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

Hyperfocus or Lack of focus? ADHD problems and misunderstandings

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

What is ADHD and How is it Treated?


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Untreated ADHD

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

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

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


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For information on counselling and therapy services in Burnaby, Vancouver, Coquitlam and surrounding areas contact Dr. Roche at: (Office phone) 778.998.7975
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As usual, let me warn you that this blog, any of my other blogs, or my web pages are not designed to provide you with an assessment, diagnosis or treatment. If you are concerned you have a health issue such as ADHD, anxiety, depression or Asperger's | autism please see your health service provider, either a medical doctor or Registered Psychologist. What may appear to be symptoms of one disorder can often be caused by another unexpected disorder. Other disorders, such as ADHD, are very likely to exist at the same time as another disorder (called co-morbid disorder) such as anxiety, depressing or OCD. You need to see a professional to find this out. On-line symptom checklists will not provide this, and are often misleading.

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

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

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

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

Drinking and ADHD Medications? UNRELATED.

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




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

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

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

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

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

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

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

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

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

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

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

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

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

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

Dr. Jim Roche




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

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Dr. Jim Roche

ADHD and Anxiety (Especially at School!)

Well, it's that time of year and parents are calling about their kids getting into difficulties at school. And many wonder, "Was it really ADHD? It seems more like anxiety?" Well, it may very well be anxiety, but ADHD also. Many, nearly 50%, of children with Attention Deficit Hyperactivity Disorder (ADHD or ADD) have another co-morbid disorder. This often includes anxiety, and sometimes depression. If your child is dealing with anxiety you need to determine how serious it is, and make a decision on involving a professional, or taking on the task yourself. Whichever you chose, I'm going to provide some simple. clear and very useful resources for any child with anxiety at school.

First, got to the website www.anxietybc.com

Anxietybc has some excellent materials, nd often these are the materials we use here in the office. This includes Cognitive Behavioural Therapy (CBT) help for your child, explanations about anxiety and how it happens for you, and lessons and activities for your child. Try to remember, your goal is not to get rid of all anxiety. Anxiety is a normal part of every day, and sometimes is a useful warning system for us. IT's when the levels of anxiety get to be too great, or happen too frequently, that we need to worry.

So AnxietyBC, great website, lots of useful materials for adults, kids and teens.

They also have a series of video DVDs. These include one on Separation Anxiety, one on obsessive compulsive disorder and one for adults on anxiety. These are priced at around $25.00 each for parents, but they are also available for parents to use from many public library's.  A great gift to your school might be one of these DVD to use during a teacher training day.

Another useful DVD (and book) for dealing with emotions, including anxiety, fear, depression and anger, is "Raising An  Emotionally Intelligent Child" by Dr. John Gottman. This is available at his website (www.gottman.com or through my office).

Finally, some books and activities you can use at home:
"When My Worries Get Too Big!" is an excellent book for younger children. It's by Kari Dunn Buron.
"A Volcano in my Tummy" is a great book about helping children learn to handle anger. It's by Elaine Whitehouse and Warwick Pudney.
Finally there is a series of materials called "The Incredible 5-Point Scale" by Kai Buron and Mitzi Curtis. There are books, workbooks, games, exercises, and these materials are appropriate for children in grade 1 through high school. I use a lot of these materials with my adult clients who have problems with anxiety, stress and depression. Your going to find The 5-Point Scale associated a lot with Aspergers and autism programs, don't worry. It's a very appropriate program for anyone with anxiety and stress related problems.

These materials are all appropriate for use in the classroom as well. In my practice I use these materials with children, teens and adults with anxiety and stress related issues. Including the anxiety materials from AnxietyBC. For many situations there isn't a need for anything more comprehensive. I also provide training programs on anxiety, fear, phobias and stress in the school.

