I’m restarting the Vancouver Adult ADD Support Group, the local Adult ADHD support group that I started and ran for 3 years until we became homeless and the group stopped. It’s the adult group of CHADD Vancouver, which I’m on the board of.

We have found a new home for the group, the old home has become available, Thanks for the search & persistence Ed! Thanks also to those that were willing to help out with the group.

The first meeting will be Tuesday May 5th from 6.30 to 8.30pm

Location: Our old home Ravensong Community Healthcare Center, 2450 Ontario st, near main and Broadway, map on the group’s webpage.

Discussion Leader: Pete Quily
Topic: Direction of the group.

For those who attended our support group in the past, 2 questions.

* What worked well in our support group in the past?
* What didn’t work so well or what would you like to change about the group?

For everyone

* What do you want out of & what are you willing to put into the Vancouver Adult ADD Support Group?
* What topics would you like to see covered in the monthly meetings?
* Any news on BC politicians talking about/ignoring the BC Medical Association’s ADHD Policy Paper & 8 Recommendations, including requiring the BC govt to treat ADHD. I.e., what did your local candidate say when you asked them if they supported it, since no one else is asking?

Please help us get the word out there about the only Adult ADHD support group in BC. If you know of any organization or individual that might be interested in finding out about the group, please let them know.

I received this from John Scrivin, its his response the the Vancouver Sun article that profiled him and Adult ADHD, I’m posting it in full. My apologies for misspelling your name before John.

The Article is now in 2 place on the Vancouver Sun’s website, different headlines but same article, both with many comments. Some denying ADHD exists or minimizing it’s impact and some real stories from people with ADHD, quite moving ones. I guess John’s courage to tell his story inspired other adults with ADHD to do the same. More of those and maybe the BC politicians might take Adult ADHD, currently NONE of the BC political parties mention ADHD in their platform. Looks like they’re going to ignore the BC medical Association’s 8 ADHD policy recommendation’s unless enough ADDers convince em otherwise. I’d encourage everyone to read both of them.

B.C. lacks resources to treat, diagnose adults with ADHD

Man turns life around after ADHD diagnosis at age 55

Here’s John Scrivin’s response.

In response to the article in the Vancouver Sun, April 13 profiling my ADD issues, I would like to add the following. I felt it was a bit unfortunate for the comments on ADDers being accident prone and the fact that I am a professional bus driver and have been for the last thirty some odd years. Several issues need to be brought up here. First, the medications ADDers take should to be very carefully chosen by the prescribing doctor. In my case, several medications were selected and tested out separately on minimal strengths until the best was selected. Each test took about six to eight weeks. After the best (for me) was chosen, the strength was increased to the appropriate level. In my case, they needed to provide focus and not easily and negate distraction when performing the task at hand. However there was also a need not to hyperfocus either. A delicate balance. I would suggest also that the selection of appropriate medications or other therapeutic interventions is critical for all ADDers. I have heard too often that ‘my meds don’t work’ or ‘I can’t handle the side effects’. Perhaps these are indications that the therapies need to be revisited and/or reassessed as to the validity for that particular ADDer. What is true for all people, especially ADDers is to be in the right environment, occupationally, romantically and one’s other associations. We do not fit well in boxes designed by others and therefore often exhibit the well-known characteristics of the stereo-type ADDer that the world seems to know. What is so missing are demonstrations of the positives of ADD. There are thousands of ADDers who have done wonderful things not in spite of their ADD, BUT BECAUSE OF IT. Many entrepreneurs are ADDers who have followed their passion. Perhaps Leonardo da Vinci was the most prolific of all. Steve Jobs is another and I could go on and on. Perhaps we cannot totally emulate these high profile ADDers, but when our environments are right for us, we can soar. ADD is a gift One really needs to enjoy what we do and who we associate with on a day to basis. What are the results? We are infinitely happier. ‘Anger Management courses’ are not required. Our senses of humour are even sharper, others enjoy our company much more and unkind comments either by ourselves or others are minimal. We need not rely on illicit drugs or alcohol to make the world go away. We need not to be aggressive in a negative way. Our physical health improves. Our job satisfaction and performance soars and our relationships are joyful. Need I go on? I remember many years ago an advertisement in a national magazine from an employer who said, “Send me someone who reads.” I look forward to the day when the statement will be “Send me an ADDer.”

Today’s Vancouver Sun Monday April 13th 2009 has an article on Adult ADHD on p A5. The title is B.C. lacks resources to treat, diagnose adults with ADHD by Amy O’Brian. Web version is here.
They interviewed a local adult with ADHD, John Scrivin.

Please check it out and let others that might be interested in it know about it.

If you have any opinion about the article you might want to express it in the comments section at the end of the article. Here’s a few excerpts.

John Scrivin spent his whole life feeling like he didn’t fit in — like he never quite understood what was going on.

As a teenager and an adult, he identified as an outsider. Angry outbursts were common and he was eventually diagnosed with depression.

But Scrivin always suspected there was something more going on.

It wasn’t until he was 55 that he was diagnosed with Attention Deficit/Hyperactivity Disorder or ADHD, a disorder most commonly associated with children, but also highly prevalent in adults.”

Finding out it had a name and treatment was huge,” he said.

“Even at the tender age of 55, it made a world of difference in terms of my happiness.”

How many more people will have to wait 5 decades or more to get diagnosed with ADHD?

John Scriven: “There is no doubt I would have been diagnosed sooner if there had been more resources.”

