"Notes on Autism Assessment and Treatment" are written by Dr. Jim Roche. These autism notes are not meant to provide a guide to either diagnosis or treatment. For information on diagnosis and treatment contact your medical doctor or a registered/licensed psychologist for an appointment and assessment. Information about Dr. Roche's services can be found at these addresses:
Relatedminds: http://www.relatedminds.com
ADHD Help BC: http://www.adhdhelp.ca
At Psychology Today: http://therapists.psychologytoday.com/rms/70682
At the BCPA website: http://bcpa.pixelmountainarts.com/users/jimroche
At CounsellingBC: http://www.counsellingbc.com/listings/JRoche.htm
At Psyris: http://psyris.com/drjimroche
At Autism Community Training: http://www.actcommunity.net/jim-roche.html
What causes autism, Autism spectrum disorder and Asperger's Syndrome? We now know more about the cause of autism than we have for a long long time. But we need to be careful not to allow the anti-vaccine / anti-scient crowd misdirect us. Moises Velasques-Manoff, the author of "An Epidemic of Absence: A new Way of Understanding Allergies and Autoimmune Diseases" has written an excellent summary of the latest research for the New York Times. It can be found here:
http://www.nytimes.com/2012/08/26/opinion/sunday/immune-disorders-and-autism.html?smid=pl-share
Velasques-Manoff points out that one subset of those with autism, which makes up at least if not more than 1/3 of those with autism, seem to have some type of inflammatory disorder. And this inflammatory disease doesn't start as a result of vaccinations - it's starts way before that, in the womb. We know this is true because the brain changes that are associated with autism are noted prior to the age of immunizations, and there is no correlation between those getting these vaccines and those who develop autism. Hopefully, someday, the uninformed will start to notice the basic problems with their science, or maybe start to have some respect for science.
What the research Velasques-Manoff writes about notes is that a large number of mothers of autistic children have had some sort of immune compromising condition while they were pregnant. This leads to a inflammatory reaction, in both the mother and child, and this effects the astroglia and microglia - which ar enlarged from chronic inflammation.
A population-wide study in Denmark spanning two decades indicates that infections during pregnancy increases the risk of autism in children. Sounds simple enough, doesn't it? Infections during pregnancy ...must cause autism. So cut down the number of infections. But again, the epidemiology doesn't lead in that direction. Like much of science, it's more complicated than that. You see, while world wide viral and bacterial infections have gone down ....autism rates have gone up. Especially places where there are fewer infections! Somewhat of a contradiction.
You see while infections and other disorders have decreased, the number of inflammatory disorders HAS gone up. And the relationship between these inflammatory infections and autism is very clear. A mother with rheumatoid arthritis, an inflammatory disorder, has an 80 percent increase in the chance of having a child with autism. A mother with celiac disease increase her risk 350 percent.
So the questions now becomes why we are now so prone to inflammatory disorders, and if there is anything we can do to decrease these risks? There are several suggested therapies - for the mother - and these oddly follow the idea of doing something about what Velasques-Manoff calls our "microbial deprivation." (Remember: dirt and parasites are "famous for limiting inflammation.")
Probiotics? "domesticated parasites?" These are just some of the thoughts Velasques-Manoff and others are looking at. What we do know is that we have spent too much time looking at the effects of dysregulation in the child with autism, and not enough time looking at dysregulation and other problems in parents .... remember, it's a genetic disorder to a great degree.
Click on the above link to get the New York Times article, and check out some of Velasques-Manoff's writing elsewhere.
Monday, August 27, 2012
Wednesday, August 22, 2012
Autism Risk and Parental Age
Another research paper points to the problem of older men having children, something most thought was not an issue a few years ago. The research shows that older men are more likely than young ones to father a child who develops autism or schizophrenia. This is because of random genetic mutations that become more numerous with advancing paternal age. This study of the effects of parental age on likelihood of having a child with autism is the first study to quantify the effect as it builds each year. The study also notes that the age of mothers had no bearing on the risk for these disorders. What you need to remember is that this is just one of MANY risks that we have associated with autism. One risk that isn't related to autism is vaccinations, which, in spite of the overwhelming evidence is still thought of as an issue by many uninformed parents, especially those who rely on pseudo-scientific research for answers.
Click here for the article in the New York Times, which does a great job of explaining the research these scientists undertook:
Thursday, August 2, 2012
Autism and Pets
(From MedPage) "Getting a pet may help autistic children improve their social skills, a small study showed."
"Children with autism who acquired a pet after age 5 showed gains in two prosocial behaviors -- "offering to share" and "offering comfort" -- compared with those who had never had a pet (P<0.0014 for both), according to Marine Grandgeorge, PhD, of the Centre Hospitalier Regional Universitaire de Brest in France, and colleagues."
"Autistic children who had had a pet since birth, however, showed no differences compared with their pet-less peers, the researchers reported online in PLoS One."
"Given the potential ability of individuals with autism to develop prosocial behaviors, related studies are needed to better understand the mechanisms involved in the development of such child-pet relationships," the authors wrote.
Click here to read the entire article:
Pets Boost Social Skills in Kids with Autism
Click http://www.medpagetoday.com/Neurology/Autism/34012
For information on services I provide for children, adolescents and adults with Autism Spectrum Disorder, Asperger's Syndrome and ADHD visit my website at www.relatedminds.com
Wednesday, August 1, 2012
Sensory Processing Disorder and ASD
According to a policy statement from the section on Complementary and Integrative Medicine of the American Academy of Pediatrics Sensory Processing Disorder should not be used as a medical diagnosis. They express concern with it's overuse, and the application of sensory based therapies for which there is little if any evidence of effectiveness. Regretfully, even with a diagnosis of Autism Spectrum Disorder or Asleger's Syndrome many school district produce IEPs (Individual Education Plans) that rely heavily on these unproven treatment- while they avoid the use of validated behavioural treatments. Often the reason for this is that sensory based treatments are easier to implement with untrained staff, and there is simply a lack of trained professionals in the field of behavioural interventions (or classroom management).
Click http://www.medpagetoday.com/Pediatrics/GeneralPediatrics/33018 for the full story
The statement says, "Pediatricians should not use sensory processing disorder as a diagnosis, according to a policy statement from the American Academy of Pediatrics. Although there are standardized measures of a child's sensory processing abilities, there is not a widely accepted framework for diagnosing the disorder, members of the AAP's Section on Complementary and Integrative Medicine wrote in the June issue of Pediatrics."
The reort notes, "that the committee developing the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) has called for further research before officially recognizing sensory processing disorder." In addition, the authors wrote, "it is unclear whether children who present with sensory-based problems have an actual 'disorder' of the sensory pathways of the brain or whether these deficits are characteristics associated with other developmental and behavioral disorders."
The report suggests that instead of diagnosing sensory processing disorder, pediatricians should perform a thorough evaluation -- usually with appropriate referral to a developmental and behavioral pediatrician, child psychiatrist, or child psychologist.
The report continues, "consideration should be given to other developmental and behavioral disorders that may be associated with difficulty tolerating or processing sensory information, including autism spectrum disorders, attention-deficit/hyperactivity disorder (ADHD), developmental coordination disorders, and childhood anxiety disorders."
"Pediatricians should inform families that occupational therapy is a limited resource, particularly the number of sessions available through schools and through insurance coverage," the authors wrote. "The family, pediatrician, and other clinicians should work together to prioritize treatment on the basis of the effects the sensory problems have on a child's ability to perform daily functions of childhood."
Here in Bc there has been tremendous growth in school based "sensory rooms." Often children with ADHD, Autism Spectrum Disorder or Asperger's Syndrome are removed from class and sent to the "sensory rooms" in an effort to calm them down, rather than the school completing an appropriate Functional Behavioral Assessment and developing a behavior based intervention plan that either teaches new skills or uses behavioural techniques (long known about and familiar to experts in the field) such as controlled exposure, relaxation and thought stopping interventions to teach the child appropriate ways to deal with unwanted sensory input. Little effort is made to help the child develop coping skills, self-southing skills or other alternative behavioural skills to deal with the sensory issues. Many parents feel that the over use of sensory rooms and removal from the teaching environment do little more than reinforce inappropriate and unwanted behaviours. A second look at the over use of the "sensory Processing Disorder" diagnosis seems like an appropriate place to start.
