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 am already aware of the ‘refrigerator mothers’ theory; that is not my question. My question is: how can clinicians distinguish between autism and attachment disorders, given that they share overlapping symptoms? I know there has been some literature published on this topic, and a specific tool was developed to assist clinicians with this differentiation.

My daughter had a private adhd assesment last month and was diagnosed. The assessor commented she saw significant asd traits as well. CAMHS have declined the asd assesment as she didn’t score high enough.

is it right that girls don’t always trigger the score even if traits are present?

The Coventry Grid, which is widely available.

Are you asking what the tool is or are you asking if the OP knows what it is? You're not clear at all.

Thank you. I feel a lot better.

How do you tell the difference between trauma and ADHD in adults. I’ve been referred for assessment but also EMDR for childhood trauma. Seems they overlap a lot.

How many people who think they have ADHD or autism do you find don't have it? I.e. if someone self refers, how often are they right?

May a child being 'old before their time' and preferring adult company be an indicator of autism?

Can people be diagnosed with ADHD or autism even if most of their friends and family would say that they hadn't stopped any signs ?

'Stopped' was meant to say 'shown'. I.e. is it possible to mask that highly? Thank you.

My son (4) has just been diagnosed with autism. I found the process to be excellent. The assessors were approachable, listened, clearly assessed him from the moment they saw him. I haven’t received his report yet, but after a lengthy telephone discussion with his assessor she said that he presents in all 7 areas of development. When I asked about levels she said that autism isn’t assessed based on levels anymore due to the fact it’s often misleading I.e a person might struggle in one situation but excel in another. So my question is, without levels how can support be determined? My sons EHCP has so far been a nightmare, at every turn the council do everything in their power to cut his support to the absolute bare minimum.

I also do support the idea of non levelled assessments, I just want to ensure my son who has a high level of care need is supported x

I don't particularly like the Coventry grid tbh. It's simplistic especially in its description of autism.

You are looking at types of play, drivers of behaviour, history, language usage, nature of interests, that kind of thing. Sometimes it's hard to tell.

You spoke earlier in the thread about how puberty (and menopause), as well as trauma, can affect the symptoms of autism and make it more apparent, and more easily diagnosed.
do you think that sometimes girls can be diagnosed incorrectly because of this?

my DD was diagnosed in 2022 at age 13 after a very short wait for assessment (only about 3 months). In the couple of years prior she had a rough ride with new school, Covid, a death in the family, house move, leaving all her friends - and she really struggled with puberty.
three years on and it’s like she’s a different child, and it makes me wonder if her diagnosis was correct.

Thanks for doing this OP.
Like Arnie, I'll be back!
Main question: what can parents do to help you do your job (i.e. does it help you to have a parent with their folder of all dc's history, questionnaires responses, ed psych report etc or as a panel, will you have read it all/know it inside out pre the ADOS?)
Also, what is the difference between ADOS and DISCO?
Finally, what do you do if you have an uncooperative teen or one who tells you all the "right" answers (yes, I'm fine. Nothing to see here. Fine at school. Got friends etc) when the parent knows full well that it's the opposite.

How is someone with Down syndrome diagnosed? Or those who are non-verbal? How do you feel about parents who refuse to do anything to help their child socially and just excuse everything saying “he/she’s autistic”? In fact I’ve only know boys be excused in this way. There’s a mum at school who does nothing to help her child by explaining how other children might feel due to his behaviour. She just dismisses all children fed up with his behaviour as mean or unkind. My own son is ND as an I but he knows that people won’t tolerate some behaviour. Things like getting in someone’s face, not taking no for an answer and keep pushing and pushing until the other child gets really annoyed, saying things that are rude and not telling him things are rude or explaining why. It’s just a case of “awww come on Teddy, let’s go over here away from him/her” My son and I have been on the receiving end of much rudeness from this child and it’s not improved in the 6 years we’ve known him and his mum. We used to be friends but now we tend to avoid them. She only talks about how mean people are to poor Teddy and she hovers over him and doesn’t let him develop socially. He has PDA which is a challenge in school for other children when he cries over everything and refuses to do it disrupting the class. He goes to secondary school in 2 years and his mum is sending him to the local, massive high school. What is your opinion on children with significant additional needs attending mainstream school? SEN provision is paltry and there’s a small separate class of 8 places for those with autism and other conditions where they learn life skills. They do aim to integrate the children into classes but I’m not sure if this happens. They don’t follow the curriculum so I’m not sure how it all works despite reading the school info. The poor kill will be eaten alive at this school. I’m worried enough for my own child knowing how much I struggled with the move. Sorry, lots of questions and a stream of consciousness about this child I worry about in how he’ll cope with life. His mum is lovely and I think she will struggle massively with high school parenting too.

Finally, my Ds has his first ADHD appointment tomorrow-any tips? It’s at the local hospital paediatric department, not CAMHS.

Lindy2 · Yesterday 10:28
I'm a parent of a teenager who has ADHD with autistic traits. Not diagnosed ASD - in fact in hindsight it was burnout from secondary school that caused a sudden escalation is autistic type behaviour and PDA.
Anyway as a parent living with a neurodiverse child/young adult I have a few questions. I hope that's OK.
What do you think about the explosion of non binary/trans in neurodiverse children? Has it always been there but hidden as less socially known or is there social contagion? Do you think this tendency is here to stay now?
What do you think about the level of support given to families? Personally I think there is some support for low level needs but when needs escalate, like we experienced with puberty and burnout, there's just nothing of actual practical help out there.
Possibly controversial, but my growing belief is that there is just neurodiversity. There's so much overlap and such a range of symptoms that I increasingly believe there shouldn't be different ASD, ADHD diagnosis. It is in fact just neurodiversity.
Do you believe PDA exists? I understand some professionals say it doesn't. My experience is that when overwhelmed my ADHD child goes into a massive PDA crisis. When not overwhelmed the PDA lessens. Perhaps it's a sign of crisis rather than an actual diagnosis?

