Husband-wife team's company aids those with attention deficits.

Source: Richmond Times-Dispatch (Richmond, VA)

Byline: Joan Tupponce

Jul. 17--When Steven Butnik and his wife, Julia Frishtick, moved to Richmond in 1978 to look for a job, they expected to stay in the area for one year.

Twenty-eight years later, the two are running their own practice, Addvantage, counseling children and adults with attention deficit- and learning problems.

Butnik, a licensed clinical psychologist, became interested in child psychology during his teens when he worked one summer at a residential treatment center in Cleveland for children with serious emotional and behavioral problems.

"After that summer, I worked as a recreational worker at the center for seven summers," Butnik said. "That made me a more viable candidate for graduate school."

After receiving his doctorate from Ohio State University, Butnik served as director of the Crater Child Development Clinic in Petersburg and as staff psychologist at the Psychiatric Institute of Richmond before going into private practice.

"My interest in attention-deficit hyperactivity disorder had been brewing for some time," he said. "About 10 years ago, it became clear that much of my practice was diagnosing and treating children with ADHD."

Frishtick, a licensed clinical social worker, met Butnik at OSU, where she was studying for her master's degree in social work.

"At the time, I was interested in community activism," she said. "I realized later on that I really enjoyed working with individuals. I did some clinical internships and began to focus on clinical work."

The two married in 1978. They opened Addvantage in 2001.

"We had been part of a large practice and wanted a practice that was more tailored to ADHD work," Frishtick said. "We wanted an office where people could feel comfortable."

The couple started the practice with carried-over accounts receivable from a former practice.

About 15 years ago, Frishtick discovered she had ADD.

"I felt more frazzled after having my first child," she said. "I realized I was different from my friends. I was a good student in school. I was able to focus on that. When I had my kids, I had piles [of stuff] everywhere. I would have to get up earlier to get all my work done."

In their practice, the couple see many adults with ADHD.

"Parents often recognize themselves when we are diagnosing their child," Butnik said. "It was first thought that people would outgrow ADHD, but in the 1990s the diagnosis of adult ADHD became more common. It's been a misunderstood and controversial topic."

Several of Frishtick's female patients complained of not being able to achieve what they wanted to achieve in life. They had previously been diagnosed with depression and anxiety.

"I figured out that a lot of them had ADHD and were on an antidepressant when a stimulant medication might have addressed the root cause," she said. "Once they were treated accordingly, they accomplished their goals more easily."

Butnik and Frishtick diagnose ADHD through such evaluations as developmental and family histories, clinical interviews, personality/emotional assessments, performance tests and a quantitative electroencephalography (QEEG).

Butnik explains that the QEEG scan measures brain-arousal patterns. Brain-wave data are recorded while the person is at rest and also while reading, listening and writing. Butnik then analyzes and interprets the data. A capital investment was needed for training and the purchase of the equipment.

"People's brains that have ADHD are not wired in a way that is friendly to daily living," Butnik said. "Most often, ADHD is acquired genetically. It impacts an individual's executive functions, such as organizing and prioritizing work, maintaining attention, especially when bored, and finishing tasks."

Part of the couple's mission is to provide such nonmedical services as neurocognitive counseling.

"You can't cure ADHD, but you can learn to manage it," Frishtick said.

Butnik and Frishtick often use neurofeedback to help patients. The therapy uses computer technology to train individuals to pay attention more easily. A computer transforms brain waves into video and audio displays similar to video games. The displays provide immediate feedback about the person's concentration, especially when it is drifting off.

"We teach adolescents how to use calendars properly and PDAs, how to modify their environment so they can function in the classroom," Butnik said. "We work with adults to help them find ADHD-friendly jobs."

The counselors also encourage patients to form positive lifestyle habits, such as getting enough sleep, proper nutrition and exercise.

Since opening their practice, the couple's patient load has grown. Butnik specializes in working with children, adolescents and college-age students. Frishtick works with adolescents, college-age students and adults. Lori Hedrick, also with Addvantage, works with children and adolescents.

One of the couple's goals is to start providing services to the business community. Butnik said national expenses for ADHD run in the neighborhood of $77 billion a year. Employees with ADHD may have excess absenteeism, more accidents, trouble with paperwork and difficulty getting along with other employees.

"We want to help people in the business place understand the impact that ADHD has on companies," Butnik said. "We want to help them understand how to recognize and develop strategies to help workers perform better."

Dr. Sherman Master, medical director of Tucker Pavilion at CJW Medical Center's Chippenham campus and clinical professor of psychiatry at Virginia Commonwealth University, refers patients to Addvantage.

"Whenever I have a patient that I suspect might have ADD or ADHD, I refer that person to them," he said. "They do a sophisticated evaluation. They do QEEGs to differentiate pseudo ADD from ADD."

Master believes the work Butnik and Frishtick are doing is cutting edge.

"They keep up with illnesses that could give a false positive," he said. "It isn't an easy diagnosis. They give me some idea of the subtype of ADD and ADHD the patient might have. That assists me in making my decision on what to prescribe. With all the publicity about overprescribing [medication for the illness], I feel comfortable using this group."

Master describes Butnik as "an expert on learning disorders and educational psychology."

"I don't know of any other group," he added, "totally dedicated to making this [type of] diagnosis."

Psychiatrist Dr. James E. Sellman has known Butnik for 25 years.

"Steve is the most informed psychologist working in ADHD in Richmond," he said. "He is the top authority for ADHD and nonmedical intervention in the city. He and his practice are first-class."

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Copyright (c) 2006, Richmond Times-Dispatch, Va.

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