School Based Interventions for Angry, Acting Out Kids

Behavioural Problems and Younger Children, including Temper Tantrums


School has not even started and several parents have come by for advice on dealing with behavioural issues at school. The live in expectation and fear! Most of these kids have Attention Deficit Hyperactivity Disorder, or another executive disorder, sometimes called “EF” problems or “Executive Function” disorders. There are differences between executive function disorders and ADHD, but for the most part the behaviours of either type appear the same in a classroom setting. Sometimes these types of behaviours are called dysfunctions of “self-regulation.” 
So what to do if your child is out of their seat, calling out, talking without permission, fighting, out of line..in the hall...last off the playground and your teacher already needs a vacation in week 2 of school?
Lets start with “Positive Behavioural Supports: Token Systems”
In the classroom and home the most effective intervention for acting out behaviour is a positive behavioural support system - a token system. This provides a mechanism to immediately reinforces appropriate behaviours and increases their frequency. It’s about teaching and reinforcing new skills and not relying on “correcting” misbehaviours that have already happened. For the most part, if a correction was going to work ...it would have worked already!.
Here is a typical plan for using a reinforcement system: Often a timer is set in the classroom and 7-10 times per day the students are reinforced for appropriate behaviours using the token system. Responding to the timer rather than student behaviour increases the positive feedback the student receives and decreases the ineffective “corrective” feedback. The timer is critical! Dr. Barkley’s DVD “ADHD in the Classroom, Strategies for Teachers,” provides an excellent example of using these techniques. Dr. Barkley also has excellent parenting videos such as “Understanding the Defiant Child” which I would recommend to any parent. Token systems have an extensive history and have been proven to be highly effective over and over again. Why don’t teachers use them? Usually because they used them wrong. Watch Dr. Barkley’s video and see them in action. (I also provide training in to schools on the basics of classroom management where I demonstrate the system by using it throughout the workshop...and it’s not disrupting and takes very little time.)
Good behaviours are learned, so teach them!
Modeling, practicing and formally reinforcing appropriate behaviours is another intervention necessary to teach self-regulation skills. Self-talk is a key component to a successful program addressing problems with self-regulation. There are several places schools can get information on teaching self-regulation skills, one is an excellent book by Peg Dawson and Richard Guare, “Executive Skills in Children and Adolescents.”  (The Guilford Press).
A more comprehensive set of materials is “Skillstreaming in Early Childhood,” by Ellen McGinnis and Arnold Goldstein. These materials come from Research Press as part of their “Anger Replacement Training” program, which includes an excellent training DVD. Every middle and senior high school should have staff trained in this method of anger management.
It’s not just good behaviour, but learning problem solving as well!
To decrease the frequency of serious outbursts and tantrums in younger children I recommend Dr. Ross Green’s book “The Explosive Child.” This book teaches a specific interaction style which helps the child stop, think and use collaborative problem solving skills. (These techniques can be highly effective, but are not a primary intervention.) Dr. Green also has a website on his “Collaborative Problem Solving” method which schools and parents could refer to. Lot’s of videos demonstrations are available. Take a look!
Thought Stopping and Cognitive Behaviour Therapy for Children
One simple technique to help children stop the cycle of anger that overwhelms them is teaching them what is called the “Behavioural Call Back.”  Also called the “Behaviour Macarena.”  The class is taught to respond to a teacher’s call, “Stop, Think, Make-a-Choice, Not a Bad Choice, A Good Choice.” This  is done with both the verbal response and hand movements. This complicated hand movement response, practiced many times, and every day, is then used to help a child at the early point of a problem is starting, when it is difficult to stop a cycle of anger. When the teacher observes a problem starting, she signals the child with the hand movements, and in order to signal back the child has to “switch mental sets.” This is a basic “thought stopping” technique used in almost every anger management program. Other thought blocking or stopping techniques can also be taught, and appropriate self-talk helps here as well. These are just a few of the techniques that behavioural therapists use when working with children with anger management problems - or disorders of self-regulation.
Other books I would suggest be read to/with children at home or school include “What to Do When Your Temper Flares,” by Huebner, and “A Volcano in my Tummy,” by Whitehouse.  Teaching a child to understand different emotions and recognizing their varying levels within him or herself is a critical part of any intervention aimed at decreasing outbursts of anger and frustration. Schools often use books such as Kari Buron’s “When My Worries Get Too Big! A Relaxation Book for Children Who Live with Anxiety”  and various forms of Kari’s book “The Incredible 5-Point Scale.”

