Adult Autism Diagnosis (Asperger's)

I am often asked about how to get an adult autism diagnosis, this might mean the individual or a family member has concerns about autism Asperger's Disorder (in spite of the fact it is no longer part of the official DSM-5 diagnostic categories it is still what people ask about and talk about) or sometimes they have previously been told they might have a "non-verbal learning disorder."

The short answer to their questions is, yes, I do adult assessments for the diagnosis of autism, Asperger's and other related disorders.  You are welcome to look at my website at www.relatedminds.com to find out about the process.

The longer answer is complicated. A diagnosis of autism, Asperger's or any similar problem can be simple, or it can be complicated. And what you need the diagnosis for makes a difference. How can that be?

If you are having difficulty at work, socially, and perhaps are in some sort of trouble due to what you suspect is Asperger's Disorder we need to do a very complete assessment. That means not only looking for the symptoms of Aspegers or autism, as you likely did on line somewhere, but also look at other possible reasons for the same symptoms. And there are many of those. Sometimes a personality disorder or anxiety looks like Asperger's or autism. Sometimes ADHD does. Or these disorders might mask the symptoms. For a comprehensive assessment that you can use in a situation such as a legal case we need to follow the same guidelines as we would for a child or teen applying for funding with the Ministry of Children and Family Services. That means several lengthy tests, self reports and collecting a comprehensive history from someone who knew you at a pretty early age. This can be a long and expensive process, and one that is not necessarily important to you.

At other times wives bring in their husbands, or husbands bring in their wives, or brothers bring a brother in, to find out why there has been such ongoing, long term social difficulty between them. This does not always need to involve all these steps, and sometimes it's best to get right to work and spend our efforts on dealing with immediate symptoms and relationship issues. We would undertake a briefer assessment, and deal with problems as we find them. This doesn't mean that we don't do an assessment, but the standards and requirements are different when your involved in possible legal issues - including having difficulty at work.

So it's hard to answer these questions directly, as the situation is different from person to person. It's best to set up an initial visit with a professional, have a brief assessment done and then together make a determination about where you are going and what needs to be done after all the choices are put in front of you.

Uncertainty is hard to deal with, it causes anxiety for individuals with Asperger's and related disorders. But it's better to start from a position of knowledge than to just guess at what the final goal might be.

For more information about my services for adults with Asperger's, autism and related disorders please visit my website at: www.relatedmings.com.

You can also find out more about me at my Psychology Today webpage: http://therapists.psychologytoday.com/rms/name/Jim_Roche_JD,PhD,CAGS,RPsych,RMFT_Burnaby_British+Columbia_70682

Dr. Jim Roche  email: relatedminds@gmail.com  phone: 778.998-7975

Adult and Adolescent Therapy for Autism and Asperger's Disorder

ASSESSMENT AND TREATMENT FOR ADULTS WITH ASPERGER'S DISORDER AND HIGH FUNCTIONING AUTISM

In addition to services for children and adolescents I am one of the few providers in BC with extensive experience working with young adults and adults with autism and Asperger’s Disorder / Syndrome. As a matter of fact, over the past few years more and more of my practice has focused on working with young adults and social/work place issues. This includes social coaching, workplace evaluations, intervention planning and family consultations. Full comprehensive evaluations and diagnosis of adult Aspergers is also available.  Some of the aims of therapy for adults with Asperger's or high functioning autism are:

• to teach new cognitive and behavioral skills that were never learned
• to teach compensatory strategies for deficits that cannot be changed
• to facilitate self-acceptance
• to teach strategies to decrease or prevent symptoms of co-morbid mental health problems, such as anxiety disorders and depression

SERVICES FOR AUTISM AND ASPERGER'S DISORDER / SYNDROME

• Assessment and Diagnostic Services (autism, Asperger’s, ADHD and related disorders)
• Workplace consultations and site based education programs
• Community based social coaching programs for individuals with high functioning autism and Asperger’s Disorder / Syndrome
• Educational / Social coaching for young adults in the workplace, college and similar settings
• Social coaching for adults with high functioning autism, Asperger's Disorder / Syndrome
• Couples counselling for couples dealing with adult autism,  adult  Asperger's Disorder / Syndrome

FREQUENTLY ASKED QUESTIONS (FAQS):
WHAT IS YOUR BACKGROUND FOR PROVIDING TREATMENT FOR ADULTS WITH ASPERGER'S AND HIGH FUNCTIONING AUTISM?

