ADHD Assessments for Children, Adolescents and Adults

As a registered and licensed psychologist I have been working with patients with ADHD| ADD for over 30 years. I have worked with children and adolescents in school settings as well as their homes, and provided adults with ADHD treatment to address problems in the home, with relationships, school| college and in the workplace. I have served as the neuropsychologist on community based rehabilitation teams and worked closely with occupational therapists, social workers and other psychologists to develop rehabilitation and general intervention plans.

Unlike others who work with individuals with ADHD I have worked with individuals across the life span. My experience as a hospital based psychologist, school psychologist and teacher of special education has prepared me to develop intervention programs that make sense for the settings they are used in. I know what's possible, and not possible for a teacher to do, and what makes sense in a workplace or home.

I provide ADHD assessment and intervention services in my offices in Burnaby, BC, Vancouver, BC and Seattle, WA. ADHD assessment services include comprehensive testing, not just collecting symptoms. I work to first, make sure your issues are ADHD related, work to rule out other possible causes of the symptoms, and work to try to understand any co-morbid disorders that might be making ADHD even more difficult to deal with.

As a psychologist I do not prescribe medications but instead work with your physician to 1) develop a comprehensive assessment plans to do the best we can to make the right diagnosis, 2) I do further testing to make sure we understand the exact nature of the problems ADHD presents in your case. This means some academic, cognitive and neuro-spychological testing, in addition to the simple collecting of symptoms many use to make a diagnosis of ADHD.

Psycho-educational Assessments are sometimes needed to help a school make a determination about how ADHD is effecting you, and what types of school based information they might need to provide appropriate services and accommodations. 

A comprehensive ADHD assessment starts with an initial appointment to review your history and make sure we are right to be proceeding with an assessment. Together, if appropriate, we then proceed to gathering a history and observations from others. Then we finish the assessment with a day of testing to provide further and deeper insight. The cost of the initial appointment in my Canadian offices is $175. The comprehensive testing costs $600 and if you need a psycho-educational assessment for school, college or university the cost of the psycho-ed is approximately $1,600-$1,950.  In this case the cost of the ADHD assessment component is included.

For further information on ADHD testing / assessment, diagnosis and treatment of ADHD in children, teens/adolescents or adults, please contact me on my web page at www.relatedminds.com

https://therapists.psychologytoday.com/rms/name/Jim_Roche_JD,PhD,CAGS,RPsych,RMFT_Burnaby_British+Columbia_70682

http://www.psychologists.bc.ca/users/jimroche

http://www.relatedminds.com

Psychoeducational Assessment

Psychoeducational Assessment (Burnaby, Vancouver)

Dr. Jim Roche is a Registered (BC) and Licensed (CA, WA, NY) Psychologist specializing in treating ADHD, autism spectrum disorder, Aspergers disorder in children, adolescents and adults, learning disabilities, behavioral disorders and severe mental health issues. He also provides mental health assessments and individual, couple and marriage therapy. You can find more information about his practice at the websites below:

Relatedminds: http://www.relatedminds.com
ADHD Help BC: http://www.adhdhelp.ca
At Psychology Today: http://therapists.psychologytoday.com/rms/70682
At Psyris: http://psyris.com/drjimroche
At Autism Community Training: http://www.actcommunity.net/jim-roche.html

Key Words
ADHD | ADHD coaching | workplace coaching | Anxiety and Stress | Autism and Asperger's Disorder | Individual Counselling | Child Therapy | Testing and Assessments and Learning Disabilities | Couples Counselling | Depression | The Angry Child | Anger Management | Pain Management and PTSD | Forensic Services | Attention Deficit Hyperactivity Disorder | Vancouver | Burnaby | Coquitlam | New Westminster | Maple Ridge | Port Moody | Child Psychologist | Psychologist | Learning Disability | Assessment | Testing | Psycho-educational Assessment | Neuropsychological Assessment | Psychoeducational Testing

Salish Court at Bell (google map) (yahoo map)

ADHD Self Help Books ..ADHD Coaches ...and everything else

I am often asked to recommend books for children, adolescents and adults with ADHD (Attention Deficit Hyperactivity Disorder). Most of the time my primary recommendation is one of the ADHD books by Dr. Russell Barkley, for whom I have great respect. Dr. Barkley is one of the major figures in the ADHD field and should be read by every professional in the field. His books about ADHD with children and adults are also highly useful.

If your reading this post you have probably been reading  several recent articles in the news about the increasing number of ADHD diagnoses, as well as the impression many people have that ADHD is OVER diagnosed. This may or may not be true in certain settings. Until very recently we did not diagnose a teenager or adult with ADHD. If you hadn’t been noted to have the symptoms of ADHD at an early age it was assumed you didn’t have ADHD. More recently we have seen how the effects of the executive deficits that are core to ADHD might only become serious when there are specific developmental demands you might not be confronted with until you are 15, 18 or even 25 (and got that promotion that require a new, higher level of organizational and planning skills).

But back to recommending books, especially self help books. One of the problems I see in recommending self help books for teens or adults with ADHD is that almost all of the good books – those based on firm scientific grounds – are just too long!  The one I’m going to recommend right now, The Energetic Brain: Understanding and Managing ADHD by Cecil Reynolds, Kimberly Vannest and Judith Harrison is just over 400 pages. If you have ADHD it seems a little stretch to me that you’re going to not only finish  but understand – underline, take notes, pick out the parts that are meaningful to you....re-organize the book!  This is why self help books for ADHD (as well as for high functioning autism/ASD and Aspeger’s Disorder) often need to be used with some help – an ADHD coach, therapist or counsellor.

The Energetic Brain: Understanding and Managing ADHD is, despite its length, a really excellent  book. Cecil Reynolds, one of the authors, is a highly respected writer, researcher and test developer.  Many of the assessment tools I use were developed by Cecil Reynolds. This means that the book is based not upon anecdote and myth, but instead is based upon “exacting scientific evidence and uses data-driven interventions to manage the disorder.”  As the foreword points out, you are able to benefit from not just good and what appears to be practical advice, but from the authors “collective expertise in neuropsychology, psychology, education, and behaviour...”  For those with children or adolescents with ADHD in school  the authors also address the critical issue of PBIS (Positive Behavioural Intervention Support).  While a lot of the materials about schools is addressed to public school law in the United States, I thinks it’s a good idea for those in Canada to take a look at how things SHOULD be for a student in school with ADHD. Note: We DO have laws, regulations about ADHD, and the provincial ministry as well as individual school districts have policies and procedures about students with ADHD. They simply fail to implement them.

