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



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

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

Is ADHD part of your marriage problem?



Research shows that upwards of 75% of adult ADHD is undiagnosed.  That means 3 out of every 4 adult ADHD cases are untreated. This is a shocking number, especially in light of the problems it can cause between you and your family, friends and co-workers.


In a recent episode of the Dr. Oz Show, Dr. Oz brings to his viewers the topic of undiagnosed adult male ADHD and its effect on marriages. Now while I'm NOT a fan of Dr. Oz, due to his reliance on woo science and anti-vaccine mentality, this episode actually addressed an important issue. 
Dr. Oz begins by explaining that ADHD affects not only children, but adults as well. And, that when an adult has ADHD and is in a marriage, it can make his or her partner feel as if they are in a tailspin. One member of the couple finds themselves feeling they are never listened to, ignored, that they constantly have to remind their partner of things, to do things, to remember things, to get organized. The simplest task is difficult. Often we hear that they got married and now find their is no partner, "just another child" that requires their constant attention. Over time this can wear a marriage, or any relationship, down.
In the show,Dr. Oz has a special guest, Dr. Edward Hallowell, MD who as an adult was diagnosed with ADHD. I often recommend Dr. Hallowell's books to patients. Dr. Hallowell and his wife Sue, who is a couple’s therapist - describe how before the diagnosis the two of them had different views of what their relationship was like and how much strain it placed on their marriage. According to their story, which Dr. Hallowell describes here, and in many of his books,  there were many daily tasks, such as parenting their children, that his wife felt she alone did...without support.  “There were moments I was pretty frustrated and I wondered how I was going to get through another day,” she admitted.  Dr. Hallowell says, “ADHD undiagnosed ruins marriages ....but when ADHD is diagnosed, (an treated) you see marriages saved - brought back from the brink of destruction.”
Since his diagnosis of ADHD, Dr. Hallowell has dedicated his career toward the problem of adult ADHD and how it affects marriages. “I discovered that the struggle [of ADHD] can be turned into a victory and I wanted other people to know that this need not be a marriage breaker, a career breaker,” he says. “That in fact, if you get the right help, you can turn it around totally and become a winner - victorious not only at work, but in your marriage as well.”
Dr. Hallowell is the author of a more recent book on this topic, “Married to Distraction.” It deals with the problems couples face when one of them has ADHD.
During the show audience members described the situations they find themselves in as couples. Dr. Hallowell says, “If there’s one message I can get out to folks listening is that it’s not that he doesn’t love you, it’s the way his brain is wired.” Education is the first step in treatment. Fully understanding ADHD and its symptoms leads to understanding interventions, knowing what to do, and just as importantly, why you are doing it.  During this episode Dr. Oz showed images from an article published in the New England Journal of Medicine that illustrates neural differences between someone with ADHD and someone without ADHD. Images comparing a normal brain with an ADHD-affected brain illustrated a normal brain lit up like a neon sign with activity, whereas the ADHD brain is significantly lacking in neuronal activity—indicating that the two brains are processing information differently. To help others determine whether their spouse may have undiagnosed ADHD, Dr. Oz offers four warning signs to watch out for. Honestly, one of the real problems we still face when it comes to ADHD is that many people do not believe it's a real disorder. They still think it's a set of behaviours made by choice. In spite of the decades of research, the brain studies and genetic work that has shown how ADHD is a genetic disorder, inherited, for the most part, and unavoidable.
I always warn against simple check lists and self diagnosis, and want to stress the danger of self diagnosis again! Remember, MANY things can look like ADHD, and you need a full assessment to tell.  Dr. Oz did make these suggestions (warning signs) when looking for symptoms of ADHD:
Warning sign #1: Your partner is easily distracted. Is he trying to do several things at once, but cannot stay focused on one single task?
Warning sign #2: Your partner is disorganized. Are clothes left lying about on the floor all the time? Does he have trouble locating his car keys?
Warning sign #3: Your partner has poor time management. Is he never on time for an appointment? Is he a procrastinator who tries to cram everything in the last 5 minutes?
Warning sign #4: Your partner is unreliable. Do you ask him to pick up eggs at the store and he comes back with pretzels? Does he forget to meet you at a school PTA meeting?
Just because someone has these symptoms doesn't mean they have ADHD. IT can mean many other disorders, ranging from anxiety to depression to mild strokes! If you experience these behaviours (warning signs) in your relationship, see a professional. If nothing else, you might benefit from some "light" couples counselling and coaching for organization and planning. Right?
When is it ADHD? When asking Dr. Hallowell how someone can differentiate whether a partner has ADHD or not, Dr. Hallowell said, “It’s a matter of intensity and duration of these symptoms, which last over a lifetime,” and he offers two things you can do to help your partner focus—whether he has ADHD or not:
Tip #1: Try to communicate differently, not harder. Do this by offering to help with suggestions rather than by hounding and pounding your message to your partner.
Tip #2: Set up structure. Give him a list, but with no more than three items on it at a time. And, be sure to place the list where he can see it.
Of course the topic of ADHD medications came up. Dr. Hallowell pointed out that, "If diagnosed with ADHD, your partner may or may not have to take medications for it. Medications for treating ADHD do not always work. but they are highly effective in helping with focus and concentration when they do work. “Don’t be afraid of meds,” he says. “When they are used properly they are among the safest medications we’ve got. They’re very effective.” Dr. Hallowell says that his three children have been diagnosed with ADHD, take medication for it, and are all doing very well.
If these warning signs are present in your relationship, or at work or school, try to see a professional as soon as possible. Individuals diagnosed with ADHD often respond well to both medication and behavioural treatments. Make sure the professional you see (a medical doctor of psychologist) is well versed in ADHD, and has treated children, adolescents as well as adults. Someone with experience with rehabilitation in school and workplace settings is probably the best direction to go in.
........................................

