Monterey Bay Forum

When parents of young children have a concern about their child’s development they often go first to their pediatrician.

Parent concerns might include: “Our child does not turn his head when I call him.” or “ Our child does not make much eye contact or smile.” “He does not play with toys like other children.”

If the pediatrician thinks that more assessment is needed, when MD’s refer out they often refer to to other physicians at large hospitals — such as Stanford Hospital (LPCH), Children’s Health Council and U.C. San Francisco. Physicians know other physicians and often do not know local resources, e.g., licensed psychologists trained in psychological assessment.

When parents are referred to large hospital complexes such as Stanford Hospital, Kaiser Permanente and U.C. San Francisco, parents can help get the best possible assessment by finding out ahead of time:

Will their child’s pediatrician MD automatically send along the child’s medical records as part of the referral process? If not, then the parent needs to request a complete set of medical records and bring the medical records to the appointment.

Who knows the child best besides the parent? Does the child go to a nursery school or day care? Is the child taken care of by a grandparent or neighbor?

Write down the name, address, telephone number and e-mail address for all persons who know your child best. Let those people know that the child will be assessed and that someone from that institution may call to gather information. Bring the list of people who know your child best to the appointment.

Can the parent take a video of the behaviors that concern them? For example, does the child insist on lining up all his toys? Does the child have a melt-down whenever the normal routine changes? If possible, get out your ‘smart phone’ or camera and take a video of those behaviors. Bring the video with you to show whoever does the assessment.

Call ahead of time to the institution where the assessment will be done and find out (and write it down) exactly who will do the assessment? Will it be a team assessment of various areas of functioning or will the assessment be done by only one specialist?

Know that it is Best Practice in the assessment of young children to examine several areas of functioning (e.g., speech, non-verbal communication, gross and fine motor) and that the assessment be done by appropriate specialists.

Depending on the concerns, some times one person doing the assessment is sufficient and sometimes not.

Know that it is Best Practice that records and information be obtained from various sources (MD, school, day care provider, parent, grandparent) over a period of time.

It is often the case that young children do not perform as they typically do when driven several hours to an appointment and then required to do certain activities with persons they do not know.

Summary: Parents can greatly assist in the accurate assessment of young children with possible developmental delays by 1) gathering all medical records and bringing them to the appointment; 2)making a list of all persons who know your child best including email and telephone numbers; 3)inquiring ahead as to exactly who will do the assessment and what areas will be assessed.

And do not be afraid to press the professionals for understandable answers. If they cannot say it so you can understand,they are useless to you and your child.

Any questions or comments? Contact Dr. Cameron Jackson DrCameronJackson@gmail.com 831-216-6002

DrCameronJackson@gmail.com

How to increase the IQ of all children? Especially children with ADHD or Autistic Spectrum difficulties?

This technique to raise IQ applies to all children. It can be especially helpful for children with difficulties with focus, attention, sequencing, executive functioning and ‘working memory’ difficulties. Children with those difficulties are often labeled as having ADHD or Autistic Spectrum difficulties.

Can your child’s IQ be changed? Of course. Can parents and relatives help? Yes! And to raise your child’s I.Q. you don’t need Obama-Care, the U.S. Department of Education nor permission from any federal, state or local governmental entity.

How to raise IQ? Teach to the test. Well, not exactly to the test as IQ tests are proprietary information which test makers and test givers protect. But it’s fine to teach the general tasks measured by many I.Q. tests.

All good teachers teach to the test in some sense. Take the teaching of math.

Everyone knows that 5 + 4 =9 and not 8 or 10. There is one correct answer. If you want a child’s math abilities to increase you have to practice. And if you want them to remember – make it fun.

It’s the same for raising IQ. Teach the general tasks that are tested by IQ tests. And make it fun so they remember and want to learn the tasks.

So, let’s start with one way to strengthen a child’s ability to focus and pay attention.

Digit Span: Measuring digit span abilities is one task which is part of many IQ batteries. So how can this ability become stronger for all children? And is it an important task?

Why teach Digit Span? Every kid needs to learn their phone number including the area code. For safety reasons children should be able to state a telephone number so that an adult can be alerted. So, learning a series of digits is an important, useful task. So, how can we make an important task fun. See how below:

Take my telephone number for example. 831 216-6002 [Please do not call it!] Here’s how to teach a child to learn their telephone number digits:

Get a lined pad of paper and in a column write: 0 at bottom, then 1,2,3,4,5,6,7,8.9 Next, draw dots next to the numbers. And then connect the dots with lines.

