Category: DSM-5 & Psychology

Diagnostic & Statistical Manual (DSM) & Psychology topics including autism, autistic spectrum disorders, intellectual disability, mental retardation & ADHD

Aptos, CA psychologist: Do you have an adult child who needs their parent to make most decisions? Think about a Limited Conservatorship if in California….

DrCameronJackson@gmail.com

Do you have an adult child in California who substantially – very different from others his or her age — cannot do what society typically expects a young person to do?

For example, let’s say you have a son or daughter age 25 who has never held a part time job more than a couple months, who still lives with you or in a separate space you pay for, who has no real friends, who cannot cook more than microwave and who cannot make normal decisions that young persons make at that age?

Are you in effect still acting as the parent in charge although the adult child is moving along in age — but quite delayed?

What to do?

Think about a Limited Conservatorship as one vehicle that might assist.

For those who can, of course you can contact your personal attorney.

You need to know that there are free (govt paid for) or relatively low cost alternatives:

For example, SPIN in Santa Cruz County, supported by your tax dollars, offers workshops which assist families with children with developmental disabilities and delays.

Tonight SPIN (10-26-2010) in Watsonville, California held a meeting (6:30 – 8:00) with an attorney present. The meeting was to provide legal information concerning Limited Conservatorships.

I am a licensed, clinical Ph.D. psychologist. I attended the SPIN meeting because I had referred a couple families and on occasion I write reports recommending Limited Conservatorships.

As I could not stay for the entire SPIN meeting (10-26-2010) regarding Limited Conservatorships here is some info — perhaps it was not provided — concerning how to get a Limited Conservatorshp.

This is not legal advise. This is based on my experience as a licensed clinical psychologist interacting with families who need to exert control over the affairs of adult children:

There is FREE assistance for families who need to assist adult (over age 18) persons who cannot manage their life without family or other assistance.

What you can do:

Using Google:

1) type into Google” California Judicial Council Forms
go to: Browse All Forms
type in: Probate – Guardianships and Conservatorships
Download appropriate forms for Conservatorships
2) not know what forms to download?
3) go to the Law Library in Santa Cruz (in the Court House, basement, there is an attorney there to assist you).
4) With assistance from the attorney, file the forms with the County clerk of SAnta Cruz, CA
5) Get a Hearing Date stamped on your legal form by the County Clerk of Santa Cruz County.
6) Be sure to “ Notice” the Regional Center – learn what that means with assistance from the lawyer provided by Santa Cruz County
7) With a Hearing Date, Notice and what you are requesting (how many of the usual 7 powers are you requesting be removed from your adult child) in my experience the regional center near you in CA will respond to Superior Court
8) In my experience, when Superior Court requests a California regional center to provide a Limited Conservatorship that report will be provided in a timely manner.

A Limited Conservatorship is one vehicle that may assist parents who need to provide basic assistance to adult children. There are other vehicles. If you need more information or assistance, contact Dr. Cameron Jackson DrCameronJackson@gmail.com 831 688-6002 P.O.Box 1972, Aotos, CA 95002-1972

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Aptos, CA psychologist: How best to measure autism? Caveats about use of the ADOS? What happened to the toddler version of the ADOS? Is there a way to accurately used standardized scores when measuring autism?

Cameron Jackson DrCameronJackson@gmail.com

Some caveats concerning the use of the ADOS in the assessment of autism.

One caveat: The ADOS measures autistic spectrum disorders but does not distinguish between the severity of autistic symptoms. That is, it does not distinguish between 299.0 Autistic Disorder (most severe), PDD-NOS (less severe) and Asperger’s Disorder (normal IQ and normal adaptive functioning).

A second caveat: The ADOS only picks up information between the interaction of an adult (psychologist, therapist) with a child. Unfortunately, there is no sampling of the child’s behaviors with same age peers. And, needless to say, how a child interacts with same age peers is crucial information. Frequently persons with an autistic spectrum disorder (ASD) do fine with persons older or younger. How the ASD functions in relation to persons fairly close in age is highly important. Why? In America, we educate children that are the same age. In many states, including California, once a child has been held back one time they cannot be held back again. So if a child cannot readily function with same age peers that is highly significant for that child’s educational experience.

