Areas covered today1. Background information2. Issues for adults suspected of having HFA/AS3. Diagnostic processes4. Clinical experience5. Literature, information, support & resources for professionals6. Post diagnosis support
Autistic disorder or autism Pervasive developmental disorder characterised by impairment in: Social skills Communication skills Or by the presence of stereotyped behaviour and interests Delay/abnormality before age of 3 in at least one of: social interaction, language, symbolic/imaginative play High functioning autism (HFA) simply means “autism with an IQ 70 or above”
Asperger’s disorder(or Asperger syndrome)Essentially the same as autism but: no clinically significant impairment in langauage no clinically significant delay in cognitive development or age-appropriate adaptive behaviour
Autism Spectrum DisorderResearch indicates that after the age of 3, when IQ isaccounted for, there is no difference between peoplewith autistic disorder (autism) & Asperger syndrome2008 - NZ Autism Spectrum Disorder Guideline2013 - DSM-V will use ASD only
Basic facts NZ Autism Spectrum Disorder Guideline suggests that over 40,000 people in NZ have ASD, & most are undiagnosed adults More males than females (but this seems to be changing) Probably genetic Not related to MMR vaccine Cannot be “cured”
Issues for adults ASD is a lifelong condition, not only a disorder of childhood Pervasive - effects all aspects of life Often undiagnosed Diagnostic overshadowing (ADHD, depression) Misdiagnosed (atpical schizophrenia, personality disorder)
Impact varies time/situation Relationships (friends, partners, children, colleagues) Education (academic, organisational & physical demands) Work (unemployment, under-employment, income) Emotional well-being (self-esteem, depression, anxiety, abuse) Health (attention to needs, sensory sensitivity, epilepsy) Rights & responsibilities (citizenship, participation, legal issues)
Being undiagnosed meansFeeling different (“wrong planet”) or crazyBeing misunderstood, & often blamed unfairlyAlmost constant anxietyIsolation
Being diagnosed meansUnderstanding of self & by othersFinding a peer groupLearning how to manage impact of symptomsGetting the right helpRelief to some, shock to others“Congratulations It’s Asperger Syndrome” Jen Birch2003 www.aspergers.co.nz"Beyond diagnosis: Welcome to the autism spectrum"ASK Trust 2011 www.asknz.net
But ... Few formal or funded pathways for diagnosis exist for adults without an intellectual disability or not “in trouble” Mental health services lack relevant experience & training Private practitioners lack skills &/or confidence The experience of adults seeking diagnosis is too often one of being fobbed off, referred on, or poorly served
Reason for today’spresentationHelp you increase your skillsIncrease your confidenceIncrease the number of psychologists willing/able toconduct these assessmentsImprove life experiences of adults with HFA/ASPlease put your name and contact details on the list!
Diagnostic assessmentSee NZ ASD Guideline & www.asdguideline.comMultidisciplinary gold standard, but sole practitionerpossible (supervision & peer support essential)MethodicalMatch complexity of assessment to reason for referral: Curiosity vs. Trouble Legal vs. Clinical Referrer / payee
Assessment componentsDetailed health, developmental & behavioural historyPattern of skills, disabilities & behavioursComprehensive file review (transitions, peer relations)Medical evaluation (health sometimes neglected)Direct evaluation (interview &/or observation)IQ & other cognitive sills (not all geniuses)Adaptive functioning (Vineland ABS-2 has ASD norms)Mental health (multiple diagnoses, disagreement)
Assessment components (ctd)Neurological assessment (epilepsy)Communication & audiology (hearing, body language)Sensory, motor & perceptual (sensitivity)VisionOccupational & physical therapySocial competenceFamily resources & needsConsideration of co-morbid & co-existing conditions
What do I do?Minimum: interview the person, observe how theyrespond in meet/greet & interview, administer screensor self-report testsMedium: as above, plus interview significant others &review historical documentsComprehensive: as above, try to cover or have coveredall apects on previous slides, & use “gold standard”tests like the Autism Diagnostic Interview - Revised
Gold standard testsAutism Diagnostic Interview - Revised - trainers inAustralia, one NZ workshopAutism Diagnostic Observation Schedule - as aboveDISCO - often used in other countries - no training hasoccurred in NZNZ ASD Guideline updates: www.asdguideline.com
Differential diagnosis More obvious symptoms: Obsessive interests (find out in advance, time them) Communication skills (reciprocal conversations) Social skills (meet & greet observation, small talk) Unique and deep topics of conversation But similar/same symptoms occur in many other disorders (OCD, social phobia, psychoses, ADHD)
Differential diagnosis (ctd) Look for what was/is missing (a.k.a. behavioural deficits): Joint attention, sharing interests & pleasure Responding to social cues Giving (and needing) comfort Recognising emotions in self and others Subtle emotions (rather than extremes) If these present in early childhood, ASD more likely
Clinical cases Brian, 30s - engineer, married, some relationship issues, son recently diagnosed with ASD, recognition of symptoms in Brian’s behaviour - ASD confirmed Sally, 40s: long mental health history, multiple diagnoses, professional disagreements, interventions had little of no effect, repeated offending despite more serious consequences - ASD confirmed (e.g. the line)
Clinical cases (ctd) Albert, 70s: retired farmer, adult children, wife saw article on ASD on “Sunday”, suspect ASD is reason for marital problems - ASD excluded George, late 20s: charged with very serious offence against a person, referral “role of ASD in offence?”, long history of antisocial and criminal behaviour, historically autism diagnosed after 1 hour consultation, - ASD not confirmed
Key autism journals Autism Autism Research Focus on Autism and Other Developmental Disabilities Research in Autism Spectrum Disorders Journal of Autism and Developmental Disorders
Other helpful journals Mental Retardation and Developmental Disabilities Research Reviews Journal of Intellectual and Developmental Disability Journal of Intellectual Disability Research Journal of Applied Research in Intellectual Disabilities
Information, support &resources for professionals Altogether Autism www.altogetherautism.org.nz National contract for ASD information provision Expert searching of Internet (17/8/11: 81,400,000 Google hits for autism &14,100,000 for Asperger) Tailor made information packages (including reading lists, recommended texts) Access to clinical consultant & team of ASD experts ASD Provider Database (please put names on list) Circulates information on training
Information, support &resources for professionals Ministry of Health sponsored website on ASD recognition & referral www.asdguideline.com Research Autism - website aimed at anyone people with ASD, parents & carers, service providers and policy makers. Big, up-to-date, & scientifically reliable www.researchautism.net Autism New Zealand bookshop and library www.autismnz.org.nz Werry Centre training, ADI-R & ADOS workshops
Post diagnosis support Learn about ASD & how it affects the individual & family Hard copy information Information on ASD (books and first person accounts, reputable websites, You Tube, science & facts) Networking with other people with ASD (national and international websites, ASD organisations) Contact Altogether Autism for an information pack
Thank you & questionsTanya BreenConsultant Clinical Psychologisttanya@tanyabreen.co.nzClinical Consultant, Altogether Autismtanyabreen@altogetherautism.org.nzPlease put your name on the list!
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