Any comprehensive intervention for anger issues and problems with self-regulation must provide a student with psychoeducation about emotions, and skills to “self sooth” such as the “Turtle Hug.” Examples of these can be found in the various “Incredible 5-Point Scale” books and classroom materials. Using these with the entire class makes then the norm.
As you can see, there are dozens of well known, scientifically validated interventions for anger, aggression, temper tantrums and emotional meltdowns at school. Classroom teachers are often not aware of these techniques, but  with training and consultation any classroom can become a more pleasant and positive experience for a child with an executive dysfunction....even those with problems of self-regulation and anger management. One thing we know for sure, getting angry back, and using punishment doesn’t work...or there would be no problem. These are skills that need to be taught. And that’s what school is for.
"ADHD Assessment and Treatment" are written by Dr. Jim Roche. These autism notes are not meant to provide a guide to either diagnosis or treatment. For information on diagnosis and treatment contact your medical doctor or a registered/licensed psychologist for an appointment and assessment. Information about Dr. Roche's services can be found at these addresses:

Relatedminds: http://www.relatedminds.com
ADHD Help BC: http://www.adhdhelp.ca
At Psychology Today: http://therapists.psychologytoday.com/rms/70682
At the BCPA website: http://bcpa.pixelmountainarts.com/users/jimroche
At CounsellingBC: http://www.counsellingbc.com/listings/JRoche.htm
At Psyris: http://psyris.com/drjimroche
KEY WORDS: ADHD, ADD, Attention Deficit Hyperactivity Disorder, School, Behaviour, acting out, temper tantrums, classroom management, Vancouver, Seattle, New Westminster, Coquitlam

How Much Does a Psychoeducational Assessment Cost?


How much should a Psychoeducational Assessment Cost?
Well, I hate to say this, but "it depends."

Not All Assessments are Alike
The exact nature of the Psychoeducational Assessment you need can be very different from case to case. This includes assessments because of in class behaviour such as aggression towards peers to a student who are struggling..and then the student who isn't doing work and seems bored and we suspect is really "gifted" and whose needs we are not meeting. And that's the issue we should be focusing on when it comes to psychoeducational assessments: what needs does any student have that need to be met for this student to be successful as they can be?

So any individual psychoeducational assessment may be very different. Let's first look at what usually is the same:

A common feature, if not a necessary feature, is a comparison of a students cognitive or intellectual abilities and their academic abilities. Usually this means administering a cognitive-intelligence test (this might be any of the following: The Cattell Culture Fair, Kohs block, Leiter International Performance Scale, Otis-Lennon School Ability Test, Raven's Progressive Matrices, Stanford-Binet IQ test, Wechsler Adult Intelligence Scale. Wechsler Intelligence Scale for Children, Wechsler Preschool and Primary Scale of Intelligence, the Wonderlic Test or the more recent and very popular Reynolds Intellectual Assessment Scale or RIAS). In addition to the intelligence test a test of academic skills is also administered (This might include anything from the Wechsler Individual Achievement Test to the Wide Range Achievement Test-4 or a any of several others).

The most common combinations are one of the Wechsler Tests of intelligence and a Wechsler test of academic skills, or the Reynolds (RIAS) and Wide Range Achievement Test.  The next step is usually to compare these scores and see if there is any reason to suspect a specific learning disability. This is done several ways, but is most often referred to as a "discrepancy analysis." The basic question is: Does the student work at an academic level we would expect, based upon their intelligence.

After this most basic analysis a psychoeducational assessment can go in several directions. If there are behavioural issues it might include testing for personality issues, anxiety, depression, or ADHD. One problem is that school psychologists are neither psychologists or doctors (usually ...some school psychologists here in BC actually are Registered Psychologists) and should not be diagnosing mental health disorders. They look for educational problems, often perform "coding" which is the process of classifying students for different types of services based upon ministry guidelines, and make suggestions for classroom supports. But they usually do not diagnose something like ADHD. You need your family medical do cot or a Registered Psychologist to do that.

