Showing posts with label counselling. Show all posts
Showing posts with label counselling. Show all posts

Saturday, November 8, 2014

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

Thursday, June 5, 2014

Adult Autism and Asperger's Syndrome Reading

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

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

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

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

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

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

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

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

Asperger Syndrom and Long Term Relationship by Ashley Stanford

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

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











Tuesday, February 21, 2012

About Counselling and Therapy Services (Burnaby/Vancouver)


As a Registered Psychologist I provide individual therapy and counselling services using the evidence based techniques of Cognitive Behaviour Therapy (CBT) and Rational Emotive Behaviour Therapy (REBT). Individuals are seen in both my Burnaby and Vancouver offices for a variety of issues including chronic pain, depression, anxiety, stress, panic, anger management, ADHD and work or relationship issues. 
I hold an Advanced Certificate in Cognitive Therapy from the Albert Ellis Institute in New York. If you are looking for a cognitive therapist you should ask what training they have in CBT, as many individuals claim they practice CBT after completing only a workshop or reading a book. The Advanced Certificate Program at the Albert Ellis Institute included extensive CBT readings, group and individual training and supervised practice of Cognitive Behaviour Therapy/Rationale Emotive Behaviour Therapy under the supervision of a licensed mental health practitioner. In addition to my practicum at the Ellis Institute I also focused on CBT during my graduate studies and post doctoral internship. Registered Psychologists undergo one year of of full time supervised practicum experience, as well as a year of post doctoral experience. Since graduation I have practiced counselling and therapy for over 20 years and have served as the program director and practicum supervisor in several hospitals, universities and community mental health centres.
FAQs:
Could you tell me more about Cognitive Behaviour Therapy (CBT)?
My primary mode of practice is rational-emotive/cognitive therapy. Cognitive Behaviour Therapy or CBT (including Rational Emotive Therapy) is a highly effective, research driven approach that helps people to combat and overcome such difficulties as high anxiety/stress, panic attacks, depression, anger, relationship problems, phobias, worry, obsessions, compulsions, addictions (food or drugs), social anxiety, sexual problems, ADHD and low self-esteem. The course of treatment is typically short-term (approximately 8-12 sessions), and people often enjoy rapid and enduring relief from their symptoms. I am also trained in other counselling and therapy techniques, and use these when and where appropriate. Overall I try to match  the skills and techniques to your needs. My office provides a supportive, caring and safe environment to work on change and focus on growth and future success.
I have heard about "Schema Therapy," what's that?
Schema-Focused Cognitive Therapy goes further, to help people address and break long-standing or particularly stubborn patterns of thinking, feeling and behaving that arise from deep-seated beliefs, such as “I’m unlovable,” “I’m a failure,” “People don’t care about me,” “I’m not important,” “Something bad is going to happen,” “People will leave me,” “I will never get my needs met,” “I will never be good enough,” etc. Remarkable results have been achieved via the Schema-Focused approach, even for people who have previously found other therapies to be ineffective. Results of course cannot be guaranteed, however, compared with other types of therapeutic intervention research has shown Cognitive Therapy to be effective.
Schema-Focused and Rational Emotive and Cognitive Behaviour Therapy do more than address symptoms, they address a way of thinking that causes you problems in life, work and relationships. In addition to individual therapy I often recommend readings which emphasize the personal growth aspects of cognitive behaviour therapy as well as those that focus on symptom relief.
Do you do any "Mindfulness" work?
In collaboration with other health related professionals I have recently (the past two to three years) begun to offer a longer and more intensive form of Cognitive Behaviour Therapy called Mindfulness Based Cognitive Therapy (MBCT). This method of therapy blends together features of two disciplines: Cognitive Behaviour Therapy (CBT), which aims to identify and alter cognitive distortions (irrational or inaccurate thoughts) and Mindfulness, which is a meditative (mental focusing) practice taken from Buddhism which aims to help people identify their thoughts, moment by moment, but without passing judgement on the thoughts. As with other medically based meditative interventions, this is not a religious oriented practice, but a scientifically supported methodology used in many medical and mental health centers throughout the world. This particular intervention is based upon Mindfulness-Based Stress Reduction (MBSR), an eight week program developed by Jon Kabat-Zinn in 1979 at the University of Massachusetts Medical Center. MBSR research has shown that this combined intervention method is enormously empowering for patients with chronic pain, hypertension, heart disease, gastrointestinal disorders, ADHD, as well as psychological problems such as anxiety, panic and depression.
