Child playing with lego blocks
Autism Assessments in Ontario – What Parents Need to Know

Autism Spectrum Disorder is a neuro-developmental disorder that affects how a person communicates, interacts with others, and behaves. It is considered a spectrum disorder, meaning that there can be countless variations in the presentation of symptoms, resulting in there being no one specific way that autism looks or presents. Similarly, there is no specific test for autism that is the best. The assessment process will vary depending on the type of practitioner you see, the age of your child, and presentation of their symptoms.

In Ontario, autism can be diagnosed by qualified and trained professionals including the following, if they have undergone specific training to assess and diagnose autism:

• Medical doctors such as family physicians, pediatricians, developmental pediatricians and psychiatrists
• Psychologists and psychological associates
• Nurse practitioners

You can make an appointment with any of these professionals directly at their office, or you can contact one of Ontario’s five diagnostic hubs to get on a waitlist for an autism assessment via a multi-disciplinary team. If you choose to see a medical provider or to go to a diagnostic hub, the cost of the assessment and diagnosis is covered under OHIP, but the waitlists are usually years long. If you choose to work with a practitioner in private practice, you will be billed for the assessment, but will likely have the assessment completed sooner.

Depending on who you see, the assessment process can vary, as long as the basic required information is obtained. Your practitioner will need to collect information about your child, using whatever methods they are trained in, to determine whether your child is presenting with symptoms within the two broad categories required by the DSM-5

• Differences in social-communication skills, verbal and nonverbal communication, play, and understanding and establishing friendships and relationships.
• Repetitive and restricted interests, repetitive behaviours, rituals and compulsions, resistance to change, and sensory interests or aversions.

A basic assessment might simply include a parent interview and a short clinical observation to determine the presence or absence of autism symptoms.

A more comprehensive assessment will also attempt to measure your child’s cognitive abilities, adaptive skills (independent daily living skills for their age), graphomotor skills, language / vocabulary skills, attention, and self-regulation skills. The comprehensiveness of the assessment will vary depending on the practitioner you see, so it’s always advisable to ask about the components of the assessment before choosing a practitioner.

Information can be collected using a combination of questionnaires, interviews, clinical observations, and direct testing. There is no rule about which methods or tools must be used. There are several questionnaires, standardized interviews, and standardized tests to choose from. For this reason, the single most important factor in obtaining a valid assessment and accurate diagnosis is the training and expertise of the practitioner you choose.

Questionnaires may be simple checklists or may be standardized, normed screeners and rating scales (these contain scores obtained from a representative sample to which you can compare your child’s score). Questionnaires are often used to determine if there are sufficient concerns to move ahead with an assessment. Sometimes they are used as part of the assessment data, to obtain information from third parties such as daycare providers or classroom teachers. Questionnaires are also often used to gather other types of information about your child’s functioning, such as their attention, self-regulation, or their independent daily living skills, which are all important elements in understanding your child’s unique profile and the areas and degree of support they will require. Questionnaires are almost always included in assessments.

Your practitioner will also likely complete a diagnostic interview with you, to find out detailed information about your child’s development, your family history, other medical concerns or diagnoses, how your child interacts with others, responds to others, communicates with others, plays with other children, and also about restricted and repetitive interests and behaviours. This interview can be an informal list of questions that your practitioner uses, or a standardized interview that includes scores, the most popular of which is the Autism Diagnostic Interview – Revised (ADI-R). Regardless of the type of interview used, the training and experience of your practitioner is again the most important factor in identifying behaviours of concern.

