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The other thing I wanted to share with you is that today I have a fantastic interview with Dr. Cathy Lord, co-author of the ADOS and ADI-R to share with you. It was a great interview, but we had some tech issues. So the audio is a little less clear than usual, but I think you will still be able to get plenty of good information from this interview. With that said, enjoy.
Hey everybody. Welcome to another episode of The Testing Psychologist podcast. Today, I am absolutely [00:02:00] thrilled to be talking with Dr. Cathy Lord. You have likely heard Cathy’s name over the years. She’s a co-author for both the ADI-R and the ADOS, which have come to become some of the gold standards for autism spectrum assessment in our field.
So we’ll talk a lot about that and a number of other topics here as we go along with Cathy. Let me give a brief introduction and then we can jump into our conversation.
Dr. Cathy Lord is Professor of Psychology and Psychiatry and Founding Director of the Center for Autism and the Developing Brain, which is a collaboration between New York Presbyterian Hospital, Weill Cornell Medicine, Columbia University College of Physicians and Surgeons, and in New York Collaborates for Autism. She is a licensed clinical psychologist with obvious specialties in diagnosis and intervention in autism spectrum disorders.
[00:03:00] Like I said, she’s been renowned for her longitudinal work with kids with autism and in her role in developing these diagnostic measures that so many of us have used over the years and continue to use. She got her degrees at UCLA and Harvard. She did her internship at the TEACCH program at the University of North Carolina.Cathy, I am honored to have you on the podcast. Welcome.
Dr. Cathy: It’s nice to be here.
Dr. Sharp: Thank you so much for taking the time to be here to chat with us. I think like myself, a lot of other folks will be excited to hear this. You’ve been around for a while and you’ve done some important things here in our field. So I am very excited to jump into it and start talking about your work with autism spectrum disorders and diagnostic measures.
Dr. Cathy: Great.
Dr. Sharp: It’s normal for us here on the podcast to check [00:04:00] in here at the beginning. I would love to hear about your training, but really, what you’re currently doing. It sounds like you’re involved with a lot of different agencies and a number of different projects. Can you catch me up on what you’re doing clinically and research-wise right now?
Dr. Cathy: Right now I am the Director of a clinic that sees people with autism from tiny babies all the way up to adults. We provide assessments, intervention and consultation. So we do a little bit of everything and not enough of anything as outpatients.
And then we do clinical research. So we are on the fringes of biological research in that we help the basic scientists describe their patients, but mostly what we do is our clinical things. Mostly our focus right now is on trying to improve the [00:05:00] measures we’ve done.
For example, we’re trying to come up with a better ADI, the parent interview. We’re trying to make it modular, so shorter. We’re trying to make it so that you can do it on an iPad. It’s still an interview, but you can enter it on an iPad. You can pick the kinds of questions you want to ask, you can perhaps ask them over and over again to be follow-up questions but it won’t be quite so onerous as the whole long thing that exists currently.
Our biggest focus is something called the BOSCC, which stands for Brief Observation of Social Communication Behavior, which is a 12-minute videotape observation that can be done by somebody pretty untrained, like a post-baccalaureate research assistant or also a parent interacting with a child. The idea is that you video it with somebody with minimal instructions. And [00:06:00] then you can code this.
Somebody with a minimal amount of training codes the child’s social behavior. The codes are laid out so that they’re much more sensitive to change than an ADOS. They’re more focused on frequency and not diagnostic. This is not a mini ADOS, this is looking for change.
We’re hoping that we’ll be able to get a measure that will be sensitive to things like a child’s change after say, three to six months of early intervention or three to six months of participation in a social group. That’s a big focus of what we’re doing.
We’ve finished the version for minimally verbal kids and are working away on a version for verbal kids. Right now, that’s primarily available for researchers, but we hope we can make it available to clinicians too, and maybe make available a service that would actually code these things so you could just [00:07:00] upload it and have somebody for a minimal cost, not super expensive, give you your codes back so that you can be blinded, because as clinicians, we are biased, we know we are, and so are parents seeing changes because partly we’re hoping to see them, and we’re just so invested, so they give you feedback. So that’s something we’re doing.