Overall this is a great book. I usually have it in my office for patients, along with Barkley’s books. These two sources of information make a good starting point for anyone dealing with ADHD.

One of the things I am reminded when reading these books is the need for some sort of ADHD Coaching, and the need for this ADHD Coach to be someone with real training in the field. I’ve discussed this issue with several colleagues and there are two points of view: 1) Than a coach is a coach, and that the skills they are going to teach and support are the same as with any one of their clients; and 2) You need an ADHD coach who is familiar with all of the issues relating to ADHD – neuropsychological, psychological (depression, anxiety), education (being familiar with the requirements of the school setting – from elementary to graduate school) and the work setting (experience with workplace rehabilitation issues). The first coach is going to cost you $50.00 an hour. The second $175.00 and up.  But I’ve seen too many clients work with coaches who do not have the knowledge of neuro-psycho-social issues and waste their time and money. If nothing else I would suggest using a coach who is associated – supervised by a licensed professional such as an MD or PhD. Looking over the ADHD coaching sites in this area I find mostly individuals who do not have the appropriate background, and often have little life experience themselves. Locally there are two coaches who as far as I can tell have no other successful work experience and simply decided they had ADHD, had read a lot of books about it, and therefore would make good ADHD coaches. When looking for a coach, at a minimum, ask for their resume and ask for a couple of professional references if they are not a professional themselves (What psychologist or medical doctor have you collaborated with?).

Regretfully during the past few years ADHD has become a way to make money for a lot of people. They approach the field as, “I’m going to open an ADHD business” rather than being a professional who focuses on ADHD. It reminds me of someone who opens a business whitening teeth. They aren’t a dentist. But lots of people need to have their teeth whitened. Why not do that? There is little to learn, some training when you get the tools you need or sign the contract for a franchise. But my dentist, who WOULD charge more also checks for many other issues.

Check out the book, and if you think you have ADHD and wonder, see a licensed/registered professional for a comprehensive diagnosis. Do not diagnose yourself. ADHD looks like a lot of other issues, and a lot of other mental health issues and learning deficits can look just like ADHD. A comprehensive assessment is the best way to go.
(In British Columbia only a medical doctor or registered psychologist can make a diagnosis of ADHD. “Counsellors,” registered, licensed or certified,  cannot. The same holds true in Washington state and California. )

For more information on my practice please visit my website at http://www.relatedminds.com or http://www.adhdhelp.ca  I am licensed and practice in British Columbia, Washington State and California (San Francisco).

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Key Words
ADHD | Anxiety and Stress | Autism and Asperger’s Disorder | Individual Counselling | Child Therapy | Testing and Assessments and Learning Disabilities | Couples Counselling | Depression | The Angry Child | Anger Management | Pain Management and PTSD | Forensic Services | Attention Deficit Hyperactivity Disorder | Vancouver | Burnaby | Coquitlam | New Westminster | Maple Ridge | Port Moody | Child Psychologist | Psychologist | Learning Disability | Assessment | Testing | Psycho-educational Assessment | Neuropsychological Assessment

Learning Styles Don't Exist

Again, I find myself confronted by a teacher who talks..and talks..and talks about "learning styles." Learning styles are the ONLY issue she is willing to discuss when it comes to providing supports for a student with a specific learning disability and ADHD that I have diagnosed and provided a psychoeducational assessment for. What we need are classroom modifications and a simple reinforcement system, things that we have used in classrooms for years and are backed by science. Why not instead consider the issue of "learning styles?" Watch this video to understand. And if your teacher start talking learning styles...have the teacher watch it!

http://www.youtube.com/watch?v=sIv9rz2NTUk&feature=player_embedded#at=218


Autism Spectrum Disorder and Psychoeducational Assessments

I have been asked by several parents about the difference between a psychoeducational assessment and an assessment for autism spectrum disorder (ASD) or Aspeger's Disorder. There is some confusion out there, and several parents have arranged for the wrong kind of assessment in order to obtain the services they need. So I'll try to explain when you need each of these types of assessments: Psychological Assessment, Psychoeducational Assessment and Autism Disorder Assessment very briefly.

An Initial Psychological Assessment
In British Columbia parents are often sent to a registered psychologist by their school or physician when autism is suspected. Initially you should be arranging an appointment to have the psychologist meet you and your child and do a brief psychological assessment. This usually can be done in one session. You may be asked to complete a number of forms, such as the SNAP-4, some behavioural forms, and maybe an adaptive behavioural assessment form (ABAS).  These can sometimes be sent to you before the examination and returned so that the psychologist is ready to meet you. The psychologist will interview you, observe your child and take a comprehensive history. Form this a determination can usually be made about what is the best way to proceed. Often what looks like autism spectrum disorder or Asperger's can be something else, such as ADHD or a developmental disorder. Perhaps anxiety, or a specific learning disability. The psychologist can then help you proceed down the correct path.

A Diagnostic Assessment for Autism
If autism is suspect, or Aspegers Disorder, your psychologist will then proceed to complete a comprehensive assessment for autism spectrum disorder. This includes two critical examinations that are necessary for funding in British Columbia. These are the Autism Diagnositic Rating Scale (ADOS) and the Autism Diagnostic Interview (ADI-R).  There are a number of other autism tests and tools out there, but these are the two that are necessary for funding from the ministry in British Columbia, and for services through any school district. If your child goes to public school in Burnaby, Vancouver, New Westminsiter, Coquitlam...anywhere in the province, the psychologist who completes the assessment must be trained in using these tools and use them for the diagnosis. Nothing else will do. Sometimes parents go to a professional who uses other tools and completes this assessment in another way. If they do the assessment will not qualify, so make sure you see someone who uses these tools for the autism assessment.  These are not the only tools he or she might use, but these are essential. For children under six years old a separate assessment by a speech pathologist and medical doctor need to be part of the process as well. If a full psychoeducational assessment is not being done, usually some sort of intelligence/cognitive testing is necessary to rule out other possible disorders.

