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
Showing posts with label assessment. Show all posts
Showing posts with label assessment. Show all posts
Wednesday, June 25, 2014
Saturday, July 13, 2013
Child, Adolescent and Adult Testing for Autism / Aspeger's Disorder
This week two patients came to me and said they wanted an assessment for autism. Actually one said autism, this was an assessment for a teenager, and another wanted an assessment for Aspeger's Disorder. Both were sent by their family physicians, which is how I usually get my referrals.
Both wanted to know what it consisted of and how much it would cost. Those are very reasonable questions, but not so easy to answer. An assessment usually is completed to answer a specific question, and most of the time a diagnosis alone isn't worth spending time or money on. So I usually ask, "What do you need this diagnosis for?"
With a child an autism diagnosis, and it doesn't matter if we are looking at "classical autism" or Asperger's Disorder, High Functioning Autism or whatever term you may be using (it is now all one diagnosis on a spectrum in the new Diagnostic and Statistical Manual, the DSM-5) if it's to help with education you often need both an assessment for autism using the ADOS (Autism Diagnostic Observation Schedule) and the ADI-R (Autism Diagnostic Interview-Revised) to qualify for school and provincial services here in British Columbia, as well as a full psychoeducational assessment. This is necessary to help determine what interventions to use in the school to help the student learn. This is a very comprehensive procedure and can cost between $2,600 and $3,400.00
I ask about this because the school may be able to complete the psychoeducational assessment component, which significantly reduces the cost. Or, maybe a psychoeducational assessment has already been completed!
Adults, on the other hand, often come to me for an assessment and diagnosis because they want to understand themselves and be able to explain behaviours. They just want to know why they might be doing the things they are doing. In this case I'm often reluctant to conduct a time consuming and expensive assessment. An assessment should not just tell you what you have, it should tell you what to do about it! Adult assessments often are used in employment as well, to get accommodations and consideration at the work place.
A diagnosis of adult autism or Asperger's Disorder (sometimes called Asperger's Syndrome) means not just seeing if you meet a list of criteria or symptoms, it means ruling out the many other possible disorders that look very much like Asperger or High Functioning Autism. This means completing not only the usual assessment for autism/Aspergers but also personality assessments, some neuropsychological tests and often speech and language assessments, as some specific speech and language deficits can look just like autism/Asperger's.
Just like a student, who would use the assessment/test results to develop an educational plan (an IEP or Individual Education Plan is developed by the school based upon the assessment results) an adult should also expect to be able to use their test results to make a life intervention plan, use the results to come up with a plan to improve issues at work, home, in relationships or recreation.
Assessments are used to make plans and look forward, not just to diagnose. I would agree with parents who object to getting a "label" but would urge them to get a good diagnosis and use it to make a plan.
For more information about the diagnostic services I provide you can visit my web page at www.relatedminds.com. You will find information about autism services for children, adolescents and adults and assessment services. You can also call me at 778.998-7975 or email me at relatedminds@gmail.com
I provide assessment services, diagnosis of autism/Aspergers for provincial funding, parent education, behaviour management programs and individual and couple therapy for adults with high functioning autism and Asperger's Disorder.
Monday, August 27, 2012
What Causes Autism? Science is slowly approaching an understanding.
"Notes on Autism Assessment and Treatment" are written by Dr. Jim Roche. These autism notes are not meant to provide a guide to either diagnosis or treatment. For information on diagnosis and treatment contact your medical doctor or a registered/licensed psychologist for an appointment and assessment. Information about Dr. Roche's services can be found at these addresses:
Relatedminds: http://www.relatedminds.com
ADHD Help BC: http://www.adhdhelp.ca
At Psychology Today: http://therapists.psychologytoday.com/rms/70682
At the BCPA website: http://bcpa.pixelmountainarts.com/users/jimroche
At CounsellingBC: http://www.counsellingbc.com/listings/JRoche.htm
At Psyris: http://psyris.com/drjimroche
At Autism Community Training: http://www.actcommunity.net/jim-roche.html
What causes autism, Autism spectrum disorder and Asperger's Syndrome? We now know more about the cause of autism than we have for a long long time. But we need to be careful not to allow the anti-vaccine / anti-scient crowd misdirect us. Moises Velasques-Manoff, the author of "An Epidemic of Absence: A new Way of Understanding Allergies and Autoimmune Diseases" has written an excellent summary of the latest research for the New York Times. It can be found here:
http://www.nytimes.com/2012/08/26/opinion/sunday/immune-disorders-and-autism.html?smid=pl-share
Velasques-Manoff points out that one subset of those with autism, which makes up at least if not more than 1/3 of those with autism, seem to have some type of inflammatory disorder. And this inflammatory disease doesn't start as a result of vaccinations - it's starts way before that, in the womb. We know this is true because the brain changes that are associated with autism are noted prior to the age of immunizations, and there is no correlation between those getting these vaccines and those who develop autism. Hopefully, someday, the uninformed will start to notice the basic problems with their science, or maybe start to have some respect for science.
What the research Velasques-Manoff writes about notes is that a large number of mothers of autistic children have had some sort of immune compromising condition while they were pregnant. This leads to a inflammatory reaction, in both the mother and child, and this effects the astroglia and microglia - which ar enlarged from chronic inflammation.
A population-wide study in Denmark spanning two decades indicates that infections during pregnancy increases the risk of autism in children. Sounds simple enough, doesn't it? Infections during pregnancy ...must cause autism. So cut down the number of infections. But again, the epidemiology doesn't lead in that direction. Like much of science, it's more complicated than that. You see, while world wide viral and bacterial infections have gone down ....autism rates have gone up. Especially places where there are fewer infections! Somewhat of a contradiction.
You see while infections and other disorders have decreased, the number of inflammatory disorders HAS gone up. And the relationship between these inflammatory infections and autism is very clear. A mother with rheumatoid arthritis, an inflammatory disorder, has an 80 percent increase in the chance of having a child with autism. A mother with celiac disease increase her risk 350 percent.
So the questions now becomes why we are now so prone to inflammatory disorders, and if there is anything we can do to decrease these risks? There are several suggested therapies - for the mother - and these oddly follow the idea of doing something about what Velasques-Manoff calls our "microbial deprivation." (Remember: dirt and parasites are "famous for limiting inflammation.")
