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.

Brain based education: Fad or breakthrough?

Brain this, brain that. This brain, that brain, everyone has a brain based program to offer your children. I was just in chapters and there was en entire table about "changing your brain." Most of it, by the way, is baloney. (Here is Harriet Hall's comments: click here) Arrowsmith School has an entire curriculum based on "brain training" but the truth is that most of this brain based training isn't going to make much difference.

Here is what all these programs are based upon: plasticity. Brain plasticity. That means we believe that by engaging in certain actions/behaviours the brain itself changes (or to be mysterious and flaky, as Dr. Aiken says, the Brain Changes itself!!!!). We really didn't believe this 20 years ago. We thought the brain grew to a certain point, a process called "pruning" took place during which we actually lost unused brain cells and neurons making the brain more efficient, and that was it. If you damaged a part of your brain, that was it. The brain, unlike the rest of the body, didn't really change or grow or heal to any great extent.

Then in the Northeast US several psychiatrists thought this might not be true and began what was called "psychiatric rehabilitation." I was (a small) part of this early research. We took what were called "back ward" patients, patients who sometimes had been sitting on the floor in the back ward of the psychiatric hospital for 10 or more years, doing little, and we brought them into the lab and put them in front of the computer and engaged them in games very similar to those your kids play now and very similar to the tasks that schools like Arrow Smith use. Watching the Arrowsmith video they look amazingly the same! And what happened? Well we compared them on many behaviour scales to patients who did not recieve the training and they became vastly better. Some talked for the first time in years, began attending groups and were actually discharged.

Amazing! These computer brain games cured these patients of many mental illnesses..... they went from sitting all day in the corner of the psych ward to walking around the grounds, meeting other people and talking and going on home visits. Wow! Brain games. A few years later were were actually able to measure increase blood flow in the brain and growth of NEW NEUROS and CONNECTIONS!

Not so fast.

There were other differences between these successful patients and the ones who remained on the psychward in the corner or on the floor. Those patients received very little staff interaction, most were spoken to 2-5 times a day by staff. They just sat, and sat, and little changed. Little tried to make them change. The "brain game" patients were moved off the ward twice a day to the treatment center, talked to, encourage, reinforced (with points traded for candy and smokes) for participating and engaging in the tasks. There really was more going on than just these brain games.

So the question was: Did the "Brain Games" change the patients, or was it the different treatment, the positive attitudes of staff, the encouragement and reinforcement for engaging in behaviours we wanted to see more of ...and measuring? The new, positive and reinforcing environment? I vote for the encouragement, reinforcement and support rather than the games.

That is basically what the skeptics say about all these brain games. Recently there was a CBC documentary on Arrowsmith, and Linda Siegel, a UBC education professor specializing in learning disabilities was interviewed for that special. During the interview questioned the effectiveness of the Arrowsmith program. She noted a lot of things, like the $24,000 a year tuition! Siegle say it was her belief...well lets just copy what is printed on Canada.com "I think the Arrowsmith program is a fraud. I think they're taking money from people and not showing any improvement in any kind of objective way..." Well a libel lawyer from Arrowsmith got an order to remove the comments about "fraud" or face legal action. And I would agree, fraud is a very strong term, and I think the people at Arrowsmith believe in what they are doing, and are sincere and positive, supportive and...well most likely great teachers. But in the end Siegel is the only real critic of the program, and she was silenced by legal threats.

The problem is, as with the "plasticity" research from the 80's, it's true that the brain can be changed through behaviour and exercises. The repetitive exercises (the "Brain Camp") that Arrowsmith uses haven't, as far as I know, been shown to improve anyone's behaviour in and of themselves. I'd vote for the reinforcing environment, friendly teachers, the new and structured environment....but these particular exercises? Not too sure. One thing we do know is that these types of repeated exercises don;t really make generalizable changes in people's behaviours, or their brains. THINKING isn't developed out of discrete repeatable computer exercises. And this goes for Arrowsmith, Brain Balance ....all of these computerized programs.

