Autism Spectrum Disorder and Psychoeducational Assessments

I have been asked by several parents about the difference between a psychoeducational assessment and an assessment for autism spectrum disorder (ASD) or Aspeger's Disorder. There is some confusion out there, and several parents have arranged for the wrong kind of assessment in order to obtain the services they need. So I'll try to explain when you need each of these types of assessments: Psychological Assessment, Psychoeducational Assessment and Autism Disorder Assessment very briefly.

An Initial Psychological Assessment
In British Columbia parents are often sent to a registered psychologist by their school or physician when autism is suspected. Initially you should be arranging an appointment to have the psychologist meet you and your child and do a brief psychological assessment. This usually can be done in one session. You may be asked to complete a number of forms, such as the SNAP-4, some behavioural forms, and maybe an adaptive behavioural assessment form (ABAS).  These can sometimes be sent to you before the examination and returned so that the psychologist is ready to meet you. The psychologist will interview you, observe your child and take a comprehensive history. Form this a determination can usually be made about what is the best way to proceed. Often what looks like autism spectrum disorder or Asperger's can be something else, such as ADHD or a developmental disorder. Perhaps anxiety, or a specific learning disability. The psychologist can then help you proceed down the correct path.

A Diagnostic Assessment for Autism
If autism is suspect, or Aspegers Disorder, your psychologist will then proceed to complete a comprehensive assessment for autism spectrum disorder. This includes two critical examinations that are necessary for funding in British Columbia. These are the Autism Diagnositic Rating Scale (ADOS) and the Autism Diagnostic Interview (ADI-R).  There are a number of other autism tests and tools out there, but these are the two that are necessary for funding from the ministry in British Columbia, and for services through any school district. If your child goes to public school in Burnaby, Vancouver, New Westminsiter, Coquitlam...anywhere in the province, the psychologist who completes the assessment must be trained in using these tools and use them for the diagnosis. Nothing else will do. Sometimes parents go to a professional who uses other tools and completes this assessment in another way. If they do the assessment will not qualify, so make sure you see someone who uses these tools for the autism assessment.  These are not the only tools he or she might use, but these are essential. For children under six years old a separate assessment by a speech pathologist and medical doctor need to be part of the process as well. If a full psychoeducational assessment is not being done, usually some sort of intelligence/cognitive testing is necessary to rule out other possible disorders.

The Psychoeducational Assessment
Along with the autism assessment most schools require a comprehensive psychoeducational assessment. This assessment looks at bith intelligence and academic ability. Children from age 3 up can be given a psychoeducational assessment, although in British Columbia schools seem unwilling to assess younger children due to financial constraints. It is best practice and done throughout most of North America, but not common here. The two components of the assessment, the intelligence and academic parts, are then compared and from that information we can make determinations about specific learning disabilities. Most children with ASD have a comorbid learning disorder. Nearly 50% of children with ADHD have a comorbid learning disorder. And without understanding the cognitive strengths and weaknesses of a child it is difficult to develop an Individualized Education Plan.

These are the three main types of assessments children and adolescents go through in order to develop an educational and behavioural plan. You often hear of a neuropsychological exam as well. These are highly specific examinations of brain processes that help with both diagnostic questions and developing education plans. Most of the time a good psychoeducational assessment and autism assessment (if necessary) are enough to move forward with.

Costs? Full psychoeducational exams can cost from $2,200-$3,600 depending on who you see and what tests are completed. Your school can and should be providing this exam for free, however here in BC there are very long waiting lists. An Autism Assessment runs around the same, but the two can often be done together. Again, the Provincial government can provide these services, for free, however there is again a waiting list, and some parents prefer to have an autonomous outside professional see their child rather than the ministry.

I hope this information is valuable. My best advice is to make sure the professional you see is a registered psychologist, that they have experience with children or adolescents, and have experience working with the schools. Understanding the system is as important as understanding the tests.

For information on services that I provide please visit my web page at: www.relatedminds.com
I provide autism and Aspergers assessments not only for children and adolescents, but for adults as well.

Psychoeducational Assessments


Dr. Jim Roche
Registered Psychologist
Relatedminds.com

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



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

Psychoeducational Assessments and IEP's

I work in Vancouver, Burnaby, Coquitlam, Maple Rdige, New Westminster and throughout the lower mainland. Parents come to me and tell me their child is having trouble at school and they have asked for psychoeducational assessments from their school districts. Often instead of a psychoeducational assessment they are told they will be placed on a waiting list, sometimes a long waiting list. 


As a matter of fact in Burnaby, Vancouver, North Vancouver, Maple Ridge, Coquitlam and other districts in the lower mainland school districts they seem reluctant to provide any psychoeducational assessment for a child younger than 8 or so. Sometimes that wait for the psychoeducational exam you requested takes years, and your child is 8,9 or 10 before they get necessary services. And parents wonder, "why are schools reluctant to provide these examinations until the children are older, and have had multiple years of academic failure before providing the assessment?"


Honestly, I don't know. I've worked with and in school districts in California, Washington, New York, Massachusetts and Vermont, as well as overseas, and everywhere else I have ever worked school districts provided appropriate psychoeducational assessments as soon as there were educational concerns. Most of the school districts I've worked in prior to coming to British Columbia have special teams trained in the tools needed to assess younger children. (A child of 8 doesn't take the same tests as a child of 5, and a school psychologist can't be expected to be familiar with ever test for every age.) So, elsewhere school districts are not only willing to provide a psychoeducational assessment to a kindergardener or 1st grader, they also have professionals specially trained in giving those psychoeducation tests.


I've asked several dozen school, educational and registered psychologists, and no one can offer me an answer as to why we wait to assess here in BC.  Sure, psychoeducational assessments at age 5,6 or 7 are not as predictive of future educational outcomes as ones given at age 12, 13 or 14. But they are valid. How someone performs years in the future may very well change based upon interventions (or lack of interventions) we provide. But any good assessment should help us to understand how a particular child learns, what cognitive and skill deficits they have, and what abilities they possess we might be able to use to improve their academic functioning. Even at age 5.


