Im an Autism and ADHD Assessor - AMA

[magictits]

I get heaps of questions about this IRL so thought I would post here and answer any questions in case they are helpful to anyone.

I’m 44 and definitely have adhd and autism. Up to now 2 of my 4 kids have an official diagnosis, with the other two pending. My dad very clearly has autism, although high functioning in some areas and awful in others.

what I don’t underhand is that I’ve been refered with the nhs through right to choose as the official nhs pathway is 3 years where we are. My assessment is 3 weeks but then I have to pay £70 ish a month for my medication which seems bonkers as I’m on benefits. My gp refuses to do shared care at all so I’m going to be absolutely stuck after 3-4 months when I’ll be in debt from purchasing the drugs. Crazy!

do you think the spectrum is too wide

does everyone who see you get a diagnosis?

How much of the behaviour that you pick up on would you relate to 'trauma' as the root cause of some behaviours?

Do you think it (trauma) has a big impact on symptoms, if not a causal effect - obviously not all, but many perhaps?

Withdraw now and find a RTC provider that prescribes without cost for those who cannot get shared care. If you go onto Facebook there is a RTC for adults group (and if you aren’t on FB, it’s worth signing up to get this information) who will tell you which providers prescribe without you having to pay. Get your GP to re-refer to one that prescribes and even if it’s a longer wait, it will be worth it long term.

When my son was diagnosed, he was observed by SLT at school which was incredibly insightful. Are there similar observations going on with this 'contracted out' (for want of a better phrase) approach?

I feel lucky that DS was diagnosed when he was in 2021 because I'm hearing now it's impossible on the usual pathway and the right to choose does not seem to give the same thorough process.

Don't mean to be rude at all as I am sure you are knowledgeable and diligent. I just wonder if people are missing out on what we had.

what is the age of the oldest person diagnosed by you?

What do you do if a child discloses they have done an ADOS before?

Great thread - thank you. I have a similar question to one already asked. I do not have anyone available to me that has known since I was a child. I have been warned this may mean I am not diagnosed or my assessment is inconclusive. Is that likely do you think please?

Same here, and on the ados training page it says its aimed at Physicians, Psychologists, Occupational Therapists, and Speech and Language Therapists. SALT should still have input into a MDA even if they don't carry out the ADOS test particularly in pre-verbal young children when there are other s&l disorders which may present in a similar way to autism.

@TheGoodEnoughWife I was my own informant for the ASD assessment. My mum filled out my adhd form and the word on that was low because she doesn’t see inside my head and I am similar to her and my dad who I strongly suspect are/were ND. She also did t connect how I am to what was on the form yet to most it’s obvious.
The assessors are skilled at prizing out details and examples that you might consider normal but actually are traits. My unusual hobby whilst not unusual in my family provided an example towards diagnosis. I had to think back to being at school and my earliest memories. How I interacted with people, how I played, what I ate, how I slept, friendships, hobbies. So much detail. It was exhausting.

As a psych who is also part of a MD autism diagnostic team, actually best practice in NICE guidelines is for a multidisciplinary assessment and a joint decision making process regarding whether a person should be diagnosed.

My friend is in the same position and was still able to be privately diagnosed. She used Re:Cognition Health who only used psychiatrists for their assessments.

So I believe I have adhd (possibly autism) and many of my close family have recently one by one been diagnosed with both. I didn’t know what this was when I was younger (born in the 70s) so just thought I was weird. Masked a lot and still do. Anyway my daughter who is 18 is on the waiting list for an adhd assessment (again possibly autistic too) but I can’t stop feeling guilty that me being the way I am and not coping well with a young child/children, constantly feeling over stimulated by noise, touch etc has caused her to have mental health issues. I feel terrible how I treated her in those moments of meltdowns from burn out. So my question is has my poorly managed adhd caused her to have poor mental health and adhd symptoms or would her having undiagnosed adhd caused poor mental health anyway? Also she is on a long waiting list with very little help in the mean time (although doesn’t do a lot to help herself) is there anything we can do to speed up the process?

Are there times where it’s genuinely borderline with ADHD?

(I’ve just been assess and diagnosed combined ADHD, assessor said I was ‘very obvious’ from paperwork and having the assessment met all criteria. But wondering if people can be very much ‘just’ into the criteria and diagnosed? )

Yes as I'm sure you are aware a psychiatrist should always be involved in making the diagnosis. What is your professional opinion on providers like ADHD 360 who don't have any psychiatrists working for them, but are still diagnosing and prescribing?

No a psychiatrist does not always have to be involved in the diagnosis. Can you quote the part of the guidelines that specifies this? We have a psychiatrist as part of the team but they are not expected to be involved in every assessment.

I have little time for online assessment or single uni professional assessment, that's entirely different.

Having been through the process via NHS for myself and my son I know how robust it is. It angers me these throwaway comments about anyone can get a diagnosis/ we are all autistic / it’s bad parenting etc .
Ive only seen the NHS process though , are private companies as robust?

Ex recently obtained a ADHD diagnosis and started on Elvanse, and then suspected that DS18 had ADHD. DS had previous Edsyc report for Dyslexia and slow processing.
Ex booked DS on a private ADHD assessment (with a Dr at a leading london clinic) and then led him with his with answers that steered the assessment toward ADHD diagnosis. Previous diagnosis was not revealed, nor was adverse cardiac family history on my side. Fidgeting and disruptive behaviour was invented. DS now on Elevanes to assist with academic focus. All for a few extra UCAS points.
Call me a cynic, but it seems overly easy to get a diagnosis.

Assessment was online.

@Hobbiestwriter Here is the clinical commissioning guidance about best practice fyi. Makes it very clear that professionals other than psychiatrists are qualified to diagnose and other professionals make a valuable contribution as part of a MD team.

NHS England » A national framework to deliver improved outcomes in all-age autism assessment pathways: guidance for integrated care boards share.google/yl9Epg6ixZQQtrdws

I've had a late diagnosis of both, at the start of the year. I have tried the two main ADHD stimulants, the two main non stimulants, two highly regarded off label drugs and... nothing. But now what? Why does nothing work for some? What other options are there? All those drugs did was lead me to the autism diagnosis. Is this zero impact common? Thank you 😊

From the NICe website.A muktidisiplinary approach is necessary but as I'm sure you learned in medi al school, the doctors role in the MDT is to diagnose and prescribe, and orher members of the team have their own expertise. As I'm sure you know from working in the NHS, doctors jobs are often outsourced to other roles due to money and other issues, and clearly a social workers shouldn't be making the diagnosis though they have a huge role to play.

Having been to medical school how concerned are you by some services outsourcing work that needs to be done by a psychiatrist to other staff to save money? How concerned are you that some services are making diagnoses without a doctor involved?

This literally says that only psychiatrists, paediatricians and psychologists are qualified to do the full assessment, but other members of staff can do parts of the assessment.
And it says other members of staff must be under clinical supervision. Did you read it?

Thankyou, I can see the difficulties. Part of my problem is that i dont feel traumatised at all, other people are shocked when i talk about my childhood but im able to inappropriately overshare about it because i feel quite logical about it. I also disociated from what was happening as a child so it doesnt feel like it happened to me iyswim. Part of me would find life easier with a asd diagnosis because i could explain why i struggle with life to others.