ADHD/ASD and CASA medicals

[Cedrik]

Originally Posted by Capt Fathom

Usually AVMED will state why your medical has been refused, and more importantly, what you have to do to progress it.

Usually the day before your 2 month extension issued when you do your medical is about to run out. Why does it take so long? Atrocious, you can't call it service.

[Clinton McKenzie]

Some good detective work by personwithadhd.

The disclosed documents include an email, dated 20 June 2018, from Michael Drane to Mike Seah that says:

Hi Mike - I think the language can be moved to less school orientated. I have made some suggestions. (Also less US!!)

Attached to that email is a document with mark-up changes, but only in the ‘Out of Aircraft’ column. There are no mark-up changes to the ‘In aircraft’ column, which column includes the offensive quip.

That document is headed: “ADHD AND AUTISM SPECTRUM DISORDER INSTRUCTOR’S QUESTIONNAIRE”, and the footers say: “Form 420 ADHD AND AUTISM SPECTRUM DISORDER ASSESSMENT PROTOCOL 06/2018.”

It therefore appears that the version of the Form marked-up by Drane was created before 20 June 2018 and already included the ‘In aircraft’ column with the offensive quip. The ‘In aircraft’ column was obviously created by someone with enough knowledge of aircraft operations to be dangerous. Consistent with that, there is internal correspondence prompted by an email about Form 420 from a person in industry. That version of the Form has “08/2013” in the footers.

On 25 June 2018 Mike Seah sent an email to David Fitzgerald that said:

Hi David

Do you know where the original Form 420 came from for ADHD.

We’re looking to update it.

The disclosed documents do not include any response to that email. I note that Mike Seah refers only to ADHD and not ASD.

Meanwhile, the ICC took his own action to try to get Avmed to address the fact that the substance of Form 420 was aimed at ADHD and not ASD. On 31 July 2018 the ICC sent an email to Philippa Woonton that said:

[Name redacted] has asked if Form 420 can be updated. I’ve taken the liberty of making changes I recommend (but keeping the questions verbatim - can you please advise how I might be able to get this approved for use by instructors of ASD applicants? If not used more broadly, as a minimum can we ensure it’s used for [name redacted] audit requirements?

The second redacted name, if not the first as well, is the name of the complainant the subject the ICC’s inquiry I outlined earlier.

(If that complainant is reading this and had “For CASA Audit” imposed as a purported restriction on the complainant’s medical certificate, I note that the purported restriction was imposed unlawfully and corruptly by CASA Avmed, because by that time CASA had conceded that a purported restriction in those terms could not lawfully be imposed.)

That email from the ICC to Philippa Woonton was prompted by an email to the ICC, dated 30 July 2018 from the complainant that said:

I have received my audited Class 2 medical, and on the conditions it states that I need a form 420 completed every 3 months. This wouldn’t be an issue, if the form was actually made correctly, and I didn’t have any previous issues with it. Do you know if CASA is updating the form, to meet the requirements that were imposed for me? (i.e signature, detailed answers and such), or could you draft me a form that meets those recommendations, to reduce the headache in future?

The subsequent ‘Client Services Improvement Request Form’ failed to deal with the point that the Form 420 questions were aimed at ADHD and not ASD, but was still expressed in its terms to be applicable to ASD. The ‘Client Services Improvement Request Form’ dated 13 August 2018 said, in the ‘Description / Details of Issue’ and ‘Details of Proposed Action’ fields, respectively:

Amendments to Form 420 ADHD and Autism Spectrum Disorder Instructor’s questionnaire following complaint made by via the ICC’s office.

Amendments include clearer instructions for the applicant’s instructor to comment on behaviour, larger text boxes for comments, and a dedicated area for the instructor to provide the details and signature.

The next internal correspondence after August 2018 about Form 420 in the disclosed documents is dated 20 September 2021 - that is, over three years later. As I posted earlier, based on the disclosed documents it was not until October 2021 that this was said in a string of internal emails:

I have a problem with the combined intent of the ASD/ADHD questionnaire as the behavioural aspects of ADHD and Autism are like opposite ends of the spectrum. …

ADHD questions predominate, however autistic individuals are often socially withdrawn and apprehensive when being looked at and like to be left alone in a corner away from everyone, not near doors or passageways etc. in class.

