Showing posts with label psychologist. Show all posts
Showing posts with label psychologist. Show all posts

Thursday, April 21, 2016

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

I conduct diagnostic assessments for autism spectrum disorder (ASD), sometimes called Asperger's Disorder, with individuals aged 6 and above. There are special conditions for those below the age of six involving a team of professionals that I cannot make arrangements for, however, another member of a team may ask me to participate in such an investigation. Private assessments are costly, with the cost ranging from $1,600-$1,950. The BC government does provide for these assessments through their own system. If you wish to make arrangements for the government to provide an assessment please see your family doctor who may refer you to the British Columbia Autism Assessment Network (BCAAN) for assessment and diagnosis. There are, sometimes, substantial waiting lists. Also, while at one age a child may not meet the criterion for a diagnosis, as two, three or more years go by patterns may develop that make the diagnosis much clearer, and sometimes it is very difficult to arrange a second assessment, so families often contact a private psychologist such as myself.
From the BCAAN site: "BCAAN is responsible for assessing and diagnosing children in British Columbia who may have Autism Spectrum Disorder (ASD) and will arrange for an assessment to be done as close to where you live as possible. There is no charge for their services. For more information on ASD diagnosis and testing, visit the BCAAN website or contact BCAAN at 604 453-8343." 
Often parents who wish to arrange for a private diagnostic assessment. BCANN states: "These assessments must meet the same standards and guidelines as BCAAN assessments. The clinician will need to complete a Non-BCAAN (Private) Diagnosis of Autism Spectrum Disorder form to document the diagnosis if the family wishes to apply for Autism Funding programs. Parents are responsible for any costs charged by the private clinician."  Clinicians who provide these services must have specific tools and experience, these include the use of the ADOS and ADI-R assessment instruments, required by the provincial government to accept the practitioner's diagnosis. Many times parents see a practitioner who is not familiar with the government requirements, and then, regretfully, need to have a new assessment completed. Make sure your provider knows their way around these regulations. 
I complete diagnostic assessments on children, adolescents/teens, as well as adults who suspect they have autism spectrum disorder, or what previously had been referred to as "Asperger's Disorder." In addition to being a registered psychologist I am also an approved member of the RASP list of behaviour interventionists, and my services (after diagnosis and acceptance of the diagnosis by the ministry) are paid for through ministry fundings. I provide autism consultation services to parents, families, brothers and sisters of children or teens with autism spectrum disorder or "Asperger's" who may be having relational difficulties, I provide training and consultation to individual teachers, schools, and the workplace of many young adults. i also provide couples therapy for individuals who are in relationships and one or both may have autism spectrum disorder of "Asperger's Disorder." These services are provide in my Burnaby office, and some arrangements can be made for my Vancouver office.
If your child is diagnosed with ASD, you may be eligible to receive funding from the ministry's Autism Funding Programs. If your child does not have ASD, there may be other services to assist you and your child such as tax credits or special education services and supports based upon other issues such as learning disorders, ADHD or dyslexia. Many of these issues require additional testing, such as a psychoeducational assessment.
My services are available to those with autism spectrum disorder of any age. Please contact me through my webpage at www.relatedminds.com. Email is the best way to make arrangements for an initial meeting, as I am often with patients throughout the day.

Sunday, April 27, 2014

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

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

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

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

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

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

READ THE CARTOON. See what happened?

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

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

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

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

Thursday, August 2, 2012

Autism and Pets

(From MedPage) "Getting a pet may help autistic children improve their social skills, a small study showed." "Children with autism who acquired a pet after age 5 showed gains in two prosocial behaviors -- "offering to share" and "offering comfort" -- compared with those who had never had a pet (P<0.0014 for both), according to Marine Grandgeorge, PhD, of the Centre Hospitalier Regional Universitaire de Brest in France, and colleagues." "Autistic children who had had a pet since birth, however, showed no differences compared with their pet-less peers, the researchers reported online in PLoS One." "Given the potential ability of individuals with autism to develop prosocial behaviors, related studies are needed to better understand the mechanisms involved in the development of such child-pet relationships," the authors wrote. Click here to read the entire article: Pets Boost Social Skills in Kids with Autism Click http://www.medpagetoday.com/Neurology/Autism/34012 For information on services I provide for children, adolescents and adults with Autism Spectrum Disorder, Asperger's Syndrome and ADHD visit my website at www.relatedminds.com

Sunday, June 13, 2010

Researchers Blast Another Link Between Autism and Vaccines

Researchers Blast Another Link Between Autism and Vaccines

"Some myths never go away; they just change form." that includes the debate about vaccines and childhood autism. One that never seems to go away. Here are the simple facts: there's no link between the disorder and thimerosal. So the anti-vacciners have simply changed the rules and now say that it's not the thimerosal, but vaccines still cause autism because children get too many vaccines too soon. "Their little bodies are overloaded." How they have determined this is hard to understand, and they have come up with alternative vaccine schedules, seemingly out of thin air.