While here in BC excessive removal from a classroom (Time Out / Time Away) due to behavioural issues seems acceptable. In the United States such removal would be considered a "change in educational placement" and would require approval by both the school special education team and parents.
An excellent source of information on how behaviours that interfere with learning should be addressed in the classroom through well know and scientifically supported educational and behavioural techniques can be found at this web page: http://www.pent.ca.gov The PENT website offers free materials which any school district could use to address problematic behaviours which interfere with learning. An appropriate Functional Behavioural Assessment (FBA) is the place to start when addressing these kinds of issues. I have used the PENT training materials to implement training programs in completing and writing Functional Behavioural Assessments for almost 10 years and it is really unmatched ....and FREE. All of these training materials are....FREE. Rather than providing easy interventions that are not supported by science. I would hope that every school instead provides science based assessment and intervention programs that directly assess the behaviours of concern and use interventions techniques we know work.
The problem comes down to this: If your child has a serious behavioural problem at school, you should expect that the school would implement strong, science based interventions that are designed to directly address the problem AND teach new adaptive behaviours. Changing the child's environment, and removing them from the classroom, is not a plan. Sensory room or not. If your having such problems with your child in school I would suggest contacting an expert in the field, a psychologist or professional educator, to visit the school, observe the situation and complete an FBA (Functional Behavioural Assessment)
Wednesday, July 11, 2012
What Treatments are there for Adults with Asperger's Syndrome or Disorder?
I am often asked: "What Treatments Are Available for Adults with Asperger Syndrome?"
Many adults who have been having low level but continuous problems socially, at college, work or in their own family go on line and seek out a diagnosis. Often they complete a check list somewhere and it tells them they MAY have Asperger's Syndrome or Asperger's Disorder. Of course, one of the problems is the short check list was designed to do nothing more than search out signs and symptoms of Aspeger's, and honestly, there are a lot of people who you see most of those signs or symptoms in. A real diagnosis would have taken a broader view, and looked at alternative causes for these symptoms. This process is called "differential diagnosis" and a licensed psychologist or medical doctor familiar with Asperger's would have ruled in or out several very similar disorders.
But, at any rate, you have completed the checklist, it says Asperger's and your symptoms are of concern. Many people wonder why someone would even go through an examination to get a diagnosis, because they aren't sure what "therapies" are even available.
For children with Asperger Syndrome (AS) and other forms of autism usually there is a fairly common set of treatment interventions available through the school district. This might include physical, occupational and speech therapy along with some kind of social skills (social reciprocity) training and behaviour support. But for adults it's a very different matter.
Most people start treatment because of some event that is currently going on in their lives. They may have had difficulty at school with more complex subjects, and their difficulty is related to Asperger's tendency to limit cognitive flexibility. This can be addressed through psychoeducation, practice and feedback.
Others may be having problems at work. They could be similar to those just mentioned, or include time management issues, focus and attention problems very similar to ADHD, or social interaction issues. All of these are addressed through fairly common techniques, and the issue of social interactions, or social cognition, is usually addressed through psychoeducation (readings and discussions about how the brain works in social interactions) and modelling, then practice in using social cognition skills. For the individual with Asperger's this is a very different issue than "social skills training," which many people are pointed to by therapists who are not familiar with the complexity of Asperger's Syndrome or Disorder. As I always do, let me mention the work of Michelle Garcia Winner here. Here web page, www.socialthinking.com explains this issue really well. When adults come to my offices in Burnaby or Vancouver for treatment of aspects of their Asperger Syndrome I often recommend trying to look over Michelle's materials to get a firm grip on what exactly is going on when they have difficulty in social settings.
Family issues is another point that often brings individuals with Asperger's Syndrome to the office. Sometimes we work together one-to-one on understanding and improving communications, sometimes we work on things as simple as arranging appropriate schedules and interaction times. Couples often need relationship counselling as well. And of course, educating your spouse can make a big difference. This is another place where a trained professional comes in handy.
Finally, many individuals come in for the same symptoms and problems anyone might come to a therapist or psychologist for. They may have anxiety issues, phobias or depression. For these issues we often use an adapted form of CBT - Cognitive Behavioural Therapy to address the thoughts and feelings of loneliness, depression and isolation.
Of course others come in because of legal issues after work place incidents, or to help get social services and so on. Some individuals need help with daily living skills like keeping a bank account, eating properly, exercising and finding a job. Others with Asperger's have anxiety because of their limited ability reading social cues at work where they may be a department head, director of research or university faculty. Asperger's is a spectrum disorder and individuals come in with a spectrum of issues they can use support and help with.
These are just a few of the reasons individuals come to my office seeking help with Asperger Syndrome symptoms. For more information on the services I provide please feel free to contact me, or check out the information on my web page at www.relatedminds.com
Tuesday, July 10, 2012
Adolescents and Young Adults with Aspergers and High Functioning Autism
Treatment for adolescents (teens) and young adults with Asperger's Disorder or High Functioning Autism are few and far between. One of the reasons is that many of these individuals are fairly high functioning and reluctant to join in groups, so, we have a really hard time outside of major/major metropolitan areas forming groups. What we often rely upon is individual therapy and coaching for these individuals.
What does individual therapy consist of? Well, it usually starts with psycho-education. That is, learning the ins and outs of the disorder. Often this means learning it from the perspective of others, because one of the major difficulties people have is getting and understanding the perspective of others. While there are a lot of materials and training programs out there for younger teens and children with Asperger's Disorder there really aren't many for older teens and young adults. Still, we are able to make use of some of the materials from Michelle Garcia Winner which can easily apply to and be adapted for young adults and the work place. One set of materials we often use is her "social Behavior Mapping" method, which refocuses their attention on how they are perceived by others. This lack of "reciprocity" or use and understanding of "pragmatic language" is a common source of difficulty.
An example of this is the individual who, while at work, is asked to sign a get well card for the office manager's daughter, who he has never met. While everyone else in the office signs the card as it is passed around, this individual, let's call him Tom, instead of signing says, "Well, I don't really know her." While this is true, and often family, friends and even therapists spend a lot of time arguing about the "truthfulness" of such statements, it becomes a work issue because such a reaction and comment is simply unexpected in the workplace, where social rules instruct you to sign the card, and if you can't think of anything just....sign your name and write "get well."
How many arguments about this I've had with clients with Asperger's I can't tell you. Like Tom they know the social norm, they could recite it to you, but don't implement it because they need to stick to the facts of the situation. The big leap for them is to understand 1 How other's see their actions; and 2) Learn how to use the reaction of others to monitor and adjust their own behaviour. Something that just doesn't go on often enough.
Michelle's work addresses these issues, not by going right to a problem area and ...well "sticking a finger in someone's eye while pointing out their problem." Instead we address the learning and thinking process as a who, and give students simple techniques to support their use of appropriate social interactions.
Therapy for adolescents, teens, and young adults with Asperger's Disorder also often focuses on some of the same themes you would expect anyone their age to be dealing with. Individuals with Asperger's and high functioning Autism almost always tell me they want to develop relationships, make friends and become close to others. But because of these social cognitive deficits, like the one described above, this can be difficult task. This isolation can lead to anxiety, stress and depression just as it could with anyone else. So often these individuals with Asperger's Disorder and high functioning autism are often seen for the same reasons anyone else is seen. Therapies that are effective with others, such as Cognitive Behavioural Therapy 9CBT) is often just as effective, and can be easily adapted to make use of external and visual support systems.
Finally there is the use of self-help books. Often individuals with Aspegers Disorder or high functioning autism can't afford the services of a psychologist or other licensed health professional. For those individuals a coaching mode using self help / self directed materials may be a good place to start. One book I often recommend, especially for young adults entering college or the workplace, is "Social 'Thinking at Work," again, by Michelle Garcia Winner. This is an excellent book, written especially for those with Aspeger's or high functioning autism. I would suggest this is one of the best books around for young adults, and recommend it highly. You can call around and find it at several bookstores, find it through the "suggested readings" link on my web page (at www.relatedminds.com) or borrow it through your local library.
