Is Ritalin for ADHD Over Prescribed?

Click to watch this video on ADHD and Ritalin : Is Ritalin Over Prescribed?  Generally, professionals in the field see ADHD medications under-prescribed for those who actually need them. ADHD, as a matter of fact, is under-diagnosed, and certainly under-treated. This is hard for many individuals to understand because we are bombarded with media coverage that seems to rage against medical treatment of  ADHD. Many people falsely claim teens become addicted to ADHD drugs, and end up using illegal substances.  The truth is the opposite. Teens with ADHD which is UNTREATED are those that are more likely to become involved in illegal substances. More likely to fail math and other classes. More likely to engage in risky-dangerous behaviour. Those who are medicated properly are far more likely to graduate, go to college, and have generally successful and happier lives.

So why do we read so many anti-medication comments on line? Why are there so many web pages that warn parents of the "dangers' of medication? Well, first of all there is a group of anti-drug, anti-medication individuals who object to all medications and are simply uninterested in listening to the facts. And second, pay close attention to those pages ...they are always selling you something. Usually a "natural" cure or fix that has no science backing it up, nothing except for testimonials - the worse place to get information from.

Take a moment. Watch the video (click above). Read what Dr. Russell Barkley and other have to say based upon research. We have several good, effective and safe treatments available for ADHD. Talk to your medical doctor and psychologist about these.

Are ADHD Medications Safe?

Here is another wonderful, simple and SCIENCE BASED video to help answer you questions about the safety of ADHD/ ADD medications. People always ask, and I think this video helps clarify many issues. Click here:


Are Medications Safe?


The video is part of a series on ADHD you will find informative and understandable. Additionally, concerning the specific question of safety and ADHD medications I suggest you turn to the webpage ADDitude.com where you can read this for further information:



"Are the medications safe?
The stimulants commonly prescribed for ADHD are considered among the safest of all psychiatric medications. "The risks of using these medications are very low," says William W. Dodson, M.D., a Denver-based psychiatrist who specializes in ADHD. "The risks involved in not treating ADHD are very high. These include academic failure, social problems, car accidents, and drug addiction."
As with many prescription drugs, of course, stimulants can interact dangerously with certain other medications. Be sure to alert the doctor about any other medications your child takes."  THERE'S MORE!
You can read the rest of this article by clicking here: http://www.additudemag.com/adhd/article/1592.html
What's most important is that you do not make medical decision based upon the unscientific "experiences" of friends, the prejudices of relative or the "advice" of web experts who tell you not to use medication ..... oh, but purchase my unregulated "natural cures" by pressing a purchase now button.
There is almost 70 years of research on what to do about ADHD, and what medications do ...including their side effects and long term outcomes. ADHD can be addressed with medications safely under the supervision of your physician. You family medical doctor, or other specialist he or she may recommend in the field of ADHD can help you make clear, science and evidence based choices. Go to your licensed mental health professional for advice on these matters, not to friends, relatives or someone selling books or "natural cures" on the web.
This blog is not meant to give you medical advice. Over and over again I stress seeing your family doctor - and writing down your concerns and questions about ADHD before you do that. As a licensed and registered Psychologist I am available to help you with a comprehensive diagnosis of ADHD, provide assessments for co-morbid problems such as learning disorders, anxiety or depression, and to help you develop an intervention plan to address your specific needs. Check out my web page at www.relatedminds.com or www.adhdhelp.ca, and contact me with any questions you might have.
If you are concerned about your child having ADHD, or you having ADHD, start in the most obvious place, with a simple visit to your family doctor for advice.

ADHD Diagnosis Rates in US

The Northwestern University issued the following news release:

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

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

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

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

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

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

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


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


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

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


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

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

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

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

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

Do the results last?