The ADOS, a measure of autistic spectrum disorders, is a very different kind of measure compared to measures of intelligence.

We have lots of measures of intelligence and they all do a fairly good job. Most of the well known measures of intelligence result in standard scores and persons can be classified in a range: Average range, Superior range, Deficient range. A person who scores in the Average range on one measure typically and usually will score in the Average range on other measures of intelligence. For example, the Test of Nonverbal Intelligence (TONI) will give a standard score in the Average range that is fairly close to the Performance I.Q. of a Wechsler IQ test.

In contrast to measures of intelligence (I.Q.), the measurement of autistic spectrum disorders with an ADOS does not result in a standard scores. Scores are not spread out along the bell curve. Thus it is mot possible to talk about Average range, Superior range, Deficient range.

Hence, because there are no standard scores there is no way to compare performance on the ADOS with all the hundreds of tests that exist which use standard scores.

Instead of providing standard score information, the ADOS has a “cut-off” score. If the person scores above then they supposedly have an autistic spectrum disorder. The ADOS does include Category 3 (repetitive behaviors, unusually strong, limited interests) items in determining the overall scores.

So what happened to the ADOS for toddlers that was coming soon — but not here yet?

How did the new ADOS Module T perform?

1.The sensitivity of the ADOS Toddler module was 91%. That is, the test was able to correctly identify 91% of the cases of ASD (based on a cut off score of 12).

2.The specificity of the ADOS-Module T when tested against non-ASD disorders was also 91%. This means that only in 9% of the cases, the test suggested a diagnosis when the child had been previously identified as not having an ASD.

3.The specificity of the ADOS-Module T when tested against typically developing cases was 94%. That is, only in 6% of the cases, the test suggested a diagnosis in children who were actually typically developing kids.
What happened to the ADOS Toddler Module? Not happening?

One of the authors writes:

“These are actually excellent numbers and indicate that the ADOS Toddler Module has excellent sensitivity and specificity. However, the authors also described some general concerns and limitations.

The ADOS, although it is the most reliable and valid diagnostic instrument available, it is still only a clinical tool that must be used in the context of a comprehensive clinical evaluation and it is subservient to clinical judgment.

Specifically, a diagnosis of autism is provided only when the person meets the DSM-IV diagnostic criteria. Therefore, clinicians must use their judgments in interpreting and applying the results from the ADOS. There will be cases when the ADOS suggests a diagnosis but the clinician will not provide the diagnosis because the child doesn’t meet full diagnostic criteria based on the DSM-IV.

So you may ask, what is the point? Why do we have the ADOS if all a clinician has to do is go down the list of the DSM-IV criteria and add up the check marks? The ADOS provides for a reliable and valid tool to assess for the specific symptoms included in the DSM-IV criteria and it helps the clinician interpret the child’s clinical presentation as it applies to the DSM-IV criteria. The ADOS standardizes this process so that diagnoses are less dependent upon other factors, such as biases in parental reporting of symptoms, or the skills or training of the clinician in properly indentifying such symptoms. Therefore, the ADOS greatly improves the validity and accuracy of our ‘clinical judgment’.

On a personal note and disclaimer. Dr. Luyster (lead author of the study), Dr. Richler, and Dr. Oti were all my classmates in graduate school and I congratulate them for their wonderful work. In addition Dr. Lord, creator of the ADOS and founder of the University of Michigan Autism and Communication Disorders Clinic, will be my collague this Fall when I join the University of Michigan faculty.

The Reference: Luyster, R., Gotham, K., Guthrie, W., Coffing, M., Petrak, R., Pierce, K., Bishop, S., Esler, A., Hus, V., Oti, R., Richler, J., Risi, S., & Lord, C. (2009). The Autism Diagnostic Observation Schedule—Toddler Module: A New Module of a Standardized Diagnostic Measure for Autism Spectrum Disorders Journal of Autism and Developmental Disorders DOI: 10.1007/s10803-009-0746-z

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Aptos psychologist: Yes there are ways to reduce early signs of autism. Figure out ways so, unprompted, your infant gazes at you. Pay attention most to the non-verbal clues.

