Re: I failed the test....

[Guest guest]

Nope you didn't fail the test. It was "front loaded" to start with.

This is a response and "addition" to 's original post. For the moment, I'm not taking on the issue of whether a consultative examination and evaluation by a VR contracting psychologist is "definitive or not." That can come later. But see what should have gone into the evaluation that "didn't make it" is important.

First, consider the reason "why" the examination is sought, and who it serves. The VR counselors first seen suggested that a neuropsych would be helpful, and the program has money to pay for that. One of the reasons why that's done is that a neuropsych eval is pretty much routine business because VR agencies are mandated, now, to handle the most "severely impaired" applicants first. The instant case may be an example of what happens when you have an agency and agency professionals having their OWN agenda to satisfy when they refer clients out for evaluations. This also appears to be an example of the worst of what can happen when you rely on other people's motivations, unstated agendas, and professional incompetence in dealing just with the first stage of a professional consultation: the diagnosis. Where the diagnostician often goes wrong is in extending their recommendations in an evaluation where they themselves have no valid or certifiable expertise, and I'd be willing to bet dollars to doughnuts that the psychologist engaged by VR does NOT have professional board certification from either the APA for specific learning disabilities or the American Occupational Therapy Association for certification of sensory processing disorders.

This calls into question and provides the context for just the diagnosis. As and others have suggested, may have "presented" with typically understated sequellae common to higher functioning mature adult women. That's one of the reasons why new neuropsychological inventories and diagnostic scales take the "female factor" into account, and why, specifically, the Ritvo Autism/Asperger Syndrome Diagnostic Scale - Revised, was introduced over a year ago as the best and up to date predictive scale for an eventual professional DX of ASD. I use the term ASD, because the instrument's developers were careful to include criteria in the proposed DSM V language...the only scale designers yet to do so. Second, the RAADS-R was developed with an equal number of women and men "on the spectrum" so you don't have the effect of the 4:1 ratio, and a more representative sampling of women who, indeed, have received a formal diagnosis at the hands of a Ph.D., Psy D., or MD. Third, the questionnaire and scale was extensively pretested and normed on individuals in Australia, Canada, several sites in the US, and the UK, unlike ANY of the other ASD scales. While the scale's developers caution against drawing too many conclusions about the questionnaire/scale itself, they are far more rigorous in their call for post-development verification and validation than any other scale developers have been when their scales were introduced.

The RITVO RAADS-R scale can be found, in full, along with its Journal of Autism and Developmental Disability published article, at the www.aspdx.org web site by simply clicking on "research papers" and VOILA, you come upon the RAADS-R article as the first item in our link. The instrument itself is found between pages 8 and 13 of the article. Since its publication in the journal in November, 2010, its authors have gone on to other projects, but the instrument itself is currently undergoing further development (mainly in preparation of its test manual) prior to its being added to the small number of other autism predictive scales.

Second point: It may be worthwhile for to seek a diagnosis on her own, if it can be afforded, and a diagnosis from a psychologist or medical doctor highly experienced in diagnosing ASD in mature adults. If just the diagnosis "is the same" as what she's already received, perhaps it's time to stop, and focus primarily on what VR CAN provide, and what it isn't likely to provide, given the agenda of the agency,its capacity to really support a person-centered plan developed by with her counselor(s), and the realistic prospects of even benefitting at all from VR's involvement.

