Would you diagnose ASD?

[sweetteamum]

Dd aged 11 had feedback appointment for ados-2 module 3, whilst undergoing the WISC assessment.

The details are:

Dd did not repeat herself or examiner. Or used stereotyped/idiosyncratic words or phrases.

She offered lots of info, including being bullied and her interest in one direction.

She used gesture inc, nodding, shaking head, pointing, miming how to brush teeth.

Overall level of spoken language was poorer than what girls her age usually are.

She used short phrases such as "I have friends at home and school" used some complex speech but grammatical errors like "I think one of my friends called x did get bullied"

Did not spontaneously ask examiner about his thoughts, feelings, or experiences although showed appropriate interest in them.
Descriptions of events that happened to her lacked detail.

Dd did provide some conversational leads for examiner to follow , like "I have a one direction jumper at home" but overall the interaction was one sided with examiner asking and dd providing responses.

Eye contact was infrequent, but appropriate. Used a range of facial expressions to communicate emotions. Seemed to be enjoying interacting with the examiner, especially when reading a story and talking about one direction
She could label emotions that may be experienced by characters in a story and show empathy with other young people that might feel lonely.

Dd insight into typical social relationships was poor. She said she got on better with younger people but couldn't explain why. She didn't seem to understand why she, or other people could be a target for bullies.

Dd seemed to want examiners attention at times but didn't know how to get it. The quality of rapport was sometimes comfy but not sustained - social responses were slightly awkward.

Dd struggled to manage pretend play, even with support.

No stereotyped behaviour and restricted interests - this is because dd didn't want to say what she liked

Other behaviours. . Dd seemed quite anxious, especially the beginning.

Summary. . Dd scores on the ados indicate significant social communication difficulties. However there are some strengths and she used non verbal facial expressions, nods and gestures to compensate for lack of social language. Seemed to enjoy interaction and showed empathy with others.

The ados-2 is not diagnostic in isolation and factors an influence a child's performance. Therefore this info will be considered along with other reports.

Phew sweet, that is a difficult question!

I dont know much about Ados as Dd3 never had one, however proffs do not usually bandy around the word significant if they dont have concerns and the fact that he/she wants to look at it alongside the other reports indicates that more info is needed before they make a call.

When Dd3 had her assessment the psychiatrist said that she still needed to use professional judgement even after reading all the reports as Dd3 was complex due to the masking skills that she had developed.

Fingers crossed for you sweet

Thanks ineed It's so scary this waiting isn't it. I'm going to look at the triad of impairments in more detail, just to see what she HAS to struggle with, rather than has extra things she struggles with IYSWIM, ready for my phone call this week.

DD has also been called 'complex' as she's also able to mask her difficulties.

DD also has lots of other reports etc. She told DD it is nice to be complicated as DD was also in the room at the time.

Last week when I was told they would do the WISC for her IQ. I asked if her IQ was low would she have general delay and if her IQ was average or above, would she be classed as ASD - she replied yes but I get the feeling they don't want to diagnose.

The psychiatrist gave absolutely nothing away about her general feelings about Dd3, I had totally convinced myself that she wouldnt diagnose her, but then she did and she made quite a thing about her being complex!

I really feel for you and totally know what you are going through I hope the waiting will soon be over for you and your Dd.

Good luck

Thanks again, seems like we had similar experiences with camhs then. I have convinced myself that dd won't get diagnosed. But, and it's a hopeful but, I suppose they don't want to get people's hopes up.

Good luck sweettea, what a wait you are having. When are they going to call you?

Thanks handy

Well, she said she should have the feedback/results by friday (as I already had an appointment at camhs anyway, to discuss where to go next) so I hope there's no extra wait.

What happens if they're still not sure?? I'd rather they didn't say no and waited longer but not sure what will happen !!

Aww hope it enough for dx ifykwim, I know you need it for the school. Here

All the research says that girls manifest symptoms slightly differently to boys and are more skilled at the masking.
I hope the right diagnosis is made for her (and for your sanity!)

Thank you both also.

It's been a long time coming and dd has definitely learnt how to hide her difficulties.

