ADHD and Homework

Only a week of school has gone by and already homework is becoming an issue with many families who have children with ADHD.  What to do? There is no one-size-fits-all solution to the ideal homework setting, each situation is different, however there are some pretty simple rules I can tell you to start with.


Should my child study alone, or in the kitchen or living room where I can watch him/her?  
Some children with ADHD work inefficiently in an isolated, quiet setting like their room, and do better in the middle of some noise, movement and stimulation. I'm like that, during law school if I studied in the back of the law library ....well...I usually got a good nap! I needed to study at the front of the library where there was some action that activated my frontal lobes and forced me to work even harder to concentrate. So, there is no one rule. Experiment. Some kids do well at the kitchen table with headphones on, some with music, some with white noise. Some, yes, do need the absolutely quiet space. Try different settings and observe your child.  


What if they take too long to get something done?
This is my favourite question because it brings up an essential point. Many kids with ADHD start to learn to hate homework, and  school too, because they have a long history of failure at these tasks.  So, if your measuring "task completion" you are most likely not going to provide reinforcement because it becomes too hard and never gets done. Another issue: At the end of the homework period kids with ADHD start to work slower, get distracted and off task, and parents often give in. So, ultimately they get reinforced not for getting their homework done, but for getting off task, becoming non-compliant and just plain goofing around!  What to do? Set up a homework period, a set time that has a clear beginning and end, and don't reinforce or reward task completion (ADHD kids don't complete tasks!) but instead reward (immediately and frequently) on-task behaviour. "Hey Tommy, glad to see your still working on that, just five minutes to go, then we can watch that movie together!"


Reward on-task behaviour, not task completion. It works better.


My kid always forgets what the assignment is or forgets the books at school! His teacher says he does it on purpose.
No, he doesn't. He has ADHD. It's a mental health disorder your kid's teacher should make accommodations for. Heres an easy one: On Mondays give Tommy a list of all assignments for the week.  Or even better: On Monday email Tommy's assignments to his home email address (and yours!). A teacher unwilling to do this is ignoring your child's handicapping condition, and needs education or correction. This is not a moral issue, it's not about laziness or being stupid. It's about neurological deficits that are specific, limited and can easily be compensated for with appropriate accommodations.


But every other night he forgets his books?
Again, that's called ADHD. Accommodate. Get a second set of books for at home. I have seen this silly issue become a major argument between parents and teachers. Just give him a second set of books. Not fair? Well, this isn't about fairness, it's about appropriate accommodations for a handicapping condition: ADHD. Demand appropriate supports!


When his time is up, often the homework is done, but it's a mess and sometimes just wrong!
Again, that's called ADHD. Simple solution, after every third math problem, write "see me." Tommy brings it to you, you know he is on task, you can check the quality of his work...and evaluate if he understands it, and give him frequent positive reinforcement for: You got it- BEING ON-TASK! Way to go! Overcoming so many symptoms of ADHD already!


Your son or daughter might need breaks, and they might also need the time you require them to be on-task adjusted. Sometimes school, homework and academics in general become objects of fear for a child with ADHD. Don't let that happen. Don't let the mention of school, homework or academics make your child anxious.


How can you do that? Here is a simple rule. Your child should be successful at what he or she is doing about 85% of the time. We call that efficacy. Good enough to enjoy the work, but not so good at it that they become bored. If your child is operating at a 70-60-50% success rate, it's your duty as parents, and his or her teacher's duty as a teacher to check out what's going on, what the problems are and provide whatever support your child with ADHD needs to be successful at that level of efficacy.


There are many more tips and suggestions available. But I want to stop here. Don't take on too much. ADHD is difficult for families to deal with, and you should focus on one or two interventions at a time. If you were to follow my suggestions, and get these done pat, you would already have a good handle on dealing with ADHD because these rules and suggestions apply about so many issues. And one of the skills someone with ADHD needs to learn is to focus on one thing at a time. So do.  Good luck!


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

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

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


Management of ADHD

Further information about ADHD | ADD assessment and treatment can be found at my website: http://www.relatedminds.com and http://www.adhdhelp.ca




In this video Russell Barkley, Ph.D., discusses the recent advancements in understanding the nature and subtyping of ADHD. as well as recent discoveries in what might cause the disorder, and medications that might help treat ADHD. This video is from the series: M.I.N.D. Institute Lecture Series on Neurodevelopmental Disorders [11/2008] [Health and Medicine] [Show ID: 14660]

Dr. Barkley talks about a very important issue with ADH, how the problem is one of future orientation, of planning, or thinking ahead, and how the fact that it is so closely connected with the motor area of the brain (a place we do a lot of planning).

Dr. Barkley also looks carefully at many of the advances in the treatment of ADHD. This includes an interesting discussion of the nature of attention. He reviews the six types of inattention, and how ADHD is about sustained attention or persistence. This type of attention is on the motor side of the brain, while the other types are on the perceptual side of the brain. He discusses how they react to stimuli differently. It is a different kind of distraction of attention from that found in depression or anxiety.

Resistance to distraction is also a key component to the issues of ADHD. But again the problem isn't on the perceptual side of the brain, while with the child with ADHD it is a deficit on the motor abnormality, rather than perceptual side.

