ADHD Awareness Week October 16-22nd 2011 How You Can Make A Difference

Post from: Adult ADD Strengths

ADHD Awareness Week is October 16-22, 2011. Do you think most non ADHD people really understand what ADHD actually is & how it affects people who have it?

If not, read what ADHD Awareness week is about and some ways you can help reduce the ignorance and stigma many people have about ADHD, and increase awareness about ADHD.

The ADHD Awareness Coalition announced the dates for the 2011  ADHD Awareness Week as October 16th to 22nd, 2011. I helped organize an ADHD Awareness Day event in Vancouver, BC a  few years ago. It’s the 7th year of ADHD awareness days in the US, but still none in Canada. Sigh…

The ADHD Awareness Coalition is made up the following organizations.

ADHD Coaching Organization (ACO)

Additude Magazine

Attention Deficit Disorder Association (ADDA)

Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD)

The group encourages our colleague organizations and volunteers to plan ADHD Awareness activities during the week of October 16th to 22nd, 2011. Here’s the website for the 2011 ADHD Awareness week campaign.

Here are some ADD ADHD Advocacy Resources From ADDitude Magazine. They list essential articles, expert Q&As, tools & checklists, and resources about ADD ADHD and learning disabilities.

What can I/we do for ADHD Awareness Day?

Here are some ideas from an older article from a previous ADHD Awareness day that is sadly no longer on their website. FYI if you need to book space for an event, start looking for it NOW, things book up very quickly.

For Individuals

• Hand out the ADDA Fact Sheet in your community. Ask if you can place some ADDA Fact Sheets at your physician’s office, schools, disability centers of your local colleges, libraries in your area, or at local coffee shops (many of which have community bulletin boards, or places to leave information).

• Contact the mental health centers in your area. Ask them to put something up on their website and put flyers in their waiting rooms. Better yet, ask them to sponsor ADHD screenings, informational meetings or other activities on Awareness Day.

• Speak to your PTA meeting, Rotary Club, Chamber of Commerce or other group about ADHD. Offer ADDA as a resource and/or hand out the Fact Sheet.

• Ask your local library to display ADHD books prominently, perhaps with the ADDA Fact Sheet (see the sample letter in the ADHD Awareness Day Kit on the ADDA website).

• Write and op/ed piece or letter to the editor of your local newspaper.

For Groups

• Place an announcement on your website.

• Do an “email blast” to your e-list.

• Sponsor a workshop on ADHD or have an inservice at your local school.

• Sponsor a fundraiser and donate the proceeds to ADDA.

• Ask your local library if you can set up a table to hand out information.

• Participate in local health fairs where you can pass out fact sheets.

• Collaborate with other advocacy or educational groups in your area to sponsor an event to raise awareness about ADHD in your community.

• Try getting your local newspaper to write an article or op/ed piece about ADHD and/or Awareness Day.

• Ask your Chamber of Commerce if your group can have 5-10 minutes at their next meeting to announce National ADHD Awareness Day and hand out information.

• Place an announcement on your cable company’s free community bulletin board.

• Ask the radio station to do a community service announcement on Awareness Day, or be a guest on a local radio program talking about ADHD.

• Write to ADHD authors encouraging them to request book signings in their local area on ADHD Awareness Day. Most Borders, etc. will order books and let authors sign. They also put up signs announcing the event and some even advertise in their local papers and libraries.

The CHADD ADHD awareness week toolkit for local CHADD groups

Here’s the material it covers

Section 1: Recruit Your Volunteers & Delegate
Section 2: Decide on the Type of the Event
Section 3: Developing A Timeline
Section 4: Plan a Budget
Section 5: Select your Location
Section 6: Solicit Sponsors
Section 7: Publicize the Event
Section 8: Share Information
Section 9: Complete Financial Reports

Do you have any plans for ADHD Awareness week?

Any other ideas on what else can be done to promote ADHD Awareness?

Good Tips on How to Reduce the Side Effects of ADHD Medications

Post from: Adult ADD Strengths

Like medications for any other mental or physical condition, medications for ADHD can also have some side effects.

Unfortunately many doctors are not properly trained on ADHD in medical school. For example, here in Vancouver BC Canada, UBC medical students only get one hour on ADHD. So unless they went out to learn more about ADHD on their own time & dime, many aren’t that familiar with the condition of ADHD, let alone the medications which are one of many ways to manage ADHD, let alone how to manage some of their side effects.

Ideally, your doctor will tell you about the possible side effects of ADHD medications, how to manage them, and realistic expectation (pills won’t teach skills), but if they don’t, here are some tips from WebMD. Of course, before doing any changes to ADHD medications, ALWAYS discuss them with your doctor. If your doctor doesn’t know about ADHD, point them to CADDRA’s Canadian ADHD Practice Guidelines so they can learn.

Keep in mind one size never fits all, and one ADHD med never fits all. It can take time to get the right medication(s) and the right dose for you, they’re called medication trials not medication psychics. You might also want to do an ADHD medication log too. The more information you can give your doctor on how/when the meds are working, the better they can adjust your dosage for maximum effectiveness

WebMD has some good tips on how you can reduce the side effects that sometimes come with ADHD medications. While they’re focused on children with ADHD, some of their medication tips are applicable to adults with ADHD. Here’s one of their sections of tips on managing side effects of ADHD medications.

Managing difficulties with sleep

• Give the morning dose of ADHD medication earlier in the day. Discuss medication changes with the doctor. It may be necessary to try shorter-acting medications.

• Don’t allow your child to drink caffeinated beverages. Cocoa and many sodas, coffees, and teas all contain caffeine. A child who drinks these in the afternoon or evening may be tossing and turning at bedtime.

• Establish a sleep-only zone. Your child’s bedroom should be dedicated to sleep — not for homework, not for entertainment. Move the computer, radio, television, toys, and games to another room. A few stuffed animals are fine, but there should be no other distractions.

• Teach your child to relax at bedtime. A special blanket or a stuffed animal can help a child fall asleep. But it’s best to avoid bedtime activities that depend on a parent’s presence — like rocking or holding the child until sleep comes.

• Establish consistency. Bedtimes and waking times should be the same seven days a week. Waking times are more important than bedtimes in establishing sleep rhythms. It is easier to enforce a waking time than a bedtime. “Sleeping in” can be a sign that the child is not getting enough sleep.

• Establish daytime routines. Regular meal and activity times help, too. Routines make it easier for children to “wind down” to sleep.

• Discourage midnight visits. Waking up at night can become a habit for children. It can also be a way to get attention. While you don’t want to let a child cry themselves to sleep, it’s best to discourage middle-of-the-night visits with mom and dad or midnight snacks. Also, don’t allow interesting toys near the child’s bed (a stuffed animal or two is fine).

• Avoid sleep medications. Medications stop working over time, and may affect daytime alertness. They may also wear off during the night, and cause night waking. Some medications may cause nightmares or other types of sleep problems. If medications are absolutely necessary, talk to your child’s doctor about safe and effective treatments.

• Consider medical problems. Allergies, asthma, or conditions that cause pain can disrupt sleep. If your child snores loudly and/or pauses in breathing, medical evaluation is necessary. Consult your physician for help with the possible medical causes of sleep problems.

I find that it’s also useful to turn off all stimulating electronic devices like computers, tv, cell phones, video games an hour before you go to sleep so you give your racing ADHD brain time to slow down so you get to sleep earlier AND have better sleep. Sometimes this is easier said than done, I know by personal experience:)

For some people, having a snack with protein before bed helps them get to sleep, for others it keeps them awake, so experiment to see what types/quantity/timing of food(s) works best for you.

