Harold Robert Meyer The ADD Resource Center · Reviewed: August 19, 2026 · Published: August 20, 2026
A prescriber, a therapist, a coach, a pediatrician, a school. Nobody is holding the whole picture, and the person the picture is about is usually the last to be told.
Your prescriber adjusts the dose. Your therapist thinks the problem is anxiety, not dosing. Your child’s teacher reports the afternoons are worse than the mornings, and nobody has told the prescriber, because nobody asked the teacher. Each of these people is competent. Each is working from a fragment. And each of them assumes, quietly, that someone else has the whole file.
Nobody does.
Key Takeaway
There is no default coordinator in American ADHD care. Unless someone is explicitly assigned the role, it falls to you or to the parent. The good news is that you are not fighting the model when you step into it – the model now expects you.
Why This Matters
Care for ADHD is delivered by people who rarely occupy the same building, the same record system, or the same profession. The American Academy of Pediatrics classifies ADHD as a chronic condition to be managed under the chronic care model, which assumes a coordinating medical home. In practice, adults in particular often have no medical home at all – a psychiatrist found through a directory, a therapist found through insurance, a coach found through word of mouth. Fragmentation is not a failure of any one provider. It is the structure.
Key Findings
- Shared decision making is the recommended model in current guidance, not a favor a clinician grants you. NICE published a dedicated guideline on it in 2021, and the AAP’s ADHD guideline states plainly that family preference is essential in determining the treatment plan.
- Under HIPAA, providers may share information with each other for treatment purposes without your written authorization. The common belief that a release is always required is wrong, with a narrow exception for psychotherapy notes.
- Coaches, tutors, organizers, and schools are generally not covered entities, so bringing them into the loop does require your written permission.
- Formal team-conference billing codes exist, but Medicare classifies them as bundled and many commercial plans follow, so a group meeting is usually an out-of-pocket cost.
- Contradictory opinions are frequently not contradictions at all – they are two accurate reports from two different vantage points.
First: you are not intruding
Many people manage their care, or their child’s, as though every question were a small act of trespass. They rehearse the phrasing. They apologize before asking. They decide not to mention the thing the other provider said, because raising it might look like they are shopping for a better answer.
That instinct is built on an old model, and the model has changed.
Shared decision making – a clinician and a patient working together to reach a joint decision, rather than the clinician deciding and the patient consenting – is now the recommended standard rather than an optional courtesy. NICE issued a guideline devoted entirely to it in 2021, covering how to embed it in everyday practice across all healthcare settings. In ADHD specifically, the AAP’s clinical practice guideline states that family preference is essential in determining the treatment plan, and NICE’s ADHD guidance directs that the annual medication review include a discussion with the person about whether treatment should continue. The person’s view is written into the recommendation, not appended to it.
Practically, that means two things. You do not need permission to ask what the alternatives are, what the evidence behind a recommendation is, or what another provider’s view would change. And you can name the coordination problem out loud – there are four people involved in my care and none of them have spoken – without it reading as a complaint about anyone.
One honest qualification. Guidance is not the same as universal practice, and implementation of shared decision making in mental health care has been uneven; researchers examining the NICE guideline have written specifically about the gap between the policy and what happens in the room. Most clinicians will meet this well. Some will not. If a provider treats a reasonable question as a challenge to their authority, that is worth knowing about the relationship, and it is information you did not have before you asked.
When should providers speak to each other, and when shouldn’t they?
Not routinely. Direct provider-to-provider contact is worth arranging at four moments: at the start, so each knows who else is involved; when a medication change is made that another provider will observe the effects of; when two providers are giving you guidance that appears to conflict; and when something is deteriorating and nobody can see why.
Outside those moments, relaying it yourself is faster, cheaper, and often more accurate, because you are the only participant who attends every appointment.
There is a real cost on the other side of this. Information you share with a therapist can travel to a prescriber under the treatment exception without your signature. If there is something you want kept in one room, say so explicitly and ask for it to be noted. You can also request a restriction on disclosure; the provider is not obliged to agree, but if they do agree, they are bound by it.
Who should coordinate?
Ask, in order: does anyone here have a formal care-coordination role? Some pediatric practices and integrated systems do. If yes, use them. If no, does one provider function as the hub – usually the prescriber, or a pediatrician who has known the child for years? If yes, tell them plainly that you are treating them as the hub and ask whether they accept that.
If neither, the job is yours. Doing it deliberately looks like this: one page, kept by you, listing every provider with contact information, the current medication and dose with the date it was set, the two or three things you are actually trying to change, and what each provider has said about them. Bring it to every appointment. Update it in the parking lot afterward, not later.
This is unglamorous and it is the entire intervention. Practice-based care coordination research in pediatrics found that organizing critical information into written care summaries is what makes a team approach function; the summary is not a byproduct of coordination, it is the mechanism.
For a child, the parent holds this. For an adult, hold it yourself, and consider whether executive function is going to make that unreliable – if it is, that is a legitimate thing to hand to a coach, a spouse, or a case manager, and it is worth naming out loud rather than assuming you will manage.
What happens when they contradict each other?
First, check whether they actually do. Three patterns account for most apparent conflicts:
Different vantage points. The teacher sees 8:00 to 3:00. The parent sees 3:00 to 9:00. The prescriber sees twenty minutes in an office. “He’s fine at school” and “he falls apart at home” are both true and together they describe a coverage gap, not a disagreement.
Different questions. A prescriber asked whether the medication is working answers about symptoms. A therapist asked whether you are doing better answers about functioning and mood. Guidelines and meta-analytic evidence increasingly treat these as separate outcomes that do not move together.
Different scope. A coach who tells you to build a system and a therapist who tells you to examine why you avoid the system are not competing. One is downstream of the other.
