Psychoeducational Assessments, ADHD and Autism

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

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

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

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

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

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

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

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

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

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

Offices in Burnaby and Vancouver

What is a Psychoeducational Assessment? School Testing and Learning Disabilities

A lot of people call and tell me that the teacher told them their child needed a "psychoeducational assessment." They aren't sure what it is, or how much it will cost. So I'd like to answer some basic questions about psychoeducational assessments and how they relate to ADHD, learning disabilities, accommodations in school and other similar questions people often ask.

1. What is a Psychoeducational Assessment?
A psychoeducational assessment is a set of tests, observations and history taking about a child, adolescent or, even an adult in college that helps us understand how they learn and process information.  Usually we are asked to complete a psychoeducational assessment when a school or teacher suspects a learning disability. For instance, a child or adolescent might have difficulty with one particular subject such as math or reading. Sometimes a child is performing below what would be expected for their grade level, and a teacher wants to know what might possibly be happening to prevent the child from learning like his or her peers. The psychoeducational assessment helps us understand the student's current level of functioning, as well as their potential level of functioning. It also helps us understand a student's strengths and weaknesses so we can develop a plan to help the child succeed in the classroom.

2. What kinds of tests are used in a psychoeducational assessment?
Usually there are two major sets of tests. One is for measuring cognitive ability - intelligence. This might include tests like the WISC or WAIS, common intelligence tests. Or two other tests commonly used are the RIAS (Reynolds Intellectual Assessment Scales) or the Woodcock Johnson. Sometimes another test is chosen because of language difficulties, however the purpose of this part of the assessment is to understand the various cognitive abilities that a student has. In a way you can think of this as a measurement of potential.

A second set of tests are the academic tests. This might include the WIAT (Weschler Individual Academic Test) , the WRAT-4 or some other specific test of reading, oral reading, math skills, writing and so on. This set of tests measures a student's current skill level. What academic skills the student is able to demonstrate.

We then do two kinds of comparisons. We look at general and specific cognitive skills, and see if there are strengths and weaknesses there that might point to a "processing disorder" or specific cognitive deficit, and then we compare the cognitive tests (abilities) to the academic tests (level of functioning) and try to understand if there are specific weaknesses in the student's ability to produce work. Here we might find a specific learning disability.

Other tests are then used as needed based upon these results (this is why you usually need to go back to the psychologist more than once, they need to score and analyze these results to see what needs further investigation before continuing). These tests might look at auditory processing, learning and memory functions, executive functions, social skills or specific academic skills. Some school psychologists give a single battery, always the same, to every student. They usually have a rational for that. Others use a more flexible battery and may put more emphasis on the latter part of the investigation.

3. Who administers a psychoeducational assessment?
Usually schools are able to administer a psychoeducational assessment. School psychologists are experts in looking for specific learning disabilities, and are usually familiar with the school districts procedures and expectations for students, which can differ from district to district. This service is free in Canada and the United States. In the United States, when a parent requests a psychoeducational assessment the school district needs to look at the request and investigate it. The parent get either a reply that the district doesn't feel an assessment is necessary, or a psychoeducational assessment, within 50 days. If the district feels one is not necessary, and the parents disagree, there is a structured appeal process utilizing outside experts to determine if it is necessary or not.  In Canada, regretfully, schools  have very limited resources and requests for assessments are often put off for several years. There is an appeal process to the Ministry of Education, but not all schools inform parents of this right.  Children are placed on a "priority list" which is often redone at the end of every year, and I have seen some children wait three or more years before being considered for an assessment.

Parents also have the option of using outside Registered Psychologist to provide a psychoeducational assessment. One advantage of this is that a Registered Psychologist is able to diagnose mental disorders, and school psychologists (who usually only hold an MA degree) are not. Some school psychologists, especially in BC, are also Registered Psychologists. The fee, which is not covered by MSP, ranges from $2,200 - $3,200 depending upon the complexity and length of the assessment.

4. What happens after the psychoeducational assessment is complete?
Not all psychoeducational assessments lead to a diagnosis, and some are simply not valid due to a student's behaviour or efforts. So nothing can be guaranteed. If there is a learning disability evident, or a mental health disability, usually the school's committee on special education meets with the parent and a child is "coded" meaning they are given a category that enables them to be provided appropriate accommodations and interventions. This is written up in an agreement called the IEP or Individual Education Plan. Parents should be informed and involved with this process at every step, and if you use an external psychologist you should make sure they are either present or agree with the IEP.

Here I'd like to make a cautionary statement: Often psychoeducational assessment reports contain a long....sometimes very long...list of suggestions for the school to implement. It is critical to work with a psychologist who has experience with the schools and the classroom. Otherwise they are likely to suggest interventions that are not practical and demonstrate a lack of awareness of the classroom.  When I started working in this field I wanted to become a school psychologist (I am both a licensed/Registered Psychologist and a Licensed/Registered School Psychologist), but couldn't because to be accepted into a school psychology program required that I be a certified teacher for 5 years first!  I did become a teacher and have classroom experience, without which it would be difficult to understand what interventions and supportive techniques work in the classroom. Give this consideration when picking a psychologist to complete your ch  need for a "full psychoeducational assessment" must mean they feel they have completed a "not full" psychoeducational assessment, and I would agree. Many schools, especially in British Columbia, allow and even encourage teachers with minimal training to administer some simple and basic tests, including a brief IQ tests such as a TONI (Test of Non-Verbal Intelligence) and a brief academic test such as the WRAT-4. While the publisher of these tests say that they can be administered by an experienced teacher, that doesn't mean a teacher should administer a handful of these brief tests and then feel they are qualified to rule out a learning disability or other deficit. Using these tests in this way is a misunderstanding of the purpose of screening with these tests. They are meant to rule in students who would need further, more in depth, diagnostic testing. They are not meant to rule out learning disabilities or other academic or cognitive problems- which is how they are being used! If your child is failing at school, or having significant struggles, and they are administered a brief IQ test - which comes out in the normal range, and then a brief academic test, again scoring in the normal range, but he or she cannot produce in class .....these tests do not mean there is nothing wrong. The mean the exact opposite - THERE IS SOMETHING WRONG! Further assessment/testing needs to be done by a qualified school psychologist or licensed/registered psychologist. These screening should not be used to ignore problems that are real and obvious from a teacher report to student behaviour or a report card. A screener isn't suppose to be used to stop inquiry.

