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We believe that no one should ever have to walk alone when learning about the treatment options and deciphering between myths and facts associated with ADHD. Now, you can learn how a Portrait Health Nurse Navigator evaluates a child and determines appropriate investigative steps from the comfort of your home.
What is a Nurse Navigator?
Every patient and parent at a Portrait Health Center is assigned a Nurse Navigator. As the title implies, the Nurse Navigator is the guide who literally takes your hand and leads you through the initial evaluation and serves as your advocate when the team of specialists design personalized treatment plans. Every parent concerned about a child should visit a Portrait Health Centers for an evaluation by a Nurse Navigator.
Since there is no single test for ADHD, the Nurse Navigator must first rule out other conditions for which there are tests. The Nurse Navigator does this through a series of questions which lead to the development of an investigative protocol unique to the child being examined. Here are some of the types of questions a Nurse Navigator will ask followed by an explanation as to why this information is important:
1. Health history
a. Because a comprehensive health history provides insight as to what may be contributing to the clinical symptoms being observed today.
b. Sample question: List any medical problems that your doctors have diagnosed or treated.
c. Why we ask: Conditions like anemia (iron deficiency) and hypoglycemia (low blood sugar) can lead to the lack of ability to concentrate, which is often mistaken as ADHD- inattentive form.
d. Nurse Navigator Recommendations: A visit to the physician who will order a blood test to check for metabolic disorders is recommended. If either anemia or hypoglycemia is identified, the physician will develop a customized treatment plan, in conjunction with the Registered Dietitian, to treat the underlying cause of the inattentiveness.
2. Current prescription drug usage by the child
a. Because a thorough drug history provides insight as to what may be contributing to the outward symptoms being observed today.
b. Sample question: List all prescribed drugs and over-the-counter medications, including vitamins, herbal preparations and inhalers taken in the past year.
c. Why we ask: The side effects of more than 34 medications include the hyperactive symptoms that may be mistaken for ADHD.
d. Nurse Navigator Recommendations: A visit to the physician who will assess whether the symptoms being observed are related to current prescribed and/or over-the-counter medications.
3. Family Health History
a. Because both ADHD and many of the other conditions that have symptoms like ADHD are hereditary.
b. Sample question: Does anyone in your family have a food allergy like an allergy to wheat gluten (Celiac disease)?
c. Why we ask: Food allergies are often inherited. Some food allergies like Celiac disease, an allergy to wheat-containing products, can often cause symptoms that look like ADHD. Celiac disease can be easily treated in most cases.
d. Nurse Navigator Recommendation: A visit to the physician who will order a blood test for food allergies is recommended. If allergies are found, a visit to the Registered Dietician would follow where a diet would be developed to avoid the foods causing the symptoms and behaviors.
4. Lifestyle review of the child and the family
a. Because depression and anxiety can be caused by traumatic events in the child’s life. These can range from a death in the family, to divorce and even to the loss of a family pet. Depression and anxiety can look like ADHD.
b. Sample question: Have any significant changes occurred in your family (a death, divorce, loss of a pet) recently?
c. Why we ask: Because changes in the family routine or structure can cause depression and anxiety which often presents symptoms similar to ADHD.
d. Recommendation: If events have occurred, an appointment with the Psychologist could help the child (and sometimes, the family) adjust more easily to these events or changes.
5. Behavior Assessment
a. Because how and when a child behaves in certain ways can tell us much about the underlying causes of that behavior.
b. Sample question: When do you notice your child acting in a way that concerns you (hyperactive, depressed, anxious)? Before meals? After meals? Bedtime? Early morning? At school?
c. Why we ask: Because the type of behavior and the timing of the behavior can help us identify possible causes for the behavior. For example, if the behavior is hyperactivity and it occurs after certain meals, the child may have a food allergy. If the behavior is a lack of energy and interest and it occurs early in the morning, sleep issues may be the cause.
d. Nurse Navigator Recommendation: Depending on the answer to these questions, a visit with a Registered Dietician to avoid food allergies or a visit to a Sleep Specialist to identify and correct sleep issues may be recommended.
6. Diet
a. Because what is consumed, and when it is consumed provides information concerning nutritional deficiencies and energy level.
b. Sample question: Does your child experience episodes of excess energy or lack of energy at any time of the day?
c. Why we ask: Consumption of foods that are high in simple carbohydrates and sugar can lead to both energy spikes and hyperactivity, followed quickly by energy depletion and inattentiveness.
d. Nurse Navigator Recommendation: Depending on the responses, a visit with a Registered Dietitian to prepare a customized meal plan may be recommended.
