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
Wednesday, June 25, 2014
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.
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.
Wednesday, May 28, 2014
Autism | Asperger's | Behaviour
Many parents with children on the autism scale find themselves at a crossroad and need to address inappropriate behaviours which are preventing their child from succeeding at school or at home- social or academically and come to see me. Many already use a "behavioural interventionist" from the ACT referral services, but find that they just can't get a plan and intervention together for their child in spite of already having a behaviour interventionist on their team. While I am a member of the ACT Behaviour Interventionist list (the "RASP") I am also a Registered and Licensed Psychologist with a speciality in behaviour management and behaviour therapy. This is a different field which goes beyond dealing with symptoms normally thought of as relating to ASD.
ABA training in itself often doesn't provide a wide enough background in psychology to help these children, as their underlying problems can be depression, anxiety, OCD and other related disorders. And ABA, as helpful as it is, isn't designed to work with these kinds of problems. So, first of all we need to really understand and diagnose the problem. This is usually done through a process called a functional behaviour assessment or FBA. An FBA may include school and home observations, data collection and testing, but it also can be a much shorter and contained process. An FBA is about the "process." We look at what the child is doing, and the child's environment to find out what the function of the behaviour is. "What function does X have for this child?" I often teach FBA development to teachers and psychologists, and it can range from a comprehensive several page written report, to a 3X5 card with some notes jotted down. What's important is that we consider the situation to understand the function, and then move on from their to 1) make environmental changes so the child doesn't need to engage in the behaviour as the sam frequency or severity, and 2) teach new appropriate skills so that the child now has a new appropriate behaviour that meets the SAME function as the original behaviour. The most comprehensive system for completing FBA's and writing these intervention plans for children and adolescents with autism and Aspergers can be found at the California website PENT. Click here: http://www.pent.ca.gov What's great about the PENT website is how comprehensive it is, and how much training materials are available to school staff - psychologist, teachers, administrators- to make sure a school is performing these procedures correctly. A key component to the California PENT program is a system that checks the QUALITY of the process and intervention. A quality control system is built right in. I've taught this system in several districts and those that adopt it improve the quality of there interventions for children with behaviour problems and autism/Aspergers significantly.
The other issue that seems to come up and keep individuals from providing good evidence based interventions is the general lack of experience most teachers, behaviour interventionists and general psychologists have in old fashioned behavioural therapy. Too often I hear that a token system didn't work for a child with ADHD (although we have 40 plus years of research supporting the use of token reinforcement systems with children with ADHD!) or that planned ignoring or exposure programs have failed. Usually they are implemented straight from a book, and when they don't work everyone quickly gives up. These systems have a long history of working, but, if you ever watched "Super-Nanny" on television you know ever week she has to come back, look at the data, watch the parents implementing the program and make changes. You always need some feedback from a third party ...always. And if someone has never had success implementing such a behaviour program, then maybe they shouldn't be doing this without supervision. Token systems and other behaviour management practices are complicated and tricky. If they don't seem to be working at first, don't give up! Consult!
Finally, it's a tricky issue to implement a behavioural intervention program to deal with difficult behaviours when at the sam time your dealing with the symptoms of Asperger's or autism. Many parents I see come to me after many unsuccessful attempts on their own. Again, get consultation from an expert!
Where can we learn about this? Well, I think you need a multitude of handy interventions and plans. Not just one. I tell most of the parents I work with we are about to start a graduate degree in behaviour management, so hold on. Some good books to start with are these:
First: Read or watch Raising an Emotionally Intelligent Child: The Heart of Parenting by John Gottman. This is NOT a book on behaviour management, nor is it a book about behaviour problems. However, when your done you will feel better about all the other part s of parenting, and you'll understand the concept of being a "coach" for your child. I usually suggest the video which is available at the local library or John Gottman's website.
If your child is really a handful - EXPLOSIVE! Then I'd read or listen to "The Explosive Child," by Ross W. Green, PhD. This is a great book on parenting and dealing with really difficult behavioural problems. What it is not is a book on behaviour management from a behaviourist point of view. Instead it gives you a place to start, and a "style" to do it in. Dr. Greene also has a wonder website. Go check it out.
