Category Archives: Practice

Social/Emotional Evaluations: Unraveling the ED/SM Dilemma
Part 2

Last week, we presented the first part of a two-part series on unraveling the ED/SM dilemma. This week, we talk to the experts on how to use various assessments to evaluate emotional disturbance and social maladjustment.

Catch up on last week’s blog here.

School staff members often have difficulties when it comes to assessing a student who may have emotional disturbance (ED), and getting hard data to back up the decision can be just as difficult. PAR spoke with experts in the field about the use of various instruments that have proven to be useful in gathering the hard data needed in order to make an informed decision about ED eligibility.

Behavior Rating Inventory of Executive Function, Second Edition (BRIEF2)

Peter K. Isquith, PhD, is a practicing developmental school neuropsychologist and instructor in psychiatry at Harvard Medical School. He’s the coauthor of the BRIEF2, the new BRIEF2 Interpretive Guide, and the Tasks of Executive Control (TEC).

PAR: Why would it be helpful to include a measure of executive functioning in the assessment of a student being evaluated for an ED eligibility?

PI: In general, the purpose of including the BRIEF2 when asking about ED is to know whether or not the child actually has an emotional disturbance or if his or her self-regulation gives that appearance. So, if a child is referred who has frequent severe tantrums, we want to know if this is an emotional disturbance or if it is part of a broader self-regulatory deficit. That is, is the child melting down because he or she truly experiences emotional distress? Or is he or she doing so because of poor global self-regulation? To answer this, I would want to look at two things:
Is there evidence of an actual emotional concern? Does the child exhibit mood problems, anxiety, or other emotional issues?
And does the child’s self-regulation have an impact on other domains, including attention, language, and behavior? That is, is he or she physically, motorically, attentionally, and/or verbally impulsive or poorly regulated?

If the first answer is yes, then there is likely an emotional disturbance. But if it is no, then there may be a self-regulatory issue that is more broad. By using the BRIEF2, clinicians can quickly learn if a student is impulsive or poorly regulated in other domains, not just emotionally. A BRIEF2 profile with high Inhibit and Emotional Control scales suggests that the child is more globally disinhibited. If it is primarily the Emotional Control scale that’s elevated, and there is an emotional concern like mood problems, then it may be more of an emotional disturbance.

Pediatric Behavior Rating Scale (PBRS)

Richard Marshall, EdD, PhD, is an associate professor in the Department of Educational and Psychological Studies in the College of Education at the University of South Florida. He is also an adjunct associate professor in the Department of Psychiatry and Behavioral Neurosciences at the USF College of Medicine. In addition to the PBRS, published in 2008, he is the author of 2011’s The Middle School Mind: Growing Pains in Early Adolescent Brains.

PAR: How does the PBRS fit into the diagnosis of ED?

RM: Two gaps in practice prompted us to develop the PBRS. The first was that the assessment instrument available at the time had few if any items about rage attacks, irritability, assaultive aggression, and other symptoms associated with early onset bipolar disorder. Hence, despite significantly abnormal behaviors, results of assessments were often within normal limits because they failed to capture symptoms of interest. So, our first goal was to include these new behaviors into parent and teacher ratings.

A second problem was that symptom overlap between ADHD and early onset bipolar disorder made it difficult to differentiate ADHD and bipolar disorder. The problem is that the standard treatment for ADHD, stimulant medication, induces mania in individuals with bipolar disorder. Thus, diagnosis accuracy is paramount.

What we learned during the PBRS norming sample was that students with ADHD and bipolar disorder produce a similar pattern of scores, but students with bipolar disorder produce a higher level of scores. That is, both groups have similar symptoms, but individuals with bipolar disorder have more serious symptoms. Thus, the PBRS can assist clinicians in differentiating individuals with mood disorders from those with ADHD.

PAR: Decades of research in cognitive neuroscience, combined with changes in our understanding and classification of mental illness in children, impels us to continually reevaluate theory and practice. Formulated more than a half-century ago, the idea of social maladjustment is one of those policies in desperate need of revision. In 1957, the idea of being able to identify students who were socially maladjusted may have seemed reasonable.

