Psychoeducational Assessments, ADHD and Autism

After a few weeks away from the office things are back to usual ...almost. Office hours are available in both the Burnaby and Vancouver locations for assessments, including Psychoeducational assessments, neuropsychological assessments, diagnostic assessments for both Autism Spectrum Disorder and Aspergers Disorder (which meet the Ministery requirements in British Columbia for private assessments of ASD) and related diagnostic work. Please feel free to contact the office, however the schedule is still rather full and it can often take until the weekend before youer call is answered. An initial contact through email is welcome at relatedminds@gmail.com, however if you do contact the office through email please do not include any personal information you would not want shared. People make mistakes emailing, sometimes emailing to the wrong address, so make a more general inquiry first.

A number of people want to kniow how quickly a psychoeducational assessment can be completed. Usually it takes 2 days of face to face testing with the student. There are additional items to be completed, however those can often be done on line or at home. So, two days of actual testing. Usually 3-4 hours each day. The report is usually done within the next ten days. This is a much shorter time than you will find elsewhere.  Appointments can usually be made within the next 2-3 weeks.

Costs of psychoeducational assessments average around $2,400.00, but can be more if additional testing needs to be donne.  Payments are usually made as follows: Payment for the three  hours of testing time scheduled is made before an appointment for the assessment can be made. Cancellations must be made 72 hours in advance, as a large block of time is scheduled. At the initial session 50% of the fee is due, and at the time you recieve the report the remaining 50% is due. Payments can be made in the office by Mastercard or VisISA, or on line using other credit cards or a back card. Checks are also accepted.

Assessments for Autism Spectrun Disorder. The cost of an ASD asseswsment ranges from $2,600.00 to $3,200. The final cost is dependant upon what the assessment calls for. Some children need both an ASD assessment for diagnosis (using the ADOS and ADI-R) AND a Psychoeducational Assessment in order for the school to set up an appropriate Individual Education Plan. You need a Psychoeducational Assessment before an IEP can be completed. Sometimes the school can or already has provided that service. With younger children a medical doctor's report and a report from a Speech and Language Pathologist  must be part of the assessment to meet the needs of the Ministry. Those are obtained seperately and are then used as part of the final process by the psychologist.

Getting an assessment does not automatically lead to a diagnosis of ASD, nor does it automatically lead to Ministry funding. Just as getting a Psychoeducational Assessment does not necessarily lead to an IEP or services from the schools.

Finally, often parents and adults are seen for ADHD (Attention Deficit Hyperactivity Disorder) assessments. These vary in cost, as they may include a psychoeducational assessment, or may not. These are arranged individually.

If you are exprecting to use any assessment in a legal situation (often adults with ADHD want an assessment due to work difficulties) the assessment process is different. It requires using different tools, and gathering additional information. You need to be clear on the purpose of the assessment from the start.

I aklways suggest that parents write out what they want an assessment to do. What should it provide? Assessments are always done in order to answer a question. "Why doesn't John read as well as he thinks?"  "Why can't Nancy write? She reads above grade level but can't seem to write out answers to questions?" It's always good to spend time thinking out these questions.

ADHD assessment and treatment also need to address specific deficits and needs. An assessment is much better at answering how best to reach a goal, rather than asking what goals should we have.

Dr. Jasmes Roche
relatedminds.com
www.relatedminds.com

Offices in Burnaby and Vancouver

Kids with ADHD deserve action: One Year Later

Today I reread this great letter to the editor about ADHD, ADHD treatment and ADHD in the schools here in BC. The link is below and you should read this letter yourself, it's a cry from a parent for the local school districts to do SOMETHING for students with ADHD in the schools, anything! Because what BC schools are doing for students with ADHD is totally unacceptable. It's actually nearly nothing. Here is a link to the web site and letter to the editor: http://www.burnabynow.com/health/Kids+with+ADHD+deserve+action/3699644/story.html

Here are some of the comments from the letter, and my additional comments: First, the writer talks about being "anxious and frightened on how we'll try to navigate through an education system that doesn't recognize my child's ADHD as a disorder." This is perhaps the most shocking and incomprehensible part of the letter. And it's true. ADHD, one of the disorders most likely to cause school failure, academic failure, lead to low graduation rates, low employment rates and even relates to many co-morbid disorders (such as specific learning disabilities) is IGNORED by many of our local school districts. Some districts will provide help, but only if the child is a "behavioural problem." Academic stress and failure in school aren't enough. We need to wait until there is "behavioural disruption" due to the ADHD. Strange. Backwards. And it's no wonder British Columbia is tied with two other provinces for the worse services for children with ADHD.