Checking out Mitchelle's web page at www.socialthinking.com may also reveal some more recent books and materials. I'd give a look there.
I hope this has been helpful. All i can do is recommend you find a clinician, therapist, counsellor or registered psychologist, who has expertise in this field. And that would mean working for several years with all age groups, children, adolescents and dults, in order to understand the complexity of this developmental disorder. The good news is that overall research has shown we are highly successful at helping higher functioning children, adolescents and adults than we could have hoped. 'Good luck in your reading!
Saturday, June 30, 2012
ADHD and Autism
"I heard that you can't have autism, or Asperger's, and ADHD at the same time, is that true?"
I hear this a lot. Parents go to their MD and their child, whom might have mild or high functioning autism or Asperger's Disorder is also diagnosed with ADHD. But someone "in the know" has told them this can't be true! They then worry that their medical doctor or psychologist is confused, or doesn't know what he or she is doing!
Here is the simple answer: The DSM (Diagnostic and Statistical Manual of the American Psychiatric Association) does say that ASD (autism) rules out ADHD. But honestly, we don't always follow every rule stated in the DSM IV. Some of these rules, years after publication, don't make the same sense they once did. That's why there is a new version of the DSM coming out in the next year or so. The rules, or diagnostic criteria, for Autism, Aspergers (which will disappear) and ADHD (Attention Deficit Hyperactivity Disorder) are all changing to meet the real world facts we have been confronted with since the last publication of the DSM. Another reason an MD may diagnose ADHD and Autism is that he or she needs to rationalize the prescription for the ADHD medication. ADHD medications are closely monitored, and giving them to individuals without a diagnosis of ADHD is simply problematic.
Do children, adolescents and adults with ASD also have ADHD? I think so. Sometimes it's obvious. But at other times what looks like inattention, focus issues and hyperactivity is nothing more than the symptoms of autism spectrum disorder. One needs to look at the severity of the autism disorder and observe the situation to make a real determination. And sometimes ADHD medications are prescribed to deal with those symptoms.
Still worried about this issue? Talk it over with your medical doctor or psychologist. I often recommend that patients write out their concerns and questions before they come in to see me. That way it's easier to stay on track and not leave your appointment with the same concerns and anxiety you went there with.
Tuesday, May 29, 2012
Sensory Therapies and Autism: Some Concerns
There are a lot of IEP's filled with interventions for which there is little if any scientific evidence of efficacy. HealthNews has an excellent report this week on some serious doubts about the use of many sensory interventions for children with autism spectrum disorder and Aspergers Disorder that calls many of them into question. Sensory therapies using brushes, swings and other play equipment are increasingly used by occupational therapists to treat children with developmental issues such as autism, but a large pediatricians organization says there isn't much evidence that such therapies actually work. And how often are children taken from the classroom to a "sensory room" for interventions such as brushing and swinging when there is so little evidence this makes sense?What is important is that before parents spend the time and money on taking children to sensory therapy, they should know that as of now many of these techniques are largely unproven.
"It's OK for parents to try these types of therapies, but there is little research backing up the effectiveness of these therapies and whether or not they improve long-term outcomes for kids with developmental disabilities," said Dr. Michelle Zimmer, an assistant professor of pediatrics at Cincinnati Children's Hospital Medical Center.
Zimmer is the co-author of a new American Academy of Pediatrics policy statement on what is often referred to as "sensory integration therapy." The policy statement appears online May 28 and in the June print issue of Pediatrics. According to the pediatrician group, "sensory processing disorder" should not be used as a "standalone diagnosis."
No one disputes that children with conditions such as autism can have abnormalities in their responses to sensory stimuli, including sight, taste, touch and sound. For example, autistic children may have aversions to loud noises, to certain food textures or to being touched unexpectedly, Zimmer said. But that doesn't necessarily mean the problem is with their brain pathways for processing sensory information, as the term "sensory processing disorder" implies.
Instead, some other issue could underlie their reactions to stimuli, such as a behavioral issue, said Dr. Susan Hyman, chair of the American Academy of Pediatrics subcommittee on autism and an associate professor of pediatrics at University of Rochester Medical Center, in Rochester, N.Y. Instead of chalking up various aversions or compulsions to sensory processing disorder, health care providers need to consider what other developmental issues may be going on with the child, such as autism, attention-deficit hyperactivity disorder (ADHD) and so on, Zimmer said. A full and comprehensive diagnosis needs to take place, along with a Functional Behavioural Analysis to determine the cause of the unwanted and harmful behaviours before employing unproven techniques, especially when they are often offered IN PLACE OF interventions that are known to work. "There has never been a study that has shown that a child can have just sensory processing disorder, isolated from another developmental disabilities, such as autism or ADHD," Zimmer said.
In sensory integration therapy, occupational therapists put children on a "sensory diet," exposing them to different sights, smells, sounds and sensations, to improve the brain's ability to process the information. "For now, however, whether it works remains a theory," Dr. Zimmer said. In the absence of controlled clinical trials testing whether sensory therapies work, parents have to try to be objective, ask themselves tough questions about whether the treatment is really working, set specific goals and determine if the child is moving toward the target.
"Is it improving the child's ability to function? That's where more research needs to happen," Zimmer said. Hyman, who studies sensory differences in children with autism, agreed. "The scientific testing of this intervention has not demonstrated that it is effective for all children as a standalone treatment," she said. "However, for individual children, it may be an important part of a total therapy package." "You don't want to spend a lot of time money and energy on a treatment if it's not right for them. They have to be prudent," Hyman said. "In the absence of data, parents have to utilize the information that's available to them in making choices."
One serious problem is that children are removed from classrooms in order to effect this "sensory diet." Limited time, staff and funding is used to implement these unproven treatments, and there is little left to implement treatments that are known to work. It is far easier to get an aide to take a child to a sensory room to swing, or to brush them on the arm during class, that to get a staff member adequately trained in behavioural interventions. Often staff training and availability leads to certain interventions. When a child with moderate to severe behavioural issues is receiving a sensory diet, brushing, "social stories" and "walks" throughout the day rather than having a professionally trained behavioural specialist complete an FBA (Functional Behavioural Assessment) and implement a behavioural program, parents should wonder if this is due to an assessment based on science, or staffing availability and limitations.
OTs (Occupational Therapists) and PTs (Physical Therapists) are highly trained and critically important members of any school intervention team. They can offer critical help and insight into working with children with autism spectrum disorder, ADHD and other similar conditions. But today there is an over emphasis on simple, easy and unproven interventions because schools simply don't have enough professionals trained to implement the most basic behavioural interventions ranging from token systems (positive behavioural reinforcement systems) to desensitization programs. These well tried, scientifically proven and studied techniques require trained staff members, something we seem to have fewer and fewer of with all the funding cuts our educational system has undergone.
KEY WORDS: ADHD, ADD, Attention Deficit Hyperactivity Disorder, Coaching, Diagnosis, Burnaby, Vancouver, Coquitlam, New Westminister, Psychologist, ADHD Coaching
For more information visit:
http://www.relatedminds.com/adhd-attention-deficit-hyperactivity-disorder
http://www.relatedminds.com
http://www.counsellingbc.com/listings/JRoche.htm
Saturday, April 7, 2012
Autism Rate is Irate!
http://www.nytimes.com/2012/04/08/sunday-review/the-autism-wars.html
Tomorrow's *New York Times* (Sunday, April 8) has an article in its Sunday Review section: "The Autism Wars" by Amy Harmon.
Here are some excerpts:
[begin excerpts]
THE report by the Centers for Disease Control and Prevention that one in 88 American children have an autism spectrum disorder has stoked a debate about why the condition's prevalence continues to rise.
The C.D.C. said it was possible that the increase could be entirely attributed to better detection by teachers and doctors, while holding out the possibility of unknown environmental factors.
