Wednesday, December 28, 2011
Adult Asperger's Disorder Diagnosis / Testing / Assessment
Sitting in a coffee shop last week I heard an adult discuss how they were sure they had Asperger Disorder, or High Functioning Autism. "I read the symptoms and I have all of them!" he said. I've actually overheard several adults claim they have autism spectrum disorder, Asperger's or other forms of social cognitive deficit while trying to read, and they always have a story about how their doctor dismissed them, and they really know Asperger's is the cause of every problem in their life! All they need for happiness is a proper assessment and diagnosis of adult Asperger's. I honestly wish it were that easy.
The problem is that several factors complicate the diagnosis of Asperger syndrome (AS), an autism spectrum disorder (ASD). Like other ASD forms, Asperger syndrome is characterized by impairment in social interaction accompanied by restricted and repetitive interests and behavior; it differs from the other ASDs by having no general delay in language or cognitive development. But having social problems, not understanding, catching on or reacting properly to social cues does not in and of itself mean you have adult Asperger's. Those symptoms can mean many different things, ranging from simple "quirkiness" on your part, an "odd personality" to a serious personality disorder, mood disorder, anxiety disorder....or simple shyness. Matching the symptoms to your behaviour and experience is no way for an adult to be diagnosesed with Asperger's Disorder (Notice I sometimes refer to this this disorder as Asperger's Disorder, the most common name, and sometimes Asperger Syndrome, another common name. Both mean essentially the same thing.)
Further problems in the diagnosis of Asperger's, especially in an adult, include disagreement among diagnostic criteria, controversy over the distinction between AS and other ASD forms or even whether AS exists as a separate syndrome. Right now the plan seems to be to stop giving this diagnosis the next time the DSM (Diagnostic and Statistical Manual - the "Bible" of psychiatric diagnosis, is published). As with other ASD forms, early diagnosis is important, and differential diagnosis must consider several other conditions. If Asperger's Syndrome or Disorder is not diagnosed early much of the important information we need to make a final diagnosis becomes hard to obtain. We usually use parent reports, teacher reports and observations of play to make the diagnosis. This is hard to do for an adult!
Whena family medical doctor who you have been seeing dismisses your self diagnosis of adult Asperger's disorder or Syndrome it is often because the diagnosis requires that the impairments are "significant, and must affect important areas of function." Often a medical doctor who has seen you for a number of years and observed you makes a quick determination that your "impairments" simply are not "significant." Even though you might think they are. With a few simple questions he or she can, pretty much, rule out Asperger's as a major concern. So, no diagnosis of adult Asperger's for you.
Developmental screening during a routine check-up by a general practitioner or paediatrician should have identified these signs and symptoms, which we would expect would have had a greater impact on you when you were young. Because many individuals come to a physician or psychologist for a diagnosis of "adult Asperger's" when they are having trouble at work, school or other social situations they are very cautious about giving out the diagnosis. The issue often, for the family doctor, is one of severity of symptoms. Why do you need the diagnosis, and what good will it do you? Are you seeking treatment for adult Aspergers? Is there a problem at work? Home? What are the reasons for you coming in?
Many times the symptoms of adult Asperger's are the same as Anxiety Disorders and the treatment is often very similar. The likelihood they could make a diagnosis they might have to defend is small. And, as I've mentioned, many people seeking the diagnosis are have some sort of work or social problem.
There are some other reasons you are unlikely to get a diagnosis from your family doctor: "A comprehensive evaluation includes neurological and genetic assessment, with in-depth cognitive and language testing to establish IQ and evaluate psychomotor function, verbal and nonverbal strengths and weaknesses, style of learning, and skills for independent living. An assessment of communication strengths and weaknesses includes the evaluation of nonverbal forms of communication (gaze and gestures); the use of non-literal language (metaphor, irony, absurdities and humor); patterns of speech inflection, stress and volume; pragmatics (turn-taking and sensitivity to verbal cues); and the content, clarity and coherence of conversation."
Further, "Asperger syndrome can be misdiagnosed as a number of other conditions. Conditions that must be considered in a differential diagnosis include other pervasive developmental disorders (autism, PDD-NOS, childhood disintegrative disorder, Rett disorder), schizophrenia spectrum disorders (schizophrenia, schizotypal disorder, schizoid personality disorder), attention-deficit hyperactivity disorder, obsessive compulsive disorder, depression, semantic pragmatic disorder, selective mutism, stereotypic movement disorder and bipolar disorder[10] as well as traumatic brain injury or birth trauma, conduct disorder, Cornelia De Lange syndrome, fetal alcohol syndrome, fragile X syndrome, dyslexia, Fahr syndrome, hyperlexia, leukodystrophy, multiple sclerosis and Triple X syndrome."
That's a lot to expect your medical doctor to do in a 15 minute examination. And if your symptoms aren't severe, it's unlikely you swill get a diagnosis in the first place.