RM: There are two problems with this idea. First, the government has never defined social maladjustment, and states (and practitioners) have been left without clear ways of differentiating students who are or are not socially maladjusted. Second, without a clear definition, the concept of social maladjustment has created what Frank Gresham refers to as a “false dichotomy” that is used to exclude students from receiving interventions that would help them and to which they are entitled.

Emotional Disturbance Decision Tree (EDDT)

Bryan Euler, PhD, author of the EDDT as well as the EDDT Parent Form and the new EDDT Self-Report Form, has a background in clinical and counseling psychology, special education, and rehabilitation counseling. He has 27 years of experience as a school psychologist working in urban and rural settings with multicultural student populations.

PAR: Can you describe the overall benefits of the EDDT system and what makes it unique from other instruments?

BE: The EDDT series was designed to map directly onto the IDEA criteria for emotional disturbance, which are different from and broader than constructs such as depression or conduct. The federal criteria are, some might say, unfortunately wide and “fuzzy,” rather than clean-cut. The EDDT scales are written to address these broad domains thoroughly and help school psychologists apply the unwieldy criteria.

The EDDT also includes a social maladjustment scale (SM). Since students who are only SM are not ED eligible, the EDDT is useful in ruling out these students and in identifying those for whom both conditions may be present. This can be helpful with program decisions, so children or adolescents who are primarily “fragile” are not placed in classrooms with those who have both depression/anxiety and severe aggression.

The EDDT also has an Educational Impact scale, which helps to document that the student’s social-emotional and behavioral issues are having educational effects, which IDEA requires for eligibility. All of the EDDT forms include a Severity scale, which helps to gauge this and guide service design.

The EDDT Parent and Self-Report forms also include Resiliency and Motivation scales, which help to identify a student’s strengths and determine what may most effectively modify his or her behavior. The presence of all these factors in the EDDT scales is intended to facilitate the actual practice of school psychology with ED and related problems.

PAR: Why is it important to have multiple informants as part of an evaluation?

BE: Having multiple informants is, in effect, one way of having multiple data sources. Multiple data sources add incremental validity, or accuracy, to evaluations as well as breadth of perspective. A rough analogy might be to lab tests, which are often done in panels, or multiples, rather than in singles, to help with insight, efficiency, and decisions.

PAR: What are the benefits of having the student perspective as part of an evaluation with multiple informants?

BE: Having a student’s perspective on his or her behavior and social-emotional adjustment is a critical but sometimes overlooked component of assessment, especially for ED and ADHD evaluations. If only teacher anecdotal reports, teacher-completed ratings, and behavior observations are used, this vastly increases the chance that the evaluation will be skewed toward externalized behavior like aggression and rule-breaking. Internal factors such as depression or anxiety, which may be causing the behavior, will be deemphasized, if noted at all. Research corroborates that if teachers rate a student, and ratings are also obtained from the parent and the child, the teacher results tend to highlight difficult, disruptive behavior, while other ratings may result in other insights. Relatedly, in children and adolescents, depression is often primarily manifest in irritability or anger rather than sadness. If there is no observable sadness and only problem behavior, teacher ratings may understandably focus on what stands out to them and complicates classroom management.

Even if students minimize their depression, anxiety, or social problems, they do sometimes rate one or more of these as “at risk.” This can provide a window into subjective emotional pain that may otherwise be obscured. Finally, gathering student-derived data enhances school psychology professional practice. Psychologists who complete child custody or juvenile corrections evaluations gather data directly from the child to facilitate insight, which can also aid in school psychology.

Adolescent Anger Rating Scale (AARS)

Darla DeCarlo, Psy S, has been a clinical assessment consultant with PAR for nine years. She is a licensed mental health counselor and certified school psychologist in the state of Florida.

PAR: Can you speak about your use of the AARS in ED evaluations?

DD: Within the context of assessing those students referred for behavior-related evaluations, I found the AARS to be a great compliment to the various other instruments I used during the evaluation process. Making an ED determination is a sensitive issue, and I wanted as much hard data as possible to help me make a well-informed decision. The AARS allowed me to assess a student’s level of anger and his or her response to anger through a self-report. Limited instruments are able to give clinicians information that can help them look at the ED/SM issue. The AARS helped me identify students who were at risk for diagnoses of conduct disorder, oppositional defiant disorder, or ADHD. Combine these results with results on the EDDT and other instruments, and I was able to get a good picture (not to mention some hard data) on whether SM factored into the student’s issues.

