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


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

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.

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Dr. Jim Roche

Management of ADHD

Further information about ADHD | ADD assessment and treatment can be found at my website: http://www.relatedminds.com and http://www.adhdhelp.ca




In this video Russell Barkley, Ph.D., discusses the recent advancements in understanding the nature and subtyping of ADHD. as well as recent discoveries in what might cause the disorder, and medications that might help treat ADHD. This video is from the series: M.I.N.D. Institute Lecture Series on Neurodevelopmental Disorders [11/2008] [Health and Medicine] [Show ID: 14660]

Dr. Barkley talks about a very important issue with ADH, how the problem is one of future orientation, of planning, or thinking ahead, and how the fact that it is so closely connected with the motor area of the brain (a place we do a lot of planning).

Dr. Barkley also looks carefully at many of the advances in the treatment of ADHD. This includes an interesting discussion of the nature of attention. He reviews the six types of inattention, and how ADHD is about sustained attention or persistence. This type of attention is on the motor side of the brain, while the other types are on the perceptual side of the brain. He discusses how they react to stimuli differently. It is a different kind of distraction of attention from that found in depression or anxiety.

Resistance to distraction is also a key component to the issues of ADHD. But again the problem isn't on the perceptual side of the brain, while with the child with ADHD it is a deficit on the motor abnormality, rather than perceptual side.

Finally he addresses the problem of holding information in mind  helps us stay focused on the task, to return to the task.

Many clients who have watched this video have found it to answer so many questions they have had about themselves and their behaviour. Understanding these deficits helps you develop a plan for action, and not be overwhelmed by feelings of guilt about what you do.

Great video! Enjoy.

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

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

Study urges doctor's OK before teen with ADHD (attention deficit hyperactivity disorder)can drive

Study urges doctor's OK before teen with ADHD can drive

When patients visit my office I have to go over an informed consent form. One item that might seem odd is that I have to inform patients that I am required by law to report impaired driving. That doesn't mean driving while intoxicated ...well, it does, but it means more. It means if you have a head injury, a stroke or other disability that makes your driving dangerous to others, I need to file a report with the proper authorities. Your medical doctor needs to do this too, he or she just doesn't inform every patient that comes through the door. As a matter of fact, medical doctors never do any informed consent until a major treatment intervention is at hand ....but that's another story. Bt impaired driving is one of those critical issues for mental health providers here in BC. Research is clear that ADHD can and often does impair driving. People with untreated ADHD (attention deficit hyperactivity disorder) are more likely to get in accidents, more likely to be injured and when injured spend more time and money in the hospital. Those are the simple facts.

This interesting little article points our thatthe opinion of many that behaviour disorders should be listed among official conditions that force young drivers to get doctors' approval before earning and maintaining their licence. This new study that finds behaviour issues are behind a significant portion of vehicle crashes among teen boys.

The study led by Dr. Donald Redelmeier at the University of Toronto said conditions such as attention deficit hyperactivity disorder (ADHD) could reasonably be added to an existing list of conditions that require medical clearance before driving.

"Maybe ADHD ought to be considered just like diabetes, epilepsy . . . or narcolepsy — that is the patient must show they are in good medical condition if they wish to maintain their driver's licence," said Redelmeier, who is also a physician at Sunnybrook Hospital in Toronto. "I don't think it should be a prohibition, but think it should be on the list of notifiable medical conditions.

He said, however, that the prominence of crashes involving teens between the ages of 16 and 19 aren't limited to when the teens are behind the wheel. "The risks don't end when you stop driving. We find teenagers with ADHD are also predisposed to be pedestrians involved in motor vehicle crashes." Now think about that! Not only are teenage boys in more accidents, its both as the driver and the victim! OFten parents with children on ADHD medication want to just give the medication to their child when they are at school, "It's for learning, right?" they say to me. I tell them it's for life, not just learning. The medication and behavioural treatments are designed to reduce impulsive and RISKY behaviour, something teens are already doing too much of, and teens with ADHD increase the frequency and severity of risk taking behaviour (that includes drugs, sex, and jumping from places you just shouldn't jump from! - wathc youtube for examples of this behaviour).

The test group in this study included 3,421 Ontario teens who were hospitalized following a car crash over a seven-year period. Of those, some 767 were diagnosed with a behaviour issue within the last decade, including 402 cases of ADHD. The researcher said the test group's demographic are the riskiest for vehicle crashes, citing that teen boys between 16 and 19 represent roughly three per cent of all drivers, but about six per cent of all crashes.

"(Teen boys) are so overrepresented in serious crashes, despite their low amounts of driving and despite excellent physical health otherwise," said Redelmeier. "(They have) wonderful reaction times, great visual acuity and a relative freedom from cognitive decline or alcoholism or heart attacks or many other conditions that can impair adults behind the wheel." Redelmeier said the main limitation of the study, which was published this week in PLoS Medicine, is the rate of incorrect diagnosis or diagnosis by someone other than a medical professional. That is no suprise (see my MANY posts on the need to get a proper and comprehensive diagnosis for ADHD). Another problem with the study is that although it accounted for thousands of crashes, the study did not record whether the teen males involved were at fault for the crashes. But, lack of attention doesn't only CAUSE accidents, it keeps you from AVOIDING accidents. We all know this from experience.

So should we add ADHD (attention deficit hyperactivity disorder) to the list of disorders for which you need clearance before getting your driver's permit? Some point out this will just keep parents and teens away from doctors, an incentive NOT to be diagnosed and not to be noticed. And would this make teens even more reluctant to accept the diagnosis of ADHD? And what effect would it have on medication compliance? Regretfully ADHD (attention deficit hyperactivity disorder) still has a stigma that you don't find with other disorders. We have a long way to go in dealing with ADHD (attention deficit hyperactivity disorder) including dealing with the stigma of both the diagnosis itself and the treatment (medication and cognitive behaviour therapy).

Read more: http://www.canada.com/health/Study+urges+doctor+before+teen+with+ADHD+drive/3836160/story.html#ixzz17DGCCKUe

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This blog is not offered as medical advice or as a means of diagnosing or treating ADHD or any other disorder. Don't go on line and take an ADHD "test." The diagnosis is complex, and it involves not just looking for symptoms of ADHD, but also ruling out other disorders that might look just like ADHD. 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. Medical doctors can diagnose ADHD, but the diagnosis is complex and often they will make a referral to a Registered Psychologist. You can obtain a referral from the British Columbia Psychological Association for a psychologist near you.

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.

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

Groups Assail Vision Therapy as Remedy for Learning Disabilities - from MedPage Today

Click here to go to the original article and an excellent video: Medical News: Groups Assail Vision Therapy as Remedy for Learning Disabilities - in Pediatrics, General Pediatrics from MedPage Today

SAN FRANCISCO, July 27 -- Behavioral vision therapy, eye exercises, and colored lenses have no role in treatment of dyslexia and other learning disabilities, according to the American Academy of Pediatrics.

