Distressing assessment and diagnosis

I received a negative ASD diagnosis this week and it’s left me feeling very upset and confused. It’s not just that I disagree with the diagnosis (as do my family and long term partner) but the way I was treated has left me feeling very distressed. I spoke with a GP and was referred for assessment in Jan 2020. This was after I started reading numerous articles and watching videos by women with a late diagnosis - it was like they were all describing my life and experiences back to me, for the first time it all clicked. 
The first assessment I had was with a doctor who I later found out is studying to be a psychiatrist, so not yet qualified. We were both wearing masks and sitting two metres apart, with the doctor looking at her screen and typing loudly for 95% of the 2 hour session. She often misunderstood what I said and I’d have to try and explain again, and when she went over previous comments I realised she had recorded details incorrectly - as if she was applying her own subjective personal experience to my life rather than trying to understand me. The interview marched on at pace and because I often lose access to information recall when I’m anxious, I found it difficult to answer the questions in the timeframe I was expected to (I mentioned this at the time) - I had provided a detailed list of difficulties I have to my GP which this doctor had a copy of and I assumed would be taken into account. I was often in tears when I was talking about very difficult times in my life (including when my mother died from a heart attack) and so I asked if I could have a tissue but was told there weren’t any in the room. I then asked if she could please get me one from somewhere. The doctor reluctantly got up from her desk and stood by the door and said she could get one from the loo if I really needed one - I had tears streaming down my face and my nose was running - she eventually left and came back with some paper towels which she handed to me without a word. I felt totally vulnerable and humiliated and wish I had just walked out but I stayed for the rest of the assessment because I thought it was my only chance to get a diagnosis. When I got home I couldn’t do anything but lie on the sofa under a blanket crying for the rest of the afternoon. I still feel upset thinking about that assessment now.
The next session was only 45mins and once again with masks and socially distanced. At least this time the assessor (an occupational therapist) was sitting looking at me and there was also a student observing (I wasn’t given any notice of this). I was asked to do what seems to be the standard childish tests - place rubber blocks on a shape printed on paper, describe what’s happening in a picture book about flying frogs, talk about a holiday, act out brushing my teeth, and creating a story from objects from a bag… All of which I did but once again I struggled with recall because I felt anxious.
The report I received this week is such a factually inaccurate record of my family and myself it would be laughable if this experience hadn’t been so distressing. There are so many inaccuracies and misquotes that I would need to go through the document line by line to point them all out. It reads as if the report was written weeks, if not months, after my assessment when there was no longer any recollection of the session and only sparse notes to base it on. Even my age, date of birth, and date of assessment are incorrect. Apparently because I sat in my chair for the entire assessment, showed no signs of echolalia or repetitive movement, but did make eye contact, display signs of empathy, creativity, and humour (I ‘laughed on at least one occasion’) I do not meet the criteria for ASD. However, the report does describe (what are to me) so many clear behavioural indicators of someone with ASD. I’m a 45 year old woman and an expert masker, I can’t stop it - it just switches on as soon as I’m with people and I start going through my scripts and memorised behaviours. I have even changed my laugh and used decades of meditation and yoga to train myself to sit still and not fidget in front of people. I can look people in the eye because I make myself do it, and every time I’m guessing how long to do it for because I don't know what each individual person expects. There was no attempt to even try to assess me beyond the most obvious and physical traits of ASD. There appears to be no awareness at all of how ASD can manifest in women. They also didn’t take into account the only person I have to provide details of my childhood is my sister who is 6 years older than me - she was a child herself so her recollection will reflect that. They didn’t ask for any information from my partner of 12 years.  
Sorry this has become very long! I haven’t been able to sleep for the last few nights and I’m posting here because I’m hoping someone has some advice as to what I do next. I don’t want that report attached to my medical file because it’s so bizarre and inaccurate. My mental health has deteriorated over the last few years to the extent I’m struggling to work and pay the bills - they did conclude that I’m suffering from anxiety, depression, and OCD and should seek help (ie. add myself to another waiting list). I had hoped a diagnosis would help me get the support I need with social and communication issues and to find employment that I can cope with but I've been left feeling vulnerable, humiliated, and dismissed.
  • I have wondered about the stats thing too... or that they simply made an assumption about me and filtered everything through that. Or perhaps it's better (due to the NHS being overstretched) to channel me into another mental health service than towards ASD support (though I doubt any NHS service has sufficient funding!)