Probiotics? "domesticated parasites?" These are just some of the thoughts Velasques-Manoff and others are looking at. What we do know is that we have spent too much time looking at the effects of dysregulation in the child with autism, and not enough time looking at dysregulation and other problems in parents .... remember, it's a genetic disorder to a great degree.
Click on the above link to get the New York Times article, and check out some of Velasques-Manoff's writing elsewhere.
Relatedminds: http://www.relatedminds.com
ADHD Help BC: http://www.adhdhelp.ca
At Psychology Today: http://therapists.psychologytoday.com/rms/70682
At the BCPA website: http://bcpa.pixelmountainarts.com/users/jimroche
At CounsellingBC: http://www.counsellingbc.com/listings/JRoche.htm
At Psyris: http://psyris.com/drjimroche
At Autism Community Training: http://www.actcommunity.net/jim-roche.html
What causes autism, Autism spectrum disorder and Asperger's Syndrome? We now know more about the cause of autism than we have for a long long time. But we need to be careful not to allow the anti-vaccine / anti-scient crowd misdirect us. Moises Velasques-Manoff, the author of "An Epidemic of Absence: A new Way of Understanding Allergies and Autoimmune Diseases" has written an excellent summary of the latest research for the New York Times. It can be found here:
http://www.nytimes.com/2012/08/26/opinion/sunday/immune-disorders-and-autism.html?smid=pl-share
Velasques-Manoff points out that one subset of those with autism, which makes up at least if not more than 1/3 of those with autism, seem to have some type of inflammatory disorder. And this inflammatory disease doesn't start as a result of vaccinations - it's starts way before that, in the womb. We know this is true because the brain changes that are associated with autism are noted prior to the age of immunizations, and there is no correlation between those getting these vaccines and those who develop autism. Hopefully, someday, the uninformed will start to notice the basic problems with their science, or maybe start to have some respect for science.
What the research Velasques-Manoff writes about notes is that a large number of mothers of autistic children have had some sort of immune compromising condition while they were pregnant. This leads to a inflammatory reaction, in both the mother and child, and this effects the astroglia and microglia - which ar enlarged from chronic inflammation.
A population-wide study in Denmark spanning two decades indicates that infections during pregnancy increases the risk of autism in children. Sounds simple enough, doesn't it? Infections during pregnancy ...must cause autism. So cut down the number of infections. But again, the epidemiology doesn't lead in that direction. Like much of science, it's more complicated than that. You see, while world wide viral and bacterial infections have gone down ....autism rates have gone up. Especially places where there are fewer infections! Somewhat of a contradiction.
You see while infections and other disorders have decreased, the number of inflammatory disorders HAS gone up. And the relationship between these inflammatory infections and autism is very clear. A mother with rheumatoid arthritis, an inflammatory disorder, has an 80 percent increase in the chance of having a child with autism. A mother with celiac disease increase her risk 350 percent.
So the questions now becomes why we are now so prone to inflammatory disorders, and if there is anything we can do to decrease these risks? There are several suggested therapies - for the mother - and these oddly follow the idea of doing something about what Velasques-Manoff calls our "microbial deprivation." (Remember: dirt and parasites are "famous for limiting inflammation.")
Probiotics? "domesticated parasites?" These are just some of the thoughts Velasques-Manoff and others are looking at. What we do know is that we have spent too much time looking at the effects of dysregulation in the child with autism, and not enough time looking at dysregulation and other problems in parents .... remember, it's a genetic disorder to a great degree.
Click on the above link to get the New York Times article, and check out some of Velasques-Manoff's writing elsewhere.
Thursday, September 22, 2011
Assessment and Treatment of Autism in BC
I am often asked for basic information on the assessment and treatment of autism in BC. Here in BC autism assessments need to be completed by a professional with specialized training in two specific assessment tools. First, there is the ADOS ( the Autism Diagnostic Observation System) and second the ADI-R (Autism Diagnostic Inventory-Revised). These two tools are necessary for any child to be assessed here in BC and obtain provincial funding and appropriate school "coding" and supports for a student with autism (ASD0. This also applies for students with what some call "High Functioning Autism" or HFA and Asperger's. Although these names will soon be left behind as we move to a new diagnostic book and category.
If your child is under six years old they need to be assessed by a full team, including a physician, speech pathologist and a psychologist or other professional specially trained to use these specialized autism tools. If your child is older than that a psychologist alone (again, with the appropriate skills) can complete the testing, but always needs an assessment from your paediatrician or family doctor. This is in order to full out other possible causes for the symptoms you are concerned about. While it isn't necessary at this age to include a speech pathologist, it's a good idea if the psychologist isn't familiar with speech and language problems.
Several hospitals and other provincial facilities provide these assessments for free. Why do people go to a private practitioner? Some simply want their own doctor rather than one paid by the government. Some are getting a second opinion. And finally, there is a significant waiting list for the services the province provides.
Often it is appropriate, and really necessary, to also complete a "psychoeducational" assessment. Students with Autism and Asperger's often have co-morbid disorders that need treatment, including school related problems such as learning disabilities, ADHD, anxiety or depression. In most cases, unless such an examination has already taken place, the psychoeducational examination is necessary.
How much should this cost? The cost varies from one autism assessment to another. One child may take a long time completing the tasks that are part of the exam, and another may need several additional tests to get to a learning disability. So it should vary. Costs run, on average, from $1,600-$2,600.00 depending upon how much work is to be done.
My final recommendation is that you always find a professional who has experience with schools, knows how schools work, how teachers react to suggestions and plans. If the professional does't have experience with the classroom they will have a hard time making realistic suggestions for accommodations and supports. They should also have hands on experience in dealing with children with behavioural problems. Don't be afraid to ask. You can find a psychologist with expertise in autism through the British Columbia Psychological Association.
If your child is under six years old they need to be assessed by a full team, including a physician, speech pathologist and a psychologist or other professional specially trained to use these specialized autism tools. If your child is older than that a psychologist alone (again, with the appropriate skills) can complete the testing, but always needs an assessment from your paediatrician or family doctor. This is in order to full out other possible causes for the symptoms you are concerned about. While it isn't necessary at this age to include a speech pathologist, it's a good idea if the psychologist isn't familiar with speech and language problems.
Several hospitals and other provincial facilities provide these assessments for free. Why do people go to a private practitioner? Some simply want their own doctor rather than one paid by the government. Some are getting a second opinion. And finally, there is a significant waiting list for the services the province provides.