The academy came down hard on these "scientifically unsupported" alternative treatments in a joint statement with the American Academy of Ophthalmology and other vision organizations.

Because learning disabilities are difficult to treat and have long-term consequences for education and socioeconomic achievement, unproven therapies have become highly visible, Sheryl Handler, MD, of the AAO, and colleagues wrote in the August issue of Pediatrics.

"Ineffective, controversial methods of treatment such as vision therapy may give parents and teachers a false sense of security that a child's learning difficulties are being addressed, may waste family and/or school resources, and may delay proper instruction or remediation," they cautioned.

Co-author Walter M. Fierson, MD, chair of the pediatricians' learning disabilities subcommittee on ophthalmology, argued that the very lack of supporting evidence for these popular alternative treatments carries weight. Action Points
Explain to interested patients that learning disabilities are typically caused by abnormalities in the brain processing of letters and sounds rather than by vision problems.


Note that the statement recommended physicians dispel myths about unproven treatments for learning disabilities when referring patients for further evaluation or support services.
"They've been around for decades and the opportunity to prove them has been around for a similarly long period of time," he said. "That they are unproven after all this time gives rise to very serious doubt about their validity."

Dyslexia -- which accounts for 80% of learning disabilities -- should not be classed with secondary problems such as visual disorders, mental retardation, or poor instruction, Dr. Handler's group noted.

Rather, it usually stems from altered brain function in the processing of the sound structure of language, which is why systematic phonetics instruction intervention often works.

Although visual processing in the brain has long been speculated as a cause of dyslexia, they said, "We now know these theories to be untrue."

Visual difficulties related to dyslexia, such as faulty directionality and abnormal saccadic eye movements, are symptoms rather than causes, they emphasized.

Only a small subset of dyslexic patients are affected by problems in the magnocellular visual system -- which is responsive to quick movement and moving objects -- that may blur visual acuity when reading.

Studies have yielded conflicting support for this cause. "At the present, there is insufficient evidence to base any treatment on this possible deficit," the statement concluded.

Likewise, "there is inadequate scientific evidence to support the view that subtle eye or visual problems, including abnormal focusing, jerky eye movements, misaligned or crossed eyes, binocular dysfunction, visual-motor dysfunction, visual perceptual difficulties, or hypothetical difficulties with laterality or 'trouble crossing the midline' of the visual field, cause learning disabilities," the statement emphasized.

The joint statement called the literature supporting vision therapy a collection of poorly validated research that relies on anecdote and poorly designed and controlled studies. Any benefits, it said, reflect the placebo effect or the traditional educational remediation with which the therapies are combined.

Overall, visual function and ocular health are the same for children with dyslexia and related learning disabilities as in other children. Notably, children with dyslexia often enjoy playing videogames that make the same intensive demands on the eye.

Physicians and ophthalmologists have a role in periodic vision screenings in this population, as with all children. But they play a more important role in providing further evaluation and support for parents -- and dispelling myths, Dr. Handler's group said.

"This should include discussion regarding the lack of efficacy of vision therapy and other 'alternative treatments' with the parents," they wrote. "Parents need to be informed that dyslexia is a complex disorder and that there are no quick cures."

"Remediation programs through the child's school or local specialists should include specific instruction in decoding, fluency training, vocabulary, and comprehension, they recommended.Children with reading disabilities need to practice reading aloud to a parent or tutor each day. Classroom accommodations might include extra time for or shortened assignments, a separate, quiet room for taking tests, provision of lecture notes, and tutoring. Diagnosing and treating any specific vision problems will make reading more comfortable, but parents can't expect it to improve decoding or understanding of reading, the writing committee noted."

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This blog is not offered as medical advice or as a means of diagnosing or treating ADHD or any other disorder. Don't go on line and take an ADHD "test." The diagnosis is complex, and it involves not just looking for symptoms of ADHD, but also ruling out other disorders that might look just like ADHD. 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. Medical doctors can diagnose ADHD, but the diagnosis is complex and often they will make a referral to a Registered Psychologist. You can obtain a referral from the British Columbia Psychological Association for a psychologist near you.

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.

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

How Docs Organize to Promote Unproven Therapies They Believe In

Medical News: Docs Organize to Promote Unproven Therapies They Believe In - in Public Health & Policy, General Professional Issues from MedPage Today

This is an interesting article on medical doctors who have ideas that are contrary to those of mainstream research. An interesting read. As you can see, it only takes a few, and with the help of the internet they are able to appear to be a significant number. Additionally, the internet and these informal organizations allow these doctors to play around the edges of the normal rules of what is science, and what is "hunch." I provide this to help you understand how some of the ideas that are not supported by real science spread.

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This blog is not offered as medical advice or as a means of diagnosing or treating ADHD or any other disorder. Don't go on line and take an ADHD "test." The diagnosis is complex, and it involves not just looking for symptoms of ADHD, but also ruling out other disorders that might look just like ADHD. 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. Medical doctors can diagnose ADHD, but the diagnosis is complex and often they will make a referral to a Registered Psychologist. You can obtain a referral from the British Columbia Psychological Association for a psychologist near you.

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.

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

ADHD Collaborative: We could learn something from this very simple program.

About the ADHD Collaborative, a program at Cincinnati Children's Medical Center: The goal of the ADHD Collaborative is to improve functioning, quality of life, and access to care for children with ADHD. This is accomplished by training community primary care providers to implement the American Academy of Pediatrics (AAP) and Cincinnati Children's Hospital Medical Center evidence-based guidelines for the diagnosis and treatment of this disorder.

As a process improvement initiative, the Collaborative emphasizes using best – practice recommendations and quality improvement science to achieve desired long-term outcomes.ADHD
Best-practice means using those interventions, tests, techniques that are scientifically supported, and taking a close look at how they are working. Here are the simple steps they have taken. They are SO simple, yet most of the time they aren't followed by physicians or psychologists:

Guideline Summary
For the diagnosis of ADHD, the guidelines recommend:
␣ PCP initiates an evaluation for ADHD in a child 6-12 years old
␣ Child must meet DSM-IV criteria.
␣ The assessment requires evidence obtained from parents or caregiver AND classroom teacher.
␣ Evaluation should include assessment for coexisting conditions. (This is the differential diagnosis issue I often write about. Do these symptoms mean ADHD, or might they mean something else that we are missing because we jump on the ADHD bandwagon?) Other diagnostic test are not routinely indicated to establish the diagnosis of ADHD, but may be used for the assessment of other coexisting conditions.

