed lawsuits challenging the constitutionality of the individual mandate.

Health reform expands Medicaid mandatory eligibility to 133 percent of the federal poverty level in 2014 ($29,327 for a family of four). Ninety days after enactment, persons who have no access to insurance because of pre-existing condition exclusions could have their insurance premiums paid by a new “National High Risk Pool.” These pools would terminate upon the enactment of “insurance exchanges.”

Health reform mandates that states establish state-based health insurance exchanges for individuals and small businesses by 2014. Income tax credits would be available for persons with incomes less than 400 percent of the poverty level ($88,200 for a family of four) to purchase insurance.

2. Require “parity” for mental health assessment and treatment, including prohibiting non-discrimination between health conditions

Health reform extends the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (P.L. 110-343) protections to all health plans in the exchanges, as well as all commercial plans currently covered. Mental health and substance abuse benefits, to be defined by regulation, are also part of the mandatory “essential” health benefits package.

3. Prohibit discrimination on the basis of pre-existing conditions

Health reform requires that for plan years beginning on or after six months from enactment, health plans may not discriminate on the basis of pre-existing conditions for children. However, media stories have already identified a conflict between interpretations of this prohibition by insurers and by the Obama administration. Both the insurers and the administration agree that for children offered insurance, the plans must cover pre-existing conditions. The insurers argue that the law does not require them to issue health plan coverage for children with pre-existing conditions. Any children and others denied coverage for pre-existing conditions would be eligible for assistance in the National High Risk Pool to be established within 90 days of enactment.

In 2014, all pre-existing condition exclusions would be prohibited.

4. Prohibit health plans from terminating coverage when people become seriously ill or when they are treated for long-term chronic conditions and eliminate lifetime conditions

Rescissions (the practice of terminating health plan coverage) and lifetime limits are prohibited, effective for plan years beginning on or after six months after enactment.

5. Prohibit exorbitant out-of-pocket deductibles and co-pays

This goal is difficult to define and subject to lots of debate. The Department of Health and Human Services and the National Association of Insurance Commissioners would define by regulation what constitute “unreasonable” premiums, deductibles, and co-pays. There is much debate about the affordability of the premiums and subsidies.

6. Allow young adults to stay covered on their parents’ plan until the age of 26

Effective for plan years beginning on or after six months after enactment, health reform requires insurers to allow young people to stay on their parents’ policies through age 26.

7. Target specific coverage of young adults, particularly those with special health care needs

Not specifically addressed. A new long-term care program, named CLASS, would be created by 2014.

8. Target specific coverage of children, particularly those with special health care needs

Not specifically addressed. A new long term care, named CLASS, would be created by 2014.

9. Require continued affordable coverage when one loses or changes jobs

Health reform requires guaranteed issue and renewal, effective 2014. Individuals and families who purchase coverage through the exchanges will not be stuck with their employer’s health plan or subjected to losing coverage due to loss of job.

10. Include wellness and prevention services

Health reform creates a Prevention and Public Health Fund, which will provide for expanded and sustained national investment in prevention and public health programs to improve health and help restrain the rate of growth in private and public sector health care costs. The Fund provides mandatory funding, over the fiscal year 2008 level, for programs authorized by the Public Health Service Act, for prevention, wellness, and public health activities including prevention research and health screenings. It is important to note that, for fiscal year 2010, $500 million will be appropriated for the aforementioned initiatives. Additionally, Health reform instructs the HHS Secretary to plan and implement a national public-private partnership for a prevention and health promotion outreach and education campaign to raise public awareness of health improvement across the life span. Health plans are required to include annual wellness visits.

11. Promote integrated primary care with specialty services, including promotion of the “medical home” concept and including consumer-oriented and meaningful use of electronic medical records and personal health records

Health reform creates state grants for community-based health teams to support implementation of patient-centered medical homes and allocates funds to state Medicaid programs to implement such medical homes.

12. Allow consumers a choice of health plans

Health reform establishes state-based health insurance exchanges for individuals and small businesses by 2014. Income tax credits would be established for persons with incomes less than 400 percent of the poverty level ($88,200 for a family of four) to purchase insurance.

13. Include culturally and linguistically appropriate programs that affirmatively address racial and ethnic disparities, including the recognition of disability-based health disparities

Federally conducted and supported health care programs must collect data on race, ethnicity, sex, primary language, and disability status. A population is considered a health disparity population if there is a significant disparity in disease incidence, prevalence, morbidity, mortality, or survival rates or in quality, outcomes, cost, use of health services, or satisfaction with health services compared to the general population. Health plans and health providers are then required, albeit with federal financial assistance, to address these disparities.

Health plans in the health insurance exchanges are to conduct public education activities, including those that are culturally and linguistically appropriate for the needs of the population to be served. Federal grants will be available to promote shared decision-making between patients and professionals including trade-offs among treatment options, patient preferences, and patient values.