Dr. Jim Roche
778.998-7975
Offices in Burnaby and Vancouver
 www.RelatedMinds.com

For more information about the services I provide my web page can be found at www.relatedminds.comhttp://www.relatedminds.com/anxiety-stress/. Other information on my practice can be found at: http://Therapists.Psychologytoday.com/70682http://www.bcpsychologist.org/users/jimroche, and http://psyris.com/drjimroche

Kids do well if they can: Dealing with angry, aggressive and explosive kids

Often parents and teachers ask me about readings, videos and other materials that might help with their child who has anger management problems. Well, it's difficult to make one or two suggestions because kids who have anger problems, are explosive, fight, act-out and disrupt can be doing it for a number of reasons. One child may have a mood disorder, another may have an executive function deficit, another may have sensory issues and yet another is responding to cumulative failures due to learning disabilities, ADHD and other causes. So, not every difficult child should get the same treatment, either at home or at school. This is especially true for children with ADHD. Kids with ADHD are very likely to have a co-morbid disorder, something going on besides ADHD. And just treating the ADHD with medication isn't going to solve all the problems. So, start with  real diagnosis. Not just a simple 15 minute office interview where the parents and teacher fill out a form (usually the SNAP-IV) that only asks about ADHD and was given because even before we started looking at things we had made a decision it was ADHD. No, start with a good diagnostic assessment by a psychologist, either a school psychologist or a registered psychologist. That's important to rule out learning disabilities, personality disorders or mood disorders (depression or anxiety). From there you will be ready to move on.

But if you are a parent with an aggressive, acting out child you might start by reading two books. First, Dr. Russell Barkley has an excellent book on parenting skills called The Defiant Child. A great book that will set you on the path to being a behaviour expert. ( He also has one called The Defiant Teen).  Barkley's book is a guide to behavioural interventions, and if your having these kinds of problems, you need this book.  Oh, and watch "Super Nanny" too. She's not always right, but she's right enough of the time, and you'll see, managing a difficult child isn't easy for ANYONE.

The second book I would recommend is from Dr. Green called The Explosive Child. This book is a very, very different take on child management. It might be hard to think of using them together, but if you can, your doing everything right you can do.  Dr. Green has a simple philosophy, "Kid's do well if they can." Remember that. Kids do do well if they can, and most of the kids I've seen over the past 25 years who were not doing well knew it and felt awful.... they just couldn't help themselves. Greens program is called "Collaborative Problem Solving" and I think it's the goal everyone should be working on. Teaching your child to deal with problems by engaging with others. Green has a really great web site, and here is a place to start:

http://www.livesinthebalance.org/what-is-collaborative-problem-solving-cps

Watch these videos. Get the books.

People often ask me why I am so willing to share materials? I have a fairly well stocked library of books and DVDs for parents. They think that if I suggest a self-help book you'll use that and ...well, what happens to my practice? Just watch an episode of Super Nanny and you'll see. These skills and techniques are easy to write down, but hard to implement. I'm here to help you, answer questions, walk you through the skills, role play and practice. When your ready for some parent training or coaching, take a look at my web site and give me a call. I can be found at http://www.relatedminds.com

Now go to the book store or library and get these materials!

Children with ADHD are at greater risk of being hit by cars.


