Bay Area Parent Support Group

There is a new support group forming in Walnut Creek, CA for parents of Middle and High School age kids with Asperger's or Autism Spectrum Disorders. The first meeting is October 9, 2013, at 7 pm, at John Muir Hospital. See the flyer below for more information.  

ADHD Parent Support Group in Walnut Creek

I just got this notice, and I'm really excited that this is available to local families:

We are pleased to announce a new CHADD Parent Support Group in Walnut Creek, beginning this month. Let's start off the new school year with tips and tools to help your child be successful. 

WHAT:  

Parent Support Group (drop-in). The purpose of our group is to develop and foster positive skills for parents of children with ADHD.

WHEN:

2nd Wednesday of every month from 6:30 - 8:00pm; next meeting is Sept. 11th

   

WHERE:

Kaiser Mental Health Bldg., 710 S. Broadway, Walnut Creek  (the bldg. next to Safeway on the corner of Mt. Diablo Blvd.) 

 

CONTACT:

 Sherry Chase, Ph.D., Coordinator - 510-433-9448 - sherrychase@comcast.net 

CHADD meetings are open to the public and free to CHADD members. A $5 donation is suggested of non-members, but no one is turned away for lack of funds. Become a CHADD member here and enjoy all the benefits of CHADD membership. Visit CHADD.org for more information about ADHD. Enjoy a $10 discount if you
join or renew by 9/30/13 (promo code: chadd10off).
  

ADHD and Executive Function

Thinking of ADHD as a deficit of Executive Function (EF) offers a wealth of treatment possibilities. For clinicians, adults with ADHD, and parents of children with ADHD, this executive function conceptualization opens up a new way to organize thinking around deficits and strengths, and points the way to generating effective treatment plans. 

I recently read an excellent article from Dr. Thomas E. Brown of the Yale Clinic for Attention and Related Disorders, titled ADD/ADHD and Impaired Executive Function in Clinical Practice. In it, Brown defines ADHD as “a cognitive disorder, a developmental impairment of executive functions (EFs), the self-management system of the brain.” By stepping away from the behavioral aspects of ADHD and moving toward this cognitive understanding, treatment planning can be readily tailored to compensate for specific missing skills and abilities. I frequently direct my clients to create structure and systems which will shore up the weaker areas, allowing them to improve their performance.

                                       

In Brown’s article, he defines six areas of Executive Function Deficit. The first, called activation, includes activities required in beginning to work. Clearly, this deficit is familiar to anyone struggling with procrastination. Second, Brown defines focus, the difficulty in actually paying attention to the work at hand. Third would be effort, especially as needed to complete longer tasks. Fourth is emotional regulation. (Emotional regulation is not mentioned specifically in the symptom list in the DSM-IV or 5, but the inclusion of it in the DSM-5 was articulately argued for by Russ Barkley in his keynote to the CHADD conference.) Brown mentions memory as the fifth executive function, especially memory for more recent events, and problems in holding information. The sixth and final executive function is action, including impulsivity, pacing and taking in feedback from others. 

                                             

Russ Barkley offers both the Barkley Deficits in Executive Functioning Scale (BDEFS for Adults) and the Barkley Deficits in Executive Functioning Scale--Children and Adolescents (BDEFS-CA), which allow clinicians to evaluate client’s executive functioning in their daily life. The executive functions in the BDEFS are similar to Brown's, broken down to time management, organization and problem solving, self-restraint, self-motivation, and self-regulation of emotions. Because the BDEFS is a validated measure, results of the test can indicate exactly where individuals are struggling and what can be done to improve performance. 

For some clients, medication alone can have a huge impact, for others, therapy such as Cognitive Behavioral Therapy (CBT) can address problem areas. Many clients can benefit from a combination of medication and therapy. I've found this EF conceptualization to be especially effective in treatment planning for my clients. 

CIP's Employment and Education Panel Discussion

Today is the day to be posting about events for young adults with Asperger's, Autism Spectrum, and ADHD! As I discussed more generally in an earlier post this afternoon, supportive programs can be the key to success for young adults who are in the process of leaving high school and entering into higher education, employment, or job training.

The College Internship Program, with locations all around the country, including Berkeley, CA, is offering a free panel discussion: Thinking Positive About the Future on Wednesday, June 26, 2013, at Foothill College in Los Altos Hills, CA. CIP offers support for young adults with Asperger's, Autism Spectrum and other special needs who are transitioning beyond high school. This panels features a discussion from experts, such as employments programs and educational experts. Please visit the link for more details and to see an introductory video.

Resources for Young Adults with Autism Spectrum Disorders

In my last post, I discussed adding general supports for transitioning young adults with Asperger's or on the autism spectrum. The Transition Options Program (TOPS) in Concord, CA is a great example of this type of program. The TOPS program, through the Mount Diablo Unified School District Adult Education, (open to students in other districts as well) offers support for social, employment, education, and living skills. As they describe in their flyer:

"Social/Relationship Skills May include social stories/social thinking, communication and interaction, social/emotional behavior, relationships, problem solving, self-advocacy, stress management, managing transitions and change, support systems development, forming friendships, planning social activities.

