Autism Spectrum Disorder and Psychoeducational Assessments

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

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

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

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

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

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

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

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

Psychoeducational Assessments


Dr. Jim Roche
Registered Psychologist
Relatedminds.com

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



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

Ups and Downs of ADHD

This short blog article looks at the ups and downs of ADHD, how individuals with ADHD can have variations in their abilities to focus, concentratrate and plan, and can have variations in mood.

Individuals with ADHD often have "ups and downs" from one day to another. A good day, then a bad day. Sometimes it's an up and down during the same day. For anyone with ADHD (Attention Deficit Hyperactivity Disorder or ADD as it is sometimes called) the first issue is to make sure, if these ups and downs are frequent and severe, that you do not have a co-morbid mood disorder. This is usually looked at during the initial ADHD diagnosis. Often a family doctor doesn't have the time or expertise to look at possible mood disorders, so a visit to a psychologist familiar with ADHD is suggested. (This is another reason to make sure, if you are using the services of an ADHD coach, that they are supervised by a licensed mental health professional and not simply working as a "certified coach" which is an unregistered/unlicensed and unregulated field in BC and most other provinces and states.)

The other issue is that often parents, teachers and co-workers (or worse yet, your boss!) take these ups and downs to mean that 1) you CAN keep your symptoms under control and simply aren't trying hard enough, or 2) see, there really is no such thing as ADHD, it's just an excuse. Both of these are untrue and counter to the scientific evidence, and the ups and downs ......they're proof of the real nature of ADHD as well.

ADHD symptoms do vary, they vary at different times and of course in different situations. The daily fluctuations may be related to the daily activity you are engaged in. Dr. Barkley says, "If the tasks required on a specific day demand lot's of self-control and organization as well as time management and persistence, then those days with A.D.H.D. will generally report that their symptoms are worse that day. If on the other hand, it is a vacation or weekend day and they could do more things they enjoyed, they often report their symptoms were less pronounced that day." (See Dr. Barkley's related article on the New York times Health page.)

So, if you need to focus on work that is difficult and holds little interest or reinforcement, expect problems. And if your going to an action movie after a quiet morning and lunch ...things will go well.  Novel situations go well much of the time, and do one-on-one encounters. The more planning and self-restraignt necessary, the less well it is going to go. All of this should make sense, knowing what ADHD is.

But there is also those days that just seem to go wrong. We start the day, some incident happens, anxiety builds and nothing seems to go right after that. We find ourselves in a downward spiral. Something we could do yesterday not becomes a difficult and sometimes  impossible task today. Again, to some this is proof that ADHD isn't real, or that you aren't trying hard enough.  Don't get caught in the definition others put on your behaviours based upon their preconceived (and wrong) ideas. It is simply the nature of ADHD to change like this.

What you need is a Plan B. Plan A  may not be going well, and it may not work out at all. So have a Plan B, a plan that gives you 1) A time to help yourself "switch mental sets," and change the way your brain is thinking and working (like taking a walk, having tea, doing a cross word puzzle or reading a book or listening to a podcast). Do something to change your mental direction. Maybe go to the gym. And then, 2) if you need it, spend time on an alternative but constructive activity. This might mean setting a timer and using the time to straighten out your papers, clean your office, get ten phone calls done.  What's important here is to have a structured Plan B and not to reinforce any avoiding behaviours - procrastination - that might be going on.  Keep a record of when and where this happens, and while you need a Plan B remember, your goal is to stick to Plan A. Ask yourself: "What about Plan A went wrong?" Was it where the activity/task took place, the time, what happened before or will happen after? If you have multiple experiences with Plan B - it's time to check in with your psychologist, doctor of mental health coach. But don't take changes in ability to be anything more than ADHD doing what ADHD does. Your question is: "What can I do to deal with this specific symptom of ADHD?" And then come up with a new and better Plan A AND Plan B!

For information concerning the services I provide for children, adolescents and adults with ADHD please visit my web page at www.relatedminds.com or www.adhdhelp.ca  In addition to working with individuals, providing diagnosis, treatment plans and coaching services, I also provide school based training and consultation services as well as work place services.

Hyperfocus or Lack of focus? ADHD problems and misunderstandings

Hyperfocus ....or lack of focus? Almost everyone assumes that ADHD comes with a very short attention span. It is ADHD-with the first D standing for "Deficit." But it’s really more accurate to say that a person with ADHD has an uncontrollable attention span. They have difficulty with what we call "switching mental sets." An executive dysfunction, the part of the brain that controls what you pay attention to and what you don't. A person with ADHD may pay attention to one thing, but not another. And the problem is, it's seldom under their control. Another problem is this switching of focus can be different from day to day. People often observe that on Monday a student was able to do their work (because they were hyper focused) and on Tuesday they could not. Then they accuse the student with ADHD of making a choice to do something ...." because he was able to yesterday! He just needs to take it serious!" Not so. Hyperfocus is the term used to describe when a person with ADHD is immersed in an activity he or she finds interesting - a preferred activity, that is somehow reinforcing. TV, computer games, or occasionally a book might be an activity that one becomes hyper-focused on. But the issue is one of self-regulation. Individuals with ADHD cannot regulate their attention, so they will be engrossed by something they find interesting while neglecting important areas of their lives. They then lose track of time, other things that need to be done, and what is going on in the world around them. This can also lead to social isolation. While there may be situations where we need to really focus to understand something or complete a task, hyper-focus in itself isn't as useful as many coaches and "ADHD is a gift" types would make you think. And when medication is used, often this hyper-focus is lost...and individuals then reject medication. Instead, they need to be taught specific skills to learn to maintain and shift focus appropriate -at will. (But so often I hear the ADHD is a gift types appealing to those with ADHD telling them that instead they need to take "advantage" of their gift .....usually because they don't understand or know of techniques to train attention control.) The best way to approach the issue of attention switching- or switching mental sets - is to use external prompts and cues of significant enough impact to help the individual move from one task to another ....or to stay on a task for a significant period of time. A well trained and licensed/registered mental health professional can guide you along that path, because this is one task where an outside coach is tremendously useful. Below is a short, funny little video on hyper-focus. I don't agree with everything it says, but it's part of a very helpful series that is science based. Hope you enjoy it.