5. Can the school diagnose ADHD, depression, anxiety or autism?
Generally, no. A particular school psychologist may also be a Registered Psychologist and qualified to do this, but that is usually not the case. School Psychologists are not qualified by their school psychology certificate to diagnose mental disorders such as ADHD, depression, anxiety or Asperger's Syndrome/autism spectrum disorder. A properly trained Registered Psychologist can help you with that.

6. How young can a child be and need testing or assessment?
While here in BC there is a reluctance on the part of school districts to complete comprehensive psychoeducational assessments on students until they are older, this is not the case elsewhere, and is not best practice. For almost every disorder the general rule is that the sooner we have a diagnosis and get treatment, the better off the student is. In some jurisdictions, such as California and New York, special teams assess children at ages 4 and 5, in order to make sure they receive appropriate services before the enter school. Some jurisdictions offer treatment to children with special needs before grade 1 or K to make sure they do the best they can and experience as little difficulty as possible.  You might ask your medical doctor about a referral to Children's Hospital or another provincial provider here in BC. Some providers associated with the Ministry of Families and Children work with children down to 3 years old. The earlier a child gets help, the better the outcome. If your school disagrees it's usually because they simply don't have properly trained professionals. Talk to your medical doctor and get an appropriate referral if you have concerns,

I hope this brief overview of Psychoeducational Assessment is helpful. For parents with concerns about their child's academic progress I often suggest a book by Dr. Mel Levine called, "The Myth of Laziness." Another alternative book by Dr. Levine is "Minds of All Kinds."  There is also an organizational website for Minds of All Kinds which can provide very helpful information. Click here to get to that site: http://www.allkindsofminds.org  You'll also find a great book there for teachers called "Schools for All Kinds of Minds." Take a look!

For more information on the psychoeducational assessment services I provide  please visit my website at http://relatedminds.com or click here: http://www.relatedminds.com/testing/

KEY WORDS: ADHD, Learning Disorder, Learning Disability, Testing, Psychoeducational Assessment, School Testing, Psychologist, ADHD Coaching, Vancouver, Burnaby, San Franscisco

ADHD and Executive Function

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

What is ADHD and How is it Treated?


What is ADHD? ADHD is a problem with inattentiveness, over-activity, impulsivity, distractibility or a combination or some or all of these things. More recently we have begun to realize that "slow cognitive processing" or "slow cognitive tempo" is also part of this. You know, you ask someone a question and ....you wait a long time for an answer. Sometimes they forget to answer.

So ADHD might be noticed because your overactive and inattentive, disorganized and confused.  OR you might be very quiet, forgetful, and processing slow.  These can look like very different problems, but are actually part of the same disorder.

Most people think of ADHD as a childhood disorder. Until recently we didn't think teens or adults had ADHD, we thought they grew out of it. About 50% of children with ADHD continue to have the disorder as a teen and adult, although it's nature ....how it presents itself in behaviours and deficits, may change as you grow older and your environment changes and presents new problems for you to cope with. There are plenty of adults who suffer from ADHD as well. Almost 2/3rd of my ADHD patients are adults.

ADHD needs to be treated. Untreated children with ADHD are far more likely to have oppositional and defiant behavior, drug use, alcohol abuse and criminal activity. They are also far more susceptible to the stress, anxiety, depression, family issues, divorce, family conflict, and other external stressors. The first and foremost recommendation for young children is parent education or training (to teach you special techniques to support your child with ADHD) and only after that, if there is not significant improvement, medications. ADHD medications are about the most studied and understood medications we have. There are several different types, and your best source of information is from your medical doctor. A lot of what you read on line about ADHD treatment is nonsense, untrue, unproven and often proven not to work...but it's the internet and people can saw and write anything. Go to your medical doctor and see a psychologist for further support.

Adults with ADHD continue to have difficulties. Untreated adults may have trouble keeping up on important home responsibilities, such as record-keeping or bill-paying; may have difficulties following through with work responsibilities. They often experience relationship and other problems because of difficulties staying focused. Cognitive Behavioural Therapy can help, psycho-education for you and your partner ...or the entire family...can help. Behavioural therapy can help easy problems
What does ADHD look like in children?

The symptoms of ADHD fall into three groups: Lack of attention (inattentiveness), Hyperactivity and Impulsive behavior (impulsivity).
Again, more recently we have found that the "slow cognitive processing" type is also a major issue. Some children with ADHD primarily have the inattentive type. Others may have a combination of types. Those with the inattentive type are less disruptive and are more likely to not be diagnosed with ADHD.

