Adult Autism Evaluations

Autism is a developmental and neurological disorder that affects how people communicate with others, learn, and behave.

Autism is a spectrum, meaning symptoms vary in their type and severity. Put another way, no two people with autism have the exact same presentation.

For adults questioning if they may be on the spectrum, a psychological evaluation can be life changing. If you are having difficulties communicating effectively with others, have restricted interests and repetitive behaviors, fear changes, or have challenges with transitions, I truly hope you will consider a free consultation.

TERMS

Today, the field has moved away from the pathologizing term “disorder” and many autistics believe autism is not a disease or disorder, There is still some debate over person first vs. identity first language. Other medical model terms, such as “high-functioning,” are considered outdated labels and not commonly used. Many times, autism spectrum has been misdiagnosed as obsessive-compulsive disorder, severe social anxiety, bipolar disorder, ADHD (which is in the same class of neurodevelopmental disorders), and even schizophrenia.

AUTISM SPECTRUM MEASURES: A BRIEF HISTORY

Many autism measures currently in use today, including the ADOS and ADI-R, were originally released in 1989 and 1994, respectively. This means that there are entire generations of people that may have missed the opportunity for diagnosis before these instruments were widely used.

My office uses the MIGDAS-2, which was published in 2018. This is a flexible instrument that helps determine sensory and communicative symptoms of autism. Whereas the ADOS-2 is static and can miss adults, especially with people presenting with a level of adaptive functioning success, the MIGDAS-2 provides a structured clinical interview approach that streamlines the diagnostic process for both males and females, regardless of educational history.

WHAT TO EXPECT AT AN EVALUATION

Autism tests are not primarily focused on cognitive assessment, unless this is part of the presenting concern (job difficulties, accommodations, etc.). Instead, you will answer questions in structured clinical interviews, self-report forms on an iPad, paper-and-pencil measures, and review important medical and clinical history.

You can expect to receive your results in two weeks, where you will receive recommendations and next steps that may involve social group supports, individual therapy supports, academic or job accommodations, or more.

Most adult clients bring a person that knew them during childhood to the evaluation, although this is not necessary. Many clients bring a family member, friend, counselor, teacher, or coach. Some people have arranged their person call the office at the time of the MIGDAS-2, especially for people living out of state.

The assessment lasts 4-5 hours in total with breaks provided.

Your designated person will be required to stay for approximately 1.5 hours during the MIGDAS-2 structured clinical interview, about 2 hours in total from the start of the evaluation.

If you are in Colorado, please feel free to call or email me with any questions at office@mindingmyownpsych.com or sign up below for a free consultation. I look forward to hearing from you -Brian Burgoyne, PsyD

Dealing With Insurance

This post explains how to put yourself in the best position to achieve a successful pre-authorization for psychological testing services.  

While some clients forego insurance and pay out of pocket to keep their personal health information private, insurance plans often cover these evaluations, although you should always check your specific plan.

 Many times, insurance might state they require a “pre-authorization” for testing services.

The following suggestions put yourself in the best position to receive an insurance authorization:

1.     Contact your insurance company by dialing the number on the back of your insurance card.

2.     Know going into a discussion that neuropsychological testing is often covered, whereas educational (academic achievement) testing is rarely covered. Psychological testing depends on plan-specific provisions.

3.     Neuropsychological testing often focuses on specific medical questions related to a loss of functioning, intellectual disability, or potential ADHD.

4.     Having a medical or therapy provider complete a referral for assessment often provides additional evidence for insurance companies that testing services are necessary.

5.     Personality testing, while fascinating and very important for people experiencing consistent difficulties at work, home, and with others, is not covered by insurance and always a private pay evaluation.

6.     Adult autism evaluations may require an out-of-pocket charge. Usually, adults will be asked to provide a contact of someone who knew them during their childhood for additional information on the day of the evaluation.

7.     Some insurance policies do not allow for a re-test within a 12-month period.

8.     You will want to ask your insurance provider if they cover the following CPT codes, which are used to document testing services performed in the office: 90791, 96136, 96137, 96132, 96133, 90887.