The Psychoeducational Assessment
Along with the autism assessment most schools require a comprehensive psychoeducational assessment. This assessment looks at bith intelligence and academic ability. Children from age 3 up can be given a psychoeducational assessment, although in British Columbia schools seem unwilling to assess younger children due to financial constraints. It is best practice and done throughout most of North America, but not common here. The two components of the assessment, the intelligence and academic parts, are then compared and from that information we can make determinations about specific learning disabilities. Most children with ASD have a comorbid learning disorder. Nearly 50% of children with ADHD have a comorbid learning disorder. And without understanding the cognitive strengths and weaknesses of a child it is difficult to develop an Individualized Education Plan.

These are the three main types of assessments children and adolescents go through in order to develop an educational and behavioural plan. You often hear of a neuropsychological exam as well. These are highly specific examinations of brain processes that help with both diagnostic questions and developing education plans. Most of the time a good psychoeducational assessment and autism assessment (if necessary) are enough to move forward with.

Costs? Full psychoeducational exams can cost from $2,200-$3,600 depending on who you see and what tests are completed. Your school can and should be providing this exam for free, however here in BC there are very long waiting lists. An Autism Assessment runs around the same, but the two can often be done together. Again, the Provincial government can provide these services, for free, however there is again a waiting list, and some parents prefer to have an autonomous outside professional see their child rather than the ministry.

I hope this information is valuable. My best advice is to make sure the professional you see is a registered psychologist, that they have experience with children or adolescents, and have experience working with the schools. Understanding the system is as important as understanding the tests.

For information on services that I provide please visit my web page at: www.relatedminds.com
I provide autism and Aspergers assessments not only for children and adolescents, but for adults as well.

Psychoeducational Assessments, ADHD and Autism

After a few weeks away from the office things are back to usual ...almost. Office hours are available in both the Burnaby and Vancouver locations for assessments, including Psychoeducational assessments, neuropsychological assessments, diagnostic assessments for both Autism Spectrum Disorder and Aspergers Disorder (which meet the Ministery requirements in British Columbia for private assessments of ASD) and related diagnostic work. Please feel free to contact the office, however the schedule is still rather full and it can often take until the weekend before youer call is answered. An initial contact through email is welcome at relatedminds@gmail.com, however if you do contact the office through email please do not include any personal information you would not want shared. People make mistakes emailing, sometimes emailing to the wrong address, so make a more general inquiry first.

A number of people want to kniow how quickly a psychoeducational assessment can be completed. Usually it takes 2 days of face to face testing with the student. There are additional items to be completed, however those can often be done on line or at home. So, two days of actual testing. Usually 3-4 hours each day. The report is usually done within the next ten days. This is a much shorter time than you will find elsewhere.  Appointments can usually be made within the next 2-3 weeks.

Costs of psychoeducational assessments average around $2,400.00, but can be more if additional testing needs to be donne.  Payments are usually made as follows: Payment for the three  hours of testing time scheduled is made before an appointment for the assessment can be made. Cancellations must be made 72 hours in advance, as a large block of time is scheduled. At the initial session 50% of the fee is due, and at the time you recieve the report the remaining 50% is due. Payments can be made in the office by Mastercard or VisISA, or on line using other credit cards or a back card. Checks are also accepted.

Assessments for Autism Spectrun Disorder. The cost of an ASD asseswsment ranges from $2,600.00 to $3,200. The final cost is dependant upon what the assessment calls for. Some children need both an ASD assessment for diagnosis (using the ADOS and ADI-R) AND a Psychoeducational Assessment in order for the school to set up an appropriate Individual Education Plan. You need a Psychoeducational Assessment before an IEP can be completed. Sometimes the school can or already has provided that service. With younger children a medical doctor's report and a report from a Speech and Language Pathologist  must be part of the assessment to meet the needs of the Ministry. Those are obtained seperately and are then used as part of the final process by the psychologist.

Getting an assessment does not automatically lead to a diagnosis of ASD, nor does it automatically lead to Ministry funding. Just as getting a Psychoeducational Assessment does not necessarily lead to an IEP or services from the schools.

Finally, often parents and adults are seen for ADHD (Attention Deficit Hyperactivity Disorder) assessments. These vary in cost, as they may include a psychoeducational assessment, or may not. These are arranged individually.

If you are exprecting to use any assessment in a legal situation (often adults with ADHD want an assessment due to work difficulties) the assessment process is different. It requires using different tools, and gathering additional information. You need to be clear on the purpose of the assessment from the start.

I aklways suggest that parents write out what they want an assessment to do. What should it provide? Assessments are always done in order to answer a question. "Why doesn't John read as well as he thinks?"  "Why can't Nancy write? She reads above grade level but can't seem to write out answers to questions?" It's always good to spend time thinking out these questions.

ADHD assessment and treatment also need to address specific deficits and needs. An assessment is much better at answering how best to reach a goal, rather than asking what goals should we have.

Dr. Jasmes Roche
relatedminds.com
www.relatedminds.com

Offices in Burnaby and Vancouver

Psychoeducational Assessments


Dr. Jim Roche
Registered Psychologist
Relatedminds.com

Psychoeducational Assessments
Dr. Jim Roche is a Registered (BC) and Licensed (CA, WA, NY) Psychologist specializing in treating ADHD, autism spectrum disorder, learning disabilities, behavioral disorders and severe mental health issues. He psychoeducational assessments,  mental health assessments and individual, couple and marriage therapy. You can find more information about his practice at the websites below:



KEY WORDS
ADHD | ADHD coaching | workplace coaching | Anxiety and Stress | Autism and Asperger’s Disorder | Individual Counselling | Child Therapy | Testing and Assessments and Learning Disabilities | Couples Counselling | Depression | The Angry Child | Anger Management | Pain Management and PTSD | Forensic Services | Attention Deficit Hyperactivity Disorder | Vancouver | Burnaby | Coquitlam | New Westminster | Maple Ridge | Port Moody | Child Psychologist | Psychologist | Learning Disability | Assessment | Testing | Psycho-educational Assessment | Neuropsychological Assessment | Psychoeducational Testing

