Autism Spectrum Disorder and Psychoeducational Assessments

I have been asked by several parents about the difference between a psychoeducational assessment and an assessment for autism spectrum disorder (ASD) or Aspeger's Disorder. There is some confusion out there, and several parents have arranged for the wrong kind of assessment in order to obtain the services they need. So I'll try to explain when you need each of these types of assessments: Psychological Assessment, Psychoeducational Assessment and Autism Disorder Assessment very briefly.

An Initial Psychological Assessment
In British Columbia parents are often sent to a registered psychologist by their school or physician when autism is suspected. Initially you should be arranging an appointment to have the psychologist meet you and your child and do a brief psychological assessment. This usually can be done in one session. You may be asked to complete a number of forms, such as the SNAP-4, some behavioural forms, and maybe an adaptive behavioural assessment form (ABAS).  These can sometimes be sent to you before the examination and returned so that the psychologist is ready to meet you. The psychologist will interview you, observe your child and take a comprehensive history. Form this a determination can usually be made about what is the best way to proceed. Often what looks like autism spectrum disorder or Asperger's can be something else, such as ADHD or a developmental disorder. Perhaps anxiety, or a specific learning disability. The psychologist can then help you proceed down the correct path.

A Diagnostic Assessment for Autism
If autism is suspect, or Aspegers Disorder, your psychologist will then proceed to complete a comprehensive assessment for autism spectrum disorder. This includes two critical examinations that are necessary for funding in British Columbia. These are the Autism Diagnositic Rating Scale (ADOS) and the Autism Diagnostic Interview (ADI-R).  There are a number of other autism tests and tools out there, but these are the two that are necessary for funding from the ministry in British Columbia, and for services through any school district. If your child goes to public school in Burnaby, Vancouver, New Westminsiter, Coquitlam...anywhere in the province, the psychologist who completes the assessment must be trained in using these tools and use them for the diagnosis. Nothing else will do. Sometimes parents go to a professional who uses other tools and completes this assessment in another way. If they do the assessment will not qualify, so make sure you see someone who uses these tools for the autism assessment.  These are not the only tools he or she might use, but these are essential. For children under six years old a separate assessment by a speech pathologist and medical doctor need to be part of the process as well. If a full psychoeducational assessment is not being done, usually some sort of intelligence/cognitive testing is necessary to rule out other possible disorders.

The Psychoeducational Assessment
Along with the autism assessment most schools require a comprehensive psychoeducational assessment. This assessment looks at bith intelligence and academic ability. Children from age 3 up can be given a psychoeducational assessment, although in British Columbia schools seem unwilling to assess younger children due to financial constraints. It is best practice and done throughout most of North America, but not common here. The two components of the assessment, the intelligence and academic parts, are then compared and from that information we can make determinations about specific learning disabilities. Most children with ASD have a comorbid learning disorder. Nearly 50% of children with ADHD have a comorbid learning disorder. And without understanding the cognitive strengths and weaknesses of a child it is difficult to develop an Individualized Education Plan.

These are the three main types of assessments children and adolescents go through in order to develop an educational and behavioural plan. You often hear of a neuropsychological exam as well. These are highly specific examinations of brain processes that help with both diagnostic questions and developing education plans. Most of the time a good psychoeducational assessment and autism assessment (if necessary) are enough to move forward with.

Costs? Full psychoeducational exams can cost from $2,200-$3,600 depending on who you see and what tests are completed. Your school can and should be providing this exam for free, however here in BC there are very long waiting lists. An Autism Assessment runs around the same, but the two can often be done together. Again, the Provincial government can provide these services, for free, however there is again a waiting list, and some parents prefer to have an autonomous outside professional see their child rather than the ministry.

I hope this information is valuable. My best advice is to make sure the professional you see is a registered psychologist, that they have experience with children or adolescents, and have experience working with the schools. Understanding the system is as important as understanding the tests.

For information on services that I provide please visit my web page at: www.relatedminds.com
I provide autism and Aspergers assessments not only for children and adolescents, but for adults as well.

Help! My kid with ADHD needs academic coaching!

If your child needs academic coaching, here is something I would give a try. This is a very exciting program that is currently used in many schools and it switches study time. Kid's basically complete their assignments at home by watching video instructions and then do their "homework" in the classroom. Teacher time is switched from being spent giving general one-size-fits-all lectures to 100% individualized instruction and tutoring. And this program is great because it's FREE. So useful for children having difficulty at school, those with ASD (Autism Spectrum Disorder), Aspergers of ADHD (Attention Deficit Hyperactivity Disorder). First, check out this video of the Khan Academy: http://www.khanacademy.org/ and then think about how you want to do this. There are several choices:

1. Approach you child's classroom teacher, and show them the web page and ask if there is any way he/she or anyone in the school might be interested in setting up a tutorial program using the system. This system allows the coach to follow student's progress effortlessly. It provides easy charts of what the student is having an easy time with, and what the student is having difficulty with. How much time they spend on each problem, watching the videos and so on. And it AUTOMATICALLY guides the student from one exercise to another WHEN they are ready, based upon testing. Automatically! so what's the teacher/coach for? To help the student with those areas they need help with ...and to provide feedback for those areas they are doing well in (although the system already rewards students automatically with buttons, badges and points!). So there is little time spent on this.