So what can you do if you really do need a professional and comprehensive diagnosis as an adult with possible Asperger's Disorder (Asperger Syndrome)? Ask for a referral to a neurologist, or a psychologist. Counsellors cannot diagnosis Asperger's. Social Workers can not. Most psychologists do not have the training, experience or the tools to do the testing required. You need to find psychologist who has experience with Asperger's in children as well as adults. Here in BC ACT (Autism Community Training) could recommend someone with the experience and training (they have a list of approved MDs and psychologists). The psychologist looking into your possible "adult Asperger's Disorder" needs to be familiar with the most commonly used tools, the ADOS and ADI-R. The Ministry requires these tools, along with a psychoeducational assessment and functional behavioural assessment before approving an assessment of any child. If your going to a psychologist for an adult assessment of Asperger's, you really should see a practitioner who uses these instruments with children.
A comprehensive assessment of an adult for Asperger's takes two or three days of testing, totalling anywhere from 6-10hours, and can cost from $1,800-$2,600. This kind of assessment is not covered by MSP. Only occasionally will extended health care cover these costs. So it's really best to set up an initial appointment with a psychologist or neurologist and discuss the pro's and con's of undergoing an assessment for adult Asperger's.
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As a Registered Psychologist I provide diagnostic assessments for children, adolescents and adults for Asperger's Disorder, Autism Spectrum Disorder and related social-cognitive deficits. Please feel free to visit my web page: www.relatedminds.com or www.socialcognitivetherapy.com for more information.
This page is not meant to supply medical or psychological advice, or make any suggestions about diagnosis. If you have questions about disorders such as adult Asperger Syndrome or adult Asperger's Disorder, call and speak directly with a Registered Psychologist. The internet is not a good place for any medical or psychological advice!
Monday, December 26, 2011
Aspergers and Relationships: An Adult Love Story
Young adults with Asperger's or high functioning autism have very few resources here in BC. Autism funding is cut at age 19, and there are very few psychologists or other practitioners with experience with adults. In my own practice I see many of these young people as they try to navigate the new and complex set of relationships in college or work that are not as structured or supported as their high school experience may have been. Many young adults with high functioning autism or Asperger's disorder get into social trouble at work, refusing to sign a get well card, or making repeated social mistakes when others are trying to include them. Often the highly intelligent and skilled engineers or other professionals just can't navigate the twists and turns of "small talk." And relationships, which people with autism seek (in spite of what many think) are way beyond their reach without help. I use several books designed especially for young adults, as well as materials based upon the work of Michelle Garcia Winner, a leader in the filed of therapy with children and adolescents with Asperger's or high functioning autism. I also try to find good audio-visual resources, and the New York Times has just printed an excellent article on high functioning autism / Aspergers which contains a wonderful story about a couple and has some excellent and insightful video in it. I recommend it to teens, young adults with autism or Aspegers, and the parents, families, husbands and wires of those with high functioning autism or Aspergers. Here is the information and link:
Navigating Love and Autism
By AMY HARMON
Published: December 26, 2011
For Jack Robison and Kirsten Lindsmith, both of whom fall on the autism spectrum, being in a relationship together has created a unique set of comforts and challenges.
http://www.nytimes.com/2011/12/26/us/navigating-love-and-autism.html
Dr. Jim Roche
Offices in Vancouver and Burnaby
http://www.socialcognitivetherapy.com
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Key words
ADHD | ADHD coaching | workplace coaching | 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 | Psychoeducational Testing
http://www.relatedminds.com
http://Therapists.PsychologyToday.com/rms/70682
http://www.therapistlocator.net/member?183420
http://www.bcpsychologist.org/users/jimroche
http://www.actcommunity.net/jim-roche.html
http://www.counsellingbc.com/listings/JRoche.htm
Thursday, December 22, 2011
Autism Rates Increase...dramatically. Why?
According to the Centers for Disease Control (CDC), nearly one percent of U.S. children have some form of autism. This is 20 times higher than the rate of autism spectrum disorder found in the 1980s. In this NPR broadcast (link below) Alan Zarembo of The Los Angeles Times and clinical psychologist Catherine Lord discuss what’s behind the growing number of diagnoses. The explanations may not be as mysterious as some project.
Listen here: NPR
Tuesday, December 13, 2011
Aggression, Autism and Families
Dr. Jim Roche is a registered psychologist who provides diagnostic assessments for autism (ASD) and Asperger's Disorder as well as individual treatment and intervention for children, adolescents and adults with autism spectrum disorder in both his Vancouver and Burnaby BC offices.
More information on Dr. Roche's autism related services can be found at: http://www.relatedminds.com or at http://www.socialcognitivetherapy.com
A recent story in the LA Times about autism provides an excellent video about Jonah Funk, 13, who was diagnosed with autism nine years ago. His mother, Stacie, says she often describes herself as his eyes, his ears and his voice. "I want him to be treated fairly," she said. "I want him to receive the things he needs." The video is interesting in that it opens up this family's life from moment to moment, showing us both their successes as well as their ongoing problems. One of the issues that is evident in the video is Jonah's ongoing aggression. While appearing pretty mild, his parents are concerned about where this aggression will lead, as he disrupts the lives of his siblings and travel in the community becomes problematic.
