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

ADHD Services for Children, Adolescents, Adults and Families

How can I help you? If you or your child have ADHD (Attention Deficit Hyperactivity Disorder - or ADD) I provide a number of services that can be of help to you, your child or your relationship. For over the past 25 years I have worked with children with ADHD, adolescents with ADHD, adults with ADHD and families dealing with ADHD. Unlike many other "counsellors" and "coaches" who work with individuals with ADHD but have never worked in a school, work or family setting, I bring nearly three decades of experience working with individuals in the schools - as a classroom teacher with students having behavioural and academic problems due to ADHD, in the workplace, as a rehabilitation and community based neuropsychologist with adults returning to work with ADHD and related issues of impulsivity and concentration due to head injuries, and as a registered marriage and family therapist and clinical member of AAMFT (American Association of Marriage and Family Therapy). Because of my classroom experience as a teacher (and licensed school psychologist) I understand how teachers can implement classroom based interventions to help a child or adolescent with ADHD, and understand the interaction between ADHD and Specific Learning Disabilities (my offices located in both Burnaby and Vancouver) offer not only psychological assessments for ADHD but also full psychoeducational assessments for the diagnosis of learning disabilities and other co-morbid disorders often found with ADHD. Often this includes school based observations and consultation with the teaching/school staff. I have offered teacher workshops on ADHD throughout British Columbia, California and New York State. I also offer parent training and education programs which focus on teaching parents and other caregivers specific skills to help them teach their child with ADHD necessary behaviours and skills. I also work with adolescents, young adults and adults in dealing with both workplace problems and relational problems stemming from the symptoms of ADHD. This might include on site observations and consultation, as well as ongoing coaching and skills development. My years as a community based neuropsychologist working with programs such as Gentiva's Rehab Without Walls focusing on helping individuals with focus, concentration and executive skills development after workplace injury or strokes has provided me with specialized and focused skills in this area. Finally, many individuals with ADHD come to see me about issues such as depression, anxiety, stress and relationship (including parenting and marriage) problems. The services of a REgistered Psychologist are not covered in BC under MSP, however many extended health care plans do cover the cost of psychological services, including therapy, counselling, coaching and assessments. Check with your provider. For those with limited funds who do not have medical coverage for ADHD I often try to work with individuals using one of several self-help programs that are science/evidence based. Please feel free to call me and set up an initial consultation. As these consultations last for approximately an hour, there is a cost, however, usually during that hour we are able to establish a good outline of a program for you, based upon your individual needs and abilities. My offices are located near Lougheed Town Center (near Fitness 2000 on Salish Court) and near the Cambie Bridge and City Hall on 8th Ave. More information can be found at my web page at www.relatedminds.com or www.adhdhelp.ca

ADHD and Executive Function Disorder


Problems with organization, planning, inability to get things done on time or in the right order are often diagnosed as ADHD (Attention Deficit Hyperactivity Disorder), and then again sometimes referred to as EFD (Executive Function Disorder).  The question often comes up: "Aren't these the same thing?"  Well that depend on who you talk to.

You see the terms ADHD and Executive Dysfunction are now often used interchangeably. But that isn't necessarily a good thing because some of the finer points of both disorders get confused. A child, adolescent or adult might have ADHD (or sometimes it's called ADD, a leftover term from the last decade) and have problems with hyperactivity, being inattentive, procrastination, or be highly impulsive. The hyperactivity and impulsivity is common, but not always the case. Some individuals have ADHD without hyperactivity or impulsivity. These individuals have what is more commonly know as "inattentive type" of ADHD. Some may be labeled with "slow cognitive processing," a newer form of the disorder that is being defined by Dr. Russell Barley, a leader in the field. These individuals may not have any of the outward signs of symptoms that parents and teachers associate with ADHD. They don't move around, fidget at their desk, or act impulsively during class blurting out answers or simply talking out loud. Instead they can't seem to stay on-taks, focused and seldom reach a state of task completion. They may also have trouble following what is being said or red because they simply cannot stay focused. A subgroup also has problems with handwriting.

EFD, Executive Function Disorder, is often used to refer to a broader and less focused set of problems which involves a pattern of chronic difficulties with executing every day tasks 

What are Executive Tasks? And do they relate to ADHD?
Executive taks include the ability to understand the whole and analyze a task, being able to plan how you will address a task and get it done, organizing the steps you need to take to carry out a task, developing a time line for task completion and understanding how long and how much energy it will take to complete a task (without this skill we can easily drift off from what should be focused on. The task may appear to have no beginning, middle and end.

Children with EFD have trouble getting assignment handed in, lose them, misplace them, do the wrong assignment, hand in the wrong assignment even when the correct one is done, have trouble organizing materials, including personal items, and can't keep their room, locker or desk clear. 

What is important to note is that one student or adult with ADHD may do very well on medication and with minimal support and coaching. Another with very similar test scores during a psychoeducational assessment may improve, but continue to have problems understanding the materials, organizing them, and perhaps even getting how to find an answer within all the materials in front of them. This student most likely has an EFD and a Learning Disability and needs very different supports and accommodations to support them in the classroom.

EDF can be reflective of ADHD, or it can tell us that there is a more serious Learning Disability present that needs support. Reading, writing and math fluency are often problems for these students, and interventions that support those specific issues need to be implemented. This is why we are often reluctant to provide a quick and simply ADHD diagnosis. (Often, regrettably, family doctors look only for signs of the list of symptoms that match ADHD, they use quick "screeners" like the SNAP-4 and other "symptom lists" and quickly prescribe medicine for what appears to be ADHD. Any student with ADHD should really be assessed for Learning Disabilities, this includes either a full psychoeducational evaluation or a neuropsychological evaluation. When might this not be necessary? Well, I suppose when a student had ADHD but is doing well academically. But even in this situation the difficulty and complexity of the school curriculum changes year after year, and often a student doing well in grade 2-3 suddenly finds failure in grade 4 because tasks that were simple now require Executive Functions far beyond what was previously necessary. Similar curriculum changes happen in the middle school and high school. In high school this can happen due to the very different learning requirements of different subjects now taught in different ways.

Not all professionals and practitioners understand that these same symptoms can bring about a diagnosis of ADHD AND Learning Disabilities based upon deficits in executive functioning. Very few medical doctors are knowledgeable about school based learning issues, and few can perform the necessary assessments.

If you suspect you child has ADHD, or you yourself have ADHD, a psychologist with a background in both ADHD and Education is your best bet. A full and comprehensive evaluation may be more expensive, but it may also be necessary in order to understand the exact nature of your ADHD symptoms and to then develop a logical and focused intervention.

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Forn information about my practice serving clients with ADHD in Vancouver, Burnaby, Coquitlam and the surrounding areas please go to my web page at www.relatedminds.com or www.adhdhelp.ca

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KEY WORDS: ADHD, ADD, Vancouver, Burnaby, East Vancouver, West Vancouver, North Vancouver, New Westminster, Coquitlam, Port Moody, Maple ridge, Assessment, Testing, ADHD Coaching

ADHD and Procrastination (again)

Again this week 3 or 4 patients coming to see me are visiting my office because of problems with procrastination relating to ADHD. Attention Deficit Hyperactivity Disorder (ADHD or sometimes called ADD) is a neurological disorder, and executive disfunction, that effects not only our ability to focus, stay on-task, concentrate, plan and follow through, but also effects our ability to get started - we procrastinate and out things off. And this is one of the most disturbing aspects of ADHD. 

Dr. Russell Barkley, a leader in the field of ADHD says this about executive dysfunction and ADHD: ""In ADHD, if the information that is suppose to be generated by executive functions is being generated at all, it appears to be extraordinarily weak in controlling and sustaining behaviour towards the further..." We seem to get stuck in the here and now and can't ...well move forward.

What Dr. Barkley says about treating this aspect of ADHD is that, "clinicians treating those with ADHD must beat the environment at it's own game. They must put into the immediate context the sorts of cues, prompts, physical reminders, and other captivating information that will guide behaviour towards the intended goal."

That's a very fancy way to say that you need to develop prompts and cues that help you move from one state of mind (maybe watching TV or lying in bed) and move to the next (getting up and taking a shower, or getting out the door to get in the car and get to work.).  That means alarms, signs, signal and prompts. But it isn't as easy as it sounds.

Two things inter fear with just setting up a system of prompts and cues and moving forward. They include  anxiety and ...the lack of reinforcers for engaging in the behaviours you want to be doing.

