Wednesday, December 28, 2011
Adult Asperger's Disorder Diagnosis / Testing / Assessment
Sitting in a coffee shop last week I heard an adult discuss how they were sure they had Asperger Disorder, or High Functioning Autism. "I read the symptoms and I have all of them!" he said. I've actually overheard several adults claim they have autism spectrum disorder, Asperger's or other forms of social cognitive deficit while trying to read, and they always have a story about how their doctor dismissed them, and they really know Asperger's is the cause of every problem in their life! All they need for happiness is a proper assessment and diagnosis of adult Asperger's. I honestly wish it were that easy.
The problem is that several factors complicate the diagnosis of Asperger syndrome (AS), an autism spectrum disorder (ASD). Like other ASD forms, Asperger syndrome is characterized by impairment in social interaction accompanied by restricted and repetitive interests and behavior; it differs from the other ASDs by having no general delay in language or cognitive development. But having social problems, not understanding, catching on or reacting properly to social cues does not in and of itself mean you have adult Asperger's. Those symptoms can mean many different things, ranging from simple "quirkiness" on your part, an "odd personality" to a serious personality disorder, mood disorder, anxiety disorder....or simple shyness. Matching the symptoms to your behaviour and experience is no way for an adult to be diagnosesed with Asperger's Disorder (Notice I sometimes refer to this this disorder as Asperger's Disorder, the most common name, and sometimes Asperger Syndrome, another common name. Both mean essentially the same thing.)
Further problems in the diagnosis of Asperger's, especially in an adult, include disagreement among diagnostic criteria, controversy over the distinction between AS and other ASD forms or even whether AS exists as a separate syndrome. Right now the plan seems to be to stop giving this diagnosis the next time the DSM (Diagnostic and Statistical Manual - the "Bible" of psychiatric diagnosis, is published). As with other ASD forms, early diagnosis is important, and differential diagnosis must consider several other conditions. If Asperger's Syndrome or Disorder is not diagnosed early much of the important information we need to make a final diagnosis becomes hard to obtain. We usually use parent reports, teacher reports and observations of play to make the diagnosis. This is hard to do for an adult!
Whena family medical doctor who you have been seeing dismisses your self diagnosis of adult Asperger's disorder or Syndrome it is often because the diagnosis requires that the impairments are "significant, and must affect important areas of function." Often a medical doctor who has seen you for a number of years and observed you makes a quick determination that your "impairments" simply are not "significant." Even though you might think they are. With a few simple questions he or she can, pretty much, rule out Asperger's as a major concern. So, no diagnosis of adult Asperger's for you.
Developmental screening during a routine check-up by a general practitioner or paediatrician should have identified these signs and symptoms, which we would expect would have had a greater impact on you when you were young. Because many individuals come to a physician or psychologist for a diagnosis of "adult Asperger's" when they are having trouble at work, school or other social situations they are very cautious about giving out the diagnosis. The issue often, for the family doctor, is one of severity of symptoms. Why do you need the diagnosis, and what good will it do you? Are you seeking treatment for adult Aspergers? Is there a problem at work? Home? What are the reasons for you coming in?
Many times the symptoms of adult Asperger's are the same as Anxiety Disorders and the treatment is often very similar. The likelihood they could make a diagnosis they might have to defend is small. And, as I've mentioned, many people seeking the diagnosis are have some sort of work or social problem.
There are some other reasons you are unlikely to get a diagnosis from your family doctor: "A comprehensive evaluation includes neurological and genetic assessment, with in-depth cognitive and language testing to establish IQ and evaluate psychomotor function, verbal and nonverbal strengths and weaknesses, style of learning, and skills for independent living. An assessment of communication strengths and weaknesses includes the evaluation of nonverbal forms of communication (gaze and gestures); the use of non-literal language (metaphor, irony, absurdities and humor); patterns of speech inflection, stress and volume; pragmatics (turn-taking and sensitivity to verbal cues); and the content, clarity and coherence of conversation."
Further, "Asperger syndrome can be misdiagnosed as a number of other conditions. Conditions that must be considered in a differential diagnosis include other pervasive developmental disorders (autism, PDD-NOS, childhood disintegrative disorder, Rett disorder), schizophrenia spectrum disorders (schizophrenia, schizotypal disorder, schizoid personality disorder), attention-deficit hyperactivity disorder, obsessive compulsive disorder, depression, semantic pragmatic disorder, selective mutism, stereotypic movement disorder and bipolar disorder[10] as well as traumatic brain injury or birth trauma, conduct disorder, Cornelia De Lange syndrome, fetal alcohol syndrome, fragile X syndrome, dyslexia, Fahr syndrome, hyperlexia, leukodystrophy, multiple sclerosis and Triple X syndrome."
That's a lot to expect your medical doctor to do in a 15 minute examination. And if your symptoms aren't severe, it's unlikely you swill get a diagnosis in the first place.
So what can you do if you really do need a professional and comprehensive diagnosis as an adult with possible Asperger's Disorder (Asperger Syndrome)? Ask for a referral to a neurologist, or a psychologist. Counsellors cannot diagnosis Asperger's. Social Workers can not. Most psychologists do not have the training, experience or the tools to do the testing required. You need to find psychologist who has experience with Asperger's in children as well as adults. Here in BC ACT (Autism Community Training) could recommend someone with the experience and training (they have a list of approved MDs and psychologists). The psychologist looking into your possible "adult Asperger's Disorder" needs to be familiar with the most commonly used tools, the ADOS and ADI-R. The Ministry requires these tools, along with a psychoeducational assessment and functional behavioural assessment before approving an assessment of any child. If your going to a psychologist for an adult assessment of Asperger's, you really should see a practitioner who uses these instruments with children.
A comprehensive assessment of an adult for Asperger's takes two or three days of testing, totalling anywhere from 6-10hours, and can cost from $1,800-$2,600. This kind of assessment is not covered by MSP. Only occasionally will extended health care cover these costs. So it's really best to set up an initial appointment with a psychologist or neurologist and discuss the pro's and con's of undergoing an assessment for adult Asperger's.
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As a Registered Psychologist I provide diagnostic assessments for children, adolescents and adults for Asperger's Disorder, Autism Spectrum Disorder and related social-cognitive deficits. Please feel free to visit my web page: www.relatedminds.com or www.socialcognitivetherapy.com for more information.
This page is not meant to supply medical or psychological advice, or make any suggestions about diagnosis. If you have questions about disorders such as adult Asperger Syndrome or adult Asperger's Disorder, call and speak directly with a Registered Psychologist. The internet is not a good place for any medical or psychological advice!
Monday, December 26, 2011
Aspergers and Relationships: An Adult Love Story
Young adults with Asperger's or high functioning autism have very few resources here in BC. Autism funding is cut at age 19, and there are very few psychologists or other practitioners with experience with adults. In my own practice I see many of these young people as they try to navigate the new and complex set of relationships in college or work that are not as structured or supported as their high school experience may have been. Many young adults with high functioning autism or Asperger's disorder get into social trouble at work, refusing to sign a get well card, or making repeated social mistakes when others are trying to include them. Often the highly intelligent and skilled engineers or other professionals just can't navigate the twists and turns of "small talk." And relationships, which people with autism seek (in spite of what many think) are way beyond their reach without help. I use several books designed especially for young adults, as well as materials based upon the work of Michelle Garcia Winner, a leader in the filed of therapy with children and adolescents with Asperger's or high functioning autism. I also try to find good audio-visual resources, and the New York Times has just printed an excellent article on high functioning autism / Aspergers which contains a wonderful story about a couple and has some excellent and insightful video in it. I recommend it to teens, young adults with autism or Aspegers, and the parents, families, husbands and wires of those with high functioning autism or Aspergers. Here is the information and link:
Navigating Love and Autism
By AMY HARMON
Published: December 26, 2011
For Jack Robison and Kirsten Lindsmith, both of whom fall on the autism spectrum, being in a relationship together has created a unique set of comforts and challenges.
http://www.nytimes.com/2011/12/26/us/navigating-love-and-autism.html
Dr. Jim Roche
Offices in Vancouver and Burnaby
http://www.socialcognitivetherapy.com
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Key words
ADHD | ADHD coaching | workplace coaching | Anxiety and Stress | Autism and Asperger's Disorder | Individual Counselling | Child Therapy | Testing and Assessments and Learning Disabilities | Couples Counselling | Depression | The Angry Child | Anger Management | Pain Management and PTSD | Forensic Services | Attention Deficit Hyperactivity Disorder | Vancouver | Burnaby | Coquitlam | New Westminster | Maple Ridge | Port Moody | Child Psychologist | Psychologist | Learning Disability | Assessment | Testing | Psycho-educational Assessment | Neuropsychological Assessment | Psychoeducational Testing
http://www.relatedminds.com
http://Therapists.PsychologyToday.com/rms/70682
http://www.therapistlocator.net/member?183420
http://www.bcpsychologist.org/users/jimroche
http://www.actcommunity.net/jim-roche.html
http://www.counsellingbc.com/listings/JRoche.htm
Thursday, December 22, 2011
Autism Rates Increase...dramatically. Why?
According to the Centers for Disease Control (CDC), nearly one percent of U.S. children have some form of autism. This is 20 times higher than the rate of autism spectrum disorder found in the 1980s. In this NPR broadcast (link below) Alan Zarembo of The Los Angeles Times and clinical psychologist Catherine Lord discuss what’s behind the growing number of diagnoses. The explanations may not be as mysterious as some project.
Listen here: NPR
Tuesday, December 13, 2011
Aggression, Autism and Families
Dr. Jim Roche is a registered psychologist who provides diagnostic assessments for autism (ASD) and Asperger's Disorder as well as individual treatment and intervention for children, adolescents and adults with autism spectrum disorder in both his Vancouver and Burnaby BC offices.
More information on Dr. Roche's autism related services can be found at: http://www.relatedminds.com or at http://www.socialcognitivetherapy.com
A recent story in the LA Times about autism provides an excellent video about Jonah Funk, 13, who was diagnosed with autism nine years ago. His mother, Stacie, says she often describes herself as his eyes, his ears and his voice. "I want him to be treated fairly," she said. "I want him to receive the things he needs." The video is interesting in that it opens up this family's life from moment to moment, showing us both their successes as well as their ongoing problems. One of the issues that is evident in the video is Jonah's ongoing aggression. While appearing pretty mild, his parents are concerned about where this aggression will lead, as he disrupts the lives of his siblings and travel in the community becomes problematic.
What to do? Well, it's a good example of when professional help is necessary. A behavioural specialist is seen in the video, however this specialist isn't seen doing any real interventions. This is too bad, as it would be interesting to see what steps the intervention specialist, and Jonah's parents, are taking. From my perspective it's obviously well past time to conduct a functional behavioural analysis (FBA). This behavioural assessment will tell us what the function of the unwanted behaviour is, and we can then take two important steps towards dealing with it: 1) Teaching an appropriate alternative behaviour that meets the same function (know as a "FERB" or Functionally Equivalent Replacement Behaviour) and what environmental changes we need to make to reduce Jonah's need to engage in the behaviour.
Working with a highly trained behaviourist is important when trying to reduce these negative and sometimes aggressive behaviours. As a behavioural specialist in school districts for over the past 15 years I have relied upon one particular site for training materials: PENT California. The PENT site is a website provided for school based professionals working with all sorts of behavioural issues in the public schools. Their training materials are free, up to date and have withstood legal battles over the adequacy of an FBA.