What to do? Well, it's a good example of when professional help is necessary. A behavioural specialist is seen in the video, however this specialist isn't seen doing any real interventions. This is too bad, as it would be interesting to see what steps the intervention specialist, and Jonah's parents, are taking. From my perspective it's obviously well past time to conduct a functional behavioural analysis (FBA). This behavioural assessment will tell us what the function of the unwanted behaviour is, and we can then take two important steps towards dealing with it: 1) Teaching an appropriate alternative behaviour that meets the same function (know as a "FERB" or Functionally Equivalent Replacement Behaviour) and what environmental changes we need to make to reduce Jonah's need to engage in the behaviour.
Working with a highly trained behaviourist is important when trying to reduce these negative and sometimes aggressive behaviours. As a behavioural specialist in school districts for over the past 15 years I have relied upon one particular site for training materials: PENT California. The PENT site is a website provided for school based professionals working with all sorts of behavioural issues in the public schools. Their training materials are free, up to date and have withstood legal battles over the adequacy of an FBA.
Working with a highly trained behaviourist is important when trying to reduce these negative and sometimes aggressive behaviours. As a behavioural specialist in school districts for over the past 15 years I have relied upon one particular site for training materials: PENT California. The PENT Positive Environment Network of Trainers) site is a website provided for school based professionals working with all sorts of behavioural issues in the public schools. Their training materials are free, up to date and have withstood legal battles over the adequacy of an FBA. Completing a functional Analysis can be very difficult, and the individual completing it needs fairly advanced training and experience in behavioural theory. If you are having trouble with aggression, even minor aggression, I would talk with your school based team first. They may very well have someone who is an expert on these issues. The next level would be the school psychologist who may have expertise on autism and aggression. After that, here in BC you might ask for a consultation from POPARD, the Provincial Outreach Program for Autism and Related Disorders. POPARD's professionals often have extensive training and experience in dealing with this type of low level behavioural issue. Finally, there are outside behavioural interventionists (usually approved by ACT: Autism Community Training, as a Behaviour Interventionist or behavioural specialist. At any rate, address these issues quickly. and start by having an FBA completed. These days we usually don't just use the term FBA, but instead use the terms FBA and PBSP, meaning "Positive Behavioural Support Plan," as the emphasis, as you can see from my description above, is not on punishment or control, but instead on skills development and environmental support. Usually that's all we need to change these low level aggressive behaviours before they become problematic.
Click here to see the LA Times story: LATimes Video
More information on Dr. Roche's autism related services can be found at: http://www.relatedminds.com or at http://www.socialcognitivetherapy.com
A recent story in the LA Times about autism provides an excellent video about Jonah Funk, 13, who was diagnosed with autism nine years ago. His mother, Stacie, says she often describes herself as his eyes, his ears and his voice. "I want him to be treated fairly," she said. "I want him to receive the things he needs." The video is interesting in that it opens up this family's life from moment to moment, showing us both their successes as well as their ongoing problems. One of the issues that is evident in the video is Jonah's ongoing aggression. While appearing pretty mild, his parents are concerned about where this aggression will lead, as he disrupts the lives of his siblings and travel in the community becomes problematic.
What to do? Well, it's a good example of when professional help is necessary. A behavioural specialist is seen in the video, however this specialist isn't seen doing any real interventions. This is too bad, as it would be interesting to see what steps the intervention specialist, and Jonah's parents, are taking. From my perspective it's obviously well past time to conduct a functional behavioural analysis (FBA). This behavioural assessment will tell us what the function of the unwanted behaviour is, and we can then take two important steps towards dealing with it: 1) Teaching an appropriate alternative behaviour that meets the same function (know as a "FERB" or Functionally Equivalent Replacement Behaviour) and what environmental changes we need to make to reduce Jonah's need to engage in the behaviour.
Working with a highly trained behaviourist is important when trying to reduce these negative and sometimes aggressive behaviours. As a behavioural specialist in school districts for over the past 15 years I have relied upon one particular site for training materials: PENT California. The PENT site is a website provided for school based professionals working with all sorts of behavioural issues in the public schools. Their training materials are free, up to date and have withstood legal battles over the adequacy of an FBA.
