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[00:00:00] Dr. Sharp: Hey y’all, this is The Testing Psychologist podcast. This is Dr. Jeremy Sharp. And this is the podcast where we talk all about the business and practice of psychological and neuropsychological assessment. Welcome back.

I’m excited for our episode today. I say that a lot, but it’s always true. And today it is particularly true because I had an action-packed conversation with Dr. Stephen Kanne at the University of Missouri. Stephen and I talk all about the GAIN program, which is a tele-training program aimed at helping clinicians gain better skills with the ADOS-2, which is a big part of many of our autism assessments.

Stephen and I talk a lot about the GAIN program: what that looks like, how you can participate, and the benefits of that. We also spend the second half of the podcast just diving into autism assessment in general. He tackles some emerging questions that I’ve had over the past few months. We just have a great discussion about autism assessment and ways to get better at that.

Let me tell you a little bit about Steve. He is the executive director of the Thompson Center for Autism and Neurodevelopmental Disorders. He is also a Professor in the Department of Health Psychology at the University of Missouri. He got his bachelor’s and doctoral degree in clinical psychology from Washington University, did his internship at the University of California, San Diego, and then a post in pediatric neuropsychology at the University of Missouri-Columbia.

His current research interest focus on kids with autism targeting diagnostic tools, outcome measures, behavioral phenotyping, co-occurring symptoms, evidence-based therapies, and sub-threshold symptoms, which we’ll talk a bit about. In addition to publishing in the area of [00:02:00] autism, he’s also published in the areas of cognitive neuropsychology, history of neuropsychology, and pediatric TBI. He’s also board-certified in clinical neuropsychology.

Stephen and I have a great conversation. He is a really entertaining guy. I think that there’s a lot to take away from this episode. So I hope you stick around.

At the time of this release, which I believe will be early March, maybe late February, I will likely have 1 to 2 spots in my advanced practice mastermind group open. And due to popular demand, I believe I’ll have a second cohort of Beginner Practice Mastermind spots open. So if you were worried about missing out on that Beginner Practice Mastermind group, the first one did fill up and now I think I’m going to open a second one because a lot of people are interested. So check that out. You can go to thetestingpsychologist.com/consulting, find the links to get more info about both of those groups, and apply to join.

All right, without further ado, let’s get to my conversation with Dr. Stephen Kanne.

Hey everybody. Welcome back to another episode of The Testing Psychologist podcast. Like you heard in the intro, I have a fantastic guest with me today. I think that y’all are going to take a lot from this episode. This is one that was very clinically relevant. I have Dr. Stephen Kanne here to talk all about the GAIN program and autism assessment and the ADOS.

Stephen, welcome to the podcast.

Dr. Stephen: All right. Thank you for having me on. I appreciate it.

Dr. Sharp: Like I said before we started recording, I’ve been looking [00:04:00] forward to this one for a while.

Dr. Stephen: Oh, good.

Dr. Sharp: Ever since I heard of the GAIN program. 

Dr. Stephen: I hope I don’t disappoint.

Dr. Sharp: No, absolutely not. There’s no way. You’ve got a lot of good info to share from what I can tell. And this is just another instance of the small world that we live in. I talked with Celine Saulnier. She gave a great interview and she said, you should really check out this GAIN program and Steve would be a good option. So, I’m just fortunate to get connected.

Dr. Stephen: Yeah, absolutely. 

Dr. Sharp: I did want to lead off as usual just to ask really why is this important to you and why do you do this work in particular within our field? 

Dr. Stephen: It’s interesting because my path to what I do now isn’t one that I would recommend to most people. It’s been a journey of many twists and turns but not without regrets because I think the life experience I got on the way has certainly benefited me now.

I actually started out as an adult neuropsychologist studying, believe it or not, Alzheimer’s and Parkinson’s. And then on my internship out in San Diego, for the first time, I started working with kids at one of their children’s and adolescent’s psychiatric hospitals. And that’s actually where I met my first child with autism too. And quite honestly, I just fell in love working with children, the families, and the parents. I haven’t looked back since.

I think my personality tends to go along better with kids than it does adults for some reason. So it worked out really well. And then I fell into the autism field that way as well. I started learning about autism itself, this is in the early 2000s, how to diagnose it, started one of the first clinics in Missouri and St. Louis. And again, my path just continued down that road. I’m a believer that when your skill set matches your passion, good things happen. And that’s certainly what happened with me. 

Dr. Sharp: That in itself was a nice takeaway already from the interview. Can I just ask out of curiosity, what was that like to make [00:06:00] that switch from adults to kids midstream? 

Dr. Stephen: It’s not as hard as you might think, believe it or not. Even as a neuropsychologist who did a lot of assessment testing, the things we struggle with in terms of cognitive assessment, they’re not dissimilar across board. They’re the developmental trajectories, but there’s also someone has a brain injury or has some type of medical issue. You’re still dipping into all the various domains the same way. The difference is this developmental overlay that’s on top of it with kids and how the brain just changes massively.

In some ways, I think part of it was great because it was hopeful. It’s like working with Alzheimer’s. I love that as well, but there’s a real end point there if you think about it, but with kids, you never know. There’s this hope and there’s this intervention points with the kids and with the parents that you can touch on, that gives you just so many more intersecting points where you can make a difference, I think. So the switch wasn’t hard because I ended up enjoying it that much more. 

Dr. Sharp: I like that. Yeah, it’s true. That’s a big reason that I work with kids myself. It just feels like there’s a little more hope, maybe is the right word.

Dr. Stephen: Right. And I saw all of our kids with autism grow up. I definitely still have contact with them and do assessments with them. So it doesn’t change. But I like focusing on the young kids. I think the big difference is the families because now I’m doing so much more work with the parents and the siblings than I was when I was working with the adult population. 

Dr. Sharp: Sure. It’s a system for sure. So tell me a little bit about what your work looks like these days. What’s a typical week or typical month? I’m not sure how you might quantify it.

Dr. Stephen: When I started out, I was much more of a clinician. I worked in a typical position at a hospital as a clinical pediatric neuropsychologist. I did tons of assessments, shifted it much more to the world of autism, a little bit away from neuropsychology. That’s even an interesting question of itself [00:08:00] is, autism diagnosis, is that the same as doing neuropsychological work? We can go there if you want. I have some ideas.

Then I had an opportunity when the center that I’m at now opened up, which is in the middle of Missouri, it’s called the Thompson Center. They recruited me here to be one of the heading up to pediatric neuropsychological services, but also the diagnostic work in autism. And that’s really where my specialty has evolved is in assessing kids for a diagnosis of autism. So my world shifted when I came here to much more autism-related.