Another tip I and some of my adult ADHD coaching clients have found useful is to have a pad of paper and pen by your bed. So just as you’re getting ready to bed, if you think of something you have to/want to do the next day/ worry/concern, to write it down on the pad and remember to look at it the next day near your daytimer. That way you don’t have that thought/worry rattling around in your brain all night taking up psychic rent when you’re half asleep and too tired to do anything about it.

Check out the other tips on managing the side effects of Attention Deficit Hyperactivity Disorder medications on Web MD’s site.

What tips have you found useful in managing the side effects of ADHD medications?

CHADD Vancouver Meeting Feeding Your ADHD Child May 19th

Post from: Adult ADD Strengths

The next CHADD Vancouver meeting is, Tuesday May 19th.

Topic: Feeding Your Child who has ADHD

Speaker: Joy Kiddie, Registered Dietician. She’s done research on ADHD and nutrition with Dr. Margaret Weiss, head of the BC ADHD Clinic at Children’s Hospital. Here’s her website

Date: May 20th

Time: 6.30-8.30pm

Location: 2450 Ontario St. Raven Song Community Health Centre (between Broadway & West 8th Ave)

Joy has ADHD and has ADHD children. She’s spoken before at 2 CHADD Vancouver meetings before. She know’s her topic, is an engaging speaker, and we’ve had good audience feedback.

The next Vancouver Adult ADD support group meeting will be Tues June 2nd topic TBA.

BC Liberal Party Is Violating BC Election Act Sec 223 on Election Day by Online Advertising

Post from: Adult ADD Strengths

Update3 The Vancouver Sun today Wed may 13th 09 has linked to this post and covered the story on page A11.  Also The Victoria Times Colonist is also linking to this post on their story in todays paper on page B7.

The penalty for breaking the law could include up to a $10,000 fine and a year in jail. “The penalties are up to the chief electoral officer’s discretion,” said Ken Faris ( Elections B.C. spokesman). “Since the B.C. Liberals responded to our request (to take the offending tweets down), we’re not going to pursue the issue any further.”

Liberal spokesman Chad Pederson said the party removed the items after being contacted by Elections B.C.

“We think it’s a debatable point,” Pederson said, noting that the technology is new. But rather than argue the matter, he said, the party chose to take the items down and pursue the issue at a later date.

Update2 Looks like Green Party also breaking election laws advertising on Twitter on election day #bcelection #bcvotes2009 Like the liberals they’ve deleted their tweets from twitter via Georgia Straight here’s the tweet

Go Green – Be Green – Vote Green

BCGreens: Go Green – Be Green – Vote Green #bcelection
about 14 hours ago from Nambu

http://twitter.com/BCGreens/statuses/1773456965

and the same tweet 6 hours later

You can find it by searching twitter for the name of the tweet

Also BC Liberals violated the law 3 times not one, my mistake.

The Vancouver Suns @gillianshaw shows that Elections BC doesn’t really understand the internet that well and that Elections BC said the BC Liberals “were in contravention of the act” and ordered the BC Liberal party to delete their tweets at 10.30am. But the one I took a screenshot of was still there at 1.30pm

UPDATE: The BC Liberal party has deleted the tweet, without apology or explanation. I have i higher rez version if people are interested they can email me for it.

Around 9.30 this morning, Tuesday May 12th, 2009, The BC Liberal Party violated the BC elections act, section 223 by doing online advertising on Twitter.

The BC Liberal Party’s Offical Twitter account

published this tweet

The BC Liberals are the best choice to build B.C.: http://tinyurl.com/dmy3mq #bcelection
http://twitter.com/bcliberalparty/statuses/1775236510

clicking on that tinyURL link goes to this link on the BC Liberal Party’s official website titled “Improving and protecting vital public services” and talks about how much the govt has spent on health spending.

Rather ironic since the BC Liberals are TOTALLY Ignoring the BC Medical Associations 8 recommendations on ADHD in their February policy paper. It said that ADHD is costing BC half a billion annually but they only counted children with ADHD and ignored adults with ADHD, and there’s more adults with ADHD than kids with ADHD. So it’s costing BC multiple billions

I’ve tried asking several Liberals on twitter for their position on the BCMA ADHD policy paper and none have responded. The Liberals like the BC NDP, BC Greens & BC conservative party are basically using social media in an Anti-social manner, just one way advertising vs acutal conversations. I’ve asked many BC MLA candidates on twitter for their position on the BCMA ADHD policy paper and got either no response or some generic non answer avoidance strategy ie “whole system needs to be revamped”

I even asked 2 of their MLA candidates Colin Hansen and  Margaret MacDiarmid in person last Thursday at the Ridge and the responses I basically got was the Kim Campell quote ie an election is no time to discuss policy. They and NDP Mel Lehman all basically said there’s only a few days left in the campaign no time for policy discussions contact me after the election. Marget was the past president of the BC Medical Association and said as a doctor she’d be more open to dealing with that, and Mel seemed to be genuinely interested if my memory serves me correctly but still no policy response. I wish I had brought a tape recorder.

Here’s my screenshot of the BC Liberal Party’s tweet from my Flickr site

Found this on twitter from @lobbycanada on my #bcelction tweetdeck feed

RT @lobbycanada: Watch the @bcliberalparty break #bcelection law in real-time! Just follow them on Twitter as they tweet away in contravention of Section 233
http://twitter.com/lobbycanada/statuses/1775311783

then this

RT @lobbycanada: #BCElection Act, Section 233: On General Voting Day, election advertising must not be published, transmitted or broadcast. @BCliberalparty
http://twitter.com/lobbycanada/statuses/1775327696

Then I googled the elections act. The BC election site was limited to votefinder and election results all rest locked down.

So on BClaws.ca found this

Election Act
[RSBC 1996] CHAPTER 106

Part 11 — Election Communications
This Act is current to November 1, 2008

Adhd – Busting The Myths, Breaking The Stigma, Showing Reality, One Post And Tweet At A Time

Post from: Adult ADD Strengths

THere are the notes and the links for my presentation Adhd – Busting The Myths, Breaking The Stigma, Showing Reality, One Post And Tweet At A Time for Mental Health Camp Vancouver April 25, 2009. I won’t be able to cover all this material during the session so I have some extra info here. Tell me what you think of it in the comments.

Here are the topics I’ll cover.

1. Defining ADHD
2. ADHD Impairments
3. Co-existing or Co-morbid conditions that go along with ADHD
4. Costs of ADHD
5. Positives of ADHD
6. Famous people with ADHD
7. Myths about ADHD
8. Social media
9. Some ADHD links

1. Defining ADHD

Diagnosis of ADHD as a child

Adult ADHD 5 minute screening test from Harvard & W.H.O.

CADDRA Canadian ADHD Practice Guidelines 2007-8.

Detailed PDFs on diagnosis, treatment, medication, dealing with side effects etc. Must read for ADDers, show your doctor

2. ADHD Impairments

From Dr. Margaret Weiss head of the BC ADHD children’s clinic excellent PowerPoint entitled “The Economic Costs of ADHD”. Hope to blog it in more detail later

Smoking, drug use, health costs, driving, accidents, school performance, behavior, academic achievement, peer relations, parental functioning, divorce, work, unemployment, dysemployment, psychopathology, quality of life, adaptive skills, divorce

Faraone SV, 2003. 2. Pelham WE, 2007 3. Barkley R, ADHD, Guilford 2006
Jensen P ADHD State of Science, Best Practices.  Kingston, NJ. Civic Research
Institute

Also higher rates of attempted suicide, teen pregnancy,

3. Co-existing or Co-morbid conditions that go along with ADHD

Here’s a list of some on my website Note, comorbidity is the norm with ADHD, not the exception, that being said not everyone with ADHD has one of these conditions.