Working with a highly trained behaviourist is important when trying to reduce these negative and sometimes aggressive behaviours. As a behavioural specialist in school districts for over the past 15 years I have relied upon one particular site for training materials: PENT California. The PENT Positive Environment Network of Trainers) site is a website provided for school based professionals working with all sorts of behavioural issues in the public schools. Their training materials are free, up to date and have withstood legal battles over the adequacy of an FBA. Completing a functional Analysis can be very difficult, and the individual completing it needs fairly advanced training and experience in behavioural theory. If you are having trouble with aggression, even minor aggression, I would talk with your school based team first. They may very well have someone who is an expert on these issues. The next level would be the school psychologist who may have expertise on autism and aggression. After that, here in BC you might ask for a consultation from POPARD, the Provincial Outreach Program for Autism and Related Disorders. POPARD's professionals often have extensive training and experience in dealing with this type of low level behavioural issue. Finally, there are outside behavioural interventionists (usually approved by ACT: Autism Community Training, as a Behaviour Interventionist or behavioural specialist. At any rate, address these issues quickly. and start by having an FBA completed. These days we usually don't just use the term FBA, but instead use the terms FBA and PBSP, meaning "Positive Behavioural Support Plan," as the emphasis, as you can see from my description above, is not on punishment or control, but instead on skills development and environmental support. Usually that's all we need to change these low level aggressive behaviours before they become problematic.
Click here to see the LA Times story: LATimes Video
Wednesday, November 30, 2011
Do you provide assessment and therapy for individuals with Autism | Asperger's Disorder?
Do you provide services for individuals with autism, ASD and Aspergers Disorder?
I have served as the director of autism programming for several school districts in California, and as a provincial consultant for autism and related disorders here in British Columbia. I have consulted throughout the province on autism and behaviour planning, from the lower mainland to Northern BC. I am a certified member of the Autism Commuity Training RASP list of behavioural intervention service providers. I provide comprehensive autism assessment, counselling and therapy services for individuals (children/adolescents/adults), couples and families in the Burnaby, Coquitlam, Port Moody and central Vancouver areas. Social Cognitive Therapy is available for children, adolescents and adults with ASD, autism, Asperger's Disorder, NVLD and related cognitive deficits.
For information on counselling and therapy services in Burnaby, Vancouver, Coquitlam and surrounding areas contact Dr. Roche at: (Office phone) 778.998.7975
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Sunday, November 27, 2011
Psychoeducational Assessment | Burnaby | Vancouver | New Westminster | Coquitlam
Psychoeducational Assessments
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 | Psychoeducational Assessment | Neuropsychological Assessment
http://www.relatedminds.com
http://Therapists.PsychologyToday.com/rms/70682
http://www.therapistlocator.net/member?183420
http://www.bcpsychologist.org/users/jimroche
http://www.actcommunity.net/jim-roche.html
I have just added a new pdf to my web page describing my psychoeducational services. Please click here: http://www.relatedminds.com/wp-content/uploads/2011/11/Psychoeducational-Assessment-Burnaby.pdf
Here is the text:
Testing | Psychoeducational Assessments | Neuropsychological Assessments
Psychoeducational Assessments for learning disabilities, school or testing accommodations and IEP support
Neuropsychologcal Assessments and Testing for forensic, legal and workplace purposes
Autism | Developmental Assessments for autism funding and treatment planning (ACT Approved provider)
Comprehensive ADHD (Attention Deficit Hyperactivity Disorder) Assessments and Diagnosis
Psychological, Educational (Psychoeducational), Neuropsychologcal, Developmental Assessments and Testing
Dr. Jim Roche brings his experience as a parent, psychologist, school psychologist, classroom teacher and provincial consultant and teacher trainer on child behaviour, classroom management to to each report, providing a unique and valuable perspective. He has worked with school districts for over 20 years providing assessments, training and consultation in British Columbia, California, New York and Europe. In addition to his training as a school psychologist and registered psychologist he has completed two years of post doctoral work in neuropsychology and training at the University of North Carolina with Dr. Mel Levine. (Minds of All Kinds)
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Psychological and psychoeducational educational assessments are available for children, adolescents and adults. These assessments may be completed to assist with diagnostic questions, help in developing learning, treatment and intervention plans for school, or may be part of a forensic (legal) examination which might be addressing issues such as your ability to work or return to work, drive a car or sign legal documents.
As part of a psychoeducational or clinical assessment I review records, complete a detailed history, administer appropriate test instruments, confer with other members of your health team and then write a comprehensive report focused on developing an appropriate treatment plan or sometimes answering specific questions your doctor or lawyer may have asked.
The base fee for an educational evaluation, usually aimed at obtaining specific accommodations in the educational setting, is $2,400.00 CND This covers the initial evaluation and a post-evaluation meeting to discuss the results with the student and family. A written report will be presented at that meeting and specific interventions are usually addressed at that time. Psychoeducational assessments are available in my Vancouver office (Vancouver, North Vancouver, West Vancouver and Richmond)as well as my Burnaby office (serving Burnaby, New Westminster, Coquitlam, Port Coquitlam, Port Moody and Maple Richmond).
For school purposes a shorter/brief psychoeducational screening can be performed, usually this takes four sessions. From this process we are able to write a letter and give specific rationales for requesting an appropriate evaluation be completed by the school. You should be aware, however, that school districts are taking excessive time in completing their assessments. We can discuss this alternative approach when you come in. I have provided psychoeducational assessments for many lower mainland districts including Burnaby, Vancouver, New Westminster, Coquitlam, Maple Ridge, Surrey, Langley, North Vancouver and West Vancouver. As a former classroom teacher, school psychologist and school behaviour management consultant I offer unique insight into how assessments and test results can be applied in the classroom by the teacher.