PAR: What about interventions? Does the AARS help with that in any way?

DD: Anger control, as defined by the AARS, “is a proactive cognitive behavioral method used to respond to reactive and/or instrumental provocations. Adolescents who display high levels of anger control utilize the cognitive processes and skills necessary to manage anger related behaviors.”

What I liked about the instrument is that it qualifies the type of anger the student is displaying and then gives the clinician information about whether or not the student displays anger control or even has the capacity for anger control. As a school psychologist, I needed to know if the student already had the skills to follow through with some of the possible interventions we might put in place or if we needed to teach him or her some skills before attempting the intervention. For example, something as simple as telling a student to count to 10 or walk away when he or she feels anger escalating may seem like an easy task, but not all students recognize the physiological symptoms associated with their outbursts. Therefore, asking them to recognize the symptoms and then act by calming themselves is pointless. I have seen this mistake many times, and have made the mistake myself by suggesting what I thought was a useful and effective intervention, only to find out later that the intervention failed simply because the student did not possess the skills to perform the task. The AARS gave me information that helped guard against making this type mistake.

As with every evaluation, the instruments we choose in our assessments are important, but even the best instrument is useless without the keen skills of well-trained school staff to properly administer and interpret results with accuracy and precision.

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It’s National School Counseling Week!

The week of Feb. 6-10, 2017, is National School Counseling Week, sponsored by the American School Counselor Association. This year’s theme is “School Counseling: Helping Students Realize Their Potential.” The celebration places a spotlight on how school counselors can help students achieve school success and plan for a career.

PAR is proud to salute those who are dedicated to the task of working with children in schools across the country who devote their time and energy to this vital and important endeavor.

In the spirit of celebrating, we’d like to tell you about some new assessment products that will soon be available to help you help your students.

The Multidimensional Everyday Memory Ratings for Youth (MEMRY) is the first and only nationally standardized rating scale designed to measure everyday memory, in children, adolescents, and young adults ages 5-21 years. It measures everyday memory, learning, and executive aspects of memory in youth, including working memory.

The Reynolds Interference Task (RIT) is a Stroop-style test of complex processing speed that measures neuropsychological integrity, complex processing speed deficits, and attention across a wide age range (6-94 years). It adds a layer of cognitive processing difficulty to simple tasks, making them more complex and thus more indicative of cognitive flexibility and selective attention.

The MEMRY and RIT will be released in March.

PAR would like to thank all school counselors for the crucial work you perform every single day. Your efforts are the personification of our tagline: Creating Connections. Changing Lives.

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Using cognitive neuroscience to understand why kids struggle in school

The term dyslexia has been a part of the education lexicon for decades. When it was first “discovered” in the 1970s, there were no technological processes yet in place to prove it was a brain-based condition.

However, writes Martha Burns, PhD, in a Science of Learning blog, “psychologists, neurologists, and special educators …. assumed dyslexia [had] a neurological basis. In fact, the term ‘dyslexia’ actually stems from the Greek ‘alexia,’ which literally means ‘loss of the word’ and was the diagnostic term used when adults lost the ability to read after suffering a brain injury.”

At the time, the cause, “was deemed not important,” continues Burns. “Rather, the goal was to develop and test interventions and measure their outcomes without an effort to relate the interventions to the underlying causation.”

However, using neuroscience to pinpoint exactly why a student struggles in reading or math can help educators come up with specific and effective interventions.

School psychologist Steven G. Feifer, DEd, ABSNP, became interested in neuroscience as it relates to reading when, early in his career, he had an opportunity to evaluate a very impaired student named Jason.

“His IQ was 36,” recalls Dr. Feifer, “but he was an incredible reader.   This was pretty difficult to explain using a discrepancy model paradigm, which falsely implies that an IQ score represents a student’s potential.  I made a concerted paradigm shift, and tried to find a more scientifically rigorous explanation for Jason’s amazing skills.  This quickly led me to the research library at the National Institutes of Health (NIH).