Working with a highly trained behaviourist is important when trying to reduce these negative and sometimes aggressive behaviours. As a behavioural specialist in school districts for over the past 15 years I have relied upon one particular site for training materials: PENT California. The PENT Positive Environment Network of Trainers) site is a website provided for school based professionals working with all sorts of behavioural issues in the public schools. Their training materials are free, up to date and have withstood legal battles over the adequacy of an FBA. Completing a functional Analysis can be very difficult, and the individual completing it needs fairly advanced training and experience in behavioural theory. If you are having trouble with aggression, even minor aggression, I would talk with your school based team first. They may very well have someone who is an expert on these issues. The next level would be the school psychologist who may have expertise on autism and aggression. After that, here in BC you might ask for a consultation from POPARD, the Provincial Outreach Program for Autism and Related Disorders. POPARD's professionals often have extensive training and experience in dealing with this type of low level behavioural issue. Finally, there are outside behavioural interventionists (usually approved by ACT: Autism Community Training, as a Behaviour Interventionist or behavioural specialist. At any rate, address these issues quickly. and start by having an FBA completed. These days we usually don't just use the term FBA, but instead use the terms FBA and PBSP, meaning "Positive Behavioural Support Plan," as the emphasis, as you can see from my description above, is not on punishment or control, but instead on skills development and environmental support. Usually that's all we need to change these low level aggressive behaviours before they become problematic.
Click here to see the LA Times story: LATimes Video
More information on Dr. Roche's autism related services can be found at: http://www.relatedminds.com or at http://www.socialcognitivetherapy.com
A recent story in the LA Times about autism provides an excellent video about Jonah Funk, 13, who was diagnosed with autism nine years ago. His mother, Stacie, says she often describes herself as his eyes, his ears and his voice. "I want him to be treated fairly," she said. "I want him to receive the things he needs." The video is interesting in that it opens up this family's life from moment to moment, showing us both their successes as well as their ongoing problems. One of the issues that is evident in the video is Jonah's ongoing aggression. While appearing pretty mild, his parents are concerned about where this aggression will lead, as he disrupts the lives of his siblings and travel in the community becomes problematic.
What to do? Well, it's a good example of when professional help is necessary. A behavioural specialist is seen in the video, however this specialist isn't seen doing any real interventions. This is too bad, as it would be interesting to see what steps the intervention specialist, and Jonah's parents, are taking. From my perspective it's obviously well past time to conduct a functional behavioural analysis (FBA). This behavioural assessment will tell us what the function of the unwanted behaviour is, and we can then take two important steps towards dealing with it: 1) Teaching an appropriate alternative behaviour that meets the same function (know as a "FERB" or Functionally Equivalent Replacement Behaviour) and what environmental changes we need to make to reduce Jonah's need to engage in the behaviour.
Working with a highly trained behaviourist is important when trying to reduce these negative and sometimes aggressive behaviours. As a behavioural specialist in school districts for over the past 15 years I have relied upon one particular site for training materials: PENT California. The PENT site is a website provided for school based professionals working with all sorts of behavioural issues in the public schools. Their training materials are free, up to date and have withstood legal battles over the adequacy of an FBA.
Working with a highly trained behaviourist is important when trying to reduce these negative and sometimes aggressive behaviours. As a behavioural specialist in school districts for over the past 15 years I have relied upon one particular site for training materials: PENT California. The PENT Positive Environment Network of Trainers) site is a website provided for school based professionals working with all sorts of behavioural issues in the public schools. Their training materials are free, up to date and have withstood legal battles over the adequacy of an FBA. Completing a functional Analysis can be very difficult, and the individual completing it needs fairly advanced training and experience in behavioural theory. If you are having trouble with aggression, even minor aggression, I would talk with your school based team first. They may very well have someone who is an expert on these issues. The next level would be the school psychologist who may have expertise on autism and aggression. After that, here in BC you might ask for a consultation from POPARD, the Provincial Outreach Program for Autism and Related Disorders. POPARD's professionals often have extensive training and experience in dealing with this type of low level behavioural issue. Finally, there are outside behavioural interventionists (usually approved by ACT: Autism Community Training, as a Behaviour Interventionist or behavioural specialist. At any rate, address these issues quickly. and start by having an FBA completed. These days we usually don't just use the term FBA, but instead use the terms FBA and PBSP, meaning "Positive Behavioural Support Plan," as the emphasis, as you can see from my description above, is not on punishment or control, but instead on skills development and environmental support. Usually that's all we need to change these low level aggressive behaviours before they become problematic.
Click here to see the LA Times story: LATimes Video
Wednesday, November 30, 2011
Do you provide assessment and therapy for individuals with Autism | Asperger's Disorder?
Do you provide services for individuals with autism, ASD and Aspergers Disorder?
I have served as the director of autism programming for several school districts in California, and as a provincial consultant for autism and related disorders here in British Columbia. I have consulted throughout the province on autism and behaviour planning, from the lower mainland to Northern BC. I am a certified member of the Autism Commuity Training RASP list of behavioural intervention service providers. I provide comprehensive autism assessment, counselling and therapy services for individuals (children/adolescents/adults), couples and families in the Burnaby, Coquitlam, Port Moody and central Vancouver areas. Social Cognitive Therapy is available for children, adolescents and adults with ASD, autism, Asperger's Disorder, NVLD and related cognitive deficits.
For information on counselling and therapy services in Burnaby, Vancouver, Coquitlam and surrounding areas contact Dr. Roche at: (Office phone) 778.998.7975
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Sunday, November 27, 2011
Psychoeducational Assessment | Burnaby | Vancouver | New Westminster | Coquitlam
Psychoeducational Assessments
Key Words
ADHD | Anxiety and Stress | Autism and Asperger’s Disorder | Individual Counselling | Child Therapy | Testing and Assessments and Learning Disabilities | Couples Counselling | Depression | The Angry Child | Anger Management | Pain Management and PTSD | Forensic Services | Attention Deficit Hyperactivity Disorder | Vancouver | Burnaby | Coquitlam | New Westminster | Maple Ridge | Port Moody | Child Psychologist | Psychologist | Learning Disability | Assessment | Testing | Psychoeducational Assessment | Neuropsychological Assessment
http://www.relatedminds.com
http://Therapists.PsychologyToday.com/rms/70682
http://www.therapistlocator.net/member?183420
http://www.bcpsychologist.org/users/jimroche
http://www.actcommunity.net/jim-roche.html
I have just added a new pdf to my web page describing my psychoeducational services. Please click here: http://www.relatedminds.com/wp-content/uploads/2011/11/Psychoeducational-Assessment-Burnaby.pdf
Here is the text:
Testing | Psychoeducational Assessments | Neuropsychological Assessments
Psychoeducational Assessments for learning disabilities, school or testing accommodations and IEP support
Neuropsychologcal Assessments and Testing for forensic, legal and workplace purposes
Autism | Developmental Assessments for autism funding and treatment planning (ACT Approved provider)
Comprehensive ADHD (Attention Deficit Hyperactivity Disorder) Assessments and Diagnosis
Psychological, Educational (Psychoeducational), Neuropsychologcal, Developmental Assessments and Testing
Dr. Jim Roche brings his experience as a parent, psychologist, school psychologist, classroom teacher and provincial consultant and teacher trainer on child behaviour, classroom management to to each report, providing a unique and valuable perspective. He has worked with school districts for over 20 years providing assessments, training and consultation in British Columbia, California, New York and Europe. In addition to his training as a school psychologist and registered psychologist he has completed two years of post doctoral work in neuropsychology and training at the University of North Carolina with Dr. Mel Levine. (Minds of All Kinds)
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Psychological and psychoeducational educational assessments are available for children, adolescents and adults. These assessments may be completed to assist with diagnostic questions, help in developing learning, treatment and intervention plans for school, or may be part of a forensic (legal) examination which might be addressing issues such as your ability to work or return to work, drive a car or sign legal documents.
As part of a psychoeducational or clinical assessment I review records, complete a detailed history, administer appropriate test instruments, confer with other members of your health team and then write a comprehensive report focused on developing an appropriate treatment plan or sometimes answering specific questions your doctor or lawyer may have asked.
The base fee for an educational evaluation, usually aimed at obtaining specific accommodations in the educational setting, is $2,400.00 CND This covers the initial evaluation and a post-evaluation meeting to discuss the results with the student and family. A written report will be presented at that meeting and specific interventions are usually addressed at that time. Psychoeducational assessments are available in my Vancouver office (Vancouver, North Vancouver, West Vancouver and Richmond)as well as my Burnaby office (serving Burnaby, New Westminster, Coquitlam, Port Coquitlam, Port Moody and Maple Richmond).
For school purposes a shorter/brief psychoeducational screening can be performed, usually this takes four sessions. From this process we are able to write a letter and give specific rationales for requesting an appropriate evaluation be completed by the school. You should be aware, however, that school districts are taking excessive time in completing their assessments. We can discuss this alternative approach when you come in. I have provided psychoeducational assessments for many lower mainland districts including Burnaby, Vancouver, New Westminster, Coquitlam, Maple Ridge, Surrey, Langley, North Vancouver and West Vancouver. As a former classroom teacher, school psychologist and school behaviour management consultant I offer unique insight into how assessments and test results can be applied in the classroom by the teacher.
In addition to a psychoeducational evaluation being useful for accommodations, it is also often a key component used in developing a long term education plan (IEP or Individual Education Plan) for students. Many programs and supports require a psychoeducational assessment before a student can be considered for assistance. For adults an assessment may lead to a work plan as part of our return to work or coaching program. Attending an IEP meeting at the school or consultating with secondary institutions is done at an hourly rate of $175.00 plus travel and transportation expenses with a minimum of a 1/2 day billing.
Fee’s for a full Functional Behavioral Analysis are approximately $2,200.00 plus expenses related to meetings with the IEP committee or education hearing.
Frequently Asked Questions (FAQs)
Do you test adults?
Yes. Besides seeing children and adolescents for assessment of issues such as problems with academic classwork, on task behaviour, depression, anxiety or worries about a specific learning disabilities I also see adults. This may be for a psychoeducational assessment for college, or for other problems relating to your home or job. Adults are often seen for issues relating to diagnosis of depression, anxiety and often PTSD. Often family doctors want comprehensive assessments and a diagnosis to help made treatment and medication decisions. Sometimes these are work related assessments. I also complete ADHD/ADD assessments and help with follow-up monitoring when patients are receiving medications. Other more comprehensive assessments and testing are often completed relating to ICBC and other work or legal claims. You can read more about those specialized services elsewhere on this website. As with children, adults are seen in both my Vancouver and Burnaby office.
Do you work with college age students?
Yes. I work extensively with students at the post-secondary level. Often this includes psychoeducational testing, educating the student about their strengths and weaknesses, and then developing a plan to address the academic (and sometimes social) problems they are having. Often this includes monthly follow-up and coaching, either in the office or by phone. UBC students often see me in my Vancouver office for psychoeducational assessments and learning advice. SFU students are seen in my Burnaby office, near the SFU famous in Burnaby for psychoeducational assessments.
How long will the evaluation or psychoeducational testing take?
The typical evaluation takes approximately six to eight hours, usually scheduled over two days. Some students may require additional time to complete the testing to fit their work speed and need for breaks, or to gather additional test data to better understand their learning difficulties. Some materials are completed at home. Autism evaluations often require school and home observations as well.
What does the evaluation involve? The psychoeducational evaluation includes a clinical interview, a battery of educational, psychological and cognitive tests to assess a student’s intellectual ability, academic achievement in core areas, (i.e., reading, math, and written language), strengths and weaknesses in processing information, and their emotional state. Often there is also a neuropsychological procedure or examination that requires performing a number of specific tasks.
What happens after the evaluation?
After the psychoeducational evaluation is complete each student is scheduled for an individual feedback session with me (if appropriate). The session typically lasts from one to two hours. In this session I will review the test results, make recommendations for academic accommodations and other support services, and answer any questions. The parents or student may bring anyone to the session. All feedback sessions can be audio taped/recorded so that the student and family can take home a recording of the discussion to listen to again or share with others.
Following the feedback, where appropriate, the student will receive a written report that describes all the tests that were administered and the scores obtained. This report will also document the presence of any disability that warrants academic accommodation and list appropriate accommodations and other recommendations. This report will not be shared with anyone else without the student’s or parent’s written permission.
