I was notified about an incident that occurred during a Vancouver City Park Board meeting which highlighted the continued misunderstanding and stigma which still remains about adult ADHD. Vancouver Park Board Commissioner Melissa DeGenova shamed and stigmatized Vancouver Park Board Commissioner Sarah Blyth, who is the first politician in Canada to go public with ADHD.
Asking a question about Vancouver paying for the cost of business coaching is of course acceptable, making someone with a medical condition feel ashamed for asking for assistance is not.
About a year ago Sarah Blyth asked park board staff for help as she would be chairing some upcoming contentious meetings. She was offered business coaching. At this park board meeting questions were asked with regard to expenses surrounding the ADHD coaching she received. Commissioner Jasper asked staff to bring to the board any related information; and added that chairing the park board is at times a difficult job, and that if a commissioner needed help that he thought the request was reasonable. He also stated that Sarah Blyth was open about being diagnosed with ADHD.
Following this discussion, Melissa DeGenova asked why the governing party would not elect someone capable of doing the job, and further stated that she had disabilities, too. Melissa has two diagnosed Learning Disabilities: dyslexia and written output disorder, and is on the City of Vancouver Disability Advisory Committee. Ms. Blyth and others reported that, as she was leaving the meeting, Commissioner DeGenova proceeded to follow her out the door asking why she was playing the, "Poor me, I have a disability card."
To access Sarah Blyth’s description of the stigma she felt, please click on the following link or copy and paste it into your browser: https://www.facebook.com/notes/sarah-blyth/stigma/10152386409495210
To access Jamie Lee Hamilton’s account of the incident and request for an apology, please click on the following link or copy and paste it into your browser: https://www.facebook.com/jamie.hamilton.9480/posts/461977273945834
In 2012, CADDAC conducted a survey of parents with ADHD children. Participants were asked to define the stress levels experienced during the school year.
More than half of the Canadian parents surveyed were not satisfied with the help their child is received at school, nor the knowledge that teachers and principals are perceived to have about ADHD.
Long wait times for comprehensive assessments and treatments, as well as difficulty accessing information about the disorder, were also flagged to be of significant concern. The full survey can be viewed here:
Dr. Kenny Handleman talks exclusively with CADDAC about turning stress into a comprehensive action plan. With school almost out for summer, there is plenty of time to make sure the next year is a smooth one!
I recently came across an article that nicely summed up things parents should consider when deciding on ADHD medication treatment: linked here.
The article listed five things to parents should consider when making the decision, the first being a thorough medical evaluation by a trusted expert in the field of ADHD. For a description of what is involved in a thorough ADHD assessment access Diagnosing ADHD on the CADDAC Website. For further reading, access Assessment and Diagnosis for Children and Adolescents.
Once you are assured that your child has ADHD, your next step would be to ask yourself what is your desired outcome. How will it benefit your child? I would add that your expectations of medication treatment should be realistic. The symptoms that you would like to target should actually be something that medication will assist.
You will then need to consider all side effects; not just those of medication treatment, but also symptoms of untreated ADHD. Also consider that the decision to try medication as a treatment is not a permanent decision. Most ADHD medication may be started and stopped quickly or used only when required.
Finally, remember that this is not a decision that must be made quickly or under pressure. Other treatments, such as school accommodations and parenting strategies, should be tried initially. Medication treatment can always be added at a later date if necessary.
On the other hand, it may become evident very quickly that many things have been tried unsuccessfully in the past and the child is in significant distress. In this case, a medication trial may be initiated immediately. Also you should be aware that it may actually take some time to find the right medication and the right dose.
Medical professionals make a treatment decision by assessing benefit /risk ratio and so should you. What are the potential benefits to your child and what are the potential risks? While assessing these, make sure that you are relying on proper medical research that has been peer-reviewed and duplicated on a large scale, not anecdotal stories on the Internet.
Although we have not received any significant feedback from parents or patients reporting distress regarding this shortage it is something that we CADDAC has been made aware of. Should you have any concerns please contact us and we would be happy to speak with you about this. For information on what to do if you are caught short please access http://addadhdblog.com/methylphenidate-shortage-in-canada/?inf_contact_key=f6f12e39fac0ce24a27dc692404b39f579083aeb0d6v
Sincerely,
CADDAC
I just finished listening to a great presentation by Dr. David Goodman about this topic. If you are interested in this topic I would highly recommend you access this presentation sponsored by the National Resource Centre on AD/HD at https://www.youtube.com/watch?v=L7lYicr3s5A.