ADHD Questions and Ansers

I was reading some really basic, but important, questions and answers about ADHD in the New York Times today. Here are the questions, and they are the kinds of questions every paretn of a child with ADHD has, as well as adults with ADHD. The answers, done nicely, can be found by following this link to the New York Times ADHD web page - a really great resouce I've recommended several times. Take a look, first for the answers to these ADHD rquestions, and second,all the other great science based information, stories and resources. Click here for the answers: http://www.nytimes.com/ref/health/healthguide/esn-adhd-ask.html The Questions: What’s the difference between your average high-energy kid and a child with attention-deficit hyperactivity disorder? Is there one medical test, like a brain scan, that diagnoses A.D.H.D.? My child was just diagnosed with A.D.H.D., and it’s supposed to run in families. Should I be evaluated for it? Our daughter’s pediatrician thinks she may have inattentive-type A.D.H.D. — A.D.H.D. without the “H”. Can you have A.D.H.D. without being hyperactive? I hear a lot about lax parenting or too little discipline causing A.D.H.D. Could our parenting style have caused our daughter’s A.D.H.D.? How do stimulant medications work in A.D.H.D.? Isn’t Ritalin basically speed? What other kinds of treatments besides medication are available for children with A.D.H.D.? Is A.D.H.D. different in girls from in boys? At what age is it appropriate to tell a child that he’s been diagnosed with A.D.H.D.? I had A.D.H.D. as a kid, but it was never diagnosed or treated back then, and I still survived. Why does my child with A.D.H.D. need treatment in order to get through it?

Early ADHD Treatment May Save Math Skills

Here is British Columbia we are very reluctant to test children in the early school years. Often, from parents, I hear that their child, who is failing academically at school, is not a "priority" as there are no severe behavioural issues. So, they are placed on a waiting list, which usually is rewritten every school year, and they never get assessed. Parents are often waiting for the school assessment - a psychoeducational assessment - to tell them about ADHD. They are often surprised when the psychoeducational assessment is completed to find out the schools neither diagnose ADHD, nor do they provide any structured and measurable treatments for ADHD (for the most part.) While there are some individual school districts here in BC that do have organized interventions for ADHD, they are few and far between, and BC is known for providing the fewest services for children with ADHD of all the provinces. So, we often wait through grades 1,2 and 3 and maybe in grade 4 or 5 we finally get a psychoeducational assessment and are old to visit either a medical doctor or a registered psychologist for a diagnosis of ADHD. Only after all of this waiting around are we ready to begin treatment interventions. And one thing we have known for sure is that early intervention for ADHD is critical, because its a developmental disorder, and developmentally appropriate skills are often not learned, and are hard to teach at the "wrong" developmental stage. Math is often the first academic skills to suffer. And trying to catch up in math in grades 5,6 or 7 is very difficult. This review article from Medpage looks at the results of EARLY treatment for ADHD, and how early ADHD treatment may be critical in saving math skills. Click http://www.medpagetoday.com/Pediatrics/ADHD-ADD/33441 for the full story The research points out two critical facts that I want to make clear at the beginning: 1) Starting treatment for attention-deficit/hyperactivity disorder (ADHD) sooner rather than later appears to lower the likelihood of a decline in academic performance as children move from elementary to middle school, and 2)that the timing of ADHD treatment had little influence on the risk of a decline in language arts performance.This is also important because parents, and teachers, often assume that because language based skills -reading, writing - are pretty much up to par the student only needs to be further encouraged to take academic work seriously. "They can do the work they want to do ...so we know they can do the work," is the false, misinformed and unfortunate thing I often hear. Here are the basic findings from the article, found at Medpage: "Starting treatment for attention-deficit/hyperactivity disorder (ADHD) sooner rather than later appears to lower the likelihood of a decline in academic performance as children move from elementary to middle school." "Among Icelandic children receiving ADHD medications, those who started treatment later had greater risks of a decline in math performance (RR 1.7, 95% CI 1.2 to 2.4), an association that was stronger in girls than in boys." Fairly early meds lead to better academic outcomes. Here is an interesting historical fact: "In 1937 -- 75 years ago -- when children were treated with stimulant medication for the first time, the boys referred to the medication as their 'arithmetic pills' since they noticed their math performance improve." Even the kids knew this was helping, and helping specifically in math. "More recently," the researchers continued, "math performance (speed and accuracy) has proven to be a very sensitive and reliable clinical measure of medication effectiveness in many research studies." The researchers noted that previous studies have shown that mathematics disabilities and language disorders involve different parts of the brain. "Possibly," they wrote, "stimulant drug treatment has more positive effects on the cognitive function underlying mathematical ability than on that underlying language ability." Although stimulants have been shown to improve the core symptoms of ADHD, there are few long-term data on their effect on academic progress. To explore the issue, the researchers, Zoëga and colleagues looked at data from 11,872 children ages 9 to 12 born from 1994 to 1996 who took standardized tests in the Icelandic school system in the fourth and seventh grades. Information came from the Icelandic Medicines Registry and the Database of National Scholastic Examinations. About 8% of the children were treated with ADHD drugs at some point during the study period. Nearly all of those treated received methylphenidate (96%); 9% also received atomoxetine and 34% received another psychotropic drug concurrently. The children who started taking ADHD drugs between the fourth and seventh grades were more likely to decline in test performance -- defined as a drop of at least 5 percentile points -- compared with nonmedicated children. So we see that while the medication might be helping, it is not enough alone. But they noted, "There were also differences seen within the treated group; later treatment initiation (25 to 36 months after the fourth grade tests) was associated with higher rates of performance decline compared with earlier initiation (within 12 months of the fourth grade tests).Declines in math were seen in 73% of those who started later and 41% for those who started earlier. Language arts declines were seen in 43% of those who started later and 39% of those who started earlier." They also note that, "When broken down by sex, the relationship between starting treatment later and a decline in math performance was stronger for girls than for boys (RR 2.7 versus 1.4). That finding could be due to chance or could be related to sex differences in ADHD symptoms, according to the researchers, who noted that girls with ADHD typically present with symptoms of inattention and have less hyperactivity than boys." They noted, "It is possible that children who started ADHD treatment earlier may have more family or social support to help them in school." However the results are fairly clear. Here in BC we find ourselves in an educational system that is over focused on math. You can't get into a university here without completing specific high school math courses - even if you have high grades in all your other courses and plan on majoring in history or fine art, problems in math will hold you back in BC (while the schools essentially ignore ADHD and other neurological deficits that are at the root). You may agree or disagree with this emphasis on math. The problem is that it is real. So EARLY intervention is critical. Talk to your medical doctor, see a registered psychologist for information on ADHD diagnosis and non-medical interventions, and speak up for services at school. For those interested in the problem of math education, the New York Times had an excellent article this morning on just this subject. It can be found here: http://www.nytimes.com/2012/07/29/opinion/sunday/is-algebra-necessary.html?smid=pl-share Information on ADHD assessment and treatment services I provide can be found at www.relatedminds.com or www.adhdhelp.ca.