Finally he addresses the problem of holding information in mind  helps us stay focused on the task, to return to the task.

Many clients who have watched this video have found it to answer so many questions they have had about themselves and their behaviour. Understanding these deficits helps you develop a plan for action, and not be overwhelmed by feelings of guilt about what you do.

Great video! Enjoy.

Brain Balance

Brain Balance

Several people have emailed me about the original article in Science Based MEdicine that takes aim at "Brain Balance" and other computer based brain training programs. Well, SBM has finally started to allow these direct links, so here (above) is the article. I regret to inform you that there really is very little scientific proof that these easy and fun computer games (or even most of their big brother medical office versions you read about at drugs stores or on the web) have any effect at all on ADHD. Reading the literature that seems to go for "neuro-therapy" and biofeedback as well. Overall, there just isn't any evidence that these games and exercises have any real life effects for an individual with ADHD (Attention Deficit Hyperactivity Disorder). They teach little skills, particular skills, but there just isn't any real proof these translate into better living for anyone with ADHD.

One area of intervention that has shown some scientific promise is short-term or active memory. Holding something, like a set of numbers, in your hear for a moment, manipulating them in some way and expressing them again. Here, with training, and this includes computerized training (somewhat costly however, usually %1,500+ for 10-15 sessions!) we can make improvements. But there are also simple training books which can do the same thing, but not with as much fun, noises or bright lights. Improving you short term, active memory isn't a minor skill, it makes many of the other issues that people with ADHD suffer from easier. So, it might be a good idea IF active memory is your problem. Many people swear it is, but after testing find out that it's not actually a memory issue, but one of focus, attention and concentration. For that medical interventions are often best.

Back to the topic of the day, I suggest anyone who is considering spending time and money on computer programs or computerized training read the above article carefully, and then maybe follow it up with reading more by the same authors. It could save you a lot of money.

Oh, what does research say helps the most with improving our overall cognitive abilities, especially as we grow older? Hold on: Exercise, moderate, simple, not too difficult, exercise as you get older. Talk to your doctor.



For more information on ADHD (Attention Deficit Hyperactivity Disorder, parenting, child behaviour, academic problems and relationship issues, please feel free to visit my website at www.relatedminds.com I also have specific information on ADHD available at www.adhdhelp.ca and information on my counselling and assessment services can be found at either the British Columbia Psychological Association (click here), Psychology Today (click here) or my AAMFT Family Therapist website (Click here). I am a registered Psychologist here in British Columbia, along with being a Registered Marriage and Family Therapist and teacher of special education. There is also some specific information on treatment for aggression and anger in children on my webpage called "The Angry Child," (Click here)

I look forward to hearing from you.

Dr. Jim Roche
Registered Psychologist
Offices in Burnaby and Vancouver, British Columbia

Age Related ADHD? How Attnetion Deficit Hyperactivity Disorder can ruin your day.

Looking around on the web for a new video of Dr. Barkley I ran into this funny...and short ..."adult onset ADHD" video. Usually I find I can't use these humour videos because they will upset someone. But this one seems just right. Take a look:



What's interesting is how this is clearly a situation where behavioural and cognitive behavioural (CBT) training would help. One of the tools we use in my practice is an eight part course that addresses how to avoid procrastination, stay on task, deal with paperwork, planning and goal making and how to change the environment so that you can counter these weaknesses in attention and get to doing what you need to do. A simple and short "to do list" (an external prompt which, if used properly, is hard to avoid) would have made a world of difference for this person, keeping her on track and providing an external prompt as to what needs to be done. But this story, as exaggerated as it may seem, isn't too far from the problems many adults come to me with. And do you think the situation for a child or teen with ADHD is different? No, they experience life just like this. Besides medication, which can help with the issue of focus and concentration, as well as planning, there are many techniques we can use to keep ourselves on track and going steadily towards one goal at a time. Dr. Barkley's new book, Managing Your Adult ADHD, addresses many of these. But the truth is we often need some extra help and coaching to move on stay on target. The eight part course I use in my practice (more information is available from my web page) guides you through learning these specific skills.

A fun exercise might be watching this video again and seeing if you can come up with some tools, skills, prompts and supports that would have.....remember? Gotten the car washed?

For more information on ADHD (Attention Deficit Hyperactivity Disorder, parenting, child behaviour, academic problems and relationship issues, please feel free to visit my website at www.relatedminds.com I also have specific information on ADHD available at www.adhdhelp.ca and information on my counselling and assessment services can be found at either the British Columbia Psychological Association (click here), Psychology Today (click here) or my AAMFT Family Therapist website (Click here). I am a registered Psychologist here in British Columbia, along with being a Registered Marriage and Family Therapist and teacher of special education. There is also some specific information on treatment for aggression and anger in children on my webpage called "The Angry Child," (Click here)

I look forward to hearing from you.