But the report, released last month, also appears to be serving as a lightning rod for those who question the legitimacy of a diagnosis whose estimated prevalence has nearly doubled since 2007.
As one person commenting on The New York Times's online article about it put it, parents "want an 'out' for why little Johnny is a little hard to control."
Or, as another skeptic posted on a different Web site, "Just like how all of a sudden everyone had A.D.H.D. in the '90s, now everyone has autism."
The diagnosis criteria for autism spectrum disorders were broadened in the 1990s to encompass not just the most severely affected children, who might be intellectually disabled, nonverbal or prone to self-injury, but those with widely varying symptoms and intellectual abilities who shared a fundamental difficulty with social interaction.
As a result, the makeup of the autism population has shifted: only about a third of those identified by the C.D.C. as autistic last month had an intellectual disability, compared with about half a decade ago.
Thomas Frazier, director of research at the Cleveland Clinic Center for Autism, has argued for diagnostic criteria that would continue to include individuals whose impairments might be considered milder.
"Our world is such a social world," he said. "I don't care if you have a 150 I.Q., if you have a social problem, that's a real problem. You're going to have problems getting along with your boss, with your spouse, with friends."
Some parents bristle at the notion that their child's autism diagnosis is a reflection of the culture's tendency to pathologize natural variations in human behavior.
Difficulty in reading facial expressions, or knowing when to stop talking, or how to regulate emotions or adapt to changes in routine, while less visible than more classic autism symptoms, can nonetheless be profoundly impairing, they argue.
Children with what is sometimes called "high functioning" autism or Asperger syndrome, for instance, are more likely to be bullied than those who are more visibly affected, a recent study found -- precisely because they almost, but don't quite, fit in.
According to the C.D.C., what critics condemn as over-diagnosis is most likely the opposite.
Twenty percent of the 8-year-olds the agency's reviewers identified as having the traits of autism by reviewing their school and medical records had not received an actual diagnosis.
The sharpest increases appeared among Hispanic and black children, who historically have been less likely to receive an autism diagnosis.
In South Korea, a recent study found a prevalence rate of one in 38 children, and a study in England found autism at roughly the same rate -- 1 percent -- in adults as in children, implying that the condition had gone unidentified previously, rather than an actual increase in its incidence.
Those numbers are, of course, dependent on the definition of autism -- and the view of a diagnosis as desirable.
For John Elder Robison, whose memoir "Look Me in the Eye" describes his diagnosis in middle age, the realization that his social awkwardness was related to his brain wiring rather than a character flaw proved liberating.
"There's a whole generation of people who grew up lonelier and more isolated and less able to function than they might have been if we had taken steps to integrate them into society," he said.
Yet even some parents who find the construct of autism useful in understanding and helping children others might call quirky say that in an ideal world, autism as a mental health diagnosis would not be necessary.
"The term has become so diffuse in the public mind that people start to see it as a fad," said Emily Willingham, who is a co-editor of "The Thinking Person's Guide to Autism."
"If we could identify individual needs based on specific gaps, instead of considering autism itself as a disorder, that would be preferable. We all have our gaps that need work."
[end excerpts]
Tomorrow's *New York Times* (Sunday, April 8) has an article in its Sunday Review section: "The Autism Wars" by Amy Harmon.
Here are some excerpts:
[begin excerpts]
THE report by the Centers for Disease Control and Prevention that one in 88 American children have an autism spectrum disorder has stoked a debate about why the condition's prevalence continues to rise.
The C.D.C. said it was possible that the increase could be entirely attributed to better detection by teachers and doctors, while holding out the possibility of unknown environmental factors.
But the report, released last month, also appears to be serving as a lightning rod for those who question the legitimacy of a diagnosis whose estimated prevalence has nearly doubled since 2007.
As one person commenting on The New York Times's online article about it put it, parents "want an 'out' for why little Johnny is a little hard to control."
Or, as another skeptic posted on a different Web site, "Just like how all of a sudden everyone had A.D.H.D. in the '90s, now everyone has autism."
The diagnosis criteria for autism spectrum disorders were broadened in the 1990s to encompass not just the most severely affected children, who might be intellectually disabled, nonverbal or prone to self-injury, but those with widely varying symptoms and intellectual abilities who shared a fundamental difficulty with social interaction.
As a result, the makeup of the autism population has shifted: only about a third of those identified by the C.D.C. as autistic last month had an intellectual disability, compared with about half a decade ago.
Thomas Frazier, director of research at the Cleveland Clinic Center for Autism, has argued for diagnostic criteria that would continue to include individuals whose impairments might be considered milder.
"Our world is such a social world," he said. "I don't care if you have a 150 I.Q., if you have a social problem, that's a real problem. You're going to have problems getting along with your boss, with your spouse, with friends."
Some parents bristle at the notion that their child's autism diagnosis is a reflection of the culture's tendency to pathologize natural variations in human behavior.
Difficulty in reading facial expressions, or knowing when to stop talking, or how to regulate emotions or adapt to changes in routine, while less visible than more classic autism symptoms, can nonetheless be profoundly impairing, they argue.
Children with what is sometimes called "high functioning" autism or Asperger syndrome, for instance, are more likely to be bullied than those who are more visibly affected, a recent study found -- precisely because they almost, but don't quite, fit in.
According to the C.D.C., what critics condemn as over-diagnosis is most likely the opposite.
Twenty percent of the 8-year-olds the agency's reviewers identified as having the traits of autism by reviewing their school and medical records had not received an actual diagnosis.
The sharpest increases appeared among Hispanic and black children, who historically have been less likely to receive an autism diagnosis.
In South Korea, a recent study found a prevalence rate of one in 38 children, and a study in England found autism at roughly the same rate -- 1 percent -- in adults as in children, implying that the condition had gone unidentified previously, rather than an actual increase in its incidence.
Those numbers are, of course, dependent on the definition of autism -- and the view of a diagnosis as desirable.
For John Elder Robison, whose memoir "Look Me in the Eye" describes his diagnosis in middle age, the realization that his social awkwardness was related to his brain wiring rather than a character flaw proved liberating.
"There's a whole generation of people who grew up lonelier and more isolated and less able to function than they might have been if we had taken steps to integrate them into society," he said.
Yet even some parents who find the construct of autism useful in understanding and helping children others might call quirky say that in an ideal world, autism as a mental health diagnosis would not be necessary.
"The term has become so diffuse in the public mind that people start to see it as a fad," said Emily Willingham, who is a co-editor of "The Thinking Person's Guide to Autism."
"If we could identify individual needs based on specific gaps, instead of considering autism itself as a disorder, that would be preferable. We all have our gaps that need work."
[end excerpts]
Tuesday, April 3, 2012
IEP's and Autism Spectrum Disorder
I've just returned from my third IEP meeting this week. These IEP meetingss were for children, all in grades 4-8, with Autism Spectrum Disorder, all high functioning, two were students who would be better diagnosed with Asperger's Disorder.
Oddly none of these IEP's mentioned an intervention for social cognitive deficits! None! There were concerns for behavioural issues (that's usually how I get asked to a meeting, because I specialize in behavioural disorders), academic problems and anxiety, two IEP's mentioned anxiety.
An IEP needs to FOCUS on the disorder which lead the child to be classified or designated ("coded" in BC schools) and bringing about the IEP. At the team meeting I discovered the reason for this lack of focus on the student's social cognitive deficits: No properly trained staff to implement an intervention. Sad, but true!
Academic goals were the most common issues addressed in the IEP. Parents of course want their children to do well academically so they often go along with an IEP that addresses one academic goal after another. Who doesn't want their child to do well in reading or math? But the child is receiving support services for a deficit of social cognition - not an academic deficit. Why don't these IEP's address this issue?