North Vancouver school district discriminated against dyslexic boy, Supreme Court rules

North Vancouver school district discriminated against dyslexic boy, Supreme Court rules

It's about time! Parents bring their children to me every day who are waiting, 1, 2, 3 or more years  just for an evaluation of a learning problem...while other programs at schools go on. School districts tell parents that testing and evaluating students needs to wait, and that there is  policy against early testing even though this is standard care throughout most of North America. No assessment, and then, no treatment. Teachers can't provide appropriate education due to a lack of skill and support. Students with ADHD are told to do home schooling, or join out door programs because teachers have no skills in dealing with these students in British columbia schools. Just ask your school district for a list of what was offered to teachers last year during there days of "professional development" training. How many workshops were scheduled focused on ADHD, learning disabilities, classroom management? You will be shocked to see the lack of support available for teachers.  Students with attention deficits, which could be addressed in the classroom through environmental adaptions are told to take medication or on-line classes. Because teachers don't get the training and support they need. (Most BC schools will not even classify -code- a student with ADHD so that they could qualify for support!) In the mean time teachers attending SFU and other graduate programs in education are required to take little if any training in classroom management, working with children who have learning disabilities, or any other skills focused training. Go on line and check out the requirements for these school district based degree programs. There is lots of focus on "reflection" but little on skills development and practice. If your plumber got licensed by focusing on "self reflection" as much as teachers do we would all drown in our homes. We need skill development, classroom management training, school psychologists to assess our children and well written IEPs that are followed by teachers who know what to do with students with special needs.

Just a few kilometres south, in Washington State, a parent or teacher may ask for an assessment and you can expect it to be completed within 50 days - by law. Then you can expect an education plan to be written that directly addresses the specific needs of the student. Finally you can expect your child's teacher to implement this plan because they have the training and support they need. Why can't we do better?

Self-Regulation and ADHD: Misusing Shanker's writings and the Calm, Alert and Learning concept.

Self regulation is something I write about and teach all the time.  Right now, on my desk, is a lesson for a 7 year old on self regulation. We are going to use a book called "The Incredible 5 Point Scale" to understand emotions, and practice some CBT (Cognitive Behavioural Therapy) techniques to regulate them. It's a very simple lesson, but often very helpful for children with anxiety who over react to stressful situations. I also go to schools and demonstrate class wide (universal) techniques to teach and learn these self regulation skills. This is not new stuff, it's the focus of many of the programs in our schools already, especially for children with social-cognitive disorders such as Asperger's Syndrome or High Functioning ASD.  POPARD, the Provincial Outreach Program for Autism and Related Disorders has an excellent team of professionals who teach this all across the province.

So why am I so upset by the recent article in the Vancouver Sun about using self-regulation techniques in our classrooms?

Here is a direct link to the article:
(http://www.vancouversun.com/technology/schools+promote+student+self+discipline/7287707/story.html)

Here is the part that scares me:


"Former education minister George Abbott echoed that view and predicted during an interview last month before he left the ministry that the project now underway will bring significant change to all 60 districts within two to four years. “This is hugely exciting,” he said. “I think it can reshape the way we manage the challenge of special needs in the 21st century.”

He expects it will move schools away from their emphasis on diagnosing a child’s special need, attaching a label — which may or may not bring additional funding — and developing an individual education plan (IEP). The goal, instead, will be for schools to make better use of groundbreaking neuroscience research on self-regulation to benefit all students.
“Let’s not be blowing our resources on trying — at often too early an age — to diagnose precisely what the challenge is,” Abbott told leading school officials at a self-regulation conference earlier this year. Regardless of what the challenge is — whether the child is the next Isaac Newton or has attention deficit hyperactivity disorder (ADHD) — the strategies to help with learning are the same, he said."

Wow. So a subtext to this is to cut the waste of time we spend doing psychoeducational assessments, "Let's not be blowing our resources on trying -at often too early an age -to diagnose precisely what the challenge is."  This is in stark contrast to volumes of research on the effectiveness of early intervention, and the ability of most other jurisdictions in North America to provide early assessment and intervention, often BEFORE students enter school, to make sure they do not fall behind and have adequate supports.  But as he also notes, why bother, because these "labels" "may or may not be bring additional funding."

By the way, here in BC students, often students who have failed academically for two or more years, are placed on waiting lists to be assessed. They often remain on those waiting lists for two or more years! At the end of every year the waiting list is often reworked, and those with severe behavioural problems go to the top, so a student who almost got to the top this year might be at the bottom of the waiting list next year. Compare this to getting an assessment in Washington State. It take 50 working days for an assessment to be completed. Just keep this issue in mind as you read the article.

Mr. Abbott's most frightening statement is, "Regardless of what the challenge is - whether the child is the next Isaac Newton or has attention deficit hyperactivity disorder (ADHD) - the strategies to help with learning are the same..." 

This is the most uninformed and misinforming statement I can imagine making. You use the same strategies to help a child who is "gifted" as a child with ADHD, autism, Aspeger's, a disorder or written expression, dyslexia....really? There is some research that supports this? You mean that all of the programs designed to address specific visual, motor, cognitive, auditory, and sensory deficits are ....the same? And I guess that means lets just stop with all this assessment stuff, stop wasting our time understanding the individual child, and apply a blanket procedure to everyone...because if children would just learn to "remain calm, be focused and alert" everything would be fine.

This attitude dismisses the real nature of disorders such as depression, anxiety, learning disabilities, ADHD and many, many others. Can you imagine this attitude in any other field? Would you like your doctor to think like this? "Hey, we don't need a diagnosis, who cares if its mumps, an allergy, cancer ..... just learn to eat healthy and exercise." Besides, we don't have enough funding!

Don't misunderstand me. Preventative interventions, like Shanker's, are great! Let's implement them, today! But for students with real learning disorders they are not a replacement for real assessment, diagnosis and focused interventions and support. When you read that and local school officials members of our government think that promoting "self-discipline" and "self-regulation" is a proven therapy for children with diagnosable learning disorders, be skeptical. And when you read that they also suggest we just skip over that unnecessary diagnosis stuff ....because it won't lead to funding...be angry!