An interesting article in the Huffington Post addresses an issues I've been talking with parents about all summer. Here is the link: http://www.huffingtonpost.com/2011/07/25/kids-with-adhd-more-likel_n_907102.html
In this study Despina Stavrinos, assistant professor at the University of Alabama Birmingham's Injury Control Center and the study's lead author, points out that children with attention deficit hyperactivity disorder(ADHD or ADD)are shown to be at greater risk for, for instance, being hit by a car when crossing the street. The new study suggests that because of differences in their ability to perceive risk, children with ADHD may choose to cross the street when it is less safe, even if they follow safety protocol like checking both ways. They know what to do, know the rules, try to use them, but still place themselves at risk.
"They are looking," explained Stavrinos. "But they are failing to see. Just like distracted drivers, they are going through the motions, but they are not actually processing the risk."
Here are the details of this ADHD study: "To better understand the potential dangers of street crossing, researchers from the University of Alabama at Birmingham looked at 78 children, 39 of whom had ADHD-C -- a subtype that includes both inattention as well as hyperactivity and impulsivity issues -- and 39 of whom did not. The children were between 7 and 10, the age at which The American Academy of Pediatrics states it may be okay for children to be unsupervised pedestrians."
"Using a simulator that mimicked a typical street scene, the children were given 10 different street crossing scenarios. Researchers found that those with ADHD performed as well as non-ADHD participants in terms of looking both ways before crossing. However, when it came time to actually cross, those with ADHD picked smaller gaps in oncoming traffic, had more "close calls" and gave themselves less time to reach the other end of the crosswalk before traffic approached."
In 2009, a Canadian study gave several possibilities for why children with ADHD might have such difficulties, suggesting that they might overestimate their physical abilities when it comes time to weigh risks. That same study also found that children with ADHD might not have actually perceived any consequences for engaging in a risky behaviour. "These studies -- and there need to be more -- suggest that there is a different way of processing," she continued, adding that these issues are not necessarily unique to ADHD.
The potential implications of such risk-taking behavior are serious: According to the Centers for Disease Control, unintentional injury is the leading cause of death in children. And a growing body of scientific literature suggests that children with behavioral disorders, including ADHD, are more likely to suffer injury than those without the disorder.
So what can be done?
Parents of children with ADHD should increase supervision, said Dr. Steven Meyers, a professor of psychology at Roosevelt University and a Chicago-based clinical psychologist. He said that "over-practicing" of certain safety behaviors is essential, so that they become second-nature in children.
"Over practice," and taking medication ALL THE TIME is essential to providing children with ADHD both the skills and the ability to avoid risk taking behaviours. Dr. Russell Barkley has been addressing this issue for years. In his papery The ADHD Report (May 2002, page 2-5) he addresses the issue of parents taking their children off ADHD medication for the summer, on weekend or for a "drug break."  His studies have shown that children on stimulant medications are shown to have fewer, and less dangerous, accidents. " Children with ADHD have approximately a three-fold increase in the likelihood of accidental poisoning...15% of hyperactive children have had at least four serious accidents...68% of children with ADHD have experienced physical trauma sufficient to warrant sutures or hospitalization...and only while only 39% of the general public has....40% of teens with ADHD have experienced two or more driving accidents while  only 5.6% of the general public has."
The list goes on. The point?  Children with ADHD have a significant increased risk of injury due to poor cognitive processing. They know the rules, can demonstrate them, and know when they aren't following them. In spite of that they have a high level of engagement in risk taking behaviour. If your child is requires medication (and not all children with ADHD do) remember, as Russell Barkley says, the ADHD medication is LIFE medication, something to take every day to stay safe. It's not just for taking math exams.  And about behaviours? Rules? Procedures like Stop-Look-Walk? Those may be known, maybe your child can explain them...but they need to be over learned. Over taught. Habits.

For more information on my practice, which provides both ADHD assessment and treatment programs, please go to my website at either www.relatedmindsbc.com/adhd, www.relatedminds.com or www.adhdhelp.ca


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

 


ADHD | ADD Testing and Diagnosis


RelatedMinded Educational Services
Services I provide for Attention Deficit Hyperactivity Disorder (ADHD or ADD) include:I have been providing services for individuals with Attention Deficit Hyperactivity Disorder (ADHD/ADD) for over twenty years. This has included diagnosis (with the aim of obtaining appropriate school, work and testing modifications), individual treatment such as skill development to deal with deficit areas like planning, attention, organization and procrastination, teacher training about ADHD and classroom consultations, cognitive behaviour therapy to help deal with the psychological effects of ADHD and finally couples/relationship/family therapy.

