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
Thursday, March 27, 2014
Friday, March 7, 2014
Asperger's Disorder, Autism and Visual Supports
One of the key features of autism interventions for children, adolescents and adults are visual support systems. These range from visual schedules to visual prompts and cues, hand signals and reminder notes. Visual supports are critical to success with young people with autism, but regretfully they are one of the first things that teachers, aides and parents want to drop because they feel their student or child no longer needs such supports. This, most of the time, is a mistake.
Today on my way to the office I checked my fridge for any notes from family members, checked my calendar (yes, in spite of the fact I have a Mac and every program know for schedules etc I use a paper calendar to maintain my daily schedule) and then checked a short to do list at the office, a list of things I didn't complete yesterday. On the way to work there were road signs telling me to switch lanes, and someone actually holding a bright orange and yellow sign, waving it, tell me and everyone else to "slow down."
Amazingly there seems to be an attitude that as soon a a student begins to write, or as soon as they speak fluently they no longer need these visual support systems you and I seem to need every day. I often urge parents to maintain visual prompts and cues because when a problem does come up, and having had several teenagers myself I know problems come up, you need a system to use to correct the problem, to teach new skills and to reinforce those skills. If you already have a system in place you are using you don't need to invent a new support/intervention method while addressing the new crisis. And childhood, teen years and early adulthood are full of these crisis moments!
My answer to parents who wonder when to give up visual supports is: Never! You change them, make them more age and socially appropriate and rework them and focus on using them to generalize new behaviours, but don't give up a good tool that you could use later on.
Schools especially seem to give up visual supports, especially when an aide is assigned to a student. Often the aide will say, "Well, he talks to me and asks questions so I don't think we need those. Besides, he needs to learn to ask questions and talk more." This is not true. Children who use visual supports use more language, and when it comes to a choice of a visual support or a verbal prompt from a classroom aide I would usually suggest sticking to the visual support." The visual support should be reminding the student to look to his or her environment to get social cues as to what is going on, and what we are doing next. An aide often stands in the way of that behaviour by providing constant verbal cues or prompts. I can't tell you how many times I've gone into a classroom and seen a student with a high IQ, very aware, sitting while other students get their coats on...waiting for the prompt of cue from the aide rather than looking at the schedule, looking at and listening to the teacher or simply watching what all the other students are doing - putting on their coats. The behavioural process becomes - other students are putting on their coats to go to the playground - that means I should turn to my aide and wait for her to tell me to - "put on your coat!" Students become overly reliant on verbal prompts, and maintaining visual prompts can help avoid that.
Visual supports remain a critical part of any person's life, and it sometimes seems odd that we withdraw these supports so quickly from individuals with Asperger's and autism. Some places to find information on visual supports are:
http://autismdigest.com/visual-strategies-valuable-support-at-any-age/
POPARD, the Provincial Outreach Program for Autism and Related Disorders also has several great handouts and videos on using visual supports: http://www.autismoutreach.ca/assets/30visual.pdf
This article: 30 Reasons to Use and Keep Using a Visual Schedule or "Please don't take my visual schedule away," is a great resource for teachers, or parents who have to convince a teacher to maintain visual supports.
Finally, a lot of times visual supports are stopped because they seem to stop working, things get complicated and confusing for staff who don't have a lot of training in behavioural interventions, and rather than fix something that doesn't seem to work they just stop using the system. This sometimes happens with very young children as teachers or parents become frustrated as students seem to object to using the visual supports or seem to work against them. Well there are two great manuals on this issue EVERY teacher or parent of a child with Aspergers or autism should have:
Visual Strategies for Improving Communication and Solving Behavioural Problems in Autism by Linda A Hodgdon. These are the best books I've seen in this area in years. There are also video training programs and other support materials that go with this comprehensive program. My favourite part of these books is the chapter on using your body, hands, face, posture and so on as a visual support to get the meaning of what you are saying across to the student with Asperger's or autism, and to help them with issues such as anxiety and stress. Great book!
To sum this up - don't stop using visual supports. Learn more about them, get creative, make them more age and environmentally appropriate. We all use them and they can make a huge difference in how well anyone with Aspeger's or autism navigates the world.
