ADHD | Attention Deficit Hyperactivity Disorder

For a downloadable PDF on ADHD Assessment, Treatment and Coaching, click here: click here for a pdf of this page (ADHD-Burnaby-Vancouver)

Attention Deficit Hyperactivity Disorder (ADHD or ADD)
I have been providing services for individuals with Attention Deficit Hyperactivity Disorder (ADHD/ADD) for over twenty years. This has included diagnosis (with the aim of obtaining appropriate school, work and testing modifications), individual treatment such as skill development to deal with deficit areas like planning, attention, organization and procrastination, teacher training about ADHD and classroom consultations, cognitive behaviour therapy to help deal with the psychological effects of ADHD and finally couples/relationship/family therapy.

ADHD/ADD can affect the entire family constellation as well as the work or school setting. As a former classroom teacher, director of behavioural services for several school districts and the neuropsychologist for a community based rehabilitation program I am familiar not only with the diagnostic issues relating to ADHD, but also how behavioural, cognitive and systemic interventions work in real life settings. The specific services for ADHD/ADD I provide in both my Vancouver and Burnaby offices are:

ADHD testing and assessment (neuropsychological and psycho-educational)
ADHD Diagnosis
ADHD Treatment Plans for home, work and school
Couple and Relationship Counselling for ADHD related issues
Training for problems with focus, concentration, reading, planning and procrastination and anger management

Frequently Asked Questions (FAQ’s)
Well, I think I have ADHD. Where do we start?
All treatment for Attention Deficit Hyperactivity Disorder (ADHD/ADD) begins with a comprehensive assessment. ADHD is a very general diagnosis and it doesn’t tell us much about the specific problems you as an individual are having with ADHD. If your medical doctor has told you he or she suspects ADHD, it might be ADHD Inattentive Type, where we see an individual unable to focus, concentrate, having difficulty planning or completing tasks, or it it might be ADHD Hyperactive Type, in which the main problems you face is an inability to sit still, the need to constantly move around or fiddle with things (and people with ADHD Inattentive Type might have no problem with this issue what-so-ever!), or it might be ADHD Combined Type, in which the symptoms of ADHD take in both the problems with attention/focus/planning and excessive movement and fidgeting. And within each of these specific types of ADHD there are individual differences in the severity of symptoms, and how we can tolerate them.

Can I get services from my MD? Isn’t a medical doctor necessary to diagnose ADHD?
No, a medical doctor is not necessary to diagnose ADHD. A trained psychologist can do an ADHD diagnosis, and many times the diagnosis is actually completed by psychologist. Many medical doctors would prefer you to see a qualified psychologist about ADHD because they do not have the expertise to do a full diagnosis, which often involves not just a simple checklist of ADHD or ADD symptoms, but also ruling out other possible reasons for the symptoms you or your child may be experiencing. This means completing some other possible testing and an extensive history taking your MD may not have time to complete. Of course, some MDs are able and willing to do a diagnosis of ADHD for you and will use these simple scales. In both my Burnaby and Vancouver offices I see many patients who are referred by their MD after they have already met the criteria for ADHD. This is because they may not feel they have the experience to do a complete diagnosis correctly – because in approximately 50% of cases ADHD or ADD is associated with co-morbid disorders such as learning disabilities, language deficits and behavioural problems you will need to see the psychologist about anyway. The MD, however, is often able to complete an initial diagnosis under your provincial MSP, which is free to you. Services from a psychologist must be paid by your extended health care provider, your employer or through self pay. This is a very legitimate concern.

Is a neuropsychological assessment necessary?
Not always. The neuro-cognitive (neuropsychological) assessment that I provide for those with ADHD includes, but is not limited to, issues such as verbal memory, visual memory, processing speed, executive function (decision making, picking out what is important or salient, impulsivity and emotional control), psychomotor speed, reaction time, complex attention, cognitive flexibility and long term attention and focus. Through this testing we learn about how ADHD affects your flexibility of thinking, concept formation, problem solving, planning, creativity, impulse control, emotional stability, inhibition and procrastination (an inability to switch from one task to another). This information is very helpful in determining where to focus our interventions. Not only telling us about the weaknesses you may have due to ADHD, but also pointing out your cognitive strengths and affinities. This helps us develop strategies based upon your strengths.