For treatment of ADHD, the guidelines recommend that primary care clinicians:
␣ Establish a treatment program that recognizes ADHD as a chronic condition
(Chronic means long term, not going away, BUT something we can treat and do something about)
␣ Specify appropriate target outcomes to guide management
(Determine what the goals of treatment are. What are we to expect from the treatment? How long should it take? How will we know it's working? This means follow-up forms and maybe testing that pinpoints performance levels in specific cognitive areas. This is often better than simple self reports.)
␣ Recommend stimulant medication and/or behavioral therapy as appropriate to improve target outcomes.
(Always ask, when medication is suggested, what symptoms is this medication for? How long will it take to work? What should I see as a result of it working? And what will it not help with?)
␣ Provide a systematic follow-up for the child with ADHD. When a child has not met target outcomes, evaluate: the original diagnosis, medication, and/or behavioral therapy as appropriate to improve target use of all appropriate treatments, adherence to the treatment plan presence of coexisting conditions when a child has not met target outcomes.
(This is THE critical part of their program. If you go to the hospital's web site you will find they supply doctors with forms to TRACK changes in behaviour. Those initial self-reports and parent reports you might have filled out were often originally designed to be used to track the effects of treatment interventions or medication. You were suppose to fill them out weekly, so you could track change. Without some structured way to track change we end up relying upon verbal reports from parents and teachers which might suffer from what we call "confirmation bias," see what you expect or want to see. OR they may be influenced by the environment, a change in teacher, holidays, home situation. Without ongoing assessment of treatment, including medication, we really don't know how things are going.)

Besides their ADHD Collaborative program the hospital has a great ADHD information page. Click here to view it.

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This blog is not offered as medical advice or as a means of diagnosing or treating ADHD or any other disorder. Don't go on line and take an ADHD "test." The diagnosis is complex, and it involves not just looking for symptoms of ADHD, but also ruling out other disorders that might look just like ADHD. 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. Medical doctors can diagnose ADHD, but the diagnosis is complex and often they will make a referral to a Registered Psychologist. You can obtain a referral from the British Columbia Psychological Association for a psychologist near you.

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.

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

ADHD Rates Are Increasing - in Pediatrics, ADHD/ADD from MedPage Today

Medical News: ADHD Rates Are Increasing - in Pediatrics, ADHD/ADD from MedPage Today

MedPage Today reports that more parents are reporting that their children have been diagnosed with attention deficit hyperactivity disorder (ADHD) at some point in their lives than earlier in the decade, this according to the US Centre for Disease Control. The percentage of children and teens ranging from ages 4 to 17 with a "parent-reported ADHD diagnosis" increased from 7.8% in 2003 to 9.5% in 2007. These are children and adolescents whose parents report their children have ADHD according to what they have been told by any medical provider. This does not mean a formal diagnosis took place, only that a medical provider gave them this opinion at some point. This data was reported by researchers from the agency's National Center on Birth Defects and Developmental Disabilities and from the National Center for Health Statistics reported in the Nov. 12 issue of Morbidity and Mortality Weekly Report.

These findings are consistent with other reports using different sets of data. According to the editorial notes from this article, "Increasing rates of estimated ADHD prevalence might indicate an actual increase in the number of cases of ADHD or changes in diagnostic practice over time, which might have been influenced by increased awareness of the disorder over the period of study...additional studies are needed to understand other geographic or environmental risk factors associated with rates of ADHD diagnosis, such as state-based policy and healthcare provider characteristics," the editors continued. "Ongoing surveillance is critical to understanding the public health effect of ADHD and the needs of a growing number of families affected by this disorder."

The 22% relative increase in the number of parents who answered yes to this question about being told their child may have ADHD over the interval from 2003 to 2007 shows an increase of roughly 1 million children (from 4.4 million to 5.4 million) who were ever diagnosed with ADHD. The rate of parent-reported ADHD was significantly higher in 2007 for almost all demographic subgroups, with the greatest jumps in teens ages 15 to 17 (+42%), multiracial and Hispanic children (+46% and +53%, respectively), and children with a primary language other than English (+82%).

Twelve US states saw significant increases in the rate of parent-reported ADHD ranging from 31.7% to 67.1%; none had a significant decrease. "Changes in the sociodemographic composition of states or state-based policy or practice changes, such as widespread behavioral health screening, might have contributed to the increasing rates," according to the MMWR editors. In other words, the increase may be real, and may be due to the fact that over the years more children have been either informally or formally screened. Many of these subgroups have medical care and options available to them that were not there several years ago due to changes in government programs and the availability of medical services to children and families with lower incomes.

A question about whether the child currently had ADHD was added to the 2007 survey. Of those who had ever received a diagnosis, 78% currently were found to have the disorder. Of those with current ADHD, two-thirds were taking medications for it. Overall, 4.8% of the children included in the survey were taking medications for ADHD. The MMWR editors noted that the analysis was limited by the use of parental report for ADHD diagnosis, the fact that the survey included a question about current ADHD status in 2007 only, and the inability to reach families that did not have a landline telephone. Still the data demonstrates that there is most likely fewer children being treated than should be. Regretfully the survey did not ask direct questions about what services or interventions were being used, or where helpful.

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This blog is not offered as medical advice or as a means of diagnosing or treating ADHD or any other disorder. Don't go on line and take an ADHD "test." The diagnosis is complex, and it involves not just looking for symptoms of ADHD, but also ruling out other disorders that might look just like ADHD. 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. Medical doctors can diagnose ADHD, but the diagnosis is complex and often they will make a referral to a Registered Psychologist. You can obtain a referral from the British Columbia Psychological Association for a psychologist near you.

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.

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

3 provinces failing students with ADHD: Yep, BC is right there!

3 provinces failing students with ADHD: Study

"A first-ever report card into how Canada's special education systems "recognize, identify and support" students with attention-deficit hyperactivity disorder, has given Ontario, Quebec and British Columbia failing grades."

Well, most districts in BC provide minimal or no services to students diagnosed with ADHD. Period. They don't qualify for official "exceptional student" status unless they have a second learning disability or another recognized disorder. This in spite of the fact that if you asked teachers what students they need the most help with they would name students with ADHD!

Heidi Bernhardt, the centre's national director, who raised three children with ADHD, said that has a huge impact. "They (children with ADHD) won't be able to access things like extra time to write their tests or exams, having assignments broken down for them . . . instead of potentially doing 30 questions, they could do 10," she said, adding what takes most students 45 minutes to do takes two to three hours for those with ADHD.

It can be very frustrating for parents, said Bernhardt, adding some have launched human-rights complaints or found sneaky ways around the system as a result. The article tells of some horrific situations parents find themselves in.

