Autism Diagnosis and Treatment in Vancouver, Burnaby, Coquitlam: Child, Teen and Adult

I provide diagnostic services for individuals suspected of having autism spectrum disorder, ASD (formerly called Aspergers Disorder). This includes diagnostic services for children under 19 to obtain ministry funding and qualify for school-based support services.

Additionally I see many adults for suspected autism disorder, and have worked with adults with ASD or "Asperger's" for over 25 years.  This includes working on issues of social cognition, social learning, employment, higher education and various legal issues.

I have served as the behaviour management specialist for several school districts, worked as a teacher of children with autism, as a school psychologist and as a clinical psychologist in the field. The focus of much of my work is on "social learning" and applying the techniques and methods of Michelle Garcia Winner to adults. I advise all parents, teens and adults dealing with issues in this area to look over Mitchell's wonderful site and her curriculum materials at www.socialthinking.com

For more information of autism related services that I provide please visit my website at www.relatedminds.com

Adolescents and Teen Therapy for Asperger's Disorder and Autism Spectrum Disorder

As a Behaviour Interventionist (member of the BC RASP) I am often asked about what services I provide for children and teens with autism spectrum disorder and what was formerly called "Asperger's Disorder."

Of course, many of my patients come for initial assessments of autism spectrum disorder. Additionally, many people see me for significant/severe behavioural issues they are experiencing, that their regular behaviour interventionist can't deal with. This often involves behaviour management consultation, parent training and sometimes working with the schools and classroom teacher to develop specific positive behavioural support programs for an individual student (PBIS). This often involves observations, interviews and sometimes means writing a formal FBA or Functional Behaviour Assessment. Any behaviour plan a school writes should start with a formal FBA. If your child doesn't have an FBA, but is having behavioural problems at school, ask for someone to complete an FBA.

To learn EVERYTHING you need to learn about functional behavioural assessments you could start at the California State webpage: http://www.pent.ca.gov/frm/forms.html

This is by far the most comprehensive site for FBAs available, and I often use these materials exclusively when providing training in behaviour management to school districts.  And it's all FREE!

Often parents of children or teens see me just for psychoeducation. They are trying to implement a behaviour plan, a token or other reinforcement system, and need to know exactly how it's done. This, by the way, is covered under your provincial funding for children with autism.

But one place parents often fall down is keeping a child or teen connected with a behavioural therapist or psychologist over the long term, someone they develop a relationship with, feel free to talk to, and who can teach social learning skills over a long period of time. Often I see children or teens, after an initial emergency is over, for an extended period, but only sporadically. We stay in touch to make sure things are going well, and so that I can continue to monitor school programs and deal with issues before they become major problems again.

Some of this takes ppace within the context of what might be called "play therapy," as we play, and talk about feelings, emotional issues and work through them as we engage in activities that are distracting enough to make the child comfortable with the process.

Usually we try to also follow a structured curriculum such as Michelle Winner's "Superflex" curriculum, or one of her other books that are addressed to older teens and young adults.

While I am familiar with ABA, Floor Time and many other behavioural interventions, high functioning teens and young adults with Asperger's or Autism Spectrum Disorder have a high rate of co-morbid disorders such as depression, anxiety or learning disabilities. And...ADHD. These are issues we address together.

CBT or "Cognitive Behavior Therapy" is one of the many wys we teach skills and address issues successfully. CBT is very similar to therapies and skills children with autism spectrum disorder are exposed to in many school programs, such as The Incredible 5-Point Scale and other emotional regulation programs.

For more information please visit my webpage at www.relatedminds.com or http://www.relatedminds.com/autism/

Feel free to contact me to discuss the services I provide. I am happy to answer any of your questions.

Concerns about autism spectrum disorder: Where to get advice, a diagnosis and treatment in Vancouver/Burnaby and the lower mainland.