Antisocial Personality Disorder
Asperger’s Disorder
Autism
ODD Oppositional Defiant Disorder
Bipolar Disorder
Conduct Disorder
Antisocial Personality Disorder
Depression
Dysthymia
Generalized Anxiety Disorder
Learning Disabilities
Narcissistic Personality Disorder
OCD Obsessive-Compulsive Disorder
ODD Oppositional Defiant Disorder
Post Traumatic Stress Disorder
Substance Abuse Disorder
Tourette’s Syndrome

For more detail the Mayo Clinic has good overviews of each condition.

Or there’s a book ADHD Comorbidities: Handbook for ADHD Complications in Children and Adults. Edited by Thomas E. Brown, Ph.D.

4. Costs of ADHD

Here’s info from 2 slides from Dr. Margaret Weiss, head of the BC ADHD children’s clinic PowerPoint entitled ADHD in the Health Care System. Will upload later

Costs of ADHD in Children

Annual cost ADHD in children
$14,600 per individual in 2005 US $
18% health care
34% education
48% crime and delinquency
42.5 billion/year
Comparable to asthma2
Increased risk ER visits, co-morbidity, accidents
Depression costs 44 billion

1 Pelham W 2007; Chan 2002; Leibson 2001, Swensen 2003

Cost of Adult ADHD

Excess per capita health care and work loss age 7 to 44 and family members
Administrative claims data from a large company
Total excess cost ADHD in 2000 in the US $31.6 billion
5% treatment of the condition
38% other health care costs
45% increased health care costs of family members
12% productivity losses of adult family members
1 Birnbaum 2005

Costs not accounted for

From Dr. Margaret Weiss head of the BC ADHD children’s clinic excellent PowerPoint entitled “The Economic Costs of ADHD” Will upload later.

Smoking 2
Drug abuse3
Foster care
Fetal alcohol and narcotic syndrome
Victims of crime
Victims of drug accidents
Insurance rates
Increased prevalence and adult prevalence 4.4% with 90% comorbidity4
Suffering to the individual, siblings, families, other children and teachers
Decreased life1
1 Barkley R 2 Pomerleau 3 Wilens T 4 Kessler R

ADHD in BC

BC has NO strategy for ADHD. None at all.

The ADHD clinic at Children’s hospital added on an adult ADHD clinic, they soon found it took have their case load, and it developed a year long wait list for an entire year They asked the BC govt for money to take care of the wait list and they said no, so they closed down the adult ADHD clinic. One way to deal with politically embarrassing wait lists.

In Feb the BC medical association released a policy paper on ADHD, with 8 recommendations. They noted the cost of ADHD to BC, called for the BC govt to treat Adults with ADHD, develop a provincial strategy for ADHD etc. They said ADHD cost BC half a billion a year, but they only counted the cost of children with ADHD which means ADHD is costing BC Multiple Billions of dollars annually. Actual treatment of ADHD is the smallest cost.

Here are their 8 recommendations:

Recommendation 1.

The provincial government must restructure the Child and Youth Mental Health Network so that it meets more frequently, is supported with an adequate budget, and is responsible for producing tangible outputs outlined in a publicly-available strategic plan.

Recommendation 2.

The provincial government should work with stakeholders to ensure that any new child mental health plan includes a strategic plan for the delivery of services specifically for patients with ADHD.

One consequence of the lack of strategic direction has been the reduction in services offered to patients with ADHD through the province’s sole centre for ADHD diagnosis and treatment initiation at BC Children’s Hospital (the ADHD Clinic):

Recommendation 3.

The provincial government must provide services for adults with ADHD and follow-up services for children who graduate from the ADHD clinic at age 18.

Recommendation 4.
Funding for ADHD services should be increased to guarantee waitlists of less than three months for all ADHD patients.

Recommendation 5.
A billing fee for consulting with third parties, such as teachers, should be added to the BCMA Fee Guide to encourage optimal coordination with teachers in the diagnosis and management of ADHD.

Recommendation 6.
Medical professional associations for pediatrics, child psychiatry, psychiatry, neurology, and family practice should endorse the Canadian Attention Deficit Disorder Resource Alliance (CADDRA) ADHD practice guidelines; or review, amend, and then endorse revised CADDRA guidelines. Such guidelines should be accompanied by the implementation, in primary care offices across British Columbia, of a ‘diagnostic toolkit’ for ADHD.

Recommendation 7.
PharmaCare should expand coverage for long-acting ADHD medication in order to facilitate compliance, minimize stigma and prevent missed opportunities for focused learning.

Recommendation 8.

In order to improve access to services for ADHD patients and foster the kind of collaborative care arrangements necessary to provide optimal care, both the MoHS and MCFD should train specialized ADHD clinicians for mental health teams and provide BC families access to community services to complement treatment by physicians.

End of Recommendations.

The BC NDP who in the 70′s emptied the mental hospitals in the guise of community care and never did that and then abandoned the mental patients to the predators of the downtown eastside, said nothing about it. NONE of the BC political parties have mentioned ADHD in their platform. Hopefully ADDers and their families will start contacting their MLA candidates to show that their is a need for proper treatment.

Here’s a Vancouver Sun article on a local with ADHD

5. Positives of ADHD

Top Ten ADD Advantages in a Hi Tech Career.

This post got me top of Digg, Delicious, 30,000 unique hits in 3 days, and 200+ links. Still my most popular post on my blog.

1. The Ability to Hyperfocus. IF interested.
2. Rapid Fire Mind.
3. Multitasking at Will.
4. High Energy Level.
5. Highly Creative.
6. Quick Learner. IF interested.
7. Stimulus Seeking Brain.
8. Constantly Scanning your Environment.
9. Great in a Crisis.
10. Risk Taker.

151 Advantages of ADD

My ADHD strengths blog post category

6. Famous people with ADHD

Paul Orfalea who founded Kinko’s. His book is called Copy This! : Lessons from a Hyperactive Dyslexic who Turned a Bright Idea Into One of America’s Best Companies

JetBlue Founder and billionaire CEO David Neeleman who attributes his creativity to ADHD

Magic Johnson

Michael Phelps

Justin Timberlake (ADHD & OCD)

Howie Mandel (ADHD & OCD)

Seth Godin Marketer Author Blogger. “I clearly have ADHD,” he says. “Lucky for me the world kind of organized around me rather than the other way around. It’s such an asset.”

Clarence Page Chicago Tribune Columnist & Author Famous for: Winning a Pulitzer Prize. Twice.

Ty Pennington

James Carville Political Strategist who co lead Bill Clinton’s campaign that won the presidency

Payne Stewart who won the 1999 and 1991 US Open & other pro golfers

7. Myths about ADHD

Myths About ADHD Misconceptions About ADHD – Separating Fact from Fiction

Many Parents Want Distance Between Own Kids And Those With Mental Illness

New research suggests that Americans are more likely to socially reject children with mental illness than they are those with physical illnesses such as asthma. Almost 30 percent of the 1,134 participants said they would not like their child to become friends of a child with depression, and almost one in four said the same thing about ADHD. But a kid with “normal troubles” and asthma, only 10%.

Many ways to take action on stigma from SAMHSA’s Resource Center to Promote Acceptance, Dignity and Social Inclusion Associated with Mental Health.

*  Tips on Taking Action
* Organizing a Campaign or Program
* Planning Anti-stigma Events and Strategies

How to Respond to People Who Say “ADHD doesn’t exist”  & Clinical Evidence of The Existence of ADHD as a Real Condition My answer to the flat earth people.

Pencil, Pens and Meds. LA Times Editorial Stigmatizing ADHD Get’s Fisked By Gina Pera

Helping Your Child Cope with the Stigma of ADHD

Silencing Skeptics: The Truth About ADHD and LD
What is ADHD? Does medication really help? Can adults have ADD? Learn to clear up common misperceptions about ADHD with authority.

Overcoming the ADHD Stigma
An expert psychologist shares his secrets for fighting ADD ADHD stereotyping in children and adults.

