Punishment in the Schools for Students with Asperger's or Autism Spectrum Disorder

Our Province is know for it’s poor treatment of special education students. For example, read this about students with ADHD in Canada: http://shar.es/1X3bOa or here: http://www.ldao.ca/educational-implications-of-recent-supreme-court-ruling/   These articles demonstrate some of the evidence of what parents of students with ADHD are up against when dealing with the public school system here in BC.

But more shocking than how students with ADHD can be is the treatment of children with autism spectrum disorder (ASD) or "Asperger’s Disorder" sometimes called high functioning autism.  On my desk right now is a folder of writing assignments I have copied over the years given to students with autism/Asperger's as the result of behavioural issues they have had in the school. They may have hit another child, got in a fight, refused to cooperate or follow rule or yelled something inappropriate. These writing assignments range from a “Behavioural Worksheet” which calls for a student to fill in a blank worksheet that is a problem solving techniques (which I myself have used, with appropriate children) to a list of questions about what the student had done wrong and what he or she will do to make up for their behaviour to a sheet of sentences they needed to copy repeatedly, yes, “ I will not…..” just like Bart Simpson.

Oh, I also have an outline of a public meeting where the student was suppose to take part in a “restitution process” which I was told is based upon a "First nations" way of dealing with conflict…and called for the student, an elementary student with autism spectrum disorder, to make a public apology while standing in front of his entire class, state what he did, why it was wrong and explain how he would change…oh, he also discussed his diagnosis and medications with the other students. His teacher thought they should know. That day I had great difficulty containing myself, especially when in response to my concerns about using punishment as a corrective intervention with students with diagnosed mental health issues i heard that, “every student should be treated the same, fairly.” Otherwise, “what would other students think?”

In none of these classrooms were their any of the well researched classroom management techniques taking place such as token reinforcement systems, visual support systems, use of a "time away" procedure instead of punitive time out (read here to know the difference: http://www.pent.ca.gov/beh/rst/timeaway.pdf  Sometimes this is very frustrating. The constant questioning if a student is doing something, "because he wants to" or "because of his disorder." More time is honestly spent trying to answer that question than to figure out what deficits the student has and what skills they need to learn or supports need to be provided. Sometimes we spend a lot of energy in the wrong place.

Let me quote:
“Students with autism spectrum disorders (ASD) present unique challenges to educators trying to plan effective instructional programs…..6 core elements that have empirical support and should be included in any sound, comprehensive instructional program for students With ASD. These core elements are (a) individualized supports and services for students and families, (b) systematic instruction, (c) comprehensible/structured learning environments, (d) specialized curriculum content, (e) functional approach to problem behavior, and (f) family involvement.” (Effective Educational Practices for Students with Autism Spectrum Disorder,   Rose Iovannone, SAGE Press.
Our BC Minstry of Education actually does have some guidelines, and those can be found here:
http://www.bced.gov.bc.ca/specialed/docs/autism.pdf  If your a parent of a child with ASD I would get a copy of these guidelines.

In spite of these guidelines we find some odd things happening. In the past few years I have visited schools and found “TimeOut” or Isolation Rooms for students with autism. In some cases I can understand this, but these rooms had no rules, no manual of “policies and procedures” to be used, no real limits and seemed to have no purpose. Oddly, in those cases there were not even Functional Behaviour Assessments completed on the students, or Positive Behavioural Support Plans developed. (More on this below) All that existed were “Risk Assessments,” which, if you read the regulations about Risk Assessments you would come to realize they have NOTHING to do with student, and are only used to address danger to staff and other students. "Risk Assessments" which are constantly written up on 5 and 6 year old students here in BC are a Work Place Safety procedure, not an educational procedure.  Remember this when they discuss the "Risk Assessment" they have developed on your 6 year old after he punched an aide. About these Time Out rooms, there were no plans, and they were shut immediately. Read these articles if you think this is unusual:
https://ca.news.yahoo.com/blogs/dailybrew/advocates-demand-b-c-schools-end-called-seclusion-213327613.html
http://www.edu.gov.on.ca/eng/general/elemsec/speced/asdfirst.pdf

If your looking for some positive guidelines on what a good program for a student with autism should consist of, try this webpage from the Ministry of Education in Ontario:
http://www.edu.gov.on.ca/eng/general/elemsec/speced/autismSpecDis.htm

And to make the point clear that schools in BC are often simply not prepared to deal with children with ASD/Aspergers/autism here is an interesting blog article about a child in a Langley school who was removed by Work Safe BC because staff were not properly trained!  This article, and the outcomes, are shocking.
http://autisminnb.blogspot.ca/2011/04/child-with-autism-removed-from-bc.html

Finally, to understand how backwards and ill prepared BC schools are compared to ANY school in the US, I advise parents to visit this website and see the strengths of the US system, where children are guaranteed a “free and appropriate public education” (FAPE) and schools are legally held to the contracts they sign with parents (IEPs -individual education plans are CONTRACTS). In the US a parent doesn’t need to spend all their money on court costs and have cases go on for a decade, only to have the school district lose but then say the outcome of the case only applied to this one student.
http://www.wrightslaw.com

Here is what I have to say about punishment and students with autism spectrum disorder- especially Asperger’s Disorder:
I understand that there are some situations where a student should experience the same consequences as others. I get that. But a special education student with an IEP is NOT bound to the same school rules as every other student. They are provided appropriate accommodations and supports consistent with their IEP and their handicapping condition.

If a student with Asperger’s or high functioning autism is given punishment, it should be done so in a way that takes into account their mental health condition. A school needs to pay special attention to what might be negative outcomes from an especially sensitive student. For example: Does this punishment increase the student’s ANXIETY, which is a primary symptom of the disorder? Might it lead to school refusal, depression….the list goes on. This needs to be thought about honestly and seriously.

DON’T administer punishments that will only make maters worse. For instance, a teacher told the parent that after a fight the child’s trip to the zoo, in two weeks, should be taken away. It’s unlikely that a punishment one, two or town days later will have any effect.

And ask yourself, is what I am proposing going to be effective? Taking into account that autism spectrum disorder in a disorder of social communications, social understanding and is a neurological disorder?

And then the most important part: No what are YOU, the teacher, teacher, school, parent, going to do about this? Are you going to conduct a Functional Behavioural Assessment? This SHOULD be done before or at the same time a “Risk Assessment” is done. If a child needs a “Risk Assessment” written up on them, ask “Where is the FBA?” and then the plan that comes from it —- the Positive Behavioural Support Plan (PBSP)? If there is no FBA and PBSP then the student’s handicapping condition was ignored. No learning will occur. And you punished for punishment’s sake.

Here in BC the Ministry is clear on the need for an FBA - a Functional behavioural Assessment. Many people think the “Risk Assessment” is about the child. IT IS NOT. If a school district is writing a “Risk Assessment” on your child and has no plan to address the skills your child needs to be taught, they are confused and going down the wrong path. Contact the director of special education or superintendents office in writing and ask about the plan your child really needs.