I conduct diagnostic assessments for autism spectrum disorder (ASD), sometimes called Asperger's Disorder, with individuals aged 6 and above. There are special conditions for those below the age of six involving a team of professionals that I cannot make arrangements for, however, another member of a team may ask me to participate in such an investigation. Private assessments are costly, with the cost ranging from $1,600-$1,950. The BC government does provide for these assessments through their own system. If you wish to make arrangements for the government to provide an assessment please see your family doctor who may refer you to the British Columbia Autism Assessment Network (BCAAN) for assessment and diagnosis. There are, sometimes, substantial waiting lists. Also, while at one age a child may not meet the criterion for a diagnosis, as two, three or more years go by patterns may develop that make the diagnosis much clearer, and sometimes it is very difficult to arrange a second assessment, so families often contact a private psychologist such as myself.

From the BCAAN site: "BCAAN is responsible for assessing and diagnosing children in British Columbia who may have Autism Spectrum Disorder (ASD) and will arrange for an assessment to be done as close to where you live as possible. There is no charge for their services. For more information on ASD diagnosis and testing, visit the BCAAN website or contact BCAAN at 604 453-8343." 

Often parents who wish to arrange for a private diagnostic assessment. BCANN states: "These assessments must meet the same standards and guidelines as BCAAN assessments. The clinician will need to complete a Non-BCAAN (Private) Diagnosis of Autism Spectrum Disorder form to document the diagnosis if the family wishes to apply for Autism Funding programs. Parents are responsible for any costs charged by the private clinician."  Clinicians who provide these services must have specific tools and experience, these include the use of the ADOS and ADI-R assessment instruments, required by the provincial government to accept the practitioner's diagnosis. Many times parents see a practitioner who is not familiar with the government requirements, and then, regretfully, need to have a new assessment completed. Make sure your provider knows their way around these regulations. 

I complete diagnostic assessments on children, adolescents/teens, as well as adults who suspect they have autism spectrum disorder, or what previously had been referred to as "Asperger's Disorder." In addition to being a registered psychologist I am also an approved member of the RASP list of behaviour interventionists, and my services (after diagnosis and acceptance of the diagnosis by the ministry) are paid for through ministry fundings. I provide autism consultation services to parents, families, brothers and sisters of children or teens with autism spectrum disorder or "Asperger's" who may be having relational difficulties, I provide training and consultation to individual teachers, schools, and the workplace of many young adults. i also provide couples therapy for individuals who are in relationships and one or both may have autism spectrum disorder of "Asperger's Disorder." These services are provide in my Burnaby office, and some arrangements can be made for my Vancouver office.

If your child is diagnosed with ASD, you may be eligible to receive funding from the ministry's Autism Funding Programs. If your child does not have ASD, there may be other services to assist you and your child such as tax credits or special education services and supports based upon other issues such as learning disorders, ADHD or dyslexia. Many of these issues require additional testing, such as a psychoeducational assessment.

My services are available to those with autism spectrum disorder of any age. Please contact me through my webpage at www.relatedminds.com. Email is the best way to make arrangements for an initial meeting, as I am often with patients throughout the day.

Behaviour Interventionist Burnaby / Vancouver

I provide behaviour interventionist services in my Burnaby office for individuals with autism spectrum disorder (ASD and Asperger's disorder. I am a member of the ACT (Autism Community Training) RASP list and my services are covered under minsitry funding programs for children and teens.

Most of my services are focused on specific behavioural problems which parents and consultants are having a hard time dealing with. I provide parent training, consultation and some school based training and consltation. I have workd as the behaviour management specialist for several school districts and as a provincial autism consultant through the Provinical Outreach Program for Autism and Related Services (POPARD). I am deeply familiar with school based programs and have supervised and cnsulted with many professionals in local districts.

Two other things that I provide in my pracritce:

First, I provide autism diagnosist services. If you suspect your child has autism an appointment can usually be set up within 10 days to 2 weeks. I prioritize my cases with individuals with autism spectrum disorder because I am aware how few services there are here in BC.  Please visit my website for more information on arranging an appointment for an autism diagnostic consultation. I require an initial 1 hour session to discuss current symptoms and history. The cost of this session is $175.00 and this is part of the overall costs if we decide to move forward with testing.

I also see children and teens in my office for individual therapy. This therapy usually is focused on issues of communications and follows the structure of interventions you will find in the work of Michelle Winner ( Social Thinking). Often these sessions include a period of play therapy, some didactic training and skills development, and then a period of feedback with parents so that they will understand the process and be able to impliment supportive skills trainng in the home.