Myths and Misconceptions About AD/HD: Science over Cynicism

Helping your child overcome the stigma of ADHD

Spread The Truth About ADHD
3 ways to help friends and family understand that ADHD is a real disorder with real symptoms and real solutions.

8. Social media

12 Ways to Fight Mental Health Stigma With Social Media
I created this post specifically for my presentation. Please check it out, and if you have any other ideas, let me know.

What things have you done to fight stigma against ADHD?

What are you willing to do?

9. Some ADHD links

ADDCoach4u My 130 page ADD Website

Pills Don’t Teach Skills Website of one of my ADHD Coaching Clients

CHADD Vancouver Local ADHD support group I’m on the board of

CADDAC Center for ADD Advocacy, Canada

CADDRA Canadian ADD Resource Alliance

Thanks and please let me know any feedback in the comments

12 Ways to Fight Mental Health Stigma With Social Media

Post from: Adult ADD Strengths

This is for a presentation I’m doing at Mental Health Camp Vancouver (a conference combining social media with mental health) called ADHD – Busting the myths, breaking the stigma, showing reality, one post and tweet at a time. While ADHD is especially stigmatized as the orphan of mental health conditions, especially Adult ADHD, it’s not the only one that suffers stigma.

12 Ways to Fight Mental Health Stigma With Social Media

Arranged from more anonymous to more personal, and less effort to more effort. There’s a choice for everyone.

1. Click on a factually correct, non stigmatizing mental health article, or personal story via a blog post, tweet, podcast, YouTube video, Facebook update, Friendfeed, web forum etc. Result will traffic to the site/account, encouragement for the creator to continue to create, possible revenue and good for SEO just from that one simple easy click.

2. Actually read/listen/watch above content. Assuming the content is non stigmatizing, and helpful, interesting, or entertaining do one or more of the following.

3. Vote on it /rate it, i.e. number of stars if available.

4. Socially bookmark it in site’s like Stumbleupon, Delicious, etc.

5. Submit it to sites like Digg, Yahoo Buzz, Reddit, Mixx, Propeller etc.

6. Forward the content to others either without a comment, or with a personal comment by :

a) Email
b) Twitter i.e. Retweet it, or on Facebook, Friendfeed etc

7. Comment on the original article, post, video etc in one of the following ways depending on your comfort level:

a) anonymously
b) with your first name
c) with your full name
d) with your full name and the name of your blog/website/Twitter account etc.

8. Do a response to the original content by a blog post, tweet, or video on your blog or social media account

9. Respond to someone lying, stigmatizing, minimizing, trivializing, or shaming a person with a mental health condition or the actual condition itself. This can be done in a wide variety of creative ways depending on your personality, subject knowledge, and comfort level with conflict, some of us occasionally enjoy conflict for a good cause:) Perhaps involve your social media friends in the effort.

10. Create some original content that’s factual, anti stigma or a personal story or story about someone you know, or all of the above on one or more of your social media accounts.

11. Participate in a social media mental health campaign. I.e., anti stigma, awareness, fund raising, political action, online petition, contacting politicians etc. Could be all online or a combination of online and offline i.e. involving traditional media.

12. Create a social media mental health campaign.

If you know of any other ones or some good examples of the above, please share them in the comments for others. If you think this was useful, please do one of the above for this post:)

Hopefully some of you might take one action now and ask your BC MLA candidate if they support the 8 Recommendations of the BC Medical Association in their February policy paper on ADHD. Currently BC has NO Strategy at all on ADHD, Adults with ADHD are especially ignored, ADHD is costing BC billions annually, and the BC Liberal Party, the BC NDP, and the BC Green Party have all ignored the recommendations, they have nothing at all in their platforms for ADHD. Hopefully BC ADDers won’t be abandoned again.

If you don’t know your riding use the BC MLA finder

List of  BC Liberal Party candidates

List of BC NDP candidates

List of BC Green Party candidates

List of BC MLA candidates on twitter

Pete Quoted in CNN Article on Using Music at Work to Help You Focus

Post from: Adult ADD Strengths

I was quoted today on CNN’s website on an interesting article called “Listening to music at work — dos and don’ts”by Anthony Balderrama

Listening to music at work can be more than just fun for some people. According to Peter Quily, adult Attention Deficit Disorder coach, music can have a physiological effect on his patients who suffer from adult ADD. According to Quily, listening to music boosts the levels of neurotransmitter dopamine, a brain chemical that can help people focus.

Some of Quily’s clients listen to music when they can’t focus or when they’re performing a task they find boring. People who have ADHD often have dopamine levels that are low or quickly used up, and the music is a welcome help.

For some of his clients, music is just another distraction that they don’t need. And while many workers can’t imagine a day without music, plenty of people, such as Jay Levitt, prefer to leave the tunes outside of work hours.”

Check out the full article.

Just a clarification, I don’t have patients, but I do have Adult ADHD coaching clients

Music can also help Adults with ADHD (and non ADDers too) get motivated and focused to do things around the house that they may find boring like housework, cleaning, doing the dishes etc. Pick the music you like, crank it up or put on the headphones and go at it. I know some people that just use white noise to do it.

Some students with ADHD use music to help them focus or just to tune out the other noise around them so they can concentrate better.

I even have a play list on itunes called a wake up list that contains music that I find energizing and stimulating that I use from time to time. You might want consider creating one or more playlists on itunes or your ipod / mp3 player for the same purpose.

But it’s also important to notice what types of tasks you have to do at work, school or home when music won’t be useful and is an actual distraction.

How do you use music at work/school/home to help you focus? What kind works for you?

Your Attention Please – Improving Access for ADHD Patients Full Text of BCMA ADHD Policy Paper

Post from: Adult ADD Strengths

UPDATE: the 500 million figure is incorrect, it’s actually Billions of dollars yearly. The BCMA underestimated the cost because they only counted the cost of children with ADHD ie 18 and under. They didn’t include adults with ADHD which are far more numerous than kids with ADHD, i.e., 19 years to 70, 80 etc. See page 7, 3rd paragraph of the report

So it’s costing BC MULTIPLE BILLIONS of Dollars Annually to deal with ADHD and the actual treatment cost is the smallest amount, and many are undiagnosed and untreated.

I think the recent policy paper by the BCMA (British Columbia Medical Association) on ADHD, “Your Attention, Please”: Improving Access for ADHD Patients, is so important for BC adults and children with ADHD, their families and society at large that’s I’m posting the full text here. You can also download the PDF of the 16 page document with 2 pages of footnotes from the BCMA website here.

Hopefully people with ADHD their families, medical professionals, Adult ADHD coaches, teachers, criminal justice officials and anyone who deals with people with ADHD will help pass on this document to other people including their family doctors, teachers, family, friends, work colleagues, the media, the police, addiction services etc. I’ll be commenting on the paper in a later post or posts.

Here’s the BC Medical Association’s full policy paper.

“Your Attention, Please”: A Call to Improve Access to Care for ADHD Patients

A Policy Paper by BC’s Physicians
February 2009

The BCMA Council on Health Economics and Policy (CHEP) reviews and formulates policy through the use of project oriented groups of practising physicians and professional staff.

BCMA Council on Health Economics and Policy (CHEP)

Membership 2007-2009

Dr. Shelley Ross, Chair – General Practice, Burnaby
Dr. David Attwell – General Practice, Victoria
Dr. Brian Brodie – General Practice, Chilliwack
Dr. Sam Bugis – General Surgery, Vancouver
Dr. Ian Gillespie – Psychiatry, Victoria
Dr. Brian Gregory – Dermatology, Vancouver
Dr. Jeff Harries – General Practice, Penticton
Dr. Alexander (Don) Milliken – Psychiatry, Victoria
Dr. Lloyd Oppel – General Practice, Vancouver
Dr. Alan Ruddiman – General Practice, Oliver
Dr. David F. Smith – Pediatrics, Vancouver

BCMA Staff Support

Staff support was provided by Jim Aikman, Director of Economics and Policy Analysis; Dr. Jonathan Agnew, Assistant Director of Policy; and Linda Grime, Administrative Assistant.