  • Send the complaint first, explain in the complaint there is further correspondence to follow. Xxx

  • Thank you :)  I do wonder how after only 2hrs and 45mins with me, while wearing masks and social distancing, they can be so definite about their diagnosis! I know I should go through the report and markup all the inaccuracies, it's going to take me a long time to do and feel I need to send a complaint in the meantime - but perhaps it's better to wait until I can send it all at once?

  • I completely agree - surely it's verging on negligence to not be using appropriate diagnostic techniques and ignoring the latest research. In some ways it reminds me of when I was in primary school and I broke my arm when I fell off a climbing frame. A teacher didn't believe I was in pain and thought I was just making a fuss so didn't call my parents or do anything about it. It wasn't until I got home and my father (a doctor) looked at my arm that I was taken to the hospital where they did an x-ray and put my arm in a plaster cast (it was a greenstick fracture so not completely broken). When I turned up to school the next day, the teacher was very sheepish indeed! This experience feels a bit like that - someone clearly unqualified to make a diagnosis is insisting they're right, while the trained and experienced professionals use the correct equipment to diagnose what isn't clear from the surface and provide the right treatment.

  • It's a relief to hear there is a place where the professionals are getting it right! Hopefully I'll find some way of being referred there. 

  • Thank you, I didn't know about the Lorna Wing Centre, I'll look into it. Unfortunately I don't have the funds for private assessment but I'll try talking to a GP about a referral (unfortunately there is no continuity of care at the practice I'm registered so it's a matter of starting the conversation all over again). It's heartbreaking to hear so many people are being treated so appallingly my the public health system and experiencing so much distress when looking for answers and support. I'm so sorry you're having to battle for a diagnosis for your daughter too.

  • thing is, anxiety and depression are symptoms of every single mental illness going on the planet, so it doesnt rule ASD out as those are symptoms of ASD too.

    i guess maybe they dont want to over diagnose ASD for some reason? its all about stats in the end for them, they want to keep down the ASD statistics i guess and perhaps they will instead assign you some label they want to promote. like ADHD... they absolutely love handing ADHD out to inflate those figures.

  • Yes indeed. I was assessed at the Lorna Wing Centre. They don't see it where it isn't, but they sure don't miss a thing. If ASD is there, they WILL find it and they are absolutely lovely and will not leave you feeling like s**t because you haven't been heard. I can't thank them enough. Their extensive report was bang on the mark. Oh yeah, that was me.

  • My heart goes out to you.

    The most troubling thing about your story, and one for other reasons I identify with, is the fact that so many details are wrong. I think the 'experts' sometimes listen through the lense they have preset for themselves (perhaps because they are too over stretched) to listen to what is actually said.

    Their are several possibilities here:

    a) They have missed the diagnosis because they are inexpert in the subtle presentation of women and girls / and / or are not paying attention

    b) You have some but not all of the traits or something else is the problem inspite of the fact they weren't listening

    You are obviously stuck until you know you have been heard properly and know the truth - whatever that is.

    I know it's the last thing you'll feel like doing, but go through that report line by line with ALL those corrections and send it back to them. It should in any case be in draft only for you now. If they don't budge from their current position, ask for a second opinion.

    In the meantime, think about any material you may have missed - school reports, old diaries etc. Which an assessor should see.

    Dunno what the frogs and teeth brushing are about. They were no part of my assessment.

    Bless you. I know this is so hard. All any of us want is the truth, huh? And it sounds like they aren't hearing yours.