Dr. Jim Roche
Registered Psychologist
Offices in Burnaby and Vancouver, British Columbia

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

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

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

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

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

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

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

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

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

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

Procrastination and Adult ADHD (Attention Deficit Hyperactivity Disorder)

Procrastination is the number one or two on the issue list when people come see me for either a diagnosis or treatment of Attention Deficit Hyperactivity Disorder (ADD or ADHD). Here are some basic facts about procrastination, along with some suggestions and reading material:

First, about 10% of school children are diagnosed with ADHD. While a lot of people think we over diagnose here in Canada research (Barkley) shows we actually are more likely under diagnosing ADHD. Plus, honestly, there is a bit of misdiagnosis, ADHD being diagnosed as something else, and something else being diagnosed as ADHD.

Of those children Young (2007) says that 40-70% continue to struggle with the symptoms in adulthood. Other reports, such as Ferrari and Sanders (2006) find that about 4-5% of adults report the chronic condition of ADHD. These symptoms often lead to adults being misunderstood and labeled as "lazy" or "malingering."

Recently there has been more and more research on the relationship between procrastination and ADHD. In Joseph Ferrari and Sarah Sander's research it is clear that there is a higher level of in "decisional procrastination and other behavioural procrastination." Well, my patients don't need to be told this, but it is important to know that the research supports what many of us think and feel from our observations and personal experiences.

So, what's causing this procrastination. There can be several causes: First, there is a problem with ADHD itself. The frontal lobes of the brain, the executive area, isn't functioning up to task. Individuals with ADHD have difficulty moving from one task to another, stopping one thing, and starting something new. In neuropsychological terms we call this "switching mental sets." Another issue may be motivation: Individuals with ADHD are simply not motivated by cues and prompts in the environment that might tell them to move on, get going and start a new task. They are often not motivated by the task itself, at least not to the degree others are. If you don't have positive experience engaging in activities, completing them and being reinforced for completing tasks successfully....you will not be motivated like others around you to do that. And, on top of this is often the issue of focus, attention and emotional control. ALL issues of the frontal lobes or executive areas of the brain. Understanding all of this, and understanding your own profile, is critical to getting started on doing something about procrastination. This is usually an issue we look closely at during a neuropsychological exam completed as part of the ADHD diagnosis.

One thing I didn't mention but can't be forgotten: Memory. Short term, long term, active memory. Often people think they "procrastinate" but their real problem is one of focus, attention, memory. These are deficits you can discuss with your medical doctor and perhaps make choices about including medication and treatment. Or you can procrastinate and avoid them.

And that's another critical issue about procrastination. What behaviours do you think we engage in more often than others? Well, behaviours we find reinforcing, behaviours that are reinforced by the environment, ourselves, others. And putting something off, even for a moment, is VERY reinforcing. Procrastination is a behaviour that easily becomes entrenched because it has within it the ability to automatically and immediately reinforce itself. When you procrastinate you feel good, if only for a moment. If you put something off, right at the moment you put it off you reinforce "putting things off." And regretfully, the moment you think about doing it, engage in the task, you are taught not to because it's anything but reinforcing. Usually it's anxiety producing, which is something that reinforces putting it off again.

What can you do about this? Well, behavioural therapy helps. Basically clear prompts and cues, and what we call exposure therapy, along with Cognitive Behaviour Therapy to deal with our deep inner nearly subconscious thoughts about avoiding. CBT has been found very effective in dealing with this troubling aspect of procrastination and ADHD.

One of the tools I often use in my practice is a workbook by Safren, Sprich Perlman and Otto called "Mastering Your Adult ADHD: A Cognitive Behavioral Treatment Program." This workbook addresses procrastination directly. They looks at your strategies for dealing with issues of planning and organization; managing distractability; improving adaptive thinking (that switching mental sets thing); and then directly address the attractiveness of procrastination (and I've pointed out above, it is attractive and self-reinforcing) as well as the consequences of procrastination. They engage you in exercises to work cognitively on changing how you see procrastination, teach you how to use adaptive thinking and problem solving to directly address procrastination; have you keep thought records to understand your "automatic thoughts" and address, in an ongoing manner, the thoughts you might be having that reinforce procrastination and develop a plan for addressing these thoughts when they occur.

In addition to approaching procrastination and ADHD from a Cognitive Behavioural perspective I also include training and coaching in making environmental changes that include external (outside your head) prompts and visual cues to help you get started and switch tasks, and teach you to estimate task length and effort needed. Nothing is more important than setting up tasks you WILL succeed at. Visual prompts and cues help you remember, and finally, keeping a record of your successes and areas of continuing difficulty.

Dealing with procrastination means a multi-faceted approach to the problem.Procrastination, for those with ADHD, does occur as an isolated problem. It occurs as a result of years of negative experiences and reinforcement of poor adaptive choices that may have once worked, but no longer due.