The Los Angeles Times reports "an increasing number of parents are asking their pediatricians to space out vaccines and booster shots." But, "There's no need to do that, according to pediatric infectious disease specialists Drs. Michael J. Smith and Charles R. Woods of the University of Louisville School of Medicine." See the study here.

ULSM released a study in the medical journal Pediatrics, the leading journal in the field, that states unequivocally there is no relation between autism and the frequency of childhood vaccines. The authors, Smith and Woods, analyzed data on 1,047 children from a previous study investigating the thimerosal claim.

The children were born between 1993 and 1997, and had been vaccinated on a schedule of their parents' choosing. Later they were given a series of 42 neuropsychological tests between the ages of 7 and 10. Smith and Woods report roughly 47 percent of the children received their vaccines on a regular schedule. Another 23 percent received their vaccines, but not on schedule, and the remaining children received only some of their shots. From the results it is clear that the spacing of the vaccines had no effect on whether or not the children developed autism. The authors state "This study provides the strongest clinical outcomes evidence to date that on-time receipt of vaccines during infancy has no adverse effect on neurodevelopmental outcomes 7 to 10 years later....These results offer reassuring information that physicians and public health officials may use to communicate with parents who are concerned that children receive too many vaccines too soon." There simply were no differences, none.

Over and over again, with research study after research study, we see that vaccines have no relationship to autism, Asperger's Disorder or any neurological deficits.

What we should learn from these studies is that there is a group of individuals who for some philosophical or political reason seem to want to spread discontent among parents, who want to scare them, and for some reason return us to the medicine of 100 years ago. I fail to understand it. I just hope that the overwhelming evidence will sooner or later keep parents from wasting their time and money of treatments (like chelation, chiropractic and homeopathy) that are based upon the same woo science.

Dr. Jim Roche is a registered psychologist in Vancouver, British Columbia. He has offices in Burnaby (Coquitlam, Port Moody, Maple Ridge and New Westminster) and downtown Vancouver. His website can be seen at www.relatedminds.com and www.socialcognitivetherapy.com

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, May 8, 2010

Floor Time

Stanley Greenspan, the developer of the autism intervention "Floor Time" died this week at 68.

Dr. Greenspan was a psychiatrist who developed this influential approach to teaching children with autism and other developmental disabilities. He died of a stroke. He leaves his wife and co-author Nancy Thorndike Greenspan, who helped author several of his more than 30 books on education and children.

"Floor Time," as it is called, is used in many special education classrooms and therapeutic settings. It is one of the major early interventions for autism. Often times "Floor Time" is seen as an approach that is in opposition to other interventions such as behavioural interventions like ABA (Applied Behavioural Analysis) and clients are often surprised when I recommend both more traditional behavioural interventions as well as this more child centred intervention.

Dr. Greenspan encouraged parents, teachers and behavioural interventionists to get down on the floor with their child, even very young children, and engage with them with words, gestures and modelling in order to encourage the development of one-to-one interpersonal relationships and to expand their world of ideas, concepts, words and communications skills.

In 2000 Dr. Greenspan and Dr. Barry Brazelton co-authored an important book, "The Irreducible Needs of Children." In it he differentiates behavioural approaches from "Floor Time" in which the child leads. Dr. Greenspan found that babies who failed to connect with parents, for whatever reason, are deprived of emotional tools that he feels are necessary for learning and growth. These cannot happen without these ability to use these basic emotional ties. He writes, "Our emotions serve as the orchestra leader for getting the whole mind and brain working together."

While for a child with little communication ABA and behavioural training is a necessary component to teaching basic associations and skills, the emotional component of communication also needs to be focused on. In the best programs I have observed teachers work on ABA goals during several structured periods of the day and then spend several other periods engaged in "Floor Time" skills with children, letting the child lead.

Often schools and agencies want to limit the number of different interventions they use. But emotional contact, and teaching the child to lead, are critical to teaching the child to communicate in a human way. "Floor Time" may really be more about teaching the parent, teacher or interventionist how to follow than it is about direct intervention with the child. ( Another book I often recommend for parents of high functioning children is by Dr. John Gottman, Raising an Emotionally Healthy Child.)

Floor Time is hard to describe, but there is a wonderful video on Dr. Greenspan's web page showing him engaging in play with a child and his mother. Click here to get to the web page. you can also see him working on various videos on YouTube.

Our thoughts go out to Dr. Greenspan's family and co-workers.

Again, for more information on assessments for autism, Aspergers and learning disabilities you can visit my website at www.socialcognitivetherapy.com or www.drjimroche.com

I have offices located in Burnaby and Vancouver which are convenient to the entire lower mainland.