We’re also interested in trying to pick apart what changes and why in different interventions. With Sophie Kim, who is one of my colleagues, she just got a big grant to try to use this instrument to look at what changed in early intervention and why, and how that relates to parents’ behaviors. So that’s another project.
And then the last big thing we’re doing is continuing our longitudinal study which has been following about [00:08:00] 200 young people whom we met when they were two years of age, referred for possible autism, who are now in their mid-20s.
Obviously, we have not at all determined these young people’s lives. We’re just watching them, following them, hearing from their families and from them how their lives have gone. It’s been a wonderful way to get a natural history of what happens in the lives of these 200 young individuals and watch them grow up. So that’s the main way I spend my time now.
Dr. Sharp: Okay. It sounds like you’ve got a lot going on. You’re still very much on the front lines doing the research and developing these things.
Dr. Cathy: We are. There’s a lot more to do and we could keep doing. We could make things better. There’s a million ways we could make what we’ve done better. So it never stops.
[00:09:00] Dr. Sharp: Always. I think that’s familiar for anybody in research. You started off with some pretty hot topics right off the bat. When I hear you talk about putting the ADI-R on an iPad and shortening it, the light bulb goes off. I wanted to shout for joy. I feel like I have to ask, is that close at all to be able to roll that out?Dr. Cathy: Two years, I think.
Dr. Sharp: Oh, okay.
Dr. Cathy: Sorry. It won’t be handing the parent the iPad. It’ll still be an interview because we feel like it’s important that someone asks the questions, but you’ll be able to rule the answers and code it on the iPad so the codes will come right back to you.
We still feel like we need the human clinician. I’m a real believer in human clinician. [00:10:00] It’ll be shorter and more to the point. There’ll be modules, so you’ll be, am I interested in a diagnosis? Do I already have a developmental history so I don’t need to spend a lot of time talking about toilet training? Am I worried about comorbidity, so I need to really talk about behavior problems or is that something someone else is going to do or I’ll do later?
And then the other thing is, is this a follow-up visit? Do I want to go through and talk about things that I’ve talked about before so I’m just focusing on current? And then being able to compare that quickly to what I got before.
We’re hoping that we can do all this with the help of an iPad or putting it right on your Mac or something so that there’s not all the craziness of filling out forms and then doing currents and evers and sorting all that out.
So we [00:11:00] hope quicker, more user-friendly, and more focused.
Dr. Sharp: I think that’s great. It seems like that’s the direction that we’re moving with assessment in general. So that’s great to hear that y’all are trying to move in that direction as well.
I would say for a lot of folks, anecdotally, the ADI-R and the length involved in the minutiae nuances of scoring are sometimes hurdles to administering the whole thing.
Dr. Cathy: Yeah. We know.
Dr. Sharp: I’m sure. You’ve lived it. Gosh, I just had like five thoughts at once from your little introduction, but I’m going to try to stay on script a little bit here. For anybody who doesn’t know, we’re casually throwing out ADOS and ADI-R and that kind of thing. Could you generally talk about what those instruments are [00:12:00] and what they’re trying to assess for anybody who might not know?
Dr. Cathy: Sure. The idea of the ADOS is to use the powers of a human clinician or to observe and interact with a person with autism in order to make a diagnosis, and to try to standardize that in a way that two trained, experienced clinicians who did this twice within a reasonable period of time would come up with the same diagnosis and the same scores so that we’re both having the benefit of both skilled and a human being, but also standards so that if I see scores, I know what they mean. I know [00:13:00] that it has a meaning for me, that it is the same for me and for you and for somebody who is in Sweden or Korea or Thailand or Australia.
And that has to be individualized to some degree because all people with autism are different. Also the context in which we behave. Part of the difficulty with autism is that a person may not be responsive to context. So we’re counting on the clinician to be aware of that.
Essentially, what the ADOS is, is a series of tasks that vary according to the age and the language level of an individual. There were different modules that you select from depending on age and language level. There’s about 10 tasks that you do over the course of about 45 minutes.