Team Psychoeducational/Neurodevelopmental Evaluations Most evaluations are completed by myself, a registered psychologist, however, in some situations testing instruments may be administered by one of my clinical assistants. Each of my assistants is either a licensed/registered psychologist or school psychologist who has experience in this field. When appropriate some components of an evaluation are also done by other practitioners where I would like input from a related field of practice. For instance, a speech pathologist may complete part of an examination, or an occupational therapist. The team will then have a consultative meeting, review their results and I will review all records, complete an appropriate history, confer with outside members of your health team and write a comprehensive report focused on developing an appropriate treatment intervention plan. What is a Functional Behavioural Analysis (FBA)?
A Functional Behaviour Analysis is an in-depth observation of a student’s behaviour in the school or home setting. This is a procedure often completed when there are complex questions about emotional or behavioural issues. These are often required by schools when students are classified with moderate or sever behavioural issues, a specific educational coding used by the Ministry of Education to determine placement and funding. They are often part of assessments for autism as well. Fee’s for a full Functional Behavioural Analysis are approximately $2,200.00 plus expenses related to travel, meetings with the IEP committee or attending educational hearings.
Can you do an assessment for autism (ASD)?
Assessments are available for diagnostic purposes relating to Autism, Asperger’s Disorder and related social cognitive deficits. (These assessments include using specific Ministry required tools: the ADOS and ADI-R) These evaluations involve several sessions and the addition of consultation with a speech pathologist and medical doctor for children under six in order to meet the stringent guidelines set forth by the Ministry. Usually the cost of these examinations is $2,600.00
What kind of payments do you accept?
Methods of payment include: Cash, check, or money order. Payments by credit card need to be made on-line and you can contact me directly about that. Payment is expected prior to the actual assessment. Because several hours are scheduled for the assessment, 48 hours notice are necessary if the assessment session is to be cancelled. A 50% per hour fee is charged for cancelled evaluation time when less than 48 hours notice is given. Do you accept insurance? I do not file for insurance payments, but I will provide you with the necessary documentation so that they may file with your insurance carrier after you have made full payment.
What about third party payments (e.g., Department of Rehabilitation Services, WorkSafe BC or Blue Cross)?
The client must supply the psychologist with an official letter (on letterhead), or a voucher from the third party, giving promise of payment and detailed payment information. In most situations payment is expected in full prior to any assessment.
How long does it take to get an appointment? It usually takes three to six weeks to arrange an appointment and begin the assessment process. However, please call, as cancellations can provide a opening sooner. (Dr. Jim Roche @ 778.998-7975).
More information on Dr. Roche and his services can be found below:
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Psychological services (including assessment, testing and therapy) provided in my offices include (covered by most extended health care insurance): ADHD (click here: http://www.relatedminds.com/adhd-attention-deficit-hyperactivity-disorder/)
Anxiety and Stress (click here: http://www.relatedminds.com/anxiety-stress/ )
Autism and Asperger’s Disorder (Click here: http://www.relatedminds.com/autism/)
Individual Counselling (click here: http://www.relatedminds.com/individual-therapy/)
Child Counselling / Therapy (click here: http://www.relatedminds.com/child-therapy/)
Testing and Assessments and Learning Disabilities (Click here: http://www.relatedminds.com/testing/)
Couples Counselling / Therapy (click here: http://www.relatedminds.com/couples-therapy/)
Depression The Angry Child (click here: http://www.relatedminds.com/dealing-with-angry-aggressive-and-explosive-children/)
Anger Management (Click here: http://www.relatedminds.com/anger-management/)
Pain Management and PTSD (Click here: http://www.relatedminds.com/pain/ )
Forensic Services (Independent Medical Examinations or IME)
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About Dr. Roche I am a Registered Psychologist and a Registered Marriage and Family Therapist (RMFT) in British Columbia. In addition to my doctorate in clinical Psychology (The Union of Experimenting Universities), I hold a master’s degree in family therapy from Goddard college, a certificate of advanced graduate studies (CAGS) in school and educational psychology from Norwich University, and have completed two years of post doctoral studies in neuro-psychology at The Fielding Institute in Santa Barbara, California. I am also a certified school psychologist, certified teacher of special education (New York and California), and a Clinical Member of the American Association of Marriage and Family Therapists (AAMFT). Finally, I hold a doctoral degree in law (JD) with an emphasis in medical malpractice and education law. Beyond my academic credentials, I have completed two years of supervised clinical experience in both hospital and community based clinics and two years of post doctoral training in neuropsychology. I have served as director of behaviour programming for several school districts, as a consultant on autism for the province, and have held numerous academic positions including Clinical Instructor in Psychiatry at New York University and Bellevue Hospital in New York as well as being a faculty member at NYU, Brooklyn College, SUNY New Paltz, and Norwich University.
My offices in Burnaby and Vancouver serve Burnaby, Vancouver, Coquitlam, Port Moody, Port Coquitlam, New Westminster and Maple Ridge. Clients often come to my Vancouver office from North Vancouver, West Vancouver and even as far as the Sunshine Coast. For more information on the location of my Burnaby and Vancouver offices, please see my “Office Location” page, which contains a Google map.
Neuropsychologcal Assessments and Testing for forensic, legal and workplace purposes
Autism | Developmental Assessments for autism funding and treatment planning (ACT Approved provider)
Comprehensive ADHD (Attention Deficit Hyperactivity Disorder) Assessments and Diagnosis
Psychological, Educational (Psychoeducational), Neuropsychologcal, Developmental Assessments and Testing
Dr. Jim Roche brings his experience as a parent, psychologist, school psychologist, classroom teacher and provincial consultant and teacher trainer on child behaviour, classroom management to to each report, providing a unique and valuable perspective. He has worked with school districts for over 20 years providing assessments, training and consultation in British Columbia, California, New York and Europe. In addition to his training as a school psychologist and registered psychologist he has completed two years of post doctoral work in neuropsychology and training at the University of North Carolina with Dr. Mel Levine. (Minds of All Kinds)
…………………………………….
Psychological and psychoeducational educational assessments are available for children, adolescents and adults. These assessments may be completed to assist with diagnostic questions, help in developing learning, treatment and intervention plans for school, or may be part of a forensic (legal) examination which might be addressing issues such as your ability to work or return to work, drive a car or sign legal documents.
As part of a psychoeducational or clinical assessment I review records, complete a detailed history, administer appropriate test instruments, confer with other members of your health team and then write a comprehensive report focused on developing an appropriate treatment plan or sometimes answering specific questions your doctor or lawyer may have asked.
The base fee for an educational evaluation, usually aimed at obtaining specific accommodations in the educational setting, is $2,400.00 CND This covers the initial evaluation and a post-evaluation meeting to discuss the results with the student and family. A written report will be presented at that meeting and specific interventions are usually addressed at that time. Psychoeducational assessments are available in my Vancouver office (Vancouver, North Vancouver, West Vancouver and Richmond)as well as my Burnaby office (serving Burnaby, New Westminster, Coquitlam, Port Coquitlam, Port Moody and Maple Richmond).
For school purposes a shorter/brief psychoeducational screening can be performed, usually this takes four sessions. From this process we are able to write a letter and give specific rationales for requesting an appropriate evaluation be completed by the school. You should be aware, however, that school districts are taking excessive time in completing their assessments. We can discuss this alternative approach when you come in. I have provided psychoeducational assessments for many lower mainland districts including Burnaby, Vancouver, New Westminster, Coquitlam, Maple Ridge, Surrey, Langley, North Vancouver and West Vancouver. As a former classroom teacher, school psychologist and school behaviour management consultant I offer unique insight into how assessments and test results can be applied in the classroom by the teacher.
In addition to a psychoeducational evaluation being useful for accommodations, it is also often a key component used in developing a long term education plan (IEP or Individual Education Plan) for students. Many programs and supports require a psychoeducational assessment before a student can be considered for assistance. For adults an assessment may lead to a work plan as part of our return to work or coaching program. Attending an IEP meeting at the school or consultating with secondary institutions is done at an hourly rate of $175.00 plus travel and transportation expenses with a minimum of a 1/2 day billing.
Fee’s for a full Functional Behavioral Analysis are approximately $2,200.00 plus expenses related to meetings with the IEP committee or education hearing.
Frequently Asked Questions (FAQs)
Do you test adults?
Yes. Besides seeing children and adolescents for assessment of issues such as problems with academic classwork, on task behaviour, depression, anxiety or worries about a specific learning disabilities I also see adults. This may be for a psychoeducational assessment for college, or for other problems relating to your home or job. Adults are often seen for issues relating to diagnosis of depression, anxiety and often PTSD. Often family doctors want comprehensive assessments and a diagnosis to help made treatment and medication decisions. Sometimes these are work related assessments. I also complete ADHD/ADD assessments and help with follow-up monitoring when patients are receiving medications. Other more comprehensive assessments and testing are often completed relating to ICBC and other work or legal claims. You can read more about those specialized services elsewhere on this website. As with children, adults are seen in both my Vancouver and Burnaby office.
Do you work with college age students?
Yes. I work extensively with students at the post-secondary level. Often this includes psychoeducational testing, educating the student about their strengths and weaknesses, and then developing a plan to address the academic (and sometimes social) problems they are having. Often this includes monthly follow-up and coaching, either in the office or by phone. UBC students often see me in my Vancouver office for psychoeducational assessments and learning advice. SFU students are seen in my Burnaby office, near the SFU famous in Burnaby for psychoeducational assessments.
How long will the evaluation or psychoeducational testing take?
The typical evaluation takes approximately six to eight hours, usually scheduled over two days. Some students may require additional time to complete the testing to fit their work speed and need for breaks, or to gather additional test data to better understand their learning difficulties. Some materials are completed at home. Autism evaluations often require school and home observations as well.
What does the evaluation involve? The psychoeducational evaluation includes a clinical interview, a battery of educational, psychological and cognitive tests to assess a student’s intellectual ability, academic achievement in core areas, (i.e., reading, math, and written language), strengths and weaknesses in processing information, and their emotional state. Often there is also a neuropsychological procedure or examination that requires performing a number of specific tasks.
What happens after the evaluation?
After the psychoeducational evaluation is complete each student is scheduled for an individual feedback session with me (if appropriate). The session typically lasts from one to two hours. In this session I will review the test results, make recommendations for academic accommodations and other support services, and answer any questions. The parents or student may bring anyone to the session. All feedback sessions can be audio taped/recorded so that the student and family can take home a recording of the discussion to listen to again or share with others.
Following the feedback, where appropriate, the student will receive a written report that describes all the tests that were administered and the scores obtained. This report will also document the presence of any disability that warrants academic accommodation and list appropriate accommodations and other recommendations. This report will not be shared with anyone else without the student’s or parent’s written permission.
Team Psychoeducational/Neurodevelopmental Evaluations Most evaluations are completed by myself, a registered psychologist, however, in some situations testing instruments may be administered by one of my clinical assistants. Each of my assistants is either a licensed/registered psychologist or school psychologist who has experience in this field. When appropriate some components of an evaluation are also done by other practitioners where I would like input from a related field of practice. For instance, a speech pathologist may complete part of an examination, or an occupational therapist. The team will then have a consultative meeting, review their results and I will review all records, complete an appropriate history, confer with outside members of your health team and write a comprehensive report focused on developing an appropriate treatment intervention plan. What is a Functional Behavioural Analysis (FBA)?
A Functional Behaviour Analysis is an in-depth observation of a student’s behaviour in the school or home setting. This is a procedure often completed when there are complex questions about emotional or behavioural issues. These are often required by schools when students are classified with moderate or sever behavioural issues, a specific educational coding used by the Ministry of Education to determine placement and funding. They are often part of assessments for autism as well. Fee’s for a full Functional Behavioural Analysis are approximately $2,200.00 plus expenses related to travel, meetings with the IEP committee or attending educational hearings.
