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GP Referral
A GP referral is required for all undiagnosed & diagnosed ADHD assessments.
Please see your GP prior to contacting our clinic.
Your GP will send your referral directly to us.
Booking Approach
Text message confirmation within 3 days of the clinic receiving your GP referral.
Phone call and text contact to book your appointment within 7-10 days of receiving your GP referral
Appointment Location
Video appointments and at our clinic in Belconnen, 2617.
Undiagnosed ADHD Diagnosis
$1500 with a Medicare rebate of $255.90= $1244.10
2 to 3 hour clinical assessment
30 mins consultation with Psychiatrist
Already Diagnosed ADHD
Diagnosed ADHD by a neurologist or paediatrian or psychiatrist:
Reviews, changes or optimisation of current ADHD medication
Diagnosed ADHD by a Clinical Psychologist :
Commencement on ADHD medication
Price :
60 minute appointment $700 with a Medicare rebate of $192= $508
90 minute appointment $900 with a Medicare rebate of $192= $708
The price includes covers 3 aspects
1. Clinical Assessment
2 to 3 hours with Mental Health Clinician
Details
2. Psychiatric Consultation & Diagnosis
30 mins with Psychiatrist
3. Medication Support
check-in call from Dr Lewis
email helpdesk
phone review
clinical support to help with finding the correct dose Details
Duration
RMC practices a Neurodiverse Affirming assessment.
We allow 3 hours for this aspect, typically the average duration is about 2.5 hours.
This aspect is a relaxed and yet structured approach which allows clients the freedom to
engage in a conversation style assessment.
We encourage a partner or adult family members to be present in the clinical assessment, if the client wishes this to be so. Clients can also find it helpful when completing the self report electronic questionnaires to share the questions, for a perspective from another trusted adult.
Clients are encouraging to take a comfort break at any stage.
Our team are very aware that individuals with neurodiverse presentations may benefit from
movement and a comfort break from the assessment for a brief period.
For video consultations we encourage our Clients to be in a physical space where they feel safe and at peace.
The ADHD clinical assessment explores :
1. Executive Functioning
This investigation explores symptoms across Self Organisation, Self Restraint,
Self Motivation, Self Regulation of Emotions, & Self Management to Time.
Executive Functioning challenges encompasses:
Difficulty with focused and sustained attention
Hype-focusing , Distractability, Procrastination,
Verbal & cognitive impulsivity, Behavioural Impulsivity,
Difficulties with emotional regulation & Rejection sensitivity,
Planning & prioritisation, Time Blindness
Working Memory, Inner Restlessness, Insomnia & Sleep hygiene
The clinical assessment uses :
Barkley Deficits in Executive Functioning Scale (BDEFS)
Difficulties in Emotional Regulation Scale (DERS)
Rejection Sensitivity Questionnaire (RSQ)
2. Clinical Interview
This activity is conducted using the :
DIVA-5, The Diagnostic Interview for ADHD in adults
The Adult ADHD self-report Scale (ASRS)
Insomnia Severity Scale
3. Functional Impairment
Functional impairment is central to ADHD and consequences and difficulty functioning in certain areas of daily life are for the most part what triggers the request for an ADHD assessment.
This activity is explored using :
The WEISS Functional Impairment Rating Scale .
Impairment typically occurs across Family, Work, Education, Life Skills, Self Esteem ,Relationships
4. Mental Health Disorders
The symptoms of ADHD are common in other mental health disorders.
An evaluation will consider whether the symptoms belong to ADHD, another mental health condition,
another physical health condition, or if they represent more than one disorder.
ADHD can be present with other mental health disorders.
The clinical assessment uses the:
SCID-5, The Structured Clinical Interview for DSM-5.
Screening for Trauma, Autism, Bipolar Mood Disorder,
Borderline Personality Disorder, Anxiety & Depression.
A referral to a Clinical Psychologist may be required if the
Clinical team identify a possible Intellectual Disability.
Our diagnostic approach does not include the use of neuropsychological tests.
Further information
Psychiatrists are specialists in diagnosing, and treating the range of adult mental health and psychiatric disorders. See ADHD diagnostic frameworks.
The Psychiatrist confirms the diagnosis of ADHD.
Psychiatrists are trained in understanding how medication works on the brain and body and any interactions or potential complications between different medications.
Dr Lewis will collaboratively discuss ADHD medication:
Explanation of ADHD medication
Clinical trials highlighting effectiveness and safety
Studies on Safety of Vyvanse medication:
How ADHD medication works: click here for more details
Finding the correct dose
With stimulant medication is fundamental to gaining benefits of longer attention, less distractibility, greater focused attention, less difficulty with starting and finishing activities that are boring, long, tedious, repetitive, difficult, needing a lot of thought or preparation or do not offer an immediate reward.
The optimal dose
For ADHD medication is not determined by height or weight, but is determined by how efficiently the medication is metabolised in the GI tract, how efficiently the medication is metabolised and how efficiently the medication passes across the blood brain barrier.