The BCMA gratefully acknowledges the contribution of BCMA intern Mark Witten, medical student at UBC.

Contents of this publication may be reproduced in whole or in part, provided the intended use is for non-commercial purposes and full acknowledgement is given to the British Columbia Medical Association.

“Your Attention, Please”:

A Call To Improve Access to Care for ADHD Patients

Introduction

It was arguably the greatest story from the 2008 Olympic Games. American swimmer Michael Phelps took home a record-breaking eight gold medals, setting multiple world records in the process. Although the feat itself would have earned the attention of the entire world, it was even more remarkable given his background, for mentioned in nearly every news story about his successes was the fact that Michael suffered from Attention Deficit/Hyperactivity Disorder (ADHD) (Bagnall 2008; Winerip 2008).

ADHD is a chronic behavioural disorder with symptoms including hyperactivity, impulsivity, and inattention, and it is associated with sometimes severe impairment in functioning at school, in social settings, and at work. Current research suggests the disorder is approximately 80% genetic and 20% a product of one’s environment (Faraone and Khan 2006).

ADHD is a chronic behavioural disorder with symptoms including hyperactivity, impulsivity, and inattention.

Phelps’ success in overcoming ADHD to swim to Olympic victory will certainly bring additional attention to the disorder. There has been scepticism around ADHD (Stevens 2007) – despite being perhaps the most well researched childhood psychiatric disorder (Pliszka 2007) and supported by evidence of its neurological basis (Arnsten 2006). This may have led policymakers to place greater emphasis on other mental illnesses.

As resources and attention are devoted elsewhere, ADHD patients experience two main difficulties in accessing care for their condition:

1. Too few cases of ADHD are recognized. The prevalence of ADHD is estimated at 2-9% of the population (Pelham, Foster et al. 2007). Using a conservative prevalence of 3.3% and a child and youth (4-17) population estimate of 936,500 from 2002, BC’s youth ADHD population was estimated to be 30,900 (Ministry of Children and Family Development 2003). In a 2007 study of US children, Froehlich et al. found that less than half of children meeting DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, fourth edition) criteria report receiving either a diagnosis of ADHD or regular medication treatment.

2. Too few ADHD patients can be treated appropriately. In Canada, it takes more than 18 months for a patient with ADHD to be treated after first contact with a physician (World Federation for Mental Health 2004). Once diagnosed, only half of children and as few as 11% of adults receive treatment (Kessler, Adler et al. 2006; Reich, Huang et al. 2006). As the waitlist for the BC Children’s Hospital ADHD Clinic shows, demand for such services greatly exceeds supply.

The resulting health, social, and economic consequences are larger than many would assume. Children with ADHD are prone to delinquency, crime, substance abuse, teen pregnancy, and traffic accidents, as well as a decrease in workplace effectiveness (Matza, Paramore et al. 2005). Among adults, impairment from ADHD can lead to additional missed work days, difficulty accomplishing tasks in the workplace, and less job stability (Birnbaum, Kessler et al. 2005; Matza, Paramore et al. 2005). Taking into account the direct health, education, and justice-related costs associated with ADHD, the total costs to the government of British Columbia may exceed $500 million each year – enough money to pay for nearly half of BC’s $1.061 billion PharmaCare budget or more than all of the Ministry’s capital plan budget for 2008/09 (Ministry of Health 2008).

Too few cases of ADHD are recognized … too few ADHD patients can be treated appropriately.

Such economic, social, and health costs are unnecessary. While ADHD itself is not preventable, the negative consequences stemming from the untreated disorder are. Research suggests that evidence- based behavioural and pharmacological interventions can reduce the incidence of criminality, school drop-out, and substance abuse among those suffering from ADHD (Wilens 2003). The burden of ADHD can be reduced, but only once access to care is improved.

This policy paper on ADHD will propose ways to improve access to care for patients with ADHD. The first section begins by reviewing the economic and social costs of the disorder, followed by an examination of provincial policy and the delivery of care in British Columbia. The paper continues with a discussion of quality of care issues and concludes with recommendations for government and other health care stakeholders.

Economic and Social Costs of ADHD

ADHD poses a significant economic and public health burden. Research has demonstrated that, on average, people with ADHD access health care services more frequently, require special educational services, and possess elevated rates of other psychiatric conditions such as anxiety and oppositional defiant disorder (Matza, Paramore et al. 2005). Further research has indicated that as they enter adolescence and adulthood, they are prone to delinquency, crime, substance abuse, teen pregnancy, and traffic accidents, as well as a decrease in workplace effectiveness (Matza, Paramore et al. 2005). Preliminary research also found that persons with ADHD have almost a three-fold increased risk of committing suicide (James, Lai et al. 2004).

These data translate into significant direct and indirect costs to the health care, education, and justice systems:

• Health costs. Health costs associated with ADHD are typically separated between pharmacological and other health care costs including physician fees, psychosocial mental health treatments, and hospital services. According to a review of the economic burden of ADHD published in 2007 by Pelham et al., the mean cost of pharmacologic therapy in the United States is US$459 per patient (Pelham, Foster et al. 2007). Studies of health care costs other than medication range from US$438 per year (Matza, Paramore et al. 2005) to US$1,580 per year (Birnbaum, Kessler et al. 2005). Average total health care costs associated with children with ADHD in the United States total US$2,636 per year.
• Education costs. ADHD is the most frequently encountered behavioural challenge in the classroom (Pelham, Foster et al. 2007). Children with ADHD are prone to poor academic achievement, disruptive classroom behaviour, and learning disabilities. Several American studies have examined educational costs linked to ADHD, with one finding that the average incremental annual cost to educate a child with ADHD from kindergarten to grade 12 is more than 18 times that of non-ADHD children (Pelham, Foster et al. 2007).
• Justice system costs. Much of ADHD’s cost of illness stems from costs linked to criminal behaviour and the resulting burden on the justice system (Pelham, Foster et al. 2007). Longitudinal studies in the US have correlated ADHD with a significantly higher juvenile arrest rate of 46%, versus 11% among a control population. Similarly, adults with ADHD were found to have a 21% chance of having been arrested in the past, versus just 1% among normal control subjects (Matza 2005). One study estimated the economic impact of criminality associated with ADHD during adolescence and teenage-years at $12,868, versus $498 for controls (Matza 2005).
• Adult ADHD. ADHD in adulthood is linked to poorer job performance, an average of 35 annual absences from work (Birnbaum 2005), lower educational achievement, lower occupational status, and less job stability compared to adults without the disorder (Matza 2005). A preliminary and limited estimate of the cost of adult ADHD posited a cost of US$31.6 billion per year (Birnbaum, Kessler et al. 2005). Pelham projected a rough estimate of total annual US costs of the entire lifespan of individuals with ADHD at US$74.1 billion (Pelham et al).

There are some gaps in the research on the costs of ADHD. The costs associated with significant ADHD sequelae such as substance abuse, for example, remain unknown (Pelham 2007), as do the inherent and likely widespread costs involving parental stress and family dysfunction associated with the disorder.

However, even without including the above, the costs of ADHD are high and significant, particularly in relation to major chronic diseases and mental health disorders. In the United States, ADHD’s total annual costs of US$42.5 billion are closely comparable to major depressive disorder (US$44 billion) and stroke (US$53.6 billion) (Pelham, Foster et al. 2007).