For guidance on how VR should be working with , her VR professionals should have in their hand and be familiar with Standifer's excellent, seminal article on VR and Autism. That guide can be found, in full at the following University of Missouri website: http://www.dps.missouri.edu/Autism/Adult%20Autism%20 & %20Employment.pdf . 's paper has been out and widely circulated for nearly two years. It has been endorsed by Wehman, Ph.D., a highly respected guru in the field of vocational rehabilitation best practices, an expert on autism and VR, and the editor of the Journal of Vocational Rehabilitation. Wehman's standing has not changed or diminished over the past years, and what he and most of his colleagues at Virginia Commonwealth University do, say, and publish on this topic is highly relevant for best practices involving mature adults. Authors who've addressed the issue of adult employment intelligently since the publication of Standifer's leading work invariably invoke it as the best possible guide for state agencies. Whether a given counselor, his or her agency, and the state training folks in that state adhere to best practices is another matter, but the guide does, indeed, present litmus test kinds of criteria to help VR clients determine whether they're dealing with a brain dead state agency. Look beyond what a state agency says it does. Look at what it actually does -- its actual outcomes, including dollar and cents figures for their hours and level of compensation -- with and for mature adults on the spectrum, and decide for yourself whether that's all there is to it. If it isn't, do something about your situation, and do it "away" from the VR process.

One note of caution: It won't pay to take the state VR agency to a fair hearing, even if it's behaving badly or in the dark ages. You'll only become involved in the tiny details of due process and finding a good legal advocate. All this will do is side-track you. Believe me. I tried it, and fair hearings just don't work. But I didn't give up or continue to "legalize" the matter. Instead, I went out and found my own community resources and providers who were interested in more than just holding onto their jobs.

Ignore the agency and go on your own way, based upon your best knowledge about yourself, and work with others in the private market. With budget limitations being so severe that every state's VR agency is on bare-bones life support via the "order of selection process," expect career civil servants to be looking only to retaining their jobs and to-hell-with-the-client's-best-interests in most circumstances. The people you're now dealing with in ALL state agencies are survivors. They've learned how to hold onto their jobs, and that's how many of them privately define their own success. As far as employment outcomes for their clients...this situation isn't likely to change soon because VR has a classic, chronic record of repeated failure with working with people who have intellectual disabilities or classical mental health issues. If anything, across the board, its failures have increased over the time VR agencies have been required to report their record of success (since FY 1992)with specific disability categories. That reporting process has been going on for twenty years, so showings of disastrous failure with state agencies isn't just a recent phenomenon.

Third. Repeat this almost like a mantra: Most consulting professionals on contract with a state agency will identify individuals more often with conditions they're familiar with, and with treatment recommendations they, themselves, provide. This applies to what has reported about her bout with a particular psychologist. If the diagnosis and the recommended "treatment" seems self-serving, you can bet it is.

Note that the two areas of concern: dyspraxia and sensory disorders, are areas of specialization the average neuropsychologist isn't trained to either identify properly or treat. Specifically, an adult specific-learning-disability, APA-board-certified specialist is required to tease out just what kind of specific learning disabilities are, indeed, involved. These folks are out there, and there's been much more development in this particular field with adult learners over the past decade than one would imagine. Stay away from specialists who only work with kiddos and adolescents. What they've found effective often does NOT work with mature adults with well-entrenched, inefficient or non-existent learning skills and practices.

Secondly, occupational therapists are the ONLY experts in sensory issues, as far as even a bare, informed recognition of sensory processing disorders, are concerned. Not neurologists, and not voodo-endorsing approaches from counselors who aren't OT's. That being said, however, be aware, that the American Occupational Therapy Association has been largely hijacked by the physical medical industry and pediatric insurance and the special education (K-12) industrial complex. The best practitioners who operate independent of physical medicine rehabilitation clinics and the K-12 public school system follow the Canadian holistic model of Occupational Therapy. The best article on this different approach than the American model can be found in the following article link: http://www.gigusa.org/hisg/resources/eg/32.pdf. There are newer papers, but this one still remains the best.