The correct dose is specific to each person and one person may require a much higher dose to obtain the same benefits as another individual. Some people may experience mild physical side- effects, and so an approach of gradually testing out a gradually increased dose, incrementally, is required.
Dr Lewis has created a comprehensive Improvements & Side Effects Diary to help monitor your progress and decide on the most suitable dose of ADHD medication.
The easy to read diary includes explanations and answers to any common occurring side effects which sometimes present while a person in adapting to the medication at different doses.
Our approach follows an established approach of diluting medication in water, and by using a plastic syringe, gradually increasing the amount of the solution every three days.
Blood Test, ECG & Urine Drug Test
A pathology visit is required where a brief ECG test on your heart and Urine Drug test and
Blood Test will take place.
Click here for more detail Blood Pressure reading Obtained from any pharmacy
Blood Test
At the pathology clinic the nurse will undertake a full blood test which explores a number of different medical conditions and presentations.
This is important to rule out any possible medical causes of long-term challenges with attention, concentration, energy, and motivation.
Your GP may have undertaken this blood test at the time of your appointment with them when you first discussed the possibility of ADHD.
If the blood test has not been undertaken by your GP then our clinic will send you a script which will include the ECG and urine drug test.
Detail on a Full Blood Test can be found here at Health Direct Gov AU
ECG and Urine Drug Test
Emailed to you
Please print this form out & take to either:
Laverty Pathology
Capital Capital
Both have multiple clinics
Results sent directly to our clinic
ECG
This is a brief test that which monitors your heart.
This is required as ADHD can cause an increase in heart rate.
Further details found here
Urine drug test
This is to ensure that any prescribed ADHD medication does not
interact with any possible substances an individual is using.
Blood Pressure Reading
Any pharmacy offers a reading. It takes a few minutes and does not require an appointment.
Please take a picture on your smart device and email this directly to the clinic
Adults with attention-deficit/hyperactivity disorder (ADHD) have difficulty in self-management,
including organisation, planning, initiating and completing tasks on a timely basis, tracking
and shifting tasks, self-monitoring, and self-inhibition.
These are termed “executive functions” (EFs) which, can be viewed
as “those self-directed actions needed to choose goals and to create, enact,
and sustain actions toward those goals (Barkley, 2012).
This difficulty in self-regulation typically results in reduced productivity, inefficiency, missed deadlines,
poor planning, “careless” errors, and losing and forgetting things as a result of disorganistation.
In some (particularly those with the combined form of ADHD), reduced inhibitory control
may also lead to emotional dysregulation and inappropriate verbal and/or physical behavior in interpersonal interelationships. Over the lifetime of the individual, these difficulties contribute to failure to achieve goals—personally, academically, and occupationally. These failures in turn likely contribute to the high rates of anxiety and depression in adults with ADHD
The diagnostic clinical assessment is conducted using a semi-structured clinical interview, which explores the presentation as an Executive Functioning Deficits Disorder.
ADHD is a neurodevelopmental disorder that manifests in something called executive dysfunction.
Executive dysfunction causes your brain to have difficulty selecting and monitoring your
behavior to reach your goals.
It affects task management, scheduling, awareness of time, goal setting, and concentration.
A better way to think about and detect these symptoms are as problems with executive functioning (EF).
Executive Functioning encompasses working memory, self-inhibition, resistance to distraction,
attentional shifting, organising, planning, self-monitoring and time blindness.
The term “Attention Deficit“ is unhelpful and leads to confusion and misunderstanding of
exactly what this presentation is.
Hyperactivity is one of the many aspects of ADHD, however adults with ADHD are not hyperactive in the same way an 8 year boy is. This misunderstanding is what has lead to so many adults remaining undiagnosed for so long.
The term “hyperactivity ” current evidence shows, has no diagnostic validity in adults, and should be replaced with Impulsivity. Impulsivity has the potential to lead to significant negative consequences for adults in multiple areas of their life.
The most significant issue is that the current diagnostic criteria and terms used are wholly inadequate and discriminatory when considering how this disorder presents in Women and Adolescent girls.
Our diagnostic approach embraces ADHD as a broader Executive Functioning Self Regulation Deficit Disorder in Women which encompasses difficulty in emotional regulation and rejection sensitivity and cognitive and verbal and behavioural impulsivity.
More than two-thirds of individuals with ADHD have at least one other coexisting condition. The symptoms of ADHD—constant motion and fidgetiness, interrupting and blurting out, difficulty sitting still and need for constant reminders, etc.—may overshadow these other disorders.
But just as untreated ADHD can present challenges in everyday life, other disorders can also cause unnecessary suffering in individuals with ADHD and their families if left untreated. Any disorder can coexist with ADHD, but certain disorders tend to occur more commonly with ADHD. ADHD may coexist with one or more
Disruptive behaviour disorders
40 percent of individuals with ADHD have
oppositional defiant disorder (ODD). ODD involves a pattern of arguing; losing one’s temper; refusing to follow rules; blaming others; deliberately annoying others; and being
angry, resentful, spiteful and vindictive.