You have to learn to do [00:14:00] this and you have to practice. You present these tasks to a person that you think might have autism. As you present them, in a particular way, you are watching how the person with autism responds to you and also how they initiate with the materials. The materials are deliberately selected to provoke or evoke certain kinds of behaviors.
And then when you’re finished, you code what the person does, and this gives you a diagnostic algorithm that can be rated on severity. It’s not severity for life, it’s severity compared to other people of the same age and the same language level, how severe are that person’s symptoms in terms of social communication and repetitive behaviors in that 45 minutes? That’s what the ADOS does.
I think that the other main value of the ADOS is that for young children, the parents or caregivers are expected to be there. You can use them to participate. This is not why it was created, but I think that a tremendous value is parents can actually see what it is that you’re doing and understand what it is that you’re looking for in making a diagnosis, and be part of this in a positive way, because we’ve put positive experiences, pleasant experiences in there.
For older kids, I think the value is that there are deliberately situations that we hope aren’t misery creating, but are hard for many people with autism that they may be able to avoid often in other [00:16:00] circumstances, and that it does make you think about things that might be hard for somebody that you might not see otherwise. So it does give you these standardized scores for difficulty.
What the ADI-R is a very lengthy caregiver interview that a clinician gives. What’s different about it than other things is it’s relatively open-ended. It’s a semi-structured interview, which means that the clinician has a certain question that’s open-ended, but then you have codes and it’s up to the clinician to get enough information to answer that code.
Once you’ve asked the first question, it’s up to the clinician to keep probing till you can honestly check off one of the codes. So you can ask any other question that you need to [00:17:00] ask or get the person talking about, whatever you need to in order to reach those codes. So it’s very different than something like an SRS or a CBCL where you’re just filling out a form.
I think for me, the primary value for us in our clinic, we always try to get away from an ADI-R and then we end up coming back to it, is it gives parents a chance to tell us about their children. It gives us a chance to see the child through their parents’ eyes.
There are other ways to do that. I think people work out all kinds of ways of getting that information, but for us, especially in a training clinic, it’s been very helpful to start with that, particularly for families who are fairly well-informed and seeking a diagnosis.
It can be a great entry point for a clinician to get a sense of what is the family thinking about? What do they know about their child? What are they [00:18:00] worried about? And then go from there. It’s way too long and there’s a lot of things in it that don’t need to be there.
Dr. Sharp: That’s interesting to hear you say that. It sounds like y’all are working on that for sure. It’s a very useful tool either way.
I think over the years, between those two tools that you’ve helped develop, the ADI-R and ADOS, that term, gold standard for autism assessment really became commonplace, especially with the ADOS. It seemed like for a while, there was a lot of emphasis put on ADOS as the deciding factor in a diagnosis.
And now it seems like we’re going back the other direction. You’ve been an author on some of those papers to say, hey, this is maybe not the only thing to use, there are other tools. Am I right with that?
Dr. Cathy: I think there isn’t one answer [00:19:00] ever. What we’ve tried to do with the calibrated severity scores is say, there is a continuum and it’s important to use these scores like a blood pressure metric. You should compute it and say, where does this child fall and what does this mean? And then take that into account with other things.
At least in our clinic, and obviously we are so biased, because we talk about this all the time and we all do it. We trust our own judgment more than we trust almost anything else, which maybe we shouldn’t. I think that you’ve got to know what the child is like in other circumstances, you’ve got to know what they’re like at school and other circumstances. You also need to know from the parents and the [00:20:00] teachers.
We know that autism diagnoses that take into account information from a teacher or a parent and a clinician using something like an ADOS and an ADI-R or an SCQ or an SRS are going to be more diagnosis of stable and reliable than a diagnosis made just on one source. So that we know. Those probably make less difference.
Dr. Sharp: Oh, that’s interesting. I was going to ask, maybe you’ve already answered this but in your mind, what is the ideal suite of assessment tools when you’re looking at autism in kids? I know it varies depending on age and things like that, but in a kid, what else would you [00:21:00] recommend?