In his opening Dr. Goodman reviews the actual accuracy of newspaper articles on ADHD research.
He goes on to explain how journalists construct articles with victims, villains and heroes in order to catch a reader’s interest. He suggests that readers try and identify these roles in the storey and also question whether the author is trying to express extreme attitudes to sensationalize the story to increase interest. He points out that many journalists, especially national journalists, have agendas, or have been given agendas by their publishers, so ask yourself “What is the agenda of this article?” as you are reading it. He closes by stating, “The credibility of the information is dependent on the intent of the provider.”
Two parts of the presentation confirmed my fears that these type of articles increase fear and shame in parents and impact patient diagnoses and treatment. Furthermore, he indicated that the public is easily seduced by articles that sound scientific, but are actually lacking in up-to-date or comprehensive research on a topic, and may sensationalize new unproven research in order to interest more readers.
In the presentation and Q&A period Dr. Goodman offers concrete suggestions on:
An interesting article called "The Smart Pill Oversell" was just published in the latest issue of the online publication Nature International Weekly Journal of Science. Unlike much of what has come out in lately in the media, this article is more balanced; offering a variety of opinions and some interesting points of discussion.
The majority of current studies indicate that medication treatment alone does not improve long term academic performance. ADHD and how it impacts learning is very complex, so why would we expect that medication alone would solve these complex impairments, especially those of executive functioning? This is why multimodal treatment for ADHD: including learning strategies, behaviour strategies, therapy, coaching, and so forth is recommended.
Unfortunately, many forms of treatment are often difficult to access due to the lack of availability, cost, and the continuous demand by schools that students with ADHD prove their learning is actually impaired. This requirement still exists in in many school boards and some universities; although current testing does not accurately assess executive functioning impairment in those with ADHD. At the same time, medication has proven beneficial for many children, and parents should not be made to feel guilty for or fearful of choosing to add this treatment to a child’s regime. They should, however, be fully informed, as some researchers in the article point out, medication is not magic, and will not automatically make their child academically successful.
Recently, many of the researchers involved in the original MTA study and the follow-up of the study are evaluating why long term gains for those in the study were not what they originally expected. This article presents a variety of different viewpoints, including the fact that after three years, these children went back to accessing community treatment, which was most often of a lower quality of care than they received in the study. Peter Jensen’s statement that only one in four children in the U.S. is getting adequate treatment for ADHD is very concerning, because I would assume it is no different here in Canada. Further research is really the only option that would provide us with a definitive answer. Unfortunately, these long term studies are very expensive; and often unethical because they necessitate a control group of children that you inadequately treated for a long period of time.
The article also points out that, while we know that medications for ADHD are misused by those without ADHD as study aids or cognitive enhancers, there is no evidence that these medications actually enhance cognition. Interestingly though, a paper that is cited here states that students who do not have ADHD, report feeling a boost motivation after taking the medication and perhaps that is why they feel their learning has been enhanced. This theory is yet unproven. We should be improving our efforts to educate young adult students that ADHD mediations do not really make them smarter or improve their academic abilities.
In closing, I would recommend this article for anyone interested in the current discussions on ADHD medication.
Heidi Bernhardt
ADHD is neither a mental health crisis nor a cultural one, as Maclean’s Magazine asks in the title of their article this week. It is a mental health condition that needs to be taken seriously as a medical issue, and not used to sell newspapers and books. I was actually interviewed for this article and, as I was assured, by the author, were Canadian medical ADHD experts, this however was not evidence anywhere in this article. One would expect the authors and publishers of the books highlighted in this article to do their utmost to sensationalize the title of their books and create catchy, if inaccurate sound bites, to sell their books, but how easily journalists, such as Kate Lanau fall into line with the marketing ploy is rather shocking. Journalists who use these exact tactics themselves to increase sales totally disregard the harm they do when they sensationalize a medical condition without balancing it with decades of scientific research. How many children and adults who may have received help will go undiagnosed because this misinformation is being promoted? The most unfortunate thing is that some real issues that do need looked at here in Canada, such as the misuse of medication by some post-secondary students, and the lack of training for physicians and educators in ADHD, won’t be discussed because everyone will be focused on the pure sensationalism of this article.