How do you know I have ADHD and not something else?
In addition to these neuropsychological tests and extensive history taking we also look at factors that might direct us towards other or co-morbid diagnoses such as depression, anxiety, bi-polar disorder, learning disabilities and so on. ADHD is known for being found in combination (co-morbid) with several of these other disorders in children, adolescents and adults. Sometimes these disorders mask the nature of the ADHD. Sometimes we can mistake another disorder for ADHD. So along with the comprehensive neuropsychological assessment we also look at personality issues that help in ruling out other possible causes for the issues that you are concerned about. This is a particularly helpful for medical doctors who often send their patients to me for help as they are often not equipped or experienced in this level of diagnosis. This information helps your medical doctor in making better choices in terms of medication if you and your doctor make a choice to explore medication for your ADHD.

Finally, we complete a comprehensive behavioural and medical history that also helps us understand your problems, how ADHD may effect your day to day life at work, home or school, and how we might intervene to help you deal with your ADHD symptoms.

Some parts of this examination are repeatable, so that at a later time we can see if ADHD treatment interventions have really had an effect on your symptoms. I provide a set of procedures and documents that you, your child’s school or parents can use to measure the effects of any ADHD intervention (behavioural or medical). The truth is sometimes we feel better because we think we are better, or sometimes we fail to notice complex cognitive improvements after taking medication because they are hard to measure. These tests and data collection procedures are specifically designed to help determine if real changes have taken place in your ADHD symptoms.

What would a treatment plan for an adult look like?
Often I see adolescents and adults for an initial cognitive evaluation and diagnosis. Once a diagnosis of ADHD is made and we have enough information to understand how ADHD impacts you we develop an intervention plan. We usually meet an average of eight times, using a combination of psycho-educational (teaching) and weekly consultation to get you off on a program you can continue on your own. Here is a general outline of the meetings and intervention schedule I often use:

Assessment, Review and Overview
Session 1 Review of assessment results; Overview of the ADHD program; Discussion of involvement of family and work mates

Organization and Planning for Individuals with ADHD
Session 2 The basics of organization and planning skills; Organizing multiple tasks
Session 3 Problem-solving and managing overwhelming tasks; Organizing papers

Reducing Distractibility due to ADHD
Session 4 Gauging your attention span and distractibility; Modifying your environment

Adaptive Thinking Part 1
Session 5 Introducing the Cognitive Model of ADHD (Cognitive Behaviour Therapy)

Adaptive Thinking Part 2
Session 6 Review of Adaptive Thinking and previous sessions
Session 7 Dealing with Procrastination
Session 8 Preventing ADHD Relapse and setting future goals

Following this eight week course outline together we cover all major areas of concern that commonly are found with ADHD. As I mentioned above, we also fine tune the program to address your specific deficits and strengths that we identified during the assessment process, making success much more likely. Individuals are then able to use appropriate self-help tools with confidence and the knowledge and experience they need to make the most of them.

After this initial program ADHD clients sometimes see me on a monthly basis, or quarterly, for “check ups” and to address problems with relapse.

Finally, for those who with the help of their primary medical provider decide to take medication to deal with this disorder, we are able to provide ongoing neuro-cognitive assessments that help monitor the effects of the medication. Research has found that for those diagnosed with Attention Deficit Hyperactivity Disorder (ADHD or ADD) a combination of medication and behavioural training is the most effective path.

What about ADHD treatment for children and adolescents?
I work extensively with children and adolescents. One thing I am able to provide that others may not are interventions for the school and home that are acceptable to the school stafff. My experience as a classroom teacher for nearly 10 years, and as a school based educational psychologist, gives me insight into how common treatments for ADHD are best adapted to the school environment. I also provide schools with training workshops and teacher consultation on ADHD.

Do you recommend any specific books about ADHD? There are so many out there I don’t know where to start!
For adults we often use the Cognitive-Behavioural Treatment Program for Adults with ADHD developed by Safren and Sprich, which has been found useful with adults. I also ask clients to watch Russell Barkley’s A New Understanding of ADHD (a DVD available in the office) as well as his new book Managing Your Adult ADHD and read either Kelly and Ramundo’s You Mean I’m Not Lazy, Stupid or Crazy?, Hallowell and Ratey’s Driven to Distraction or Thomas E. Brown’s Attention Deficit Disorder: The Unfocused Mind in Children and Adults. All of these books can be obtained in my office or through Amazon.ca (just click!). For those who find reading difficult or find finding time to read difficult (and these are all 200+ page books) I have CD’s and DVDs available. I have similar books on ADHD for parents that specifically address parenting and school related issues.