Foor more information on ADHD, autism spectrum disorder and school related behaviours please feel free to contact my office via my website at www.relatedminds.com

http://psyris.com/drjimroche

http://www.actcommunity.ca/profiles/224/

http://www.psychologists.bc.ca/users/jimroche

www.therapistlocator.net/member?226046

http://psychologybc.weebly.com

http://www.medident.ca/show_page_general.php?id=3203

http://www.aamft.org/cgi-shl/TWServer.exe?Run:LOCATECN_2:TradeWinds_KEY=201

http://www.yelp.ca/biz/dr-jim-roche-registered-psychologist-burnaby

http://www.canpages.ca/page/BC/burnaby/dr-jim-roche-registered-psychologist/5087170.html

Key Words: Autism, Autism Spectrum Disorder, Vancouver, Burnaby, ASD, Asperger's, Asperger's Disorder, Asperger's Syndrome, School, Punishment, Classroom

Is the Best Treatment for Teens with Asperger's or Autism Social Skills?

Looking at several websites I find that the most often suggested treatment (counselling or therapy) for teens with Asperger's Disorder or teens with  "high functioning autism" is usually social skills training. While the websites often seem to be produced by people who should be familiar with treatment for teens with Asperger's or autism spectrum disorder, they demonstrate a misunderstanding of the disorder right from the start. From the "My Aspergers Child" webpage here are the goals for social skills training for helping kids and teens with Aspergers:

1. read body language of others
2. play and have fun
3.learn to cope with mistakes
4. learn strategies for developing peer relationships
5.learn peer group problem solving
6. become aware of their emotions

And it then follows with this statement, " Aspergers kids are pliable to treatment because they tend to be compliant."  All of this seems to run counter to what I experience day to day with kids and teens with Asperger's or high functioning autism. As a trainer and consultant with many school districts ( I am also a member of the BC RASP and an approved Behavioural Specialist with the ministry) I hear kids with Asperger's are difficult for those teaching social skills because of their lack of cognitive flexibility and ritualistic behaviour. So I spend much of my time trying to distinguish for these educational partners the difference between a "social skills" group and a "social learning" group.  Thinking teens with Asperger's need, most of all, social skills training is to be going down the wrong neurological pathway.

Where can one turn for ideas and techniques to use with teens with Asperger's and high functioning autism? Turn to the web page social thinking.com  This website is about the work of a speech pathologist Michelle Garcia Winner who has a clinic in San Jose, California. She has trained most professionals working with teens with Asperger's here in the Northwest and BC, including myself. And notice she is a speech pathologist. That's because Asperger's or high functioning autism is not a disorder of social skills - many of these kids and teens can tell you all you ever want to know about social skills, instead it is a disorder of communications and executive functioning. Yes, developmentally BECAUSE of Asperger's or autism your teen may have missed out on experiencing and learning developmentally appropriate social skills, and those need to be reviewed. But at the heart of the matter are the child's social-cognitive-speech deficits. And that's where treatment should start.

When you visit Michelle's web page you will see many many social cognitive directed books, training manuals for teachers and posters, stories, all you need. These are the materials I use with children with Aspergers, teens with Asperger's and yes, my work with adults with Asperger's disorder.

Here is an outline of what treatment for a child, teen or adult with Asperger's Disorder should look like, a brief synopsis of Michelle's model from her web page found here:  https://www.socialthinking.com/what-is-social-thinking/the-ilaugh-model

" I = Initiation of Communication (Kranz & McClannahan, 1993)
Initiation of communication is the ability to use one’s language skills to establish social relations and to seek assistance or information from others. Many students with autism spectrum disorders have significant problems initiating communication in stressful situations or when information is not easily understood. Language retrieval is difficult in anything other than calm, secure situations. Even within the higher functioning population with autism spectrum disorders, the student’s ability to talk about a favorite topic of interest can exist in sharp contrast to how that student communicates when needing help or when attempting to gain social entry into peer groups. Yet, these two skills – asking for help and understanding how to join a group for functional or personal interaction - are paramount for any student’s future success.

L= Listening With Eyes and Brain (Mundy & Crowson, 1997; Kunce and Mesibov, 1998; Jones & Carr, 2004)
Many persons with autism spectrum disorders and other social cognitive deficits have difficulty with auditory comprehension. From a social perspective, listening requires more than just taking in auditory information. It also requires the person to integrate information seen with that which is heard, to understand the full meaning of the message being conveyed, or to make an educated guess about what is being said when one cannot clearly understand it. For example, classroom teachers expect students to “listen with their eyes” when they point to information that is part of the instruction. They also indicate to whom they are speaking in a class, not by calling the student’s name but instead by looking at the student or moving closer. Students repeatedly relate to their peers through nonverbal cues, ranging from rolled eyes to signal boredom, to raised eyebrows to indicate questioning, to gazing at a particular item to direct a peer’s attention. Clearly to “listen with one’s eyes” requires students to have mastered the concept of joint attention – a skill that seems to effortlessly develop by the time a child is 12 months to 15 months old in neurotypical children, but may be missing from the social repertoire of the student with autism spectrum disorders, ADHD and similar challenges. Instruction in this essential and fundamental function of social interaction begins with teaching students that eyes share social information. Not all students understand this concept, nor do they grasp that listening requires full attention to both verbal and nonverbal cues. It can then expand to teaching students to relate to each other’s thoughts through play and other activities of social relatedness, followed by extending the student’s realm to attending to and processing increasingly complex cues that help students “listen with their whole bodies.”

A = Abstract and Inferential Language/Communication (Minshew, Goldstein, Muenz & Payton, 1992)
Most of the language we use is not intended for literal interpretation. Our communication is peppered with idioms, metaphors, sarcasm and inferences. Societies around the world bestow awards to writers, and even comedians, who are most creative with language. Each generation of teens creates its own slang; kids who follow along are in; those who don’t, are often out. Advertising and other forms of mass media follow these cues. The abstract and inferential component of communication is huge and constantly in flux. It is a mistake to assume that our students with social thinking deficits understand our society’s non-literal use of language. In fact, most of them don’t! Literal interpretation of language is a hallmark characteristic of individuals with ASD. Yet, as educators and parents, we either miss this impairment entirely – thinking our smart kids must understand our nuanced communication - or we address it in the briefest of ways, with instruction dedicated only to explaining idioms, irony and metaphors as part of English class.

Accurate comprehension of a communicative message depends first on the basic recognition that two codes of language exist: literal and figurative. It also involves recognizing and interpreting both the verbal words and the nonverbal cues that accompany them. It requires an individual to place the communication within the context of the social and cultural environment within which it occurs. Furthermore, the listener must take into consideration any prior knowledge or history involved and the possible motives of the person initiating the message. Finally, emotional maturity and social development factor into how well a person interprets what is being said.