One of the dangerous things about procrastination is that it is "self reinforcing." If I have to work on a task, go do something I don't particular want to do, to avoid it ..to wait a few minutes before I do it, is rewarding - reinforcing. For that few moments the anxiety associated with the task is gone. I need to get to the office ....but I wait. When I first thought about going to the office I had some anxiety -about what I'm going to do there, getting there on time, maybe about my ability to get there ...since I procrastinate and avoid so much. Just the thought of going to work is a negative experience. And avoiding it makes me feel good, immediately ....if only a little bit. For those of use who understand behaviourism we know an IMMEDIATE reformer is VERY powerful, even if small and short lived. So, avoiding and procrastinating in itself reinforces the behaviour of procrastinating. You may have had one or two things you were avoiding and this reinforcement was very strong. Then avoiding itself started being reinforcing and spread through everything. Now avoiding is your preferred way of dealing with things.

The second issue is reinforcement. A simple rule of behaviour is this: Anything we do that is reinforcing we will do more often, for longer periods and with more intensity. Things that are not reinforcing, we do less often. As adults, the plain and hard truth in life is this: When you stop procrastinating and actually get things done...your more likely going to be rewarded with more hard work. More things to do. Not very reinforcing, is it?

Both of these issues need to be addressed through understanding them, applying your understanding to the situation, and changing the environment so getting things done IS reinforcing rather than the opposite. Through coaching and planning we can usually find ways to do this. Setting up a variable schedule where work completed (non-preferred tasks) are followed by preferred tasks (and remember, the reinforcement or reward can be small...but needs to be immediate). We can use check lists, visual schedules, there are all sorts of things we can do to help with this depending upon the situation.

Now one step back: While all this is going on with procrastination we also have the issue of needing to increase the environmental prompts and cues to help you "switch mental sets" and move from one task to another. SIMPLE visual, auditory and other types of prompts help. and setting things up so that small initial changes are rewarded and reinforced ...one, two, three...before we get to bigger changes.

So, ADHD and procrastination may be difficult to deal with, but there are things we can do.  Understanding the nature of the disorder is critical, and a good deal of the time I spend with clients is spent explaining how the brain works ...and how ADHD effects the brain. Knowledge is the first step towards health.  Often CBT is also recommended for clients with ADHD, this is because we have been worn down by failed attempts to control these behaviours caused by ADHD. And friends, relatives and work mates often turn ADHD symptoms into what they think are signs of your personality. Often they turn this into a moral or ethical issue. "If you would just put more effort in to this!" Well, ADHD is a complicated disorder, and more effort doesn't necessarily lead to success. Understand and ADHD specific interventions are what help. CBT (Cognitive Behavioural Therapy) helps individuals with the issues of inappropriate and negative thinking that comes from repeated exposure to failure. CBT is a critical part of dealing with ADHD.

For more information on ADHD (ADD) and procrastination, along with help in making an ADHD diagnosis, ADHD (ADD) coaching in Vancouver or Burnaby, please visit my website at www.relatedminds.com or call me directly to set up an appointment. There are also a number of science based self help books on ADHD listed on my web page.


This blog is not meant as treatment or diagnosis. For treatment and diagnosis please see a registered or licensed professional in your community. Both medical doctors and registered psychologists can diagnosis and treat ADHD (ADD or Attention Deficit Hyperactivity Disorder).
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KEYWORDS:  ADD, ADHD, Attention Deficit Hyperactivity Disorder, ADHD coaching Vancouver, ADHD coaching, Burnaby, ADHD coaching Coquitlam, ADHD coaching New Westminster, psychologist, diagnosis, treatment, procrastination, executive disorder, psychoeducational assessment, psychological testing

Executive Skills and ADHD (Attention Deficit Hyperactivity Disorder)

Often patients come to the office for a diagnosis of ADHD (Attention Deficit Hyperactivity Disorder) and they have heard that ADHD is related to what is called "Executive Function." This is true, and deficits in executive function are a critical issue in ADHD. Coming up with useful interventions for ADHD usually brings us right to the front door of executive disorders. Schools are often at a loss as to how to approach ADHD in the classroom, and the last set of IEP's I reviewed from school districts here in BC (including IEP's from Burnaby, Vancouver, North Vancouver, Coquitlam, Langley, New Westminister and Maple Ridge all seems to fall off the track and miss the point that ADHD is primarily a function of executive deficit and dysfunction.

Too many times the Individualized Education Plans, usually developed from the Psychoeducational Assessment, focused on increasing academic outcome, getting work completed and increasing scores with very little understanding of the effect of executive deficits and their relationship to ADHD.

(For instance, starting a task may very well be related to difficulty with switching mental sets, changing what we are doing, moving from one task to another. This is an executive deficit ...sometimes we might call it "procrastination" or simply ADHD, but we need to understand the nature of the executive disfunction in order to develop an appropriate intervention plan. This might include both environmental changes, such as cues and prompts, and teaching new skills such as what to do next, how to set up a project and move forward with a step to step plan. There is additionally the problem that changing behaviours, not procrastinating but instead changing tasks and moving forward, may not be inherently rewarding or reinforcing. Honestly, if you have been avoiding work for two years and now someone gets you to deal with it ....your reward is usually more work! And for an 8 year old, more work isn't the reward he or she was looking for (And it's even worse for adults with ADHD!) So, developing a plan means not just following a script but also finding a good behavioural therapist to help develop and watch the plan.

So where can yo get some help in developing an intervention plan for ADHD, including a school IEP, that takes into account issues relating to executive dysfunction and deficits? Here are two good executive dysfunction and skill resources:

First, an excellent book from the Guilford Practical Intervention in the Schools Series: Executive Skills in Children and Adolescents: A Practical Guide to Assessment and Intervention by Peg Dawson and Richard Guare.  This book covers the basics of executive skills and brain development, reviews methods that we use in psychoeducational assessments and neuropsychological assessments to assess executive skills, talks about how to make behavioural observations with formal assessment measures of specific executive skill areas such as 1) Self Regualtion of Affect, 2) Metacognition, 3) Goal-Directed Persistence, 4) Cognitive Flexibility, 5) Sustained Attention, 6) Working Memory, 7) Response Inhibition (Impulsivity), 8) Planning and Prioritizing, 9) Time Management, 10) Organization, 11) Task Initiation (avoiding Procrastination).

The book also gives home simple case examples of developing and implementing simple plans to address each of these specific areas of deficit. This list (above) should give you some idea of how your school should be assessing your child and addressing specific deficits for intervention in the classroom.

The book also addresses developing interventions that promote executive skills for those with ADHD. These plans involve addressing the psychical and social environment; changing the nature of the tasks at hand; improving how cues and prompts are given; and for the schools, changing how adults and students interact.

Specific interventions for the classroom and individual are also discussed, as well as applications of these interventions to specific populations, such as children with Aspergers Syndrome or autism spectrum disorder who may also have ADHD symptoms or executive function deficits that interfere with learning. This is an great, evidence based book that any school team should have.

On my ADHD website page (http://www.relatedminds.com/adhd-attention-deficit-hyperactivity-disorder/) you will also find information and a link to a short article by Thomas Brown on executive dysfunction and it's relationship to ADHD.

Finally, Russell Barkley has an excellent article on ADHD and Executive Function which you can download here: http://www.relatedminds.com/wp-content/uploads/2011/06/ADHD_EF_and_SR.pdf

KEYWORDS:  ADHD, ADD, Attention Deficit Hyperactivity Disorder, Psychologist, Diagnosis, Treatment, Registered Psychologist, Burnaby, Vancouver, Port Moody, Coquitlam, New Westminster, North Vancouver, Coaching, ADHD Coaching, Professional Coaching, Assessment, Psychoeducational Assessment, Testing.

For more information on the services I provide you can find help at these links:







How to Diagnose ADHD (ADD)

Often it is a child's teacher who is the first person to suspect that a child has ADHD, especially if he or she is hyperactive and often disrupts class. However, parents may notice signs of ADHD before the child begins school. These signs may include problems with social skills and disruptive behaviour. If you or your child’s teacher suspect your child might have ADHD, your child should be assessed by a medical doctor or a doctor of psychology. Often a medical doctor will send your child to a psychologist for a diagnosis of ADHD as it is rather complex, and ADHD is often not the only issue. Almost 50% of children with ADHD also have a learning disability and require a psychoeducational assessment. Psychoeducational assessments need to be completed by a registered or licensed psychologist.