There is nothing wrong with asking for an assessment at the first signs of learning problems. A semester of "watching" and data collection, maybe trying some classroom based intervention, is appropriate. But I have trouble thinking more than a semester of "waiting and watching" makes sense.


I've also been hearing from parents that their child's teacher is unfamiliar with the psychoeducational assessment they have been given when we have one.  Sometimes I hear the classroom teacher hasn't read the psychoeducational exam report, and I've witnessed this at many school based meetings. It this something we should expect and accept?  Some teachers feel the information in the psychoeducational assessment is too complex, and that they don't have the training, knowledge or skills to make use of the test. That's understandable, some of these psychoeducational reports are written in a manner that's hard for me to understand. And grasping all the data can be difficult. So, I can understand why a teacher with a full load of classes decides his or her time is best spent elsewhere. Still, I feel the teacher needs to know about the results to make good teaching choices.


Here's what to do:
Schedule a sperate meeting with your child's teacher, the psychologist who wrote the report, administrators who deal with your child and appropriate members of the support team. At that meeting the school psychologist will review the report for everyone, and should be able to tell you and the teacher how these test results can be used in the classroom to make appropriate changes, accommodations to support your child.


Limit the topics at this meeting. Focus on the psychoeducational assessment and what we can learn from it. Make sure the psychologist is prepared to explain the report, and prepared with some suggestions. Don't surprise them! They may even write a one page brief summary to distribute at the meeting.


Psychoeducational reports can provide valuable information about a students strengths and weaknesses, and how to use their strengths, called "affinities by Dr. Mel Levine because he combines strengths with things you like to do, to overcome deficits. Teachers don't received training in understanding these reports, so as a parent you can set up the situation so that you child's teacher gets the support they need to know how to support your child with the help he or she needs. It's a win-win situation.


You don't need to accept a situation where the professionals working with your child are not even familiar  with his or her psychoeducational assessment.  Rather than becoming mad or frustrated, turn the situation into a learning opportunity for everyone. A good teacher will appreciate your help. Especially that one page summary!


Oh, and limit the number of suggested interventions. It's hard to implement more than three new things, monitor them and evaluate their effectiveness when you have a full class to take care of. Some reports come with 10,20 or more suggestions. Prioritize and pick three! 



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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 | 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
http://www.counsellingbc.com/listings/JRoche.htm

What is ADHD Coaching?


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



Diagnosis and Treatment for ADHD in Vancouver, Burnaby and Coquitlam

Information about the diagnosis of ADHD | ADD (Attention Deficit Hyperactivity Disorder) can be found on the following websites: www.relatedminds.com,  http://www.relatedminds.com/adhd-attention-deficit-hyperactivity-disorder/, www.adhdhelp.ca, http://www.bcpsychologist.org/users/jimroche or http://Therapists.Psychologytoday.com/70682  ADHD assessments and followup treatment is provided in Burnaby, Vancouver, Coquitlam, New Westminster and Maple Ridge. Psychological services for ADHD are not covered by MSP but are often covered by extended health care. Speak to your health care provider for information. Psychoeducational Assessments are also available. Waiting times are short, and reports are usually completed within 10 day.

Psychoeducational Assessments


Psychoeducational Assessments are provided in my Burnaby and Vancouver offices. These offices serve Vancouver, Burnaby, New Westminster, Coquitlam, MapleRidge, North Vancouver and West Vancouver. As a registered psychologist and a former classroom teacher (as well as a school psychologist and school behaviour management specialist) I provide a unique point of view on how psychoeducational assessment and test results apply to the real classroom and can be used successfully by teachers to make positive change. Psychoeducational assessments are costly, and are not covered by MSP. They are, however, usually covered by extended health care plans. Appointments for psychoeducational assessments are usually available within two weeks, and are completed in approximately ten days. Sometimes faster. For more information please visit my website at www.relatedminds.com or my psychoeducational assessment page.

For an appointment please call me at 778.998-7975
Dr. Jim Roche
Registered Psychologist

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

Changes to my ADHD pages | CogMed coming soon!


There have been some changes to my ADHD page and individuals are asked to go directly to the page at my website.  Most important, within the next three months I will be offering Cogmed services, a cognitive rehabilitation and training program for memory and focus issues. This is a computerized program you can use right in your own home under the guidance of one of my staff members. Cogmed is the only computerized training program that has been proven to help with issues of memory and more specifically active or working memory, a key factor in ADHD (Attention Deficit Hyperactivity Disorder). Stay tuned for the announcement, staff are attending their final training in October!  For more information on CogMed Services for Working Memory Training click here: http://www.cogmed.com/

Dr. Jim Roche is a Registered Psychologist and Marriage, Family Counsellor | Therapist. He has offices near Lougheed Mall in Burnaby (Servicing Burnaby, Coquitlam, Port Moody, New Westminster and Maple Ridge) and downtown Vancouver. Services include assessment - diagnosis of Autism (ADOS / ADR-I), psychoeducational assessment for learning disabilities, ADHD (Attention Deficit Hyperactivity Disorder) assessment and treatment and behavioural interventions for children and adolescents.  In addition to assessments Dr. Roche provides treatment for anxiety, stress, depression, and OCD in children and adolescents. Dr. Roche has been providing counselling,  therapy and assessments for over twenty years and has worked as a consultant to numerous school districts in both the United States and Canada.

For information on counselling and therapy services in Burnaby, Vancouver, Coquitlam and surrounding areas contact Dr. Roche at: (Office phone) 778.998.7975
Information on the details of counselling, therapy, assessment and testing services can also be found at:
http://bcpsychologist.org/users/jimroche
http://www.relatedminds.com/
http://Therapists.Psychologytoday.com/70682
http://psyris.com/drjimroche

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/)
Testing and Assessments and Learning Disabilities (Click here: http://www.relatedminds.com/testing/)
Couples Counselling / Therapy (click here: http://www.relatedminds.com/couples-therapy/)
Depression
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

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 webpage blog (http://www.relatedminds.com/kids-with-adhd-deserve-action-still/) this week looks back at a "Letter to the Editor" about ADHD | ADD treatment and services in local school districts. This letter is a year old, and addresses problems with getting ADHD recognized, getting ADHD services and the problems with the stigma and "chronic lack of awareness of ADHD" that the author found. I don't things have changed, and these same issues still come up win bring to deal with ADHD | ADD in our local school districts (Burnaby, Vancouver, Coquitlam, New Westminster and Maple Ridge). For more on this, click above and visit the blog from my website.