Yes, our research and our clinical experience show that the effects of Cogmed Training last after training. The reason is that once working memory capacity increases, you naturally continue to use it at its new level, which serves as constant maintenance training. Each Cogmed user also has access to optional Cogmed Extension Training at no extra cost.
Summary
There are many ways to treat ADHD. The best advice is to work closely with your medical doctor and psychologist, using techniques and interventions that have been proven to be effective. Regretfully there are a lot of programs and interventions on the internet that claim to work for which there is little evidence, or sometimes evidence they do not work (for instance, there are claims that acupuncture and homeopathic "medicines" work, yet there are no studies, and the rationale for these interventions often make little sense. Rely upon your licensed and registered medical doctor or psychologist for guidance. There are things you can do, intervention and medicines that have been proven to be effective with many years of research to back them up. Don't wait, don't procrastinate (especially for children). See your doctor and understand your choices.
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For information on counselling and therapy services in Burnaby, Vancouver, Coquitlam and surrounding areas contact Dr. Roche at: (Office phone) 778.998.7975
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As usual, let me warn you that this blog, any of my other blogs, or my web pages are not designed to provide you with an assessment, diagnosis or treatment. If you are concerned you have a health issue such as ADHD, anxiety, depression or Asperger's | autism please see your health service provider, either a medical doctor or Registered Psychologist. What may appear to be symptoms of one disorder can often be caused by another unexpected disorder. Other disorders, such as ADHD, are very likely to exist at the same time as another disorder (called co-morbid disorder) such as anxiety, depressing or OCD. You need to see a professional to find this out. On-line symptom checklists will not provide this, and are often misleading.
Services provided in my offices include: (covered by most extended health care insurance)
Anxiety and Stress (click here: http://www.relatedminds.com/anxiety-stress/)
Autism and Asperger's Disorder (Click here: http://www.relatedminds.com/autism/)
Individual Counselling (click here: http://www.relatedminds.com/individual-therapy/)
Child Counselling / Therapy (click here: http://www.relatedminds.com/child-therapy/)
Testing and Assessments and Learning Disabilities (Click here: http://www.relatedminds.com/testing/)
Couples Counselling / Therapy (click here: http://www.relatedminds.com/couples-therapy/)
Anger Management (Click here:http://www.relatedminds.com/anger-management/)
Pain Management and PTSD (Click here:http://www.relatedminds.com/pain )
Forensic Services (Independent Medical Examinations or IME)
About Dr. Roche
My name is Dr. Jim Roche and I am a Registered Psychologist and a Registered Marriage and Family Therapist (RMFT) in British Columbia. In addition to my doctorate in clinical psychology, I hold a master's degree in family therapy, a certificate of advanced graduate studies (CAGS) in school and educational psychology from Norwich University, and have completed two years of post doctoral studies in neuro-psychology at The Fielding Institute in Santa Barbara, California. In addition to being a registered psychologist, I am a certified school psychologist, certified teacher of special education (New York and California), and a Clinical Member of the American Association of Marriage and Family Therapists (AAMFT). I also hold a doctoral degree in law with an emphasis in medical malpractice and education law. Beyond my academic credentials, I have completed two years of supervised clinical experience in both hospital and community based clinics and two years of post doctoral training in neuropsychology. I have served as director of behaviour programming for several school districts, as a consultant on autism for the province, and have held numerous academic positions including Clinical Instructor in Psychiatry at New York University and Bellevue Hospital in New York as well as being a faculty member at NYU, Brooklyn College, SUNY New Paltz, and Norwich University.
Key words
ADHD | Anxiety and Stress | Autism and Asperger's Disorder | Individual Counselling | Child Therapy | Testing and Assessments and Learning Disabilities | Couples Counselling | Depression | The Angry Child | Anger Management | Pain Management and PTSD | Forensic Services | Attention Deficit Hyperactivity Disorder | Vancouver | Burnaby | Coquitlam | New Westminster | Maple Ridge | Port Moody | Child Psychologist | Psychologist | Learning Disability | Assessment | Testing | Psycho-educational Assessment | Neuropsychological Assessment

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

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


Let's go over what it says: 


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


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


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


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


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

 

 


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

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

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

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

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

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

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

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

About

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

 

Key words

ADHD | Anxiety and Stress | Autism and Asperger's Disorder | Individual Counselling | Child Therapy | Testing and Assessments and Learning Disabilities | Couples Counselling | Depression | The Angry Child | Anger Management | Pain Management and PTSD | Forensic Services

 

http://www.relatedminds.com

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

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

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

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

Phone: 778.998-7975

Drinking and ADHD Medications? UNRELATED.