…

Decision made – please call this questionnaire ADHD instructors questionnaire formand problem solved.

…

The problem is the title includes autism spectrum disorder and if we remove that then the questionnaire is specific to ADHD. Not sure why it was combined into one questionnaire as they are two quite distinct conditions.

…

[Clare Prop]

[Sunfish]

That questionnaire is valueless because it does not address the subjects behaviors as compared to "normal" human behaviors. ie.: "careless" compared to what?

Then there is a reliance on ONE persons opinion.

For example there are people who are highly numerate, display rigid personalities and have zero tolerance for mistakes. To them anything but absolute accuracy and timeliness from students is "careless, disorganised work". This begs the question: "what about the sanity of the instructor?" as discussed in the referenced thread right now?

Instructors with attitude problems

A look at the FAA entry on the subject shows that it s a complex matter and not something amenable to cheap self suggesting questionnaires.

[Clinton McKenzie]

Clare Prop: The version of Form 420 in your post #80 looks to be the version to which Drane proposed changes via the marked-up version attached to his email dated 20 June 2018.

For example, the first (d) in the ‘Out of Aircraft’ column in the version you posted says: “(d) often does not follow through on instructions and fails to finish school work, chores or duties in the workplace …”, and Drane proposed that to be changed to: “(d) often does not follow through on instructions and fails to finish assigned work or duties in the workplace …”. The second (d) in that column – note they couldn’t even get the question numbering correct – in the version you posted says: “(d) often has difficulty playing or engaging in leisure activities quietly”, and Drane proposed that be changed to: “(d) often has difficulty engaging in leisure activities quietly”.

(Sunfish: The content of the form is not the sole input to the solemn deliberations of the dabblers in Avmed. For example, as I noted in my post about a complaint made to the ICC about Form 420, the victim was asked to provide a completed Form 420 plus: “Medicare consultation and prescription records for the past five years; academic and employment history; copies of any special reports (such as QEEG or neuropsychological testing); previous specialists reports)”. I say “victim” because – setting aside the confusion and consequential delay and stress created by the Form, which confusion was evident to the ICC – the questions were aimed at ADHD and not the opposite end of the spectrum – ASD - but the form purported to apply to both. That’s what happens when dabblers are left to their own devices.)

The provenance of the questions in the ‘In aircraft’ Column remains a mystery. The disclosed documents include a version with “08/2013” in the footer, and that version includes the column. If I had to bet folding money on who drafted it, I’d say Pooshan Navathe. Navathe describes himself as “an internationally acknowledged thought leader in aviation medicine”. The questions seem to me to have been the product of someone with enough knowledge of operational aviation to be dangerous but not enough knowledge to realise that a student pilot manifesting even a few of the behaviours the subject of the questions wouldn’t be let loose solo in an aircraft by an instructor, irrespective of Avmed’s opinions as to the medical fitness or otherwise of the student.

STOP PRESS: I have been informed by CASA that:

[T]he form 420 is currently being reviewed. An external panel of experts/doctors are reviewing the form, I’m not aware of when this review will conclude.

It’s a pity the form wasn’t created by a panel of experts in the first place. But - hey - who cares about the unnecessary stresses, delays and costs inflicted on CASA Avmed's guinea pigs along the way.

[Clare Prop]

Clinton what is your opinion on the actual meaning of "may" as per all except the first four questions on the right hand column? It is so vague. To me it is as meaningless as "may not". To me it indicates that this is nothing but specualtion on the part of the person filling it in. Certainly not grounds to tell Bloggs that he can never be a pilot.

[Clinton McKenzie]

Every version of Form 420, including the current one, is poorly drafted. None has ever been properly proofread or ‘user tested’ in context prior to it being inflicted on applicant guinea pigs and their instructors along the way. More importantly, every version of the form has been insufficiently informed by people with specialist expertise in the subject matter of ADHD and ASD (though it appears that, around 8 years in, someone with expertise provided input – Tony Hochberg in October 2021 – resulting in ASD being disappeared from the heading of the Form ((but not from the Purpose statement, because no one properly proof read the Form…) and now it’s being “reviewed” by “experts”). Nor has any version been sufficiently informed by people with specialist expertise in the instruction of pilots. Assuming it is medically efficacious for the content of a questionnaire filled out by an instructor to be taken into account by dabblers in Avmed in the first place – a very big assumption - there should only be one ‘Out of aircraft’ question and there should only be one ‘In aircraft’ question. The present circumstances are just a manifestation of CASA Avmed’s carefree arrogance which started with Navathe.