Since the chances that they will publish it are slim, here is my letter to the editor of MacLean’s Magazine.
“It is irresponsible to publish an article regarding a medical condition, in a Canadian publication, using US medical, information statistics and issues with very vague Canadian references, but not include Canadian expert interviews covering the Canadian situation. We are seeing far too much of this type of journalism lately in regards to ADHD.”
CADDAC’s ADHD FAQ SHEET
CADDAC has compiled a list of the most frequently asked questions about ADHD. We hope this list can help as a resource for anyone looking for answers on ADHD. Feel free to share this resource and let us know what you think, we love you feedback.
What is ADHD?
Scientists agree that ADHD is a medical neurobiological disorder. It is an illness or deficit of the nervous system most often due to genetic or biological factors. ADHD is a chronic condition that can present at all levels of severity and rarely occurs by itself. There are three core symptoms: the inability to regulate attention, the inability to regulate activity, and difficulty with inhibitory behaviour resulting in impulsivity.
However, difficulty with regulating emotions is often an issue as well. It is important to note that symptoms of ADHD can vary from day to day and hour to hour, and while many people may exhibit these symptoms, it is the degree of presentation, the inability to regulate them and a level of impairment, that results in a diagnosis.
How is ADHD treated?
How can I get a diagnosis?
The diagnostic procedure for children, adolescents or adults should be comprised of:
Medical history
An extensive interview with the patient and parents or significant other and the administration of various symptom rating scales - ideally more than one scale to confirm the results. The process includes evaluating symptoms and their degree of severity, while at the same time excluding any other possible reasons for these symptoms.
For a diagnosis to be made, symptoms need to be seen in more than one setting. This is necessary, because symptoms may be due to conditions in a particular environment, rather than being due to a medical condition.
During a complete diagnostic procedure, screening should be performed for other conditions that exist with ADHD called “co-morbid conditions.” Very few people have ADHD without any other co-existing conditions. Some of the conditions that we routinely see with ADHD are: learning disabilities, anxiety, depression, and Oppositional Defiant Disorder (ODD). Diagnosis can be made by a physician, psychiatrist, or psychologist knowledgeable about ADHD.
Psychologists and clinics charge a fee above the provincial coverage. Some physicians or psychiatrists may also have minimal office charges as well.
When you call offices for an appointment, these are some key questions to ask:
Are they accepting new patients?
How long is their wait list?
How much to they charge over the provincial coverage
Does this physician do follow-up care?
You will want to ask your family doctor (or even just a walk in clinic) to fax them referral to get the process started. It would be a good idea to call the doctor’s office in a few weeks to make sure that the referral has been received. Wait lists tend to be long and it would also be a good idea to follow up in a few months to see how things are moving. Sometimes they may have cancellations and can fit you in sooner than expected.
How can I get accommodations in school?
One option is to have your child assessed for ADHD by a developmental Paediatrician or a child and adolescent psychiatrist which are both covered under OHIP. We recommend that a specialized physician always do a thorough assessment for ADHD to assess the symptoms that fit the ADHD criteria and to rule out any physician conditions that may mimic the symptoms of ADHD.
Another option is to have your child receive a psycho-educational assessment from a qualified psychologist. This is a comprehensive testing that also testes for learning disabilities as well as ADHD symptoms. The psychologist will write specific recommendations for accommodations in their report if Learning Disabilities and/or ADHD are diagnosed.
This comprehensive report may assist with the student being recognized as an exceptional learner and developing an Individual Education Plan (IEP); however, before giving the report to the school, find out what your school board's policy is on identifying students as exceptional. Some boards and Ministries of Education recognize ADHD, while, unfortunately, others do not.
Some schools may offer psycho-educational testing through their school psychologist. While this can be a great help to some families financially, we urge parents to pay for testing out of pocket if at all possible. The diagnosis paperwork is therefore YOUR property and you have control of the information.