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

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

Services provided in my offices include: (covered by most extended health care insurance)
Anxiety and Stress (click here: http://www.relatedminds.com/anxiety-stress/)
Autism and Asperger's Disorder (Click here: http://www.relatedminds.com/autism/)
Individual Counselling (click here: http://www.relatedminds.com/individual-therapy/)
Child Counselling / Therapy (click here: http://www.relatedminds.com/child-therapy/)
Testing and Assessments and Learning Disabilities (Click here: http://www.relatedminds.com/testing/)
Couples Counselling / Therapy (click here: http://www.relatedminds.com/couples-therapy/)
Anger Management (Click here:http://www.relatedminds.com/anger-management/)
Pain Management and PTSD (Click here:http://www.relatedminds.com/pain )
Forensic Services (Independent Medical Examinations or IME)

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

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


What is ADHD and How is it Treated?


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Untreated ADHD

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

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

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


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

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

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

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

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

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

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

Accommodation for Students with ADHD | ADD | Attention Deficit Hyperactivity Disorder

(For more complete information on assessment and treatment please go to my web page at www.adhdhelp.ca)

Often parents wonder if their school is actually providing ADHD or ADD accommodations that make sense. Or they ask what accommodations they should consider. Recently there was an extensive newspaper article about research that showed British Columbia, including Vancouver, Burnaby, Coquitlam, Maple ridge, New Westminster and other local school districts were some of the worse when it came to providing support services for students with ADHD. While there are always trainings and supports for students with autism, ASD, Asperger's, physical and other cognitive deficits, there are very few trainings, consultations or other supports for either the students with ADHD of for their teachers. Check out your school district's list of training programs on a teacher professional development day. You are very unlikely to find any programs relating to ADHD. (I do many speaking engagements and trainings for autism, Aspeger's and social cognitive deficits in the Burnaby/Vancouver area, but only one time was I asked for training or consultative support for a student with ADHD.) This seems odd, as these are the students teachers feel are the most difficult for them to support. Speak to your school's principal and parent association about providing this kind of support.

Here are some common ADHD accommodations. You might want to just print this list off and use it as a check list for your child's school:


(Environmental Accommodations for ADHD | ADD)
PHYSICAL ARRANGEMENT OF ROOM:
__A. seating student near the teacher
__B. seating student near a positive role model
__C. having the teacher standing near the student when giving directions or presenting lessons
__D. avoiding distracting stimuli (air conditioner, high traffic area, etc.)
__E. increasing the distance between the desks
__F. providing an alternative (but positive) work space for the student to move to to complete tasks


LESSON PRESENTATION:
__A. pairing students to check work
__B. writing key points on the board (always in the same place!)
__C. providing peer tutoring
__D. providing visual aids (schedules, what to do next and what to do first visual lists)
__E. providing peer notetaker who share his or her notes
__F. making sure directions are understood by asking the student to repeat what has been said
__G. including a variety of activities during each lesson, including some that are hands on and physical
__H. breaking longer presentations into shorter segments with clear starts and finishes
__I. using computer assisted instruction
__J. providing written outline before the class
__K. allowing student to digitally record lessons
__L. having student review key points orally with a model if necessary
__M. using a system that clearly asks pivotal questions such as: "What do we need to do first"


ASSIGNMENTS and WORKSHEETS
__A. giving extra time to complete tasks
__B. simplifying complex directions, breaking them into components 
__C. handing worksheets out one at a time
__D. reducing the reading level of the assignments
__E. requiring fewer correct responses to achieve grade
__F. allowing student to tape record assignments/homework
__G. providing a structured routine in writing form
__H. providing study skills training/learning strategies
__I. giving frequent short quizzes and avoiding long tests
__J. shortening assignments; breaking work Into smaller segments
__K. allowing typewritten or computer printed assignments
__L. rewarding time on-task rather than task completion
__M. using self-monitoring devices such as visual checklists
__N. reducing or removing the need for homework
__O. not grading handwriting

TEST TAKING
__A. a1lowing open book exams
__B. giving exams orally (ie reading test items to student)
__C. giving take-home tests
__D using more objective items (fewer essay responses)
__E. allowing student to give test answers on tape recorder
__F. giving frequent short quizzes, not long exams