Look at the visual image how the dots are connected. That visual pattern is what you want your child to learn. You can see the visual pattern in the image at the top of this post.

Is your child a stronger visual learner? A lot of kids with ADHD and autistic spectrum difficulties are stronger visual learners than they are verbal learners. That means if the child can see what to do they can learn it faster than if they just hear what to do.

Now make learning the telephone number digits fun:

Use sounds to teach telephone number/ Digit Span to child

Try different methods: For example, 1) try using a xylophone and see if music helps cement the digits together for your child. Or 2) try using a different color pens for each digit. One is red, two is blue, three is yellow. Always be consistent so color becomes associated with the number. Or 3) try just drawing the pattern over and over again.
You know your child’s strengths so play to those strengths. Make it a fun activity.

How to start? Small chunks. Teach it in two chunks – the first three digits and then the remaining four digits.

Once a child can learn 3 digits forward, teach those digits backwards. 2-1-6 and 6-1-2. Why also teach backwards? That strengths the visual and auditory memory systems.

Just like push ups strengthen physical muscles learning visual and auditory patterns with numbers strengths your child’s focus, attention and concentration. Your child is having fun doing something with you. And, your child is ‘growing’ his or her I.Q.

Pediatricians frequently recommend medications, e.g., Ritalin, Concerta, to assist with attention, concentration and focus. Research shows that a combination of medication (if they work) and cognitive-behavioral therapy for child and family provides the best results.

In my clinical experience, it only takes one concerned, involved, consistent adult to dramatically affect the overall development of children with various disabilities. So this technique can be used by an older brother or sister, aunt or uncle or grandparent. Sometimes the parents themselves have disabilities such that they are not the ideal person to help ‘grow’ their child’s I.Q.

Try the technique and let me know how it goes for you and your child.

Below is the real story of a young person whose I.Q. could grow if… [personal identifying information has been changed to protect privacy].

Jose is age 17 and a twin. His brother has been diagnosed with mental retardation. Jose’s father is in prison. Jose has an older sister diagnosed with depression. Jose’s mother has various physical disabilities and receives social security, disability. Jose has one older sister who is completing college, has a job and has a boy friend. This sister has been a positive, involved person in his life. This sister is the main person who takes Jose places, listens, helps him set goals and complete tasks. Jose’s teachers over the years report that he shows substantial difficulties with attention, concentration and focus. Jose’s pediatrician tried Jose on five different medications without success. County Mental Health referred Jose to a local counseling service where he received one-to-one therapy from a therapist to address ADHD. Jose’s cognitive I.Q. abilities to think abstractly visually and verbally are in the Low Average range. When Jose’s “working memory” abilities are tested they are low, i.e. in the Deficient range.

Can Jose’s ‘working memory’ be improved? I think so. If there are concerned adults that stay involved with Jose.

DrCameronJackson@gmail.com

To see a book recently published by Dr. Cameron Jackson go to: http://www.smashwords.com/books/view/109312

Many CA children are wrongly diagnosed by reputable institutions such as Stanford Hsoital (LPCH) with Intellectual Disability/ Mental Retardation.

Read the story of Maria below. To make a referral to Stanford hospital ( LPCH) as County Mental Health did with Maria is simply wrong. County Mental Health actions — and lack of actions — harm children who deserve better.

Maria’s story is not unusual. The story describes how many children are routinely mis-diagnosed by Stanford hospital (LPCH). Information concerning Maria and the actual parties involved have been changed or not specified to maintain privacy.

Maria, not the child’s real name, was for real exposed in utero to multiple illegal drugs. And as is true for many children exposed in utero to drugs, Maria, now age eight, has substantial difficulties that affect her overall development. Front and center, she has substantial difficulties with with executive functioning, attention and concentration.

Maria was removed at birth from her biological parents. She lives with a foster mother who only speaks Spanish and a handful of other children. In the home, she has no daily chores and prefers to play by herself. For the last several years, Maria has received County mental health services (medications and therapy) to assist with her dificulties related to inutero drug exposure.

In the home, Spanish is the principal language spoken by the foster mother. At school, Maria’s special education classes (SDC) are in English. Maria speaks a mixture of Spaish and English. For example she know shapes (circle, rectangle) and colors in English but not Spanish; on the other hand, she knows animals and and common home items better in Spanish.

Through her public school, Maria’s cognitive abilities have been assessed in Spanish, English and also with non-verbal tests. At school, she performs best on non-verbal, visual tests of intelligence that have less cultural bias. Assessed on multiple occasions, Maria performs variously. On I.Q. tests that do not rely on lanugae she performs in the Average to Low Average range.