Taking into account health, education, and justice-related costs from thirteen separate analyses, Pelham et al. determined the mean annual cost of illness of ADHD to be $14,576 per child in 2005 US dollars. Assuming a prevalence of 5%, this translates to US$42.5 billion. Using a prevalence of 4.5% for ADHD in British Columbia (MCFD 2003), there are roughly 42,000 British Columbian children with ADHD. If one assumes a conservative, per-person annual cost of C$10,000 per person with ADHD, the total costs to the BC government would be $420 million every year. Less conservative estimates would push this figure well beyond half a billion dollars per year.

…the costs of ADHD are high and significant, particularly in relation to both major chronic diseases and mental health disorders.
Provincial Public Policy and Funding for ADHD

Responsibility for ADHD is divided among several government ministries in British Columbia. The Ministry of Health Services (MoHS) funds research, parent education, physicians’ services and tertiary care for ADHD. BC Mental Health and Addiction Services (MH&A), an agency of the Provincial Health Services Authority, is responsible for the child and adolescent mental health and addiction programs, including BC Children’s Hospital ADHD Clinic. However, it is the Ministry of Children and Family Development (MCFD) that is most responsible for children’s mental health policy and ADHD. The MCFD funds and provides services primarily through interventional programs and community based inter-disciplinary mental health teams, intended to support patients transitioning from traditional physician and tertiary care.

Through these ministries, the government of British Columbia spends substantially more on mental health services compared to other Canadian provinces: 6.4% of total provincial health funding is spent on mental health, compared to the national average of 4.8% (Jacobs, Yim et al. 2008). In addition, the government has acknowledged that childhood is a critical time to prevent mental illness and now allocates 15% of child mental health resources towards prevention (McEwan, Waddell et al. 2007).

These are very positive steps. However, the division of ministerial responsibility has led to a fragmented strategic direction for ADHD and other children’s mental health issues. To address this problem, an Inter-ministerial Child and Youth Mental Health Network was formed, which includes

representation from the ministries of health, education, children and family development and other relevant stakeholders. Its mandate is to “… facilitate inter-jurisdictional service coordination and planning for child and youth mental health service delivery” (Ministry of Children and Family Development 2008). However, meeting just four times per year, the network has been severely limited in its ability to deliver tangible outputs. To the extent that improvements in the access to and the quality of health care services for ADHD patients depend upon a coordinated effort across ministries, progress with the network is essential. For this reason, the BCMA recommends that the network be restructured to meet more frequently, supported with an adequate budget, and responsible for producing tangible outputs outlined in a publicly-available strategic plan.

Recommendation 1.

The provincial government must restructure the Child and Youth Mental Health Network so that it meets more frequently, is supported with an adequate budget, and is responsible for producing tangible outputs outlined in a publicly-available strategic plan.

Even within the context of a strengthened Child and Youth Mental Health Network, it is possible that ADHD will remain a lower-priority mental illness. In 2003 the MCFD introduced a 5-year “Child and Youth Mental Health Plan for BC” (CYMH Plan). Its major emphasis was the delivery of community-based care and prevention and early intervention strategies (Ministry of Children and Family Development 2003). The plan was implemented in concert with a doubling of the budget for the Child and Youth Mental Health Services branch of the MCFD from $43 million to $87 million. ADHD was largely absent within the implementation of the CYMH Plan. Illness- specific interventions were instead focused on anxiety and depression – which a 2008 progress report mistakenly cited as the two most prevalent child psychiatric disorders1 (Ministry of Children and Family Development 2008). Similarly, while the MoHS and MCFD have funded provincial strategic plans for anxiety, depression, suicide, fetal alcohol syndrome, substance abuse, and early psychosis, there is currently no specific strategic direction for ADHD (BC Ministry of Health Services 2008). Therefore, in addition to implementing changes to the Child and Youth Mental Health Network, the government must also work with stakeholders to create a new 5-year child mental health plan, including a strategic plan for delivery of services for patients with ADHD, no later than June 2009.

1 While anxiety is the most prevalent disorder, ADHD is actually the second most prevalent, and depression is fourth. See Waddell et al., 2007.

Recommendation 2

The provincial government should work with stakeholders to ensure that any new child mental health plan includes a strategic plan for the delivery of services specifically for patients with ADHD.

One consequence of the lack of strategic direction has been the reduction in services offered to patients with ADHD through the province’s sole centre for ADHD diagnosis and treatment initiation at BC Children’s Hospital (the ADHD Clinic):

• In 2004, $150,000 was allocated to the Clinic as part of a three-year pilot project to help meet the burgeoning need for adult ADHD assessment and treatment. The demand proved so high that the clinic’s waitlist rapidly lengthened to 14 months. Although the pilot continued beyond the 3-year term (it was agreed that ethically, adults who had been referred and accepted prior to the end of the three-year term should be provided an assessment and offered group therapy), new referrals and requests for re-evaluation were not accepted. Today, the PHSA offers no similar service for adults with ADHD or follow-up for the children who graduate from the ADHD clinic at age 18.
• In 2006, each division of child and youth psychiatric care administered by the PHSA, except for the ADHD clinic, included in the MH&A business plan a proposal for additional funding from the government. By 2008, funding for 2.3 full-time equivalent employees at the ADHD clinic ended, despite evidence of very high ongoing demand for the clinic’s services. Data from 2004- 2005, for example, indicated that of all ambulatory clinics, ADHD received the highest number of referrals (643), had the highest number of patients on the waitlist (78), and had the second longest wait-time at 3.5 months (MH&A 2006).

To guarantee that the needs of all ADHD patients are met, the government must provide services for adults with ADHD and follow-up for children who graduate from the ADHD clinic at age 18. This can be done by either expanding the mandate of the clinic to encompass children, youth, and adult patients, or by offering similar services for adults in another setting. In either case, funding for these services should be increased to ensure a maximum waitlist of three months for ADHD patients, regardless of age.

Recommendation 3

The provincial government must provide services for adults with ADHD and follow-up services for children who graduate from the ADHD clinic at age 18.

Recommendation 4

Funding for ADHD services should be increased to guarantee waitlists of less than three months for all ADHD patients.

Traditionally, there have been many financial disincentives to physicians wishing to provide optimal care for ADHD patients, in large part because diagnosing ADHD is a lengthy process. A Health Canada Survey indicated that an average of 69 minutes of assessment and 47 minutes of administration are required to diagnose ADHD (HealthCanada 1999). Recently, however, steps have been taken to improve compensation. Changes to the BCMA Fee Guide allow general practitioners to bill four $100 “mental health planning fees” per patient per year, and four $50-$65 follow-up fees (BCMA 2007). For a pediatrician, a $344 “complex behavioural” fee can be billed for a detailed battery of assessments and exams. These fee changes are an important first step in decreasing financial barriers to optimal care (BCMA 2008).

While a significant improvement, these new fees do not address the disincentive for physicians to communicate with schools. Ideally, prior to diagnosis, a physician would speak with a teacher. Then, after initiating treatment, the physician would be in close communication with the child’s teacher to ensure the correct dosage is being used, and to monitor side-effects (Leslie and Wolraich 2007). This practice is evidenced to help improve outcomes over standard care (MTA Cooperative Group 1999). Yet in reality this does not happen, as busy physicians are not compensated for such a time-consuming practice. Ultimately, assessment and treatment of ADHD in private primary care practices is poorly remunerated because it is a time-intensive activity associated with considerable indirect care and poor compliance.

Recommendation 5

A billing fee for consulting with third parties, such as teachers, should be added to the BCMA Fee Guide to encourage optimal coordination with teachers in the diagnosis and management of ADHD.

Such a fee would be similar to the current patient management conference fee for psychiatrists. A billing fee for consulting with third parties, such as teachers, should be added to the BCMA Fee Guide to encourage optimal coordination with teachers in the diagnosis and management of ADHD.