Almost always there was this, "Tommy will learn to ....." Fill in the blank. Seldom did the IEP mention how he would "learn to...." And seldom did it mention any issue in relationship to the psychoeducational assessment the student should have had prior to the IEP? (I can't tell you how often I go to schools in BC and find no real psychoeducational assessment for a child that is "coded." This is NOT suppose to happen, but it does. )
The psychoeducational assessment should be on the table, literally on the table, at every team meeting. It contains valuable information on the student's strengths and weaknesses that can help us determine which interventions will be successful, and which will not be. Often the "list of strengths and weaknesses" is nothing more than a list of comments taken at the beginning of the meeting. Don't waste this valuable information! And every parent should review the psychoeducational assessment with the school psychologist to see how the real data (as compared to opinions) relates to the IEP.
If your child has autism spectrum disorder, Asperger's Syndrome or another related problem with social cues and communication his or her IEP needs to address that. The IEP needs to say what the deficit is, how it will be supported, what tools and techniques will be use, who will implement them, how often for how long (so important!) and how we will measure the outcome. How will we know things are getting better. It's as simple as that.
Here is a simple IEP outline I like:
http://trainland.tripod.com/sample.htm
Ontario's IEP can be found here:
http://www.ontariodirectors.ca/IEP-PEI/IEP-PEI_Eng_Downloads/autism%20-%20sec.pdf
What's important is to ask yourself, "Are the areas that had deficiencies during the assessment for my child's diagnosis addressed in the IEP?" (This means the original assessment for the autism diagnosis done at the hospital or by a private clinician - you were asked to supply this in order to get services, and the psychoeducational assessment that was either part of that or came later.)
This means sensory issues, social cognition/social reciprocity (NOT social skills!), communications, behaviour, motor issues. These must be covered!
Recently I spoke with a parent who told me that she didn't get a copy of her son's IEP, but the school would send it if she wanted it... I was rather surprised to say the least. I asked what services her son was getting. Remember, he has autism, has an IEP, his school gets specific funding to provide support. Her answer was: "They are keeping an eye of him." Regretfully I've heard this too many times. Keeping an eye on things means we will wait for failure, then act. That's not a plan.
A key issue to remember is this: Your child, no matter how high or low functioning he or she is, needs to develop a set of skills they can use to approach life with. These skills are best taught when things are going well. Not during a crisis. This is why I tell parents and teachers not to avoid the use of basic tools like visual supports - so often abandoned because "my child is more advanced..." Visual supports, anti-anxiety skills, relaxation skills.
An IEP is an important document. It's a contract between you and the school. Make sure it tells you enough to know what to expect as outcomes for this year ....and upon graduation. Take the IEP process serious. Look up sample IEP's on the web. Talk to other parents. See a psychologist and ask him or her to look over the IEP before you sign it. Bring someone to the IEP with you. Go to every meeting.
Oddly none of these IEP's mentioned an intervention for social cognitive deficits! None! There were concerns for behavioural issues (that's usually how I get asked to a meeting, because I specialize in behavioural disorders), academic problems and anxiety, two IEP's mentioned anxiety.
An IEP needs to FOCUS on the disorder which lead the child to be classified or designated ("coded" in BC schools) and bringing about the IEP. At the team meeting I discovered the reason for this lack of focus on the student's social cognitive deficits: No properly trained staff to implement an intervention. Sad, but true!
Academic goals were the most common issues addressed in the IEP. Parents of course want their children to do well academically so they often go along with an IEP that addresses one academic goal after another. Who doesn't want their child to do well in reading or math? But the child is receiving support services for a deficit of social cognition - not an academic deficit. Why don't these IEP's address this issue?
Almost always there was this, "Tommy will learn to ....." Fill in the blank. Seldom did the IEP mention how he would "learn to...." And seldom did it mention any issue in relationship to the psychoeducational assessment the student should have had prior to the IEP? (I can't tell you how often I go to schools in BC and find no real psychoeducational assessment for a child that is "coded." This is NOT suppose to happen, but it does. )
The psychoeducational assessment should be on the table, literally on the table, at every team meeting. It contains valuable information on the student's strengths and weaknesses that can help us determine which interventions will be successful, and which will not be. Often the "list of strengths and weaknesses" is nothing more than a list of comments taken at the beginning of the meeting. Don't waste this valuable information! And every parent should review the psychoeducational assessment with the school psychologist to see how the real data (as compared to opinions) relates to the IEP.
If your child has autism spectrum disorder, Asperger's Syndrome or another related problem with social cues and communication his or her IEP needs to address that. The IEP needs to say what the deficit is, how it will be supported, what tools and techniques will be use, who will implement them, how often for how long (so important!) and how we will measure the outcome. How will we know things are getting better. It's as simple as that.
Here is a simple IEP outline I like:
http://trainland.tripod.com/sample.htm
Ontario's IEP can be found here:
http://www.ontariodirectors.ca/IEP-PEI/IEP-PEI_Eng_Downloads/autism%20-%20sec.pdf
What's important is to ask yourself, "Are the areas that had deficiencies during the assessment for my child's diagnosis addressed in the IEP?" (This means the original assessment for the autism diagnosis done at the hospital or by a private clinician - you were asked to supply this in order to get services, and the psychoeducational assessment that was either part of that or came later.)
This means sensory issues, social cognition/social reciprocity (NOT social skills!), communications, behaviour, motor issues. These must be covered!
Recently I spoke with a parent who told me that she didn't get a copy of her son's IEP, but the school would send it if she wanted it... I was rather surprised to say the least. I asked what services her son was getting. Remember, he has autism, has an IEP, his school gets specific funding to provide support. Her answer was: "They are keeping an eye of him." Regretfully I've heard this too many times. Keeping an eye on things means we will wait for failure, then act. That's not a plan.
A key issue to remember is this: Your child, no matter how high or low functioning he or she is, needs to develop a set of skills they can use to approach life with. These skills are best taught when things are going well. Not during a crisis. This is why I tell parents and teachers not to avoid the use of basic tools like visual supports - so often abandoned because "my child is more advanced..." Visual supports, anti-anxiety skills, relaxation skills.
An IEP is an important document. It's a contract between you and the school. Make sure it tells you enough to know what to expect as outcomes for this year ....and upon graduation. Take the IEP process serious. Look up sample IEP's on the web. Talk to other parents. See a psychologist and ask him or her to look over the IEP before you sign it. Bring someone to the IEP with you. Go to every meeting.
Autism Rate continue to Climb and Climb and Climb
The likelihood of a child’s being given a diagnosis of autism (ASD), Asperger's Syndrome or a related disorder seems to have increased more than 20 percent from 2006 to 2008. The New York Times and other major papers have proclaimed a definite rise.
Click here to view the article from the NYT
http://www.nytimes.com/2012/03/30/health/rate-of-autism-diagnoses-has-climbed-study-finds.html
Reading the New York Times we see there is a new report from the US Center for Disease Control (CDC) which estimates that in 2008 one child in 88 received one of these diagnoses (by the age of 8), known as autism spectrum disorders or ASD, compared with about one in 110 diagnosed with ASD two years earlier. Does this indicate that we are seeing an epidemic of autism, as some have speculated, or is the issue one of changes in the way we diagnose autism, or that we (doctor, teachers, parents) now pay more attention to the symptoms and therefore notice and then diagnose more children? At this point, it's not clear.
As some have suggested, one possibility is that we are seeing the result of better detection rather than a real surge in autism. However, there are some striking parts of this new CDC study that again makes us wonder if there isn't really an increase in the number of cases.
One report notes, "The rate of autism increased by more than 45% from 2002 to 2008 in numerous sites. It was a larger and more consistent increase than from 2002 to 2006. The increase was also very uneven in terms of geography, gender, race and ethnicity. Some sites had nearly five times as many children with autism as others. In several sites, almost 1 in 33 8-year-old boys were diagnosed with autism. This seems difficult to believe, particularly when these sites had smaller samples and children with less severe intellectual disabilities. One wonders if some sites became part of the study because of a long-term commitment to autism services, and this had drawn certain families to live nearby, resulting in an increase in the frequency of diagnoses made by local medical centers or educational programs." In other words, people may move closer to some centres that study autism and therefore the local rates are, indeed, higher.
Also, since the children didn't just meet the CDC study criteria for autistic characteristics -- 80% of them had autistic diagnosis from community physicians -- it may be that there is truly a higher rate of autism. Granted, the children were not actually seen by CDC researchers, so it's possible that the methods of diagnosis varied among the sites. All of these variations make it difficult to really understand this data. Apples and oranges.