 The writer notes, "it is a neurological disorder that is medically recognized and that requires treatment." The writer needed to have her child tested privately to finally get the diagnosis. Let me make clear, when we say it's a neuropsychological or neurological disorder that means we can put a child into an MRI and SEE areas of the brain failing to function. ADHD is one of the most researched and tested diagnoses of all childhood disorders, yet some school district personnel still fail to accept that it even exists! The writer goes on to say, "each year, we are frustrated at the stigma associated with a chronic lack of awareness of ADHD, and lack of support and resources for a disorder that affects thousands of children." If your child has autism, the school gets funding, usually assigns an aide, and for children under 6 parents get over $20,000 in funding for treatment. Over six years of age they continue to get thousands of dollars of funding a year, both the school and directly to parents for treatment they find and make use of. In BC we have zero funding. A child suspected of having ADHD needs to be assessed and usually this means not just an ADHD assessment but also a full psychoeducational assessment as nearly 50% of these children have other disorders such as anxiety, depression, OCD, ODD or specific learning disabilities. Yet MSP will pay zero, and most private insurance will pay from 100-500 dollars for services. (A full diagnostic evaluation can cost from $1,200-2,600.00) When visiting schools I am usually there to see students with autism spectrum disorder or Aspergers Syndrome. These children have funding and get classroom aides, teacher training and consultation from professionals like myself or the provincial organization 9POPARD- the Provincial Outreach Program for Autism and Related Disorders). Yet the teachers I meet who are burned out, confused, need the most help and are most likely to be the ones going out on sick/stress leave are the teachers of students with ADHD. For them, regretfully, there is little support.

 In the past few years I have been invited to consult on hundreds of students, and present workshops for teachers during their professional development periods. Only twice has a school thought it important enough to bring me in to speak about ADHD. Autism, Aspeger's Syndrome, general classroom management,and severe behaviour problems. I always tell them, the biggest bang for your buck is training your teachers in techniques and skills to work with and support students with ADHD. Every class has 1-3 students with ADHD, and the techniques and tools we teach that address ADHD work for almost every other issue. But before teachers and administrators ask for help with ADHD training they need basic education to understand and recognize ADHD.

Regretfully, we still have teachers and administrators who think ADHD is a made up excuse for laziness and poor parenting. It's time BC moved out of the dark ages of mental health. "ADHD Assessment and Treatment" are written by Dr. Jim Roche. These autism notes are not meant to provide a guide to either diagnosis or treatment. For information on diagnosis and treatment contact your medical doctor or a registered/licensed psychologist for an appointment and assessment. Information about Dr. Roche's services can be found at these addresses:

 At Relatedminds: http://www.relatedminds.com
 At ADHDHelp BC: http://www.adhdhelp.ca
 At Psychology Today: http://therapists.psychologytoday.com/rms/70682
 At the BCPA website: http://psychologists.bc.ca/users/jimroche
 At CounsellingBC: http://www.counsellingbc.com/listings/JRoche.htm
 At Psyris: http://psyris.com/drjimroche

KEYWORDS: ADD, ADHD, Attention Deficit Hyperactivity Disorder, ADD Coaching, ADHD Coaching, ADHD Coaching Vancouver, ADHD Coaching Burnaby, ADHD Coaching Langley, ADHD Coaching Coquitlam, Psychoeducational Assessment, Learning Disability, ADHD Diagnosis

Think Your Child Has ADHD?