My background for working with adults starts with my work with children and adolescents for over two decades. Understanding adult symptoms requires being familiar with the developmental issues of Asperger's and high functioning autism. I have worked as a teacher of special education, a school psychologist, a district behaviour specialist for autism and a provincial consultant for autism and related disorders providing consultation throughout the province of British Columbia.

Three other important skills and experience also come into play in working with adults with Asperger's Disorder or high functioning autism. First, several years of experience working as a neuropsychological consultant with Rehab Without Walls in California provided me with experience in working with workplace related problems. Second, many adults come to me with concerns about their relationships, including couple relations and relations as a parent. Before becoming a registered psychologist I was a licensed and registered Marriage and Family Therapist and have worked as a couple and family therapist for several years. This includes advanced training in the Gottman Couple's Therapy technique. Third, one of the most commonly used individual therapy techniques when working with adults with Asperger's or High Functioning Autism is Cognitive Behavioural Therapy or CBT. I hold an advanced certificate in CBT from the Albert Ellis Institute in New York City. 

DO YOU WORK WITH ADHD (ATTENTION DEFICIT HYPER ACTIVITY DISORDER) AND EXECUTIVE DYSFUNCTION?

ADHD is now often diasgnosed along with Asperger's Disorder of High Functioning Autism. Much of my work with children, adolescents and adults focuses on ADHD and deficits of executive function. Executive function is the concept referring to the cognitive processes required to plan and direct activities, including what we refer to as task initiation and follow-through, working memory, sustained attention, performance monitoring, inhibition of impulses, and goal directed persistence. It also effects an individuals ability to control and modulate their emotions.

Many clients I see have deficits in executive functioning which prevents them from having the necessary skills to perform well in school, work or in social settings. With these clients we often need to make diagnostic decisions through testing and assessment, and then develop an individualized treatment plan addressing school, home and work. This might involve individual behavioural therapy, school or work consultation, referral to medical professionals, and psychoeducation. I often work closely with schools and employers in Burnaby, Coquitlam, Vancouver, New Westminster and Port Moody.

I often provide reading material, training videos and demonstrate and practice specific intervention techniques with clients. Much of the work we do in the area of ADHD is based upon the research and treatment programs developed by Dr. Russell Barkley. Please refer to my ADHD/ADD page on my website for more information.

WHAT ABOUT ANXIETY, DEPRESSION OR FAMILY ISSUES?

Adolescents and adults are also seen for both diagnostic assessment and treatment of depression, anxiety and behaviour problems that might arise out of environmental or other situations. These individuals might take part in cognitive based therapy or counselling, or they might be provided with more traditional supportive therapy. I have provided child, adolescent and adult therapy for over twenty years using scientifically sound treatment techniques to meet the child or adolescent’s needs.  Anxiety and depression are frequent co-morbid disorders for adults with Asperger's Disorder or high functioning autism and need to be addressed in treatment.

HOW DO I MAKE AN APPOINTMENT AND IS THERE A WAITING LIST?

You may phone my office at 778.998-7975 or email me to begin setting up an appointment. The home page of this website has an email form you may use. Fees for sessions follow the guidelines of the British Columbia Psychology Association ($175.00 per session) and may be paid by cash, check or through PayPal.  Often extended health care covers the cost of seeing a registered psychologist.  Long term therapy is usually provided at a reduced rate. There is usually no longer than a one to two week waiting period. 