Dr. Cathy: I think you want something from a parent. Ideally, I would like something from a teacher, maybe not so much diagnostic but I would want to know from a teacher how they think the child is doing. I would want to know either the equivalent of the CBCL or a Vineland or something or input from the teacher. And then I probably would do an ADOS, but partly it’s because I’ve done so many ADOSes, they’re second nature to me, so it’s easy for me to slot in an individual child compared to other kids.
I think that for young kids, the STAT is very good. It’s just much more limited in terms of the age of the kids and you do get bigger age effects and language effects. The problem with these [00:22:00] instruments that are specific to particular ages is that if you have a very bright child or a child who has very minimal skills, you’re going to lose them either end.
And that’s been the value of the ADOS is it covers such a broad range by the time you have all the modules that you can move up and down easier. I think the STAT is also very good. So that’s another instrument that involves clinician observation.
The CFBS for the little kids is probably over-diagnostic of communication problems, but also a place where you observe the child. It’s focusing on communication. You can look at repetitive behaviors during it. It’s for very young kids as well.
Basically, though, you want an observation and then you want some kind of way of reporting from kids. The SRS people use it a lot. It makes me [00:23:00] nervous because the SRS is far more correlated with the CBCL and behavior problems than it is with social deficits. So you’ve got to be really careful. I think it means something’s wrong when you get a high on SRS, but it certainly doesn’t mean autism.
Dr. Sharp: I see what you mean. I think it’s a dilemma we get in.
Dr. Cathy: That’s the problem. People use it, but who knows. There’s a variety of other autism measures that I’m less familiar with, that a lot of people like a lot. I just shouldn’t comment because I don’t know.
Dr. Sharp: Sure. I think that’s the dilemma with the behavior checklist is that, at least in my experience with some colleagues, it’s been hard to find the right one. I’ve settled on the SRS in conjunction with these other methods we’re talking about, [00:24:00] but it’s tough, like the GARS and the CARS I’m a huge fan of, this has been tough to find the right checklist. It sounds like that’s not just me, maybe.
Dr. Cathy: Right.
Dr. Sharp: So an observation, an ADOS and certainly getting information from multiple sources, those are pretty important. And then you just have to be careful with the behavior checklist that you’re using and integrate that appropriately. Is that about right?
Dr. Cathy: Right. With the behavior checklist, so when you have like a CBCL, you’ve got to remember that the SRS and the CBCL are going to be more correlated with each other than they are with anything else because you have method variants that’s stronger than the kid. That’s where you have to be careful but it’s still better than not doing it.
[00:25:00] So get that and get an ADOS alongside of the not doing it, but it’s not the same thing as getting separate autism information. Just because it’s called the Social Responsiveness Scale does not mean it measures social responsiveness. It means that we didn’t want to call it the Autism Responsiveness Scale because that upsets parents. So you’ve got to be really careful.I think that’s where you’ve got to be careful. The CARS was the original autism measure. It was the best thing around for a lot of people and it still works most of the time just because most of the kids who have the things on the CARS have autism, but it doesn’t really match up with what is in DSM-5 or what will be in ICD-11 at all.
It’s just fortuitous that it [00:26:00] describes autism symptoms. It just includes a lot of other things in there, like low IQ which many kids with autism but not most by any means, have.
Dr. Sharp: It is hard to separate and hard to find the one that is exactly right. I think that speaks to the variance in presentation with folks on the spectrum. That’s a good segue, I did want to ask you about how you see the ADOS fitting in with, and assessing that variation, particularly there’s the girl versus boy or male versus female question, and then there’s the higher functioning versus more lower functioning on the spectrum question.
I wonder if we could tackle that a little bit and how you see the ADOS, [00:27:00] particularly for higher functioning females, but it seems to maybe miss some folks on the spectrum. How do you work with that or do you have thoughts on that?
Dr. Cathy: I think that the role of sex differences in girls with autism is a real question that we just don’t understand. When you look at the data, they’re all over the place. There’s some data that suggests that we really are missing a lot of girls and other data that suggests that we aren’t.
I think part of the problem is that girls, like the boys, are so variable, and we all remember the girl that we missed. On a gut level, I do believe that girls are different than the boys.