Clinical observations and Standardized tests
Direct observation is usually a component of an autism assessment, and can range from 15 minutes, to several hours, depending on the practitioner you see. During this observation, your child’s social interactions, communication with others, interests, and behaviors are observed. Often this takes the form of a play-based session where your practitioner will attempt to interact, speak, and play with your child. You may or may not be invited to stay in the room during these sessions, depending on the age and needs of your child. These can be informal play observation sessions, or structured / semi-structured standardized observations such as the Autism Diagnostic Observation Schedule, 2nd Edition (ADOS-2). The ADOS-2 is broadly considered by many as the ‘gold standard’ for direct observation in the assessment of autism because it is sensitive, specific, and reliable (when administered by a trained, experienced practitioner). However, the ADOS-2 is not required for a valid autism diagnosis in Ontario. Rather, a clinical observation by a trained and experienced practitioner is the most important factor.

If you have chosen a practitioner who provides comprehensive assessments, other types of direct testing might include standardized tests of cognitive ability (general knowledge, reasoning, problem solving, memory, speed), fine motor skills (drawing, copying), and receptive / expressive vocabulary (pointing to pictures or naming things).

Autism Assessment Report and Diagnosis
The entire process can take one day, or may be broken up over several days. A diagnosis might be provided right away (for example, if you see a physician) or you may be asked to wait several weeks for a final feedback meeting and report (for example, if you see a psychologist). The report usually contains descriptions of your child’s strengths and needs, test results and scores, observation data, any diagnoses made, and a list of recommendations and resources for moving forward.

While the information you receive at the end of the process may vary in comprehensiveness depending on the practitioner, the diagnosis that you receive holds the same medical validity, and has the same power to access resources, regardless of which practitioner you saw, and regardless of the comprehensiveness of the report. Once you receive the written diagnosis, you are able to move forward and apply for services and funding, such as through the Ontario Autism Program.

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Woman with OCD washing hands repeatedly
What is Obsessive Compulsive Disorder (OCD) – symptoms and treatment

Obsessive Compulsive Disorder (OCD) is a type of anxiety disorder that affects about 2% of the population. The causes of OCD are not yet determined but researchers believe that there is a genetic and neurological component, and also an environmental component. People with OCD have persistent thoughts and urges that cause them so much distress, that they try to suppress or neutralize them by performing specific behaviours or mental acts.

What are Obsessions and Compulsions

Obsessions are persistent thoughts, images or urges that are unwanted, intrusive, and cause anxiety or distress. Examples include recurrent worries about getting sick, thoughts about harm befalling a loved one, unwanted sexual images, or the need for things to be symmetrical or ‘just right’. These can lead to feelings of anxiety, guilt, disgust, or something being not quite right.

Compulsions are repetitive behaviours or mental acts in response to the obsession, usually to try to get rid of the bad feelings, or prevent some dreaded event from happening. Examples are excessive washing or cleansing, constant checking or reassurance seeking, compulsively replacing bad images with good ones, ordering and arranging things, or repeating certain thoughts or actions.

OCD Diagnosis

At some point in their lives, most people experience obsessive thoughts or compulsive behaviours to some degree. But they don’t necessarily all have OCD. To have OCD, the obsessions and compulsions must be extreme and cause feelings of distress, must be time consuming (taking up 1 hour or more per day), and must interfere with the person’s functioning or stop them from doing activities they would like to do, or need to do.

The OCD Cycle

People with OCD find their obsessions very distressing, and often try hard to avoid anything that triggers the thoughts, images or urges. For example, if a person with OCD has the thought that they might spread germs to their loved ones and make them ill, this will cause them high anxiety and distress, and they will likely try to avoid anything that will trigger that anxiety. They might avoid touching public door handles that they think are germy, or using public bathrooms. This avoidance leads to even lower anxiety tolerance over time, leading to even more avoidance. If they do touch the door, the ensuing anxiety is often so high that it is not tolerable, and they engage in a compulsion: a behaviour, mental act, or ritual to neutralize the anxiety. This compulsion brings immediate relief. This becomes an OCD cycle, where an action triggers an obsession, which triggers anxiety, which is then neutralized by a compulsion, and then it repeats. This cycle provides short-term relief but makes things much worse in the long run.

