Kids with ADHD deserve action: One Year Later

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

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

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

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

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

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

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

Think Your Child Has ADHD?

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

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

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

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

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

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

Psychoeducational Assessments and ADHD

Does a Psychoeducational Assessment also diagnose ADHD?
Psychoeducational Assessments are usually completed by your school district. In many provinces and all of the United States school districts provide timely psychoeducational assessments upon a reasonable request from a parent or teacher (with the parent's permission). Usually those psychoeducational assessments happen within 50 working days.

Here in British Columbia we have the regrettable problem of poor school funding and staffing. In some school districts children are placed on a waiting list that can last for one, two, three or more years! Many school districts place children on a "waiting list" only to redo the waiting list at the end or every year! So parents often make a choice to go to a registered psychologist to get a psychoeducational assessment.

One of the advantages of a psychoeducational assessment completed by a Registered Psychologist rather than a School Psychologist is that a REgistered Psychologist is authorized to diagnose ADHD (Attention Deficit Hyperactivity Disorder) and a School Psychologist is not. School Psychologists usually only hold an MA or MS degree, not a doctoral degree, and are not a "regulated profession" in BC. You should know, however, that many School Psychologists who are completing psychoeducational assessments for learning disabilities and behavioural issues are actually Registered Psychologists who have chosen to specialize in school based psychology. So, they may or may not be able to diagnose ADHD. Adding to the confusion is the fact that many school districts have rules that limit what school psychologists do, and some districts do not allow even their Registered Psychologists to make a diagnosis of ADHD (Attention Deficit Hyperactivity Disorder) or other related childhood disorders such as Autism Spectrum Disorder or Aspgerger's Syndrome.

Another important factor to consider is that when a child is diagnosed with ADHD it is often critical to complete a Psychoeducational Assessment, as nearly 50% of children with ADHD also have another disorder, often a specific learning disability. A Registered Psychologist or your School Psychologist can complete that assessment.

When is the best time to get a Psychoeducational Assessment?
It is appropriate to get a psychoeducational assessment whenever a child has had repeated academic failures, and classroom based interventions have failed. Waiting more than a year of academic failure places your child in a difficult position to get out of. This is especially true of children in grade 3-4, when the classroom curriculum begins to change and become much more difficult. A lack of strong basic skills can make academic work very difficult if not impossible for some children.

Does a Psychoeducational Assessment also address behaviour problems? 
Usually a Psychoeducational Assessment does look at behavioural problems. First, it's often necessary to rule out that the behavioural issues are not caused by academic deficits. Second, schools are able to complete not just a Psychoeducational Assessment but also a Functional Behavioural Analysis (FBA) to understand the reasons for the child's behaviour. Most school districts have someone trained in completing FBA's. Again, while all schools in a state like California would be required by law to provide FBA's, and to have them completed by a fully and appropriately trained specialist, this is often not the case here in British Columbia.

If the school is going to provide an FBA you should ask what training, expertise and experience the provider has (how many FBAs have they completed? What training did they get? How many hours of training? How much of it, if any, was supervised by an expert in behaviour? These are good questions to ask.

Finally, remember, your medical doctor can usually make a diagnosis of ADHD. If they feel unsure, they can make a referral to someone else. But a diagnosis of ADHD leaves out a lot. It's best practice to also complete, at least for children, a Psychoeducational Assessment. Your family MD is covered by MSP, however services by a Registered Psychologist, even though they are a regulated health provider, are not covered by MSP. Most extended health care programs cover some or all of these costs, but you need to check with your individual provider before having a Psychoeducational Assessment done. Some providers will not cover the cost of an assessment.

 Dr. Jim Roche provides both Psychoeducational Assessments and ADHD Assessments, as well as treatment and coaching for children, adolescents and adults with ADHD, behavioural disorders and autism spectrum disorder. His website can be found at: http://www.relatedminds.com

New ADHD Widget added to web page


You will find the new ADHD Widget on the right side of most pages of my web page. This new widget guides you through making a decision about ADHD - that is, it helps you decide if it might or might now be a good idea to see you psychologist to medical doctor. It's not meant to diagnose ADHD. It's a handy interactive means of helping you put things into perspective. Deciding if a child has ADHD is a several step process. There is no single test to diagnose ADHD, and many other problems, like anxiety, depression, and certain types of learning disabilities, can have similar symptoms.