In addition to a psychoeducational evaluation being useful for accommodations, it is also often a key component used in developing a long term education plan (IEP or Individual Education Plan) for students. Many programs and supports require a psychoeducational assessment before a student can be considered for assistance. For adults an assessment may lead to a work plan as part of our return to work or coaching program. Attending an IEP meeting at the school or consultating with secondary institutions is done at an hourly rate of $175.00 plus travel and transportation expenses with a minimum of a 1/2 day billing.
Fee’s for a full Functional Behavioral Analysis are approximately $2,200.00 plus expenses related to meetings with the IEP committee or education hearing.
Frequently Asked Questions (FAQs)
Do you test adults?
Yes. Besides seeing children and adolescents for assessment of issues such as problems with academic classwork, on task behaviour, depression, anxiety or worries about a specific learning disabilities I also see adults. This may be for a psychoeducational assessment for college, or for other problems relating to your home or job. Adults are often seen for issues relating to diagnosis of depression, anxiety and often PTSD. Often family doctors want comprehensive assessments and a diagnosis to help made treatment and medication decisions. Sometimes these are work related assessments. I also complete ADHD/ADD assessments and help with follow-up monitoring when patients are receiving medications. Other more comprehensive assessments and testing are often completed relating to ICBC and other work or legal claims. You can read more about those specialized services elsewhere on this website. As with children, adults are seen in both my Vancouver and Burnaby office.
Do you work with college age students?
Yes. I work extensively with students at the post-secondary level. Often this includes psychoeducational testing, educating the student about their strengths and weaknesses, and then developing a plan to address the academic (and sometimes social) problems they are having. Often this includes monthly follow-up and coaching, either in the office or by phone. UBC students often see me in my Vancouver office for psychoeducational assessments and learning advice. SFU students are seen in my Burnaby office, near the SFU famous in Burnaby for psychoeducational assessments.
How long will the evaluation or psychoeducational testing take?
The typical evaluation takes approximately six to eight hours, usually scheduled over two days. Some students may require additional time to complete the testing to fit their work speed and need for breaks, or to gather additional test data to better understand their learning difficulties. Some materials are completed at home. Autism evaluations often require school and home observations as well.
What does the evaluation involve? The psychoeducational evaluation includes a clinical interview, a battery of educational, psychological and cognitive tests to assess a student’s intellectual ability, academic achievement in core areas, (i.e., reading, math, and written language), strengths and weaknesses in processing information, and their emotional state. Often there is also a neuropsychological procedure or examination that requires performing a number of specific tasks.
What happens after the evaluation?
After the psychoeducational evaluation is complete each student is scheduled for an individual feedback session with me (if appropriate). The session typically lasts from one to two hours. In this session I will review the test results, make recommendations for academic accommodations and other support services, and answer any questions. The parents or student may bring anyone to the session. All feedback sessions can be audio taped/recorded so that the student and family can take home a recording of the discussion to listen to again or share with others.
Following the feedback, where appropriate, the student will receive a written report that describes all the tests that were administered and the scores obtained. This report will also document the presence of any disability that warrants academic accommodation and list appropriate accommodations and other recommendations. This report will not be shared with anyone else without the student’s or parent’s written permission.
Team Psychoeducational/Neurodevelopmental Evaluations Most evaluations are completed by myself, a registered psychologist, however, in some situations testing instruments may be administered by one of my clinical assistants. Each of my assistants is either a licensed/registered psychologist or school psychologist who has experience in this field. When appropriate some components of an evaluation are also done by other practitioners where I would like input from a related field of practice. For instance, a speech pathologist may complete part of an examination, or an occupational therapist. The team will then have a consultative meeting, review their results and I will review all records, complete an appropriate history, confer with outside members of your health team and write a comprehensive report focused on developing an appropriate treatment intervention plan. What is a Functional Behavioural Analysis (FBA)?
A Functional Behaviour Analysis is an in-depth observation of a student’s behaviour in the school or home setting. This is a procedure often completed when there are complex questions about emotional or behavioural issues. These are often required by schools when students are classified with moderate or sever behavioural issues, a specific educational coding used by the Ministry of Education to determine placement and funding. They are often part of assessments for autism as well. Fee’s for a full Functional Behavioural Analysis are approximately $2,200.00 plus expenses related to travel, meetings with the IEP committee or attending educational hearings.
Can you do an assessment for autism (ASD)?
Assessments are available for diagnostic purposes relating to Autism, Asperger’s Disorder and related social cognitive deficits. (These assessments include using specific Ministry required tools: the ADOS and ADI-R) These evaluations involve several sessions and the addition of consultation with a speech pathologist and medical doctor for children under six in order to meet the stringent guidelines set forth by the Ministry. Usually the cost of these examinations is $2,600.00
What kind of payments do you accept?