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


Dr. Jim Roche

Children with ADHD are at greater risk of being hit by cars.


An interesting article in the Huffington Post addresses an issues I've been talking with parents about all summer. Here is the link: http://www.huffingtonpost.com/2011/07/25/kids-with-adhd-more-likel_n_907102.html
In this study Despina Stavrinos, assistant professor at the University of Alabama Birmingham's Injury Control Center and the study's lead author, points out that children with attention deficit hyperactivity disorder(ADHD or ADD)are shown to be at greater risk for, for instance, being hit by a car when crossing the street. The new study suggests that because of differences in their ability to perceive risk, children with ADHD may choose to cross the street when it is less safe, even if they follow safety protocol like checking both ways. They know what to do, know the rules, try to use them, but still place themselves at risk.
"They are looking," explained Stavrinos. "But they are failing to see. Just like distracted drivers, they are going through the motions, but they are not actually processing the risk."
Here are the details of this ADHD study: "To better understand the potential dangers of street crossing, researchers from the University of Alabama at Birmingham looked at 78 children, 39 of whom had ADHD-C -- a subtype that includes both inattention as well as hyperactivity and impulsivity issues -- and 39 of whom did not. The children were between 7 and 10, the age at which The American Academy of Pediatrics states it may be okay for children to be unsupervised pedestrians."
"Using a simulator that mimicked a typical street scene, the children were given 10 different street crossing scenarios. Researchers found that those with ADHD performed as well as non-ADHD participants in terms of looking both ways before crossing. However, when it came time to actually cross, those with ADHD picked smaller gaps in oncoming traffic, had more "close calls" and gave themselves less time to reach the other end of the crosswalk before traffic approached."
In 2009, a Canadian study gave several possibilities for why children with ADHD might have such difficulties, suggesting that they might overestimate their physical abilities when it comes time to weigh risks. That same study also found that children with ADHD might not have actually perceived any consequences for engaging in a risky behaviour. "These studies -- and there need to be more -- suggest that there is a different way of processing," she continued, adding that these issues are not necessarily unique to ADHD.
The potential implications of such risk-taking behavior are serious: According to the Centers for Disease Control, unintentional injury is the leading cause of death in children. And a growing body of scientific literature suggests that children with behavioral disorders, including ADHD, are more likely to suffer injury than those without the disorder.
So what can be done?
Parents of children with ADHD should increase supervision, said Dr. Steven Meyers, a professor of psychology at Roosevelt University and a Chicago-based clinical psychologist. He said that "over-practicing" of certain safety behaviors is essential, so that they become second-nature in children.
"Over practice," and taking medication ALL THE TIME is essential to providing children with ADHD both the skills and the ability to avoid risk taking behaviours. Dr. Russell Barkley has been addressing this issue for years. In his papery The ADHD Report (May 2002, page 2-5) he addresses the issue of parents taking their children off ADHD medication for the summer, on weekend or for a "drug break."  His studies have shown that children on stimulant medications are shown to have fewer, and less dangerous, accidents. " Children with ADHD have approximately a three-fold increase in the likelihood of accidental poisoning...15% of hyperactive children have had at least four serious accidents...68% of children with ADHD have experienced physical trauma sufficient to warrant sutures or hospitalization...and only while only 39% of the general public has....40% of teens with ADHD have experienced two or more driving accidents while  only 5.6% of the general public has."
The list goes on. The point?  Children with ADHD have a significant increased risk of injury due to poor cognitive processing. They know the rules, can demonstrate them, and know when they aren't following them. In spite of that they have a high level of engagement in risk taking behaviour. If your child is requires medication (and not all children with ADHD do) remember, as Russell Barkley says, the ADHD medication is LIFE medication, something to take every day to stay safe. It's not just for taking math exams.  And about behaviours? Rules? Procedures like Stop-Look-Walk? Those may be known, maybe your child can explain them...but they need to be over learned. Over taught. Habits.

For more information on my practice, which provides both ADHD assessment and treatment programs, please go to my website at either www.relatedmindsbc.com/adhd, www.relatedminds.com or www.adhdhelp.ca


Accommodation for Students with ADHD | ADD | Attention Deficit Hyperactivity Disorder

(For more complete information on assessment and treatment please go to my web page at www.adhdhelp.ca)

Often parents wonder if their school is actually providing ADHD or ADD accommodations that make sense. Or they ask what accommodations they should consider. Recently there was an extensive newspaper article about research that showed British Columbia, including Vancouver, Burnaby, Coquitlam, Maple ridge, New Westminster and other local school districts were some of the worse when it came to providing support services for students with ADHD. While there are always trainings and supports for students with autism, ASD, Asperger's, physical and other cognitive deficits, there are very few trainings, consultations or other supports for either the students with ADHD of for their teachers. Check out your school district's list of training programs on a teacher professional development day. You are very unlikely to find any programs relating to ADHD. (I do many speaking engagements and trainings for autism, Aspeger's and social cognitive deficits in the Burnaby/Vancouver area, but only one time was I asked for training or consultative support for a student with ADHD.) This seems odd, as these are the students teachers feel are the most difficult for them to support. Speak to your school's principal and parent association about providing this kind of support.