“As it turned out, Jason was quite easy to explain,” he continues. “He had a condition called hyperlexia. After much research, I presented information about the neural mechanisms underscoring hyperlexia at Jason’s IEP meeting.  The IEP team was incredibly receptive to the information and immediately amended Jason’s IEP so he received inclusionary services in a regular fifth-grade classroom.

“Jason turned out to be the single highest speller in fifth grade. I was convinced that discussing how a child learns from a brain-based educational perspective, and not solely an IQ perspective, was the best way to understanding the dynamics of learning and inform intervention decision making.

“The following year, I enrolled in a neuropsychology training program and was fortunate enough to study with the top neuropsychologists in the country.”

Dr. Feifer, who has 19 years of experience as a school psychologist, was voted the Maryland School Psychologist of the Year in 2008 and the National School Psychologist of the Year in 2009. He is a diplomate in school neuropsychology and currently works as a faculty instructor in the American Board of School Neuropsychology (ABSNP) school neuropsychology training program.  He continues to evaluate children in private practice at the Monocacy Neurodevelopmental Center in Frederick, Maryland, and consults with numerous school districts throughout the country.

Dr. Feifer has written several books and two assessments that examine learning disabilities from a neurodevelopmental perspective—the Feifer Assessment of Reading (FAR) and the Feifer Assessment of Mathematics (FAM).

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The Growing Field of Telepsychology

In every area imaginable, technology has paved the way for innovations that make life more convenient—from the first television, to the microwave oven, to smartphones, the list is constantly growing. And the field of mental health is no exception. People who desire to speak with a psychologist can now do so from the comfort of their homes. Telepsychology is a method of therapy that provides psychological services using technology such as telephone, e-mail, online chat, text, and videoconferencing.

Telepsychology allows more flexibility, increasing access between doctor and patient because the session isn’t limited to face-to-face visits. However, questions remain as to its legitimacy and effectiveness. In response to these questions, the American Psychological Association (APA) has prepared eight guidelines to educate psychologists and their patients regarding the opportunities and challenges to using telepsychology. The guidelines were developed by the Joint Task Force for the Development of Telepsychology Guidelines for Psychologists, established by the following three entities: The APA, the Association of State and Provincial Psychology Boards, and the APA Insurance Trust.

The guidelines for psychologists using telepsychology are as follows:

Guideline #1: The Competence of the Psychologist – Take appropriate trainings to ensure they are competent to use the technology and that they tailor the technology to the needs of the patient.

Guideline #2: Standards of Care in the Delivery of Telepsychology Services – Ensure the same ethical and professional standards of care are followed as when providing in-person services.

Guideline #3: Informed Consent – Obtain consent, following applicable laws, regulations, and requirements that specifically address the unique concerns related to providing telepsychology services.

Guideline #4: Confidentiality of Data and Information – Protect and maintain the confidentiality of patient data and inform patients of any potential risk in loss of confidentiality due to the use of telecommunication.

Guideline #5: Security and Transmission of Data and Information – Ensure security measures are in place to protect data from unintended access or disclosure.

Guideline #6: Disposal of Data and Information and Technologies – Dispose of data and the technologies used to prevent unauthorized access and dispose data safely and appropriately.

Guideline #7: Testing and Assessment – Consider the unique limitations inherent in administering tests and assessments that are normally designed to be implemented in person.

Guideline #8: Interjurisdictional Practice – Comply with all relevant laws and regulations when providing telepsychology services across jurisdictional and international borders.

These guidelines are intended to offer the best guidance for incorporating telecommunication technology into the doctor/patient relationship. As telepsychology evolves, these guidelines can help psychologists to provide their telepsychology clients with the same level of professionalism as their in-person clients.

Do you use telepsychology in your practice? What tips can you share? PAR wants to hear from you, so leave a comment and join the conversation!

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Assessing Gifted Students: An Interview with Cecil R. Reynolds (Part 2)

Cecil R. Reynolds, co-author of the Reynolds Intellectual Assessment Scales (RIAS) and recently revised RIAS-2, is one of the leaders in the field of gifted assessment. The following is part two of a two-part interview conducted with Dr. Reynolds concerning the use of assessments in gifted and talented programs. Did you miss part one of this series? Click here.

