Why pursue a comprehensive cognitive assessment

Most of us have heard the saying that no two people with Autism are alike. A comprehensive cognitive assessment is an individualised process, it enables you to identify your strengths and weaknesses. Cognitive tests assess your concentration, memory, organisation, reasoning, problem-solving, decision making and higher level cognitive capabilities. It helps to determine whether there are any other underlying issues e.g. ADHD. Identification is important because it allows you to identify where you may need support.

I received a diagnosis of Asperger’s Syndrome approximately three years ago. When I pursued my Asperger/Autism diagnosis it was never suggested to me that I could undergo further testing to see how this condition uniquely affects me. I assume this is because it is usually children who undergo testing for early intervention and supports. I am a little too old for early intervention, so my reasons for pursuing an assessment was to ascertain whether or not I had ADHD (inattentive type). My personal history (my recollections, school report cards, GP notes, and observations by others) showed that I had issues with attention throughout schooling. However, no interventions took place to rectify this issue with attention. I assume this was partly due to not being disruptive in class (i.e. ADHD – hyperactive type). Perhaps teachers assumed it wasn’t such a big deal and I would grow out of it or they just weren’t educated in such matters, who knows. Nevertheless, this lack of anything perpetuated my struggles throughout schooling and beyond.

I can say that another added complexity for me is emotional dysregulation (aka central nervous system dysregulation). I have a history of depression and anxiety, due to complex family and social history. This ‘complex-trauma’ can cause emotional dysregulation. Emotional dysregulation also goes hand-in-hand with autism. Symptoms of central nervous system dysregulation from trauma or anxiety can create similar problems with organisation and attention as conditions like ADHD, or it may add further complexities to underlying cognitive issues (e.g. ADHD).

During my first university degree, my grades went down at the height of my anxiety and depression. I worked through some of those issues on my own before and as I was completing another degree. For this latter degree, I was able to achieve an award of academic excellence. This was in spite of still experiencing issues with fatigue, concentration and brain fog. So, to outsiders, it is easy to think that it was my mood disorder that impacted my ability to focus and excel. I know it wasn’t the whole picture, as I still experience issues with organisation, concentration and decision making even though I no longer have clinical depression or anxiety as bad I had about eight years ago.

In my experience, I have found that professionals tend to consider presenting issues above all other considerations or possibilities. This creates unwittingly creates barriers. From their point of view, Occam’s razor, the simplest explanation is usually the correct one.  In these circumstances, you need to persevere with what you know is best for you even when the professional is walking down the garden path. If you find yourself having an emotional response to the situation then step back and give yourself a moment to consider the consequences of having an emotional reaction. Strong emotional reactions tend to put people off, especially when it causes their stress response to go off. So, despite what professionals may say just pursue the testing anyway to rule out whether or not you have an underlying cognitive condition.

The comprehensive cognitive test usually goes for a number of hours. You are given numerous tests in Abstract Reasoning, Verbal Reasoning, and Numerical Reasoning among other things. The outcome of my cognitive assessment was that it identified that I have sensory processing disorder. It also revealed that there is a big discrepancy between my intellect (gifted range) and working memory capacity (below average). This discrepancy is called twice exceptional (i.e. gifted with a disability). And it accounts for my lifelong frustrations and challenges with everything. These challenges of mine are not solely due to mood and anxiety disorders.

This process of investigation has brought up feelings of hurt and injustice. Hurt because I have been hard on myself due to my failings (some failings that were outside of my control) and that due to my strengths masking my disabilities I never received support.

The outcome of all this, I have to put thought into whether I wish to pursue the ‘treatment?’ program which is neurofeedback.

Further Reading:-

High IQ Kids With ADHD – Thomas E. Brown, Ph.D.


10% Students may have working memory problems: Why does it matter?

Thanks for reading!

Have you had a cognitive assessment or considered having one?
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What professional support services are available to those on the Autistic Spectrum (in Australia) at this point in time?

In Australia, gaining affordable supportive services for Autism is dependent on whether or not you qualify for NDIS (that is, if NDIS has rolled out into your area). It also depends on your age! Those aged 18 and above may encounter difficulties obtaining support services. Individuals who have received a late diagnosis or those labelled as ‘borderline’ or ‘mildly’ autistic will also encounter barriers when seeking support.

Employment Help?
There are a few services that can be accessed to receive assistance in finding and maintaining employment. I am not going to be providing recommendations, as I believe that quality is dependent on location and staff, and not just the service provider itself. There is a lack of consistency across services, as some just try to meet their quotas and don’t offer much help at all. For instance, you might have one job service provider that is fantastic, in let’s say, North Sydney but is quite poor in Bankstown. So, my recommendation would be to look at reviews online or just try it out to see if it suits your needs.

Nova Employment – Disability Service.
This service is free (as it is government funded), however, you need to meet their eligibility criteria: To participate in this program, you must have a disability, or a permanent medical condition or significant barriers to employment.

ASPECT – Autism Spectrum Australia

ASPECT’s employment help  (Aspect Capable) is not a free service. I am not sure what the current rate is per hour, but I think it is somewhere between $60-80. If you are feeling stuck and want a mentoring service with a good understanding of Autism Spectrum Conditions then ASPECT is something you could consider.

My only critique about employment services is that they may box you in, simply for the reason that you have Autism. For example, the misconception that the only work deemed okay for people with Autism are things like factory work, computing, gardening or working in warehousing. It’s true that there may be some things you’re not suited to, however, it shouldn’t be ruled out as impossible (or not worth trying).

Mental Health Support?
I suppose that working in community mental health makes me privy to the various barriers and strengths that exist within the system. I have found that not all workers are fluent in ‘spectrum conditions’ and misunderstandings arise because of this. I presently work with a few individuals diagnosed with an Autism Spectrum Condition, and I liaise with other workers who work with individuals on the spectrum.