Cogmed and ADHD. Well, maybe Cogmed +

Someone recently wrote to me about using Cogmed, a computerized training program to address problems with "working memory" and ADHD (Attention Deficit Hyperactivity Disorder or ADD) That's the part of memory that holds something in your head while you do something else - like hearing a phone number, getting a piece of paper and pencil and writing it down. One writer pointed out that Cogmed isn't designed for "curing" ADHD. The writer is correct, Cogmed training isn’t supported for helping with ADHD. When you are certified to provide the services, you are told not to make such claims. Sorry, generalization with these techniques is pretty poor. None of these "brain games" work well with something as complex as ADHD. But Cogmed is good for working memory, and if working memory is an issue improving working memory can really help. And sometimes working memory is holding someone back ...so, get your working memory assessed and see if it's a significant part of the problem. Any registered or licensed psychologist can help you with that. (Regretfully many ADHD coaches seem to rush people off into using these programs when they are simply inappropriate. Make sure your ADHD coach is a registered or licensed mental health practitioner, and not simply someone certified in "coaching.") While there are always suggestions that some treatment will “fix” ADHD, one critical issue is always missed. ADHD is a developmental disorder. During normal childhood development,because of ADHD, a number of developmental skills are either not learned, or learned improperly. Because of core neuropsychiatric impairments in attention, inhibition and self-regulation individuals often fail to learn to use appropriate compensatory strategies to be successful at organizing, planning and managing procrastination/avoidance/distractibility. This leads to a functional impairments which none of these "quick fix" methods including neurotherapy, biofeedback, brain games, diets and supplements helps with. There is no pill or simple intervention to fix the functional impairments of ADHD and teach these skills, just like there is no pill to teach French, hockey or cooking. Organization is something you learn very early in life, usually in play, and it is reinforced naturally in the environment. (Parents clap, say ”what a nice job!” or the blocks stand up really tall!) When we work with an adult who might be having trouble at work with organizing, well, honestly, learning the skill is one thing, using it, is NOT reinforcing. Most of my adult clients need to deal with the fact that if they become more organized at work they will most likely ..... get more work! If you remember to do 10 things on your to-do list, it’s most likely not 10 “fun and exciting” things to do... and not terribly reinforcing things either. If they were, you would have done them. "Getting better can be a bummer," someone once said to me. And to top it off, then mood disturbances can develop. After a history of failure, underachievement, the development of negative thoughts and beliefs takes over (get the CBT manual out!). People really do need a coach, therapist or a very supportive friend to do this kind of work. Someone specifically trained in dealing with the cognitive issues involved in most mood disorders. A good program for ADULTS with ADHD should address medication, health and exercise, teaching organization and planning skills, working with multiple tasks, learning to prioritize, problem solve, reducing distractibility, understanding and gauging your attention span (there is a really neat device suggested by Russell Barkley called “The Motivator” - a timer/buzzer/reminder you wear to remind you to stay on task. Most of my clients love it!). Clients also need help modifying their environment to reduce distraction, and need help with adaptive thinking (it’s a frontal lobe issue!) It’s really a plate full. Usually the key to success, as Dr. Russell Barkley would stress, is externalizing key information. Giving clients something to rely on more than their own memory. About 1/2 of my practice is adult ADHD cases, and most clients come already taking medication or after using some other specific technique. Many spend a lot of time with these “brain games” and try all sorts of diets, supplements and “alternative” treatments. After some initial success, there are set backs. In the end, anyone seeing adults with ADHD should remember the majority of the work we will be doing together is old fashioned therapy - maybe people would call it “coaching” now - but it involves assessing and understanding the FUNCTIONAL deficits each client has, and not just implementing a single technique or intervention. It means addressing each, one after another. A good, structured approach works best, but there are simply no quick and dirty cures, fixes or ways to avoid the problems of ADHD. With the help of a properly trained mental health provider you can learn the skills you missed out on, improve those that you know to a degree, and together develop a holistic plan to make your life better, easier and more successful.

