American Psychiatric Association poised to impact Autistic Spectrum Disorder treatment

by Mitch Nagler, M.A. LMHC

The American Psychiatric Association has made what seems to be a confusing and disturbing decision to change how autistic spectrum disorders are going to be defined in the near future. Anyone with a child or family member on the spectrum, especially if they are currently diagnosed with a milder form, such as Asperger Syndrome or PDD-NOS, should be concerned about how these changes are going to impact access to health, educational and social services for their loved ones. It is possible, if not likely, that when these changes are put into effect in 2013, many who qualify for services now, will not meet the new standards, and thus be left without therapeutic options.

What we have learned since the current diagnostic criteria were put into effect in the DSM-IV in 1994, is that early intervention is critical for making positive changes in performance. Diagnostic tools have been developed that now make diagnosis possible as early as 18 months of age. Children and their families that have had access to the creative and important support services in all important areas of life, have made extraordinary improvements. If/when these changes to the DSM-V are put into place, insurance coverage, school services, and institutional support programs are likely all going to be curtailed for many people.

As the Director of the Bridges to Adelphi Program, and as a private practitioner, I have worked with hundreds of high school and college aged individuals with diagnoses of High Functioning Autism, Asperger Syndrome, and PDD-NOS. Most of them came from supportive elementary, middle school and high school environments. Many also received outside support and counseling services. As they have progressed through their lives, whether in their college careers at Adelphi, or elsewhere, I have seen first hand how important the early interventions were in their development. In fact, as we begin to graduate Bridges students from Adelphi, I worry about the younger students that are still in Pre-K or elementary school.

I am worried that if/when these proposed diagnostic changes are put into effect; the developmental future of young individuals with these diagnoses will be negatively impacted. Many who would have been able to build independent, successful lives, and enroll in programs like the Bridges to Adelphi Program, may not be able to do so because they will not have access to the important early interventions and support services.

My advice is to do what I did. Call the American Psychiatric Association, at 703-907-7300, and tell them that you object to these changes. Tell them that you have a family member or loved one who may be excluded from receiving services if these changes go through.

Mitch Nagler, M.A. LMHC, is a private practitioner and an Assistant Director at the Adelphi Student Counseling Center. He is also the Director of the Bridges to Adelphi Program, a multifaceted intervention program that includes coaching, learning strategies, behavioral modeling, and peer mentoring that addresses social, academic and vocational areas.

What do we do next?

by Audrey Freshman, Ph.D., LCSW, CASAC

The holidays were busy in unimaginable ways for many families on Long Island. During the Christmas break I fielded 3 separate calls from parents, each resembling the next, and detailing the following request:

My son is a student at a state university. He is currently in the hospital having said that he “tried” some drugs at a party. He almost overdosed. Unbeknownst to us he has become addicted to opiates. He is now ready to be discharged and we need to bring him home. What do we do next?

I need help for my 10 year old who is very anxious and getting in trouble in school. Actually, there is a lot going on in my family. My older child is a nursing student. She is now in a de-tox for the past few days but plans to return to school for the January semester. She is addicted to opiates and other drugs that help her “study.” I feel desperate about her returning home. What should I do now?

My husband has been acting strange. It started last year when he injured his leg and was placed on medication. Now he is slurring, and spends days in the basement. He refuses to stop seeing his doctor who is giving him “the stuff.” He does not think there is anything wrong with him. Is he depressed? What should I do?

The holiday week culminated with the New Years Day reports of yet another Long Island pharmacy death, this time the Seaford shooting. The public is alarmed. Pharmacists are frightened. Lawmakers are calling for action. All of us want to know, “what should we do next?”

From 2007 to 2010, a report cited in the The New York Times released by the New York State Attorney General’s office indicated that oxycodone use has increased 82% in New York State; all other narcotic pain medication increased an additional 36% during the same time period. The National Institute on Drug Abuse (NIDA) notes that there were enough prescription painkillers prescribed “to medicate every American adult around-the-clock for a month.” In spite of this, New York State Senator Charles Schumer had to recently issue a warning to the Food and Drug Administration (FDA) against approving another, and even more powerful version of hydrocodone known as a “super painkiller” according to the Associated Press.