Active interpretation of the motives and intentions of others emerges in the first year of life and expands in complexity thereafter. Children learn that mom’s tone of voice speaks volumes and that attention to only her words can miss much of her message. As children grow developmentally, they understand that message interpretation depends heavily on one’s ability to “make a smart guess” based on past experiences, what they know (or don’t know) about the current person and situation and the communication clues available. Language users assume their communicative partners are trying to figure out their messages. By third grade, neurotypical students understand that we are to infer meaning rather than expect it to be coded literally.

Abstract and inferential language comprehension appears to be directly tied to a person’s ability to quickly and flexibly discern the different thoughts, perceptions and motives of other people – in essence to “read the mind” of another from a social perspective.

For example, a 17 year-old teenager with high-functioning autism was visiting this author at her house. When the author tried to strike up a conversation with the teenager by saying to him, “I hear you are in the school choir”, the teen responded with, “No, I am in your house.” This is not sarcasm, but literal language interpretation.

Students who fail to expeditiously interpret the abstract/inferential meaning of language also struggle with academic tasks such as reading comprehension, especially that which requires interpreting a character’s thoughts and actions based on the context of the story and what one understands about the character’s history and motives. Without the benefit of real-world experience, these students are unable to imagine how characters might think, feel and act within the story.

U = Understanding Perspective (Baron-Cohen & Jolliffe, 1997; Baron-Cohen, 2000)
To understand the differing perspectives of others requires that one’s Theory of Mind (perspective taking) work quickly and efficiently. Most neurotypical students acquire a solid foundation in ToM between the ages of 4 to 6 years old. Perspective taking is not one thing, it represents many things happening all at once meaning it is a synergistic and dynamic process. A definition of perspective taking can include the ability to consider your own and others:

• Thoughts
• Emotions
• Physically coded intentions
• Language based intentions
• Prior knowledge and experiences
• Belief systems
• Personality
• While considering all of this with regards to the specific situation being considered.

Perspective taking is required any time you are in the presence of other people, even when you are not talking to them. Responding to another person’s perspective while communicating with them requires you do all of the above in relative light-speed, processing and responding your own as well as other’s thoughts within milliseconds to two seconds. The process can be overwhelming to those with social learning challenges, even if they are very bright.

The ability to take perspective is key to participation in any type of group (social or academic) as well as interpreting information that requires understanding of other people’s minds, such as reading comprehension, history, social studies, etc. Weakness in perspective taking is a significant aspect of ASD and other social cognitive deficits. However, like all other concepts explored in the ILAUGH model, one’s ability to take perspective is not a black or white matter. There is a vast range of perspective taking skills across the autism spectrum (Winner, 2004)

G=Gestalt Processing/Getting the Big Picture (Shah & Frith, 1993; Fullerton, Stratton, Coyne & Gray, 1996)

Information is conveyed through concepts, not just facts. When involved in conversation, the participants intuitively determine the underlying concept being discussed. When reading a book of literature, the purpose is to follow the overall meaning (concept) rather than just collect a series of facts. Conceptual processing is a key component to understanding social and academic information. Difficulty developing organizational strategies cannot be isolated from conceptual processing. Students with conceptual processing challenges often have difficulties with written expression, organizational skills, time management and being overly tangential in their social relations. (All of these concepts require us to stay focused on a central theme or main idea and to keep our writing, discussions or planning focused to this central point. Many of our folks struggle with this, over-focusing on details and not focusing in the concept (an intuitive skills for neurotypicals).

H= Humor and Human Relatedness (Gutstein, 2001; Greenspan, & Wieder, 2003; Prizant, Wetherby, Rubin, Laurent & Rydell, 2006)
Most individuals with autism spectrum disorders, Asperger’s and similar challenges have good senses of humor, but they feel anxious since they miss many of the subtle cues that help them understand how to participate successfully with others. It is important for educators and parents to work compassionately and with humor to help minimize the anxiety these children are experiencing. At the same time, many of our clients use humor inappropriately; direct lessons about this topic are needed and relevant.

Human relatedness - the ability to bond emotionally with others - is at the heart of human social relationships and the fuller development of empathy and emotional regulation. Teaching students how to relate and respond to other people’s emotions as well as their own, while also helping them feel the enjoyment that arises through mutual sharing, is critical to the development of all other aspects of social development. " (selection taken from the above webpage)

Books related to the above discussion include:

1. Inside Out: What Makes a Person with Social Cognitive Deficits Tick?
2. Thinking About YOU Thinking About ME, 2nd Edition

If you have a child, teen or you are an adult with Asperger's disorder of High Functioning Autism (HFA) I urge you to click on the link above and visit her web page. This is basic and essential knowledge that should be at the forefront of any treatment program. I cannot recommend her books enough!

Are there other issues that teens with Asperger's need to deal with?

Yes, just like any teen, teens with Asperger's disorder can suffer from anxiety, stress, depression...learning disabilities or ADHD. They can have a mood disorder or a speech disorder. When finding a clinician to work with your child make sure they are capable of dealing with these issues- and have experience dealing with them from the point of view of someone with Asperger's or autism spectrum disorder. The treatment for an individual with Aspeger's needs to come from knowledge about the neurological implications of the disorder.

One final note: Most of the teens and young adults I see in my private practice are doing well in many areas of life. Parents often feel overwhelmed and hopeless when they get their child's diagnosis. Most of the adults I see having problems with depression, anxiety or relationship issues have good paying jobs, have attended college or university, many..if not most..of my clients with Asperger's have graduate degrees and significant careers. Like the rest of us, sometimes they need a little support in life. But our expectations should be high.

Please feel free to contact me about autism spectrum disorder or Asperger's disorder. I provide testing and diagnosis for the Ministry of Family Services, help with educational planning, provide couples, marriage and family counselling and see individuals for supportive therapy and coaching. My website is at: www.relatedminds.com or http://www.relatedminds.com/autism/

KEYWORDS: Aspergers, Asperger's Disorder, autism spectrum disorder, teen, adult, therapy, counselling, Vancouver, Burnaby, Seattle, behaviour interventionist, psychologist

Adult Autism Testing and Assessment

In my offices in Vancouver and Burnaby I complete assessments / testing for Aspergers and Autism Spectrum Disorder. While until recently these were two different diagnoses they are now, in the DSM-5, combined and what we all would have agreed was "Asperger's Disorder" or "Asperger's Syndrome" last year this year is referred to as Autism Spectrum Disorder - a disorder on the autism spectrum.

My practice has focused on teens, young adults and adults with Aspeger's for the past 20 years, since I worked in Souther California and received training in treating Asperger's from Michelle winner through my local school district where I served as the behaviour management specialist.

Why get a diagnosis?
First, I don't always suggest getting a full diagnosis. The problem is the cost. This is not a simple process like going to the doctor to get a diagnosis of a cold or flu. There are many complicating factors and possible causes for Asperger's Disorder/Autism Disorder like symptoms in an adult. These can include a personality disorder, depression, anxiety, OCD or other neurological issue.