Quality of Care

In a 2005 survey of British Columbians with mental health needs, 76.3% indicated that ‘acceptability of services’ was the greatest impediment to care (MHECCU 2005). However, patients with ADHD, their families, and their physicians face additional challenges beyond those experienced by patients with other mental illnesses, including a lack of national guidelines on the treatment of ADHD, inadequate public coverage of ADHD medications, and poor coordination among providers of care for ADHD patients.

The process of diagnosing ADHD can be difficult since there is no definitive diagnostic test. Canadian surveys indicate that 70% of physicians believe there are too few properly qualified diagnosticians for ADHD and that physicians in general are not well informed about standard diagnostic criteria (HealthCanada 1999). Indeed, the peer-reviewed literature demonstrates that highly variant diagnostic practices exist (Chan, Hopkins et al. 2005). The prospect of long-term psychoactive medication hinging on variant diagnostic practices is a significant problem.

Research suggests that while there is no evidence of the rampant over-diagnosis some fear, misdiagnoses do occur, as do ‘missed’ diagnoses (Goldman, Genel et al. 1998). In an effort to improve diagnostic practices, in 2001 the American Academy of Pediatrics implemented official guidelines for the assessment and diagnosis of ADHD, and offered ADHD training to all physicians. In conjunction with the guidelines, in primary care offices across America, the AAP implemented what is referred to as a ‘diagnostic toolkit’ which standardized the method of gathering diagnostic information and the DSM assessment checklists to be used in diagnosis (Leslie, Weckerly et al. 2004).

In Canada, no guidelines have been officially endorsed by the medical professional associations. National experts in ADHD (e.g., Canadian ADD Resource Alliance) have developed consensus guidelines and a ‘diagnostic toolkit’, but they have not been acknowledged as the national standard of care (Edmunds 2008). Therefore, the BCMA calls upon health professional associations for pediatrics, child psychiatry, psychiatry, neurology, and family practice to endorse CADDRA’s ADHD practice guidelines or review, amend and then endorse revised CADDRA guidelines. In concert with the guidelines, a diagnostic toolkit for ADHD should be implemented in primary care offices across British Columbia. Such a toolkit might include, for example, standardized teacher and parent DSM-based assessment sheets; standardized sequence and method for distributing and gathering assessments and booking a series of appointments; and a clear delineation of available community resources and referral process, perhaps in collaboration with the developing Community Health and Resource Directory (CHARD) (Brown and DeSandoli 2008).

Recommendation 6


Medical professional associations for pediatrics, child psychiatry, psychiatry, neurology, and family practice should endorse the Canadian Attention Deficit Disorder Resource Alliance (CADDRA) ADHD practice guidelines; or review, amend, and then endorse revised CADDRA guidelines. Such guidelines should be accompanied by the implementation, in primary care offices across British Columbia, of a ‘diagnostic toolkit’ for ADHD.

Simply writing a prescription for ADHD is woefully insufficient care, and practice guidelines universally acknowledge that treatment of ADHD with medication must be accompanied by psychoeducation about the disorder, appropriate environmental accommodations, and behavioural intervention. Prescription of medication without additional support has been shown to be associated with poor compliance, persistence and community-based outcomes (MTA 1999). Within a year, almost 50% of parents discontinue their children’s medication (Firestone 1982).

One factor influencing non-compliance is pills that must be taken multiple times per day. Research demonstrates that “once daily” formulations improve compliance by 32% (Swanson 2003). Currently, MSP covers short- and intermediate acting ADHD stimulant medication (4-6 hour or 6-8 hour effectiveness) that must be taken two or three times daily, forcing children to experience bursts of symptom rebound as the medication wears off. They must also take the pill at school, which necessitates coordinating supervision and may lead to stigmatization and embarrassment. Missing a dose equates to losing an afternoon of focused learning. Medications that can be taken once daily, with efficacy comparable to those requiring more frequent dosing, exist but are not covered by BC PharmaCare (i.e., long-acting medications with 12-24 hour effectiveness). These once daily formulas are typically 25% more expensive. However, the most expensive covered short-acting medication – dexedrine spansule – is actually more expensive than the least expensive long-acting medication, Biphentin.2 Saskatchewan, Ontario, and Quebec have already approved coverage or restricted access to long-acting ADHD medication, as have Australia and other countries around the world.

Recommendation 7

PharmaCare should expand coverage for long-acting ADHD medication in order to facilitate compliance, minimize stigma and prevent missed opportunities for focused learning.

In Canada, according to research performed by the World Federation for Mental Health, from the first point of contact with a physician it takes 1.59 years to receive treatment for ADHD (World Federation for Mental Health 2004). In the US, it takes an average of one year. Such a wait time must be taken seriously, given children’s rapid development and the consequences of falling behind academically.

Understandably, this is greatly frustrating to physicians who feel that they are forced to over rely on medication rather than refer patients and families to parent training, proper psycho-education, or other appropriate expert consultation when needed. Similarly, some patients feel that physicians are not sufficiently informed about alternative resources and treatment options. The failure to coordinate comprehensive care inevitably leads to patient frustration, lack of treatment, and noncompliance.

Acknowledging the important role for community-based care in managing ADHD, MCFD’s 2003 Mental Health Plan stated:

“ADHD is best managed in community settings by multidisciplinary child and youth mental health teams where possible, working together with families, schools, family physicians, and others in the community as needed” (Ministry of Children and Family Development 2003).

2 Based on July 9, 2008 prices in Vancouver.

Nonetheless, other mental health disorders such as psychosis, anxiety, and depression often supersede ADHD. Many Health Authority mental health teams do not consider ADHD as part of their mandate. The common misconception that there is little to offer children and families with ADHD beyond medication also prevents effective community-based care. Ironically, the service designed to improve transitions from physician services and coordinate access to care is not itself accessible.

Recommendation 8

In order to improve access to services for ADHD patients and foster the kind of collaborative care arrangements necessary to provide optimal care, both the MoHS and MCFD should train specialized ADHD clinicians for mental health teams and provide BC families access to community services to complement treatment by physicians.

In order to improve access to services for ADHD patients and foster the kind of collaborative care arrangements necessary to provide optimal care, both the Ministry of Health and Ministry of Children and Family Development should train specialized ADHD clinicians for mental health teams and provide BC families access to community services to complement treatment by physicians.

Conclusion

When Olympic swimmer Michael Phelps was in the fifth grade, his mother and physician discussed whether he might have ADHD. A string of disciplinary issues at school and his inability to concentrate led them to consider that his problems went beyond those of an ordinary, high-energy child. At age nine, he began taking Ritalin. Two years later, again after having consulted their family physician, Michael’s mother agreed to take him off the medication. The stigma of going to the school nurse’s office to take a pill at lunch was too great, and Michael had asked to stop taking them. By that time, Michael’s talents were becoming obvious to his swimming coach, and plans were being laid for his participation in the Olympics.

Michael’s condition was correctly diagnosed, treated, and managed by a physician and his family such that they removed whatever barriers it might have placed before his potential successes. While few BC children and adults with ADHD will excel as far in their field as Phelps has in his, all should expect that they, too, will be able to access the health care services necessary to manage their condition. BC has already taken several positive steps, including, for example, increasing funding for mental health services and the creating of the Child and Youth Mental Health Network. By continuing down this path and giving ADHD the kind of attention currently devoted to other mental health issues, we will enable many British Columbians to realize their fullest potential.

LIST OF RECOMMENDATIONS

1. The provincial government must restructure the Child and Youth Mental Health Network so that it meets more frequently, is supported with an adequate budget, and is responsible for producing tangible outputs outlined in a publicly-available strategic plan.

2. The provincial government should work with stakeholders to ensure that any new child mental health plan includes a strategic plan for the delivery of services specifically for patients with ADHD.