Yet, it is the failure to connect these storylines that remains central to the ongoing plight of opiate addiction on Long Island. The reality behind the distressed phone calls shows us that the face of the “addict” belongs to the student in our high schools and universities, who become exposed to the insidious epidemic of pharmaceutical availability through a friend’s locker or a parent’s medicine cabinet. It is the face of one of the adults in our community who receives a prescription for pain medication from a local physician or pain clinic that paves the way for iatrogenic addiction. It is the face of the younger sibling witnessing the chaos in their family that becomes the next in-line to medicate their fears.

We need to respond by acknowledging that the problem is “ours” and begin to own our “next steps.”

At the Adelphi University School of Social Work’s Department of Continuing Education, our goal is to recognize the contagion of addiction and to elevate the professional workforce capacity to address the urgency of the problem. Our Postgraduate Certificate Program in Addictions will enable interdisciplinary behavioral therapists to receive specialized training in addictions that can lead towards the Credential of Alcoholism and Substance Abuse Counselor in the State of New York. We expect that with additional training these professionals can bring their skills to each and every practice setting from the public health centers, to the criminal justice institutions, to the education systems, and into the private counseling offices.

This spring, our continuing education workshops will look at the co-occurrence of substance abuse and trauma, which is one of the most common overlapping mental disorders. We are continuing our quest to partner with private and nonprofit drug treatment organizations to bring leaders and researchers in the field of addiction to our campus to address issues of drug use in our communities and schools.

The treatment of addiction is complex. It requires an integrative family-based model of treatment along with a contemporary understanding of the current evidence-based research, community resources and supports that are in place to sustain recovery.

Most importantly, it requires a knowledge base that can diagnostically disentangle complex psychological, social, and economic issues in order to best respond to the question, “What do we do next?”

Dr. Audrey Freshman, Ph.D., LCSW, CASAC, is the Director of the Adelphi University School of Social Work Office of Continuing Education and Professional Development. She has nearly 30 years experience in conducting interventions, diagnostic assessment, and treatment of adolescents, adults and families coping with issues of substance use and abuse. Prior to Adelphi, she was the associate director of Tempo Group, a New York State Office of Alcoholism and Substance Abuse (OASAS) agency located on Long Island.

New year, new you?

Happy 2012 from Adelphi’s Center for Health Innovation!

The beginning of the year often finds us focused on making new year’s resolutions, which are often be health-related. The top resolutions usually include some variation on improving our fitness and workout habits, losing weight, and quitting smoking. But most resolutions don’t make it past the end of January, which leaves us feeling as if we have missed our big window into making meaningful changes.

But why do resolutions fail? In many cases, it’s fundamentally misunderstanding why we don’t succeed combined with setting unrealistic expectations.

A December 2011 article in the Wall Street Journal reported that “in a survey of 1,134 adults released last month by the American Psychological Association, willpower was the top reason people cited for failing to make positive changes.” But is it really a lack of willpower that has people reaching for their cigarettes and skipping the gym?

Relying on willpower may not be the answer, as “willpower springs from a part of the brain, in the prefrontal cortex, that is easily overloaded and exhausted. What works far better, researchers say, is training other parts of the brain responsible for linking positive emotions to new habits and conditioning yourself to new behaviors.” Researchers recommend visualization and “linking your new habits to other pleasant changes” as more successful strategies.

Understanding what will help you succeed is only half the battle. In many cases, the very nature of the goals we set don’t do us any favors. Dr. Jonathan Jackson, the director of Adelphi’s Center for Psychological Services recently shared his thoughts on the pitfalls of resolutions with the 101.9 FM News audience.

Jackson believes that a resolution “should not be to reverse something, it should be to do things differently.” Many people incorrectly view the new year as a time when we are a blank slate, with a chance to do things over again. But Jackson says “it’s unrealistic to think that you’re ever a blank slate,” and he recommends taking “small steps,” where you can easily see progress and feel a “sense of closure and a sense of triumph” that you have achieved.

If you’re looking to take some small steps this year, Adelphi and the Center for Health Innovation can help put you on the path to a healthy and satisfying 2012.

• Want to get fit? Visit our Center for Recreation and Sports to sign up for our Adult Fitness Program
• Want to enrich your mind? Attend a spring event at the AUPAC
• Want to help your community? Stop by our Hauppauge Center during January and donate a coat or warm clothing to our Warm Drive

However you choose to take a small step, the Center for Health Innovation looks forward to being a partner on your path towards increased health and wellness.