This means a couple of days of testing using state of the art methods. I follow the same criteria which the province of British Columbia has set forth for diagnosing children: The ADOS (Autism Diagnostic Observation System) and the ADI-R (Autism Diagnostic Inventory-Revised) as the heart of the Asperger's/Autism diagnosis, along with scales and tests that address depression, anxiety, OCD and personality issues. While in some situations someone might use just one test or checklist, this is insufficient for two reasons: First, legally the diagnosis is used to obtain many benefits and legal accommodations, and 2) A good number of individuals with Asperger's/Autism have comorbid conditions such as depression, anxiety or ADHD. ADHD (Attention Deficit Hyperactivity Disorder) is a common comorbid condition, and not properly treating these disorders, sometimes FIRST, can make treating Asperger's or autism difficult or impossible.

Should you get a formal diagnosis? If you can, yes. Go to your GP and ask for a referral to a psychologist or psychiatrist who is familiar with Asperger's / Autism and move forward.

What would symptoms look like?
Most individuals with Asperger's/Autism have difficulty with social communication, difficulty with social interactions, difficulty with social imagination and some repetitive, hyper focused behaviours or thinking processes.

You may want a diagnosis as an adult who potentially has Asperger's or autism spectrum disorder in order to understand yourself, to help you understand your behaviours and difficulties, and to help you understand how treatment - much of it psychoeducation and coaching - can help you.

How much does an assessment cost?
It varies from individual to individual, but usually around $1,200.00 for a full assessment. Some individuals also need a psychoeducational assessment to get appropriate accommodations at college or on the job. That can be an additional few hundred dollars.

How long does the assessment take?
We usually meet for an initial session to go over current symptoms and problems you are having, get to know each other, and gather a medical and behavioural history. Sometimes people make a choice to move right into some type of treatment to address immediate issues, such as problems at work or with a friend or spouse. The assessment usually calls for two more sessions of face to face time, about 2 hours each, and the collection of data from people who have known you for some time. We especially want to talk to someone who knew you at an early age, as the diagnosis release heavily upon behaviour patterns you had at an early age. Usually this entire process is done in 2 weeks.

How long does it take to make an appointment?
I usually see patients for Asperger's and autism assessments within a week to 10 days. I leave a good deal of my time open for adult Asperger's and autism assessment and treatment because I know there are very few practitioners around with the tools, skills and background in the field to help everyone in need.

What's the next step?
The next step would be looking over my web page at www.relatedminds.com and then contacting me by phone or email. Phone is preferred, and it's best not to send extensive personal information over the internet.

Is this covered by insurance?
For my patients in Washington State, usually it is, however you need to contact your provider first. Payments are made at the time of the sessions and you will be reimbursed by your insurance company. But check your coverage!  For patients in British Columbia MSP - the government sponsored health care plan - does not cover psychological services. Your extended health care plan may, however each plan is different. Some cover the entire cost, some a minimal amount. Check first.

Some local colleges and universities in BC also pay for services for students. Check with your student health plan provider.

You can find out more about me and my practice at the following webpages:

http://psyris.com/drjimroche

http://www.relatedminds.com

http://www.actcommunity.ca/profiles/224/

http://www.psychologists.bc.ca/users/jimroche

www.therapistlocator.net/member?226046

http://psychologybc.weebly.com

College Students and Aspergers Disorder or Autism Spectrum Disorder

Academic Support Plans for College Students with Aspergers/Autism

Much of my practice at this time of year is with students attending college who suspect they have Aspergers or ADHD. An cult assessment for Asperger's Disorder, now called Autism Spectrum Disorder since it was moved to become part of the autism spectrum, have average to above average intelligence, study hard, but are having difficulty socially with peers, and sometimes with facility. They often have developed high levels of anxiety around the school day after having done so well in a highly supported secondary school.

Besides being amazed that most of my patients were not diagnosed during high school or before, I also regret that they are now confronted with the costs of an assessment which should have been provided earlier for free by the school district.  An assessment for adult Asperger's costs approximately $1,950.00 due to the time and complexity of the process. Usually it leads to some accommodations in the school setting, and below I am posting a general statement on accommodations. More importantly a comprehensive assessment helps us understand what skills and abilities a student has socially, and where their deficits are so we can focus treatment on those - making use of their strengths. Almost all therapy for adults with Asperger's starts with psychoeducation, fully and completely understanding the disorder. We then review, model, practice and critique a series of specific skill sets, always using our new insight to guide us.

But what accommodations can you expect from a college or university?  In the United States laws are very specific bout what services can be expected. In Canada the laws are not specific, and often not enforced, so it can vary greatly from school to school. This year I developed a hand out based upon one I found at a university website, I think this one is from Allegheny College. You can do a simple search on the web and see many colleges have a set policy and supports for students with Asperger's of ASD. If your son or daughter's college doesn't have such a procedure already set up, you might consider working with them to do so. Here is what I use, based on Allegheny College's outline:

Appropriate Accommodation for Students who have Autism Spectrum Disorder or “Asperger’s Syndrome” 

Asperger’s Syndrome is a developmental disorder characterized by major difficulties in social interactions and unusual patterns of behaviour. It was discovered by Hans Asperger in 1944 and was added to the Diagnostic and Statistical Manual- IV in 1994. Asperger’s Syndrome is often referred to as “high functioning autism.” Currently, in the newest version of the Diagnostic and Statistical Manual-5 Asperger’s Syndrome has become part of a spectrum of disorders called autism-Autism Spectrum Disorder. This can be confusing to some as there is an expectation that an individual with Autism Spectrum Disorder has some cognitive or intellectual deficit. This is not the case. Many people with Asperger’s Syndrome have high intellectual and verbal abilities, but appear to be socially awkward. In my own practice I work extensively with adults who have Autism Spectrum Disorder or “Asperger’s” and these individuals work at high level jobs, in management, in a variety of setting and fields and have successful and full careers, families and social lives. ASD is a language based developmental disorder which makes it difficult for individuals to “see the perspective of others” and “read their minds” as many of us do day to day in order to interact socially. There are also some neurocognitive difficulties common with ASD, such as resistance to change, hyper focus and sensory sensitivities.