Those provinces that fared best (and BC is NOT one of them) have specific categories of disability that catch students with ADHD and don't require secondary ailments to qualify for specialized attention. Some provinces have "inclusive systems" where students aren't labelled special needs, but Bernhardt said it's important to have a "paper trail" to show a student is "exceptional" to ensure their right to special accommodation is met.

If you compare the graduation rate for students with ADHD to the graduation rates of other students, you'll quickly find that if your child had autism, Asperger's, is cognitively impaired or a severe learning disability he or she is far more likely to get a diploma. This is a shocking situation, those most likely to fail are given no help.

As a school psychologist and registered psychologist I have, for several years, provided many training workshops for local school districts. They request multiple workshops on working with students with autism, Aspergers and especially reading disabilities, but even at my urging school districts in BC are reluctant to ask for or provide training for teachers in supporting students with ADHD. (Reading some of the other articles in the Province and Vancouver Sun you might understand why. Articles question the validity of the diagnosis, and the appropriateness of medical interventions. Many, apparently, still want to blame the student for being lazy or having "family issues" which cause these behaviours. It's time to move into the current century and stop publishing this garbage!).

Sooner or later parents will take a stand, or a good lawyer will collect this data and go to court. How a student with a medical disorder can be allowed to fail, be refused support and ignored is beyond me. ADHD is a serious disorder that keeps smart, positive, good kids from succeeding. It's time the local districts took this serious, stopped blaming the students and their parents, and opened up a simple, clear and serious track for these families to follow to help their children succeed. British Columbia, Ontario and Quebec are considered failures, as ADHD students are only designated "exceptional learners" if a coexisting disorder meets the required definition. Newfoundland and Labrador gets "good" grades but is faulted for having no official designation process. The Centre for ADHD Advocacy Canada says some legal documentation of a disability should exist to ensure a student's right to accommodations. Nova Scotia, Prince Edward Island and the Northwest Territories are faulted for the same thing. The Northwest Territories and P.E.I. also got low grades for leaving accommodation decisions to school staff who may not have "up-to-date" knowledge about the disorder.

What a sad state of affairs. The plan: Ignore, avoid or have staff without training make decisions! We can do better than that for our children!

This blog is not offered as medical advice or as a means of diagnosing or treating ADHD or any other disorder. Don't go on line and take an ADHD "test." The diagnosis is complex, and it involves not just looking for symptoms of ADHD, but also ruling out other disorders that might look just like ADHD. 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. Medical doctors can diagnose ADHD, but the diagnosis is complex and often they will make a referral to a Registered Psychologist. You can obtain a referral from the British Columbia Psychological Association for a psychologist near you.

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.

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

Children with ADHD at increased risk for depression and suicidal thoughts as adolescents

Click here for link to the original article

ScienceDaily (Oct. 4, 2010) — Children diagnosed with attention deficit/hyperactivity disorder (ADHD) at ages 4 to 6 are more likely to suffer from depression as adolescents than those who did not have ADHD at that age, according to a long-term study published in the October issue of the Archives of General Psychiatry. Although it was an uncommon occurrence, the children with ADHD also were somewhat more likely to think about or attempt suicide as adolescents.

"This study is important in demonstrating that, even during early childhood, ADHD in is seldom transient or unimportant" said study director Benjamin Lahey, Ph.D., a professor of health studies and psychiatry at the University of Chicago. "It reinforces our belief that parents of young children with ADHD should pay close attention to their child's behavior and its consequences and seek treatment to prevent possible long-term problems."

Children with ADHD have trouble paying attention and controlling impulsive behaviors and are often overly active. This can cause poor performance in school, difficulties in social situations, and a loss of confidence and self esteem. The Centers for Disease Control and Prevention estimate that about 4.4 million children, including about four percent of those aged 4 to 6, have ADHD. While many of us hear that there is an "over-diagnosis" of ADHD, in reality there is an under-diagnosis, and many children, adolescents and adults go untreated, either with medications or cognitive therapy.

Most of the earlier studies of the long-term connections between ADHD, depression and suicidal thoughts produced mixed results. The current study benefited from a more comprehensive assessment of depression taking place over a decade, a focus on specific child and family factors that predict which children are most at risk, and consideration of other factors associated with suicidal ideation - suicidal thoughts.

The study was performed by researchers at the University of Chicago and the University of Pittsburgh. It followed 123 children diagnosed with ADHD at age 4 to 6 for up to 14 years, until they reached ages 18 to 20. It compared these diagnosed children with 119 other children from similar neighborhoods and schools, matched for age, sex, and ethnicity. The children were assessed annually in study years 1 through 4, 6 through 9, and 12 through 14. During the course of the study researchers found that 18 percent of children diagnosed early with ADHD suffered from depression as adolescents. That's about 10 times the rate among those without ADHD. They found that children with early ADHD were five times more likely to have considered suicide at least once, and were twice as likely to have made an attempt.

"Suicide attempts were relatively rare, even in the study group," cautioned Lahey. "Parents should keep in mind that more than 80 percent of the children with ADHD did not attempt suicide and no one in this study committed suicide."

"Although the subtypes of ADHD--based on whether they had attention deficit or hyperactivity or both--predict subsequent depression and suicidal thoughts, distinct forms of the disease at age 4 to 6 were moderately predictive for specific problems later on. Children with inattention or combined subtype were at greater risk for depression. Those with combined type or hyperactivity were at greater risk for suicidal thoughts."

"Far more boys that girls suffer from ADHD, but being female increased the risk of depression. Children whose mothers suffered from depression were also at increased risk. Children with more complicated ADHD were most at risk, the authors conclude. Greater numbers of depression, anxiety, oppositional defiant disorder, and conduct disorder symptoms at ages 4 to 6 among children with ADHD robustly predicted risk for depression during adolescence. Children with uncomplicated ADHD with few concurrent symptoms of other disorders were at low risk for depression, but children with many concurrent symptoms were at very high risk."

What does this mean for you and your child or adolescent who you suspect has ADHD? For one thing it means if you suspect ADHD, attention Deficit Hyperactivity Disorder, you need to do more than complete a simple form or self report and obtain a diagnosis and medication. Often, regretfully, that is all that takes place in an MD's office. A "SNAP-4" is given to the parents and the teacher, and after a brief and cursory history 9"Has he been like this for a long time?") a diagnosis is made. I often tell parents we don't "do a diagnosis" but instead engage in a "differential diagnostic process." That means gathering basic information, looking at how the child, adolescent or adult with suspected ADHD presents during the interview (a Mental Status Exam is often the formal means of doing this), collect an extensive history and whenever possible information and observations from a number of people and settings, and complete a battery of tests, self reports and other assessments that RULE OUT other possible causes of the behaviours that are of concern. Remember, there are actually many different possible causes for the behaviours that concern you, and we need to rule out other possible causes and not just jump to a conclusion that ADHD is the cause. Finally, we need to look at a full range of cognitive and academic or workplace results of the behaviour to see exactly how it is affecting the child or yourself. Part of this more in-depth diagnositic procedure includes assessments for depression, mood disorders, neurological disorders, anxiety, autism...all other possible causes and co-morbid (at the same time) conditions. One thing we don't want is to treat ADHD with a medication or treatment that would make another condition w that was masked by the ADHD worse!