In addition to diagnosising and providing therapy for autism spectrum disorder / Aspegers disorder, I also focus much of my practice on ADHD and executive dysfunction issues. These are often co-morbid with a diagnosis of ASD.

Finally, I not only provide autism spectrum disorder services to children and teens, but also to adults as well, and see patients from across the lifespan.

Please visit my website at www.relatedminds.com or http://www.relatedminds.com/autism and contact me if you have any questions I can help you with.

Adult Diagnosis of Autism Spectrum Disorder and Asperger's Disorder

The diagnosis of autism spectrum disorder (ASD), sometimes referred to as "Asperger's Disorder" can be very difficult for a family practitioner  due to the amount of time and the instruments and tools used to complete a comprehensive examination.

While many people make a determination by filling out an on-line form, the diagnsis is actually far more complex. In British Columbia an "offical" diagnosis of autism spectrum disorder, especially high functioning autism which until recently was referred to as Asperger's Disorder - sometimes also diagnosed as "non-Verbal LEarning Disorder" requires several specific tests. For children under six a team is required, including a psychologist, physician and a speech pathologist. The reason a team is required is that autism can often look like other disorders, and other disorders can often look just like autism. Here the Ministry of Children and Families also requires specific tests be used. These include AT LEAST the ADOS- Autism Diagnossit Observation System, which is a procedural test that looks at current symptoms and behaviours, and the ADI-R, the Autism Diagnositic Interview Revised, which is a highly structured history. These are necessary for recognition of ASD by schools and the ministry.

When assessing/testing adult I use these same tests, as an autism diagnosis in BC can be used for obtaining tax credits, social services and most often accomodations at school, college, university and the workplace.

In addition to these specific tests and procedures I also administer a series of neuropsychological tests and personality assessments in order to rule out other possible causes of the symptoms. Additionally individuals with autism spectrum disorder/ adult Asperger's can also have co-morbid disorders, such as depression, anxiety, OCD and ADHD. This comprehensive look at your symptoms and hisotry helps guide treatment choices.

The cost of such an assessment is $1,200-1,600, depending upon the complexity. Regretfully, these costs are not covered by provincial MSP (medical Service Plan) but some costs may be covered by your extended health care plan.

My schedule allows me to see most individuals who are seeking an assessment for adult autism spectrum disorder within 3-4 weeks, as I try not to schedule out more than 4-6 weeks in advance, and prioritize adult autism spectrum disorder assessments as there are few professionals in the lower mainland with the ability or experience necessary to do these assessments.

For more information on adult autism spectrum disorder assessments please visit my web page and contact me by phone or by completing the form on the web page. I am a Registered Psychologist in British Columbia with over 25 years experience in the field of autism, including working as a special education teacher for students with autism spectrum disorder, as a school district behaviour management specialist and as a provincial autism consultant. I have also worked as a rehabilitation psychologist and neuropsychologist with adults returning to the workplace. This hands on experience with individuals across the spectrum of ages and development provides me with a unique set of skills and knowledge base.

Web page:  www.relatedminds.com
http://www.relatedminds.com/autism/
http://www.relatedminds.com/adult-autism-and-aspergers-disorder/
                 

Therapy for Teens and Young Adults with Asperger's / Autism in Vancouver and Burnaby

While some schools provide small groups to work on skills training with students with Aspeger's Disorder, it seems to be the exception here in the lower mainland. Children, teens and young adults with autism spectrum disorder, especially those who are higher functioning and until recently we would have said they had "Aspergers Disorder," need supportive servies for a number of issues. These services can be provided in several different ways:

1. In small groups, such as what one might find in a school setting. This type of group, often called a "social thinking" group is often directed by a psychologist or school speech pathologist. The most frequent type of group that we see are those modelled after Michelle Garcia Winner's Social Thinking program, and address issues such as developing the ability to engage in small-talk, learning to "read others," by studying their entire body and learning to use methods to gather information that they can use to engage in the give and take of conversation, and sometimes direct learning and practice using another of Michelle's curriculums such as her "Social Behavior Mapping" program.  You can see many of these materials at her website" www.socialthinking.com

