Attention Deficit Hyperactivity Disorder (ADHD or ADD) in Vancouver/Burnaby, BC

I have been providing services for children, adolescents and adults with Attention-Deficit/Hyperactivity Disorder (ADHD/ADD) for over thirty years. This includes comprehensive ADHD/ADD testing/diagnosis with the aim of obtaining appropriate school, work and testing accommodations and supportive service, as well as individual behavioural treatment, such as skill development, to deal with deficit areas such as planning, attention, organization, and procrastination.

I also provide teacher training and classroom consultations about ADHD. As a former classroom teacher, special education supervisor and behavioural consultant for several school districts in Canada and the United States I bring a unique set of skills and perspective to this work.

Over thirty years ago I began seeing couples dealing with ADHD, sometimes one or more of their children had ADHD, sometimes one or both of the parents. For them I provided cognitive behaviour therapy to help deal with the psychological effects of ADHD and couples/relationship/family therapy to deal with the stress that ADHD can have on your relationships. I try to provide simple, understandable and focused treatment aimed at teaching specific skills you will find helpful in your day to day life and relationships. These ADHD services are provided in my offices in Burnaby and Vancouver. 

Services include:

  • ADHD testing and assessment (neuropsychological and psycho-educational assessments)
  • ADHD Treatment Plans for home, work and school
  • Couple and Relationship Counselling for ADHD related issues
  • Training for problems with focus, concentration, reading, planning and procrastination and anger management (including Cogmed and other training programs for deficits in working memory)
  • Assistance with obtaining appropriate accommodations and services through your school, college, university or workplace
  • You may be asked to complete a number of forms before you come in for your appointment. They can be found by clicking here.

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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. Testing also helps us differentiate symptoms that look like ADHD from other things, such as depression, anxiety, mood disorders or related "executive dysfunctions." Many people are diagnosed with ADHD who in reality have something else. These services are available in both Vancouver and Burnaby.
 

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. Many medical doctors would prefer you to see a qualified psychologist about ADHD because they do not have the expertise to do a full diagnosis, which often involves not just a simple checklist of ADHD or ADD symptoms, but also ruling out other possible reasons for the symptoms you or your child may be experiencing. This means completing some other possible testing and an extensive history taking your MD may not have time to complete. Of course, some MDs are able and willing to do a diagnosis of ADHD for you and will use these simple scales. In both my Burnaby and Vancouver offices I see many patients who are referred by their MD after they have already met the criteria for ADHD. This is because they may not feel they have the experience to do a complete diagnosis correctly – because in approximately 50% of cases ADHD or ADD is associated with co-morbid disorders such as learning disabilities, language deficits and behavioural problems you will need to see the psychologist about anyway. The MD, however, is often able to complete an initial diagnosis under your provincial MSP, which is free to you. Services from a psychologist must be paid by your extended health care provider, your employer or through self pay. This is a very legitimate concern.

Is a neuropsychological assessment necessary for an ADHD diagnosis?No. 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? I understand a lot of people get diagnosed with ADHD who don't really have ADHD
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 with ADHD look like?
Once a diagnosis of ADHD is made and we have enough information to understand how ADHD impacts you we develop an intervention plan. We 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. Over 8 consecutive meetings we will likely discuss immediate uses you are having, and spend part of the time discussing these following topics:

  • 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

Following this eight week 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.

For those who with the help of their primary medical provider decide to take medication to deal with this disorder I 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, psychoeducation 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 staff. 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 and classroom environment. I also provide schools with training workshops and teacher consultation on ADHD.

Do you recommend any specific books about ADHD? Especially about Adult 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. For those who find reading difficult or find finding time to read difficult (and these are all 300+ page books) there are CD’s and DVDs available. I have similar books on ADHD for parents that specifically address parenting and school-related issues.