We have tools to help you address procrastination within the spectrum of deficits we find in Attention Deficit Hyperactivity Disorder. The above book by SDafren (Mastering Your Adult ADHD) is a really good place to start. A second recommended reading is Russell Barkley's "Taking Charge of Adult ADHD." This book is full of the latest science based information and interventions for adults with ADHD. You can find these books and others through my own website at www.adhdhelp.ca

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I remind you again that this blog is not meant to provide a diagnosis of ADHD or any other disorder. I advise against on-line "tests" as they often only list symptoms of a specific disorder, and don't take into account the many other causes that may exist for the issues you are concerned with. See you doctor. A medical doctor can usually diagnose ADHD here in Canada, as can a psychologist. A registered Psychologist will usually be able to provide a diagnosis along with other neuropsychological assessment tools to help you fully understand the exact nature of your problems. You can locate a psychologist near you through the web site of the British Columbia Psychological Association. I provide diagnostic services for children, adolescents and adults in both my Burnaby and Vancouver offices. More information about my services can be found at my website at www.relatedminds.com

More on Diet and ADHD / ADD

A couple of days ago, or many a week or so ago, I wrote several comments here and elsewhere about the research coming from the Netherlands on Diet and ADHD. In that research there is a claim (a "claim" I'm writing, meaning NOT TRUE) that changing diets can have a significant effect on the behaviour with ADHD. There are so many serious problems with this bit of research it's hard to list them all. Fist and foremost, it disagrees with many many previous research findings. When a new bit of research disagrees with a huge volume of previous research we usually question the way the research was done. Instead the web is plastered with articles using this research to tell parents to take their children off of medication, and on so many of these web pages and blogs there are adds for "natural alternatives." Of course there is no research to support these, but all they are asking for is your credit card number....how could that hurt?

Look, children with ADHD / ADD have a number of different symptoms. Some are so hyperactive they nearly fall out of my office. Sitting in my waiting room the lights go on and off, the sound machine changes volume, a plant falls over. Others are simply easily distracted, and seem to not "be there" as their teachers and parents say. Some have what Dr. Russell Barkley calls "slow tempo" or slow processing time. Some have all of these symptoms.

In this study about 200 kids were divided into two groups. One group ate a very restricted diet. VERY restricted. Water, rice, turkey, lamb, lettuce, carrots and a few other things. And then they had to stick to this diet. Now just imagine getting your child with ADHD to stick to such a diet. Miricles, I suppose, do occur. The second group were "counselled" about food but ate whatever they wanted.

The study claims that 64% of the kids on the restricted diet showed significant improvement. Now remember, that's measured by parent and teacher reports. Measured by the attitude of the people implementing the diet. See any problems here?

So, lets get the facts straight. Any GOOD research would attempt to be "blinded" so that the individuals getting the treatment don't know. THIS study obviously was not. Parents have expectations, after all that hard work...well...something has to change. And one thing we already know from research is that a structured and controlled environment, where expectations are clearly spelled out and implemented appropriately...well, that alone has been show for years to be highly effective in changing the behaviour patterns of children with ADHD. So...."children with ADHD often improve with regular, focused attention" from adults.

Now, the other issue is, did all these children actually have ADHD? Remember all the problems that have come up lately about the difficulty of diagnosing ADHD in children this age? How, with these issues, can we say that food sensitivity is causing problems in 64% of these children? MAybe a test of parenting skills, observations of the home and classroom environment, and more information on how the ENVIRONMENT was changed by the procedures would be helpful, because it's clear there were significant ...huge...environmental changes for these kids.

I remind you of the 1970's when it was decided, based upon poor research like this, that modifying diets changed children's behaviours. The Feingold diet, as it was called, eliminated foods and additives but achieved only modest results, which most researches saw as resulting from 1) significant changes in the behavioural environment and; 2) actual change for a small, a very small, group of children who had actual food allergies and sensitivities. Really, if your finding that a child's behaviour changes dramatically because you eliminate a specific food or additive, then the chances are greater that the child had a food allergy and not ADHD.

Dr. Jaswinder Ghuman, a child psychiatrist at the University of Arizona says, ""To be sure, the prospect of treating ADHD with diet instead of drugs would appeal to many parents, but parents who want to give it a try should be sure to consult with their child's physician first....it's not that easy to implement appropriately."

Three children I've seen in my practice in the past 10 days have had ADHD / ADD diagnoses for over 5 years. All of them have had 5 plus years of school failure. All were tried on diets, some on "biofeedback" and "neuro-therapy," most had tried vitamin and fish oil suppliments, two had homeopathic medication (it's water dropped on a sugar tablet, you knwo that, right?) and one even went to a chiropractor who treats children with ADHD and autism. All continued to fail and all are only now getting around to being ready to try medication, behavioural interventions and cognitive behaviour therapy (CBT)or psycho-education in combination. Medication, behavioural treatment and CBT have been show, in combination, to work. They are backed by years of research. I suggest these are the treatment options you talk to your medical doctor about. It's difficult at best to make up for years of both academic and social failure, and the time to act is as soon as possible.

Again I remind you that this blog is not meant to provide therapy, intervention advice or a diagnosis. If you suspect you or your child have ADHD / ADD (Attention Deficit Hyperactivity Disorder) you should see your medical doctor and a psychologist to help you with a firm diagnosis and intervention plan (visit the British Columbia Psychological Association website to locate one near you). You can find information about my services for individuals with ADHD at www.adhdhelp.ca or www.relatedminds.com

Russell Barkley's new Adult ADHD Book: A Good Choice!