Q: What originally prompted you to design an assessment for gifted identification?

CR: To reduce the confounds present in most traditional measures of intelligence. We wanted to have better instrumentation for identifying the intellectually gifted using methods that are less influenced by culture than most tests—the RIAS is not “culture-free,” nor do such psychological tests exist, and the desirability of a culture-free test is questionable conceptually as well. We live in societies, not in isolation. That said, confounds such as motor coordination, especially fine motor coordination and speed, interpretation of directions that have cultural salience, and even short-term memory can all adversely influence scores on intelligence tests, and these variables are not associated strongly with general intelligence. For programs that seek to identify intellectually gifted individuals, the RIAS and now RIAS-2 are strong choices.

Q: The RIAS (and now RIAS-2) has been one of the most popular and widely used assessment instruments for gifted testing. Is the instrument useful for other types of assessments?

CR: The RIAS-2 is useful any time an examiner needs a comprehensive assessment of intelligence, especially one that is not confounded by motor speed, memory, and certain cultural issues. When understanding general intelligence, as well as crystallized and fluid intellectual functions, are important to answering referral questions, the RIAS-2 is entirely appropriate.

Q: What makes the RIAS-2 unique from the previous version?

The unique feature of the RIAS-2 is the addition of a co-normed Speeded Processing Index (SPI). It is greatly motor-reduced from similar attempts to measure processing speed on other more traditional, lengthy intelligence batteries. In keeping with the original philosophy of the RIAS, we do not recommend, but do allow, examiners to use this SPI as a component of the Intelligence Indexes, and we worked very hard to reduce the motor-confounds that typically plague attempts to assess processing speed.

Q: Originally there were no processing speed subtests on the RIAS. Why is that?

CR: Processing speed represents a set of very simple tasks that by definition anyone should be able to perform with 100% correctness if given sufficient time. This conflicts with our view of intelligence as the ability to think and solve problems. Processing speed correlates with few variables of great interest as well—it is a poor predictor of academic achievement, and tells us little to nothing about academic or intellectual potential. It is useful in screening for attentional issues, performance of simple tasks under time pressures, and coordination of simple brain systems, and as such can be useful especially in screening for neuropsychological issues that might require follow up assessment, but processing speed tasks remain poor estimates of intelligence.

Many RIAS users asked us to undertake the development of a motor-reduced set of processing speed tasks. Students who ask for extended time as an accommodation on tests are often required by the determining agency to have scores form some timed measures as well, and we felt we could derive a more relevant way of providing this information without the motor issues being as salient as a confound. The ability to contrast such performance with measured intelligence is important to this decision-making process.

Q: What advice do you have for psychologists and diagnosticians when it comes to assessing a student for giftedness?

CR: When choosing assessments to qualify students for a GT program, be sure you understand the goals of the program and the characteristics of the students who are most likely to be successful in that program. Then, choose your assessments to measure those characteristics so you have the best possible match between the students and the goals and purposes of the GT program.

 

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Assessing Gifted Students: An Interview with Cecil R. Reynolds (Part 1)

Cecil R. Reynolds, co-author of the Reynolds Intellectual Assessment Scales (RIAS) and recently revised RIAS-2, is one of the leaders in the field of gifted assessment. The following is part one of a two-part interview conducted with Dr. Reynolds concerning the use of assessments in gifted and talented programs.

Q: Theoretically speaking, what do you believe would be the most effective way to identify a gifted student?

Cecil Reynolds: I am often asked what tests or other processes should be used to identify children for participation in a gifted and talented program in the schools. My answer is almost always something along the lines of “What are the goals of the program itself?” and “What are the characteristics of the children you wish to identify?” The most important thing we can do is match the children to the program so they have the highest likelihood of success. So, for example, if the program is intended to promote academic achievement among the most academically able students in the school, I would recommend a very different selection process and different tests than if the program was intended to take the most intellectually talented students in the school and provide them with a challenging, engaging curriculum that would enrich their school experience, motivate them to achieve, and allow them to fall in love with something and pursue it with passion. While the students in these programs would overlap, the two groups would not be identical and certainly the academic outcomes would not be the same. But, the point is that we must know what characteristics we need to assess to identify and to place students in programs where they will be successful, and that requires us to first know what it is our program is intended to do.