Honestly? I think they are wondering if she has a language disorder or general learning diffs that would explain what they have seen, though the BAS she had suggests not, so I think they are confused. I think they think that if she had moderate learning difficulties her presentation would make sense...!

I guess they just want a WISC to double check her learning. Do they have a SALT as part of the team? She is the kind of kid who in our team would get referred for a double check to the SALT as well. If her learning is average and there is no specific language problem, she has been acknowledged as having social communication diffciulties so they may well go for asd. I think they are proceeding with integrity though, wanting to thoroughly check before applying any label :-)

Thanks ilike, they are working very thorough and its appreciated (albeit frustrating)

She has got two speech and language reports, both saying significant delays with receptive language and also difficulties with expressive language.

They told me through last week it was as simple as low iq = development delay and average iq = asd. However now it seems as though that's changed. I just don't understand which is why I'm so frustrated with it all.

I still think many proffs are confused by the way Asd presents in girls.

Dd3 had 2 SALT assessments both of pointed to Asd, so much so that even the Salt was surprised, especially the one that did the ToM test.

And yet it still took another 18 months to get a dx, for her.

People with knowledge about Asd can all see it in her now she has a dx, funnily enough.

sweet I wonder if your camhs would consider doing a DISCO assessment if they are still puzzled, it was designed to weed out the complex cases who are hard to diagnoses.

Agree with Polter's last post, IQ shouldn't come into it.

DS has a dx of Social Communication Disorder or delay, I'm pretty sure the bottom of DS ADOS had the words 'significant social communication difficulties' too. However we're in Scotland and (just through experience on the boards) I don't think that is given as a dx regularly. That said DS was a lot younger than your DD and of course girls typically are more skilled at masking...

How frustrating for you - hope your wait is over soon ((hugs))

Thank you for the additional comments and support. I can't tell you how much it's needed right now.

I did make a point of saying that i'd researched girls on the spectrum and understand how different they can appear to people. Plus, she's 11 and we've spent years trying to get her to say the right things - it's just unfortunate that she chose to do and say everything that was asked of her on the day. She left some bits out though as when I made a comment about her onlt using facial expressions since watching beauty pageants online, the examiner looked shocked.

I honestly think they don't want to give her a diagnosis - purely from some of the very subtle comments about her needing support in school rather than being at a particular school (that just so happens to need a diagnosis)

Ineed, I think I will mention the DISCO to her when she calls me - actually, do you think I should contact them and ask for them to it, rather than waiting for them to say "we don't know" again?

Not yet Polter although I have downloaded it onto my Kindle :)

I think you should wait until they feed back about the Ados, if that is inconclusive you have more grounds for requesting a DISCO.

You never know, common sense might prevail and you wont need to.

Thanks ineed. I think with all the other information they have, it'll be amazing not to diagnose her. But then I'm not the 'expert'

I'm going to take your advice and hang in there :)

The ADOS atm goes in the main by 2 of the scores Communicaton and Social Interaction. It sounds like your daughter may have scored at the threshold on one and not the other - maybe? There are people on here whoose children have not scored high enough for a diagnosis going by the ADOS but have later been given one anyway.

Thanks for that wasuup. Tbh I got the impression (from the report and feedback) that she did quite poor on those categories but scored lower of the repetitive/restricted behavior - mainly as dd said she didn't want to tell them what she was in to!

I thought the ADOS was based over the 3 categories, which is why they are debating.

However, my confusion comes from the call in the week where I was told dd appeared much younger than her age and they didn't believe her iq was average, as stated. They said she came across as having a much lower iq and if that was the case then dd would get a dx of development delay. When I confirmed this and asked if her iq was average or higher would she get dx'd as asd. She said yes. . This is where I'm confused

Well ASD is a development delay anyway so not sure what they are on about either.......

Hmmmm thanks for pointing that out. Think I need to ask the question "why are they not giving her the dx" and would rather hold off and keep her struggling until someone will dx her :(

Do you think they would consider Development Delay over ASD because DD does have language delay also?

I'm not sure what Autism Diagnosis she could get with having language delay and average cognitive profile.