Monterey Bay Forum

written by Cameron Jackson DrCameronJackson@gmail.com

Does Peter — this is a hypothetical clinical case — suffer from NLD or Asperger’s Disorder or PDD-NOS? So some combination? What is the best fit? Many of the facts are true however names and identifying information has been changed to protect privacy.

Remember the children’s verse: “Peter, Peter, pumpkin eater… had a wife and couldn’t keep her… so he put her in a pumpkin shell… there he kept her very well… ”

It certainly was socially inept of Peter to keep his wife locked in a shell….Was that the best that Peter could do?

Non-verbal learning disability (NLD) was much talked about 10 years ago. Maybe because NLD never made it into in the Diagnostic and Statistical Manual (DSM-IV) it’s only known in certain circles.

In some ways NLD is similar to 298.0 Asperger’s Disorder — which is a diagnosis in the DSM-IV.

Many people somewhat approximate the diagnosis that are in the DSM-IV. The issue is to find the best fit.

Let’s see what is the best diagnosis for Peter. A number of facts are changed to protect privacy. Let’s see whether Nonverbal Learning Disability (NLD) or Asperger’s fit as a better fit for this young man.

Peter — not his real name — is in his middle 20′s. He went to private schools in Santa Cruz County and finished at an alternative high school. Both his parents finished college and work professionally. Peter is an only child.

From his father for years he heard, “Just step up to the plate… you can do it… Try harder…” Yes, Peter has low self esteem. (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…)

Like designer jeans, Asperger’s Disorder has become a “hot” diagnosis.

Asperger’s is much more preferred by parents as a diagnosis than a diagnosis of Mental Retardation. Or Autistic Disorder. It’s easy to see why: In Asperger’s Disorder the person’s cognitive I.Q and functional abilities (self care abilities, ability to work) are in the normal range.

In Asperger’s Disorder, only the social abilities are in the Borderline or Deficient range.

One young woman I recently had the opportunity to assess (a young 18 year old with Asperger’s) said that she preferred to learn over the Internet — with her lap top on her bed — so she did not have to interact with people. She views her mother as her best and only friend. She tries to stay “with it” by not showering and having dirty hair — as that is socially acceptable here in Santa Cruz, California. She is right — in Santa Cruz, California dirty hair and rarely washing hair or taking showers is “in”. In certain circles.

written by Dr. Cameron Jackson DrCameronJackson@gmail.com Monterey Bay Forum www.FreedomOK.net (more…)

Medical Diagnosis: You go to a doctor. He/She says that you have a diagnosis of cancer. You say, what do I do …? The doctor suggests various treatments. Here, diagnosis is the flip side of treatment. Nobody BUYS or WANTS a diagnosis of cancer. If a person has cancer then treatment may involve radiation, surgery or chemotherapy or a combination of all three. All these treatments have significant medical side effects. None of these should be undertaken lightly.

Psychiatric/psychology diagnosis: Parents are concerned about mental and emotional development of their child. They take their child to a doctor — this one is a psychologist and / or psychiatrist. The parents want maximum services to address the concerns they see in the development of their child. So long as the services don’t hurt the child why not maximize them? That is the parents point of view.

Does the doctor conservatively diagnose or? Most of the treatments offerred for children with a diagnosis of autism do not have substantial side effects as in cancer. No lose of hair or feeling lousy because of radiation. So why not maximize treatment to assist the child? Why not “err” and offer maximum kinds of treatment?

Ethics: I say that it is best to do as accurate a diagnosis as possible and not “err” in order to maximize services. Better to incrementally come back and add necessary services rather than overload at the beginning.

This is an ethical dilemma. Does the MD give out drugs that are not necessary but the patient came all that way, waited an hour and expects to get “something”? Does the psychologist diagnose Autistic Disorder 299.0 and not PDD-NOS knowing that one will probably maximize all possible services and the other may not?

Another issue is who pays. If the patient pays for it akin to buying groceries then he may decide that some services are crucial and others can wait. If the “government” is paying the tab — how does that affect decisions?

Would anyone buy a diagnosis of CANCER? I don’t think so. Will parents BUY a diagnosis of AUTISM? Yes – some parents will try. And some families are quite successful.

Why “buy” a diagnosis of autism? Because there are lots of expensive “goodies” that attach with a diagnosis of autism. Expensive school services such as Occupatonal Therapy (OT) and Speech therapy and Social Skills therapy.

In contrast to Mental Retardation — not a diagnosis that parents seek — more and more parents do try to buy a diagnosis of autism.

Is there a real explosion of autism? Appears to be. Are the numbers way up in part because of the push by many parents to BUY a diagnosis. Yes, I think so.

To date, I have seen no research that addresses this issue: many parents WANT a diagnosis of autism and DESIRE affects t how they retrospectively describe their child’s behavior.

written by Cameron Jackson, Ph.D., J.D. Licensed Psychologist PSY 14762
831 688-6002