9.     Finally, if testing is covered, ask if you need a “pre-authorization” to answer your specific referral question. When talking to any psychologist, you may consider asking if they are an “in network” or “out of network” provider. This will help you know if the professional accepts your insurance. Dr. Burgoyne is in-network with United Health Care, Aetna, Medicare, and Medicaid.

I hope this clarifies some steps you can take when considering a psychological evaluation. Until next time. -Brian Burgoyne, PsyD

Dyslexia Evaluations: The Basics

Do you or a family member struggle with spelling, pronunciation challenges, and/or reading and writing errors? This blog post is for you!

Minding My Own uses the latest advancements in psychological test measures to identify symptoms and provide formal accommodations for dyslexia and learning disorders.

What is Dyslexia?

Dyslexia is a language processing condition that affects millions of Americans.

Successful, brilliant people have been diagnosed with dyslexia. Did you know Albert Einstein, John Lennon, Steve Jobs, Bill Gates, Jennifer Aniston, Florence Welch, Salma Hayek, and Steven Spielberg have all received a diagnosis of dyslexia?

Dyslexia IS NOT a negative assessment of intellectual functioning.

Dyslexia causes people to spend a lot of time and energy reading and understanding content, tasks that may seem mundane to others. Many people with dyslexia struggle in silence or become frustrated at themselves, without finding accommodations that could make life much easier.

This is where psychological testing can help. After your evaluation, we will schedule a feedback call. During this call, you will receive actionable steps that you can use immediately. This may include sharing the report with a school, university, or employer, additional time on tests and quizzes, a resource room, or technological assistance, if results qualify.

Is Dyslexia Common?

Dyslexia’s prevalence has grown exponentially, due to exposure and advancements in testing. Estimates suggest 1 in 5 people have dyslexia, according to the International Federation of Dyslexia and Dyscalculia Associations.

Approximately 40 million US adults are estimated to have dyslexia, yet only 2 million have a formal diagnosis. These numbers are staggering, when we consider how many people struggle with challenges spelling words, labored reading, and difficulties with pronunciation from a young age. Causes of dyslexia include genetics: children have a 50% higher chance of dyslexia if one parent struggles in these domains.

Where Does Testing Come In?

Previously, dyslexia evaluations lacked standardization measurements. Different psychologists used various test measures, weighed different factors unevenly, and used a range of theories (cognitive discrepancy model vs. response to intervention (RTI) vs. constellation model vs. revised discrepancy model). The list goes on… Now, a newly released assessment can answer all these questions in one single test, with the most up-to-date research in the field of clinical psychology.

The Tests of Dyslexia (TOD: 2023) were created by leading psychologists in academic achievement evaluations. This battery includes an intervention guide for recommendations regarding classroom instruction, including college students and others looking for extended time on standardized tests.

If you or a loved one is seeking formal accommodations and help understanding reading or writing difficulties, please use the link below to schedule a free consultation.

PS: This program Lexie will help anyone who struggles with reading. Lexie is recommended by the American Dyslexia Association. More information may be found here.

Sources:

Six facts about dyslexia - American Dyslexia Association : American Dyslexia Association

Binda Dyslexia Center. "Facts About Dyslexia." Binda Dyslexia Center. Accessed April 28, 2014.

33 Dyslexia Statistics & Facts: How Many People Have Dyslexia? (crossrivertherapy.com)

Mood and Basic Self-Care

A client last week asked me a question that I thought would help others, and I wanted to share some of my reply here. They asked me, essentially, “Is there anything I can start doing when I leave today to make life easier?”

I welcome these questions because it shows a client’s dedication to their mental health and the right attitude for change.

There are three things you can focus on immediately: achieving adequate sleep, proper diet, and exercise.

SLEEP

How’s your sleep? A lack of quality sleep can cause difficulties with learning, encoding, and retrieving information. Put another way, students will struggle in school after a bad night of sleep and adults may not perform well at their jobs. Inadequate sleep causes irritability, daytime sleepiness, fatigue, trouble thinking and processing, slowed reaction times, and even anxiety and headaches.

Good practices become habits that will improve your quality of life. About an hour before bed, try to begin a routine that alerts your brain that it is time to rest. Put down any screen devices and try to maintain a consistent bedtime whenever possible. For people who require a fan or type of sound to sleep, a white noise machine is advised over television.