The American Psychiatric Association's Diagnostic and Statistical Manual-IV, Text Revision (DSM-IV-TR) is used by mental health professionals to help diagnose ADHD. The criteria are presented here in modified form in order to make them more accessible to the general public. They are listed here for information purposes and should be used only by trained health care providers to diagnose or treat ADHD.

If a parent or other adult is concerned about a child’s behavior, it is important to discuss these concerns with the child’s health care provider. A diagnosis is made up of more than a simple checklist.

See my web page for more information at www.relatedminds.com
                                   

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

ADHD symptoms worsen quality of life for individuals with autism, study finds

Dr. Jim Roche provides diagnostic and intervention services for children, adolescents and adults with ADHD (Attention Deficit Hyperactivity Disorder) and ASD (Autism Spectrum Disorder) in both his Vancouver and Burnaby offices.

ADHD symptoms worsen quality of life for individuals with autism, study finds


Research supported by the Autism Speaks Autism Treatment Network (ATN), demonstrating that symptoms of attention deficit and hyperactivity worsen quality of life for individuals with autism spectrum disorders (ASD), has been presented at the Society for Developmental & Behavioral Pediatrics Annual Meeting in San Antonio, Texas.

Researchers Parul Vora, M.D., developmental-behavioral pediatric fellowat Nationwide Children's and Darryn Sikora, Ph.D., Director of the Autism Program at Oregon Health Sciences University, used data exclusively from the ATN Registry to examine whether the presence of symptoms of attentiondeficit hyperactivity disorder (ADHD) might have additional impact on the adaptive functioning and quality of life of children and adolescents with ASD. After reviewing measures of attention and hyperactivity, and measures of quality of life, for over 2,000 children and adolescents with ASD, they found that over half of this group had symptoms of either attention or hyperactivity problems. More than a third had significant symptoms of both.

While there is sometimes a reluctance to directly address ADHD symptoms with children, adolescents and adults with autism spectrum disorder, it's clear to many in the field that successful treatment interventions must also address these often debilitating symptoms. Click on the article above for more information.

ADHD symptoms worsen quality of life for individuals with autism, study finds

Dr. Jim Roche provides diagnostic and intervention services for children, adolescents and adults with ADHD (Attention Deficit Hyperactivity Disorder) and ASD (Autism Spectrum Disorder) in both his Vancouver and Burnaby offices.

ADHD symptoms worsen quality of life for individuals with autism, study finds


Research supported by the Autism Speaks Autism Treatment Network (ATN), demonstrating that symptoms of attention deficit and hyperactivity worsen quality of life for individuals with autism spectrum disorders (ASD), has been presented at the Society for Developmental & Behavioral Pediatrics Annual Meeting in San Antonio, Texas.

Researchers Parul Vora, M.D., developmental-behavioral pediatric fellowat Nationwide Children's and Darryn Sikora, Ph.D., Director of the Autism Program at Oregon Health Sciences University, used data exclusively from the ATN Registry to examine whether the presence of symptoms of attentiondeficit hyperactivity disorder (ADHD) might have additional impact on the adaptive functioning and quality of life of children and adolescents with ASD. After reviewing measures of attention and hyperactivity, and measures of quality of life, for over 2,000 children and adolescents with ASD, they found that over half of this group had symptoms of either attention or hyperactivity problems. More than a third had significant symptoms of both.

While there is sometimes a reluctance to directly address ADHD symptoms with children, adolescents and adults with autism spectrum disorder, it's clear to many in the field that successful treatment interventions must also address these often debilitating symptoms. Click on the article above for more information.

Functional brain pathways disrupted in children with ADHD

Functional brain pathways disrupted in children with ADHD


Click above for an interesting article on brain pathways in children with an ADHD diagnosis. The research written about in this article demonstrated that compared to "the normal control group, the children with ADHD showed abnormal functional activity in several regions of the brain involved in the processing of visual attention information." Sounds good, however, " The researchers also found that communication among the brain regions within this visual attention-processing pathway was disrupted in the children with ADHD."