For teachers dealing with ADHD in the classroom, the Ministry of Education provides some guidelines and intervention strategies which are an excellent place to start. This information may be helpful for parents as well, as often it is unclear what level of intervention we should expect for a student with ADHD in the classroom. Here is the website url: http://www.bced.gov.bc.ca/specialed/adhd/

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 by themselves 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 minimal evidence that neuro-feedback or neurotherapy has any significant effect on behaviour, school success, attention or impulsivity. Recently there has been some evidence that a combination of neurofeedback and medication is more effective than medication alone, but the best known interventions include medication, psychoeducation and behavioural/environmental interventions in the school and home. (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 websites 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 ADHD treatment cost?
Initial, Assessment and Continuing Sessions (usually 50 mins) are billed at a rate of $200.00. This is below the current rate recommended by the British Columbia Psychological Association. For those seeing me long term (more than 4 sessions) there is a reduction in the hourly rate. A full ADHD assessment for a diagnosis, which takes several hours - three sessions- costs $800.00. The testing and assessment usually take three to four sessions, including a feedback session where we discuss the specific nature of ADHD and how it affects you and treatment interventions that would be appropriate. More comprehensive diagnostic testing is sometimes necessary for obtaining adaptations and modifications in school, the workplace or for high stakes testing.
 

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OTHER HELP and ADHD RESOURCES
Often I suggest readings, web pages and other resources for individuals or their families with ADHD, autism, Asperger's Disorder and related neuro-cognitive disorders. Here is a list of several of those resources you may find useful. If any of these pages/links become outdated, please email me at relatedmin

Is ADHD a "real" illness? 
Often I am asked this question, in spite of many decades of clear supportive research, people still fall victim to some nonsense on the web that questions the validity of the ADHD diagnosis. Here is a link to the consensus report showing support by the vast overwhelming body of scientific researchers: Click here: Consensus Report on ADHD

What's the best website for science-based information on ADHD?
The best websites I can suggest are:
1) Dr. Russell Barkley's site (click here: http://www.russellbarkley.org)
2) the CHADD website (click here: http://www.chadd.org).
Dr. Barkley is THE leading researcher and is the man to go to for up to date information on ADHD research and treatment. CHADD is a great support network and a good way to avoid less than useful theories and fads that are all over the internet.
There is also a local chapter of CHADD: Click here: http://www.vcn.bc.ca/chaddvan/home.htm 

There are also two very good government websites to help you understand ADHD, it's diagnosis and treatment, that are scientifically based - evidence based. One for Canada, and one for the United States. Here are the links: 

NIMH web page: This page has everything you need to know about treatment, diagnosis, ongoing research, medications and so on. http://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml  This link addresses ADHD in children and teens: http://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder-teens-fact-sheet/index.shtml

Canada also has a very useful site: http://www.caddra.ca The CADDRA website has a lot of good reading and resources for you. Very helpful, and often, regretfully, not something your family doctor is familiar with. 
 

What does a good diagnosis of ADHD consist of - and why does your ADHD assessment cost $700? 
Let's start by looking at the "practice guidelines for Canada on the CADDRA site: http://www.caddra.ca/practice-guidelines/expanded-toolkit. These are the forms and  procedures your doctor should use to make a real diagnosis of ADHD. Because ADHD symptoms can be caused by several other issues, and ADHD can mask other co-morbid conditions, an assessment of any quality takes time. We have to rule other possible causes out, and make sure you don't have other problems as well (nearly 50% of children diagnosed with ADHD have another disorder such as anxiety, depression or a specific learning disability. While in truth a diagnosis of ADHD can be made in a few minutes by collecting a history and current symptoms, and some professionals say no testing is really needed (Dr. Barkley says this, but if you look at the history and number of symptoms checklists Dr. Russell advises you to use you will see following his "no-test" procedure will take even longer than using tests!) Finally, writing a treatment plan means knowing more than the fact you have ADHD. We need to understand your strength and weaknesses in order to develop a plan that fits you. These things take time.
 