Here are some common ADHD accommodations. You might want to just print this list off and use it as a check list for your child's school:


(Environmental Accommodations for ADHD | ADD)
PHYSICAL ARRANGEMENT OF ROOM:
__A. seating student near the teacher
__B. seating student near a positive role model
__C. having the teacher standing near the student when giving directions or presenting lessons
__D. avoiding distracting stimuli (air conditioner, high traffic area, etc.)
__E. increasing the distance between the desks
__F. providing an alternative (but positive) work space for the student to move to to complete tasks


LESSON PRESENTATION:
__A. pairing students to check work
__B. writing key points on the board (always in the same place!)
__C. providing peer tutoring
__D. providing visual aids (schedules, what to do next and what to do first visual lists)
__E. providing peer notetaker who share his or her notes
__F. making sure directions are understood by asking the student to repeat what has been said
__G. including a variety of activities during each lesson, including some that are hands on and physical
__H. breaking longer presentations into shorter segments with clear starts and finishes
__I. using computer assisted instruction
__J. providing written outline before the class
__K. allowing student to digitally record lessons
__L. having student review key points orally with a model if necessary
__M. using a system that clearly asks pivotal questions such as: "What do we need to do first"


ASSIGNMENTS and WORKSHEETS
__A. giving extra time to complete tasks
__B. simplifying complex directions, breaking them into components 
__C. handing worksheets out one at a time
__D. reducing the reading level of the assignments
__E. requiring fewer correct responses to achieve grade
__F. allowing student to tape record assignments/homework
__G. providing a structured routine in writing form
__H. providing study skills training/learning strategies
__I. giving frequent short quizzes and avoiding long tests
__J. shortening assignments; breaking work Into smaller segments
__K. allowing typewritten or computer printed assignments
__L. rewarding time on-task rather than task completion
__M. using self-monitoring devices such as visual checklists
__N. reducing or removing the need for homework
__O. not grading handwriting

TEST TAKING
__A. a1lowing open book exams
__B. giving exams orally (ie reading test items to student)
__C. giving take-home tests
__D using more objective items (fewer essay responses)
__E. allowing student to give test answers on tape recorder
__F. giving frequent short quizzes, not long exams

ORGANIZATION
__A. providing peer assistance with organizational skills
__B. assigning volunteer homework buddy
__C. allowing student to have an extra set of books at home (critical!)
__D. sending daily/weekly progress reports home (with an emphasis on positives!)
__E. developing a reward system for in-school work and homework completion
__F. providing student with a homework assignment notebook
__G. additional accommodations:


BEHAVIORS
__A. praising specific behaviors
__B. using self-monitoring strategies (visual if possible)
__C. giving extra privileges and rewards
__D. keeping classroom rules simple and clear
__E. making "prudent use" of negative consequences
__F. allowing for short breaks between assignments
__G. cuing student to stay on task (nonverbal signal)
__H. marking student's correct answers, not his/her mistakes.
__I. implementing a classroom behavior management system ( a token system)
__J. allowing student time out of seat to run errands, etc.
__K. Ignoring inappropriate behaviors not drastically outside classroom limits
__L. using an individualized token system
__M. allowing legitimate movement
__N. contracting with the student
__O. increasing the immediacy of rewards
__P. implementing time-out procedures

 


ADHD | ADD Testing and Diagnosis


RelatedMinded Educational Services
Services I provide for Attention Deficit Hyperactivity Disorder (ADHD or ADD) include:I have been providing services for individuals with Attention Deficit Hyperactivity Disorder (ADHD/ADD) for over twenty years. This has included diagnosis (with the aim of obtaining appropriate school, work and testing modifications), individual treatment such as skill development to deal with deficit areas like planning, attention, organization and procrastination, teacher training about ADHD and classroom consultations, cognitive behaviour therapy to help deal with the psychological effects of ADHD and finally couples/relationship/family therapy.