DrCameronJackson@gmail.com

A family has one  child  diagnosed with autism.  Then they have a second child.  Siblings of autistic children have a 25 times greater  likelihood than average also developing autism.

Can parents reduce likelihood of autism in child #2? Possibly and certainly worth the try. One avenue: what are ways to increase gaze between parent and child which is unprompted?

DSM IV 299.0 Autistic Disorder is characterized by three kinds of difficulties: the hardest to “fix” are the non-verbal social communication problems (poor eye contact, not ‘reading’ facial clues, low social and emotional reciprocity).

It is possible to identify children at risk of autism quite early. Interestingly, when and to whom a child gazes is an early marker. To me that suggests why not figure out all sorts of ways that babies can do something to prompt adults for gaze. The baby is not seeking gaze but by doing something they in fact increase gaze.

Might it not be the total gazing and human interactions that gaze provides that assists children to learn all sorts of non-verbal clues?

 Per article below, at six months, siblings do less gazing at parents when not prompted than children who do not have a autistic sibling.

So what might be some ways to encourage siblings of autistics to increase non-prompted gazing at parents and caregivers? Below are some ideas and why not share your ideas? Continue reading “Aptos psychologist: Yes there are ways to reduce early signs of autism. Figure out ways so, unprompted, your infant gazes at you. Pay attention most to the non-verbal clues.”

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Therapy center rather than a mosque at Ground Zero proposed by Drums and Disabilities

Excellent idea to have a therapy center rather than a mosque at Ground Zero. See recent article in New Patriot Journal 9-19-2010 by Cindy Chafian reprinted from The Daily Right.

Bad idea to make therapy free — better to make it sliding scale and everyone pays according to an agreed on formula.

Instead of Hollywood stars and well known folks, get community involvement and require parent/family participation from all using the center.

It works fine to have some pay more. The proposed therapy center at Ground Zero needs to attract families with money and stability and connections who want to get behind the goals of the project. Get those people on the board.

Again — don’t make it “free”.

The above advise is based on my five years experience starting and running a child care center in Santa Cruz, CA to assist homeless families get on with their lives. The name is Calvary Childcare Center and – 20 years later – it is still serving the community.

I learned that children’s lives could be turned around with as little as 4 hours child care 2 days a week. I learned that ‘free-bees” are not the way to motivate people to change their lives.

The impulse and motivation of DAD’s offer are authentic. And the timing is right.

Just get the pricing right. And get personal involvement by every family served. I support the therapy center’s overall goals. And many, many people can get behind the idea. written by Cameron Jackson

See the following story about the proposed therapy center:

Non-Profit Organization Proposes Ground Zero Mosque Compromise

Written By: Cindy Chafian
Published: 9/19/2010
“New Jersey based Non-Profit organization Drums and Disabilities is prepared to move forward with plans to build a state of the art therapy facility in the location where the Ground Zero Mosque is currently slated to be built.

“Weeks ago, Pat Gesauldo, an accomplished, award-winning drummer and CEO of D.A.D. presented Governor Patterson, New York City Mayor Michael Bloomberg, Imam Faisal Rauf and property owners Sharif El-Gamal, and Hisham El-zanaty with his proposal, timeline and plan to build the center.

The State-of–the Art Therapy Center will offer free physical and cognitive therapy services for children whose parents were victims of the 9/11 terrorist attacks, the Police, Fire, and Rescue workers who might now be disabled, and for the wounded troops from the Tri-State Area.

As of yet, no one from Governor Patterson’s or Mayor Bloomberg’s office has even bothered to return calls from Gesualdo about joining efforts to reach a less controversial use of one of the last remaining buildings directly impacted by the attacks from 9/11. (The top of the building was damaged by the landing gear from one of the planes during the attack.)

