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: http://www.russellbarkley.org/content/ADHD_EF_and_SR.pdf For more information on ADHD services I provide in my offices in Burnaby, Vancouver and San Francisco, please check my website at http://www.relatedminds.com or http://www.adhdhelp.ca 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.

ADHD Diagnosis Rates in US

The Northwestern University issued the following news release:

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

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

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

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

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

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

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


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


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

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


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

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

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

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

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

Do the results last?

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

Is ADHD part of your marriage problem?



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


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

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

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

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

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

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


What is ADHD and How is it Treated?


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Untreated ADHD

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

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

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


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

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

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

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

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

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

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

My ADHD website has move! Click below.

My ADHD (Attnetion Deficit Hyperactivity Disorder) site has recently moved to a new url: http://www.relatedminds.com/adhd-attention-deficit-hyperactivity-disorder


ADHD/ADD can affect the entire family constellation as well as the work or school setting. As a former classroom teacher, director of behavioural services for several school districts and the neuropsychologist for a community based rehabilitation program I am familiar not only with the diagnostic issues relating to ADHD, but also how behavioural, cognitive and systemic interventions work in real life settings. The specific services for ADHD/ADD I provide in both my Vancouver and Burnaby offices are:
ADHD testing and assessment (neuropsychological and psycho-educational)
ADHD Diagnosis
ADHD Treatment Plans for home, work and school
Couple and Relationship Counselling for ADHD related issues
Training for problems with focus, concentration, reading, planning and procrastination and anger management

Frequently Asked Questions (FAQ’s)
Well, I think I have ADHD. Where do we start?

All treatment for Attention Deficit Hyperactivity Disorder (ADHD/ADD) begins with a comprehensive assessment. ADHD is a very general diagnosis and it doesn’t tell us much about the specific problems you as an individual are having with ADHD. If your medical doctor has told you he or she suspects ADHD, it might be ADHD Inattentive Type, where we see an individual unable to focus, concentrate, having difficulty planning or completing tasks, or it it might be ADHD Hyperactive Type, in which the main problems you face is an inability to sit still, the need to constantly move around or fiddle with things (and people with ADHD Inattentive Type might have no problem with this issue what-so-ever!), or it might be ADHD Combined Type, in which the symptoms of ADHD take in both the problems with attention/focus/planning and excessive movement and fidgeting. And within each of these specific types of ADHD there are individual differences in the severity of symptoms, and how we can tolerate them.

Can I get services from my MD? Isn’t a medical doctor necessary to diagnose ADHD?
No, a medical doctor is not necessary to diagnose ADHD. A trained psychologist can do an ADHD diagnosis, and many times the diagnosis is actually completed by psychologist. Many medical doctors would prefer you to see a qualified psychologist about ADHD because they do not have the expertise to do a full diagnosis, which often involves not just a simple checklist of ADHD or ADD symptoms, but also ruling out other possible reasons for the symptoms you or your child may be experiencing. This means completing some other possible testing and an extensive history taking your MD may not have time to complete. Of course, some MDs are able and willing to do a diagnosis of ADHD for you and will use these simple scales. In both my Burnaby and Vancouver offices I see many patients who are referred by their MD after they have already met the criteria for ADHD. This is because they may not feel they have the experience to do a complete diagnosis correctly – because in approximately 50% of cases ADHD or ADD is associated with co-morbid disorders such as learning disabilities, language deficits and behavioural problems you will need to see the psychologist about anyway. The MD, however, is often able to complete an initial diagnosis under your provincial MSP, which is free to you. Services from a psychologist must be paid by your extended health care provider, your employer or through self pay. This is a very legitimate concern.

For more information visit my website at the above address, or at: www.relatedminds.com

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

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

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

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

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

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

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

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

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

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

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

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


Excessive Video Gaming Not Just a Symptom: Issues in ADHD

Medical News: Excessive Video Gaming Not Just a Symptom - in Pediatrics, Parenting from MedPage Today

to start, I remind you again that due to Apple Computer ending it's web hosting services I've moved my website to a new host. The website is still found through the url: wwwrelatedminds.com or www.relatedmindsbc.com. My blog is also move. For the time being most blogs, in addition to being posted on blogger, will be reposted at the new site at: http://www.relatedmindsbc.com/blog
Now, back to video gaming.

Many families come in with their children, who often have a diagnosis of ADHD or ADD, and complain about excessive video gaming. They can't drag their kids away from the machines, and can't get them to stop. They ask me if the video gaming is, in itself, pathological, or if it can cause pathology such as excessive anger, violent behaviour and poor concentration (this is a big concern for parents who already have a diagnosis of ADHD for their child). There really hasn't been much research on this issue until recently, and the research there is isn't very clear. However, this study by Douglas Gentile, PhD, of Iowa State University, has found some interesting...and worrying...connections.

