Meet our new provider Megan Benham

It’s been nearly a year since I moved into the new and larger office. Many people have asked about what I’m going to do with all the space upstairs and next door since it’s just me afterall. I’m thrilled to share that the practice is growing into a team of providers that bring a greater breadth of skills and specialities to better serve our community.

I’d like you to meet our first new provider, Megan Benham. Megan and I started working together while I was on my post-doctoral fellowship, and I am so happy to welcome her into our practice as a new provider offering therapy, assessments, consulting, and working with new patient intakes.

Megan is accepting new therapy clients through Presence Development Services (I’ll share more on this soon) and you can contact her at megan@bryanharrisonphd.com.

Megan works from the building we lovingly refer to as the “side office,” the stand-alone building next to the main office. She’s mixed our style with her own pops of personality (and board games!) to create a welcoming space for patients and their families.

So, in her own words, meet Megan.

I am an advanced doctoral student pursuing my Doctorate of Psychology (Psy.D.), and I am so excited to have the opportunity to become a part of Dr. Bryan Harrison's practice.

I moved to Rochester in 2007 to attend St. John Fisher College for undergraduate and quickly fell in love with Rochester. In 2011, I began my doctoral program at the University of Hartford.

After living in Connecticut while completing my coursework and beginning my clinical training, I moved back to Rochester and happened to link up with someone at Mt. Hope Family Center who put me in touch with Dr. Christie Petrenko at the Univeristy of Rochester. Dr. Petrenko took me on as a graduate student, and for the last five years I have been working with her on various projects for individuals with fetal alcohol spectrum disorder (FASD) and their families.

Through Dr. Petrenko’s research projects, I provided direct support to children and adolescents with FASD through a skills group for children and the FASD Family Night Program. I have also spent a lot of time working with the caregivers of individuals with FASD as part of the Families Moving Forward Program; those caregivers own a special piece of my heart. Raising and loving an individual with a developmental disability is a very unique (and sometimes overwhelming) experience, but also such a rewarding one. Working directly with those caregivers has been one of the best parts of my training.

In addition to gaining clinical skills in individual and group therapy, I gained assessment skills in the FASD Diagnostic and Evaluation Clinic run by Dr. Petrenko. I seized the opportunity to administer various educational and neurodevelopmental assessments and learned the process of recognizing and diagnosing children and adolescents with FASD. At the University of Rochester, I also worked within the Department of Developmental and Behavioral Pediatrics (DBP) - that was led by Bryan's long-time mentor Dr. Tristram Smith - doing assessments for adolescents with autism.

During my time at Mt. Hope Family Center, I also assisted with Project STRONGER doing trauma-focused work with children, adolescents, and families. I provided both individual and family interventions with a trauma-informed lens with a focus on parent-child relationships. Working with family systems is very important to me, as I think that understanding the family as a whole allows me to better support each individual. Over the years, I have also spent time advocating and consulting with different schools in the area. I really enjoy collaborating with school teams to help them better understand and support individuals with diverse neurodevelopmental differences.

This fall (2019) I ran a group for adolescent boys with refugee status here in the United States. I was truly inspired by the resilience and joy I witnessed during my time with them. I enjoy group work with adolescents and I even spent a short time working on a project whose intervention included providing group yoga sessions as part of a social skills group. This meant I actually had to do the yoga with them, as part of their therapy, which the teens found hiliarious given my natural clumsiness and inflexibility.

I first met Bryan when he was completing his postd-octoral fellowship at DBP (which was super reassuring to witness someone that close to being finished with grad school!) and I was training within DBP's Behavioral Intervention for Families (BIFF) program with Dr. Laura Silverman. Bryan and I would eventually go on to do some more work together with assessments once his post-doc wrapped up as he began working in private practice.

And a little about me personally: I grew up in the Adirondacks and love spending time in the mountains visiting family and taking in the fresh air. Sitting by the water is my happy place; I am thrilled that my office is right on the Erie Canal with an excellent view! In my free time (which is currently pretty limited while I work on my dissertation), I like to read, spend time outside, and watch The Golden Girls. Once I finish my dissertation, I promise I will take up some more interesting hobbies!