A bad night of sleep here and there is unavoidable, but to perform our best, consistency is key. For the occasional bad night, if possible, try to take a nap early enough in the day to sleep later on without disrupting your rhythms.

Some people with clinical depression sleep too much, a condition called hypersomnia. There is a line that crosses into “too much sleep.” The answer to this phenomenon is complicated, but related to the neurotransmitters norepinephrine, dopamine, and serotonin.

DIET

Second, there is a link between diet and mood. Consider the food you eat for a moment. Specifically, are you eating a lot of frozen foods, microwave meals, and Door Dash, or do you cook for yourself using natural ingredients? No judgement at all from me, I have been there myself! I mention this because deficiencies in certain types of foods can cause difficulties with attention and concentration and worsen behaviors. A healthy and balanced diet can ensure optimized brain health, including foods with high protein content and low sugars. Attempt to eat high-protein meals with iron, magnesium, and zinc. Foods with high sugar content are not recommended for individuals with executive functioning deficits, as they can cause challenges attending to information.

EXERCISE

Finally, our exercise and activity level has a profound impact on our mood and emotional state. There is research from the Anxiety and Depression Association of America that suggests one session of vigorous cardiovascular exercise can improve mood and lessen symptoms of anxiety for hours, with long-term effects with consistent practice. Moderate exercise also shows significant health and mood benefits.

Some clients cite a lack of time as their biggest obstacle to joining a gym or starting a workout plan. In Europe, there is something called the, “Green prescription.” People who are prescribed the “Green Prescription” are asked to enjoy the outdoor world in whatever way suits them. This could include walks, hikes, and other light exercise in nature.

If have your pets, they can help you stay consistent with routines. Walking a dog outside reduces the stress hormone cortisol and is good for mental health. Research with veterans suggests that both physiological (body) and psychological symptoms of stress were reduced when on walks with others or a service animal. Even a short nature walk helps lower stress and improve mood. Thus, even for people with very little time to spare, there are always little changes we can make to improve our overall health and wellness.

I hope this blog has provided some helpful information. Happy Memorial Day Weekend! -Brian Burgoyne, PsyD

*On sleep, according to NHI/ NHLBI, adults should aim to achieve 7-9 hours nightly. School-age children (ages 6-13 years old) need 9-12 hours of nightly sleep, and teenagers should attempt to achieve 8-10 hours. Adults ages 65 and older need 7-8 hours of sleep.

What Are Psychological Assessments? Who Needs One?

Thank you for visiting my blog, where I provide some brief information about psychological testing for people interested in booking an evaluation.

Evaluations are requested for many reasons, which makes the process difficult to generalize. In my practice, I see children (age 7 and older), adolescents, adults, and aging adults. Some of the most common things I hear from clients include: “Is this ADHD/ Dyslexia/ Depression/ Trauma/ (Other)?” and, “My primary care physician/ nurse/ psychologist/ life coach says I have X, but I think it is Y. Can you help?” People seeking documentation for academic accommodations or standardized testing are often required to attend an evaluation.

Psychological testing is a unique process used to achieve a specific goal. I specialize in neuropsychological cross-battery assessment, which means I choose subtests from a variety of different measures to comprehensively meet your needs. Before an evaluation, we will discuss your clinical history and goals. Our conversation will help me set up a test battery tailored to examine the issues that matter to you. The evaluation typically lasts 4-6 hours, with breaks, as needed.

Some common suggestions for the morning of the evaluation include: 1) Attempt to achieve a good night sleep the night before, 2) Abstain from any cannabis or alcohol beginning approximately 24 hours before the evaluation, 3) Eat a good breakfast, 4) Bring water and snacks with you. Parents, it is important that your child not take any prescription ADHD medication on the day of the scheduled evaluation.

Psychological evaluations use a combination of paper-and-pencil and iPad tasks to document a wide range of skills, including cognitive and adaptive functioning. More specifically, we will examine attention, language, memory, visuospatial abilities, executive functions, and much more. Testing does not include diagnostic imaging, like MRIs. Evaluations occasionally require a second day, and this will be discussed, if necessary. Approximately two weeks after your evaluation, we will discuss the implications of the test results for your everyday functioning and further treatment planning. You will receive a pdf of your results with any diagnoses, treatment recommendations, and a summary of everything we discussed over the phone.