There is one computerized program that has actually shown to make actual differences in a skill that matters, and thats increasing the ability of individuals to use what we call "working memory." Working memory might best be described as your ability to hold information in your head and use it, work on it, change it, and remember it. Pearson Publishing uses a computer based program to help develop "working memory" that they have found to be effective (click here to read research on the program). One of the differences between Cogmed, Pearson Publishing and all these books on "fixing your brain" and these Brain Balance, Brain Gym and Brain Training programs is that Cogmed doesn't rely on parent statements to prove the effectiveness of their program. They don't publish pages of parent testimonials, and they don't make any claims other than those they have been able to prove. And that means they are really clear about the severe limits of their computerized "brain training" program: It has been found to help with working memory. Nothing more. It doesn't fix reading, spelling, science, music ability, art ability ...... or make your kid a novelist. it can help, in most cases, with deficits of working memory. But with poor working memory, your going to have problems with almost everything.

As a parent you need to figure this stuff out, but your resources should not be limited to poorly constructed research and never should it rely upon the testimonials of other parents. That, I can say, should always be a red flag. As usual, I suggest you ask your doctor. Or maybe give Dr. Siegel at UBC a call ....unless there's a court order forbidding her to give her opinion.

We are still at the very early stages of using these techniques. Read an article here (click here) about the assessment of another similar software program used with kids with ADHD. Finally, here's a nice video about Brain Based Education:

If your having trouble click here.






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The ADHD blog is not offered as medical advice or as a means of diagnosing or treating ADHD or any other disorder. My recommendations: Don't go on-line and take an ADHD "test." The diagnosis of ADHD is complex and involves not just looking for symptoms of ADHD, which is all that those “tests” do, but also involves ruling out other disorders that might look just like ADHD. Often individuals who think they have ADHD have other disorders, and may have co-morbid disorders such as depression, anxiety or OCD. A simple check off sheet of “symptoms” doesn’t differentiate these. So avoid these on-line "tests" which are nothing more than a collection of symptoms. You need to see a licensed or registered professional for a real diagnosis. Medical doctors can diagnose ADHD, but the diagnosis is complex and often they will make a referral to a Registered Psychologist for a full understanding of a patient’s symptoms. You can obtain a referral for a psychologist with expertise in ADHD from the British Columbia Psychological Association (BCPA).

In my practice I offer Attention Deficit Hyperactivity Disorder (ADHD) assessment and treatment services for individuals, couples, families, children and adolescents in the Burnaby, Vancouver, Coquitlam, Port Moody, New Westminster and Maple Ridge areas of the lower mainland. This includes neuro-developmental assessments, psycho-education, cognitive rehabilitation for problems with memory and concentration and cognitive behaviour therapy. I also provide diagnostic assessments for autism and Asperger's Disorder in my Burnaby office.

My web page lists a number of resources you can make use of yourself in dealing with Attention Deficit Hyperactivity Disorder (ADHD). Please visit it at www.adhdhelp.ca or one of my other sites at either Psychology Today, AAMFT, PSYRIS or my professional site. Please feel free to call if you have questions about ADHD or other cognitive issues.


Dr. Jim Roche
Registered Psychologist, British Columbia 01610
778.998-7975
www.relatedminds.com
www.adhdhelp.ca

Groups Assail Vision Therapy as Remedy for Learning Disabilities - from MedPage Today

Click here to go to the original article and an excellent video: Medical News: Groups Assail Vision Therapy as Remedy for Learning Disabilities - in Pediatrics, General Pediatrics from MedPage Today

SAN FRANCISCO, July 27 -- Behavioral vision therapy, eye exercises, and colored lenses have no role in treatment of dyslexia and other learning disabilities, according to the American Academy of Pediatrics.

The academy came down hard on these "scientifically unsupported" alternative treatments in a joint statement with the American Academy of Ophthalmology and other vision organizations.

Because learning disabilities are difficult to treat and have long-term consequences for education and socioeconomic achievement, unproven therapies have become highly visible, Sheryl Handler, MD, of the AAO, and colleagues wrote in the August issue of Pediatrics.

"Ineffective, controversial methods of treatment such as vision therapy may give parents and teachers a false sense of security that a child's learning difficulties are being addressed, may waste family and/or school resources, and may delay proper instruction or remediation," they cautioned.

Co-author Walter M. Fierson, MD, chair of the pediatricians' learning disabilities subcommittee on ophthalmology, argued that the very lack of supporting evidence for these popular alternative treatments carries weight. Action Points
Explain to interested patients that learning disabilities are typically caused by abnormalities in the brain processing of letters and sounds rather than by vision problems.


