Who can Diagnose Autism?

[pastorphysician]

Hey Guys,

Just need some Info...

can a child psychologist diagnose autism? or it has to be a person with MD degree? How far child psychologist role in treating children with autism?

My fiancee is a special education teacher dealing with autism and want to pursue a further career in dealing/helping children with Autism, ADHD, and Down Syndrome. However, medical school seems to expensive and too long ( 4 years Med School, 4 years Psyc Residency, 1 year Fellowship) for her.

Thanks

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[txpsychgirl]

Pediartic neurologist and developmental peditricans often make the diganosis for autism. I believe clincial psychologist with special training in neruo also can make the diagnosis.. Most of the time the doctor or specialist is only need for the diagnosis, its often the therapist that work with children on a regular basis.
Some other career paths to working with children with autism including behavior therapy, occupational therapy, speech therapy, physical therapist, & caseworkers.

 

[Pia Getty]

Pastorphysician, psychologists routinely diagnose autism. Most clinicians who diagnose have specialized training in child developmental disorders and assessment (do not necessarily need to be neurotrack as mentioned).

 

[Pia Getty]

From her background, she might want to check out the field of school psychology

 

[socialcog]

any discipline that could administer an ADOS.

 

[pastorphysician]

Thanks for the feedback!

 

[paramour]

And if your wife does decide to pursue a psych doctorate, please advise her that she shouldn't tell people she decided to pursue this route because medical school takes too long. She likely wouldn't get very far, especially since doctoral programs take approximately 7 years on average with some programs having an even higher completion length.

 

[toby jones]

I met a psychologist once who specialized in treating people with autism / autistic spectrum disorder and also in treating children (in particular) who were intellectually handicapped.

His theoretical orientation was 'radical' (or 'root') behaviorist. He worked in a lab where they would conduct behavioral analyses of problematic behaviour (e.g., head banging, tantrums, failure to engage in social play, failure to follow instructions) and then provide a program of intervention. They would work with the children directly, and also work with the parents / teachers / caregivers to teach them the techniques so they could use them as well.

(E.g., finding a reinforcer such as M&M's and then introducing a token sticker economy in order to teach eye contact, social play, and encourage verbal skills etc).

He trained in that someplace in the US. Can't remember where, unfortunately. Might be worth looking into, though. They really did have some very successful results.

 

[toby jones]

http://dickmalott.com/home/

This could have been it (Western Michigan)

The BATS program:
http://www.dickmalott.com/students/prospectivegrads.html

 

[erg923]

I would just add that while yes, a psychologist can and does diagnose the disorder, all the supervisors I have worked with are cautious and use the input of other specialties before doing so. Most would like to have medical causes ruled out by a physician (especially ped neurologists) and formal neuropsych testing done before making the diagnosis.
Getting a doctorate is pretty much necessary for doing the formal diagnosis, and Ph.D in clinical or school psych will take just as long as med school and residency. Many masters level practitioners can play a large role in other aspects including advocacy, education, and some treatments.

 

[Cosmo75]

I met a psychologist once who specialized in treating people with autism / autistic spectrum disorder and also in treating children (in particular) who were intellectually handicapped.

His theoretical orientation was 'radical' (or 'root') behaviorist. He worked in a lab where they would conduct behavioral analyses of problematic behaviour (e.g., head banging, tantrums, failure to engage in social play, failure to follow instructions) and then provide a program of intervention. They would work with the children directly, and also work with the parents / teachers / caregivers to teach them the techniques so they could use them as well.

(E.g., finding a reinforcer such as M&M's and then introducing a token sticker economy in order to teach eye contact, social play, and encourage verbal skills etc).

He trained in that someplace in the US. Can't remember where, unfortunately. Might be worth looking into, though. They really did have some very successful results.

Programs with specialties in Applied Behavioral Analysis (ABA) are geared to train people to work with developmental disabilities, including autism. My school has one, which is actually for the masters program. They just added it at the doctoral level last year I believe. I'm sure there are many programs out there with this concentration.