Often it is appropriate, and really necessary, to also complete a "psychoeducational" assessment. Students with Autism and Asperger's often have co-morbid disorders that need treatment, including school related problems such as learning disabilities, ADHD, anxiety or depression. In most cases, unless such an examination has already taken place, the psychoeducational examination is necessary.
How much should this cost? The cost varies from one autism assessment to another. One child may take a long time completing the tasks that are part of the exam, and another may need several additional tests to get to a learning disability. So it should vary. Costs run, on average, from $1,600-$2,600.00 depending upon how much work is to be done.
My final recommendation is that you always find a professional who has experience with schools, knows how schools work, how teachers react to suggestions and plans. If the professional does't have experience with the classroom they will have a hard time making realistic suggestions for accommodations and supports. They should also have hands on experience in dealing with children with behavioural problems. Don't be afraid to ask. You can find a psychologist with expertise in autism through the British Columbia Psychological Association.
About Dr. Roche:
Dr. Jim Roche is a Registered Psychologist and a Registered Marriage and Family Therapist with offices in Vancouver and Burnaby, BC. He has been in practice for over 25 years and has served as a Provincial Consultant on Asperger's/Autism/ASD as well as Director of Behaviour Programming for several school districts here in Canada, in New York and California. In addition to being a Registered Psychologist he is a Certified/Licensed Teacher of Special Education and School Psychologist.
Other information about Dr. Roche can be found at: www.relatedminds.com , www.relatedminds.com/adhd, http://Therapists.Psychologytoday.com/70682, www.bcpsychologist.org/users/jimroche, http://psyris.com/drjimroche.
Specific Information about his services for children with autism and Asperger's Disorder can be found at: http://www.relatedminds.com/autism/
Tuesday, January 18, 2011
ADHD and Autism
Kids with ADHD deserve action
Here is an excellent letter to the editor from the local Burnaby paper (click above).
Every year kids come to school with a variety of learning disabilities and mental health disorders, these include Autism, ADHD/ADD, depression, anxiety and related disorders. And recently studies have shown that BC is one of the places in Canada that is very unlikely to be prepared to help children with one of the most common of these disorders, ADHD, or ADD as many people mistakenly call it.
As the writer of this letter states, "Our Ministry of Education, as well as school communities, needs to know that ADHD is not a behaviour issue, that it can't be "cured" by changing diet, that it's not a result of poor parenting and that the kids who suffer from it aren't bad kids. And they need to know that I am not unnecessarily "drugging" my child. They need to know it's a genuine medical condition, that many kids with ADHD are very bright, that it affects up to 12 per cent of school children, that it's stressful for parents and hard to deal with for kids."
Well, I couldn't have said it better myself, and I am often frustrated by the way ADHD/ADD is treated or should I say not treated in the schools. This is especially important to parents of children with ASD or Asperger's Disorder. Treatment is often non-existant for ADHD. There is an assumption that behaviours are the result of choice, that the problems and failures are purposeful. While the provincial government had taken steps to address the need to provide treatment in the schools and community for autism and Asperger's Disorder, there is really very little available in the schools for children with ADHD/ADD. While there is a large percentage of children with ADHD/ADD you very seldom find a school district providing ADHD specific training for it's staff or parents. While I have spoken in dozens and dozens of schools throughout BC on autism and Asperger's Disorder, and provided training, consultation and observations focused on children with autism, it is nearly impossible to get a school to ask for a workshop, training session or a consultation on ADHD. And often our children with autism and Asperger's have ADHD as a co-morbid disorder. It is seldom addressed in Individual Education Plans (IEPs) and when a school does deal with the symptoms / behaviours that result from ADHD they apply "warnings" and punishments as the "treatment." This is something that sooner or later has to be addressed by our schools. This week alone three of the children seen in my practice were being punished for their ADHD symptoms. A school would never punish a student for their behaviours-symptoms of anxiety, or punish a student for behaviours-symptoms of Tourette's syndrome (although I have to admit, I have spent more than one full semester dealing with just this issue in a major school district in California). More than ny other disorder I have heard negative comments from teacher's and staff when addressing the simplest behaviours relating to ADHD/ADD. Sometimes it's like they have either never heard of the disorder, or if they agreed it existed out entire society would fall.
For parents I have suggested reading "So I'm Not Lazy, Crazy or Stupid," Mel Levine's "The Myth of Laziness" or Dr. Barkley's many works on ADHD. (All of these can be found on my web page.
Often different disorders have separate"camps" of supporters. There are "autism awareness" days, walks, Depression awareness days...all sorts of support groups and programs. Oddly, there is no ADHD walk or ADHD day in any school's or towns I've been to. That's too bad. ADHD more than any other disorder needs to be brought out of the closet and addressed, and those who deny that it is a real disorder, or that it's really a choice a ten year old is making to fail all his subjects and lose all his friends needs to be confronted and dealt with.
I can offer this one piece of advice to parent. Get a copy of the diagnosis for both Autism/Aspergers AND ADHD. Make a copy. LEarn it. Mark the important terms in yellow, underline them. Make a copy for everyone on your child's IEP team. And then make sure everyone know that punishment for symptoms went out about 100 years ago. We don't punish individuals who have a diagnosed disorders like autism, Aspergers, Tourette's syndrome or ADHD for exhibiting their symptoms. Ever. If they try, ask for the research that shows such a "technique" is a good idea. What supports that as an intervention? Instead redirect everyone back to answering how we as a team, parents and school, are going to provide positive behavioural support through the IEP process to teach your child how to do better and succeed. That's what an IEP is all about!
...............................
...............................
The Autism blog is not offered as medical advice or as a means of diagnosing or treating Autism or Asperger's Disoder. The diagnosis of autism is complex and involves not just looking for symptoms of autism, which is all that those “web tests” do, but also involves ruling out other disorders that might look just like autism. Often individuals who think they or their child has autism or Asperger's Disoder have other disorders, and may have co-morbid disorders such as depression, anxiety or OCD. A simple check off sheet of “symptoms” doesn’t differentiate these. So avoid these on-line "tests" which are nothing more than a collection of symptoms. You need to see a licensed or registered professional for a real diagnosis. Medical doctors can diagnose autism, but the diagnosis is complex and often they will make a referral to a Registered Psychologist for a full understanding of a patient’s symptoms. You can obtain a referral for a psychologist with expertise in autism from the British Columbia Psychological Association (BCPA). The professional you select needs specific training and needs to use specific tools in British Columbia, including the ADI-R and ADOS, and also needs to complete a psycho-educational assessment. The government of BC provides these services for free, there is a waiting list, and some parents prefer private practitioners.