It is hard to find a truly independent practitioner really knowledgeable about sensory issues and ASD. They are out there and should be actively sought by mature adults on the spectrum. Doing so will save lots of time and casting about for unsubstantiated, expensive, flashy-but-ineffective remediation, adjustment, or "living with it better" eye-and-wallet-catchy advertisements. A good place to "start looking" is at AOTA-certified advanced degree programs in your state or region (minimum master's level) which are NOT totally beholden to the regional or state medical establishment as well as the state public school system to dictate their curriculum, steer their internships, or affect their continuing education curricula. Hard to do, but not impossible. Best person to speak with is the dean of academics at such graduate programs. Stay away from faculty or staff specializing in placement or "consumer interaction" because consumer service really means cozying up to those very negative, self-serving forces I've identified above. After all, if students can be comfortably placed in settings that satisfy a medical rehab clinic or school district's need for for cheap, unpaid labor that often operates way beyond entry-level COTA (certified OT assistant), that will happen every time unless you find a really ethical OT student holding out for a self-directed internship placement following the student's expectations of the kind of private market paying client they'll have once they graduate. One little secret they don't tell you about in graduate school is that the only way your client will have his or her insurance paid --and you get paid as a consequence - is if the OT actually works under the roof of a medical rehabiliation unit, or for the local school district. This fact alone has kept the profession largely captured by the nepharious industrial interests identified above. It has also left insurance policy holders beholden to a minimalist "restoration of minimum fuction" mantra that affects every insurance scheme's claim adjustment practices. Since many adults on the spectrum may not even HAVE a prior level of function, you can imagine how successful asking for restoration of something you've never had will be. From a private insurer, all you'll run into is a blanket practice of not paying claims of folks who have any significant form of pre-existing disability. Since you don't get ASD by falling off a turnip truck or eating a bad truffle, try to prove your way out of that bind!

So, to keep the focus just on finding effective ways out of a bind, try to avoid going the intellectual route of determining, to the "nth degree" just why your experience with a handful of professional providers hasn't worked. We could all go that route, and some of us have, but it won't help you find a career and satisfying work. All it will do is cement your feelings of justified disgust. Working positively from a negative set of reactive emotions, no matter how justified, isn't really a healthy use of one's time.

N. Meyer

Been there, done that, and somehow got out of it

I failed the test.... > >Thursday I met with the DVR counselor to learn the psychologist's >conclusions. Her take is that I do not fit the AS criteria, and can be >better explained as nonverbal learning disorder and social phobia. Okay >- maybe - although two separate counselors on the basis not of a few >hours and the WAIS, but working with me over a period of time have >concluded that I fit into Aspergers. (I'm not denying the NLD, mind; in >fact, some asper or other wrote a book in which he identified himself as >having the NLD type of AS (as opposed to technogeek).) > >What concerns me more, though, is that the recommendations have nothing >to do with NLD, really, and the dyspraxia and sensory processing issues >are not even mentioned. The psychologist is much more concerned with >treating the "social phobia" through CBT, DBT and desensitization, while >ignoring the social skills deficits which are the cause of anxiety in >social situations. It's like treating illiteracy with psychotherapy >instead of reading instruction. > >Andromeda > > >------------------------------------ > > "We each have our own way of living in the world, together we are like a symphony. >Some are the melody, some are the rhythm, some are the harmony >It all blends together, we are like a symphony, and each part is crucial. >We all contribute to the song of life." > ...Sondra > > We might not always agree; but TOGETHER we will make a difference. > > ASPIRES is a closed, confidential, moderated list. >Responsibility for posts to ASPIRES lies entirely with the original author. > Do NOT post mail off-list without the author's permission. > When in doubt, please refer to our list rules at: > http://www.aspires-relationships.com/info_rules.htm > ASPIRES ~ Climbing the mountain TOGETHER > http://www.aspires-relationships.com >

[Guest guest]

,

Some of the information in your letter here would interest Kris,

our local Autism coordinator here.   If I removed all references to and

her post, would you mind if I forwarded it to her?     It’s very interesting to

learn about how these things work overseas.   I’m sure things are a bit more

user friendly and efficient out here nowadays.

Ron.

From: aspires-relationships

[mailto:aspires-relationships ] On Behalf Of rogernmeyer@...

Sent: Monday, 7 May 2012 3:50 AM

To: aspires-relationships ;

aspires-relationships

Subject: Re: I failed the test....