Can you do an assessment for autism (ASD)?
Assessments are available for diagnostic purposes relating to Autism, Asperger’s Disorder and related social cognitive deficits. (These assessments include using specific Ministry required tools: the ADOS and ADI-R) These evaluations involve several sessions and the addition of consultation with a speech pathologist and medical doctor for children under six in order to meet the stringent guidelines set forth by the Ministry. Usually the cost of these examinations is $2,600.00
What kind of payments do you accept?
Methods of payment include: Cash, check, or money order. Payments by credit card need to be made on-line and you can contact me directly about that. Payment is expected prior to the actual assessment. Because several hours are scheduled for the assessment, 48 hours notice are necessary if the assessment session is to be cancelled. A 50% per hour fee is charged for cancelled evaluation time when less than 48 hours notice is given. Do you accept insurance? I do not file for insurance payments, but I will provide you with the necessary documentation so that they may file with your insurance carrier after you have made full payment.
What about third party payments (e.g., Department of Rehabilitation Services, WorkSafe BC or Blue Cross)?
The client must supply the psychologist with an official letter (on letterhead), or a voucher from the third party, giving promise of payment and detailed payment information. In most situations payment is expected in full prior to any assessment.
How long does it take to get an appointment? It usually takes three to six weeks to arrange an appointment and begin the assessment process. However, please call, as cancellations can provide a opening sooner. (Dr. Jim Roche @ 778.998-7975).
More information on Dr. Roche and his services can be found below:
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Psychological services (including assessment, testing and therapy) provided in my offices include (covered by most extended health care insurance): ADHD (click here: http://www.relatedminds.com/adhd-attention-deficit-hyperactivity-disorder/)
Anxiety and Stress (click here: http://www.relatedminds.com/anxiety-stress/ )
Autism and Asperger’s Disorder (Click here: http://www.relatedminds.com/autism/)
Individual Counselling (click here: http://www.relatedminds.com/individual-therapy/)
Child Counselling / Therapy (click here: http://www.relatedminds.com/child-therapy/)
Testing and Assessments and Learning Disabilities (Click here: http://www.relatedminds.com/testing/)
Couples Counselling / Therapy (click here: http://www.relatedminds.com/couples-therapy/)
Depression The Angry Child (click here: http://www.relatedminds.com/dealing-with-angry-aggressive-and-explosive-children/)
Anger Management (Click here: http://www.relatedminds.com/anger-management/)
Pain Management and PTSD (Click here: http://www.relatedminds.com/pain/ )
Forensic Services (Independent Medical Examinations or IME)
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About Dr. Roche I am a Registered Psychologist and a Registered Marriage and Family Therapist (RMFT) in British Columbia. In addition to my doctorate in clinical Psychology (The Union of Experimenting Universities), I hold a master’s degree in family therapy from Goddard college, a certificate of advanced graduate studies (CAGS) in school and educational psychology from Norwich University, and have completed two years of post doctoral studies in neuro-psychology at The Fielding Institute in Santa Barbara, California. I am also a certified school psychologist, certified teacher of special education (New York and California), and a Clinical Member of the American Association of Marriage and Family Therapists (AAMFT). Finally, I hold a doctoral degree in law (JD) with an emphasis in medical malpractice and education law. Beyond my academic credentials, I have completed two years of supervised clinical experience in both hospital and community based clinics and two years of post doctoral training in neuropsychology. I have served as director of behaviour programming for several school districts, as a consultant on autism for the province, and have held numerous academic positions including Clinical Instructor in Psychiatry at New York University and Bellevue Hospital in New York as well as being a faculty member at NYU, Brooklyn College, SUNY New Paltz, and Norwich University.
My offices in Burnaby and Vancouver serve Burnaby, Vancouver, Coquitlam, Port Moody, Port Coquitlam, New Westminster and Maple Ridge. Clients often come to my Vancouver office from North Vancouver, West Vancouver and even as far as the Sunshine Coast. For more information on the location of my Burnaby and Vancouver offices, please see my “Office Location” page, which contains a Google map.
Key Words
ADHD | Anxiety and Stress | Autism and Asperger’s Disorder | Individual Counselling | Child Therapy | Testing and Assessments and Learning Disabilities | Couples Counselling | Depression | The Angry Child | Anger Management | Pain Management and PTSD | Forensic Services | Attention Deficit Hyperactivity Disorder | Vancouver | Burnaby | Coquitlam | New Westminster | Maple Ridge | Port Moody | Child Psychologist | Psychologist | Learning Disability | Assessment | Testing | Psychoeducational Assessment | Neuropsychological Assessment
http://www.relatedminds.com
http://Therapists.PsychologyToday.com/rms/70682
http://www.therapistlocator.net/member?183420
http://www.bcpsychologist.org/users/jimroche
http://www.actcommunity.net/jim-roche.html
Friday, September 23, 2011
HuffPost Get's OCD Story Headline Wrong - As Usual
The Huffington Post get's another story 100% wrong and proves why they (and many other newspapers) are not to be trusted when it comes to science reporting of any kind. Reporting on a recent research paper on the use of Cognitive Behavioural Therapy with OCD with children they head their article, "
Talk Therapy Shows Results For Kids With OCD." Well there is a big difference between the "talk therapy" many parents send their kids to and Cognitive Behavioural Therapy, which this research addressed.
They write, " A new study shows using talk therapy in conjunction with medication can produce better results for treating obsessive-compulsive disorder in children." Simple talk therapy doesn't involve the necessary components of "argumentation," "teaching logical thinking" and "behavioural-exposure-homework" which are the critical elements of Cognitive Behavioural Therapy (CBT) that make it work with OCD. And often kids end up with therapists who have no experience with either CBT or OCD, wasting time and money.
"OCD (Obsessive Compulsive Disorder) can affect up to 1 in 50 kids and teens, according to background research from the study. The anxiety disorder often causes children to become preoccupied with whether something is harmful or dangerous, or with thoughts that something bad may happen. Rituals, or compulsions, are adopted to try to ward these "bad things" off."
Dr. Judith Beck, President of the Beck Institute for Cognitive Behavior Therapy, says, "Cognitive behavioral therapy (CBT) is a time-limited form of psychotherapy used to treat mental disorders...In the context of solving your current problems, you learn skills, such as how to correct your unrealistic or unhelpful thinking and how to modify your behavior to reach your goals."
That's not what usually goes on with a therapist in simple "talk therapy." All therapy is not the same. Now for many issues different forms of therapy have been found effective, often as effective as CBT. But not in this case (with OCD) and not in this research. The research was specific. It's like saying, "Pills found to cure headaches!." While pills? How many? How effective?
Another 2007 study drew similar conclusions about the benefit of CBT for adults with OCD. "Specifically, the data showed that patients receiving any form of Cognitive Behavioral Therapy (CBT) had significantly fewer obsessive-compulsive symptoms post-treatment than subjects receiving treatment as usual." (Reuters)
To sum up, it's CBT in this research. Other forms of therapy may help with other issues, but the research on OCD (Obsessive Compulsive Disorder) is specifically about CBT, and most likely it works because of components of CBT not found in many other forms of therapy.
Headlines matter, because many people only remember the headlines, and others filter everything they read through the headline. This same research was written up in a number of medical journals and webpages, they all noted it was "Behavior Therapy," that was used. As the past 50 years or more of psychology has been a battle between conventional "talk therapy" like analysis ,"Rogerian Counselling, non-directive counselling" and the new "behaviour therapies" it's amazing that a newspaper would headline an article and use the term "talk therapy" - usually meant to describe analysis, Rogerian and other forms of non-directive talk therapy rather than the correct term used in the medical journals, "Behavior Theray" or, in this case, Cognitive Behavioural Therapy." The wrong headline leads parents to seeking the wrong therapy.
For more information about the services I provide my web page can be found at www.relatedminds.com, http://www.relatedminds.com/depression. Other information on my practice can be found at: http://Therapists.Psychologytoday.com/70682, http://www.bcpsychologist.org/users/jimroche, and http://psyris.com/drjimroche
Thursday, September 22, 2011
Assessment and Treatment of Autism in BC
I am often asked for basic information on the assessment and treatment of autism in BC. Here in BC autism assessments need to be completed by a professional with specialized training in two specific assessment tools. First, there is the ADOS ( the Autism Diagnostic Observation System) and second the ADI-R (Autism Diagnostic Inventory-Revised). These two tools are necessary for any child to be assessed here in BC and obtain provincial funding and appropriate school "coding" and supports for a student with autism (ASD0. This also applies for students with what some call "High Functioning Autism" or HFA and Asperger's. Although these names will soon be left behind as we move to a new diagnostic book and category.
If your child is under six years old they need to be assessed by a full team, including a physician, speech pathologist and a psychologist or other professional specially trained to use these specialized autism tools. If your child is older than that a psychologist alone (again, with the appropriate skills) can complete the testing, but always needs an assessment from your paediatrician or family doctor. This is in order to full out other possible causes for the symptoms you are concerned about. While it isn't necessary at this age to include a speech pathologist, it's a good idea if the psychologist isn't familiar with speech and language problems.
Several hospitals and other provincial facilities provide these assessments for free. Why do people go to a private practitioner? Some simply want their own doctor rather than one paid by the government. Some are getting a second opinion. And finally, there is a significant waiting list for the services the province provides.
Often it is appropriate, and really necessary, to also complete a "psychoeducational" assessment. Students with Autism and Asperger's often have co-morbid disorders that need treatment, including school related problems such as learning disabilities, ADHD, anxiety or depression. In most cases, unless such an examination has already taken place, the psychoeducational examination is necessary.
How much should this cost? The cost varies from one autism assessment to another. One child may take a long time completing the tasks that are part of the exam, and another may need several additional tests to get to a learning disability. So it should vary. Costs run, on average, from $1,600-$2,600.00 depending upon how much work is to be done.
My final recommendation is that you always find a professional who has experience with schools, knows how schools work, how teachers react to suggestions and plans. If the professional does't have experience with the classroom they will have a hard time making realistic suggestions for accommodations and supports. They should also have hands on experience in dealing with children with behavioural problems. Don't be afraid to ask. You can find a psychologist with expertise in autism through the British Columbia Psychological Association.
If your child is under six years old they need to be assessed by a full team, including a physician, speech pathologist and a psychologist or other professional specially trained to use these specialized autism tools. If your child is older than that a psychologist alone (again, with the appropriate skills) can complete the testing, but always needs an assessment from your paediatrician or family doctor. This is in order to full out other possible causes for the symptoms you are concerned about. While it isn't necessary at this age to include a speech pathologist, it's a good idea if the psychologist isn't familiar with speech and language problems.
Several hospitals and other provincial facilities provide these assessments for free. Why do people go to a private practitioner? Some simply want their own doctor rather than one paid by the government. Some are getting a second opinion. And finally, there is a significant waiting list for the services the province provides.
Often it is appropriate, and really necessary, to also complete a "psychoeducational" assessment. Students with Autism and Asperger's often have co-morbid disorders that need treatment, including school related problems such as learning disabilities, ADHD, anxiety or depression. In most cases, unless such an examination has already taken place, the psychoeducational examination is necessary.
How much should this cost? The cost varies from one autism assessment to another. One child may take a long time completing the tasks that are part of the exam, and another may need several additional tests to get to a learning disability. So it should vary. Costs run, on average, from $1,600-$2,600.00 depending upon how much work is to be done.
My final recommendation is that you always find a professional who has experience with schools, knows how schools work, how teachers react to suggestions and plans. If the professional does't have experience with the classroom they will have a hard time making realistic suggestions for accommodations and supports. They should also have hands on experience in dealing with children with behavioural problems. Don't be afraid to ask. You can find a psychologist with expertise in autism through the British Columbia Psychological Association.