Q: What are some of the challenges that psychologists and diagnosticians face when attempting to identify a gifted student accurately?

CR: Regardless of the program and its goals for students, the tremendous diversity in the American schools is our greatest challenge. We have an obligation to be fair, and just, and to promote the best in all children, and that is our intention. However, no schools in any country serve the range of backgrounds and abilities such as are served in our schools. The demands upon school staff to be culturally competent in so many areas, and to devise methods of teaching and accurate measures of intelligence, academic outcomes, behavioral outcomes, and school success generally, and to understand and to motivate such a wide array of eager young minds, are just incredible and require a commitment from the school board on down to the teacher aides. Maintaining this commitment and acquiring these competencies are undoubtedly staunch challenges to us all. These challenges can be magnified in the domain of gifted education because how “giftedness” is defined and valued may vary tremendously from one cultural group to another. The biggest concerns I hear from practitioners and diagnosticians center around the lack of proportionate representation of some ethnic minority groups in GT programs and how it can change assessment practices to overcome these issues. The RIAS and RIAS-2 are well suited to assist in identifying more minority students for GT programs since the minority-white differences on mean scores on the RIAS and now RIAS-2 are smaller by about half the differences seen on most traditional intelligence batteries.

Q: A lot has been written about the idea that just because a student has been identified as academically gifted, it does not mean he or she will be successful. Identifying them is simply step one. What things do you find tend to hinder their progress in our schools?

CR: Often it is the mismatch between the program and the student. It is hard to overemphasize the importance of the match between the program goals and methods of achieving them and the students in the program and their characteristics. We simply have to get the right students into the right programs. We also have to attend to students’ motivation to achieve academically as well as focus on study skills, time management, organization skills, listening skills, and other non-intellective factors that go into academic learning. IQ generally only accounts for less than 50% of the variance on academic achievement, and that is one of the many reasons we also developed the School Motivation and Learning Strategies Inventory (SMALSI). Just because a student is bright does not mean he or she knows how to study and learn, has good test-taking skills, or is motivated to engage in school learning—we should assess these variables as well and intervene accordingly.

Come back next week for the second part of this interview!

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Is Hypnosis Useful for Retrieving Lost Memories?

Among academics and mental health professionals, there is a widespread belief that hypnosis has the power to retrieve lost memories. In 1980, Elizabeth and Geoffrey Loftus found that 84% of psychologists and 69% of non-psychologists endorsed the statement that “memory is permanently stored in the mind” and that “with hypnosis, or other specialized techniques, these inaccessible details could eventually be recovered.”

The idea of whether people can truly forget traumatic memories has been debated for years. Early psychologists and psychiatrists such as Sigmund Freud, Joseph Breuer, and Pierre Janet also endorsed the memory-enhancing powers of hypnosis. In addition, belief in the power of hypnosis has spilled over into the mainstream with the help of TV shows, movies, and books. However, experts in general agree that “hypnosis either has no effect on memory or that it can impair and distort recall.” While people can certainly remember events they haven’t thought about for years, the issue at question is whether a special mechanism of repression exists that accounts for the forgetting of traumatic experiences.

While there are many reports of people who seem to have recovered memories of abuse through hypnosis, David Holmes reviewed 60 years of research and found no convincing laboratory evidence for repression. In his book, Remembering Trauma, psychologist Richard McNally concludes that repressed memories are “a piece of psychiatric folklore devoid of convincing empirical support.” In addition, McNally gives an alternate explanation for the recovery of repressed memories: “Children may be more confused than upset by sexual advances from a relative, yet years later recall the event with revulsion as they realize that it was, in fact, an instance of abuse.”

People sometimes forget significant life events, such as accidents and hospitalizations, even a year after they occur; therefore, a delay in the recall of events isn’t unusual. While hypnosis may not be the magic potion that uncovers traumatic memories, not all uses of hypnosis are scientifically problematic. Controlled research evidence suggests that hypnosis may be useful in pain management, treating medical conditions, eliminating habits such as smoking addiction, and as therapy for anxiety, obesity, and other conditions. Memories recalled even decades later aren’t necessarily false; however, it shouldn’t be assumed that recovered memories are valid unless corroborating evidence exists.