Executive Function in Independent Living May include problem solving/decision making, navigating daily life, time management, planning for independent living, home management, personal hygiene, cooking/nutrition, healthy living, money management, banking, paperwork organization, emergency preparedness, safety.

Employability/College Readiness May include job applications and resumes, interview skills, vocational exploration, referrals, time management, organizational skills, navigating college application/registration/other processes, commitments, using personal organization technology.

Community Access & Resources accessing social, recreational, educational and therapeutic resource"

The Transition Options Program is putting on a Creativity Expo in Concord, this Friday, June 21, 2013. The TOPS Expo allows participants to showcase their creations and performances to the public. For young adults with Asperger's or ASDs, this expo is a great opportunity to learn more about the program, and for parents of ASD teens or adults, it's a chance to see what your child's peers are accomplishing.

You can read some interesting stories of the individuals behind the scenes of the expo in the Contra Costa Times.  

Resources for Young Adults on the Autism Spectrum

For so many young autistic or ADHD adults who successfully negotiate high school, there's a bump in the road right after graduation. High school is quite structured, with a clear path to follow and few exceptions made. Accommodations are laid out clearly in an IEP. (We hope!) And, almost every peer is also attending high school.

After graduation, so many adults with special needs struggle. Suddenly, that clear path of kindergarten, elementary, middle school, to high school branches out into so many options. College, junior college, year off, job training, or work? All the flexibility is wonderful, and challenging at the same time.

As an example, while peers may be headed off to a four year college, many kids on the spectrum aren't ready for that level of academic rigor, or the life skills that college demands. While a junior college may offer more appropriate academics, the course load is flexible, which can be an advantage, or can provide too little structure. When students can skip classes, or drop them, or miss assignments without anyone overseeing, students may not be able to complete the courses.

At the same time, junior colleges and job skills training programs don't offer a clear social structure. There are students of all ages living all over the region, and in all stages of life, from high school kids getting a little extra academics, to employed adults going to school at night. All that variety can make it hard for anyone to meet appropriate peers, especially for those who struggle with social skills.

For many individuals, adding in some structured support can be transformative for special needs adults. It might be a social skills group, a more structured program, or work with a therapist or coach of some sort. This structure, combined with the flexibility of post high school eduction, can be the combination that brings transitioning young adults to success. I encourage any student who is struggling with making academic and job skills progress to look for an added source of structure to add into their program. My next few blog posts will highlight a few examples.

Image attribution: By Serge Melki from Indianapolis, USA (Frozen tree branches  Uploaded by russavia) [CC-BY-2.0 (http://creativecommons.org/licenses/by/2.0)], via Wikimedia Commons

Thoughts About DSM-5 and Neurodevelopmental Disorders

It was just delivered in the mail, my brand new copy of the DSM-5. After all the reviews and discussion, I don’t think there are surprises about what’s in it, so much as questions. Some questions are potentially life changing, like: “How will the changes impact diagnosis rates?”, and “Will support services change for those previously diagnosed?” (A pressing concern for the Asperger’s community.) Other questions are less crucial, but still important to many, like: “For how many years will people use terms like Asperger’s and ADD?” (Considering that ADD, as opposed to ADHD, wasn’t even in the 1994 version, my guess is these terms will be used for a long time, especially since Europe will still use the term Asperger’s. Still, I renamed my earlier incarnation of this blog from Coach for Asperger’s as soon as I heard what the APA was planning. Other terms were already working their way out of common usage, like Intellectual Disability replacing Mental Retardation, so the DSM-5 will just move things along.)

The new DSM-5 does more than just update the mental disorder map, it seismically shifts the landscape, with ripples that impact treatments, services, insurance, and education. As an example, the new category of Social (Pragmatic) Communication Disorder is a vast unknown to clinicians like me, since I can’t predict how often I’ll see clients with that diagnosis, nor if it will be used extensively to re-diagnose those who no longer fit into other categories. Helen Tager-Flusberg, in the Simons Foundation Autism Research Initiative special report on the DSM- 5, wrote an interesting review of the history of Social (Pragmatic) Communication Disorder from a research perspective, while John Elder Robison, on his Psychology Today blog, takes his straight-forward and practical analysis and discusses the issue that “we need to make a decision about what services will support people with the new diagnosis.  Otherwise we risk doing that population a great disservice – giving them a diagnosis that leaves them nowhere, with no indicated services or therapy.”     

Simon Baron-Cohen also raises the issue of services for those with SCD, but in general praises the new DSM for its combination of social and communication symptoms into one category, as well as the addition of severity levels and intellectual impairment specifiers for autism. Within the same special report, Ari Ne’eman talks about the advantages of merging Asperger’s, PDD-NOS and Autism Spectrum, and how they could result in more school and Medicaid services for those formerly identified with Asperger’s. 

But far beyond these practical matters, are people: individuals, families, couples, from supportive self advocacy groups, like ASAN and GRASP, to parents support groups in so many communities, and even to how a wife thinks about her own husband’s emotional processing. Personal stories will be different, because of the words written in a 947 page book.  How will the new DSM-5 impact you?