WebMD has an excellent and short video on the initial steps to diagnosing ADHD in children. This ADHD video on diagnosis also addresses the use of medication for children and teens with ADHD. As usual, medication is not the first step one should necessarily take after finding your child has ADHD. Common, well known behavioural interventions in the home and classroom are the recommended first step, and these remain important parts of treatment for ADHD no matter if you make the choice to use medication or not. Certainly it is clear that parent education, student/child psychoeducation and behavioural therapy and ADHD Coaching are step one and are always part of any good treatment plan.

Here is the link to this ADHD video: Think Your Child May Have ADHD? Learn More - Watch WebMD Video http://www.webmd.com/add-adhd/video/diagnosing-adhd

For more information on the diagnosis of ADHD in children, adolescents or adults, see my web page at www.relatedminds.com ADHD can be diagnosed by either a medical doctor or registered psychologist with appropriate training and experience. An initial medical exam is always necessary to rule out possible disorders that cause the behaviours of concern that may not be ADHD. To find a registered psychologist who can diagnose ADHD contact the British columbia Psychological Association.

More information about my practice can be found at: "ADHD Assessment and Treatment" are written by Dr. Jim Roche. These autism notes are not meant to provide a guide to either diagnosis or treatment. For information on diagnosis and treatment contact your medical doctor or a registered/licensed psychologist for an appointment and assessment.

Information about Dr. Roche's services can be found at these addresses: Relatedminds: http://www.relatedminds.com
ADHD Help BC: http://www.adhdhelp.ca
At Psychology Today: http://therapists.psychologytoday.com/rms/70682
At the BCPA website: http://psychologists.bc.ca/users/jimroche
At CounsellingBC: http://www.counsellingbc.com/listings/JRoche.htm
At Psyris: http://psyris.com/drjimroche

 KEYWORDS: ADD, ADHD, Attention Deficit Hyperactivity Disorder, ADD Coaching, ADHD Coaching, ADHD Coaching Vancouver, ADHD Coaching Burnaby, ADHD Coaching Langley, ADHD Coaching Coquitlam, Psychoeducational Assessment, Learning Disability, ADHD Diagnosis

Girls with ADHD more prone to self-injury, suicide as they enter adulthood

Girls with ADHD more prone to self-injury, suicide as they enter adulthood

Science Daily, a science based blog which often includes information on medical issues including ADHD has an excellent review about girls with Attention Deficit Hyperactivity Disorder (ADHD) and their families . (click on the link above to find it) They note how the families often "look forward to the likely decline in visible symptoms such as fidgety or disruptive behavior as they mature into young women. However, new findings from UC Berkeley caution that, as they enter adulthood, girls with histories of ADHD are more prone to internalize their struggles and feelings of failure -- a development that can manifest itself in self-injury and even attempted suicide."

According to the article, "Like boys with ADHD, girls continue to have problems with academic achievement and relationships, and need special services as they enter early adulthood," said Stephen Hinshaw, UC Berkeley professor of psychology and lead author of a study that reports after 10 years on the largest-ever sample of girls whose ADHD was first diagnosed in childhood.

I experience these special needs all the time with both girls and boys with ADHD who come to my office. While you can look on the web and see that "talk therapies" do little to help the symptoms of ADHD such as inattentiveness, hyperactivity and poor emotional regulations, talk therapy, especially CBT (cognitive behaviour therapy) specifically addresses these issues of anxiety and depression which we see in boys - and girls - not just teen agers, but also 8,9 and 10 year olds. Children with ADHD often have feelings of frustration, failure and hopelessness due to their ADHD symptoms. Some feel that they are "evil" in that they disobey their parents, cause fights between them and family stress, and can't seem to do the right thing even though they know what the right thing is. If you have a child with ADHD, girl or boy, I'd take a look at this article and consider your child's need for supportive counselling from a license or registered mental health professional. ADHD isn't just co-morbid with these disorders, but can be the root cause of many of them.  Not all children react this way, those with supportive families, friends and a positive school environment can and do do well. But a good relationship with an experienced mental health professional may be necessary.

