Adult Autism Assessment

BENEFITS OF AN AUTISM (ASD) DIAGNOSIS

A clear diagnosis can help you reinterpret your experiences and behaviors in a completely new light.

It can also provide:

a path to self-acceptance,
answers to questions about yourself that may have been unanswered for years,
help identifying your strengths and how to build on them,
access to resources designed to support like-minded autistic individuals,
the shortest path to the most effective treatment options if needed (our clinicians also offer autism-centric therapy),
feelings of relief as you finally understand yourself and your emotions better, and
a way to build plan to address your struggles.

CHALLENGES OF AN AUTISM ASSESSMENT

In spite of the benefits, there can be obstacles in a client obtaining and/or a clinician making a diagnosis. These may include:

Masking (i.e., learning to act the way you are expected to behave instead of in a way that is genuine) can lead to core traits being hidden.
Excellence in specific areas that cause others to ignore deficits or differences.
On-line screening tests may be helpful at determining if further action is needed but they can often be misleading and can not replace a thorough evaluation.
There is no blood or genetic test for ASD.
Co-existing challenges (e.g., ADHD, general anxiety, OCD, deficits in executive functioning, and depression) that garner attention while the ASD is overlooked).
Bias toward recognizing ASD in men over women.

Diagnostic Criteria

In pursuit of a formal diagnosis, please keep in mind that:

A combination of information is required.
There is NO individual test or indicator that is definitive.
The diagnosis ultimately is based on the clinician's judgment.

DIAGNOSTIC CRITERIA

There are two sets of autism spectrum diagnostic criteria commonly used throughout world:

DSM-5 - United States

The diagnostic criteria used in the USA is the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (currently in its fifth edition – DSM-5). This manual requires an assessment of:

identification of symptoms in two domains:
- social communication and social interaction, and
- restricted and repetitive behaviors.
the impact of symptoms on a person’s life.

We use the DSM-5 for assessments.

ICD-11 - Most of the rest of the world

The World Health Organization's International Classification of Diseases (currently in its 11th edition – ICD-11). In addition to the criteria in the DSM-5, the ICD-11 requires clinicians to specify the presence and extent of intellectual and language impairment (if any), along with the impact on numerous areas of functioning.

PROCESS FOR CLINICAL DIAGNOSIS

DIAGNOSTIC PROCESS

Our process is designed to get at the most important diagnostic information in a streamlined fashion to reduce and eliminate the trial and error approach to a full and effective assessment.

The following four steps are involved in our diagnostic process:

1. QUESTIONNAIRES

You will be invited to complete two detailed clinical assessments: SRS-2 and the MIGDAS-2.
- The SRS-2 will be completed at home and we will review the results with you.
- The MIGDAS-2 will be completed during session in an interview style format.
You may also be invited to complete screening questionnaires (AQ, EQ and RAADS-14). You will share scores with your therapist who will incorporate that information into the diagnostic process.
You will complete a developmental history / family of origin questionnaire with a focus on the quality of attachment to family members. This will be reviewed in session. You are welcome to invite family members to be present if you believe this would be helpful.

2. DISCUSSION AND OBSERVATION

We will take the following steps during our sessions together:

Invite you to complete a Family Background and Life History. We will review the completed form with you in session.
Discuss your development of peer relationships and friendships.
Make behavioral observations including your social and emotional presentation.
Interviewing your partner (if applicable) regarding the nature of interactions and the quality of attachment.
Observe your self-awareness, perspective-taking and level of insight into social and behavioral issues.
Discuss your ability to understand another person’s feelings, intentions and beliefs.
Ask for your self-report of certain characteristics including:
- Social interactions
- Special interests (intensity and depth)
- How change is handled
- Sensory seeking and avoidant behaviors
- Use of eye contact
- Stimming
- Repetitive behaviors
- Expressing emotions
- Maintaining conversations
Assess the level of impact of characteristics (ranges from Level 1 to Level 3).
Possibly meet with other friends or family members who can provide additional perspective.
Assess for related issues such as Attention-Deficit/Hyperactivity Disorder (ADHD), obsessive-compulsive tendencies, general anxiety and depression.

3. EVALUATION

Item-by-item review of the DSM 5 Diagnostic Criteria with you. You are welcome to invite family members to be present if you believe this would be helpful.
Review any additional documentation you may have, such as previous school and pediatrician reports, medical assessments, work evaluations or other descriptions that could be helpful in the diagnosis of ASD.
Review the results of the free on-line screening tests listed above.

4. DETERMINATION

Based on all the information gathered, your therapist will make a determination of Asperger’s/ASD and present conclusions in a face-to-face meeting.

CLINICAL ASSESSMENT TOOLS

The SRS-2 and MIGDAS-2 are the primary assessments that are used by our group.

Social Responsiveness Scale, Second Edition (SRS™-2)

Measures Social Responsiveness providing five scores including: Social Awareness, Social Cognition, Social Communication, Social Motivation, and Restricted Interests and Repetitive Behavior.
Can be administered remotely for adults.
A total composite score (T-score) of 59 and below is considered low to no symptomology and generally not associated with ASD. A total composite score between 60 and 65 is associated with mild to moderate deficits in social interaction. Scores between 66 and 75 are considered to display a moderate deficit in social interaction, and a score greater than 76 is considered severe and strongly associated with the clinical diagnosis of ASD.
(For internal purposes: SRS-2 test #'s: W-608DP5 and W608MP)

Monteiro Interview Guidelines for Diagnosing the Autism Spectrum, Second Edition (MIGDAS-2)

Structured interview process for gathering and organizing the qualitative information needed to diagnose autism in children, adolescents, and adults.
We only administer the version for adults with verbal fluency.
Does NOT provide quantitative results but is a structured format to evaluate individuals for autism.
Can be administered remotely for adults.
(W-690C and W-690M)

Other assessments that are infrequently used by our group but may be relevant in certain situations when the above assessments do not yield clear results:

Autism Diagnostic Observation Schedule-2 (ADOS-2)

Considered the "gold standard" among autism assessments for children.
Consists of four modules, each one optimized for the language level of the client. Module 4 is for adolescents and adults with fluent language ability
It is NOT a definitive diagnostic tool (does not indicate "yes" or "no" to autism) but rather identifies deficits and aids clinical formulation.
Mostly used with children but has an adult version (research is mixed on effectiveness with adults).
Can NOT be administered remotely.

Autism Diagnostic Interview-Revised (ADI-R)

ADI-R is a companion assessment to the ADOS-2.
It is a structured interview conducted with the parents of the referred individual, and covers the subject's full developmental history.
Assesses reciprocal social interactions, communication, and language.

None of these assessments are technically required for a formal diagnosis but are extremely helpful.

Lastly, please note that neurological testing is not required to get a “formal” diagnosis.

CAVEATS ON DETAILED FORMAL TESTS

Caveats related to detailed ASD assessments include:

Some of these more detailed assessments were primarily developed for children since children are often harder to assess because of verbal limitations. Accordingly, certain tests include creative ways of understanding the thinking of children and measuring the results systematically. Although these challenges are less prominent for adults, the assessments that we use have adult versions.
The tests listed below were standardized using in-person administration. Tele-assessment methods are considered an adaptation of the standardized administration and, as such, the remote administration will be taken into consideration when reporting and interpreting the results.