This is the broad process to book an evaluation at Minding My Own Psychological Assessments, PLLC. If you are interested in more information or booking an appointment, please use the orange button at the bottom of the website to schedule a free, 15-minute consultation. I look forward to hearing from you! - Brian Burgoyne, PsyD

ADHD And Psychological Testing

There is a paradox to ADHD that many parents know all too well…When a child is asked to pay attention in school, they immediately check out and/or talk to peers. Now, sit that same child in front of their favorite video game or an arts and crafts project, and they can focus for hours! What gives? The answer is complicated, but scenarios like these highlight the importance of testing to confirm a potential ADHD diagnosis and examine additional factors that may be at play, such as oppositional behaviors, anxiety, and other mood disorders.

I often tell concerned parents that ADHD is a disorder of “doing, “ not “knowing.” Many ADHD children and teens require multiple daily reminders to complete tasks, from homework to personal hygiene. Often, children know exactly what they are supposed to do, but the moment they are tasked to complete the request, something distracts them and they pursue that distraction instead. This can appear to parents like oppositional behavior, although this may not be the actual case. Believe it or not, many children with ADHD can hyper-focus on activities that interest them.

To have a child act without reminders, parents must engage their “executive functions” to help them learn to act without oversight. Instead of repeatedly asking a child every day for years to complete the tasks you are hoping they learn for themselves, here are a few strategies that can be taught quickly.

Two strategies include using visual reminders (excellent for children who are visual learners, generally) and changing the script. Visual reminders can be placed throughout the house, and provide multi-step instructions in an easy to identify visual graph. Visual graphs work best for young children. For older children and teens, I teach parents to “flip the script” in order to engage their child’s executive functions. This is one of my favorite communication techniques that I use with parents with children with ADHD and oppositional behaviors.  Instead of providing directives, ask questions. Instead of saying “you need to get your work done before you can leave,” ask the child “what do you need to get done before you can leave?” Instead of saying, “Go brush your teeth and make your bed,” ask the child, “Tell me your morning ritual, and is there anything you have left to do?” This causes the child to think through their actions and verbalize the directives. Over time, this line of questioning, when used consistently, provides a child with autonomy and responsibility. For particularly challenging cases, I also recommend occupational therapy.

ADHD testing only takes a few hours and can open the door to helpful accommodations for the rest of your life. Assessments are used to determine whether difficulties are due to a true neurodevelopmental disorder (ADHD), or are better explained by mood symptoms. In ADHD testing, we examine executive functions, such as the ability to shift attention, remain vigilant, engage short-term memory, behavioral activation, and effort. Please call the office for more information about ADHD testing. Until next time! -Brian Burgoyne, PsyD

How is Testing Different From Therapy?

Testing is not therapy, although they are easy to confuse.

Broadly, therapy is a weekly examination of thoughts, feelings, and behaviors. An individual therapist may spend 50 minutes discussing one symptom or a set of symptoms. Therapy often examines large, philosophical questions and looks at a person’s history to provide context for current behaviors.

Testing is different, less concerned with the “why” behind actions and instead focused on examining functional impairment. A psychological assessment is often a one-day encounter, used to assist in treatment planning. Evaluations use data sets to figure out what is going on, quickly, in order to target specific symptoms with individual recommendations. Most, although not all, people interested in testing come with a specific question or goal.

Evaluations begin with a comprehensive clinical interview discussing your symptoms and life history. Testing is a cooperative effort, and clients struggling with anxiety and ADHD may request to type out their answers before the evaluation through Minding My Own’s online portal. It is considered a best practice to ensure clients have discussed everything they hoped to cover before moving to cognitive assessment measures. Clients are encouraged to share any records they might have, either from previous therapy providers, schools, or hospitals. Following the evaluation, clients have the opportunity to discuss their results and will receive a pdf copy to share with any medical or therapy providers.

I hope this blog post helped explain some of the differences between psychotherapy and psychological assessment. Until next time! -Brian Burgoyne, PsyD