About Dr. Roche:
Dr. Jim Roche is a Registered Psychologist and a Registered Marriage and Family Therapist with offices in Vancouver and Burnaby, BC. He has been in practice for over 25 years and has served as a Provincial Consultant on Asperger's/Autism/ASD as well as Director of Behaviour Programming for several school districts here in Canada, in New York and California. In addition to being a Registered Psychologist he is a Certified/Licensed Teacher of Special Education and School Psychologist.
Other information about Dr. Roche can be found at: www.relatedminds.com , www.relatedminds.com/adhd, http://Therapists.Psychologytoday.com/70682, www.bcpsychologist.org/users/jimroche, http://psyris.com/drjimroche.
Specific Information about his services for children with autism and Asperger's Disorder can be found at: http://www.relatedminds.com/autism/
Sunday, September 18, 2011
Transitioning to Adulthood with Autism Asperger's Disorder
Transitioning from adolescents to adulthood, for people with autism, is extremely difficult, and that planning needs to start very early. Every week at least one family comes to my office with a teen with autism or Asperger's (ASD) and wants advice on how to prepare their child for living on their own. Let's be frank, parents get older and realize they will not be around to take care of their son or daughter forever, and they want to know what to do. I am sometimes horrified that school districts have done little if any planning for this transition. Sometimes they wait until grade 11 or 12. By then it is difficult to make a transition plan, if not impossible. Some services are available for these students through provincial funding, but time after time even applying for these services has not been planned for. Applications require a recent -within the last two years - psychological assessment, and schools in this province have been taking one, two or even three or more years to provide an initial assessment, never mind a follow-up assessment of their students. Parents are then forced to fund these assessments themselves. For any child that comes in to my office I ask his or her parents, "What do you think Mike will be doing when he's 25?" Sometimes their is a clear plan, one with a bright future, their child working, living independently and ...paying taxes! Sometimes parents break down and are overwhelmed by their stress about what to do. Aspeger's, high functioning autism, autism and related social cognitive disorders require one thing more than anything else: A plan.
Parent's of children with autism often bring in a 3 ring binder which has a picture of their child on it, and inside are stories, photos, all the testing and treatment information, work samples and so on. They use this to present their child to others in a positive way that makes them consider them as more than a disorder, coding and problem, but instead as a real person with interests, skills, and a story.
I sometimes suggest they start a second book with their child...one about the future. With drawings about where they might live some day, what they will do, who they will know and what life will be like. There's a Dr. Seuss book like thins called, " The Places we will go." So, start a "Future Book" or "Planning Book" with your child.
Today's blog started because of a great article in the New York Times about just this situation. It's about a young man transitioning out of high school in a great supportive transition/training program. (A program you should pay attention to: This is the minimal quality of support you should expect for YOUR child with autism or Asperger's Disorder - minimal! Maybe you should suggest his or her teachers read this.)
Here is how it starts, "People with autism, whose unusual behaviors are believed to stem from variations in early brain development, typically disappear from public view after they leave school. As few as one in 10 hold even part-time jobs. Some live in state-supported group homes; even those who attend college often end up unemployed and isolated, living with parents.
But Justin is among the first generation of autistic youths who have benefited throughout childhood from more effective therapies and hard-won educational opportunities. And Ms. Stanton-Paule’s program here is based on the somewhat radical premise that with intensive coaching in the workplace and community — and some stretching by others to include them — students like Justin can achieve a level of lifelong independence that has eluded their predecessors." Here is the link:
http://www.nytimes.com/2011/09/18/us/autistic-and-seeking-a-place-in-an-adult-world.html
Great article, great video. A lot to think about. For those looking for some materials to look at right now bout adults with autism and Asperger's Disorder I suggest going to Michelle Garcia Winner's web page, "Socialthinking.com" You'll find a lot of great support material there, most of what I use in my practice, and a lot of what local school districts use, comes from Michelle's hands.
Two good books:
Socially Curious and Curiously Social: A Social Thinking Guidebook for Bright Teenagers and Young Adults by Michelle Garcia Winner
Social Thinking at Work: A Guidebook for Understanding and Navigating the Social Complexities of the Workplace. Also by Mitchell.
I hope you find the article helpful.
About Dr. Roche:
Dr. Jim Roche is a Registered Psychologist and a Registered Marriage and Family Therapist with offices in Vancouver and Burnaby, BC. He has been in practice for over 25 years and has served as a Provincial Consultant on Asperger's/Autism/ASD as well as Director of Behaviour Programming for several school districts here in Canada, in New York and California. In addition to being a Registered Psychologist he is a Certified/Licensed Teacher of Special Education and School Psychologist.
Other information about Dr. Roche can be found at: www.relatedminds.com , www.relatedminds.com/adhd, http://Therapists.Psychologytoday.com/70682, www.bcpsychologist.org/users/jimroche, http://psyris.com/drjimroche.
Specific Information about his services for children with autism and Asperger's Disorder can be found at: http://www.relatedminds.com/autism/
Wednesday, September 14, 2011
Helping Your Child Face Fears and Anxiety: Exposure Therapy.
One of the most basic therapeutic interventions we use in dealing with Anxiety (stress, fears and phobias) is Exposure Therapy. It's also one of the most complicated ones, and one that can go wrong easily. Children with Aspeger's Disorder, autism (ASD), ADHD and other related disorders relating to anxiety need, eventually, to "face their fears" and become exposed to what scares them. The complication with children who have Asperger's and autism is that some of the normal responses we would expect during exposure don't happen. These children have difficulty switching mental sets...transitioning from one mental or emotional state to another- and some of their anxiety is more related to neurological causes that need careful intervention. (A good resource for help with issues such as sensory issues would be your school's Ot or Occupational Therapist.)
Still, there are two good resources I can recommend on this topic, both are provided by the BC government.
1) AnxietyBC has an excellent handout, downloadable and free, that is part of their overall Anxiety Program for children. You'll find this at their website: AnxietyBC. The name of this handout is "Helping Your Child Face Fears: Behavioural Exposure. Thi set of materials helps you develop an understanding of fears and anxiety that your child suffers from, and helps you develop a clear program for address it. This includes building a "Fear Ladder," telling you how to appropriately reward brave behaviour, and how to do "exposure" and "Face Their Fears." Over and over they give you an important piece of advice: Don't Rush, Practice, Set Goals.
2) AnxietyBC also has a couple of excellent videos that walk you through the process, actually demonstrating these techniques. I'd recommend watching the DVD "Separation Anxiety" and the DVD on Obsessive Compulsive Disorder." I'd watch both of these because the more exposure to use of these techniques you have, the greater your chances you will do them correctly. And the more information, knowledge and practice you have the less anxiety you will have yourself. And nothing is more important than doing this in a relaxed manner. There is a third excellent DVD for adults: Effectively Managing Panic Disorder: A Self Help Guide that might also help you understand the process.
All of these DVDs are available through AnxietyBC, and most can be found at the public library. Remember, you can go on-line and reserve a DVD (or book) and as soon as it is available the library will email you and you can pick it up at any branch. If your anxious about doing this, just drop in to your local library and ask for a demonstration or walk-through.
While there are other programs and materials that I suggest and use in my practice with children and adolescents with Anxiety and Stress issues, especially children with Asperger's Disorder, autism (ASD) and related problems, these are great materials to start with. If your going to help your child with Anxiety, you need to become an Anxiety expert. This is possible with these types of supports.
Still, there are two good resources I can recommend on this topic, both are provided by the BC government.
1) AnxietyBC has an excellent handout, downloadable and free, that is part of their overall Anxiety Program for children. You'll find this at their website: AnxietyBC. The name of this handout is "Helping Your Child Face Fears: Behavioural Exposure. Thi set of materials helps you develop an understanding of fears and anxiety that your child suffers from, and helps you develop a clear program for address it. This includes building a "Fear Ladder," telling you how to appropriately reward brave behaviour, and how to do "exposure" and "Face Their Fears." Over and over they give you an important piece of advice: Don't Rush, Practice, Set Goals.
2) AnxietyBC also has a couple of excellent videos that walk you through the process, actually demonstrating these techniques. I'd recommend watching the DVD "Separation Anxiety" and the DVD on Obsessive Compulsive Disorder." I'd watch both of these because the more exposure to use of these techniques you have, the greater your chances you will do them correctly. And the more information, knowledge and practice you have the less anxiety you will have yourself. And nothing is more important than doing this in a relaxed manner. There is a third excellent DVD for adults: Effectively Managing Panic Disorder: A Self Help Guide that might also help you understand the process.
All of these DVDs are available through AnxietyBC, and most can be found at the public library. Remember, you can go on-line and reserve a DVD (or book) and as soon as it is available the library will email you and you can pick it up at any branch. If your anxious about doing this, just drop in to your local library and ask for a demonstration or walk-through.
While there are other programs and materials that I suggest and use in my practice with children and adolescents with Anxiety and Stress issues, especially children with Asperger's Disorder, autism (ASD) and related problems, these are great materials to start with. If your going to help your child with Anxiety, you need to become an Anxiety expert. This is possible with these types of supports.
About Dr. Roche:
Dr. Jim Roche is a Registered Psychologist and a Registered Marriage and Family Therapist with offices in Vancouver and Burnaby, BC. He has been in practice for over 25 years and has served as a Provincial Consultant on Asperger's/Autism/ASD as well as Director of Behaviour Programming for several school districts here in Canada, in New York and California. In addition to being a Registered Psychologist he is a Certified/Licensed Teacher of Special Education and School Psychologist.
Other information about Dr. Roche can be found at: <a href="http://relatedmnds.com">www.relatedminds.com</a> or <a href="http://www.relatedminds.com/adhd">www.relatedminds.com/adhd</a>. Other information on my practice can be found at: <a href="http://Therapists.Psychologytoday.com/70682">http://Therapists.Psychologytoday.com/70682</a>, http://www.bcpsychologist.org/users/jimroche or <a href="http://psyris.com/drjimroche">http://psyris.com/drjimroche</a>.
Specific Information about his services for children with autism and Asperger's Disorder can be found at: http://www.relatedminds.com/autism/
Tuesday, September 6, 2011
Poorer movement skills at seven months in children at risk of autism, study finds
Dr. Jim Roche
Poorer movement skills at seven months in children at risk of autism, study finds
Poorer movement skills detected as early as 7 months old are observed in children at a higher risk of developing Autistic Spectrum Disorder (ASD) than children in the general population. These are the findings of a study being presented on 7th September 2011 at the British Psychological Society's Developmental Section Conference
in Newcastle.Saturday, August 13, 2011
Autism and Relaxation for Stress and Anxiety
For more information on the services I provide for individuals with autism spectrum disorder (ASD) and Aspergers please visit my web page at http://www.relatedminds.com
Click here: http://www.autismoutreach.ca/elearning/environmental-issues/relaxation-strategies
This is an excellent video by Jacquie Bezo, an Educational and Behavioural Consultant with POPARD. in the video she discusses some of the challenges individuals with ASD may face in the area of stress & coping. She provides both concrete and abstract methods of relaxation to deal with stress and anxiety with children with Autism Spectrum Disorder (ASD) or Aspergers. For parents with children with autism (ASD) or Aspergers in the school system will find this a valuable video as it presents several skills that should be part of any child's IEP (Individual Education Plan). It a nice, simple and show learning lesson.
Dr. Jim Roche
Registered Psychologist
Click here: http://www.autismoutreach.ca/elearning/environmental-issues/relaxation-strategies
This is an excellent video by Jacquie Bezo, an Educational and Behavioural Consultant with POPARD. in the video she discusses some of the challenges individuals with ASD may face in the area of stress & coping. She provides both concrete and abstract methods of relaxation to deal with stress and anxiety with children with Autism Spectrum Disorder (ASD) or Aspergers. For parents with children with autism (ASD) or Aspergers in the school system will find this a valuable video as it presents several skills that should be part of any child's IEP (Individual Education Plan). It a nice, simple and show learning lesson.