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




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

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

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

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

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

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

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

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

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

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

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

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

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

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

Dr. Jim Roche




Medical News: No Higher Cardio Risk With ADHD Drugs - in Pediatrics, ADHD/ADD from MedPage Today

Medical News: No Higher Cardio Risk With ADHD Drugs - in Pediatrics, ADHD/ADD from MedPage Today

Too often I read articles and blogs that tell people ADHD (Attention Deficit Hyperactivity Disorder) medications are dangerous, that there are "black box" warnings and they will have negative effects on your child's health. I've supplied many references ere to medication, ADHD treatment and "science based medicine" that I hope have been helpful. Here is a recent reference about a concern that I hear from many parents: "Can't these medications cause heart attacks?"

This question is often asked because individuals have read many blogs - which more often than not are really ads for health related products - that make these claims. They never give the rationale for these, often simply quote a parent of someone who has a credential - but never do i see any science behind these claims. Along with these articles are many "alternative" produces, oils, herbs, homeopathic medications. Some which are actually dangerous, some which interfere with other medications and some which scientifically and logically simply can't work (homeopathic "medications" are little more than sugar pills with a drop of water. (For more information on homeopathy and alternative medicine I again suggest going to the website "science-based medicine" or "quackwatch.com).

If your fear is that you have heard that ADHD medications cause heart attacks, here (above) is an article that addresses the research. I suggest you print it out, read it, and take it with you to discuss with your family medical doctor: the best source of reliable information about medicine. You hear and read a lot about "big pharma," how these big companies are spreading medications that we don't need or are dangerous. I trust my doctor to help me understand these medications, and I rely upon the research myself. It is silly to pretend that these multi-billion dollar companies producing "alternative-natural-healthy" alternative to medication like suppliments, fish oils, herbs and anti-toxin devices are telling you the truth, are doing science to prove if their medications work, or are somehow not first and foremost interested in making a profit by selling you a produce, any produce, for as much as possible.

ADHD (Attention Deficit Hyperactivity Disorder) is best addressed with medical interventions combined with behavioural and cognitive behavioural therapy. Don't be mislead by those who seem to question the value of the scientific method, especially when it comes to proving or disproving the efficacy of their own products.

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As usual, this blog is not meant to provide medical advice. I am not a doctor. It provides information you may find useful, but should only be taken as one source of information in making decisions. Any decision about treatment should be made in conjunction with your family medical doctor. Medical doctors and Registered Psychologists are qualified to diagnose ADHD / ADD here in British Columbia. Making an appointment with one of these professionals is the best place to start.

For more information on the services I provide please feel free to contact me at:

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

School Accommodations and Solutions that Provide Help for Parents of ADHD Children

A parent came back to see me today after taking her son's neuropsychological report to his school and, after amazingly waiting six weeks, had an IEP meeting. For those who are new to this an IEP meeting stands for an Individual Education Plan meeting. After a child is determined to have a disability the school should be setting up a meeting and reviewing the test results. From those results, and feedback from the child's teacher, a plan is written up to set up accommodations that will help the child succeed. So, for a child with ADHD (Attention Deficit Hyperactivity Disorder) we should be looking at what environmental changes need to take place, what support and special teaching or training the child should have. Regretfully once again the IEP for ADHD that the school developed consisted of no more than a long list of behaviours the school wanted to stop or change, and the consequences for the child continuing to engage in those behaviours. This result, an all too often one, is the worse of all possible worlds for your child. And I'm going to make some suggestions on how to avoid this happening to you.

1. Put everything in writing. Anything you say to the school, and agreement, any information exchanged needs to be in writing. That means either a letter or an email to the committee AND the principal. EVERYTHING. I would also purchase a small notebook, one with numbered pages if possible, and bring it with me to every meeting. EVERY meeting. Write down what was said, and what you think it means. Write down who said it, and who was there. A year of inaction can quickly go by. This documentation will be very important later if you need to appeal to the Ministry of Education or if you need a lawyer to get your child the education they should be getting. Letting the staff see that you are keeping notes also helps remind them that what was said and agreed to is going to be remembered. At least by you.