For the behavioural (didn't think I'd get to that did you?): The two best books I know of are "Your Defiant Teen: 10 steps to resolving conflict and rebuilding your relationship," by Dr. Russell Barkley and "Your Defiant Child: 8 steps to better behaviour," also by Dr. Barkley. These two books prove everything you need to start using time tested, evidence based behavioural interventions in your home.
These are the best places to start, but be warned: Children with Asperger's Disorder and autism spectrum disorder (ASD) do not react the same as other children to these or any interventions. For a multitude of reasons, sone biological, some cognitive, some relational, these children may react poorly to something that another child would react well to. So again, get advice and consultation from an expert.
These four resources, plus those available on child behaviour issues from the PENT website are a good place to start. If you would like to contact me and visit my office for a consult, please follow one of the links below:
ABA training in itself often doesn't provide a wide enough background in psychology to help these children, as their underlying problems can be depression, anxiety, OCD and other related disorders. And ABA, as helpful as it is, isn't designed to work with these kinds of problems. So, first of all we need to really understand and diagnose the problem. This is usually done through a process called a functional behaviour assessment or FBA. An FBA may include school and home observations, data collection and testing, but it also can be a much shorter and contained process. An FBA is about the "process." We look at what the child is doing, and the child's environment to find out what the function of the behaviour is. "What function does X have for this child?" I often teach FBA development to teachers and psychologists, and it can range from a comprehensive several page written report, to a 3X5 card with some notes jotted down. What's important is that we consider the situation to understand the function, and then move on from their to 1) make environmental changes so the child doesn't need to engage in the behaviour as the sam frequency or severity, and 2) teach new appropriate skills so that the child now has a new appropriate behaviour that meets the SAME function as the original behaviour. The most comprehensive system for completing FBA's and writing these intervention plans for children and adolescents with autism and Aspergers can be found at the California website PENT. Click here: http://www.pent.ca.gov What's great about the PENT website is how comprehensive it is, and how much training materials are available to school staff - psychologist, teachers, administrators- to make sure a school is performing these procedures correctly. A key component to the California PENT program is a system that checks the QUALITY of the process and intervention. A quality control system is built right in. I've taught this system in several districts and those that adopt it improve the quality of there interventions for children with behaviour problems and autism/Aspergers significantly.
The other issue that seems to come up and keep individuals from providing good evidence based interventions is the general lack of experience most teachers, behaviour interventionists and general psychologists have in old fashioned behavioural therapy. Too often I hear that a token system didn't work for a child with ADHD (although we have 40 plus years of research supporting the use of token reinforcement systems with children with ADHD!) or that planned ignoring or exposure programs have failed. Usually they are implemented straight from a book, and when they don't work everyone quickly gives up. These systems have a long history of working, but, if you ever watched "Super-Nanny" on television you know ever week she has to come back, look at the data, watch the parents implementing the program and make changes. You always need some feedback from a third party ...always. And if someone has never had success implementing such a behaviour program, then maybe they shouldn't be doing this without supervision. Token systems and other behaviour management practices are complicated and tricky. If they don't seem to be working at first, don't give up! Consult!
Finally, it's a tricky issue to implement a behavioural intervention program to deal with difficult behaviours when at the sam time your dealing with the symptoms of Asperger's or autism. Many parents I see come to me after many unsuccessful attempts on their own. Again, get consultation from an expert!
Where can we learn about this? Well, I think you need a multitude of handy interventions and plans. Not just one. I tell most of the parents I work with we are about to start a graduate degree in behaviour management, so hold on. Some good books to start with are these:
First: Read or watch Raising an Emotionally Intelligent Child: The Heart of Parenting by John Gottman. This is NOT a book on behaviour management, nor is it a book about behaviour problems. However, when your done you will feel better about all the other part s of parenting, and you'll understand the concept of being a "coach" for your child. I usually suggest the video which is available at the local library or John Gottman's website.
If your child is really a handful - EXPLOSIVE! Then I'd read or listen to "The Explosive Child," by Ross W. Green, PhD. This is a great book on parenting and dealing with really difficult behavioural problems. What it is not is a book on behaviour management from a behaviourist point of view. Instead it gives you a place to start, and a "style" to do it in. Dr. Greene also has a wonder website. Go check it out.