One of the things I keep reminding myself is that at one point when I was younger, I was in [00:28:00] London, I was going through the records at the Institute of Psychiatry with Michael Rutter, 90% of the kids there had atypical autism diagnoses. Only 10% got regular autism diagnoses. Everybody that came to their clinic, they would say atypical autism.
My point is that it’s very seldom do we see a classically autistic child. We’re always saying, oh yeah, not quite classically autistic. I think we’ve got to remember that because when you get the idea in your head that somebody is going to be atypical, which is going around right now with the girls, you’re going to see that.
On the other hand, I think that the experience that girls have is different than boys. We know that girls are less hyperactive, girls are less aggressive, girls are less disruptive [00:29:00] and girls are less likely to be language-delayed than ordinary girls. All of those factors probably contribute to looking less autistic as an adjective, not as a diagnosis.
And then I think girls are socialized to be better behaved and so I think that contributes probably; both biological differences and social differences to being different. We have to be careful. I think that one of the things to try to remind people with the ADOS and ADI-R is there is flexibility in there. There’s a lot of stuff in the ADOS and you can also choose your examples, so don’t be rigid, choose your examples so they’re appropriate [00:30:00] to a girl.
Sometimes people say, oh this stuff is so geared toward boys, but it’s not, there is stuff in there for girls. Use it for goodness sake.
Dr. Sharp: Can I jump in and ask that?
Dr. Cathy: Do not do the same thing that you’ve just done with all those boys. Try to find the stuff in there that you think will appeal if you think this girl wants to do it. Not all the girls are dying to do girl stuff, but I think that you do have to remember that.
It’s certainly on the ADI-R, you can think of examples that might be more appropriate if you think that you’re pulling the wrong example because at this point, there isn’t evidence that we’re actually looking for something different in the girls. It’s just [00:31:00] that we may need to shift our expectations a little bit and provide different examples.
I do think the threshold may be different. I just saw a 13-and-a-half-year-old girl, she had a diagnosis of pretty much everything else under the sun than ASD. I think she has ASD and nobody saw it.
Dr. Sharp: What things did you see that others maybe didn’t catch or how did you pull those things out through the assessment?
Dr. Cathy: This is a young girl who is very nice-looking. She has a beautiful smile and otherwise, no facial expression, but she does have a beautiful smile. I think people saw that smile. She has pretty good eye contact, but she also has a visual problem so she doesn’t quite look at you right. She also has a [00:32:00] astigmatism so that’s part of it.
So I think people didn’t put that together. I think they didn’t catch that it’s actually quite hard to catch her eye. They always thought it’s because of the astigmatism. And then they didn’t even notice that with this lovely smile, otherwise, there’s nothing there.
She’s a very fine actress. When she is animated, she can she can re-enact Frozen for you. And then she gestures, she sings, but otherwise, she does not move her body, she does not gesture. In that sense, she does look classically autistic in terms of her nonverbal behavior.
I think people were so surprised, at a very early age, she started singing. That so [00:33:00] much overwhelmed people. Also, the fact that she had delayed motor skills, which is perhaps maybe more common in girls with autism than boys. We don’t know. And the visual problem, and her verbal skills, she’s always been very verbal. That’s not necessarily typical of girls with autism, so they just didn’t even think of autism.
And then when she started having terrible temper tantrums, everyone got so obsessed with that, they went off onto a whole other diagnostic route. And then I think what she’s rigid about is mental health. She’s obsessed about her own mental health and everyone else’s mental health, and then a little bit about social justice and various other issues which are not the [00:34:00] same as like being obsessed about flags or subways or ceiling fans.
Dr. Sharp: Sure, but still a restricted interest as far as you can tell.
Dr. Cathy: Yeah. If you counted up her references to social justice and the unfairness of buying $700 shoes, which is specific to Manhattan, that may be female in the sense that I don’t know how many boys would even know who bought $700 shoes.
