Ups and Downs of ADHD

This short blog article looks at the ups and downs of ADHD, how individuals with ADHD can have variations in their abilities to focus, concentratrate and plan, and can have variations in mood.

Individuals with ADHD often have "ups and downs" from one day to another. A good day, then a bad day. Sometimes it's an up and down during the same day. For anyone with ADHD (Attention Deficit Hyperactivity Disorder or ADD as it is sometimes called) the first issue is to make sure, if these ups and downs are frequent and severe, that you do not have a co-morbid mood disorder. This is usually looked at during the initial ADHD diagnosis. Often a family doctor doesn't have the time or expertise to look at possible mood disorders, so a visit to a psychologist familiar with ADHD is suggested. (This is another reason to make sure, if you are using the services of an ADHD coach, that they are supervised by a licensed mental health professional and not simply working as a "certified coach" which is an unregistered/unlicensed and unregulated field in BC and most other provinces and states.)

The other issue is that often parents, teachers and co-workers (or worse yet, your boss!) take these ups and downs to mean that 1) you CAN keep your symptoms under control and simply aren't trying hard enough, or 2) see, there really is no such thing as ADHD, it's just an excuse. Both of these are untrue and counter to the scientific evidence, and the ups and downs ......they're proof of the real nature of ADHD as well.

ADHD symptoms do vary, they vary at different times and of course in different situations. The daily fluctuations may be related to the daily activity you are engaged in. Dr. Barkley says, "If the tasks required on a specific day demand lot's of self-control and organization as well as time management and persistence, then those days with A.D.H.D. will generally report that their symptoms are worse that day. If on the other hand, it is a vacation or weekend day and they could do more things they enjoyed, they often report their symptoms were less pronounced that day." (See Dr. Barkley's related article on the New York times Health page.)

So, if you need to focus on work that is difficult and holds little interest or reinforcement, expect problems. And if your going to an action movie after a quiet morning and lunch ...things will go well.  Novel situations go well much of the time, and do one-on-one encounters. The more planning and self-restraignt necessary, the less well it is going to go. All of this should make sense, knowing what ADHD is.

But there is also those days that just seem to go wrong. We start the day, some incident happens, anxiety builds and nothing seems to go right after that. We find ourselves in a downward spiral. Something we could do yesterday not becomes a difficult and sometimes  impossible task today. Again, to some this is proof that ADHD isn't real, or that you aren't trying hard enough.  Don't get caught in the definition others put on your behaviours based upon their preconceived (and wrong) ideas. It is simply the nature of ADHD to change like this.

What you need is a Plan B. Plan A  may not be going well, and it may not work out at all. So have a Plan B, a plan that gives you 1) A time to help yourself "switch mental sets," and change the way your brain is thinking and working (like taking a walk, having tea, doing a cross word puzzle or reading a book or listening to a podcast). Do something to change your mental direction. Maybe go to the gym. And then, 2) if you need it, spend time on an alternative but constructive activity. This might mean setting a timer and using the time to straighten out your papers, clean your office, get ten phone calls done.  What's important here is to have a structured Plan B and not to reinforce any avoiding behaviours - procrastination - that might be going on.  Keep a record of when and where this happens, and while you need a Plan B remember, your goal is to stick to Plan A. Ask yourself: "What about Plan A went wrong?" Was it where the activity/task took place, the time, what happened before or will happen after? If you have multiple experiences with Plan B - it's time to check in with your psychologist, doctor of mental health coach. But don't take changes in ability to be anything more than ADHD doing what ADHD does. Your question is: "What can I do to deal with this specific symptom of ADHD?" And then come up with a new and better Plan A AND Plan B!

For information concerning the services I provide for children, adolescents and adults with ADHD please visit my web page at or  In addition to working with individuals, providing diagnosis, treatment plans and coaching services, I also provide school based training and consultation services as well as work place services.

