Psychoeducational Assessments, ADHD and Autism

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

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

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

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

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

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

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

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

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

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

Offices in Burnaby and Vancouver

What is a Psychoeducational Assessment? School Testing and Learning Disabilities

A lot of people call and tell me that the teacher told them their child needed a "psychoeducational assessment." They aren't sure what it is, or how much it will cost. So I'd like to answer some basic questions about psychoeducational assessments and how they relate to ADHD, learning disabilities, accommodations in school and other similar questions people often ask.

1. What is a Psychoeducational Assessment?
A psychoeducational assessment is a set of tests, observations and history taking about a child, adolescent or, even an adult in college that helps us understand how they learn and process information.  Usually we are asked to complete a psychoeducational assessment when a school or teacher suspects a learning disability. For instance, a child or adolescent might have difficulty with one particular subject such as math or reading. Sometimes a child is performing below what would be expected for their grade level, and a teacher wants to know what might possibly be happening to prevent the child from learning like his or her peers. The psychoeducational assessment helps us understand the student's current level of functioning, as well as their potential level of functioning. It also helps us understand a student's strengths and weaknesses so we can develop a plan to help the child succeed in the classroom.

2. What kinds of tests are used in a psychoeducational assessment?
Usually there are two major sets of tests. One is for measuring cognitive ability - intelligence. This might include tests like the WISC or WAIS, common intelligence tests. Or two other tests commonly used are the RIAS (Reynolds Intellectual Assessment Scales) or the Woodcock Johnson. Sometimes another test is chosen because of language difficulties, however the purpose of this part of the assessment is to understand the various cognitive abilities that a student has. In a way you can think of this as a measurement of potential.

A second set of tests are the academic tests. This might include the WIAT (Weschler Individual Academic Test) , the WRAT-4 or some other specific test of reading, oral reading, math skills, writing and so on. This set of tests measures a student's current skill level. What academic skills the student is able to demonstrate.

We then do two kinds of comparisons. We look at general and specific cognitive skills, and see if there are strengths and weaknesses there that might point to a "processing disorder" or specific cognitive deficit, and then we compare the cognitive tests (abilities) to the academic tests (level of functioning) and try to understand if there are specific weaknesses in the student's ability to produce work. Here we might find a specific learning disability.

Other tests are then used as needed based upon these results (this is why you usually need to go back to the psychologist more than once, they need to score and analyze these results to see what needs further investigation before continuing). These tests might look at auditory processing, learning and memory functions, executive functions, social skills or specific academic skills. Some school psychologists give a single battery, always the same, to every student. They usually have a rational for that. Others use a more flexible battery and may put more emphasis on the latter part of the investigation.

3. Who administers a psychoeducational assessment?
Usually schools are able to administer a psychoeducational assessment. School psychologists are experts in looking for specific learning disabilities, and are usually familiar with the school districts procedures and expectations for students, which can differ from district to district. This service is free in Canada and the United States. In the United States, when a parent requests a psychoeducational assessment the school district needs to look at the request and investigate it. The parent get either a reply that the district doesn't feel an assessment is necessary, or a psychoeducational assessment, within 50 days. If the district feels one is not necessary, and the parents disagree, there is a structured appeal process utilizing outside experts to determine if it is necessary or not.  In Canada, regretfully, schools  have very limited resources and requests for assessments are often put off for several years. There is an appeal process to the Ministry of Education, but not all schools inform parents of this right.  Children are placed on a "priority list" which is often redone at the end of every year, and I have seen some children wait three or more years before being considered for an assessment.

Parents also have the option of using outside Registered Psychologist to provide a psychoeducational assessment. One advantage of this is that a Registered Psychologist is able to diagnose mental disorders, and school psychologists (who usually only hold an MA degree) are not. Some school psychologists, especially in BC, are also Registered Psychologists. The fee, which is not covered by MSP, ranges from $2,200 - $3,200 depending upon the complexity and length of the assessment.