Inattentive symptoms
1. Does not give close attention to details or makes careless mistakes in schoolwork
2. Has difficulty keeping attention during tasks or play
3. Does not seem to listen when spoken to directly
4. Does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace
5. Has trouble organizing tasks and activities
6. Avoids or dislikes tasks that require sustained mental effort (such as schoolwork)
7. Often loses toys, assignments, pencils, books, or tools needed for tasks or activities
8. Is easily distracted
9. Is often forgetful in daily activities

Hyperactivity symptoms:
1. Fidgets with hands or feet or squirms in seat
2. Leaves seat when remaining seated is expected
3. Runs around or climbs in inappropriate situations
4. Has difficulty playing quietly
5. Is often “on the go,” acts as if “driven by a motor,” talks excessively

Impulsivity symptoms:
1. Blurts out answers before questions have been completed
2. Has difficulty awaiting turn
3. Interrupts or intrudes on others (butts into conversations or games)

Although less likely than children to show the hyperactivity symptoms, adults with ADHD can show the same symptoms of impulsivity and inattention.  Often adults confuse "memory problems" with ADHD. They also get seen as having a "bad attitude" and "not caring." This is often far from the truth. A key component to treatment success is self education and educating your friends and family. Sometimes even your co-workers or boss.

What causes ADHD?
Research seems to clearly point to ADHD as being a genetic disorder. Something you inherit. If you look through a family tree, it is likely you will see it hop scotching its way across the generations. It is not unusual for one parent to have it and pass it along to one or more offspring. It is not unusual to have an entire family in treatment in one form or another.

Besides ADHD being a genetic disorder head trauma or brain injury (TBI) can often be a cause of ADHD. With both brain injury and ADHD we often see problems with "frontal lobe" functions in the brain. An area referred to as the "executive" area. But remember, many of these symptoms can be cause by something other than ADHD. People can have brain injuries, memory problems, brain tumours, depression, anxiety, movement disorders, OCD, tics ....any number of things can look just like ADHD. So remember, don't diagnose yourself. You may not have ADHD, and you may be missing what is really the problem! See a doctor - a psychologist or a medical doctor - who understands ADHD for a full assessment.

Treatments for ADHD
There are medical and non-medical ways to treat ADHD. Often it is best to use both. Behavioural therapy, parent education, Cognitive Behavioural Therapy, the learning of new specific skills to improve focus, planning and follow-through ...all of these can be done with or without medication. EEG and HEG Neurofeedback are often suggested, however, these are not as effective as those treatment already listed. Some research shows Neurofeedback to be fairly ineffective and it fails to generalize across symptoms.

Memory is also often a problem, specifically what we call "active memory," or "working memory." This is the processing of holding something in your head for a short period of time while you do something (like saying a group of numbers backwards). There are a number of computerized programs out there that claim to help with ADHD and memory. Right now there is only one intervention using computers that has been proven to improve "working memory," that is CogMed. CogMed has been show to improve working memory in the majority of patients. It is a five week program that can be extended, and is pretty costly (pricing ranges from $1,200-$2,200 for the program).  And it ONLY helps with "working memory."

Because working memory is so important to all other memory, focus, concentration and planning processes, I think improving your active and working memory is often a good idea. Talk to your doctor about testing for working memory problems before you invest in such a program.

Untreated ADHD

Anyone who suspects they or their child may be struggling with ADHD should get themselves or their child evaluated immediately. Oftentimes we will simply assume that it’s just “laziness.” ( Dr. Mel Levine has an excellent book for parents called "The Myth of Laziness."  It addresses this problem of perception, and also addresses the complexity of what is going on when a child fails to produce at a rate we would expect of them. An excellent read designed just for parents.  You can find this and other books on my website.) Not treating ADHD often results in in feeling humiliated, angry, and with children, a quick dislike of school -where they simple experience too many failures.

An adult with untreated ADHD will not be able to meet his/her full potential in education, work, or relationships. ADHD is a "developmental disorder" and often requires training in organizational and planning skills that you missed learning and practicing (successfully) as a child. ADHD can be treated, medication can quickly and effectually address problems of concentration and focus, and parent education can address skills that will help you support your child. Behavioural treatment teaches you skills to overcoming problems with planning, organizing, procrastination and emotional regulation. And Cognitive Behavioural Therapy (CBT) can help you with clear thinking and the emotional problems like anxiety and depression that often come with ADHD.

Finally, with both children and adults, a full assessment is often recommended as nearly 50% of individuals with ADHD have co-morbid learning disabilities.  Don't be fooled into thinking "my child has ADHD, so now he's taking medicine everything at school should be alright."  Make sure you or your child actually get all the support you need.


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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)
ADHD (click here:http://www.relatedminds.com/adhd-attention-deficit-hyperactivity-disorder/)
Anxiety and Stress (click here: http://www.relatedminds.com/anxiety-stress/)
Autism and Asperger's Disorder (Click here: http://www.relatedminds.com/autism/)
Individual Counselling (click here: http://www.relatedminds.com/individual-therapy/)
Child Counselling / Therapy (click here: http://www.relatedminds.com/child-therapy/)
Couples Counselling / Therapy (click here: http://www.relatedminds.com/couples-therapy/)
The Angry Child (click here: http://www.relatedminds.com/dealing-with-angry-aggressive-and-explosive-children/)
Anger Management (Click here:http://www.relatedminds.com/anger-management/)
Pain Management and PTSD (Click here:http://www.relatedminds.com/pain )
Forensic Services (Independent Medical Examinations or IME)

About
My name is Dr. Jim Roche and I am a Registered Psychologist and a Registered Marriage and Family Therapist (RMFT) in British Columbia. In addition to my doctorate in clinical psychology, I hold a master's degree in family therapy, a certificate of advanced graduate studies (CAGS) in school and educational psychology from Norwich University, and have completed two years of post doctoral studies in neuro-psychology at The Fielding Institute in Santa Barbara, California. In addition to being a registered psychologist, I am a certified school psychologist, certified teacher of special education (New York and California), and a Clinical Member of the American Association of Marriage and Family Therapists (AAMFT). I also hold a doctoral degree in law with an emphasis in medical malpractice and education law. Beyond my academic credentials, I have completed two years of supervised clinical experience in both hospital and community based clinics and two years of post doctoral training in neuropsychology. I have served as director of behaviour programming for several school districts, as a consultant on autism for the province, and have held numerous academic positions including Clinical Instructor in Psychiatry at New York University and Bellevue Hospital in New York as well as being a faculty member at NYU, Brooklyn College, SUNY New Paltz, and Norwich University.