"What this tells us is that children with ADHD are using partially different functional brain pathways to process this information, which may be caused by impaired white matter pathways involved in visual attention information processing," Dr. Li  (the chief researcher) said.

Regretfully, after decades of similar research, ADHD is taken by many to be nothing more than a “made up” disorder. Many teachers, administrators and even health professionals seem to doubt the reality of ADHD and continue to blame the child, student or adult who suffer from this disorder.  The changing nature of the disorder throughout the day, the ups and downs of it’s apparent severity, and untrained practitioners who mistakenly call ADHD a “gift” are to thank for this. In spite of the fact that research like that noted above (click the article title to go to a review of the research article and be directed to more comprehensive information from there) clearly proves, without a doubt, that ADHD is real, we need to keep battling to get appropriate funding and recognition of the seriousness of this disorder. 

For more information on ADHD, including ADHD diagnostic services and therapy, please visit my web page at http:www.relatedminds.com or http://www.adhdhelp.ca

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

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

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

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

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

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

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

Ups and Downs of ADHD

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

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

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

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

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

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

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

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

ADHD Services for Children, Adolescents, Adults and Families

How can I help you? If you or your child have ADHD (Attention Deficit Hyperactivity Disorder - or ADD) I provide a number of services that can be of help to you, your child or your relationship. For over the past 25 years I have worked with children with ADHD, adolescents with ADHD, adults with ADHD and families dealing with ADHD. Unlike many other "counsellors" and "coaches" who work with individuals with ADHD but have never worked in a school, work or family setting, I bring nearly three decades of experience working with individuals in the schools - as a classroom teacher with students having behavioural and academic problems due to ADHD, in the workplace, as a rehabilitation and community based neuropsychologist with adults returning to work with ADHD and related issues of impulsivity and concentration due to head injuries, and as a registered marriage and family therapist and clinical member of AAMFT (American Association of Marriage and Family Therapy). Because of my classroom experience as a teacher (and licensed school psychologist) I understand how teachers can implement classroom based interventions to help a child or adolescent with ADHD, and understand the interaction between ADHD and Specific Learning Disabilities (my offices located in both Burnaby and Vancouver) offer not only psychological assessments for ADHD but also full psychoeducational assessments for the diagnosis of learning disabilities and other co-morbid disorders often found with ADHD. Often this includes school based observations and consultation with the teaching/school staff. I have offered teacher workshops on ADHD throughout British Columbia, California and New York State. I also offer parent training and education programs which focus on teaching parents and other caregivers specific skills to help them teach their child with ADHD necessary behaviours and skills. I also work with adolescents, young adults and adults in dealing with both workplace problems and relational problems stemming from the symptoms of ADHD. This might include on site observations and consultation, as well as ongoing coaching and skills development. My years as a community based neuropsychologist working with programs such as Gentiva's Rehab Without Walls focusing on helping individuals with focus, concentration and executive skills development after workplace injury or strokes has provided me with specialized and focused skills in this area. Finally, many individuals with ADHD come to see me about issues such as depression, anxiety, stress and relationship (including parenting and marriage) problems. The services of a REgistered Psychologist are not covered in BC under MSP, however many extended health care plans do cover the cost of psychological services, including therapy, counselling, coaching and assessments. Check with your provider. For those with limited funds who do not have medical coverage for ADHD I often try to work with individuals using one of several self-help programs that are science/evidence based. Please feel free to call me and set up an initial consultation. As these consultations last for approximately an hour, there is a cost, however, usually during that hour we are able to establish a good outline of a program for you, based upon your individual needs and abilities. My offices are located near Lougheed Town Center (near Fitness 2000 on Salish Court) and near the Cambie Bridge and City Hall on 8th Ave. More information can be found at my web page at www.relatedminds.com or www.adhdhelp.ca