Characteristics of students with Autism Spectrum Disorder (ASD) or Asperger’s Syndrome

• May have difficulty communicating, including difficulty understanding facial expressions, nonverbal communication, and have poor eye contact in conversational settings. • May have difficulty asking for help when they need it, or difficulty talking when experiencing stress. • May lack social awareness and misread social cues; may experience difficulty making friends or working in small groups. • May have trouble dealing with change; students withASD/Asperger’s Syndrome do best with structured routines and schedules. • May be very rule-oriented and logical • May not do well with noisy settings or bright lights.Tips for Positive Communication • Stress the importance of good study habits and effective time management. • Be firm and direct with the student, as a student with ASD/Asperger’s may not understand social cues or nonverbal    communication. • Give praise when merited; it builds confidence. • Give timely feedback to the student; errors need to be corrected as soon as possible.
Possible Classroom Accommodations • Be open to students recording lectures; if you are concerned have the counselling department write up an agreement and confidentiality form. Recording classes can be a critical component to academic success. • Point out the organizational items in textbooks, e.g., chapter summaries, sub-headings, graphic design, charts, maps, and indexes. • Give all assignments and course expectations in written and oral form. • Incorporate “hands on” and lab experiences when they are appropriate. • Consult with your schools student counselling centre when assistance is needed in solving problems. • Give students a clear syllabus, listing tests and assignments with due dates noted. • Use demonstrations and hands-on experiences. • Use overhead projectors or PowerPoint presentations. Break down difficult concepts into steps or parts. • Outline the day’s lecture on the board, overhead, or PowerPoint. • Keep the structure of the class the same everyday, and if it must change giving the student advance notice is helpful. • Give a brief review of the material presented and emphasize key points. • Include a time for questions and answers. • Encourage all students to take advantage of the school based tutoring and consultation services. • When group projects are a must, assign the groups and put the student with Asperger’s in a smaller group. All of these accommodations are not necessary all the time, and many of these can be easily dealt with by assigning a student/peer coach who can essential provide most of these services through simply modelling and a 15 min daily check up with the student.Test Accommodations and Administration • Allow extra time for test taking (usually time and one half). • Arrange for exams to be taken in a separate room. • Explain directions more fully and if something isn’t understood - write it out. • Keep all test formats the same. Offer alternate means to demonstrate competency if the student has difficulty with the testing format.

Each student and situation can be different, but working with a professional you should be able to come up with a good outline of what your child's needs, in terms of support for their "handicapping condition"- and I advise you to use those words as they will lead to more serious consideration by the college.  For information on the services I provide in terms of autism/Asperger's testing, treatment and support, visit my web page at www.relatedminds.com

Using Visual Supports: Positive Autism Supports for School or Home

Last month I visited a number of schools for parents, completing observations, writing a plan and meeting with staff. Most of these were for younger children, grades 4-6. What was bothersome is that one of the most important and successful supports we provide our children with ASD (autism spectrum disorder or Aspeger's Disorder), namely Visual Supports, were not used in any class. 5 of of 5 had "visual supports" in the IEP, but none of them used any visual supports while I was there doing my observations.  Why? Most of the people I asked said they didn't think the child needed them anymore. Well, I wasn't asked to come in and provide behavioural consultation because the student was doing well!

Here is an excellent place to find a handout about using visual supports with children with autism or Asperger's Disorder: http://www.autismoutreach.ca/assets/30visual.pdf  POPARD, the Provincial Outreach Program for Autism and Related Disorders has several great handouts about the usefulness of visual supports, and why NOT to stop using them.  They also have a really useful handout: "Visual Schedules." You can download the one above and bring it to your next school based team meeting, and request a copy of the other. POPARD also has a number of useful training videos on line addressing this issue.

While I didn't see anyone using a visual schedule or other support, here is what I did see: Taking 100 data points -marking down every 15 seconds what is happening with the student - are they getting a corrective feedback, positive feedback, neutral statement, following an instruction - whatever they are doing- after 100 measures each and every one of these students was getting 90% or above negative feedback. "Corrections" to be polite. Nagging that gets no where to be frank. Over and over I say students waiting - watching what other students were doing - not doing that- but instead waiting- looking at their "aide" until they get a verbal command. That's what visual supports can avoid. Verbal instructions are almost always negative or corrective. That's not useful with out kids with autism or Aspergers Disorder. Often students see exactly what is expected of them and wait...and wait...until they get a verbal prompt. Almost always negative or "corrective" to be polite. When everyone else is putting their books away the student with autism - with a higher than average IQ and enough cognitive abilities to know what to do - has become accustomed to getting a verbal prompt from an adult.

If it's time for lunch and the student isn't getting ready, visually point to what other students are doing. Point to the schedule. Give a non-verbal signal and teach the student to obtain information from the environment by watching. It's a simple change, but one that is even less likely to happen when your child has a full time aide assigned to them who just can't wait to be helpful and talk to them, explain to them, and unknowingly teach them to ignore their environment and instead rely upon a verbal prompt. Even when they know what to do.

Don't let this happen to your child. Make sure the school is not just writing "use visual prompts" down on the IEP but also really using these visual methods in practice. This goes for students of all levels and abilities.

Dr. Jim Roche is a Registered and Licensed Psychologist providing behavioural consultant services, family counselling and individual therapy for children, adolescents and adults with autism spectrum disorder. For more information on the services he provides visit his web page at: http://www.relatedminds.com/autism/

Dr. Roche also provides testing and assessment for autism spectrum disorder, Asperger's Disorder and Non-Verbal Learning Disabilities for children, adolescents and adults.

Testing for Adult Autism / Asperger's Disorder

I've been asked by a number of people if there is time during the summer for any further adult assessments for autism spectrum disorder or Asperger's Disorder: yes. I have several days set aside for patients who are seeking an assessment for adult Aspergers or adult autism, as I know there are not many clinicians prepared to complete this work.

What does testing for adult Aspeger's or adult autism spectrum disorder consist of?  Primarily we look at symptoms and behaviours you had as a young child. This is done with a structured clinical interview, the ADI-R. In addition to that we engage in a structured interview process called the ADOS which requires you to participate in a number of activities and answer some questions about your current life and thoughts. Usually individuals take a structured personality assessment to rule out possible disorders that may look just like adult autism or Aspegers, and when appropriate we use some neuropsychological tests to help flesh out the diagnosis. It is just about necessary to have someone who knows you well, especially your behavioural and social history, to complete some forms about these issues.

We usually start with an initial one hour session and discuss your current signs, symptoms and problems so that we can make a good choice about the appropriateness of proceeding with an assessment.

For more information on testing for Aspeger's Disorder or autism spectrum disorder in adults, teens/adolescents or children, please visit my website and then contact me directly.

My website can be found at www.relatedminds.com

Dr. Jim Roche

Adult Autism and Asperger's Syndrome Reading

In my practice I provide services for children, teens and adults with autism spectrum disorder and Aspergers Syndrome. Often adults come by with marital problems or oner relationship issues and we work on social learning skills and CBT (Cognitive Behaviour Therapy) that is helpful to them in their relationships. Often, however, I am asked for book recommendations. I don't think there are currently any "GREAT" books out there to recommend because most adults have very specific issues and problems and often want direct, specific and to the point advice. Most books, on the other hand, are more targeted to a general reading audience. This only makes sense as its hard to write and sell a book about a small and particular topic. Because of this face to face therapy is often the best way for adults to approach issues.

now most issues adults with Aspergers or high functioning autism do have are not that different than the general population so it's more than appropriate to look at workbooks and self help books that anyone their age would look at - and get some advice and "translation" of the materials from someone who knows about Aspergers Syndrome in adults.