Yes this is a very common problem for adults with ADHD in BC. As an Vancouver based adult ADHD coach, I get calls and emails on a regular basis from people trying to find someone that knows enough about ADHD to diagnose it, especially in adults. Some say their doctor says they can’t have ADHD because they did well in school or work, which show their ignorance of the condition since there’s a MENSA ADHD group with 500 people in it and billionaires with ADHD. But there’s also a lot of addicts with ADHD, people in jail with ADHD and many in between

Medical student’s & psychologists aren’t properly taught about ADHD in University according to many BC based doctors, psychiatrists & psychologists I’ve talked to who DO know about ADHD because they went out of their way to learn about the condition on their own time and dime.

“There are few resources for adults with ADHD and not enough awareness about symptoms and diagnosis, says Dr. Derryck Smith, a Vancouver-based psychiatrist who treats people of all ages with ADHD — including some in their “geriatric years.”

“There’s nowhere to send these people for treatment,” Smith said.

“We want more resources in the adult treatment sector. We want Pharmacare to cover some of the longer-acting, more modern medications. And we want the government to have a treatment strategy for dealing with this as a public health issue.”

The BC government currently has NO STRATEGY for ADHD. None.

Also there’s no sign that the NDP will be any better at dealing with ADHD. The Green party leader is pretty clueless about ADHD.

Expecting people with a condition that’s known for having problems with distraction, impulsivity, poor time management, and forgetfullness to take a pill 3 times a day every day on a regular schedule? Isn’t that sadistic? Even without the problems of the rebound effect of short term ADHD medications? Maybe one day BC will catch up to Saskatchewan, Ontario & Quebec that do cover long acting ADHD medication.

The only public Adult ADHD clinic in the province, the BC adult ADHD clinic at Children’s hospital had a year long wait list for an entire year for adults. They asked the government for money to deal with the waiting list, the BC Liberal government refused and they closed the clinic in 2007, and didn’t reopen the clinic at another hospital, they abandoned adults with ADHD because the long wait list was politically embarrassing.

Hopefully people with ADHD & their family members will ask their potential MLA’s if they will implement the 8 recommendations of the BCMA’s ADHD policy paper. Best time to get a politician’s attention is when they want your vote. There’s a BC election May 12 next month.

contact your local NDP candidate

contact your local Liberal candidate

Just to let people in the Vancouver area know there’s a new ADHD related parent support group in Ladner BC. Here’s the details.

Ladner Parent Support Circles

A biweekly parent gathering with a focus on parenting children with ADHD or BEHAVIOUR challenges.

Each self-help parent-support Circle is led by trained facilitators.

Location: Reach Child and Youth Development Society #3 – 3800 72nd Street, Ladner (off Hwy 10)

To register:

Call: Lisa at 604-949-6622, ext. 342
Email: lisaw@reachdevelopment.org
Web: www.reachdevelopment.org

Or Bella at 604-569-3110
Email: office@parentsupportbc.ca
Web: www.parentsupportbc.ca

Always nice to hear of a new local ADHD support group in the lower mainland. They can be quite useful. Here’s why you might want to start an ADHD support group Here’s how to start run and operate an ADHD support group.

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

1. Arnsten, A. F. (2006). “Fundamentals of attention-deficit/hyperactivity disorder: circuits and
pathways.”J Clin Psychiatry 67 Suppl 8: 7-12.

2. Bagnall, J. (2008). Michael Phelps shows the way for parents of ADHD kids. The Gazette.
Montreal. August 27, 2008.

3. BCMA (2008). BCMA Guide to Fees, Pediatrics.

4. BCMA, G. P. S. C. (2007). Community-Based Mental Health Initiative.

5. Birnbaum, H. G., R. C. Kessler, et al. (2005). “Costs of attention deficit-hyperactivity disorder
(ADHD) in the US: excess costs of persons with ADHD and their family members in 2000.”
Curr Med Res Opin 21(2): 195-206.

6. Brown, K. and M. DeSandoli (2008). Community Healthcare and Resource Directory
(CHARD). Presentation to GPSC VIHA Physician Leads. Victoria, BC, HealthLines Services &
BCMA.

7. Chan, E., M. R. Hopkins, et al. (2005). “Diagnostic practices for attention deficit hyperactivity
disorder: a national survey of primary care physicians.” Ambul Pediatr 5(4): 201-8.

8. Faraone, S. V. and S. A. Khan (2006). “Candidate gene studies of attention-deficit/hyperactivity
disorder.”J Clin Psychiatry 67 Suppl 8: 13-20.

9. Firestone, P. (1982). “Factors associated with children’s adherence to stimulant medication.” Am
J Orthopsychiatry 52(3): 447-57.

10. Health Canada (1999). Survey of Attention Deficit Hyperactivity Disorder Diagnosis and
Treatment with Methylphenidate Among Canadian Physicians.

11. Jacobs, P., R. Yim, et al. (2008). “Expenditures on mental health and addictions for canadian
provinces in 2003 and 2004.” Can J Psychiatry 53(5): 306-13.

12. James, A., F. H. Lai, et al. (2004). “Attention deficit hyperactivity disorder and suicide: a review
of possible associations.” Acta Psychiatr Scand 110(6): 408-15.

13. Kessler, R. C., L. Adler, et al. (2006). “The prevalence and correlates of adult ADHD in the
United States: results from the National Comorbidity Survey Replication.” Am J Psychiatry
163(4): 716-23.

14. Leslie, L. K., J. Weckerly, et al. (2004). “Implementing the American Academy of Pediatrics
attention-deficit/hyperactivity disorder diagnostic guidelines in primary care settings.” Pediatrics
114(1): 129-40.