Dr. Sharp: Sure. That’s a good question. That’s an interesting case that touches on the sex differences, but it also raises a question for me that during the ADOS, I often have a hard time picking up those repetitive behaviors, restricted [00:35:00] interests, particularly if they’re not obvious. I often end up with a bunch of zeros on that bottom half of the scoring rubric. I wonder, do you have thoughts on things to look for in that regard or ways to pick up more nuanced, repetitive behavior, particularly during the ADOS that people might be missing?
Dr. Cathy: That’s a really good question. She was a good example where I debated what to score there and ended up finally scoring that because I thought, in the end, there were just so many references. I had such a hard time getting her off that topic. I had to define it as a topic, which seemed a bit odd to me for me to define that as a topic.
I think that sometimes you are going to have zeros. We have to admit sometimes we [00:36:00] don’t know. I think that we are basically going back and forth realizing that in some cases, for example, in research, we’ve had young research assistants trained to do ADOSes, they come back, and every 10-year-old boy that they assess, whether they have autism or they’re typically developing, comes back and they say they have repetitive interests in video games.
You have to be careful to define what a repetitive interest is. On the other hand, here I am giving you an example where I’m struggling whether to call something a repetitive interest. It is pretty nuanced.
With odd behaviors, what we’ve ended up saying to people is if [00:37:00] you see something that looks odd, go ahead and score it because you’re not going to make someone autistic by having one odd behavior. They’ve got to have other things as well.
It should be odd in a way that’s clearly autistic. It shouldn’t be picking your fingernails or rubbing a table. It should be smelling something that no one else would smell or something very clearly autistic. Otherwise, we have to live with the fact that we can’t always catch things.
Sometimes we don’t see it and then literally, you’re walking someone to the waiting room, and out comes some clear example of something that you were trying desperately to get someone to tell you during an ADOS and they’re not doing it.
[00:38:00] Dr. Sharp: So what do you do with that situation? I’m curious because I think we’ve all had that, like the ADOS goes pretty well, but then there’s something in the waiting room or something during the other portions of testing, and you’re like, oh, if I could just score that as part of the ADOS, how do you work into that?Dr. Cathy: I don’t score it in the ADOS but I still trust my judgment. I would just overrule the ADOS. What I do is write up the ADOS, I say what I saw but I’m wishy-washy about what it means. And then I say what I really think.
I would write up the ADOS probably emphasizing the aspects that made me suspicious but you can’t put it in the ADOS, because the ADOS is a measurement. You can’t put it in that [00:39:00] measurement. You’re stuck but you can in your clinical formulation. You can say, the ADOS gave me this information and then you don’t have to put the negative information.
The ADOS gave me this information, my clinical observation gave me this information, this is my decision. Ultimately, it is your decision. One caveat I would stick in here is that we have seen a number of very small kids who’ve had high ADOS scores where clinicians could not bring themselves, I’m talking about two year olds, to say they had ASD. There I would be really careful not to rule it out.
I would be careful because those kids often get in the denied services, and when we see them often they do have ASD because they get worse. So there are lots of groups where [00:40:00] if you get a middling high ADOS score, I would be tempted to be really careful not to deny a kid services if it’s going to be dependent on an ADOS.
Dr. Sharp: Can I put you on the spot a little bit? I agree with that, absolutely. I wonder about the wording and how you might phrase that to parents because I feel like parents come in for these evaluations and I hope that they are conclusive to some degree. Do you have a sense of how you would present that to parents to leave it open so they would still get services but not be definitive in the diagnosis?
Dr. Cathy: I have an easier life because I work at an autism center, so I realize that it’s different for me than someone who works in a more general place, because families have bitten the bullet by [00:41:00] walking in here. What we do say here is we say, look, your child barely met criteria for ASD on the ADOS. I don’t know if he has ASD. That’s what I would say.
I don’t know. He’s little, he’s got everything going for him. I don’t know, but I think we’ve got to get to work and make sure that this doesn’t get worse. I am going to give you this diagnosis, but I don’t know if it’s going to last. Let’s assume this is a working diagnosis but I honestly don’t know if it’s really going to hang on.
Dr. Sharp: Okay. That’s good to hear.
Dr. Cathy: That’s what I would say. I would say, if you don’t want to think of this as a diagnosis, it’s fine. If you want to leave this [00:42:00] up in the air, it’s okay.