County mental health gave Maria a diagnosis of Pervasive Developmental Disorder, Not Otherwise Specified (PPP-NOS). Saying that they sought more ‘diagnostic clarity’, the County recently referred Maria to Lucile Packard Children’s Hospital (LPCH) located in Stanford, CA.

Though County Menal Health initiated the referral to Stanford hospital (LPCH) they did not send along their own mental health records. The Mental Health therapist or psychiatrist could have put relevant mental health summary records in an envelope and given it to the family to take with them. That did not happen.

Nor did County Mental Health assist so that relevant school psychological assessments accompanied their referral to Stanford hospital (LPCH). With a Release signed by the mother the County Mental Health therapist could have ensured that school assessments accompanied the County’s referral to Stanford hospital. That did not happen.

As a result, there was no collaboration between County Mental Health, the local schools and local physicians. As a result Stanford hospital (LPCH) lacked up-to-date relevant records available for review. Very importantly, and one wonders about arrogance by Stanford hospital, LPCH routinely does not seek out additional information other than what it gets from their own assessment.

The family had to travel two to two and a half hours each way to go to Stanford hospital (LPCH). Although there are numerous licensed psychologists trained in assessment and diagnosis the County routinely chooses to refer outside the County to LCPH. If they wanted to, County Mental Health could reaadily refer to the local Psychological Association. Every County in CA has a psychological association.

Maria was recently assessed by Lucile Packard Children’s Hospital (LPCH). Of importance, the LPCH assessment did not request nor review Maria’s multiple prior school assessments. And LPCH did not review Maria’s medical records nor her mental health records.

LPCH limited the assessment of Maria’s current functional abilities to the ratings that they obtained that day from Maria’s foster mother. No ratings were obtained from Maria’s teachers. Based on a one day assessment, done in English using a Wechsler IQ test known to have strong cultural biases, LPCH gave Maria diagnosis of Intellectual Disability/ Mental Retardation.

Yes this 9 year old child suffers from dificulties related to in utero drug exposure. And she has not yet stabilized her language abilities because she hears only Spanish at home and English at school. And yes on certain tests of executive functioning, attention and concentration she scores quite low.

Maria and other children referred by County mental halth deserve an accurate diagnosis based on a thorough review of relevant school, medical and mental health records. County mental health should collaborate with local psychological associations and use locally trained psychologists who can visit schools and observe children in their home enviornment. When referring outside the County, County Mental Healh should see that relevant school, medical and mental health records accompany their referral.

As I wrote above, to make a referral to Stanford hospital ( LPCH) as County Mental Health did with Maria is simply wrong. County Mental Health’s actions and lack of actions harm children who disserve better.

With an erroneous diagnosis in hand, County Mental Health will close Maria’s case saying that her supposed diagnosis of intellectual disability makes it impossible for her to profit from therapy. And with this diagnosis the schools probably will refer the family to social security.

What Maria truly needs is: 1) time to develop and stabilize her language abilities; 2) training in how to use schedules and other techniques that assist persons with problems with attention and concentration. Just because this eight year old tends to skip from step 1 to 4 does not mean she cannot learn to do tasks correctly. With correct interventions, Maria will be happier and society will not have to support her as an adult.

Commnets welcome. Send to: DrCameronJackson@gmail.com

Roughly 1 in 6 persons get a check in the mail from the government. That’s a huge number of people dependent on the government. It’s time to reduce that dependency.

Lots of people think that it’s wrong to cut social security. Yes, it’s wrong to cut benefits to those who paid into SSI, have retired and who rely on social security.

How to responsibly cut the federal deficit and encourage independence? Time to trim Social Security Disability benefits (SSI-D) to children and youth ages 3-21. Let’s reduce SSI-D payments to children and youth 1) assessed inaccurately or 2) who have “out grown” their diagnosis. Children change rapidly. Assessments should be accurate and up to date.

Another way to cut government deficits is to require proof of citizenship to obtain government funded services such as the regional center services. (The regional centers serve persons with low cognitive IQ abilities, requiring treatment similar to persons with low cognitive IQ, autism, seizures and cerebral palsy.) (more…)

by Cameorn Jackson
Time that Social Security Disability got a razor hair cut? Yes. And time to lighten the load for taxpayers.

The federal government hit the Replace function and Mental Retardation (MR) became Intellectual Disability (ID). Per the WSJ article 11-30-2010 no change in services occurs. The hurtful label goes.

