AutismUp-Date

To end National Autism Awareness Month (April 2017), I wanted to share some exciting news about my increased involvement with the autism community here in the Rochester metropolitan area.

I was recently added to the Board of Directors at AutismUp, and My Better Half and I celebrated by attending the AutismUp Gala "Hope Lights the Night" on Saturday, April 29. I am excited to take on this leadership role and hope that I can be an asset to individuals with autism and their families. Plus we had a great time on our last planned date night before the baby arrives, dressed to the 1920's theme, 36 weeks (and counting) baby bump and all.

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.

World Autism Day 2017

I really enjoy Christmas lights, so much so that I'm one-step removed from Walt Griswold.

While placing candle lights in the window back in November, I decided that I wanted to keep them up through April so that my family and I could Light it up Blue for World Autism Day.

I went to this website to buy candle lights, and I picked up standard bulbs at Home Depot.

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April 2 is World Autism Awareness Day, making this the 10th year of recognition on this day. Initially envisioned to bring greater awareness, the focus now broadens to include acceptance, advocacy, and greater autonomy for individuals on the autism spectrum and their families.

My goal this month is talk more with my kids about people with autism and their families. They each know I work with people with autism, but I want to deepen their understanding in a way that matches their developmental level. I think these shows might be a good start for them.

I'm going to light up my house blue for all of April, and I hope that people who see the lights on at night reflect and respond inclusively for individuals with autism and their families.

Wind, Snow, Time, & Faith

These last two weeks (March 7 to 16) have been full of weather and safety-related concerns, and it's led me to take stock of what drives me these days and how I want to live my life now.

For those readers living outside the Rochester metropolitan area, we experienced a windstorm on March 7 that left over half of the region without power for days followed by a cold weather snap with daytime temps in the 20's. As many of the trees were cleared and power was mostly restored by the start of the next week, we were hit by Winter Storm Stella that dumped approximately two feet of snow in an on-going two day snow shower starting on March 14. 

I had a full caseload every day these last two weeks, but the windstorm and emerging snow storm prompted me to shuffle my schedule and cancel a full day of patients on March 15.

Now I'll be honest: I do not like it when anything prevents me from doing what I had planned. Yes: this is the pot calling the kettle black coming from this here clinical psychologist.

But the truth is I needed this dose of reality that was served up to me over the last two weeks.

It gave me a chance to meet people near us who took us in while our power was out.

It gave me a chance to be present for my daughter during and after outpatient eye surgery.

It gave me a chance to connect with people deeply because there was space and time for it.

I wish I could say that I’d never been here before
— Chris Stapleton, Fire Away

That's how I feel right about now as I realize I would've missed my daughter's surgery had the weather not laid to waste my plans to focus on my work instead. So many times before I've been so driven that I don't even see the road I'm driving the car of my life on. And for that, I feel compelled to reflect on how I can align my priorities more consistently with my values.

I had planned on my previous post (UnReal InstaLife) being the final one in a series about digital communication and re-framing our experience with it. After my daughter's surgery, I am reassessing how my digital existence impacts my reality as a parent, partner, and provider. I have such an intense, unrelenting desire to improve things that I very often forget to slow down, turn off the phone, and make the time to reflect rather than react to the moment I'm in.

So the weather gave me cause for pause and the opportunity to be present for my family, but another thought snuck in without my realizing it until the past weekend turned into this week.

When I think it could be therapeutically helpful and when I feel it logistically necessary, I have shared with my clients a bit about my personal life. Many folks know that My Better Half and I are expecting our third child in May and have showed such care and interest in her well-being. 

Knowing that my client's think and care about my family is something that moves me in a way I can't really describe in words, which is saying a lot given my predilection for hearing my own voice.

And on more than one occasion in the past two weeks, I've had clients look me in the face or tell me sincerely in writing that they have prayed for my wife's health and my daughter's. Now my faith is something I have generally regarded as a private matter, but the deep gratitude I feel toward my client's in sharing their faith with me has led me to re-examine mine in my work.

This then is a long-winded thank you to my clients, my family, my friends, and my community for calling my faith to mind during this unexpectedly trying month of March. So in the spirit of sharing more of myself, here is a picture of my family, in our comfy clothes, celebrating St. Patrick's Day by appreciating our warm home, our health, and some much needed time together.

Unreal InstaLife

Following up on my last two blog posts regarding social and electronic media, My Better Half shared this video with me:

The way this video represents a range of social media behaviors feels raw and real by focusing on the actions and nonverbal forms of communication in the physical presence of each person. I thought this was worth sharing in so far as it's evocative and can help facilitate a discussion. 

I have a few guidelines I've implemented in my daily life - and recommended to clients - that I think could be helpful to incorporate into everyone's daily routines:

Zero tolerance for technology during meals.

This can be delimited and brief (even 5 to 10 minutes) with no one looking at their phone. The ritual of breaking bread with others is so valuable for a variety of reasons, and I think that is a routine worth establishing as often and as early as possible with children and families.

Now, what I would encourage people to do is to have a fairly elastic definition of meal times. I get to meet with a number of children and adolescent clients who are working on skills like sitting during meals or eating a variety of food. It's not cheating if you change the definition. A meal could be a snack your kid likes to eat after school. Or meal planning time when you pick out what you're going to eat for breakfast or pack lunches for the next day together.

Keep the phone out of the bed. Literally.

Don't bring your phone in bed when reading stories to your children, talking with your partner, or transitioning to sleep. Even if you're a medical provider who needs to be on call at night, the psychological distance of putting it on a night stand that is a few feet away can be very real.

Be intentional about how & when you use your phone.

Rather than mindlessly and passively scrolling into the oblivion of your Facebook feed, go on a mission to find something or connect with someone through direct messaging. Messaging with intent is very different than just liking the buh-Jesus out of every witty or contrarian thought.

Reward yourself and your children for setting and sticking to technology limits.

If your 7-year-old child can go from 5 to 7 PM with a focus on playing outdoors or building something with their hands or their imagination, praise them like they're walking on the water. It's a big damn deal in this day and age to occupy ones self without the aid of technology. Pay attention to what you want to see more of and bring on the parade when you see the good behavior in action.

Take your teen's access to technology seriously.

A paper I read yesterday highlights the complexity of adolescents' access to social media and how it impacts their well-being. The catalytic effect of one post or accidental share can alter the trajectory of a child's academic year or self-concept without caregivers' even knowing.

This line in particular rung most true for me and ties in nicely with the video above:

...the social exclusion and comparison resulting from vast amounts of time reading large social media feeds and seeing friends doing things without you and comparing your inner emotional experience to everyone else’s highly groomed depictions of their seemingly marvelous lives.

While this run-on sentence may seem a far cry from the reality of parent- or adult-hood, I'd bet the farm that the so-called average adolescent could speak to the truth of this point of view. The world is both bigger and more constrained than it's ever been, making the boundaries harder to find and more difficult to delineate during times like these...