I recommend a number of different books for clients with ADHD, and with adult clients focus on using the workbook "Mastering Your Adult ADHD" by Safren, Sprich, Perlman and Otto. Often times clients want to know a little more about the origin and nature of ADHD than that book provides. My web page (click here) provides several articles and other websites to go to for this kind of information, but finally there is a really strong, in depth and scientifically backed reference book. Russell Barkely's Taking Charge of Your Adult ADHD. (You can obtain this book through Amazon.ca by clicking here.)

This book book presents information and clinical insights accrued over decades of work by a preeminent leader in the field, Dr. Russell Barkley. He clearly and thoughtfully discusses the causes of adult ADHD and how to get diagnosed and treated. Many leading authors in the field have recommended this book. Here is what some had to say:

"Dr. Barkley’s advice to individuals who have ADHD (or think they might) represents a remarkable blend of science and practicality. This book offers a lifeline to adults with ADHD and their families."--Michael Gordon, PhD, Director, ADHD Program, Department of Psychiatry, State University of New York Upstate Medical University

"Consider this book the Rosetta Stone of adult ADHD. No one but Dr. Barkley could translate the sophisticated grasp of ADHD for which he is well known into lay terms and solid strategies. Comprehensive, immensely practical, highly readable, and wholly compassionate, Taking Charge of Adult ADHD is the definitive guide for adults with ADHD and the people who care about them."--Gina Pera, author of Is It You, Me, or Adult A.D.D.?

"This book will surely become a classic. If you are an adult with ADHD, Dr. Barkley can help you make sense of your lifelong struggles and develop a clear road map for overcoming them. Stories and examples from others facing the same challenges bring Dr. Barkley's ideas to life. I will certainly recommend this easy-to-read yet scientifically based book to everyone who comes through our adult ADHD clinic."--J. Russell Ramsay, PhD, Codirector, Adult ADHD Treatment and Research Program, University of Pennsylvania

“Barkley debunks common myths about medications and co-occurring disorders and offers straightforward advice on how to improve quality of life….Verdict: This is a comprehensive and scientifically based yet comprehensible manual for understanding and managing adult ADHD. With this information, adults with ADHD or those close to them can be informed consumers of available treatment options, behavioral strategies, and supplemental support resources.”--Library Journal

For adults with problems with attention, planning, problem solving, and controlling emotions can make daily life an uphill battle. Dr. Barkley provides step-by-step strategies for managing symptoms and reducing their harmful impact. Readers get hands-on self-assessment tools and skills-building exercises, plus clear answers to frequently asked questions about medications and other treatments. Specific techniques are presented for overcoming challenges in critical areas where people with the disorder often struggle—work, finances, relationships, and more. Finally, for those who are confused by the seemingly limitless amount of pseudo-science out there, the fanciful recommendations about diet, fish oil and neuro-feedback, Dr. Barkley discusses each of these and reveals the scientific evidence ...or lack of evidence... that exists. If you own only one reference book on ADHD, this should be it.

Jim Roche, Registered Psychologist
www.relatedminds.com
www.adhdhelp.ca

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

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

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

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

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

This is confused thinking.

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

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

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

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

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

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

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


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

Brain based education: Fad or breakthrough?

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

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

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

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

Not so fast.

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

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

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

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

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

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

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

If your having trouble click here.






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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

The Daily School Note: A proven intervention for children with ADHD.

In my last post I mentioned Daily School Notes. These are little feedback forms that let you know how your child is doing in school. That sounds simple enough, but often they are misused and abused, causing more harm than good. Here are some really simple rules:

1. This note is designed to emphasize what went right, not what went wrong. It's a means of measuring progress, not failure!

2. The goal of every day at school is a "good day at school," it's as simple as that.

3. Point systems and other reinforcement programs should ALWAYS be used in a manner that point to success. NEVER to deny something, or to punish. (I don't get NEGATIVE pay checks, do you?)

Look at the research on behaviour management of children in schools. The most successful method of teaching new behaviours and getting them to happen more frequently is a positive reward / token system. For the past 30 plus years school/home notes have been a component of nearly every successful behaviour intervention program written about. If you hear "I've tried that, it doesn't work," it's most likely because it wasn't done properly. Regretfully teacher education programs no longer seem to require any training in classroom management. So, we need to make these changes back to what we know works "one classroom at a time."

So what does a daily school note look like? Usually it's a SHORT series of questions relating to behaviour, on-task behaviour, academic completion (should be effort!) and so on. Usually it has no more than 5 issues, and a line about homework. Every day the note goes home and in the morning comes back. Some schools do these on line now.

A problem with many of these is that they are used to punish children, to inform parents of bad behaviour, and to get parents to "do something" at home about what went on at school. These are all really bad ideas. By 6 pm it's too late to have much of an influence on a child's behaviour from 10 am that morning. Punishing and criticism won't make a change. If they would, it would have happened by now.

Instead a good school note should offer some feedback on the day that is on a scale, say 1-5, and not a scale of success or failure. Here is an example:

1. On-Task behaviour (focusing on your work for 5 mins at a time)
(Circle) Had difficulty 1-2-3-4-5 Great day!

So the child gets a score of 1-5. Now often these scores are then taken to be an opportunity to punish a child. You got a 2! What was wrong? And the child loses some privilege or reward. This is not a good idea. Soon the home note becomes something to avoid, and school becomes a negative, also to be avoided.