What is ADHD (Attention Deficit Hyperactivity Disorder)? 
ADHD is very common. It is estimated that between 5% and 12% of children in the general population have ADHD. For this reason, a medical doctor or psychologist will consider ADHD when they see a child who:
  • is doing poorly or failing at school
  • disrupts class
  • cannot sit still or is hyperactive
  • acts without thinking
  • does not pay attention or does not seem to listen
  • cannot concentrate
  • daydreams
  • has problems with friendships and other social relationships
  • has low self-esteem
If your child has signs or symptoms that make your child's medical doctor suspect your child has ADHD, he or she will do a thorough assessment. In Canada we have specific recommendations as to what that assessment will consist of, and it is more than a simple checklist or screening form. ADHD is not always easy to diagnose, for several reasons:
  • The symptoms of ADHD are inattention and/or hyperactivity and impulsivity, but it is normal for all children to be restless, impulsive, or inattentive sometimes.
  • There is no one specific test for ADHD.
  • Children behave differently in different settings and with different people.
  • The symptoms of ADHD look different in different children, in boys and girls, and at different ages.
  • Children with only symptoms of inattention are often overlooked.
For these reasons, the  medical doctor will need as much information as possible from you, your child, your child's teacher, and other caregivers. It may take some time to figure out whether your child really has ADHD or another disorder (see below). Once the medical doctor knows what is happening with your child, he or she will sit down with you and explain the diagnosis and together you will develop a treatment plan. Often this process involves or is directed by a child psychologist who is familiar with child behaviour issues as well as education regulations and expectations.

Why isn't there an easy test for ADHD?
Children mature at different rates and have different personalities, temperaments, and energy levels. Most children get distracted, act impulsively, and struggle to concentrate at one time or another. Sometimes, these normal factors may be mistaken for ADHD. ADHD symptoms usually appear early in life, often between the ages of 3 and 6, and because symptoms vary from person to person, the disorder can be hard to diagnose. 
For more information on the suggested guidelines in Canada for diagnosing ADHD see this webpage: http://www.caddra.ca/cms4/index.php?option=com_content&view=article&id=26&Itemid=70&lang=en


For information on my services for ADHD, including diagnosis, psychoeducational  assessments or treatment please visit my web page at http://www.relatedminds.com or http://www.adhdhelp.ca 


ADHD Diagnosis Rates in US

The Northwestern University issued the following news release:

Diagnosis of ADHD on the rise.They note that 10 million American children diagnosed with ADHD during doctors' visits. The number of American children leaving doctors' offices with an attention deficit hyperactivity disorder (ADHD) diagnosis has risen 66 percent in 10 years, according to a new Northwestern Medicine study.

The study also found that over this same timeframe, specialists, instead of primary care physicians, have begun treating an increasing number of these young patients. The study, which was published in the March/April issue of the journal Academic Pediatrics, analyzed ADHD trends from 2000 to 2010 among children under the age of 18 who were diagnosed and treated by office-based physicians.

Researchers analyzed changes in the diagnosis of ADHD and treatment of the disorder over this 10-year time period. "ADHD is now a common diagnosis among children and teens," said Craig Garfield, M.D., first author of the study. "The magnitude and speed of this shift in one decade is likely due to an increased awareness of ADHD, which may have caused more physicians to recognize symptoms and diagnose the disorder."

Garfield is an assistant professor in pediatrics and medical social sciences at Northwestern University Feinberg School of Medicine and a pediatrician at Children's Memorial Hospital and Northwestern Memorial Hospital. Symptoms of ADHD, such as trouble paying attention and controlling impulsive behaviors and being overly active, can affect children and teens both academically and socially, Garfield said. In the past decade several important regulatory and clinical changes regarding ADHD and the medications used to treat it have occurred, yet it was unknown how these factors have affected ADHD management, Garfield said. For the study, Garfield and his team of researchers quantified ADHD diagnosis and treatment patterns among people under 18 using the IMS Health National Disease and Therapeutic Index.

This is a nationally representative sample of office-based visits and included 4,300 office-based physicians in 2010. According to the study, in 2010, 10.4 million children and teens under age 18 were diagnosed with ADHD at physician outpatient visits, versus 6.2 million in 2000. Researchers also found that psychostimulants have remained the most common medication prescribed to children with ADHD. Psychostimulants were used in 96 percent of treatments in 2000 and 87 percent in 2010. The exact reason for the decrease is unclear, but there was not an increase in treatment with other, substitute medications, Garfield said.

While the majority of children and teens with ADHD are still managed by primary physicians, the study found that there has been a substantial shift away from primary doctors and towards specialists, such as pediatric psychiatrists. "Recently, there's been more public health advisories issued about problems or side effects of different ADHDmedications," Garfield said. "It may be that general pediatricians are shying away from treating patients themselves and instead rely on their specialist colleagues to provide the treatment and management of these medications."

Given the short supply of psychiatrists specializing in pediatric ADHD, Garfield said this trend might make it difficult for many children to receive medical treatment of ADHD in the future.


What is regrettable is the lack of information on non-medical treatment of ADHD. While the AMA (American MEdical Association) and the association of paediatricians clearly suggest that non-medical interventions be the first intervention tried, especially with younger children, there is little research on the number of cases seen by trained psychologist or other educational | behavioural specialist who would provide training, supervision and direct treatment of children and families effected by ADHD. Environmental and behavioural interventions remain the first line of interventions, however research and funding remains focused on medication and medical providers. Often, while medical intervention is critical and necessary for treatment success, behaviour and educational  intervention are just as necessary. ADHD is a developmental disorder, and being able to focus, maintain focus, start tasks on time, plan and organize are not not taught by medication. These are skills that are learned during our development, and need to be taught in a new way when they are being learned at a later point in development. These are the tasks and interventions mental health professionals such as psychologists are there to help you with. They are necessary components, but as the above research shows, they are too often ignored.


For information on my practice and support services for children, adolescents and adults with ADHD (Attention Deficit Hyperactivity Disorder) in Burnaby, Vancouver, New Westminster and Coquitlam, please visit my web page at www.relatedminds.com or www.adhdhelp.ca

ADHD and Disability Tax Credits


One of the sites I often recommend to people is the CADDAC website, especially for information on science based guidelines for diagnosis and treatment of ADHD. It can be found here at : http://www.caddac.ca.  Today I went back to their website to see of there was anything new and found some clear information about Disability Tax Information. For that information you can go directly to: http://www.caddac.ca/cms/page.php?104  I'm also going to quickly outline some of their information below.

About Disability Tax Credit and Federal Tax Deductions
"The Federal Government allows a Disability Tax Credit for those individuals and their dependents who have a "severe mental or physical development: deficits that cause marked restrictions all or almost all of the time in any of the basic activities of daily living and the impairment is prolonged, ie. has lasted or is expected to last for a continuous period of at least twelve months."


This may be a little difficult to understand, but looking at the government forms you may be able to get a clearer picture of what is necessary to qualify. Here is a link to the form itself: Website Form T2201: http://www.cra-arc.gc.ca/E/pbg/tf/t2201/README.html  

These marked restrictions include deficit areas such as "sight, hearing, mobility, speech, memory, thought and perception."  What is critical, and CADDAC points out, is that  "The catch is that these restrictions must occur despite: having therapy and the use of appropriate devices and medications." ADHD in many cases may qualify, and I have had patients who have used this tax credit successfully.  You need to remember that receiving a disability benefit such as "autism services" or school based supports does not guarantee eligibility for the Disability Tax Credit. It's a little more complicated than that. You do need a diagnostic form completed by a medical doctor or psychologist (or other professional depending on the disability) to apply for this credit. That's the form referenced above with a link. In the case of learning disabilities and ADHD, the authorizing professional can be a registered psychologist.


CADDRE points out that, "It may also be helpful for you to include supporting documents such as psychological assessments (Psychoeducational Assessment) and testimonials from teachers, detailing the impact of the impairment on the student in the classroom."
They go on to note: "In addition to the standard medical expenses such as prescription drugs and a variety of assistive devices, in 1999 the Federal government recognized that individuals with learning disabilities may have a need for supplementary educational service. These expenses may also include tuition costs if a patient, (for example, a dependent);
  • suffers from a behavioural problem arising out of a mental or physical disability,
  • or suffering from a learning disability, including dyslexia,
  • who attends a school, that specializes in the care and training of persons who have the same type of problem or disability,
is considered to qualify under P118.2(2) (e). Therefore the expenses paid for the patient are qualifying medical expenses, even though some part of the expense could be construed as being tuition fees." So, perhaps school fees qualify. (The school need not limit its enrolment to persons who require specialized care and training.) There may also be additional refundable medical expenses.