Help with Procrastination - and an alternative to medication for ADHD!

OK, if procrastination is a big part of your ADHD, start by going to this web site: http://habitchange.com/ There you will find a product called The MotiAider. Several years ago I notice this and similar products were endorsed by Dr. Russell Barkley, the leading researcher in ADHD (Attention Deficit Hyperactivity Disorder, sometimes called ADD). There you are going to find a simple, inexpensive and useful device called the MotiAider. It's a simple reminder system that can help with staying on task, changing behaviours, and avoiding procrastination. Why would I suggest this device. Because it simply makes sense. It does what I always asks parents and teachers to do: Provides a positive prompt or cue - an EXTERNAL CUE - to you, your child or student, about a simple skill, task or behaviour they should engage in. It doesn't step in AFTER a mistake and correct - instead, at a steady rate -in preloads you or your student to be successful. Lately I've been emailing back and forth with Steve Levinson, PhD, President at Behavioral Dynamics, Inc. who makes this device (there are several other similar ones, including wrist watches) and want to share some of what he has given me permission to put on the website: "Let’s face it, procrastination sucks. It’s exhausting, stressful, and it can do a number on your self-esteem and career. Even though you eventually finish most of the unpleasant tasks you put off, you pay dearly for having postponed them. It takes lots of extra energy to avoid doing something you know you must do. One of the world’s most famous psychologists, William James, put it best when he said, “Nothing is as fatiguing as the hanging on of an uncompleted task.” "If you’re a chronic procrastinator, learning time management techniques can be, well, a waste of time. That’s because time management is like dieting. It’s not enough to know what you really should do. To get results, you have to actually do it. You probably already know that it makes sense to tackle unpleasant tasks right away. But when a truly unpleasant task is staring you right in the face, doing what makes sense is no match for the powerful urge to put it off." "To avoid procrastination, you must first understand the psychology of procrastination. Although chronic procrastinators may assume that their brains are wired entirely differently from the brains of people who make a habit of jumping in right away and doing whatever needs to be done, I disagree. Procrastinators and non-procrastinators are more alike than they are different. We all do what we’ve decided we should do only when we actually feel like we must do it." "When faced with an unpleasant task, we don’t get moving until we reach the point where leaving the unpleasant task undone actually feels worse than doing it. In other words, we all wait until the last minute. The only difference between non-procrastinators and procrastinators is that for non-procrastinators, the last minute comes sooner!" "If you’re willing to think about procrastination as the result of being slow to reach the “Get Moving” point, I have good news for you. There is a solution. The way to stop procrastinating is to make the last minute come sooner. By making the last minute come sooner, you can dramatically reduce the amount of time and energy you’d otherwise waste avoiding an unpleasant task that you’ll eventually have to do anyway." "Suppose there’s a report that you absolutely dread working on that’s due in a month. You estimate that the report will take several extremely unpleasant hours to complete. You have the time available, and you tell yourself that you really should just tackle the task right away and get it off your back instead of letting it nibble away at you for the next few weeks." "Yes, that’s what should happen. But you know yourself well enough to know what actually will happen. Despite your good intentions, you’ll end up putting off the unpleasant task until the very last minute − maybe a couple of days before its due − and in a panic, with the clock feeling like a knife in your back, you’ll get the report done on time − like you always do." "But suppose this time, instead of just relying on your good intentions, you deliberately change the situation to make the last minute come sooner. You do it in a way that at first glance seems nearly insane. You write out a check for $5,000 to a political party you absolutely despise. Then you give the check to your assistant with strict orders to mail it next Tuesday unless you show up with the finished report before then." "Now that you’re in the new situation you created, you still dread doing the report. In fact, you still put it off until the last minute. But this time, the last minute comes much sooner! Because you reach the “Get Moving” point sooner, you won’t have to wait so long or suffer so much to get the pesky job done and off your back. And you’ll have a delightfully smooth ride through the rest of the month. To conquer procrastination: Realize that what eventually gets you in gear is the pressure of the last minute. Treat pressure as your friend rather than your enemy − as the solution rather than the problem. Be willing to deliberately create situations that make the last minute come sooner." I think this is all GREAT advice, and working with the MotiAider it's something that we have a much, much better chance at succeeding in. Theres an excellent book for adults available on using this system, and a FREE downloadable book for using it with children and teens. (Some may want to use a less conspicuous device such as the wrist watch system ...that should be discussed and decided before you make any purchases). Now clearly this is just one step in helping those with ADHD (Attention Deficit Hyperactivity Disorder or ADD). Medication is also highly effective, especially with issues of hyperactivity, impulse control, managing emotions, focusing attention and transitioning from one task or activity to another (switching mental sets). And neither medication nor the Motiaider is going to help you work with complex problems, large issues, planning, picking out what is important or developing study skills. Addressing ADHD is a multi-phased problem, and most people need a therapist or professionally trained coach (who has a background in behavioural psychology). But just as the Cogmed System can help with working memory issues -which are often a hugh stumbling block for individuals with ADHD, finding a way to get positive, external prompts and cues out there in the environment is critical to successfully treating all of the components of ADHD. (We also need to remember that nearly 50% of individuals with ADHD/ADD also have a comorbid condition such as a specific learning disability, depression, anxiety or mood disorder. These need to be assessed and treated as well.) If your interested, take a look at the website above. I don't think this is a one step cure all for ADHD. But it's a good and smart component of a total program. Feel free to call me, and look at my web page at www.relatedminds.com or www.adhdhelp.ca. We can set up an appointment, review your history, arrange any testing or assessment that might be necessary and start you on a comprehensive program to deal with ADHD.