  • I think that applying 'yes/no' criteria to autism assessment and diagnosis just indicates that the clinicians carrying out the assessment are, at the very least, uneducated in how autism manifests in different people - it is called a spectrum, for God's sake - or are just incompetent. They note that you make eye contact, and assume that it is the same process as for NT people. I make eye contact, I'm good at it, but I do it consciously and time when to make and break it and the duration, which is soooo not an NT approach. I had a chat with the psychiatrist who did my assessment about how we both loved Monty Python, and I still got a diagnosis. It is time that any clinician given the power of deciding whether or not a person has autism was made to read current research on the condition as a prerequisite for continuing to carry out assessments, and they should be made to pass an exam also.

  • I'm so sorry you went through this and that it has left you feeling so vulnerable. It is such a difficult process to manage. There are so many times that I've come away from dealing with doctors feeling unheard and humiliated.

    When I took my daughter for her initial assessment the doctor we saw said that he'd refer her on but that he doubted it was ASD because she'd listened to me and made eye contact, and when we got the document about the appointment it was FULL of inaccuracies despite the fact that most of the things mentioned were things I had included on the form submitted prior to the appointment. It broke my heart and still makes me furious, especially as I had to fight to get her on the waiting list for an assessment and it looks like that fight isn't over.

    Have you considered contacting the Lorna Wing Centre? They use the DISCO assessment method rather than ADOS and they specialise in complex presentations. You can go to them privately or, I believe, you can talk to your GP about getting referred there, though I think there is some special sort of funding form needed from them for that to happen. 

  • Thank you for your kind words and I’m so sorry you’ve been put through a similar experience. I’m baffled that with so many adults in this forum posting about struggling to either be referred for assessment, or being dismissed if they finally get one, that nothing is being done about it. How can there be so many easily accessible studies and research papers out there about how ASD can manifest in adults and that masking is a barrier to diagnosis and yet nothing is being done to address this and change the testing criteria in this country? It’s like they’re putting their heads in the sand and carrying on regardless of all the mounting information and with complete disregard for the mental health of the individuals they’re assessing. I’m going to write an email and state what my complaints are but I don’t have the mental energy or capacity at the moment to address all the inaccuracies in their report. I have no faith in that particular assessment centre but unfortunately can’t afford to go private so I don’t know where I can go for a second opinion as it seems I can’t be referred to an assessment centre outside my borough. I wish you the best of luck with your assessment and that it goes better for you this time round.

  • I’m so sorry you went through this, I was wrongly referred for a MH assessment by my GP instead of a specific ASD assessment but my assessor was very similar to yours in making me cry and being very cold, then mis-reporting things I had said - even saying there’s no point in getting an Autism diagnosis because there’s no cure.
    On my letter for the appointment it had an email and address for the department so I wrote a long email stating how this impacted me and was a terrible experience and that I wished to make a complaint - if you could maybe write them a letter or an email addressing how you were treated and how this is impacting you now mentally, and due to this you would require a second opinion with someone who is familiar with undiagnosed adult ASD and would be aware of masking techniques.

    I worry masking will hinder my own assessment when it comes so I really hope this works out for you.

    lots of love

  • Thank you. I think perhaps I was a bit naive in thinking this assessment centre in London (NHS) would be using current/more sophisticated diagnostic techniques, hopefully you'll have a more positive experience with a suitably qualified team. I thought it would be difficult but I actually wasn't that worried about it beforehand because I assumed I would be treated with kindness and respect throughout the process. And I think you're right - it's like a mindless decision tree/process that doesn't take the individual manifestation of traits (or masking behaviours) into account and depending on your score, based on the presentation of 'classic' physical behaviours on the day, you either receive a positive or negative diagnosis - there is no capacity for assessing complex and nuanced behaviour 

  • This is awful. I am waiting for a diagnosis myself and I am quite worried about it. I fear it is going to be a box-ticking exercise done by someone who does not understand what this is about. I am very sorry that you went through that.