And then there’s all these nexus points that came in my career because I’m also a tenured professor. So it’s like, oh, should I go strictly academic and do research, do I stay as more of a clinician or do I combine them? I took the third path, which is, let’s move more into administration. So actually, most of my time these days is in running the whole center that we have here, which is very multidisciplinary. But I feel like I still do a lot of training, a lot of diagnosing, a lot of mentoring. It allows me to create a whole place that affects and impacts these families and these kids rather than just my own singular practice. 

Dr. Sharp: I can totally identify with that as a much smaller scale, I think, but as a director of a practice with several clinicians. It’s nice to see the impact grow through these other folks. 

Dr. Stephen: Absolutely. And I’ll be honest, there’s a lot about my job that I don’t like. I didn’t start off going, gosh, I want to be an administrator and run a center. You’re crazy if you do. It’s like you’re a parent of an entire place. There’s so many fires to put out and things to deal with, but that’s part of the fun too because you create a family here that is its own entity that then creates its own impact. 

Dr. Sharp: Exactly. I think the pros outweigh the cons, at least for me.

Dr. Stephen: Yes.

Dr. Sharp: For now. 

Dr. Stephen: It depends on the day. 

Dr. Sharp: That’s a good point. I’d love to hear more about the Thompson Center and the [00:10:00] GAIN program specifically, because that’s what we’re really here to talk about, I think.

Dr. Stephen: Sure. I’ll do just a brief overview of our center and then how the GAIN program evolves too. We opened up here in 2005; a gift from Bill and Nancy Thompson who are alums of the University of Missouri. It started off very small, just 5 of us, a handful, grew very quickly because autism was on the rise. We got several grants that put us on a national stage. So we were basically tripling in size with three months almost, grew and grew and grew.

What we wanted here was a center where we initially recruited people that were in their own silos. So occupational therapy, speech-language therapy, pediatric neuropsychology and medicine, and behavioral analysts. But then we knew that we wanted everyone to start working on teams together. 2+2= 17, rather than 4. And that’s what happened.

So we start working on teams together. We start sharing knowledge together. The processes that we evolved over time were difficult to do because every provider had their own notion of how things should be done. We all have, I think, pretty massive egos when it comes to our own specialties, like, no, my way is the right way. So we had to really develop new processes to say, how do we work together as an entire unified center rather than individual providers?

So it’s been a 10-15 year process to get us to where we are now. We have from, birth all the way through 20 years of age, we actually don’t turn away at that age to tell you truth, any type of service here from diagnostic, we have medical services, we have neurology, psychiatry, developmental pediatrics, speech-language, OT, nursing, dieticians, ABA, severe behavior disorder, clinic psychologists. It’s huge. We have about 16,000 visits a year now with about 80 faculty staff members. So, it’s quite the center. We’re pretty proud of what we built. 

Dr. Sharp: That’s amazing. Can I just interject? I know there are folks out there who are either building or [00:12:00] working in similar environments. Do you have any quick takeaways for how to integrate teams like that in different disciplines? Anything you’ve learned over the years that might be helpful?

Dr. Stephen: Yeah. Again, that could be its own podcast.

Dr. Sharp: Sure.

Dr. Stephen: It’s true. For me, having run those teams and been on those teams, I think we all have this pie-in-the-sky notion of interdisciplinary work. And again, this is my own personal opinion. I want to put that out where it’s like, oh, let’s have these teams where we’re all completely equal and we all contribute our own opinions.

I think what we found through the years is that instead, you have to have this combination of multidisciplinary and interdisciplinary work. Everything doesn’t have to be everybody all the time on every patient. What we found is like, that could be someone’s dream, but it doesn’t make sense. Every kid doesn’t need to see 14 people depending on the question that they have and how efficient it might be. So we’ve learned to be much more selective. One size doesn’t fit all. There are certain kids who benefit hugely from the full team, but there’s others that might just need to see 1 or 2 people.

The other part is, in terms of these teams is really respecting boundaries. So it’s like, yes, I understand my specialty is this. I need to respect your specialty. I need to not go beyond and start interfering with your expertise. I need to respect your expertise. But then it’s how you have those different specialties communicate their knowledge to each other to create the solution.

And I think what we found is, almost every time it doesn’t have to be a single specialty, but to identify a lead for that team for that day so that that person can gather the information and then coalesce it and be responsible for it rather than a full democratic process every time. It could work for certain people who are all cool and love each other all the time, but that’s not been my experience. So having processes in place is very important. 

Dr. Sharp: Nice. That totally makes sense.

Dr. Stephen: I’m very pragmatic.

Dr. Sharp: Sure. But you need that, right? You [00:14:00] can totally get mired in the process if you don’t have.

Dr. Stephen: Exactly.

Dr. Sharp: Yeah, you’re right. That could be a whole other conversation. So I’ll resist the temptation to just dive into that.

Dr. Stephen: It’s a whole podcast right there.

Dr. Sharp: Right. I’m in the process right now of embedding 2 clinicians in a local pediatric practice that also has OT and speech. So, this is totally right.

Dr. Stephen: You’re living it.

Dr. Sharp: Yes. Anyway, maybe another time. Talk to me about the GAIN program and how that looks within the center and what that is.

Dr. Stephen: Sure. And let me back up to say that what GAIN is based on is a diagnostic tool that we use in autism. One of the well-accepted gold standard instruments or tools to help us as clinicians diagnose autism is called the Autism Diagnostic Observation Schedule or ADOS is what we call in the field. Most people have heard of it if you’re in the field. It’s gained a certain shininess about it that I think there’s myths that are surrounding it, that I’m happy to strike those down as well.

There’s about, I don’t know, 30 or 40 of us that are certified independent trainers on the ADOS, which means that we’re allowed by the testing company and by the authors of the test to go around and teach other people and train other people how to conduct this measure and get better at it. So for years, that’s one of my roles. I’m an independent trainer of both the ADOS and the ADI, which is the interview component of it.

I love going around the country, working with other groups, and training them up on how to do and use this tool appropriately. But we found that if you know about the ADOS, what we’ve taught are there these two different levels of training. So there’s levels of training. We’ll go out and just about anyone can take it to be honest, it could be a MD, PhD, speech-language, school psychologist. They learn how to do the ADOS. And then we basically just ship them off into the real world and trust that they’re ethical enough to practice it enough [00:16:00] and become competent enough to use this measure well.

For people who want to do even better with the ADOS, there’s what’s called a research training or an advanced training. You don’t have to only do research to do that training. You can take that training whether you do research or not. The idea there is it’s much more intensive training, and then you have to get reliable on the measure, which means you have to turn in tapes to us. We make sure you’re coding things reliably, and then you’re at a whole different level of understanding of the measure and ability to give the measure. And the notion is it’s our research-grade ADOS. We can actually use it in research now. So that’s why they termed that.