What do you think? Is hypnosis the real deal? PAR wants to hear from you, so leave a comment and join the conversation!

 

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A Visual Representation of the Autism Spectrum

The story of autism spectrum disorder has always been told largely through statistics. Professionals speak of the costs to families of autistic children, the earliest age for diagnoses, and the percentage of children who develop the disorder. Many people have heard the term autism but don’t really know what it means because the statistics can’t fully convey what it means to be autistic.

Autism spectrum disorder is difficult to explain and grasp because it’s a very wide spectrum. According to psychologist Kathleen Platzman, “We need an educational model wide enough to take in the whole spectrum. That means it’s going to have to be a fairly broad model.”

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) proposes three levels of severity for autism spectrum disorder, which is meant to describe its impact on everyday functioning. Individuals who require “very substantial support” are rated level 3; those who require “substantial support” are rated level 2; and those who require “support” are rated level 1. While these ratings provide important information, they don’t do a lot to help visualize the complexities of the disorder.

Michael McWatters is a designer and UX Architect at TED, the organization responsible for TED Talks and various other initiatives. He’s also the father of a boy with autism spectrum disorder. When his son was diagnosed, McWatters wanted to know where he fell on the spectrum, but quickly became frustrated by the lack of an accurate visual representation of the disorder. He had envisioned the spectrum as a straight line that looks something like this:

Autism image

Was his son’s condition mild, severe, or somewhere in between? It seemed overly simplistic. But then McWatters had a revelation—the spectrum isn’t a single line or flat continuum at all! So he decided to create his own diagram, basing his visualization on the three generally accepted axes for the disorder: social, communication, and behavioral.

autism-disorder1 (1)

In his visualization, the greater the impairment on any of the three axes, the further the point moves away from the center. This visualization of the symptoms acknowledges the dimensionality of the disorder in a way a simple spectrum line cannot.

We had the opportunity to speak with McWatters. He indicated that this is just the beginning of his efforts and that he views this as an experimental project. He is currently working with two leading autism researchers to revise his visualization to align more closely with DSM-5 and hopes to find a way to demonstrate both the strengths and deficits associated with autism.

For Michael McWatters, autism spectrum disorder can’t be reduced to statistics and percentages—it’s deeply personal. “People have responded very positively to this visualization,” he says, “and I think it’s because it not only provides a more accurate view of autism, it demonstrates just how unique each person on the spectrum is.”

You can learn more about Michael and his son on his Web site, ASDDad. We’re looking forward to his new discoveries and the graphic representation that he will create as a result.

What do you think? PAR wants to hear from you, so leave your comments below.

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The Importance of Properly Diagnosing Early Onset Bipolar Disorder

Although early onset bipolar disorder (EOBD) was first described in 150 AD, the diagnosis remains surrounded in controversy because no such diagnosis exists. A person either meets the criteria for bipolar disorder set forth in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) or not. The problem is that, as with DSM-IV, the criteria describe bipolar disorder as it exists in adults. The child phenotype differs markedly from adult onset bipolar disorder. Children with this disorder exhibit a more chronic form of irritability, more rapid mood swings, intense emotional outbursts, and impulsive aggression.

An additional complication when making the diagnosis in children is that most of the symptoms associated with EOBD also exist in ADHD, OCD, and ASD. Moreover, children with EOBD also have high rates of comorbid conditions.

Though it was hoped that DSM-5 would resolve the main concerns, the following issues remain unaddressed:

  1. Technically, EOBD diagnosis still does not exist.
  2. Teens and children must meet adult criteria to be diagnosed as bipolar.
  3. Many children who would have received a diagnosis of bipolar disorder prior to the publication of DSM-5 will now receive a diagnosis of disruptive mood dysregulation disorder (DMDD).

Despite the hope for some consensus, experts in the field have yet to reach agreement on (a) what symptoms constitute the core features of EOBD, (b) how to differentiate bipolar disorder from other childhood disorders, and (c) how best to manage children who have the disorder.

