The diagnosis of Attention Deficit
Disorder (ADD) is surrounded with controversy. For many
years children who experienced problems in attention and
executive functioning were given labels such as minimal
brain dysfunction or developmentally delayed. The
percentage of children diagnosed stayed around the same
amount for years.
With the rise in awareness of Attention Deficit Disorder
it is important that individuals seeking this evaluation
from Dr. Carr be aware of the commitment required. To
review his policy on ADHD evaluation you can review the
protocol by
clicking here
(requires Adobe Reader).
Insurance carriers are likely
to have restrictions governing the use of psychological
testing. To read Dr. Carr's position statement on this
please click here.
However in the last 10 to 15
years there has been an explosion of children and
adolescents diagnosed with ADD and growing alarm that we
are needlessly medicating our
youth because we do not dedicate sufficient support to
our schools or find ourselves unable to have the time to
structure their environment for effective learning.
As to my position on the question of whether the
syndrome of ADD exists I am clearly of the view that
there is such a problem. For the person experiencing the
cognitive problems of ADD the medications that are
available can work wonders and I believe that their use
is entirely appropriate. However, with that said, I
would observe that there are many forces in our society
that "want" the diagnosis to be made. The schools want
it for the purpose of how the medication can calm or
restrict the child in behavior thereby requiring less
attention from the teacher and school system that is
overworked and underpaid. As long as a teacher makes
less than a prison guard there is something terribly
wrong with our system.
The pharmaceutical companies enjoy significant profit
in the medications they market for ADD and other
behavioral problems of our children. Flip through any
psychiatric journal and count the endless pages devoted
to ads showing the effectiveness of their agent for ADD.
Among my fellow practitioners there is a coercion to
give the diagnosis because of pressure from the schools,
the pharmaceutical companies, other practitioners and
the parents who are seeking a solution that is less
demanding. Again I will note that many parents make
tremendous effort to help their child but there is a
growing number of parents who are so overwhelmed with
financial problems, two jobs, lack of extended family
support, or just plain fatigue that they cannot make it
happen for their children. What is needed NOW is that we
as a people pressure our government to not just give lip
service to "leaving no children behind" but to actually
do what is needed in helping parents help their
children. In the final analysis it is cheaper to support
after school programs and offer education classes to our
families than what it takes to house a person in prison.
 The
central part of my evaluation for ADD is to approach the
question from the view that past history is important
but that the first priority is to establish a controlled
structure in the child's home and school environment and
then judge their response to this rule-setting. I view
ADD as a neurological condition (i.e., seizures, memory
disorders) that should not be altered by changing the
conditioning factors in the environment. In other words
the child should continue to display problems even if
properly reinforced.
I obtain the historical information by asking the
school to complete standardized testing used in
distinguishing between an ADD and general youth
population. I also collect information about executive
function capacity and an extensive developmental history
questionnaire is completed. I obtain "real-time" data
about the child through direct observation in the office
and also administer a computerized test battery that
establishes baseline measures of attention and other
cognitive features. The parents are guided in a
discussion about the principles of learning and
extensive handouts are used for home reference and to
assist the teachers and others involved with the child
so that standardization is obtained.
The program is allowed to run for approximately 4-6
weeks and communication is maintained with all members
of the team. If the child is found to not have altered
their behavior and other indices suggest to me that
other possible problems have been ruled out then a
diagnosis of ADD is made. I recognize that my
requirements for the diagnosis are high and that most
other practitioners would be much easier to work with,
however I am committed to the child and want to be as
sure as possible as to the diagnosis. If you are found
to have ADD from my office you can rest assured that
there is no better explanation.
For those adolescents and
young adults I find to have ADD I will usually refer
back to their primary care physician for medication
trials. In some cases I will also refer to Ashot Azatian,
M.D. a psychiatist who is well-versed in issues of medication.
For teenagers and children below the age of 16 I will
usually refer back to their treating physician for
medication management. I have worked for over thirty years in the local health care community and have
good working relationships with the majority of
physicians in Lubbock and West Texas.
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