While many disagree about the appropriate role of the federal government in health care, the individual mandate, and the financial impact of taxes and fees, people with ADHD and related and co-occurring disorders should directly benefit from health reform. Individuals who have faced discrimination and lack of insurance coverage because of their disability would benefit from health reform. While issues of affordability continue to be confusing and controversial, health reform makes the most significant progress toward universally affordable and appropriate health insurance in generations.


Thursday, January 28, 2010

Promoting Employment of Adults with AD/HD to the SSA

I am pleased to share a message from public policy specialist Cindy Smith on CHADD’s efforts to promote employment for adults with AD/HD. My 19-year-old son is in a post-high school program. He is struggling with getting to class and obligations on time, bringing all the materials necessary to learn and participate, and effectively organizing his time. Many young adults have these challenges. But if the daily and weekly challenges continue—even with supports—there is a disability factor involved. My son has had these substantial challenges his entire life.

Three CHADD volunteers—a young woman with AD/HD, an educator teaching adults in a community college setting, and a physician specializing in the diagnosis and treatment of AD/HD—recently testified to the Social Security Administration on accommodations needed by some adults with AD/HD in order to become and remain meaningfully employed. Chronic and substantial inattention and executive functioning challenges can be disabling and should be so recognized by the SSA. I am proud to share Cindy’s summary of CHADD’s advocacy efforts with the SSA.


CHADD Provides Comments to Social Security Administration Advisory Panel
On January 20 and 21, 2010, three members of CHADD’s public policy committee provided public comment to supplement CHADD’s written recommendations at the quarterly meeting of the Occupational Information Development Advisory Panel (OIDAP). In addition to discussing their personal and family experiences with AD/HD, they explained how executive functioning skills, including the ability to sustain attention, can impact the ability to be gainfully employed. This is the first time CHADD has provided comment to an advisory panel convened by the Social Security Administration.

A subset of adults with AD/HD is unable to be gainfully employed because of the chronic, substantial inattention and executive functioning challenges caused by the disorder. CHADD is working to have the SSA recognize AD/HD as a disability that can inhibit the ability to work, and to ensure that reasonable job accommodations and supports are available for individuals who cannot engage in substantial and meaningful employment without them.

The OIDAP was formed on December 9, 2008, and charged with providing “independent advice and recommendations on plans and activities to replace the Dictionary of Occupational Titles currently used in the Social Security Administration’s (SSA) disability determination process.” The OIDAP has been working on meeting its charge, and recently published a summary of its work and recommendations in a report titled Content Model and Classification Recommendations for the Social Security Administration Occupational Information System (PDF).

Visit CHADD’s public policy webpage to see what CHADD is doing to advocate for adults with AD/HD and how you can help.

You can read this blog and others like it at the HealthCentral website.

Wednesday, January 13, 2010

Health Exchanges: What Are They?

The healthcare reform legislation now separately approved by the House and Senate contains a new mechanism—health exchanges—for persons not working for large employers and not on Medicaid, Medicare, or other public programs to purchase health insurance. Working adults with AD/HD with modest incomes who not employed by large employers will look to health exchanges to purchase insurance. Enactment of the healthcare reform legislation would result in an estimated 30 million Americans receiving health insurance through exchanges. As a small employer (25 employees), CHADD would likely turn to an exchange for our health insurance.

What are health exchanges and how will they work?

A health exchange is a government-sponsored or authorized organized market for purchasing health insurance. Examples of existing exchanges are the Federal Employee Health Benefits Program (FEHBP), Massachusetts Health Connector, Connecticut Business and Industry Association Health Connections, and the Utah Health Exchange. Exchanges created in California, Florida, and Texas have closed, as they were not financially viable as structured. Governments do not operate these exchanges; rather, governments sponsor or authorize them.

I don’t want to scare people, but exchanges are based on the Clinton administration-proposed managed-competition philosophy, where preregistered and preapproved private insurance companies compete for enrollees based on publicly stated measures of price, benefits, provider networks, consumer satisfaction surveys, and in theory, quality. At a seminar I attended last week in Washington, DC, the CEOs of the Massachusetts and Connecticut exchanges stated that quality is not yet a factor in their exchanges. Only preapproved health plans meeting standards and requirements may compete in an exchange.

Exchanges would prior-approve health plans. Under healthcare reform, plans would have to deliver standardized benefits and would have to ensure practices such as guaranteed coverage and renewal (thus prohibiting pre-existing condition exclusions) and establish publicly known and regulated premiums.

There are major differences between the House and Senate legislation around exchanges: how much national government control and authority versus how much state government; how much public disclosure and transparency by health plans; how much authority to require risk pools and risk adjustments; how much authority to limit-regulate premiums. There are also differences in whether individuals who are not part of small group plans would use the exchange or some other mechanism to purchase health insurance. And, a larger issue of congressional healthcare reform is the affordability and amount of subsidy for people with modest incomes.

The seminar on exchanges was conducted by the Alliance for Health Reform and financed by the Commonwealth Fund and the Kaiser Family Foundation. The Alliance for Health Reform has posted a webcast, podcast, and videos of the seminar for anyone interested in learning more.

I hope this is helpful.


You can read this blog and others like it at the HealthCentral website.