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.

Psychoeducational Assessments and IEP's

I work in Vancouver, Burnaby, Coquitlam, Maple Rdige, New Westminster and throughout the lower mainland. Parents come to me and tell me their child is having trouble at school and they have asked for psychoeducational assessments from their school districts. Often instead of a psychoeducational assessment they are told they will be placed on a waiting list, sometimes a long waiting list. 


As a matter of fact in Burnaby, Vancouver, North Vancouver, Maple Ridge, Coquitlam and other districts in the lower mainland school districts they seem reluctant to provide any psychoeducational assessment for a child younger than 8 or so. Sometimes that wait for the psychoeducational exam you requested takes years, and your child is 8,9 or 10 before they get necessary services. And parents wonder, "why are schools reluctant to provide these examinations until the children are older, and have had multiple years of academic failure before providing the assessment?"


Honestly, I don't know. I've worked with and in school districts in California, Washington, New York, Massachusetts and Vermont, as well as overseas, and everywhere else I have ever worked school districts provided appropriate psychoeducational assessments as soon as there were educational concerns. Most of the school districts I've worked in prior to coming to British Columbia have special teams trained in the tools needed to assess younger children. (A child of 8 doesn't take the same tests as a child of 5, and a school psychologist can't be expected to be familiar with ever test for every age.) So, elsewhere school districts are not only willing to provide a psychoeducational assessment to a kindergardener or 1st grader, they also have professionals specially trained in giving those psychoeducation tests.


I've asked several dozen school, educational and registered psychologists, and no one can offer me an answer as to why we wait to assess here in BC.  Sure, psychoeducational assessments at age 5,6 or 7 are not as predictive of future educational outcomes as ones given at age 12, 13 or 14. But they are valid. How someone performs years in the future may very well change based upon interventions (or lack of interventions) we provide. But any good assessment should help us to understand how a particular child learns, what cognitive and skill deficits they have, and what abilities they possess we might be able to use to improve their academic functioning. Even at age 5.


There is nothing wrong with asking for an assessment at the first signs of learning problems. A semester of "watching" and data collection, maybe trying some classroom based intervention, is appropriate. But I have trouble thinking more than a semester of "waiting and watching" makes sense.


I've also been hearing from parents that their child's teacher is unfamiliar with the psychoeducational assessment they have been given when we have one.  Sometimes I hear the classroom teacher hasn't read the psychoeducational exam report, and I've witnessed this at many school based meetings. It this something we should expect and accept?  Some teachers feel the information in the psychoeducational assessment is too complex, and that they don't have the training, knowledge or skills to make use of the test. That's understandable, some of these psychoeducational reports are written in a manner that's hard for me to understand. And grasping all the data can be difficult. So, I can understand why a teacher with a full load of classes decides his or her time is best spent elsewhere. Still, I feel the teacher needs to know about the results to make good teaching choices.


Here's what to do:
Schedule a sperate meeting with your child's teacher, the psychologist who wrote the report, administrators who deal with your child and appropriate members of the support team. At that meeting the school psychologist will review the report for everyone, and should be able to tell you and the teacher how these test results can be used in the classroom to make appropriate changes, accommodations to support your child.


Limit the topics at this meeting. Focus on the psychoeducational assessment and what we can learn from it. Make sure the psychologist is prepared to explain the report, and prepared with some suggestions. Don't surprise them! They may even write a one page brief summary to distribute at the meeting.


Psychoeducational reports can provide valuable information about a students strengths and weaknesses, and how to use their strengths, called "affinities by Dr. Mel Levine because he combines strengths with things you like to do, to overcome deficits. Teachers don't received training in understanding these reports, so as a parent you can set up the situation so that you child's teacher gets the support they need to know how to support your child with the help he or she needs. It's a win-win situation.


You don't need to accept a situation where the professionals working with your child are not even familiar  with his or her psychoeducational assessment.  Rather than becoming mad or frustrated, turn the situation into a learning opportunity for everyone. A good teacher will appreciate your help. Especially that one page summary!