In spite of all this, I'll make a few recommendations of books you might want to own, have around for reference, or maybe just borrow from the public library to skim through:

Aspeger's From the Inside Out: A Supportive and Practical Guide for Anyone with Asperger's Syndrome by Michael Carley and Peter Gerhardt

Emotional Mastery for Adults with Aspegers: practical techniques to work with anger, anxiety and depression by Leslie Burby and Mark Blakey

(For clinicians) Cognitive-Behavioural Therapy for Adults Asperger Syndrom by Valerie Gauss, MD

Aspeger's on the Job: Must-have Advice for People with Asperger's or High Functioning Autism and their Employers by Simone and Temple Grandin

Parenting a Teen or Young Adult with Aspeger Syndrom (Autism Spectrum Disorder0 by Brenda Boyd

Asperger Syndrom and Long Term Relationship by Ashley Stanford

These are some of the books patients have spoken positively about and that I have reviewed. Again, I think the best idea is to see a professional who is familiar with Asperger's Syndrome and high functioning autism across the age span and develop and individualized intervention plan. It's always important to start with psychoeducation - learning more about what is going on - and the best place to start from my point of view is with works and writings by Michelle Winner at www.socialthinking.com  While most of her materials are aimed at teens, the insights are valuable to everyone of all ages.  When you find someone to work with, you should also make sure that that professional is VERY familiar with her work and has used and applied it in a number of settings.

I hope these suggestions are helpful. for more information about my practice in the field of autism spectrum disorder and adult Aspeger's Syndrome please visit my web page at www.relatedminds.com or call me for an appointment. I provide individual counselling for children, teens and adults with Aspeger's Syndrome and ASD, couples/marriage counselling or therapy and do home and workplace observations and work with schools and workplaces. I also provide assessments and testing for adults with autism/Asperger's and work on numerous legal cases relating to workplace issues and adults with Aspegers.

http://psyris.com/drjimroche

http://www.relatedminds.com

http://www.actcommunity.ca/profiles/224/

http://www.psychologists.bc.ca/users/jimroche

www.therapistlocator.net/member?226046

http://psychologybc.weebly.com

Autism | Asperger's | Behaviour

Many parents with children on the autism scale find themselves at a crossroad and need to address inappropriate behaviours which are preventing their child from succeeding at school or at home- social or academically and come to see me. Many already use a "behavioural interventionist" from the ACT referral services, but find that they just can't get a plan and intervention together for their child in spite of already having a behaviour interventionist on their team. While I am a member of the ACT Behaviour Interventionist list (the "RASP") I am also a Registered and Licensed Psychologist with a speciality in behaviour management and behaviour therapy. This is a different field which goes beyond dealing with symptoms normally thought of as relating to ASD.

ABA training in itself often doesn't provide a wide enough background in psychology to help these children, as their underlying problems can be depression, anxiety, OCD and other related disorders. And ABA, as helpful as it is, isn't designed to work with these kinds of problems. So, first of all we need to really understand and diagnose the problem. This is usually done through a process called a functional behaviour assessment or FBA. An FBA may include school and home observations, data collection and testing, but it also can be a much shorter and contained process. An FBA is about the "process." We look at what the child is doing, and the child's environment to find out what the function of the behaviour is. "What function does X have for this child?" I often teach FBA development to teachers and psychologists, and it can range from a comprehensive several page written report, to a 3X5 card with some notes jotted down. What's important is that we consider the situation to understand the function, and then move on from their to 1) make environmental changes so the child doesn't need to engage in the behaviour as the sam frequency or severity, and 2) teach new appropriate skills so that the child now has a new appropriate behaviour that meets the SAME function as the original behaviour. The most comprehensive system for completing FBA's and writing these intervention plans for children and adolescents with autism and Aspergers can be found at the California website PENT. Click here: http://www.pent.ca.gov   What's great about the PENT website is how comprehensive it is, and how much training materials are available to school staff - psychologist, teachers, administrators- to make sure a school is performing these procedures correctly. A key component to the California PENT program is a system that checks the QUALITY of the process and intervention. A quality control system is built right in. I've taught this system in several districts and those that adopt it improve the quality of there interventions for children with behaviour problems and autism/Aspergers significantly.

The other issue that seems to come up and keep individuals from providing good evidence based interventions is the general lack of experience most teachers, behaviour interventionists and general psychologists have in old fashioned behavioural therapy. Too often I hear that a token system didn't work for a child with ADHD (although we have 40 plus years of research supporting the use of token reinforcement systems with children with ADHD!) or that planned ignoring or exposure programs have failed. Usually they are implemented straight from a book, and when they don't work everyone quickly gives up. These systems have a long history of working, but, if you ever watched "Super-Nanny" on television you know ever week she has to come back, look at the data, watch the parents implementing the program and make changes. You always need some feedback from a third party ...always. And if someone has never had success implementing such a behaviour program, then maybe they shouldn't be doing this without supervision. Token systems and other behaviour management practices are complicated and tricky. If they don't seem to be working at first, don't give up!  Consult!

Finally, it's a tricky issue to implement a behavioural intervention program to deal with difficult behaviours when at the sam time your dealing with the symptoms of Asperger's or autism. Many parents I see come to me after many unsuccessful attempts on their own. Again, get consultation from an expert!

Where can we learn about this? Well, I think you need a multitude of handy interventions and plans. Not just one. I tell most of the parents I work with we are about to start a graduate degree in behaviour management, so hold on.  Some good books to start with are these:

First: Read or watch Raising an Emotionally Intelligent Child: The Heart of Parenting by John Gottman. This is NOT a book on behaviour management, nor is it a book about behaviour problems. However, when your done you will feel better about all the other part s of parenting, and you'll understand the concept of being a "coach" for your child. I usually suggest the video which is available at the local library or John Gottman's website.

If your child is really a handful - EXPLOSIVE! Then I'd read or listen to "The Explosive Child," by Ross W. Green, PhD. This is a great book on parenting and dealing with really difficult behavioural problems. What it is not is a book on behaviour management from a behaviourist point of view. Instead it gives you a place to start, and a "style" to do it in. Dr. Greene also has a wonder website. Go check it out.

For the behavioural (didn't think I'd get to that did you?): The two best books I know of are "Your Defiant Teen: 10 steps to resolving conflict and rebuilding your relationship," by Dr. Russell Barkley and "Your Defiant Child: 8 steps to better behaviour," also by Dr. Barkley. These two books prove everything you need to start using time tested, evidence based behavioural interventions in your home.

These are the best places to start, but be warned: Children with Asperger's Disorder and autism spectrum disorder (ASD) do not react the same as other children to these or any interventions. For a multitude of reasons, sone biological, some cognitive, some relational, these children may react poorly to something that another child would react well to. So again, get advice and consultation from an expert.