2. Prioritize your child's needs. Make a list of what are THE most important things you think your child needs. It should not be too long. But make sure you understand what your goals are going into the meeting. A school can seldom follow through on more than three big items, so know what those are. Having them written down will help you stay focused at the meeting. (Maybe teach this skill to your child when it's appropriate too!)

3. Pre-plan the meeting. Who is going to be there? I can't tell you how often a teacher-aide is at a meeting, but not the child's teacher! The special education or support teacher ISN'T YOUR CHILD'S TEACHER. Get that straight in your mind right now. I'll repeat it: THE SUPPORT TEACHER IS NOT YOUR CHILD'S TEACHER. The classroom teacher is responsible for your child and the need to be at the meeting or the meeting is a waste of time, period. Get the school to agree who will be attending ...and get it IN WRITING. The school psychologist should be there. The speech pathologist if appropriate. Whoever is in charge of "discipline" needs to be there. But most of all, your child's classroom teacher.

Prepare an opening statement. You need to take control of the meeting from the start. A short, one or two paragraphs, statement of what you are looking for. It should emphasize that your are looking for "positive behavioural and educational support," and will not accept punishment or negative consequences of any kind for your child's DISABILITY. Get use to using that word, I know it might be painful, and there are those who preach against "labels" and all the rest of it. STOP! That philosophy is often misused to hold children with disabilities "accountable" for their symptoms. Don't fall into this political trap. You child, right now, needs help to be successful. If you don't want to talk about it in useful medical and LEGAL terms you will end up fighting a losing battle because the number one thing you have on your side to protect your child is that his or her behaviour and academic difficulties is caused by a DISABILITY. And we do not punish, give consequences for or expect san 8 year old to be accountable for their symptoms. It's the schools job to teach alternative skills, alternative behaviours and to do this through positive reinforcement, modelling, rewarding, training and extra support.

(Some parents bring photos of their child, art work, pictures of things they have created or made, and cookies....yep, if you can set the stage for a positive and friendly exchange. Remember, these are the people you are going to leave your child with for most of his or her awake day. This is a give and take situation.)

As I have mentioned before on this blog, many parents make a copy of the DSM-IV's symptom list for ADHD (Attention Deficit Hyperactivity Disorder) and start the meeting by distributing it, along with a statement that these are my child's symptoms, caused by a disability. He will not be punished for his symptoms. Our job is to teach him ways to deal with his symptoms, new skills, and to provide whatever support is necessary for him to be successful.

You might practice these little speeches with a friend. And remember, you can bring a friend with you for support. I would.

4. Be open to what the school says. I have been pretty hard on the schools so far, but they really do have limitations on funding and personnel. Be open to negotiate and to give and take.

5. Find out who is the responsible person. Someone is in charge of your child's case, a "case manager." Make sure you know who that is, but make clear that you are not side stepping the classroom teacher. The classroom teacher needs to be made aware of all communications, plans, interventions and needs to be familiar with your child. Ask if the classroom teacher has read the psychological or educational assessment. Most of the time they have not. If they haven't, ask them to, and ask if the school psychologist could review the testing with the classroom teacher. For a classroom teacher to not have read the child's report, or at least read the IEP, is unforgivable to me. But the plane truth is MOST classroom teachers have not. So, find a gentile and supportive way to get them to do it. Ask at the meeting if your child's teacher could be given an extra prep period to use to review the testing and IEP with the school psychologist. Be supportive. But insist.

6. Make sure there is time to end the meeting properly. You want an ACTION PLAN. Who will do what? By when? How will all of you know that's been done? Ask someone to write it out and have copies made for everyone BEFORE you leave the school.

7. Follow up with a thank you note to everyone who attended, and if you can, an outline of your understanding of the plan.

Somewhere in all of this you need to arrange for an appropriate communication system about how your child does every day. Research has shown that a DAILY school note about academics and behaviour is one of the most powerful interventions available for ADHD. (See Russell Barkley) A daily school note. My next blog is going to address the way we do a school note and provide feedback because it can either be something that supports you child's school success, or something that causes problems, headaches and makes you child hate school because it is used to punish and control. So make sure you read my next blog.