4. What happens after the psychoeducational assessment is complete?
Not all psychoeducational assessments lead to a diagnosis, and some are simply not valid due to a student's behaviour or efforts. So nothing can be guaranteed. If there is a learning disability evident, or a mental health disability, usually the school's committee on special education meets with the parent and a child is "coded" meaning they are given a category that enables them to be provided appropriate accommodations and interventions. This is written up in an agreement called the IEP or Individual Education Plan. Parents should be informed and involved with this process at every step, and if you use an external psychologist you should make sure they are either present or agree with the IEP.

Here I'd like to make a cautionary statement: Often psychoeducational assessment reports contain a long....sometimes very long...list of suggestions for the school to implement. It is critical to work with a psychologist who has experience with the schools and the classroom. Otherwise they are likely to suggest interventions that are not practical and demonstrate a lack of awareness of the classroom.  When I started working in this field I wanted to become a school psychologist (I am both a licensed/Registered Psychologist and a Licensed/Registered School Psychologist), but couldn't because to be accepted into a school psychology program required that I be a certified teacher for 5 years first!  I did become a teacher and have classroom experience, without which it would be difficult to understand what interventions and supportive techniques work in the classroom. Give this consideration when picking a psychologist to complete your ch  need for a "full psychoeducational assessment" must mean they feel they have completed a "not full" psychoeducational assessment, and I would agree. Many schools, especially in British Columbia, allow and even encourage teachers with minimal training to administer some simple and basic tests, including a brief IQ tests such as a TONI (Test of Non-Verbal Intelligence) and a brief academic test such as the WRAT-4. While the publisher of these tests say that they can be administered by an experienced teacher, that doesn't mean a teacher should administer a handful of these brief tests and then feel they are qualified to rule out a learning disability or other deficit. Using these tests in this way is a misunderstanding of the purpose of screening with these tests. They are meant to rule in students who would need further, more in depth, diagnostic testing. They are not meant to rule out learning disabilities or other academic or cognitive problems- which is how they are being used! If your child is failing at school, or having significant struggles, and they are administered a brief IQ test - which comes out in the normal range, and then a brief academic test, again scoring in the normal range, but he or she cannot produce in class .....these tests do not mean there is nothing wrong. The mean the exact opposite - THERE IS SOMETHING WRONG! Further assessment/testing needs to be done by a qualified school psychologist or licensed/registered psychologist. These screening should not be used to ignore problems that are real and obvious from a teacher report to student behaviour or a report card. A screener isn't suppose to be used to stop inquiry.

5. Can the school diagnose ADHD, depression, anxiety or autism?
Generally, no. A particular school psychologist may also be a Registered Psychologist and qualified to do this, but that is usually not the case. School Psychologists are not qualified by their school psychology certificate to diagnose mental disorders such as ADHD, depression, anxiety or Asperger's Syndrome/autism spectrum disorder. A properly trained Registered Psychologist can help you with that.

6. How young can a child be and need testing or assessment?
While here in BC there is a reluctance on the part of school districts to complete comprehensive psychoeducational assessments on students until they are older, this is not the case elsewhere, and is not best practice. For almost every disorder the general rule is that the sooner we have a diagnosis and get treatment, the better off the student is. In some jurisdictions, such as California and New York, special teams assess children at ages 4 and 5, in order to make sure they receive appropriate services before the enter school. Some jurisdictions offer treatment to children with special needs before grade 1 or K to make sure they do the best they can and experience as little difficulty as possible.  You might ask your medical doctor about a referral to Children's Hospital or another provincial provider here in BC. Some providers associated with the Ministry of Families and Children work with children down to 3 years old. The earlier a child gets help, the better the outcome. If your school disagrees it's usually because they simply don't have properly trained professionals. Talk to your medical doctor and get an appropriate referral if you have concerns,

I hope this brief overview of Psychoeducational Assessment is helpful. For parents with concerns about their child's academic progress I often suggest a book by Dr. Mel Levine called, "The Myth of Laziness." Another alternative book by Dr. Levine is "Minds of All Kinds."  There is also an organizational website for Minds of All Kinds which can provide very helpful information. Click here to get to that site: http://www.allkindsofminds.org  You'll also find a great book there for teachers called "Schools for All Kinds of Minds." Take a look!

For more information on the psychoeducational assessment services I provide  please visit my website at http://relatedminds.com or click here: http://www.relatedminds.com/testing/

KEY WORDS: ADHD, Learning Disorder, Learning Disability, Testing, Psychoeducational Assessment, School Testing, Psychologist, ADHD Coaching, Vancouver, Burnaby, San Franscisco

How Much Does a Psychoeducational Assessment Cost?