ADHD Services for Children, Adolescents, Adults and Families

How can I help you? If you or your child have ADHD (Attention Deficit Hyperactivity Disorder - or ADD) I provide a number of services that can be of help to you, your child or your relationship. For over the past 25 years I have worked with children with ADHD, adolescents with ADHD, adults with ADHD and families dealing with ADHD. Unlike many other "counsellors" and "coaches" who work with individuals with ADHD but have never worked in a school, work or family setting, I bring nearly three decades of experience working with individuals in the schools - as a classroom teacher with students having behavioural and academic problems due to ADHD, in the workplace, as a rehabilitation and community based neuropsychologist with adults returning to work with ADHD and related issues of impulsivity and concentration due to head injuries, and as a registered marriage and family therapist and clinical member of AAMFT (American Association of Marriage and Family Therapy). Because of my classroom experience as a teacher (and licensed school psychologist) I understand how teachers can implement classroom based interventions to help a child or adolescent with ADHD, and understand the interaction between ADHD and Specific Learning Disabilities (my offices located in both Burnaby and Vancouver) offer not only psychological assessments for ADHD but also full psychoeducational assessments for the diagnosis of learning disabilities and other co-morbid disorders often found with ADHD. Often this includes school based observations and consultation with the teaching/school staff. I have offered teacher workshops on ADHD throughout British Columbia, California and New York State. I also offer parent training and education programs which focus on teaching parents and other caregivers specific skills to help them teach their child with ADHD necessary behaviours and skills. I also work with adolescents, young adults and adults in dealing with both workplace problems and relational problems stemming from the symptoms of ADHD. This might include on site observations and consultation, as well as ongoing coaching and skills development. My years as a community based neuropsychologist working with programs such as Gentiva's Rehab Without Walls focusing on helping individuals with focus, concentration and executive skills development after workplace injury or strokes has provided me with specialized and focused skills in this area. Finally, many individuals with ADHD come to see me about issues such as depression, anxiety, stress and relationship (including parenting and marriage) problems. The services of a REgistered Psychologist are not covered in BC under MSP, however many extended health care plans do cover the cost of psychological services, including therapy, counselling, coaching and assessments. Check with your provider. For those with limited funds who do not have medical coverage for ADHD I often try to work with individuals using one of several self-help programs that are science/evidence based. Please feel free to call me and set up an initial consultation. As these consultations last for approximately an hour, there is a cost, however, usually during that hour we are able to establish a good outline of a program for you, based upon your individual needs and abilities. My offices are located near Lougheed Town Center (near Fitness 2000 on Salish Court) and near the Cambie Bridge and City Hall on 8th Ave. More information can be found at my web page at or

News for those with ADHD and Bipolar Disorders

There is a new study about ADHD (Adult ADHD) and Bipolar Disorder. If you have ADHD and Bipolar Disorder you may want to send this study to your doctor. here's the basic information, and a link: (This study was published as an abstract and presented orally at a conference. These data and conclusions should be considered to be preliminary as they have not yet been reviewed and published in a peer-reviewed publication.) SAN DIEGO, May 24 -- When attention deficit hyperactivity disorder meets bipolar disorder in an adult, the diagnosis is hard and the course is poorly understood but the co-morbidity appears to exacerbate matters, researchers said here. A systematic review of rates of bipolar disorder and ADHD in adults revealed that co-morbidity ranges anywhere from about 5% to 47%, reported Aliza P. Wingo, M.D., and S. Nassir Ghaemi, M.D., M.P.H., of Emory University in Atlanta. But patients with the co-morbid conditions may benefit from the addition of bupropion (Wellbutrin) to their antimanic agents, said Dr. Wingo, who co-authored the study with Dr. Ghaemi. The full study review of the study can be downloaded here: APA: Co-Morbid ADHD in Bipolar Adults May Respond To Non-Stimulants Click Co-morbid conditions (ADHD PLUS something else) can be very complicated to treat. A referral from your family doctor to a properly trained psychiatrist is always advised.