Oh, and limit the number of suggested interventions. It's hard to implement more than three new things, monitor them and evaluate their effectiveness when you have a full class to take care of. Some reports come with 10,20 or more suggestions. Prioritize and pick three! 



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

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



Diagnosis and Treatment for ADHD in Vancouver, Burnaby and Coquitlam

Information about the diagnosis of ADHD | ADD (Attention Deficit Hyperactivity Disorder) can be found on the following websites: www.relatedminds.com,  http://www.relatedminds.com/adhd-attention-deficit-hyperactivity-disorder/, www.adhdhelp.ca, http://www.bcpsychologist.org/users/jimroche or http://Therapists.Psychologytoday.com/70682  ADHD assessments and followup treatment is provided in Burnaby, Vancouver, Coquitlam, New Westminster and Maple Ridge. Psychological services for ADHD are not covered by MSP but are often covered by extended health care. Speak to your health care provider for information. Psychoeducational Assessments are also available. Waiting times are short, and reports are usually completed within 10 day.

Psychoeducational Assessments


Psychoeducational Assessments are provided in my Burnaby and Vancouver offices. These offices serve Vancouver, Burnaby, New Westminster, Coquitlam, MapleRidge, North Vancouver and West Vancouver. As a registered psychologist and a former classroom teacher (as well as a school psychologist and school behaviour management specialist) I provide a unique point of view on how psychoeducational assessment and test results apply to the real classroom and can be used successfully by teachers to make positive change. Psychoeducational assessments are costly, and are not covered by MSP. They are, however, usually covered by extended health care plans. Appointments for psychoeducational assessments are usually available within two weeks, and are completed in approximately ten days. Sometimes faster. For more information please visit my website at www.relatedminds.com or my psychoeducational assessment page.

For an appointment please call me at 778.998-7975
Dr. Jim Roche
Registered Psychologist

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.
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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
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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.
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.


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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
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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.

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

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

Drinking and ADHD Medications? UNRELATED.

OK, I wanted to include this crazy and absurd photo that is on the "inter-press" (http://www.livescience.com/16269-adhd-stimulant-medication-kids.html) at the top of an article about the increase in use of ADHD MEDICATIONS with teens. The article appears on the "Live Science" webpage at this photo:




This is a photo of "Drinking Teenagers" as this stock photo title actually says. Drinking teens? What's that got to do with the article? ZERO. Why use it? To scare people, get attention with misinformation and fear, and make a headline where no headline exists. Here is what the article - and research - is actually about:

A recent study shows that the use of prescription stimulants to treat attention deficit hyperactivity disorder (ADHD) in kids has increased steadily over the last decade. Between 1996 and 2008, the percentage of U.S. children taking stimulant medications for ADHD rose from 2.4 to 3.5 percent — an increase of a half million kids.

Should we worry? Are we flooding our children with unnecessary medication? are we drugging our children..and leading to alcohol abuse? No. Let's not be mislead into thinking this article doesn't intend to scare you, one of it's major links is to another article about the over prescription of psychiatric drugs to children. They want to make sure you see the link, no matter how unrelated it is. You know, almost all children with diabetes are treated with DRUGS! So misleading!) Read on:

Researchers found the rise in the use of medication was due mainly to an increase in use of these meds among teens. "In the past, ADHD was primarily a concern of children in elementary school and middle school," said study researcher Dr. Benedetto Vitiello, of the NIMH. "This continuous increase among teens likely reflects a recent realization that ADHD often persists as children age. They do not always grow out of their symptoms."

So the increase in medication is the result of - doctors and parents starting to treat teens, not just children. Because... we now know that ADHD doesn't go away as kids grow older. Oh, and I might suggest that as children with ADHD take medications and succeed in school, stay in school and attend school we start to notice they continue to need treatment ... treatment that has been successful for them as children.

The article continues with Dr. Vitiello stating: "In addition, more children have been diagnosed with ADHD in recent years. The new findings cannot tell us whether ADHD medications are being over-prescribed in kids, as some experts have claimed. But the decision to treat ADHD with stimulants should be made on an individual basis, and each child should be monitored to see how he responds to the drugs."

So, what's with the article title about increases in medications and the photo of teens drinking? I really don't understand the media ...and their "science writers."

Now, if you are confused about ADHD medication being possibly overprescribed, read this:
"Previous work showed that between 1987 and 1997, the percentage of children receiving ADHD stimulant medications increased steeply, from 0.6 to 2.7 percent. To see how prescriptions of stimulants have changed since then, Vitiello and colleagues examined data from a nationally representative survey of U.S. households sponsored by the government's Agency for Healthcare Research and Quality. The survey showed that between 1996 and 2008, the number of children receiving ADHD medications rose steadily, from 1.8 million to 2.3 million. Among 13- to 18-year-olds, stimulant use increased from 2.3 to 4.9 percent over the study period.

Stimulant use was highest among 6- to 12-year-olds. In 2008, about 5.1 percent of children in this age group were prescribed stimulants. Only about 0.1 percent of preschoolers were prescribed stimulants, the survey showed. This suggests use of ADHD drugs among very young children is disfavored, the researchers said."

So, in spite of the fact that we read continually that the drug companies and doctors are pushing ADHD medication on to children, here we read in reality it is disfavoured. 