Key words
ADHD | Anxiety and Stress | Autism and Asperger's Disorder | Individual Counselling | Child Therapy | Testing and Assessments and Learning Disabilities | Couples Counselling | Depression | The Angry Child | Anger Management | Pain Management and PTSD | Forensic Services | Attention Deficit Hyperactivity Disorder | Vancouver | Burnaby | Coquitlam | New Westminster | Maple Ridge | Port Moody | Child Psychologist | Psychologist | Learning Disability | Assessment | Testing | Psycho-educational Assessment | Neuropsychological Assessment

http://www.relatedminds.com
http://Therapists.PsychologyToday.com/rms/70682
http://www.therapistlocator.net/member?183420
http://www.bcpsychologist.org/users/jimroche
http://www.actcommunity.net/jim-roche.html
Phone: 778.998-7975

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

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

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

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


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


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


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

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

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


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

 


SPECT Scans – A New Phrenology? The Pro's and Con's of the Amen Clinic

OMG! Another report came in today from The Amen Clinic. The parent shared it with me, and then told me how neuro-therapy and cranial something or other were suggested, along with a long list of suppliments, oils, and other "natural" medications (whatever that meant). I have learned from experience that this is a topic that is difficult to explain, and that there is really little hope of getting a parent to look at the assumptions they are making and give modern, scientific based interventions and mainstream medication another chance. But I'm going to at least give it one more try. First: READ THIS ARTICLE! Read it with a pen, marker, underliner...whatever you need to really understand it!

SPECT Scans at the Amen Clinic – A New Phrenology?

And then this:

http://www.quackwatch.com/06ResearchProjects/amen.html


This article points out, "Phrenology was a 19th century pseudoscience that claimed to associate brain areas with specific personality traits. It was based on palpating bumps on the skull and was totally bogus. New brain imaging procedures are giving us real insights into brain function in health and disease. They are still blunt instruments, and it is easy and tempting to over-interpret what we are seeing. In his book The New Phrenology William Uttal warns that “the excitement of these new research tools can lead to a neuroreductionist wild goose chase” and that we must be careful not to succumb to new versions of the old phrenology."

The Amen Clinics offer SPECT (single photon emission computed tomography) scans to help diagnose and manage conditions such as attention deficit disorders (ADD), mood disorders, anxiety and panic disorders, autistic spectrum disorders, obsessive compulsive disorder (OCD), substance abuse, toxic exposure, brain trauma, memory problems, temper problems, and relationship and marital struggles. The scans generate colored pictures of the brain that show “areas of your brain that work well, areas that work too hard (not sure how that is determined, I don't even know what it means!) and areas that do not work enough.” And then the goal of this treatment he proposes, often involving medications, suppliments, diet and so on, is to balance the brain..or balance the brain's function. Again, no real research to tell you exactly what that means.

The charge is $3250 up front, and most insurance companies will not provide reimbursement because they consider it experimental. There is a 10% discount for testing additional family members...yes there is a family plan for PET Scans at the clinic! And as the writer of the article points out: "The Amen Clinic’s informed consent form is misleading: it does not divulge that the American Psychiatric Association has spoken out against SPECT scanning for these purposes and has warned of potential harm – especially to children, who are more susceptible to the effects of radiation." Yep, the APA says they don't work for the purposes they are being used, AND that they are dangerous, especially for children. You'd think that would be in the informed consent, wouldn't you? But desperate parents and individuals will try anything.
As the writers tell us, "There is no excuse for misrepresenting an unproven treatment as a treatment that has been proven effective. And there is no excuse for concealing essential information from patients, or for creating false hopes by implying a promise of more than they can really deliver."

Testimonials. The Amen Clinic site is full of them, and as you know I feel they are the worse information you can provide, the are misleading, misleading and very misleading. The article also talks a great deal about the treatment provided. I urge you to read it, take it to your medical doctor and get some professional advice before making any investment of this kind of money. See your doctor, and make an informed choice....informed by a professional who understands the complexity of these issues.

Here is my suggestion. Go ahead, read the Amen Clinic brochure. Then read this article (the link is found above), and if you want, go to the Quackwatch website and read BOTH the articles that support the procedure and clinic and those that don't, then take a few more minutes to read this article about ADHD diagnosis in the New York Times. It's an interesting controversy I've recently written about. Here the link: http://www.nytimes.com/2011/05/14/health/14consumer.html

When you are done, and it should take you less than 30 minutes total, you will know more about ADHD than most of your friends, relatives and maybe even some of the professionals you've seen. Take these articles to your medical doctor or psychologist and have a frank, informed and complete discussion about ADHD and how you should approach it. Know is good, science is great ....but NEVER rely on testimonials. My final word. Good luck! Like Dr. Amen says, there are ways to make your brain better functioning ....give it better information!


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As always, I remind you that this blog is not meant to be a diagnostic tool, these disorders are complex. Don't take on line tests and diagnose yourself. Contact your medical doctor, see what he or she can do for you. If need be, contact a Registered Psychologist, one with experience with ADHD, and get a real diagnosis and help in making treatment choices.


For information on treatment services I provide for children, click here: http://web.me.com/jimroche/relatedminds/child_therapy.html

For information on diagnostic and treatment services for children with ADHD, click here:http://web.me.com/jimroche/relatedminds/adhd.html

For information on diagnostic and treatment services for adults, click here: http://web.me.com/jimroche/relatedminds/adult_adhd.html

You can also just check out my regular web page at www.adhdhelp.ca or www.relatedminds.com

Self-help readings on ADHD, Try these:
Dr. Barkley's "Taking Charge of your ADHD"
Kathleen Nadeau's Understanding Girls with AD/HD
Mary Solantos' Cognitive Behaviour Therapy for Adult ADHD

These are a great place to start!

