Late Diagnosis: What Happens during an Adult Autism Assessment?
One of the main issues when looking to get a clinical diagnosis of autism as an adult, is that there is very limited information available on what happens at this type of appointment.
As an autistic person, I prefer for things to be clear ahead of doing them to make sure as much of the uncertainty is removed (where possible).
My biggest fear of going into this was to spend a significant amount of money and be told the result was inconclusive. I would have been okay with the results being “you are autistic” or “you are not autistic” as long as it was definitive.
The account below is to provide a general idea of what can happen, but every assessment will be different depending on the professional organising or providing it. It may contain more of fewer parts and will be different if in person or online, during pandemic times or not.
My assessment was in person and took place in October 2020 (we where in a smallish room but staying 6ft apart and wearing a mask for the whole process).
Before the assessment
So a couple of weeks before my assessment, there was an interview with my husband. The interviewer was a different person to the one who saw me later. For me, this part made it even more difficult to access a diagnosis as most professionals I reached out to where very insisting that they had to interview my parents and that was not an option in my case. Some areas he was asked about were my behaviours, special interests, family history, work history, social and personal relationships and communication style.
This step was done via zoom and took between 1.5 and 2 hours.
During the assessment
The assessment lasted 5 hours and was divided into 3 parts with breaks in between. First, the psychologist asked me why I had referred myself to be assessed. She talked about her expertise and why she is doing this on the weekends besides having a full time job in the HSE. She explained what will happen during the day (to be honest, I would have preferred to have received this information weeks ahead to be prepared).
The first part of the assessment started where the psychologist lead the conversation asking questions about the following areas:
- Family background and development
- Education and vocational history
- Relationship history
- Medical and Psychiatric history
- Sensory and practical issues
- Interests, hobbies and goals
This took about 1.5 hours and then we had a 30 min break.
The next part was an IQ test using the Weschler Abbreviated Scales of Intelligence 2nd Edition (WASI-II). This took about 1 hour.
After that we had a one-hour break for lunch before resuming with the last part of the test.
The final part consisted in the verbal component of the ADOS 2 (Autism Diagnostic Observation Schedule Second Edition). The ADOS 2 normally includes a set of standard activities but they could not be completed due to Covid.
I left that day with a set of questionnaires to fill in. Some were for me and some were for my husband to complete.
The questionnaires I had to complete were:
- The Beck Depression Inventory 2nd Edition
- The Beck Anxiety Inventory 2nd Edition
- The Social Responsiveness Scale 2nd Editions (SRS2)
- The Ritvo Autism-Aspergers Diagnostic Scale Revised (RAADS-R)
After the assessment
The debrief was scheduled for 3-4 weeks after the questionnaires were submitted by post. This was a two-hour session were the psychologist went through the written report which contained all her notes from the meeting with me, my husband, and results from all the tests.
Remember when I said that my biggest fear was to have an inconclusive result? Well, in the RAADS-R, I got a score of 140 when the cut off score is 65. This alone is not a definitive diagnostic tool because it is self-reported, but it is an indication of my experience.
A combination of my presentation during the assessment, the responses to the ADOS-2, the description of the challenges I experience together with the collateral provided by my husband was enough evidence for the psychologist to provide a clinical diagnosis.