Now CADDRE makes this note:
To avoid undesirable surprises at refund time, it is advisable to have Revenue Canada review your claim before you file your return to rule on your eligibility. This will also give you time to contest the decision if necessary before you file.


I am no expert on tax advice and this blog note DOES NOT OFFER TAX ADVICE. I suggest taking this note, a copy of the forms from the government web page, and speaking directly with someone certified in tax issues. This can be a complicated mess, and you don't want to expect a refund, pay for services, and not get it. And that very well may happen. So, SEE YOUR TAX EXPERT and get professional advice. My experience has been most doctors are unaware of how this work, and so are many tax preparers. If you want to speak to an expert below is a link to one such organization. Be aware, they are a for-profit company, and I would expect will be asking you to pay for their services. I don't know how their services work, but their web page is pretty clear.  You can just look up "tax help, disabilities, Canada" on the web and see what you find, or try this website. I do not recommend anyone, and honestly, know nothing about this particular company. You might ask your tax preparer about them and see what he or she says.


http://www.thenba.ca/


At any rate, start investigating. Don't spend money before you have it, and get a certified or licensed expert in the tax field to check what your doing. It may very well be a good way to help you pay for services you need for yourself or a family member.

ADHD Coaching and Diagnostic Services

Dr. Jim Roche
ADHD Services
ADHD | ADD Assessment, Diagnosis and Treatment, including ADHD Coaching by a Registered Psychologist with over 20 years experience in the filed of ADD | ADHD treatment and intervention in schools, home and work. ADHD affects individuals, families and relationship. I provide interventions based upon the latest science and evidenced based treatments.

KEY WORDS: ADHD, ADD, Attention Deficit Hyperactivity Disorder, Coaching, Diagnosis, Burnaby, Vancouver, Coquitlam, New Westminister, Psychologist, ADHD Coaching

 

What is ADHD Coaching?


What is ADHD Coaching?
ADHD coaching consists of two main elements: First: learning about your ADHD and skills or tools that you can use to address your symptoms, and Second: Practicing these skills in the real world. That might be at home, in school of the workplace.
At our initial session we review your diagnosis (or test, assess and diagnose you if need be), look at your strengths and weaknesses, and together develop a plan that will help you address your problems and deficits by using your strengths and abilities. 
The initial ADHD coaching sessions (one or two sessions) focus on understanding your particular form of ADHD, and how the behavioural and cognitive interventions we are going to use address your problems, how they work, and why they work. I firmly believe that understanding the underlying theory ...the why and how of things...helps make treatment successful. If you don't know why your doing something, why do it? And that goes for ADHD coaching as much as for anything else.
What kinds of issues does coaching help with ?
Well, lets start with the basics: Organization. Planning. Procrastination. Figuring out what is important, and what isn't. Learning to avoid distractors and distractions. Problem solving. How to deal deal with emotions and emotional dysregulation. Anger management. Stress. Intrusive thoughts. Self-esteem. We do this with behaviour therapy, check lists, visual planners, external cues and prompts, schedules and cognitive therapy. And as an ADHD coach I provide backup, quality control, feedback and encouragement when things don't work as they are suppose to, and that happens ...to everyone.
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. For an ADHD coaching program we often meet two or three times in a two week period, get a general understanding of the program and how it works, and then continue to speak by phone, SKYPE or in person.
Usually as an ADHD coach I provide you with a set of materials you practice using in my office, and then try to use in the real world. Each week we speak at a predetermined time, review a small reading (selected from the sessions below) and then review your schedule, and how the tools we have chosen together are working for you. Often there needs to be adjustment and change, but we keep trying until your comfortable with the procedures.
Here is a general outline of the meetings, phone or SKYPE training 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
Learning new skills continues for eight weeks, the first two or three in the office, and the remainder on your own. 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 set of learnings and coaching we continue for another month., Usually we work together for three to four months. Sometimes we continue the ADHD coaching relationship on a less frequent basis for several months, but that isn't always necessary.
For ADHD coaching, how long would ADHD coach go on all together?
A successful program usually runs about 12 weeks.
How much does ADHD coaching cost?
The three hourly visits are at my usual rate. After we are done with the initial sessions we usually spend 30 minutes on the phone or SKYPE (we can use Google Chat, Apple Face to Face or any other system you might be use to using). This is at a reduced rate, less than 50% of the normal office visit, and a total three month packet can be arranged to further reduce the costs.
What about ADHD coaching for high school students?
Many parents like the idea of having an ADHD coach work with their child or adolescent because it reduces the stress at home. A third party member is often easier for an adolescent to deal with, however, I still recommend some parent training and education in these cases. In other words, another aim of ADHD coaching for your child or adolescent is for you to learn to be your child's ADHD coach!
Do I really need a Registered Psychologist as an ADHD coach?
The cost is only slightly higher than using an untrained coach with no experience in the field of psychology, neuropsychology and cognitive processes. I think it's a good idea, whenever possible, to use someone who in addition to coaching understand's learning disabilities, how schools work and the basics of the neurobiology of ADHD. Coaching with a psychologist is a good way to go. Sometimes a psychologist might have a coach that works with them.
For more information on ADHD coaching
For more information on ADHD coaching please feel free to call me at my office or check out my web page at http://www.relatedminds.com
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Services provided in my offices include: (covered by most extended health care insurance)
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/)
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
My name is Dr. Jim Roche and I am a Registered Psychologist and a Registered Marriage and Family Therapist (RMFT) in British Columbia. In addition to my doctorate in clinical psychology, I hold a master's degree in family therapy, 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. In addition to being a registered psychologist, I am 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). I also hold a doctoral degree in law 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.
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
http://www.counsellingbc.com/listings/JRoche.htm



What is Attention Deficit Hyperactivity Disorder (ADD | ADHD)?


What is ADHD or ADD (Attention Deficit Hyperactivity Disorder) ?
Attention deficit hyperactivity disorder (ADHD) is a condition in which a person has trouble focusing, paying attention, sustaining attention and focus, exhibits impulsivity (tends to act without thinking) and sometimes exhibits more movement than we would expect - he or she has trouble sitting still. It usually begins in early childhood (we now are able to diagnose ADHD at 4-5 years old) and can continue through the teen years into adulthood. 50% of individuals with ADHD continue to have symptoms in adulthood. Without treatment ADHD can cause problems at home, school, work, and with relationships. ADD is an older tern for ADHD without the hyperactivity, but today we always use the diagnosis: ADHD, and if there is no hyperactivity we would diagnose ADHD, Inattentive Type, meaning there is no hyperactivity. Often problems with attention and focus are dismissed because teachers, parents and medical professionals don't see hyperactivity. ADHD can still be the problem, hyperactivity or not.
What causes ADHD?
The exact cause is not clear, but ADHD tends to run in families and is most likely a generic disorder. We can sometimes see it on brain scans, and we have actually found genetic keys to ADHD.
What are the symptoms?
There are four types of ADHD symptoms including:
Trouble paying attention. People with ADHD are easily distracted by the environment and have a hard time focusing on any one task for a sustained period (but yes, they CAN focus on a preferred task for extended periods, and this "hyper-focus" or extreme attention is another sign of an individual's inability to control and regulate focus and attention).
Trouble sitting still for even a short time. This is called hyperactivity. Children with ADHD may squirm, fidget, or run around at the wrong times. Teens and adults often feel restless and fidgety and are not able to enjoy reading or other quiet activities.  Not all cases of ADHD show signs of hyperactivity! But the majority of cases do.
Acting before thinking. People with ADHD sometimes talk too loud, laugh too loud, or become angrier than the situation calls for. They are impulsive and have difficulty regulating their emotions. Children may not be able to wait for their turn or to share. This makes it hard for them to play with other children, often causing them to become socially isolated as time goes by. Teens and adults seem to "leap before they look." They may make quick decisions that have a long-term impact on their lives. They may spend too much money or change jobs often. It's important to differentiate impulsivity from manic behaviour, and an assessment of this is part of any good ADHD diagnostic assessment.
How is ADHD diagnosed?
ADHD is often diagnosed when a child is between 4 and 12 years old. Teachers may notice symptoms in children who are in this age group. We always recommend that you first haver your child see a medical doctor for a full physical exam, to rule out the many other possible causes for the symptoms that may look like ADHD, but may not be ADHD at all. For children a more comprehensive assessment is often called for because nearly 50% of children with ADHD also have a learning disorder, anxiety, depression or other co-morbid disorder. This is usually done by a licensed, registered or certified psychologist. Usually school psychologists are not trained or able to diagnose ADHD. This differs from state to state, province to province.
How is ADHD treated?
There is no cure for ADHD. Treatments, such as medication, therapy, behavioural interventions, only help control the symptoms.  Treatment often includes both  medicines and behavior therapy. Parents and other adults (teachers) need to closely watch children after they begin to take medicines for ADHD as initially they may cause side effects such as loss of appetite, headaches or stomachaches, tics or twitches, and problems sleeping. Side effects usually get better after a few weeks. If they don't, the doctor can change the dose.
Therapy focuses on making changes in the environment to improve the child’s behaviour. This often includes positive reinforcement systems, external and visual cues and prompts, and changes in the way a child is taught (especially changes in the expectation that they need to sit all day, be still and work on task for extended periods. These tasks are often impossible for children because their symptoms make them impossible. With medication and behavioural intervention can help tremendously, but education adults, parents, relatives and teachers about how to react to ADHD symptoms, and how to change the environment so the child can be successful is critical. This is often the focus of parent education and training. Counselling and extra support at home and at school help children succeed at school and feel better about themselves. A child's IEP (Individual Education Plan) usually addresses these issues, but again, staff education and training is critical!
How does ADHD affect adults?
Sometimes adults don't realize that they have ADHD until their children are diagnosed. When completing history forms they realize they had, and continue to have, many of these same symptoms and difficulties. Sometimes a change of job or promotion makes these problems more evident.  Many adults have problems with work and relationships due to impulsivity and problems regulating their emotions. Some report "memory problems," which are really issues of focus and attention. 
How is Adult ADHD Treated?
Treatment with medication, counselling, and behavior therapy can help adults with ADHD. Some therapists provide structured training programs, and for both children and adults with what seems like "short term memory" problems, what we call "working memory" deficits.  One program proven to be effective is called "Cogmed." 
What is Cogmed Working Memory Training?

