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October 7, 2011

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August 17, 2011

This is something I spend half of my day doing on many days and is not an easy task to come up with a clear diagnosis. It is even more difficult to be sure that you’re properly identifying risk. So I am sharing this information with you not so you can diagnose someone or even be experts at identifying children at risk of having an autism spectrum disorder (ASD). However, a brilliant psychologist from Great Britain who goes by the name Simon Baron-Cohen (see: Autism Research Center) published a study in approximately 2002 the demonstrated that the 20 children out of the 16,000 screen who failed to produce three specific behaviors went on to be diagnosed with having some form of an ASD. These were the three provider-administered items off the original seven item Checklists for Autism in Toddlers (CHAT). Essentially if a child 18 months of age or older could not look the direction the examiner pointed when she called the child’s attention, could not point to an object like a door when asked to, and could not perform a simple make-believe gesture such as pouring a cup of tea even after it was demonstrated, then that child had, by this study, a 100% chance of later being diagnosed with an ASD. The problem is many children out of the 16,000 children screened in general practice clinics did not fail all three of those items yet went on to get some diagnosis of an ASD later in life.

Thus, in this country the M-CHAT was developed, which is a 23 item questionnaire that anybody who knows the child well enough can answer and it will indicate whether or not a child should be sent to a professional like myself to confirm or disconfirm the diagnosis of an ASD. This tool “casts a wider net to recommend referral.”  Since I’ve been using these tools I have yet to find a child who failed all three of the provider administered CHAT items and did not get diagnosed with an ASD. There are not many things in my profession that have that high of an accuracy even if they might have a low specificity (namely they miss a lot).

Another factor that has that high of an accuracy in our field is that if a marriage has four negative attributes, then that there is a 95% chance they will be divorced within five years: these include stonewalling, criticalness, contempt and defensiveness. Again there are a lot of people that get divorced who didn’t necessarily have these four negative factors in their marriage; but if you have them you need to get help and you need to get it now!

That’s how I feel about these three items that are easy to attempt to do with a young child. You’re not going to catch everything but if a child cannot do these three things you should get them to a professional as soon as possible if they are 18 months of age or older. We know that identifying autism risk early and beginning intense (20-25 hours a week of engaging/interactive activities therapy and otherwise) intervention is what leads to the best outcomes. 

That’s the free stuff for this month and here are the links to the M-CHAT and even to John Gottman’s Four Horsemen of the Apocalypse. I will provide you with the M-CHAT in both English and Spanish.


Joseph McCoy, PhD



John Gottmann


July 24, 2011

The Healthcare Insurance Portability and Accountability Act (HIPAA) required many changes for us in the way we practice healthcare.  You are actually responsible for holding the people that you do business with accountable for maintaining confidentiality .  If you actually exchange confidential information with them as a means of conducting business then you should have them sign a HIPAA Business agreement. For example, if you became a subcontractor for someone providing mental health services to another agency you would want to have an agreement with that person because you’re actually conducting business as well as exchanging confidential information. Progress with somebody is just another clinician all you need is a release of information form in order to exchange information on a one-time basis regarding a particular client. Business means that money exchanges hands, otherwise it’s just two clinician’s talking about the client with that client’s permission. Even if money does not exchange hands but it’s clearly a business arrangement you have that requires exchanging confidential information, then you need to have one of these agreements between the two of you.

Another common situation is that someone like an electrician, carpenter, document shredder company, janitor etc. comes onto your premises and provides a service for you in which they might run into confidential information. If that does not involve exchanging confidential information, then all you need to do is have them fill out a HIPAA Vendor Agreement. Below are some free PDFs of ones like I use. If you would like Word documents of these and all the basic documents you would need to see a patient for the first time so you can simply find and replace your company name with the phrase YOUR COMPANY NAME, please e-mail me at  If I get enough response I may make this package of documents available on my commercial website

for a very modest price possibly as as low as $3.99. In the meantime here are the free HIPAA documents.

Sincerely, Joseph H McCoy PhD

BEFORE YOU CLICK! You accept the responsibility of the accuracy of the information contained within the documents and the proper use of these documents if you choose to download the documents at the two links below this disclaimer.

FREE Bus Assoc Agrmnt

FREE Vendor Contractor Bus Confid Agreement


July 22, 2011



July 19, 2011

Recent radio campaigns suggest that your friend with Bipolar, Major Depression, Panic Attacks that keep them isolated are less likely to recover or function well without your friendship. Well guess what. It’s worse than that. People in your life are more likely to do poorly healthwise if they feel lonely often and/or are measurably isolated, i.e. few contact with people per week. A new study in the recent issue of  Health Psychology, published by the American Psychological Association, demonstrated that those who feel lonely and are isolated are more likely to engage in many poor health behaviors such as being inactive, smoking, not eating well, as well as other unhealthy behaviors. However, it’s the clearly demonstrable fact a few social contacts that correlates most highly with physical measures that are highly associated with stroke and heart attack which include high blood pressure,C-reactive protein, and fibrinogen.    In short the study showed perceiving you’re lonely is associated with unhealthy behavior but actually being lonely is connected to the worst outcomes.

Other studies, that I remember the results to but don’t have the citation for right now, show that even after a heart attack or a heart procedure if you are isolated and depressed you have 4 to 5 times the chance of being dead inside of five years if you were depression goes untreated and you don’t do something about decreasing your social isolation. So “the take-home message” as my statistics professor used to always say is spend time with people for your own health, and to show consideration for others who you know are isolated spend time with them. Even if they have no other disorder the time you spend with them is good for your health and for theirs. This study also implies why your friend with bipolar disorder is not only more likely to do better in their fight against bipolar disorder if you spend time with them and support them, but they’re also less likely to get other complicating health disorders that are common in those with serious mental illness.

I see an example almost every day of what we could all do more of. I look up to him not just because he is a giant of a man but because he walks down my street every day with a limp arm on one side, likely from a stroke, and is always raising the other arm waving at every person whom he goes by whether they’re walking, in a car, or on a bike. If I woke up in a bad mood and he waved at me I’m in a better mood than had he not. I’m thankful for this man who lives on my street. It may be that you need to be that person on your street who waves at everyone who goes by. If not call one more person a week than you do.  Stop by a friend’s place for a brief visit just to say hi.  Remember, it’s not just good for them, but in the long run you may be preventing a trip to the emergency room for a heart attack by you or another person.

Have a wonderful day and here is my wave to you!

Have a Great Day!

 Dr. Joseph McCoy

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