ORGANIZATION
__A. providing peer assistance with organizational skills
__B. assigning volunteer homework buddy
__C. allowing student to have an extra set of books at home (critical!)
__D. sending daily/weekly progress reports home (with an emphasis on positives!)
__E. developing a reward system for in-school work and homework completion
__F. providing student with a homework assignment notebook
__G. additional accommodations:


BEHAVIORS
__A. praising specific behaviors
__B. using self-monitoring strategies (visual if possible)
__C. giving extra privileges and rewards
__D. keeping classroom rules simple and clear
__E. making "prudent use" of negative consequences
__F. allowing for short breaks between assignments
__G. cuing student to stay on task (nonverbal signal)
__H. marking student's correct answers, not his/her mistakes.
__I. implementing a classroom behavior management system ( a token system)
__J. allowing student time out of seat to run errands, etc.
__K. Ignoring inappropriate behaviors not drastically outside classroom limits
__L. using an individualized token system
__M. allowing legitimate movement
__N. contracting with the student
__O. increasing the immediacy of rewards
__P. implementing time-out procedures

 


SPECT Scans – A New Phrenology? The Pro's and Con's of the Amen Clinic

OMG! Another report came in today from The Amen Clinic. The parent shared it with me, and then told me how neuro-therapy and cranial something or other were suggested, along with a long list of suppliments, oils, and other "natural" medications (whatever that meant). I have learned from experience that this is a topic that is difficult to explain, and that there is really little hope of getting a parent to look at the assumptions they are making and give modern, scientific based interventions and mainstream medication another chance. But I'm going to at least give it one more try. First: READ THIS ARTICLE! Read it with a pen, marker, underliner...whatever you need to really understand it!

SPECT Scans at the Amen Clinic – A New Phrenology?

And then this:

http://www.quackwatch.com/06ResearchProjects/amen.html


This article points out, "Phrenology was a 19th century pseudoscience that claimed to associate brain areas with specific personality traits. It was based on palpating bumps on the skull and was totally bogus. New brain imaging procedures are giving us real insights into brain function in health and disease. They are still blunt instruments, and it is easy and tempting to over-interpret what we are seeing. In his book The New Phrenology William Uttal warns that “the excitement of these new research tools can lead to a neuroreductionist wild goose chase” and that we must be careful not to succumb to new versions of the old phrenology."

The Amen Clinics offer SPECT (single photon emission computed tomography) scans to help diagnose and manage conditions such as attention deficit disorders (ADD), mood disorders, anxiety and panic disorders, autistic spectrum disorders, obsessive compulsive disorder (OCD), substance abuse, toxic exposure, brain trauma, memory problems, temper problems, and relationship and marital struggles. The scans generate colored pictures of the brain that show “areas of your brain that work well, areas that work too hard (not sure how that is determined, I don't even know what it means!) and areas that do not work enough.” And then the goal of this treatment he proposes, often involving medications, suppliments, diet and so on, is to balance the brain..or balance the brain's function. Again, no real research to tell you exactly what that means.

The charge is $3250 up front, and most insurance companies will not provide reimbursement because they consider it experimental. There is a 10% discount for testing additional family members...yes there is a family plan for PET Scans at the clinic! And as the writer of the article points out: "The Amen Clinic’s informed consent form is misleading: it does not divulge that the American Psychiatric Association has spoken out against SPECT scanning for these purposes and has warned of potential harm – especially to children, who are more susceptible to the effects of radiation." Yep, the APA says they don't work for the purposes they are being used, AND that they are dangerous, especially for children. You'd think that would be in the informed consent, wouldn't you? But desperate parents and individuals will try anything.
As the writers tell us, "There is no excuse for misrepresenting an unproven treatment as a treatment that has been proven effective. And there is no excuse for concealing essential information from patients, or for creating false hopes by implying a promise of more than they can really deliver."

Testimonials. The Amen Clinic site is full of them, and as you know I feel they are the worse information you can provide, the are misleading, misleading and very misleading. The article also talks a great deal about the treatment provided. I urge you to read it, take it to your medical doctor and get some professional advice before making any investment of this kind of money. See your doctor, and make an informed choice....informed by a professional who understands the complexity of these issues.

Here is my suggestion. Go ahead, read the Amen Clinic brochure. Then read this article (the link is found above), and if you want, go to the Quackwatch website and read BOTH the articles that support the procedure and clinic and those that don't, then take a few more minutes to read this article about ADHD diagnosis in the New York Times. It's an interesting controversy I've recently written about. Here the link: http://www.nytimes.com/2011/05/14/health/14consumer.html

When you are done, and it should take you less than 30 minutes total, you will know more about ADHD than most of your friends, relatives and maybe even some of the professionals you've seen. Take these articles to your medical doctor or psychologist and have a frank, informed and complete discussion about ADHD and how you should approach it. Know is good, science is great ....but NEVER rely on testimonials. My final word. Good luck! Like Dr. Amen says, there are ways to make your brain better functioning ....give it better information!