Private psycho-educational assessments frequently cost at least $2,000 since psychologists are not covered by provincial health care coverage. Some private insurance plans may cover a portion of this fee. This fee can sometimes be split under more than one family member or the testing can cross more than one year's allowable coverage.
Psychologists cannot prescribe medication but can offer other treatments and therapy; however, if medication treatment is desired the child or adolescent will also need to be seen by a physician or psychiatrist.
What are symptoms of child/adolescent ADHD?
Inattentive Symptoms: Easily distracted, difficulty focusing, daydreaming, difficulty remembering verbal instructions, misunderstanding instructions, difficulty understanding others’ cues, difficulty making transitions between activities, difficulty with organizing belongings and work, losing things, easily overwhelmed, and trouble beginning tasks and completing projects.
Hyperactive Symptoms: fidgeting and squirming excessively, difficulty remaining seated, talking excessively and at inappropriate times, difficulty with quiet activities, risk-taking behaviours, and frequently touching objects. Possible symptoms of child/adolescent impulsivity include: interrupting conversations, blurting out answers in the classroom, beginning work before instructed, disturbing others, seemingly excessive frustration, taking others’ belongings, difficulty waiting in line, difficulty taking turns, and making impulsive choices.
What are symptoms of adult ADHD?
Possible symptoms of adult ADHD include: not being able to focus on tasks that are dull, easily distractible, difficulty paying attention to detail, hyper-focusing on something you may find stimulating, difficulty and possibly frustration with transitions in activities (especially when in hyper-focus), forgetting things, losing things, fidgeting, internal restlessness, procrastination, interrupting conversations or blurting out random or inappropriate thoughts, making impulsive and/or risky decisions, difficulties with organization, difficulties finishing projects but frequently starting them, impatience, low frustration tolerance, mood swings, tuning out when spoken to, difficulty realizing how your behaviour affects others, difficulty with self-awareness, problems with self-esteem, problems with social interactions and relationships, excessive career/job changes or loss, problems with time management, and difficulty paying bills on time and managing money.
For more information, please visit our website www.caddac.ca
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This is another perfect example of how the media jumps on anything about ADHD that is controversial.
http://nypost.com/2014/01/04/adhd-does-not-exist/
Harper Collins the publisher is doing a superb job of selling the book even before it is released and the media falling right in line with their marketing plan. Again the hugely frustrating thing is that almost every article and blog about this book does not allow for a rebuttal from the other 99.9 percent of medical experts to comment on some of the sensational statements that are obviously meant as a selling tool for the book. Unfortunately the author and publisher, as well as the journalists who buy into these tactics, totally disregard the harm they do by using sensationalism without balancing it with decades of scientific research. How many children and adults who may have received help will go undiagnosed because this misinformation is being promoted?
As Dr. Kenny Handelman stated in his blog post in January: http://www.drkenny.com/adhd-does-not-exist. I was also reluctant to comment on this fearing I would drive more attention to this book, but taking the high road in the past has not helped to decrease misunderstanding and stigma around ADHD in the past. ADHD professionals understand, as should parents and adults, that making a diagnosis of ADHD means ruling out any other potential reasons for symptoms of distractibility and hyperactivity, as much as it does confirming that the symptoms are due to ADHD. This is a very basic part of the assessment process. But, of course this is fact is not included in these articles.
If you come across any articles promoting this book and its messages, I encourage you to send your comment so people can “Get Real” about ADHD.
Shire Canada ADHD Scholarship Program
Deadline for Applications is April 15, 2014
Shire Canada will award up to FIVE scholarships to residents of:
who have been accepted to or are enrolled in a program at a Canadian accredited two- or four-year college, university, trade school, technical school, or vocational school located in the afore-mentioned provinces for the academic school year 2014-2015.
The recipients must be diagnosed with ADHD and under the care of a licensed health care professional for their ADHD, but do not have to be receiving medication treatment in order to be eligible.
Each scholarship recipient will receive an award of $1,500 and one year’s worth of ADHD coaching services from the EDGE Foundation. Winners will be notified on May 25, 2014.
To apply, please visit their website at: http://www.shireadhdscholarship/com/CA-EN/default.aspx and either apply online or print and apply via form, which must be sent in.