What is left after those three are ruled out is a genuine clinical disagreement, and it is uncommon.
How do you weigh a genuine disagreement?
Not by seniority, and not by who you like most. Four questions, in order:
- Whose scope is it? Medication questions belong to the prescriber. Diagnostic reconsideration belongs to whoever can perform a differential evaluation. Skills and systems belong to the coach. Deference follows scope, not credentials in general.
- Who has seen the relevant data? An opinion formed without the school reports, or without the sleep history, is a less informed opinion, however confidently held.
- What is each one’s evidence? “In my experience” is legitimate and is not the same as a guideline recommendation. Ask which one you are hearing. Most good clinicians will tell you without defensiveness.
- What does each option cost if it’s wrong? A reversible trial with a review date beats a confident argument.
Then ask the dissenting provider directly: Dr. X recommends this and you recommend that. What would change your mind? An answer that names a specific observable thing is a good sign. An answer that only restates the position is also information.
Who decides?
You do, or the parent does, among the options that are clinically acceptable. This is not a claim about your rights in the abstract; it is what the shared-decision-making model actually specifies. Your preferences, values, and tolerance for particular trade-offs are treated as inputs to the decision rather than obstacles to it.
The prescriber decides what they are willing to prescribe – that is their license, and no amount of preference obliges them to write something. Within that boundary, the choice is yours, including the choice to seek a second opinion, which is due diligence rather than disloyalty.
The one arrangement to refuse is the unspoken one, where nobody decides and the disagreement simply persists across appointments while nothing changes.
Should you have – and pay for – a group meeting?
Sometimes, and usually yes, you pay.
Formal medical team conference codes exist for a meeting of at least three professionals from different disciplines, running thirty minutes or more, with or without the family present. But Medicare assigns these codes a bundled status, meaning they are not separately payable, and many commercial payers mirror that policy. In practice, providers who convene these meetings often bill their time directly to the family or absorb it.
So treat it as a purchase. It is worth buying when a decision is genuinely stuck, when three or more people are involved and two of them have never spoken, or at a transition point – a new diagnosis, a school change, leaving for college, a hospitalization. It is not worth buying for routine updates, for a two-person disagreement that a phone call would settle, or to make everyone feel included.
If you do convene one, run it: circulate one page of specific questions beforehand, keep it to those questions, and end by writing down who is doing what by when, and who checks. A meeting that produces agreement but no assignment has produced nothing.
The next step
Before your next appointment, build the one page. Providers, medications and dates, the two or three things you are trying to change, and what each person has said. You will discover, in the building of it, exactly where the gaps are – and that discovery is worth more than any single opinion you are waiting on.
Bibliography
Cooley, W. C., & McAllister, J. W. (2007). Practice-based care coordination: A medical home essential. Pediatrics, 120(3), e723–e733. https://doi.org/10.1542/peds.2006-1684
Council on Children with Disabilities and Medical Home Implementation Project Advisory Committee. (2014). Patient- and family-centered care coordination: A framework for integrating care for children and youth across multiple systems. Pediatrics, 133(5), e1451–e1460. https://doi.org/10.1542/peds.2014-0318
Louisiana Department of Health. (2022). Payment policy: Status “B” bundled services (LA.PP.046). https://www.ldh.la.gov/assets/medicaid/MCPP/11.18.22/1/1484_LHCC_LA.PP.046_Status_B_Bundled_Services_8.22.pdf
National Institute for Health and Care Excellence. (2021). Shared decision making (NICE guideline NG197). https://www.nice.org.uk/guidance/ng197
U.S. Department of Health and Human Services, Office for Civil Rights. Does HIPAA permit health care providers to share patient information for treatment purposes without authorization? https://www.hhs.gov/hipaa/for-professionals/faq/481/does-hipaa-permit-doctors-to-share-patient-information-for-treatment-without-authorization/index.html
Wolraich, M. L., Hagan, J. F., Allan, C., Chan, E., Davison, D., Earls, M., Evans, S. W., Flinn, S. K., Froehlich, T., Frost, J., Holbrook, J. R., Lehmann, C. U., Lessin, H. R., Okechukwu, K., Pierce, K. L., Winner, J. D., & Zurhellen, W. (2019). Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics, 144(4), e20192528. https://doi.org/10.1542/peds.2019-2528
Zisman-Ilani, Y., Chmielowska, M., Dixon, L. B., & Ramon, S. (2021). NICE shared decision making guidelines and mental health: Challenges for research, practice and implementation. BJPsych Open, 7(5), e154. https://doi.org/10.1192/bjo.2021.987 · Free full text (PMC)
Resources
From The ADD Resource Center
- Essential ADHD Doctor Appointment Checklist: Maximize Your Visit
- When Your ADHD Medication Isn’t Working: How to Talk to Your Prescriber
- If ADHD is a neurobiological condition, why are coaching and therapy often recommended?
- Did Your Diagnosis Stop at a Page in the DSM?
- How to Make the Most of Your Telehealth Visit: A Guide for ADHD Patients and Caregivers
External
- NICE: Shared decision making (NG197)
- American Academy of Pediatrics: Care Coordination Resources
- American Speech-Language-Hearing Association: CPT coding for case management and team conferences
- HHS Office for Civil Rights: Sharing information for treatment purposes
About the Author
Harold Robert Meyer is Founder and Managing Director of The ADD Resource Center, established in 1993. He co-founded CHADD of New York in 1989, has served on CHADD National’s board and executive committee, including as VP Finance, and was elected to lead the Institute for the Advancement of ADHD Coaching. A Senior Certified ADHD Coach, author, and international speaker, he has spent more than three decades in ADHD advocacy and education. He can be reached at [email protected].
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