For the behavioural (didn't think I'd get to that did you?): The two best books I know of are "Your Defiant Teen: 10 steps to resolving conflict and rebuilding your relationship," by Dr. Russell Barkley and "Your Defiant Child: 8 steps to better behaviour," also by Dr. Barkley. These two books prove everything you need to start using time tested, evidence based behavioural interventions in your home.
These are the best places to start, but be warned: Children with Asperger's Disorder and autism spectrum disorder (ASD) do not react the same as other children to these or any interventions. For a multitude of reasons, sone biological, some cognitive, some relational, these children may react poorly to something that another child would react well to. So again, get advice and consultation from an expert.
These four resources, plus those available on child behaviour issues from the PENT website are a good place to start. If you would like to contact me and visit my office for a consult, please follow one of the links below:
KEY WORDS: Behavioural Interventionist, Behavior Therapy, Autism, Asperger's, Therapy, Vancouver, Burnaby, Psychologist
Monday, May 26, 2014
Testing and Treatment for Asperger's and Autism | Children, Adolescents and Adults
Testing, Assessment and Treatment for Autism and Aspeger's Disorder
Dr. Jim Roche provides testing and diagnostic services, as well as therapy, for children, adolescents and adults with autism spectrum disorder, Aspeger's Disorder and related cognitive deficits. For more information please visit my web page at: http://www.relatedminds.com/autism/
or http://psychologists.bc.ca/users/jimroche or www.relatedminds.com
Dr. Roche also sees adolescents and young adults for therapy and social cognitive therapy in his office, and accepts BC Ministry payments for these services. Services are also covered by your extended health care plan. He has over 20 years experience with children, adolescents and teens with autism spectrum disorder, non-Verbal Learning Disorders, Social Cognitive Disorders and Asperger's Disorder.
Please feel free to examine the web page or call doctor Roche with questions about assessments, testing and treatment for autism and Asperger's Disorder.
His offices are located in Burnaby and Vancouver and are close to Port Coquitlam, New Westminster, Port Moody and Maple Ridge.
Dr. Jim Roche provides testing and diagnostic services, as well as therapy, for children, adolescents and adults with autism spectrum disorder, Aspeger's Disorder and related cognitive deficits. For more information please visit my web page at: http://www.relatedminds.com/autism/
or http://psychologists.bc.ca/users/jimroche or www.relatedminds.com
Dr. Roche also sees adolescents and young adults for therapy and social cognitive therapy in his office, and accepts BC Ministry payments for these services. Services are also covered by your extended health care plan. He has over 20 years experience with children, adolescents and teens with autism spectrum disorder, non-Verbal Learning Disorders, Social Cognitive Disorders and Asperger's Disorder.
Please feel free to examine the web page or call doctor Roche with questions about assessments, testing and treatment for autism and Asperger's Disorder.
His offices are located in Burnaby and Vancouver and are close to Port Coquitlam, New Westminster, Port Moody and Maple Ridge.
Sunday, April 27, 2014
Behavioural Interventionist and Visual Supports for Children with Aserger's Disorder
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
Adult Autism | Aspeger's Disorder in Burnaby | Vancouver
Dr. Jim Roche provides diagnostic testing, assessments and treatment for adults with ASD|High Functioning Autism|Aspeger's Disorder. He has been working with adults with Aspeger's and related cognitive disorders for over 20 years.
Dr. Roche has worked as a clinical psychologist in private practice, a psychologist for local school districts, a provincial consultant on autism and related disorders and in community based rehabilitation programs. For more information visit his website at www.relatedminds.com
Dr. Roche has worked as a clinical psychologist in private practice, a psychologist for local school districts, a provincial consultant on autism and related disorders and in community based rehabilitation programs. For more information visit his website at www.relatedminds.com
Monday, April 21, 2014
Behavioural Consultants and Asperger's Disorder
I am often asked what a behavioural consultant can do, what services we provide, for children, adolescents and adults with Asperger's Disorder, high functioning autism and NVLD (Non-Verbal Learning Disorders)?
