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

Hyperfocus or Lack of focus? ADHD problems and misunderstandings

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

ADHD and Executive Function

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

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

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

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

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

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

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

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

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

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

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

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


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

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