Now, for the final section:
"Most kids don't get stimulants. Despite the increase in stimulant use, most children with ADHD are not treated with these drugs, the researchers said. In 2007, about 9.5 percent of children in the United States were diagnosed with ADHD. Children with more severe symptoms are more likely to be taking stimulants, the researchers said. But those with milder symptoms may receive non-drug treatments, including behavioral therapies."

So, 4.9 percent get medication. 9.5 percent have ADHD. Have we overprescribed?

The study is published in the American Journal of Psychiatry (Sept. 28th). And what does it tell us? That less than 50% of kids with ADHD get medications. That the increase in children getting treatment for ADHD has been ongoing and hopefully will continue. And that even a clearly positive research article about a disorder that nearly 10% of children have can be misinterpreted by writers looking to get attention.
By the way, research shows that teens who have ADHD and don't get appropriate treatment are MORE likely to have problems with alcohol, drugs and the law, not the other way around.

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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




My webpage blog (http://www.relatedminds.com/kids-with-adhd-deserve-action-still/) this week looks back at a "Letter to the Editor" about ADHD | ADD treatment and services in local school districts. This letter is a year old, and addresses problems with getting ADHD recognized, getting ADHD services and the problems with the stigma and "chronic lack of awareness of ADHD" that the author found. I don't things have changed, and these same issues still come up win bring to deal with ADHD | ADD in our local school districts (Burnaby, Vancouver, Coquitlam, New Westminster and Maple Ridge). For more on this, click above and visit the blog from my website.

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Dr. Jim Roche

What causes ADHD (ADD)?

My professional web page is located at: http://www.relatedminds.com
I'm often asked "What causes ADHD?" and thought today's blog might just address that.

How many people have ADHD? Isn't it over diagnosed?
ADHD occurs in approximately 3-7 percent of the childhood population. Studies find that approximately 2-5 percent of the adult population have ADHD. Boys more likely to have the disorder than girls by 3:1. Among adults, the gender ration falls to 2:1 or lower. The reason for that seems to be that girls don't exhibits some aspects of ADHD that boys do, such as hyperactivity, but later do show signs of inattention. 


ADHD has been found to exist in virtually every country in which it has been investigated, including North America, South America, Great Britain, Scandinavia, Europe, Japan, China, Turkey and the middle East. It is NOT something made up by Western doctors, as some would tell you. The disorder may not be referred to as ADHD in these countries, and may not be medically treated as in North America. Still  there is little doubt that the disorder is universal among human populations everywhere. 


One of the things we have found is that ADHD is more likely to be found in families in which others have the disorder or where depression is more common. Dr. Russell Barkley (most of the information provided here can be found in his writing, and I highly recommend his website) has found that ADHD is also more likely to occur in those with conduct problems and delinquency, tic disorders or Tourette’s Syndrome, learning disabilities, or those with a history of prenatal alcohol or tobacco-smoke exposure, premature delivery or significantly low birth weight, or significant trauma to the frontal regions of the brain.  Almost 50% of individuals with ADHD also have another comorbid disorder. This is why, especially with children, you should consider getting a more comprehensive assessment than often given in a medical doctors office, as learning disabilities and other comorbid conditions need to be ruled out.


What causes ADHD?
Scientific evidence is overwhelming that ADHD "has very strong biological contributions to its occurrence." What those are have not yet been identified, but there is little question that heredity/genetics makes the largest contribution to the expression of the disorder in the population.  How big of an influence does genetics have on ADHD? Approximately 80 percent, meaning that genetic factors account for 80 percent of the differences among individuals in this set of behavioral traits. This is about the same as for how tall you are, or how smart you are. Several genes associated with the disorder have been already been identified. There are some situations where heredity does not seem to be a factor.  These include "difficulties during pregnancy, prenatal exposure to alcohol and tobacco smoke, prematurity of delivery and significantly low birth weight, high body lead levels, as well as post-natal injury to the prefrontal regions of the brain have all been found to contribute to the risk for ADHD." But these are usually the exceptions. For the most part, the vast majority of ADHD seems directly related to genetics.


Dr. Barkley points out, "Research has not supported popularly held views that ADHD arises from excessive sugar intake, food additives, excessive viewing of television, or poor child management by parents."  Full moons and sugar highs seem to affect the parents and teachers more than the children. Therefore, most medical interventions are not aimed at these disproven theories, which remain popular because they have quick miracle cures attached to them...which do not work.


I hope the brief and basic outline is helpful.

Learning Disabilities and other Comorbidities Common with ADHD/ADD

Medical News: Comorbidities Common with ADHD - in Pediatrics, ADHD/ADD from MedPage Today

For information on ADHD Assessment and Treatment services in Vancouver and Burnaby please visit my website at either: www.relatedmindsbc.com/adhd or www.relatedminds.com


This week I saw three adults for ADHD assessment. Two were fairly quick assessments for a diagnosis that was requested by their medical doctors. The third was more complicated and involved more extensive testing. Two children were also see, and both of those cases involved extensive testing, including cognitive and academic assessments. Clients often ask: "Why such differences from case to case?" And at our initial session we spend a good deal of time deciding how externes (and honestly expensive) an assessment is necessary.

This short article reviewing a recent research program explains this pretty well. In this study two-thirds of U.S. children with attention deficit/hyperactivity disorder were found to have comorbid learning disorders or other mental health or neurodevelopment conditions. Two-thirds of all children with ADHD or ADD have a comorbid - secondary -disorder. So if you are diagnosed with ADHD you are more likely than not to also have a learning disorder, anxiety, depression or similar problem.