.................................
As always, I remind you that this blog is not meant to be a diagnostic tool, these disorders are complex. Don't take on line tests and diagnose yourself. Contact your medical doctor, see what he or she can do for you. If need be, contact a Registered Psychologist, one with experience with ADHD, and get a real diagnosis and help in making treatment choices.


For information on treatment services I provide for children, click here: http://web.me.com/jimroche/relatedminds/child_therapy.html

For information on diagnostic and treatment services for children with ADHD, click here:http://web.me.com/jimroche/relatedminds/adhd.html

For information on diagnostic and treatment services for adults, click here: http://web.me.com/jimroche/relatedminds/adult_adhd.html

You can also just check out my regular web page at www.adhdhelp.ca or www.relatedminds.com

Self-help readings on ADHD, Try these:
Dr. Barkley's "Taking Charge of your ADHD"
Kathleen Nadeau's Understanding Girls with AD/HD
Mary Solantos' Cognitive Behaviour Therapy for Adult ADHD

These are a great place to start!

How Much Should an ADHD Diagnosis cost? Some disagree in the New York Times

New York Times Article on Adult ADHD: click here.

Response letter from Neuropsychologists: click here.

There's a fight going on in the ADHD/ADD world and it's become rather public. There are two schools of thought about ADHD diagnosis. One is that a diagnosis of ADHD should be made through a series of simple questions and a structured interview. Of course, this is pretty cheap. Dr. Russell Barkley supports this method of ADHD diagnosis.The other is that psychological testing, often neuropsychological testing, is appropriate when doing a diagnosis of ADHD (Attention Deficit Hyperactivity Disorder). One of the issues at hand was that some statements were made in the Times article about how much an exam should cost, and Dr. Barkley pretty much low balled it (around $500 or less!).

The NYT article follows Liz Goldberg, age 53, through the process of deing diagnosed with ADHD. It addresses many of the problems and difficulties with the diagnostic process for adults and adolescents. First, adults rarely exhibit the most noticeable symptom, hyperactivity. They often, instead, display symptoms of being distracted and disorganized. Often adults with ADHD also are procrastinators and avoiders of tasks that don't seem to be of interest to them. 5% of the adult population has ADHD. While you may have read about the over use of medications and the over diagnosis of this disorder in some news articles or on the web, the scientific estimate is that of the 5% of adults who have ADHD or ADD only 10% have a formal diagnosis. 10%!

Adults with ADHD, especially women, are often misdiagnosed with depression, anxiety and bipolar disorder. Sometimes their symptoms are just dismissed and ignored as a problem of "women," leaving them untreated and at the mercy of some serious symptoms.

THe article stresses that for most it might be best to avoid a lengthy neuropsychological assessment, often unnecessary and almost always expensive. Usually that means completing a series of questionnaires or self-reports, and having someone who knows you also fill out reports. From these we are often able to make a preliminary diagnosis. MRI scans, brain scans, neuro-brain-mapping are really all unnecessary for a preliminary diagnosis. This should include a Mental Status Examination, and at a minimum a structured diagnostic interview that helps rule out other possible causes for your symptoms. This should take 3-4 hours. And a little longer if you need a report written. While the Times says this can cost from $200-500 it really requires a minimum 3-4 hours, and at the going rate for psychologists in British Columbia this would put the cost in the range from $480-640 or so. That's for an examination that consists of no more than the gathering of information and a structured interview.

What Dr. Barkley and Tuckerman suggest in their article is that most importantly you find an experience clinician to do the ADHD diagnosis.

Now Dr. Barkley also says to, "avoid an expensive neuropsychological evaluation." He, and Dr. Tuckerman, think this is overkill. I think their explaination is a little too simple. After a diagnosis a good neuropsychological examination can help point out specific learning disabilities, tell you what your neurological strengths and weaknesses are, and be used as a grounding point in developing a comprehensive intervention plan. Sometimes it is useful, sometimes, when other disorders are suspect it is necessary, and yes, Dr. Barkley is right, sometimes it's more than you need. You and your psychologist should be able to make that decision together after discussing the severity and nature of your specific symptoms. At any rate, the NYT's article lists the cost of a neuropsychological exam at somewhere between $2,000 and 5,000. You need to decide if this is a necessary expense. Remember, as Dr. Barkley says, neuropsychological tests are "inaccurate when it comes to ADHD." That may be true, some would argue with that, but it Is misleading. Most of the time the neuropsychological exam is not being given to diagnose ADHD at all. It is being given to rule out other possible neurological causes of symptoms, and to develop an understanding of the clients strengths and weaknesses. So don't be afraid to ask your doctor "Why am I going to take this exam?" "What, exactly, might we learn from it?" There are many good reasons to take a neuropsychological exam. For children, adolescents or young adults having educational and learning problems we need to look at a number of factors in order to rule out, or diagnose, a specific learning disability. For individuals with impulsivity and anger issues, or problems with emotional regulation, we need to look at possible mood disorders vs ADHD. There are many good reasons, just don't be afraid to ask why.

Read the original article about Attention Deficit Hyperactivity Disorder in the Times, and read the reply by the neuropsychologists.