In my practice I offer autism assessment and treatment services for individuals, couples, families, children and adolescents in the Burnaby, Vancouver, Coquitlam, Port Moody, New Westminster and Maple Ridge areas of the lower mainland. This includes neuro-developmental assessments, psycho-education, cognitive rehabilitation for problems with memory and concentration and cognitive behaviour therapy. I also provide diagnostic assessments for autism and Asperger's Disorder in my Burnaby office.
My web page lists a number of resources you can make use of yourself in dealing with Attention Deficit Hyperactivity Disorder (ADHD). Please visit it at www.adhdhelp.ca or one of my other sites at either Psychology Today, AAMFT, PSYRIS or my professional site. Please feel free to call if you have questions about ADHD or other cognitive issues.
My autism web page can be found by clicking here. (www.socialcognitivetherapy.com)
Dr. Jim Roche
Registered Psychologist, British Columbia 01610
778.998-7975
www.relatedminds.com
Here is an excellent letter to the editor from the local Burnaby paper (click above).
Every year kids come to school with a variety of learning disabilities and mental health disorders, these include Autism, ADHD/ADD, depression, anxiety and related disorders. And recently studies have shown that BC is one of the places in Canada that is very unlikely to be prepared to help children with one of the most common of these disorders, ADHD, or ADD as many people mistakenly call it.
As the writer of this letter states, "Our Ministry of Education, as well as school communities, needs to know that ADHD is not a behaviour issue, that it can't be "cured" by changing diet, that it's not a result of poor parenting and that the kids who suffer from it aren't bad kids. And they need to know that I am not unnecessarily "drugging" my child. They need to know it's a genuine medical condition, that many kids with ADHD are very bright, that it affects up to 12 per cent of school children, that it's stressful for parents and hard to deal with for kids."
Well, I couldn't have said it better myself, and I am often frustrated by the way ADHD/ADD is treated or should I say not treated in the schools. This is especially important to parents of children with ASD or Asperger's Disorder. Treatment is often non-existant for ADHD. There is an assumption that behaviours are the result of choice, that the problems and failures are purposeful. While the provincial government had taken steps to address the need to provide treatment in the schools and community for autism and Asperger's Disorder, there is really very little available in the schools for children with ADHD/ADD. While there is a large percentage of children with ADHD/ADD you very seldom find a school district providing ADHD specific training for it's staff or parents. While I have spoken in dozens and dozens of schools throughout BC on autism and Asperger's Disorder, and provided training, consultation and observations focused on children with autism, it is nearly impossible to get a school to ask for a workshop, training session or a consultation on ADHD. And often our children with autism and Asperger's have ADHD as a co-morbid disorder. It is seldom addressed in Individual Education Plans (IEPs) and when a school does deal with the symptoms / behaviours that result from ADHD they apply "warnings" and punishments as the "treatment." This is something that sooner or later has to be addressed by our schools. This week alone three of the children seen in my practice were being punished for their ADHD symptoms. A school would never punish a student for their behaviours-symptoms of anxiety, or punish a student for behaviours-symptoms of Tourette's syndrome (although I have to admit, I have spent more than one full semester dealing with just this issue in a major school district in California). More than ny other disorder I have heard negative comments from teacher's and staff when addressing the simplest behaviours relating to ADHD/ADD. Sometimes it's like they have either never heard of the disorder, or if they agreed it existed out entire society would fall.
For parents I have suggested reading "So I'm Not Lazy, Crazy or Stupid," Mel Levine's "The Myth of Laziness" or Dr. Barkley's many works on ADHD. (All of these can be found on my web page.
Often different disorders have separate"camps" of supporters. There are "autism awareness" days, walks, Depression awareness days...all sorts of support groups and programs. Oddly, there is no ADHD walk or ADHD day in any school's or towns I've been to. That's too bad. ADHD more than any other disorder needs to be brought out of the closet and addressed, and those who deny that it is a real disorder, or that it's really a choice a ten year old is making to fail all his subjects and lose all his friends needs to be confronted and dealt with.
I can offer this one piece of advice to parent. Get a copy of the diagnosis for both Autism/Aspergers AND ADHD. Make a copy. LEarn it. Mark the important terms in yellow, underline them. Make a copy for everyone on your child's IEP team. And then make sure everyone know that punishment for symptoms went out about 100 years ago. We don't punish individuals who have a diagnosed disorders like autism, Aspergers, Tourette's syndrome or ADHD for exhibiting their symptoms. Ever. If they try, ask for the research that shows such a "technique" is a good idea. What supports that as an intervention? Instead redirect everyone back to answering how we as a team, parents and school, are going to provide positive behavioural support through the IEP process to teach your child how to do better and succeed. That's what an IEP is all about!
...............................
...............................
The Autism blog is not offered as medical advice or as a means of diagnosing or treating Autism or Asperger's Disoder. The diagnosis of autism is complex and involves not just looking for symptoms of autism, which is all that those “web tests” do, but also involves ruling out other disorders that might look just like autism. Often individuals who think they or their child has autism or Asperger's Disoder have other disorders, and may have co-morbid disorders such as depression, anxiety or OCD. A simple check off sheet of “symptoms” doesn’t differentiate these. So avoid these on-line "tests" which are nothing more than a collection of symptoms. You need to see a licensed or registered professional for a real diagnosis. Medical doctors can diagnose autism, but the diagnosis is complex and often they will make a referral to a Registered Psychologist for a full understanding of a patient’s symptoms. You can obtain a referral for a psychologist with expertise in autism from the British Columbia Psychological Association (BCPA). The professional you select needs specific training and needs to use specific tools in British Columbia, including the ADI-R and ADOS, and also needs to complete a psycho-educational assessment. The government of BC provides these services for free, there is a waiting list, and some parents prefer private practitioners.
In my practice I offer autism assessment and treatment services for individuals, couples, families, children and adolescents in the Burnaby, Vancouver, Coquitlam, Port Moody, New Westminster and Maple Ridge areas of the lower mainland. This includes neuro-developmental assessments, psycho-education, cognitive rehabilitation for problems with memory and concentration and cognitive behaviour therapy. I also provide diagnostic assessments for autism and Asperger's Disorder in my Burnaby office.