2. When groups and school based programs are not available many children, teens and adults use one-to-one therapy to learn and practice these skills. Sessions might include some diadactic learning, some conversation time and then a period to reflect on the quality of the conversation and on issues relating to their experiences in other environments, such as school, home or the workplace. While I organize and sometimes direct small groups through schools, in my private practice much of my time is spent providing these types of services. I find that most individuals can make use of Mitchell's materials, and keeping the focus on skill development for reciprocal conversation skills is key. Many adults see me because of relationship issues, and problems in the workplace relating to asperger's and communications problems.

In addition to these language based services, I often spend a good deal of time directly teaching skills relating to anxiety, stress, and for many, depression. Manby of my patients have previously seen therapists or counsellors who have tried to address issues like anxiety, stress and depression who are not familiar with autism spectrum disorder and how it effects individuals across the lifespan.

3. The third way I often see patients about asperger's or autism spectrum disorder is through my services as a family therapist. This might mean working with a couple, or working with parents, providing parent education and behavioral skills training.

For those with children who have provincial funding I am a registered behavior specialist with ACT - Autism Community Training, and my services for children or teens can be billed directly to the Ministry.  If you suspect your child or teen has autism spectrum disorder I also provide diagnostic / testing services that help you meet the qualifications for BC autism funding.

Adult services are often covered by their extended health plans, and in some cases cololege, universities and employers help with payments. Most individuals with autism spectrum disorder - Asperger's Disorder - also qualify for tax benifits, which can help defer the costs.

For more information on my services please feel free to contact me through my website at www.relatedminds.com, or call 778.998-7975

Dr. Jim Roche is a licensed and Registered Psychologist with over 30 years experience in the field of autism, education and neuropsychological assessment.

KEY WORDS: Autism, Asperger's Disorder, Burnaby, Vancouver, Coquitlam, New Westminster

Books for Teens, Young Adults and Adults with Autism / Aspergers

As a provider of assessments for children, teens and adults with sautism spectrum disorder, or what was previously called "Asperger's Disorder," I am often asked for a good book to read on the subject. Specifically, today, I will suggest one book for teens and young adults. There are others for adults and married couples, but honestly, there isn't too much quality material available.

For teens and young adults I would recommend "Socially Curious and Curiously Social" by Mitchelle Garcia winner and Pamela Crooke. I also often suggest this to adult who can relate to many of the issues and experiences that this teen-young adult book speaks about.

After recieving a diagnosis of autism spectrum disorder (ASD) or Asperger's Disorder young people are often in need of a book, or at least a resourse of materials, on issues they relate to every day. This book, which is an anime-illustrated guidebook, is written to help explain how the social mind is expected to work in order to effectively relate to others at school, at work and in the community. This book redines what it means "to be social."

Michelle Winner is the leading practitioner in the field of ASD - Asperger's. She has a large clinic in San Jose California where she provides individual, group and family therapy to those with Aspergers/ASD, and provides training and curriculum material that most of the schools I work with, in many different states and provinces, in the schools. This includes materials such as here "Social Thinking" curriculum, "Social Behavior Mapping," and "Thinking About You Thinking About Me." These materaisl work well with other related systems such as "The Incredible five Point Scale."

Here web page, www.socialthinking.com is an excellent resourse for other related materials.

..............................................

Dr. Jim Roche provides assessments / testing for autism spectrum disorder and Asperger's in his offices in Burnaby and Vancouver, providing services for children with autism, Asperger's and NVLD in Vancouver, Burnaby, coquitlam, North Vancouver, West Vancouver and throughout the region. He is a licensed and registered psychologist, a certified teacher of special education and a licensed school psychologist. He has worked as a behaviour management specialist for schools in BC, California, Washingto, and New York. He has been providing assessment and testing for children, teens/adiolescents and adults with autism spectrum disorder and Asperger's Disorder for over twenty years. His assessments help many individuals qualify for provinical funding and related support programs. He is one of the few practitioners in BC who has worked in schools and workplaces directly with individuals with autism spectrum disorder and Asperger's Disorder and brings his experience as a teacher, psychologist and consultant to each case.