Instead the reinforcement and correction happens WHEN THE SCORE IS GIVEN, and that should be right when the behaviour happens. The immediacy of the feedback and reinforcement is what makes it work. You can't wait 25 minutes to give feedback and reinforcement to a child with ADHD. It just doesn't work. So the feedback should be immediate, corrective, specific and emphasizing the positive whenever possible. Home notes used to punish, where the feedback occurs a long time after the behaviour don't work.

So give the feedback right away. Writing on the note helps reinforce it. THAT is the reinforcer. Later when the child takes it home the points should be totalled up and are always, ALWAYS, leading to some greater reinforcer.

So a note that had five threes gets 15 points, and Tommy needs 100 to get to go to the movie. Rather than saying "Well, you didn't earn your reward today..." and ending up with crying and hating the school note you should say, "Fifteen points today, well, your getting closer, just 70 more to go! What gave you trouble? Anything we can do to help?" The response to the note should be specific and positive. Now the teacher has had an opportunity to correct inappropriate and reinforce appropriate behaviour, a method to give the reinforcement has been provided (the note), the child is learning to put off rewards (it might take several days to earn enough points) and don't we all want our children to learn that they need to wait for good stuff and earn it over time? And finally, the parent has feedback that whatever is going on needs some improvement. There are simply too many 2 and 3 point days. So you need to ask ourself "What can we change to support Tommy better so he is getting 4's and 5's?"

That's basically how a positive support system is used. And as you probably know that's often NOT how home notes re used. We end up with kids crying, parents yelling, kids hating school and teachers expecting parents to fix their kids behaviour after it happened.

I often provide training and consultation on setting up feedback systems with schools, and moving from the punishment mentality to the support, model, reinforce model isn't easy. But it's the only way to go with a child with ADHD (Attention Deficit Hyperactivity Disorder).

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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

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

Evidence-Based Medical Care Cuts ADHD Symptoms but Not Impairment

One of the comments alternative practitioners often make about medicine and medical practice is that their methods, the alternative methods, aren't "cookie cutter" but are instead "individualized." With ADHD (attention deficit hyperactivity disorder) as with many disorders that may, or may not, b a good way to practice.

We actuctually have guidelines for both the diagnosis and treatment of ADHD. Certainly we could end a lot of this misclassification and misdiagnosis if doctors used well know standards and guidelines for the diagnosis of ADHD, but they often don't. Instead they make a quick adjustment based upon their individual experience and a short form or two filled out by a teacher or parent. That leads to misdiagnosis, the wrong medications, and failed treatment.

But the same can be said for interventions and treatment. While I often write about the need for individualized treatment programs what I am usually suggesting is taking a close look at how the symptoms of ADHD effect the individual and focusing treatment based upon the individual's profile. But This doesn't mean we need to, or should, invent treatment modes for everyone. As a matter of fact the main focus of my intervention is following a specific eight week program that addresses a number of different symptoms, and completing the whole program. In ADDITION to this we look at specific deficits and symptoms and address those with individualized interventions. But research has been very clear that following both assessment and treatment guidelines for any number of diseases leads to better outcomes. Highly individualized treatments, overall, show a much poorer response.

The research article noted below, which addresses evidenced-based care, addresses just this issue with ADHD. Researchers show that by adhering to guidelines when treating children with attention deficit hyperactivity disorder (ADHD)we have a better chance at relieving symptoms. But, and this is important to note also, this had no effect on kids' performance in school or in their relationships with others.

The research program notes that while parents and teachers noted significant improvements in symptoms among ADHD kids in a specialized treatment program, there weren't similar outcomes for functional impairment, that is, how we function in school or in our relationships with others. So attention was improved by following treatment guidelines, but not academic or social outcome.

"This finding highlights the need for physicians to work with or refer patients to educational and mental healthcare specialists who can work with children to develop skills to address targeted areas of deficit," the researchers wrote. The researchers found that, based on teacher and parent ratings, children showed vast improvements in ADHD symptoms (P<0.001). "Improvement of ADHD symptoms occurred mainly in the first three months of treatment and remained improved and relatively stable thereafter," the researchers wrote. "These results suggest that community-based physicians can achieve gains in ADHD symptom improvement comparable with carefully controlled, university-based clinical trials.....However, there were no significant improvements in functional impairment as measured by parents and teachers." The researchers concluded that, "Effective treatment likely requires a multimodal strategy that includes a focus on teaching children [organizational and learning] skills," adding that collaboration (by medical professionals) with other mental health or educational services "appears to be warranted." Often I hear some physicians starting children on a low dose of medication, and titrating them to the highest level they can tolerate. Other physicians do the opposite, trying to find the lowest dose. (There are actually guidelines about this for each medication, and you should ask your doctor about those guidelines.) Some suggest "drug holidays," while others urge parents to resist this idea. Some put an emphasis on medications at school, while others take not these are "life medicines" and not "school medicines." Which is right? I suggest looking at what the NIMH suggests, and checking out what Dr. Russell Barkley, a leader in the treatment of ADHD suggests. Ask, "What are the professional guidelines for this type of treatment?" Finally, if the medication is making the symptoms of ADHD better, what is there so little improvement in academics and social behaviour? (As with any medication, some children and adults do much better in response to the medications than others, but in general we can expect a smaller change in terms of academics, social and behavioural interactions, and for adults, work place behaviour and outcomes.) The answer is simple: ADHD is a developmental disorder. The skills you don't seem to have you really don't have. A pill will not make you organized. Nor will a pill make you start studying better, write papers better, organize your calendar or avoid procrastination. Those are the specific developmental skills an individual with ADHD didn't learn at the appropriate developmental time, and no pill teaches these things. The medication provides your brain with the ABILITY to engage in these behaviours successfully. but you need to learn this skills, you need to have them taught, and they will be harder to learn because you are learning them at the wrong developmental moment. But, thank goodness, we have the ability to teach, monitor and improve those skills through structured positive supportive interventions. If you or your child showed some improvement on ADHD medication for three or four months and then you seemed to hit a plateau what you need is training and support in learning and mastering those developmental tasks you never learned as well as others. And this we can provide. So, in sum, we need to follow both an evidence-based medication treatment program AND and evidenced-based social/academic/workplace skills development program to successfully overcome ADHD. It's easy to get rid of the symptoms, but academic, social and workplace success doesn't come in a pill. for more on the article click on the link below: Medical News: Evidence-Based Care Cuts ADHD Symptoms, Not Impairment - in Pediatrics, ADHD/ADD from MedPage 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
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

