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.

SPECT Scans – A New Phrenology? The Pro's and Con's of the Amen Clinic

OMG! Another report came in today from The Amen Clinic. The parent shared it with me, and then told me how neuro-therapy and cranial something or other were suggested, along with a long list of suppliments, oils, and other "natural" medications (whatever that meant). I have learned from experience that this is a topic that is difficult to explain, and that there is really little hope of getting a parent to look at the assumptions they are making and give modern, scientific based interventions and mainstream medication another chance. But I'm going to at least give it one more try. First: READ THIS ARTICLE! Read it with a pen, marker, underliner...whatever you need to really understand it!

SPECT Scans at the Amen Clinic – A New Phrenology?

And then this:

http://www.quackwatch.com/06ResearchProjects/amen.html


This article points out, "Phrenology was a 19th century pseudoscience that claimed to associate brain areas with specific personality traits. It was based on palpating bumps on the skull and was totally bogus. New brain imaging procedures are giving us real insights into brain function in health and disease. They are still blunt instruments, and it is easy and tempting to over-interpret what we are seeing. In his book The New Phrenology William Uttal warns that “the excitement of these new research tools can lead to a neuroreductionist wild goose chase” and that we must be careful not to succumb to new versions of the old phrenology."

The Amen Clinics offer SPECT (single photon emission computed tomography) scans to help diagnose and manage conditions such as attention deficit disorders (ADD), mood disorders, anxiety and panic disorders, autistic spectrum disorders, obsessive compulsive disorder (OCD), substance abuse, toxic exposure, brain trauma, memory problems, temper problems, and relationship and marital struggles. The scans generate colored pictures of the brain that show “areas of your brain that work well, areas that work too hard (not sure how that is determined, I don't even know what it means!) and areas that do not work enough.” And then the goal of this treatment he proposes, often involving medications, suppliments, diet and so on, is to balance the brain..or balance the brain's function. Again, no real research to tell you exactly what that means.

The charge is $3250 up front, and most insurance companies will not provide reimbursement because they consider it experimental. There is a 10% discount for testing additional family members...yes there is a family plan for PET Scans at the clinic! And as the writer of the article points out: "The Amen Clinic’s informed consent form is misleading: it does not divulge that the American Psychiatric Association has spoken out against SPECT scanning for these purposes and has warned of potential harm – especially to children, who are more susceptible to the effects of radiation." Yep, the APA says they don't work for the purposes they are being used, AND that they are dangerous, especially for children. You'd think that would be in the informed consent, wouldn't you? But desperate parents and individuals will try anything.
As the writers tell us, "There is no excuse for misrepresenting an unproven treatment as a treatment that has been proven effective. And there is no excuse for concealing essential information from patients, or for creating false hopes by implying a promise of more than they can really deliver."

Testimonials. The Amen Clinic site is full of them, and as you know I feel they are the worse information you can provide, the are misleading, misleading and very misleading. The article also talks a great deal about the treatment provided. I urge you to read it, take it to your medical doctor and get some professional advice before making any investment of this kind of money. See your doctor, and make an informed choice....informed by a professional who understands the complexity of these issues.

Here is my suggestion. Go ahead, read the Amen Clinic brochure. Then read this article (the link is found above), and if you want, go to the Quackwatch website and read BOTH the articles that support the procedure and clinic and those that don't, then take a few more minutes to read this article about ADHD diagnosis in the New York Times. It's an interesting controversy I've recently written about. Here the link: http://www.nytimes.com/2011/05/14/health/14consumer.html

When you are done, and it should take you less than 30 minutes total, you will know more about ADHD than most of your friends, relatives and maybe even some of the professionals you've seen. Take these articles to your medical doctor or psychologist and have a frank, informed and complete discussion about ADHD and how you should approach it. Know is good, science is great ....but NEVER rely on testimonials. My final word. Good luck! Like Dr. Amen says, there are ways to make your brain better functioning ....give it better information!


.................................
As always, I remind you that this blog is not meant to be a diagnostic tool, these disorders are complex. Don't take on line tests and diagnose yourself. Contact your medical doctor, see what he or she can do for you. If need be, contact a Registered Psychologist, one with experience with ADHD, and get a real diagnosis and help in making treatment choices.


For information on treatment services I provide for children, click here: http://web.me.com/jimroche/relatedminds/child_therapy.html

For information on diagnostic and treatment services for children with ADHD, click here:http://web.me.com/jimroche/relatedminds/adhd.html

For information on diagnostic and treatment services for adults, click here: http://web.me.com/jimroche/relatedminds/adult_adhd.html

You can also just check out my regular web page at www.adhdhelp.ca or www.relatedminds.com

Self-help readings on ADHD, Try these:
Dr. Barkley's "Taking Charge of your ADHD"
Kathleen Nadeau's Understanding Girls with AD/HD
Mary Solantos' Cognitive Behaviour Therapy for Adult ADHD

These are a great place to start!

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

(1/2) Do Vaccines Cause Autism? Correlation vs. Causation

This is a great, and funny little video about the mistakes people make with data:



If you haven't been paying attention, preventable diseases in children are popping up all over due to people avoiding childhood vaccines because of misinformation and conspiracy theory thinking they find on the web. Again, I urge you to read information from reliable sources such as www.science-basedmedicine.com and ask your medical doctor.

for information on treatment of ADHD (Attention Deficit Hyperactivity Disorder), autism, Asperger's Disorder and learning disabilities you can look at my web site at www.relatedminds.com or my Psychology Today website.