Talk to your medical doctor about this need, or contact a registered or licensed psychologist for an assessment and consultation. It's best to teach children the social-emotional skills they need rather than to be applying these skills after the fact. Your best bet is to ask questions of trusted professionals in the field. 

Ups and Downs of ADHD

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

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

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

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

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

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

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

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

Early ADHD Treatment May Save Math Skills

Here is British Columbia we are very reluctant to test children in the early school years. Often, from parents, I hear that their child, who is failing academically at school, is not a "priority" as there are no severe behavioural issues. So, they are placed on a waiting list, which usually is rewritten every school year, and they never get assessed. Parents are often waiting for the school assessment - a psychoeducational assessment - to tell them about ADHD. They are often surprised when the psychoeducational assessment is completed to find out the schools neither diagnose ADHD, nor do they provide any structured and measurable treatments for ADHD (for the most part.) While there are some individual school districts here in BC that do have organized interventions for ADHD, they are few and far between, and BC is known for providing the fewest services for children with ADHD of all the provinces. So, we often wait through grades 1,2 and 3 and maybe in grade 4 or 5 we finally get a psychoeducational assessment and are old to visit either a medical doctor or a registered psychologist for a diagnosis of ADHD. Only after all of this waiting around are we ready to begin treatment interventions. And one thing we have known for sure is that early intervention for ADHD is critical, because its a developmental disorder, and developmentally appropriate skills are often not learned, and are hard to teach at the "wrong" developmental stage. Math is often the first academic skills to suffer. And trying to catch up in math in grades 5,6 or 7 is very difficult. This review article from Medpage looks at the results of EARLY treatment for ADHD, and how early ADHD treatment may be critical in saving math skills. Click http://www.medpagetoday.com/Pediatrics/ADHD-ADD/33441 for the full story The research points out two critical facts that I want to make clear at the beginning: 1) Starting treatment for attention-deficit/hyperactivity disorder (ADHD) sooner rather than later appears to lower the likelihood of a decline in academic performance as children move from elementary to middle school, and 2)that the timing of ADHD treatment had little influence on the risk of a decline in language arts performance.This is also important because parents, and teachers, often assume that because language based skills -reading, writing - are pretty much up to par the student only needs to be further encouraged to take academic work seriously. "They can do the work they want to do ...so we know they can do the work," is the false, misinformed and unfortunate thing I often hear. Here are the basic findings from the article, found at Medpage: "Starting treatment for attention-deficit/hyperactivity disorder (ADHD) sooner rather than later appears to lower the likelihood of a decline in academic performance as children move from elementary to middle school." "Among Icelandic children receiving ADHD medications, those who started treatment later had greater risks of a decline in math performance (RR 1.7, 95% CI 1.2 to 2.4), an association that was stronger in girls than in boys." Fairly early meds lead to better academic outcomes. Here is an interesting historical fact: "In 1937 -- 75 years ago -- when children were treated with stimulant medication for the first time, the boys referred to the medication as their 'arithmetic pills' since they noticed their math performance improve." Even the kids knew this was helping, and helping specifically in math. "More recently," the researchers continued, "math performance (speed and accuracy) has proven to be a very sensitive and reliable clinical measure of medication effectiveness in many research studies." The researchers noted that previous studies have shown that mathematics disabilities and language disorders involve different parts of the brain. "Possibly," they wrote, "stimulant drug treatment has more positive effects on the cognitive function underlying mathematical ability than on that underlying language ability." Although stimulants have been shown to improve the core symptoms of ADHD, there are few long-term data on their effect on academic progress. To explore the issue, the researchers, Zoëga and colleagues looked at data from 11,872 children ages 9 to 12 born from 1994 to 1996 who took standardized tests in the Icelandic school system in the fourth and seventh grades. Information came from the Icelandic Medicines Registry and the Database of National Scholastic Examinations. About 8% of the children were treated with ADHD drugs at some point during the study period. Nearly all of those treated received methylphenidate (96%); 9% also received atomoxetine and 34% received another psychotropic drug concurrently. The children who started taking ADHD drugs between the fourth and seventh grades were more likely to decline in test performance -- defined as a drop of at least 5 percentile points -- compared with nonmedicated children. So we see that while the medication might be helping, it is not enough alone. But they noted, "There were also differences seen within the treated group; later treatment initiation (25 to 36 months after the fourth grade tests) was associated with higher rates of performance decline compared with earlier initiation (within 12 months of the fourth grade tests).Declines in math were seen in 73% of those who started later and 41% for those who started earlier. Language arts declines were seen in 43% of those who started later and 39% of those who started earlier." They also note that, "When broken down by sex, the relationship between starting treatment later and a decline in math performance was stronger for girls than for boys (RR 2.7 versus 1.4). That finding could be due to chance or could be related to sex differences in ADHD symptoms, according to the researchers, who noted that girls with ADHD typically present with symptoms of inattention and have less hyperactivity than boys." They noted, "It is possible that children who started ADHD treatment earlier may have more family or social support to help them in school." However the results are fairly clear. Here in BC we find ourselves in an educational system that is over focused on math. You can't get into a university here without completing specific high school math courses - even if you have high grades in all your other courses and plan on majoring in history or fine art, problems in math will hold you back in BC (while the schools essentially ignore ADHD and other neurological deficits that are at the root). You may agree or disagree with this emphasis on math. The problem is that it is real. So EARLY intervention is critical. Talk to your medical doctor, see a registered psychologist for information on ADHD diagnosis and non-medical interventions, and speak up for services at school. For those interested in the problem of math education, the New York Times had an excellent article this morning on just this subject. It can be found here: http://www.nytimes.com/2012/07/29/opinion/sunday/is-algebra-necessary.html?smid=pl-share Information on ADHD assessment and treatment services I provide can be found at www.relatedminds.com or www.adhdhelp.ca.