So the real question is, does excessive gaming cause pathology, or does pathology cause excessive gaming? This two year prospective study (with over 3,000 children identified in the data) identified several baseline psychological factors that predicted excessive gaming. These include: impulsivity, depression, social difficulties and poor overall school performance.  These conditions seemed to act as outcomes of pathological gaming. But this excessive pathological gaming seems not to simply be secondary to these other disorders, but to be predictive of poorer functioning overall. This poor overall functioning can last for several years.

For instance, while impulsivity is a risk factor for excessive and pathological gaming, impulsivity worsens after a youth becomes a pathological gamer. The study found that increases in pathological gaming were predictive of depression, anxiety, social phobia and poor school performance.  The relationship between these factors was especially strong for depression.  Some limitations of this study were: it's location (Singapore -can it be generalized to Western cultures?) and that the study relied on self reports from these children.

What can we learn from this? First, I think, that we should not ignore the possibility that there is an underlying depression or anxiety with children who spend too much time gaming. This can often be determined through a clinical interview and further assessment if necessary. And second, that impulsivity is a critical factor in helping the child reduce gaming activity. This is especially true for kids with ADHD who seemingly can focus on an XBox game for several hours, but can't spent 10 minutes reading or doing math problems. (This is the student who often really agitates the teacher, who assumes that it's a matter of choice rather than a result of the child's disability or cognitive deficits such as ADHD or depression.)

Overall if your child is having problems with excessive time spend at the computer gaming, has become isolated and seems non-compliant when asked to get off the computer: get professional help. There seems to be a strong relationship between pathological gaming and psychological problems such as impulsivity, depression, anxiety, social isolation and poor academic performance. You may have difficulty directly addressing the gaming at first, but working on these other areas may very well help.  A psychologist with expertise in diagnosis and treatment of these disorders can help you set up a home program to teach skills necessary to disengage from the video game, address irrational thinking that comes with anxiety and depression, teach social skills and skills to reduce anxiety and finally develop a positive sup[port plan to address issues relating to learning difficulties.

Feel free to contact my office or contact the British columbia Psychological Association to locate an expert near you.


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

New York Times Article on Adult ADHD: click here.

Response letter from Neuropsychologists: click here.

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

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

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

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

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

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

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

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

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


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

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

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

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

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

These are a great place to start!

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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):

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


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

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.

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


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

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.

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

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.

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

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

Children with ADHD at increased risk for depression and suicidal thoughts as adolescents

Click here for link to the original article

ScienceDaily (Oct. 4, 2010) — Children diagnosed with attention deficit/hyperactivity disorder (ADHD) at ages 4 to 6 are more likely to suffer from depression as adolescents than those who did not have ADHD at that age, according to a long-term study published in the October issue of the Archives of General Psychiatry. Although it was an uncommon occurrence, the children with ADHD also were somewhat more likely to think about or attempt suicide as adolescents.

"This study is important in demonstrating that, even during early childhood, ADHD in is seldom transient or unimportant" said study director Benjamin Lahey, Ph.D., a professor of health studies and psychiatry at the University of Chicago. "It reinforces our belief that parents of young children with ADHD should pay close attention to their child's behavior and its consequences and seek treatment to prevent possible long-term problems."

Children with ADHD have trouble paying attention and controlling impulsive behaviors and are often overly active. This can cause poor performance in school, difficulties in social situations, and a loss of confidence and self esteem. The Centers for Disease Control and Prevention estimate that about 4.4 million children, including about four percent of those aged 4 to 6, have ADHD. While many of us hear that there is an "over-diagnosis" of ADHD, in reality there is an under-diagnosis, and many children, adolescents and adults go untreated, either with medications or cognitive therapy.

Most of the earlier studies of the long-term connections between ADHD, depression and suicidal thoughts produced mixed results. The current study benefited from a more comprehensive assessment of depression taking place over a decade, a focus on specific child and family factors that predict which children are most at risk, and consideration of other factors associated with suicidal ideation - suicidal thoughts.

The study was performed by researchers at the University of Chicago and the University of Pittsburgh. It followed 123 children diagnosed with ADHD at age 4 to 6 for up to 14 years, until they reached ages 18 to 20. It compared these diagnosed children with 119 other children from similar neighborhoods and schools, matched for age, sex, and ethnicity. The children were assessed annually in study years 1 through 4, 6 through 9, and 12 through 14. During the course of the study researchers found that 18 percent of children diagnosed early with ADHD suffered from depression as adolescents. That's about 10 times the rate among those without ADHD. They found that children with early ADHD were five times more likely to have considered suicide at least once, and were twice as likely to have made an attempt.

"Suicide attempts were relatively rare, even in the study group," cautioned Lahey. "Parents should keep in mind that more than 80 percent of the children with ADHD did not attempt suicide and no one in this study committed suicide."

"Although the subtypes of ADHD--based on whether they had attention deficit or hyperactivity or both--predict subsequent depression and suicidal thoughts, distinct forms of the disease at age 4 to 6 were moderately predictive for specific problems later on. Children with inattention or combined subtype were at greater risk for depression. Those with combined type or hyperactivity were at greater risk for suicidal thoughts."

