Face to Face Services: Miranda (Sydney)  (02) 9541 1177

Neurodevelopmental Presentations

Neurodevelopmental presentations are common in individuals with 'brain differences' which can impact an individual's behaviour, social behaviour, memory or ability to learn e.g. intellectual disabilities, dyslexia, attention deficit hyperactivity disorder (ADHD), learning deficits and autism spectrum conditions.


 

Autism Spectrum Disorder (ASD)

ABOUT AUTISM SPECTRUM DISORDER

Autism spectrum disorder (ASD) is a neuro-developmental disorder, which is characterised by difficulties in social communication (verbal/non verbal) which impacts social interactions, routines and repetitive behaviours, circumscribed interests, and/or sensory sensitivities.

All children diagnosed with ASD have a wide range of difficulties and abilities. Some kids and teens with ASD have very impressive skills and strengths. One child with ASD might be gifted, highly verbal and have a very good memory. Another child might be an excellent artist or a gifted visual learner or have excellent computational skills. Despite their strengths, kids and teens with ASD struggle in their social and emotional development and require ongoing intervention and support.

In Australia, Autism Spectrum Australia (Aspect) has revised its autism prevalence rates from 1 in 100 to an estimated 1 in 70 people in Australia on the autism spectrum. ASDs affect almost four times as many boys than girls. However, many girls do have ASD, but learn to mask their challenges through imitation and practice.

ASSESSMENT & TREATMENT OF ASD AT ACPC PSYCHOLOGY

ACPC is a reputable provider in the assessment, diagnosis and treatment of individuals with an Autism Spectrum Disorder (including Asperger's Syndrome). and receives a high number of referrals from various sources including Paediatricians, General Practitioners, Allied Health Professionals (Speech & Occupational Therapists) as well as schools and preschools.

A comprehensive assessment is conducted with famiilies for the purpose of creafing an intervention plan specific to the individual needs of your child, adolescent and family. The assessment and treatment process usually includes:

  • Standardised assessment and screening measures that assesses social, emotional, and behavioural developmental issues associated with Autism Spectrum Disorder
  • Gold standard therapeutic interventions derived from evidence based research specific to ASD
  • Pre and post outcome measures to enhance treatment outcomes.

Practitioners tend to share a special interest in Autism Spectrum Disorders, and aim to deliver services whilst ensuring that they are up to date on the research and evidence based therapies within this area.

Practitioners adopt several innovative and creative strategies to increase their client's attention and engagement during sessions.

Not only are ACPC practitioners competent in delivering suitable interventions that will keep clients engaged throughout sessions, whilst keeping the treatment goals in mind, but they are also well informed of the many special interests that kids and teens with ASD may have!

This ultimately leads to building an effective rapport building with kids and teens, whilst implementing evidence based therapies and thus maximising outcomes during therapy sessions...

Girls on the Autism Spectrum

Research shows that the average age of being diagnosed with ASD Level 1 for boys worldwide is approximately 8 years of age, in contrast, for girls the age is approximately 13 years of age. In recent years however, professionals working with children and adolescents are increasingly receiving referrals for diagnostic assessments of girls due to more awareness that girls on the spectrum may present very differently than males. 

The most common reason why girls receive a late diagnosis is mainly due to their ability to successfully camouflage their autism. Girls and women on the spectrum are often missed on standardised measures for autism and in clinical settings due to their camouflaging ability which allows them to hide some of the characteristics of autism. Instead, they would rely on observing people in their social world including peers, by analysing and mimicking the observed social rules and conventions. In this way, they can acquire social and interpersonal abilities successfully. 

Whilst camouflaging may assist in 'bending in' with peers and the social world, it has also been shown to be associated with poorer mental health and wellbeing outcomes including; anxiety, depression and low self esteem. In addition, camouflaging often delays the diagnosis of autism and thus accessing appropriate support and intervention that is individually tailored to ASD individuals.

Pathways to diagnosis for girls and women with ASD may include; an initial diagnosis of social anxiety, ADD/ ADHD, selective mutism, depression or bipolar disorder, gender dysphoria, OCD or even anorexia nervosa. Another common pathway for girls is searching on the internet and discovering that they resonate with a description of Asperger's Syndrome. Another common pathway for women in particular is reflection following a diagnosis in one of their children or another family member. 

Regardless of when or how diagnosis is sought, at ACPC we believes that the main underlying reason for diagnosis is for the individual to further their strengths and difficulties when it comes to abilities including intellectual, language, learning, social and emotional development, which in turn can contribute to increased self identity and promote self acceptance to be able to live fulfilling lives!