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

As always, I remind you that this blog is not meant to be a diagnostic tool, these disorders are complex. Don't take on line tests and diagnose yourself. Contact your medical doctor, see what he or she can do for you. If need be, contact a Registered Psychologist, one with experience with ADHD, and get a real diagnosis and help in making treatment choices.


For information on treatment services I provide for children, click here: http://web.me.com/jimroche/relatedminds/child_therapy.html

For information on diagnostic and treatment services for children with ADHD, click here:http://web.me.com/jimroche/relatedminds/adhd.html

For information on diagnostic and treatment services for adults, click here: http://web.me.com/jimroche/relatedminds/adult_adhd.html

You can also just check out my regular web page at www.adhdhelp.ca or www.relatedminds.com

Self-help readings on ADHD, Try these:
Dr. Barkley's "Taking Charge of your ADHD"
Kathleen Nadeau's Understanding Girls with AD/HD
Mary Solantos' Cognitive Behaviour Therapy for Adult ADHD

These are a great place to start!

Genetic mutation may be key to ADHD (Attention Deficit Hyperactivity Disorder)

While it seems popular these days to blame ADHD on food additives, parenting and "toxins" the evidence against these causes has mounted year after year. Little if any evidence for them can be found in respected scientific journals or research. Most research has pointed to ADHD (Attention Deficit Hyperactivity Disorder) being a genetic disorder, something inherited. New research further supports this, pointing to a single-letter change in the DNA code which "may spell ADHD."

ADHD -- attention deficit hyperactivity disorder (sometimes called ADD) can be found in 5% of school-aged children to learn. Kids with ADHD may be impulsive, can't sit still, they can't focus their attention and have trouble learning and remembering. (Different combinations of these symptoms leads to "inattentive type," "hyperactive type," and "combined type." Korean researchers report that children with ADHD tend to have a particular DNA misspelling -- a single-nucleotide polymorphism or SNP -- that affects an important brain function gene called GIT1. This has long been suspected, and this research backs up the theory.

Mice genetically engineered to carry this SNP "misspelling" are hyperactive and have poor learning and memory skills. But when given stimulant ADHD drugs, these mice exhibit normal behaviour. "Our study reveals a previously unidentified role of GIT1 in ADHD and establishes a new mouse model for ADHD," conclude Hyejung Won of the Korea Advanced Institute of Science and Technology and colleagues in the journal Nature Medicine.

More recently Won and his colleagues compared the genomes of 192 Korean children with ADHD to 196 age-matched children without ADHD. It was very rare for any child to inherit copies of gene mutation from both parents. Having just one copy of the mutation meant a 2.66-fold higher risk of ADHD.

Mice needed two copies of the mutant SNP to get ADHD, not just the single copy linked to ADHD in children. But these mice had nearly all the symptoms of human ADHD -- and just like children, their symptoms improved when they got stimulant ADHD drugs.

Just like some children with ADHD, mice with the ADHD genetic mutation tended to get over their ADHD when they grew up. At a mouse age of 7 months, equivalent to human age of 20 to 30 years, ADHD symptoms spontaneously went away. (Well, we think, the "hyperactivity went away, but we don't know if these mice had difficulty with concentration, planning, procrastination and so on found in adult human!) It seems that brain cells maintain a careful balance between being in a state of excitation and one of inhibition. By affecting the function of the GIT1 gene, the ADHD-linked mutation makes brain cells more excitable. This is just the function we see addressed by ADHD medications.

What did we learn? Well, that there isn't any "bad parenting" or "bad teaching" to blame for the cause of ADHD. But there is something, several things, we can do. These interventions range from medication to cognitive behaviour therapy to environmental changes to make dealing with ADHD symptoms easier. For more information on this topic I suggest checking out Dr. Russell Barkley's books, Controlling Your ADHD and Controlling Your Adult ADHD. both provide excellent sources of information to understand the cause of ADHD and interventions that are science based. Avoid interventions that promise too much, avoid those that promise a lot too easy. Stick with interventions supported by real science.
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This blog is not meant to provide therapy, interventions or diagnostic services. As always, I suggest avoiding looking for answers on-line, and especially avoiding on-line diagnostic "tests" or simple check lists of ADHD symptoms. ADHD needs to be diagnosed by a professional, and as always, that diagnosis includes ruling out other possible causes for your symptoms.

For more information, assessment and treatment please feel free to contact me at:

Dr. Jim Roche
778.998-7975
http://www.relatedminds.com
http://www.adhdhelp.ca

Is ADHD ever a "gift?" While some ADHD "specialists" and anti-medical treatment folk like to say that, most experts disagree.

Today there was an excellent article in the New york Times in which Dr. Russell Barkley, one of the leading researches and consultant/practitioners in ADHD (Attention Deficit Hyperactivity Disorder) answered questions from readers. The perennial question about ADHD (sometimes called ADD) came up: "Is there a time ADHD is considered beneficial or a gift?"