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

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

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


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

ADHD/ADD (Attention Defiict Hyperactivity Disorder) Relationship Advice

Re-Tie the Knot: ADHD Relationship Advice | ADDitude - Attention Deficit Information & Resources (click to read the article)


Although all married couples have to navigate challenges, communicate effectively, and work cooperatively, ADHD places extra strain on a relationship. In the article above (just click the article to find it) this clinician points out that “many clients with ADHD (Attention Deficit Hyperactivity Disorder) have partners who are so highly organized that they are jokingly accused of having Attention Surplus Syndrome, or ASS. Over time, it seems, the “opposite” qualities that originally attracted the two to each other lose their appeal.”

I couldn’t agree more, and this article contains a nice and simple little rating scale used to help you out with these issues. ADHD is often a major factor in pushing a couple over the edge. As a Registered Marriage and Family Therapist I often see couples who are having numerous problems, but taking the steps necessary to salvage their relationship really means taking a step towards dealing with one (or sometimes both) spouses ADHD. Sometimes one parent has ADHD and one or more of the children, and the remaining spouse ends up being a “parent” to everyone...until his or her energy simply runs out.

So here are some hints on how to handle your partner if you suspect ADHD is underlying a great deal of your issues:

1. Get a comprehensive diagnosis. This means not relying on inconclusive evidence. Short forms and tests (very similar to those you often see on ADHD web pages ...and I urge you to STOP reading those!) often only look for symptoms of ADHD. And the problem is that those symptoms are sometimes caused by ADHD, sometimes by OCD, sometimes by focused memory problems, sometimes by specific learning disabilities or depression or anxiety or a language disorder...the list is really pretty long. Individuals get these quick diagnoses and then get medication, then time goes by and nothing happens. Nothing changes. Often it’s because the diagnosis is wrong.
Trying medication to see if it works! I don’t know what to say, some people try their kids medication, or their brothers, and sometimes the medication helps with a particularly difficult task (like taking a test). Don’t do this, get a decent psycho-educational evaluation. Your choice of medication may just be masking a more serious problem.

2. Taking current problems to mean life long problems you didn’t discover. Lots of people do this. What appears to be ADHD is really the result of temporary anxiety and stress, working beyond your capacity and ability. ADHD is chronic and long term. It starts fairly early in life, and can manifest itself in different ways. (Yes, there is an inattentive type, and a “slow processing” type that many people would never think of as “ADHD.” But they are. A clinical history is necessary to understand the nature of your problems.

3. Failing to consider co-existing conditions. This is a common mistake. Some patients have ADHD, but their anxiety is very high, and dealing with the anxiety is just as important, if not more important, than dealing with the ADHD. The anxiety, or depression or anger management issues need to be addressed systematically, usually with Cognitive Behaviour Therapy or CBT. This is why I often recommend to clients that they see a Registered or Licensed mental health professional rather than someone who is a “certified coach” or “professional organizer.” These individuals are not trained or prepared to help you with a diagnostic clarification or with the complex interventions that are part of CBT. See a professional, and that means someone who is Registered or Licensed by the Provincial government or your state.

4. Don’t leave your spouse/partner out of this! Psycho-education is a critical component of ADHD treatment. This is especially important in a situation that involves a relationship because many people don’t accept the diagnosis of ADHD, think the person with ADHD is doing what they are doing purposefully, with intent, and mistake many behaviours such as the variability of attention and focus as proof that the behaviours are controllable. Nothing could be further from the truth. The variability of symptoms from day to day, if not hour to hour, are part of the diagnosis and the disorder itself. The ability to focus on something an individual finds interesting, for long period...long periods...is part of the disorder. It isn’t just your spouse who thinks your “simply lazy” but lots of people I’m afraid, and THEY need to be educated. (My web page suggests a great book by Mel Levine called “The Myth of Laziness” and one by Kate Kelly and Peggy Ramundo called “You Mean I’m Not Lazy, Stupid or Crazy.” The answer is “Yes, that’s exactly what I mean ...... and now we have to teach you to get this across to important people in your life.