The statistics of people who take the clinical training and how it funnels down to almost like, I think it’s 1% go to other research training and of those that go to that, 1-2% are making up these numbers by the way. Actually becoming reliable is disheartening in some way, because there are not that many people who go on to higher levels of training.

So there are lots of people out in the field who have been trained clinically and are using this measure, and we have no idea how good they are on it. And that’s our fault to be honest as a field because we have allowed it to happen. We’re training people because you feel this pressure and this need to diagnose more kids. We’re all feeling that. We’re all inundated with a question of autism. So we want to train more people to be able to do it and do it well, but there’s not a whole lot of quality control on the competence of who comes and when they leave how good they are or how good they become on the measure.

In terms of testing and assessment, the ADOS stands very uniquely because it’s not like, oh, if you’ve learned the WISC, you can do the WAIS, or you can pick up the Stanford-Binet pretty easily, practice a couple of times, you’re good. It’s not like that. This measure is incredibly sophisticated. It requires years, at least, of all the different modules, knowing them and being able to give them.

The reason why I talk so passionately about it as a trainer [00:18:00] is I think those of us in the field tend to become cavalier about the giving of the diagnosis. But those of us who do this a lot, these assessments change people’s lives. If you are a parent and you’re told that your child has autism, I have parents that come to me 10 years later and remember that day word for word. It’s a significant event. A significant diagnosis that transforms their lives. So it needs to be taken very seriously: how we diagnose it, how we approach the families, the support we give them afterward, and the measures that we use to do it accurately. We feel very strongly about that.

So you feel this tension in the field between train as many people as you can to use this tool that’s the best in the field, and yet there’s no kind of follow-up to see how good they’re doing on the measure or any quality control afterward. And now it’s bothering several of us who are trainers to say, we can do better than that. We should do better than that because it’s causing problems out there, quite honestly.

Now, I should say as a waiver that the ADOS is a very robust test; meaning, we’ve done studies and shown internally that even when you’re only clinically trained, the measure is very robust to still coming up with accurate results. So that’s good news.

Dr. Sharp: That is good news.

Dr. Stephen: Yeah. There was actually a person who worked here. Her name was Courtney Christopher. She’s now a graduate student of Catherine Lord, who’s the author of the ADOS in LA. It was her idea. We’re at a training and she’s like, we should come up with some idea to leverage technology to be able to do a better job of helping people understand this measure better and get better at it if they want to.

Our sector here does a lot of work in telemedicine, telehealth, and telementoring and we thought, well, we’ve done this. We have a technological infrastructure here. Why not see if we can create something? Am I talking too much? Is this good?

Dr. Sharp: You’re great.

Dr. Stephen: Once I just start talking about ADOS, I love [00:20:00] it.

Dr. Sharp: No, I promise I will jump in if I feel the need, but this is all good here. This is good.

Dr. Stephen: So, we’re sitting around and we’re like, how would this look or how would this work, and would anyone even care about it? So we decided to create a system of working with people where… The ADOS is made up of five modules. For those people who know it, it is based on language use. You really do have to become proficient in each module.

So we’re like, well, what about why don’t we do a quarterly approach? So for the first three months, every month of those three months, we’re going to focus on just one module, but do something a little bit different for each month. So it’s called the watch, do, share model is what we came up with.

The first month, it’s almost as if you’re at a training. What we do is we send out a recording of one of our people doing an ADOS at the right module level, people out there in the universe watch this recording, they score it, and then they turn their scores into us via a database REDCap where it’s all anonymous. Those scores get loaded in.

The notion is, at the end of that month, when we get all the scores in, we’ll have four of the premier trainers in the country talk through those codes. We are one of those trainers. We is myself, Somer Bishop, Vanessa Bal, and Amy Esler. We do them a lot of training across the country. And the notion is, we will go through those codes ourselves, and we’ll talk about how we got to the code we got and why, because for us, it’s not only about did you get the right code? It’s about understanding the gist of that code and why it’s an important thing. And this, of course, then increases reliability across the country. Our notion is with regard to scoring. So that’s the first month.

The second month, the same module set. We send it out there, but now we invite the entire universe out there to be panelists on the call and say, you guys ask us questions now and we’ll respond to those.

In the third month, we had people throughout the first two months submit questions like, oh, I [00:22:00] don’t know, am I supposed to do this test this way? Why do we do this? And we answer all those questions. And sometimes we’ll go through a research paper or something that’s very relevant and topical for that module. And then the next three months, we do a different module; the next three months, different module.

Again, just the notion was by doing this and offering it, can we allow a pathway that people who don’t have access to these trainers, especially at the level of the trainers that we have on the calls, be able to continue to hear, learn about the ADOS, but get reliable on it. So it’s fidelity. All this is it’s test fidelity. We’re trying to create an avenue and a platform to increase test fidelity, exposure, and a community of learning.

So now, all these people out there, they get exposed to Somer Bishop who’s this legend out there, or Amy Esler, who’s a legend. You hear them talk and we all talk through the codes differently. So it’s fun to hear the different perspectives.

We weren’t sure if anyone was going to go for this. We thought maybe 30 or 50 people would. I think we currently, I don’t know the exact numbers, but we’re around 500 people enrolled from 19 different countries. It’s been a huge success which just reflects the need for something out there like this.

Dr. Sharp: I have to say, I am not surprised at that because everyone I’ve talked to about this or shared it with, their eyes light up and it’s just like this relief, like thank goodness. We feel it on the other side as clinicians who were trained and especially those of us who were maybe trained a long time ago on the original ADOS that it’s just sort of been like, no man’s land for a while and to have some kind of touch point… 

Dr. Stephen: And you had to almost seek out a booster somewhere, and there it’s expensive, and it’s hard, and travel, and time. I agree. Totally.

Dr. Sharp: Yeah.

Dr. Stephen: The bad news is, I don’t know if this is bad news, that’s probably an unfair characterization, but it’s expensive. We have our software platform. We have time of all these people. So the first six [00:24:00] months were free as a pilot and we had a grant to do that. But now we’re actually charging the subscription to be able to do it, but I’ll be honest with you for the price of the subscription, it it’s well worth the fidelity on the measure. 

Dr. Sharp: Can you speak to the cost of the membership?

Dr. Stephen: They’re going to kill me if I get this wrong. I think it’s $20 a month. So it’s $60 for full three months. We offer CEs as well, additionally. 

Dr. Sharp: Oh, geez. If there is anyone out there listening right now who is balking at $20 a month for everything you just described, you get a virtual slap in the face.  

Dr. Stephen: I appreciate your violence.

Dr. Sharp: Virtual slap in the face. I mean, that’s incredible. That’s that strikes me as the best deal of the clinical world that I’ve ever had.

Dr. Stephen: And for us, it’s not profit. It’s like, we just need to keep the program sustainable and grow.