The deep deep message here is that it is through personal responsibility and self-discipline that change will occur. That simplistic message is what is appealing to people here. That's really  hard to argue with. To disagree makes you sound like a total quack. But for many disorders, such as ADHD (which British Columbia is famous for addressing poorly) children, teens and adults know what they should do, they understand their behaviours, but cannot help themselves. THAT is the nature of the ADHD - a brain based neurological disorder, not poor attitude. I suggest George Elliot and others supporting the further gutting of school psychology services read about ADHD in science based books and articles by professionals like Russell Barkley, PhD). Students with ADHD are helped through specific classroom environmental changes, externalized prompts and cues and, sometimes, medical intervention. There are many proven and effective classroom based interventions for these students, with years of research backing them up. But when was the last time you heard a school district was providing training for teachers in addressing the needs of their students with ADHD, learning disabilities or Aspeger's Disorder? 

The tone of self-discipline and self-regulation to address disorders like these leads to blaming the victim mentality. We expect them to fit the program rather than "to diagnose precisely what the challenge is" and providing appropriate supports. Something Mr. Elliot says directly is a waste of time and money. 

After reading those comments I need to be "calm and alert" myself.



Why Men Fail: Focus and Flexibility and CBT

http://www.nytimes.com/2012/09/11/opinion/brooks-why-men-fail.html?smid=pl-share

One of the key components to cognitive behavioural therapy, an essential part of most treatment programs for ADHD, is working on "cognitive flexibility." Being able to "switch mental sets" and use social perspective taking.  In her new book, “The End of Men,” Hanna Rosin posits a theory that seems to go along with this neurological problem. It has to do with adaptability. 

"Women, Rosin argues, are like immigrants who have moved to a new country. They see a new social context, and they flexibly adapt to new circumstances. Men are like immigrants who have physically moved to a new country but who have kept their minds in the old one. They speak the old language. They follow the old mores. Men are more likely to be rigid; women are more fluid."

What is important here is that this theory has less to do with innate traits and more to do with social position and personal cognition. "When there’s big social change, the people who were on the top of the old order are bound to cling to the old ways. The people who were on the bottom are bound to experience a burst of energy. They’re going to explore their new surroundings more enthusiastically."
It's an interesting read, especially when you try to apply what it teaches about the humankind and come up with a means of changing how that mind works.  CBT -Cognitive Behavioural Therapy - to me, offers an answer. Reading this NYT opinion piece is a good place to start.

Kids with ADHD deserve action: One Year Later

Today I reread this great letter to the editor about ADHD, ADHD treatment and ADHD in the schools here in BC. The link is below and you should read this letter yourself, it's a cry from a parent for the local school districts to do SOMETHING for students with ADHD in the schools, anything! Because what BC schools are doing for students with ADHD is totally unacceptable. It's actually nearly nothing. Here is a link to the web site and letter to the editor: http://www.burnabynow.com/health/Kids+with+ADHD+deserve+action/3699644/story.html

Here are some of the comments from the letter, and my additional comments: First, the writer talks about being "anxious and frightened on how we'll try to navigate through an education system that doesn't recognize my child's ADHD as a disorder." This is perhaps the most shocking and incomprehensible part of the letter. And it's true. ADHD, one of the disorders most likely to cause school failure, academic failure, lead to low graduation rates, low employment rates and even relates to many co-morbid disorders (such as specific learning disabilities) is IGNORED by many of our local school districts. Some districts will provide help, but only if the child is a "behavioural problem." Academic stress and failure in school aren't enough. We need to wait until there is "behavioural disruption" due to the ADHD. Strange. Backwards. And it's no wonder British Columbia is tied with two other provinces for the worse services for children with ADHD.

 The writer notes, "it is a neurological disorder that is medically recognized and that requires treatment." The writer needed to have her child tested privately to finally get the diagnosis. Let me make clear, when we say it's a neuropsychological or neurological disorder that means we can put a child into an MRI and SEE areas of the brain failing to function. ADHD is one of the most researched and tested diagnoses of all childhood disorders, yet some school district personnel still fail to accept that it even exists! The writer goes on to say, "each year, we are frustrated at the stigma associated with a chronic lack of awareness of ADHD, and lack of support and resources for a disorder that affects thousands of children." If your child has autism, the school gets funding, usually assigns an aide, and for children under 6 parents get over $20,000 in funding for treatment. Over six years of age they continue to get thousands of dollars of funding a year, both the school and directly to parents for treatment they find and make use of. In BC we have zero funding. A child suspected of having ADHD needs to be assessed and usually this means not just an ADHD assessment but also a full psychoeducational assessment as nearly 50% of these children have other disorders such as anxiety, depression, OCD, ODD or specific learning disabilities. Yet MSP will pay zero, and most private insurance will pay from 100-500 dollars for services. (A full diagnostic evaluation can cost from $1,200-2,600.00) When visiting schools I am usually there to see students with autism spectrum disorder or Aspergers Syndrome. These children have funding and get classroom aides, teacher training and consultation from professionals like myself or the provincial organization 9POPARD- the Provincial Outreach Program for Autism and Related Disorders). Yet the teachers I meet who are burned out, confused, need the most help and are most likely to be the ones going out on sick/stress leave are the teachers of students with ADHD. For them, regretfully, there is little support.

 In the past few years I have been invited to consult on hundreds of students, and present workshops for teachers during their professional development periods. Only twice has a school thought it important enough to bring me in to speak about ADHD. Autism, Aspeger's Syndrome, general classroom management,and severe behaviour problems. I always tell them, the biggest bang for your buck is training your teachers in techniques and skills to work with and support students with ADHD. Every class has 1-3 students with ADHD, and the techniques and tools we teach that address ADHD work for almost every other issue. But before teachers and administrators ask for help with ADHD training they need basic education to understand and recognize ADHD.