So, if your child has ADHD (attention Deficit Hyperactivity Disorder) you also need to be asking yourself, is he or she also depressed? Does he or she have anxiety? Are there specific learning disabilities that also make school difficult? And if my child or adolescent has ADHD what skills did they not learn properly that either I should re-teach or the school should re-teach?

What do we learn from this on-going research? Get a complete evaluation to start.

This study was funded by The National Institutes of Health.

This blog is not offered as medical advice or as a means of diagnosing or treating ADHD or any other disorder. Don't go on line and take an ADHD "test." The diagnosis is complex, and it involves not just looking for symptoms of ADHD, but also ruling out other disorders that might look just like ADHD. 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. Medical doctors can diagnose ADHD, but the diagnosis is complex and often they will make a referral to a Registered Psychologist. You can obtain a referral from the British Columbia Psychological Association for a psychologist near you.

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.

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

What you need besides medication for Attention Deficit Hyperactivity Disorder (ADHD)

If you use only medication to treat Attention Deficit Hyperactivity Disorder (ADHD) you’re likely to only get a partial response that does little to help your child or an adult with all of the effects of living with ADHD. ADHD is considered a developmental disorder, and many of it's most disabling effects are ones that are developmental in nature. Often children with Attention Deficit Hyperactivity Disorder (ADHD) did not learn skills (or learned them poorly) at the developmental moment that was best to learn them. Lets take being "orderly" as a simple example: putting things in order, organizing, having a clean bedroom, kitchen or workspace. Most of us learn this at a very early age, putting together blocks, putting items together by colour, size. Putting away toys in their proper places. At a young age these activities were fun, self reinforcing. Someone clapped their hands and said, "Great job!" The problem is, when you wait until the age of 12 rr 25 to take ADHD medication and try to teach yourself to be "organized," to set your daily schedule, to keep your desk clean, to organize your bedroom or kitchen.... no one is there to reinforce you, and these tasks are simply not self reinforcing. Your learning a new skill at a poorly chosen developmental time. Normally we learn new skills when they are easy. With ADHD you not only have difficulty with the skill, you often learn it when it's a painful task and hard. No wonder we need support, guidance and structure!

Psychotherapy, social skills training and even anger management training are not only important options to consider — they are mandatory in order to treat the long-term issues that go hand-in-hand with attention deficit disorder.

Once some of the behavior problems are under control with children we are better able to approach the situation and provide an intervention. Often, that's what the medication does, and it also offers us a chance to STOP, THINK and THEN take action. Something that without the medication, we can have a hard time to follow. (There are specific techniques to teach children and adults to STOP, THINK and then ACT without medication. Usually this is in response to external cues and stimuli. In my clinic's in Burnaby and Vancouver we spend a lot of time doing just that. Medication may not be the right choice, and if it isn't, we can work on these techniques. But evidence shows medication is the most effect measure we can take initially.)

Parenting training has been shown to be an effective and an important component of any treatment of ADHD in children. We offer a number of different parent training options including individual sessions, home visits to set up positive behaviour support systems, and books and video training that is supported by scientific evidence. Think of the TV show, Super Nanny — except that the therapist helps the parents learn how to best help their child with ADHD. And remember, on every episode of Super Nanny, Super Nanny needed to return more than once because these techniques are complex and you need feedback.

Psychotherapy for ADHD
We have research demonstrating the effectiveness of a wide range of psychotherapies for the treatment of ADHD in both children and adults. Some people use only psychotherapy instead of medication, as it is an approach that does not rely on taking stimulant medications. Others use psychotherapy as an adjunct to medication treatment. Cognitive Behaviour Therapy is the primary type of therapy for use with ADHD. You learn to understand how what's already in your mind (automatic thoughts) effects the outcome (feelings) and not the other way around. You learn to deal with irrational thoughts, how to think "scientifically," and how to deal with others.

Behavioral therapy is a critical part of the parent training program. It teaches specific techniques to deal directly with immediate issues...behaviours .... of concern. Primarily we use techniques that put an emphasis on positive behavioural support, reinforcing positive behaviours, and ignoring (NOT reinforcing) behaviours we want to see less of. Punishment and negative interactions have been shown to do little to effect the behaviour of children with ADHD.

Psycho-education, for both adults and children, is also a critical component of treatment. Issues of self esteem, depression and anxiety need to be addressed throughout the treatment process.

Social Skills Training for ADHD
Often children with ADHD are sent to "social skills training." This has it's good side, and it's bad. Most children learned social skills through watching others, then practicing them. For the person with ADHD these skills often didn't seem to work, and they developed new and often inappropriate ways to relate to others, get what they want and organize their environment. In a good social skills training classes we provide a safe environment in which to demonstrate and practice these skills, and then set up a graduated process of using these skills in the real world. Social skills training helps the child to learn and use these skills in a safe practice environment with the therapist (or parent). These skills include learning how to have conversations with others, learning to see others’ perspective, listening, asking questions, the importance of eye contact, what body language and gestures are telling you. Often we use a social skills inventory to get a good idea of what specific skills someone has, and what skills they need to learn.

Support Groups for ADHD
Mutual self-help support groups can be very beneficial for parents and individuals with ADHD themselves. A sense of regular connection to others in the same boat leads to openness, problem-sharing, and sharing of advice. Concerns, fears and irritations can be released in a compassionate environment where members can safely let off steam and know that they are not alone. As well as this type of support, the groups can invite experts to give lectures and answer specific questions. They can also help members to get referrals to reliable specialists.
Psych Central hosts two support groups online for people with attention deficit disorder: Psych Central ADHD support group and NeuroTalk’s ADHD support group. While I am happy to give information on these groups, I also have to warn you that often individual's in support groups spread false and misleading information. They join groups in order to spread this information. Sometimes this is in the form of rumours and scare tactics about medications, sometimes it's in the form of misleading information on treatments they "know" work but which have no scientific basis. Be careful, and always go to your medical doctor for advice. There really are no simple diets, vitamins or supplements that fix ADHD. And fish oil tablets are NOT a cure. Go talk to "reliable" sources.

This blog is not offered as medical advice or as a means of diagnosing or treating ADHD or any other disorder. Don't go on line and take an ADHD "test." The diagnosis is complex, and it involves not just looking for symptoms of ADHD, but also ruling out other disorders that might look just like ADHD. 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. Medical doctors can diagnose ADHD, but the diagnosis is complex and often they will make a referral to a Registered Psychologist. You can obtain a referral from the British Columbia Psychological Association for a psychologist near you.