For more information on assessments and testing for autism spectrum disorder or Asperger's disorder please visit his webpage at www.relatedminds.com

https://therapists.psychologytoday.com/rms/70682

Autism Diagnostic Services| Burnaby

Dr. Jim Roche provides diagnostic services for children, teens and adults with suspect autism spectrum disorder or Asperger's disorder. These services are used to help families obtain funding through the BC autism funding program, school-based services and accommodations in school, college, university or work for adults.
I am a registered and licensed psychologist with 

over twenty-five years of experience in this field. I also hold licenses and certificates in school psychology and as a teacher of special education, so I am familiar with what it's like to run a classroom.

For ore information on my services please visit the ACT-RASP web page at http://www.actcommunity.ca/profiles/224/

Or visit my web page at www.relatedminds.com

Other places you can find information about my services include:
http://psyris.com/drjimroche

https://therapists.psychologytoday.com/rms/name/Jim_Roche_JD,PhD,CAGS,RPsych,RMFT_Burnaby_British+Columbia_70682

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

Dr. Jim Roche

I am a Registered Psychologist and Marriage and Family Therapist who specializes in working with teens and young adults with autism spectrum disorder (ASD), and what has been called Asperger's Disorder.   My work with teens and young adults addresses school issues, sometimes psychoeducational testing, school observations, emotional issues and behavioural issues.

I am a member of the ACT RASP and am a registered behaviour consultant with them, and therefore can see children below the age of six using provincial funding. I provide autism diagnostic services and help parents become familiar with the many treatment modalities that are available to them. As a registered psychologist my services are also covered by most extended health care plans.

A number of patients see me for weekly 1-2 therapy, often addressing issues of anxiety, stress, depression or behavioural issues. I also see parents for parent education and sometimes for family or couples related counselling relating to the stress of dealing with the many aspects of ASD.

With most clients my focus is on either behavioural training, aimed at parents, caregivers or schools, or on social communications issues. I often use materials from Michelle Winner and her Social Thinking program. This includes curriculum materials such as "Social Behaviour Mapping," and "The Incredible Five Point Scale." I also teach a number of visual support techniques.

The methods I use are those that are considered by most school districts as "research based" and in use in those districts. As a previous POPARD provincial consultant for autism I am familiar with the methods, materials and curriculum used in most schools in the Vancouver/BC area and try to work in a manner that works well with what you should expect from the schools.

I also provide school based observations and consultations in both public and private schools.

I am a registered and licensed psychologist with over twenty five years of experience in this field. I also hold licenses and certificates in school psychology and as a teacher of special education, so I am familiar with what it's like to run a classroom.

For ore information on my services please visit the ACT-RASP web page at http://www.actcommunity.ca/profiles/224/

Or visit my web page at www.relatedminds.com

Other places you can find information about my services include:
http://psyris.com/drjimroche

https://therapists.psychologytoday.com/rms/name/Jim_Roche_JD,PhD,CAGS,RPsych,RMFT_Burnaby_British+Columbia_70682

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

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

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 | 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

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

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/

What is a Psychoeducational Assessment?

I am often asked by parents to complete a psychoeducational assessment and a good part of the time they are unsure exactly what it is and why it is necessary. Here are some simple answers about psychoeducational assessments:

A psychoeducational is a report produced by either a school psychologist or a registered psychologist that looks at a student's academic skill set, their intellectual capacities and behaviours and tried to determine where they stand compared to either their age group or grade. From the information we look at their intellectual capacity - by using an IQ test, to some extent their neuro-developmental levels with tools that look at writing speed, auditory processing and related specific skills, and we compare those to their current academic skill looking for unexpected deficits - sometimes called "discrepancies." A good psychoeducational assessment also looks at a child's social and behavioural development, and if your lucky, emotional development.

All this information, as well as observations and history, are used to develop an education plan called an IEP or Individualized Education Plan. That plan, developed WITH the parents present (not developed by the school and presented to you, you should be there to develop it with the school because you know a lot about your child) should consider the child's deficits that need to be addressed, and then their strengths that might be helpful in addressing those deficits (for instance, a child might have poor auditory memory but out of this world visual memory ....that visual memory can be used to address the deficit area). The plan should address all significant deficits that make learning difficult, and should list measurable goals the school will meet on they way. It should also address in detail how the school and teacher are going to support the student in reaching those goals.

