Is ADHD on the rise?

Though several sources agree that attention deficit/hyperactivity disorder (ADHD) is is on the rise, new numbers question how much. According to a recent study published in JAMA Pediatrics, diagnoses of ADHD increased 24 percent in Southern California over the past 10 years, bringing to issue previous estimates.

 As part of the study, doctors reviewed the charts of children treated at the Kaiser Permanante Southern California physician’s group from 2001 to 2010 – 842,830 children in all. They found that in 2001, 2.5 percent of children age 5 to 11 were diagnosed with ADHD, but that number increased to 3.1 percent in 2010.

The Centers for Disease Control and Prevention (CDC) estimates that about 9.5 percent of children age 4 to 17 have ADHD. Researchers in the California study believe their estimate gives a more accurate picture of the rate of ADHD in Southern California because they reviewed actual medical records, rather than relying on parents to respond to telephone surveys, which is how the CDC got its number. Furthermore, the majority of ADHD diagnoses in the California study were made by specialists using strict Diagnostic and Statistic Manual of Mental Disorders (DSM-IV) diagnoses. This complicates previous estimates, as new research found that only 38 percent of primary care physicians actually use the DSM-IV for diagnosing ADHD.

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New CPT Codes for Psychotherapy

New current procedural terminology (CPT) codes went into effect January 1 of this year, marking the first overhaul of the codes used to describe psychotherapy treatment since 1998. The only codes that were revised were the psychotherapy family of codes – codes used to describe testing, health, and behavior remain unchanged.

Reports of the new codes causing major glitches for many providers have started to surface. Many third-party payers, including Medicare and Medicaid, were not updated to recognize the new claim codes, causing delays for payment and denials for service. Though steps are being taken steps to rectify these issues, many providers have not received payment for the work they have done this year.

The American Psychological Association’s coding Web site has had more than 300,000 hits in the past month and has published an extensive list of questions on how to handle this transition and what to do if you are being denied payment. For more information on the new codes, APA has published a special issue.

What has your experience been with the new CPT codes?

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Stress levels highest for youngest adults, study shows

A recent study conducted by the American Psychological Association found that the generation known as Millennials, defined as 18- to 33-year-olds in the U.S., reported the highest stress levels along with the most stress-caused ill effects among the four groups surveyed.

On a 10-point scale, Millennials reported an average stress level of 5.4, the same as that reported by individuals in Generation X (ages 34-47 years). However, more than 52 percent of Millennials reported stress-induced sleeplessness, compared to 48 percent of Generation Xers, 37 percent of Boomers (ages 48-66 years) and 25 percent of Matures (67 years and older). In addition, more Millennials and Generation Xers reported anger and irritability due to stress than Boomers or Matures.

Stress is a risk factor for many health conditions, including high blood pressure, headaches, sleeping problems, heart disease, ulcers, and stroke.

It’s not hard to understand why young Americans are on edge. Work was named as a “somewhat or significant stressor for 76 percent of Millennials,” and the U.S. unemployment rate is 7.9 percent. Thirty-nine percent of Millennials have experienced an increase in stress over the past year. And despite efforts to reduce their stress (i.e., 62% have made attempts to decrease their stress levels over the past five years), 25% of Millennials believe they’re not doing enough to manage it.

The good news? Apparently, we experience generally lower levels of stress as we age—Matures’ average stress level was 3.7 out of 10—and we get better at dealing with stress: 50 percent of Matures think they’re doing an excellent or very good job at managing their stress.

What do you think? Does maturity play a big role in handling stress? What can be done to reduce stress in Millennials and in general? Leave a comment and let us know what you think!

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The Inner Voices Behind Violent Behavior

Firestone_LisaThe following is a guest blog by PAR author Lisa Firestone, PhD. Dr. Firestone is the director of research and education at the Glendon Association.