Property owners Sharif El-Gamal and Hisham El-zanaty as well as Imam Faisal Rauf recently turned down Donald Trump’s offer of $6 million to purchase the building, claiming that the building was worth almost 4 times that amount.

Gesualdo respects the right to build the mosque in this location but feels that his idea would be a much more reasonable compromise for the community and country. He describes the facility as one that “will be funded by our own organization, our own community, and our own Government. Additionally it will offer free therapy services for special needs children whose parents were victims of the 9/11 terrorist attacks, the Police, Fire and Rescue Workers, and wounded troops.”

Gesualdo has reached out to Trump hoping to join efforts and his support as well.

Through private, state and federal grants and donations, Gesualdo is willing to come to the table with an offer of $12 million. This is double what Donald Trump came to the table with last week. and a 3 times the amount the current owners purchased the property for a little over a year ago.

Critics of Gesualdo and his plan have raised questions as to the timing, funding and motivation of his proposal. He addressed those concerns with me in an interview yesterday.

The Daily Right: There are those who would question why you have chosen now to get involved. Why have you chosen now to build the center? What motivated you to propose your center here vs. somewhere else?

Gesualdo: I have been searching for a building to build a DAD Program Therapy Center in the Ground Zero area and lower Manhattan for 3 years. What not a better location then to offer our free therapy services for 9/11 victims? This building is the last remaining building that was directly damaged by one of the planes as it flew into the twin towers. No one should tear it down, whether it be the mosque developers, or an American construction company.

My motivation for this purchasing this specific building is because I offer a truly healing opportunity for this location. We help children and adults with Autism, Dyslexia, ADD/ADHD, Tourette’s, Aspberger’s Cerebral Palsy, Muscular Dystrophy, ODD, OCD, and other disabilities, to develop retention, coordination, self-esteem, fine motor skills, and physical and cognitive functioning.

We currently offer our program, which is conducted by doctors, teachers, and special needs service providers in schools, hospitals, and community centers throughout the world.

TDR: You say that this facility will provide free therapy services for special needs children from those affected by 9/11 as well as military members and their family. How will your organization be able to provide these services free of charge?

Gesualdo: We plan to build a state-of the-art non-profit therapy center that would offer free therapy services for special needs children whose parents were victims of 9/11, free therapy services for the Police Officers, Firefighters, and Rescue Heroes who are now disabled as part of 9/11, and free therapy services for wounded troops from Walter Reed Army Medical Center, and the Wounded Warriors Project. We can offer our services to these victims for free, because we will offset the cost with other paid therapy services and income from this building. Additionally, we have a team of therapists willing to donate their services for free.

TDR: $12 million is a lot of money. How do you intend to raise the money if Trump or anyone else won’t get involved?

Gesualdo: I have countered Donald Trump’s original offer of $6,000,000.00 with my own offer of $6,000,000.00, to raise the purchase the mosque property at Ground Zero, with an offer of $12,000,000.00. I have recently invited Donald Trump to join forces with me in this effort, by using our combined donations. If he does not wish to join me, then I will raise the $12,000,000.00 through our own efforts of our non-profit organization, with part private and public funding.

TDR: You are hoping to raise the funds through the generosity of everyday American’s who are willing to support your vision. What happens if you raise the $12 million and those who currently hold the rights to those properties decide not to relinquish those right or move the Islamic center/mosque?

Gesualdo: I have put the offer on the table for mosque developers and leaders Imam Rauf, Sharif El-Gamal, and Hisham Elzanaty, and privately and publicly encouraged them to discuss this purchase price. I am not starting a fund raising effort now, and only will when the mosque developers accept my offer. At that time, and only at that time, will our fundraising campaign begin for the purchase of the mosque property. Our fundraising campaign and financial management is independently over seen from myself and the DAD Program, by a major CPA firm.

TDR: If those who claim to want to reach a reasonable solution to this controversial issue decide not to accept your generous offer, will you build your center in a different location? If so, won’t those who donated on behalf of the project being built at this specific location feel betrayed?