These four resources, plus those available on child behaviour issues from the PENT website are a good place to start. If you would like to contact me and visit my office for a consult, please follow one of the links below:

http://psyris.com/drjimroche

http://www.relatedminds.com

http://www.actcommunity.ca/profiles/224/

http://www.psychologists.bc.ca/users/jimroche

www.therapistlocator.net/member?226046

KEY WORDS: Behavioural Interventionist, Behavior Therapy, Autism, Asperger's, Therapy, Vancouver, Burnaby, Psychologist

Testing and Treatment for Asperger's and Autism | Children, Adolescents and Adults

Testing, Assessment and Treatment for Autism and Aspeger's Disorder

Dr. Jim Roche provides testing and diagnostic services, as well as therapy, for children, adolescents and adults with autism spectrum disorder, Aspeger's Disorder and related cognitive deficits. For more information please visit my web page at: http://www.relatedminds.com/autism/ 
or http://psychologists.bc.ca/users/jimroche or www.relatedminds.com

Dr. Roche also sees adolescents and young adults for therapy and social cognitive therapy in his office, and accepts BC Ministry payments for these services. Services are also covered by your extended health care plan. He has over 20 years experience with children, adolescents and teens with autism spectrum disorder, non-Verbal Learning Disorders, Social Cognitive Disorders and Asperger's Disorder.

Please feel free to examine the web page or call doctor Roche with questions about assessments, testing and treatment for autism and Asperger's Disorder.

His offices are located in Burnaby and Vancouver and are close to Port Coquitlam, New Westminster, Port Moody and Maple Ridge.

Behavioural Interventionist and Visual Supports for Children with Aserger's Disorder

I visited another school a few weeks ago and asked the parent of the child I was observing if I could go over my observations in the blog, "YES! Share so that other people realize this!"

So, parents are always arguing for classroom aide, a paraprofessional, to work with their child. And they often want that assistant there ALL the time. But there is a problem with this, actually a few. See if you can tell what the problem will be from the old cartoon I often show parents to explain the issue.

Heres number 1: Your child should be getting his or her cues from a couple of places in the classroom environment. Often teacher aides become the only place they look. Where should the social cue come from? First, the classroom teacher. And second, other students. When I do my observations in a school I pay close attention to the number of cues a child picks up, and usually the number from the teacher, other students or the white board or classroom schedule is near zero. Almost all of the social cues, what to do when, are obtained from the teacher aide.

This is why as a behavioural consultant I push the use of visual prompts and cues over verbal prompts and cues. Verbal prompts end up being requested, they end up being waited for, and students end up reliant on verbal prompts.  "Use visual prompts - point, and stop talking so much," is my usual advice. Yes, I know we want students with ASD and Aspegers to talk more and give eye contact, but you need to be careful. The eye contact becomes a prompt for the teacher aide to tell the student what to do.  Look at the cartoon. Got it?

Here is an example: The bell rings for recess (environmental cue ...a big one!), the teacher says, "Let's get our desks cleaned up and line up..." (another Massive prompt here, but regretfully not from where the student is use to looking. He or she usually looks to his classroom aide for prompts!) At this point the other students all start to put their coats on for recess. (a GIANT social cue). But what is this a prompt to do? The student sees the other students getting their coats on and turns ......to his aide!!!!!! At that point she says, "Now lets get your coat on."

READ THE CARTOON. See what happened?

This is why its necessary to occasionally have your behavioural interventionist go to the school and observe what's going on. In most professions observation and feedback is a critical part of quality control, but who is doing that for the teacher aide? The teacher? I don't think most teachers have the behavioural expertise to take on that task.

So, that's that. All of this could have been avoided by using the classroom aide (the schools behavioural interventionist) use visual supports to guide the student, not to getting things done, but to learning how and where to find social prompts as to what is going on and what I should be doing. The aim of a support person is to teach skills that lead to independence, not get todays math done or your child's coat put on. Independence comes through learning to use environmental and social prompts to navigate the world.

Besides that, the cartoon is funny. Just so typical, right?

For information of behavioural interventions services, autism diagnosis and treatment that Dr. Roche provides please visit his website at www.relatedminds.com

Adult Autism | Aspeger's Disorder in Burnaby | Vancouver

Dr. Jim Roche provides diagnostic testing, assessments and treatment for adults with ASD|High Functioning Autism|Aspeger's Disorder.  He has been working with adults with Aspeger's and related cognitive disorders for over 20 years.

Dr. Roche has worked as a clinical psychologist in private practice, a psychologist for local school districts, a provincial consultant on autism and related disorders and in community based rehabilitation programs. For more information visit his website at www.relatedminds.com

Behavioural Consultants and Asperger's Disorder

I am often asked what a behavioural consultant can do, what services we provide, for children, adolescents and adults with Asperger's Disorder, high functioning autism and NVLD (Non-Verbal Learning Disorders)?

First and foremost, I provide psychoeducation - I help parents, children, teens and adults understand the nature of their disorder.  Most individuals come to me because they want a behavioural consultant for Asperger's. That sometimes includes diagnostic testing, sometimes additional psychoeducational testing to help develop a school IEP 9Individual Education Plan) or with adult a workplace intervention plan.

some individuals see me, and have another behaviour interventionist in the home who is attuned to ABA techniques. Regretfully, while every parent of a child with Asperger's Disorder or autism spectrum disorder needs to know about ABA they also need to understand the neurocognitive details of the disorder to get why someone does what they do. This often includes working with older children and teens on materials such as Michelle Winners "Social Behavior Mapping" or using programs such as the "Social Detective" series or "SuperFlex" to understand themselves and start to make changes. It's hard to imagine working towards a goal without understanding what road your on! Psychoeducation helps with this. Often we meet every other week to go over how skills and tools we learned about in the office are working at home, school or the workplace.

I also consult with individuals about more basic behavioural problems, especially with small children who develop co-morbid disorders and need supportive interventions. This may include working on issues of anxiety, emotional regulation, anger management and social interactions.

I try, as much as possible, to use materials similar to those used by many school districts when working with students with Asperger's Disorder.

And frankly, every other week an adult takes home one or more of my children's books, posters or other materials because these really simple and clear programs clarify issues for them that adult autism and Asperger's materials just don't.

As a registered marriage and family therapist (RMFT), in addition to being a registered psychologist, teacher of special education and school psychologist, I also spend a good deal of time working with families on "family systems" issues. These can range from direct couple counselling for the adult with Aspeger's, to parent education and family dynamics. The range of services is wide, and depends upon your needs.

For more information on working with me as a "behavioural consultant," (I am an approved ACT Behavioural Consultant and work with provincial funding when it is available) or for information on testing, assessment, educational or workplace issues, please visit my web page at https://www.relatedminds.com/adult-autism-and-aspergers-disorder/ for adults or https://www.relatedminds.com/autism/ for children and teens.