ADHD/ADD can effect 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:
  1. ADHD testing and assessment (neuropsychological and psycho-educational)
  2. ADHD Diagnosis
  3. ADHD Treatment plans for home, work and school
  4. Couple and relationship counselling for ADHD related issues
  5. 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 most diagnoses are 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 some other possible testing and a rather 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. This is because they may not feel they have the experience to do this diagnosis correctly, and because in many 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 do this 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.
Is a neuropsychological assessment necessary?Not always. The neuro-cognitive (neuropsychological) assessment that I provide for those with ADHD includes, but is not limited to, issues such as verbal memory, visual memory, processing speed, executive function (decision making, picking out what is important or salient, impulsivity and emotional control), psychomotor speed, reaction time, complex attention, cognitive flexibility and long term attention and focus. Through this testing we learn about how ADHD affects your flexibility of thinking, concept formation, problem solving, planning, creativity, impulse control, emotional stability, inhibition and procrastination (an inability to switch from one task to another). This information is very helpful in determining where to focus our interventions. Not only telling us about the weaknesses you may have due to ADHD, but also pointing out your cognitive strengths and affinities. This helps us develop strategies based upon your strengths.
How do you know I have ADHD and not something else?
In addition to these neuropsychological tests and extensive history taking we also look at factors that might direct us towards other or co-morbid diagnoses such as depression, anxiety, bi-polar disorder, learning disabilities and so on. ADHD is known for being found in combination (co-morbid) with several of these other disorders in children, adolescents and adults. Sometimes these disorders mask the nature of the ADHD. Sometimes we can mistake another disorder for ADHD. So along with the comprehensive neuropsychological assessment we also look at personality issues that help in ruling out other possible causes for the issues that you are concerned about. This is a particularly helpful for medical doctors who often send their patients to me for help as they are often not equipped or experienced in this level of diagnosis. This information helps your medical doctor in making better choices in terms of medication if you and your doctor make a choice to explore medication for your ADHD.
Finally, we complete a comprehensive behavioural and medical history that also helps us understand your problems, how ADHD may effect your day to day life at work, home or school, and how we might intervene to help you deal with your ADHD symptoms.
Some parts of this examination are repeatable, so that at a later time we can see if ADHD treatment interventions have really had an effect on your symptoms. I provide a set of procedures and documents that you, your child’s school or parents can use to measure the effects of any ADHD intervention (behavioural or medical). The truth is sometimes we feel better because we think we are better, or sometimes we fail to notice complex cognitive improvements after taking medication because they are hard to measure. These tests and data collection procedures are specifically designed to help determine if real changes have taken place in your ADHD symptoms.
What would a treatment plan for an adult look like?Often I see adolescents and adults for an initial cognitive evaluation and diagnosis. Once a diagnosis of ADHD is made and we have enough information to understand how ADHD impacts you we develop an intervention plan. We usually meet an average of eight times, using a combination of psycho-educational (teaching) and weekly consultation to get you off on a program you can continue on your own. Here is a general outline of the meetings and intervention schedule I often use:
Assessment, Review and OverviewSession 1    Review of assessment results; Overview of the ADHD program; Discussion of involvement of family and work mates
Organization and Planning for Individuals with ADHDSession 2    The basics of organization and planning skills; Organizing multiple tasks
Session 3    Problem-solving and managing overwhelming tasks; Organizing papers
Reducing Distractibility due to ADHDSession 4    Gauging your attention span and distractibility; Modifying your environment
Adaptive Thinking Part 1Session 5    Introducing the Cognitive Model of ADHD (Cognitive Behaviour Therapy)
Adaptive Thinking Part 2Session 6    Review of Adaptive Thinking and previous sessions
Session 7    Dealing with Procrastination
Session 8    Preventing ADHD Relapse and setting future goals
Following this eight week course outline together we cover all major areas of concern that commonly are found with ADHD. As I mentioned above, we  also fine tune the program to address your specific deficits and strengths that we identified during the assessment process, making success much more likely. Individuals are then able to use appropriate self-help tools with confidence and the knowledge and experience they need to make the most of them.
After this initial program ADHD clients sometimes see me on a monthly basis, or quarterly, for “check ups” and to address problems with relapse.
Finally, for those who with the help of their primary medical provider decide to take medication to deal with this disorder, we are able to provide ongoing neuro-cognitive assessments that help monitor the effects of the medication. Research has found that for those diagnosed with Attention Deficit Hyperactivity Disorder (ADHD or ADD) a combination of medication and behavioural training is the most effective path.
What about ADHD treatment for children and adolescents?I work extensively with children and adolescents. One thing I am able to provide that others may not are interventions for the school and home that are acceptable to the school stafff. My experience as a classroom teacher for nearly 10 years, and as a school based educational psychologist, gives me insight into how common treatments for ADHD are best adapted to the school environment. I also provide schools with training workshops and teacher consultation on ADHD.
Do you recommend any specific books about ADHD? There are so many out there I don’t know where to start!For adults we often use the Cognitive-Behavioural Treatment Program for Adults with ADHD developed by Safren and Sprich, which has been found useful with adults. I also ask clients to watch Russell Barkley’s A New Understanding of ADHD (a DVD available in the office) as well as his new book Managing Your Adult ADHD and read either Kelly and Ramundo’s You Mean I’m Not Lazy, Stupid or Crazy?, Hallowell and Ratey’s Driven to Distraction or Thomas E. Brown’s Attention Deficit Disorder: The Unfocused Mind in Children and Adults.  All of these books can be obtained in my office or through Amazon.ca (just click!).  For those who find reading difficult or find finding time to read difficult (and these are all 200+ page books) I have CD’s and DVDs available. I have similar books on ADHD for parents that specifically address parenting and school related issues.
What about faster methods for dealing with ADHD like Neuro-Feedback, Hypnosis or Diet Changes? Don’t they work?The short answer is no, they don’t. There is very little evidence supporting any of these treatment methods for ADHD. You may hear that there is research showing neuro-feedback works for ADHD, autism, Aspergers and many other problems. The truth is that after over twenty years of research there is no real evidence that neuro-feedback or neurotherapy has any significant effect on behaviour, school success, attention or impulsivity.  (Dr. Russell Barkley, a leading researcher in the field addresses this issue on his web page.) Diets, except for those with a specific allergy, have been shown to have no effect on ADHD. Chiropractic and homeopathic interventions have not been shown to have any effect. “Sound therapy” and hypnosis, likewise, has been show to have no effect.  Two web sites I often suggest individuals look at for information about these “alternative” therapies are www.sciencebasedmedicine.com and www.quackwatch.com. I would be more than happy to share the research on these alternative methods with you upon request. My best advice is to ask your medical doctor what he or she knows about these often ineffective yet expensive interventions. He or she is your best source of information.
How much does treatment cost?
Individual sessions cost $160.00 per hour, slightly below the rate suggested by the British Columbia Psychological Association. Testing, such as a basic diagnostic assessment usually take four sessions, including the feedback session where we discuss the specific nature of ADHD and how it affects you. More comprehensive diagnostic testing is sometimes necessary for obtaining adaptations and modifications in school, the workplace or for high stakes testing. This level of ADHD assessment includes cognitive, academic and personality components and costs approximately $1,600-$1,800. However, this is not always necessary or recommended. A basic ADHD diagnosis for use by your medical doctor should take approximately four hours total. Services are available in both Burnaby and Vancouver. The Burnaby office serves Burnaby, Coquitlam, Port Moody, Port Coquitlam, New West Minster and Maple Ridge. The Vancouver office serves Vancouver, West Vancouver and North Vancouver.
Before you come in:
My website’s “forms” page has several handouts, books and articles on ADHD. (click here) Please, go there and check them out. And if you are coming in for an appointment there are several forms I’d like to have you complete prior to coming in, but please wait until I tell you which forms. Different cases and situations complete different packets of information. You should also feel free to call me and ask any questions you might have. My office number is 778.998-7975. If I’m not available feel free to leave a message and I’ll return your call as soon as I can.

More on Diet and ADHD / ADD

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

ADHD Diet Plan Improves Behaviour? No, not really. Read the small print.

Every newspaper, weekly magazine and blog seems to have published a headline about an "elimination diet" that helps kids with ADHD (Attention Deficit Hyperactivity Disorder) control behaviour. "Change their diet, and their behaviour changes." Yep, as easy as that, and here is the scientific proof it works. No, not really. After years and hundreds of studies showing this idea that ADHD is caused by and can be cured by diet IS NOT TRUE, suddenly there is a study that shows it is true. How can his be? Well, read on and I'll tell you.