 

[Neuro-Dr]

Anyone who can bill for the consult could, in theory, bill the diagnosis. Typically, pediatricians, psychologists, neurologists, psychiatrists, MSW, etc all make this diagnosis routinely.

"any discipline that could administer an ADOS."....not sure where this came from since Autism is a clinical diagnosis at present and the ADOS has two levels of training, one for clinical use and one for research. Since an OT could be trained to adminster the ADOS and could bill for an OT consult under that diagnosis, I guess one could argue that they will make the diagnosis. Not sure that was the question of the OP.

 

[toby jones]

Often times these conditions are diagnosed fairly early in development (particularly in severe cases). And then the parents are referred on with respect to getting some help / education / treatment for their kid.

So even if one trained so one could help educate parents / treat the kid and one didn't train to do differentials on different types of developmental disorders I'm really not sure that that would put one at a disadvantage with respect to treating.

What is required in a functional behavioural analysis of the problematic behaviours is very different from what disorder the kid may or may not have...

 

[GiantSteps]

http://dickmalott.com/home/

This could have been it (Western Michigan)

The BATS program:
http://www.dickmalott.com/students/prospectivegrads.html

Dr. Richard W. Mallott! Behaviorist King and author of the best text book ever written. The Man, The Myth, The Legend! We're not worthy!!! This guy has a behaviorist solution to every problem which has ever plagued mankind as well as a solution to nearly every question which has perplexed SDNers. Of course, I do not think that the large SDN gay/ lesbian community would care for his section on a gay man who is conditioned (on his own request) to behave like a straight person but that is another issue. "SAVE THE WORLD WITH BEHAVIOR ANALYSIS!"

 

[GiantSteps]

By the way, after working with many people with Autistic Spectrum Disorder and reading Dr. Temple Grandin, one can not but help think that Autism is a rather meaningless diagnosis. As Dr. Grandin points out, each case is so different and there are so many subtypes that the classifications are endless and the research and treatments can be rather meaningless since what goes for one person with "Autism" can be entirely different for another person with "Autism". Many parents of people with Autism or people who suffer from some type of it themselves just want or don't want the diagnosis to obtain or prevent from getting certain types of services.

 

[Therapist4Chnge]

As Dr. Grandin points out, each case is so different and there are so many subtypes that the classifications are endless and the research and treatments can be rather meaningless since what goes for one person with "Autism" can be entirely different for another person with "Autism".

I think the DSM-IV leaves a lot to be desired in this regard.

 

[JR in SB]

"SAVE THE WORLD WITH BEHAVIOR ANALYSIS!"

Amen.

 

[Therapist4Chnge]

I did some research that utilized some hardcore behavioral techniques....big fan.

 

[MaddieMay]

And if your wife does decide to pursue a psych doctorate, please advise her that she shouldn't tell people she decided to pursue this route because medical school takes too long. She likely wouldn't get very far, especially since doctoral programs take approximately 7 years on average with some programs having an even higher completion length.

This is true for the PhD but not for the PsyD.

 

[Therapist4Chnge]

This is true for the PhD but not for the PsyD.

It depends on the program, some Psy.D.'s have a pretty high average year completion rate, particularly those with full dissertations requirements.

 

[73BARMYPgsp]

Anyone who can bill for the consult could, in theory, bill the diagnosis.

I have been watching this thread with mild curiosity. This is the literal answer to the OP. Anyone provider with a license.

 

[Cobblestone]

Another facet of the Autism diagnosis is the Medical diagnosis vs. Educational diagnosis. From what I understand, a Medical diagnosis is made by a neurologist or psychiatriast, while an Educational diagnisis is made by a school psychologist or a diagnistician working for a school district. IIRC, there is a slight difference in the criteria between the two. In the Individual Education Plans (IEPs) that I routinely see in Missouri, it usually specifies if the student has an Educational or Medical diagnosis.

 

[paramour]

This is true for the PhD but not for the PsyD.

It depends on the program, some Psy.D.'s have a pretty high average year completion rate, particularly those with full dissertations requirements.