(Let’s think about what happened – say – 20 years ago, before ADHD became a ‘big thing’. According to ABC’s Health Report as recently as Monday this week, a few percent of the population has ADHD. I don’t recall the exact percentage, but it’s not important for present purposes. What’s important for present purposes is that people with the group of behaviours now given the description “ADHD” were around e.g. 20 years ago. Why wasn’t it raining aluminium e.g. 20 years ago because these people weren’t being caught by self-described thought leaders with delusions of grandeur in Avmed? Answer: Because a person with even a few of the behaviours described in the questionnaire would not be able to pass the theory and practical examinations to get and maintain the qualification anyway. That remains true today.)

[Clinton McKenzie]

Heads up! The Senate Standing Committee on Community Affairs is conducting an inquiry into the barriers to consistent, timely and best practice assessment of attention deficit hyperactivity disorder (ADHD) and support services for people with ADHD. Details here.

[Sunfish]

A nephew of mine was diagnosed wIth ADHD and dosed to the gills with ritalin etc.

The proximate cause of his behaviour was an absolutely horrible, regimented and uncaring home life inflicted on him by a social climbing mother and a rigid father with an emotional IQ of minus 120. There was nothing wrong with the kid that couldnt have been solved with kind words, some good advice and love....

Boys behave differently from girls in educational settings for starters, then there are five(?) different learning styles and at least four communication styles..... it's just too easy to label someone a little different as ADHD because they don't mirror your preferred behaviour.

CASA should be ashamed. In fact the questionnaire, if it was to be of any use at all, which I doubt, would need to be preceded by a detailed questionnaire for the instructor in order to calibrate their responses in the student questionnaire. For example, one instructor may have a very different definition of bad behavior from another. For example, the slackest, laziest student I've ever seen is now flying for Qantas.

You Tube

[Clinton McKenzie]

Here is a link to the documents about CASA Form 420 provided to me under FOI. One of the many remarkable things the documents reveal is the lack any record of who made and implemented the decision to airbrush the offensive words from the Form. That's a manifestation of an organisation lacking corporate integrity.

[43Inches]

I applied that form to people I worked with and over half of them have ASD/ADHD, I guess we will have to ground half the airline pilots in Australia. The other half displayed traits of silent bitterness, deep seated resentment and irrational hatred towards their employers, so fitted into the underlying psychotic killer form.

AvMed MO, lets start at mild cases, ban everything and then drip feed harder cases until something breaks. Real world way, start by banning those that have displayed unsafe related behavior in real life and then move the bar up as necessary.

Items (c) onward on page 2-4 describe most the pilots I know when at a party. And they display items (a) to (c) when in classroom environs.

I have also flown with a number of pilots that I would not want to be alone in a dark alley with, but they were good pilots and safe...

Would I report somebody that displayed unsafe aviation related conditions, hell yes, and unless it was immediately evident they were about to do something stupid, I'd probably have a chat with them to seek help first.

[Chronic Snoozer]

Originally Posted by Clinton McKenzie

Here is a link to the documents about CASA Form 420 provided to me under FOI. One of the many remarkable things the documents reveal is the lack any record of who made and implemented the decision to airbrush the offensive words from the Form. That's a manifestation of an organisation lacking corporate integrity.

Comically inept and inappropriate. I have difficulty imagining someone who is "inpatient" to take-off. Logistically impossible I suspect, unless they are talking about the RFDS and an actual patient. Would be funny if it wasn't so serious.

[Sunfish]

Here is the source of the CASA ADHD questionnaire - one of those sleazy "studies" probably funded by drug companies, that is used by equally sleazy clinics and "Doctors" in the USA to extract as much money as possible by convincing you that your child is a freak who requires daily drugging into compliance.

And the lazy sods at CASA just pick it up paraphrase it and apply it to grown ups (if you can call pilots adults). This is just disgusting. What next CASA? Hemorrhoid surveys you want that part checked for dangers to air safety?

What Are the Signs of ADD Distractibility? Symptoms of ADHD with Inattention

The first part of the ADHD test for kids covers signs of distractibility. These signs are sometimes called inattentive symptoms, or previously, ADD symptoms in children.