First and foremost, I provide psychoeducation - I help parents, children, teens and adults understand the nature of their disorder. Most individuals come to me because they want a behavioural consultant for Asperger's. That sometimes includes diagnostic testing, sometimes additional psychoeducational testing to help develop a school IEP 9Individual Education Plan) or with adult a workplace intervention plan.
some individuals see me, and have another behaviour interventionist in the home who is attuned to ABA techniques. Regretfully, while every parent of a child with Asperger's Disorder or autism spectrum disorder needs to know about ABA they also need to understand the neurocognitive details of the disorder to get why someone does what they do. This often includes working with older children and teens on materials such as Michelle Winners "Social Behavior Mapping" or using programs such as the "Social Detective" series or "SuperFlex" to understand themselves and start to make changes. It's hard to imagine working towards a goal without understanding what road your on! Psychoeducation helps with this. Often we meet every other week to go over how skills and tools we learned about in the office are working at home, school or the workplace.
I also consult with individuals about more basic behavioural problems, especially with small children who develop co-morbid disorders and need supportive interventions. This may include working on issues of anxiety, emotional regulation, anger management and social interactions.
I try, as much as possible, to use materials similar to those used by many school districts when working with students with Asperger's Disorder.
And frankly, every other week an adult takes home one or more of my children's books, posters or other materials because these really simple and clear programs clarify issues for them that adult autism and Asperger's materials just don't.
As a registered marriage and family therapist (RMFT), in addition to being a registered psychologist, teacher of special education and school psychologist, I also spend a good deal of time working with families on "family systems" issues. These can range from direct couple counselling for the adult with Aspeger's, to parent education and family dynamics. The range of services is wide, and depends upon your needs.
For more information on working with me as a "behavioural consultant," (I am an approved ACT Behavioural Consultant and work with provincial funding when it is available) or for information on testing, assessment, educational or workplace issues, please visit my web page at https://www.relatedminds.com/adult-autism-and-aspergers-disorder/ for adults or https://www.relatedminds.com/autism/ for children and teens.
First and foremost, I provide psychoeducation - I help parents, children, teens and adults understand the nature of their disorder. Most individuals come to me because they want a behavioural consultant for Asperger's. That sometimes includes diagnostic testing, sometimes additional psychoeducational testing to help develop a school IEP 9Individual Education Plan) or with adult a workplace intervention plan.
some individuals see me, and have another behaviour interventionist in the home who is attuned to ABA techniques. Regretfully, while every parent of a child with Asperger's Disorder or autism spectrum disorder needs to know about ABA they also need to understand the neurocognitive details of the disorder to get why someone does what they do. This often includes working with older children and teens on materials such as Michelle Winners "Social Behavior Mapping" or using programs such as the "Social Detective" series or "SuperFlex" to understand themselves and start to make changes. It's hard to imagine working towards a goal without understanding what road your on! Psychoeducation helps with this. Often we meet every other week to go over how skills and tools we learned about in the office are working at home, school or the workplace.
I also consult with individuals about more basic behavioural problems, especially with small children who develop co-morbid disorders and need supportive interventions. This may include working on issues of anxiety, emotional regulation, anger management and social interactions.
I try, as much as possible, to use materials similar to those used by many school districts when working with students with Asperger's Disorder.
And frankly, every other week an adult takes home one or more of my children's books, posters or other materials because these really simple and clear programs clarify issues for them that adult autism and Asperger's materials just don't.
As a registered marriage and family therapist (RMFT), in addition to being a registered psychologist, teacher of special education and school psychologist, I also spend a good deal of time working with families on "family systems" issues. These can range from direct couple counselling for the adult with Aspeger's, to parent education and family dynamics. The range of services is wide, and depends upon your needs.
For more information on working with me as a "behavioural consultant," (I am an approved ACT Behavioural Consultant and work with provincial funding when it is available) or for information on testing, assessment, educational or workplace issues, please visit my web page at https://www.relatedminds.com/adult-autism-and-aspergers-disorder/ for adults or https://www.relatedminds.com/autism/ for children and teens.
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