Nope

you didn't fail the test. It was " front loaded " to start with.

This

is a response and " addition " to 's original post. For the

moment, I'm not taking on the issue of whether a consultative examination and

evaluation by a VR contracting psychologist is " definitive or not. "

That can come later. But see what should have gone into the evaluation that

" didn't make it " is important.

First,

consider the reason " why " the examination is sought, and who it

serves. The VR counselors first seen suggested that a neuropsych would be

helpful, and the program has money to pay for that. One of the reasons why

that's done is that a neuropsych eval is pretty much routine business because

VR agencies are mandated, now, to handle the most " severely impaired "

applicants first. The instant case may be an example of what happens when you

have an agency and agency professionals having their OWN agenda to satisfy when

they refer clients out for evaluations. This also appears to be an example of

the worst of what can happen when you rely on other people's motivations,

unstated agendas, and professional incompetence in dealing just with the first

stage of a professional consultation: the diagnosis. Where the diagnostician

often goes wrong is in extending their recommendations in an evaluation where

they themselves have no valid or certifiable expertise, and I'd be willing to

bet dollars to doughnuts that the psychologist engaged by VR does NOT

have professional board certification from either the APA for specific

learning disabilities or the American Occupational Therapy Association for

certification of sensory processing disorders.

This

calls into question and provides the context for just the diagnosis. As

and others have suggested, may have " presented " with typically

understated sequellae common to higher functioning mature adult women. That's

one of the reasons why new neuropsychological inventories and diagnostic scales

take the " female factor " into account, and why, specifically, the

Ritvo Autism/Asperger Syndrome Diagnostic Scale - Revised, was introduced over a

year ago as the best and up to date predictive scale for an eventual

professional DX of ASD. I use the term ASD, because the instrument's developers

were careful to include criteria in the proposed DSM V language...the only

scale designers yet to do so. Second, the RAADS-R was developed with an equal

number of women and men " on the spectrum " so you don't have the

effect of the 4:1 ratio, and a more representative sampling of women who,

indeed, have received a formal diagnosis at the hands of a Ph.D., Psy D., or

MD. Third, the questionnaire and scale was extensively pretested and normed on

individuals in Australia, Canada, several sites in the US, and the UK, unlike

ANY of the other ASD scales. While the scale's developers caution against

drawing too many conclusions about the questionnaire/scale itself, they are far

more rigorous in their call for post-development verification and validation

than any other scale developers have been when their scales were introduced.

The

RITVO RAADS-R scale can be found, in full, along with its Journal of Autism and

Developmental Disability published article, at the www.aspdx.org web site by simply clicking on

" research papers " and VOILA, you come upon the RAADS-R article as the

first item in our link. The instrument itself is found between pages 8 and 13

of the article. Since its publication in the journal in November, 2010, its

authors have gone on to other projects, but the instrument itself is currently

undergoing further development (mainly in preparation of its test manual) prior

to its being added to the small number of other autism predictive scales.

Second

point: It may be worthwhile for to seek a diagnosis on her own, if it

can be afforded, and a diagnosis from a psychologist or medical doctor highly

experienced in diagnosing ASD in mature adults. If just the diagnosis " is

the same " as what she's already received, perhaps it's time to stop, and

focus primarily on what VR CAN provide, and what it isn't likely to provide,

given the agenda of the agency,its capacity to really support a person-centered

plan developed by with her counselor(s), and the realistic prospects of even

benefitting at all from VR's involvement.

For

guidance on how VR should be working with , her VR professionals

should have in their hand and be familiar with Standifer's excellent,

seminal article on VR and Autism. That guide can be found, in full at the

following University of Missouri website: http://www.dps.missouri.edu/Autism/Adult%20Autism%20 & %20Employment.pdf .