I am so excited to be welcomed into Dr. Bryan Harrison's practice and am looking forward to working with individuals with developmental disabilities and their families. I am excited to begin using my beautiful new therapy chair, too. - Thank you, Bryan!

Losing an autism diagnosis

As a licensed clinical psychologist, I am an active member of the American Psychological Association. Every month I receive a copy of their publication/magazine, Monitor on Psychology. The magazine covers a variety of current topics in psychology, and I enjoy learning about developments in other areas of the field. In April 2019, Monitor on Psychology published an article titled, Losing an autism diagnosis. After reflecting on this article and thinking about what I think it missed, I wrote a response and my remarks were published in the the June issue.

Here is the original response that I emailed to the Monitor on April 10:

I am an APA member and avid reader of the Monitor. My primary specialty as a clinical psychologist focuses on the treatment and assessment of individuals with autism across the lifespan. Two points I would like to make regarding the News Feature on "Losing an Autism Diagnosis" (April 2019).

1. I believe that there is a substantial lack of training in the assessment of individuals with autism, particularly as they age into puberty and adulthood. I think that the lack of oversight at a broader health care level explains some of the variations in having and then later losing an autism spectrum diagnosis. I would refer readers to the work of Cathy Lord's clinical research for a better understanding of the evidence base and training for autism assessment.

2. The consequences of losing an autism diagnosis in adolescence or adulthood can be quite dire and drastic in terms of service eligibility and access. State offices for people with disabilities often require further substantiation of an autism diagnosis later in childhood, and a person losing their autism diagnosis can quite literally "flip the table" on what services a person and their family can access. I think there needs to be more cross-talk between health care and government systems to understand the consequences of losing an autism diagnosis.

I felt like the article failed to touch on how losing an autism diagnosis can adversely impact service eligibility and access. Moreover, it did not speak to disability identity in adults. I also think this piece missed an opportunity to speak more directly to how variations in provider training and experience can impact the reliability and validity of a diagnostic evaluation.

I am grateful to be able to voice this concern to a larger audience and hope that these reflections inform how professionals approach the process of evaluating patients for autism.

Remembering my Mentor

Tris Smith was the greatest combination of intelligence and kindness I have ever known.

The distinction is one he won in my heart without my knowing and secured in my mind as he mentored me toward my dissertation. He listened to my cynicism and endured my self-doubt, giving me hope and confidence at a time when I lacked it and sorely needed it.

Today marks 1 year since his passing.

Much has been written and said about Tris’ contributions to the field of psychology and his care for those in it – both patients and providers – so I will not belabor a point better made by others.

Tris examined the impact of early intensive behavioral intervention for young children with autism spectrum disorder. This work began about 15 years ago and a follow-up study recently looked at how these children are now faring as adolescents and adults.

The clinical research Tris led lives and breathes still. 

Participants who were once children in these studies are now adolescents and adults, and I have had the fortune of knowing a few of these people as patients. I know that much of their progress is due to their own hard work and that of their families’, but I often think of Tris and his belief in scientific progress when I meet with them. I see the impact of his work every day.

During my training, Tris gave me the opportunity to work on a clinical study that focused on helping parents and caregivers learn strategies to support their young children with autism. This experience has shaped how I work with families and led me to adopt an approach that generally insists on getting to know parents as well as their children as part of helping the family as a whole.

Tris gave so much that it’s hard to imagine anyone filling the space his absence leaves. On learning of his passing last year, I shared a few words with others. I share them again here:

It is beyond my ability to summarize his intellectual contribution to the field of autism research. He studied under Ivar Lovaas as part of the initial group of researchers at UCLA who used the scientific method and randomized clinical trials to quite literally prove that therapy could help improve the lives of children with autism. He expanded on this research at the University of Rochester Medical Center and showed further how parents could learn strategies to improve the behavior of their children with autism in home and community settings. His more recent research reached directly into school districts and minority communities.