15. Leslie, L. K. and M. L. Wolraich (2007). “ADHD service use patterns in youth.” Ambul Pediatr
7(1 Suppl): 107-20.

16. Matza, L. S., C. Paramore, et al. (2005). “A review of the economic burden of ADHD.” Cost Eff
Resour Alloc 3: 5.

17. McEwan, K., C. Waddell, et al. (2007). “Bringing children’s mental health “out of the shadows”.”
Cmaj 176(4): 471-2.

18. Ministry of Children and Family Development (2003). Child and Youth Mental Health Plan for
British Columbia.

19. Ministry of Children and Family Development (2008). Child and Youth Mental Health Plan for
BC: Progress Report 2008.

20. Ministry of Health. (2008). “2008/09–2010/11 Service Plan.” Retrieved October 6, 2008, from

http://www.bcbudget.gov.bc.ca/2008/sp/hlth/default.html#5.

21. MTA Cooperative Group (1999). “A 14-month randomized clinical trial of treatment strategies
for attention-deficit/hyperactivity disorder. The MTA Cooperative Group. Multimodal
Treatment Study of Children with ADHD.” Arch Gen Psychiatry 56(12): 1073-86.

22. Pelham, W. E., E. M. Foster, et al. (2007). “The economic impact of attention-
deficit/hyperactivity disorder in children and adolescents.” J Pediatr Psychol 32(6): 711-27.

23. Pliszka, S. (2007). “Practice parameter for the assessment and treatment of children and
adolescents with attention-deficit/hyperactivity disorder.” J Am Acad Child Adolesc Psychiatry
46(7): 894-921.

24. Reich, W., H. Huang, et al. (2006). “ADHD medication use in a population-based sample of
twins.”J Am Acad Child Adolesc Psychiatry 45(7): 801-7.

25. Stevens, S. (2007). “A Convenient Diagnosis.” CTV National News March 17, 2007. Retrieved
October 3, 2008, from

http://www.ctv.ca/servlet/ArticleNews/story/CTVNews/20070316/wfive_diagnosis_070317/

20070317?hub=WFive.

26. Swanson, J. (2003). “Compliance with stimulants for attention-deficit/hyperactivity disorder:
issues and approaches for improvement.” CNS Drugs 17(2): 117-31.

27. Winerip, M. (2008). Phelps’s Mother Recalls Helping Her Son Find Gold-Medal Focus New
York Times. New York: L14.

28. World Federation for Mental Health (2004). Without Boundaries: Challenges and Hopes for
Living with ADHD: An International Survey.

Photo Credits: dogsbody and Brent Granby

Vision Vancouver’s Gregor Robertson’s campaign understood the internet, social media, and web culture much better than the NPA’s Peter Ladner’s did and that’s one of the many reasons he won the 2008 Vancouver civic election.

In this comprehensive post I compare and contrast the two Vancouver Mayoral candidates in the 2008 Vancouver civic election. Gregor Robertson of Vision Vancouver and Peter Ladner of the NPA in 25 different areas involving social media websites, (Facebook, YouTube, Twitter, Flickr and Friend Feed), various search engine results & web presence. Data was collected election day, Nov 15, 2008. I did a similar post comparing Barack Obama & John McCain in social media & SEO. I’m an adult ADHD coach and a former political science student and long time political junkie who’s been online since before the world wide web started.

Here’s what I’ll be showing you.

9 overview slides of the data

Comparison chart of the data

Analysis and opinion

Links to Vision Vancouver’s and the NPA’s campaign’s social media profile pages

Overall conclusions

Social media lessons and resources

Links to Vancouver area blogs that cover politics

My 9 slides have an Attribution-NonCommercial-ShareAlike Creative Commons license, so feel free to use them or remix them, just give me credit and a link.

Intro

This blog is usually about the strengths and challenges of adult ADHD, and trying to raise awareness of Adult ADHD in Canada, where we’re a decade behind the Americans, and Vancouver is way behind Ontario, sigh… and the world from the perspective of an Adult ADHD Coach who has Attention Surplus Condition more commonly called ADHD.

BUT I’m also a political science major and a politics junkie. So occasionally I’ll do posts on politics, humour, and other things that interest me. Disclosure, I’ve talked to both candidates briefly during the beginning of the 2008 Vancouver civic election.

Since the 2008 Vancouver civic election was so close the US Presidential election where I recently did a post called Barack Obama Vs. John McCain Social Media and Search Engine Scorecard, I decided to a similar post for the 2008 Vancouver civic election in my hometown. Congratulations to our new Mayor Gregor Robertson.

Social Media Websites

Facebook

Gregor Robertson has 3 Facebook pages
1. His personal one.
2. His politician one, his word.
3. His Gregor Robertson and the Vision Team One. This is the one I’m measuring in the chart.

Peter Ladner seems to only have two,
1. His personal one
2. His Vancouver NPA one. This is the one I’m measuring in the chart because that’s the main one they seem to be using for the campaign. That being said, Peter has more friends on his personal Facebook page, 617, than he does fans on the Vancouver Non Partisan Association’s Facebook page, 488.

So I just compared the two official campaign pages. Peter Ladner has 8 videos in a YouTube box while Gregor only list 3 videos, less prominently on the lower right hand side. But he has 15 videos on YouTube. Why didn’t the Ladner campaign post the other 7 on their Facebook page?

Both Peter and Gregor allowed wall posts on their respective individual pages. Vision Vancouver’s online campaign team decided to allow wall posts on their Facebook page, unfortunately the Non Partisan Association did not. Being open and engaging in the community was probably part of the reason why Gregor Robertson had twice as many Facebook Friends as Peter Ladner. Too bad Peter Ladner wasn’t as interactive on his NPA page as his personal page. That was a lost opportunity to engage the Facebook community. Seemed here like an open source style campaign vs. the old fashioned tradition command and control one. Command and control doesn’t work so well online, look at what happened to John McCain.