's paper has been out and widely circulated for nearly two years. It has

been endorsed by Wehman, Ph.D., a highly respected guru in the field of

vocational rehabilitation best practices, an expert on autism and VR, and the

editor of the Journal of Vocational Rehabilitation. Wehman's standing has

not changed or diminished over the past years, and what he and most of

his colleagues at Virginia Commonwealth University do, say, and publish on

this topic is highly relevant for best practices involving mature adults.

Authors who've addressed the issue of adult employment intelligently since the

publication of Standifer's leading work invariably invoke it as the best

possible guide for state agencies. Whether a given counselor, his or her

agency, and the state training folks in that state adhere to best practices is

another matter, but the guide does, indeed, present litmus test kinds of criteria

to help VR clients determine whether they're dealing with a brain dead

state agency. Look beyond what a state agency says it does. Look at what it

actually does -- its actual outcomes, including dollar and cents figures

for their hours and level of compensation -- with and for mature adults on

the spectrum, and decide for yourself whether that's all there is to it. If it

isn't, do something about your situation, and do it " away " from the

VR process.

One

note of caution: It won't pay to take the state VR agency to a fair hearing,

even if it's behaving badly or in the dark ages. You'll only become involved in

the tiny details of due process and finding a good legal advocate. All this

will do is side-track you. Believe me. I tried it, and fair hearings just don't

work. But I didn't give up or continue to " legalize " the matter.

Instead, I went out and found my own community resources and providers who were

interested in more than just holding onto their jobs.

Ignore

the agency and go on your own way, based upon your best knowledge about

yourself, and work with others in the private market. With budget limitations

being so severe that every state's VR agency is on bare-bones life support via

the " order of selection process, " expect career civil servants to be

looking only to retaining their jobs and

to-hell-with-the-client's-best-interests in most circumstances. The people

you're now dealing with in ALL state agencies are survivors. They've learned

how to hold onto their jobs, and that's how many of them privately define their

own success. As far as employment outcomes for their clients...this situation

isn't likely to change soon because VR has a classic, chronic record of

repeated failure with working with people who have intellectual disabilities or

classical mental health issues. If anything, across the board, its failures

have increased over the time VR agencies have been required to report their

record of success (since FY 1992)with specific disability categories. That

reporting process has been going on for twenty years, so showings of disastrous

failure with state agencies isn't just a recent phenomenon.

Third.

Repeat this almost like a mantra: Most

consulting professionals on contract with a state agency will

identify individuals more often with conditions they're familiar with, and

with treatment recommendations they, themselves, provide. This

applies to what has reported about her bout with a particular

psychologist. If the diagnosis and the recommended " treatment " seems

self-serving, you can bet it is.

Note

that the two areas of concern: dyspraxia

and sensory disorders, are areas of specialization the average

neuropsychologist isn't trained to either identify properly or treat.

Specifically, an adult specific-learning-disability, APA-board-certified

specialist is required to tease out just what kind of specific learning

disabilities are, indeed, involved. These folks are out there, and there's been

much more development in this particular field with adult learners over the

past decade than one would imagine. Stay away from specialists who only work

with kiddos and adolescents. What they've found effective often does NOT work

with mature adults with well-entrenched, inefficient or non-existent learning

skills and practices.

Secondly,

occupational therapists are the ONLY experts in sensory issues, as far as even

a bare, informed recognition of sensory processing disorders, are

concerned. Not neurologists, and not voodo-endorsing approaches from

counselors who aren't OT's. That being said, however, be aware, that the

American Occupational Therapy Association has been largely hijacked by the

physical medical industry and pediatric insurance and the special education

(K-12) industrial complex. The best practitioners who operate independent of physical

medicine rehabilitation clinics and the K-12 public school system follow the

Canadian holistic model of Occupational Therapy. The best article on this

different approach than the American model can be found in the following

article link: http://www.gigusa.org/hisg/resources/eg/32.pdf.

There are newer papers, but this one still remains the best.