Dr. Jim Roche
Registered Psychologist
Thursday, August 11, 2011
Raising awareness of adult autism | BPS
Raising awareness of adult autism | BPS
Autism Spectrum Disorder (ASD) and Asperger's Disorder are lifelong conditions that in the UK alone affects over 500,000 people. In the UK there are a number of current government sponsored initiatives to raise awareness of adult autism and Asperger's. Often ASD is overlooked when adults are seen in mental health facilities, and many medical practitioners are unaware and untrained to administer tests and measures that effectively diagnose these conditions. While most professionals know something about autism, they do not necessarily understand how autism affects people, and these effects are what really matter in day to day living.
The British Psychological Society has developed a series of e-learning modules to raise awareness of adult autism. These are delivered through their BPS Learning Centre, the modules appeal to a range of learners, including members of the public. The modules concentrate on raising awareness, delivering knowledge and understanding from introductory to specialist levels. These are excellent training programs to start with, especially when it comes to adult autism, as there are so few good recourses out there. The link to the British Psychological Society site is above.
The three e-learning modules are:
• Building awareness of adult autism
• Supporting adults with autism (coming soon)
• Working with adults with autism (suitable for Practitioner Psychologists and other professionals) (coming soon)
If you are in need of assessment, diagnosis and treatment for autism and its effects on adults in the home, in relationships or in the work place, please feel free to contact me.
Dr. Jim Roche, Registered Psychologist
RelatedMinds Educational Services
www.relatedminds.com
Autism Spectrum Disorder (ASD) and Asperger's Disorder are lifelong conditions that in the UK alone affects over 500,000 people. In the UK there are a number of current government sponsored initiatives to raise awareness of adult autism and Asperger's. Often ASD is overlooked when adults are seen in mental health facilities, and many medical practitioners are unaware and untrained to administer tests and measures that effectively diagnose these conditions. While most professionals know something about autism, they do not necessarily understand how autism affects people, and these effects are what really matter in day to day living.
The British Psychological Society has developed a series of e-learning modules to raise awareness of adult autism. These are delivered through their BPS Learning Centre, the modules appeal to a range of learners, including members of the public. The modules concentrate on raising awareness, delivering knowledge and understanding from introductory to specialist levels. These are excellent training programs to start with, especially when it comes to adult autism, as there are so few good recourses out there. The link to the British Psychological Society site is above.
The three e-learning modules are:
• Building awareness of adult autism
• Supporting adults with autism (coming soon)
• Working with adults with autism (suitable for Practitioner Psychologists and other professionals) (coming soon)
If you are in need of assessment, diagnosis and treatment for autism and its effects on adults in the home, in relationships or in the work place, please feel free to contact me.
Dr. Jim Roche, Registered Psychologist
RelatedMinds Educational Services
www.relatedminds.com
Wednesday, August 10, 2011
Study finds new ADHD genes, links susceptibility with autism and other neuropsychiatric conditions
Study finds new ADHD genes, links susceptibility with autism and other neuropsychiatric conditions
New research led by The Hospital for Sick Children (SickKids) and the University of Toronto has identified more genes in attention deficit hyperactivity disorder (ADHD) and shows that there is an overlap between some of these genes and those found in other neuropsychiatric conditions such as autism spectrum disorder (ASD). The scientists used microarrays (gene-chip technology) to study the DNA of 248 unrelated patients with ADHD. They specifically searched for copy number variants (CNVs), which are insertions or deletions affecting the genes. In three of 173 children for whom the DNA of both parents was available, they found spontaneous CNVs, which occur when the parents are not affected and mutations are new to the child. Rare CNVs that were inherited from affected parents were found in 19 of 248 patients.
Within the group of inherited CNVs, the researchers found some of the genes that had previously been identified in other neuropsychiatric conditions including ASD. To explore this overlap, they tested a different group for CNVs. They found that nine of the 349 children in the study, all of whom had previously been diagnosed with ASD, carried CNVs that are related to ADHD and other disorders. The findings suggest that some CNVs, which play a causal role in ADHD, demonstrate common susceptibility genes in ADHD, ASD and other neuropsychiatric disorders.
"For the first time, we've tested these genetic alterations in ADHD and have a pretty good handle on a couple of decent ADHD candidate genes," says Scherer, who is also Professor in the Department of Molecular Genetics at the University of Toronto and GlaxoSmithKline Chair in Genome Sciences at SickKids. "This is critical, as it gives us confidence in interpreting our results."
ADHD is a common neuropsychiatric disorder that affects four per cent of school-age children worldwide. It is associated with inattention, hyperactivity and impulsiveness that often results in learning difficulties, social problems and underachievement. ASDs are diagnosed in roughly one in 100 children in North America and cause deficits in communication, social understanding and behaviour.
For more information on this study visit the above webpage. For information on services for children, adolescents and adults with autism spectrum disorder (ASD) please visit my website at http://www.relatedminds.com
New research led by The Hospital for Sick Children (SickKids) and the University of Toronto has identified more genes in attention deficit hyperactivity disorder (ADHD) and shows that there is an overlap between some of these genes and those found in other neuropsychiatric conditions such as autism spectrum disorder (ASD). The scientists used microarrays (gene-chip technology) to study the DNA of 248 unrelated patients with ADHD. They specifically searched for copy number variants (CNVs), which are insertions or deletions affecting the genes. In three of 173 children for whom the DNA of both parents was available, they found spontaneous CNVs, which occur when the parents are not affected and mutations are new to the child. Rare CNVs that were inherited from affected parents were found in 19 of 248 patients.
Within the group of inherited CNVs, the researchers found some of the genes that had previously been identified in other neuropsychiatric conditions including ASD. To explore this overlap, they tested a different group for CNVs. They found that nine of the 349 children in the study, all of whom had previously been diagnosed with ASD, carried CNVs that are related to ADHD and other disorders. The findings suggest that some CNVs, which play a causal role in ADHD, demonstrate common susceptibility genes in ADHD, ASD and other neuropsychiatric disorders.
"For the first time, we've tested these genetic alterations in ADHD and have a pretty good handle on a couple of decent ADHD candidate genes," says Scherer, who is also Professor in the Department of Molecular Genetics at the University of Toronto and GlaxoSmithKline Chair in Genome Sciences at SickKids. "This is critical, as it gives us confidence in interpreting our results."
ADHD is a common neuropsychiatric disorder that affects four per cent of school-age children worldwide. It is associated with inattention, hyperactivity and impulsiveness that often results in learning difficulties, social problems and underachievement. ASDs are diagnosed in roughly one in 100 children in North America and cause deficits in communication, social understanding and behaviour.
For more information on this study visit the above webpage. For information on services for children, adolescents and adults with autism spectrum disorder (ASD) please visit my website at http://www.relatedminds.com
Monday, July 18, 2011
Social Skills classes are not the answer for students with ASD
For information on assessment and treatment programs offered by Dr. Jim Roche, a Registered Psychologist in British Columbia, please see his web page at www.relatedmindsbc.com or www.relatedmindsbc.com/autism.
Again a school district wanted to know about social skills training for kids with ASD (actually, Asperger's Disorder or high functioning autism as some people would call it).This request came three minutes after writing an email to another school psychologist who wanted to know about social skills evaluation programs for students with ASD. I suspect that both these programs are being managed by someone with little or no experience in autism, or any real theoretical background for that matter. Suggesting that ASD students, students on the autism spectrum, need social skills training is clearly a sign they are lost in the mae of terminology or don't understand the nature of ASD.
Sure, kids with ASD (autism) have some strange social skills at times. They come across in a strange way, and this deficit causes problems between them and staff, other students and even their friends. But the issue isn't one of social skills. A social skills program (like Skills Streaming by Research press, a GREAT social skills program) simply doesn't address their deficit. These students with autism have a deficit of perspective taking. Their problem is seeing things from the other persons point of view. It's a deficit of social reciprocity.
all the social skills training in the world will not teach your child reciprocity and perspective taking. Often, when working with teens with ASD I get, " Yeah, but it really doesn't matter....I did the right thing" as an answer to why they did some behaviour, said some statement or behaved a certain way in spite of what the social results were.
I'll just give the the bluntest situation, and one that I hear about a lot. A student passes gas, farts, in class. Then when another student makes a comment he gets in a prolonged argument. " It's a natural process..." "I had to do it, everyone does, it's natural." Because of the student's rigidity of thinking and inability to accept the viewpoint of others he ends up socially isolated and often picked on. Social skills training is NOT what this student needs.
Working from the perspective of "social learning" we address this student's deficit in social reciprocity, in perspective taking. The student needs to understand that his actions cause people to react a certain way, and from observing others we learn to understand how we are doing - socially. Mitchell Winner has a program called "social behaviour mapping" in which we engage the student in a process of understanding how others feels and respond by asking new questions. One set of formal questions we ask is: "Was that an expected behaviour, or unexpected?" Unexpected behaviours make people anxious, nervous and want to avoid you. Expected behaviours are more familiar, and we don't avoid those.
Sometimes other processes are used, such as social stories, drawings, mapping out the situation visually. This method of intervention addresses the key deficit that is causing the child difficulty: a lack of social understanding. In a social skills class you are unlikely going to get a student to engage in the social behaviour you want because it simply doesn't make sense to them. Often they already know the proper social skill, and make the choice not to engage in it because it makes no sense to them. Out job is to teach this skill of social reciprocity.
If your school is trying to put your child with ASD (autism, Asperger's Disorder of NVLD) into a "social skills" group they are setting your child up for more social failure because they are not addressing the real issue. Perhaps they understand and are using the wrong terms? If that's so, make sure and correct them. I also don't want people thinking that children with ASD simply lack social skills .... that often leads to a rejecting and punitive environment. Check out what your school is up to. And for more information feel free to contact me, or look up the work of Mitchell Winner on the web.
Again a school district wanted to know about social skills training for kids with ASD (actually, Asperger's Disorder or high functioning autism as some people would call it).This request came three minutes after writing an email to another school psychologist who wanted to know about social skills evaluation programs for students with ASD. I suspect that both these programs are being managed by someone with little or no experience in autism, or any real theoretical background for that matter. Suggesting that ASD students, students on the autism spectrum, need social skills training is clearly a sign they are lost in the mae of terminology or don't understand the nature of ASD.
Sure, kids with ASD (autism) have some strange social skills at times. They come across in a strange way, and this deficit causes problems between them and staff, other students and even their friends. But the issue isn't one of social skills. A social skills program (like Skills Streaming by Research press, a GREAT social skills program) simply doesn't address their deficit. These students with autism have a deficit of perspective taking. Their problem is seeing things from the other persons point of view. It's a deficit of social reciprocity.
all the social skills training in the world will not teach your child reciprocity and perspective taking. Often, when working with teens with ASD I get, " Yeah, but it really doesn't matter....I did the right thing" as an answer to why they did some behaviour, said some statement or behaved a certain way in spite of what the social results were.
I'll just give the the bluntest situation, and one that I hear about a lot. A student passes gas, farts, in class. Then when another student makes a comment he gets in a prolonged argument. " It's a natural process..." "I had to do it, everyone does, it's natural." Because of the student's rigidity of thinking and inability to accept the viewpoint of others he ends up socially isolated and often picked on. Social skills training is NOT what this student needs.
Working from the perspective of "social learning" we address this student's deficit in social reciprocity, in perspective taking. The student needs to understand that his actions cause people to react a certain way, and from observing others we learn to understand how we are doing - socially. Mitchell Winner has a program called "social behaviour mapping" in which we engage the student in a process of understanding how others feels and respond by asking new questions. One set of formal questions we ask is: "Was that an expected behaviour, or unexpected?" Unexpected behaviours make people anxious, nervous and want to avoid you. Expected behaviours are more familiar, and we don't avoid those.