If your wondering if your child has autism you need to have a specially trained medical doctor or Registered Psychologist perform a specialized examination using several tools that most psychologists and family doctors do not have training in, and simply don't own.

So to start usually we take a look at cognitive/intellectual ability and compare that to academic ability. From that we determine if there might be a specific learning disability. After that step other tests are usually used to look at specific areas of concern. This might include tests of reading, specific math skills (Key Math is one commonly used test), tests of pragmatic language, visual perceptual skills, auditory processing, balance, gait, motor skills and so on. So the initial phase of the assessment is only the beginning.

Each psychoeducational exam is different, or should be. Often the psychoeducational exam is just a starting point, and to understand the issues a student may also need an assessment by an occupational therapist and/or a speech pathologist. A medical examination should also have been administered to rule out medical reasons for the issues of concern.

So, when a parent asks me how much a psychoeducational examination will cost, I have to ask questions to determine what kind of psychoeducational examination we will be doing. Many parents tell me they are told by other professionals that "a psychoeducational assessment will cost $2,600." A straight forward price. But in reality, until we meet and look at the situation, we aren't sure. Sometimes a psychoeducational assessment isn't even appropriate until a child is seen by his or her medical doctor, an occupational therapist and a speech pathologist, so that other causes of academic difficulty are mistaken and misunderstood. This is why I personally suggest an initial meeting to gather information, history and concerns.

The cost of a psychoeducational exam? Well, it can range from $1,200 -$2,600. It depends. It depends on the situation, the information we need, the amount of testing and how cooperative and able the child is. One price does not fit all, and one "psychoeducational assessment" does not fit all. After an initial meeting we usually know, and together can shape a plan to fit your needs.

Finally, remember, your school should provide a psychoeducational exam....for free. Yes, there are sometimes long waiting lists. And sometimes a school psychologist can't make a diagnosis of a disorder such as ADHD (Attention Deficit Hyperactivity Disorder) or Autism Spectrum Disorder. Some parents also prefer to have an outsider look at their child and give an opinion. All of these are reasons for looking outside the school for an assessment. (Psychoeducational Assessments are not covered by MSP, but most Extended Health Care Plans do provide some or complete coverage for an assessment).

Talk to your family doctor, your school psychologist and give a Registered Psychologist a call. All would be more than willing to talk to you about this subject. (Registered Clinical Counsellors are not qualified to complete Psychoeducational Assessments. An independent Psychoeducational Assessment must be completed by a Registered Psychologist.)

In my offices in Burnaby (serving Burnaby, Coquitlam, New Westminster, Port Moody, Port Coquitlam and Maple Ridge) and Vancouver (serving Vancouver, North Vancouver, West Vancouver and Richmond) I provide comprehensive psychoeducational assessments. I also provide diagnostic assessments for ADHD and Autism Spectrum Disorder). Please feel free to contact me if you have any questions about these services.
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About Dr. Roche
My name is Dr. Jim Roche and I am a Registered Psychologist and a Registered Marriage and Family Therapist (RMFT) in British Columbia. In addition to my doctorate in clinical psychology, I hold a master's degree in family therapy, a certificate of advanced graduate studies (CAGS) in school and educational psychology from Norwich University, and have completed two years of post doctoral studies in neuro-psychology at The Fielding Institute in Santa Barbara, California. In addition to being a registered psychologist, I am a certified school psychologist, certified teacher of special education (New York and California), and a Clinical Member of the American Association of Marriage and Family Therapists (AAMFT). I also hold a doctoral degree in law with an emphasis in medical malpractice and education law. Beyond my academic credentials, I have completed two years of supervised clinical experience in both hospital and community based clinics and two years of post doctoral training in neuropsychology. I have served as director of behaviour programming for several school districts, as a consultant on autism for the province, and have held numerous academic positions including Clinical Instructor in Psychiatry at New York University and Bellevue Hospital in New York as well as being a faculty member at NYU, Brooklyn College, SUNY New Paltz, and Norwich University.
Key words
ADHD | ADHD coaching | workplace coaching | Anxiety and Stress | Autism and Asperger's Disorder | Individual Counselling | Child Therapy | Testing and Assessments and Learning Disabilities | Couples Counselling | Depression | The Angry Child | Anger Management | Pain Management and PTSD | Forensic Services | Attention Deficit Hyperactivity Disorder | Vancouver | Burnaby | Coquitlam | New Westminster | Maple Ridge | Port Moody | Child Psychologist | Psychologist | Learning Disability | Assessment | Testing | Psycho-educational Assessment | Neuropsychological Assessment
http://www.counsellingbc.com/listings/JRoche.htm