Now I know many people make the choice to simply see their family medical doctor, who asks a few questions, looks at your history, maybe asks you to complete a form of 20 questions and makes a diagnostic decision: "Yes, you meet the diagnostic criteria for ADHD or ADD, now lets put you on meds." They write a script and much of the time you feel better, able to concentrate, focus a bit better and there is improvement. Much of the time. But it's the likelihood that you have a comorbid disorder -more likely than not - that is troublesome. Recently two adults came in who told me about temper outbursts, crying, frustration and intrusive thoughts. They had ADHD, but may also have had depression, anxiety, bipolar disorder and we hadn't even addressed learning disabilities. All of these possibilities should have an effect on a medical doctor's decision of which, if any, medications would be appropriate for these adults with ADHD. Should someone with manic episodes really be trying to address ADHD with stimulant medication? And if your depressed and having a difficult time at work, does the stimulant medication address your difficulty with learning new tasks, spelling mistakes or math errors? Most likely not. I'd guess that 50% of the time additional testing isn't necessary, maybe a little higher, with adults. But at a minimum a thorough look at possible comorbid mental disorders such as anxiety, depression, mood disorders and learning disabilities needs to be looked at.

With children this is even more important, as a child with ADHD is far more likely to have a learning or speech disorder that is causing academic difficulty if not failure. Only addressing the ADHD often masks these other issues for months if not years. Schools and parents think, "Well things are getting better...that good enough." only to discover three years later that a specific math learning disability or anxiety disorder has continued and now become the primary issue.

Lets look at what this survey found: It included more than 5,000 children with ADHD, found that 33% had one comorbid disorder, 16% had two, and 18% had three or more. This is not new information. These finding have been found again and again. "School and social problems, along with poor communication with parents, were significantly associated with ADHD as well,: the researchers stated. "Comprehensive screening for other problems that occur with ADHD is necessary, and treatment profiles should be tailored by comorbidity status and levels of functional impairment in home and school settings."

Comprehensive screening for other problems that occur with ADHD is necessary. Comprehensive screening takes time, and regretfully costs, but I have to agree, it is necessary. Most physicians do not have the tests or expertise to do this type of assessment. Yes, they are able to diagnose ADHD, but how to they diagnose a learning disability in a 15 minute session? This study concludes that, " many physicians already screen (screening is not testing or diagnosing) for common comorbidities among children with ADHD, few are adequately trained to treat such co-occurrence."

The study linked to above analyzed the 2007 National Survey of Children's Health, which included 5,028 children with ADHD among the 61,779 children ages 6 to 17, who participated in the nationally-representative telephone survey of parents and guardians. According to parental report of physician diagnosis ADHD prevalence was 8.2 %. Prevalence was higher among children in lower income families and those headed by single mothers, or more specifically, a diagnosis was given more frequently when parents were of a higher economic status. Overall, 67% of ADHD children had at least one other mental health or neurodevelopmental disorder compared with 11% in other children.

ADHD was associated with the following:
Learning disabilities (46% versus 5% in other children, adjusted relative risk 7.79)
Conduct disorder (27% versus 2%, adjusted RR 12.58)
Anxiety (18% versus 2%, adjusted RR 7.45)
Depression (14% versus 1%, adjusted RR 8.04)
Speech problems (12% versus 3%, adjusted RR 4.42)
Comorbidities didn't vary by age or gender, but poor children with ADHD were 3.8 times more likely to have three or more comorbidities than the most affluent (30% versus 8%). For various reasons the researchers state that over-diagnosis was unlikely to be the cause of this socioeconomic factor. Rather, there may be common etiologic factors, like maternal stress or prenatal smoke exposure or genetic susceptibility, that are more prevalent in lower income families, they suggested. Every measure of functioning showed a disadvantage with ADHD, including higher odds of the following:
Activity restriction (adjusted odds ratio 4.14)
School problems (69% versus 27%, adjusted OR 5.18)
Grade repetition (29% versus 9%, adjusted OR 3.71)
High parent aggravation scores (53% versus 19%, adjusted OR 4.30)
Low social competence scores (43% versus 18%, adjusted OR 2.86)
Poor parent-child communication (8% versus 3%, adjusted OR 2.55)
Poorer functioning increased with each step-wise increase in the number of comorbidities, as did use of mental health and education services.

Researchers also found that the high rate of grade repetition and school problems "indicates that existing management strategies are falling short of meeting the needs of these children." Yes, medication is helpful, but not enough. While this study was limited because it relied on parent self reports it is similar to what we have found in research over and over again. If you or your child have ADHD you are more likely than not also going to have a second issue, a comorbid disorder. Specific learning disabilities are the most likely. Because of this research I don't offer just simple quick diagnostic procedures for ADHD or ADD. Instead I provide a wide range of testing, assessment and treatment for those who suspect they have ADHD or ADD. This includes testing for learning disabilities, personality assessments (especially for adults) to rule out any significant mood disorders such as anxiety or depression, and followup services such as behaviour planning for school, parent education, cognitive therapy (for anxiety, depression), anger management training and specific skill training for deficits in organization, planning and procrastination.

If you have ADHD and need treatment, get the assessment you need. It might be a short, easy and quick assessment done by your medical do cot in his or her office and covered my MSP. Or you might need something more complex and detailed. Talk this over with a psychologist or psychiatrist who is an expert in ADHD.