Dr. Sharp: Of course.

Dr. Stephen: One final thing about it is I think our initial goal was to create a model by which any measure can now be transported to use as ongoing fidelity thing through technology. So you can imagine this for the WISC or the WAIS or something else. You can adapt the model, but here’s a way to say, okay, for all you out there using this, you want more fidelity on whatever model you’re using, whatever measure, here’s a model that can actually be used. 

Dr. Sharp: Sure. Can I ask just some logistical questions about it?

Dr. Stephen: Absolutely.

Dr. Sharp: Can anyone register for this, and if so, how do they do it?

Dr. Stephen: We have a website which I can give to you later that people can just link in. The website explains what GAIN is a little bit more, and it also leads you to the place where you buy your subscriptions. It’s like amazon.com. You basically always say, okay, I want this, this, and this package. And it gives you, let’s you check out, and pay whatever you want. We do really only want people who’ve been to clinical training. So we don’t want people who have never been exposed or used the ADOS before. They’ve been to clinical training because it really is about fidelity of the measure for those who are using it and have been [00:26:00] trained at that level to use it.

We have a mixture on it, of people who are clinically trained versus research trained on it as well. And for us, if you look under the hood, it’s interesting to see we’re gathering all this information on, if you think about it on codes, like what codes have the most variability with regard? Which are the hardest codes to code? Research reliable people, are they actually better than people rolling clinically trained in terms of rating our consensus codes? So, we’re gathering lots of information to help improve our training as well. 

Dr. Sharp: Fantastic. Now, I’ll self-disclose a little bit. I mentioned earlier, I was originally trained on the first ADOS through the training materials. How do y’all work with that? So people who haven’t attended a clinical training in person, but have this sort of legacy training from them?

Dr. Stephen: To be honest, we haven’t been asked directly about that yet. It’s a great question. Like any rule, I’m sure there’s exceptions, right? So if you were trained 10 years ago based on the DVD sets they have, but you’ve been using the ADOS for 10 years now, it’s almost like it’s grandfathering that can occur here that we’d have to talk about. What’s interesting though is the difference between the DVD training versus an in-person training, if you’ve ever been, I highly encourage people to go. There’s a Grand Canyon chasm of difference between us being able to explain the codes and demonstrate in front of you on the clinical training than the DVD training is. So we highly encourage people to do that.

Dr. Sharp: Sure. Nice. Okay. That’s good to know. 

Dr. Stephen: Yeah, it’s funny. And this is just, again, our opinion, those of us who do this, if you use the measure a lot, you know what I’m talking about. It’s a very sophisticated measure, not only in its coding, but also in its administration. And the problem is, if you’re just watching the DVD, there’s just so many questions you must have about, like, what about this? Why do you do this? And you get no feedback on any of that. So that’s why we highly encourage people to go into the clinical training. 

Dr. Sharp: Of course. Yeah, that makes sense. For folks who have had the [00:28:00] training and are using the measure, certainly. Once you sign up for the subscription, can you, how would I phrase it, activate and deactivate depending on which models you want to participate in or is it just an ongoing thing?

Dr. Stephen: Great question. It’s funny because most of us in this field we’re not actually business people as much anyway. We have a business background. We’re running the center. But wow, it’s like you can take a lesson from the gym memberships and stuff like how this works, right? There’s a whole marketing behind this.

The way that we set this up is you buy a package; that package is a module set which is three months. So you can buy three months, you can buy a six months, you can buy the full year. There are different discounts related to that. Just like any other thing, if you buy more or you get more of a discount if there’s a group of people. We also want to recognize that if you’re at the University of Wisconsin and there’s 6 of you there, we’d rather get all 6 of you. So why not talk to your university and get a university a higher discount because there’s more people enrolling. So we have that as well.

Yeah, you can cancel. There’s not a contract that you sign up for a year. It depends on what package you do buy, because the way our system’s set up, there’s no refunds though. So if you buy a year and then you’re like, after three months, I’m done, sorry, we got your money. We spent it probably. So we’re not going to give your money back. So you have to be aware of that. So it might be like, depending on what you want to do in terms of the three months or six months.

We do publish the schedule, because maybe you only want to do module two. Maybe you only want to get better at the toddler. You can sign up for just those three months. But even better than that, that’s not salesman now, even better than that is, these are all recorded. These are all webinars that are recorded. So let’s say that you said, you know what? I want to get module three, but we did that last year, so you can actually sign up to get that module and download it. And so you can actually watch the video and then you would watch the webinar to get the codes and hear us talk through the codes. So we have an archive now of all these other tapes that have already been coded at a very high level that you can go back and watch.[00:30:00] And again, that’s part of the subscription packages. 

Dr. Sharp: That’s wonderful. The more I learn about it, the better it sounds. 

Dr. Stephen: So we better see your name on the subscription soon. 

Dr. Sharp: It is timely. I was just talking to my postdoc two weeks ago and they had someone come in and do an in-person training for the schools. She works part-time in the schools and they did a trial coding, a sample with a real kiddo, but they all coded and the differences in coding were vast. That’s her takeaway from that. And I talked to her about the GAIN program. I’m going to try to get our staff on board and get us in there.

Dr. Stephen: The other part of this which is more nonspecific really is this ability for people then to see these people who do this all. This is my job. This is what I do. And to have the hope as a model to be able to say, you’re participating in a program that the people who do it at the highest level, you can listen to and learn from, that just creates a whole different level of fidelity and reliability.

Dr. Sharp: Of course. Actually, before I totally switch gears and ask some questions just about autism assessment in general, since we ran through it fast, could you just articulate again the three-month cycle and what each of those months looks like for folks who are pretty interested at this point?

Dr. Stephen: Sure, absolutely. I think we’ll start out with the Mod 1, just give a more concrete sense of it. In the first month, we send out a tape or a recording of, I should say, the administrations that we send out, I inadvertently call them dirty administrations, because that’s what I call them in my head. That probably isn’t the best term. But what I mean by that is these aren’t like these fantastic admins that we’re vetting as the best admin. I just pull them off of. We record everything here and we get permission from the parents to use them.

These are just [00:32:00] every day administrations. I want people to see that. It’s like, not everything is perfect. You have kids who have behaviors. You might make a mistake in your administration. That’s okay.  So, we pull off an administration, we send it out, people code it, and send it back.

The first month is when the four trainers have consensus coded that administration. And then we invite other trainers to be panelists. This is done through Zoom technology, if you’ve ever seen that which is like, you have The Brady Bunch up there where you have like 15, 10, whatever trainers, we have our 4 lead trainers sitting around and we discuss it over Zoom. And then we have these other trainers that also weigh in with questions and comments. So that’s more like just watch the trainers talk.