Well the answer is no for many reasons, however, we are often taken down a path that is misleading at best and destructive and harmful at worse by those who like to say "ADHD is a gift." This is reflective of a group of individuals who somehow think "diagnosis" in and of itself is harmful - that having your child or yourself diagnosed with ADHD will cause more harm than ADHD causes (got that?) and that first and foremost we need to avoid "labeling." This thinking leads parents to avoiding a diagnosis, it leads to children failing year after year in school because no one diagnoses or treats this very treatable disorder because they know their child's problems and failures are really "an issue of people not appreciating his/her gifts or special personality," and the avoidance of simple and effective cognitive behaviour therapy, psycho-education (which is simply impossible if we can't say "ADHD")and the avoidance of medications that has been show in study after study to be effective.

Often you will hear, "I don't want to step on his or her creativity" or "I don't want to change his personality." But it's not creativity or personality that is making this child struggle at school. It's a dysfunction of the executive parts of the brain, an inability of the child (or adult) to in reality make choices rather than being pushed into them.

Here is the real danger of this "gift" belief. Often, after years of struggle and frustration, an individual with ADHD sees a medical doctor and considers treatment. But at the last minute they say, no. The reason- the symptoms that are problematic are considered a "gift" or "special ability" by him or her, and he's been told that for years. Taking medication, or getting behavioural treatment, is going to make the "specialness" go away.

This is confused thinking.

People with ADHD report that they can really be "in the zone" at certain points, when they are able to think fast, clear and creatively. But this often varies from day to day, and varies from task to task. If it didn't, they never would have been concerned about ADHD/ADD in the first place. When doing something of interest, something they enjoy or is reinforcing, they are able to remain focused, concentrate and get down to work. It is when situations becoming demanding, are anxiety producing or are not preferred that problems quickly become apparent. Dr. Barkley makes a distinction between accepting your ADHD and pretending it's some sort of gift that makes you different in a positive way. As he says, "There is NO EVIDENCE that ADHD is a gift or conveys any advantages beyond what other people in the general population might have. People are individuals, like anyone else, and may have been blessed with particular talents that are superior to levels seen in most people." But these talents and abilities have nothing at all to do with ADHD. "they would have had them anyway." There is no research that certain jobs or careers are better for those with ADHD/ADD. There are careers that may be more ADHD "friendly." But that means that those jobs or careers don't have overwhelming requirements that fly in the face of ADHD.

One of the things we try to do in any good assessment is make you aware of your individual strengths and weaknesses, this includes your individual neurological strengths and weaknesses. Knowing those will help you understand what situations might be good for you, and what situations might pose a problem, as well as help you understand what strengths you have which you can use to bolster any deficits ADHD may have produced. Honestly, this is no different than what everyone does in life. What am I good at? What am I not good at? What do I want to do? And how can I fit all this together. The first step though is understand and accepting that you have ADHD.

Here's what Dr. Barkley says (click here for the entire article in the New York Times):

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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).

I also recommend against programs that seem just to easy. Vancouver has many "ADHD cure" programs, quick fixes involving everything from neurofeedback to diet. There is very little evidence for most of these programs. I suggest you look up any of these ideas on the "Quack watch"website or simply by adding the word "skeptic" to any google or other web search you do.

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

Fast food diet causes ADHD? No not really.

Western diet link to ADHD, Australian study finds

While newspapers around the world are saying this Australian study shows fast food diets, and diets with high fat content cause ADHD, the study doesn't say that. Actually the study says there is no proven link at all. Maybe kids with ADHD eat more junk food. Maybe their family's have work schedules that lead to more eating out. Maybe lots of things. Now eating fast food isn't a good idea. I try to avoid it if possible. I wouldn't feed my kids fast food very often if I had a choice. And I recommend healthier foods. But this study clearly says it doesn't really show any causal link between fast foods and ADHD (Attention Deficit Hyperactivity Disorder). So what is wrong with our media science reporters? They read blogs instead of the research. Like many people these reporters read blogs that have been written by individuals who already have an idea in their heads about how the world works and what causes what. And they twist information, use statistics to lie and confuse whenever possible, because their aim is to convince the public that they are right.

Avoid McDonald's if you can. But if your child has ADHD, McDonald's isn't the cause.

What's really awful, and you need to be aware of, is that even the authors of research can have some issue they are pushing that is beyond the limits of what the science says. That's the case here too.

The authors says: "We suggest that a Western dietary pattern may indicate the adolescent has a less optimal fatty acid profile, whereas a diet higher in omega-3 fatty acids is thought to hold benefits for mental health and optimal brain function. "It also may be that the Western dietary pattern doesn't provide enough essential micronutrients that are needed for brain function, particularly attention and concentration, or that a Western diet might contain more colours, flavours and additives that have been linked to an increase in ADHD symptoms. It may also be that impulsivity, which is a characteristic of ADHD, leads to poor dietary choices such as quick snacks when hungry." (By the way, there are some basic logical fallacies here, can you pick them out?)