Gesualdo: I would be more then happy to build a therapy center, and offer the same services anywhere, and have been looking at different locations in NY, NJ, and CA. for the past few years. Each specific fundraising campaign will be focused for a specific location only. Therefore, the money raised from the fundraising campaign to purchase the mosque property, will be used to purchase the mosque property only. A fundraising campaign for the Mosque property will begin when the mosque developers agree to a purchase price with me, and at that time only.

TDR: How can you guarantee that the money donated by everyday American’s will be used for the purpose they intended?

Gesualdo: The nice thing about working on this specific project, is that I want all people to feel they have some part in saving this building. Since we are a 501 (C)(3) non-profit organization, anyone who donates can use their donation as a write off. It is mandatory that everyone knows exactly how much money we have raised, and the current amount at all times, which will be disclosed publicly, constantly. Donors may also wish to remain anonymous. The fundraising campaign and financial management for the purchase of the mosque property at Ground Zero is independently over seen from myself and the DAD Program, by CPA Michel Karu and the major CPA firm of Levine/Jacobs & Company. We will also have a separate Board of Directors for the Therapy Center, which will be comprised of many of the celebrities, sports stars, executives, and community leaders, and police officials who currently take part in our program.

If those who are currently in the middle of the controversial issue surrounding the Ground Zero Mosque truly are interested in achieving a compromise that all communities are satisfied with, it would appear as though Mr. Gesualdo’s offer would achieve just that.

What better use of this property than a non-profit organization who has a proven track record of giving back to the community? This offer would enable those currently holding the rights to the property to put their money where their mouth is, so to speak. It would truly show the American citizens, all of whom were affected by the attacks from 9/11 in one way or another, that this Imam and his associates really are about mending fences,healing and moving forward.

If they reject this truly altruistic offer by Gesualdo and the D.A.D. program then it will show America and the rest of the world that they really don’t care what they feel, rather they are only in it for themselves.

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Aptos, CA psychologist: Why and How to Reform Social Security Disability

Here’s a case that illustrates why and how to reform social security disability.

Billy – not his real name – is a five year old boy. When age 3 he was diagnosed with Autistic Disorder and put on social security disability.

Billy’s parents have drug problems, are unemployed and have been in and out of shelters.

Due to neglect, Billy was removed by CPS and placed in a foster home 2 days a week. The other 5 days Billy lives with his mother in a shelter. His father’s where-abouts are unknown.

The care that Billy received 2 days a week for 10 months in a foster home was sufficient that Billy changed dramatically.

Billy changed from having no language to speaking in 4-5 word sentences, from not being potty trained to potty trained, from ignoring other children to seeking them out.

This child is not autistic and should not receive social security disability based on that or any other diagnosis. Currently, Billy has behavior problems and having missed considerable school is behind other students.

How to reform the system so children are not put on disability who should not?

There are some very simple ways to radically reform social security disability.

Judiciously limit who gets on social security disability to start with. Limit the time period to maximum of 1 or 2 years depending on severity. Make it clear that any new information that shows much higher functioning will automatically cut off the benefit.

Tell the family that the benefit automatically dies once the 1 or 2 years has passed. Make the family be the moving party to continue the benefit. Assess the child again prior to re-newing the benefit.

Legislative changes: Require that a copy of all 3 year school assessments is sent electronically to social security for review. Hire licensed psychologists as independent contractors to review cases.

Require that all California regional centers provide social security with electronic copies of psychological and medical reports.

These simple changes can reform social security disability.

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Aptos psychologist: elite parents with $ steal for autistic child. Why?

These parents have money. Connections. Why steal? I do not get it. Do you? Is it arrogance?

See story below:

“A former partner at a well-known law firm and his marketing consultant wife were arrested Wednesday on felony charges of bilking the San Francisco school district and private insurers out of about $400,000 via fraudulent bills for treatment of their autistic son, officials say.

“The San Francisco couple, Jonathan S. Dickstein and Barclay J. Lynn, both 43, surrendered Wednesday and are expected to appear in court this morning for arraignment on 30 counts of fraud, theft and conspiracy, authorities say.

They were briefly jailed Wednesday on $100,000 bail each but were released on bond.