For information about my practice and services I offer for children with Autism, adolescents and young adults with Asperger's and High Functioning Autism, please visit my website at: http://www.relatedminds.com or http://www.relatedminds.com/adult-autism-and-aspergers-disorder/
Today on my way to the office I checked my fridge for any notes from family members, checked my calendar (yes, in spite of the fact I have a Mac and every program know for schedules etc I use a paper calendar to maintain my daily schedule) and then checked a short to do list at the office, a list of things I didn't complete yesterday. On the way to work there were road signs telling me to switch lanes, and someone actually holding a bright orange and yellow sign, waving it, tell me and everyone else to "slow down."
Amazingly there seems to be an attitude that as soon a a student begins to write, or as soon as they speak fluently they no longer need these visual support systems you and I seem to need every day. I often urge parents to maintain visual prompts and cues because when a problem does come up, and having had several teenagers myself I know problems come up, you need a system to use to correct the problem, to teach new skills and to reinforce those skills. If you already have a system in place you are using you don't need to invent a new support/intervention method while addressing the new crisis. And childhood, teen years and early adulthood are full of these crisis moments!
My answer to parents who wonder when to give up visual supports is: Never! You change them, make them more age and socially appropriate and rework them and focus on using them to generalize new behaviours, but don't give up a good tool that you could use later on.
Schools especially seem to give up visual supports, especially when an aide is assigned to a student. Often the aide will say, "Well, he talks to me and asks questions so I don't think we need those. Besides, he needs to learn to ask questions and talk more." This is not true. Children who use visual supports use more language, and when it comes to a choice of a visual support or a verbal prompt from a classroom aide I would usually suggest sticking to the visual support." The visual support should be reminding the student to look to his or her environment to get social cues as to what is going on, and what we are doing next. An aide often stands in the way of that behaviour by providing constant verbal cues or prompts. I can't tell you how many times I've gone into a classroom and seen a student with a high IQ, very aware, sitting while other students get their coats on...waiting for the prompt of cue from the aide rather than looking at the schedule, looking at and listening to the teacher or simply watching what all the other students are doing - putting on their coats. The behavioural process becomes - other students are putting on their coats to go to the playground - that means I should turn to my aide and wait for her to tell me to - "put on your coat!" Students become overly reliant on verbal prompts, and maintaining visual prompts can help avoid that.
Visual supports remain a critical part of any person's life, and it sometimes seems odd that we withdraw these supports so quickly from individuals with Asperger's and autism. Some places to find information on visual supports are:
http://autismdigest.com/visual-strategies-valuable-support-at-any-age/
POPARD, the Provincial Outreach Program for Autism and Related Disorders also has several great handouts and videos on using visual supports: http://www.autismoutreach.ca/assets/30visual.pdf
This article: 30 Reasons to Use and Keep Using a Visual Schedule or "Please don't take my visual schedule away," is a great resource for teachers, or parents who have to convince a teacher to maintain visual supports.
Finally, a lot of times visual supports are stopped because they seem to stop working, things get complicated and confusing for staff who don't have a lot of training in behavioural interventions, and rather than fix something that doesn't seem to work they just stop using the system. This sometimes happens with very young children as teachers or parents become frustrated as students seem to object to using the visual supports or seem to work against them. Well there are two great manuals on this issue EVERY teacher or parent of a child with Aspergers or autism should have:
Visual Strategies for Improving Communication and Solving Behavioural Problems in Autism by Linda A Hodgdon. These are the best books I've seen in this area in years. There are also video training programs and other support materials that go with this comprehensive program. My favourite part of these books is the chapter on using your body, hands, face, posture and so on as a visual support to get the meaning of what you are saying across to the student with Asperger's or autism, and to help them with issues such as anxiety and stress. Great book!
To sum this up - don't stop using visual supports. Learn more about them, get creative, make them more age and environmentally appropriate. We all use them and they can make a huge difference in how well anyone with Aspeger's or autism navigates the world.
For information about my practice and services I offer for children with Autism, adolescents and young adults with Asperger's and High Functioning Autism, please visit my website at: http://www.relatedminds.com or http://www.relatedminds.com/adult-autism-and-aspergers-disorder/
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