ADHD/ADD can effect the entire family constellation as well as the work or school setting. As a former classroom teacher, director of behavioural services for several school districts and the neuropsychologist for a community based rehabilitation program I am familiar not only with the diagnostic issues relating to ADHD, but also how behavioural, cognitive and systemic interventions work in real life settings. The specific services for ADHD/ADD I provide in both my Vancouver and Burnaby offices are:
  1. ADHD testing and assessment (neuropsychological and psycho-educational)
  2. ADHD Diagnosis
  3. ADHD Treatment plans for home, work and school
  4. Couple and relationship counselling for ADHD related issues
  5. Training for problems with focus, concentration, reading, planning and procrastination and anger management
Frequently Asked Questions (FAQ’s)
Well, I think I have ADHD.  Where do we start?
All treatment for Attention Deficit Hyperactivity Disorder (ADHD/ADD) begins with a comprehensive assessment.  ADHD is a very general diagnosis and it doesn’t tell us much about the specific problems you as an individual are having with ADHD. If your medical doctor has told you he or she suspects ADHD, it might be ADHD Inattentive Type, where we see an individual unable to focus, concentrate, having difficulty planning or completing tasks,  or it it might be ADHD Hyperactive Type, in which the main problems you face is an inability to sit still, the need to constantly move around or fiddle with things (and people with ADHD Inattentive Type might have no problem with this issue what-so-ever!), or it might be ADHD Combined Type, in which the symptoms of ADHD take in both the problems with attention/focus/planning and excessive movement and fidgeting. And within each of these specific types of ADHD there are individual differences in the severity of symptoms, and how we can tolerate them.
Can I get services from my MD? Isn’t a medical doctor necessary to diagnose ADHD?No, a medical doctor is not necessary to diagnose ADHD. A trained psychologist can do an ADHD diagnosis, and most diagnoses are actually completed by psychologist. Many medical doctors would prefer you to see a qualified psychologist about ADHD because they do not have the expertise to do a full diagnosis, which often involves not just a simple checklist of ADHD or ADD symptoms, but also ruling out other possible reasons for the symptoms you or your child may be experiencing. This means some other possible testing and a rather extensive history taking your MD may not have time to complete. Of course, some MDs are able and willing to do a diagnosis of ADHD for you and will use these simple scales. In both my Burnaby and Vancouver offices I see many patients who are referred by their MD. This is because they may not feel they have the experience to do this diagnosis correctly, and because in many cases ADHD or ADD is associated with co-morbid disorders such as learning disabilities, language deficits and behavioural problems you will need to see the psychologist about anyway.  The MD, however, is often able to do this under your provincial MSP, which is free to you. Services from a psychologist must be paid by your extended health care provider, your employer or through self pay. This is a very legitimate concern.
Is a neuropsychological assessment necessary?Not always. The neuro-cognitive (neuropsychological) assessment that I provide for those with ADHD includes, but is not limited to, issues such as verbal memory, visual memory, processing speed, executive function (decision making, picking out what is important or salient, impulsivity and emotional control), psychomotor speed, reaction time, complex attention, cognitive flexibility and long term attention and focus. Through this testing we learn about how ADHD affects your flexibility of thinking, concept formation, problem solving, planning, creativity, impulse control, emotional stability, inhibition and procrastination (an inability to switch from one task to another). This information is very helpful in determining where to focus our interventions. Not only telling us about the weaknesses you may have due to ADHD, but also pointing out your cognitive strengths and affinities. This helps us develop strategies based upon your strengths.
How do you know I have ADHD and not something else?
In addition to these neuropsychological tests and extensive history taking we also look at factors that might direct us towards other or co-morbid diagnoses such as depression, anxiety, bi-polar disorder, learning disabilities and so on. ADHD is known for being found in combination (co-morbid) with several of these other disorders in children, adolescents and adults. Sometimes these disorders mask the nature of the ADHD. Sometimes we can mistake another disorder for ADHD. So along with the comprehensive neuropsychological assessment we also look at personality issues that help in ruling out other possible causes for the issues that you are concerned about. This is a particularly helpful for medical doctors who often send their patients to me for help as they are often not equipped or experienced in this level of diagnosis. This information helps your medical doctor in making better choices in terms of medication if you and your doctor make a choice to explore medication for your ADHD.
Finally, we complete a comprehensive behavioural and medical history that also helps us understand your problems, how ADHD may effect your day to day life at work, home or school, and how we might intervene to help you deal with your ADHD symptoms.
Some parts of this examination are repeatable, so that at a later time we can see if ADHD treatment interventions have really had an effect on your symptoms. I provide a set of procedures and documents that you, your child’s school or parents can use to measure the effects of any ADHD intervention (behavioural or medical). The truth is sometimes we feel better because we think we are better, or sometimes we fail to notice complex cognitive improvements after taking medication because they are hard to measure. These tests and data collection procedures are specifically designed to help determine if real changes have taken place in your ADHD symptoms.