More information can be found at my website: http://www.relatedminds.com

 

Child, Adolescent and Adult Testing for Autism / Aspeger's Disorder

This week two patients came to me and said they wanted an assessment for autism. Actually one said autism, this was an assessment for a teenager, and another wanted an assessment for Aspeger's Disorder. Both were sent by their family physicians, which is how I usually get my referrals.​

Both wanted to know what it consisted of and how much it would cost. Those are very reasonable questions, but not so easy to answer. An assessment usually is completed to answer a specific question, and most of the time a diagnosis alone isn't worth spending time or money on. So I usually ask, "What do you need this diagnosis for?"​

With a child an autism diagnosis, and it doesn't matter if we are looking at "classical autism" or Asperger's Disorder, High Functioning Autism or whatever term you may be using (it is now all one diagnosis on a spectrum in the new Diagnostic and Statistical Manual, the DSM-5)​ if it's to help with education you often need both an assessment for autism using the ADOS (Autism Diagnostic Observation Schedule) and the ADI-R (Autism Diagnostic Interview-Revised) to qualify for school and provincial services here in British Columbia, as well as a full psychoeducational assessment. This is necessary to help determine what interventions to use in the school to help the student learn. This is a very comprehensive procedure and can cost between $2,600 and $3,400.00

I ask about this because the school may be able to complete the psychoeducational assessment component, which significantly reduces the cost. Or, maybe a psychoeducational assessment has already been completed!​

​Adults, on the other hand, often come to me for an assessment and diagnosis because they want to understand themselves and be able to explain behaviours. They just want to know why they might be doing the things they are doing. In this case I'm often reluctant to conduct a time consuming and expensive assessment. An assessment should not just tell you what you have, it should tell you what to do about it! Adult assessments often are used in employment as well, to get accommodations and consideration at the work place.

A diagnosis of adult autism or Asperger's Disorder​ (sometimes called Asperger's Syndrome) means not just seeing if you meet a list of criteria or symptoms, it means ruling out the many other possible disorders that look very much like Asperger or High Functioning Autism. This means completing not only the usual assessment for autism/Aspergers but also personality assessments, some neuropsychological tests and often speech and language assessments, as some specific speech and language deficits can look just like autism/Asperger's. 

Just like a student, who would use the assessment/test results to develop an educational plan (an IEP or Individual Education Plan is developed by the school based upon the assessment results) an adult should also expect to be able to use their test results to make a life intervention plan, use the results to come up with a plan to improve issues at work, home, in relationships or recreation. ​

Assessments are used to make plans and look forward, not just to diagnose. ​I would agree with parents who object to getting a "label" but would urge them to get a good diagnosis and use it to make a plan.

For more information about the diagnostic services I provide you can visit my web page at www.relatedminds.com. ​ You will find information about autism services for children, adolescents and adults and assessment services. You can also call me at 778.998-7975 or email me at relatedminds@gmail.com

I provide assessment services, diagnosis of autism/Aspergers for provincial funding, parent education, behaviour management programs and individual and couple therapy for adults with high functioning autism and Asperger's Disorder.​

What Causes Autism? Science is slowly approaching an understanding.

"Notes on Autism Assessment and Treatment" are written by Dr. Jim Roche. These autism notes are not meant to provide a guide to either diagnosis or treatment. For information on diagnosis and treatment contact your medical doctor or a registered/licensed psychologist for an appointment and assessment. Information about Dr. Roche's services can be found at these addresses:

Relatedminds: http://www.relatedminds.com
ADHD Help BC: http://www.adhdhelp.ca
At Psychology Today: http://therapists.psychologytoday.com/rms/70682
At the BCPA website: http://bcpa.pixelmountainarts.com/users/jimroche
At CounsellingBC: http://www.counsellingbc.com/listings/JRoche.htm
At Psyris: http://psyris.com/drjimroche
At Autism Community Training: http://www.actcommunity.net/jim-roche.html