What we know from past research is that parent and teacher expectations of the effects of diet on kids with ADHD (Attention Deficit Hyperactivity Disorder). In previous studies we did things like tell one group of parents that kids were eating sugar filled candies and we wanted to know what the effect was. Well, the kids went crazy! And then another group of kids were given candies with no sugar ...hmmmm. No effect. Then we find out the candies were all the same. And sometimes we have done similar experiments when none of the candies had sugar and so on and on and on. What happens are a couple of things: Parents and teachers change their behaviour to match what they think is happening. When the kids are getting the food they think should quiet the kids down the parents become more structured and organized, and also interpret the kids behaviour that way. And the parents and teachers told that their kids we getting the food with the harmful and ADHD causing ingredients acted in a way to excite the kids, over-reacting, and saw many behaviours that were similar to the first group as signs of ADHD. This is sometimes called observation bias or confirmation bias. We see and note what we expect. We all do this, and a good scientific study avoids this by "blinding" the study. In a good study no one knows who is getting what medicine, no one knows what group is getting the treatment, what group is not.

On top of this problem is the placebo effect. Kids told that a pill containing nothing is really going to help them feel like it has and act like it has. And the same goes for parents.

These are what, for decades, we have found to be happening when studies have shown a relationship between food additives, colouring, sugar, wheat and so on and behaviour in children and adolescents with ADHD (Attention Deficit Hyperactivity Disorder). We see parents changing their family schedule to fit a new diet they think will cure their child's ADHD, they put charts up, measure food, insist time schedules are met and are in constant contact with the school and teacher about the diet. Everyone's expectations change, everyone's behaviour. and somehow they all think it's the diet. t isn't, it's the placebo effect plus confirmation bias plus a touch of behavioural expectation change.

Research has been clear that there is no effect on ADHD by a restrictive diet, except in those cases where a specific child might have a specific allergy or reaction to some food or ingredient. And those cases are few and far between. That doesn't mean your child may not have a food allergy that causes discomfort and thereby causes acting out. Ask your MD about that. But ADHD is a genetic disorder relating to the frontal lobes of the brain, it's an executive disorder, and it isn't caused by junk food.

That doesn't mean your kid should eat junk food. A child who eats a crappy diet is going to feel crappy. But potato chips will not make him a serial killer.

So back to this study. If you actually read it, which apparently none of the great newspaper science reporters or the million and one bloggers have, you will note some very serious problems. Let's start with: Nothing was blinded. Parents knew who was eating what, teachers knew. And I expect the kids knew. So what are we seeing from the results? I'm afraid nothing more than the combined effects of placebo effect (a healthy diet will calm you down, lets eat a healthy diet) and confirmation bias (see, he really has calmed down now he doesn't eat that junk)....oh, and a good helping of positive effect from the behavioural efforts of parents and teachers making sure diets were followed. (Behaviour changes when it is watched.)

What we have in these results isn't proof that decades of research was wrong, but instead proof that it was right. Diet is unlikely to have a significant effect on your child's behaviour. But changing your behaviour, organizing your life, structuring meals, changing your expectations, interpreting behaviours more positively and communicating actively with the school actively WILL have a significant effect on your child's behaviour. Note that those are the components of a good ADHD intervention program that experts like Dr. Russell Barkley have suggested for years.

I know, I am a curmudgeon. I doubt everything, so I came prepared with the opinions of other experts in the field:

Harvey Leo, an allergist and immunologist at the University of Michigan, said in an e-mail, "There are severe limitations to this study, and after reviewing the current paper, I do not think any of the data presented [have] any true validity." Dr. Leo noted the lack of strict monitoring of compliance with the dietary recommendations and the lack of information on the exact makeup of the diet. Like me he said the benefits observed were likely due to enrollment in the study and rigorous monitoring -- rather than an effect from diet modification -- because children with ADHD respond to structure and organization. "If the parent was truly committed to the diet," Leo said, "I think the child would see some benefit in behavior."

Then there is Michael Daines, MD, a pediatric allergist and immunologist at the University of Arizona, who called the study "interesting, but flawed," pointing to the lack of blinding in the study groups, which would potentially affect all of the data. And William Pelham, PhD, a psychologist at the University of Buffalo, who cited studies conducted over the past 30 years that have failed to support a consistent relationship between dietary manipulations and ADHD symptoms. "One open study allegedly demonstrating a relationship does not change my mind," he wrote in an e-mail. More on these opinion can be found at:

Medical News: ADHD Diet Plan Gets Mixed Reviews - in Pediatrics, ADHD/ADD from MedPage Today

What I regret is that the many newspaper articles and blogs that reported this (more often than not with ads on the side of the web page advertising miracle ADHD cure diets!) failed repeatedly to note the problems with the studies, and failed to note that decades of other studies found the opposite results. odd to leave those issues out. I am surprised the Vancouver Sun hasn't made this a front page article with it's usual lack of analysis. But it's only been a couple days. I suggest we all write to our local papers and ask them to pay more for a science editor, and maybe get someone with a science degree.

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

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

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


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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

School Accommodations and Solutions that Provide Help for Parents of ADHD Children

A parent came back to see me today after taking her son's neuropsychological report to his school and, after amazingly waiting six weeks, had an IEP meeting. For those who are new to this an IEP meeting stands for an Individual Education Plan meeting. After a child is determined to have a disability the school should be setting up a meeting and reviewing the test results. From those results, and feedback from the child's teacher, a plan is written up to set up accommodations that will help the child succeed. So, for a child with ADHD (Attention Deficit Hyperactivity Disorder) we should be looking at what environmental changes need to take place, what support and special teaching or training the child should have. Regretfully once again the IEP for ADHD that the school developed consisted of no more than a long list of behaviours the school wanted to stop or change, and the consequences for the child continuing to engage in those behaviours. This result, an all too often one, is the worse of all possible worlds for your child. And I'm going to make some suggestions on how to avoid this happening to you.