For further reading, please see links below:

https://attwoodandgarnettevents.com/2019/12/12/understanding-girls-on-the-spectrum-by-prof-tony-attwood-and-dr-michelle-garnett/

https://attwoodandgarnettevents.com/2019/12/04/camouflaging-girls-and-women-with-autism-by-prof-tony-attwood-and-dr-michelle-garnett/

Catering for ASD Individuals across the lifespan

ACPC caters for individuals with ASD across the lifespan. The following lists a summary of services offered for individuals and families:

EARLY CHILDHOOD (16 months to 5 years old)

  • Child screening
  • Diagnostic Assessment
  • Clinical preschool/ Child care observations
  • Parent coaching & support
  • Professional opinion & guidance
  • Assisting in challenging behaviours
  • Assisting in toilet training
  • Support for preschool/ child care staff

SCHOOL AGED CHILDREN (6 years to 12 years old)

  • Assessment & Diagnosis
  • Assessment of IQ and Learning
  • Assisting in managing challenging behaviours
  • Emotional skills training
  • Anxiety treatment
  • Anger management
  • Social skills training
  • Friendship management 
  • Dealing with bullying
  • Teaching problem solving
  • Support for educators
  • Parent coaching and support 
  • School Advocacy 

ADOLESCENTS (13 years to 17 years old) 

  • Assessment & diagnosis
  • Assessing learning difficulties
  • Intervention & Skills building 
  • Anxiety treatment
  • Anger management training
  • Educational coaching
  • Career guidance
  • Friendship management
  • Family relationships
  • Parent coaching & support 
  • School advocacy 


YOUND ADULTS & ADULTS (18 years to 25 years old)

  • Assessment & Diagnosis
  • Assisting with relationship issues
  • Assisting in work related matters
  • Anxiety treatment 
  • Emotional & Social skills training

Attention Deficit Disorder (ADHD)

At ACPC, we offer comprehensive diagnostic assessments to determine whether a child may have an underlying ADHD condition which is seemingly impacting their functioning. We also work with parents/ caregivers and families on assisting them in the management of ADHD. 

For further information about our assessment and treatment services, please read through our services. 

WHAT IS ADHD?

Attention Deficit Hyperactivity Disorder (ADHD) is a complex neurodevelopmental disorder which affects a person’s ability to exert age-appropriate self-control. It is characterised by persistent patterns of inattentive, impulsive, and sometimes hyperactive behaviour, and is frequently accompanied by emotional regulation challenges.

What you need to know: People with ADHD have little control over these behaviours as they stem from underlying neurological differences. They arise due to an impaired ability to inhibit and regulate attention, behaviour and emotions; to reliably recall information in the moment; to plan and problem solve; to self-reflect and self-monitor; and to self soothe. 


HOW PREVALENT IS ADHD?

ADHD is the most common presentation in children and adolescents in Australia. It affects approximately 281,200 children and adolescents (aged 0-19) and approximately 533,300 adults (aged 20+). 

What you need to know: ADHD does not discriminate. It affects males and females of all IQ levels and from all socioeconomic and cultural backgrounds. 


WHAT ARE THE CAUSES OF ADHD?

Genetic studies, including family, twin and adoption studies, show ADHD is a highly heritable disorder. No single ADHD gene appears responsible for causing ADHD. Instead, research suggests it is likely to result from number of interacting genes. Expression of these genes is thought to result in alterations in brain structure, neurochemical composition and availability, and brain connectivity and function. There are a number of environmental risk factors that may also contribute to the development of ADHD including maternal smoking and alcohol intake during pregnancy, premature birth and low birth weight. 

What you need to know: There is no evidence that ADHD is caused by poor parenting, watching too much TV, eating sugar, family stress or traumatic experiences. It is also untrue that children with ADHD are simply ‘naughty children’.


WHAT ARE THE THREE TYPES OF ADHD?

ADHD symptoms tend to present early in childhood, and must be present before the age of 12 in order for a person to qualify for an ADHD diagnosis. The ADHD symptoms people can experience may vary from person to person and can change throughout a person’s lifespan.

According to the Diagnostic and Statistics Manual of Mental Disorders (DSM-5), ADHD can present in three ways: 

1. Predominantly inattentive symptoms 

People with inattentive symptoms tend to:

  • Struggle to focus and concentrate on information or tasks they find boring or tedious
  • Experience mind-wandering and be frequently interrupted by unrelated thoughts
  • Be easily distracted by external stimuli miss instructions or relevant information
  • Have trouble remembering information struggle to pay close attention to detail and make careless mistakes
  • Fail to finish tasks or to achieve their goals lose items
  • Avoid or seem reluctant to engage in task requiring sustained effort.