Hyperfocus or Lack of focus? ADHD problems and misunderstandings

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

ADHD and Executive Function

Dr. Russell Barkley is a leading expert in ADHD/ADD and Executive Function Disorders. In this short video Dr. Barkley addresses this critical issue for everyone with ADHD. Executive Dysfunctions have been found to be a critical part of ADHD, and may even be THE critical issue at the heart of ADHD. The "Executive Functions" that we talk about are those that help us maintain goal directed or related behaviour. If you have ADHD, or your child has ADHD, you will know what this means because you know "what's missing." Dr. Barkley, in this short video and in his books and articles, suggests that there are five essential "Executive Functions": 1. The ability to "inhibit your behaviour,":stop what your doing, and stay on task by not reacting to other outside, distracting stimuli; 2. The ability to use non-verbal working memory- visual memory- in order to imagine working your way through a task. This is especially true with math. Often individuals with ADHD score lower on tests of visual memory than what would be expected by their overall intellectual capabilities; 3. The ability to "talk to yourself," to have a voice in our head to instruct ourselves- also called "verbal working memory." Most of us have this inner voice, and we use it to guide our behaviour throughout the day. Those with ADHD do not seem to have this skill (but it can be practiced and learned!); 4. The ability to control our own emotions, and to moderate those emotions so that we want to stay on task, and are able to maintain mental and emotional energy throughout the stages of longer, more complex tasks; 5. The ability to plan and problem solve - to manipulate information to figure out how to get complex things done. This, like many of the other skills listed above, are not simply fixed with medication, but instead need to be worked on individually through education, modelling, practice and reinforcement. These are the "mind tools" Dr. Barkley and others suggest we focus on when addressing ADHD in counselling, therapy and coaching. Most of them are addressed through basic behavioural therapy and interventions, as well as Cognitive Behavioural Therapy. Below is a link to Dr. Barkley's brief, but informative video. In addition to the video there is also a more in-depth written explanation of these "executive skills" and how they effect ADHD. That can be found by clicking here: For more information on ADHD services I provide in my offices in Burnaby, Vancouver and San Francisco, please check my website at or This page is not meant to offer diagnostic services or suggest specific services to address ADHD. ADHD is a complex disorder, and many symptoms and behaviours taken for ADHD can actually be signs and symptoms of other disorders such as anxiety, depression, Autism spectrum disorder, Asperger's or even depression. See a licensed or registered mental health professional for an appropriate diagnosis.

Are ADHD Medications Safe?

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

Are Medications Safe?

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

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

ADHD and Procrastination (again)

Again this week 3 or 4 patients coming to see me are visiting my office because of problems with procrastination relating to ADHD. Attention Deficit Hyperactivity Disorder (ADHD or sometimes called ADD) is a neurological disorder, and executive disfunction, that effects not only our ability to focus, stay on-task, concentrate, plan and follow through, but also effects our ability to get started - we procrastinate and out things off. And this is one of the most disturbing aspects of ADHD. 

Dr. Russell Barkley, a leader in the field of ADHD says this about executive dysfunction and ADHD: ""In ADHD, if the information that is suppose to be generated by executive functions is being generated at all, it appears to be extraordinarily weak in controlling and sustaining behaviour towards the further..." We seem to get stuck in the here and now and can't ...well move forward.

What Dr. Barkley says about treating this aspect of ADHD is that, "clinicians treating those with ADHD must beat the environment at it's own game. They must put into the immediate context the sorts of cues, prompts, physical reminders, and other captivating information that will guide behaviour towards the intended goal."

That's a very fancy way to say that you need to develop prompts and cues that help you move from one state of mind (maybe watching TV or lying in bed) and move to the next (getting up and taking a shower, or getting out the door to get in the car and get to work.).  That means alarms, signs, signal and prompts. But it isn't as easy as it sounds.

Two things inter fear with just setting up a system of prompts and cues and moving forward. They include  anxiety and ...the lack of reinforcers for engaging in the behaviours you want to be doing.

One of the dangerous things about procrastination is that it is "self reinforcing." If I have to work on a task, go do something I don't particular want to do, to avoid it wait a few minutes before I do it, is rewarding - reinforcing. For that few moments the anxiety associated with the task is gone. I need to get to the office ....but I wait. When I first thought about going to the office I had some anxiety -about what I'm going to do there, getting there on time, maybe about my ability to get there ...since I procrastinate and avoid so much. Just the thought of going to work is a negative experience. And avoiding it makes me feel good, immediately ....if only a little bit. For those of use who understand behaviourism we know an IMMEDIATE reformer is VERY powerful, even if small and short lived. So, avoiding and procrastinating in itself reinforces the behaviour of procrastinating. You may have had one or two things you were avoiding and this reinforcement was very strong. Then avoiding itself started being reinforcing and spread through everything. Now avoiding is your preferred way of dealing with things.