How much should a Psychoeducational Assessment Cost?
Well, I hate to say this, but "it depends."

Not All Assessments are Alike
The exact nature of the Psychoeducational Assessment you need can be very different from case to case. This includes assessments because of in class behaviour such as aggression towards peers to a student who are struggling..and then the student who isn't doing work and seems bored and we suspect is really "gifted" and whose needs we are not meeting. And that's the issue we should be focusing on when it comes to psychoeducational assessments: what needs does any student have that need to be met for this student to be successful as they can be?

So any individual psychoeducational assessment may be very different. Let's first look at what usually is the same:

A common feature, if not a necessary feature, is a comparison of a students cognitive or intellectual abilities and their academic abilities. Usually this means administering a cognitive-intelligence test (this might be any of the following: The Cattell Culture Fair, Kohs block, Leiter International Performance Scale, Otis-Lennon School Ability Test, Raven's Progressive Matrices, Stanford-Binet IQ test, Wechsler Adult Intelligence Scale. Wechsler Intelligence Scale for Children, Wechsler Preschool and Primary Scale of Intelligence, the Wonderlic Test or the more recent and very popular Reynolds Intellectual Assessment Scale or RIAS). In addition to the intelligence test a test of academic skills is also administered (This might include anything from the Wechsler Individual Achievement Test to the Wide Range Achievement Test-4 or a any of several others).

The most common combinations are one of the Wechsler Tests of intelligence and a Wechsler test of academic skills, or the Reynolds (RIAS) and Wide Range Achievement Test.  The next step is usually to compare these scores and see if there is any reason to suspect a specific learning disability. This is done several ways, but is most often referred to as a "discrepancy analysis." The basic question is: Does the student work at an academic level we would expect, based upon their intelligence.

After this most basic analysis a psychoeducational assessment can go in several directions. If there are behavioural issues it might include testing for personality issues, anxiety, depression, or ADHD. One problem is that school psychologists are neither psychologists or doctors (usually ...some school psychologists here in BC actually are Registered Psychologists) and should not be diagnosing mental health disorders. They look for educational problems, often perform "coding" which is the process of classifying students for different types of services based upon ministry guidelines, and make suggestions for classroom supports. But they usually do not diagnose something like ADHD. You need your family medical do cot or a Registered Psychologist to do that.

If your wondering if your child has autism you need to have a specially trained medical doctor or Registered Psychologist perform a specialized examination using several tools that most psychologists and family doctors do not have training in, and simply don't own.

So to start usually we take a look at cognitive/intellectual ability and compare that to academic ability. From that we determine if there might be a specific learning disability. After that step other tests are usually used to look at specific areas of concern. This might include tests of reading, specific math skills (Key Math is one commonly used test), tests of pragmatic language, visual perceptual skills, auditory processing, balance, gait, motor skills and so on. So the initial phase of the assessment is only the beginning.

Each psychoeducational exam is different, or should be. Often the psychoeducational exam is just a starting point, and to understand the issues a student may also need an assessment by an occupational therapist and/or a speech pathologist. A medical examination should also have been administered to rule out medical reasons for the issues of concern.

So, when a parent asks me how much a psychoeducational examination will cost, I have to ask questions to determine what kind of psychoeducational examination we will be doing. Many parents tell me they are told by other professionals that "a psychoeducational assessment will cost $2,600." A straight forward price. But in reality, until we meet and look at the situation, we aren't sure. Sometimes a psychoeducational assessment isn't even appropriate until a child is seen by his or her medical doctor, an occupational therapist and a speech pathologist, so that other causes of academic difficulty are mistaken and misunderstood. This is why I personally suggest an initial meeting to gather information, history and concerns.

The cost of a psychoeducational exam? Well, it can range from $1,200 -$2,600. It depends. It depends on the situation, the information we need, the amount of testing and how cooperative and able the child is. One price does not fit all, and one "psychoeducational assessment" does not fit all. After an initial meeting we usually know, and together can shape a plan to fit your needs.