7. Hearing and Auditory Processing
a. Because hearing is one of the primary senses used in the learning process. A child must be able to hear and understand the lesson being communicated.
b. Sample question: Would others say that your child needs to have instructions repeated?
c. Why we ask: The need to have verbal instructions repeated is a sign that hearing is impaired, or that an auditory processing disorder may be a contributing factor to learning difficulties.
d. Nurse Navigator Recommendations: A visit to the Audiologist will be recommended for a comprehensive hearing examination and assessment for auditory processing disorders.
8. Vision and Visual Processing
a. Because vision is one of the primary senses used in the learning process. A child must be able to see the written instruction and comprehend the written message.
b. Sample question: Does your child need to re-read written text in order to better understand what has been read?
c. Why we ask: Poor reading comprehension may be due to a number of factors, all of which are treatable if identified.
d. Nurse Navigator Recommendations: A visit to the Optometrist will be recommended for a comprehensive eye examination and assessment for visual processing disorders.
9. Musculoskeletal Health and Fitness
a. Because posture and spinal health are important to optimized learning
b. Sample question: Has your child ever complained of pain in the head or neck?
c. Why we ask: Misalignments of the vertebra in the neck, also called subluxations, cause compressions on the spinal cord, which blocks the impulses and nerve communications between the brain and the senses. Very often, correcting these subluxations leads to the elimination of the symptoms associated with ADHD and learning impairments.
d. Nurse Navigator Recommendations: A visit to the Chiropractor will be recommended for an assessment of spinal misalignments. If a subluxation is identified, the Chiropractic Physician will outline a recommended course of treatments and exercises to relieve the compression on the spinal cord.
10. Emotional Stability and Psychological Health
a. Because many psychological conditions exhibit similar or identical symptoms as ADHD.
b. Sample question: Are you concerned about how your child reacts to change, stress, worry or sadness?
c. Why we ask: Anxiety and depression is quite common in children, and identifying the root cause for the symptoms is critical to implementing the appropriate therapies.
d. Nurse Navigator Recommendations: Based on the responses, a visit to the Clinical Psychologist may be recommended to provide a series of comprehensive standardized behavioral and mental health assessments, and as appropriate, a course of counseling sessions with the child and/or family.
11. Sleep Assessment
a. Because sleep deprivation or lack of quality nighttime sleep is a common cause of impaired learning and classroom inattentiveness.
b. Sample question: Does your child ever awake during the night?
c. Why we ask: Disruptions to nighttime sleep prevent the brain from resting and recharging for the demands of a school day.
d. Nurse Navigator Recommendations: A visit to a Pediatric Sleep Specialist may be recommended to determine the cause for disrupted sleep.
From this information, a Portrait Health Nurse Navigator can design a thorough investigative program to determine the true underlying cause(s) of impaired learning and/or behavioral deficiencies.
Since there is no single test for ADHD, the Nurse Navigator must first rule out other conditions for which there are tests. The Nurse Navigator does this through a series of questions which lead to the development of an investigative protocol unique to the child being examined. Here are some of the types of questions a Nurse Navigator will ask followed by an explanation as to why this information is important:
1. Health history
a. Because a comprehensive health history provides insight as to what may be contributing to the clinical symptoms being observed today.
b. Sample question: List any medical problems that your doctors have diagnosed or treated.
c. Why we ask: Conditions like anemia (iron deficiency) and hypoglycemia (low blood sugar) can lead to the lack of ability to concentrate, which is often mistaken as ADHD- inattentive form.
d. Nurse Navigator Recommendations: A visit to the physician who will order a blood test to check for metabolic disorders is recommended. If either anemia or hypoglycemia is identified, the physician will develop a customized treatment plan, in conjunction with the Registered Dietitian, to treat the underlying cause of the inattentiveness.
2. Current prescription drug usage by the child
a. Because a thorough drug history provides insight as to what may be contributing to the outward symptoms being observed today.
b. Sample question: List all prescribed drugs and over-the-counter medications, including vitamins, herbal preparations and inhalers taken in the past year.
c. Why we ask: The side effects of more than 34 medications include the hyperactive symptoms that may be mistaken for ADHD.
d. Nurse Navigator Recommendations: A visit to the physician who will assess whether the symptoms being observed are related to current prescribed and/or over-the-counter medications.
3. Family Health History
a. Because both ADHD and many of the other conditions that have symptoms like ADHD are hereditary.
b. Sample question: Does anyone in your family have a food allergy like an allergy to wheat gluten (Celiac disease)?
c. Why we ask: Food allergies are often inherited. Some food allergies like Celiac disease, an allergy to wheat-containing products, can often cause symptoms that look like ADHD. Celiac disease can be easily treated in most cases.
d. Nurse Navigator Recommendation: A visit to the physician who will order a blood test for food allergies is recommended. If allergies are found, a visit to the Registered Dietician would follow where a diet would be developed to avoid the foods causing the symptoms and behaviors.