His contributions to the field of autism research are innumerable and incalculable. The work he led and supported will ripple out for many years after his passing. Tris was on my dissertation committee and the person I most credit with my being able to defend my dissertation. He was a consummate mentor. He was a mensch and will remain a saint to those who knew him well.

Visible Voices Vote

My Better Half shared this article with me on November 6, 2018 (Election Day), and I want to pass it along to others while trying to touch on some of the issues and resources in this article.

I really appreciate the idea and process of supporting all persons with making informed choices and to do so in a way that respects their autonomy as humans and their rights as citizens.

The idea of a social story and anticipatory guidance feels so smart and kind for most adults who are voting for the first time. I think many young adults could benefit from this resource and, as such, I consider it a gift from this mother to have created it for her son and share it.

As I read and re-read the resources in this article, I delved deeper into the Bazelon Center site.

It’s eye-opening and mind-blowing how variable and fraught with ambiguity the law seems to be on the matter of whether individuals with disabilities and mental health concerns can vote. It reminds me, in many ways, of the bar we set before people wishing to become a US citizen.

More specifically, my work often involves talking with families about the topic of guardianship for their children as they transition from adolescence to adulthood. This article gave me cause for pause and added to my understanding about how guardianship determinations could impact a person’s ability to vote later in life or in another state if they so choose to move.

In closing, I would like to encourage folks to share this Know Your Rights resource on voting.

Autism Evaluation Process

April is National Autism Awareness Month, so I wanted to post about topics that relate to the autism aspects of my professional training and practice. One piece that is often not discussed is what actually goes into an autism diagnostic evaluation - for patient and practitioner alike.

I take the process of conducting an autism diagnostic evaluation very seriously. I try to give as much of myself as I can intellectually and emotionally in order to provide patients and families with guidance. My goal is to offer an evaluation that is compassionate, informative, and useful.

These are the measures I routinely use as part of an autism diagnostic evaluation:

• Autism Diagnostic Observation Schedule - Second Edition (ADOS-2) - clinician-administered
• Social Communication Questionnaire (SCQ) - caregiver report
• Social Responsiveness Scale - Second Edition (SRS-2) - caregiver & self-report
• Detailed Developmental History - caregiver report
• Chart Review - pediatric medical records and educational services & assessment history

As outlined above, the diagnostic evaluation is not just me and the patient taking a prescribed set of tests. It is often what I learn in the life narrative that gives me the confidence to proceed with a clear diagnosis and treatment plan. In order to get this information and an accurate health history, I need to talk to caregivers and review pediatric records. This is true for my adult patients seeking a diagnosis as well. While it may seem like a long time ago, childhood behaviors as reported by caregivers give me a fuller picture of the patient's life. 

Beyond the ADOS, I provide anxiety, ADHD, and mood screening Instruments when applicable. An evaluation is so much more than a "Yes" or "No" stamp for a single diagnosis, as it represents a person and a plan to improve their lives based on the challenges they have had and face today.

The inspiration for my wanting to be Ever Better at conducting autism diagnostic evaluations comes from the families I've met along the way. Those who've talked with me about what went well and what they wished could've been different on the day they learned the diagnosis.

I've also found new inspiration and room for growth in working with adults who are seeking a diagnosis later in life. The feelings and dynamics of obtaining a first diagnosis as an adult are something I am learning to navigate with my clients, and I am honored to learn with them.

I am starting to get into a rhythm with scheduling diagnostic evaluations, and I hope to keep receiving referrals for individuals across the lifespan who wonder if they're on the spectrum. In private practice, I am afforded more flexibility in scheduling and administering tests. What this has meant is that patients can get an appointment more quickly and often during "outside of typical office hours" so they can get the answers and help they are seeking more smoothly. 

This April, I'm providing autism diagnostic evaluations on Saturday mornings. So far, I have enjoyed serving new patients in a timely manner - it is very fulfilling for me to get a call from a new referral and be able to serve them within a week or two of their inquiry. Providing answers and helping families better understand their loved ones is one of the most satisfying parts of my work, and I am grateful for the opportunity to serve patients and families in this way.