What causes autism, Autism spectrum disorder and Asperger's Syndrome? We now know more about the cause of autism than we have for a long long time. But we need to be careful not to allow the anti-vaccine / anti-scient crowd misdirect us. Moises Velasques-Manoff, the author of "An Epidemic of Absence: A new Way of Understanding Allergies and Autoimmune Diseases" has written an excellent summary of the latest research for the New York Times. It can be found here:

http://www.nytimes.com/2012/08/26/opinion/sunday/immune-disorders-and-autism.html?smid=pl-share

Velasques-Manoff points out that one subset of those with autism, which makes up at least if not more than 1/3 of those with autism, seem to have some type of inflammatory disorder. And this inflammatory disease doesn't start as a result of vaccinations - it's starts way before that, in the womb. We know this is true because the brain changes that are associated with autism are noted prior to the age of immunizations, and there is no correlation between those getting these vaccines and those who develop autism. Hopefully, someday, the uninformed will start to notice the basic problems with their science, or maybe start to have some respect for science.

What the research Velasques-Manoff writes about notes is that a large number of mothers of autistic children have had some sort of immune compromising condition while they were pregnant. This leads to a inflammatory reaction, in both the mother and child, and this effects the astroglia and microglia - which ar enlarged from chronic inflammation.

 A population-wide study in Denmark spanning two decades indicates that infections during pregnancy increases the risk of autism in children.  Sounds simple enough, doesn't it? Infections during pregnancy ...must cause autism. So cut down the number of infections. But again, the epidemiology doesn't lead in that direction. Like much of science, it's more complicated than that. You see, while world wide viral and bacterial infections have gone down ....autism rates have gone up. Especially places where there are fewer infections! Somewhat of a contradiction.

You see while infections and other disorders have decreased, the number of inflammatory disorders HAS gone up.  And the relationship between these inflammatory infections and autism is very clear. A mother with rheumatoid arthritis, an inflammatory disorder, has an 80 percent increase in the chance of having a child with autism. A mother with celiac disease increase her risk 350 percent.

So the questions now becomes why we are now so prone to inflammatory disorders, and if there is anything we can do to decrease these risks?  There are several suggested therapies - for the mother - and these oddly follow the idea of doing something about what Velasques-Manoff calls our "microbial deprivation." (Remember: dirt and parasites are "famous for limiting inflammation.")

 Probiotics? "domesticated parasites?"  These are just some of the thoughts Velasques-Manoff and others are looking at. What we do know is that we have spent too much time looking at the effects of dysregulation in the child with autism, and not enough time looking at dysregulation and other problems in parents .... remember, it's a genetic disorder to a great degree.

Click on the above link to get the New York Times article, and check out some of Velasques-Manoff's writing elsewhere.

Autism Risk and Parental Age

Another research paper points to the problem of older men having children, something most thought was not an issue a few years ago. The research shows that older men are more likely than young ones to father a child who develops autism or schizophrenia. This is because of random genetic mutations that become more numerous with advancing paternal age. This study of the effects of parental age on likelihood of having a child with autism is the first study to quantify the effect as it builds each year. The study also notes that the age of mothers had no bearing on the risk for these disorders. What you need to remember is that this is just one of MANY risks that we have associated with autism. One risk that isn't related to autism is vaccinations, which, in spite of the overwhelming evidence is still thought of as an issue by many uninformed parents, especially those who rely on pseudo-scientific research for answers.

Click here for the article in the New York Times, which does a great job of explaining the research these scientists undertook:

http://www.nytimes.com/2012/08/23/health/fathers-age-is-linked-to-risk-of-autism-and-schizophrenia.html?smid=pl-share