Cogmed Working Memory Training is an evidence-based, computerized training program designed by leading neuroscientists to improve attention by effectively increasing working memory capacity over a 5 week training period.
Who is Cogmed training for?

Cogmed training is for people who wish to improve their ability to concentrate and are constrained by their working memory. Cogmed users range from young children to senior adults. Some have diagnosed attention deficits, some have suffered a brain injury, some feel the deteriorating effects of normal aging, and others find they’re not doing as well as they could, academically or professionally, given their intelligence and their efforts.
What is working memory and why is it important?

Working memory is an essential cognitive function necessary for a wide-range of tasks related to attention and focus. It is the ability to keep information in your mind for several seconds, manipulate it, and use it in your thinking. It is central to concentration, problem solving, and impulse control. Working memory is closely correlated to fluid intelligence and is a strong indicator of academic and professional success. Poor working memory is the source of many problems related to attention and is often linked to ADHD, and other learning disabilities.
What are the effects of Cogmed training?

Cogmed training improves attention, concentration, focus, impulse control, social skills, and complex reasoning skills by substantially and lastingly improving working memory capacity. The goal is improved performance and attentional stamina. The best way to learn about the effects is to talk to the Cogmed practice of your choice and to read the Cogmed User Stories.

Do the results last?

Yes, our research and our clinical experience show that the effects of Cogmed Training last after training. The reason is that once working memory capacity increases, you naturally continue to use it at its new level, which serves as constant maintenance training. Each Cogmed user also has access to optional Cogmed Extension Training at no extra cost.
Summary
There are many ways to treat ADHD. The best advice is to work closely with your medical doctor and psychologist, using techniques and interventions that have been proven to be effective. Regretfully there are a lot of programs and interventions on the internet that claim to work for which there is little evidence, or sometimes evidence they do not work (for instance, there are claims that acupuncture and homeopathic "medicines" work, yet there are no studies, and the rationale for these interventions often make little sense. Rely upon your licensed and registered medical doctor or psychologist for guidance. There are things you can do, intervention and medicines that have been proven to be effective with many years of research to back them up. Don't wait, don't procrastinate (especially for children). See your doctor and understand your choices.
........................................
For information on counselling and therapy services in Burnaby, Vancouver, Coquitlam and surrounding areas contact Dr. Roche at: (Office phone) 778.998.7975
.........................................
As usual, let me warn you that this blog, any of my other blogs, or my web pages are not designed to provide you with an assessment, diagnosis or treatment. If you are concerned you have a health issue such as ADHD, anxiety, depression or Asperger's | autism please see your health service provider, either a medical doctor or Registered Psychologist. What may appear to be symptoms of one disorder can often be caused by another unexpected disorder. Other disorders, such as ADHD, are very likely to exist at the same time as another disorder (called co-morbid disorder) such as anxiety, depressing or OCD. You need to see a professional to find this out. On-line symptom checklists will not provide this, and are often misleading.
Services provided in my offices include: (covered by most extended health care insurance)
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/)
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
My name is Dr. Jim Roche and I am a Registered Psychologist and a Registered Marriage and Family Therapist (RMFT) in British Columbia. In addition to my doctorate in clinical psychology, I hold a master's degree in family therapy, 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. In addition to being a registered psychologist, I am 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). I also hold a doctoral degree in law 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.
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

What is ADHD and How is it Treated?


What is ADHD? ADHD is a problem with inattentiveness, over-activity, impulsivity, distractibility or a combination or some or all of these things. More recently we have begun to realize that "slow cognitive processing" or "slow cognitive tempo" is also part of this. You know, you ask someone a question and ....you wait a long time for an answer. Sometimes they forget to answer.

So ADHD might be noticed because your overactive and inattentive, disorganized and confused.  OR you might be very quiet, forgetful, and processing slow.  These can look like very different problems, but are actually part of the same disorder.

Most people think of ADHD as a childhood disorder. Until recently we didn't think teens or adults had ADHD, we thought they grew out of it. About 50% of children with ADHD continue to have the disorder as a teen and adult, although it's nature ....how it presents itself in behaviours and deficits, may change as you grow older and your environment changes and presents new problems for you to cope with. There are plenty of adults who suffer from ADHD as well. Almost 2/3rd of my ADHD patients are adults.

ADHD needs to be treated. Untreated children with ADHD are far more likely to have oppositional and defiant behavior, drug use, alcohol abuse and criminal activity. They are also far more susceptible to the stress, anxiety, depression, family issues, divorce, family conflict, and other external stressors. The first and foremost recommendation for young children is parent education or training (to teach you special techniques to support your child with ADHD) and only after that, if there is not significant improvement, medications. ADHD medications are about the most studied and understood medications we have. There are several different types, and your best source of information is from your medical doctor. A lot of what you read on line about ADHD treatment is nonsense, untrue, unproven and often proven not to work...but it's the internet and people can saw and write anything. Go to your medical doctor and see a psychologist for further support.

Adults with ADHD continue to have difficulties. Untreated adults may have trouble keeping up on important home responsibilities, such as record-keeping or bill-paying; may have difficulties following through with work responsibilities. They often experience relationship and other problems because of difficulties staying focused. Cognitive Behavioural Therapy can help, psycho-education for you and your partner ...or the entire family...can help. Behavioural therapy can help easy problems
What does ADHD look like in children?

The symptoms of ADHD fall into three groups: Lack of attention (inattentiveness), Hyperactivity and Impulsive behavior (impulsivity).
Again, more recently we have found that the "slow cognitive processing" type is also a major issue. Some children with ADHD primarily have the inattentive type. Others may have a combination of types. Those with the inattentive type are less disruptive and are more likely to not be diagnosed with ADHD.

Inattentive symptoms
1. Does not give close attention to details or makes careless mistakes in schoolwork
2. Has difficulty keeping attention during tasks or play
3. Does not seem to listen when spoken to directly
4. Does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace
5. Has trouble organizing tasks and activities
6. Avoids or dislikes tasks that require sustained mental effort (such as schoolwork)
7. Often loses toys, assignments, pencils, books, or tools needed for tasks or activities
8. Is easily distracted
9. Is often forgetful in daily activities

Hyperactivity symptoms:
1. Fidgets with hands or feet or squirms in seat
2. Leaves seat when remaining seated is expected
3. Runs around or climbs in inappropriate situations
4. Has difficulty playing quietly
5. Is often “on the go,” acts as if “driven by a motor,” talks excessively

Impulsivity symptoms:
1. Blurts out answers before questions have been completed
2. Has difficulty awaiting turn
3. Interrupts or intrudes on others (butts into conversations or games)

Although less likely than children to show the hyperactivity symptoms, adults with ADHD can show the same symptoms of impulsivity and inattention.  Often adults confuse "memory problems" with ADHD. They also get seen as having a "bad attitude" and "not caring." This is often far from the truth. A key component to treatment success is self education and educating your friends and family. Sometimes even your co-workers or boss.