News for those with ADHD and Bipolar Disorders

There is a new study about ADHD (Adult ADHD) and Bipolar Disorder. If you have ADHD and Bipolar Disorder you may want to send this study to your doctor. here's the basic information, and a link: (This study was published as an abstract and presented orally at a conference. These data and conclusions should be considered to be preliminary as they have not yet been reviewed and published in a peer-reviewed publication.) SAN DIEGO, May 24 -- When attention deficit hyperactivity disorder meets bipolar disorder in an adult, the diagnosis is hard and the course is poorly understood but the co-morbidity appears to exacerbate matters, researchers said here. A systematic review of rates of bipolar disorder and ADHD in adults revealed that co-morbidity ranges anywhere from about 5% to 47%, reported Aliza P. Wingo, M.D., and S. Nassir Ghaemi, M.D., M.P.H., of Emory University in Atlanta. But patients with the co-morbid conditions may benefit from the addition of bupropion (Wellbutrin) to their antimanic agents, said Dr. Wingo, who co-authored the study with Dr. Ghaemi. The full study review of the study can be downloaded here: APA: Co-Morbid ADHD in Bipolar Adults May Respond To Non-Stimulants Click http://www.medpagetoday.com/MeetingCoverage/APA/5764 Co-morbid conditions (ADHD PLUS something else) can be very complicated to treat. A referral from your family doctor to a properly trained psychiatrist is always advised.

Hyperfocus or Lack of focus? ADHD problems and misunderstandings

Hyperfocus ....or lack of focus? Almost everyone assumes that ADHD comes with a very short attention span. It is ADHD-with the first D standing for "Deficit." But it’s really more accurate to say that a person with ADHD has an uncontrollable attention span. They have difficulty with what we call "switching mental sets." An executive dysfunction, the part of the brain that controls what you pay attention to and what you don't. A person with ADHD may pay attention to one thing, but not another. And the problem is, it's seldom under their control. Another problem is this switching of focus can be different from day to day. People often observe that on Monday a student was able to do their work (because they were hyper focused) and on Tuesday they could not. Then they accuse the student with ADHD of making a choice to do something ...." because he was able to yesterday! He just needs to take it serious!" Not so. Hyperfocus is the term used to describe when a person with ADHD is immersed in an activity he or she finds interesting - a preferred activity, that is somehow reinforcing. TV, computer games, or occasionally a book might be an activity that one becomes hyper-focused on. But the issue is one of self-regulation. Individuals with ADHD cannot regulate their attention, so they will be engrossed by something they find interesting while neglecting important areas of their lives. They then lose track of time, other things that need to be done, and what is going on in the world around them. This can also lead to social isolation. While there may be situations where we need to really focus to understand something or complete a task, hyper-focus in itself isn't as useful as many coaches and "ADHD is a gift" types would make you think. And when medication is used, often this hyper-focus is lost...and individuals then reject medication. Instead, they need to be taught specific skills to learn to maintain and shift focus appropriate -at will. (But so often I hear the ADHD is a gift types appealing to those with ADHD telling them that instead they need to take "advantage" of their gift .....usually because they don't understand or know of techniques to train attention control.) The best way to approach the issue of attention switching- or switching mental sets - is to use external prompts and cues of significant enough impact to help the individual move from one task to another ....or to stay on a task for a significant period of time. A well trained and licensed/registered mental health professional can guide you along that path, because this is one task where an outside coach is tremendously useful. Below is a short, funny little video on hyper-focus. I don't agree with everything it says, but it's part of a very helpful series that is science based. Hope you enjoy it.

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.

Is Ritalin for ADHD Over Prescribed?

Click to watch this video on ADHD and Ritalin : Is Ritalin Over Prescribed?  Generally, professionals in the field see ADHD medications under-prescribed for those who actually need them. ADHD, as a matter of fact, is under-diagnosed, and certainly under-treated. This is hard for many individuals to understand because we are bombarded with media coverage that seems to rage against medical treatment of  ADHD. Many people falsely claim teens become addicted to ADHD drugs, and end up using illegal substances.  The truth is the opposite. Teens with ADHD which is UNTREATED are those that are more likely to become involved in illegal substances. More likely to fail math and other classes. More likely to engage in risky-dangerous behaviour. Those who are medicated properly are far more likely to graduate, go to college, and have generally successful and happier lives.