OCD Treatment

Sometimes mild OCD passes on its own, but most OCD tends to get worse or reoccur over time unless treated. The good news is that there are several treatments for OCD that have been shown to be effective. The most common are:

1) Psycho-therapeutic interventions such as Cognitive Behaviour Therapy (CBT) with Exposure with Response Prevention (ERP) – this is a supported approach done with a trained professional where the person is helped to gradually and systematically confront their fears without engaging in compulsions. This leads to new learning and behaviour changes over time. Acceptance and Commitment Therapy (ACT) for OCD is another highly effective therapeutic approach.

2) Medications – OCD responds well to medications known as Selective Serotonin Reuptake Inhibitors (SSRI’s). Although medications address the severe anxiety and compulsive behaviours, it is still often advised to engage in therapeutic treatment as well, because gains are not maintained after medication-only treatment.

If you suspect your loved one might be struggling with OCD, our therapists at CASE Psychology are trained in both CBT and ERP, and are ready to help. Please contact us to book a consultation.

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Does My Child Have Social Anxiety?

Does My Child Have Social Anxiety?

It can be hard to know if your child’s shyness is normal or something to worry about. If you are wondering whether your child’s shyness is more than just bashfulness, read on.

Social Anxiety Disorder (SAD) refers to intense fears or anxiety about being in social situations in which you might be negatively judged by others. For example, worrying about sounding stupid when you speak, making a mistake in a speech or performance, not being liked by new people, that other people will laugh or make fun of you, about offending other people, or about eating or drinking in front of others.

Social Anxiety Disorder: Is Your Child Struggling?

In young children, this anxiety can look like crying, tantrums, freezing, clinging, shrinking, and avoiding. In teens, it often manifests as irritability, anxiety attacks, rumination, and avoidance.

Social anxiety does not usually go away on its own. In fact, as your child avoids more social situations, the anxiety often grows over time, making things worse in the long run. This can lead to problems making friends, social isolation, and increasing mental health problems.

Signs of Anxiety to Watch Out for in Your Child

While some children do go through shy phases that they grow out of with maturity and support, or may be natural introverts, there are a few things to watch out for that can indicate that your child might be struggling with something more.

1) The anxiety occurs in peer settings, not just with adults. It is normal for young children to be anxious in the presence of unfamiliar adults or intimidating adults, where there is a power difference. However, when anxiety occurs in the presence of other children their own age, where there is no power difference, it often stems from a fear of being judged by peers.

2) The anxiety is related to a fear of being negatively evaluated by others, such as what other people will think, whether others will laugh at them or make fun of them, or looking stupid or awkward in front of others.

3) The fear is intense and out of proportion to the actual threat. This means that your child avoids the social situation, or endures it with high distress.

4) The anxiety almost always occurs in the social situation, not just occasionally. This can include anxiety in advance of the social situation (such as worrying for weeks in advance about a speech or social event), during the situation, or emotional meltdowns right after. If the anxiety is almost always there, and has persisted over time, this is a sign that it is probably more than shyness.

5) Your child’s anxiety causes interference in their life. Interference is probably the strongest red flag that your child’s shyness might be a bigger problem. Interference means when the anxiety stops your child from doing things they want to do, or things they need to do. For example, if your child stays home to avoid tests or presentations, avoids social situations with peers, has other people speak for them, prefers to stay home than go out with friends, or chooses to cancel or miss out on social events due to their anxiety, this is interference. Over time, this can lead to isolation, increased anxiety, and depression. When interference is high, it is usually time to see a professional to get some support.

Fortunately, Social Anxiety is highly treatable. Cognitive Behaviour Therapy (CBT) with supported and systematic exposure is one of the most common types of treatment. This is where your child learns to reframe the way they think, how to relax their bodies when stressed and tense, and then gradually face their fears with the support of a trained therapist.

At CASE Psychology, our experienced Child Therapists are highly trained in a variety of evidence-based approaches for treating anxiety disorders in children and teens, including CBT. If you are worried that your child might be struggling with social anxiety and might need professional support, please contact our office to book a consultation with a member of our team.