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

ADHD (Attention Deficit Hyperactivity Disorder) in the classroom

For nearly 20 years I have been providing consultation and training to school districts about how to support the student with ADHD /ADD in the classroom.  This has included ADHD consultation with individual teachers and school wide training on the subject. I've worked in Vancouver, Burnaby, Maple Ridge, West Vancouver, North Vancouver, Coquitlam and throughout BC with individual teachers, and have provided school wide consultation and training on ADHD in BC, California and New York.

The student with ADHD / ADD has special needs that can be supported by some very simple classroom or environmental changes, and some specific individual supports. For an individual teacher I have several info sheets available on my website. You can start here with this sheet on Executive Function, Emotions and ADHD in the classroom (click here),  or you can seek out general information on ADHD from my ADHD / ADD page by clicking here: http://www.relatedmindsbc.com/adhd. Other genreral information on children with anger control issues and difficulty with emotional control can he found here: http://www.relatedmindsbc.com/the-angry-child. Other general information can be found on my websites "Forms" page.

In this first post on ADHD / ADD in the classroom I'd like to review several general rules. In my next post I'll address some simple classroom interventions, and then in the final post on in this series address the issue of reinforcement systems. So here are some basic rules, following the guidelines for Accommodations for Children and Teens with ADHD by Russell Barkley (The complete guide is available free from his web page).

1. Rules and Instructions provided to children with ADHD must be clear, brief and delivered more clearly than to regular students.  Start by making sure the child with ADHD has given you his or her full attention ("Mike, are you ready? Yes.") Have the child repeat the instructions out loud, or to themselves. Support the rules or instructions with visual prompts such as signs. Use prompts such as pointing to your ears, eyes, etc. Don't give multi-part instructions unless they are supported with an external aide such as a list, hand gestures, or picture cues.  Ask yourself, "Did he get enough of a warning? Did he get a prompt to pay attention? Did I have his FULL attention before we started? What could help him focus on what I am saying?

2. Consequences for students with ADHD must be "swift and immediate." ANY delay, even just a couple minutes, in giving a consequence to a student with ADHD significantly degrades the power of the consequence.  It is not the size or harshness of the consequence that matters as much as how quickly it is given after the inappropriate or unwanted behaviour.  Frequent feedback is essential. Token systems, visual cues and prompts and hand signals all can help deliver minor but immediate feedback. Remember, these "consequences" for a student with ADHD are meant to be feedback, not so much punishment.

3. Every consequence should be counted!  Consider how many positive feedback moments the student has compared to negative. If you are giving more negatives than positives, consider how environmental changes can help change this to positive feedback. Too often students with ADHD are given constant, low level, late and ineffective negative feedback that becomes nothing more than a drone to their minds. Then then begin to associate the classroom environment with negative consequences. The classroom should be associated with positive experiences, positive feedback for successful behavioural efforts. Ask, "What supports does my student need to get positive feedback more often?"

4. The type of consequences used with students with ADHD must be "of a higher magnitude" than that provided to regular students. That means that positive reinforcers must be more powerful for the student with ADHD. And they must be more frequent and most important more IMMEDIATE for the student with ADHD. If you need help developing these skills, get feedback or consultation. Avoid going down the negative/punishment only path.

5. Positive Feedback must be more powerful and more frequent than negative feedback. Usually token or other reinforcement systems start with two or three weeks of positive only feedback before any negative feedback or consequences are provided to the student with ADHD / ADD. The rule is "Positives BEFORE negatives." Often students with ADHD do not respond to punishment or time out. If punishment is failing, you should seek out professional and experienced help before increasing the magnitude of punishment for a student with ADHD.