Note that the statement recommended physicians dispel myths about unproven treatments for learning disabilities when referring patients for further evaluation or support services.
"They've been around for decades and the opportunity to prove them has been around for a similarly long period of time," he said. "That they are unproven after all this time gives rise to very serious doubt about their validity."

Dyslexia -- which accounts for 80% of learning disabilities -- should not be classed with secondary problems such as visual disorders, mental retardation, or poor instruction, Dr. Handler's group noted.

Rather, it usually stems from altered brain function in the processing of the sound structure of language, which is why systematic phonetics instruction intervention often works.

Although visual processing in the brain has long been speculated as a cause of dyslexia, they said, "We now know these theories to be untrue."

Visual difficulties related to dyslexia, such as faulty directionality and abnormal saccadic eye movements, are symptoms rather than causes, they emphasized.

Only a small subset of dyslexic patients are affected by problems in the magnocellular visual system -- which is responsive to quick movement and moving objects -- that may blur visual acuity when reading.

Studies have yielded conflicting support for this cause. "At the present, there is insufficient evidence to base any treatment on this possible deficit," the statement concluded.

Likewise, "there is inadequate scientific evidence to support the view that subtle eye or visual problems, including abnormal focusing, jerky eye movements, misaligned or crossed eyes, binocular dysfunction, visual-motor dysfunction, visual perceptual difficulties, or hypothetical difficulties with laterality or 'trouble crossing the midline' of the visual field, cause learning disabilities," the statement emphasized.

The joint statement called the literature supporting vision therapy a collection of poorly validated research that relies on anecdote and poorly designed and controlled studies. Any benefits, it said, reflect the placebo effect or the traditional educational remediation with which the therapies are combined.

Overall, visual function and ocular health are the same for children with dyslexia and related learning disabilities as in other children. Notably, children with dyslexia often enjoy playing videogames that make the same intensive demands on the eye.

Physicians and ophthalmologists have a role in periodic vision screenings in this population, as with all children. But they play a more important role in providing further evaluation and support for parents -- and dispelling myths, Dr. Handler's group said.

"This should include discussion regarding the lack of efficacy of vision therapy and other 'alternative treatments' with the parents," they wrote. "Parents need to be informed that dyslexia is a complex disorder and that there are no quick cures."

"Remediation programs through the child's school or local specialists should include specific instruction in decoding, fluency training, vocabulary, and comprehension, they recommended.Children with reading disabilities need to practice reading aloud to a parent or tutor each day. Classroom accommodations might include extra time for or shortened assignments, a separate, quiet room for taking tests, provision of lecture notes, and tutoring. Diagnosing and treating any specific vision problems will make reading more comfortable, but parents can't expect it to improve decoding or understanding of reading, the writing committee noted."

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This blog is not offered as medical advice or as a means of diagnosing or treating ADHD or any other disorder. Don't go on line and take an ADHD "test." The diagnosis is complex, and it involves not just looking for symptoms of ADHD, but also ruling out other disorders that might look just like ADHD. So avoid these on line "tests" which are nothing more than a collection of symptoms. You need to see a licensed or registered professional for that. Medical doctors can diagnose ADHD, but the diagnosis is complex and often they will make a referral to a Registered Psychologist. You can obtain a referral from the British Columbia Psychological Association for a psychologist near you.

My web page lists a number of resources you can make use of yourself in dealing with Attention Deficit Hyperactivity Disorder (ADHD). Please visit it at www.adhdhelp.ca or one of my other sites at either Psychology Today, AAMFT, PSYRIS or my professional site.

Attention Deficit Hyperactivity Disorder (ADHD) assessment and treatment services are offered for individuals, couples, families, children and adolescents in the Burnaby, Vancouver, Coquitlam, Port Moody, New Westminster and Maple Ridge areas of the lower mainland. This includes neuro-developmental assessments, psycho-education and cognitive behaviour therapy. I also provide diagnostic assessments for autism and Asperger's Disorder in my Burnaby office.

Dr. Jim Roche
Registered Psychologist, British Columbia 01610
778.998-7975
www.relatedminds.com