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.

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?
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!
The 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.

 
When we introduced our two concussion apps, the Concussion Recognition and Response™ (CRR) and the Concussion Assessment & Response™: Sport Version (CARE), it was our hope that they would help as many children as possible to play sports safely. In order to reach a wider audience, we are pleased to announce that we will be reducing the price of the CRR app from $3.99 to 99 cents and the CARE from $9.99 to $4.99.

The CRR app helps parents and coaches to recognize when an individual is exhibiting signs and symptoms of a suspected concussion, helping them to respond quickly in less than five minutes.

The CARE app provides tools for athletic trainers, team physicians, and other qualified health care professionals to assess the likelihood of a concussion and respond appropriately in less than five minutes.

PAR donates 15 percent of the proceeds from the sale of this app to concussion research at the Children’s National Medical Center and the Matthew A. Gfeller Sport-Related Traumatic Brain Injury Research Center at the University of North Carolina, Chapel Hill.

Visit the App Store or Google Play to download your copy of the app today!
A recent study provides insight into how obsessive compulsive disorder (OCD) develops. Led by Claire Gillan and Trevor Robbins at the University of Cambridge and Sanne de Wit at the University of Amsterdam, the study suggests that compulsive behavior may not be a response to obsessive fears, but instead may be a precursor to those fears (American Journal of Psychiatry, July 2011). That is, compulsions such as repetitive hand-washing may lead to an obsessive fear of germs—rather than the other way around.

“It has long been established that humans have a tendency to ‘fill in the gaps’ when it comes to behavior that cannot otherwise be logically explained,” said Gillan in a recent issue of Cambridge’s Research News. “In the case of OCD, the overwhelming urge to senselessly repeat a behavior might be enough to instill a very real obsessive fear in order to explain it.”

The study, which involved 20 patients suffering from OCD and 20 control subjects, measured patients’ tendency to develop habit-like behavior. Participants were required to learn simple associations among stimuli, behaviors, and outcomes in order to win points on a task. The researchers found that patients suffering from OCD were much more likely to continue to respond with a learned behavior, even when that behavior did not produce the desired outcome; that is, they quickly formed habits, or irresistible urges, to perform a task. These behaviors, initiated and observed in a laboratory setting and in the absence of any related obsessions, suggest that the compulsions themselves may be the critical feature of OCD.

This finding seems to support the approach of exposure and response prevention (ERP) as a treatment for OCD. ERP is a therapy that challenges patients to discontinue compulsive responding and learn that the feared consequence does not occur. Proponents of ERP say that once the compulsion is stopped, the obsession tends to diminish or disappear.

What do you think? What therapies have you found most effective for your clients with OCD? PAR wants to hear from you, so leave a comment and join the conversation!
We are proud to announce the winners for our PARPOP and PARMATCH games. The games were part of the launch of the new PARiConnect platform, PAR’s innovative online testing Web site.

Anthony Donofrio from Ashland, Ohio earned the fastest score on PARPOP, which asks players to race against the clock to test sequential processing speed.

Tricia Cassel from Coral Gables, Florida took the top spot in PARMATCH, a memory game that asks users to match up the logos of various PAR assessments two at a time.

Both winners will receive 25 free administrations and reports on the new PARiConnect system. Congratulations!
Will you be attending the American Board of Vocational Experts 2013 Conference? If so, don’t miss the presentation given by James A. Athanasou, PhD, MAPS, entitled “The Use of the Earning Capacity Assessment Form™-2 in a Medico-Legal Setting: An Australian Experience” on Saturday, April 13, 2013 at 3 p.m.

The American Board of Vocational Experts 2013 Conference will be held in Scottsdale, Arizona from April 12-14, 2013. For more information on the Earning Capacity Assessment Form-2nd Edition, visit its product page to learn more, read a review of the product, or view a PowerPoint presentation.
We are delighted to introduce you to PARiConnect, an online assessment platform that gives you access to your favorite PAR instruments through the convenience of a secure, easy-to-use Web site.

PARiConnect is an intuitive system that allows you to focus on what is most important to you—whether that means scoring your favorite PAR assessments quickly and easily, administering instruments through our secure online system, or allowing our powerful interpretive logic help formulate your treatment plans. Whether you are a researcher looking for a quick way to score paper-and-pencil administrations, a clinician in need of immediate interpretation, or a school psychologist wanting to use e-mail to send assessments, PARiConnect is a highly individualized and customizable interface that brings your work to you, wherever you are.

We are so proud of the PARiConnect system that we would like to offer you three free assessments and three free reports so you can try it without risk. Register today and experience PARiConnect yourself.

Visit www.pariconnect.com to learn more or call 1.855.856.4266 to register.

PAR’s Customers clearly understand what “Creating Connections and Changing Lives” means—our 2012 “Capture the Connection” photography contest solicited 178 entries! Narrowing our choices to just three was a difficult task conducted by two professional photographers and our in-house marketing team.


The efforts and talent of all those who entered are greatly appreciated. The full gallery is available at http://www.parinc.com/capture/Gallery.aspx.


And now, on to our winners!


First Place
Aloha C. Romay, MS
Clinical Psychology
Paducah, KY


When I think of the word "Connection," I think of Family. Everything that we are and we will be begins at home. This photo to me describes how, even before we are born, we create a bond with those around us, those who love us unconditionally. A life that is about to begin has already changed the lives of those who have already started one.

Thank you PAR, Inc. for not only providing us therapists with the tools and resources we need to do our jobs more efficiently, but also for the amazing opportunity to be a part of this contest. For the latter one, I feel very grateful.

Second Place
Bonnie Voegeli, PsyD
School Psychologist
Brookfield, CT


My sons had spent an afternoon last summer playing in the sprinkler and on their swing set. In an effort to get all three kids into one picture, I spontaneously hung my youngest from the chains and had each brother grab him around the waist. They were so surprised and they stayed this way just long enough for me to capture this shot.

As I considered the theme of “Creating Connections, Changing Lives” this photo instantly came to mind, for the obvious reason of my youngest connecting to his two older brothers. Beyond that, however, is the life-changing connection that occurs from growing up with siblings. The bonds that are formed from simple joys such as a sprinkler, a swing set, and a warm summer day are as life-changing as you can get!

When PAR called to tell me that my photo had won second place, it was three days after my hometown of Newtown, CT had been devastated by the horrific school shooting at Sandy Hook Elementary School. Needless to say, our community is heartbroken over the loss of our town’s babies, teachers, administrator, and a fellow school psychologist. The news from PAR was such a welcomed surprise, and I told PAR that it was the first time I had smiled in three days. Thank you, PAR!


Third Place
Terri Sisson
School Psychologist
Madison County, VA


My name is Terri Sisson and I’m the one-and-only school psychologist in my small hometown, Madison County, Virginia. I love taking photos… and the photo session in Virginia Beach was no exception! This picture is one of my favorites because it is truly about “creating connections, changing lives.” Every year, my family goes camping in Virginia Beach with several families from our community. We spend lots of time at the beach, riding bikes, and bonding around the campfire. We are truly making connections and creating memories that I hope our children will cherish for a lifetime. I cannot express my excitement over the fact that my photo won the third-place prize. I am so happy that the judges saw the potential in a photo that is so near and dear to my heart. Thank you to PAR for this opportunity… What a wonderful Christmas present!