So, what are the implications of this new study?
The CDC researchers are aware that it's critical to identify the sources of variability in their data. For example, why were nearly twice as many children diagnosed with autism in Utah than in Colorado or Arizona? If the rates are really increasing, does it mean that many more children, particularly those from ethnic or racial minorities who are often missed, could have autism and we just don't know yet? If we do a better job of identifying children with autism, the rate will certainly continue to increase. How do we address this issue, which is not unique to autism?
Thomas Insel, director of the National Institute of Mental Health, commented that the most useful approach right now is to assume that there is an increase in autism and try to figure out why this is happening. He says, "Regardless of all the unanswered questions, we should keep in mind that autism is a common condition. More children need autism services than ever before. We need cost-effective ways to identify the disorder at early ages, provide adequate support and work with affected families to help their children transition to adulthood."
"For families concerned that their child might have autism, it's important to be persistent in seeking help. The study suggests that children with autism in some parts of the country are much more likely to be recognized than in other parts, so seek the best resources possible and do not give up until you are sure. It may be that your child does not have autism since the disorder overlaps with various other common conditions such as delayed language ability and attention deficit disorder. Far more children don't have autism than do."
So, lets sum this up:
That is apparently a relative increase of 23% from a previous analysis of data from the same network of clinics and doctors for 2006, when the estimated prevalence was one out of 111 children, and a 73% relative increase from 2002, according to a surveillance summary in Morbidity and Mortality Weekly Report.
Understanding this is tricky because of a lack of objective diagnostic markers and changes in clinical definitions over time, so it's unknown how much of the increase is real and how much is related to changing diagnostic criteria and better identification of cases. But here is the important point: If these children really meet the diagnostic criteria for autism spectrum disorder, new, previously missed, finally noticed doesn't matter as much as: Are we funding research properly? At a rate that is commiserate with the seriousness of this disorder? Have we wasted enough money, time, research effort on false theories like autism and vaccines already? Is it time to start a "war on autism" like the war on cancer? Time to devote a lot more money to both treatment and research into prevention? Those questions can be answered, and the answer is yes.
Wednesday, March 21, 2012
Adults, Work and Asperger's Disorder
Social Thinking at Work
“a game changer…” — Special Education Advisor
I am often asked to recommend books for children, adolescents and adults with Asperger’s Syndrome. As many of you know my first choice is usually something by Michelle Garcia Winner, and again, for adults facing social cognitive deficit problems in the workplace it’s another book by Michelle Garcia winner.
Here is some of what is said about this excellent book:
“Needing help to understand social interaction in the workplace? Michelle Winner and Pamela Crooke are the ones to show you the ropes. This user-friendly guide to understanding social thinking on the job is a much-needed guide which simply and clearly outlines why brilliant workers might not be succeeding socially. If you are puzzled about why your work is of exceptional quality, but you are still not accepted by your co-workers, this guide is for you!” – Donna B. Wexler, MA, CCC-SLP
“Needing help to understand social interaction in the workplace? Michelle Winner and Pamela Crooke are the ones to show you the ropes. This user-friendly guide to understanding social thinking on the job is a much-needed guide which simply and clearly outlines why brilliant workers might not be succeeding socially. If you are puzzled about why your work is of exceptional quality, but you are still not accepted by your co-workers, this guide is for you!” – Donna B. Wexler, MA, CCC-SLP
This is a 205-page book based on the clinical experiences of these two top notch practitioners working with very high functioning adults (Aspergers) who have social learning challenges. They suggest that another possible title for this book was, “Good Intentions Are Not Good Enough,” given our observation that our clients have such good intentions and simply want to appreciated for what they are attempting to contribute (just like all of us)!
The authors say, “In this book, we have explained the ideas and lessons we often review in our clinical sessions to help our professional adults learn about the social world cognitively since they have struggled to learn this intuitively. Many of our adults who struggle socially don’t identify their problems with diagnostic labels. We also find our students/clients learn from a stronger base when exploring their own social cognition/social learning abilities and challenges rather than exploring which label fits them best. For this reason, we have avoided referring to diagnostic labels in this book.”
There are simply few practical books for individuals who are high functioning – productive workers who still need help understanding the social and emotional complexities of the workplace. This is a book about building and sustaining relationships in the workplace, a skill that is critical to adult and workplace success.
From Michelle’s site review: “Social functioning in the workplace is complicated for us all! Most adults continue to learn to develop better social coping strategies with age; our clients with social learning challenges are very capable of learning but need information about the social emotional relationship process presented in a more directed, stair stepped manner.”
Contents
The title’s from the book’s chapters help to convey the scope of the information covered in the book. In each chapter we explore the issues in depth with specific ideas for the reader to explore.
The title’s from the book’s chapters help to convey the scope of the information covered in the book. In each chapter we explore the issues in depth with specific ideas for the reader to explore.
Introduction: The Social Mind: It’s Always on the Job, Even When You’re Off the Job
Chapter 1: Social Thinking: What Is It, and How Is It Different From Social Skills?
Chapter 2: What Plays Into Good Communication Skills?
Chapter 3: Emotions: The Uninvited Guest That Keeps Showing Up
Chapter 4: Perspective Taking: Are You Thinking What I’m Thinking?
Chapter 5: The Four Steps of Communication
Chapter 6: The Core of Communication
Chapter 7: Fitting In
Chapter 8: Relating at Work
Chapter 9: Social Technology: How It’s Changeing the Way We Communicate
Chapter 10: Social Behavior Maps: Navigating the Social-Emotional World
Chapter 11: Strategies: Tips and Pointers
Chapter 1: Social Thinking: What Is It, and How Is It Different From Social Skills?
Chapter 2: What Plays Into Good Communication Skills?
Chapter 3: Emotions: The Uninvited Guest That Keeps Showing Up
Chapter 4: Perspective Taking: Are You Thinking What I’m Thinking?
Chapter 5: The Four Steps of Communication
Chapter 6: The Core of Communication
Chapter 7: Fitting In
Chapter 8: Relating at Work
Chapter 9: Social Technology: How It’s Changeing the Way We Communicate
Chapter 10: Social Behavior Maps: Navigating the Social-Emotional World
Chapter 11: Strategies: Tips and Pointers
The final chapter provides points of exploration for the reader to develop better self-awarenss of their own social functioning as well as tips to help them continue to learn new concepts and skills related to each of the previous chapters in the book.
The audience for this book is intended to be the person with social learning challenges -but it is useful for HR departments, college counselling centres and professionals working with individuals with these social cognitive challenges.
Reviews
Special Education Advisor, by Dennise Goldberg:
Special Education Advisor, by Dennise Goldberg:
“`Social Thinking at Work: Why Should I Care,’ by Michelle Garcia Winner and Pamela Crooke is a game changer. This book provides practical advice to every adult whether you are on the Autism Spectrum, Neurotypical (NT), or somewhere in between on how to navigate the social intricacies involved with the workplace. I have long held the opinion that the ability to socialize and get along with people is as important to creating a successful career as being good at your job. Thus, success very often requires a combination of academic intelligence and social intelligence. Social Thinking at Work creates a roadmap for those individuals with weaknesses in social intelligence to `better understand the expectations of the social mind’… I highly recommend this book to anyone that has ever experienced social challenges at work but especially for those adults on the autism spectrum or with known social weaknesses.”
Special Needs Book Review:
“Social Thinking at Work: Why Should I Care? is helpful to all adults in the workplace who wish they could blend in and have a better relationship with the others they meet or work with every day. You will benefit greatly from this book if:
You are unable to pick up facial or verbal cues.
You miss subtle behaviours used to convey emotions.
You struggle to recognize people’s feelings.
You have problems entering or exiting a group.
In a group you do not know what to do if you are not talking.
You do not know how to interpret sarcasm or read between the lines.
You can’t get people to listen to your ideas.