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.

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

Vancouver Sun doesn't get the point about ADHD Diagnosis and Treatment

This story has been around for some time, and has been misused by many in the anti-medicine, anti-science and anti-medical crowd. Most papers have done as poor a job as the Vancouver sun in reporting this story. But on the front page? It's sad that here in Vancouver we don't seem to have a decent science reporter, and very sad that such a simplistic interpretation science appears as front page news. You would expect something a little deeper and thought-out for a front page story. Instead we get a hysterical headline, "One in five hyperactive kids possibly misdiagnosed. Youngest in kindergarten are most at risk, study says." Gosh! you think you had better warn all your friends who have kids on medication!

The writer, Tracy Sherlock, goes on to tug at your heart strings with a story of a child who has taken Ritalin, and as his mom says,"I saw that he was a zombie and it took his joy away..." Those evil drugs and doctors! Making kids into zombies!

But the Vancouver Sun writer doesn't seem to know how to deal with a science based story. If it's about science, you really need to get the facts right. And maybe shouldn't mess the story up trying to turn it into a human interest story. Here's an example: "Although a psychologist said X's son was gifted, she decided to try Ritalin to see if it helped." Research becomes human interest ....1,2,3!

Two issues: One, being "gifted" has no relationship with having ADHD (Attention Deficit Hyperactivity Disorder). As a matter of fact, many gifted (and I assume we mean "intelligent" or academically gifted here, not art or dance kind of gifted) students have ADHD. One does not preclude the other. And understand that because of poor impulse control, an inability to focus, concentrate, pick out what's salient or important, or initiate and follow through on tasks, these "gifted" children fail at school all the time. (How many children with ADHD drop out of school? How many stay in? How many students with ADHD taking medication graduate, as compared to students with ADHD not taking medication? Russell Barkley has all that information, and there is a link to his web site below.

These "gifted" children often become frustrated, angry, depressed and learn to hate and avoid school. The research is clear that stimulant medication makes a positive difference for these children, adolescents and even adults. They are far more likely to do well at school, to graduate, to stay out of legal trouble and stay off illegal drugs.

But all the research crumbles under the weight of one human interest story of a boy who becomes a "Zombie." Not giving the full story is a disservice to all of our families and individuals struggling with the problems of ADHD (Attention Deficit Hyperactivity Disorder).

A side note or two: The writer seems to not understand how the health system works here in BC. Registered Psychologists do not, and can not, prescribe medication. Period. Medical doctors do not prescribe medication because a psychologist told them to. Sherlock's understanding of how the process works is minimal and not up to the most basic standards we would expect, at least what one would hope would be the standards for a front page story.

Next we read that Mrs. X (the mother, not the doctor, not a doctor, not a researcher, not an expert in the field) "believes many kids with vision or hearing problems are misdiagnosed with ADD and ADHD." How can that be? ANY school psychologist, registered psychologist, family doctor or psychiatrist would seek out the results of your child's vision and hearing assessment prior to making a diagnosis. At least anyone who follows the rules. And why are we writing about the opinion of someone's mother? How much effort would it take to find out if hearing problems and vision problems are often misdiagnosed as ADHD? (They aren't.)

Then the story takes the big leap, and this is common: "I was not going to have my son labelled..." We often hear this. It's part of the anti-medical meme out there. It's not a "label," it's a diagnosis, like a broken leg, a viral or bacterial infection. The diagnosis helps providers focus their interventions. The child's problems are not caused by the diagnosis or "label."

If there are significant problems with behaviour at school or home, how do we approach the problem if we cannot name it? I understand that in schools once a child is diagnosed with ADHD, a learning disability or any other number of learning deficits staff behave differently. And not every child on ADHD needs medication. Staff often focus on the medication issues rather than the many other positive and supportive interventions that are possible and necessary even if medication is used. But this is a systemic problem, a staff problem. And ignoring the diagnosable disorder and refusing to name it doesn't help. We don't know what to treat if we can't even say what it is.

Later in the article "Vancouver's expert on boys" says, "There is no blood test for ADHD- it's very subjective and this study makes that very clear...." He goes on to point out that it is a developmental disorder, and that boys develop more slowly than girls, and therefore that explains why more boys are diagnosed with ADHD than girls. Except that we see the same numbers with teens and with adults. I don't think this is proof of any problem with the validity of the diagnosis. It IS a problem of poor staff training, expectations on young children that are unreasonable, and societal pressures that are far greater than anyone might suspect on young children.

But let me stop here. I'm afraid this front page article is very problematic not only in what it says, but in what it doesn't say. So let me say a few things:

ADHD is a real disorder. It leads to school, work, and social dysfunction. Unaddressed it leads many to a failed school experience. To avoid the topic, to refuse to even say it or name it (no labels please!) hurts children more than it helps. Ask your school district what the percentage of students with an ADHD diagnosis graduate, as compared to a diagnosis of autism, Asperger's or even mental retardation. You will be very surprised by the numbers.

Medications help in many cases. The research on this is clear. Student's with significant ADHD who do not take medication are less likely to graduate from high school, less likely to attend college, more likely to become involved with the law (impulsive behaviour), when involved in accidents they have more serious accidents that lead to longer hospitalizations and higher costs. All of this research is well documented over many years and many studies. I suggest going to Russell Barkley's web page for more information on the research. Russell Barkley has a number of video's you can watch, some on YouTube, that go over these numbers.

There are non-medical interventions for ADHD. These include some visual supports, use of schedules, reinforcement programs and other simple behavioural interventions. Many medical doctors and psychologists may not be familiar with these interventions, so you should see someone who is an expert in the field.

Changes in diets have little effect, except on those few kids who had a food allergy. There are no toxin treatments that work, and very little or contrary evidence for the effectiveness of supplements, vitamins and "alternative treatments" like "sound therapy" or bio-feedback.

The diagnosis is not as subjective as some would want you to believe. For medical doctors, there is ample information through The Centre for ADHD/ADD Advocacy, Canada (CADDAC). CADDAC is a national, not-for-profit organization providing leadership in education and advocacy for ADHD organizations and individuals with ADHD across Canada. CADDAC's mandate is to take a national leadership role in networking all organizations, professionals, patients, caregivers and other stakeholders involved in ADHD related issues, and to then support those people through education and advocacy. They have standards for assessment which are excellent and comprehensive. There are other standards for diagnosis which, if followed, also prevent much of the misdiagnosis we read about. Most of the children misdiagnosed underwent the most minimal of assessment. Russell Barkley, again, has an excellent program for completing a child, adolescent and adult diagnosis.