Is this a superficial face lift for Mental Retardation? Does the underlying structure remain the same but the pain associated with the label continues? Perhaps less pain. But confusion continues.

Confusion exists and continues because words used in one context – education — mean something quite different in another — the medical setting.

In the educational setting, Mental Retardation is a catch-all category to provide special educational services for various students who “don’t fit” That includes behavior problems and a wide variety of other behaviors.

In contrast, in the medical setting (doctors, psychiatrists, psychologists) Mental Retardation means that certain criteria are met. Those criteria are specified in the Diagnostic and Statistical Manual (DSM-IV) or what will be in DSM-V in 2013. For a medical diagnosis of MR or IT must meet the criteria set out in 317.0 Mental Retardation or a gradation of it. (more…)

Let’s imagine what might happen were President Obama given an ADOS assessment. An ADOS is administered one-to-one — not done here.

What the ADOS is: The ADOS assesses for autistic spectrum disorders. Adolescents or adults assessed with an ADOS are asked to do various tasks including: 1) play interactively with the person who is assessing; 2) demonstrate how to do an activity; and 3) tell a story based on a picture book which has no words.

One ADOS task is engaging in interactive play that involves joint attention and ability to change based on what the other person does. President Obama seems to engage in a lot of “my way or no way” behavior which is not interactive. When President Obama got the stimulus bill signed he immediately turned it over to Speaker of the House Nancy Pelosi to figure out how to distribute the “pork”. President Obama did not wield his mighty pen and interactively “cut” out pork. Overall global assessment: As Obama’s abilities to interactively “play” appear low, he gets a score of 2 for the joint interactive task.

A second task on the ADOS: The person must demonstrate both verbally and non-verbally how to do something in daily life. Getting bills such as ObamaCare passed has been part of President Obama’s daily life. Can you imagine President Obama — without a teleprompter — explaining with use of gesture and words how he got ObamaCare passed? On the demonstrate a Daily Activity task Obama scores another 2. The total score is now 4 points.

A third task on the ADOS: The person assessed must tell a story based on a picture book that has no words. So, imagine a picture book showing the Tea Party movement at various rallies. How might Obama tell that story? Can Obama see a series of pictures and make a coherent story about a major political event, i.e. the Tea Party movement? Doubtful. Hence, on the Tell a Story task President Obama gets another score of 2.

On just three ADOS tasks Obama is already up to a total score of 6. There are about 12 or so tasks on the ADOS.

Let’s hypothetically assume that President Obama can meet the ADOS cutoff score for a possible diagnosis of an autistic spectrum disorder. More information is necessary to assign a diagnosis of autism or some variation.

The foregoing gives you an idea of the kind of tasks persons must perform during an ADOS assessment. (more…)

I work in California as a licensed psychologist with children who have disabilities. Some of the children and youth I assess should never have been diagnosed as disabled. There is an entitlement mentality such that some families want a diagnosis because of the benefits that will come with the diagnosis.

Let’s hope that newly elected Tea Party representatives to Congress address how to rein in the cost of entitlement programs. One way to start could be to take a close look at the social security disability entitlements that children receive.

An appropriate way to limit entitlements is to limit the time that children with disabilities receive disability money. Many children with disabilities make amazing growth. For example, some children diagnosed with Autistic Disorder at age three will lose many of the characteristic symptoms within 3-4 years. On the other end, too many young 18 year olds who score low on IQ tests as they leave high school get diagnosed as mentally retarded and moved on to social security for life.

For children and youth age 3 – 25, a limit of 3 years on disability is probably the best way to go. Children should be eligible for a maximum of 3 years and review required to extend eligibility. The federal government could require schools to send for review all 3 year IEP psycho-educational evaluations.

As children shed their difficulties based on successful school interventions they should also shed their federal government disability entitlement.

Have the review done by an independent source, i.e., private licensed psychologists in the same geographical area where the child resides. For older youth who score low on IQ tests the federal government via private psychologists in the locale should examine the applicants. Does the young 18 year old fit in fairly well to their culture and what is expected of them? What kinds of hopes does the young person have and how can that young person become employable? (more…)

 

There is a saying, “the devil is in the details…” 

Assessment of autism with the ADOS is fraught with difficulties.  The ADOS per the Manual does not assess for Category 3 behaviors — repetitive, stereotypic behaviors. 

 There must be substantial Category 3 behaviors for a DSM-IV-TR diagnosis.  It sounds like, per Assessment of Autism Spectrum Disorders (2009) that a new algorithm published in 2007 takes care of the problem. But does it?  (more…)