YouTube

Peter Ladner cranked out much more content on YouTube than Gregor Robertson did, more than 4 times the number of videos. Surprisingly, both candidates had very few subscribers on YouTube. Peter had 7, but for some reason refused to show any, Gregor had 4 and did list them. Both were smart enough to repurpose their videos by embedding them in their Facebook pages.

I went to a debate at the Greek Church on Arbutus and saw a videographer at the back filming it, later found out it was for the Ladner team. I assumed it was for ads or to improve their candidates speaking performance. I tried to ask a question about why everyone in the campaign was talking about the well known problems of addiction and mental health in Vancouver but no candidates or media outlets were talking about the links between undiagnosed and untreated ADHD and addictions. These links are well known among those knowledgeable about ADHD but less so in the general public. Unfortunately they didn’t ask that one.

The SMALLEST numbers I’ve seen on ADHD and addiction are 20-25% in peer reviewed clinical journals in Pub Med and I’ve seen much higher. For example see this as well as this, and this.

Kind of frustrating especially when the BC Liberal government and Children’s hospital closed down the only provincial Adult ADHD clinic in the province (where it’s very difficult to find someone that knows enough about ADHD to diagnose it) at BC Childrens hospital because it had a 1 year wait list, which was politically embarrassing. Kill the wait list; avoid bad media coverage about long wait lists. I contacted various people in the BC NDP’s offices and got promises of action from several NDP staffers, who subsequently did absolutely nothing. It’s easy to forget one big reason we have so many homeless people in Vancouver is the NDP emptied out large mental institutions because they were so “terrible” and decided to “house them in the community” then promptly abandoned them to the predators of the streets.

We got coverage of the adult ADHD clinics shutting their doors on BCTV, but no other media outlet covered it, and the only public BC adult ADHD clinic is still dead and the patients are still abandoned.

Twitter

Gregor has nearly 5 times as many twitter followers than Peter, but Peter has 3 times as many Twitter update posts or tweets.

Gregor’s tweets (posts on twitter) were nearly all one way promotional broadcasts. He (or the person(s) that posted as him) only responded to other Twitterers 3 times and 2 of them were to his online campaign manager, @koriB. Sounded to me like Kori was talking to himself but I can’t be sure. UPDATE: Kori just mentioned in the comments it was Gregor doing the tweeting not him. But Gregor did technically follow 159 people. Whether he or his campaign staff actually read any of their tweets, responded to his followers or other’s Tweets or cared about interacting with those people, I couldn’t tell.

Most of the NPA’s tweets seemed to be mainly from/about NPA council candidate Sean Bickerton

The NPA’s tweets were 100% self promotional, not a single response to anyone else on twitter. They didn’t believe in the mantra of social media consultants and connected web strategists, “listen to the conversation”.
That is, they weren’t interested in following anyone else on Twitter, they didn’t even fake it, they had 0 followers. Obviously clueless about Twitter.

Vision Vancouver Twitter jacked Peter Ladner’s name on Twitter. That is, Peter and his campaign didn’t bother to register his name on twitter, (an internet rookie movie) so someone from the vision Vancouver camp registered his name and created a Peter Ladner account on Twitter, started putting out Tweets that insulted/made fun of Peter Ladner. This is why politicians and other visible people, businesses and other organizations should start learning more about social media, just as a defensive move if nothing else.

Frankly it was a clueless move. It’s one thing for a third party to do something like that like the brilliant Fake Steve Jobs did.

But for someone from the opposing campaign to do so and not create something like fakepeterladnder instead of using his real name is just not kosher, someone who did that in the US would probably get fired for it. Plus it irritated members of the local twitterati and others on twitter, especially Vision Vancouver’s seemingly unwillingness to apologize about it. It’s still up there, and was really counterproductive. Hopefully our new mayor understands the lessons of what happens to arrogant politicians in BC, they get defeated. Miss 604 reports that #civicvote2008 is now the second most talked about topic on Twitter today.

It also got mainstream media coverage since Vancouver Sun Journalist and blogger Gillian Shaw is unlike most Vancouver journalists and has a blog and a twitter account, and unlike other Vancouver Sun and Vancouver Province journalists, she actually is clued into the blogosphere enough to have a blogroll with other non company blogs listed. Was also picked up by several blogs here are a few stories on it.

Most of the searches on Twitter for Peter Ladner seem to be related to Vision Vancouver’s campaign’s Twitterjacking of his name. Gregor (or his campaign) was smart enough to create an individual account on Twitter with his real name, which has no content but links to the Gregor08 Twitter page. Unlike John McCain, both candidates were smart enough to send out get out the vote tweets on November 15th, election day.

Flickr

There was more than 3 times the number of search results for Gregor Robertson as there were for Peter Ladner on Flickr, and 256% more photos on Vision’s Vancouver Flickr profile page than the Vancouver NPA’s. Vision Vancouver’s group pool on Flickr had 9 members and 400 items; the NPA had no group pool.

Vision started using Flickr on Nov 16, 2007, the NPA first started using Flickr on Jul 6, 2007, so the NPA started 4 months earlier, plus the NPA has been a political party since 1937 (so you might assume they’d have more photos to upload). Vision just started up 3 years ago and the mayor was from the NPA, and they had more elected members than Vision, but still had fewer photos.

Probably those restless cultural creatives and young folk creating all that content. Also Vision’s online team seemed far more web 2.0 savvy then the NPA’s. Plus I think Vision’s policies appealed more to that crowd.