6. Reinforcers work only for a little while. Be ready to change them, increase them, provide them in new ways and provide new types of reinforcers for the child with ADHD. This is significantly different from other students in your class, expect that and be prepared to provide it.

7. Behavioural programs for students with ADHD often only work for a short period of time before needing to be modified. Be prepared. Monitor how the program is working, and when you are no longer seeing success alter the program in a manner that makes it effective. Also remember that for the student with ADHD the behavioural changes occur while the program is in effect, and are very likely not to work when you stop them. Does this mean behaviour programs don't work? No. It means they are an effective technique to use to assist you in finding ways to support the student while learning of other kinds occur. For a program of behaviour modification to work for longer periods you need to develop a program that includes components for decreasing the frequency of reinforcers, to generalize the behaviours to new environments and substitute natural reinforcers, prompts and cues for the artificial ones you have been providing. This may be beyond your knowledge and experience. If it is, ask for consultation with a specialist. These types of behavioural programs have been show to work effectively and are generalizable by those who know the techniques and have the experience. Don't be afraid to ask for help. That's what you expect from your student with ADHD.

These are some of the most basic components of a classroom program that can supports students with ADHD / ADD and other related cognitive and emotional deficits. A good classroom program includes visual supports, a means of tracking behaviour, specialized environmental supports and a systematic method of providing positive feedback or reinforcement. This type of program will help you design a classroom that can support these students, and thereby make teaching all of your students  easier.

There are some excellent books on classroom modifications and individual intervention planning for students with Attention Deficit Hyperactivity Disorder available from Dr. Russell Barkley, as well as some very helpful DVD/video training. I am also available to provide individual teacher/student consultations or school wide training in setting up classrooms that are friendly to and support of those with ADHD. Feel free to contact me for more information.

In the next post I'll address some specific classroom and student interventions. Then I'll address using reinforcement systems (such as token systems) that have been found to be one of the, if not THE most effective means of supporting children with ADHD in the classroom. Finally, I may have a few words to say about writing behaviour plans and completing a  Functional Behaviour Analysis (FBA) with a student with ADHD.

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

Attention Deficit Hyperactivity Disorder: School Tips

Well, it's really that time again. Already! And you and your child need to be ready for school, and the school needs to be ready for him or her. What should you do and where do you start? Attention Deficit Hyperactivity Disorder (ADHD) is a particular problem in some schools, and how teacher's react and tolerate students can be very different. Last year might have been great. Or it might have been a disaster. This year can be different, and it most likely will be different, so get ready...now!

So here we go with some school tips for children with ADHD:

1. First, get to know who's who in your school, and your district. Prepare a contact list of everyone you might need to work with during the year. The time to do this is now, while there are no problems, and there is time. Your phone calls and initial contacts will also be more welcomed as your a parent trying to be prepared, rather than a parent with a complaint.

These individuals might include the Director of Special Education or Support Services (whatever your district might call this person), the supervisor of the program your child is in (there may be one in the school, and one in the district office), the chair of the special education or support committee at the school, the head of your school's parent group, your local schools school psychologist, counsellor and of course the school principal, secretary and if its an older child there may be a department head or dean you should know. Also, you may want to get the contact information for your schools Ot or PT, who often can be very useful with developing plans and interventions. Get their phone numbers, and school emails. The emails are very important because you may use those to leave important messages, and especially messages that might need to be revisited later. Remember, if it wasn't in writing, it didn't happen.

2. Gather copies of last years IEP (individual education plans), behaviour plans of FBAs (Functional Behaviour Analysis) school grades, previous correspondence, doctor's diagnosis and psycho-educational assessments. Clearly mark any suggested interventions you find on your child's IEP or behaviour plan. Never go to a meeting without these documents in hand. After every meeting take a few minutes to write up a short summary note for yourself. Especially note who was suppose to do what, by when, and how they were suppose to measure success. I recommend punching holes in them and putting them together in a binder so that they never get lost. (And you thought kids were the only ones who lost important papers!).

3. As soon as you can meet with the classroom teacher and whoever is the supervisor of your child's program. Remember, the classroom teacher is SUPPOSE to be the person designated to implement an Individual Education Plan. That's not always the way it is, and often classroom teachers have not even read the child's IEP.