Therapy for children and teens with autism | Burnaby | Vancouver

Dr. Jim Roche provides individual and family therapy as well as parent education to individuals with Asperger's disorder and autism in Vancouver and Burnaby. He is a registered psychologist and approved behaviour interventionist with ACT (Autism Community Training). Additionally he provides diagnostic assessment and testing for individuals suspected of autism which can lead to government funding. Information on his autism/Asperger's practice can be found here:
http://therapists.psychologytoday.com/rms/70682
http://www.relatedminds.com/autism/
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A recent article in the New York Times addresses children with autism, "Inside the Mind of a Child with Autism." Here is the link: http://nyti.ms/1kk8Zcq  This is a great article about something so simple you might wonder why it needs to be discussed, but it does. How to work --- actually, how to PLAY---with your child who has autism (or Asperger's).  It talks about something really basic we all do: The more time a child spends giving eye contact - and some social reciprocity - the more time the child gets to play with those special little things they like to play with. Using the child's "affinities" to reinforce social reciprocity. An example they give is, "If a child is fascinated by Thomas the Tank Engine, use those characters to prompt and reinforce social development." This is what I actually do with children in their homes, in the office and at schools. Often being down on the floor playing side by side and demonstrating how to encourage this social reciprocity.  Many people do this, and when I model it I often use "self talk" to teach parents not just how to do this, but what they are doing and why it helps. Understanding why something makes things better lets you do that thing better than before.

There is a new book about this by Ron Suskind, a former wall street reporter called, "Life, Animated" in which he describes going through this process with his autistic son.

Finally Sally Rogers, a professor of psychiatry at the Mind Institute at the University of Davis in California (they have a great series of podcasts by the way) is looking at this teaching process and gathering some real data on it's effectiveness. The whole aim is to find out how best to do this "joint play" that is so critical to a child with autism spectrum disorder or Asperger's in order to develop social interaction skills. Another place you can read about this is Dr. Stanley Greenspan's "Floortime," which is, for the most part, exactly what it seems. Time on the floor interacting through joint play.

Using play that is an "affinity" to the child a lot can be done, and while I am always stressing the need for basic research on the causes of autism, it's a pleasure to read about some in depth research on the day to day therapeutic interventions we use when working with children with autism spectrum disorder.

Take a look at the article, and at the New York Time's website on mental health issues.

Adult Treatment for Autism and Asperger's

In my practice in Burnaby I am often asked to suggest books and reading about Aspeger's and couples..dating..and working. Here is the best book I recommend: The Journal of Best Practices by David Finch.

David's book is an easy read, funny and informative. He gives many examples of how the person with Asperger's needs to deal with the world around them to "be a better husband" as he says. The book is based upon his essay "Somewhere Inside, the Path to Empathy," which appeared in the New York Times.

You can find this book through my website at www.relatedminds.com

There you will also find information on testing and diagnostic services for teens and adults who suspect they have Asperger's or High Functioning Autism. A full assessment for Aspeger's with an adult costs approximately $1,200.00 and is not always recommended. Sometimes it might be better to simply spend our time looking at current problems, understanding how they develop and working on step by step solutions. Often, amazingly enough, the solutions for problems that a couple with one member having Aspeger's might experience might be very similar to what we do with children or teens. The skills are all pretty similar.

For more information on the diagnosis of Aspegers or autism spectrum disorder in children, teens or adults, please visit my web page or contact me to make an appointment.

Dr. Jim Roche
Offices located in Burnaby, BC
Serving Burnaby, Vancouver, New Westminster, Coquitlam and Maple Ridge.

Getting an Adult Aspeger's Diagnosis

In my Burnaby office I provide testing and diagnostic services for adults who are concerned about Asperger's Disorder or High Functioning Autism. You can find more specific information about adult autism / Asperger's Disorder testing on the following webpage: http://www.relatedminds.com/adult-autism-and-aspergers-disorder/

A professional diagnosis for Asperger's is necessary and should be based on the following:
Observations of specific behaviours and abilities by a highly trained professional. This might include a psychiatrist, psychologist, speech pathologist or medical doctor familiar with this disorder. The individual should be familiar with Asperger's Disorder over the lifespan.

In addition to a  face-to-face semi-structured clinical interview it is highly recommended that a professional normed diagnostic tool be used such as the Autism Diagnostic Observation Schedule (ADOS). Other tools that are sometimes used include the Childhood Autism Rating Scale (CARS) and Autism Diagnostic Interview-R (ADI-R). These may not be normed for the adult's particular age range so they may be used to gather data in a less formal but still highly structured manner.

In addition to this an comprehensive assessment needs to include information from a third part, both as o current symptoms and if possible, about childhood symptoms.

Because of the limited information we often have available for adults as compared to children we also include a short neuropsychological screening to help us understand neurological symptoms and strengths and weaknesses. A additional neurological exam might also be part of this examination.

A general understanding of an adults current social and adaptive abilities is also necessary, so an intelligence test and adaptive abilities test might be necessary.

Finally, Aspeger's Disorder is often misdiagnosed when an underlying personality issue is present, so a comprehensive personality assessment to rule out other possible reasons for these symptoms is necessary.

The cost of such an assessment is approximately $1,200. Forensic assessments, those involving legal or workplace issues, are billed on an individual basis. Some individuals with other possible disorders may require further assessment.

There are some psychiatrists in the lower mainland who are able to complete this type of assessment, however they have waiting lists and you would need a referral from your medical doctor. Please see your medical doctor about that process.

Assessments by a psychologist are not covered in BC by MSP. This is regrettable, as this also applies to children. Children seeking an autism diagnosis/Aspeger's diagnosis should ask their medical doctor for a referral to Children's Hospital or another provincial provider.  Extended health care often covers some of these expenses, but you need to contact your insurance provider for information on what they will cover.

The process of obtaining an adult diagnosis of Asperger's is complicated. It is not simply about seeing if you have a list of symptoms, and many of these on-line lists are very misleading in that they strongly suggest you have a disorder based upon a list of symptoms but do not provide any "differential" component to the diagnosis. A diagnosis is not just seeing what problem you have, but ruling out other possible reasons for the symptoms that may mimic Aspegers but not be Aspergers at all!  Finally, it needs to be remembered that even if you do have Aspeger's there is a high chance that you have a comorbid disorder such as anxiety, depression or ADHD. Often, until these co-morbid disorders are treated there is little progress made on dealing with the troublesome aspects of Asperger's.

If you suspect you have Aspeger's start with a visit to your medical doctor, and then see either a psychiatrist, psychologist or speech pathologist with experience in this field.

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This post is not meant to offer medical advice or suggest any medical diagnosis. If you suspect you have a mental health disorder, or suffer from symptoms that you find distressing, speak with your medical doctor or psychologist.

Form information on assessments and treatment I provide in my Burnaby office please visit my web page at http://www.relatedminds.com