3. The provincial government must provide services for adults with ADHD and follow-up services for children who graduate from the ADHD clinic at age 18.

4. Funding for ADHD services should be increased to guarantee waitlists of less than three months for all ADHD patients.

5. A billing fee for consulting with third parties, such as teachers, should be added to the BCMA Fee Guide to encourage optimal coordination with teachers in the diagnosis and management of ADHD.

6. Medical professional associations for pediatrics, child psychiatry, psychiatry, neurology, and family practice should endorse the Canadian Attention Deficit Disorder Resource Alliance (CADDRA) ADHD practice guidelines; or review, amend, and then endorse revised CADDRA guidelines. Such guidelines should be accompanied by the implementation, in primary care offices across British Columbia, of a ‘diagnostic toolkit’ for ADHD.

7. PharmaCare should expand coverage for long-acting ADHD medication in order to facilitate compliance, minimize stigma and prevent missed opportunities for focused learning.

8. In order to improve access to services for ADHD patients and foster the kind of collaborative care arrangements necessary to provide optimal care, both the Ministry of Health and Ministry of Children and Family Development should train specialized ADHD clinicians for mental health teams and provide BC families access to community services to complement treatment by physicians.

REFERENCES

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BC Medical Assn says ADHD Costing BC 500 Million Yearly. Asks Govt to Improve Access to Care for ADHD Patients

Post from: Adult ADD Strengths

UPDATE: the 500 million figure is incorrect, it’s actually Billions of dollars yearly. The BCMA underestimated the cost because they only counted the cost of children with ADHD ie 18 and under. They didn’t include adults with ADHD which are far more numerous than kids with ADHD, i.e., 19 years to 70, 80 etc. See page 7, 3rd paragraph of the report

So it’s costing BC MULTIPLE BILLIONS of Dollars Annually to deal with ADHD and the actual treatment cost is the smallest amount, and many are undiagnosed and untreated.

Finally. Finally. Still can’t believe it was written. Thought BC would remain the Canadian equivalant of Mississippi in terms of how they treat or ignore adults and children with ADHD. I.e., in last place.

Here’s the BCMC news release from February 23, 2009 BCMA recommends improved access to treatement for ADHD

Here’s the February 2009 – BCMA Policy Paper – Your Attention, Please: A Call to Improve Access to Care for ADHD Patients It’s a 16 page PDF conclusions, are on page 14 and I’ve pasted their 8 recommendations in below. I agree with all of them especially requiring the govt to treat adults with ADHD and it should have been done 20 years ago. The chair was Dr. Shelly Ross who is a GP in Burnaby.

But if you live in BC and have ADHD or have friends/family members or relatives with ADHD you should read all 16 pages and pass it around to as many people as you can.

I think it’s the most important document ever written on ADHD in BC, period.

The Vancouver Sun covered the story yesterday Feb 24th on p A5 and in their online edition, I was quoted by the reporter Amy O’ Brian. If you think it’s an important story, leave a comment on their site (or here) telling them why this report’s recommendations should be implemented or what’s it like being an adult with ADHD. You don’t have to use your full name.

You might consider writing a letter to your local paper, call in to your local talk show, leave a comment on your local blog about it, or tweet it, mention it on facebook etc. There’s a BC election in May. I’d also suggest contact your MLA as well as the various opposition parties about it and ask them if they agree with and will implement all 8 suggestions. Not just “we’ll study it”. As a political science major, I know governments often respond to public pressure. If ADDers and their family don’t bother to do so no one will, and we won’t get a better chance than this, possible not for a decade.

I’ll list some ways to contact politicians and the media after the recommendations and will blog about the policy document later. Here’s a few excerpts from the report.

In Canada, it takes more than 18 months for a patient with ADHD to be treated after first contact with a physician. Once diagnosed, only half of children and as few as 11% of adults receive treatment. As the waitlist for the BC Children’s Hospital ADHD Clinic shows, demand for such services greatly exceeds supply.

Taking into account the direct health, education, and justice-related costs associated with ADHD, the total costs to the government of British Columbia may exceed $500 million each year – enough money to pay for nearly half of BC’s $1.061 billion PharmaCare budget or more than all of the Ministry’s capital plan budget for 2008/09 (Ministry of Health 2008).

This policy paper on ADHD will propose ways to improve access to care for patients with ADHD. The first section begins by reviewing the economic and social costs of the disorder, followed by an examination of provincial policy and the delivery of care in British Columbia. The paper continues with a discussion of quality of care issues and concludes with recommendations for government and other health care stakeholders.

Simply writing a prescription for ADHD is woefully insufficient care, and practice guidelines universally acknowledge that treatment of ADHD with medication must be accompanied by psychoeducation about the disorder, appropriate environmental accommodations, and behavioural intervention. Prescription of medication without additional support has been shown to be associated with poor compliance, persistence and community-based outcomes. Within a year, almost 50% of parents discontinue their children’s medication.

BC Medical Associations’s List of Recommendations

1. The provincial government must restructure the Child and Youth Mental Health Network so that it meets more frequently, is supported with an adequate budget, and is responsible for producing tangible outputs outlined in a publicly-available strategic plan.

2. The provincial government should work with stakeholders to ensure that any new child mental health plan includes a strategic plan for the delivery of services specifically for patients with ADHD.

3. The provincial government must provide services for adults with ADHD and follow-up services for children who graduate from the ADHD clinic at age 18.

4. Funding for ADHD services should be increased to guarantee waitlists of less than three months for all ADHD patients.

5. A billing fee for consulting with third parties, such as teachers, should be added to the BCMA Fee Guide to encourage optimal coordination with teachers in the diagnosis and management of ADHD.

6. Medical professional associations for pediatrics, child psychiatry, psychiatry, neurology, and family practice should endorse the Canadian Attention Deficit Disorder Resource Alliance (CADDRA) ADHD practice guidelines; or review, amend, and then endorse revised CADDRA guidelines. Such guidelines should be accompanied by the implementation, in primary care offices across British Columbia, of a ‘diagnostic toolkit’ for ADHD.

7. PharmaCare should expand coverage for long-acting ADHD medication in order to facilitate compliance, minimize stigma and prevent missed opportunities for focused learning.

8. In order to improve access to services for ADHD patients and foster the kind of collaborative care arrangements necessary to provide optimal care, both the Ministry of Health and Ministry of Children and Family Development should train specialized ADHD clinicians for mental health teams and provide BC families access to community services to complement treatment by physicians.

I have been trying to get the word out on ADHD and why ADHD adults and children should get diagnosis and treatment for years. This report and the upcoming provincial election is our best shot to make a difference for people with ADHD and their family members.

If you want change, now’s the time to take action.

List of BC Liberal Party candidates

List of BC NDP candidates

List of BC Green Party Candidates

BC Minister of Health Services is George Abbott
Ministers direct phone # 250 953-3547
Toll-free in B.C.: 1 800 465-4911
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Here’s some helpful tips on writing a letter to the editor and a list of BC based newspapers websites and editor email addresses courtesy BC Liberal Party

Here’s a list of BC based talk radio shows with phone numbers, host names, times and online comments

I‘ll be blogging about the report in detail later in another post. I’ve asked the BC NDP, the BC liberal minister of health’s office and the Green party for comment. I’ve already got a response from the BC Liberals, they’re quicker than the other two. When I phoned the BC NDP party, I talked to a legislative assistant to MLA’s and said I was a blogger who would like to hear the NDP’s official position on the BCMA 8 recommendations, the NDP staffer said “what’s a blogger?” Wow. Not impressed. Maybe she should read this Obama McCain social media scorecard post or this Vancouver civic election social media scorecard post I did to see why social media is important in politics.

What do you think of the BCMA’s 8 ADHD recommendations?

Another

Post from: Adult ADD Strengths

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