“This was an elaborate scheme to defraud the school district and insurance companies out of a lot of money,” said Chief Assistant District Attorney David Pfeifer. “They used this scheme to make money off their child’s special needs – that’s terrible.”

Until this year, Dickstein, who graduated from Stanford and then Harvard Law School, was a partner at the internationally recognized San Francisco firm of Morrison & Foerster, specializing in intellectual property issues and the law surrounding life sciences. He has since started his own practice, according to his Facebook page.

He and his wife had arranged for the home care of their young son through another school district before transferring to the San Francisco school district. Under state guidelines, school districts are obligated to provide or compensate parents for home education of autistic or other severely disabled children.

By law, parents are required to use licensed private educational providers to develop individual treatment plans that meet state guidelines for their disabled children.

Dickstein and Lynn had employed such a private provider, but in 2006, they created their own: Puzzle Pieces. Prosecutors said it was actually a dummy company that was not licensed to develop autism education.

Double dipping

In fact, they say, the couple used Puzzle Pieces to overbill and “double dip” – charging both the school district and insurers for the exact same services – from 2006 to 2008. They billed for counselors and doctors at allegedly inflated rates and charged both the district and insurers for the same hours of treatment. They allegedly told insurers the district would not pay.

Gentle Blythe, spokeswoman for the district, said it was school officials who raised red flags to prosecutors last year.

“The parents weren’t allowing the district personnel to talk to the service providers,” Blythe said. She said it was then that the district uncovered the fact that Puzzle Pieces was not a licensed provider and in fact had been started by Lynn in 2006.

Dickstein’s attorney, Garrick Lew, said the couple were devoted to their severely challenged son, but admittedly took efforts too far.

“They put a lot of work into getting whatever the child needed,” he said. “In the process of getting all those needs met, there were problems.”

He said he hopes to “try to work something out” with prosecutors.

Douglas Rappaport, Lynn’s attorney, said that it was too soon to comment in detail but that there was “some indication that their conduct could be construed as lawful.”

He said the couple volunteered many hours of their time to causes associated with autism.

The alleged fraud went undetected for about three years, until the school district assigned a new case supervisor over the education and treatment of the child last year.

Blythe said the district’s earlier efforts to supervise the child’s care met with resistance from the couple, but officials acted quickly when the problem was uncovered by the new supervisor.

The new supervisor noticed that Puzzle Pieces was charging twice what would typically be paid for in-home autism care and counseling for autistic children, prosecutors say.

A doctor who supposedly provided help had no specialty in autism, prosecutors say. Dr. Robert Schenck describes himself on the Internet as a specialist in depression in adults. He declined to comment.

When confronted about the questionable billings, the couple told authorities at the district that they did not have copies of the checks used to pay Puzzle Pieces.

Prosecutors said the couple attempted to pass off Puzzle Pieces as a company that they were not directly involved in, saying they would have to talk to the company people and get back to the district. But, Pfeifer noted: “They are the company.”

Thousands in losses

According to prosecutors, the district lost as much as $240,000 while Anthem Blue Cross lost an estimated $100,000 and CIGNA, which administered the law firm’s health plan, lost about $40,000.

In an Internet profile, Lynn said that from March 2006 until June of this year, she was a “director” of “private autism services” and that she “designed and directed (an) individualized home education program for (a) child affected by Autism” that combined “best practices” in ” therapies and techniques …”

She said that the “10 year old child in question went from an ‘untestable’ IQ in 2004 to being able to reach (sic) at a 2nd grade level, write several pages of text and is able to do 2nd grade math.”

Lew, Dickstein’s attorney, said the couple got overwhelmed as they worked with the many intricacies involved in securing care for their son.

“They were dealing with multiple agencies,” he said. “Somehow things kind of went south. It’s really unfortunate for them, as people, and also for their kid.”

E-mail Jaxon Van Derbeken at jvanderbeken@sfchronicle.com.

This article appeared on page A – 1 of the San Francisco Chronicle

Read more: http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2010/08/26/MNUI1F3CFL.DTL#ixzz0xrvRHDwD

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