Using the web tools alone is not enough if your policies and past actions don’t resonate with those people creating and consuming content on those social media sites. Just as John McCain had George Bush as an anchor on his campaign, Ladner had his own anchor, Sam Sullivan, i.e., Sam’s Strike. But to be fair to Sam, he was a small anchor compared to George Bush.
Flickr was created in Vancouver and it’s a very popular photo sharing site, that many local blogger use to spice up their blog posts. I’ve posted creative commons licensed slides for this post on my Flickr set here.

Friend Feed

10 of the links to “Peter Ladner” was done by one user that had them removed, but still showed up in the Friend Feed search, so the actual number was smaller. Even still, more results for Peter Ladner. I didn’t check every single link on both, but in this case the last ones looked pretty similar by the same user. They probably just had trouble uploading the video file on blip TV.

MySpace

I didn’t list MySpace activity on the chart, since neither candidate has any profiles on the site unlike Barack Obama and John McCain did on my previous post. There were only 6 search results for Peter Ladner, 4 for Gregor Robertson. When I searched for Peter Ladner on MySpace, there was an ad for Peter Ladner and the NPA. Interestingly, when I searched for Gregor Robertson, I found the same ad for Peter Ladner and the NPA. Maybe Gregor’s team was doing the same thing, I’m not sure.

Didn’t list WordPress.com results either, since there was such little activity there. There were 10 search results for Gregor Robertson on WordPress.com, 9 results for Peter Ladner.

Search Engine Results For “Gregor Robertson” and “Peter Ladner”

Gregor Robertson was elected as an NDP MLA in 2005. Peter Ladner was elected to Vancouver city council in 3 years earlier in 2002 and yet Gregor Robertson beat Peter Ladner in every search engine. His margin was biggest in google’s index, 48%, but not by that much in the other ones, around the 10% range. Keep in mind that more search engine results or user generated social media does not always mean that the results are positive towards the candidate, many are negative of both. The political blogosphere can be a tough place. One other thing to keep in mind is that bloggers are often content creators on other social media websites as well.

Quick Short Diversion to BC Provincial Politics

Gordon Campbell’s BC Liberal party is smart enough to realize this. The BC Liberals are encouraging their supporters to target bloggers on their website, and get involved in social media. I noticed that they’ve removed some BC bloggers from the list. I believe that bloggers and social media content creators will be even more important in coming civic and provincial elections, political campaigns will ignore them at their peril. The BC Liberal Party has got a very well designed and modern website, more similar to Vision’s than the NPA’s.

Carole James’s BC NDP’s website is quite antiquated in comparison, and is too clueless to even mention anything about blogs or social media on their get involved section. Look at the wording of their main URL, http://home.bcndp.ca, home? Did someone create this website a decade ago and forget about it? It get’s worse. Look at the order of the URL’s on their top navigation bar, they’re all subdomains! I.e., http://newsroom.bcndp.ca/ instead of http://bcndp.ca/newsroom. If you don’t know why this seems nuts, ask someone who knows SEO to explain. This web 2.0 cluelessness will hurt the BC NDP in the upcoming election.. I guess the old fashioned left can be command and control too. Maybe they should hire Gregor’s online team quickly, the election’s in May 2009, not too far away. Also hire an SEO, same title tag for every page on the site? Which after permalinks is THE most important on page SEO thing you can do. Just like John McCain’s and Peter Ladner’s website. Perhaps being so unaware of the internet that your campaign has the same title tag on every page of your site is a predictor of electoral defeat:)

Compare the design and functionality of the BC Liberal Party’s get involved section to the NDP’s version. Which one would you be more likely to click through? Hire a usability expert too. The BC NDP’s website looks like a decade old. Looks like the BC NDP will be roadkill on the information superhighway in the upcoming election. Maybe the BC NDP needs to lose and election too in order to find a new leader the gets the internet and social media.

Responding to Bloggers

I can only give my personal example, not sure if/how the campaigns responded to other bloggers. If you blogged about the civic election and got a response from either campaign, let me know in the comments.

I recently did a post calling for the civic election candidates and the media to start talking about the connection between ADHD and drug addiction and crime and the lack of services for adults with ADHD in Vancouver, and calling for a mental health advocate. One member of Vision mentioned in a comment on my post that vision supported a mental health advocate while the NPA opposed it but ignored the main question of my post and never bothered answering my follow up question. At least they responded, the Ladner campaign never bothered to.

Internet Presence for Gregor Robertson and Peter Ladner

From just the 2 domains visionvancouver.ca vs peterladner.ca, Vision clearly wins in every category. But Vision only has one website. If you look at the Vancouver NPA site, they beat Vision’s in pages in google’s index 283 pages to 219, the NPA has less Yahoo Links-Pages 201 vs 481, but more Yahoo Links-Inlinks, 1281 vs 219. So if you combine both Peter Ladner’s site with the NPA’s one, they have a greater online presence then Vision Vancouver in 2 out the 3 metrics.

However Vision Vancouver’s website is superior in to both Peter Ladner’s and the Vancouver NPA’s website in:

Design
Functionality
Usability
Interactivity
Encouraging Engagement
Social media features

I’ll do another post later comparing the two main websites.

List of Gregor Robertson and Peter Ladner’s Online Profiles on Social Media Websites

Gregor Robertson’s Websites

Vision Vancouver’s Website
Gregor’s personal Facebook page
Gregor’s politician Facebook page, his word
Gregor Robertson and the Vision Team Facebook page
Gregor Robertson YouTube
Gregor Robertson Twitter page
Gregor Robertson’s Fake Peter Ladner Twitter Page (Twitter jacked)
Vision Vancouver’s Flickr Photostream

Peter Ladner’s Websites

Peter Ladner.ca
NPA Vancouver website
NPA Vancouver Facebook page
Peter Ladner’s personal Facebook page
Peter Ladner YouTube
Peter Ladner Twitter
NPA Vancouver’s Flickr Photostream

Overall Conclusions

Of the 25 different metrics I used, Gregor won 17, Peter Ladner won 6, and they tied on two. Gregor Robertson was the clear winner. He won every single category in the search engines if you don’t add the 2nd NPA Vancouver website.