5. Looking for Quick Fixes to Immediate Problems. Well, I do want to help you find quick, immediate and useful strategies to immediate problems. That’s a good idea. But a well structured ADHD intervention will cover a wide area of topics and skills, some of which you may already have. We do this so that we can make use of your cognitive/behavioural strengths to make up for cognitive/behavioural weaknesses. A structured treatment approach is best.

6. Expecting miracle cures from those “magic pills.” Medication is the first and most important intervention for ADHD/ADD. Research is clear about this, and there are specific ways medication should be given. One medication that helped your brother may not help you, and the one that help the neighbor’s kid may make your kid a little jumpy. Having a comprehensive diagnosis helps get the medication right. And once you take it, well most people report significant and positive changes. But remember: ADHD/ADD is a developmental disorder. If you have severe ADHD/ADD and can’t organize your way out of a paper bag, medication isn’t going to help you get organized. It will prevent your brain from preventing you from getting organized. But organization is a behaviour skill you should have learned as a small child, when learning to be organized was fun and reinforcing. Learning to organize your room, homework time, paperwork or schedule is not going to be fun at age 12, 18 or 35. You may need both the medication AND some behaviour techniques to learn the skills you never really learned very well, and maybe learned to do in ineffective ways.

6. Anger Management. This is often the last thing someone wants to deal with, and is the most damaging to a relationship. Poor impulse control often has done a lot of damage to a relationship and you will need help undoing that damage and learning skills to control your emotions. Often, to the surprise of many, this involves learning some self control techniques AND getting some assertiveness training.

7. Finally, there is communication. Communication problems often have developed over time, with both partners becoming frustrated with the lack of appropriate responses, the lack of skills and taking what seems like the best path...communicating less. When you find a professional to work with make sure they have basic skills in working with couples, and communications training is a critical part of that.

I hope this isn’t an overwhelming list. I often try to make these posts short and direct. But here I’ve tried to outline as many of the essential components to a properly implemented treatment program for ADHD/ADD when there are others involved. Actually, as I look it over, this isn’t too different from what we always need to do with ADHD/ADD. Find a professional who has experience in mental health, assessment and relationships, not just ADHD/ADD. A minimal program usually involves a few months of treatment. If it’s too costly you can find a professional to guide you through one of the many structured self-help books for individuals with ADHD/ADD. I use an 8 week structured program, and we go from there. What important to remember is that when you are involved in a relationship the treatment of ADHD/ADD can become complicated but for most treatment leads to significant, positive and long lasting changes. The outlook is bright! Go back to the top of this page and read the short article I’ve suggested on communication. You’ll see a simple and effective technique you could start using today.

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

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

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


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

ADHD Collaborative: We could learn something from this very simple program.

About the ADHD Collaborative, a program at Cincinnati Children's Medical Center: The goal of the ADHD Collaborative is to improve functioning, quality of life, and access to care for children with ADHD. This is accomplished by training community primary care providers to implement the American Academy of Pediatrics (AAP) and Cincinnati Children's Hospital Medical Center evidence-based guidelines for the diagnosis and treatment of this disorder.

As a process improvement initiative, the Collaborative emphasizes using best – practice recommendations and quality improvement science to achieve desired long-term outcomes.ADHD
Best-practice means using those interventions, tests, techniques that are scientifically supported, and taking a close look at how they are working. Here are the simple steps they have taken. They are SO simple, yet most of the time they aren't followed by physicians or psychologists:

Guideline Summary
For the diagnosis of ADHD, the guidelines recommend:
␣ PCP initiates an evaluation for ADHD in a child 6-12 years old
␣ Child must meet DSM-IV criteria.
␣ The assessment requires evidence obtained from parents or caregiver AND classroom teacher.
␣ Evaluation should include assessment for coexisting conditions. (This is the differential diagnosis issue I often write about. Do these symptoms mean ADHD, or might they mean something else that we are missing because we jump on the ADHD bandwagon?) Other diagnostic test are not routinely indicated to establish the diagnosis of ADHD, but may be used for the assessment of other coexisting conditions.