Cogmed and ADHD. Well, maybe Cogmed +

Someone recently wrote to me about using Cogmed, a computerized training program to address problems with "working memory" and ADHD (Attention Deficit Hyperactivity Disorder or ADD) That's the part of memory that holds something in your head while you do something else - like hearing a phone number, getting a piece of paper and pencil and writing it down. One writer pointed out that Cogmed isn't designed for "curing" ADHD. The writer is correct, Cogmed training isn’t supported for helping with ADHD. When you are certified to provide the services, you are told not to make such claims. Sorry, generalization with these techniques is pretty poor. None of these "brain games" work well with something as complex as ADHD. But Cogmed is good for working memory, and if working memory is an issue improving working memory can really help. And sometimes working memory is holding someone back ...so, get your working memory assessed and see if it's a significant part of the problem. Any registered or licensed psychologist can help you with that. (Regretfully many ADHD coaches seem to rush people off into using these programs when they are simply inappropriate. Make sure your ADHD coach is a registered or licensed mental health practitioner, and not simply someone certified in "coaching.") While there are always suggestions that some treatment will “fix” ADHD, one critical issue is always missed. ADHD is a developmental disorder. During normal childhood development,because of ADHD, a number of developmental skills are either not learned, or learned improperly. Because of core neuropsychiatric impairments in attention, inhibition and self-regulation individuals often fail to learn to use appropriate compensatory strategies to be successful at organizing, planning and managing procrastination/avoidance/distractibility. This leads to a functional impairments which none of these "quick fix" methods including neurotherapy, biofeedback, brain games, diets and supplements helps with. There is no pill or simple intervention to fix the functional impairments of ADHD and teach these skills, just like there is no pill to teach French, hockey or cooking. Organization is something you learn very early in life, usually in play, and it is reinforced naturally in the environment. (Parents clap, say ”what a nice job!” or the blocks stand up really tall!) When we work with an adult who might be having trouble at work with organizing, well, honestly, learning the skill is one thing, using it, is NOT reinforcing. Most of my adult clients need to deal with the fact that if they become more organized at work they will most likely ..... get more work! If you remember to do 10 things on your to-do list, it’s most likely not 10 “fun and exciting” things to do... and not terribly reinforcing things either. If they were, you would have done them. "Getting better can be a bummer," someone once said to me. And to top it off, then mood disturbances can develop. After a history of failure, underachievement, the development of negative thoughts and beliefs takes over (get the CBT manual out!). People really do need a coach, therapist or a very supportive friend to do this kind of work. Someone specifically trained in dealing with the cognitive issues involved in most mood disorders. A good program for ADULTS with ADHD should address medication, health and exercise, teaching organization and planning skills, working with multiple tasks, learning to prioritize, problem solve, reducing distractibility, understanding and gauging your attention span (there is a really neat device suggested by Russell Barkley called “The Motivator” - a timer/buzzer/reminder you wear to remind you to stay on task. Most of my clients love it!). Clients also need help modifying their environment to reduce distraction, and need help with adaptive thinking (it’s a frontal lobe issue!) It’s really a plate full. Usually the key to success, as Dr. Russell Barkley would stress, is externalizing key information. Giving clients something to rely on more than their own memory. About 1/2 of my practice is adult ADHD cases, and most clients come already taking medication or after using some other specific technique. Many spend a lot of time with these “brain games” and try all sorts of diets, supplements and “alternative” treatments. After some initial success, there are set backs. In the end, anyone seeing adults with ADHD should remember the majority of the work we will be doing together is old fashioned therapy - maybe people would call it “coaching” now - but it involves assessing and understanding the FUNCTIONAL deficits each client has, and not just implementing a single technique or intervention. It means addressing each, one after another. A good, structured approach works best, but there are simply no quick and dirty cures, fixes or ways to avoid the problems of ADHD. With the help of a properly trained mental health provider you can learn the skills you missed out on, improve those that you know to a degree, and together develop a holistic plan to make your life better, easier and more successful.