Gregor Robertson’s Online Campaigner was Kori Brus. who has a blog, and twitter account and is active online While the twitter jacking was a definite screw up, overall he performed far superior to his counterpart in Peter Ladner’s campaign, if in fact Peter did have a dedicated person for that. I couldn’t find out by googling it. Clearly not a good sign.

Both campaigns could have done better in engaging people on Youtube, Flickr and Twitter instead of just old fashioned push broadcasts. They both could have had created groups of individual on their website by demographics or areas like the Obama and McCain campaign did.

Social Media Lessons.

1. It’s important for a political organization, business, non profit that wants to get involved in social media websites like Facebook, Twitter, Youtube, Flickr etc to understand how the tools work, simply from a defensive point of view, even if you don’t plan on participating in them. I.e., avoiding getting Twitterjacked like Peter Ladner.

2.Why were both candidates so anti social on social networking sites that were designed specifically to allow people to, you know.. socialize?

Robertson did well on Facebook.

But look how many YouTube subscribers they both had. Look at how many YouTube groups they were members of. Zero.

Look at the how many photos they both posted on Flickr. Then compare how many contacts they had on Flickr. Look at how many Flickr groups they joined, ZERO.

Now look at the number of contact and groups this sociable local blogger’s has on Flickr.

If you’re creating all that content, LEVERAGE IT. And do so by being engaging with the community in a non pushy way. Google open source politics to see the way of the future.

If you’re an individual business person you may or may not want to get that involved in social networks because to do them right can take time and resources, or it may not be the right fit for you, or your resources are devoted elesewhere. Frankly I can’t picture myself spending time on MySpace, but I know some people love it.

3. It’s even more important to understand the ecosystem in which the tools are used.

For example flashy blinking graphics with extreme contrast are fine on MySpace, but would not be fine on LinkedIn. If you don’t understand the culture of the site and the users and how they interact with each other, you could be seen as an unwelcome outsider or a spammer, and have some really counterproductive results.

Here are a few social media mistakes to avoid.

So if you decide to participate in a social media network, learn about the culture of the site and engage with the community. Barack Obama didn’t dominate John McCain in social media and on the internet simply because he understood the tools and McCain didn’t, he beat him because he understood the environments in which the tools were used, the users of those tools and used the tools to engage and organize people and to get them to engage and organize others.

If you don’t understand this, hire someone that does like a social media consultant.

Gregor beat Peter Ladner by a fairly wide margin for many reasons but in a close election a good website and blogging and social media strategy could make the difference between losing and winning. I’ve watched elections for 30 years some are really close. Smart politicians will get clued in or pay someone to help them get a clue, the dinosaurs that don’t will be adding another potentially dangerous vulnerability to their campaign.

Resources relating to why and how to get involved in Social Media

The emergence and rise of mass social media

Social Media – Visual and simple images explaining trends, concepts and technologies driving Social Media growth

How do I convince my boss of the ROI of new marketing? David Meerman Scott answers the question via video.

Is It Worth It? An ROI Calculator for Social Network Campaigns

Social media ROI resources and general social media stats

A graphical categorization list of social media tools

Social Media & NonProfits: Make it Easy for Your Fans to Help You by local blogger and social media consultant Monica Hamburg

Alltop – Top Social Media News

E-Metrics: Followers, Friends, and Fans - Expanding Your Online Community By Beth Kanter

Vancouver Blogs That Cover Politics

Here’s a list of some blogs that cover politics in Vancouver that you might want to check out. I didn’t list politicians that blogged, since most of them just start up before the election, go dead shortly after and often just use blogs mainly as a press release device. This is by no means an comprehensive list, and it’s just of list of some blogs that I sometimes read or have searched to see who blogs about Vancouver politics. In listing them, I’m not saying I agree with what every blog on the list has to say.

I know some of the bloggers on the list personally from meeting them at the excellent Vancouver Bloggers Meetup Group hosted by Raul, or other blogging/tech events around Vancouver of which there are many, Vancouver has a thriving tech/blogging/Web2.0 community Apologies in advance if I’ve missed your political related blog on this list, I’m sure I missed quite a few.

If you have an opinion on what you read on someone’s blog, agree, disagree (respectfully, not rudely), or have another related point to make, let the bloggers know in the comment section of the particular blog post. Bloggers love feedback. Including this one:)

Vancouver Political Bloggers or Occasional Political Bloggers

For Vancouver Sun civic politics reporter Frances Bula is in a class of her own. Read her first, and encourage her to fully join the blogosphere by adding a blogroll of local Vancouver bloggers:)

The others are in grouped in sections then alphabetically.

Vancouver Online Magazines

Georgia Straight Politics Blog
Only Magazine
The Tyee
The Vancouver Observer

Vancouver Group Blogs

Beyond Robson Especially Sean Orr
Vancouver Metblogs
Vancity Buzz

Vancouver Primarily Political Blogs
Bill Tieleman
Irwin Loy
Keeping it Real
Left Eye on Vancouver
Oldtown News
Pacific Current Vancouver Sun blog
Paying Attention
Pacific Gazette
Public Eye Online
The Official 2010 Olympics Newswire
The Vancouver Manifesto

Vancouver Blogs That Sometimes Discuss Vancouver Politics

Adult ADD Strengths
Buzz Networker
Chinese in Vancouver
Currents
Hummingbird 604
Loud Murmurs
Miss 604
Mori Therapy
Paul Hillsdon Yes he’s in Surrey but he does have some great material, and I hope he wins next time.
Rob Cottingham
Stephen Rees
Tris Hussey
The Ugly Chinese Canadian
The Vancouverite
Ursa Minor Bear 604
Van Rambling

Why Blogs & Other Social Media Matter. Quantifying The Dangers Of Not Cluing In. 29 Social Media & SEO Metrics.