For treatment of ADHD, the guidelines recommend that primary care clinicians:
␣ Establish a treatment program that recognizes ADHD as a chronic condition
(Chronic means long term, not going away, BUT something we can treat and do something about)
␣ Specify appropriate target outcomes to guide management
(Determine what the goals of treatment are. What are we to expect from the treatment? How long should it take? How will we know it's working? This means follow-up forms and maybe testing that pinpoints performance levels in specific cognitive areas. This is often better than simple self reports.)
␣ Recommend stimulant medication and/or behavioral therapy as appropriate to improve target outcomes.
(Always ask, when medication is suggested, what symptoms is this medication for? How long will it take to work? What should I see as a result of it working? And what will it not help with?)
␣ Provide a systematic follow-up for the child with ADHD. When a child has not met target outcomes, evaluate: the original diagnosis, medication, and/or behavioral therapy as appropriate to improve target use of all appropriate treatments, adherence to the treatment plan presence of coexisting conditions when a child has not met target outcomes.
(This is THE critical part of their program. If you go to the hospital's web site you will find they supply doctors with forms to TRACK changes in behaviour. Those initial self-reports and parent reports you might have filled out were often originally designed to be used to track the effects of treatment interventions or medication. You were suppose to fill them out weekly, so you could track change. Without some structured way to track change we end up relying upon verbal reports from parents and teachers which might suffer from what we call "confirmation bias," see what you expect or want to see. OR they may be influenced by the environment, a change in teacher, holidays, home situation. Without ongoing assessment of treatment, including medication, we really don't know how things are going.)

Besides their ADHD Collaborative program the hospital has a great ADHD information page. Click here to view it.

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This blog is not offered as medical advice or as a means of diagnosing or treating ADHD or any other disorder. Don't go on line and take an ADHD "test." The diagnosis is complex, and it involves not just looking for symptoms of ADHD, but also ruling out other disorders that might look just like ADHD. 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 that. Medical doctors can diagnose ADHD, but the diagnosis is complex and often they will make a referral to a Registered Psychologist. You can obtain a referral from the British Columbia Psychological Association for a psychologist near you.

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.

Attention Deficit Hyperactivity Disorder (ADHD) assessment and treatment services are offered 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 and cognitive behaviour therapy. I also provide diagnostic assessments for autism and Asperger's Disorder in my Burnaby office.

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

What you need besides medication for Attention Deficit Hyperactivity Disorder (ADHD)

If you use only medication to treat Attention Deficit Hyperactivity Disorder (ADHD) you’re likely to only get a partial response that does little to help your child or an adult with all of the effects of living with ADHD. ADHD is considered a developmental disorder, and many of it's most disabling effects are ones that are developmental in nature. Often children with Attention Deficit Hyperactivity Disorder (ADHD) did not learn skills (or learned them poorly) at the developmental moment that was best to learn them. Lets take being "orderly" as a simple example: putting things in order, organizing, having a clean bedroom, kitchen or workspace. Most of us learn this at a very early age, putting together blocks, putting items together by colour, size. Putting away toys in their proper places. At a young age these activities were fun, self reinforcing. Someone clapped their hands and said, "Great job!" The problem is, when you wait until the age of 12 rr 25 to take ADHD medication and try to teach yourself to be "organized," to set your daily schedule, to keep your desk clean, to organize your bedroom or kitchen.... no one is there to reinforce you, and these tasks are simply not self reinforcing. Your learning a new skill at a poorly chosen developmental time. Normally we learn new skills when they are easy. With ADHD you not only have difficulty with the skill, you often learn it when it's a painful task and hard. No wonder we need support, guidance and structure!

Psychotherapy, social skills training and even anger management training are not only important options to consider — they are mandatory in order to treat the long-term issues that go hand-in-hand with attention deficit disorder.

Once some of the behavior problems are under control with children we are better able to approach the situation and provide an intervention. Often, that's what the medication does, and it also offers us a chance to STOP, THINK and THEN take action. Something that without the medication, we can have a hard time to follow. (There are specific techniques to teach children and adults to STOP, THINK and then ACT without medication. Usually this is in response to external cues and stimuli. In my clinic's in Burnaby and Vancouver we spend a lot of time doing just that. Medication may not be the right choice, and if it isn't, we can work on these techniques. But evidence shows medication is the most effect measure we can take initially.)