Regretfully, we still have teachers and administrators who think ADHD is a made up excuse for laziness and poor parenting. It's time BC moved out of the dark ages of mental health. "ADHD Assessment and Treatment" are written by Dr. Jim Roche. These autism notes are not meant to provide a guide to either diagnosis or treatment. For information on diagnosis and treatment contact your medical doctor or a registered/licensed psychologist for an appointment and assessment. Information about Dr. Roche's services can be found at these addresses:

 At Relatedminds: http://www.relatedminds.com
 At ADHDHelp BC: http://www.adhdhelp.ca
 At Psychology Today: http://therapists.psychologytoday.com/rms/70682
 At the BCPA website: http://psychologists.bc.ca/users/jimroche
 At CounsellingBC: http://www.counsellingbc.com/listings/JRoche.htm
 At Psyris: http://psyris.com/drjimroche

KEYWORDS: ADD, ADHD, Attention Deficit Hyperactivity Disorder, ADD Coaching, ADHD Coaching, ADHD Coaching Vancouver, ADHD Coaching Burnaby, ADHD Coaching Langley, ADHD Coaching Coquitlam, Psychoeducational Assessment, Learning Disability, ADHD Diagnosis

Think Your Child Has ADHD?

WebMD has an excellent and short video on the initial steps to diagnosing ADHD in children. This ADHD video on diagnosis also addresses the use of medication for children and teens with ADHD. As usual, medication is not the first step one should necessarily take after finding your child has ADHD. Common, well known behavioural interventions in the home and classroom are the recommended first step, and these remain important parts of treatment for ADHD no matter if you make the choice to use medication or not. Certainly it is clear that parent education, student/child psychoeducation and behavioural therapy and ADHD Coaching are step one and are always part of any good treatment plan.

Here is the link to this ADHD video: Think Your Child May Have ADHD? Learn More - Watch WebMD Video http://www.webmd.com/add-adhd/video/diagnosing-adhd

For more information on the diagnosis of ADHD in children, adolescents or adults, see my web page at www.relatedminds.com ADHD can be diagnosed by either a medical doctor or registered psychologist with appropriate training and experience. An initial medical exam is always necessary to rule out possible disorders that cause the behaviours of concern that may not be ADHD. To find a registered psychologist who can diagnose ADHD contact the British columbia Psychological Association.

More information about my practice can be found at: "ADHD Assessment and Treatment" are written by Dr. Jim Roche. These autism notes are not meant to provide a guide to either diagnosis or treatment. For information on diagnosis and treatment contact your medical doctor or a registered/licensed psychologist for an appointment and assessment.

Information about Dr. Roche's services can be found at these addresses: Relatedminds: http://www.relatedminds.com
ADHD Help BC: http://www.adhdhelp.ca
At Psychology Today: http://therapists.psychologytoday.com/rms/70682
At the BCPA website: http://psychologists.bc.ca/users/jimroche
At CounsellingBC: http://www.counsellingbc.com/listings/JRoche.htm
At Psyris: http://psyris.com/drjimroche

 KEYWORDS: ADD, ADHD, Attention Deficit Hyperactivity Disorder, ADD Coaching, ADHD Coaching, ADHD Coaching Vancouver, ADHD Coaching Burnaby, ADHD Coaching Langley, ADHD Coaching Coquitlam, Psychoeducational Assessment, Learning Disability, ADHD Diagnosis

Psychoeducational Assessments and ADHD

Does a Psychoeducational Assessment also diagnose ADHD?
Psychoeducational Assessments are usually completed by your school district. In many provinces and all of the United States school districts provide timely psychoeducational assessments upon a reasonable request from a parent or teacher (with the parent's permission). Usually those psychoeducational assessments happen within 50 working days.

Here in British Columbia we have the regrettable problem of poor school funding and staffing. In some school districts children are placed on a waiting list that can last for one, two, three or more years! Many school districts place children on a "waiting list" only to redo the waiting list at the end or every year! So parents often make a choice to go to a registered psychologist to get a psychoeducational assessment.

One of the advantages of a psychoeducational assessment completed by a Registered Psychologist rather than a School Psychologist is that a REgistered Psychologist is authorized to diagnose ADHD (Attention Deficit Hyperactivity Disorder) and a School Psychologist is not. School Psychologists usually only hold an MA or MS degree, not a doctoral degree, and are not a "regulated profession" in BC. You should know, however, that many School Psychologists who are completing psychoeducational assessments for learning disabilities and behavioural issues are actually Registered Psychologists who have chosen to specialize in school based psychology. So, they may or may not be able to diagnose ADHD. Adding to the confusion is the fact that many school districts have rules that limit what school psychologists do, and some districts do not allow even their Registered Psychologists to make a diagnosis of ADHD (Attention Deficit Hyperactivity Disorder) or other related childhood disorders such as Autism Spectrum Disorder or Aspgerger's Syndrome.

Another important factor to consider is that when a child is diagnosed with ADHD it is often critical to complete a Psychoeducational Assessment, as nearly 50% of children with ADHD also have another disorder, often a specific learning disability. A Registered Psychologist or your School Psychologist can complete that assessment.

When is the best time to get a Psychoeducational Assessment?
It is appropriate to get a psychoeducational assessment whenever a child has had repeated academic failures, and classroom based interventions have failed. Waiting more than a year of academic failure places your child in a difficult position to get out of. This is especially true of children in grade 3-4, when the classroom curriculum begins to change and become much more difficult. A lack of strong basic skills can make academic work very difficult if not impossible for some children.

Does a Psychoeducational Assessment also address behaviour problems? 
Usually a Psychoeducational Assessment does look at behavioural problems. First, it's often necessary to rule out that the behavioural issues are not caused by academic deficits. Second, schools are able to complete not just a Psychoeducational Assessment but also a Functional Behavioural Analysis (FBA) to understand the reasons for the child's behaviour. Most school districts have someone trained in completing FBA's. Again, while all schools in a state like California would be required by law to provide FBA's, and to have them completed by a fully and appropriately trained specialist, this is often not the case here in British Columbia.

If the school is going to provide an FBA you should ask what training, expertise and experience the provider has (how many FBAs have they completed? What training did they get? How many hours of training? How much of it, if any, was supervised by an expert in behaviour? These are good questions to ask.

