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For Physicians

For Physicians
Background Info
For Physicians

Background Information

Schools and school boards have informed CADDAC that receiving more detailed reports from the ADHD diagnosing and/or treating physician would be helpful. They have also shared that even when they are able to access psychoeducational reports, the reports are not always helpful in identifying the student’s specific ADHD impairment profile and deciding on possible accommodations.

The following information and attached charts are intended to serve as a resource to support the development of a comprehensive report identifying your patient’s impairments and possible appropriate school and classroom accommodations. Since the success of any specific accommodation is very individual all parties, medical professionals, educators, parents and students should understand that suggested accommodations in your report are a “starting point” in identifying the best possible accommodations for that particular student. The development of a good individualized education plan is an on-going process. IEPs and their implementation should be reviewed several times during a school year and improved upon as necessary.

Please Note:
The possible accommodations included in the “ADHD Symptoms, Impairments and Accommodations in the Elementary School and High School” charts are based on expert consensus opinion,[i], [ii] . While certain accommodations are beneficial for some students with ADHD [iii] [iv] the listed accommodations are not uniformly beneficial for all students with ADHD. Therefore, physicians and other medical professionals should use the charts as a tool to assess functional impairments while reviewing possible accommodations that would likely be helpful.

[i] Froelich & Brinkman 2017
[ii] Fabiano & Pylr 2018
[iii] Jansen et al, 2017
[iv] Lovett et al 2018

For instructions on how to use this chart when writing a report for an elementary school requesting accommodations for your patient please see file below.

Instructions for Elementary and HS Chart of ADHD medical professionals

Download PDF
Elementary School

Download PDF
High School

Download PDF
Post-Secondary School

Download PDF

For more information please visit ADHD in Education

ADHD and Education

Assessment and Diagnosis

ADHD Symptoms

ADHD Treatment

School


The preschool age and environment are the perfect time and place to recognize ADHD impairments and begin to understand and support these children. Not allowing the child with ADHD to remain at preschool is a disservice to the child as well as the staff who should take the opportunity to learn about ADHD as they will undoubtedly have more children with ADHD cross their path in the future.


Behaviour Management


Behavioural therapy is the most effective if done as uniformly as possible between home and school. The implementation of behavioural support and strategies can occur even before an ADHD diagnosis, since these techniques are beneficial for all children. The key to ADHD behaviour management is consistency and immediacy through clear, calm positive communication. Children with ADHD are often subjected to an abundance of scolding, nagging and general negative interaction with adults and even other children. This takes a huge toll on their self-image and wellbeing.
Since ADHD is a very individual disorder which presents in a variety of ways, across a range of severities and commonly with coexisting disorders, finding the exact right behavioural plan may take some time. The help of an expert in the field of ADHD may even be required to get the process on the right track. However, here are some basic principles on ADHD behavioural techniques that often work in the home and school setting.


Behavioural Management Techniques for Home and School

 

  1. Set up a limited number of rules focusing on a few hard and fast concepts such as we do not hurt people, we stay safe.
  2. Structure the environment and set up consistent routines; consistency helps the formation of habits decreasing the load on executive functioning skills.
  3. Pay attention to the child when they are doing what you want then to do and ignore nuisance behaviours or minimize your interactions around them.
  4. Use positive consequences like praise, or small rewards like: additional time doing an activity they love, a sticker or star, or points toward a larger reward when the child is doing what you want them to do.
  5. Be immediate and very specific when giving positive feedback on appropriate behaviour so they know exactly what they did right.
  6. Give brief, simple instructions, without too many steps informing them of what you want them to do and not what you don’t want them to do.
  7. Have them report back to you when they have completed the first step or two so you can praise and then share the next step or two in the sequence.
  8. Provide visual prompts like picture charts as reminders.
  9. Decrease distractions.
  10. Be proactive: anticipate times and places when their self-regulation will be challenged and set up accommodations and strategies to help them cope.
  11. Use parent/teacher social coaching to help the child acquire and practice social skills.