2. If your child's teacher isn't interested, contact the Parent-Teacher group at your school and get a few parents to watch the video and scan the pages of the web site with you. A team can do what an individual will have difficulty with. THEN approach the school administration about setting up a program.

3. No one interested? Go to MeetUp.com and set up a group of other interested parents. Together you may be able to find volunteers to do the coaching, maybe a college student, student teacher, one or more of the parents or maybe as a group you can afford to hire someone to do it.

4. If you are in the lower mainland and would like my participation, email me or call. I'm eager to support a group that can develop a low cost...if not free, tutorial service for children and focus on academic success.

Good luck! Watch the video, do some of the exercises and watch a few videos. You will be amazed!

Dr. Jim Roche
drjroche@gmail.com

Teaching Empathy, an overview.

I am often asked about teaching empathy in the schools. How? Well I suggest different programs depending upon the situation. One is a component of the Anger Replacement Training program from research press, another are materials from Michelle Garcia Winner focused on "social behaviour mapping." There are several, and I'd be more than happy to recommend specific programs for specific schools. But recently I came across this great article from The New York Times that discusses one private school in New York and how they approached it. And the reaction as well! Not everyone likes being taught "empathy" because they don't like being told what to think. But if your teaching it right your not teaching what to think. Programs like Anger Replacement Training instead put an emphasis on the skill of seeing things from the other person's perspective. This is done through exercises and experience. This article is a great overview. Take a look.

Gossip Girls and Boys Get Lessons in Empathy
By WINNIE HU
Published: April 5, 2009
Privileged teenagers at one middle school are learning to empathize this year, whether they like it or not.


http://www.nytimes.com/2009/04/05/education/05empathy.html

Bringing Science Back to America.

A great article from the LA Times can he found here.

Chris Mooney, author of the 2005 bestseller "The Republican War on Science," and his coauthor Sheril Kirshenbaum, a marine scientist at Duke University, seek to explain how Americans have come to minimize science in a time when, they assert, we will need it most -- as global warming, advances in genetics and the possibility of large-scale engineering of the Earth's climate loom in our future.

Pointing to what they see as a deep-seated streak of anti-intellectualism in this country, the authors write: "Americans built the bomb, reached the moon, decoded the genome, and created the Internet. And yet today this country is also home to a populace that, to an alarming extent, ignores scientific advances or outright rejects scientific principles."

This deep seated anti-intellectualism is very obvious in the pseudo-science we read in the area of autism, where the arguments of a "mom" is held to be equal to those of a research doctor with twenty years of experience. Further, we tend to sprinkle on a goof dose of paranoia and conspiracy theory to top things off. This is a good read for anyone interested in the social-political-cultural aspects of this ongoing debate.

The Problems of "Alternative Medicine."

I sent my daughter a great cartoon the other day. An ambulance was at the scene of an accident, and on it's side it read "Alternative Medical Services." The ambulance attendant was kneeling by an accident victim yelling "clear!" She has two acupuncture needles in her hands. Not the kinds of services that I would hope for. Yet not one block away from my home in Vancouver there is a "holistic medicine" practice. They advertise they provide treatment for ADHD, autism and Asperger's. They provide a long list of their services from blood cleaning to auditory "realignment." None of these are supported by scientific evidence, and many have been clearly proven to be ineffective. Yet families go to these clinics and spend all of their government funding looking for cures and hope. The lack of regulation disappoints me. And watching families waste all their funds on unproven, or worse, disproven therapies is disheartening.

In my assessment reports I have begun to list web sites and resources that I hope guide people to scientifically proven interventions. But we need more of these, and professional organizations like the BC Colleges of Medicine, Psychology and Nursing need to take a firmer stand on the promotion of unproven or disproven treatments.

For ADHD one good source is Dr. Russell Barkley.

Dr. Barkley has written about the various treatments that do not have a sound scientific basis for use in ADHD or that have been disproven in research. These include diet or nutrition treatments or diet supplements for ADHD, health food or homeopathy, sensory integration therapy (usually provided under occupational therapy or physical therapy), chiropractic treatment, EEG biofeedback, neurofeedback, or neurotherapy, cognitive or cognitive-behavioral training, or alternative treatments. One of his recent research reviews on EEG and its use in biofeedback appears on his site. I urge all parents to read it.

Dr. Barkley

Two other good sites are Quack Watch and Science Based Medicine. Check them out for good information on ADHD, Autism and Alternative MEdicine you should avoid. There are also resources listed on my web site, RelatedMinds.