Psychoeducational Assessment

Psychoeducational Assessment (Burnaby, Vancouver)

Dr. Jim Roche is a Registered (BC) and Licensed (CA, WA, NY) Psychologist specializing in treating ADHD, autism spectrum disorder, Aspergers disorder in children, adolescents and adults, learning disabilities, behavioral disorders and severe mental health issues. He also provides mental health assessments and individual, couple and marriage therapy. You can find more information about his practice at the websites below:

Relatedminds: http://www.relatedminds.com
ADHD Help BC: http://www.adhdhelp.ca
At Psychology Today: http://therapists.psychologytoday.com/rms/70682
At Psyris: http://psyris.com/drjimroche
At Autism Community Training: http://www.actcommunity.net/jim-roche.html

Key Words
ADHD | ADHD coaching | workplace coaching | 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 | Psychoeducational Testing

Salish Court at Bell (google map) (yahoo map)

Ups and Downs of ADHD

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

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

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

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

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

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

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

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

ADHD Services for Children, Adolescents, Adults and Families

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

ADHD Over Diagnosed?


The Canadian Medical Association Journal has scheduled a publication for an upcoming edition entitled: Influence of Relative Age on Diagnosis and Treatment of Attention-Deficit/Hyperactivity Disorder in Children.” As other studies that I have pointed out have shown, there is a problem with the diagnosis of young children with ADHD. There is what is called a “relative age effect.” That is, we have more children (as a percentage to the overall population) diagnosed with ADHD at lower, younger ages. This is measured within each grade, in other words, younger boys or girls in grade k-1-2-3 etc are more likely to be diagnosed with ADHD than are older boys or girls in the same grade. So if your child is born in November or December, the cut off ages for school entry in British Columbia, you are much more likely to end up with a diagnosis of ADHD. So what looks like ADHD, everyone assumes, may really be nothing more than a reflection of a younger age within the classroom. This is usually, some feel, the result of gathering too much information from one source, the school, where the child’s behaviour is not measured against his or her age group, but against his or her class. It’s really an unavoidable problem, but not one that we cannot correct for.
Boys born in December were 30% more likely to receive a diagnosis than those born in January (the oldest boys in the class). These boys were also 41% more likely to get medication than the older boys. As medication can have harmful affects on sleep, appetite and other issues, this should be of concern. What also should be of concern is that teachers making these reports that doctors rely upon to make a diagnosis (usually using a simple procedure called the SNAP-IV) don’t seem to be aware of these normal developmental differences within the class, and seem to fail to program for these with appropriate environmental supports for children with significantly different behaviour patterns based upon natural growth and maturation.
This study seems like a repeat of several completed in the past few years in the United States, and researchers might be using their time and our research money finding ways to compensate for these factors, but that’s my personal complaint about basic research that is often repeated many times for the sake of publication.

What can you do to make sure your child is not misdiagnosed?
First, remember that a younger child, especially in a younger grade, will act in ways that might appear to be reflective of ADHD. You need more than a simple diagnosis based upon a five minute observation and a couple of SNAP-IV forms. Medical doctors often do not have time to spend watching, playing, observing and interviewing as is necessary. You also need some basic data, like the SNAP-IV, but a key to the ADHD diagnosis is ruling out other causes for the behaviours of concern. That means ruling out anxiety, stress, panic, depression, mood disorders and…yes, normal developmental issues. I suggest you schedule an appointment and see a psychologist who is familiar with ADHD, children and classrooms. Being familiar with classroom expectations is critical, as often times misbehaviour is the result of environmental factors.
Most medical and psychological associations, groups and individual practitioners recommend a trail of behavioural therapy and environmental supports to attempt to deal with the behaviours of concern before medication is tried. Several of my recent posts have gone over these guidelines by the leading paediatric organizations. So, you need someone familiar with classroom environments, curriculum and teaching techniques to work with you.
Finally, nearly 50% of all children with ADHD have a comorbid disorder. That is, they have ADHD AND something else. That might include depression, anxiety, stress or any one of multiple learning disorders. If these comorbid disorders are dealt with properly the ADHD symptoms may be significantly reduced. So assessments for these problems should be part of any assessment and intervention for ADHD. Ask your school district of psychologist to conduct a psychoeducational assessment. A psychoeducational assessment will provide the data we need to develop a targeted intervention plan.

For more information on psychoeducational assessments please see my testing page at:http://www.relatedminds.com/testing/

finally, my ADHD pages have a good deal of information to help you understand the assessment process. Assessment for ADHD, and Psychoeducational Assessments are fully explained.http://www.relatedminds.com/adhd-attention-deficit-hyperactivity-disorder/