How Much Should an ADHD Diagnosis cost? Some disagree in the New York Times

New York Times Article on Adult ADHD: click here.

Response letter from Neuropsychologists: click here.

There's a fight going on in the ADHD/ADD world and it's become rather public. There are two schools of thought about ADHD diagnosis. One is that a diagnosis of ADHD should be made through a series of simple questions and a structured interview. Of course, this is pretty cheap. Dr. Russell Barkley supports this method of ADHD diagnosis.The other is that psychological testing, often neuropsychological testing, is appropriate when doing a diagnosis of ADHD (Attention Deficit Hyperactivity Disorder). One of the issues at hand was that some statements were made in the Times article about how much an exam should cost, and Dr. Barkley pretty much low balled it (around $500 or less!).

The NYT article follows Liz Goldberg, age 53, through the process of deing diagnosed with ADHD. It addresses many of the problems and difficulties with the diagnostic process for adults and adolescents. First, adults rarely exhibit the most noticeable symptom, hyperactivity. They often, instead, display symptoms of being distracted and disorganized. Often adults with ADHD also are procrastinators and avoiders of tasks that don't seem to be of interest to them. 5% of the adult population has ADHD. While you may have read about the over use of medications and the over diagnosis of this disorder in some news articles or on the web, the scientific estimate is that of the 5% of adults who have ADHD or ADD only 10% have a formal diagnosis. 10%!

Adults with ADHD, especially women, are often misdiagnosed with depression, anxiety and bipolar disorder. Sometimes their symptoms are just dismissed and ignored as a problem of "women," leaving them untreated and at the mercy of some serious symptoms.

THe article stresses that for most it might be best to avoid a lengthy neuropsychological assessment, often unnecessary and almost always expensive. Usually that means completing a series of questionnaires or self-reports, and having someone who knows you also fill out reports. From these we are often able to make a preliminary diagnosis. MRI scans, brain scans, neuro-brain-mapping are really all unnecessary for a preliminary diagnosis. This should include a Mental Status Examination, and at a minimum a structured diagnostic interview that helps rule out other possible causes for your symptoms. This should take 3-4 hours. And a little longer if you need a report written. While the Times says this can cost from $200-500 it really requires a minimum 3-4 hours, and at the going rate for psychologists in British Columbia this would put the cost in the range from $480-640 or so. That's for an examination that consists of no more than the gathering of information and a structured interview.

What Dr. Barkley and Tuckerman suggest in their article is that most importantly you find an experience clinician to do the ADHD diagnosis.

Now Dr. Barkley also says to, "avoid an expensive neuropsychological evaluation." He, and Dr. Tuckerman, think this is overkill. I think their explaination is a little too simple. After a diagnosis a good neuropsychological examination can help point out specific learning disabilities, tell you what your neurological strengths and weaknesses are, and be used as a grounding point in developing a comprehensive intervention plan. Sometimes it is useful, sometimes, when other disorders are suspect it is necessary, and yes, Dr. Barkley is right, sometimes it's more than you need. You and your psychologist should be able to make that decision together after discussing the severity and nature of your specific symptoms. At any rate, the NYT's article lists the cost of a neuropsychological exam at somewhere between $2,000 and 5,000. You need to decide if this is a necessary expense. Remember, as Dr. Barkley says, neuropsychological tests are "inaccurate when it comes to ADHD." That may be true, some would argue with that, but it Is misleading. Most of the time the neuropsychological exam is not being given to diagnose ADHD at all. It is being given to rule out other possible neurological causes of symptoms, and to develop an understanding of the clients strengths and weaknesses. So don't be afraid to ask your doctor "Why am I going to take this exam?" "What, exactly, might we learn from it?" There are many good reasons to take a neuropsychological exam. For children, adolescents or young adults having educational and learning problems we need to look at a number of factors in order to rule out, or diagnose, a specific learning disability. For individuals with impulsivity and anger issues, or problems with emotional regulation, we need to look at possible mood disorders vs ADHD. There are many good reasons, just don't be afraid to ask why.

Read the original article about Attention Deficit Hyperactivity Disorder in the Times, and read the reply by the neuropsychologists.

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As always, I remind you that this blog is not meant to be a diagnostic tool, these disorders are complex. Don't take on line tests and diagnose yourself. Contact your medical doctor, see what he or she can do for you. If need be, contact a Registered Psychologist, one with experience with ADHD, and get a real diagnosis and help in making treatment choices.


For information on treatment services I provide for children, click here: http://web.me.com/jimroche/relatedminds/child_therapy.html

For information on diagnostic and treatment services for children with ADHD, click here:http://web.me.com/jimroche/relatedminds/adhd.html

For information on diagnostic and treatment services for adults, click here: http://web.me.com/jimroche/relatedminds/adult_adhd.html

You can also just check out my regular web page at www.adhdhelp.ca or www.relatedminds.com

Self-help readings on ADHD, Try these:
Dr. Barkley's "Taking Charge of your ADHD"
Kathleen Nadeau's Understanding Girls with AD/HD
Mary Solantos' Cognitive Behaviour Therapy for Adult ADHD

These are a great place to start!

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

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

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

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

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

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

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

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

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

ADHD: Science-Based Medicine and Psychology!

This past week the Vancouver Sun, along with most other major new outlets in Canada, published articles about ADHD (Attention Deficit Hyperactivity Disorder) diagnosis that mislead the public about diagnosis, scared parents about treatment, and demonstrated a lack of understanding of the psychological and medical systems here in British Columbia.