I hear all sorts of things about sugar, diet, herbs, homeopathic treatments and scary things about medication. How do I know what's true and what isn't?
That's a hard one. Start by reading articles on a popular science-based website called "Science-Based Medicine." The website can be found here: http://www.sciencebasedmedicine.org  Learning the ins and outs of science research is a big task, and honestly, many people with graduate degrees don't do too well at this either. But Science Based Medicine is a good and fun place to start. A lot of people come in and ask about homeopathic treatment. Homeopathy is not what most of them think. Here's a good place to start: http://www.sciencebasedmedicine.org/reference/homeopathy/  Another place to learn about homeopathy or to find out about any treatment you have some doubts about is a site with the direct name: Quackwatch. You can find that site here: http://www.quackwatch.com Finally, you can type into google or any search engine a question about some treatment and type the word "skeptic" after it, this will usually lead you to an article on some science based web page that includes information from someone who has "done their homework" on the topic.

I bring these issues up because many parents and adults come to my office after having spent a great deal of time and money on treatment, interventions or life-style changes for which there is no scientific evidence, and sometimes evidence that they don't work or harm, but for which you can find many web pages full of science "sounding" information that is nothing more than someone with a strange, often paranoid belief system who tells you about 1/2 the story. Before you engage in anything, look it up on these websites and simply ask your doctor. And remember, if your doctor says, "It won't hurt..." she usually means it won't help, but I don't want to hurt your feelings or get into a long discussion. Go to Quackwatch, Science-Based Medicine or type the word "skeptic."


Do you have recommendations for an ADHD coach?
Regretfully most of the ADHD coaches" I've met are individuals with no training and no license who have very little understanding of the complexity of ADHD, it's neurological causes and how medications work and how ADHD interacts with other co-morbid disorders. I often suggest, once we get going on a treatment plan for your ADHD that you simply bring in a friend, a co-worker, your spouse or whoever and they spend some time with the two of us learning about the disorder and how they can become your coach by providing simple check-ups of about 5-10 minutes a few times a week. It's cheaper, often more effective, and they are then working under the supervision of a professional in the field. Sorry, that's just how I see it. Most books on ADHD talk about coaches and how to use them, and usually you and someone you can trust and rely upon can use the instructions in one of these books to work out a procedure for you to get the help and support you need.

ADHD is a life-long disorder, and treatments need to change as you change, grow and mature. Life situations change, jobs and responsibilities, relationships all change, and these changes can have an effect on your symptoms that on one day were under control and the next, not so much. Find a good mental health professional to work with.

How do I know someone is an expert in this field?
Someone licensed (if your in the US) or Registered (if you are in Canada). That means someone who didn't just join some association or take a weekend workshop or two about ADHD or "coaching."  A "REGISTERED" professional in Canada is someone who has a license to practice granted by a regulatory board. Here we have only a few REGISTERED professions (although some individuals call themselves registered - not everyone is. The REGISTERED professions here in BC are Registered Psychologist, Psychiatrist, your Medical Doctor, nurses and Registered Social Workers. "Registered Counsellors" in BC are actually not regulated, they have no regulation body and minimal training standards. Some are very good and experienced, but the BC Counselling Association is not a regulatory body like psychologists, social workers and medical doctors practice under.) 

My perspective is that someone practicing ANY specialty should have a number of classes in that area, many hours of study- not just a weekend course, Plus supervised experience. That means for a period of time they had a senior specialist in the field to work with. When you contact someone about ADHD services ask, "What specialized training do you have in ADHD? And did you get supervised experience? What school or association was that through?"  If you are embarrassed to ask this in person or over the phone send them an email.  If you are looking for someone to deal with your child's school problems ask what experience do they have in the schools? Of if you need couple, marital or family counselling, what background do they have in couple, marriage or family therapy? Family therapy, offered by many "counsellors," is actually a specialized field of study with a separate graduate degree track, certification and licensing/registration. While we don't have a regulatory body in BC for "Registered Marriage and Family Therapists(RMFT)" we do have a professional association that requires members to have been credentialed by the American Association for Marriage and Family Therapy, taken two years of full-time supervised experience and, in most states, an exam. Look for a psychologist who is also a member of the British Columbia Association for Marriage and Family Therapy (BCAMFT).
 