About Assessments for ADHD, Autism and Learning Disabilities

A lot of people call my office and have been told by a day care provider or teacher that they are sure their child has autism, Asperger's Disorder or ADHD. And often this is based on some list of symptoms that they read on the internet. Parents often then scramble and start looking themselves. Even adults do this, I get a fair number of adults who have wondered about possibly having autism after someone mentioned it to them and they began a web search.

Autism, ADHD, Asperger's disorder are not an easy diagnosis to make. And one of the important things that takes place when assessing a child, adolescent of adult for autism spectrum disorder (ASD) is what we call a "differential diagnosis." The symptoms you may be concerned about may or may not be ASD. They could be another problem such as a language disorder, auditory processing disorder, a learning disability, some form of speech disorder, mental retardation, ADHD (both often confused with ASD), a movement disorder, OCD. The list goes on.

Additionally the disorder may be more than one thing. ASD is often found to be c-omorbid with another disorder such as ADHD. ADHD itself is not an easy disorder to diagnose. The Centre for ADHD/ADD Advocacy, Canada (CADDAC) has set standards for a full differential diagnosis of ADHD and it includes an extensive amount of data collection and takes a considerable amount of time. Another source of information on diagnosis ADHD is from Dr. Russell Barkley. His procedures are very similar to CADDAC and are the procedures I follow in my practice. As I mention below for autism diagnoses, you usually have one chance at an assessment and it should include all of the tests below except the ADOS and ADI-R. You need to know if there is a co-morbit learning disorder, and you need to understand exactly how ADHD is expressing itself in your child. While a neuropsychological examination is not necessary for a diagnosis, it is necessary if you want to know what to do about it. A very simple computer based test a medical doctor could offer you for a child 8 years old or over is the CNS-Vital Signs assessment which tells us about memory, ability to switch sets, executive functioning, processing speed and other critical bits of data we need to develop a treatment plan. Many of my patients are referred by medical doctors because they do not have the time or specific skills to make a firm diagnosis.

Here in British Columbia a full diagnostic autism assessment is usually completed by a provincial agency. This might take place at Children's Hospital or through a provincial health authority provider. You start this process with a referral from your medical provider. The Ministry for Children and Families has information about the assessment process on their web site. Those services should be free to anyone here in British Columbia. However, there is a long waiting list for these services. Private practitioners, including medical doctors and psychologists, who have had specialized training in the two instruments I'll talk about below, can also provide this service, however either you or your extended health care (if your lucky enough to have it) has to cover this cost. It's usually about $1,800 -$2,100. And for children under 6 an assessment needs to be completed by a team of professionals, hard to arrange through a private practitioner and even more expensive.

What does the assessment consist of? First, for most children and adolescents there is an initial interview history taking. Then, usually, a psycho-educational assessment is completed. This includes an intelligence (cognitive) test and an academic performance test. Usually these scores are compared to look for discrepancies that would lead us to finding a specific learning disability. If your child get X score on this part of the intelligence test, we would expect he or she would score Y on this part of the academic test. This testing also helps rule out mental retardation or other cognitive impairments. If you are going the private practitioner route, you might be lucky enough to have the school complete the psycho-educational assessment, cutting back your costs.

Next your child is usually examined for behavioural and personality issues. This might take place through interviews, pencil and paper tests or self reports like the Beck Youth Scales and reports from parents and teachers. The examiner wants to rule out personality disorders, psychosis, depression, anxiety and similar issues that can often be mistaken for ASD.

There might now be some specialized test that the examiner would use to look at an issue he or she is concerned with. And some examiners will do more complete neuropsychological tests to give us information on problems that might relate to executive function, memory and learning, impulse control, motor and visual-motor issues. This is especially important for children with co-morbid ADHD or for whom we find ADHD is the primary concern. This information helps us come up with focused treatment interventions.

Finally, for children we are still concerned about ASD with the provincial government here in British Columbia requires two specific tests: The Autism Diagnostic Observation System (ADOS) and the Autism Diagnostic Interview (ADI-R). There are several other very good and reliable tests that focus on autism, however the ministry will only accept a report containing these two specific tests.

The ADOS is a series of activities and questions the examiner goes through with the child, giving him or her an opportunity to see how the child responds to new stimuli. The ADI-R is a lengthy report completed during an interview with the parents or other caregivers about the child's developmental history focused on symptoms found in ASD.

Some practitioners complete shorter reports using just the ADOS and ADI-R. This might be quicker but leaves us with doubts about other possible reasons for the behaviours of concern (not a real "differential" diagnosis) and provides little information we would be able to use to provide targeted interventions / treatment. And honestly, it's very difficult to obtain a second assessment to obtain this kind of essential information as there is a long waiting list of children and adolescents for initial evaluations.

To find a practitioner who can help you with an assessment I would start with my medical doctor, who may have a doctor of clinical psychology he or she knows and referrals to, or contact the British Columbia Psychological Association for a referral. You must, however, see a licensed or registered psychologist for these types of diagnostic services. Registered Clinical Counsellors (RCC) are not qualified to provide these services and often parents pay for assessments that are then not accepted by school districts or the ministry. School psychologists can only perform these tasks as part of their employment in the school district and are not qualified to do these types of assessments independently. (However, an RCC or school psychologist may ALSO be a licensed or registered psychologist, so ask,) Finally, before paying someone to complete any assessment, ask the agency you plan to use the assessment with (ministry or school) if this provider is qualified to provide such information to them.

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.