Too many IEPs in BC say, "Tommy will learn to multiply," and fail to state what was originally interfering with his ability to multiply (maybe being off task, having problems focusing or maybe a visual-spatial problem that can be addressed with larger print or another supportive scaffold) and how we -the school ,the teacher and the parents, are going to teach him and support him.

At many IEP meetings I just want to ask, "And how is that going to happen with YOUR support?" That is exactly what the psychoeducational assessment is designed to address. What are this student's strengths and weaknesses, and how can we use this knowledge to support the student in meeting these reasonable educational goals.

That's, in general, how a psychoeducational assessment helps a student, and why we need a psychoeducational assessment every time a student is "coded" or "labeled" as needing special education support services. Students with cognitive deficits, students with specific learning disabilities, students with autism, Aspeger's or emotional problems. Parents often ask why a psychoeducational assessment is necessary for their child who is diagnosed with Aspeger's or autism spectrum disorder. The answer is, "To tell us where the student is academically and SOCIALLY - this is a student with ASD - and tell us about the student's strengths and weaknesses so we can develop not just a plan that states goals, but a plan that tells us what we - the school, the teacher and the parents- can do to support that student in reaching that goals.

Regretfully students in BC are on long waiting lists for psychoeducational assessments. These should be completed by the school district, however, most districts are low on funds and staffing, Because of that many parents make the choice of going to a registered psychologist for a psychoeducational assessment. Please visit my web page at www.relatedminds.com for information about psychoeducational assessments. In addition to being a licensed and registered psychologist I am also a certified school psychologist with over two decades of experience in the school system. This includes working as a program director, behaviour program specialist, school psychologist, counsellor and classroom teacher.

www.relatedminds.com
Dr. Jim Roche
relatedminds@gmail.com
778.998-7975

What does research say about treatments for adolescents and young adults with Autism Spectrum Disorder and Aspergers?

A 2012 publication"Interventions for Adolescents and Young Adults with Autism spectrum Disorders" was published by the Agency for Healthcare Research and Quality. It is an excellent report, 374 pages of data, and would be useful to any parent of a young adult, and should be part of the collection of literature in any school district, private practice or mental health program that works with young adolescents (teens) or young adults with Asperger's Disorder/Syndrome.

The full report can be found here: http://www.ncbi.nlm.nih.gov/books/NBK107275/
For instance, many school districts provide "Music Therapy" for student's with Autism Spectrum Disorder or Aspergers. Often this is provided by a "Registered Music Therapist" here in British Columbia.  How does this government report look at music therapy for students with autism?

" 2 poor-quality case studies. Some gains in social skills reported using unvalidated and largely subjective measures. No comparison groups or measures of treatment fidelity; participants not clearly characterized; assessors not masked; differences in concomitant interventions not reported.”

If music therapy is being offered to your child, but no behavioural program, small group social learning group (using materials such as ABA for some or "social learning" programs such as Michelle Winners for others), you need to know that the evidence for using music therapy with autism is weak.
While the report is long it can be downloaded in PDF format and read on your computer or iPad screen. At least those professionals designing, approving and supervising the programs out children use should be familiar with this compendium of research and it's implications as to where to put our effort, money and hearts when dealing with our children, students and clients.

The study comes to this rather bleak conclusion:

"Few studies have been conducted to assess treatment approaches for adolescents and young adults with ASD, and as such there is very little evidence available for specific treatment approaches in this population; this is especially the case for evidence-based approaches to support the transition of youth with autism to adulthood. Of the small number of studies available, most were of poor quality, which may reflect the relative recency of the field. Five studies, primarily of medical interventions, had fair quality. Behavioral, educational, and adaptive/life skills studies were typically small and short term and suggested some potential improvements in social skills and functional behavior. Small studies suggested that vocational programs may increase employment success for some individuals. Few data are available to support the use of medical or allied health interventions in the adolescent and young adult population. The medical studies that have been conducted focused on the use of medications to address specific challenging behaviors, including irritability and aggression, for which effectiveness in this age group is largely unknown and inferred from studies including mostly younger children."