Ditto. Although some people may get out of a PsyD program in 4-5 years, there are people who take longer. As T4C has already stated, it's largely dependent upon the program requirements. I still stand by my previous statement that it's a bad idea to claim you want to pursue one route simply because the other one takes longer. Akin to saying, well, I want to work but not too hard at it so I decided to go with this instead.

 

[Pia Getty]

A licensed psychology can diagnose Autism which is essentially a medical diagnoses. Does not need to be a neurologist or psychiatriast.

School systems use IDEA's framework for deeming students eligible for special education services as a student with Austism. This framework is a bit different, though it does not relate to whether a licensed psychologist outside of a school setting can diagnose AU.

 

[PsyDGrrrl]

By the way, after working with many people with Autistic Spectrum Disorder and reading Dr. Temple Grandin, one can not but help think that Autism is a rather meaningless diagnosis. As Dr. Grandin points out, each case is so different and there are so many subtypes that the classifications are endless and the research and treatments can be rather meaningless since what goes for one person with "Autism" can be entirely different for another person with "Autism". Many parents of people with Autism or people who suffer from some type of it themselves just want or don't want the diagnosis to obtain or prevent from getting certain types of services.

Indeed, that is why it is now often referred to as "autistic spectrum disorders" and is better seen as dimensional, not categorical. I mean, most people would consider/describe Asperger's as a type of high-functioning autism, rather than a truly different disorder.

 

[GiantSteps]

Indeed, that is why it is now often referred to as "autistic spectrum disorders" and is better seen as dimensional, not categorical. I mean, most people would consider/describe Asperger's as a type of high-functioning autism, rather than a truly different disorder.

Also, (based on Dr. Temple Grandin's research, personal experience as someone who is diagnosed with Autism, and theories) another type of high-functioning Autism is a computer programmer! (Dr. Grandin really writes that a great many of computer programmers have some type of Autism!) Therefore, any school which grants a degree or certificate in computer programming is more than likely diagnosing Autism! MIT and CalTech diagnose some of the best!

 

[Neuro-Dr]

I have to say that this probably the most disturbed I have ever been since joining this listserve. The fact that we are having a serious conversation about the diagnosis being (a) meaningless or (b) that Asperger's could be viewed as diet autism is very troubling to me. I guess we should just stop doing any meaningful science and rely on continuum theory to inform our treatment recommendations and individual differences to account for all pathology instead of pattern, prognosis, onset and physical findings. I hope this is tongue-and-cheek and we have not seriously begun to use Temple Grandin's personal experience (however inspiring) as a substitute for science. If this was more off the cuff comments, then I'll shut up.

 

[PsyDGrrrl]

I have to say that this probably the most disturbed I have ever been since joining this listserve. The fact that we are having a serious conversation about the diagnosis being (a) meaningless or (b) that Asperger's could be viewed as diet autism is very troubling to me. I guess we should just stop doing any meaningful science and rely on continuum theory to inform our treatment recommendations and individual differences to account for all pathology instead of pattern, prognosis, onset and physical findings. I hope this is tongue-and-cheek and we have not seriously begun to use Temple Grandin's personal experience (however inspiring) as a substitute for science. If this was more off the cuff comments, then I'll shut up.

Are you disagreeing with the current trend of diagnosing autistic spectrum disorders and saying that Asperger's is NOT a form of autism?

 

[Neuro-Dr]

There is no trend in diagnosing Autistic Spectrum Disorder and I am not aware of any ICD-10 or DSM code for that condition. I am not arguing that Asperger's Disorders does not fall under Pervasive Developmental Disorders. What I am saying is that treating all of them as points on a continuum is about as illogical as treating dysthymia as MDD, GAD as OCD or lumping any other disorders within the same broad catagoy as having the same pathogensis simple because they are coded under the same doamin. Should we treat Rett Syndrome as a point on the continuum of autism as well?

 

[Neuro-Dr]

As an aside to this arguement, if we were to treat high functioning autism and asperger's disorder as similar conditions, why does autism carry a seizure rate of 30% and Asperger's no higher than the general pediatric population?