Methods of payment include: Cash, check, or money order. Payments by credit card need to be made on-line and you can contact me directly about that. Payment is expected prior to the actual assessment. Because several hours are scheduled for the assessment, 48 hours notice are necessary if the assessment session is to be cancelled. A 50% per hour fee is charged for cancelled evaluation time when less than 48 hours notice is given. Do you accept insurance? I do not file for insurance payments, but I will provide you with the necessary documentation so that they may file with your insurance carrier after you have made full payment.
What about third party payments (e.g., Department of Rehabilitation Services, WorkSafe BC or Blue Cross)?
The client must supply the psychologist with an official letter (on letterhead), or a voucher from the third party, giving promise of payment and detailed payment information. In most situations payment is expected in full prior to any assessment.
How long does it take to get an appointment? It usually takes three to six weeks to arrange an appointment and begin the assessment process. However, please call, as cancellations can provide a opening sooner. (Dr. Jim Roche @ 778.998-7975).
More information on Dr. Roche and his services can be found below:
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Psychological services (including assessment, testing and therapy) provided in my offices include (covered by most extended health care insurance): ADHD (click here: http://www.relatedminds.com/adhd-attention-deficit-hyperactivity-disorder/)
Anxiety and Stress (click here: http://www.relatedminds.com/anxiety-stress/ )
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/)
Testing and Assessments and Learning Disabilities (Click here: http://www.relatedminds.com/testing/)
Couples Counselling / Therapy (click here: http://www.relatedminds.com/couples-therapy/)
Depression The Angry Child (click here: http://www.relatedminds.com/dealing-with-angry-aggressive-and-explosive-children/)
Anger Management (Click here: http://www.relatedminds.com/anger-management/)
Pain Management and PTSD (Click here: http://www.relatedminds.com/pain/ )
Forensic Services (Independent Medical Examinations or IME)
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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.
Neuropsychologcal Assessments and Testing for forensic, legal and workplace purposes
Autism | Developmental Assessments for autism funding and treatment planning (ACT Approved provider)
Comprehensive ADHD (Attention Deficit Hyperactivity Disorder) Assessments and Diagnosis
Psychological, Educational (Psychoeducational), Neuropsychologcal, Developmental Assessments and Testing
Dr. Jim Roche brings his experience as a parent, psychologist, school psychologist, classroom teacher and provincial consultant and teacher trainer on child behaviour, classroom management to to each report, providing a unique and valuable perspective. He has worked with school districts for over 20 years providing assessments, training and consultation in British Columbia, California, New York and Europe. In addition to his training as a school psychologist and registered psychologist he has completed two years of post doctoral work in neuropsychology and training at the University of North Carolina with Dr. Mel Levine. (Minds of All Kinds)
…………………………………….
Psychological and psychoeducational educational assessments are available for children, adolescents and adults. These assessments may be completed to assist with diagnostic questions, help in developing learning, treatment and intervention plans for school, or may be part of a forensic (legal) examination which might be addressing issues such as your ability to work or return to work, drive a car or sign legal documents.
As part of a psychoeducational or clinical assessment I review records, complete a detailed history, administer appropriate test instruments, confer with other members of your health team and then write a comprehensive report focused on developing an appropriate treatment plan or sometimes answering specific questions your doctor or lawyer may have asked.
The base fee for an educational evaluation, usually aimed at obtaining specific accommodations in the educational setting, is $2,400.00 CND This covers the initial evaluation and a post-evaluation meeting to discuss the results with the student and family. A written report will be presented at that meeting and specific interventions are usually addressed at that time. Psychoeducational assessments are available in my Vancouver office (Vancouver, North Vancouver, West Vancouver and Richmond)as well as my Burnaby office (serving Burnaby, New Westminster, Coquitlam, Port Coquitlam, Port Moody and Maple Richmond).
For school purposes a shorter/brief psychoeducational screening can be performed, usually this takes four sessions. From this process we are able to write a letter and give specific rationales for requesting an appropriate evaluation be completed by the school. You should be aware, however, that school districts are taking excessive time in completing their assessments. We can discuss this alternative approach when you come in. I have provided psychoeducational assessments for many lower mainland districts including Burnaby, Vancouver, New Westminster, Coquitlam, Maple Ridge, Surrey, Langley, North Vancouver and West Vancouver. As a former classroom teacher, school psychologist and school behaviour management consultant I offer unique insight into how assessments and test results can be applied in the classroom by the teacher.
In addition to a psychoeducational evaluation being useful for accommodations, it is also often a key component used in developing a long term education plan (IEP or Individual Education Plan) for students. Many programs and supports require a psychoeducational assessment before a student can be considered for assistance. For adults an assessment may lead to a work plan as part of our return to work or coaching program. Attending an IEP meeting at the school or consultating with secondary institutions is done at an hourly rate of $175.00 plus travel and transportation expenses with a minimum of a 1/2 day billing.