The problem we often see is that a teacher or other person who knows the child thinks "Tommy has ADHD." Then someone simply goes through the most basic diagnostic criteria the find on the web, gives the teacher and parents a simple self-report consisting of 20 or so obvious questions and makes a diagnosis because Tommy meets the minimal criteria.

This is NOT how a diagnosis is made. To complete a true diagnosis we need to rule out other possible causes for the behaviours at issue. Yes, this means ruling out a vision problem, ruling out a hearing problem, ruling out possible medical issues, ruling out mood disorders and other more serious problems. This process is called a "differential diagnosis." It means following a procedure of gathering information, history, tests and assessments that guide us to the best possible diagnosis. Using a simple 20 question form is NOT best practice in making this diagnosis.

Often I see ADHD medications given to children, adolescents or adults and they do not see the doctor for several months afterwards. This seems rather odd. There are numerous means of tracking behavioural changes and the effectiveness of medications. These include parent observation reports, self reports and even computerized neuropsychological tests that we repeat over time to see the real effects of the medication and not just what people hope or wish. This follow up is done too infrequently. But this doesn't mean ADHD isn't real. It doesn't mean the diagnosis isn't right. And it doesn't mean the medication doesn't help.

Finally, ADHD is a form of what is often called an "executive disfunction." There may not be one simple test for ADHD, but as I pointed out above there are a series of tests, assessment tools and history taking methods that can help us in not just making the diagnosis, but in understanding the exact nature of this person's ADHD. This can mean we are able to provide specific behavioural interventions, specific environmental changes and specific medications that don't just address generic ADHD but address the child's individual problems. Parents who don't want an assessment because they fear labelling their child need to think about what they will miss.

This research article (actually what the original article does is compares the rate of ADHD diagnosis and prescribing of medication for the youngest and oldest students in schools and we shouldn't mistake this kind of look at data with real "experimental research") is regretfully being used all over the country to bash doctors, psychologists, teachers and life changing medication. ADHD is a real disorder. It can be very destructive to a child's life, but most importantly, it can be addressed and dealt with safely and with a fairly good rate of success.

I hope the Vancouver Sun can do a better job next time when making the decision to address a complex issue in a headline.

For more information about my practice in Vancouver and Burnaby you can click here. Information on adult and child diagnosis for ADHD can be found by clicking here.
Information on CADDAC can be found by clicking here.
To find Russell Barkley's web page on ADHD click here.
My Psychology Today web site can be found by clicking here.
My AAMFT web page can be found by clicking here.

Dr. Jim Roche
email: jamesroche@gmail.com
Child and Adolescent Treatment for ADHD
Adult Treatment for ADHD

Fast food diet causes ADHD? No not really.

Western diet link to ADHD, Australian study finds

While newspapers around the world are saying this Australian study shows fast food diets, and diets with high fat content cause ADHD, the study doesn't say that. Actually the study says there is no proven link at all. Maybe kids with ADHD eat more junk food. Maybe their family's have work schedules that lead to more eating out. Maybe lots of things. Now eating fast food isn't a good idea. I try to avoid it if possible. I wouldn't feed my kids fast food very often if I had a choice. And I recommend healthier foods. But this study clearly says it doesn't really show any causal link between fast foods and ADHD (Attention Deficit Hyperactivity Disorder). So what is wrong with our media science reporters? They read blogs instead of the research. Like many people these reporters read blogs that have been written by individuals who already have an idea in their heads about how the world works and what causes what. And they twist information, use statistics to lie and confuse whenever possible, because their aim is to convince the public that they are right.

Avoid McDonald's if you can. But if your child has ADHD, McDonald's isn't the cause.

What's really awful, and you need to be aware of, is that even the authors of research can have some issue they are pushing that is beyond the limits of what the science says. That's the case here too.

The authors says: "We suggest that a Western dietary pattern may indicate the adolescent has a less optimal fatty acid profile, whereas a diet higher in omega-3 fatty acids is thought to hold benefits for mental health and optimal brain function. "It also may be that the Western dietary pattern doesn't provide enough essential micronutrients that are needed for brain function, particularly attention and concentration, or that a Western diet might contain more colours, flavours and additives that have been linked to an increase in ADHD symptoms. It may also be that impulsivity, which is a characteristic of ADHD, leads to poor dietary choices such as quick snacks when hungry." (By the way, there are some basic logical fallacies here, can you pick them out?)

IT MAY BE. Did you read that? This is the author talking to the press. IT MAY BE. That's what he says. I'll translate that, " I think this, but there is NO PROOF WHAT-SO-EVER." Research shows clearly that food additive have little to do with ADHD, except for a few kids who have a specific allergy to them. And that has nothing to do with ADHD. Food colouring? No evidence after years of trials and studies ....except a few kids who might have an allergy. Look elsewhere. Omega-3? He says "Is thought to have benefits..." Actually, with ADHD, it's clear there are NO benefits except a placebo effect. And the relationship between these diets, yes, crappy diets that will make your kid fat, and ADHD? "Dr Oddy said that whilst this study suggests that diet may be implicated in ADHD, more research is needed to determine the nature of the relationship." MAY BE IMPLICATED. Translation: "There is no evidence of a relationship. I just wish there was."

He finally admits: "This is a cross-sectional study so we cannot be sure whether a poor diet leads to ADHD or whether ADHD leads to poor dietary choices and cravings," ( Dr Oddy).

But please understand, the good doctor has given us a false choice, a false dichotomy. "If it isn't this, it must be that." That's not true, and not being fooled by such false choices is one of the basic things you learn in science. Teach that to your kids, because people use false choices like this all the time to take advantage of others. The truth is these two "facts" may have no relationship to each other, and most likely, the situation is that they are both related to something else, a third factor (like income, housing, genetics). Thats why there is a statistical correlation, and most scientists would know that. But that would be boring, and wouldn't get your research paper covered by the national media.

What do bloggers make of this? Here is one blog:

Fast-food teen diets tied to ADHD By William Atkins
Sunday, 01 August 2010 00:14
An Australian study has shown that teenagers have over double the risk of getting attention-deficit hyperactivity disorder (ADHD) when they eat unhealthy diets of highly processed and fast foods than when they eat healthy diets of fruits and vegetables.

Who said that? Where did that come from? It's nonsense, it has nothing to do with what the study says. Nothing.

A source in Indiana writes: "Pay Attention! Processed Foods May Lead To ADHD, Study Shows." No it doesn't. Why say that? But what a clever title, Pay attention - ADHD, get it. Makes you want to read it. If only as much effort was put into understanding what they were reporting on. Oh, the rest of the "healthy living page" this appears on is covered with ads for health food and organic this and that. Do you think the editors of that web page (Indiana Public Media no less) are aware that they are lying to the public about the research paper? Why would they do such a thing? (And people worry about big pharma.) It's an awful situation.