What causes ADHD?
Research seems to clearly point to ADHD as being a genetic disorder. Something you inherit. If you look through a family tree, it is likely you will see it hop scotching its way across the generations. It is not unusual for one parent to have it and pass it along to one or more offspring. It is not unusual to have an entire family in treatment in one form or another.

Besides ADHD being a genetic disorder head trauma or brain injury (TBI) can often be a cause of ADHD. With both brain injury and ADHD we often see problems with "frontal lobe" functions in the brain. An area referred to as the "executive" area. But remember, many of these symptoms can be cause by something other than ADHD. People can have brain injuries, memory problems, brain tumours, depression, anxiety, movement disorders, OCD, tics ....any number of things can look just like ADHD. So remember, don't diagnose yourself. You may not have ADHD, and you may be missing what is really the problem! See a doctor - a psychologist or a medical doctor - who understands ADHD for a full assessment.

Treatments for ADHD
There are medical and non-medical ways to treat ADHD. Often it is best to use both. Behavioural therapy, parent education, Cognitive Behavioural Therapy, the learning of new specific skills to improve focus, planning and follow-through ...all of these can be done with or without medication. EEG and HEG Neurofeedback are often suggested, however, these are not as effective as those treatment already listed. Some research shows Neurofeedback to be fairly ineffective and it fails to generalize across symptoms.

Memory is also often a problem, specifically what we call "active memory," or "working memory." This is the processing of holding something in your head for a short period of time while you do something (like saying a group of numbers backwards). There are a number of computerized programs out there that claim to help with ADHD and memory. Right now there is only one intervention using computers that has been proven to improve "working memory," that is CogMed. CogMed has been show to improve working memory in the majority of patients. It is a five week program that can be extended, and is pretty costly (pricing ranges from $1,200-$2,200 for the program).  And it ONLY helps with "working memory."

Because working memory is so important to all other memory, focus, concentration and planning processes, I think improving your active and working memory is often a good idea. Talk to your doctor about testing for working memory problems before you invest in such a program.

Untreated ADHD

Anyone who suspects they or their child may be struggling with ADHD should get themselves or their child evaluated immediately. Oftentimes we will simply assume that it’s just “laziness.” ( Dr. Mel Levine has an excellent book for parents called "The Myth of Laziness."  It addresses this problem of perception, and also addresses the complexity of what is going on when a child fails to produce at a rate we would expect of them. An excellent read designed just for parents.  You can find this and other books on my website.) Not treating ADHD often results in in feeling humiliated, angry, and with children, a quick dislike of school -where they simple experience too many failures.

An adult with untreated ADHD will not be able to meet his/her full potential in education, work, or relationships. ADHD is a "developmental disorder" and often requires training in organizational and planning skills that you missed learning and practicing (successfully) as a child. ADHD can be treated, medication can quickly and effectually address problems of concentration and focus, and parent education can address skills that will help you support your child. Behavioural treatment teaches you skills to overcoming problems with planning, organizing, procrastination and emotional regulation. And Cognitive Behavioural Therapy (CBT) can help you with clear thinking and the emotional problems like anxiety and depression that often come with ADHD.

Finally, with both children and adults, a full assessment is often recommended as nearly 50% of individuals with ADHD have co-morbid learning disabilities.  Don't be fooled into thinking "my child has ADHD, so now he's taking medicine everything at school should be alright."  Make sure you or your child actually get all the support you need.


....................................................

For information on counselling and therapy services in Burnaby, Vancouver, Coquitlam and surrounding areas contact Dr. Roche at: (Office phone) 778.998.7975
.........................................

As usual, let me warn you that this blog, any of my other blogs, or my web pages are not designed to provide you with an assessment, diagnosis or treatment. If you are concerned you have a health issue such as ADHD, anxiety, depression or Asperger's | autism please see your health service provider, either a medical doctor or Registered Psychologist. What may appear to be symptoms of one disorder can often be caused by another unexpected disorder. Other disorders, such as ADHD, are very likely to exist at the same time as another disorder (called co-morbid disorder) such as anxiety, depressing or OCD. You need to see a professional to find this out. On-line symptom checklists will not provide this, and are often misleading.

Services 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/)
Couples Counselling / Therapy (click here: http://www.relatedminds.com/couples-therapy/)
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
My name is Dr. Jim Roche and I am a Registered Psychologist and a Registered Marriage and Family Therapist (RMFT) in British Columbia. In addition to my doctorate in clinical psychology, I hold a master's degree in family therapy, 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. In addition to being a registered psychologist, I am 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). I also hold a doctoral degree in law 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.

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

http://www.relatedminds.com
http://Therapists.PsychologyToday.com/rms/70682
http://www.therapistlocator.net/member?183420
http://www.bcpsychologist.org/users/jimroche
http://www.actcommunity.net/jim-roche.html
Phone: 778.998-7975

ADHD Medications (Ritalin) could be used with four year olds!

Scary headline, isn't it? The Vancouver Sun likes to create these headlines, which pretend to be balanced but really are designed to get you to worry ...and feel the need to read the article. The problem is, many people skim or never even look at the article itself. 


Let's go over what it says: 


The American Academy of Paediatricians released updated guidelines for treating ADHD. These guidelines expanded the ages for both the diagnosis and treatment of ADHD. The diagnosis of ADHD use to be restricted to the ages 6-12. Recently, with children attending pre-school and a careful eye on how the disorder progressing in adolescents and adults, we have expanded the ages when we think it's appropriate to diagnose ADHD. There is nothing nefarious about that.


But Sun writer Sharon Kirkey warns us that children may be misdiagnosed and may receive unnecessary medications. I suppose that's true of any medication or treatment, isn't it? But why is that the focus of this article? Here in Canada we actually have some decent diagnostic standards to determine who has and who doesn't have ADHD. I really think it would be have been helpful to tell the readers about that. Tell readers that a diagnosis should include more than a simple checklist a parent fills out, and should include some testing if necessary, and follow-up. Regretfully a major problem here in Canada is that children are seen, diagnosed, and then not seen again for a long time. Or seen by a different doctor because it's so difficult to get your own family doctor. But we do have standards of practice that are aimed at protecting us against misdiagnosis. ( see http://www.caddac.ca ) If we are really worried about misdiagnosis of ADHD maybe we should suggest that a parent ask their medical or psychological service provider what experience they have diagnosing ADHD, if they have observed children in school settings, and what guidelines they are following (see Caddac above).  That, I would suggest, is a simple step in avoiding misdiagnosis of ADHD any parent can take.


Well, the article gets worse. We further read that there will be a "further frenzy of aggressive marketing by drug companies..." Sounds scary. (I would suggest there will be a frenzy of marketing by holistic health care providers offering unproven and disproven treatments. Treatments that do nothing, and often have been proven to do nothing. Why our focus is on a treatment that has decades of research behind it and has been proven to be effective, is a puzzle to me. An online search for ADHD treatment in Vancouver shows some really unconscionable results.) This statement seems way out of line...especially if you actually read what the Academy suggests.


If your wondering if this is an anti-medication article ...well read on. The article then addresses the issue of heart problems and deaths due to medication. This is a tricky area for any parent to understand. Yes, children taking this medication have died. Did they die because they were taking these medications? Children die taking aspirin, cold medications, all sorts of medications. But bringing this issue up scares parents, and they should worry, be concerned, and deal with that concern by getting good information. A simple place to get information on this risk, an obvious place, is by asking your prescribing medical doctor. Here is what one doctor on the web says in answer to a parents concern about harmful effects of ADHD medications:


"There were 186 Ritalin related deaths in a ten-year period. In contrast there are 11 million prescriptions for Ritalin a year. If you divide the number of children who died from Ritalin by the number of annual prescriptions, that is 186/11,000,000= .000017. That means .0017% of children who take Ritalin are at risk for death. Now I realize that this is not really an exact calculation. The real way to determine the exact death rate is to divide 186 by the number of people who took Ritalin during the last decade. I couldn't find any data on this. The point is that whatever the death rate is, it is very small. It is probably more likely for a child to die from a Tylenol overdose than to die from Ritalin use. 

