What is the diagnostic process like for a child?
The process begins with a phone call or email. I would learn a little bit about your child, and we can determine if work together would be a good fit for your family’s needs. We may schedule an initial appointment, with testing on a later date, or we may schedule a single day for all of the procedures. The specific series of steps depends on the questions being asked. I will send you a packet to complete so that you can provide more details about your child before we meet. The actual appointment(s) involve a fairly lengthy interview with you and shorter interviews with your child and often with your child’s teacher or another important adult in the child’s life (the latter by phone). Testing is done in my office and usually feels to your child like talking together, playing together, and/or doing academic-style work tasks together. Testing sometimes requires a couple of appointments to be sure that all the information is collected. A feedback session occurs a couple of weeks later where we discuss the results and recommendations. A detailed report is produced in the course of the evaluation that includes results and recommendations for next steps.
What is the diagnostic process like for adults?
Every individual is unique, and there is some variation in every diagnostic procedure based on what the individual person brings to the process. A typical diagnostic evaluation experience occurs in this way:
An initial email or phone exchange occurs to talk about what you are looking for and why. I may suggest that you might do something else to see if it meets your needs first.
If you decide to proceed with a diagnostic evaluation, we may have an initial video session but then would meet for about 2 to 4 hours in my office. This visit includes:
A clinical interview
Some testing (e.g., the Autism Diagnostic Observation Schedule – Second Ed.)
Questionnaires for you to complete
I will need to speak to one or more other people who know you well*. I try to do this on the same day whenever possible. It is most helpful to talk to someone who knew you when you were a young child, like a family member. It is also useful to talk to someone who knows you very well now. This may be the same person. This interview:
Usually takes another 1 to 2 hours
May include more than one person who knows you well and is important to you
May occur by phone if needed
I may be able to give you some preliminary results on the same day, or I may need to take time to consider all of the information I have collected. Either way, we will schedule a feedback session approximately 2 weeks later. This session is scheduled for up to 90 minutes.
A few weeks after we meet, I will have a detailed, written report for you to summarize the information you and others shared with me. This report will also include a formal diagnosis and a list of recommendations.
* Sometimes it is difficult to identify someone who can speak accurately about one’s early life experience. We can work together to determine the best way to get the information we can in a way that is comfortable for you.
Do you look for other things? If I don’t have the diagnosis I am asking about, will you consider other diagnoses?
Yes. This is a process that no one undertakes lightly, and there is some reason for asking the questions, although from time to time, the result is not what a person thinks it will be. I always consider alternative explanations as well as possible co-occurring conditions when conducting evaluations.
It is important for people seeking a diagnosis to realize that even when they are sure they or their loved one meets criteria for a diagnosis, they may not get that diagnosis. There are specific rules associated with diagnoses, and someone may meet some of the criteria but not all of the essential ones to get a diagnosis. Portrayals of experiences of people with different diagnoses on social media often include “relatable” experiences that are not actually diagnostic criteria, although it is true that other portrayals include more accurate or valid representations of essential diagnostic features. It is essential to be open to the possibility that you may not get the diagnosis you seek.
Why seek an autism spectrum diagnosis in adulthood?
When a person asks whether or not (s)he might have Asperger’s or an autism spectrum disorder (or autism spectrum condition) as an adult, (s)he will often have already gone down several different paths for answers in her/his life and may have received other diagnoses in the past (e.g., ADHD, anxiety disorder, etc.). Many times, other diagnoses just do not seem to capture all that is happening.
Some of the most important benefits that may come from getting a diagnosis of ASD as an adult include:
- Helping the individual understand why some things may have been unusually difficult in her/his life, when those same things have seemed easy for most other people. A diagnosis can help take away blame a person has felt within her- or himself or from others for being different.
- Helping other people in the person’s life understand the person better, such as why the person does some specific behaviors or reacts in particular ways. This understanding may alleviate personal stress or frustration for the individual with ASD and also for important people in that individual’s life.
- Gaining access, if needed, to some social services or accommodations that might help the person achieve his/her life goals.
- Possibly protecting from risk of some types of discriminatory action through use of the Americans with Disabilities Act (ADA).
How do you account for differences in females being evaluated for ADHD and autism spectrum conditions?
This is an important and excellent question. Females are different than males for both ADHD and autism spectrum conditions (ASC). Some ways that females and males differ are in the intensity of symptoms they express, the content or form of their behavior, when people notice differences, and parts of their behavior that are not core aspects of the diagnosis (i.e. associated features). Knowledge of the nature of these differences is important to perceiving them in a person’s profile and recording them as a part of a diagnosis. My research and clinical work over more than 15 years has allowed me to develop a deep understanding of these topics.