When Drs. Richard M. Marshall and Berney J. Wilkinson began seeing children who exhibited severe symptoms of bipolar disorder, they used omnibus rating scales as part of their initial diagnostic assessment. To their surprise, many of the scales completed by parents and teachers had ratings in the normal range even though the children had symptoms of bipolar disorder. An item analysis revealed that existing rating scales did not contain a sufficient number of items associated with the disorder. To address these shortcomings, Marshall and Wilkinson developed the Pediatric Behavior Rating Scale (PBRS), a standardized, norm-referenced parent and teacher rating scale for use with children ages 3 to 18 years.

Rather than providing specific diagnoses, the PBRS enables clinicians to identify the core features of EOBD, thereby serving as the critical first step in differential diagnosis and intervention planning. The PBRS provides clinical researchers with another tool to assist in (a) defining this disorder, (b) differentiating EOBD from related disorders, and (c) evaluating the efficacy of interventions aimed at alleviating its symptoms.

Approximately 20% of our nation’s 50 million K–12 students meet diagnostic criteria for a mental disorder, and 10% experience significant functional impairments at home, at school, and with peers. Nevertheless, children exhibiting such symptoms are often punished for willful disobedience rather than receiving effective treatment. In fact, 80% of children with mental illness remain undiagnosed and untreated, resulting in increased risk for suicide, school failure, and criminal behavior. Accurate differential diagnoses of EOBD and related disorders is the key to effective interventions.

Unless otherwise cited, source material is attributed to:
Marshall, M. M., & Wilkinson, B. J. (2008). Pediatric Behavior Rating Scale. Lutz, FL: PAR.

What do you think? PAR wants to hear from you, so leave a comment and join the conversation!

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Explore the Mysteries of the Brain

In April 2013, President Obama announced the BRAIN (Brain Research through Advancing Innovative Neurotechnologies) Initiative. During the speech, he said, “We have a chance to improve the lives of not just millions, but billions of people on this planet through the research that’s done in this BRAIN Initiative alone.”

The BRAIN Initiative’s purpose is to help researchers better understand brain disorders such as Alzheimer’s and Parkinson’s diseases, depression, and traumatic brain injury. It will allow researchers to produce dynamic pictures of how the brain records, processes, uses, stores, and retrieves vast quantities of information and shed light on the complex links between brain function and behavior.

According to National Institutes of Health (NIH) Director Francis S. Collins, “The human brain is the most complicated biological structure in the known universe. We’ve only just scratched the surface in understanding how it works—or, unfortunately, doesn’t quite work when disorders and disease occur… This is just the beginning of a 12-year journey, and we’re excited to be starting the ride.”

Many technology firms, academic institutions, and scientists, such as the NIH, the Food and Drug Administration, and the National Science Foundation (NSF), have committed to advancing this initiative. The NSF has partnered with NBC Learn to produce a video series entitled “Mysteries of the Brain,” which draws on research conducted through the White House for the BRAIN Initiative. The series will discuss how the brain develops, controls emotions, and creates memories.

This eight-part video series will include the following segments:

  • Searching for Answers—Discusses how new research has begun to decipher the unsolved mysteries of the brain.
  • Thinking Brain—Discusses how the brain can store and process large amounts of information.
  • Evolving Brain—Discusses how the basic movements of a tiny fish can teach us big ideas about how the brain’s circuitry works.
  • Emotional Brain—Discusses using a virtual reality room to study how the brain reacts to positive and negative emotions.
  • Brain States and Consciousness—Discusses the study of a fruit fly to understand how the brain’s cells communicate to control sleep patterns.
  • Building a Brain—Discusses how the brains of tadpoles help us understand how neural circuits develop and absorb information from the surrounding environment.
  • Perceiving Brain—Discusses how functional magnetic resonance imaging allows researchers to view the brain and determine how it distinguishes important information from every day scenes.
  • Brain-Computer Interface—Discusses how devices can monitor and extract brain activity to enable a machine or computer to accomplish tasks, from playing video games to controlling a prosthetic arm.

The “Mysteries of the Brain” series is available for free viewing at NBCLearn, Science360, and the White House Blog. The National Science Teachers Association is developing lesson plans for middle and high school students, which will be available later this summer.

Did you watch the series? If so, what did you think? PAR wants to hear from you, so leave a comment and join the conversation!

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