IT MAY BE. Did you read that? This is the author talking to the press. IT MAY BE. That's what he says. I'll translate that, " I think this, but there is NO PROOF WHAT-SO-EVER." Research shows clearly that food additive have little to do with ADHD, except for a few kids who have a specific allergy to them. And that has nothing to do with ADHD. Food colouring? No evidence after years of trials and studies ....except a few kids who might have an allergy. Look elsewhere. Omega-3? He says "Is thought to have benefits..." Actually, with ADHD, it's clear there are NO benefits except a placebo effect. And the relationship between these diets, yes, crappy diets that will make your kid fat, and ADHD? "Dr Oddy said that whilst this study suggests that diet may be implicated in ADHD, more research is needed to determine the nature of the relationship." MAY BE IMPLICATED. Translation: "There is no evidence of a relationship. I just wish there was."

He finally admits: "This is a cross-sectional study so we cannot be sure whether a poor diet leads to ADHD or whether ADHD leads to poor dietary choices and cravings," ( Dr Oddy).

But please understand, the good doctor has given us a false choice, a false dichotomy. "If it isn't this, it must be that." That's not true, and not being fooled by such false choices is one of the basic things you learn in science. Teach that to your kids, because people use false choices like this all the time to take advantage of others. The truth is these two "facts" may have no relationship to each other, and most likely, the situation is that they are both related to something else, a third factor (like income, housing, genetics). Thats why there is a statistical correlation, and most scientists would know that. But that would be boring, and wouldn't get your research paper covered by the national media.

What do bloggers make of this? Here is one blog:

Fast-food teen diets tied to ADHD By William Atkins
Sunday, 01 August 2010 00:14
An Australian study has shown that teenagers have over double the risk of getting attention-deficit hyperactivity disorder (ADHD) when they eat unhealthy diets of highly processed and fast foods than when they eat healthy diets of fruits and vegetables.

Who said that? Where did that come from? It's nonsense, it has nothing to do with what the study says. Nothing.

A source in Indiana writes: "Pay Attention! Processed Foods May Lead To ADHD, Study Shows." No it doesn't. Why say that? But what a clever title, Pay attention - ADHD, get it. Makes you want to read it. If only as much effort was put into understanding what they were reporting on. Oh, the rest of the "healthy living page" this appears on is covered with ads for health food and organic this and that. Do you think the editors of that web page (Indiana Public Media no less) are aware that they are lying to the public about the research paper? Why would they do such a thing? (And people worry about big pharma.) It's an awful situation.

Bad science, and bad science reporting, leads to parents wasting their time, wasting their energy and wasting their money on fixes and cures that have been supported by weak and silly evidence like this. This irresponsible reporting is they type of "news" that leads people into avoiding real treatment that work for fake treatments that don't work. You know this article will now appear all over the web as proof that doctors want to poison your child with medications (scientifically proven interventions) in order to make money and are hiding the fact that it's really caused by diet and processed foods. (Not that their web pages, usually covered with health / organic this and that ads are trying to make a profit).

I'll agree with one thing: Fast food is a bad thing for kids...and adults. But so is bad science.

I'm much more concerned with the effects of bad science on the brains of our children than a medium fries at McDonald.

Information about my intervention programs for children and adults with ADHD (Attention Deficit Hyperactivity Disorder) can be found at my web site www.relatedminds.com There is also specific information there about adult ADHD assessments and treatment. For that information click here. More general information on my practice can be found by clicking here or here. (Yep, it's basically an ad, but at least I'll admit it. I'm selling science!)

Dr. Jim Roche, Registered Psychologist
778.998-7975
drjimroche@gmail.com

ADHD - Medication or not?

I just did a web search for information on treatments for ADHD. I do this every few weeks to check what parents and adults are finding. I was again shocked. Nonsense on food colouring causing ADHD so switching to a new diet will help, sugar causing ADHD. This one is so tiring. Again and again real scientific studies show there is virtually no relationship between any form of sugar and ADHD symptoms. And finally, rant after rant about the evils of medication. This little video with Dr. Russell Barkley addresses that issue and in the next few weeks I am going to try to provide more information in video format as I find it.

ADHD is a life long disorder, and if it is severe enough, and especially if there IS NOT hyperactivity but instead just inattentive behaviour, you need to speak with your medical doctor about medication. As a psychologist one thing I can do is fully assess you for ADHD. And I can give you specific neuropsychological tests that will help us determine what behavioural treatments and skills will help. And finally, if you and your doctor want, we can do repeatable test batteries that measure cognitive changes that happen, or don't happen, as the result of medication. This helps us understand how you are being affected by the medication. For more information on this and other interventions I provide for ADHD / Attention Deficit Hyperactivity Disorder, including an eight week training program for adults, contact me through my web page at www.relatedminds.com

Our offices serve Burnaby, New Westminster, Coquitlam, Maple Ridge, Port Moody and Vancouver.

About Assessments for ADHD, Autism and Learning Disabilities

A lot of people call my office and have been told by a day care provider or teacher that they are sure their child has autism, Asperger's Disorder or ADHD. And often this is based on some list of symptoms that they read on the internet. Parents often then scramble and start looking themselves. Even adults do this, I get a fair number of adults who have wondered about possibly having autism after someone mentioned it to them and they began a web search.