1. My child has trouble paying attention.
2. My child makes careless mistakes.
3. It’s very difficult for my child to stay focused on homework or other tasks.
4. My child rarely completes an activity before moving to the next activity.
5. Even when spoken to directly, my child seems to not listen.
6. My child is disorganized and even with my help can’t seem to learn how to become organized.
7. My child loses things necessary for tasks or activities, such as toys, homework assignments, pencils, books, and so on.
8. My child tries to avoid activities or does them grudgingly when they require sustained concentration and a lot of mental effort.
9. My child frequently forgets to do things, even when constantly reminded.
10. Even the smallest distractions throw my child off task.
11. My child has trouble following instructions and finishing tasks.

The second part of the ADHD test for kids covers hyperactivity and impulsivity.

1. Sometimes my child acts as if she/he is driven by a motor and is constantly “on the go.”
2. My child always seems to be squirming in the chair or fidgeting.
3. No matter how hard he/she tries, my child has problems remaining seated even when she/he is supposed to — he/she gets up, runs around, or climbs during class or in other situations where one should stay seated.
4. My child talks a lot, even when she/he has nothing much to say.
5. My child often interferes in the classroom because she/he has difficulty engaging in quiet activities without disturbing others.
6. In class or at home, my child blurts out answers to questions before they are fully asked.
7. My child has difficulty waiting patiently to take turns, and frequently butts ahead in lines or grabs toys from playmates.
8. Sometimes my child seems intrusive. She/he interrupts constantly other peoples’ activities, conversations, and games.

If you checked off five or more symptoms — and these symptoms have been a persistent problem interfering in your child’s life at home and at school — he or she may have attention deficit disorder. It would be prudent to talk with a physician or a licensed mental health practitioner.

Take this form with you to the doctor’s office. Treatments are available for ADHD in children that can reduce substantially these neurologically based behaviors.

Same questions.

https://www.additudemag.com/adhd-test-for-kids/


And get this; AVMED may have just latched on to the latest money making medical fad, like sleep Apnoea and RSI....remember the RSI epidemic??????

Overdiagnosis of Attention-Deficit/Hyperactivity Disorder in Children and AdolescentsA Systematic Scoping Review

Luise Kazda, MPH1; Katy Bell, PhD1; Rae Thomas, PhD2; et al

Is Adult Attention-Deficit Hyperactivity Disorder Being Overdiagnosed?

Joel Paris, MD,1 Venkat Bhat, MD,2 and Brett Thombs, PhD3

This review offers a perspective on the question as to whether attention-deficit hyperactivity disorder (ADHD) is being overdiagnosed in adults. Considering underlying causes as well as consequences, we conclude that the diagnosis of adult ADHD should be made cautiously, making use of multiple sources of information, including self-report, clinical interviews, collateral information, childhood documentation, and neuropsychological testing. Routine screening with symptom checklists is insufficient, and stimulant response is diagnostically uninformative. The causes of overdiagnosis may include changes in diagnostic thresholds, poor diagnostic practices, and advertising by the pharmaceutical industry. Overdiagnosis leads to overtreatment, and dramatic increases in prescriptions for adult ADHD during the last decade should arouse concern.

Keywords: overdiagnosis, adult attention-deficit hyperactivity disorderOverdiagnosis in psychiatry occurs where patients are identified with a mental disorder when they do not have significant impairment and would not be expected to benefit from treatment.1 These problems can arise even when diagnostic criteria are met, that is, in the presence of milder symptoms that fall close to, or within, a normal range on a diagnostic spectrum.2 Overdiagnosis can lead to unnecessary labelling, unneeded tests, unnecessary therapies, and inflated health care costs.1 In medicine, with the best of intentions, practice has come to favour more tests and more treatments, all of which tend to drive overdiagnosis.2 This problem may be worsened by a prevailing cultural ethos that more is better.1

AVMED - Physician heal thyself..

[Clare Prop]

Well found.

I think this sys it all:
NOTE: This ADHD test for kids is not intended to diagnose or to replace the care of a health care professional.
Pilots aren't usually children and a flying instructor is not a health care professional.