The second issue is reinforcement. A simple rule of behaviour is this: Anything we do that is reinforcing we will do more often, for longer periods and with more intensity. Things that are not reinforcing, we do less often. As adults, the plain and hard truth in life is this: When you stop procrastinating and actually get things done...your more likely going to be rewarded with more hard work. More things to do. Not very reinforcing, is it?

Both of these issues need to be addressed through understanding them, applying your understanding to the situation, and changing the environment so getting things done IS reinforcing rather than the opposite. Through coaching and planning we can usually find ways to do this. Setting up a variable schedule where work completed (non-preferred tasks) are followed by preferred tasks (and remember, the reinforcement or reward can be small...but needs to be immediate). We can use check lists, visual schedules, there are all sorts of things we can do to help with this depending upon the situation.

Now one step back: While all this is going on with procrastination we also have the issue of needing to increase the environmental prompts and cues to help you "switch mental sets" and move from one task to another. SIMPLE visual, auditory and other types of prompts help. and setting things up so that small initial changes are rewarded and reinforced, two, three...before we get to bigger changes.

So, ADHD and procrastination may be difficult to deal with, but there are things we can do.  Understanding the nature of the disorder is critical, and a good deal of the time I spend with clients is spent explaining how the brain works ...and how ADHD effects the brain. Knowledge is the first step towards health.  Often CBT is also recommended for clients with ADHD, this is because we have been worn down by failed attempts to control these behaviours caused by ADHD. And friends, relatives and work mates often turn ADHD symptoms into what they think are signs of your personality. Often they turn this into a moral or ethical issue. "If you would just put more effort in to this!" Well, ADHD is a complicated disorder, and more effort doesn't necessarily lead to success. Understand and ADHD specific interventions are what help. CBT (Cognitive Behavioural Therapy) helps individuals with the issues of inappropriate and negative thinking that comes from repeated exposure to failure. CBT is a critical part of dealing with ADHD.

For more information on ADHD (ADD) and procrastination, along with help in making an ADHD diagnosis, ADHD (ADD) coaching in Vancouver or Burnaby, please visit my website at or call me directly to set up an appointment. There are also a number of science based self help books on ADHD listed on my web page.

This blog is not meant as treatment or diagnosis. For treatment and diagnosis please see a registered or licensed professional in your community. Both medical doctors and registered psychologists can diagnosis and treat ADHD (ADD or Attention Deficit Hyperactivity Disorder).
KEYWORDS:  ADD, ADHD, Attention Deficit Hyperactivity Disorder, ADHD coaching Vancouver, ADHD coaching, Burnaby, ADHD coaching Coquitlam, ADHD coaching New Westminster, psychologist, diagnosis, treatment, procrastination, executive disorder, psychoeducational assessment, psychological testing

Executive Skills and ADHD (Attention Deficit Hyperactivity Disorder)

Often patients come to the office for a diagnosis of ADHD (Attention Deficit Hyperactivity Disorder) and they have heard that ADHD is related to what is called "Executive Function." This is true, and deficits in executive function are a critical issue in ADHD. Coming up with useful interventions for ADHD usually brings us right to the front door of executive disorders. Schools are often at a loss as to how to approach ADHD in the classroom, and the last set of IEP's I reviewed from school districts here in BC (including IEP's from Burnaby, Vancouver, North Vancouver, Coquitlam, Langley, New Westminister and Maple Ridge all seems to fall off the track and miss the point that ADHD is primarily a function of executive deficit and dysfunction.

Too many times the Individualized Education Plans, usually developed from the Psychoeducational Assessment, focused on increasing academic outcome, getting work completed and increasing scores with very little understanding of the effect of executive deficits and their relationship to ADHD.

(For instance, starting a task may very well be related to difficulty with switching mental sets, changing what we are doing, moving from one task to another. This is an executive deficit ...sometimes we might call it "procrastination" or simply ADHD, but we need to understand the nature of the executive disfunction in order to develop an appropriate intervention plan. This might include both environmental changes, such as cues and prompts, and teaching new skills such as what to do next, how to set up a project and move forward with a step to step plan. There is additionally the problem that changing behaviours, not procrastinating but instead changing tasks and moving forward, may not be inherently rewarding or reinforcing. Honestly, if you have been avoiding work for two years and now someone gets you to deal with it ....your reward is usually more work! And for an 8 year old, more work isn't the reward he or she was looking for (And it's even worse for adults with ADHD!) So, developing a plan means not just following a script but also finding a good behavioural therapist to help develop and watch the plan.