Social Thinking at Work: Why Should I Care? is also for parents, educators and service providers to teach the Social Thinking required for the development of real social skills. If your are an employer or work in the Human Relations department for a company, this book will help you understand human behavior and help you be more aware of the different feelings and needs of some of your employees.”
You miss subtle behaviours used to convey emotions.
You struggle to recognize people’s feelings.
You have problems entering or exiting a group.
In a group you do not know what to do if you are not talking.
You do not know how to interpret sarcasm or read between the lines.
You can’t get people to listen to your ideas.
Social Thinking at Work: Why Should I Care? is also for parents, educators and service providers to teach the Social Thinking required for the development of real social skills. If your are an employer or work in the Human Relations department for a company, this book will help you understand human behavior and help you be more aware of the different feelings and needs of some of your employees.”
About the Authors
Michelle Garcia Winner is a Congressional-award winning speech-language pathologist who specializes in treating individuals who are experiencing social and communication problems. She runs a clinic in San Jose, CA, has authored number books and speaks internationally on the Social Thinking treatment approach she developed. She serves on the panel of professional advisers of the Autism Society of America.
Michelle Garcia Winner is a Congressional-award winning speech-language pathologist who specializes in treating individuals who are experiencing social and communication problems. She runs a clinic in San Jose, CA, has authored number books and speaks internationally on the Social Thinking treatment approach she developed. She serves on the panel of professional advisers of the Autism Society of America.
Pam Crooke is part of the clinical faculty at San Jose State University and senior therapist at the Social Thinking Center in San Jose, CA. Prior to joining Social Thinking, she conducted research published in the Journal of Autism and Developmental Disorders on the effectiveness of the Social Thinking Vocabulary in the teaching of students with high-functioning autism.
Great book, available through Amazon.ca For more information on treatment for adults as individuals, couples and family units, please feel free to contact me or visit my web page at www.relatedminds.com
Adults with Aspergers and ASD in the workplace
I am often asked to see young adults with Asperger's to help them find "the right career." What is the right career for someone with Aspergers? Well that's really hard to say because the truth is individuals with Asperger's come in all shapes, sizes, colours, temperaments, with different dreams, wishes, hopes, abilities, skills, interests, talents and...deficits. Some people do find with working a full day...but have difficulty when they come home continuing a long period of social interaction, while some others can deal with 20 hours of work a week, or can only deal with work that involves few social interactions. But keep in mind, the vast majority of adults I see with Aspergers hold full time jobs, in exciting careers, doing complicated and demanding tasks. Some that I can't imagine myself doing. What work would suit them best? Ask them! And try different experiences out. If your working with a therapist there are ways to get a better idea about what might be more to your liking. This includes interest inventories, psychoeducational assessments and things like Michelle Winner's Social Thinking- Social communication Profile. (www.socialthinking.com)
Adults with AS can be very capable workers in the work force who are highly productive but struggle to relate socially. An example of this is the worker who is asked to sign a get well card for someone they don't know, and refuses. Or someone who just can't participate in the "small talk" that goes on and is necessary to be part of a team. These are often skills that need to be explained (psychoeducation), modelled and practiced in the workplace with feedback and....more practice. This can be difficult and anything but rewarding at first. These individuals need support throughout the process.
There is a good book available for those trying to learn about counseling adults with AS, Cognitive Behavioural Therapy for Adult Asperger Syndrome by Valerie Gaus. This is really a book for the therapist rather than the client, but its a minimal requirement for anyone you might find yourself working with.
So what are some of the types of issues I've dealt with in the past few weeks with my own clients with AS? Heres a short list:
1. Dealing with anxiety through Cognitive Behavioural Therapy
2. Dealing with depression through Cognitive Behavioural Therapy
3. Learning to listen to others and hold a conversation that's two way - using reflective thinking and understanding the perspective of others
4. Using Michelle Winner's "Social Behaviour Mapping" program
5. Dealing with a spouse and child after a full day at work
6. Understanding appropriate limits in email (a pretty common problem for everyone at work!)
7. Dealing with panic attacks
8. Dealing with OCD behaviours
9. Anger management and assertiveness training
10. Staying awake and off the internet
11. Goal setting, time management and planning large projects
12. Workplace romanace, and sexual appropriateness
13. Going to Vegas with workmates
14. Going out after work and engaging in small talk
15. Asking for a raise
When I look over this list I realize it isn't that much different than anyone else's list of problems and concerns. So don't be discourages, get to work, find a coach or therapist and get ready to jump in!
For more information on my practice and services I provide, including full diagnostic services for autism spectrum disorder (ASD) for children, adolescents and adults, as well as individual, couple and family therapy, please see my website at http://www.relatedminds.com or at http://www.relatedminds.com/autism/
.................................................................
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)
…………….
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.
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)
…………….
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
Tuesday, February 21, 2012
About Counselling and Therapy Services (Burnaby/Vancouver)
As a Registered Psychologist I provide individual therapy and counselling services using the evidence based techniques of Cognitive Behaviour Therapy (CBT) and Rational Emotive Behaviour Therapy (REBT). Individuals are seen in both my Burnaby and Vancouver offices for a variety of issues including chronic pain, depression, anxiety, stress, panic, anger management, ADHD and work or relationship issues.
I hold an Advanced Certificate in Cognitive Therapy from the Albert Ellis Institute in New York. If you are looking for a cognitive therapist you should ask what training they have in CBT, as many individuals claim they practice CBT after completing only a workshop or reading a book. The Advanced Certificate Program at the Albert Ellis Institute included extensive CBT readings, group and individual training and supervised practice of Cognitive Behaviour Therapy/Rationale Emotive Behaviour Therapy under the supervision of a licensed mental health practitioner. In addition to my practicum at the Ellis Institute I also focused on CBT during my graduate studies and post doctoral internship. Registered Psychologists undergo one year of of full time supervised practicum experience, as well as a year of post doctoral experience. Since graduation I have practiced counselling and therapy for over 20 years and have served as the program director and practicum supervisor in several hospitals, universities and community mental health centres.
FAQs:
Could you tell me more about Cognitive Behaviour Therapy (CBT)?
My primary mode of practice is rational-emotive/cognitive therapy. Cognitive Behaviour Therapy or CBT (including Rational Emotive Therapy) is a highly effective, research driven approach that helps people to combat and overcome such difficulties as high anxiety/stress, panic attacks, depression, anger, relationship problems, phobias, worry, obsessions, compulsions, addictions (food or drugs), social anxiety, sexual problems, ADHD and low self-esteem. The course of treatment is typically short-term (approximately 8-12 sessions), and people often enjoy rapid and enduring relief from their symptoms. I am also trained in other counselling and therapy techniques, and use these when and where appropriate. Overall I try to match the skills and techniques to your needs. My office provides a supportive, caring and safe environment to work on change and focus on growth and future success.
I have heard about "Schema Therapy," what's that?
Schema-Focused Cognitive Therapy goes further, to help people address and break long-standing or particularly stubborn patterns of thinking, feeling and behaving that arise from deep-seated beliefs, such as “I’m unlovable,” “I’m a failure,” “People don’t care about me,” “I’m not important,” “Something bad is going to happen,” “People will leave me,” “I will never get my needs met,” “I will never be good enough,” etc. Remarkable results have been achieved via the Schema-Focused approach, even for people who have previously found other therapies to be ineffective. Results of course cannot be guaranteed, however, compared with other types of therapeutic intervention research has shown Cognitive Therapy to be effective.
Schema-Focused and Rational Emotive and Cognitive Behaviour Therapy do more than address symptoms, they address a way of thinking that causes you problems in life, work and relationships. In addition to individual therapy I often recommend readings which emphasize the personal growth aspects of cognitive behaviour therapy as well as those that focus on symptom relief.
Do you do any "Mindfulness" work?