 

Resources

There are a variety of medical professionals that may assess/diagnose (and treat) ADHD:

Who can Assess and Diagnose ADHD
Wait time
Is there a Cost
Referral from a family physician or walk in clinic
Who can Assess and Diagnose ADHD
Family Physician (with ADHD training)
Wait time
1-8 weeks
Is there a Cost
No - Covered under provincial health plan (i.e OHIP)
Referral from a family physician or walk in clinic
No
Who can Assess and Diagnose ADHD
Child and adolescent psychiatrist
Wait time
1-6 months
Is there a Cost
No - Covered under provincial health plan (i.e OHIP)
Referral from a family physician or walk in clinic
Yes
Who can Assess and Diagnose ADHD
Developmental Pediatrician
Wait time
2-8 months
Is there a Cost
No - Covered under provincial health plan (i.e OHIP)
Referral from a family physician or walk in clinic
Yes
Who can Assess and Diagnose ADHD
General Pediatrician (with ADHD training)
Wait time
1-6 months
Is there a Cost
No - Covered under provincial health plan (i.e OHIP)
Referral from a family physician or walk in clinic
Yes
Who can Assess and Diagnose ADHD
Psychologist (with ADHD training) – Psychologists cannot prescribe medication
Wait time
2-8 weeks
Is there a Cost
Yes – workplace or private benefits may cover a portion of the cost. Fee is approximately $1,000-$2,000
Referral from a family physician or walk in clinic
No
Who can Assess and Diagnose ADHD
Neurologist (with ADHD training)
Wait time
Is there a Cost
No - Covered under provincial health plan (i.e OHIP)
Referral from a family physician or walk in clinic
Yes

Questions to ask your healthcare provider:

  • What is the current wait time?
  • Do they provide long term follow-up care?
  • Is a full screening for other potential medical disorders part of the assessment process?
  • Are there additional cost associated with the ADHD assessment

 

PHYSICIANS, PEDIATRICIANS, PSYCHIATRISTS, NEUROLOGISTS


The assessment and diagnosis of ADHD by a medical professional is generally covered by your provincial health care plan, however, always ask if any additional fees will be charged.


The potential diagnosis of ADHD should include;

  • A medical history
  • As psychiatric medical history
  • Screening to rule out any possible physical disorders
  • Vision and hearing test

 

PSYCHOLOGIST


Psychologists may assess and diagnose ADHD, but they cannot prescribe medication. Psychologists are not covered by provincial health care plans, but may be partially covered by private health coverage. Speak to the psychologist prior to contacting your private insurance provider.

 

Psychoeducational assessments are different from an ADHD assessment.


Children who are struggling academically may seek a psychoeducational assessment to assess whether any coexisting learning disabilities (LDs) may exist along with ADHD. A complete assessment of a child’s learning strengths and needs is essential for a student who continues to be impaired at school. Psycho-educational assessments cost approximately $2,000-$4,000


Important Things to Know About the Health Care Professional that you choose:

  • Their expertise in the area of ADHD
  • Their accreditation and registration (pertinent to a psychologist’s ability to diagnosis)
  • What is the current wait time?
  • Do they provide long term follow-up care?
  • Is a full screening for other potential medical disorders part of the assessment process?

For more information about ADHD assessments please contact our Resource Navigator at info@caddac.ca

Common symptoms of ADHD in Preschool


While many behaviours such as: inattention, distractibility, being fidgety, tantrums and oppositional behaviour are common for preschool children these behaviours in a child with ADHD are more extreme. They are more frequent and more intense. Most often young children with ADHD will stand out in a group of children and appear to function as a younger child.

However, each child with ADHD will be unique; they will present with a different group of ADHD symptoms, on a spectrum from very mild to very severe. Symptom levels can vary throughout the day and from day to day but will always become more apparent when the environment and tasks before the child challenge their impaired skills.


Questions to Ask Yourself

 

  1. Are the child’s behaviours similar to other children their age?
  2. Would their behaviours appear to mimic those of a younger child?
  3. Do the behaviours change in different settings? (symptoms will increase when placed in an environment that challenges their impairments)
  4. Is the expected behaviour that you are NOT seeing something that would be developmentally appropriate for their age?

Hyperactivity

  • continuously moving, bouncing a knee, jiggling their foot, tapping a pencil, and the inability to sit without squirming;
  • frequently needing to get up and move around;
  • being unable to stop for meals, naps and cuddles;
  • being unable to stay on task when they must sit still;
  • the inability to sit still for calm activities like eating and having books read to them;
  • talking and making noise excessively;
  • running from toy to toy;
  • being unable to be still even for an activity they enjoy;
  • constantly climbing, even when instructed not to do so; and
  • running and moving so quickly that it results in injury, even after being cautioned.

Impulsivity

  • displaying extreme impatience with others;
  • grabbing toys and things from others;
  • refusing to wait their turn when playing with other children;
  • interrupting when others are talking;
  • blurting out comments at inappropriate times;
  • intruding when others are playing, rather than asking if they may join in;
  • being aggressive in their play;
  • lacking caution with strangers;
  • displaying overly bold behaviour;
  • showing unusually low fear in situations that can lead to dangerous consequences, potentially endangering self or others; and
  • destroying toys and other things due to not thinking of the consequences.