Finally, remember, your school should provide a psychoeducational exam....for free. Yes, there are sometimes long waiting lists. And sometimes a school psychologist can't make a diagnosis of a disorder such as ADHD (Attention Deficit Hyperactivity Disorder) or Autism Spectrum Disorder. Some parents also prefer to have an outsider look at their child and give an opinion. All of these are reasons for looking outside the school for an assessment. (Psychoeducational Assessments are not covered by MSP, but most Extended Health Care Plans do provide some or complete coverage for an assessment).

Talk to your family doctor, your school psychologist and give a Registered Psychologist a call. All would be more than willing to talk to you about this subject. (Registered Clinical Counsellors are not qualified to complete Psychoeducational Assessments. An independent Psychoeducational Assessment must be completed by a Registered Psychologist.)

In my offices in Burnaby (serving Burnaby, Coquitlam, New Westminster, Port Moody, Port Coquitlam and Maple Ridge) and Vancouver (serving Vancouver, North Vancouver, West Vancouver and Richmond) I provide comprehensive psychoeducational assessments. I also provide diagnostic assessments for ADHD and Autism Spectrum Disorder). Please feel free to contact me if you have any questions about these services.
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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



My ADHD website has move! Click below.

My ADHD (Attnetion Deficit Hyperactivity Disorder) site has recently moved to a new url: http://www.relatedminds.com/adhd-attention-deficit-hyperactivity-disorder


ADHD/ADD can affect the entire family constellation as well as the work or school setting. As a former classroom teacher, director of behavioural services for several school districts and the neuropsychologist for a community based rehabilitation program I am familiar not only with the diagnostic issues relating to ADHD, but also how behavioural, cognitive and systemic interventions work in real life settings. The specific services for ADHD/ADD I provide in both my Vancouver and Burnaby offices are:
ADHD testing and assessment (neuropsychological and psycho-educational)
ADHD Diagnosis
ADHD Treatment Plans for home, work and school
Couple and Relationship Counselling for ADHD related issues
Training for problems with focus, concentration, reading, planning and procrastination and anger management

Frequently Asked Questions (FAQ’s)
Well, I think I have ADHD. Where do we start?

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

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

For more information visit my website at the above address, or at: www.relatedminds.com

Excessive Video Gaming Not Just a Symptom: Issues in ADHD

Medical News: Excessive Video Gaming Not Just a Symptom - in Pediatrics, Parenting from MedPage Today

to start, I remind you again that due to Apple Computer ending it's web hosting services I've moved my website to a new host. The website is still found through the url: wwwrelatedminds.com or www.relatedmindsbc.com. My blog is also move. For the time being most blogs, in addition to being posted on blogger, will be reposted at the new site at: http://www.relatedmindsbc.com/blog
Now, back to video gaming.

Many families come in with their children, who often have a diagnosis of ADHD or ADD, and complain about excessive video gaming. They can't drag their kids away from the machines, and can't get them to stop. They ask me if the video gaming is, in itself, pathological, or if it can cause pathology such as excessive anger, violent behaviour and poor concentration (this is a big concern for parents who already have a diagnosis of ADHD for their child). There really hasn't been much research on this issue until recently, and the research there is isn't very clear. However, this study by Douglas Gentile, PhD, of Iowa State University, has found some interesting...and worrying...connections.

So the real question is, does excessive gaming cause pathology, or does pathology cause excessive gaming? This two year prospective study (with over 3,000 children identified in the data) identified several baseline psychological factors that predicted excessive gaming. These include: impulsivity, depression, social difficulties and poor overall school performance.  These conditions seemed to act as outcomes of pathological gaming. But this excessive pathological gaming seems not to simply be secondary to these other disorders, but to be predictive of poorer functioning overall. This poor overall functioning can last for several years.

For instance, while impulsivity is a risk factor for excessive and pathological gaming, impulsivity worsens after a youth becomes a pathological gamer. The study found that increases in pathological gaming were predictive of depression, anxiety, social phobia and poor school performance.  The relationship between these factors was especially strong for depression.  Some limitations of this study were: it's location (Singapore -can it be generalized to Western cultures?) and that the study relied on self reports from these children.

