ADHD Diagnosis and Medication Coverage Issues in Taiwan

ADHD test results and health insurance medication issues?

Hello, Doctor.
I am Lin, the student who previously inquired.
I went to review my ADHD report today.
After the doctor reviewed it, he prescribed me Adderall, but since I had not been prescribed long-acting medications like Strattera before the age of 14, the health insurance only covers Adderall for adults.
Last week, the assessment method involved a screen displaying English subtitles, where I had to click the space bar when they appeared, but not when an "X" appeared.
Here are my report findings:
1.
The subject can understand instructions and execute them.
During the process, they maintained good posture in the chair, occasionally changing positions (such as shaking legs, switching hands, etc.).
2.
The subject's response style (T=46) balances accuracy and response speed.
3.
Key performance indicators:
(1) Detectability T=71 (significantly abnormal).
(2) Omission T=67 (abnormal).
(3) Commission T=70 (significantly abnormal).
(4) Perseveration T=52 (average).
(5) Hit RT T=38 (abnormally fast).
(6) Hit RT SD T=43 (average).
(7) Variability T=43 (average).
(8) HRT Block Change T=57 (above average).
(9) HRT ISI Change T=48 (average).
1.
The test results indicate that compared to the normal group, the subject has difficulty recognizing targets, with high rates of omission and errors, and a fast response speed.
2.
Among the nine measured items, the subject exhibited four abnormal T-scores, which are related to poor attention, sustained attention, and impulsivity; it is inferred that the likelihood of the subject having ADHD falls within a highly probable range (while excluding the influence of other psychological/neuro conditions).
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I would like to ask the doctor a few questions:
1.
Is this type of assessment and report sufficient to confirm that I am indeed an ADHD patient? (Although being prescribed Adderall is covered by health insurance, it is difficult for me to accept the idea of being a patient with a disorder, especially since I also have anxiety.)
2.
Why is there this strange phenomenon where health insurance covers Adderall but not Strattera? Is it possible to be prescribed Strattera depending on the hospital?
3.
According to your previous explanation: "If diagnosed with ADHD, the first-line medication will primarily be ADHD treatment medications, and if anxiety is also present, it will be supplemented with anti-anxiety medications." Should I consider myself as having anxiety disorder with comorbid ADHD? (Or do you have a different perspective that you would like to share?) Currently, my coping strategies are: A) Taking 30mg of Mirtazapine before bed → Based on my experience, it has improved my distraction by about 70%.
B) Scheduling behavioral therapy with the school counselor → Addressing both ADHD and anxiety issues.
C) Taking Adderall as needed; does this seem acceptable to you? Does the behavioral therapy provided by the counselor effectively address the root causes?
4.
Based on my experience of taking Adderall four times, I have not felt the significant differences that other ADHD patients report online, or I might not have felt any difference at all.
Does this mean the medication is ineffective for me? Or could it mean that I do not have ADHD? (In contrast, I feel about 70% calmer with the anxiety medication Mirtazapine 30 mg and do not have racing thoughts.) Thank you, Doctor!

Lin Tongxue, 20~29 year old female. Ask Date: 2020/07/15

Dr. Wang Yazhen reply Psychiatry

Dear Student Lin,
Thank you for your trust.
Regarding your questions:
1.
Testing cannot replace a doctor's diagnosis; it serves as a reference for the physician's assessment.
2.
There isn't a definitive reason for what medications are covered by health insurance.
Many diseases have medications that are either covered or not covered.
This can be due to cost considerations, safety concerns, or the adequacy of treatment evidence.
Physicians need to prescribe medications in accordance with health insurance coverage.
3.
I apologize, but I cannot provide an online consultation.
Your diagnosis needs to be explained by your attending physician, and I believe your doctor will be happy to clarify and discuss it with you.
4.
Individual responses to medications can vary.
Additionally, it's important to note that attention can be influenced by many factors, including inherent traits or anxiety, which can also affect focus and are difficult to differentiate.
I recommend discussing your medication responses with your attending physician.
Thank you!

Reply Date: 2020/07/15

More Info

Understanding ADHD diagnosis and medication coverage in Taiwan can be quite complex, especially for individuals like yourself who are navigating the healthcare system. Let's break down your concerns and questions regarding your ADHD diagnosis, medication options, and the implications of your test results.

1. ADHD Diagnosis Validity: The assessment you underwent, which included a series of tests measuring various cognitive and behavioral responses, provides valuable insights into your attention and impulse control. The report indicates significant abnormalities in areas related to attention and impulsivity, suggesting a high likelihood of ADHD. However, it’s essential to understand that while these tests are informative, they are not definitive on their own. A comprehensive diagnosis typically involves a combination of clinical interviews, behavioral assessments, and sometimes input from family or teachers. Your feelings of uncertainty about being labeled as a patient are valid; many individuals experience similar emotions when faced with a diagnosis. It’s crucial to remember that ADHD is a neurodevelopmental disorder, and having it does not define your worth or capabilities.

2. Medication Coverage Issues: The discrepancy in medication coverage by health insurance in Taiwan, where only certain medications like Ritalin (利他能) are covered for adults, while others like Strattera (專司達) may not be, can be frustrating. This situation often arises from various factors, including the drug's approval status, cost-effectiveness, and the evidence supporting its use in specific populations. While some hospitals may have different protocols or be able to prescribe other medications, the overarching guidelines set by health insurance often dictate what is covered. It’s advisable to discuss this with your prescribing physician, who may provide insights or alternative options.

3. Co-occurring Conditions: Your mention of anxiety alongside ADHD is quite common, as many individuals with ADHD also experience anxiety disorders. Your current treatment plan, which includes Mirtazapine for anxiety and Ritalin for ADHD, seems reasonable. It’s essential to monitor how these medications interact and affect your overall mental health. Behavioral therapy, as you mentioned, can be an effective adjunct to medication, helping you develop coping strategies and skills to manage both ADHD and anxiety. While behavioral therapy may not "cure" ADHD, it can significantly improve your functioning and quality of life.

4. Medication Efficacy: The variability in how individuals respond to ADHD medications is well-documented. Some people may not experience the dramatic effects that others report, which does not necessarily mean that the medication is ineffective or that you do not have ADHD. Factors such as dosage, individual brain chemistry, and the presence of co-occurring conditions can all influence how you respond to treatment. If you feel that Ritalin is not providing the expected benefits, it’s essential to communicate this to your healthcare provider. They may consider adjusting the dosage or exploring alternative medications.

In conclusion, navigating ADHD and its treatment involves a multifaceted approach that includes understanding your diagnosis, exploring medication options, and engaging in therapeutic interventions. It’s vital to maintain open communication with your healthcare providers, as they can offer tailored advice and adjustments based on your unique situation. Remember, managing ADHD is a journey, and finding the right combination of strategies and supports can lead to significant improvements in your daily life.

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