More about Cognitive Behaviour Therapy
Albert Ellis and the Institute for Rational Emotive Behaviour Therapy
In 1955 Dr. Albert Ellis developed  Rational Emotive Behaviour Therapy or “REBT”  which is an action-oriented therapeutic approach that stimulates emotional growth by teaching people to replace their self-defeating thoughts, feelings and actions with new and more effective ones. REBT teaches individuals to be responsible for their own emotions and gives them the power to change and overcome their unhealthy behaviors that interfere with their ability to function and enjoy life.
Today the Albert Ellis Institute is a world center of research, training, and practice of REBT, its founder Dr. Albert Ellis remains one of the most influential psychologists of our time, and authored more than 70 books and 700 articles all designed to help people overcome destructive, self-defeating emotions and improve their lives.  Later Dr. Aaron Beck developed what is commonly called Cognitive Behaviour Therapy (CBT) along the same lines as REBT. Today these two cognitive based therapies are very similar, although some specific techniques may differ in the two schools of practice. Both are referred to as Cognitive Behaviour Therapy. I have received both my Basic and Advanced Certificates in Cognitive and Rational Emotive Therapy through the Albert Ellis Institute in New York City. For more information you can click here:
http://www.rebt.org Albert Ellis Institute in New York City
What will I be learning in Cognitive Behaviour Therapy (REBT/CBT)
and Schema-Focused Therapy?
You will learn to:
1. Identify the themes and patterns in your thoughts, feelings and behavior that cause you emotional wear and tear;
2. Learn how to handle your thoughts and manage your emotions so that you feel better and cope more effectively;
3. Learn how to handle problematic situations to maximize positive outcomes and experiences;
4. Prevent maladaptive cycles of thinking, feeling and behaving from repeating over and over again;
5. Find ways to reach your goals and get your needs met rather than running up against the proverbial brick wall.
Could you say more about Schema-Focused Cognitive Therapy?
Schema-Focused Cognitive Therapy is the approach developed by Jeffrey E. Young, Ph.D., who was a protégée of Dr. Aaron Beck. Prior to his founding the Cognitive Therapy Centers of NY and Connecticut, as well as the Schema Therapy Institute, Dr. Young served as the Director of Research and Training at the Center for Cognitive Therapy at U. Penn with Dr. Beck, where he trained many clinicians in the application of CBT. In working with clients, however, Dr. Young and his colleagues found a significant segment of people who came for treatment but had perplexing difficulty in benefiting from the standard approach. He discovered that these people typically had long-standing patterns or themes in thinking and feeling—and consequently in behaving or coping—that required a different means of intervention. Dr. Young’s attention turned to ways of helping patients to address and modify these deeper patterns or themes, also known as “schemas” or “lifetraps.”
The schemas (listed below) that are targeted in treatment are enduring and self-defeating patterns that typically begin early in life, get repeated and elaborated upon, cause negative/dysfunctional thoughts and feelings, and pose obstacles for accomplishing one’s goals and getting one’s needs met. Although schemas are usually developed early in life (during childhood or adolescence), they can also form later, in adulthood. These schemas are perpetuated behaviorally through the coping styles of schema maintenance, schema avoidance, and schema compensation. Dr. Young’s model centers on helping the person to break these patterns of thinking, feeling and behaving, which are often very tenacious.
In formulating the Schema-Focused approach, Young combined the best aspects of cognitive-behavioral, experiential, interpersonal and psychoanalytic therapies into one unified model of treatment. Through Young’s work and the efforts of those trained by him, Schema-Focused Therapy has shown remarkable results in helping people to change patterns which they have lived with for a long time, even when other methods and efforts they have tried before have been largely unsuccessful.
Schema’s that REBT / Cognitive and Schema Focused Therapy Focus on:
Emotional Deprivation: The belief and expectation that your primary needs will never be met. The sense that no one will nurture, care for, guide, protect or empathize with you.
Abandonment: The belief and expectation that others will leave, that others are unreliable, that relationships are fragile, that loss is inevitable, and that you will ultimately wind up alone.
Mistrust/Abuse: The belief that others are abusive, manipulative, selfish, or looking to hurt or use you. Others are not to be trusted.
Defectiveness: The belief that you are flawed, damaged or unlovable, and you will thereby be rejected.
Social Isolation: The pervasive sense of aloneness, coupled with a feeling of alienation.
Vulnerability: The sense that the world is a dangerous place, that disaster can happen at any time, and that you will be overwhelmed by the challenges that lie ahead.
Dependence/Incompetence: The belief that you are unable to effectively make your own decisions, that your judgment is questionable, and that you need to rely on others to help get you through day-to-day responsibilities.
Enmeshment/Undeveloped Self: The sense that you do not have an identity or “individuated self” that is separate from one or more significant others.