The next month, we send out the same module, another module 1, people watch it. It’s a different kid. They watch that. All the people turn in their codes. At the end of the month is the webinar, and now, we invite the general public out there; meaning all the people who are watching the webinar to raise their hands, if they want to be panelist. It’s just like a clinical training where everyone in the audience can actually be like… The people are really shy is what we’re finding out. So we actually have to force them. But you want people out there and then it’s just like, they don’t have to talk. They can talk. They can ask questions. So it’s much more interactive with the audience, if you will.

And then the last month is, throughout the first two months, we just accumulate questions- both administration questions and coding questions. Like, are you supposed to let this task go so long? Is it okay to do this? What do you do when they echo this? So we pull out the themes of the most important questions or common ones and we, as the trainers discuss those. We open it up so people can chat in with all kinds of questions. We answer so many questions on the fly. Now it’s a whole different kind of, we weren’t expecting that. We get all these questions. We have another person monitoring the chat so that we can watch. Oh, let’s answer that one. So, and so had this question.

But what’s cool too is during the first two months, we actually put on screen the distribution of the codes so people can see. Like of the 200 people that put in codes, [00:34:00] how many scored a zero? How many, one? How many, 2? And it’s cool to see because you say, oh, the majority of people coded this way, but there have been codes where we, as the trainer said, yeah, most of you coded 1, but it’s actually a 2 and this is why. So, those are the ones we really focus in on and spend the most time on in terms of consensus and reliability.

In the third month, not only do we answer questions, but we try to make it more didactic as well because we do want people to… We have more flexibility at a third month. We might change this up. Several of us have presented a recent research article that we’ve written about that uses the ADOS or is relevant to it just to ground this in academics as well and to show that we as clinicians have a strong academic leaning as well, that we’re not just making this measure up. There is actually research and evidence behind what we’re doing.

Dr. Sharp: Nice. And again, that is, for folks listening, $20 a month. That’s $20 a month for all of that. I’m going to do some sales for you. That’s a gift. I’m excited about it. I’m going to jump on and look at it again and see when the next one start. Is it quarterly? So would the next one be in April 1st, I guess?

Dr. Stephen: I don’t know when the second one is. You can actually, let’s see, we just did our first month of Mod 2. Right now is our 2nd month of mod 2. And you don’t have to wait. You can jump on at any time.

Dr. Sharp: Oh, okay. That’s fantastic.

Dr. Stephen: Actually on the second month, I’ll make sure I look for you and you’re going to be one of the panelists on The Brady Bunch.

Dr. Sharp: What am I getting myself into? That’s awesome. I did want to follow up on something you said earlier that I’d love to come back to, which is, it was something in the vein of, is assessment of autism a neuropsychological pursuit? I would love to get your thoughts on that.

Dr. Stephen: Yeah. It’s this is more of an ideological/philosophical question. I was at St. Louis children’s [00:36:00] hospital, and I had a colleague who was a child psychologist who did a ton of testing, and I’ll never forget the conversation I had because we’re sitting next to each other in offices, I’m a neuropsychologist, he’s a child psychologist. We basically use all the same measures; all the same tests; D-KEFS, Woodcock-Johnson, the WISC, and the WASI and all these. And we used to have all these conversations about like, well, what makes what you do different from what I do?

I think what we decided is two things. One is training; not in any way, pejorative that one is better, but they’re very different. As a neuropsychologist, your training makes you look at the data in a very specific way having to do with relating brain function to this, what does this mean and how you interpret the test, and what additional test am I going to give to find out what the intention of the assessment is? And in many ways, that can be much different than if it’s not a neuropsychological question. So a lot has to do with the referral question and how you arrange your clinic.

It made me think a lot about like, we’re using the same tools. So what really separates us in terms of how we approach the assessment, the decisions we make, how we interpret the data that we get from it, and the recommendations that we make from that? A lot of that has to do again with training and how we’re looking at the data.

So the reason I preface that is the same thing happened in autism because, in my experience, the more and more I did autism, the less and less I use my neuropsychological tests. But the reason why that was is not a good reason. It’s because the pressure for diagnosis became so strong and is so strong that to really satisfy the urgency related to waitlist and diagnoses, we’ve had to create efficiency around our diagnostic testing and model that has minimized to the degree that we’re willing to, without giving up quality, what tests we’re giving.

Now in a perfect world, I would give those tests, plus all my other tests [00:38:00] to do a much better job. And we really do separate, what do I need for diagnosis? I don’t need a D-KEFS. I don’t need a memory test. I don’t need all these other, even a language test sometimes, to diagnose autism. So do I want those? Yes. Is it better to know those to plan intervention for the child? Yes.

That’s where in my career it’s really shifted towards more this emphasis on just the minimal for a diagnosis. I’ve had to let go of the rest of it because of just infrastructure in the world out there that wants more diagnoses. We do have a clinic out here by the way. I have 2 neuropsychologists who see kids with autism and assess them neuropsychologically, but it’s not a diagnostic question. It’s more of, oh, I have autism, but I also have a seizure disorder. I also have this. And so they apply the neuropsychological test to understand it in the context of their autism.  

Dr. Sharp: Right. So you speak of the minimum battery that maintains the quality that you need. Can you talk about that battery? What is that autism diagnostic battery that you’re using? 

Dr. Stephen: Yeah, absolutely. And we’ve actually written about it. We published here at Missouri. We call the Missouri Autism Guidelines Initiative which is online for free. It really speaks to how we separated theoretically, what is needed for diagnosis versus what is needed for assessment for intervention is what we called it. Because to truly understand the child, we do agree with all the practice parameters that you need speech-language, you need medical, you need OT, you need physical therapy, you need all these things. The problem is we can’t do all those and meet the demands. We need to serve the most patients.

So if you really stop and think about it theoretically, what do you actually need for a diagnosis of autism? And you look back at either the ICD or the DSM to answer. That’s how our society is now defining autism. And you really have to look at like, how do we assess social communication, repetitive behaviors. There’s two different parts of that. Are they showing the symptoms of that now and currently, how do I look [00:40:00] at that, but also by history.

So the two most essential components of autism diagnosis are what are you doing in the moment, which has to involve direct observation and interaction with a child. So you just can’t get it from a phone call. You have to, as a clinician, interact directly and observe directly with a child with autism. And we have tools like the ADOS that enable us to do that in a standardized way. Equally important is the component of history. Does your developmental history track with what we know is consistent with autism? Because if you are only starting to show these symptoms at age 5, that’s probably not autism, then that’s something different. Those are the two main components.

If you look at the DSM, it’s interesting because IQ is listed as one of the paragraphs of, yeah, you probably need this. Interestingly, IQ is not a diagnostic component of autism because it can’t be. We have a range from as low as it gets to as high as it gets. So it’s not a diagnostic feature. However, the reason why IQ is an essential element of the initial diagnosis is it contextualizes their developmental symptoms.