Cognitive Behavioral Therapy Improves Adult ADHD Symptoms

Medical News: Cognitive Behavioral Therapy Improves Adult ADHD - in Psychiatry, ADHD/ADD from MedPage Today

While at least 4.4% of adults (in the U.S.) have attention deficit hypoeractivity disorder (ADHD) there have really been very few randomized studies of therapeutic or psychosocial interventions. Actually, only three randomized studies. The usual study, and intervntion, has been about medication and medication trails for ADHD. This study, from Steven Safren at Massachusetts General Hospital in Boston, tries to fill this gap. Safren undertook a randomized trail of 86 patients and compared cognitive behaviour therapy for attention deficit hyperactivity disorder (ADHD) and compared it to relaxation therapy, combined with education about attention deficit hyperactivty disorder (ADHD). The cognitive behaviour therapy program outperformed the other intervention, and improvements were maintained over a nine month follow-up after the end of treatment. All of the adults in this clinical trial had previously been on medication.

The researches round improvements on an attention deficit hyperactivity disorder (ADHD) rating scale, as well as on a self-report, where significant improvements were noted. They concluded that "cognitive behavioural therapy for ADHD in adults appears to be a useful and efficacious next-step strategy" for adults on medication with continuing symptoms.

In my practice I use the cognitive behaviour therapy program that Mass General Hospital uses, buildt into a structured eight week program of CBT for ADHD. You can find information about my program at my website below.

One note: Often when searching the web you will find practitioners who say they provide CBT, cognitive behaviour therapy. Often people ask me, how do they know they are really seeing someone who is trained in CBT? The problem is many people see a clinician who has gone through little more than a weekend workshop. There are two certification programs in CBT: The Albert Ellis ?Institute and the Beck Institute. Individuals from either of these programs are trained. Otherwise you need to know a couple things: Ask how much training did they get? It should be more than a workshop or single college course. And most important, ask, "Did you recieve any supervision in CBT?" In other words, did they practice CBT under a supervisor, someone they met with for a semester or year, who observed them, listened to tapes of their sessions, and provided feedback? Supervision is key, and weekend workshop don't provide supervision. Don't be afraid to ask!

So what have we learned from this research trail? That for individuals with on-going symptoms from ADHD, a structured cognitive behaviour therapy program has been found effective and lasting.

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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

Teen Depression Commonly Reoccurs

Medical News: Teen Depression Commonly Reoccurs - in Psychiatry, Depression from MedPage Today

This simple and straight forward research article addresses the issue that while nearly all teens bounce back from depression, but almost half relapse within the next few years (according to results of long-term follow-up of a randomized treatment trial).

When followed for five years, depression returned in 46.6% of the 96.4% of teens who had recovered from their initial episode, John Curry, PhD, of Duke University Medical Center, and colleagues found."The finding that recurrence rates increased significantly from two to three years after baseline suggests that recurrence prevention efforts, such as symptom or medication monitoring or cognitive behavioral therapy booster sessions, may be of value beyond the maintenance period included in TADS," Curry's group wrote in the paper.

The TADS study originally randomized 439 adolescents ages 12 to 17 to 36 weeks of treatment with the antidepressant fluoxetine (Prozac), cognitive behavioral therapy, their combination, or placebo. This is a serious problem and with adults is addressed with Mindfulness Based Cognitive Therapy to prevent relapse. Relapse prevention should be part of every treatment plan. This is especially true of adolescents and adults with ADHD who frequently have co-morbid depression.