Failure: The expectation that you will fail, or belief that you cannot perform well enough.
Subjugation: The belief that you must submit to the control of others, or else punishment or rejection will be forthcoming.
Self-Sacrifice: The belief that you should voluntarily give up of your own needs for the sake of others, usually to a point which is excessive.
Approval-Seeking/Recognition-Seeking: The sense that approval, attention and recognition are far more important than genuine self-expression and being true to oneself.
Emotional Inhibition: The belief that you must control your self-expression or others will reject or criticize you.
Negativity/Pessimism: The pervasive belief that the negative aspects of life outweigh the positive, along with negative expectations for the future.
Unrelenting Standards: The belief that you need to be the best, always striving for perfection or to avoid mistakes.
Punitiveness: The belief that people should be harshly punished for their mistakes or shortcomings.
Entitlement/Grandiosity: The sense that you are special or more important than others, and that you do not have to follow the rules like other people even though it may have a negative effect on others. Also can manifest in an exaggerated focus on superiority for the purpose of having power or control.
Insufficient Self-Control/Self-Discipline: The sense that you cannot accomplish your goals, especially if the process contains boring, repetitive, or frustrating aspects. Also, that you cannot resist acting upon impulses that lead to detrimental results.
Reference: "A Client's Guide to Schema-Focused Cognitive Therapy" by David C. Bricker, Ph.D. and Jeffrey E. Young, Ph.D.,
Cognitive Therapy Center of New York. 1999
Summary
I hope you have found this very brief introduction to Cognitive Behaviour Therapy useful. In the office we discuss these issues, practice understanding our “automatic” and often irrational thinking, and learn to apply cognitive behaviour techniques to stop and change these debilitating thoughts. Progress is made through a combination of in-office counselling/therapy, readings and homework during which you apply what you have learned and practiced in the real world. While CBT may often be the primary therapy technique we use I often also involve psycho-education (direct teaching about your mental health issues), behavioural techniques and sometimes use my skills in Systemic and Family Therapy to address issues you may have with relationships, family or at work.
Fees
EAP and EFAP consignment, crime victims assistance program as well as extended insurance and self-pay are accepted. Session fees are $175.00 per hour. There is a sliding scale available to those will lower incomes. I also accept credit cards through on-line PayPal.
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Psychological services (including assessment, testing and therapy) provided in my offices include (covered by most extended health care insurance):
Autism and Asperger's Disorder (Click here:)  http://www.relatedminds.com/autism/
Individual Counselling (click here: ) http://www.relatedminds.com/individual-therapy/
Child Counselling / Therapy (click here: ) http://www.relatedminds.com/child-therapy/
Couples Counselling / Therapy (click here:)  http://www.relatedminds.com/couples-therapy/
About Dr. Roche
I am a Registered Psychologist and a Registered Marriage and Family Therapist (RMFT) in British Columbia. In addition to my doctorate in clinical Psychology (The Union of Experimenting Universities), I hold a master's degree in family therapy from Goddard college, a certificate of advanced graduate studies (CAGS) in school and educational psychology from Norwich University, and have completed two years of post doctoral studies in neuro-psychology at The Fielding Institute in Santa Barbara, California. I am also a certified school psychologist, certified teacher of special education (New York and California), and a Clinical Member of the American Association of Marriage and Family Therapists (AAMFT). Finally, I hold a doctoral degree in law (JD) with an emphasis in medical malpractice and education law. Beyond my academic credentials, I have completed two years of supervised clinical experience in both hospital and community based clinics and two years of post doctoral training in neuropsychology. I have served as director of behaviour programming for several school districts, as a consultant on autism for the province, and have held numerous academic positions including Clinical Instructor in Psychiatry at New York University and Bellevue Hospital in New York as well as being a faculty member at NYU, Brooklyn College, SUNY New Paltz, and Norwich University.
My offices in Burnaby and Vancouver serve Burnaby, Vancouver, Coquitlam, Port Moody, Port Coquitlam, New Westminster and Maple Ridge. Clients often come to my Vancouver office from North Vancouver, West Vancouver and even as far as the Sunshine Coast. For more information on the location of my Burnaby and Vancouver offices, please see my "Office Location" page, which contains a Google map.
Key words
ADHD | Anxiety and Stress | Autism and Asperger's Disorder | Individual Counselling | Child Therapy | Testing and Assessments and Learning Disabilities | Couples Counselling | Depression | The Angry Child | Anger Management | Pain Management and PTSD | Forensic Services | Attention Deficit Hyperactivity Disorder | Vancouver | Burnaby | Coquitlam | New Westminster | Maple Ridge | Port Moody | Child Psychologist | Psychologist | Learning Disability | Assessment | Testing | Psycho-educational Assessment | Neuropsychological Assessment