4. Lifestyle review of the child and the family
a. Because depression and anxiety can be caused by traumatic events in the child’s life. These can range from a death in the family, to divorce and even to the loss of a family pet. Depression and anxiety can look like ADHD.
b. Sample question: Have any significant changes occurred in your family (a death, divorce, loss of a pet) recently?
c. Why we ask: Because changes in the family routine or structure can cause depression and anxiety which often presents symptoms similar to ADHD.
d. Recommendation: If events have occurred, an appointment with the Psychologist could help the child (and sometimes, the family) adjust more easily to these events or changes.
5. Behavior Assessment
a. Because how and when a child behaves in certain ways can tell us much about the underlying causes of that behavior.
b. Sample question: When do you notice your child acting in a way that concerns you (hyperactive, depressed, anxious)? Before meals? After meals? Bedtime? Early morning? At school?
c. Why we ask: Because the type of behavior and the timing of the behavior can help us identify possible causes for the behavior. For example, if the behavior is hyperactivity and it occurs after certain meals, the child may have a food allergy. If the behavior is a lack of energy and interest and it occurs early in the morning, sleep issues may be the cause.
d. Nurse Navigator Recommendation: Depending on the answer to these questions, a visit with a Registered Dietician to avoid food allergies or a visit to a Sleep Specialist to identify and correct sleep issues may be recommended.
6. Diet
a. Because what is consumed, and when it is consumed provides information concerning nutritional deficiencies and energy level.
b. Sample question: Does your child experience episodes of excess energy or lack of energy at any time of the day?
c. Why we ask: Consumption of foods that are high in simple carbohydrates and sugar can lead to both energy spikes and hyperactivity, followed quickly by energy depletion and inattentiveness.
d. Nurse Navigator Recommendation: Depending on the responses, a visit with a Registered Dietitian to prepare a customized meal plan may be recommended.
7. Hearing and Auditory Processing
a. Because hearing is one of the primary senses used in the learning process. A child must be able to hear and understand the lesson being communicated.
b. Sample question: Would others say that your child needs to have instructions repeated?
c. Why we ask: The need to have verbal instructions repeated is a sign that hearing is impaired, or that an auditory processing disorder may be a contributing factor to learning difficulties.
d. Nurse Navigator Recommendations: A visit to the Audiologist will be recommended for a comprehensive hearing examination and assessment for auditory processing disorders.
8. Vision and Visual Processing
a. Because vision is one of the primary senses used in the learning process. A child must be able to see the written instruction and comprehend the written message.
b. Sample question: Does your child need to re-read written text in order to better understand what has been read?
c. Why we ask: Poor reading comprehension may be due to a number of factors, all of which are treatable if identified.
d. Nurse Navigator Recommendations: A visit to the Optometrist will be recommended for a comprehensive eye examination and assessment for visual processing disorders.
9. Musculoskeletal Health and Fitness
a. Because posture and spinal health are important to optimized learning
b. Sample question: Has your child ever complained of pain in the head or neck?
c. Why we ask: Misalignments of the vertebra in the neck, also called subluxations, cause compressions on the spinal cord, which blocks the impulses and nerve communications between the brain and the senses. Very often, correcting these subluxations leads to the elimination of the symptoms associated with ADHD and learning impairments.
d. Nurse Navigator Recommendations: A visit to the Chiropractor will be recommended for an assessment of spinal misalignments. If a subluxation is identified, the Chiropractic Physician will outline a recommended course of treatments and exercises to relieve the compression on the spinal cord.
10. Emotional Stability and Psychological Health
a. Because many psychological conditions exhibit similar or identical symptoms as ADHD.
b. Sample question: Are you concerned about how your child reacts to change, stress, worry or sadness?
c. Why we ask: Anxiety and depression is quite common in children, and identifying the root cause for the symptoms is critical to implementing the appropriate therapies.
d. Nurse Navigator Recommendations: Based on the responses, a visit to the Clinical Psychologist may be recommended to provide a series of comprehensive standardized behavioral and mental health assessments, and as appropriate, a course of counseling sessions with the child and/or family.
11. Sleep Assessment
a. Because sleep deprivation or lack of quality nighttime sleep is a common cause of impaired learning and classroom inattentiveness.
b. Sample question: Does your child ever awake during the night?
c. Why we ask: Disruptions to nighttime sleep prevent the brain from resting and recharging for the demands of a school day.
d. Nurse Navigator Recommendations: A visit to a Pediatric Sleep Specialist may be recommended to determine the cause for disrupted sleep.
From this information, a Portrait Health Nurse Navigator can design a thorough investigative program to determine the true underlying cause(s) of impaired learning and/or behavioral deficiencies.