ADHD and Procrastination (again)

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

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

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

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

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

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

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

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

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

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

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


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

30 Tips for Being Organized with ADHD ...REALLY?

On one popular web page for those with ADHD there is an article called 30 Tips for Organizing Your ADHD Life. 30 tips! That seems, well, excessive. It reminds me of the many ADHD books people come in to my office with that have 3-4-5 hundred pages. And they are just lost. Now while some of these tips are interesting and sound simple (like getting a wallet that's red or another bright colour so it's harder to lose). But tip after tip after tip.... This leaves someone with ADHD even more confused and in the end feeling even more like a failure.

Here is an important work: Salient. (http://dictionary.reference.com/browse/salient)

If you have ADHD (Attention Deficit Hyperactivity Disorder, sometimes called ADD) you most likely already have 30 tips ...if not more. The problem is implementing the right ones. No one, with or without ADHD can implement 30 plus changes, no matter how small, into their daily life successfully. An ADHD coach - usually a psychologist or other licensed or registered mental health professional with experience working with children, adolescents and adults with ADHD- can help you by figuring out where to start and what to start with.  (There are a number of individuals in Vancouver and the greater Vancouver area calling themselves ADHD coaches, but few are actually licensed or registered professionals. Find a good ADHD coach by calling the British Columbia Psychological Association and asking for someone in your area who has expertise in ADHD and they will provide you with a list of three or more registered -that means regulated by the government - professionals.

A good place to start is with an assessment of your strengths and weaknesses. Some individuals with ADHD have weaknesses in visual memory, some auditory memory (what they hear versus what they see). Some, both. some have weaknesses that only show up when things become complicated or they become anxious (many individuals with ADHD have co-morbid disorders of anxiety, depression and specific learning disabilities, and only a registered or licensed professional can help you determine if this is the case with you).

Other may have difficult switching mental sets, moving from one topic to another - sometimes people call this "transitioning." This may very well be the case with some individuals who suffer from procrastination. Procrastination, for instance, may be caused by this issue of difficulty with switching sets- moving from one activity to another, or it may be cause by anxiety, or depression or due to thoughts and scripts running in your head about what is going on. These individuals often benefit from cognitive Behavioural Therapy.

