Musings

Losing an autism diagnosis

As a licensed clinical psychologist, I am an active member of the American Psychological Association. Every month I receive a copy of their publication/magazine, Monitor on Psychology. The magazine covers a variety of current topics in psychology, and I enjoy learning about developments in other areas of the field. In April 2019, Monitor on Psychology published an article titled, Losing an autism diagnosis. After reflecting on this article and thinking about what I think it missed, I wrote a response and my remarks were published in the the June issue.

Here is the original response that I emailed to the Monitor on April 10:

I am an APA member and avid reader of the Monitor. My primary specialty as a clinical psychologist focuses on the treatment and assessment of individuals with autism across the lifespan. Two points I would like to make regarding the News Feature on "Losing an Autism Diagnosis" (April 2019).

1. I believe that there is a substantial lack of training in the assessment of individuals with autism, particularly as they age into puberty and adulthood. I think that the lack of oversight at a broader health care level explains some of the variations in having and then later losing an autism spectrum diagnosis. I would refer readers to the work of Cathy Lord's clinical research for a better understanding of the evidence base and training for autism assessment.

2. The consequences of losing an autism diagnosis in adolescence or adulthood can be quite dire and drastic in terms of service eligibility and access. State offices for people with disabilities often require further substantiation of an autism diagnosis later in childhood, and a person losing their autism diagnosis can quite literally "flip the table" on what services a person and their family can access. I think there needs to be more cross-talk between health care and government systems to understand the consequences of losing an autism diagnosis.

I felt like the article failed to touch on how losing an autism diagnosis can adversely impact service eligibility and access. Moreover, it did not speak to disability identity in adults. I also think this piece missed an opportunity to speak more directly to how variations in provider training and experience can impact the reliability and validity of a diagnostic evaluation.

I am grateful to be able to voice this concern to a larger audience and hope that these reflections inform how professionals approach the process of evaluating patients for autism.

Remembering my Mentor

Tris Smith was the greatest combination of intelligence and kindness I have ever known.

The distinction is one he won in my heart without my knowing and secured in my mind as he mentored me toward my dissertation. He listened to my cynicism and endured my self-doubt, giving me hope and confidence at a time when I lacked it and sorely needed it.

Today marks 1 year since his passing.

TrisPodium.png

Much has been written and said about Tris’ contributions to the field of psychology and his care for those in it – both patients and providers – so I will not belabor a point better made by others.

Tris examined the impact of early intensive behavioral intervention for young children with autism spectrum disorder. This work began about 15 years ago and a follow-up study recently looked at how these children are now faring as adolescents and adults.

The clinical research Tris led lives and breathes still. 

Participants who were once children in these studies are now adolescents and adults, and I have had the fortune of knowing a few of these people as patients. I know that much of their progress is due to their own hard work and that of their families’, but I often think of Tris and his belief in scientific progress when I meet with them. I see the impact of his work every day.

During my training, Tris gave me the opportunity to work on a clinical study that focused on helping parents and caregivers learn strategies to support their young children with autism. This experience has shaped how I work with families and led me to adopt an approach that generally insists on getting to know parents as well as their children as part of helping the family as a whole.

Tris gave so much that it’s hard to imagine anyone filling the space his absence leaves. On learning of his passing last year, I shared a few words with others. I share them again here:

It is beyond my ability to summarize his intellectual contribution to the field of autism research. He studied under Ivar Lovaas as part of the initial group of researchers at UCLA who used the scientific method and randomized clinical trials to quite literally prove that therapy could help improve the lives of children with autism. He expanded on this research at the University of Rochester Medical Center and showed further how parents could learn strategies to improve the behavior of their children with autism in home and community settings. His more recent research reached directly into school districts and minority communities.

His contributions to the field of autism research are innumerable and incalculable. The work he led and supported will ripple out for many years after his passing. Tris was on my dissertation committee and the person I most credit with my being able to defend my dissertation. He was a consummate mentor. He was a mensch and will remain a saint to those who knew him well.