Sometimes other processes are used, such as social stories, drawings, mapping out the situation visually. This method of intervention addresses the key deficit that is causing the child difficulty: a lack of social understanding. In a social skills class you are unlikely going to get a student to engage in the social behaviour you want because it simply doesn't make sense to them. Often they already know the proper social skill, and make the choice not to engage in it because it makes no sense to them. Out job is to teach this skill of social reciprocity.
If your school is trying to put your child with ASD (autism, Asperger's Disorder of NVLD) into a "social skills" group they are setting your child up for more social failure because they are not addressing the real issue. Perhaps they understand and are using the wrong terms? If that's so, make sure and correct them. I also don't want people thinking that children with ASD simply lack social skills .... that often leads to a rejecting and punitive environment. Check out what your school is up to. And for more information feel free to contact me, or look up the work of Mitchell Winner on the web.
Tuesday, July 5, 2011
New Research: Environmental Factors found in Autism
Click here to read the New York Times article: http://www.nytimes.com/2011/07/05/health/research/05autism.html
For more details from the original article, click here: http://archpsyc.ama-assn.org/cgi/content/full/archgenpsychiatry.2011.76
A new study implicates environmental factors in the cause of autism (ASD, Asperger's and related disorders). By "environmental factors" they mean conditions for the fetus while in the womb. These conditions, the researchers say, are as at least as important as overall genetic factors.
Researchers say that, "This is a very significant study because it confirms that genetic factors are involved in the cause of the disorder....but it shirts the focus to the possibility that environmental factors could also be really important."
This was a twin study. 192 pairs of identical twins were drawn from California data bases. At least one twin in each pair had the classic form of autism, extreme social withdrawal, communications problems and repetitive behaviours. Identical twins share 100 percent of their genes. The study found that autism occurred in both children 77 percent of the time when they were males and 36 percent with females. Mathematical models suggest only 38 percent of the cases could be attributed to genetic factors, compared with 90 percent from previous studies. Even more surprising, shared environmental factors appeared to be at work in 58 percent of the cases.
The rate of autism occurring in siblings who are not twins is much lower, suggesting that the conditions the twins shared in the womb, rather than what they were exposed to after birth ( vaccines... again show not to be a cause) contributed to the development of autism.
There was a second study that showed an elevated risk of autism in children whose mothers took a popular type of antidepressant during the year before delivery. The authors assure mothers that the risk is still very low. Speak with your doctor directly if you have concerns.
These two articles are considered "game changers" and will redirect studies to what is going on in terms of prenatal and perinatal factors with respect to autism susceptibility.
As the "fear factor" of the anti-science and conspiracy crowd around individuals like Jenny McCarthy and the former Dr. Wakefield (see :http://www.sciencebasedmedicine.org/index.php/anti-vaccine-warriors-vs-research-ethics/) lose their credibility with the public, more important and actual science based research can now become the focus of the publics attention. There may be environmental factors, but they are not what we have been told. We urgently need to refocus research efforts and monies, but this time lets let scientist guide the direction of the inquiry rather than a former model, a movie comedian and a defrocked MD.
For information on autism treatment your welcome to view my web page at: http://www.relatedmindsbc.com/autism or at http://www.relatedmindsbc.com/ General information about my practice can be found at: http://www.bcpsychologist.org/users/jimroche or at http://Therapists.Psychologytoday.com/70682
For more details from the original article, click here: http://archpsyc.ama-assn.org/cgi/content/full/archgenpsychiatry.2011.76
A new study implicates environmental factors in the cause of autism (ASD, Asperger's and related disorders). By "environmental factors" they mean conditions for the fetus while in the womb. These conditions, the researchers say, are as at least as important as overall genetic factors.
Researchers say that, "This is a very significant study because it confirms that genetic factors are involved in the cause of the disorder....but it shirts the focus to the possibility that environmental factors could also be really important."
This was a twin study. 192 pairs of identical twins were drawn from California data bases. At least one twin in each pair had the classic form of autism, extreme social withdrawal, communications problems and repetitive behaviours. Identical twins share 100 percent of their genes. The study found that autism occurred in both children 77 percent of the time when they were males and 36 percent with females. Mathematical models suggest only 38 percent of the cases could be attributed to genetic factors, compared with 90 percent from previous studies. Even more surprising, shared environmental factors appeared to be at work in 58 percent of the cases.
The rate of autism occurring in siblings who are not twins is much lower, suggesting that the conditions the twins shared in the womb, rather than what they were exposed to after birth ( vaccines... again show not to be a cause) contributed to the development of autism.
There was a second study that showed an elevated risk of autism in children whose mothers took a popular type of antidepressant during the year before delivery. The authors assure mothers that the risk is still very low. Speak with your doctor directly if you have concerns.
These two articles are considered "game changers" and will redirect studies to what is going on in terms of prenatal and perinatal factors with respect to autism susceptibility.
As the "fear factor" of the anti-science and conspiracy crowd around individuals like Jenny McCarthy and the former Dr. Wakefield (see :http://www.sciencebasedmedicine.org/index.php/anti-vaccine-warriors-vs-research-ethics/) lose their credibility with the public, more important and actual science based research can now become the focus of the publics attention. There may be environmental factors, but they are not what we have been told. We urgently need to refocus research efforts and monies, but this time lets let scientist guide the direction of the inquiry rather than a former model, a movie comedian and a defrocked MD.
For information on autism treatment your welcome to view my web page at: http://www.relatedmindsbc.com/autism or at http://www.relatedmindsbc.com/ General information about my practice can be found at: http://www.bcpsychologist.org/users/jimroche or at http://Therapists.Psychologytoday.com/70682
Sunday, July 3, 2011
Teaching Autistic Teens To Make Friends
Teaching Autistic Teens To Make Friends
Can the skills of making friends really be taught? The answer seems to be yes. In a study appearing in the April edition of the Journal of Autism and Developmental Disorders, UCLA clinical instructor of psychiatry Elizabeth Laugeson and colleagues report that in comparison with a control group, the treatment group taking the class significantly improved their overall social skills and interactions with their peers. "Although, typically, developing teens often learn basic social rules through observation of peer behavior and specific instruction from parents," Laugeson said, "adolescents with autism spectrum disorders often require further instruction. You can read more about this study by clicking above.
"It's hard enough to be a teenager," she said, "but it's harder still for adolescents with autism because they typically lack the ability to pick up on all the social cues most of us take for granted — things like body language, hand gestures and facial expressions, along with speech inflections like warmth, sarcasm or hostility. "Lack of these basic social skills may lead to rejection, isolation or bullying from their peers. And sadly, that isolation can carry into their adult life."
Many of these skills need to be directly taught. Preferably in a group context where teens with autism spectrum disorder / Aspergers can practice and observe others practicing these skills (and do it in a protected environment) or individually. If the teen needs to work on these skills one-to-one because there are no groups or they have difficulty working in a group, there is still that option. If, however, individual training is used it is critical that parents become involved in knowing what skills are being taught, how they are cued, and how they can help with homework...using these new skills in a wide variety of environments. That's how they become part of your child's daily lives.
In this group study Laugeson and her colleagues developed a social skills class called PEERS (Program for the Education and Enrichment of Relational Skills), to give high-functioning teens with ASD a set of specific social skills. In it they worked on issues such as: "How do you have a successful get-together with someone? How do you go up to a group of teens and join their conversation? What do you say as a comeback when someone teases you? Without these core social skills, it becomes very difficult for teenagers to make and keep friends."
In the study, 33 teens with ASD — 28 males and five females — attended the PEERS classes. All the participants had a previous diagnosis of high-functioning autism, Asperger's Disorder or Pervasive Developmental Disorder–Not Otherwise Specified (PDD-NOS). The teens met once a week for 12 weeks; each session lasted 90 minutes. Instruction was conducted in a small-group format, with seven to 10 teens, using established strategies for teaching social skills to adolescents with ASD. How could you get a class like this going in your school? First, contact the school's support teacher. If that doesn't work, go to the principal. Failing there many lower mainland districts have ASD or "Autism Teams." Ultimately, if your school doesn't have the skills or ability to put together such a program you should ask for a consultation with the "POPARD Partner," this is the individual who works with the Provincial Outreach Program for Autism and Related Disorders (POPARD). They often provide training, support and consultation to schools and individual teachers in developing these "social learning" groups. Here in BC we are more likely to call such a group a "social learning" group as the issue at hand isn't simply not knowing a specific social skill (although our student most likely doesn't), instead it's a matter of understanding the nature of social reciprocity. The give and take of language and communication involving emotion and meaning. (See books by Michelle Winner on "Social Learning" through my website at http://www.relatedminds.com/autism or directly through Amazon.ca
As part of the study this article is about parents were required to attend separate, concurrent sessions where they were provided direct instruction and guidance to support their child's development. Honestly, if someone is treating your child for deficits in social awareness and not seeing you on a regular basis to review and teach skills...something is missing in the program.
"Parental involvement was mandatory and important," said Laugeson, associate director of the UCLA Parenting and Children's Friendship Program and director of the Help Group–UCLA Autism Research Alliance. "Other research has shown us that parent involvement can have significant positive effects upon children's friendships, both in terms of direct instruction and supervision, as well as supporting a child's development of an appropriate peer network."
Please, take a moment to read the article. One of the problems in the field of autism/ASD/Aspergers is that we really don't have solid research proving that what we do brings about change. Often it is obvious to those doing the work, but it's good to see some basic science going on to back up our day to day practice in the field.
Can the skills of making friends really be taught? The answer seems to be yes. In a study appearing in the April edition of the Journal of Autism and Developmental Disorders, UCLA clinical instructor of psychiatry Elizabeth Laugeson and colleagues report that in comparison with a control group, the treatment group taking the class significantly improved their overall social skills and interactions with their peers. "Although, typically, developing teens often learn basic social rules through observation of peer behavior and specific instruction from parents," Laugeson said, "adolescents with autism spectrum disorders often require further instruction. You can read more about this study by clicking above.
"It's hard enough to be a teenager," she said, "but it's harder still for adolescents with autism because they typically lack the ability to pick up on all the social cues most of us take for granted — things like body language, hand gestures and facial expressions, along with speech inflections like warmth, sarcasm or hostility. "Lack of these basic social skills may lead to rejection, isolation or bullying from their peers. And sadly, that isolation can carry into their adult life."
Many of these skills need to be directly taught. Preferably in a group context where teens with autism spectrum disorder / Aspergers can practice and observe others practicing these skills (and do it in a protected environment) or individually. If the teen needs to work on these skills one-to-one because there are no groups or they have difficulty working in a group, there is still that option. If, however, individual training is used it is critical that parents become involved in knowing what skills are being taught, how they are cued, and how they can help with homework...using these new skills in a wide variety of environments. That's how they become part of your child's daily lives.
In this group study Laugeson and her colleagues developed a social skills class called PEERS (Program for the Education and Enrichment of Relational Skills), to give high-functioning teens with ASD a set of specific social skills. In it they worked on issues such as: "How do you have a successful get-together with someone? How do you go up to a group of teens and join their conversation? What do you say as a comeback when someone teases you? Without these core social skills, it becomes very difficult for teenagers to make and keep friends."
In the study, 33 teens with ASD — 28 males and five females — attended the PEERS classes. All the participants had a previous diagnosis of high-functioning autism, Asperger's Disorder or Pervasive Developmental Disorder–Not Otherwise Specified (PDD-NOS). The teens met once a week for 12 weeks; each session lasted 90 minutes. Instruction was conducted in a small-group format, with seven to 10 teens, using established strategies for teaching social skills to adolescents with ASD. How could you get a class like this going in your school? First, contact the school's support teacher. If that doesn't work, go to the principal. Failing there many lower mainland districts have ASD or "Autism Teams." Ultimately, if your school doesn't have the skills or ability to put together such a program you should ask for a consultation with the "POPARD Partner," this is the individual who works with the Provincial Outreach Program for Autism and Related Disorders (POPARD). They often provide training, support and consultation to schools and individual teachers in developing these "social learning" groups. Here in BC we are more likely to call such a group a "social learning" group as the issue at hand isn't simply not knowing a specific social skill (although our student most likely doesn't), instead it's a matter of understanding the nature of social reciprocity. The give and take of language and communication involving emotion and meaning. (See books by Michelle Winner on "Social Learning" through my website at http://www.relatedminds.com/autism or directly through Amazon.ca
As part of the study this article is about parents were required to attend separate, concurrent sessions where they were provided direct instruction and guidance to support their child's development. Honestly, if someone is treating your child for deficits in social awareness and not seeing you on a regular basis to review and teach skills...something is missing in the program.