If you see a kid acting pretty severely and you know their IQ is 40, well, is that developmental delay or is that autism? You don’t know. But if that same kid has an IQ of 150, well, that changes how you view those behaviors. So IQ is an adaptive skill essential feature, but you can get those from parent report, history, and direct observation.

We are very big also from an evidence-based standpoint of saying, you do need to use a standardized tool. Whether it be the CAARS-2, whether it be the ADOS, younger kids sometimes, we use SCAT, that’s another tool that we sometimes use; has some limitations. But the notion is you just can’t say, I can eyeball you, and I think you have autism. It just doesn’t work that way. And if I got a report that did that, I wouldn’t trust it.

My analogy for the ADOS is, if I have a specific kind of eating disorder where if [00:42:00] there’s a buffet, this is halfway true, by the way, if there’s a buffet out there, I can’t stop myself from eating. I have to try it, even if I’m not hungry. I don’t know what it is, but I have to try the food. Well, the ADOS is that buffet for kids of autism. Over the years through research and the way it was developed, it has incredibly strong way of pulling for autism symptoms, both by the stimuli and your actions that just in other situations, you might not see the autism symptoms, but the ADOS will show them to you. So, it is the best test for that, I think.

That’s my pitch for the ADOS. I don’t worship at the altar of the ADOS. None of the trainers do. It’s not the be all end, all. It is only a tool. And it has to be interpreted by you, the clinician on how to use it.

Dr. Sharp: Of course. I want to ask some specific questions about the ADOS, but before I do that, I want to close the loop on the battery. You mentioned two specific measures: interview, observation, standardized measures. So does that mean AADI-R, ADOS, and then checklists? What are actually…? 

Dr. Stephen: Good question. So I’ll just say, our battery here that we have, since we live in the center of our state, it’s a very rural state. We have families that travel 4 to 5 hours to come see us so they can’t come back. So we’ve really honed it down to a half-day visit basically. So we send out a measure for emotional behavioral difficulties. So we use the CBCL then TRF. Other folks use the BASC, and that’s fine. So anything that tap into those, because those help you interpret the behavior you’re seeing.

We also do an adaptive measure ahead of time. We do the AVAs or the Vineland, depending if it’s more research oriented. We get that ahead of time as well. We typically use a screener to help us triage the patient. It could be an MCAT, could be an SCQ depending on the age of the child. Sometimes we have the SRS, if it’s more of research as well. So we have those measures ahead of time.

We have a very complex, comprehensive history form that we send out ahead of time. Basically, a lot of it on the core autism [00:44:00] symptoms were based on EDI type of interview, but we get that from the families. So then when they get here, that’s what we said ahead of time, they get here, we have all that information ahead of time. They’re triaged into very specific clinics depending on how the presentation is and other symptoms and how complex it might be.

While they’re here, the core diagnostic assessment consists of the ADOS. And also some type of history. It’s not the ADI typically. The only reason why is the ADI clinically, you just can’t bill for it, to be honest with you. But what we found is people who are trained on the ADI do a much better job of doing a focus, diagnostic interview if they’re able to. So we do a developmental history, this general one and then we do a core autism symptom history that can be very focused, but it usually takes about an hour and a half to get all of that as well. And then we staff, we figure out what we think is happening.

We insist that our providers here give the ADOS themselves or watch it. And again, this is just another plug where I think is best practice is the ADOS was never designed as a tool to order like an MRI. Like, oh, physician says, go get an ADOS or go get an MRI. It’s not like that. It has always from day one, supposed to be a tool that you as a clinician give.

This is what makes it unique. You are both the stimulus and the coder. No other test is like that. So your behaviors matter. So the notion is, through your interaction and through the standardized assessment, you develop and help your own diagnostic differentiation. So we insist that they give the ADOS. They walk out of here with a single page that day with a diagnosis and top three recommendations. And then we contact them within two weeks. They come back within 1 to 3 months for a class basically. That’s our model here. 

Dr. Sharp: Nice. I know there are a good number of folks out there who are working in maybe integrated care clinics or something are trying to do this one-day model. So I think that’s helpful for people.

Dr. Stephen: By the way, I should note [00:46:00] that every single one of our patients also see then in the afternoon a medical provider and they do a brief medical exam. That’s to make sure there aren’t any outstanding medical issues. But it’s also to establish a medical point of care for them so that they can continue medical to be seen.

Dr. Sharp: I see. Earlier in our talk, you mentioned myths about the ADOS that you would like to dispel or talk about. If we haven’t covered those, could we do that? 

Dr. Stephen: Yeah. I’ll start off with two, and then I’d love to hear even from you being a practitioner out there, what you’ve heard because I’ve heard many.

One is that we do a lot of training. I’ve consulted a lot of places. It’s funny as this bifurcation of either hate the ADOS or you love it and it can go both ways. Some people are like, I don’t need the ADOS. I can look in your eyes and tell if you have autism. It’s like, well, why would you do that? If you have a tool that improves your accuracy, why would you do that?

So, one of the myths though, is that the ADOS is always right. You give the ADOS and it confers a diagnosis. It doesn’t. Actually, if your ADOS is 100% aligned with your diagnosis, you’re doing something wrong because like any other diagnostic test, it has false positives and false negatives. And it’s your interpretation of the results that matter. So all kinds of red flags if you’re always believing the ADOS, to be honest. So that’s one of the myths that we’ve heard that it’s always right. You should always use it. Not true.

Dr. Sharp: That’s a good one.

Dr. Stephen: Have you heard myths out there? 

Dr. Sharp: Yeah. I’m trying to think about myths versus just information. There seems to be a lot of questions of, is the ADOS sensitive to “higher functioning individuals” or is the ADOS sensitive to what autism looks like in girls versus boys? Can you comment on either of those?

Dr. Stephen: Absolutely. Great question. The answer is yes to both of those. The reason why is, ADOS has been fine-tuned is a diagnostic tool. One of the problems with it, and this is one of the myths, is that it’s a great measure of change. It’s not. Meaning, there’s a lot of people who have tried to say, oh, I’ll give you an ADOS at the beginning of your therapy, and after your therapy, I’m going to see a great change. Well, you won’t, unless there’s a big change in their overall core symptom presentation anyway.

And it makes sense if you think about it. This is a genetic disorder. For the test to be a good diagnostic test, no matter how subtle the symptoms or how complex they might be hidden, if this is a good test, it should uncover those. A lot of that has to do with the skill of the clinician, obviously, but most of our data show that across the lifespan, most people, 80% are pretty consistent with their core autism symptoms, despite all kinds of therapy.