Three Years In

Today marks the anniversary of when the practice first opened on July 11, 2016.

In this time I have had the privileged to serve so many amazing people, get to know wonderful families, and help people through life’s challenges big and small. As I reflect on all of the things that have happened over the last three year my most overwhelming feeling is gratitude…

Gratitude to have a job that I love going to each and every single day.

Gratitude to have a career that offers flexibility to be a present parent and partner.

Gratitude to have a business that supports and works with our community.

Gratitude to be in a community that creates services to meet community needs.

Gratitude for YOU for supporting my dream to help people in our community.

In the last three years, so many things have changed. I’ve practiced in three different locations before landing in my forever home in January 2019. I started out as one person in 2016 and today we are in the process of hiring talented therapists to join me in serving our community.

In 2016, I planned on focusing primarily on weekly therapy. Between then and now, I have had opportunities to use my skills for educational evaluations and advocacy; helping patients obtain OPWDD services; testifying in federal court as an expert witness; and working with different school districts to provide social skills for students with developmental differences.

In the last three years, a lot has also remained the same. I’m still committed to serving every patient and family to the best of my ability. I’ve kept the quirky even as I have moved and upgraded my office location. Patients and their families have gifted me sentimental tokens - Lego mini-figures and socks. These mementos have traveled with me and bring a smile when an unsuspecting character is spotted in an otherwise professional looking office.

The traditional gift for a 3rd Anniversary is leather, so My Better Half recently upgraded the chair I sit in to a new leather one. Feels like I have celebrating covered even while sitting.

New office, new chair, but I still wear goofy socks everyday. Today is fox socks.

New office, new chair, but I still wear goofy socks everyday. Today is fox socks.

Thank you for believing in and supporting my dream. That is the greatest gift of them all.









We're Hiring!

On January 2 we moved into our new space that has the room to grow!

The second therapy office is furnished and ready to be used!

The second therapy office is furnished and ready to be used!

I have been blessed to have a full and thriving practice. I am so grateful for the community referrals that keep coming. While I am humbled by the outreach, I am overwhelmed by the unmet need in our community. So I am going to do my part to change that.

I am seeking a licensed mental health therapist with passion and a sense of humor to join me in serving this amazing community. I am looking for someone to start from day one helping all of those patients patiently waiting on a wait list.

Here is the link to the job posting, or you can inquire directly at apply@bryanharrisonphd.com

Stay tuned - I cannot wait to find the right person and introduce them to all of you!

Beyond IF, Toward CAN

Many of us want things to be different this year.

To feel different, to look different, to extract from our time something more than last year. From the outset, I try to remember that the one gift we are given that we can simply cannot make more of is time — it spends itself at the same rate and rhythm no matter how we fill it.

Fill your time with things that restore you.

I recognize that this is easier said than done, but it can be done by choosing to make time for things you want or miss or need. I encourage folks to think about one or two things they want to add or improve upon and then allocate five minutes to it every single day. No matter what.

Go with others beside you.

There are many paths you can go down to reach the same goal, and many goals reached from that one path. The point for me, as a person and a professional, is to pick a path and to ask others to walk with us on it. It can be difficult to predict whether this path will send us forward, backward, sideways, or in a different direction. It can be even harder to trust that others will be willing to walk with us when darkness falls on the path we have set out upon.

Always forward.*

As the first few weeks give way to February, I imagine that many of us will start wondering if we have what it takes to hold fast to our resolutions. My advice is to shake the snow globe by looking for a fresh perspective on your habits and then rebooting by taking action with others.

It can often feel impossible to move beyond IF and SHOULD, but I think joy and hope are found in things we WILL and CAN do this year. The IFs are mostly unanswerable, and the SHOULDs are usually unbearable. But there are so many things we CAN do if we break things down, start small, look to others when we reach setbacks, and trust the process WILL continue to unfold.

*Yes this mantra is borrowed from Marvel Comics.

*Yes this mantra is borrowed from Marvel Comics.