What can we learn from this? First, I think, that we should not ignore the possibility that there is an underlying depression or anxiety with children who spend too much time gaming. This can often be determined through a clinical interview and further assessment if necessary. And second, that impulsivity is a critical factor in helping the child reduce gaming activity. This is especially true for kids with ADHD who seemingly can focus on an XBox game for several hours, but can't spent 10 minutes reading or doing math problems. (This is the student who often really agitates the teacher, who assumes that it's a matter of choice rather than a result of the child's disability or cognitive deficits such as ADHD or depression.)

Overall if your child is having problems with excessive time spend at the computer gaming, has become isolated and seems non-compliant when asked to get off the computer: get professional help. There seems to be a strong relationship between pathological gaming and psychological problems such as impulsivity, depression, anxiety, social isolation and poor academic performance. You may have difficulty directly addressing the gaming at first, but working on these other areas may very well help.  A psychologist with expertise in diagnosis and treatment of these disorders can help you set up a home program to teach skills necessary to disengage from the video game, address irrational thinking that comes with anxiety and depression, teach social skills and skills to reduce anxiety and finally develop a positive sup[port plan to address issues relating to learning difficulties.

Feel free to contact my office or contact the British columbia Psychological Association to locate an expert near you.


Brain based education: Fad or breakthrough?

Brain this, brain that. This brain, that brain, everyone has a brain based program to offer your children. I was just in chapters and there was en entire table about "changing your brain." Most of it, by the way, is baloney. (Here is Harriet Hall's comments: click here) Arrowsmith School has an entire curriculum based on "brain training" but the truth is that most of this brain based training isn't going to make much difference.

Here is what all these programs are based upon: plasticity. Brain plasticity. That means we believe that by engaging in certain actions/behaviours the brain itself changes (or to be mysterious and flaky, as Dr. Aiken says, the Brain Changes itself!!!!). We really didn't believe this 20 years ago. We thought the brain grew to a certain point, a process called "pruning" took place during which we actually lost unused brain cells and neurons making the brain more efficient, and that was it. If you damaged a part of your brain, that was it. The brain, unlike the rest of the body, didn't really change or grow or heal to any great extent.

Then in the Northeast US several psychiatrists thought this might not be true and began what was called "psychiatric rehabilitation." I was (a small) part of this early research. We took what were called "back ward" patients, patients who sometimes had been sitting on the floor in the back ward of the psychiatric hospital for 10 or more years, doing little, and we brought them into the lab and put them in front of the computer and engaged them in games very similar to those your kids play now and very similar to the tasks that schools like Arrow Smith use. Watching the Arrowsmith video they look amazingly the same! And what happened? Well we compared them on many behaviour scales to patients who did not recieve the training and they became vastly better. Some talked for the first time in years, began attending groups and were actually discharged.

Amazing! These computer brain games cured these patients of many mental illnesses..... they went from sitting all day in the corner of the psych ward to walking around the grounds, meeting other people and talking and going on home visits. Wow! Brain games. A few years later were were actually able to measure increase blood flow in the brain and growth of NEW NEUROS and CONNECTIONS!

Not so fast.

There were other differences between these successful patients and the ones who remained on the psychward in the corner or on the floor. Those patients received very little staff interaction, most were spoken to 2-5 times a day by staff. They just sat, and sat, and little changed. Little tried to make them change. The "brain game" patients were moved off the ward twice a day to the treatment center, talked to, encourage, reinforced (with points traded for candy and smokes) for participating and engaging in the tasks. There really was more going on than just these brain games.

So the question was: Did the "Brain Games" change the patients, or was it the different treatment, the positive attitudes of staff, the encouragement and reinforcement for engaging in behaviours we wanted to see more of ...and measuring? The new, positive and reinforcing environment? I vote for the encouragement, reinforcement and support rather than the games.

That is basically what the skeptics say about all these brain games. Recently there was a CBC documentary on Arrowsmith, and Linda Siegel, a UBC education professor specializing in learning disabilities was interviewed for that special. During the interview questioned the effectiveness of the Arrowsmith program. She noted a lot of things, like the $24,000 a year tuition! Siegle say it was her belief...well lets just copy what is printed on Canada.com "I think the Arrowsmith program is a fraud. I think they're taking money from people and not showing any improvement in any kind of objective way..." Well a libel lawyer from Arrowsmith got an order to remove the comments about "fraud" or face legal action. And I would agree, fraud is a very strong term, and I think the people at Arrowsmith believe in what they are doing, and are sincere and positive, supportive and...well most likely great teachers. But in the end Siegel is the only real critic of the program, and she was silenced by legal threats.