Hey Lindy2. I am so sorry I missed this post with what I consider very important questions. I may get piled on here, and I am just giving my opinion here - I am just being honest about where I sit with these things.

I have very very strong views about trans ideology - especially how damaging it is for teenage girls with autism. I believe it is a social contagion, and a mental health issue that is encouraging autistic girls in particular down a path so they feel they 'fit in' better. The non-binary issue is because typically (but not always) autistic girls are 'gender non-conforming' - I loathe that term, but basically its because so many autistic girls are highly sensory and loathe the feelign of make up, fussy clothes and hairstyles and seek comfort, so therefore may present with short hair, no make up and baggy boy clothes. All completely fine and does not need them pathologised as being in the wrong body or being 'non-binary' which again i feel is an ideology that is extremely dangerous to autistic girls. I dont think the tendency is here to stay because I think the tide is turning on trans ideology and I think in several years we will be aghast at this period of time.

About your view that there is just neurodiversity, I think that is a fascinating viewpoint and something I don't disagree with. I think it can be helpful to separate the two, because often its the people who are diagnosed with both that struggle so much because of the contradictions but I do take your point. Id have to consider that more though. Great question though!

I do believe PDA exists but not as a standalone diagnosis but as a symptom.

No. It would be an indicator, but the lack of it would not mean you wouldn't get diagnosed. I was, for example, and Ive never had any disciplinary issues at work.

I actually think you are both right. Autism IS technically a disability under the Equality Act. I don't believe it is a disability though - I believe it is a difference. I also believe in the social model of disability that what is disabling is the way society is set up and not the ability itself. HOWEVER, some of the symptoms (especially without support) can be disabling in our current society. But autism is different for every person, and the levels of support vary from each person. This is the very reason why PIP is never about your diagnosis per se, but about how you function in the world each day. One person with autism could have the right scaffolding around them and support and be absolutely thriving and need no help from PIP and be considered a very high achiever - for another it can be utterly debilitating, and everything in between.

I don't like or use the term 'ASD' or 'ASC' for this reason. I strongly disagree that it is a disorder or a condition. Both of those sound negative and 'disabling'. As I said I consider it a difference.

Autism isn't recognised as a physical condition. Some children and adults with autism should get DLA/PIP in my view because they need support. Some don't need it. Its how they present that matters, not the label.

To get CAHMS to do an assessment is incredibly hard and girls fall through the gaps all the time. Its very frustrating and in my view misogyny-rooted neglect. Girls just don't matter.

Much like trans, I do think their is an element of social contagion with people thinking they have autism/adhd, like they want to be special in some way. That frustrates me a lot tbh. They won't get past the screening tbh, and some get very very angry that I won't go ahead with an assessment. I think it is unethical to take someones time and money when it is highly likely to be a negative, and also those people tend to be those that think they are paying for a diagnosis - not an assessment. There is a difference!

Yes a child being that way could be an indictor for sure. Obviously would need to know far more, but yes.

Yes people can be diagnosed without friends or family support of a dx. That's not uncommon. Especially girls. I have had women in their 50s whose husbands of 30 years can't see it - their wives have been very successful maskers, and then the wheels fall off during menopause usually.

I don't know how robust the assessment was, but if it was, then I would say its more likely the dx is correct, and she will have periods of her life where she is doing better than others. Transitions may hit her hard, so for example, if she goes to university and moves into halls that could trigger more struggles for her.

@magictitsthats so depressing to hear. The only consolation is that the MH lead at the school was talking in a way that made it sound like she believed she has ASD so I can only hope they support her as if she does have it alongside the ADHD. CAMHS have said they will assess again in one year after the suggested mitigations for her have been put in place. Bear in mind her maternal aunt and her Dad are both on waiting list for assesment.

they accepted the ADHD diagnosis no problem.

For DLA, autism is considered a physical disability. Case law established that. This is why some autistic children can be eligible for HRM under the VUW criteria, which, as one part of the criteria, requires there to be a physical condition. Similarly, it is why some autistic children can be eligible for HRM under the SMI criteria, which, as one part of the criteria, requires there to be state of arrested development or incomplete physical development of the brain, both of which are considered physical. For most parts of DLA it is based on needs, but for HRM you need to prove a physical cause and one way of doing that is via a diagnsois of ASD.

thanks for answering questions! I suspect I’m AuDHD. But that for a large part of my life they’ve cancelled each other out. My sister has been diagnosed with both but it took a long time and she had to have separate assessments.

i understand you have to have separate assessments, but do they take into account that you might have a combination when you do the assessment?

Im not a benefits expert - but I dont see how autism could be considered a physical disability. It simply isn't. There is some argument in the field as to what it falls under, and what it is considered legally, or under different systems is in some way irrelevant, and there isn't consistency. What I think (as do some in my field, and others do not) is it is a neurodivergence - a difference - and not a disability, or a 'condition' or a 'disorder'. And I think society has made it very difficult for people with neurodivergence to function without support. If society was more neurodiverse friendly there would be less people struggling. Just my opinion though, not everyone agrees with me, even within the profession. I would be interested to know what millionsofmonkeys thinks as a psych doing assessments?

Legally, for DLA, autism is considered a physical condition. As I said, case law established that. That isn’t irrelevant when my original question was about if a pp not thinking autism is a physical condition meant they disagreed with some children getting HRM in part because autism is recognised as a physical condition. You/the other poster might disagree, but if it wasn’t, some autistic children would not be entitled to the HRM they currently get.