So they look very different from toddler to adult in terms of their language, their IQ, their adaptive functioning, but if you, even though they’re changing with all those symptom presentations, because the ADOS does a different modules, it does a really good job of extracting core autism symptoms that would indicate do you fall into a range that is more similar to autism or not? So that’s what makes it so robust. It’s very good at that part.

The sex difference one is a very interesting question, because I found just in my career that pendulum swings back and forth. Two years ago it was like, oh, oh my gosh, we’re missing all the girls. It’s like, where we are, we’re missing all of them. So then, even at my own clinics here, it’s like every girl came through had autism suddenly, because we’re missing all of them. That’s not true either.

So I think the pendulum is swinging back to the middle. Actually, our group has run studies as well to show that, well actually we don’t even need different algorithms for boys versus girls. The ADOS does a good job and other measures do actually a really good job of saying what are the core symptoms? There are obviously subtle differences between girls versus boys and how they present with their symptoms. And again, the data is pretty mixed, but in general, boys show more RBs, for example, they’re more severe as what a lot of the data is showing, but the ADOS can pick out girls versus boys.

I think a [00:50:00] lot of it has to do with our own biases and awareness that we bring to it as clinicians because if you have a special interest in vacuum cleaners, you’re like that’s autism. If you have one in stuffed animals, doesn’t seem so bad. But if you really think about it and if the girl might lean more towards the stuffed animals, that’s equally a special interest. So you just have to change and be more aware of your biases and how you’re approaching the symptoms that are being presented to you. 

Dr. Sharp: Yeah, that makes sense. I feel like we’re just learning more and more about gender differences or sex differences. 

Dr. Stephen: Just so you know, it used to be a 5:1 ratio is what we used to talk about. It’s now the men analysis are down to 3:1, so we are identifying more females appropriately saying, yeah, we’re actually catching up. 

Dr. Sharp: Good. Yeah, I know that could be a whole other topic in itself too, that I’m hoping to tackle on the show soon-ish but that’s good to hear. That is one of those things that I hear, the ADOS just doesn’t capture these folks.

Dr. Stephen: It does.

 Dr. Sharp: It does. Yeah.

Dr. Stephen: And by the way, the toddler goes down to 12 months. We’ve seen kids here probably as low as 13 months. It’s harder to see them at that age, unless the symptoms are obvious. So you just have to be really careful as a clinician, but the subtle presentations, that’s true of any measure though, the more complex or subtle, it’s going to be harder. You get more false positives and false negatives, but it still does a pretty good job. 

Dr. Sharp: True. Where do you see the role of other diagnostic instruments? I think of the MIGDAS a lot and that’s, I don’t know if you call it a competitor exactly, but it’s a different choice. Where do you see those fitting in? 

Dr. Stephen: Yeah, I think that’s when people talk to people like myself who are a trainer in the field for the ADOS. One of the miss is that people get certified on the ADOS. That’s not true anymore. To get reliable on ADOS, we send you a letter saying reliable. There’s no certification.

The way I approach it is if you go through an ADOS training, for example, it just ups your autism IQ. You know a lot more about the disorder. It gives you vocabulary to [00:52:00] talk about what you’re seeing, the symptoms, and how we parse out all the different components of autism. That’s the benefit of the history and legacy of the ADOS is it allows you to learn a lot.

Knowing the CAARS too as well. That’s another one that actually has a lot of empirical validation behind it saying, with the right training, someone can use the CAARS-2 very well as well to have similar metrics in terms of the ability to differentiate autism for others.

I think the reason why I lean towards the ADOS if I had my choice is because the ADOS supplies or gives you a standardized approach where the CAARS doesn’t as much. The CAARS allows you to code things, but it doesn’t allow you to elicit symptoms in a standardized way. And that’s problematic if you think about our field, because what you do in your clinic, if you’re not listening to behavior is the same way I am, are we really seeing the same thing? Standardized tool generally has a little bit of an edge up. This CAARS tool is, but not as much with regard to materials and prompts and stuff like that.

So as you look through all the different tools, I don’t have any problem with other tools, it’s just that I look at it this way, if you were going to go, and you let’s say you were afraid that your child; your son and your daughter might have cancer, are you going to take him to a clinic down the road that has a machine that’s 8 years old or has really low power or are you going to want to go to the Mayo with some of the best new tools, with the best MRI machine to really know, is this really what it is? So that’s why I counter-approach it.

If these tools ever arise to that level in terms of empirical proof that they work accurately, then I’m there. I really am. But until that point, I don’t want my families to experience anything less than they would from any other disorder out there. So that’s our passion too. It’s like, we should treat this as seriously as any other disorder. It’s that impactful. So why would we suggest anything less for those families?

Dr. Sharp: Well said. I like that comment about the history. There is just a rich history of the ADOS and [00:54:00] you have a lot of information. There’s a lot of information, a lot of tapes, a lot of people out there doing it. And that speaks really highly. That counts for a lot.

Dr. Stephen: The challenge in our field is going to be technology. We actually are doing ourselves here. There there’s many measures that use technology to help us figure out if autism symptoms are present. And that’s our hope. Maybe it’s a false hope. It’s like, wouldn’t it be cool if I could just set you up in front of a computer, it does two things that tells you if you have autism or not?

We might get there someday. We’re not there yet. A blood test would be great too. But there’s this seduction to that that we want to jump on that bandwagon right away. I see many devices and tools and techniques out there, and we’re testing them ourselves, that probably purport to do more than they actually can do; which I can’t have a problem with, except that it gives the wrong message to the family. Let’s be honest about how accurate those tools are and again, what is the evidence that they work at the level that they say do?

Autism has been a field that’s been abused for a while in terms of what the causes are and why it happens. A very vulnerable field. So we just want to be cautious and make sure we’re giving families the right information. 

Dr. Sharp: Sure. It’s funny. I just got an email two weeks ago about a brand new saliva test for autism. 

Dr. Stephen: We got the same.

Dr. Sharp: Okay. So you’re saying that’s not reliable.

Dr. Stephen: There’re two of those out now. We’re actually testing one ourselves. We’re in the middle of a clinical trial with it. I think what’s interesting to me is this tension between these companies that are producing them. They need to get money or FDA approval. So they call it something, the marketing puts it out there and it gets the money.

But the problem is, I think the claims are outreaching what the tool can actually do depending on the study, the clinical trial. The problem is science is hard work. It really is to know like, oh, across all the populations, [00:56:00] community referred, clinician referred, is this tool really that accurate? It just raises for me these other design tools for autism. That’s one of the things I do. It’s this a really weird question: What makes something a screener versus a diagnostic instrument? At what level of screening is this accurate enough? Does it become a diagnostic instrument?