Regretfully in our schools today there are 1) a great number of UNDIAGNOSED children who are failing educationally and failing socially, and 2) a number of teachers who do not know the basic scientific facts about ADHD. This in spite of the fact that recent popular press articles have focused on there being misdiagnosed children. As a matter of fact, the articles were about POSSIBLE misdiagnosed children. No information was given about the number of children we know have ADHD versus the number actually diagnosed (lower) and the number getting any kind of science based treatment intervention (very low). Dr. Barkley discusses this issue in the video I have posted below and I'll leave it to you to watch (teaser!)

Over the past several years I have given several dozen presentations to schools relating to child behaviour and teaching. Almost every one of these presentations has been on the subject of autism or Asperger's disorder, in spite of my own urging to the schools that what they need is training, information and support to help students with ADHD. (Ask any teacher what student is most difficult for them to teach effectively and understand, most would admit it's the student with ADHD. Yet there is little funding in this area, some district do not even provide services to these children, and little if any training.)

A common response from classroom teachers about students with ADHD is that they purposefully engage in the "troublesome" behaviours that cause disruption, that they make a "choice" to do this, and finally, that they are capable of just sitting down and doing the work "because they can focus on something that interests them for hours!" These accusations of "laziness" and "willfulness" are often shocking, but come from a point of view that is uninformed, or if they get science information from sources like the Vancouver Sun, MISINFORMED.

I am providing a link here to a rather long lecture by Dr. Russell Barkley, PhD.
Click here for Dr. Barkley's lecture given at UC Davis.

I always want to also mention an excellent book about children having educational difficulty by Dr. Mel Levine called "The Myth of Laziness." While this book isn't about ADHD it is about executive dysfunction and students who, despite being bright and capable, simply cannot produce work at school. I cannot recommend this book enough!

Dr. Barkley's lectures are always interesting. If you have never heard him speak, this lecture is worth watching. It is long but filled with great information. And I suggest that every school purchase Dr. Barkley's series of DVDs on ADHD.

If you and your doctor are interested in a comprehensive assessment for ADHD, which consists of extensive behavioural and medical history taking, comprehensive cognitive and educational assessment, as well as neuropsychological assessment to determine the exact nature of your problem and help with developing an individualized intervention plan, please feel free to contact me. My evaluations follow the guideline for a comprehensive differential diagnostic exam as suggested by professional associations and medical groups. It is more than a simple 20 question checklist! (Remember, when trying to find the reason for a problem we don't just look at what we think something is, we also need to do a comprehensive differential diagnostic process to rule out other possible causes of the problem!) Additionally I am able to provide ongoing assessment of cognitive processes through specialized neuropsychological tool which tell us if treatment is really working, and improvement isn't just "placebo" based.

For more information about my practice in Vancouver and Burnaby you can click hereclick 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

Attention Deficit Hyperactivity Disorder (ADHD): Assessment and Treatment Plans for Adults

I have written at length about the necessity of obtaining a comprehensive evaluation for Attention Deficit Hyperactivity Disorder (ADHD) elsewhere in my blog and on my website. ADHD is a very general diagnosis and most likely doesn’t tell you much about the particular problems you are having as an individual with ADHD. The neuro-cognitive assessment I provide include, but are not limited to, issues such as verbal memory, visual memory, processing speed, executive function (decision making, picking out what is important or salient, impulsivity and emotional control), psychomotor speed, reaction time, complex attention, cognitive flexibility and long term attention and focus. Additionally we usual look at factors that might direct us towards other or co-morbid diagnoses such as depression, anxiety and so on.

This is far more comprehensive than the assessment you might have received from your medical doctor, which might have included little more than one or two self report forms and a short history taking. That’s not to say that your MD didn’t get it right, or can’t make such a diagnosis that quickly. Often it can be. What a more comprehensive evaluation provides is a deeper understand of your individual strengths and weaknesses. From this we can determine how to help you develop an individualized intervention plan that addresses deficits, and also makes use of your cognitive strengths.

What would a treatment plan for an adult look like?
Often I see adults for an initial evaluation and then meet an average of eight times, using a combination of psycho-educational planning and weekly consultation to get them off on a a program they themselves can continue. Here is a general outline of the meeting schedule:

Assessment, Review and Overview
Session 1: Review of assessment results
Overview of the ADHD program
Discussion of involvement of family and workmates

Organization and Planning
Session 2 The basics of organization and planning skills
Organizing multiple tasks
Session 3 Problem-solving and managing overwhelming tasks
Organizing papers

Reducing Distractibility
Session 4 Gauging your attention span and distractibility
Modifying your environment

Adaptive Thinking
Session 5 Introducing the Cognitive Model of ADHD
(Cognitive Behaviour Therapy)

Session 6 Review of Adaptive Thinking and previous sessions
Session 7 Dealing with Procrastination
Session 8 Preventing Relapse and setting future goals

For adults we often use the Cognitive-Behavioural Treatment Program developed by Safren and Sprich, which has been found useful with adults. I also ask clients to watch Russell Barkley’s A New Understanding of ADHD (a DVD available in the office) and read either Kelly and Ramundo’s You Mean I’m Not Lazy, Stupid or Crazy?, Hallowell and Ratey’s Driven to Distraction or Thomas E. Brown’s Attention Deficit Disorder: The Unfocused Mind in Children and Adults. All three of these books can be obtained in my office or for those who find reading difficult or finding time to read difficult (and these are all 300-400 page books) I have them available on CD.

Following this eight week plan we can cover all major areas of concern that come from ADHD, and we can additionally fine tune the program to address your specific deficits and strengths, making success much more likely. Individuals are then able to use self-help tools with confidence and the underlying knowledge and experience they need to make the most of them. After this initial program clients sometimes see me on a monthly basis, or even quarterly, for “check up” and to address problems with relapse.