1. Put everything in writing. Anything you say to the school, and agreement, any information exchanged needs to be in writing. That means either a letter or an email to the committee AND the principal. EVERYTHING. I would also purchase a small notebook, one with numbered pages if possible, and bring it with me to every meeting. EVERY meeting. Write down what was said, and what you think it means. Write down who said it, and who was there. A year of inaction can quickly go by. This documentation will be very important later if you need to appeal to the Ministry of Education or if you need a lawyer to get your child the education they should be getting. Letting the staff see that you are keeping notes also helps remind them that what was said and agreed to is going to be remembered. At least by you.

2. Prioritize your child's needs. Make a list of what are THE most important things you think your child needs. It should not be too long. But make sure you understand what your goals are going into the meeting. A school can seldom follow through on more than three big items, so know what those are. Having them written down will help you stay focused at the meeting. (Maybe teach this skill to your child when it's appropriate too!)

3. Pre-plan the meeting. Who is going to be there? I can't tell you how often a teacher-aide is at a meeting, but not the child's teacher! The special education or support teacher ISN'T YOUR CHILD'S TEACHER. Get that straight in your mind right now. I'll repeat it: THE SUPPORT TEACHER IS NOT YOUR CHILD'S TEACHER. The classroom teacher is responsible for your child and the need to be at the meeting or the meeting is a waste of time, period. Get the school to agree who will be attending ...and get it IN WRITING. The school psychologist should be there. The speech pathologist if appropriate. Whoever is in charge of "discipline" needs to be there. But most of all, your child's classroom teacher.

Prepare an opening statement. You need to take control of the meeting from the start. A short, one or two paragraphs, statement of what you are looking for. It should emphasize that your are looking for "positive behavioural and educational support," and will not accept punishment or negative consequences of any kind for your child's DISABILITY. Get use to using that word, I know it might be painful, and there are those who preach against "labels" and all the rest of it. STOP! That philosophy is often misused to hold children with disabilities "accountable" for their symptoms. Don't fall into this political trap. You child, right now, needs help to be successful. If you don't want to talk about it in useful medical and LEGAL terms you will end up fighting a losing battle because the number one thing you have on your side to protect your child is that his or her behaviour and academic difficulties is caused by a DISABILITY. And we do not punish, give consequences for or expect san 8 year old to be accountable for their symptoms. It's the schools job to teach alternative skills, alternative behaviours and to do this through positive reinforcement, modelling, rewarding, training and extra support.

(Some parents bring photos of their child, art work, pictures of things they have created or made, and cookies....yep, if you can set the stage for a positive and friendly exchange. Remember, these are the people you are going to leave your child with for most of his or her awake day. This is a give and take situation.)

As I have mentioned before on this blog, many parents make a copy of the DSM-IV's symptom list for ADHD (Attention Deficit Hyperactivity Disorder) and start the meeting by distributing it, along with a statement that these are my child's symptoms, caused by a disability. He will not be punished for his symptoms. Our job is to teach him ways to deal with his symptoms, new skills, and to provide whatever support is necessary for him to be successful.

You might practice these little speeches with a friend. And remember, you can bring a friend with you for support. I would.

4. Be open to what the school says. I have been pretty hard on the schools so far, but they really do have limitations on funding and personnel. Be open to negotiate and to give and take.

5. Find out who is the responsible person. Someone is in charge of your child's case, a "case manager." Make sure you know who that is, but make clear that you are not side stepping the classroom teacher. The classroom teacher needs to be made aware of all communications, plans, interventions and needs to be familiar with your child. Ask if the classroom teacher has read the psychological or educational assessment. Most of the time they have not. If they haven't, ask them to, and ask if the school psychologist could review the testing with the classroom teacher. For a classroom teacher to not have read the child's report, or at least read the IEP, is unforgivable to me. But the plane truth is MOST classroom teachers have not. So, find a gentile and supportive way to get them to do it. Ask at the meeting if your child's teacher could be given an extra prep period to use to review the testing and IEP with the school psychologist. Be supportive. But insist.

6. Make sure there is time to end the meeting properly. You want an ACTION PLAN. Who will do what? By when? How will all of you know that's been done? Ask someone to write it out and have copies made for everyone BEFORE you leave the school.

7. Follow up with a thank you note to everyone who attended, and if you can, an outline of your understanding of the plan.

Somewhere in all of this you need to arrange for an appropriate communication system about how your child does every day. Research has shown that a DAILY school note about academics and behaviour is one of the most powerful interventions available for ADHD. (See Russell Barkley) A daily school note. My next blog is going to address the way we do a school note and provide feedback because it can either be something that supports you child's school success, or something that causes problems, headaches and makes you child hate school because it is used to punish and control. So make sure you read my next blog.



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

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

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


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

Evidence-Based Medical Care Cuts ADHD Symptoms but Not Impairment

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

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

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

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

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

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

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

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

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


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

ADHD/ADD (Attention Defiict Hyperactivity Disorder) Relationship Advice

Re-Tie the Knot: ADHD Relationship Advice | ADDitude - Attention Deficit Information & Resources (click to read the article)


Although all married couples have to navigate challenges, communicate effectively, and work cooperatively, ADHD places extra strain on a relationship. In the article above (just click the article to find it) this clinician points out that “many clients with ADHD (Attention Deficit Hyperactivity Disorder) have partners who are so highly organized that they are jokingly accused of having Attention Surplus Syndrome, or ASS. Over time, it seems, the “opposite” qualities that originally attracted the two to each other lose their appeal.”

I couldn’t agree more, and this article contains a nice and simple little rating scale used to help you out with these issues. ADHD is often a major factor in pushing a couple over the edge. As a Registered Marriage and Family Therapist I often see couples who are having numerous problems, but taking the steps necessary to salvage their relationship really means taking a step towards dealing with one (or sometimes both) spouses ADHD. Sometimes one parent has ADHD and one or more of the children, and the remaining spouse ends up being a “parent” to everyone...until his or her energy simply runs out.