Now, let's address some strategies that should be seen in use in the classroom:

4. Make sure there are classroom rules posted prominently somewhere. Have your child repeat the rules back to you to make sure he or she understands them. These rules should be stated in the positive. We do this, or do that. Not in the negative. We don't do this or that.

5. Make sure your child will be seated close to the teacher, and away from distractors such as doors, windows, pencil sharpeners and so on. In no way should your child be seated separately, or made to feel different or pointed out.

6. The most effective means we have of modifying behaviour with students with Attention Deficit Hyperactivity Disorder is through immediate feedback and consequences. Consequences should be positive and reinforcing rather than punitive and reactionary. Make sure there is a way to monitor how many positive reinforcing statements are made, compared to corrections. If corrections worked, you would have no worries and their would be no IEP for your child.

7. Positive point systems are the most effective means we have to teach new skills to children with ADHD. Make sure there is one in place in class. It should be a system that always get's your child closer to his or her goal, rather than one that leaves them two points short at the end of the day. (Hey, you earned 98 points! Only two more to go, bet you'll earn those early in the morning!)

8. Make sure your child is allowed physical breaks, is allowed to walk around (with permission) and stand if necessary to do work. Many of these breaks can be built into your child's day with tasks like handing out papers, erasing the board and so on.

9. Use visual cues to help your child follow rules, switch activities and transition throughout the day. Visual supports are less likely to make your child prompt dependent than verbal reminders (which quickly become nagging and turn a child off).

10. Reduce background noise and distractions as much as possible. Some children with ADHD listen to music or "white noise" on headsets. This is something the OT can help you arrange.

11. Reduce the total workload, and reduce homework! There are numerous papers out there about the need to reduce homework for children with ADHD. The goal is to work hard, not to finish everything. It's to make a good effort, the best effort you can. And that's enough.

12. Make sure when giving instructions the teacher get an initial recognition from your child (hey, look here for a minute. Great. ....) and then repeats back the instructions. This will vastly increase the chances a task will actually get done. And any task with more than 3 steps, should be written down.

13. Reduce (do away with) copying from the board! This is one of the most difficult tasks there is for a student with ADHD. There is simply no reason to insist on this.

14. Use visual timers, not just clocks, to help your child stay focused and understand how long a task will take to complete. There are a number of these available commercially (Time-Timer) or you can make one with a few pieces of tape and coloured paper around your clock.

15. Do not use loss of recess as a punishment for a student with ADHD. Why would you remove an activity that will most likely lead to the child doing better the rest of the day?

16. Schedule the difficult tasks and subjects early if you can. The more tired your child is, the more difficulty they will have with focus and attention. Do the hard stuff first, then take it easy. Just like adults do!

17. Use a peer buddy. Yep, someone for your child to look at, follow, get social cues from. He or she should be allowed to look at that student's work as an example, and ask that student questions to clarify.

The most complete and authoritative guides for parents of children with ADHD is "Taking Charge of ADHD" by Russell A. Barkley, PhD. If you have trouble locating this book you can find it on my website where I connect you with books I have suggested through Amazon.ca If you have more time to read about school and learning I would also suggest Dr. Mel Levine's "A Mind at a Time," "The Myth of Laziness," a great book for any teacher interested in why students fail and how they can help,and for kids "Keeping A Head in School: A student's book about learning abilities and learning disorders." Dr. Levine has several other excellent books for children and adolescents to help them understand their brains and how having a disorder like ADHD is not a disaster because they also have some wonderful and powerful skills and talents that others don;t have. Everyones brain is different, and every brain fits in.


For more information about child and adolescent parenting you can visit my web page at www.relatedminds.com, for children with ADHD click here, and for adults with ADHD click here (ADHDHelp.ca) or my Psychology Today Website. You can also call my office at 778.998-7975 to make an appointment for a consultation.

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.

ADHD: Changing a behaviour? How about teaching a new one instead?

Often parents and teachers approach me with questions about changing, or more specifically, getting rid of, a behaviour that is driving them crazy, disrupting their family or classroom, or maybe even dangerous!

I'd like to start by describing a very formal procedure we use in the schools when dealing with a problematic behaviour, and take it from there.

Sam, an 8 year old boy who becomes upset when given math work often rips it up, hides it, or just starts acting out by disrupting other students. His teacher says he's "just trying to get away with it! He knows he can do it, he just doesn't want to!"