Executive Functioning

  • difficulty following directions, forgets what to do;
  • unable to remember, or confuses the order of steps of a task;
  • difficulty with starting and completing tasks;
  • difficulty estimating how long it will take to do something;
  • insisting that things are done in a certain way;
  • acting out instead of expressing feelings;
  • unable to keep track of belonging, frequently loses things;
  • unable to manage or find things in their cubby;
  • inability to organize and get things together at the beginning or end of the day;
  • unable to remember what they were going to say or do;
  • off-topic when speaking or answering questions;
  • becoming agitated when the schedule or the occurrence of an expected activity changes; and
  • needing consistent rules that they interpret as being fair

Emotional Regulation

  • more intense and unexpected tantrums than those of other children their age;
  • difficulty controlling their emotions with displays longer and more intense;
  • becoming easily frustrated and expressing their frustration in unacceptable ways;
  • being prone to outbursts;
  • feedback or expulsion from preschool due to aggressive and impulsive behaviour;
  • being unable to play peacefully with others;
  • the inability to settle down after being excited or active;
  • displaying aggression, to the level of having to remove the child from a situation, due to the inability to regulate their emotions; and
  • being louder and noisier than fellow playmates

Physical Development

  • delay in speech development,
  • gross motor skill delay (inability to hop on one foot by age 4),
  • fine motor skill delay, (difficulty with colouring, using scissors, tying shoes, printing),
  • difficulty with sleep,
  • sensory issues, and
  • delayed toilet training.

Treatment of ADHD in Children under 6 yrs


ADHD should be treated using a “multimodal‘ approach”. Simply put, this means using more than one type of treatment to manage ADHD symptoms. Examples of ADHD treatments are listed below


Psycho Education


Educating parents, individuals, and any other adults who routinely interact with the child about ADHD is the first and most important component of an ADHD treatment plan. Studies have shown that providing education on ADHD greatly increases the chance that treatment will continue long term. The more a family understands about ADHD and how it affects their child, the better they will be at making informed choices and implementing strategies and accommodations in the home. insert link to events page – parenting programs


Classroom/school Accommodations


It is important to seek classroom accommodations for your ADHD child, please refer to our section on education (insert link)


Behavior Therapy


Guidelines on ADHD for preschools developed by the American Academy of Pediatrics (AAP) state that behaviour therapy should be the first line of treatment for children four and five years of age. However, the guidelines go on to state that if behavioural therapy is not accessible, has not worked, or if symptoms are severe enough that the child or family are at risk of harm, medication can and should be considered. Insert link to“Understanding early childhood ADHD”


Exercise


Exercise produces several hormones that can benefit brain functioning and help improve focus.

http://add.about.com/od/treatmentoptions/a/ratey.htm
http://www.everydayhealth.com/add-adhd/can-you-exercise-away-adhd-symptoms.aspx


Mindfulness


Mindfulness can assist with better awareness of attention, manage stress, be less reactive to impulsive thoughts and be less judgmental of ADHD symptoms.

http://www.psychologytoday.com/blog/here-there-and-everywhere/201206/adhd-mindfulness-interview-lidia-zylowska-md


Sleep


Sleep plays a major role in our health and development. For example, sleep is important for learning, attention, and memory, academic achievement, and even physical growth1, 2. As such, it is important for children to get age-appropriate quality and quantity of sleep! According to the National Sleep Foundation, school aged children (6-13 years old) should receive between 9 and 11 hours of sleep each night3. Children who sleep less or who have poor quality sleep (e.g., up and down throughout the night) will not be able to perform their best during the day, especially in school.


PDF on ADHD and Sleep


Alternative Treatments


Access the Canadian Paediatric Society’s article on Alternative ADHD Therapies by clicking here.


Access a comprehensive article reviewing the evidence on Cognitive Training (brain training games) and brain training strategies by clicking here.


Medication Management – if required


It not usually recommended that children under the age of 6yr take ADHD medication, however in certain instances it may be required. Please speak with a knowledgeable ADHD physician to see if ADHD medication is right for your child.

In uncomplicated cases of ADHD, medication management is fairly straight forward and effective with minimal side effects. ADHD medication has been around for more than fifty years and there are thousands of published research papers on their safety and efficacy. There are two types of medications used to manage ADHD medication. For more information on medication please speak with a medical professional

  1. Stimulant medication.
  2. Non-stimulant medication

Please refer to the charts below for information on specific medications

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