So where can yo get some help in developing an intervention plan for ADHD, including a school IEP, that takes into account issues relating to executive dysfunction and deficits? Here are two good executive dysfunction and skill resources:

First, an excellent book from the Guilford Practical Intervention in the Schools Series: Executive Skills in Children and Adolescents: A Practical Guide to Assessment and Intervention by Peg Dawson and Richard Guare.  This book covers the basics of executive skills and brain development, reviews methods that we use in psychoeducational assessments and neuropsychological assessments to assess executive skills, talks about how to make behavioural observations with formal assessment measures of specific executive skill areas such as 1) Self Regualtion of Affect, 2) Metacognition, 3) Goal-Directed Persistence, 4) Cognitive Flexibility, 5) Sustained Attention, 6) Working Memory, 7) Response Inhibition (Impulsivity), 8) Planning and Prioritizing, 9) Time Management, 10) Organization, 11) Task Initiation (avoiding Procrastination).

The book also gives home simple case examples of developing and implementing simple plans to address each of these specific areas of deficit. This list (above) should give you some idea of how your school should be assessing your child and addressing specific deficits for intervention in the classroom.

The book also addresses developing interventions that promote executive skills for those with ADHD. These plans involve addressing the psychical and social environment; changing the nature of the tasks at hand; improving how cues and prompts are given; and for the schools, changing how adults and students interact.

Specific interventions for the classroom and individual are also discussed, as well as applications of these interventions to specific populations, such as children with Aspergers Syndrome or autism spectrum disorder who may also have ADHD symptoms or executive function deficits that interfere with learning. This is an great, evidence based book that any school team should have.

On my ADHD website page ( you will also find information and a link to a short article by Thomas Brown on executive dysfunction and it's relationship to ADHD.

Finally, Russell Barkley has an excellent article on ADHD and Executive Function which you can download here:

KEYWORDS:  ADHD, ADD, Attention Deficit Hyperactivity Disorder, Psychologist, Diagnosis, Treatment, Registered Psychologist, Burnaby, Vancouver, Port Moody, Coquitlam, New Westminster, North Vancouver, Coaching, ADHD Coaching, Professional Coaching, Assessment, Psychoeducational Assessment, Testing.

For more information on the services I provide you can find help at these links:

Could you define ADHD Coaching?

ADHD coaching
ADHD coaching is a specialized type of life coaching that uses specific techniques geared toward working with the unique brain wiring of individuals with attention-deficit hyperactivity disorder. Coaches work with clients to help them better manage time, organize, set goals and complete projects. In addition to helping clients understand the impact ADHD has had on their lives, coaches can help clients develop “work-arounds” strategies to deal with specific challenges, and determine and use individual strengths. ADHD Coaches also help clients get a better grasp of what reasonable expectations are for them as individuals, since people with ADHD “brain wiring” often seem to need external mirrors for accurate self-awareness about their potential despite their impairment.
For information on ADHD coaching I offer in Vancouver (serving Vancouver, West Vancouver and North Vancouver) and Burnaby (serving Burnaby, New Westminster, Coquitlam, Maple Ridge and Langley) see my ADHD web page (click here).

KEY WORDS: ADD, ADHD, ADHD Coaching, ADD Coaching, Coach, psychologist, ADHD Coach Vancouver, ADHD Coach West Vancouver, ADHD Coach North Vancouver

What is ADHD Coaching?