2. Predominantly hyperactiveimpulsive symptoms

People with hyperactive-impulsive symptoms tend to:

  • Fidget, tap objects, restlessly wiggle legs and generally move around more than others
  • Talk excessively, blurt out answers or interrupt others. Children may also make loud noises or narrate their actions
  • Respond quickly to situations without anticipating the consequences (i.e. make rash decisions or rush in without waiting to hear all of the instructions)
  • Impatiently badger their parent, partner, friends etc. when they want something
  • Find boredom intolerable, constantly seek stimulation
  • Participates in more risk taking or dangerous behaviour
  • Choose a smaller reward now rather than postpone gratification in order to receive a larger, more significant reward later.

3. Combined Symptoms

People with combined symptoms tend to display both inattentive and hyperactive-impulsive symptoms.


WHAT ARE THE KEY FEATURES OF ADHD?

Deficits in Executive Functioning

ADHD affects a person’s ability to self-regulate. The mental processes people rely on to self regulate are called executive functions. The executive functions enable a person to control their thoughts, words, actions and emotions. They also assist them to perceive and manage time, and to direct and manage their behaviour over time. For example, the executive functions enable a person to concentrate and pay attention, to inhibit their instinctual or habitual responses, to recall and evaluate information, to consider the consequences that may result from implementing an idea, and to wilfully adjust and direct their behaviour. They also enable a person to self reflect, to self-motivate, to delay gratification, to achieve their goals, to successfully navigate social situations, and to moderate their emotions in line with societal expectations. 

Executive functioning abilities are thought to develop sequentially, one skill building atop the next, starting at around age 2 and reaching full development at around age 30. Children with ADHD lag significantly behind in the development of their executive functions – by approximately 30% or 3-6 years. Additionally, as they mature the majority of these children tend to only develop approximately 75-80% of the executive functioning capacity of their neurotypical peers and thus will continue to lag behind indefinitely.

Emotional Dysregulation

People with ADHD often have difficulty regulating their emotions. For example they may:

  • Experience emotional lability (rapid, often exaggerated changes in mood)
  • Display their emotions more intensely
  • Become easily excitable
  • Be quick to anger and become verbally or physically aggressive
  • Focus on the more negative aspects of a task or situation
  • Report increased psychological distress from their emotional experience. 

Motivation depending on Interest

The executive function challenges and associated symptoms people with ADHD experience can vary depending upon the level of interest they have in a task, the timeliness of the reward they may receive and how familiar they are with a given situation. For example, a person with ADHD may struggle to start or to complete a task if the reward for their effort is delayed or if they feel the task or situation is boring or tedious. If, on the contrary, there is an immediate reward or positive reinforcement, or the situation is new, interesting and positively challenging, they will often find starting and completing the task much easier.

However, if a person with ADHD finds a task intensely interesting they may become hyperfocused (so intensely fixated on the task that they become over-absorbed in it). When hyperfocused, they may struggle to disengage their focus and to redirect their attention away from the task or topic that is holding their interest in order to attend to more pressing or important tasks.

Fatigue (tiredness) and time of the day can also impact on the executive function capacity and symptom severity people with ADHD.


WHAT ARE THE STRENGTHS OF INDIVIDUALS WITH ADHD?

It is important to remember people with ADHD also have incredible strengths that need to be harnessed. For example, research suggests people with ADHD are often:

  • curious
  • creative
  • imaginative
  • innovative
  • inventive
  • great at brainstorming and thinking outside the box.

Additionally, the research suggests people with ADHD tend to do well in environments that are stimulating, challenging, busy, fast paced, intrinsically motivating, full of novelty and requiring multitasking.

Parents, partners and friends often report the people in their lives with ADHD tend to be:

  • loving
  • energetic
  • spontaneous
  • enthusiastic
  • adventurous
  • loyal
  • honest
  • genuine
  • resilient
  • determined lots of fun.

WHAT ARE THE RISKS OF UNDIAGNOSED & POORLY TREATED ADHD INDIVIDUALS?

Without appropriate diagnoses, treatment and support, people with ADHD experience symptoms which can have a profoundly negative effect on their lives.