Parenting training has been shown to be an effective and an important component of any treatment of ADHD in children. We offer a number of different parent training options including individual sessions, home visits to set up positive behaviour support systems, and books and video training that is supported by scientific evidence. Think of the TV show, Super Nanny — except that the therapist helps the parents learn how to best help their child with ADHD. And remember, on every episode of Super Nanny, Super Nanny needed to return more than once because these techniques are complex and you need feedback.

Psychotherapy for ADHD
We have research demonstrating the effectiveness of a wide range of psychotherapies for the treatment of ADHD in both children and adults. Some people use only psychotherapy instead of medication, as it is an approach that does not rely on taking stimulant medications. Others use psychotherapy as an adjunct to medication treatment. Cognitive Behaviour Therapy is the primary type of therapy for use with ADHD. You learn to understand how what's already in your mind (automatic thoughts) effects the outcome (feelings) and not the other way around. You learn to deal with irrational thoughts, how to think "scientifically," and how to deal with others.

Behavioral therapy is a critical part of the parent training program. It teaches specific techniques to deal directly with immediate issues...behaviours .... of concern. Primarily we use techniques that put an emphasis on positive behavioural support, reinforcing positive behaviours, and ignoring (NOT reinforcing) behaviours we want to see less of. Punishment and negative interactions have been shown to do little to effect the behaviour of children with ADHD.

Psycho-education, for both adults and children, is also a critical component of treatment. Issues of self esteem, depression and anxiety need to be addressed throughout the treatment process.

Social Skills Training for ADHD
Often children with ADHD are sent to "social skills training." This has it's good side, and it's bad. Most children learned social skills through watching others, then practicing them. For the person with ADHD these skills often didn't seem to work, and they developed new and often inappropriate ways to relate to others, get what they want and organize their environment. In a good social skills training classes we provide a safe environment in which to demonstrate and practice these skills, and then set up a graduated process of using these skills in the real world. Social skills training helps the child to learn and use these skills in a safe practice environment with the therapist (or parent). These skills include learning how to have conversations with others, learning to see others’ perspective, listening, asking questions, the importance of eye contact, what body language and gestures are telling you. Often we use a social skills inventory to get a good idea of what specific skills someone has, and what skills they need to learn.

Support Groups for ADHD
Mutual self-help support groups can be very beneficial for parents and individuals with ADHD themselves. A sense of regular connection to others in the same boat leads to openness, problem-sharing, and sharing of advice. Concerns, fears and irritations can be released in a compassionate environment where members can safely let off steam and know that they are not alone. As well as this type of support, the groups can invite experts to give lectures and answer specific questions. They can also help members to get referrals to reliable specialists.
Psych Central hosts two support groups online for people with attention deficit disorder: Psych Central ADHD support group and NeuroTalk’s ADHD support group. While I am happy to give information on these groups, I also have to warn you that often individual's in support groups spread false and misleading information. They join groups in order to spread this information. Sometimes this is in the form of rumours and scare tactics about medications, sometimes it's in the form of misleading information on treatments they "know" work but which have no scientific basis. Be careful, and always go to your medical doctor for advice. There really are no simple diets, vitamins or supplements that fix ADHD. And fish oil tablets are NOT a cure. Go talk to "reliable" sources.

This blog is not offered as medical advice or as a means of diagnosing or treating ADHD or any other disorder. Don't go on line and take an ADHD "test." The diagnosis is complex, and it involves not just looking for symptoms of ADHD, but also ruling out other disorders that might look just like ADHD. 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 that. Medical doctors can diagnose ADHD, but the diagnosis is complex and often they will make a referral to a Registered Psychologist. You can obtain a referral from the British Columbia Psychological Association for a psychologist near you.

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.

Attention Deficit Hyperactivity Disorder (ADHD) assessment and treatment services are offered 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 and cognitive behaviour therapy. I also provide diagnostic assessments for autism and Asperger's Disorder in my Burnaby office.

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