Too often, the subject of violence is addressed in our society from a platform of sensationalism, disgust, and trepidation. The reporting of violent events incites two reactions from viewers: horrified fascination or a repelled reflex to turn away. Neither reaction inclines us to seek a better understanding of why violence occurs, nor to ask the question: What makes a human being become violent?

The media’s weighted focus on the effects of violence as opposed to the causes isn’t entirely to blame for our resistance to exploring the roots of violence. Part of our hesitance stems from the fact that violence is a deeply disturbing problem. Violent behavior can be triggered by frustration, anger, or a perceived humiliation. Its purpose can be to retaliate, or intimidate, or exert control. It is only when we have a better understanding of violence that we can begin to make a difference.

Even though there is not one answer to what causes violence, there is something I found in my research that has offered an invaluable insight into what goes on in the mind of someone who is violent. After years of researching, interviewing, and assessing violent individuals, along with my father Dr. Robert Firestone, I began to recognize certain “voices” (negative thought processes) that flood the minds of these individuals influencing them to engage in acts of violence.

These “voices” aren’t experienced as hallucinations but rather are a systematic pattern of negative thoughts against to the self, and hostile and suspicious toward others. We call these destructive thoughts “voices” because many of the people we interviewed reported experiencing them that way.

As I developed The Firestone Assessment of Violent Thoughts (FAVT), to measure the “voices” that incite violence, I was able to identify the thinking that sets the stage for violent and aggressive behavior. This information is not only helpful for predicting violent intent, but also for providing an overall understanding that helps explain all types of violence from the extreme examples that make the headlines to the angry and violent reactions that we sense in ourselves and others.

Voices that contribute to violence include those that support social mistrust. These paranoid, suspicious thoughts encourage people to assume a self-protective and defended posture from a perceived danger. Because the paranoia and misperception makes the threat seem real, people feel justified in acting out violence to protect themselves. The paranoia is supported by negative voices about other people being different, strange and bad. It is easier to hurt someone who is perceived as “not like you.” These voices contribute to a person’s suspicion and mistrust of the world at large. An example of these types of voices is: They are out to get you. Don’t trust them.

Other voices that lead to violence are the ones that support people feeling victimized and persecuted. They advise a person that he/she is the victim of mistreatment by others. These voices promote and support thoughts of being discounted, blamed, or humiliated by other people. An example of these voices is: They are going to make a fool of you. They don’t take you seriously.

Violent people have also reported having self-depreciating voices that make them feel that they are unlovable, and that no one will love or care about them. These voices promote isolation and encourage a person to take care of him/herself. They attack other people and see them as rejecting. All of these voices encourage a person not wanting anything from anyone else. An example of these voices is: You will have to take care of yourself because no one else will. Don’t expect anything from anyone, you will only be disappointed.

Self-aggrandizing voices can be a precursor of violence as well because they promote a view that a person is superior to others and deserves to be treated as such. They support an inflated self-image that functions to compensate for deep-seated self-hatred. When the aggrandized sense of self is threatened, for example by slights or perceived disrespect, a person often reacts violently in an effort to regain the aggrandized self-image. Research that links high self-esteem in adolescents to violence actually measured inflated self-esteem or vanity. An example of these voices is: You are so much better than them. How dare they talk to you like that!!

Overtly aggressive voices also contribute significantly to violence. These voices directly encourage taking violent action. They convince a person that to act out aggressively and violently would be appropriate, or that it would be a welcome release, or even be pleasurable. There is a lack of remorse expressed by the person who is influenced by these types of voices. An example of these voices is: Violence is the way to go. Just smash them; you’ll feel better.

Understanding what is going on in the mind of someone who is violent allows us to better assess the risk for violence and to intervene, protecting both the potential perpetrator and victim. Many risk factors for violence can’t be changed, but a person’s thinking is a risk factor that can be. By monitoring the decrease in a person’s violent thoughts during treatment, we are able to assess their improvement. Moreover, in offering violent people an understanding of the thoughts that underlie their tortured thinking, we are providing them with a means by which to take up arms against the voices that lure them into acts of violence.

 

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