What about faster methods for dealing with ADHD like Neuro-Feedback, Hypnosis or Diet Changes? Don’t they work?
The short answer is no, they don’t. There is very little evidence supporting any of these treatment methods for ADHD. You may hear that there is research showing neuro-feedback works for ADHD, autism, Aspergers and many other problems. The truth is that after over twenty years of research there is no real evidence that neuro-feedback or neurotherapy has any significant effect on behaviour, school success, attention or impulsivity. (Dr. Russell Barkley, a leading researcher in the field addresses this issue on his web page.) Diets, except for those with a specific allergy, have been shown to have no effect on ADHD. Chiropractic and homeopathic interventions have not been shown to have any effect. “Sound therapy” and hypnosis, likewise, has been show to have no effect. Two web sites I often suggest individuals look at for information about these “alternative” therapies are www.sciencebasedmedicine.com and www.quackwatch.com. I would be more than happy to share the research on these alternative methods with you upon request. My best advice is to ask your medical doctor what he or she knows about these often ineffective yet expensive interventions. He or she is your best source of information.

How much does treatment cost?
Individual sessions cost $175.00 per hour, the rate suggested by the British Columbia Psychological Association. Testing, such as a basic diagnostic assessment usually take four sessions, including the feedback session where we discuss the specific nature of ADHD and how it affects you. More comprehensive diagnostic testing is sometimes necessary for obtaining adaptations and modifications in school, the workplace or for high stakes testing. This level of ADHD assessment includes cognitive, academic and personality components and costs approximately $1,200.00 For children and adolescents we usually need to complete a comprehensive psychoeducational assessment as well as an ADHD assessment. The average cost for this is $2,400.00 However, this is not always necessary or recommended. A basic ADHD diagnosis for use by your medical doctor should take approximately four hours total and will be billed at the hourly rate. Services are available in both Burnaby and Vancouver. The Burnaby office serves Burnaby, Coquitlam, Port Moody, Port Coquitlam, New West Minster and Maple Ridge. The Vancouver office serves Vancouver, West Vancouver and North Vancouver.

Before you come in:
My website’s “forms” page has several handouts, books and articles on ADHD. (click here) Please, go there and check them out. And if you are coming in for an appointment there are several forms I’d like to have you complete prior to coming in, but please wait until I tell you which forms. Different cases and situations complete different packets of information. You should also feel free to call me and ask any questions you might have. My office number is 778.998-7975. If I’m not available feel free to leave a message and I’ll return your call as soon as I can.

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Psychological services (including assessment, testing and therapy) provided in my offices include (covered by most extended health care insurance):
ADHD (click here: http://www.relatedminds.com/adhd-attention-deficit-hyperactivity-disorder/)
Anxiety and Stress (click here: http://www.relatedminds.com/anxiety-stress/ )
Autism and Asperger’s Disorder (Click here: http://www.relatedminds.com/autism/)
Individual Counselling (click here: http://www.relatedminds.com/individual-therapy/)
Child Counselling / Therapy (click here: http://www.relatedminds.com/child-therapy/)
Testing and Assessments and Learning Disabilities (Click here: http://www.relatedminds.com/testing/)
Couples Counselling / Therapy (click here: http://www.relatedminds.com/couples-therapy/)
Depression
The Angry Child (click here: http://www.relatedminds.com/dealing-with-angry-aggressive-and-explosive-children/)
Anger Management (Click here: http://www.relatedminds.com/anger-management/)
Pain Management and PTSD (Click here: http://www.relatedminds.com/pain/ )
Forensic Services (Independent Medical Examinations or IME)

About Dr. Roche
I am a Registered Psychologist and a Registered Marriage and Family Therapist (RMFT) in British Columbia. In addition to my doctorate in clinical Psychology (The Union of Experimenting Universities), I hold a master’s degree in family therapy from Goddard college, a certificate of advanced graduate studies (CAGS) in school and educational psychology from Norwich University, and have completed two years of post doctoral studies in neuro-psychology at The Fielding Institute in Santa Barbara, California. I am also a certified school psychologist, certified teacher of special education (New York and California), and a Clinical Member of the American Association of Marriage and Family Therapists (AAMFT). Finally, I hold a doctoral degree in law (JD) with an emphasis in medical malpractice and education law. Beyond my academic credentials, I have completed two years of supervised clinical experience in both hospital and community based clinics and two years of post doctoral training in neuropsychology. I have served as director of behaviour programming for several school districts, as a consultant on autism for the province, and have held numerous academic positions including Clinical Instructor in Psychiatry at New York University and Bellevue Hospital in New York as well as being a faculty member at NYU, Brooklyn College, SUNY New Paltz, and Norwich University.

My offices in Burnaby and Vancouver serve Burnaby, Vancouver, Coquitlam, Port Moody, Port Coquitlam, New Westminster and Maple Ridge. Clients often come to my Vancouver office from North Vancouver, West Vancouver and even as far as the Sunshine Coast. For more information on the location of my Burnaby and Vancouver offices, please see my “Office Location” page, which contains a Google map.