What would a treatment plan for an adult look like?Often I see adolescents and adults for an initial cognitive evaluation and diagnosis. Once a diagnosis of ADHD is made and we have enough information to understand how ADHD impacts you we develop an intervention plan. We usually meet an average of eight times, using a combination of psycho-educational (teaching) and weekly consultation to get you off on a program you can continue on your own. Here is a general outline of the meetings and intervention schedule I often use:
Assessment, Review and OverviewSession 1    Review of assessment results; Overview of the ADHD program; Discussion of involvement of family and work mates
Organization and Planning for Individuals with ADHDSession 2    The basics of organization and planning skills; Organizing multiple tasks
Session 3    Problem-solving and managing overwhelming tasks; Organizing papers
Reducing Distractibility due to ADHDSession 4    Gauging your attention span and distractibility; Modifying your environment
Adaptive Thinking Part 1Session 5    Introducing the Cognitive Model of ADHD (Cognitive Behaviour Therapy)
Adaptive Thinking Part 2Session 6    Review of Adaptive Thinking and previous sessions
Session 7    Dealing with Procrastination
Session 8    Preventing ADHD Relapse and setting future goals
Following this eight week course outline together we cover all major areas of concern that commonly are found with ADHD. As I mentioned above, we  also fine tune the program to address your specific deficits and strengths that we identified during the assessment process, making success much more likely. Individuals are then able to use appropriate self-help tools with confidence and the knowledge and experience they need to make the most of them.
After this initial program ADHD clients sometimes see me on a monthly basis, or quarterly, for “check ups” and to address problems with relapse.
Finally, for those who with the help of their primary medical provider decide to take medication to deal with this disorder, we are able to provide ongoing neuro-cognitive assessments that help monitor the effects of the medication. Research has found that for those diagnosed with Attention Deficit Hyperactivity Disorder (ADHD or ADD) a combination of medication and behavioural training is the most effective path.
What about ADHD treatment for children and adolescents?I work extensively with children and adolescents. One thing I am able to provide that others may not are interventions for the school and home that are acceptable to the school stafff. My experience as a classroom teacher for nearly 10 years, and as a school based educational psychologist, gives me insight into how common treatments for ADHD are best adapted to the school environment. I also provide schools with training workshops and teacher consultation on ADHD.
Do you recommend any specific books about ADHD? There are so many out there I don’t know where to start!For adults we often use the Cognitive-Behavioural Treatment Program for Adults with ADHD developed by Safren and Sprich, which has been found useful with adults. I also ask clients to watch Russell Barkley’s A New Understanding of ADHD (a DVD available in the office) as well as his new book Managing Your Adult ADHD and read either Kelly and Ramundo’s You Mean I’m Not Lazy, Stupid or Crazy?, Hallowell and Ratey’s Driven to Distraction or Thomas E. Brown’s Attention Deficit Disorder: The Unfocused Mind in Children and Adults.  All of these books can be obtained in my office or through Amazon.ca (just click!).  For those who find reading difficult or find finding time to read difficult (and these are all 200+ page books) I have CD’s and DVDs available. I have similar books on ADHD for parents that specifically address parenting and school related issues.
What about faster methods for dealing with ADHD like Neuro-Feedback, Hypnosis or Diet Changes? Don’t they work?The short answer is no, they don’t. There is very little evidence supporting any of these treatment methods for ADHD. You may hear that there is research showing neuro-feedback works for ADHD, autism, Aspergers and many other problems. The truth is that after over twenty years of research there is no real evidence that neuro-feedback or neurotherapy has any significant effect on behaviour, school success, attention or impulsivity.  (Dr. Russell Barkley, a leading researcher in the field addresses this issue on his web page.) Diets, except for those with a specific allergy, have been shown to have no effect on ADHD. Chiropractic and homeopathic interventions have not been shown to have any effect. “Sound therapy” and hypnosis, likewise, has been show to have no effect.  Two web sites I often suggest individuals look at for information about these “alternative” therapies are www.sciencebasedmedicine.com and www.quackwatch.com. I would be more than happy to share the research on these alternative methods with you upon request. My best advice is to ask your medical doctor what he or she knows about these often ineffective yet expensive interventions. He or she is your best source of information.
How much does treatment cost?
Individual sessions cost $160.00 per hour, slightly below the rate suggested by the British Columbia Psychological Association. Testing, such as a basic diagnostic assessment usually take four sessions, including the feedback session where we discuss the specific nature of ADHD and how it affects you. More comprehensive diagnostic testing is sometimes necessary for obtaining adaptations and modifications in school, the workplace or for high stakes testing. This level of ADHD assessment includes cognitive, academic and personality components and costs approximately $1,600-$1,800. However, this is not always necessary or recommended. A basic ADHD diagnosis for use by your medical doctor should take approximately four hours total. Services are available in both Burnaby and Vancouver. The Burnaby office serves Burnaby, Coquitlam, Port Moody, Port Coquitlam, New West Minster and Maple Ridge. The Vancouver office serves Vancouver, West Vancouver and North Vancouver.
Before you come in:
My website’s “forms” page has several handouts, books and articles on ADHD. (click here) Please, go there and check them out. And if you are coming in for an appointment there are several forms I’d like to have you complete prior to coming in, but please wait until I tell you which forms. Different cases and situations complete different packets of information. You should also feel free to call me and ask any questions you might have. My office number is 778.998-7975. If I’m not available feel free to leave a message and I’ll return your call as soon as I can.