Here’s what I’ll be showing you in this post:

Comparison chart of the data

Overview slides of the data

Analysis and opinion

Links to both campaign’s social media profile pages

Overall conclusions

Analysis of both candidate’s websites and understanding of the internet & social media

Why “getting” the net & social media is critical for future campaigns

My 10 slides have an Attribution-NonCommercial-ShareAlike Creative Commons license, so feel free to share and remix them, just give me credit and a link.

UPDATE: I added some charts below to better present the data.

Comparison chart of 29 measurements of Barack Obama’s & John McCain’s activities, followers and presence on popular social media sites , Facebook, MySpace, Twitter, YouTube, Flickr & several search engines (data collected Nov 5, 08, excel charts above below nov 12) Analysis below the slides.

* = The Candidates Sites on Flickr, Youtube, Facebook, Myspace and Twitter.

I got the idea for this as I was surfing the 2008 US Presidential candidates websites late Monday night, looking for ideas for online ADHD advocacy from my last post. As an Adult ADHD coach who has ADHD, I wanted examples to help raise awareness of Adult ADHD. I wondered how many pages Barack Obama’s website had in Google’s index vs John McCain’s. So I did a site search site:www.barackobama.com etc. to find out. Wow.

Nearly 6,000 % more pages on Barack Obama’s website than John McCain’s.

So being the curious type (a major ADHD strength), and a political junkie (I had the same major as Barack Obama, Political Science, concentration in International Relations) I examined the differences between the 2 candidates web presences via different categories of search engine results and checking out their presence and popularity on some of the many popular social media websites as of November 4, 2008. The chart above quantifying Barack Obama’s domination of John McCain in social media websites and search engines is the result.

Barack Obama vs. John McCain – Social Media Presence

Facebook

3,032% more hits for Barack Obama than John McCain, Barack Obama’s Facebook page had nearly 4 times more followers and posts than John McCain’s page and had 1,335% more notes up. TechPresident reported Barack Obama‘s added 400,000 new friends on facebook in the last 2 weeks, a 20% surge.

MySpace

Both Candidates pages were fairly well designed compared to the usual chaotic look some favour. Barack Obama had nearly 4 times the number of friends on MySpace as John McCain, and 269% more search results for his name. Strangely enough, I found 147K comments on Barack Obama’s MySpace page but none at all on John McCain’s. Not sure why he didn’t display any, which seems one of the main points of Myspace. Possibly the fear of too many negative ones?

Twitter

Here we have a case of severe internet cluelessness on the part of the John McCain Campaign. Barack Obama cranked out 10 times more tweets than John McCain, had 2254% more followers, and 1,029% more search results. John McCain’s last tweet was October 24th! So clueless that he didn’t send a vote today tweet on election day!. Some power twitter users like Alltop Media mogul Guy Kawasaki have large numbers of follower, in Guy’s case 24,726 followers. Imagine having a few of those people on your list AND the fact that some of their followers will retweet and/or blog the message if they like it, and they have followers, etc, etc.

UPDATE: Thanks to Oliver and Faruk for pointing out I listed the wrong John McCain Twitter page, just corrected it. I mistakenly linked to a McCain fan page, who had nearly half the followers as the offical one but massively more tweets. Maybe John McCain should have outsourced his twittering to him:) Also updated, he has 29,202 YouTube subscribers.

Friend Feed

Barack Obama had 25% more mentions than John McCain.

Youtube

Barack Obama had nearly twice as many search results for his name as John McCain, and more than 5 times as many videos posted. Barack Obama had 117k subscribers and 25k friends and strangely enough John McCain had no friends or subscribers Sorry, still has no friends but 29,202 subscribers, Obama beat him by 300% on this. Or at least none displayed. Wonder why? Maybe’s his campaign doesn’t know how to use Youtube or maybe they’re semi antisocial about social networking? Or there might be too many people posting negative videos and comments? Not sure.

Flickr

The photo sharing site that was created here in Vancouver BC Canada, had nearly 5 times more search results for Barack Obama than John McCain. I found 50,000 photos on Barack Obama’s flickr page and 7,000 contacts, I could not find a profile of John McCain on Flickr.

Barack Obama’s and John McCains Official Social Media Sites

Barack Obama’s Facebook Site
Barack Obama’s Myspace Site
Barack Obama’s Twitter Site
Barack Obama’s Youtube Site
Barack Obama’s Flickr Photostream

John McCain’s Facebook Site
John McCain’s Myspace Site
John McCain’s Twitter Site
John McCain’s Youtube Site
John McCain has no Flickr Photostream

Search Engine Results for “Barack Obama” and “John McCain”

Google News, Images and Video

John McCain beats Barack Obama significantly in Google News though by 173%. There’s almost 3 times as many results for Barack Obama in Google images and 51% more hits in Google Video as there is for John McCain.

Blog Search Engines

Barack Obama has more search engine results than John McCain in both blog search engines, google and technorati and in in wordpress.com a site with 4,592,973 blogs where users create blogs for free and host them there. This blog uses WordPress, the free standalone version. Keep in mind that more search engine results or user generated social media does not always mean that the results are positive of the candidate, many are negative of both. The political blogosphere can be a brutal place. But as a politician, being ignored is the worst thing. Getting no attention won’t get you elected. Plus bloggers are often creating content and commenting in other social media sites beyond their individual blog. Bloggers will become even more important and courted in the future by political campaigns.