Bad science, and bad science reporting, leads to parents wasting their time, wasting their energy and wasting their money on fixes and cures that have been supported by weak and silly evidence like this. This irresponsible reporting is they type of "news" that leads people into avoiding real treatment that work for fake treatments that don't work. You know this article will now appear all over the web as proof that doctors want to poison your child with medications (scientifically proven interventions) in order to make money and are hiding the fact that it's really caused by diet and processed foods. (Not that their web pages, usually covered with health / organic this and that ads are trying to make a profit).

I'll agree with one thing: Fast food is a bad thing for kids...and adults. But so is bad science.

I'm much more concerned with the effects of bad science on the brains of our children than a medium fries at McDonald.

Information about my intervention programs for children and adults with ADHD (Attention Deficit Hyperactivity Disorder) can be found at my web site www.relatedminds.com There is also specific information there about adult ADHD assessments and treatment. For that information click here. More general information on my practice can be found by clicking here or here. (Yep, it's basically an ad, but at least I'll admit it. I'm selling science!)

Dr. Jim Roche, Registered Psychologist
778.998-7975
drjimroche@gmail.com

ADHD, Anxiety and Children

One of the co-morbid disorders we often find in children with ADHD is anxiety. Sometimes this anxiety can be so strong it makes all of or ADHD intervention attempts seem hopeless. For years I have been using Cognitive Behaviour Therapy in combination with ADHD therapies with children. Many therapists, teachers, school counsellors and others have been unsure about the use of Cognitive Behaviour Therapy because they feel a child of six or seven doesn't have the capacity to make use of the CBT techniques. As with many emotional issues with children we are able to circumvent that problem by using visual supports. I make use of two visual support systems, one is called "Give Me aHand" which uses the five fingers on your hand to differentiate between different levels of emotions, and the other is a popular system used within the schools called "The Incredible Five Point Scale." These visual supports help students understand the differences between minor feelings of anxiety, situations in which it is OK to have anxiety (like in a scary movie or when playing a game), situations that they feel moderately uncomfortable in, all the way up to situations they feel they must get out of soon, and those they simply can't deal with and feel like they will "explode" in, or melt down. I highly recommend these books and games from the authors of The Incredible Five Point Scale. You can find many of the books I recommend at my web site's resource page here.

REcently there has been some research to support the use of Cognitive Behaviour Therapy with anxiety and, I am sure, ADHD (Attention Deficit Hyperactivity Disorder). Cognitive Behaviour Therapy is also a basis for treatment of both child and adult ADHD, so the treatment fits in well. What's important is we are training our brains how to think rationally, and that can include thinking rationally about ADHD, procrastination, anxiety or depression. It's teaching a way of thinking that avoids many of the thought distortions we find in people diagnosed with ADHD, anxiety, depression and related disorders.

I wanted to provide a little information about the recent research into using Cognitive Behaviour Therapy with children for anxiety.

The authors are Dina R. Hirshfeld-Becker , Bruce Masek, Aude Henin, Lauren Raezer Blakely, Rachel A. Pollock-Wurman, Julia McQuade, Lillian DePetrillo, Jacquelyn Briesch, Thomas H. Ollendick, Jerrold F. Rosenbaum, & Joseph Biederman.

Here's how the article starts: [excerpts]
Anxiety disorders represent one of the most common categories of childhood disorders (Costello et al., 1996; Costello, Mustillo, Erkanli, Keeler, & Angold, 2003). Studies suggest that childhood anxiety disorders are associated with social, familial, and academic impairment (Essau, Conradt, & Petermann, 2000; Ezpeleta, Keeler, Erkanli, Costello, & Angold, 2001; Ialongo, Edelsohn, Werthamer-Larsson, Crockett, & Kellam, 1995; Strauss, Frame, & Forehand, 1987), are likely to persist if untreated, and tend to predispose children to develop anxiety disorders later in adolescence and adulthood (Costello et al., 2003; Hirshfeld, Micco, Simoes, & Henin, 2008; Newman et al., 1996; Weissman, 1999). Clearly, the ability to intervene early to treat these disorders
would be beneficial.

Over the last two decades, promising cognitive behavioral therapies (CBT) have been developed to treat childhood anxiety disorders, including social phobia, separation anxiety disorder, and generalized anxiety disorder (GAD; James, Soler, & Weatherall, 2005; Ollendick & King, 1998; Silverman, Pina, & Viswesvaran, 2008). Such studies have suggested that CBT can be efficacious for these disorders when offered individually or as a family treatment (Kendall, Hudson, Gosch, Flannery- Schroeder, & Suveg, 2008) and when offered alone or in combination with sertraline (Walkup et al., 2008). However, despite at least eight early studies showing the efficacy of approaches such as in vivo desensitization; filmed, live, and participant modeling; graded exposure; reinforced practice; and verbal self-instruction to treat fears or specific phobias in preschool- and kindergarten-age children (see Ollendick & King, 1998), the protocols addressing the other major childhood anxiety disorders have been evaluated mainly among school-age children and adolescents. Although some studies extended their inclusion age downward to age 5 or 6? (e.g., King et al., 1998; Shortt, Barrett, & Fox, 2001), they generally included relatively small numbers of the youngest children (with mean sample ages of 11.03 and 7.8 years, respectively) and did not examine results separately for the youngest age group.

The underrepresentation of younger children in studies of CBT protocols for major childhood anxiety disorders may have derived from beliefs about the transience of anxiety disorders in this age group or from the assumption that younger children were not developmentally mature enough to benefit from cognitive behavioral interventions. However, recent studies have challenged these assumptions. First, studies have demonstrated that preschoolers present with persistent anxiety disorders at rates almost as high as older children (Egger & Angold, 2006; Lavigne et al., 1998), and factor-analytic studies have shown that the symptom presentations in preschoolers closely parallel those found in older children (Eley et al., 2003; Spence, Rapee, McDonald, & Ingram, 2001). In addition, several groups have recently begun testing the use of CBT protocols for a variety of anxiety disorders in younger children.

So anxiety is as common among younger children as any other group. It is an area of concern, and it appears CBT is a helpful intervention. The anxiety these children experience often comes from the same cognitive distortions that teens and adults experience. And we have ways to work on those distortions. And training in relaxation, thought stopping and breathing techniques work with children as well. This goes for adults as well.

Information about my intervention programs for children and adults with ADHD (Attention Deficit Hyperactivity Disorder) can be found at my web site www.relatedminds.com There is also specific information there about adult ADHD assessments and treatment. For that information click here. More general information on my practice can be found by clicking here or here.

Dr. Jim Roche, Registered Psychologist
778.998-7975
drjimroche@gmail.com