It

is hard to find a truly independent practitioner really knowledgeable about

sensory issues and ASD. They are out there and should be actively sought by

mature adults on the spectrum. Doing so will save lots of time and casting

about for unsubstantiated, expensive, flashy-but-ineffective remediation,

adjustment, or " living with it better " eye-and-wallet-catchy

advertisements. A good place to " start looking " is at AOTA-certified

advanced degree programs in your state or region (minimum master's level) which

are NOT totally beholden to the regional or state medical establishment as well

as the state public school system to dictate their curriculum, steer their

internships, or affect their continuing education curricula. Hard to do, but

not impossible. Best person to speak with is the dean of academics at such

graduate programs. Stay away from faculty or staff specializing in placement or

" consumer interaction " because consumer service

really means cozying up to those very negative, self-serving forces I've

identified above. After all, if students can be comfortably placed in settings

that satisfy a medical rehab clinic or school district's need for for

cheap, unpaid labor that often operates way beyond entry-level COTA (certified

OT assistant), that will happen every time unless you find a really ethical OT

student holding out for a self-directed internship placement following the

student's expectations of the kind of private

market paying client they'll have once they graduate. One

little secret they don't tell you about in graduate school is that the only way

your client will have his or her insurance paid --and you get paid as a

consequence - is if the OT actually works under the roof of a medical

rehabiliation unit, or for the local school district. This fact alone has kept

the profession largely captured by the nepharious industrial interests identified

above. It has also left insurance policy holders beholden to a minimalist

" restoration of minimum fuction " mantra that affects every insurance

scheme's claim adjustment practices. Since many adults on the spectrum may not

even HAVE a prior level of function, you can imagine how successful asking for

restoration of something you've never had will be. From a private insurer, all

you'll run into is a blanket practice of not paying claims of folks who have

any significant form of pre-existing disability. Since you don't get ASD by

falling off a turnip truck or eating a bad truffle, try to prove your way out

of that bind!

So, to keep the focus just on finding effective ways out of a bind, try to

avoid going the intellectual route of determining, to the " nth

degree " just why your experience with a handful of professional providers

hasn't worked. We could all go that route, and some of us have, but it won't

help you find a career and satisfying work. All it will do is cement your

feelings of justified disgust. Working positively from a negative set of

reactive emotions, no matter how justified, isn't really a healthy use of one's

time.

N. Meyer

Been there, done that, and somehow got out of it

I failed the test....

>

>Thursday I met with the DVR counselor to learn the psychologist's

>conclusions. Her take is that I do not fit the AS criteria, and can be

>better explained as nonverbal learning disorder and social phobia. Okay

>- maybe - although two separate counselors on the basis not of a few

>hours and the WAIS, but working with me over a period of time have

>concluded that I fit into Aspergers. (I'm not denying the NLD, mind; in

>fact, some asper or other wrote a book in which he identified himself as

>having the NLD type of AS (as opposed to technogeek).)

>

>What concerns me more, though, is that the recommendations have nothing

>to do with NLD, really, and the dyspraxia and sensory processing issues

>are not even mentioned. The psychologist is much more concerned with

>treating the " social phobia " through CBT, DBT and

desensitization, while

>ignoring the social skills deficits which are the cause of anxiety in

>social situations. It's like treating illiteracy with psychotherapy

>instead of reading instruction.

>

>Andromeda

>

>

>------------------------------------

>

> " We each have our own way of living in the world, together we are

like a symphony.

>Some are the melody, some are the rhythm, some are the harmony

>It all blends together, we are like a symphony, and each part is crucial.

>We all contribute to the song of life. "

> ...Sondra

>

> We might not always agree; but TOGETHER we will make a difference.

>

> ASPIRES is a closed, confidential, moderated list.

>Responsibility for posts to ASPIRES lies entirely with the original author.

> Do NOT post mail off-list without the author's permission.

> When in doubt, please refer to our list rules at:

> http://www.aspires-relationships.com/info_rules.htm

> ASPIRES ~ Climbing the mountain TOGETHER

> http://www.aspires-relationships.com

>