 

 


If your child has ADHD and Ritalin is helping, then I feel that benefits she gets from taking a drug like Ritalin far outweigh the risk of death from the drug. The bottom line is that no parent wants her child on Ritalin or some similar drug. However, if the child needs it, you as a parent should not worry that your child will be the one child in 60,000 that has a serious problem." (Anthony Kane, MD)"

Still confused? Ask your doctor. Why doesn't the Sun suggest you ask your doctor? I always wonder why they don't.

And finally, this is a comment you'll find in the middle of the article: "The authors emphasize that - for preschoolers - behavioural therapy should be tried first, such as group or individual parent training in behaviour management."  Only after that fails should medication be tried.

Actually they suggest first, foremost, and only after it fails, psychological, behavioural treatment and parent education. But this gets mentioned as an afterthought.

So I wonder, why isn't the headline of this article "American Paediatric Association Strongly Suggests Behavioural and Parent Training for Children ages 4-6 with ADHD."

I'm a psychologist. Here in Canada I can't write prescriptions for medication (although psychologists can and do in other jurisdictions). I provide behavioural therapy, parent education and teacher training to address ADHD. I offer these services all the time to schools (Burnaby, Coquitlam, Vancouver, Maple ridge), and almost always they turn ADHD specific training down, instead asking for training on ASD, Aspergers and other related disorders. ADHD, even though it's the most highly diagnosed disorder and causes the most problems in school and for the child (and teacher) is not a priority. ADHD and behaviours relating to ADHD are THE MOST RESEARCHED issues in school behaviour management we have. We know what works, we know how to change classroom environments and teach teachers skills that improve outcomes. Still, we do nothing. I wish the local papers would focus on the lack of training for etchers, and the lack of training for parents (MSP will pay for the medication, but will not pay for one single hour of parent education!)

But the American Academy of Pediatrics already suggested we do that, didn't they?

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For information on counselling and therapy services in Burnaby, Vancouver, Coquitlam and surrounding areas contact Dr. Roche at: (Office phone) 778.998.7975

About

My name is Dr. Jim Roche and I am a Registered Psychologist and a Registered Marriage and Family Therapist (RMFT) in British Columbia. In addition to my doctorate in clinical psychology, I hold a master's degree in family therapy, 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. In addition to being a registered psychologist, I am 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). I also hold a doctoral degree in law 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.

 

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

 

http://www.relatedminds.com

http://Therapists.PsychologyToday.com/rms/70682

http://www.therapistlocator.net/member?183420

http://www.bcpsychologist.org/users/jimroche

http://www.actcommunity.net/jim-roche.html

Phone: 778.998-7975

Changes to my ADHD pages | CogMed coming soon!


There have been some changes to my ADHD page and individuals are asked to go directly to the page at my website.  Most important, within the next three months I will be offering Cogmed services, a cognitive rehabilitation and training program for memory and focus issues. This is a computerized program you can use right in your own home under the guidance of one of my staff members. Cogmed is the only computerized training program that has been proven to help with issues of memory and more specifically active or working memory, a key factor in ADHD (Attention Deficit Hyperactivity Disorder). Stay tuned for the announcement, staff are attending their final training in October!  For more information on CogMed Services for Working Memory Training click here: http://www.cogmed.com/

Dr. Jim Roche is a Registered Psychologist and Marriage, Family Counsellor | Therapist. He has offices near Lougheed Mall in Burnaby (Servicing Burnaby, Coquitlam, Port Moody, New Westminster and Maple Ridge) and downtown Vancouver. Services include assessment - diagnosis of Autism (ADOS / ADR-I), psychoeducational assessment for learning disabilities, ADHD (Attention Deficit Hyperactivity Disorder) assessment and treatment and behavioural interventions for children and adolescents.  In addition to assessments Dr. Roche provides treatment for anxiety, stress, depression, and OCD in children and adolescents. Dr. Roche has been providing counselling,  therapy and assessments for over twenty years and has worked as a consultant to numerous school districts in both the United States and Canada.

For information on counselling and therapy services in Burnaby, Vancouver, Coquitlam and surrounding areas contact Dr. Roche at: (Office phone) 778.998.7975
Information on the details of counselling, therapy, assessment and testing services can also be found at:
http://bcpsychologist.org/users/jimroche
http://www.relatedminds.com/
http://Therapists.Psychologytoday.com/70682
http://psyris.com/drjimroche

Services 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
My name is Dr. Jim Roche and I am a Registered Psychologist and a Registered Marriage and Family Therapist (RMFT) in British Columbia. In addition to my doctorate in clinical psychology, I hold a master's degree in family therapy, 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. In addition to being a registered psychologist, I am 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). I also hold a doctoral degree in law 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.

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

http://www.relatedminds.com
http://Therapists.PsychologyToday.com/rms/70682
http://www.therapistlocator.net/member?183420
http://www.bcpsychologist.org/users/jimroche
http://www.actcommunity.net/jim-roche.html
Phone: 778.998-7975

The Nature and Diagnosis of ADHD



Uploaded by  on Oct 9, 2008

In this video Russell Barkley, Ph.D., discusses the recent advancements in understanding the nature and subtyping of ADHD as well as recent discoveries in what might cause the disorder and medications that might help treat ADHD. This is from the series: M.I.N.D. Institute Lecture Series on Neurodevelopmental Disorders [11/2008] [Health and Medicine] [Show ID: 14660]  It's a long, but excellent video. Some still seem to think ADHD is not a real disorder, and question it's validity. This lecture, along with other works on ADHD by Dr. Barkley, directly address this issue.

Here is the link:

http://youtu.be/q3d1SwUXMc0
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As usual, let me warn you that this blog, any of my other blogs, or my web pages are not designed to provide you with an assessment, diagnosis or treatment. If you are concerned you have a health issue such as ADHD, anxiety, depression or Asperger's | autism please see your health service provider, either a medical doctor or Registered Psychologist. What may appear to be symptoms of one disorder can often be caused by another unexpected disorder. Other disorders, such as ADHD, are very likely to exist at the same time as another disorder (called co-morbid disorder) such as anxiety, depressing or OCD. You need to see a professional to find this out. On-line symptom checklists will not provide this, and are often misleading.

Dr. Jim Roche
http://www.relatedminds.com/adhd-attention-deficit-hyperactivity-disorder/ Other information on my practice can be found at: http://Therapists.Psychologytoday.com/70682http://www.bcpsychologist.org/users/jimroche, and http://psyris.com/drjimroche

Key Words
ADHD Treatment Vancouver, ADHD Treatment Burnaby, ADHD Treatment Coquitlam, Adult ADHD, Child ADHD, ADHD Diagnosis,  Attention Deficit Hyperactivity Disorder, Psychologist Vancouver, Psychologist Burnaby, Psychologist Coquitlam, Cognitive Behaviour Therapy for ADHD, ADD, Learning Disabilities, ADHD Medication

Slow Cognitive Processing in ADHD | ADD (Attention Deficit Hyperactivity Disorder)

Today I published a blog that addressed the issue of "slow cognitive process" or "slow cognitive tempo" in ADHD | ADD (Attention Deficit Hyperactivity Disorder.  This topic is important to many who seem to have some of the symptoms of ADHD but wonder why they don't exhibit the "classic" symptoms. Slow processing is also often the cause of a lot of relationship issues in families with ADHD and needs to be understood.

To see the blog go to: http://www.relatedminds.com/slow-processing-and-adhd/

As usual, let me warn you that this blog, any of my other blogs, or my web pages are not designed to provide you with an assessment, diagnosis or treatment. If you are concerned you have a health issue such as ADHD, anxiety, depression or Asperger's | autism please see your health service provider, either a medical doctor or Registered Psychologist. What may appear to be symptoms of one disorder can often be caused by another unexpected disorder. Other disorders, such as ADHD, are very likely to exist at the same time as another disorder (called co-morbid disorder) such as anxiety, depressing or OCD. You need to see a professional to find this out. On-line symptom checklists will not provide this, and are often misleading.



Dr. Jim Roche

Can Adults Really Have ADHD?

Yes, adults can have ADHD, and you may not have noticed this until well into your work career. Read more:
Often, throughout elementary school, high school and even college life can, for some, already be pretty organized. Parents and teachers make just that little effort that makes the difference between failure and success. So I'm not surprised when I hear, " Can I really have ADHD? No one noticed when I was a kid."