 

[PsyDGrrrl]

There is no trend in diagnosing Autistic Spectrum Disorder and I am not aware of any ICD-10 or DSM code for that condition. I am not arguing that Asperger's Disorders does not fall under Pervasive Developmental Disorders. What I am saying is that treating all of them as points on a continuum is about as illogical as treating dysthymia as MDD, GAD as OCD or lumping any other disorders within the same broad catagoy as having the same pathogensis simple because they are coded under the same doamin. Should we treat Rett Syndrome as a point on the continuum of autism as well?

I am not saying there is a disorder called Autistic Spectrum Disorder, I am saying that they are seen as falling into that larger class....may I refer you to the State of California's Department of Developmental Services' Best Practices on Assessment and Treatment of Autistic Spectrum Disorders used by Kaiser Permanente in their Autistic Spectrum Disorders clinics? Also note that UC Davis's MIND institute has an Autism Spectrum Disorders Specialized Studies Program. Oh yeah, and for good measure, an article from NIH about best practices re: autistic spectrum disorders. So are you still arguing there is no trend towards seeing these disorders as part of the autistic spectrum? And no, Rett Syndrome is a different type of disorder and while it is a developmental disorder, it does not fall on the same continuum of autistic disorders.

And if you want to continue arguing over the dimensional vs. categorical approach, you really think that dysthymia and MDD should not be considered to be on a spectrum of depression?

 

[Neuro-Dr]

I think if you want to call them part of a class of conditions for the purposes of discription, that is fine with my. If you want to reference several of these large scale, epidimiological studies and their efforts to recruit subjects from Autism, Asperger's, and PDD, I'm still with you. However, the major failings of research from the past several decades has been to treat all the conditions the same. This is why prior to Wing in the mid 80's Aspergers was not being used in this country with any great regularity. The MIND study you have reference has broken their neuroradiological arm into High and low functioning autism, Asperger's and PDD NOS for very specific reasons, namely that rates of positive imaging findings, birth complications, regression versus stagnation, and genetic markers are all very different in each disorder. They have found similarities, in terms of abnormal growth rates within the lateral nucleus of the amygdala, immunoglobulin markers in mothers and Cold Springs lab has found a consistent deletion of genetic mutations within Autism in family carriers and non. The issue with outcome rates from PDD, and this is from several of the main researchers from UC Davis, out your way, have criticize the reliance on previous studies in which PDD was treated as a homogenous entity since the diagnostic classification included patients with a variety of different backgrounds.

Realistically and this would extend all the way back to Lovaas' original studies from the 1980's, outcome research has consistently shown that there is a very real subtype of responders to quality interventions even within Autism, which may suggest a seperate pathogenesis. This type of classification is not unlike what is seen in epilepsy in which cases are idiopathic, cryptogenic or symptomatic. teh casual observers may call them all epilepsy because of their common presentation, but this would be a highly problematic classification.
To your last point, I would certainly consider dysthymia much differently than MDD.

 

[mkberry85]

Anyone that is legally allowed to diagnose in that state can diagnose, this includes medical professionals, nurse practitioners, licensed psychologists, licensed counselors, etc. There is no true career as a child psychologist, closest options are pediatric psychology (treats and researchers psychosocial aspects of injury and diseases) and child clinical psychologists. Many individuals who want to specialize in ASD will typically complete a masters or specialist in school psychology and a doctorate in clinical (or child clinical) psychology, or complete their doctorate in school psychology (which typically allow you for licensure as a licensed psychologist) and complete an internship in either a school system or a child hospital.

Depending on the location, I would say a pediatrician is the most common professional to diagnose ASD, but that does not mean they are the most competent. In reality, a diagnosis of ASD should include a pediatric neuropsychologist and developmental-behavioral pediatrician or neurodevelopmental pediatrician, along with the help of the school system. A pediatric neurologist is hardly ever involved with a diagnosis, nor should they really be (unless they specialized in behavioral neurology).

As someone mentioned, there is a difference between a diagnosis of ASD (per the DSM or ICD) and the educational classification (per IDEA). As I have mentioned, a diagnosis is made by one of the professionals I stated (typically, and I would always take a diagnosis by a neurologist with a grain of salt), while the educational classification is made with the ARC committee, not a school psychologist or diagnostician.