The Hunt Assessment and Treatment System

The Hunt Assessment and Treatment System^®

There are four essential components to achieving a comprehensive assessment that includes acknowledge-ment of areas of strength, intelligence, accomplishments and supportive relationships – as well as clarity about areas of difficulty. We strive to genuinely get an awareness of who you are as a person, not just what symptoms are bothering you today. We are invested in your life, not just your problems. Most of our patients lead very interesting lives.

1. Symptom Quantification: We want to know in precise terms what the problem is that prompts you to seek treatment. This is accomplished through three complimentary processes: your written description rating scales, and our joint clinical personal interview. Your written descriptions, using our initial intake forms, allows you to clearly express and define your concerns. We seek your response to questions such as – in what circumstances have you noticed difficulties paying attention? How has this affected your life functioning? When did you first notice these limitations in your life?

We have developed a computer system that helps us systematically identify and quantify the problems that bring you here. The computer rating scales, using SmartSoft-ADD allow you to define these processes more precisely – by responding to questions about the frequency, severity and impact on life functioning of these issues. SmartSoft- also asks about issues of mood, thinking and reasoning. It produces instant, elegant scoring – comparing the results of your responses across symptoms in relationship to those of other patients and normal controls.

SMARTSoft-ADD

Your responses to theses questions are scored, analyzed and summarized by the computer.

Children also can rate themselves using a child-friendly set of animations that make them comfortable and able to convey their experience. There is smoke coming out of a Tiger’s ears (I loose my temper) and dinosaurs fighting (I quarrel and fight a lot). It becomes very interesting to compare the child’s and the parents’ evaluation of themselves.

You can see this child working to covey his experience of ADD and depression.

Children’s Self-Rating

There is a segment of the computer tasks designed to help children to describe their experience. These figures are animated – so children can relate their emotions.

2. Measuring Attention & Reasoning: The cognitive section of SmartSoft-ADD consists of actual measures of attention required for progressively more complex tasks that assess vigilance, inhibition and problem-solving. Your baseline (pre-treatment) performance provides an index of ADD; your performance on medication reflects the effectiveness of treatment.

The Continuous Performance Task (CPT) assesses sustained attention or vigilance through

response to changing stimuli: circle, star or triangle in three different colors, the patient responds to all stimuli except, perhaps the green triangle. The forbidden stimulus changes, requires inhibition in response to a shift of expectations.

The Color Naming Task (CNT) requires shifting of attention. Depending on the cue, you must

Respond to the word or the color in a shifting palate. The computer tracks error of omission and commission as the task becomes progressively more complicated.

The Deductive Logic Test (DLT) measures your ability to reason and remember. On this task you will

see a circle, square and triangle in 3 different positions (left, right and center) and be asked to determine which one the computer has selected. On each guess you receive feedback – allowing you to develop logic for problem-solving as the patterns shift. The task is to logically determine which one of 9 stimuli the computer has selected: a specific shape, color or position -- based on feedback from your prior responses. The computer measures your rate and efficiency of figuring this out. The effect of attention on your memory and problem-solving can then be measured.

The value of these tasks is that they provide objective measures of attention that can be repeated at follow-up as an index of medication effectiveness. Having developed the Hunt Assessment & Treatment System and SmartSoft-ADD, we are now beginning to make this system available to clinicians nationally.

Coexistent Disorders:

Treating ADD in Combination with Other Medical and Psychiatric Disorders

Complex ADD is often embedded in other psychiatric disorders, such as depression, anxiety, bipolar disorder, aggression or learning disabilities. The art of treatment is in knowing what to do first – and how to balance the interventions for maximal complementary benefit. We have been systematically studying this process – through assessing the complementary effects of medications when treatment combined disorders – what effect do antidepressants have on attention – or do psychostimulants have on depression – in patients with combined mood and attentional problems? We witness patients whose lives have been devastated by substance abuse – develop the strength to overcome this when the vulnerability of their underlying ADD is resolved.