My web page lists a number of resources you can make use of yourself in dealing with Attention Deficit Hyperactivity Disorder (ADHD). Please visit it at www.adhdhelp.ca or one of my other sites at either Psychology Today, AAMFT, PSYRIS or my professional site. Please feel free to call if you have questions about ADHD or other cognitive issues.
My autism web page can be found by clicking here. (www.socialcognitivetherapy.com)
Dr. Jim Roche
Registered Psychologist, British Columbia 01610
778.998-7975
www.relatedminds.com
Tuesday, December 28, 2010
What is the best treatment for Asperger's?
If your child has ASD, autism or Aspergers you most likely wonder what is the most useful, powerful and successful treatment for him or her? How can you help your child meet their potential? Simply, what is the most effective Aspergers treatment and help for aspergers? Many parents of aspergers children worry that their child will never be able to develop strong friendships let alone a human-romantic relationships that could eventually lead to marriage and children and a full life. Relationships during childhood, who you have as friends and how well you get along and attach, as Dr., John Gottman has pointed out, are the #1 factor in determining outcome later in life. They correlate to employment success, to later relational success and even to life span. People who related better in the 4th grade earn more money, are happier and live longer. It's more important that academic grades, prizes in science or awards in sports.
So can your child with Asperger's do well in relationships? The truth is, it is possible, but it takes a lot of work, the right advice, access to the right information and treatment interventions. Which ones work best? Regretfully, the answer is "it depends." What we do know is there are treatments know to work, and those for which there is no scientific support.
Here are the top 4 methods of aspergers treatment:
1. Applied Behavioural Analysis
2. Floor Time
3. Speech Therapy
4. Social-Cognitive Therapy (training in theory of mind)
Notice "social skills" isn't in this list. We are always teaching social skills, but there is a difference between a lack of social skill knowledge and the social-cognitive deficits children and adults with Asperger's suffer from. (I recently posted two great videos that explain "theory of mind" and urge you to watch those. Understanding the difference between a social skills deficit and a deficit in theory of mind is critical for successful treatment for you or your child. And many schools and therapists don't understand the difference.
At different times your child my need one or all of these treatment interventions. They each have their place at the appropriate developmental time, and can be adapted to use at different developmental moments. Heres a little more detail on each:
1. Applied behavioural analysis (ABA)
ABA is a method of teaching that involves breaking tasks into small, discrete 'teachable' steps. At each step appropriate behaviours are reinforced. ABA selects developmentally appropriate behaviours as teaching targets. These can range from maintaining eye contact to complex responses such as social interaction. The child is given enough support to ensure success, which is then positively reinforced by consequences that are reinforcing for that child. Gradually the amount of support and reinforcement is reduced.
Early intervention programmes for children with autism and Asperger's have the potential to produce positive changes in development and consequently reduce the need for later interventions. Therefore in many ABA programmes parents are trained to become the primary therapists and their children receive one-to-one tuition in their own homes. There is evidence that intervening in a child's development in this way can help children with autism to be more successful in mainstream schools (Keenan et al., 2000). Often parents want to avoid this step, especially if their child is a little most socially developed, verbal etc. DON'T AVOID ABA! ABA training is necessary for you as a parent to understand the basics of behavioural interventions. Exposing your child to good, competently taught ABA prepares them with tools you can use later to teach new skills. It's a tool best learned young, and then used again and again.
ABA is not everything, however, and for some schools and intervention programs it seems to be. There are other, more complex skills that cannot be taught through ABA. But ABA is the foundation of your future work.
2. Floor Time
Here is one description of ABA I really like, "During floor time, your child will stretch his imagination and logical understanding of the world as he stages make-believe games and locks horns with you over rules. He'll use gestures and words to express his needs and to explore a broad range of emotions, from exhilaration to anger. He will also hone his physical skills as his muscles strengthen and grow." Yes, floor time means getting down on the floor and MODELLING appropriate make believe games, using your imagination, and exposing your child to the idea of "sharing the floor" with another person. It's the environment you use to generalize behavioural skills you have taught. Later Floor Time can be thought of as becoming Social Cognitive Therapy I mention below in 4. Floor time has not been shown to change "autistic" behaviours (self stimulation etc.) but it has been shown to improve the quality of the relationship between the child and parent. I expect research will show it does the same with the child and therapist, teacher, teacher aide and so on. Some positive play time involving the reciprocal interactions between the child and adult needs to be part of any program. And it needs to be fun, reinforcing and relaxing!
3. Speech Therapy
Speech Therapy may help their child with communication difficulties. The difficulties are not in how the child speaks or pronounces words, but rather in how the child perceives the meaning of other people's speech. A speech therapist focuses on issues of social reciprocity, understanding the second level of communication in speech. Often this is more about what is not said than what is said. In speech therapy I would expect a child to learn to understand how what he or she says effects others. And in addition, a speech therapist is able to measure our overall progress in terms of "pragmatic language and help with simple speech difficulties that make communication, already difficult, even more difficult. Every child with Asperger's should be seen by a speech pathologist.
4. Social Cognitive Therapy
The I-LAUGH Model of Social Cognition developed by Michelle Garcia Winner is a framework of social cognition designed to explain the multiple skills and concepts that we must process and react to in order to succeed at social interaction and personal problem solving. Each of these elements of social cognition affects not only our ability to make and keep friends, but also our ability to process complex information in the classroom and the workplace. The I-LAUGH Model is evidence-based in that each aspect of it has been researched and defined as a trait of persons with social relatedness issues. A brief summary of the I-LAUGH framework from her web page is below. You can find out more about here work at her website at www.socialthinking.com:
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 favourite 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.
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.
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 humour, 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 humour to help minimize the anxiety these children are experiencing. At the same time, many of our clients use humour 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.
Michelle Winner's "Social Thinking" approach may sound overwhelming, but it is in reality simply, fun and reinforcing for children. She has numerous books, workbooks, videos and other resources for use at home and in the school. One of my favourite is a book called "Superflex," a book for kids/students that teachers about the way the mind of a person with Asperger's works, and steps you can take to overcome many of the problems this brings. She demonstrates this through an exciting and funny set of stories involving super-heros battling super villains like "RockBrain," an evil doer who keeps you from using your brain in a flexible manner. If you have a teen, or are an adult with Aspergers, you'll understand and like this story.