  • People with the disorder may struggle to learn, achieve academically, behave appropriately, meet classroom/workplace expectations, navigate social situations and maintain friendships.
  • They may constantly find themselves on the receiving end of disciplinary, academic and social repercussions and as a result develop a poor sense of self, begin to feel like a failure, start to predict future failure and give up, or develop oppositional and defiant behaviour.
  • Children with poorly treated ADHD have been shown to have an increased likelihood of developing anti-social behaviour, anxiety and depression, alcohol and substance abuse issues and eating disorders in adulthood as well as other adverse long-term health outcomes which can reduce life expectancy.
  • Adults with poorly treated ADHD are at higher risk of relationship, workplace and financial difficulties. Additionally, they are at higher risk of relationship breakdown, divorce, driving infringements, criminality, injury, self-harm and suicide. 


Information adapted from: www.adhdaustralia.org.au What is ADHD 201909 factsheet - version 1.4. Compiled by Lou Brown from Thriving with ADHD for ADHD Australia (2019)

Managing Challenging Behaviours

At ACPC Psychology,  we are passionate about working with children with neurodevelopment conditions (incl. autism spectrum disorders) and their families using Functional Behavioural Analysis (FBA) principles and Positive Behaviour Support (PBS), alongside others evidence based therapies. Our treatment plans are individually tailored to assist your child's and family's needs. Our role as professionally trained therapists, is to help improve the quality of life for children with developmental delays and their families to empower them with new ways of understanding, managing and thus reducing challenging behaviour.

Children will engage in challenging behaviour for various reasons. There is always a 'function' underlying their behaviour. Generally speaking, it may be as a way to get something good whether it be a tangible thing or a feeling, or they might do it to get away from something that they don't like or that makes them uncomfortable.

The team at ACPC Psychology is committed to examining underlying reasons for challenging behaviour displayed by any child. Our therapists are trained through their qualifications on how to assess the function of a particular behaviour. Once the function of the behaviour is determined, then we look for ways to help our kids fulfil that need in a way that keeps them safe and is functional. In behavioural therapy, this is referred to as a replacement behaviour. Whatever our clinicians decide to teach it would be something that we determine based on the child's strengths and preferences whilst also working with parents or guardians of the child since they know their child the best!

When it comes to managing challenging behaviours, ACPC team takes into consideration the following important factors:

1. Individual differences

The initial stage of investigated the underlying reasons behind the challenging behaviours is to determine whether changing such behaviour needs to be addressed in the first place. In doing so, we work collaboratively with the individual and their families to examine the nature of the behaviours and prioritising which behaviour seems to be having a significant impact on the child and family's quality of life.

The second stage is to meet with the child and learn as much as we are able to about the child in terms of their overall development (i.e. language level, play skills, temper regulation), their strengths and interests, what types of things are they really good at it and what motivates them, things that they may dislike and the types of skills that would benefit from further development and training. Such information is vital when developing the individualised treatment plan for the child and their family.

2. Reasons underlying the challenging behaviour

It can be difficult for a parent or guardian, being emotionally attached to their child, to determine underlying reasons to challenging behaviours displayed by their children. As trained professionals in behavioural analysis, we work on analysing particular behaviours to help the individual to learn a new way to meet their needs, and assist families in understanding and managing displayed behaviours. It is important to involve trained professionals because there are tools that they have learned about that can help identify why it is happening.

3. Teaching a new behaviour / skill

Behavioural therapy principles works on empowering the child by teaching more effective skills to get their needs met in a more functional manner. In doing so, it is necessary to obtain observations of child's developmental level, functioning ability (i.e. interaction with parents, peers etc.) and analyse their progress in both their home and educational setting.This would involve working with parents/ carers and liaising with educators and other therapists including speech pathologists and occupational therapists.

4. Taking into account that the "student is always right"

Behavioural therapy works in the framework of "If the person we are trying to teach is not learning what we are trying to teach then we need to change how we are teaching". Reasons as to why a child may not be learning could include the possibility of selecting the wrong thing to teach; or that the skill is too hard and we need to teach the basics first prior to jumping to what the child is 'expected to know'. We therefore aim on breaking down each skill to the child's developmental level (i.e. level of understanding, readiness, temper regulation, attention/regulation etc.).

Summary Adapted from: Sarah Kupferschmidt, Autism Daily News http://www.autismdailynewscast.com/applied-behaviour-analysis-aba-challenging-behaviour/28818/guest/

Please Contact our clinic for a Consultation!
Call: +61 2 9541 1177

Our goal is to ensure your advocacy needs are met through the process of continuous engagement and genuine understanding of your needs