The Behavior, Development, and Mental Health Team at Duke Children's Primary Care is a multidisciplinary team that provides on-site triage, consultation, assessment, and intervention for children referred by their primary care provider for developmental, behavioral, educational, or mental health concerns.  

The team is coordinated by:

• Barbara Keith Walter, PhD, MPH
  Clinical Psychologist
• Jane Howard, MSW, LCSW
  Clinical Social Worker
• Patricia S Cheng, PhD
  Clinical Psychologist
• Richard D'Alli, MD
  Child and Adolescent Psychologist

Patients must be patients at one of the three sites of Duke Children’s Primary Care and referred by their primary care provider.

ADHD Evaluation

The Behavior, Development, and Mental Health Team provides evidence-based evaluation and treatment of possible ADHD. We are committed to following the American Academy of Pediatrics (AAP) guidelines for assessment and management of ADHD in school-aged children.

In particular, the ADHD assessment involves the following components: 

• Review of medical, developmental, educational, and social history;
• Use of explicit DSM-IV criteria for diagnosis of ADHD;
• Request for information about the child's symptoms in more than one setting. Information is obtained from a teacher and the parent/guardian as well as from direct observation in structured as well as unstructured situations;
• Careful assessment of potential coexisting conditions, including disruptive behavior disorders, learning disorders, anxiety, and depression;
• Consideration of developmental and family context of presenting symptoms.

Initial Appointment
The initial diagnostic evaluation appointment is scheduled for 90 minutes, and you and your child need to be present. At the initial visit, your child's clinic chart and available school or outside records are reviewed.

Your child's attention, behavior, emotional development, cognitive abilities, and academic achievement are screened using clinical interviews and a variety of instruments, including a parent report, teacher report, and self-report questionnaires, as appropriate. Questionnaires (Vanderbilt) are given to parents and teachers to be completed prior to the evaluation.   

Follow-Up Appointment
A 50-minute follow-up appointment is also scheduled one to two weeks following the initial appointment for you to return without your child to discuss the results of the diagnostic evaluation and develop an intervention plan.

Recommendations
Recommendations for an intervention plan are based on research about effective treatment of ADHD and may include the following: 

• Educational accommodations and support to minimize the impact of ADHD on academic achievement;
• Parent education, training, and support regarding the challenges of parenting a child or adolescent with ADHD and assistance with educational advocacy;
• Consideration of a trial of stimulant medication to target ADHD symptoms;
• Individual skills training to improve time management, organizational, and study skills;
• Individual and family therapy to target co-existing conditions that may affect the ADHD intervention.

Resources for Parents
You will be provided with information about the Teer House ADHD parent education sessions as well as information about other community resources and/or clinical trials being conducted through the Duke Child and Family Studies Center ADHD program. In addition, we will provide individualized education and support as appropriate.

Payment and Insurance
The cost of evaluation and treatment of possible ADHD is typically covered by insurance, but you will need to consult with your insurance company about your specific benefits and co-payments or deductibles. Our financial care representatives will also assist with verifying benefits after a referral is made and before an appointment is scheduled.

Contact
If you have questions about the Behavior, Development, and Mental Health Team at Duke Children’s Primary Care, please contact Barbara Keith Walter, PhD, MPH at 919-620-5388.