Fee’s for a full Functional Behavioral Analysis are approximately $2,200.00 plus expenses related to meetings with the IEP committee or education hearing.
Frequently Asked Questions (FAQs)
Do you test adults?
Yes. Besides seeing children and adolescents for assessment of issues such as problems with academic classwork, on task behaviour, depression, anxiety or worries about a specific learning disabilities I also see adults. This may be for a psychoeducational assessment for college, or for other problems relating to your home or job. Adults are often seen for issues relating to diagnosis of depression, anxiety and often PTSD. Often family doctors want comprehensive assessments and a diagnosis to help made treatment and medication decisions. Sometimes these are work related assessments. I also complete ADHD/ADD assessments and help with follow-up monitoring when patients are receiving medications. Other more comprehensive assessments and testing are often completed relating to ICBC and other work or legal claims. You can read more about those specialized services elsewhere on this website. As with children, adults are seen in both my Vancouver and Burnaby office.
Do you work with college age students?
Yes. I work extensively with students at the post-secondary level. Often this includes psychoeducational testing, educating the student about their strengths and weaknesses, and then developing a plan to address the academic (and sometimes social) problems they are having. Often this includes monthly follow-up and coaching, either in the office or by phone. UBC students often see me in my Vancouver office for psychoeducational assessments and learning advice. SFU students are seen in my Burnaby office, near the SFU famous in Burnaby for psychoeducational assessments.
How long will the evaluation or psychoeducational testing take?
The typical evaluation takes approximately six to eight hours, usually scheduled over two days. Some students may require additional time to complete the testing to fit their work speed and need for breaks, or to gather additional test data to better understand their learning difficulties. Some materials are completed at home. Autism evaluations often require school and home observations as well.
What does the evaluation involve? The psychoeducational evaluation includes a clinical interview, a battery of educational, psychological and cognitive tests to assess a student’s intellectual ability, academic achievement in core areas, (i.e., reading, math, and written language), strengths and weaknesses in processing information, and their emotional state. Often there is also a neuropsychological procedure or examination that requires performing a number of specific tasks.
What happens after the evaluation?
After the psychoeducational evaluation is complete each student is scheduled for an individual feedback session with me (if appropriate). The session typically lasts from one to two hours. In this session I will review the test results, make recommendations for academic accommodations and other support services, and answer any questions. The parents or student may bring anyone to the session. All feedback sessions can be audio taped/recorded so that the student and family can take home a recording of the discussion to listen to again or share with others.
Following the feedback, where appropriate, the student will receive a written report that describes all the tests that were administered and the scores obtained. This report will also document the presence of any disability that warrants academic accommodation and list appropriate accommodations and other recommendations. This report will not be shared with anyone else without the student’s or parent’s written permission.
Team Psychoeducational/Neurodevelopmental Evaluations Most evaluations are completed by myself, a registered psychologist, however, in some situations testing instruments may be administered by one of my clinical assistants. Each of my assistants is either a licensed/registered psychologist or school psychologist who has experience in this field. When appropriate some components of an evaluation are also done by other practitioners where I would like input from a related field of practice. For instance, a speech pathologist may complete part of an examination, or an occupational therapist. The team will then have a consultative meeting, review their results and I will review all records, complete an appropriate history, confer with outside members of your health team and write a comprehensive report focused on developing an appropriate treatment intervention plan. What is a Functional Behavioural Analysis (FBA)?
A Functional Behaviour Analysis is an in-depth observation of a student’s behaviour in the school or home setting. This is a procedure often completed when there are complex questions about emotional or behavioural issues. These are often required by schools when students are classified with moderate or sever behavioural issues, a specific educational coding used by the Ministry of Education to determine placement and funding. They are often part of assessments for autism as well. Fee’s for a full Functional Behavioural Analysis are approximately $2,200.00 plus expenses related to travel, meetings with the IEP committee or attending educational hearings.
Can you do an assessment for autism (ASD)?
Assessments are available for diagnostic purposes relating to Autism, Asperger’s Disorder and related social cognitive deficits. (These assessments include using specific Ministry required tools: the ADOS and ADI-R) These evaluations involve several sessions and the addition of consultation with a speech pathologist and medical doctor for children under six in order to meet the stringent guidelines set forth by the Ministry. Usually the cost of these examinations is $2,600.00
What kind of payments do you accept?
Methods of payment include: Cash, check, or money order. Payments by credit card need to be made on-line and you can contact me directly about that. Payment is expected prior to the actual assessment. Because several hours are scheduled for the assessment, 48 hours notice are necessary if the assessment session is to be cancelled. A 50% per hour fee is charged for cancelled evaluation time when less than 48 hours notice is given. Do you accept insurance? I do not file for insurance payments, but I will provide you with the necessary documentation so that they may file with your insurance carrier after you have made full payment.