This is a lot to think about, and most parents need to find someone to guide them through this maze of techniques, programs and new language. Often I see parents jump at quick and easy answers that make promises based upon "testimonials" of others. These include the use of "brain tuning," "hearing training," ""sound tuning," biofeedback or neuro-therapy and many miracle diets and supplements. None of these have any scientific basis, and many plainly don't make sense. These four treatment methods should be the foundation of your plan. They are supported by research, used in most schools and intervention programs, and are accepted by the professional community. If you insist on "testimonials" I can even say, although I am reluctant, that these are the programs most highly recommended by parents.
..........................................
My web page lists a number of resources you can make use of yourself in dealing with Autism Spectrum Disorder and Asperger's, as well as many other social-cognitive deficits and learning disabilities. Please visit it at www.socialcognitivetherapy.com, or one of my other sites at: Psychology Today, AAMFT, PSYRIS or my professional site or www.adhdhelp.ca.
Autism assessment and treatment services are offered for individuals, couples, families, children, adolescents and adults in the Burnaby, Vancouver, Coquitlam, Port Moody, New Westminster and Maple Ridge areas of the lower mainland. This includes neuro-developmental assessments, psycho-education assessments, autism assessments as well as behavioural and cognitive behaviour therapy. I also provide diagnostic assessments for autism and Asperger's Disorder in my Burnaby office.
Dr. Jim Roche
Registered Psychologist, British Columbia 01610
778.998-7975
www.relatedminds.com
So can your child with Asperger's do well in relationships? The truth is, it is possible, but it takes a lot of work, the right advice, access to the right information and treatment interventions. Which ones work best? Regretfully, the answer is "it depends." What we do know is there are treatments know to work, and those for which there is no scientific support.
Here are the top 4 methods of aspergers treatment:
1. Applied Behavioural Analysis
2. Floor Time
3. Speech Therapy
4. Social-Cognitive Therapy (training in theory of mind)
Notice "social skills" isn't in this list. We are always teaching social skills, but there is a difference between a lack of social skill knowledge and the social-cognitive deficits children and adults with Asperger's suffer from. (I recently posted two great videos that explain "theory of mind" and urge you to watch those. Understanding the difference between a social skills deficit and a deficit in theory of mind is critical for successful treatment for you or your child. And many schools and therapists don't understand the difference.
At different times your child my need one or all of these treatment interventions. They each have their place at the appropriate developmental time, and can be adapted to use at different developmental moments. Heres a little more detail on each:
1. Applied behavioural analysis (ABA)
ABA is a method of teaching that involves breaking tasks into small, discrete 'teachable' steps. At each step appropriate behaviours are reinforced. ABA selects developmentally appropriate behaviours as teaching targets. These can range from maintaining eye contact to complex responses such as social interaction. The child is given enough support to ensure success, which is then positively reinforced by consequences that are reinforcing for that child. Gradually the amount of support and reinforcement is reduced.
Early intervention programmes for children with autism and Asperger's have the potential to produce positive changes in development and consequently reduce the need for later interventions. Therefore in many ABA programmes parents are trained to become the primary therapists and their children receive one-to-one tuition in their own homes. There is evidence that intervening in a child's development in this way can help children with autism to be more successful in mainstream schools (Keenan et al., 2000). Often parents want to avoid this step, especially if their child is a little most socially developed, verbal etc. DON'T AVOID ABA! ABA training is necessary for you as a parent to understand the basics of behavioural interventions. Exposing your child to good, competently taught ABA prepares them with tools you can use later to teach new skills. It's a tool best learned young, and then used again and again.
ABA is not everything, however, and for some schools and intervention programs it seems to be. There are other, more complex skills that cannot be taught through ABA. But ABA is the foundation of your future work.
2. Floor Time
Here is one description of ABA I really like, "During floor time, your child will stretch his imagination and logical understanding of the world as he stages make-believe games and locks horns with you over rules. He'll use gestures and words to express his needs and to explore a broad range of emotions, from exhilaration to anger. He will also hone his physical skills as his muscles strengthen and grow." Yes, floor time means getting down on the floor and MODELLING appropriate make believe games, using your imagination, and exposing your child to the idea of "sharing the floor" with another person. It's the environment you use to generalize behavioural skills you have taught. Later Floor Time can be thought of as becoming Social Cognitive Therapy I mention below in 4. Floor time has not been shown to change "autistic" behaviours (self stimulation etc.) but it has been shown to improve the quality of the relationship between the child and parent. I expect research will show it does the same with the child and therapist, teacher, teacher aide and so on. Some positive play time involving the reciprocal interactions between the child and adult needs to be part of any program. And it needs to be fun, reinforcing and relaxing!
3. Speech Therapy
Speech Therapy may help their child with communication difficulties. The difficulties are not in how the child speaks or pronounces words, but rather in how the child perceives the meaning of other people's speech. A speech therapist focuses on issues of social reciprocity, understanding the second level of communication in speech. Often this is more about what is not said than what is said. In speech therapy I would expect a child to learn to understand how what he or she says effects others. And in addition, a speech therapist is able to measure our overall progress in terms of "pragmatic language and help with simple speech difficulties that make communication, already difficult, even more difficult. Every child with Asperger's should be seen by a speech pathologist.
4. Social Cognitive Therapy
The I-LAUGH Model of Social Cognition developed by Michelle Garcia Winner is a framework of social cognition designed to explain the multiple skills and concepts that we must process and react to in order to succeed at social interaction and personal problem solving. Each of these elements of social cognition affects not only our ability to make and keep friends, but also our ability to process complex information in the classroom and the workplace. The I-LAUGH Model is evidence-based in that each aspect of it has been researched and defined as a trait of persons with social relatedness issues. A brief summary of the I-LAUGH framework from her web page is below. You can find out more about here work at her website at www.socialthinking.com:
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 favourite 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.
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.
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 humour, 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 humour to help minimize the anxiety these children are experiencing. At the same time, many of our clients use humour 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.
Michelle Winner's "Social Thinking" approach may sound overwhelming, but it is in reality simply, fun and reinforcing for children. She has numerous books, workbooks, videos and other resources for use at home and in the school. One of my favourite is a book called "Superflex," a book for kids/students that teachers about the way the mind of a person with Asperger's works, and steps you can take to overcome many of the problems this brings. She demonstrates this through an exciting and funny set of stories involving super-heros battling super villains like "RockBrain," an evil doer who keeps you from using your brain in a flexible manner. If you have a teen, or are an adult with Aspergers, you'll understand and like this story.