Suddenly after years of success people can find themselves in a mess. Suddenly they are clearly disorganized, distracted and forgetful. Often this is because they have moved up the ladder to a job and family responsibilities that are just above their level of coping. And now, suddenly, they report that everything is falling apart.When we go through a symptom checklist of current symptoms it's there, and then when we review their childhood history ...well, there it is again.

As an adult who finds that you are suffering there are some things you can do. First, learn everything you can about Attention Deficit Hyperactivity Disorder (ADHD or ADD). Yes, many adults don't have problems with hyperactivity, but right now that the accepted medical term. ADHD rather than ADD. If you don't have the hyperactive symptoms it is usually Attention Deficit Hyperactivity Disorder-Inattentive Type. And understand, just because you were not aware of the disorder a s a child doesn't mean you don't have it now (although it is a developmental disorder and in some form or another should have been noticeable at a fairly young age).

The important thing is, if you think you haveADHD as an adult, get a comprehensive diagnosis. Not just a quick check of symptoms, because all of the symptoms of ADHD can be caused by other issues, but a complete and fairly comprehensive diagnosis. This doesn't mean you need a lot of testing, and doesn't mean you need a "neuropsychological assessment." But at least a diagnostic evaluation that rules out other possible causes (we call this a "differential diagnosis." You may want and need further testing because almost 1/2 of individuals with ADHD (ADD) have a co-morbid disorder such as a specific learning disability, depression or especially anxiety. And while it's usually not necessary to do a neuro-psych exam, you ma want a more comprehensive examination that includes a neuro-psych component in order to understand the exact nature of your strengths and weaknesses. This is something to discuss with your psychologist.

One of the sad things about finding out you have ADHD as an adult is to realize you may not get the support you expect. MAny people think this disorder is willful, that with a little extra effort and willpower you can overcome these problems of distraction, poor planning and lack of focus. This, frankly, isn't true. ADHD may certainly look like a lack of willpower, but it isn't. Decades of research have shown it's a chemical problem in the management of the brain, especially the "executive areas" know as the frontal lobes.

Some people also think that because you have ADHD you can't have depression, OCD or anxiety. As a matter of fact, I just wrote about the diagnostic process which focuses on ruling out these other disorders. Make no mistake, you can have ADHD and depression, or anxiety. And the problem is anxiety, OCD or depression can make the ADHD much more difficult to deal with. Sometimes our treatments need to focus on your depression or anxiety before we can address ADHD.

Adult ADHD can have a little different twist than child ADHD. Or at least, the problems that come to peoples attention may be different. With adults we often see a problem with "hyper-focus." This is a problem when we become absorbed in tasks we find enjoyable and reinforcing ....to the detriment of all the little boring details we needed to complete at the same time. Many have noted that hyper focus in adult ADHD is actually a coping mechanism. We hyper-focus to avoid being distracted. Hyper-focus, and the other side of the coin ...all those things your not focusing on...can be a real problem with relationships. This is why many adults with ADHD find it disrupting their relationships, their marriages, their relationship with their children and relatives.

Often the methods we developed as teenagers for being organized and focused in school no longer work in the adult-working world. Luckily we have some excellent skills training programs to help with just these issues, but the help of a "coach" or therapist can be very useful.

Other areas that adults with ADHD often find themselves having trouble with include regulating their emotions, including having a sense of underachievement, getting easily stressed, being irritable, difficulty staying motivated or having an explosive temper. While medication often helps with these problems Cognitive Behavioural Therapy and Anger Management Training are found to be useful by many adults with ADHD.

Some adults do have the typical restlessness that many think of when they think of ADHD. But for adults with ADHD it can be very different in nature. They might report just a feeling of "inner restlessness,"  some adults with ADHD actually report a feeling of wanting to travel, move, go elsewhere. Others report a constant craving for excitement, trouble sitting still, fidgeting, racing and intrusive thoughts, the need to talk excessively and the inability to do less than 20 things at a time. All of these are typical problems of adults with ADHD.

Professionals trained in Adult ADHD can help you with these issues. With your medical provider you can decide if you are a good candidate for medication. There are many choices, and different medications address different issues that ADHD present. Discuss these possibilities with your family physician. A Registered Psychologist can help you with a number of things: Fist, he or she can give you a comprehensive diagnostic examination. This would include ruling out other causes for your symptoms, and looking for co-morbid disorders like depression, anxiety, OCD or specific learning disabilities that may be part of your global problem. After that your psychologist can help you with stress, anxiety, OCD and depression by using Cognitive Behavioural Therapy (CBT). They can also put you through a structured program to address issues of organization, planning and procrastination. While it would be nice if there were a pill for these things, there really isn't. Medication can help you focus, concentrate and often stabilize your mood, but there are no "skill pills" to teach you how to remember appointments and organize tasks in an appropriate manner.

A psychologist can also help you with issues of self-esteem, confidence building and problems that may have developed in your marriage or relationships due to symptoms of Adult ADHD.  Whatever you decide to do, find a professional with experience working with children, adolescents AND adults with ADHD, as ADHD is a developmental disorder, and a comprehensive understanding of this disorder throughout the lifespan helps in putting together an intervention plan.

A Book: Best book on the subject of Adult ADHD, "Controlling Your Adult ADHD" by Dr. Russell Barkley. You can find information about ordering this book on my web page.





Study Finds ADHD Leads to Higher Rates of Injury in Children


In this new study children with Attention Deficit Hyperactivity Disorder (ADHD or ADD) are twice as likely to be injured badly enough to need medical attention as other children are, a new study finds. Twice!  You'll find this study written up here: http://yourlife.usatoday.com/parenting-family/special-needs/story/2011-09-17/ADHD-doubles-a-childs-risk-of-injury/50435398/1 The actual study will appear in the September/October issue of Academic Pediatrics, a professional journal.
In the study, researchers analyzed data from questionnaires filled out by the parents of 4,745 fifth graders in Houston, Los Angeles and Birmingham, Ala. that assessed ADHD symptoms. Children who scored high on the ADHD assessment are likely to have ADHD. Parents of children who scored in the 90th percentile for symptoms of ADHD (this research was meant to look at the symptoms of ADHD rather than the diagnosis, and some of these children, in spite of the fact they had all the symptoms were not diagnosed) were nearly twice as likely to report their child had been injured in the previous year than the parents of kids in the lowest percentile (10th percentile) for ADHD symptoms.
"ADHD is a disorder that's associated with impulsive behaviors -- children (especially those with ADHD or ADHD like symptoms) do things without thinking. It's associated with inattention -- they're not really paying attention to risks in their environment. And it's associated with executive function -- planning ahead, thinking ahead and having inhibition when you need it," wrote David Schwebel, author of the study and director of the University of Alabama at Birmingham's Youth Safety Laboratory. "Children with ADHD are poor at those skills, and that combination of things is leading them to take risks and behave impulsively, which leads to getting hurt." In the study, about 10 percent of kids had one injury during the prior year, 3.5 percent had more than one injury and 86 percent were not injured.
So what should parents do? First, pay attention and be aware.  Observe your child and make sure they practice basic safety rules (wearing a helmet, looking before crossing the street and so on). Practice these skills and over-practice them. "Over-learning" is a key point to training your child to be safe. And then explain all of this to your child. That's right, sit them down, with your doctor or therapist if needed, and review the situation...in a positive light! Remember, every bodies brains are different! Some good reading to help with this are books by Dr. Mel Levine and available at the "Schools Attune" or "Minds of All Kinds" websites. Heres the website: http://www.allkindsofminds.org/
Finally, with your doctor, assess the problem. How impulsive is your child? How effective is the behavioural treatment or medications he or she is taking? Remember, these injuries are caused (or at least linked) to impulsiveness and lack of focus. These are the symptoms that medication helps with the most.  As Dr. Russell says, "These are life medications, not school medications." Often parents come to my office and ask, "I'm thinking about asking Tommy's doctor to take him off his meds on weekend ...and maybe in the afternoon after school," because they are worried, unnecessarily, about effects of different medications. These results should explain why that really needs to be thought through. Concerning the side effects: Ask your doctor. Don't be satisfied with medications that solve one problem and cause another because your child will grow to resist the medication and hate the diagnosis. If there is a problem with the medication, see your doctor. Maybe the best way to think about this is this: ADHD medications are suppose to make your child's life happier. Make sure they do. You and your doctor should be a team.
For more information on my diagnostic and treatment services for children, adolescents and adults with ADHD (ADD) please refer to my web page.  The above opinions are not meant to be medical or psychological advice. See a Licensed or Registered Professional.
Dr. Jim Roche