Finally, for those who, with the help of their primary medical provider, decide to take medication to deal with this disorder we are able to provide ongoing neuro-cognitive assessments that help monitor the effects of the medication.

In the next few weeks I will be trying to address some of these specific topics here in the blog. If you would lke more information about my practice and the assessment and treatment of Attention Deficit Hyperactivity Disorder (ADHD) please look at my web site: www.relatedminds.com or my Psychology Today website by clicking here.

ADHD - Medication or not?

I just did a web search for information on treatments for ADHD. I do this every few weeks to check what parents and adults are finding. I was again shocked. Nonsense on food colouring causing ADHD so switching to a new diet will help, sugar causing ADHD. This one is so tiring. Again and again real scientific studies show there is virtually no relationship between any form of sugar and ADHD symptoms. And finally, rant after rant about the evils of medication. This little video with Dr. Russell Barkley addresses that issue and in the next few weeks I am going to try to provide more information in video format as I find it.

ADHD is a life long disorder, and if it is severe enough, and especially if there IS NOT hyperactivity but instead just inattentive behaviour, you need to speak with your medical doctor about medication. As a psychologist one thing I can do is fully assess you for ADHD. And I can give you specific neuropsychological tests that will help us determine what behavioural treatments and skills will help. And finally, if you and your doctor want, we can do repeatable test batteries that measure cognitive changes that happen, or don't happen, as the result of medication. This helps us understand how you are being affected by the medication. For more information on this and other interventions I provide for ADHD / Attention Deficit Hyperactivity Disorder, including an eight week training program for adults, contact me through my web page at www.relatedminds.com

Our offices serve Burnaby, New Westminster, Coquitlam, Maple Ridge, Port Moody and Vancouver.

Rebecca Saxe: How we read each other's minds | Video on TED.com

Rebecca Saxe: How we read each other's minds | Video on TED.com

I often share this video at workshops I do about Asperger's Disorder and autism. It's a great little video. While still a graduate student, Rebecca Saxe made a breakthrough discovery: There's a specific region in our brain that becomes active when we contemplate the workings of other minds. Now, at MIT's Saxelab, she and her team have been further exploring her grad-school finding, exploring how it may help us understand conditions such as autism. It gives great insight into why it is so hard to understand what other people are thinking. The problem of language pragmatics, putting yourself in the shoes of another.

In this short video Saxe delves into the complexities of social cognition. iT's fun and has several "ah ha!" moments.

The next post will get back to some of the details of interventions in the field of autism and Asperger's.


Jim Roche, PhD
www.relatedminds.com
www.socialcognitivetherapy.com
778.998-7975

Sir Ken Robinson: Bring on the learning revolution! | Video on TED.com

Sir Ken Robinson: Bring on the learning revolution! | Video on TED.com

Often when dealing with children, adolescents, adults and parents who are dealing with ADHD I find myself wanting to step back and ask them to take a time-out, relax, and think about taking care of themselves for a little while. Make sure your not just solving problems, but that your happy too. As a behaviourist I am often stuck in the dirty, nitty-gritty details of getting school to work out for a 7 year old, or helping someone to increase their "output" at work before they lose their job. But we all need time to step back and ask if we are ...happy. Are we taking care of ourselves as much as the needs of others. And often when dealing with ADHD we seem to be working on meeting the needs, wishes and "wants" of someone else.

This short video from Ken Robinson reminded me that besides working as a behaviour specialist I've also trained as an "educator." Someone who wants to have an effect on learning and growth of individuals. On my bookshelf are not just books on managing behaviour but also books like "Summerhill" by A.S. Neil, "Pedagogy for the Oppressed" and "Teaching as a Subversive Activity." Books about the philosophy of education.

I often ask parents what their plans are for their child when he or she is 25. And hope I can help them see great plans for their child. And this goes for adults too.

Want a college experience about you? Look at Goddard College's history and philosophy. (www.goddard.edu)

Want to think about other alternatives? Read "What Should I do with my Life?" by Po Bronson.

Most of all, take some time to focus on you. On your dreams and hopes. Find out about those of your partner or child. Watch this video and hear what happened to the kid whose teacher though it below him to become a firefighter. Find your place.

Next time, back to the details of ADHD.

Ritalin May Make Learning Easier - Health News Story - KRXI Reno

Ritalin May Make Learning Easier - Health News Story - KRXI Reno

By: Dr. Jim Roche

Ritalin is about the most common medication prescribed for ADHD. Usually it is prescribed for the problems of focus and concentration. This new research demonstrates that Ritalin is also effect, at least in these animal studies, for improving learning speed. Learning speed and processing speed, two similar but different issues, are the focus of concern of the research of Russell Barkley and several others in the field.

This current study was published March 7, 2010 in Nature Neuroscience.

While medication is considered to be the most effective intervention for issues of focus and concentration in ADHD it is often not enough. Children and adults have often developed inappropriate behaviour response patterns to compensate for their ADHD symptoms, and additionally have not learned to use many appropriate behavioural responses and social skills. Therefore behavioural interventions are still needed, even with the often immediate and striking improvements we see from medication. If your child is in school his or her Individual Education Plan (IEP) should address the need to teach and reinforce new "replacement" behaviours. A Positive Behaviour Support Plan should appropriately address these missing links that have developed over time. Understanding them often means conducting of FBA or Functional Behaviour Analysis prior to developing a plan.

Adults often go through this activity when they engage in behaviour therapy for ADHD. For both children and adults specific training might address issues of social skills, self regulation of affect (anger management), response inhibition (the ability to think before you respond), task initiation (procrastination), mental flexibility (the ability to revise plans) and goal-directed persistence (sticking with a task until it is finished). As you might imagine, as effective and necessary as medication may be, there is no medication that quickly teaches these skills. In addition to these skill sets we often need to train individuals in planning, organization, time management, how to improve and use working memory (some very basic skills many individuals don't know about!) and metacognition (self-monitoring, asking yourself "How did I do that? or How am I doing?" in order to improve your performance. Learning and mastering these skills seldom happens automatically.