Another example of  overused interventions are sensory interventions. Some schools are full of these programs, with specialized rooms that children are taken to when they are having behavioural or emotional difficulty. Many times this is the primary intervention on an IEP for a child, in spite of the lack of supportive research for using these techniques. Here is what the American Paediatric Association says:

"Sensory-based therapies using brushes, swings, balls and other equipment are increasingly used by occupational therapists to treat children with developmental and behavioral disorders. However, it’s unclear whether children with sensory-based problems have an actual disorder related to the sensory pathways of the brain, or whether these problems are due to an underlying developmental disorder. In a new policy statement, “Sensory Integration Therapies for Children With Developmental and Behavioral Disorders,” published in the June 2012 Pediatrics (published online May 28), the American Academy of Pediatrics (AAP) recommends that pediatricians not use sensory processing disorder as an independent diagnosis. When sensory problems are present, health care providers should consider other developmental disorders, including autism spectrum disorders, attention deficit/hyperactivity disorder, developmental coordination disorder and anxiety disorder. Occupational therapy with the use of sensory-based therapies may be acceptable as one component of a comprehensive treatment plan. The AAP recommends pediatricians communicate with families about the limited data on the use of sensory-based therapies, and help families design simple ways to monitor the effects of treatment and discuss whether the therapy is working to achieve their goals for their child. Occupational therapy is a limited resource and families should work with pediatricians to prioritize treatments based on problems that affect a child’s ability to perform daily functions. - See more at: http://www.aap.org/en-us/about-the-aap/aap-press-room/pages/AAP-Recommends-Careful-Approach-to-Using-Sensory-Based-Therapies.aspx#sthash.ORoTzKDN.dpuf

So what is a parent (or spouse) to do? 

First of all, do not rely on the overly optimistic reviews from practitioners. Many school and mental health facilities use the least trained ( meaning cheapest) staff available to work with these students and clients. Start by making sure you have a licensed or registered professional involved. High Functioning Autism and Asperger's Disorder are neurologically based. In many ways they are first and foremost language disorder and disorder of executive function - inability to move from one subject to another, accept changes, "read" other people, demonstrate mental flexibility and control their emotions. These are issues familiar to both behavioural psychologists and speech and language pathologists. (Remember, there is a reason the leader in this field, Michelle Garcia Winner, is a speech and language pathologist!) Start with experts in the behaviours you are most concerned with. Not with a "program."

Next, develop a clear outline of what you want to deal with, what are the problematic symptoms, deficits and concerns.

Then develop a program to address those.

What this study clearly shows is that too much effort is spent on ancillary treatments, that happen to be available, or for which their is a "workbook" that a para-professional can follow. Treatments address deficits and concerns, and whether it be in an IEP meeting (individual educational Plan) or a one to one meeting with your therapist, an appropriate assessment is the best way to find a path to appropriate treatment!

For older teens and young adults these group sessions are not available, and often inappropriate, as higher functioning teens and young adults are more likely than not to be suffering from co-morbid disorders such as anxiety, stress, depression and low self esteem. These, like many of the specific symptoms, can be addressed individually use adaptations of familiar, well researched and evidence based treatments.

While the problem of poor research for treatment of autism and Aspeger's is real, there are still many treatments which we know work, and work well, for most people, and if properly modified by a mental health professional who is familiar with autism spectrum disorder in children, adolescents and adults, the odds start to change.

For more information on diagnostic assessments for autism spectrum disorder (I am an approved provider with Autism Community Training -ACT, and a member of the RASP provider's list) which I provide as a private practitioner, contact my at 778.998-7975. My website is www,relatedminds.com and I have offices in both Burnaby and Vancouver. Most testing is done in Burnaby, as that is where most of the testing materials are. 

My waiting list for autism assessment for children over 6 through adults is fairly short, about 10 days to start the process.

I also provide therapy for adolescents/teens and adults with Asperger's Disorder and Autism Spectrum Disorder.