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Reasons to see a therapist in Burlington
5 Reasons You Should See a Therapist

The world is gradually shifting towards greater acceptance of mental health needs, but there is sometimes still a deep hesitance towards therapy, which is seen as best reserved for people with the most crippling problems, serious mental health disorders, or extreme traumas.

Humans have great capacity for struggle, and so it is that we carry on, comforted by the thought that our problems aren’t that big, and silenced by the belief that we should be able to deal with them on our own. Not surprisingly, individuals often seek support only after life has begun to feel unmanageable and overwhelming.

If you have reached this point, reaching out for support is a necessity. To reach out before this point is a great act of proactive self-care. Either way, taking that first step takes a whole lot of courage.

If you have ever wondered about therapy, but convinced yourself that your problems aren’t big enough, here are some reasons therapy might actually be perfect for you!

  1. We all experience stress: Big or small, stressors are real, and can have serious effects on your mental and physical health. Many people are not aware of their own past and present stressors. Others are acutely aware and are highly distressed. Whether your stress is related to childhood experiences, anxiety, work, relationships, or parenting, having someone you can talk with can help you to recognize, identify, process, and address stressors in your life.
  1. Emotional awareness: This refers to the ability to identify the emotions you are experiencing. Emotional awareness is important because you need to know what you are feeling in order to monitor, process and respond to those feelings in a healthy way. There are different levels of emotional awareness, with people at the highly developed end having better mental health outcomes. Engaging in therapy is a great way to develop your own emotional awareness, as well as awareness of emotions in others, so that you are better able to tolerate difficult situations when they do arise.
  1. New coping skills: We all find ways to cope in times of stress. You might reach for comfort foods, go for walks, take long showers, vent to a friend, cry it out, distract yourself, use humour, pray, or use self reminders to get through tough times. Some coping behaviours can be “maladaptive”, meaning that they seem to help in the short term, but actually cause more harm and distress over time. When you lack strong, healthy coping skills, you are more likely to resort to unhealthy and maladaptive ways of coping when you are faced with negative events or changes in your life. Engaging in therapy is a great way to add some tools to your toolkit, so that you have a wider range of powerful, flexible, and healthy coping tools to reach for in times of stress.
  1. Self-care and self-compassion: As a society, we have accepted that maintaining our physical health and avoiding physiological illnesses requires constant work. We have yet to embrace working on mental health with the same level of acceptance and necessity. Self-care includes finding ways to take care of your physical, emotional, social, mental, and spiritual needs. People who practice regular self-care have better mental health. Therapy can help to reframe the way you think about yourself, and the way you practice self-care, so that you are more resourced in times of stress.
  1. An outside perspective: Sometimes it can be therapeutic to talk to an impartial third party, who can help you to think about things from a different perspective, to normalize life events and emotional reactions, to create some distance between you and your problems, to explore alternative solutions, and to find meaning in difficult life circumstances.


Burlington Therapists

In Ontario, psychologists, psychotherapists, and clinical social workers in private practices do not require a doctor’s referral. You can simply call our Burlington therapists to book a session yourself. However, some insurance companies require a referral, so always check with your insurance provider first, to find out if they require a doctor’s referral for reimbursement.

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Psychoeducational Assessments

What is a psychoeducational assessment?

A psychoeducational assessment is a series of specialized tests (like questions, vocabulary, puzzles, patterning, sequencing, memory tests, hand-eye coordination tests, and academic tests) that provide a detailed understanding of a person’s cognitive and academic skills. Cognitive skills refer to thinking, learning, problem solving, memory, attention / concentration, phonological processing, and processing speed. This is what people typically refer to as “IQ”. Academic skills are related to reading, writing, and math. Together, an understanding of these skills provides a profile of the learner, which outlines their strengths and weaknesses, conditions under which they learn and perform best, and situations and tasks they are likely to struggle with.