So why do we read so many anti-medication comments on line? Why are there so many web pages that warn parents of the "dangers' of medication? Well, first of all there is a group of anti-drug, anti-medication individuals who object to all medications and are simply uninterested in listening to the facts. And second, pay close attention to those pages ...they are always selling you something. Usually a "natural" cure or fix that has no science backing it up, nothing except for testimonials - the worse place to get information from.

Take a moment. Watch the video (click above). Read what Dr. Russell Barkley and other have to say based upon research. We have several good, effective and safe treatments available for ADHD. Talk to your medical doctor and psychologist about these.

ADHD Questions and Ansers

I was reading some really basic, but important, questions and answers about ADHD in the New York Times today. Here are the questions, and they are the kinds of questions every paretn of a child with ADHD has, as well as adults with ADHD. The answers, done nicely, can be found by following this link to the New York Times ADHD web page - a really great resouce I've recommended several times. Take a look, first for the answers to these ADHD rquestions, and second,all the other great science based information, stories and resources. Click here for the answers: http://www.nytimes.com/ref/health/healthguide/esn-adhd-ask.html The Questions: What’s the difference between your average high-energy kid and a child with attention-deficit hyperactivity disorder? Is there one medical test, like a brain scan, that diagnoses A.D.H.D.? My child was just diagnosed with A.D.H.D., and it’s supposed to run in families. Should I be evaluated for it? Our daughter’s pediatrician thinks she may have inattentive-type A.D.H.D. — A.D.H.D. without the “H”. Can you have A.D.H.D. without being hyperactive? I hear a lot about lax parenting or too little discipline causing A.D.H.D. Could our parenting style have caused our daughter’s A.D.H.D.? How do stimulant medications work in A.D.H.D.? Isn’t Ritalin basically speed? What other kinds of treatments besides medication are available for children with A.D.H.D.? Is A.D.H.D. different in girls from in boys? At what age is it appropriate to tell a child that he’s been diagnosed with A.D.H.D.? I had A.D.H.D. as a kid, but it was never diagnosed or treated back then, and I still survived. Why does my child with A.D.H.D. need treatment in order to get through it?

Are ADHD Medications Safe?

Here is another wonderful, simple and SCIENCE BASED video to help answer you questions about the safety of ADHD/ ADD medications. People always ask, and I think this video helps clarify many issues. Click here:


Are Medications Safe?


The video is part of a series on ADHD you will find informative and understandable. Additionally, concerning the specific question of safety and ADHD medications I suggest you turn to the webpage ADDitude.com where you can read this for further information:



"Are the medications safe?
The stimulants commonly prescribed for ADHD are considered among the safest of all psychiatric medications. "The risks of using these medications are very low," says William W. Dodson, M.D., a Denver-based psychiatrist who specializes in ADHD. "The risks involved in not treating ADHD are very high. These include academic failure, social problems, car accidents, and drug addiction."
As with many prescription drugs, of course, stimulants can interact dangerously with certain other medications. Be sure to alert the doctor about any other medications your child takes."  THERE'S MORE!
You can read the rest of this article by clicking here: http://www.additudemag.com/adhd/article/1592.html
What's most important is that you do not make medical decision based upon the unscientific "experiences" of friends, the prejudices of relative or the "advice" of web experts who tell you not to use medication ..... oh, but purchase my unregulated "natural cures" by pressing a purchase now button.
There is almost 70 years of research on what to do about ADHD, and what medications do ...including their side effects and long term outcomes. ADHD can be addressed with medications safely under the supervision of your physician. You family medical doctor, or other specialist he or she may recommend in the field of ADHD can help you make clear, science and evidence based choices. Go to your licensed mental health professional for advice on these matters, not to friends, relatives or someone selling books or "natural cures" on the web.
This blog is not meant to give you medical advice. Over and over again I stress seeing your family doctor - and writing down your concerns and questions about ADHD before you do that. As a licensed and registered Psychologist I am available to help you with a comprehensive diagnosis of ADHD, provide assessments for co-morbid problems such as learning disorders, anxiety or depression, and to help you develop an intervention plan to address your specific needs. Check out my web page at www.relatedminds.com or www.adhdhelp.ca, and contact me with any questions you might have.
If you are concerned about your child having ADHD, or you having ADHD, start in the most obvious place, with a simple visit to your family doctor for advice.