"Parental involvement was mandatory and important," said Laugeson, associate director of the UCLA Parenting and Children's Friendship Program and director of the Help Group–UCLA Autism Research Alliance. "Other research has shown us that parent involvement can have significant positive effects upon children's friendships, both in terms of direct instruction and supervision, as well as supporting a child's development of an appropriate peer network."
Please, take a moment to read the article. One of the problems in the field of autism/ASD/Aspergers is that we really don't have solid research proving that what we do brings about change. Often it is obvious to those doing the work, but it's good to see some basic science going on to back up our day to day practice in the field.
Monday, June 27, 2011
Another early test for autism?
Notes from Dr. Jim Roche:
NPR has an interesting story about autism and early brain development. You can read the transcript of listen to the report by clicking here: http://www.npr.org/2011/06/02/136882002/looking-for-early-signs-of-autism-in-brain-waves
NPR has an interesting story about autism and early brain development. You can read the transcript of listen to the report by clicking here: http://www.npr.org/2011/06/02/136882002/looking-for-early-signs-of-autism-in-brain-waves
Thursday, June 23, 2011
Autism testing while asleep? Maybe....
First, a reminder that my blogsite is moving to Wordpress. You can find the new WordPress version at: www.relatedmindsbc.com/blog My professional site is now at www.relatedminds.com
Medical News: Brain Out of Sync in Tots With Autism - in Pediatrics, Autism from MedPage Today
This new and interesting study finds that toddlers with autism displayed weaker interhemispheric synchronization as shown by functional magnetic resonance imaging testing conducted during sleep compared with those with language delay or typical development. The investigators suggested that this might provide an early diagnostic tool which could then prompt earlier intervention. While none of these tools will be terribly useful as stand alone instruments, they will help us differentiate on disorder from another, saving time, getting appropriate treatment to the correct children and in the long run, saving money.
The study demonstrates that toddlers with autism have poorer synchronization between the hemispheres of the brain during sleep, potentially providing a biomarker that can aid in early diagnosis of the disorder, researchers found. Among children ages 1 to 3½, those with autism had significantly worse synchronization in two areas of the brain associated with language production and comprehension than other kids, according to Ilan Dinstein, PhD, of the Weizmann Institute of Science in Rehovot, Israel, and colleagues. How does this related to autism? Well the inferior frontal gyrus is positively associated with verbal ability and negatively associated with the severity of autism-related communication problems.
"These results suggest that poor neural synchronization is a notable neurophysiological characteristic that is evident at the earliest stages of autism development and is related to the severity of behavioral symptoms....The ability to measure this characteristic during sleep, when task compliance and subject cooperation are not required, suggests its utility as a possible diagnostic measure to aid growing efforts of identifying autism during infancy," they concluded, adding that early identification would lead to earlier intervention. Yes, this is a test we might be able to use with children who are uncooperative, sometimes seemingly untestable...while they sleep.
The researchers say that "the fact that poor synchronization was found in the language system of toddlers with autism, and not in toddlers with language delay (both groups exhibited similarly low expressive language scores), suggests that reduced synchronization may reflect the existence of a specific pathophysiological mechanism that is unique to autism."
This is where our limited autism funding should be going, rather than more testing of alternative medicines that have no logical hope of cure, or searching for causes that have been ruled out multiple times. We need to focus on where the science drives us, not politics.
Medical News: Brain Out of Sync in Tots With Autism - in Pediatrics, Autism from MedPage Today
This new and interesting study finds that toddlers with autism displayed weaker interhemispheric synchronization as shown by functional magnetic resonance imaging testing conducted during sleep compared with those with language delay or typical development. The investigators suggested that this might provide an early diagnostic tool which could then prompt earlier intervention. While none of these tools will be terribly useful as stand alone instruments, they will help us differentiate on disorder from another, saving time, getting appropriate treatment to the correct children and in the long run, saving money.
The study demonstrates that toddlers with autism have poorer synchronization between the hemispheres of the brain during sleep, potentially providing a biomarker that can aid in early diagnosis of the disorder, researchers found. Among children ages 1 to 3½, those with autism had significantly worse synchronization in two areas of the brain associated with language production and comprehension than other kids, according to Ilan Dinstein, PhD, of the Weizmann Institute of Science in Rehovot, Israel, and colleagues. How does this related to autism? Well the inferior frontal gyrus is positively associated with verbal ability and negatively associated with the severity of autism-related communication problems.
"These results suggest that poor neural synchronization is a notable neurophysiological characteristic that is evident at the earliest stages of autism development and is related to the severity of behavioral symptoms....The ability to measure this characteristic during sleep, when task compliance and subject cooperation are not required, suggests its utility as a possible diagnostic measure to aid growing efforts of identifying autism during infancy," they concluded, adding that early identification would lead to earlier intervention. Yes, this is a test we might be able to use with children who are uncooperative, sometimes seemingly untestable...while they sleep.
The researchers say that "the fact that poor synchronization was found in the language system of toddlers with autism, and not in toddlers with language delay (both groups exhibited similarly low expressive language scores), suggests that reduced synchronization may reflect the existence of a specific pathophysiological mechanism that is unique to autism."
This is where our limited autism funding should be going, rather than more testing of alternative medicines that have no logical hope of cure, or searching for causes that have been ruled out multiple times. We need to focus on where the science drives us, not politics.
Monday, June 20, 2011
Reminder: AutismBC Blog relocated
Reminder: My autism blog has moved to a new server and site: http://www.relatedmindsbc.com/blog
Sunday, June 12, 2011
Canadians resist call to screen all babies for autism
Reminder: the autismvancouver blog is becoming part of my wordpress blog space and after a couple more weeks will only be found there. Please go to: http://www.relatedmindsbc.com/blog to find my wordpress blog.
Canadians resist call to screen all babies for autism
Another article on early diagnosis of autism focuses on how Canadian doctors approach this issue. The article can be found here: Canadians resist call to screen all babies for autism.
What does this mean? Sounds pretty horrible? If you read this in local papers this week you might be wondering what it means. Heres the story:
Canadian researchers are warning that not nearly enough evidence exists to support a move to screen every preschooler for autism, as U.S. doctors are urging.
In the U.S. paediatricians are being urged by their professional body (the American Academy of Pediatrics) to routinely check toddlers for signs of autism at 18 to 24 months of age during regular visits for checkups or vaccinations, regardless of whether the parents have any concerns about their babies. The are screening, and recently I addressed ways that this screening can take place, even at this age, through simple procedures and an interview.
But from McMaster University in Hamilton, Ont., we hear that current screening tools not good enough, “there is no evidence yet that such a program would do more good than harm.” It may be hard to understand, but sometimes when we do screening, based upon no reason at all, just screening everyone, we end up finding many false positives. Mass screenings for several adult disorders have come under fire recently just for this reason.
So while some feel that if autism screening were added to routine baby visits, virtually every child potentially could be reached, while others find that none of the screening techniques available today are sensitive enough to reliably detect — or rule out — autism. (Dr. Jan Willem Gorter, a researcher in McMaster’s CanChild Centre for Childhood Disability Research.) And there are many potentially negative impacts of a wrong diagnosis.
“These conclusions ( in Dr. Gorter's report) raise a fundamental question: what do we aim to achieve when we screen for a non-preventable condition for which there is currently no research evidence that intervention strategies improve the daily lives of all children with autism spectrum disorder and their families?” I know that may seem harsh, but realize they are saying that there is no evidence that early...ages 2,3,4 ....interventions will help, at all.
Others argue that early diagnosis and intervention are crucial. "Parents of children with autism have reported seeing signs of trouble before their baby’s first birthday but autism usually isn’t diagnosed until age three or four. Wait lists for diagnosis and treatment can stretch a year or more." So we have a situation where parents report they see early signs, however what we know about autism (right now, which isn't a lot) is that the physical changes that cause the symptoms we see in behavioural changes don;t occur till ages 3-4. So, do we screen every child, and possibly make a good number of mistakes when diagnosing, or do we wait? Those who think the mistakes are worth it don't take into account the funding and limited resources, those who don't feel that there are no proven effective treatments for children of this age anyway. Both sides seem to have a point.
So, with the limited resources, do we diagnose? Or do we wait? And what difference will there really be? The truth is, sometimes screening can cause more harm than good. It's not an easy problem to solve, but we need to be sensitive to doctors and professionals on either side of the argument. Both sides have the best interests of the children in mind.
Read more: http://www.ottawacitizen.com/health/Canadians+resist+call+screen+babies+autism/4934804/story.html#ixzz1PCORkrOh
Canadians resist call to screen all babies for autism
Another article on early diagnosis of autism focuses on how Canadian doctors approach this issue. The article can be found here: Canadians resist call to screen all babies for autism.
What does this mean? Sounds pretty horrible? If you read this in local papers this week you might be wondering what it means. Heres the story:
Canadian researchers are warning that not nearly enough evidence exists to support a move to screen every preschooler for autism, as U.S. doctors are urging.
In the U.S. paediatricians are being urged by their professional body (the American Academy of Pediatrics) to routinely check toddlers for signs of autism at 18 to 24 months of age during regular visits for checkups or vaccinations, regardless of whether the parents have any concerns about their babies. The are screening, and recently I addressed ways that this screening can take place, even at this age, through simple procedures and an interview.
But from McMaster University in Hamilton, Ont., we hear that current screening tools not good enough, “there is no evidence yet that such a program would do more good than harm.” It may be hard to understand, but sometimes when we do screening, based upon no reason at all, just screening everyone, we end up finding many false positives. Mass screenings for several adult disorders have come under fire recently just for this reason.
So while some feel that if autism screening were added to routine baby visits, virtually every child potentially could be reached, while others find that none of the screening techniques available today are sensitive enough to reliably detect — or rule out — autism. (Dr. Jan Willem Gorter, a researcher in McMaster’s CanChild Centre for Childhood Disability Research.) And there are many potentially negative impacts of a wrong diagnosis.
“These conclusions ( in Dr. Gorter's report) raise a fundamental question: what do we aim to achieve when we screen for a non-preventable condition for which there is currently no research evidence that intervention strategies improve the daily lives of all children with autism spectrum disorder and their families?” I know that may seem harsh, but realize they are saying that there is no evidence that early...ages 2,3,4 ....interventions will help, at all.
Others argue that early diagnosis and intervention are crucial. "Parents of children with autism have reported seeing signs of trouble before their baby’s first birthday but autism usually isn’t diagnosed until age three or four. Wait lists for diagnosis and treatment can stretch a year or more." So we have a situation where parents report they see early signs, however what we know about autism (right now, which isn't a lot) is that the physical changes that cause the symptoms we see in behavioural changes don;t occur till ages 3-4. So, do we screen every child, and possibly make a good number of mistakes when diagnosing, or do we wait? Those who think the mistakes are worth it don't take into account the funding and limited resources, those who don't feel that there are no proven effective treatments for children of this age anyway. Both sides seem to have a point.
So, with the limited resources, do we diagnose? Or do we wait? And what difference will there really be? The truth is, sometimes screening can cause more harm than good. It's not an easy problem to solve, but we need to be sensitive to doctors and professionals on either side of the argument. Both sides have the best interests of the children in mind.
Read more: http://www.ottawacitizen.com/health/Canadians+resist+call+screen+babies+autism/4934804/story.html#ixzz1PCORkrOh
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