The problem is, as with the "plasticity" research from the 80's, it's true that the brain can be changed through behaviour and exercises. The repetitive exercises (the "Brain Camp") that Arrowsmith uses haven't, as far as I know, been shown to improve anyone's behaviour in and of themselves. I'd vote for the reinforcing environment, friendly teachers, the new and structured environment....but these particular exercises? Not too sure. One thing we do know is that these types of repeated exercises don;t really make generalizable changes in people's behaviours, or their brains. THINKING isn't developed out of discrete repeatable computer exercises. And this goes for Arrowsmith, Brain Balance ....all of these computerized programs.

There is one computerized program that has actually shown to make actual differences in a skill that matters, and thats increasing the ability of individuals to use what we call "working memory." Working memory might best be described as your ability to hold information in your head and use it, work on it, change it, and remember it. Pearson Publishing uses a computer based program to help develop "working memory" that they have found to be effective (click here to read research on the program). One of the differences between Cogmed, Pearson Publishing and all these books on "fixing your brain" and these Brain Balance, Brain Gym and Brain Training programs is that Cogmed doesn't rely on parent statements to prove the effectiveness of their program. They don't publish pages of parent testimonials, and they don't make any claims other than those they have been able to prove. And that means they are really clear about the severe limits of their computerized "brain training" program: It has been found to help with working memory. Nothing more. It doesn't fix reading, spelling, science, music ability, art ability ...... or make your kid a novelist. it can help, in most cases, with deficits of working memory. But with poor working memory, your going to have problems with almost everything.

As a parent you need to figure this stuff out, but your resources should not be limited to poorly constructed research and never should it rely upon the testimonials of other parents. That, I can say, should always be a red flag. As usual, I suggest you ask your doctor. Or maybe give Dr. Siegel at UBC a call ....unless there's a court order forbidding her to give her opinion.

We are still at the very early stages of using these techniques. Read an article here (click here) about the assessment of another similar software program used with kids with ADHD. Finally, here's a nice video about Brain Based Education:

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The ADHD blog is not offered as medical advice or as a means of diagnosing or treating ADHD or any other disorder. My recommendations: Don't go on-line and take an ADHD "test." The diagnosis of ADHD is complex and involves not just looking for symptoms of ADHD, which is all that those “tests” do, but also involves ruling out other disorders that might look just like ADHD. Often individuals who think they have ADHD have other disorders, and may have co-morbid disorders such as depression, anxiety or OCD. A simple check off sheet of “symptoms” doesn’t differentiate these. So avoid these on-line "tests" which are nothing more than a collection of symptoms. You need to see a licensed or registered professional for a real diagnosis. Medical doctors can diagnose ADHD, but the diagnosis is complex and often they will make a referral to a Registered Psychologist for a full understanding of a patient’s symptoms. You can obtain a referral for a psychologist with expertise in ADHD from the British Columbia Psychological Association (BCPA).

In my practice I offer Attention Deficit Hyperactivity Disorder (ADHD) assessment and treatment services for individuals, couples, families, children and adolescents in the Burnaby, Vancouver, Coquitlam, Port Moody, New Westminster and Maple Ridge areas of the lower mainland. This includes neuro-developmental assessments, psycho-education, cognitive rehabilitation for problems with memory and concentration and cognitive behaviour therapy. I also provide diagnostic assessments for autism and Asperger's Disorder in my Burnaby office.

My web page lists a number of resources you can make use of yourself in dealing with Attention Deficit Hyperactivity Disorder (ADHD). Please visit it at www.adhdhelp.ca or one of my other sites at either Psychology Today, AAMFT, PSYRIS or my professional site. Please feel free to call if you have questions about ADHD or other cognitive issues.


Dr. Jim Roche
Registered Psychologist, British Columbia 01610
778.998-7975
www.relatedminds.com
www.adhdhelp.ca