In terms of free support, the government provides funding for several programs run through NGOs.  These programs exist to assist those ‘suffering’ from mental illness to work toward their recovery goals. You are partnered with a support worker who will provide practical support, social support, and greater access to community participation among other things. Support is usually relinquished when the participant no longer needs someone to walk alongside them (i.e. they have developed a greater capacity for independence).

Remember, the focus of these programs is for Mental Health Recovery and not Autism Spectrum Conditions. So, if you want to access support that is specifically developed for those on the spectrum you would need to find an organisation that provides this service, and often at your own expense ($$$).

Programs include:-
RichmondRPA (NSW and QLD only):
Provides a range of services, including support for women and children, youth, and adults.

Compeer (through St Vincent de Paul Society):
An international program to support individuals faced with social isolation by matching you with a volunteer.

Personal Helpers and Mentor Service (PHaMs): –

You can self-refer to this program. However, you need to be aware that some areas aren’t taking referrals at this time or may have a wait list due largely to demand.

Neami National:-
Offers several services, including community outreach and peer-led programs. It’s probably best to check your location on their site to see what services are available.

For those aged 12-25. Again, be aware that depending on what area you live in there could be a long wait-list for psychological support! They’re also a little adverse to those considered ‘too complex’, as it challenges their current capacities. They’re not able to offer long-term subsidised assistance and generally, young people who attend this service have more straightforward depression and anxiety. They will receive 10 sessions, as per better access scheme with the potential to extend (it’s up to the practitioner’s discretion). http://headspace.org.au/

Free national telephone and online service, for anxiety and depression

Support for day to day living program:-
Another government initiative which focuses on providing structured and social-based activities. Again, you need to check the website to see what is available in your location.

Lastly, another alternative is asking your GP to refer you to one of those rare psychologists who bulk-bills.  You can also access private services if you have private health insurance.

Service Coordination.
In Australia, federal and state governments fund programs that facilitate the coordination of supports. This means that these organisations build a picture from your story and link you into the appropriate supportive services (a holistic approach).

New South Wales ONLY- Abilitylinks (Disability):-https://www.adhc.nsw.gov.au/individuals/inclusion_and_participation/ability_links_nsw
You will need to visit the site to see which organisation is the lead in your area.

All States and Territories – Partners in Recovery (Mental Health):-

Social Support?
In terms of social supports, there are mainstream supports and peer-led groups.

ASPECT facilitates social networks and social groups.

Autism Community Network

This site has a number of Autism/Asperger groups. You’d need to search for what is in your area. Alternatively, you can look up groups along a similar vein, for example, shy and socially anxious. You can also join groups that align with your personal interests.

ASPIA – Group for partners of individuals with Asperger’s

New South Wales
Diverse minds, located in Erskineville (Sydney), runs an adult female group (18-35) and an adult group (for those aged between 20-30).

Asperger Centre –
Has links to several groups for individuals with Asperger’s

Asperger Victoria – Adult monthly meetings and social events

South Australia
Nothing at this time

Western Australia
Autism West – Chat time

Nothing at this time

Australian Capital Territory
Autism Asperger ACT – Discussion Group

Northern Territory
Nothing at this time

Assessments and Private Psychological Support!
Personally, if I were to go for an assessment or pay for psychological services I would find a place that specialises in autism. If you are female, a clinic that is familiar with female presentations would be best. Sessions can be quite expensive if you pay from your own pocket, anywhere from $200-$350. You might be able to get discounts if you have a concession, are experiencing financial hardship or if they have a student (registrar) psychologist at the clinic.

Regarding seeking support through more generalist clinics. I am not saying this is the case for everyone (some people might have had a good experience), however, I have heard quite a decent amount of people retell experiences of grief at having gone through generic psychological services i.e. depression, anxiety, schizophrenia and bipolar disorder among other things. This is due largely to professionals lacking an awareness and understanding regarding Autism Spectrum Conditions.

Finding a good psychiatrist can be challenging. Your General Practitioner (GP) may have a list, but it is usually a good idea to do your own research. And to ring a psychiatrist’s practice inquiring after wait lists before you see your GP for a referral. Unfortunately, some psychiatrists have a wait list that lasts months.

Under the Better Access Initiative, Medicare subsidies are available for any patient referred by a doctor for 50 sessions each year (compared with 10 sessions for a psychologist). However, you will need to have a severe and persistent mental illness to be eligible for this scheme.

More on the Better Access Initiative:
The Better Access initiative was introduced to address low treatment rates for common mental disorders such as depression and anxiety, particularly presentations of mild to moderate severity, where short-term evidence-based interventions are most likely to be useful. The number of treatment sessions required for mental disorders depends on the diagnosis, duration and severity of the particular disorder. Under this initiative, patients can access Medicare rebates for up to 10 individual allied mental health services per calendar year and/or up to 10 group therapy services.

To access Medicare services under the Better Access initiative, you will need to visit your GP who will assess whether you have a mental disorder and whether the preparation of a GP Mental Health Treatment Plan (MHTP) is appropriate for you, given your health care needs and circumstances. If you are diagnosed as having a mental disorder, your GP may either prepare a GP MHTP, or refer you to a psychiatrist who may prepare a psychiatrist assessment and management plan. Alternatively, your GP may refer you to a psychiatrist who, once an assessment and diagnosis is in place, can directly refer you to allied mental health services. Further information on the Better Access Initiative is available at:http://health.gov.au/mentalhealth-betteraccess.

Thanks for Reading!

I’ll probably create another post at a future time to reflect the implementation of NDIS, so stay tuned!

What services do you have or what services have you found?
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