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

Sensory Processing Disorder and ASD

According to a policy statement from the section on Complementary and Integrative Medicine of the American Academy of Pediatrics Sensory Processing Disorder should not be used as a medical diagnosis. They express concern with it's overuse, and the application of sensory based therapies for which there is little if any evidence of effectiveness. Regretfully, even with a diagnosis of Autism Spectrum Disorder or Asleger's Syndrome many school district produce IEPs (Individual Education Plans) that rely heavily on these unproven treatment- while they avoid the use of validated behavioural treatments. Often the reason for this is that sensory based treatments are easier to implement with untrained staff, and there is simply a lack of trained professionals in the field of behavioural interventions (or classroom management). Click http://www.medpagetoday.com/Pediatrics/GeneralPediatrics/33018 for the full story The statement says, "Pediatricians should not use sensory processing disorder as a diagnosis, according to a policy statement from the American Academy of Pediatrics. Although there are standardized measures of a child's sensory processing abilities, there is not a widely accepted framework for diagnosing the disorder, members of the AAP's Section on Complementary and Integrative Medicine wrote in the June issue of Pediatrics." The reort notes, "that the committee developing the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) has called for further research before officially recognizing sensory processing disorder." In addition, the authors wrote, "it is unclear whether children who present with sensory-based problems have an actual 'disorder' of the sensory pathways of the brain or whether these deficits are characteristics associated with other developmental and behavioral disorders." The report suggests that instead of diagnosing sensory processing disorder, pediatricians should perform a thorough evaluation -- usually with appropriate referral to a developmental and behavioral pediatrician, child psychiatrist, or child psychologist. The report continues, "consideration should be given to other developmental and behavioral disorders that may be associated with difficulty tolerating or processing sensory information, including autism spectrum disorders, attention-deficit/hyperactivity disorder (ADHD), developmental coordination disorders, and childhood anxiety disorders." "Pediatricians should inform families that occupational therapy is a limited resource, particularly the number of sessions available through schools and through insurance coverage," the authors wrote. "The family, pediatrician, and other clinicians should work together to prioritize treatment on the basis of the effects the sensory problems have on a child's ability to perform daily functions of childhood." Here in Bc there has been tremendous growth in school based "sensory rooms." Often children with ADHD, Autism Spectrum Disorder or Asperger's Syndrome are removed from class and sent to the "sensory rooms" in an effort to calm them down, rather than the school completing an appropriate Functional Behavioral Assessment and developing a behavior based intervention plan that either teaches new skills or uses behavioural techniques (long known about and familiar to experts in the field) such as controlled exposure, relaxation and thought stopping interventions to teach the child appropriate ways to deal with unwanted sensory input. Little effort is made to help the child develop coping skills, self-southing skills or other alternative behavioural skills to deal with the sensory issues. Many parents feel that the over use of sensory rooms and removal from the teaching environment do little more than reinforce inappropriate and unwanted behaviours. A second look at the over use of the "sensory Processing Disorder" diagnosis seems like an appropriate place to start. While here in BC excessive removal from a classroom (Time Out / Time Away) due to behavioural issues seems acceptable. In the United States such removal would be considered a "change in educational placement" and would require approval by both the school special education team and parents. An excellent source of information on how behaviours that interfere with learning should be addressed in the classroom through well know and scientifically supported educational and behavioural techniques can be found at this web page: http://www.pent.ca.gov The PENT website offers free materials which any school district could use to address problematic behaviours which interfere with learning. An appropriate Functional Behavioural Assessment (FBA) is the place to start when addressing these kinds of issues. I have used the PENT training materials to implement training programs in completing and writing Functional Behavioural Assessments for almost 10 years and it is really unmatched ....and FREE. All of these training materials are....FREE. Rather than providing easy interventions that are not supported by science. I would hope that every school instead provides science based assessment and intervention programs that directly assess the behaviours of concern and use interventions techniques we know work. The problem comes down to this: If your child has a serious behavioural problem at school, you should expect that the school would implement strong, science based interventions that are designed to directly address the problem AND teach new adaptive behaviours. Changing the child's environment, and removing them from the classroom, is not a plan. Sensory room or not. If your having such problems with your child in school I would suggest contacting an expert in the field, a psychologist or professional educator, to visit the school, observe the situation and complete an FBA (Functional Behavioural Assessment)