In collaboration with other health related professionals I have recently (the past two to three years) begun to offer a longer and more intensive form of Cognitive Behaviour Therapy called Mindfulness Based Cognitive Therapy (MBCT). This method of therapy blends together features of two disciplines: Cognitive Behaviour Therapy (CBT), which aims to identify and alter cognitive distortions (irrational or inaccurate thoughts) and Mindfulness, which is a meditative (mental focusing) practice taken from Buddhism which aims to help people identify their thoughts, moment by moment, but without passing judgement on the thoughts. As with other medically based meditative interventions, this is not a religious oriented practice, but a scientifically supported methodology used in many medical and mental health centers throughout the world. This particular intervention is based upon Mindfulness-Based Stress Reduction (MBSR), an eight week program developed by Jon Kabat-Zinn in 1979 at the University of Massachusetts Medical Center. MBSR research has shown that this combined intervention method is enormously empowering for patients with chronic pain, hypertension, heart disease, gastrointestinal disorders, ADHD, as well as psychological problems such as anxiety, panic and depression.
More about Cognitive Behaviour Therapy
Albert Ellis and the Institute for Rational Emotive Behaviour Therapy
In 1955 Dr. Albert Ellis developed Rational Emotive Behaviour Therapy or “REBT” which is an action-oriented therapeutic approach that stimulates emotional growth by teaching people to replace their self-defeating thoughts, feelings and actions with new and more effective ones. REBT teaches individuals to be responsible for their own emotions and gives them the power to change and overcome their unhealthy behaviors that interfere with their ability to function and enjoy life.
Today the Albert Ellis Institute is a world center of research, training, and practice of REBT, its founder Dr. Albert Ellis remains one of the most influential psychologists of our time, and authored more than 70 books and 700 articles all designed to help people overcome destructive, self-defeating emotions and improve their lives. Later Dr. Aaron Beck developed what is commonly called Cognitive Behaviour Therapy (CBT) along the same lines as REBT. Today these two cognitive based therapies are very similar, although some specific techniques may differ in the two schools of practice. Both are referred to as Cognitive Behaviour Therapy. I have received both my Basic and Advanced Certificates in Cognitive and Rational Emotive Therapy through the Albert Ellis Institute in New York City. For more information you can click here:
http://www.rebt.org Albert Ellis Institute in New York City
What will I be learning in Cognitive Behaviour Therapy (REBT/CBT)
and Schema-Focused Therapy?
You will learn to:
1. Identify the themes and patterns in your thoughts, feelings and behavior that cause you emotional wear and tear;
2. Learn how to handle your thoughts and manage your emotions so that you feel better and cope more effectively;
3. Learn how to handle problematic situations to maximize positive outcomes and experiences;
4. Prevent maladaptive cycles of thinking, feeling and behaving from repeating over and over again;
5. Find ways to reach your goals and get your needs met rather than running up against the proverbial brick wall.
Could you say more about Schema-Focused Cognitive Therapy?
Schema-Focused Cognitive Therapy is the approach developed by Jeffrey E. Young, Ph.D., who was a protégée of Dr. Aaron Beck. Prior to his founding the Cognitive Therapy Centers of NY and Connecticut, as well as the Schema Therapy Institute, Dr. Young served as the Director of Research and Training at the Center for Cognitive Therapy at U. Penn with Dr. Beck, where he trained many clinicians in the application of CBT. In working with clients, however, Dr. Young and his colleagues found a significant segment of people who came for treatment but had perplexing difficulty in benefiting from the standard approach. He discovered that these people typically had long-standing patterns or themes in thinking and feeling—and consequently in behaving or coping—that required a different means of intervention. Dr. Young’s attention turned to ways of helping patients to address and modify these deeper patterns or themes, also known as “schemas” or “lifetraps.”
The schemas (listed below) that are targeted in treatment are enduring and self-defeating patterns that typically begin early in life, get repeated and elaborated upon, cause negative/dysfunctional thoughts and feelings, and pose obstacles for accomplishing one’s goals and getting one’s needs met. Although schemas are usually developed early in life (during childhood or adolescence), they can also form later, in adulthood. These schemas are perpetuated behaviorally through the coping styles of schema maintenance, schema avoidance, and schema compensation. Dr. Young’s model centers on helping the person to break these patterns of thinking, feeling and behaving, which are often very tenacious.
In formulating the Schema-Focused approach, Young combined the best aspects of cognitive-behavioral, experiential, interpersonal and psychoanalytic therapies into one unified model of treatment. Through Young’s work and the efforts of those trained by him, Schema-Focused Therapy has shown remarkable results in helping people to change patterns which they have lived with for a long time, even when other methods and efforts they have tried before have been largely unsuccessful.
Schema’s that REBT / Cognitive and Schema Focused Therapy Focus on:
Emotional Deprivation: The belief and expectation that your primary needs will never be met. The sense that no one will nurture, care for, guide, protect or empathize with you.
Abandonment: The belief and expectation that others will leave, that others are unreliable, that relationships are fragile, that loss is inevitable, and that you will ultimately wind up alone.
Mistrust/Abuse: The belief that others are abusive, manipulative, selfish, or looking to hurt or use you. Others are not to be trusted.
Defectiveness: The belief that you are flawed, damaged or unlovable, and you will thereby be rejected.
Social Isolation: The pervasive sense of aloneness, coupled with a feeling of alienation.
Vulnerability: The sense that the world is a dangerous place, that disaster can happen at any time, and that you will be overwhelmed by the challenges that lie ahead.
Dependence/Incompetence: The belief that you are unable to effectively make your own decisions, that your judgment is questionable, and that you need to rely on others to help get you through day-to-day responsibilities.
Enmeshment/Undeveloped Self: The sense that you do not have an identity or “individuated self” that is separate from one or more significant others.
Failure: The expectation that you will fail, or belief that you cannot perform well enough.
Subjugation: The belief that you must submit to the control of others, or else punishment or rejection will be forthcoming.
Self-Sacrifice: The belief that you should voluntarily give up of your own needs for the sake of others, usually to a point which is excessive.
Approval-Seeking/Recognition-Seeking: The sense that approval, attention and recognition are far more important than genuine self-expression and being true to oneself.
Emotional Inhibition: The belief that you must control your self-expression or others will reject or criticize you.
Negativity/Pessimism: The pervasive belief that the negative aspects of life outweigh the positive, along with negative expectations for the future.
Unrelenting Standards: The belief that you need to be the best, always striving for perfection or to avoid mistakes.
Punitiveness: The belief that people should be harshly punished for their mistakes or shortcomings.
Entitlement/Grandiosity: The sense that you are special or more important than others, and that you do not have to follow the rules like other people even though it may have a negative effect on others. Also can manifest in an exaggerated focus on superiority for the purpose of having power or control.
Insufficient Self-Control/Self-Discipline: The sense that you cannot accomplish your goals, especially if the process contains boring, repetitive, or frustrating aspects. Also, that you cannot resist acting upon impulses that lead to detrimental results.
Reference: "A Client's Guide to Schema-Focused Cognitive Therapy" by David C. Bricker, Ph.D. and Jeffrey E. Young, Ph.D.,
Cognitive Therapy Center of New York. 1999
Summary
I hope you have found this very brief introduction to Cognitive Behaviour Therapy useful. In the office we discuss these issues, practice understanding our “automatic” and often irrational thinking, and learn to apply cognitive behaviour techniques to stop and change these debilitating thoughts. Progress is made through a combination of in-office counselling/therapy, readings and homework during which you apply what you have learned and practiced in the real world. While CBT may often be the primary therapy technique we use I often also involve psycho-education (direct teaching about your mental health issues), behavioural techniques and sometimes use my skills in Systemic and Family Therapy to address issues you may have with relationships, family or at work.
Fees
EAP and EFAP consignment, crime victims assistance program as well as extended insurance and self-pay are accepted. Session fees are $175.00 per hour. There is a sliding scale available to those will lower incomes. I also accept credit cards through on-line PayPal.
.............................................
Psychological services (including assessment, testing and therapy) provided in my offices include (covered by most extended health care insurance):
Anxiety and Stress (click here:) http://www.relatedminds.com/anxiety-stress/">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/
Couples Counselling / Therapy (click here:) http://www.relatedminds.com/couples-therapy/
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 | Psycho-educational Assessment | Neuropsychological Assessment
Subscribe to:
Posts (Atom)