This is a lot to think about, and most parents need to find someone to guide them through this maze of techniques, programs and new language. Often I see parents jump at quick and easy answers that make promises based upon "testimonials" of others. These include the use of "brain tuning," "hearing training," ""sound tuning," biofeedback or neuro-therapy and many miracle diets and supplements. None of these have any scientific basis, and many plainly don't make sense. These four treatment methods should be the foundation of your plan. They are supported by research, used in most schools and intervention programs, and are accepted by the professional community. If you insist on "testimonials" I can even say, although I am reluctant, that these are the programs most highly recommended by parents.
..........................................
My web page lists a number of resources you can make use of yourself in dealing with Autism Spectrum Disorder and Asperger's, as well as many other social-cognitive deficits and learning disabilities. Please visit it at www.socialcognitivetherapy.com, or one of my other sites at: Psychology Today, AAMFT, PSYRIS or my professional site or www.adhdhelp.ca.
Autism assessment and treatment services are offered for individuals, couples, families, children, adolescents and adults in the Burnaby, Vancouver, Coquitlam, Port Moody, New Westminster and Maple Ridge areas of the lower mainland. This includes neuro-developmental assessments, psycho-education assessments, autism assessments as well as behavioural and cognitive behaviour therapy. I also provide diagnostic assessments for autism and Asperger's Disorder in my Burnaby office.
Dr. Jim Roche
Registered Psychologist, British Columbia 01610
778.998-7975
www.relatedminds.com
Wednesday, July 7, 2010
(1/2) Do Vaccines Cause Autism? Correlation vs. Causation
This is an excellent little video about the use, and misuse, of data. In spite of all the information out there that clearly shows vaccines have no relationship to autism some individuals and groups continue to confuse correlation and causation. Watch this for a simple explanation.
For information about my diagnostic services (ASD / autism diagnostic services are available within 10 days to 2 weeks) and my science based treatment programs please read the information provided on my website at www.relatedminds.com or go to my Psychology Today website to find out more about me.
For information about my diagnostic services (ASD / autism diagnostic services are available within 10 days to 2 weeks) and my science based treatment programs please read the information provided on my website at www.relatedminds.com or go to my Psychology Today website to find out more about me.
Friday, February 5, 2010
About Assessment for Autism, Asperger's, Learning Disorders and ADHD
A lot of people call my office and have been told by a day care provider or teacher that they are sure their child has autism, Asperger's Disorder or ADHD. And often this is based on some list of symptoms that they read on the internet. Parents often then scramble and start looking themselves. Even adults do this, I get a fair number of adults who have wondered about possibly having autism after someone mentioned it to them and they began a web search.
Autism, ADHD, Asperger's disorder are not an easy diagnosis to make. And one of the important things that takes place when assessing a child, adolescent of adult for autism spectrum disorder (ASD) is what we call a "differential diagnosis." The symptoms you may be concerned about may or may not be ASD. They could be another problem such as a language disorder, auditory processing disorder, a learning disability, some form of speech disorder, mental retardation, ADHD (both often confused with ASD), a movement disorder, OCD. The list goes on.
Additionally the disorder may be more than one thing. ASD is often found to be c-omorbid with another disorder such as ADHD. ADHD itself is not an easy disorder to diagnose. The Centre for ADHD/ADD Advocacy, Canada (CADDAC) has set standards for a full differential diagnosis of ADHD and it includes an extensive amount of data collection and takes a considerable amount of time. Another source of information on diagnosis ADHD is from Dr. Russell Barkley. His procedures are very similar to CADDAC and are the procedures I follow in my practice. As I mention below for autism diagnoses, you usually have one chance at an assessment and it should include all of the tests below except the ADOS and ADI-R. You need to know if there is a co-morbit learning disorder, and you need to understand exactly how ADHD is expressing itself in your child. While a neuropsychological examination is not necessary for a diagnosis, it is necessary if you want to know what to do about it. A very simple computer based test a medical doctor could offer you for a child 8 years old or over is the CNS-Vital Signs assessment which tells us about memory, ability to switch sets, executive functioning, processing speed and other critical bits of data we need to develop a treatment plan. Many of my patients are referred by medical doctors because they do not have the time or specific skills to make a firm diagnosis.
Here in British Columbia a full diagnostic autism assessment is usually completed by a provincial agency. This might take place at Children's Hospital or through a provincial health authority provider. You start this process with a referral from your medical provider. The Ministry for Children and Families has information about the assessment process on their web site. Those services should be free to anyone here in British Columbia. However, there is a long waiting list for these services. Private practitioners, including medical doctors and psychologists, who have had specialized training in the two instruments I'll talk about below, can also provide this service, however either you or your extended health care (if your lucky enough to have it) has to cover this cost. It's usually about $1,800 -$2,100. And for children under 6 an assessment needs to be completed by a team of professionals, hard to arrange through a private practitioner and even more expensive.
What does the assessment consist of? First, for most children and adolescents there is an initial interview history taking. Then, usually, a psycho-educational assessment is completed. This includes an intelligence (cognitive) test and an academic performance test. Usually these scores are compared to look for discrepancies that would lead us to finding a specific learning disability. If your child get X score on this part of the intelligence test, we would expect he or she would score Y on this part of the academic test. This testing also helps rule out mental retardation or other cognitive impairments. If you are going the private practitioner route, you might be lucky enough to have the school complete the psycho-educational assessment, cutting back your costs.
Next your child is usually examined for behavioural and personality issues. This might take place through interviews, pencil and paper tests or self reports like the Beck Youth Scales and reports from parents and teachers. The examiner wants to rule out personality disorders, psychosis, depression, anxiety and similar issues that can often be mistaken for ASD.
There might now be some specialized test that the examiner would use to look at an issue he or she is concerned with. And some examiners will do more complete neuropsychological tests to give us information on problems that might relate to executive function, memory and learning, impulse control, motor and visual-motor issues. This is especially important for children with co-morbid ADHD or for whom we find ADHD is the primary concern. This information helps us come up with focused treatment interventions.
Finally, for children we are still concerned about ASD with the provincial government here in British Columbia requires two specific tests: The Autism Diagnostic Observation System (ADOS) and the Autism Diagnostic Interview (ADI-R). There are several other very good and reliable tests that focus on autism, however the ministry will only accept a report containing these two specific tests.