Monday, May 24, 2010

Autism Gluten-free Diet, Casein-free Diet Did Not Improve Behavior

Autism Gluten-free Diet, Casein-free Diet Did Not Improve Behavior

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Again scientific research has dealt another blow to the idea that diets can curb the effects of autism.

Doing a web search for autism treatment here in British Columbia you will often find that the first, second and third search results on Google or Bing include treatments that have little scientific research to back them. These include chiropractics (even suggested for infants), homeopathy (one local homeopathic doctor provides homeopathic "inoculations" for childhood diseases!), and diets. Often the web pages you are directed to include testimonials of miracle cures. But successfully treating autism calls for hard work, time, and not so much for miracles. And one thing anyone in science knows, testimonials are notoriously misleading.

After viewing these pages patients often come to my office asking about gluten-free and casein-free diets. They tell me they have heard about "dramatic improvements" after the implementation of these diets plans. Research, I tell them, is pretty conclusive: diets have little impact, including on gastrointestinal problems!

Often times parents report changes when a diet is implemented, but fail to understand that along with the change in diet came changes in their expectations, changes in their behaviour, changes in their attitudes such as a reduction of anxiety and stress. And most importantly, a sudden easy to implement structured way to address and now explain the symptoms. Often they fail to see that the behaviour programming, language training and structured classrooms their children are often in may have had a far greater impact. Relying upon individual testimonials, rather than research designed to isolate the cause and effect of an intervention, is never a good way to make clinical choices.

In this study, which you can read more about through the above links, we have a randomized, double-blinded (meaning neither the participants nor the researches knew which treatment was being received), placebo controlled study, and we again find that the effects of these diets is null. (Numerous large scale studies show there is no support for these diets.)

In this study children were given snack foods with and without gluten and casein, both or neither. The researches evaluated the effects on attention, sleep, stool patterns and other characteristics of autistic behaviour. The study did not show any significant changes in any of these symptoms for any of the groups.