So here are some hints on how to handle your partner if you suspect ADHD is underlying a great deal of your issues:

1. Get a comprehensive diagnosis. This means not relying on inconclusive evidence. Short forms and tests (very similar to those you often see on ADHD web pages ...and I urge you to STOP reading those!) often only look for symptoms of ADHD. And the problem is that those symptoms are sometimes caused by ADHD, sometimes by OCD, sometimes by focused memory problems, sometimes by specific learning disabilities or depression or anxiety or a language disorder...the list is really pretty long. Individuals get these quick diagnoses and then get medication, then time goes by and nothing happens. Nothing changes. Often it’s because the diagnosis is wrong.
Trying medication to see if it works! I don’t know what to say, some people try their kids medication, or their brothers, and sometimes the medication helps with a particularly difficult task (like taking a test). Don’t do this, get a decent psycho-educational evaluation. Your choice of medication may just be masking a more serious problem.

2. Taking current problems to mean life long problems you didn’t discover. Lots of people do this. What appears to be ADHD is really the result of temporary anxiety and stress, working beyond your capacity and ability. ADHD is chronic and long term. It starts fairly early in life, and can manifest itself in different ways. (Yes, there is an inattentive type, and a “slow processing” type that many people would never think of as “ADHD.” But they are. A clinical history is necessary to understand the nature of your problems.

3. Failing to consider co-existing conditions. This is a common mistake. Some patients have ADHD, but their anxiety is very high, and dealing with the anxiety is just as important, if not more important, than dealing with the ADHD. The anxiety, or depression or anger management issues need to be addressed systematically, usually with Cognitive Behaviour Therapy or CBT. This is why I often recommend to clients that they see a Registered or Licensed mental health professional rather than someone who is a “certified coach” or “professional organizer.” These individuals are not trained or prepared to help you with a diagnostic clarification or with the complex interventions that are part of CBT. See a professional, and that means someone who is Registered or Licensed by the Provincial government or your state.

4. Don’t leave your spouse/partner out of this! Psycho-education is a critical component of ADHD treatment. This is especially important in a situation that involves a relationship because many people don’t accept the diagnosis of ADHD, think the person with ADHD is doing what they are doing purposefully, with intent, and mistake many behaviours such as the variability of attention and focus as proof that the behaviours are controllable. Nothing could be further from the truth. The variability of symptoms from day to day, if not hour to hour, are part of the diagnosis and the disorder itself. The ability to focus on something an individual finds interesting, for long period...long periods...is part of the disorder. It isn’t just your spouse who thinks your “simply lazy” but lots of people I’m afraid, and THEY need to be educated. (My web page suggests a great book by Mel Levine called “The Myth of Laziness” and one by Kate Kelly and Peggy Ramundo called “You Mean I’m Not Lazy, Stupid or Crazy.” The answer is “Yes, that’s exactly what I mean ...... and now we have to teach you to get this across to important people in your life.

5. Looking for Quick Fixes to Immediate Problems. Well, I do want to help you find quick, immediate and useful strategies to immediate problems. That’s a good idea. But a well structured ADHD intervention will cover a wide area of topics and skills, some of which you may already have. We do this so that we can make use of your cognitive/behavioural strengths to make up for cognitive/behavioural weaknesses. A structured treatment approach is best.

6. Expecting miracle cures from those “magic pills.” Medication is the first and most important intervention for ADHD/ADD. Research is clear about this, and there are specific ways medication should be given. One medication that helped your brother may not help you, and the one that help the neighbor’s kid may make your kid a little jumpy. Having a comprehensive diagnosis helps get the medication right. And once you take it, well most people report significant and positive changes. But remember: ADHD/ADD is a developmental disorder. If you have severe ADHD/ADD and can’t organize your way out of a paper bag, medication isn’t going to help you get organized. It will prevent your brain from preventing you from getting organized. But organization is a behaviour skill you should have learned as a small child, when learning to be organized was fun and reinforcing. Learning to organize your room, homework time, paperwork or schedule is not going to be fun at age 12, 18 or 35. You may need both the medication AND some behaviour techniques to learn the skills you never really learned very well, and maybe learned to do in ineffective ways.

6. Anger Management. This is often the last thing someone wants to deal with, and is the most damaging to a relationship. Poor impulse control often has done a lot of damage to a relationship and you will need help undoing that damage and learning skills to control your emotions. Often, to the surprise of many, this involves learning some self control techniques AND getting some assertiveness training.

7. Finally, there is communication. Communication problems often have developed over time, with both partners becoming frustrated with the lack of appropriate responses, the lack of skills and taking what seems like the best path...communicating less. When you find a professional to work with make sure they have basic skills in working with couples, and communications training is a critical part of that.

I hope this isn’t an overwhelming list. I often try to make these posts short and direct. But here I’ve tried to outline as many of the essential components to a properly implemented treatment program for ADHD/ADD when there are others involved. Actually, as I look it over, this isn’t too different from what we always need to do with ADHD/ADD. Find a professional who has experience in mental health, assessment and relationships, not just ADHD/ADD. A minimal program usually involves a few months of treatment. If it’s too costly you can find a professional to guide you through one of the many structured self-help books for individuals with ADHD/ADD. I use an 8 week structured program, and we go from there. What important to remember is that when you are involved in a relationship the treatment of ADHD/ADD can become complicated but for most treatment leads to significant, positive and long lasting changes. The outlook is bright! Go back to the top of this page and read the short article I’ve suggested on communication. You’ll see a simple and effective technique you could start using today.

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

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

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


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

Daily Coaching and Professional Organizers May Help With ADHD

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

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

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


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

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

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

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This blog is not offered as medical advice or as a means of diagnosing or treating ADHD, learning disabilities, autism, relationship issues or any other disorder. Don't go on line and take an autism, ADHD, intelligence or relationship "test." Diagnosis is complex, and it involves not just looking for symptoms of a disorder, but also ruling out other disorders that might look just like what your worried about. So avoid these on line "tests" which are nothing more than a collection of symptoms. You need to see a licensed or registered professional for that. You can obtain a referral from the British Columbia Psychological Association for a psychologist near you to help you with these matters, or if you are in another province or state contact their psychological association.

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