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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

Adult ADHD: A great intro video



This is an fun little introductory video on ADULT ADHD (Attention Deficit Hyperactivity Disorder). It addresses the major problem that many people have in dealing with ADHD- others thinking it isn't a real disorder! If you really have ADD or ADHD you can't just "try harder" until you improve. Special help is likely. I am not too sure about the assessment they administered (there really isn't as much validity to these particular drawing tests as people think) but everyone I see gets a similar computerized neuropsychological assessment, along with several other tests to do something important I didn't note in this film: rule out other possible causes. (And while this person appears "intelligent" and smart, at least a short IQ test is needed. I'd also give a short academic test and see if there are any signs of a learning disability, and understand how ADHD effected this young man's academic development. Another issue I found concerning was this psychologist say she was "going to talk about diet..." Well, the truth is, regretfully, there is very little scientific basis for making diet changes, there is just no correlation, no scientific proof. But what we do see here is an adult who tries to avoid his diagnosis, finds that ADHD is frustrating his life, and makes a choice to see a professional and get some answers.

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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

Study urges doctor's OK before teen with ADHD (attention deficit hyperactivity disorder)can drive

Study urges doctor's OK before teen with ADHD can drive

When patients visit my office I have to go over an informed consent form. One item that might seem odd is that I have to inform patients that I am required by law to report impaired driving. That doesn't mean driving while intoxicated ...well, it does, but it means more. It means if you have a head injury, a stroke or other disability that makes your driving dangerous to others, I need to file a report with the proper authorities. Your medical doctor needs to do this too, he or she just doesn't inform every patient that comes through the door. As a matter of fact, medical doctors never do any informed consent until a major treatment intervention is at hand ....but that's another story. Bt impaired driving is one of those critical issues for mental health providers here in BC. Research is clear that ADHD can and often does impair driving. People with untreated ADHD (attention deficit hyperactivity disorder) are more likely to get in accidents, more likely to be injured and when injured spend more time and money in the hospital. Those are the simple facts.

This interesting little article points our thatthe opinion of many that behaviour disorders should be listed among official conditions that force young drivers to get doctors' approval before earning and maintaining their licence. This new study that finds behaviour issues are behind a significant portion of vehicle crashes among teen boys.

The study led by Dr. Donald Redelmeier at the University of Toronto said conditions such as attention deficit hyperactivity disorder (ADHD) could reasonably be added to an existing list of conditions that require medical clearance before driving.

"Maybe ADHD ought to be considered just like diabetes, epilepsy . . . or narcolepsy — that is the patient must show they are in good medical condition if they wish to maintain their driver's licence," said Redelmeier, who is also a physician at Sunnybrook Hospital in Toronto. "I don't think it should be a prohibition, but think it should be on the list of notifiable medical conditions.

He said, however, that the prominence of crashes involving teens between the ages of 16 and 19 aren't limited to when the teens are behind the wheel. "The risks don't end when you stop driving. We find teenagers with ADHD are also predisposed to be pedestrians involved in motor vehicle crashes." Now think about that! Not only are teenage boys in more accidents, its both as the driver and the victim! OFten parents with children on ADHD medication want to just give the medication to their child when they are at school, "It's for learning, right?" they say to me. I tell them it's for life, not just learning. The medication and behavioural treatments are designed to reduce impulsive and RISKY behaviour, something teens are already doing too much of, and teens with ADHD increase the frequency and severity of risk taking behaviour (that includes drugs, sex, and jumping from places you just shouldn't jump from! - wathc youtube for examples of this behaviour).

The test group in this study included 3,421 Ontario teens who were hospitalized following a car crash over a seven-year period. Of those, some 767 were diagnosed with a behaviour issue within the last decade, including 402 cases of ADHD. The researcher said the test group's demographic are the riskiest for vehicle crashes, citing that teen boys between 16 and 19 represent roughly three per cent of all drivers, but about six per cent of all crashes.

"(Teen boys) are so overrepresented in serious crashes, despite their low amounts of driving and despite excellent physical health otherwise," said Redelmeier. "(They have) wonderful reaction times, great visual acuity and a relative freedom from cognitive decline or alcoholism or heart attacks or many other conditions that can impair adults behind the wheel." Redelmeier said the main limitation of the study, which was published this week in PLoS Medicine, is the rate of incorrect diagnosis or diagnosis by someone other than a medical professional. That is no suprise (see my MANY posts on the need to get a proper and comprehensive diagnosis for ADHD). Another problem with the study is that although it accounted for thousands of crashes, the study did not record whether the teen males involved were at fault for the crashes. But, lack of attention doesn't only CAUSE accidents, it keeps you from AVOIDING accidents. We all know this from experience.

So should we add ADHD (attention deficit hyperactivity disorder) to the list of disorders for which you need clearance before getting your driver's permit? Some point out this will just keep parents and teens away from doctors, an incentive NOT to be diagnosed and not to be noticed. And would this make teens even more reluctant to accept the diagnosis of ADHD? And what effect would it have on medication compliance? Regretfully ADHD (attention deficit hyperactivity disorder) still has a stigma that you don't find with other disorders. We have a long way to go in dealing with ADHD (attention deficit hyperactivity disorder) including dealing with the stigma of both the diagnosis itself and the treatment (medication and cognitive behaviour therapy).

Read more: http://www.canada.com/health/Study+urges+doctor+before+teen+with+ADHD+drive/3836160/story.html#ixzz17DGCCKUe

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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