What is ADHD Coaching?
ADHD coaching consists of two main elements: First: learning about your ADHD and skills or tools that you can use to address your symptoms, and Second: Practicing these skills in the real world. That might be at home, in school of the workplace.
At our initial session we review your diagnosis (or test, assess and diagnose you if need be), look at your strengths and weaknesses, and together develop a plan that will help you address your problems and deficits by using your strengths and abilities. 
The initial ADHD coaching sessions (one or two sessions) focus on understanding your particular form of ADHD, and how the behavioural and cognitive interventions we are going to use address your problems, how they work, and why they work. I firmly believe that understanding the underlying theory ...the why and how of things...helps make treatment successful. If you don't know why your doing something, why do it? And that goes for ADHD coaching as much as for anything else.
What kinds of issues does coaching help with ?
Well, lets start with the basics: Organization. Planning. Procrastination. Figuring out what is important, and what isn't. Learning to avoid distractors and distractions. Problem solving. How to deal deal with emotions and emotional dysregulation. Anger management. Stress. Intrusive thoughts. Self-esteem. We do this with behaviour therapy, check lists, visual planners, external cues and prompts, schedules and cognitive therapy. And as an ADHD coach I provide backup, quality control, feedback and encouragement when things don't work as they are suppose to, and that happens everyone.
What would a treatment plan for an adult look like?
Often I see adolescents and adults for an initial cognitive evaluation and diagnosis. Once a diagnosis of ADHD is made and we have enough information to understand how ADHD impacts you we develop an intervention plan. We usually meet an average of eight times, using a combination of psycho-educational (teaching) and weekly consultation to get you off on a program you can continue on your own. For an ADHD coaching program we often meet two or three times in a two week period, get a general understanding of the program and how it works, and then continue to speak by phone, SKYPE or in person.
Usually as an ADHD coach I provide you with a set of materials you practice using in my office, and then try to use in the real world. Each week we speak at a predetermined time, review a small reading (selected from the sessions below) and then review your schedule, and how the tools we have chosen together are working for you. Often there needs to be adjustment and change, but we keep trying until your comfortable with the procedures.
Here is a general outline of the meetings, phone or SKYPE training and intervention schedule I often use:
Assessment, Review and Overview
Session 1 Review of assessment results; Overview of the ADHD program; Discussion of involvement of family and work mates
Organization and Planning for Individuals with ADHD
Session 2 The basics of organization and planning skills; Organizing multiple tasks
Session 3 Problem-solving and managing overwhelming tasks; Organizing papers
Reducing Distractibility due to ADHD
Session 4 Gauging your attention span and distractibility; Modifying your environment
Adaptive Thinking Part 1
Session 5 Introducing the Cognitive Model of ADHD (Cognitive Behaviour Therapy)
Adaptive Thinking Part 2
Session 6 Review of Adaptive Thinking and previous sessions
Session 7 Dealing with Procrastination
Session 8 Preventing ADHD Relapse and setting future goals
Learning new skills continues for eight weeks, the first two or three in the office, and the remainder on your own. Together we cover all major areas of concern that commonly are found with ADHD. As I mentioned above, we also fine tune the program to address your specific deficits and strengths that we identified during the assessment process, making success much more likely. Individuals are then able to use appropriate self-help tools with confidence and the knowledge and experience they need to make the most of them.
After this initial set of learnings and coaching we continue for another month., Usually we work together for three to four months. Sometimes we continue the ADHD coaching relationship on a less frequent basis for several months, but that isn't always necessary.
For ADHD coaching, how long would ADHD coach go on all together?
A successful program usually runs about 12 weeks.
How much does ADHD coaching cost?
The three hourly visits are at my usual rate. After we are done with the initial sessions we usually spend 30 minutes on the phone or SKYPE (we can use Google Chat, Apple Face to Face or any other system you might be use to using). This is at a reduced rate, less than 50% of the normal office visit, and a total three month packet can be arranged to further reduce the costs.
What about ADHD coaching for high school students?
Many parents like the idea of having an ADHD coach work with their child or adolescent because it reduces the stress at home. A third party member is often easier for an adolescent to deal with, however, I still recommend some parent training and education in these cases. In other words, another aim of ADHD coaching for your child or adolescent is for you to learn to be your child's ADHD coach!
Do I really need a Registered Psychologist as an ADHD coach?
The cost is only slightly higher than using an untrained coach with no experience in the field of psychology, neuropsychology and cognitive processes. I think it's a good idea, whenever possible, to use someone who in addition to coaching understand's learning disabilities, how schools work and the basics of the neurobiology of ADHD. Coaching with a psychologist is a good way to go. Sometimes a psychologist might have a coach that works with them.
For more information on ADHD coaching
For more information on ADHD coaching please feel free to call me at my office or check out my web page at