[Clinton McKenzie]

[size=13px]And now we’re seeing another perverse incentive: To ‘over-diagnose’ ASD or ‘misdiagnose’ ADHD as ASD in order to gain NDIS funding and other special support.[/size]

If you can get your child diagnosed with Level 2 or 3 ASD rather than Level 1, the NDIS funding rolls in.

A snippet from many available articles:

Some observations that have been drawn from the recent survey include:

• teachers pushing families of children with ADHD to try for a diagnosis with better funding, such as autism or oppositional defiance disorder (ODD)
• funding being allocated to a teacher's aide, which some experts say this is not necessarily helpful as 'you are putting the least qualified person with the child who needs the most qualified person'
• it encourages the "agglomeration process" where you get one diagnosis and then keep adding on top of each other until you tip a child into emergency funding
• pushing for an incorrect diagnosis could affect a child's self-perception and inappropriate adjustments might be put in place by the school
• distorting figures through "diagnosis substitution" creates the perception that autism and ADHD are over-diagnosed.

I shake my head in astonishment at the number of parents who are off to the doctor as soon as their child sneezes these days. I can remember seeing a doctor twice in my childhood: getting my tonsils out at around the age of 4, and just before joining the RAAF as an apprentice.

I honestly can’t comprehend how these children could provide an accurate medical ‘history’ later in life, or how they could possibly ‘satisfy’ the likes of CASA Avmed of compliance with aviation medical standards, without submitting themselves as guinea pigs to extensive, expensive and intrusive demands from the bureaucracy. I very much doubt that the parents realise they’re effectively dooming their children to a life of being treated as a collection of medical ‘conditions’ to be ‘managed’, in some cases even for conditions they never had but for which it seemed like a ‘good idea’ for them to be diagnosed at the time.

[tossbag]

I did one of these test forms for a lad enrolled on an integrated CPL course. CASA wanted an assessment in the aircraft of course. He was a quiet fella but exhibited no behavioural issues on the ground, what I would call a normal young bloke. We jump in the aircraft, we get the aircraft going, I direct him through the climb, talk him through setting up the cruise and say 'maintain 1500.' He did, bang on for the rest of the flight.

We get back on the ground and I said 'that was pretty good, how many lessons have you done?' he said 'none' nearly fell off the chair. He had been in theory for the start of his course. Aviation needs more young people with 'Autistic Spectrum Disorder'

Disorder my arse. What a joke. Avmed are supposed to be medical experts, we look to physicians as professionals, they are nothing but schysters.

[Clinton McKenzie]

CASA Avmed’s amateur hour form 420 should never have been inflicted on applicants diagnosed with ASD in the first place. At least the CASA ICC had enough nous to work that out.

[Clare Prop]

"Thanks to you we have children in our town that like Phil Collins"

SouthPark ADHD - YouTube

[Chronic Snoozer]

Originally Posted by Sunfish

Here is the source of the CASA ADHD questionnaire - one of those sleazy "studies" probably funded by drug companies, that is used by equally sleazy clinics and "Doctors" in the USA to extract as much money as possible by convincing you that your child is a freak who requires daily drugging into compliance.

And the lazy sods at CASA just pick it up paraphrase it and apply it to grown ups (if you can call pilots adults). This is just disgusting. What next CASA? Hemorrhoid surveys you want that part checked for dangers to air safety?

Same questions.
https://www.additudemag.com/adhd-test-for-kids/
And get this; AVMED may have just latched on to the latest money making medical fad, like sleep Apnoea and RSI....remember the RSI epidemic??????

The left hand column (Out of Aircraft) of Form 420 Clare Prop posted here ADHD/ASD and CASA medicals has wording which is practically identical to the wording on the CDC website. https://www.cdc.gov/ncbddd/adhd/diagnosis.html Note these are the symptoms for diagnosing ADHD in children.

Not really that interesting until you are directed to another website that provides the symptoms for diagnosing ADHD in adults (defined as 17 years or older) https://chadd.org/for-adults/diagnos...dhd-in-adults/ which has wording which is along similar lines however probably more appropriate for Form 420.

[Clare Prop]

Also they emphasise above how this should be diagnosed, by a medical professional with a detailed history and using multiple sources, not a flying instructor who has absolutely no qualifications as a mental health clinician on a bad day because they are busy teaching people to fly and have this shoved under their nose.
Or maybe we should let the psychologists do the flying training and we can swap our headset for a white coat and a clipboard.