20 percent of parents in the Autism Treatment Network report using "alternative" treatments such as diet. 50% of these were diets. These diets has been promoted by celebrities such as Jenny McCarthy who details the diet she used with her son. However, what is not reported is that many parents report no success with these diets, or that it is far more likely that other treatments being administered at the same time have been the cause of behavioural changes. The above article reviews some of these cases.

What is important from this study is to note that, "There has not been any research to substantiate the GFCF diet for children with autism who do not (already) have celiac disease or wheat/milk allergies." In other words, yes, sometimes children have improved because they had allergies to milk, gluten, heat etc. Just as any child might. And that fact is unrelated to autism.

There are treatments that work, that have been scientifically proven to improve behaviour, communication and social interaction. Regretfully these are intensive, slow and prolonged. But they are your best bet. Here in British Columbia there are many services available to help you with behavioural issues, including trained behaviour specialists paid for through your autism funding, speech pathologists, paid for through your autism funding and in our school districts training for teachers, teacher aides and others through the Provincial Outreach Program for Autism and Related Disorders. There is hope, there are treatment, but there are few miracles. Another valuable source for behavioural experts is ACT. Whatever you do, look to treatments that have been rigorously tested, that make sense, and don't imply a simple answer you could only call "miraculous".

If you would like further information about assessment or treatment for autism, Aspergers, ADHD and other childhood disorders you can find further information on my professional web page at www.socialcognitivetherapy.com or www.relatedminds.com

I can also be contacted at drjimroche@gmail.com

Dr. Jim Roche
Registered Psychologist
778.998-7975

Saturday, March 27, 2010

New Resource from Yale Child Study Center

As we all know individuals with autism spectrum disorders exhibit a range of behavioral excesses and deficits that can interfere significantly with adaptive functioning at home, in the community, and at school. These challenges can lead to isolation, cause injury or harm to others, and lead ultimately to the exclusion of some students from programs and training they need to progress socially and linguistically. There is a considerable amount of evidenced based research and this has been turned into training and interventions. Often this training is not available to parents and caregivers. Yale Child Study Center has graciously decided to share their autism training course with the public for free. You can get to it on their website here or locate it here on YouTube.

http://autism.yale.edu

The Yale Child Study Center brings quality research and clinical programs to families and children living with Autism all around the world. The lecture content and supporting materials available online for free to anyone who desires to learn about Autism Spectrum Disorders. They can easily be translated into several languages.

Video of each lecture was captured in highdefinition format. One of the features available through Google/YouTube's technology is the ability to provide a version of each video with English-language closed captioning turned on.

The lecture I am first recommending introduces the foundations of behavioral assessment and treatment of significant challenging behavior in persons with autism. If your school hasn't seen this, and you have doubts about their ability to deal with your child due to a lack of training, suggest this video and the others. The assessment and intervention principles discussed are firmly grounded in the behavior analytic research literature, and have enjoyed widespread clinical application with a diverse range of behaviors including aggression, self-injury, stereotypy, property destruction, and pica. Following a detailed discussion of the use of the technology of functional analysis, those variables and conditions in the environment that maintain challenging behavior are discussed in relation to the development of treatment plans that are functional, based on positive behavior supports, and that teach more adaptive prosocial behavioral repertoires.

This is by far the best lecture I have seen available on the web. And it's free.

for more information on my own services please check out my professional site at www.relatedminds.com or www.socialcognitivetherapy.com We provide individual consultation and behavioural interventions for children and adolescents with autism disorder and Aspergers. We provide training to schools and individual classroom consultation. We have ABA certified providers for those seeking ABA services and individuals with training in social communications therapy. Assessments for Aspergers Disorder, autism spectrum disorder and co-morbid disorders such as ADHD are also available in our offices in Burnaby and Vancouver. We service individuals in Burnaby, Coquitlam, Vancouver and through individual arrangements throughout the lower mainland. In addition to providing services to children and adolescents we have several years experience working with young adults attending college, entering the workplace and older adults.