Finally, remember, your medical doctor can usually make a diagnosis of ADHD. If they feel unsure, they can make a referral to someone else. But a diagnosis of ADHD leaves out a lot. It's best practice to also complete, at least for children, a Psychoeducational Assessment. Your family MD is covered by MSP, however services by a Registered Psychologist, even though they are a regulated health provider, are not covered by MSP. Most extended health care programs cover some or all of these costs, but you need to check with your individual provider before having a Psychoeducational Assessment done. Some providers will not cover the cost of an assessment.

 Dr. Jim Roche provides both Psychoeducational Assessments and ADHD Assessments, as well as treatment and coaching for children, adolescents and adults with ADHD, behavioural disorders and autism spectrum disorder. His website can be found at: http://www.relatedminds.com

New ADHD Widget added to web page


You will find the new ADHD Widget on the right side of most pages of my web page. This new widget guides you through making a decision about ADHD - that is, it helps you decide if it might or might now be a good idea to see you psychologist to medical doctor. It's not meant to diagnose ADHD. It's a handy interactive means of helping you put things into perspective. Deciding if a child has ADHD is a several step process. There is no single test to diagnose ADHD, and many other problems, like anxiety, depression, and certain types of learning disabilities, can have similar symptoms.

The American Psychiatric Association's Diagnostic and Statistical Manual-IV, Text Revision (DSM-IV-TR) is used by mental health professionals to help diagnose ADHD. The criteria are presented here in modified form in order to make them more accessible to the general public. They are listed here for information purposes and should be used only by trained health care providers to diagnose or treat ADHD.

If a parent or other adult is concerned about a child’s behavior, it is important to discuss these concerns with the child’s health care provider. A diagnosis is made up of more than a simple checklist.

See my web page for more information at www.relatedminds.com
                                   

School Based Interventions for Angry, Acting Out Kids

Behavioural Problems and Younger Children, including Temper Tantrums


School has not even started and several parents have come by for advice on dealing with behavioural issues at school. The live in expectation and fear! Most of these kids have Attention Deficit Hyperactivity Disorder, or another executive disorder, sometimes called “EF” problems or “Executive Function” disorders. There are differences between executive function disorders and ADHD, but for the most part the behaviours of either type appear the same in a classroom setting. Sometimes these types of behaviours are called dysfunctions of “self-regulation.” 
So what to do if your child is out of their seat, calling out, talking without permission, fighting, out of line..in the hall...last off the playground and your teacher already needs a vacation in week 2 of school?
Lets start with “Positive Behavioural Supports: Token Systems”
In the classroom and home the most effective intervention for acting out behaviour is a positive behavioural support system - a token system. This provides a mechanism to immediately reinforces appropriate behaviours and increases their frequency. It’s about teaching and reinforcing new skills and not relying on “correcting” misbehaviours that have already happened. For the most part, if a correction was going to work ...it would have worked already!.
Here is a typical plan for using a reinforcement system: Often a timer is set in the classroom and 7-10 times per day the students are reinforced for appropriate behaviours using the token system. Responding to the timer rather than student behaviour increases the positive feedback the student receives and decreases the ineffective “corrective” feedback. The timer is critical! Dr. Barkley’s DVD “ADHD in the Classroom, Strategies for Teachers,” provides an excellent example of using these techniques. Dr. Barkley also has excellent parenting videos such as “Understanding the Defiant Child” which I would recommend to any parent. Token systems have an extensive history and have been proven to be highly effective over and over again. Why don’t teachers use them? Usually because they used them wrong. Watch Dr. Barkley’s video and see them in action. (I also provide training in to schools on the basics of classroom management where I demonstrate the system by using it throughout the workshop...and it’s not disrupting and takes very little time.)
Good behaviours are learned, so teach them!
Modeling, practicing and formally reinforcing appropriate behaviours is another intervention necessary to teach self-regulation skills. Self-talk is a key component to a successful program addressing problems with self-regulation. There are several places schools can get information on teaching self-regulation skills, one is an excellent book by Peg Dawson and Richard Guare, “Executive Skills in Children and Adolescents.”  (The Guilford Press).
A more comprehensive set of materials is “Skillstreaming in Early Childhood,” by Ellen McGinnis and Arnold Goldstein. These materials come from Research Press as part of their “Anger Replacement Training” program, which includes an excellent training DVD. Every middle and senior high school should have staff trained in this method of anger management.
It’s not just good behaviour, but learning problem solving as well!
To decrease the frequency of serious outbursts and tantrums in younger children I recommend Dr. Ross Green’s book “The Explosive Child.” This book teaches a specific interaction style which helps the child stop, think and use collaborative problem solving skills. (These techniques can be highly effective, but are not a primary intervention.) Dr. Green also has a website on his “Collaborative Problem Solving” method which schools and parents could refer to. Lot’s of videos demonstrations are available. Take a look!
Thought Stopping and Cognitive Behaviour Therapy for Children
One simple technique to help children stop the cycle of anger that overwhelms them is teaching them what is called the “Behavioural Call Back.”  Also called the “Behaviour Macarena.”  The class is taught to respond to a teacher’s call, “Stop, Think, Make-a-Choice, Not a Bad Choice, A Good Choice.” This  is done with both the verbal response and hand movements. This complicated hand movement response, practiced many times, and every day, is then used to help a child at the early point of a problem is starting, when it is difficult to stop a cycle of anger. When the teacher observes a problem starting, she signals the child with the hand movements, and in order to signal back the child has to “switch mental sets.” This is a basic “thought stopping” technique used in almost every anger management program. Other thought blocking or stopping techniques can also be taught, and appropriate self-talk helps here as well. These are just a few of the techniques that behavioural therapists use when working with children with anger management problems - or disorders of self-regulation.
Other books I would suggest be read to/with children at home or school include “What to Do When Your Temper Flares,” by Huebner, and “A Volcano in my Tummy,” by Whitehouse.  Teaching a child to understand different emotions and recognizing their varying levels within him or herself is a critical part of any intervention aimed at decreasing outbursts of anger and frustration. Schools often use books such as Kari Buron’s “When My Worries Get Too Big! A Relaxation Book for Children Who Live with Anxiety”  and various forms of Kari’s book “The Incredible 5-Point Scale.”