Autism, ADHD, Asperger's disorder are not an easy diagnosis to make. And one of the important things that takes place when assessing a child, adolescent of adult for autism spectrum disorder (ASD) is what we call a "differential diagnosis." The symptoms you may be concerned about may or may not be ASD. They could be another problem such as a language disorder, auditory processing disorder, a learning disability, some form of speech disorder, mental retardation, ADHD (both often confused with ASD), a movement disorder, OCD. The list goes on.

Additionally the disorder may be more than one thing. ASD is often found to be c-omorbid with another disorder such as ADHD. ADHD itself is not an easy disorder to diagnose. The Centre for ADHD/ADD Advocacy, Canada (CADDAC) has set standards for a full differential diagnosis of ADHD and it includes an extensive amount of data collection and takes a considerable amount of time. Another source of information on diagnosis ADHD is from Dr. Russell Barkley. His procedures are very similar to CADDAC and are the procedures I follow in my practice. As I mention below for autism diagnoses, you usually have one chance at an assessment and it should include all of the tests below except the ADOS and ADI-R. You need to know if there is a co-morbit learning disorder, and you need to understand exactly how ADHD is expressing itself in your child. While a neuropsychological examination is not necessary for a diagnosis, it is necessary if you want to know what to do about it. A very simple computer based test a medical doctor could offer you for a child 8 years old or over is the CNS-Vital Signs assessment which tells us about memory, ability to switch sets, executive functioning, processing speed and other critical bits of data we need to develop a treatment plan. Many of my patients are referred by medical doctors because they do not have the time or specific skills to make a firm diagnosis.

Here in British Columbia a full diagnostic autism assessment is usually completed by a provincial agency. This might take place at Children's Hospital or through a provincial health authority provider. You start this process with a referral from your medical provider. The Ministry for Children and Families has information about the assessment process on their web site. Those services should be free to anyone here in British Columbia. However, there is a long waiting list for these services. Private practitioners, including medical doctors and psychologists, who have had specialized training in the two instruments I'll talk about below, can also provide this service, however either you or your extended health care (if your lucky enough to have it) has to cover this cost. It's usually about $1,800 -$2,100. And for children under 6 an assessment needs to be completed by a team of professionals, hard to arrange through a private practitioner and even more expensive.

What does the assessment consist of? First, for most children and adolescents there is an initial interview history taking. Then, usually, a psycho-educational assessment is completed. This includes an intelligence (cognitive) test and an academic performance test. Usually these scores are compared to look for discrepancies that would lead us to finding a specific learning disability. If your child get X score on this part of the intelligence test, we would expect he or she would score Y on this part of the academic test. This testing also helps rule out mental retardation or other cognitive impairments. If you are going the private practitioner route, you might be lucky enough to have the school complete the psycho-educational assessment, cutting back your costs.

Next your child is usually examined for behavioural and personality issues. This might take place through interviews, pencil and paper tests or self reports like the Beck Youth Scales and reports from parents and teachers. The examiner wants to rule out personality disorders, psychosis, depression, anxiety and similar issues that can often be mistaken for ASD.

There might now be some specialized test that the examiner would use to look at an issue he or she is concerned with. And some examiners will do more complete neuropsychological tests to give us information on problems that might relate to executive function, memory and learning, impulse control, motor and visual-motor issues. This is especially important for children with co-morbid ADHD or for whom we find ADHD is the primary concern. This information helps us come up with focused treatment interventions.

Finally, for children we are still concerned about ASD with the provincial government here in British Columbia requires two specific tests: The Autism Diagnostic Observation System (ADOS) and the Autism Diagnostic Interview (ADI-R). There are several other very good and reliable tests that focus on autism, however the ministry will only accept a report containing these two specific tests.

The ADOS is a series of activities and questions the examiner goes through with the child, giving him or her an opportunity to see how the child responds to new stimuli. The ADI-R is a lengthy report completed during an interview with the parents or other caregivers about the child's developmental history focused on symptoms found in ASD.

Some practitioners complete shorter reports using just the ADOS and ADI-R. This might be quicker but leaves us with doubts about other possible reasons for the behaviours of concern (not a real "differential" diagnosis) and provides little information we would be able to use to provide targeted interventions / treatment. And honestly, it's very difficult to obtain a second assessment to obtain this kind of essential information as there is a long waiting list of children and adolescents for initial evaluations.

To find a practitioner who can help you with an assessment I would start with my medical doctor, who may have a doctor of clinical psychology he or she knows and referrals to, or contact the British Columbia Psychological Association for a referral. You must, however, see a licensed or registered psychologist for these types of diagnostic services. Registered Clinical Counsellors (RCC) are not qualified to provide these services and often parents pay for assessments that are then not accepted by school districts or the ministry. School psychologists can only perform these tasks as part of their employment in the school district and are not qualified to do these types of assessments independently. (However, an RCC or school psychologist may ALSO be a licensed or registered psychologist, so ask,) Finally, before paying someone to complete any assessment, ask the agency you plan to use the assessment with (ministry or school) if this provider is qualified to provide such information to them.