A psychoeducational assessment sometimes only evaluates cognitive and academic skills. However, if the assessment is more comprehensive, it can also evaluate a person’s social, emotional and behavioural functioning, such as problems with social skills, attention, executive functions, anxiety, emotional regulation, or sensory problems. This is usually done through observation of the child / person, talking to parents and teachers, and asking parents and teachers to complete questionnaires and observation forms.

Your psychologist will also review past information contained in report cards, medical documents, or past assessment reports, to find out how long problems have existed, and what supports have been tried so far.

At the end, a written report is provided, with all test results, diagnoses, and recommendations for home and school supports. You will meet with your psychologist to go over the results and talk about the recommendations.

At CASE Psychology we provide comprehensive psychoeducational assessments that examine all areas of functioning: cognitive, academic, social, emotional, and behaviour.

Who can benefit from a psychoeducational assessment?

Psychoeducational assessments can identify learning strengths and weaknesses, diagnose learning disabilities, giftedness and attention disorders, and can determine the most effective supports to help a child / person to be successful at school, and at home. These assessments are typically requested for school-age children, but can also be completed for adults.

A psychoeducational assessment should be considered if your child is not meeting grade-level expectations, is struggling with basic academic skills, is inattentive or has behaviour problems at school, or is working much harder than their peers to maintain their grades.

Common signs that a person may benefit from a psychoeducational assessment:

  • Problems with reading, comprehension, writing, spelling, or math
  • Slow and laborious printing, or writing refusal
  • Difficulty understanding and following directions
  • Poor memory or organization
  • Problems with language, communication, or social skills
  • Work refusal or fights at homework time
  • Can answer questions orally, but struggles to write them down
  • Discrepancies in performance e.g., does well with reading but struggles with math
  • Anxiety about school
  • Negative self-talk related to academic performance
  • Working much harder than peers to maintain grades
  • Working too slowly; needing extra time to process information or to complete tasks

What kinds of recommendations will be provided?

Psychoeducational assessments help provide clarity around learning problems by painting a picture of a person’s strengths and weaknesses. With this picture, educators can build on strengths, and provide support for weaknesses. Depending on the type of learning problem the child / person is experiencing, varying environmental supports may be suggested. Some examples are individual education plans (IEPs), differentiated instruction, specialized programs, extra time on tests, shortened assignments, additional learning support, assistive technology at school, social skills classes, or counselling support.

For adults, recommendations usually focus on learning accommodations in post-secondary settings, such as extra time on examinations, access to technology, or reduced course loads.

Reports will also include any diagnoses made (such as learning disabilities, giftedness, attention disorders, autism, or other developmental disorders) and specific recommendations that are relevant to the diagnosis.

In all cases, regardless of whether a diagnosis is provided or not, the assessment will result in clear recommendations and specific steps to improve the person’s success and confidence in educational settings.

What the psychoeducational assessment does not measure

Psychoeducational assessments measure the types of abilities that are most relevant and predictive of academic performance at school. They do not measure other abilities and characteristics that are also important predictors of success, such as discipline, motivation, persistence, emotional readiness, overall ‘grit’ and determination, curiosity, creativity, musical ability, athletic ability, etc. As such, although these results may predict academic performance at school, the results represent only a small snapshot of the person’s overall ability for success and happiness in life.

Things to consider about the psychoeducational assessment

Psychologists in private-practice do not require a doctor’s referral for a psychoeducational assessment. You can simply phone our clinic and self-refer. However, some insurance companies require a referral, so always check with your insurance provider first, to find out if they require a doctor’s referral for reimbursement.

Early intervention matters! An early assessment is useful for getting the right support in place. However, there are optimal age-ranges for different types of assessments and we are happy to discuss these further when you call us.

Psychological services are not covered by OHIP, but all or a portion of the fees may be covered by your extended health insurance – please check your insurance provider for your coverage.

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