What about third party payments (e.g., Department of Rehabilitation Services, WorkSafe BC or Blue Cross)?
The client must supply the psychologist with an official letter (on letterhead), or a voucher from the third party, giving promise of payment and detailed payment information. In most situations payment is expected in full prior to any assessment.
How long does it take to get an appointment? It usually takes three to six weeks to arrange an appointment and begin the assessment process. However, please call, as cancellations can provide a opening sooner. (Dr. Jim Roche @ 778.998-7975).
More information on Dr. Roche and his services can be found below:
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Psychological services (including assessment, testing and therapy) provided in my offices include (covered by most extended health care insurance): ADHD (click here: http://www.relatedminds.com/adhd-attention-deficit-hyperactivity-disorder/)
Anxiety and Stress (click here: http://www.relatedminds.com/anxiety-stress/ )
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/)
Testing and Assessments and Learning Disabilities (Click here: http://www.relatedminds.com/testing/)
Couples Counselling / Therapy (click here: http://www.relatedminds.com/couples-therapy/)
Depression The Angry Child (click here: http://www.relatedminds.com/dealing-with-angry-aggressive-and-explosive-children/)
Anger Management (Click here: http://www.relatedminds.com/anger-management/)
Pain Management and PTSD (Click here: http://www.relatedminds.com/pain/ )
Forensic Services (Independent Medical Examinations or IME)
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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 | Psychoeducational Assessment | Neuropsychological Assessment
http://www.relatedminds.com
http://Therapists.PsychologyToday.com/rms/70682
http://www.therapistlocator.net/member?183420
http://www.bcpsychologist.org/users/jimroche
http://www.actcommunity.net/jim-roche.html
Friday, September 23, 2011
HuffPost Get's OCD Story Headline Wrong - As Usual
The Huffington Post get's another story 100% wrong and proves why they (and many other newspapers) are not to be trusted when it comes to science reporting of any kind. Reporting on a recent research paper on the use of Cognitive Behavioural Therapy with OCD with children they head their article, "
Talk Therapy Shows Results For Kids With OCD." Well there is a big difference between the "talk therapy" many parents send their kids to and Cognitive Behavioural Therapy, which this research addressed.
They write, " A new study shows using talk therapy in conjunction with medication can produce better results for treating obsessive-compulsive disorder in children." Simple talk therapy doesn't involve the necessary components of "argumentation," "teaching logical thinking" and "behavioural-exposure-homework" which are the critical elements of Cognitive Behavioural Therapy (CBT) that make it work with OCD. And often kids end up with therapists who have no experience with either CBT or OCD, wasting time and money.
"OCD (Obsessive Compulsive Disorder) can affect up to 1 in 50 kids and teens, according to background research from the study. The anxiety disorder often causes children to become preoccupied with whether something is harmful or dangerous, or with thoughts that something bad may happen. Rituals, or compulsions, are adopted to try to ward these "bad things" off."
Dr. Judith Beck, President of the Beck Institute for Cognitive Behavior Therapy, says, "Cognitive behavioral therapy (CBT) is a time-limited form of psychotherapy used to treat mental disorders...In the context of solving your current problems, you learn skills, such as how to correct your unrealistic or unhelpful thinking and how to modify your behavior to reach your goals."
That's not what usually goes on with a therapist in simple "talk therapy." All therapy is not the same. Now for many issues different forms of therapy have been found effective, often as effective as CBT. But not in this case (with OCD) and not in this research. The research was specific. It's like saying, "Pills found to cure headaches!." While pills? How many? How effective?
Another 2007 study drew similar conclusions about the benefit of CBT for adults with OCD. "Specifically, the data showed that patients receiving any form of Cognitive Behavioral Therapy (CBT) had significantly fewer obsessive-compulsive symptoms post-treatment than subjects receiving treatment as usual." (Reuters)
To sum up, it's CBT in this research. Other forms of therapy may help with other issues, but the research on OCD (Obsessive Compulsive Disorder) is specifically about CBT, and most likely it works because of components of CBT not found in many other forms of therapy.
Headlines matter, because many people only remember the headlines, and others filter everything they read through the headline. This same research was written up in a number of medical journals and webpages, they all noted it was "Behavior Therapy," that was used. As the past 50 years or more of psychology has been a battle between conventional "talk therapy" like analysis ,"Rogerian Counselling, non-directive counselling" and the new "behaviour therapies" it's amazing that a newspaper would headline an article and use the term "talk therapy" - usually meant to describe analysis, Rogerian and other forms of non-directive talk therapy rather than the correct term used in the medical journals, "Behavior Theray" or, in this case, Cognitive Behavioural Therapy." The wrong headline leads parents to seeking the wrong therapy.
For more information about the services I provide my web page can be found at www.relatedminds.com, http://www.relatedminds.com/depression. Other information on my practice can be found at: http://Therapists.Psychologytoday.com/70682, http://www.bcpsychologist.org/users/jimroche, and http://psyris.com/drjimroche
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