What about schools and ADHD? What should I expect for services in the BC public school system?
I have little positive to say about the schools in BC and the services they provide children or teens with ADHD. Some students in BC with significant learning problems wait for 2-3 years before a psychoeducational assessment is provided, and even with a psychoeducational assessment completed they wait months before an Individual Education Plan (IEP) is written. I have worked in schools all over North America, in Europe and Asia and I have never seen a situation like this. If your child has learning problems or possible ADHD he or she needs interventions and accommodations as early as possible. And those interventions need to be strong enough to make your child's educational experience successful. Am I just a complainer? Read this from the Canadian Association of medical doctors who specialize in ADHD (CAADRA): http://www.cbc.ca/news/technology/3-provinces-get-failing-grades-on-adhd-report-1.926530   Yes, BC received a failing grade for how it deals with ADHD in the classroom. 

Here is a copy of the BC regulations about ADHD. If you have a child in the BC school system, I advise you to read these pages: http://www.bced.gov.bc.ca/specialed/adhd/

Other provinces have really excellent support, handbooks and video training for teachers. I often share those materials when I consult with schools. Dr. Barkley has a great training video for teachers with students who have ADHD.  The number one intervention that we have used, that has been shown to improve behaviour and maintain student progress is an old one: positive behavioural supports. Completing a good functional behaviour assessment (FBA) and then writing "positive behavioural support plan" (PBSP) is the first step. I use to teach these skills in districts during treacher professional days, but the topic of "special needs students" has become a difficult one here in BC and interest seems to focus not on getting a good IEP written, or a good FBA and PBSP, instead most meetings focus on how many hours and minutes of teacher-aide time will be available. So, for a complex educational issue the emphasis is often on increasing the time the child spends with the least trained person on staff. An odd and difficult situation. My advice is to go back, read the handouts on ADHD in the classroom from the ministry, print them out and use those as your basic level of expectation.

In the USA many parents rely on this site and the materials available from it: http://www.wrightslaw.com/speak/schedule.htm  Regretfully here in Canada we have different laws, but take a look at what the expectations are just across the border!  One thing I can tell you is: Send every concern in writing, emails provide a record of your interactions with the schools and their responses. And never attend any IEP or "support team" meeting alone. Bring a mental health professional with you if you can afford it, or at least bring a friend. Your child's educational plan is to be developed with your input and agreement. If you disagree there are formal ways to contact the ministry of education. Every school should have a flyer about that available for parents. I see them in some schools, and in others they don;t know what I'm talking about. Your child should have an IEP as soon as school opens, and it should be based upon a comprehensive assessment. It's as simple as that. Oh, and take a look at the American Academy of Pediatric's statement on the use of medications with children. Medication can be an important part of your child's learning success - but the AAP says behavioural therapy, classroom management techniques and parent education come first. Click here for the information: http://www.cdc.gov/ncbddd/adhd/guidelines.html

OTHER WEB RESOURCES

General Articles on ADHD

I hope this brief outline of resources is helpful. There are many, many more, but this provides enough to get you going. Again, if you have concerns about ADHD with children, adolescents or adults, feel free to contact me.

Study and School Related Resources

  • The Cornell Note Taking Method: Click here  This is the best way to take serious notes that help you in understanding materials, clarifying materials and studying for quizzes, tests and exams. I also teach another note taking method called the "Two Column Note" that is useful in more general study situations, but the Cornell System is overall the number one method of note taking.

 

To contact me about an appointment, please use the form below:

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Services are available in Burnaby. The Burnaby office serves Burnaby, Coquitlam, Port Moody, Port Coquitlam, New Westminster, Maple Ridge and Vancouver. The office is located in an office building connected directly to the Production Way Sky Train station.

You may have been asked to complete some forms prior to coming in. You can find those by clicking here.

Key Words: ADHD, ADD, Attention Deficit Hyperactivity Disorder, Burnaby, Vancouver, Maple Ridge, Coquitlam, New Westminster, Psychologist, Coach, Testing, Assessment, Diagnosis