Dr. Sharp: Okay. And giving them permission to embrace it however they’d like.
Dr. Cathy: If families say, I don’t think so, I would say, you know what, I am with you. I don’t want you to walk away from this and not do the things that I think he needs now because there’s enough going on here that you came and then I see. That’s what I would say. And then we know that many kids at this age get worse, so we don’t want that to happen. So that’s what I would say.
I would also say, look, this is so in that mild range that I’m not saying to you, this is forever. I’m not saying this is a lifelong diagnosis, I’m just saying, let’s get going.
Dr. Sharp: Okay. [00:43:00] That’s really helpful. I want to be respectful of your time. It seems like these interviews go by so fast, this one particularly. Can I ask one last question that’s related to that and your thoughts on the idea of someone growing out of autism?
Dr. Cathy: Sure. I think it happens. I didn’t used to think it happens, but I think that partly it’s that we are diagnosing autism in smarter kids. I think both formal early intervention makes a difference. The key in early intervention is both direct services, but also parents realizing they’ve got to keep kids engaged and that sometimes they have to change their behavior, that it is different having a [00:44:00] child with ASD, or a child who may have ASD.
In our longitudinal study, we have a significant minority of the people who have average intelligence do seem to be moving out of the spectrum. It’s not the majority. It’s also important to point out that there also are people who clearly still have ASD as adults who are doing okay. So it’s not whether moving out of the spectrum is any better than staying in the spectrum, but having a job and being happy in your life, it’s not better, probably.
It’s quite amazing to see somebody that you knew when they were two who had pretty classic autism who doesn’t anymore. I think that it can happen. [00:45:00] Mostly, it doesn’t happen early. It can but it mostly doesn’t. It’s a long process.
Dr. Sharp: Okay. Thank you. I appreciate all your thoughts and the time. This has been a pleasant conversation. I’m aware there’s so much more we could talk about, but maybe there’s a round two somewhere down the road here on the podcast.
Dr. Cathy: Good question.
Dr. Sharp: Thank you. This has been great. Could we maybe end with any resources on training in the ADOS or ASD assessment in general that you might recommend to folks or ways to get better?
Dr. Cathy: WPS, which is the Western Psychological Services, which is the publisher keeps updates of ADOS trainings, which are now all over the place. I’m [00:46:00] sorry, I don’t keep track of them.
Dr. Sharp: I’m sorry.
Dr. Cathy: We do training and UCSF does training twice a year here. They’re also pretty much all over the U.S. and pretty much all over the world now. If you’re interested in particular places, you can email me and I’ll pass you on to our coordinator and they can let you know for specifics. I don’t know books and stuff.
The good news about the ADOS is we have an adapted ADOS now, which I don’t know if WPS is going to sell, but there is an adapted ADOS for less able adults that is available. You probably know there’s a toddler version. So we are continuing to try to expand it to make it more [00:47:00] appropriate for more people. So we’ll keep working on that.
Dr. Sharp: That sounds great. I’m going to keep close tabs on all these projects. You’ve got some cool stuff going on. It sounds like you’re working so hard to develop these measures, use them in your clinic and then use that feedback to tweak the measures. Just going through that whole process where you’re incorporating all these sources of information in the real world and research, that’s fantastic.
Dr. Cathy: Thanks, Jeremy.
Dr. Sharp: Sure. Cathy, it’s been an honor to be able to spend some time with you. I appreciate it. Hopefully, our paths will cross in the future again.
Dr. Cathy: Thank you very much.
Dr. Sharp: All right, take care.
Dr. Cathy: Bye bye.
Dr. Sharp: All right, y’all. Thanks again for listening to that interview with Dr. Cathy Lord. She’s clearly done a ton over the years and continues to do pretty [00:48:00] incredible clinical and research work in the field of autism spectrum assessment.
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So y’all take care. I should have two more episodes coming out here before the Christmas season. In the meantime, I hope everyone is enjoying the holiday season and staying warm or staying cool, depending on where you’re [00:50:00] at, and having a good year. We’ll talk to you later. Thanks for listening. Bye bye.