Services provided in my offices include: (covered by most extended health care insurance)
Anxiety and Stress (click here:
Autism and Asperger's Disorder (Click here:
Individual Counselling (click here:
Child Counselling / Therapy (click here:
Testing and Assessments and Learning Disabilities (Click here:
Couples Counselling / Therapy (click here:
Anger Management (Click here:
Pain Management and PTSD (Click here: )
Forensic Services (Independent Medical Examinations or IME)
About Dr. Roche
My name is Dr. Jim Roche and I am a Registered Psychologist and a Registered Marriage and Family Therapist (RMFT) in British Columbia. In addition to my doctorate in clinical psychology, I hold a master's degree in family therapy, a certificate of advanced graduate studies (CAGS) in school and educational psychology from Norwich University, and have completed two years of post doctoral studies in neuro-psychology at The Fielding Institute in Santa Barbara, California. In addition to being a registered psychologist, I am a certified school psychologist, certified teacher of special education (New York and California), and a Clinical Member of the American Association of Marriage and Family Therapists (AAMFT). I also hold a doctoral degree in law with an emphasis in medical malpractice and education law. Beyond my academic credentials, I have completed two years of supervised clinical experience in both hospital and community based clinics and two years of post doctoral training in neuropsychology. I have served as director of behaviour programming for several school districts, as a consultant on autism for the province, and have held numerous academic positions including Clinical Instructor in Psychiatry at New York University and Bellevue Hospital in New York as well as being a faculty member at NYU, Brooklyn College, SUNY New Paltz, and Norwich University.
Key words
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Daily Coaching and Professional Organizers May Help With ADHD

Medical News: USPSYCH: Daily Coaching and Professional Organizers May Help With ADHD - in Meeting Coverage, USPSYCH from MedPage Today

While drug or pharmacological treatments are the primary and usually first therapy for attention-deficit hyperactivity disorder (ADHD) in adults psycho-social treatments may be a useful adjunct and improve patients' quality of life.

Psychosocial treatments include not only psychotherapy but less-well known approaches such as an ADHD "coach" and a professional organizer, said Carol E. Watkins, M.D., of Northern Country Psychiatric Associates in Baltimore at this national meeting.

Individual psychotherapy: This approach can help patients identify "maladaptive patterns" related to the ADHD and find better ways of coping with them. Studies have found that both the insight-oriented therapy and cognitive and behavioral therapy can be useful, Dr. Watkins said. ADHD can put a major strain on a marriage, Dr. Watkins said. Spouses may not understand that their partner's inattention and forgetfulness is not intentional. Extended couples therapy may help the non-ADHD spouse learn to give supportive structure without being controlling, Dr. Watkins said.

"ADHD Coaching" is distinct from psychotherapy, Dr. Watkins said. An ADHD coach talks to patients at regular, often daily intervals and helps them define, clarify, and prioritize their goals. ADHD coaching is relatively new phenomenon and currently there is no regulation or oversight of this profession so it is important to make sure that coaches are trained, have experience and better yet, are part of a treatment team and supervised by a licensed or registered psychologist. ADHD is often seen with other co-morbid disorders, and untrained "coaches" can misunderstand the nature of the presentation of different disorders.

Dr. Watlin further states that a Professional Home Organizer can be hired for patients with cluttered, disorganized homes. Professional organizers come to the house and help determine what can be thrown away. Working out who to hire to do exactly what can be difficult. It may be best to see a psychologist who is trained to evaluate the exact nature of your ADHD, develop a treatment plan and monitor that plan, while using a paraprofessional to implement it.


This blog is not offered as medical advice or as a means of diagnosing or treating ADHD, learning disabilities, autism, relationship issues or any other disorder. Don't go on line and take an autism, ADHD, intelligence or relationship "test." Diagnosis is complex, and it involves not just looking for symptoms of a disorder, but also ruling out other disorders that might look just like what your worried about. 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. You can obtain a referral from the British Columbia Psychological Association for a psychologist near you to help you with these matters, or if you are in another province or state contact their psychological association.

My web page lists a number of resources you can make use of yourself in dealing with Attention Deficit Hyperactivity Disorder (ADHD) as well as other learning and social disorders. Please visit it at 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