Following the philosophy of Dr. Green, I try to think "kids do well when they can" rather than "kids do well when they want to." And I wonder about why he might not be able to do well. I assume Sam would rather complete the work and get a good grade and bring it home to show his parents. Something is keeping him from doing that. And that's the first of two interventions we are going to engage Sam in. This one we call the environmental intervention. We ask "What allows or causes Sam to engage in this behaviour?" It's tempting to think that more punishment, stricter rules or some other form of control will help, but that is usually not the case. Such interventions, if they would work, would already have worked.  We want to check out the environment and make some decisions. This often includes academic testing. More often than not students object to academic work because it's at the wrong level. Too hard, or maybe too easy. If that's the case we change the work to meet his ability level. That means Sam can do whatever work we give him at about an 85% level of efficiency. We call this his level of "efficacy." It's that point where doing the work is easy enough to not cause stress, but not so easy as to be boring or meaningless. This is especially hard to do in today's classrooms where everyone is suppose to operate at exactly the same level! Even though we know there are hugh developmental differences between students in every class. At any rate, we try to determine what in the environment allows this to happen, or makes it happen. With his math it may be the work is too hard, so we change the work to meet his level of competence. It might also have been he has ADHD and can only focus for 15 minutes before becoming distracted. So, we might set a timer for him to react to and come and get feedback. Or simply shorten the work by making a line that says "get here, see me" so that he comes to the teacher for feedback.  Sometimes a student may get in arguments on the playground because he isn't supervised. What allows his behaviour to happen? A lack of supervision. So we either provide it or we put him in a more successful environment. That's step one. We figure out what environmental changes we need to make to reduce Sam's need to engage in the behaviour. And we mean positive, support based changes.

But that isn't the end of the problem. We need to also understand the specific function of the behaviour to teach a new skill that helps Sam meet that goal next time in an appropriate way. We do what is called a Functional Behaviour Analysis (FBA). We observe Sam and try to figure out WHY he doesn't do his math. What is the function of his behaviour? He makes noises and disrupts to? In this case we determine he does this to avoid work he finds difficult.

Yes, we have changed the work so it's difficulty level is reduced, but step two of changing a behaviour is teaching a new skill that meets the function of the previous behaviour. In this case Sam was avoiding difficult work. Instead of avoiding difficult work by being disruptive we might teach him to ask for help. We could do this any number of different ways. We might start assignments by having Sam look them over and asking one question that will make it easier. We might give him "question tokens" he can use to ask for help, or give him yellow tabs he can attach to any piece of work and use to get rid of the work and complete it at another time with the help of a classroom aide. Every day he gets three stickers he can place on work he is having difficulty with and place it on the teacher's desk. When the aide comes in she takes Sam aside and quickly and painlessly (a key element) helps him get his work done and answers questions.

The key point here is that we are teaching Sam what we call a Functionally Equivalent Replacement Behaviour. Previously, when confronted with something he found hard and difficult, he acted out and disrupted the class. Now when confronted with something he finds hard and difficult he knows how to ask for help. He still is avoiding doing the work alone. But we all do that. Think of how many times a difficult project at your job was given to a committee and divided up. It's an appropriate replacement behaviour. And we can't make the behaviour go away by changing the work and be satisfied, because the real problem was Sam's behavioural response to this kind of situation. Now we have taught him a new skill.

This is how to deal with almost every behaviour of concern. You make environmental changes to reduce the need to engage in it, and then you teach a new functionally equivalent replacement behaviour. For an excellent, complete and FREE set of training materials for yourself or your school you can go to the State of California's PENT (Positive environment Network of Trainers) site. There you will find complete programs for working with children in the schools, for training teachers and for completing a Functional Behaviour Analysis. Their site is located here.

This blog isn;t written to teach you everything you need to know about dealing with school or home behaviours. But I do hope it helps you understand that there is a formal way to look at, understand and intervene in schools. And if your child is having behaviour problems, especially if they are "coded: H or R, ask your school "Where is the FBA?" You want to make sure both of these important components of a behavioural intervention are present.

For more information on children and behavioural issues you can visit my web site at www.relatedminds.com