Working memory issues can also be a real issue for someone with ADHD. Working memory is the process of storing something in your head for a short time, like a phone number, while you do something with it...like dial a phone. And some of us are much more susceptible to visual or auditory distractions.

ADHD is complicated, it can manifest itself in many different ways, and understanding your neurological strengths and weaknesses are critical to making good choices in picking out which "tips" to use. Reading several Vancouver ADHD coaching webpages I see links to these "Tip" articles. Most of my patients tell me how they have tried these, and tried them again, and "nothing works." A well trained professional coach or therapist can help you figure out which 1, 2 or 3 tipis might actually work for you. He or she can keep you on track, modify the procedure based upon your neurological strengths and weaknesses, and help you to understand why this particular skill or tool works when others don't. After a while you will learn to recognize common factors in the tools you use, and instead or trying to memorize 30 tips to do you will learn how to approach situations that have given you difficulty in the past in a new way.

A good place to start for almost everyone is to try and figure out what is salient -important. Picking out the critical issues from the many many issues you are confronted with every day. Rather than a complex schedule and planner having a simple list of 3 things I need to do. Because most important is know what IS important.

I'd avoid the 16 tips, 30 tips and the "book of tips." Find a professional by calling the British Columbia Psychological Association, they can provide the name of a professional in Vancouver, Burnaby, New Westminster, Coquitlam ....anywhere in BC. Then get a reasonable evaluation completed by that person. Know exactly where your strengths and weaknesses are because all ADHD is not the same. And then start to find out what would be salient for you to do. 1-2-3. That's it.

Forn information about my practice serving clients with ADHD in Vancouver, Burnaby, Coquitlam and the surrounding areas please go to my web page at www.relatedminds.com or www.adhdhelp.ca

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KEY WORDS: ADHD, ADD, Vancouver, Burnaby, East Vancouver, West Vancouver, North Vancouver, New Westminster, Coquitlam, Port Moody, Maple ridge, Assessment, Testing, ADHD Coaching

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ADHD Coaching and Diagnostic Services

Dr. Jim Roche
ADHD Services
ADHD | ADD Assessment, Diagnosis and Treatment, including ADHD Coaching by a Registered Psychologist with over 20 years experience in the filed of ADD | ADHD treatment and intervention in schools, home and work. ADHD affects individuals, families and relationship. I provide interventions based upon the latest science and evidenced based treatments.

KEY WORDS: ADHD, ADD, Attention Deficit Hyperactivity Disorder, Coaching, Diagnosis, Burnaby, Vancouver, Coquitlam, New Westminister, Psychologist, ADHD Coaching

 

Could you define ADHD Coaching?


ADHD coaching
ADHD coaching is a specialized type of life coaching that uses specific techniques geared toward working with the unique brain wiring of individuals with attention-deficit hyperactivity disorder. Coaches work with clients to help them better manage time, organize, set goals and complete projects. In addition to helping clients understand the impact ADHD has had on their lives, coaches can help clients develop “work-arounds” strategies to deal with specific challenges, and determine and use individual strengths. ADHD Coaches also help clients get a better grasp of what reasonable expectations are for them as individuals, since people with ADHD “brain wiring” often seem to need external mirrors for accurate self-awareness about their potential despite their impairment.
For information on ADHD coaching I offer in Vancouver (serving Vancouver, West Vancouver and North Vancouver) and Burnaby (serving Burnaby, New Westminster, Coquitlam, Maple Ridge and Langley) see my ADHD web page (click here).

KEY WORDS: ADD, ADHD, ADHD Coaching, ADD Coaching, Coach, psychologist, ADHD Coach Vancouver, ADHD Coach West Vancouver, ADHD Coach North Vancouver

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



ADHD Coaching | ADD Coaching

ADHD | ADD assessment, diagnosis and treatment, including ADHD Coaching services information can be found through my website. Coaching services include initial psychoeducational evaluation or appropriate neuropsychological assessment, weekly training and coaching via SKYPE or home. Low cost and highly effective evidence based interventions are the focus of this service.
My new CounsellingBC website can be found at: http://www.counsellingbc.com/listings/JRoche.htm