And for me, it’s semantics, but those semantics are so important to parents because if you say, take that saliva test and it gives you a diagnosis of autism, what the heck? What does that mean? That is not okay because that family’s not getting everything else that family needs from a diagnostic appointment with a provider that can understand that child, do the other test, and give them the right resources. So for me, it just caution om how it’s marketed and the claims are being made about it. 

Dr. Sharp: Yeah, I can see that. When you think about the ADOS, we talked a little bit about capturing different populations and accurate diagnosis of course. This is an ill-formed question, but hopefully, we can sort through it together. Do you find patterns in risk for false negatives, if that makes sense? Who is being missed by the ADOS or how are people being missed?

Dr. Stephen: No, it’s a great question and a very interesting one. What’s interesting is in a tertiary clinic like mine, if you think about it, most of the kids that we see are referred here for a question of autism because something’s going on. So generally what we see in our clinics aren’t false negatives. They’re false positives because there it’s something else going on that creates symptoms that might overlap with or look like autism. So if I even a result on the ADOS or my other measures, it’s usually a false positive.

But what the literature’s showing me is in population-based samples, especially younger kids like the M-CHAT for example, there’s a recent study conducted at the M-CHAT that shows it’s an enormous amount of false negatives. I think what’s happening there, and we see this [00:58:00] just anecdotally is parents don’t know what they’re looking for when they fill them out. They don’t know what an anchor group to compare it is.

So I think a lot of the false negatives arise because parents don’t understand or have, and again, this isn’t a slam against parents, like we’re trained to do this, but they don’t see these things. And just to press the point more, we make the point during our training, it’s like, it’s so interesting to us that, if I actually had to test you and say, what is the average age that a child has first words? It’s an interesting question, because we know when it’s delayed, right? Oh, they don’t have first words by 18 months, raised red flag. But what is the distribution around just first words or two-word phrases or walking, even. These are the main things.

Now, extend that to the symptoms we look for in autism. What is the average age a kid uses joint attention or pointing or turning to the name? We know none of that stuff. We know when it’s delayed. We know that there’s qualitative differences, but these are the studies that we’re doing and need to do more of to find those out. So to expect parents to do them when we can’t even answer them is insane.

So that’s why I think when we rely on screeners and parent report measures or even pediatricians who aren’t as trained, they’re not trained in these things, that’s where you get lots of false negatives because like, oh, that’s not autism, his brother’s talking for him or whatever it might be. So that’s why we want to say, you know what, if there’s a suspicion, move it on, get an evaluation. 

Dr. Sharp: Right. I’m with you with all of that. It seems like when we get kids who are missed it’s, or how would I phrase it? Like the confusing evals, the hard evals are the ones where the parent checklists come back “normal” but yet, even in our interview and maybe in the ADOS too, or the observations, it’s like, oh my goodness. We have a difference of opinion here or different experiences.

Dr. Stephen: If there’s any hand slapping, they say no, and the kids in the corner finding their [01:00:00] hands, like, well, what is that? 

Dr. Sharp: Yeah. That’s so interesting. I asked those repetitive behaviors. It’s finding a way to ask that that makes sense to parents.

Dr. Stephen: Yes. I think it’s also age-related. I see less of that as the kids get older, because either the difference is more stark or parents are experiencing more difficulties, but I think there’s certain psychology around younger kids where you as a parent protectively don’t normalize behaviors that others might see as atypical. And that’s just, I think part of our nature.

So again, relying on parents where the false negatives are coming from, I think we can’t do that. Because again, why do you need a standardized assessment and say, oh, let’s look at these compared to other things? 

Dr. Sharp: Right. Well, geez. I feel like we’ve covered a lot of ground and packed this episode full.

Dr. Stephen: There will be more podcasts coming up, we probably can do.

Dr. Sharp: That’s right. We set quite a schedule for ourselves here. No, I really appreciate it. Maybe we could close just by talking about resources and places where people can turn in addition, of course, to the GAIN program and everything that you’ve mentioned. Are there other resources that you like folks to pay attention to in the research world? Really anything you know that we should test.

Dr. Stephen: One of our favorites, there are our two main ones that I turn to just if I did mention. Big ones; Autism Speaks you can’t say enough about them. As a resource, they have videos that you can refer parents to, to compare different behaviors to, the amount of toolkits they have. We use these all the time. They have toolkits for just about anything you can think of for a child with autism: brushing teeth, dentistry, toileting, ABA. So that’s a huge resource. For every patient that’s diagnosed with autism, we hand out the 100-day toolkit from Autism Speaks. It is an amazing resource. Can’t say enough good things about them.

If you’re more of a want to gather more knowledge for yourself the Simon foundation. The Simon’s foundation is out of New York. They’re one of the largest funders of autism research. They have a newsletter basically called Spectrum that is very well [01:02:00] done. They hit all the top research in the field and talk about it. So it’s a great way to just keep up on the field if you want to gather more information. Those are the two big ones.

I would encourage too that if people are out there, we’re all being inundated with autism. But again, just rely on your own ethics of competence to know, like, when am I beyond that, that I should be referring to a specialist in the field as well because I think we’re all field to pull and the draw. My waitlist is huge. But we want to be careful with how we disseminate our knowledge. 

Dr. Sharp: Yes. That might be a good point to end on, I think.

Dr. Stephen: Oh, great.

Dr. Sharp: Yeah. Well again, thank you so much. This was a fantastic episode. I think people are going to take away a ton of information. So I really appreciate it much. 

Dr. Stephen: Great questions too, by the way. Great questions. 

Dr. Sharp: Oh, thank you. It was easy. Thanks, Stephen.

Dr. Stephen: You’re welcome.

Dr. Sharp: All right y’all, thank you. Thanks for checking out that episode and sticking around to hear my conversation with Steve. Hopefully, you took a lot away from that. I personally have been just since our recording emailing with Stephen about joining the GAIN program. And I’m talking to all my clinicians here about jumping into that, just for some ongoing continuing Ed on the ADOS.

I think a lot of us probably got trained way back when, or took the clinical training once and then didn’t have much supervision after that. And this is just a fantastic, easy, and relatively inexpensive way to get some continuing ed for an area of our field that’s super important. So check that out. There are some great links in the show notes for any of the information that we mentioned during the interview.

Like I said at the beginning, if you feel like you could benefit from a group coaching experience to build or grow or expand your testing practice, check out the Beginner Practice Mastermind and the Advanced Practice Mastermind. Those will be starting late [01:04:00] March- early April. You can get more information at thetestingpsychologist.com/consulting, and you can also apply there.

And as always, if you have not subscribed and rated the podcast, always happy if you take a few minutes to do that. If you’re a new listener, this is a great way to make sure that you don’t miss any episodes. They’ll automatically download to whatever podcast player you might be listening in. And I’d be happy to have you jump on board.

All right, everybody. Thanks again. We’ll be back next week. Take care.

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