"Far more boys that girls suffer from ADHD, but being female increased the risk of depression. Children whose mothers suffered from depression were also at increased risk. Children with more complicated ADHD were most at risk, the authors conclude. Greater numbers of depression, anxiety, oppositional defiant disorder, and conduct disorder symptoms at ages 4 to 6 among children with ADHD robustly predicted risk for depression during adolescence. Children with uncomplicated ADHD with few concurrent symptoms of other disorders were at low risk for depression, but children with many concurrent symptoms were at very high risk."

What does this mean for you and your child or adolescent who you suspect has ADHD? For one thing it means if you suspect ADHD, attention Deficit Hyperactivity Disorder, you need to do more than complete a simple form or self report and obtain a diagnosis and medication. Often, regretfully, that is all that takes place in an MD's office. A "SNAP-4" is given to the parents and the teacher, and after a brief and cursory history 9"Has he been like this for a long time?") a diagnosis is made. I often tell parents we don't "do a diagnosis" but instead engage in a "differential diagnostic process." That means gathering basic information, looking at how the child, adolescent or adult with suspected ADHD presents during the interview (a Mental Status Exam is often the formal means of doing this), collect an extensive history and whenever possible information and observations from a number of people and settings, and complete a battery of tests, self reports and other assessments that RULE OUT other possible causes of the behaviours that are of concern. Remember, there are actually many different possible causes for the behaviours that concern you, and we need to rule out other possible causes and not just jump to a conclusion that ADHD is the cause. Finally, we need to look at a full range of cognitive and academic or workplace results of the behaviour to see exactly how it is affecting the child or yourself. Part of this more in-depth diagnositic procedure includes assessments for depression, mood disorders, neurological disorders, anxiety, autism...all other possible causes and co-morbid (at the same time) conditions. One thing we don't want is to treat ADHD with a medication or treatment that would make another condition w that was masked by the ADHD worse!

So, if your child has ADHD (attention Deficit Hyperactivity Disorder) you also need to be asking yourself, is he or she also depressed? Does he or she have anxiety? Are there specific learning disabilities that also make school difficult? And if my child or adolescent has ADHD what skills did they not learn properly that either I should re-teach or the school should re-teach?

What do we learn from this on-going research? Get a complete evaluation to start.

This study was funded by The National Institutes of Health.

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

First direct evidence that ADHD is a genetic disorder: Children with ADHD more likely to have missing or duplicated segments of DNA

ScienceDaily (2010-09-30) -- New research provides the first direct evidence that attention-deficit/hyperactivity disorder, or ADHD, is a genetic condition. Scientists in the UK found that children with ADHD were more likely to have small segments of their DNA duplicated or missing than other children.

Click here for the story

I am still amazed that I hear people say, "So called" ADHD. And teachers who doubt it is a real disorder, or the general public who assumes people with ADHD are either stupid, lazy or somehow immoral. amazed, but not surprised.

The evidence of this disorder, in it's various incarnations (inattentive vs hyperactive type) is overwhelming. And the science is there to prove it. Again, I urge anyone who has doubt to visit Dr. Russell Barkley's web page (click here).

This study, however, is something new. Researchers found overlaps in the DNA segments, that is, children with a diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) were found to have small segments of their DNA that "overlapped" or were duplicated. These are called "copy number variants (CNVs) and this kind of genetic problem is being seen with many disorders including autism, mood disorders and schizophrenia. ADHD is one of the most common problems found in children, it is highly heritable, is found to be a strong component in twin studies, But until now we have not been able to see the actual genetic material that might be at the source of this issue.

A team at Cardiff University analysed the genomes of 366 children who were diagnosed with ADHD and compared them to 1000 children who were not diagnosed. They found these rare CNVs were more than twice as likely to be found in children diagnosed with ADHD. The chances were even higher for children with co-morbid learning disorders. ADHD, however, is not necessarily the result of a singe genetic change, it is most likely the result of multiple causes. Screening for these CNVs will not help diagnose a child, as it appears that it is the number of repetitions of the gene produced, in combination with other conditions, that cause the disorder.

Research is clear that there are multiple causes of ADHD, that it is a real disorder, and that there is little we can do to cure ADHD ....but we can treat the child, make environmental changes and teach appropriate coping skills to help overcome many negative effects of the disorder. Promises of cures by diet, which assumes diet is a major cause (there are no scientific studies backing this theory) are a waste, as are chiropractic manipulation, neurotherapy and similar "natural" treatments. For more information go to Dr. Barkley's web page.

The best advice is to get a complete assessment so that you know exactly how this disorder is affecting you or your child. This usually consists of a comprehensive history, a clinical interview, cognitive and neuropsychological tests. And find a professional who also has experience working in the environment when the changes need to take place, for children that means someone who has worked in the schools and understands the school system and the issues confronting children. For adults that means someone with several years of clinical experience with adults with ADHD- but also someone with experience working with children and developmental issues.

My web page lists a number of resources you can make use of yourself. Please visit it at www.adhdhelp.ca or one of my other sites at either Psychology Today, AAMFT, PSYRIS or my professional site. 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.

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