Organization and Planning for those with ADHD (Attention Deficit Hyperactivity Disorder)

For information on my services for the diagnosis of ADHD and treatment for ADHD refer to my website at: www.relatedmindsbc.com/adhd or www.adhdhelp.ca.  You could also start at my general web page at www.relatedminds.com  My offices are located in both Vancouver (Mt. Pleasant area) and Burnaby (near Coquitlam, Port Moody and Maple Ridge).

ADHD (ADD, or Attention Deficit Hyperactivity Disorder) is a "developmental disorder." That means it starts early in out development. Not at age 45. More likely before the age of 7, and continued on. Perhaps staying the same, or perhaps changing.

Understand what that means. You had a deficit in a cognitive skill at an early age, say age 4, and because of that you didn't learn certain skills that others learned, or you may have found a way to compensate for the deficit that made sense at age 5, but doesn't at age 35. So during your development there were certain skills you missed out on that now you find yourself needing.

Organization and planning are two such skills. People with ADHD have a lot of trouble with both of these skills. How you might have learned them at age 4, 5, 6 or so is very different than how your going to learn them now at age 35.  You may have found ways to deal with these skill deficits, like avoiding, procrastinating or maybe the environment was changed to support you (someone checked your homework every night, and your book bag every afternoon). No one is check when your 35.

You can, however, learn these skills. But you need to set up the environment (home, work and friends) to support you in this endeavour. It's not an easy one, but not impossible by any means. And with the help of an ADHD therapist or coach, you'll be able to do it.

Learning to organize and plan usually involves the initial step of developing a visual calendar. This mans a paper an pencil calendar you can look at, change, estimate times from and put in front of you and make an estimate of what you need to do, when, and how long it will take. This is a very different process from using a pda or calendar program on your iphone or computer, and we almost always recommend taking a step back to pencil and paper.

From the calendar we develop a simple visual task list, yes, a to do list. But this list needs to do something special, it needs to help you prioritize tasks. That means every day, if not several times a day, checking your calendar for items on your task list and checking your task list for things on your calendar. THEN learning how to prioritize. There is never enough time for anyone, especially someone with ADHD, to complete everything they need to do (or think they need to do). We usually teach a simple prioritizing skills called A, B, C's.  Rearranging daily tasks into a list of those that you want to remember, those you need to remember and those you need to do, TODAY.  An excellent source f help in developing this calendar and list is a workbook by Steven Safren and Susan Sprich called Mastering Your Adult ADHD.  I suggest getting this workbook and using it with a friend or coach. There are many variations on this approach for ADHD and organization, one called "the three boxes" and another called 1, 2 and 3! They all follow the same process.

Tips: Don't try to fix everything. Fix what's most important  to you. If your not sure what that is, talk with a counsellor, therapist or friend to decide.

Have someone monitor your progress! Just like the teacher checked you got your homework written down, and your mom checked your bag before you left ...you need someone to check your doing what you agreed to do. After a period of time (a long time) this process will become a habit. But until then, buddy up with someone who promises to check on you.

The secret to being organized is knowing what drawer, box, list, line, space, place or trash can everything is suppose to go in. That means learning to prioritize .... everything. Identify it, give it a rating and know where it goes.  It isn't just that you have ADD or ADHD that keeps you from getting everything done. The simple truth is we CAN'T get everything done. Figure out what needed to be done and do that. Then move on!

I provide coaching and treatment ofr ADHd in my office in Vancouver and in Burnaby, serving Burnaby, Port Coquitlam, New Westminster, Port Moody and Coquitlam.