Among individuals with ADHD, conduct disorder (CD) may also be present, occurring in 27 percent of children, 45–50 percent of adolescents and 20–25 percent of adults with ADHD. Children with conduct disorder may be aggressive to people or animals, destroy property, lie or steal things from others, run away, skip school or break curfews. Adults with CD often exhibit behaviors that get them into trouble with the law.
Learning disorders
Up to 50 percent of children with ADHD have a coexisting learning disorder, whereas 5 percent of children without ADHD have learning disorders. Learning disorders can cause problems with how individuals acquire or use new information such as reading or calculating. The most common learning disorders are dyslexia and dyscalculia. In addition, 12 percent of children with ADHD have speech problems, compared with 3 percent without ADHD.
Sleep disorders
One-quarter to one-half of parents of children with ADHD report that their children suffer from a sleep problem, especially difficulties with falling asleep and staying asleep. Sleep problems can be a symptom of ADHD, may be made worse by ADHD or may make the symptoms of ADHD worse.
Anxiety
Up to 30 percent of children and up to 53 percent of adults with ADHD may also have an anxiety disorder. Patients with anxiety disorders often worry excessively about a number of things (school, work, etc.) and may feel edgy, stressed out, tired and tense and have trouble getting restful sleep.
Mood disorders
In adults, approximately 38 percent of ADHD patients have a co-occurring mood disorder. Mood disorders are characterized by extreme changes in mood. Children with mood disorders may seem to be in a bad mood often. They may cry daily or be frequently irritable with others for no apparent reason. Mood disorders include depression, mania and bipolar disorder.
Approximately 14 percent of children with ADHD also have depression, whereas only 1 percent of children without ADHD have depression. In adults with ADHD, approximately 47 percent also have depression. Typically, ADHD occurs first and depression occurs later. Both environmental and genetic factors may contribute.
Up to 20 percent of individuals with ADHD may show symptoms of bipolar disorder, a severe condition involving periods of mania, abnormally elevated mood and energy, contrasted by episodes of clinical depression. If left untreated, bipolar disorder can damage relationships and lead to job loss, school problems and even suicide.
Our diagnostic approach uses the Weiss Functional Impairment Rating Scale.
The WFIRS-S items collect the reporter’s perspective of their own functioning across seven domains:
Family (8 items), Work (11 items), School (10 items), Life Skills (12 items),
Self-Concept (5 items), Social (9 items) and Risk (14 items).
A functional impairment indicates that the available resources, comprised of internal resources eg, ability to concentrate, remember, and not be impulsive) and external resources (eg, support from parents and teachers), are inadequate to meet the environmental demands (eg, academic, occupational, financial, and social functions) that tend to increase in number, scope, and complexity with increasing age and level of independence.
As the numbers and levels of internal and external resources differ between individuals, functional impairments will emerge at different timepoints; some patients will demonstrate impairments early in childhood, whereas impairments may not emerge in others until later in life.
At RMC we explore your lived experience of your impairments and when they emerged for you and that may well be into your adult life.
Click here for resources on Women and ADHD
Introduction to ADHD
By Dr Tracy Marks YouTube
Dr Thomas Brown Video
ADHD as a disorder of Self Regulation
by Dr Russell Barkley video
Inner Restlessness & ADHD
By Russell Barkley video
ADHD & Caffeine
By Dr Russell Barkley
Men with ADHD
Resources for managing disregulation, shame & anger
Executive Functioning
ADHD & Executive Functioning
By Dr Russell Barkley
Causes of ADHD
By Dr Russell Barkley
Why ADHD is so impairing
By Dr Russell Barkley
Rejection Sensitivity Dysphoria
Rejection Sensitivity & Borderline Personality Disorder & ADHD
Video By Dr Sanil Rege
ADHD & Rejection Sensitivity Dysphoria
By Dr Russell Barkley
An ADHD guide to Emotional Dysregulation &
Rejection Sensitivity Dysphoria
By Dr William Dodson
Rejection Sensitivity & Social Anxiety
By Dr Sharon Saline
Hyperfocusing
by Dr Russell Barkley
Perfectionism
By Dr Sharon Saline
Sleep
Sleep & ADHD
By Dr Russell Barkley
Already Diagnosed ADHD :
Diagnosed ADHD by a neurologist or paediatrician or psychiatrist will cover
changes or optimisation of current ADHD medication.
Diagnosed ADHD by a Clinical Psychologist will cover
trialing and starting on ADHD medication.
Price
60 minute appointment $700 with a Medicare rebate of $192= $508
90 minute appointment $900 with a Medicare rebate of $192= $708
1. Clinical Assessment
60 mins or 90 mins with Medical Practitioner & Mental Health Specalist
2. Prescribing of ADHD Medication by Dr Lewis
Dr Lewis to prescribe or amend stimulant medication.
Detail. Read for detailed information on ADHD stimulant medication
Dr Res to prescribe all classes of psychiatric & physical health medication
3. Medication Support
email helpdesk
phone review
clinical support to help with finding the correct dose
review phone call from Dr Lewis or Dr Res
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