The ADOS is a series of activities and questions the examiner goes through with the child, giving him or her an opportunity to see how the child responds to new stimuli. The ADI-R is a lengthy report completed during an interview with the parents or other caregivers about the child's developmental history focused on symptoms found in ASD.
Some practitioners complete shorter reports using just the ADOS and ADI-R. This might be quicker but leaves us with doubts about other possible reasons for the behaviours of concern (not a real "differential" diagnosis) and provides little information we would be able to use to provide targeted interventions / treatment. And honestly, it's very difficult to obtain a second assessment to obtain this kind of essential information as there is a long waiting list of children and adolescents for initial evaluations.
To find a practitioner who can help you with an assessment I would start with my medical doctor, who may have a doctor of clinical psychology he or she knows and referrals to, or contact the British Columbia Psychological Association for a referral. You must, however, see a licensed or registered psychologist for these types of diagnostic services. Registered Clinical Counsellors (RCC) are not qualified to provide these services and often parents pay for assessments that are then not accepted by school districts or the ministry. School psychologists can only perform these tasks as part of their employment in the school district and are not qualified to do these types of assessments independently. (However, an RCC or school psychologist may ALSO be a licensed or registered psychologist, so ask,) Finally, before paying someone to complete any assessment, ask the agency you plan to use the assessment with (ministry or school) if this provider is qualified to provide such information to them.
Autism, ADHD, Asperger's disorder are not an easy diagnosis to make. And one of the important things that takes place when assessing a child, adolescent of adult for autism spectrum disorder (ASD) is what we call a "differential diagnosis." The symptoms you may be concerned about may or may not be ASD. They could be another problem such as a language disorder, auditory processing disorder, a learning disability, some form of speech disorder, mental retardation, ADHD (both often confused with ASD), a movement disorder, OCD. The list goes on.
Additionally the disorder may be more than one thing. ASD is often found to be c-omorbid with another disorder such as ADHD. ADHD itself is not an easy disorder to diagnose. The Centre for ADHD/ADD Advocacy, Canada (CADDAC) has set standards for a full differential diagnosis of ADHD and it includes an extensive amount of data collection and takes a considerable amount of time. Another source of information on diagnosis ADHD is from Dr. Russell Barkley. His procedures are very similar to CADDAC and are the procedures I follow in my practice. As I mention below for autism diagnoses, you usually have one chance at an assessment and it should include all of the tests below except the ADOS and ADI-R. You need to know if there is a co-morbit learning disorder, and you need to understand exactly how ADHD is expressing itself in your child. While a neuropsychological examination is not necessary for a diagnosis, it is necessary if you want to know what to do about it. A very simple computer based test a medical doctor could offer you for a child 8 years old or over is the CNS-Vital Signs assessment which tells us about memory, ability to switch sets, executive functioning, processing speed and other critical bits of data we need to develop a treatment plan. Many of my patients are referred by medical doctors because they do not have the time or specific skills to make a firm diagnosis.
Here in British Columbia a full diagnostic autism assessment is usually completed by a provincial agency. This might take place at Children's Hospital or through a provincial health authority provider. You start this process with a referral from your medical provider. The Ministry for Children and Families has information about the assessment process on their web site. Those services should be free to anyone here in British Columbia. However, there is a long waiting list for these services. Private practitioners, including medical doctors and psychologists, who have had specialized training in the two instruments I'll talk about below, can also provide this service, however either you or your extended health care (if your lucky enough to have it) has to cover this cost. It's usually about $1,800 -$2,100. And for children under 6 an assessment needs to be completed by a team of professionals, hard to arrange through a private practitioner and even more expensive.
What does the assessment consist of? First, for most children and adolescents there is an initial interview history taking. Then, usually, a psycho-educational assessment is completed. This includes an intelligence (cognitive) test and an academic performance test. Usually these scores are compared to look for discrepancies that would lead us to finding a specific learning disability. If your child get X score on this part of the intelligence test, we would expect he or she would score Y on this part of the academic test. This testing also helps rule out mental retardation or other cognitive impairments. If you are going the private practitioner route, you might be lucky enough to have the school complete the psycho-educational assessment, cutting back your costs.
Next your child is usually examined for behavioural and personality issues. This might take place through interviews, pencil and paper tests or self reports like the Beck Youth Scales and reports from parents and teachers. The examiner wants to rule out personality disorders, psychosis, depression, anxiety and similar issues that can often be mistaken for ASD.
There might now be some specialized test that the examiner would use to look at an issue he or she is concerned with. And some examiners will do more complete neuropsychological tests to give us information on problems that might relate to executive function, memory and learning, impulse control, motor and visual-motor issues. This is especially important for children with co-morbid ADHD or for whom we find ADHD is the primary concern. This information helps us come up with focused treatment interventions.
Finally, for children we are still concerned about ASD with the provincial government here in British Columbia requires two specific tests: The Autism Diagnostic Observation System (ADOS) and the Autism Diagnostic Interview (ADI-R). There are several other very good and reliable tests that focus on autism, however the ministry will only accept a report containing these two specific tests.
The ADOS is a series of activities and questions the examiner goes through with the child, giving him or her an opportunity to see how the child responds to new stimuli. The ADI-R is a lengthy report completed during an interview with the parents or other caregivers about the child's developmental history focused on symptoms found in ASD.
Some practitioners complete shorter reports using just the ADOS and ADI-R. This might be quicker but leaves us with doubts about other possible reasons for the behaviours of concern (not a real "differential" diagnosis) and provides little information we would be able to use to provide targeted interventions / treatment. And honestly, it's very difficult to obtain a second assessment to obtain this kind of essential information as there is a long waiting list of children and adolescents for initial evaluations.
To find a practitioner who can help you with an assessment I would start with my medical doctor, who may have a doctor of clinical psychology he or she knows and referrals to, or contact the British Columbia Psychological Association for a referral. You must, however, see a licensed or registered psychologist for these types of diagnostic services. Registered Clinical Counsellors (RCC) are not qualified to provide these services and often parents pay for assessments that are then not accepted by school districts or the ministry. School psychologists can only perform these tasks as part of their employment in the school district and are not qualified to do these types of assessments independently. (However, an RCC or school psychologist may ALSO be a licensed or registered psychologist, so ask,) Finally, before paying someone to complete any assessment, ask the agency you plan to use the assessment with (ministry or school) if this provider is qualified to provide such information to them.
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