Internet Presence for Barack Obama’s and John McCains Official Websites

As previously mentioned, Barack Obama had nearly 6,000 percent more pages on his main website than John McCain did on his, 1,820,000 vs 30,700. Barack Obama has more and deeper links, more hits for his name in Google,

Overall Metrics

Of the 27 29 metrics I chose, Barack Obama absolutely crushed John McCain. Barack Obama led on 25 27 out of 27 29, John McCain led on only 1 (Google Blog Search) and the Candidates were tied on one (Google page rank). In some cases the John McCain campaign didn’t even bother to show up. The McCain campaign had no Youtube subscribers, Youtube friends, and Myspace comments, or at least none posted. Was that a result of campaign malpractice? Or not wanting to show the hostile reactions of users to his messages? Or something else? Republican minds should start asking some pointed questions, Democrats should be thankful.

Maybe they need to find a republican version of James Carville, head strategist for Bill Clinton’s winning presidential election who has ADHD. I remember reading somewhere that the #1 career for adults with ADHD was politics and #2 was sports (27% and 23% I think). We have understimulated brains (or are brains are processing so fast we burn up dopamine) so we do best in high stimulation, creative, challenging jobs. Many ADDers in high tech, marketing, advertising, entrepreneurs etc. In those areas, having ADHD can be a competitive edge. Factory floors are death for us. Boring repetitive paperwork is our kryptonite.

Choose Your Bias

Waxy‘s Andy Biao created an excellent Greasemonkey script that I use called Memeorandum Colors for the US political aggregator site that’s almost been my home page for the last few months, Memeorandum, the Techmeme of politics

Left-leaning blogs are blue and right-leaning blogs are red, with darker colors representing strong biases.

Check it out, it’s based on who the blogs link to, and don’t just view the blogs on your side of the political spectrum, view the rogue ones too:)

Conclusions

Overall Barack Obama’s campaign has

• a larger, more comprehensive presence
• more followers or subscribers on the social media websites
• more interaction with those followers
• much greater results in search engines

This is in spite of John McCain being a big political celebrity FAR longer than Barack Obama was. John McCain was first elected to congress in 1982, and even before McCain ran in 2008, other than George Bush, McCain was probably the best known, most interviewed, and most written about Republican politician. That’s why I laughed when I saw McCain’s celebrity ad about Obama, look at how many mention’s John McCain has in the Internet Movie Database, like Bill Clinton, he was jealous because he was no longer the biggest political celebrity in Washington.

Outside of Illinois, Barack Obama was largely unknown until he gave his famous keynote speech at the democratic convention in 2004. So 26 years of exposure vs 4 years and yet Obama still massively dominated the online landscape.

Candidates Websites

Obama’s website one of the best designed websites I’ve seen in 15 years online, far better designed then John McCain’s, plus Obama’s has more features, more option and more content and is far more sophisticated than John McCain’s. Senator Obama hired Blue State Digital to run his online campaign, here’s their case study on it.

Barack Obama’s Website simply crushes McCains in:

• quantity
• design
• features
• sophistication
• participation
• usability
• Social media features

Take a few moments and look at both sites and you’ll see the huge gap. Obama even created an online rapid response team to counter the lies thrown at him, called fight the smears. Brilliant move, cheaper than responding with TV ads.

McCain’s social network page has only 3 suggested sites, Obama’s suggests 16.

John McCain’s Knowledge of the Internet

John McCain’s unfamiliarity with the internet is well known,

I am learning to get online myself, and I will have that down fairly soon, getting on myself

in fact the Obama campaign created an ad based on it. Knowing the tubes does matter. Check out the Design for Obama website, no similar site for the McCain campaign.

Barack Obama’s Knowledge of the Internet

Barack Obama is younger and more computer and web savy. Here’s one quote from Marc Andreessen, coauthor of Mosaic, founder of netscape, and co founder of roll your own social network Ning who had a 90 minute one on one with Obama, early in 2007.

In particular, the Senator was personally interested in the rise of social networking, Facebook, Youtube, and user-generated content, and casually but persistently grilled us on what we thought the next generation of social media would be and how social networking might affect politics — with no staff present, no prepared materials, no notes. He already knew a fair amount about the topic but was very curious to actually learn more. We also talked about a pretty wide range of other issues, including Silicon Valley and various political topics.

Politicans can always hire people to create their websites and do their online marketing, fundraising, organizing and voter outreach programs. But if they don’t “get the net” or don’t know what questions to ask, they’re at a severe disadvantage to those that do get it and do spend time on it.

Barack Obama won the presidency for many reasons, but one is that he really understood the force multiplier called the internet. He knew who the internet users are, understood their needs and wants, how and why they use it, and how to connect with those people, and get them involved so they do most of the building and content creation themselves.

Fear can be effective in politics, but it doesn’t create as much content as hope. Republicans like Sarah Palin and Rudy Guiliani mocked Barack Obama for being a community organizer. Barack Obama community organized on the net with devastating effects to the Republican campaign.

One reason Barack Obama won was because he open sourced his campaign especially the online aspect. McCain’s was command and control by multiple competing lobbyists.

Other politicians in the US, Canada, and other countries will either start learning more about the internet culture, blogging, other social media and getting involved the right ways (the wrong ways will cause a massive backlash) or risk getting their asses kicked in online fundraising, raising awareness, finding and engaging new volunteers, online and offline organization, and voter outreach by those who do understand and use the internet and social media. Plus they have to change their beliefs, attitudes, policies and operating procedures to appeal too younger, digitally connected people, technology by itself ain’t enough.

Social media consultants will be getting much busier.