For more information on ADHD assessment, treatment and support you can visit my web page at www.drjimroche.com or www.relatedminds.com.

About Assessments for ADHD, Autism and Learning Disabilities

A lot of people call my office and have been told by a day care provider or teacher that they are sure their child has autism, Asperger's Disorder or ADHD. And often this is based on some list of symptoms that they read on the internet. Parents often then scramble and start looking themselves. Even adults do this, I get a fair number of adults who have wondered about possibly having autism after someone mentioned it to them and they began a web search.

Autism, ADHD, Asperger's disorder are not an easy diagnosis to make. And one of the important things that takes place when assessing a child, adolescent of adult for autism spectrum disorder (ASD) is what we call a "differential diagnosis." The symptoms you may be concerned about may or may not be ASD. They could be another problem such as a language disorder, auditory processing disorder, a learning disability, some form of speech disorder, mental retardation, ADHD (both often confused with ASD), a movement disorder, OCD. The list goes on.

Additionally the disorder may be more than one thing. ASD is often found to be c-omorbid with another disorder such as ADHD. ADHD itself is not an easy disorder to diagnose. The Centre for ADHD/ADD Advocacy, Canada (CADDAC) has set standards for a full differential diagnosis of ADHD and it includes an extensive amount of data collection and takes a considerable amount of time. Another source of information on diagnosis ADHD is from Dr. Russell Barkley. His procedures are very similar to CADDAC and are the procedures I follow in my practice. As I mention below for autism diagnoses, you usually have one chance at an assessment and it should include all of the tests below except the ADOS and ADI-R. You need to know if there is a co-morbit learning disorder, and you need to understand exactly how ADHD is expressing itself in your child. While a neuropsychological examination is not necessary for a diagnosis, it is necessary if you want to know what to do about it. A very simple computer based test a medical doctor could offer you for a child 8 years old or over is the CNS-Vital Signs assessment which tells us about memory, ability to switch sets, executive functioning, processing speed and other critical bits of data we need to develop a treatment plan. Many of my patients are referred by medical doctors because they do not have the time or specific skills to make a firm diagnosis.

Here in British Columbia a full diagnostic autism assessment is usually completed by a provincial agency. This might take place at Children's Hospital or through a provincial health authority provider. You start this process with a referral from your medical provider. The Ministry for Children and Families has information about the assessment process on their web site. Those services should be free to anyone here in British Columbia. However, there is a long waiting list for these services. Private practitioners, including medical doctors and psychologists, who have had specialized training in the two instruments I'll talk about below, can also provide this service, however either you or your extended health care (if your lucky enough to have it) has to cover this cost. It's usually about $1,800 -$2,100. And for children under 6 an assessment needs to be completed by a team of professionals, hard to arrange through a private practitioner and even more expensive.

What does the assessment consist of? First, for most children and adolescents there is an initial interview history taking. Then, usually, a psycho-educational assessment is completed. This includes an intelligence (cognitive) test and an academic performance test. Usually these scores are compared to look for discrepancies that would lead us to finding a specific learning disability. If your child get X score on this part of the intelligence test, we would expect he or she would score Y on this part of the academic test. This testing also helps rule out mental retardation or other cognitive impairments. If you are going the private practitioner route, you might be lucky enough to have the school complete the psycho-educational assessment, cutting back your costs.

Next your child is usually examined for behavioural and personality issues. This might take place through interviews, pencil and paper tests or self reports like the Beck Youth Scales and reports from parents and teachers. The examiner wants to rule out personality disorders, psychosis, depression, anxiety and similar issues that can often be mistaken for ASD.

There might now be some specialized test that the examiner would use to look at an issue he or she is concerned with. And some examiners will do more complete neuropsychological tests to give us information on problems that might relate to executive function, memory and learning, impulse control, motor and visual-motor issues. This is especially important for children with co-morbid ADHD or for whom we find ADHD is the primary concern. This information helps us come up with focused treatment interventions.

Finally, for children we are still concerned about ASD with the provincial government here in British Columbia requires two specific tests: The Autism Diagnostic Observation System (ADOS) and the Autism Diagnostic Interview (ADI-R). There are several other very good and reliable tests that focus on autism, however the ministry will only accept a report containing these two specific tests.

The ADOS is a series of activities and questions the examiner goes through with the child, giving him or her an opportunity to see how the child responds to new stimuli. The ADI-R is a lengthy report completed during an interview with the parents or other caregivers about the child's developmental history focused on symptoms found in ASD.

Some practitioners complete shorter reports using just the ADOS and ADI-R. This might be quicker but leaves us with doubts about other possible reasons for the behaviours of concern (not a real "differential" diagnosis) and provides little information we would be able to use to provide targeted interventions / treatment. And honestly, it's very difficult to obtain a second assessment to obtain this kind of essential information as there is a long waiting list of children and adolescents for initial evaluations.

To find a practitioner who can help you with an assessment I would start with my medical doctor, who may have a doctor of clinical psychology he or she knows and referrals to, or contact the British Columbia Psychological Association for a referral. You must, however, see a licensed or registered psychologist for these types of diagnostic services. Registered Clinical Counsellors (RCC) are not qualified to provide these services and often parents pay for assessments that are then not accepted by school districts or the ministry. School psychologists can only perform these tasks as part of their employment in the school district and are not qualified to do these types of assessments independently. (However, an RCC or school psychologist may ALSO be a licensed or registered psychologist, so ask,) Finally, before paying someone to complete any assessment, ask the agency you plan to use the assessment with (ministry or school) if this provider is qualified to provide such information to them.