Many physicians have their favorite medication for a problem and give nearly all their patients the same treatment with little attention to the details of finding the optimal medication for that specific patient. Since ADD often coexists with serious difficulties with mood and thought regulation, that may require extended treatment, I believe it is extremely important to find the best medication for you. We have developed the Hunt-Medication Optimization System that provides an extremely efficient and effective system for determining the best treatment for each individual patient – reflecting your personality and the tasks you must perform in your life.

3. Spect Brain Imaging:

The Center for Attention is one of about ten sites nationally that has a Spect scan in our office. The Spect scan is an elegant 2-ton brain imaging machine that can produce extraordinary pictures of your brain. Following the injection of a mild radio-ligand that has the radiation equivalent of a chest X-ray, the brain scan records the blood flow in the brain – which reflects regional brain activity. The brain image shows the outer surface of the brain in rotation (every angle), and also can reveal interior structures of the brain -- the areas producing the top 15 and even 5% of brain activity. The regions of greatest brain activity are often problem areas where the brain has to work extra hard to compensate for a deficit in efficiency.

We are performing some of the leading research seeking to relate these brain patterns to patient’s clinical symptom patterns. We are then determining the extent to which these images may improve our ability to predict and select the best treatment for each patient – thereby reducing the "trial and error" approach to treatment.

The patterns of these images shows differences between disorders such as ADD, learning disability, depression and bipolar disorder -- and can also show improvement in the brain from effective treatment.

We are striving to obtain insurance coverage for the Spect scan procedure because it often helps us to provide the optimal treatment quicker.

The Hunt Medication Optimization System^®:

4. Medication Selection & Optimization - the Comparison Trial:

We strive to identify and prescribe the best medication for you or your child. We usually do this by giving

you a comparative trial of several medications in order to determine the best fit for you. Initially we may try

several mediations, usually making one change at a time – to select the best mediation for you in each

treatment category. Once you are clearly better, we will often begin to taper the medication in order to

determine the lowest possible dose that will helping you stay better. Then we may shift to generic

mediations, if equivalent, to see if we can help reduce your medication costs.

Finding the Best Medication:

The Hunt Assessment and Treatment System uses rating scales to measure treatment response. After we determine what general category of medication is likely to work best – based on your symptoms and problems – the real challenge becomes finding the specific medication that is the best match for you. For ADD medications the psychostimulants are usually the medication of choice. During our in initial trial, we compare the effectiveness, duration of action, comfort, and side effects for a long-acting Ritalin-type medication with a long-acting Adderall-type medication. In general, methylphenidate helps people focus in more detail on one task or problem; Adderall seems to help people select between several tasks and shift gears more easily. Strattera helps with thinking and reasoning – but takes longer to work.

We will place you on one of these medications for 2 weeks each; using a low dose the first week and a higher (moderate) dose the second week. At least once / week we ask you to complete ratings scales that allow you to score improvement in functioning and side effects. We have found that a very effective way for adults to determine this is to use a palm pilot to record, every 2 hrs one day / week during this trial phase. We can download our tracking form on your palm pilot so that you can record: what task are your doing; how good is your attention, your organization, and your mood. Are their any side effects? By doing this through the day- we can determine how effective and comfortable the mediation is, plus how long it lasts. Although though this takes a little extra effort, it is extremely useful for finding the best treatment individualized for your personality, the tasks you are doing, and the time of day you perform them. We have patented this system and are making it available to other physicians nationally.

Because medications are so effective at correcting specific neurochemical alterations in the brain that impact attention, mood, thinking and reasoning, we use medications as a significant, precise intervention. We take great care to find the best medication for each patient – and even to adjust the dose and timing to your schedule of events and tasks. You may not have the same medication needs on Sunday when you’re relaxing as on Monday when you have a lot to organize.

Our therapeutic goal is not only to improve both components of these combined disorders – but to optimize the dose and timing to create maximal productivity and stability. When these goals are achieved – which is common in our hands – patients experience a growth in productivity, enhancement of personal and work relationships and a renewed sense of self. It is a privilege to witness and contribute to this process of healing.

THE CENTER FOR ATTENTION AND BRAIN FUNCTION | 2129 Belcourt Ave. | Nashville, TN 37212
Phone (615) 383-1222 | fax (615) 383-0680 | Email: info@centerforattention.com