After 20 years in general pediatric practice, Wiley decided to devote his time to helping patients affected by these problems, including two of his three children. “Over the years, technology for a more precise diagnosis and very careful medication management has emerged,” Wiley says. “The answers are there, but we as a medical community have been slow to adopt them. ADHD is a neurological problem, not a psychological problem. We’ve known for 13 years that medication is the best treatment for ADHD.
In our clinics, we have the time to dedicate to ADHD and the family, and our cutting-edge testing allows us to correctly diagnose the problem and to achieve dose optimization for patients who require medication.”
Focus uses QbTest, an FDA-approved testing system developed in Sweden. Wiley says he is not aware of anyone else in Alabama who uses this test. “We’ve had great outcomes in Mobile, and I know we can help kids everywhere,” he says. Focus also uses a test called CNS Vital Signs as a complementary testing system, with QbTest as the primary evaluative system. CNS screens for learning disorders that may affect an ADHD diagnosis.
QbTest is a computer-based objective assessment that measures all three core symptoms of ADHD – hyperactivity, inattention and impulsivity in patients between 6 and 12 years of age. Focus is also eagerly awaiting FDA approval for an updated version of QbTest that will also allow testing of patients age 13 and older. As soon as that approval comes through, that testing will also be available through Focus. Tanikqua Moore, MD, a general pediatrician and practicing physician at the new Birmingham clinic, says that the test has high clinical validity and gives the clinician a new perspective on which to base decisions. It also offers a way to monitor the dosage effects on patients who take medication for ADHD.
“We don’t want to over medicate, and QbTest allows us to see if the patient is over medicated. Dose optimization is our goal,” Moore says. “No two patients are alike, and we want to fine tune treatment, including medications, for each patient. We want the child to be himself and still be able to get his school work done. We want his family to enjoy being a family.”
QbTest is a 15-minute non-verbal, computer-administered attention test. The patient sits in front of the computer and responds to stimuli by clicking a button. During the test, a high-resolution infrared camera monitors the movement of the patient. The system calculates measures of activity, attention and impulsivity based on the performance on the task and level of activity. The data is then processed and compared with a norm group of the same age and sex.
During the computer test, Tonya Wallace, administrator of the Birmingham office, will track the behavior of the child. She makes notes of whether the child is sitting still, fidgeting, or exhibiting any other type of behavior. “Knowing what the child is doing during the test can help with the final diagnosis,” Moore says. “For instance, if a child keeps rubbing his eyes or nose, it is helpful to know if we are dealing with allergies instead of an avoidance behavior, as those movements can impact test results.”
New patient appointments are booked for one hour of provider time. Each test is given a 30-minute block to account for patient instruction, though the test itself only takes about 15 minutes to complete. In total, new patient appointments generally take about two hours. Follow-up visits take 30 minutes and are scheduled every few weeks until the right dose of medication is established. “These meetings allow for precise diagnosis and optimization of treatment,” Moore says. “If the child has ADHD, we generally treat with medication. We will give the child the QbTest again in the first follow-up visit to adjust the medication as needed.”
Wallace points out that Focus is a non-competitive practice. “We want to be a resource, and we invite open lines of communication with practitioners. We don’t practice general pediatrics and we don’t treat other comorbid disorders,” she says.
It is also important to note that, if in the process of our testing and evaluation it is found that the diagnosis is not ADHD, Moore is comfortable stating that. “Focus is dedicated to the diagnosis and treatment of ADHD, but its practitioners have no hesitations in ruling out a diagnosis of ADHD and helping to point families in a proper direction for a true solution to the problem that is indicated,” she adds.
Focus takes referrals from physicians and other health professionals, but a referral is not required, Wallace says. Parents can complete an appointment form, available on the website at www.focus-md.com, and send it to the office. “According to Dr. Wiley, we get a lot of referrals from schools, but we also are finding that word of mouth among parents is a huge network,” she says. “Parents are vital to getting the word out about our clinic. One parent told us, ‘we got our child back; we got our life back.’ That’s what it’s all about – transforming lives. ADHD affects the whole family.”
In addition to the new Birmingham clinic, Focus also has expanded to add clinics in Daphne, AL, as well as Charlotte and Greensboro, NC, and Charleston and Greenville, SC. “Growth has been substantial because there is such a need for someone to care for these people. It requires precise control – just like controlling diabetes – for the best outcome,” Wiley says. “We are so excited to have the Birmingham office open and providing service to the area. The reception we have received has been great. For us, it is a labor of love. So many kids will benefit.”
Focus Birmingham currently is accepting new patients, ages four years through young adult.