Any comprehensive intervention for anger issues and problems with self-regulation must provide a student with psychoeducation about emotions, and skills to “self sooth” such as the “Turtle Hug.” Examples of these can be found in the various “Incredible 5-Point Scale” books and classroom materials. Using these with the entire class makes then the norm.
As you can see, there are dozens of well known, scientifically validated interventions for anger, aggression, temper tantrums and emotional meltdowns at school. Classroom teachers are often not aware of these techniques, but  with training and consultation any classroom can become a more pleasant and positive experience for a child with an executive dysfunction....even those with problems of self-regulation and anger management. One thing we know for sure, getting angry back, and using punishment doesn’t work...or there would be no problem. These are skills that need to be taught. And that’s what school is for.
"ADHD Assessment and Treatment" are written by Dr. Jim Roche. These autism notes are not meant to provide a guide to either diagnosis or treatment. For information on diagnosis and treatment contact your medical doctor or a registered/licensed psychologist for an appointment and assessment. Information about Dr. Roche's services can be found at these addresses:

Relatedminds: http://www.relatedminds.com
ADHD Help BC: http://www.adhdhelp.ca
At Psychology Today: http://therapists.psychologytoday.com/rms/70682
At the BCPA website: http://bcpa.pixelmountainarts.com/users/jimroche
At CounsellingBC: http://www.counsellingbc.com/listings/JRoche.htm
At Psyris: http://psyris.com/drjimroche
KEY WORDS: ADHD, ADD, Attention Deficit Hyperactivity Disorder, School, Behaviour, acting out, temper tantrums, classroom management, Vancouver, Seattle, New Westminster, Coquitlam

ADHD symptoms worsen quality of life for individuals with autism, study finds

Dr. Jim Roche provides diagnostic and intervention services for children, adolescents and adults with ADHD (Attention Deficit Hyperactivity Disorder) and ASD (Autism Spectrum Disorder) in both his Vancouver and Burnaby offices.

ADHD symptoms worsen quality of life for individuals with autism, study finds


Research supported by the Autism Speaks Autism Treatment Network (ATN), demonstrating that symptoms of attention deficit and hyperactivity worsen quality of life for individuals with autism spectrum disorders (ASD), has been presented at the Society for Developmental & Behavioral Pediatrics Annual Meeting in San Antonio, Texas.

Researchers Parul Vora, M.D., developmental-behavioral pediatric fellowat Nationwide Children's and Darryn Sikora, Ph.D., Director of the Autism Program at Oregon Health Sciences University, used data exclusively from the ATN Registry to examine whether the presence of symptoms of attentiondeficit hyperactivity disorder (ADHD) might have additional impact on the adaptive functioning and quality of life of children and adolescents with ASD. After reviewing measures of attention and hyperactivity, and measures of quality of life, for over 2,000 children and adolescents with ASD, they found that over half of this group had symptoms of either attention or hyperactivity problems. More than a third had significant symptoms of both.

While there is sometimes a reluctance to directly address ADHD symptoms with children, adolescents and adults with autism spectrum disorder, it's clear to many in the field that successful treatment interventions must also address these often debilitating symptoms. Click on the article above for more information.

ADHD symptoms worsen quality of life for individuals with autism, study finds

Dr. Jim Roche provides diagnostic and intervention services for children, adolescents and adults with ADHD (Attention Deficit Hyperactivity Disorder) and ASD (Autism Spectrum Disorder) in both his Vancouver and Burnaby offices.

ADHD symptoms worsen quality of life for individuals with autism, study finds


Research supported by the Autism Speaks Autism Treatment Network (ATN), demonstrating that symptoms of attention deficit and hyperactivity worsen quality of life for individuals with autism spectrum disorders (ASD), has been presented at the Society for Developmental & Behavioral Pediatrics Annual Meeting in San Antonio, Texas.

Researchers Parul Vora, M.D., developmental-behavioral pediatric fellowat Nationwide Children's and Darryn Sikora, Ph.D., Director of the Autism Program at Oregon Health Sciences University, used data exclusively from the ATN Registry to examine whether the presence of symptoms of attentiondeficit hyperactivity disorder (ADHD) might have additional impact on the adaptive functioning and quality of life of children and adolescents with ASD. After reviewing measures of attention and hyperactivity, and measures of quality of life, for over 2,000 children and adolescents with ASD, they found that over half of this group had symptoms of either attention or hyperactivity problems. More than a third had significant symptoms of both.

While there is sometimes a reluctance to directly address ADHD symptoms with children, adolescents and adults with autism spectrum disorder, it's clear to many in the field that successful treatment interventions must also address these often debilitating symptoms. Click on the article above for more information.

Functional brain pathways disrupted in children with ADHD

Functional brain pathways disrupted in children with ADHD


Click above for an interesting article on brain pathways in children with an ADHD diagnosis. The research written about in this article demonstrated that compared to "the normal control group, the children with ADHD showed abnormal functional activity in several regions of the brain involved in the processing of visual attention information." Sounds good, however, " The researchers also found that communication among the brain regions within this visual attention-processing pathway was disrupted in the children with ADHD."

"What this tells us is that children with ADHD are using partially different functional brain pathways to process this information, which may be caused by impaired white matter pathways involved in visual attention information processing," Dr. Li  (the chief researcher) said.

Regretfully, after decades of similar research, ADHD is taken by many to be nothing more than a “made up” disorder. Many teachers, administrators and even health professionals seem to doubt the reality of ADHD and continue to blame the child, student or adult who suffer from this disorder.  The changing nature of the disorder throughout the day, the ups and downs of it’s apparent severity, and untrained practitioners who mistakenly call ADHD a “gift” are to thank for this. In spite of the fact that research like that noted above (click the article title to go to a review of the research article and be directed to more comprehensive information from there) clearly proves, without a doubt, that ADHD is real, we need to keep battling to get appropriate funding and recognition of the seriousness of this disorder. 

For more information on ADHD, including ADHD diagnostic services and therapy, please visit my web page at http:www.relatedminds.com or http://www.adhdhelp.ca