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.

More Do Less, Well

The March 2017 edition of the Monitor on Psychology included an article on how "...how smartphones are affecting our health and well-being..." I thought this piece dovetailed nicely with my recent post on Doing Less, Well and wanted to share it with you here in hopes of generating future discussion around this topic. I hope you find it useful and interesting to read.

The key points of the article that jumped out to me (as illustrated ecard):

Smart devices can wreak havoc on sleep routines and rhythms.

My recommendation: Initialize parental controls or Do Not Disturb at a specific time.

FOMO is real. 

My recommendation: Keep your account, but delete the Facebook app from your phone. Try it. I did and I've been mobile-Facebook-free for two months. It has really changed my perspective.

How we use social media (actively vs. passively) impacts how it affects us personally.

My recommendation: Limit your scrolling and commit to initiating conversations with others.

and one BONUS RECOMMENDATION:

Call someone instead of texting them. I'll bet you enjoy it and wish you had done it more often.

A habit I started over the last few weeks (and miss when I don't do it) is calling my mother on the way home from work. It reminds me of when I was in high school, and we could give each other a hard time every morning on the car ride to school and still say "I love you" at the end of the conversation.

I always feel more connected after hearing her voice.

Picking through Dinner

Last week I posted on how to make change incrementally. After I wrote this, I got thinking about a concrete way to demonstrate these principles. An example we can all relate to and even start practicing in our own lives. I had to think no further than dinnertime. Every. Evening.

My 3-year-old adorable son has a way of eating at a pace that is uniquely his (and not the rest of his family's). God bless him for marching to the beat of his own drum, but sometimes, child, I just wish he could take an ounce of our Type A and get the eating done on Harrison time.

Needless to say, it can be a struggle to get him to eat a decent amount. Setting a goal of "finishing your plate" has rarely, if ever, ended well. Then, predictably, right before bed we hear the plaintiff plea, "I'm hungry." Here are the steps our household is taking to deal with it: 

• Control portion size. We dish out much less than we want him to eat. It makes the goal of finishing more attainable, and we can praise the heck out of him for it like he's just "walked on the water."  We reinforce asking for healthy food if he wants more dinner.
   
• Adjust expectations. We're all done eating, and he still has half of his mini-portion left. Instead of telling him to eat or threatening to remove a reward, we'll pull out 2 bites that I really want him to eat, usually a meat or veggie piece. I clear the rest of his plate. Once he finishes those two bites, he is finished at the table (sans treat if we had to negotiate).
   
• Offer a reward & make it contingent. If he finishes his plate, he gets something he wants to eat right then and there. One he can pick for himself. We have a perpetual candy bowl in the house that started with Halloween and will transfer like miscellaneous sugar tumbleweeds into an Easter basket soon enough. All of the candy is individual bite-sized servings so they're not inhaling a ton of it. ALSO: He only gets to pick out a piece of candy after he has eaten his meal to our general satisfaction; there is no foraging later or earlier in the day for candy until he has eaten the meal we reasonably provided.
   
• Offer alternatives. But only if it's already an option (side dish) associated with the dinner you prepared. This is hard for my Better Half. She seriously thinks he will starve to death if he doesn't eat one meal. If he cries at the sight of chili and short-cons us into offering chicken fingers, we're effectively reinforcing crying to get the food you want. I fully recognize that this example is not that simple in a lot of situations, but I do think there's a lot of value in making sure whatever options you intend to offer are already available.

One way to re-route this process is to have your "what they ingest" priorities straight out of the gate and have your "check-downs" at the ready before you engage them. If the meal is chili with crackers and cheese, have it all laid out on the table and lead with a small portion of chili, reminder of eating this portion, then incrementally dole out the crackers with cheese once you have some positive momentum on the chili side of the dinner. Then, only the candy bowl after the small-sized serving of chili and the crackers and cheese are finished. Yes, I really do put this much thought into this, but I only do it because, more often than not, it works well for us.

Here's a simple dinner contingency map for those visual learners out there.

New Year, New Health Insurance Plans

It seems like none of us are immune to the ever-changing landscape of healthcare insurance. Like many others, my family and I are going through new plans, rules, and deductibles effective with the New Year. I think these insurance changes can be confusing and overwhelming.

I wanted to use this transition to the New Year as an opportunity to highlight the healthcare coverage options available to my clients.

• I accept health insurance, health savings account (HSA), and fee for service clients.
• I am an approved provider with:
  • Excellus Blue Cross Blue Shield
  • Aetna
  • Other insurance companies (as an out of network provider)

If your insurance provider is not listed, you may be able to pay for fee for service with a pre-tax healthcare savings vehicle, such as a Flexible Spending Account or HSA. Consult with your employer or health insurance company to learn more. 

Last year, I worked with several clients to maintain their level of care while effectively navigating the health insurance landscape. This included seeking out pre-authorizations or offering more tailored, focused sessions prior to families having met their annual deductibles.

My mission has and will remain the same as stated on the homepage of this website: 

“I will work with you to improve your quality of life”

Being on both sides of the health insurance system as a provider and a patient, I understand how challenging it can be to read the tea-leaves of ever-evolving health insurance coverage.

At the beginning of a New Year, I don't want client progress hindered or halted because of insurance changes. So let's work together in 2017 to focus on quality of life through behavioral change rather than getting bogged down in details while perseverating on the fine print.

Baby Wearing

Staying at home with kids when they're little is a crash course on multi-tasking. It took me a while to get the hang of it, but baby wearing is totally where it's at when they're so little.

1. Sling - This one is my personal favorite because it was so simple to use even I figured it out. Some of my favorite baby memories and pictures involved wearing the sling while our little one was passed out in the nook of it. I also liked that this sling din't take up much space and fit in almost any diaper bag we brought.

2. Baby Bjorn - I liked this for longer walks once the kids gained more neck and trunk strength. Facing them outward was fun for outings and festivals, facing them inwards was great when I really needed them to chill and/or fall asleep. Using this took a bit more style and finesse than the sling.

3. Moby Wrap - My Better Half bought one of these, and I never figured out how to use it. It required more hand-eye coordination than I will ever acquire, but she always made it look easy.